Reproduction de : Thèse de doctorat : Immunologie : Lille 2 : 2008. / Résumé en français et en anglais. Titre provenant de l'écran-titre. Bibliogr. f. 60-79.

Le CD40 ligand (CD40L) est une molécule inflammatoire appartenant à la famille du Facteur de Nécrose Tumorale ("Tumor Necrosis Factor", TNF), originalement identifié au niveau des cellules immunitaires. L’interaction du CD40L avec son récepteur de haute affinité présent sur les cellules B, le CD40, est d’une importance cruciale à la production d’immunoglobulines lors de la réponse immunitaire. Aujourd’hui, nous savons que ces deux molécules qui constituent l’axe CD40/CD40L sont aussi exprimées au niveau des cellules du système vasculaire et occupent une place importante dans une variété de réactions inflammatoires, de sorte que le CD40L est présentement reconnu comme une molécule thrombo-inflammatoire prédictive des évènements cardiovasculaires. Les plaquettes sont la principale source du CD40L soluble ("soluble CD40L", sCD40L) plasmatique et il fut démontré être impliqué dans l’activation plaquettaire, malgré que son impact exact sur la fonction plaquettaire et les mécanismes sous-jacents demeurent inconnus. Ainsi, le but de ce projet était de déterminer l’impact du sCD40L sur la fonction plaquettaire et d’élucider les mécanismes cellulaires et moléculaires sous-jacents. Les objectifs spécifiques étaient : 1) d’évaluer l’impact du sCD40L sur l’activation et l’agrégation plaquettaire in vitro; 2) de déterminer le récepteur cible (CD40 ou autre) impliqué dans ces effets; 3) de décortiquer les voies signalétiques intracellulaires et moléculaires induites par le sCD40L, impliquant la participation potentielle de la famille du facteur associé du récepteur du TNF ("Tumor Necrosis Factor Receptor Associated Factor", TRAF) et 4) d’analyser l’effet du sCD40L sur la formation du thrombus in vivo. Le sCD40L augmente fortement l’activation et l’agrégation plaquettaire induite par de faibles doses d’agonistes. Les plaquettes humaines traitées avec une forme mutante du sCD40L qui n’interagit pas avec le CD40 et les plaquettes de souris CD40 déficientes (CD40-/-) ne furent pas en mesure d’induire ces effets. De plus, nous démontrons la présence de plusieurs membres de la famille des TRAFs dans les plaquettes, parmi lesquels seulement TRAF-2 interagit avec le CD40 suite à la stimulation par le sCD40L. Le sCD40L agit sur les plaquettes au repos par l’entremise de la protéine Rac1 et de sa cible en aval, soit la protéine kinase activatrice du mitogène p38 ("Mitogen Activating Protein Kinase", MAPK). Ceci mène ultimement au changement de forme plaquettaire et à la polymérisation de l’actine. Par ailleurs, il est intéressant de noter que les souris CD40-/- démontrent un défaut significatif de l’agrégation plaquettaire en réponse au collagène, ce qui souligne l’importance du CD40 dans les interactions plaquettes-plaquettes. Dans un deuxième temps, le sCD40L amplifie l’agrégation plaquettaire en sang complet, accélère les temps de thrombose in vitro mesurés à l’aide du système PFA-100 et augmente l’adhésion plaquettaire au collagène sous condition de flux, le tout par l’entremise du CD40. Finalement, dans un modèle de thrombose artérielle murin, l’infusion du sCD40L exacerbe la formation du thrombus chez les souris du type sauvage ("Wild Type", WT), mais non chez les souris CD40-/-. Ceci fut en plus associé à une augmentation significative du nombre de leucocytes au sein du thrombus des souris WT traitées à l’aide du sCD40L, tel que démontré par marquage immuno-histologique anti-CD45 et par quantification des coupes artérielles par microscopie optique. En résumé, ce projet identifie une nouvelle voie signalétique, TRAF-2/Rac1/p38 MAPK, en réponse au sCD40L et démontre ses effets sur l’activation et l’agrégation plaquettaire. De manière encore plus importante, nous démontrons pour la première fois la présence d’une corrélation positive entre les niveaux circulants du sCD40L et la thrombose artérielle, tout en soulignant l’importance du CD40 dans ce processus. Ainsi, le sCD40L constitue un activateur important des plaquettes, les prédisposant à une thrombose exacerbée en réponse au dommage vasculaire. Ces résultats peuvent expliquer le lien étroit qui existe entre les niveaux circulants du sCD40L et l’incidence des maladies cardiovasculaires. / CD40 ligand (CD40L) is an inflammatory molecule of the tumor necrosis factor (TNF) superfamily originally identified on cells of the immune system. Interaction of CD40L with its respective receptor on B cells, CD40, is of critical importance for immunoglobulin isotype switching during the immune response. Today, we know that these two molecules are also present on cells of the vascular system and have important implications in various inflammatory reactions, such that CD40L is now regarded as a thrombo-inflammatory molecule that predicts cardiovascular events. Platelets constitute the major source of soluble CD40L (sCD40L) found in plasma and it has been shown in return to influence platelet activation, albeit the exact functional impact and underlying mechanisms remain undefined. Hence, this project was designed to investigate the effects of sCD40L on platelet function and to elucidate the cellular and molecular mechanisms involved. The specific aims of this study are four fold: 1) evaluate the impact of sCD40L on platelet activation and aggregation in vitro; 2) determine through which receptor (CD40 or other) these responses are mediated; 3) elucidate the underlying intracellular signalling pathways and molecular mechanisms involved, including the potential participation of the Tumor Necrosis Factor Receptor Associated Factor (TRAF) family and 4) assess the impact of sCD40L on thrombus formation in vivo. sCD40L strongly enhances activation and aggregation of washed human platelets induced by sub-threshold concentrations of agonists. Human platelets treated with a mutated form of sCD40L that does not bind CD40 and CD40 deficient (CD40-/-) mouse platelets failed to elicit such responses. Furthermore, we found that platelets express multiple members of the TRAF family, among which only TRAF-2 associates with CD40 upon sCD40L stimulation. Noticeably, sCD40L primes resting platelets through activation of the small GTPase Rac1 and its downstream target p38 mitogen activating protein kinase (MAPK), which leads to platelet shape change and actin polymerization. Interestingly, CD40-/- mice exhibit impaired platelet aggregation in response to collagen, thus highlighting the importance of CD40 in platelet-platelet interactions. Moreover, sCD40L dose-dependently enhances whole blood platelet aggregation and accelerates platelet function analyzer (PFA)-100 closure times in a CD40-dependant fashion. Preincubation of whole blood with sCD40L significantly increases platelet adhesion to collagen in an ex-vivo perfusion system under flow. In addition, in a ferric chloride-induced murine arterial thrombosis model, infusion of sCD40L exacerbates thrombus formation in wild type (WT), but not in CD40-/- mice. This was further associated with increased leukocyte infiltration within the thrombus mass of WT mice treated with sCD40L. In this project, we identify a new TRAF-2/Rac1/p38 MAPK signaling pathway in response to sCD40L and its effects on platelet activation and aggregation. More importantly, we establish a direct positive correlation between levels of sCD40L and thrombus formation in vivo, while highlighting the requirement of CD40 in this process. Thus, sCD40L is an important platelet primer predisposing platelets to enhanced thrombus formation in response to vascular injury. These results may explain the link between circulating levels of sCD40L and the occurrence of cardiovascular diseases.

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Atherosclerosis is an inflammatory disease, occurring preferentially in arterial regions with disturbed flow. We have shown that disturbed flow induces inflammation in endothelial cells (ECs) by producing bone morphogenic protein-4 (BMP4). Moreover, chronic BMP4 infusion induces endothelial dysfunction and systemic hypertension in mice. Here, we examined which BMP receptors (BMPR) mediate BMP4 action in ECs. Western blot, immunostaining and RT-PCR studies using human and bovine ECs, mouse aortas and human coronary arteries (HCA) showed that BMPRI (ALK2 and 6) and BMP-RII were expressed in ECs. As a functional test, ECs were treated with a BMPRII siRNA to knockdown expression. BMPRII knockdown blocked a well-known BMP4 response - smad1/5/8 phosphorylation, as expected. Unexpectedly, BMPRII knockdown itself significantly stimulated ICAM-1 and VCAM-1 expression and monocyte adhesion in a BMP4-independent manner. Inflammatory responses caused by BMPRII knockdown were blocked by inhibitors of NADPH oxidase and NFκ B. From these results, we hypothesized that BMP-RII knockdown in ECs would cause inflammation, which is a critical event in atherosclerosis initiation and progression. Genetic mutations of BMPRII have been linked to primary pulmonary hypertension. However, it is not known whether BMP-RII is regulated by atherosclerotic conditions and plays a role in non-pulmonary vessels causing inflammation and atherosclerosis. We examined BMPRII levels in HCA by immunostaining. While non-diseased arteries showed intense staining of BMPRII, the expression decreased as lesions became more advanced. BMPRII was virtually undetectable in the most advanced lesions. These findings suggested a potential link between pro-atherosclerotic conditions and BMP-RII levels. We tested this hypothesis by treating ECs with pro-inflammatory cytokines found in atheromas: TNFα decreased BMPRII by 2-fold. In contrast, statins increased BMPRII by 4-fold. In summary, we demonstrate for the first time that BMPRII can be down- or up-regulated by pro- or anti-atherogenic conditions, respectively, and it is dramatically decreased in HCA with advanced plaques. Moreover, BMPRII knockdown in ECs induces inflammation, a critical atherogenic step. We propose that focal inflammation initiated by disturbed flow, together with circulating pro-atherogenic risk factors, may lead to a vicious cycle of BMPRII down-regulation causing secondary inflammation and atheroma progression.

[Truncated abstract] Iron is a trace mineral used by the body in many physiological processes that are essential to athletic performance. Commonly, the body's iron stores are compromised by exercise via several well established mechanisms. One such mechanism is the destruction of red blood cells (hemolysis), in response to the mechanical stress and circulatory strain of exercise. Although it appears that a force-dependent relationship between the heel-strike of the running gait and ground contact exists, the effects of the intensity trained at and the ground surface type trained upon have not been documented. Similarly, the effects of a cumulative training stress (i.e. multiple daily sessions) has not been examined. In addition to hemolysis, exercise also invokes an inflammatory response that results in an up-regulation of the cytokine interleukin-6 (IL-6). This cytokine is the primary mediator of hepcidin expression, a liver-produced hormone that regulates iron metabolism in the gut and in macrophages. The influence of exercise on hepcidin expression is relatively unknown, and as such it is possible that this hormone may be a mitigating factor implicated in athletic-induced iron deficiency. Therefore, the purpose of this thesis was to investigate the effect of different training frequencies, intensities and ground surfaces on the hemolytic response. In addition, the impact of exercise-induced inflammation on hepcidin expression in the 24 h post-exercise was investigated, with the aim of determining whether this hormone may be a potential new mechanism associated with athletic-induced iron deficiency. Finally, an interaction between hemolysis and hepcidin activity was examined to investigate their potential combined effect on iron status in the 24 h post-exercise. ... Venous blood and urine samples were collected pre- and immediately post-exercise, and at 3 and 24 h of recovery. Samples were analysed for circulating levels of IL-6, free Hb, Hp, serum iron, ferritin and urinary hepcidin activity. At the conclusion of both the T1 and T2 interval runs, the free Hb and serum Hp were significantly increased (p<0.05) from pre-exercise levels. Furthermore, a cumulative effect of two running sessions was shown in the T2 trial, via a further significant fall in serum Hp. The IL-6 and hepcidin activity were significantly increased after each running session (p<0.05) with no cumulative effect seen. Serum iron and ferritin were significantly increased post-exercise after each interval run (p<0.05), but were not influenced by the addition of a prior LSD run 12 h earlier. As a result, this investigation showed a cumulative effect of consecutive training sessions on RBC destruction in male athletes. Furthermore, post-exercise increases to serum iron and hepcidin, and their interaction was suggested to have potential implications for an athlete's iron status. Overall, the findings of this thesis show that hemolysis is evident at the conclusion of endurance running, and is influenced by training intensity and frequency. The results enabled a time-line for hepcidin expression post-exercise to be established, and the implications of increases to the activity of this hormone, in association with the hemolytic changes seen with endurance exercise are discussed.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol inst., 2003. / Härtill 7 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.