Notre équipe a récemment découvert l’importance du ciblage des granules d’insuline aux lysosomes lors d’une mise à jeun chez les cellules pancréatiques β. Le diabète de type 2 (TD2) est caractérisé par la résistance à l’insuline couplé au dysfonctionnement des cellules β-et à leur perte. Je souhaitais évaluer le ciblage des granules d’insuline aux lysosomes dans le contexte diabétique. Grâce à un modèle murin, nous avons trouvé que le nombre des lysosomes contenant des granules d’insuline était augmenté chez les cellules β-provenant de souris diabétiques en comparaison aux contrôles. Ceci était accompagné par l’augmentation des niveaux de la protéine lysosomale CD63. Parce que PKD1 contrôle le ciblage des granules d’insuline aux lysosomes lors d’une mise à jeun, nous nous sommes demandé si PKD1 était importante lors d’un diabète de type 2. Dans nos modèles, les niveaux de PKD1 étaient diminués en conditions diabétiques en comparaison aux contrôles. De plus, l’inhibition de PKD1 entrainait l’augmentation du ciblage des granules d’insuline aux lysosomes et accélérait l’apparition du diabète dans notre modèle murin. Nous souhaitions ensuite savoir si l’activation de PKD1 dans les cellules pancréatiques β-pouvait être avantageuse dans un contexte diabétique. De fait, grâce à l’utilisation d’un composé spécifique, nous avons pu montrer que l’activation de PKD1 menait à l’augmentation des niveaux d’insuline sur des ilots pancréatiques humains et ralentissait l’apparition du diabète dans notre modèle murin. Pour conclure, j’ai aussi débuté la caractérisation des lysosomes sur d’autres types cellulaires des ilots pancréatiques. Nous avons observé que LIMP2, une autre protéine lysosomale, était fortement exprimée chez les cellules pancréatiques α. / Our team recently uncovered the importance of the targeting of insulin granules to the lysosomal compartments in pancreatic β-cells during fasting. Type 2 Diabetes (T2D) is characterised by insulin resistance coupled with pancreatic β-cell failure which account for both β-cells dysfunction and β-cells death. I wanted to assess the targeting of insulin granule to the lysosomes in the context of T2D. Using murine diabetic model, we found that the number Granule-containing Lysosomes was enhanced in diabetic β-cells in comparison to controls. This was accompanied by an increase in the level of the lysosomal protein CD63. Because PKD1 controls the targeting of insulin granule to the lysosomes during fasting, I wondered if PKD1 was important during T2D. PKD1 levels were decreased in our diabetic models in comparison to controls. Moreover inhibition of PKD1 led to enhanced targeting of the insulin granules to the lysosomes and accelerated apparition of diabetes in our murine model. I also tested if activation of PKD1 in pancreatic β-cells could be beneficial in the context of diabetes. Indeed using a specific compound, we showed that PKD1 activation led to an increase in insulin levels and delayed onset of diabetes in our murine model. My work thus uncovered mechanisms underlying a fundamentally new process in β-cells with potential implications for novel therapeutic directions in T2D. Finally, I started to assess lysosomes in another pancreatic islets cell type. I found that LIMP2, another lysosomal membrane protein, was specifically highly expressed in the pancreatic α-cells.

Made available in DSpace on 2016-02-26T13:34:42Z (GMT). No. of bitstreams: 2 livia_carmo_ioc_mest_2014.pdf: 120790006 bytes, checksum: 2a0bcc88a34d66489c438b53fd76cf18 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2016-01-13 / Os eosinófilos são leucócitos que estão envolvidos em respostas inflamatórias, alérgicas e imunoreguladoras, através da secreção de proteínas catiônicas e citocinas armazenadas em seus grânulos específicos. Os mecanismos de secreção podem ocorrer por: (i) desgranulação por piecemeal (PMD), caraterizada pelo transporte mediado por vesículas que brotam dos grânulos e levam os produtos até a superfície celular; (ii) exocitose clássica, caracterizada pela fusão dos grânulos com a membrana plasmática e (iii) citólise, quando os grânulos são liberados após lise celular. O CD63 é uma molécula da família das tetraspaninas que parece atuar como facilitador na secreção de mediadores da inflamação. Entretanto, não existem estudos ultraestruturais que demonstrem a associação de CD63 com processos de secreção de eosinófilos. Este trabalho teve por objetivo investigar a mobilização de CD63 e sua correlação com mecanismos de secreção em eosinófilos humanos estimulados com mediadores inflamatórios (eotaxina e fator de necrose tumoral -TNF-\03B1). A expressão de CD63 foi investigada na superfície celular através de imunofluorescência e em compartimentos subcelulares através de imunomarcação pre-embedding por microscopia eletrônica de transmissão que permite melhor preservação antigênica e os anticorpos mostram ótimo acesso a microdomínios celulares com partículas de ouro (1.4 nm) conjugadas a anticorpos secundários A imunofluorescência mostrou elevada expressão de CD63 na superfície celular, mas com padrões diferentes dependendo do estímulo. Enquanto a eotaxina induziu imunomarcação pontual, a expressão de CD63, induzida por TNF- \03B1, mostrou-se de maneira difusa, indicando a ocorrência de processos de secreção diferentes. As análises ultraestruturais revelaram que a eotaxina induziu PMD, enquanto o TNF-\03B1 desencadeou exocitose clássica. O CD63 foi detectado principalmente nos grânulos de secreção. As análises quantitativas mostraram que nos grupos estimulados ocorreu aumento significativo do número de grânulos CD63- positivos em comparação com o grupo controle não estimulado. Além disso, 89,94 % dos grânulos sofrendo PMD (grupo eotaxina) e 84,73% dos grânulos sofrendo fusão (grupo TNF-\03B1) eram positivos para CD63. A marcação para CD63 foi também documentada em endossomos e em vesículas, incluindo vesículas tubulares típicas de eosinófilos (Eosinophil Sombrero Vesicles \2013 EoSVs), envolvidas no transporte de moléculas dos grânulos. Em conjunto, nossos dados demonstraram, pela primeira vez, que CD63 é um marcador tanto de grânulos de secreção como de processos secretores envolvidos na liberação de produtos de eosinófilos. Isto é importante para o entendimento de mecanismos de liberação de mediadores imunes durante respostas de eosinófilos a doenças alérgicas e inflamatórias / Eosinophils are leukocytes involved with inflammatory, allergic and immmunoregulatory responses through the secretion of granule-stored cationic proteins and cytokines. Secretion can occur by: (i) piecemeal degranulation (PMD), characterized by vesicle-mediated transport of products from granules to cell surface; (ii) classical exocytosis, characterized by granule fusion with the plasma membrane e (iii) cytolysis, in which the granule content is released after cell lysis. CD63 is a tetraspanin family molecule which seems to act as a facilitator during secretion of inflammatory mediators. However, there are no ultrastructural studies demonstrating association of CD63 with secretory processes of eosinophils. The goal of this work was to investigate the mobilization of CD63 and its association with mechanisms of secretion in human eosinophils stimulated with inflammatory mediators (eotaxin and tumoral necrosis factor-TNF-α). Expression of CD63 was investigated at the cell surface using immunofluorescence technique and in subcellular compartments by pre-embedding ultrastructural immunolabeling which enables better antigenic preservation. Optimal access of antibodies to cellular microdomains was achieved with gold particles (1.4 nm) conjugated with secondary antibodies. Immunofluorescence showed high CD63 expression at cell surface, but with different profiles, depending on the stimulus. While eotaxin induced a punctual immunolabeling, expression of CD63, induced by TNF-α, was more diffuse, indicating occurrence of different secretory processes. Ultrastructural analyses revealed that eotaxin induced PMD, while TNF-α led to classical exocytosis. CD63 was detected mainly on secretory granules. Quantitative analyses showed a significant increase of the numbers of CD63-positive granules compared to the unstimulated, control group. Moreover, 89.94 % of the granules undergoing PMD (eotaxin group) and 84.73% of the granules in fusion process (TNF-α group) were positive for CD63. CD63 labeling was also documented in endosomes and vesicles, including tubular vesicles typical of eosinophils (Eosinophil Sombrero Vesicles – EoSVs), involved in the transport of granule molecules. Altogether, our data demonstrated, for the first time, that CD63 is a marker for secretory granules as well as for secretory processes involved with the release of products from eosinophils. This is important for understanding mechanisms of secretion of immune mediators during inflammatory responses of eosinophils to allergic and inflammatory diseases.

Le TIMP-1, inhibiteur naturel des métalloprotéinases matricielles, exerce des effets pléïotropes indépendants de l'inhibition des MMPs et participe au développement de certains cancers et maladies neurodégénératives. Ces effets cytokiniques du TIMP-1 impliquent sa liaison à des récepteurs membranaires dont certains sont caractérisés, la glycoprotéine CD63/intégrine beta 1 et le complexe pro MMP-9/CD44. Cependant les acides aminés ou les domaines du TIMP-1 se liant à ces récepteurs ne sont pas identifiés. Les travaux réalisés au cours de cette thèse mettent en évidence un nouveau récepteur du TIMP-1, la protéine LRP-1. Dans les neurones corticaux murins, le TIMP-1 se fixe aux domaines DII et DIV de LRP-1, est endocyté et induit une réduction de la taille des neurites ainsi qu'une augmentation du volume des cônes de croissance. Afin de caractériser cette interaction, nous avons utilisé une approche originale de modélisation moléculaire associant les analyses de modes normaux et la dynamique moléculaire. Ces analyses in silico ont permis d'identifier un mouvement de pince entre les domaines N et C-terminaux du TIMP-1. Nous avons muté trois résidus (F12, K47 et W105) localisés dans une région essentielle d'un point vue énergétique à l'exécution de ce mouvement. Ces trois mutants n'ont pas d'effet sur la longueur du réseau neuritique et ne sont pas endocytés par LRP-1. En revanche, ils interagissent avec les 2 autres récepteurs (CD63 et proMMP-9) et reproduisent les effets du TIMP-1 sauvage. De plus, nous avons identifié une séquence de 6 acides aminés localisée dans le domaine extracellulaire I de CD63 et essentielle à la liaison avec le TIMP-1. L'ensemble de ces travaux a permis l'identification de régions impliquées dans l'interaction du TIMP-1 avec ses différents récepteurs et pourrait permettre le développement de nouveaux outils pharmacologiques ciblant les activités cytokiniques du TIMP-1. / TIMP-1, a natural inhibitor of matrix metalloproteinases, exerts pleiotropic effects independent of MMP inhibition and thus participates to the development of some cancers and neurodegenerative disorders. These cytokine-like activities require TIMP-1 binding to membrane receptors. Up to date two receptors, CD63/integrin beta 1 and proMMP-9/CD44, have been characterized. Nevertheless, TIMP-1 residues or regions binding these receptors remain unknown. In this work, we have identified the protein LRP-1 as a new receptor for TIMP 1. In mouse cortical neurons, TIMP-1 preferentially binds DII and DIV domains of LRP-1, is internalized via a LRP-1-dependent endocytosis, reduces neurite length and increases growth cone volume. To go deeper into TIMP-1/LRP-1 interaction, we used an original molecular modeling approach which combined normal mode analysis and molecular dynamic. These in silico studies allow us to point out a clamp movement between the N- and C-terminal domains of TIMP-1. Three residues localized in a region that seems essential for the movement have been mutated (F12, K47 and W105) and single mutants have been produced. These mutants do not reduce neurite outgrowth and are not internalized by LRP-1. In contrast, they interact with the two others receptors proMMP-9 and CD63 and induce associated biological effects. Furthermore, we have identified a sequence of six residues localized in the CD63 extracellular domain I and essential for TIMP 1 binding. The set of our data highlighted new regions of TIMP-1 interacting with its receptors and could lead to design novel therapeutic agents targeting the TIMP-1 cytokine like activities.

We previously demonstrated that embryonic stem (ES) cells over-expressing tissue inhibitor of metalloproteinase-1 (TIMP-1) have increased potential to engraft and differentiate into cardiac myocytes following transplantation into the infarcted heart. However, the ability of TIMP-1 to activate endogenous stem cells and enhance their differentiation into cardiac regenerative cell types is still unknown. We postulate that TIMP-1 may additionally activate a stem cell population that enhances cardiac cell type differentiation in the infarcted myocardium. To prove this hypothesis, we isolated c-kit+ve cells from four weeks old C57BL/6 mice and cultured them in vitro in presence of ES conditioned media (ESCM), ES-TIMP-1-CM or TIMP-1. Our immunostaining data validate the existence of a novel CD63+ve/c-kit+ve cells. When treated with TIMP-1, these cells showed significantly (p < 0.05) increased proliferation and differentiation into cardiac myocytes, vascular smooth muscle cells, and endothelial cells. Western blot analysis revealed significantly (p < 0.05) increased expression of CD63, phosphorylated and total β-catenin proteins. Furthermore, our RT-PCR data showed increased cardiac gene expression (GATA-4, Mef2C, and Nkx-2.5) when compared to ESCM and control cells. Based on the in vitro findings, we investigated the effect of intramyocardial delivery of TIMP-1 on endogenous CD63+ve/c-kit+ve cells following myocardial infarction (MI). C57BL/6 and TIMP-1 KO mice underwent coronary artery ligation followed by intramyocardial delivery of 20μl of culture media (CC), ESCM, ES-TIMP-1-CM or TIMP-1. Subsequent immunohistochemistry analysis demonstrated the presence of a CD63+ve/c-kit+ve cell population within the peri-infarct area and confirmed intramyocardial delivery of ES-TIMP-1-CM or TIMP-1 significantly (p < 0.05) enhanced their proliferation. Percentage of CD63+ve/c-kit+ve cells was significantly (p < 0.05) lower in TIMP-1 KO mice compared to C57BL/6 animals. RT-PCR analysis revealed TIMP-1 KO animals expressed significantly less CD63 and TIMP-1 mRNAs compared to C57BL/6 mice. Activated CD63+ve/c-kit+ve cells were also able to differentiate into major cardiac cell types as previously shown in vitro. The differentiation potential of these cells was however higher in C57BL/6 mice compared to TIMP-1 KO mice. We also demonstrate that CD63+ve/c-kit+ve cells differentiation is regulated by CD63/β-catenin pathway in vivo. Additionally, we provide evidence that TIMP-1 protects the heart from adverse cardiac remodeling through inhibition of cardiac apoptosis and fibrosis leading to significantly (p < 0.05) improved contractile function. Collectively, our data show TIMP-1 plays a dual protective role in the MI heart. It activates a unique stem cell population, CD63+ve/c-kit+ve, which proliferates and differentiates into functional myocytes, smooth muscle cells and endothelial cells mediated through CD63/β-catenin pathway. TIMP-1 also protects the heart from adverse cardiac remodeling. Increased cardiac regeneration and inhibition of adverse cardiac remodeling consequently lead to restored cardiac function.

Die Prävalenz einer Insektengiftallergie beträgt 2,8 %. Am häufigsten sind Honigbienen (Apis melliferi) und Faltenwespen (Vespula vulgaris, Vespula germanica) Auslöser einer Insektengiftallergie in Deutschland. Sie ist eine allergische Typ-I-Reaktion und durch eine Immunglobulin-E-vermittelte (IgE) Immunreaktion charakterisiert. IgE führt zur Sensibilisierung der an einer Immunreaktion beteiligten Mastzellen und basophilen Granulozyten. Durch den Zweitkontakt erfolgt die Aktivierung jener mit Degranulation von Histamin, Serinproteasen, Prostaglandinen, Leukotrienen und Zytokinen. Dies spiegelt sich in einer allergischen Reaktion mit Vasodilatation, Tachykardie, Hypotonie, Bronchokonstriktion, Pruritus, Schmerzen, Erythem oder Flush, Nausea, Vomitus und Diarrhoe wieder. Mittels Hauttests wie Prick- und Intrakutantest kann eine IgE-vermittelte Sensibilisierung auf das Insektengiftallergen nachgewiesen werden. Es werden die Serumparameter Gesamt-IgE und spezifisches IgE auf native und rekombinante Allergene des Insektengiftes gemessen. Der Basophile Aktivierungstest (BAT) kann ergänzt werden. Hierbei wird die immunologische Quantifizierung der Rezeptorenaktivität auf basophilen Granulozyten mittels Detektion der membranständigen Aktivierungsmarker CD63 und CD203c vor und nach Antigenexposition gemessen. CD63 befindet sich intragranulär gespeichert in ruhenden basophilen Granulozyten, Mastzellen, Makrophagen und Monozyten. In vitro konnte eine verstärkte Expression von CD63 v.a. allergen-induziert und FcεRI-vermittelt beobachtet werden. CD203c ist ein hochspezifischer Marker für die basophile Differenzierungslinie. Nach Allergenstimulation wird eine rasche Expression von CD203c beobachtet, welche FcεRI-vermittelt ist. Am Ausmaß der Expression von CD63 und CD203c kann die allergene Eigenschaft abgeleitet und bei Kreuzreaktivität i.R. der in-vitro-Diagnostik das auslösende Allergen identifiziert werden. Die spezifische Immuntherapie (SIT) ist die einzige kausale Therapie einer Insektengiftallergie. Pathophysiologisch wird eine immunmodulatorische Wirkung angenommen. Die Stichprovokation schätzt die Therapieeffektivität einer SIT auf Grund von Mangel an validen laborchemischen Kriterien ein. Bei Asymptomatik oder lokaler allergischer Reaktion hat das Ergebnis einen hohen prädiktiven Wert für die Verträglichkeit weiterer Stiche. Bei ausbleibender systemischer Reaktion nach 3 bis 5 Jahren SIT kann jene beendet werden, wenn SIT oder Stichprovokation ohne Nebenwirkungen vertragen wurden. Ein Feldstich ist der Stichprovokation ebenbürtig, wenn das allergieauslösende Insekt sicher identifiziert wurde. Nach SIT kommt es bei bis zu 15% der Patienten zum Verlust des Schutzes nach 5-10 Jahren (Epidemiology of Insect Venom Sensitivity | JAMA | The JAMA Network, 2017). Die Leitlinie empfiehlt daher ein Notfallset dauerhaft mitzuführen. Vor einer Stichprovokation muss eine 109 Risiko-Nutzen-Abwägung bei relevanten Nebenerkrankungen oder vorbekannter Mastozytose erfolgen. Da die Aktivität des Insektes sowie die Giftzusammensetzung in Abhängigkeit der Jahreszeit variieren, geht die Stichprovokation mit einer eingeschränkten Beurteilbarkeit einher. Auf Grund von erhöhter Angst und Arbeitsausfall für bis zu 3 Tage wird eine Provokation häufig nicht durchgeführt. Daher besteht die Notwendigkeit nach Messmethoden, welche die Therapieeffektivität einer SIT sicher beurteilen. Ziel der vorliegenden Arbeit ist den BAT bezüglich seines Nutzens als Monitoringinstrument während einer SIT zu prüfen und die Therapieeffektivität jener beurteilen zu können. Es wurden 50 Probanden während einer SIT begleitet (6 Kinder mit 4x Bienengift- und 2x Wespengiftallergie, 44 Erwachsene mit 4x Bienengift- und 40x Wespengiftallergie). Die Probanden erklärten sich zu Blutentnahmen vor der SIT und alle 6 Monate bis 3 Jahre während der SIT einverstanden. Hieraus erfolgte die Bestimmung der Serumparameter mittels des ImmunoCAP® 250 der Firma Thermo Fisher Scientific/ Phadia. Mit Hilfe des Flow CAST® Kit (FK-CCR) von der Firma Bühlmann Laboratories AG wurde die Expression der Oberflächenmarker basophiler Granulozyten CD63 und CD203c im BAT gemessen. Anhand des a2-Wertes wurde der relative Anteil an aktivierten basophilen Granulozyten [%] auf die Stimulation mit der Allergenkonzentration von 56,8 ng/ml (c2) bestimmt. Der kalkulierte c50-Wert definiert die mindest notwendige Konzentration an Allergen, um eine Aktivierung von 50% aller in der Testprobe vorliegenden basophilen Granulozyten zu induzieren. Klinische Daten wurden in halbjährlichen Visiten telefonisch, vor Ort, mittels Fragebogen und durch Einsicht in Patientenakten erhoben. Probanden wurden nach Stichprovokation oder Feldstich während SIT und Studie zu Verträglichkeit und Klinik befragt. 90,9% der Erwachsenen und 100% der Kinder boten eine allergische Reaktion Stadium II oder III nach Ring & Messmer. Anaphylaktische Reaktionen wurden nicht beschrieben oder beobachtet. Es waren 40 Erwachsene mit einer Wespengift-SIT zu verzeichnen. Für CD203c sind jene im BAT alle Responder, für CD63 waren 4 Probanden Nonresponder. Für CD63 zeigten sich für 60% steigende und für etwa 30% konstante c50-Werte i.V. der SIT. Dies spiegelt sich in fallenden a2-Werten bei etwa 60% aller Probanden dieser Gruppe wieder. Für CD203c konnten für 60-75% der Probanden steigende sowie für 20% konstante c50-Werte kalkuliert werden. Nach einem Jahr SIT boten 20%, nach zwei Jahren 32,5% und nach drei Jahren SIT 47,5% aller Probanden eine geringere Aktivierung basophiler Granulozyten. In der vorliegenden Studie konnte für 4 Testkonzentrationen (c1 = 284 ng/ml, c2 = 56,8 ng/ml, c3 =11,4 ng/ml sowie c4 = 2,27 ng/m) in allen untersuchten Studiengruppen (Kinder mit Bienengift-SIT, Erwachsene mit Bienengift-SIT, Kinder mit Wespengift-SIT und Erwachsene mit Wespengift-SIT) fallende am-Werte über die Zeit der SIT ermittelt werden. 110 Dies korrelierte mit steigenden c50-Werten über die Dauer der SIT. Die Routinetest-konzentration des Flow CAST® Kit (56,8 ng/ml) gibt hierbei die beste Diskriminierung wieder. Alle 40 Erwachsenen mit einer Wespengiftallergie beschrieben eine mildere klinische Symptomatik unter SIT. Für alle 21 Probanden, welche an einer Stichprovokation teilnahmen oder einen Feldstich erlitten, bestätigte sich dies im BAT. Anhand von Serologie oder Kinetikmessungen lässt sich in der vorliegenden Studie keine Aussage zur Immunmodulation einer SIT und ihrer Therapieeffektivität treffen. Der BAT hingegen ist ein mögliches valides Messverfahren, um die Effektivität einer SIT zu prüfen. Hierfür eignen sich bei guter Korrelation zu Klinik und Stichprovokation/ Feldstich der a2-Wert sowie der kalkulierte c50-Wert. Das Ergebnis eines BAT ist reproduzierbar. Es können Arbeitsausfall und ein erhöhtes Angstempfinden vermieden werden. Ein Routineeinsatz des BAT kann anhand der Studie noch nicht abgeleitet werden. Hausmann et. al konnten jedoch 2014 den c50-Wert als valides Monitoringinstrument der Effektivität bei guter Korrelation zur Stichprovokation belegen. Der BAT ist daher in Fällen interessant, in denen eine Stichprovokation nicht möglich ist (Kontraindikationen, Schwangerschaft, Patientenwunsch). Eine Langzeitwirkung der SIT könnte ggf. mit begleitenden BAT-Messungen geprüft werden. Damit ließe sich die Effektivität einer SIT zum Beispiel auch nach 10 oder 15 Jahren prüfen. Dann wäre eine Aussage darüber möglich, ob das Notfallset lebenslang indiziert ist. Weitere Studien sind notwendig, um die vorliegenden Ergebnisse zu stützen. Eine multizentrische Studie mit standardisiertem BAT und begleitender Stichprovokation ist hierfür Voraussetzung.:Abbildungsverzeichnis Tabellenverzeichnis Abkürzungsverzeichnis 1 Einleitung und Zielstellung 2 Hintergrund und Wissensstand 2.1. Insektengiftallergie 2.1.1. Terminologie der Allergie 2.1.2. Prävalenz der Insektengiftallergie 2.1.3. Hymenoptera - Arten, Taxonomie und Gifte 2.1.4. Immunologische Grundlagen der allergischen Reaktion 2.2. Diagnostik allergischer Reaktionen 2.2.1. Anamnese 2.2.2. Klinik 2.2.3. Hauttests 2.2.4. In-vitro-Allergiediagnostik 2.2.5. Zelluläre Testverfahren 2.3. Therapie 2.3.1. Allgemeine Maßnahmen 2.3.2. Notfalltherapie 2.3.3. Spezifische Immuntherapie (SIT) nach aktueller Leitlinie 2.3.4. Stichprovokation 3 Material und Methoden 3.1. Patientenkollektiv 3.2. Blutentnahmen im Rahmen der Studie während der SIT 3.3. Serologische Untersuchungen 3.4. Zelluläre Testverfahren 3.4.1. Basophiler Aktivierungstest (BAT) 3.4.2. Kinetikuntersuchungen 3.5. Stichprovokation und Feldstiche 3.6. Anamnestische Datenerhebung 3.7. Statistische Methoden 4 Ergebnisse 4.1. Studienpopulation 4.2. Stichereignisse 4.3. Aktivierung basophiler Granulozyten im BAT 4.3.1. Aktivierung basophiler Granulozyten im BAT - c50 und a2 4.3.2. Zeitlicher Verlauf der mittleren Aktivierung basophiler Granulozyten während SIT, Dosis-Wirkungs-Kurve 4.4. Verlauf der serologischen Messdaten 4.5. Kinetikuntersuchungen im BAT 4.6. Anamnese und Klinik 4.7. Korrelation BAT-Ergebnisse und Anamnese/ Klinik 4.8. Korrelation BAT-Ergebnisse und Stichprovokationen/ Feldstiche 5 Diskussion 5.1. Prävalenz der Insektengiftallergie und Verteilungsmuster der allergischen Reaktion nach Ring und Messmer 5.2. Diagnostik und Therapie einer Insektengiftallergie, Studienpopulation 5.3. State of the art - Lücken in Diagnostik und Therapie einer Insektengiftallergie 5.4. Alternative Methoden der Beurteilung der Effektivität einer SIT 5.5. Aktivierung basophiler Granulozyten im BAT 5.5.1 Aktivierung basophiler Granulozyten BAT - a2 und c50 5.5.2. Kinetik der Immunmodulation unter SIT 5.5.3. Interleukin-3 und Expressionskinetik der Oberflächenmarker CD63/ CD203c 5.5.4. Responder versus Nonresponder 5.5.5. Korrelation BAT-Ergebnisse und Anamnese/ Klinik 5.5.6. Korrelation BAT-Ergebnisse und Stichprovokation 5.6. Verlauf der serologischen Messdaten 5.7. Fehleranalysen 5.8. Ausblick in die zukünftige Forschung 6 Zusammenfassung 7 Literaturverzeichnis 8 Danksagung Anhang A Curriculum vitae Anhang B. Veröffentlichungen Anhang C. Anlage 1 - Eröffnung Promotionsverfahren Anhang D. Anlage 2 - Einhaltung gesetzlicher Vorgaben Anhang E. Anlage 3 - Eidesstattliche Erklärung Anhang F. Anlage 4 - Fragebogen Anhang G. Anlage 5 - Experimentelle Daten

Introdução: Atualmente, o diagnóstico das reações de hipersensibilidade a anti-inflamatórios não esteroidais (AINEs) baseia-se na história relatada pelo paciente e, em determinados casos, é realizado o Teste de Provocação. Todavia, este teste pode expor os pacientes a riscos graves, inclusive anafilaxia. Em busca de ferramenta mais segura, tem-se estudado o Teste de Ativação de Basófilos (BAT). Trata-se de um teste in vitro, no qual é possível testar diversos estímulos em uma única amostra de sangue, avaliando a ativação dos basófilos (indicativo de reação de hipersensibilidade), através do aumento da expressão de moléculas na superfície desses leucócitos, como o CD63. Objetivo: Padronizar e validar o BAT para ácido acetilsalicílico (AAS), diclofenaco, dipirona e paracetamol em pacientes com hipersensibilidade a AINEs. Metodologia: Participaram 20 (testados com os quatro AINEs) + 33 (testados somente com AAS) pacientes atendidos no Serviço de Imunologia Clínica e Alergia do HCFMUSP, que apresentaram manifestações cutâneas em até 24 horas após exposição a um ou múltiplos AINEs, bem como 13 (quatro AINEs) + 26 (AAS) controles. A técnica consistiu em incubar sangue total com os AINEs já mencionados e, depois, marcar as amostras com anticorpos monoclonais (CD45, anti-IgE e CD63) para posterior leitura por citometria de fluxo. Os resultados obtidos foram comparados com as histórias clínicas e os testes de provocação oral, quando realizados. Resultados: Utilizando os critérios de positividade do BAT empregados na literatura (isto é, porcentagem de CD45+IgE+highCD63+ e índice de estimulação), a sensibilidade e a especificidade variaram de acordo com o AINE: para ácido acetilsalicílico foram 75,0% e 16,7%, respectivamente, diclofenaco, 100% e 0%, dipirona, 23,5% e 66,7%, paracetamol, 40,0% e 42,9%. Após a realização de curvas dose-resposta e tempo-resposta somente com AAS, foi encontrado novo critério de positividade: média de intensidade de fluorescência (MFI) menor do que 6575 representava BAT positivo; com isso, os valores de sensibilidade e especificidade foram: 84,4% e 34,6%, respectivamente. O BAT foi mais sensível em pacientes cuja última reação ocorreu há menos de um ano da data de execução do BAT (93,7%). Conclusão: Devido aos baixos valores de sensibilidade e/ou especificidade, não foi possível padronizar e, por conseguinte, validar o BAT para ácido acetilsalicílico, diclofenaco, dipirona e paracetamol. / Introduction: Currently, the diagnosis of nonsteroidal antiinflammatory drugs (NSAIDs) hypersensivitity is based on patients´ clinical history and drug provocation tests, which are done in selected cases. Nevertheless, this test may expose patients to severe risks, including anaphylaxis. Looking for a safer tool, Basophil Activation Test (BAT) for allergy diagnosis has been studied in the last years. It is an in vitro method where a wide variety of stimuli can be tested, incubating them with the patient\'s blood sample, and observing basophil activation (indication of hypersensitivity) through upregulation of CD63 (or other basophil activation markers) on this leucocyte\'s membrane. Objective: To standardize and validate BAT stimulated with acetylsalicylic acid (ASA), diclophenac, dipyrone and paracetamol in NSAID hypersensitive patients. Methods: Patients which reported immediate reactions (less than 24 hours) after exposure to one or multiple NSAIDs, with cutaneous symptoms were enrolled from Clinical Immunology and Allergy outpatient clinic from HC-FMUSP. BAT with the four NSAIDs was tested on 20 patients and 13 controls and BAT with ASA only, on 33 patients and 26 controls. BAT consisted of incubating whole blood with NSAIDs, then triple-labeled with monoclonal antibodies (CD45, anti-IgE, CD63) for analysis by flow cytometry. BAT results were compared to clinical history and oral provocation tests, when available. Results: According to literature\'s positivity criteria (percentage of CD45+IgE+highCD63+ and stimulation index), sensitivity and specificity varied according to the NSAID tested: for ASA was 75.0% and 16.7% respectively, diclophenac, 100.0% and 0.0%, dipyrone, 23.5% and 66.7%, paracetamol, 40.0% and 42.9%. A new positivity criterion was possible to be defined after further dose-response and time-response curves only for ASA: Mean Fluorescence Intensity lower than 6575 (positive BAT). Accordingly, new sensitivity and specificity for BAT in ASA hypersensitivity were 84,4% and 34,6%. Patients that presented the last reaction in the last year were more likely to present a positive BAT (93.7%). Conclusion: Due to low values for sensitivity and/or specificity, it was not possible to standardize and validate BAT for ASA, diclophenac, dipyrone and paracetamol.

Introdução: Atualmente, o diagnóstico das reações de hipersensibilidade a anti-inflamatórios não esteroidais (AINEs) baseia-se na história relatada pelo paciente e, em determinados casos, é realizado o Teste de Provocação. Todavia, este teste pode expor os pacientes a riscos graves, inclusive anafilaxia. Em busca de ferramenta mais segura, tem-se estudado o Teste de Ativação de Basófilos (BAT). Trata-se de um teste in vitro, no qual é possível testar diversos estímulos em uma única amostra de sangue, avaliando a ativação dos basófilos (indicativo de reação de hipersensibilidade), através do aumento da expressão de moléculas na superfície desses leucócitos, como o CD63. Objetivo: Padronizar e validar o BAT para ácido acetilsalicílico (AAS), diclofenaco, dipirona e paracetamol em pacientes com hipersensibilidade a AINEs. Metodologia: Participaram 20 (testados com os quatro AINEs) + 33 (testados somente com AAS) pacientes atendidos no Serviço de Imunologia Clínica e Alergia do HCFMUSP, que apresentaram manifestações cutâneas em até 24 horas após exposição a um ou múltiplos AINEs, bem como 13 (quatro AINEs) + 26 (AAS) controles. A técnica consistiu em incubar sangue total com os AINEs já mencionados e, depois, marcar as amostras com anticorpos monoclonais (CD45, anti-IgE e CD63) para posterior leitura por citometria de fluxo. Os resultados obtidos foram comparados com as histórias clínicas e os testes de provocação oral, quando realizados. Resultados: Utilizando os critérios de positividade do BAT empregados na literatura (isto é, porcentagem de CD45+IgE+highCD63+ e índice de estimulação), a sensibilidade e a especificidade variaram de acordo com o AINE: para ácido acetilsalicílico foram 75,0% e 16,7%, respectivamente, diclofenaco, 100% e 0%, dipirona, 23,5% e 66,7%, paracetamol, 40,0% e 42,9%. Após a realização de curvas dose-resposta e tempo-resposta somente com AAS, foi encontrado novo critério de positividade: média de intensidade de fluorescência (MFI) menor do que 6575 representava BAT positivo; com isso, os valores de sensibilidade e especificidade foram: 84,4% e 34,6%, respectivamente. O BAT foi mais sensível em pacientes cuja última reação ocorreu há menos de um ano da data de execução do BAT (93,7%). Conclusão: Devido aos baixos valores de sensibilidade e/ou especificidade, não foi possível padronizar e, por conseguinte, validar o BAT para ácido acetilsalicílico, diclofenaco, dipirona e paracetamol. / Introduction: Currently, the diagnosis of nonsteroidal antiinflammatory drugs (NSAIDs) hypersensivitity is based on patients´ clinical history and drug provocation tests, which are done in selected cases. Nevertheless, this test may expose patients to severe risks, including anaphylaxis. Looking for a safer tool, Basophil Activation Test (BAT) for allergy diagnosis has been studied in the last years. It is an in vitro method where a wide variety of stimuli can be tested, incubating them with the patient\'s blood sample, and observing basophil activation (indication of hypersensitivity) through upregulation of CD63 (or other basophil activation markers) on this leucocyte\'s membrane. Objective: To standardize and validate BAT stimulated with acetylsalicylic acid (ASA), diclophenac, dipyrone and paracetamol in NSAID hypersensitive patients. Methods: Patients which reported immediate reactions (less than 24 hours) after exposure to one or multiple NSAIDs, with cutaneous symptoms were enrolled from Clinical Immunology and Allergy outpatient clinic from HC-FMUSP. BAT with the four NSAIDs was tested on 20 patients and 13 controls and BAT with ASA only, on 33 patients and 26 controls. BAT consisted of incubating whole blood with NSAIDs, then triple-labeled with monoclonal antibodies (CD45, anti-IgE, CD63) for analysis by flow cytometry. BAT results were compared to clinical history and oral provocation tests, when available. Results: According to literature\'s positivity criteria (percentage of CD45+IgE+highCD63+ and stimulation index), sensitivity and specificity varied according to the NSAID tested: for ASA was 75.0% and 16.7% respectively, diclophenac, 100.0% and 0.0%, dipyrone, 23.5% and 66.7%, paracetamol, 40.0% and 42.9%. A new positivity criterion was possible to be defined after further dose-response and time-response curves only for ASA: Mean Fluorescence Intensity lower than 6575 (positive BAT). Accordingly, new sensitivity and specificity for BAT in ASA hypersensitivity were 84,4% and 34,6%. Patients that presented the last reaction in the last year were more likely to present a positive BAT (93.7%). Conclusion: Due to low values for sensitivity and/or specificity, it was not possible to standardize and validate BAT for ASA, diclophenac, dipyrone and paracetamol.

Allergic asthma is characterized by airway hyperresponsiveness, inflammation, and a cellular infiltrate dominated by eosinophils. Numerous epidemiological studies have related the exacerbation of allergic asthma with an increase in ambient inhalable particulate matter from air pollutants. This is because inhalable particles efficiently deliver airborne allergens deep into the airways, where they can aggravate allergic asthma symptoms. However, the cellular mechanisms by which inhalable particulate allergens (pAgs) potentiate asthmatic symptoms remain unknown, in part because most in vivo and in vitro studies exploring the pathogenesis of allergic asthma use soluble allergens (sAgs). Using a mouse model of allergic asthma, we found that, compared with their sAg counterparts, pAgs triggered markedly heightened airway hyperresponsiveness and pulmonary eosinophilia in allergen-sensitized mice. Mast cells (MCs) were implicated in this divergent response, as the differences in airway inflammatory responses provoked by the physical nature of the allergens were attenuated in MC-deficient mice. The pAgs were found to mediate MC-dependent responses by enhancing retention of pAg/IgE/FcεRI complexes within lipid raft–enriched, CD63(+) endocytic compartments, which prolonged IgE/FcεRI-initiated signaling and resulted in heightened cytokine responses. These results reveal how the physical attributes of allergens can co-opt MC endocytic circuitry and signaling responses to aggravate pathological responses of allergic asthma in mice. / Dissertation

No description available.