Homocysteine-Methionine (HM) cycle produces a universal methyl group donor S-adenosylmethionine (SAM), a competitive methylation inhibitor S-adenosylhomocysteine (SAH), and an intermediate amino acid product homocysteine (Hcy). Elevated plasma levels of Hcy is termed as hyperhomocycteinemia (HHcy) which is an established risk factor for cardiovascular disease (CVD) and neural degenerative disease. We were the first to describe methylation inhibition as a mediating biochemical mechanism for endothelial injury and inflammatory monocyte differentiation in HHcy-related CVD and diabetes. We proposed metabolism-associated danger signal (MADS) recognition as a novel mechanism for metabolic risk factor-induced inflammatory responses, independent from pattern recognition receptor (PRR)-mediated pathogen-associated molecular pattern (PAMP)/danger-associated molecular pattern (DAMP) recognition. In this study, we examined the relationship of HM cycle gene expression with methylation regulation in human disease. We selected 115 genes in the extended HM cycle, including 31 metabolic enzymes and 84 methyltransferases (MT), examined their mRNA levels in 35 human disease conditions using a set of public databases. We discovered that: 1) HM cycle senses metabolic risk factor and controls SAM/SAH-dependent methylation. 2) Most of metabolic enzymes in HM cycle (8/11) are located in cytosol, while most of the SAM-dependent MTs (61/84) are located in the nucleus, and Hcy metabolism is absent in the nucleus. 3) 11 up-regulated, 3 down-regulated and 24 differentially regulated SAM/SAH-responsive signal pathways are involved in 7 human disease categories. 4) 8 SAM/SAH-responsive H3/H4 hypomethylation sites are identified in 8 disease conditions. We conclude that HM cycle is a key metabolic sensor system which mediates receptor-independent MADS recognition and modulates SAM/SAH-dependent methylation in human disease. We propose that HM metabolism takes place in cytosol and that nuclear methylation equilibration requires nuclear-cytosol transfer of SAM, SAH and Hcy. CD40 is a cell surface molecule which is expressed on antigen presenting cells such as monocyte, macrophage, dendritic cells and neutrophils. The costimulatory pair, CD40 and CD40L, enhances T cell activation and induce chronic inflammatory disease. Also, DNA hypomethylation on CD40 promotor induces inflammatory monocyte differentiation in chronic kidney disease. In order to figure out if CD40 is a prototypic HM cycle regulated master gene, RNA-seq analysis were performed for CD40+ and CD40- monocytes from mouse peripheral blood and 1,093 differentially expressed genes (DEGs) were selected from those two groups. All the DEGs modulate as much as 15 functional gene groups such as cytokines, enzymes and transcriptional factors. Furthermore, CD40+ monocytes activated trained immunity pathways especially in Acetyl-CoA generation and mevalonate pathway. In HM cycle, CD40 is a prototypic HM cycle regulated master gene to induce the most of the Hcy metabolic enzymes as well as MT, which can further modulate the methylation-regulated pathological signaling. / Biomedical Sciences

Les lymphocytes B jouent un rôle central dans l’immunité humorale par leur capacité à présenter des antigènes aux lymphocytes T, à sécréter des cytokines et à se différencier en plasmocytes produisant des anticorps. Ces fonctions peuvent être induites par leur stimulation in vitro. Par leur aptitude à présenter des antigènes indépendamment de la spécificité du récepteur des lymphocytes B (BCR), les lymphocytes B peuvent être utilisés comme cellules présentatrices d’antigènes (antigen-presenting cells, APC) afin d’induire la réponse cellulaire des lymphocytes T CD8+ cytotoxiques spécifiques. L’immunité cellulaire est cruciale pour prévenir les infections contre certains virus et en immunothérapie du cancer. L’objectif général de ces travaux est d’étudier la biologie des lymphocytes B. Plus particulièrement, nous souhaitons comprendre et améliorer leur fonction de présentation d’antigène afin d’utiliser les lymphocytes B comme source alternative d’APC. Dans la première partie de ces travaux, notre attention s’est portée sur la compréhension du mécanisme de présentation croisée par le complexe majeur d’histocompatibilité de classe I (CMH-I) par lequel un épitope de la protéine gp100 du mélanome, inséré dans une nanoparticule pseudo-virale (VLP) composée de la protéine de surface du virus de la mosaïque de la papaye (PapMV), est présenté par les lymphocytes B. Cette VLP est une plateforme vaccinale capable de stimuler le système immunitaire sans l’aide d’adjuvant et facilite la présentation croisée de l’épitope inséré, de façon indépendante de l’activité du protéasome. Les résultats obtenus démontrent que l’apprêtement de l’épitope inséré dans la nanoparticule s’effectue selon une voie de présentation croisée vacuolaire qui dépend de l’activité de la cathepsine S, de l’acidification des lysosomes et requiert l’induction de l’autophagie. Ainsi, nous avons défini plus précisément le mécanisme de présentation croisée par lequel les lymphocytes B apprêtent et présentent un épitope inséré dans la VLP de PapMV. Par la suite, nous avons cherché à améliorer le protocole d’activation in vitro permettant d’amplifier et d’induire les fonctions de présentation d’antigènes des lymphocytes B, dans le but d’utiliser ces cellules pour activer les réponses cellulaires des lymphocytes T CD8+ cytotoxiques. Les stimulations in vitro des lymphocytes B par le CD40 ligand (CD40L) et l’interleukine (IL)-21 ou la combinaison de l’IL-4 et l’IL-21 au lieu de l’activation standard avec le CD40L et l’IL-4 ont été évaluées. Nos résultats ont approfondi nos connaissances de la biologie des lymphocytes B. Nous avons démontré que la stimulation des lymphocytes B avec le CD40L et l’IL-21 augmente leur prolifération, mais mène à leur différenciation en plasmocytes sécrétant des anticorps. Au contraire, la stimulation avec le CD40L et l’IL-4 induit efficacement leur fonction de présentation d’antigènes. La stimulation des lymphocytes B avec le CD40L et la combinaison de l’IL-4 et de l’IL-21 augmente leur prolifération, mène seulement faiblement à leur différenciation en cellules sécrétrices d’anticorps, mais induit efficacement leur fonction de présentation d’antigènes. Nous avons démontré pour la première fois que cette méthode permet de générer des APC puissantes capables d’induire la réponse des lymphocytes T CD8+ cytotoxiques in vitro. Nos résultats nous permettent de postuler que ces cellules pourraient être capables de mener à une réponse cellulaire in vivo. En tant qu’APC efficaces, les lymphocytes B pourraient être utilisés dans une stratégie vaccinale ou être employés comme APC afin d’améliorer les traitements d’immunothérapie du cancer par transfert adoptif de lymphocytes T. Ainsi, les travaux présentés dans cette thèse ont porté tant sur la compréhension des mécanismes de présentation croisée d’un épitope inséré dans la VLP de PapMV par les lymphocytes B, que sur l’amélioration de la méthode permettant d’induire leur fonction de présentation d’antigènes pour activer les lymphocytes T CD8+ cytotoxiques. Ces travaux de recherche fondamentale ont permis de contribuer à des avancées sur les connaissances de la biologie des lymphocytes B. Ils offrent de nouvelles pistes de réflexion quant aux utilisations biotechnologiques des lymphocytes B comme source alternative d’APC pour des applications de recherche fondamentale et clinique telles que la vaccination et les traitements d’immunothérapie du cancer. / B lymphocytes are central to humoral immunity due to their ability to present antigens to T cells, secrete cytokines and to differentiate into antibody-producing plasma cells. These functions can be induced by their in vitro stimulation. Being able to present antigens independently of the specificity of their B cell receptor (BCR), B cells can be used as antigen-presenting cells (APC) to induce specific cytotoxic CD8+ T cell cellular responses. Cellular immunity is crucial to prevent infections against viruses and in cancer immunotherapy. The main aim of this thesis is to study B cell biology. Specifically, we aim to deepen our understanding of their antigen presentation function and improve this function to use B cells as an alternative source of APC. First, we focused on deciphering the class I major histocompatibility complex (MHC-I) cross-presentation mechanism by which an epitope from gp100 melanoma protein, inserted in a virus-like particle (VLP) made of the coat protein of the papaya mosaic virus (PapMV), is presented by B cells. This VLP is a vaccine platform able to stimulate the immune system with no adjuvant and mediate a proteasome independent cross-presentation of the inserted epitope. Our results show that the inserted epitope is processed through a vacuolar pathway dependent on cathepsin S activity, lysosome acidification and requires the induction of autophagy. Thus, we provide a more detailed characterization of the mechanism used by B cells to process and cross-present an epitope inserted in PapMV VLP. Secondly, we aimed to improve the in vitro activation protocol used to expand B cells and induce their antigen presentation functions to use these cells to trigger cytotoxic CD8+ T cell cellular responses. We evaluated the in vitro stimulation of B cells with CD40 ligand (CD40L) and interleukin (IL)-21 or the combination of IL-4 and IL-21 instead of the standard activation method based on CD40L and IL-4. Our results deepen our knowledge of B cell biology. We showed that stimulating B cells with CD40L and IL-21 increases their proliferation but leads to their differentiation in antibody-producing plasma cells. In comparison, the stimulation with CD40L and IL-4 efficiently induces their antigen presentation function. The stimulation of B lymphocytes with CD40L and the combination of IL-4 and IL-21 increases their proliferation, weakly leads to their differentiation in antibody-secreting cells but is very efficient in inducing their antigen presentation function. We show for the first time that this method can generate potent APC able to induce cytotoxic CD8+ T cell responses in vitro. Our results allow us to hypothesize that these cells could be capable of triggering cellular immunity in vivo. As efficient APC, B cells could be used in a vaccination strategy or be employed as APC to improve cancer immunotherapy treatments such as adoptive cell transfer of T lymphocytes. Thus, the work presented in this thesis provides a deeper understanding of the antigen cross-presentation pathway by which B cells process and present an epitope inserted in PapMV VLP. It also reports an improved method to induce antigen presentation function of B cells to stimulate cytotoxic CD8+ T cells. This research work constitutes a leap forward in fundamental B cell research by increasing our knowledge of B cell biology. It also brings new opportunities regarding biotechnological uses of B cells as an alternative source of APC for fundamental and clinical applications such as vaccination and cancer immunotherapy treatments.

Von TRAIL, FasL und APRIL, drei Mitgliedern der TNF-Liganden-Familie, ist bekannt, dass Trimerstabilität und Oligomerisierungsstatus maßgeblich das Rezeptoraktivierungspotential dieser Liganden beeinflussen. Für die immunstimulatorischen TNF-Liganden CD27L, CD40L, OX40L, 41BBL und GITRL war hingegen vor der Durchführung dieser Arbeit praktisch nicht bekannt, inwieweit Trimerbildung, Stabilisierung und Oligomerisierung wichtig für deren Aktitvität sind. Dies wurde in dieser Arbeit systematisch untersucht. CD40L besaß bereits als trimeres Molekül eine hohe Aktivität, die durch sekundäre Oligomerisierung nur wenig gesteigert wurde. Die spezifische Aktivität konnte durch Stabilisierung mit Hilfe der Tenascin-C (TNC)-Trimerisierungsdomäne nur geringfügig gesteigert werden. CD27L war als lösliches Flag-markiertes sowie als hexameres Fc-Protein selbst nach Quervernetzen nicht in der Lage, seinen Rezeptor CD27 zu binden und zu aktivieren. Die TNC-stabilisierte trimere Form des CD27L hingegen induzierte nach Oligomerisierung mit einem anti-Flag-Antikörper ein starkes Signal. Trimerer OX40L und trimerer 41BBL konnten nur in oligomerisierter Form ihre Rezeptoren aktivieren, wobei die Aktivität der TNC-stabilisierten Form signifikant stärker ausgeprägt war. GITRL aktivierte seinen Rezeptor bereits als stabilisiertes Trimer und Hexamer, die Aktivität konnte durch Quervernetzen nur gering gesteigert werden. Zusammenfassend kann man sagen, dass CD27L, OX40L und 41BBL zu der Untergruppe der TNF-Ligandenfamilie gehört, für die eine Stabilisierung des trimeren Moleküls und dessen Oligomerisierung nötig sind, um eine starke Rezeptoraktivierung zu ermöglichen. Im Gegensatz dazu zeigten CD40L und GITRL bereits oligomerisierungsunabhängig eine hohe Aktivität. GITRL benötigte allerdings die Stabilisierung des trimeren Moleküls durch die TNC-Domäne, um gute Aktivität zu zeigen. Im Weiteren wurden Antikörperfragment (scFv-)-TNF-Ligand-Fusionsproteine konstruiert und untersucht, die ein Zelloberflächenantigen binden. Eine starke Zelloberflächenantigen-spezifische Aktivierung des jeweiligen Rezeptors konnte für scFv-41BBL und für scFv-OX40L gezeigt werden, wohingegen scFv-CD40L und scFv-GITRL bereits auf antigennegativen Zellen stark aktiv waren. scFv-CD27L war selbst auf antigenpositiven Zellen inaktiv. Verwendet man an Stelle des Antikörperfragments eine extrazelluläre Proteinbindedomäne, z.B. die eines TNF-Rezeptors, erhält man Fusionsproteine, die zum einen eine selektive Aktivierung der TNF-Ligandendomäne und somit die Aktivierung des korrespondierenden Rezeptors auf der Zielzelle ermöglichen, zum anderen aber durch die Bindung an den membranständigen Liganden dessen Aktitvät neutralisieren können. Für CD40-, RANK- und B7-2-FasL konnte der immobilisationabhängige Aktivierungseffekt auf entsprechenden Zelloberflächenmolekül-exprimierenden Zellen gezeigt werden. Anhand von T47D-Zellen, die durch eine autokrine CD40L-CD40-Signalschleife vor Apoptose geschützt sind, konnte gezeigt werden, dass durch die Bindung von CD40-FasL an membranständigen CD40L die CD40L-CD40-Interaktion gestört und gleichzeitig Apoptose verstärkt induziert werden kann. Das Prinzip der antigenabhängigen Aktivierung von TNF-Liganden könnte Anwendung in der Tumortherapie finden, da bei Verwendung entsprechender selektiv exprimierter Marker eine lokale Rezeptoraktivierung erreicht und so Nebenwirkungen minimiert werden können. / Trimer stability and oligomerization status of TRAIL, FasL and APRIL, three members of the TNF ligand family, critically determine their receptor activating potential. However, detailed information for the immunostimmulatory ligands CD27L, CD40L, OX40L, 41BBL and GITRL regarding the importance of trimer formation, stabilization and oligomerization for ligand activity was lacking. These aspects were investigated systematically in this work. CD40L was highly active as a trimeric molecule. Secondary oligomerization and/or stabilization via the tenascin-C (TNC) trimerization domain slightly enhanced its specific activity. As soluble Flag-tagged and as hexameric Fc protein CD27L failed to bind and activate its cognate receptor CD27, even after crosslinking. However, the TNC stabilized form of CD27L induced a strong signal after oligomerization with anti-Flag antibody. Receptor signaling was only activated by oligomerized molecules of trimeric OX40L and 41BBL whereas the respective TNC fusion protein showed significant stronger activity. Stabilized GITRL trimers and hexamers already activated their receptor whereas oligomerization of GITRL just slightly enhanced the specific activity. Taken together, CD27L, OX40L and 41BBL belong to a TNF ligand family subgroup which requires oligomerization and stabilization of the trimeric molecule to ensure strong receptor activation. In contrast, CD40L and GITRL already display high oligomerization-independent activity, though the latter needs stabilization by the TNC domain. Furthermore, antibody fragment (scFv)-ligand fusion proteins targeting specific cell surface antigens were designed and analyzed. Strong cell surface antigen-selective TNF receptor activation was achieved for scFv-41BBL and scFv-OX40L whereas scFv-CD40L and scFv-GITRL already induced signaling in the absence of antigen-positive cells. scFv-CD27L lacked activity even on antigen-positive cells. Using an extracellular protein binding domain for example the ligand binding domain of a TNF receptor instead of an antibody fragment resulted in fusion proteins that on the one hand activate the TNF ligand domain and thus the corresponding receptor on target cells and on the other hand neutralize membrane ligand activity by binding. The effect of cell surface immobilization-mediated activation of these fusion proteins on cells expressing the corresponding target molecule was shown here for CD40-, RANK- and B7-2-FasL. The CD40-FasL fusion protein simultaneously blocked CD40L-CD40 interaction and induced strong apoptosis in T47D cells displaying an antiapoptotic autocrine CD40L-CD40 signaling loop. The principle of antigen-dependent activation of TNF ligands could be of use in tumor treatment due to the fact that tumor specific marker targeting leads to locally restricted receptor activation on antigen positive cells, promising a reduction in potential off target effects.

Introdução: O fragmento C4d e os anticorpos anti-HLA doador específicos (DSA) são marcadores de resposta humoral em enxertos renais com rejeição, mas o papel das células B nesse processo ainda não é claro. Neste estudo foi avaliada a correlação entre C4d, DSA e células B de enxertos com disfunção e sua associação com aspectos morfológicos, função e sobrevida do rim transplantado. Material e Métodos: A marcação para C4d, células B CD20+ e plasmócitos CD138+ foi realizada por imunoperoxidase em biópsias por indicação de 110 receptores de transplante renal. Positividade para CD20 e CD138 foi definida por curva ROC (≥5 céls./mm2). O soro coletado concomitante a biópsia foi testado para DSA classe I e classe II. Estes marcadores foram correlacionados com dados clínicos e do transplante, a histopatologia de Banff e a evolução do rim transplantado. Resultados: Depósitos de C4d e DSA circulantes foram detectados em 100% e 70% dos pacientes com rejeição mediada por anticorpos (RMA) respectivamente, e nos casos de rejeição aguda celular (RAC) em 42% (p<0,001, vs. RMA) e 28% (p=0,003, vs. RMA). Estes dois marcadores correlacionaram-se positivamente (r=0,31, p=0,016). Houve correlação significativa entre DSA e plasmócitos CD138+ (r=0.32 p=0,006), mas as células CD20 e CD138 não se correlacionaram entre si. As células CD138+ predominaram na RMA, associadas com maior painel pré-transplante e DSA, mas não a C4d, e as células CD20+ predominaram na RAC e nas biópsias com fibrose intersticial/atrofia tubular, associadas a maior incompatibilidade HLA e a retransplantes. Pacientes com C4d+ tiveram pior função e sobrevida do enxerto em três anos de transplante, e aqueles com DSA+ uma pior 7 sobrevida do enxerto. Positividade para CD20 ou CD138 não foi preditiva da função ou sobrevida do enxerto. Na análise multivariada, somente o C4d foi fator de risco para perda do enxerto. Conclusões: Esses resultados confirmam o valor prognóstico do C4d e dos DSA para uma pior evolução do enxerto renal, e sugerem uma associação das células B CD20+ com parâmetros de rejeição celular e dos plasmócitos CD138+ com marcadores de resposta humoral. Entretanto, nesse estudo o infiltrado de células B na biópsia do enxerto não foi preditivo de uma pior evolução do rim transplantado. / Introduction: The fragment C4d and the donor specific anti-HLA antibodies (DSA) are markers of the humoral response in rejecting kidney grafts, but the role of B cells in this process is still unclear. In this study we evaluated the correlation between C4d, DSA and B cells in dysfunctional grafts, and their association with morphological features, and graft function and survival. Material and Methods: The staining for C4d, CD20+ B cells and CD138+ plasmocytes were done by immunoperoxidase in 110 kidney graft biopsies for cause. Positivity for CD20 and CD138 were established by ROC curve (≥5 cells/mm2). Serum collected at biopsy were tested for anti-HLA class I and II antibodies. These markers were correlated with clinical and transplant characteristics, Banff histopathology and graft outcomes. Results: C4d deposits and circulating DSA were detected in 100% and 70% of the patients with antibody-mediated rejection (AMR) respectively, and in cases with acute cellular rejection (ACR) in 42% (p<0.001, vs. AMR) and 28% (p=0.003, vs. AMR), respectively. Both markers were positively correlated (r=0.31, p=0.016), and there was also a significant correlation between DSA and plasmocytes CD138+ (r=0.32 p=0.006). CD20 and C138 cells were not siginificantly correlated. Plasmocytes CD138+ predominated in AMR, and were associated with higher pre transplant PRA and DSA positivity, but not with C4d. CD20+ B cells were highly expressed in ACR and in biopsies with interstitial fibrosis and tubular atrophy, in association with more HLA mismatches and re-transplants. Patients with C4d had poorer graft function and survival, and those 9 with DSA + also had a worse graft survival in three years of transplant. CD20 or CD138 cells were not predictive of graft outcomes. In multivariated analysis, only C4d remained a risk factor for graft loss. Conclusion: These results confirm the prognostic value of C4d and circulating DSA for a worse kidney graft outcome, and suggest an association of CD20+ B cells with parameters of cellular rejection whereas CD138+ plasmocytes correlated with markers of the humoral response. However, in this study the B cell infiltrate in graft biopsy was not predictive of adverse outcomes to the transplanted kidney.

Thesis (Ph. D.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Vita. Bibliography: 195-256.

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.

O transplante de ilhotas humanas, utilizado como reposição das células produtoras de insulina em pacientes portadores de diabetes mellitus tipo 1, está se tornando uma importante prática clínica. Entretanto, eventos inflamatórios não específicos presente nas ilhotas, são responsáveis pela vulnerabilidade das mesmas, e contribuem à diminuição do número celular durante o processo de isolamento e posterior transplante. CD40 é um membro da família do receptor de necrose tumoral, descrito em uma variedade de células. Em condições fisiológicas, o CD40 presente nas células apresentadoras de antígenos participa como molécula co-estimulatória na ativação dos linfócitos T. Porém, o CD40 também foi descrito em condições patológicas, como psoríase, aterosclerose e fibrose cística, onde sua expressão está envolvida em eventos crônicos inflamatórios. É interessante ressaltar que, o CD40 também tem sido descrito em neurônios, células que apresentam uma variedade de moléculas similares às expressas nas células M pancreáticas. Em vista desses achados, tentou-se determinar se a células M também poderiam expressar o receptor de CD40, e se presente, determinar possíveis conseqüências próinflamatórias após a sua ativação. Utilizaram-se diversas técnicas como RT-PCR, western blot, citometria de fluxo, imuno-histoquímica assim como imunofluorescência, para detectar a expressão de CD40 em ilhotas de camundongo, macaco e humano, e também na linhagem de células M NIT-1. Determinaram-se as vias de transdução de sinais de CD40 por western blot e ensaios com gene repórter. Foi determinada por tecnologia luminex, a secreção de citocinas e quimiocinas dependente de CD40 em ilhotas humanas, estimuladascom a proteína recombinante CD40L e em alguns casos confirmada por RT-PCR e imunofluorescência. Os resultados demonstram a expressão de CD40 nas células M, que pode ser aumentada pela ação de citocinas pró-inflamatórias, cuja ativação induz a secreção de mais citocinas e quimiocinas (IL-6, IL-8, MCP-1 e MIP-1M) dependentes das vias de transdução de sinais Raf/MEK/ERK e NF-VB. A interação CD40-CD40L aumentou a expressão de ICAM-1 e a induziu morte celular nas células M pancreáticas. Nesse sentido, a ativação de CD40 induz a secreção de mediadores solúveis próinflamatórios que podem comprometer a viabilidade das células M. O cenário próinflamatório sustentando pela ação de CD40 sugere que o mesmo poderia ter um papel ativo orquestrando um processo inflamatório

Introdução: O fragmento C4d e os anticorpos anti-HLA doador específicos (DSA) são marcadores de resposta humoral em enxertos renais com rejeição, mas o papel das células B nesse processo ainda não é claro. Neste estudo foi avaliada a correlação entre C4d, DSA e células B de enxertos com disfunção e sua associação com aspectos morfológicos, função e sobrevida do rim transplantado. Material e Métodos: A marcação para C4d, células B CD20+ e plasmócitos CD138+ foi realizada por imunoperoxidase em biópsias por indicação de 110 receptores de transplante renal. Positividade para CD20 e CD138 foi definida por curva ROC (≥5 céls./mm2). O soro coletado concomitante a biópsia foi testado para DSA classe I e classe II. Estes marcadores foram correlacionados com dados clínicos e do transplante, a histopatologia de Banff e a evolução do rim transplantado. Resultados: Depósitos de C4d e DSA circulantes foram detectados em 100% e 70% dos pacientes com rejeição mediada por anticorpos (RMA) respectivamente, e nos casos de rejeição aguda celular (RAC) em 42% (p<0,001, vs. RMA) e 28% (p=0,003, vs. RMA). Estes dois marcadores correlacionaram-se positivamente (r=0,31, p=0,016). Houve correlação significativa entre DSA e plasmócitos CD138+ (r=0.32 p=0,006), mas as células CD20 e CD138 não se correlacionaram entre si. As células CD138+ predominaram na RMA, associadas com maior painel pré-transplante e DSA, mas não a C4d, e as células CD20+ predominaram na RAC e nas biópsias com fibrose intersticial/atrofia tubular, associadas a maior incompatibilidade HLA e a retransplantes. Pacientes com C4d+ tiveram pior função e sobrevida do enxerto em três anos de transplante, e aqueles com DSA+ uma pior 7 sobrevida do enxerto. Positividade para CD20 ou CD138 não foi preditiva da função ou sobrevida do enxerto. Na análise multivariada, somente o C4d foi fator de risco para perda do enxerto. Conclusões: Esses resultados confirmam o valor prognóstico do C4d e dos DSA para uma pior evolução do enxerto renal, e sugerem uma associação das células B CD20+ com parâmetros de rejeição celular e dos plasmócitos CD138+ com marcadores de resposta humoral. Entretanto, nesse estudo o infiltrado de células B na biópsia do enxerto não foi preditivo de uma pior evolução do rim transplantado. / Introduction: The fragment C4d and the donor specific anti-HLA antibodies (DSA) are markers of the humoral response in rejecting kidney grafts, but the role of B cells in this process is still unclear. In this study we evaluated the correlation between C4d, DSA and B cells in dysfunctional grafts, and their association with morphological features, and graft function and survival. Material and Methods: The staining for C4d, CD20+ B cells and CD138+ plasmocytes were done by immunoperoxidase in 110 kidney graft biopsies for cause. Positivity for CD20 and CD138 were established by ROC curve (≥5 cells/mm2). Serum collected at biopsy were tested for anti-HLA class I and II antibodies. These markers were correlated with clinical and transplant characteristics, Banff histopathology and graft outcomes. Results: C4d deposits and circulating DSA were detected in 100% and 70% of the patients with antibody-mediated rejection (AMR) respectively, and in cases with acute cellular rejection (ACR) in 42% (p<0.001, vs. AMR) and 28% (p=0.003, vs. AMR), respectively. Both markers were positively correlated (r=0.31, p=0.016), and there was also a significant correlation between DSA and plasmocytes CD138+ (r=0.32 p=0.006). CD20 and C138 cells were not siginificantly correlated. Plasmocytes CD138+ predominated in AMR, and were associated with higher pre transplant PRA and DSA positivity, but not with C4d. CD20+ B cells were highly expressed in ACR and in biopsies with interstitial fibrosis and tubular atrophy, in association with more HLA mismatches and re-transplants. Patients with C4d had poorer graft function and survival, and those 9 with DSA + also had a worse graft survival in three years of transplant. CD20 or CD138 cells were not predictive of graft outcomes. In multivariated analysis, only C4d remained a risk factor for graft loss. Conclusion: These results confirm the prognostic value of C4d and circulating DSA for a worse kidney graft outcome, and suggest an association of CD20+ B cells with parameters of cellular rejection whereas CD138+ plasmocytes correlated with markers of the humoral response. However, in this study the B cell infiltrate in graft biopsy was not predictive of adverse outcomes to the transplanted kidney.

O transplante de ilhotas humanas, utilizado como reposição das células produtoras de insulina em pacientes portadores de diabetes mellitus tipo 1, está se tornando uma importante prática clínica. Entretanto, eventos inflamatórios não específicos presente nas ilhotas, são responsáveis pela vulnerabilidade das mesmas, e contribuem à diminuição do número celular durante o processo de isolamento e posterior transplante. CD40 é um membro da família do receptor de necrose tumoral, descrito em uma variedade de células. Em condições fisiológicas, o CD40 presente nas células apresentadoras de antígenos participa como molécula co-estimulatória na ativação dos linfócitos T. Porém, o CD40 também foi descrito em condições patológicas, como psoríase, aterosclerose e fibrose cística, onde sua expressão está envolvida em eventos crônicos inflamatórios. É interessante ressaltar que, o CD40 também tem sido descrito em neurônios, células que apresentam uma variedade de moléculas similares às expressas nas células M pancreáticas. Em vista desses achados, tentou-se determinar se a células M também poderiam expressar o receptor de CD40, e se presente, determinar possíveis conseqüências próinflamatórias após a sua ativação. Utilizaram-se diversas técnicas como RT-PCR, western blot, citometria de fluxo, imuno-histoquímica assim como imunofluorescência, para detectar a expressão de CD40 em ilhotas de camundongo, macaco e humano, e também na linhagem de células M NIT-1. Determinaram-se as vias de transdução de sinais de CD40 por western blot e ensaios com gene repórter. Foi determinada por tecnologia luminex, a secreção de citocinas e quimiocinas dependente de CD40 em ilhotas humanas, estimuladascom a proteína recombinante CD40L e em alguns casos confirmada por RT-PCR e imunofluorescência. Os resultados demonstram a expressão de CD40 nas células M, que pode ser aumentada pela ação de citocinas pró-inflamatórias, cuja ativação induz a secreção de mais citocinas e quimiocinas (IL-6, IL-8, MCP-1 e MIP-1M) dependentes das vias de transdução de sinais Raf/MEK/ERK e NF-VB. A interação CD40-CD40L aumentou a expressão de ICAM-1 e a induziu morte celular nas células M pancreáticas. Nesse sentido, a ativação de CD40 induz a secreção de mediadores solúveis próinflamatórios que podem comprometer a viabilidade das células M. O cenário próinflamatório sustentando pela ação de CD40 sugere que o mesmo poderia ter um papel ativo orquestrando um processo inflamatório

Introdução: O fragmento C4d e os anticorpos anti-HLA doador específicos (DSA) são marcadores de resposta humoral em enxertos renais com rejeição, mas o papel das células B nesse processo ainda não é claro. Neste estudo foi avaliada a correlação entre C4d, DSA e células B de enxertos com disfunção e sua associação com aspectos morfológicos, função e sobrevida do rim transplantado. Material e Métodos: A marcação para C4d, células B CD20+ e plasmócitos CD138+ foi realizada por imunoperoxidase em biópsias por indicação de 110 receptores de transplante renal. Positividade para CD20 e CD138 foi definida por curva ROC (≥5 céls./mm2). O soro coletado concomitante a biópsia foi testado para DSA classe I e classe II. Estes marcadores foram correlacionados com dados clínicos e do transplante, a histopatologia de Banff e a evolução do rim transplantado. Resultados: Depósitos de C4d e DSA circulantes foram detectados em 100% e 70% dos pacientes com rejeição mediada por anticorpos (RMA) respectivamente, e nos casos de rejeição aguda celular (RAC) em 42% (p<0,001, vs. RMA) e 28% (p=0,003, vs. RMA). Estes dois marcadores correlacionaram-se positivamente (r=0,31, p=0,016). Houve correlação significativa entre DSA e plasmócitos CD138+ (r=0.32 p=0,006), mas as células CD20 e CD138 não se correlacionaram entre si. As células CD138+ predominaram na RMA, associadas com maior painel pré-transplante e DSA, mas não a C4d, e as células CD20+ predominaram na RAC e nas biópsias com fibrose intersticial/atrofia tubular, associadas a maior incompatibilidade HLA e a retransplantes. Pacientes com C4d+ tiveram pior função e sobrevida do enxerto em três anos de transplante, e aqueles com DSA+ uma pior 7 sobrevida do enxerto. Positividade para CD20 ou CD138 não foi preditiva da função ou sobrevida do enxerto. Na análise multivariada, somente o C4d foi fator de risco para perda do enxerto. Conclusões: Esses resultados confirmam o valor prognóstico do C4d e dos DSA para uma pior evolução do enxerto renal, e sugerem uma associação das células B CD20+ com parâmetros de rejeição celular e dos plasmócitos CD138+ com marcadores de resposta humoral. Entretanto, nesse estudo o infiltrado de células B na biópsia do enxerto não foi preditivo de uma pior evolução do rim transplantado. / Introduction: The fragment C4d and the donor specific anti-HLA antibodies (DSA) are markers of the humoral response in rejecting kidney grafts, but the role of B cells in this process is still unclear. In this study we evaluated the correlation between C4d, DSA and B cells in dysfunctional grafts, and their association with morphological features, and graft function and survival. Material and Methods: The staining for C4d, CD20+ B cells and CD138+ plasmocytes were done by immunoperoxidase in 110 kidney graft biopsies for cause. Positivity for CD20 and CD138 were established by ROC curve (≥5 cells/mm2). Serum collected at biopsy were tested for anti-HLA class I and II antibodies. These markers were correlated with clinical and transplant characteristics, Banff histopathology and graft outcomes. Results: C4d deposits and circulating DSA were detected in 100% and 70% of the patients with antibody-mediated rejection (AMR) respectively, and in cases with acute cellular rejection (ACR) in 42% (p<0.001, vs. AMR) and 28% (p=0.003, vs. AMR), respectively. Both markers were positively correlated (r=0.31, p=0.016), and there was also a significant correlation between DSA and plasmocytes CD138+ (r=0.32 p=0.006). CD20 and C138 cells were not siginificantly correlated. Plasmocytes CD138+ predominated in AMR, and were associated with higher pre transplant PRA and DSA positivity, but not with C4d. CD20+ B cells were highly expressed in ACR and in biopsies with interstitial fibrosis and tubular atrophy, in association with more HLA mismatches and re-transplants. Patients with C4d had poorer graft function and survival, and those 9 with DSA + also had a worse graft survival in three years of transplant. CD20 or CD138 cells were not predictive of graft outcomes. In multivariated analysis, only C4d remained a risk factor for graft loss. Conclusion: These results confirm the prognostic value of C4d and circulating DSA for a worse kidney graft outcome, and suggest an association of CD20+ B cells with parameters of cellular rejection whereas CD138+ plasmocytes correlated with markers of the humoral response. However, in this study the B cell infiltrate in graft biopsy was not predictive of adverse outcomes to the transplanted kidney.