Previous studies have suggested that T cell contact‐dependent signaling of macrophages (MΦ) is mediated by membrane tumor necrosis factor‐α (memTNF‐α), based on the observation that anti‐TNF‐α could inhibit T cell‐mediated MΦ activation. The current report confirms that anti‐TNF‐α does inhibit activation of interferon‐γ (IFN‐γ)‐primed MΦ by paraformaldehyde‐fixed activated T cells. However, the involvement of membrane molecules other than memTNF‐α in the contact‐dependent signaling is suggested by two lines of evidence. First, the TH2 clone, AK8, displayed neither secreted TNF‐α/β nor memTNF‐α/β detectable by bioassay or immunofluorescence. Nonetheless, AK8 cells were equally effective, on a per cell basis, in contact‐dependent signaling of MΦ activation as TH2 and TH1 cells which do express memTNF‐α. Second, the expression of memTNF‐α by the TH clone, D10.G4, is maximal 24 h after activation, whereas the ability of this clone to activate MΦ is maximal at 6–8 h of activation and declines thereafter. Since TNF‐α is known to play a critical role in activation of MΦ effector function, it was hypothesized that T cell membrane components other than memTNF‐α might signal MΦ production of TNF‐α, thus allowing autocrine TNF‐α stimulation of MΦ effector function. In support of this, it is demonstrated that paraformaldehyde‐fixed activated TH2 cells can induce de novo production and release of TNF‐α by MΦ. This effect was not an artifactual result of paraformaldehyde fixation since paraformaldehyde‐fixed resting T cells did not induce TNF‐α gene expression. Previous studies have demonstrated a role for autocrine TNF‐α stimulation in LPS induction of effector function in recombinant IFN‐γ‐primed MΦ. The current study confirms that TNF‐α plays a critical role in T cell contact‐dependent signaling of MΦ but indicates that memTNF on the T cells may not be a sine qua non factor for contact‐dependent signaling. The data suggest that other T cell membrane molecules contribute to activation of MΦ effector function by stimulation of MΦ TNF‐α production.

Les maladies alcooliques du foie (MAF) sont responsables de 3,8% de la mortalité mondiale et restent une cause majeure de mortalité par maladies hépatiques, plus importante que l’hépatite C. Malgré le fardeau qu’elles représentent, tant sur le plan de la morbi-mortalité que sur le plan économique, il n’existe que très peu d’options thérapeutiques hormis l’abstinence et la transplantation hépatique. Une meilleure compréhension de la pathophysiologie et des facteurs impliqués dans les MAF permettrait d’identifier de nouvelles cibles thérapeutiques afin d’améliorer la prise en charge et le pronostic des patients.Il est largement admis que les patients souffrant de MAF présentent une dérégulation de leur réponse immunitaire. A l’état de base, il existe déjà une hyper-activation de leurs monocytes circulants et une élévation de leurs taux plasmatiques de cytokines pro-inflammatoires, dont le tumor necrosis factor-α (TNF-α). Lors d’une stimulation, la réponse inflammatoire des patients avec une MAF est exacerbée, les taux de TNF-α augmentent rapidement. Cet état, dont tous les mécanismes ne sont pas encore élucidés, est associé avec la sévérité et la mortalité de la MAF, ainsi qu’avec la survenue de complications de la cirrhose. Identifier les facteurs qui sous-tendent à cette réponse inflammatoire excessive et délétère aiderait probablement à mieux la réguler. Les patients atteints de MAF présentent de manière très fréquente un état de dénutrition qui est également associé au développement de complications et à la mortalité de la cirrhose. Les études de supplémentation nutritionnelle, dont les résultats sont controversés, se sont portées principalement sur le versant protéino-calorique des carences, alors que les patients souffrant de MAF présentent aussi des déficiences spécifiques en micro-nutriments, notamment en vitamines A et D, dont la signification pathophysiologique n’a jamais été étudiée. En effet, les vitamines A et D possèdent, en plus de leurs effets classiquement décrits, des effets immuno-modulateurs, anti-inflammatoires, anti-TNF-α et anti-fibrosants. Les carences en vitamine A et en vitamine D, ou en leurs métabolites actifs, l’acide all-trans rétinoïque (ATRA) et la 1α,25-dihydroxyvitamine D (1,25(OH)2D), pourraient donc être impliquées dans l’hyper-réponse inflammatoire délétère et dans la fibrose présentes dans les MAF. Dans un premier temps, nous avons étudié l’association entre les taux plasmatiques des vitamines A, D et d’ATRA, et la sévérité et la mortalité des MAF. Nous avons confirmé l’existence de déficiences en ces micro-nutriments chez les patients souffrant de MAF et nous avons montré l’association significative de ces carences avec la sévérité de la maladie, évaluée par les scores de MELD et de Child-Pugh, ainsi qu’avec la mortalité. Ces observations épidémiologiques très intéressantes ne permettent, cependant, pas de déterminer le rôle biologique potentiel des carences en vitamines A et D dans le développement et la progression des lésions hépatiques liées à l’alcool. En effet, le foie étant l’organe principal de stockage de la vitamine A et le lieu de la première hydroxylation de la vitamine D, les carences pourraient aussi bien être la conséquence de l’insuffisance hépatique et donc, un marqueur de sévérité, qu’une cause aux lésions, et donc une cible thérapeutique potentielle. Afin de déterminer l’existence d’un lien causal entre déficience et maladie hépatique, nous avons élaboré des expérimentations in vitro sur des cellules de patients et in vivo chez la souris. Nous montrons que les supplémentations in vitro en ATRA ou en 1,25(OH)2D modifient la réponse inflammatoire exacerbée des lymphomonocytes circulants (PBMC :peripheral blood mononuclear cells) de patients avec MAF. Elles diminuent l’expression et la production de TNF-α et augmentent celle de l’interleukine-10 (IL-10), cytokine anti-inflammatoire, en ce qui concerne l’ATRA. L’action de ce dernier est pré-transcriptionnelle puisqu’il agit sur l’expression de TNF-α, et semble être dépendante de son récepteur à l’acide rétinoïque de type RAR. En effet, l’ATRA agit via sa liaison à deux types de récepteurs, le RAR et le RXR, récepteur rétinoïque X. Nos données montrent que l’utilisation d’un agoniste RAR reproduit les mêmes effets que l’ATRA, à l’inverse de l’utilisation d’un agoniste RXR. In vivo, dans un modèle murin de MAF, nous montrons que la supplémentation orale en 1,25(OH)2D est capable de diminuer l’expression intra-hépatique de TNF-α qui est augmentée par le régime alcoolisé. Nos résultats montrent donc que dans le contexte des lésions hépatiques liées à l’alcool, les supplémentations en métabolites actifs des vitamines A et D, in vitro, sur des cellules de patients, et in vivo, dans le modèle Lieber-DeCarli, ont un effet inhibiteur sur le TNF-α circulant et intra-hépatique. En parallèle à ces données de supplémentation, nous montrons que la carence en vitamine A chez des souris s’accompagne d’une augmentation de l’activation et de la fonction de leurs macrophages péritonéaux, état réversible par l’administration orale d’ATRA. De manière intéressante, nous observons également un état d’hyper-activation des monocytes circulants de patients avec MAF, dont la déficience en vitamine A a été démontrée. Ces données suggèrent que la carence en vitamine A présente chez les patients atteints de MAF pourrait faire partie des mécanismes favorisant cet état d’hyper-réponse inflammatoire.Certaines données montrent que la consommation chronique d’alcool induit une stabilisation de l’ARNm de TNF-α, expliquant en partie l’augmentation de ses taux plasmatiques chez les patients avec MAF. D’autres montrent qu’un traitement par l’ATRA est capable de déstabiliser l’ARNm de TNF-α, accélérant ainsi sa dégradation. Nos résultats montrent que la carence en vitamine A chez la souris s’accompagne d’un allongement du temps de demi-vie de l’ARNm de TNF-α exprimé par les macrophages péritonéaux murins, illustrant sa plus grande stabilité comparée aux souris non carencées en vitamine A. La déficience en vitamine A présente dans les MAF pourrait donc expliquer, du moins en partie, l’augmentation des taux de TNF-α par la stabilisation de son ARNm.Finalement, nous avons étudié l’effet de la 1,25(OH)2D sur le phénotype de cellules stellées humaines, impliquées dans le processus de fibrose hépatique. Le traitement de ces cellules par le métabolite actif de la vitamine D diminue leur activation, modifie l’expression de gènes pro- et anti-fibrosants, mais n’a pas d’action sur l’apoptose.En conclusion, nous montrons pour la première fois l’association entre les déficiences en vitamine A/ATRA et vitamine D, et la sévérité des MAF. De plus, nos résultats suggèrent que les carences vitaminiques, présentes chez les patients avec une MAF, pourraient participer à la pathophysiologie de ces maladies en activant les cellules immunitaires, et que leur supplémentation pourrait diminuer l’état pro-inflammatoire et pro-fibrosant délétère de la cirrhose. Les déficiences en vitamines A et D ne seraient pas seulement le reflet de la sévérité de la MAF, mais joueraient bien un rôle dans le développement et la progression des lésions hépatiques. Leur évaluation et leur correction devraient être étudiées comme cible thérapeutique dans la prise en charge des MAF. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18682号 / 医博第3954号 / 新制||医||1007(附属図書館) / 31615 / 京都大学大学院医学研究科医学専攻 / (主査)教授 羽賀 博典, 教授 野田 亮, 教授 坂井 義治 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

These studies indicate that tumor necrosis factor-α (TNFα) alters albumin permeability and unlike bradykinin (BK) the increased albumin permeability lasts for the duration of the application. Neither agonist requires the presence of white blood cells or other blood-borne substances to produce this inflammatory response. These experiments were completed in the in situ, microcannulated, perfused venules of the mesentery in the anesthetized hamster. Albumin transport was measured using intravital fluorescence microscopy, TRITC-labeled albumin, and densitometric tracking. Further, by varying the intravascular pressure, the hydraulic (L(p)(1 - σ)) and diffusive permeability (P0) coefficients of these microvessels were determined. Both BK and TNFα produced an increase in albumin flux, which was dependent upon the dose and time domains. This response was present when the agonists were given by either intra- or extravascular presentation. Both hydraulic coupling and microvascular permeability were increased by BK and TNFα. TNFα increased albumin permeability rapidly and its effect lasted as long as TNFα was present, whereas the increased albumin transport by BK was biphasic. The results implicate a dynamic modification in the microvascular wall to these inflammatory agonists and the mechanism(s) for transduction in the endothelium are quite different.

<p>Cytokines are soluble signalling mediators within the immune system, and have been shown to be of importance in the development of type 1 diabetes (T1D). This thesis studied the production of cytokines in experimental models of T1D and during transplantation of insulin-producing islets of Langerhans. </p><p>We have demonstrated that the transcriptional TNFα-inhibitor MDL 201,449A, previously shown to reduce immune-mediated diabetes induced in mice by multiple low doses of streptozotocin, was not TNFα-specific, but also inhibited IFNγ and IL-10 in spleen cells. Furthermore, when the inhibitor was removed from in vitro cultures, a rebound phenomenon of increased cytokine secretion occurred.</p><p>The thesis also investigated whether plastic adhesion, a method generally employed to deplete macrophages, influenced cytokine production in spleen cells. We observed that plastic adhesion increased TNFα, IFNγ and IL-10 release, and decreased IL-4 secretion. Plastic adhesion depleted only ~30% of the macrophages, but as much as ~60% of the regulatory T cells. </p><p>Thirdly, we found that “control” treatments for islet transplantations, i.e. syngeneic and sham transplantations, exerted a clear effect on cytokine production from spleen cells, possibly due to a decrease in regulatory T cells that may be caused by the surgery and/or anaesthesia. Moreover, spleen cells from mice exposed to surgery exhibited a decreased proliferative capacity to concanavalin A stimulation. We also perceived a marked difference in cytokine response depending on the mouse strain used in the experiments.</p><p>Finally, we aimed to elucidate if, besides autoimmune activities, also high glucose- and free fatty acid concentrations as seen in diabetes could cause changes in cytokine production. We observed that spleen cells cultured in varying glucose concentrations had different cytokine production profiles. The free fatty acid palmitate might also influence cytokine release, but this effect was obscured by the cytokine-suppressive action of the ethanol used to dissolve the palmitate.</p>

Despite major advances in the treatment and prevention of atherosclerosis the last several decades, cardiovascular disease still accounts for the majority of deaths in Sweden. With the population getting older, more obese and with rising numbers of diabetics, the cardiovascular disease burden may increase further in the future. The focus in cardiovascular disease has shifted with time from calcification and narrowing of arteries to the biological processes within the atherosclerotic plaque. C-reactive protein (CRP) has emerged as one of many proteins that reflect a low grade systemic inflammation and is suitable for analysis as it is more stable and easily measured than most other inflammatory markers. Several large prospective studies have shown that CRP is not only an inflammatory marker, but even a predictive marker for cardiovascular disease. C-reactive protein is associated with several other risk factors for cardiovascular disease including obesity and the metabolic syndrome. Our study of twenty healthy men during a two week endurance cross country skiing tour demonstrated a decline in already low baseline CRP levels immediately after the tour and six weeks later. In a study of 200 obese individuals with impaired glucose tolerance randomised to a counselling session at their health care centre or a one month stay at a wellness centre, we found decreased levels of CRP in subjects admitted to the wellness centre. The effect remained at one, but not after three years of follow-up. In a prospective, nested, case-referent study with 308 ischemic strokes, 61 intracerebral haemorrhages and 735 matched referents, CRP was associated with ischemic stroke in both uni- and multivariate analyses. No association was found with intracerebral haemorrhages. When classifying ischemic stroke according to TOAST criteria, CRP was associated with small vessel disease. The CRP 1444 (CC/CT vs. TT) polymorphism was associated with plasma levels of CRP, but neither with ischemic stroke nor with intracerebral haemorrhage. A study on 129 patients with atrial fibrillation was used to evaluate whether inflammation sensitive fibrinolytic variables adjusted for CRP could predict recurrence of atrial fibrillation after electrical cardioversion. In multivariate iv models, lower PAI-1 mass was associated with sinus rhythm even after adjusting for CRP and markers of the metabolic syndrome. In conclusion, lifestyle intervention can be used to reduce CRP levels, but it remains a challenge to maintain this effect. CRP is a marker of ischemic stroke, but there are no significant associations between the CRP1444 polymorphism and any stroke subtype, suggesting that the CRP relationship with ischemic stroke is not causal. The fibrinolytic variable, PAI-1, is associated with the risk of recurrence of atrial fibrillation after electrical cardioversion after adjustment for CRP. Our findings suggest a pathophysiological link between atrial fibrillation and PAI-1, but the relation to inflammation remains unclear.

Cytokines are soluble signalling mediators within the immune system, and have been shown to be of importance in the development of type 1 diabetes (T1D). This thesis studied the production of cytokines in experimental models of T1D and during transplantation of insulin-producing islets of Langerhans. We have demonstrated that the transcriptional TNFα-inhibitor MDL 201,449A, previously shown to reduce immune-mediated diabetes induced in mice by multiple low doses of streptozotocin, was not TNFα-specific, but also inhibited IFNγ and IL-10 in spleen cells. Furthermore, when the inhibitor was removed from in vitro cultures, a rebound phenomenon of increased cytokine secretion occurred. The thesis also investigated whether plastic adhesion, a method generally employed to deplete macrophages, influenced cytokine production in spleen cells. We observed that plastic adhesion increased TNFα, IFNγ and IL-10 release, and decreased IL-4 secretion. Plastic adhesion depleted only ~30% of the macrophages, but as much as ~60% of the regulatory T cells. Thirdly, we found that “control” treatments for islet transplantations, i.e. syngeneic and sham transplantations, exerted a clear effect on cytokine production from spleen cells, possibly due to a decrease in regulatory T cells that may be caused by the surgery and/or anaesthesia. Moreover, spleen cells from mice exposed to surgery exhibited a decreased proliferative capacity to concanavalin A stimulation. We also perceived a marked difference in cytokine response depending on the mouse strain used in the experiments. Finally, we aimed to elucidate if, besides autoimmune activities, also high glucose- and free fatty acid concentrations as seen in diabetes could cause changes in cytokine production. We observed that spleen cells cultured in varying glucose concentrations had different cytokine production profiles. The free fatty acid palmitate might also influence cytokine release, but this effect was obscured by the cytokine-suppressive action of the ethanol used to dissolve the palmitate.

Die Haut ist das größte Organ des Menschen und bildet die Barriere gegenüber Einwirkungen aus der Umwelt. Die Störung der Hautbarriere durch exogene und endogene Reize führt zu einer Entzündungsreaktion in der Haut. In der Folge können Hauterkrankungen wie die irritative oder Atopische Dermatitis entstehen. Der Tumor Nekrose Faktor-α (TNF-α) ist ein pleiotrop wirksames Zytokin, das eine zentrale Rolle bei entzündlichen Prozessen spielt. Ziel der vorgelegten Promotionsarbeit war zu untersuchen, ob und wie TNF-α zu Entzündungsgeschehen, ausgelöst durch exogene und endogene Faktoren, beiträgt. Die Bedeutung von TNF-α wurde in TNF-ko Mäusen in verschiedenen Hautmodellen untersucht. Für das Irritationsmodell wurden chemische und physikalische Reize verwendet. TSLP (Thymic stromal lymphopoietin) wurde durch die verschiedenen Stimuli signifikant induziert. Diese Induktion war unabhängig von der endogenen TNF-α Produktion, gezeigt durch den Einsatz von TNF- ko Mäusen . Da endogenes TNF-α für die Hautirritation keine notwendige Bedingung darstellte, wurde die Bedeutung von TNF-α bei der atopischen Dermatitis (AD) untersucht. TNF-α defiziente Mäuse zeigen verstärkt Ekzeme im Vergleich zu Wildtyp Mäusen. Die Behandlung von TNF-ko Mäusen mit einem TSLP Antikörper führte zu einer Verminderung des Ekzems. Mastzellen wurden vermehrt in läsionaler Haut gefunden und korrelierten mit dem Schweregrad des atopischen Ekzems sowie der TSLP-Expression. / The skin is the largest organ of an individuum and builds the barrier for a host against the environment. Skin barrier disruption by exogenous or endogenous stimuli can lead to skin inflammation. As a consequence, irritant or atopic eczema, frequent skin diseases, may evolve. Tumor necrosis factor-α (TNF-α) is a pleiotropic cytokine which plays a central role in inflammatory processes. The main aim of this thesis was to clarify whether and how endogenous TNF-α is contributing to skin inflammation driven by exogenous and endogenous triggers. The role of endogenous TNF-α was studied using TNF knockout (-/-) mice. In an irritation model, chemical and physical stimuli were applied on to mouse skin. Thymic stromal lymphopoietin (TSLP) was significantly induced by the used irritants. This TSLP induction was independent from endogenous TNF-α proven by using TNF-/- mice. Next the role of TNF-α in atopic dermatitis (AD) promoting an allergic skin inflammation was investigated. TNF-/- mice developed more severe AD compared to the wildtype mice and TSLP was significantly increased and correlated with the severity of the eczema. To prove the pathophysiological role of TSLP for AD progression, TNF-/- mice were pretreated with an TSLP antibody. Indeed, these mice developed less AD symptoms compared to the control mice. Mast cells (MCs) were also significantly increased in lesional skin in the AD model and moreover, correlated with AD severity, but also with TSLP expression.

SMOFLipid® is a commonly used fat emulsion for parenteral nutrition. We investigated how enrichment of SMOFLipid® with n-3 polyunsaturated fatty acids (PUFA) in a form of second fat emulsion, Omegaven® , changes fatty acid composition of total plasma phospholipids and erythrocyte phospholipids, cytokine concentrations in serum and in supernatant from in vitro whole blood culture stimulated with lipopolasaccharide (LPS) and we evaluated also changes in oxido- reductive balance. Eight patients on long-term home parenteral nutrition recieved both emulsions, SMOFLipid® (6 weeks) and SMOFLipid® +Omegaven® (4 weeks), one by one. We observed no significant differences in common laboratory and clinical parameters between these two types of diet. Enrichment of SMOFLipid® with Omegaven® led to an increase in eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) in total plasma phospholipids and there was also an increse in proportion of EPA in erythrocyte phospholipids, while proportion of DHA remained unchanged. These changes were in both phospholipids of plasma and erythrocyte compensated for a decrease in proportion of linoleic and arachidonic acid (n-6 PUFA). There were elevated IL-6 and TNF-α serum concentrations in patients after both diets. There was a decrease in IL-6 production by 36% with SMOFLipid®...

Transplantation of multipotent mesenchymal progenitor cells is a valuable option for treating tendon disease. Tenogenic differentiation leading to cell replacement and subsequent matrix modulation may contribute to the regenerative effects of these cells, but it is unclear whether this occurs in the inflammatory environment of acute tendon disease. Equine adipose-derived stromal cells (ASC) were cultured as monolayers or on decellularized tendon scaffolds in static or dynamic conditions, the latter represented by cyclic stretching. The impact of different inflammatory conditions, as represented by supplementation with interleukin-1β and/or tumor necrosis factor-α or by co-culture with allogeneic peripheral blood leukocytes, on ASC functional properties was investigated. High cytokine concentrations increased ASC proliferation and osteogenic differentiation, but decreased chondrogenic differentiation and ASC viability in scaffold culture, as well as tendon scaffold repopulation, and strongly influenced musculoskeletal gene expression. Effects regarding the latter differed between the monolayer and scaffold cultures. Leukocytes rather decreased ASC proliferation, but had similar effects on viability and musculoskeletal gene expression. This included decreased expression of the tenogenic transcription factor scleraxis by an inflammatory environment throughout culture conditions. The data demonstrate that ASC tenogenic properties are compromised in an inflammatory environment, with relevance to their possible mechanisms of action in acute tendon disease.