La transplantation d’hépatocytes est une nouvelle approche thérapeutique pour le traitement des maladies métaboliques. Elle peut être proposée en alternative à la transplantation de foie entier ou, à tout le moins, en attente de celle-ci chez les patients instables, à risque de décompensation métabolique. Les essais cliniques effectués chez 9 patients aux cliniques St Luc ainsi que ceux publiés dans la littérature démontrent l’intérêt de la transplantation de cellules hépatiques à court et moyen terme. La qualité de la suspension cellulaire transplantée reste le premier facteur limitant pour le développement clinique de la technique. La cryopréservation reste le moyen le plus approprié pour la conservation à long terme des cellules. Elle permet de constituer une banque de cellules pouvant être utilisées à tout moment. Nous avons d’abord analysé les protocoles de cryopréservation décrits dans la litérature, ainsi que leurs limites tant au niveau de la préservation de la qualité cellulaire après décongélation in vitro qu’après transplantation in vivo. Dans ce travail, nous avons démontré l’intérêt d’utiliser des cellules cryopréservées/décongelées, afin de stabiliser des patients atteints de maladies du cycle de l’urée, avant la greffe de foie entier. Les tests de contrôle de qualité effectués sur ces cellules ont cependant montré une altération aux niveaux biochimique et cellulaire, après décongélation. Nous avons ainsi démontré une chute des concentrations intracellulaires d’ATP, signe d’une atteinte mitochondriale. Nos travaux ont également permis de mettre en évidence une diminution de la consommation d’oxygène des hépatocytes en suspension, due plus particulièrement à une atteinte du complexe 1 de la chaîne respiratoire. Cette atteinte mitochondriale peut déjà être observée après l’incubation de la suspension cellulaire à –20°C. Aux alentours de cette température critique se fait le passage de l’état aqueux à l’état cristallin suggérant que les dégâts mitochondriaux observés sont dès lors vraisembablement dus à la formation de glace intracellulaire durant le processus de cryopréservation ou de décongélation. Diverses tentatives visant à améliorer les paramètres mitochondriaux affectés par le processus de congélation/décongélation par l’addition d’agents protecteurs du complexe 1 (Bilobalide), d’ inhibiteurs du pore de transition de perméabilité (Ciclosporine A), d’ anti-oxydants ou encore de solutions hyperosmotiques à la solution de cryopréservation, n’ont pas permis d’améliorer la qualité cellulaire. Le tri de sous-types de populations hépatocytaires ou l’isolement de foies hépatectomisés n’ont pas permis de révéler de différences de capacité de résistance à la cryopréservation. Toujours dans le but d’améliorer le rendement de la transplantation d’hépatocytes et d’augmenter l’efficacité d’implantation dans le parenchyme receveur, nous avons démontré dans la deuxième partie de la thèse la capacité des hépatocytes isolés (fraîchement isolés ou cryopréservés/décongelés) à induire un phénomène de coagulation dépendant du facteur tissulaire. Cette activité pro-coagulante, inhibée in vitro par lea N-acetyl-L-cystéine, pourrait être le point de départ d’une réaction inflammatoire aspécifique influençant ainsi la réussite de la transplantation cellulaire. En conclusion, nous proposons dans ce travail différentes stratégies en vue de l’amélioration du rendement de la thérapie cellulaire. La vitrification, autre technique de cryopréservation, permettrait d’éviter la formation d’eau intracellulaire. Enfin la modulation de l’activité pro-coagulante par la N-acetyl-L-cystéine, due à la transplantation cellulaire, constitue une piste intéressante pour essayer d’améliorer l’implantation des cellules transplantées et ainsi le rendement de la greffe. / Liver cell transplantation provides clinical benefit to patients with congenital metabolic abnormalities and currently represents an alternative to orthotopic liver transplantation or at least an interim measure for unstable patients awaiting transplantation. Our team and others have already demonstrated that transplanted hepatocytes can achieve metabolic control in the short or medium term. The quality of transplanted cells remains the first limiting factor for the success of liver cell transplantation. Because the use of freshly isolated cells is restricted by contemporary organ donation, cryopreservation remains necessary for long-term storage and permanent availability of the cells. In this thesis, we have first reviewed and discussed established hepatocyte cryopreservation protocols, especially the cooling procedure, and have focussed on the in vitro and in vivo assays used for the evaluation of post-thawing hepatocyte quality. Amongst 9 cell transplanted patients in our center, several received exclusively or predominantly cryopreserved/thawed hepatocytes. We demonstrated post-transplantation benefits of using these cells in control patients with congentital abnormalities in the urea cycle, particularly with respect to clear evidence of cell engraftment and de novo appearance of enzyme activity. However, despite these clinical benefits, we found an in vitro relationship between the low post-thawing quality of cryopreserved /thawed hepatocytes and an alteration in their mitochondrial function. This post-thawing mitochondrial damage was already evident after the first −20°C cryopreservation step of our protocol, suggesting it occurrs early in the process, around the nucleation point, by intracellular ice formation. Cellular impairment could therefore be possibly explained by mechanical alteration of mitochondria due to water crystallisation during the cryopreservation process or thawing procedure. We also observed a poor efficacy of cryopreserved/thawed hepatocytes (as compared to freshly isolated cells) when used liver engraftment in two mice transplantation models. The marked reductions in intracellular ATP concentrations and the decreases in oxygen consumption by hepatocytes were therefore used as markers for the evaluation of the effects of several compounds such as bilobalide, hyperosmotic or anti-oxidant molecules, pore transition permeability inhibitors, and for the evaluation of the resistance of selected hepatocyte subtypes to cryopreservation protocols. We also demonstrated that isolated hepatocytes exert tissue factor-dependent pro-coagulant activity, which may contribute to the early loss of infused cells. We observed that the addition of N-acetyl-L-cysteine to hepatocyte suspensions inhibits coagulation activation. In conclusion, this work has identified several ways to improve the clinical benefit of liver cell transplantation, including new cryopreservation strategies, such as vitrification. In addition, modulation of the pro-coagulant activity induced by cell infusion with N-acetyl-L-cysteine might beneficially enhance cell engraftment.

Introduction: Cancer associated thrombosis is a well-recognized phenomenon that results in considerable patient morbidity and mortality. Malignancy conveys an increased risk for thrombosis and chemotherapy further elevates this risk. The pathophysiological mechanisms underlying this process remain poorly defined. Materials and Methods: A human acute monocytic leukemia cell line (THP-1) was treated with commonly used anthracycline chemotherapeutics at concentrations similar to those found in the plasma of cancer patients. Cells were analyzed for tissue factor (TF) mRNA, protein, and activity. Microparticle (MP) TF activity was also measured. Phosphatidylserine (PS) exposure on cells and MPs was analyzed by flow cytometry. PS levels on MPs was also evaluated in an annexin V capture assay. Results: Anthracycline treatment of THP-1 cells resulted in a concentration-dependent increase in cellular TF activity without a change in TF protein, which was associated with increased PS exposure on the cell surface and apoptosis. The increase in TF activity was abolished by annexin V or lactadherin indicating that PS exposure was required. Anthracycline treatment of THP-1 cells also increased the number of TF-positive MPs. Conclusion: Treatment of THP-1 cells with anthracyclines induces apoptosis and increases cellular TF activity. The increased activity required an increase in exposure of PS. Additionally, anthracyclines increase the release of TF-positive MPs from THP-1 cells. We propose that the increase in cellular TF activity in circulating leukemic cells, combined with increased numbers of TF-positive MPs, may contribute to thrombosis in cancer patients receiving chemotherapy.

Optimal induction of coronary thrombolysis depends in part upon the nature of the specific plasminogen activator used. The two general classes of plasminogen activators available clinically differ in a fundamental respect delineated by the term, clot selectivity. Clot selective agents are less prone to induce plasminemia and consequent occult activation of the coagulation cascade than are non-selective agents. However, under clinical conditions, all plasminogen activators result in some activation of the cascade with consequent generation of thrombin. Accordingly, optimal therapy requires the use of conjunctive anticoagulation to preclude the deleterious effects of rebound generation of thrombin, which has been well documented biochemically. The potential value of antiplatelet agents that can attenuate the positive feedback loop between activation of platelets and markedly amplified generation of thrombin in the setting of coronary thrombolysis is under active exploration. With appropriate monitoring of the efficacy of such agents in vivo it should be possible to enhance even further the benefits that can be conferred by pharmacologically induced coronary thrombolysis.

Platelet-derived microparticles, released as a result of platelet activation, promote coagulation through the surface exposure of phosphatidylserine, acting as the catalytic site for the conversion of prothrombin to thrombin by the activated coagulation factors X and V. Although elevated numbers of circulating platelet-derived microparticles can be detected in a number of clinical disorders, the methods for the detection of these microparticles are far from standardised. In addition, recent reports have also speculated that not all microparticles may expose phosphatidylserine, demonstrating that the binding of Annexin V, a phosphatidylserine-specific binding protein, is not detectable on a population of microparticles. The initial stage of this thesis was to establish a flow cytometric method for the detection and enumeration of microparticles based on their capacity to bind Annexin V and to utilise this assay to investigate a number of the issues that have limited assay standardisation. The assay could be performed on either stimulated or unstimulated plasma or whole blood samples. Interestingly, plasma microparticle counts were significantly higher than whole blood microparticle counts. The effects of centrifugation alone could not be attributed as the sole source of this discrepancy. The antigenic characteristics of platelet-derived microparticles were also investigated, with platelet-derived microparticles demonstrated to express the platelet glycoproteins CD31, CD41a, CD42a and CD61. Platelet-derived microparticles also expressed CD42b, and this expression was significantly decreased when compared to their progenitor platelets. The expression of the platelet activation markers CD62p, CD63, CD40L and PAC-1 was dependent upon the sample milieu, suggesting that the centrifugation conditions required to generate platelet-poor plasma may lead to artefactual increases in the expression of platelet activation markers. An investigation of the role of the GpIIb/IIIa complex on the formation of platelet-derived microparticles was also performed. A monoclonal antibody to the GpIIb/IIIa complex (Abciximab) significantly inhibited in vitro collagen-stimulated platelet-derived microparticle formation. Interestingly, platelets obtained from two subjects with impaired GpIIb/IIIa activation, demonstrated normal microparticle formation following collagen stimulation, suggesting that the presence of GpIIb/IIIa complex, but not its activation, is required for collagen-induced microparticle formation. A novel mechanism for microparticle formation was also investigated, with platelet-derived microparticles demonstrated to form in response to the sclerosing agents sodium-tetradecyl sulphate and polidocanol. Interestingly, the removal of plasma proteins by the washing of platelets left platelets more susceptible to sclerosant-induced microparticle formation, suggesting that plasma proteins may protect platelets from microparticle formation. The procoagulant activity of platelet-derived microparticles was also investigated using a novel coagulation assay (XACT) specific for the procoagulant phospholipid. An evaluation of this assay demonstrated a significant correlation between Annexin V binding microparticle counts and procoagulant activity in both whole blood and plasma samples. There was more procoagulant activity in whole blood samples than in plasma samples, suggesting that the procoagulant phospholipid activity was also associated with erythrocytes or leukocytes. To further investigate this phenomenon, a whole blood flow cytometric assay was developed to assess Annexin V binding to erythrocytes, leukocytes, platelets and microparticles. This assay demonstrated that a large proportion of Annexin V binding (51.0%) was associated with erythrocytes. Interestingly, a proportion of the Annexin V binding erythrocytes (24.5%) and leukocytes (78.8%) were also associated with platelet CD61 antigen, suggesting that they also bound a platelet or platelet-derived microparticle. The effect of sample anticoagulant on microparticle procoagulant activity was investigated. Microparticle counts were most stable in EDTA anticoagulated samples, but were stable in sodium citrate for up to 15 minutes following sample collection. The procoagulant activity of microparticles was significantly inhibited by EDTA in collagen-stimulated platelet-rich plasma samples, when compared to sodium citrate anticoagulated samples. Although the initial method used to investigate microparticles was based upon their ability to bind Annexin V, it was consistently observed that a large proportion of events in the size region of a microparticle were Annexin V negative. An investigation was therefore commenced into the procoagulant activity of microparticles based on their capacity to bind Annexin V. The presence of Annexin V negative microparticles was confirmed by flow cytometry and the proportion of microparticles that bound Annexin V was dependent upon type of agonist used to stimulate microparticle formation. Varying the assay constituents (calcium concentration / Annexin V concentration / buffer type) did not alter the proportion of Annexin V binding microparticles. When compared to Annexin V positive microparticles, Annexin V negative microparticles expressed significantly higher levels of CD42b on their surface, but possessed significantly decreased expressions of CD62p, and CD63. A significant correlation between the percentage of Annexin V binding and XACT procoagulant activity was found (p=0.03). Furthermore, Annexin V binding inhibited greater than 98% of procoagulant phospholipid activity, suggesting that Annexin V binding was a true reflection of procoagulant activity. Microparticles could be sorted using either a flow cytometric or magnetic sorting strategy. By electron microscopy, Annexin V negative events isolated following magnetic sorting were vesicular structures and not small platelets or the remnants of activated platelets. In summary, this thesis has demonstrated the ability of the flow cytometer and XACT assays to detect microparticles and their procoagulant activity. It has also shown that the use of Annexin V to detect microparticles may warrant further investigation.

Platelet-derived microparticles, released as a result of platelet activation, promote coagulation through the surface exposure of phosphatidylserine, acting as the catalytic site for the conversion of prothrombin to thrombin by the activated coagulation factors X and V. Although elevated numbers of circulating platelet-derived microparticles can be detected in a number of clinical disorders, the methods for the detection of these microparticles are far from standardised. In addition, recent reports have also speculated that not all microparticles may expose phosphatidylserine, demonstrating that the binding of Annexin V, a phosphatidylserine-specific binding protein, is not detectable on a population of microparticles. The initial stage of this thesis was to establish a flow cytometric method for the detection and enumeration of microparticles based on their capacity to bind Annexin V and to utilise this assay to investigate a number of the issues that have limited assay standardisation. The assay could be performed on either stimulated or unstimulated plasma or whole blood samples. Interestingly, plasma microparticle counts were significantly higher than whole blood microparticle counts. The effects of centrifugation alone could not be attributed as the sole source of this discrepancy. The antigenic characteristics of platelet-derived microparticles were also investigated, with platelet-derived microparticles demonstrated to express the platelet glycoproteins CD31, CD41a, CD42a and CD61. Platelet-derived microparticles also expressed CD42b, and this expression was significantly decreased when compared to their progenitor platelets. The expression of the platelet activation markers CD62p, CD63, CD40L and PAC-1 was dependent upon the sample milieu, suggesting that the centrifugation conditions required to generate platelet-poor plasma may lead to artefactual increases in the expression of platelet activation markers. An investigation of the role of the GpIIb/IIIa complex on the formation of platelet-derived microparticles was also performed. A monoclonal antibody to the GpIIb/IIIa complex (Abciximab) significantly inhibited in vitro collagen-stimulated platelet-derived microparticle formation. Interestingly, platelets obtained from two subjects with impaired GpIIb/IIIa activation, demonstrated normal microparticle formation following collagen stimulation, suggesting that the presence of GpIIb/IIIa complex, but not its activation, is required for collagen-induced microparticle formation. A novel mechanism for microparticle formation was also investigated, with platelet-derived microparticles demonstrated to form in response to the sclerosing agents sodium-tetradecyl sulphate and polidocanol. Interestingly, the removal of plasma proteins by the washing of platelets left platelets more susceptible to sclerosant-induced microparticle formation, suggesting that plasma proteins may protect platelets from microparticle formation. The procoagulant activity of platelet-derived microparticles was also investigated using a novel coagulation assay (XACT) specific for the procoagulant phospholipid. An evaluation of this assay demonstrated a significant correlation between Annexin V binding microparticle counts and procoagulant activity in both whole blood and plasma samples. There was more procoagulant activity in whole blood samples than in plasma samples, suggesting that the procoagulant phospholipid activity was also associated with erythrocytes or leukocytes. To further investigate this phenomenon, a whole blood flow cytometric assay was developed to assess Annexin V binding to erythrocytes, leukocytes, platelets and microparticles. This assay demonstrated that a large proportion of Annexin V binding (51.0%) was associated with erythrocytes. Interestingly, a proportion of the Annexin V binding erythrocytes (24.5%) and leukocytes (78.8%) were also associated with platelet CD61 antigen, suggesting that they also bound a platelet or platelet-derived microparticle. The effect of sample anticoagulant on microparticle procoagulant activity was investigated. Microparticle counts were most stable in EDTA anticoagulated samples, but were stable in sodium citrate for up to 15 minutes following sample collection. The procoagulant activity of microparticles was significantly inhibited by EDTA in collagen-stimulated platelet-rich plasma samples, when compared to sodium citrate anticoagulated samples. Although the initial method used to investigate microparticles was based upon their ability to bind Annexin V, it was consistently observed that a large proportion of events in the size region of a microparticle were Annexin V negative. An investigation was therefore commenced into the procoagulant activity of microparticles based on their capacity to bind Annexin V. The presence of Annexin V negative microparticles was confirmed by flow cytometry and the proportion of microparticles that bound Annexin V was dependent upon type of agonist used to stimulate microparticle formation. Varying the assay constituents (calcium concentration / Annexin V concentration / buffer type) did not alter the proportion of Annexin V binding microparticles. When compared to Annexin V positive microparticles, Annexin V negative microparticles expressed significantly higher levels of CD42b on their surface, but possessed significantly decreased expressions of CD62p, and CD63. A significant correlation between the percentage of Annexin V binding and XACT procoagulant activity was found (p=0.03). Furthermore, Annexin V binding inhibited greater than 98% of procoagulant phospholipid activity, suggesting that Annexin V binding was a true reflection of procoagulant activity. Microparticles could be sorted using either a flow cytometric or magnetic sorting strategy. By electron microscopy, Annexin V negative events isolated following magnetic sorting were vesicular structures and not small platelets or the remnants of activated platelets. In summary, this thesis has demonstrated the ability of the flow cytometer and XACT assays to detect microparticles and their procoagulant activity. It has also shown that the use of Annexin V to detect microparticles may warrant further investigation.

Para avaliar a capacidade da toxina ExoU de P. aeruginosa de induzir a expressão do fator tissular (FT) por células epiteliais respiratórias da linhagem BEAS-2B, células infectadas pela cepa PA103, produtora da toxina, foram comparadas com outras infectadas por cepa mutante obtida por deleção do gene exoU e com células controles não infectadas quanto a i) expressão do mRNA do FT, por RT-PCR; ii) expressão da proteína FT em lisados celulares, por ensaio imunoenzimático (ELISA), e na superfície celular, por citometria de fluxo; iii) atividade pró-coagulante das células, pela determinação da capacidade de indução de coagulação de plasma humano normal e do lisado celular, através de ensaio colorimétrico; iv) presença de FT solúvel no sobrenadante das culturas, por ELISA; v) liberação de micropartículas expressando FT e fosfatidilserina (FS), por citometria de fluxo. Nossos resultados mostraram que ExoU foi responsável pelo aumento da expressão do mRNA e da concentração da glicoproteína FT tanto nos lisados quanto na superfície celular. Esse aumento foi revertido quando as bactérias foram tratadas com uma droga inibidora de PLA2 (MAFP), comprovando-se a dependência da atividade fosfolipásica A2 de ExoU para a modulação da expressão do FT. Células infectadas pela cepa PA103 induziram uma diminuição no tempo de coagulação do plasma humano normal e o aumento da hidrólise do substrato sintético utilizado no teste colorimétrico em comparação com as células infectadas com a cepa mutante, mostrando que o FT expresso era funcionalmente ativo. Foi também detectado um aumento na concentração de FT solúvel presente nos sobrenadantes de culturas infectadas por PA103 e no número de micropartículas expressando, simultaneamente, FT e FS em relação à cultura infectada pela cepa PA103∆exoU. Os resultados obtidos nos testes in vitro foram validados pela demonstração de que a concentração de FT no parênquima pulmonar de camundongos infectados, por via intratraqueal, com a cepa selvagem foi significativamente superior à detectada nos animais infectados com a cepa mutante. / To evaluate the capacity of the P. aeruginosa toxin ExoU to induce the expression of tissue factor (TF) by epithelial respiratory cells from the BEAS-2B cell line, cells infected with the ExoU-producing PA103 bacterial strain were compared with cells infected with a mutant obtained by deletion of the exoU gene and with control non-infected cells in their i) expression of the TF mRNA, by RT-PCR; ii) expression of the protein TF in cell lisates and surfaces, by enzyme immunoassay (ELISA) and flow cytometry, respectively; iii) procoagulant activity by determining the ability of intact cells to induce the coagulation of normal human plasma and the ability of cell lysates to cleave the synthetic substrate of a chromogenic assay; iv) presence of soluble TF in cell culture supernatants, by ELISA and v) release of microparticles simultaneously expressing TF and phosphatidylserine, by flow cytometry. Cells infected with the wild type bacteria exhibited increased expression of TF mRNA 1 hour after infection and a positive modulation of TF expression in both cell lysates and cell surfaces. The enhancement of TF expression was inhibited when cells were infected with bacteria previously treated with a PLA2 inhibitor (MAFP), confirming that the ability of ExoU to modulate TF expression depended on its phospholipase A2 activity. Newly expressed TF was shown to be functionally active, by both the decrease in the clotting time of human plasma and the enhancement of the hydrolysis of the chromogenic assay substrate. Cells infected with the ExoU-producing bacteria exhibited also higher concentrations of soluble TF and of TF and PS bearing microparticles in the cell culture supernatants. These in vitro results were validated by our finding of increase TF concentrations in the lung parenchyma of mice infected intratracheally with the ExoU producing-bacteria at 24 h post-infection.

Para avaliar a capacidade da toxina ExoU de P. aeruginosa de induzir a expressão do fator tissular (FT) por células epiteliais respiratórias da linhagem BEAS-2B, células infectadas pela cepa PA103, produtora da toxina, foram comparadas com outras infectadas por cepa mutante obtida por deleção do gene exoU e com células controles não infectadas quanto a i) expressão do mRNA do FT, por RT-PCR; ii) expressão da proteína FT em lisados celulares, por ensaio imunoenzimático (ELISA), e na superfície celular, por citometria de fluxo; iii) atividade pró-coagulante das células, pela determinação da capacidade de indução de coagulação de plasma humano normal e do lisado celular, através de ensaio colorimétrico; iv) presença de FT solúvel no sobrenadante das culturas, por ELISA; v) liberação de micropartículas expressando FT e fosfatidilserina (FS), por citometria de fluxo. Nossos resultados mostraram que ExoU foi responsável pelo aumento da expressão do mRNA e da concentração da glicoproteína FT tanto nos lisados quanto na superfície celular. Esse aumento foi revertido quando as bactérias foram tratadas com uma droga inibidora de PLA2 (MAFP), comprovando-se a dependência da atividade fosfolipásica A2 de ExoU para a modulação da expressão do FT. Células infectadas pela cepa PA103 induziram uma diminuição no tempo de coagulação do plasma humano normal e o aumento da hidrólise do substrato sintético utilizado no teste colorimétrico em comparação com as células infectadas com a cepa mutante, mostrando que o FT expresso era funcionalmente ativo. Foi também detectado um aumento na concentração de FT solúvel presente nos sobrenadantes de culturas infectadas por PA103 e no número de micropartículas expressando, simultaneamente, FT e FS em relação à cultura infectada pela cepa PA103∆exoU. Os resultados obtidos nos testes in vitro foram validados pela demonstração de que a concentração de FT no parênquima pulmonar de camundongos infectados, por via intratraqueal, com a cepa selvagem foi significativamente superior à detectada nos animais infectados com a cepa mutante. / To evaluate the capacity of the P. aeruginosa toxin ExoU to induce the expression of tissue factor (TF) by epithelial respiratory cells from the BEAS-2B cell line, cells infected with the ExoU-producing PA103 bacterial strain were compared with cells infected with a mutant obtained by deletion of the exoU gene and with control non-infected cells in their i) expression of the TF mRNA, by RT-PCR; ii) expression of the protein TF in cell lisates and surfaces, by enzyme immunoassay (ELISA) and flow cytometry, respectively; iii) procoagulant activity by determining the ability of intact cells to induce the coagulation of normal human plasma and the ability of cell lysates to cleave the synthetic substrate of a chromogenic assay; iv) presence of soluble TF in cell culture supernatants, by ELISA and v) release of microparticles simultaneously expressing TF and phosphatidylserine, by flow cytometry. Cells infected with the wild type bacteria exhibited increased expression of TF mRNA 1 hour after infection and a positive modulation of TF expression in both cell lysates and cell surfaces. The enhancement of TF expression was inhibited when cells were infected with bacteria previously treated with a PLA2 inhibitor (MAFP), confirming that the ability of ExoU to modulate TF expression depended on its phospholipase A2 activity. Newly expressed TF was shown to be functionally active, by both the decrease in the clotting time of human plasma and the enhancement of the hydrolysis of the chromogenic assay substrate. Cells infected with the ExoU-producing bacteria exhibited also higher concentrations of soluble TF and of TF and PS bearing microparticles in the cell culture supernatants. These in vitro results were validated by our finding of increase TF concentrations in the lung parenchyma of mice infected intratracheally with the ExoU producing-bacteria at 24 h post-infection.

Ce travail porte sur le rôle des microparticules procoagulantes (MPs) générées par les cellules vasculaires en réponse à un état septique. Après une introduction rappelant la structure et les propriétés des microparticules et la réponse del’hôte à un agent pathogène, en particulier en terme d’activation de la coagulation, nous rapportons nos travauxexpérimentaux et cliniques. Le premier travail a été réalisé sur un modèle cellulaire de vésiculation induite par le LPS. Il nous a permis de caractériser le transfert du complexe CD14/TLR4 à différents types cellulaires in-vitro dépourvus du récepteur au LPS. Ainsi, les MPs monocytaires pourraient avoir un rôle d’amplification de la réponse inflammatoire mais aussi dans la réponse anti-inflammatoire secondaire en participant à l’apoptose lymphocytaire. Le second travail aété réalisé chez l’animal. Après induction d’un choc septique, nous avons observé une amélioration hémodynamique enréponse à la perfusion de protéine C activée associée à une modulation du phénotype des MPs. Réinjectées à des ratsnaïfs, les MPs issues des rats septiques traités par protéine C activée développaient une moindre vasoplégie. Enfin, nous avons réalisé une étude prospective sur 100 patients en choc septique. Nous avons ainsi pu caractériser la présence d’une concentration élevée de microparticules procoagulantes, avec une variation phénotypique en présence de coagulation intravasculaire disséminée (CIVD) : réduction du contingent plaquettaire au profit des MPs d’origine leucocytaires qui deviennent prépondérantes et témoignent d’une activation leucocytaire accrue, et surtout une activation des cellules endothéliales avec génération de MPs porteuses d’endogline (CD105). En analyse multivariée,CD105+-MPs étaient fortement associée à la CIVD et pourraient constituer un marqueur précoce de l’atteinte endothéliale au cours du choc septique. / This work focused on procoagulant microparticles shed after vascular cells stress during sepsis. The first part gives an overview on MPs and host response during pathogen challenge. The first lab experimental work confirms direct and functional transfer of CD14/TLR4 LPS sensor by MPs shed to target cells after monocytic THP-1 challenge by LPS.CD14-MPs amplify LPS-induced apoptosis in monocytes but also prompted lymphocyte apoptosis and could play a role in secondary anti-inflammatory response. Then, septic shock was induced in rats after caecal ligature and puncture.Activated protein C (APC) infusion improved haemodynamic parameters and alter septic microparticular content. Infused in naïve rats, APC-treated MPs were associated with reduced hypotension and inflammatory response, confirming cytoprotective effect of both APC and APC-induced MPs. Finally, we performed a clinical prospective study in 3 medical ICU in France. Patients referred for septic shock had an increased level of circulating procoagulant MPs regardless disseminated intravascular coagulopathy (DIC) diagnosis. Nevertheless, DIC patients evidenced a specific pattern with lower platelet-MPs, increased leucocyte-MPs and specific endothelial cells activation with endoglin (CD105) shedding. In multiple logistic regression analysis, CD105-MPs were strongly associated with DIC and were evidenced before DIC diagnosis according to routine laboratory assays.

Distúrbios de hemostasia são uma das principais manifestações clínicas observadas nos acidentes por serpentes do gênero Bothrops. Tendo em vista a importância da ativação de fatores da cascata de coagulação no desenvolvimento da patologia no envenenamento, o presente trabalho descreve o isolamento e a caracterização bioquímica e funcional de uma metaloprotease capaz de induzir a ativação de fatores de coagulação, a partir da peçonha de Bothrops moojeni. A metaloprotease foi isolada por três etapas cromatográficas utilizando colunas de exclusão molecular (Sephacryl S-200), interação hidrofóbica (Phenyl Sepharose) e troca aniônica (ES 502N). A protease isolada, denominada moojenactivase, é uma glicoproteína com massa molecular de aproximadamente 89 kDa e ponto isoelétrico de 4,92, sendo composta por três cadeias com massas de 66; 17 e 14 kDa, ligadas por pontes dissulfeto. A determinação da sequência de aminoácidos por espectrometria de massas evidenciou grande identidade sequencial com outras metaloproteases, indicando a presença dos domínios metaloprotease, desintegrina-like e lectinas-like e classificando-a como uma protease da classe PIIId. Funcionalmente, a moojenactivase foi capaz de induzir a cogulação de plasma humano pela ativação dos fatores II (protrombina) e X da cascata de coagulação, gerando -trombina e fator X ativado, respectivamente. A protease apresentou atividade fibrinogenolítica, especialmente sobre a cadeia da molécula de fibrinogênio, porém não foi capaz de induzir a formação do coágulo de fibrina pela ativação deste. A moojenactivase foi parcialmente inibida quando incubada em condições de pH entre 3,5 e 5,0 e em pH 9,0, além de temperaturas acima de 60ºC, bem como na presença de ions Cu2+, além dos inibidores EDTA, SDS, DTT e soro anti-ofídico crotalico/botrópico. A protease induziu agregação plaquetária e não apresentou atividades fibrinolítica e hemorrágica. Células mononucleares de sangue periférico (PBMC) tratadas com a protease foram capazes de produzir TNF- assim como expressar fator tecidual (Fator III da coagulação) na forma ativa, fazendo com que essas células apresentassem caráter procoagulante. Com o objetivo avaliar os efeitos nos parâmetros hematológicos in vivo, a moojenactivase foi administrada em ratos (3g/Kg) onde foi observado que a protease foi capaz de prolongar o tempo de sangramento dos animais e induzir a diminuição do número de plaquetas sanguíneas, caracterizando um quadro de trombocitopenia. Ainda, o plasma dos animais administrados com a moojenactivase apresentaram valores elevados do tempo de protrombina e tempo de tromboplastina parcialmente ativada, assim como redução na concentração de fibrinogênio. Na análise dos parâmetros da série branca, foi observado aumento leucocitário na circulação, com predominância de neutrófilos até 3h após a administração, indicando a instalação de um quadro inflamatório. Com relação à análise da série vermelha, a moojenactivase não foi capaz de alterar nenhum dos parâmetros estudados. Os resultados obtidos no presente trabalho mostram, pela primeira vez, o isolamento de uma metaloprotease da classe P-IIId da peçonha de Bothrops moojeni capaz de atuar sobre diferentes ii eventos do processo hemostático, sendo essa ação prócoagulante responsável pelo quadro de incoagulabilidade sanguínea em animais. Os dados gerados podem auxiliar no entendimento dos distúrbios de coagulação em pacientes envolvidos em acidentes por serpentes da espécie Bothrops moojeni, levando ao melhor direcionamento na terapia anti-ofídica. Ainda, a função da moojenactivase sobre componentes biológicos credencia a molécula para uma possível aplicação biotecnológica em processos que envolvem o sistema hemostático. / Haemostasis disorders are a major clinical manifestation induced by Bothrops snake envenomations. Considering the relevance of the activation of coagulation factors during the envenomation pathophysiology, the present work describes, for the first time, the isolation and functional and biochemical characterization of a coagulation factor activator metalloprotease from Bothrops moojeni snake venom. The protease was purified by three chromatographic procedures using size exclusion (Sephacryl S-200), hydrophobic interaction (Phenyl Sepharose) and anion exchange (ES 502N) chromatographies. The isolated protease, named moojenactivase, is a glycoprotein with molecular mass of approximately 89 kDa by SDS-PAGE, and composed of 66 kDa, 17 kDa and 14 kDa disulfide linked chains, with pI of 4,92. The amino acid sequence determination of tryptic peptides from moojenactivase by mass spectrometry presented fragments with high identity to snake venom metalloproteases, confirming the presence of the metalloprotease, disintegrin-like and lectin-like domains, which allowed its classification as a PIIId class snake venom metalloprotease. Regarding its functional properties, the protease was capable to induce human plasma coagulation by inducing activation of coagulation factors II and X, forming-thrombin and factor X activated, respectively. Also, moojenactivase presented fibrinogenolitic activity, by cleaving preferentially -chain of fibrinogen, however was not capable to induce the formation of fibrin clot from fibrinogen. The enzyme stability was assessed and showed that moojenactivase presented a reduced functional activity when preincubated in pH values ranging from 3,5 to 5,0 and at pH 9,0, and in temperature conditions over 60ºC. Cu2+ ions and inhibitors such as EDTA, SDS, DTT and crotalic/bothropic antiophidian serum reduced the protease activity. Moojenactivase induced platelet aggregation, but no fibrinolytic and haemorrhage activities. In order to evaluate the stimulation of peripheral blood mononuclear cells (PBMC), cells were treated with the protease and we observed the release of proinflammatory cytokine TNF- and expression of active Tissue Factor (coagulant factor III), inducing a procoagulant state on PBMC. In order to evaluate in vivo haematological effects, the protease (3 g/Kg) was administered in rat (i.v.) and was observed that moojenactivase induced a prolonged bleeding time and reduced platelet counting (indicating a thrombocytopenia state). Moreover, the evaluation of the hemostasis parameters was assessed by the the prothrombin time and activated partial thromboplastin time assays and showed a prolonged clot time on both tests, and also a decrease in fibrinogen plasma levels. The leukogram analysis showed an increase in the circulating leukocyte number up to 3 hours after moojenactivase administration, composed predominantly of neutrophils. However, parameters envolving red cells shows that the protease do not affect. The results obtained in the present work show, for the first time, the isolation of a PIIId class metalloprotease from Bothrops moojeni snake venom involved on the activation of several hemostatic events, inducing a pro coagulant activity and leading to blood unclottable state in experimental animals. These data can assit in understanding coagulation disturbs in iv patients involved in Bothrops moojeni envenomation and leading to a better anti ophidic therapy guidance. Moreover, moojenactivase functional activities accredits this protease as a possible molecular instrument applied on biotechnological prospect related to the hemostasis.

Made available in DSpace on 2014-12-17T14:16:35Z (GMT). No. of bitstreams: 1 YamaraASM_DISSERT_Parcial.pdf: 1235608 bytes, checksum: 64be8e29311055ebff593313fa2f1681 (MD5) Previous issue date: 2013-07-04 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The extraction, chemical and structural characterization of a wide variety of compounds derived from plants has been a major source of bioactive molecules. Several proteases have been isolated in the plant kingdom, with numerous pharmacological and biotechnological applications. Among the proteases isolated from plants, are the fibrinogenolytic, with relevant application in the treatment of disorders in the coagulation cascade, in addition to potential use as a tool in clinical laboratories. In this study, in addition to evaluating the effects of the protein extract of Cnidoscolus urens (L.) Arthur (Euphorbiaceae) in the coagulation cascade also investigates the presence of antimicrobial activity and characterizes the proteolytic activity detected in this extract, aiming to determine their potential pharmacological and biotechnological application. In this way, crude protein extracts obtained from the leaves of C. urens in Tris-HCl 0.05M, NaCl 0.15M, pH 7.5, were precipitated in different concentrations of acetone, and assessed for the presence of proteolytic activity in azocase?na and fibrinogen. The most active fraction (F1.0) in these tests was chosen for assessment of biological activity and biochemical characterization. The A? chain and B? of fibrinogen were completely cleaved at a concentration of 0.18 ?g/?L of protein fraction in 4 minutes. Fibrinogenolytic activity presented total inhibition in the presence of E-64 and partial in the presence of EDTA. The fraction demonstrated coagulant activity in plasm and reduced the APTT, demonstrating acting on the factors coagulation of the intrinsic pathway and common, not exerting effects on the PT. Fibrinolytic activity on plasma clot was detected only in SDS-PAGE in high concentrations of fraction, and there were no defibrinating. Although several proteases isolated from plants and venomous animals are classically toxic, the fraction F1.0 of C. urens not expressed hemorrhagic nor hemolytic activities. Fraction F1.0 also showed no antimicrobial activity. In proteolytic activity on the azocasein, the optimal pH was 5.0 and optimum temperature of 60?C. The enzyme activity has been shown to be sensitive to the presence of salts tested, with inhibition for all compounds. The surfactant triton did not influence the enzyme activity, but the tween-20 and SDS inhibited the activity. In the presence of reducing agents increase in enzyme activity occurred, a typical feature of enzymes belonging to the class of cysteine proteases. Several bands with proteolytic activity were detected in zymogram, in the region of high-molecular-weight, which were inhibited by E-64. In this study, we found that C. urens presents in its constitution cysteine proteases with fibrinogenolytic and procoagulant activity, which may be isolated, with potential application in treatment of bleeding disorders, thrombolytic and clinical laboratory / A extra??o, caracteriza??o qu?mica e estrutural de uma grande diversidade de compostos derivados de plantas tem sido uma fonte importante de mol?culas bioativas. Diversas proteases t?m sido isoladas no reino vegetal, com in?meras aplica??es farmacol?gicas e biotecnol?gicas. Dentre as proteases isoladas de plantas, est?o as fibrinogenol?ticas, com relevante aplica??o no tratamento de dist?rbios na cascata da coagula??o, al?m do uso em potencial como ferramenta em laborat?rios cl?nicos. Neste trabalho, al?m de avaliar os efeitos do extrato prot?ico de Cnidoscolus urens (L.) Arthur, pertencente ? fam?lia Euphorbiaceae, na cascata de coagula??o, tamb?m se investigou a presen?a de atividade antimicrobiana e caracterizou a atividade proteol?tica detectada neste extrato, tendo como objetivo determinar sua potencial aplica??o farmacol?gica e biotecnol?gica. Desse modo, extratos prot?icos brutos obtidos das folhas de C. urens em tamp?o Tris-HCl 0,05M, NaCl 0,15M, pH 7,5, foram precipitados em diferentes concentra??es de acetona, e avaliados quanto a presen?a de atividade proteol?tica em azocase?na e fibrinog?nio. A fra??o mais ativa (F1.0) nestes testes foi escolhida para realiza??o de avalia??o de atividade biol?gica e caracteriza??o bioqu?mica. As cadeias A? e B? do fibrinog?nio foram completamente clivadas na concentra??o de 0.18 ?g/?L de prote?na da fra??o em 4 minutos. A atividade fibrinogenol?tica apresentou inibi??o total em presen?a de E-64 e parcial em presen?a de EDTA. A fra??o demonstrou atividade coagulante sobre o plasma e reduziu o tempo de tromboplastina parcial ativada, indicando atuar sobre os fatores da via intr?nseca e comum da coagula??o, n?o exercendo efeitos sobre o tempo de protrombina. A atividade fibrinol?tica sobre o co?gulo de plasma foi detectado apenas em SDS-PAGE em concentra??es elevadas da fra??o, e apesar da atividade fibrin(ogen)ol?tica, n?o foi observada atividade defibrinogenante in vivo. Apesar de v?rias proteases de plantas e animais pe?onhentos serem classicamente t?xicas, a frac??o F1.0 n?o expressou atividade hemorr?gica nem hemol?tica. A fra??o F1.0 tamb?m n?o demonstrou atividade antimicrobiana. Na avalia??o da atividade proteol?tica sobre a azocase?na, o pH ?timo de rea??o foi 5.0, e a temperatura ?tima igual a 60?C. A atividade enzim?tica demonstrou ser sens?vel ? presen?a dos sais testados, com inibi??o para todos os compostos. O tensoativo triton n?o influenciou a atividade enzim?tica, por?m o tween-20 e SDS inibiram tal atividade. Em presen?a de agentes redutores ocorreu aumento da atividade enzim?tica, caracter?stica t?pica de enzimas pertencentes ? classe das ciste?no proteases. Diversas bandas prot?icas com atividade proteol?tica foram detectadas em zimograma, na regi?o de elevada massa molecular, que foram inibidas por E-64. Neste trabalho, foi revelado que C. urens apresenta fra??o enriquecida com ciste?no-proteases que apresentam atividade fibrinogenol?tica e procoagulante, que podem ser isoladas, com potencial aplica??o no tratamento de dist?rbios hemorr?gicos, como trombol?tico e em laborat?rio cl?nico / 2020-01-01