Rozprawy doktorskie na temat „Pulmonary Pathophysiology”

Includes bibliographical references (leaves 218-249) The preferred theory to explain the aetiology of emphysema points to an imbalance in the protease-antiprotease systems within the lung with human leukocyte elastase and [alpha]1-protease inhibiter being the main candidates. Examines some aspects of this theory.

Bibliography: leaves 168-184. The work in this study encompasses oxygen free radical related inflammation in the peripheral lung and in lung cells. Animal and human studies have been used. Methods include cell culture with function studies, protein chemistry, animal and human physiology, and cell and lung structure through histopathology, and various forms of electron microscopy. The work resulting from this thesis has formed an important basis for understanding acute and chronic lung injury.

The original work presented in this thesis investigates some of the mechanisms that may be responsible for the aetiology of altitude-related cough. Particular attention is paid to its relationship to the long recognised, but poorly understood, changes in lung volumes that occur on ascent to altitude. The literature relevant to this thesis is reviewed in Chapter 1.

Widespread reports have long existed of a debilitating cough affecting visitors to high altitude that can incapacitate the sufferer and, on occasions, be severe enough to cause rib fractures (22, 34, 35). The prevalence of cough at altitude has been estimated to be between 22 and 42% at between 4200 and 4900 m in the Everest region of Nepal (10, 29). Traditionally the cough was attributed to the inspiration of the cold, dry air characteristic of the high altitude environment (37) but no attempts were made to confirm this aetiology. In the first formal study of cough at high altitude, nocturnal cough frequency was found to increase with increasing altitude during a trek to Everest Base Camp (5300 m) and massively so in 3 climbers on whom recordings were made up to 7000 m on Everest (8). After 9 days at 5300 m the citric acid cough threshold, a measure of the sensitivity of the cough reflex arc, was significantly reduced compared with both sea level and arrival at 5300 m.

During Operation Everest II, a simulated climb of Mount Everest in a hypobaric chamber, the majority of the subjects were troubled above 7000 m by pain and dryness in the throat and an irritating cough despite the chamber being maintained at a relative humidity of between 72 and 82% and a temperature of 23ºC (18). This argued against the widely held view that altitude-related cough was due to the inspiration of cold, dry air.

In the next major hypobaric chamber study, Operation Everest III, nocturnal cough frequency and citric acid cough threshold were measured on the 8 subjects in the study. The chamber temperature was maintained between 18 and 24ºC and relative humidity between 30 and 60% (24). This work is presented in Chapter 2 and, demonstrated an increase in nocturnal cough frequency with increasing altitude which immediately returned to control values on descent to sea level. Citric acid cough threshold was reduced at 8000 m compared to both sea level and 5000 m values. Changes in citric acid cough threshold at lower altitudes may not have been detected because of the constraints on subject numbers in the chamber. The study still however demonstrated an increase in clinical cough and a reduction in the citric acid cough threshold at extreme altitude, despite controlled environmental conditions, and thus refuted the long held belief that altitude-related cough is solely due to the inspiration of cold, dry air.

If altitude-related cough is not simply due to the inspiration of cold, dry air, other possible aetiologies are:

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Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished

A inflamação pulmonar pode variar de acordo com o sitio primário da injuria e poder ser afetado pelo estresse mecânico gerado pela ventilação mecânica. (VM) Objetivos: estudar as eventuais diferenças na reposta pulmonar e sistêmica na lesão pulmonar aguda pulmonar (LPA P ) e extra pulmonar (LPA Exp) após ventilação mecânica. Métodos: Camundongos BALB/c foram divididos em doze grupos. Os grupos controle pulmonar (CP) e extra pulmonar (C Exp) receberam solução salina (SAL) ou Lipopolissacarideo (LPS) via intratraqueal (IT) ou intraperitoneal (IP) respectivamente. Os grupos foram submetidos ou não a simples manobra de pressurização (SMP) até 45 cm H2O. Resultados: Os grupos LPAP e LPAExp não ventilados apresentaram o mesmo nível de inflamação; uma diferença estatisticamente significativa na densidade de células inflamatórias foi observada no grupo LPA P VM (3,84±1,28 cels/2) comparado ao grupo LPA Exp VM ((1,75±0,14 cels/2), p=0,013. O mesmo foi observado na LPA P SMP (2,92±0,44 cels/2) comparado ao LPA Exp SMP (1,46±0,23 cels/2), p<0,0001. LPAP mostrou estatisticamente significante aumento no El (56,19 ± 12,26 cm H2O) em comparação ao LPA Exp SMP (26,88 ± 36,38 cm H2O) após SMP (p = 0,029). Nenhuma diferença estatisticamente significante foi observada no estresse oxidativo no rim. Conclusão: Observamos um padrão diferente da resposta inflamatória e mecânica pulmonar comparando LPA pulmonar e extra-pulmonar submetido à ventilação mecânica de curto prazo. Embora a ventilação mecânica represente uma ferramenta essencial para estabilizar o paciente critico, é necessário individualizar a abordagem do tratamento ventilatório
Lung inflammation may vary according to the primary site of injury and may be affected by the mechanical stress generated by mechanical ventilation (MV). Objectives: to address possible differences in lung and systemic responses in pulmonary and extra pulmonary ALI after mechanical ventilation. Methods: BALB/c mice were divided in twelve groups of six animals. In pulmonary and extrapulmonary control or ALI groups received either saline or LPS (intratracheally instilled or intraperitoneally injected), respectively. Ventilated groups were either recruited or not with a single recruitment maneuver (SRM) reaching 45 cm H2O. Results: At baseline ALI P and ALI EXP non ventilated groups presented the same level of inflammation; a statistically significant difference in density of inflammatory cells was noted in ALI P MV (3,84±1,28 cells/2) compared to ALI EXP MV (1,75±0,14 cells/2), p=0,013. The same was observed in ALI P SRM (2,92±0,44 cells/2) compared to ALI EXP SRM (1,46±0,23 cells/2) ventilated groups (p<0,0001). ALI P showed a statistically significant increase in El (56,19 ± 12,26 cm H2O) in comparison to ALI EXP (26,88 ± 36,38 cm H2O) after SRM (p = 0,029). No statistical differences were observed in kidney oxidative stress. Conclusion: We observed a different pattern of response in lung inflammation and mechanics comparing pulmonary and extra pulmonary ALI, submitted to short term mechanical ventilation. Although mechanical ventilation represents a fundamental tool to stabilize critical patients, it is essential to individualize the approach of the ventilatory treatment

Le paf-acéther (paf) est un médiateur pro inflammatoire dérivé du métabolisme des lipides constitutifs des membranes cellulaires. Nous avons étudié les effets physiothologiques du paf dans le domaine cardio-pulmonaire et lors d'une inflammation locale et articulaire. L'injection de ce médiateur dans la circulation pulmonaire chez la brebis induit une thrombocytopénie et une leucopénie immédiate puis une accumulation leucocytaire pulmonaire décelable à la 5ème minute. On observe une hypertension pulmonaire indépendante du thromboxane B2 (TxB2). Toutes les réponses induites par le paf sont inhibées par un antagoniste spécifique de ce médiateur, le WEB 2086. L'administration du complexe héparine-protamine chez le lapin s'accompagne d'une production transitoire de paf associée à une thrombocytopénie et à une leucopénie et d'une production retardée mais prolongée de TxB2. L'effet protecteur du BN 52021, autre antagoniste spécifique du paf, sur la trombocytopénie et le niveau plasmique du TxB2 indique d'une part que le paf exerce un rôle précoce au niveau cellulaire, d'autre part que la production de TxB2 est partiellement médiée par le paf. Notre travail a également montré l'implication du paf dans l'arthrite induite par la carragénie chez le lapin, notamment dans sa phase aiguë. Un antagoniste spécifique du paf, le BN 50730, exerce une action préventive et curative sur l'arthrite. Dans le modèle du granulome inflammatoire induit par la carragénine chez le rat, le paf est produit in situ au cours de la phase aiguë mais également au cours du passage à la phase chronique ce qui suggère son implication à cette étape de la réaction inflammatoire. L'action du paf doit se concevoir en fonction de ses nombreux effets cellulaires et de ses interrelations avec d'autres médiateurs de l'inflammation. Les effets bénéfiques des antagonistes des récepteurs au paf pourraient représenter une alternative thérapeutique et un intérêt clinique, notamment dans l'inflammation chronique.

Adult congenital heart disease (ACHD) patients have markedly depressed exercise capacity. This thesis examined (i) the prevalence of chronotropic incompetence, its relationship to symptoms and exercise capacity and its prognostic value in ACHD patients; (ii) investigated exercise capacity in patients with Eisenmenger syndrome and assessed survival prospects in this cohort as well as risk factors for mortality. In addition, clinical effects of Bosentan (a pulmonary vasodilator) were examined during longer-term follow-up. (iii) Mathematical modelling studies were employed to assess the impact of intracardiac shunting on oxygen delivery and tissue oxygenation potentially affecting exercise capacity, (iv) As pulmonary and systemic endothelial dysfunction are integral features of pulmonary arterial hypertension (and are related to exercise intolerance in this setting), this thesis examined the number and function of endothelial progenitor cells (EPC) in patients with idiopathic pulmonary hypertension and Eisenmenger syndrome.

La sclérose systémique (ScS) est une maladie auto-immune dont l’un des principaux auto-anticorps, dirigé contre la protéine centromérique B (CENP-B), est fortement associé à l’hypertension artérielle pulmonaire, l’une des causes majeures de décès dû à la ScS. L’hypertension résulte de l’occlusion progressive des vaisseaux suite à une hyperactivation des cellules musculaires lisses (CML) de la paroi vasculaire. Cependant, les facteurs responsables de ce remodelage vasculaire restent inconnus. Plusieurs études récentes ont démontré que certains auto-antigènes possèdent des fonctions biologiques additionnelles lorsqu'ils se retrouvent dans le milieu extracellulaire. En effet, une fois libérés par nécrose ou apoptose, ces auto-antigènes adoptent une activité biologique qui s'apparente à celles des cytokines et peuvent ainsi participer aux processus normaux de réparation de blessure et/ou acquérir une activité pathogène qui contribue au développement de certaines maladies auto-immunes. Nos résultats suggèrent que la CENP-B peut être ajoutée à cette liste de molécules bifonctionnelles. À l'aide des techniques d'immunofluorescence, d'ELISA cellulaire et de cytométrie en flux, nous avons démontré que la CENP-B se liait spécifiquement à la surface des CML vasculaire de l’artère pulmonaire avec une plus grande affinité pour le phénotype contractile que synthétique. Cette liaison provoquait la migration des cellules ainsi que la sécrétion de cytokines pro-inflammatoires telles que l’interleukine 6 et 8. Les mécanismes par lesquels la protéine exerçait ces effets impliquaient la phosphorylation de FAK et Src ainsi que la voie des MAP kinases, avec ERK1/2 et p38. Des études de signalisation intracellulaire effectuées à l’aide de plusieurs inhibiteurs spécifiques ainsi que des études de désensibilisation nous ont permis d’identifier le récepteur de la CENP-B en plus d’identifier les mécanismes complets de sa signalisation membranaire. Nous avons démontré que la CENP-B se liait de manière spécifique aux CML vasculaire via le récepteur de chémokine 3 (CCR3) pour ensuite transactiver le récepteur EGF, selon un mécanisme métalloprotéase-dépendant qui implique le relargage du HB-EGF. Cette transactivation est un processus important dans l’activation de la voie des MAP kinases ainsi que dans la sécrétion d’IL-8 induite par la CENP-B. Finalement, nous avons démontré que les auto-anticorps anti-CENP-B pouvaient abolir cette cascade de signalisation, empêchant ainsi la CENP-B d’exercer son rôle de cytokine. L’identification de la CENP-B comme ligand du CCR3 ouvre donc plusieurs perspectives quant à l’étude du rôle pathogène des auto-anticorps anti-CENP-B dans la ScS.
CENP-B is a highly conserved, centromere associated protein and is a major autoantigen in systemic sclerosis (SSc). Anti-CENP-B autoantibodies are associated with prominent vascular manifestations such as pulmonary arterial hypertension (PAH) in the limited cutaneous subset of SSc. PAH occurs as a consequence of progressive obliteration of small arteries due to vascular smooth muscle cell dysfunction, migration and proliferation. However, the factors driving this obliteration are unknown. Earlier in vitro studies have demonstrated that some autoantigens have an additional role when they are released in the extracellular environment during the course of injurious insults resulting in cell death. Indeed, it was previously suggested that extracellular autoantigens participate in normal wound repair processes by acting like cytokines and/or chemokines and subsequently displaying pathogenic activities that contribute to the development of autoimmune diseases. Our present findings suggest that the nuclear autoantigen CENP-B can be added to this set of bifunctional molecules. The present study clearly indicates that exogenous CENP-B bound specifically to the surface of human pulmonary artery SMCs. Binding of CENP-B to SMC stimulated their migration during in vitro wound healing assays, as well as their secretion of interleukins 6 and 8. The mechanism by which CENP-B mediated these effects involved the focal adhesion kinase, Src, ERK1/2, and p38 MAPK pathways. Moreover, CENP-B released from apoptotic endothelial cells was found to bind to SMC, thus indicating a plausible in vivo source of extracellular CENP-B. Here, we also report several lines of evidence indicating that CENP-B, which has no obvious primary or secondary structural homology to chemokines, induced SMC activation by interacting with CCR3. Moreover, the present study clearly demonstrates the involvement of EGFR in CENP-B signaling leading to IL-8 secretion. Finally, anti-CENP-B autoantibodies were found to abolish this signaling pathway, thus preventing CENP-B from transactivating EGFR and exerting its cytokine-like activities toward vascular SMCs. The present study sheds new light on the possible role of extracellular CENP-B and its potent biological effects on human pulmonary artery SMCs. The identification of CENP-B as a CCR3 ligand opens up new perspectives for the study of the pathogenic role of anti-CENP-B autoantibodies.

Indiana University-Purdue University Indianapolis (IUPUI)
Carbon nanomaterials are widely produced and used in industry, medicine and scientific research. To examine the impact of exposure to nanoparticles on human health, the human airway epithelial cell line, Calu-3, was used to evaluate changes in the cellular proteome that could account for alterations in cellular function of airway epithelia after 24 h exposure to 10 μg/mL and 100 ng/mL of two common carbon nanoparticles, singleand multi-wall carbon nanotubes (SWCNT, MWCNT). After exposure to the nanoparticles, label-free quantitative mass spectrometry (LFQMS) was used to study differential protein expression. Ingenuity Pathway Analysis (IPA) was used to conduct a bioinformatics analysis of proteins identified by LFQMS. Interestingly, after exposure to a high concentration (10 μg/mL; 0.4 μg/cm2) of MWCNT or SWCNT, only 8 and 13 proteins, respectively, exhibited changes in abundance. In contrast, the abundance of hundreds of proteins was altered in response to a low concentration (100 ng/mL; 4 ng/cm2) of either CNT. Of the 281 and 282 proteins that were significantly altered in response to MWCNT or SWCNT, respectively, 231 proteins were the same. Bioinformatic analyses found that the proteins common to both kinds of nanotubes are associated with the cellular functions of cell death and survival, cell-to-cell signaling and interaction, cellular assembly and organization, cellular growth and proliferation, infectious disease, molecular transport and protein synthesis. The decrease in expression of the majority proteins suggests a general stress response to protect cells. The STRING database was used to analyze the various functional protein networks. Interestingly, some proteins like cadherin 1 (CDH1), signal transducer and activator of transcription 1 (STAT1), junction plakoglobin (JUP), and apoptosis-associated speck-like protein containing a CARD (PYCARD), appear in several functional categories and tend to be in the center of the networks. This central positioning suggests they may play important roles in multiple cellular functions and activities that are altered in response to carbon nanotube exposure. To examine the effect of nanotubes on the plasma membrane, we investigated the interaction of short purified MWCNT with model lipid membranes using a planar bilayer workstation. Bilayer lipid membranes were synthesized using neutral 1, 2-diphytanoylsn-glycero-3-phosphocholine (DPhPC) in 1 M KCl. The ion channel model protein, Gramicidin A (gA), was incorporated into the bilayers and used to measure the effect of MWCNT on ion transport. The opening and closing of ion channels, amplitude of current, and open probability and lifetime of ion channels were measured and analyzed by Clampfit. The presence of an intermediate concentration of MWCNT (2 μg/ml) could be related to a statistically significant decrease of the open probability and lifetime of gA channels. The proteomic studies revealed changes in response to CNT exposure. An analysis of the changes using multiple databases revealed alterations in pathways, which were consistent with the physiological changes that were observed in cultured cells exposed to very low concentrations of CNT. The physiological changes included the break down of the barrier function and the inhibition of the mucocillary clearance, both of which could increase the risk of CNT’s toxicity to human health. The biophysical studies indicate MWCNTs have an effect on single channel kinetics of Gramicidin A model cation channel. These changes are consistent with the inhibitory effect of nanoparticles on hormone stimulated transepithelial ion flux, but additional experiments will be necessary to substantiate this correlation.