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Meningococcemia, a disease of the 
endothelial cells
Xavier Nassif	

Institut Necker-Enfants Malades	

Université Paris Descartes	

Paris, France
PHARYNX
CSF
BLOOD
CARRIER
Meningococcal sepsis
Clinically : multiorgan failure, extensive
necrotic purpura.
.
Histologically : thrombosis, vasculitis,
hemorragic necrosis (adrenal, skin)
MENINGITIS
Heart	

Kidney
Human skin transplantation model model in SCID mice
1 cm x 1 cm	

Before	

 After	

CB17/SCID
6 week-old females
Before	

 After
Nm targets human endothelial cells
(immuno histochemistry)	

Anti human CD31
Anti Nm
PilD
PilF PilT
E
Assembly Retraction
Outer
membrane
Inner
membrane
PilC PilQ
PilW
Assembly
PilM, N, O, P
Stabilization
PilC, G, H, I, J, K, W
Maturation
PilC, I, J, K, W
PilE! Minor pilins!
(PilX, PilV, ComP)!
Prepilin	

Minor pilins!
assembly!
re!traction!
(PilT)!
emergence !on the!
(PilQ)!
Functional Tfp (PilE, PilX, PilV, ComP)!
(PilD, F, M, N, O, P)! (PilC, G, H, I, J, K, W)!
cell surface!
(Craig et al, Molecular Cell 2006)
Non piliated strains do not colonize human skin grafts and do
not induce thrombosis nor vascular damage	

X 100	

X 1000	

100 µm	

 100 µm	

 100 µm	

10 µm	

 10 µm	

 10 µm	

Nm antigen was only found within the cytoplasm of circulating or resident phagocytes
Vasculitis
Thrombus
CD147 β2AR
Adhesion
PilE
PilV
PilE, PilV
Signalling
Type IV pilus Receptor :
Cellular Complex involving an « Adhesion Receptor » and a « Signalling Receptor »
Receptors for N. meningitidis Type IV pili
Coureuil et al, Cell, 2010
Bernard et al, Nature Medicine, 2014
ICAM-1
ICAM-2
CD44
E-selectin
Ezrin-Moesin
Coureuil et al, Science, 2009
Cdc42
Par3/PKCζ/Par6
complex
p120
β	

α	

Z0-1
Claudins
VE-Cadherin
permeability
Bacterial diffusion
Type IV pilus-mediated signaling events
Doulet et al, J Cell Biol, 2006
Lambotin et al J Cell Science, 2005
Eugene et al, J Cell Science, 2002
Hofffmann et al, J Cell Biol, 2001
How this meningococcal endothelial cells
interaction promotes the thrombotic leakage
syndrome responsible for Purpura fulminans ?
Two endothelial membranous receptors
are required for the activation of protein C
Coagulation triggers
(endotoxin, pro-inflammatory
cytokines)
Coagulation cascade
Fibrinogen Fibrin
(thrombus)
Endothelial cells
TM
Thrombin Thr Thr
PCaPC
EPCR
PC
-­‐	
  
Heart	

Kidney
Jean-Philippe Barnier
Jean Bergougnioux
Emmanuelle Bille
Terry Brissac
Elena Capel Malo
Mathieu Coureuil
Daniel Euphrasie
Eric Frapy
Gaël Gesbert
Anne Jamet
Olivier Join-Lambert
Hervé Lécuyer
Julie Meyer
Zoé Virion
Institut Cochin - Paris	

Team 11 – INSERM U1151 – INEM - Paris	

Alain Schmitt (Electron Microscopy)
Sandrine Bourdoulous
Stefano Marullo

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Professor Xavier Nassif @ MRF's Meningitis & Septicaemia in Children & Adults 2015

  • 1. Meningococcemia, a disease of the endothelial cells Xavier Nassif Institut Necker-Enfants Malades Université Paris Descartes Paris, France
  • 2. PHARYNX CSF BLOOD CARRIER Meningococcal sepsis Clinically : multiorgan failure, extensive necrotic purpura. . Histologically : thrombosis, vasculitis, hemorragic necrosis (adrenal, skin) MENINGITIS
  • 4. Human skin transplantation model model in SCID mice 1 cm x 1 cm Before After CB17/SCID 6 week-old females Before After
  • 5. Nm targets human endothelial cells (immuno histochemistry) Anti human CD31 Anti Nm
  • 6. PilD PilF PilT E Assembly Retraction Outer membrane Inner membrane PilC PilQ PilW Assembly PilM, N, O, P Stabilization PilC, G, H, I, J, K, W Maturation PilC, I, J, K, W PilE! Minor pilins! (PilX, PilV, ComP)! Prepilin Minor pilins! assembly! re!traction! (PilT)! emergence !on the! (PilQ)! Functional Tfp (PilE, PilX, PilV, ComP)! (PilD, F, M, N, O, P)! (PilC, G, H, I, J, K, W)! cell surface! (Craig et al, Molecular Cell 2006)
  • 7. Non piliated strains do not colonize human skin grafts and do not induce thrombosis nor vascular damage X 100 X 1000 100 µm 100 µm 100 µm 10 µm 10 µm 10 µm Nm antigen was only found within the cytoplasm of circulating or resident phagocytes
  • 9. CD147 β2AR Adhesion PilE PilV PilE, PilV Signalling Type IV pilus Receptor : Cellular Complex involving an « Adhesion Receptor » and a « Signalling Receptor » Receptors for N. meningitidis Type IV pili Coureuil et al, Cell, 2010 Bernard et al, Nature Medicine, 2014
  • 10. ICAM-1 ICAM-2 CD44 E-selectin Ezrin-Moesin Coureuil et al, Science, 2009 Cdc42 Par3/PKCζ/Par6 complex p120 β α Z0-1 Claudins VE-Cadherin permeability Bacterial diffusion Type IV pilus-mediated signaling events Doulet et al, J Cell Biol, 2006 Lambotin et al J Cell Science, 2005 Eugene et al, J Cell Science, 2002 Hofffmann et al, J Cell Biol, 2001
  • 11. How this meningococcal endothelial cells interaction promotes the thrombotic leakage syndrome responsible for Purpura fulminans ?
  • 12. Two endothelial membranous receptors are required for the activation of protein C Coagulation triggers (endotoxin, pro-inflammatory cytokines) Coagulation cascade Fibrinogen Fibrin (thrombus) Endothelial cells TM Thrombin Thr Thr PCaPC EPCR PC -­‐  
  • 14. Jean-Philippe Barnier Jean Bergougnioux Emmanuelle Bille Terry Brissac Elena Capel Malo Mathieu Coureuil Daniel Euphrasie Eric Frapy Gaël Gesbert Anne Jamet Olivier Join-Lambert Hervé Lécuyer Julie Meyer Zoé Virion Institut Cochin - Paris Team 11 – INSERM U1151 – INEM - Paris Alain Schmitt (Electron Microscopy) Sandrine Bourdoulous Stefano Marullo