Identification des cibles antigéniques d'origine mitochondriale, reconnues par les autoanticorps dans le lupus érythémateux disséminé

Mitochondria are intracellular organelles in control of numerous biological functions (e.g.,from energy supply to steroidogenesis and programmed cell death by apoptosis). Evolutively, mitochondria are considered as derived from the endosymbiosis between an α-proteobacterium and a primitive eukaryotic cell. Due to its origin, the organelle displays prokaryotic motifs such as a circular double-stranded hypomethylated DNA (i.e., mtDNA) and N-formylated peptides. Intact or damaged mitochondria, as well as mitochondrial components may be extruded in the extracellular space upon cell activation or death. These features, as well as several biomolecules localized within the mitochondrion (e.g.,ATP, cytochrome C) are able to be recognized by the innate immune system as mitochondrial damage-associated molecular patterns, thus eliciting a proinflammatory response. A humoral immune response comprising anti-mitochondrial antibodies (AMA) is also described in various autoimmune conditions, such as AMA-M2 in primary biliary cirrhosis (i.e., PBC). Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the alternance of flares and phases of remission, due to the deposition of antibody-antigen scaffolds (i.e., immune complexes) within tissues, leading to various clinical manifestations (e.g., neuropsychiatric, hematological or dermatological disorders). The antiphospholipid syndrome (i.e., APS) is an autoimmune disease, with thromboembolic and/or obstetrical manifestations, that can either be found alone or along with SLE. While the immunogenicity of cardiolipin (i.e., a phospholipid uniquely synthetized by mitochondria In humans) is well described in SLE and APS (i.e., anticardiolipins), mitochondrial proteins targeted by autoantibodies are still poorly known. The present doctoral thesis follows my masters' project during which I developed ELISAs allowing for the detection of AMA targeting intact mitochondria (i.e., AwMA) or mtDNA (i.e., AmtDNA)¹. The present project aims aims to characterize the mitochondrial immunogenicity in SLE and APS. The University of Toronto Lupus Clinic cohort comprise sera from patients with SLE or APS (n=175 and n=12 respectively). AwMA and AmtDNA levels were assessed in these samples, as well as in sera from healthy volunteers (n=43) or patients with PBC (n=12). I observed that all patients had increased AwMA, compared to healthy individuals. AmtDNA were only increased in SLE patients and were associated with increased past reports of lupus nephritis (p=0.01). These results were published in March 2019 in Scientific Reports². During the acquisition of these data, I observed that patients' sera also presented immunoreactivity against mitochondrial RNA (i.e., mtRNA). I thus adapted my assays to detect autoantibodies against mtRNA (i.e., AmtRNA), and assessed their levels in sera from patients includes in the systemic autoimmune rheumatic disease biobank and data repository (i.e., SARD-BDB. Healthy:n=30, SLE:n=87). AmtRNA were significantly elevated in SLE (IgG: p<0.0001, IgM:p=0.0493). Surprisingly, AmtRNA-IgG were associated with decreased reports of past lupus nephritis (p=0.03) and carotid plaque (p=0.04). This study was published in Frontiers in Immunology in May 2019³. As each AMA assessed displayed biostatistical associations with antiphospholipids, I replicated these protocols, using sera from patients with APS, included in the SARD-BDB (n=27). AmtRNA (IgG:p=0.0005, IgM:p=0.01) and AmtDNA-IgM were increased in APS (p=0.009). However, only AmtDNA-IgM were associated with reports of arterial thromboses (p=0.047). This pilot study was published in Lupus in August 2020⁴. In a a recent study, accepted in Arthritis & Rheumatology in January 2022⁵, we identified by mass spectrometry 1345 proteins associated with AwMA, 431 of with were assigned to the mitochondrial proteome. These results allowed to identify two candidates: C1qBP and Mfn-1. IgGs to C1qBP were increased in (p=0.0167) and associated with positivity to the lupus anticoagulant (p=0.049) in SLE. IgGs against Mfn-1 are interesting candidates for the prediction of the disease (p=0.0052) and are associated with positivity to antiphospholipids (p=0.011) and antibodies against double-stranded DNA (p = 0.0005). These results highlight the immunogenicity of the organelle in SLE and APS. Mitochondrial antigens are interesting candidates for the development of novel clinical assays allowing improved prognosis, diagnosis, or disease stratification, ultimately contributing to the improvement of medical care for people with autoimmune conditions.

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