Dissertation (DScD) -- Boston University, Henry M. Goldman School of Dental Medicine, 2010 (Department of Periodontology and Oral Biology). / Diabetes and periodontal disease exhibit a bidirectional relationship centered on an enhanced inflammatory response manifested both locally and systemically. The observation that hyperglycemia by itself, in the absence of additional inflammatory signals, promotes a proinflammatory environment indicates that diabetes is an independent risk factor for periodontal disease. Leukocyte pre-activation or priming in diabetes has been demonstrated. Excessive ROS release by leukocytes, upregulation of pro-inflammatory mediators and adhesion molecules are characteristic to T2DM-associated low-grade inflammation. However, the mechanisms by which chronic hyperglycemia leads to leukocyte activation are not fully understood. [TRUNCATED]

A meta-clorofenilpiperazina (1-(3-clorofenil)piperazina; mCPP) é uma piperazina sintética que vem sendo apreendida de forma crescente no mercado de drogas ilícitas, primeiro na Europa e, a partir de 2006, também no Brasil. Recentemente há relatos de aumento significativo da apreensão de comprimidos vendidos como ecstasy e que na realidade contêm mCPP, porém estudos sobre potenciais riscos dessa utilização à saúde ainda são escassos. O papel da mCPP como agonista de receptores serotoninérgicos já está bem descrito na literatura, razão pela qual esta substância é amplamente empregada em trabalhos científicos, principalmente psiquiátricos. No entanto, poucos são os trabalhos realizados com o intuito de investigar mais profundamente as ações desencadeadas no organismo pela substância em si. É sabido que a serotonina é um neurotransmissor liberado por plaquetas no local de inflamação e que exerce papel imunomodulatório importante sobre as células imune Assim, considerando (1) a relevância atual da mCPP no contexto de apreensão de drogas de abuso, (2) a necessidade de estudos sobre efeitos das drogas de abuso no organismo, (3) escassez de avaliações dos efeitos da mCPP sobre o sistema imunológico e (4) sua provável correlação com este sistema a partir de suas ações em receptores serotoninérgicos, o presente trabalho pretendeu iniciar investigações acerca da atividade da mCPP sobre as respostas imune inatas e sobre os mecanismos da mobilização leucocitária. Para tanto, ratos Wistar machos foram tratados com mCPP (1mg/kg, v.o.) e foram realizadas quantificações de leucócitos na medula óssea, no compartimento circulante e no foco inflamatório (peritônio), em presença ou ausência de estímulo inflamatório (LPS, 1 mg/mL, i.p.), como também da mieloperoxidase presente em tecido hepático, pulmonar e do baço. Complementando os estudos in vivo, ainda foi quantificada a cortisona plasmática em animais que receberam tal tratamento tendo seus receptores de glicocorticoides previamente antagonizados (RU38486). Neutrófilos coletados do exsudato peritoneal foram incubados nas concentrações de 10 µM, 100 µM e 1000 µM in vitro e investigados a migração neutrofílica, a expressão das moléculas de adesão na superfície neutrofílica, a quantificação de mediadores inflamatórios no sobrenadante de cultura de neutrófilos e o processo de adesão neutrófilo-endotélio, com células endoteliais coletados a partir do cremáster. Os resultados demonstram que a mCPP diminuiu a quantificação de leucócitos no exsudato peritoneal e, concomitantemente, aumentou o influxo de PMN para o tecido pulmonar, em vigência de estímulo inflamatório. Ainda, in vivo, não foi possível observar diferenças na concentração de cortisona sérica entre animais cujos receptores de glicocorticóides foram antagonizados e aqueles cujos receptores em questão encontravam-se normais. In vitro, a mCPP, nas três concentrações empregadas, e tanto na vigência quanto na ausência de estímulo (LPS ou fMLP), causou alterações na migração dos neutrófilos, na adesão deste tipo celular ao endotélio, na expressão de moléculas de adesão (Lselectina, β2-integrina e PECAM-1) na superfície neutrofílica e na quantificação das concentrações de mediadores inflamatórios (NO, IL-1β, IL-10, TNF-α) no sobrenadante de cultura de neutrófilos. Os resultados obtidos sugerem, em conjunto, que a mCPP exerce atividade pró-inflamatória no que se refere à atividade neutrofílica, bem como sugerem que o fármaco seja capaz de amplificar a resposta inflamatória em modelo animal de rato, tanto in vivo quanto in vitro. / The meta-chlorophenylpiperazine is a synthetic piperazine which has been seized increasingly in the illicit drug market, primarily in Europe and after 2006, in Brazil. Recently, there has been a significant increase on the apprehension of tablets sold as ecstasy but that in reality contain mCPP. Despite its importance, studies over its potential health risks are few. The mCPP role as serotonergic receptor agonist is well known in the literature, reason why this substance is widely employed in scientific research, particularly in psychiatric studies. But there are few reports that aim to investigate thoroughly the actions that this substance triggers in the organisms. It is also known that serotonin is a neurotransmitter released by platelets at the site of inflammation and plays important immunomodulatory role on immune cells. Therefore, considering (1) the relevance of mCPP in the drug abuse context nowadays, (2) the necessity of researching the effects of the drug abuse in the organisms, (3) the lack of studies containing analysis of the mCPP effects over the immune system and (4) the probable correlation between mCPP and this system, through its activity in serotoninergic receptors, this report intended to lead investigations about the mCPP activity over the innate immune response and over the leukocyte mobilization mechanisms. For this purpose, Wistar male rats were treated with mCPP (1mg/kg, v.o.), their leukocytes were measured in the bone marrow, in the circulating compartment and in the inflammatory foci (peritoneum) in the presence or absence of inflammatory stimuli (LPS, 1 mg/mL, i.p.) and the myeloperoxidase present in liver tissue, lung and spleen was also quantified. In addition to in vivo studies, the cortisone plasma was quantified in animals receiving such treatment with glucocorticoid receptors antagonized previously (RU38486). Neutrophils collected from the peritoneal exudate were incubated at concentrations of 10 mM, 100 mM and 1000 mM in vitro. It was then investigated the neutrophil migration and the expression of adhesion molecules on the surface of neutrophils as well as the quantification of inflammatory mediators in the culture supernatant. The process of neutrophil-neutrophil adhesion to endothelium was also analyzed and endothelial cells were collected from the cremaster. Results reflect that mCPP decreased the amount of leukocytes at the peritoneal exudate and, concomitantly, increased the influx of PMN into the lung tissue during an inflammatory stimulus. Also, in vivo, it was possible to observe differences in the concentration of serum from animals which cortisone glucocorticoid receptors were previously antagonized and those in which the receptors in question were normal. In vitro, mCPP in three concentrations employed, and both in the presence or absence of stimulus (LPS or fMLP) caused changes in the migration of neutrophils, in the cell adhesion to the endothelium, in the expression of adhesion molecules (L-selectin, integrin-β2 and PECAM-1), on the surface of neutrophils and in the concentrations of inflammatory mediators (NO, IL-1β, IL-10, TNF-α) in the culture supernatant of neutrophils. The results suggest that, together, mCPP exerts pro-inflammatory activity with respect to neutrophil activity. They also suggest that the drug is able to amplify the inflammatory response in an animal model rat both in vivo and in vitro.

O Chikungunya é um vírus reemergente que causa uma doença caracterizada por uma artralgia incapacitante que afeta milhares de pessoas. A resposta inata contra este vírus é bem descrita pela participação de macrófagos, células dendríticas e células NK, porém há poucos trabalhos que demonstram o papel dos neutrófilos nesta infecção. As Neutrophil Extracellular Traps (NETs) constituem uma rede de DNA complexada a enzimas antimicrobianas que foram descritas por combaterem diversos patógenos. Porém, não há trabalhos que demonstram sua importância em infecção por Chikungunya. Nosso objetivo foi investigar se há produção de NETs na infecção por Chikungunya, descrever seus mecanismos e demonstrar sua importância in vitro e in vivo. Observamos que neutrófilos murinos e humanos incubados com Chikungunya são capazes de produzir NETs via Toll-Like 7 e produção de espécies reativas de oxigênio. Estas NETs foram capazes de capturar o vírus e impedir sua infecção in vitro. Mais além, animais infectados com Chikungunya e tratados com rhDNAse apresentam maior carga viral e são mais suscetíveis à infecção, demonstrando sua importância in vivo. Por fim, pacientes diagnosticados em fase aguda de infecção por Chikungunya possuem elevados níveis de NETs correlacionados com uma alta carga viral. / Chikungunya is a reemerging virus which causes a disease characterized by an incapacitanting arthralgia and affects thousands of people. Innate response against this virus is well described by participation of macrophages, dendritic cells and NK cells, however few works demonstrate the roe of neutrophils in this infection. Neutrophils Extracellular Traps are a web of DNA complexed with antimicrobial enzymes which were described for fighting against many pathogens. However, there are no works which demonstrate its relevance in Chikungunya infection. Our objective was to evaluate if there is release of NETs in Chikungunya infection, describe its mechanisms and demonstrate its relevance in vitro and in vivo. We observed that mouse and human neutrophils incubated with Chikungunya are able to produce NETs via Toll-Like 7 and reactive oxygen species production. These NETs were able to capture the virus and inhibit its infection in vitro. Moreover, animals infected with Chikungunya virus and treated with rhDNAse demonstrated higher viral load and are more susceptible to the infection, showing its importance in vivo. Lastly, patients diagnosed during acute infection of Chikungunya infection have high levels of NETs correlated with a high viral load.

Neutrophils are recognised to play a pivotal role at the interface between the innate and adaptive immune responses following their rapid recruitment to inflamed tissues and lymphoid organs. Whilst neutrophil trafficking through blood vessels has been extensively studied, the molecular mechanisms regulating their migration into the lymphatic system are still poorly understood. This thesis therefore aimed to investigate the mechanisms involved in neutrophil migration across the lymphatic endothelium during TNF- or Complete Freund's Adjuvant + antigen (CFA+Ag)-induced inflammation of cremaster muscles in vivo. This work revealed that TNF- or CFA+Ag-stimulation induces a rapid but transient entry of tissue-infiltrated neutrophils into lymphatic vessels, a response associated with the regulation and redistribution of the lymphatic endothelial cell glycocalyx. Interestingly, antigen sensitisation resulted in the production of endogenous TNF within cremaster muscles. Using anti-TNF blocking antibodies and mice deficient in both TNF receptors (p55 and p75), endogenous TNF was demonstrated for the first time to be involved in priming and triggering the migration of neutrophils into tissue-associated lymphatic vessels upon antigen challenge. Additionally, the use of chimeric mice exhibiting neutrophils deficient in both TNFRs demonstrated that TNF directly acts on leukocytes to induce neutrophil migration into lymphatic vessels. Furthermore, the results show that TNF-induced migration of neutrophils into the lymphatic system occurs in a strictly CCR7-dependent manner; blocking CXCR4 or CXCL1 signalling does not affect this response. Finally, both TNF- or CFA+AG-stimulation induced ICAM-1 up-regulation on lymphatic vessels, allowing neutrophils to crawl along the lumen; a response that was demonstrated to be TNF-dependent. These results have provided new insights into the mechanisms that mediate neutrophil migration into lymphatic vessels and their subsequent crawling within these vessels during inflammation. In particular, a new role for TNF as a key regulator of these processes has been demonstrated. Taken together, this work has highlighted potential and effective targets to manipulate the role of neutrophils in adaptive immune responses in vivo.

O Chikungunya é um vírus reemergente que causa uma doença caracterizada por uma artralgia incapacitante que afeta milhares de pessoas. A resposta inata contra este vírus é bem descrita pela participação de macrófagos, células dendríticas e células NK, porém há poucos trabalhos que demonstram o papel dos neutrófilos nesta infecção. As Neutrophil Extracellular Traps (NETs) constituem uma rede de DNA complexada a enzimas antimicrobianas que foram descritas por combaterem diversos patógenos. Porém, não há trabalhos que demonstram sua importância em infecção por Chikungunya. Nosso objetivo foi investigar se há produção de NETs na infecção por Chikungunya, descrever seus mecanismos e demonstrar sua importância in vitro e in vivo. Observamos que neutrófilos murinos e humanos incubados com Chikungunya são capazes de produzir NETs via Toll-Like 7 e produção de espécies reativas de oxigênio. Estas NETs foram capazes de capturar o vírus e impedir sua infecção in vitro. Mais além, animais infectados com Chikungunya e tratados com rhDNAse apresentam maior carga viral e são mais suscetíveis à infecção, demonstrando sua importância in vivo. Por fim, pacientes diagnosticados em fase aguda de infecção por Chikungunya possuem elevados níveis de NETs correlacionados com uma alta carga viral. / Chikungunya is a reemerging virus which causes a disease characterized by an incapacitanting arthralgia and affects thousands of people. Innate response against this virus is well described by participation of macrophages, dendritic cells and NK cells, however few works demonstrate the roe of neutrophils in this infection. Neutrophils Extracellular Traps are a web of DNA complexed with antimicrobial enzymes which were described for fighting against many pathogens. However, there are no works which demonstrate its relevance in Chikungunya infection. Our objective was to evaluate if there is release of NETs in Chikungunya infection, describe its mechanisms and demonstrate its relevance in vitro and in vivo. We observed that mouse and human neutrophils incubated with Chikungunya are able to produce NETs via Toll-Like 7 and reactive oxygen species production. These NETs were able to capture the virus and inhibit its infection in vitro. Moreover, animals infected with Chikungunya virus and treated with rhDNAse demonstrated higher viral load and are more susceptible to the infection, showing its importance in vivo. Lastly, patients diagnosed during acute infection of Chikungunya infection have high levels of NETs correlated with a high viral load.

Introduction: Bronchiectasis is a common chronic debilitating respiratory condition. Patients suffer daily cough, excess sputum production and recurrent chest infections because of inflamed and permanently damaged airways. The pathogenesis of bronchiectasis is poorly understood. Pulmonary pathology shows excess neutrophilic airways inflammation, but despite this over two thirds of patients are chronically infected with potential pathogenic microorganisms. The acute inflammatory response is a protective mechanism that is evolved to eliminate invading organisms and should ideally be self-limiting and lead to complete resolution. The driver for persistent neutrophilic airway inflammation in bronchiectasis is unknown, but infection is considered to play a major role. AIMS The main aims of this thesis were to: (i) Characterize neutrophils in the serum and airways in bronchiectasis in the stable state and during exacerbations; (ii) Cohort study to establish if LXA4 deficiency correlates with disease severity (iii) Characterize lipids in bronchiectasis airways and peripheral blood to establish the correlation of LXA4 to disease severity; (iv) To investigate a potential mechanism for low levels of LXA4 in bronchiectasis, lipoxin biosynthetic genes expression will be measured; (v) Assess the anti-inflammatory and pro resolution effect of LXA4 on neutrophils and monocyte derived macrophages from healthy volunteers; (vi) Assess the anti-inflammatory and pro resolution effect of LXA4 on neutrophils during exacerbations in bronchiectasis and community acquired pneumonia. Methods (I) To establish the serum neutrophil subtype in stable state and following antibiotic treatment in patients with bronchiectasis, the following studies were done. Inclusion criteria: Patients aged 18-80 were recruited. All had an established radiological diagnosis of bronchiectasis (CT of the chest). Patients had clinically significant bronchiectasis, aetiology being either idiopathic or post infection. Exclusion Criteria: current smokers or ex-smokers of less than 1 year; >20 pack year history; cystic fibrosis; active allergic bronchopulmonary aspergillosis; active tuberculosis; poorly controlled asthma; severe COPD requiring nebulised bronchodilators or long term oxygen therapy; patients on aspirin or leukotriene inhibitors, pregnancy or breast feeding, active malignancy. A. 6 patients with mild bronchiectasis, 6 patients with severe bronchiectasis and 6 healthy volunteers were recruited. Serum and airways neutrophils were subsequently isolated. Neutrophil apoptosis, CD11b and CD62L expression, myeloperoxidase release, superoxide generation, phagocytosis and killing of GFP labeled bacteria were assessed. B. To compare serum with airways neutrophils function, bacterial phagocytosis and killing of GFP labeled bacteria was done, with both serum and airways neutrophils. Samples were obtained from the above group of patients. C. To establish neutrophil function following antibiotic treatment, 6 bronchiectasis patients at the beginning (day1) and the end (day14) of intravenous antibiotic therapy for an exacerbation were studied. As a control group, 6 community acquired pneumonia patients at the beginning (day1) and the end (day 5) of intravenous antibiotic therapy for infection were studied. Induced sputum and peripheral blood was taken at day1 and 5, where able. Phagocytosis and killing of GFP labeled bacteria was assessed and the two groups compared. (II) To address if lipoxin A4 deficiency correlates with disease severity, a cohort study was done in bronchiectasis patients. 169 patients were recruited and followed up for 1 year. Assessments done were Bronchiectasis severity index, systemic inflammatory markers (white cell count, ESR and c-reactive protein), Forced Expired Volume in 1sec, Forced Vital Capacity and its ratio, antibiotic courses in 1 year, hospital admissions in 1 year, sputum microbiology, quality of life assessments by Leicester Cough Questionnaire and St. Georges Respiratory Questionnaire, interleukin 8, myeloperoxidase, neutrophil elastase and leukotriene B4 (from sputum). (III) To assess effect of lipoxin on disease severity, 6 healthy volunteers, 10 patients with mild disease, 15 with moderate and 9 with severe disease were recruited. Disease severity was calculated as per the bronchiectasis severity index. All participants had 60mls of blood taken and underwent a bronchoscopy. Two segments of the lungs were washed out from bronchiectasis patients, an area affected by bronchiectasis and an area unaffected by bronchiectasis. This led to patients acting as their own internal control. Serum and airways neutrophils (from both segments) were subsequently isolated. Assessments done were systemic inflammatory markers (white cell count, ESR and c-reactive protein), serum lipoxin A4 and the cathelicidin LL-37, Forced Expired Volume in 1sec, Forced Vital Capacity and its ratio, transfer factor for carbon monoxide, antibiotic courses in 1 year, hospital admissions in 1 year and sputum microbiology. Phagocytosis and bacterial killing were assessed by both serum and airways neutrophils. From bronchoalveolar lavage fluid (BALF), I measured myeloperoxidase and neutrophil elastase. For both serum and BALF, lipidomics were obtained. (IV) To address the impact of anatomic compartment, gene expression was measured in from endobronchial brushings from the same cohort of bronchiectasis patients and controls as above, where samples were available. qPCR was performed for the following eicosanoid biosynthetic genes- 5 Lipoxygenase (LOX), 15 LO-A, 15LO-B and leukotriene (LT) A4 hydrolase. (V) To assess the anti inflammatory and pro resolution effect of LXA4 on neutrophils and monocyte derived macrophages from healthy volunteers, freshly isolated PMN will be treated with LXA4 or vehicle control. Spontaneous apoptosis was measured. fMLF and cytochalasin B was added and the inflammatory response assessed measuring myeloperoxidase (MPO), free neutrophil elastase (NE), CD11b, CD18 and CD62L. Human monocytes and PMNs were isolated from bronchiectasis patients. Following differentiation, LXA4 treated or control adherent, washed MDMs will be incubated with apoptotic stained PMNs. Efferocytosis was analyzed by flow cytometry. (VI) To establish the effect of Lipoxin A4 on neutrophil function following antibiotic treatment, the same study group used to evaluate aim 1 was taken. As a control group, 6 community acquired pneumonia patients at the beginning (day1) and the end (day 5) of oral or intravenous antibiotic therapy for infection were studied. Induced sputum and peripheral blood was taken at day1 and 5, where able. Phagocytosis and killing of GFP labeled bacteria and the effect of Lipoxin A4 was assessed and the two groups compared. Serum and sputum lipidomics were obtained in bronchiectasis exacerbations on day 1 and day 14. Serum lipidomics was obtained in pneumonia on day 1 and day 5. RESULTS (I) Neutrophil sub type study (Studied on healthy volunteers/ mild/ severe bronchiectasis) Peripheral blood neutrophils from bronchiectasis patients showed that there was significantly more viable neutrophils in mild and severe bronchiectasis compared to healthy volunteers, p=0.002 and p=0.005 respectively. In addition, there was significantly less apoptotic neutrophils in mild and severe bronchiectasis compared to healthy volunteers, p=0.0003 and p < 0.0001 respectively. There was a significantly higher level of CD11b in the mild (p=0.01) and severe bronchiectasis (p=0.01) compared to healthy volunteers. There was more CD62L shedding (p=0.02) and myeloperoxidase release (p=0.04) in bronchiectasis compared to healthy volunteers. There was lesser phagocytosis in mild (p=0.04) and severe (p=0.03) bronchiectasis compared to healthy volunteers. This led to lesser bacterial killing in mild (p=0.04) and severe (p=0.0004) bronchiectasis compared to healthy volunteers.

Francisella tularensis is the causative agent of the life-threatening disease tularemia. The Centers for Disease Control considers F. tularensis among the most likely agents of biowarfare due to its high mortality rate, ease of aerosol transmission, and low infectious dose. A fundamental aspect of tularemia pathogenesis is the overwhelming accumulation of neutrophils in the lung that are incapable of bacterial clearance and furthermore injurious to the host tissue, as neutrophilia exacerbates disease and blockade of neutrophil influx into the lungs favors host survival. We hypothesized that the pathologic accretion of neutrophils may be the result of decreased neutrophil death and/or decreased clearance by macrophages. Our lab recently demonstrated that F. tularensis delays neutrophil apoptosis by at least 48 hours to preserve its replicative niche, but the mechanism by which this occurs was poorly defined. Here, we investigate alterations in neutrophil apoptosis and survival signaling at the molecular level and find that, in addition to effects on neutrophil transcription, F. tularensis also modulates protein abundance, activity, and subcellular localization. Specifically, we report that F. tularensis preserves mitochondrial integrity by inhibiting the pro-apoptotic proteins Bid and Bax as well as maintaining expression of the pro-survival factors XIAP and calpastatin. Moreover, we found that infection diminishes the ability of R-roscovitine to induce apoptosis, suggesting bacterial modulation of CDK-mediated survival signaling. Following apoptosis, effete neutrophils are rapidly cleared by macrophages in a process termed efferocytosis to avoid neutrophil progression to secondary necrosis and consequent host tissue damage. We demonstrate for the first time that neutrophils laden with F. tularensis are readily consumed by macrophages and release their infectious cargo into the macrophage cytoplasm. The engulfing cell is unable to eradicate the infection and extensive bacterial replication ensues. Intriguingly, we found that unlike other pathogens, covert infection of macrophages by F. tularensis triggers an inflammatory cytokine response that is highly similar to that of directly infected cells, suggesting that efferocytosis is not an essential virulence mechanism for this bacterium. Together, these studies significantly advance our understanding of fundamental F. tularensis virulence mechanisms and disease pathophysiology as well as shed light on other inflammatory disorders characterized by dysregulated neutrophil turnover and clearance.

One-half million cases of septicemia are reported annually with a mortality of around 35%. Diagnosis depends in part on blood cultures which require one to two weeks. It would be advantageous if an early sign of septicemia were available. Cytoplasmic vacuolation of polymorphonuclear neutropnils is occasionally seen in the peripheral blood smears of patients who have infections. The object of this work was to determine the cause and significance of cytoplasmic vacuolation with the goal of using the occurrence of vacuolation as an early indicator of infection.

Neutrophils accumulate around Trichinella spiralis larvae encysted in skeletal muscle cells of the host. The magnitude of the neutrophil infiltration follows a pattern relating to the stage of infection of T.spiralis. This study was performed to determine if there are factors chemotactic for neutrophils present in the sera of mice infected with T.spiralis, and if present, to compare the chemotactic potential of sera from several time points during the infection. Female MRL++ mice hosted the T.spiralis infection and provided neutrophils for all experiments. The chemotactic potentials of sera were tested by placing 150 ul of serum collected at zero, four, 11, or 28 days following initial infection of the mouse with T.spiralis, into the bottom well of a modified Boyden chamber called a deep well chemotaxis chamber. Next a PVP-free polycarbonate micropore membrane with a pore size of 5 um was placed over the bottom well. The top chamber was then fastened to the bottom well and filled with a neutrophil suspension which was obtained by gradient layer centrifugation using the NIM • 2 step gradient reagent system. A cover glass was placed over the opening of the top well and the entire apparatus was incubated at 37°C under 5% C02 in a humidified incubator for four hours. Following the incubation cells which had migrated through to the bottom well were counted using a hemocytometer and the membranes were stained with Diff Quick. The results demonstrate that there are factors present in the sera of mice infected with T.spiralis that elicit the chemotactic response of neutrophils in vivo. This work also demonstrates that sera from mice infected 11 and 28 days are significantly more chemotactic for neutrophils than are sera from uninfected mice and mice infected four days. These findings correlated with the histologic appearance of the infected skeletal muscle at four, 11 and 28 days post infection as determined by other members of our laboratory. The chemokines IL-8 and KC, and other chemotactic factors such as C5a are discussed as potential mediators of the neutrophil chemotaxis found in this experiment.

The body is under constant attack from pathogens trying to slip by our immune defence. If the barrier is breached, invading pathogens enter the tissues and cause inflammation. During this process neutrophils, constituting the first line of defence, leave the bloodstream and seek out and kill the invading pathogens. The mechanisms leading to activation of receptors on neutrophils must be closely orchestrated. Pro- and anti-inflammatory substances can influence the outcome of the inflammation process by affecting the involved players. If not well balanced, inflammatory diseases, such as atherosclerosis and rheumatoid arthritis, can be the outcome. The aim of this thesis was to elucidate the effect of pro- (fMLP, Leukotriene B4, and Interleukin-8) and anti- (lipoxins, aspirin and statins) inflammatory substances on the β2 integrins, mediating adhesion of neutrophils both under “normal” conditions and during coronary artery disease. More specifically, the effect of these substances on the β2 integrins were studied in regard to: i) the activity (i.e. affinity and avidity) of β2 integrins, ii) the signalling capacity of β2 integrins (i.e. detected as release of arachidonic acid, and the production of reactive oxygen species, and iii) the signal transduction mediated by the β2 integrins (i.e. phosphorylation of Pyk2). The pro-inflammatory substances belong to the family of chemoattractants that induces transmigration and chemotaxis. A hierarchy exists between the different family members; the end-target chemoattractants (e.g. fMLP) being more potent than intermediary chemoattractants (e.g. IL-8 and LTB4). It was found that intermediary chemoattractants regulate β2 integrins by mainly affecting the avidity of β2 integrins. End-target chemoattractants on the other hand, affected the β2 integrins by increasing the avidity and the affinity, as well as their signalling capacity. The anti-inflammatory substances used in this study were the exogenous aspirin and statins, and the endogenous lipoxins. In the presence of aspirin, stable analogues of lipoxin (i.e. epi-lipoxins) are formed in a trans-cellular process. Lipoxin inhibited the signalling capacity of β2 integrins mediated by intermediary chemoattractants, as well as the signal transduction induced by end-target chemoattractants. Moreover, the signalling capacity of β2 integrins in neutrophils from patients suffering from coronary artery disease (CAD) was impaired. Arachidonic acid, the precursor for both pro- and anti-inflammatory eicosanoid, induced an increase in the β2 integrin activity (both affinity and avidity), but had no effect on the signal transduction. In conclusion, different “roles” were observed for end-target and intermediary chemoattractants in the regulation of β2 integrins. The inhibitory effects of the anti-inflammatory lipoxins support earlier studies suggesting that these agents function as “stop signals” in inflammation. This is also confirmed by our findings in CAD patients, who have elevated levels of epi-lipoxins due to aspirin treatment. Moreover, Pyk2 was identified as a possible target for the inhibitory effect of anti-inflammatory drugs.