Die vorliegende Arbeit beinhaltet die Generierung und Evaluation von Natürlichen Killerzellen, die EGFRvIII-positive und SDF-1alpha sekretierende primäre Glioblastomzellen aufspüren, erkennen und effizient abtöten können. Die Kombination der gelenkten Zytotoxizität mit einer optimierten Migration von Effektorzellen des Immunsystems wird auf Grundlage der in dieser Arbeit gewonnenen Daten als ein vielversprechender Ansatz für eine zukünftige Therapie des primären Glioblastoms vorgeschlagen.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

The Tec family kinases Itk and Rlk have been previously shown to have an important role in signaling downstream of the T cell receptor [TCR]. Almost all of the work done in the past on these two kinases looked at their role in conventional αβ T cells, specifically CD4+ T cells. These studies demonstrated functions for Itk [primarily] and Rlk in T cell development, activation, and differentiation. However, despite the wealth of knowledge on conventional CD4+ T cells, prior to the work presented here little to no studies addressed the role of Tec family kinases on CD8+ or innate T cell development. My studies show a clear role for Itk [and in some cases Rlk] in innate T cell development; whether it be deprecating, in the case of innate CD8+ T cells or some subsets of γδ T cells, or beneficial, in the case of NKT cells. I show that Itk has a crucial role in conventional CD8+ T cell development, as absence of Itk [or Itk and Rlk] causes strongly reduced numbers of conventional CD8+ T cells and a vigorous enhancement of an innate-like CD8+ T cell population. In NKT cells, my work demonstrates that Itk [and to a lesser extent Rlk] is required for terminal maturation, survival, and cytokine secretion. Finally, on γδ T cells Itk is important in maintaining the Th1 cytokine secretion profile usually associated with these cells, and regulating the development of CD4+ or NK1.1+ γδ T cells. Taken together, this work clearly illustrates an important role for Tec family kinases in innate T cell development and function.

O complexo Sporothrix schenckii reúne espécies etiologicamente relacionadas à esporotricose, uma micose que pode acometer seres humanos e animais. Foi realizada a identificação fenotípica e molecular de 85 isolados provenientes de quatro estados brasileiros (Minas Gerais, Rio de Janeiro, Rio Grande do Sul e São Paulo). Foram pesquisadas a produção de enzimas, o perfil de inibição por leveduras killer, a suscetibilidade aos antifúngicos comerciais e aos extratos de plantas. Os isolados foram identificados como S. schenckii, S. brasiliensis e S. globosa, com predomínio de S. schenckii. Houve discordância de 37,7% entre a identificação das espécies do complexo S. schenckii utilizando metodologias fenotípicas e genotípicas. Entre os antifúngicos testados, a terbinafina foi o fármaco mais ativo; seguido por cetoconazol e itraconazol, enquanto fluconazol e voriconazol foram os menos ativos. Cinco isolados fúngicos foram detectados como resistentes ao itraconazol, sendo um S. globosa e quatro S. schenckii. Não houve diferença nos perfis de suscetibilidade aos antifúngicos entre as espécies do complexo Sporothrix schenckii. Entre os extratos de origem vegetal, o mais ativo foi o proveniente de Pterocaulon polystachyum, mostrando que o uso popular das plantas reforça a importância de pesquisas etnofarmacológicas, abrindo a possibilidade de encontrar novos agentes antifúngicos clinicamente eficazes. Doze das 18 leveduras killer avaliadas apresentaram atividade frente a todos os isolados do complexo S. schenckii estudados. No entanto, não houve diferença na suscetibilidade as toxinas entre as espécies de Sporothrix. Todos os isolados produziram desoxiribonuclease, urease e proteinase. Atividade fosfolipase e esterase foi detectada em 83 (97,6%) e 80 (94,1%), respectivamente, dos isolados testados. Todas as amostras do complexo S. schenckii produziram, pelo menos, quatro das enzimas avaliadas, e 78 (91,8%) dos isolados produziram todas as enzimas analisadas no estudo. No entanto, não foi possível diferenciar as espécies de Sporothrix baseado no perfil enzimático. Entre as enzimas extracelulares avaliadas nos isolados do complexo S. schenckii, desoxiribonuclease e esterase foram produzidas em maior quantidade, podendo vir a ser um fator de virulência. Além disso, o caldo Sabouraud dextrose mostrou potencial para ser usado na avaliação in vitro da atividade antifúngica frente ao complexo S. schenckii. / The Sporothrix schenckii complex combines species etiologically related to sporotrichosis, a mycosis which can affect humans and animals. The phenotypic and genotypic identification of 85 strains from four Brazilian States (Minas Gerais, Rio de Janeiro, Rio Grande do Sul and São Paulo) was performed. The enzymatic production, profile of inhibition by killer yeasts, susceptibility to marketed antifungal and to plant extracts were surveyed. The isolates were identified as S. schenckii, S. brasiliensis and S. globosa, with the predominance of S. schenckii. There was 37.7% disagreement regarding the species classification using phenotypic and genotypic methodologies. Among the tested antifungals, terbinafine was the most active drug, followed by ketoconazole and itraconazole, while fluconazole and voriconazole were the least active ones. Five isolates - one S. globosa and four S. schenckii - were resistent to itraconazole. There was no difference as to the profiles of the susceptibility to the antifungal agents among the Sporothrix species. The most active vegetal extract was from Pterocaulon polystachyum, showing that the popular use of these plants reinforces the importance of ethnopharmacological researches, with the possibility of finding new clinically effective antifungal agents. Twelve out of the 18 evaluated killer yeasts showed activity against all the tested strains of the S. schenckii complex. However, there was no difference in susceptibility to the toxins among the Sporothrix species complex. All the isolates were desoxiribonuclease, urease and proteinase positive. Phospholipase and esterase activities were detected in 83 (97.6%) and 80 (94.1%), respectively, among the isolates evaluated. All the S. schenckii complex strains produced at least four of the evaluated enzymes, and 78 (91.8%) of the isolates produced all the enzymes analyzed in the study. However, it is not possible to differentiate the Sporothrix species based on their enzymatic profile. Among the extracellular enzymes evaluated in the S. schenckii complex isolates, desoxiribonuclease and esterase were the most prominent ones, and their production may be a virulence factor. Furthermore, the Sabouraud dextrose broth showed potential to be used in the in vitro evaluation of the antifungal activity against the S. schenckii complex.

O complexo Sporothrix schenckii reúne espécies etiologicamente relacionadas à esporotricose, uma micose que pode acometer seres humanos e animais. Foi realizada a identificação fenotípica e molecular de 85 isolados provenientes de quatro estados brasileiros (Minas Gerais, Rio de Janeiro, Rio Grande do Sul e São Paulo). Foram pesquisadas a produção de enzimas, o perfil de inibição por leveduras killer, a suscetibilidade aos antifúngicos comerciais e aos extratos de plantas. Os isolados foram identificados como S. schenckii, S. brasiliensis e S. globosa, com predomínio de S. schenckii. Houve discordância de 37,7% entre a identificação das espécies do complexo S. schenckii utilizando metodologias fenotípicas e genotípicas. Entre os antifúngicos testados, a terbinafina foi o fármaco mais ativo; seguido por cetoconazol e itraconazol, enquanto fluconazol e voriconazol foram os menos ativos. Cinco isolados fúngicos foram detectados como resistentes ao itraconazol, sendo um S. globosa e quatro S. schenckii. Não houve diferença nos perfis de suscetibilidade aos antifúngicos entre as espécies do complexo Sporothrix schenckii. Entre os extratos de origem vegetal, o mais ativo foi o proveniente de Pterocaulon polystachyum, mostrando que o uso popular das plantas reforça a importância de pesquisas etnofarmacológicas, abrindo a possibilidade de encontrar novos agentes antifúngicos clinicamente eficazes. Doze das 18 leveduras killer avaliadas apresentaram atividade frente a todos os isolados do complexo S. schenckii estudados. No entanto, não houve diferença na suscetibilidade as toxinas entre as espécies de Sporothrix. Todos os isolados produziram desoxiribonuclease, urease e proteinase. Atividade fosfolipase e esterase foi detectada em 83 (97,6%) e 80 (94,1%), respectivamente, dos isolados testados. Todas as amostras do complexo S. schenckii produziram, pelo menos, quatro das enzimas avaliadas, e 78 (91,8%) dos isolados produziram todas as enzimas analisadas no estudo. No entanto, não foi possível diferenciar as espécies de Sporothrix baseado no perfil enzimático. Entre as enzimas extracelulares avaliadas nos isolados do complexo S. schenckii, desoxiribonuclease e esterase foram produzidas em maior quantidade, podendo vir a ser um fator de virulência. Além disso, o caldo Sabouraud dextrose mostrou potencial para ser usado na avaliação in vitro da atividade antifúngica frente ao complexo S. schenckii. / The Sporothrix schenckii complex combines species etiologically related to sporotrichosis, a mycosis which can affect humans and animals. The phenotypic and genotypic identification of 85 strains from four Brazilian States (Minas Gerais, Rio de Janeiro, Rio Grande do Sul and São Paulo) was performed. The enzymatic production, profile of inhibition by killer yeasts, susceptibility to marketed antifungal and to plant extracts were surveyed. The isolates were identified as S. schenckii, S. brasiliensis and S. globosa, with the predominance of S. schenckii. There was 37.7% disagreement regarding the species classification using phenotypic and genotypic methodologies. Among the tested antifungals, terbinafine was the most active drug, followed by ketoconazole and itraconazole, while fluconazole and voriconazole were the least active ones. Five isolates - one S. globosa and four S. schenckii - were resistent to itraconazole. There was no difference as to the profiles of the susceptibility to the antifungal agents among the Sporothrix species. The most active vegetal extract was from Pterocaulon polystachyum, showing that the popular use of these plants reinforces the importance of ethnopharmacological researches, with the possibility of finding new clinically effective antifungal agents. Twelve out of the 18 evaluated killer yeasts showed activity against all the tested strains of the S. schenckii complex. However, there was no difference in susceptibility to the toxins among the Sporothrix species complex. All the isolates were desoxiribonuclease, urease and proteinase positive. Phospholipase and esterase activities were detected in 83 (97.6%) and 80 (94.1%), respectively, among the isolates evaluated. All the S. schenckii complex strains produced at least four of the evaluated enzymes, and 78 (91.8%) of the isolates produced all the enzymes analyzed in the study. However, it is not possible to differentiate the Sporothrix species based on their enzymatic profile. Among the extracellular enzymes evaluated in the S. schenckii complex isolates, desoxiribonuclease and esterase were the most prominent ones, and their production may be a virulence factor. Furthermore, the Sabouraud dextrose broth showed potential to be used in the in vitro evaluation of the antifungal activity against the S. schenckii complex.

A evolução do conhecimento sobre o HIV e seus efeitos sobre as diferentes células do sistema imune possibilitaram a criação e o aperfeiçoamento de um grande arsenal terapêutico. Atualmente, a sobrevida de casos recém-­ diagnosticados é medida em décadas; entretanto, alguns pacientes não apresentam recuperação do sistema imune após a agressão inicial sofrida pelo vírus, a despeito de tratamento adequado. As células NK são identificadas como componentes da imunidade inata, responsáveis pelo combate a infecções virais e tumores. Elas são divididas em CD56dim e CD56hi, com diferentes capacidades citotóxicas e de produção de citocinas; uma terceira subpopulação composta por células CD56neg está presente em proporções mínimas em adultos saudáveis, porém tem maior importância em neonatos e está expandida em indivíduos cronicamente infectados pelo HIV, podendo ser identificada pelos marcadores CD7 e CD16. Dentre diversos outros, as células NK expressam receptores ativadores e inibitórios chamados KIR, que interagem com moléculas HLA, identificando células próprias e aquelas que reduzem sua expressão como mecanismo de escape imunológico; a interação entre KIR e HLA tem papel na evolução clínica da infecção por HIV/AIDS, particularmente envolvendo o receptor KIR3DL1. PD-­ 1 é um checkpoint do sistema imunológico que pode ter sua expressão aumentada em tumores e infecções virais crônicas. A expressão de PD-­1 em células T correlaciona-­se a marcadores prognósticos na infecção por HIV/AIDS; sua expressão em células NK já foi documentada, porém temos poucas informações a respeito. Este trabalho buscou detalhar a expressão de PD-­1 e seu ligante PD-­L1 em células NK e monócitos em participantes infectados pelo HIV e controles. Foram recrutados participantes diagnosticados e acompanhados desde a infecção aguda, participantes diagnosticados após um intervalo de tempo desconhecido desde a soroconversão e controles não infectados sob alto risco por exposição sexual. As amostras foram processadas a fresco no LIM-­60; PD-­1 e outros marcadores foram analisados por citometria de fluxo multicor. A expressão de PD-­1 em células NK correlacionou-­se a contagens de células T CD4+ e expressão de PD-­1 em células T nos participantes infectados; dentre estes, os participantes seguidos desde a infecção aguda tiveram menor expressão de PD-­1. Os participantes seguidos desde a infecção aguda tiveram ainda menor expressão de PD-­L1 em monócitos quando comparados aos participantes diagnosticados em fase desconhecida da doença, e também quando comparados aos controles não infectados. Houve aumento expressivo da proporção de células KIR3DL1+ entre as células CD56neg nos participantes infectados em comparação ao grupo não infectado. Concluímos que a expressão de PD-­1 em células NK está aumentada em pessoas infectadas pelo HIV e correlaciona-­se a outros parâmetros imunológicos, como contagem de células T CD4+ e expressão de PD-­1 em células T. A exaustão das células NK pode, portanto, contribuir para o dano imunológico causado pelo HIV e pode ser explorada como um alvo para novas modalidades terapêuticas / The expansion of our knowledge about the HIV and its effects on the entire immune system has led the development of a vast therapeutic arsenal. Survival for newly diagnosed cases is now measured in decades;? some patients, however, never recover full immune function following the initial aggression inflicted by HIV, despite adequate treatment. NK cells are identified as innate immunity components, responsible for fighting viral infections and tumors. They are separated in CD56dim and CD56hi cells, which present different cytotoxicity and cytokine production capacity. A third distinct subpopulation constituted by CD56neg cells can be found in minimal counts in healthy adults, but is present in newborns and is expanded in chronically HIV-­ infected subjects;? these cells can be identified as CD7+CD16+. Among others, NK cells express activating and inhibitory receptors called KIR, which interact with HLA molecules and identify \"self\" cells and cells that have downregulated its expression as an immunologic evasion strategy. Studies have documented the importance of KIR and HLA interaction in HIV/AIDS infection clinical course, particularly involving the receptor KIR3DL1. PD-­1 is an immune checkpoint that can be upregulated by tumors and chronic viral infections. PD-­ 1 expression on T cells is correlated to prognostic factors in HIV/AIDS infection; NK cells have been shown to express it, but further information is necessary. This study aimed at investigating PD-­1 and its ligand PD-­L1 expression on NK and monocytes in HIV-­infected participants and controls. We recruited a group of participants who were diagnosed during acute phase of HIV infection and have been followed ever since, a group of participants who were diagnosed after unknown interval since seroconversion, and a group of uninfected controls who have a high risk due to sexual exposure. Samples were freshly processed at LIM-­60; PD-­1 and other markers were analyzed by multicolor flow cytometry. We found PD-­1 expression on NK cells was correlated to T CD4+ cell counts and PD-­1 expression on T cells, in infected participants; among them, participants followed since acute infection expressed less PD-­1. They also expressed less PD-­L1 in monocytes, as compared to participants diagnosed after unknown interval since seroconversion, as well as compared to the uninfected group. We found significant increase in proportion of KIR3DL1-­expressing cells among CD56neg cells in infected participants compared to the uninfected group. We concluded that PD-­1 expression on NK cells is increased in people infected by HIV and correlated to other immunologic parameters such as T CD4+ counts and PD-­1 expression on T cells. NK cell exhaustion may, therefore, contribute to the immune damage induced by HIV-­1 infection and can be also explored as a target to find new ways to restore antiviral immunity

A HAM/TSP é uma doença de caráter neurológico que acomete aproximadamente 5% dos infectados pelo vírus HTLV, afetando-os principalmente em sua capacidade locomotora. Não são conhecidos até o momento os fatores que fazem o indivíduo infectado desenvolver ou não as patologias associadas ao vírus. Nesse contexto, estudamos a participação das células natural killer T (NKT) visando contribuir na elucidação da patogênese da paraparasia espática tropical HAM/TSP. As células natural killer T (NKT) são um subtipo de linfócitos T, com capacidade efetora e auxiliar, e está associado à doenças infecciosas, alergias e a doenças autoimunes, e a hipótese deste trabalho é que elas participem da progressão da HAM/TSP. Após realizarmos testes para avaliação da ativação das NKT (PD-1), bem como avaliar sua capacidade de secretar IFN- y e Granzima B concluimos que as mesmas não possuem potencial de ativação na periferia e pressupomos que estas podem estar no sítio acometido pela patologia, o SNC. Neste contexto, nosso estudo acrescenta informações quanto à patogenia da HAM/TSP e contribui com conhecimento para a futura elucidação da doença / The HAM/TSP is a neurological disease that affects approximately 5% of HTLV infected individuals, especially in their locomotor capacity. They are not known yet the factors that make the infected individual to develop or not the pathologies associated with virus. In this context, we study the participation of natural killer T cells (NKT), trying to contribute to clarify the HAM/TSP pathogenesis. NKT cells are a subtype of lymphocytes with effector and helper capacities, and are associated with infectious, allergies and autoimmune diseases. Our hypothesis is that they participate in the progression of HAM/TSP. After evaluate the activation of NKT through PD-1 marker, as well evaluate assess their ability to secrete IFN-y and Granzyme B, we conclude that the NKT cells lack periphery in activation potential, and presuppose that they are present at the central nervous system, the site affected by the disease. In this context, our study adds information on the pathogenesis of HAM / TSP and contributes knowledge for future elucidation of disease

Orientadores: Cármino Antonio de Souza, Jeane Eliete Laguila Visentainer / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T17:20:39Z (GMT). No. of bitstreams: 1 Cardozo_DanielaMaira_D.pdf: 3033896 bytes, checksum: b4696b2dc5fc0ec422091c74289aed9f (MD5) Previous issue date: 2013 / Resumo: No organismo humano, as moléculas HLA (Human Leukocyte Antigens) são proteínas expressas na superfície da maioria das células nucleadas e são codificadas por genes localizados no braço curto do cromossomo 6 na região do Complexo Principal de Histocompatibilidade (CPH). Essas proteínas são caracterizadas pelo alto grau de polimorfismo, e também faz a ligação com receptores KIR (Immunoglobulin-like Receptors), expressos nas células Natural Killer. Os receptores KIR, que reconhecem moléculas do complexo HLA de classe I, estão entre os principais receptores inibidores dos linfócitos NK. Células infectadas por vírus e células tumorais perdem ou têm diminuída a expressão de moléculas HLA de classe I e, por isso, são eliminadas pela ausência de ligação entre moléculas HLA e receptores KIR inibitórios. Atualmente, muitos estudos têm destacado a importância dos genes KIR e HLA no Transplante de Células Progenitoras Hematopoiéticas (TCPH). O TCPH é o tratamento de escolha para muitas doenças hematológicas e dependem de vários fatores incluindo o estágio da doença, o regime de condicionamento, a fonte de células, o grau de identidade HLA entre doador e receptor e o desenvolvimento da doença do enxerto contra o hospedeiro (DECH). Estudos recentes indicam que a presença de células NK alorreativas no enxerto representa um fator favorável à recuperação de pacientes, uma vez que essas células têm a capacidade de eliminar células tumorais residuais pela ausência ou diminuição da expressão de moléculas HLA e sem a indução da DECH. Também outros fatores podem estar envolvidos na resposta pós-transplante, como a presença e ausência de determinados alelos HLA e genes KIR, os quais podem estar ligados à melhor ou pior resposta pós-transplante. O primeiro ensaio investigou a associação entre HLA e a ocorrência da DECH aguda e crônica em pacientes que receberam transplante de células progenitoras hematopoiéticas HLA-idêntico, aparentados. No total, foram 176 pacientes que receberam o primeiro transplante entre 1997 e 2009. DECH aguda foi positivamente associada ao HLA-A10 (P = 0.0007), HLA-A26 (P = 0.002), B55 (P = 0.001), DRB1*15 (P = 0.0211) e DQB1*05 (P = 0.038), enquanto que HLA-B16 (P = 0.0333) foi mais frequente em pacientes sem DECH aguda. DECH crônica foi positivamente associada com HLA-A9 (P = 0.01) e A23 (P = 0.0292) e negativamente associada com HLA-A2 (P = 0.0031) e B53 (P = 0.0116). HLA-B35 (P = 0.0373), B49 (P = 0.0155) e B55 (P = 0.0024) foi alta em pacientes com DECH aguda grau 3 ou mais, do que os outros pacientes. Nos pacientes com DECH crônica extensa, HLA-A9 (P = 0.0004), A24 (P = 0.0059) e A26 (P = 0.0411) foi maior do que nos outros pacientes, enquanto HLA-A2 foi baixo (P = 0.0097). O objetivo do segundo ensaio foi avaliar as possíveis interações dos genes KIR e HLA com o curso clínico do transplante HLA compatível, aparentado e não depletado de linfócitos T, particularmente na doença do enxerto contra o hospedeiro (DECH) aguda e crônica, recaída, sobrevida global e sobrevida livre de evento. A maioria dos doadores (78%) apresentaram o haplótipo B do KIR enquanto que 22% apresentaram o haplótipo A. Dos pacientes que receberam o haplótipo A do doador, 90% tiveram DECH, aguda ou crônica, comparados com os que receberam o haplótipo B (58%) (dados não estatisticamente significantes). Não houve diferença significativa para recaída entre pacientes que receberam os haplótipo A ou B (27% vs 23%). Não houve diferença no desenvolvimento da DECH e recaída para os pacientes homozigotos (C1C1 ou C2C2) e heterozigotos (C1C2) e nem para aqueles com HLA-Bw4 presente e ausente. Também, a sobrevida global não foi diferente para os grupos de pacientes analisados. No entanto, houve forte correlação entre o grupo de pacientes heterozigotos para HLA-C (C1C2) e a incidência de DECH aguda e recaída. A SLE foi maior nos pacientes heterozigotos que não desenvolveram DECHa (p<0,0001). Resultados mostraram que as variantes de HLA podem influenciar na ocorrência de DECH em transplante alogênico, com doadores relacionados, HLA-idênticos, tanto como fatores de proteção, quanto como fatores de susceptibilidade. Ainda, a interação KIR/HLA tem impacto significante no resultado dos transplantes relacionados, HLA compatível, sem depleção de linfócitos T, influenciando na incidência de recaída e na ocorrência da DECH. Resultados mostraram que para o grupo heterozigoto (C1C2) a maioria dos pacientes não desenvolveu DECH aguda e apresentou maior SLE, sugerindo um possível efeito protetor para esse grupo / Abstract: In the human organism, the HLA (human leukocyte antigens) are proteins expressed on the surface of most nucleated cells and are encoded by genes located on the short arm of chromosome 6 in the region of the Major Histocompatibility Complex (MHC). These proteins are characterized by a high degree of polymorphism, and also make the connection with KIR (Immunoglobulin-like Receptors), expressed in Natural Killer cells. KIR receptors that recognize HLA molecules of class I are among the major inhibitory receptors of NK-cells. Virus infected cells and tumor cells have lost or diminished expression of HLA class I molecules and therefore are eliminated by the absence of binding between HLA molecules and inhibitory KIR receptors. Currently, many studies have highlighted the importance of KIR and HLA genes in Hematopoietic Stem Cell Transplantation (HSCT). HPCT is the treatment of choice for many hematological malignancies and depends on various factors including stage of disease, the conditioning regimen, the source of cells, the degree of identity between donor and recipient HLA and development of chronic graft-versus-host (GVHD). Recent studies indicate that the presence of alloreactive NK cells in the graft is a factor aiding the recovery of patients, since these cells have the ability to eliminate residual tumor cells by the absence or diminution of expression of HLA molecules and without inducing GVHD. Also other factors may be involved in response post-transplant, as the presence or absence of certain HLA genes and KIR, which can be connected to a better or worse response after transplantation. The first trial investigated the association between HLA and the occurrence of acute and chronic GVHD in patients receiving hematopoietic stem cell transplant HLA-identical related. In total, 176 patients who received a first transplant between 1997 and 2009. GVHD was positively associated with HLA-A10 (P = 0.0007), HLA-A26 (P = 0.002), B55 (P = 0.001), DRB1 * 15 (P = 0.0211) and DQB1 * 05 (P = 0.038), while that HLA-B16 (P = 0.0333) was more frequent in patients without acute GVHD. Chronic GVHD was positively associated with HLA-A9 (P = 0.01) and A23 (P = 0.0292) and negatively associated with HLA-A2 (P = 0.0031) and B53 (P = 0.0116). HLA-B35 (P = 0.0373), B49 (P = 0.0155) and B55 (P = 0.0024) was high in patients with acute GVHD grade 3 or more, than the other patients. In patients with extensive chronic GvHD, HLA-A9 (P = 0.0004), A24 (P = 0.0059) and A26 (P = 0.0411) was greater than in the other patients, whereas HLA-A2 was low (P = 0.0097). The objective of the second test was to evaluate the possible interactions of KIR and HLA genes with the clinical course of the transplant HLA compatible related and not depleted of T lymphocytes, particularly in chronic graft versus host disease (GVHD) acute and chronic relapse, survival overall and event-free survival. Most donors (78%) presented the KIR B haplotype while 22% were haplotype A. Of the patients who received the donor haplotype A, 90% had GvHD, acute or chronic, compared with those who received the haplotype B (58%) (data not statistically significant). There was no significant difference in relapse between patients who received the haplotype A or B (27% vs 23%). There was no difference in the development of GVHD and relapse for patients homozygous (C1C1 or C2C2) and heterozygous (C1C2) and not for those with HLA-Bw4 present and absent. Also, the overall survival was not different for the groups of patients studied. However, there was strong correlation between the group of patients heterozygous for HLA-C (C1C2) and the incidence of acute GVHD and relapse. The SLE was higher in patients who did not develop GVHD heterozygotes (p <0.0001). Results showed that the HLA variants may influence the occurrence of GVHD in allogeneic transplantation with related donors, HLA-identical, both as protective factors, such as susceptibility factors. Furthermore, the interaction KIR / HLA has a significant impact on the outcome of transplantation related HLA-compatible, without depletion of T cells, influencing the incidence of relapse and the occurrence of GVHD. Results showed that for the heterozygous group (C1C2) most patients did not develop acute GVHD and showed higher SLE, suggesting a possible protective effect for this group / Doutorado / Clinica Medica / Doutora em Clínica Médica

Sans corps, pas d'histoires. Vecteur d'action, instrument de la narration, et support d'un lien d'identification fort entre le spectateur et le personnage, le corps est la principale figure des médiums cinématographique et télévisuel. Si le cinéma a toujours, depuis ses balbutiements, glorifié la vivacité inépuisable des corps, parallèlement déjà, planait la face inversée de cette exposition, la menace muette de la mort. Mais si le dernier souffle avant la mort est bien souvent encore, au cinéma et à la télévision, synonyme d'ultime communion avec la vie et de résistance à la mort, qu'en est-il du corps et du personnage quand la mort s'en est saisi à jamais et qu'il ne reste plus aux vivants, personnages et spectateurs, qu'à se confronter au cadavre ? Figure parasitaire, le cadavre n'est ni un personnage ni même un figurant. A la fois signe vide et noyau narratif, c'est à partir de lui et de son examen pendant l'autopsie ou sur les lieux du crime que va se nourrir et se développer l'intrigue policière. Et s'il peut paraître secondaire, voire accessoire, à regarder les fictions policières sous l'angle de son non-regard fixe et opaque, il donne à voir quelque chose du crime, de son caractère profondément injuste, et des rapports qu'entretiennent les vivants avec une mort qui se présente sur la table d'autopsie, sous ses traits les plus abjects. L'enjeu de cette thèse sera d'envisager la façon dont les fictions policières mettent en scène le cadavre comme le reflet, d'une troublante précision, d'un défaut contemporain de distanciation face à la mort. Il s'agira bien pour nous, et selon un principe analogue à celui qu'applique le philosophe Maxime Coulombe dans son essai sur les zombies, de considérer le cadavre fictionnel comme « analyseur de la société contemporaine » et comme « symptôme de ce qui taraude la conscience de notre époque » / Without bodies, no stories. A vehicle of action, a narrative agent, and the support of a strong identification link between the audience and the character, the body is the main figure of cinematographic and television mediums.If cinema has always, from its early stages, glorified the endless liveliness of bodies, the reverse side of this exposure has simultaneously been lingering: the mute threat of death. However, in films or in television series, if the last breath before death is often synonymous with a ultimate communion with life and with a resistance to death, what happens to the body and the character when death has seized them for ever, and the living – characters and audience – are only left facing the corpse? As a parasite figure, the corpse is neither a character nor even an extra. Both an empty sign and a narrative core, the crime plot will indeed develop from the corpse and its examination, during the autopsy or on the crime scene. And whereas the corpse may seem secondary, even minor, if we look at crime fictions from the angle of its fixed and opaque non-look, it still allows us to see something of the crime and of its deeply unfair nature, and of the relations between the living and a death that appears in its most abject features on the autopsy table. In this study, we will examine how crime fictions stage corpses as disturbingly precise reflects of a contemporary lack of perspective in front of death. Similarly to the philosopher Maxime Coulombe in his essay on zombies, we will consider the fictional corpse as an "analyser of contemporary society" and as a "symptom of what is tormenting the consciousness of our time"

L’infection par le virus de l’hépatite C (VHC) représente un problème majeur de santé publique du fait de sa prévalence élevée et de la sévérité de ses complications, cirrhose et carcinome hépatocellulaire (CHC). Les objectifs du projet de thèse sont (i) de mettre en place et caractériser des modèles orthotopiques de CHC chez le petit animal (xénogreffe orthotopique de la lignée de CHC humaine Huh-7 exprimant le gène rapporteur de la luciférase chez la souris immunodéficiente) et chez le gros animal (transplantation autologue d’hépatocytes de cochon préalablement transformés ex vivo par transfert par voie lentivirale d’une combinaison de six oncogènes) et (ii) d’apporter la preuve de concept d’une approche innovante d’immunothérapie adoptive allogénique du CHC et de l’infection chronique par le VHC, par administration de lymphocytes génétiquement modifiés (LGM) allogéniques exprimant un gène de toxicité conditionnelle, ou gène suicide. Un tel gène suicide permet le contrôle des LGM, conduisant à leur élimination conditionnelle en cas d’effets secondaires indésirables. Ainsi, nous avons montré que, à dose élevée, ces LGM exercent in vitro une activité cytotoxique vis-à-vis de lignées de CHC humaines et in vivo une activité anti-tumorale vis-à-vis de tumeurs orthotopiques Huh-7. A faible dose, les LGM présentent une activité anti-virale vis-à-vis du VHC sans induire de toxicité. Ces résultats ouvrent la perspective à une approche originale d’immunothérapie du CHC, associée aux traitements actuels et de prévention de la réinfection du greffon hépatique par le VHC lors de la transplantation. / The hepatitis C virus (HCV) infection is a major problem of public health, due to its high prevalence and to the severity of its complications, cirrhosis and hepatocellular carcinoma (HCC). The aims of the thesis project are (i) to set up and characterize orthotopic HCC models in the small animal (orthotopic transplantation in immunodeficient mice of the human HCC cell line Huh-7, expressing the luciferase reporter gene) and in the large animal (autologous transplantation of porcine hepatocytes previously ex vivo-transformed by lentiviral-meidated transfer of a combination of six oncogenes) and (ii) to provide the proof-of-concept of an innovative adoptive allogeneic immunotherapy approach for the treatment of HCC and prevention of liver graft reinfection by HCV, through the administration of allogeneic suicide gene-modified lymphocytes (GML). Such a suicide gene allows for the control of GML, leading to their conditional elimination in case of undesirable side effects. Thus, we have demonstrated that, at high dose, these GML present an in vitro cytotoxic activity toward HCC cell lines and an in vivo antitumoral effect against orthotopic Huh-7 tumors. At low level, the GML have an antiviral activity against HCV, without toxicity against target cells. These results open the perspective for an original approach of immunotherapy for the treatment of HCC in association with current treatments and for the prevention of liver graft reinfection by HCV at time of liver transplantation.