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

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

Diss. (sammanfattning) Linköping : Linköpings universitet, 2010. / Härtill 4 uppsatser.

Multiple Sclerosis (MS) is a chronic inflammatory and demyelinating disease of the central nervous system. The etiology of MS is unknown but many researchers believe that it is autoimmune mediated. This study investigated naive CD4+ and naive CD8+ T-cell homeostasis in patients with Primary Progressive Multiple Sclerosis and Relapsing Remitting Multiple Sclerosis. The naive T-cell compartment involves a balance between thymic production of naive T-cells, homeostatic proliferation and the delivery of death and survival signals. Naive T-cell production was quantified by measuring signal joint T-cell receptor excision circles (sj-TRECs); episomal byproducts formed during V(D)J T-cell receptor rearrangement. / Homeostatic proliferation was quantified by flow cytometry analysis of % expression of CD31 and Ki-67. CD31 is a marker found on CD4+ recent thymic emigrants (RTE) but not on naive T-cells that have undergone homeostatic proliferation. CD31 can be used as a marker of the proliferation history of naive CD4+ T-cells. Ki-67 is a nuclear and nucleolar antigen found in actively cycling cells. It can be used as a marker of cell proliferation at the moment of isolation. Cell survival was measured by quantifying plasma IL-7 levels and by measuring Bcl-2 expressions. IL-7 plays an important role in maintaining and restoring peripheral naive T-cell homeostasis. It stimulates naive T-cell proliferation and prevents the reduction of Bcl-2, an antiapoptotic protein. / In this study, PPMS patients had significantly reduced naive CD4 + T-cell sj-TRECs compared to healthy controls (p = 0.0007) and compared to RRMS patients (p = 0.0010). RRMS patients had fewer sj-TRECs than healthy controls but this difference was not significant (p = 0.4652). Similarly, in PPMS, naive CD4+ T-cells had significantly lower CD31 expression than healthy controls (p = 0.0017) and RRMS patients (p = 0.0032). This finding indicates increased homeostatic proliferation in naive CD4 + T-cells in PPMS, most probably a response to decreased thymic export as marked by the decreased naive CD4+ T-cell sj-TRECs. % CD31 expression in naive CD4+ T-cells did not differ significantly in RRMS compared to healthy controls (p = 0.7455) which is consistent with their naive CD4+ sj-TREC levels. / Naive CD8+ T-cell sj-TRECs were significantly reduced in PPMS patients compared to healthy controls (p = 0.0212) but not compared to RRMS patients (p = 0.2379). RRMS patients had fewer naive CD8 + T-cell sj-TRECs compared to healthy controls but this difference was not significant (p = 0.1517). PPMS patients expressed increased Bcl-2 levels in their naive CD8+ T-cells. This finding indicates upregulation of survival signals, most probably a consequence of reduced thymic export of naive CD8+ T-cells. / The data from this study indicate that PPMS is different from RRMS in their naive CD4+ T-cell sj-TRECs and naive CD4 + T-cell % CD31 expression but is similar to RRMS in their naive CD8+ T-cell sj-TRECs. This study concludes, therefore, that both PPMS and RRMS patients have altered naive T-cell homeostasis.

Virus-specific cellular immune responses have been shown to be important in the control of viral replication in several animal and human virus models. Cells of both the CD8+ and CD4+T cell lineages have been shown to play protective roles during viral infections by exerting effector functions that can kill infected host cells or inhibit the production and spread of infectious virions. The continued spread of HIV-1 infection throughout the world, as well as the lack of a prophylactic HIV-1 vaccine have generated much interest in HIV-specific cellular immune responses. Recent technical advances have yielded a tremendous increase in our understanding of HIV-1-specific immunity, as well as HIV-1 replication dynamics and host cell factors that shape the course of acute and chronic infection. Unfortunately, due to small sample volumes and technological limitations, the study of HIV-1-specific T cell immunity in infants and children has been difficult. An improved understanding of the timing, specificity, and intensity of pediatric HIV-specific T cell responses would contribute to the development of a HIV-1 vaccine for use in regions of the developing world without access to antiretroviral therapeutics. In the small number of published studies investigating pediatric HIV-specific immunity, T cell responses were uncommonly detected in infants. It remains unclear, however, whether the lack of HIV-specific T cells is an accurate reflection of the in vivoimmune state in vertically-infected infants, or rather is a consequence of reagents and assays ill-suited to the detection of low-level and/or diverse T cell responses in pediatric subjects. In the present dissertation, several methodologies were used to investigate HIV-specific T cell responses in vertically-infected infants and children. HIV-specific CD8+ T cell responses were infrequently detected in a cohort of young infants, but are commonly detected in older infants and children. Interestingly, CMV-specific CD8+ T cell responses were detected in several young infants that lacked HIV-specific responses, suggesting a specific defect in the ability of some infants to generate HIV-specific CD8+ T cell responses. Further experiments characterizing detectable HIV-1-specific CD8+ T cell responses found that the HIV-1 accessory proteins may be important targets of the immune response during early vertical infection. The role of HLA class I genotype and viral sequence are also explored in a pair of vertically-infected twins with discordant CD8+T cell responses. Finally, viral isolates from an infant with a marked shift in gag-specific epitope usage during infancy are analyzed for the presence of escape mutations. Gag-specific CD4+ T cell responses were commonly detected in a large cohort of vertically-infected children. A linear relationship between HIV-1 replication and the presence and intensity of HIV-specific CD4+ T cell responses was found, but ongoing HIV-1 replication appeared to blunt CD4+T cell proliferation. The data presented in this dissertation describe pediatric T cell immune responses and how they relate to HIV-1 replication. This information may be useful to the design of a prophylactic or therapeutic HIV-1 vaccine for vertically-infected infants and children.

Itk is a member of the Tec family of non-receptor tyrosine kinases. It is expressed in T cells, NK cells, and mast cells. The purpose of this study was to determine the role of Itk in T cell development. Previous work from our lab and others has demonstrated that Itk is involved in signaling downstream of the T cell receptor and initial analysis of Itk-deficient mice revealed that these mice had some defects in T cell development. There are two stages of T cell development, the pre-T cell stage and the CD4+ CD8+ double positive stage, at which signals downstream of the T cell receptor are important. At the CD4+ CD8+ double positive stage, these signals direct two concurrent, but distinct processes known as repertoire selection and CD4/CD8 lineage commitment/differentiation. I show that there are only slight defects in development at the pre-T cell stage, presumably due to reduced TCR signaling. However these results clearly demonstrate that Itk is not essential at this stage of development. In contrast, repertoire selection, in particular positive selection, is significantly affected by the absence of Itk. Similarly, I show that Itk plays a role in lineage differentiation, although commitment to the appropriate lineage occurs normally in the absence of Itk.

Professional antigen presenting cells (APCs) represent an important link between the innate and adaptive immune system. Macrophages (MΦs) and dendritic cells (DCs) serve as sentinels in the periphery collecting samples from their environment and processing this information. These cells then present antigenic fragments to T cells in the context of self-MHC molecules. Although a clear role for both of these APCs in the stimulation of already activated or memory T cells has been established, the ability of MΦs to activate naive T cells is still unknown. In this thesis the ability of bone marrow-derived MΦs and DCs to prime naive CD8+ and CD4+ T cells was investigated. Using adoptively transferred transgenic CFSE-Iabeled P-14 T cells, specific for gp33 from lymphocytic choriomeningitis virus in the context of Db, we were able to demonstrate the ability of both MΦs and DCs to induce naive CD8+ T cells proliferation. Once primed by MΦs these T cells gained effector function as shown by interferon- γ (IFN-γ) production and in vivo cytolysis. In addition, immunization of wild type animals with gp33-pulsed MΦs, as well as DCs, led to greater than a 95% reduction in lymphocytic choriomeningitis virus titers. To rule out the role of cross-presentation in the observed priming, two models were used. In the first model, lethally irradiated F1 bxs chimeras reconstituted with either H-2s or H-2b bone marrow were used as host for the adoptive transfer experiments. Since the gp33 peptide binds to Db, the H-2s reconstituted animals should be unable to cross-present the peptide to the P-14 T cells. Using this model, we were able to clearly demonstrate the ability of MΦs to activate naive P-14 T cells to undergo division. Additional experiments, demonstrated that these MΦ primed T cells went on to develop into effector cells. Finally, the ability of the MΦ primed T cells to develop into functional memory cells was demonstrated. To confirm the chimera results, these experiments were repeated using β2 microglobulin deficient animals (whose cells don't express MHC I) as host in adoptive experiments. MΦs were able to stimulate the naive P-14 T cells to divide and gain effector function as demonstrated by the ability to produce IFN-γ. In contrast to the CD8 system, MΦ were poor stimulators of D011.10 CD4+ T cell proliferation. Additionally, D011.10 T cells stimulated by DCs were able to produce interleukin-2 (IL-2), IL-4, tumor necrosis factor and granulocyte-macrophage colony stimulating factor where as MΦ stimulated D011.10 T cells were only able to produce IL-2. In conclusion this body of work clearly demonstrates the in vivo ability of MΦ to stimulate CD8+ T cell proliferation, effector function, as well as the formation of functional CD8+ T cell memory. Whether or not the nature of the memory pools stimulated by the two APCs is exactly the same is still unknown and needs further investigation. The ability of APCs other than DCs to stimulate functional protective memory needs to be considered in the quest to design vaccines that offer broad-spectrum protection.

Stimulation of CD40 on APCs through CD40L expressed on helper CD4+ T cells activates and “licenses” the APCs to prime CD8+ T cell responses. While other stimuli, such as TLR agonists, can also activate APCs, it is unclear to what extent they can replace the signals provided by CD40-CD40L interactions. In this study, we used an adoptive transfer system to re-examine the role of CD40 in the priming of naïve CD8+ T cells. We find an approximately 50% reduction in expansion and cytokine production of TCR-transgenic T cells in the absence of CD40 on all APCs, and on dendritic cells in particular. Moreover, CD40-deficient and CD40L-deficient mice fail to develop endogenous CTL responses after immunization and are not protected from a tumor challenge. Surprisingly, the role for CD40 and CD40L are observed even in the absence of CD4+ T cells; in this situation, the CD8+T cell itself provides CD40L. Furthermore, we show that although TLR stimulation improves T cell responses, it cannot fully substitute for CD40. We also investigated whether CD40-CD40L interactions are involved in the generation, maintenance, and function of memory CD8+ T cells. Using a virus infection system as well as a dendritic cell immunization system, we show that the presence of CD40 on DCs and other host APCs influences the survival of activated effector cells and directly affects the number of memory CD8+ T cells that are formed. In addition, memory CD8+ T cell persistence is slightly impaired in the absence of CD40. However, CD40 is not required for reactivation of memory CD8+ T cells. It seems that CD40 signals during priming also contribute to memory CD8+ T cell programming but this function can be independent of CD4+T cells, similar to what we showed for primary responses. Altogether, these results reveal a direct and unique role for CD40L on CD8+ T cells interacting with CD40 on APCs that affects the magnitude and quality of primary as well as memory CD8+ T cell responses.

Dengue virus (DENV) infects 50-100 million people worldwide every year and is the causative agent of dengue fever (DF) and the more severe dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). There are four genetically and immunologically distinct DENV serotypes (DENV-1, DENV-2, DENV-3, and DENV-4). Evidence suggests that an increased risk for DHF/DSS during secondary infection with a heterologous DENV serotype is due to an immunopathological response mediated by serotype-cross-reactive memory T cells from the primary infection. Furthermore, epidemiological studies have shown that the sequence of infection with different DENV serotypes affects disease severity. Though much has been learned from human studies, there exist uncontrollable variables that are intrinsic in this system such as genetic factors and unknown infection histories. These factors can skew experimental results, making interpretations difficult. Therefore, a murine model to study the immunologic aspects of sequential dengue infections would be an asset to the field of dengue research. To examine the effect of sequential infection with different DENV serotypes on the CD8+ T cell response, we immunized Balb/c mice with a primary DENV infection on day 0 and subsequently challenged with a heterologous secondary DENV infection on day 28. We tested all possible sequences of infection with the four serotypes. We analyzed the T cell response to two previously defined epitopes on the DENV E (Ld-restricted) and NS3 (Kd-restricted) proteins. Using ELISPOT and intracellular cytokine staining, we measured the frequency of T cells secreting IFNγ and TNFα in response to stimulation with these epitopes during three phases: acute primary, acute secondary, and the memory phase after primary infection. We found that the T cell response in heterologous secondary infections was higher in magnitude than the response in acute primary infection or during the memory phase. We also found that the hierarchy of epitope specific responses, as measured by IFNγ secretion, was influenced by the sequence of infections. The adoptive transfer of immune serum or immune splenocytes suggested that memory T cells from the primary infection responded to antigens from the secondary infection. In vitroexperiments with T cell lines generated from mice with primary and secondary DENV infections suggested the preferential expansion of crossreactive memory T cells. In testing all of the different possible sequences of infection, we observed that two different sequences of infection (e.g., DENV-2 followed by DENV-1 versus DENV-2 followed by DENV-3) resulted in differential CD8+ T cell responses to the NS3 peptide even though both secondary infection serotypes contain the identical peptide sequence. To investigate this phenomenon, we examined the role of CD4+ T cell help on the memory CD8+ T cell response. We found that CD4+ T cell cytokine responses differ depending on the sequence of infection. In addition, it was also shown that crossreactivities of the CD4+ T cell response are also sequence-dependent. Moreover, denguespecific memory CD4+ T cells can augment the secondary CD8+ T cell response. Taken together, we demonstrated that this serotype sequence-dependent phenomenon is the result of differential help provided by cross-reactive memory CD4+T cells. The findings in this novel mouse model support the hypothesis that both CD4+ and CD8+ serotype-cross-reactive memory T cells from a primary dengue virus infection alter the immune response during a heterologous secondary dengue virus infection. These data further elucidate potential mechanisms whereby the specific sequence of infection with different dengue virus serotypes influences disease outcomes in humans.