Study of HLA-G gene 14-bp ins/del and codon 93 (CAC/CAT) polymorphisms association with spontaneous abortion in a Tunisian population

In the recent years, spontaneous abortion (SA) frequency increased awareness about medical and social-economic related problems. Human leukocyte antigen-G (HLA-G) is a non-classic HLA I molecule initially described in trophoblastic tissue in foeto-maternal interface. HLA-G polymorphism association with SA has been extensively studied. One amongst the foremost studied variants was HLA-G 14-bp Insertion (Ins)/Deletion (Del) polymorphism. Nevertheless, such a study was not performed in Tunisian population yet. We aim to investigate two HLA-G polymorphisms, 14-bp Ins/Del 3'UTR, and for the first time, codon 93 (CAC/CAT) polymorphisms association with SA risk in the Tunisian population. The results revealed HLA-G 14-bp Ins/Del polymorphism and CIns haplotype association with SA. No association of the HLA-G codon 93 (CAC/CAT) polymorphism to SA was observed. Considering both polymorphism together, female's homozygosity for 14-bp Ins/Del and for codon 93 (CAC/CAT) polymorphism may increase the risk of SA susceptibility

The metabolism of cells regulates their sensitivity to NK cells depending on p53 status

Leukemic cells proliferate faster than non-transformed counterparts. This requires them to change their metabolism to adapt to their high growth. This change can stress cells and facilitate recognition by immune cells such as cytotoxic lymphocytes, which express the activating receptor Natural Killer G2-D (NKG2D). The tumor suppressor gene p53 regulates cell metabolism, but its role in the expression of metabolism-induced ligands, and subsequent recognition by cytotoxic lymphocytes, is unknown. We show here that dichloroacetate (DCA), which induces oxidative phosphorylation (OXPHOS) in tumor cells, induces the expression of such ligands, e.g. MICA/B, ULBP1 and ICAM-I, by a wtp53-dependent mechanism. Mutant or null p53 have the opposite effect. Conversely, DCA sensitizes only wtp53-expressing cells to cytotoxic lymphocytes, i.e. cytotoxic T lymphocytes and NK cells. In xenograft in vivo models, DCA slows down the growth of tumors with low proliferation. Treatment with DCA, monoclonal antibodies and NK cells also decreased tumors with high proliferation. Treatment of patients with DCA, or a biosimilar drug, could be a clinical option to increase the effectiveness of CAR T cell or allogeneic NK cell therapies

Clinical amplification of NK cells : effect of metabolism

La formation et le développement d’une tumeur sont provoqués par une série de défauts qui se produisent à l'intérieur de la cellule cancéreuse et dans son microenvironnement. Ces anomalies permettent à la cellule de développer ses propres stratégies de croissance, de prolifération, de différenciation et de métabolisme.La modification du métabolisme respiratoire, est l'une des stratégies utilisée par les cellules cancéreuses favorisant la fermentation lactique au lieu de la phosphorylation oxydative OXPHOS (respiration). Cette adaptation métabolique porte le nom d’effet Warburg.Nous avons proposé un concept thérapeutique novateur basé sur l'induction de changements métaboliques par l'utilisation de dichloroacétate (DCA) associée avec l'immunothérapie en utilisant les cellules NK activées. Le DCA, molécule inhibitrice de la PDK, induit l'activation de la PDH, responsable de la catalyse de pyruvate en Acétylcoenzyme A (Ac-CoA), favorise alors l’oxydation du glucose dans la mitochondrie. Le DCA a déjà été utilisé depuis longtemps comme traitement hypocholestérolémiant et bloquant l’acidose lactique. Mon équipe a montré auparavant que le changement métabolique permet aux cellules tumorales d'échapper à la réponse immune.Nous avons observé que le traitement par DCA induisait, dépendante du phénotype p53, une forte up-régulation de l'expression du mRNA et des protéines de stress MICA, MICB et ULBP1, ligands spécifiques des récepteurs activateurs NKG2D des cellules NK, et induise alors une réponse cytotoxique contre les cellules tumorale.D'autre part nous avons évalué l'effet de DCA sur l'expression des transporteurs ABC qui interviennent dans l'efflux des agents anticancéreux utilisé dans la chimiothérapie. L'expression des transporteurs ABC était fortement liée aux phénotypes de chimiorésistance. Nous avons bien confirmé que le DCA provoque une diminution de l'expression de ABCB1, ABCC1, ABCC5 et ABCG2 dans les cellules wtp53 alors qu'il induit une augmentation dans les cellules mutantp53 ou nullp53.Les promoteurs des transporteurs et les protéines de stress étudiés comportent également plusieurs sites de liaison spécifique au facteur de transcription MEF2, qui est la cible d’ERK5. Nous avons bien constaté que en plus de ca capacité de changer le métabolisme tumorale, le DCA modifie l'expression ABCB1, ABCC1, ABCC5 et ABCG2 par l'activation de la voie ERK5/MEF2 .Ces résultats sont confirmé dans diverses lignées cellulaires, ainsi que dans des cellules issues de patients et dans un modèle in vivoTumorigenesis is caused by a series of defects that occur within the cancer cell and its microenvironment. These abnormalities allow the tumor cell to develop its own strategies for growth, proliferation, differentiation and metabolism. In the last, cancer cells favor lactic fermentation instead of oxidative phosphorylation OXPHOS (respiration). This metabolic adaptation is called the Warburg effect.We proposed an innovative therapeutic concept based on the induction of metabolic changes by the use of dichloroacetate (DCA) and this is associated with immunotherapy using activated NK cells. DCA, a pyruvate dehydrogenase kinase (PDK) inhibitor, induces the activation of pyruvate dehydrogenase (PDH), responsible for the catalysis of pyruvate to acetylcoenzyme A (Ac-CoA), promoting the oxidation of glucose/pyruvate in the mitochondria. DCA has been used for a long time as a cholesterol-lowering and anti-lactic acidosis therapy. My team has previously shown that the metabolic change allows tumor cells to escape the immune response. I have observed that DCA treatment induced a high upregulation of mRNA and protein expression of the stress ligands MICA, MICB and ULBP1. These are recognized by the NK cell activating receptor NKG2D, inducing a NK cell-mediated cytotoxic response against tumor cells. DCA-induced expression of these stress ligands depends on wtp53 expression on the tumor cell.On the other hand, we evaluated the effect of DCA on the expression of ABC carriers, which intervene in the efflux of anticancer agents used in chemotherapy. The expression of ABC carriers is strongly related to drug resistance phenotypes. We observed that DCA causes a decrease in the expression of ABCB1, ABCC1, ABCC5 and ABCG2 in wtp53 cells while it induces an increase in mutantp53 or nullp53 cells. Conversely, DCA-induced accumulation of antitumor drugs, i.e. daunorubicin, and favors chemotherapy-induced tumor death only in wtp53-expressing cancer cells. The promoters of these ABC transporters and the stress proteins presented above contain several binding sites specific to the transcription factor MEF2, which is the target of ERK5. We have found that in addition to the ability to change tumor metabolism, DCA modifies the expression ABCB1, ABCC1, ABCC5 and ABCG2 by activation of the ERK5 / MEF2 pathway. These results are confirmed in various cell lines, in cells derived from patients and in an in vivo mode

Immunothérapie et métabolisme tumorale

Tumorigenesis is caused by a series of defects that occur within the cancer cell and its microenvironment. These abnormalities allow the tumor cell to develop its own strategies for growth, proliferation, differentiation and metabolism. In the last, cancer cells favor lactic fermentation instead of oxidative phosphorylation OXPHOS (respiration). This metabolic adaptation is called the Warburg effect.We proposed an innovative therapeutic concept based on the induction of metabolic changes by the use of dichloroacetate (DCA) and this is associated with immunotherapy using activated NK cells. DCA, a pyruvate dehydrogenase kinase (PDK) inhibitor, induces the activation of pyruvate dehydrogenase (PDH), responsible for the catalysis of pyruvate to acetylcoenzyme A (Ac-CoA), promoting the oxidation of glucose/pyruvate in the mitochondria. DCA has been used for a long time as a cholesterol-lowering and anti-lactic acidosis therapy. My team has previously shown that the metabolic change allows tumor cells to escape the immune response. I have observed that DCA treatment induced a high upregulation of mRNA and protein expression of the stress ligands MICA, MICB and ULBP1. These are recognized by the NK cell activating receptor NKG2D, inducing a NK cell-mediated cytotoxic response against tumor cells. DCA-induced expression of these stress ligands depends on wtp53 expression on the tumor cell.On the other hand, we evaluated the effect of DCA on the expression of ABC carriers, which intervene in the efflux of anticancer agents used in chemotherapy. The expression of ABC carriers is strongly related to drug resistance phenotypes. We observed that DCA causes a decrease in the expression of ABCB1, ABCC1, ABCC5 and ABCG2 in wtp53 cells while it induces an increase in mutantp53 or nullp53 cells. Conversely, DCA-induced accumulation of antitumor drugs, i.e. daunorubicin, and favors chemotherapy-induced tumor death only in wtp53-expressing cancer cells. The promoters of these ABC transporters and the stress proteins presented above contain several binding sites specific to the transcription factor MEF2, which is the target of ERK5. We have found that in addition to the ability to change tumor metabolism, DCA modifies the expression ABCB1, ABCC1, ABCC5 and ABCG2 by activation of the ERK5 / MEF2 pathway. These results are confirmed in various cell lines, in cells derived from patients and in an in vivo modelLa formation et le développement d’une tumeur sont provoqués par une série de défauts qui se produisent à l'intérieur de la cellule cancéreuse et dans son microenvironnement. Ces anomalies permettent à la cellule de développer ses propres stratégies de croissance, de prolifération, de différenciation et de métabolisme.La modification du métabolisme respiratoire, est l'une des stratégies utilisée par les cellules cancéreuses favorisant la fermentation lactique au lieu de la phosphorylation oxydative OXPHOS (respiration). Cette adaptation métabolique porte le nom d’effet Warburg.Nous avons proposé un concept thérapeutique novateur basé sur l'induction de changements métaboliques par l'utilisation de dichloroacétate (DCA) associée avec l'immunothérapie en utilisant les cellules NK activées. Le DCA, molécule inhibitrice de la PDK, induit l'activation de la PDH, responsable de la catalyse de pyruvate en Acétylcoenzyme A (Ac-CoA), favorise alors l’oxydation du glucose dans la mitochondrie. Le DCA a déjà été utilisé depuis longtemps comme traitement hypocholestérolémiant et bloquant l’acidose lactique. Mon équipe a montré auparavant que le changement métabolique permet aux cellules tumorales d'échapper à la réponse immune.Nous avons observé que le traitement par DCA induisait, dépendante du phénotype p53, une forte up-régulation de l'expression du mRNA et des protéines de stress MICA, MICB et ULBP1, ligands spécifiques des récepteurs activateurs NKG2D des cellules NK, et induise alors une réponse cytotoxique contre les cellules tumorale.D'autre part nous avons évalué l'effet de DCA sur l'expression des transporteurs ABC qui interviennent dans l'efflux des agents anticancéreux utilisé dans la chimiothérapie. L'expression des transporteurs ABC était fortement liée aux phénotypes de chimiorésistance. Nous avons bien confirmé que le DCA provoque une diminution de l'expression de ABCB1, ABCC1, ABCC5 et ABCG2 dans les cellules wtp53 alors qu'il induit une augmentation dans les cellules mutantp53 ou nullp53.Les promoteurs des transporteurs et les protéines de stress étudiés comportent également plusieurs sites de liaison spécifique au facteur de transcription MEF2, qui est la cible d’ERK5. Nous avons bien constaté que en plus de ca capacité de changer le métabolisme tumorale, le DCA modifie l'expression ABCB1, ABCC1, ABCC5 et ABCG2 par l'activation de la voie ERK5/MEF2 .Ces résultats sont confirmé dans diverses lignées cellulaires, ainsi que dans des cellules issues de patients et dans un modèle in viv

Erysipèle du membre inférieur: étude de 400 cas [Erysipelas of the lower limb: study of 400 cases]

Introduction: Erysipelas is an acute, non-necrotizing dermo-hypodermitis of predominantly streptococcal origin. Objective: To clarify the epidemiological and evolutionary features of the lower limb erysipelas through a hospital series. Materiels and Methods: We retrospectively analyzed all cases of lower limb erysipelas hospitalized in the Department of Dermatology of the Farhat Hached Hospital of Sousse between January 2000 and December 2015 (10 years). Results: Four hundred cases of erysipelas of the lower limb were recorded. The mean age of the patients was 55.82 years. The sex ratio was 1.51. The main predisposing factors were sedentarity, diabetes and obesity. In 96.75% of cases, entry lesion, like mycoses or traumatic injuries was noted. Clinically, a classic presentation of erysipelas was described in all cases. Erysipela was unilateral in 96% of cases. Treatment was based on intravenous penicillin G in 86.5% of cases, on an average of 9.75 days. The evolution was favorable in 83.25% of cases. Antibioprophylaxis was prescribed in 38% of cases. Loco-regional and general complications were noted in 10.25% of cases. Three patients died. Late complications were dominated by relapses and persistence of sequelled lymphedema. RÉSUMÉ Introduction: L’érysipèle est une dermo-hypodermite aigue, non nécrosante, d’origine principalement streptococcique. Objectif: préciser les particularités épidémio-cliniques et évolutives de l’Erysipèle du membre inferieur à travers une série hospitalière. Matériel et Méthodes: Nous avons rétrospectivement analysé tous les cas d’érysipèle du membre inférieur hospitalisés dans le service de dermatologie de l’hôpital Farhat Hached de Sousse entre janvier 2000 et décembre 2015 (10 ans). Résultats: Quatre cents cas d’érysipèle du membre inférieur ont été recensés. L’âge moyen des patients était de 55.82 ans. Le sexe ratio était de 1.51. Les principaux facteurs favorisants étaient : la sédentarité, le diabète et la surcharge pondérale. Une porte d’entrée à type d’intertrigo interorteil ou de plaie traumatique était notée dans 96.75% des cas. Cliniquement, un tableau typique d’érysipèle était décrit dans tous les cas. L’atteinte était unilatérale dans 96% des cas. Le traitement était à base de pénicilline G par voie intraveineuse dans 86,5% des cas pendant en moyenne 9.75 jours. L’évolution était favorable dans 83.25% des cas. Une antibioprophylaxie était prescrite chez 38% des cas. Les complications loco-régionales et générales précoces étaient notées dans 10.25% des cas. Trois patients étaient décedés. Les complications tardives étaient dominées par les récidives et la persistance d’un lymphoedème séquellaire

Changes in metabolism affect expression of ABC transporters through ERK5 and depending on p53 status

International audienceChanges in metabolism require the efflux and influx of a diverse variety of metabolites. The ABC superfamily of transporters regulates the exchange of hundreds of substrates through the impermeable cell membrane. We show here that a metabolic switch to oxidative phosphorylation (OXPHOS), either by treating cells with dichloroacetate (DCA) or by changing the available substrates, reduced expression of ABCB1, ABCC1, ABCC5 and ABCG2 in wild-type p53-expressing cells. This metabolic change reduced histone changes associated to active promoters. Notably, DCA also inhibited expression of these genes in two animal models in vivo. In contrast, OXPHOS increased the expression of the same transporters in mutated (mut) or null p53-expressing cells. ABC transporters control the export of drugs from cancer cells and render tumors resistant to chemotherapy, playing an important role in multiple drug resistance (MDR). Wtp53 cells forced to perform OXPHOS showed impaired drug clearance. In contrast mutp53 cells increased drug clearance when performing OXPHOS. ABC transporter promoters contain binding sites for the transcription factors MEF2, NRF1 and NRF2 that are targets of the MAPK ERK5. OXPHOS induced expression of the MAPK ERK5. Decreasing ERK5 levels in wtp53 cells increased ABC expression whereas it inhibited expression in mutp53 cells. Our results showed that the ERK5/MEF2 pathway controlled ABC expression depending on p53 status

The PDK1 Inhibitor Dichloroacetate Controls Cholesterol Homeostasis Through the ERK5/MEF2 Pathway

Abstract Controlling cholesterol levels is a major challenge in human health, since hypercholesterolemia can lead to serious cardiovascular disease. Drugs that target carbohydrate metabolism can also modify lipid metabolism and hence cholesterol plasma levels. In this sense, dichloroacetate (DCA), a pyruvate dehydrogenase kinase (PDK) inhibitor, augments usage of the glycolysis-produced pyruvate in the mitochondria increasing oxidative phosphorylation (OXPHOS). In several animal models, DCA decreases plasma cholesterol and triglycerides. Thus, DCA was used in the 70 s to treat diabetes mellitus, hyperlipoproteinemia and hypercholesterolemia with satisfactory results. However, the mechanism of action remained unknown and we describe it here. DCA increases LDLR mRNA and protein levels as well as LDL intake in several cell lines, primary human hepatocytes and two different mouse models. This effect is mediated by transcriptional activation as evidenced by H3 acetylation on lysine 27 on the LDLR promoter. DCA induces expression of the MAPK ERK5 that turns on the transcription factor MEF2. Inhibition of this ERK5/MEF2 pathway by genetic or pharmacological means decreases LDLR expression and LDL intake. In summary, our results indicate that DCA, by inducing OXPHOS, promotes ERK5/MEF2 activation leading to LDLR expression. The ERK5/MEF2 pathway offers an interesting pharmacological target for drug development

The PDK1 Inhibitor Dichloroacetate Controls Cholesterol Homeostasis Through the ERK5/MEF2 Pathway

Controlling cholesterol levels is a major challenge in human health, since hypercholesterolemia can lead to serious cardiovascular disease. Drugs that target carbohydrate metabolism can also modify lipid metabolism and hence cholesterol plasma levels. In this sense, dichloroacetate (DCA), a pyruvate dehydrogenase kinase (PDK) inhibitor, augments usage of the glycolysis-produced pyruvate in the mitochondria increasing oxidative phosphorylation (OXPHOS). In several animal models, DCA decreases plasma cholesterol and triglycerides. Thus, DCA was used in the 70 s to treat diabetes mellitus, hyperlipoproteinemia and hypercholesterolemia with satisfactory results. However, the mechanism of action remained unknown and we describe it here. DCA increases LDLR mRNA and protein levels as well as LDL intake in several cell lines, primary human hepatocytes and two different mouse models. This effect is mediated by transcriptional activation as evidenced by H3 acetylation on lysine 27 on the LDLR promoter. DCA induces expression of the MAPK ERK5 that turns on the transcription factor MEF2. Inhibition of this ERK5/MEF2 pathway by genetic or pharmacological means decreases LDLR expression and LDL intake. In summary, our results indicate that DCA, by inducing OXPHOS, promotes ERK5/MEF2 activation leading to LDLR expression. The ERK5/MEF2 pathway offers an interesting pharmacological target for drug development