Objetivo: Avaliar a qualidade de vida relacionada à saúde (QVRS) de crianças e adolescentes com hepatite autoimune (HAI). Métodos: Estudo transversal avaliou 80 pacientes com HAI e 45 controles saudáveis utilizando o instrumento Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0). Os dados demográficos, a presença de comorbidade autoimune, dose de corticóide, remissão e gravidade da doença e dor abdominal também foram avaliados. Resultados: A idade atual média foi similar em pacientes HAI e controles saudáveis [13 (5-18) vs. 14 (3-18) anos, p = 0,804]. De acordo com os relatos das crianças, os escores físico, emocional e escolar foram significativamente menores nos pacientes com HAI comparado ao grupo controle (p < 0,05). Os escores físico e total foram significantemente menores de acordo com relato dos pais de pacientes com HAI comparado aos controles (p < 0,05). Uma análise mais aprofundada em pacientes com HAI e presença de dor abdominal no último mês, revelou significativo prejuízo dos domínios físico, social e total (p < 0,05). Não foram observadas diferenças quanto à presença de comorbidade autoimune, remissão da doença e gravidade da doença (p > 0,05). Pacientes em uso de doses < 0,16 mg / kg / dia de prednisona quando comparados aos em uso de dose >= 0.16 mg / kg / dia no momento da entrevista, mostraram prejuízo significante no domínio físico [87,5 (50-100) vs. 75 (15,63-100) vs. 87 (50-100), p = 0,006]. Conclusões: Observouse redução de capacidades física, emocional e escolar em pacientes pediátricos com hepatite autoimune. Dor abdominal e dose de prednisona em uso influenciaram negativamente na QVRS de crianças e adolescentes com HAI / Objective: To evaluate health related quality of life (HRQL) in children and adolescents with autoimmune hepatitis (AIH). Methods: A cross-sectional study assessed 80 patients with AIH and 45 healthy controls using Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) instrument. Demographic data, presence of autoimmune comorbidity, prednisone dose, disease remission, disease severity and abdominal pain were also evaluated. Results: According to the child-self report, physical, emotional, school and total scores were significantly lower in AIH patients compared to controls (p < 0.05). Only the physical and total scores were significantly lower in parent\'s report in AIH patients versus controls (p < 0.05). Further analysis in AIH patients with abdominal pain in the last month revealed significant decreased medians of physical, social and total scores (p < 0.05). No differences were observed regarding the presence of concomitant other autoimmune disease, disease remission and disease severity (p > 0.05). AIH patients using prednisone dose below the median ( < 0.16 mg/kg/day) had significantly reduced physical score [87.5(50-100) vs. 75(15.63-100) vs. 87 (50- 100), p=0.006]. Conclusions: Reduced scores in physical capacity, emotional and school domains were observed in pediatric AIH patients. Abdominal pain and corticosteroid dose influenced negatively the HRQL in children and adolescents with AIH

Introdução: Os anticorpos antiproteína P ribossomal (anti-P) são considerados marcadores sorológicos específicos do Lúpus Eritematoso Sistêmico (LES) e estão associados a acometimento hepático nesta doença. As semelhanças entre a hepatite autoimune (HAI) e a hepatite associada ao LES levou ao questionamento se o anticorpo anti-P também estaria presente na HAI. Objetivo: Avaliar a frequência e significância clínica do anticorpo anti-P em uma grande coorte de pacientes com HAI. Métodos: Foram analisados os soros de 96 pacientes com HAI, coletados no diagnóstico e comparados com 82 soros de indivíduos saudáveis. Todos os soros foram testados para a presença do anticorpo anti-P pelo método de ELISA, do anticorpo anti-DNA de dupla fita pelo método de imunofluorescência indireta usando Crithidia luciliae e do anticorpo anti-Sm pelo método de ELISA. Os critérios de exclusão adotados foram a presença de outros anticorpos específicos de LES como o anti-DNA de dupla fita (n=1) e o anti-Sm (n=2) ou se o paciente apresentasse o diagnóstico de LES definido pelo Colégio Americano de Reumatologia (n=0). Os prontuários médicos foram revisados para dados demográficos, clínicos e resultados de exames laboratoriais relacionados a hepatopatia e anticorpos específicos de HAI. Resultado: Títulos moderados ou alto (> 40 U) de anti-P foram encontrados em 9,7% (9/93) dos pacientes com HAI e em nenhum dos controles (p = 0,003). No diagnóstico, os pacientes com anti-P positivo ou negativo apresentavam características demográficas/clínicas semelhantes, como a frequência de cirrose (44,4% vs 28,5%, p = 0,44) e exames laboratoriais relacionados a hepatite (p > 0,05). Entretanto, ao final do seguimento destes pacientes (média de 10,2 ± 4,9 anos), os pacientes positivos para anticorpos anti-P apresentaram uma maior frequência de cirrose quando comparados a pacientes negativos para anti-P (100% vs 60%, p = 0,04). Conclusão: a demonstração da presença do anticorpo anti-P em pacientes com HAI sem evidência de LES sugere um mecanismo comum de acometimento hepático nestas duas doenças. Além disso, a presença deste anticorpo parece predizer um pior prognóstico nos pacientes com HAI / Background: Autoantibodies to ribosomal P proteins (anti-rib P) are specific serological markers for systemic lupus erythematosus (SLE) and are associated with liver involvement in this disease. The similarity in autoimmune background between autoimmune hepatitis (AIH) and SLE- associated hepatitis raises the possibility that anti-rib P antibodies might also have relevance in AIH. Aims: To evaluate the frequency and clinical significance of anti-rib P antibodies in a large AIH cohort. Methods: Sera obtained at diagnosis of 96 AIH patients and of 82 healthy controls were tested for IgG anti-ribosomal P protein by ELISA. All of the sera were also screened for other lupus-specific autoantibodies, three patients with the presence of anti-dsDNA (n=1) and anti-Sm (n = 2) were excluded. Results: Moderate to high titers (> 40 U) of anti-rib P antibody were found in 9.7% (9/93) of the AIH patients and none of the controls (P = 0.003). At presentation, AIH patients with and without anti-rib P antibodies had similar demographic/clinical features, including the frequency of cirrhosis (44.4% vs. 28.5%, P = 0.44), hepatic laboratorial findings (p > 0.05). Importantly, at the final observation (follow-up period 10.2 ± 4.9 years), the AIH patients with anti-rib P had a significantly higher frequency of cirrhosis compared to the negative group (100% vs. 60%, P = 0.04). Conclusion: The novel demonstration of anti-rib P in AIH patients without clinical or laboratory evidence of SLE suggests a common underlying mechanism targeting the liver in these two diseases. In addition, this antibody appears to predict the patients with worse AIH prognoses

Autoimmune hepatitis (AIH) was identified as an entity by the Swedish professor Jan Waldenström in the 1950s. It was then denoted lupoid hepatitis, characterized by liver inflammation and most often affecting young women. During the years the diagnosis has become more defined (as the non A non B hepatitis has been identified as Hepatitis C) and now can be safely separated from other diseases with liver inflammation. Studies of epidemiological data and long term prognosis have been scarce in the literature. Within a collaboration between the university hospitals in Sweden, we collected what we believe is the largest cohort in the world of patients with AIH. Data from the medical records of 473 individuals was, after AIH-score calculations where the diagnosis was confirmed, collected in a data base, in which most of the analysis was done. Data from the Swedish national registers of cancer, death cause, and birth register was searched for these patients as well as controls. The aim of the thesis was to explore epidemiological and clinical outcome of AIH.The onset of AIH may be at any age, but the incidence seems to increase after 50 years of age; 75% are females, the overall incidence (0.85/ 100,000 inhabitants and year) and prevalence (11/100,000 inhabitants) are figures that are within the range of another but smaller Scandinavian study. Approximately 30 % had cirrhosis already at diagnosis and 87% displayed at some time positive auto-antibodies indicating AIH (Smooth muscle ab and or antinuclear ab).  Indications of future risk for liver transplantation or death is an advanced AIH at diagnosis with liver cirrhosis, decompensated liver disease, elevated PK INR as well as age. Acute hepatitis-like onset seems to carry a lower risk for later liver transplantation or death. Current Swedish national therapy traditions with immune suppression seem to be well tolerated. Five and ten years overall life expectancy does not differ from controls. Thirty-five women gave birth to 63 children, for 3 after liver transplantation of the mother. Thirteen of the women had liver cirrhosis. Current pharmacological treatment seems to be safe both for the patient and the foetus. Thirty percent of the patients experienced flair after delivery. It has been supposed that there is an overrisk for hepatocellular cancer (HCC) associated with AIH. Our figures are the first in the world to be presented that confirms a twenty-three fold overrisk (95% Confidence Interval 7.5-54.3) for hepatobiliar cancer. We found as well an overrisk of non-Hodgkin lymphomas of 13.09 (95% CI 4.2-30.6).Conclusion:  Our epidemiological results confirm that AIH is a fairly uncommon disease, and that many already at time of diagnosis have an advanced disease with liver cirrhosis. There is a clear overrisk for HCC and lymphoma. For those women with AIH who become pregnant the prognosis for the child as well as for the mother is good, even for those women who already have compensated cirrhosis. There is a risk for relapse after delivery. The overall survival for AIH patients with current therapy is good.

Submitted by Caroline Falcao (caroline.rfalcao@ufpe.br) on 2017-04-06T17:10:41Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) 2012-dissertação-WhevertonRicardoCorreiaNascimento.pdf: 4035736 bytes, checksum: f33cf235cb56b67d16c3e819dbebb2a1 (MD5) / Made available in DSpace on 2017-04-06T17:10:41Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) 2012-dissertação-WhevertonRicardoCorreiaNascimento.pdf: 4035736 bytes, checksum: f33cf235cb56b67d16c3e819dbebb2a1 (MD5) Previous issue date: 2012-03-02 / O extrato de vermes adultos de Ascaris suum (Asc) possui atividade imunossupressora em modelos vacinais, de asma alérgica e doenças auto-imunes. Neste estudo, foi verificado o efeito da administração do Asc, profilática ou terapêutica, no modelo de hepatite induzida por Com A (HAI). Para isto, camundongos BALB/c, receberam ConA, i.v., (20mg/kg corpóreo) e três grupos de animais foram formados (n=6). 1)HAI: recebeu apenas ConA; 2)Protocolo profilático HAI+Asc: tratados com Asc (1mg/mL), i.p., 30 minutos antes da indução da HAI; 3)protocolo terapêutico HAI+Asc: tratados com Asc 2 horas após indução da HAI. Como grupo controle animais receberam apenas PBS. Foram dosados transaminases e imunoglobulinas totais séricas, 8, 24 horas e 7 dias após tratamento. Cultivou-se esplenócitos estimulados com Asc e ConA. Níveis de IL-4, IL-10, IL-13 e IFN-γ dos sobrenadantes foram dosados por ELISA. Os fígados foram pesados e analisados histologicamente (hematoxilina-eosina e Tricômico de Masson). No grupo HAI, ocorreu aumento no peso do fígado, dos níveis de transaminases e Imunoglobulinas totais. Estes parâmetros foram reduzidos nas 8, 24 horas e 7º dia no grupo profilático, enquanto no terapêutico apenas no 7º dia.Em ambos os tratamento houve aumento de IL-4, IL-10 e IL-13. No grupo profilático, houve redução do infiltrado celular e aumento da fibrose hepática. A administração profilática do Asc preveniu, e a terapêutica reduziu o dano hepatocelular da lesão. Ambas estimularam a fibrose hepática a longo prazo, pela possível ação da IL-13. Desta forma, o Asc teria eficiência mais acentuada na fase inicial da doença hepática. / The extract of adult Ascaris suum worms (Asc) has immunosuppressive activity in vaccine models, allergic asthma and autoimmune diseases. This study evaluated the prophylactic or therapeutic effect of administration of the Asc in a mouse model of Concanavalin A (Con A)-induced hepatitis. For this, BALB/c mice received ConA, i.v., (20mg/kg) and three groups of animals were formed (n=6). 1) IAH: received only ConA; 2) AIH+Asc prophylactic: treated with Asc (1mg/mL), i.p., 30 minutes before induction of the AIH; 3) AIH+Asc therapeutic: treated with Asc two hours after induction of AIH. The control group of animals received only PBS. Were measured transaminases and total immunoglobulins, in serum, 8, 24 hours and 7 days after treatment. Was cultivated splenocytes stimulated with ConA and Asc. IL-4, IL-10, IL-13 and IFN-γ were assayed in the supernatants by ELISA. The livers were weighed and examined histologically (hematoxylin-eosin and Masson’s trichrome). In the AIH group, there was an increase in liver weight, transaminase levels and total immunoglobulins. These parameters were reduced in 8, 24 hours and 7 days in the prophylactic group, while the therapeutic treatment only on day 7. In both treatments increased IL-4, IL-10 and IL-13. In the prophylactic group, decreased cellular infiltration and increased liver fibrosis. The prophylactic administration of Asc prevented, and treatment reduced the damage of hepatocellular injury. Both stimulated liver fibrosis in long term by IL-13 action. Thus, the efficiency of Asc would more pronounced in the initial stage of liver disease.

Orientador: Gabriel Hessel / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T18:27:38Z (GMT). No. of bitstreams: 1 Pereira_ThalitaCremonesi_M.pdf: 1737488 bytes, checksum: 5ad93d7cbdf6ec7ffe8a969713e5b3e2 (MD5) Previous issue date: 2009 / Resumo: A deficiência de zinco em crianças ou adolescentes acarreta danos ao crescimento, desenvolvimento e ao sistema imune dos indivíduos. Essa deficiência ainda não foi investigada em pacientes com hepatite auto-imune que apresentam comprometimento hepático e utilizam medicamentos que podem causar a deficiência de vitaminas e minerais no organismo. Esta pesquisa teve por finalidade verificar a existência de deficiência de zinco plasmático e/ou leucocitário em adolescentes com hepatite auto-imune. Para isso, participaram do estudo 23 pacientes com hepatite auto-imune entre 10 e 18 anos atendidos no Ambulatório de Hepatologia Pediátrica do Hospital de Clínicas da Unicamp e 23 adolescentes com idade pareada com os pacientes formaram o grupo controle. Foi coletado sangue dos indivíduos dos dois grupos em quantidade suficiente para preencher dois tubos de heparina para a dosagem de zinco leucocitário e um tubo de EDTA para a análise de glutationa reduzida eritrocitária. O zinco plasmático foi analisado pelo HC/Unicamp como exame de rotina. Foi avaliado nos grupos o estado nutricional por meio da aferição de dados antropométricos como peso, altura, circunferência do braço, prega cutânea tricipital e subescapular. Somente no grupo de pacientes também foi realizado o exame de bioimpedância elétrica com aparelho que fornecia dados de resistência e reactância que foram utilizados em cálculos por equações preditivas para estimar a gordura corporal dos pacientes. A ingestão alimentar dos pacientes e do grupo controle foi avaliada pelo preenchimento, pelos próprios adolescentes, de três dias de diário alimentar. Os testes estatísticos empregados foram o de Mann Whitney, correlação de Spearman e análise de concordância interclasses. O nível de significância adotado foi de 5%. A média de zinco plasmático nos pacientes foi de 71.91±11.79 µg/dl e no grupo controle foi de 80.74±10.92 µg/dl, essa diferença foi significante (p=0.04). O nível de zinco leucocitário nos pacientes foi igual a 222.33±166.13 pmol/106 células e no grupo controle foi de 226.64±217.81 pmol/106 células, não ocorrendo diferença estatisticamente significante entre esses (p=0.45). A análise de glutationa mostrou média de 57.34±25.95 mg/dl nos pacientes e de 52.55±23.08 mg/dl no grupo controle, sem diferença estatística (p=0.50). A avaliação do estado nutricional mostrou que a eutrofia é prevalente nos pacientes e estes possuem maior valor de gordura corporal que o grupo controle com diferença significativa. A ingestão alimentar média de zinco (mg/dia) foi de 9.40±3.60 nos pacientes e de 10.94±4.32 no grupo controle, sendo que esta diferença não foi significante (p=0.16). Em comparação com as recomendações nutricionais, a ingestão de zinco e macronutrientes apresenta alta probabilidade de adequação tanto nos pacientes como no grupo controle. Entretanto, a proteína foi o único nutriente estudado que apresentou ingestão significantemente menor nos pacientes quando comparada ao grupo controle, mas ainda dentro do ideal. Conclui-se que os pacientes com hepatite auto-imune apresentam deficiência de zinco plasmático; não apresentam deficiência de zinco leucocitário; possuem ingestão alimentar adequada em relação à Zn, carboidratos, proteínas e lipídeos; não estão em estresse oxidativo e apresentam estado nutricional prevalente de eutrofia com tendência à obesidade. / Abstract: Zinc deficiency in children and adolescents impairs their growing, development and immune system. This deficiency was still not investigated in patients with autoimmune hepatitis who present hepatic involvement and use medications that may cause vitamin and mineral deficiency in their organism. The aim of this research was to verify the existence of plasma and leukocyte zinc deficiency in adolescents with autoimmune hepatitis. The study comprised 23 patients with autoimmune hepatitis, aged 10-18 years, assisted at the Ambulatory Service of Pediatric Hepatology of the University of Campinas Teaching Hospital (HC/Unicamp); and adolescents with ages compatible with the patients'ages comprised the control group. Two blood tubes containing heparin for the dosage of leukocyte zinc and one tube with EDTA for analysis of reduced erythrocitary glutathione were collected from both groups. The plasma zinc was analyzed by HC/Unicamp as custom examination. The nutritional state in both groups was evaluated by anthropometric data measurement, such as weight, height, arm circumference, triciptal and subscapular cutaneous fold. Only the patient group underwent electrical bioimpedance examination with device that provided resistance and reactance data, which were used in calculations by predictive equations in order to estimate the patients' body fat. The alimentary ingestion of the group of patients and control group was evaluated by the application of a three-day alimentary inquiry, filled by adolescents. The following statistical tests were used: Mann Whitney, Spearman's correlation and interclass concordance analysis. The significance level adopted was 5%. The mean plasma zinc in patients was 71.91±11.79 µg/dl, and in the control group, it was 80.74±10.92 µg/dl, showing a significant difference (p=0.04). The leukocyte zinc level in patients was 222.33±166.13 pmol/106 células, and in the control group, it was 226.64±217.81 pmol/106 células; there was not statistical significance between them (p=0.45). The glutathione analysis showed a mean of 57.34±25.95 mg/dl in patients and 52.55±23.08 mg/dl in the control group; without statistical significance (p=0.50). The evaluation of the nutritional state showed that the eutrophy is prevalent in patients, and they presented a higher body fat value than the control group, with significant difference. The mean alimentary ingestion of zinc (mg/day) was of 9.40±3.60 in patients, and of 10.94±4.32 in the control group; therefore, there was not a significant difference (p=0.16). In comparison with nutritional recommendations, zinc and macronutrient ingestion had a high probability of adequacy in group of patients and control group. However, the protein was the only nutrient studied that presented ingestion significantly lower in patients when compared with the control group, but within of recommended values. The results showed that patients with autoimmune hepatitis presented plasma zinc deficiency; did not present leukocyte zinc deficiency; and they showed adequate alimentary ingestion in relation to Zn, carbohydrates, proteins and lipids; as well as they were not in oxidative stress and presented prevalent nutritional state of eutrophy with obesity tendency. / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

para diversos tipos de tratamento, como doenças auto-imunes, inflamatórias e até para pacientes submetidos a transplante de órgãos. Assim também, é capaz de causar efeitos adversos como toxicidade hepática e mais frequentemente a mielossupressão. Tiopurina Smetiltransferase (TPMT), uma enzima que catalisa a S-metilação dessas drogas, exibiu um polimorfismo genético em 10% de Caucasianos, sendo 1/300 indivíduos com completa deficiência. Pacientes intermediários ou completamente deficientes da atividade de TPMT estão em risco por excessiva toxicidade após receberem doses padrões de medicações tiopurínicas. O presente estudo visa a 1) pesquisar a frequência desses polimorfismos (TPMT*2, TPMT*3A, TPMT*3B e TPMT*3C) em populações de doadores de sangue em Hospital terciário Universitário e em pacientes que utilizem a Azatioprina para o tratamento da hepatite autoimune e transplantado renal, 2) padronizar os métodos para a identificação dos polimorfismos e associá-los com os níveis dos metabólitos da AZA. Esses achados podem explicar os efeitos benéficos da Azatioprina e ter importante implicação para o desenho de novas terapias específicas em doenças autoimunes e em transplante de orgãos / Thiopurine drugs such as azathioprine (AZA) are widely used for many types of treatment: autoimmune and inflammatory diseases and for patients who had undergone organ transplantation. AZA is capable of causing adverse effects such as hepatotoxicity and myelosuppression. Thiopurine S-methyltransferase (TPMT), which catalyzes the Smethylation of such drugs, exhibits a genetic polymorphism in 10% of Caucasians, and 1 / 300 individuals with complete deficiency. Patients who are intermediary or completely deficient in TPMT activity are at risk for excessive toxicity after receiving standard doses of thiopurine drugs. This recent study aims to 1) investigate the frequency of these polymorphisms (TPMT*2, TPMT*3A, TPMT * 3B and TPMT*3C) in blood donors from a terciary University Hospital and in patients using azathioprine for the treatment of autoimmune hepatitis and transplanted kidney; 2) standardize the methods for the identification of polymorphisms and associate with levels metabolites of AZA. These findings may explain the beneficial effects of azathioprine and have important implications to design new therapies for autoimmune diseases and organ transplant

No description available.

Les maladies auto-immunes résultent d’un dysfonctionnement du système immunitaire. L’étiologie de la pathologie reste souvent inconnue, compliquant la conception de traitements adaptés. Ce projet de thèse s’est focalisé sur la molécule « a proliferation inducing ligand » (APRIL), facteur de survie des plasmocytes (PC) produisant les anticorps, dans l’hépatite auto-immune (HAI) et la sclérose en plaques (SEP). Dans l’HAI, une principale caractéristique histologique est la présence d’un infiltrat lymphoplasmocytaire formant une hépatite d’interface dommageable. Dans cette maladie, nous avons d’abord pu mettre en évidence une corrélation positive entre l’expression d’APRIL et l’infiltration des PC dans les espaces portes. In vitro, nous avons observé une survie augmentée des PC du foie en présence d’APRIL. La corticothérapie communément prise par les patients HAI ne cible pas directement les PC. Cependant, nous avons remarqué une réduction simultanée de la densité de PC et de l’expression d’APRIL. Ainsi, cette étude étend le rôle de facteur de survie d’APRIL aux PC du foie dans l’HAI. Les rechutes sont fréquentes après arrêt du traitement, nous indiquant que les cellules pathogènes sont épargnées par la thérapie. Nos résultats montrent que le ciblage d’APRIL pourrait être précieux dans l’HAI. Propre de son rôle sur les PC, APRIL a été ciblée avec succès dans plusieurs maladies auto-immunes. Outre ces succès, un essai clinique visant à bloquer APRIL dans la SEP à malheureusement conduit à une exacerbation inattendue de la maladie. Nous avons été capables de montrer qu’APRIL cible un nouveau type cellulaire dans le système nerveux central, les astrocytes. La fixation d’APRIL à la surface des astrocytes dépend d’un nouveau partenaire de liaison, exprimé par ces derniers, les chondroïtines sulfates protéoglycans. Cette interaction induit la production de la cytokine anti-inflammatoire IL-10, conduisant à l’inhibition de, la prolifération des lymphocytes T auto-réactifs et la sécrétion de cytokines pro-inflammatoires. L’utilisation de souris déficientes pour APRIL dans le modèle standard de la SEP nous a permis de confirmer le rôle neuro-protecteur d’APRIL. Finalement, après injection d’APRIL recombinante dans ce modèle murin, une réduction de la sévérité de la maladie a été observée. Globalement, nous avons identifié APRIL comme une molécule à double rôle dans les maladies auto-immunes. / Autoimmune diseases result from a dysfunction of the immune system. The disease etiology is often unknown, complicating the design of appropriate treatments. This thesis project focused on the molecule “a proliferation inducing ligand” (APRIL), a survival factor for antibody-producing plasma cells (PC), in autoimmune hepatitis (AIH) and multiple sclerosis (MS). In AIH, one main histological feature is the presence of a lymphoplasmacytic infiltration forming a damaging interface hepatitis. In this disease, we first noticed a positive correlation between APRIL expression and PC infiltration in portal spaces. In vitro, we further observed an extended survival of liver PC in the presence of APRIL. The corticosteroid therapy commonly applied to AIH patients does not directly target PC. However, we noticed a concomitant reduction in portal PC density and APRIL expression. Hence, this study is extending the survival role of APRIL to liver PC in AIH. Relapses are frequent after treatment withdrawal, telling us that pathogenic cells are spared by the therapy. Our results indicate that APRIL targeting might also be valuable in AIH. Own to its role on PC, APRIL has been successfully targeted in several autoimmune diseases. Besides successes, a clinical trial aiming at APRIL blockade in MS has unfortunately led to an unexpected disease exacerbation. We have been able to show that APRIL targets a new cell type in the central nervous system, the astrocyte. The APRIL binding to astrocyte surface depends on a new binding partner, expressed by the latter, the chondroitin sulfate proteoglycans. This binding induces the production of the anti-inflammatory cytokine IL-10, leading to the inhibition of, self-reactive T-cell proliferation and pro-inflammatory cytokine secretion. Use of APRIL-deficient mice in the standard model of MS allowed us to confirm the neuroprotective role of APRIL. Finally, after recombinant APRIL injection in this model, a lowered disease severity was observed. Overall, we identified APRIL as a dual role molecule in autoimmune diseases.

Indiana University-Purdue University Indianapolis (IUPUI) / Autoimmune Hepatitis (AIH), an incurable chronic condition of unknown cause where the body attacks its own liver, is a rare disease, with a current diagnosed worldwide prevalence of < 150,000. Inadequately treated, AIH can cause progressive liver damage and ultimately liver failure. A wide variety of symptoms are associated with AIH including severe fatigue, joint pain, depression, anxiety, and insomnia. While precision medicine’s genomics has attempted to shed light on the disease, other non-molecular “-omics” approaches can be taken in studying AIH patients, who often utilize social media to gather information from other patients or care providers to apply to their own AIH disease course. It is proposed that these patient-generated social mediomes can create self-report health records for patients – and facets of their lives - otherwise unreachable by conventional research. In this feasibility study, I examined in an exploratory fashion the social mediome of a large (N > 1000) gathering of AIH patients and caregivers as present on a Facebook Group to determine the potential of mining various types health-related user information. The following types of information were mined, with feasible indicating a reliability of F >= 0.670: 1) Types of health information shared and structures of information sharing (Feasible) 2) Types and directionality of support provided by and to users (Portions feasible) 3) Clinical factors (AIH-related and otherwise) disclosed by users a. Medication intake (Feasible) b. Signs and symptoms (including pain and injury) and diagnosed comorbidities (Portions feasible) c. Results of disease monitoring blood tests (Portions feasible) 4) Contextual (non-clinical; environmental; social) factors disclosed by users (Detection of which type of factor discussed occasionally feasible). The resulting knowledge is required to adequately describe the disease not only clinically, but also environmentally and socially, and will form part of the basis for future disease studies.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.