Regulatorische Foxp3+CD4+ T-Zellen sind essentiell für das Gleichgewicht des intestinalen Immunsystems. Eine Einschränkung ihrer Suppressionsfunktion wird bei Patienten mit Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX)-Syndrom beobachtet und führt im Tiermodell zu lymphoproliferativen Erkrankungen und intestinalen Entzündungen. Von entscheidender Bedeutung für Homöostase und Suppressionsfunktion regulatorischer T-Zellen ist das Signalmolekül Interleukin-2 (IL-2). Im Gegensatz zu Effektor-T-Zellen exprimieren Foxp3+CD4+ T-Zellen den hochaffinen IL-2-Rezeptor αβγ konstitutiv. IL-2 wird von regulatorischen T-Zellen nicht in relevanten Mengen exprimiert. Sie sind somit auf von anderen Zellen sezerniertes IL-2 angewiesen. In der vorliegenden Arbeit wird gezeigt, dass im Tiermodell regulatorische Foxp3+CD4+ T-Zellen durch Applikation eines IL-2/anti-IL-2-Antikörperkomplex nicht nur in mesenterialen Lymphknoten und Milz, sondern auch lokal in der Lamina propria mucosae des Kolons der Versuchstiere expandiert werden. Als relevante Quelle von IL-2 in situ könnten aktivierte proliferierende T-Zellen dienen. Um dies näher zu untersuchen, wurde die Proteinexpression proliferierender Einzelzellen mittels Matrix assisted laser desorption/ionisation-Time of flight-Massenspektrometrie-Imaging (MALDI-Imaging) analysiert. Es gelang die Identifikation präferentiell in lymphoiden Geweben exprimierter Peptidmassen. Obwohl die Einzelzellanalyse mittels MALDI-Imaging prinzipiell möglich erscheint, ist ein Nachweis von Zytokinen wie IL-2 derzeit aufgrund fehlender Sensitivität im Proteinmassebereich zwischen 10kDa und 20kDa nicht möglich. Die therapeutischen Möglichkeiten der Expansion regulatorischer Foxp3+ T-Zellen durch stabile IL-2-Rezeptor-Agonisten und die Rolle von IL-2 für die intestinale Immunregulation sollten weiter untersucht werden.:Bibliographische Beschreibung 3 Inhaltsverzeichnis 4 Abkürzungsverzeichnis 7 1. Einleitung 9 1.1. Störung der Barrierefunktion des intestinalen Immunsystems als Ursache chronisch entzündlicher Darmerkrankungen 9 1.2. Foxp3+ regulatorische T-Zellen 10 1.3. Die Rolle von Interleukin-2 für regulatorische T-Zellen 11 1.4. Signaltransduktion in regulatorischen T-Zellen als Grundlage ihrer selektiven Expansion und Induktion 12 1.5. Möglichkeiten der präferentiellen Expansion regulatorischer T-Zellen 15 1.5.1. Expansion regulatorischer T-Zellen durch Agonisten des hochaffinen IL-2-Rezeptors 15 1.5.2. Induktion regulatorischer T-Zellen durch TGF-β 16 1.5.3. Expansion regulatorischer T-Zellen durch Rapamycin (Sirolimus) 17 1.5.4. Expansion regulatorischer T-Zellen durch UVB-Bestrahlung bzw. Vitamin D-Rezeptor-Agonisten 18 1.5.5. Expansion regulatorischer T-Zellen durch Histon-Deacetylaseinhibitoren 19 1.6. Suppression von Effektor-T-Zellen durch regulatorische T-Zellen 20 1.6.1. Zellkontaktabhängige Mechanismen 20 1.6.2. Zellkontaktunabhängige Mechanismen 22 1.7. Matrix assisted laser desorption ionisation-Time of flight-Massenspektromie (MALDI-TOF-MS): Bedeutung und Funktion 23 1.8. Zielstellung 25 2. Materialien und Methoden 26 2.1. Versuchstiere 26 2.2. IL-2/IgG2b-Fusionsprotein-Vorexperiment 26 2.2.1. Induktion von 2,4,6-Trinitrobenzensulfonsäure (TNBS)-Kolitis 26 2.2.2. Durchführung des IL-2/IgG2b-Fusionsprotein-Vorexperimentes 26 2.3. Durchführung des IL-2/anti-IL-2-Antikörperkomplex-Experiments 27 2.4. Durchflusszytometrie 27 2.5. Histologische Färbungen 28 2.5.1. Probenvorbereitung 28 2.5.2. Hämatoxylin/Eosin (HE) Färbung 29 2.5.3. Immunfluoreszenz-Färbungen 29 2.5.4. Ki67-Schnellfärbung 30 2.5.5. Mikroskopie und Photographie 30 2.6. Histologische Auswertungen 31 2.6.1. Kolitis-Score 31 2.6.2. Bildanalyse 31 2.6.3. Validierung der automatischen Bildanalyse mittels CellProfiler 33 2.7. MALDI-Imaging 35 2.7.1. Probenvorbereitung für MALDI-Imaging 35 2.7.2. Analyse der Peptidexpression in Gewebeschnitten mittels MALDI-Imaging 36 2.8. Statistische Auswertungen 36 2.8.1. Statistische Tests 36 2.8.2. Berechnung der zu erwartenden Zahl von Kontakten zwischen Ki67+ und Foxp3+ Zellen 36 3. Ergebnisse 38 3.1. Design des IL-2/anti-IL-2-Antikörperkomplex Experimentes 38 3.2. Mit IL-2/anti-IL-2-Antikörperkomplex behandelte Tiere zeigen Splenomegalie und Lymphadenomegalie 40 3.3. Behandlung mit einem IL-2/anti-IL-2-Antikörperkomplex führt zur präferentiellen Expansion regulatorischer T-Zellen in mesenterialen Lymphknoten und Milz 41 3.4. Behandlung mit IL-2/anti-IL-2-Antikörperkomplex führt nicht zu Kolitis 43 3.5. Behandlung mit IL-2/anti-IL-2-Antikörperkomplex führt zur präferentiellen Expansion regulatorischer T-Zellen in der Lamina propria mucosae 45 3.6. IL-2/anti-IL-2-Antikörperkomplex steigert die Proliferation regulatorischer T-Zellen in der Lamina propria mucosae und lymphoiden Follikeln des Kolons 47 3.7. Regulatorische T-Zellen sind nach Behandlung mit IL-2/anti-IL-2-Antikörperkomplex weiter mit proliferierenden Zellen assoziiert. 50 3.8. MALDI-Imaging als Möglichkeit der Proteinexpressionsanalyse in situ 52 3.8.1. Vergleich der Proteinexpression in verschiedenen Geweben von Ileum und Zäkum mit der Expression in Thymus und mesenterialem Lymphknoten 55 3.8.2. MALDI-Imaging nach Schnellfärbung Ki67+ Zellen mit Streptavidin 63 3.8.3. Analyse der Massenspektren von Einzelzellen mittels MALDI-Imaging 66 4. Diskussion 68 4.1. Applikation von IL-2/anti-IL-2-Antikörperkomplex hat keine fatalen Nebenwirkungen 68 4.2. IL-2/anti-IL-2-Antikörperkomplex führt zur präferentiellen Expansion regulatorischer T-Zellen in mesenterialen Lymphknoten, Milz und Kolon 70 4.3. IL-10 als wichtiger Vermittler der Suppressionsaktivität durch IL-2/anti-IL-2-Antikörperkomplex expandierter regulatorischer T-Zellen 71 4.4. Expansion regulatorischer T-Zellen beim Menschen: Voraussetzungen und Chancen 72 4.5. Regulatorische T-Zellen akkumulieren an proliferierenden Zellen 73 4.6. Nachweis spezifischer Massen in Gewebe und Einzelzellen mittels MALDI-Imaging 74 5. Zusammenfassung 80 Literaturverzeichnis 83 Publikationen 90 Erklärung über die eigenständige Abfassung der Arbeit 97 Lebenslauf 98 Danksagungen 99

L’hépatite autoimmune (HAI) résulte d’une perte de tolérance du système immunitaire envers des antigènes de l’hépatocyte. Elle peut se présenter sous forme d’hépatite aiguë, parfois fulminante, ou comme une maladie chronique menant progressivement à une cirrhose hépatique. En absence de traitement, cette maladie est fatale. La pathogenèse de l’HAI et les mécanismes responsables de sa progression restent inconnus à ce jour. L’objectif global de ce projet est d’examiner les facteurs prédisposants et les mécanismes immunologiques responsables de l’apparition et de la progression de l’HAI. Pour permettre l’étude de la pathogenèse de l’HAI, nous avons développé un modèle murin expérimental d’hépatite autoimmune de type 2. Celui-ci est basé sur la xénoimmunisation de souris C57BL/6 avec les deux antigènes ciblés dans l’HAI de type 2 chez l’homme (CYP2D6 et FTCD). Par mimétisme moléculaire, le système immunitaire de ces souris réagit contre les protéines murines homologues et une HAI s’ensuit. Ce modèle expérimental présente la plupart des caractéristiques histologiques, biochimiques et sérologiques d’une HAI de type 2. Les souris développent une inflammation autoimmune chronique avec présence d’hépatite d’interface et d’infiltrations intralobulaires, un infiltrat composé majoritairement de lymphocytes T CD4+ mais aussi de lymphocytes T CD8+ et B, d’une élévation des ALT sériques, des niveaux d’immunoglobulines G circulantes augmentés ainsi que d’autoanticorps anti-LKM1 et anti-LC1. L’étude de l’influence du bagage génétique a permis de définir l’importance relative des gènes du CMH et des gènes non-CMH sur le développement d’une HAI. Les gènes du locus CMH sont essentiels mais insuffisants pour mener au développement d’une HAI et donc, la susceptibilité génétique à l’HAI est comme chez l’homme, multigénique. Les patients atteints d’HAI de type 2 sont généralement des jeunes filles. L’étude des influences de l’âge et du sexe dans ce modèle a permis de montrer que les souris femelles avant et au début de leur maturité sexuelle sont plus susceptibles au développement d’une HAI de type 2. De plus, les femelles ont un nombre réduit de lymphocytes T régulateurs, ce qui leur confère une susceptibilité accrue comparé aux mâles. L’ensemble de ces travaux nous a conduits à proposer un mécanisme où le développement d’une HAI chez les femelles d’un âge particulier résulterait de l’activation de cellules T CD4+ autoréactives ayant échappé aux mécanismes de tolérance centrale, via un mécanisme de mimétisme moléculaire avec un antigène exogène. En présence d’une tolérance périphérique réduite due à un faible nombre de cellules T régulatrices, les cellules T autoréactives proliféreraient et activeraient des cellules B autoréactives entraînant la sécrétion d’autoanticorps. L’activation subséquente de cellules T CD8+ cytotoxiques spécifiques amènerait la lyse des hépatocytes et la relâche d’autoantigènes permettant la perpétuation de l’autoimmunité. / Autoimmune hepatitis (AIH) is an autoimmune disease resulting from a loss of immunological tolerance against hepatocyte antigens. It can present itself as an acute hepatitis, sometime fulminant, or as a chronic disease leading to progressive liver cirrhosis. In absence of treatment, this disease is fatal. The pathogenesis of AIH and the mechanisms responsible for its progression remain unknown. The overall objective of this project is to examine predisposing factors and immunological mechanisms responsible for the onset and progression of HAI. To study the pathogenesis of AIH, we developed a mouse model of experimental autoimmune hepatitis type 2. This model is based on xenoimmunization of C57BL/6 wild type mice with human type 2 AIH autoantigens (CYP2D6 and FTCD). Molecular mimicry between the xenoantigens and their homologous murine proteins results in the development of an autoimmune response followed by liver inflammation. This experimental mouse model shows most histological, biochemical and serological features of human type 2 AIH. Mice develop autoimmune chronic liver inflammation characterized by the presence of interface hepatitis and intralobular inflammation, infiltrates composed predominantly of CD4+ but also of CD8+ T and B cells, elevated ALT serum levels, increased serum immunoglobulin G and circulating anti-LC1 and anti-LKM1 autoantibodies. Studies of the influence of genetic background on AIH susceptibility have defined the relative importance of MHC and non-MHC genes. Specific MHC haplotype are necessary but not sufficient to lead to the development of AIH and therefore, the genetic susceptibility to HAI is, as in humans, multigenic. In humans type 2 AIH is found predominantly in young women. In our experimental models, female mice before or at beginning of sexual maturity are more susceptible to AIH. Females at this age have reduced numbers of regulatory T cells, conferring an increased susceptibility compared to males. Based on these results, we propose a mechanism in which the development of AIH results from the activation, through a mechanism of molecular mimicry with an exogenous antigen, of autoreactive CD4+ T cells that have escaped central tolerance. In presence of reduced peripheral tolerance due to low number of regulatory T cells, autoreactive T cells proliferate and activate autoreactive B cells leading to secretion of autoantibodies. The subsequent activation of specific cytotoxic CD8+T cells results in hepatocytes lysis and autoantigens release, leading to perpetuation of autoimmunity.

At birth, the immune system is immature and the gut microbiota influences immune maturation. Staphylococcus aureus (S. aureus) and lactobacilli are part of the neonatal gut microbiota and have seemingly opposite effects on the immune system. S. aureus is a potent immune activator and early-life colonization associates with higher immune responsiveness later in life. Lactobacilli-colonization associates with reduced allergy-risk and lower immune responsiveness. Further, lactobacilli modulate immune-activation and have probiotic features. Here, we investigated S. aureus-induced activation of human lymphocytes, including T regulatory cells (Tregs), conventional T-cells (CD4+ and CD8+), unconventional T-cells (γδ T-cells and MAIT-cells) and NK-cells from children and adults, together with the modulatory effect of lactobacilli on immune-activation. Further, early-life colonization with these bacteria was related to lymphocyte-maturation, plasma cytokine- and chemokine-levels and allergy.  S. aureus cell free supernatant (CFS) and staphylococcal enterotoxin (SE) A induced an increased percentage of FOXP3+ Tregs and of CD161+, IL-10+, IFN-γ+ and IL-17A+ Tregs (Paper I). The same pattern was observed in children with a lower degree of activation, possibly due to lower CD161-expression and poor activation of naive T-cells (Paper II). S. aureus-CFS induced IFN-γ-expression, proliferation and cytotoxic capacity in conventional and unconventional T-cells, and NK-cells. SEA, but not SEH, induced activation of unconventional T-cells and NK-cells by unknown mechanism(s) (Paper III, extended data). Lactobacilli-CFS reduced S. aureus-induced lymphocyte activation without the involvement of IL-10, Tregs or monocytes, but possibly involving lactate (Paper III). Early-life colonization with S. aureus associated with increased percentages of CD161+ and IL-10+ Tregs while lactobacilli-colonization negatively correlated with the percentage of IL-10+ Tregs later in life (Paper II). Allergic disease in childhood associated with double allergic heredity, being born wintertime and with higher plasma levels of TH2-, TH17- and TFH-related chemokines early in life. Lactobacilli-colonization associated with lower prevalence of allergy, reduced chemokine-levels and increased levels of IFN-γ in plasma (Paper IV).    This thesis provides novel insights into S. aureus- and SE-mediated activation of Tregs, unconventional T-cells and NK-cells and suggests an overall impairment of immune-responsiveness towards this bacterium in children. Further, S. aureus-colonization may influence the maturation of peripheral Tregs. Our data show that lactobacilli potently dampen lymphocyte-activation in vitro and that colonization associates with Treg-responsiveness, altered plasma cytokine- and chemokine-levels and with remaining non-allergic, thereby supporting the idea of lactobacilli as important immune-modulators. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Manuscript.</p><p> </p>

Background: Tobacco smoking is the main cause of chronic obstructive pulmonary disease, COPD, but the mechanisms by which cigarette smoke induces COPD are still elusive. T lymphocytes have been implicated in the pathogenesis of the disease, but their role in the airway inflammation in COPD is not fully understood. The aim of this thesis was therefore to address T lymphocyte subsets and their activation in the airways of subjects with COPD, in comparison to smokers with normal lung function (S) and never smokers (NS). Methods: Subjects with moderate to severe COPD were recruited along with controls. They were all non-atopic and clinically stable, without any exacerbation during at least three months prior to inclusion. Only medication with short-acting β2-agonists and/or anti-cholinergic drugs was permitted. All subjects underwent bronchoscopy with endobronchial mucosal biopsy sampling as well as bronchial wash, BW, and bronchoalveolar lavage, BAL, collection. Biopsies were immunohistochemically stained for inflammatory cells and markers. BW and BAL fluids were prepared for differential cell counts. Soluble markers were measured in BW and lymphocyte subsets were determined in BAL using flow cytometry. Results: In biopsies, an increase in epithelial CD3+ and CD8+ cells was found in COPD, compared to NS. In BAL fluid, CD8+ cells were enhanced, whereas CD4+ cells were reduced in subjects with COPD and S, compared to NS. Furthermore, CD4+ and CD8+ cells were more activated both in COPD and S, in terms of increased expression of CD25, CD69 and HLA-DR. NKG2D-expressing CD8+ T cells in BAL fluid were enhanced in both COPD and S. CD4+CD25bright cells were upregulated in COPD and S, suggesting the presence of regulatory T cells. Further analyses of T cell subsets with the more specific markers for regulatory T cells, FoxP3 and CD127, indicated a smoking-induced expansion of non-regulatory T cells, which tended to normalize after smoking cessation in COPD. Currently smoking subjects with COPD still expressed high proportions of activated non-regulatory CD4+ T cells. The data on FoxP3 expression further indicated that the increase in CD25 expression in COPD and S was not only associated with the expansion of regulatory T cells. As CD127 expression is reported to be inversely associated with FoxP3, the data indicate the expansion of a non-regulatory CD25+ population in smokers and patients with stable COPD. The immunohistochemical staining for the NKG2D ligands MICA and MICB on epithelial cells was unchanged. Conclusion: The results of this thesis suggest a role for CD4+ and CD8+ T-cells in clinically stable COPD, indicating that T-cells are of importance in the long-term inflammatory response in COPD. Regardless of current smoking habits, activated CD8+ T lymphocytes were found to be increased in BAL fluid from subjects with COPD, suggesting that changes in CD8+ T cells are associated with a persistent immune response and, thus, of importance in COPD pathogenesis. In contrast, the expansion of non-regulatory CD25+CD4+ cells in BAL fluid seemed to be preferentially smoke-related. In summary, the data indicate that, among airway T cells, changes in CD8+ cells seem to be highly associated with COPD pathogenesis, whereas changes in CD4+ cells appear to be related to cigarette smoke-induced responses. Further, a non regulatory population of helper T cells was identified in BAL fluid of COPD patients, which may contribute to the persistent cytotoxic T cell responses.

L’hépatite autoimmune (HAI) résulte d’une perte de tolérance du système immunitaire envers des antigènes de l’hépatocyte. Elle peut se présenter sous forme d’hépatite aiguë, parfois fulminante, ou comme une maladie chronique menant progressivement à une cirrhose hépatique. En absence de traitement, cette maladie est fatale. La pathogenèse de l’HAI et les mécanismes responsables de sa progression restent inconnus à ce jour. L’objectif global de ce projet est d’examiner les facteurs prédisposants et les mécanismes immunologiques responsables de l’apparition et de la progression de l’HAI. Pour permettre l’étude de la pathogenèse de l’HAI, nous avons développé un modèle murin expérimental d’hépatite autoimmune de type 2. Celui-ci est basé sur la xénoimmunisation de souris C57BL/6 avec les deux antigènes ciblés dans l’HAI de type 2 chez l’homme (CYP2D6 et FTCD). Par mimétisme moléculaire, le système immunitaire de ces souris réagit contre les protéines murines homologues et une HAI s’ensuit. Ce modèle expérimental présente la plupart des caractéristiques histologiques, biochimiques et sérologiques d’une HAI de type 2. Les souris développent une inflammation autoimmune chronique avec présence d’hépatite d’interface et d’infiltrations intralobulaires, un infiltrat composé majoritairement de lymphocytes T CD4+ mais aussi de lymphocytes T CD8+ et B, d’une élévation des ALT sériques, des niveaux d’immunoglobulines G circulantes augmentés ainsi que d’autoanticorps anti-LKM1 et anti-LC1. L’étude de l’influence du bagage génétique a permis de définir l’importance relative des gènes du CMH et des gènes non-CMH sur le développement d’une HAI. Les gènes du locus CMH sont essentiels mais insuffisants pour mener au développement d’une HAI et donc, la susceptibilité génétique à l’HAI est comme chez l’homme, multigénique. Les patients atteints d’HAI de type 2 sont généralement des jeunes filles. L’étude des influences de l’âge et du sexe dans ce modèle a permis de montrer que les souris femelles avant et au début de leur maturité sexuelle sont plus susceptibles au développement d’une HAI de type 2. De plus, les femelles ont un nombre réduit de lymphocytes T régulateurs, ce qui leur confère une susceptibilité accrue comparé aux mâles. L’ensemble de ces travaux nous a conduits à proposer un mécanisme où le développement d’une HAI chez les femelles d’un âge particulier résulterait de l’activation de cellules T CD4+ autoréactives ayant échappé aux mécanismes de tolérance centrale, via un mécanisme de mimétisme moléculaire avec un antigène exogène. En présence d’une tolérance périphérique réduite due à un faible nombre de cellules T régulatrices, les cellules T autoréactives proliféreraient et activeraient des cellules B autoréactives entraînant la sécrétion d’autoanticorps. L’activation subséquente de cellules T CD8+ cytotoxiques spécifiques amènerait la lyse des hépatocytes et la relâche d’autoantigènes permettant la perpétuation de l’autoimmunité. / Autoimmune hepatitis (AIH) is an autoimmune disease resulting from a loss of immunological tolerance against hepatocyte antigens. It can present itself as an acute hepatitis, sometime fulminant, or as a chronic disease leading to progressive liver cirrhosis. In absence of treatment, this disease is fatal. The pathogenesis of AIH and the mechanisms responsible for its progression remain unknown. The overall objective of this project is to examine predisposing factors and immunological mechanisms responsible for the onset and progression of HAI. To study the pathogenesis of AIH, we developed a mouse model of experimental autoimmune hepatitis type 2. This model is based on xenoimmunization of C57BL/6 wild type mice with human type 2 AIH autoantigens (CYP2D6 and FTCD). Molecular mimicry between the xenoantigens and their homologous murine proteins results in the development of an autoimmune response followed by liver inflammation. This experimental mouse model shows most histological, biochemical and serological features of human type 2 AIH. Mice develop autoimmune chronic liver inflammation characterized by the presence of interface hepatitis and intralobular inflammation, infiltrates composed predominantly of CD4+ but also of CD8+ T and B cells, elevated ALT serum levels, increased serum immunoglobulin G and circulating anti-LC1 and anti-LKM1 autoantibodies. Studies of the influence of genetic background on AIH susceptibility have defined the relative importance of MHC and non-MHC genes. Specific MHC haplotype are necessary but not sufficient to lead to the development of AIH and therefore, the genetic susceptibility to HAI is, as in humans, multigenic. In humans type 2 AIH is found predominantly in young women. In our experimental models, female mice before or at beginning of sexual maturity are more susceptible to AIH. Females at this age have reduced numbers of regulatory T cells, conferring an increased susceptibility compared to males. Based on these results, we propose a mechanism in which the development of AIH results from the activation, through a mechanism of molecular mimicry with an exogenous antigen, of autoreactive CD4+ T cells that have escaped central tolerance. In presence of reduced peripheral tolerance due to low number of regulatory T cells, autoreactive T cells proliferate and activate autoreactive B cells leading to secretion of autoantibodies. The subsequent activation of specific cytotoxic CD8+T cells results in hepatocytes lysis and autoantigens release, leading to perpetuation of autoimmunity.

Epstein-Barr virus (EBV) infects almost all humans and establishes lifelong latency in B cells. Posttransplant lymphoproliferative disorder (PTLD) is a rare but serious complication after transplantation triggered by immunosuppression and often related to EBV infection. The aim of this thesis was to study the role of EBV in relation to clinical and histological features of PTLD, regulatory T cells (Tregs), and donor or recipient origin of PTLD. EBV surveillance after allogeneic hematopoietic stem cell transplantation (allo-HSCT) showed that EBV reactivations were common, but that symptomatic EBV disease (including PTLD) only occurred in the high-risk group (unrelated or mismatched related grafts, reduced-intensity conditioning). A threshold of 1000 copies/ml plasma distinguished EBV disease from asymptomatic reactivations. In a population-based cohort of 135 PTLDs/lymphomas after solid organ transplantation (SOT) almost half were EBV–. EBV+ PTLDs were associated with B cell phenotype, non-germinal center subtype of diffuse large B cell lymphoma (DLBCL), early-onset, graft involvement, antithymocyte globulin treatment, and younger age. EBV– PTLDs were associated with T cell phenotype, bone marrow involvement, and hepatitis C. Most PTLDs displayed few or no intratumoral Tregs with the marker FoxP3, possibly due to heavy immuno­suppres­sion. Half of both FoxP3+ and FoxP3– PTLDs were EBV+. FoxP3+ PTLDs were associated with B cell phenotype and hepatitis C. All PTLDs for which tumor origin could be determined were recipient-derived and half of them were EBV+. Eight of twelve recipient-derived graft PTLDs were disseminated outside the graft. T cell PTLD and hepatitis C were independently associated with inferior overall survival, whereas subtype of DLBCL, FoxP3-expression, and EBV-status did not influence survival. In conclusion, monitoring of EBV DNAemia in high-risk patients after allo-HSCT and pre-emptive therapy is valuable for prevention of PTLD. Use of anti­thymocyte globulin increases the risk for EBV+ PTLDs after allo-HSCT and SOT. With long follow-up time, a large proportion of PLTDs after SOT are EBV– with a different clinical presentation. Tregs are rare in PTLD and do not affect survival. The vast majority of PTLDs after SOT is of recipient origin. Graft PTLDs are more likely recipient-derived if disseminated. EBV-status is not associated with intratumoral Tregs or PTLD of recipient origin.

Submitted by Hiolanda Rêgo (hiolandarego@gmail.com) on 2015-03-27T11:52:21Z No. of bitstreams: 1 Dissertação_ICS_ Vanessa da Silva Brito.pdf: 1550973 bytes, checksum: a932addd006a46862584dd772338e50a (MD5) / Made available in DSpace on 2015-03-27T11:52:21Z (GMT). No. of bitstreams: 1 Dissertação_ICS_ Vanessa da Silva Brito.pdf: 1550973 bytes, checksum: a932addd006a46862584dd772338e50a (MD5) / Introdução: O vírus linfotrópico de células T humanas tipo 1 (HTLV-1) é um retrovírus linfotrópico, descrito como agente causador da leucemia/linfoma de células T do adulto (ATL) e paraparesia espástica tropical/mielopatia associada ao HTLV-1 (HAM/TSP). Mesmo nos portadores aparentemente assintomáticos existem evidências de comprometimento funcional da resposta imune celular. Os objetivos do presente trabalho foram avaliar as subpopulações linfocitárias e células T regulatórias em indivíduos infectados pelo HTLV-1 e comparar as populações de células T (CD4+, CD8+), por dois kits comerciais diferentes disponíveis. Material e Métodos: Este estudo foi aprovado pelo CEP-207/2009CPqGM/FIOCRUZ. Em amostras de sangue periférico de 55 indivíduos infectados com HTLV-1 (soropositivos) e 80 controles (não infectados / HTLV soronegativos), foram quantificados com os reagentes e kits Lymphogram (Cytognos-Espanha) e Tritest (BD-USA), linfócitos T (CD4+, CD8+, CD25+), células NK e linfócitos B, por reagentes de marcação simultânea, e avaliada a expressão de Foxp3 nas células T CD4+CD25+. Resultado: Com os dados analisados, os indivíduos infectados pelo HTLV-1 apresentam valores mais elevados de células T CD4+ e CD8+, redução na frequência de células NK (p<0,05), sem diferença nas células B, quando comparados aos controles. Observa-se uma menor expressão da proteína Foxp3 em células T CD3+CD4+CD25+ de indivíduos infectados pelo HTLV quando comparados aos não infectados/soronegativos (p<0,05). Discussão: Com base nos resultados, pode-se concluir que o Lymphogram® é um método confiável, rápido e de baixo custo para o diagnóstico e monitoramento de linfopatias como a infecção pelo HTLV-1. Conclusão: As análises quantitativas mostraram que indivíduos infectados pelo HTLV-1 apresentam uma contagem de células T CD4+ e CD8+ maior, mantendo a proporcionalidade nas duas células, e valores menores de células NK, quando comparados aos controles não infectados.

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京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21303号 / 医博第4392号 / 新制||医||1030(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小川 誠司, 教授 生田 宏一, 教授 濵﨑 洋子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Regulatory T cells (Treg) play a key role in maintaining the immune tolerance. They suppress development of autoimmune diseases and contribute to maintaining the homeostasis of the immune system. Expansion and excessive ability of regulatory T cells to suppress the immune response is increasingly observed also at many types of cancer. Due to the active inhibition of the antitumor immune response Treg contribute to tumor progression. Specific phenotype based detection and analysis of Treg functional properties may contribute to the successful monitoring of Treg accounts and to the effective cancer immunotherapy itself. Tumor cells express high amounts of so-called tumor antigens, which may play a key role in the antitumor immune response. Expression level of the tumor antigens gives the evidence about relevancy of each antigen in the specific immune response and efficiency of cancer immunotherapy. These data are obviously important to be obtained from the tumor cell lines as well as primary tumor cells. In the first part of the thesis I was focusing on the quantitative analysis of regulatory T cells in tumor tissue and peripheral blood of patients with ovarian cancer. For this purpose I used the newly introduced methyl-sensitive quantitative PCR (MS-qPCR) method and compare the data with the widely...