INTRODUÇÃO: A incidência de pacientes apresentando alergia à proteína do leite de vaca (APLV) após os 5 anos de idade vem crescendo. Definir se estes pacientes tolerariam a ingestão de alimento produzido com leite processado a altas temperaturas (LPAT) proporcionaria melhor qualidade de vida, definiria melhor prognóstico e possibilitaria avaliar a indicação de dessensibilização com muffin. OBJETIVO: (1) identificar quais pacientes com APLV persistente aos quatro anos poderiam tolerar a ingestão de LPAT, (2) descrever as características clínicas e laboratoriais dos grupos reativo e não reativo ao LPAT, e (3) compara-las entre os dois grupos. MÉTODOS: Estudo transversal, utilizando amostra de conveniência, incluindo todos os pacientes acompanhados no ambulatório de alergia alimentar do Instituto da Criança HCFMUSP que preenchiam os critérios de inclusão e que concordaram em realizar o TPO, entre janeiro/2013 e novembro/2014. Os pacientes foram admitidos em hospital-dia sob supervisão médica e submetidos à ingestão de um muffin contendo 2,8 gramas de proteína do leite de vaca. Foram definidos como tolerantes se não apresentassem nenhuma reação alérgica. Estes pacientes foram submetidos na sequência a novo TPO com leite de vaca in natura para excluir a tolerância ao leite de vaca. RESULTADOS: Foram realizados 38 TPO com LPAT, sendo que 30 pacientes (15 masculinos) preencheram todos os critérios de inclusão. A mediana da idade foi de 7 anos e 7 meses (4a10m -14a2m). 14 pacientes (46%) não apresentaram reação após a ingestão do muffin, sendo considerados como não reativos. A análise comparativa entre os grupos reativos e não reativos ao LPAT, não mostrou diferença estatisticamente significante quanto às características clínicas: idade (p=0,8), sexo (p=0,4), história pessoal de rinite (p=0,7), história pessoal de asma (p=0,7), história pessoal de outras alergias (p=0,6), história familiar de rinite (p=0,7), história familiar de asma (p=0,3), história familiar de outras alergias (p=0,1), relato de anafilaxia prévia (p=0,07), relato de ingestão de traços de leite previamente ao TPO (p=0,4), relato de reação alérgica no último ano antes da provocação (p=0,6), relato de anafilaxia no último ano antes do TPO (p=0,6). Não se observou diferença estatisticamente significante entre os dois grupos para IgE total (p=0,1) e eosinófilos (p=0,6). O teste de puntura para leite de vaca e frações mostrou diferença estatisticamente significante para ?-lactoalbumina (p= 0,01) e para a caseína (p = 0,004); em relação ao ImmunoCAP® apenas para a caseína (p= 0,05) essa diferença foi significante. Ao avaliar estes pacientes 1 ano após o TPO, nenhum dos 16 pacientes que foram reativos ao LPAT estava ingerindo leite de vaca, enquanto 28% dos pacientes que foram tolerantes ao LPAT estavam consumindo leite de vaca in natura sem reação (p=0,037). CONCLUSÃO: O estudo mostrou que os pacientes com APLV desta amostra brasileira apresentaram 2 diferentes fenótipos, sendo que aproximadamente metade tolerou o LPAT. Sendo assim, o TPO para LPAT deve ser considerado para pacientes com APLV, sempre sob supervisão médica e estrutura segura e adequada, pois pode contribuir para uma mudança no paradigma do seguimento destes pacientes. Teste de puntura e ImmunoCAP® para caseína podem sugerir quais pacientes estariam tolerantes ao TPO com LPAT, reforçando dados da literatura internacional / INTRODUCTION: The incidence of patients with cow\'s milk allergy (CMA) after the age of 5 has been growing. Defining whether these patients can tolerate the ingestion of food produced with baked milk without allergy reaction could provide a better quality of life, a better prognosis and would make it possible to evaluate indication of desensitization with baked milk. OBJECTIVE: (1) To identify which patients with persistent CMA at the age of four could tolerate the baked milk, (2) to describe the clinical and laboratory characteristics of the baked milk reactive group and the baked milk non-reactive group, and (3) to compare those two groups. METHODS: A cross-sectional study was conducted between January/2013 and November/2014. A convenience sample was applied, including all the patients followed in the Food Allergy Center of the Instituto da Criança HCFMUSP, who met inclusion criteria and agreed to carry out the oral food challenge (OFC). The patients were admitted to a day-hospital under medical supervision. They were submitted to a muffin intake containing 2.8 grams of cow\'s milk protein, and then classified as tolerant if they did not present any allergic reaction. To exclude cow\'s milk tolerance these patients were submitted to a new OFC with cow\'s milk in natura. RESULTS: 38 OFC with baked milk were performed, 30 patients (15 male) met all of the inclusion criteria. The median of age was 7 years and 7 months (4y10m -14y2m). 14 patients (46.6%) were considered as non-reactive because they did not present any reaction after the muffin intake. The comparative analysis between baked milk reactive group and baked milk non-reactive group did not show statistically significant difference in the clinical characteristics: age (p=0.8), gender (p=0.4), personal history of rhinitis (p=0.7), personal history of asthma (p=0.7), personal history of others allergies (p=0.6), family history of rhinitis (p=0.7), family history of asthma (p=0.3) family history of others allergies (p=0.1), previous anaphylaxis report (p=0.07), report of milk traits intake prior to OFC (p=0.4), allergic reaction in the last year before the OFC (p=0.6), anaphylaxis in the last year before the OFC (p=0.6). There was no statistically significant difference between the two groups for total IgE (p=0.1) and eosinophils (p=0.6). The Prick test for cow\'s milk and fractions showed statistically significant difference for ?-lactalbumin (p = 0.01) and for casein (p =0.004); in relation to the ImmunoCAP® only for casein (p=0.05) this difference was significant. After 1 year of the OFC, none of the patients which have been reactive to the baked milk were ingesting cow\'s milk, while 28% of the baked milk tolerant patients were consuming cow\'s milk in natura without reaction (p=0.037). CONCLUSION: The present study showed that patients with CMA of this brazilian sample presented 2 different phenotypes. Approximately half of them tolerated baked milk at age four. In conclusion, OFC for baked milk should be considered for patients with CMA, always under medical supervision and appropriate structure, so it could contribute for a change in these patients follow-up. Prick test and ImmunoCAP® for casein can suggest which patients would tolerate the OFC with baked milk, strengthening data of international literature

Le diabète auto-immun résulte de la destruction des cellules bêta pancréatiques sécrétrices d’insuline par les lymphocytes T du système immunitaire. Il s’ensuit une déficience hormonale qui peut être comblée par des injections quotidiennes d’insuline d’origine exogène, toutefois il demeure à ce jour impossible de guérir les patients atteints de la maladie. De façon générale, un système immunitaire sain reconnaît une multitude d’antigènes différents et assure ainsi notre défense à l’égard de différents pathogènes ou encore de cellules tumorales. Il arrive cependant que, pour des raisons génétiques et/ou environnementales, les lymphocytes T puissent s’activer de façon aberrante suite à la reconnaissance d’antigènes provenant du soi. C’est ce bris de tolérance qui mène au développement de pathologies auto-immunes telles que le diabète auto-immun. Afin de limiter l’auto-immunité, des mécanismes de sélection stricts permettent d’éliminer la majorité des lymphocytes T présentant une forte affinité envers des antigènes du soi lors de leur développement dans le thymus. Certains de ces lymphocytes réussissent toutefois à échapper à l’apoptose et migrent en périphérie afin d’y circuler en quête d’un antigène spécifiquement reconnu. Il est alors primordial que des mécanismes périphériques assurent le maintien de la tolérance immunitaire en faisant obstacle à l’activation et à la prolifération des lymphocytes T auto-réactifs. L’une des avenues afin d’inhiber le développement de réponses immunitaires aberrantes est la génération de lymphocytes T régulateurs. Ces cellules, d’origine thymique ou périphérique, peuvent arborer différents phénotypes et agissent via de multiples mécanismes afin d’inactiver et/ou éliminer les cellules impliquées dans l’apparition de pathologies auto-immunes. L’utilisation de modèles murins transgéniques a permis la mise en évidence d’une population peu caractérisée de lymphocytes T au potentiel régulateur. En effet, la proportion de ces cellules T n’exprimant pas les corécepteurs CD4 et CD8 (double négatives, DN) a été inversement corrélée à la prédisposition à l’auto-immunité chez ces ii souris. L’objectif principal de cette thèse est de démontrer la fonction immuno-régulatrice des lymphocytes T DN, tout en investiguant les facteurs génétiques responsables du maintien de cette population cellulaire. Nous avons observé que les lymphocytes T DN exercent une activité cytotoxique à l’égard des lymphocytes B de façon spécifique à l’antigène, via la libération de granules cytolytiques contenant du granzyme B et de la perforine. Par ailleurs, nous avons établi qu’un unique transfert adoptif de ces cellules est suffisant afin d’inhiber le développement du diabète auto-immun chez des hôtes transgéniques prédisposés à la maladie. Le recours à des souris déficientes pour l’expression du gène CD47 a permis de constater que la voie de signalisation CD47-Sirp est essentielle dans le maintien de la proportion des lymphocytes T DN. De plus, le locus murin de prédisposition au diabète auto-immun Idd13, qui contient le gène Sirp, a été identifié pour son rôle dans la régulation de la proportion de ces cellules. Finalement, une analyse génétique a révélé que d’autres intervalles génétiques sont impliqués dans le contrôle de la population des lymphocytes T DN. Parmi ceux-ci, un locus situé en région proximale du chromosome 12 a été validé grâce à la création de souris congéniques. Grâce aux résultats présentés dans cette thèse, notre compréhension de la biologie ainsi que de la régulation des lymphocytes T DN est approfondie. Ces connaissances constituent un pas important vers la création de thérapies cellulaires novatrices permettant de prévenir et de guérir diverses pathologies auto-immunes. / Autoimmune diabetes results from the destruction of the insulin-secreting pancreatic beta cells by the T lymphocytes of the immune system. This leads to a hormonal deficiency that can be regulated with daily injections of exogenous insulin. However, to date, there is no cure for autoimmune diabetes. A healthy immune system generally recognizes a multitude of antigens in order to ensure our defence against different pathogens and tumor cells. Yet, depending on genetic and/or environmental factors, individuals may develop T cells that are aberrantly activated following the recognition of self-antigens. This break in tolerance leads to the development of autoimmune pathologies, such as autoimmune diabetes. In order to limit autoimmunity, rigorous selection mechanisms eliminate the vast majority of the T lymphocytes that present a high affinity for self-antigens during their thymic development. However, some of these auto-reactive lymphocytes escape from the elimination processes and migrate to the periphery where they might encounter a self-antigen. It is then essential that peripheral mechanisms maintain the immune tolerance by abrogating the activation and the proliferation of these self-specific T lymphocytes. One of the means to inhibit aberrant immune responses is the generation of regulatory T lymphocytes. These cells, which can be of thymus or peripheral origin, display various phenotypes and can mediate their action through several mechanisms in order to inactivate and/or eliminate the cells that are implicated in the development of autoimmune diseases. The use of transgenic mouse models made it possible to identify a poorly characterized population of T lymphocytes that exhibit a regulatory potential, namely CD4-CD8- (double negative, DN T cells). Indeed, the proportion of DN T cells in lymphoid organs is inversely correlated to autoimmune predisposition. The main objective of this thesis is to determine the immunoregulatory function of the DN T cells, as well as to reveal the genetic factors underlying the regulation of the proportion of DN T cells. iv We observed that through the release of cytolytic granules containing granzyme B and perforin, DN T lymphocytes exert a cytotoxic activity towards B cells in an antigen-specific manner. In addition, we have established that a single injection of those DN T cells is sufficient to inhibit the development of autoimmune diabetes in highly susceptible transgenic mice. The use of CD47 deficient mice also demonstrated that the CD47-Sirp pathway is essential to maintain DN T cell proportion. Also, we identified that the autoimmune diabetes susceptibility locus Idd13, which contains Sirp participates in defining the proportion of DN T cells. Finally, a genetic analysis revealed that other loci are implicated in the control of the DN T cell population. Among those, the role of a locus situated in the proximal region of chromosome 12 has been validated through to the generation of congenic mice. The results presented in this thesis have allowed us to enhance our understanding of the biology and genetic regulation of DN T lymphocytes. This knowledge constitutes an important step towards the creation of innovative cellular therapies that may prevent and cure a diversity of autoimmune pathologies.

La contribution des DCs dans l’initiation et la perpétuation des maladies auto-immunes est bien établie. Chez la souris Non Obèse Diabétique (NOD), modèle spontané du diabète de type 1 (DT1), plusieurs travaux ont rapportés des anomalies phénotypiques et fonctionnelles des DCs. Les DCs sont parmi les premières cellules qui infiltrent les ilots pancréatiques, produisent des quantités excessives de cytokines pro-inflammatoires et contribuent à l’activation des lymphocytes T auto-réactifs (Teff). Cette capacité accrue des DCs à activer les Teffs est régulée par plusieurs voies de signalisation intracellulaire. STAT5 est parmi les facteurs de transcription critiques dans la régulation des gènes associés au développement, la maturation et les fonctions des DCs. La prédisposition au DT1 chez la NOD est déterminée par plusieurs régions de susceptibilités au diabète (idd1-20). De façon intéressante, le gène Stat5b est localisé dans la région de susceptibilité idd4 chez la souris NOD suggérant son implication dans le développement du diabète. En effet des études récentes ont identifiés un dysfonctionnement dans la voie de signalisation JAK-STAT5 chez les souris NOD, y compris la présence d’une mutation (L327M) au niveau du domaine de liaison à l’ADN de Stat5b qui altère sa liaison à l’ADN. Par ailleurs, les études réalisées dans notre laboratoire ont montré que le conditionnement des DCs au GM-CSF ou à la TSLP, qui activent la voie de signalisation Jak-Stat5, constitue une voie potentielle d’immunothérapie chez la souris NOD. Ces données suggèrent un rôle central de Stat5b dans la régulation des fonctions tolérogènes des cellules du système immunitaire. Nous avons généré un modèle de souris NOD transgéniques (NOD.CD11cStat5b-CA) exprimant de façon constitutive la forme active de STAT5B de la souris C57BL/6 spécifiquement dans les DCs. Nos résultats ont montré que ces souris transgéniques ont développées une protection totale contre le diabète auto-immun. Cette résistance au diabète à long terme est associe à l’acquisition des fonctions tolérogènes par les Stat5b-CA.DCs qui se manifestent par un phénotype mature tolérogène, marquées par une forte expression de molécules immunorégulatrices (PD-L1 et PD-L2) et une grande production de cytokines anti-inflammatoire (TGF-β) et une baisse significative de la production de cytokines pro-inflammatoires (IL-12p70, TNF-α et d’IL-23). Par ailleurs, nous avons mis en évidence le rôle de STAT5B dans la régulation à la hausse d’IRF4 et l’implication du complexe STAT5B/EZH2 dans le contrôle de la régulation à la baisse d’IRF8. En effet, cette régulation différentielle de l’expression des gènes Irf4 et Irf8 est accompagnée du développement d’une sous population CD11c+ CD11b+ DCs. Nos études ont démontré que le potentiel tolérogène des Stat5b-CA.DCs à rétablir et à maintenir la tolérance périphérique du système immunitaire vis-à-vis des auto-antigènes est associe à leur grande capacité d’induire la conversion et l’expansion des Tregs ainsi que la différentiation de deux populations cellulaires régulatrices Th2 et Tc2. Nous avons aussi démontré in vivo qu’une injection intraveineuse unique de Stat5-CA.DCs (spléniques ou générés de la moelle osseuse) ou de Tregs des souris transgéniques NOD.CD11cStat5b-CA a induit une protection totale contre le diabète chez les souris NOD receveuses. Notre étude apporte donc une évidence claire que la correction du défaut de la voie de signalisation Jak-Stat5b au sein des DC chez la souris NOD induit une protection à long terme contre le diabète. Finalement, cette voie de signalisation peut constituer une cible thérapeutique éventuelle non seulement dans le contexte du diabète de type 1 mais également dans d’autres maladies auto-immunes. / The contribution of DCs in the initiation and progression of autoimmune diseases is well established. Several studies have reported that phenotypic and functional abnormalities of DCs, in Non Obese Diabetic (NOD), contribute to spontaneous type 1 diabetes (T1D) development. DCs are among the first cells that infiltrate the pancreatic islets, produce excessive amounts of pro-inflammatory cytokines, and contribute to the activation of T effector cells (Teff). This increased ability of DCs to activate Teff is regulated by several intracellular signaling pathways. STAT5 is among the critical transcription factors in the regulation of genes associated with the development, maturation and functions of DCs. The predisposition to T1D in NOD is determined by several regions of susceptibility to diabetes (idd1-20). Interestingly, the Stat5b gene is located in the idd4 susceptibility region in NOD mice suggesting its involvement in the development of diabetes. Recent studies have identified a dysfunction in the Jak-Stat5 signaling pathway in NOD mice, including the presence of a mutation (L327M) at the DNA-binding domain of Stat5b which alters its binding to DNA. Furthermore, previous studies from our laboratory have shown that the GM-CSF- or TSLP-conditioned DCs, which activate the Jak-Stat5 signaling pathway, is a potential pathway for immunotherapy in NOD mice. These data suggest a central role for Stat5b in the regulation of tolerogenic functions of the immune cells. Here, we generated a transgenic NOD mouse model (NOD.CD11cStat5b-CA) that constitutively express the active form of STAT5B from the C57BL/6 mouse specifically in DCs. Our results showed that these transgenic mice are completely protected against autoimmune diabetes. This long-term diabetes protection is associated with the acquisition of tolerogenic functions by Stat5b-CA.DCs, that exhibit a mature tolerogenic phenotype, overexpression of immunoregulatory molecules (PD-L1 and PD-L2) and produce anti-inflammatory cytokines (TGF-β) and a significantly decrease their production of pro-inflammatory cytokines (IL-12p70, TNF-α and IL-23). Moreover, we have highlighted the role of STAT5B in the upregulation of IRF4 and also the involvement of the STAT5B/ EZH2 complex in downregulation of IRF8. This differential regulation of the Irf4 and Irf8 genes expression is accompanied by promoting the development of CD11c+CD11b+ DC subset. Furthermore, we demonstrated that the tolerogenic Stat5b-CA.DCs were able to restore and maintain peripheral immune tolerance to autoantigens, which is associated with their high ability to induce conversion and expansion Tregs and to promote Th2 and Tc2 immune deviation. We also demonstrated that a single intravenous injection of Stat5-CA.DCs (splenic or bone marrow derived dendritic cells) or Tregs from transgenic mice NOD.CD11cStat5b-CA halted ongoing diabetes in recipient NOD mice. Thus, our study provides clear evidence that the correction of the Jak-Stat5b signaling pathway defect in DC of NOD mice induces long-term protection against diabetes suggesting that signaling pathway can be a potential therapeutic target not only in the context of type 1 diabetes but also in other autoimmune diseases.

À l’inverse des autres sous types de cellules dendritiques conventionnelles (cDC), la présentation de peptides dérivés de corps apoptotiques par les DC mérocytiques (mcDC) cause un bris de la tolérance. Ces cellules induisent le diabète lorsqu’elles présentent des peptides dérivés de cellules bêta du pancréas. De plus, chargées avec des peptides dérivés de cellules tumorales, elles permettent la réactivation des lymphocytes T et l’élimination de la tumeur. Ces propriétés spécifiques aux mcDCs mettent en évidence de nouveaux aspects dans le contrôle des bris de tolérance. Comprendre leur relation avec les autres DCs et leur régulation sont nécessaires pour comprendre les mécanismes associés à la tolérance immune. Nous avons déterminé que les mcDCs étaient des cDCs. Les mcDCs sont des cellules avec une courte durée de vie et qui induisent une réponse allogénique. Elles expriment le facteur de transcription spécifique aux cDCs, Zbtb46. Les mcDCs se différencient à partir des précurseurs communs aux cDCs. Elles expriment le facteur de transcription IRF-4, important pour les cDC2, et son absence affecte leur homéostasie. Cependant, la proximité des mcDCs avec les cDC2 diffère en matière de métabolisme où elles ont des signatures différentes. Les mcDCs sont retrouvées en plus grand nombre dans un modèle murin de diabète auto-immun spontané (NOD) que dans une lignée de souris résistante (C57BL/6). Notre laboratoire a validé que le locus Idd13 du chromosome 2 était lié au nombre de mcDCs, suggérant donc qu’un ou plusieurs gènes de ce locus ont un rôle dans la régulation du nombre de mcDCs. En ciblant des gènes polymorphiques entre la souris NOD et la souris C57BL/6, nous avons déterminé que le gène Bim, qui code pour une molécule proapoptotique, régule de manière moelle osseuse intrinsèque spécifiquement les mcDCs. Les mcDCs sont donc un sous-type de cDCs spécifiquement régulé par Bim. Ce sous- type de cDCs est une population clé dans les bris de tolérance et comprendre leur homéostasie est primordial pour déterminer leur rôle dans le contrôle de la tolérance immune. / Unlike other conventional dendritic cells (cDCs) subtypes, presentation of peptides derived from apoptotic bodies by merocytic dendritic cells (mcDCs) is associated with a break of tolerance. Presentation of peptides derived from pancreatic beta cells by mcDC is linked to diabetes induction. However, when loaded with peptides derived from tumor cells, they allow the reactivation of T cells and the elimination of the tumor. These properties specific to mcDC highlight new aspects in the control of break of tolerance. Understanding their relationships with other DCs and their regulation is important for understanding the mechanisms associated with immune tolerance. We have determined that mcDCs are cDCs. mcDCs are short-lived cells able to induce an allogeneic response. They express the specific cDC transcription factor, Zbtb46. mcDCs are differentiated from the cDC common precursors. They express and require IRF-4 for their homeostasis, a transcription factor associated with cDC2 differentiation. However, the proximity of mcDC to cDC2 differs in terms of metabolism where they have different signatures. mcDCs are found in greater numbers in the mouse model of spontaneous autoimmune diabetes (NOD) than in a resistant line (C57BL/6). Our laboratory validated that the Idd13 locus of chromosome 2 was linked to mcDC number, thus suggesting that one or more genes of this locus have a role in regulating the number of mcDC. By targeting polymorphic genes between the NOD and C57BL/6 mice, we determined that Bim gene, encoding a pro-apoptotic molecule, regulate specifically mcDC in a bone marrow intrinsic manner. Therefore, mcDCs are a subset of cDCs specifically regulated by Bim. This subtype of cDCs is a key player in break of tolerance and understanding their homeostasis is important in determining their role in immune tolerance.

La thérapie génique consiste à introduire du matériel génétique dans des cellules dans l’objectif de traiter une pathologie. Le plus souvent, la thérapie génique s’effectue au moyen d’un vecteur viral, transportant le gène jusque dans les cellules cibles. Dans le cas des maladies monogéniques, l’adeno-associated virus (AAV) s’est imposé progressivement comme un vecteur de choix. Son absence de pathogénicité, son large tropisme et sa capacité à transduire des cellules quiescentes sont autant d’avantages comparés à d’autres vecteurs utilisés en thérapie génique. L’utilisation d’AAV est approuvé en Europe pour le traitement d’un déficit rare en lipoprotéine lipase et vient récemment d’être approuvé par les autorités américaines pour le traitement d’un déficit de la vision. Toutefois, les essais de thérapies géniques se heurtent souvent aux réponses immunitaires dirigées contre l’AAV. En effet, les différents composants de ce vecteur viral ont été identifiés comme pouvant déclencher des réponses immunitaires s’opposant à l’efficacité à long terme de la thérapie génique. De plus, la protéine transgénique peut s’avérer immunogène, ce qui conduit au déclenchement de réponses immunitaires, à la destruction des cellules transduites et in fine à l’échec de la thérapie génique. En clinique, des immunosuppresseurs sont utilisés pour palier à ses effets indésirables. Toutefois, de par leurs effets secondaires infectieux et tumorigènes, des stratégies visant plutôt à induire de la tolérance vis-à-vis de la protéine transgénique, associées à un bénéfice pour la santé des patients, se sont développées.L’objectif de ce travail de thèse a été d’implémenter une nouvelle stratégie visant à étudier l’effet immunorégulateur et tolérogène de protéines de fusion dérivées de CTLA-4/Fc et de PD-L1/Fc. Pour cela, nous avons utilisé un modèle murin récapitulant les réponses immunitaires induites par un AAV permettant l’expression d’une protéine modèle fortement immunogène, l’ovalbumine (Ova). Ensuite, des AAV codant pour les protéines au potentiel immunorégulateur ont été synthétisés et injectés aux souris conjointement à l’AAV-Ova. Cette stratégie d’immunorégulation vectorisée (VIR) nous a permis d’évaluer la capacité de chacune des protéines à moduler les réponses immunitaires dirigées contre l’Ova directement in vivo. Au total, ce travail a permis de mettre en évidence i) l’intérêt et les limites de la stratégie VIR, ii) celui du rôle délétère de CTLA-4/Fc au long terme sur les lymphocytes Tregs CD4+FoxP3+, périphériques et centraux, iii) et de démontrer l’intérêt de 2 nouvelles molécules dérivées PD-L1/Fc sur la persistance de l’Ova. / Gene therapy consist into introducing genetic material into cells to treat genetic disorders. Most gene therapies use viral vectors to carry the gene within target cells. In case of monogenic disorders, adeno-associated viruses (AAV) has become a vector of choice because of its lack of pathogenicity, its large tropism and its capacity to transduce quiescent cells. The use of AAV is approved in Europe to treat a rare lysosomal storage disease and has recently been approved by the FDA to treat a genetic cause of blindness. However, most clinical trials face immune responses directed against AAV components which may be highly immunogenic. This deleterious immunogenicity often lead to the trial failure. In addition, transgenic protein can also be immunogenic, aimaing to the destruction of transduced cells and ultimatly to gene therapy failure. In clinic, immunosuppressive drug remain the only option to counteract unwanted immune responses. These drugs possess infectious and tumorigenic side effects, therefore strategies aiming to rather capable to induce tolerance toward the transgenic protein are being developped and needed. The objectif of this work was to implement a new strategy aiming to study the immunoregulatory and tolerogenic effect of fusion proteins derived from CTLA-4 and PD-L1. We used a murin model recapitulating the immunes responses induced by an AAV coding for an immunogenic model protein, ovalbumin (Ova) presented in previous studies by our group and others. Then, we synthesized AAV coding for our newly designed immunoregulatory protein and injected them into mice along with AAV-Ova. This strategy of vectorized immunoregulation (VIR) allowed to evaluate the intrinsic capacity of each individual proteins to modulate immune responses against Ova directly in vivo. Eventually, this work allow to 1) assess the benefits and limits of the VIR strategy, 2) the deletrious long-term effects of CTLA-4/Fc on central and peripheral Tregs in mice, 3) to demonstrate the interest of new molecules specifically derived from PD-L1/Fc over the immune tolerance through the long-term persistance of Ova transgene.

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The prevalence of diabetes is approaching epidemic proportions worldwide. There is currently no cure for type 1 diabetes, and successful treatment requires constant monitoring of blood sugars and use of exogenous insulin to prevent hyperglycemia. Diabetes will be curable when pancreatic β-islet cells can be transplanted into diabetes patients without requiring long-term immunosuppression. This will require learning more about the induction of functional tolerance, a state that maintains the competence of the immune system to most antigens but protects graft-specific antigens from immune rejection, permitting transplantation. One known mechanism of peripheral tolerance is T cell anergy, a phenotype of hypo-reponsiveness in CD4+ T cells. The focus of this thesis is a description of factors shown to be specific to the induction and maintenance of T cell anergy, whose loss reverses the anergic phenotype, restoring the ability of the cells to proliferate in response to antigen. The first of these is Egr-2, a zinc-finger transcription factor, whose presence is required for the induction of anergy induced in T cell clones by TCR stimulation in the absence of costimulation. Egr-2 is shown to be important to anergy induction but not anergy maintenance. In contrast, a negative costimulation receptor, PD-1, is shown to be necessary for the maintenance of anergy. It is possible that learning more about the genetic factors that orchestrate T cell anergy will prove useful in the development of tolerance-based protocols for organ and tissue transplantation without the use of long-term immunosuppression.

Plasmacytoid dendritic cells (pDC) represent innate immune cells capable to detect viruses in their endosomal environment via Toll-like receptors (TLRs). Viral nuclear acid recognition leads to the massive production of type I interferon (IFN I) and induction of the antiviral state in uninfected cells. Crosslinking of the surface regulatory receptors, such as BDCA-2, with monoclonal antibodies or with some viruses leads to the activation of MEK1/2- ERK signaling pathway and inhibition of IFN I production in pDC. In this study, the role of MEK1/2 kinase has been highlighted. Its inhibition reversed the inhibitory effect of BDCA-2 crosslinking and its direct activation with PMA led to the inhibition of IFN-α production. Yet an unclear role of pDC in sensing of BK polyomavirus virus (BKV) responsible for kidney transplant rejection was investigated as a major topic of this thesis. Experiments with the pDC cell line Gen2.2 and HRPTEC primary cell line showed that pDCs were not able to detect BKV particles, however, exposure of activated Gen2.2 cells to BKV inoculum dramatically upregulated production of IFN-α. Most importantly, coculture of Gen2.2 cells with BKV- infected HRPTEC cells resulted in IFN-α and TNF-α production, which was prevented by Bafilomycin. These results suggest that BKV-infected...

Plasmacytoid dendritic cells (pDC) are a highly specialized subset of immune cells that sense viral nucleic acids by endosomal toll-like receptors 7 and 9 (TLR7/9). Activation of TLR7/9 leads to the production of type I interferons (IFN-I). Moreover, pDC contribute to the antiviral response by presenting viral antigens to T lymphocytes and link innate and adaptive immunity. pDC need to be properly regulated in order to limit excessive production of IFN-I that is associated with autoimmune diseases. Therefore, pDC possess a battery of regulatory receptors (RR) that limit TLR7/9-mediated cytokine production. This thesis focuses on the mechanism of RR-mediated inhibition of IFN-I production in pDC and explores interactions between pDC and two enveloped viruses, that possess the ability to hijack RR in pDC: hepatitis B virus (HBV) and human immunodeficiency virus (HIV). We showed, that MEK-ERK signaling pathway plays an active role in RR-mediated inhibition of IFN-I in pDC. Our results indicate that in line with other studies of our group, pharmacological targeting of MEK1/2-ERK signaling could be a strategy to re-establish immunogenic activity of pDC. Then, we investigated whether antiretroviral therapy (ART) in a cohort of 21 treatment-naive chronic HIV-infected patients has restored the number and...

Plasmacytoid dendritic cells (pDC) represent innate immune cells capable to detect viruses in their endosomal environment via Toll-like receptors (TLRs). Viral nuclear acid recognition leads to the massive production of type I interferon (IFN I) and induction of the antiviral state in uninfected cells. Crosslinking of the surface regulatory receptors, such as BDCA-2, with monoclonal antibodies or with some viruses leads to the activation of MEK1/2- ERK signaling pathway and inhibition of IFN I production in pDC. In this study, the role of MEK1/2 kinase has been highlighted. Its inhibition reversed the inhibitory effect of BDCA-2 crosslinking and its direct activation with PMA led to the inhibition of IFN-α production. Yet an unclear role of pDC in sensing of BK polyomavirus virus (BKV) responsible for kidney transplant rejection was investigated as a major topic of this thesis. Experiments with the pDC cell line Gen2.2 and HRPTEC primary cell line showed that pDCs were not able to detect BKV particles, however, exposure of activated Gen2.2 cells to BKV inoculum dramatically upregulated production of IFN-α. Most importantly, coculture of Gen2.2 cells with BKV- infected HRPTEC cells resulted in IFN-α and TNF-α production, which was prevented by Bafilomycin. These results suggest that BKV-infected...