FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / The Hasumi vaccine (VH) is an imune-stimulant mode by two preparations obtained from distinctive forms, it is an assisting in a pool of tumours antigens. The assisting is taken off from calf splens and the antigen, from different forms of tumor. The VH is a sterile uncoloured liquid, conditioned in 0,5mL glass ampoules, separately. The present research aimed to evaluate, throughout a Phase I study, the security of VH, as well as the comprehension of its action mechanism. The clinical experiment was conducted in 24 healthy volunteers in wich the VH was given subcutaneously every 5 days during 2 months, accomplishing an amount in wich the two first ones were given in the hospital. Before the first administration, all the voluteers did the Prick test, to evaluate the possibility of reacting to hipersensibility. After that they were submit to clinical and laboratorial evaluation (hemogram, biochemical, urine extract and parasitological excrements exams, sorology to B and C hepatitis, HIV, FAN, reumatoidic factor, C3, CD3, CD4, CD8, IgA, IgG, IgE, IgM, PSA, CEA, AFP and HCG-beta). The planning of the experiment also had the repetition of such exams after the 3th, 6th and the 12th doses, as well as in the after-study 30 days after the last dose. By hte and of the study, significant adverse events were not observed. Therefore, in the last dose and within the stabilished treatment period of this experiment, the VH was shown to be safe and with no toxity. / A Vacina Hasumi (VH) à um imuno estimulante constituÃdo por duas preparaÃÃes obtidas de formas distintas, sendo um adjuvante e um pool de antÃgenos tumorais. O adjuvante à retirado de cÃlulas de baÃo de bezerros e o antÃgeno, de diversas formas de tumor. A VH à um lÃquido incolor estÃril, acondicionado em ampolas de vidro, no volume de 0,5mL, separadamente. O presente trabalho objetivou avaliar, atravÃs de um Estudo de Fase I, a seguranÃa da VH, bem como a compreensÃo do seu mecanismo de aÃÃo. O ensaio clÃnico foi conduzido em 24 voluntÃrios sadios nos quais a VH foi administrada por via subcutÃnea a cada 5 dias durante 2 meses, perfazendo um total de 12 administraÃÃes, sendo as 2 primeiras em regime de internamento hospitalar. Antes da primeira administraÃÃo, todos os voluntÃrios realizaram o prick teste, para avaliar a possibilidade de reaÃÃo de hipersensibilidade, apÃs o que, foram submetidos a avaliaÃÃes clÃnica e laboratorial (hemograma completo, bioquÃmica, sumÃrio de urina, parasitolÃgico de fezes, sorologia para hepatite B e C, HIV, FAN, fator reumatÃide, C3, CD3, CD4, CD8, IgA, IgG, IgE, IgM, PSA, CEA, AFP, Beta HCG). O planejamento do experimento compreendeu tambÃm a repetiÃÃo das avaliaÃÃes apÃs a 3a, 6a e a 12a doses e no pÃs-estudo, 30 dias apÃs a Ãltima dose. Ao final do estudo nÃo foram observados eventos adversos significantes. Portanto, na dose e no tempo de tratamento estabelecidos neste ensaio, a VH mostrou-se segura e nÃo apresentou toxicidade.

As piodermites, superficiais ou profundas, representam uma das dermatopatias caninas mais comuns no cotidiano da clínica dermatológica de cães. Dentre as classificadas como superficiais, destacam-se a foliculite bacteriana e a piodermite esfoliativa ou superficial disseminada, que representam a grande maioria dos casos. Em alguns cães, as piodermites superficiais são idiopáticas, apresentam evolução crônica e caráter recidivante. A despeito de criteriosa investigação acerca de sua possível etiologia, por vezes, não se consegue evidenciar a causa para a instalação e recorrência do quadro mórbido. Tais animais apresentam frequentes recidivas, em variáveis períodos de tempo, após o término da terapia antibiótica. Para estes caninos, na bibliografia médico-veterinária há recomendação de emprego das controvertidas imunoterapia ou de antibioticoterapia sob a forma de pulsos. Portanto, objetivou-se na casuística do Serviço de Dermatologia do Hospital Veterinário da USP, determinar as principais espécies bacterianas envolvidas, a susceptibilidade destas frente a diferentes antimicrobianos, bactericidas ou bacteriostáticos, assim como, comparar a eficácia e a segurança de três distintos protocolos terapêuticos no manejo a longo prazo, de piodermites superficiais recidivantes idiopáticas. Utilizaram-se 23 animais, de quaisquer dos sexos, de distintas raças e faixas etárias. A amostragem foi aleatoriamente disposta em três grupos de experimentação (GI, GII, G III), respectivamente submetidos à imunoterapia com bacterina comercial (Estafilin®) e às pulsoterapias de \"finais de semana\" ou em \"semanas alternadas\", empregando-se cefalexina \"per os\". O principal patógeno, em 67,6 % da totalidade de isolamentos bacterianos, foi Staphylococcus intermedius. Evidenciou-se (32,4 %), ainda, as espécies S. hyicus, S. schleiferi subespécie coagulans, S. warneri e Micrococcus sp. Segundo os antibiogramas, os fármacos mais efetivos in vitro foram a amoxicilina associada ao clavulanato de potássio, a cefalexina e o ceftiofur. Verificou-se resposta plena em percentis de, respectivamente, 50,0 %, 33,3 % e 28,6 % nos Grupos II, III e I; destarte, ao se agrupar as respostas plena e moderada evidenciaram-se valores relativos de, respectivamente, 83,3 %, 50,0 % e 42,9 %. À luz da estatística (Teste do Qui Quadrado), não se observaram quaisquer diferenças estatisticamente significativas (p > 0,05) entre os percentuais de resposta aos três protocolos empregados. Todos eles mostraram-se seguros, sem acarretar efeitos adversos farmacodérmicos. / Superficial and deep pyodermas are common canine skin disorders in the small animal dermatology practice. Among the superficial form, the bacterial folliculitis and superficial spreading pyoderma represent the great majority of cases. Some dogs are affected by idiopathic, chronic and recurrent type of superficial pyoderma. Despite a rigorous search for possible reasons for its etiology, sometimes it is not possible to determine an underlying cause for the disease recurrence. At variable time periods, these dogs show frequent recurrent episodes, after the interruption of antibiotic therapy. For these patients, the veterinary medicine literature recommends the use of the controversial immune therapy or antibiotic pulse therapy. Thus, using the University of Sao Paulo / Dermatology Service\'s casuistry the present study aimed to determine the major bacterial species responsible for pyodermas, their susceptibility to several bactericidal and bacteriostatic antibiotics as well as compare the efficacy and safety of three different therapeutics protocols for the long term management of idiopathic recurrent superficial pyoderma. A total of 23 male and female, purebred dogs from different ages were randomly allocated in three distinct experimental groups (G I, G II and G III), respectively treated with bacterin immune therapy, \"weekend\" antibiotic pulse therapy and \"week on - week off\" antibiotic pulse therapy, receiving cephalexin PO. S. intermedius was identified from 67,6 % of the totality of bacterial isolates and the remaining 32,4 % was composed of S. hyicus, S. schleiferi subspecie coagulans, S. warneri and Micrococcus sp. According to the antimicrobial susceptibility results the more effective drugs were amoxicillin plus potassium clavulanate, cephalexin and ceftioufur. In percentage values a full response of 50,0 %, 33,3 % and 28,6 % was achieved in Groups I, II and III, respectively. On the other hand, when the comparison was made considering full and moderate together the values were 83,3 %, 50,0 % and 42,9 % for Groups I, II and III, respectively. Through a statistical analysis (Qui score test) no significant difference (p > 0,05) among the response to treatment percentage values was observed for the three groups. All treatments were secure and no drug eruption side effects were observed.

Avaliamos os mecanismos regulatórios desencadeados pela imunização materna na resposta alérgica da prole OVA. A imunização materna com OVA promoveu alterações como o aumento da expressão dos receptores FcgRIIb nos linfócitos B esplênicos dos neonatos aos 3 dias de idade (d.i.), o que se manteve até os 20 d.i. Com a imunização das proles no período neonatal a imunização materna inibiu a produção de anticorpos IgE anti-OVA. Além disso, foi observado na população de linfócitos B da prole o aumento da expressão dos receptores FcgRIIb e CD44. A transferência passiva de IgG de mães imunes no pós-natal mostrou uma inibição da produção de IgE, e no período pré-natal foi capaz de reduzir a expressão das moléculas CD40 e CD23 nos linfócitos B e a secreção de IL-10 em linfócitos T CD4 na prole no período neonatal. As evidências mostram que a imunização pré-concepcional com OVA induz mecanismos que regulam a resposta IgE da prole imunizada no período neonatal, o que foi parcialmente observado com a transferência passiva de anticorpos IgG durante o período pré e pós-natal. / To evaluate the regulatory mechanisms triggered by maternal immunization in the immune response of the offspring, the effect of preconceptional immunization with OVA was evaluated. Maternal immunization with OVA led to early alteration with increased expression of FcgRIIb in B lymphocytes from 3 days old pups. Offspring from immune mother showed diminished percentage of CD4 T cells IL-4+. The immunization of offspring during neonatal period showed that maternal immunization inhibits the production of anti-OVA IgE antibodies. The evaluation of CD4 T cell population revealed diminished IL-4+ cells. Passive IgG transfer from immune mother during neonatal period showed inhibition in the IgE synthesis, during pregnancy showed capacity to reduce the expression of CD40 molecules in B cells from neonatal pups. These evidences show that maternal OVA immunization down regulates the IgE response of offspring including phenotypic and functional alteration in B and CD4 T cells. These alterations were partially observed with IgG transfer during pregnancy or after birth.

Orientadores: Lucimara Gaziola de la Torre, Patrícia Cruz Bergami-Santos / O texto da introdução e conclusão estão na lingua portuguesa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Química / Made available in DSpace on 2018-08-22T15:41:58Z (GMT). No. of bitstreams: 1 Vitor_MicaelaTamara_M.pdf: 6469643 bytes, checksum: c14b8646a57fec71cc1e0eac8a82cddb (MD5) Previous issue date: 2013 / Resumo: Esta pesquisa teve como objetivo o desenvolvimento tecnológico de uma vacina lipossomal contendo RNA tumoral destinado à imunoterapia do câncer. Nesta estratégia, RNA total codificando o antígeno tumoral Her-2/neu extraído de linhagem de células de adenocarcinoma de mama humano SK-BR-3 foram incorporados em lipossomas catiônicos introduzidos in vitro em células dendríticas (DCs). A vacina de DCs tem a função de auxiliar o sistema imunológico a identificar antígenos tumorais para que as células cancerígenas sejam eliminadas. Porém uma das etapas críticas é a introdução (transfecção) de RNA nas DCs. Lipossomas catiônicos é uma alternativa promissora, pois além de ativarem as DCs, é capaz mediar a transfecção de ácidos nucléicos para células. A experiência prévia do grupo de pesquisa na área de lipossomas catiônicos mostrou a possibilidade da obtenção de lipossomas em larga escala para o desenvolvimento de vacina de DNA contra a tuberculose. Neste contexto, este trabalho avaliou os lipossomas catiônicos com a composição lipídica de fosfatidilcolina natural de ovo (EPC), 1,2-dioleoil-sn-glicero-3-fosfatidiletanolamina (DOTAP) e 1,2-dioleoil-3-trimetilamônio-propano (DOPE), na respectiva proporção molar de 50/25/25%. Metodologicamente, o trabalho foi dividido em quatro partes: na primeira parte foi apresentada uma visão geral do trabalho desenvolvido, demonstrando o potencial dos lipossomas catiônicos complexados com RNA na imunoterapia do câncer. Na segunda parte do trabalho investigaram-se os efeitos dos lipossomas produzidos através do processo laboratorial na diferenciação/maturação das DCs in vitro e as DCs estimuladas por estes lipossomas, na indução da proliferação de linfócitos T, resultando em lipossomas catiônicos incorporados pelas DCs, com a capacidade de ativar as DCs in vitro e de induzir proliferação de linfócitos T. A terceira parte do trabalho teve como finalidade a otimização da produção dos lipossomas catiônicos obtidos através do método de injeção de etanol utilizando a ferramentas estatísticas, obtendo lipossomas com menor polidispersidade e tamanho, que demonstraram in vitro serem incorporadas e ativarem as DCs e induzirem a proliferação de linfócitos T. A última etapa refere-se ao estudo da incorporação do RNA nos lipossomas catiônicos produzidos através do processo escalonado otimizado e comparado com o laboratorial no intuito de serem internalizados pelas DCs, transfectar o RNA e induzir a proliferação de linfócitos T através das DCs. Os resultados demonstraram que os complexos foram internalizados pelas DCs e que estas são capazes de induzir a proliferação de linfócitos T, porém há necessidade de se obter a condição ótima de transfecção. Dessa forma, conclui-se que os lipossomas catiônicos em questão têm potencial para serem usados como ferramenta em futuras estratégias na imunoterapia do câncer / Abstract: This research aimed at the technological development of a liposomal vaccine containing tumor RNA for cancer immunotherapy. In this strategy, total RNA encoding the Her-2/neu tumor antigen extracted from cell line of human breast adenocarcinoma SK-BR-3 were incorporated into cationic liposomes, which were introduced in vitro into dendritic cells (DCs). DCs vaccine has the function of helping the immune system to identify tumor antigens in order to eliminate cancerous cells. However, one of the critical steps is the introduction (transfection) of RNA in DCs. Cationic liposomes are a promising alternative, because besides activating DCs, they are able to mediate transfection of nucleic acids into cells. Previous work of our research group in the cationic liposomes field developed a liposomal nanostructure obtained by a scale up process containing DNA vaccine against tuberculosis. In this context, this work evaluated the cationic liposomes composed by egg phosphatidylcholine (EPC), 1,2-dioleoyl-3-trimethylammonium propane (DOTAP) and 1,2-dioleoylphosphatidylethanolamine (DOPE), at 50/25/25% molar proportion respectively. Methodologically, the present work was carried out in four mean steps: in the first step, it was carried out an overview of all work, showing the relevancy of cationic liposomes complexed with RNA for cancer immunotherapy. The second part of this work investigated the effects of liposomes produced via laboratory process upon DCs differentiation/maturation in vitro and induction of T lymphocytes proliferation by DCs stimulated with these liposomes, resulting in cationic liposomes incorporated by DCs, capable to activate DCs in vitro and to induce proliferation of T lymphocytes. The third part of the work aimed at optimizing the production of cationic liposomes obtained via the ethanol injection method using statistical tools, obtaining liposomes with smaller size and polydispersity, which demonstrated to be incorporated and activate DCs in vitro and to induce T lymphocytes proliferation. The last step refers to the study of RNA incorporation in the cationic liposomes produced via optimized scalable process compared to the laboratory process in order to be internalized by DCs, transfected RNA and to induce T lymphocytes proliferation by DCs. The results showed that the complexes were internalized by DCs and they are able to induce T lymphocytes proliferation, however we still have to obtain the optimal transfection condition. In sum, we conclude that the cited cationic liposomes can be used as a potential tool in further strategies in cancer immunotherapy / Mestrado / Desenvolvimento de Processos Biotecnologicos / Mestra em Engenharia Química

Orientadores: Carlos Alberto Petta, Fernando Guimarães / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T13:56:32Z (GMT). No. of bitstreams: 1 Silva_RodrigoFernandesda_M.pdf: 2312952 bytes, checksum: 26e5506763c6314d5615c77880da2e51 (MD5) Previous issue date: 2013 / Resumo: As células NK são linfócitos conhecidos pela capacidade de eliminar uma variedade de células malignas, sem a necessidade de estímulo prévio e por meio de um processo de reconhecimento inato, o qual envolve receptores ativadores e inibidores. Esta capacidade também foi observada nos linfócitos NK-like T, porém a via de reconhecimento imunológico envolvida pode ser tanto a inata quanto a adaptativa. Neste estudo, avaliou-se a atividade funcional e a expressão de receptores ativadores DNAM-1, NKp30 e NKp44 das células NK e NK-like T, do sangue e ascite de pacientes com neoplasia de ovário. Foi colhido sangue de 24 pacientes com neoplasia de ovário (11 benignas, Bng; 6 malignas sem metástases, Mlg e 7 malignas com metástases, MlgMt) e ascite (Asc) de 6 pacientes, mediante consentimento assinado. Células mononucleares foram separadas por gradiente de centrifugação. A ativação das células NK e NK-like T foi determinada pela expressão da molécula CD107a por meio da citometria de fluxo, quando coincubadas com as células K562 (proporção 1:1). Foram comparados os efeitos de dois procedimentos de cultivo celular, um de curta duração (18h) empregando meio RPMI-1640 suplementado com SFB (10%), L-glutamina (2mM) e IL-2 (1000UI/ml) e outro de longa duração (21 dias) empregando meio SCGM CellGro suplementado com anti-CD3 (10ng/ml, nos primeiros 5 dias), IL-2 (1000UI/ml) e SFB (10%) em relação à atividade funcional e a expressão dos receptores ativadores. A atividade funcional das células NK pareceu ser afetada em decorrência da evolução da doença. A estimulação com IL-2 de curta duração aumentou a atividade funcional das células NK, mas não significantemente. A estimulação com IL-2 de longa duração aumentou a atividade funcional das células NK significantemente (p<0.001). A porcentagem de células NK expressando os receptores ativadores DNAM-1, NKp30 e NKp44 aumentou significantemente (p<0.05) depois da estimulação com IL-2 de longa duração. As células NK-like T apresentaram baixa atividade funcional nos períodos de estimulação de pré e curta duração e nenhuma atividade na estimulação de longa duração. Foi observado que a integridade funcional das células NK foi comprometida com o desenvolvimento do câncer de ovário. A estimulação de longa duração resultou em um maior número de células NK funcionais quando comparado à de curta duração, conferindo este método para uso imunoterápico. A estimulação de longa duração também foi eficiente no aumento da expressão do receptor ativador DNAM-1 nas células NK, sugerindo este método para reverter à supressão deste receptor, que frequentemente é observada em pacientes com carcinoma de ovário. A falta de ativação das células NK-like T (pré, curta e longa duração) sugere que, no sistema experimental aplicado, estas células não são ativadas pela via imune inata / Abstract: NK cells are lymphocytes known by their ability to eliminate a variety of malignant cells without previous stimulation, in a process involving innate recognition by an array of stimulatory and inhibitory receptors. Similarly, the variant subset of NK-like T lymphocytes has been reported to eliminate tumor cells, but the targeting process might involve either innate or adaptive immune recognition. This study evaluated the functional activation of NK and NK-like T cells, the expression of activating receptors DNAM-1, NKp30 and NKp44 (pre, short- and long-term IL-2 stimulated), from blood and ascites of ovarian neoplasia patients. Blood was collected from 24 patients with ovarian neoplasias after signed consent: 11 benign (Bng), 6 malignant without metastasis (Mlg) and 7 malignant with metastasis (MlgMt). Ascites (Asc) was collected from 6 patients with ovarian neoplasia. Mononuclear cells were separated by gradient centrifugation. NK and NK-like T cells activation (pre, short- and long-term stimulated) was evaluated against K562 (1:1 ratio) by the expression of CD107a, analyzed by flow cytometry. Short-term stimulation with IL-2 (1000UI/ml) was conducted overnight in RPMI-1640 medium supplemented with FBS (10%) and L-glutamine (2mM). Long-term stimulation was conducted by a 21 day culturing process with SCGM CellGro medium supplemented with anti-CD3 (10ng/ml, first 5 days), IL-2 (1000UI/ml) and FBS (10%). The functional activation of NK cells pre stimulated seemed to be impaired with the progression of the disease. Short-term stimulation increased NK cells activation, but not significantly. Long-term stimulation increased NK cells activation significantly (p<0.001). The percentage of NK cells expressing the activating receptors DNAM-1, NKp30 and NKp44 increased significantly (p<0.05) after long-term stimulation. NK-like T cells showed low activation on pre and short-term and none activation on long-term IL-2 stimulation. Long-term stimulation resulted in a much higher number of functional NK cells compared to short-term, entitling this method for adoptive therapy. Long-term stimulation was particularly efficient to up-regulate DNAM-1 activating receptor on NK cells, representing a way to overcome down-regulation demonstrated on patients with ovarian carcinoma. The lack of activation of NK-like T cells (pre, short- and long-term IL-2 stimulated) suggests that, in the method applied; these cells are not activated through innate pathway / Mestrado / Fisiopatologia Ginecológica / Mestre em Ciências da Saúde

Immunotherapy is a potent new treatment for non-small cell lung cancer. However, immunotherapy is much more expensive than many treatment alternatives. Previous cost-effectiveness analyses determined that nivolumab would be cost effective if it elicits a response rate greater than 20% (Sullivan et al., 2016), is given to all non-squamous and all PD-L1 positive squamous stage IV non-small cell lung cancer patients (Aguiar et al., 2016), or is 33% cheaper for PD-L1 positive patients or 45% cheaper for all patients (Matter-Walstra et al., 2017). This thesis analyzes these three studies and accounts for the effect that many responders survive much longer than those who respond to other treatments by modeling overall survival for patients on nivolumab with two regressions. These regressions estimate, that after 150 months, the value (in terms of life-years saved) of nivolumab is about four times greater than that of docetaxel. Depending on pricing strategy, nivolumab was found to cost either $1,000 less or $16,000 more per month of survival than docetaxel. These estimates differ considerably due to imprecision in price estimates. Because of this high degree of uncertainty, it is impossible to say whether or not nivolumab is cost effective. Due to the considerably longer average survival which results from nivolumab treatment and the ambiguous cost-effectiveness results, immunotherapy should be treated as a possibly cost-effective treatment. Further cost-effectiveness analyses will be necessary once future costs of immunotherapy can be better estimated.

SAMMANFATTNING Introduktion Olika typer av allergier utgör de vanligaste folksjukdomarna i Sverige. Allergenspecifik immunterapi (ASIT) är en behandlingsmetod för patienter med måttlig till svår allergisk rinit med eller utan astma, då symtomlindrande behandling varit otillräcklig. Syfte Syftet med denna studie var att få ökad kunskap om hur patienter skattar sina allergiska symtom, skattning av egenvårds medicinering samt skattning av den hälsorelaterade livskvaliteten, före, under och efter avslutad ASIT-behandling mot björkpollen och/eller 5-gräs. Metod Studien var en kvantitativ registerstudie med deskriptiv och komparativ ansats. Patienters skattning av allergiska symtom och skattning av egenvårds medicinering samt den skattade livskvaliteten har studerats. Datainsamlingen är gjord under åren 2005 - 2009 med hjälp av ett självskattningsformulär som tilldelades patienter som fick ASIT-behandling på en Lung- och allergimottagning på ett sjukhus i mellan Sverige. Undersökningsgruppen bestod av 42 patienter, 22 män och 20 kvinnor. Medelåldern i gruppen var 34,7 år. Resultat Resultatet i denna studie visade att det finns ett negativt samband mellan patienters skattning av allergiska symtom och skattning av livskvalitet både före och efter avslutad ASIT behandling. Livskvaliteten skattades signifikant högre mellan första och sista mätningen i hela patientgruppen. Både kvinnor och män skattade lägre egenvårds medicinering under behandlingstiden, men resultatet visar inte på några signifikanta skillnader i skattning av medicinering mellan kvinnor och män. Resultatet visade inga skillnader mellan könen avseende förändringen i den skattade livskvaliteten. Slutsats Patienterna skattar mindre allergiska symtom och lägre behov av egenvårds medicinering men högre livskvalitet efter ASIT-behandling. Resultatet visar inga skillnader mellan könen. Sådan kunskap kan bidra till värdefull information till vårdgivaren och det i sin tur kan bidra till en bättre omvårdnad av patienter som erhåller ASIT-behandling. / ABSTRACT Introduction Different types of allergies constitutes one of the public health diseases in Sweden. Allergenspecific immunotherapy (ASIT) is a treatment for patients with moderate to severe allergic rhinitis with or without asthma, where symptomatic treatment was insufficient. Aim The aim of this study was to obtain knowledge about how patients estimate their allergic symptoms, their estimation for self-care medication and their estimation of quality of life before, during and after ending the ASIT-treatment with birch pollen and or 5-grass allergen. Method A descriptive, comparative, quantitative patient journal study was conducted. Patients estimation of their allergy symptoms, their estimation of self-care medication and estimation of quality of life have been studied. The data was collected during the years of 2005-2009 by using self -assessment questionnaires wish was given to patients that was receiving ASIT treatmentat a Lung and Allergy Department, at a hospital in the middle of Sweden. The study group consisted of 42 patients, 22 men and 20 women with a mean age of 34,7 years. Results The main findings of this study shows that there is a negative connection between patient’s estimation of their allergic symptoms and quality of life both before and after ending ASIT treatment. Patients estimation of the quality of life got significantly higher in the whole study group comparing first and last measurement. Both women and men estimated lowered selfcare medication during the treatment period, but no significantly differences could be found between the genders regarding estimation of their medication. The result showed no differences between the genders regarding estimation of quality of life. Conclusion Patients estimated less allergic symptoms and lower need of self-care medication but a higher quality of life after ASIT-treatment. The result shows no differences between genders. Such knowledge can contribute to valuable information to caregivers and in turn it may result in a better care of patients who receives ASIT-treatment.

Un nouveau couple de récepteurs de co-signalisation (BTLA/HVEM) a récemment été proposé comme un acteur important dans l’échappement tumoral. L'expression d’HVEM a été identifiée dans la plupart des cancers. Son niveau expression est inversement corrélé avec la survie des patients. L'expression d’HVEM par des cellules tumorales pourrait inhiber la réponse immunitaire à travers BTLA exprimé par les lymphocytes T.Ainsi, dans notre travail, des anticorps monoclonaux (mAb) ciblant HVEM ont été évalués dans un modèle de souris NSG greffées avec des lymphocytes T et des tumeurs humaines. Nous avons tout d’abord caractérisé un clone anti-HVEM avec une forte affinité in vitro. Le clone choisi pour notre étude a montré sa capacité à favoriser l’activation des lymphocytes T humains in vivo, attesté par une aggravation des symptômes et de la mortalité associée au transfert de PBMC humains chez la souris. L’effet anti tumoral observé en l’absence de transfert adoptif était renforcé en présence de lymphocytes T, suggérant un effet additif de l’anticorps sur la tumeur et les lymphocytes T. Une diminution des lymphocytes T régulateurs et une augmentation de la prolifération des lymphocytes T CD8+ dans la tumeur était parfois associée à ce retard de croissance.En reproduisant un environnement partiellement humain chez la souris NSG, nous avons pu évaluer l'effet thérapeutique d’un mAb anti-HVEM dans le développement de deux types de tumeurs humaines et son impact sur le système immunitaire humain. Nos résultats indiquent qu’HVEM, de par son expression par la tumeur et les lymphocytes T, pourrait être une piste judicieuse pour l’immunothérapie du cancer. / A new pair of co-signaling receptors (BTLA / HVEM) has recently been proposed as an important actor in tumor escapement. HVEM expression has been identified in wild type of cancers. Its expression level is inversely correlated with patient survival. Expression of HVEM by tumor cells could inhibit the immune response through BTLA expressed by T lymphocytes.Thus, in our work, monoclonal antibodies (mAb) targeting HVEM were evaluated in a model of NSG mice grafted with human T cells and tumors. We first characterized an anti-HVEM clone with high affinity in vitro. The clone selected for our study showed its ability to promote activation of human T lymphocytes in vivo as evidenced by worsening symptoms and mortality associated with human PBMC transfer in mice. The anti-tumor effect observed in the absence of adoptive transfer was enhanced in the presence of T lymphocytes, suggesting an additive effect of the antibody on the tumor and T lymphocytes. A decrease in regulatory T lymphocytes and an increase in the proliferation of CD8 + T lymphocytes in the tumor was sometimes associated with this growth retardation.By reproducing a partially human environment in NSG mice, we were able to evaluate the therapeutic effect of an anti-HVEM mAb in the development of two types of human tumors and its impact on the human immune system. Our results indicate that HVEM, by its expression by the tumor and the T lymphocytes, could be a judicious track for the immunotherapy of the cancer.

Les papillomavirus humains (HPV) oncogènes sont les agents étiologiques des cancers du col utérin. S’il est établi que 30 à 60% des femmes sont infectées par un HPV oncogène, seul 1% des cas d’infection évoluera vers un cancer invasif, les autres se résolvant spontanément, ce qui autorise à penser qu’une vaccination adéquate pourrait permettre de maîtriser, voire de guérir, les lésions (pré)cancéreuses induites par ces virus. A ce titre, les cibles préférentielles sont les protéines virales E6 et E7. En effet, non seulement ces protéines sont à la base du processus de transformation cellulaire et leur présence est requise pour le maintien du phénotype transformé mais, de plus, elles contiennent des épitopes reconnus par les lymphocytes T auxiliaires et cytotoxiques. Nous avons choisi d’orienter nos recherches sur le virus HPV de type 16 car son incidence est majeure. De même, le taux élevé d’expression de la protéine E7 dans les tumeurs nous a conduit à la choisir comme cible. Notre travail a consisté en la construction de vecteurs plasmidiques codant pour des protéines HPV-16 E7 native ou de fusion. Les fusions ont été réalisées afin de modifier la nature de la protéine E7 afin de la cibler vers les voies de présentation en association avec les molécules du complexe majeur d’histocompatibilité de classe I ou de classe II (MHC-I ou MHC-II). Nous avons étudié et comparé les réponses induites par nos vecteurs afin de déterminer le vecteur le plus efficace. Nous avons ensuite étudié le mécanisme d’action de ce vecteur afin de déterminer les points clés de l’élaboration d’une réponse immune anti-HPV-16 E7. Nous avons ainsi déterminé que cibler la protéine HPV-16 E7 vers la voie du MHC-I (protéines de fusion avec l’ubiquitine; Ub) n’augmentait pas son immunogénicité. A l’inverse, le ciblage de cet antigène vers la voie du MHC-II (protéine de fusion avec la chaîne invariante; Ii) permet à une majorité de souris C57BL/6 de résister à l’injection d’une dose léthale de cellules tumorales syngéniques E7-positives. Nous avons également montré que l’injection du vecteur ciblant E7 vers la voie du MHC-II permet l’élimination de cellules présentant un épitope classe I H-2Db. Cette réponse est médiée par des lymphocytes T CD8+. Nous avons également montré que, si la présence des cellules T CD4+ n’est pas nécessaire pour l’élimination proprement dite de cellules E7-positives, la génération des effecteurs de cette élimination requiert la présence de lymphocytes T CD4+. Nos investigations nous ont permis d’émettre l’hypothèse de l’apparition d’une réponse par transfection directe d’APC et présentation d’épitopes par les voies classiques sur MHC-I et –II, le phénomène de cross-présentation semblant ne pas être impliqué dans la genèse de la réponse. Nos résultats suggèrent donc que c’est l’instabilité de E7 qui fait de cet antigène abondamment synthétisé un piètre inducteur de réponses cytotoxiques. En effet, l’ubiquitination N-terminale de E7 provoque sa dégradation rapide et pourrait empêcher sa sécrétion. Lorsque l’on tient compte de la nécessité de l’activation de cellules T auxiliaires dans l’élaboration des réponses anti-E7 enregistrées, cette dégradation pourrait permettre à E7 de ne pas être présenté sur MHC-II et donc de ne pas générer les cellules CD4+ requises pour la génération des cellules CD8+. Finalement, nous avons montré que cibler une protéine E7 délétée de son motif oncogénique majeur vers la voie du MHC-II menait à l’apparition de réponses cytotoxiques anti-E7 efficaces. / Doctorat en Sciences / info:eu-repo/semantics/nonPublished

Cytotoxicity is the capacity for immune cells to kill infected or malignant cells in order to eliminate pathogens and tumours through different mechanisms including the exocytosis of perforin-containing cytosolic granules. This crucial property is usually restricted to specialized innate and adaptive lymphocytes such as natural killer (NK) cells and CD8 T cells. T lymphocytes differentiate in the thymus and are delivered to the peripheral blood as naive T cells committed to either the CD8 or the CD4 lineage. CD8 T cells are programmed to acquire cytotoxic effector functions under the control of the transcription factor (TF) Runx3. The fate of CD4 T cells is to acquire multiple helper functions through the action of the TF ThPOK that promotes CD4 helper functions and restricts the CD8 cytotoxic program. However, this restriction is not absolute as cytotoxic CD4 (CD4CTX) T cells differentiate in vivo, indicating that the multipotency of human naive CD4 T cells includes the ability to acquire perforin expression and potent cytotoxicity in vitro and ex vivo. This cytotoxic potential correlates with outcome in human pathology and mediates protection against viral challenge and tumour eradication in murine models. CD4CTX T cells are terminally differentiated effector memory T cells that accumulate during cytomegalovirus chronic infection and ageing. They are phenotypically and functionally related to T helper type 1 (Th1)-effector memory cells. However, whether they belong to the Th1 pathway or constitute a separate specialized helper T cell subset is unknown. In this work, we show that CD4CTX T cell differentiation is an integral part of the Th1 pathway. Indeed, CD4 T cells acquire cytotoxic potential early in the memory differentiation process as central memory Th1 but not Th2 and Th17 cells are epigenetically primed to develop a cytotoxic program. The expression of perforin and other cytotoxic genes present a stepwise increase profile that is specific of the Th1 differentiation pathway. This profile has been recapitulated in an in vitro model of effector CD4 T cell differentiation in which naive CD4 T cells acquire cytotoxicity one to two weeks after polyclonal stimulation when cultured in presence of Th1 cytokines. The molecular regulation of CD4CTX T cells is poorly understood and most available data have been generated in mice. These data include the observation of intraepithelial CD4CTX T cells in the mouse gut after loss of ThPOK expression and subsequent up-regulation of a Runx3-dependent cytotoxic program. Other candidate regulators of CD4 T cell cytotoxic function include the TF regulating Th1 and CD8CTX T cells differentiation such as Runx3, T-bet and Eomesodermin (Eomes). We show that the transcriptional program of human CD4CTX T cells is enriched in CD8-lineage genes. However, by contrast to CD4CTX T cells from the mouse intestine, human circulating CD4CTX T cells maintain the expression of ThPOK and even up-regulate this TF upon differentiation from naive CD4 T cells. Surprisingly, this sustained expression of ThPOK was compatible with the establishment of a T-bet- and Runx3-dependent cytotoxic transcriptional program. The specific knockdown of T-bet or Runx3 but not Eomes resulted in impaired cytotoxic differentiation whereas ThPOK knockdown enhanced perforin expression and cytotoxicity. We propose that CD4CTX T cells constitute the terminal stage of Th1 memory differentiation and that ThPOK, Runx3 and T-bet co-regulate this process by instructing a cytotoxic transcriptional network largely shared with CD8CTX T cells. The modulation of this network is a potential target for novel immunotherapeutic strategies in viral infections and cancer. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished