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Background Ischemic stroke (IS) usually initiates inflammation and oxidative stress leading to neuronal death. Diabetes and impaired fasting glucose are associated with incidence of cerebrovascular and cardiovascular diseases. Methods In the present study, we assessed the relationship of fasting glucose with antioxidative parameters (erythrocyte glutathione peroxidase [GPx] and superoxide dismutase [SOD] activities) and inflammatory markers (high-sensitivity C-reactive protein [hs-CRP] and fibrinogen) in IS patients with and without type 2 diabetes mellitus (T2DM). In addition, we determined factors associated with the risk of IS among these patients. Antioxidative, inflammatory, and lipid parameters were measured in 196 patients with IS (117diabetics and 79 nondiabetics). Results After adjustment of covariates, multiple logistic regression analysis showed that SOD and GPx significantly decreased the risk of IS among patients with and without T2DM. However, hs-CRP increased the risk of IS. For the diabetic patients, fasting glucose was positively correlated with hs-CRP and fibrinogen and was negatively correlated with GPx and SOD levels. In addition, fasting glucose and hemoglobin A1c or glycosylated hemoglobin (HbA1c) have been shown to increase the risk of IS in diabetic patients. Conclusions These data suggest that the antioxidant activity of plasma may be an important factor that provides protection from IS. hs-CRP concentrations can be used as a clinical screening tool to identify individuals with higher risk of IS. Finally, fasting glucose and HbA1c may also be useful indicators for cerebrovascular risk in diabetic patients that may be mediated by low levels of antioxidative defense markers and high inflammation status.

International audience; The c.61\₆3dupCTG (L10) allele of rs72555377 polymorphism in PCSK9 has been reported to be associated with low-density lipoprotein-cholesterol (LDL-C) levels and with a decreased risk of coronary artery disease (CAD). We investigated the effect of two known alleles for rs72555377, L10 and L11, on the risk of CAD in a Tunisian cohort (218 patients diagnosed by angiography and 125 control subjects). Two subgroups of patients were defined by their level of stenosis: >= 50% for CAD and = 50% in two or three major coronary arteries (0.210 vs 0.125, p = 0.028). Multiple regression analysis showed that the L10 allele was significantly associated with a reduced risk of CAD (p = 0.049, OR = 0.51[0.26-1.00]), and with its reduced severity (p = 0.045, OR = 0.44[0.20-0.98]). The L10 allele is associated with a reduced risk and severity of CAD, seemingly independently of its LDL-lowering effect, suggesting a direct effect of PCSK9 on atherogenesis.

The systemic response to ischemic stroke is associated with the hepatic acute phase response (APR) that modulates leukocytes recruitment to the injured brain. The inappropriate recruitment of leukocytes to the brain parenchyma can result in blood–brain barrier (BBB) breakdown. Emerging data suggest that peroxisome proliferator-activated receptor beta/delta (PPAR-β/δ) activation has a potential neuroprotective role in ischemic stroke. However, mechanisms of PPAR-β/δ mediated protection in ischemic insults remain unclear. In the present study, we determined for the first time, the effects of GW0742, a PPAR-β/δ agonist on the APR following brain injury and assessed the effects on BBB permeability and tight junction integrity via claudin-5, occludin, and zona occludens-1 expression. C57/BL6 mice were exposed to 1 hour of ischemia and received 10 minutes before reperfusion either a vehicle solution or GW0742. Hepatic expression of chemokines (C-X-C motif ligand: CXCL1, CXCL2, and CXCL10), serum amyloid A-1, tumor necrosis factor alpha, interleukin-1β, and interleukin-6 was measured, and the extent of brain and hepatic neutrophil infiltration was determined. The results showed that GW0742 treatment decreased infarct volume and edema, reactant production and neutrophil recruitment to the brain and liver, which is a hallmark of the APR. GW0742 significantly reduced BBB leakage and metalloproteinase 9 expression and upregulated the expression of tight junction proteins. These findings may help to guide the experimental and clinical therapeutic use of PPAR-β/δ agonists against brain injury., This work is funded from the University for a Project Program by a grant number 2015-801680.

Matrix metalloproteinases (MMPs) play an important role in early atherosclerosis, extracellular matrix remodeling, plaque rupture and myocardial infarction. MMP gene polymorphisms contribute to the risk of developing cardiovascular diseases. In this study, we investigated, for the first time, the association between MMP-1-16071G/2G, MMP-12 -82A/G and MMP-12 1082A/G genotypes and haplotypes and the risk of ischemic stroke (IS) among patients with type 2 diabetes mellitus (T2DM). To examine whether these genetic polymorphisms are associated with susceptibility to IS, 196 patients with IS and 192 controls were examined by PCR-based RFLP. When the analyses were adjusted for multiple risk factors, no interaction between T2DM and MMP-1-1607 1G/2G polymorphism on the risk of ischemic stroke was found (p=0.074). However, MMP-12 polymorphisms genotypes were associated with the higher risk of IS in diabetic patients compared with total patients. The -82G-1082G haplotype of MMP-12 polymorphisms was associated with higher risk of ischemic stroke in diabetic patients [AOR=2.33; 95% CI (1.25-3.62), P=0.032]. These findings showed that there was an important joint effect of the MMP-12 polymorphisms and T2DM on the risk of IS and therefore it can be considered as a potential marker of cerebrovascular disorders in diabetic patients.

Vascular cells are particularly susceptible to oxidative stress that is believed to play a key role in the pathogenesis of cardiovascular disorders. Thioredoxin-1 (Trx-1) is an oxidative stress-limiting protein with anti-inflammatory and anti-apoptotic properties. In contrast, its truncated form (Trx-80) exerts pro-inflammatory effects. Here we analyzed whether Trx-80 might exert atherogenic effects by promoting macrophage differentiation into the M1 pro-inflammatory phenotype. Trx-80 at 1 µg/ml significantly attenuated the polarization of anti-inflammatory M2 macrophages induced by exposure to either IL-4 at 15 ng/ml or IL-4/IL-13 (10 ng/ml each) in vitro, as evidenced by the expression of the characteristic markers, CD206 and IL-10. By contrast, in LPS-challenged macrophages, Trx-80 significantly potentiated the differentiation into inflammatory M1 macrophages as indicated by the expression of the M1 cytokines, TNF-α and MCP-1. When Trx-80 was administered to hyperlipoproteinemic ApoE2.Ki mice at 30 µg/g body weight (b.w.) challenged either with LPS at 30 µg/30 g (b.w.) or IL-4 at 500 ng/30 g (b.w.), it significantly induced the M1 phenotype but inhibited differentiation of M2 macrophages in thymus and liver. When ApoE2.Ki mice were challenged once weekly with LPS for 5 weeks, they showed severe atherosclerotic lesions enriched with macrophages expressing predominantly M1 over M2 markers. Such effect was potentiated when mice received daily, in addition to LPS, the Trx-80. Moreover, the Trx-80 treatment led to a significantly increased aortic lesion area. The ability of Trx-80 to promote differentiation of macrophages into the classical proinflammatory phenotype may explain its atherogenic effects in cardiovascular diseases. J. Cell. Physiol. 228: 1577–1583, 2013. © 2013 Wiley Periodicals, Inc.

Autosomal dominant hypercholesterolemia (ADH) is characterized by an isolated elevation of plasmatic low-density lipoprotein (LDL), which predisposes to premature coronary artery disease (CAD) and early death. ADH is largely due to mutations in the low-density lipoprotein receptor gene (LDLR), the apolipoprotein B-100 gene (APOB), or the proprotein convertase subtilisin/kexin type 9 (PCSK9). Early diagnosis and initiation of treatment can modify the disease progression and its outcomes. Therefore, cascade screening protocol with a combination of plasmatic lipid measurements and DNA testing is used to identify relatives of index cases with a clinical diagnosis of ADH. In Tunisia, an attenuated phenotypic expression of ADH was previously reported, indicating that the establishment of a special screening protocol is necessary for this population.

International audience; Intraperitoneal injection of arglabin (2.5 ng/g of body weight, twice daily, 13 weeks) into female human apolipoprotein E-2 gene knock-in (ApoE(2)Ki) mice fed a high-fat Western-type diet (HFD) reduced plasma levels of glucose and insulin by similar to 20.0% +/- 63.5% and by 50.0% +/- 2.0%, respectively, in comparison with vehicle-treated mice. Immunohistochemical analysis revealed the absence of active caspase-3 in islet sections from ApoE(2)Ki mice fed a HFD and treated with arglabin. In addition, arglabin reduced interleukin-1 beta(IL-1 beta) production in a concentration-dependent manner in Langerhans islets isolated from ApoE(2)Ki mice treated with lipopolysaccharide (LPS) and with cholesterol crystals. This inhibitory effect is specific for the inflammasome NOD-like receptor family, pyrin domain-containing 3 (NLRP3) because IL-1 beta production was abolished in Langerhans islets isolated from Nlrp3(-/-) mice. In the insulin-secreting INS-1 cells, arglabin inhibited, in a concentration-dependent manner, the maturation of pro-IL-1 beta into biologically active IL-1 beta probably through the inhibition of the maturation of procaspase-1 into active capsase-1. Moreover, arglabin reduced the susceptibility of INS-1 cells to apoptosis by increasingBcl-2 levels. Similarly, autophagy activation by rapamycin decreased apoptosis susceptibility while autophagy inhibition by 3-methyladenin treatment promoted apoptosis. Arglabin further increased the expression of the autophagic markers Bcl2-interacting protein (Beclin-1) and microtubule-associated protein 1 light chain 3 II (LC3-II) in a concentration-dependent manner. Thus, arglabin reduces NLRP3-dependent inflammation as well as apoptosis in pancreatic beta-cells in vivo and in the INS-1 cell line in vitro, whereas it increases autophagy in cultured INS-1 cells, indicating survival-promoting properties of the compound in these cells. Hence, arglabin may represent a new promising compound to treat inflammation and type 2 diabetes mellitus development.

Resume Objectifs Les variations du gene de la lipoproteine lipase peuvent contribuer a l’atherosclerose et aux maladies coronariennes. Le but de ce travail est d’examiner les frequences des trois variations du gene de la lipoproteine lipase (p.Asp9Asn, p.Asn291Ser et p.Ser447X) dans la population tunisienne et d’etudier leur association avec les parametres lipidiques et le risque de maladies coronariennes. Methodes Les variations genomiques ont ete determinees par PCR-RFLP et les parametres lipidiques ont ete doses par des methodes enzymatiques chez 135 patients et 109 temoins. Resultats La variation p.Asp9Asn etait plus frequente chez les patients que chez les temoins (10,37 % vs 3,66 % respectivement). Au contraire, la frequence de la variation p.Ser447X etait plus elevee chez les temoins que chez les patients (13,7 % vs 8,8 % respectivement). Cependant, il n’y avait aucune association significative entre ces variations et les maladies coronariennes. La variation p.Asn291Ser etait absente dans cette population d’etude. Chez les sujets temoins, les heterozygotes p.Asp9Asn presentent une augmentation significative du taux de cholesterol total (5,6 ± 1,2 mmol/L vs 4,2 ± 0,9 mmol/L, p = 0,01) et une diminution significative du taux de HDL-cholesterol (0,93 ± 0,1 mmol/L vs 1,36 ± 0,3 mmoL/L, p = 0,045) par rapport aux non-porteurs. Conclusion Il n’y a pas d’association significative entre les variations du gene de la lipoproteine lipase et les maladies coronariennes dans la population tunisienne. Toutefois, la variation p.Asp9Asn affecte le metabolisme du cholesterol. La rarete du variant p.Asn291Ser pourrait etre une specificite ethnique de la Tunisie.

Background Autosomal dominant hypercholesterolemia (ADH) is commonly caused by mutations in the low-density lipoprotein (LDL) receptor gene ( LDLR ), in the apolipoprotein B-100 gene ( APOB ), or in the proprotein convertase subtilisin kexine 9 gene ( PCSK9 ). ADH subjects carrying a mutation in LDLR present highly variable plasma LDL-cholesterol (LDL-C). This variability might be due to environmental factors or the effect of some modifying genes such as PCSK9 and APOE . Aims We investigated the molecular basis of thirteen Tunisian ADH families and attempted to determine the impact of PCSK9 and APOE gene variations on LDL-cholesterol levels and on the variable phenotypic expression of the disease. Methods and results Fifty six subjects were screened for mutations in the LDLR gene through direct sequencing. The causative mutation was found to segregate with the disease in each family and a new frameshift mutation, p.Met767CysfsX21, was identified in one family. The distribution of total- and LDL-cholesterol levels, adjusted for age and gender, among homozygous and heterozygous ADH patients varied widely. Within seven families, nine subjects presented low LDL-cholesterol levels despite carrying a mutation in the LDLR gene. To identify the molecular actors underlying this phenotypic variability, the PCSK9 gene was screened using direct sequencing and/or enzymatic restriction analysis, and the apo E genotypes were determined. A new missense variation (p.Pro174Ser) in the PCSK9 gene was identified and characterized as a new putative loss-of-function mutation. Conclusion Genetic variations in PCSK9 and APOE genes could explain only part of the variability observed in the phenotypic expression in Tunisian ADH patients carrying mutations in the LDLR gene. Other genetic variants and environmental factors very probably act to fully explain this phenotypic variability.

In response to the letter of Drs Takahashi and Karasawa, we thought it might be of interest to open the debate about the mechanism by which arglabin, a natural compound isolated from Artemisia glabella , inhibits cholesterol crystal–induced activation of the NLRP3 inflammasome in murine macrophages. In the March 2015 online issue of Circulation 1 we evaluated the impact of arglabin on cholesterol crystal–mediated NLRP3 activation in cultured murine macrophages and in ApoE2.Ki mice fed a high-fat diet. We showed that both Nlrp3 knockout and inhibition of NLRP3 activation by the compound arglabin significantly decreased the size of atherosclerotic lesions in ApoE2.Ki mice fed a high-fat diet. At the molecular level, arglabin inhibited the activity of the NLRP3 inflammasome and significantly reduced the subsequent production of interleukin 1β (IL-1β) and interleukin 18 in vitro …

Macrophages play a pivotal role in the pathophysiology of atherosclerosis. These cells express cathepsin L (CatL), a cysteine protease that has been implicated in atherogenesis and the associated arterial remodeling. In addition, macrophages highly express peroxisome proliferator-activated receptor (PPAR) γ, a transcription factor that regulates numerous genes important for lipid and lipoprotein metabolism, for glucose homeostasis, and inflammation. Hence, PPARγ might affect macrophage function in the context of chronic inflammation such as atherogenesis. In the present study, we examined the effect of PPARγ activation on the expression of CatL in human monocyte-derived macrophages (HMDM). Activation of PPARγ by the specific agonist GW929 concentration-dependently increased the levels of CatL mRNA and protein in HMDM. By promoter analysis, we identified a functional PPAR response element-like sequence that positively regulates CatL expression. In addition, we found that PPARγ-induced CatL promotes the degradation of Bcl2 without affecting Bax protein levels. Consistently, degradation of Bcl2 could be prevented by a specific CatL inhibitor, confirming the causative role of CatL. PPARγ-induced CatL was found to decrease autophagy through reduction of beclin 1 and LC3 protein levels. The reduction of these proteins involved in autophagic cell death was antagonized either by the CatL inhibitor or by CatL knockdown. In conclusion, our data show that PPARγ can specifically induce CatL, a proatherogenic protease, in HMDM. In turn, CatL inhibits autophagy and induces apoptosis. Thus, the proatherogenic effect of CatL could be neutralized by apoptosis, a beneficial phenomenon, at least in the early stages of atherosclerosis.

Peroxisome proliferator-activated receptor delta (PPAR-delta) is a transcription factor implicated in metabolism and inflammation. The +294T/C polymorphism in the PPAR-delta gene is associated with risk of coronary artery disease (CAD) in dyslipidemic women and hypercholesterolemic men. Whether this polymorphism influences the risk of CAD in the absence of dyslipidemia was not known, so we investigated a possible association of this polymorphism with plasma lipid and lipoprotein levels and with risk and outcome of CAD in a normolipidemic Tunisian population. Genotyping was performed by PCR-RFLP in 112 CAD patients and 113 healthy volunteers. The C-allele was significantly more frequent in patients than in controls (0.320 vs 0.189, P = 0.001). This association remained significant after adjustment for age, gender, body mass index, smoking, hypertension, and high-density lipoprotein cholesterol. Subjects carrying either one or two copies of the C-allele had a 2.7-fold higher risk of CAD than subjects homozygous for the T-allele. PPAR-delta genotypes were not associated with lipoprotein concentrations or outcome of CAD. We conclude that PPAR-delta +294T/C polymorphism is an independent risk factor of CAD in normolipidemic Tunisian subjects. The lack of association with lipoprotein concentrations suggests that the effect of the polymorphism on CAD is not mediated through lipoprotein levels in this population and that it may influence the atherosclerotic process through mechanisms involving inflammation.

Familial hypercholesterolemia or autosomal dominant hypercholesterolemia is characterized by raised serum LDL (low density lipoproteins)-cholesterol levels, which result in excess deposition of cholesterol in tissues, leading to accelerated atherosclerosis and increased risk of premature coronary heart disease. Familial hypercholesterolemia results from defects in the hepatic uptake and degradation of LDL via the LDL receptor pathway. Familial hypercholesterolemia is commonly caused by a loss of function in the LDL receptor gene, or by a mutation in the gene encoding apolipoprotein B (APOB) or PCSK9 gene. In Tunisia, the frequency of this disease is about one of 165 for heterozygote. It is a higher frequency compared to most European countries, which is about one of 500 for heterozygote. Only five mutations in the LDLR gene were reported in this population. No mutations in the APOB or PCSK9 gene were reported.

Familial hypercholesterolemia (FH) is an autosomal dominant disease caused by mutations in the low-density lipoprotein receptor ( LDLR ), apolipoprotein B ( APOB ), and proprotein convertase subtilisin/kexin type 9 ( PCSK9 ) genes. In previous studies, we have identified novel mutations in Tunisian FH families. In this study, we have extended our investigation to additional families. Five unrelated probands were screened for mutations in the LDLR and APOB genes, using direct sequencing and enzymatic restriction. We identified two novel LDLR mutations: a missense mutation in exon 7: p.Gly343Cys (c.1027G>T), and a nonsense mutation in exon 17: p.Lys816X (c.2446A>T). Using the PolyPhen and SIFT prediction computer programs the p.Gly343Cys is predicted to have a deleterious effect on LDL receptor activity. The missense mutation we found in exon 3, p.Cys89Trp (c.267C>G), has previously been identified in patients from United Kingdom and Spain, and is reported here for the first time in the Tunisian population. Finally, the framshift mutation in exon 10, p.Ser493ArgfsX44, is reported here for the fourth and fifth time in Tunisian families. The latter is the most frequent FH-causing mutation in Tunisia. These LDLR gene mutations enrich the spectrum of mutations causing FH in the Tunisian population. The framshift mutation, p.Ser493ArgfsX44, seems to be a founder mutation in this population.

Background Abetalipoproteinemia (ABL) and Homozygous Familial Hypobetalipoproteinemia (Ho-FHBL) are rare monogenic diseases characterised by very low plasma levels of cholesterol and triglyceride and the absence or a great reduction of apolipoprotein B (apoB)-containing lipoproteins. ABL results from mutations in the MTP gene; Ho-FHBL may be due to mutations in the APOB gene. Methods We sequenced MTP and APOB genes in three Tunisian children, born from consanguineous marriage, with very low levels of plasma apoB-containing lipoproteins associated with severe intestinal fat malabsorption. Results Two of them were found to be homozygous for two novel mutations in intron 5 (c.619-3T > G) and in exon 8 (c.923 G > A) of the MTP gene, respectively. The c.619-3T > G substitution caused the formation of an abnormal mRNA devoid of exon 6, predicted to encode a truncated MTP of 233 amino acids. The c.923 G > A is a nonsense mutation resulting in a truncated MTP protein (p.W308X). The third patient was homozygous for a novel nucleotide deletion (c.2172delT) in exon 15 of APOB gene resulting in the formation of a truncated apoB of 706 amino acids (apoB-15.56). Conclusions These mutations are expected to abolish the apoB lipidation and the assembly of apoB-containing lipoproteins in both liver and intestine.

Evidence is emerging that inflammation plays a key role in the pathophysiology of ischemic stroke (IS). The aim of this study was to explore, for the first time, the relationship between IL-1β −31 T/C polymorphism and the risk of ischemic stroke (IS) among patients with type 2 diabetes mellitus (T2DM). One hundred ninety-six patients with IS (117 diabetics and 79 nondiabetics) and 192 controls were recruited to enroll in this study. IL-1β genotyping was performed by PCR-RFLP technique. After adjusting for sex, age, smoking, obesity, dyslipidemia, and hypertension, there was no significant difference in the distribution of IL-1β −31 T/C genotypes and allele frequencies between IS patients with or without type 2 diabetes mellitus and control group (p > 0.05). Moreover, a significant positive correlation between serum IL-1β level and glucose (p1 = 0.044) was showed. In addition, serum levels of IL-1β were found to be higher among TT genotype carriers than TC and CC genotype carriers in ischemic stroke patients with or without T2DM but these differences were not significant. These results indicate that IL-1β gene polymorphism might not be a risk factor in the development of ischemic stroke in Tunisian population. © 2015, Springer Science+Business Media New York., A part of this work was supported by a grant from “Ministère de l’Enseignement Supérieur, de la Recherche Scientifique et de la Technologie-Tunisie”.

Background— This study was designed to evaluate the effect of arglabin on the NLRP3 inflammasome inhibition and atherosclerotic lesion in ApoE 2 Ki mice fed a high-fat Western-type diet. Methods and Results— Arglabin was purified, and its chemical identity was confirmed by mass spectrometry. It inhibited, in a concentration-dependent manner, interleukin (IL)-1β and IL-18, but not IL-6 and IL-12, production in lipopolysaccharide and cholesterol crystal–activated cultured mouse peritoneal macrophages, with a maximum effect at ≈50 nmol/L and EC 50 values for both cytokines of ≈ 10 nmol/L. Lipopolysaccharide and cholesterol crystals did not induce IL-1β and IL-18 production in Nlrp3 −/− macrophages. In addition, arglabin activated autophagy as evidenced by the increase in LC3-II protein. Intraperitoneal injection of arglabin (2.5 ng/g body weight twice daily for 13 weeks) into female ApoE 2 .Ki mice fed a high-fat diet resulted in a decreased IL-1β plasma level compared with vehicle-treated mice (5.2±1.0 versus 11.7±1.1 pg/mL). Surprisingly, arglabin also reduced plasma levels of total cholesterol and triglycerides to 41% and 42%, respectively. Moreover, arglabin oriented the proinflammatory M1 macrophages into the anti-inflammatory M2 phenotype in spleen and arterial lesions. Finally, arglabin treatment markedly reduced the median lesion areas in the sinus and whole aorta to 54% ( P =0.02) and 41% ( P =0.02), respectively. Conclusions— Arglabin reduces inflammation and plasma lipids, increases autophagy, and orients tissue macrophages into an anti-inflammatory phenotype in ApoE 2 .Ki mice fed a high-fat diet. Consequently, a marked reduction in atherosclerotic lesions was observed. Thus, arglabin may represent a promising new drug to treat inflammation and atherosclerosis.

The peroxisome proliferator-activated receptor (PPAR)-β/δ has emerged as a promising therapeutic target for treating dyslipidemia, including beneficial effects on HDL cholesterol (HDL-C). In the current study, we determined the effects of the PPAR-β/δ agonist GW0742 on HDL composition and the expression of liver HDL-related genes in mice and cultured human cells. The experiments were carried out in C57BL/6 wild-type, LDL receptor (LDLR)-deficient mice and PPAR-β/δ-deficient mice treated with GW0742 (10 mg/kg/day) or a vehicle solution for 14 days. GW0742 upregulated liver phospholipid transfer protein (Pltp) gene expression and increased serum PLTP activity in mice. When given to wild-type mice, GW0742 significantly increased serum HDL-C and HDL phospholipids; GW0742 also raised serum potential to generate preβ-HDL formation. The GW0742-mediated effects on liver Pltp expression and serum enzyme activity were completely abolished in PPAR-β/δ-deficient mice. GW0742 also stimulated PLTP mRNA expression in mouse J774 macrophages, differentiated human THP-1 macrophages and human hepatoma Huh7. Collectively, our findings demonstrate a common transcriptional upregulation by GW0742-activated PPAR-β/δ of Pltp expression in cultured cells and in mouse liver resulting in enhanced serum PLTP activity. Our results also indicate that PPAR-β/δ activation may modulate PLTP-mediated preβ-HDL formation and macrophage cholesterol efflux. © 2015 Elsevier Inc., This work was partly funded by European Cooperation in Science and Technology (COST) action BM0904, Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, FIS 11-0176 (to F.B.-V.) and FIS 12-00291 (to J.C.E.-G.), Academy of Finland (Grant #257545 to M.J.), and Ministerio de Economía y Competitividad, SAF2012-30708 (to M.V.-C.). CIBER de Diabetes y Enfermedades Metabólicas Asociadas is an Instituto de Salud Carlos III Project.

Aims: We investigated the effect of plasma levels of human tissue inhibitor of metalloproteinase (hTIMP)-1 on arterial lesion development and aneurysm formation in apolipoprotein-E-deficient mice (ApoE–/–). Methods: Control and transgenic mice were fed either a chow diet or a high-fat diet for 90 and 180 days. Results: hTIMP-1 has a tendency to decrease atherosclerotic lesions, but did not attain significance (approximately 6% reduction in hTIMP-1+/+, p = 0.075, and approximately 4% in hTIMP-1+/0, p = 0.088 vs. control). Immunohistological and histological analyses revealed a reduction in macrophage accumulation (23% of control in hTIMP+/0, p = 0.065, and 49% of control in hTIMP+/+, p < 0.05) but not in collagen degradation within the lesion in transgenic mice. Moreover, elastin degradation in sites of pseudo-microaneurysms was reduced in transgenic mice (37% of control in hTIMP-1+/0, p < 0.05, and 50% of control in hTIMP-1+/+, p < 0.05). DNA array analysis of matrix metalloproteinase (MMP) expression followed by real-time PCR quantification revealed a significant up-regulation of MMP-3, MMP-12 and MMP-13 in arterial lesions of ApoE–/– mice fed a high-fat diet in comparison with the same mice fed a chow diet. Conclusion: These data show that hTIMP-1 reduces aneurysm formation in ApoE–/– mice but does not protect them against the development of arterial lesions.

International audience; Peroxisome proliferator-activated receptor gamma (PPAR gamma) is a ligand-activated transcription factor involved in the regulation of lipid metabolism, diabetes, obesity, atherogenesis and inflammation. PPAR gamma genetic variation has been associated with metabolic and cardiovascular diseases. The aim of this study was to explore, for the first time, the relationship between PPAR gamma C161T polymorphism and the risk of ischemic stroke (IS) among patients with type 2 diabetes mellitus (T2DM). A total of 196 patients with IS (117 diabetics and 79 nondiabetics) and 192 controls were recruited to enroll in this study. PPAR gamma C161T genotyping was performed by PCR-RFLP technique. The 161T allele as compared with C allele was found to be higher in controls than in IS patients (with or without T2DM). After adjusting for multiple risk factors, the T allele carriers had significantly reduced IS risk (OR = 0.575, 95 % CI 0.348-0.951, p = 0.030) compared to the CC homozygotes which increased significantly the risk in IS patients with T2DM (OR = 1.85, 95 % CI 1.23-2.62). Moreover, the triglycerides (TG) and ApoB levels in CC homozygote carriers were significantly higher than those in T allele carriers. These results indicate that the C161T of PPAR gamma may reduce the risk of IS by modulation of adipose metabolism especially TG and ApoB in IS patients with T2DM.

The association of E670G (rs505151) polymorphism in PCSK9 gene with an increased risk of coronary artery disease (CAD) and ischemic stroke (IS) was reported in previous studies. We investigated the effect of the E670G (rs505151) on the risk of CAD and IS in a Tunisian cohort. Genotyping of the PCSK9 E670G was performed using polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) and then confirmed by direct sequencing. The frequency of the 670G allele was significantly higher in the CAD than in the no-CAD subgroup (0.132 vs. 0.068, p = 0.030). As expected, the incidence of E670G was significantly important in IS subgroup than control group (0.122 vs. 0.073, p = 0.032). Furthermore in CAD patients, the 670G carriers showed significantly increased plasma total cholesterol and LDL-cholesterol levels compared to E670 carriers (6.78 [6.47–7.00] vs. 4.92 [4.02–5.46] mmol/l, p

11th International Symposium on VIP, PACAP and Related Peptides, Univ Pecs, Pecs, HUNGARY, AUG 27-31, 2013; International audience; PPAR delta +294T/C polymorphism was investigated in diabetics, in normolipidemic healthy controls, in dyslipidemic and nondyslipidemic coronary artery disease patients but never in ischemic stroke patients. The aim of this study was to explore, for the first time, the relationship between the genetic polymorphism of PPAR delta and the risk of ischemic stroke among patients with diabetes. The study group consisted of 196 patients with ischemic stroke and 192 controls. Plasma concentrations of total cholesterol, triglycerides, low-, and high-density lipoprotein did not differ significantly between subjects carrying the TT genotype and those carrying the CC/TC genotype in both ischemic stroke patients (with or without diabetes) and control groups. The +294C allele (CC + CT genotypes) as compared with TT genotypes was found to be higher in total ischemic stroke patients than in controls. On the other hand, no interaction between diabetes and PPAR +294T/C polymorphism on the risk of ischemic stroke was found (p = 0.089). The PPAR delta +294T/C polymorphism was associated with the risk of ischemic stroke in Tunisian subjects. This polymorphism has no influence on plasma lipoprotein concentrations and body mass index either in healthy subjects or in ischemic stroke patients with or without diabetes both in males and females.

Autosomal Dominant Hypercholesterolemia (ADH) is due to defects in the LDL receptor gene (LDLR), the apolipoprotein B-100 gene (APOB) or the proprotein convertase subtilisin/kexin type 9 gene (PCSK9). The aim of this study was to identify and to characterize the ADH-causative mutations in two Tunisian families. Analysis of the LDLR gene was performed by direct sequencing, multiplex ligation-dependent probe amplification (MLPA) and by long range PCR and sequencing. The PCSK9 gene was analysed by direct sequencing and the APOB gene was screened for the most common mutation: p.Arg3527Gln. In the LDLR gene, we found two large deletions and characterized their exact extent and breakpoint sequences. The first one is a deletion of 12,684 bp linking intron 1 to intron 5: g.11205052_11217736del12684. The second deletion spans 2364 bp from intron 4 to 6: g.11216885_11219249del2364. Sequence analysis of each deletion breakpoint indicates that intrachromatid non-allelic homologous recombination (NAHR) between Alu elements is involved. These two large rearrangements in the LDLR gene are the first to be described in the Tunisian population, increasing the spectrum of ADH-causative mutations.

OBJECTIVES In this study, we investigated the association between matrix metalloproteinase-1 (MMP-1) G-1607GG, MMP-12 A-82G and MMP-12 A1082G genotypes and haplotypes and the prognosis of coronary artery disease (CAD). METHODS A total of 129 Tunisian patients with CAD were followed prospectively for a median of 2.5 years. Genotypes were determined by a PCR-based restriction fragment length polymorphism. Two endpoints were considered: restenosis and incidence of clinical vascular events (restenosis, myocardial infarction, stroke, cardiac death). RESULTS Genotypes of MMP-1 G-1607GG, MMP-12 A-82G and MMP-12 A1082G were not associated with the incidence of restenosis or clinical events. Analysis of haplotypes consisting of alleles of MMP-1 G-1607GG and MMP-12 A1082G showed that the rate of clinical events was significantly higher in patients carrying the GG-A haplotype than those with other haplotypes (0.637 vs. 0.424, respectively, odds ratio=1.45; 95% confidence interval=1.04-2.04; P

Autosomal dominant hypercholesterolaemia (ADH) is due to defects in the LDL receptor gene ( LDLR), in the apolipoprotein B-100 gene ( APOB) or in the proprotein convertase subtilisin/kexin type 9 gene ( PCSK9). The aim of this study was to identify and to characterize mutations at the origin of ADH in two Tunisian families. We found three genomic variations: (1) c.1845 + 1G > A, a splice site mutation in the LDLR gene and (2) two variations in the PCSK9 gene (p.Phe515Leu and p.Gly670Glu) that were both reported to be associated with high LDL-C levels. These results enlarge the spectrum of ADH-causative LDLR and PCSK9 variations in Tunisia. Our observations indicate that missense variations in the PCSK9 gene do not influence the clinical phenotype of ADH patients carrying a mutation in the LDLR gene.

Background Autosomal Dominant Hypercholesterolemia (ADH) is an autosomal dominant disease caused by mutations in the low density lipoprotein receptor ( LDLR ), apolipoprotein B ( APOB ), and proprotein convertase subtilisin/kexin type 9 ( PCSK9 ) genes. Xanthomas and coronary heart diseases (CHD) at an early age are the major clinical manifestations of the disease. Methods 16 families with familial hypercholesterolemia from different regions in Tunisia participated in the study. Mutations within the LDLR gene were screened through DNA sequencing. Lipids values were measured by standard enzymatic methods. Results We present here thirty five homozygotes and fifty six heterozygotes. Homozygotes presented extensive xanthomatosis, variable clinical manifestations of CHD, and total cholesterol levels in males and females of 17.26 ± 4.18 and 17.64 ± 2.59 mmol/L respectively. HDL-cholesterol levels were 0.62 ± 0.24 and 1.00 ± 0.61 mmol/L for males and females, respectively. None of the heterozygotes had tendon xanthomas (except for one female aged 62), eight had corneal arcus, and nine developed CHD mean between 46 and 88 years old. Total cholesterol levels in males and females ranged from 4.60 to 8.90 and from 4.30 to 10.50 mmol/L, respectively. Conclusion Tunisian FH heterozygotes are characterized by a moderate clinical and biological expression of the disease.

Matrix metalloproteinases are a family of enzymes which collectively can cleave all components of the extracellular matrix. In physiological situations, the expression of matrix metalloproteinases is very low. The increase of their expression leads to several diseases as atherosclerosis, restenosis, rheumatoid arthritis and cancers. In atherosclerosis, metalloproteinases are implicated in the rupture of the atheromatous plaque and contribute to acute vascular accident. Consequently, several studies hypothesized that the inhibition of matrix metalloproteinases activity could reduce the volume of the atheromatous plaque and prevent its destabilisation and therefore could be useful in the treatment of atherosclerosis. However, clinical results have so far been inconclusive because matrix metalloproteinases inhibitors are not very specific. The development of selective inhibitors and gene transfer approaches may better suit the treatment of atherosclerosis.

Background Familial hypercholesterolemia (FH) is an autosomal dominant inherited disease caused by mutations in either the low-density lipoprotein receptor, the apolipoprotein B or the proprotein convertase subtilisin/kexin type 9 genes. It is characterized by a high concentration of low-density lipoprotein (LDL), which frequently gives rise to premature coronary disease. In this study, we report a novel splice site mutation of the LDL receptor gene in a Tunisian family. Methods Seven patients from the family were screened for mutations in the LDLR gene and the apoB gene, using direct sequencing. RT-PCR and study on cultured skin fibroblast were realised to characterize the effect of novel mutation. Results Direct sequencing of the promoter and 18 exons reveals a G > A substitution in the splice site junction of intron 8 (c.1186 + 1 G > A). Study on cultured skin fibroblasts showed a residual activity of 10% of the LDL receptor. Reverse transcription, amplification and direct sequencing of RNA from patient's lymphocytes reveal a deletion of the final 51 bp of exon 8 preserving the reading frame. Conclusions The study identified a novel splice mutation c.1186 + 1 G > A in the LDL receptor gene. It causes the utilization of a new cryptic donor splice site 51 bp downstream from the normal site.

Several matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) have been implicated in the development and outcome of coronary artery disease (CAD). We investigated whether MMP-12 and TIMP-1 levels were associated with risk, severity, and outcome of CAD. Plasma MMP-12 and TIMP-1 levels are measured in 50 and 44 patients with CAD, respectively, by enzyme-linked immunosorbent assay. Of all patients, 16 were taking statins. Patients who were not on statins were classified into 3 groups according to number of >50% stenotic vessels. Compared with 29 volunteers without CAD, patients without statins (n = 34) had higher MMP-12 concentrations (1.71 vs 1.08 ng/ml, p = 0.021). MMP-12 levels were significantly lower in patients with than in those without statin treatment (0.99 vs 1.71 ng/ml, p = 0.008). There was no association between MMP-12 levels and number of >50% stenotic vessels. MMP-12 concentrations were not associated with outcome of CAD. However, plasma TIMP-1 levels were associated with restenosis independently of number of stenotic vessels and age (p = 0.035) but not with risk or severity of CAD. In conclusion, plasma MMP-12 concentration was associated with the presence of CAD. Statin therapy decreases plasma MMP-12 levels in patients with CAD. Increased TIMP-1 levels may prevent restenosis after angioplasty.

Familial hypercholesterolemia (FH) has a higher prevalence in central Tunisia together with a milder clinical expression than in western countries. The molecular basis of FH in Tunisia remains unknown. Our aim was to identify FH-causing mutations in three unrelated families (21 subjects) from the area of Souassi (central Tunisia). In probands with a presentation of homozygous FH, the promoter and 18 exons of the low density lipoprotein (LDL)-receptor gene were sequenced in both orientations. A novel complex frameshift mutation was identified in exon 10, nucleotides 1477-1479 (TCT) at Serine 472 were replaced by an insertion of seven nucleotides (AGAGACA), producing a premature termination codon 43 amino acids downstream. Binding of 125I-labelled LDL at 4 degrees C to cultured fibroblasts from two probands showed

We studied 14 families with familial hypercholesterolaemia (FH) from Central and Southern Tunisia. Twenty-six living homozygotes were identified in these areas of whom 24 homozygotes and 27 of their obligate heterozygote parents are the subject of this report. Ten of the 14 families are unrelated and in 9 of them there were consanguineous marriages. The mean age of homozygotes was 16 for females (range 2.5–40) and 12.5 for males (range 2–34). All the homozygotes had extensive xanthomatosis and showed variable clinical manifestations of coronary heart disease (CHD). Plasma total and LDL cholesterol levels averaged 18 and 16.9 mmol/l, respectively. Mean high density lipoprotein (HDL) cholesterol values were 0.48 mmol/1 for males and 0.70 mmol/l for females. The mean age of the obligate heterozygotes was 44 (range 32–62 years) for mothers and 51 (range 35–80 years) for fathers. None of them had tendon xanthomas, not even the oldest, who was aged 80. Only 5 of the 27 obligate heterozygotes had developed CHD (aged 34–58). Plasma cholesterol levels varied more than twofold (4.1–10 mmol/1) and averaged 6.79 and 7.51 mmol/l for males and females, respectively. LDL cholesterol values were below the age- and sex-related 95th percentile from the Lipid Research Clinics Prevalence Study in 46% of male and 30% of female heterozygotes. The frequency of homozygotes was 1:125 000 and the minimum estimated frequency of heterozygotes was 1:165 in Central and Southern Tunisia. Only Afrikaners in South Africa and French Canadians have such high frequencies of FH.

The NLRP3 inflammasome activity is abnormally elevated in many human inflammatory diseases, including cardiovascular and metabolic diseases such as atherosclerosis and type 2 diabetes mellitus (T2DM) respectively. Therefore, there is considerable interest in the identification of effective therapeutics that selectively inhibit the NLRP3 inflammasome pathway. In this study, we have identified Arglabin as a potential small molecule inhibitor that targets the NLRP3 inflammasome activity in cell culture and in an animal model, the ApoE2.Ki mice fed a high-fat Western-type diet (HFD). Arglabin, a plant sesquiterpene lactone, has been used extensively as an herbal remedy that proved effective in treating cancer of the liver, lungs and breast at early stages. Arglabin inhibited, in a concentration-dependent manner, IL-1β and IL-18 production in lipopolysaccharide and cholesterol crystal-activated cultured mouse peritoneal macrophages. In addition, Arglabin activated autophagy as evidenced by the increase in LC3-II protein. Intraperitoneal injection of Arglabin (2.5 ng/g body weight twice daily for 13 weeks) into female ApoE2.Ki mice fed a HFD resulted in a decreased IL-1β plasma level and reduced plasma levels of total cholesterol and triglycerides. Treatment of ApoE2.Ki mice fed a HFD with Arglabin significantly reduced the plasma concentration of anti-oxLDL antibodies. Moreover, Arglabin oriented the proinflammatory M1 macrophages into the anti-inflammatory M2 phenotype in spleen and arterial lesions. Consequently, a marked reduction in atherosclerotic lesions was observed in the median areas in the sinus and whole aorta. In comparison to vehicle-treated mice, Arglabin reduced plasma levels of glucose and insulin. Immunohistochemical analysis revealed the presence of active caspase 3 in Langerhans islets of ApoE2.Ki mice fed a HFD that was significantly inhibited by Arglabin treatment. Moreover, Arglabin reduced susceptibility to apoptosis in cultured INS-1 cells by increasing concentration-dependently Bcl-2 levels, which led to concomitantly decreased Bax/Bcl-2 ratio. In cultured INS-1 cells, Arglabin increased the expression of the autophagic markers Becline 1 and LC3-II in a concentration-dependent manner. Consequently, our results indicate survival-promoting properties of the Arglabin molecule in pancreatic β-cells.In conclusion, our findings demonstrate that Arglabin may represent a promising new drug to treat atherosclerosis and T2DM., L’inflammasome NLRP3, un complexe protéique pro-inflammatoire, joue un rôle essentiel dans le processus pathologique de l’athérosclérose et du diabète de type 2 (DT2). Il est responsable de la maturation de la pro-IL-1β et de la pro-IL-18 respectivement en IL-1β et IL-18 biologiquement actives. L’objectif de cette étude consiste à identifier et caractériser un inhibiteur spécifique de l’inflammasome NLRP3 qui pourrait contribuer à limiter l’évolution des plaques d’athérome et l’installation du DT2. Au cours de cette thèse, nous avons isolé l’Arglabine d’une plante, Artemisia glabella, connue pour ses vertus anti-tumorales. L’effet de l’Arglabine a été étudié au niveau des macrophages et des cellules β-pancréatiques, et chez des souris ApoE2.Ki et ApoE2.Ki/NLRP3-/- placées sous régime High Fat Diet (HFD). Les résultats in vitro montrent que l’Arglabine réduit, d’une façon dose-dépendante, l’activité de l’inflammasome NLRP3 et inhibe l’expression des protéines Nlrp3, IL-1β et caspase-1. Elle induit l’autophagie en augmentant significativement l’expression de la LC3-II au niveau des macrophages murins en culture. L’injection intra-péritonéale de deux doses journalières d’Arglabine (2.5 ng/g de m.c.) à des souris ApoE2.Ki placées sous régime HFD, normalise le profil lipidique et réduit l’oxydation des LDL au niveau du plasma des souris. Elle réduit le nombre des monocytes pro-inflammatoires (Ly-6Chigh) et augmente le nombre des monocytes anti-inflammatoires (Ly-6Clow). Au niveau des lésions artérielles, l’Arglabine oriente les macrophages présents vers un phénotype anti-inflammatoire M2. L’ensemble de ces résultats montre un rôle athéroprotecteur de l’Arglabine : elle réduit la surface des lésions artérielles au niveau du sinus aortique ainsi qu’au niveau de la totalité de l’aorte des souris ApoE2.Ki placées sous régime athérogène. De plus, le traitement par l’Arglabine normalise le profil glycémique et insulinémique des souris ApoE2.Ki. Elle réduit également l’activité de la caspase 3 au niveau des îlots de Langerhans et augmente de manière dose-dépendante l’expression de la protéine Bcl-2 au niveau des cellules β-pancréatiques. Par ailleurs, nous avons montré une augmentation de l’expression de protéines impliquées dans l’autophagie telles que la Becline 1 et la LC3-II sous l’effet de l’Arglabine. Ainsi, l’Arglabine réduit non seulement l’activité de l’inflammasome NLRP3 mais améliore aussi la survie des cellules β-pancréatiques. L’Arglabine constitue donc une molécule très prometteuse dans le traitement des maladies cardiovasculaires et le DT2.

The NLRP3 inflammasome activity is abnormally elevated in many human inflammatory diseases, including cardiovascular and metabolic diseases such as atherosclerosis and type 2 diabetes mellitus (T2DM) respectively. Therefore, there is considerable interest in the identification of effective therapeutics that selectively inhibit the NLRP3 inflammasome pathway. In this study, we have identified Arglabin as a potential small molecule inhibitor that targets the NLRP3 inflammasome activity in cell culture and in an animal model, the ApoE2.Ki mice fed a high-fat Western-type diet (HFD). Arglabin, a plant sesquiterpene lactone, has been used extensively as an herbal remedy that proved effective in treating cancer of the liver, lungs and breast at early stages. Arglabin inhibited, in a concentration-dependent manner, IL-1β and IL-18 production in lipopolysaccharide and cholesterol crystal-activated cultured mouse peritoneal macrophages. In addition, Arglabin activated autophagy as evidenced by the increase in LC3-II protein. Intraperitoneal injection of Arglabin (2.5 ng/g body weight twice daily for 13 weeks) into female ApoE2.Ki mice fed a HFD resulted in a decreased IL-1β plasma level and reduced plasma levels of total cholesterol and triglycerides. Treatment of ApoE2.Ki mice fed a HFD with Arglabin significantly reduced the plasma concentration of anti-oxLDL antibodies. Moreover, Arglabin oriented the proinflammatory M1 macrophages into the anti-inflammatory M2 phenotype in spleen and arterial lesions. Consequently, a marked reduction in atherosclerotic lesions was observed in the median areas in the sinus and whole aorta. In comparison to vehicle-treated mice, Arglabin reduced plasma levels of glucose and insulin. Immunohistochemical analysis revealed the presence of active caspase 3 in Langerhans islets of ApoE2.Ki mice fed a HFD that was significantly inhibited by Arglabin treatment. Moreover, Arglabin reduced susceptibility to apoptosis in cultured INS-1 cells by increasing concentration-dependently Bcl-2 levels, which led to concomitantly decreased Bax/Bcl-2 ratio. In cultured INS-1 cells, Arglabin increased the expression of the autophagic markers Becline 1 and LC3-II in a concentration-dependent manner. Consequently, our results indicate survival-promoting properties of the Arglabin molecule in pancreatic β-cells.In conclusion, our findings demonstrate that Arglabin may represent a promising new drug to treat atherosclerosis and T2DM., L’inflammasome NLRP3, un complexe protéique pro-inflammatoire, joue un rôle essentiel dans le processus pathologique de l’athérosclérose et du diabète de type 2 (DT2). Il est responsable de la maturation de la pro-IL-1β et de la pro-IL-18 respectivement en IL-1β et IL-18 biologiquement actives. L’objectif de cette étude consiste à identifier et caractériser un inhibiteur spécifique de l’inflammasome NLRP3 qui pourrait contribuer à limiter l’évolution des plaques d’athérome et l’installation du DT2. Au cours de cette thèse, nous avons isolé l’Arglabine d’une plante, Artemisia glabella, connue pour ses vertus anti-tumorales. L’effet de l’Arglabine a été étudié au niveau des macrophages et des cellules β-pancréatiques, et chez des souris ApoE2.Ki et ApoE2.Ki/NLRP3-/- placées sous régime High Fat Diet (HFD). Les résultats in vitro montrent que l’Arglabine réduit, d’une façon dose-dépendante, l’activité de l’inflammasome NLRP3 et inhibe l’expression des protéines Nlrp3, IL-1β et caspase-1. Elle induit l’autophagie en augmentant significativement l’expression de la LC3-II au niveau des macrophages murins en culture. L’injection intra-péritonéale de deux doses journalières d’Arglabine (2.5 ng/g de m.c.) à des souris ApoE2.Ki placées sous régime HFD, normalise le profil lipidique et réduit l’oxydation des LDL au niveau du plasma des souris. Elle réduit le nombre des monocytes pro-inflammatoires (Ly-6Chigh) et augmente le nombre des monocytes anti-inflammatoires (Ly-6Clow). Au niveau des lésions artérielles, l’Arglabine oriente les macrophages présents vers un phénotype anti-inflammatoire M2. L’ensemble de ces résultats montre un rôle athéroprotecteur de l’Arglabine : elle réduit la surface des lésions artérielles au niveau du sinus aortique ainsi qu’au niveau de la totalité de l’aorte des souris ApoE2.Ki placées sous régime athérogène. De plus, le traitement par l’Arglabine normalise le profil glycémique et insulinémique des souris ApoE2.Ki. Elle réduit également l’activité de la caspase 3 au niveau des îlots de Langerhans et augmente de manière dose-dépendante l’expression de la protéine Bcl-2 au niveau des cellules β-pancréatiques. Par ailleurs, nous avons montré une augmentation de l’expression de protéines impliquées dans l’autophagie telles que la Becline 1 et la LC3-II sous l’effet de l’Arglabine. Ainsi, l’Arglabine réduit non seulement l’activité de l’inflammasome NLRP3 mais améliore aussi la survie des cellules β-pancréatiques. L’Arglabine constitue donc une molécule très prometteuse dans le traitement des maladies cardiovasculaires et le DT2.