Plusieurs lymphomes à cellules B présentent des anomalies génétiques qui sont importantes pour déterminer leurs caractéristiques biologiques et peuvent être utiles pour le diagnostic. Les types les plus courants sont le lymphome folliculaire et le lymphome diffus à grandes cellules B (LDGCB), qui représentent à eux deux plus de 60 % de tous les lymphomes. Les LDGCB sont agressifs mais peuvent être traités par chimiothérapie à agents multiples. Cependant, les gènes suppresseurs de tumeur (GST) potentiellement responsables de la lymphomagenèse ne sont pas tous connus. Le rationnel de ce projet reposait sur des données non publiées du projet translationnel GHEDI (déchiffrer l'hétérogénéité génétique du lymphome diffus à grandes cellules B à l'ère du rituximab). Une hybridation génomique comparative (CGH) (puce Agilent 180 K) a été réalisée sur une série de 202 LDGCB de la série GHEDI et 40 % des délétions de la région 6q21 ont été identifiées, dont la région minimale commune délétée qui contient le gène HACE1. Par ailleurs, l'analyse transcriptomique a montré une corrélation significative entre le nombre de copies du gène et le niveau d'expression. Le gène HACE1, situé sur le chromosome 6q, code pour une ubiquitine ligase E3 et est régulé négativement chez l'homme dans les tumeurs, y compris les neuroblastomes et les lymphomes à cellules tueuses naturelles (NK). Il a été montré que le gène HACE1 ubiquityle Rac1, une protéine impliquée dans la prolifération cellulaire et la progression G2/M du cycle cellulaire. La fonction du gène HACE1 et les facteurs impliqués dans sa régulation transcriptionnelle sont en grande partie inconnus dans le contexte des lymphomes à cellules B. Dans cette étude, nous avons examiné si le gène HACE1 était un gène candidat dans la région génomique 6q impliqué dans la lymphomagenèse des LDGCB et plus largement dans les lymphomes B. Nous avons déterminé la fréquence de l'inactivation du gène HACE1 dans le lymphome à cellules B et analysé les mécanismes impliqués dans son extinction. / Several B-cell lymphomas have characteristic genetic abnormalities that are important in determining their biologic features and can be useful in differential diagnosis. Historically, classical Hodgkin lymphomas have been distinguished from non-Hodgkin lymphomas (NHL). The most common types are follicular lymphoma and diffuse large B-cell lymphoma (DLBCL), which together make up more than 60% of all lymphomas. DBCL are aggressive but potentially curable with multi-agent chemotherapy. However the putative tumor suppressor genes (TSG) responsible for lymphomagenesis still remain unknown. The rational of this project was based on unpublished data from the translational project GHEDI (Deciphering the Genetic Heterogeneity of Diffuse large B-cell lymphoma in the rituximab era). Array comparative genomic hybridization (aCGH) (Agilent 180 K) was performed in a series of 202 DLBCL and found 40% of deletions of 6q21 region, whose minimal commune deleted region (MCR) contains HACE1 gene. Furthermore, transcriptomic analysis showed a significant correlation between gene copy number and expression level. HACE1, located on chromosome 6q, encodes an E3 ubiquitin ligase and is downregulated in human tumors such as neuroblastomas and natural killer (NK) lymphomas. HACE1 has been shown to ubiquitylate Rac1, a protein involved in cell proliferation and G2/M cell cycle progression. The function of HACE1 and the factors involved in its transcriptional regulation are largely unknown in the context of B-cell lymphomas. In this study, we investigated whether HACE1 is a candidate gene in the 6q genomic region involved in DLBCL lymphomagenesis. We determined the frequency of HACE1 inactivation in B-cell lymphoma and analyzed the mechanisms involved in its silencing. We show, by RT-qPCR, that HACE1 gene is constitutively expressed in normal lymph nodes and in normal B-cells isolated from peripheral blood, contrasting with a strong downregulation of its expression in more than 70% (77/111) of B-cell lymphoma cases and in four tested B-Lymphoma cell lines. HACE1 gene copy number was assessed by quantitative multiplex PCR of short fluorescent fragments (QMPSF) and array for comparative genomic hybridization (aCGH) in 91 DLBCL cases.

La polyarthrite Rhumatoïde (PR) et le syndrome de Sjögren primitif (pSS) sont des deux maladies auto-immunes invalidantes pour lesquelles il n’existe à ce jour pas de traitement permettant la guérison des patients. Bien que les lymphocytes B soient impliqués dans le développement ces pathologies, l’existence de lymphocytes B capables de réguler l’inflammation est maintenant largement reconnue. Ces lymphocytes B régulateurs (Bregs) sont capables à la fois d’induire des lymphocytes T régulateurs et d’empêcher le développement de lymphocytes T pro-inflammatoires. In vivo, le transfert de ces Bregs est protecteur dans de nombreux modèles murins de maladies auto-immunes suggérant ainsi que promouvoir ces Bregs serait prometteur pour traiter les patients atteints de PR ou pSS. Cependant, il n’existe à ce jour pas de marqueur spécifique des Bregs, ce qui complique leur étude. Comme leurs fonctions régulatrices sont principalement médiées par l’IL-10, une cytokine anti-inflammatoire, les Bregs peuvent être définis par leur capacité à produire de l’IL-10 après activation par des composés bactériens, notamment CpG, motifs mimant l’ADN microbien. Ces Bregs sont appelés B10+. Toutefois, les fonctions de ces B10+ ne sont pas bien définies chez l’homme. Ainsi, nous ignorons si la seule production d’IL-10 est suffisante pour définir les Bregs.Cette thèse a donc pour premier objectif de définir les fonctions les B10+ stimulés par CpG chez les individus sains et chez les patients, afin de déterminer si la production d’IL-10 était un bon marqueur des Bregs. Nous avons montré que les B10+ induits par CpG étaient capables d’induire des lymphocytes T régulateurs (Tregs et Tr1) mais ne diminuaient pas la proportion de lymphocytes T pro-inflammatoires (Th1 et LT-TNFα+). Chez les patients PR et pSS, les B10+ induisaient des Tregs et Tr1 mais chez les patients PR, ils induisaient également des Th1. Ces résultats suggèrent que la production d’IL-10 seule ne suffit pas à récapituler toutes les fonctions régulatrices des Bregs, et que le stimulus CpG impacte probablement leur fonctions.Pour mieux comprendre les mécanismes contrôlant la production d’IL-10 des lymphocytes B et pouvoir proposer d’autres stimuli pour les générer, nous avons étudié l’effet de l’acétate, un composé produit par les bactéries commensales, sur la génération des B10+. L’acétate était capable d’induire des B10+ chez la souris et chez l’homme. D’autre part, nous avons également étudié le métabolisme cellulaire de ces B10+. Nous avons montré que la glutamine était un nutriment essentiel à la génération des B10+ et à leurs fonctions régulatrices. En définitive, ce travail a permis de définir les fonctions des B10+ induits par CpG, de caractériser leur métabolisme et de proposer de un stimulus alternatif pour générer les B10+. / Rheumatoid arthritis (RA) and primary Sjögren's syndrome (pSS) are two debilitating autoimmune diseases. There is currently no treatment to cure patients. Although B lymphocytes are involved in the development of these pathologies, the existence of B cells capable of regulating inflammation is now widely recognized. These regulatory B cells (Bregs) are able of both inducing regulatory T cells and preventing the development of pro-inflammatory T cells. In vivo, the transfer of these Bregs is protective in many mouse models of autoimmune diseases thus suggesting that promoting these Bregs would be promising for treating patients with RA or pSS. However, there is currently no specific marker for Bregs, which largely hinders their study. Since their regulatory functions are mainly mediated by IL-10, an anti-inflammatory cytokine, Bregs can be defined by their ability to produce IL-10 after activation by bacterial compounds, including CpG. Those Bregs are called B10+ cells. However, the functions of these B10+ cells are not well defined in humans. We do not know whether IL-10 production is a sufficient marker to define Bregs.The main goal of this thesis was to define CpG-induced B10+ cell functions in healthy individuals and patients, to determine whether IL-10 production was a good marker for Bregs. We showed that CpG-induced B10+ cells were able to induce regulatory T cells (Tregs and Tr1) but did not decrease the proportion of pro-inflammatory T cells (Th1 and LT-TNFα +). In RA and pSS patients, B10+ cells induced Tregs and Tr1 but in RA patients they also induced Th1. These results shows that IL-10 production alone does not recapitulate all the Breg functions and that CpG stimulation might impact their functions.To better understand the mechanisms controlling IL-10 production by B cells, and to be able to propose other stimuli to generate them, we studied the effect of acetate, a compound produced by commensal bacteria, on B10+ cells generation. Acetate was able to induce B10+ cells in mice and humans. Besides, we studied B10+ cell metabolism. We have showed that glutamine was an essential nutrient for B10+ cell generation and for their regulatory functions. This work has made it possible to define the CpG-induced B10+ cell functions, to characterize their metabolism and to propose an alternative stimulus to generate B10+ cells.

Le lupus érythémateux disséminé (LED) est une maladie auto-immune systémique caractérisée par une inflammation provoquant des lésions dans de nombreux organes tels que les reins, les poumons ou la peau. Dans cette pathologie, une activation excessive du système immunitaire conduit à la production d’auto-anticorps dirigés, le plus souvent, contre du matériel nucléaire. La différenciation des lymphocytes B (LB) en cellules productrices d’anticorps requiert une communication entre les LT et les LB. Ce dialogue est régulé par de nombreux acteurs cellulaires et moléculaires afin de permettre la mise en place d’une réponse humorale efficace en cas d’infections, mais aussi de prévenir le développement de maladies auto-immunes. Mon projet de thèse a consisté à étudier l’implication de deux de ces acteurs, l’un favorisant la différenciation des LB en plasmocytes, à savoir, les cellules T folliculaires auxiliaires (TFH) et le second régulant négativement l’activation lymphocytaire, le récepteur co-inhibiteur BTLA (pour B and T Lymphocyte Attenuator) dans le LED chez l’Homme. Au cours de cette étude, nous avons d’une part amélioré les connaissances concernant les sous-populations de TFH circulantes humaines, en décrivant que parmi les cellules TFH CXCR3-CCR6- sont retrouvées des cellules aux propriétés suppressives. De plus, nous avons suggéré que la contraction des TFH1 (CXCR3+CCR6-) au profit des TFH2 (CXCR3-CCR6-), observées chez les patients lupiques, pourrait être le reflet d’une migration des TFH1 vers les organes inflammés. D’autre part, nous avons mis en évidence un défaut fonctionnel de BTLA dans les LT CD4+ de patients lupiques. Ce défaut, restauré en normalisant le métabolisme lipidique des LT CD4+, semble associé à la sévérité de la pathologie. En parallèle de ces observations, nous avons démontré un défaut d’expression de BTLA sur les LB et les LT CD4+ régulateurs de patients lupiques. L’ensemble de nos données sont prometteuses et ouvrent de nouvelles perspectives thérapeutiques pour le traitement du LED. / Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by lesions in several organs such as kidneys, lungs and skin for instance. In this pathology, an excessive activation of the immune system leads to the production of autoantibodies targeting mainly nuclear antigens. B cell differentiation into antibody-secreting cells requires a close collaboration between T and B cells. This cross-talk is regulated by various cellular and molecular factors in order to mount an efficient humoral response in case of infection, but also to prevent autoimmune disease development. The aim of my thesis was to study two regulating factors of the B cell response, one promoting the B cell differentiation into plasma cells, i.e the follicular helper T cells (TFH) and the other one inhibiting lymphocyte activation, i.e a co-inhibitory receptor called BTLA (« B and T Lymphocyte Attenuator ») in human SLE. In this study, we first improved our knowledge concerning human circulating TFH cells, by describing among the CXCR3-CCR6- TFH cell subset, a population with suppressive capacities. Moreover, we suggested that the decreased frequency of TFH1 in lupus patients’ blood could be explained by the migration of these cells into inflamed tissues. We also highlighted a BTLA functional deficiency in lupus CD4+ T cells. This deficiency, which can be restored by normalizing the lipid metabolism, seems to be associated to disease severity. Furthermore, we described an altered expression of BTLA in lupus B cells and regulatory T cells. Altogether, our data show promising results and suggest new potential therapeutic strategies for lupus treatment.

CD4 T cells and B cells are cells associated with the adaptive immune system. The adaptive immune system is designed to mount a rapid antigen-specific response to pathogens by way of clonal expansions of T and B cells bearing discrete antigen-specific receptors. During viral infection, interactions between CD4 T cells and B cells occur in a dynamic process, where B cells that bind to the virus internalize and degrade virus particles. The B cells then present viral antigens to virus-specific CD4 T cells that activate the B cells and cause them to proliferate and differentiate into virus-specific antibody-secreting cells. Yet, non-specific hypergammaglobulinemia and the production of self-reactive antibodies occur during many viral infections, and studies have suggested that viral antigen-presenting B cells may become polyclonally activated by CD4 T cells in vivo in the absence of viral engagement of the B cell receptor. This presumed polyclonal B cell activation associated with virus infection is of great medical interest because it may be involved in the initiation of autoimmunity or contribute to the long-term maintenance of B cell memory. In order to directly examine the interactions that occur between T cells and B cells, I asked what would happen to a polyclonal population of B cells that are presenting viral antigens, if they were transferred into virus-infected hosts. I performed these studies in mice using the well-characterized lymphocytic choriomeningitis virus (LCMV) model of infection. I found that the transferred population of antigen-presenting B cells had two fates. Some antigen-expressing B cells were killed in vivo by CD4 T cells in the first day after transfer into LCMV-infected hosts. However, B cells that survived the cytotoxicity underwent a dynamic polyclonal activation manifested by proliferation, changes in phenotype, and antibody production. The specific elimination of antigen-presenting B cells following adoptive transfer into LCMV-infected hosts is the first evidence that MHC class II-restricted killing can occur in vivo during viral infection. This killing was specific, because only cells expressing specific viral peptides were eliminated, and they were only eliminated in LCMV-infected mice. In addition to peptide specificity, killing was restricted to MHC class II high cells that expressed the B cell markers B220 and CD19. Mice depleted of CD4 T cells prior to adoptive transfer did not eliminate virus-specific targets, suggesting that CD4 T cells are required for this killing. I found that CD4 T cell-dependent cytotoxicity cannot be solely explained by one mechanism, but Fas-FasL interactions and perforin are mechanisms used to induce lysis. Polyclonal B cell activation, hypothesized to be the cause of virus-induced hypergammaglobulinemia, has never been formally described in vivo. Based on previous studies of virus-induced hypergammaglobulinemia, which showed that CD4 T cells were required and that hypergammaglobulinemia was more likely to occur when virus grows to high titer in vivo, it was proposed that the B cells responsible for hypergammaglobulinemia may be expressing viral antigens to virus-specific CD4 T cells in vivo. CD4 T cells would then activate the B cells. However, because the antibodies produced during hypergammaglobulinemia are predominantly not virus-specific, nonvirus-specific B cells must be presenting viral antigens in vivo. In my studies, the adoptively transferred B cells that survived the MHC class II-restricted cytotoxicity became polyclonally activated in LCMV-infected mice. Most of the surviving naïve B cells presenting class II MHC peptides underwent an extensive differentiation process involving both proliferation and secretion of antibodies. Both events required CD4 cells and CD40/CD40L interactions to occur but B cell division did not require MyD88-dependent signaling, type I interferon signaling, or interferon γ signaling within B cells. No division or activation of B cells was detected at all in virus-infected hosts in the absence of cognate CD4 T cells and class II antigen. B cells taken from immunologically tolerant donor LCMV carrier mice with high LCMV antigen load became activated following adoptive transfer into LCMV-infected hosts, suggesting that B cells can present sufficient antigen for this process during a viral infection. A transgenic population of B cells presenting viral antigens was also stimulated to undergo polyclonal activation in LCMV-infected mice. Due to the high proportion of B cells stimulated by virus infection and the fact that transgenic B cells can be activated in this manner, I conclude that virus-induced polyclonal B cell activation is independent of B cell receptor specificity. This approach, therefore, formally demonstrates and quantifies a virus-induced polyclonal proliferation and differentiation of B cells which can occur in a B cell receptor-independent manner. By examining the fate of antigen-presenting B cells following adoptive transfer into LCMV-infected mice, I have been able to observe dynamic interactions between virus-specific CD4 T cells and B cells during viral infection. Adoptive transfer of antigen-presenting B cells results in CD4 T cell-mediated killing and polyclonal activation of B cells during LCMV infection. Studies showing requirements for CD4 T cells or MHC class II to control viral infections must now take MHC class II-restricted cytotoxicity into account. Polyclonal B cell activation after viral infection has the potential to enhance the maintenance of B cell memory or lead to the onset of autoimmune disease.

No description available.

Long-term renal graft acceptance still requires long-term immunosuppressive therapy, which is accompanied by many adverse effects. Contrarily insufficient immunosuppression could lead to graft rejection and its failure. Therefore, research continues for biomarkers that reflect a patient's immunological status and thus allowing for individualized immunosuppressive therapy. In our study we showed lower incidence of acute rejection in kidney transplant recipients treated with rabbit anti-thymocyte globulin (rATG) or basiliximab induction within the first three months after transplantation. The rATG induction caused profound decrease of recipient's peripheral blood T and NK cells, as well as transcripts that are exclusively expressed by these cell types together with expansion of regulatory T cells (Tregs) among CD4+ T cells. In rATG group the increase of two transcripts associated with rejection (MAN1A1 and TLR5) was also observed in early post-transplant period. After the basiliximab induction we transiently detected CD4+CD25low/-FoxP3+ cell population along with disappearance of CD4+CD25+FoxP3+ Tregs. Basiliximab induction resulted in a transient increase in CD4+FoxP3+ Tregs, accompanied by the highest peripheral expression levels of markers associated with operational tolerance (FOXP3 and TCAIM)....

1 ABSTRACT B-cell non-Hodgkin lymphomas (B-NHL) represent the most common mature lymphoproliferative diseases. B-NHL arise at different stages of B-cell development and represent their malignant counterpart. Diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) are aggressive types of B-NHLs. Deregulation of cell cycle control, inhibition of apoptosis or abnormal DNA damage response play a key role in the pathogenesis of DLBCL and MCL. Aberrant activation of several signaling pathways that further promote survival, cell proliferation or affect the tumor microenvironment have been recently recognized. Increased understanding of the oncogenic mechanisms implicated in pathogenesis of B-NHL lead to development of novel agents that target the oncogenic drivers of distinct lymphoma subtypes. MCL is an aggressive subtype of B-NHL associated with poor prognosis. In vivo models of human MCL for experimental therapy are however scarce. We established and characterized several mouse models of human MCL by xenotransplantation of either primary cells or established cell lines into immunodeficient mice (publication no 1). We demonstrated that engrafted MCL cells displayed complex changes of gene expression profile, phenotype and sensitivity to cytotoxic agents compared to the original in vitro growing...

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, qui touchent plus de 5% de la population, sont induites par une perte de la tolérance aux antigènes du Soi. Ces pathologies, généralement multifactorielles, résultent de l’effet combiné de plusieurs allèles de susceptibilité et de différents facteurs environnementaux. Les agents infectieux ont été tout particulièrement incriminés, mais les mécanismes en jeu restent encore mal élucidés. Les lymphocytes B, qui jouent un rôle central dans la pathogénie de nombreuses maladies auto-immunes, sont susceptibles d’être activés selon différents mécanismes au cours d’un processus infectieux et cette activation peut englober des cellules autoréactives. On ne sait cependant pas si cette activation peut entraîner la production d’auto-anticorps pathogènes de forte affinité et d’isotype IgG à partir du pool de cellules productrices d’auto-anticorps naturels de faible affinité, qui sont présentes de façon constitutive dans le répertoire B de l’individu sain. Nous avons mis au point un nouveau modèle murin knock-in pour des lymphocytes B présentant une affinité intermédiaire pour leur auto-antigène, la protéine HEL2X mutée (Hen-Egg Lysozyme). Ce modèle autoréactif d’affinité intermédiaire SWHEL X HEL2X, élaboré sur un fond génétique non autoimmun, permet de suivre le processus de maturation d’affinité des cellules B anti-HEL en présence de leur auto-antigène HEL2X au cours de l’infection chronique par la bactérie Borrelia burgdorferi. L’infection induit au niveau ganglionnaire une prolifération ainsi qu’une activation lymphocytaire B incluant des cellules anergiques. Certains clones autoréactifs sont capables de gagner les centres germinatifs ganglionnaires, de commuter vers l’isotype IgG et présentent des mutations somatiques au niveau de la région variable de la chaîne lourde de leur immunoglobuline, dans la zone d’interaction avec HEL2X, indiquant un processus de sélection par l’auto-antigène. Malgré un taux augmenté d’auto-anticorps d’isotype IgM, ces animaux ne produisent pas de plasmocytes capables de sécréter des auto-anticorps d’isotype IgG. Nos observations suggèrent l’existence de mécanismes de tolérance périphérique intrinsèques mis en place en particulier au niveau du centre germinatif. Un premier point de contrôle va éliminer les lymphocytes B autoréactifs ayant commuté de classe et présentant des mutations somatiques leur conférant une affinité augmentée pour l’auto-antigène tandis qu’un second point de contrôle va empêcher la différenciation en plasmocytes IgG+.Chez l’individu non prédisposé génétiquement, des mécanismes pourraient ainsi permettre de prévenir le développement d’une auto-immunité pathogène au cours d’un épisode infectieux. / Autoimmune diseases, affecting more than 5% of the population, reflect a loss of tolerance to selfantigens. These multifactorial diseases result from the combined effect of several susceptibility alleles and different environmental factors. Infectious agents have been particularly incriminated but there is no clear understanding of the underlying mechanisms. B lymphocytes, that appear central to the pathogenesis of several autoimmune diseases, may be activated by several mechanisms during infectious processes and this activation can encompass autoreactive cells. Whether or not the lattercan induce the production of high-affinity pathogenic IgG isotype auto-antibodies from the naturally present low-affinity self-reactive B cells is still unknown. To gain further insight into this question, we created a new intermediate affinity autoreactive mouse model called SWHEL X HEL2X. In these mice, knock-in B cells express a B cell receptor highly specific for Hen-Egg Lysozyme (HEL) that recognizes HEL2X mutated auto-antigen with intermediate affinity. This model, generated on a non-autoimmune-prone genetic background, allows the following of anti-HEL B cells affinity maturation process in presence of their auto-antigen during Borrelia burgdorferi chronic bacterial infection. The infection leads to lymph nodes lymphoproliferation and B cell activation including anergic cells. Some autoreactive clones are able to form germinal centers, toswitch their immunoglobulin heavy chain and to introduce somatic mutations in the heavy chain variable regions on amino-acids forming direct contacts with HEL2X, suggesting an auto-antigen-driven selection process. Despite increased levels of IgM autoantibodies, infected mice are unable to generate IgG autoantibody secreting plasma-cells. These observations suggest the existence of intrinsic peripheral tolerance mechanisms operating mainly at the level of germinal centers. The first checkpoint eliminates switched autoreactive B cells with increasing affinity mutations while a secondcheckpoint avoids IgG+ plasma-cell differentiation. Thus, in genetically non predisposed individuals, tolerance mechanisms may be set-up to prevent the development of pathogenic autoimmunity during the course of an infection.

Pacientes com linfoma difuso de grande célula B (LDGCB) do mesmo grupo de risco pelos critérios do Índice de Prognóstico Internacional (IPI), tratados com quimioterapia convencional à base de antraciclina, podem ter resposta terapêutica não esperada para seu grupo de risco. Isso pode ser explicado pelo fato do prognóstico dos LDGCB, que têm origem no centro germinativo (CG), ser superior aos originados após o CG (NCG). No intuito de aprimorar a avaliação de prognóstico e a abordagem terapêutica em LDGCB de IPI ajustado para a idade (IPIa) de risco intermediário alto e alto, elaboramos projeto de pesquisa, para verificar o papel dos marcadores imuno-histoquímicos (IH) e do transplante de medula óssea autólogo (ATMO), em primeira remissão completa (RC), neste grupo de pacientes. Avaliamos o impacto da expressão dos marcadores CD10, Bcl-6, MUM-1, Bcl-2 e p63 na obtenção de RC, sobrevida livre de doença (SLD) e sobrevida global (SG), isoladamente e de acordo com a origem em CG e NCG. Avaliamos 82 pacientes abaixo dos 60 anos, dos quais 16 (19,5%) receberam ATMO em primeira RC, além de serem comparados com os pacientes tratados com quimioterapia convencional e mantidos em observação após RC. A IH foi avaliável em 73 casos, 24 (32,9%) tiveram origem no CG e 49 (67,1%) NCG, sem diferença de sobrevida entre os grupos. A proteína Bcl-2 foi positiva em 27 (37%) pacientes e foi o único fator preditivo independente para SG à análise multivariada, com tendência de significância para RC. As SG e SLD em cinco anos para os 16 pacientes que receberam ATMO foi de 75% e 85,2%, respectivamente, a taxa de recidiva de 6,5% e diferença estatisticamente significativa para SLD (p = 0,015) em comparação aos pacientes apenas observados. Concluímos que o ATMO foi seguro e capaz de melhorar a sobrevida em LDGCB de risco intermediário alto e alto, e que a expressão de Bcl-2 pode ser utilizada na programação terapêutica inicial desses pacientes. / Diffuse large B cell lymphoma (DLBCL) patients from the same risk group according to the International Prognostic Index (IPI) treated with conventional anthracycline-based chemotherapy may show an unexpected therapeutic response. This can be explained by the fact that the prognosis of DLBCL originating in germinal center (GC) cells is superior than that originating out of germinal center (NGC). In order to improve the prognostic evaluation and the therapeutic approach to DLBCL patients with high intermediate to high age-adjusted IPI (aIPI), a research project was designed for the analysis of immunohistochemical markers and the role of autologous stem cell transplantation (ASCT) in first complete remission (CR) for this group of patients. The impact of the expression of CD10, Bcl-6, MUM-1, Bcl-2 and p63 markers on complete remission (CR), disease-free survival (DFS) and overall survival (OS), either individually and according to cell origin was evaluated by means of immunohistochemistry. Eighty-two patients aged under 60 years old were assessed, of which 16 (19.5%) underwent ASCT in first CR and were compared to patients receiving conventional chemotherapy and being monitored after CR. Immunohistochemistry was assessable in 73 cases, 24 (32.9%) being classified as GC-type and 49 (67.1%) as NGC-type, with no survival difference between the two groups. Bcl-2 expression was found in 37% (27) of the patients and was the single independent predicting factor of OS prognosis according to multivariate analysis. A significant tendency of expression of this protein was also observed for achieving CR, which was essential for longer survival, as shown by multivariate analysis. OS and DFS within 5 years were of 75% and 85.2% respectively for the group of 16 patients treated with ASCT, which resulted in lower relapse rates (6.5%) with statistically significant difference for DFS (p=0.015) when compared to the group of patients who achieved CR and was kept under monitoring. In this study ASCT was found to be a safe procedure for improving survival rates of DLBCL patients with high intermediate to high aIPI risk. Also, the expression of Bcl-2 protein was found to be useful as one of the variables to be analysed in the therapeutic approach to these patients