Cryptococcus sp é um fungo saprófita, cosmopolita, que causa micose sistêmica, geralmente, subaguda ou crônica, conhecida, sobretudo, por sua localização meníngea, após aquisição da infecção por via respiratória Embora seja ubíquo, a criptococose ocorre predominantemente em indivíduos imunodeficientes e podendo ocorrer, também, em indivíduos imunocompetentes. Os estudos experimentais e em humanos avaliando a ativação do sistema complemento e a produção de anticorpos específicos mostram que a resposta inata e de anticorpos são importantes para a delimitação do processo infeccioso por Cryptococcus sp, como também, a administração de anticorpos monoclonais podem induzir uma resposta eficaz na disseminação da doença. O sistema complemento contribui para a defesa do organismo contra o Cryptococcus sp de diferentes maneiras: secretando opsoninas e fatores quimiotáticos e colaborando com a ação dos anticorpos específicos, aumentando a interação entre a imunidade inata e adquirida. Os anticorpos antiglicuroxilomanana (GXM) possuem numerosas atividades biológicas: a) opsonização para fagocitose, b) ativação da via clássica do complemento resultando na deposição precoce de fragmentos de C3 no fungo, c) supressão do excesso de acúmulo de C3 pela via alternativa; d) facilitação do clareamento do GXM do soro in vivo, resultando no maior acúmulo de GXM nos tecidos ricos em células do sistema fagocítico mononuclear; e) proteção em modelos murinos da criptococose e f) facilitação de vários aspectos da imunidade celular ao Cryptococcus sp. O objetivo desse estudo foi avaliar a resposta humoral ao GXM e às proteínas da parede celular (Ag S) avaliando a atividade do sistema complemento como também a produção de anticorpos específicos em amostras séricas de adultos com e sem neurocriptococose. Foram coletadas 106 amostras de soro e divididas em 3 grupos: grupo 1- 21 indivíduos com neurocriptococose e baixa exposição a levedura, grupo 2- foi composto por 23 indivíduos saudáveis com alta exposição ao fungo e HIV negativos, granjeiros da cidade de Jumirim localizada a 164 km de São Paulo, na região de Sorocaba e, o grupo 3- 60 indivíduos saudáveis, HIV negativos e com baixa exposição ao Cryptococcus sp. Dois pacientes foram excluídos do estudo por apresentarem tumores (timona e câncer de pulmão). O sistema complemento foi avaliado por ensaio hemolítico (CH 50 e AP 50) e, a dosagem da proteína ligadora de manose (MBL) foi feita por ELISA. Os valores de CH 50 estiveram dentro da normalidade em 17/21, 13/23, 59/60 indivíduos dos grupos 1, 2 e 3 respectivamente. A média dos valores de CH 50 foi diferente significativamente entre o três grupos (P < 0,0001). O grupo 2 mostrou níveis reduzidos significantes em comparação aos dois outros grupos. Os valores de AP 50 estiveram dentro da normalidade em 11/21; 21/23 e 60/60 indivíduos dos grupos 1, 2 e 3 respectivamente. Houve diferença nos valores de AP 50 (P = 0,0005) e apenas um paciente do grupo 1 apresentou valores indetectáveis desta via. Houve diferença significante na dosagem de MBL entre os três grupos (P = 0,0277). Anticorpos IgG anti-GXM foram quantificados por ELISA e expressos por densidade óptica (DO). IgG anti GXM foi detectado em todos os grupos com diferença significante entre eles (P= 0,0127). As médias de IgG anti- GXM (DO) foram: 1.191 (0,49 a 1.217) no grupo 1, 1.572 (0,815 a 2.479) no grupo 2 e 0,965 (0,321 a 1.295) no grupo 3. Dois indivíduos assintomáticos do grupo 2 tiveram títulos de GXM detectáveis (1/256 e 1/32). Quatro pacientes com neurocriptococose faleceram (19%) e seus resultados mostravam: CH 50 normal, 2/4 tinham valores de AP 50 baixo (12 UI/mL) e indetectável; 3/4 tinham altos níveis de MBL e apenas um tinha baixa DO de IgG anti-GXM. Baseado em nosso estudo, podemos concluir que a resposta humoral (sistema complemento e anticorpos) não é suficiente para explicar a susceptibilidade a neurocriptococose, porém a alta e constante exposição ao Cryptococcus sp pode prevenir o desenvolvimento de doença, ou seja, a constante e intensa exposição ao fungo induz a produção de anticorpos que previnem a doença clínica mas não a infecção. Por outro lado fatores genéticos que determinam as concentrações de MBL podem influenciar na susceptibilidade a neurocriptococose. Os anticorpos contribuem para o clearence de GXM, entretanto as concentrações séricas não se correlacionam com resistência à doença / Cryptococcus sp is a fungal pathogen with a worldwide distribution. Although it is ubiquitous in the environment, cryptococcal disease occurs predominantly in immunocompromised hosts and can also occur in apparently immunocompetent individuals. The innate immunity is of special relevance for the antifungal reaction, as it allows an immediate reaction and recognizes a broad variety of fungal pathogens. The host immune response is a major determinant of the outcome of cryptococcal infection; however, the antibodies response is poorly understood. In addition, most of the studies are experimental and there is restricted knowledge concerning the human immune response. Complement system has soluble factors, restrictive regulator proteins and cellular receptors involved in defense mechanism. Glucuroxylomannan (GXM) monoclonal antibodies (MAbs) have numerous biological activities: a) opsonization for phagocytosis, b) activation of the classical complement pathway leading to early deposition of C3 fragments on the yeast, c) suppression overall accumulation of C3 via the alternative pathway; d) clearance facilitation of GXM from serum in vivo, leading to increased accumulation of GXM in tissues rich in mononuclear phagocyte system; e) protection in murine models of cryptococcosis and f) facilitation of various aspects of cellular immunity to Cryptococcus sp. The goal of our study was to evaluate if the antibody response to GXM and cell wall proteins regarding specific antibodies as well as complement system in sera of immunocompetent adults with and without neurocryptococcosis. The aim of our research was to evaluate classical and alternative complement system pathway, to quantify mannose-binding lectin (MBL) as well antibody response to GXM and cell wall proteins (AgS) regarding specific antibodies in sera of immunocompetent adults with and without neurocryptococcosis. One hundred and six samples were collected and classified in 3 groups: group 1- 21 individuals with neurocryptococcosis and low exposure to the yeast; group 2- was composed by 23 healthy individuals, chicken farmings from Jurumirim, a town 164 km to São Paulo, and with high exposure to Cryptoccocus spp and HIV negative. The third group included 60 healthy HIV negative individuals with presumed low exposure to Cryptococcus. Two patients were excluded by report of previous malignancies (timoma and pulmonary cancer). The complement system was evaluated by hemolytic assay and ELISA to MBL. CH 50 and AP 50 values were within the normal range in 17/21; 13/23; 59/60 patients in groups 1, 2 and 3 respectivelly. Mean CH 50 values were significantly different among the three groups (P < 0,0001). Group 2 showed significantly reduced levels in comparison with groups 1 and 3. AP 50 values were within the normal range in 11/21; 21/23; 60/60 patients in groups 1, 2 and 3 respectivelly. There was difference in the AP 50 values (P=0,0005) and one no activation of this pathway in group 1. There was significant difference in MBL among the groups (P = 0,0277). GXM antibodies IgG was measured by ELISA and expressed as optical density (OD). GXM- IgG was detected in all the groups with significant difference among them (P = 0,0127). The means of IgG anti-GXM (OD) were: 1.191 (range 0,49 to 1.217) in group 1, 1.572 (range 0,815 to 2.479) in group 2 and 0,965 (range 0,321 to 1.295) in the group 3. Two of the group 2 individuals had low GXM titers (1/256 and 1/32) and no symptoms. Four patients (4/21; 19%) with neurocryptococcosis died and the results showed: normal classical pathway activation, 2/4 had low (12 UI/mL) or undetectable alternative pathway values ; 3/4 had high MBL concentrations and only one had low OD for IgG anti-GXM. In conclusion, our results suggest that constant and high exposure to Cryptococcus sp can prevent the development of cryptococcosis, i.e. constant and intensive fungal exposition induces protective antibodies to clinical disease but not to the infection. In the other side, genetic factors which determine MBL concentrations could influence the susceptibility to neurocryptococcosis. The antibodies contribute to GXM clearance, however, the concentrations did not correlate with the resistance to the disease

Objetivos: Os objetivos deste estudo foram: avaliar a frequência de imunodeficiências primárias de anticorpos e Complemento em pacientes com lupus eritematoso sistêmico juvenil (LESJ); avaliar possíveis associações entre a presença de imunodeficiência primária (IDP) e dados demográficos, ocorrência de infecções, manifestações clínicas, atividade da doença, dano cumulativo e terapêutica direcionada ao LESJ; e determinar a frequência do anticorpo anti-C1q, estabelecendo a sua especificidade, sensibilidade e valores preditivos para o diagnóstico de LESJ. Métodos: Setenta e dois pacientes com LESJ foram avaliados para a determinação dos níveis séricos de imunoglobulinas (IgG, IgA, IgM e IgE) e subclasses de IgG, e dos componentes iniciais da via clássica do sistema Complemento (C1q, C1r, C1s, C4, C2, C3). Sessenta e sete pacientes e 26 controles saudáveis foram avaliados para a presença do anticorpo anti-C1q. O número de cópias do gene C4 foi determinado por PCR (reação de polimerase em cadeia) em tempo real nos pacientes com deficiência de C4. Setenta pacientes foram avaliados para a presença de deficiência de C2 tipo I. Resultados: Evidência de IDP foi identificada em 16 pacientes (22%): 3 com deficiência (D) de C2, 3 com C4D, 2 com C1qD, 4 com IgG2D (<20mg/dL), 3 com IgAD (<7mg/dL), e 3 com IgMD (<35mg/dL); um destes pacientes apresentou deficiência concomitante de IgA, C4 e C2. Quatro dos 13 pacientes do sexo masculino (30%) e 12 das 59 pacientes do sexo feminino (20%) apresentaram diagnóstico de IDP. As características clínicas de LES não diferiram entre os pacientes com e sem IDP. A mediana do SLICC/ACR-DI foi maior entre os pacientes com IDP (p=0,0033), assim como a frequência de SLICC/ACR-DI>1 (p=0,023). Os grupos também foram semelhantes quanto à ocorrência de infecção e terapêutica utilizada para o LESJ. Os únicos dois casos de LESJ com idade de início antes dos 2 anos apresentaram C1qD e IgMD, respectivamente. Para o diagnóstico de LESJ, o anticorpo anti-C1q apresentou especificidade de 100% (IC 86.7-100%), sensibilidade de 19.4% (IC 10.7-30.8%), valor preditivo positivo de 100% (IC 75.3-100%) e valor preditivo negativo de 32,5% (IC 22,4-43,9%). Conclusões: Foi observada uma elevada frequência de imunodeficiências de anticorpos e Complemento nos pacientes com LESJ, sugerindo que esses defeitos podem contribuir para a patogênese do lúpus. Esses achados indicam que os dois grupos de IDPs devem ser investigados em pacientes com LES de início precoce e de maior gravidade / Objectives. The objectives of this study were: to establish the frequency of primary immunoglobulin and Complement deficiency in Juvenile SLE (JSLE); to evaluate possible associations between the presence of primary immunodeficiency and demographic data, occurrence of infections, JSLE clinical manifestations, disease activity, cumulative damage and therapy; and to determine the frequency of anti-C1q antibody, establishing its sensitivity, specificity and predictive values for JSLE diagnosis. Methods. Seventy-two JSLE patients were analyzed for serum levels of immunoglobulin classes (IgG, IgA, IgM e IgE) and IgG subclasses and early components of the classical Complement pathway (C1q, C1r, C1s, C4, C2, C3). Sixty-seven patients and 26 healthy controls were evaluated for the presence of anti-C1q antibody. C4 gene copy number was determined by real time PCR (polymerase chain reaction) in C4 deficient patients. Seventy patients were analyzed by PCR for the presence of type I C2 deficiency. Results. Evidence of PID was identified in 16 patients (22%): 3 with C2 deficiency (D), 3 with C4D, 2 with C1qD, 4 with IgG2D (<20mg/dL), 3 with IgAD (<7mg/dL), and 3 with IgMD (<35mg/dL); one of these patients presented concomitant IgA, C2 and C4 deficiency. Four out of the 13 boys (30%) and 12 out of 59 girls (20%) had PID diagnosis. SLE features did not differ between patients with and without PID. The median SLICC/ACR-DI was higher among PID subjects (p=0.0033), as was the frequency of SLICC/ACR-DI>1 (p=0.023). Both groups did not differ regarding the occurrence of infections and therapeutic for JSLE. The only 2 cases with age of onset below 2 years presented C1qD and IgMD, respectively. For JSLE diagnosis, the anti-C1q antibodies presented a specificity of 100% (CI 86.7-100%), sensitivity of 19.4% (CI 10.7-30.8%), positive predictive value of 100% (CI 75.3-100%) and negative predictive value of 32,5% (CI 22,4-43,9%). Conclusions. A high frequency of immunoglobulin and Complement deficiency was observed in this JSLE series, suggesting that these defects may contribute to lupus development. Our findings indicate that these two groups of PID should be investigated in early-onset and severe lupus

La dégénérescence maculaire liée à l’âge ou DMLA représente la première cause de cécité légale dans les pays industrialisés. C’est une affection multifactorielle (facteurs environnementaux et génétiques), caractérisée par la dégénérescence des photorécepteurs et une dysfonction de l’épithélium pigmentaire de la rétine (EPR). La présence de dépôts sous-rétiniens, les drusen, qui sont un facteur de risque de développer la DMLA contiennent de l’amyloïde-b (Ab), le peptide neurotoxique impliqué dans la maladie d’Alzheimer (MA) et le facteur H du complément (CFH), qui est un des inhibiteurs solubles majeurs de l’activation de la voie du complément. L’Aβ est capable de lier le CFH et il existe une corrélation inverse entre les taux de CFH et d’Aβ dans le cerveau et la rétine de modèles murins de la MA, de plus, le polymorphisme H402Y dans le gène codant pour le CFH est associé à la moitié des cas de DMLA et est aussi un facteur de risque pour la MA. Au début de ma thèse, rien n’était connu sur les fonctions de la protéine précurseur de l’amyloïde β (APP), et du CFH dans la rétine. Ainsi, le but de ma thèse a été d’étudier d’une part le rôle physiologique de l’APP au cours de la différenciation de la rétine et à l’âge adulte chez la souris, et d’autre part le CFH dans la rétine normale chez la souris normale adulte et chez la souris Rd10, un modèle de dégénérescence des photorécepteurs. Nous avons montré par l’utilisation d’une souris dont le gène de l’APP est invalidé (APPko), une diminution stable de 35% de nombre de cellules amacrines glycinergiques et de 36% de celui des cellules bipolaires, associé à une désorganisation importante des laminations des synapses au stade adulte, et une augmentation transitoire à 50% du nombre cellules horizontales au cours de la phase précoce de la différenciation rétinienne. Nous avons identifié Ptf1a, facteur de transcription indispensable à la différenciation des cellules amacrines, comme la cible de l’APP. De plus, non montrons que SorLA, le récepteur de l’APP, est indispensable à la fonction de différenciation rétinienne de l’APP. Dans la deuxième partie de mon étude, j’ai montré que le CFH protége in vitro les cellules de l’EPR contre les effets létaux du stress oxydant. Après avoir caractérisé les processus associés à la dégénérescence des photorécepteurs chez la souris Rd10 (activation gliale, microgliale, activation de l’inflammation et de la voie du complément), j’ai montré que l’injection intrapéritonéale répétée de CFH humain durant la dégénérescence protège partiellement les photorécepteurs de la mort. L’ensemble de mon étude montre pour la première fois un rôle important de l’APP dans la différenciation de la rétine et un nouveau rôle, comme antioxydant, pour le CFH, qui pourrait être un agent thérapeutique ciblant des photorécepteurs et l’EPR dans les pathologies dégénératives rétiniennes. / Age-related macular degeneration (AMD) is the first cause of central vision loss, due to photoreceptor degeneration and retinal pigmented epithelium (RPE) dysfunction. It is a multifactorial disease (genetic and environmental factors) and subretinal deposits of materials called drusen, is a major risk to develop AMD. Drusen contain amyloïd β (Aβ), the major neurotoxic peptide involved in Alzheimer disease (AD), and complement factor H (CFH), one of the major inhibitor of the complement pathway. Aβ and CFH interact and there is an inverse correlation between CFH and Aβ in the brain and retina of mouse models of AD. Polymorphism H402Y of CFH may be a cause of AMD in as many as 50% of cases. At the beginning of my thesis, nothing was known about the role of the amyloid precursor protein (APP) in the retina, as well as CFH. Therefore, the aim of my work was to investigate the retinal functions of both APP during retinal development and in adult mouse and CFH in normal mouse and in the Rd10 mouse model of photoreceptor degeneration. By using a mouse knock-out for app, we showed that APP regulates differentiation of retinal interneurons: it positively controls differentiation of glycinergic amacrine cells and bipolar cells, whereas it negatively controls differentiation of horizontal cells. Moreover, we identified the transcription factor, Ptf1-1, as a main transcriptional target of APP. Finally, we demonstrated that SorLA, an APP receptor, participates to the differentiation role of APP in the retina. In the second part of the study, I demonstrated that CFH protects RPE cells from lethal oxidative stress in cultures. Moreover, I showed that expression of CFH is very low in neural retina in comparison to the RPE/choroid/sclera complex in normal mice, and that CFH expression increases in both the neural retina and the RPE/choroid/sclera complex during photoreceptor degeneration in the Rd10 mice, suggesting an adaptive response of these tissues to degeneration. Intrapéritonéale injections of CFH partially protect photoreceptors from degeneration, suggesting a protective effect of CFH against retinal degeneration. Altogether, my study showed for the first time a physiological function of APP in the retina, and a new role for CFH in the protection of photoreceptors against degeneration, suggesting that it may be a therapeutic target against retinal degeneration.

Hemolytic uremic syndrome (HUS) induced by Shiga toxin-producing E. coli (STEC) is the most common causes of acute kidney injury in children. The therapy of the disease is symptomatic and the main factors leading to the development of severe course of a STEC-HUS are still unknown. In our study, we dealt with factors leading to development of a severe course of STEC-HUS in pediatric patients on both the host and pathogen side. Using retrospective analysis of the courses in children in the Czech Republic, we found that the most common cause of STEC-HUS was serotype O26 and HUS most often affected children under 3 years of age. 63,8 % required dialysis and mortality was 8.62 %. On the host side we focused on the relationship between the activation of the alternative complement pathway and the severity of the course of HUS. We found a significant difference in the level of the C3 part of complement in patients who required dialysis and patients for whom dialysis was not necessary. We also a cut-off value for the C3 part of complement and its reduction below 0.825 g / l was associated with the need for dialysis treatment and a higher incidence of extrarenal complications. Based not only on our results, it can be assumed that the therapeutic effect of complement could affect the severity of the disease....

Neisseria gonorrhoeae (Ng) which causes gonorrhea has become multidrug-resistant, necessitating the development of novel therapeutics and vaccines. mAb 2C7 which targets an epitope within an important virulence factor, the lipooligosaccharide (LOS), is a candidate therapeutic mAb. Ninety-four percent of clinical isolates express the 2C7-epitope which is also a vaccine target. Ng expresses multiple LOS(s) due to phase-variation (pv) of LOS glycosyltransferase (lgt) genes. mAb 2C7 reactivity requires a lactose extension from the LOS core Heptose (Hep) II (i.e. lgtG ‘ON’ [G+]). Pv results in HepI with: two (2-), three (3-), four (4-), or five (5-) hexoses (Hex). How HepI glycans impact Ng infectivity and mAb 2C7 function are unknown and form the bases of this dissertation. Using isogenic mutants, I demonstrate that HepI LOS glycans modulate mAb 2C7 binding. mAb 2C7 causes complement (C’)-dependent bacteriolysis of three (2-Hex/G+, 4-Hex/G+, and 5-Hex/G+) of the HepI mutants in vitro. The 3-Hex/G+ mutant (resistant to C’-dependent bacteriolysis) is killed by neutrophils in the presence of mAb and C’. In mice, 2- and 3-Hex/G+ infections are significantly shorter than 4- and 5-Hex/G+ infections. A chimeric mAb 2C7 that hyperactivates C’, attenuates only 4- and 5-Hex/G+ infections. This study enhances understanding of the role of HepI LOS pv in gonococcal infections and shows that longer HepI glycans are necessary for prolonged infections in vivo. This is the first study that predicts in vitro efficacy of mAb 2C7 against all four targetable HepI glycans thereby strengthening the rationale for development of 2C7-epitope based vaccines and therapeutics.