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The purpose of this review is to explore how clinical metabolomics could help physicians in the future. The recent advent of medical genomics brings new and interesting technological tools to measure genetic predispositions to a disease. But metabolomics will allow us to go even further by linking the patient’s pathological phenotype with gene expression defects and metabolic disorders. It is in this context that the clinical chemist must adapt and be a force of proposal to meet these health challenges. He must help the clinician by mastering these new innovative tools, in order to participate in the implementation of clinical studies for the discovery of biomarkers, but also to propose the assays of biomarkers called “signatures,” which can be composite biomarkers or fingerprints, which will ultimately guide the clinician. He will have to propose them as clinical chemistry tests. In the first part, we will look at some concrete examples of the use of clinical metabolomics in clinical research projects that have led to the identification of a new biomarker. We will use the example of trimethylamine N-oxide (or TMAO) and review the clinical studies that have proposed TMAO as a biomarker for cardiovascular diseases. In a second part, we will see through bibliographic studies, how the metabolomic fingerprint can be useful to build a supervised model for patient stratification. In conclusion, we will discuss the limitations currently under debate.

BackgroundCOVID-19 severity is mainly related to lung impairment. However, preexisting patient characteristics and biomarkers at admission associated with this event are not precisely known.MethodsWe report 205 patients admitted for a proven COVID-19 in our institution between March 7 and April 22, 2020, particularly their comorbidities, respiratory severity, immune profile, and metabolic profile.FindingsMedian age was 70 years [interquartile range (IQR) 25-75: 60;79]; 115 (56·1%) patients were men. Oxygen supplementation of >2L/min was required in 107 patients (52·2%) after a median time of 8 days [IQR: 6;10] after the first symptoms; 67 (32·7%) patients were admitted to the intensive care unit (ICU), almost exclusively due to severe hypoxia. Patients requiring >2L/min oxygen therapy and/or ICU admission were older and more frequently males, with a significantly higher body mass index (BMI), a significantly higher total cholesterol (TC) / HDL cholesterol ratio, and higher triglycerides. They also had higher plasma levels of C-reactive protein (CRP) and interleukin 6 (IL-6); IL-6 >20 ng/L and CRP >70 mg/L were significantly associated with ICU admission and/or (for patients with a decision of limitation of life-support therapy) death. Higher BMI and TC/HDL-c ratio were associated with higher CRP and IL-6 levels. Steroid therapy was performed in 61 patients; while its clinical impact was inconclusive due to heterogeneous situations, IL-6 levels decreased significantly more in these patients.InterpretationSevere COVID-19 mostly relates to late-onset pneumonia associated with preexisting metabolic syndrome markers and a surge in inflammatory markers, allowing the early identification of at-risk patients.FundingThis work was supported by Foundation University of Grenoble Alpes.

The gut microbiota is now recognized as a key parameter affecting the host’s anti-cancer immunosurveillance and ability to respond to immunotherapy. Therefore, optimal modulation for preventive and therapeutic purposes is very appealing. Diet is one of the most potent modulators of microbiota, and thus nutritional intervention could be exploited to improve host anti-cancer immunity. Here, we show that an inulin-enriched diet, a prebiotic known to promote immunostimulatory bacteria, triggers an enhanced Th1-polarized CD4+and CD8+αβ T cell-mediated anti-tumor response and attenuates tumor growth in three preclinical tumor-bearing mouse models. We highlighted that the inulin-mediated anti-tumor effect relies on the activation of both intestinal and tumor-infiltrating γδ T cells that are indispensable for αβ T cell activation and subsequent tumor growth control, in a microbiota-dependent manner. Overall, our data identified these cells as a critical immune subset, mandatory for inulin-mediated anti-tumor immunityin vivo, further supporting and rationalizing the use of such prebiotic approaches, as well as the development of immunotherapies targeting γδ T cells in cancer prevention and immunotherapy.SignificanceOur study reveals that γδ T cells anti-cancer activity can be improved by nutritional intervention, in a microbiota-dependent manner. This work also indicates that γδ T cells are indispensable for reinforcing αβ T cells cancer immunosurveillance and subsequent tumor growth control. We believe that these findings could be of interest to the field of gut microbiota modulation, rationalizing the use of such prebiotic approaches as well as γδ T cells targeting, in cancer prevention and immunotherapy.

Over the past decade, studies have demonstrated the importance of bioactive metabolites derived from the microbiota in the regulation of physiological processes essential for homeostasis and the maintenance of human health. Strategies to modulate the production of these metabolites in the gastrointestinal tract hold promise for combating dysbiosis or inflammatory bowel disease. Metabolic engineering of probiotics could be one of these solutions. In this work, we engineered Escherichia coli Nissle 1917 (EcN) to overproduce spermidine, a metabolite known for its anti-immunosenescence and anti-inflammatory properties. Using a rational synthetic biology approach coupled with analysis by high resolution mass spectrometry, we designed in several steps and validated engineered probiotics overproducing and excreting spermidine. Based on our results, we first added the enzyme substrate putrescine and showed the overproduction of spermidine and decided to add a transporter limiting the production of the acetylated form of spermidine. Next, we used untargeted metabolomics to study the impact of engineering on the central metabolism of E. coli Nissle. Untargeted metabolomics appears to be a good strategy to optimize the metabolic engineering of probiotic strains and thus accelerate their development for personalized medicine.

Microbiota-derived metabolites have biological importance for their host. Spermidine, a metabolite described for its protective effect in age-related diseases, is now studied for its role in the resolution of inflammation and gut homeostasis. Strategies to modulate its production in the gastrointestinal tract are of interest to increase host spermidine intakes. Here, we show that metabolic engineering can be used to increase spermidine production by the probiotic

Background and ObjectivesKappa free light chains (KFLC) seem to efficiently diagnose MS. However, extensive cohort studies are lacking to establish consensus cut-offs, notably to rule out non-MS autoimmune CNS disorders. Our objectives were to (1) determine diagnostic performances of CSF KFLC, KFLC index, and KFLC intrathecal fraction (IF) threshold values that allow us to separate MS from different CNS disorder control populations and compare them with oligoclonal bands' (OCB) performances and (2) to identify independent factors associated with KFLC quantification in MS.MethodsWe conducted a retrospective multicenter study involving 13 French MS centers. Patients were included if they had a noninfectious and nontumoral CNS disorder, eligible data concerning CSF and serum KFLC, albumin, and OCB. Patients were classified into 4 groups according to their diagnosis: MS, clinically isolated syndrome (CIS), other inflammatory CNS disorders (OIND), and noninflammatory CNS disorder controls (NINDC).ResultsOne thousand six hundred twenty-one patients were analyzed (675 MS, 90 CIS, 297 OIND, and 559 NINDC). KFLC index and KFLC IF had similar performances in diagnosing MS from nonselected controls and OIND (p= 0.123 andp= 0.991 for area under the curve [AUC] comparisons) and performed better than CSF KFLC (p< 0.001 for all AUC comparisons). A KFLC index of 8.92 best separated MS/CIS from the entire nonselected control population, with better performances than OCB (p< 0.001 for AUC comparison). A KFLC index of 11.56 best separated MS from OIND, with similar performances than OCB (p= 0.065). In the multivariate analysis model, female gender (p= 0.003), young age (p= 0.013), and evidence of disease activity (p< 0.001) were independent factors associated with high KFLC index values in patients with MS, whereas MS phenotype, immune-modifying treatment use at sampling, and the FLC analyzer type did not influence KFLC index.DiscussionKFLC biomarkers are efficient tools to separate patients with MS from controls, even when compared with other patients with CNS autoimmune disorder. Given these results, we suggest using KFLC index or KFLC IF as a criterion to diagnose MS.Classification of EvidenceThis study provides Class III evidence that KFLC index or IF can be used to differentiate patients with MS from nonselected controls and from patients with other autoimmune CNS disorders.

Resume La calprotectine est une proteine de liaison au calcium exprimee au site inflammatoire par les neutrophiles et les monocytes afin d’activer le systeme immunitaire inne. Grâce a cette caracteristique unique, elle constitue un bon indicateur de l’inflammation locale dans les rhumatismes inflammatoires chroniques. L’ensemble des donnees met en evidence le role cle que joue la calprotectine dans le processus inflammatoire de plusieurs rhumatismes inflammatoires. L’interet des dosages de calprotectine serique ou plasmatique a ete largement etudie ces dernieres annees, en particulier dans la polyarthrite rhumatoide, la spondyloarthrite, l’arthrite juvenile idiopathique et les vascularites associees aux ANCA. La calprotectine a ete identifiee comme un biomarqueur performant qui permet d’evaluer et de suivre l’activite de la maladie mais egalement de predire l’evolution structurale ou la reponse au traitement. La calprotectine a montre son interet dans la prediction de la progression radiologique dans la polyarthrite rhumatoide et la spondylarthrite ankylosante. La calprotectine est egalement un biomarqueur predictif du risque de rechute dans les vascularites associees aux ANCA et de maladie inflammatoire de l’intestin dans les spondyloarthrites. Neanmoins, les etudes rapportent des resultats contradictoires qui necessitent d’etre confirmes dans de plus larges cohortes. L’absence de standardisation du dosage de calprotectine rend difficile la reproduction des resultats et la comparaison entre les differentes etudes. Dans cette revue, nous discutons de l’interet de la calprotectine dans les rhumatismes inflammatoires chroniques en tant que biomarqueur diagnostique, d’activite ou pronostique.

Calprotectin is a calcium binding protein produced by neutrophils and monocytes locally at the site of inflammation in order to trigger the innate immunity receptors. This unique characteristic makes it a good proxy for evaluation of local inflammation in chronic inflammatory rheumatic diseases. Complete data suggest, in inflammatory rheumatic diseases, a relevant role of calprotectin in the inflammatory process. The interest of serum or plasma calprotectin dosage has been studied intensively, in the current years, especially in rheumatoid arthritis, spondyloarthritis, juvenile idiopathic arthritis and ANCA associated vasculitis. Calprotectin seems to be a great candidate as biomarker to assess and monitor disease activity, to predict structural progression or response to the treatment. Calprotectin showed its ability to predict radiological progression in rheumatoid arthritis and ankylosing spondylitis. Serum calprotectin can predict the risk of relapse in ANCA associated vasculitis and the risk of inflammatory bowel disease in spondyloarthritis. Nevertheless, studies report controversial result requiring replication in other large cohort. The lack of assay standardization between studies is a problem to replicate and compare studies. In this review, we discuss on the interest of systemic calprotectin in chronic inflammatory rheumatic disease as a diagnostic, activity or prognostic biomarker.

Objective We aimed to determine whether calprotectin and α-defensins could discriminate septic from other inflammatory arthritides. Methods Synovial fluids with a predominance of neutrophils from patients with septic arthritis, pseudogout and RA were prospectively collected. Neutrophil-related proteins calprotectin and human neutrophil α-defensins levels were assessed in synovial fluids. Demographic parameters and biomarkers with P-value ⩽0.05 for differentiating septic from non-septic arthritis were included in a multivariable model. Multivariable logistic regression with stepwise selection was performed to build the final combined model. Results A total of 74 patients were included: septic arthritis (n = 26), pseudogout (n = 28) and RA (n = 20). Patients with septic arthritis were more likely to be male and young, and to display higher synovial neutrophil count. Calprotectin was significantly increased in patients with septic arthritis. The multivariable model included calprotectin, synovial fluid neutrophil count and gender. Calprotectin was the only biomarker that discriminated septic arthritis from non-septic inflammatory arthritides, with 76% sensitivity, 94% specificity and a positive likelihood ratio = 12.2 at the threshold for calprotectin of 150 mg/l. Conclusion Synovial fluid calprotectin is a relevant biomarker to discriminate septic arthritis from other inflammatory arthritides. This biomarker should be tested in an independent cohort.

Background Immune checkpoints inhibitors (ICI) are becoming new standards of care for the treatment of non-small cell lung cancer (NSCLC), both as first (alone or in association with chemotherapy) and second line. However, no powerful predictive biomarker of therapeutic response to ICI has been found to date. It has been recently shown that microbiota composition could influence the ability of patients to respond to ICI. Indeed, the microbiota produces circulating metabolites that will subsequently act on immune system, the investigators hypothesized that plasma metabolic signature, reflecting a global microbiota function, could represent a predictive biomarker of response to ICI. Methods Monocentric prospective study. Primary objective is to identify baseline metabolic signature (metabolomics analysis by mass spectrometry) associated to ICI response. Secondary objectives are to link metabolic signature with microbiota composition (metagenomics analysis RNA 16S) and immune profile, and altogether with clinic response to ICI. The study will include 60 NSCLC patients treated by ICI in 1st, 2nd or 3rd line of treatment at the Grenoble Alpes University hospital (CHUGA) in 18 months. Patients that have received antibiotic or steroid treatment, 2 or 4 weeks before ICI initiation, respectively, will be excluded. Blood and feces will be collected prior to, at 2 months after ICI treatment initiation, and at 6 months or at progression. Expected results We expect to highlight a metabolic profile predictive of response to ICI. By identifying factors associated with early progression, we could avoid to treat potential non-responding patients. Moreover, by restoring a favorable microbiota, patients’ ability to respond to these treatments might be restored.

Pseudomonas aeruginosa (P.a) is one of the most critical antibiotic resistant bacteria in the world and is the most prevalent pathogen in cystic fibrosis (CF), causing chronic lung infections that are considered one of the major causes of mortality in CF patients. Although several studies have contributed to understanding P.a within-host adaptive evolution at a genomic level, it is still difficult to establish direct relationships between the observed mutations, expression of clinically relevant phenotypes, and clinical outcomes. Here, we performed a comparative untargeted LC/HRMS-based metabolomics analysis of sequential isolates from chronically infected CF patients to obtain a functional view of P.a adaptation. Metabolic profiles were integrated with expression of bacterial phenotypes and clinical measurements following multiscale analysis methods. Our results highlighted significant associations between P.a &ldquo, metabotypes&rdquo, expression of antibiotic resistance and virulence phenotypes, and frequency of clinical exacerbations, thus identifying promising biomarkers and therapeutic targets for difficult-to-treat P.a infections

Introduction: Giant cell arteritis (GCA) is a systemic vasculitis with important relapses and sometimes severe complications. Serum amyloid A (SAA) is a protein of the acute phase of inflammation and could be involved in the pathophysiology of GCA. The aim of this study is determining if SAA is a marker of disease activity. Methods: Patients with diagnosis or relapse of GCA were included between October 2015 and January 2018 in our center. SAA dosage was realized at baseline then every 3 months for one year. Along the study, patients were separated in 3 groups according to clinical status: active disease, inactive disease or infections. Results: Twenty patients were included: 15 newly diagnosed and 5 relapses. There have been 21 clinical situations with active disease, 46 with inactive disease and 8 infections. SAA level were significantly higher during active disease (84.5, IR: 30.7-220 mg/l) compared with patients in inactive disease (23.85, IR: 14.6-35.3 mg/l), p = 0.01. There were no statistically difference between SAA level in active disease and infections, p = 0.09. Conclusion: We have shown that SAA is a marker of disease activity. The second step is determinate if SAA is more specific than erythrocyte sedimentation rate or C-protein reactive and could be a potential diagnostic test.

We have analyzed the prebiotic effect of softwood hemicelluloses on specific bacterial species in vitro and on microbiota diversity and metabolism in healthy mice in vivo. The ethanol-precipitated glycans from the softwood hemicellulose autohydrolysate were able to stimulate in vitro the growth of Bifidobacterium adolescentis, but to a much lesser extent than that of adherent-invasive E. coli. B. adolescentis was the best producer of SCFA. When mice were fed with the ethanol precipitate fraction, the relative abundance of Bacteroidetes increased while that of Proteobacteria diminished, suggesting change towards a less obesogenic microbiome. Following treatment, lipid analysis showed a decrease in cholesterol, bile acids and free fatty acids, indicating a potential cardioprotection role. Furthermore, analysis of fermentation metabolites revealed an increase in metabolites important for immune health and well-being. Our results highlight the value of hemicelluloses as a potential source of prebiotics supporting both a healthy digestive tract and immune system.

Pseudomonas aeruginosa is a critical pathogen for human health, due to increased resistances to antibiotics and to nosocomial infections. There is an urgent need for tools allowing for better understanding mechanisms underlying the disease processes and for evaluating new therapeutic strategies with animal models. Here, we used a novel approach, applying high-resolution magic angle spinning nuclear magnetic resonance spectroscopy (HRMAS NMR) directly to lung biopsies of mice to better understand the impact of infection on the tissue at a molecular level. Mice were infected with two P. aeruginosa strains of different virulence levels. Statistical analysis applied to HRMAS NMR data allowed us to build a multivariate discriminant model to distinguish the lungs' metabolic profiles of mice, infected or not. Moreover, a second model was built to appreciate the degree of severity of infection, demonstrating sufficient sensitivity of HRMAS NMR-based metabolomics to investigate this type of infection. The metabolic features that discriminate infection statuses are dominated by some key differentially expressed metabolites that are related, respectively, to bacterial carbon metabolism (glycerophosphocholine) and to septic hypoxic stress response of host (succinate). Finally, to get closer to clinical and diagnosis issues, we proposed to build simple logistic regression models to predict the infection status on the basis of only one metabolite intensity. Thus, we have demonstrated that succinate intensity could discriminate the infected/noninfected status infection with a sensibility of 89% and a specificity of 95%, and leucine/isoleucine intensity could predict the severe/not severe status of infection with a sensibility of 100% and a specificity of 95%. We also looked for the interest of this model in order to predict the efficacy of anti- P. aeruginosa treatment. By HRMAS metabolomics analysis of lungs infected with P. aeruginosa after vaccination, we demonstrated that this model could be a useful tool to predict the efficacy of new anti- P. aeruginosa drugs. This metabolomics approach could therefore be useful both for the definition of biomarkers of severity of infection and for an earlier characterization of therapeutic efficacy.

Background Septic arthritis is a life threatening purulent invasion of a joint by an infectious agent which produces arthritis. If untreated, septic arthritis causes structural damage to the joint. Unfortunately no relevant biomarkers are available for the diagnosis of this disabling condition. We aimed at determining whether calprotectin (S100A8/A9) and Human neutrophil alpha-defensins (HNP1–3) could discriminate septic from other inflammatory arthritides Objectives We aimed at determining whether calprotectin (S100A8/A9) and Human neutrophil alpha-defensins (HNP1–3) could discriminate septic from other inflammatory arthritides Methods Patients joint effusions for which septic arthritis was suspected were prospectively collected in Grenoble Hospital. Patients with inflammatory synovial fluid (i.e. with white blood cell >2000/mm3 and >80% polymorphonuclear neutrophils (PMN)) were included in this trial. Diagnosis of septic arthritis was retained if bacteria were cultured from inflammatory synovial fluid and/or blood samples. Diagnosis of pseudo gout was retained when pyrophosphate calcium crystals were observed in inflammatory synovial fluid. Diagnosis of rheumatoid arthritis was retained according to rheumatologist opinion. C Reactive protein (CRP), both neutrophil-related proteins calprotectin and human neutrophil alpha-defensins (HNP1–3) levels were assessed in synovial fluids. Threshold for biomarkers were determined by ROC curve analysis. Sensibility, Specificity, Positive (PPV) and Negative (NPV) Predictive Values at a pre specified threshold were calculated. Biomarkers with p value≤0.05 were included into a multivariate model. Multivariate logistic regression with stepwise selection was performed to build the final combined model. Results A total of 74 patients were included: septic arthritis (n=26), pseudo gout (n=28) and Rheumatoid arthritis (n=20). Patients with septic arthritis group were more likely to be male (69% vs. 31%, p=0.030), were younger (median age (range) 65.5 (27–84) vs. 72.5 (33–91), p=0.047)), displayed higher synovial fluid PMN count (9,600 (1,800–68000) vs. 6560 (750–22500, p=0.047))., LR+12.2 and LR- 0.26. Calprotectin was significantly increased in patients with septic arthritis (190 (0.1–247) vs. 62 (0–208) mg/L, p In the multivariate model, including calprotectin, HNP1–3, synovial fluid PMN count and gender, calprotectin was the only biomarker discriminating septic arthritis from non-septic inflammatory arthritides with 76% sensitivity, 94% specificity, 86% PPV and 88% NPV. Conclusions Our data show here that synovial fluid calprotectin is a relevant biomarker to discriminate septic arthritis from other inflammatory arthritides. This biomarker should be tested in an independent cohort. Acknowledgements The authors thank Sylvie Papacatzis for her help in the study. Disclosure of Interest None declared

Objectives Tumour necrosis factor-alpha inhibitors (TNFi) are effective treatments for Rheumatoid Arthritis (RA). Responses to treatment are barely predictable. As these treatments are costly and may induce a number of side effects, we aimed at identifying a panel of protein biomarkers that could be used to predict clinical response to TNFi for RA patients. Methods Baseline blood levels of C-reactive protein, platelet factor 4, apolipoprotein A1, prealbumin, α1-antitrypsin, haptoglobin, S100A8/A9 and S100A12 proteins in bDMARD naive patients at the time of TNFi treatment initiation were assessed in a multicentric prospective French cohort. Patients fulfilling good EULAR response at 6 months were considered as responders. Logistic regression was used to determine best biomarker set that could predict good clinical response to TNFi. Results A combination of biomarkers (prealbumin, platelet factor 4 and S100A12) was identified and could predict response to TNFi in RA with sensitivity of 78%, specificity of 77%, positive predictive values (PPV) of 72%, negative predictive values (NPV) of 82%, positive likelihood ratio (LR + ) of 3.35 and negative likelihood ratio (LR−) of 0.28. Lower levels of prealbumin and S100A12 and higher level of platelet factor 4 than the determined cutoff at baseline in RA patients are good predictors for response to TNFi treatment globally as well as to Infliximab, Etanercept and Adalimumab individually. Conclusion A multivariate model combining 3 biomarkers (prealbumin, platelet factor 4 and S100A12) accurately predicted response of RA patients to TNFi and has potential in a daily practice personalized treatment.

In the context of value added valorization of hemicelluloses (HCs), their soft extraction by autohydrolysis (AH) of softwood (SW) chips has been optimized via the temperature/time parameters (170°C/2 h, 170°C/1 h and 150°C/1 h). Two enzyme mixtures containing mainly a glucanase and a mannanase were used to decrease the degree of polymerization (DP) of the extracted HCs. Hydrolysates containing HCs were analyzed in terms of monomers and oligomers, molecular weight distribution (MWD) and chemical composition. The MW was strongly dependent on AH conditions: most of the water-soluble HCs with 1800 Da MW were obtained at 150°C/1 h. The parameters 170°C/2 h gave rise to MWs

Pseudomonas aeruginosa (Pa) is a significant cause of morbidity and mortality, especially in cystic fibrosis patients. Its eradication is difficult due to a wide phenotypic adaptability and an increase of its resistance to antibiotics. After the failure of several recombinant vaccines which mainly triggered humoral response, live-attenuated vaccines received attention thanks to their ability to elicit a broad immunity with both humoral- and cell-mediated responses, essential to fight this pathogen. In this study, we developed an innovative and safer live-attenuated Pa vaccine based on a Killed But Metabolically Active (KBMA) attenuation method. KBMA Pa has been further rationally designed to overexpress beneficial effectors like the type 3 secretion system apparatus. We demonstrated that KBMA Pa elicits a high and broad humoral response in mice against several antigens of particular interest such as OprF and PcrV proteins. Moreover, we assessed cytokines in the serum of immunized mice and showed that KBMA Pa elicits Th1, Th2 and especially Th17 pathways of cell-mediated immune responses. Th17 pathway involvement was also confirmed after specific stimulation of helper T cells in immunized mice. Finally, we showed that this vaccine is safe and has a protective effect in a murine acute pulmonary infectious challenge. In conclusion, KBMA Pa is a new platform with high potential for the development of a vaccine against Pa.

International audience; Ectopic expression of defined transcription factors (TFs) for cell fate handling has proven high potential interest in reprogramming differentiated cells, in particular for regenerative medicine, ontogenesis study and cell based modelling. Pluripotency or transdifferentiation induction as TF mediated differentiation is commonly produced by transfer of genetic information with safety concerns. The direct delivery of proteins could represent a safer alternative but still needs significant advances to be efficient. We have successfully developed the direct delivery of proteins by an attenuated bacterium with a type 3 secretion system that does not require challenging and laborious steps for production and purification of recombinant molecules. Here we show that this natural micro-syringe is able to inject TFs to primary human fibroblasts and cord blood CD34(+) hematopoietic stem cells. The signal sequence for vectorization of the TF Oct4 has no effect on DNA binding to its nucleic target. As soon as one hour after injection, vectorized TFs are detectable in the nucleus. The injection process is not associated with toxicity and the bacteria can be completely removed from cell cultures. A three days targeted release of Oct4 or Sox2 embryonic TFs results in the induction of the core pluripotency genes expression in fibroblasts and CD34(+) hematopoietic stem cells. This micro-syringe vectorization represents a new strategy for TF delivery and has potential applications for cell fate reprogramming.

This chapter presents a general overview of type III secretion system (T3SS) regulation in the main pathogenic bacteria, and focuses on the different aspects of the regulation of T3SS gene expression in Pseudomonas aeruginosa. Pathogenic bacteria occupy very different infection foci; for instance, the animal pathogens Shigella spp. and Salmonella spp. live intracellularly after successful invasion, whereas Yersinia spp., P. aeruginosa, and enteropathogenic Escherichia coli (EPEC) predominantly remain extracellular. Therefore, different stimuli could be used to up or downregulate the expression of T3SS genes: temperature, divalent cations, host cell contact, serum, or other factors. Although the mechanism by which metabolic pathways influence virulence gene expression in bacteria is unclear, the example of P. aeruginosa detailed could facilitate progress in that field. It has been shown that T3SS expression is dependent on cell density and that exsCEBA operon expression decreases rapidly in the second part of stationary phase, and also that indole-3-acetic acid (IAA), naphthalenacetic, and 3-hydroxykynurenine inhibit exsCEBA operon expression at millimolar concentrations. In 2005, Wu and coworkers proposed that the opportunistic pathogen P. aeruginosa could adapt to the host by sensing alterations in the host immune function and respond by enhancing the virulence phenotype. Despite the large number of genes that influence the regulation of the expression of T3SS genes in P. aeruginosa, only a minority have been shown to have a precise role. Both fundamental and applied research can make the inhibition of T3SS expression as one of the first new antibacterial therapeutics.

Background Pseudomonas aeruginosa (Pa) is a Gram-negative bacteria frequently involved in healthcare-associated pneumonia with poor clinical outcome. To face the announced post-antibiotic era due to increasing resistance and lack of new antibiotics, new treatment strategies have to be developed. Immunomodulation of the host response involved in outcome could be an alternative therapeutic target in Pa-induced lung infection. Kynurenines are metabolites resulting from tryptophan catabolism and are known for their immunomodulatory properties. Pa catabolizes tryptophan through the kynurenine pathway. Interestingly, many host cells also possess the kynurenine pathway, whose metabolites are known to control immune system homeostasis. Thus, bacterial metabolites may interfere with the host’s immune response. However, the kynurenine pathway in Pa, including functional enzymes, types and amounts of secreted metabolites remains poorly known. Using liquid chromatography coupled to mass spectrometry and different strains of Pa, we determined types and levels of metabolites produced by Pa ex vivo in growth medium, and the relevance of this production in vivo in a murine model of acute lung injury. Results Ex vivo, Pa secretes clinically relevant kynurenine levels (μM to mM). Pa also secretes kynurenic acid and 3-OH-kynurenine, suggesting that the bacteria possess both a functional kynurenine aminotransferase and kynurenine monooxygenase. The bacterial kynurenine pathway is the major pathway leading to anthranilate production both ex vivo and in vivo. In the absence of the anthranilate pathway, the kynurenine pathway leads to kynurenic acid production. Conclusion Pa produces and secretes several metabolites of the kynurenine pathway. Here, we demonstrate the existence of new metabolic pathways leading to synthesis of bioactive molecules, kynurenic acid and 3-OH-kynurenine in Pa. The kynurenine pathway in Pa is critical to produce anthranilate, a crucial precursor of some Pa virulence factors. Metabolites (anthranilate, kynurenine, kynurenic acid) are produced at sustained levels both ex vivo and in vivo leading to a possible immunomodulatory interplay between bacteria and host. These data may imply that pulmonary infection with bacteria highly expressing the kynurenine pathway enzymes could influence the equilibrium of the host’s tryptophan metabolic pathway, known to be involved in the immune response to infection. Further studies are needed to explore the effects of these metabolic changes on the pathophysiology of Pa infection. Electronic supplementary material The online version of this article (doi:10.1186/s12866-016-0756-x) contains supplementary material, which is available to authorized users.

We have read with great interest the article by Jonsson et al that was recently published online in ARD ,1 which suggested that calprotectin, also known as S100A8/S100A9 heterodimer, was associated with radiographic progression in early rheumatoid arthritis (RA). Calprotectin correlates significantly with inflammatory markers and disease activity score.2 Besides correlations between baseline calprotectin levels, Clinical Disease Activity Index and ultrasonography power Doppler, the authors showed that baseline calprotectin levels correlated with van der Heijde modified Sharp score (SHS) progression (defined as an increase ≥1 unit/year from 0 to 24 months), independently of age, gender, Clinical Disease Activity Index, erythrocyte sedimentation rate (ESR), C reactive protein (CRP) levels and rheumatoid factor positivity.1 We analysed the initial serum calprotectin among patients with early RA fulfilling American College of Rheumatology/European League Against Rheumatism 2010 of the French observational cohort Etude et Suivi des POlyarthrites Indifferenciees Recentes (ESPOIR). Calprotectin serum concentrations were assessed according to manufacturer method (Hycult, Frontstraat, Netherlands; …

International audience; Obstructive sleep apnea (OSA) is a multi-component chronic disease affecting 6-17% of adults in the general population. The main hallmark of OSA, intermittent hypoxia (IH), is reported as the main trigger for cardiometabolic co-morbidities. Recent studies, both in rodent models exposed to IH and in humans, have suggested an enhanced incidence and accelerated progression of cancer. However, mechanisms underlying the relationships between OSA and cardiovascular disease on one hand, and cancer on the other hand, have not been entirely deciphered yet. Tryptophan (TRP) metabolism results in nicotinamid and serotonin production, but also in the production of numerous intermediates such as kynurenine, anthranilic and kynurenic acids, 3-hydroxykynurenine, 3-hydroxyanthranilic and quinolinic acids. Each of these metabolites has been linked to cardiovascular disease and cancer mainly in epidemiologic studies. We hypothesize that an alteration of TRP metabolism may play a role in OSA-related cardiovascular co-morbidities and might be one of the players in the relationship between cancer and intermittent hypoxia/OSA. If this is true, interventions aiming to modify TRP metabolism, may constitute a new therapeutic strategy against cardiovascular disease progression and cancer occurrence in OSA populations.

Chronic lung infection with Pseudomonas aeruginosa (P. a.) is considered as the leading cause of cysticfibrosis (CF) morbidity and mortality. During this persistent infection, the bacterium adapts to the typical lungenvironment of these patients and evolves within its host for decades. This adaptive evolution is driven byphenotypes, including a decrease in virulence and an increase in antibiotic resistance over time. Althoughseveral studies have attempted to elucidate the genetic mechanisms of this evolution, it remains difficulttoday to explain the relationships between the accumulated genomic mutations and the expression ofclinically relevant phenotypes, or to correlate these mutations with the patient’s health status.In this work, we propose to study the mechanisms underlying this adaptive evolution at a post-genomicobservation level: metabolomics. Metabolomics, the newest of the -omics disciplines, provides an instantview of the metabolic activities, and furnishes a vision as close as possible to the phenotype. To this end,we constructed a bank of evolutive clonal P. a. lineages sampled during chronic lung infection in patientswith CF. This bank was then clinically, phenotypically and metabolomically characterized. Integration ofthese different levels of information by multi-block statistical methods has allowed us to highlight metabolicpathways involved in within-host patho-adaptation of P. a. .Our results rise new hypotheses for the development of therapeutic and diagnostic tools with the aim ofimproving the management of these infections particularly resistant to antibiotics. In addition, our workdemonstrates the interest of metabolomics to study bacterial adaptive evolution under natural conditions.; L’infection pulmonaire chronique à Pseudomonas aeruginosa (P. a.) est considérée comme la principalecause de morbidité et de mortalité liée à la mucoviscidose. Au cours de cette infection persistante, labactérie s'adapte à l’environnement pulmonaire caractéristique de ces patients et évolue avec son hôtependant des décennies. Cette évolution adaptative est portée par les phénotypes, avec notamment unediminution de la virulence et une augmentation de la résistance aux antibiotiques au cours du temps. Bienque plusieurs études aient tenté d’évaluer les mécanismes génétiques de cette évolution, il demeureaujourd’hui difficile d’expliquer les relations entre les mutations accumulées dans le génome bactérien etl’expression de phénotypes cliniquement pertinents, ou encore de corréler ces mutations avec l’état desanté du patient.Nous proposons dans ce travail d’étudier les mécanismes sous-tendant cette évolution adaptative à unniveau d’observation post-génomique : la métabolomique. Dernière-née des disciplines –omiques, lamétabolomique permet la prise de vue instantanée du métabolisme, et offre une vision au plus proche duphénotype. Pour cela, nous avons constitué une banque de lignées clonales évolutives de P. a. prélevéesau cours de l’infection pulmonaire chronique chez des patients atteints de mucoviscidose. Cette banque aensuite été caractérisée aux plans clinique, phénotypique et métabolomique. L’intégration de ces différentsniveaux d’information par des méthodes statistiques multi-tableaux nous a permis de mettre en évidencedes voies métaboliques impliquées dans la patho-adaptation de P. a. à son hôte.Nos résultats permettent de faire émerger de nouvelles hypothèses pour le développement d’outilsthérapeutiques et diagnostiques visant à améliorer la prise en charge de ces infections particulièrementrésistantes aux antibiotiques. De plus, nos travaux démontrent l’intérêt de la métabolomique pour l’étudede l’évolution adaptative bactérienne en conditions naturelles.

Chronic lung infection with Pseudomonas aeruginosa (P. a.) is considered as the leading cause of cysticfibrosis (CF) morbidity and mortality. During this persistent infection, the bacterium adapts to the typical lungenvironment of these patients and evolves within its host for decades. This adaptive evolution is driven byphenotypes, including a decrease in virulence and an increase in antibiotic resistance over time. Althoughseveral studies have attempted to elucidate the genetic mechanisms of this evolution, it remains difficulttoday to explain the relationships between the accumulated genomic mutations and the expression ofclinically relevant phenotypes, or to correlate these mutations with the patient’s health status.In this work, we propose to study the mechanisms underlying this adaptive evolution at a post-genomicobservation level: metabolomics. Metabolomics, the newest of the -omics disciplines, provides an instantview of the metabolic activities, and furnishes a vision as close as possible to the phenotype. To this end,we constructed a bank of evolutive clonal P. a. lineages sampled during chronic lung infection in patientswith CF. This bank was then clinically, phenotypically and metabolomically characterized. Integration ofthese different levels of information by multi-block statistical methods has allowed us to highlight metabolicpathways involved in within-host patho-adaptation of P. a. .Our results rise new hypotheses for the development of therapeutic and diagnostic tools with the aim ofimproving the management of these infections particularly resistant to antibiotics. In addition, our workdemonstrates the interest of metabolomics to study bacterial adaptive evolution under natural conditions., L’infection pulmonaire chronique à Pseudomonas aeruginosa (P. a.) est considérée comme la principalecause de morbidité et de mortalité liée à la mucoviscidose. Au cours de cette infection persistante, labactérie s'adapte à l’environnement pulmonaire caractéristique de ces patients et évolue avec son hôtependant des décennies. Cette évolution adaptative est portée par les phénotypes, avec notamment unediminution de la virulence et une augmentation de la résistance aux antibiotiques au cours du temps. Bienque plusieurs études aient tenté d’évaluer les mécanismes génétiques de cette évolution, il demeureaujourd’hui difficile d’expliquer les relations entre les mutations accumulées dans le génome bactérien etl’expression de phénotypes cliniquement pertinents, ou encore de corréler ces mutations avec l’état desanté du patient.Nous proposons dans ce travail d’étudier les mécanismes sous-tendant cette évolution adaptative à unniveau d’observation post-génomique : la métabolomique. Dernière-née des disciplines –omiques, lamétabolomique permet la prise de vue instantanée du métabolisme, et offre une vision au plus proche duphénotype. Pour cela, nous avons constitué une banque de lignées clonales évolutives de P. a. prélevéesau cours de l’infection pulmonaire chronique chez des patients atteints de mucoviscidose. Cette banque aensuite été caractérisée aux plans clinique, phénotypique et métabolomique. L’intégration de ces différentsniveaux d’information par des méthodes statistiques multi-tableaux nous a permis de mettre en évidencedes voies métaboliques impliquées dans la patho-adaptation de P. a. à son hôte.Nos résultats permettent de faire émerger de nouvelles hypothèses pour le développement d’outilsthérapeutiques et diagnostiques visant à améliorer la prise en charge de ces infections particulièrementrésistantes aux antibiotiques. De plus, nos travaux démontrent l’intérêt de la métabolomique pour l’étudede l’évolution adaptative bactérienne en conditions naturelles.

Like embryonic stem cells, induced pluripotent stem cells (iPS) are characterized by their ability to differentiate into any cell type in an organism. However their use doesn't raise the ethical issue linked to the use of embryos. iPS are generated from somatic cells by overexpression of embryonic transcription factors. iPS are thereby very promising in fundamental and applied biology as well as for regenerative medicine.Most of the protocols used to generate iPS are based on the delivery of nucleic acid sequences encoding embryonic transcription factors responsible for the activation of the pluripotency gene network. In spite of their efficiency, these methods are associated with major safety concerns incompatible with clinical applications. The more rational path to safely produce iPS is to deliver the exogenic transcription factors under their protein form. Recently some protocols using protein delivery have been developed to produce iPS. However associated efficiencies are very low and protocols are quite fastidious.The aim of this Ph.D. project was to develop a new efficient and simplified protein delivery method for the safe generation of iPS compatible with clinical applications. Cell sources were selected depending of the final applications of iPS: (i) fibroblasts, extensively used and described in bibliography and allowing autologous therapies with many applications in the field of hematology; (ii) cord blood hematopoietic stem cells, one of the safest biomaterials, with the aim to generate red blood cells in vitro in order to respond to increasing needs for transfusion products, particularly for rare blood types.First, different protein vectors developed by the TheREx team of the TIMC-IMAG laboratory were compared for their efficiency of production and delivery as well as for the activity of associated factors. The selected vector is a natural micro-syringe expressed by Pseudomonas aeruginosa, able to inject the transcription factors Oct4, Sox2, Nanog and Lin28a (Thomson combination) with c-Myc directly into the cytoplasm of target cells, without the need for any purification step. Once injected, transcription factors are addressed to the nucleus in less than 2 hours where they efficiently activate transcription of pluripotency genes, with significant responses observed as early as 24h after injection. We also highlighted the secured and controllable nature of this vector by completely eliminating the bacteria from the cultures in a few hours after injection with an antibiotic treatment. Optimizations of the reprogramming conditions were also made by adjusting many parameters such as the combination of transcription factors, the injection frequency and the bacteria : cell ratio.; Les cellules souches pluripotentes induites (iPS) partagent avec les cellules souches embryonnaires la capacité à se différencier en tous les types cellulaires d'un organisme, mais leur obtention ne nécessite pas l'utilisation d'embryons. Elles sont générées par la surexpression de facteurs de transcription embryonnaires au sein de cellules somatiques. Les iPS représentent un outil de choix en biologie fondamentale et appliquée ainsi qu'en médecine régénérative.La plupart des protocoles de génération d'iPS reposent sur un transfert des séquences nucléotidiques codant les facteurs de transcription embryonnaires impliqués dans la mise en place du réseau de pluripotence. Bien qu'efficaces, ces méthodes présentent des problèmes de sécurité majeurs, incompatibles avec une utilisation clinique des iPS générées. La voie la plus rationnelle pour produire des iPS de manière parfaitement sécurisée est d'apporter les facteurs exogènes directement sous leur forme protéique. Des protocoles de reprogrammation par transfert de protéines ont été récemment développés, mais les efficacités associées sont relativement faibles et les protocoles relativement fastidieux.L'objectif de ce projet de thèse était de mettre au point une nouvelle approche de transfert de protéines, sécurisée et simplifiée, pour la génération de cellules souches pluripotentes induites utilisables en clinique. Les cellules à reprogrammer ont été choisies en fonction des applications potentielles des iPS générées : (i) les fibroblastes, faisant référence dans la bibliographie et permettant d'envisager des thérapies autologues avec notamment de nombreuses applications en hématologie ; (ii) les cellules souches hématopoïétiques de sang de cordon, l'un des matériaux biologiques les plus sûrs, afin de générer des globules rouges in vitro, dans la perspective de répondre aux demandes croissantes en terme de transfusion, en particulier pour les groupes sanguins rares.Nous avons donc comparé les différents vecteurs de transduction de protéines développés par l'équipe TheREx du laboratoire TIMC-IMAG, en termes de facilité de production, d'efficacité de transfert ainsi que sur l'activité des facteurs de transcription associés. Le vecteur sélectionné est une micro-seringue naturelle portée par la bactérie Pseudomonas aeruginosa, capable d'injecter les facteurs Oct4, Sox2, Nanog et Lin28 (facteurs de Thomson) mais aussi c-Myc, directement dans le cytoplasme des cellules cibles, sans étape de purification nécessaire. Les facteurs de transcription injectés sont adressés jusqu'au noyau des cellules en moins de 2h, où ils activent rapidement la transcription des gènes de pluripotence, avec des réponses significatives mesurées dès 24h après injection. Nous avons également mis en évidence le caractère sécurisé et contrôlable du vecteur puisque nous sommes capables d'éliminer complètement les bactéries des cultures grâce à un traitement antibiotique, et ce dès quelques heures après l'injection. Des optimisations des conditions de reprogrammation ont été réalisées en modifiant les principaux paramètres que sont, le choix des facteurs de transcription, la fréquence des injections et le ratio bactéries : cellules.Ainsi, bien que nous ne soyons pas parvenus à générer des iPS à ce jour avec ce système, la micro-seringue naturelle que nous avons développé et optimisé se positionne comme un vecteur de choix pour le transfert de protéines dans l'optique de générer des iPS, en termes d'efficacité de vectorisation et d'induction transcriptionnelle, de sécurité mais aussi de facilité d'utilisation.

Like embryonic stem cells, induced pluripotent stem cells (iPS) are characterized by their ability to differentiate into any cell type in an organism. However their use doesn't raise the ethical issue linked to the use of embryos. iPS are generated from somatic cells by overexpression of embryonic transcription factors. iPS are thereby very promising in fundamental and applied biology as well as for regenerative medicine.Most of the protocols used to generate iPS are based on the delivery of nucleic acid sequences encoding embryonic transcription factors responsible for the activation of the pluripotency gene network. In spite of their efficiency, these methods are associated with major safety concerns incompatible with clinical applications. The more rational path to safely produce iPS is to deliver the exogenic transcription factors under their protein form. Recently some protocols using protein delivery have been developed to produce iPS. However associated efficiencies are very low and protocols are quite fastidious.The aim of this Ph.D. project was to develop a new efficient and simplified protein delivery method for the safe generation of iPS compatible with clinical applications. Cell sources were selected depending of the final applications of iPS: (i) fibroblasts, extensively used and described in bibliography and allowing autologous therapies with many applications in the field of hematology; (ii) cord blood hematopoietic stem cells, one of the safest biomaterials, with the aim to generate red blood cells in vitro in order to respond to increasing needs for transfusion products, particularly for rare blood types.First, different protein vectors developed by the TheREx team of the TIMC-IMAG laboratory were compared for their efficiency of production and delivery as well as for the activity of associated factors. The selected vector is a natural micro-syringe expressed by Pseudomonas aeruginosa, able to inject the transcription factors Oct4, Sox2, Nanog and Lin28a (Thomson combination) with c-Myc directly into the cytoplasm of target cells, without the need for any purification step. Once injected, transcription factors are addressed to the nucleus in less than 2 hours where they efficiently activate transcription of pluripotency genes, with significant responses observed as early as 24h after injection. We also highlighted the secured and controllable nature of this vector by completely eliminating the bacteria from the cultures in a few hours after injection with an antibiotic treatment. Optimizations of the reprogramming conditions were also made by adjusting many parameters such as the combination of transcription factors, the injection frequency and the bacteria : cell ratio., Les cellules souches pluripotentes induites (iPS) partagent avec les cellules souches embryonnaires la capacité à se différencier en tous les types cellulaires d'un organisme, mais leur obtention ne nécessite pas l'utilisation d'embryons. Elles sont générées par la surexpression de facteurs de transcription embryonnaires au sein de cellules somatiques. Les iPS représentent un outil de choix en biologie fondamentale et appliquée ainsi qu'en médecine régénérative.La plupart des protocoles de génération d'iPS reposent sur un transfert des séquences nucléotidiques codant les facteurs de transcription embryonnaires impliqués dans la mise en place du réseau de pluripotence. Bien qu'efficaces, ces méthodes présentent des problèmes de sécurité majeurs, incompatibles avec une utilisation clinique des iPS générées. La voie la plus rationnelle pour produire des iPS de manière parfaitement sécurisée est d'apporter les facteurs exogènes directement sous leur forme protéique. Des protocoles de reprogrammation par transfert de protéines ont été récemment développés, mais les efficacités associées sont relativement faibles et les protocoles relativement fastidieux.L'objectif de ce projet de thèse était de mettre au point une nouvelle approche de transfert de protéines, sécurisée et simplifiée, pour la génération de cellules souches pluripotentes induites utilisables en clinique. Les cellules à reprogrammer ont été choisies en fonction des applications potentielles des iPS générées : (i) les fibroblastes, faisant référence dans la bibliographie et permettant d'envisager des thérapies autologues avec notamment de nombreuses applications en hématologie ; (ii) les cellules souches hématopoïétiques de sang de cordon, l'un des matériaux biologiques les plus sûrs, afin de générer des globules rouges in vitro, dans la perspective de répondre aux demandes croissantes en terme de transfusion, en particulier pour les groupes sanguins rares.Nous avons donc comparé les différents vecteurs de transduction de protéines développés par l'équipe TheREx du laboratoire TIMC-IMAG, en termes de facilité de production, d'efficacité de transfert ainsi que sur l'activité des facteurs de transcription associés. Le vecteur sélectionné est une micro-seringue naturelle portée par la bactérie Pseudomonas aeruginosa, capable d'injecter les facteurs Oct4, Sox2, Nanog et Lin28 (facteurs de Thomson) mais aussi c-Myc, directement dans le cytoplasme des cellules cibles, sans étape de purification nécessaire. Les facteurs de transcription injectés sont adressés jusqu'au noyau des cellules en moins de 2h, où ils activent rapidement la transcription des gènes de pluripotence, avec des réponses significatives mesurées dès 24h après injection. Nous avons également mis en évidence le caractère sécurisé et contrôlable du vecteur puisque nous sommes capables d'éliminer complètement les bactéries des cultures grâce à un traitement antibiotique, et ce dès quelques heures après l'injection. Des optimisations des conditions de reprogrammation ont été réalisées en modifiant les principaux paramètres que sont, le choix des facteurs de transcription, la fréquence des injections et le ratio bactéries : cellules.Ainsi, bien que nous ne soyons pas parvenus à générer des iPS à ce jour avec ce système, la micro-seringue naturelle que nous avons développé et optimisé se positionne comme un vecteur de choix pour le transfert de protéines dans l'optique de générer des iPS, en termes d'efficacité de vectorisation et d'induction transcriptionnelle, de sécurité mais aussi de facilité d'utilisation.