Le virus d’Epstein-Barr (EBV) est un gamma-Herpesvirus associé à de nombreux cancers chez l’homme. In vitro, l’infection de lymphocytes B primaires par EBV conduit à leur immortalisation (genèse de lignées lymphoblastoides (LCL)). Dans ces cellules, seules 9 protéines virales (protéines dites de latence) sont exprimées et coopèrent pour stimuler la prolifération des cellules. Afin de comprendre les mécanismes moléculaires par lesquels les 3 protéines de latence de la famille EBNA3 (-3A, -3B et -3C) participent à l’induction et au maintien de la prolifération cellulaire induite par EBV, nous avons réalisé un crible deux-hybrides dans la levure en utilisant EBNA-3A, -3B ou -3C comme appâts. Ce crible nous a permis d’identifier de nombreux nouveaux partenaires particulièrement pertinents au vu de ce que l’on connaît des rôles respectifs des protéines EBNA3. Parmi les nouveaux partenaires de la protéine EBNA-3A se trouve le facteur de transcription Miz-1 qui est connu pour jouer un rôle clef dans l’arrêt du cycle cellulaire en transactivant l’expression de gènes tels CDKN1A, CDKN1C et CDKN2B. Nous avons validé cette interaction par GST-pull down ainsi que par co-immunoprécipitation en cellules humaines. Nous avons ensuite étudié l’effet de la protéine virale EBNA-3A sur l’activation de la transcription induite par Miz-1. Pour cela, nous avons comparé le niveau des transcrits de certains gènes cibles de Miz-1 dans des LCL exprimant ou non EBNA-3A et avons trouvé que certains gènes codant des inhibiteurs du cycle cellulaire sont différemment exprimés en présence d’EBNA-3A. Enfin, nous avons pu montrer que la protéine virale EBNA-3A est capable de réprimer l’activation de la transcription de Miz-1 en inhibant le recrutement de l’une de ses protéines co-activatrices, la protéine NPM. Ces résultats permettent de mieux comprendre les mécanismes par lesquels les protéines EBNA3 et plus largement EBV, dérégulent le cycle cellulaire. / Epstein-Barr Virus (EBV) is a human Herpesvirus that infects over 90% of the world population and is associated with several malignancies. EBV has the unique capacity to activate and to induce growth transformation of resting primary human B-lymphocytes, upon their in vitro infection, leading to the establishment of lymphoblastoid cell lines (LCLs). In these cells (called Lymphoblatoid cell lines (LCLs)), nine latent proteins are expressed driving the activation and proliferation of the infected B cells. In order to understand the molecular mechanism by which the EBNA3s latent proteins play a role in growth transformation, we used a large scale two-hybrid yeast screen. Thanks to that screen we identified several cellular partners very interesting in relation to what we know about the EBNA3s functions. One of the proteins identified in this screen is the transcription factor Miz-1, which has a cell growth arrest activity via inhibition of cell-cycle progression and has been shown to activate transcription of target genes including CDKN1A, CDKN1C and CDKN2B. We confirmed the interaction between EBNA-3A and Miz-1 by GST-pull down assay as well as by co-immunoprecipitation in HeLa cells We next investigated the effect of EBNA-3A on Miz-1-dependent regulation by comparing the transcript levels of selected Miz-1 target genes between EBNA-3A positive and negative LCLs by RT-qPCR. Interestingly, several Miz-1 target genes, among which CDKN2B, were found to be differentialy regulated in the presence of EBNA-3A. We found that EBNA-3A inhibits Miz-1 dependant activation by inhibiting the recrutement of the co-activator NPM. Those results bring new insights to the mechanisms by which the EBNA3s, and more largely EBV, regulate the cell cycle.

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.

O Epstein-Barr vírus (EBV) é a única espécie humana pertencente ao gênero Lymphocryptovirus. A transmissão ocorre através da saliva contaminada e geralmente ainda na infância. Nosso estudo analisou 165 amostras clínicas de pacientes, portadores de HIV, em tratamento com antiretrovirais, atendidos no Sistema Hospitalar do Sistema Penitenciário do Estado de São Paulo. Nosso enfoque foi pesquisar o EBV nas células mononucleares do sangue periférico, através das técnicas de PCR, Nested-PCR e seqüenciamento de nucleotídeos. Os resultados obtidos, indicaram que 11,51% (19) das amostras analisadas, apresentaram-se positivas para o EBV. Essas 19 amostras, foram seqüenciadas com primers específicos para a região da EBNA-1 (Epstein Barr Nuclear Antigen 1). As amostras foram alinhadas com o auxílio do DNASTAR. Ao alinharmos as amostras, encontramos uma troca de base (de G para A) em 7 amostras e essa troca não alterou a conformação da proteína EBNA-1. Na análise filogenética de nossas sequências com as depositadas no GenBank, foi possível observar dois grupos, que representam tipo 1 e o tipo 2 do EBV. 100% das amostras estudadas por nós foram identificadas como pertencentes ao grupo que caracteriza o tipo 2. Sendo assim, as 7 amostras que apresentaram a troca sugerem a origem um novo subtipo. / The Epstein-Barr Virus (EBV) is the only species to the genus Lymphocriptovirus that infects humans. One of the possible route for its transmission thought by contamined saliva and usually occurs in the childhood. This study analysed 165 clinical samples from HIV infected patients, treated by HARRT, attended in the Hospitalar System in the Penitentiary System from Sao Paulo State. The aim of this study was to search EBV in peripheral blood mononuclear cells by PCR, Nested-PCR and sequencing analysis. The results showed 11,51% of the analysed samples, positive for EBV. This samples, was sequenced with specifics primers from the EBNA-1 (Epstein Barr Nuclear Antigen 1) region. The samples were aligned by DNASTAR program. The aligned sequences showed the base conversion G to A in seven samples. This conversion caused no alteration in the EBNA-1 protein conformation. In the phylogenetic analysis the studied sequences with the sequences from GenBank was possible to observe two groups represented with type 1 and type 2 from EBV. 100% the samples studied was identified with the group characterized by the type 2 to EBV. So the seven samples showed the conversion, suggesting the origin of the one new subtype.

Le risque de LH est augmenté en cas de déficit immunitaire acquis ou inné. Les déficits immunitaires innés associés à un risque accru de LH, sont les DICV (Déficit Immunitaire Commun Variable), XLP (Syndrome lymphoprolifératif lié au chromosome X) et ALPS (Syndrome lymphoprolifératif Autoimmun). L’objectif de notre travail était d’évaluer la prévalence de ces déficits immunitaires chez des enfants atteints de LH. Nous avons reçu, 395 prélèvements de patients atteints de LH au diagnostic. L’âge médian de la population étudiée est de 13 ans, allant de 3 à 18 ans. Le sex-ratio M/F est de 1.1. Il augmente à 3 au dessous de l’âge de 10 ans. Parmi les biopsies (n=84) qui ont été relues, 87% sont de type scléro-nodulaires (SN), 7% à cellularité mixte (CM) et 6% non spécifié. L’EBV est détecté in situ dans 23% des cas de LH. Les patients atteints de LH-EBV+ sont significativement plus jeunes que ceux atteints de LH-EBV- (p=3.10-4). Ce sont plus fréquemment des garçons que des filles (63% ; M/F : 1,7) et fréquemment de sous-type CM (40%). Enfin, ils ont une charge virale EBV significativement plus élevée (p=3.10-3) que les enfants qui ont un LH-EBV-.Parmi les 83 premiers enfants analysés, un immunophénotypage approfondi a montré une diminution de la population lymphocytaire par rapport aux témoins et une lymphopénie B fréquente (31 patients sur 83 soit 37% des patients). La lymphopénie B était corrélée aux facteurs pronostiques connus du LH. Dans un cas parmi les 31, une baisse des immunoglobulines a été mise en évidence ce qui est évocateur de DICV. Nous avons montré que dans les autres cas, les lymphopénies se corrigeaient à distance de la maladie. La recherche de profil cytokinique associé à ces lymphopénies (TGF, BAFF, IL-7) n’a pas permis de mettre en évidence de mécanisme physiopathologique simple pour expliquer ces lymphopénies. Nous émettons l’hypothèse qu’elles sont liées à l’exposition au contact des cellules tumorales à des signaux favorisant l’apopotose.En ce qui concerne la recherche d’autres déficits immunitaires innés, aucun cas évocateur de XLP n’a été mis en évidence sur la base de la quantification des lymphocytes NKT. Cinq cas parmi les 83 (6%) avaient une expansion de lymphocytes T DN (Lymphocytes TCRαβ CD4-CD8-) dans le sang périphérique. Des dosages de Fas ligand et d’IL-10 plasmatiques ont permis d’exclure un ALPS. Au total, nous n’avons pas pu affirmer de défaut qualitatif des sous-populations lymphocytaires évoquant les déficits immunitaires de type XLP et ALPS. Seule une lymphopénie B avec baisse des IgG est évocatrice de DICV. Nous avons étendu l’analyse à l’ensemble des patients (395patients) avec un contrôle à distance du diagnostic pour ceux qui étaient anormaux. Nous avons identifié 4 patients potentiellement atteints de DICV, 1,5%. Parallèlement, nous avons recherché un déficit de la réponse T anti-EBV par cytomètrie de flux et l’Elispot. L’étude de la réponse T anti-EBV par la cytométrie de flux, a montré une tendance vers une baisse de la production d’IL-2 par les CD4 et les CD8 de patients avec une charge virale EBV élevée en réponse à une stimulation par des peptides EBV en présence de lignées autologues. L’étude de la réponse T anti EBV par la technique d’ELISPOT sur 9 patients n’a pas montré globalement de déficit du contrôle de l’EBV sauf pour une jeune patiente de 10 ans ayant une charge virale EBV très élevée sans réponse T anti-EBV efficace. Les résultats que nous avons obtenus restent à approfondir, ce qui permettra d’enrichir les connaissances actuelles sur cette pathologie. / Hodgkin’s Lymphoma (HL) is one of the most frequent lymphomas occurring in childhood. In young children, there is a high predominance in boys and frequent association with Epstein-Barr Virus (EBV). Cohort studies have shown that patients affected by several immune deficiency syndromes - e.g. X-linked lymphoproliferative syndrome (XLP), functional deficit of Fas/FasL pathway and common variable immunodeficiency (CVID) - are risk factors of HL. We intend to search for qualitative and quantitative immune deficiencies as susceptibility factors to child's HL in a prospective study related to Euronet –PHL C1 protocol. Eighty-three patients at diagnosis of HL have been analysed. Median age of the study population is 13 years, (5-18 years). Gender-ratio M/F is 1.1 with a larger male predominance before the age of 10 (gender-ratio of 3). The search for a defect of NKT population that would be suggesting of XLP was negative in all patients. A moderate expansion of circulating TCRαβ+ double negative cells (DNT) has been detected in 5 patients. This expansion has been further explored in the hypothesis of a defect of Fas/FasL pathway by plasmatic quantification of Fas ligand and Il-10. This led to the exclusionof the diagnosis of ALPS. An unexpected high frequency of B-cell lymphopenia has been detected in 31 out of 83 patients (37%). Peripheral B cell lymphopenia was associated with the following poor prognostic factors: advanced stages (p<0.04), low hemoglobin (p<0.06) and B symptoms (p<0.01). B-cell lymphopenia was not statistically correlated with morphology (subtype, amount of tumor cells and necrosis). Remarkably, B-lymphocytic counts were significantly higher in patients with in situ EBV (<0.05).Only a B lymphopenia with low IgG level suggesting DICV was detected. We extended the analysis to all the 395 patients included in the protocol EURONET, so we identified 4 patients with CVID. These cases will be further explored by molecular analyses. In parallel, the specific T-cells response against EBV was studied by flow cytometry in 15 patients and ELISPOT assay in 9 patients with HL. Flow cytometry , suggested a decrease in production of IL-2 by CD4 T cells in patients with high EBV viral load in response to EBV latent and lytic-cycle peptides and autologous lymphoblatoid cells lines compared to controls or patients with LH-EBV-. The ELISPOT-IFNγ assay was used to determine the frequency of T cells that produced IFNγ in response to peptides. One patient demonstrated inappropriate EBV-specific T-cell IFNγ production (<10 IFNγ secreted T cells and >1,000 EBV copies per 250000 PBMCs). These cases will be further explored by molecular analyses.Our findings confirm the known epidemiological data of HL now mainly associated to NS subtype in children and adolescents and EBV status in HL at this age. We show that peripheral B cell lymphopenia in paediatric and adolescent HL patients is frequent and associated with poor prognosis factors. We confirm the association between CVID and HL.

Notre équipe à montré que les cellules de lymphome de Burkitt (LB) infectées par le variant P3HR1 du virus d’Epstein Barr (EBV) sont plus résistantes à l’apoptose que les cellules de LB EBV(-) ou infectées par la souche sauvage. Le variant P3HR1 porte une délétion de son génome à l’origine de l’expression d’une forme tronquée d’EBNA-LP (EBNA-LPt). Nous avons étudié le rôle fonctionnel d’EBNA-LPt dans les cellules de LB infectées par le variant P3HR1. Nous avons, dans un premier temps, identifié par une étude protéomique ses partenaires cellulaires et viraux. Nous avons ainsi confirmé l’interaction entre EBNA-LPt et la PP2A, déjà établie par notre équipe, et montré qu’elle forme également des complexes avec d’autres protéines impliquées dans de nombreux processus cellulaires, notamment dans l’apoptose et dans la régulation transcriptionnelle. Nous avons ensuite, par une étude du transcriptome, montré le rôle de régulateur transcriptionnel des deux formes d’EBNA-LP exprimées de façon stable dans les cellules de LB EBV(-). En effet, nous avons montré que les deux formes d’EBNA-LP sont capables de réguler l’expression des gènes cellulaires indépendamment du contexte viral. Certains de ces gènes sont communs aux deux formes d’EBNA-LP, d’autres sont spécifiques de chaque forme. Nous avons constaté que le domaine Y1Y2 est indispensable à la surexpression, par EBNA-LP, du gène cellulaire codant pour la protéine ID1 qui est impliquée dans la stabilisation de la LMP1 et dans l’immortalisation cellulaire. Nous avons également remarqué que certains gènes sont régulés de la même façon en présence d’EBNA-LP seule ou dans un contexte viral complet. Enfin et pour mieux comprendre les mécanismes de résistance à l’apoptose dans les cellules de LB infectées par la souche P3HR1, nous avons élargi notre étude du transcriptome à des cellules traitées ou non par un inducteur de l’apoptose, la cycloheximide. Nos résultats préliminaires montrent que les voies de signalisation des récepteurs au TNF (TNFR1 et 2) sont rapidement et fortement induites dans les cellules sensibles alors qu’elles sont faiblement et tardivement induites dans les cellules résistantes. Cette étude montre également que la voie de signalisation JNK est probablement activée de façon très précoce dans les cellules sensibles contrairement aux cellules résistantes. / Our group has previously shown that Burkitt’s lymphoma (BL) cells infected by the P3HR1 variant of Epstein-Barr virus (EBV) are more resistant to apoptotsis than EBV (-) BL cells or cells infected by wild-type EBV. The genome of the P3HR1 variant carries a deletion responsible for the expression of a truncated form of EBNA-LP (tEBNA-LP). We studied the functional role of tEBNA-LP in BL cells infected by the P3HR1 variant. A proteomic study allow us to identify cellular and viral partners of tEBNA-LP. These results confirmed the interaction between tEBNA-LP and PP2A, already established by our group, and showed that tEBNA-LP can form complexes with other proteins involved in many cellular processes including apoptosis and regulation of transcription. We have then demonstrated by a transcriptomic study, the transcriptional regulatory role of both forms of EBNA-LP stably expressed in EBV(-) BL cell lines. Indeed, we showed that both forms of EBNA-LP can regulate the expression of cellular genes independently of viral context. Some of these genes are common to both forms of EBNA-LP, others are specific to each form. We found that Y1Y2 domaine of EBNA-LP is essential to overexpression of the cellular gene encoding ID1 protein which is involved in LMP1 stabilization and cellular mmortalization. We also noted that some genes are similarly regulated in the presence of EBNA-LP alone or in the presence of viral genome. Finally, to better undertand the mecanisms of resistance to apoptosis in BL cell lines infected by the P3HR1 variant we extended our transcriptomic analysis to cell lines treated or not with an apoptosis inducer, cycloheximide. Our preliminary results show that TNF receptors signaling pathways (TNFR1 and 2) are rapidly and strongly induced in sensitive cell lines while being weakly and belatedly induced in the resistant cell lines. This study also shows that the JNK signaling pathway is probably activated very early in the sensitive cells in contrast to resistant cell lines.

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.

Allergic diseases are influenced by genetics and the environment. Maternal allergy appears to confer a higher risk for allergic sensitization than paternal allergy, suggesting an in utero influence. A decrease in particular infections or a lower exposure to microbial components during infancy is suggested to contribute to the high allergy prevalence in affluent societies. Toll-like receptors (TLR) 2 and 4 recognize peptidoglycan (PGN) and LPS respectively, are expressed on e.g. monocytes, and have been implicated in modulating the risk of IgE-sensitization. This thesis aimed to study the influence of maternal allergy and early microbial exposure on monocyte function and allergic sensitization during childhood. Blood samples from children participating in a prospective allergy cohort were used. Two-year old infants with allergic mothers had lower IL-6 production and reduced activation of the TLR-signalling intermediate p38-MAPK in response to PGN than children with non-allergic mothers. In 5-year old children, allergic disease and not maternal allergy influenced monocytic TLR2-regulation. Five-year olds who were seropositive for Epstein-Barr virus (EBV) at 2-years of age had a lower risk of persistent IgE-sensitization while EBV contraction after 2-years of age related to a higher risk of IgE-sensitization. Upon in vitro stimulation, NK cells from EBV+ 2-year olds produced lower IFN-g levels. EBV+ 2-year olds had also lower systemic IFN-g. In comparison to CD14++CD16- monocytes, CD14+CD16+ cells induced NK-cell IFN-g more potently in vitro, and EBV+ infants tended to have lower proportions of these CD14+CD16+ monocytes. This thesis highlights the importance of early-life microbial (EBV) exposure for a proper allergy-protective immunity. Also, maternal allergic heredity appears to influence monocytic microbial responses in early infancy. All these aspects relate to altered monocyte functionality, which suggest that they could have a role in allergic sensitization.

Background Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. It usually strikes during young adulthood, and 2.5 million individuals are estimated to have the disease worldwide. The causes of MS are not known, but several factors have been shown to be associated with the risk of the disease, including certain genes, vitamin D, smoking and Epstein- Barr virus infection. Little is known about how/if these factors interact. Methods Study I: The risk of MS by month of birth was investigated using MS cases from the Swedish MS registry and using general population controls. Studies II–V: We identified MS cases who had donated blood prior to disease onset, and MS cases whose mothers had donated blood during pregnancy, by cross-linking a database of MS cases, and a database of mothers of MS cases, to two local biobank cohorts. One of them consisted of blood samples collected during early pregnancy, and one with samples collected during health controls. Levels of 25(OH)D (25-hydroxyvitamin D), RBP (retinol binding protein, a surrogate marker for vitamin A), CRP (C- reactive protein), cotinine (a nicotine metabolite) and anti Epstein-Barr virus nuclear antigen-1 (EBNA-1) antibodies were measured in cases and matched controls. The risk of MS by categories of these exposures was estimated in bi- and multivariable matched logistic regression models. Results Subjects born in spring had a higher risk of MS, but no influence of early gestational levels of the measured risk factors on the risk of MS in the offspring was observed. In prospective samples from MS cases and controls, 25(OH)D levels ≥75 nmol/l, intermediate RBP levels, and elevated CRP levels in young were associated with a decreased risk of MS. Elevated cotinine levels (suggestive of smoking) and high antibody reactivity against EBNA-1 were associated with an increased risk of MS. All factors but RBP were more clearly associated with MS in young subjects. Conclusion All factors analyzed in prospectively collected samples were associated with the risk of MS, and taken together, the data indicate that the key etiopathological events that lead to MS occur before the age of 20–30. Study II provides support for trials exploring the primary preventive potential of oral vitamin D supplementation.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Lic.-avh. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 3 uppsatser.