To understand the type of cell death induced by RAPA M0, M1 and M2 macrophages were assessed using DNA staining and annexin V/PI staining. Consistent with apoptotic cell death, RAPA selectively increased annexin V-positive cells (P < 0·01, n = 6) and cells with hypodiploid DNA content in M2 and M0 macrophages (P < 0·01, n = 6) (Fig. 2). The presence SRT1720 mouse of RAPA induced modifications of macrophage phenotype depending on the type of polarization (Fig. 3). In M1, RAPA significantly reduced the

expression of CD25, TLR2, CD127, CD64, CD14, CD163, CD36, CD206 and CD209, but increased CCR7, CD86 and CD32 expression. In M2, RAPA significantly reduced the expression of CD86, CD32, CD36, CD206, CXCR4 and CD209. As for phenotype, the cytokine/chemokine secretion was also modified by RAPA depending on polarization (Table 1). During M1 polarization CXCL11, CCL19, IL-10, VEGF and CCL18 were down-regulated while IL-6, TNF-α and IL-1β were

up-regulated. On the other hand, RAPA reduced CCL18, CC13 and SCGF-β during M2 polarization. In view of the in vitro effect of RAPA, we examined the chemokine/cytokine release by PBMC after LPS stimulation and the efficiency to polarize macrophages to M1 or M2 in patients who were treated with RAPA (0·1 mg/kg/day) as monotherapy. Twelve patients who received RAPA before islet transplant were analysed prospectively. During RAPA treatment circulating inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate and fibrinogen increased significantly (Fig. 4a). The LPS-stimulated

PBMC release of M1-related factors such as CXCL9, CXCL10, IFN-γ, G-CSF and IL-1ra was strongly up-regulated MLN2238 molecular weight after 14 days of RAPA monotherapy (Table 2). Moreover, a milder, Grape seed extract even if significant, increase was also observed for CCL11, CCL27, GM-CSF, intercellular adhesion molecule-1, hepatocyte growth factor, IL-2, IL-4, IL-9, IL-13, IL-15, IL-18 and macrophage migration inhibitory factor, while CCL4 appeared down-regulated. The efficiency to polarize to M1 or M2 was evaluated in nine of 12 patients (Fig. 4b). At baseline, 3951 cells/ml blood (2303–5318) and 2868 cells/ml blood (1686–5692) were obtained by in vitro M1 and M2 polarization, respectively (P = ns; M1/M2 ratio 1·41 ± 0·49). After 21 days of RAPA monotherapy 7795 cells/ml blood (2107–18 864) and 3247 cells/ml blood (1762–7431) were obtained by in vitro M1 and M2 polarization, respectively (P = 0·01; M1/M2 ratio 1·79 ± 0·84). Mounting evidence indicates that mTOR-mediated signalling regulates both adaptive and innate immune cell development and functions.[12, 38, 39] In this study we described the effect of mTOR inhibition by RAPA on the plasticity of mononuclear phagocytes. In vitro, RAPA induced apoptotic cell death during M0/M2 but not M1 macrophage polarization. Previously a role for RAPA on survival of non-proliferating cells that can be derived from monocytes was suggested for osteoclasts[40, 41] and dendritic cells.