A Artrite Reumatóide (AR) é uma artropatia autoimune multifatorial com etiologia desconhecida que afeta aproximadamente 1% da população adulta. A estratégia padrão para o tratamento da AR consiste na administração de baixas doses de Metotrexato (MTX), cujo efeito anti-inflamatório está relacionado com a manutenção dos níveis elevados de adenosina (ADO) extracelular. No entanto, uma parte considerável dos pacientes com AR é refratária ao tratamento com MTX e o mecanismo pelo qual este fenômeno ocorre ainda não está totalmente esclarecido. Neste contexto, o presente estudo descreveu que a eficácia terapêutica ao MTX está associada com a expressão em células Tregs da ectoenzima CD39, cuja função biológica é a geração de ADO extracelular via metabolização do ATP. Especificamente, através da realização de um estudo longitudinal, observamos que pacientes respondedores ao MTX (R-MTX) apresentam uma expansão de células Tregs circulantes expressando CD39 após o tratamento com MTX. Por outro lado, identificamos que pacientes não respondedores ao MTX (UR-MTX) possuem uma redução da expressão de CD39 em células Tregs, o que culmina em um comprometimento das suas funções supressoras. Ainda, demonstramos que a expressão de CD39 em células Tregs é um biomarcador apto em predizer a resposta terapêutica ao MTX, visto que pacientes UR-MTX apresentam uma expressão reduzida de CD39 em Tregs mesmo antes do início do tratamento com MTX. Posteriormente, nós investigamos as bases moleculares que acarretam na expressão reduzida de CD39 observada em células Tregs de pacientes URMTX. Demonstramos que a estimulação com TGF-? tanto em células Tregs isoladas quanto diferenciadas in vitro aumenta a expressão de CD39 através da ativação sequencial da seguinte plataforma molecular: receptores de TGF-? (TGFBRII e TGFBRI), transdutor de sinal SMAD2, fator de transcrição CREB, de modo dependente da atividade de p38. Uma vez identificada a via envolvida com a indução da expressão de CD39, demonstramos que células Tregs diferenciadas de indivíduos que apresentam uma expressão reduzida de CD39 são incapazes de induzir a expressão desta ectoenzima através da estimulação com TGF-?. Por fim, transpondo nossos achados para pacientes com AR, observamos que pacientes UR-MTX apresentam uma redução nos níveis de RNAm para TGFBRII e CREB bem como também uma redução das proteínas fosforiladas SMAD2 e CREB em células CD4+ e Tregs, sugerindo que o comprometimento na cascata de sinalização de TGF-?, envolvida com a indução da expressão de CD39 em células Tregs, está associado com a resistência ao MTX. / Rheumatoid arthritis (RA) is an autoimmune multifactorial arthropathy with unknown etiology that affects approximately 1% of the adult population. The standard strategy for RA treatment comprises the administration of low doses of methotrexate (MTX), whose antiinflammatory effects are associated with maintenance of high levels of extracellular adenosine (ADO). However, a considerable proportion of RA patients is resistant to MTX treatment and the mechanisms underlying this phenomenon occurs is poorly understood. Within this context, the present study showed that therapeutic efficacy of MTX is associated with expression on Treg cells of the ectoenzyme CD39, whose function is related to the generation of extracellular ADO by ATP metabolism. Specifically, we conducted a longitudinal study and observed that responsive patients to MTX (R-MTX) exhibit an increase in the frequency of circulating Treg cells expressing CD39 after MTX treatment. On the other hand, we found that non-responsive patients to MTX (UR-MTX) have a reduction of CD39 expression on Treg cells, which culminates in an impairment of Treg function. Furthermore, these findings indicate that CD39 expression on Treg cells is a biomarker for therapeutic response to MTX, since UR-MTX patients had a depressed CD39 expression on Treg cells even before MTX treatment. Subsequently, the present study investigated the molecular mechanisms that would cause the reduction of CD39 expression on Treg cells from UR-MTX patients. For this, we demonstrated that TGF-? stimulation increases CD39 expression in isolated and in vitro differentiated Treg cells through participation/activation of the following molecules: receptors of TGF-?, TGFBRII and TGFBRI, signal transducer SMAD2 and transcription factor CREB, through p38 activity dependent-manner. Once identified these molecules involved with CD39 induction, we demonstrated that differentiated Treg cells from healthy individuals with an intrinsic reduction of CD39 expression on circulating Treg cells are unable to increase CD39 expression by TGF-? stimulation. Transposing our findings to RA patients, we found that UR-MTX patients exhibit a reduction of mRNA for TGFBRII and CREB as well as reduction on levels of phospho-SMAD2 and phospho-CREB in CD4+ and Treg cells, suggesting that an impairment in TGF-? signaling pathway, related to induction of CD39 expression on Treg cells, is associated with MTX resistance.

Suivant la tendance de la coopération internationale, la recherche comparative entre les cultures devient de plus en plus importante. Dans la mesure où la sinologie et la culture de l’Occident se croisent sur certains points de vue notamment autour de la philosophie politique de Derrida fondée sur la recherche du terme d’amitié. Face à la violence politique au nom de la justice, de la démocratie ou des droit de l’homme, Derrida énonce que c’est la politique actuelle est dominée par la maladie auto-immunitaire, par laquelle la démocratie s’enferme à l’intérieur du territoire de l’Etat, dans la mesure où l’authenticité de la démocratie, à savoir la démocratie universelle n’est pas encore présente. Considérant que les réformes dans le cadre de la politique n’aident pas à résoudre l’auto-immunité, Derrida pense qu’il nous faut retourner à l’idéologie en repensant le terme d’amitié en tant que racine des relations humaines en société, dans le but d’accéder à l’idée de l’hospitalité inconditionnelle et par conséquent à la démocratie universelle. C’est aussi pourquoi Derrida commence sa recherche de la philosophie politique à partir du terme d’amitié. En ce sens, Derrida traite de l’amitié canonique dans l’histoire occidentale, à savoir l’amitié antique, l’amitié chrétienne et l’amitié rationaliste, en aboutissant à la conclusion que l’amitié canonique de l’Occident favorise le même en supprimant la différence, dans la mesure où la consanguinité, la frontière jouent un rôle fondamental tout au long de l’histoire occidentale, ce qui détermine la démocratie conditionnelle fondée sur la souveraineté de l’Etat-nation. Cette manière de partir de l’amitié existe également dans le Confucianisme en tant qu’essentiel de la culture sinologique traditionnelle. Car l’image de frère, à savoir la consanguinité persiste tout au long de l’histoire sinologique en tant qu’axe, dans la mesure où les structures du clan et de la famille monopolisent la politique féodale de la Chine. Ce qui nous permet de constater la similarité plutôt que la divergence entre les cultures. De plus, face à l’amitié fondée sur la consanguinité et la frontière, Derrida propose une nouvelle sorte d’amitié qui offre l’hospitalité inconditionnelle dans le but de supprimer l’auto-immunité politique en aboutissant à « la démocratie à venir », bien que son infini absolu provoque un écart entre l’idéologie et la pratique. Nous constatons en effet l’amour universel de Mo Tzu dans la culture sinologique traditionnelle correspondant à l’amitié de Derrida qui se détache de la consanguinité, par laquelle, la société « Da-Tong » qui implique la démocratie universelle se présente toujours comme la société idéale dans l’histoire de la Chine. Cela risque de provoquer aussi un écart entre l’idéologie et la politique pratique, dans la mesure où les deux cultures se croisent plutôt qu’elles ne divergent. Cette étude vise, par la mise en regard entre les cultures, à clarifier la transition de la politique à la morale, dans le but de traiter de « la démocratie à venir » et la société « Da-Tong » avec une attitude objective face à la critique de l’Utopie. Au cours de cette étude nous constaterons que la conversation entre les cultures devient de plus en plus importante sous le cosmopolitisme universel. / Following the trend of international cooperation, comparative research across cultures becomes increasingly important. Consequently Sinology and Western culture could intersect at certain points of view, particularly around Derrida’s political philosophy research based on the term friendship. Faced with political violence in the name of justice, democracy or human rights, Derrida states that the current policy is dominated by the disease of “autoimmunity”, by which democracy is locked to the within the territory of the State. So the universal democracy as the authenticity of democracy is not yet present. Considering that the reforms in the policy framework does not help to solve the “autoimmunity”, Derrida believes that we should return to the ideology by reflecting the term friendship as the root of human relations in society, in order to access the idea of the unconditional hospitality and therefore the universal democracy. This is why Derrida begins his research of political philosophy from the term friendship. In this sense, Derrida discusses the canonical friendship, namely the ancient friendship, Christian friendship and rationale friendship, in the western history, in concluding that the canonical friendship of the Western history favors the sameness by eliminating the difference, as far as the consanguinity, the frontier play a foundational rule throughout the Western history, which determines the conditional democracy based on the sovereignty of the nation-state. This way of beginning from the friendship exists also in Confucianism which acts as the essential of sinology, because of the image of brother, in other words the consanguinity persists throughout the sinological history as an axis, and in terms of structures of clan and family which monopolize the feudal politics of China. This allows us to note the similarities rather than the differences between the two cultures. In addition, face to the friendship based on consanguinity and the frontier, Derrida proposes a new way of friendship which contains the unconditional hospitality, in order to suppress the disease of autoimmunity, then lead to "democracy to come", even if it might causes a gap between ideology and political practice. Indeed, the “universal love” exists also in sinological history, for example in the theory of Mo Tzu. By which the society "Da-Tong" implying a universal democracy is always presented as the ideal society in the history of China. This may also make a gap between ideology and practical politics regarding the two cultures intersect instead of diverging. Face to the critiques concerning Utopia of "democracy to come" and the society "Da-Tong", this study aims at the confrontation between cultures, the transition between politics and ethics, in order to deal with these concepts with an objective attitude. In this process of comparative research we find that the conversation between cultures becomes increasingly important in universal cosmopolitanism.

A Artrite Reumatóide (AR) é uma artropatia autoimune multifatorial com etiologia desconhecida que afeta aproximadamente 1% da população adulta. A estratégia padrão para o tratamento da AR consiste na administração de baixas doses de Metotrexato (MTX), cujo efeito anti-inflamatório está relacionado com a manutenção dos níveis elevados de adenosina (ADO) extracelular. No entanto, uma parte considerável dos pacientes com AR é refratária ao tratamento com MTX e o mecanismo pelo qual este fenômeno ocorre ainda não está totalmente esclarecido. Neste contexto, o presente estudo descreveu que a eficácia terapêutica ao MTX está associada com a expressão em células Tregs da ectoenzima CD39, cuja função biológica é a geração de ADO extracelular via metabolização do ATP. Especificamente, através da realização de um estudo longitudinal, observamos que pacientes respondedores ao MTX (R-MTX) apresentam uma expansão de células Tregs circulantes expressando CD39 após o tratamento com MTX. Por outro lado, identificamos que pacientes não respondedores ao MTX (UR-MTX) possuem uma redução da expressão de CD39 em células Tregs, o que culmina em um comprometimento das suas funções supressoras. Ainda, demonstramos que a expressão de CD39 em células Tregs é um biomarcador apto em predizer a resposta terapêutica ao MTX, visto que pacientes UR-MTX apresentam uma expressão reduzida de CD39 em Tregs mesmo antes do início do tratamento com MTX. Posteriormente, nós investigamos as bases moleculares que acarretam na expressão reduzida de CD39 observada em células Tregs de pacientes URMTX. Demonstramos que a estimulação com TGF-? tanto em células Tregs isoladas quanto diferenciadas in vitro aumenta a expressão de CD39 através da ativação sequencial da seguinte plataforma molecular: receptores de TGF-? (TGFBRII e TGFBRI), transdutor de sinal SMAD2, fator de transcrição CREB, de modo dependente da atividade de p38. Uma vez identificada a via envolvida com a indução da expressão de CD39, demonstramos que células Tregs diferenciadas de indivíduos que apresentam uma expressão reduzida de CD39 são incapazes de induzir a expressão desta ectoenzima através da estimulação com TGF-?. Por fim, transpondo nossos achados para pacientes com AR, observamos que pacientes UR-MTX apresentam uma redução nos níveis de RNAm para TGFBRII e CREB bem como também uma redução das proteínas fosforiladas SMAD2 e CREB em células CD4+ e Tregs, sugerindo que o comprometimento na cascata de sinalização de TGF-?, envolvida com a indução da expressão de CD39 em células Tregs, está associado com a resistência ao MTX. / Rheumatoid arthritis (RA) is an autoimmune multifactorial arthropathy with unknown etiology that affects approximately 1% of the adult population. The standard strategy for RA treatment comprises the administration of low doses of methotrexate (MTX), whose antiinflammatory effects are associated with maintenance of high levels of extracellular adenosine (ADO). However, a considerable proportion of RA patients is resistant to MTX treatment and the mechanisms underlying this phenomenon occurs is poorly understood. Within this context, the present study showed that therapeutic efficacy of MTX is associated with expression on Treg cells of the ectoenzyme CD39, whose function is related to the generation of extracellular ADO by ATP metabolism. Specifically, we conducted a longitudinal study and observed that responsive patients to MTX (R-MTX) exhibit an increase in the frequency of circulating Treg cells expressing CD39 after MTX treatment. On the other hand, we found that non-responsive patients to MTX (UR-MTX) have a reduction of CD39 expression on Treg cells, which culminates in an impairment of Treg function. Furthermore, these findings indicate that CD39 expression on Treg cells is a biomarker for therapeutic response to MTX, since UR-MTX patients had a depressed CD39 expression on Treg cells even before MTX treatment. Subsequently, the present study investigated the molecular mechanisms that would cause the reduction of CD39 expression on Treg cells from UR-MTX patients. For this, we demonstrated that TGF-? stimulation increases CD39 expression in isolated and in vitro differentiated Treg cells through participation/activation of the following molecules: receptors of TGF-?, TGFBRII and TGFBRI, signal transducer SMAD2 and transcription factor CREB, through p38 activity dependent-manner. Once identified these molecules involved with CD39 induction, we demonstrated that differentiated Treg cells from healthy individuals with an intrinsic reduction of CD39 expression on circulating Treg cells are unable to increase CD39 expression by TGF-? stimulation. Transposing our findings to RA patients, we found that UR-MTX patients exhibit a reduction of mRNA for TGFBRII and CREB as well as reduction on levels of phospho-SMAD2 and phospho-CREB in CD4+ and Treg cells, suggesting that an impairment in TGF-? signaling pathway, related to induction of CD39 expression on Treg cells, is associated with MTX resistance.

L’implication des cellules B dans le développement de l’auto-immunité ne cesse d’être illustrée par de récentes publications. Les cellules présentent des peptides du soi aux cellules T auto-réactives ce qui mène à la production de cytokines pro-inflammatoires et d’anticorps auto-réactifs. Dans le présent document, nous explorons la présentation antigénique et la modification post-traductionnelle du complexe majeur d’histocompatibilité II (CMH-II). MARCH1 est une E3 ubiquitine ligase qui cible le CMH-II et le relocalise le complexe vers les endosomes de recyclage. Ainsi, MARCH1 est un inhibiteur de la présentation d’antigènes exogènes. Ici, nous démontrons que MARCH1 est exprimé seulement dans la sous-population des cellules B folliculaires et que cette expression est perdue lors de l’entrée dans les centres germinatifs. Nous proposons que MARCH1 établie une barrière de formation de centres germinatifs. Nous démontrons le lien entre MARCH1 et la hausse de CMH-II à la surface des cellules B à la suite d’un traitement à l’IL-10. De plus, nous avons testé plusieurs stimuli activateurs des cellules B et démontrons que MARCH1 est régulé à la baisse dans tous les cas. De plus, nous mettons en valeurs le rôle de la voie canonique d’activation de NF-κB dans cette régulation de MARCH1. Finalement, nous avons développé un système de lentivirus exprimant MARCH1 qui nous permet de forcer l’expression de MARCH1 dans des cellules réfractaires à la transfection. Nous discutons de l’implication de cette régulation du CMH-II par MARCH1 dans le développement de maladies auto-immunes. / Increasing evidence suggests a major role for B cells in the onset of auto-immune diseases. B cells present self-antigens to auto-reactive T cells which leads to the production of pro-inflammatory cytokines and auto-immune antibodies. Here we look at the process of antigen presentation and at post-transcriptional modifications of the MHC-II molecule. MARCH1 is an E3 ubiquitin ligase which targets MHC-II and re-localises the complex into recycling endosomes. Thus, MARCH1 is a direct inhibitor of exogenous antigen presentation. Here we show that only follicular B cells express MARCH1 and that upon germinal center entry, these cells lose all traces of MARCH1. We propose that MARCH1 may establish a threshold for germinal center creation. Moreover we demonstrate that the well-established increase in surface MHC-II induced by IL-10 on murine B cells is a result of a decrease in MARCH1 expression. We tested different B cell activation stimuli and showed that upon activation, MARCH1 mRNA is decreased in a time-dependent manner. In addition, we demonstrate the implication of the canonical NF-κB pathway in this regulation. Finally, we developed a lentiviral vector system expressing MARCH1 which enables us to force the expression of our target protein in non-transfectable cell types. We discuss the implication of MARCH1 in the presentation of self-antigens to auto-reactive T cells and the generation of auto-immunity.

No description available.

RÉSUMÉ L’implication des cellules B dans le développement de l’auto-immunité ne cesse d’être illustrée par de récentes publications. Les cellules présentent des peptides du soi aux cellules T auto-réactives ce qui mène à la production de cytokines pro-inflammatoires et d’anticorps auto-réactifs. Dans le présent document, nous explorons la présentation antigénique et la modification post-traductionnelle du complexe majeur d’histocompatibilité II (CMH-II). MARCH1 est une E3 ubiquitine ligase qui cible le CMH-II et le relocalise le complexe vers les endosomes de recyclage. Ainsi, MARCH1 est un inhibiteur de la présentation d’antigènes exogènes. Ici, nous démontrons que MARCH1 est exprimé seulement dans la sous-population des cellules B folliculaires et que cette expression est perdue lors de l’entrée dans les centres germinatifs. Nous proposons que MARCH1 établie une barrière de formation de centres germinatifs. Nous démontrons le lien entre MARCH1 et la hausse de CMH-II à la surface des cellules B à la suite d’un traitement à l’IL-10. De plus, nous avons testé plusieurs stimuli activateurs des cellules B et démontrons que MARCH1 est régulé à la baisse dans tous les cas. De plus, nous mettons en valeurs le rôle de la voie canonique d’activation de NF-κB dans cette régulation de MARCH1. Finalement, nous avons développé un système de lentivirus exprimant MARCH1 qui nous permet de forcer l’expression de MARCH1 dans des cellules réfractaires à la transfection. Nous discutons de l’implication de cette régulation du CMH-II par MARCH1 dans le développement de maladies auto-immunes. / ABSTRACT Increasing evidence suggests a major role for B cells in the onset of auto-immune diseases. B cells present self-antigens to auto-reactive T cells which leads to the production of pro-inflammatory cytokines and auto-immune antibodies. Here we look at the process of antigen presentation and at post-transcriptional modifications of the MHC-II molecule. MARCH1 is an E3 ubiquitin ligase which targets MHC-II and re-localises the complex into recycling endosomes. Thus, MARCH1 is a direct inhibitor of exogenous antigen presentation. Here we show that only follicular B cells express MARCH1 and that upon germinal center entry, these cells lose all traces of MARCH1. We propose that MARCH1 may establish a threshold for germinal center creation. Moreover we demonstrate that the well-established increase in surface MHC-II induced by IL-10 on murine B cells is a result of a decrease in MARCH1 expression. We tested different B cell activation stimuli and showed that upon activation, MARCH1 mRNA is decreased in a time-dependent manner. In addition, we demonstrate the implication of the canonical NF-κB pathway in this regulation. Finally, we developed a lentiviral vector system expressing MARCH1 which enables us to force the expression of our target protein in non-transfectable cell types. We discuss the implication of MARCH1 in the presentation of self-antigens to auto-reactive T cells and the generation of auto-immunity.

La sclérodermie systémique (ScS) est une maladie autoimmune rare qui se caractérise par une fibrose cutanée et parfois pulmonaire. Nous avons tout d’abord évalué le rôle de BAFF, une cytokine impliquée dans le développement des lymphocytes B (LB), dans la fibrose pulmonaire induite par la bléomycine chez la souris. Nous avons démontré que BAFF était augmenté en réponse à la bléomycine et que les souris BAFF-/- ou traitées par le BAFF-R-Ig sont protégées de la fibrose pulmonaire. Ensuite, nous avons évalué si les LB et BAFF pouvaient moduler la production de collagène par des fibroblastes de peau isolés de patients atteints de ScS. Nous avons démontré que les LB augmentent la production de collagène et de cytokines impliquées dans la fibrose cutanée et l’ajout de BAFF augmente cet effet des LB sur les fibroblastes. Enfin, nous avons étudié la régulation de l’expression de BAFF par les microARNs. Nos résultats montrent que les miR-30a*, d* et e* ciblent directement l’ARNm de BAFF. / Systemic sclerosis (SSc) is a rare autoimmune disease characterized by skin fibrosis and occasionally pulmonary fibrosis. We first assessed the role of BAFF, a cytokine involved in B cell maturation, in bleomycin-induced pulmonary fibrosis in mice. We showed that BAFF was increased in response to bleomycin and that BAFF-/- mice or BAFF-R-Igtreated mice are protected from pulmonary fibrosis. Then, we assessed whether B cells and BAFF could regulate collagen production by skin fibroblasts isolated from SSc patients. We demonstrated that B cells increase collagen production and cytokines involved in skin fibrosis. The addition of BAFF increases the effect of B cells on fibroblasts. Lastly, we studied the regulation of BAFF expression by microRNAs. Our results show that miR-30a*, d* and e* directly target the BAFF mRNA.

Les maladies auto-immunes et systémiques sont des maladies sur lequel le champ de la recherche pose son œil de façon appuyée depuis 15 ans, du fait de l’émergence de thérapies biologiques ciblées. Ces pathologies sont volontiers hétérogènes, au mieux de fréquence ou caractéristiques particulières dans les populations d’origine Africaine. La connaissance de l’épidémiologie, et des caractéristiques de ces maladies est un préalable essentiel à la mise en place de recherche plus fondamentale pour aider à décomposer leurs physiopathologies souvent extrêmement complexes. En effet, la comparaison de différences marquées entre deux expressions dans des populations différentes d’une même maladie peut permettre d’aider à en dénouer le fil. Nous proposons dans ce travail une estimation des caractéristiques du lupus cutané et du lupus systémique en Guyane Française qui retrouve une faible fréquence de la maladie, la plus faible jamais retrouvée dans une population subsaharienne. Nous décrivons en Martinique sur le plan épidémiologique comme clinique une forme rare de myosite appelée syndrome des anti-synthétases semblant très particulière, l’épidémiologie et la description de la maladie de Kikuchi-Fujimoto pour la première fois dans la littérature, l’épidémiologie et les caractéristiques à base de population de la maladie de Behcet, des principales vascularites (périartérite noueuse, micropolyangéite, granulomatose éosinophile avec polyangéite, granulomatose avec polyangéite), de l’hypertension pulmonaire des connectivites qui semblent plus fréquentes que chez les Européens. Les néphropathies du lupus systémiques sont décrites dans la population Guadeloupéenne montrant une grande fréquence des néphropathies prolifératives. Le protocole EUROLUPUS qui permet le traitement de ces néphropathies prolifératives du lupus systémique avec de faibles doses de cyclophosphamide et de corticoïdes, est évalué en Martinique sur 30 patients alors qu’il ne l’a jamais été dans une population d’origine Africaine. Il semble y être aussi efficace que chez les patients d’origine Européenne, alors que les néphropathies y ont un pronostic meilleur. La maladie de Sjögren primaire est décrite en Martinique très proche de ce qu’on trouve en Europe sur le plan du tableau clinique et évolutif alors que cela n’est l’objet d’aucune étude dans une population d’origine noire Africaine. Nous avons par ailleurs montré en Martinique l’amélioration de la prise en charge du lupus systémique en Martinique au travers de la régression au fil du temps d’une des complications de la corticothérapie les plus pénibles pour les patients, l’ostéonécrose aseptique. La sclérodermie systémique est décrite à base de population avec épidémiologie dans les deux départements de Guadeloupe et Martinique, montrant des caractéristiques proches de celles retrouvées chez les AfroAméricains. Nous avons aussi montré la fréquence et la gravité des atteintes ORL des myopathies inflammatoires sur ces 2 départements avec une fréquence inhabituelle de certaines maladies auto-immunes dont le lupus systémique et les myosites inflammatoires associées aux anticorps anti-SRP, et l’absence de myosite à inclusion. Au total, nous apportons une somme de connaissance descriptive de ces maladies auto-immunes et systémiques permettant la mise en place de recherches plus fondamentales avec des bases solides par rapport aux profils hétérogènes de ces maladies. / Auto-immunes and systemic diseases are priorities for researchers since 15 years. This is related to the emergence of biological therapies, associated to great efficacy. Although, these diseases are heterogeneous, depending of different parameters such as ethnicity or geography. In the African descent population, we encounter unusual or particular manifestations of these diseases. Also, the knowledge of epidemiology and population based descriptions are crucial to properly initiate works on these populations, but also to understand a particularly complex physiopathology by using differences between populations. We describe in this work the population based characteristics of pure cutaneous lupus and systemic lupus, including an epidemiology of the incidence of the lowest incidence ever found in a population of African heritage. We also describe a population based series of anti-synthetase syndrome, confirming that the presentation is totally different compared to caucasians, and allows in Martinique the incidence, never explored before. We also provide the first evaluation of Kikuchi-Fujimoto disease in a population of African origin, and the first incidence ever realized. We do the same evaluation of the epidemiology of Behcet’s disease in a black origin population that shows that this disease was at a similar frequency in Martinique and in Europe. Micropolyangeitis, polyarteritis, eosinophilic granulomatosis with polyangeitis and Granulomatosis with polyangeitis were evaluated in an epidemiologic study in Martinique, with addition of some cases from other French American region for a more powerful characteristics description. These diseases seem less frequent than in Europe, associated with less severity except for micropolyangeitis. EUROLUPUS, a protocol with low dose IV cyclophosphamide and low dose steroids, used to treat proliferative nephritis of systemic lupus is shown to have the same efficacy in Martinique than in patients of European origin. Primary Sjögren syndrome, evaluated in Martinique, is very similar in expression than what is found in Europe. The decrease overtime of aseptic osteonecrosis, a steroid side effect, is a witness of better control of systemic lupus activity with less usage permitted by protocols and new immunosuppressive drugs such as mycophenolate. Systemic sclerosis is described as very close to African American in a population based study in Martinique and Guadeloupe. We finally show that the rare ENT involvement of idiopathic inflammatory myositis is frequent in our population, associated with poor outcome, and surprisingly frequently related to systemic lupus and necrotizing myositis associated to SRP antibody but not to inclusion body myositis. To conclude, we allow an amount of description of these diseases in our region, including pioneer studies. This works tends to be the basis for studies to be continued in a more fundamental way in our countries.

Le pemphigus est une maladie bulleuse auto-immune sévère causée par des auto- anticorps (Ac) ciblant la desmogléine (Dsg) 1 et/ou 3, principalement de la sous-classe IgG4. Certains Ac non spécifiques à la Dsg ont été décrits, comme la desmocolline 3 (Dsc3), mais leur pertinence est peu connue. Suite à l’étude RITUX3 en 2017, le traitement de première intention du pemphigus est le rituximab (RTX). Ce projet comprend trois volets qui s’inscrivent dans la caractérisation immunologique des patients inclus dans l’étude RITUX3, visant à mieux comprendre la pathogénèse et la prise en charge du pemphigus. Nous avons d’abord étudié la diversité isotypique des Ac anti-Dsg3. Nous avons démontré qu’un nombre d’isotypes plus élevé mène à un risque de rechute, particulièrement l’IgG3 anti-Dsg3 qui était détecté chez 71% des rechuteurs, comparativement à 12% des patients en rémission complète. Ensuite, nous avons étudié la prévalence et la pathogénicité in vitro des Ac anti-Dsc3. Ils étaient détectés chez 21% des patients, soit significativement plus qu’une population de donneurs sains. L’isotype principal était l’IgA, et leur pathogénicité in vitro a été démontrée à partir de sérums de patients et de souris immunisées. La présence de ces Ac permettait d’expliquer une bonne proportion des cas de discordance entre le profil sérologique d’anti-Dsg et le phénotype clinique des patients. Finalement, nous avons étudié la prévalence d’Ac anti-rituximab (ARA) chez les patients traités par RTX. Ils étaient détectés chez 31% des patients, mais n’affectaient pas l’atteinte d’une rémission complète et ne seraient pas une contre-indication à des perfusions subséquentes. Par contre, un petit groupe de patients qui présentaient des ARA fonctionnels étaient à risque de rechute. / Pemphigus is a severe auto-immune blistering disease caused by auto-antibodies (Abs) targeting desmoglein (Dsg) 1 and/or 3, mainly of the IgG4 subclass. Several Abs non-specific to the Dsg have been described, including desmocollin (Dsc) 3, but their relevance is not well known. Since the RITUX3 clinical trial in 2017, rituximab (RTX) is recommended as the first-line treatment for moderate-to-severe pemphigus. This project consists of three parts with the main goal of immunologically characterizing patients who were included in the RITUX3 trial, to allow a better understanding of the pathogenesis and treatment of pemphigus. First, we studied the diversity of IgG anti-Dsg3 subclasses. A higher number of subclasses was associated with a significant risk of relapse, especially with IgG3 anti-Dsg3 detected in 71% of relapsing patients, compared to 12% of patients in complete remission. Then, we studied the prevalence and pathogenicity of anti-Dsc3 Abs. They were detected in 21% of patients, significantly more than healthy donors. The main isotype was IgA, and their in vitro pathogenicity was demonstrated with sera from patients and immunized mice. Their presence explained a good proportion of cases who presented discrepancies between the clinical phenotype and the serological profile of anti-Dsg Abs. Finally, we studied the prevalence of anti-RTX Abs (ARA) in patients treated with RTX. They were detected in 31% of patients but did not affect the rate of complete remission and are not a contra-indication to receive subsequent perfusions. However, a small group of patients who presented functional ARA were at risk of relapse.