Macrophage Plasticity in Experimental Atherosclerosis

As in human disease, macrophages (MØ) are central players in the development and progression of experimental atherosclerosis. In this study we have evaluated the phenotype of MØ associated with progression of atherosclerosis in the apolipoprotein E (ApoE) knockout (KO) mouse model

Peritoneal Sclerosis in a Patient on Long-term Continuous Ambulatory Peritoneal Dialysis (CAPD). : An Autopsy Case.

若年性ネフロン癆による慢性腎不全でCAPD (continuous ambulatory peritoneal dialysis)導入し, 6年6ヵ月後に死亡した20歳男性の1剖検例を報告した。CAPD導入数カ月後, 腹膜炎による除水能低下を起こしたが, 約5ヵ月後に回復した。CAPD導入1年5ヵ月以降重症な腹膜炎罹患により除水能低下状態が遷延したが, 次第に回復した。しかし, 体液貯留傾向のため, 3年2ヵ月後より高張透析液を使用し除水量の増加を得たが, 3年9ヵ月後に不可逆的な除水能低下状態となった。一方, クレアチニンの透析排液/血漿濃度比(D/P)から見た溶質除去能は, その約半年後まで保たれており, 血清クレアチニン値の上昇は軽度であった。剖検にて腹膜の線維性肥厚と高度の内腔狭窄を伴う動静脈硬化を認め, 腹膜硬化症と診断した。本例の腹膜硬化症は, 頻回の腹膜炎と高張透析液の使用が主な原因と考えられた。腹膜機能を長期に維持するためには, 腹膜炎の予防と高張透析液の使用を最小限にすることが重要と考えられた。A 20-year-old man, treated with continuous ambulatory peritoneal dialysis (CAPD) for 6.5 years because of-end-stage renal disease due to juvenile nephronophthysis, died of ultrafiltration failure, and the morphological examination of peritoneum was carried out at autopsy. Nine episodes of peritonitis developed, and ultrafiltration transiently decreased after each episodes. At 2 years after the start of CAPD, severe peritonitis occurred, and then his body weight and blood pressure gradually increased. At 4 years after the beginning of CAPD, when hyperosmotic dialysate was frequently used, ultrafiltration was irreversively deteriorated. On the other hand, creatinine dialysate/plasma ratio remained within normal limits for about several months, and the increase in the level of serum creatinine was very little. The peritoneum obtained at autopsy revealed marked fibrous thickening as well as the conspicuous luminal narrowing of arteries and veins due to intimal thickening. The development of peritoneal sclerosis seemed to be related with the frequency and severity of peritonitis and the use of hyperosmotic dialysate

New factors contributing to the regulation of normal and ineffective erythropoiesis : the Transferrin receptor and the Activin receptor IIA

L’érythropoïèse est le processus de formation des globules rouges. L’anémie demeure à l’heure actuelle un problème de santé publique majeur. Par conséquent, une meilleure compréhension des mécanismes impliqués dans le contrôle de ce processus dans des conditions physiologiques et pathologiques, ainsi que l’établissement de stratégies thérapeutiques ciblées constituent un enjeu de recherche majeur. Le récepteur de la transferrine 1 (CD71/RTf1) est un élément essentiel de l'érythropoïèse, la majorité des travaux de recherche étant focalisés sur son rôle indéniable dans le métabolisme du fer. Cependant, de nouveaux ligands du RTf1 ont été découverts ouvrant de nouvelles perspectives relatives aux fonctionnalités de ce récepteur. Ayant démontré que le RTf1 fixait les immunoglobulines A1 (IgA1), nous nous sommes intéressés au rôle des IgA1 dans l’érythropoïèse. Nous montrons que le RTf1 lié aux polymères d'IgA1 (pIgA1) induit la croissance et une augmentation de la prolifération des érythroblastes en concentration sous-optimale d'érythropoïétine (Epo). De même, l'expression transgénique d’IgA1 humaine (souris alpha1-KI), ou le traitement de souris de type sauvage avec les pIgA1 permettent une récupération accélérée de l’anémie aiguë. L’engagement du RTf1 module la sensibilité à l'Epo, en diminuant le seuil d'activation cellulaire, et en induisant les voies de signalisation MAPK/ERK et phosphatidylinositol-3-kinase (PI3K/AKT). Ces données mettent en évidence un nouveau rôle du RTf1 en tant que régulateur positif de l'érythropoïèse. Parallèlement au RTf1, nous avons identifié un autre récepteur pouvant constituer une cible thérapeutique pour corriger une érythropoïèse inefficace : le récepteur de l’activine de type IIA (ActRIIA). Dans un modèle murin de Beta-thalassémie intermédiaire (Hbbth1/th1), résultant d'une déficience génétique de la chaîne Beta de la globine, nous montrons que l'administration d'une protéine de fusion constituée du domaine extracellulaire de l’ActRIIA lié à un fragment Fc d’IgG de souris (RAP-011), corrige l'anémie, augmente le taux d'hémoglobine et diminue la splénomégalie. Ce traitement favorise l’érythropoïèse splénique et diminue la saturation de la transferrine et l’hémolyse. Fait intéressant, des niveaux élevés de GDF11 (Growth Differentiation Factor 11) sont observés sur des coupes spléniques de souris thalassémiques ainsi que dans le sérum de patients thalassémiques. In vivo, l’inhibition de l’interaction GDF11/ActRIIa par le RAP-011 favorise l’apoptose des érythroblastes précoces par la voie Fas/FasLigand. Ces résultats suggèrent que l’activation constitutive des signaux GDF11/ActRIIA contribue à l’établissement d’une érythropoïèse inefficace caractéristique de la Beta-thalassémie. La neutralisation de cette signalisation inverse ce processus. En conclusion, nos travaux ouvrent de nouvelles perspectives dans la compréhension de l'hématopoïèse normale et pathologique, et pourraient conduire à envisager des traitements innovants pour l'anémie.Anemia produced by a variety of underlying causes is the most common disorder of the blood, and remains a major global public health problem associated with a poor quality of life for many patients. Thus, better understanding the erythroid process in physiological and pathological conditions, and developing new strategies to boost erythropoiesis appear of great interest. Transferrin receptor 1 (CD71/TfR1) plays an essential role in erythropoiesis, and investigations of TfR1 functions have been focused on their undeniable role in iron metabolism. However, recent data demonstrate that TfR1 is a multi-ligand receptor that participates in a wide array of cellular functions. We have identified TfR1 as a receptor for A1 isotype immunoglobulins (IgA1). In this work, we show that pIgA1s are able through their interaction with the TfR1, to stimulate erythropoiesis by sensitizing erythroblasts to Epo. Likewise, transgenic expression of human IgA1 (Alpha1-KI mice) or treatment of wild-type mice with pIgA1 accelerated recovery from acute anemia. TfR1 engagement by pIgA1 increased cell sensitivity to Epo by inducing activation of mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K) signaling pathways. These findings unveiled a new role of TfR1 as a signaling competent molecule positively regulating erythropoiesis. In addition to TfR1, our work identifies another receptor as a putative target for correcting ineffective erythropoiesis: the activin receptor IIA (ActRIIA). Indeed, using a mouse model of Beta-thalassemia intermedia (Hbbth1/th1) resulting from a genetic deficiency of Beta-globin chain, we show that administration of a ligand trap (named RAP-011), consisting in a fusion protein between the extracellular domain of ActRIIA and the Fc fragment of a mouse IgG, improves anemia, increases total hemoglobin levels and decreases splenomegaly. In addition, targeting ActRIIa signaling corrects ineffective erythropoiesis in the spleen, reduces hemolysis and transferrin saturation. Interestingly, high levels of Growth Differentiation Factor 11 (GDF11) are detected in spleen sections from Beta-thalassemic mice, as well as in sera from thalassemic patients. In addition, the inactivation of GDF11 promotes terminal erythroblast differentiation. Finally, blockade of the GDF11/ActRIIa signaling, promotes premature apoptosis of early erythroblasts through induction of Fas/FasLigand pathway. Therefore, these results first suggest that constitutive GDF11/ActRIIa signaling pathway may promote ineffective erythropoiesis in Beta-thalassemia intermedia, and secondly, support the use of ActRIIa traps for the treatment of chronic anemia and ineffective erythropoiesis. Altogether, these results open new perspectives in the understanding of normal and pathological hematopoiesis and lead to propose innovative treatments for anemia

Nouveaux acteurs contribuant à la régulation de l'érythropoïèse normale et inefficace (le récepteur à la transferrine et le récepteur à l'activine IIA.)

L érythropoïèse est le processus de formation des globules rouges. L anémie demeure à l heure actuelle un problème de santé publique majeur. Par conséquent, une meilleure compréhension des mécanismes impliqués dans le contrôle de ce processus dans des conditions physiologiques et pathologiques, ainsi que l établissement de stratégies thérapeutiques ciblées constituent un enjeu de recherche majeur. Le récepteur de la transferrine 1 (CD71/RTf1) est un élément essentiel de l'érythropoïèse, la majorité des travaux de recherche étant focalisés sur son rôle indéniable dans le métabolisme du fer. Cependant, de nouveaux ligands du RTf1 ont été découverts ouvrant de nouvelles perspectives relatives aux fonctionnalités de ce récepteur. Ayant démontré que le RTf1 fixait les immunoglobulines A1 (IgA1), nous nous sommes intéressés au rôle des IgA1 dans l érythropoïèse. Nous montrons que le RTf1 lié aux polymères d'IgA1 (pIgA1) induit la croissance et une augmentation de la prolifération des érythroblastes en concentration sous-optimale d'érythropoïétine (Epo). De même, l'expression transgénique d IgA1 humaine (souris alpha1-KI), ou le traitement de souris de type sauvage avec les pIgA1 permettent une récupération accélérée de l anémie aiguë. L engagement du RTf1 module la sensibilité à l'Epo, en diminuant le seuil d'activation cellulaire, et en induisant les voies de signalisation MAPK/ERK et phosphatidylinositol-3-kinase (PI3K/AKT). Ces données mettent en évidence un nouveau rôle du RTf1 en tant que régulateur positif de l'érythropoïèse. Parallèlement au RTf1, nous avons identifié un autre récepteur pouvant constituer une cible thérapeutique pour corriger une érythropoïèse inefficace : le récepteur de l activine de type IIA (ActRIIA). Dans un modèle murin de Beta-thalassémie intermédiaire (Hbbth1/th1), résultant d'une déficience génétique de la chaîne Beta de la globine, nous montrons que l'administration d'une protéine de fusion constituée du domaine extracellulaire de l ActRIIA lié à un fragment Fc d IgG de souris (RAP-011), corrige l'anémie, augmente le taux d'hémoglobine et diminue la splénomégalie. Ce traitement favorise l érythropoïèse splénique et diminue la saturation de la transferrine et l hémolyse. Fait intéressant, des niveaux élevés de GDF11 (Growth Differentiation Factor 11) sont observés sur des coupes spléniques de souris thalassémiques ainsi que dans le sérum de patients thalassémiques. In vivo, l inhibition de l interaction GDF11/ActRIIa par le RAP-011 favorise l apoptose des érythroblastes précoces par la voie Fas/FasLigand. Ces résultats suggèrent que l activation constitutive des signaux GDF11/ActRIIA contribue à l établissement d une érythropoïèse inefficace caractéristique de la Beta-thalassémie. La neutralisation de cette signalisation inverse ce processus. En conclusion, nos travaux ouvrent de nouvelles perspectives dans la compréhension de l'hématopoïèse normale et pathologique, et pourraient conduire à envisager des traitements innovants pour l'anémie.Anemia produced by a variety of underlying causes is the most common disorder of the blood, and remains a major global public health problem associated with a poor quality of life for many patients. Thus, better understanding the erythroid process in physiological and pathological conditions, and developing new strategies to boost erythropoiesis appear of great interest. Transferrin receptor 1 (CD71/TfR1) plays an essential role in erythropoiesis, and investigations of TfR1 functions have been focused on their undeniable role in iron metabolism. However, recent data demonstrate that TfR1 is a multi-ligand receptor that participates in a wide array of cellular functions. We have identified TfR1 as a receptor for A1 isotype immunoglobulins (IgA1). In this work, we show that pIgA1s are able through their interaction with the TfR1, to stimulate erythropoiesis by sensitizing erythroblasts to Epo. Likewise, transgenic expression of human IgA1 (Alpha1-KI mice) or treatment of wild-type mice with pIgA1 accelerated recovery from acute anemia. TfR1 engagement by pIgA1 increased cell sensitivity to Epo by inducing activation of mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K) signaling pathways. These findings unveiled a new role of TfR1 as a signaling competent molecule positively regulating erythropoiesis. In addition to TfR1, our work identifies another receptor as a putative target for correcting ineffective erythropoiesis: the activin receptor IIA (ActRIIA). Indeed, using a mouse model of Beta-thalassemia intermedia (Hbbth1/th1) resulting from a genetic deficiency of Beta-globin chain, we show that administration of a ligand trap (named RAP-011), consisting in a fusion protein between the extracellular domain of ActRIIA and the Fc fragment of a mouse IgG, improves anemia, increases total hemoglobin levels and decreases splenomegaly. In addition, targeting ActRIIa signaling corrects ineffective erythropoiesis in the spleen, reduces hemolysis and transferrin saturation. Interestingly, high levels of Growth Differentiation Factor 11 (GDF11) are detected in spleen sections from Beta-thalassemic mice, as well as in sera from thalassemic patients. In addition, the inactivation of GDF11 promotes terminal erythroblast differentiation. Finally, blockade of the GDF11/ActRIIa signaling, promotes premature apoptosis of early erythroblasts through induction of Fas/FasLigand pathway. Therefore, these results first suggest that constitutive GDF11/ActRIIa signaling pathway may promote ineffective erythropoiesis in Beta-thalassemia intermedia, and secondly, support the use of ActRIIa traps for the treatment of chronic anemia and ineffective erythropoiesis. Altogether, these results open new perspectives in the understanding of normal and pathological hematopoiesis and lead to propose innovative treatments for anemia.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Defective palmitoylation of transferrin receptor triggers iron overload in Friedreich ataxia fibroblasts

International audienceAbstract Friedreich ataxia (FRDA) is a frequent autosomal recessive disease caused by a GAA repeat expansion in the FXN gene encoding frataxin, a mitochondrial protein involved in iron-sulfur cluster (ISC) biogenesis. Resulting frataxin deficiency affects ISC-containing proteins and causes iron to accumulate in the brain and heart of FRDA patients. Here we report on abnormal cellular iron homeostasis in FRDA fibroblasts inducing a massive iron overload in cytosol and mitochondria. We observe membrane transferrin receptor 1 (TfR1) accumulation, increased TfR1 endocytosis, and delayed Tf recycling, ascribing this to impaired TfR1 palmitoylation. Frataxin deficiency is shown to reduce coenzyme A (CoA) availability for TfR1 palmitoylation. Finally, we demonstrate that artesunate, CoA, and dichloroacetate improve TfR1 palmitoylation and decrease iron overload, paving the road for evidence-based therapeutic strategies at the actionable level of TfR1 palmitoylation in FRDA

Protein-based therapeutic for anemia caused by dyserythropoiesis

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The thermolysin-like metalloproteinase and virulence factor LasB from pathogenic Pseudomonas aeruginosa induces anoikis of human vascular cells.

International audienceDisruption of cell/ECM interactions resulting from uncontrolled pericellular proteolysis leads to detachment-induced cell apoptosis (anoikis), contributing to the morbid evolution of inflammatory vascular diseases. During cardiovascular infections, bacterial proteinases might induce vascular cells to enter a similar pathway. We focused on LasB, the predominant metalloproteinase secreted by the haematotropic pathogen Pseudomonas aeruginosa. While the exosecretome of the LasB-deficient pseudomonal strain PAO1lasB? had limited impact on human vascular cell adherence and viability, secretomes from the LasB-expressing reference strain, PAO1, or clinical isolates from patients with cardiac infection all induced anoikis, as did purified LasB. Immunofluorescence and/or immunoblotting analysis of heart valve myofibroblast cultures or whole tissue revealed an extensive, LasB-dependent degradation of ECM-associated fibronectin and vitronectin, that preceded cell de-adherence, whereas type I collagen showed limited degradation. Moreover, LasB produced a rapid endoproteolysis of the cell-associated urokinase receptor/uPAR, leaving a truncated receptor that is unable to support cell adherence and survival via interactions with vitronectin and integrins. Conversely, major myofibroblast integrins showed no or only minor alterations. Thus, among P. aeruginosa-secreted metalloproteinases, LasB can induce vascular cell anoikis through simultaneous proteolysis of ECM components and cell receptors, suggesting the uPAR-vitronectin axis as a major target in this process

Restoration of Physiological Levels of Uric Acid and Ascorbic Acid Reroutes the Metabolism of Stored Red Blood Cells

After blood donation, the red blood cells (RBCs) for transfusion are generally isolated by centrifugation and then filtrated and supplemented with additive solution. The consecutive changes of the extracellular environment participate to the occurrence of storage lesions. In this study, the hypothesis is that restoring physiological levels of uric and ascorbic acids (major plasmatic antioxidants) might correct metabolism defects and protect RBCs from the very beginning of the storage period, to maintain their quality. Leukoreduced CPD-SAGM RBC concentrates were supplemented with 416 µM uric acid and 114 µM ascorbic acid and stored during six weeks at 4 °C. Different markers, i.e., haematological parameters, metabolism, sensitivity to oxidative stress, morphology and haemolysis were analyzed. Quantitative metabolomic analysis of targeted intracellular metabolites demonstrated a direct modification of several metabolite levels following antioxidant supplementation. No significant differences were observed for the other markers. In conclusion, the results obtained show that uric and ascorbic acids supplementation partially prevented the metabolic shift triggered by plasma depletion that occurs during the RBC concentrate preparation. The treatment directly and indirectly sustains the antioxidant protective system of the stored RBCs

Combining Imaging Flow Cytometry and Machine Learning for High-Throughput Schistocyte Quantification: A SVM Classifier Development and External Validation Cohort.

International audienceBACKGROUND: Schistocyte counts are a cornerstone of the diagnosis of thrombotic microangiopathy syndrome (TMA). Their manual quantification is complex and alternative automated methods suffer from pitfalls that limit their use. We report a method combining imaging flow cytometry (IFC) and artificial intelligence for the direct label-free and operator-independent quantification of schistocytes in whole blood. METHODS: We used 135,045 IFC images from blood acquisition among 14 patients to extract 188 features with IDEAS\textregistered software and 128 features from a convolutional neural network (CNN) with Keras framework in order to train a support vector machine (SVM) blood elements' classifier used for schistocytes quantification. FINDING: Keras features showed better accuracy (94.03%, CI: 93.75-94.31%) than ideas features (91.54%, CI: 91.21-91.87%) in recognising whole-blood elements, and together they showed the best accuracy (95.64%, CI: 95.39-95.88%). We obtained an excellent correlation (0.93, CI: 0.90-0.96) between three haematologists and our method on a cohort of 102 patient samples. All patients with schistocytosis (>1% schistocytes) were detected with excellent specificity (91.3%, CI: 82.0-96.7%) and sensitivity (100%, CI: 89.4-100.0%). We confirmed these results with a similar specificity (91.1%, CI: 78.8-97.5%) and sensitivity (100%, CI: 88.1-100.0%) on a validation cohort (n=74) analysed in an independent healthcare centre. Simultaneous analysis of 16 samples in both study centres showed a very good correlation between the 2 imaging flow cytometers (Y=1.001x). INTERPRETATION: We demonstrate that IFC can represent a reliable tool for operator-independent schistocyte quantification with no pre-analytical processing which is of most importance in emergency situations such as TMA. FUNDING: None