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It has been reported that dipyridamole and some benzodiazepines potentiate the responses to adenosine in peripheral organs and in particular in the guinea pig isolated atria or trachea by inhibition of adenosine uptake and/or metabolism. In this study, we have examined the sensitization of guinea pig isolated trachea to relaxant responses to adenosine produced by dipyridamole, diazepam and 3 compounds chemically unrelated to benzodiazepines but which display selective agonistic activity towards the central (zolpidem and zopiclone) or peripheral (alpidem) type benzodiazpine receptors. In preparations under spontaneous tone and in the absence of adenosine, dipyridamole (10(-5) M) and diazepam (10(-5)-10(-4) M), alpidem (3 x 10(-6) M-10(-5) M) and zopiclone (10(-6)-10(-4) M) induced a relaxation of the airway smooth muscle. In addition, dazepam (10(-4) M) attenuated the phasic response to histamine (10(-5) M). Dipyridamole (10(-5) M) and diazepam (10(-4) M) respectively produced a 56.2 and 32.4-fold potentiation of adenosine relaxant effects. Alpidem (10(-6)-10(-5) M), zolpidem (10(-6)-10(-4) M) and zopiclone (10(-6)-10(-4) M) were without any significant effect on the adenosine concentration-response curves. Moreover, alpidem, zolpidem, and zopiclone did not modify the 2-chloroadenosine dose-response curves nor the diazepam induced sensitization of adenosine-induced relaxation. In conclusion, adenosine sensitization of the guinea pig isolated trachea caused by diazepam might involve a peripheral benzodiazpine receptor subtype coupled to a nucleoside transporter system which is different from those recognized by compounds derived from the imidazopyridine series.

1. The influence of epithelium removal and/or thiorphan on the effects of neurokinins (substance P (SP), neurokinin A (NKA), neurokinin B (NKB)) and related peptides on airway contractility was investigated on the guinea-pig isolated trachea. 2. Removing the tracheal epithelium significantly enhanced the sensitivity but not the maximum contractile responses to the peptides. 3. After removal of the epithelial layer, the shifts to the left of the log concentration response curves were greater for SP and SP-OMe (1.62 and 1.94 log units, respectively) than for two SP analogues substituted in position 9 namely [Pro9]SP sulfone and [beta-Ala4, Sar9]SP(4-11) sulfone (0.66 and 0.68 log units, respectively). The leftward shifts for compounds related to NKA or NKB lay between 0.58 and 0.73 log units. 4. The leftward shifts of the log concentration-response curves for SP, SP-OMe, [Pro9]SP sulfone, [beta-Ala4, Sar9]SP(4-11) sulfone and NKA were of similar magnitude after removal of the epithelium or after pretreatment with thiorphan (10(-5) M), an enkephalinase inhibitor, in the presence of epithelium. No significant additional shift of the curves to the left was observed with thiorphan plus epithelium removal. 5. The results obtained with the selective agonists for each of the three classes of neurokinin receptor (i.e NK1, NK2, NK3) suggest that the guinea-pig trachea contains receptors for SP and NKA but few if any for NKB. 6. It was concluded that neurokinins and related peptides (especially SP and analogues not substituted in position 9) are degraded by enkephalinase mainly located in the tracheal epithelium and that the addition of thiorphan or epithelium removal results in an inhibition or loss of enkephalinase activity, thereby increasing similarly the potencies of these peptides. It was, therefore, suggested that the supersensitivity to neurokinins produced by epithelium removal was due neither to the elimination of a permeability barrier nor to reduced production of a relaxant factor, but mainly to reduced peptide degradation.

Sensitive afferent nerves and the neurokinins they release upon activation are considered to be important in controlling bronchomotor tone. Human isolated bronchi respond to neurokinin A (NKA), substance P (SP), and neurokinin B (NKB) with dose-dependent contractions. The order of potency of the three natural neurokinins is NKA greater than SP greater than NKB, suggesting the presence of NK-2 receptors. To further characterize the neurokinin receptors in human bronchi, we used selective agonists for each receptor type (i.e., NK-1, NK-2, and NK-3). In fact, NK-1 selective compounds, [Pro9]SP(1-11) sulfone and [beta-ala4,Sar9]SP(4-11) sulfone, did not induce significant contractions up to 10(-5) M. Similarly, the selective agonist for the NK-3 receptor, [MePhe7]NKB(4-10), was almost inactive. However, the NK-2 selective fragment [Nle]NKA(4-10) was a potent stimulant. The negative log of the peptide concentration that caused 50% of maximal effect (pD2) was 6.99 for NKA and 6.12 for [Nle10]NKA(4-10). Removal of the epithelium significantly enhanced the contractile responses to the three neurokinins and also to the NK-2 selective agonist. Phosphoramidon, an enkephalinase inhibitor, was more potent than epithelium removal in enhancing the contractile responses to these agonists. However, epithelium removal and phosphoramidon did not increase the weak responses to the NK-1 and NK-3 selective compounds. In the presence of phosphoramidon, removal of the epithelium slightly enhanced the contractile responses to NKA and [Nle]NKA(4-10) but not to SP and NKB.(ABSTRACT TRUNCATED AT 250 WORDS)

1. The influence of epithelium removal on the effects of adenosine on airway contractility was investigated on the guinea-pig isolated trachea. 2. In preparations under resting tone or precontracted with histamine 10(-5) M, removal of the tracheal epithelium resulted in similar shifts to the left of the adenosine concentration-response curves (0.61 +/- 0.18 (P less than 0.05) and 0.80 +/- 0.09 (P less than 0.001) log units; n = 5), corresponding to 4.07 and 6.31 fold potentiations of the relaxant effect of adenosine. 3. In the presence of dipyridamole 10(-5) M the relaxant effects of adenosine were potentiated 85.1 fold on tracheae with epithelium; removal of the epithelium did not produce a significant additional shift to the left of the adenosine concentration-response curves (0.07 +/- 0.03 log units; n = 5; NS). 4. In the absence of dipyridamole, the theophylline-adenosine antagonism was not of the competitive type, irrespective of whether the tracheae were with or without epithelium. 5. In the presence of dipyridamole, this antagonism was likely to be of the competitive type and its characteristics were the same when the epithelium was present or absent. Regression slope and pA2 values were 0.84 and 5.07, respectively, in the presence of epithelium and 0.76 and 4.89, respectively, in its absence. 6. It is suggested that, at least in the guinea-pig isolated trachea model, the airway epithelium seems to be involved only in the uptake and metabolism of adenosine.

Points essentielsLa BPCO est une maladie pulmonaire avec un retentissement systémique dont il est nécessaire d’évaluer la sévérité avant de décider et initier une stratégie thérapeutique.Le sevrage tabagique est primordial quel que soit le stade de la maladie, pour ralentir le déclin de la fonction respiratoire, améliorer les symptômes, réduire la fréquence des exacerbations, améliorer la tolérance à l’effort et diminuer la mortalité globale.Les bronchodilatateurs ont une place essentielle dans la prise en charge médicamenteuse de la BPCO. Les bronchodilatateurs inhalés de longue durée d’action sont indiqués lorsque la symptomatologie persiste (notamment la dyspnée) malgré l’utilisation pluriquotidienne d’un bronchodilatateur de courte durée d’action. Ils modifient l’évolution au long cours de la maladie, notamment en réduisant la fréquence des exacerbations.Le choix entre un β2-adrénergique et un anticholinergique est fonction du bénéfice symptomatique individuel.Les corticoïdes ne sont indiqués que sous forme d’associations fixes avec un β2-adrénergique de longue durée d’action par voie inhalée chez des patients ayant des exacerbations répétées malgré un traitement continu par bronchodilatateur. L’association d’un corticoïde inhalé à un β2-adrénergique de longue durée d’action permet de réduire la fréquence des exacerbations modérées à sévères.La réhabilitation devrait être proposée à tout patient qui a une dyspnée, une intolérance à l’exercice, ou une limitation de ses activités quotidiennes liées à la BPCO malgré un traitement médicamenteux optimal de sa maladie et des éventuelles comorbidités. Par une prise en charge multidisciplinaire et individualisée, elle permet d’optimiser les performances physiques, l’insertion sociale, l’autonomie et diminue la consommation de soins en réduisant les exacerbations, les consultations en urgence et la durée des hospitalisations.Les objectifs de la réhabilitation ne se limitent pas à l’obtention d’une augmentation de la capacité fonctionnelle d’effort mais aussi à des changements durables de comportement nécessaires à une amélioration de l’état de santé et de la qualité de vie du patient. C’est un moment privilégié pour l’éducation thérapeutique, essentielle dans le parcours de soin du patient souffrant de BPCO.Key pointsCOPD is a pulmonary disease with a systemic impact. The goals of COPD assessment are to determine the severity of the disease to guide management.Smoking cessation is a prime objective at all the stages of the disease to modify the long-term decline in lung function, reduce the COPD symptoms, and the frequency of exacerbations, improve health status and reduce mortality.The bronchodilators are central in the pharmacologic management of COPD. Long-acting bronchodilators are indicated as maintenance treatment to relieve COPD symptoms (particularly dyspnea) despite regular use of short-acting bronchodilators. Long-acting bronchodilators reduce the exacerbation rate. The choice between a long-acting β2-adrenergic and an anticholinergic depends on the patient's perception of symptom relief.The inhaled corticoids are only indicated in COPD combined with long-acting β2-adrenergic in patients with severe COPD and a history of repeated exacerbations, who have significant symptoms despite therapy with bronchodilators. The combination of an inhaled corticosteroid with a long-acting β2-agonist reduces the exacerbation rate.The rehabilitation should be offered to all patients with dyspnea, exercise intolerance, or limitation in everyday activities related to COPD despite optimal pharmacological therapy and management of co-morbidities. Pulmonary rehabilitation is a multidisciplinary and tailored management of the COPD patients which enable to optimize exercise capacity, social reintegration, autonomy, reduce health care costs by decreasing the exacerbation rate, urgent visits and duration of hospitalisation.The rehabilitation is not just focusing on the improvement of exercise capacity, but also seeks sustained behavioural changes that are needed to achieve real improvement in health status and quality of life. Pulmonary rehabilitation is also an excellent opportunity for education which is critical in the healthcare pathway.

We studied nasal responses to allergen, saline, and distilled water aerosol in 7 subjects with allergic rhinitis to determine whether they caused a similar release of mediators and influx of inflammatory cells into the nasal lumen. The subjects were challenged first with allergen and then with aerosols of distilled water and of normal saline in random order on separate days. We measured nasal airway resistance (Rn) by posterior rhinomanometry, measured the concentrations of protein, histamine, leukotrienes (LT) B4, C4, and D4, and platelet-activating factor (PAF-acether) and performed total and differential cell counts in nasal lavage fluid obtained before and after each challenge. Allergen challenge provoked a 2-fold or greater increase in nasal airway resistance in all subjects (mean increase = 12.2-fold). This response was associated with significant increases in protein, histamine, LTB4, and sulfidopeptide leukotrienes. 2-lyso-PAF-acether increased significantly, indicating activation of phospholipase A2, but PAF-acether was detected in only one subject. The total cell count increased from 55 +/- 44 x 10(3)/ml to 200 +/- 168 x 10(3)/ml; polymorphonuclear neutrophils increased from 11 +/- 22 x 10(3)/ml to 108 +/- 96 x 10(3)/ml, and eosinophils increased from 1.3 +/- 1.8 x 10(3)/ml to 10.6 +/- 15.3 x 10(3)/ml (p less than 0.05). Saline insufflation provoked insignificant changes in mean Rn, in the levels of protein and all inflammatory mediators, and in the number and types of cells in nasal lavage fluid. Distilled water insufflation also provoked an insignificant increase in mean Rn, but there was a 14-fold increase in one subject.(ABSTRACT TRUNCATED AT 250 WORDS)

Kinins are a group of peptides released in blood and tissues by the action of trypsin-like endopeptidases, the kallikreins. A variety of stimuli have been shown to transform the inactive prekallikreins into kallikreins and thus start the process of the liberation of kinins from large protein precursors of hepatic origin, the kininogens (1). Bradykinin and related kinins appear to be autacoids, released in tissues to act on a variety of cells and structures, including arterial and venous smooth muscles, endothelia, especially capillary endothelia, mast cells, fibroblasts and both sensory and motor nerve endings. Kinins are indeed the most potent endogenous stimulants of pain fibers and of a variety of sensory fibers distributed throughout the cardiovascular system to monitoring vascular reactivity, blood flow and cardiovascular reflexes (2). Kinins act also as modulators of transmitter release, especially in the sympathetic nervous system (3).

Various vasoactive peptides were compared for their histamine releasing effects on rat mast cells. Neurotensin, substance P (SP), and kallidin were the most active natural peptides, followed by bradykinin; neurokinin A and B, bombesin, angiotensin and tuftsin were practically inactive. Several kinins and tachykinin-related peptides were tested in an attempt to characterize the receptors mediating histamine liberation. The order of potency of the kinins was the following: kallidin greater than [Tyr(Me)8]bradykinin = bradykinin greater than [desArg10]kallidin greater than desArg9-bradykinin, the same as that found in smooth muscle possessing receptors of the B2 type. Tachykinin-related peptides were potent stimulants and followed the order: [D-Tryp7,9,10]SP-(1-11) greater than [D-Pro2,D-Tryp7,9,10]SP-(1-11) greater than SP-(1-11) greater than SP-(1-9) greater than [D-Pro4,D-Tryp7,9,Leu11]SP-(4-11) greater than SP-(1-7) greater than SP-(4-11) greater than neurokinin A = neurokinin B, indicating that: (a) undecapeptide antagonists of SP behave as superagonists; (b) both N- and C-terminal portions of SP-(1-11) are essential for activity; and (c) receptors for the tachykinins mediating histamine release appear to be of the SP-P type.

A series of substance P (SP)- and bradykinin (BK)-related peptides have been compared for their histamine-releasing activities on rat peritoneal mast cells. Some of these peptides only differed in the N-acetylation of the N-terminal arginine residue or by the removal of charged residue at the N-terminal. The aim was to examine the role of the N-terminal positive charges in the histamine-releasing activity of compounds that are selective for the SP receptor (named NK-1) or for the B2 type bradykinin receptor. Only compounds with positive charges at the N-terminal caused non-cytotoxic histamine release from rat mast cells. It is suggested that SP- and BK-related peptides caused histamine release by a mechanism which appeared to be non-specific and not related to the activation of mast cell NK-1 or B2 receptors, respectively. Our results show that NK-1 agonists or B2 antagonists devoid of histamine-releasing activity, which could be of potential use in the clinic, can be obtained by removing the positively charged N-terminal aminoacids or by N-acetylation of the N-terminal arginine.

The deduced amino acid sequences of CALLA, a cell surface marker of human acute lymphocytic leukemia, and human enkephalinase (neutral endopeptidase, EC 3.4.24.11) were recently reported to be almost identical. We show that membranes of CALLA+ cells of the REH lymphoblastic cell line as well as blast cells derived from the blood or bone marrow of patients with acute lymphocytic leukemia display high enkephalinase activity. This activity was abrogated by several enkephalinase inhibitors at concentrations closely similar to those required to inhibit pure human enkephalinase. However, these compounds did not significantly modify the rate of REH cell proliferation in vitro. Hence, the functional role, if any, of the high peptidase activity in lymphoblastic cells remains to be established.

Substance P and two recently identified neurokinins, substance K and neuromedin K as well as the nonmammalian tachykinin kassinin were compared for (a) histamine-releasing abilities from rat mast cells, (b) plasma extravasation effects on rat skin, and (c) wheal and flare responses on human skin. Among the four tachykinins, a significantly dose-dependent histamine release from rat mast cells and a flare response in human skin was observed only with substance P, indicating the possible implication of histamine in this response. On the other hand, the four peptides were similarly active on the wheal response (plasma extravasation produced by increased permeability of capillaries and venules) in human skin and on the plasma extravasation in the rat skin, suggesting a dissociation of effects and possibly of receptors.

Kinins are known to be potent releasers of histamine. In the present study, the B2 antagonist analogues of bradykinin (BK) and kallidin (KD): [( Thi6,9,D-Phe8]KD, [Thi5,8,D-Phe7]BK) were also found to be potent releasers of histamine from rat mast cells and not to exert any antagonistic effect. Similarly, two B1 receptor antagonists, des-Arg10-[Leu9]KD and des-Arg9-[Leu8]BK, were shown to promote histamine release and acted only as agonists. The order of potency of these analogues was the following: [Thi6,9,D-Phe8]KD greater than [Thi5,8,D-Phe7]BK greater than des-Arg10- [Leu9]KD greater than des-Arg9-[Leu8]BK. The high activity of some of these compounds suggests that (1) the potency of kinins for histamine release from rat mast cells not only increases in parallel with the number of positively charged amino acids (Lys, Arg) but also, because of others factors such as peptide conformation, receptor binding affinity or receptor accessibility, (2) the histamine release by kinins is either a non-specific effect not mediated by receptors or, if receptors are involved, these sites may be different from other kinin receptors (i.e. B1 or B2).

International audience; Background: MASK-air® is an app that supports allergic rhinitis patients in disease control. Users register daily allergy symptoms and their impact on activities using visual analog scales (VASs). We aimed to assess the concurrent validity, reliability, and responsiveness of these daily VASs. Methods: Daily monitoring VAS data were assessed in MASK-air® users with allergic rhinitis. Concurrent validity was assessed by correlating daily VAS values with those of the EuroQol-5 Dimensions (EQ-5D) VAS, the Control of Allergic Rhinitis and Asthma Test (CARAT) score, and the Work Productivity and Activity Impairment Allergic Specific (WPAI-AS) Questionnaire (work and activity impairment scores). Intra-rater reliability was assessed in users providing multiple daily VASs within the same day. Test–retest reliability was tested in clinically stable users, as defined by the EQ-5D VAS, CARAT, or “VAS Work” (i.e., VAS assessing the impact of allergy on work). Responsiveness was determined in users with two consecutive measurements of EQ-5D-VAS or “VAS Work” indicating clinical change. Results: A total of 17,780 MASK-air® users, with 317,176 VAS days, were assessed. Concurrent validity was moderate–high (Spearman correlation coefficient range: 0.437–0.716). Intra-rater reliability intraclass correlation coefficients (ICCs) ranged between 0.870 (VAS assessing global allergy symptoms) and 0.937 (VAS assessing allergy symptoms on sleep). Test–retest reliability ICCs ranged between 0.604 and 0.878—“VAS Work” and “VAS asthma” presented the highest ICCs. Moderate/large responsiveness effect sizes were observed—the sleep VAS was associated with lower responsiveness, while the global allergy symptoms VAS demonstrated higher responsiveness. Conclusion: In MASK-air®, daily monitoring VASs have high intra-rater reliability and moderate–high validity, reliability, and responsiveness, pointing to a reliable measure of symptom loads.

Obesity promotes the development of chronic bronchial diseases (asthma, COPD) and complicates their management, induces sleep breathing disorders and increases susceptibility to respiratory infections. Adipocytea are a source of mediator production including adipokines. Among these, adiponectin (APN) is a 30kDa protein that can associate in multimers of variable molecular weight. It circulates at high level but its serum concentration decreases with weight gain. APN is involved in immunoregulation and pulmonary development. But the pro or anti-inflammatory role of the APN is still a matter for debate. The association between serum levels of APN and the occurrence of bronchial diseases is not clearly demonstrated in humans. We explored the role of adipokines within the respiratory system. In particular, we studied the effect of the APN on the production of cytokines by pulmonary macrophages and bronchial epithelial cells. We obtained lung specimens from patients operated for carcinoma, from which we carried out primary cultures of parenchymal explants, pulmonary macrophages or bronchial epithelial cells and we also prepared bronchial rings for study in organ bath. We have revealed an in situ production of APN by human lung tissue, which is correlated with patient weight. We have verified that APN receptors (AdipoR1 and AdipR2) were both expressed by pulmonary macrophages, bronchial explants, and bronchial epithelial cells. We have treated human lung macrophages with APN (3-10-30 μg/ml) before stimulation with LPS (10 ng / ml) or Poly I: C (10 ng/ml) or IL-4 (10 ng/ml).We have shown that the APN decreased the production of M1 cytokines induced by LPS and Poly I: C (IL-6, CCL3, CCL4, CCL5, CXCL8, TNFa) as well as those of M2 cytokines induced by IL-4 (CCL13, CCL18, CCL22). AdipoRon, a synthetic adiponectin receptor agonist, exhibited the same effects as the recombinant protein. In comparison, leptin at its highest concentration (1000 ng/ml) induced the production of M1-type cytokines (IL-6, CCL3, CCL4, CCL5, TNF-α) by unstimulated macrophages whereas visfatin and chemerin did not reveal any effect on cytokine production by macrophages. Only APN demonstrated an effect on bronchial epithelial cells: decreasing the production of CXCL1 and CCL2 at basal state and after stimulationwith TNF (50 ng / ml) but increasing production of IL6, CCL20 and CXCL8 in the basal situation. We have completed this work by experiments on the regulation of bronchial tone by adipokines, using bronchial rings in isolated organ baths. These results have been the subject of a European patent application. This work is the first looking at the effect of APN and AdipoRon on primary human pulmonary macrophages and bronchial epithelial cells. APN is able to modulate the polarization of these cells. Adipokines are essential for understanding the respiratory burden of obesity.; L’obésité est responsable de diverses complications médicales, notamment respiratoires. Elle favorise l’apparition de maladies bronchiques chroniques (asthme, BPCO) et complique leur prise en charge. Elle s’accompagne de troubles respiratoires du sommeil et augmente la susceptibilité aux infections respiratoires.Le tissu adipocytaire est désormais reconnu comme un tissu hormonal, source de nombreux médiateurs dont font partie les adipokines, cytokines produites principalement par les adipocytes. Parmi celles-ci, l’adiponectine (APN) est une protéine de 30kDa qui peut s’associer en multimères de plus ou moins haut poids moléculaire. Ses taux circulants sont élevés mais sa concentration sérique diminue avec le gain de poids.L’adiponectine est impliquée dans les phénomènes d’immunorégulation associés aux modifications nutritionnelles et également dans le développement pulmonaire. Mais le rôle pro ou anti-inflammatoire de l’APN est toujours un sujet à débat. L’association entre les taux sériques d’APN et la survenue de maladies bronchiques n’est pas clairement démontrée chez l’homme.Nous nous sommes intéressés au rôle que joue l’APN au sein du système respiratoire, dans la régulation du fonctionnement des macrophages et cellules épithéliales bronchiques. Nous avons plus particulièrement étudié l’effet de l’APN sur la sécrétion de cytokines par ces deux types cellulaires.Nous disposons de pièces opératoires pulmonaires de patients opérés pour un cancer bronchique, à partir desquelles nous réalisons des cultures primaires d’explants de parenchyme, de macrophages pulmonaires ou de cellules épithéliales bronchiques et nous disséquons des anneaux bronchiques.Nous avons montré qu’il existait une production d’APN in situ par du tissu pulmonaire humain et que cette production était corrélée, à l’instar de la forme circulante, au poids du patient. Nous avons vérifié que les récepteurs à l’APN (AdipoR1 et AdipR2) étaient tous les deux exprimés par des macrophages pulmonaires, des explants de bronches et des cellules épithéliales bronchiques.Nous avons soumis les macrophages pulmonaires humains à un traitement par de l’APN à différentes concentrations (3-10-30 microg/ml) avant de les stimuler par du LPS (10 ng/ml ou Poly I:C 10 ng/ml) ou d’IL-4 (10 ng/ml). Nous avons montré que l’adiponectine diminuait la sécrétion des cytokines M1 induites par le LPS et le Poly I:C (IL6, CCL3, CCL4, CCL5, CXCL8, TNF). tout comme celles des cytokines M2 induites par l’IL-4 (CCL13, CCL18, CCL22). L'adipoRon, agoniste synthétique des récepteurs de l'adiponectine, a montré les mêmes effets que la protéine recombinante.Nous avons comparé avec l’effet d’autres adipokines : la leptine à sa plus grande concentration (1000 ng/ml) induisait la production de cytokines de type M1 (IL6, CCL3, CCL4, CCL5, TNFa) par des macrophages non stimulés alors que la visfatine et la chémérine n’avaient aucun effet sur la production de cytokines par les macrophages.Seule l’adiponectine a démontré un effet sur les cellules épithéliales bronchiques, en modulant de façon opposée la production de certaines cytokines : diminution de la sécrétion de CXCL1 et CCL2 en situation basale et après traitement par TNF (50 ng/ml) mais augmentation de celle d’IL6 et CXCL8 en situation basale.Nous avons complété ce travail par des expériences sur la régulation du tonus bronchique par les adipokines, en utilisant des anneaux bronchiques dans des cuves à organes isolées. Ces résultats ont fait l'objet d’un dépôt de brevet européen.Ces travaux sont les premiers à s’intéresser à l’effet de l’APN et de l’AdipoRon sur un modèle de culture primaire de macrophages et cellules épithéliales bronchiques humains. L’APN est capable de moduler la polarisation de ces cellules. Les adipokines régulent aussile tonus bronchique. Les adipokines sont essentielles à la compréhension du retentissement pulmonaire de l’obésité.

Lung transplantation is considered as a valid therapeutic option for patients with end-stage lung disease. Despite considerable progress in immunosuppressive therapy, allograft rejection remains a major cause of graft loss. Multiple studies have highlighted the importance of acute rejection as an important risk factor for the development of chronic lung allograft dysfunction (CLAD) leading to graft failure. Therefore, the improvement in the diagnosis of acute rejection represents a major challenge to prevent CLAD. In this study, we evaluated the tissue markers of acute antibody-mediated rejection (AMR) in lung transplantation. In our experience, the histopathologic findings including the microvascular inflammation in pulmonary AMR are not specific and C4d staining is a useful marker to confirm the diagnosis of AMR. Secondly, we investigated by flow cytometry the polarization of alveolar macrophage obtained by bronchoalveolar lavage (BAL) from lung transplant patients with and without acute rejection. Our results show the limits of surface markers (CD206 and HLA-DR) in the evaluation of alveolar macrophage polarization. This study shows the interest of tissue markers, especially the C4d staining, in monitoring of lung transplant patients and highlights the need to identify appropriate and available markers for future studies of alveolar macrophage polarization by flow cytometry.; La transplantation pulmonaire est depuis une vingtaine d’années une option thérapeutique valide pour une grande variété de pathologies pulmonaires au stade terminal. Malgré les progrès réalisés ces dernières années en matière de traitement immunosuppresseur, les rejets restent une cause majeure de la perte du greffon. Plusieurs études ont souligné l'importance du rejet aigu comme un facteur contributif important à l’évolution de la dysfonction chronique du greffon (ou CLAD) et, in fine, à la perte du greffon. Par conséquent, des outils diagnostiques fiables de rejet aigu s’imposent pour mieux prévenir le CLAD. Dans notre première étude, nous avons évalué les marqueurs tissulaires de rejet aigu humoral (RAH) pulmonaire. Nous avons montré ainsi que les lésions histologiques dont l’inflammation microvasculaire ne sont pas spécifiques et le marquage C4d est un marqueur utile pour confirmer le diagnostic de RAH. Dans un second temps, nous avons étudié en cytométrie de flux la polarisation des macrophages obtenus par lavage bronchiolo-alvéolaire (LBA) chez des patients transplantés avec et sans rejet. Nos résultats montrent les limites des marqueurs membranaires (HLA-DR et CD206) dans l’évaluation de l’état de polarisation des macrophages au cours des rejets. Ce travail montre l’intérêt des marqueurs tissulaires, en particulier le marquage C4d, dans le suivi des patients transplantés pulmonaires et souligne la nécessité d’identifier des marqueurs appropriés et utilisables en cytométrie de flux pour avancer sur l’état de polarisation des macrophages alvéolaires.

Lung transplantation is considered as a valid therapeutic option for patients with end-stage lung disease. Despite considerable progress in immunosuppressive therapy, allograft rejection remains a major cause of graft loss. Multiple studies have highlighted the importance of acute rejection as an important risk factor for the development of chronic lung allograft dysfunction (CLAD) leading to graft failure. Therefore, the improvement in the diagnosis of acute rejection represents a major challenge to prevent CLAD. In this study, we evaluated the tissue markers of acute antibody-mediated rejection (AMR) in lung transplantation. In our experience, the histopathologic findings including the microvascular inflammation in pulmonary AMR are not specific and C4d staining is a useful marker to confirm the diagnosis of AMR. Secondly, we investigated by flow cytometry the polarization of alveolar macrophage obtained by bronchoalveolar lavage (BAL) from lung transplant patients with and without acute rejection. Our results show the limits of surface markers (CD206 and HLA-DR) in the evaluation of alveolar macrophage polarization. This study shows the interest of tissue markers, especially the C4d staining, in monitoring of lung transplant patients and highlights the need to identify appropriate and available markers for future studies of alveolar macrophage polarization by flow cytometry., La transplantation pulmonaire est depuis une vingtaine d’années une option thérapeutique valide pour une grande variété de pathologies pulmonaires au stade terminal. Malgré les progrès réalisés ces dernières années en matière de traitement immunosuppresseur, les rejets restent une cause majeure de la perte du greffon. Plusieurs études ont souligné l'importance du rejet aigu comme un facteur contributif important à l’évolution de la dysfonction chronique du greffon (ou CLAD) et, in fine, à la perte du greffon. Par conséquent, des outils diagnostiques fiables de rejet aigu s’imposent pour mieux prévenir le CLAD. Dans notre première étude, nous avons évalué les marqueurs tissulaires de rejet aigu humoral (RAH) pulmonaire. Nous avons montré ainsi que les lésions histologiques dont l’inflammation microvasculaire ne sont pas spécifiques et le marquage C4d est un marqueur utile pour confirmer le diagnostic de RAH. Dans un second temps, nous avons étudié en cytométrie de flux la polarisation des macrophages obtenus par lavage bronchiolo-alvéolaire (LBA) chez des patients transplantés avec et sans rejet. Nos résultats montrent les limites des marqueurs membranaires (HLA-DR et CD206) dans l’évaluation de l’état de polarisation des macrophages au cours des rejets. Ce travail montre l’intérêt des marqueurs tissulaires, en particulier le marquage C4d, dans le suivi des patients transplantés pulmonaires et souligne la nécessité d’identifier des marqueurs appropriés et utilisables en cytométrie de flux pour avancer sur l’état de polarisation des macrophages alvéolaires.

In pulmonary diseases such as asthma and chronic obstructive pulmonary disease, macrophages orchestrate inflammatory reactions. In response to environmental signals, macrophages exhibit a phenotypic polarization that mirrors the Th1/Th2 polarization. Upon exposure to bacterial lipopolysaccharide (LPS), macrophages undergo M1 polarization. In contrast, interleukin (IL)-4/IL-13 induce M2 polarization.In our first study, we characterized the phenotypic differentiation of human lung macrophages (LM) using a whole-transcriptome approach. Cytokines, lipid metabolism and membrane markers were among the most affected genes. LPS-induced M1 polarization was associated with an increase in the production of cytokines (TNF-α, IL-1β, CCL2, 3, 4, 5, CXCL1, 8, 10), in PGE2 signalling and in the expression of CD38 and CD197. IL-4/IL-13-induced M2 macrophages increased expression of cytokines (CCL13, 17, 22, 26), 15-lipoxygenase (15-LOX) and CD206. In the second study, we investigated the expression of 15-LOX-1 and 15-LOX-2 and their roles in regulating the polarization of human LM. LPS increased the expression of 15-LOX-2 whereas IL-4/IL-13 induced the expression of 15-LOX-1. Inhibition of the 15-LOX pathways decreased the production of both M1 and M2 cytokines. The third study investigated the expression of α7 nicotinic receptors (α7nAChR) and their regulating roles in the polarization of LM. Expression of α7nAChR was found in unstimulated LM. Specific α7nAChR agonists decreased the in vitro production of both M1 and M2 cytokines. Our work adds new insights in the macrophage polarization and some of the regulatory pathways that may be involved in pulmonary diseases, Les macrophages jouent un rôle dans l'inflammation de certaines pathologies pulmonaires comme l'asthme et la broncho pneumopathie chronique obstructive. Selon la dichotomie Th1 et Th2, les macrophages s'activent en phénotype M1/M2 en fonction du microenvironnement. Sous l'influence du lipopolysaccharide (LPS) les macrophages s'activent en phénotype M1. A l'inverse, l'exposition aux cytokines Th2 (interleukine (IL)-4/IL-13) induit un phénotype M2 des macrophages. Nous avons réalisé une étude transcriptomique des marqueurs de la polarisation M1/M2 des macrophages pulmonaires humains. La polarisation M1 induite par le LPS augmente la production des cytokines (TNF-α, IL-1β, CCL2, 3, 4, 5, CXCL1, 8, 10), de la PGE2 et l'expression du CD38 et CD197. La polarisation M2 induite par l'IL-4/IL-13 augmente l'expression des cytokines (CCL13, 17, 22, 26), de la 15-lipoxygénase (15-LOX) et du CD206. Nous avons évalué l'expression des 15-LOX-1 et 15-LOX-2 et leur rôle dans la régulation de la polarisation des macrophages pulmonaires. Le LPS augmente l'expression de la 15-LOX-2 alors que l'IL-4/IL-13 augmente l'expression de la 15-LOX-1. L'inhibition des 15-lipoxygénases diminue la production des cytokines M1/M2. Enfin, nous avons étudié l'expression et le rôle du récepteur nicotinique α7 dans la polarisation des macrophages pulmonaires humains. Ces derniers expriment les récepteurs nicotiniques α7 dont la stimulation par des agonistes nicotiniques α7 diminue la production des cytokines M1/M2. Ce travail apporte de nouvelles connaissances sur la polarisation des macrophages, dont certaines voies de régulation peuvent être impliquées dans les pathologies inflammatoire pulmonaires

Mémoire de DES (Diplôme d'Etudes Spécialisées) tenant lieu de thèse d'exercice.; Le thromboxane A2, métabolite majeur de l'acide arachidonique, est un médiateur majeur de l'agrégation plaquettaire et de la vasoconstriction. Parce qu'il est impliqué dans de nombreuses situations pathologiques, notamment cardiaques et vasculaires, le thromboxane A2 est une cible thérapeutique intéressante. Par ailleurs, le glibenclamide, une sulfonylurée hypoglycémiante, et le furosémide, un puissant diurétique, exercent des effets au niveau vasculaire et interagissent avec les prostanoïdes. Notre étude met en évidence, in vitro, sur préparations d'artères mammaires internes (AMI) et de veines saphènes (VS) humaines que le glibenclamide et le furosémide se comportent comme deux antagonistes vis-à-vis du thromboxane A2 ; pA2 du glibenclamide = 6,3 ± 0,4 M et 6,5 ± 0,8 M sur AMI et VS respectivement, et pA2 du furosémide = 4,4 ± 0,3 M et 4,2 ± 0, 1 M sur AMI et VS respectivement. Cet antagonisme semble être spécifique puisque le glibenclamide et le furosémide ne modifient pas la réponse contractile des AMI à la nordrénaline et à l'endothéline, ni celle des VS à la sérotonine. L'indométhacine ne modifie pas l'antagonisme du furosémide vis-à-vis de la vasoconstriction au thromboxane A2. Cette nouvelle propriété de ces deux molécules pourrait contribuer au bénéfice clinique de leur utilisation dans la prévention de la microangiopathie diabétique pour le glibenclamide, et dans les pathologies cardiovasculaires pour le furosémide.