Audrey Casemayou

A Role for VAV1 in Experimental Autoimmune Encephalomyelitis and Multiple Sclerosis

VAV1 plays a role in regulating proinflammatory cytokines, which underlie the susceptibility for developing experimental autoimmune encephalomyelitis and multiple sclerosis. Rat Genetics Moving Up Multiple sclerosis (MS) is a common autoimmune disease with a complex etiology that attacks the brain and spinal cord and emerges as a result from both genetic and environmental factors. At present, there is no predictive biomarker for MS and no cure for adults who present with the disease, and only a few genes have been unambiguously linked to its development. The hunt has been to address these challenges, but also to uncover new targets that are associated with a high susceptibility for MS to augment disease-modifying treatments that are in clinical use. Using experimental autoimmune encephalomyelitis, an animal model of MS, Jagodic et al. have focused on a region of the rat genome on chromosome 9 that encodes the gene Vav1. Although this gene was initially identified as an oncogene, it later was found to be an important signal transducer with a pivotal role in immune cells, the very first hint being its specific activation after T cell receptor stimulation. The authors show that a specific mutation identified in rat Vav1 altered Vav1 protein abundances, immune cell activation, and neuroinflammation induction. Taking this observation a step further, among 12,735 individuals of European descent, Jagodic et al. reveal an association between a set of common variants within the first intron of VAV1 and susceptibility for MS. Like what they observed in the rat, common VAV1 variants altered VAV1 expression and immune activation in the peripheral blood and in the cerebrospinal fluid cells of MS patients. This study displays the power of using rat genetics to encourage the discovery of human genetic targets in common diseases such as MS. Multiple sclerosis, the most common cause of progressive neurological disability in young adults, is a chronic inflammatory disease. There is solid evidence for a genetic influence in multiple sclerosis, and deciphering the causative genes could reveal key pathways influencing the disease. A genome region on rat chromosome 9 regulates experimental autoimmune encephalomyelitis, a model for multiple sclerosis. Using interval-specific congenic rat lines and association of single-nucleotide polymorphisms with inflammatory phenotypes, we localized the gene of influence to Vav1, which codes for a signal-transducing protein in leukocytes. Analysis of seven human cohorts (12,735 individuals) demonstrated an association of rs2546133-rs2617822 haplotypes in the first VAV1 intron with multiple sclerosis (CA: odds ratio, 1.18; CG: odds ratio, 0.86; TG: odds ratio, 0.90). The risk CA haplotype also predisposed for higher VAV1 messenger RNA expression. VAV1 expression was increased in individuals with multiple sclerosis and correlated with tumor necrosis factor and interferon-γ expression in peripheral blood and cerebrospinal fluid cells. We conclude that VAV1 plays a central role in controlling central nervous system immune-mediated disease and proinflammatory cytokine production critical for disease pathogenesis.

The HNF1B score is a simple tool to select patients for HNF1B gene analysis

HNF1B-related disease is an emerging condition characterized by an autosomal-dominant inheritance, a 50% rate of de novo mutations, and a highly variable phenotype (renal involvement, maturity-onset diabetes of the young type 5, pancreatic hypoplasia, and urogenital tract and liver test abnormalities). Given the current lack of pathognomonic characteristics and the wide overlap with other conditions, a genetic test is the diagnostic gold standard. However, pre-genetic screening is mandatory because genetic testing has substantial costs. Our aim was to develop a HNF1B score, based on clinical, imaging, and biological variables, as a pivotal tool for rational genetic testing. A score was created using a weighted combination of the most discriminative characteristics based on the frequency and specificity in published series. The HNF1B score is calculated upon 17 items including antenatal discovery, family history, and organ involvement (kidney, pancreas, liver, and genital tract). The performance of the score was assessed by a ROC curve analysis in a 433-individual cohort containing 56 HNF1B cases. The HNF1B score efficiently and significantly discriminated between mutated and nonmutated cases (AUC 0.78). The optimal cutoff threshold for the negative predictive value to rule out HNF1B mutations in a suspected individual was 8 (sensitivity 98.2%, specificity 41.1%, and negative predictive value over 99%). Thus, the HNF1B score is a simple and accurate tool to provide a more rational approach to select patients for HNF1B screening.

The p.Arg63Trp polymorphism controls Vav1 functions and Foxp3 regulatory T cell development

A single nucleotide polymorphism causing constitutive activation of Vav1 results in increased natural Treg generation and is responsible for the imbalance between Vav1 GEF and adaptor functions.

Hnf-1β transcription factor is an early hif-1α-independent marker of epithelial hypoxia and controls renal repair.

Epithelial repair following acute kidney injury (AKI) requires epithelial-mesenchyme-epithelial cycling associated with transient re-expression of genes normally expressed during kidney development as well as activation of growth factors and cytokine-induced signaling. In normal kidney, the Hnf-1β transcription factor drives nephrogenesis, tubulogenesis and epithelial homeostasis through the regulation of epithelial planar cell polarity and expression of developmental or tubular segment-specific genes. In a mouse model of ischemic AKI induced by a 2-hours hemorrhagic shock, we show that expression of this factor is tightly regulated in the early phase of renal repair with a biphasic expression profile (early down-regulation followed by transient over-expression). These changes are associated to tubular epithelial differentiation as assessed by KSP-cadherin and megalin-cubilin endocytic complex expression analysis. In addition, early decrease in Hnf1b expression is associated with the transient over-expression of one of its main target genes, the suppressor of cytokine signaling Socs3, which has been shown essential for renal repair. In vitro, hypoxia induced early up-regulation of Hnf-1β from 1 to 24 hours, independently of the hypoxia-inducible factor Hif-1α. When prolonged, hypoxia induced Hnf-1β down-regulation while normoxia led to Hnf-1β normalization. Last, Hnf-1β down-regulation using RNA interference in HK-2 cells led to phenotype switch from an epithelial to a mesenchyme state. Taken together, we showed that Hnf-1β may drive recovery from ischemic AKI by regulating both the expression of genes important for homeostasis control during organ repair and the state of epithelial cell differentiation.

Tocilizumab added to conventional therapy reverses both the cytokine profile and CD8+Granzyme+ T‐cells/NK cells expansion in refractory hemophagocytic lymphohistiocytosis

To the Editor, Hemophagocytic lymphohistiocytosis (HLH) is a lifethreatening syndrome characterized by severe systemic inflammation and uncontrolled activation of natural killer (NK) and cytotoxic CD8+ T-cells, which both contribute to organ damage. In patients with HLH, overproduction of Th1 [interferon gamma (IFN-γ), interleukin 2 (IL-2), IL-6, IL-12 and tumour necrosis factor alpha (TNF-α)] cytokines contrasts with low levels of Th2 cytokines (IL-4) [1]. Overproduction of IL-10 is observed during the acute phase of the disease, as expected during IFN-γ overproduction [2]. Diagnostic criteria of HLH were developed in the HLH-2004 protocol and include an increased soluble CD25 (sCD25) [3]. The association of high levels of IFN-γ and IL-10 with normal or moderately elevated levels of IL-6 differentiates HLH from infection [4]. Besides primary/familial HLH mainly observed in childhood, most secondary forms occur in the setting of infection, malignancy or rheumatologic disorders. Corticosteroids, cyclosporine, etoposide or TNF-α can reverse HLH in most patients with underlying systemic disease or cancer [5]. To date, no firm consensus treatment emerged, and the treatment of refractory HLH remains challenging. In 2013, a 59-year-old patient was referred to our intensive care unit (ICU) for acute renal and respiratory failure and features of HLH including hemophagocytosis in bone-marrow aspirate, hypertriglyceridemia, hypofibrinogenemia, hyperferritinemia, anaemia and low platelet count, a slightly enlarged spleen, and a dramatic increase of sCD25. Two months before his admission, he developed autoimmune manifestations characterized by arthritis, myositis, lung interstitial disease, acral cutaneous sclerosis and dry syndrome. Immunological tests showed low complement C3, C4, CH50 components, type III cryoglobulin, polyclonal hypergammaglobulinemia, positive Coombs’ test, high levels of anti-SSA, anti-SSB, anti-PMScl, anti-double strand DNA and anti-citrullinated peptides antibodies. He had been receiving corticosteroids for 2months (0.5–1mg/kg/day) without any improvement of the autoimmunity-related organ disorders. At admission in the ICU, diagnosis of HLH was retained. Abnormal liver tests, acute renal failure requiring dialysis and a moderate encephalopathy were observed.

Hepatocyte Nuclear Factor-1β Controls Mitochondrial Respiration in Renal Tubular Cells

AKI is a frequent condition that involves renal microcirculation impairment, infiltration of inflammatory cells with local production of proinflammatory cytokines, and subsequent epithelial disorders and mitochondrial dysfunction. Peroxisome proliferator-activated receptor γ coactivator 1-α (PPARGC1A), a coactivator of the transcription factor PPAR-γ that controls mitochondrial biogenesis and function, has a pivotal role in the early dysfunction of the proximal tubule and the subsequent renal repair. Here, we evaluated the potential role of hepatocyte nuclear factor-1β (HNF-1β) in regulating PPARGC1A expression in AKI. In mice, endotoxin injection to induce AKI also induced early and transient inflammation and PPARGC1A inhibition, which overlapped with downregulation of the HNF-1β transcriptional network. In vitro, exposure of proximal tubule cells to the inflammatory cytokines IFN-γ and TNF-α led to inhibition of HNF-1β transcriptional activity. Moreover, inhibition of HNF-1β significantly reduced PPARGC1A expression and altered mitochondrial morphology and respiration in proximal tubule cells. Chromatin immunoprecipitation assays and PCR analysis confirmed HNF-1β binding to the Ppargc1a promoter in mouse kidneys. We also demonstrated downregulation of renal PPARGC1A expression in a patient with an HNF1B germinal mutation. Thus, we propose that HNF-1β links extracellular inflammatory signals to mitochondrial dysfunction during AKI partly via PPARGC1A signaling. Our findings further strengthen the view of HNF1B-related nephropathy as a mitochondrial disorder in adulthood.

Asymptomatic circulating T-cell clone cause renal polymorphic inflammatory fibrosis

BackgroundRenal complications of non-Hodgkin lymphoma encompass a wide spectrum of monoclonal Ig-related pathologies. Clonal circulating T cells can also be associated with non-renal autoimmune disorders induced by overproduction of specific patterns of cytokines or unbalanced lymphocytes sub-populations.MethodsImmunophenotyping of circulating T cells and TCR gene restriction analysis using Biomed-2 protocol. NF-κB staining and mRNA quantification of inflammatory genes in HK-2 epithelial renal cells exposed to supernatants of peripheral blood mononuclear cells with clonal T-cell population.ResultsHere, we could identify a persistent clonal T-cell population, only characterized by in-depth immunophenotyping of circulating lymphocytes and using multiplex PCR analysis of TCR gene rearrangements, in two patients with polymorphic inflammatory renal fibrosis of unknown origin. Using an in vitro approach, we could demonstrate that peripheral blood mononuclear cells including the clonal population can trigger a phenotype switch of epithelial renal cells from a quiescent state to a pro-inflammatory state characterized by NF-κB nuclear translocation and overexpression of inflammatory cytokine or chemokine.ConclusionThese preliminary data suggest that circulating T-cell clones may directly activate epithelial renal cells or promote a T-/B-cell population with autoimmune reactive properties against kidney cells, which, in the absence of overt renal lymphoma infiltration, lead to the subsequent inflammatory renal fibrotic phenotype.