O objetivo do presente estudo foi avaliar o efeito do suporte ventilatório com ventilação assistida proporcional (PAV) na capacidade ao exercício em pacientes com fibrose pulmonar idiopática (FPI). Dez pacientes foram submetidos a um teste cardiopulmonar de esforço máximo, prova de função pulmonar completa e 3 testes submáximos (60% da carga máxima): sem suporte ventilatório, com pressão positiva contínua nas vias aéreas (CPAP) e PAV. Foram avaliadas a capacidade de exercício, as adaptações cardiovasculares e ventilatórias e a percepção subjetiva de esforço. Uma amostra de lactato sanguíneo foi também obtida no repouso e no final do exercício. Nossos resultados mostram que a capacidade de exercício submáximo com suporte ventilatório PAV aumentou o tempo de exercício quando comparado com a CPAP e sem suporte ventilatório (respectivamente, 11,10±8,88 min, 5,60±4,74 e 4,50±3,84 min). O suporte ventilatório com PAV ocasionou uma menor demanda cardiovascular com redução do duplo produto e da freqüência cardíaca. Uma melhor oxigenação e uma menor percepção de esforço também foram observadas nos pacientes quando realizaram a atividade com PAV. Nossos resultados sugerem que o suporte ventilatório com PAV pode aumentar a tolerância ao exercício e reduzir a dispnéia em pacientes com fibrose pulmonar idiopática. / The objective of the present study was to evaluate the effect of ventilatory support using proportional assist ventilation (PAV) on exercise capacity in patients with idiopathic pulmonary fibrosis. Ten patients were submitted to a cardiopulmonary exercise testing, lung function and 3 submaximal exercise tests (60% of maximum load): without ventilatory support, with continuous positive airway pressure (CPAP) and PAV. Exercise capacity, cardiovascular and ventilatory adaptations and subjective perception to effort in lower limb and respiratory breathing were evaluated. Lactate plasmatic levels were obtained before and after submaximal exercise. Our results show that submaximal exercise capacity duration was increased with PAV compared with CPAP and without ventilatory support. (respectively, 11.10±8.88 min, 5.60±4.74 e 4.50±3.84 min). Ventilatory support with PAV lead to a lower cardiovascular demand such as double product and heart rate decreased. An improved arterial oxygenation and lower subjective perception to effort was also observed in patients with IPF when exercise was performed with PAV. Our results suggest that ventilatory support with PAV can increase exercise tolerance and decrease dyspnea in patients with idiopathic pulmonary fibrosis.

Sepse é uma resposta inflamatória inapropriada desencadeada pela presença de bactérias e/ou produtos bacterianos como lipopolissacarídeos (LPS). A sepse grave e o choque séptico estão associados a taxas de mortalidade de 40 a 60%. A falência respiratória está entre as mais frequentes complicações da sepse grave, ocorrendo em quase 80% dos casos. Cerca de 40% dos pacientes com sepse desenvolvem a síndrome do desconforto respiratório agudo (SDRA), caracterizada principalmente pela alteração da função respiratória, surgimento de edema intersticial pulmonar e deposição de colágeno nos pulmões. Embora a reposição volêmica seja normalmente utilizada em pacientes sépticos, não há consenso quanto ao volume a ser administrado, sendo atualmente recomendada a utilização de pequenos volumes. Neste contexto, a solução salina hipertônica (NaCl 7,5%, SH) tem sido apresentada como um potencial agente terapêutico. Visando contribuir para o conhecimento dos benefícios da solução salina hipertônica (SH) na sepse, o presente trabalho teve como objetivo avaliar a ação do tratamento precoce e tardio com solução hipertônica no pulmão de ratos endotoxêmicos. Ratos Wistar foram separados em 4 grupos (n=10): CTL (sem nenhum insulto ou tratamento); LPS (injetados com LPS 10mg/Kg i.p); HIPER (animais que receberam tratamento com solução hipertônica 7,5% NaCl i.p na dose de 4ml/Kg 15 min. ou 1,5 horas após injeção de LPS) e SALINA ((animais que receberam tratamento com solução salina 0,9% NaCl i.p na dose de 34ml/Kg 15 min. ou 1,5 horas após injeção de LPS). Foram avaliados a mortalidade, e após 24 horas o edema e a mecânica pulmonar, os colágenos tipo I e tipo III, a expressão e atividade da MMP-9, a expressão de FAK e a síntese de óxido nítrico (NO). Nossos resultados mostraram que o tratamento precoce com solução hipertônica evitou a morte dos animais endotoxêmicos. Nenhum dos tratamentos modulou os mediadores inflamatórios. O tratamento precoce com solução hipertônica diminuiu a síntese de iNOS e nitrito, a expressão e atividade de MMP-9 e de FAK, junto com a deposição de colágeno tipo I evitando a substituição do colágeno III. Observamos melhora dos parâmetros de mecânica respiratória. O tratamento tardio com solução hipertônica não apresentou os mesmos resultados promissores observados no tratamento precoce, sugerindo que o tempo de administração da hipertônica é de grande importância para obtenção de seus efeitos terapêuticos / Sepsis syndrome is caused by inappropriate immune activation due to bacteria and bacterial components released during infection. The respiratory failure is among the most frequent complication of severe sepsis, occurring in almost 80% of the cases. About 40% of septic patients develop acute respiratory distress syndrome (ARDS) which is characterized mainly by the change of respiratory function, interstitial lung edema and fibronectin and collagen deposition in the lung. Fluid resuscitation is normally used in the management of patients with severe sepsis and septic shock. Hypertonic saline solution (HS, NaCl 7,5%) has shown to modulates immune function and decrease pulmonary injury triggered by endotoxemic shock. Our objective was to investigate the effects of early and later HS treatment on the mechanism involved in pulmonary injury, in an experimental model of endotoxemic shock. Wistar rats received lipopolysaccharide - LPS (10mg/kg i.p.) and volume i.v. after 15 minutes (early) or 1,5 hours (later). The animals were assigned in four groups (n=10): control group (not subjected to LPS); LPS group (injected with LPS 10mg/kg i.p); HS group (treated with hypertonic saline, 4 mL/Kg i.v. after LPS) and NS group (treated with normal saline, 34 mL/kg i.v. after LPS). We evaluated mortality and at 24h after treatment, pulmonary edema and mechanics, type I and type III collagen expression, metalloproteinase 9 expression and activity, focal adhesion kinase (FAK) and nitric oxide (NO) synthesis were measured. In the early treatment NS increased pulmonary resistance and elastance, compared to other groups. HS inhibited collagen expression compared to LPS and NS groups and prevented pulmonary injury by decreasing MMP-9 activity in tissue. Expression of FAK was decreased in HS groups compared to LPS and NS groups. NO expression was decreased in HS group, compared to LPS and NS groups. The later treatment with HS did not showed improvement of previous parameters increasing mortality and pulmonary injury. We concluded that HS treatment of endotoxemic shock at the earliest possible time point maximizes its efficacy in preventing pulmonary injury probably acting on nitric oxide-induced FAK activation pathway, which could modulate the collagen deposition in pulmonary tissue, and consequently decrease the progression of pulmonary fibrosis. Later treatment with HS decreased beneficial effects of hypertonic saline observed in early infusion, showed the importance of timing in the result of fluid therapy

Estudou-se por morfologia, morfometria e imuno-histoquímica o remodelamento vascular (moléculas de adesão), epitelial (moléculas de adesão) e intersticial (colágeno V e células imunes) nos três tipos maiores de pneumonias intersticiais idiopáticas: em 62 casos de IPF, 22 casos de NSIP e 25 casos de AIP. O impacto dessas alterações foi avaliado nas provas de função, sobrevida e prognóstico. Demonstrou-se que o remodelamento vascular ativo e fibroelastótico é diretamente proporcional ao grau de atividade parenquimatosa principalmente na UIP. O colágeno V, o mapeamento das células imunes, o aumento da atividade endotelial e epitelial tiveram impacto no espectro diferencial e possivelmente na patogênese das três pneumonias intersticiais estudadas. A resposta imune celular na UIP teve impacto na sobrevida dos pacientes / Studied for morphology, morphometry and immunohischemistry the vascular (adhesion molecules), epithelial (adhesion molecules) and interstitial (collagen V and immune cells) remodeling in the three major types of idiopathic interstitial pneumonias: in 62 cases of IPF, 22 cases of NSIP, and 25 cases of AIP. The impact of these alterations was evaluated in the function tests, survival and prognostic. We demonstrated that the active and fibroelastotic vascular remodeling is directly proportional to the degree of parenchymal activity, mainly in the UIP. Collagen V, mapping of the immune cells, increase of the endothelial and epithelial activity had possibly impact in the distinguishing specter and in pathogenesis of the three interstitial pneumonias studied. The cellular immune reply in the UIP it had impact in survival of the patients

A patogênese da fibrose pulmonar idiopática (FPI), forma mais comum de pneumonia intersticial idiopática, não é bem conhecida. Os estudos histopatológicos evidenciam uma extensa lesão do epitélio alveolar com destruição intensa dos pneumócitos tipo e exposição e perda de integridade da membrana basal subjacente, impedindo a reepitelização e rendotelização alveolar, com conseqüente proliferação de fibroblastos e deposição de matriz extracelular. O fator etiológico responsável por essa resposta fibrosante ainda não é conhecido. Em doenças como a síndrome do desconforto respiratório agudo (SDRA) e a lesão pulmonar induzida pela ventilação mecânica, o papel da abertura e fechamento cíclicos das pequenas vias aéreas já está bem estabelecido. Esse estudo tem como objetivo avaliar a presença de colapso alveolar e de pequenas vias aéreas em pacientes com FPI através de tomografia computadorizada (TC) de tórax multislice. As tomografias foram realizadas em 3 diferentes momentos do ciclo respiratório - na capacidade pulmonar total (CPT), na capacidade residual funcional (CRF) e no volume residual (VR) - inicialmente em ar ambiente (O2 a 21%) e as duas últimas etapas, CRF e VR, foram repetidas após 10 minutos de ventilação com O2 a 100%. Admitimos que o surgimento de colapso alveolar após a manobra com O2 a 100% se deve ao fechamento das pequenas vias aéreas seguido de atelectasia de absorção. Foi utilizado o programa Osiris para análise quantitativa das densidades pulmonares e um programa em linguagem LabVIEW 6.0 para quantificação da massa de pulmão não aerado (colapsado) cuja densidade situa-se entre -100 e + 100 UH. A casuística foi composta por 18 pacientes com diagnóstico histológico e/ou clínico de FPI e 12 controles sem doença respiratória conhecida. Os indivíduos do grupo controle foram mais idosos (63 x 70 anos), não havendo diferença quanto à história de tabagismo. A atenuação média do parênquima pulmonar foi maior no grupo fibrose na CPT, CRF 21% e VR 21%. Quando analisamos a massa de pulmão não aerado, o grupo fibrose apresentou valores significativamente maiores do que o grupo controle em todos os volumes respiratórios avaliados em ar ambiente e após O2 a 100%. A avaliação da massa de pulmão não aerado no VR e na CRF após ventilação com O2 a 100%, em comparação com os mesmos volumes pulmonares em ar ambiente, mostrou aumento do colapso tanto em pacientes quanto em controles, não havendo diferença entre os grupos quando se comparou o aumento absoluto da massa de pulmão não aerado após essa manobra. Entretanto, no grupo de pacientes com FPI, houve aumento significativo da massa de pulmão não aerado à medida que se reduziram os volumes pulmonares em ar ambiente, alteração essa não encontrada no grupo controle. Podemos concluir que a ventilação com O2 a 100% causou colapso de vias aéreas tanto nos pacientes quanto no grupo controle. Nos pacientes com FPI, foi evidenciado colapso alveolar durante a ventilação em ar ambiente, colapso esse quase totalmente revertido (88%) após uma manobra de inspiração máxima até a CPT, o que demonstra seu potencial de reversibilidade / The pathogenesis of idiophatic pulmonary fibrosis (IPF), the most common form of idiopathic interstitial pneumonias, is not completely understood. It is related to a type I pneumocyte injury with loss of basement membrane integrity and failure of normal re-epithelialization and re-endothelialization leading to fibroblast proliferation and extra cellular matrix deposition. However, the etiology of this fibroproliferative response is unknown. In ARDS and ventilator-induced lung injury, it has been postulated that the pulmonary injury is caused by the cyclic opening and closing of collapsed airways. Our aim is to measure the collapsed areas of the lung (alveolar and small airways collapse) using a multislice computed tomography (CT) in a group of patients with IPF. They were submitted to a CT scan of the thorax in 5 different situations: at total lung capacity (TLC), functional residual capacity (FRC) and residual volume (RV) at 21% O2 as well as at FRC and RV after breathing 100% O2 for 10 minutes. We assumed that the gain in collapsed areas after 100% O2 corresponds to trapped areas with airways closure and absorption atelectasis. We employed the Osiris Software program to the quantitative analysis of CT attenuation of lung tissue and a program written in LabVIEW to measure the mass of nonaerated lung tissue (- 100 to +100 HU). Eighteen IPF patients and twelve controls without respiratory disease were studied. The control group was older than IPF group (70 x 63 years, respectively) and the smoking history was not different between both groups. The mean lung attenuation was higher in IPF patients at TLC, 21% FRC and 21% RV. When we analyzed the mass of nonaerated lung tissue, the IPF group showed significantly higher values in all respiratory maneuvers (TLC, FRC and RV) at 21% O2 and 100% O2. Both groups presented an increase in collapsed areas when exposed to 100% at RV and FRC and this increment was of similar magnitude. However, only IPF patients had an increase in the mass of nonaerated lung tissue when the lung volume was reduced from TLC to FRC and from FRC to RV during air breathing. We concluded that patients and controls had airways collapse after 100% O2 breathing. In contrast, only IPF patients demonstrated alveolar collapse during air breathing which was almost completed reversible after TLC maneuver

Les canaux chlore volume-sensibles (VRACs) régulent les activités différenciatives, migratoires et prolifératives des fibroblastes et pourraient donc être impliqués dans la pathobiologie de l’hypertension artérielle pulmonaire (HTAP) et la fibrose pulmonaire interstitielle (FPI). Diverses études antérieures ont montré que l’endothéline-1 (ET1) a des propriétés pro-fibrosantes, en plus cette molécule participe au remodelage des artérioles pulmonaires dans l’HTAP. D’autre part, ces pathologies d’HTAP et de fibrose pulmonaire peuvent être antagonisées par la mélatonine et par l’interaction entre protéines de morphogenèse (BMPs: bone morphogenetic proteins) et leur récepteur 2 (BMPR2). <p>La première partie de mon travail s’est intéressée aux effets de la BMP2 et de l’endothéline1 sur les canaux chlore volume-sensibles de fibroblastes pulmonaires. <p>La stimulation hypotonique du courant a été inhibée par la BMP2 en dépendance de la dose appliquée et de la durée d’exposition à la molécule. Un maximum d’effet de la BMP2 a été observé avec une concentration de 10ng/ml pendant 45min de prétraitement. En plus, les courants chlore volume-sensibles, inhibés par la BMP2, se sont restaurés en présence de l’inhibiteur spécifique de la voie de la protéine kinase C (PKC), le GFX. D’autre part, le prétraitement des fibroblastes avec l’ET1 à 100μM pendant 2heures a induit l’apparition d’un courant activable par l’acide lysophosphatidique (ICl-LPA) (marqueur de la différenciation des fibroblastes) et l’expression de l’α-sma (alpha smooth muscle actin, marqueur classique des myofibroblastes). La migration des fibroblastes a été aussi induite en présence de l’ET1, alors que l’inhibition des canaux chlore par le DIDS (Diisothiocyanatostilbene-disulfonic acid) a bloqué cet effet. La BMP2 s’est opposée à l'effet de l’ET1 sur la différenciation des fibroblastes par l’inhibition de l’induction du courant ICl-LPA et de l’expression génique de l’α-sma. En plus, la migration des fibroblastes, induite par l’ET1, a été inhibée par la BMP2. Nous avons aussi montré que l’expression de gène du canal anoctamine6 a été stimulée par l’ET1, alors la BMP2 s’est opposée à cet effet, ce qui suggère que l’anoctamine6 est le canal responsable de la différenciation des fibroblastes marquée par l’apparition du courant ICl-LPA. Il apparaît donc que l’ET1 et la BMP2 ont des effets opposés sur la différenciation et la migration des fibroblastes pulmonaires via leurs effets sur l’activité et l’expression des canaux chlore volume-sensibles. <p>La deuxième partie du travail s’est intéressée à l’effet de la mélatonine sur les canaux chlore volume-sensibles de fibroblastes L929 et aux conséquences de cet effet sur la migration et la prolifération de ces cellules. Le prétraitement des fibroblastes avec 100μM de mélatonine pendant 30min a inhibé significativement l’activation des canaux chlore volume-sensibles. En plus, une concentration de 100 nM pendant une nuit a donné le même effet observé avec la mélatonine à 100μM pendant 30 min. Nous avons aussi constaté que l’inhibition des VRACs par la mélatonine a été dose-dépendante. L’effet de la mélatonine sur les VRACs a été inhibé en présence de l’antagoniste non sélectif des récepteurs de la mélatonine (Luzindole) et l’antagoniste sélectif pour le récepteur 2 (MT2) de la mélatonine (K185). En plus, l’inhibiteur de la voie de la PKC (GFX) a empêché la mélatonine d’agir sur les canaux chlore volume-sensibles. Ces résultats suggèrent que la mélatonine agit sur les VRACs en se fixant sur MT2 et en activant la voie de la PKC. L’inhibition des VRACs par la mélatonine a eu pour conséquence l’inhibition du phénomène de RVD (regulatory volume decrease), qui suit le gonflement hypotonique. Nous avons aussi montré que la migration des fibroblastes L929 a été inhibée par la mélatonine à 100μM et cela via l’inhibition des VRACs, puisque la mélatonine s’est montrée incapable d’induire une inhibition supplémentaire de la migration en présence de l’inhibiteur des canaux chlore volume-sensibles (DIDS). En plus, l’antagoniste non sélectif des récepteurs de la mélatonine (luzindole), l’antagoniste sélectif pour MT2 (K185) et l’inhibiteur de la voie de PKC (GFX) ont provoqué la disparition de l’effet de la mélatonine sur la migration. Cela suggère que la mélatonine agit sur la migration via les voies empruntées pour l’inhibition des VRACs. L’inhibition des VRACs, par la mélatonine et le DIDS, n'a pas induit d'inhibition significative sur la prolifération des fibroblastes L929, ce qui veut dire que l’inhibition des VRACs est insuffisante pour induire une inhibition significative de la prolifération. Donc, la mélatonine inhibe les canaux chlore volume-sensibles via sa fixation sur MT2 et l’activation de la voie de la PKC. Cela a pour conséquence l’inhibition du RVD et de la migration des fibroblastes L929, mais cette inhibition des VRACs est insuffisante pour inhiber la prolifération de ces cellules. <p>En conclusion, j’ai pu montrer l’importance des canaux chlore volume-sensibles dans la régulation de la physiologie des fibroblastes et leurs interactions avec des médiateurs d’affections pulmonaires à composante fibrosante, telles que l’HTAP et la FPI./<p>Volume-regulated anion channels (VRACs) regulate fibroblast differentiation, migration and proliferation. Fibroblasts have been shown to be involved in several pathologic states including pulmonary arterial hypertension (PAH) and interstitial pulmonary fibrosis (IPF). A number of previous studies have shown that endothelin-1 (ET1) has pro-fibrotic properties and participates in the remodeling of pulmonary arterioles in PAH. On the other hand, PAH and IPF may be controlled by melatonin and bone morphogenetic protein receptor 2 (BMPR2) signaling. <p>The first part of my work described the effects of BMP2 and ET1 on the VRAC in the pulmonary fibroblasts and the consequences of these effects on differentiation and migration of these cells. Pretreatment of fibroblasts with BMP2 inhibited hypotonic current stimulation and this effect was dependent on the BMP2 concentration and on the time of exposition to the molecule. The maximum effect of BMP2 was observed at a concentration of 10ng/ml for 45 min of pretreatment. In addition, volume-sensitive chloride current, inhibited by BMP2, was restored in presence of PKC (protein kinase C) pathway inhibitor (GFX). On the other hand, the pretreatment of fibroblasts with100μM of ET1 for 2 hours, induced the appearance of a lysophosphatidic acid-activable chloride current (ICl-LPA) (a marker of fibroblast differentiation) and stimulated the expression of the smooth muscle actin alpha (α-sma) (the classical marker of myofibroblasts). ET1 also stimulated fibroblast migration, while the inhibition of chloride channels by (DIDS) (Diisothiocyanatostilbene disulfonic acid) bloked this effect. The BMP2 opposed the effect of ET1 on fibroblast differentiation by preventing the induction of ICl-LPA current and α-sma gene expression. In addition, BMP2 inhibited the fibroblast migration induced by ET1. We have also shown that ET1 stimulated anoctamin6 channel gene expression and that BMP2 opposed this effect, which suggests the implication of anoctamin6 on fibroblast differentiation marked by the appearance of ICl-LPA current. Thus, ET1 and BMP2 have opposite effects on pulmonary fibroblast differentiation and migration via their effects on the activity and expression of volume-regulated anion channels. <p>The second part of the work focused on the effect of melatonin, which is a vasorelaxant and antifibrotic agent, on the volume-sensitive chloride channels in L929 fibroblasts and primary rat fibroblasts and on the consequences of this effect on migration and proliferation of these cells. Fibroblast pretreatment with 100μM of melatonin for 30 min significantly inhibited the activation of volume-sensitive chloride channels. In addition, a concentration of 100 nM of melatonin overnight produced the same effect observed with melatonin at 100μM for 30 min. The effect of melatonin on VRAC current was dose-dependent. Inhibition of VRACs by melatonin resulted the inhibition of the RVD phenomenon (Regulatory Volume Decrease) following the hypotonic swelling. The effect of melatonin on VRACs was inhibited in the presence of the non-selective antagonist of melatonin receptors (Luzindole) and the selective antagonist of the melatonin receptor 2 (MT2), the K185. In addition, the PKC pathway inhibitor (GFX) inhibited the effect of melatonin on the volume-sensitive chloride channels. These results suggest that, melatonin acts on the VRACs by binding to MT2 and by activating the PKC pathway. We have also shown that the L929 fibroblast migration was inhibited by melatonin (100μM) via inhibition of VRAC channels, since melatonin was unable to induce further inhibition of migration in the presence of the volume-sensitive chloride channels inhibitor (DIDS). In addition, the non-selective melatonin receptors antagonist (luzindole), the selective antagonist for MT2 (K185) and the PKC pathway inhibitor (GFX), blocked the effect of melatonin on migration, which suggests that melatonin acts on migration via the same pathways that inhibit VRAC channels. Inhibition of VRACs by melatonin and DIDS have not shown any significant inhibition of L929 fibroblast proliferation, which means that the VRAC inhibition is not sufficient to induce a significant inhibition of proliferation. Thus, melatonin inhibits volume-sensitive chloride channels via its binding to MT2 and activation of the PKC pathway. This has as consequences the inhibition of RVD and migration of L929 fibroblasts but insufficient to inhibit the proliferation of these cells. <p>In conclusion, I have shown the importance of volume-sensitive chloride channels in the regulation of fibroblast physiology and its interactions with ET-1, BMP and melatonin signaling. These results are compatible with the notion that the participation of fibroblasts in the pathobiology of PAH or IPF is mediated by VRAC channels, which can be activated by ET-1 and inhibited by BMP’s or melatonin. The translational relevance of these findings will have to be investigated on fibroblasts from patients with PAH or IPF, or from animal models of pulmonary hypertension or lung fibrosis.<p><p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

Rationnel : L’implication établie des progéniteurs endothéliaux circulants dans les phénomènes de néovascularisation chez l’adulte a stimulé la recherche de thérapeutiques angiogènes basées sur la greffe de ces cellules. Deux types cellulaires au phénotype endothélial sont actuellement définis entre autres par leur cinétique d’apparition en culture : les progéniteurs précoces (CFU-EC ou CAC) et tardifs (ECFC). Notre équipe a montré que l’injection thérapeutique de cellules mononucléées de moelle osseuse (BM-MNC) permettait la néovascularisation du site ischémié chez des patients atteints d’artériopathie des membres inférieurs, et que les néovaisseaux formés avaient le phénotype d’ECFC. Nous avons dans un premier temps mesuré les concentrations de différentes protéines modulant l’angiogenèse, chez des patients atteints de pathologies ischémiques et cardiovasculaires, ou impliquant des anomalies vasculaires associées à la fibrose. Ainsi, le transforming growth factor - β1 (TGF-β1) dans la fibrose pulmonaire idiopathique (FPI), la thrombospondine-1 (TSP-1) dans l’artériopathie des membres inférieurs (AMI), et le placental growth factor (PlGF) chez les patients atteints de pathologies cardiovasculaires [syndrome coronarien aigu (SCA), ou patients devant subir une chirurgie de la valve ou un pontage coronarien], se sont distingués comme potentiel biomarqueur plasmatique dans ces pathologies, et ont été étudiés dans la biologie des ECFC humaines.Résultats : Le taux plasmatique de TGF-β1 est augmenté chez les patients atteints de FPI par rapport à la population contrôle ; il a un effet pro-angiogène in vivo (vascularisation des implants de Matrigel®) et in vitro (prolifération et migration des ECFC) via les récepteurs ALK-1, ALK-5 et TGF-βRII. Le taux plasmatique de TSP-1 est augmenté chez les patients artéritiques par rapport à la population contrôle. Par ailleurs les néovaisseaux formés de patients artéritiques ayant été traités par injection locale de BM-MNC expriment la TSP-1. Dans les modèles murins de Matrigel®-plugs et d’ischémie du membre inférieur (IMI), la TSP-1 induit une diminution de la vascularisation des implants ainsi qu’une diminution de la revascularisation du membre ischémié. In vitro, la TSP-1 augmente l’adhésion via un mécanisme N-Terminal dépendant, et diminue le potentiel angiogène (prolifération et migration) des ECFC via sa liaison au récepteur CD47, ce qui active la voie de signalisation SDF-1/CXCR4. Le taux plasmatique de PlGF est augmenté chez les patients atteints de SCA par rapport à 2 populations contrôles ; il est également augmenté chez les patients ayant subit une chirurgie cardiaque. Les PlGF-1 et -2 potentialisent la tubulogenèse des ECFC in vitro via la phosphorylation du récepteur VEGFR1. Cet effet est aboli lorsque le VEGFR1 est inhibé par ARN interférence ou par le composé chimique « 4321 ». De plus ce composé « 4321 » inhibe la vascularisation des implants de Matrigel®, ainsi que la revascularisation du membre ischémié dans le modèle d’IMI.Conclusions : Le TGF-β1 joue un rôle dans le remodelage vasculaire de la FPI via les ECFC ; la TSP-1 est un potentiel biomarqueur de l’angiogenèse induite par les ECFC dans l’AMI ; l’inhibition de la voie PlGF/VEGFR1 module la tubulogenèse induite par les ECFC, cellules impliquées dans la formation de nouveaux vaisseaux. Nous avons ainsi mis en évidence 3 protéines modulant l’angiogenèse dans 3 contextes pathologiques différents, caractérisés par un remodelage vasculaire et où les ECFC sont impliquées dans leurs mécanismes physiopathologiques. Ces 3 protéines se présentent donc comme de potentiels biomarqueurs plasmatiques, modulant les propriétés angiogènes des ECFC et pouvant influencer leur efficacité en tant que produit de thérapie cellulaire. Ces protéines jouent un rôle probable dans l’équilibre homéostatique au décours des pathologies concernées. / Rationale: The pro-angiogenic capacities of endothelial progenitor cells are now well established, and their involvement in neovascularization events in adults has stimulated the research in the field of angiogenic therapy based on transplant of these cells. Current data converge towards the notion of two cell types with endothelial phenotype, defined at least by their kinetics of appearance in culture: early endothelial progenitor cells (CFU-EC or CAC) and late (ECFC). Our team has shown that the therapeutic injection of bone marrow mononuclear cells (BM-MNC) led to neovascularization of the ischemic site in patients with critical limb ischemia, and that the new vessels formed bore the phenotype of ECFC. We initially measured the concentrations of different proteins modulating angiogenesis in patients with ischemic and cardiovascular diseases, or involving vascular abnormalities associated with fibrosis. Thus, the transforming growth factor - ß1 (TGF-ß1) in idiopathic pulmonary fibrosis, the thrombospondin-1 (TSP-1) in peripheral artery disease, and the placental growth factor (PlGF) in patients with cardiovascular diseases [acute coronary syndrome (ACS), patients undergoing valve surgery or coronary artery bypass surgery], emerged as potential plasmatic biomarkers in these pathological settings, and have been studied in the biology of human ECFC.Results: TGF-ß1 plasma level is increased in patients with idiopathic pulmonary fibrosis (IPF) compared to the control population; it exerts a pro-angiogenic effect in vivo (vascularization of Matrigel ®-plugs) and in vitro (proliferation and migration of ECFC) via ALK-1, ALK-5 and TGF-ßRII receptors. TSP-1 plasma level is increased in patients with peripheral artery disease (PAD) compared to the control population. In addition, the new vessels formed in PAD patients treated by local injection of BM-MNC express TSP-1. In murine models of Matrigel ®-plugs and hindlimb ischemia, TSP-1 induces a decrease in plugs vascularization and impaired revascularization of ischemic limb. In vitro, TSP-1 increases ECFC adhesion via an N-terminal dependent mechanism and reduces their angiogenic potential (proliferation and migration) via its binding to CD47 receptor, which activates the SDF-1/CXCR4 signaling pathway. PlGF plasma level is increased in ACS patients compared with the control population and stable angina patients and is also increased in patients undergoing cardiac surgery. PlGF-1 and -2 potentiate ECFC tubulogenesis in vitro via phosphorylation of the VEGFR1 receptor. This effect was abolished when the ECFC VEGFR1 is inhibited by RNA interference or by the chemical compound "4321". In addition this compound "4321" inhibits the vascularization of Matrigel ®-plugs, and revascularization of the ischemic limb in the hindlimb ischemia model.Conclusions: TGF-ß1 is involved in the IPF vascular remodeling through ECFC; TSP-1 is a potential biomarker of angiogenesis induced by ECFC in PAD; the inhibition of the PlGF/VEGFR1 pathway modulates ECFC tubulogenesis, cells involved in the formation of new vessels. We thus identified three proteins that modulate angiogenesis in three different pathological settings characterized by a vascular remodeling and where ECFC are involved in their pathophysiology. These three proteins therefore state as potential plasmatic biomarkers, modulating ECFC angiogenic properties and are able to influence their efficacy as a cell therapy product. These plasmatic biomarkers likely play a role in the homeostasis of those pathologies progress.

Abstract Pulmonary fibrosis, lung cancer and chronic obstructive pulmonary disease (COPD) are severe diseases and common death causes worldwide. Due to the lack of an effective therapy, the investigation of cell biological mechanisms behind these diseases is essential. An activation of stromal cells, including myofibroblasts, is a main feature found in the pathogenesis of lung diseases. Myofibroblasts express alpha-smooth muscle actin (α-SMA), have specific ultrastructure, produce extracellular matrix proteins and possess contractile capacity. Detailed structure and function of myofibroblasts and their roles in healthy and diseased lung are not yet wholly understood. The investigation of the myofibroblasts may further offer novel tools for the acquisition of proper diagnosis, prognosis and medical treatment. The study aimed to characterize the ultrastructural, functional and disease-specific features of stromal cells, particularly myofibroblasts, in interstitial and malignant lung diseases. The functional properties evaluated here were differentiation, invasive and contractile properties. The study material included in vitro stromal cells cultured from bronchoalveolar lavage (BAL) fluids. The appearance and location of myofibroblasts in different lung compartments of non-smokers and the COPD-patients were examined in vivo. The cells were investigated by light and electron microscopy. The α-SMA expression was analysed by gene or protein assays. The study demonstrated that stromal cells could be cultured from diagnostic BAL fluid samples and lung tissues. Cultured cells were a mixture of fibroblasts and myofibroblasts. A small proportion of cells exhibited progenitor-like features. Myofibroblasts revealed differential features in electron microscopy and invasive or contractile assays. When studying tissues from healthy and COPD lungs, myofibroblasts were located both in alveoli and airways. In alveoli myofibroblasts localized in widened alveolar tips which were newly described structures and locations of myofibroblasts in healthy and diseased lung. The amount of myofibroblasts in large airways, but not in peripheral lung, was increased in COPD. We concluded that myofibroblasts have several locations in normal and COPD lung, which suggests a function both in pulmonary regeneration and the pathogenesis of COPD. Smoking altered the phenotype of myofibroblasts regardless of its origin. / Tiivistelmä Keuhkofibroosi, keuhkosyöpä ja keuhkoahtaumatauti (COPD) ovat kansallisesti ja maailmanlaajuisesti yleisiä ja kuolemaan johtavia sairauksia. Taudinmääritys ja hoito ovat vaativia, eikä kaikille potilaille ole parantavaa hoitoa. Keuhkosairauksien kaikkia solubiologisia mekanismeja ei vielä tunneta, mikä on yksi syy lääkekehityksen ongelmiin. Interstitiaaleissa ja pahanlaatuisissa keuhkosairauksissa esiintyy paljon aktiivisia sidekudossoluja, kuten muuntuneita fibroblasteja eli myofibroblasteja. Ne tunnistetaan hienorakenteesta, jota voidaan tutkia elektronimikroskoopilla. Myofibroblastit ilmentävät myös solun sisäistä sileän lihaksen alfa-aktiinia (α-SMA), tuottavat sidekudoksen proteiineja ja kykenevät supistumaan. Myofibroblastien hienorakenteen ja toiminnan selvittäminen voi antaa lisätietoa keuhkosairauksien syntymekanismeista, jolloin diagnostiikkaa, ennustetta sekä hoitoja voidaan arvioida paremmin. Väitöskirjassa selvitettiin myofibroblastien hienorakennetta ja toimintaa eri keuhkosairauksissa. Tutkitut toiminnalliset ominaisuudet olivat erilaistumispotentiaali, invasiivisuus ja supistumiskyky. Sairauksien kliinistä käyttäytymistä ja potilaiden tupakointitottumuksia tarkasteltiin suhteessa solubiologiatason havaintoihin. Tutkimusmateriaali kerättiin taudinmäärityksen yhteydessä interstitiaalisia keuhkosairauksia, keuhkoahtaumatautia tai keuhkosyöpää sairastavilta potilailta. Tulosten mukaan bronkoalveolaarihuuhtelunesteestä (BAL) ja keuhkokudospaloista voidaan soluviljelymenetelmin kasvattaa ja ylläpitää solulinjoja. Viljellyt solut muodostivat sekasolupopulaatiota, joissa esiintyi pääosin fibroblasteja ja vaihteleva osuus myofibroblasteja. Pieni osa soluista ilmensi kantasoluille tyypillisiä piirteitä. Myofibroblastien tyyppipiirteet ja toiminnalliset ominaisuudet vaihtelivat taudeittain. Kudoksessa myofibroblasteja ilmentyi sekä keuhkorakkuloissa että ilmateissä. Keuhkorakkulatasolla myofibroblastit sijoittuivat irrallisten alveoliseinämien laajentuneisiin päihin, joita ei ole aiemmin tutkittu tieteellisessä kirjallisuudessa myofibroblastien yhteydessä. Keuhkoahtaumatauti ja tupakointi vähensivät näiden rakenteiden määrää perifeerisessä keuhkossa, kun taas suurissa ilmateissä keuhkoahtaumatauti lisäsi myofibroblasteja. Päättelimme, että myofibroblastit edistävät keuhkoahtaumataudin syntyä isoissa ilmateissä, mutta saattavat osallistua keuhkojen korjaukseen keuhkorakkuloissa ja pienissä ilmateissä.

La fibrose pulmonaire idiopathique (FPI) est de pronostic sombre et sans traitement efficace. Elle est caractérisée par un début sous pleural et la présence de myofibroblastes responsables de la synthèse excessive de la matrice extracellulaire. La voie de signalisation du Transforming Growth Factor (TGF)-β1, facteur clé de la genèse de la fibrose et sa progression, passe par les Smads, notamment Smad4. Le TGF-β1 induit la différenciation des fibroblastes pulmonaires et des cellules épithéliales et mésothéliales en myofibroblastes. AB-crystallin est une protéine de choc thermique surexprimée dans la fibrose du foie, du rein et la fibrose vasculaire. Elle peut être induite par le TGF-β1. Dans ce travail, nous avons étudié le rôle d’αB-crystallin dans la fibrose pleurale et pulmonaire. Nous montrons qu’αB-crystallin est surexprimée dans les poumons et la plèvre de patients atteints de FPI. In vivo, dans trois modèles de fibrose pulmonaire (bléomycine, surexpression de TGF-β1 ou d’IL-1β) les souris KO pour αB-crystallin sont protégées de la fibrose avec une inhibition de la voie du TGF-β. In vitro, dans les cellules épithéliales, mésothéliales ou les fibroblastes, αB-crystallin augmente la localisation nucléaire de Smad4. En interagissant avec TIF1γ, responsable de l’export nucléaire de Smad4, elle favorise la séquestration nucléaire de Smad4 et son activité pro-fibrosante. Au contraire, son inhibition permet la formation du complexe Smad4/TIF1γ et l’export nucléaire de Smad4 inhibant son activité. Ce travail montre l’importance d’αB-crystallin dans la fibrose pleuro-pulmonaire et son rôle sur la voie du TGF-. AB-crystallin pourrait être une cible thérapeutique de la FPI. / Idiopathic pulmonary fibrosis (IPF) has no effective current treatment. It is characterized by a sub-pleural onset and the presence of myofibroblasts, responsible for the excessive extracellular matrix synthesis. Transforming Growth Factor (TGF)-β1 is considered as the major profibrotic cytokine. Its signaling pathway occurs through the Smads proteins, including Smad4. TGF-β1 allows the differentiation of lung fibroblasts and epithelial and mesothelial cells into myofibroblasts. AB-crystallin is a small heat shock protein overexpressed in liver, renal and vascular fibrosis and can be induced by TGF-β1. In this study, we assessed the role of αB-crystallin in pleural and pulmonary fibrosis. We show that αB-crystallin is overexpressed in the lung and the pleura of IPF patients. In vivo, in three pulmonary fibrosis models (bleomycin, TGF-β1 or IL-1β overexpression) αB-crystallin KO mice are protected from fibrosis with an inhibition of the TGF-β pathway. In vitro, in epithelial and mesothelial cells or fibroblasts, αB-crystallin increases Smad4 nuclear localization. Interacting with TIF1γ, responsible for the nuclear export of Smad4, it promotes the nuclear sequestration of Smad4 and thus its profibrotic activity. Instead, αB-crystallin inhibition allows the formation of the Smad4/TIF1γ complex and promotes Smad4 nuclear export an profibrotic activity. This work shows the importance of αB-crystallin in pleuro-pulmonary fibrosis and its role on the TGF-β1 pathway. AB-crystallin appears as a putative therapeutic target for IPF.

Idiopathic Pulmonary Fibrosis (IPF) is a debilitating respiratory disorder that is characterized by a progressive decline in lung function. Originating through unknown etiology, it is essentially an unchecked wound healing response that causes the build-up of excessive scar tissue in the lung interstitial tissue with a heavy toll on the patient’s respiratory capacity. Pro-fibrotic alternatively activated macrophages (M2) have been linked as an important contributor to the fibrotic remodeling of the lung. Previous Ask research indicates that targeting M2 macrophages is possible through the use of the Dectin-1 receptor, a transmembrane cell surface receptor found in high abundance on M2 macrophages. Activating the Dectin-1 receptor through the use of beta-glucan, a ligand the receptor has a high affinity for, initiates a pro-inflammatory response within the naturally immunosuppressive macrophage and can alter its activity to be less fibrogenic. Our data suggest that M2 polarization of naïve macrophages can be inhibited in vitro by beta-glucan microparticles. Additionally, we have found that polarized M2 macrophages adopt M1-like characteristics when treated with beta-glucan microparticles, in a process that is largely Dectin-1 dependent. M2 cell surface marker CD206, increased levels of which are associated with rapidly progressing IPF, shows significantly decreased frequency of expression in M2 macrophages treated with beta-glucan microparticles. Our assessment for cell-specific uptake of beta-glucan microparticles suggests an important role of the Dectin-1 receptor for significantly increased uptake in murine wild-type M2 macrophages relative to their Dectin-1 knockout counterpart. The use of beta-glucan microparticles as a potential anti-fibrotic therapeutic was assessed in the bleomycin model of fibrotic lung disease. Mice given bleomycin and treated with beta-glucan displayed decreased soluble collagen content and TGFB expression within lung homogenate relative to fibrotic bleomycin control mice. Overall, these results provide insight into the use of beta-glucan as a potential activity modulator of macrophage function in IPF and the possibility of its use as a therapeutic. / Thesis / Master of Science (MSc)

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease with worsening respiratory symptoms and physiological impairment. Pulmonary fibrosis is a chronic lung disease characterized by forming scar tissue (fibrosis) in the lungs. Alternatively activated macrophages (M2) known as pro-fibrotic are known to contribute to the fibrotic remodeling of the lung. In addition to the polarization of slices from naïve to pro-fibrotic, the addition of anti-fibrotic therapeutics reprogram slices back to a naïve condition. To polarize the slices, naïve slices are incubated with a previously investigated method in the lab known as the polarization cocktail. The polarization cocktail can be achieved by adding of IL-4, IL-6 and IL-13 to naïve(M0) slices in the Precision Cut lung slice (PCLS) model. For the therapeutic model, slices are incubated with the polarization cocktail and subsequently with the therapeutic. Our results have shown that the precision cut lung slice model can mimic previously investigated in-vivo experiments with the polarization cocktail. Secondly, the addition of therapeutics result in the slices exhibiting lower amounts of M2 markers and arginase activity concluding the model is suitable for the polarization and reprogramming of macrophages. / Thesis / Master of Science in Medical Sciences (MSMS)