Es wurden die Effekte von Plättchenaktivierendem Faktor (PAF, 1-O-Alkyl-2-azetyl-sn-glyzero-3-phosphocholin) auf intrazelluläre Kalziumkonzentration und Zelllänge isolierter und feldstimulierter Kardiomyozyten der Ratte untersucht. Intrazelluläre Kalziumkonzentration und Zelllänge der feldstimulierten Zellen wurden mittels Laser-Raster-Mikroskopie simultan unter Verwendung des Kalzium-Fluoreszenzfarbstoffes Fluo-3 bestimmt. PAF (0.001nM - 10nM) inhibierte den systolischen Anstieg der intrazellulären Kalziumkonzentration zeit- und konzentrationsabhängig. Die maximalen Effekte wurden nach einer Inkubationszeit von 6-8 min beobachtet. Es kam zu 17% (0.001nM), 41% (0.1nM) und 52% (10nM PAF) Reduktion des systolischen Kalziumanstiegs. Zusätzlich konnte eine zeit- und konzentrationsabhängige Verringerung der simultan gemessenen Zellverkürzung nachgewiesen werden. Die Zellverkürzung war nach einer Inkubationszeit von 8 min um 10% (0.001nM), 32% (0.1nM) und 50% (10nM PAF) reduziert. Die Wirkungen von PAF konnten durch den Einsatz des spezifischen PAF-Rezeptorantagonisten WEB 2170 inhibiert werden. Diese Ergebnisse zeigen einen rezeptorvermittelten negativ inotropen Effekt von PAF, hervorgerufen durch eine Verringerung der systolischen intrazellulären Kalziumkonzentration ohne Desensibilisierung der Myofilamente. / We investigated the effects of platelet-activating factor (PAF, 1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine) on intracellular calciumconcentration and cell length in isolated and field-stimulated rat cardiomyocytes. Intracellular calciumconcentration and cell length of field-stimulated cells were determined simultaneously by confocal laser scan microscopy by using the fluorescent calcium dye Fluo-3. PAF (0.001nM - 10nM) inhibited systolic intracellular calciumconcentration increase in a time- and concentration-dependent manner. Maximal effects were observed after an incubation time of 6-8 min, resulting in a 17% (0.001nM), 41% (0.1nM) and 52% (10nM PAF) inhibiton of systolic calcium increase. A time- and concentration-dependent decrease in simultaneously measured cell shortening also was demonstrated. Cell shortening was inhibited by 10% (0.001nM), 32% (0.1nM) and 50% (10nM PAF) after an incubation time of 8 min. The effects of PAF could be antagonized by the PAF-receptor antagonist WEB 2170. These data demonstrate that PAF receptor-dependently induces a negativ inotropic effect, which is correlated with a decrease in systolic intracellular calciumconcentration and is most likely not due to a decrease in myofilament sensitivity.

Receptores do tipo Toll (TLRs) e o receptor do fator ativador de plaquetas (PAF-R) são altamente expressos em macrófagos. Neste estudo, investigamos o efeito da ativação do PAF-R na resposta de macrófagos peritoneais a agonistas de TLR. Descobrimos que PAF exógeno inibiu a produção de citocinas pró-inflamatórias (IL-6, IL-12p40 e TNF-α) e aumentou a produção de IL-10 em macrófagos estimulados com Pam3Cys (TLR2) e LPS (TLR4), mas não Poly(I:C) (TLR3). PAF não afetou a expressão de MyD88 e TRIF, sugerindo que o efeito do PAF na modulação das citocinas é downstream aos adaptadores. PAF inibiu a fosforilação induzida por LPS da subunidade p65 do NF-κB que direciona a expressão de genes pró-inflamatórios, e aumentou a fosforilação da proteína precursora p105 do NF-κB, que induz a expressão da IL-10. Esses resultados indicam que em macrófagos ativados com LPS, a diminuição da atividade transcricional da p65 e o aumento da fosforilação da p105 induzidos pelo PAF são responsáveis pela downregulation das citocinas pró-inflamatórias e upregulation da IL-10, respectivamente. / Toll-like receptors (TLRs) and platelet-activating factor receptor (PAF-R) are highly expressed in macrophages. In this work, we investigated the effect of PAF-R activation on peritoneal macrophages responses to TLR agonists. We found that exogenous PAF inhibited the production of pro-inflammatory cytokines (IL-12p40, IL-6 and TNF-α) and increased IL-10 in macrophages challenged with Pam3Cys (TLR2) and LPS (TLR4), but not by Poly(I:C) (TLR3). PAF did not affect MyD88 and TRIF expression, suggesting that PAF modulation on cytokines is downstream to adaptors. PAF inhibited LPS-induced phosphorylation of NF-κB p65 that drives inflammatory cytokine gene expression and increased NF-κB p105 precursor phosphorylation, which induces IL-10 expression. These findings indicate that in LPS-activated macrophages, the impaired transcriptional activity of p65 subunit and enhanced p105 phosphorylation induced by PAF are responsible for the downregulation of pro-inflammatory cytokines and up-regulation of IL-10, respectively.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-04-04T15:36:20Z No. of bitstreams: 2 Dissertação - Hélio Galdino Júnior - 2008.pdf: 1866044 bytes, checksum: 37a41759b9e3790adfe67161890f0dd4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-04-04T15:38:24Z (GMT) No. of bitstreams: 2 Dissertação - Hélio Galdino Júnior - 2008.pdf: 1866044 bytes, checksum: 37a41759b9e3790adfe67161890f0dd4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-04-04T15:38:24Z (GMT). No. of bitstreams: 2 Dissertação - Hélio Galdino Júnior - 2008.pdf: 1866044 bytes, checksum: 37a41759b9e3790adfe67161890f0dd4 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2008-02-29 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Microorganisms express conserved molecules which ones activate the innate immune system. These molecules are known as pathogen-associated molecular patterns (PAMPs), such as lipopolysaccharide (LPS) and bacterial lipoproteins. The PAMPs can be recognized by Toll-like receptors (TLR). The innate immunity activation through TLR pathway induces pro-inflammatory cytokines and lipid mediators, as tumor necrosis factor (TNF) and platelet-activating factor (PAF), respectively. Several reports showed the interaction between TLR4 and PAF receptor (PAFR) signaling to the TNF production; however, the interaction between PAF and other TLR was poorly investigated. The aim of this study was to evaluate the PAF regulatory activity on TLR2-induced TNF production. Thus, Mycoplasma fermentans PG 18 lipoproteins (LAMPf), TLR2/TLR6 agonists and Pam3Cys, a synthetic lipopeptide agonist of TLR2/TLR1 were added to human whole blood cultures and TNF was evaluated by enzyme-linked immunosorbent assay. To evaluate the effects of endogenous PAF on TNF production, a PAF receptor antagonist, WEB2170 was used, and to evaluate the effect of exogenous PAF, PAF was added to the cultures. The blood cultures were also activated with Gram-positive or negative heat-killed bacteria (Staphylococcus aureus or Escherichia coli). The TLR2 expression on polymorphonuclear (PMN) and monocytes were evaluated by flow cytometry, analyzing total cellularity for PMN and CD14+ cells for monocytes. LAMPf, Pam3Cys or LPS induced TNF and the treatment with WEB2170 increased TNF production after TLR2 activation, but not after TLR4 activation. Priming of the blood cultures with PAF up regulated TLR2- induced TNF production. Addition of PAF did not alter TNF release induced by LPS. E. coli induced higher levels of TNF than S. aureus and the treatment with WEB2170 lead to a significant reduction of S. aureus-induced TNF release. However, addition of PAF did not significantly alter bacteria-induced TNF production. With E. coli neither treatment with WEB2170 nor with PAF modulated TNF release. Results indicate that PAF can increase or decrease TNF production induced by TLR2 depending on the time when PAF is combined with TLR2. The increase of the TNF production after extended priming with PAF it was not caused by an increase in TLR2 expression. Thus, it is suggested that interaction between PAFR and TLR2 signaling determines the levels of TNF release. TLR2/PAF/TNF signaling pathway can be relevant in innate immune responses against Gram positive bacteria as well as in inflammatory diseases. / Os microrganismos expressam moléculas conservadas que ativam as células do sistema imune inato. Estas são conhecidas como padrões moleculares associados aos patógenos (PAMPs), tais como o lipopolissacarídeo (LPS) e as lipoproteínas bacterianas. Estes PAMPs são reconhecidos por receptores da família dos Toll-like receptors (TLR). A ativação das células da imunidade natural via TLR induz a produção de citocinas e mediadores lipídicos pro-inflamatórios dentre eles, o fator de necrose tumoral (TNF) e o fator ativador de plaquetas (PAF), respectivamente. A modulação da produção de TNF induzida por agonista de TLR4 (o LPS), pelo PAF, é conhecida, no entanto, a interação entre PAF e outros TLR foi pouco investigada. O presente trabalho teve o objetivo de avaliar a atividade moduladora do PAF na produção de TNF induzida por agonistas de TLR2. Para isto, foram utilizados as lipoproteínas de Mycoplasma fermentans PG 18 (LAMPf), agonistas de TLR2/TLR6 e o Pam3Cys, um lipopeptídeo sintético agonista de TLR2/TLR1. Culturas de sangue total periférico humano foram ativadas com os agonistas de TLR2 ou TLR4 e o TNF foi avaliado nos sobrenadantes, por meio do ELISA. Para avaliar os efeitos do PAF endógeno na produção do TNF, foi utilizado o antagonista do receptor do PAF (PAFR), o WEB2170, e para avaliar o efeito do PAF exógeno, o PAF foi adicionado às hemoculturas. As hemoculturas também foram ativadas com bactérias inteiras (S. aureus ou E. coli) inativadas pelo calor. A expressão de TLR2 em polimorfonucleares (PMN) e monócitos foi avaliada por citometria de fluxo, analisando a celularidade total para os PMN e as células CD14+, para os monócitos. As LAMPf, Pam3Cys ou LPS induziram TNF nas hemoculturas. O tratamento com WEB2170 aumentou a produção de TNF nas hemoculturas estimuladas com agonistas de TLR2, mas não de TLR4. A pré-estimulação das hemoculturas com o PAF aumentou a produção de TNF induzida pelos agonistas de TLR2. A adição de PAF não causou alterações significantes na produção de TNF induzida pelo LPS. Nos ensaios com as bactérias inteiras, E. coli induziu maiores concentrações de TNF do que S. aureus. O tratamento com WEB2170 das hemoculturas estimuladas com S. aureus reduziu a produção de TNF, no entanto, a adição de PAF não alterou significantemente a produção de TNF nas hemoculturas estimuladas com as bactérias. Para E. coli, nem o tratamento com WEB2170, nem com o PAF alterou significantemente a produção de TNF. Os resultados indicam que o PAF pode aumentar ou diminuir a produção de TNF induzida por agonista de TLR2, dependendo do momento em que ele ativa o PAFR em relação à ativação do TLR2. O aumento da produção de TNF após prolongada pré-ativação das hemoculturas com o PAF não foi devido a um aumento na expressão de TLR2. Assim, é sugerido que a interação entre as vias bioquímicas de sinalização do PAFR e do TLR2 determina o nível de produção de TNF. A via de sinalização TLR2/PAF/TNF pode ser importante na imunidade inata contra infecções causadas por bactérias Gram positivas tão bem quanto em doenças inflamatórias.

No description available.

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<p>The gastrointestinal mucus gel layer and blood flow are two important mechanisms for protection at the pre-epithelial and sub-epithelial levels, respectively. <i>Helicobacter pylori</i> might circumvent these mechanisms and elicit a chronic inflammatory response with consequent ulcers in the stomach and duodenum. In this thesis, the physical state and properties of the adherent mucus gel layer was studied from the stomach to colon. Furthermore, the acute and chronic effects of <i>H. pylori</i> on the integrity of the mucus gel layer and mucosal blood flow were studied in the anesthetized rat.</p><p>A translucent mucus gel covers all studied segments of the gastrointestinal tract during fasting conditions, with the thickest layers in the colon and ileum. Carefully applied suction revealed that the mucus gel was a multi-layered structure comprising a firmly adherent layer covering the mucosa, impossible to remove, and a loosely adherent upper layer. The firmly adherent layer was thick and continuous in the corpus (80μm), antrum (154μm) and colon (116μm), but thin (<20μm) and discontinuous in the small intestine.</p><p>Following mucus removal, a rapid renewal of the loosely adherent layer ensued. The highest rate was observed in the colon with intermediate values in the small intestine. Mucus renewal in the stomach was attenuated on acute luminal application of water extracts from <i>H. pylori</i> (HPE). In animals with a chronic <i>H. pylori</i> infection the mucus renewal rate was unaffected, but the total gastric mucus gel thickness was reduced and the mucus secretory response to luminal acid (pH1) attenuated in the antrum. </p><p>HPE from type I strains acutely reduced corporal mucosal blood flow, measured with laser-Doppler flowmetry, by approximately 15%. The reduction in blood flow was mediated by a heat stable factor other than VacA and CagA. Inhibition of endogenous nitric oxide production with Nω-nitro-l-arginine augmented the decrease. However, ketotifen, a mast cell stabilizer, completely attenuated the effect of the extract as did the platelet activating factor (PAF) receptor-antagonist, WEB2086, thus depicting a detrimental role for the microvascular actions of PAF.</p>

The gastrointestinal mucus gel layer and blood flow are two important mechanisms for protection at the pre-epithelial and sub-epithelial levels, respectively. Helicobacter pylori might circumvent these mechanisms and elicit a chronic inflammatory response with consequent ulcers in the stomach and duodenum. In this thesis, the physical state and properties of the adherent mucus gel layer was studied from the stomach to colon. Furthermore, the acute and chronic effects of H. pylori on the integrity of the mucus gel layer and mucosal blood flow were studied in the anesthetized rat. A translucent mucus gel covers all studied segments of the gastrointestinal tract during fasting conditions, with the thickest layers in the colon and ileum. Carefully applied suction revealed that the mucus gel was a multi-layered structure comprising a firmly adherent layer covering the mucosa, impossible to remove, and a loosely adherent upper layer. The firmly adherent layer was thick and continuous in the corpus (80μm), antrum (154μm) and colon (116μm), but thin (&lt;20μm) and discontinuous in the small intestine. Following mucus removal, a rapid renewal of the loosely adherent layer ensued. The highest rate was observed in the colon with intermediate values in the small intestine. Mucus renewal in the stomach was attenuated on acute luminal application of water extracts from H. pylori (HPE). In animals with a chronic H. pylori infection the mucus renewal rate was unaffected, but the total gastric mucus gel thickness was reduced and the mucus secretory response to luminal acid (pH1) attenuated in the antrum. HPE from type I strains acutely reduced corporal mucosal blood flow, measured with laser-Doppler flowmetry, by approximately 15%. The reduction in blood flow was mediated by a heat stable factor other than VacA and CagA. Inhibition of endogenous nitric oxide production with Nω-nitro-l-arginine augmented the decrease. However, ketotifen, a mast cell stabilizer, completely attenuated the effect of the extract as did the platelet activating factor (PAF) receptor-antagonist, WEB2086, thus depicting a detrimental role for the microvascular actions of PAF.

Pseudomonas aeruginosa é um importante agente de pneumonia, particularmente em pacientes submetidos à ventilação mecânica, que pode evoluir para sepse, com elevadas taxas de letalidade. Na sepse, o processo inflamatório sistêmico exacerbado favorece o desequilíbrio entre as vias de coagulação e fibrinólise e a instalação de um estado pró-coagulante, com o aparecimento de trombose microvascular, coagulação intravascular disseminada e falência de múltiplos órgãos. Conhecendo a potente atividade pró-inflamatória da toxina ExoU produzida por P. aeruginosa, decorrente de sua atividade fosfolipásica A2, o objetivo desta tese foi investigar seu potencial de indução de alterações hemostáticas relacionadas à patogênese da sepse. Utilizando modelo de sepse em camundongos inoculados, por via intratraqueal, com suspensões de P. aeruginosa produtora de ExoU (PA103) ou de cepa com deleção do gene exoU, não produtora da toxina, foi mostrado que ExoU determinou maior gravidade da infecção, maior taxa de letalidade, leucopenia, trombocitose, hiperpermeabilidade vascular e transudação plasmática, evidenciadas, respectivamente, pela maior concentração de proteínas nos lavados broncoalveolares (LBAs) e acúmulo do corante Azul de Evans, previamente inoculado nos animais, por via endovenosa, no parênquima renal. ExoU favoreceu, também, a ativação plaquetária, confirmada pela maior concentração de plaquetas expressando P-selectina em sua superfície, maior número de micropartículas derivadas de plaquetas e maior concentração plasmática de tromboxano A2. A histopatologia dos pulmões e rins dos animais infectados com PA103 confirmou a formação de microtrombos, que não foram detectados nos animais controles ou infectados com a cepa mutante. Nos pulmões, a produção de ExoU determinou intensa resposta inflamatória com maior concentração de leucócitos totais e polimorfonucleados, interleucina-6 e fator de necrose tumoral-&#945; nos LBAs. A análise imunohistoquímica mostrou intensa deposição de fibrina nos alvéolos e septos interalveolares. A atividade pró-coagulante dependente do fator tissular detectada nos LBAs dos camundongos infectados com PA103 foi independente da produção do inibidor da via de ativação do fator tissular (TFPI), mas associada ao aumento da produção do inibidor do ativador do plasminogênio-1 (PAI-1). Para investigar a participação do fator de ativação plaquetária (PAF) na liberação de PAI-1, foi pesquisada a atividade da enzima PAF-acetil-hidrolase (PAF-AH) nos LBAs dos camundongos. A atividade de PAF-AH apresentou-se significativamente elevada nos LBA dos camundongos infectados com PA103. O tratamento dos animais com um inibidor do PAF, antes da infecção, resultou na diminuição significativa das concentrações de PAI-1 e de leucócitos totais, bem como da atividade pró-coagulante dos LBAs. In vitro, ExoU induziu maior expressão do RNA mensageiro de PAI-1 e maior liberação da proteína PAI-1 nos sobrenadantes de células epiteliais respiratórias da linhagem A549. O tratamento das células A549 com um anticorpo anti-receptor de PAF, antes da infecção, reduziu significativamente a concentração de PAI-1 nos sobrenadantes de células infectadas com a cepa selvagem. Estes resultados demonstraram um novo mecanismo de virulência de P. aeruginosa através da atividade pró-trombótica de ExoU e a possibilidade de utilização da identificação de ExoU em isolados clínicos de pacientes graves como um marcador prognóstico para estes pacientes. / Pseudomonas aeruginosa is an important agent of pneumonia, mainly in patients undergoing mechanical ventilation, which can progress to sepsis with high mortality rates. In sepsis, the systemic inflammatory process favors exacerbated imbalance between the coagulation and fibrinolysis pathways and the installation of a procoagulant state, leading to microvascular thrombosis, disseminated intravascular coagulation and multiple organ failure. Knowing the powerful proinflammatory activity of the P. aeruginosa toxin ExoU, secondary to its phospholipase A2 activity, the goal of this study was to investigate the ExoU potential to induce hemostatic changes related to sepsis pathogenesis. By using a murine model of pneumosepsis, obtained by the intratracheal injection of suspensions of the ExoU-producing PA103 P. aeruginosa strain or of its isogenic mutant PA103&#916;exoU, defective in the toxin synthesis, ExoU was shown to enhance the severity of the infection and to induce higher mice mortality rate as well as leukopenia, thrombocytosis, vascular hyperpermeability and plasma transudation, evidenced, respectively, by the higher protein concentration in the bronchoalveolar lavage fluids (BALF) and accumulation of Evans blue dye, previously intravenous injectioned, in mice renal parenchyma. ExoU also favored platelet activation, evidenced by the higher concentration of platelets expressing P-selectin on their surface, greater number of platelet-derived microparticles and increased plasma concentration of thromboxane A2. Histopathology of the lungs and kidneys of PA103-infected animals confirmed the formation of microthrombi, which were not detected in controls or in animals infected with the bacterial mutant. In lungs, ExoU induced an intense inflammatory response with high concentrations of total and polymorphonuclear leukocytes, interleukin-6 and tumor necrosis factor-&#945; in mice BALF. Immunohistochemical analysis showed intense fibrin deposition in the alveoli and interalveolar septa. The tissue factor-dependent procoagulant activity detected in BALF from PA103-infected mice did not depend on decreased production of tissue factor pathway inhibitor (TFPI) production, but was associated with increased concentration of plasminogen activator inhibitor-1 (PAI-1). To investigate the role of platelet activating factor (PAF) in PAI-1 release, we compared the activity of the enzyme PAF-acetylhydrolase (PAF-AH) in BALF from control and infected mice, and we observed that PAF-AH activity was significantly elevated in BALF from PA103-infected animals. Mice treatment with a PAF inhibitor prior to infection resulted in a significant reduction of PAI-1 concentration, as well as of BALF total leukocytes and procoagulant activity. In vitro, ExoU induced higher expression of PAI-1 m RNA and increased release of PAI-1 protein in supernatants from A549 epithelial respiratory cell cultures. A549 cell treatment with an anti-PAF receptor prior to infection significantly reduced PAI-1 concentration in supernatants from cells infected with the wild type strain. These results show a novel mechanism by which a baterial product can favor a prothrombotic activity and ExoU production by infecting P. aeruginosa isolates may have prognostic implications for patients.

Pseudomonas aeruginosa é um importante agente de pneumonia, particularmente em pacientes submetidos à ventilação mecânica, que pode evoluir para sepse, com elevadas taxas de letalidade. Na sepse, o processo inflamatório sistêmico exacerbado favorece o desequilíbrio entre as vias de coagulação e fibrinólise e a instalação de um estado pró-coagulante, com o aparecimento de trombose microvascular, coagulação intravascular disseminada e falência de múltiplos órgãos. Conhecendo a potente atividade pró-inflamatória da toxina ExoU produzida por P. aeruginosa, decorrente de sua atividade fosfolipásica A2, o objetivo desta tese foi investigar seu potencial de indução de alterações hemostáticas relacionadas à patogênese da sepse. Utilizando modelo de sepse em camundongos inoculados, por via intratraqueal, com suspensões de P. aeruginosa produtora de ExoU (PA103) ou de cepa com deleção do gene exoU, não produtora da toxina, foi mostrado que ExoU determinou maior gravidade da infecção, maior taxa de letalidade, leucopenia, trombocitose, hiperpermeabilidade vascular e transudação plasmática, evidenciadas, respectivamente, pela maior concentração de proteínas nos lavados broncoalveolares (LBAs) e acúmulo do corante Azul de Evans, previamente inoculado nos animais, por via endovenosa, no parênquima renal. ExoU favoreceu, também, a ativação plaquetária, confirmada pela maior concentração de plaquetas expressando P-selectina em sua superfície, maior número de micropartículas derivadas de plaquetas e maior concentração plasmática de tromboxano A2. A histopatologia dos pulmões e rins dos animais infectados com PA103 confirmou a formação de microtrombos, que não foram detectados nos animais controles ou infectados com a cepa mutante. Nos pulmões, a produção de ExoU determinou intensa resposta inflamatória com maior concentração de leucócitos totais e polimorfonucleados, interleucina-6 e fator de necrose tumoral-&#945; nos LBAs. A análise imunohistoquímica mostrou intensa deposição de fibrina nos alvéolos e septos interalveolares. A atividade pró-coagulante dependente do fator tissular detectada nos LBAs dos camundongos infectados com PA103 foi independente da produção do inibidor da via de ativação do fator tissular (TFPI), mas associada ao aumento da produção do inibidor do ativador do plasminogênio-1 (PAI-1). Para investigar a participação do fator de ativação plaquetária (PAF) na liberação de PAI-1, foi pesquisada a atividade da enzima PAF-acetil-hidrolase (PAF-AH) nos LBAs dos camundongos. A atividade de PAF-AH apresentou-se significativamente elevada nos LBA dos camundongos infectados com PA103. O tratamento dos animais com um inibidor do PAF, antes da infecção, resultou na diminuição significativa das concentrações de PAI-1 e de leucócitos totais, bem como da atividade pró-coagulante dos LBAs. In vitro, ExoU induziu maior expressão do RNA mensageiro de PAI-1 e maior liberação da proteína PAI-1 nos sobrenadantes de células epiteliais respiratórias da linhagem A549. O tratamento das células A549 com um anticorpo anti-receptor de PAF, antes da infecção, reduziu significativamente a concentração de PAI-1 nos sobrenadantes de células infectadas com a cepa selvagem. Estes resultados demonstraram um novo mecanismo de virulência de P. aeruginosa através da atividade pró-trombótica de ExoU e a possibilidade de utilização da identificação de ExoU em isolados clínicos de pacientes graves como um marcador prognóstico para estes pacientes. / Pseudomonas aeruginosa is an important agent of pneumonia, mainly in patients undergoing mechanical ventilation, which can progress to sepsis with high mortality rates. In sepsis, the systemic inflammatory process favors exacerbated imbalance between the coagulation and fibrinolysis pathways and the installation of a procoagulant state, leading to microvascular thrombosis, disseminated intravascular coagulation and multiple organ failure. Knowing the powerful proinflammatory activity of the P. aeruginosa toxin ExoU, secondary to its phospholipase A2 activity, the goal of this study was to investigate the ExoU potential to induce hemostatic changes related to sepsis pathogenesis. By using a murine model of pneumosepsis, obtained by the intratracheal injection of suspensions of the ExoU-producing PA103 P. aeruginosa strain or of its isogenic mutant PA103&#916;exoU, defective in the toxin synthesis, ExoU was shown to enhance the severity of the infection and to induce higher mice mortality rate as well as leukopenia, thrombocytosis, vascular hyperpermeability and plasma transudation, evidenced, respectively, by the higher protein concentration in the bronchoalveolar lavage fluids (BALF) and accumulation of Evans blue dye, previously intravenous injectioned, in mice renal parenchyma. ExoU also favored platelet activation, evidenced by the higher concentration of platelets expressing P-selectin on their surface, greater number of platelet-derived microparticles and increased plasma concentration of thromboxane A2. Histopathology of the lungs and kidneys of PA103-infected animals confirmed the formation of microthrombi, which were not detected in controls or in animals infected with the bacterial mutant. In lungs, ExoU induced an intense inflammatory response with high concentrations of total and polymorphonuclear leukocytes, interleukin-6 and tumor necrosis factor-&#945; in mice BALF. Immunohistochemical analysis showed intense fibrin deposition in the alveoli and interalveolar septa. The tissue factor-dependent procoagulant activity detected in BALF from PA103-infected mice did not depend on decreased production of tissue factor pathway inhibitor (TFPI) production, but was associated with increased concentration of plasminogen activator inhibitor-1 (PAI-1). To investigate the role of platelet activating factor (PAF) in PAI-1 release, we compared the activity of the enzyme PAF-acetylhydrolase (PAF-AH) in BALF from control and infected mice, and we observed that PAF-AH activity was significantly elevated in BALF from PA103-infected animals. Mice treatment with a PAF inhibitor prior to infection resulted in a significant reduction of PAI-1 concentration, as well as of BALF total leukocytes and procoagulant activity. In vitro, ExoU induced higher expression of PAI-1 m RNA and increased release of PAI-1 protein in supernatants from A549 epithelial respiratory cell cultures. A549 cell treatment with an anti-PAF receptor prior to infection significantly reduced PAI-1 concentration in supernatants from cells infected with the wild type strain. These results show a novel mechanism by which a baterial product can favor a prothrombotic activity and ExoU production by infecting P. aeruginosa isolates may have prognostic implications for patients.

La phospholipase A2 liée aux lipoprotéines (Lp-PLA2) est une biomarqueur de plusieurs maladies inflammatoires et une niveau sérique élevé est associé à l’instabilité de la plaque artérioscléreuse. Comme son nom l’indique, la Lp-PLA2 est liée aux lipoprotéines plasmatiques (LDL et HDL) et son rôle est de prévenir l’accumulation de phospholipides oxidés a la surface des lipoprotéines. Toutefois, les produits de dégradation des phospholipides oxidés par la Lp-PLA2 - le lysophosphatidyl choline par les acides gras oxidés peuvent aussi promouvoir l’inflammation. Mieux comprendre le métabolisme de la Lp-PLA2 pourrait nous permettre de mieux apprécier son rôle dans la formation d’une plaque artérioscléreuse instable, car des études antérieures ont démontré une forte expression de la Lp-PLA2 dans la plaque. De plus, il existe une forte corrélation entre les niveaux et l’activité plasmatiques de la Lp-PLA2 et la maladie coronarienne, les accidents cérébraux-vasculaires et la mortalité cardiaque. L’inhibition de la Lp-PLA2 avec une petite molécule, le darapladib, n’a pas démontré de bénéfice sur les évènements cardiovasculaires dans deux études cliniques. Cette thèse présentera d’abord une revue de la littérature sur la Lp-PLA2 et les maladies cardiovasculaires et les deuxième et troisième chapitres, une étude clinique réalisée sur des patients avec un syndrome coronarien aigu. / Lipoprotein associated phospholipase A2 (Lp-PLA2) is a biomarker of several inflammatory diseases and syndromes. An elevated Lp-PLA2 level is associated with unstable atherosclerotic plaques. Bound to plasma lipoproteins (LDL and HDL), Lp-PLA2 prevents the formation of biologically active oxidized phospholipids on their surface such as oxidized phosphatidylcholine (oxPC). Nevertheless, the products of Lp-PLA2 action, lysophosphatidylcholine (LPC) and non-esterified fatty acids (NEFA) are both known to aggravate inflammation. Thus, understanding the metabolism of Lp-PLA2 could help us better understand its role in plaque formation, as studies have shown high expression of Lp-PLA2 and LPCs in unstable plaques. Moreover, studies showed correlation between increased Lp-PLA2 mass and activity and increased risk of coronary artery disease, stroke, and death. The inhibition of Lp-PLA2 with a small molecule, Darapladib, has not demonstrated benefit in reduction of cardiovascular events in two clinical studies. Here, the first chapter will focus on Lp-PLA2 and cardiovascular disease in man, highlighting the latest updates in the literature. The second and third chapters will introduce experimental work on Lp-PLA2 in the setting of acute coronary syndrome.