Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20976号 / 医博第4322号 / 新制||医||1026(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 髙折 晃史, 教授 岩田 想, 教授 中川 一路 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Nous avons découvert que les DC pathologiques (LCH DC) qui s’accumulent dans les granulomes de patients atteints d’histiocytose langerhansienne (LCH) produisent l’IL-17A (Coury et al, Nat Med 2008). In vitro, les LCH DC fusionnent en cellules géantes (MGC) sous l’influence de leur production autocrine d’IL-17A. In vivo, les granulomes de LCH DC et MGC détruisent les tissus. Pendant la thèse, nous avons étudié les transcriptomes des monocytes, DC, traitées ou non par l’IL-17A et des LCH DC. L’IL-17A induit BCL2A1, un membre de la famille Bcl-2 qui prolonge la survie des DC. Elle induit aussi les chémokines CCL20 et CCL2, qui regroupent les DC avant leur fusion. L’induction du récepteur nucléaire LXR-α, de protéines impliquées dans le métabolisme, le transport et le stockage des lipides témoignent d’un profond remodelage lipidique. Après la confirmation de ces régulations par PCR et western, les goutelettes lipidiques sont quantifiées à l’huile rouge, puis l’analyse lipidomique révèle l’augmentation de phospholipides, triglycérides, esters de cholestérol et cholestérol par l’IL-17A dans les DC qui sont aussi capables de capturer du palmitate extracellulaire fluorescent. Les transcriptomes des DC traitées à l’IL-17A et des LCH DC sont similaires. La simvastatine qui bloque la synthèse de cholestérol tue les LCH DC. Ce travail établit pour la première fois que l’IL-17A affecte profondément le métabolisme lipidique des DC, une activité qui pourrait avoir d’importantes applications dans les maladies chroniques inflammations associées à une dérégulation lipidique comme l’athérosclérose, l’obésité, la tuberculose et la LCH / We found that the pathological DCs (DC LCH), accumulating in the granulomas of patients affected with Langerhans cell histiocytosis (LCH), produce IL-17A (Coury et al, Nat Med 2008). In vitro, LCH DCs form multinucleated giant cells (MGC) by a fusion process, under the influence of their IL-17A autocrine production. In vivo, granulomas, which are mainly composed of LCH DCs and MGCs, destroy tissues of the patients. During the PhD, we studied the transcriptomes of monocytes, DCs, treated or not with IL-17A, and LCH DCs. IL-17A induceed BCL2A1, a member of the Bcl-2 family that prolonged DC survival. It also induced the CCL2 and CCL20 chemokines that clustered DC, a process required to license DC fusion. The inductions of LXR-α nuclear receptors, proteins involved in metabolism, transport and storage of lipids signed a deep lipid remodeling induced by IL-17A in DCs. We confirmed these regulations by PCR and western studies, then the lipid droplets were quantified after Oil Red-O staining. Further lipidomic analysis revealed an increase of phospholipids, triglycerides, cholesteryl esters and cholesterol by IL-17A in DCs, which are also able to capture extracellular fluorescent palmitate. Transcriptomes of DCs treated with IL-17A and LCH DCs were similar. Simvastatin, which inhibits the synthesis of cholesterol, killed LCH DC. For the first time, this work establishes that IL-17A profoundly affects the lipid metabolism of DCs, an activity that may have important applications in chronic inflammations associated with lipid deregulations such as atherosclerosis, obesity, tuberculosis and LCH

L’histiocytose langerhansienne (HL) est la plus fréquente des histiocytoses, liée à l’accumulation de cellules pathologiques de phénotype langerhansien. La découverte de la mutation somatique BRAFV600E dans environ 50% des cas à ouvert un nouveau champ d’investigation pour tirer bénéfice de ce statut moléculaire pour la prise en charge des patients.Tout d’abord, nous avons montré l’efficacité des inhibiteurs de BRAF sans rapporter de résistance dans les formes actives d’HL, en particulier dans les formes multisystémiques avec atteinte des organes à risque (MS OR+) du nourrissons, confirmant le rôle driver de cette mutation dans l’HL. Toutefois, après l’arrêt du traitement administré durant 2 à 6 mois, de nombreuses récidives ont été constatées.Ensuite, nous avons montré que pour les enfants atteints d’HL, la mutation BRAFV600E était significativement associée aux formes MS OR+, retrouvée dans 87,8% de ces cas. Comparés aux patients non mutés BRAF, les patients avec la mutation BRAFV600E présentaient un taux de résistance plus élevé à la chimiothérapie de première ligne velbé - corticoïde (21,9% contre 3,3%), un taux plus élevé de réactivation à 5 ans (42,8% contre 28,1%) et un taux de séquelles supérieur (27,9% contre 12,6%).Par ailleurs, nous avons montré que, pour les HL BRAFV600E mutées, la quantification de BRAFV600E dans l’ADN libre circulant par PCR digitale en gouttelette était un biomarqueur pertinent pour les cas d’HL MS OR+ et les présentations résistantes au traitement de première ligne.Enfin, après un criblage de points chauds mutationnels d’une série d’échantillons tissulaires d’HL ayant permis de mettre en évidence un cas avec la mutation somatique PIK3CAE542K, 9 couples d’échantillons tumeur/constitutionnel ont été étudiés par séquençage d’exome. Cela nous a permis de mettre en évidence une mutation récurrente (n=2) de BRAF au niveau du site d’épissage 5’ (donneur) de l’intron 12. Selon l’analyse de l’ARN, cette mutation conduirait à l’insertion de 3 acides aminés (LLR) dans le domaine kinase de la protéine mutée, dont l’analyse fonctionnelle est en cours. / Langerhans cell histiocytosis (LCH) is the most common type of histiocytosis owing to accumulation of pathologic CD1a+ CD207+ histiocytes. The identification of BRAFV600E in more than half of patients with LCH has launched a new field of investigation to study potential patient’s management benefits and implications from this molecular status.First, in BRAFV600E mutated LCH, we reported the effectiveness of BRAF inhibitors. Efficacy with no resistance to vemurafenib was reported in all cases with active LCH disease, especially for multi-system LCH with risk organ (MS RO+) involvement, confirming the driver status of this mutation in LCH. However, after discontinuation of this treatment administered during 2-6 months, many recurrences were observed.Then, we showed that children with BRAFV600E mutated LCH manifested more severe disease, comprised 87.8% of patients with MS RO+ involvement. Compared to patients with wild-type BRAF, patients with BRAFV600E more commonly displayed resistance to combined vinblastine and corticosteroid therapy (21.9% vs. 3.3%), showed a higher 5-year reactivation rate (42.8% vs. 28.1%) and had more long-term permanent consequences (27.9% vs. 12.6%).Moreover, we showed that BRAFV600E quantification in circulating cell-free DNA by droplet digital PCR is a relevant biomarker to monitor response to therapy for MS RO+ LCH and RO- LCH children who failed to respond to first line chemotherapy.Finally, after the screening of LCH biopsy (n=86) for the BRAF, KRAS, NRAS and PI3KCA most common mutations, leading to highlight one case with the PIK3CAE542K somatic mutation, 9 paired tumor-normal samples from children with LCH were analyzed by whole exome sequencing. Data showed a new BRAF recurrent mutation (n=2) in the 5′ splice sites of the intron 12. According to RNA analysis, this mutation would lead to the insertion of 3 amino acids (LLR) in the smaller N-terminal lobe of the BRAF kinase domain. Functional analysis is ongoing.

A histiocitose de células de Langerhans (HCL) é uma neoplasia mieloide inflamatória comumente afetando pacientes pediátricos e apresenta frequentemente mutações ativadoras somáticas em genes da via MAPK, incluindo BRAF e MAP2K1. Vários estudos sugerem que as células lesionais da HCL podem recrutar e modular células inflamatórias e cujas citocinas parecem fornecer sinais recíprocos de sobrevivência celular. Para o presente estudo foram selecionados 15 casos de HCL (10 crianças, 5 adultos), sendo as amostras de tecido avaliadas através de imunoistoquímica utilizando marcadores para macrófagos (CD68 e CD163), células dendríticas maduras (CDm) (CD83 e CD208), linfócitos T regulatórios (LTregs) (CD4, CD25 e FOXP3) e linfócitos citotóxicos (LCs) (CD56, CD57, perforina e granzima B). Além disso, marcadores de células B (CD20), células T (CD3, CD8) e confirmatórios de HCL foram analisados. Todos os casos de HCL foram positivos para S100, CD1a, CD207 e CD4; enquanto que Bcl-2 e Ciclina D1 foram positivos em 13/15 (86,7%) casos. No microambiente imune intralesional, macrófagos M2 (CD68+/CD163+), seguidos por LTregs, foram as populações celulares mais predominantes. Em quantidade significativamente menor, foram observadas CDm, seguidas por escassos LCs. Considerando a população linfoide, linfócitos T CD3+ foram mais numerosos do que linfócitos B CD20+. Dentro dos linfócitos T, linfócitos T CD4+ foram mais numerosos do que linfócitos T CD8+ (p<0,05). Nossos resultados sugerem que a infiltração de células imunes na HCL, provavelmente através de mecanismos pró-tumorais, inflamatórios e/ou imunossupressores mediados por citocinas, pode promover o desenvolvimento e sobrevivência das células lesionais da HCL, fornecendo uma justificativa para a combinação de imunoterapia e terapia gênica (BRAF) na HCL / Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasia often affecting children with constitutively somatic activating mutations in MAPK pathway genes including BRAF and MAP2K1. Several studies suggest that LCH cells can recruit and modulate inflammatory cells and whose cytokines appear provide reciprocal survival signals. For the present study, 15 cases of LCH (10 children, 5 adults) were selected, and the tissue samples were evaluated through immunohistochemistry using markers for macrophages (CD68 and CD163), mature dendritic cells (mDC) (CD83 and CD208), regulatory T-cells (Tregs) (CD4, CD25 and FOXP3) and cytotoxic lymphocytes (CLs) (CD56, CD57, perforin and granzime B). Moreover, B-cell (CD20), T-cell (CD3, CD8) and LCH markers were analyzed. All LCH cases were positive for S100, CD1a, CD207 and CD4, while Bcl-2 and Cyclin D1 were positive in 13/15 cases (86.7%). In the immune microenvironment, M2-polarized macrophages (CD68+/CD163+), followed by LTregs, were the predominant cell populations. In a significantly lower amount, mDC were observed, followed by scarce CLs. Moreover, CD3+ Tcells than CD20+ B-cells were more numerous (p>0.05), the former presenting a higher number of CD4+ than CD8+ T-cells (p<0.05). Our results suggest that immune cell infiltration in LCH, probably through cytokine-mediated pro-tumoral, inflammatory and/or immunosupressive mechanisms, can promote LCH cell development and survival, providing a rationale for combining immunotherapy and BRAF-targeted therapy in LCH