A asma é uma doença heterogênea caracterizada por um processo inflamatório crônico das vias aéreas inferiores que está associado ao desenvolvimento da hiperresponsividade brônquica e remodelamento da via aérea. Atualmente, a asma é considerada uma síndrome, ou ao menos uma doença com diversos fenótipos. Tradicionalmente, dois fenótipos são bem definidos pela clínica e exames subsidiários: asma alérgica e asma não alérgica. Eles são diferentes quanto á idade de início, apresentação clínica, história pessoal e familiar de atopia e resposta ao tratamento. Ao contrário da asma alérgica, cuja fisiopatologia está bem caracterizada, a etiologia e mecanismos envolvidos na asma não alérgica não estão bem elucidados. Algumas possibilidades incluem alergia desencadeada por antígenos desconhecidos (fungos), infecção persistente (Chlamydia trachomatis, Mycoplasma sp) e auto-imunidade. Estudos têm descrito em diferentes populações associações entre a asma e alelos/antígenos HLA classe I e II, mas os resultados têm sido inconclusivos. O objetivo deste estudo foi identificar possíveis associações do antígeno leucocitário humano (HLA) classe I (A, B, C) e II (DR, DQ, DP) em pacientes brasileiros com asma alérgica e não alérgica. Um total de 109 pacientes com o diagnóstico de asma (56 com asma alérgica e 53 com asma não alérgica) que estavam em acompanhamento no Serviço de Imunologia Clínica e Alergia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, e 297 controles (doadores falecidos de órgãos sólidos) tiveram seu sistema HLA classe I (A, B e C) e II (DR, DQ e DP) tipificado. Os pacientes também realizaram espirometria e coletaram sangue para a quantificação da imunoglobulina E (IgE) sérica total e nível sérico de eosinófilos. Além disso, foram avaliados quanto à IgE específica para aeroalergenos através do teste cutâneo de puntura e a pesquisa da IgE sérica específica (ImmunoCAP). O grupo com asma alérgica foi constituído por pacientes que apresentavam resultado positivo para a pesquisa da IgE específica em ambos teste cutâneo de puntura e na investigação in vitro. E o grupo com asma não alérgica apresentava resultados negativos nos dois testes. A comparação do HLA classe I nos grupos estudados identificou frequência significativamente maior do HLA-B*42 e HLA-C*17 no grupo com asma alérgica, enquanto o HLA-B*48 estava estatisticamente associado com o fenótipo não alérgico. Na análise do HLA classe II, o HLA-DPA1*03 e HLA-DPB1*105 apresentou associação com os pacientes com asma alérgica. Concluindo, o estudo observou diferentes associações dos alelos HLA classe I e II com asma alérgica e não alérgica na população brasileira, a qual é caracterizada pela diversidade de origens e miscigenação. Porém, a predisposição genética para asma é poligênica e novos estudos em grandes populações são necessários para confirmar a associação do HLA como fator protetor ou causador da doença / Asthma is a heterogeneous chronic inflammatory disease of lower airways associated with the development of bronchial hyperresponsiveness and airway remodeling. Currently, asthma is regarded as a syndrome or at least a disease with several phenotypes.Traditionally, two phenotypes of asthma have been defined according to clinical and laboratory features: allergic and non-allergic asthma. Each of them has distint age of onset, clinical presentation, personal and family history of allergy and response to therapy. In contrast to allergic asthma, which pathophysiology is well characterized, the etiology and mechanisms involved in non-allergic asthma remain unclear. Some possibilities include allergy triggered by unknow antigens (fungi), persistent infection (Chlamydia trachomatis, Mycoplasma sp) and autoimmunity. Studies have reported associations between asthma and HLA class I and II alleles/antigens in different populations, but the results have been inconclusive. The objective of this study was to identify possible associations of the human leukocyte antigens (HLA) class I (A, B and C) and II (DR, DQ and DP) in Brazilian patients with allergic and non-allergic asthma. A total of 109 patients with asthma (56 with allergic asthma and 53 with non-allergic asthma), who were being followed at the Service of Clinical Immunology and Allergy of the Hospital das Clínicas of the University of São Paulo Medical School, and 297 controls (deceased solid organ donors) had their HLA class I (A,B and C) and II (DR, DQ and DP) typing. Patients performed spirometry and had their blood drawn to measure total serum immunoglobulin E (IgE) levels and eosinophil count. Furthermore, they were assessed for specific IgE to aeroallergens with skin prick test and serum tests (ImmunoCAP). The allergic asthma group was composed of patient presenting positive results for specific IgE in both skin prick test and in vitro assay. And the non-allergic asthma group had negative results in both tests. There were significantly higher frequencies of HLA-B*42 and HLA-C*17 in the allergic asthma group, whereas the HLA-B*48 was associated with the non-allergic group. Regarding HLA class II analysis, HLA-DPA1*03 and HLA DPB1*105 were associated with allergic asthma patients. In conclusion, the study identified different associations of HLA class I and II with allergic and non-allergic asthma in the Brazilian population, which is characterized by diversity of origins and miscegenation. However, the genetic predisposition of asthma is polygenic and new studies on large populations are needed to confirm the role of HLA as a protective or predisposing factor of disease

La fructose-1,6-bisphosphate aldolase de classe I est une enzyme glycolytique (EC 4.1.2.13) qui catalyse le clivage réversible du fructose-1,6-bisphosphate (FBP) en dihydroxyacétone phosphate (DHAP) et glycéraldéhyde-3-phosphate (G3P). Des années de recherche sur FBP aldolase ont permis d’identifier les résidus impliqués dans son mécanisme réactionnel, ont tracé en grande partie les coordonnées de la réaction, ont révélé de nouvelles fonctions dites « moonlighting », et ont validé l’aldolase comme une cible attrayante pour des applications anti-glycolytiques tel que le cancer. Il existe néanmoins des questions en suspens relatives à ces activités que nous avons étudiées. Tout d'abord, la trajectoire détaillée de l'aldéhyde relatif à sa liaison au site actif allant jusqu’à la formation du lien carbone-carbone par condensation aldolique est indéfini. Pour élucider les détails moléculaires liés à ces événements, nous avons déterminé des structures cristallographiques à hautes résolution de l’aldolase de classe I chez Toxoplasma gondii, qui porte une identité de séquence élevée avec l’aldolase humaine (57%), en complexe avec l’intermédiaire ternaire de pré-condensation. Le complexe ternaire révèle un mode de liaison non-productive inhabituel pour G3P dans une configuration cis qui permet l’alignement de l'aldéhyde à proximité du nucléophile naissant. La configuration compétente pour la condensation aldolique provient d'une transposition cis-trans de l'aldéhyde qui produit une liaison hydrogène courte permettant la polarisation de l'aldéhyde et le transfert de proton au niveau de Glu-189. Nos résultats informent les chimistes synthétiques qui cherchent à développer l’aldolase comme biocatalyseur pour des réactions stéréo-contrôlées. Le rôle présumé de l’aldolase dans la production du méthyglyoxal (MGO), un métabolite dicarbonyle hautement réactif qui génère des « advanced glycation end products » (AGES) a également été étudié structurellement et enzymatiquement. Une enquête structurelle cristallographique de MGO générée par décomposition enzymatique chez l’aldolase de classe I a révélé que, contrairement aux indications préliminaires, l'apparition hypothétique de MGO et de phosphate inorganique (Pi) résultant de la décomposition enzymatique de DHAP dans le site actif de l’aldolase est mieux interprétée par une population mixte de DHAP et de molécules d'eau. Une étude enzymatique a révélé que la décomposition spontannée des trioses-phosphate est une source majeure de la production de MGO, alors qu’une production catalysée par l’aldolase est peu concluante. L’identification des sources de production de MGO continue d'être une priorité afin de développer des stratégies pour atténuer les manifestations cliniques de pathologies associées au MGO. La FBP aldolase est également reconnu pour ses activités « moonlighting » - du fait qu’elle effectue plus d'une activité sans rapport avec sa fonction glycolytique. Divers partenaires de l’aldolase sont rapportés dans la littérature, y compris les adhésines de surface cellulaire chez les parasites apicomplexes, dans lequel l’aldolase exécute une fonction d'échafaudage entre le complexe actomyosine et les adhésines - une interaction qui est décisive pour la motilité et l'invasion des cellules hôte. Le mode de liaison de cette interaction a été étudié et nos résultats sont compatibles avec une liaison au site actif. Les détails précis de cette interaction ont des implications thérapeutiques, étant donné que le ciblage de celui-ci réduit l'invasion des cellules hôte par les parasites. Enfin, l’aldolase de classe I est de plus en plus reconnu pour son potentiel comme cible anti-glycolytique dans les cellules qui sont fortement tributaires du flux glycolytique, comme les cellules cancéreuses et les parasites protozoaires. Le développement de nouveaux inhibiteurs de haute affinité est donc non seulement avantageux pour des études mécanistiques, mais représente un potentiel pharmacologique sans fin. Nous avons développé une nouvelle classe d’inhibiteurs de haute affinité de type inhibition lente et avons déterminé la base moléculaire de leur inhibition grâce à des structures cristallographiques à haute résolution et par un profilage enzymatique. Cette étude, qui combine plusieurs disciplines, y compris la cristallographie, enzymologie et chimie organique, souligne l'intérêt et l'importance d'une approche multidisciplinaire. / Class I Fructose-1,6-bisphosphate aldolases are glycolytic enzymes (EC 4.1.2.13) that catalyze the reversible cleavage of fructose-1,6-bisphosphate (FBP) to dihydroxyacetone phosphate (DHAP) and glyceraldehyde-3-phosphate (G3P). Years of research on FBP aldolases has identified residues implicated in the reaction mechanism, mapped the greater part of the reaction coordinates, and revealed novel moonlighting functions. Further, FBP aldolase is recognized as an attractive target for anti-glycolytic applications such as cancer. There are nevertheless outstanding questions related to these activities that were investigated in this thesis. First, the detailed trajectory of the reaction mechanism from aldehyde binding in the active site to carbon-carbon bond formation by aldol condensation is undefined. To elucidate the molecular details related to these events, we solved high-resolution crystallographic structures of native class I aldolase from Toxoplasma gondii, which has a high sequence identity with human aldolase (57 %), in complex with the pre-condensation ternary intermediate. The ternary complex reveals a condensation-incompetent binding mode for G3P in a cis-configuration that aligns the aldehyde alongside the nascent nucleophile. The productive aldol-competent configuration arises from a cis-trans rearrangement of the aldehyde that produces a short hydrogen bond required for polarization of the aldehyde and coincident proton transfer at Glu-189. Our results inform synthetic chemists seeking to develop aldolases for stereo-controlled reactions in biosynthetic applications. The suspected role of aldolase in methylglyoxal (MGO) production, a highly reactive dicarbonyl metabolite that produces advanced glycation end-products (AGES) was also probed structurally and enzymatically. A crystallographic structural investigation of MGO generated by enzymatic decomposition in class I aldolase revealed that, contrary to preliminary indications, the appearance of MGO and inorganic phosphate (Pi) resulting from enzymatic decomposition of DHAP in the active site of aldolase is more appropriately modeled by a mixed population of DHAP and water molecules. Enzymatic investigation revealed triose-phosphate decomposition to be a major source of MGO production, whereas production by aldolase did not exceed assay background levels. Identifying the main sources of MGO production continues to be a priority for mitigating the clinical manifestations of MGO-derived pathologies. FBP aldolase is also recognized for its moonlighting properties – performing more than one activity unrelated to the glycolytic function. Diverse aldolase partners are reported, including cell surface adhesins in apicomplexan parasites, in which aldolase performs a bridging function between the actomyosin complex and the cytoplasmic domain of the adhesins – an interaction that is crucial for motility and host-cell invasion. The binding mode of this interaction was investigated and our results are consistent with active site binding. The precise details of aldolase-adhesin binding has therapeutic implications, since targeting of the latter reduces host-cell invasion by parasites. Finally, class I aldolase is gaining prominence as an anti-glycolytic target in cells that are highly dependent on glycolytic flux, such as cancer cells and protozoan parasites. Developing new high-affinity inhibitors for these enzymes is therefore not only advantageous for mechanistic studies, but has endless pharmacological potential. We developed a novel class of high-affinity aldolase inhibitors, bisphosphonates, and determined the molecular basis of their inhibition with high-resolution crystallographic structures and enzymatic profiling. This study, which combined several disciplines, including crystallography, enzymology, and organic chemistry, underscores the interest and significance of a multidisciplinary approach.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Bacterial adherence to the acquired dental pellicle, important in caries, is mediated by receptor-adhesin interactions such as Streptococcus mutans antigen I/II (I/II). Ten I/II epitopes from the A, V, P and C regions were chosen to determine their reactivity in human saliva. Underlying the body’s ability to immunologically respond to bacteria that lead to caries are the human leukocyte antigen (HLA) genes, specifically HLA class II (HLA-II) genes that control antigen presentation. Previous studies suggested that a specific HLA biomarker group (HLA-DRB1*04) may have differential control of immune responses to I/II. However, it was not known whether secretory IgA (SIgA) responses to the selected epitopes from HLA-DRB1*04 positive subjects were different compared to their non-biomarker counterparts (negative), or across other caries factors, since no study to date had thus assessed these questions. Methods: Per IRB approval, the study population was divided into age, sex and race matched DRB1*04 positive (n=16) and negative groups (n=16). SIgA-epitope (and whole cell) reactivity was determined using ELISA. Other caries factors were measured. Subjects received a clinical exam by a trained examiner. ix Differences between DRB1*04 positive and negative groups were examined using a two-sided, two-sample t-test. Results: DRB1*04 positive subjects had numerically, but not statistically, higher reactivity to 9 out of 10 epitopes, the exception being residues 834-853 from the V and P regions of I/II across multiple measures. Though statistically insignificant, DRB1*04 positive subjects also exhibited 25-30 μg mL-1 less total IgA (TIgA) than negative counterparts. All clinical caries data proved inconclusive when comparing groups, likely due to exogenous factors and sample size. Conclusion: DRB1*04 positive subjects showed a trend toward lower TIgA. Moreover, they also showed a lower SIgA response across multiple measures to 834-853, the I/II V and P region epitope. This region forms a sort of functional epicenter involved in collaboration between domains along the entire I/II antigen, and governs the region involved in initial attachment to the acquired dental pellicle. This region may be involved in an in vivo discontinuous conformationally specific immunogenic epitope that serves as an HLA-II binding motif which remains elusive.

Die vorliegende Arbeit behandelt die kollektive Dynamik identischer Klasse-I-anregbarer Elemente. Diese können im Rahmen der nichtlinearen Dynamik als Systeme nahe einer Sattel-Knoten-Bifurkation auf einem invarianten Kreis beschrieben werden. Der Fokus der Arbeit liegt auf dem Studium aktiver Rotatoren als Prototypen solcher Elemente. In Teil eins der Arbeit besprechen wir das klassische Modell abstoßend gekoppelter aktiver Rotatoren von Shinomoto und Kuramoto und generalisieren es indem wir höhere Fourier-Moden in der internen Dynamik der Rotatoren berücksichtigen. Wir besprechen außerdem die mathematischen Methoden die wir zur Untersuchung des Aktive-Rotatoren-Modells verwenden. In Teil zwei untersuchen wir Existenz und Stabilität periodischer Zwei-Cluster-Lösungen für generalisierte aktive Rotatoren und beweisen anschließend die Existenz eines Kontinuums periodischer Lösungen für eine Klasse Watanabe-Strogatz-integrabler Systeme zu denen insbesondere das klassische Aktive-Rotatoren-Modell gehört und zeigen dass (i) das Kontinuum eine normal-anziehende invariante Mannigfaltigkeit bildet und (ii) eine der auftretenden periodischen Lösungen Splay-State-Dynamik besitzt. Danach entwickeln wir mit Hilfe der Averaging-Methode eine Störungstheorie für solche Systeme. Mit dieser können wir Rückschlüsse auf die asymptotische Dynamik des generalisierten Aktive-Rotatoren-Modells ziehen. Als Hauptergebnis stellen wir fest dass sowohl periodische Zwei-Cluster-Lösungen als auch Splay States robuste Lösungen für das Aktive-Rotatoren-Modell darstellen. Wir untersuchen außerdem einen "Stabilitätstransfer" zwischen diesen Lösungen durch sogenannte Broken-Symmetry States. In Teil drei untersuchen wir Ensembles gekoppelter Morris-Lecar-Neuronen und stellen fest, dass deren asymptotische Dynamik der der aktiven Rotatoren vergleichbar ist was nahelegt dass die Ergebnisse aus Teil zwei ein qualitatives Bild für solch kompliziertere und realistischere Neuronenmodelle liefern. / We study the collective dynamics of class I excitable elements, which can be described within the theory of nonlinear dynamics as systems close to a saddle-node bifurcation on an invariant circle. The focus of the thesis lies on the study of active rotators as a prototype for such elements. In part one of the thesis, we motivate the classic model of repulsively coupled active rotators by Shinomoto and Kuramoto and generalize it by considering higher-order Fourier modes in the on-site dynamics of the rotators. We also discuss the mathematical methods which our work relies on, in particular the concept of Watanabe-Strogatz (WS) integrability which allows to describe systems of identical angular variables in terms of Möbius transformations. In part two, we investigate the existence and stability of periodic two-cluster states for generalized active rotators and prove the existence of a continuum of periodic orbits for a class of WS-integrable systems which includes, in particular, the classic active rotator model. We show that (i) this continuum constitutes a normally attracting invariant manifold and that (ii) one of the solutions yields splay state dynamics. We then develop a perturbation theory for such systems, based on the averaging method. By this approach, we can deduce the asymptotic dynamics of the generalized active rotator model. As a main result, we find that periodic two-cluster states and splay states are robust periodic solutions for systems of identical active rotators. We also investigate a 'transfer of stability' between these solutions by means of so-called broken-symmetry states. In part three, we study ensembles of higher-dimensional class I excitable elements in the form of Morris-Lecar neurons and find the asymptotic dynamics of such systems to be similar to those of active rotators, which suggests that our results from part two yield a suitable qualitative description for more complicated and realistic neural models.

The MHC class I status of tumour cells during immunotherapy is often underestimated. It represents one of important tumour escape mechanisms and thus can contribute to the failure of most of the cancer clinical trials that are usually based on the induction of cytotoxic T cell responses. Epigenetic changes in the promoters of genes involved in the MHC class I Ag presentation can result in decreased expression of the cell surface MHC molecules on tumour cells. Thus, epigenetic modifiers can restore an expression of the MHC class I molecules and make tumours visible to the CD8+ effector cells. Besides the epigenetic changes on the tumour cells, epigenetic modulators affect cells of the immune system such as dendritic cells (DC). Tumour cells can escape from the immune response not only by changes in the cancer cells, but also by influencing, expanding and/or activating immunoregulatory cell populations, such as regulatory T cells (Treg). This thesis focuses on the potential of the DC-based vaccines against HPV-16-associated tumours with a different MHC class I expression, on the combination of cancer immunotherapy with the treatment using epigenetic modifiers, with special attention paid to their effects on DC, and, finally, on the impacts of the anti-CD25 antibody (used for Treg elimination) on Treg and NKT...

Das Proteasomensystem der Zelle ist für die Degradation von Proteinen verantwortlich und spielt eine zentrale Rolle bei der Generierung von Epitopen, die auf MHC-Klasse-I Molekülen den cytotoxischen T-Lymphozyten (CTLs) präsentiert werden. Die Stimulation von Zellen mit Interferon-gamma (IFNgamma) führt zu der Bildung von Immunoproteasomen, die im Vergleich zu den konstitutiven Proteasomen eine verbesserte Generierung vieler MHC-Klasse-I Epitope aufweisen. In gesunden Mäusen werden Immunoproteasomen vorwiegend in den lymphatischen Geweben exprimiert, wohingegen nicht-lymphatische Gewebe hauptsächlich konstitutive Proteasomen enthalten. In der vorliegenden Arbeit wurde der Einfluss der Listeria monocytogenes Infektion auf die aus der Leber, der Milz, dem Dünndarm und dem Colon stammenden murinen 20S Proteasomen untersucht. Die Struktur der isolierten 20S Proteasomen wurde mittels zweidimensionaler Gelelektrophorese und Westernblot ermittelt, während die Funktion durch in vitro Prozessierung von drei oligomeren Peptidsubstraten analysiert wurde. Die Prozessierungsprodukte wurden mittels HPLC-ESI-Ionenfalle massenspektrometrisch identifiziert sowie quantifiziert. Die vorliegende Arbeit zeigt zum ersten Mal, dass nach einer Infektion die aus den nicht-lymphatischen Organen und Zellen isolierten 20S Proteasomen eine strukturelle und funktionelle Plastizität aufweisen: Nach der Infektion wurde die Bildung von Immunoproteasomen induziert, was mit der gesteigerten Generierung der immunrelevanten Fragmente korreliert werden konnte. Dies verlief unabhängig von der direkten Präsenz von Listeria monocytogenes in den Organen und wurde ausschließlich durch das Cytokin IFNgamma reguliert. Es konnte außerdem eine Zunahme der posttranslationalen Modifikation von Leberproteasomen mit dem Monosaccharid N-Acetylglucosamin nach der Infektion nachgewiesen werden. Des Weiteren wurde eine detaillierte Analyse der massenspektrometrischen Daten hinsichtlich des Schnittverhaltens der konstitutiven und Immunoproteasomen etabliert. Die Auswertung ergab, dass die Immunoproteasomen nach der Infektion durch schnellere und veränderte Nutzung bestehender Spaltstellen an der verbesserten Epitoppräsentation beteiligt sind. / The proteasome system of the cell is responsible for the degradation of proteins and plays a central role in the generation of epitopes which are presented to cytotoxic T-lymphocytes (CTLs) on MHC-class-I molecules. The stimulation of cells by interferon-gamma (IFNgamma) leads to the formation of immunoproteasomes that show an improved generation of many MHC-class-I epitopes compared to constitutive proteasomes. In healthy mice, immunoproteasomes are mainly expressed in the lymphatic tissues, whereas the non-lymphatic organs predominantly contain constitutive proteasomes. In this project the effect of Listeria monocytogenes infection on murine 20S proteasomes derived from the liver, spleen, small intestine and colon were investigated. The structure of the isolated proteasomes was analyzed by two-dimensional gel electrophoresis and western blots while the function was studied by in vitro processing of three oligomeric peptide substrates. Identification and quantification of the processing products was performed by HPLC-ESI-ion trap mass spectrometry. The project showed for the first time, that after infection 20S proteasomes isolated from non-lymphatic organs as well as from non-lymphatic cells displayed structural and functional plasticity: immunoproteasomes were induced post infection which could be correlated with the enhanced generation of immuno-relevant fragments. This was independent of the direct presence of Listeria monocytogenes in the organs and solely controlled by the cytokine IFNgamma. In addition, an increased posttranslational modification with the monosaccharide N-acetylglucosamine could be detected in liver-derived proteasomes after infection. Furthermore, a detailed analysis of the mass spectrometry data was established according to the cleavage site usage of constitutive and immunoproteasomes. The result was that immunoproteasomes are involved in improved generation of the immuno-relevant fragments by the faster cleavage and the changed usage of existing cleavage sites after infection.

Os alelos HLA-DPB1*04 e HLA-DRB1*15 estão fortemente associados à Granulomatose com poliangeíte (GPA). Neste estudo, analisamos se os pacientes brasileiros com diagnóstico de GPA apresentam uma base genética na região HLA. Conduzimos um estudo caso-controle, em que analisamos os alelos da região HLA classe I e II em 55 pacientes com diagnóstico de GPA, atendidos no ambulatório de Vasculites Pulmonares do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, e comparamos com os resultados de 110 controles saudáveis. Comparamos também quatro diferentes apresentações clínicas da GPA e a positividade do anticorpo anticitoplasma de neutrófilos (ANCA) com os alelos da região HLA classe I e II. Foi também construída uma árvore de decisões, usando o algoritmo de CART, para a verificação da associação entre os alelos HLA e GPA. Como resultados, observamos que a GPA esteve fortemente associada à presença dos alelos DPB1*04 e DRB1*15 (p = 0,007, odds ratio [OR]: 2,9, 95% intervalo de confiança [IC]: 1,09-3,8; p = 0,006, OR: 2,87, 95% IC: 1,44-4,75, respectivamente) e não à presença do alelo DRB1*04. O alelo DRB1*13 esteve associado com proteção contra GPA (p = 0,042, OR: 0,42, 95% CI: 0,21-0,99). O alelo DPB1*04 esteve significativamente associado a GPA e ANCA-C positivo (OR: 5,47) e à presença de insuficiência renal aguda (p = 0,01037). Concluímos que houve uma interdependência significativa entre os alelos DPB1*0401, DPB1*0402, DRB1*13, C*2 e GPA. Na população estudada, quando o alelo DPB1*04 esteve presente em homozigose, o risco de GPA foi de 81%. Quando o alelo DPB1*0401 esteve ausente ou em heterozigose com o DPB1*0402, como o outro alelo, ou DPB1*0402 esteve em homozigose, o risco da GPA foi de 52,9%. No caso de ausência dos alelos DPB1*0401, DPB1*0402 e DRB1*13, a presença do alelo C*2 aumentou o risco da GPA para 62,5%. Finalmente, na ausência do alelo DPB1*0401 e DPB1*0402 e na presença do alelo DRB1*13, o risco de GPA diminuiu para 0% / The alleles HLA-DPB1*04 and HLA-DRB1*15 are strongly associated with granulomatosis with polyangiitis (GPA). In this study, we examined whether Brazilian patients with GPA had an HLA region genetic background. We conducted a case-control study, in which we analysed alleles of HLA region class I and II from 55 patients with GPA (at the Pulmonary Vasculitis Clinic of the University of São Paulo) and compared the results with those from 110 healthy controls. Comparisons were also performed for 4 different clinical presentations of GPA and anti-neutrophil cytoplasmic antibody (ANCA) positivity and the HLA class I and II region alleles. A tree model decision analysis was conducted using CART algorithm. Our results showed that GPA was strongly associated with alleles DPB1*04 and DRB1*15 (p = 0.007, odds ratio [OR]: 2.9, 95% confidence interval [CI]: 1.09-3.8; p = 0.006, OR: 2.87, 95% CI: 1.44-4.75, respectively) and not with the allele DRB1*04. DRB1*13 allele was associated with protection against GPA (p = 0.042, OR: 0.42, 95% CI: 0.21-0.99). DPB1*04 was significantly associated with GPA plus positive C-ANCA (OR: 5.47) and acute renal failure (p = 0.01037). We concluded that there was a significant interdependence among alleles and GPA. In our population, when allele DPB1*04 was presented in homozygous, the risk of GPA was 81%. When DPB1*0401 allele was absent or heterozygous with DPB1*0402 as the other allele, or DPB1*0402 was homozygous, the risk of disease was 52.9%. If DPB1*0401, DPB1*0402, and DRB1*13 were absent, the presence of C*2 increased the risk of GPA to 62.5%. Finally, in the absence of DPB1*0401 and DPB1*0402 and the presence of DRB1*13, the risk of GPA decreased to 0%

Os alelos HLA-DPB1*04 e HLA-DRB1*15 estão fortemente associados à Granulomatose com poliangeíte (GPA). Neste estudo, analisamos se os pacientes brasileiros com diagnóstico de GPA apresentam uma base genética na região HLA. Conduzimos um estudo caso-controle, em que analisamos os alelos da região HLA classe I e II em 55 pacientes com diagnóstico de GPA, atendidos no ambulatório de Vasculites Pulmonares do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, e comparamos com os resultados de 110 controles saudáveis. Comparamos também quatro diferentes apresentações clínicas da GPA e a positividade do anticorpo anticitoplasma de neutrófilos (ANCA) com os alelos da região HLA classe I e II. Foi também construída uma árvore de decisões, usando o algoritmo de CART, para a verificação da associação entre os alelos HLA e GPA. Como resultados, observamos que a GPA esteve fortemente associada à presença dos alelos DPB1*04 e DRB1*15 (p = 0,007, odds ratio [OR]: 2,9, 95% intervalo de confiança [IC]: 1,09-3,8; p = 0,006, OR: 2,87, 95% IC: 1,44-4,75, respectivamente) e não à presença do alelo DRB1*04. O alelo DRB1*13 esteve associado com proteção contra GPA (p = 0,042, OR: 0,42, 95% CI: 0,21-0,99). O alelo DPB1*04 esteve significativamente associado a GPA e ANCA-C positivo (OR: 5,47) e à presença de insuficiência renal aguda (p = 0,01037). Concluímos que houve uma interdependência significativa entre os alelos DPB1*0401, DPB1*0402, DRB1*13, C*2 e GPA. Na população estudada, quando o alelo DPB1*04 esteve presente em homozigose, o risco de GPA foi de 81%. Quando o alelo DPB1*0401 esteve ausente ou em heterozigose com o DPB1*0402, como o outro alelo, ou DPB1*0402 esteve em homozigose, o risco da GPA foi de 52,9%. No caso de ausência dos alelos DPB1*0401, DPB1*0402 e DRB1*13, a presença do alelo C*2 aumentou o risco da GPA para 62,5%. Finalmente, na ausência do alelo DPB1*0401 e DPB1*0402 e na presença do alelo DRB1*13, o risco de GPA diminuiu para 0% / The alleles HLA-DPB1*04 and HLA-DRB1*15 are strongly associated with granulomatosis with polyangiitis (GPA). In this study, we examined whether Brazilian patients with GPA had an HLA region genetic background. We conducted a case-control study, in which we analysed alleles of HLA region class I and II from 55 patients with GPA (at the Pulmonary Vasculitis Clinic of the University of São Paulo) and compared the results with those from 110 healthy controls. Comparisons were also performed for 4 different clinical presentations of GPA and anti-neutrophil cytoplasmic antibody (ANCA) positivity and the HLA class I and II region alleles. A tree model decision analysis was conducted using CART algorithm. Our results showed that GPA was strongly associated with alleles DPB1*04 and DRB1*15 (p = 0.007, odds ratio [OR]: 2.9, 95% confidence interval [CI]: 1.09-3.8; p = 0.006, OR: 2.87, 95% CI: 1.44-4.75, respectively) and not with the allele DRB1*04. DRB1*13 allele was associated with protection against GPA (p = 0.042, OR: 0.42, 95% CI: 0.21-0.99). DPB1*04 was significantly associated with GPA plus positive C-ANCA (OR: 5.47) and acute renal failure (p = 0.01037). We concluded that there was a significant interdependence among alleles and GPA. In our population, when allele DPB1*04 was presented in homozygous, the risk of GPA was 81%. When DPB1*0401 allele was absent or heterozygous with DPB1*0402 as the other allele, or DPB1*0402 was homozygous, the risk of disease was 52.9%. If DPB1*0401, DPB1*0402, and DRB1*13 were absent, the presence of C*2 increased the risk of GPA to 62.5%. Finally, in the absence of DPB1*0401 and DPB1*0402 and the presence of DRB1*13, the risk of GPA decreased to 0%