Dans le cadre des analyses des données de survie, la comparaison de plusieurs groupes d’individus, où l'événement d'intérêt est censuré par intervalle, représente un défi méthodologique. Lorsque le suivi des patients au cours de l'étude n'est pas continu, l'événement d'intérêt pourra survenir entre deux dates d'observation; il est dit censuré par intervalle. Des tests de comparaisons des distributions des temps de survie pour plusieurs groupes, adaptés à la censure par intervalle, ont été développés (tests du score, tests de pseudo log-rank pondérés, tests des rangs). C’est dans ce contexte que nous avons proposé deux nouveaux tests de comparaisons de groupes adaptés à des situations particulières de censure par intervalle. Le premier test concerne une situation où l’hypothèse alternative considère que les fonctions de risque instantané se croisent. Le second test concerne une situation où la population étudiée comporte une fraction non à risque pour l’événement d’intérêt. Ces deux tests ont fait l'objet d'une application sur des données réelles d'immunologie clinique. / In the context of analysis of survival data, the comparison of several groups of individuals, where the event of interest is interval censored, represents a methodological challenge. When the monitoring of patients during the study is not continuous, the event of interest may occur between two observation dates; it is said "interval censored". Tests of comparisons of survival time distributions for several groups, adapted for interval censoring, have been developed (score tests, weighted pseudo log-rank tests, rank tests). In this context, we have developped two new group comparison tests adapted to the particular situations of interval censoring. The first test apply to a situation where the alternative hypothesis considers that the hazard functions cross. The second test concerns a situation where the study population has a fraction not at risk for the event of interest. Both of these tests have been applied to real clinical immunology dataset.

Ovarian cancer is a disease with a high rate of mortality where the need for novel treatments will increase in the near future as older and populous generations reach the age where the cancer is usually diagnosed. Once treated, ovarian cancer tends to recur and display a newfound resistance against the platinum-based chemotherapeutic drugs that are used to treat the disease. Therefore, devising new methods of treatment is of utmost importance. Treatment with oncolytic viruses like LOAd703 offers an alternative treatment option that is more specific, causes immunogenic cell death in tumor cells, can stimulate the patient’s own immune system into fighting the cancer, and also has the potential to induce long term immune memory. In this project, the oncolytic and immunogenic capacity of LOAd703 in three different ovarian cancer cell lines was tested in conjunction with the standard-of-care chemotherapeutical drugs paclitaxel, cisplatin and carboplatin. The chemotherapy did not inhibit the replication, transgene expression or oncolysis of the LOAd703 virus. LOAd703 was able to effectively induce oncolysis in all three cell lines. The oncolytic capacity was generally increased when combined with chemotherapeutics. In cells resistant to chemotherapeutics, combination therapy with LOAd703 increased the killing capacity. While combination therapy proved effective, it did leave behind a small population of tumor cells that appeared to be resistant to both chemotherapy and viral oncolysis but longer culturing times may be tested to evaluate if complete killing will occur or if it is a primary resistance to these treatments in the cell lines. Further, if there is resistance to oncolysis or chemotherapy-mediated killing, employing tumor-immune cell co-cultures or in vivo studies might be necessary in order to assess whether the immunostimulatory effects of LOAd703 will lead to a complete eradication of the remaining tumor cells. The treatments also caused an increase in the expression of certain cell surface markers, like PD-L1 and CD262, which might open the door for future trials combining chemotherapy and LOAd703 with anti-PD-L1 inhibitors or soluble TRAIL.

Estudos em nosso laboratório caracterizaram camundongos B10.A como susceptíveis e camundongos A/J como resistentes à infecção pulmonar pelo P. brasiliensis. Para investigar o papel das células PMN na paracoccidioidomicose (PCM) pulmonar, camundongos B10.A e A/J foram depletados destas células através da inoculação in vivo por via intraperitoneal (i.p.) do anticorpo monoclonal anti-células PMN e infectados pela via intratraqueal (i.t.) com um milhão de leveduras viáveis. Camundongos-controle receberam doses equivalentes de IgG normal de rato. A depleção de granulócitos diminuiu o tempo de sobrevida dos animais B10.A, mas não dos animais A/J. Quando comparados com os animais não depletados, camundongos resistentes apresentaram aumento da carga fúngica no pulmão somente no dia 7 pós-infecção. Ao contrário, camundongos susceptíveis depletados de PMN apresentaram números mais elevados de células leveduriformes no pulmão, fígado e baço nos dias 7, 15, 30 e 120 pós-infecção, com relação aos seus grupos-controle tratados com IgG. A depleção dos granulócitos, entretanto, não alterou as reações de hipersensibilidade do tipo tardio (HTT) desenvolvidas por ambas as linhagens de animais. Considerando a resposta imune humoral, a depleção de células PMN levou à maior produção de anticorpos específicos em animais B10.A (Ig Total, IgG1, IgA e IgG3) e em animais A/J (Ig Total, IgG2a, IgG2b e IgG3). A depleção também alterou o padrão de citocinas pulmonares. Nos animais B10.A-tratados foram encontradas concentrações mais elevadas de IL-12 aos 15 dias e de IL-4 aos 120 dias pós-infecção, em comparação aos animais controle. Níveis de IL-12 significativamente mais altos foram detectados no grupo de animais A/J-depletados aos 7 e 120 dias e o IFN-γ foi detectado em níveis mais elevados em todo o curso da doença. Então, a depleção de PMN induz níveis mais altos de anticorpos e um ambiente mais pró-inflamatório no local da infecção. De acordo com esses dados, pudemos verificar que os neutrófilos são células importantes na defesa do hospedeiro à infecção pelo P.brasiliensis. Entretanto, o efeito protetor desta população celular depende do patrimônio genético do hospedeiro e é mais marcante na linhagem susceptível de camundongos. Neste trabalho também investigamos o efeito da depleção in vivo de leucócitos PMN na imunidade adquirida e protetora desenvolvida pela pré-imunização de animais B10.A. Assim, os camundongos foram previamente imunizados pela via s.c., depletados ou não de células PMN e desafiados i.t. com 1 milhão de células leveduriformes. Não foram detectadas diferenças significativas na contagem de fungos viáveis do pulmão, fígado e baço, entre os grupos imunizados tratados ou não com o AcM anti-PMN. A depleção não alterou a produção de anticorpos específicos, porém aumentou significativamente a síntese de IL-3, bem como a reatividade de HTT. Portanto, nossos resultados mostraram que, diferentemente da imunidade natural, os leucócitos PMN não exercem um papel protetor na fase adquirida da resposta imune à infecção com o P.brasiliensis. / Previous studies in our laboratory defined susceptible (B10.A) and resistant (A/J) mice to pulmonary P.brasiliensis infection. To investigate the role of PMN cells in pulmonary PCM, resistant and susceptible mice were depleted in vivo of these cells by intraperitoneal (i.p.) injection of a granulocyte-depleting monoclonal antibody and infected intratracheally (i.t) with one million yeast cells. Control mice received equivalent doses of normal rat IgG. PMN depletion decreased survival times of B10.A, but not of A/J infected mice. When compared with the non-depleted counterparts, resistant mice presented increased fungal loads in the lung only at day 7 after infection. On the contrary, PMN-depleted susceptible mice presented higher number of yeast cells in the lung, liver and spleen at days 7, 15, 30 and 120 after infection than their IgG-treated controls. PMN cells depletion, however, did not alter the DTH reaction developed by both mouse strains. Regarding humoral immune response, PMN cells depletion caused increased production of specific antibodies in B10.A (Total Ig, IgG1, IgA and IgG3) and A/J (Total Ig, IgG2a, IgG2b and IgG3) mice. Levels of pulmonary cytokines were also altered after PMN depletion. B10.A-treated mice presented increased levels of IL-12 and IL-4 at days 15 and 120 post-infection, respective/y. In A/J-depleted mice, augmented levels of IL-12 were detected at days 7 and 120 after infection; IFN-γ, however, was produced in higher levels during whole course of infection. Thus, PMN depletion induces higher levels of specific antibodies and enhanced pro-inflammatory milieu at the site of infection. As a whole, our data on PMN depletion at the onset of infection showed that neutrophils are important cells in host defense to P.brasiliensis infection. However, the effect of PMN depletion depends on the genetic background of the host and has a more pronounced effect in the susceptible strain of mice. We have also assessed the effect of in vivo depletion of the leukocytes on the acquired phase of immunity developed by B10.A mice previously immunized by the subcutaneous (s.c.) route were depleted or not of PMN cells and challenged i.t. with one million yeast cells. No differences were detected in the CFU counts in the lung, liver and spleen between untreated and PMN depleted vaccinated mice. PMN depletion also did not alter the production of specific antibodies but enhanced IL-3 synthesis as well as DTH reactivity. In conclusion, our results showed that, differently from natural immunity, PMN cells do not play a protective role in the acquired phase of immune response to P.brasiliensis infection.

Estudos em nosso laboratório caracterizaram camundongos B10.A como susceptíveis e camundongos A/J como resistentes à infecção pulmonar pelo P. brasiliensis. Para investigar o papel das células PMN na paracoccidioidomicose (PCM) pulmonar, camundongos B10.A e A/J foram depletados destas células através da inoculação in vivo por via intraperitoneal (i.p.) do anticorpo monoclonal anti-células PMN e infectados pela via intratraqueal (i.t.) com um milhão de leveduras viáveis. Camundongos-controle receberam doses equivalentes de IgG normal de rato. A depleção de granulócitos diminuiu o tempo de sobrevida dos animais B10.A, mas não dos animais A/J. Quando comparados com os animais não depletados, camundongos resistentes apresentaram aumento da carga fúngica no pulmão somente no dia 7 pós-infecção. Ao contrário, camundongos susceptíveis depletados de PMN apresentaram números mais elevados de células leveduriformes no pulmão, fígado e baço nos dias 7, 15, 30 e 120 pós-infecção, com relação aos seus grupos-controle tratados com IgG. A depleção dos granulócitos, entretanto, não alterou as reações de hipersensibilidade do tipo tardio (HTT) desenvolvidas por ambas as linhagens de animais. Considerando a resposta imune humoral, a depleção de células PMN levou à maior produção de anticorpos específicos em animais B10.A (Ig Total, IgG1, IgA e IgG3) e em animais A/J (Ig Total, IgG2a, IgG2b e IgG3). A depleção também alterou o padrão de citocinas pulmonares. Nos animais B10.A-tratados foram encontradas concentrações mais elevadas de IL-12 aos 15 dias e de IL-4 aos 120 dias pós-infecção, em comparação aos animais controle. Níveis de IL-12 significativamente mais altos foram detectados no grupo de animais A/J-depletados aos 7 e 120 dias e o IFN-γ foi detectado em níveis mais elevados em todo o curso da doença. Então, a depleção de PMN induz níveis mais altos de anticorpos e um ambiente mais pró-inflamatório no local da infecção. De acordo com esses dados, pudemos verificar que os neutrófilos são células importantes na defesa do hospedeiro à infecção pelo P.brasiliensis. Entretanto, o efeito protetor desta população celular depende do patrimônio genético do hospedeiro e é mais marcante na linhagem susceptível de camundongos. Neste trabalho também investigamos o efeito da depleção in vivo de leucócitos PMN na imunidade adquirida e protetora desenvolvida pela pré-imunização de animais B10.A. Assim, os camundongos foram previamente imunizados pela via s.c., depletados ou não de células PMN e desafiados i.t. com 1 milhão de células leveduriformes. Não foram detectadas diferenças significativas na contagem de fungos viáveis do pulmão, fígado e baço, entre os grupos imunizados tratados ou não com o AcM anti-PMN. A depleção não alterou a produção de anticorpos específicos, porém aumentou significativamente a síntese de IL-3, bem como a reatividade de HTT. Portanto, nossos resultados mostraram que, diferentemente da imunidade natural, os leucócitos PMN não exercem um papel protetor na fase adquirida da resposta imune à infecção com o P.brasiliensis. / Previous studies in our laboratory defined susceptible (B10.A) and resistant (A/J) mice to pulmonary P.brasiliensis infection. To investigate the role of PMN cells in pulmonary PCM, resistant and susceptible mice were depleted in vivo of these cells by intraperitoneal (i.p.) injection of a granulocyte-depleting monoclonal antibody and infected intratracheally (i.t) with one million yeast cells. Control mice received equivalent doses of normal rat IgG. PMN depletion decreased survival times of B10.A, but not of A/J infected mice. When compared with the non-depleted counterparts, resistant mice presented increased fungal loads in the lung only at day 7 after infection. On the contrary, PMN-depleted susceptible mice presented higher number of yeast cells in the lung, liver and spleen at days 7, 15, 30 and 120 after infection than their IgG-treated controls. PMN cells depletion, however, did not alter the DTH reaction developed by both mouse strains. Regarding humoral immune response, PMN cells depletion caused increased production of specific antibodies in B10.A (Total Ig, IgG1, IgA and IgG3) and A/J (Total Ig, IgG2a, IgG2b and IgG3) mice. Levels of pulmonary cytokines were also altered after PMN depletion. B10.A-treated mice presented increased levels of IL-12 and IL-4 at days 15 and 120 post-infection, respective/y. In A/J-depleted mice, augmented levels of IL-12 were detected at days 7 and 120 after infection; IFN-γ, however, was produced in higher levels during whole course of infection. Thus, PMN depletion induces higher levels of specific antibodies and enhanced pro-inflammatory milieu at the site of infection. As a whole, our data on PMN depletion at the onset of infection showed that neutrophils are important cells in host defense to P.brasiliensis infection. However, the effect of PMN depletion depends on the genetic background of the host and has a more pronounced effect in the susceptible strain of mice. We have also assessed the effect of in vivo depletion of the leukocytes on the acquired phase of immunity developed by B10.A mice previously immunized by the subcutaneous (s.c.) route were depleted or not of PMN cells and challenged i.t. with one million yeast cells. No differences were detected in the CFU counts in the lung, liver and spleen between untreated and PMN depleted vaccinated mice. PMN depletion also did not alter the production of specific antibodies but enhanced IL-3 synthesis as well as DTH reactivity. In conclusion, our results showed that, differently from natural immunity, PMN cells do not play a protective role in the acquired phase of immune response to P.brasiliensis infection.

This thesis concerns the investigation of novel immunotherapies for cancer eradication. CpG therapy was used in order to target antigen-presenting cells (APCs), facilitating antigen presentation and activation of T cells. Blockade of the two major immune checkpoint regulators (CTLA-4 and PD-1) was also studied to ensure proper and sustained T cell activation. The therapies were investigated alone and compared to BCG, the standard immunotherapy in the clinic today for bladder cancer. In addition, CpG as well as BCG was combined with CTLA-4 or PD-1 blockade to examine if the combination could improve therapy. Single and combination strategies were assessed in an experimental bladder cancer model. In addition, one of the therapies (local aCTLA-4 administration) was evaluated in an experimental pancreatic cancer model. To be able to study the effects of CpG in humans, a human whole blood loop system has been used. This allowed us to dissect the potential interplay between CpG and complement. CpG was found to be superior to the conventional therapy, BCG, in our experimental model and T cells were required in order for effective therapy to occur. Used as a monotherapy, CTLA-4 blockade but not PD-1 blockade, prolonged survival of mice. When CTLA-4 or PD-1 blockade was combined with CpG, survival was enhanced and elevated levels of activated T cells were found in treated mice. In addition, Treg levels were decreased in the tumor area compared to tumors in control treated mice. CTLA-4 blockade was also effective when administrated locally, in proximity to the tumor. Compared to systemic CTLA-4 blockade, local administration gave less adverse events and sustained therapeutic success. When CpG was investigated in a human whole blood loop system it was found to tightly interact with complement proteins. This is an interesting finding which warrants further investigation into the role of TLRs in complement biology. Tumor therapy could be affected either negatively or positively by this interaction. The results presented herein are a foundation for incorporating these combination therapies into the clinic, specifically for bladder cancer but in a broader perspective, also for other solid tumors such as pancreatic cancer.