Orientador: Ricardo de Lima Zollner / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T16:26:14Z (GMT). No. of bitstreams: 1 Colomeu_TalitaCristina_M.pdf: 1606110 bytes, checksum: ed843e2069440cf659e4ab7cc6c4c21f (MD5) Previous issue date: 2013 / Resumo: A linhagem NOD (non obese diabetic) é utilizada como modelo experimental de DM-1, pois desenvolve espontaneamente a doença com marcante similaridade ao observado em humanos. Vários são os mecanismos propostos para ruptura da tolerância imunológica no DM-1, como a predisposição genética do indivíduo, juntamente com fatores ambientais, tais como estresse e alimentação, parecem favorecer o desencadeamento de mecanismos auto imunes. Nos últimos anos o interesse por alimentos fitoterápicos pelos órgãos governamentais, com a finalidade de auxiliar no tratamento de doenças vem aumentando. A espécie Passiflora sp., é descrita pela farmacopeia Brasileira como fitoterápico e seu uso na medicina popular está relacionado ao tratamento de diversas doenças. Estudos sobre as propriedades das folhas do Passiflora alata Curtis no diabetes mellitus são escassos. Neste contexto, investigamos quais os melhores solventes (água, etanol e metanol/acetona) para extração de compostos bioativos da folha de P.alata, a atividade antioxidante dos solventes pelas técnicas DPPH, FRAP, ABTS e ORAC, fenóis totais, composição centesimal e investigação de quatro compostos fenólicos (vitexina, isovitexina e isoorientina) nas folhas. Além disso, avaliamos as propriedades do consumo crônico do extrato aquoso das folhas de P.alata sobre a incidência do DM-1, a insulite, os níveis de GSH no fígado/rim, a insulina sérica nos camundongos NOD e o estresse oxidativo, a apoptose e a imunofluorescência de infiltrados CD4+,CD8+ e CD11+ nas ilhotas pancreáticas desses animais. Nossos resultados sugerem que o extrato aquoso em comparação com o metanol/acetona e etanólico, apresenta atividade antioxidante e fenóis totais superiores e que seu consumo crônico é capaz de diminuir o índice de infiltrado inflamatório e consequentemente a expressão do diabetes, ajudar a manter os níveis de GSH no fígado/rim e reduzir o estresse oxidativo e apoptose nos camundongos NOD / Abstract: The strain of NOD mice (non obese diabetic) is common used for study with type 1 diabetes mellitus, because develops spontaneously the disease with strong similarity to the observed in humans. Several mechanisms are proposed to break immune tolerance in DM-1, such as genetic predisposition, environmental factors, as infections and dietetic, seem to favor the triggering of autoimmune mechanisms. In recent years the interest in herbal foods in order to prevent diseases is increasing in the population. The species Passiflora sp. is described by Brazilian Pharmacopoeia as herbal medicine and in folk medicine is related to the treatment of various diseases. Studies about properties of leaves of Passiflora alata Curtis related with diabetes mellitus are scarce. In this context, we investigate what the best solvent (water, ethanol and methanol/acetone) for the extraction of bioactive compounds from P.alata leaf, the antioxidant activity of the solvents by DPPH, FRAP, ABTS and ORAC, total phenols, composition and investigation of four phenolic compound (vetexin, isovitexin and isoorientin) in leaves. Furthemore, we evaluated the chronic consumption of aqueous extract on incidence of DM-1, insulits, GSH levels in liver/ kidney, serum insulin in NOD mice and oxidative stress, apoptosis and immunofluorescence of infiltrated CD4+,CD8+CD11+ in the pancreatic islets of these animals. Our results suggest that the aqueous extract shows higher values of antioxidant activity, total phenols and the chronic consumption can reduce the number of inflammatory infiltrate and consequently the expression of diabetes, help maintain the levels of GSH in the liver / kidney and reduce oxidative stress and apoptosis in NOD mice / Mestrado / Clinica Medica / Mestra em Clínica Médica

Orientadores: Aníbal Eugênio Vercesi, Helena Coutinho Franco de Oliveira / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T13:43:10Z (GMT). No. of bitstreams: 1 Malaguti_Carina_D.pdf: 1426741 bytes, checksum: 2f9c742cf17793b79e1517f59f841d47 (MD5) Previous issue date: 2012 / Resumo: Espécies reativas de oxigênio (EROs) tem sido associado com uma grande variedade de doenças metabólicas humanas incluindo o diabetes tipo 1 auto-imune (DM1A). A destruição das células beta pancreáticas no DM1A está associada com estresse oxidativo celular no qual a morte celular ocorre via mitocondrial. O objetivo desse trabalho foi determinar se o estresse oxidativo e a disfunção mitocondrial estão presentes no modelo experimental de DM1A, camundongos NOD (não obeso diabetico) e se isso está relacionado com o desenvolvimento da doença. Foram realizados experimentos em biópsias de fígado e músculo sóleo, mitocôndrias isoladas de fígado, linfócitos de baço e circulante, células tronco de medula óssea e ilhotas pancreáticas isoladas de camundongos NOD e camundongos Balb/c. Os camundongos NOD foram estudados nas três fases da doença: não diabéticos (glicemia < 100 mg/dL, 4-6 semanas de vida), pré-diabéticos (glicemia entre 100-150 mg/dL, 7-10 semanas de vida) e diabéticos (glicemia > 250 mg/dL, 14-25 semanas de vida) comparados aos camundongos Balb/c nas idades correspondentes. A respiração mitochondrial (consumo de oxigênio) foi medida no estado de fosforilação e repouso nas biópsias de fígado e músculo sóleo e em mitocôndrias isoladas e não foram diferentes em camundongos NOD nos três estágios em comparação com os Balb/c nas mesmas idades. Entretanto, as mitocôndrias isoladas de NOD mostraram ser mais susceptível a transição de permeabilidade mitocondrial (TPM) induzida pelo cálcio e sensível a ciclosporina A, determinado por inchamento mitocondrial e pela diminuição da capacidade de retenção de cálcio. Essa maior susceptibilidade a TPM foi observada nos três estágios de desenvolvimento do DM1A. Produção de peróxido de hidrogênio (Amplex red) foi maior nas mitocôndrias isoladas de NOD não-diabéticos, mas não foi alterada nos estágios pré-diabético e diabético. A oxidação do H2DCF pelas células intactas, foi significativamente maior nos linfócitos e células tronco de NOD não-diabéticos, pré-diabéticos e diabéticos comparadas ao controle. Além disso, observamos maiores taxas de oxidação do H2DCF em ilhotas pancreáticas de NOD não-diabéticos. Esses resultados sugerem que o estresse oxidativo precede o desenvolvimento da doença e pode ser a causa da disfunção mitocondrial que está envolvida na morte das células beta. Propomos que o estresse oxidativo é um evento chave na patogênese da DM1A e pode ser um alvo potencial para intervenções / Abstract: Reactive oxygen species (ROS) have been extensively associated with a large variety of human metabolic diseases including type 1 diabetes auto-immune (T1D A). The destruction of islet beta cells in T1DA is associated with cellular oxidative stress and with the mitochondrial pathway of cell death. The aim of this study was to determine whether oxidative stress and mitochondrial dysfunction are present in T1DA experimental model NOD (non obese diabetic mouse) and if they are related to the stages of the development of the disease. The experiments were done in liver and soleus muscles biopsies, isolated liver mitochondria, spleen and circulating lymphocytes, bone marrow stem cells and isolated pancreatic islets from NOD and control Balb/c mice. NOD mice were studied at 3 stages: non-diabetic (glycemia < 100 mg/dL, 4-6 weeks of age), pre-diabetic (glycemia range 100-150 mg/dL, 7-10 weeks of age) and diabetic (glycemia > 250 mg/dL, 14-25 weeks of age) and compared to age matched Balb/c mice. Mitochondria respiration rates (oxygen consumption) measured at phosphorylating and resting states in liver and soleus biopsies and in isolated liver mitochondria were similar in NOD at the three stages of the disease as compared to age matched Balb/c mice. However, NOD isolated liver mitochondrial were shown to be more susceptible to calcium induced mitochondrial permeability transition (MPT), as determined by calcium induced cyclosporine A sensitive swelling and by decreased calcium retention capacity. This higher MPT susceptibility was observed in all 3 stages of the development of diabetes. Hydrogen peroxide production (Amplex red) was higher in isolated liver mitochondria from non-diabetic NOD, but unaltered in pre-diabetic and diabetic NOD mice. The oxidation of H2DCF by intact cells was significantly increased in NOD lymphocytes and stem cells in non-, pre- and diabetic stages as compared to controls. In addition, we observed higher rates of H2DCF oxidation in pancreatic islets from non-diabetic NOD mice. These results suggest that the oxidative stress precedes the establishment of diabetes and may be the cause of mitochondrial dysfunction that is involved in beta cell death. We propose that oxidative stress is a key event in the pathogenesis of T1DA and may be a potential target for interventions / Doutorado / Medicina Experimental / Doutora em Fisiopatologia Médica

Abstract Proper nutrition and optimal weight status in pregnancy are important for both the mother and her child. The present study was aimed at assessment of maternal food and nutrient intake, dietary supplement use, dietary patterns, and weight during pregnancy. Additionally, associations between maternal weight, socio-demographic and perinatal factors and advanced beta cell autoimmunity in the offspring were examined. The results from a one-year cohort of mothers entering the ongoing Type 1 Diabetes Prediction and Prevention (DIPP) study in 1998–99 (n =  797) suggested that healthy food choices were positively correlated with maternal age and education. Dietary supplements were used by 85% of the women. However, the intake of vitamin D did not meet the recommendation and folic acid intake was inadequate in 44% of the pregnant women when both food and supplementation intakes were taken into account. Seven dietary patterns were identified in 3730 pregnant women who entered the DIPP study between 1997 and 2002. The ‘healthy’, the ‘low-fat foods’ and the ‘alcohol and butter’ dietary patterns were positively associated with maternal age and education. The ‘fast food’ dietary pattern was positively associated and the ‘alcohol and butter’ pattern was inversely associated with the rate of maternal weight gain during pregnancy. Altogether, 4093 children and their mothers comprised the study population in which the relationships between maternal initial body mass index, weight gain rate, and the development of beta cell autoimmunity in the offspring were examined. Maternal weight status during pregnancy was not related to the risk of advanced beta cell autoimmunity. A higher level of maternal education was significantly associated with a decreased risk of advanced beta cell autoimmunity in children. More attention should be paid to nutritional guidance among Finnish pregnant women, especially as regards young and less well educated women. Dietary patterns may be useful for risk group identification and they may offer a framework for further research concerning diet and health outcomes among mothers and their children.

Background: The One Drop vertical bar Mobile app supports manual and passive (via HealthKit and One Drop's glucose meter) tracking of self-care and glycated hemoglobin A(1c) (HbA(1c)). Objective: We assessed the HbA(1c) change of a sample of people with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the One Drop vertical bar Mobile app on iPhone and Apple Watch, and tested relationships between self-care tracking with the app and HbA(1c) change. Methods: In June 2017, we identified people with diabetes using the One Drop vertical bar Mobile app on iPhone and Apple Watch who entered two HbA(1c) measurements in the app 60 to 365 days apart. We assessed the relationship between using the app and HbA(1c) change. Results: Users had T1D (n=65) or T2D (n=191), were 22.7% (58/219) female, with diabetes for a mean 8.34 (SD 8.79) years, and tracked a mean 2176.35 (SD 3430.23) self-care activities between HbA(1c) entries. There was a significant 1.36% or 14.9 mmol/mol HbA(1c) reduction (F=62.60, P<.001) from the first (8.72%, 71.8 mmol/mol) to second HbA(1c) (7.36%, 56.9 mmol/mol) measurement. Tracking carbohydrates was independently associated with greater HbA(1c) improvement (all P<.01). Conclusions: Using One Drop vertical bar Mobile on iPhone and Apple Watch may favorably impact glycemic control.

Le modèle murin le plus utilisé pour le diabète de type 1 est la souris NOD. L’activation des lymphocytes T autoréactifs vis à vis des cellules béta nécessite la reconnaissance par le TCR de l’auto antigène présenté par le CMH ainsi que des signaux de co stimulation. Nous apportons la preuve que la voie de costimulation ICOS/ICOSL est indispensable au développement du diabète chez la souris NOD. En effet, les souris invalidées pour le gène Icos ou IcosL sont protégées du diabète. Nous avons démontré que cette protection est liée à un défaut d’activation des LT diabétogènes. De façon inattendue, nous avons observé chez ces souris ICOS-/- et ICOSL-/- une neuromyopathie. Cette pathologie se développe parallèlement au diabète chez la souris ICOSL+/+. Sur le plan histologique, le muscle strié périphérique et le nerf périphérique est envahi par un infiltrat lymphocytaire et par des cellules présentatrices d’antigène. Nous avons démontré par des expériences de transfert adoptif que la neuromyopathie est une maladie auto-immune données, nous avons étudié les souris NOD ICOSL-/- CIITA-/-. Ces souris sont dépourvues de lymphocytes T -CD4+ et ne développent pas de neuromyopathie ni de diabète. De même, nous avons étudié les souris NOD ICOSL-/- béta2m-/-. Ces souris sont dépourvues de lymphocytes T-CD8+ et développent une neuromyopathie. Cette déviation de l’auto-immunité est liée à l’interaction entre les LT et les lymphocytes B via le signal ICOS/ICOSL. Nous avons prouvé via des expériences de transfert et de chimères que l’absence de signal ICOS/ICOSL entre les lymphocytes T et les lymphocytes B oriente l’auto-immunité vers le système nerveux périphérique et le muscle strié. Enfin, l’analyse du spectre de spécificité des anticorps présent chez la souris ICOSL-/- par western blot puis par spectrométrie de masse a précisé les cibles antigéniques de la myopathie. L’invalidation de la voie ICOS/ICOSL conduit donc à une déviation de l’auto-immunité du pancréas vers le muscle et le système nerveux périphérique. Ces données prouvent que la voie ICOS/ICOSL est indispensable à l’initiation du diabète, mais aussi au contrôle de l’auto-immunité / Costimulation pathways are described as central in T cell activation and the control of autoimmune responses. We previously reported that NOD mice that are deficient for the icosl gene are protected from diabetes, but instead develop a spontaneous autoimmune neuromyopathy. The general phenotype of the neuromyopathy observed in ICOSL-/- NOD mice is globally similar to that observed in ICOS-/- and ICOS-/-ICOSL-/- double knockout NOD mice. The neuromyopathy is observed in 100% of female mice by the age of 35 weeks. The neuropathy remains limited to the peripheral nerve tissue. The disease is characterized by an infiltration of immune cells: CD4+ T cells, CD8+ T cells, dendritic cells and B lymphocytes, but does not extend to the central nervous system. A similar infiltrate is seen in muscles. Autoimmune neuromyopathy can be transfer to naive recipients by T lymphocytes. Transfer is achieved in NOD.scid recipient mice by CD4+ T-cells, although not by CD8+ T-cells, isolated from 35 week old ICOSL-/- NOD. The predominant role of CD4+T-cells is further demonstrated in this model by the observation that CIITA-/-ICOSL-/- NOD mice do not developed the neuromyopathy. By contrast, ȕ2m-/-ICOSL-/- NOD mice develop a neuromyopathy. We obtained evidence (in chimeric mice) that the interaction between antigen-presenting cells (APC) and T lymphocytes via ICOS/ICOSL is a prerequisite to the development of diabetes, while the loss of the interaction between T lymphocytes and APC play a key role in the development of nervous and muscular autoimmunity. Finally, the spectrum analysis of antibodies specificity in mouse ICOSL-/- with Western blot and mass spectrometry indicated the antigenic targets of myopathy. Altogether, our data indicate that the deviation of autoimmunity in NOD mice from the pancreas to muscles and the peripheral nervous system in the absence of ICOS/ICOSL signal is dependent on the loss of the physiological interaction between T cells and APC

Les cellules NKT invariantes (iNKT) sont des lymphocytes T non conventionnels restreints par la molécule CD1d qui présente des glycolipides. Les cellules iNKT expriment un TCR avec une chaîne a invariante, Va14-Ja18 chez la souris et Va28-Ja18 chez l’homme. Elles ont la particularité de produire de grande quantité de cytokines (IFN-? et IL-4) rapidement après leur activation et peuvent à leur tour stimuler d’autres cellules du système immunitaire comme les cellules dendritiques, les cellules NK et les lymphocytes T. Elles représentent ainsi un pont entre les réponses immunitaires innées et adaptatives. Le diabète de type 1 est une maladie autoimmune caractérisée par la destruction des cellules ß pancréatiques productrices d’insuline. Bien que l’apparition de diabète de type 1 soit associée à des polymorphismes génétiques, les facteurs environnementaux ont également été impliqués dans l’étiologie de cette maladie. De nombreuses études suggèrent que les infections virales, en particulier les infections par le virus de coxsackie B4 (CVB4), pourraient être impliquées dans le développement de cette maladie. Notre étude a été réalisée avec des souris NOD qui développent un diabète de type 1 vers 15 semaines d’âge et des souris NOD déficientes pour la proinsulin 2 (Pro-ins2-/-) développant un diabète vers 8 semaines d’âge. Nos résultats montrent qu’après infection par CVB4, la moitié des souris NOD et Pro-ins2-/- développent un diabète accéléré par rapport à des souris non infectées. Toutefois, une injection de l’agoniste des cellules iNKT, la molécule aGalactosylceramide (aGalCer), au moment de l’infection des souris, diminue fortement l’incidence de diabète. L’infection par CVB4 induit un fort recrutement de macrophages dans le pancréas et l’activation des cellules iNKT modifie la fonction de ces macrophages. En effet, les macrophages pancréatiques des souris infectées par CVB4 expriment fortement les cytokines IL-1ß, IL-6 et TNF-a, révélant leur caractère pro-inflammatoire alors que les macrophages des souris infectées et traitées par aGalCer expriment faiblement ces cytokines inflammatoires et fortement des enzymes immunosuppressives iNOS (inducible NO synthase), IDO (Indoleamine 2,3-dioxygenase) et arginase I. L’utilisation d’inhibiteurs de ces enzymes montre que la protection contre le diabète est induite par IDO. Nous avons également observé une forte infiltration de lymphocytes T autoréactifs dans les îlots pancréatiques des souris infectées. De façon intéressante, l’incidence accrue de diabète du groupe CVB4 est associée à une fréquence élevée de cellules T autoréactives produisant de l’IFN-? dans le pancréas, alors que la production d’IFN-? par les cellules T autoréactives est très faible dans les souris du groupe CVB4+aGalCer. Cette inhibition de la production d’IFN-? est dépendante de l’enzyme IDO, car l’utilisation d’un inhibiteur d’IDO augmente fortement la production d’IFN-? par les lymphocytes T anti-îlots et l’incidence de diabète. Dans l’ensemble nos résultats montrent, que l’activation des cellules iNKT lors de l’infection par CVB4 induit des macrophages immunosuppresseurs dans le pancréas, ces cellules inhibant la fonction des lymphocytes T autoréactifs et ainsi le développement du diabète. / INKT cells are non-conventional T lymphocytes that are restricted to glycolipid presenting CD1d molecule. iNKT cells express an invariant TCR a chain (Va14-Ja18 in mice and Va28-Ja18 in humans). Their particularity is to rapidly produce copious amounts of cytokines (IFN-? and IL-4) after activation and to activate other cells of the immune system such as dendritic cells, NK cells and T lymphocytes. iNKT cells, therefore, form a bridge between innate and adaptive immune responses. Type 1 diabetes is an autoimmune disease characterized by the destruction of pancreatic ß cells whose role is to produce insulin. While diabetes development can clearly be associated with genetic polymorphisms, environmental factors were also implicated in the etiology of the disease. Numerous studies suggest that viral infections, particularly infections with Coxsackievirus B4 (CVB4), could be implicated in the development of type 1 diabetes. Our study was performed with NOD mice that develop type 1 diabetes around 15 weeks of age and with proinsulin 2 knockout NOD mice (Pro-ins2-/-) which become diabetic around 8 weeks of age. Our results show that CVB4 infection induces accelerated diabetes in around half of NOD and Pro-ins2-/- mice compared to uninfected mice. However, the activation of iNKT cells with their agonist, aGalactosylceramide (aGalCer), at the time of infection greatly decreases diabetes incidence. CVB4 infection induces a strong recruitment of macrophages into the pancreas. Interestingly, iNKT cell activation modifies the function of these macrophages. Indeed, pancreatic macrophages of CVB4 infected mice strongly express IL-1, IL-6 and TNF-a, indicating their pro-inflammatory character. On the contrary, macrophages of mice infected with CVB4 and treated with aGalCer express low levels of these cytokines, but strong levels of suppressive enzymes iNOS (inducible NO synthase), IDO (Indoleamine 2,3-dioxygenase) and arginase I. The use of inhibitors of these enzymes showed that diabetes prevention is induced by IDO. We have also observed that autoreactive T cells strongly infiltrate the pancreatic islets after CVB4 infection. It is interesting to note that the high diabetes incidence of CVB4 infected mice is associated with an increased frequency of IFN-? producing autoreactive T cells in pancreatic islets. On the contrary, the frequency of these cells is very low in infected mice treated with aGalCer. The inhibition of IFN-? production is dependent on IDO enzyme, since the use of its inhibitor strongly increases IFN-? production by anti-islet T cells and diabetes incidence. To summarize, our results show that iNKT cell activation during the infection with CVB4 induces immunosuppressive macrophages in the pancreas. These cells inhibit the function of autoreactive T cells and prevent diabetes development.

Adolescents with type 1 diabetes (T1DM) are given nutritional education, but the knowledge about their adherence to the food recommendations and associations between dietary intake and metabolic control is poor. Gastrointestinal symptoms are more prevalent in adults with T1DM than in healthy controls, which may be due to disturbed gastrointestinal motility. The meal content affects the gastric emptying rate and the postprandial glycaemia in healthy adults and adults with type 2 diabetes. Meal ingestion also elicits several postprandial hormonal changes of importance for gastrointestinal motility and glycaemia. Eating disorders are more prevalent in young females with T1DM than in healthy females, and are associated with poor metabolic control. The prevalence of eating disorders in adolescent boys with T1DM is not known.  This thesis focuses on eating and gastrointestinal function in adolescents with T1DM. Three population-based, cross-sectional studies demonstrated that adolescents with T1DM consume healthy foods more often and have a more regular meal pattern than age- and sex-matched controls. Yet both boys and girls are heavier than controls. The intake of saturated fat is higher and the intake of fibre is lower than recommended in adolescents with T1DM. Patients with poor metabolic control consume more fat and less carbohydrates than patients with better metabolic control. Gastrointestinal symptoms are common in adolescents with T1DM, but the prevalence is not increased compared with controls. Gastrointestinal symptoms in patients are associated with female gender, daily cigarette smoking, long duration of diabetes, poor metabolic control during the past year, and an irregular meal pattern. Adolescent boys with T1DM are heavier and have higher drive for thinness than healthy boys, but do not differ from them in scales measuring psychopathology associated with eating disorders.   In a randomized, cross-over study, we found that a meal with a high fat and energy content reduces the initial (0–2 hours) postprandial glycaemic response and delays gastric emptying in adolescents with T1DM given a fixed prandial insulin dose compared with a low-fat meal. The glycaemic response is significantly associated with the gastric emptying rate. Both a high- and a low-fat meal increase the postprandial concentrations of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) and suppress the postprandial ghrelin levels in adolescents with T1DM. The postprandial changes of these hormones are more pronounced after the high-fat meal. Insulin-like growth factor binding-protein (IGFBP) –1 concentrations decrease after insulin administration irrespective of meal ingestion. The GLP-1 response is negatively associated with the gastric emptying rate. The fasting ghrelin levels are negatively associated with the postprandial glycaemic response, and the fasting IGFBP-1 levels are positively associated with the fasting glucose levels.  We conclude that nutritional education to adolescents with T1DM should focus more on energy intake and expenditure to prevent and treat weight gain. It should also focus on fat quality and fibre intake to reduce the risk of macrovascular complications and improve glycaemia. Gastrointestinal symptoms in adolescents with T1DM should be investigated and treated as in other people irrespective of having diabetes. However, adolescents with long duration of diabetes, poor metabolic control, and symptoms from the upper gut should have their gastric emptying rate examined during euglycaemia. There may be an increased risk for development of eating disorders in adolescent males with T1DM since they are heavier than healthy boys and have higher drive for thinness. This should be investigated in future, larger studies.  For the first time, we showed that a fat-rich meal delays gastric emptying and reduces the initial glycaemic response in patients with T1DM. The action profile of the prandial insulin dose to a fat-rich meal may need to be postponed and prolonged compared with the profile to a low-fat meal to reach postprandial normoglycaemia. Circulating insulin levels affect postprandial GIP, GLP-1, and ghrelin, but not IGFBP-1, responses less than the meal content. The pronounced GIP-response to a fat- and energy-rich meal may promote adiposity, since GIP stimulates lipogenesis. Such an effect would be disadvantageous for adolescents with T1DM since they already have increased body fat mass and higher weights compared with healthy adolescents. Adolescents with T1DM may have subnormal postprandial ghrelin suppression, which may be due to their increased insulin resistance or elevated growth hormone levels. This needs to be investigated in future, controlled studies.

Type 1 diabetes (T1D) is etiologically considered as an autoimmune disease, where insulin-producing β-cells are damaged by autoimmune attacks. Regulatory T (Treg) cells are immune homeostasis cells. In the present thesis I aimed to investigate the role of Treg cells and other immune cells in the early development of T1D. In order to do that, we first determined which immune cells that are altered at an early stage of the T1D development. We found that dendritic cells and plasmacytoid dendritic cells induce the initial immune response. Next, we investigated the role of Treg cells in multiple low dose streptozotocin (MLDSTZ) induced T1D and in NOD mice. We found that the numbers of Treg cells were increased in both MLDSTZ and NOD mice when the MLDSTZ mice were hyperglycemic. However, the increased Treg cells showed a decreased production of anti-inflammatory cytokines (IL-10, IL-35 and TGF-β) and an increased expression of pro-inflammatory cytokines (IFN-γ and IL-17a). These results revealed that Treg cells switch their phenotype under T1D conditions. IL-35 administration effectively prevented the development of, and reversed established MLDSTZ induced T1D. Treg cells from IL-35 treated mice showed an increased expression of the Eos transcription factor, accompanied by an increased expression of IL-35 and a decreased expression of IFN-γ and IL-17a. These data indicate that IL-35 administration counteracted the early development of T1D by maintaining the phenotype of the Treg cells. Furthermore, IL-35 administration reversed established T1D in the NOD mouse model by maintaining the phenotype of Treg cells, seemingly by inducing the expression of Eos. Moreover, the circulating level of IL-35 was significantly lowered in both new onset and long-standing T1D patients compared to healthy controls. In addition, patients with T1D with remaining C-peptide had significantly higher levels of IL-35 than patients lacking C-peptide, suggesting that IL-35 might prevent the loss of β-cell mass. In line with this hypothesis, we found that LADA patients had a higher proportion of IL-35+ tolerogenic antigen presenting cells than T1D patients. Subsequently, we determined the proportions of IL-35+ Treg cells and IL-17a+ Treg cells in T1D patients with diabetic nephropathy (DN), which were age, sex and BMI matched with healthy controls and T1D patients. The proportion of IL-35+ Treg cells was decreased in DN and T1D patients, but IL-17a+ Treg cells were more abundant than in healthy controls. Furthermore, we found that the number of Foxp3+ Treg cells was increased in the kidneys of MLDSTZ mice. However, infiltration of mononuclear cells was seen in kidneys of these mice. In addition, kidney tissues of IL-35 treated MLDSTZ mice did not show any mononuclear cell infiltration. These results demonstrate that IL-35 may be used to prevent mononuclear cell infiltration in kidney diseases. Our findings indicate that the numbers of Foxp3+ Treg cells are increased in T1D, but that these Treg cells fail to counteract the ongoing immune assault in islets and kidneys of hyperglycemic mice. This could be explained by a phenotypic shift of the Treg cells under hyperglycemic conditions. IL-35 administration reversed established T1D in two different animal models of T1D and prevented mononuclear cell infiltration in the kidneys by maintaining the phenotype of Treg cells.

L'interleukine-2 (IL-2) est nécessaire à l'homéostasie des lymphocytes T régulateurs CD4+ Foxp3+ (Tregs) et son administration à faibles doses permet d'induire une expansion spécifique et dose-dépendante de ces cellules. Nous avons précédemment démontré que l'administration d'IL-2 à faibles doses permet de restaurer la tolérance immunitaire chez la souris NOD (modèle murin de diabète autoimmun). Toutefois cette stratégie n'est efficace à long terme que chez 30% des souris traitées.Mon travail de thèse a porte? sur l'amélioration de la thérapie par faibles doses d'IL-2. Dans un premier temps, nous avons démontré que la combinaison de l'IL-2 avec la rapamycine, une drogue ciblant préférentiellement les lymphocytes T effecteurs et épargnant les Tregs, ne permet pas d'améliorer le traitement. Au contraire, la rapamycine abolit de façon transitoire la tolérance induite par l'IL-2. Dans un deuxième temps, nous avons essayé d'augmenter les doses d'IL-2, dans le but d'induire une activation plus forte des Tregs. Néanmoins, le traitement par fortes doses d'IL-2 ne prévient pas le diabète autoimmun mais accélère son développement et est associé à une très forte toxicité.Ensuite, un deuxième axe de ma thèse s'est articulé autour de notre découverte de l'existence d'autoanticorps anti-IL-2 neutralisants chez la souris NOD et les patients souffrant de diabète de type 1. Ces autoanticorps modulent négativement l'homéostasie des Tregs in vivo, suggérant un rôle potentiel dans la physiopathologie du diabète autoimmun.Dans l'ensemble, ces résultats permettent de reconsidérer l'utilisation de l'IL-2 à faibles doses, seule ou combinée, dans le contexte du diabète de type 1. / CD4+ Foxp3+ regulatory T cells (Treg cells) are essential for the maintenance of immune tolerance. Interleukin-2 (IL-2) is mandatory for the homeostasis of Treg cells and its administration at low-doses induces a specific dose-dependent boost of Treg cells. Previous work has demonstrated that a short-tem treatment with low-doses IL-2 can revert established autoimmune diabetes in the NOD mouse model. However, this strategy induces long-term reversal in only 30% of the treated mice and can be optimized. During my PHD, my work has focused on the optimization of T1D therapy with low-doses of IL-2. First, we tried to combine low-doses of IL-2 with rapamycin, an immunosuppressive drug known to mainly affect Teff cells. The combined treatment (IL-2/Rapa) did not induce diabetes reversal and even reversibly broke IL-2-induced tolerance. Then, we tried to increase the IL-2 dose in order to increase the amplitude of the Treg boost. However, despite an important Treg cell boost, high-doses IL-2 administration to pre-diabetic NOD mice was toxic and precipitated T1D onset. In a second project, we described the existence of neutralizing anti-IL-2 autoantibodies in NOD mice and T1D patients. Our data suggested that anti-IL-2 autoantibodies negatively impacted on Treg cell homeostasis in vivo, contributing to the impaired immune tolerance observed in NOD mice and T1D patients. Altogether, our results lead to the consideration of low-doses IL-2, alone or combined, for the treatment of T1D. In addition, our demonstration of the existence of anti-IL-2 autoantibodies in NOD mice and T1D patients leads to a better understanding of T1D physiopathology.

La régulation de la concentration de glucose dans l'organisme est nécessaire au bon fonctionnement des globules rouges et de l'ensemble des cellules, dont celles des muscles et du cerveau. Cette régulation met en jeu plusieurs organes ainsi que le système hormonal dont une hormone en particulier, l’insuline. Le diabète de type 1 est une maladie où les cellules productrices d'insuline du pancréas sont détruites. Afin de compenser cette perte de production d'insuline, le traitement de cette maladie consiste, pour le patient, à déterminer une dose d'insuline à s'injecter en fonction de mesures de sa glycémie et de certaines caractéristiques intervenant dans la régulation de celle-ci (repas, activité physique, stress,...). Cette thèse s'inscrit dans une démarche d’automatisation du traitement en proposant un nouveau modèle non-linéaire du métabolisme glucidique pouvant être utilisé dans une solution de contrôle en boucle fermée. Nous avons prouvé que ce modèle possède une unique solution positive et bornée pour des conditions initiales fixées et sa commandabilité locale. Nous nous sommes ensuite intéressés à l’identification paramétrique de ce modèle. Nous avons montré son identifiabilité structurelle et pratique. Dans ce cadre, une nouvelle méthodologie permettant de qualifier l'identifiabilité pratique d'un modèle, basée sur une divergence de Kullback-Leibler, a été proposée. Une estimation des paramètres du modèle a été réalisée à partir de données de patients réels. Dans ce but, une méthodologie d'estimation robuste, basée sur un critère de Huber, a été utilisée. Les résultats obtenus ont montré la pertinence du nouveau modèle proposé. / The development of new control models to represent more accurately the plasma glucose-insulin dynamics in T1DM is needed for efficient closed-loop algorithms. In this PhD thesis, we proposed a new nonlinear model of five time-continuous state equations with the aim to identify its parameters from easily available real patients' data (i.e. data from the insulin pump and the glucose monitoring system. Its design is based on two assumptions. Firstly, two successive remote compartments, one for insulin and one for glucose issued from the meal, are introduced to account for the distribution of the insulin and the glucose in the organism. Secondly, the insulin action in glucose disappearance is modeled through an original nonlinear form. The mathematical properties of this model have been studied and we proved that a unique, positive and bounded solution exists for a fixed initial condition. It is also shown that the model is locally accessible. In this way, it can so be used as a control model. We proved the structural identifiability of this model and proposed a new method based on the Kullback-Leiber divergence in view to test its practical identifiability. The parameters of the model were estimated from real patients' data. The obtained mean fit indicates a good approximation of the glucose metabolism of real patients. The predictions of the model approximate accurately the glycemia of the studied patients during few hours. Finally, the obtained results let us validate the relevance of this new model as a control model in view to be applied to closed-loop algorithms.