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A síndrome de Rubinstein-Taybi (RTS, OMIM 180849) é uma doença autossômica dominante caracterizada por dismorfismos craniofaciais típicos, polegares e háluces alargados, infecções respiratórias recidivantes, retardo mental e de crescimento. RTS está associada com mutação no gene CREBBP. Na avaliação da imunocompetência de 17 portadores de RTS, observaram-se algumas alterações na resposta imune inata e adaptativa: leucocitose persistente, neutrófilos com desgranulopoiese, elevada concentração sérica de IgM e IgG1, produção normal de anticorpos contra antígenos protéicos e anti-polissacarídeos, elevados valores absolutos de células B totais, B \"naive\", B de memória, subpopulação B1 e de linfócitos B com IgM de membrana, e elevado percentual de apoptose de linfócitos B. DTH negativo para três antígenos e baixa resposta linfoproliferativa para antígenos protéicos. Diante do exposto, concluímos que os pacientes RTS apresentam alterações em vários mecanismos da resposta imune e principalmente, na imunidade humoral. Portanto, com este trabalho foi possível identificar as principais alterações imunológicas destes pacientes, e com isso, caracterizar quais os defeitos da resposta imune que pode estar associada com gene CREBBP. / Rubinstein-Taybi syndrome (RTS, OMIM 180849) is a dominant Mendelian disorder characterized by craniofacial dysmorphisms, broad thumbs and toes, mental retardation and growth and recurrent respiratory infections. RTS is classically associated with CREBBP gene mutations, but recently, p300 gene mutations were reported in three individuals. In imunonocompetence investigation of a group of 17 patient of the RTS, we found that the patients really show alterations in more than one arm of the immune response. The main alterations were found in: a) innate immunity, patients have defects in the distribution of the granules citoplasmatic and partial absence of F-actin filament part of its polymorphonuclear cells. In addition, some patients had decreased phagocytic activity, b) humoral immunity: elevated serum IgM antibodies and IgG1 subclass, normal production of antibodies for protein antigens and antipolysaccharide, high absolute values of B cell total, B \"naive\", B memory, subpopulation B1 and B lymphocytes with the membrane IgM, and high percentage of apoptosis of B lymphocytes; c) cellular immunity: delayed hypersensitivity skin tests negative for three antigens and low lymphoproliferative response to protein antigens. Values reduced percentage of CD45RA+ , CD45RO+ T cells and high doublepositive CD45RA+/CD45RO +) T cell. Ahead of the severe recurrent respiratory infections that affect the patients with RTS, and of the evaluation of immunocompetence of these patients, we find that they have several alterations in mechanisms of immune response and mainly in humoral immunity. Therefore, with this study was to identify the major immunological alterations of these patients, and with this, which characterize the main defects of the immune response of the patients RTS that can is associated with gene CREBBP.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais / Recombinant proteins from Toxoplasma gondii have been used in several experimental models, as well as for serodiagnosis of human toxoplasmosis, particularly to differentiate acute from chronic phases of the infection. In the present study, we evaluated the kinetics of IgM, IgA, and IgG isotypes, in addition to IgG1 and IgG3 subclasses, by testing sequential serum samples from patients with acute toxoplasmosis. It was carried out immunoassays by using SAG2A recombinant antigen and soluble antigen of Toxoplasma (STAg). The avidity of IgG1 antibody was assessed using slot blot assay. Additionally, a ratio between IgG1 and IgG3 subclasses (IgG3:IgG1) was determined and evaluated its degree of association with levels of IgM and IgA specific for STAg and the avidity index of IgG1 specific for SAG2A. The results showed a decreasing kinetic profile for SAG2A and STAg for IgM and IgA. The kinetic profile for the IgG antibody was increasing for both antigens. Compared to the avidity for IgG1, it was observed that sera from an early stage showed a low average avidity of IgG1 for SAG2A while the same samples showed intermediate mean avidity of IgG1 when STAg was used as antigen. In a later phase, the average avidity observed was high for STAg and intermediate for SAG2A in the same tested sera suggesting that SAG2A may be a promising tool for the detection of avidity. Associations between IgG3/IgG1 and specific IgM and IgA levels for STAg and the avidity index of specific IgG1 for SAG2A were found, and together these parameters could be used as valuable tools in the diagnosis of human toxoplasmosis, especially in situations when the determination of different phases is critical. / Proteínas recombinantes de Toxoplasma gondii têm sido utilizadas em diversos modelos experimentais, assim como para o diagnóstico sorológico da infecção humana por este parasito, principalmente com o intuito de diferenciar as fases aguda e crônica da toxoplasmose. Neste estudo, foi avaliada a cinética dos anticorpos IgM, IgA ,IgG e subclasses (IgG1 e IgG3) através de imunoensaios realizados em amostras seqüenciais de soros humanos, provenientes de pacientes com toxoplasmose aguda. Estas amostras foram testadas frennte ao antígeno recombinante SAG2A, utilizando-se como paradigma de comparação o antígeno solúvel total de Toxoplasma (STAg). A avidez do anticorpo IgG1 foi avaliada utilizando a metodologia slot-blot. Adicionalmente, a razão entre as subclasses IgG3 e IgG1 (IgG3:IgG1) foi determinada e avaliada quanto ao grau de associação com os níveis de IgM e IgA específicos para STAg e aos índices avidez de IgG1 específicos para SAG2A. Os resultados demonstraram a presença de níveis decrescentes de IgM e IgA para ambos os antígenos utilizados, enquanto que para o isotipo IgG o perfil cinético demonstrou níveis crescentes para ambas preparações antígênicas. Em relação aos índices de avidez para IgG1, foi observado que amostras de soros de uma fase inicial apresentaram baixa avidez média de anticorpos IgG1 dirigidos para SAG2A, enquanto que as mesmas amostras demonstraram avidez média intermediária de IgG1 quando STAg foi utilizado como antígeno. Já em uma fase mais tardia, a avidez média observada foi alta para STAg e intermediária com SAG2A. A razão entre IgG3:IgG1 obtida no primeiro bimestre foi significantemente maior para SAG2A em comparação com STAg. Tomados em conjunto, os resultados obtidos no presente estudo indicam que a proteína recombinantes SAG2A pode se constituir em uma ferramenta efetiva na diferenciação das fases da infecção humana por T. gondii. / Mestre em Imunologia e Parasitologia Aplicadas

A síndrome de Rubinstein-Taybi (RTS, OMIM 180849) é uma doença autossômica dominante caracterizada por dismorfismos craniofaciais típicos, polegares e háluces alargados, infecções respiratórias recidivantes, retardo mental e de crescimento. RTS está associada com mutação no gene CREBBP. Na avaliação da imunocompetência de 17 portadores de RTS, observaram-se algumas alterações na resposta imune inata e adaptativa: leucocitose persistente, neutrófilos com desgranulopoiese, elevada concentração sérica de IgM e IgG1, produção normal de anticorpos contra antígenos protéicos e anti-polissacarídeos, elevados valores absolutos de células B totais, B \"naive\", B de memória, subpopulação B1 e de linfócitos B com IgM de membrana, e elevado percentual de apoptose de linfócitos B. DTH negativo para três antígenos e baixa resposta linfoproliferativa para antígenos protéicos. Diante do exposto, concluímos que os pacientes RTS apresentam alterações em vários mecanismos da resposta imune e principalmente, na imunidade humoral. Portanto, com este trabalho foi possível identificar as principais alterações imunológicas destes pacientes, e com isso, caracterizar quais os defeitos da resposta imune que pode estar associada com gene CREBBP. / Rubinstein-Taybi syndrome (RTS, OMIM 180849) is a dominant Mendelian disorder characterized by craniofacial dysmorphisms, broad thumbs and toes, mental retardation and growth and recurrent respiratory infections. RTS is classically associated with CREBBP gene mutations, but recently, p300 gene mutations were reported in three individuals. In imunonocompetence investigation of a group of 17 patient of the RTS, we found that the patients really show alterations in more than one arm of the immune response. The main alterations were found in: a) innate immunity, patients have defects in the distribution of the granules citoplasmatic and partial absence of F-actin filament part of its polymorphonuclear cells. In addition, some patients had decreased phagocytic activity, b) humoral immunity: elevated serum IgM antibodies and IgG1 subclass, normal production of antibodies for protein antigens and antipolysaccharide, high absolute values of B cell total, B \"naive\", B memory, subpopulation B1 and B lymphocytes with the membrane IgM, and high percentage of apoptosis of B lymphocytes; c) cellular immunity: delayed hypersensitivity skin tests negative for three antigens and low lymphoproliferative response to protein antigens. Values reduced percentage of CD45RA+ , CD45RO+ T cells and high doublepositive CD45RA+/CD45RO +) T cell. Ahead of the severe recurrent respiratory infections that affect the patients with RTS, and of the evaluation of immunocompetence of these patients, we find that they have several alterations in mechanisms of immune response and mainly in humoral immunity. Therefore, with this study was to identify the major immunological alterations of these patients, and with this, which characterize the main defects of the immune response of the patients RTS that can is associated with gene CREBBP.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Neosporosis is a parasitic disease of wide distribution and great importance to the cattle industry, mainly due to its associated reproductive losses. The life cycle of Neospora caninum typified by the tree know infectious stages: tachyzoites, tissue cysts with bradyzoites, and oocysts. Transmission routes can be horizontal and/or vertical. The vertical transmission or transplacentally is the most frequent form of infection, and an important form of maintain the agent in herds. With aim of to determine the occurrence of anti-Neospora caninum antibodies in serum samples of 260 bovine fetuses, collected in a slaughter in the municipality of Santa Maria, in Rio Grande do Sul, Brazil. For detection antibodies anti-N. caninum indirect fluorescent antibody test was used and immunoglobulin G and M were detected, using a cut-off 1:25. Of the 260 serum samples tested, 15% (39/260) were positive for the presence of anti-N. caninum. Of these, in 38 the presence of IgG where detected (97.4%) and in six IgM were present (10.3%). Five samples (15.4%) tested were positive for both IgG and IgM. The results reaffirming the ability of N. caninum in determine fetal infection. The results presented on the first chapter indicated that the search of IgM anti-N. caninum is of very limited help in the detection of the transplacental infection in cattle. In second chapter, was evaluated the susceptibility to infection by N. caninum in different cell cultures, for the purpose of observe the ability in vitro multiplication this agent. For this, eight cell cultures were tested, among the cell cultures tested, four presented good susceptibility to agent: cell lines VERO (yield of 21.2 tachyzoites/cell) and MA-104 (17.1); primary bovine testicle (16.3) and lung cells (13.6). Primary bovine kidney (8.2 tachyzoites/cell), MDBK (5.1) and RK-13 cell lines (0.4) presented moderate to low sensitivity. No viable tachyzoites were detected in the culture of MDCK cells. These results demonstrate that MA-104 cells present adequate susceptibility to N. caninum compared to VERO cells, which have been largely used to multiply the parasite in vitro. Due to the easy manipulation, quick multiplication and relatively low nutritional equirements, these results indicate that MA-104 cells are adequate for multiplication of N. caninum in vitro. / A neosporose é uma doença parasitária de ampla distribuição e com grande importância para a bovinocultura, principalmente pelas perdas reprodutivas que determina. O ciclo do Neospora caninum caracteriza-se por apresentar três estágios infecciosos: os taquizoítos, os cistos teciduais contendo bradizoítos e os oocistos. Suas rotas de transmissão podem ser horizontal e/ou vertical. A infecção vertical ou transplacentária é a forma mais freqüente de infecção, sendo uma importante forma de manutenção do agente nos rebanhos. Com o objetivo de determinar a ocorrência de anticorpos anti-N. caninum em fetos bovinos, foram coletadas 260 amostras de soro em abatedouro localizado no município de Santa Maria, Rio Grande do Sul, Brasil. Para detecção de anticorpos anti-N. caninum, utilizou-se a técnica de imunofluorescência indireta com a presença de imunoglobulinas G e M (IgG e IgM), sendo analisada com ponto de corte de 1:25. Do número total de amostras testadas, 15% (39/260) foram positivas para anticorpos anti-N. caninum. Destas, em 38 (97,4%) foi detectada a presença de IgG anti-N. caninum e em seis (15,4%) de IgM. Em cinco amostras (12,8%) detectaram-se ambos, IgG e IgM. Os resultados reafirmam a capacidade do N. caninum determinar infecção fetal. Os resultados obtidos no primeiro capítulo desta dissertação permitiram demonstrar que a pesquisa de IgM foi de limitada importância na detecção da infecção via transplacentária em soro fetal bovino. No segundo capítulo, foi avaliada a susceptibilidade à infecção pelo N. caninum em diferentes cultivos celulares, com a finalidade de observar a capacidade de multiplicação deste agente in vitro. Para isto, foram testados oito cultivos, sendo que quatro apresentaram boa susceptibilidade a multiplicação pelo N. caninum: células VERO (produção de 21,2 taquizoítos/célula), MA-104 (17,1), cultivo primário de testículo (16,3) e pulmão bovino (13,6). O cultivo primário de rim bovino (8,2), células MDBK (5,1) e RK-13 (0,4) apresentaram baixa sensibilidade, enquanto células MDCK não produziram taquizoítos viáveis. Os resultados obtidos demonstram que as células MA-104 apresentaram susceptibilidade semelhante a das células VERO linhagem tradicionalmente utilizada para o cultivo deste protozoário. Pela facilidade de cultivo e rápida multiplicação, menor exigência nutricional e produção de taquizoítos em níveis semelhantes às células VERO, as células MA-104 demonstraram ser adequadas para a manutenção e multiplicação do N. caninum in vitro.

Fästingburet encefalitvirus (TBEV) är ett RNA-virus som tillhör genuset flavivirus. Vid en TBEV-infektion är feber, trötthet, allmänpåverkan samt huvudvärk och muskelvärk vanligt förekommande symtom. Viruset överförs via saliven från fästingar under de första minuterna efter fästingbett. TBEV-IgM och ibland även TBEV-IgG återfinns i serum då symtom i centrala nervsystemet (CNS) yttrar sig i den andra fasen av sjukdomsförloppet. De senaste åren har prevalensen av fästingburen encefalit (TBE) ökat. Sedan 2017 har över 300 fall av TBE rapporterats årligen i Sverige. Laterala flödesanalyser (lateral flow assays, LFA) är billiga, enkla, snabba och baseras på portabla instrument som används bland annat inom biomedicinsk vetenskap. ReaScan® TBE IgM från det finska företaget Reagena är ett snabbtest, baserat på LFA-tekniken, för detektion av TBE-specifika IgM-antikroppar i humant serum och likvor. Syftet med studien var att undersöka om ReaScan® TBE IgM kan användas för att diagnostisera TBE på laboratoriet för Klinisk Mikrobiologi på länssjukhuset i Kalmar. Metodens prestanda undersöktes genom att analysera totalt 23 serumprover, 13 prover från TBE-patienter och 10 prover från icke-TBE-patienter. Sensitiviteten uppskattades genom att analysera 13 serumprover där förekomst av TBE-antikroppar sedan tidigare konfirmerats. Specificiteten uppskattades genom att analysera 10 serumprover från patienter utan känd TBEV-infektion. Den diagnostiska sensitiviteten respektive specificiteten beräknades till 100 %. På grund av den begränsade storleken på undersökningsmaterialet är dock den beräknade sensitiviteten och specificiteten ej helt tillförlitlig. Metodens prestanda ansågs vara tillräckligt god för att den skall kunna användas som en screening-metod för TBEV-IgM-antikroppar på laboratoriet för Klinisk Mikrobiologi på länssjukhuset i Kalmar. / Tick-borne encephalitis virus (TBEV) is an RNA virus that belongs to the genus flavivirus. Symptoms that commonly present during a TBEV infection include headaches, muscle pains, fever and malaise. The virus is transmitted with the saliva from ticks during the first minutes of their blood meal. TBEV-IgM and sometimes TBEV-IgG antibodies can be detected in the patient’s serum when central nervous system (CNS) symptoms present in the second phase of the disease. Over the last couple of years, the prevalence of tick-borne encephalitis (TBE) has increased. Since 2017 over 300 cases of TBE are reported every year in Sweden. Lateral flow assays (LFA) is the technology behind inexpensive, simple, quick and portable instruments that are used within the biomedical science field among others. ReaScan® TBE IgM developed by the Finnish company Reagena is a rapid test, based on the LFA technique, used for the detection of TBEV specific IgM antibodies in human serum and cerebrospinal fluid. The trial aimed to evaluate whether ReaScan® TBE IgM could be used to diagnose TBE at the laboratory of Clinical microbiology at the County hospital in Kalmar. The performance of the test was determined by analysing a total of 23 serum samples, 13 of which consisted of samples from patients with a previously confirmed TBE diagnosis and 10 samples from patients with no known TBEV infection. The diagnostic sensitivity and specificity were both determined to be 100 %. Due to the limited sample size, the calculated sensitivity and specificity are not particularly reliable.  The performance of the test was satisfactory and it could be used as a screening method for the detection of TBEV IgM antibodies at the department of Clinical microbiology at Kalmar County Hospital.

Quantitative real-time PCR (QPCR) technology has been very useful for diagnosis of viral diseases. QPCR has recently reached a level of sensitivity, simplicity, and reproducibility which allows a large number of samples to be screened rapidly, make it a suitable tool for the clinical virology diagnostics. In this thesis, broadly targeted and degenerated quantitative QPCR assays were used. A somewhat novel single-tube real-time reverse transcription-polymerase chain reaction (QRT-PCR), with takes advantage of ability of rTth DNA polymerase to reverse transcribe RNA in the presence of Mn2+ at elevated temperatures and includes protection against amplimer contamination by using thermolabile UNG, was developed. A new technique for diagnostic of recent viral infection by detection of viral immunoglobulin M (IgM) was also developed. In the first paper, a sensitive single-tube QRT-PCR for detection of enteroviral RNA in patients with aseptic meningitis was presented. In the second paper, a single-serum-dilution real-time PCR-based PIA (PCR-enhanced immunoassay), called quantitative PIA (QPIA), to detect enterovirus IgM for diagnosis of EV infection in patients with aseptic meningitis, was also developed. In the third paper, a broadly targeted, simple, single tube degenerated quantitative QPCR technique for detection of JCV, BKV and SV40 DNA was developed. A conserved region of the VP2 gene of JCV, BKV and SV40 was targeted. A false positive result due to contamination with commonly used SV40 T-antigen plasmids was therefore avoided. In manuscript four, the QPIA assay provide a rational strategy for detection of EV IgM, allows the use of viral antigens isolate from newly diagnosed Type 1 diabetes patients (T1D-EV-QPIA) to measured IgM against diabetogenic viruses in serum from newly diagnosed T1D children, siblings, and healthy children. To conclude, novel broadly targeted real-time PCR methods for diagnosis of entero- and polyoma viral infections were developed.

Antibodies can enhance or suppress the immune responses against their specific antigens. This phenomenon is known as antibody-mediated feedback regulation. We have studied the mechanisms underlying IgE-, IgM-, and IgG3-mediated enhancement of immune responses in mouse models using intravenous immunization. We attempted to answer the following questions: 1) Which cell type presents IgE-complexed antigens to CD4+ T cells? 2) Is complement activation required for specific IgM to enhance antibody responses? 3) Does IgM enhance CD4+ T-cell responses? 4) How are IgG3-antigen complexes transported into B-cell follicles? We found that CD23+ B cells transporting IgE-antigen complexes into B-cell follicles were not required to prime the antigen-specific CD4+ T cells in vivo, whereas CD11c+ cells were indispensable. After examining the three most common subpopulations of CD11c+ cells in the spleen, we determined that it was CD8α- conventional dendritic cells migrating into the T-cell zone following immunization that presented IgE-complexed antigens to CD4+ T cells. Next, we showed that specific IgM from Cµ13 mice, which is unable to activate complement, failed to enhance either antibody or germinal center responses whereas wild-type IgM enhanced both responses. Therefore, specific IgM must activate complement to enhance humoral responses. In addition, wild-type IgM did not up-regulate CD4+ T-cell responses. Finally, we showed that IgG3-antigen complexes were transported by marginal zone B cells into B-cell follicles via binding to complement receptors 1 and 2 (CR1/2) on those cells. The immune complexes were captured by follicular dendritic cells as early as 2 h after immunization. Germinal center responses were also enhanced by IgG3. Using bone marrow chimeric mice, we found that CR1/2 expression was required on both marginal zone B cells and follicular dendritic cells to provide an optimal enhancement of antibody responses.

京都大学 / 0048 / 新制・課程博士 / 博士(医科学) / 甲第21030号 / 医科博第91号 / 新制||医科||6(附属図書館) / 京都大学大学院医学研究科医科学専攻 / (主査)教授 生田 宏一, 教授 清水 章, 教授 竹内 理 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

An intact complement system is essential for the initiation of a normal antibody response. Antibodies can regulate their own production against the antigens that they are specific for. Both IgG3 and IgM are able to enhance the antibody response via complement. Here, we have compared the fate of OVA-TNP (ovalbumin-2,4,6-trinitrophenyl) administered intravenously to mice either alone or in complex with monoclonal IgG3 anti-TNP. IgG3-antigen complexes bind to marginal zone (MZ) B cells via complement receptors 1 and 2 (CR1/2) and are transported into splenic follicles. The majority (50% - 90%) of the antigens is deposited on follicular dendritic cells (FDC) and the antigen distribution pattern is strikingly similar to peripheral dendrites/processes of FDC already 2 h after immunization. The development of germinal centers (GC) induced by IgG3-antigen complexes is impaired in mice lacking CR1/2. Experiments on bone marrow chimeric mice show that CR1/2 expression on both MZ B cells and FDC is required for optimal IgG3-mediated enhancement of antibody responses. Complement factors C3 and C1q are essential for OVA-TNP delivery and deposition on splenic FDC. The production of IgG anti-OVA is abrogated in mice lacking CR1/2, C1q, and C3. Further, IgG3-antigen complexes dramatically upregulate the memory response against OVA-TNP by inducing OVA-specific memory cells. Besides small protein OVA, IgG3 can also upregulate humoral responses against large soluble keyhole limpet hemocyanin. To further study the role of MZ B-cells and CR1/2 in enhancement of antibody responses, a knock-in mouse strain, Cμ13, was used. IgM in this mouse strain is unable to activate complement due to a point mutation in the constant µ-heavy chain. Cμ13 mice have a higher proportion of MZ B cells, with higher CR1/2 expression, than wild-type mice. More IgG3-immune complexes are captured by MZ B cells and deposited on FDC in Cμ13 than in WT mice. In spite of this, IgG3 did not enhance the primary antibody response more efficiently in Cμ13 mice. The existence of endogenous IgM-mediated feedback regulation was suggested by the observation that GC development and antibody responses, after priming and boosting with suboptimal doses of SRBC, was lower in Cμ13 than in WT mice.