Percutaneous kidney biopsies have been performed since 1944 to establish diagnoses and treatment. Risk factors based on a limited amount of data have shown age, blood pressure, kidney function and needle size as some risk factors for biopsy complications. Although the techniques of biopsy have improved over the years, it is still an invasive procedure and serious complications can occur. The overall aim of this thesis was to obtain a large series of data from biopsy procedures and to use these to bring further light on risk factors to help minimize the risk for patients and to optimize diagnostics. Specific aims were to clarify if different factors, such as gender, diagnoses, localization of biopsies, needle types and sizes, could be useful to help minimize complication risks in native kidney biopsies (Nkb) and transplant kidney biopsies (Txb). Another point to investigate was the value of the Resistive Index (RI) obtained at ultrasound before performing Txb. Materials and methods: A protocol for prospective multicentre registration of various factors and complications associated with Nkb and Txb was designed. Consecutive data were obtained from seven hospitals. All biopsies, except one computer tomography-guided Nkb, were performed using real-time ultrasound guidance and an automated spring-loaded biopsy device. For the biopsies 14- to 20- Gauge (G) needles were used. The kidney function level, i.e. estimated glomerular filtration rate (eGFR), was calculated using the Modification of Diet in Renal Disease (MDRD) formula (GFR in mL/min per 1.73m2). For statistical analyses the IBM SPSS Statistic 22 (Armonk, NY, USA) and OpenEpi (Open Source Epidemiologic Statistics for Public Health, www.OpenEpi.com) were used. Data were presented as Odds Ratio (OR), Risk Ratio (RR) and Confidence Intervals (CI). A two sided p-value of <0.05 was considered significant. In total 1299 consecutive biopsies (1039 native and 260 transplant kidneys) in 1178 patients (456 women and 722 men) were used for investigation. The median age of patients was 55 years (range 16 to 90 years). Major (require an intervention) and minor biopsy complications (no need of intervention) were registered. Results: The overall frequency of biopsy complications for Nkb was 8.8% (major 6.7%, minor 2.1%) and for Txb was 6.5% (major 3.8%, minor 2.7%); no death. Women had a higher risk for development of major (10.7% versus 4.7%, OR 2.4, CI 1.4-4.2) and overall biopsy complications (13.2% versus 6.5%, OR 2.2, CI 1.4-3.5) compared to men in Nkb. In Nkb, major complications were more common after biopsies from the right kidney in women versus men (10.8% vs 3.1%, OR 3.7, CI 1.5–9.5), in patients with lower versus higher BMI (25.5 vs 27.3, p=0.016) and for younger versus older age (44.8 vs 52.3 years, p=0.002). Lower (90 mmHg) compared to higher (98 mmHg) mean arterial pressure in Txb indicated a risk of major complications (p=0.039). Factors such as number of passes and kidney function did not influence complication rates. Biopsy needles of 16 G compared to 18 G showed more glomeruli per pass in Nkb (11 vs 8, p<0.001) and in Txb (12 vs 8, p<0.001). Sub-analysis revealed that 18 G 19 mm side-notch needles in Nkb resulted in more major (11.3% vs 3%, OR 4.1, CI 1.4-12.3) and overall complications (12.4% vs 4.8%, OR 2.8, CI 1.1-7.1) in women than in men. If the physician had performed less compared to more than four Nkb per year, minor (3.5% vs 1.4%, OR 2.6, CI 1.1-6.2) and overall complications (11.5% vs 7.4%, OR 1.6, CI 1.1-2.5) were more common. The localization of biopsy within the kidney (Nkb and Txb) was not a risk factor for complications. Patients with IgA-nephritis compared to patients with other diseases had a higher risk of major complications (11.7% vs 6.4 %, OR 1.8, CI 1.1–3.2). More major complications were found in Nkb if they had higher versus lower degree of glomerulosclerosis (31% vs 20 %, p=0.008) and in Txb if there was a higher versus lower degree of interstitial fibrosis (82% vs 33%, p<0.001). Re-biopsies (Nkb) were more common in patients with IgA-nephritis than those with other diseases (4.7% vs 1.3 %, OR 4, CI 1.5–11), in younger versus older age (42.6 vs 52.3 years, p=0.031), and in those with a higher versus lower degree of interstitial fibrosis (63% vs 34 %, p=0.046). In Txb, a RI≥0.8 compared to RI<0.8 predicted major (13.3% vs 3.2%, RR 4.2, CI 1.3-14.1) and overall biopsy complications (16.7% vs 5.3%, RR 3.2, CI 1.2-8.6). In the group <0.8, RI correlated with age (rs=0.28, p<0.001) and systolic blood pressure (rs=0.18, p=0.02). In the group ≥0.8, RI correlated with degree of interstitial fibrosis (rs=0.65, p=0.006) and systolic blood pressure (rs=0.40, p=0.03). The multiple regression analysis showed that the <0.8 RI group correlated only with age (p<0.001), whereas the ≥0.8 RI group correlated only with the degree of interstitial fibrosis (p=0.003). Conclusions: The present results motivate greater attention to be paid to the possibility of major side-effects after Nkb in women and biopsies from their right side, but as well in younger patients, and in those with lower BMI. This also applies for patients with presumptive IgA-nephritis and higher degree of glomerulosclerosis. In Txb, patients with higher degree of interstitial fibrosis had a greater risk of major complications. Moreover, the present data indicate that Nkb and Txb should be preferably taken with 16 G needles with 20 mm sample size. This results in better histological quality and there is a lower risk for major complications as compared to 18 G needles. The localization of biopsy within the kidney (Nkb and Txb) does not alter complication rates. For Nkb there were fewer complications if the physician had performed at least four biopsies per year. A RI≥0.8 in Txb indicates a greater risk for major and overall complications.

Após o nascimento, os recém-nascidos são expostos a vários tipos de micro-organismos, que podem determinar um processo infeccioso devido a sua imaturidade imunológica. Dentro deste processo, a amamentação tem um papel importante pela transferência passiva de imunoglobulina A (IgA). A cavidade oral é a principal porta de entrada destes agentes, especialmente os estreptococos, sendo que alguns colonizam inicialmente como Streptococcus gordonii (SGO), S. sanguinis (SSA) e S. mitis (SMI) e outros podem causar doenças, como S. mutans (SM), por ser o principal agente etiológico da cárie dentária. Pouco se sabe sobre a especificidade de IgA do colostro contra antígenos importantes destes estreptococos, o que pode ajudar na investigação dos mecanismos de estimulação antigênica e desenvolvimento da resposta imune de mucosa. Para tanto, foi avaliado no presente estudo, a especificidade e os níveis de IgA três antígenos de virulência de SM: glucan binding protein B (gbpB), glicosiltransferase (GTF) e antígeno I/II (Ag I/II) envolvidos na capacidade destas bactérias de aderir e acumular no biofilme. Além disso, as glicosiltransferases: 153 kDa de SGO e 170 kDa de SSA e IgA1- protease de SMI (220 kDa) em amostras de colostro humano. Um total de 77 amostras de colostro foram analisadas quanto aos níveis de immunoglobulian A, M e G por ELISA. A complexidade da IgA contra as bactérias foram analisadas por Western blot. Os resultados mostraram que a concentração média de IgA foi de 2850,2 (±2567,2) mg/100 mL sendo estatisticamente maior (p<0.05) dos níveis de IgM e de IgG (respectivamente 321,8±90,3 e 88,3± 51,5 mg/100 mL). A maioria das amostras tiveram níveis detectáveis de anticorpos IgA para extratos de antígenos de bactérias e seus antígenos de virulência, apresentando um elevado número de bandas reativas. Não houve diferença estatisticamente significante no número médio de IgA reativas a Ags entre os antígenos (p>0.4). A detecção de gbpB foi significativamente menor do que os outros antígenos de SM (p<0.05). Assim, o leite materno das primeiras horas após o nascimento apresentou níveis significativos de IgA contra importantes antígenos de virulência dos estreptococos orais estudados, que pode sugerir que a amamentação antes da erupção dos dentes pode interferir no processo de instalação e acumulação destes microorganismos na cavidade oral. / After birth, newborn babies are exposed to several types of microorganisms that can determine an infectious process due to their immunological immaturity. In this case, the feeding plays an important role by passive transfering of immunoglobulin A (IgA). The oral cavity is the main gateway of these agents, especially streptococci, some initially colonize as Streptococcus gordonii (SGO), S. sanguinis (SSA) and S. mitis (SMI) and others can cause diseases such as S. mutans (SM), as the main agent of tooth decay. Little is known about the specific IgA against major antigens of these streptococci which can help in the investigation of antigenic stimulation mechanisms and development of mucosal immune response. Therefore, we evaluated in this study, the specificity and levels of IgA from colostrum against three SM virulence antigens: glucan binding protein B (gbpB), glycosyltransferase (GTF) and antigen I/II (Ag I/II) involved in capacity these bacteria to adhere to and accumulate in the biofilm. Also, the glycosyltransferases: 153 kDa-SGO and 170 kDa-SSA and IgA1- protease of SMI (220 kDa). This study involved 77 samples of colostrum that were analyzed for levels of immunoglobulian A, M and G by Elisa. The specificity of IgA against extracts of SM and initials colonizators (SSA, SMI, SGO) were analyzed by the western blot. The mean concentration of IgA was 2850.2 (± 2567.2) mg/100ml followed by IgM and IgG (respectively 321.8 ± 90.3 and 88.3 ± 51.5), statistically different (p<0.05). Results showed that the majority of samples had detectable levels of IgA antibodies to extracts of bacteria antigens and theirs virulence antigens. To SM, the GbpB was significantly lower detected than others antigens of SM (p<0.05). High complexities of response to Ags were identified in the samples. There were no significant differences in the mean number of IgA-reactive Ags between the antigens (p>0.4). So, the breast milk from first hours after birth presented significant levels of IgA specific against important virulence of antigens those oral streptococci, which can disrupt the installation and accumulation process of these microorganisms in the oral cavity.

Parasites have a major impact on host condition and fitness and thereby represent a strong selective force for individuals in wild populations. The main defence against parasite infection and associated morbidity is the host immune response, and consequently it is expected for there to be strong selection eroding genetic variation underlying immune responses in natural populations. However, studies in the wild have found considerable heritable variation underlying immune responses. Few studies have investigated the genetic variants underlying immunity in wild populations and are able to examine how genetic variation is maintained in the face of natural selection. The aim of this thesis is to investigate the selection on, and genetic variation underlying, immunity in a wild Soay sheep population by looking at antibody responses to the prevalent parasite Teladorsagia circumcincta. Anti- T. circumcincta antibody levels (IgA, IgE, IgG) were measured in neonatal plasma samples taken soon after birth, representing maternally-derived antibodies, and in samples from August yearly from four month old lambs and adults, representing endogenous antibodies. All three endogenously produced antibody measures in lambs and adults were repeatable and heritable. In addition, a genome wide association study run on the three antibody traits on August lamb and adult measures found associations between anti-T. circumcincta IgA levels and single nucleotide polymorphisms in a region on chromosome 24. There was evidence for age- and isotype- dependent negative associations between antibody isotypes and strongyle faecal egg counts (FEC). Further, there was evidence for age-dependent selection via positive associations between anti-T. circumcincta IgG and survival in females and annual fecundity in males. In comparison, there was no additive genetic variance underlying maternally-derived (neonatal) anti-T. circumcincta antibody levels in neonates, but maternal and maternal genetic effects explained a considerable proportion of the variance in these traits. There was evidence for associations between neonatal anti-T. circumcincta IgG and later offspring phenotype and fitness, independent of total antibody (IgG) transferred. We found that neonatal anti-T. circumcincta IgG levels positively predicted survival to four months old, as well as weight in August. In addition, neonatal anti-T. circumcincta IgG levels were associated with reduced strongyle FEC in August, and were associated with improved survival over the first winter. In early life, maternally-derived anti-helminth antibodies are important for early growth, survival, and parasite resistance, as well as first winter survival, while fitness benefits in adulthood were associated with higher endogenous anti-helminth antibody levels. This thesis illustrates that maternal effects and genetic variation can have strong effects on variation in immunity in the wild, and this variation in turn can have health and fitness consequences for individuals.

Após o nascimento, os recém-nascidos são expostos a vários tipos de micro-organismos, que podem determinar um processo infeccioso devido a sua imaturidade imunológica. Dentro deste processo, a amamentação tem um papel importante pela transferência passiva de imunoglobulina A (IgA). A cavidade oral é a principal porta de entrada destes agentes, especialmente os estreptococos, sendo que alguns colonizam inicialmente como Streptococcus gordonii (SGO), S. sanguinis (SSA) e S. mitis (SMI) e outros podem causar doenças, como S. mutans (SM), por ser o principal agente etiológico da cárie dentária. Pouco se sabe sobre a especificidade de IgA do colostro contra antígenos importantes destes estreptococos, o que pode ajudar na investigação dos mecanismos de estimulação antigênica e desenvolvimento da resposta imune de mucosa. Para tanto, foi avaliado no presente estudo, a especificidade e os níveis de IgA três antígenos de virulência de SM: glucan binding protein B (gbpB), glicosiltransferase (GTF) e antígeno I/II (Ag I/II) envolvidos na capacidade destas bactérias de aderir e acumular no biofilme. Além disso, as glicosiltransferases: 153 kDa de SGO e 170 kDa de SSA e IgA1- protease de SMI (220 kDa) em amostras de colostro humano. Um total de 77 amostras de colostro foram analisadas quanto aos níveis de immunoglobulian A, M e G por ELISA. A complexidade da IgA contra as bactérias foram analisadas por Western blot. Os resultados mostraram que a concentração média de IgA foi de 2850,2 (±2567,2) mg/100 mL sendo estatisticamente maior (p<0.05) dos níveis de IgM e de IgG (respectivamente 321,8±90,3 e 88,3± 51,5 mg/100 mL). A maioria das amostras tiveram níveis detectáveis de anticorpos IgA para extratos de antígenos de bactérias e seus antígenos de virulência, apresentando um elevado número de bandas reativas. Não houve diferença estatisticamente significante no número médio de IgA reativas a Ags entre os antígenos (p>0.4). A detecção de gbpB foi significativamente menor do que os outros antígenos de SM (p<0.05). Assim, o leite materno das primeiras horas após o nascimento apresentou níveis significativos de IgA contra importantes antígenos de virulência dos estreptococos orais estudados, que pode sugerir que a amamentação antes da erupção dos dentes pode interferir no processo de instalação e acumulação destes microorganismos na cavidade oral. / After birth, newborn babies are exposed to several types of microorganisms that can determine an infectious process due to their immunological immaturity. In this case, the feeding plays an important role by passive transfering of immunoglobulin A (IgA). The oral cavity is the main gateway of these agents, especially streptococci, some initially colonize as Streptococcus gordonii (SGO), S. sanguinis (SSA) and S. mitis (SMI) and others can cause diseases such as S. mutans (SM), as the main agent of tooth decay. Little is known about the specific IgA against major antigens of these streptococci which can help in the investigation of antigenic stimulation mechanisms and development of mucosal immune response. Therefore, we evaluated in this study, the specificity and levels of IgA from colostrum against three SM virulence antigens: glucan binding protein B (gbpB), glycosyltransferase (GTF) and antigen I/II (Ag I/II) involved in capacity these bacteria to adhere to and accumulate in the biofilm. Also, the glycosyltransferases: 153 kDa-SGO and 170 kDa-SSA and IgA1- protease of SMI (220 kDa). This study involved 77 samples of colostrum that were analyzed for levels of immunoglobulian A, M and G by Elisa. The specificity of IgA against extracts of SM and initials colonizators (SSA, SMI, SGO) were analyzed by the western blot. The mean concentration of IgA was 2850.2 (± 2567.2) mg/100ml followed by IgM and IgG (respectively 321.8 ± 90.3 and 88.3 ± 51.5), statistically different (p<0.05). Results showed that the majority of samples had detectable levels of IgA antibodies to extracts of bacteria antigens and theirs virulence antigens. To SM, the GbpB was significantly lower detected than others antigens of SM (p<0.05). High complexities of response to Ags were identified in the samples. There were no significant differences in the mean number of IgA-reactive Ags between the antigens (p>0.4). So, the breast milk from first hours after birth presented significant levels of IgA specific against important virulence of antigens those oral streptococci, which can disrupt the installation and accumulation process of these microorganisms in the oral cavity.

Improvements to isogeometric blended shells are introduced which blend traditional Reissner-Mindlin shells, and Kirchhoff-Love shells, with an exact interpolation of the shell director increment. A gradient extraction operator is introduced which allows derivatives of basis functions to be exactly expressed as a linear combination of the basis functions themselves. Several benchmarks are investigated and the new blended shell is compared with different shell elements in ABAQUS and NASTRAN. In addition, the effect of different quadrature schemes is included in the comparisons. The new isogeometric blended shell performs comparably in some benchmarks, and even outperforms commercial shell finite elements in some benchmarks. Future improvements to the formulation are discussed.

Acteur clé de la symbiose hôte-microbiote, les IgA sécrétoires modulent le microbiote et participe à l'homéostasie intestinale. Chez la souris, les IgA sont polyréactives, en reconnaissent diverses bactéries, elles régulent la composition du microbiote et réduisent l'inflammation intestinale. Ces observations ouvrent des perspectives thérapeutiques intéressantes. Cependant, les caractéristiques des IgA et leurs spécificités restent mal connues chez l'homme. L'objectif de ce travail a donc été d'étudier la spécificité de la réponse IgA, en distinguant IgA1 et IgA2. La mise au point d'une technique de production in vitro d'IgA monoclonales 100% humaines issues de l'intestin nous a permis de montrer le profil de polyréactivité des IgA. Chaque IgA interagit avec un spectre large mais défini de bactéries commensales. Par ailleurs, les IgA1 et les IgA2 ciblent la même fraction du microbiote. Les réponses IgA1 et IgA2 convergent aussi au niveau des épitopes polysaccharidiques reconnus. Si les IgA sécrétoires contribuent largement à l’homéostasie intestinale, des IgG sériques anti-microbiote jouent un rôle dans la relation symbiotique hôte-microbiote. Leur présence n’ayant pas encore été démontrée chez l’homme en condition physiologique, ce travail a eu pour objectif secondaire de les explorer. Le développement d’une technique de cytométrie bactérienne nous a permis de détecter des IgG ciblant les bactéries commensales dans le sérum des individus sains. Ces IgG anti-microbiote sont dirigées vers les bactéries déjà reconnues par les IgA sécrétoires, elles présentent des spécificités propres à chaque individu. / IgA, the dominant immunoglobulin produced in the gut, plays diverse roles ranging from toxin neutralization, immune functions regulation, intestinal homeostasis maintenance. It is now well established that polyreactive IgA, which target multiple bacteria, can modulate gut microbiota composition and have promising therapeutic effects. However, IgA features remain elusive in humans. We therefore determined the reactivity profile of native monoclonal antibodies from human colon and compared IgA1 and IgA2. We found that IgA are polyreactive and bind a diverse but restricted subset of gut commensals. Most commensals were dually coated by IgA1 and IgA2, yet IgA2 alone coated a distinct fraction of colonic bacteria. Besides their common microbial targets, IgA1 and IgA2 exhibited overlapping anti-carbohydrate repertoires. An essential link between IgA and IgG responses against microbiota has been recently demonstrated in mice. Nevertheless, it remains unclear whether symbiotic bacteria could induce systemic IgG under homeostatic conditions in humans. Hence, we characterized anti-microbiota IgG in serum of healthy donors by bacterial flow cytometry. We found that each individual harbored a diverse and private panel of anti-commensals IgG that converge with secretory IgA to cover a restricted fraction of the gut microbiota. Patients with IgA deficiency or common variable immunodeficiency (CVID) exhibited a distinct set of anti-commensals IgG suggesting that IgA replacement in addition to polyvalent IgG might be beneficial to treat gastro-intestinal symptoms in these patients.

Nontypeable Haemophilus influenzae (NTHi), Streptococcus pneumoniae and Moraxella catarrhalis are common bacterial agents of otitis media which is a major cause of morbidity in young children. Mucosal immune responses are an integral part of the immune defense against middle ear infection and it is known that certain populations, including Australian Aboriginal children, are highly susceptible to disease. The current study focussed on the development of the mucosal immunity to the three bacterial pathogens in Aboriginal and non-Aboriginal children from birth to two years of age, living in the Kalgoorlie-Boulder region of Western Australia. Salivary and breast milk IgA levels were measured by the enzyme Linked immunosorbent assay. The measured IgA levels, combined with socio-economic, demographic and bacteriological data were analyzed statistically to determine the influential factors on the mucosal IgA response in these children over time. This study found that each antigen-specific IgA examined followed a distinct ontogeny pattern and IgA responses differed significantly according to age, indigenous status and feeding type. Indoors smoke exposure, maternal smoking, and sibling day care attendance had some impact on salivary IgA levels in the children. However, household crowding and the presence of older siblings had the most significant impact on salivary IgA levels for children of different age groups. These two factors were correlated to increased nasophayrngeal colonization by H. influenzae, S. pneumoniae and M. catarrhalis and colonization status was also found to influence salivary IgA levels in the children. No correlation between maternal breast milk IgA levels and child salivary IgA levels was observed. The results suggest that the degree of exposure to environmental factors rather than immunological deficit is responsible for the observed differences in salivary IgA responses between Aboriginal and non-Aboriginal children and modifying these factors could lead to a reduction in the burden of otitis media experienced by the children. Further studies correlating specific salivary IgA levels to diseases such as otitis media will reveal the role of specific salivary IgA responses in the prevention of infection by respiratory pathogens.

Les vaccins des muqueuses s'administrent facilement et favorisent une immunité humorale et cellulaire au niveau des muqueuses. Ainsi, ils offrent une protection optimale contre les pathogènes envahissant par les muqueuses. Cependant, la mise sur le marché de nouveaux vaccins des muqueuses est entravée par le manque d'adjuvants des muqueuses efficaces et sans effets secondaires. La toxine cholérique (CT) est une entérotoxine à fort pouvoir adjuvant mais sa toxicité empêche son utilisation chez l'homme. En tant que modèle expérimental, elle a permis de comprendre l'importance de l'activité enzymatique et des récepteurs dans l'adjuvanticité. Notre travail se base sur l'observation que des doses sublétales de la toxine œdémateuse de Bacillus anthracis (EdTx) n'inhibent pas la réponse immune à des vaccins « nasaux » contenant CT comme adjuvant. Nous avons montré que les dérivés EdTx représentent une nouvelle classe d'adjuvants qui donnent des réponses systémiques et des muqueuses à des protéines vaccinales administrées par de multiples voies, notamment nasale. Contrairement à CT qui se fixe aux gangliosides, EdTx se fixe aux récepteurs des toxines de l'anthrax et ne cible pas les tissus du système nerveux central après administration nasale. Le facteur inné nerve growth factor intervient dans les réponses des muqueuses induites par CT mais n'affecte pas l'adjuvanticité d'EdTx in vivo. L'activité adjuvante d'EdTx implique aussi l'augmentation des fonctions de présentation de l'antigène. Enfin, nous avons montré qu'EdTx est un adjuvant efficace par les voies transcutanée et sublinguale, bien que les IgA des muqueuses ne soient induits qu'après immunisation sublinguale.

Viruses replicating in the respiratory tract (RT) triggers a wide- range of cytokines and chemokines that have antiviral and pro-inflammatory features, instigating an efficient virus- specific B and T cell response that aids in virus- clearance. The majority of antibody secreting cells (ASCs) localizing in the upper RT secrete IgA that can effectively neutralize viruses. In addition, elements of B cell memory are generated that can provide protection from re-infection. Studies examining these aspects, following murine gammaherpesvirus 68 (MHV-68) infection comprise chapter 2 of the dissertation work. Our studies demonstrate that following MHV-68 infection, unlike influenza infection, resulted in a generalized deficiency of virus-specific IgA induction and deficient B cell memory establishment in the respiratory tract. The studies indicate that these aspects of B cell response are regulated by features of virus- replication in the RT. These studies lead to the speculation that these features of B cell response may represent an evolutionary adaptation of viruses that establish long-term latency and are transmitted periodically after reactivation and shedding in secretions. Following cognate interactions with CD4+ T cells, the B cells undergo proliferation, isotype-switching and differentiate towards extrafollicular (low affinity, rapid) or germinal center pathway (high affinity). It is not clear what factors regulate these pathways of B cell differentiation, especially in the context of virus infection in the RT. Studies examining these aspects following influenza infection comprise chapter 3 of the dissertation work. Our studies establish a model for the investigation of host and viral factors that modulate the quality and effectiveness of the B cell response to influenza infection. The findings indicate that the strength of the extrafollicular B cell response depends on the nature of the infecting virus. We present evidence that this pathway of rapid antiviral antibody production relates to the production of non-specifically acting factors in the lung and also dependent of the cytokine profile of virus-specific CD4+T cells. In summary, the current dissertation findings point out to an influence of virus and host associated factors in regulating features of B cell response in the RT.

The increasing prevalence of allergic diseases in affluent societies has been associated with changes in microbial exposure early in life and a less diverse gut flora. The objective of this thesis was to assess the development of allergic sensitisation and symptoms during the first four years of life in a non-selected birth cohort in relation to environmental factors, family history, gut microbiota and salivary IgA antibodies. The cohort comprised all 1,228 infants living in a Swedish county who were born over a one-year period. The parents replied to questionnaires, and 817 children (67 %) were skin prick tested both at 1 and 4 years of age. Saliva (n=279), faecal (n=139) and blood (n=253) samples were collected at 1 year of age from children with a positive skin prick test at 1 year and from a sample of children with a negative skin prick test. Faecal samples were also obtained from 53 children at 4 years of age. Dog keeping during infancy was associated with a decreased risk of sensitisation to pollen and late-onset wheezing at age 4, and the reduced odds ratios persisted after adjustment for heredity and avoidance measures, OR 0.3, 95% CI 0.1-0.9 and OR 0.5, 95% CI 0.2-1.0, respectively. In contrast, early dog keeping was associated with an increased risk of earlyonset transient wheezing but only in children with parental asthma (OR 2,8, 95% CI 1.3-6.4). Levels of short chain fatty acids (SCFAs) in faeces were assessed both at 1 and 4 years of age and related to the development of sensitisation and symptoms. The levels of acetic (p&lt;.01) and propionic (p&lt;.01) acids decreased from one to four years of age, whereas valeric acid (p&lt;.001) increased which is in line with a more complex gut microbiota with age. Allergic children, compared with non-allergic children, had lower levels of i-butyric, i-valeric and valeric acid in faeces both at 1 and 4 years of age. Low levels of secretory IgA (SIgA) in saliva were associated with wheezing but only in sensitised children. In children with positive SPT to at least one allergen both at 1 and 4 years of age and in children with circulating IgE antibodies to egg or cat at one year of age, those who developed late-onset wheezing had lower levels of SIgA than those who did not, p=.04 and p=.02 respectively. Of 9 children with levels of SIgA in the upper quartile and persistent sensitisation, none developed wheezing, compared with 10/20 children with lower levels, (p=. 01). Having older siblings, more than three infections during infancy, at least one smoking parent and male gender were all associated with high levels (in the upper quartile) of total IgA and SIgA. The findings in this thesis indicate that the microbial load early in life could affect the development of allergy. A functional assessment of the gut flora demonstrated differences between allergic and non-allergic children both at 1 and 4 years of age. Salivary IgA was associated with infections during infancy, and high levels of secretory IgA protected from symptoms in sensitised children. Finally, dog keeping in infancy may offer protection from allergy, but the mechanism is uncertain.