Células dendríticas (DCs) são componentes centrais da imunidade celular, responsáveis pelo priming de linfócitos T naïve. A polarização de linfócitos T é restrita aos sinais fornecidos durante a apresentação do antígeno. Além desses sinais, a origem e natureza de DCs que induzem diferentes perfis de linfócitos T não é totalmente compreendida. Foi investigada a capacidade de células Natural Killer (NK) de modular estágios iniciais da diferenciação de monócitos em DCs e de impactar na sua função de primar e polarizar linfócitos T naïve. DCs derivadas de monócitos pré-co-cultivados com células NK favorecem o priming de linfócitos T CD8 do tipo Tc1/Tc17, com potente capacidade de produção de IFN-γ. Este fenômeno foi dependente de interações longas via NKp30 e da maquinaria citotóxica de células NK desencadeada nas etapas inicias da sua interação com monócitos. Esta interação pode ter implicações na compreensão da imunidade mediada por linfócitos T CD8 e pode ser explorada para imunoterapia em que a produção de IFN-γ por células T CD8 é necessária ou exacerbada. / Dendritic cells (DCs) are central components of cellular immunity, responsible for the priming of naïve T cells. The polarization of T cells is restricted to signals provided during antigen presentation. Besides such signals, the origin and nature of DCs that induce different T cell profiles is not fully understood. The ability of natural killer cells (NK) to modulate early stages of monocytes differentiation into DCs and to impact on DCs function to prime and polarize naïve T cells was investigated. DCs derived from monocytes co-cultured with NK cells support the priming of type Tc1/Tc17 CD8 T cells with potent IFN-γ production capacity. NK cell-mediated cytotoxicity triggered at early stages of NKp30-dependent long-lasting monocytes-NK-cells interactions, mediated the mechanism by which this phenomenon occurred. This interaction may have implications in the understanding of CD8 T cell-mediated immunity and can be exploited for immunotherapy in which IFN-γ production by CD8 T cells is required or exacerbated.

La ténascine-C (TNC), protéine de la matrice extracellulaire, favorise la progression tumorale et la métastase par des mécanismes pas totalement élucidés. J’ai utilisé un nouveau modèle de progression tumorale de la glande mammaire basé sur une approche de greffe de cellules tumorales orthotopiques syngéniques et j’ai ainsi identifié la TNC comme un régulateur important de la croissance tumorale. L’expression concomitante de la TNC par les cellules de l’hôte et les cellules tumorales induit une régression de la tumeur en induisant une signature de présentation d’antigène. Cette signature a été corrélée avec une meilleure survie des patientes atteintes de cancer du sein. D’autre part, la TNC exprimée par les cellules tumorales induit également l’expression de CXCL12 au sein de la tumeur, piégeant les lymphocytes CD8+ dans des travées de matrice enrichies avec le CXCL12 lié à la TNC. L’inhibition du récepteur de CXCL12, le CXCR4 provoque une régression tumorale qui s’accompagne d’un afflux important de lymphocytes T CD8+ et d’une augmentation de la mort cellulaire au sein du lit tumorale. La séquestration des lymphocytes T cytotoxiques par la TNC dans les travées de matrice peut avoir une implication importante dans le développement et l’utilisation des nouvelles immunothérapies ciblant l’activité des cellules effectrices du système immunitaire. / The extracellular matrix molecule tenascin-C (TNC) promotes tumor progression and metastasis by poorly understood mechanisms. I used a novel breast progression model based on a syngeneic orthotopic tumor cell grafting approach and identified TNC as an important regulator of tumor growth. I document that TNC promotes the battle between tumor regression and growth, where combined expression of tumor cell- and host-derived TNC induces tumor cell rejection. Tumor cell-derived TNC may elicit regression by induction of an antigen presenting signature (APS) expressed by the host, which correlates with better breast cancer patient survival. Tumor-cell derived TNC also triggers CXCL12 expression, thereby causing trapping of CD8+ T cells in the surrounding TNC matrix tracks. TNC binds CXCL12, and combined TNC/CXCL12 attracts and immobilizes CD8+ T cells. Inhibition of the CXCL12 receptor CXCR4 causes tumor regression that is accompanied by massive infiltration of CD8+ T cells and cell death inside the tumor cell nests. Altogether,TNC-triggered CXCL12 signaling may dampen CD8+ T cell function where physical trapping of CD8+ T cells in the TNC matrix may have implications for immune cell therapies. Our results and new tumor model, offer novel opportunities for preclinical cancer research and cancer patient therapy, by triggering the “good” and blocking the “bad” actions of TNC. In particular, overcoming the immune suppressive action of TNC, through inhibition of CXCR4, could be a useful approach.

In dieser Arbeit wurde die Expression von XCR1 in B6XCR1lacZ+/+ Reporter Mäusen charakterisiert, die β-Galaktosidase unter der Kontrolle des XCR1-Promotors exprimieren. In Gewebeschnitten konnten wir zeigen, dass eine starke XCR1-Expression nur in lymphatischen Organen wie Milz, Lymphknoten und Thymus nachweisbar ist. In der Milz fanden sich XCR1+ Zellen vor allem in der Marginal Zone, aber auch in der roten Pulpa und der T-Zell-Zone. Durchflusszytometrische Analysen zeigten, dass XCR1 in der Milz ausschließlich von dendritischen Zellen DZ exprimiert wird, hauptsächlich von der CD8+DZ Subpopulation aber auch von einer Minderheit der CD4−CD8−DZ. In vivo migrierten diese XCR1+ Zellen nach Applikation von chemotaktischen oder inflammatorischen Substanzen: Die Injektion sowohl einer ATAC-sezernierenden Zelllinie als auch von LPS lösten nach 3-9 h eine Translokation der XCR1+Zellen in die T-Zell-Zone der Milz aus. Untersuchungen der Phagozytose-Aktivität ergaben, dass nur XCR1+CD8+DZ, aber keine anderen DZ Subpopulationen, injizierte allogene Zellen aufnahmen, und dass eine Transfektion dieser Zellen mit ATAC diese Phagozytose signifikant verstärkte. Daher konnten wir allogene Zellen, die intrazellulär Ovalbumin OVA exprimierten, für die selektive Applikation von Antigen auf XCR1+DZ verwenden. Diese selektive Antigen-Applikation induzierte eine starke antigenspezifische zytotoxische Antwort von endogenen T-Zellen, ohne dass es zur Produktion von OVA-spezifischen Antikörpern kam. In Abwesenheit von ATAC war diese endogene zytotoxische Aktivität verringert. Durch adoptivem Transfer und Aktivierung von Wildtyp- oder ATAC-defizienten OVA-spezifischen transgenen CD8+TZellen konnten wir bestätigen, dass ATAC für die Erzeugung einer optimalen zytotoxischen Antwort benötigt wird. Die selektive Applikation von Antigen auf CD8+DZ stellt daher eine vielversprechende Strategie dar, um optimierte Vakzinierungs-Ansätze für die Auslösung einer zytotoxischen Immunantwort zu entwickeln / The G protein-coupled receptor XCR1 has been described as the sole receptor for the chemokine ATAC. As contradictory data were published on the expression pattern of XCR1, its role in the immune system has not yet been defined. In this work, expression of XCR1 was characterized in B6.XCR1 lacZ+/+ reporter mice which express β galactosidase under the control of the XCR1 promoter. In tissue sections, strong expression of XCR1 was only detected in lymphoid organs like spleen, lymph nodes and thymus. In the spleen, XCR1+ cells were mainly found in the marginal zones, but also in the red pulp and the T cell zones. Flow cytometric analysis demonstrated exclusive expression of XCR1 on DC, mainly on the CD8+ DC subset, but also on a minority of CD4− CD8− DC. In vivo, these XCR1+ cells migrated in response to chemotactic or inflammatory stimuli: application of either an ATAC-expressing cell line or LPS induced within 3 9 h the translocation of XCR1+ cells to the T cell area of the spleen. When tested for phagocytic capacity, XCR1+ CD8+ DC, but not other DC subsets, specifically took up injected allogeneic cells, and transfection of these cells with ATAC significantly enhanced their endocytosis by XCR1+ CD8+ DC. Thus, we could employ allogeneic cells expressing OVA intracellularly to target antigen selectively to XCR1+ DC. This antigen targeting induced a strong antigen-specific cytotoxic response by endogenous T cells without a generation of OVA-specific antibodies. In the absence of ATAC, the endogenous cytotoxic activity was markedly diminished. Adoptive transfer and activation of wild type or ATAC-deficient OVA-specific CD8+ transgenic T cells confirmed that ATAC is required for the generation of an optimal cytotoxic response. Targeting of antigen to CD8+ DC via XCR1 may thus be a promising strategy for the development of new vaccination approaches aimed at optimizing the induction of cytotoxic T cells.

Die Ätiologie und Pathogenese autoimmuner Lebererkrankungen sind nur unvollständig verstanden. Bei der primär sklerosierenden Cholangitis bzw. bei der autoimmunen Hepatitis sind Cholangiozyten der größeren Gallengänge und Hepatozyten die Zielzellen der Autoimmunreaktion in der Leber. Mausmodelle sind zur Analyse initialer pathophysiologischer Prozesse notwendig und tragen zum besseren Verständnis der immunologischen Vorgänge in der Leber bei. Mit Hilfe transgener Mauslinien, die das Modellantigen Ovalbumin gewebespezifisch in den Cholangiozyten (ASBT-OVA) oder in den Hepatozyten (TF-OVA) exprimieren, sowie adoptiven Transfers antigenspezifischer CD4+ und CD8+ T-Zellen wurden Untersuchungen zur Antigenpräsentation, T-Zell-Aktivierung und Toleranzinduktion in der Leber durchgeführt. Die Expression von Ovalbumin in Cholangiozyten resultierte in einer Aktivierung der CD8+ T-Zellen in der Leber und den Lymphknoten. Im Gegensatz dazu ignorierten naive CD4+ T-Zellen das Antigen und wurden nicht aktiviert. Die Expression von Ovalbumin in Hepatozyten resultierte in einer vollständigen Aktivierung der CD8+ T-Zellen zu Effektorzellen über Kreuzpräsentation durch professionelle antigenpräsentierende Zellen (APZ) in der Leber. Diese Aktivierung war transient und selbst-limitiert. Die Induktion von CD4+Foxp3+ regulatorischen T-Zellen trug entscheidend zur Limitierung der induzierten Autoimmunität und Kontrolle der Expansion von antigenspezifischen CD8+ T-Zellen bei. Naive CD4+ T-Zellen benötigten die Aktivierung durch APZ in einem anderen Organ, bevor sie in die Leber relokalisierten und wiesen keinen Effektorphänotyp auf. Beide Modelle repräsentieren nicht die chronische Eigenschaft humaner autoimmuner Lebererkrankungen, ermöglichen jedoch Untersuchungen zum besseren Verständnis der Rolle verschiedener T-Zell-Populationen in der Pathogenese autoimmuner Lebererkrankungen sowie der Antigenpräsentation und Aktivierung von T-Zellen durch hepatisches Antigen. / Aetiology and pathogenesis of autoimmune liver diseases are still incompletely understood. Cholangiocytes of the larger bile ducts and hepatocytes are the target structures of autoimmune reactions in the liver in primary sclerosing cholangitis and autoimmune hepatitis, respectively. Mouse models are necessary to analyse initial pathophysiological processes and contribute to a better understanding of immunological processes in the liver. With the help of transgenic mouse strains, in which the model antigen ovalbumin is expressed specifically in the cholangiocytes (ASBT-OVA) or in hepatocytes (TF-OVA), as well as the adoptive transfer of antigen specific CD4+ and CD8+ T cells, antigen presentation, T cell activation and tolerance induction in the liver, were analyzed. Expression of ovalbumin in cholangiocytes resulted in activation of CD8+ T cells in the liver and lymph nodes. In contrary, naïve antigen specific CD4+ T cells ignored the antigen expressed by cholangiocytes and were not activated. Expression of ovalbumin in hepatocytes resulted in complete activation of CD8+ T cells to become effector cells by crosspresentation depending on professional antigen presenting cells (APCs) in the liver. This activation was transient and self-limiting. Induction of CD4+Foxp3+ regulatory T cells played a crucial role in limiting autoimmunity and controlling the expansion of antigen specific CD8+ T cells in the liver. By contrast, naïve CD4+ T cells required activation by professional APCs in a different organ before relocating to the liver and did not display an effector phenotype. Both models do not represent the chronic characteristics of human autoimmune liver diseases, but help to gain a better understanding regarding the role of specific T cell populations in the pathogenesis of autoimmune liver diseases, as well as regarding antigen presentation and activation of T cells by hepatic antigen.

ZTLs vermitteln die Eliminierung von infizierten und entarteten Zellen durch Apoptose. Neuste Erkenntnisse unserer Gruppe haben gezeigt, dass eine Subpopulation der CD8+ T-Zellen, anstelle der zytotoxischen Marker das Oberflächenmolekül CD40L exprimiert. Die Expression von CD40L ist bislang als Schlüsselmolekül für die CD4+ T-Zell vermittelte Hilfe bekannt, welche durch Bindung an den CD40 Rezeptor auf anderen Immunzellen induziert wird. Das von den CD4+ T–Zellen ausgehende CD40L Signal ist besonders für die T-Zell abhängige B-Zell Aktivierung und die Bildung von Keimzentren essentiell, in denen B-Zellen heranreifen und hochaffine Antikörper produzieren um den Organismus vor eindringenden Erregern zu schützen. Aufgrund der CD40L-assoziierten Helferfunktion sollte in dieser Arbeit untersucht werden, welche Auswirkungen die Interaktion von CD8+CD40L+ T-Zellen mit B Zellen hat. In in vitro Studien konnte gezeigt werden, dass 50% der antigen-spezifischen CD8+ T-Zellen nach Aktivierung durch B-Zellen CD40L hochregulieren. Sowohl auf RNA- als auch auf Proteinebene induzierten CD8+CD40L+ T-Zellen einen B-Zell Phänotyp, der stark dem von CD4+ T-Zellen stimulierten B-Zellen ähnelte. In Infektionsversuchen mit dem B-Zell-trophen Virus MHV-68 konnte gezeigt werden, dass transgene Mäuse mit CD40L defizienten CD8+ T-Zellen im Vergleich zu Kontrolltieren eine signifikante Reduktion der Keimzentrums-B-Zellen in den Lymphknoten der oberen Halsregion aufweisen. Eine genauere Betrachtung des B-Zell Repertoires von IgG Gedächtniszellen ergab jedoch, dass die Sequenzen der IGHJ3 Genfamilie bevorzugt für die Modifikation der CDR3 Region in Mäusen mit CD40L defizienten CD8+ T-Zellen verwendet wird, die eine entscheidende Rolle bei der Antigenerkennung spielt. Zusammengefasst kann mit dieser Arbeit zum ersten Mal gezeigt werden, dass CD8+CD40L+ T-Zellen Helferfunktionen durch Unterstützung der B-Zell Aktivierung und Bildung von Keimzentren übernehmen können. / CTLs are important for the elimination of infected and degenerated cells by inducing apoptosis of the target cells. Recently our group identified a sub-population of CD8+ T cells expressing CD40L instead of common CTL markers. To that date, transient CD40L expression on T cells has been only described as a function of activated CD4+ T cells, which displays this key molecule for CD4+ T cell mediated help by binding to the CD40 receptor on other immune cells. Particularly, CD40L signaling provided by CD4+ T cells is indispensable for T cell dependent B cell activation and GC responses, which generate B cells secreting high affinity antibodies that protect the host from invading pathogens. Due to its associated helper functions, this thesis aimed to dissect whether CD40L positive CD8+ T cells are restricted to cytotoxic killing or if this sub-population possesses similar properties as CD4+ T cells when interacting with B cells. In vitro co-culture experiments showed that 50% of murine antigen specific CD8+ T cells up-regulated CD40L upon activation by antigen presenting B cells. When compared to CD40L deficient CD8+ T cells, the interaction of CD8+ CD40L+ T cells induced remarkable changes in B cells on the RNA and protein level and triggered a B cell phenotype resembling that of B cells primed by CD4+ T cells. By the infection of mice with the B cell trophic virus MHV-68, it was found that E8IcrexCD40Lflox transgenic mice lacking CD40L only on matured CD8+ T cells, exhibited a significant decrease of GC B cells in superficial cervical lymph nodes at the acute state of infection compared to WT mice. A closer look into the memory B cell repertoire revealed a preferred usage of the murine IGHJ3 gene family that modifies the CDR3 and thus the recognition groove of the B cell antibody in E8IcrexCD40Lflox mice. In summary, this work provides sufficient evidence that CD8+ CD40L+ T cells adopt helper-like functions by supporting B cell activation and subsequent GC formation.

Notre système immunitaire a pour fonction de nous protéger des infections mais également des allergies, des cancers ou des maladies inflammatoires. Les cellules dendritiques (DC) sont au coeur de ce système en orientant les réponses immunitaires vers une voie effectrice ou tolérogène. A l’état immature, elles sont présentes, entre autres, aux interfaces avec le milieu extérieur. Elles permettent ainsi la reconnaissance des antigènes, notamment ceux présents dans le tube digestif, comme les aliments ou la flore commensale. Certaines bactéries dites probiotiques sécrètent des métabolites au cours de la fermentation définissant les produits de fermentation. Notre travail montre qu’un produit de fermentation de la souche bactérienne BbC50 (BbC50sn) activent les DC humaines grâce à sa fixation sur le récepteur TLR2 et modulent de nombreux récepteurs à leurs surfaces. Les DC ainsi maturées peuvent activer des lymphocytes T CD4+ et CD8+ et également induire des lymphocytes T régulateurs CD4+ et CD8+. / The immune system protects an organism from infections, allergy, cancer and inflammatory diseases. Dendritic cells (DC) present antigens to T cells and polarize lymphocytes toward either an effector or a tolerogenic response. In an immature state, DC are localized in mucosas at interfaces with the external environment, after receiving signals they acquire the ability to activate T cells. Thus, DC allow the recognition of antigens, present in the digestive tract, such as food or commensal flora. Some probiotic bacteria produce metabolites during fermentation defined as the fermentation products. Our work has shown that a fermentation product of the bacterial strain BbC50 (BbC50sn) activate human DC through TLR2 ligation on DC and modulate numerous receptors on their surfaces. DC activated with this fermentation product activate CD4+ and CD8+ T cells and also induce CD4+ and CD8+ regulatory T lymphocytes.

Konventionelle CD8 T-Zellen im intestinalen Epithel unterscheiden sich von T-Zellen gleicher Spezifität in anderen Organen. In dieser Arbeit sollten Mechanismen identifiziert werden, welche die Migration dieser T-Zellen in intestinale Gewebe bestimmen und/oder welche die funktionelle Adaption der T-Zellen an die mukosale Umgebung beeinflussen. Hierfür wurden Mäuse mit einem rekombinanten Listeria monocytogenes Stamm (LmOVA) infiziert, OVA-spezifische CD8 T-Zellen aus der Milz und dem intestinalem Epithel isoliert, und die mRNA-Expressionsprofile dieser Zellen mittels einer Mikroarray-Analyse verglichen. Eine Gruppe von NK-Rezeptoren zeigte auf OVA-spezifischen CD8 T-Zellen aus der intestinalen Mukosa eine geringere Expression. Dieser Unterschied war nach einer oralen Infektion wesentlich stärker ausgeprägt, als nach einer intravenösen Infektion. Die Präsenz der natürlichen Darmflora hatte nur einen sehr geringen Einfluss auf diese organspezifisch unterschiedliche NK-Rezeptor-Expression. Untersuchungen in transgenen CD4dnTGFbetaRII Mäusen wiesen auf TGFbeta als ein entscheidendes Element für die niedrigere NK-Rezeptor-Expression auf T-Zellen in der Darmmukosa hin. Die zweite Fragestellung war die, ob nach einer Lm-Infektion die primäre Aktivierung naiver CD8 T-Zellen und die Re-Aktivierung von Gedächtnis-T-Zellen auch außerhalb sekundärer lymphoider Organe stattfinden kann. Hierfür wurden Mäuse mit der immunmodulatorischen Substanz FTY720 behandelt und splenektomiert. Eine FTY720-Behandlung beeinträchtigte nach iv und nach ig Infektion weder die Ausbreitung der Lm, noch die Fähigkeit der Mäuse zu einer Elimination der Bakterien. Orale Infektionen sowie höher dosierte iv Infektionen führten auch in FTY720-behandelten und zusätzlich splenektomierten Mäusen zu einer T-Zell-Akkumulation und Proliferation in nicht-lymphoiden Organen. Nach einer niedrig dosierten iv Lm-Infektion wurden dagegen in FTY720-behandelten und splenektomierten Mäusen keine OVA-spezifischen T-Zell-Antworten ausgelöst. Insbesondere die Milz schien hier für die T-Zell Aktivierung und Proliferation erforderlich zu sein. Auch für eine Sekundärantwort nach einer iv Infektion mit LmOVA waren lymphoide Gewebe für die Ausbildung einer effektiven T-Zell-Antwort essentiell. / Conventional CD8 T cells in the intestinal epithelium differ from T cells with identical antigen specificity in other organs. One aim of this study was, to identify mechanisms, which determine gut-tropism of these T cells or which influence the functional adaptation of these cells to the mucosal environment. For this purpose, mice were infected with a recombinant Listeria monocytogenes strain (LmOVA). OVA-specific CD8 T cells were isolated from spleen and intestinal epithelium and the mRNA-expression profiles of these cells were compared in a microarray-analysis. One group of NK-receptors were substantially less expressed on Lm-specific CD8 T cells from the intestinal mucosa than on corresponding cells from the spleen. This difference was much more pronounced following oral infection than following iv infection. The presence of the natural gut-flora only slightly influenced the organ-specific NK-receptor expression in CD8 T cells. Experiments with transgenic CD4dnTGFbetaRII mice point to TGFbeta as a decisive factor for the low NK-receptor expression on T cells from the gut mucosa. In the second part of this study it was investigated, whether, following Lm infection, priming of naive CD8 T cells and re-activation of memory T cells could occur outside of secondary lymphoid organs. Mice were treated with the immunomodulatory drug FTY720 and splenectomized. Treatment with FTY720 did neither diminish bacterial dissemination into spleen, liver and MLN, nor impaired the ability of the mice to control the bacteria and to eradicate them from these organs. Oral infection and high dose iv infection led to T cell accumulation and proliferation in nonlymphoid organs of FTY720-treated and additionally splenectomized mice. Following low dose iv infection with LmOVA, no OVA-specific T cell responses were induced in FTY720-treated and additionally splenectomized mice. Especially the spleen seemed to be important for T cell activation and proliferation under these conditions. Also following a secondary iv infection with LmOVA, lymphoid tissues were essential for the generation of an effective T cell response.

A doença de Chagas, moléstia causada pelo protozoário Trypanosoma cruzi, resulta freqüentemente em um quadro de miocardite crônica que pode levar à morte do paciente. As causas que determinam a afetação cardíaca não estão totalmente esclarecidas. A nossa hipótese de trabalho é que o desafio poderia aumentar a ação efetora do sistema imune frente ao T. cruzi, resultando em redução da carga parasitária sistêmica e local, e, em longo prazo, em diminuição da patologia. A análise histopatológica mostrou que a manutenção prolongada do desafio foi capaz de reduzir moderadamente mas significantemente a patologia no coração. Estas experiências podem auxiliar a esclarecer a etiopatogenia do processo patológico cardíaco, confirmando que esta seja devida à reação frente aos parasitas remanescentes. Mais importante, os nossos resultados podem abrir uma esperançosa perspectiva de tratamento aos indivíduos de fase crônica. / Chagas disease caused by Trypanosoma cruzi frequently results in chronic myocarditis that may result in death. The mechanisms underlying cardiac pathology are not totally clear. Our working hypothesis was that challenge could increase the immune systems effector activity against T. cruzi, leading to reduction in systemic and local parasite loads, which in turn could result, at the long run, in pathology diminution. The hystopathological analysis revealed that sustained challenge led to a small, but significant, decrease in heart pathology. These results could help to elucidate the etiopathogeny of chagasic heart lesions, inasmuch as they support the hypothesis of reactivity towards locally-persisting parasites. More important, our results open a hopeful perspective for the treatment of patients at the chronic phase.

INTRODUÇÃO: A Síndrome de Sézary (SS) é um linfoma cutâneo de células T (LCCT), caracterizado por eritrodermia, linfadenopatia generalizada e presença de células tumorais na pele, linfonodos e sangue periférico. Os linfócitos TCD8+ têm papel fundamental na resposta imune antitumoral, entretanto, há escassos estudos evidenciando seu perfil fenotípico e funcional. Considerando que a resposta imunológica do paciente com SS está suprimida, estratégias para potencializar a imunidade inata e adaptativa com agonistas de receptores Toll-like (TLRs) têm sido exploradas. OBJETIVO: Caracterizar o perfil de marcadores de ativação/inibição das células TCD8+, seus estágios de diferenciação, capacidade de resposta a IL-7/IL-15 e ao agonista de TLR7/TLR8 de pacientes com SS. METODOLOGIA: Foram selecionados 15 pacientes com SS (7 homens e 8 mulheres) com 48-85 anos do Ambulatório de Linfomas Cutâneos, do HC-FMUSP, e um grupo de controle com 24 indivíduos sadios. A análise de marcadores de ativação/inibição e diferenciação celular em células TCD4/TCD8+ do sangue periférico foi realizada por citometria de fluxo. A expressão de marcadores extracelulares e citocinas intracelulares em células mononucleadas do sangue periférico (CMN) após estimulação com o agonista de TLR7/TLR8 foi analisada por citometria de fluxo. Além disto, o efeito de IL-7 e IL-5 em células T foi avaliado pela fosforilação de STAT5, na capacidade de proliferação mitogênica e expressão de BCL-2 em CMNs, como também pelos níveis séricos de IL-7 por citometria de fluxo. RESULTADOS: Os pacientes com SS mostram perfil fenotípico de ativação crônica nos linfócitos TCD8+ periféricos, decorrente do elevadopercentual de células TCD8+ CD38+, redução percentual de TCD8+ CD127+ (IL-7R) e da população naive. Além disso, ocorreu aumento de expressão de PD-1 na população naive de células TCD8+. O marcador de ativação, CD26, até então apenas relacionado com linfócitos TCD4, foi detectado em reduzida percentagem de linfócitos TCD8. A resposta para IL-7/IL-15 parece estar funcionalmente presente tanto nos linfócitos TCD4 quanto nos linfócitos TCD8. Contudo, foi encontrado um perfil diferenciado e heterogêneo de fosforilação de STAT5 assim como de expressão de BCL-2 nos linfócitos TCD8+ de pacientes com SS. O nível sérico de IL-7 reduzido dos pacientes com SS foi inversamente correlacionado com o número absoluto de linfócitos TCD4+. CONCLUSÃO: Os linfócitos TCD8+ dos pacientes com SS encontram-se reduzidos em números absolutos, e possuem um perfil alterado de diferenciação celular e expressão de marcadores extracelulares. A redução percentual da população de TCD8+ naive associada com a presença de moléculas de ativação crônica mostra um perfil de imunosenescência. As células TCD8+ exibem baixa capacidade de resposta aos ligantes de TLR intracelulares, provavelmente devido ao perfil de ativação crônica. Além disso, há resposta parcial dos linfócitos TCD8+ às citocinas ligantes do receptor yc. Nossos resultados evidenciam alterações em linfócitos TCD8+ que debilitam a resposta imune antitumoral e que pode contribuir com a patogênese da síndrome de Sézary / INTRODUCTION: Sézary syndrome (SS) is a cutaneous T cell lymphoma (CTCL), characterized by erythroderma, generalized lymphadenopathy and the presence of tumor cells in the skin, lymph nodes and peripheral blood. The TCD8+ lymphocytes play a key role in anti-tumor immune response, whereas, there are few studies showing its phenotypic and functional profile in SS. Considering that the immune response of SS patient is suppressed, strategies to enhancing the innate and adaptive immunity by Toll-like receptors (TLRs) agonists have been explored. OBJECTIVE: To characterize the profile of activation/inhibition markers of CD8+ T cells, their stages of differentiation, ability of response to IL-7/IL-15 and TLR7/TLR8 agonist of patients with SS. METHODOLOGY: Fifteen SS patients were enrolled (7 men and 8 woman) with 48-85 years from the Clinic of Cutaneous Lymphomas, HC-FMUSP, and a control group of 24 healthy individuals. Analysis of activation/inhibition markers and cellular differentiation in CD4/CD8 T cells from peripheral blood were assessed by flow cytometry. The expression of extracellular markers and intracellular cytokines in mononuclear cells in the peripheral blood (CMN) were evaluated by flow cytometry. Moreover, the effect of IL-7 and IL-15 stimulation in T cells was assessed by the STAT5 phosphorylation, proliferative mitogenic capacity, BCL-2 expression in CMNs as well as serum IL-7 levels by flow cytometry. RESULTS: Patients with SS show a phenotypic CD8 T peripheral lymphocytes profile of chronic activation, due to the high percentage of CD8+CD38+ T cells, reduced percentage of CD8+CD127+ (IL-7R) and naïve population. Furthermore, it was observed an increased PD-1 expression in the naïve CD8+ T cells. The activation marker CD26, previously only associated with CD4 T lymphocyte, was detected at decreased percentage in CD8 T lymphocytes. The TLR7/TLR8 agonist did not affect the IFN-? and TNF secretion of CD8 T lymphocytes of SS patients, in contrast to the control group. The response to IL-7/IL-15 appears to be functional in both CD4 and CD8 T lymphocytes. However, it was founded a differentiated and heterogeneous profile of STAT5 phosphorylation and Bcl-2 expression in the CD8 T lymphocytes in SS patients. The reduced IL-7 serum of patients with SS was inversely correlated with the absolute number of CD4 T lymphocytes. CONCLUSION: CD8 T lymphocytes of patients with SS are reduced in absolute numbers, and show an altered cellular differentiation profile and extracellular markers expression. The reduced percentage of CD8 naïve population associated with chronic activation of molecules reveals an immunosenescence profile. The CD8 T cells exhibit low ability to ligands of intracellular TLR receptors, probably due to chronic activation profile. In addition, there are partial response of CD8 T lymphocytes to the cytokine receptor ?c. Our results show disturbance in CD8 T lymphocytes that may impair the anti-tumor response contributing to the pathogenesis of Sézary syndrome

INTRODUÇÃO: A variante hipocromiante da micose fungoide - MF - (MFh) apresenta características peculiares, como a predileção por indivíduos jovens e melanodérmicos e curso clínico crônico. Estudos especulam a patogênese da hipocromia comparando-a à do vitiligo. No Brasil, faltam dados que permitam conhecer sua importância na saúde pública. O presente trabalho visou avaliar a epidemiologia, a histopatologia e a imunofenotipagem de uma amostra de pacientes com diagnóstico de MFh e propor hipóteses dos mecanismos patogênicos da hipocromia, além de comparar pacientes portadores de lesões hipocrômicas exclusivas com aqueles portadores de outras formas de MF com lesões hipocrômicas concomitantes. MÉTODOS: Foram selecionados pacientes do Ambulatório de Linfomas Cutâneos do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e classificados em três grupos: A (21 portadores apenas de lesões hipocrômicas); B (15 portadores de outras formas de MF com lesões hipocrômicas concomitantes) e C (8 pacientes com diagnóstico de MF clássica, estes apenas para avaliações histológica e imuno-histoquímica). Foram obtidos dados clinicoepidemiológicos e realizadas análises histológica e imuno-histoquímica de biópsias das lesões e de pele normal, como controle. Para o estudo imuno-histoquímico foram utilizados os marcadores para imunofenotipagem da neoplasia, Melan-A, tirosinase, SCF, CD117 e MITF. RESULTADOS: Do total de pacientes acompanhados naquele ambulatório, os pacientes com MF portadores de lesões hipocrômicas corresponderam a 16%. As medianas das idades de início da doença e dos tempos de história foram de, no grupo A 25 anos e 8 anos; no grupo B, 29 anos e 13 anos, respectivamente; houve predomínio de indivíduos melanodérmicos , acometimento do sexo feminino e a maioria dos pacientes encontrava-se em estágios iniciais da doença em ambos os grupos. A avaliação histológica revelou achados semelhantes, como epidermotropismo de linfócitos atípicos e infiltrado dérmico linfomonocitário nas lesões hipocrômicas e não-hipocrômicas. O imunofenótipo CD8+ do infiltrado neoplásico epidérmico foi mais frequente no grupo A, ao passo que os grupos B e C apresentaram mais casos com imunofenótipo CD4+. A avaliação da função melanocítica das lesões hipocrômicas do grupo A revelou diminuição significativa da imunomarcação dos melanócitos por todos marcadores em comparação à pele normal e às lesões do grupo C. Em relação ao grupo B, não houve diferenças para as lesões hipocrômicas, não-hipocrômicas e pele normal, quando avaliadas dentro do próprio grupo (exceto para Melan A). A expressão de SCF pelos queratinócitos foi irregular sobretudo nas lesões hipocrômicas. DISCUSSÃO: Os pacientes com lesões hipocrômicas apresentaram características semelhantes (idade precoce, predomínio do sexo feminino, doença indolente). Mostrou-se que indivíduos melanodérmicos tem maior chance de apresentar lesões hipocrômicas. Além da redução de melanócitos e do receptor melanocítico CD117 em relação à pele normal já demonstradas previamente, mostrou-se, como no vitiligo, a redução da expressão do MITF, fator vital para a função e sobrevida do melanócito. Além disso, também se explicitou desbalanço da produção de citocinas melanogênicas pelos queratinócitos. CONCLUSÃO: A presença de lesões hipocrômicas pode ser considerada um marcador de bom prognóstico na MF. Diferentes mecanismos, como ação celular citotóxica e a alteração do microambiente da unidade epidérmica, colaboram para hipocromia das lesões da MFh / INTRODUCTION: The hypopigmented variant of mycosis fungoides - MF - (MFh) presents specific characteristics, such as a predilection for young and melanodermic individuals, and chronic clinical course. Studies speculate the pathogenesis of the hypopigmentation comparing it to vitiligo\'s. In Brazil, the lack of data prevents the knowledge of its importance in public health. This study aimed to evaluate the epidemiology, the histopathology and the immunophenotyping of a sample of patients diagnosed with MFh and to propose hypotheses of the pathogenic mechanisms of hypopigmentation, in addition to comparing exclusive hypopigmented lesion-bearer patients with those bearing other types of MF with concomitant hypopigmented lesions. METHODS: Patients were selected from the Cutaneous Lymphoma Clinic, from Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo and classified in three groups: A (21 hypopigmented only lesion- bearers); B (15 bearers of other types of MF with concomitant hypopigmented lesion) and C (8 patients diagnosed with classical MF, being those only for histology and immunohistochemistry evaluations). Clinical- epidemiological data were obtained and histology and immunohistochemistry analyses of lesion biopsies and normal skin, as a control, were made. For the immunohistochemistry study, the markers for immunophenotyping the neoplasm, Melan-A, tyrosinase, SCF, CD117 and MITF were used. RESULTS: Of the total number of patients treated at that clinic, the MF patients bearing hypopigmented lesions were 16%. The medians of the age of disease onset and the medical history time were 25 years and 8 years in group A; 29 years and 13 years in group B, respectively; there were a predominance of melanodermic individuals, involvement of the female sex, and the majority of the patients were in early stages of the disease in both groups. The histological evaluation revealed similar findings, such as epidermotropism of atypical lymphocytes and lympho-monocytic dermal infiltrate in hypopigmented and non-hypopigmented lesions. The CD8+ immunophenotype of the epidermal neoplastic infiltrate was more frequent in group A, while groups B and C showed more cases of CD4+ immunophenotype. The evaluation of the melanocytic function of the hypopigmented lesions in group A revealed a significant decrease of immunostaining of the melanocytes by all markers when compared to normal skin and group C lesions. Regarding group B, there were no differences to hypopigmented and non-hypopigmented lesions and normal skin, when evaluated within the group itself (except for Melan A). The SCF expression by the keratinocytes was irregular especially in hypopigmented lesions. DISCUSSION: Patients with hypopigmented lesions showed similar characteristics (early age, female sex predominance, indolent disease). It has been showed that melanodermic subjects are more likely to have hypopigmented lesions. In addition to the previously-showed reduction of melanocytes and CD117 melanocytic receptor related to normal skin, it has been showed, as in vitiligo, the reduction of MITF expression, a vital factor for the function and survival of the melanocyte. Besides that, it has been also made explicit a production imbalance of melanogenic cytokines by the keratinocytes. CONCLUSION: The presence of hypopigmented lesions can be considered a marker of good prognosis in MF. Different mechanisms, such as cytotoxic cellular action and the change of the microenvironment of the epidermal unit, collaborate for the hypopigmentation of the lesions of MFh