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京都大学 / 新制・課程博士 / 博士(医学) / 甲第23790号 / 医博第4836号 / 新制||医||1057(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 山本 洋介, 教授 佐藤 俊哉, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Systemic lupus erythematosus (SLE) is a complex autoimmune disease that affects at least five million people worldwide. An increased expression of type I interferon (IFN) regulated genes is a hallmark of SLE, but the precise etiology of SLE initiation and flares is poorly understood. Because plasmacytoid dendritic cells (pDCs) are the primary type I IFN producers, their role in SLE has long been suspected, with murine pDC depletion models successfully delaying the progression of murine lupus-like disease. However, the mechanism behind how exactly how pDCs contribute to lupus autoimmunity is unknown, contributing to the current dearth lack of disease modifying treatments; current treatments only succeed in suppressing symptoms, and do not halt disease progression. In this study, we take a multifactorial approach to understanding the biology of pDCs in the context of lupus autoimmunity. Although the exact etiology of lupus is unknown, infections are an important environmental trigger for / Infectious Disease & Immunity

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24994号 / 医博第5028号 / 新制||医||1069(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 上野 英樹, 教授 椛島 健治, 教授 濵﨑 洋子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease with no known cure. The crosstalk between the gut microbiota and the immune system plays an important role in the tolerance induction to self-antigens both in the intestinal mucosa and at the systemic level. The MRL/lpr mouse model exhibits lupus-like symptoms early in life due to multiple SLE susceptible loci of the MRL background, plus the Faslpr mutation that offers an accelerated model. Recently, we experienced a loss of disease phenotype in our in-house colony compared to the previous published phenotype of MRL/lpr mice. We thus compared mice newly obtained from The Jackson Laboratory (JAX) with our in-house MRL/lpr mice and found that the phenotypic drift, most significantly the attenuation of glomerulonephritis, was present in both colonies. In addition, while JAX mice and mice in our colony are genetically identical, there were minor differences in disease that might be due to differences in splenic microRNAs and the gut microbiota. Once confirming that our MRL/lpr mouse model was as good as that from JAX, we continued our investigation of the role of Lactobacilli in the pathogenesis of lupus-like disease in MRL/lpr mice. We previously published that the mixture of Lactobacillus reuteri (L. reuteri), L. oris, L. johnsonii, L. gasseri, and L. rhamnosus significantly attenuated disease in MRL/lpr mice by restoring the imbalance between regulatory T cells and T helper-17 cells. To further understand the role of Lactobacillus spp., we treated MRL/lpr mice with the combined culture supernatant of the 5 strains containing secreted metabolites, given that the metabolites may induce an immunosuppressive response. The results showed significant attenuation of the inflammation of the spleen and renal lymph nodes similar to the effect of the bacteria themselves. There was also a trending decrease of double-stranded DNA autoantibodies with the combined supernatant. We thus tested the strains individually but none was able to recapitulate the effect of the bacterial mixture. This suggests cell-to-cell contact among different strains of lactobacilli may be required in ameliorating the disease. With these results, we now have a better understanding of the role of probiotic Lactobacillus spp. against SLE. Future investigations will focus on the potential therapeutic effect of Lactobacillus spp. as a combination. Additionally, our group generated a Cx3cr1-deficient MRL/lpr mouse which exhibits a distinct phenotype of exacerbated glomerulonephritis with concurrent change of the gut microbiota composition compared to Cx3cr1+/+ MRL/lpr littermates. Interestingly, upon correction of the gut microbiota with Lactobacillus administration, the phenotype of exacerbated glomerulonephritis was reversed, suggesting that CX3CR1 controls glomerulonephritis in MRL/lpr mice through a gut microbiota-dependent mechanism. In addition, a collaborative project revealed that Cx3cr1 deficiency-mediated pathogenic mechanisms also contributed to SLE-associated cardiovascular disease in MRL/lpr mice. The results of these studies will lead to the identification of new therapeutic targets for the treatment of two severe manifestations, glomerulonephritis and cardiovascular disease, that together account for most of the morbidity and mortality in SLE. / Doctor of Philosophy / Systemic lupus erythematosus (SLE) is an autoimmune disease with no known cure. Commensal microbiota, mostly bacteria living in our gut, and the immune system have a strong relationship in maintaining a healthy state of the gut as well as the whole body. Alterations in the gut microbiota, known as dysbiosis, can facilitate SLE in human and animal models. Current treatments for SLE are primarily focused on using immunosuppressants, but the side effects are still a concern. The use of long-term nonselective immunosuppressant conducts a higher incidence of severe infections in SLE patients. It is thus necessary to develop new approaches and treatments against SLE. My dissertation research is focused on understanding how commensal bacteria influence in the pathogenesis of SLE. My studies have shown that environmental factors can manipulate the gut microbiota leading to different disease outcomes. In addition, following upon previously published studies from our laboratory, I have delineated the mechanism how a mixture of probiotic Lactobacilli can exert a beneficial effect against lupus. Finally, I have revealed a new, CX3CR1-mediated mechanism through which the gut microbiota controls kidney disease in the MRL/lpr lupus-prone mouse model.

In this work the involved mechanisms between Ro/SSA complex, composed also by the tripartite motif 21 (TRIM21alpha) and trove domain 2 (TROVE2) proteins, with respect to systemic lupus erythematosus (SLE) autoantibodies is studied. The work is divided in three chapters: I- In vitro and in silico analysis of the molecular recognition between lupus autoantibodies and TRIM21alpha Fc Receptor ; II- In vitro evidence of bipolar-bridged immune TROVE2 complexes in the pathogenesis of systemic lupus erythematosus and III- Label-free piezoelectric biosensor for prognosis and diagnosis of Systemic Lupus Erythematosus. Samples of lupic patients and health subjects were kindly provided by La Fe hospital, accordingly the required protocols. After its extraction and purification, the immunoglobulin samples were obtained to study in vitro protein interactions and the involved mechanism by using a quartz crystal microbalance with dissipation factor attributions, and dual polarization interferometry. Techniques such, polarization modulation infrared interferometry, x-ray photoelectron interferometry and contact angle measurement were used in order to characterize surfaces. Pre-steady-state analysis revealed an antibody bipolar bridging involved in both TRIM21alpha and TROVE2 proteins. Identification of the main immunodominant human linear epitope for TRIM21alpha was finely mapped using a series of overlapping synthetic polypeptides with a size of 21 amino acids. The epitopes recognised by autoantibodies for this protein spanned the linear sequence from the aminoacid 151 to 183, and a conformational epitope for SLE patients and healthy subjects, respectively. Autoantibodies from lupic patients targeted protein epitopes, allowing health subjects to be discriminated. Major Histocompatibility Complex Class-II binding peptide prediction results corroborated the sequence as the immunodominant linear epitope, mostly coded as the HLA DRB1*1304 allele for SLE patients, and HLA DRB1*0806 for controls. The subdominant epitope corresponded to the PRY-SPRY domain, recently known as mammalian Fc receptor. Finally, the TRIM21alpha protein structure was modeled by a new homology modeling, never before presented. From the TROVE2 protein, the major linear epitope recognized by autoantibodies correspond to the sequence from the aminoacid 160 to 210 for healthy subjects. However, the major epitope in SLE serum is undiscovered. We suggest that the difference between epitopes could correspond to a majority necrosis-induced specificity in SLE patients, and an apoptotic via in healthy subjects. TROVE2 showed the ability to bind to Fcs, depending on alkaline earth cations in solution. The results suggest that the TROVE2-TRIM21alpha binding is a calcium-dependent protein interaction linked through the MIDAS-like motif in the vWFA-like domain. Finally, a pratical consequence of all study was the development of label-free biosensing method, based in microbalance technology, for in vitro diagnostics of systemic lupus erythematosus patients, allowing the premature sensing of autoantibodies against TRIM21alpha and TROVE2 protein, in advance of the clinical illness symptoms appear. / En este trabajo se ha estudiado el mecanismo involucrado entre el complejo Ro/SSA, compuesto también por las proteínas tripartite motif 21 alpha(TRIM21alpha;) y trove domain 2 (TROVE2) con respecto a autoanticuerpos de pacientes que tienen lupus eritematoso sistémico, en comparación con autoanticuerpos de personas sanas. El estudio comprende tres capítulos: I- Análisis in vitro e in silico del reconocimiento molecular entre autoanticuerpos de lupus y receptor TRIM21alpha; Fc; II- Evidencias in vitro de complejos inmunes TROVE2 bipolares con puentes en la patogénesis del lupus eritematoso sistémico y III- Biosensor piezoeléctrico libre de marcaje para el pronóstico y el diagnóstico del lupus eritematoso sistémico. Las muestras de pacientes lúpicos y personas sanas fueron proporcionadas por el hospital La Fe de acuerdo con los protocolos establecidos. Tras una etapa de extracción y purificación de las inmunoglobulinas fueron estudiadas la interacción de proteínas in vitro utilizando una microbalanza de cristal de cuarzo con atribución de factor de disipación e interferometria de polarización dual. Técnicas de caracterización como espectroscopía infrarroja de reflexión-absorción por modulación de la polarización, espectroscopía fotoelectrónica de rayos-x y análisis de ángulo de contacto fueron utilizadas con la finalidad de caracterizar superficies. El análisis del estado pre estacionario ha revelado un mecanismo de puente bipolar para las dos proteínas, TRIM21alpha; y TROVE2. Tras su identificación, el epítopo linear inmunodominante fue mapeado para TRIM21alpha;, utilizando una serie de polipéptidos sintéticos superpuestos de 21 aminoácidos. Los epitopos reconocidos por autoanticuerpos para esta proteína abarca la secuencia lineal a partir del aminoácido 151 hasta el 183 para epitopos de pacientes lúpicos y sujetos sanos, respectivamente. Autoanticuerpos de pacientes lúpicos reconocieron epítopos de proteínas, permitiendo la discriminación de pacientes sanos. Los resultados de la unión del Complejo Mayor de Histocompatibilidad clase II con el péptido de unión corroboraron la secuencia cómo el epítopo lineal inmunodominante, codificado como el alelo HLA DRB1 * 1304 para pacientes con LES y HLA DRB1 * 0806 para los controles. El epitopo subdominante corresponde al dominio PRY-SPRY, recientemente conocido receptor Fc de mamífero. Finalmente, la estructura de la proteína TRIM21alpha; fue determinada utilizando un nuevo modelo de homología no presentado antes. De la proteína TROVE2, el epitopo lineal immunodominante reconocido por los autoanticuerpos corresponde a la secuencia que pudiera corresponder del aminoácido 160 hasta 210 para sujetos sanos. Sin embargo, el epitopo mayoritario en sueros lúpicos no fue determinado. Se sugiere que la diferencia entre los epitopos se corresponde mayoritariamente a una necrosis-inducida en pacientes lúpicos, y a una vía apoptótica en pacientes sanos. TROVE2 presentó la habilidad de unirse a Fcs dependiendo de los cationes alcalinos presentes en la disolución. Los resultados sugieren que la unión TROVE2-TRIM21alpha; es dependiente de la interacción con calcio vinculada a través del motivo MIDAS en el dominio vWFA. Finalmente, una consecuencia práctica de todo el estudio fue el desarrollo de un biosensor libre de marcaje para diagnóstico in vitro de lupus eritematoso sistémico, permitiendo la detección prematura de autoanticuerpos anti TRIM21alpha; y anti TROVE2, varios años antes de la aparición de los síntomas clínicos de la enfermedad. / En aquest treball s'ha estudiat el mecanisme involucrat en el complex Ro/SSA, compost per les proteïnes tripartite motif 21 (TRIM21alpha;) i trove domain 2 (TROVE2) respecte a autoanticossos de pacients que tenen lupus eritematós sistèmic, en comparació amb autoanticossos de persones sanes. L'estudi es divideix en tres capítols: : I- Anàlisi in vitro i in silico del reconeixement molecular entre autoanticossos de lupus i receptor TRIM21alpha; Fc; II- Evidències in vitro de complexos immunes TROVE2 bipolars amb ponts en la patogènesi del lupus eritematós sistèmic i III-Biosensor piezoelèctric lliure de marcatge per al pronòstic i el diagnòstic del lupus eritematós sistèmic. Les mostres de pacients lúpics y persones sanes van ser amablement proporcionades per l'hospital La Fe d'acord amb els protocols establerts. Després d'una etapa de purificació adequada, el pool de mostres de immunoglobulines va ser estudiat les interaccions in vitro de les proteïnes utilitzant una microbalança de cristall de quars amb atribució de factor de dissipació i interferometria de polarització dual. Tècniques de caracterització, como ara espectroscòpia de infraroja de reflexió-absorció per modulació de la polarització, espectroscòpia fotoelèctrica de rajos X i anàlisi d'angle de contacte van ser emprades amb per tal de caracteritzar les superfícies. L¿anàlisi de l`estat preestacionari ha revelat un mecanisme de pont bipolar que involucra les dos proteïnes, TRIM21alpha; i TROVE2. Una vegada identificat, va ser mapat l'epítop immunodominant lineal per a TRIM21alpha; emprant una sèrie de polipèptids sintètics superposats de 21 aminoàcids. Els epítops reconeguts per autoanticossos per a aquesta proteïna engloben la seqüència lineal a partir de l'aminoàcid 151 fins al 183 per a epítops de pacients lúpics y subjectes sans, respectivament. Autoanticossos de pacients lúpicos van reconèixer epítops de proteïnes, fet que va permetre la discriminació de pacients sans. Els resultats de la unió del Complexe Major de Histocompatibilitat classe II amb el pèptid de unió van corroborar la seqüència com l'epítop lineal immunodominant, codificat com l'al·lel HLA DRB1 * 1304 per a pacients amb LES i HLA DRB1 * 0806 per als controls. L'epítop subdominant correspon al domini PRY-SPRY, recentment conegut receptor Fc de mamífer. Finalment, l'estructura de la proteïna TRIM21alpha; va ser determinada utilitzant un nou model d'homologia no presentat abans. De la proteïna TROVE2, l'epítop lineal immunodominant reconegut pels autoanticossos correspon a la seqüència que pogués correspondre l'aminoàcid 160 fins al 210 per a subjectes sans. No obstant això, l'epítop majoritari en sèrums lúpics no va ser determinat. Es suggereix que la diferència entre els epítops es correspon majoritàriament a una necrosis induïda en pacients lúpics i a una via apoptòtica en pacients sans. TROVE2 va mostrar l'habilitat de unir-se a Fcs en funció dels cations alcalins presents en la dissolució. Els resultats suggereixen que la unió TROVE2-TRIM21alpha; depèn de la interacció amb calci vinculada a través del motiu MIDAS en el domini vWFA. Finalment, la conseqüència pràctica de tot l'estudi va ser el desenvolupament d'un biosensor sense marcatge per al diagnòstic in vitro de lupus eritematós sistèmic, el qual permet la detecció prematura d'autoanticossos cap a les proteïnes TRIM21alpha; i TROVE2 anys abans de l'aparició dels símptomes clínics de la malaltia. / Do Nascimento, NM. (2017). The Ro/SSA Complex in Systemic Lupus Erythematosus Patients [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/80534