Le virus de l’immunodéficience humaine ou VIH est l’agent qui cause le SIDA. Le VIH donne lieu à une dérégulation dans la production de certaines cytokines qui ont un rôle immunologique très important chez les patients infectés. L’IL-18, autrement nommé facteur inducteur d’IFN-γ, est une cytokine pro-inflammatoire qui affecte le système immunitaire de façon importante. Son activité est régulée par l’"IL-18 Binding Protein" (IL-18BP), une autre cytokine qui se lie avec l’IL-18 et inhibe son activité biologique. Des études ultérieures ont montré des niveaux élevés d’Il-18 chez les patients infectés par le VIH par rapport aux personnes saines. Cependant, aucune étude n’a été réalisée concernant la production d’IL-18BP chez ces patients. Due à sa relevance dans la régulation de l’IL-18, nous avons étudié l’effet de l’infection par le VIH sur l’équilibre entre ces deux facteurs et l’impact de cet équilibre sur l’homéostasie des cellules NK. Nous avons mesuré les taux de l’IL-18 et de l’IL-18BP circulantes dans les sérums des patients infectés par le VIH en les comparants avec le même nombre de personnes saines et séronégatives. Nous avons aussi déterminé le nombre total des différents sous-types de cellules NK et analysé l’activité des cellules NK (Natural Killer). Finalement nous avons cherché à déterminer si l’IL-18 pouvait induire l’apoptose des cellules NK en activant l’expression de Fas ligand. Nos résultats nous démontrent que les patients infectés par le VIH ont trois fois plus d’IL-18 que les donneurs sains. Cependant les niveaux d’IL-18BP sont plus bas chez les patients infectés comparés aux donneurs sains. Alors, le ratio IL-18/IL-18BP est augmenté chez les patients infectés, ce qui entraîne une grande quantité d’IL-18 libre et biologiquement active circulante dans leur organisme. Nos études démontrent que chez ces patients, les concentrations d’IL-18 sont en corrélation négative avec l’activité cytotoxique de leurs cellules NK. Nos études in vitro démontrent que le traitement des cellules NK par l’IL-18 induit de façon fratricide leur apoptose en augmentant l’expression de Fas ligand. Finalement, cette production non coordonnée de ces deux facteurs pourrait contribuer à une immunopathologie induite par l’IL-18 en entraînant une apoptose fratricide des cellules NK qui possèdent un rôle important dans la réponse antivirale. Le dérèglement de l’homéostasie des cellules NK pourrait donc contribuer à la pathogenèse induite par le VIH. / HIV-1, the causative agent of AIDS, induces a deregulated production of several immunologically important cytokines in the infected persons. One of these cytokines is IL-18: a powerful proinflammatory cytokine that can regulate both innate and adaptive immune responses. In vivo, its activity is tightly regulated by IL-18 Binding Protein (IL-18BP), another cytokine that specifically binds and neutralizes IL-18 with high affinity. Previous studies have shown that IL-18 concentrations are significantly increased in the circulation of HIV-infected AIDS patients compared to those in healthy people. However, it is not yet clear how the increased levels of this cytokine affect the development of AIDS in HIV infected persons. Furthermore, little is known concerning the production of IL-18 antagonist (IL-18BP) in these patients. These issues were addressed in the studies presented in this thesis. We measured levels of IL-18 and IL-18BP in the sera of HIV-infected patients by using commercial ELISA kits and compared them with the values obtained from a similar number of healthy HIV-seronegative persons. We also determined the absolute and total number of different NK cell subsets and NK cell activity in the peripheral blood mononuclear cells (PBMC) of these individuals. Finally we determined the effects of recombinant human IL-18 as well as of IL-18-rich sera from AIDS patients on cytolytic activity and survival of human NK cells. Our results show that sera from HIV- infected patients contain up to 3 fold higher levels of IL-18 compared to the sera from healthy people. However, levels of IL-18BP were lower in the infected individuals compared to the healthy ones. Consequently, IL-18/IL-18BP ratio is increased in the patients resulting in a further increase in the concentrations of biologically active IL-18 in the circulation of these patients. Our results show that the concentrations of IL-18 correlated inversely with NK cell numbers as well as with their cytolytic activity in the infected persons. These results suggested the involvement of IL-18 in the disappearance of NK cells that prompted us to determine the potential cytocidal effects of this cytokine on human NK cells. The results from our in vitro experiments show that recombinant human IL-18 and IL-18-rich sera from AIDS patients caused apoptosis in a human NK cell line as well as in primary human NK cells. Anti-FasL antagonist antibodies inhibited this cell death. In a series of experiments, we found that IL-18 enhances expression of FasL but does not affect the expression of Fas on human NK cells. In vitro IL-18 also stimulated transcription from human FasL promoter. Furthermore, the cytokine also enhanced susceptibility of NK cells to Fas-mediated death, as it decreased the expression of an anti-apoptotic protein Bcl-XL. Our study shows that enhanced IL-18 bioactivity in HIV-infected patients may contribute to the pathogenesis of AIDS by disrupting NK cell homoeostasis.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

A ulceração aftosa recorrente (UAR) é considerada a doença ulcerativa mais frequente da cavidade bucal. Sua etiopatogenia ainda não está plenamente esclarecida, embora inúmeros fatores locais e sistêmicos já tenham sido a ela associados. Recentemente, a resposta imune anormal do tipo celular tem sido considerada a responsável pela lesão bucal na UAR, favorecendo uma resposta imunológica pró-inflamatória do tipo Th1, em conjunto com alterações em linfócitos T regulatórios. Sendo assim, o objetivo do presente estudo foi realizar análise da expressão gênica da FOXP3, MIP-3? e Interleucinas 2, 10 e 35 em pacientes com ulceração aftosa recorrente, por meio de estudo caso-controle. Os pacientes do grupo caso apresentavam quadros frequentes de UAR com pelo menos um ano de manifestação de surtos ulcerativos e história negativa de condições sistêmicas ou locais interferentes com a expressão das UAR. Estes foram submetidos a biópsia de lesão ulcerativa recente para a análise molecular. Os pacientes do grupo controle apresentavam história negativa de UAR, mucosa clinicamente saudável, e doaram voluntariamente fragmento de mucosa saudável para análise molecular, quando submetidos a procedimentos cirúrgicos como exodontia de terceiros molares ou biópsias ósseas. Todos os pacientes foram incluídos no grupo de pesquisa apenas após anuência com termo de consentimento livre e esclarecido. Submeteram-se a exame clínico, realizaram exames complementares para controle da saúde geral e suporte diagnóstico. Onze pacientes UAR e três controles voluntários compuseram a casuística estudada, sendo submetidos a biópsia de lesões de UAR ou de mucosa de revestimento sadia. As amostras de tecido bucal foram submetidas aos procedimentos laboratoriais de extração do RNA e análise da expressão gênica da FOXP3, MIP-3? e Interleucinas 2, 10 e 35 por meio da técnica de RT-PCR em tempo real. Não houve diferença significativa na expressão dos genes estudados entre as amostras de portadores de UAR e controles sadios. Concluímos que os genes aqui avaliados não parecem desempenhar papel distintivo na fase ulcerativa inicial das UAR, entretanto estudos adicionais são recomendados a fim de se verificar a real participação desses agentes da inflamação na expressão da doença. / Recurrent aphthous ulcers (RAU) is the most common ulcerative disease of the oral cavity. Its pathogenesis is poorly understood yet, although numerous local and systemic factors have been associated with it. Recently, abnormal immune response of cellular type has been considered responsible for the RAU oral lesions, promoting a pro-inflammatory immune response Th1-type, in conjunction with changes in regulatory T cells. Thus, the aim of this study was to analyze the gene expression of FOXP3, MIP-3? and interleukins 2, 10 and 35 in patients with recurrent aphthous ulceration through a case-control study. The case group of patients presented frequent RAU bouts with at least one year of manifestation of ulcerative outbreaks and negative history of local or systemic conditions interfering with the RAU expression. These patients were submitted to a biopsy procedure of a recent ulcerative lesion for molecular analysis. Patients in the control group presented no history of RAU, and agreed with a donation of a healthy mucosa fragment for molecular analysis when undergoing surgical procedures such as extraction of third molars or bone biopsies. All patients were included in the research group only after agreement with an informed consent. All subjects underwent clinical examination and were submitted to additional lab tests to check overall health and support diagnosis. Eleven RAU patients and three control volunteers composed the sample size and undergone biopsy of RAU lesions or healthy mucosal lining. The oral tissue samples were submitted to the laboratory procedures of RNA extraction and analysis of gene expression of FOXP3, MIP-3? and interleukins 2, 10, 35 by real time RT-PCR. There was no significant difference in gene expression between the studied samples of patients with RAU and healthy controls. It was concluded that the genes evaluated do not seem to play distinctive role in the initial ulcerative phase of RAU, however further studies are recommended in order to verify the actual participation of these inflammation agents in RAU expression.

A doença infecciosa que causa o maior número de mortes no mundo é a tuberculose, causada pelo bacilo Mycobacterium tuberculosis. Um dos fatores de risco que aumenta três vezes o desenvolvimento de tuberculose é a diabetes, sendo a obesidade associada com predisposição à diabetes. A obesidade gera inflamação de baixo grau que agrava a progressão de doenças crônicas. Estudos que avaliaram a associação da obesidade com tuberculose são controversos, e o tema merece maior investigação. No presente estudo, usamos um modelo experimental para determinar a interface da obesidade e da tuberculose. Camundongos C57BL/6 foram alimentados com dieta hiperlipídica (HFD - High Fat Diet) durante 60 dias, quando foram infectados com M. tuberculosis (HFD/Mtb) por via intra-traqueal. Como controles experimentais, animais foram alimentados com dieta padrão (LFD - Low Fat Diet) e infectados (LFD/Mtb). Paralelamente, um grupo recebeu HFD e outro LFD, e seguiram sem infecção. Após 30 dias de infecção, totalizando 90 dias de dieta, os diferentes grupos foram avaliados. Os animais obesos e infectados (HFD/Mtb) apresentaram aumento do peso corporal e do peso dos tecidos adiposos, aumento da expressão gênica de IL-1? no tecido adiposo, intolerância à glicose, deficiência na produção de insulina e aumento dos níveis séricos de IFN-? comparados aos animais LFD/Mtb. Além disso, o grupo HFD/Mtb foi mais suscetível e apresentou maior inflamação pulmonar comparado ao grupo LFD/Mtb. A inflamação foi caracterizada por aumento na expressão gênica para IL-17, IFN-?, TNF, IL-1?, IL-1?, NLRP3, caspase-1, IL-18, IL-6, aumento de células CD4+ produtoras de IFN-? e/ou IL-17 nos pulmões, e foi também acompanhada por aumento de células CD8+ e células CD4+Foxp3+ quando comparado ao grupo LFD/Mtb. Como NLRP3 é uma molécula chave na metainflamação induzida pela obesidade, mas seu papel ainda não está bem definido na tuberculose, animais deficientes de NLRP3 receberam HFD e foram infectados (NLRP3-/- HFD/Mtb). Esse grupo NLRP3-/- HFD/Mtb foi mais resistente e exibiu redução da inflamação pulmonar comparado ao grupo WT (Wild Type) HFD/Mtb. Sabendo que a obesidade está associada à disbiose e que produtos bacterianos derivados da dieta alimentar ou da microbiota podem estimular a liberação de IL-1? pela ativação de NLRP3, avaliamos o papel da microbiota na comorbidade obesidade e tuberculose. Encontramos disbiose intestinal, caracterizada por aumento do Filo Firmicutes e redução dos Filos Bacteroidetes e Proteobacteria, além do aumento de butirato e redução de acetato e propionato nos intestinos do grupo HFD/Mtb comparado ao grupo LFD/Mtb. O aumento na expressão de claudina-2 sugere alteração na permeabilidade intestinal e possível translocação bacteriana, caracterizada pela disbiose nos pulmões, nos quais foi detectado aumento de Firmicutes, Bacteroidetes e Actinobacteria, e redução de Proteobacteria no grupo HFD/Mtb. Em conclusão, a obesidade aumenta a magnitude da inflamação pulmonar e a suscetibilidade à infecção por M. tuberculosis por um mecanismo dependente de NLRP3. Ambos, aumento da suscetibilidade à infecção e da inflamação pulmonar estão associadas com disbiose intestinal e pulmonar, e aumento da permeabilidade intestinal. / The infectious disease that causes the largest number of deaths in the word is tuberculosis, caused by Mycobacterium tuberculosis bacilli. One of the risk factors that increases the devolpment of tuberculosis three times is diabetes. Obesity generates lowgrade inflammation that magnify the progression of chronic disease. Studies that have evaluated the association between obesity and tuberculosis are controversial, and the issue requires further investigation. In this study, we used an experimental model to determine the interface between obesity and tuberculosis. C57BL/6 mice were fed a highfat diet (HFD) for 60 days and infected by M. tuberculosis (HFD/Mtb) via intratracheal. As experimental control, animals were fed a light-fat diet (LFD) and were infected (LFD/Mtb). In parallel, one group was fed with HFD and another LFD, and they remained without infection. After 30 days of diet completing 90 days of feeding, the different groups were evaluated. Obese and infected animals (HFD/Mtb) showed increased body mass and adipose tissue weight, increased of IL-1? gene expression in adipose tissue, glucose intolerant, impaired insulin production and increased of serum levels of IFN-? compared to LFD/Mtb animals. In addition to, HFD/Mtb animals were more susceptible and exhibited higher lung inflammation compared to LFD/Mtb animals. The inflammation was characterized by increased of IL-17, IFN-?, TNF, IL-1?, IL-1?, NLRP3, caspase-1, IL-18, IL-6 gene expression and increase of IFN-? and/ or IL-17- producing CD4+ cells in the lungs, and was also accompanied by increased CD8+ and CD4+Foxp3+ cells compared to the LFD/Mtb group. As NLRP3 is a key molecule in obesity-induced meta-inflammation, but its role is still not well defined in tuberculosis, NLRP3 deficient animals fed with HFD and were infected (NLRP3-/- HFD/Mtb). This NLRP3-/- HFD/Mtb group was more resistant and exhibited reduction of lung inflammation compared to the WT (Wild Type) HFD/ Mtb group. Considerate that obesity-associated dysbiosis and that bacterial products derived from diet or microbiota can stimulate the release of IL-1? by the activation of NLRP3, we evaluated the microbiota role in obesity and tuberculosis comorbidity. We found intestinal dysbiosis characterized by increased Firmicutes phylum and reduction of Bacteroidetes and Proteobacteria phylum, as well as increased butyrate and diminished acetate and propionate in the intestine of the HFD/Mtb group compared to the LFD/Mtb group. An increase of claudin-2 expression suggests an alteration in intestinal permeability and a possible bacterial translocation characterized by dysbiosis in the lungs, with increased of Firmicutes, Bacteroidetes and Actinobacteria and diminished of Proteobacteria in the HFD/Mtb group. In conclusion, obesity increases the magnitude of pulmonary inflammation and susceptibility to M. tuberculosis infection by an NLRP3-depedent mechanism. Both increased susceptibility to infection and pulmonary inflammation are associated with intestinal and pulmonary dysbiosis, and increased intestinal permeability.

Background: Relapsing-remitting multiple sclerosis (RRMS) is an autoimmune inflammatory disorder of the central nervous system, with significant morbidity and mortality. The lymphocyte depleting, anti-CD52 monoclonal antibody alemtuzumab is a highly effective treatment option in RRMS, though associated with high rates of secondary autoimmune disorders. As alemtuzumab is now in routine clinical use, following licensing in Europe and the US, understanding the effects of repeated treatment cycles and reducing the risk of secondary autoimmunity is timely and essential. In this thesis, I explore how repeated treatment impacts the extent of lymphodepletion. I also study the role of soluble CD52, recently described as suppressive via interaction with Siglec-10, in the mechanism of secondary autoimmunity, and determine the biomarker potential of pre-treatment cytokine levels. Findings: CD4 and CD8 lymphocytes are less effectively depleted with repeated treatment cycles. Lymphocyte surface CD52 density was found by flow cytometry to be significantly lower after alemtuzumab treatment, although CD52-negative clones are not seen. In a cytolysis assay, reduced CD52 density was shown to correlate with reduced susceptibility to alemtuzumab. In addition, activated proliferating T lymphocytes, as observed after treatment, downregulated CD52 expression in a gene expression assay and shed the antigen from cell surface as demonstrated by ELISA and flow cytometry. The development of immunoassays to detect and quantify anti-idiotype antibodies to alemtuzumab is presented. The occurrence of antibodies at retreatment did not reduce lymphocyte depletion. A regulatory role for soluble CD52 was not found in suppression assays, and the proportion of antigen-activated CD52hi T cells did not vary between healthy controls and RRMS individuals. Siglec-10 was not seen on cell surface of activated T cells by flow cytometry and gene expression; thus concluding that soluble CD52 does not play a role in post-alemtuzumab induced autoimmunity. Prior to treatment, the only serum cytokine found to distinguish individuals who develop autoimmunity from those who do not was IL-21 (higher in the autoimmune cohort), however currently commercially available IL-21 immunoassays have no utility as predictive biomarker tests.

En dehors des effets cytostatiques ou cytotoxiques sur les cellules tumorales, certaines thérapies anti-cancéreuses peuvent déclencher la mort cellulaire immunogénique, libérant les signaux de danger pour alerter le système immunitaire. Les cellules T CD8+ T (Tc1) productrices d’IFN- et spécifiques de la tumeur sont nécessaires pour le succès de la chimiothérapie et la diminution de la croissance tumorale. L’amorçage d’une réponse bénéfique Tc1 dépend de la sécrétion d'IL-1β par les cellules dendritiques confrontées à des cellules tumorales traitées avec de l’anthracycline libérant de l’ATP. Pour identifier les composants inflammatoires qui lient les réponses immunitaires innées et adaptatives, nous avons analysé l'influence de la chimiothérapie immunogène sur le microenvironnement de la tumeur. Nous avons identifié une up-régulation de gènes associés à la réponse Th1 et Th17 dans un modèle de tumeur répondant au traitement par les anthracyclines par un retard de croissance. En interférant avec les voies IFN- ou l'IL-17A, l'effet thérapeutique de la doxorubicine et l'oxaliplatine a été aboli et le vaccin à base de cellules tumorales mortes ne protège plus les souris de la réintroduction de cellules tumorales vivantes. Nous avons également découvert que des sous-populations distinctes de lymphocytes T  (V4+ et V6+) colonisent des tumeurs peu de temps après la chimiothérapie, où ils ont proliféré et sont devenus producteurs majeurs de l’IL-17 au sein de la tumeur. Nous avons constaté une forte corrélation entre la présence de lymphocytes T  producteurs d’IL-17 ( T17) et de TIL CD8+ (Tc1) dans trois modèles différents de tumeurs traitées par la chimiothérapie ou la radiothérapie. IL-17A agit sur la signalisation en amont de l'IFN- puisqu’un défaut d’expression d’IL-17RA conduit à la perte complète de la production des Tc1 spécifiques de l’antigène. La contribution des cellules  T17 (V4+ et V6+) dans l’effet bénéfique de la chimiothérapie est essentielle puisque les souris V4/6-/-. L’axe IL-1β/IL-1R, mais pas IL-23/IL-23R, est essentielle pour la production d'IL-17 par les cellules T et l’effet bénéfique de la chimiothérapie. Le transfert adoptif de lymphocytes  T peut rétablir l'efficacité de la chimiothérapie dans le modèle de souris IL-17A-/- et améliorer l'effet de la chimiothérapie chez la souris wt, s'ils conservent l'expression de l'IL-1R et de l'IL-17A. Nos résultats suggèrent l’existence d’un axe fonctionnel: DC (IL-1β) → cellules T (IL-17) → Tc1 (IFN-), déclenché par la chimiothérapie induisant la mort des cellules tumorales, phénomène essentiel pour une réponse thérapeutique favorable. Pour renforcer la réponse immunitaire, nous essayons de combiner la chimiothérapie « immunogène » avec le vaccin anti-tumoral en présence d’adjuvants (poly (A:U), l'agoniste de TLR3).Ce type de thérapie séquentielle combinée, appelé VCT, pourrait retarder considérablement la croissance des tumeurs, voire l’éradiquer complètement et établir une protection spécifique à long terme. Pour décortiquer l'effet de la poly (A:U) sur le système immunitaire et sur les cellules tumorales exprimant le TLR3, nous avons effectué un traitement VCT chez la souris nude, TRIF-/- et les souris présentant une diminution de l’expression de TRIF au niveau des cellules tumorales. Ainsi l'effet anti-tumoral de VCT requiert les lymphocytes T et la voie de signalisation TRIF intacte au niveau de l'hôte et des cellules tumorales. Le traitement poly (A:U) peut induire un niveau élevé de production de certaines chimiokines associées à la réponse de type Th1 (CCL5 et CXCL10 ) par les cellules tumorales in vitro et in vivo, ce qui peut influencer négativement et positivement les résultats thérapeutiques. Le découplage de l’action de CCL5 et de XCL10, pourrait améliorer le traitement par la VCT. Notre étude souligne ainsi le rôle des facteurs inflammatoires dérivés de la tumeur et de l’hôte dans la régulation de la réponse immunitaire anti-tumorale. / Besides exerting cytostatic or cytotoxic effects on tumor cells, some anti-cancer therapies (anthracyclines, oxaliplatin, X-Rays) could trigger an immunogenic cell death modality, releasing danger signals to alert immune system. We have shown that tumor-specific IFN- producing CD8+ T cells (Tc1) are mandatory for the success of chemotherapy to prevent tumor outgrowth. Priming of Tc1 response depends on IL-1β secretion by DC confronted with anthracycline-treated tumor cells releasing ATP. To identify the inflammatory components which link innate and cognate immune responses, we analyzed the influence of immunogenic chemotherapy on tumor microenvironment. We found an upregulated Th1- and Th17-related gene expression pattern in growth-retarded tumor after anthracycline treatment. By interfering with IFN- or IL-17A pathways, therapeutic effect of doxorubicin and oxaliplatin was abolished and dying tumor cell-based vaccine lost its efficacy to protect mice from live tumor cell rechallenge. Interestingly, we discovered that distinct subsets of  T lymphocytes (V4+ and V6+) colonized tumors shortly after chemotherapy, where they proliferated and became the dominant IL-17 producers within tumor beds. In three tumor models treated with chemotherapy or radiotherapy, a strong correlation between the presence of IL-17-producing  T ( T17) and IFN--producing CD8+ TIL (Tc1) was discovered. IL-17A signaling acts as upstream of IFN- since defect in IL-17RA led to complete loss of antigen specific Tc1 priming. The contribution of  T17 cells (V4+ and V6+) to chemotherapy is critical as V4/6-/- mice showed reduced sensitivity to chemotherapy and vaccination. Also, tumor infiltrating  T17 and Tc1 cells were reduced to basal level in this strain. IL-1β/IL-1R, but not IL-23/IL-23R, is pivotal for IL-17 production by  T cells and the success of chemotherapy. Importantly, adoptive transfer of  T cells could restore the efficacy of chemotherapy in IL-17A-/- mice and ameliorate the effect of chemotherapy in wild type host, provided that they retain the expression of IL-1R and IL-17A. Our research suggest a DC (IL-1β) →  T cells (IL-17) → Tc1 (IFN-) immune axis triggered by chemotherapy-induced dying tumor cells, which is critical for the favorable therapeutic response. To boost the immune system, we try to combine immunogenic chemotherapy with tumor vaccine in the presence of TLR3 agonist Poly (A:U). This sequential combined therapy, which we named VCT, could significantly retard tumor growth or even completely eradicate tumor and establish long-term protection against rechallenge in highly tumorigenic models. To dissect the effect of Poly (A:U) on immune system and that on TLR3 expressing-tumor cells, we performed VCT treatment in nude mice, TRIF-/- mice and with TRIF-silencing tumors. Interestingly, our results suggested that anti-tumor effect of VCT required T cells and intact TRIF signaling pathway at the level of the host and that of tumor cells. Poly (A:U) treatment could induce high level of CCL5 and CXCL10 production from tumor cells both in vitro and in vivo, which could negatively and positively influence the therapeutic outcome. By uncoupling the effect of CCL5 from that of CXCL10, the VCT treatment can be ameliorated. Our study emphasizes that both tumor and host derived inflammatory factors participate in regulating anti-tumor response. We also highlight that therapeutic application of TLR agonists can be optimized through regulating the profile of chemokines and their downstream signaling events.

INTRODUÇÃO: O ozônio (O3) é encontrado na natureza e também pode ser produzido no corpo humano através da ativação de anticorpos. Seus efeitos anti-bactericidas são descritos na literatura, mas esses dados são controversos quanto a um potencial efeito benéfico da ozonioterapia no tratamento de certos tipos de infecção. OBJETIVO: Avaliar os efeitos da aplicação intraperitoneal (i.p.) de uma mistura gasosa de ozônio em um modelo de ligadura e punção de ceco (LPC) em ratos, através da dosagem de interleucinas (IL)-6, IL-10 e da quimiocina CINC-1 (cytokine-induced neutrophil chemoattractant), da lesão pulmonar aguda (LPA) e da análise das taxas de sobrevida. MÉTODO: Quatro grupos de ratos Wistar foram utilizados para análise de cada objetivo (CTR, LPC, LPC+O2 e LPC+O3). Os animais do grupo CTR foram submetidos somente a laparotomia. O grupo LPC foi submetido aos procedimentos de LPC. Os outros grupos foram submetidos à LPC e receberam injeção (i.p.) da mistura gasosa correspondente, administrada a cada 12 horas durante o período de observação. Os níveis séricos de IL-6, CINC-1 e IL-10 foram determinados por imuno- ensaio (enzyme linked immunosorbent assay- ELISA). A LPA foi avaliada através da histologia pulmonar e quantificada através do método do extravasamento pulmonar do Azul de Evans. Os animais da análise de sobrevivência foram observados por cinco dias. Os valores obtidos foramexpressos como médias ± erro-padrão da média (EP) ou medianas mais percentis 25 e 75(P25; P75), de acordo com a distribuição dos dados. Considerou-se significante p<0,05. RESULTADOS: Os ratos do grupo CTR exibiram os menores níveis de CINC-1 (p<0,01). O grupo LPC+O3 teve níveis menores de CINC-1 comparado a LPC+O2 e LPC (p<0,05). Os níveis de IL-10 do grupo CTR foram menores do que nos outros 3 grupos(p=0,02) . Não houve diferenças entre os outros 3 grupos (p=0,85). IL-6 foi significativamente menor para o grupo CTR (30,8± 4,8) quando comparado a todos os outros grupos (p<0,001). LPC+O3 e LPC+O2 exibiram níveis menores quando comparados ao grupo LPC (p<0,01). Não houve diferença entre os grupos LPC+O3 e LPC+O2 (p=0,54). O escore de histologia pulmonar foi menor para CTR (p=0,02). Os outros grupos não apresentaram diferenças significantes intergrupos (p=0,3). Os valores dos coeficientes de extravasamento pulmonar do Azul de Evans foram menores para LPC+O3 quando comparado aos grupos LPC+O2 e LPC (p=0,02), porém não houve diferença na comparação com CTR O grupo CTR teve o maior tempo de sobrevida (110±10h) comparado com os outros grupos, ou seja, LPC (57,3± 10,4h), LPC+O2 (71 ± 12,9h) e LPC+O3 (52,1 ± 8), os quais não apresentaram diferenças entre si quanto à sobrevida (p=0,4). CONCLUSÃO: No presente estudo experimental em ratos, a ozonioterapia teve um benefício potencial na modulação da resposta inflamatória e na LPA, mas não influenciou as taxas de sobrevida dos animais. / INTRODUCTION: Ozone (O3) is found in nature and also can be produced in the human body through activation of antibodies. Its antibacterial effect has been described in the literature, but these data are controversial regardi ng a benefic role of O3 therapy in the treatment of certain types of infection. OBJECTIVE: To evaluate the effects of intraperitoneal (i.p.) application of an O3 gas mixture in a rat model of cecal ligation and puncture (CLP), by analyzing interleukin (IL)-6, IL-10 and cytokine-induced neutrophil chemoattractant (CINC)-1 levels, acute lung injury (ALI) and survival rates. METHOD: Four animal groups were used (SHAM, CLP, CLP+O2 and CLP+O3). SHAM animals were submitted solely to laparotomy. CLP group was submitted to cecal ligation and puncture. The other groups were submitted to CLP and received injections (i.p.) of the corresponding gas mixture every 12 hours during the observation period. The serum concentrations of IL-6, CINC-1 and IL-10 were determined by the enzyme-linked immunosorbent assay (ELISA). ALI was evaluated with pulmonary histology and quantitated by means of the Evans blue dye (EBD) lung leakage method. For survival analysis, animals were observed for 5 days. Values were expressed as means ± SEM or medians (P25; P75), according to the data distribution. A p<0,05 was considered significant.RESULTS: SHAM rats had the lowest levels of CINC-1 compared to all other groups (p<0,01). CLP+O3 group had lower levels of CINC-1 compared to CLP+O2 and CLP (p<0,05). SHAM IL-10 levels were the lowest compared to the 3 other groups (p=0,02). There were no differences between the other 3 groups (p=0,85). IL-6 was significantly lower for SHAM compared to all groups (p<0,001). CLP+O3 and CLP+O2 had lower levels when compared to CLP (p<0,01). Comparison between groups CLP+O3 and CLP+O2 showed no significant difference (p=0,54). Pulmonary histology score was lower for SHAM (p=0,02). The other groups presented no statistical difference when compared to each other (p=0,3). EBD lung leakage values were lower to CLP+O3 compared to CLP+O2 and CLP (p=0,02). SHAM group had the longest survival time (110±10h) compared to all other groups (p=0,002). CLP (57,3± 10,4h), CLP+O2 (71 ± 12,9h) and CLP+O3 (52,1 ± 8h), which did not show difference on survival compared to each other (p=0,4). CONCLUSION: In this rat model of sepsis, ozone therapy had a potential benefit in the modulation of inflammatory response and ALI, but no improvement on survival rates was observed.

O principal mecanismo de defesa de hospedeiros infectados pelo Paracoccidioides brasiliensis (Pb), fungo dimórfico que causa a mais importante micose sistêmica da América Latina, é a imunidade celular. Neste processo participam macrófagos ativados por IFN-<font face=\"Symbol\">g e a IL-10 parece ser a citocina que se contrapõe a esta ativação. Tanto na patologia humana como em modelos experimentais há fortes indicações de que a IL-10 age como supressora da imunidade celular causando efeitos deletérios aos hospedeiros; entretanto, estudos diretos sobre a função da IL-10 na paracoccidiodomicose (PCM) não tinham sido ainda realizados. Então o objetivo fundamental deste trabalho foi estudar a função da IL-10 nos mecanismos da imunidade inata e adaptativa contra o Pb utilizando como modelo experimental camundongos geneticamente deficientes de IL-10 (IL-10 nocaute, IL-10 KO) em comparação com seus controles normais (WT). Demonstramos in vitro que macrófagos peritoneais normais de camundongos IL-10 KO apresentam uma maior atividade fagocítica e fungicida que os macrófagos de camundongos WT e isto esteve associado à maior produção de IFN-<font face=\"Symbol\">g, TNF-<font face=\"Symbol\">&#945, óxido nítrico (NO) e da quimiocina MCP-1. Verificamos, entretanto, que a produção de IFN-<font face=\"Symbol\">g era realizada por células NKT contaminantes de macrófagos aderentes nos camundongos IL-10 KO, sugerindo uma possível participação destas células na ativação de macrófagos e de células T de camundongos IL-10 KO. Estudos in vivo revelaram que a partir da 2ª semana de infecção os camundongos IL-10 KO apresentaram uma resposta imune precoce em relação aos WT, pois os pulmões dos primeiros apresentavam carga fúngica significativamente menor, associada com aumento da maioria dos isótipos de anticorpos (IgM, IgG1, IgG2a, IgG2b) específicos contra o fungo. Observamos também a inibição total da produção das citocinas IL-4 e IL-5, mostrando a ação reguladora da IL-10 na síntese de citocinas Th2. Na 4ª semana pós-infecção a carga fúngica continuou menor nos animais IL-10 KO, mas não foram observadas as diferenças quanto à síntese de anticorpos entre as duas linhagens. A análise dos leucócitos infiltrantes nos pulmões revelou um aumento na frequência de linfócitos T CD4+ ativados nos camundongos IL-10 KO em relação aos WT. A partir da 8ª semana, a carga fúngica pulmonar dos camundongos IL-10 KO reduziu consideravelmente e não ocorreu disseminação para outros órgãos. Observou-se também, nesta linhagem, um aumento na resposta de hipersensibilidade do tipo tardio (HTT), confirmando o padrão de resposta desviado para um perfil Th1. A análise histológica dos órgãos dos camundongos IL-10 KO revelou ausência de granulomas e fungos no pulmão em contraste aos seus controles WT que apresentavam elevado número de granulomas e fungos neste órgão. A análise dos linfócitos infiltrantes nos pulmões dos camundongos IL-10 KO mostrou redução na frequência de células B, o que é coerente com a baixa síntese de anticorpos observada. Houve aumento marcante na freqüência de células T CD4+ e T CD8+ memória/efetora, caracterizando mais uma vez a eficiente resposta imune celular nesses animais associada à ausência do papel regulador negativo da IL-10. Em fase mais tardia (16 semanas pós-infecção) a regressão da infecção nos camundongos IL-10 KO continuou evidente pelo pequeno número de fungos recuperados do pulmão, acompanhada de baixa síntese de citocinas (IL-5 e IL-2) e de anticorpos anti- P. brasiliensis. Na 23ª semana de infecção além da baixa carga fúngica nos camundongos IL-10 KO, associada à baixa frequência de células responsáveis pela imunidade celular ocorreu também redução na freqüência de células Treg, indicando o papel regulador da IL-10 nesta subpopulação celular. A elevada sobrevida (90%) dos animais IL-10 KO foi coerente com a baixa carga fúngica e eficiente resposta imune no curso da infecção. Em conjunto, nosso trabalho demonstra o importante papel regulador da IL-10 na imunidade da PCM. / Cellular immunity is the main defense mechanism of hosts infected by the Paracoccidioide brasiliensis (Pb), a dimorphic fungus that causes the most important systemic mycosis in Latin America. IFN-<font face=\"Symbol\">g activated macrophages participate in this activity that is antagonized by IL-10 an anti-inflammatory cytokine. Both, in the human pathology and in experimental models, there are a number of evidences indicating that IL-10 acts as a suppressor of cellular immunity leading to deleterious effects to the hosts. However, direct studies aimed at investigating the function of IL-10 in the immunity to paracoccidioidomycosis (PCM) have not been performed. Thus, the fundamental objective of this work was to study the function of IL-10 in the mechanisms of innate and adaptive immunity against Pb using as experimental model IL-10 deficient mice (IL-10 Knockout, IL-10 KO) compared to their respective wild type (WT) controls. We demonstrated in vitro that normal peritoneal macrophages of IL-10 KO mice presented increased phagocytic and microbicidal activities than macrophages of WT mice and this was associated witch an elevated production of IFN-<font face=\"Symbol\">g, TNF-<font face=\"Symbol\">&#945, nitric oxide (NO) and the chemokine MCP-1. However, the production of IFN-<font face=\"Symbol\">g seen to be performed by NTK cells contaminating adherent macrophages, suggesting a possible participation of these cells in the activation of macrophages and T cells of IL-10 KO mice. In vivo studies revealed that at the second week of infection IL-10 KO mice presented an earlier immune response when compared to wild-type mice, since their lungs exhibited a significantly reduced fungal burden and an increased production of almost all antibodies isotypes (IgM, IgG1, IgGM, IgG2b). This effect was accompanied by a total absence of IL-4 and IL-5, showing a regulatory action of IL-10 in the synthesis of Th2 cytokines. Four weeks post-infection, the fungal load was still lower in the IL-10 KO mice but no differences in antibody synthesis was observed. However, the analysis of lung infiltrating leukocytes revealed an increased frequency of TCD4+ and TCD4+CD44 high lymphocytes in IL-10 KO mice, again demonstrating an early activation of cellular immunity in IL-10 KO mice. When compared with WT mice, the pulmonary fungal loads of IL-10 KO mice at week 8 of infection were drastically reduced and no dissemination to other organs were observed. The histopathological analysis revealed an absence of granulomas and fungi in the lungs of IL-10 KO in comparison with WT mice. The analysis of lung infiltrating leukocytes showed that IL-10 KO mice had a reduction in the frequency of B cells, in agreement with the reduced synthesis of immunoglobulins. An increased frequency of activated T CD4+ and a drastic increase of TCD4+ and T CD8+ effector/memory cells charactering once again an efficient immune response associated with IL-10 deficiency. In later stages, sixteen weeks after infection, a regressive infection of IL-10 KO mice was further characterized by low numbers of fungi in the lung, reduced synthesis of cytokines (IL-4 and IL-5) and anti- P. brasiliensis antibodies. By week 23 after infection, in addition to the characteristic reduction of fungal loads and reduced frequency of immune cells, we observed a decrease in the frequency of Treg cells, demonstrating the implication of IL-10 in the control of this T cell population. The elevated survival (90%) of IL-10 KO mice was in total agreement with the low fungal burdens and efficient immune response observed during infection. In conclusion, our work demonstrates for the first time that IL-10 plays a major role in the control of innate and adaptive immunity to Pb infection.

O tratamento radioterápico continua aperfeiçoando-se, porém ainda pode estar associado com toxicidade pulmonar. Objetivo: Estudar os efeitos locais e sistêmicos provocados pela radioterapia conformacional torácica adjuvante em mulheres portadoras de câncer de mama, sem fatores de riscos prévios para desenvolvimento de alterações pulmonares. Por meio da tomografia computadorizada de alta resolução; identificar as possíveis alterações radiológicas no parênquima pulmonar. Se presentes, correlacioná-las com parâmetros obtidos da exploração funcional dos pulmões, com os efeitos sistêmicos, pela dosagem de mediadores inflamatórios, IL-1, IL-6 e TNF- , e suas repercussões sobre a qualidade de vida. Material e Métodos: Em 25 pacientes saudáveis foram coletadas amostras de sangue para serem utilizadas apenas como referência de normalidade da IL-1, IL-6 e TNF- . Em decorrência dos rígidos critérios de inclusão e exclusão estabelecidos, das 157 pacientes entrevistadas apenas 24 foram selecionadas para o estudo. A avaliação funcional pulmonar foi abrangente e constou de: medida dos volumes e capacidade dos pulmões, sendo o volume residual obtido pelo método de diluição do hélio em circuito fechado; estudo dos fluxos expiratórios máximos (curva fluxo x volume e curva volume x tempo) e medida da capacidade de difusão pulmonar pela técnica de respiração única do CO. A tomografia computadorizada de alta resolução (16 detectores) foi realizada no pré-planejamento da radioterapia conformacional do tórax, esta com dose total de 45-50 Gy em 25 frações. Para as dosagens de citocinas plasmáticas foram empregadas as técnicas de imunoabsorção enzimáticas (ELISA). Na avaliação da qualidade de vida foi aplicado o questionário Saint George´s Respiratory Questionnary traduzido e adaptado culturalmente ao Brasil. Todos estes procedimentos foram obtidos na fase pré e repedidos 3 meses após a radioterapia. Os resultados das duas fases foram comparados utilizando-se a versão exata do teste Wilcoxon e o teste de Correlação de Spearman, nível de significância p 0,05. Resultados: Entre parâmetros funcionais houve queda significativa apenas na difusão e no fluxo expiratório a 50% da capacidade vital forçada. Mesmo comportamento observou-se para citocina IL-6, já que os mesmos encontravam-se aumentados pré-RT. Não ocorreram mudanças significativas em nenhum dos domínios do questionário de qualidade de vida. As alterações tomográficas ocorreram 60,87% das pacientes na fase pós-radioterapia, em sua maioria de graus leves a moderados e não correlacionaram-se com as alterações observadas em outros parâmetros estudados. Conclusão: O aumento observado na IL-6 durante a fase pré-RT, parece ser um bom índice preditivo de alteração pulmonar. A capacidade de difusão foi a alteração mais evidente e parece ser o índice que melhor reflete as alterações pulmonares que afetam essas pacientes. Diante das discretas alterações tomográficas e funcionais observadas após a RT, é provável que para a redução observada na DLCO concorra uma combinação de fatores ao nível da membrana alvéolo-capilar. No conjunto, as alterações induzidas pela radioterapia conformacional nas pacientes estudadas foram de pequena monta, insuficientes para influenciar aspectos funcionais do pulmão e a qualidade de vida. / Radiotherapy continues to improve itself, but it may still be associated with pulmonary toxicity. Objective: To study the effects caused by local and systemic adjuvant thoracic conformal radiotherapy in women with breast cancer, without risk factors prior to the development of pulmonary alterations. Through high-resolution computed tomography, to identify the possible radiological alterations in the lung parenchyma. If positive identification occurs, correlates it with pulmonary functional parameters, its systemic effects, the dosage of inflammatory mediators IL-1, IL-6 and TNF-, and their impact on quality of life. Material and Methods: Blood samples were collected from 25 healthy patients to be used as a normal reference for IL-1, IL-6 and TNF- mediators. Due to the established strict inclusion and exclusion criteria, only 24 from the initial 157 interviewed patients were selected for this study. The evaluation of pulmonary function was comprehensive and included: Lung volume and capacity measurement through closed loop helium residual volume dilution method;Peak expiratory flow study (flow curve x volume and volume vs. time curve) and CO diffusing capacity measurement through single breath technique. High-resolution computerized tomography (16 detectors) was performed in the pre-planning phase of thoracic conformal radiotherapy where 45-50 Gy total dose was applied in 25 fractions. For cytokines plasma measurement, the enzymatic immunosorbent techniques (ELISA) were used. For quality of life assessment, the Brazil´s validated Saint George\'s Respiratory Questionnary was used. All these procedures were applied in the pre-phase and repeated three months later after radiotherapy sessions. The results of the two phases were compared using the exact version of the Wilcoxon test and Spearman correlation test with p 0.05 significance level. Results: Among the functional parameters, there were a significant decrease in dissemination and expiratory flow at 50% of forced vital capacity. The same behavior was observed for cytokine IL-6, since they were already high at pre-RT. There were no significant changes in any of the aspects of quality of life questionnaire. The tomographic alterations occurred in 60,87% of patients in the post radiotherapy phase, mostly having low to moderate degree and not correlated with the observed changes in other parameters. Conclusion: The IL-6 increase in the pre-RT phase appears to be a reasonable predictive index of pulmonary alterations. The diffusing capacity alterations were the most evident and seem to be the index that best reflects the pulmonary alterations that affect these patients. Given the discrete tomographic and functional abnormalities observed after RT, it is likely that for the observed reduction in DLCO compete a combination of factors occurring at alveolar-capillary membrane level. Overall, the conformal radiotherapy induced changes in the studied patients were not expressive, insufficient to influence the pulmonary functional aspects and the quality of life of the patients.

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