Abstract Despite the common recommendations of the criteria for the diagnosis of asthma there is still a wide variation within different regions in diagnoses, use of medications and hospitalisation rates especially among young children. This thesis elucidates the role of spesified environmental risk factors associated with the development of atopic diseases in childhood. In two prospective follow-up surveys we found that allergies and asthma associate with the consumption of margarines, butter and fish and that the common infection of childhood, RS-virus infection, does not increase asthma morbidity in adolescence. In a randomised set-up we were able to verify that the common childhood infections do not protect from allergies and asthma. In a retrospective survey we found that hospitalisation rates can reflect medication practices in different regions. Our results indicate that consumption of fat in the diet can be one triggering factor for allergies but common childhood infections are merely markers of susceptibility to allergies and asthma rather than the cause of it.

Bakgrund: Anafylaxi är en akut, svår, oftast snabbt insättandes systemisk överkänslighetsreaktion från flera organsystem och är potentiellt livshotande. Det ses en ökad förekomst av anafylaxi i samhället över tid sedan 90-talet. Syfte: Att undersöka barn och ungdomars (0–19 år) upplevelser av att leva med risk för anafylaxi. Metod: En litteraturstudie med tio kvalitativa artiklar. 170 barn och ungdomar deltog. Sökningar gjordes i PubMed, CINAHL och PsycINFO. En sekundärsökning utfördes. Resultatet presenterades med en syntes. Omvårdnadsteori: Roys adaptionsmodell. Resultat: Upplevelser kategoriserades i Känslomässig påverkan och Begränsningar i vardagen. Faktorer delades in i Mitt hem – Min familj – Min säkerhet, Miljön, Adrenalinpennan, Erfarenhet av anafylaxi, Innehållsförteckningar – ”kan innehålla spår av…”, Okunskap och Källor till stöd. Strategier delades in i Att hela tiden vara på sin vakt – värdera risker, Normalisering och Erfarenhet leder till kunskap, vilket resulterar i självsäkerhet – En genomresa. Slutsats: De allergiska barnen visade en mångfacetterad bild av att leva med risk för anafylaxi, med effekter på livskvalitet och välbefinnande initialt i livet som följd. Problematiken visades paradoxalt vara en övergående börda för de flesta: de allergiska barnen genomgick en första tid av adaption, till följd av vilken allergin blev en del av livet under tonåren. Denna litteraturstudie ger djupare insikt i allergiska barn och ungdomarnas upplevelser, samtidigt som den ger underlag till idéer för framtida forskning, i syfte att ta reda på hur samhället och sjukvården på bästa sätt skall utvecklas, för att främja adaption till att leva med risk för anafylaxi.

L'asthme allergique est caractérisé par une réponse prédominante de typeTh2, mais d'autres profils tels que Th17 et Th22 sont aussi observés dans l'asthme plus sévère. La pollution atmosphérique et notamment les hydrocarbures aromatiques polycycliques (HAP) contenus dans les particules d'échappement diesel (DEP) contribuent à l'augmentation de la prévalence de l'asthme et jouent un rôle adjuvant dans le développement et l'exacerbation de l'inflammation allergique en orientant la réponse immune vers un profil Th2Dans la première partie de la thèse, nous avons évalué les effets des HAP sur la polarisation Th17/Th22 de PBMC de sujets allergiques asthmatiques et sujets non-allergiques. Les PBMC de patients asthmatiques présentent une augmentation des profils Th17/Th22 par rapport aux sujets non-allergiques. La stimulation par DEP-HAP et le benzo [a] pyrène (B[a]P) induit une augmentation de l’IL-22 mais de façon étonnante diminue la production d'IL-17A dans les deux groupes. Les facteurs de transcription associés aux cellules Th17: RORA et RORC, sont diminués, alors que le gène cible d’AhR, CYP1A1, est augmenté dans les deux groupes. Notch est diminué uniquement chez les patients asthmatiques. La production d'IL-22 induite par les HAP provient principalement de cellules Th22. L'antagoniste d’AhR reverse presque complètement les effets des DEP, mais seulement partiellement les effets de B[a]P, sur la regulation réciproque entre IL-22/IL-17. Les kinases PI3K, JNK et ERK participent à l’augmentation de l’IL-22 induite par le B[a]P, alors que la p38 MAP kinase a un effet inhibiteur. La deuxième partie de la thèse a évalué l'effet combiné des PRRs et des allergènes sur l’activation et leur capacité à induire une polarisation Th17/Th22 chez des sujets sains et des sujets allergiques asthmatiques. Les DCs stimulées par les allergènes de chien induisent une faible production d'IL-22 par les cellules T. L’activation supplémentaire par les ligands de TLR3, TLR9 et NOD2 conduit à une augmentation de la production augmentée de chimiokines pro-Th2 uniquement par les DCs de patients asthmatiques allergiques aux chiens. 7 A l’inverse, un rôle adjuvant est observé sur la maturation et la production de cytokines pro-Th17/Th22 par les DCs de sujets asthmatiques et de sujets non-allergiques. Parmi les cellules T co-cultivées avec des DC stimulées par l'allergène de chien et les ligands de PRR, nous observons un mélange de cellules de type Th2/Th17 et Th22 chez les patients asthmatiques et un profil Th1/Th22 chez les sujets non-allergiques. L’IL-22 est principalement produite par les Th22 dans les deux groupes avec plus de cellules Th22 observés chez les sujets asthmatiques. L’IL-17 et l’IL-22 sont régulées différemment entre les sujets asthmatiques et les sujets sains, le TGF-β ayant un rôle pro-Th17 tandis que l'IL-23 a un rôle pro-Th22. In vivo, un modèle d'asthme chronique induite par l’allergène de chien a été développé et conduit à une augmentation de la résistance des voies aériennes, une production de chimiokines Th2 et de cytokines Th2/Th17/Th22 ainsi qu’au recrutement de neutrophiles mais peu d’éosinophiles dans le poumon. L'expression du gène de l'IL-22 intervient de façon précoce alors que la protéine apparait plus tard. Le ligand de NOD2 induit une augmentation de la résistance des voies aériennes, ainsi que de la production de protéines et l'expression des gènes induits par l'allergène de chien, mais réduit le recrutement des éosinophiles dans les poumons. Ces résultats montrent que chez l'homme, les productions d’IL-22 et d'IL-17 sont régulées différemment entre les sujets asthmatiques allergiques et les sujets sains. Au total, la pollution et certaines infections bactériennes ou virales pourraient participer chez les patients asthmatiques à sévérité de la maladie et la progression du remodelage des voies aériennes. La modèle in vivo développée permettra de mieux disséquer les mécanismes qui participent à la sévérité de l'asthme. / Allergic asthma is characterized by a predominant Th2 response, but additional profiles such as Th17 and Th22 are observed in more severe asthma. Components of the air pollution such as polycyclic aromatic hydrocarbons (PAH) contained in diesel exhausts particles (DEP) contributes to increased prevalence of asthma and play an adjuvant role in the development and exacerbation of allergic inflammation through the skewing of the immune response towards a Th2 profile. In the first part of the thesis, we evaluated the effects of PAH on the Th17/Th22 polarization of PBMCs from healthy and allergic asthmatic subjects, PBMCs from athmatic patients exhibited an increased Th17/Th22 profile compared with non-allergic subjects. DEP-PAH and Benzo[a]Pyrene (B[a]P) stimulation further increased IL-22 but surprisingly decreased IL-17A production in both groups. Th17 transcription factors RORA and RORC were down regulated, whereas AhR target gene CYP1A1 was up-regulated in both groups. Notch was decreased only in asthmatic patients. PAH-induced IL-22 production originated mainly from Th22 cells. The AhR antagonist reversed almost completely the effects of DEP-PAH, but only partially the effects of B[a]P, on IL-22/IL-17 reciprocal regulation. The kinases PI3K, JNK and ERK participated to the enhancing effect of B[a]P on IL-22 production, whereas p38 MAP kinase had an inhibitory effect.The second part of the thesis evaluated the co-stimulatory effect of combined PRR- and allergen-activated DCs on Th17/Th22 polarization in healthy and asthmatic subjects. Dog allergen stimulated DCs induced a small production of IL-22 in T cells. Additional activation by TLR3, TLR9 and NOD2 ligands led to increased production of pro-Th2 chemokines by DCs only from asthmatic patients allergic to dogs. In contrast, an adjuvant role was observed on the maturation and pro-Th17/Th22 cytokines production by DCs from both asthmatic and non-allergic subjects. In T cells co-cultured with DCs stimulated by dog allergen and PRR ligands, we found a mixed Th2/Th17/Th22 profile in asthmatic patients and a Th1/Th22 profile in non-allergic subjects. IL-22 producing cells were mainly Th22 in both groups with more Th22 cells were observed in asthmatic subjects. IL-17 and IL-22 production was9differently regulated between asthmatic subjects and non-allergic subjects, TGF-β having a pro-Th17 role while IL-23 having a pro-Th22 role.In vivo, a model of chronic dog-induced asthma was developed leading increased airway resistance, Th2 chemokine and Th2/Th17/Th22 cytokine production as well as neutrophil but little eosinophil recruitment in the lung. Gene expression of IL-22 was observed at early time points whereas IL-22 protein appeared later on. NOD2 ligand further increased airway resistance, protein production and gene expression induced by dog allergen challenge but inhibited the small eosinophil recruitment in the lung.These results show that in humans, IL-17 and IL-22 productions are regulated differently between allergic asthmatic and non-allergic subjects. Altogether, pollution and some bacterial or viral infections may contribute in asthmatic patients to the severity of the disease and to progression of airway remodeling. The developed in vivo model will allow dissecting the mechanisms participating to the severity of asthma.

Charles University, Faculty of Pharmacy in Hradec Králové Department of Pharmacognosy Supervisor: doc. PharmDr. Lenka Tůmová, CSc. Student: Vendula Rapiová Title of Thesis: Natural substances with toxic and allergic activity Keywords: medicinal plant, allergy, side effects, toxicity The connection between herbs and mankind dates to early ages and without discussion herbal remedies were the first one to put in use. We observe significant increase of herbal remedies used in paediatric patients in last decades. The goal of this work was set to examine available information about herbal safety. The list of herbs that are dangerous or inappropriate to use in children age was made. The herbs were grouped into simple classification system of herbal safety. In addition to chapters describing herbal safety the work contains knowledge about their general use in paediatrics phytotherapy, the pros and cons of their use. To gather the data of web research and scientific literature were employed. The analysed data were published between 1968-2017 and were collected using PubMed, ScienceDirect and Google Scholar. The rate of herbal safety is classified into five specific groups - A, B, C, S and X. The analysis of results shows that the biggest group with the most represented samples in class was the class C with...

In this research, beta-lactoglobulin was chemically modified by attaching different levels of stearic acid to the protein. The effect of this modification on hydrophobic!ty, emulsifying and foam properties, digestibility and allergenicity of the protein was investigated. It was found that the effect of fatty acid attachment or lipophilization depended on the amount of fatty acids attached to the protein. Incorporation of the hydrophobic ligands led to increased hydrophobic interactions, resulting in a decreasing solubility with extent of incorporation. Furthermore, the surface hydrophobicity measurements showed that the two fluorescence probes 8-anilinonaphthalene-l-sulfonate (ANS) and cis-parinaric acid (CPA) used for the surface hydrophobicity measurements were not equivalent This may support the. observation by earlier workers that ANS measures aromatic hydrophobicity and CPA aliphatic hydrophobicity. The studies on surface functional properties i.e. emulsifying and foaming properties, indicated that there was some improvement in these functional properties at low and medium levels of incorporation which decreased as the extent of fatty acid attachment further increased. The improvement, of these functional properties could be attributed to improved amphiphilicity of the proteins at these levels of incorporation. This research also showed that both high solubility and high ANS surface hydrophobicity is needed for the best emulsifying properties. In vitro digestibility studies showed a decrease in digestibility of the modified proteins with increased lipophilization. From the passive cutaneous anaphylaxis experiments, it was found that the level of fatty acid attachment to the protein had a significant effect on its ability to elicit IgE antibodies. Increased ability to elicit IgE antibodies was observed at a low level of fatty acid. When a medium level of fatty acid was attached the ability to elicit antibodies was reduced and almost completely destroyed when a higher level of fatty acid was incorporated. The above observations could be explained by the fact that the low level incorporation of fatty acid led to changes in the protein structure which exposed more allergenic sites. The almost complete destruction of the allergenicity could be attributed to denaturation of the protein which reduced or destroyed available allergenic sites. The antigenicity or binding of the modified proteins to the IgG antibodies raised against the native protein was studied by both direct and competitive enzyme linked immunosorbent assay. It was found that at low and medium levels of incorporation, the proteins demonstrated increased binding ability compared to the native protein. This was attributed to the increased exposure of antigenic sites on the protein with fatty acid incorporation. However, the protein with high level of incorporated fatty acid showed decreased binding ability. / Land and Food Systems, Faculty of / Graduate

<p>While drug-loaded biodegradable polymer microparticles have found many therapeutic applications, bulk manufacturing methods produce heterogeneous populations of particles. A more highly controlled manufacturing method may provide the ability improve the microparticle characteristics such as the drug release profile. Microfluidic droplet-makers manipulate liquids on the scale of tens of microns and can produce highly regular and controlled emulsions. However, microfluidic droplet manufacturing is not typically designed for clinical translation and the chemicals used are often not biocompatible.</p><p>I developed a two-chip PDMS-based microfluidic device that can manufacture PLGA microparticle loaded with hydrophilic or hydrophobic drugs. I characterized protein-loaded microparticles made using this device and compared them with bulk-generated microparticles. The microfluidics-generated microparticles had similar release curves and encapsulation efficiencies as bulk-generated microparticles but a much narrower size distribution. I generated peanut protein-loaded microparticles with this device and tested them in a mouse model of peanut allergy, improving the particles as the project evolved to have a higher loading level and lower burst release. The microparticles improved the safety and efficacy of an immunotherapy protocol. I also encapsulated hydrophilic and hydrophobic chemotherapeutic drugs for a brain cancer model.</p> / Dissertation

Asma alérgica é uma inflamação pulmonar crônica mediada por células Th2. A Hipótese da Higiene é a teoria aceita para explicar o aumento das alergias nas últimas décadas e preconiza que a menor exposição dos indivíduos a componentes microbianos prejudica a geração mecanismos imunorregulatórios. Nosso estudo abordou a modulação da resposta alérgica pulmonar induzida por ovalbumina, por cepas de bacilo Calmette-Guérin recombinantes (rBCG) que expressam fragmentos de toxinas bacterianas. Observamos que dependendo do antígeno heterólogo expresso, a imunização intranasal com rBCG pode levar tanto a supressão como a exacerbação da resposta alérgica pulmonar. Demonstramos que tanto em um contexto profilático quanto terapêutico, rBCG é capaz de suprimir os parâmetros alérgicos, e a supressão não envolve o recrutamento de células T regulatórias, é um fenômeno local, está associada a maior produção de IFN-g do que IL-4 e é dependente de IL-12. Estes dados sugerem que a infecção pulmonar por rBCG gera um milieu capaz de bloquear a migração de células Th2 inflamatórias. / Allergic asthma is an atopic disorder mediated by Th2 cells. The Hygiene Hypothesis is the accepted theory to explain the increasing in allergy in recent deacades. It states that modern health care and hygiene practices have led to a reduced exposure to microorganisms components which impairs the generation of immunoregulatory mechanisms. The present study analysed how the intranasal infection with recombinant bacillus Calmette-Guérin (rBCG) strains expressing fragments of bacterial toxins could modulate an allergic pulmonary inflammation induced by ovalbumin. We demonstrated that the rBCG strains could supress or exacerbate the allergic inflammation depending on the expressed heterologous antigen. We analysed the effect of the mycobacterial infection in a prophylactic and in a therapeutical contexts, and we have identified that for both situations the of supression allergic features does not involve the recruitment of regulatory T cells to the lungs, is a local phenomena, is associated with an increased production of IFN-g, and is an IL-12 dependent mechanism. Taken togheter, this data suggest that the rBCG pulmonary infection generates a milieu capable to supress the chemotaxis for Th2 cells, which suppress the establishment of the allergic inflammation in the lungs.

La confirmation d’une hypersensibilité médicamenteuse est importante car la plupart des cas allégués ne sont pas confirmés. Le diagnostic repose sur l’interrogatoire et le bilan allergologique, ce dernier comprenant surtout des tests in vivo. Ces tests ne sont pas dénués de risque. Ce travail se propose de répondre avec une méthodologie originale (pour le domaine de l’hypersensibilité médicamenteuse), à des questions en suspens visant la nécessité, les modalités et l’utilité du bilan allergologique, en prenant principalement mais pas exclusivement le modèle des hypersensibilités aux ß-lactamines. J’ai utilisé plusieurs approches méthodologiques, appliquées à une large base de données d’hypersensibilités médicamenteuses. Dans un premier temps, j’ai exploité les données cliniques rétrospectives afin de construire 2 modèles de diagnostic d’hypersensibilité aux ß-lactamines et j’ai ensuite testé leurs performances diagnostiques sur un échantillon prospectif de patients. Les modèles atteignent globalement une sensibilité de 50%, ce qui est difficilement acceptable, dans un contexte iatrogénique. Secondairement, j’ai réalisé le passage des protocoles de tests de provocation aux ß-lactamines, d’une étape avec paliers purement empiriques, à un protocole basé sur des données issues d’une analyse de survie. Autres 3 articles ont suivi une méthodologie similaire : les patients ayant eu un bilan allergologique négatif pour un médicament donné ont été re-contactés et interrogés au moyen d’un questionnaire. Le service rendu au patient a été calculé par le taux de patients ayant repris (sans réaction) le médicament autorisé (plus de 90% pour 3 classes médicamenteuses analysées). / Most alleged cases of hypersensitivity reactions following drug administration are actually ruled out by drug allergy work up. The diagnosis is based on clinical history and allergy tests, mainly in vivo tests. These tests carry a considerable risk of iatrogeny. The purpose of this thesis was to address some unmet needs regarding the need, technical aspects and utility of the drug allergy work up, using an original methodology applied to the drug hypersensitivity field. It focuses mainly (but not only) on drug hypersensitivity reactions to ß-lactams. I used different statistical methods, applied to a large database, the Drug Allergy and Hypersensitivity Database. First (Article 1), I used retrospective clinical data to build 2 models for ß-lactam hypersensitivity diagnosis. I then tested these models on a prospective sample, in order to analyze their diagnostic performances. The overall sensitivity of the 2 models is around 50%, which is unacceptable in an iatrogenic context. Second (Article 2), I worked on empirical protocols of drug provocation tests and I identified steps for data-driven, evidence-based protocols by means of survival analysis. The Articles 3, 4 and 5 were conceived following a similar methodology: patients with a negative drug allergy work-up for a certain drug were called and questioned on whether they had been exposed to this same drug, following allergy tests. High negative predictive values of these tests, with more than 90% of patients tolerating subsequent administration without any hypersensitivity reaction, were obtained for 3 different drug classes.

Les pénicillines font partie des molécules chimiques les plus fréquemment impliquées dans l’allergie médicamenteuse. Selon l’hypothèse de l’haptène, les molécules chimiques de petite taille doivent se lier aux protéines pour êtres immunogènes. Cependant, très peu est connu sur le processus d’immunisation des patients aux bioconjugués pénicilline-protéine. Notre groupe a récemment synthétisé des bioconjugués albumine sérique humaine-benzylpénicilline (HSA-BP) et a démontré l'existence de lymphocytes T CD4+ naïfs spécifiques du bioconjugué HSA-BP chez des donneurs sains. L'objectif de ce travail de thèse est d'identifier des séquences peptidiques issus de la HSA hapténisées avec la BP, impliquées dans l’activation des cellules T naïves ainsi que l’immunisation des patients allergiques et par conséquent les manifestations cliniques. Notre stratégie combine la spectrométrie de masse, la modélisation moléculaire et le criblage virtuel, la synthèse chimique orientée et la validation biologique sur des lignées de cellules T de longues durées chez les donneurs sains, et à l’aide du test de transformation lymphocytaire ainsi que les lignées de cellules T de courte durée chez les patients allergiques. Cette étude a permis: (1) l’identification des résidus lysine présents sur la HSA hapténisés par la BP par spectrométrie de masse, (2) la sélection par une approche in silico des peptides de 15-mer potentiellement immunogènes, (3) la synthèse orientée de ces peptides-BP à l’aide d’un monomère lysine-BP, (4) l’identification des épitopes reconnus par les cellules T naïves de donneurs sains, (5) la validation de deux épitopes situés sur les lysines 159 et 525 chez les patients allergiques aux pénicillines et (6) confirmation de la HSA comme un bon modèle pour l’hapténisation de la BP. / Penicillins are among the most prevalent drug-inducing allergy. According to the hapten hypothesis small chemical molecules needs to bind to proteins to be immunogenic. However, little is known on the process of patients immunization to penicillin-protein conjugates. Our group has recently synthesized benzylpenicillin-human serum albumin (BP-HSA) bioconjugate and demonstrated the existence of naïve CD4+ T lymphocytes specific to BP-HSA in healthy donors. The objective of this work was to identify peptides sequences from HSA haptenized with BP involved in naïve T-cells activation, immunization of patients and consequently the clinical manifestations. Our strategy combines mass spectrometry, molecular modeling and virtual screening, chemical oriented synthesis and biological validation using long-term T-cell lines in healthy donors and the lymphocyte transformation test as well as short-term T-cell lines in allergic patients. This study allowed: (1) the identification of lysine residues involved in the BP binding to HSA using mass spectrometry, (2) the selection of BP-peptides containing the lysine residues likely to induce immune response using an in silico approach, (3) the synthesis of the selected BP-15 mer peptide bioconjugates using a lysine-BP monomer, (4) the identification of epitopes recognized by naïve T cells from healthy donors, (5) the validation of two epitopes located on lysines 159 and 525 in allergic patients to penicillins and (6) the confirmation of HSA as a good model for BP haptenation.

京都大学 / 0048 / 新制・論文博士 / 博士(農学) / 乙第13346号 / 論農博第2889号 / 新制||農||1080(附属図書館) / 学位論文||R2||N5253(農学部図書室) / 京都大学大学院農学研究科応用生物科学専攻 / (主査)教授 菅原 達也, 教授 佐藤 健司, 教授 澤山 茂樹 / 学位規則第4条第2項該当 / Doctor of Agricultural Science / Kyoto University / DGAM