Recentemente, estudos têm associado a presença de vírus da família herpesviridae à doença periodontal, os quais poderiam estar envolvidos na ocorrência e progressão de diferentes formas da doença periodontal, através da supressão do sistema imune do periodonto, liberação de citotoxinas, mediadores pró-inflamatórios, o que poderia favorecer o crescimento subgengival de microrganismos. Neste estudo, testamos a hipótese de que a prevalência do herpes vírus na placa subgengival de pacientes com gengivite é igual a de pacientes portadores de periodontite crônica. Desse modo, o presente estudo teve como objetivo determinar a presença dos vírus Herpes simples vírus tipo 1 (HSV-1), Citomegalovírus (HCMV) e Epstein-Barr vírus tipo 1 (EBV-1), relacionando-os com a presença de bactérias periodontopatogênicas como: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) e Dialister pneumosintes (Dp) em amostras de placa subgengival, coletadas de 30 pacientes portadores de periodontite crônica (grupo PC), 30 pacientes com gengivite (grupo G) e 30 indivíduos periodontalmente saudáveis (grupo C). Foram coletadas quatro amostras de placa subgengival do sítio mais profundo de cada quadrante nos pacientes do grupo PC e nos pacientes do grupo G e C, um sítio aleatório de cada quadrante foi examinado. A detecção de espécies bacterianas e de herpes vírus na placa subgengival dos grupos foi realizada por PCR e Nested PCR, respectivamente. A análise estatística mostrou que o HCMV foi detectado com freqüência similar nos três grupos estudados e que houve uma maior prevalência do HSV-1, EBV-1 e P. intermedia nos pacientes com periodonite crônica e gengivite em relação ao grupo controle. Houve associação da periodontite crônica com o EBV-1 e as cinco bactérias estudadas, além da associação entre os vírus (EBV-1+ HCMV; EBV-1 + HSV-1; HSV-1 + HCMV) e entre vírus e bactérias (EBV-1+ P.intermedia, EBV-1 + P. gingivalis; HCMV + T. forsythia; HCMV + A. actinomycetemcomitans; HSV-1 + T. forsythia; HSV-1 + P. gingivalis). / Recently, studies have linked the presence of the virus family herpesviridae and periodontal disease, which may be involved in the occurrence and progression of different forms of periodontal disease through the suppression of the immune system of the periodontium, release of cytotoxins, pro-inflammatory mediators and immunopathological events, may promote growth of subgingival microorganisms. In this study, we tested the hypothesis that the prevalence of herpes virus in sub-gingival plaque of patients with gingivitis is equal to patients with chronic periodontitis. Thus, this study aimed to determine the presence of the virus Herpes simplex virus type 1 (HSV-1), Cytomegalovirus (HCMV) and Epstein-Barr virus type 1 (EBV-1), relating to the presence of bacteria as periodontopathogens: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) and Dialister pneumosintes (Dp) in subgingival plaque samples collected from 30 patients with chronic periodontitis (CP group), 30 patients with gingivitis (group G) and 30 periodontally healthy subjects (group C). We collected four samples of subgingival plaque from the deepest site in each quadrant and in the PC group and patients in group C and G, a random site in each quadrant was examined. The detection of bacterial species and herpes virus in subgingival plaque of the groups were identified by PCR and nested PCR respectively. Statistical analysis showed that HCMV was detected with a similar frequency among the three groups and significant difference in prevalence of HSV-1, EBV-1 and P. intermedia in patients with gingivitis in the control group. The chronic periodontitis was associated with EBV-1 and the five bacteria studied, and the association of the virus (EBV-1 + HCMV, EBV-1 + HSV-1, HSV-1 + HCMV) and between viruses and bacteria (EBV-1+ P.intermedia, EBV-1 + P. gingivalis; HCMV + T. forsythia; HCMV + A. actinomycetemcomitans, HSV-1 + T. forsythia; HSV-1 + P. gingivalis).

A fim de prevenir a rejeição do órgão transplantado pelo hospedeiro, se faz necessário o uso de drogas imunossupressoras, como a ciclosporina, que pode levar ao aparecimento de efeitos colaterais como hipertensão arterial, nefrotoxicidade, hepatotoxicidade, e hiperplasia gengival medicamentosa (HGM), que pode ser potencializada se bloqueadores de canal de cálcio como a nifedipina forem associados a fim de controlar a pressão arterial. A patogênese da HGM ainda é incerta, entretanto fatores como a presença de cálculo e placa, concentração plasmática da droga, idade e fatores hormonais podem influenciar as características clínicas e o desenvolvimento da HGM. Recentemente, alguns vírus têm sido associados com a HGM. O HPV (Papiloma Vírus Humano) tem sido associado com casos severos de HGM, enquanto que o EBV (Vírus Epstein-Barr) é associado ao aparecimento de desordens linfoproliferativas pós transplante, que se apresentam como HGM. O objetivo deste trabalho foi avaliar a freqüência e o grau da HGM em pacientes transplantados renais (TR), identificar o EBV e HPV na HGM destes pacientes, e correlacionar a HGM, índice de placa, presença de cálculo e presença do EBV e HPV nos pacientes TR. Foram examinados os prontuários de 58 pacientes TR atendidos no CAPEFOUSP, e os dados com relação à medicação imunossupressora em uso e presença ou ausência de HGM foram registrados. Foram contatados 15 pacientes TR, dos quais foram colhidos dados demográficos, história médica, drogas em uso e história dental. No exame intra-oral foram observados o índice de placa, grau da HGM e presença de cálculo. A HGM foi removida e enviada a Disciplina de Patologia Bucal para análise microscópica. Os espécimes removidos foram comparados com um grupo controle composto por 20 casos de hiperplasia gengival inflamatória. Ambos os grupos foram submetidos ao exame de rotina, enfatizando a presença de coilócitos e a análise molecular, com hibridização in situ para o EBV (sondas EBER e Lytic) e HPV (sonda de amplo espectro e tipos 6/11, 16/18 e 31/33 nos casos positivos para a sonda de amplo espectro). 42% dos pacientes apresentaram HGM grau 1, 50% grau 2 e 8% grau 3. Cálculo estava presente em 50% dos pacientes. O índice de placa médio encontrado foi de 72%. Todas as amostras gengivais removidas cirurgicamente apresentaram um quadro histopatológico compatível com HGM. Os coilócitos estavam presentes em 100% dos casos do grupo de estudo e em 80% dos casos do grupo controle. O HPV esteve presente em 20% dos casos do grupo de estudo e em 10% do grupo controle. O EBV estava presente em 100% dos casos do grupo de estudo e em 90% dos casos do grupo controle, para ambas as sondas, entretanto no grupo de estudo foi observada uma expressão maior do EBV, tanto em quantidade de células marcadas, como em áreas mais profundas. Concluímos que a maioria dos pacientes TR apresentou HGM leve a moderada; EBV foi encontrado em todos os pacientes TR, caracterizando uma infecção oportunista, enquanto que o HPV foi encontrado nas mesmas proporções nos pacientes TR e no grupo controle; não foi encontrada correlação entre índice da HGM, índoce de placa, presença de cálculo e presença do EBV e HPV. / In order to prevent graft rejection in organ transplantation, is necessary the use of immunosuppressive drugs, as cyclosporin, that has several side effects, such as high blood pressure, nephrotoxicity, hepatotoxicity and gingival overgrowth (GO), that can be increased if calcium channel blockers, such as nifedipine, are associated in order to control de blood pressure. The pathogenesis of GO is still uncertain, but some factors such as the presence of calculus and plaque, drug plasmatic concentration, age and hormonal factors can influence the clinical aspects and development of GO. Recently some virus have been associated to GO as well. HPV (Human Papilloma Virus) have been associated to severe cases of GO and EBV (Epstein-Barr Virus) have been associated to posttransplantation lymphoproliferative disorders presenting as GO. The aim of this work was to evaluate GO incidence and score in renal transplant patients (RTP), identify EBV and HPV in GO from RTP, and correlate GO, plaque score, presence of calculus, and presence of EBV and HPV in RTP. We reviewed 58 charts from RTP attending to Special Care Dentistry Center (CAPE-FOUSP). Immunosuppressant drugs and presence or absence of GO were registered. 15 RTP were asked to show up in order to be examined. We collected demographic data, medical history, drugs in use and dental history. In intra-oral exam we observed plaque score, GO score and presence of calculus. GO were removed and sent to Oral Pathology Department for microscopic analysis. GO was compared to a control group composed by 20 cases of inflammatory gingival hyperplasia and both groups were submitted to routine exam emphasizing the presence of koilocytes and to molecular analysis with in situ hybridization for EBV (EBER and Lytic probes) and for HPV (wide spectrum probe and 6/11, 16/18, 31/33 types in cases where wide spectrum were positive). 42% of the patients presented GO score 1, 50% score 2 and 8% score 3. Calculus were presented in 50% of the patients. The average of plaque score was 72%.All GO specimens removed had a histopathological exam compatible with drug induced gingival overgrowth. Koilocytes were presented in 100% of study group (SG) and in 80% of control group (CG). HPV were presented in 20% of the SG and in 10% of the CG. EBV was presented in 100% of SG and in 90% of CG, for both probes, but in SG it could be observed in deeper areas of the epithelium and in a more pronounced expression. We concluded that most RTP presented mild to moderate GO, EBV were found in all RTP, characterizing an opportunistic infection, while HPV were found in the same proportions than in the control group and there were no statistical correlation between GO, plaque score, presence of calculus and presence of EBV and HPV.

O vírus Epstein-Barr (EBV) é um herpes vírus humano que estabelece infecção persistente e está associado com várias doenças, como mononucleose infecciosa, linfomas, carcinoma de nasofaringe e leucoplasia pilosa, afetando principalmente pacientes imunossuprimidos. Leucoplasia pilosa é uma lesão epitelial não maligna associada ao EBV que ocorre principalmente nas bordas laterais de língua. É comum em indivíduos infectados pelo HIV e em pacientes que recebem medicações imunossupressoras. Histopatologicamente, a leucoplasia pilosa é caracterizada por hiperparaqueratose, acantose, células semelhantes a coilócitos ou células balonizantes, e discreto ou nenhum infiltrado inflamatório. As características histopatológicas da lesão não são patognomônicas, sendo necessária a detecção do EBV para o diagnóstico final de acordo com vários autores. O objetivo desse estudo foi verificar a presença do EBV, por meio da técnica de hibridização in situ, em lesões diagnosticadas histológicamente como sugestivas de leucoplasia pilosa e comparar esses resultados com algumas características histopatológicas.Trinta e seis espécimes foram selecionados do Serviço de Patologia Cirúrgica da Disciplina de Patologia Bucal. Todos foram submetidos à reação de hibridização in situ, e 27 casos (75%) foram positivos, confirmando o diagnóstico anterior. Nenhuma das características histológicas analisadas puderam se correlacionar com a hibridização in situ. Pudemos concluir que a análise histopatológica ao H&E não pode substituir a hibridização in situ no diagnóstico final da leucoplasia pilosa / Epstein-Barr virus (EBV) is a human herpesvirus that estabilishes persistent infection and is associated with many diseases, including infectious mononucleosis syndrome, lymphomas, nasopharyngeal carcinoma, and oral hairy leukoplakia, affecting principaly immunocompromised patients. Oral hairy leukoplakia is a non malignant, EBV-associated, epithelial disease that typically occurs on the lateral tongue borders. It is common in individuals with HIV infection and in patients receiving iatrogenic immunossupression. Histologically, hairy leukoplakia is characterized by shaggy hyperparakeratosis, acanthosis, “koilocyte”-like or ballon cells, and a paucity of inflamation. The histologically features of hairy leukoplakia are not patognomonic, and for the many authors definitive diagnosis requires demonstration of EBV. The aim of this study were to verify the presence of EBV, by in situ hibridization, in lesions diagnosed histologically suggestive of hairy leukoplakia and compare this results with histologically features. Thirty six biopsy specimens from lesions histologically suggestive of hairy leukoplakia were selected from the Department of Stomatology’s Oral Pathology Service archives. EBV in situ hibridization was performed on all 36 cases, and 27 cases (75%) were positive, confirmed the diagnose of oral hairy leukoplakia. Histopatologically features did not agree well with EBV in situ hibridization. We concluded that H&E histopathology should not be used as a substitute for in situ hibridization in the definitive diagnosis of hairy leukoplakia

O Epstein-Barr Vírus (EBV) é um vírus da família Herpes (HHV-4), presente em grande parte da população mundial. É o agente etiológico da mononucleose infecciosa e da leucoplasia pilosa. A leucoplasia pilosa é uma doença epitelial benigna associada ao EBV, caracterizada pela reprodução replicativa do EBV nas células do epitélio oral, e é uma das mais freqüentes lesões oportunistas em pacientes HIV positivos, sendo menos freqüente apenas que a candidíase, com uma prevalência média entre 10 % e 30%. Por ser uma lesão oportunista bucal fortemente relacionada com a infecção pelo HIV e com a imunossupressão, seu diagnóstico é importante, pois pode sugerir o diagnóstico da infecção em pacientes de sorologia desconhecida para o HIV, e auxiliar no estadiamento da doença. Sua detecção e correto diagnóstico são de particular importância por essa condição estar relacionada à capacidade imune do paciente. Além disso, em pacientes já diagnosticados, ela é indicadora da progressão da doença e da eficácia da terapia antirretroviral. O objetivo desse estudo foi avaliar a presença e a quantidade do EBV na saliva e no sangue de pacientes infectados pelo HIV atendidos no CAPE-FOUSP, verificar a presença clínica de leucoplasia pilosa, estabelecendo a possibilidade da existência de vínculo entre a carga viral do EBV, a manifestação clínica da lesão e a carga viral do HIV. Também se buscou estabelecer relação entre o tipo de terapia antirretroviral em uso e a presença de leucoplasia pilosa, bem como estabelecer relação entre a carga viral do EBV na saliva e no sangue. Foram analisadas 20 lesões de leucoplasia pilosa, num total de 94 pacientes avaliados. Foi encontrada uma correlação positiva entre a Carga Viral do EBV no sangue e na saliva (p=0,001). Quanto maior a carga viral no sangue, maior a carga viral na saliva. Foi encontrada associação entre a Carga Viral do EBV na saliva e a presença de Leucoplasia Pilosa (p=0,045). Indivíduos com Leucoplasia Pilosa apresentam maior Carga Viral de EBV na saliva do que indivíduos sem essa lesão. Foi encontrada uma correlação positiva entre a Carga Viral do HIV e a Carga Viral do EBV na saliva (p=0,006) porém não no sangue. Quanto maior a carga viral de HIV, maior a carga viral do EBV na saliva. Foi encontrada correlação positiva entre a Carga Viral do EBV no sangue e as contagens de CD4 mais baixa registrada e a mais atual (p=0,028 e p=0,030 respectivamente). Quanto maior Carga Viral do EBV no sangue, maior a contagem de CD4. Não foi encontrada associação entre o tipo de medicação antirretroviral em uso e presença de lesão de leucoplasia pilosa. / The Epstein-Barr Virus (EBV) is a herpes virus family (HHV-4), is present in great part of the world population. It is the causative agent of infectious mononucleosis and oral hairy leukoplakia. Oral hairy leukoplakia is a benign epithelial disease associated with EBV, which is characterized by the replicative reproduction of EBV in oral epithelial cells, and is one of the most frequent opportunistic lesions in HIV positive patients, only less frequent than candidiasis, with an average prevalence between 10% and 30%. Being an opportunistic oral lesion strongly associated with HIV infection and immunosuppression, its diagnosis is important, because it may suggests the diagnosis of infection in patients of unknown HIV serology, and assist in the staging of the disease. Its detection and correct diagnosis are particularly important because this condition is related to the patient\'s immune capacity. Moreover, in patients already diagnosed, it is indicative of disease progression and effectiveness of antiretroviral therapy. The aim of this study was to evaluate the presence and quantity of EBV in saliva and blood of HIV-infected patients treated at the CAPE-FOUSP, verifying the presence of clinical OHL, establishing the possibility of the existence of a link between viral load and EBV, clinical manifestation of the lesion, and HIV viral load. It was also aimed to establish the relationship between the type of antiretroviral therapy in use and the presence of oral hairy leukoplakia, as well as establish the relationship between viral load of EBV in saliva and blood. We analyzed 20 lesions of oral hairy leukoplakia, a total of 94 patients. Found a positive correlation between viral load of EBV in blood and saliva (p = 0.001). The higher the viral load in blood, the higher the viral load in saliva. Association was found between viral load of EBV in saliva and the presence of oral hairy leukoplakia (p = 0.045).Individuals with oral hairy leukoplakia have a higher viral load of EBV in saliva than those without such injury. Found a positive correlation between viral load and HIV viral load of EBV in saliva (p = 0.006) but not in blood. The higher the viral load of HIV, the higher the viral load of EBV in saliva. A positive correlation was found between viral load of EBV in blood and CD4 counts the lowest recorded and most current (p = 0.028 and p = 0.030 respectively). The higher viral load of EBV in blood, increased CD4 count. No association was found between the type of antiretroviral medications in use and presence of oral hairy leukoplakia lesions.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / O cÃncer oral representa um sÃrio problema de saÃde pÃblica mundial. Entre os tumores deste sÃtio anatÃmico, os carcinomas de cÃlulas escamosas orais (CCEO) respondem por atà 94% do total. Os mecanismos moleculares envolvidos na gÃnese e desenvolvimento tumoral ainda nÃo estÃo completamente elucidados. Algumas evidÃncias tÃm sugerido a participaÃÃo viral neste processo. AlÃm disso, estes tumores ainda carecem de marcadores confiÃveis para determinar o perfil de agressividade. Neste contexto, o presente estudo teve como objetivo avaliar a expressÃo das proteÃnas p53, E-caderina, COX-2, p16, MLH1 e MYC numa sÃrie de CCEO, considerando tambÃm a marcaÃÃo citoplasmÃtica eventualmente observada para as Ãltimas trÃs proteÃnas, confrontando os resultados entre elas e com as caracterÃsticas demogrÃficas e clÃnico-patolÃgicas. AlÃm de avaliar a prevalÃncia do PapilomavÃrus Humano (HPV) e do VÃrus Epstein-Barr (EBV) na amostra e comparÃ-las com a expressÃo das referidas proteÃnas. Materiais e MÃtodos â Cem espÃcimes de CCEO, fixados em formalina e incluÃdos em blocos de parafina, foram submetidos à imunohistoquÃmica para a detecÃÃo das referidas proteÃnas e à hibridaÃÃo in situ para detecaÃà de HPV e EBV. Resultados â Foi observada associaÃÃo referente à perda de expressÃo concomitante de p16 e MLH1 (p=0,029) e na coexpressÃo de p53 e COX-2 (p=0,045). Ademais, foi verificado que a COX-2 e o MYC nuclear estavam relacionados com a marcaÃÃo citoplasmÃtica de MLH1 (p=0,060 e p=0,018; respectivamente). A anÃlise combinada dos marcadores revelou cinco grupos principais de expressÃo alterada que eram constituÃdos, em sua maioria, de tumores mais agressivos, principalmente o grupo MLH1(-)/COX-2(+)/p16(-). Os casos com marcaÃÃo citoplasmÃtica para p16, MLH1 e/ou MYC foram mais frequentes em tumores avanÃados (p=0,009) e naqueles com metÃstases em linfonodos (p=0,001). Trinta e um casos demonstraram marcaÃÃo para HPV em tecido tumoral. O EBV nÃo foi detectado em nenhum dos casos investigados, nem no tecido tumoral nem no epitÃlio nÃo neoplÃsico. O grupo HPV(+) exibiu elevada positividade para o p16 nuclear (p=0,029) e MYC cytoplasmÃtico (p=0,039), tambÃm uma maior perda de expressÃo nuclear de MLH1 (p=0,031). Houve ainda uma tendÃncia referente ao aumento da positividade de COX-2 no grupo infectado (p=0,084). ConclusÃes â As significÃncias verificadas entre p16 e MLH1 sugerem que a ausÃncia do membro do sistema de reparo de encaixe (MMR) tambÃm favoreÃa a ocorrÃncia de mutaÃÃes no gene p16, culminando na inativaÃÃo deste supressor tumoral. As associaÃÃes de COX-2 e MYC com o MLH1 de expressÃo citoplasmÃtica suscitam um mecanismo de bloqueio de entrada de MLH1 no nÃcleo. A anÃlise combinada das proteÃnas, bem como, a marcaÃÃo citoplasmÃtica de p16, MLH1 e MYC, podem representar indicadores Ãteis na avaliaÃÃo do perfil de agressividade e, provavelmente, de prognÃstico em CCEO. Acerca dos vÃrus, nossos achados sugerem que o HPV esteja envolvido em uma importante parcela de casos de CCEO e que possa promover a expressÃo de p16 nuclear, MYC citoplasmÃtico e COX-2, e suprimir a expressÃo nuclear de MLH1. Quanto ao EBV, nÃo foram detectados EBERs (EBV-encoded small RNAs) na amostra. / The oral cancer represents a serious world public health problem. The oral squamous cell carcinomas (OSCC) account for up to 94% of the tumors of this anatomic site. The molecular mechanisms involved in the genesis and progression are still not well elucidated. Some evidences have suggested the involvement of viruses in this process. Also, these tumors still lack of reliable markers to determine the aggressiveness profile. In this context, the aim of the present study was to evaluate the expression of the proteins p53, E-cadherin, COX-2, p16, MLH1 and MYC in a serie of OSCC, including the cytoplasmic staining eventually observed for the latter three proteins, confronting the results between them and with demographic and clinico-pathological features. Besides evaluating the prevalence of Human Papillomavirus (HPV) and Epstein-Barr virus (EBV) in the sample and compare them with the expression of the referred proteins. Materials and Methods â One hundred formalin-fixed paraffin-embedded OSCC specimens were submitted to immunohistochemistry for detection of the referred proteins, and to in situ hybridization for HPV and EBV detection. Results â OSCC was associated with a concomitant lack of expression of p16 and MLH1 (p=0.029) and coexpression of p53 and COX-2 (p=0.045). Additionally, COX-2 and nuclear MYC were found to be related to exclusively cytoplasmic staining of MLH1 (p=0.060 and p=0.018, respectively). The combination analyses of the markers revealed five main groups of altered protein expression, which were mostly of the more aggressive tumors, mainly the MLH1(-)/COX-2(+)/p16(-) group. The cases with cytoplasmic staining for p16, MLH1 and/or MYC were more frequent in advanced tumors (p=0.009) and in those with lymph node metastasis (p=0.001). Thirty-one cases showed staining for HPV in tumor tissue. The EBV was not detected in any case investigated, neither in the tumor tissue nor in the non-neoplastic epithelium. The HPV(+) group demonstrated high positivity for nuclear p16 (p=0,029) and cytoplasmic MYC (p=0,039), and an increase of the lack of MLH1 nuclear expression (p=0,031). There was also a trend related to the increase of the COX-2 positivity in the HPV(+) group (p=0,084). Conclusions â The significance between p16 and MLH1 suggests that the lack of this member of mismatch repair system also favors the occurrence of mutations in the p16 gene, culminating in inactivation of this tumor suppressor. The associations of COX-2 and MYC with cytoplasmic MLH1 suggest a blocking mechanism for the entry of MLH1 into the nucleus. The combined analyses of the proteins investigated, as well as the cytoplasmic staining of p16, MLH1 and MYC, may be useful in the evaluation of the aggressive profile and probably prognosis of OSCC. Regarding the viruses, our findings suggest that the HPV is involved in an important portion of OSCC cases and that may promote the expression of the nuclear p16, cytoplasmic MYC and COX-2, and suppress the nuclear expression of MLH1. About EBV, it was not detected the EBV-encoded small RNAs (EBERs) in the sample.

Recentemente, estudos têm associado a presença de vírus da família herpesviridae à doença periodontal, os quais poderiam estar envolvidos na ocorrência e progressão de diferentes formas da doença periodontal, através da supressão do sistema imune do periodonto, liberação de citotoxinas, mediadores pró-inflamatórios, o que poderia favorecer o crescimento subgengival de microrganismos. Neste estudo, testamos a hipótese de que a prevalência do herpes vírus na placa subgengival de pacientes com gengivite é igual a de pacientes portadores de periodontite crônica. Desse modo, o presente estudo teve como objetivo determinar a presença dos vírus Herpes simples vírus tipo 1 (HSV-1), Citomegalovírus (HCMV) e Epstein-Barr vírus tipo 1 (EBV-1), relacionando-os com a presença de bactérias periodontopatogênicas como: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) e Dialister pneumosintes (Dp) em amostras de placa subgengival, coletadas de 30 pacientes portadores de periodontite crônica (grupo PC), 30 pacientes com gengivite (grupo G) e 30 indivíduos periodontalmente saudáveis (grupo C). Foram coletadas quatro amostras de placa subgengival do sítio mais profundo de cada quadrante nos pacientes do grupo PC e nos pacientes do grupo G e C, um sítio aleatório de cada quadrante foi examinado. A detecção de espécies bacterianas e de herpes vírus na placa subgengival dos grupos foi realizada por PCR e Nested PCR, respectivamente. A análise estatística mostrou que o HCMV foi detectado com freqüência similar nos três grupos estudados e que houve uma maior prevalência do HSV-1, EBV-1 e P. intermedia nos pacientes com periodonite crônica e gengivite em relação ao grupo controle. Houve associação da periodontite crônica com o EBV-1 e as cinco bactérias estudadas, além da associação entre os vírus (EBV-1+ HCMV; EBV-1 + HSV-1; HSV-1 + HCMV) e entre vírus e bactérias (EBV-1+ P.intermedia, EBV-1 + P. gingivalis; HCMV + T. forsythia; HCMV + A. actinomycetemcomitans; HSV-1 + T. forsythia; HSV-1 + P. gingivalis). / Recently, studies have linked the presence of the virus family herpesviridae and periodontal disease, which may be involved in the occurrence and progression of different forms of periodontal disease through the suppression of the immune system of the periodontium, release of cytotoxins, pro-inflammatory mediators and immunopathological events, may promote growth of subgingival microorganisms. In this study, we tested the hypothesis that the prevalence of herpes virus in sub-gingival plaque of patients with gingivitis is equal to patients with chronic periodontitis. Thus, this study aimed to determine the presence of the virus Herpes simplex virus type 1 (HSV-1), Cytomegalovirus (HCMV) and Epstein-Barr virus type 1 (EBV-1), relating to the presence of bacteria as periodontopathogens: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythia (Tf) and Dialister pneumosintes (Dp) in subgingival plaque samples collected from 30 patients with chronic periodontitis (CP group), 30 patients with gingivitis (group G) and 30 periodontally healthy subjects (group C). We collected four samples of subgingival plaque from the deepest site in each quadrant and in the PC group and patients in group C and G, a random site in each quadrant was examined. The detection of bacterial species and herpes virus in subgingival plaque of the groups were identified by PCR and nested PCR respectively. Statistical analysis showed that HCMV was detected with a similar frequency among the three groups and significant difference in prevalence of HSV-1, EBV-1 and P. intermedia in patients with gingivitis in the control group. The chronic periodontitis was associated with EBV-1 and the five bacteria studied, and the association of the virus (EBV-1 + HCMV, EBV-1 + HSV-1, HSV-1 + HCMV) and between viruses and bacteria (EBV-1+ P.intermedia, EBV-1 + P. gingivalis; HCMV + T. forsythia; HCMV + A. actinomycetemcomitans, HSV-1 + T. forsythia; HSV-1 + P. gingivalis).

Les cellules Invariant Natural Killer T (iNKT) représentent une sous-population particulière de cellules T qui se distingue par son développement, ses fonctions et les ligands qu’elle reconnaît. Chez l’homme, les cellules iNKT expriment le réarrangement Vα24-Jα18/Vβ11 et reconnaissent des glycosphingolipides présentés par la molécule monomorphe du CMH de classe I CD1d. De plus, elles produisent rapidement de grandes quantités de cytokines, et sont ainsi considérées comme des cellules T ayant des caractéristiques innées. Les mécanismes moléculaires qui régulent l’homéostasie descellules iNKT ne sont pas complètement compris. La protéine XIAP (X-linked Inhibitor of Apoptosis) est un inhibiteur physiologique des caspases 3, 7 et 9. Des mutations du gène XIAP sont à l’origine du syndrome lymphoprolifératif lié à l’X de type 2 (XLP-2), un déficit immunitaire primitif (DIP) caractérisé par une susceptibilité accrue à l’infection par le virus Epstein Barr (EBV). Les patients souffrant du XLP-2 présentent une forte réduction de leur nombre de cellules iNKT dans le sang. Au cours de mon travail de thèse, j’ai montré que XIAP est requis pour la survie des cellules iNKT humaines. Cette fonction de XIAP corrèle avec un phénotype pro-apoptotique des cellules iNKT qui n’est pas retrouvé dans les cellules T conventionnelles. La susceptibilité accrue à l’apoptose des cellules iNKT est observée en utilisant des stimuli de la voie intrinsèque ou extrinsèque de l’apoptose. Les cellules iNKT, contrairement aux cellules T conventionnelles expriment des quantités élevées de protéines pro-apoptotiques comme les caspases 3 ou 7 ou Bid. Ce phénotype proapoptotique est acquis de manière précoce, puisqu’il est déjà présent dans des cellules iNKT de thymus ou de sang de cordon. L’extinction de XIAP dans des cellules iNKT et l’analyse de patients déficients en XIAP indiquent que XIAP est un inhibiteur efficace de l’apoptose dans les cellules iNKT alors qu’il n’a qu’un effet modéré dans les cellules T conventionnelles. J’ai ensuite montré que le phénotype pro-apoptotique des cellules iNKT est dépendant de l’expression du facteur de transcription PLZF. Celui-ci est déjà connu comme étant nécessaire à l’acquisition des fonctions effectrices de cescellules. De manière concordante, la surexpression de PLZF dans des cellules T conventionnelles conduit à un phénotype pro-apoptotique et à une augmentation de l’expression de la caspase 3. Récemment, une deuxième population de cellules T invariantes, les cellules MAIT (Mucosal Associated Invariant T) a été décrite. Ces cellules expriment un TCR semi-invariant Vα7.2-Jα33 et partagent avec les cellules iNKT certaines caractéristiques qui en font des cellules T innées comme les cellules iNKT. De la même manière que les cellules iNKT, les cellules MAIT ont un phénotype proapoptotiqueet sont diminuées dans le sang des patients déficients en XIAP. Ce phénotype proapoptotique est aussi dépendant de PLZF. De manière intéressante, un patient déficient en XIAP et ayant un nombre normal de cellules iNKT a été identifié. Ce patient n’a pas encore rencontré l’EBV, suggérant que la diminution des cellules iNKT chez les patients déficients en XIAP est due à une apoptose augmentée dans un contexte d’infection par l’EBV. Enfin, j’ai obtenu des données préliminaires suggérant que l’EBV utilise un mécanisme d’échappement aux cellules iNKT en diminuant l’expression de CD1d à la surface des cellules B. Mon travail de thèse a donc permis d’identifier une voie de régulation inconnue des lymphocytes T innés qui dépend de XIAP et de PLZF. PLZF est donc un facteur clé pour la différentiation et l’homéostasie des cellules T innées en régulant l’acquisition de leurs fonctions effectrices et en limitant leur survie. Ces observations ont aussi permis d’identifier le premier DIP associé à un déficit en cellules MAIT. Enfin, ces résultats suggèrent un rôle des cellules iNKT dans le contrôle de l’infection par l’EBV. / Invariant natural killer T (iNKT) lymphocytes represent a peculiar T cell-lineage that differs from conventional T cells by its development, function, and ligands it recognizes. In humans, iNKT cells express an invariant TCR made of the V?24-J?18/V?11 rearrangement, which recognizes glycosphingolipids presented by the MHC class I monomorphic molecule CD1d. Moreover, they rapidly produce high amounts of cytokines when stimulated and are thus considered as innate-like T cells. The molecular mechanisms that control the homeostasis of iNKT are poorly understood. XIAP (X-linked Inhibitor of Apoptosis) is a physiological inhibitor of caspases 3, 7 and 9 and is mutated in the X-linked lymphoproliferation syndrome 2 (XLP-2), a rare primary immunodeficiency (PID) characterized by a peculiar susceptibility to Epstein-Barr virus (EBV) infection. Patients with a XIAP deficiency exhibit a strong reduction of their iNKT cells in blood. Here, I report that XIAP is required for the survival of iNKT cells in humans. The requirement of XIAP correlates with a pro-apoptotic phenotype of iNKT cells that is not observed in conventional T cells. The increased susceptibility to apoptosis of iNKT cells was observed upon stimuli that trigger either extrinsic or intrinsic apoptosis pathways. iNKT cells by contrast to conventional T cells express elevated amounts of pro-apoptotic molecules including caspases 3 or 7 and Bid. The pro-apoptotic phenotype of iNKT cells is early acquired since iNKT cells from cord blood and thymus display a similar pro-apoptotic phenotype. Knock-down of XIAP in iNKT cells and analysis of XIAP-deficient humans indicate that XIAP is a potent inhibitor of apoptosis in iNKT cells while it has only a moderate effect in conventional T cells. I also show that this pro-apoptotic phenotype of iNKT cells is dependent of the expression of the transcription factor PLZF. This factor is already known to be necessary for the acquisition of the effector functions of these cells. Conversely, over expression of PLZF in conventional T cells leads to a pro-apoptotic phenotype and to an increased expression of caspase 3. Recently, a second invariant T cell subpopulation, the mucosal associated invariant T (MAIT) cells was identified both in humans and mice. These cells express a semi-invariant TCR made of V?7.2-J?33 rearrangements and share with iNKT cells a number of developmental, functional and phenotypical features that lead to consider MAIT cells as innate-like T cells like iNKT cells. Similarly, MAIT cells also exhibit a pro-apoptotic phenotype and are decreased in XIAP-deficient humans. The pro-apoptotic phenotype of MAIT cells is also dependent on PLZF. Interestingly, one XIAP-deficient patient with normal iNKT cell number was identified. This patient has not yet encountered EBV, suggesting that reduction of iNKT cells in XIAP-deficient patients is likely due to increased apoptosis in the context of EBV infection. I also show that EBV might have an escape mechanism from iNKT cells by down-regulating the expression of CD1d on the surface of B cells. My thesis works identify a previously unknown pathway controlling innate T cell homeostasis depending on XIAP and PLZF. PLZF is thus a key factor involved in the differentiation and the homeostasis of innate T cells by regulating the acquisition of their effector functions and their survival. I also identified the first PID associated with a defect in MAIT cells. Finally, these results provide evidences that iNKT cells might play a role against EBV infection.

Die Entstehung verschiedener Tumorentitäten kann häufig mit einer vorliegenden Virusinfektion korreliert werden. So lässt sich beispielsweise ein Zusammenhang zwischen der Infektion mit den zur Gruppe der Herpesviren gehörenden Epstein-Barr-Viren (EBV) und der Entwicklung von Burkitt-Lymphomen, Hodgkin-Lymphomen sowie Nasopharynx-Karzinomen herstellen. Für die Transformation einer mit EBV infizierten humanen B-Zelle ist die Expression des Latenten Membranproteins 1 (LMP1) des Epstein-Barr-Virus essentiell. LMP1 ist ein Membranprotein mit einem funktionellen C-terminus, das Homologien zu den Tumornekrosefaktoren (TNF)- und Toll-like-Rezeptoren aufweist. Im Zusammenspiel mit anderen viralen Faktoren trägt LMP1 durch die von ihm aktivierten Signalwege (z.B. NF-κB, JNK, p38) zur Immortalisierung und malignen Entartung von EBV-infizierten Zellen bei. Einer dieser Signalwege ist der Jak/STAT-Signalweg. Da dessen EBV-abhängige Aktivierung bislang nur unzureichend geklärt ist, ist es Zielsetzung dieser Arbeit, die durch das Epstein-Barr-Virus vermittelte Aktivierung des Jak/STAT-Signalweges in Burkitt-Lymphomzellen näher zu untersuchen. Als Negativregulatoren des Jak/STAT-Signalweges sind hierbei die SOCS-Moleküle (Suppressor of Cytokine Signaling) von Bedeutung. Von besonderem Interesse sind dabei die Mechanismen der Aktivierung von SOCS3 durch LMP1 und dem damit verbundenen möglichen Einfluss auf den transformierten Zustand einer Zelle. In dieser Arbeit konnte gezeigt werden, dass in den untersuchten Burkitt-Lymphomzellen das exprimierte virale Onkoprotein LMP1 des Epstein-Barr-Virus ausreichend ist, den Jak/STAT-Signalweg zu aktivieren und SOCS3 zu induzieren. Die Aktivierung des Jak/STAT-Signalweges wird indirekt, das heißt über EBV-abhängig aktivierte Zytokinsignalwege, reguliert. Eine zusätzliche direkte Aktivierung durch eine Interaktion von Komponenten des Jak/STAT-Signalweges mit LMP1 kann derzeit jedoch nicht völlig ausgeschlossen werden.

Le virus d’Epstein-Barr (EBV) est le premier virus transformant à avoir été identifié chez l’Homme. Il infecte plus de 90% de la population adulte mondiale, persistant sous forme épisomale dans le compartiment B mémoire tout au long de la vie de l’hôte. Lors de la primo-infection et lors de phases de réactivation du virus, les cellules B immortalisées sont en programme de latence III, aussi appelée phase de prolifération, où l’ensemble des protéines de latence sont exprimées. Lorsque les hôtes sont immunocompétents, un équilibre entre hôte et virus s’établit et la plupart des cellules B infectées sont éliminées par le système immunitaire de l’hôte, principalement par les lymphocytes T cytotoxiques. En cas de déficit immunitaire, il peut y avoir émergence de lymphomes, tels que les désordres lymphoprolifératifs des patients immunodéprimés (PTLDs), les lymphomes non-Hodgkiniens (LNH) et Hodgkiniens (LH). Les travaux antérieurs du laboratoire ont permis de révéler que l’immuno-inhibiteur PD-L1/B7-H1/CD274 est surexprimé à la surface des lymphocytes B en latence III de l’EBV. L’interleukine-10 (IL-10) est également sécrétée par ces cellules. Ces caractéristiques sont communes aux cellules B régulatrices (Bregs). Le but de ma thèse était d’interroger les caractéristiques immuno-modulatrices des cellules B en latence III de l’EBV, dans le cadre des propriétés des Bregs. Nous montrons que les cellules B en latence III de l’EBV possèdent les déterminants antigéniques communs aux Bregs immatures (CD24High CD38High PD-L1High), associée à une surexpression des cytokines immunosuppressives cardinales des Bregs (IL-10, TGF-β1 et IL-35). Nous montrons que les cellules B en latence III de l’EBV peuvent conduire à la mort des cellules T CD4 autologues, ainsi qu’à l’inhibition de la prolifération des lymphocytes T CD4 et CD8, au profit de l’expansion de lymphocytes T régulateurs (Tregs). Nous avons trouvé que cette expansion est médiée par l’axe PD-1/PD-L1. Ces travaux mettent en évidence un nouveau mécanisme de l’EBV concernant le détournement du système immunitaire de l’hôte, augmentant ses capacités oncogéniques. / The Epstein-Barr virus (EBV) is the first transforming virus discovered in humans. It infects more than 90% of the global adult population, persisting in an episomal form in the memory B-cell compartment throughout the life of the host. During primo-infection and during phases of viral reactivation, immortalized B-cells are in latency III, also called the proliferation program, in which the full range of latency proteins are expressed. In immunocompetent subjects, a balance between virus and host is established, and most infected B-cells are eliminated by the host’s immune system, mainly by cytotoxic T lymphocytes. Deficit of the immune system may lead to lymphomagenesis, such as post-transplantation lymphoproliferative disorders (PTLDs), non-Hodgkin’s (NHL) or Hodgkin’s lymphomas (HL). Previous studies in the lab revealed that the immuno-inhibitor PD-L1/B7-H1/CD274 was overexpressed on the surface of EBV latency III B-cells. Interleukin-10 (IL-10was also secreted by these cells. These features are shared with regulatory B-cells (Bregs). Our objective was to examine the immunomodulatory features of EBV latency III B-cells, in the frame of Bregproperties. We found that EBV latency III B-cells possessed the antigenic determinants common to immature Bregs (CD24High CD38High PD-L1High), associated with overexpression of Breg immunosuppressive cytokines (IL-10, TGF-β1 and IL-35). EBV latency III B-cells led to death of autologous CD4 T-cells, as well as inhibition of CD4 and CD8 T-lymphocyte proliferation, favoring regulatory T-cell (Treg) expansion. We found that this expansion was mediated by the PD-1/PD-L1 axis. This study highlights a new mechanism of EBV for t diversion of the host immune system thereby increasing its oncogenic properties.

Le facteur de transcription ZEBRA (EB1) du virus d'Epstein-Barr joue un rôle essentiel dans l'initiation de l'infection lytique et la production virale. L'ubinucléine a été identifiée comme un partenaire cellulaire de ZEBRA, capable de l'empêcher de se fixer à ses séquences d'ADN cibles. Le rôle de l'ubinucléine dans la cellule demeure inconnu, ainsi que les conséquences de son interaction avec ZEBRA dans les cellules infectées par l'EBV. Notre travail a permis, d'abord, de mieux caractériser l'ubinucléine dans la cellule épithéliale en l'identifiant comme une protéine des jonctions serrées. L'ubinucléine a été proposée comme un nouveau membre de la famille des protéines NACos (nuclear and adhesion complex components) possèdant une double localisation, les noyaux et les jonctions des cellules. Afin de mieux comprendre son rôle dans la cellule épithéliale, nous avons étudié par une approche protéomique couplée à la spectrométrie de masse les partenaires de l'ubinucléine et identifié les protéines LYRIC et RACK-1. Nos résultats suggèrent que l'ubinucléine est impliquée dans différents processus biologiques tels que la régulation de la prolifération et de l'adhésion cellulaires. Enfin, dans les cellules épithéliales infectées par l'EBV, les fonctions de l'ubinucléine semblent dépendre de sa localisation cellulaire. Au niveau nucléaire, l'ubinucléine régule négativement le cycle lytique et la production de particules virales en empêchant ZEBRA et d'autres facteurs cellulaires de se fixer à leurs promoteurs de type AP-1. Lorsqu'elle est séquestrée dans les jonctions serrées, l'inhibition de ZEBRA est levée permettant ainsi le bon déroulement du cycle lytique du virus.