O desenvolvimento de imunidade naturalmente adquirida na malária é lento e depende de fatores como o número de malárias prévias, intervalo entre cada malária, exposição a variantes antigênicas múltiplas e idade do indivíduo. Mecanismos imunes efetores dependentes de anticorpos são importantes no desenvolvimento dessa imunidade. Vários estudos têm mostrado que as subclasses IgG1 e IgG3 anti-P. falciparum, conhecidas por sua ação citofílica, são anticorpos protetores, enquanto anticorpos não citofílicos como IgG4 reconhecendo os mesmos epítopos seriam bloqueadores dos mecanismos protetores. Dados recentes sugerem que sob determinadas condições, IgG2 também pode ter ação citoíflica e participar da proteção na malária. Neste trabalho, nós estudamos pela primeira vez, a evolução das subclasses de IgG contra formas eritrocitárias de P. falciparum de pacientes com malária falciparum não complicada internados em hospital por até 42 dias, sob tratamento com mefloquina. As subclasses de IgG foram avaliadas por ELISA em 48 pacientes (7 amostras de soro de cada um colhidas nos tempos 0h, 48h, 7, 14, 28, 35 e 42 dias), quanto à quantidade (concentração, ug/ml; índices de reatividade, IR; ou em freqüência, %) e quanto à avidez dos anticorpos (índice de avidez, IA). Amostras de soro de 14 pacientes (tempos: 0, 48h, 7, 21 e 28 dias) também foram avaliadas quanto à especificidade e a avidez de reconhecimento das diferentes bandas protéicas do antígeno de P. falciparum por Immunoblotting. As subclasses IgG1, IgG2, IgG3 e IgG4 anti-P. falciparum, na maioria de alta avidez, estavam presentes no início do tratamento, respectivamente, em 100%, 39,5%, 80,6% e 28,4% dos pacientes e com concentrações médias de 20, 2; 3,8; 1,5 e 0,05 ?g/mL. As concentrações máximas das subclasses de IgG foram alcançadas no 7o dia, e os IAs máximos de IgG1 e IgG3 foram alcançados no 7o dia, e os de IgG2 no 14o dia e os de IgG4 no 2o dia. A concentração inicial dos anticorpos IgG3 anti-P. falciparum apresentou correlação negativa com o tempo de clareamento parasitário (TCP) e a relação das somas dos anticorpos IgG1, IgG2 e IgG3 pelos níveis de IgG4 se correlacionaram negativamente com a parasitemia inicial. No Immunoblotting, foram identificadas frações protéicas que podem estar relacionadas com o reconhecimento imune protetor, por serem reconhecidas pelas subclasses IgG1, IgG2 e IgG3 e não reconhecidas ou reconhecidas tardiamente por IgG4: 125, 96, 86, 75, 55 e 47 kDa. A resposta predominante das subclasses IgG1, IgG2 e IgG3 observada nestes pacientes, todos com malária não complicada, pode indicar que esses anticorpos estão cooperando para o controle de formas graves da doença e refletirem um certo grau de desenvolvimento de imunidade adquirida / The development of naturally acquired immunity to malaria is slow and depends of several factors as number of previous malaria, interval between each malaria attack, exposure to parasite multiple antigen variant and ageassociated maturation of the immune system. Antibody-dependent effector immune mechanisms are believed to be important to the protective immunity. A number of studies have showed that anti-P. falciparum IgG1 and IG3, named cytophilic antibodies, are protective, whereas the noncytophilic, IgG4, that recognize the same epitopes may block the protective mechanisms. Recent data have suggested that in certain situations, IgG2 can also act as cytophilic and to cooperate in protection. In this work, we have studied, for the first time, the evolution of the IgG subclasses against P. falciparum blood stages in uncomplicated falciparum malaria patients taken into hospital upon mefloquine treatment and followed up 42 days. These antibodies were determined by ELISA in 48 patients (7 serum samples from each patient collected in different times: 0h, 48h, 7, 14, 28, 35 and 42 days). The results were expressed in concentration (ug/ml), index of reactivity (IR) or frequency (%) and the avidity were expressed as index of avidity (IA). Serum samples 14 patients (time of collection: 0, 48h, 7, 21 and 42 days) were also evaluated by Immunoblotting as their specificity and avidity against different proteins of the P. falciparum blood stages The subclasses Anti-P. falciparum IgG1, IgG2, IgG3 and IgG4, high avidity predominantly, were present since the beginning of the treatment, respectively, in 100%, 39,5%, 80,6% and 28,4% of the patients with the following concentrations: 20, 2; 3,8; 1,5 and 0,05 ?g/mL. The highest concentrations were reached at day 7, and IgG1 and the highest IgG3 IAs were reached at day 7, and the highest IgG2 IAs at day 14 and the highest IgG4 IAs at day 2. The initial concentration of anti-P. falciparum IgG3 showed a negative correlation with the parasitemia clearance time (PCT) and the ratio between the sum of IgG1, IgG2 and IgG3 levels to IgG4 levels was negatively correlated with the initial parasitemia. Six protein fractions were identified by the Immunoblotting that can be related to protective immune recognition, because they were recognized by IgG1, IgG2 and IgG3 antibodies and not or only later recognized by IgG4 antibodies: 125, 96, 86, 75, 55 and 47 kDa. The predominant IgG1, IgG2 and IgG3 responses observed in these uncomplicated malaria patients may suggest that these antibodies are cooperating to the control of severe disease and reflecting a certain development of protective immunity

Osteoporosis and fragility fractures are recognized complications of inflammatory rheumatic diseases. This is thought to result from the effects of chronic inflammation, relative immobility and corticosteroid use. A rare syndrome of osteoporosis in a patient with coeliac disease has been described which results from production of neutralizing antibodies to the bone protective protein osteoprotegerin (OPG). The aim of my thesis is to evaluate prevalence and clinical predictors of osteoporosis in a contemporary cohort of patients with rheumatoid arthritis (RA) and to investigate the role of OPG autoantibodies in the pathogenesis of osteoporosis in rheumatic diseases. In a retrospective cohort study, I found that the overall prevalence of osteoporosis in patients with RA was 29.9% which is in keeping with older reports that recorded a prevalence rate between 17% and 36%. In our contemporary cohort osteoporosis was significantly more common than in a gender and age matched control cohort (17.4%). Further analysis showed that only age and BMI were independent predictors of osteoporosis in RA. A predictive tool based on age and BMI was developed which had 91.4% sensitivity for the detection of osteoporosis in an independent RA population. I went on to screen for the presence of autoantibodies to OPG in patients with various rheumatic diseases. In a study of 75 patients with rheumatoid arthritis and 199 healthy controls OPG autoantibodies were detected in two controls (1%) compared with seven patients with RA (9.3%). The RA patients with detectable OPG antibodies had a longer disease duration, higher DAS28 scores and higher levels of the bone resorption marker CTX than RA patients who did not have autoantibodies. Purified IgG from patients with high levels of OPG antibodies blocked the ability of recombinant OPG to inhibit RANKL induced NFκB activation in a HEK293 cell based assay indicating that they were functional. In a further study of 134 patients with ankylosing spondylitis (AS), 16 patients (11.9%) had detectable OPG antibodies. The presence of OPG-Ab was independently associated with reduced hip bone mineral density and an increased risk of fractures in this population. In patients with a longer disease duration we have also observed that there was a higher discrepancy between spinal and hip BMD in OPG-Ab positive patients compared with OPG ab negative patients (p=0.003). In order to investigate if OPG antibodies affected measurement of serum RANKL concentrations as detected by ELISA using OPG as the capture reagent, I measured OPG ab and free RANKL concentrations in 55 rheumatic disease patients. Surprisingly there was a significant positive correlation between free RANKL and OPG Ab concentrations (r=0.430, p=0.001) which was the opposite to what I had expected. These findings reject the hypothesis that OPG ab block binding of synthetic OPG to RANKL in the ELISA. In conclusion, I have shown that osteoporosis is a common complication in RA and I have developed a new risk prediction tool for the use in clinical practice. I have also found that OPG antibodies are produced more commonly in patients with RA and AS than in healthy controls and that antibody levels correlate with bone resorption markers in RA and bone mineral density in AS patients. In vitro studies have shown that some OPG antibodies have functional effects on RANKL signalling. These findings raise the possibility that OPG antibodies may contribute to the pathogenesis of local and systemic bone loss in rheumatic diseases and signal the need to study the relationship between these antibodies and bone disease in large-scale longitudinal studies.

Technologies for early detection of tumors is critical for better therapy outcome and overall change in cancer survival. These assays must be capable of detecting tumors at early stages in order to prevent metastasis of the tumor and help reduce mortality. Biological molecules can serve as markers that can indicate the presence of cancerous cells. Current biomarkers approved by the FDA include CA 125, which is a tumor associated antigen (TAA). However, the sensitivities of these TAAs is not high enough to detect at early stages of disease. Recent technologies have found that antibodies that recognize these TAAs, also known as autoantibodies, provide more sensitive means to screen for tumors. This review aims to present recent literature data relative to the field of cancer diagnosis and treatment. However, one should note that this article covers only fraction of the broad science behind this subject.

Systemic lupus erythematosus is an autoinflammatory disorder driven by the development of autoantibodies to self-nucleic acids, in particular to DNA and to chromatin. Loss-of-function mutations of the secreted deoxyribonuclease DNASE1L3 have been implicated in the development of aggressive familial lupus. In addition, recent genome-wide association studies have linked a hypomorphic variant of DNASE1L3 to sporadic lupus. Studies in the lab determined that Dnase1l3-deficient mice develop rapid autoantibody responses against dsDNA and chromatin, and at older ages this leads to a lupus-like inflammatory disease. These disease manifestations were completely independent of the intracellular DNA sensor STING, which has been implicated in other examples of self-DNA driven autoinflammatory diseases. My project focused on developing assays to track the activity of DNASE1L3, as well as identifying the endogenous source of self-DNA normally processed by DNASE1L3. Using mouse models that allow the depletion of specific cell populations, we found that circulating DNASE1L3 is produced by hematopoietic cells, in particular by CD11c+ dendritic cells and by tissue macrophages. Taking into account the unique properties of DNASE1L3, we discovered that this enzyme is uniquely able to digest chromatin contained within and on the surface of apoptotic microparticles. Loss of DNASE1L3 activity in circulation results in elevated levels of DNA in plasma, in particular within microparticles. Microparticles are extensively bound by anti-chromatin autoantibodies isolated from both murine models of lupus as well as prototypical human clones. In addition, Dnase1l3-deficient mice have high levels of circulating IgG that bind to microparticles from young ages, and these titers increased as disease progressed in aged animals. Pretreatment of microparticles with DNASE1L3 largely abrogated this binding, demonstrating that DNASE1L3 directly reduces the immunogenicity of microparticles. We also studied two human patients with null mutations in DNASE1L3, and observed increased DNA circulating in plasma and, in particular, in their microparticles, demonstrating a conserved role for DNASE1L3 in mice and humans. Finally, we obtained plasma samples from a cohort of patients with sporadic SLE, and found that roughly 80% had circulating IgG that avidly bound microparticles. Roughly half of this group failed to bind to microparticles that had been pretreated with DNASE1L3, and this DNASE1L3-sensitive group also presented with lower levels of DNASE1L3 activity. We conclude that extracellular chromatin associated with microparticles acts as a potential self-antigen capable of causing loss of tolerance to self-DNA and inflammatory disease in both mice and humans. The secretion of a DNA-processing enzyme thus represents a novel, conserved tolerogenic mechanism by which dendritic cells restrict autoimmunity.

Introdução: O infliximabe é um anticorpo monoclonal quimérico que inibe o fator de necrose tumoral, sendo usado em doenças autoimunes e/ou inflamatórias, tais como a artrite reumatóide (AR), a espondilite anquilosante (EA), a psoríase e a artrite psoriásica (AP) e as doenças inflamatórias intestinais (DII). Objetivos: Avaliar se o infliximabe induz à formação de autoanticorpos e verificar a ocorrência de eventos adversos, sobretudo o lúpus induzido por este medicamento. Metodologia: Trata-se de um estudo aberto, prospectivo, de fase IV, onde dosamos os autoanticorpos antes e depois do tratamento (das doenças citadas anteriormente), o qual teve duração mínima de 6 meses (5 infusões). Resultados: No total, 286 pacientes foram avaliados para o fator anti-nuclear (FAN) por imunofluorescência indireta em células Hep2, sendo significativo o aumento de número de indivíduos (p = 0,0001), antes e depois da medicação. Além do FAN, foram dosados, em 146 pacientes, 17 outros autoanticorpos pelo método multiplex, sendo que o anti-DNA de dupla hélice (anti-dsDNA) e o anticardiolipina IgM (aCL IgM) tiveram um aumento significativo (p = 0,003 e 0,0024, respectivamente). Pacientes com AR tiveram uma variação significativa nos títulos do anticorpo anti-proteína citrulinada (ACPA) (antes e depois do tratamento) (p = 0,012). De todos os pacientes avaliados (n = 286), somente 1 (0,35%) apresentou sinais clínicos e laboratoriais de lúpus induzido pelo infliximabe. Conclusão: O estudo demonstrou que o infliximabe interferiu na formação de autoanticorpos (FAN, anti-dsDNA, aCL IgM e ACPA), sendo rara a indução de lúpus pelo medicamento. / Background: Infliximab is a chimeric monoclonal antibody that inhibits tumor necrosis factor, and is thus used in the treatment of autoimmune and/or inflammatory diseases, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriasis and psoriatic arthritis (PA), and inflammatory bowel diseases (IBD). Objective: To determine whether infliximab induces the formation of autoantibodies and assess the occurrence of adverse effects, mainly drug-induced lupus. Method: The study consisted of a phase IV, prospective, open-label trial, in which autoantibody levels were determined before and after treatment (of the above mentioned diseases) with a minimum duration of 6 months (5 infusions). Results: A total of 286 patients were assessed for the presence of antinuclear antibodies (ANA) by means of indirect immunofluorescence on human epithelial (HEp-2) cells, with a significant increase in the number of individuals observed after treatment (p = 0.0001). In addition to ANA, 17 other autoantibodies were assessed in 146 patients using multiplex technology, and a significant increase was observed in anti-double stranded DNA (anti-dsDNA) and anticardiolipin IgM (aCL IgM) antibody titers (p = 0.003 and 0.0024, respectively). Patients with RA showed significant variations in anti-citrullinated protein antibody (ACPA) titers (before and after treatment) (p = 0.012). Among the 286 patients assessed, only 1 (0.35%) presented clinical and laboratory signs of infliximab-induced lupus. Conclusion: The present study showed that infliximab did affect the formation of autoantibodies (ANA, anti-dsDNA, aCL IgM and ACPA), with a rare occurrence of drug-induced lupus.

Abstract   Introduction Failure in the mechanism of self-tolerance in T or B cells can lead to autoimmunity. One of the autoimmune diseases is rheumatoid arthritis (RA), which is a chronic inflammatory disease of unknown cause and is characterized by systemic inflammation, autoantibodies and joint destruction. Serology is crucial for the classification of this disease. The first autoantibody found in RA patients was Rheumatoid factor (RF). However, anti-citrullinated peptide antibodies (ACPAs), a relatively new group of autoantibodies found in 70-90% of RA patients, are diagnostically more specific than RF. Type II collagen (CII) is the most abundant protein in human cartilage. In RA patients, immunity against CII leads to cartilage degradation and loss of joint function. Already from the 1970s, antibodies to CII (anti-CII) were found in RA sera, suggesting that CII autoimmunity might be pathogenetically important. Previous studies from our group show that a subgroup of patients with high levels of anti-CII at the time of diagnosis at the same time have high levels of inflammation in the joints. This is probably caused by anti-CII immune complexes (IC) inducing pro-inflammatory cytokines from macrophages. Although anti-CII positive patients have high inflammatory activity early on, as anti-CII levels decrease during the first year, the associated inflammation also diminishes. Thus, anti-CII positive patients have a rather good prognosis. Moreover, it is assumed that since anti-CII positive patients have a better prognosis than ACPA positive, patients with elevated anti-CII at the time of diagnosis might benefit from different and milder treatment. Previous studies from the group were performed on stored patient samples from the time before modern treatments with biologic agents (1995-2005). In this study, we aimed to investigate patients belonging to a more recent RA cohort, diagnosed between 2005-2014, with the aim to investigate whether patients with the anti-CII-associated RA phenotype would respond differently depending on the use of different modern RA therapies. Patients and Methods The primary cohort consisted of 2335 RA patients and 480 non-RA controls from the Epidermiological Investigations in Rheumatoid Arthritis (EIRA) case-control study. As we run into methodological problems two subgroups with 62 and 40 RA patients from the previous anti-CII studies were investigated when modifying the ELISA procedure, as well as a group of earlier investigated patients with non-specific ELISA reactivity. Totally 2776 RA patients were investigated. All investigated patients fulfilled the American College of Rheumatology classification criteria. To measure the anti-CII levels in RA patients and healthy controls anti-CII ELISA was performed. During the experiments, several different sources of CII from human, rat and bovine origin, and two different alternative coating buffers were used. The optical density (OD) was measured at 450 nm and anti-CII concentrations were calculated against the standard curve from an RA patient with high anti-CII levels.   Results My first analysis of the EIRA cohort showed that anti-CII are higher in RA patients than in controls, but could not confirm the association with acute onset RA. This was an unexpected finding and changed the focus of this master thesis project, to modify the measurement of anti-CII. Re-investigation of EIRA I showed that a proprietary coating buffer is important in the assay. Moreover, when different samples from RA patients were tested with bovine, rat and three different lots of human CII, correlation tests with clinical measures showed that bovine collagen and a new lot of human CII- prepared by the supplying company solely for this project- showed the strongest associations. Thereafter the EIRA cohort was re-investigated with two ELISAs, using bovine and human CII coated with the proprietary buffer. At the time of thesis writing almost all of the EIRA samples have been re-analysed, and results from both the modified ELISAs show the awaited clinical associations to early inflammation.   Conclusion Keeping the integrity of triple helical collagen is very important for the identification anti-native CII in RA patients. Our results show that the use of the proprietary coating buffer appears to be instrumental in this assay, irrespective of what source of CII was used. The new lot of human CII shows significant associations with the clinical measures, but associations are somewhat stronger with bovine CII. After finalising the re-investigations, we will be able to conclude which of the two analyses is most appropriate, and the corresponding dataset will then be merged with data from the first part of the EIRA study investigated previously by other group members. As anti-CII analysis shows the association to disease activity and prognosis, it can be used for predicting prognosis of RA and choosing the appropriate therapy in newly diagnosed RA patients, which might be clinically useful for rheumatologists. Our hypothesis is that as anti-CII positive patients have strong early inflammatory response but good long-term prognosis, they might benefit from other and perhaps short-term treatment compared to other RA patients.  If this is correct, our finding can have impact on the economy as it can define the patients who will not need expensive long-term medications. As modern anti-rheumatic therapies carry the risk of infections, such individualized therapies might also benefit anti-CII positive patients.

Les maladies auto-immunes sont des maladies chroniques et hétérogènes caractérisées par des réactions du système immunitaire acquis contre les propres tissus sains de l'organisme. Ces maladies affectent presque 5% de la population mondiale et en particulier les jeunes adultes. La complexité de leur spectre est énorme et même si leur étiologie est encore incertaine, il a été démontré que des facteurs génétiques et environnementaux sont impliqués dans le déclenchement du mécanisme pathologique. Cependant, il est nécessaire d'utiliser des outils diagnostiques et / ou pronostiques fiables pour le diagnostic précoce avant que des dommages cellulaires irréversibles ne se produisent et pour surveiller la progression de la maladie.De nombreuses études ont mis en évidence la présence de différents auto-anticorps dans le sérum de patients atteints de maladies auto-immunes. Les auto-anticorps qui sont spécifiques d’une maladie peuvent être utilisés en tant que biomarqueurs (BM) pour son diagnostic alors que les auto-anticorps qui diffèrent en fonction de l'état de la maladie peuvent être utilisés dans le suivi des patients. En fait, dans le cas de l'auto-immunité, un BM facilement détectable et fiable peut être représenté par le titre d'un auto-anticorps spécifique.Dans ce contexte, nous nous intéressons à deux maladies différentes, la sclérose en plaques (SEP) et la gammapathie monoclonale, en utilisant l'approche chimique inverse via le criblage de librairies de peptides par des sérums de patients.En particulier, l'importance des anticorps anti-myéline, et surtout, des anticorps anti-MOG (myéline oligodendrocyte glycoprotéine) est toujours l’objet de débats, soulignant la question très controversée d'un rôle pathogène putatif d'anticorps anti-MOG dans la SEP. Dans cette thèse, nous avons étudié le rôle de MOG comme auto-Ag putatif dans la SEP en utilisant le modèle expérimental d’encéphalomyélite auto-immune (EAE). Ainsi, afin d'évaluer la présence d'un mécanisme d’« epitope spreading » des cellules B, à savoir l'apparition d'une réponse dirigée vers des épitopes distincts de l'agent pathogène induisant la réponse immunitaire, nous avons synthétisé et testé en tant que sondes antigéniques cinq peptides synthétiques qui couvrent la séquence 1-117 de MOG.La seconde étude a porté sur la sélection d'un peptide mimant l'épitope minimal reconnu par l'anticorps monoclonal commercial anti- natural killer cell-1 humain (anti-HNK-1) en utilisant la résonance plasmonique de surface (SPR). L’épitope HNK-1 est considéré comme le déterminant antigénique de la glycoprotéine associée à la myéline (MAG), un composant quantitativement mineur des gaines de myéline. On observe que les patients atteints de troubles neurologiques auto-immuns, tels que la gammapathie monoclonale à IgM et la polyneuropathie démyélinisante, développent souvent des anticorps anti-MAG ciblant spécifiquement l’épitope HNK-1. Par conséquent, l'identification et la caractérisation de ces anticorps est pertinente. Le peptide choisi suite à notre étude pourrait ensuite être utilisé chez des patients atteints de troubles neurologiques pour le développement d'un outil de diagnostic fiable ou de surveillance de l'activité de la maladie par l'identification d'anticorps anti-HNK-1 dans le sérum des patients. / Autoimmune diseases (ADs) refer to chronic and heterogeneous diseases with acquired immune system’s reactions against the body’s own healthy tissues. ADs affect more than 5% of the population worldwide and especially young adults. The complexity of their spectrum is enormous and even if their etiology is still unclear, it was demonstrated that both genetic and environmental factors are involved in triggering the pathological mechanism. Hence, a reliable diagnostic and/or prognostic tool for an early diagnosis of ADs before irreversible cellular damage occurs and for monitoring their progression is demanded.Numerous studies have revealed the presence of different autoantibodies (auto-Abs) in sera of patients suffering from ADs. Autoantibodies that are specific for a disease can be used as biomarkers (BMs) for its diagnosis while autoantibodies that differ depending on the disease state can be used in the follow up of the patients. Actually, in the case of autoimmunity, an easily detectable and reliable BM may be represented by the titer of a specific auto-Ab.In this context, we aimed to identify target(s) of the response for two different ADs, multiple sclerosis (MS) and monoclonal gammopathy, using the chemical reverse approach, which involves the screening of focused antigen (Ag) libraries with patients’ serum.In particular, the significance of anti-myelin antibodies, and especially, anti- Myelin Oligodendrocyte Glycoprotein (anti-MOG) antibodies is still matter of debate, underscoring the highly controversial issue of a putative pathogenetic role of anti-MOG antibodies in MS. In this thesis we investigated the role of MOG as putative auto-Ag in MS using the experimental autoimmune encephalomyelitis (EAE) model. Moreover, in order to assess the presence of a B-cell epitope spreading mechanism, i.e. the occurrence of a response directed toward epitopes distinct from the disease-inducing agent, we synthesized and tested as antigenic probes also five synthetic peptides covering the 1-117 sequence of MOG.The second issue focused on the selection of a peptide mimicking the minimal epitope recognized by the commercial available monoclonal antibody anti-human natural killer cell-1 (anti-HNK-1) using Surface Plasmon Resonance (SPR) technique. HNK-1 epitope, is considered as the antigenic determinant of myelin-associated glycoprotein (MAG), a quantitatively minor component of myelin sheaths. It is observed that patients affected by autoimmune neurological disorders, such as IgM monoclonal gammopathy and demyelinating polyneuropathy, often develop anti-MAG antibodies specifically targeting the HNK-1 epitope. Accordingly, identification and characterisation of these antibodies is relevant. The selected peptide could be subsequently used in earlier stage patients for the development of a novel and reliable diagnostic tool for anti-HNK-1 antibody identification in sera of patients affected by autoimmune neurological disorders monitoring disease activity.

No description available.

Que se passe-t-il quand le système immunitaire attaque le cerveau ? Dans l'encéphalite à autoanticorps dirigés contre les récepteurs NMDA, le système immunitaire des patients dysfonctionne : au lieu de produire des anticorps pour combattre des organismes pathogènes, le système immunitaire produit des anticorps qui attaquent une protéine spécifique dans le cerveau des patients, les récepteurs NMDA. Ces récepteur sont indispensables à la mémoire et sont impliqués dans diverses maladies (schizophrénie, maladie d'Alzheimer). Les patients atteints d'encéphalite à autoanticorps dirigés contre les récepteurs NMDA souffrent de troubles neuropsychiatriques sévères (hallucinations, paranoïa, mouvements anormaux, épilepsie, amnésie, etc.) et la gravité de leur état de santé nécessite une prise en charge en réanimation. Malgré cette sévérité, 8 patients sur 10 récupèrent avec un traitement adapté. Les patients souffrant de cette maladie sont majoritairement des jeunes femmes porteuses d'une tumeur des ovaires. Le premier objectif de ma thèse est de comprendre le rôle de cette tumeur dans le dysfonctionnement du système immunitaire de ces patientes. Mon second objectif est de comprendre comment les autoanticorps attaquant les récepteurs NMDA vont perturber le fonctionnement du cerveau. Apporter des éléments de réponse à ces questions permettra à terme d'améliorer la prise en charge des patients / Anti-NMDA receptor (NMDAR) encephalitis is a rare but severe neuropsychiatric disorder initially described by J. Dalmau and colleagues in 2007. Anti-NMDAR encephalitis is defined by a clinical picture of encephalitis associated with the presence of IgG directed against the GluN1 subunit of NMDAR (NMDAR-Abs) in the cerebrospinal fluid (CSF) of patients. This disorder predominantly affects young women. Clinical presentation usually includes psychiatric symptoms and/or neurological symptoms often accompanied by decreased responsiveness and autonomic instabilities during the course of the disease . Despite the severity of the disease, 81% of patients recover fully or with mild sequels . 38% of patients had an underlying neoplasm, 94% of which were ovarian teratomas , indicating a role for this tumor in the immunopathogenesis of the disease. Studies in vitro and on animal models have demonstrated the pathogenicity of NMDAR-Abs but more studies are required to decipher the pathological role of anti-NMDAR antibodies. Two main research focuses have emerged in our group: understanding the events leading to the immune dysregulation in the ovary teratoma and identifying the pathological element(s) and how they act at the molecular and cellular levels to cause the broad neurological spectrum of symptoms observed in patients. My PhD was especially focused on 1) understanding the involvement of the underlying ovary teratoma in the triggering of the immune response during anti-NMDAR encephalitis and 2) studying the impact of prolonged exposure of the neuronal network to patients’ NMDAR-Abs and the potential involvement of microglial cells in the physiopathology of the disease

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation eventually leading to the destruction of cartilage and bone. The aetiopathogenesis is not completely understood, but previous studies have shown that the disease is multifactorial with genetic, environmental and hormonal factors involved. Immune cells, e.g., T- and B-cells, and macrophages, migrate into the joints, with increased expression of numerous soluble factors such as cytokines, chemokines and adhesion molecules functionally active both locally and systemically. Analyses of blood samples from the Medical Biobank in Umeå from individuals before the onset of symptoms of joint disease showed that anti-citrullinated protein/peptide antibodies (ACPA) preceded the development of disease by years and this finding has been confirmed by other studies.                                         The aim of this thesis was to identify signs of activation of the immune system analysed as up-regulation of pro- and anti-inflammatory cytokines, sero-positivity for autoantibodies, and genetic factors identified as relevant for the development and disease progression of RA. The concentrations of 30 cytokines and chemokines were measured in blood samples from individuals before the onset of symptoms, and when diagnosed with RA, together with population-based matched controls using a multiplex system. The predictive value of different isotypes (IgG, IgA, and IgM) of ACPA and rheumatoid factor (RF) before onset of symptoms and different types of ACPA (e.g., mutated citrullinated vimentin, MCV) were analysed for disease development and progression in patients with early RA and controls from Northern Sweden. These factors were related to the genetic markers, HLA- shared epitope (SE) alleles and the 1858C/T polymorphism of the protein tyrosine phosphatase non-receptor type 22 (PTPN22) gene.                            In paper I, it was shown that in individuals who later developed RA (i.e., pre-patients) the levels of several cytokines and related factors that represent the adaptive immune system (Th1, Th2, and T regulatory cell related factors) were significantly elevated compared with controls, whereas, after the onset of disease the involvement of the immune system was more general and widespread. In paper II, the presence of different isotypes (IgM, IgA and IgG) of ACPA in pre-patients, patients and controls was evaluated showing that both the IgG and IgA isotype predicted the onset of RA by years with the IgG isotype having the highest predictive value. In paper III, the association of the 1858T variant of PTPN22 with RA was confirmed. Furthermore, the association was restricted to autoantibody positive disease and this variant was correlated with an earlier age for disease onset. In paper IV, anti-MCV antibodies were identified as being associated with a more severe disease course of RA, measured by disease activity score, erythrocyte sedimentation rate, and swollen joint count over time compared with anti-CCP2, anti-CCP3, and anti-CCP3.1 antibodies.                                                                                                In conclusion, individuals who later developed RA had increased concentrations of inflammatory markers reflecting an activation of the immune system years before the clinical symptoms of the disease developed. Also, the presence of ACPA of IgG and IgA isotype prior to disease onset predicted the development of RA. The PTPN22 1858T variant was associated with sero-positive RA and anti-MCV antibodies were associated with a higher inflammatory activity compared with anti-CCP2, -CCP3 and -CCP3.1 antibodies. These findings together present a possibility to better predict the development and progression of RA.