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

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

Introduction: Chronic graft-versus-host disease (cGVHD) is a serious complication following allo-HSCT characterized by immune dysregulation, organ dysfunction, risk for infection, and distressing symptoms. Complications may include scleroderma, hepatic dysfunction and bronchiolitis obliterans. Advances in allo-HSCT for many hematologic dyscrasias (e.g. acute and chronic leukemias, aplastic anemia, and myelodysplastic syndrome) have improved survival which has generated a renewed focus on survivorship issues. Distressing symptoms are noted as negatively impacting quality of life (QoL). The relationship between inflammation and behavioral responses may impact symptoms. Examining patterns and levels of inflammation with symptoms is relevant. Objective: The aims of this study were to examine: 1) levels of symptoms (cGVHD specific, general symptoms, and cluster symptoms [pain, depression and fatigue]), inflammation (cytokines [Interleukin {IL}-1β, IL-6, IL-10, TNF, and INF-γ] and C-reactive protein [CRP]) and QoL in patients diagnosed with cGVHD and 2) relationships between and among symptoms, inflammation and QoL in individuals with cGVHD. Methods: A cross-sectional study design examined 24 individuals (ages 29-79) with cGVHD enrolled from an NCI-designated cancer center after obtaining informed consent. Data were collected using medical record and validated questionnaires. Plasma cytokine levels were measured using BioRad® multiplex assay. C-reactive protein levels were measures using an enzyme-linked immunosorbant assay. Statistical analyses included descriptive statistics and pairwise correlations. Results: A total of 24 participants (58.3% female) with cGVHD enrolled in this study. Multiple, concurrent symptoms were noted. Several pro-inflammatory cytokines were higher in participants with symptoms versus those without symptoms. IL-6 correlated with lack of energy (r= .42; p= .04) and dry mouth (r= .42; p= .04). IL-10 was correlated with difficulty sleeping (r= .43; p= .03). Sexual dysfunction correlated with social well-being (r= -.44; p=.03). Many symptoms negatively correlated with QoL. Conclusion: Findings from this study, one of the first to examine levels of symptoms and inflammatory markers in individuals with cGVHD, demonstrate significant relationships among symptoms, inflammation, and quality of life. The relationship of inflammatory biomarkers with symptoms emphasizes the need for further interdisciplinary research. Better understanding mechanisms associated with symptoms is necessary for the development and testing of targeted interventions to improve QoL for individuals with cGVHD.

L'objectif de cette thèse était de faire le point sur la place de l'analyse de la moelle osseuse (MO) en tant que matrice alternative au sang en toxicologie médicolégale. Une méthode analytique a été développée et validée pour la quantification du citalopram, du diazepam et ses métabolites (nordazepam, temazepam, oxazepam) dans la MO et 10 autres matrices d'intérêt médicolégal. Cette procédure a été appliquée avec succès dans des cas réels pour l'analyse de matrices dégradées et a permis l'établissement d'une cinétique tissulaire chez l'animal au cours d'une étude pharmacocinétique. Cette cinétique animale a été intégrée dans une modélisation PBPK afin de prédire chez l'homme la distribution tissulaire du citalopram, du diazepam et son métabolite principal, le nordazepam, après administration orale thérapeutique. Ces simulations donnent des clefs intéressantes pour l'interprétation quantitative des concentrations tissulaires en toxicologie médicolégale. Une étude a été conduite pour déterminer l'influence du site de prélèvement sur la détermination des concentrations médullaires de caféine et sur la corrélation de ces concentrations avec les dosages sanguins. Elle montre que le site de prélèvement de MO est un paramètre important à prendre en considération dans l'interprétation quantitative des analyses de MO. L'ensemble de ce travail confirme l'intérêt de la MO en toxicologie médicolégale. Des études expérimentales ont permis d'approfondir les connaissances de cette matrice autour des problématiques du prélèvement, de l'analyse et de la distribution ante mortem afin de contribuer à l'interprétation qualitative et quantitative des analyses réalisées sur la MO / The aim of this work was to evaluate the interest of bone marrow (BM) analysis in forensic toxicology, as an alternative matrix to blood. An analytical method was developed and validated for the quantification of citalopram, diazepam, and its main metabolites (nordazepam, temazepam, oxazepam) in BM and 10 others matrices of forensic interest. This procedure was successfully applied to real cases for putrified sample analyses and to establish a tissue kinetic in rabbit samples for a pharmacokinetic study. These animals kinetics were implemented in PBPK modeling to predict in human tissue distribution of citalopram, diazepam, and its metabolite, nordazepam, after oral therapeutic administration. These predictions gave some clues to interpret quantitatively tissue concentrations in forensic toxicology. A study was also performed to examine whether BM sample location may influence post mortem BM quantification and correlation between BM and blood concentrations. Caffeine was used as test compound. Sample location was found to be an important parameter to consider in quantitative interpretation of BM analyses. This work confirmed the interest of BM in forensic toxicology. Experimental studies improved our knowledge on this matrix about the problematic of sample location, analytical procedure and ante mortem distribution to contribute to qualitative and quantitative interpretation of BM analyses

CHARLES UNIVERSITY IN PRAGUE Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Study program: Health Care Bioanalytics Candidate: Bc. Nikola Fučíková Supervisor: doc. MUDr. Lukáš Smolej, Ph.D. Title of diploma thesis: Prognostic significance of atypical leukemic cell morphology in chronic lymphocytic leukemia The aim of this thesis is to evaluate the prognostic significance of atypical cell morphology and smudge cells in patients with untreated chronic lymphocytic leukemia. We performed differential leukocytes count and classified lymphocytes as typical and atypical in a cohort of 101 patients (median age, 66 years; males, 69%, Rai III/IV stages, 18%). For atypical CLL, we used the 15% threshold and 59% of patients were classified as atypical CLL (aCLL). For smudge cells, we chose the 30% threshold and 33% of patients were classified as smudge cells positive. Patients in early clinical Rai stage (0) had significantly higher number of smudge cells (p=0.04). We didn't find a significant association between aCLL / smudge cells with modern prognostic indicators. We didn't find a relationship between aCLL and the time to first-line therapy (p=0.394). However, patients with aCLL had a significantly shorter overall survival (p=0.0397). There was a trend toward shorter...

L’adhésion, la migration cellulaire et l’environnement stromal sont intimement liés pour garantir l’homéostasie du système immuno-hématopoïétique. Néanmoins, nos connaissances des mécanismes responsables du maintien de ce processus fonctionnel restent fragmentaires. Notre étude a permis de mieux caractériser le stroma ganglionnaire et médullaire dans lesquels nous avons démontré de nouveaux rôles immuno-régulateurs des molécules d’adhésion jonctionnelle JAM-B et JAM-C. Dans la zone T des ganglions lymphatiques, les cellules réticulaires fibroblastiques (FRC) sécrètent des composés de la matrice extracellulaire et des chimiokines homéostatiques, nécessaires à la migration intranodale des lymphocytes T naïfs. La génération de nouveaux anticorps monoclonaux a permis d’identifier une diversité phénotypique et fonctionnelle au sein de la population FRC. L’un d’entre eux reconnaît la Thrombomoduline permettant d’identifier une population de FRC exprimant les protéines JAM-C et PDGFRα. Cette population cellulaire, dénommée FRCDP (Double Positive) sécrète des chimiokines homéostatiques, ce qui la distingue de la population FRCDN (Double Negative). Les souris sauvages traitées avec l’anticorps anti-JAM-C présentent une diminution significative du taux intranodal des chimiokines CXCL12, CCL19, CCL21 affectant la recirculation des cellules T naïves. De façon similaire, les cellules stromales des niches hématopoïétiques fournissent un environnement fonctionnel, nécessaire à l’homéostasie du système hématopoïétique. Les molécules d’adhésion sont connues pour contrôler ces mécanismes. JAM-C est exprimée à la surface des cellules souches hématopoïétiques (CSH) mais son rôle dans l’hématopoïèse reste inconnu. Notre étude montre que la molécule JAM-B est exprimée par l’environnement médullaire et interagit spécifiquement avec JAM-C sur les CSH. Les souris déficientes pour le gène jam-b présentent une diminution du nombre de CSH quiescentes et une réponse accrue aux agents mobilisants, démontrant ainsi que le couple JAM-B/JAM-C est nécessaire au maintien et à la rétention des CSH dans la moelle osseuse. / Homeostasis of the immune and hematopoietic system is dependent of cell adhesion, cell migration and stromal environment. Nevertheless, the molecular mechanisms involved in the crosstalk between hematopoietic and stromal cells have remained elusive. Our studies allowed to better characterize lymph node (LN) and bone marrow (BM) stromal compartments through the demonstration that expression of junctional adhesion molecules (JAM) in these compartments is necessary for the maintenance of immune and hematopoietic homeostasis. In the T cell zone (LN), extracellular matrix and homeostatic chemokines are secreted by fibroblastic reticular cells (FRC) which control naive T cell migration. We have identified new FRC subsets using a monoclonal antibody based approach to identify new cell surface markers of stromal cells. We have found that the FRC population expressing JAM-C, Thrombomodulin and PDGFRα (FRCDP, for Double Positive) secretes homeostatic chemokines such as CCL21, CCL19 and CXCL12. In contrast, FRCDN (Double Negative) that lack JAM-C and Thrombomodulin expression do not. Functionally, we have shown that JAM-C controls the secretion of CCL21, CCL19 and CXCL12 by FRCDP and that anti-JAM-C treated mice exhibit a decrease of intranodal chemokine contents. These results suggest that JAM-C may regulate homeostasis through the control of homeostatic chemokine secretion. We therefore asked the question whether similar function for JAM-C or its ligand JAM-B may be identified in the bone marrow. In the BM, Hematopoietic Stem Cells (HSC) are maintained quiescent and undifferentiated in specific stromal structures called HSC niches. HSC/niche interactions via adhesion molecules and chemokines are known to be active player of HSC homeostasis. Recently, JAM-C expression by HSC has been reported, but its role in hematopoiesis has remained elusive. We have demonstrated that HSC interact with JAM-B expressed by BM stromal cells in a JAM-C dependent manner. Moreover, we have observed a decreased pool of quiescent HSC in jam-b deficient mice. Finally, we have found that jam-b deficient mice exhibit an increase in intramedullary CXCL12 content and an exacerbated response to mobilizing agents. Collectively, these data demonstrate that JAM-B and JAM-C play a dual function in lymph node and bone marrow microenvironments through the regulation of leuko-stromal adhesion and chemokine secretion.

As células-tronco mesenquimais (MSCs) da medula óssea compreendem uma população de células multipotentes com propriedades imunorreguladoras e capacidade de secreção de fatores de crescimento, desempenhando um papel fundamental na regulação da hematopoiese. À luz dessas propriedades, alguns estudos fornecem uma análise das relações estabelecidas entre células-tronco hematopoiéticas normais (HSCs) e MSCs quando expostas à cocultura. Jing et al. (Haematologica, 2010) demonstram neste tipo de arranjos de cocultura a geração de três populações distintas de células: células não aderentes (Fração A), células aderidas à superfície de MSCs (Fração B) e células abaixo das MSCs (Fração C). Além disso, dados recentes apontam para a associação da progressão da doença com a evidência de transferência de mitocôndrias funcionais (mt) e espécies reativas de oxigênio (ROS) das MSCs para as células leucêmicas. É teorizado como um mecanismo de MSCs, a fim de reduzir as espécies reativas de oxigênio (ROS). No entanto, os desempenhos diferenciais nesses processos de transferência entre MSCs normais e leucêmicas em sistemas de cocultura em cada uma dessas populações de células distintas não foram estabelecidos. As células leucêmicas (CD45+) têm um aumento de quase três vezes na proliferação em todas as três populações após a cocultura com MSCs leucêmicas, mas não após a cocultura com MSCs saudáveis. As células CD45+ da fração A têm uma baixa taxa de proliferação em cocultura com MSCs normais comparadas com as células leucêmicas. Em 5d, as MSCs leucêmicas (CD73+) aumentam 20 vezes a coloração de mitotracker em comparação com 3d, implicando que os blastos AML estimulam MSCs a produzir mais mt, embora os MSCs normais apresentem os mesmos níveis de mitotracker em 3 / 5d. Além disso, os níveis de mtROS diminuem em 10 vezes em 5d em comparação com 3d em leucemia, mas não em MSCs normais, sugerindo uma recuperação mediada por mt em MSCs leucêmicas após a cocultura. Finalmente, o ROS total diminui 2 vezes nas células CD45+ após cocultura com MSCs leucêmicas por 5d, mas não em contrapartida normal. Em essência, esses achados sugerem diferentes mecanismos de doação mitocondrial de MSCs para blastos LMA. Além disso, o estudo fornece um passo importante nacompreensão da natureza complexa do metabolismo do tumor, não apenas na célula maligna, mas também dentro do microambiente que a suporta. / Bone marrow mesenchymal stromal cells (MSCs) comprise a population of multipotent cells with immunoregulatory properties and the capability of secreting growth factors, playing a key role in the regulation of hematopoiesis. In light of these properties, some studies provide analysis of the relations established between normal hematopoietic stem-cells (HSCs) and MSCs when exposed to coculture. Jing et al. (Haematologica, 2010) demonstrate in these kind of coculture arrangements the generation of three distinct cells populations: non-adherent cells (supernatant), phasebright cells (adhered to the surface of MSCs) and phase-dim cells (beneath the MSCs). Furthermore, recent data pointed to the association of disease progression in AML with the evidence of functional mitochondria (mt), and reactive oxygen species (ROS) transference from MSCs to the blasts cells. It is theorized as a mechanism of MSCs in order to reduce the reactive oxygen species (ROS). Nevertheless, the differential performances in these transference process among normal and leukemic-MSCs in coculture systems in each of those distinct cells populations were not established. AML cells (CD45+) have an increase of almost 2.5-fold in proliferation in all of 03 populations after coculture with leukemic-MSCs but not after coculture with a normalMSCs. The CD45+ cells in phase-bright/dim have a low proliferation rate in coculture with normal-MSCs compared with the leukemic cells. In 5d, the leukemic-MSCs (CD73+) increase 20-fold the mitotracker staining compared with 3d, implying that AML blasts stimulate MSCs to produce more mt, albeit the normal-MSCs present the same mitotracker levels in 3/5d. Additionally, the mtROS levels decrease by 10-fold in 5d compared with 3d in leukemic, but not in normal-MSCs, suggesting mt mediated recover in leukemic-MSCs after coculture. Finally, total ROS decrease 2-fold in CD45+ cells after coculture with leukemic-MSCs for 5d, but not in normal counterpart. In essence, these findings suggest different mechanisms of mitochondrial donation from MSCs to AML blats. Moreover, the study provides an important step in the understanding of the complex nature of tumor metabolism, not only in the malignant cell, but also within the microenvironment which supports it.

Orientador: Fernanda de Oliveira Sarreta / Resumo: O Transplante de Medula Óssea (TMO) é um tratamento especializado, realizado em centros de alta complexidade, como uma alternativa no controle de algumas doenças oncohematológicas. Esse procedimento proporciona um controle da doença, porém o risco de morte e complicações são constantes durante a realização do transplante. A vivência dos usuários nesse processo provoca diversos impactos na qualidade de vida, o que evidencia a relevância do estudo, uma vez que pode ampliar a compreensão desta realidade vivenciada pelos/as usuários/as. A pesquisa tem como objetivo geral: Compreender o Transplante de Medula Óssea (TMO) como um direito no SUS, sendo o acesso à saúde garantido a todo cidadão e de quem dela necessitar, o que inclui procedimentos de alta complexidade como o TMO. E, como os específicos: Analisar a política de saúde no contexto do neoliberalismo; Desvendar o acesso e o tratamento ao TMO no Brasil e; Refletir a atuação profissional do Serviço Social com os usuários no TMO. Trata-se de pesquisa bibliográfica e documental, com abordagem qualitativa, respaldada pelo método do materialismo histórico dialético, para o desenvolvimento referencial teórico crítico, a historicidade da política de saúde e do Transplante de Medula Óssea, como um direito no Sistema Único de Saúde. O estudo desvenda as fases do TMO e as implicações deste procedimento na vida dos usuários submetidos ao tratamento, como o longo período de internação e de permanência, rotina ambulatorial, restrições, m... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Bone Marrow Transplant (BMT) is a specialized treatment performed in high complexity centers, as an alternative in the control of some oncohematological diseases. This procedure provides disease control, but the risk of death and complications are constant during transplantation. The experience of users in this process causes several impacts on quality of life, which highlights the relevance of the study, since it can broaden the understanding of this reality experienced by users. The research aims to: Understand Bone Marrow Transplant (BMT) as a right in the SUS, and access to health is guaranteed to all citizens and those who need it, including high complexity procedures such as BMT. And, as specific: Analyze health policy in the context of neoliberalism; Unveil the access and treatment to BMT in Brazil and; Reflect the professional performance of Social Work with users in the BMT. This is a bibliographic and documentary research with a qualitative approach, supported by the dialectical historical materialism method, for the critical theoretical referential development, the historicity of health policy and Bone Marrow Transplantation, as a right in the Unified Health System. Reveals the phases of the BMT and the implications of this procedure on the life of the users submitted to the treatment, such as the long period of hospitalization and permanence, outpatient routine, restrictions, changes, fragility conditions and limitations, as well as sequelae and permanent care. Th... (Complete abstract click electronic access below) / Mestre

Objectives: Hematopoietic stem cell transplantation (HSCT) is a widely used method for treatment of hematological disorders and some other diseases. However, sometimes a suitable donor of hematopoietic stem cells (HSC) is not found for a patient. Because HSC have been described as cells with low proliferative and metabolic activity, their tolerance to the lack of oxygen or metabolic substrates may be assumed. In this study, we explored cadaveric bone marrow as an alternative source of HSC for HSCT, using a mouse experimental model. In addition, the effect of in vitro metabolic inhibition and short-term in vitro storage (1 - 4 days) on functional properties of mouse HSC was investigated. Methods: C57Bl/6 mice (wild-type or p53-/- ) were used in the experiments. To explore cadaveric HSC, bone marrow (BM) was left in intact femurs at 37řC, 20řC and 4řC under the conditions of ischemia. The bone marrow cells were harvested after defined time periods ranging 0 - 48 hours. For metabolic inhibition, the electron transport chain inhibitor potassium cyanide (KCN) and inhibitor of glycolysis 2-deoxy-D-glucose (2-DG) were used in vitro. To determine the impact of ischemia, metabolic inhibition, or in vitro storage on transplantability of HSC, the competitive repopulation assay using Ly5.1/Ly5.2 congenic model...

Introdução: A anemia aplástica (AA) adquirida é uma doença grave, caracterizada por pancitopenia e medula óssea hipocelular sem que haja associação com aumento de reticulina ou infiltração anormal na medula. Embora o mecanismo fisiopatológico não esteja totalmente elucidado, atribui-se a uma resposta imunomediada dos linfócitos T no ambiente medular. A trombopoetina (codificada pelo gene THPO) é um hormônio glicoproteico produzido pelo fígado e responsável pelo estímulo de crescimento de megacariócitos, desenvolvimento plaquetário e de demais linhagens e, quando disfuncional, contribui para o desenvolvimento da AA adquirida. Objetivos: Investigar a presença de variantes genéticas no THPO em amostras de sangue periférico e medula óssea de pacientes com AA adquirida (grupo caso) e de indivíduos saudáveis (grupo controle) e verificar a presença de alterações no número de plaquetas durante o seguimento dos pacientes com AA adquirida. Métodos: O gene THPO foi sequenciado em amostras de DNA de medula óssea de 92 pacientes com AA adquirida e no DNA de sangue periférico de 92 controles, cujas amostras haviam sido previamente armazenado no Laboratório de Hematologia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP). O sequenciamento foi realizado pelo método de Sanger. Realizou-se também a associação entre a presença (ou ausência) de variantes em THPO e o número de plaquetas em 83 pacientes utilizando o teste ANOVA Para outras análises estatísticas, foram utilizados os testes t e qui-quadrado com nível de significância de 5%. Resultados: Foram encontrados três polimorfismos de nucleotídeo único (SNPs) nos pacientes com AA adquirida (rs956732, rs6141 e rs3804618). Os mesmos três SNPs foram observados nos indivíduos do grupo controle (p>0,05). Não houve associação entre o número de plaquetas e a presença de SNPs nos pacientes (p>0,05). Conclusões: Três SNPs foram encontrados em frequências alélicas semelhantes tanto no grupo de pacientes quanto nos controles, sugerindo que a trombopoetina não apresenta alterações genéticas que possam ser associadas à fisiopatologia da AA adquirida nessa coorte. / Introduction: Acquired aplastic anemia (AA) is a severe illness, characterized by pancytopenia and hypocellular bone marrow without increased reticulin or abnormal infiltration of the bone marrow. Although the physiopathological mechanism has not been completely understood, an immune-mediated T-lymphocyte response has been attributed to the bone marrow environment. Thrombopoietin (encoded by THPO), a glycoprotein hormone produced by the liver and responsible for stimulating the growth of megakaryocytes, development of platelets and other lineages that when dysfunctional, contributes to the progress of acquired AA. Objectives: To screen the THPO gene for genetic variants in bone marrow of acquired AA patients and in the peripheral blood of controls, and to verify the correlation between the THPO status and platelet counts in the patients during the treatment. Method: Sanger sequencing of the THPO gene was carried out in 92 acquired AA patients (case group) and 92 controls, in DNA samples previously stored in the Hematology Laboratory of the Ribeirão Preto School of Medicine at the University of São Paulo. The association between the THPO status and the platelet counts was performed in 83 patients through the ANOVA test. The Chi-squared test and t-test were also applied for statistical analysis with a 5% significance level. Results: Three single nucleotide polymorphisms (SNPs) were found in the AA patients (rs956732, rs6141, and rs3804618), as well as in the healthy subjects (p>0,05). No association was verified between the platelet counts and the presence of SNPs in the AA patients (p>0,05). Conclusion: Three SNPs were found in both groups, suggesting that thrombopoietin does not harbor genetic variants that could be etiological for the acquired AA in our cohort.