Mécanismes cellulaires et moléculaires de l’immunodépression post-infectieuse

Abstract : Severe sepsis leads to a dysregulated inflammatory response followed by a complex immunosuppressive state that can favor the emergence of nosocomial infections. The cellular and molecular mechanisms that drive the post-infective immunosuppression remain poorly understood. They may involve immune cells that link innate and adaptive immunity such as dendritic cells or innate-like lymphocytes. Furthermore, Toll-like receptors (TLR) are critical determinants of the inflammatory response but their role to the development of sepsis-induced immune dysfunction are unknown. The aim of this research project was to investigate the role of dendritic cells, innatelike T cells and TLR-dependent signalling pathways in the sepsis-induced immunosuppression process. For this purpose, we combined a translational and experimental approach. We assessed dendritic cells blood count in septic patients and showed that the depletion of dendritic cells was associated with the advent of nosocomial infections. We studied 3 populations of innate-like T-cells (γδ lymphocytes, NKT- and MAIT-cells) in septic patients and demonstrated that only the MAIT-cells presented a significant depletion following severe sepsis, the persistence of which was correlated with the advent of nosocomial infection. Last, using knockout mice, we analyzed the relative contribution of TLR2, TLR4 and TLR5 to the host response in a model of late-onset secondary Pseudomonas aeruginosa pneumonia following a sublethal polymicrobial sepsis. We observed that TLR2 deficient mice were specifically protected against the secondary pneumonia through a better bacterial clearance. Our results provide new insights in the pathophysiology of post-infective immunosuppression and suggest potential therapeutic applications.
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David Grimaldi. Mécanismes cellulaires et moléculaires de l’immunodépression post-infectieuse. Médecine humaine et pathologie. Université René Descartes - Paris V, 2013. Français. ⟨NNT : 2013PA05T049⟩. ⟨tel-00924659⟩

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