According to WHO, leishmaniasis is endemic in 98 countries, and has been placed ninth in a global analysis of infectious diseases. Treatment of leishmaniasis is based on pentavalent antimonials but toxicity and developing resistance have been reported. Traditional medicine and scientific studies have shown that the extract of Galipea longiflora Krause (Evanta) exhibits antileishmanial activity. We hypothesized that the healing observed when using this plant might not only be due to the direct action on the parasite, but possibly to a parallel effect on the host immune response. We found that an alkaloid extract of Evanta (AEE) inhibited the growth of Leishmania braziliensis promastigotes while viability of eukaryotic cells was practically not affected. We also found that AEE interfered with polyclonal activation or Leishmania-specific re-stimulation of lymphocytes, as revealed by a reduction of in vitro cellular proliferation and IFN-g production. More important, AEE treatment of mice hosting L. braziliensis showed that AEE is able to control both inflammation and parasite load. Additionally, the healing process was improved when AEE and meglumine antimoniate were administered simultaneously. Dendritic cells (DCs) play a pivotal role in T-cell stimulation and polarization of naïve T cells. Therefore, we investigated if AEE could alter the activation of DCs and if allostimulatory DCs properties were altered if activated in the presence of AEE. DCs activated in the presence of AEE reduced the production of IL-12p40 and IL-23. When we analyzed the allostimulatory capacity of AEE-treated DCs, we found that allogeneic CD4+ T-cells secreted lower levels of IFN-γ. In conclusion, this thesis provides valuable insight into the effects of Evanta derived extract. The dual effect found for AEE, on Leishmania parasite and on the immune response, suggests that AEE may be useful in controlling the parasite burden and preventing over-production of inflammatory mediators and subsequently avoiding tissue damage. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Accepted. Paper 3: Submitted.</p>

Type 1 diabetes is a multifactorial disease resulting from the selective destruction of insulin-producing β-cells within the pancreatic islets of Langerhans. The mechanisms of β-cell death are not fully understood but cytokines are important mediators of this process. In the present study we found that the combination of IL-1β, TNF-α and IFN-γ induced a nitric oxide-dependent disruption of the mitochondrial membrane potential in rat insulin-producing RINm5F-cells, which seems to be a necessary event for both RINm5F-cell apoptosis and necrosis. The antiapoptotic protein Bcl-2 was able to prevent cellular death in RINm5F cells, most probably by counteracting the mitochondrial permeability transition. These results pointed out the potential of such antiapoptotic genes as gene therapy tools, to allow enhanced resistance against autoimmune destruction of β-cells in type 1 diabetes. For this purpose we used a progesterone-antagonist (RU 486)-inducible gene transfer system to achieve an efficient and controlled Bcl-2 overexpression in primary rat β-cells. However, in our experience, prolonged in vitro culture revealed adenoviral-induced islet cell necrosis, a process that was not prevented by Bcl-2 overexpression. Moreover, we observed that specific adenoviral genotypes correlate with differential induction of necrosis in both human and rat pancreatic islet cells. Although human islet cells showed an increased resistance in terms of viral concentrations required for the induction of cell-toxicity, our results showed that they were unable to build up an efficient antiviral response following infection and that their survival was dependent on the exogenous addition of α-interferon. In conclusion, adenoviral techniques for overexpression of antiapoptotic proteins in insulin-producing cells may provide useful tools against β-cell directed autoimmune destruction. However, understanding the specific interactions of the viral gene products with cellular proteins and how they are involved in β-cell death regulation is fundamental for an efficient and safe application of gene therapy approaches to type 1 diabetes.

Multiple myeloma (MM) is a virtually incurable B cell malignancy of the bone marrow. One important part of tumor progression and an obstacle for successful therapy is resistance to apoptosis. To combat this resistance, the mechanisms of apoptosis and survival in MM must be better defined. In this thesis, we identified Fas up-regulation as a mechanism underlying interferon (IFN)-mediated sensitization to Fas-induced apoptosis in the MM cell line U-266-1970. IFN treatment induced activation of signal transducer and activator of transcription (Stat)1 but, intriguingly, also attenuated activation of MM survival factor Stat3. Exploring the role of Stat1 further, we established sub-lines of U-266-1970 with a stable over-expression of Stat1 and of its active mutant Stat1C. These sub-lines displayed a decreased expression and activation of Stat3, and an altered expression of apoptosis-related genes Harakiri, Bcl-2 and Mcl-1. In a drug library screening, Stat1 over-expression was associated with an increased sensitivity to Fas-induced apoptosis and, conversely, an increased resistance to several drugs, including the cyclin dependent kinase (cdk)1 inhibitor CGP74514A. We conclude that Stat1 over-expression does not confer a general resistance or sensitivity to apoptosis in MM, but may strongly affect the response to some specific drugs. We also explored the effects of picropodophyllin (PPP), an inhibitor of the insulin-like growth factor I (IGF-I) receptor tyrosine kinase (RTK), in MM. PPP selectively inhibited the IGF-I RTK activity without inhibiting the insulin RTK activity. Furthermore, PPP potently induced cell cycle arrest and apoptosis in all MM cell lines and patient samples tested, also in the presence of survival factors IGF-I and IL-6. We conclude that PPP has great therapeutic potential in MM Finally, we examined the expression and regulation of the inhibitors of apoptosis proteins (IAPs) in a panel of MM cell lines and patient samples. The glucocorticoid dexamethasone, which is used in MM therapy, induced a transient up-regulation and a subsequent down-regulation of c-IAP2, as well as a down-regulation of XIAP, possibly influencing the sensitivity to apoptosis induced by this drug. Supporting this notion, abrogation of IGF-IR signaling by PPP, which sensitizes MM cells to dexamethasone-induced apoptosis, enhanced the down-regulation of c-IAP2 and XIAP.

L'axe IL-12-IFN-γ joue un rôle important dans l'immunité anti-mycobactérienne. J'ai identifié et étudié une cohorte de 137 patients présentant un déficit autosomique récessif complet d'IL12RB1 qui code la sous-unité β1 des récepteurs de l'IL-12 et de l'IL-23. Ces patients sont issus de 101 familles provenant de 30 pays. Ils présentent une grande diversité génétique avec 52 allèles mutants différents. Le phénotype cellulaire avec un défaut complet de réponse à l'IL-12 est homogène chez tous les patients. Les phénotypes cliniques sont eux très hétérogènes allant de l'absence d'infection jusqu'au décès. Il s'agit en grande majorité d'infections mycobactériennes (BCG, mycobactéries environnementales et tuberculose) et/ou à salmonelles. La candidose est aussi retrouvée associée à ce défaut chez un grand nombre de patients. L'axe IL-23-IL-17 participe à la différentiation et à l'activation des lymphocytes T CD4+ dits de type Th17. les cytokines et les mécanismes contrôlant la différentiation de ces cellules sont peu connus. J'ai étudié le développement des lymphocytes producteurs d'IL-17 chez des patients porteurs de défauts génétiques affectant la voie du TGF-β (patients TGFBR1, TGFBR2 et TGFB1), de l'IL-1β (patients IRAK4 et MYD88), de l'IL-6 (patients STAT3) et de l'IL-23 (patients IL12B et IL12RB1). Pour cela, j'ai quantifié la production et la sécrétion d'IL-17 dans deux modèles expérimentaux ex vivo et in vitro. Les patients IL12B-/- et IL12RB1-/-, et de façon plus drastique les patients STAT3-/- présentent une diminution des lymphocytes producteurs d'IL-17, ce qui suggère l'importance de ces molécules dans la différentiation et l'expansion des cellules Th17 in vivo

The induction of type I interferon (IFN) and subsequent activation of interferon stimulated genes (ISGs) represent a first line of defense against viral infection. Typically type I IFN signaling leads to the phosphorylation of the STAT1 and STAT2 transcription factors (TFs) which then form a trimetric complex with IRF-9 and translocate to the nucleus to induce ISG expression. However, the results of this study showed that IFN-mediated upregulation of the ISG Oas1b, the product of which confers resistance to flavivirus induced disease, can be induced in a STAT1-independent manner. Since numerous ISGs have antiviral functions, many viruses have evolved strategies to disrupt the type I IFN-signaling pathway. In cases when STAT1 activation is blocked by a viral infection, STAT1-independent upregulation of ISGs provides an additional strategy for the cell to mount an effective antiviral response. Infection of mouse embryofibroblasts (MEFs) with West Nile virus (WNV) induced the production of IFN beta and STAT1 and STAT2 phosphorylation but blocked nuclear translocation and binding of these TFs to the promoters of the ISGs, Oas1a, Oas1a, Irf7 and Irf1. However, each of these antiviral ISGs was efficiently upregulated in infected cells and IRF-9 was shown to be crucial for the upregulation of Oas1a, Oas1b and Irf-7. IRF-3 or IRF-7 was needed to maintain the upregulation of these genes at later times of infection. In contrast, the upregulation of Irf1 by WNV infection did not depend on the tested IRFs but was reduced by inhibition of the p38 or NF-kappa B pathways. Although Irf1 mRNA was efficiently upregulated in WNV-infected cells IRF-1 protein synthesis was blocked. The precise mechanism of the IRF-1 translational suppression is not yet known, but the suppression was shown not to be due to increased proteasomal degradation of IRF-1 nor to alternative splicing of Irf1 mRNA. Preliminary results suggest miRNAs may play an indirect role in regulating IRF-1 translation. The results of this study expand knowledge about the strategies evolved by viruses to evade host cell antiviral responses and also provide valuable insights about alternative mechanisms utilized by the host cell to counteract viral infections.

The quality of immune responses develops from birth into adulthood and in the context of the host microbial environment. The aim of this work was to study immune maturation during childhood, and how this process can be affected by the common herpesviruses; Epstein-Barr virus (EBV) and cytomegalovirus (CMV). In paper I we studied monocytes, an important cell type for immunity in the newborn. We showed that the neonatal monocyte subsets exist in similar frequencies as adult subsets, and have a potent capacity for pro-inflammatory cytokine production. In paper II, III and IV we studied the effects of EBV and CMV infections on immune cell function in children. In paper II we found that monocyte-induced NK-cell production of IFN-γ, and plasma IFN-γ levels, were decreased in 2-year old EBV- and/or CMV-seropositive children and mostly so in co-infected children. In paper III we found that in 5-year old children, EBV and CMV co-infection was associated with the highest levels of differentiated NKG2C+ NK cells. CMV+ children had higher plasma IFN-γ and IL-15 levels and higher NK-cell cytotoxic capacity. In vitro PBMC systems showed elevated frequencies of NKG2C+ NK cells in the presence of EBV-infected cells. In paper IV we showed that a child’s age and subsequent capacity for anti-viral cytokine production affects in vitro EBV infection in terms of B-cell proliferation and B-cell acquisition of memory phenotype. PBMC from CMV+ children had lower EBV-induced accumulation of switched memory B cells, which was connected to high prevalence of CD57+CD8+ T cells and IFN-γ production. Taken together, this thesis work shows that monocyte subsets at birth can give potent functional responses and that latency with EBV and CMV has a significant effect on the differentiation process and functional capacity of anti-viral effector cells during childhood. This in turn could affect responses to related or unrelated infections or even to non-invasive antigens such as allergens. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 3: Manuscript. Paper 4: Manuscript.</p>

Στην επίκτητη απλαστική αναιμία (ΑΑ) ο υποκυτταρικός μυελός και η πανκυτταροπενία στο περιφερικό αίμα είναι αποτέλεσμα βλάβης των αρχέγονων αιμοποιητικών κυττάρων. Προηγούμενες μελέτες έχουν δείξει ότι κύριο χαρακτηριστικό γνώρισμα της νόσου είναι η ποσοτική αλλά και ποιοτική διαταραχή της stem cell δεξαμενής. Κλινικά και εργαστηριακά ευρήματα προτείνουν το σημαντικό ρόλο του ανοσοποιητικού συστήματος και ειδικά των Τ λεμφοκυττάρων στην ανάπτυξη της απλαστικής αναιμίας. Σήμερα, πλέον, είναι ευρύτερα αποδεκτό ότι η καταστολή του μυελού, που παρατηρείται στην ιδιοπαθή απλαστική αναιμία, είναι αποτέλεσμα της υπερπαραγωγής των μυελοκατασταλτικών κυτταροκινών IFN-γ και TNF-α από διεγερμένα CD8+ κυτταροτοξικά λεμφοκύτταρα, τα οποία συναντούμε τόσο στο περιφερικό αίμα όσο και στο μυελό ασθενών με απλαστική αναιμία. Οι κυτοκίνες αυτές παρουσιάζουν μάλλον προσθετική αντί συνεργική δράση, η οποία σχετίζεται με την IFN-γ-εξαρτώμενη αύξηση της έκφρασης του Fas στα CD34+ κύτταρα και από την IFN-γ-επαγώμενη έκκριση του TNF-α από τα μακροφάγα. Μελέτες έχουν δείξει ότι τόσο τα CD34+ όσο και τα BMMNC κύτταρα του μυελού των ασθενών με ΑΑ είναι περισσότερα αποπτωτικά σε σχέση με φυσιολογικούς μυελούς. Στόχος της διατριβής ήταν η περαιτέρω μελέτη των μοριακών μηχανισμών που εμπλέκονται στην ανοσολογικής προέλευσης απλαστική αναιμία. Λόγω, όμως, του ότι η απλαστική αναιμία είναι μια σπάνια νόσος, η παρουσία ενός εύκολα αναπαραγώγιμου in vitro μοντέλου μυελικής απλασίας θα βοηθούσε περισσότερο στη μοριακή μελέτη αυτής. Στη μελέτη μας, η αναπαραγωγή του καταλληλότερου μοντέλου μυελικής απλασίας επιτεύχθηκε με την προσθήκη των μυελοκατασταλτικών κυτταροκινών IFN-γ και TNF-α σε φυσιολογικό σύστημα μακράς διάρκειας καλλιέργειας μυελού των οστών. Στο μοντέλο αυτό έγινε διερεύνηση των μοριακών μονοπατιών των σχετιζομένων με την Fas και TRAIL επαγόμενη απόπτωση. Παράλληλα, έγινε σύγκριση των δεδομένων από το in vitro μοντέλο με τα αποτελέσματα της παράλληλης μελέτης των αντίστοιχων μοριακών παραμέτρων σε κύτταρα μυελού ασθενών με απλαστική αναιμία. Στο IFN-γ/ΤNF-α μοντέλο παρατηρήθηκε σημαντική μείωση τόσο των πιο άωρων LTC-IC όσο και των πιο δεσμευμένων προγονικών κυττάρων, σε σχέση με τις καλλιέργειες-μάρτυρες. Επιπλέον, τα αποτελέσματα των πρωτογενών και δευτερογενών καλλιεργειών βραχείας διάρκειας σε μυελικά κύτταρα ασθενών με ενεργό νόσο, επιβεβαίωσαν το χαρακτηριστικό γνώρισμα της απλαστικής αναιμίας, δηλαδή, το μειωμένο αριθμό προγονικών αιμοποιητικών κυττάρων. Η επώαση φρέσκων φυσιολογικών μυελικών κυττάρων, σε 5-6 εβδομάδων LTBMC σύστημα, με συνδυασμό των TNF-α/IFN-γ παραγόντων οδηγεί σε αύξηση της Fas mRNA έκφρασης στα CD34+ κύτταρα, κάτι που δεν παρατηρείται στα, αντίστοιχα, φρέσκα και στα 5-6 εβδομάδων κύτταρα-μάρτυρες. Το εύρημα αυτό σε συνδυασμό με τη χαμηλή mRNA έκφραση της caspase 3 καθώς και την απουσία έκφρασης των Bcl-2, Bax και της caspase 8 στον ίδιο πληθυσμό, προτείνουν το σημαντικό ρόλο του external μονοπατιού επαγωγής της απόπτωσης, όπως αυτό ρυθμίζεται από την δράση των μυελοκατασταλτικών κυτοκινών TNF-α/IFN-γ. Παράλληλα, η παρουσία χαμηλής Bcl-2 mRNA έκφρασης, στα CD34+ κύτταρα, τονίζει τη σημασία της αναλογίας προ-αποπτωτικών/αντι-αποπτωτικών σημάτων στη κυτταρική έκβαση. To σημαντικότερο, πάντως, εύρημα του TNF-α/IFN-γ μοντέλου είναι η συνεχής TRAIL mRNA έκφραση, στα CD34+ κύτταρα αυτού, κάτι το οποίο δεν έχει αναφερθεί, ως τώρα, στη βιβλιογραφία. Η μοριακή ανάλυση των μυελικών κυττάρων των ΑΑ ασθενών απεκάλυψε, εκτός της Fas mRNA έκφρασης στα BMMNC και/ή στα CD34+ κύτταρα, την αυξημένη TRAIL mRNA έκφραση στο CD34+ κυτταρικό πληθυσμό των ασθενών με ενεργό νόσο. Αντίθετα, στους ασθενείς σε ύφεση, απουσιάζει η έκφραση και των δύο γονιδίων στον ίδιο πληθυσμό. Ενώ, στα BMMNC η έκφραση του TRAIL mRNA παραμένει, ένα συνεχές εύρημα, ακόμη και στους ασθενείς σε ύφεση. Επιπρόσθετα, η μειωμένη έκφραση των αντι-αποπτωτικών γονιδίων Bcl-xl και/ή Bcl-2 στα BMMNC όλων των ασθενών και του Bcl-xl στα CD34+ κύτταρα των ασθενών με ενεργό νόσο, δείχνει «ανίκανη» να αναστείλλει το μηχανισμό της απόπτωσης στους AA ασθενείς. Το γεγονός ότι η έκφραση του TRAIL mRNA είναι συνεχής στο CD34+ κυτταρικό πληθυσμό του TNF-α/IFN-γ μοντέλου και μόνο στα CD34+κύτταρα ΑΑ ασθενών με ενεργό νόσο, δείχνει τη σημαντικότητα του συγκεκριμένου μορίου στην απόπτωση των προγονικών κυττάρων στη μυελική απλασία. Συμπερασματικά, το μοντέλο μυελικής απλασίας που τελικά επιλέξαμε επιβεβαιώνει προηγούμενη γνώση της συμμετοχής των TNF-α και IFN-γ στη παθοφυσιολογία της απλαστικής αναιμίας. Παράλληλα, τα μοριακά δεδομένα, τόσο του μοντέλου όσο και των ασθενών με απλαστική αναιμία, ενισχύουν την εμπλοκή του Fas/FasL στη παθογένεση της νόσου και προτείνουν την πιθανή συμμετοχή του TRAIL/Apo2L στην όλη διαδικασία. / In aplastic anemia (AA) the hypocellular bone marrow and blood pancytopenia occur as a result of damage to hematopoietic stem cells . Previous studies have shown that a profound quantitative and qualitative defect in the stem cell compartment is a common feature in most patients with AA. Clinical and laboratory data suggest that the immune system, especially T lymphocytes, have an important role in the development of AA. It is well established that IFN-γ and TNF-α mediate hematopoietic stem cell suppression in aplastic anemia. These proinflammatory cytokines exhibit additive rather than synergistic effect, which may be mediated by the IFN-γ-dependent increase in Fas expression on CD34+ progenitor cells and by the IFN-γ-inducible secretion of TNF-α by macrophages. Bone marrow total mononuclear and progenitor cells from aplastic anemia patients are more apoptotic than cells from normal donors, indicating that apoptosis may be a major mechanism of stem cell loss in aplastic anemia. The aim of our study was to investigate the molecular mechanisms involved in the immune-mediated pathology of aplastic anemia. Since aplastic anemia is a rare disease the existence of an easily reproducible model of in vitro hematopoietic cell suppression can facilitate studies concerning the molecular pathways of this disease. In our study, we reproduced such a model with the addition of the myelosuppressive cytokines IFN-γ and TNF-α in a normal long term bone marrow culture system. In this model, we examined the Fas mediated pathway of apoptosis and especially the correlation between TRAIL expression and myelosuppression. We, also, studied these parameters in marrow cells from aplastic anemia patients. The IFN-γ and TNF-α inhibitory cytokines appeared to affect both immature LTC-ICs and more commited progenitor cells capable of lineage-specific colony formation (CFCs). In addition our progenitor cell assays results in patients, supported this unifying feature of reduced haematopoietic progenitor cells in aplastic anemia. TNF-α and IFN-γ treatment up-modulated Fas expression and induced apoptosis of 5-6 weeks cultured normal CD34+ cells, while normal freshly isolated and 5-6 weeks untreated cultured CD34+ cells showed no Fas mRNA expression. This finding, along with the low mRNA expression of caspase 3 and the absence of Bcl-2, Bax and caspase 8 expression, proposes the major role for activation of the extrinsic apoptosis pathway due to treatment of BMMNC with TNF-α and IFN-γ. In parallel, the existence of the low Bcl-xl mRNA expression in the same cell compartment points to the importance of the ratio of pro-apoptotic to anti-apoptotic signals, in cell fate. The most interesting finding is the constant TRAIL mRNA expression on CD34+ cells in TNF-α/IFN-γ treated LTBMC, something not mentioned before. Molecular analysis of patients’ marrow cells revealed, apart from Fas mRNA expression in BMMNC and/or CD34+ cells, TRAIL mRNA expression in CD34+ cell population in active disease. Ιn contrast, in patients in remission, both Fas and TRAIL mRNA expression does not exist. Instead, in BMMNC’s cell compartment TRAIL mRNA expression remains a constant finding even in patients in remission. Additionally, the decreased expression of anti-apoptotic bcl-xl and/or bcl-2 in all patients’ BMMNCs and bcl-xl expression in CD34+ cells from patients with active disease, seems unable to inhibit the mechanism of apoptosis in aplastic anemia patients. In our study, the fact that the expression of TRAIL was constant on CD34+ cells in TNF-α/IFN-γ treated LTBMC and only in CD34+ cells of patients with active disease, points out its significance in apoptosis of progenitor cells. In conclusion, our in vitro model of hematopoietic suppression confirmed previous knowledge for participation of TNF-α and IFN-γ in the pathophysiology of marrow failure in aplastic anemia. In parallel, the molecular data both from the in vitro model, as well as from patients with aplastic anemia, reinforce the implication of Fas/FasL pathway in the pathogenesis of this disease and propose a probable role for TRAIL/Apo2L in the process.

Η λεπτίνη παράγεται από τα κύτταρα του λιπώδους ιστού, καθώς και από άλλους ιστούς συμπεριλαμβανομένων του πλακούντος και ρυθμίζει τη πρόσληψη τροφής, τη κατανάλωση ενέργειας, την αναπαραγωγική διαδικασία και τις ανοσολογικές λειτουργίες. Για τη διερεύνηση του ρόλου της λεπτίνης επί του νεογνικού ανοσολογικού συστήματος μετρήσαμε τα επίπεδα λεπτίνης και κυτταροκινών (INF-γ, TNF-α, IL-2, IL-4, IL-10 και IL-12) στον ορό αίματος ομφαλίου λώρου 481 φυσιολογικών νεογνών τα οποία γεννήθηκαν από υγιείς μητέρες. 317 ήταν νεογνά με ιδανικό βάρος γέννησης για την ηλικία κύησης (AGA) και 164 έφεραν αυξημένο βάρος για την ηλικία κύησης (LGA). Η ενδιάμεση συγκέντρωση λεπτίνης σε ολόκληρο το δείγμα ήταν 11.6 ng/ml. Στο 12% AGA νεογνών, τα επίπεδα λεπτίνης ήταν υψηλότερα του μέσου όρου (ενδιάμεση τιμή 34 ng/ml). Στο 33% των νεογνών αυτών (4% του ολικού δείγματος) τα επίπεδα λεπτίνης κυμαίνονταν μεταξύ 37.5-204 ng/ml, στην ομάδα αυτή βρέθηκαν επίσης υψηλά επίπεδα ιντερφερόνης-γ (μέση τιμή 27.11 pg/ml, διακύμανση 17.5-38.5 pg/ml). Κατόπιν μελετήσαμε εάν η λεπτίνη μπορεί να επηρεάσει τη γονιδιακή έκφραση κυτταροκινών στα Τ κύτταρα και μονοκύτταρα αίματος ομφαλίου λώρου. Η καλλιέργεια των κυττάρων ομφαλίου λώρου (Τ ή μονοκυττάρων) AGA νεογνών, τυχαία επιλεγμένων ή κυττάρων περιφερικού αίματος ενηλίκου, με λεπτίνη είχε σαν αποτέλεσμα τη γονιδιακή έκφραση IL-2, INF-γ και IL-4 από τα κύτταρα του ομφαλίου λώρου, καθώς και από τα Τ κύτταρα του ενηλίκου όπως και την έκφραση IL-10 κυρίως από τα μονοκύτταρα αίματος ομφαλίου λώρου. Σημαντικά υψηλότερη γονιδιακή έκφραση INF-γ παρατηρήθηκε σε Τ κύτταρα ομφαλίου λώρου θήλεος τα οποία καλλιεργήθηκαν με λεπτίνη συγκριτικά με τα Τ κύτταρα ομφαλίου λώρου άρρενος. Συμπερασματικά, η παρουσία υψηλών συγκεντρώσεων λεπτίνης και INF-γ στον ορό αίματος ομφαλίου λώρου φυσιολογικών AGA νεογνών, καθώς και το γεγονός ότι η λεπτίνη μπορεί άμεσα να διεγείρει τη γονιδιακή έκφραση κυτταροκινών σε κύτταρα ομφαλίου λώρου (Τ και μονοκύτταρα) δείχνει ότι τα υψηλά επίπεδα λεπτίνης μπορούν ανεξάρτητα να επηρεάσουν το ανοσολογικό σύστημα των φυσιολογικών νεογνών και να συμβάλλουν στη Th1 διαφοροποίηση της ανοσολογικής απόκρισης. / Leptin is a hormone synthesized by adipocytes and other tissues, including the placenta, and it regulates food intake and energy expenditure, reproductive and immune functions. To investigate the role of leptin in neonatal immunity, we measured serum leptin and cytokine (INF-γ, TNF-α, IL-2, IL-4, IL-10, IL-12) levels in cord blood (cb) of 481 healthy neonates, born to healthy mothers, of which 317 were appropriately grown for gestational age (AGA) and 164 were large for gestational age (LGA). The median serum leptin concentration in the whole sample was 11.6 ng/ml. In 12% AGA neonates, leptin levels were well above average, with a median of 34 ng/ml. In 33% of these neonates (4% of the total sample) leptin levels ranged between 37.5-204 ng/ml; in this group, significantly elevated levels of serum IFN- were also found (mean 27.11 pg/ml, range 17.5-38.5 pg/ml). We then investigated whether leptin can independently influence cytokine gene expression by cb T-cells and monocytes (Mc). Culture of cb T-cells or Mc, isolated from randomly selected AGA neonates or adult peripheral blood mononuclear cells (PBMC), with leptin, resulted in upregulation of IL-2, IFN- and IL-4 gene expression in cb and adult T-cells and IL-10 gene expression mainly in cb-Mc. Significantly higher expression of IFN- occurred in female cb-T-cells cultured with leptin, compared with male cb-T-cells. In conclusion, the concurrent presence of high concentrations in both leptin and INF- in cb of healthy AGA infants, together with the fact that leptin can directly upregulate cytokine gene expression in cb T and Mc cells, indicate that abnormally high leptin levels can independently influence the immune system of healthy newborns, and may mediate gender differences in the development of a Th1 polarized immune response.

Despite Africa accounting for ~20% of the global cattle population, prevalence estimates and related risk factors of bovine tuberculosis (bTB), caused by Mycobacterium bovis, are still poorly quantified in many countries across the continent. Control of bTB in Africa is difficult due to poor monitoring of cattle movements and limited abattoir surveillance. Also M. bovis is zoonotic and risk factors for transmission include living in close contact with cattle and consumption of unpasteurised milk. Cattle keeping is integral to some rural populations in Cameroon and understanding the epidemiology of bTB in cattle populations is important both to bovine and public health. Detection of bTB in cattle is difficult due to variability of immune responses to M. bovis infection. The interferon-γ (IFN-γ) assay maybe useful to estimate bTB prevalence and identify bTB risk factors in Cameroon. However its performance can vary at different stages of bTB pathogenesis and in different cattle populations. Recently Fasciola hepatica co-infections have been reported to suppress IFN-γ responses in M. bovis infected cattle but the potential effect with F. gigantica co-infections on bTB prevalence estimates in Cameroon is unknown. An abattoir study was conducted in Cameroon to assess the performance of the IFN-γ assay. In 2012-13; 2064 slaughtered cattle were sampled from Bamenda abattoir (North West Region; NWR) and Ngaoundere abattoir (Vina Division; VD). Individual animal data was collected from routine meat inspection including identification of bTB and Fasciola pathology. Cattle were also tested for bTB using the IFN-γ assay and an M. bovis antibody ELISA. In the absence of a gold-standard diagnostic, the IFN-γ assay was compared to other diagnostic tests to assess agreement and identify factors that affected performance of the assay. Agreement between IFN-γ assay, TB lesion identification and an M. bovis antibody ELISA was poor-moderate, probably partly related to differences in immune response detected. A presence of Fasciola gigantica also increased the odds of false negative IFN-γ assay results. On further investigation co-infected cattle had increased odds of TB lesions and reduced IFN-γ responses that potentially could lead to ~20% reduction in test sensitivity. In an attempt to take into account the potential impact of F. gigantica, when estimating bTB prevalence, an antibody ELISA was developed to detect the exposure in live cattle. To highlight the awareness of disease in cattle-rearing communities, estimate prevalence and identify risk factors of bTB in cattle populations; two cross-sectional studies were conducted in 2013. A stratified clustered cross-sectional study of pastoral cattle herds, in the NWR and the VD, sampled 1448 pastoral cattle reared by 100 pastoralists. A smaller cross-sectional study sampled 60 dairy cattle from 46 small-holder co-operative dairy farmers. Individual animal data and herd-level data were collected and animals were screened by both the single comparative intradermal skin test (SCITT) and IFN-γ assay. Awareness of zoonotic TB was low yet consumption of raw milk was high in cattle-keeping communities highlighting the need for accurate bTB prevalence estimates. Despite the high awareness of the clinical presentation of bTB, clinical signs identified by pastoral herdsmen were not associated with cattle being bTB positive. The SCITT was used to compare two manufacturers cut offs for the IFN-γ assay, ≥0.05 and ≥0.1, and highlighted that these two diagnostics may detect different populations of bTB positive cattle. Using the IFN-γ assay at ≥0.1, bTB prevalence was highest in dairy cattle (21.67%) and was also present in pastoral cattle in the NWR and VD (11.33% and 6.55% respectively). Importantly, as F. gigantica is endemic in Cameroon and its influence could mean the true prevalence of bTB could be higher. Female pastoral cattle were at lower odds of being IFN-γ assay positive potentially due to immunosuppressive factors had lower odds of disease. Husbandry practices also decreased the odds of being IFN-γ assay positive such as drinking from streams, antelope and contact with herds at grazing. Age increased the odds of pastoral cattle being IFN- assay positive potentially being a confounder to chronicity of bTB and other co-infections may influence IFN-γ responses. Dairy cattle herds had different risk factors for being IFN- positive likely due to differences in husbandry practices. Considering the potential risk to public health of M. bovis this thesis highlights the extent of bTB across two major cattle keeping regions in Cameroon and the public health risk in cattle-rearing communities. Furthermore the relationship between Fasciola co-infection and IFN- responses to M. bovis described has potential implications for bTB diagnosis in cattle populations where the parasite is present across the globe.

Made available in DSpace on 2016-12-23T13:56:00Z (GMT). No. of bitstreams: 1 dissertacao de mestrado Tatiana Co.pdf: 1118842 bytes, checksum: f75eb8302dbe7252582bc592b702c3f7 (MD5) Previous issue date: 2006-09-28 / The cellular immune response probably plays a pivotal role in determining the clinical outcome after exposure to Mycobacterium tuberculosis (MTB). This immune response is mediated by Th1 cells, with production of IFN-g, the major cytokine in macrophage activation and mycobacteria eradication. Several factors can be related to tuberculosis resistance. We investigated the role of intestinal helminth infection on M. tuberculosis specific immune response during active tuberculosis in patients with concomitant tuberculosis and intestinal helminth infection at the time of diagnosis and during tuberculosis therapy. Forty patients with newly diagnosed tuberculosis were enrolled in this study. Twenty-seven percent of these patients were co-infected with at least one intestinal helminth (TB+Helminths patients). Concomitant intestinal helminth infection and tuberculosis had a negative impact on absolute numbers of total lymphocytes, B cells, T cells (CD4+ and CD8+), and NKT cells. These alterations were also accompanied by lower IFN-g and elevated and sustained IL-10 levels in whole blood cultures from TB+Helminths patients as compared to TB patients. In addition to a depressed anti-MTB immunity, TB+Helminths patients also presented more severe radiological pulmonary disease, with significant difference in the number of involved lung zones at the end of tuberculosis treatment. The data from this study indicated that intestinal helminth infection can disturb the protective immune response in patients with tuberculosis. / A resposta imune celular tem um papel fundamental na evolução clínica do hospedeiro após a exposição ao Mycobacterium tuberculosis (MTB). Essa resposta imune é mediada por uma resposta do tipo Th1, com a produção de IFN-g, principal citocina na ativação do macrófago e, conseqüentemente, na eliminação do bacilo. Vários fatores podem estar relacionados com a resistência a tuberculose. Neste trabalho, foi avaliado o papel da infecção helmíntica na resposta imune MTB-específica durante a tuberculose ativa em pacientes portadores de tuberculose, co-infectados por helmintos intestinais, no momento do diagnóstico e durante a terapia antituberculose. Para isso, foram arrolados 40 pacientes, com diagnóstico recente de tuberculose pulmonar. Desses pacientes, 27% eram portadores de pelo menos uma espécie de helminto intestinal (grupo TB+Helminto). A presença de helmintos intestinais nos pacientes portadores de tuberculose levou a um efeito negativo nos números absolutos de linfócitos totais, linfócitos B, linfócitos T (CD4+ and CD8+) e células NKT. Essas alterações nos números de células estavam acompanhadas de uma diminuição na produção de IFN-g e de elevados e prolongados níveis de IL-10 em sobrenadantes de cultura de sangue total no grupo TB+Helminto, quando comparado ao grupo nãoinfectado por helmintos intestinais. Adicionalmente à supressão da imunidade anti-MTB, os pacientes do grupo TB+Helminto apresentaram doença pulmonar mais grave (avaliada pelo exame radiográfico), com uma diferença significativa no número de zonas pulmonares envolvidas ao final do tratamento antituberculose. Os resultados desse trabalho sugerem que a infecção helmíntica intestinal pode prejudicar a resposta imune protetora nos pacientes portadores de tuberculose.