La coqueluche est une pathologie due à la bactérie Bordetella pertussis qui touche les voies respiratoires des patients infectés causant toux, leucocytose, fièvre, et dont les symptômes peuvent aller jusqu’au décès chez les individus les plus à risque (nouveau-nés et enfants immunodéprimés en particulier). Ciblée par différents programmes vaccinaux depuis de nombreuses années, cette pathologie sévit à nouveau dans de nombreux pays développés où le nombre de cas augmente fortement depuis la fin des années 2000. Cette résurgence montre la nécessité de développer de nouvelles stratégies afin de comprendre les mécanismes de l’infection par B. pertussis. Dans ce contexte, la recherche préclinique apparaît comme essentielle pour comprendre la physiopathologie de la coqueluche. De nombreux modèles animaux ont été décrits pour l’étude de la coqueluche mais aucun de ces modèles ne permet de reproduire l’ensemble du spectre des symptômes cliniques de la pathologie, notamment la toux. Cependant, au cours des dernières années un modèle d’infection par Bordetella pertussis chez le jeune babouin a été développé aux Etats-Unis et permet de reproduire la pathologie observée chez l’homme, notamment concernant la toux et la transmission. Ce modèle semble ainsi très prometteur pour l’étude de la physiopathologie de la coqueluche.Cependant, de nombreuses inconnues subsistent dans ce modèle, notamment concernant la colonisation bactérienne et les interactions entre la bactérie et l’hôte. Nous avons ainsi cherché dans cette étude à évaluer d’une part l’impact de différents facteurs comme l’âge des animaux, la dose d’infection ainsi que la voie d’exposition sur la pathologie déclarée par les babouins suite à l’infection par la souche B1917 de B. pertussis afin de pouvoir proposer un parallèle avec les données cliniques disponibles. Nous avons également développé l’utilisation de techniques d’imagerie in vivo comme l’endomicroscopie confocale couplée à la bronchoscopie afin d’étudier la localisation et la cinétique de colonisation et certaines interactions du pathogène dans le tractus respiratoire inférieur au cours de la pathologie. Cette étude nous a ainsi permis d’approfondir les connaissances de physiopathologie de la coqueluche dans ce modèle babouin et consolidera cet outil précieux pour l’évaluation des futures stratégies de prévention contre cette pathologie. / Whooping cough, or pertussis, is a respiratory disease caused by Bordetella pertussis bacterial colonization of human airways. Main symptoms are cough, leukocytosis, fever and may even be lethal for some patients (e.g. newborn infants and immuno-deficient patients). Despite a good vaccination coverage worldwide against pertussis, whooping cough cases have been re-increasing in several developed countries in the past twenty years. This resurgence points out the crucial need to develop new control strategies and to better understand pertussis pathophysiology, notably using appropriate animal models. Numerous preclinical models including mice, rats, rabbits and swine have been described for B. pertussis infection studies. However, none of these models reproduce the full spectrum of clinical pertussis symptoms, especially cough. The recent baboon model of whooping cough described in the last few years in the US appears to be a very relevant model for pertussis pathophysiology studies as these animals reproduced all clinical symptoms as observed in humans including cough.However, many aspects of bacterial colonization and interactions with the host have yet to be described in this model.We have then evaluated diverse parameters such as animal age, the inoculum dose and the exposition route on the pathology symptoms and immune responses developed by baboons following B. pertussis B1917 strain inoculation in order to draw a parallel with human clinical data. We also developed in this model in vivo imaging techniques like confocal endomicroscopy coupled with bronchoscopy in order to evaluate bacterial colonization kinetics, localization and some interactions in the lower respiratory tract of infected baboons. Then, this study brought additional data on whooping cough physiopathology in this baboon model, which will be crucial for evaluating future prevention strategies against pertussis disease

Bordetella pertussis, o agente etiológico da coqueluche ou tosse comprida, que estabelece a infecção através da fixação bacteriana no epitélio do trato respiratório superior. Os principais mediadores de adesão da bactéria são a toxina pertússica (PT) e a hemaglutinina filamentosa (FHA). A FHA é a adesina majoritária e contém pelo menos 4 domínios: porção Nterminal, domínio de reconhecimento de carboidrato (CRD) (FHA1141-1279), trinca de aminoácidos Arginina-Glicina-Ácido aspártico (RGD) (FHA1097-1099) e o sítio de ligação a heparina (domínio Hep) (FHA442-863). Neste trabalho, foi realizado a amplificação de duas regiões do domínio de ligação à heparina, as regiões MAL80 (FHA299-873) e HEP (FHA430-873). As regiões foram amplificadas, clonadas no vetor de expressão pAE, expressas utilizando a cepa BL21 SI de E. coli e purificadas. A proteína HEP purificada de E. coli possui baixa afinidade por heparina e não é capaz de aglutinar hemácias. A proteína recombinante HEP purificada foi utilizada para a produção de anticorpos. Através do experimento de ELISA foi demonstrado que o anti-soro anti-HEP é capaz de reconhecer além da região HEP, a região MAL80 e a proteína FHA. Estes resultados foram confirmados por experimentos de Western. Neste período também foi realizada a amplificação do domínio HEP de FHA e da subunidade S1 da toxina pertússica (PT) de B. pertussis através do método de TAP Express. Este método envolve duas reações de PCR e no final do processo é obtido um fragmento que contém uma região promotora (CMV), uma seqüência codificadora e uma região terminadora (SV40), que está pronto para ser introduzido e expresso em animais. De posse deste material e da proteína recombinante HEP, foi realizado o desafio intracerebral com Bordetella pertussis e através do monitoramento dos camundongos foi observado que nenhum dos candidatos testados foi capaz de proteger os animais contra B. pertussis. Foi realizado também a expressão do domínio Hep em lactobacilos, visando um possível sistema de imunizações de mucosas. Os anticorpos produzidos nos camundongos imunizados com a proteína HEP expressa em E. coli, lactobacilos e por vacina de DNA foram capazes de inibir a hemaglutinação promovida pela proteína FHA. / Bordetelfa pertussis, the agent of whopping cough, establishes infection by attaching to the ciliated epithelial cells of the respiratory tract. The bacterial adherence is mediated by pertussis toxin and filamentous hemagglutinin (FHA). FHA is the major adhesin of B. pertussis and displays multipie adherence activities. FHA contains four distin\'ct domains that exhibit specific affinities for different ligands or receptor, the amino-terminal end, the RGD triplet (FHA1097-1099), the lectin domain (FHA1141-1279) and the heparin-binding domain (FHA442-863). In this study, two overlapping regions of the heparin-binding domain, Mal80 (FHA299-873) and Hep (FHA442-873), were amplified by peR and subcloned in pAE expression vectors for E. coli. The fusion proteins in pAE were transformed in E. coli BL21 SI, induced with NaCI 0,3 M and purified using a nickel-charged metal chelating resin. The purified protein has low heparin affinity and does not have hemagglutination activity. The purified protein HEP was used to produce polyclonal antibodies in mouse. The anti-HEP antibodies are able to recognize the HEP, MAL80 and FHA proteins in ELISA and western assays, but anti-FHA only recognized the FHA protein. The genetically detoxified S1 subunit of pertussis toxin and Hep domain were amplified by the TAP Express method. There are two PCR reactions involved in the TAP processo At the end of the process the fragment of interest will carry a CMV promoter and a SV40 terminator and is ready to be introduced into animals or cell by transfection. Groups were immunized with proteins and/or DNA, challenged i.c. with a lethal dose of live Bordetelfa pertussis and the survival was monitored. No groups were protected against the challenge. The recombinant protein HEP were also expressed in Lactobacilfus aiming the development of potential mucosal vaccines. The polyclonal antibodies produce in mouse immunized with DNA and protein Hep expressed in E. coli and Lactobacillus were able to inhibition the FHA hemagglutination activity.

Bordetella pertussis est l’agent responsable de la coqueluche. Pour coloniser le tractus respiratoire humain, cette bactérie à Gram négatif, aérobie stricte, produit de nombreux facteurs de virulence dont l’expression est sous la dépendance du système à deux composants BvgAS. BvgS est un senseur-kinase dimérique. Chaque monomère est constitué de trois domaines putatifs de perception - deux domaines Venus flytrap périplasmiques et un domaine PAS cytoplasmique -, suivis du domaine enzymatique et deux autres domaines, de phospho-transfert et receveur, impliqués dans la cascade de phosphorylation. L’expression du régulon de virulence est activée suite à la phosphorylation par BvgS du régulateur de réponse BvgA. BvgS est en mode kinase à l’état basal, et la perception de basses températures ou de signaux chimiques comme les ions sulfate ou nicotinate cause son passage en mode phosphatase. L’étude présentée dans ce manuscrit vise à caractériser le senseur-kinase BvgS en analysant les domaines putatifs de perception ainsi que la transduction de signal qui s’effectue au sein de la molécule. L’étude de la portion périplasmique a permis de mettre en évidence, à l’état basal, un gradient de dynamique décroissant. En se fixant au domaine VFT2 proximal à la membrane, le nicotinate induirait une diminution de la dynamique du second lobe du VFT1, causée par la formation d’un bloc compact entre le domaine VFT2 et le deuxième lobe du domaine VFT1. Cette rigidification exercerait une tension sur les hélices α qui précèdent les segments transmembranaires, provoquant une transition de la portion cytoplasmique vers l’état phosphatase. La perception de modulateurs par le domaine VFT2 - ou possiblement la fixation d’un ligand dans la cavité du VFT1- modifierait cette dynamique et causerait le changement d’activité de BvgS. Ainsi, nous proposons un modèle dans lequel le VFT1 est considéré comme le moteur du système, lui impulsant une dynamique qui serait relayée ou atténuée par le domaine VFT2. Une recherche de ligands antagonistes pour le domaine VFT1 a été entreprise, selon l’idée que la fixation d’un ligand réduirait la dynamique de ce dernier. Au sein du dimère, des connecteurs prédits pour former des enroulements d’hélices α (‘coiled coil’) relient entre eux les domaines VFT et PAS, et les domaines PAS et kinase de BvgS. La transduction d’information entre les domaines périplasmiques et le site enzymatique de BvgS a été analysée par mutagénèse dirigée et ‘cysteine scanning’. Des contacts proches sont observés entre les hélices constituant le segment transmembranaire, qui ne semblent pas être modifiés après perception de modulateur. Nous suggérons donc un modèle de piston symétrique pour la transmission d’information au travers de la membrane. Le coiled coil putatif précédant le domaine PAS présente une certaine dynamique rotationnelle à l’état basal. La perception de modulateurs semble induire l’écartement de ces hélices, ce qui pourrait permettre un changement de l’interface des domaines PAS. L’étude de la topologie du domaine PAS confirme une modification de cette interface entre les modes kinase et phosphatase de BvgS. Enfin, le coiled coil reliant les domaines PAS et kinase est sujet à une forte dynamique rotationnelle à l’état basal, en accord avec un modèle de régulation de l’activité kinase proposé dans d’autres systèmes. Suite à la perception de modulateur, une rigidification marquée de ce coiled coil est observée, permettant le passage en mode phosphatase. L’existence de deux états dynamiques différents de ce coiled coil a également été mise en évidence en absence du domaine PAS.Ces études ont permis d’avancer dans la compréhension de BvgS et de proposer un modèle de la signalisation au sein de ce senseur-kinase, qui pourrait s’appliquer aux autres membres de la famille de BvgS. / Bordetella pertussis is the agent of an acute and highly contagious respiratory disease, whooping cough. In order to colonize the human respiratory tract, this strictly aerobic Gram negative bacterium produces many virulence factors, the expression of which is regulated by the BvgAS two-component system. BvgS is a sensor-kinase composed of three putative domains of perception –two periplasmic Venus flytrap domains and a cytoplasmic PAS domain -, followed by the enzymatic domain and two other domains called phosphotransfert and receiver involved in the phophorelay. The expression of the virulence regulon is activated after the phosphorylation by BvgS of the response regulator BvgA. BvgS is in a kinase mode at the basal state, and the perception of low temperatures or chemical signals like sulfate ions or nicotinate causes a shift to the phosphatase state. The study presented in this manuscript has focused on the characterization of the BvgS sensor-kinase. We have analyzed its putative domains of perception and the mechanisms of signal transduction.Investigations into the dynamics of the periplasmic moiety has provided evidence for a decreasing gradient of dynamics from N to C-terminus at the basal state. Nicotinate binding to the membrane-proximal VFT2 domains decreases the dynamics of the second lobe of VFT1. Tighter interactions between the latter and the VFT2 domain cause a tension on the α helices that precede the transmembrane segments, triggering the transition to the phosphatase state of the enzymatic portion. Perception of modulator by the VFT2 domains –or possibly binding of a ligand in the VFT1 cavity- thus appears to modify periplasmic dynamics, which shifts BvgS activity. We propose that the VFT1 domains are the motor for BvgS activity, and their dynamics are relayed or attenuated by the VFT2 domains. A search for antagonistic VFT1 ligands has been undertaken, along the idea that ligand binding may reduce their dynamics.The VFT and PAS domains, and the PAS and kinase domains are joined to each other by long α helices predicted to form coiled coils. We performed directed mutagenesis and cysteine scanning analyses to decipher signal transduction between the periplasmic domains and the enzymatic moiety of BvgS. The close contacts between the helices of the transmembrane segment are not modified after perception of the modulator, suggesting that signal transduction across the membrane is mediated by symmetrical piston motions. The putative coiled coil before the PAS domain shows rotational dynamics at the basal state. Modulator perception causes the helices to splay, and this motion may modify the PAS domains interface. Our topology analyses of the PAS domain confirm that changes occur at this interface between the kinase and phosphatase states of BvgS. Finally, the coiled coil between the PAS and kinase domains presents a strong rotational dynamics at the basal state, which is consistent with the model of regulation of kinase activity proposed for other sensor-kinases. After perception of a modulator, this coiled coil becomes more rigid, allowing the shift to the phosphatase state. The occurrence of two states of dynamics for this coiled coil has also been demonstrated in the absence of the PAS domain.These studies have advanced our understanding of BvgS and allow us to propose a model of signaling by this sensor-kinase, which may apply more broadly to other family members.

Bordetella pertussis, o agente etiológico da coqueluche ou tosse comprida, que estabelece a infecção através da fixação bacteriana no epitélio do trato respiratório superior. Os principais mediadores de adesão da bactéria são a toxina pertússica (PT) e a hemaglutinina filamentosa (FHA). A FHA é a adesina majoritária e contém pelo menos 4 domínios: porção Nterminal, domínio de reconhecimento de carboidrato (CRD) (FHA1141-1279), trinca de aminoácidos Arginina-Glicina-Ácido aspártico (RGD) (FHA1097-1099) e o sítio de ligação a heparina (domínio Hep) (FHA442-863). Neste trabalho, foi realizado a amplificação de duas regiões do domínio de ligação à heparina, as regiões MAL80 (FHA299-873) e HEP (FHA430-873). As regiões foram amplificadas, clonadas no vetor de expressão pAE, expressas utilizando a cepa BL21 SI de E. coli e purificadas. A proteína HEP purificada de E. coli possui baixa afinidade por heparina e não é capaz de aglutinar hemácias. A proteína recombinante HEP purificada foi utilizada para a produção de anticorpos. Através do experimento de ELISA foi demonstrado que o anti-soro anti-HEP é capaz de reconhecer além da região HEP, a região MAL80 e a proteína FHA. Estes resultados foram confirmados por experimentos de Western. Neste período também foi realizada a amplificação do domínio HEP de FHA e da subunidade S1 da toxina pertússica (PT) de B. pertussis através do método de TAP Express. Este método envolve duas reações de PCR e no final do processo é obtido um fragmento que contém uma região promotora (CMV), uma seqüência codificadora e uma região terminadora (SV40), que está pronto para ser introduzido e expresso em animais. De posse deste material e da proteína recombinante HEP, foi realizado o desafio intracerebral com Bordetella pertussis e através do monitoramento dos camundongos foi observado que nenhum dos candidatos testados foi capaz de proteger os animais contra B. pertussis. Foi realizado também a expressão do domínio Hep em lactobacilos, visando um possível sistema de imunizações de mucosas. Os anticorpos produzidos nos camundongos imunizados com a proteína HEP expressa em E. coli, lactobacilos e por vacina de DNA foram capazes de inibir a hemaglutinação promovida pela proteína FHA. / Bordetelfa pertussis, the agent of whopping cough, establishes infection by attaching to the ciliated epithelial cells of the respiratory tract. The bacterial adherence is mediated by pertussis toxin and filamentous hemagglutinin (FHA). FHA is the major adhesin of B. pertussis and displays multipie adherence activities. FHA contains four distin\'ct domains that exhibit specific affinities for different ligands or receptor, the amino-terminal end, the RGD triplet (FHA1097-1099), the lectin domain (FHA1141-1279) and the heparin-binding domain (FHA442-863). In this study, two overlapping regions of the heparin-binding domain, Mal80 (FHA299-873) and Hep (FHA442-873), were amplified by peR and subcloned in pAE expression vectors for E. coli. The fusion proteins in pAE were transformed in E. coli BL21 SI, induced with NaCI 0,3 M and purified using a nickel-charged metal chelating resin. The purified protein has low heparin affinity and does not have hemagglutination activity. The purified protein HEP was used to produce polyclonal antibodies in mouse. The anti-HEP antibodies are able to recognize the HEP, MAL80 and FHA proteins in ELISA and western assays, but anti-FHA only recognized the FHA protein. The genetically detoxified S1 subunit of pertussis toxin and Hep domain were amplified by the TAP Express method. There are two PCR reactions involved in the TAP processo At the end of the process the fragment of interest will carry a CMV promoter and a SV40 terminator and is ready to be introduced into animals or cell by transfection. Groups were immunized with proteins and/or DNA, challenged i.c. with a lethal dose of live Bordetelfa pertussis and the survival was monitored. No groups were protected against the challenge. The recombinant protein HEP were also expressed in Lactobacilfus aiming the development of potential mucosal vaccines. The polyclonal antibodies produce in mouse immunized with DNA and protein Hep expressed in E. coli and Lactobacillus were able to inhibition the FHA hemagglutination activity.

La voie de sécrétion bactérienne de type V permet l’exportation à la surface cellulaire de protéines dont certaines ont été identifiées comme d’importants facteurs de la pathogénicité bactérienne. Le type V regroupe la sécrétion des autotransporteurs et la sécrétion à deux partenaires (TPS). Les autotransporteurs sont constitués d’un domaine en tonneau β; et d’un domaine passager. L’interaction de l’autotransporteur avec le complexe protéique Bam, dont la pièce centrale est le transporteur BamA, permet l’insertion dans la membrane externe du tonneau β; et la sécrétion du passager. En revanche, la sécrétion à deux partenaires fait intervenir deux protéines, l’une appelée TpsA correspondant à la protéine exportée et l’autre, TpsB, formant un tonneau β qui contrôle le transport à travers la membrane externe. Les protéines TpsB sont spécifiques à leur(s) TpsA associée(s), et font partie de la superfamille des transporteurs Omp85 qui effectuent l’insertion de protéines dans la membrane externe bactérienne comme BamA, et dans celles des organites eucaryotes dont les chloroplastes et les mitochondries. Au cours de mon doctorat, je me suis intéressé à la sécrétion de l’hémagglutinine filamenteuse (FHA), qui est l’adhésine majoritaire de Bordetella pertussis, l’agent étiologique de la coqueluche. Cette adhésine qui permet à la bactérie de coloniser le tractus respiratoire de l’hôte est une protéine TpsA de 220 kD. Elle est très efficacement sécrétée par la voie de sécrétion à deux partenaires grâce à son transporteur spécifique TpsB nommé FhaC. L’étude cristallographique de FhaC a révélé un tonneau β; à 16 brins qui forme un canal dans la membrane externe obstrué par l’hélice-α; amino-terminale, H1, partagée par la majorité des TpsB, et par une boucle de surface, L6, conservée dans la superfamille Omp85. Cette conformation suggère un état au repos dans lequel le canal bouché ne pourrait pas transporter son partenaire. Afin de comprendre comment la FHA transite à l’intérieur du pore, il est donc nécessaire de connaître les changements de conformations que subit FhaC. Durant mon travail de thèse, nous avons apporté une vision plus dynamique de la sécrétion à deux partenaires en utilisant le couple FHA/FhaC comme modèle d’étude. Pour cela nous avons utilisé principalement la Résonance Paramagnétique Electronique (RPE). Cette technique de biophysique permet d’étudier FhaC en solution ou réincorporée dans une bicouche lipidique et de rendre compte de la mobilité à un site donné par l’utilisation de sondes paramagnétiques. Ainsi nous avons pu montrer que FhaC est en équilibre entre plusieurs conformations, avec H1 dans le pore ou du côté périplasmique de FhaC. La présence de la FHA déplace cet équilibre, favorisant ainsi la sortie de l’hélice hors du pore. Nous avons, par ailleurs, pu démontrer expérimentalement que la FHA transitait bien à l’intérieur du pore formé par FhaC et que l’hélice H1 se trouvait alors dans le périplasme. L’étude de la boucle L6 nous a permis de montrer que la mobilité de cette boucle était fortement contrainte à l’intérieur du pore même lors de la reconnaissance avec la FHA. Ce ralentissement de mobilité est lié, en autre, à une interaction avec un résidu d’un motif conservé présent sur le brin β13 qui influence la taille du pore. De manière plus générale, cette étude de la dynamique de FhaC contribue à la compréhension des mécanismes moléculaires de la voie TPS et des transporteurs de la superfamille Omp85. / Type V secretion in bacteria mediates the export to the cell surface of proteins, some of which have been identified as important factors of pathogenicity. Type V includes the secretion of autotransporters and the ‘Two-partner Secretion’ (TPS) pathway. Autotransporters consist of a β barrel domain and a passenger domain. The interaction of autotransporters with the Bam complex, of which the BamA transporter is the central component, allows the insertion of the β; barrel in the outer membrane and the secretion of passenger domain. In contrast, the two-partner secretion involves two proteins, the exported ‘TpsA’ protein and its TpsB partner that controls its transport across the outer membrane. TpsB proteins are specific to their associated TpsA(s) and belong to the superfamily of the Omp85 transporters, which carry out the insertion of proteins into the bacterial outer membrane, like BamA, or in the outer membranes of eukaryotic organelles including chloroplasts and mitochondria. For my PhD work, I have been interested in the secretion of filamentous hemagglutinin (FHA), which is the major adhesin of Bordetella pertussis, the causative agent of whooping cough. This adhesin allows the colonization by this bacterium of its host’s respiratory tract. This protein corresponds to a 220kD TpsA protein efficiently secreted by its specific transporter TpsB named FhaC. Crystallographic studies have revealed that FhaC harbours a 16-stranded β;-barrel occluded by both the N-terminal α;-helix, H1, shared by the majority of TpsB proteins, and by a surface loop, L6, that carries a conserved, hallmark motif of the Omp85 superfamilly. This conformation suggests that FhaC is in a resting state in which the channel does not transport its partner. To understand how the FHA passes through the FhaC pore, it is necessary to address the conformational changes undergone by FhaC. During my thesis work, we provided a more dynamic view of the TPS pathway using the FHA/FhaC couple as study model. For this we used Electron Paramagnetic Resonance (EPR). This biophysical technique allows to study of FhaC in solution or reincorporated into a lipid bilayer and it reports the mobility at specific sites of the protein by using paramagnetic probes. Thus we have shown that FhaC is in equilibrium between multiple conformations, with H1 in the pore or at the periplasmic side of FhaC. The presence of FHA displaces the conformational equilibrium, promoting the exit of the helix going from the pore. We have also experimentally demonstrated that FHA does transit through the pore formed by FhaC while helix H1 is then in the periplasm. The study of the L6 loop enabled us to show that the mobility of this loop is highly constrained in the pore and remains so upon the recognition of FHA. Its slow mobility is linked to an interaction between an invariant L6 residue and a conserved motif present on the β; strand 13 of the barrel. This interaction affects the size of the FhaC pore.More generally, the study of the dynamics of FhaC contributes to the understanding the molecular mechanisms of the TPS pathway and of transporters of the Omp85 superfamily.

Le manuscrit constituant l'annexe 1 a été publié en décembre 2013 sous la référence : Vaccine. 2013 Dec 9;31(51):6087-91. / Contexte. La coqueluche est une infection endémique dont l’incidence, la morbidité et la mortalité restent élevées chez les nourrissons. Dans ce groupe d’âge, l’exposition à des adultes infectés est un facteur de risque d’infection reconnu. La méthode de cocooning est une stratégie efficace pour protéger indirectement les jeunes nourrissons, cependant, la couverture vaccinale des adultes reste faible. Le fait d’offrir la vaccination de rappel à la maternité augmente la couverture vaccinale des deux parents, comparativement aux structures communautaires. Compte tenu de la limitation des ressources dans le domaine de la santé, le caractère coût-efficace de cette stratégie doit être évalué. Le but est de réaliser une évaluation économique de cette méthode dans la réalité du Québec, car les analyses économiques sont difficilement transposables. Objectif. L’objectif principal de l’évaluation est de mener une analyse coût-efficacité de l’implantation de la stratégie du cocooning dans les maternités du Québec. Méthode. Un modèle statique et compartimental est développé pour représenter la dynamique de transmission et le fardeau de la coqueluche au sein d’une cohorte de 1000 familles avec un nouveau-né, avec ou sans l’immunisation des deux parents contre la coqueluche, à la maternité. La stratégie du cocooning est comparée à la situation actuelle qui tient lieu de référence. Le point de départ est la naissance de l’enfant et l’horizon temporel est dix ans. Les effets observés sont le nombre de cas de coqueluche, le nombre d’années de vie perdues et le nombre d’années de vie pondérées pour la qualité (QALY) perdues. Les ratios coût-efficacité incrémentaux sont présentés selon la perspective du système de soins de santé et selon celle de la société : les coûts du système de soins, les coûts pour les familles et la perte de productivité sont considérés. Tous les coûts sont ajustés pour la valeur du dollar canadien de 2012. Les effets et les coûts sont actualisés selon un taux annuel de 3%. Le modèle est élaboré avec le programme informatique Excel 2010. La valeur des paramètres introduits dans le modèle est extraite de données publiées, d’opinions d’experts et de l’étude pilote menée dans notre institution. Des analyses de sensibilité uni-variées et multi-variées sont réalisées pour tenir compte de l’incertitude. Résultats. L’analyse de base aboutit à une diminution de 10,5% du nombre de cas de coqueluche lors de l’application de la stratégie du cocooning, et de 19,1% des hospitalisations, 13,3% des séquelles neurologiques et 26,5% des décès liés à la coqueluche. Selon la perspective du système de soins de santé, le rapport coût-efficacité incrémental est de 34 941 CAD$/QALY gagné, et, de 16 945 CAD$/QALY gagné selon la perspective de la société. Les taux d’incidence des cas de coqueluche ont un impact substantiel sur le modèle comme le montrent les analyses de sensibilité uni-variée et multi-variées. Conclusion. L’implantation de la stratégie du cocooning dans les maternités du Québec augmentera probablement la couverture vaccinale des jeunes parents, et, est un programme potentiellement coût-efficace selon notre analyse de base. Les analyses de sensibilité multi-variées montrent que l’ICER obtenus est cependant très sensible aux taux d’incidence de la coqueluche. / Background. Pertussis disease remains endemic with persistence of peak incidence and highest morbidity and mortality among infants. Exposure to infected adults is a commonly reported risk factor for disease in children. The cocoon strategy is an effective indirect strategy to protect very young infants. However, reaching adults for vaccination is challenging. Unlike community settings, a cocoon strategy implemented in a maternity ward improved vaccine uptake among new parents. In the context of limited public resources, health and economic impact of this particular option has to be evaluated. As studies are hardly transposable, our intention was to evaluate this strategy in the context of the province of Quebec. Objective. Our main goal is to carry out a cost-effectiveness analysis of the implementation of a cocoon strategy in the maternity wards of the province of Quebec. Methods. A compartmental and static model is developed to represent the dynamic of transmission and burden of pertussis in a 1000-family cohort with a newborn baby, without or with vaccination of both parents at the time of delivery. The cocoon strategy is compared with the current situation, taken as the reference. The starting point is the birth of a child and the time horizon is 10 years. Outcomes of interest are pertussis disease cases, life-year losses and quality-adjusted life year (QALY) losses. Incremental cost-effectiveness ratios are presented in both a health care and societal perspectives: inclusion of health services costs, patients and caretaker costs and costs due to productivity losses. All costs are updated to 2012 CAD$. Human and financial costs are discounted to their present (birth) value using annual rates of 3%. The pseudo-Markov model is developed using Excel 2010 software. Parameters values are derived from published data, expert panel opinion and a pilot study conducted in our institution. One-way and multivariate sensitivity analyses are performed to take into account uncertainties in parameters values. Results. The base case analysis resulted in a 10,5% reduction in pertussis cases and in a 19,1%, 13,3% and 26,5% reduction in pertussis-related hospitalizations, neurologic sequalae and death, respectively. From a health care system perspective, the incremental cost-effectiveness ratio is 34 941 CAD$/ QALY gained and is 16 945 CAD$/QALY gained from a societal perspective. Incidence rates of pertussis cases have a substantial impact on the model as shown in one-way and multi-way sensitivity analysis. Conclusion. Hospital-based postpartum dTap immunization of both parents is likely to improve vaccine uptake among new parents and is a potential cost-effective strategy from both societal and health care system perspectives, according to our analysis. Multi-way sensitivity analysis show that ICER is highly sensitive to the pertussis incidence rate.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

A coqueluche é uma doença contagiosa, causada por Bordetella pertussis e B. parapertussis e as vacinas de células inteiras (WCPs) contra pertussis, embora eficazes, foram associadas a efeitos indesejáveis. Já as vacinas pertussis acelulares são menos reatogênicas, mas caras, o que as torna inviáveis para países em desenvolvimento. Nesse estudo, avaliamos a resposta imune induzida por uma vacina pertussis celular com menor teor de LOS (Plow), desenvolvida pelo Instituto Butantan. Para isso, camundongos C57BL-6 foram imunizados com WCP tradicional ou Plow, formulada com MPL-A de B. pertussis ou com Hidróxido de Alumínio e vacinas tríplice bacterianas com componente pertussis acelular, Pertacel ou Adacel. Após o esquema de imunização, foi avaliada a resposta imune humoral e celular contra a B. pertussis, e B. parapertussis, além de resposta inata a um antígeno não relacionado, BCG. Ensaio de transmissão também foi realizado, após desafio com B. pertussis ou B. parapertussis. Nossos resultados consolidam a avaliação da resposta imune humoral e celular induzida pela Plow, além de apresentar resultados bastante interessantes relativos à atividade da Plow na diminuição da transmissão bacteriana, tanto de pertussis quanto de parapertussis. / Bordetella pertussis and B. parapertussis are the causative agents of whooping cough. Whole cell pertussis (wPs) vaccines, although effective, were associated with undesirable effects. On the other hand, aP vaccines are less reactogenic, but expensive, which made their use unable for developing countries. In this study, we assessed the immunological response, induced by a whole cell pertussis vaccine with low LOS content (Plow), developed by Instituto Butantan. To this, C57BL-6 mice were immunized with traditional whole cell pertussis vaccine or Plow, administrated with Monophosporil lipid A from B.pertussis or Aluminum hydroxide, and diphtheria-tetanus-acellular pertussis vaccines, Pertacel or Adacel. After the immunization scheme, were evaluated humoral and cellular immune responses against B. pertussis and B. parapertussis, in addition to innate response to an unrelated antigen, BCG. Transmission assay was also performed, after B. pertussis or B. parapertussis challenge. Our results consolidated the immune humoral and cellular responses induced by Plow, besides interesting results with regards the efficacy of the vaccine in decreasing the transmission of B. pertussis and B. parapertussis in mice.

A proteína Cpn60 faz parte de um grupo de proteínas altamente conservadas que estão envolvidas em funções celulares essenciais. camundongos BALB\\c foram imunizados com 5 ou 10 µg da proteína recombinante (Cpn60r) sozinha ou adicionada à vacina DTP sem hidróxido de alumínio (NADTP). A vacina DTP do Instituto Butantan (DTP) foi usada como controle. Foi avaliada a produção de citocinas por células esplênicas após reestímulo in vitro com a Cpn60r. Os animais foram desafiados após o protocolo de imunização. A Cpn60r sozinha ou misturada à vacina NADTP foi capaz de induzir níveis de anticorpos contra pertussis mais altos do que os induzidos pela DTP. Os níveis de IgG1 e IgG2a foram similares para todos os grupos. Pôde-se observar a produção de de IL-6 e IFN-&#947 nos grupos imunizados com Cpn60r. Os grupos imunizados com Cpn60r+NADTP apresentaram um índice de proteção entre 60 e 80% contra o desafio pela bactéria virulenta, semelhante ao grupo imunizado com DTP. A proteína Cpn60r é bastante promissora não somente como imunógeno, mas também como adjuvante. / The Cpn60 protein is a member of a group of higly conserved proteins linked to essencial cell functions. The Cpn60 was cloned, expressed and its immune response has been evaluated. BALB\\c mice were immunized with 5 or 10 µg of the recombinant protein (Cpn60r) alone or mixed with DPT vaccine without aluminum hidroxyde (NADPT). The DPT vaccine from Instituto Butantan was used as control. We evaluated the cytokines production by spleen cells after they have been reestimulated in vitro with Cpn60r. The animals were challenged after the immunization protocol. The Cpn60r alone or mixed with NADPT vaccine was able to induce higher antibodies levels than DPT. IgG1 and IgG2a levels were similar in all groups. We could detect levels of IL-6 and IFN-&#947 on groups immunized with Cpn60r. The groups immunized with Cpn60r+NADTP showed a 60 and 80% protection rate against the challenge with the live bacteria, similar to the group immunized with DPT. These results show the immune response of the recombinant protein that could be included in immunization protocols for pertussis.

A coqueluche vem reemergindo enquanto importante problema de saúde pública em vários países do mundo, apesar das altas coberturas vacinais na infância. O objetivo geral deste estudo foi avaliar a morbimortalidade da coqueluche no Brasil e os objetivos específicos foram: estimar as taxas de mortalidade, incidência e letalidade anuais, geral e por faixa etária, por unidade da federação e regiões do país; caracterizar a sazonalidade da doença; estimar as taxas de hospitalização anuais por faixa etária e verificar as características clínicas, histórico de contato e vacinação prévia dos casos notificados da doença. Métodos: estudo descritivo, baseado nos casos de coqueluche notificados ao Sistema de Informação de Agravos de Notificação (SINAN), de 2006 a 2013. Os resultados mostraram aumento nas taxas de incidência de coqueluche no Brasil, a partir de 2011. Em 2013, foram confirmados 6.523 casos de coqueluche no país, três vezes o número de casos confirmados em 2011, com incidência geral de 3,24 /100.000 habitantes e incidência em menores de um ano de 125,82/100.000 habitantes, as maiores durante o período estudado. As crianças menores de um ano foram as mais acometidas pela doença em todas as macrorregiões. Em 2013, todas as regiões, exceto a região sul, apresentaram suas maiores taxas de incidência geral, com destaque para as regiões sudeste e centro-oeste com 4,0 e 3,1 por 100.000 habitantes, respectivamente. As maiores taxas de letalidade foram observadas na faixa etária menor de dois meses de idade, variando de 4,0% (2008) a 9,5% (2010). As taxas de letalidade foram maiores em crianças menores de seis meses em todas as regiões, sendo as regiões nordeste e sudeste as que apresentaram maiores taxas ao longo dos anos, exceto em 2013, quando o centro-oeste superou o nordeste. Houve predomínio dos casos nos meses mais quentes, entre novembro e março. A maioria das hospitalizações ocorreu na faixa etária de menores de um ano, principalmente em menores de quatro meses, cuja frequência de hospitalização ficou em torno de 75%. A tosse e o paroxismo foram os sintomas mais frequentes, independente da faixa etária, e a cianose foi importante sintoma nos menores de dois meses, com uma frequência de 80% nos casos confirmados desta faixa etária. A complicação mais comum foi pneumonia (13,93%), principalmente na faixa etária menor de dois meses, com frequência de 27,5%. O critério mais utilizado para diagnóstico de coqueluche foi o clínico, seguido pelo laboratorial que aumentou a partir de 2011, ano em que foi responsável por 49,9% dos diagnósticos. A maioria dos casos confirmados (51%) não relatou contato prévio com casos suspeitos ou confirmados de coqueluche, no entanto quando presente, a maioria dos contatos ocorreu no domicílio (70,6%). Os resultados mostraram aumento dos casos de coqueluche no Brasil, a partir de 2011, com as maiores taxas de incidência, hospitalizações, complicações e letalidade na faixa etária de menores de um ano / Pertussis has reemerged as important public health problem in many countries, despite the high childhood vaccination coverage. The general aim of this study was to evaluate the morbimortality of pertussis in Brazil, and the specific objectives were: estimate the annual mortality, incidence and case-fatality rates, general and by age group, by federative units and country\'s regions; evaluate the disease seasonality; estimate the annual hospitalization rates by age group and verify the clinical characteristics, contact history and the previous vaccination status of the reported pertussis cases. Methods: Descriptive study, based on the pertussis cases reported to the Notifiable Diseases Information System (SINAN), from 2006 to 2013. In 2013, there were 6.523 confirmed pertussis cases in the country, three times the number of confirmed cases in 2011, with general incidence of 3.24/100,000 inhabitants, and incidence in children under one year of age of 125.82/100,000 inhabitants, the highest during the study period. Pertussis incidence rates were higher in children under one year old in all macroregions during the study. In 2013, higher general incidence rates were observed in all regions, except the south, particularly the southwest and Midwest with 4.0 and 3.1 per 100,000 inhabitants, respectively. The highest case-fatality rates were observed in infants under two months of age, varying from 4.0% (2008) to 9.5% (2010). Case-fatality rates were higher in children under six months in all regions; the northeast and southeast had the highest rates throughout the studied years, except in 2013, when the Midwest surpassed the northeast. More cases were reported in the warmer months, between November and March. Most hospitalizations occurred in the age group of children under one year old, mainly those under four months, for whom hospitalization rates were close to 75%. Cough and paroxysm were the most frequently symptoms, regardless of age, and cyanosis was important in children under two months, occurring in 80% of confirmed cases in this age group. The most common complication was pneumonia (13.93%), mainly in children under two months of age (27.5%). Clinical criteria were most frequent used for diagnosis, followed by laboratory, which increased since 2011, when 49.9% of cases had laboratory-confirmed diagnosis. Most confirmed cases (51%) had no recognized previous contact with pertussis cases. Among those with recognized previous contact, it mostly occurred at residence (70.6%).The results showed an increase in pertussis cases in Brazil, since 2011, with the highest incidence and lethality rates in children under one year of age