Les rétinopathies ischémiques prolifératives : étude des régulateurs de l’inflammation dans l’angiogenèse pathologique

Proliferative ischemic retinopathies such as proliferative diabetic retinopathy (PDR) and retinopathy of prematurity (ROP) are the principal causes of vision loss in working age and pediatric populations of industrialized countries. Although they display different initial triggers, proliferative ischemic retinopathies are biphasic ocular diseases that affect retinal vessels. There is an initial degeneration of the microvasculature, followed by a hypoxic stress on the retina. This triggers a second phase of deregulated and destructive blood vessel growth within the retina. Given this sequence of events and prominent clinical features, the currently most widely used local ocular therapeutic interventions directly target pathological blood vessel growth, yet present a number of non-desirable off-target effects such as the destruction of the retina itself. In fact, currently available treatments for proliferative ischemic retinopathies present non-negligible side effects, such as cataract formation with intravitreal use of corticosteroid or reduced visual field with laser-based photocoagulation surgery. Similarly, the anti-VEGF (Vascular endothelial growth factor) therapy may be associated with thromboembolic events, neuronal toxicity and atrophy when used as frequent long-term treatment given the fact that VEGF serves a vaso- and neuro-protective factor in the retina. Overcoming these therapeutic limitations and exploring novel pharmacological avenues are therefore required to ameliorate the safety profiles of current interventions. In our first study, we describe a novel mechanism by which severely stressed neuronal cells in the diabetic retina provoke destructive inflammation in the eye. We demonstrate that the multi-ligand co-receptor Neuropilin-1, VEGF and Semaphorin3A act as potent attractants for a specialized population of immune cells (mononuclear phagocytes) that later promote the exaggerated pathological vessel growth associated with the disease progression. Importantly, we provide evidence for a novel pharmacological intervention that reduces the inflammation associated with pathological retinal vessel growth. Our findings also suggest that current anti-VEGF therapies (a popular treatment for ocular vascular diseases) may in part be effective by reducing destructive ocular inflammation. In our second study, we provide evidence that those mononuclear phagocytes activate HIF1α in the hypoxic and inflamed retina. After using the unbiased proteomic approach of tandem mass spectrometry, we were able to identify HIF1α partners and found a novel link between HIF1α and the UPR (unfolded protein response) sensor IRE1α. Our data next established the crucial role of IRE1α (precisely via its kinase activity) in HIF1α production. We also suggested that the synergy between IRE1α and HIF1α pathways may be responsible of the pathogenic activity of the hypoxic mononuclear phagocytes via their secretion of inflammatory cytokines, thus contributing to the progression of the retinopathy. Collectively, our work identifies important regulators of the pathogenic activity of mononuclear phagocytes. We show that: 1) Neuropilin-1 promotes the infiltration of mononuclear phagocytes in the retina and 2) the convergent mechanism between IRE1α and HIF1α pathways is responsible for their release of pro-inflammatory factors during retinopathy. Our results could be used as a basis for the development of alternative therapeutic strategies (targeting Neuropilin-1, IRE1α and HIF1α) to treat ocular diseases or other pathologies characterized by an excessive inflammation.

Keyphrases: VEGF, Hypoxie, UPR, phagocytes mononucléaires (microglies/macrophages), Ischemic proliferative retinopathy, Neuropilin-1, Semaphorin3A, Hypoxia, mononuclear phagocytes (microglia/macrophages), HIF1α, IRE1α