Simpósio Regional Sobre Medicina Translacional FAPESP/ CNPq

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1 Simpósio Regional Sobre Medicina Translacional FAPESP/ CNPq Reinaldo Salomão EPM/Unifesp

2 Immune Response in Sepsis

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4 Systemic Inflammatory Response Syndrome Bone, RC. et al. Chest 1992, 101:

5 LPS It is the self desintegratingg response of the host organisms to endotoxin which makes this molecule poisonous M. Shear 1943 It is not endotoxin which is active or toxic per se, it is the higher animals with it affine cells and their receptors and the following sequences of endogenous reactions that make a species more or less sensitive to endotoxin. L. Thomas Citados por Rieschel e Westphal

6 LPS sensitive and resistant mice Sensitive Resistant C3H/HeN C3H/HeJ Freudenberg, M. et al. Infect Immun 1986, 51: 891-5

7 LPS-induced monocytes activation LPS TLR4 IL-1 TNF- LPS LBP CD14 monocyte

8 Microcirculacion

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10 Queiroz, EL. Semin Bras Med 2006, 2: 35-43

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12 DINAMICS OF INFALMMATORY RESPONSE DURING SEPSIS Riedemann, NC. et al. Nat Med 2003, 9:

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15 Hotchkiss & Karl. NEJM 2003, 348: 2-

16 Questions Hypo-response or reprogramming? Time or stages of sepsis? Same dynamic for all cells? May be different according to the functions evaluated?

17 Questions Hypo-response or reprogramming Time or stages of sepsis? Same dynamic for all cells? May be different according to the functions evaluated? --Dependent from phenotypic changes (receptors expression)? - Recognizing or signaling? - Signaling: down or up and down regulation?

18 Questions What is the biological relevance?

19 TNF-α (pg/ml) Rigato, O. & Salomao, R. Shock 2003, 19: LPS-induced TNF- in whole blood p<0, p=0,003 p<0,001 0 Septic patients Control patients Health volunteers

20 LPS-induced monocytes activation LPS TLR4 IL-1 TNF- LPS LBP CD14 monocyte

21 Strategy to evaluate LPS binding on monocytes in whole blood PE MONOCYTE FITC -HLA-DR HLA-DR HLA-DR LPS RECEPTOR (CD14) -CD14 CD14 CD14 RED 670 LPS STREPTAVIDIN Brunialti, MK. et al. Cytometry 2002 BIOTIN

22 % LPS-positive stained monocyte Salomao, R. et al. J Endotoxin Res 2002, 8: Patients Controls Healthy Volunteers * * LPSb (pg/ml)

23 % of monocytes producing TNF- Salomao, R. et al. J Endotoxin Res 2002, 8: * controls LPS Healthy Volunteers volunteers Patients

24 TNF- (pg/ml) Brunialti, MK. et al. Shock 2006, 25: # * * # 0 Healthy volunteer Sepsis Severe sepsis Septic shock

25 IL-6 (pg/ml) Brunialti, MK. et al. Shock 2006, 25: * # * # 0 Healthy volunteer Sepsis Severe sepsis Septic shock

26 Expressão de TLR4 em monócitos (MGIF) Brunialti, MK. et al. Shock 2006, 25: Expression of TLR4 on monocytes Healthy volunteer Sepsis Severe sepsis Septic shock

27 Expressão de TLR2 em monócitos (MGIF) Brunialti, MK. et al. Shock 2006, 25: Expression of TLR2 on monocytes Healthy volunteer Sepsis Severe sepsis Septic shock

28 Intracellular signaling LPS, IL-1 β and TNF-α Liew FYet al. Nat Rev Immunol. 2005;5(6): Hehlgans T et al. Immunology. 2005;115(1):1-20. Martin MU et al. Biochim Biophys Acta. 2002;1592(3):

29 IL-6 (pg/ml) Brunialti, MK. et al. Shock 2006, 25: IL-6 in supernatants from PBMC * # * # LPS IL-1 TNF- # * * # #

30 Metabolismo oxidativo de neutrófilos (MGIF) Martins, PS. et al. Critical Care 2008 Patogênese Oxygen Reactive Species - Neutrophils # + # * fmlp 0 S. aureus Sadios Sepse SOFA<7 SOFA>=7

31 Metabolismo oxidativo de monócitos (MGIF) Martins, PS. et al. Critical Care 2008 Oxygen Reactive Species - Monocytes * # # * fmlp 0 Sadios Sepse SOFA<7 SOFA>=7 LPS

32 NO e ROS generated by monocytes from patients and healthy volunteers

33 Tolerance to LPS Fernandes, ML et al. BJMBR 2010, 4: 860-8

34 Fernandes, ML et al. BJMBR 2010, 4: Tolerance to LPS Prevenção e tratamento

35 Fernandes, ML et al. BJMBR 2010, 4: Tolerance to LPS Prevenção e tratamento

36 Mosser & Edwards. Nature Reviews Immunology, -2008

37 Brunialti MK et al. submitted

38 Brunialti MK et al. submitted

39 Brunialti MK et al. submitted

40 Percentages of Th1 (A/D), Th17 (B/E) and Treg (C) lymphocytes in healthy volunteers and septic patients at inclusion (D0) and after seven days of follow-up (D7). n = number of individuals in each group. P values are shown. The Mann-Whitney test was used to compare healthy volunteer and patient samples, and the Wilcoxon test was used to compare D0- and D7-related samples.

41 CD 163 CD 206 Brunialti MK et al. submitted

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43 LPS-induced innate immunity Calvano, SE. et al. Nature 2005, 437:1032-7

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45 BECAUSE GENES INVOLVED IN A COMMON PATHWAY HAVE DIFFERENT FUNCTIONS, IT IS REASONABLE THAT THEIR EXPRESSION IS DIFFERENTIALLY REGULATED. Foster, Hargreaves & Medzhitov, Nature 2007

46 Foster, Hargreaves & Medzhitov, Nature 2007 White: N+L Black: T+L

47 Schematic representation of endotoxin tolerance model and the different techniques used for analysis. Mendes, ME. et al. Immunobioloy, 2011

48 Effect of LPS-pretreatment on the expression of TLR4 and CD14 on monocytes surface. Mendes, ME. et al. Immunobioloy, 2011

49 Detecção de TNF-α em sobrenadante de PBMC Mendes, ME. et al. Immunobioloy, 2011

50 Changes in gene expression induced by LPS pretreatment

51 Mendes, ME. et al. Immunobioloy, 2011

52 Prevenção Severe e tratamento Sepsis X Healthy Volunteers Salomao, R. et al. Crit Care Med 2009

53 Septic Shock X Healthy Volunteers

54 CONCLUSION Cell response in sepsis is complex and may be differentially regulated In different cell populations In different functions/genes in the same cell In different stages of sepsis

55 Acknowledgements Milena Karina Coló Brunialti Michelle Carolina Santos Flávia Ribeiro Machado Otelo Rigato Eliézer Silva Fundação de Amparo a Pesquisa de Estado de São Paulo (FAPESP grants 2006/ and 2008/ ). CNPq /2008-8

56 OBRIGADO