L’apparition d’une réponse immunitaire contre le Facteur VIII (FVIII) de la coagulation est une complication majeur qui survient chez 30% des hémophile A sévères. Bien que des avancées importantes aient abouti au développement de nouvelles molécules de FVIII thérapeutiques, les mécanismes conduisant à l’apparition d’une réponse immunitaire anti-FVIII restent non élucidés. Des facteurs de risques génétiques et environnementaux ont été identifiés ou suggérés, mais une compréhension complète des processus immunologiques permettant l’initiation de cette réponse au dépend de l’induction de tolérance immune chez 30% des patients restent incomprise. Ma thèse porte sur les aspects fonctionnels et structurels du FVIII et leur rôle dans l’initiation de la réponse immunitaire anti-FVIII chez le modèle murin hémophile A. Le premier rôle du FVIII est sa participation à la cascade de la coagulation, et donc la première partie de ma thèse adresse le rôle du processus de coagulation dans l’initiation de la réponse immunitaire anti-FVIII. La seconde partie de ma thèse se concentre sur l’importance des résidus du domaine C2 impliqué dans la liaison aux phospholipides dans l’endocytose et la présentation du FVIII par les cellules présentatrices de l’antigène in vitro et discute de leur relevance in vivo. / Immunogenicity of Factor VIII (FVIII) is a major hurdle that affects about 30% of severe hemophilia A patients. Though a significant advancement has been accomplished in the development of newer FVIII molecules, the factors that drive FVIII immune responses remain elusive. Many genetic and environmental risk factors have been identified or suggested but a complete understanding of the immunological basis for the antibody formation and the mechanism(s) behind tolerance induction, in the 30% of the patients that never develop anti-FVIII antibodies, are not understood. My thesis involves overlapping aspects important for initiation of an anti-FVIII immune response in a mouse model of hemophilia A. The primary role of FVIII is its participation in coagulation-associated events and thus, the first part of my thesis addresses whether coagulation events per se are implicated in the initiation of anti-FVIII immune responses. The second part of my thesis focuses on the importance of the membrane binding residues within the C2 domain of FVIII in antigen uptake and presentation by antigen presenting cells in vitro and discusses its relevance in vivo.

<p>Hemophilia A and B are X-linked recessive bleeding disorders caused by the deficiency of coagulation factor VIII (FVIII) and Factor IX (FIX), respectively. Current treatment involves life-long protein replacement therapy which is invasive, expensive and inaccessible to the majority of hemophiliacs worldwide. Treatment is further compromised by the development of neutralizing antibodies. Thus, the development of an alternative treatment that is safer, cost effective and non-invasive that circumvents immune response induction is desirable.</p> <p>To this end, a chitosan-mediated gene therapy strategy delivered orally was developed to provide clinically relevant plasma expression of FVIII or FIX. Hemophilia A mice that ingested chitosan nanoparticles containing FVIII DNA transiently expressed canine FVIII reaching >100 mU one day post treatment, together with partial phenotypic correction. Residual FVIII activity was detected for several days. Repeated administration of nanoparticles restored FVIII expression for 4 weeks and reduced clotting time in treated mice. Interestingly, inhibitors and non-neutralizing antibodies were not detectable throughout the experiment.</p> <p>The immunomodulatory effects of chitosan-mediated oral gene delivery was investigated in naive hemophilia A mice and mice with pre-existing inhibitors. Administration of nanoparticles containing human FVIII DNA in naive mice suppressed systemic antibody responses and provided long-term tolerance to rhFVIII protein immunizations for at least 8 weeks. This tolerance was transferable to naive mice, suggesting development of regulatory T cells. In contrast, repeated oral nanoparticle administration was unable to suppress FVIII-specific antibody responses in hemophilia A mice with pre-existing inhibitors.</p> <p>Treatment of hemophilia B is challenged by a 25-50 fold higher therapeutic threshold. Nevertheless, hemophilia B mice fed chitosan nanoparticles containing CpG-FIXi plasmid transiently expressed therapeutically relevant human FIX >14mU/mL plasma.</p> <p>Chitosan nanoparticle formulation was optimized <em>in vitro</em> for improved transfection efficiency. Nanoparticles formulated at a chitosan:DNA charge ratio of >2:1 (N:P) provided DNA protection against proton and enzymatic degradation that mimic conditions of the stomach and intestine, respectively. The inclusion of 25 mM sodium acetate-acetic acid decreased transfection of HEK 293 cells 4-fold, while 50 mM sodium sulphate increased uptake by ~40%. Optimal transfection was achieved with chitosan chloride (CL 213) formulated at a charge ratio of 3:1 in 50 mM sodium sulphate.</p> <p>These findings suggest chitosan nanoparticles can provide clinically relevant FVIII and FIX transgene expression, which is amenable to a one-tablet-a-day dosing strategy. Taken together, chitosan-mediate gene therapy delivered orally is proposed as a potential non-invasive alternative strategy for hemophilia treatment and without inducing neutralizing and non-neutralizing antibody production.</p> / Doctor of Philosophy (PhD)

O fator VIII de coagulação (FVIII), recombinante ou purificado de plasma, é o biofármaco necessário para o tratamento da hemofília A, a doença hemorrágica mais freqüente em humanos. O método tradicional para a purificação de FVIII parte de crioprecipitado de plasma e precipitação alcoólica. No Instituto Butantan, foi proposto um método alternativo, utilizando somente cromatografia para esta purificação. Este projeto teve por objetivo comparar dois métodos cromatográficos de purificação do FVIII: 1 - gel filtração direta do plasma e 2 - pré-purificação de FVIII do plasma por cromatografia de troca aniônica, seguida de gel filtração. A purificação foi analisada por dosagens de atividade específica de FVIII e presença de outras proteínas da cascata de coagulação nas frações de cromatografia. Foram realizadas clonagem de fragmentos gênicos de FVIII e expressão de fragmentos protéicos para imunização de animais. Os soros com anticorpos policlonais anti-FVIII foram usados em ensaios de \"western blot\" para detectar as cadeias de FVIII ou degradação. / Coagulation factor VIII (FVIII), recombinant or purified from plasma, is the biopharmaceutical used for treatment of haemophilia A, the most frequent human hemorrhagic disorder. The traditional method used for purification of FVIII starts from plasma cryoprecipitate and alcoholic precipitation. The Instituto Butantan proposed an alternative methodology using only chromatography for FVIII purification. The main objective of this project was to compare two chromatographic methods for FVIII purification: 1 - direct plasma gel filtration and 2 - pre-purification of FVIII by anion exchange chromatography, followed by gel filtration. The purification process was analyzed by determination of FVIII specific activity and detection of other coagulation factors co eluting in chromatographic fractions. Fragments of FVIII gene were cloned and protein fragments were expressed for animal immunization. Sera with polyclonal antibodies anti-FVIII were used in western blots assays to detect FVIII chains or its degradation.

O fator VIII de coagulação (FVIII), recombinante ou purificado de plasma, é o biofármaco necessário para o tratamento da hemofília A, a doença hemorrágica mais freqüente em humanos. O método tradicional para a purificação de FVIII parte de crioprecipitado de plasma e precipitação alcoólica. No Instituto Butantan, foi proposto um método alternativo, utilizando somente cromatografia para esta purificação. Este projeto teve por objetivo comparar dois métodos cromatográficos de purificação do FVIII: 1 - gel filtração direta do plasma e 2 - pré-purificação de FVIII do plasma por cromatografia de troca aniônica, seguida de gel filtração. A purificação foi analisada por dosagens de atividade específica de FVIII e presença de outras proteínas da cascata de coagulação nas frações de cromatografia. Foram realizadas clonagem de fragmentos gênicos de FVIII e expressão de fragmentos protéicos para imunização de animais. Os soros com anticorpos policlonais anti-FVIII foram usados em ensaios de \"western blot\" para detectar as cadeias de FVIII ou degradação. / Coagulation factor VIII (FVIII), recombinant or purified from plasma, is the biopharmaceutical used for treatment of haemophilia A, the most frequent human hemorrhagic disorder. The traditional method used for purification of FVIII starts from plasma cryoprecipitate and alcoholic precipitation. The Instituto Butantan proposed an alternative methodology using only chromatography for FVIII purification. The main objective of this project was to compare two chromatographic methods for FVIII purification: 1 - direct plasma gel filtration and 2 - pre-purification of FVIII by anion exchange chromatography, followed by gel filtration. The purification process was analyzed by determination of FVIII specific activity and detection of other coagulation factors co eluting in chromatographic fractions. Fragments of FVIII gene were cloned and protein fragments were expressed for animal immunization. Sera with polyclonal antibodies anti-FVIII were used in western blots assays to detect FVIII chains or its degradation.

A biotecnologia é definida como qualquer aplicação tecnológica que utilize sistemas biológicos, organismos vivos, ou seus derivados, para fabricar ou modificar produtos ou processos para alguma utilização específica (ORGANIZAÇÃO DAS NAÇÕES UNIDAS, 1992). Os produtos biotecnológicos devem atender certas especificações exigidas pela Agência Nacional de Vigilância Sanitária (ANVISA), Food and Drug Administration (FDA), European Medicine Agency (EMEA) e Wood Health Organization (WHO). Para isso, utilizam-se técnicas rotineiras aplicadas à pesquisa e análise de biomoléculas como Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis (SDS-PAGE), Western blot, Enzyme-Linked Immunosorbent Assay (ELISA) e espectrometria de massas (MS). A abordagem do Monitoramento de Reações Múltiplas (MRM) é considerada uma interessante alternativa aos ensaios imunoenzimáticos para caracterização e quantificação total de proteínas terapêuticas, sejam elas recombinantes ou não (KIM e DOYLE, 2010). Esta abordagem é baseada nos fundamentos da proteômica quantitativa pela utilização da cromatografia líquida acoplada à espectrometria de massas sequencial (LCMS/MS) cuja plataforma apresenta alta especificidade, sensibilidade e reprodutibilidade quantitativa em suas análises para detecção simultânea de várias regiões da estrutura proteica. Em vista disso, estabeleceu-se uma metodologia para quantificação do FVIII recombinante (FVIIIr) produzido pela linhagem celular humana Sk-Hep-1 ou do FVIII derivado do plasma (FVIIIdp), ambos utilizados no tratamento da Hemofilia A (HEMA). Para o estabelecimento da metodologia, toda uma estratégia de seleção e síntese química de peptídeos representativos das cadeias pesada e leve do FVIII humano foi empregada. Tais peptídeos obtidos foram utilizados como padrões das análises. Além disso, foi demonstrada a relação direta entre a quantificação total do FVIII com técnicas convencionais como ELISA, possibilitando a aplicação rotineira dessa abordagem para quantificação do FVIIIr e do FVIIIdp. / Biotechnology is defined as any technological application that uses biological systems, living organisms, or derivatives thereof, to make or modify products or processes for a specific use (ORGANIZAÇÃO DAS NAÇÕES UNIDAS, 1992). Biotechnological products must meet certain specifications required by Agência Nacional de Vigilância Sanitária (ANVISA), Food and Drug Administration (FDA), European Medicine Agency (EMEA), and Wood Health Organization (WHO). For that routine techniques applied to research and analysis of biomolecules such Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis (SDS-PAGE), Western blot, Enzyme-Linked Immunosorbent Assay (ELISA), and mass spectrometry (MS) are utilized as quality control techniques. The MS-based approach termed Multiple Reaction Monitoring (MRM) is considered an interesting alternative to immunoassays for the total quantification and characterization of therapeutic proteins, whether recombinant or not (KIM e DOYLE, 2010). This approach is based on the fundamentals of quantitative proteomics and uses of liquid chromatography coupled to tandem spectrometric mass (LC-MS/MS) to obtain a highly specific, sensitive and reproducible analysis for quantification of multiple regions of a given protein structure. Here, we established a methodology for total quantification of recombinant FVIII (rFVIII) produced in Sk-Hep-1 human cell line or of plasma derived FVIII (pdFVIII), both used in the treatment of Hemophilia A (HEMA). For that, we adopted a strategy of selection and chemical peptide synthesis of representative peptides of the heavy and light chains of human FVIII, which were used as standards in the analysis. The quantitative MRM method developed here indicated a direct correlation with FVIII quantitative techniques such ELISA, which allows routine application of such approach for rFVIII and pdFVIII quantification.

La survenue d'anticorps neutralisant le facteur VIII de la coagulation (FVIII) chez les patients hémophiles A constitue un échec thérapeutique majeur. Si les étapes effectrices de la réponse immunitaire, la nature des cellules immunitaires impliquées et les propriétés des anticorps ont été largement documentées, les étapes précoces de la réponse immunitaire restent mal connues et constituent l'objet de ma thèse. La première partie de ma thèse aborde le rôle du microenvironnement rencontré par le FVIII une fois administré in vivo, notamment le rôle des molécules du complément. Acteur majeur de l'immunité innée, le système du complément participe également aux réponses immunitaires adaptatives et peut interagir avec la cascade de la coagulation. Alors que le complément est impliqué dans les réponses immunitaires contre des agents pathogènes, son implication dans les réponses immunitaires dirigées contre les protéines thérapeutiques n'a jamais été décrite jusqu'à présent. Je me suis donc intéressé au potentiel rôle des molécules du complément dans l'immunogénicité du FVIII thérapeutique.La seconde partie de ma thèse aborde l'implication de la structure du FVIII pour sa reconnaissance par le système immunitaire. Ainsi, a-t-il été démontré l'importance du domaine C1 du FVIII pour sa prise en charge par les cellules du système immunitaire in vitro et pour son immunogénicité in vivo. En raison des fortes homologies de structure entre les domaines C1 et C2, je me suis intéressé au rôle potentiel du domaine C2 dans la capture du FVIII par les cellules présentatrices d'antigènes et l'élaboration de la réponse immunitaire anti-FVIII. / Occurrence of pro-coagulant factor VIII (FVIII) neutralizing antibodies in hemophilia A patients constitutes a major therapeutic failure. While the effector steps of the immune response, the nature of the involved immune cells and the antibodies properties have been well-reported, the early stages of the immune response are poorly described and constitute the topic of my PhD thesis. The first part of my thesis deals with the role of the microenvironment encountered by FVIII once administered in vivo, especially the role of complement system molecules. While complement system is a major actor of the innate immunity, it also participates to adaptive immune responses and can interact with the coagulation cascade. Though complement is involved in immune responses against pathogens, its contribution to immune responses against therapeutic proteins has never been reported so far. Therefore I have investigated the potential role of the complement system in the immunogenicity of therapeutic FVIII. The second part of my thesis focuses on the involvement of FVIII structure for its recognition by the immune system. It has been demonstrated that FVIII C1 domain plays a major role of its uptake by immune cells in vitro and its immunogenicity in vivo. Because of strong structural homologies between C1 and C2 domains, I investigated the potential role of FVIII C2 domain for its endocytosis by antigen presenting cells and the elicitation of the anti-FVIII immune response.

Orientador: Joyce Annichino-Bizzacchi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T06:24:29Z (GMT). No. of bitstreams: 1 Bittar_LuisFernando_D.pdf: 2765667 bytes, checksum: 034770d407c1c68eebc65646b23b7cc9 (MD5) Previous issue date: 2013 / Resumo: Introdução: Aumento dos níveis de fator VIII (FVIII) é um fator de risco prevalente e independente para tromboembolismo venoso (TEV). Síndrome pós-trombótica (SPT) é uma complicação a longo prazo da trombose venosa profunda (TVP) de membros inferiores, que está presente em 20% -50% dos pacientes, e podem ser associados a um processo inflamatório crônico. O receptor low density lipoprotein receptor-related protein 1 (LRP1) tem sido associado ao catabolismo do FVIII. Metodologia: Após uma mediana de 10 anos do primeiro episódio trombótico, avaliamos os níveis de FVIII em 68 pacientes com TEV e níveis elevados prévios deste fator, e 67 controles saudáveis. Posteriormente, foi analisada a presença de SPT em pacientes e sua relação com os níveis plasmáticos de FVIII. Além disso, foram avaliadas as regiões dos genes do FVIII e do LRP1 que codificam as regiões de afinidade entre eles, com o objetivo de verificar se essas alterações moleculares estão associadas aos níveis plasmáticos de FVIII, e com o TEV. Por último, foi avaliada a expressão proteica de LRP1 no fígado de 20 pacientes cirúrgicos. Resultados: Após 10 anos do primeiro episódio de TEV, os níveis de FVIII foram significativamente maiores em pacientes quando comparados aos controles (158,0 UI / dL vs 126,1 UI / dL, p <0,001]. Pacientes com SPT grave apresentaram níveis aumentados de FVIII (182,0 UI / dL) quando comparados aos pacientes com SPT moderada (155,5 UI / dL, p <0,001) ou sem PTS (154,0 UI / dL, p <0,001). Apesar de encontrarmos 14 alterações moleculares nos genes do FVIII e do LRP1, não foi encontrada nenhuma relação entre essas alterações moleculares e os níveis plasmáticos de FVIII ou com o TEV. Além disso, não foi observada correlação entre a expressão do LRP1 nas células hepáticas e os níveis plasmáticos de FVIII. Conclusões: Nós demonstramos um aumento persistente dos níveis de FVIII em um subgrupo de pacientes com TEV, mas de uma magnitude muito menor após 10 anos do primeiro episódio de TEV. Além disso, observamos uma associação significativa entre o aumento dos níveis plasmáticos de FVIII e SPT grave / Abstract: Introduction: Increased levels of factor VIII (FVIII) are a prevalent and independent risk factor for venous thromboembolism (VTE). Post-thrombotic syndrome (PTS) is a long-term complication of deep venous thrombosis (DVT) of the lower limbs that is present in 20%-50% of patients and can be associated to a chronic inflammatory process. The low density lipoprotein receptor-related protein 1 (LRP1) has been associated with FVIII catabolism. Methodology: After a median of 10 years of the first thrombotic episode, we evaluated FVIII coagulation levels in 68 patients with VTE and previous high levels of FVIII and in 67 healthy controls. Subsequently, we analyzed the presence of PTS in patients and its relationship with plasma levels of FVIII. Moreover, we evaluated the regions of FVIII and LRP1 genes encoding regions of affinity between these proteins, with the objective of determining whether these molecular changes are associated with plasma levels of FVIII and VTE. Finally, we evaluated the protein expression of LRP1 in the liver of 20 surgical patients. Results: After 10-years median of the first VTE episode, FVIII levels were significantly higher in patients when compared to controls (158.0 IU/dL vs. 126.1 IU/dL; p<0.001]. Patients with severe PTS showed increased levels of FVIII (182.0 IU/dL) when compared to patients with moderate PTS (155.5 IU/dL; p<0.001) or no PTS (154.0 IU/dL; p<0.001). Despite we have found 14 molecular changes in the FVIII and LRP1 genes, no relationship was found between these molecular alterations and FVIII levels or VTE. Moreover, no correlation was observed between LRP1 expression in the liver cells and plasma FVIII levels. Conclusions: We demonstrated a persistent increase of FVIII levels in a subset of patients with VTE, but in a much lower magnitude after 10 years of the first VTE episode. Moreover, we observed a significant association between increased plasma FVIII levels and severe PTS / Doutorado / Biologia Estrutural, Celular, Molecular e do Desenvolvimento / Doutor em Fisiopatologia Medica

A biotecnologia é definida como qualquer aplicação tecnológica que utilize sistemas biológicos, organismos vivos, ou seus derivados, para fabricar ou modificar produtos ou processos para alguma utilização específica (ORGANIZAÇÃO DAS NAÇÕES UNIDAS, 1992). Os produtos biotecnológicos devem atender certas especificações exigidas pela Agência Nacional de Vigilância Sanitária (ANVISA), Food and Drug Administration (FDA), European Medicine Agency (EMEA) e Wood Health Organization (WHO). Para isso, utilizam-se técnicas rotineiras aplicadas à pesquisa e análise de biomoléculas como Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis (SDS-PAGE), Western blot, Enzyme-Linked Immunosorbent Assay (ELISA) e espectrometria de massas (MS). A abordagem do Monitoramento de Reações Múltiplas (MRM) é considerada uma interessante alternativa aos ensaios imunoenzimáticos para caracterização e quantificação total de proteínas terapêuticas, sejam elas recombinantes ou não (KIM e DOYLE, 2010). Esta abordagem é baseada nos fundamentos da proteômica quantitativa pela utilização da cromatografia líquida acoplada à espectrometria de massas sequencial (LCMS/MS) cuja plataforma apresenta alta especificidade, sensibilidade e reprodutibilidade quantitativa em suas análises para detecção simultânea de várias regiões da estrutura proteica. Em vista disso, estabeleceu-se uma metodologia para quantificação do FVIII recombinante (FVIIIr) produzido pela linhagem celular humana Sk-Hep-1 ou do FVIII derivado do plasma (FVIIIdp), ambos utilizados no tratamento da Hemofilia A (HEMA). Para o estabelecimento da metodologia, toda uma estratégia de seleção e síntese química de peptídeos representativos das cadeias pesada e leve do FVIII humano foi empregada. Tais peptídeos obtidos foram utilizados como padrões das análises. Além disso, foi demonstrada a relação direta entre a quantificação total do FVIII com técnicas convencionais como ELISA, possibilitando a aplicação rotineira dessa abordagem para quantificação do FVIIIr e do FVIIIdp. / Biotechnology is defined as any technological application that uses biological systems, living organisms, or derivatives thereof, to make or modify products or processes for a specific use (ORGANIZAÇÃO DAS NAÇÕES UNIDAS, 1992). Biotechnological products must meet certain specifications required by Agência Nacional de Vigilância Sanitária (ANVISA), Food and Drug Administration (FDA), European Medicine Agency (EMEA), and Wood Health Organization (WHO). For that routine techniques applied to research and analysis of biomolecules such Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis (SDS-PAGE), Western blot, Enzyme-Linked Immunosorbent Assay (ELISA), and mass spectrometry (MS) are utilized as quality control techniques. The MS-based approach termed Multiple Reaction Monitoring (MRM) is considered an interesting alternative to immunoassays for the total quantification and characterization of therapeutic proteins, whether recombinant or not (KIM e DOYLE, 2010). This approach is based on the fundamentals of quantitative proteomics and uses of liquid chromatography coupled to tandem spectrometric mass (LC-MS/MS) to obtain a highly specific, sensitive and reproducible analysis for quantification of multiple regions of a given protein structure. Here, we established a methodology for total quantification of recombinant FVIII (rFVIII) produced in Sk-Hep-1 human cell line or of plasma derived FVIII (pdFVIII), both used in the treatment of Hemophilia A (HEMA). For that, we adopted a strategy of selection and chemical peptide synthesis of representative peptides of the heavy and light chains of human FVIII, which were used as standards in the analysis. The quantitative MRM method developed here indicated a direct correlation with FVIII quantitative techniques such ELISA, which allows routine application of such approach for rFVIII and pdFVIII quantification.

Cardiovascular disease (CVD) is a major cause of adult morbidity and mortality in developed as well as in developing countries. In black population groups, stroke is more prominent than ischaemic heart disease. This may be attributed to a combination of risk factors seen in this population group inter alia raised haemostatic markers, which favour the development of stroke since it is well known that a disturbance in the haemostatic balance (a hypercoagulable and a hypofibrinolytic state) predisposes to CVD. It is generally accepted that childhood genetic, environmental and behavioural factors lay the groundwork for the manifestation of adult CVD. Therefore, one of the studies that form part of this dissertation was a cross-sectional study to determine whether haemostatic abnormalities are already present in black African adolescents and to determine whether high risk groups exist [in relation to the following haemostatic markers: fibrinogen, factor VIII (FVIII), plasminogen activator inhibitor type 1 activity (PAI-Iact), and thrombin anti-thrombin complex (TAT)] for the development of CVD later in life. The population subdivisions were made according to gender, body fat %, maturity status, height for age Z-score, and habitual PA levels. Since behavioural factors [diet, physical activity (PA), smoking and drinking habits] are controllable determinants, it could be possible to improve CVD risk to a certain degree. Therefore, the second study that forms part of this dissertation attempted to establish whether a PA programme will successfully reduce haemostatic variables in a subset of the study population used in the first study. The reader is referred to the abstracts at the beginning of each separate study manuscript (Chapters 3 and 4), for a description of the subjects, study design and methods used in each study. The results of the cross-sectional study showed that in African adolescents (a) gender independently contributed to the variability in PAI-Iact, but that the gender difference in fibrinogen and TAT could be explained by the significant differences in fat mass and PA levels observed between the genders; (b) fibrinogen was significantly higher in the stunted compared to the non-stunted children indicating that childhood chronic malnutrition may possibly predispose independently to CVD; (c) fitness influences TAT concentrations positively and that (d) no significant differences in FVIII could be found between any of the subdivisions. As these determinants seem to be modifiable through behavioural changes and optimal nutrition status through early life, it raises a sense of urgency to develop strategies for the prevention and treatment of these risk factors. The results of the intervention study showed that an 11-week outdoor PA intervention programme had no significant effect on the haemostatic markers of African adolescents, but the results of this study should be interpreted with caution since (a) seasonal variations could have clouded the effect of the PA intervention as baseline measurements were taken in the summer and end measurements in the winter; (b) attendance of the PA sessions does not necessarily implicate compliance to the exercises given; (c) baseline values seem to play a prominent role in the changes that could be expected during an intervention and, therefore, improvements in the haemostatic profile would most likely be more significant in individuals with raised baseline levels. Similar research on African children is warranted since studies investigating PA's effect on haemostatic variables remain a topic of debate and speculation and data on African population groups are scanty. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2007

Les anticorps sont les molécules effectrices de l’immunité adaptatrice humorale. Ils se lient spécifiquement et neutralisent une large panoplie d’antigènes. Au-delà de leurs fonctions classiques, les anticorps possèdent les propriétés moins explorées que sont l’activité catalytique, qui permet aux anticorps de se comporter comme des enzymes, et la polyréactivité, qui représente la capacité d’une molécule d’anticorps à se lier à plusieurs antigènes structurellement différents. Les anticorps catalytiques sont retrouvés dans plusieurs pathologies chez l’homme, telle que l’hémophilie acquise, une maladie caractérisée par la survenue d’autoanticorps anti-facteur VIII. Dans ce travail, nous décrivons des IgG hydrolysant et activant le facteur IX de la coagulation chez les patients avec hémophilie acquise. Par ailleurs, nous avons effectué une étude longitudinale de deux ans des IgG catalytiques chez les patients subissant une transplantation rénale. Les anticorps polyréactifs représentent une proportion importante du répertoire des immunoglobulines circulantes. De plus, les sites inflammatoires sont abondants en molécules, telles que l’hème libre, capables de rendre polyréactives certaines IgG monoréactives. Nous avons étudié l’influence de la nature des régions constantes de la chaîne lourde des anticorps sur leur susceptibilité à devenir polyréactifs. Ce travail apporte un nouvel éclairage sur l’importance physiopathologique des anticorps catalytiques et polyréactifs. / Antibodies are effector molecules of the humoral arm of the adaptive immune system that bind specifically and neutralize diverse array of antigens. Beyond the classical function of antibodies exist the relatively less explored properties, of “catalytic activity” that enable antibodies to act as enzymes and “polyreactivity” that confers the ability to bind to several structurally unrelated antigens. Catalytic antibodies have been associated with several autoimmune, inflammatory and infectious diseases. Acquired hemophilia is an autoimmune disease, reported with the presence of catalytic antibodies against coagulation factor FVIII. In the present work, we have investigated the presence of factor IX (FIX) hydrolyzing IgG in patients with acquired hemophilia. We investigated the molecular mechanism and the physiological relevance of FIX activation upon hydrolysis by patients’ IgG. In addition, a longitudinal follow-up for 2 years was done in patients undergone renal transplant to investigate the evolution of catalytic antibodies in the course of disease. Polyreactive antibodies constitute a major portion of the natural antibody repertoire. Additionally, sites of inflammation are abundant in protein destabilizing agents like free heme that can induce polyreactivity in monoreactive antibodies. We have investigated the effect of the antibody constant domain on heme-induced polyreactivity. The present work has allowed us a better understanding of the physiopathological relevance of catalytic and polyreactive antibodies.