Atualmente, a Leucemia Linfocítica Crônica (LLC) pode ser dividida em dois grupos: um com mutações somáticas no gene da região variável da cadeia pesada da imunoglobulina (MIgVH) e outro sem mutações (NMIgVH). Alguns estudos mostraram que a expressão de CD38 na superfície das células B de LLC pode estar correlacionada com o estado mutacional do gene VHIg, entretanto, esses controversos. Estudos recentes mostraram que a expressão da proteína tirosina quinase Zap-70 está melhor associada com o estado mutacional do gene IgVH. O objetivo deste estudo foi avaliar a expressão de Zap-70 e CD38, por citometria de fluxo, nas células CD19+ de pacientes com LLC e correlacioná-los com o estádio clínico (EC), sobrevida livre de tratamento (SLT) e sobrevida global (SG). A expressão de Zap-70 e CD38 foi avaliada, em 144 de pacientes com LLC classificados nos estádios clínicos A, B e C de acordo com os critérios de Binet: 59 (41%) do EC-A, 38 (26%) do EC-B e 47 (33%) do EC-C. Foi observada menor positividade para Zap-70 e CD38 nos pacientes do EC-A do que nos EC-B e C. Quando avaliada a SLT nos pacientes do EC-A, os casos Zap-70+ assim como os CD38+ apresentaram menor SLT. A média de SG dos pacientes Zap-70+ e CD38+ foi menor quando comparado com os Zap-70- e CD38- entretanto quando correlacionada com o EC não foi observada diferença estatisticamente significante entre a expressão desses marcadores e o EC-A, B ou C. Pela analise combinada de CD38 e Zap-70, dividimos os pacientes em dois grupos (Zap-70-/CD38- e Zap-70+ ou CD38+). Observamos que a expressão positiva desses dois marcadores estava associada ao EC, uma vez que a grande maioria dos pacientes dos estádios B (74%) e C (66%) expressam Zap-70 ou CD38. Entretanto, os pacientes do EC-A, Zap-70+ ou CD38+, apresentaram SG menor quando comparado com os Zap-70-/CD38-. Essa diferença não foi observada nos pacientes do EC-B e do EC-C. Também foi observada menor SLT nos pacientes no EC-A, Zap-70+ ou CD38+. Esses resultados sugerem que análise combinada de Zap-70 e CD38 podem ser empregadas na avaliação dos pacientes do EC-A para se acompanhar a evolução clinica desse grupo de pacientes. Porém, estudos adicionais devem ser realizados para se validar a utilização clínica desses marcadores. / Actually, chronic lymphocytic leukemia (CLL) can be divided in two subsets: one with somatically mutated immunoglobulin heavy-chain variable-region genes (MIgVH) and other with unmutated sequences. (UMIgVH). Some studies have shown that CD38 expression in CLL cells are correlated with IgVH mutational status. However, the value of CD38 as surrogate IgVH mutational status is controversial. Recent studies, have found that Zap-70 protein tyrosine kinase expression is strongly associated with the mutational status IgVH. The aim of this study was to evaluate the Zap-70 and CD38 expression, for flow cytometry, in CD19+ LLC cells and correlate with the Binet’s staging system, treatment-free survival (TFS) and a overall survival (OS). Zap-70 and CD38 was evaluated, in 144 CLL patients that was classified in A, B and C Binet’s staging system: 59 (41%) in stage A, 38 (26%) in B and 47 (33%) in C. We observed low Zap-70 and CD38 expression in stage A patients than in stage B and C cases. When we analyzed the TFS in stage A patients Zap-70+ and CD38+ patients showed shorter TFS than Zap-70- and CD38-. Then we observed that the OS of Zap-70+ and CD38+ patients was, also, shorter than Zap-70- and CD38- cases. However, statistical differences was not found when Zap-70 and CD38 expression was correlated with stage A, B or C Binet’s staging system. To understand the associated Zap-70 and CD38 expression, we divided the CLL patients in two subgroups (Zap-70-/CD38 - and Zap-70+ or CD38+). We observed that CD38+ or Zap-70+ was associated Binet’s staging system, once most of stage B (74%) and C (66%) patients are Zap-70+ or CD38+. However, stage A patients, Zap-70+ or CD38+, showed shorter OS than Zap-70-/CD38-. These differences were not observed in stage B and C patients. Shorter TFS was also observed in the Zap-70+ or CD38+ stage A patients. These results suggest that combined analysis of Zap-70 and CD38 can be used to evaluate stage A patients to observe the clinical evolution of the disease. Nevertheless, other studies must be carried to confirm the clinical use of these markers.

A leucemia linfóide aguda nos adultos apresenta prognóstico reservado. Os objetivos deste estudo são descrição e análise de parâmetros clínicos, laboratoriais e fatores prognósticos em 102 pacientes tratados com diferentes protocolos de quimioterapia no período de 1990 a 2005, no Serviço de Hematologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Em estudo de coorte retrospectivo, com exclusão de LLA subtipo L3 (FAB) ou B-IV (EGIL), foram analisadas a taxa de remissão completa (RC), sobrevida global (SG) e sobrevida livre de doença (SLD) para a população geral e para os dois principais protocolos de tratamento. A análise estatística foi feita pelo programa SPSS 10.0. Associação entre variáveis, fatores prognósticos e resposta foram observados através do teste ?2 de Person. Curvas de SG e SLD foram construídas pelo método de Kaplan-Meier e as diferenças analisadas pelo teste de log-rank. A idade média foi de 30,6 anos (12 a 82 anos) e predominou o sexo masculino (55,9%). Ao diagnóstico, os achados clínicos foram: fadiga (58,2%), esplenomegalia (59,7%), hepatomegalia (54,6%), linfadenopatia (52,6), febre (38,8%), dor óssea(28,6%), sangramento (27,5%) e cefaléia (15,3%). Envolvimento do sistema nervoso central (SNC) foi detectado em 11 (11,8%) pacientes, enquanto envolvimento testicular acometeu um paciente. O valor médio de hemoglobina, leucócitos e plaquetas foram 8,5g/dl, 84.341/mm3 e 76.275/mm3, respectivamente. 98,7% dos pacientes apresentaram linfoblastos no sangue periférico. A classificação FAB foi igualmente observada entre os tipos L1 e L2. As LLA B e T foram observadas em 69,7% e 30,2%, respectivamente. O cariótipo foi realizado em 40 pacientes, e t (9;22) foi identificada em 20% (8/40) dos casos. Os pacientes foram tratados com quatro diferentes protocolos: BFM 86 modificado (BFM 86M) em 47,15% (48/102), Linker et al em 39,2% (40/102), Lister et al em 5,9% (6/102) e CHOP em 7,8% (8/102). Na análise para a população geral, na fase de indução, 70,6% (65/92) dos pacientes entraram em RC. Idade inferior a 18 anos e ausência de infiltração de SNC foram fatores preditores positivos de resposta em análise multivariada (p=0,03). Com mediana de seguimento de 49 meses, observamos taxa de 30,5% e 27% para SG e SLD em 4 anos. Ausência de sangramento e hepatomegalia, ao diagnóstico, e idade < 35 anos estiveram associados à maior SG através de análise multivariada (p=0,01). Os dois protocolos com maior número de pacientes, apresentaram distribuição semelhante de parâmetros clínicos e laboratoriais, a exceção da variável FAB. RC foi obtida em 76,7% e 63,9% dos pacientes tratados respectivamente com os protocolos BFM 86M e Linker (p=0,21). A SG foi de 49,5% com o BFM 86M em 4 anos Vs 16% com o protocolo Linker (p=0,004). Observou-se que o protocolo BFM86M teve melhor SG para pacientes com idade <35 anos (p=0,01), sem sangramento e hepatomegalia ao diagnóstico (p=0,03 e p=0,01) e sem leucocitose (B <30.000mm3 e T <100.000mm) (p=0,04); enquanto que pacientes com LLA T tratados com o protocolo Linker apresentaram SG inferior (p=0,05). A diferença de SLD entre os dois protocolos não foi significativa (p=0,58), entretanto na faixa etária entre 21-35 anos, o protocolo BFM se mostrou superior (p=0,03). Verificamos que o BFM 86M é superior ao Linker et al, sendo um bom protocolo para tratamento de LLA em pacientes adolescentes e adultos jovens sem fatores de risco. / Acute lymphoblastic leukemia in adults has a poor outcome. The aim of this study is to describe and evaluate clinical, laboratory and prognostic factors in 102 patients reated with different protocols of chemotherapy from 1990 to 2005. Adult ALLsubtype L3 (FAB) or B-IV (EGIL) was excluded. We evaluated complete remission (CR), overall survival (OS) and disease free survival (DFS) rates for the whole population and for the two principal treatment protocols. This retrospective cohort was done in hematology department of the FMUSP. Statistical analysis was done by SPSS 10.0. The association of features and prognosis was assessed by Person\'s chi-square. OS and DFS curves were constructed by Kaplan-Meier method and the differences were calculated by the log-rank test. Mean age was 30,6 (12 to 82) years and 55,9% was male. Clinical findings, at diagnosis, were fatigue (58,2%), splenomegaly (59,7%), hepatomegaly (54,6%), ymphadenopathy (52,6%), fever (38,8%), bone pain (28,6%), bleeding (27,5%) and headache (15,3%). Involvement of central nervous system (CNS) was detected in 11 (11,8%) patients and testicular involvement was observed in one patient. Mean blood values were 8,5g/dl, 84.341/mm3 and 76.275/mm3 for hemoglobin, leucocytes and platelets respectively. 98,7% of the patients presented with lymphoblasts in peripheral blood. FAB classification was equally observed between L1 and L2. B and T ALL was noted in 69,7% and 30,2% respectively. Karyotype analysis was performed in 40 cases, where Philadelphia chromosome (ph) was identified in 20% (8/40) of them. Patients were treated with four different protocols: BFM 86 modified (BFM 86M) in 47,1% (48/102), Linker et al in 39,2% (40/102), Lister et al in 5,9% (6/102) and CHOP in 7,8% (8/102) of the patients. In the judgment for the entire population, in induction treatment, 70,6% (65/92) of the patients had CR. Age below 18 years and no infiltration in CNS were positive factors for CR in multivariate analyses (p=0,03). In a median follow up of 49 months, we have observed a 4 years OS and DFS of 30,5% and 27% respectively. No bleeding and hepatomegaly, at diagnosis, and age less than 35 years were factors associated a better OS in multivariate analyses (p=0, 01). Protocols with highest number of patients (BFM and Linker) showed the same distribution of clinical and laboratory factors; exception FAB classification. CR were seen in 76,7% and 63,9% of the patients treated with BFM 86M and Linker respectively. (p=0,21). OS was 49,5% with BFM protocol in 4 years Vs 16% with Linker (p=0,004). We observed a better OS for patients with age below 35 years (p=0,01), no bleeding and no hepatomegaly at diagnosis (p=0,03 ; p=0,01) and no leucocytosis ( B < 30000/mm3 and T < 100000/mm3) treated with BFM 86M; however ALL - T treated with Linker protocols had inferior OS (p=0,05). DFS between protocols wasn\'t significant (p=0,58), but with age between 21 and 35 years BFM was better (p=0,03). We conclude that BFM 86M is superior than Linker et al and it is a good treatment for childhood / young adults without risk factors

Genomic integrity is important for living cells' correct functioning and propagation. Deoxyribonucleic acid as a molecule is a subject to chemical reactions with agents that can come from environment as well as from internal metabolism processes. These reactions can induce damage to DNA and thus compromise the genetic information, and result in disease and death of an organism. To mitigate the damage to DNA, cells have evolved to have multiple DNA repair pathways. Presented here is a computational study of DNA repair genes. The structure of the Homo sapiens direct DNA repair gene ALKBH1 is predicted utilizing homology modeling methods and using AlkB and DBL proteins as templates. Analysis of the obtained structure and molecular dynamics simulations give insights into potentially functionally important residues of the protein. In particular, zinc finger domains are predicted, and lysines that could perform catalytic activities are investigated. Subsequent mutagenesis experiments revealed the effect of the residues predicted to form zinc fingers on activity of ALKBH1. Structure and dynamics of AlkD, a Bascillus cereus base excision DNA repair protein is also studied. This protein has been shown to bind DNA with large alkyl adducts and perform excision catalysis without base flipping which is characteristic to other enzymes in the same family. MD simulations of AlkD revealed that B helix, which interacts with DNA, has higher fluctuations when AlkD is not bound to DNA, and thus could have a role in binding and recognition of DNA. For the purpose of finding biomarkers and to further our understanding of a mode of action of DNA repair genes, statistical methods were applied to identify mutations that are linked to cancer phenotypes. Analysis was based on case-control studies of patients with cancers of prostate, breast, pancreas, lung as well as chronic lymphocytic leukemia from NCBI dbGAP database. Those mutations that result in missense mutations were further investigated. In particular, extensive MD simulations and experimental investigations were performed on the mutation in the ALKBH7 gene that was found to be linked to prostate cancer.

Bien que l’utilité de la TEP au [18F]FDG soit confirmée pour le diagnostic et le suivi thérapeutique chez les patients atteints de lymphome, la spécificité de la captation du [18F]FDG a été mise en doute en raison de sa dépendance au métabolisme du glucose, qui peut augmenter dans des conditions bégnines comme les processus inflammatoire ou infectieux. Compte tenu de ces limites, un nucléoside a été développé en tant que nouvel outil pour l'imagerie TEP ([18F]fludarabine). Une radiosynthèse entièrement automatisée a été mise en place et des études précliniques ont été menées sur des modèles murins de xénogreffes (lignées cellulaires folliculaires: RL7 et DOHH-2, myélome multiple (MM) : RPMI8226, lymphome du système nerveux central (LSNC) : MC116), parallèlement au [18F]FDG. Le profil de distribution de la radioactivité de la [18F]fludarabine dans des organes sélectionnés a confirmé le ciblage spécifique de la tumeur. Dans un modèle de lymphome folliculaire, nous avons évalué sa fiabilité pendant le traitement par rituximab et démontré - pas d’interférence entre le traitement et sa captation - une plus forte corrélation entre la fixation de ce radiopharmaceutique et les valeurs quantitatives extraites de l'histologie, comparée au [18F]FDG-TEP. En conséquence, cet outil TEP peut être considéré comme une approche prometteuse pour détecter la maladie résiduelle persistante pendant ou après un traitement par chimiothérapie. En outre, l’évaluation de la [18F]fludarabine lors d’un processus inflammatoire induit par la térébenthine a montré une accumulation significativement plus faible dans le tissu inflammé par comparaison à celle observée avec le [18F]FDG. Dans le MM, le rôle de la [18F]FDG-TEP reste limité en raison de son manque de sensibilité pour détecter une atteinte diffuse de la moelle osseuse et de petites lésions crâniennes dues à la fixation physiologique du [18F]FDG dans le cerveau. Nos données suggèrent que la TEP à la [18F]fludarabine pourrait représenter une modalité alternative et peut-être plus spécifique pour l'imagerie de MM. Dans notre dernière étude, sur les tumeurs cérébrales de xénogreffes, ce nouvel outil TEP a révélé des réponses significativement divergentes entre le LSNC et le glioblastome (GBM), tandis que le [18F]FDG a montré un chevauchement de fixation entre ces deux modèles. Une première étude chez l'homme a été entreprise pour un diagnostic initial, où 10 patients non traités ont été recrutés avec une leucémie lymphoïde chronique à cellules B (LLC) ou un lymphome B diffus à grandes cellules (LBDGC). Les scanners partiels successifs ont été acquis pendant 250 mn après l’injection i.v d’une activité de 4MBq/kg. Les résultats avec les modalités conventionnelles (TDM et/ou [18F]FDG-TEP) ont également été considérés. L'étude a également été conçue pour estimer la dosimétrie pour les principaux organes. Chez les patients atteints d’un LBDGC, une augmentation de la captation a été observée dans les sites considérés anormaux par TDM et [18F]FDG ; chez deux patients, des résultats contradictoires ont été observés avec ces deux radiopharmaceutiques. Chez les patients LLC, la fixation de la [18F]fludarabine a coïncidé avec les sites susceptibles d'être impliqués et a montré une captation significative dans la moelle osseuse hématopoïétique. Aucune fixation n'a été observée, quel que soit le groupe de maladies, dans le muscle cardiaque et le cerveau. De plus, la dose efficace moyenne a été révélée inférieure à la dose efficace rapportée pour le [18F]FDG. En conclusion, ces résultats précliniques et cliniques ont révélé une grande spécificité de ce radiopharmaceutique pour les tissus lymphoprolifératifs. De plus, cela pourrait être un outil robuste pour quantifier plus précisément la maladie, même avec des processus inflammatoires, évitant ainsi les résultats faussement positifs, et une approche innovante pour l'imagerie des maladies lymphoprolifératives caractérisées par une faible activité mitotique. / Although PET using [18F]FDG has proved to be useful for diagnosis and therapy monitoring in patients with lymphoma, the specificity of [18F]FDG uptake has been critically questioned because of its dependence on glucose metabolism, which may indiscriminately increase in benign conditions such as inflammatory or infectious processes. Considering these drawbacks, an adenine nucleoside analogue was developed as a novel PET imaging probe ([18F]fludarabine). An efficient and fully automated radiosynthesis has been implemented and, subsequently preclinical studies in xenograft murine models (follicular cell lines: RL7 and DOHH-2, multiple myeloma (MM): RPMI8226, central nervous system (CNS) lymphoma: MC116) were conducted with this novel 18F-radiopharmaceutical in parallel with [18F]FDG. The pattern of the radioactivity distribution in selected organs confirmed the tumor-specific targeting. In a follicular lymphoma model, we evaluated its robustness during rituximab therapy and demonstrated - the treatment did not interfere with its uptake - a stronger correlation between quantitative values extracted from this 18F-radiopharmaceutical and histology when compared to [18F]FDG-PET. Accordingly, this PET tool may be considered as a promising approach for detecting the persistence of residual disease during or after rituximab-like treatment. Furthermore, its behaviour in turpentine-induced inflammatory process showed significantly weaker uptake in inflammation when compared to [18F]FDG. In MM, the role of [18F]FDG-PET remains limited because of its lack of sensitivity for detecting diffuse bone marrow involvement, small skull lesions due to the physiological [18F]FDG uptake in brain. Our data suggested that [18F]fludarabine-PET might represent an alternative and perhaps more specific modality for MM imaging. In our latest study, on xenograft brain tumors, this novel PET probe revealed significantly divergent responses between CNS lymphoma and glioblastoma (GBM), while [18F]FDG demonstrated overlap between the groups. A first in man study, was undertaken, for an initial diagnosis, where 10 untreated patients were enrolled with either B-cell chronic lymphocytic leukemia (CLL) or diffuse large B-cell lymphoma (DLBCL). Successive partial body scans were acquired for 250 min after i.v. injection with an activity of 4 MBq/kg. The results with conventional modalities (CT and/or [18F]FDG-PET) have also been investigated. The study was also designed to estimate its radiation dose for major organs. In DLBCL patients, increased uptake was observed in sites considered abnormal by CT and [18F]FDG; in two patients discrepancies were observed in comparison with [18F]FDG. In CLL patients, the uptake coincided with sites expected to be involved and displayed a significant uptake in hematopoietic bone marrow. No uptake was observed, whatever the disease group, in the cardiac muscle and brain. Moreover, its mean effective dose was below the effective dose reported for [18F]FDG. In conclusion, these preclinical and clinical findings revealed a great specificity of this 18F-radiopharmaeutical for lymphoma tissues. Furthermore, it might well be a robust tool for correctly quantifying the disease, even with inflammatory processes, thus avoiding the false-positive results, and an innovative approach for imaging lymphoid neoplasms with low mitotic activity.

No description available.

L’axe adénosinergique est au cœur de divers processus pathophysiologiques. L’enzyme CD73 joue un rôle pivot dans la génération de l’adénosine en catalysant la déphosphorylation de l’adénosine monophosphate. L’adénosine contribue à un éventail large de processus biologiques et pathologiques, principalement via l’activation de récepteurs transmembranaires. L’adénosine est principalement reconnue pour son activité régulatrice des cellules immunitaires et CD73 pour son rôle dans l’accumulation de l’adénosine dans le microenvironnement tumoral. En effet, en altérant la réponse immunitaire anti-tumorale via l’inhibition des fonctions effectrices de divers types de cellules immunes, CD73 et l’adénosine sont fréquemment associés à la progression tumorale et s’inscrivent comme cibles thérapeutiques intéressantes. Les rôles de CD73 et l’adénosine dans d’autres processus immunitaires physiologiques ne sont pas tous aussi bien compris, notamment concernant les processus d’immunisations. En utilisant un modèle murin d’immunisation contre le pneumocoque, cette thèse démontre un rôle positif, mais non essentiel, de CD73 et de l’adénosine dans la commutation isotypique des lymphocytes B et la génération d’une immunité protectrice contre l’infection au S. pneumoniae. Cette découverte est pertinente au développement de stratégies thérapeutiques afin d’augmenter l’efficacité d’immunisation dépendante des cellules B, plus particulièrement chez les populations à risque en bas âge. Ensuite, alors que la modulation de l’axe adénosinergique, notamment via l’inhibition de CD73, est une avenue thérapeutique étudiée dans divers contextes de tumeurs solides, ce potentiel thérapeutique demeure largement inexploré dans des modèles de néoplasmes sanguins. En utilisant un modèle de souris transgénique de leucémie spontanée, cette thèse démontre un rôle pro-tumorigénique, avec un biais sexuel, de CD73 dans la leucémie lymphoïde chronique des lymphocytes B (LLC), via l’altération de l’immunité anti-tumorale. Enfin, alors que les rôles immunosuppressifs de CD73 et l’adénosine sont bien décrits, leurs activités pro-tumorigéniques qui s’étendent au-delà de l’immunité anti-tumorale sont peu connues. En accord avec la littérature, cette thèse explore plusieurs hypothèses selon lesquelles CD73 module l’activité métabolique mitochondriale des cellules cancéreuses. Les résultats présentés dans cette thèse suggèrent un rôle pro-tumorigénique à l’enzyme CD73, indépendant de la signalisation adénosinergique et de l’inhibition de l’immunité anti-tumorale, qui favorise la flexibilité métabolique et plus particulièrement la respiration mitochondriale des cellules cancéreuses, via la voie de récupération de la biosynthèse du nicotinamide (NAD+). En résumé, cette thèse apporte plusieurs précisions quant aux rôles biologiques de l’enzyme CD73 qui sont pertinents à l’immunisation dépendante des lymphocytes B, à la pathogénèse de la LLC ainsi qu’à la régulation de l’activité métabolique des cellules cancéreuses. Cette thèse offre de nouvelles pistes de réflexion quant au potentiel thérapeutique que renferme l’axe adénosinergique et plus particulièrement CD73, en approfondissant nos connaissances quant à l’éventail de ses fonctions. / The adenosinergic axis is central to a plethora of pathophysiological processes. The enzyme CD73 is key to the generation of adenosine by catalyzing the dephosphorylation of adenosine monophosphate. Adenosine’s contribution to biological and pathological processes is mainly carried through the activation of transmembrane receptors. Adenosine is mostly appreciated for its regulatory activity on a variety of immunes cells whereas CD73 is often referred to the enzyme responsible for adenosine accumulation within tumor microenvironment. Thus, by hindering antitumoral immune responses, CD73 and adenosine are frequently associated with cancer progression and targeting these offers great therapeutic potential in clinic. CD73 and adenosine’s role in other immune physiological processes are not fully understood, notably regarding immunization processes. Using a murine model of pneumococcal immunization, this thesis herein demonstrates a positive, but non-essential, role for CD73 and adenosine in B cells’ isotype class switching required to protective immunity against S. pneumoniae. This finding is particularly relevant to the development of novel strategies aimed at enhancing B cell-dependent immunization in high-risk populations such as young infants. While targeting the adenosinergic axis, particularly CD73, was extensively proven efficient in restoring antitumor immunity in many solid tumor contexts, its therapeutic potential in blood neoplastic malignancies remain largely unexplored. Using a transgenic mouse model of spontaneous leukemia, this thesis identifies a sex-oriented pro-tumorigenic role for CD73 in favoring B cells chronic lymphocytic leukemia (CLL) progression, through the inhibition of antitumor immunity. Finally, while immunosuppression by CD73 and adenosine is well described in cancer, other immune-independent pro-tumorigenic roles of CD73 are poorly understood. In accordance with literature, this thesis explores various hypotheses by which CD73 regulates cancer cells’ mitochondrial metabolic activity. Results presented herein suggest an immune- and adenosine signaling-independent pro-tumorigenic function for CD73 in favoring cancer cells’ metabolic flexibility and more particularly mitochondrial respiration through the nicotinamide (NAD+) salvage biosynthesis pathway. In sum, this thesis brings many insights into CD73’s biological functions relevant to B cells-dependent immunization, in CLL pathogenesis and in cancer cells’ metabolic activity. By expanding our knowledge of the extend of CD73’s biological functions, this thesis further discusses novel potential therapeutic opportunities.

Tumor-induced immunosuppression can occur by multiple mechanisms, each posing a significant obstacle to immunotherapy. Evidence presented in this dissertation suggests that aberrant cytokine signaling, as a result of altered metabolism of Chronic Lymphocytic Leukemia (CLL) cells, confers a selective advantage for tumor survival and growth. Cells from CLL patients with aggressive disease (as indicated by high-risk cytogenetics) were found to exhibit prolongation in Interferon (IFN)-induced STAT3 phosphorylation, and increased levels of reactive oxygen species (ROS) in these cells reflected these signaling processes. Changes in the relative balance of phospho-STAT3 and phospho-STAT1 levels, in response to combinations of IL-2 + Toll-like receptor (TLR)-7 agonist + phorbol esters, as well as IFN, were associated with the immunosuppressive and immunogenic states of CLL cells. In addition, immunosuppressive leukemic cells were found to express high levels of proteins with O-linked N-acetylglucosamine (O-GlcNAc) modifications, due to increased metabolic activity through the Hexosamine Biosynthetic Pathway (HBP), which caused impaired intracellular signaling responses and affected disease progression. A conclusion of the studies presented here is that the intrinsic immunosuppressive properties of leukemic cells may be overcome by agents such as Resveratrol that target metabolic pathways of these cells.

Tumor-induced immunosuppression can occur by multiple mechanisms, each posing a significant obstacle to immunotherapy. Evidence presented in this dissertation suggests that aberrant cytokine signaling, as a result of altered metabolism of Chronic Lymphocytic Leukemia (CLL) cells, confers a selective advantage for tumor survival and growth. Cells from CLL patients with aggressive disease (as indicated by high-risk cytogenetics) were found to exhibit prolongation in Interferon (IFN)-induced STAT3 phosphorylation, and increased levels of reactive oxygen species (ROS) in these cells reflected these signaling processes. Changes in the relative balance of phospho-STAT3 and phospho-STAT1 levels, in response to combinations of IL-2 + Toll-like receptor (TLR)-7 agonist + phorbol esters, as well as IFN, were associated with the immunosuppressive and immunogenic states of CLL cells. In addition, immunosuppressive leukemic cells were found to express high levels of proteins with O-linked N-acetylglucosamine (O-GlcNAc) modifications, due to increased metabolic activity through the Hexosamine Biosynthetic Pathway (HBP), which caused impaired intracellular signaling responses and affected disease progression. A conclusion of the studies presented here is that the intrinsic immunosuppressive properties of leukemic cells may be overcome by agents such as Resveratrol that target metabolic pathways of these cells.

L’ostéonécrose (ON) et les fractures (FR) sont des complications qui prennent de plus en plus place dans le traitement pédiatrique de la leucémie aiguë lymphoblastique (LAL). L’ON peut être causée par différents facteurs, dont principalement l’utilisation de glucocorticoïdes. Les glucocorticoïdes sont administrés lors du traitement de la leucémie dans le but d’initier l’apoptose des cellules malignes tout en ayant un effet anti-inflammatoire. Cependant, l’utilisation de ces corticostéroïdes comprend des effets secondaires sérieux, notamment le développement d’ostéonécrose. Des variantes génétiques peuvent mettre certains patients plus à risque que d’autres. Plusieurs gènes ont déjà été signalés comme régulés par les actions glucocorticoïdes (GC). Les variations génétiques présentes dans les régions régulatrices de ces gènes peuvent affecter leur fonctionnement normal et, en fin de compte, de déterminer un risque accru de développer l’ON associé au traitement contre la leucémie. Pour cette raison, plusieurs polymorphismes ont été identifiés et étudiés dans la cohorte QcALL de Ste-Justine, concernant les gènes suivants : ABCB1, ACP1, BCL2L11, NFKB1, PARP1, et SHMT1. Ces gènes jouent majoritairement un rôle dans les mécanismes d’action des glucocorticoïdes, mais quelques-uns ont plutôt un effet direct sur le développement d’ostéonécrose. Nos recherches ont démontré une corrélation entre ces polymorphismes et l’apparition d’ostéonécrose chez les patients de la cohorte QcALL, traités aux glucocorticoïdes. L'incidence cumulative de l'ostéonécrose a été évaluée rétrospectivement chez 305 enfants atteints de la leucémie qui ont subi un traitement à l’hôpital Ste-Justine selon les protocoles DFCI de Boston (87-01, 91-01, 95-01 et 2000-01). Parmi les huit polymorphismes de BCL2L11 étudiés, les 891T> G (rs2241843) et 29201C> T (rs724710) ont été significativement associés à ON (p = 0.01 et p = 0.03, respectivement). L'association du polymorphisme 891T> G a été modulée par le type de corticostéroïde (CS), l’âge, le sexe et le groupe à risque (p ≤ 0,05). Le polymorphisme 29201C> T était particulièrement apparent chez les patients à haut risque (p = 0,003). La même étude était conduite en parallèle sur des patients de la cohorte DFCI de Boston (N = 192), et montrait des résultats significatifs pour les polymorphismes étudiés. En conclusion, les résultats de cette étude permettront de confirmer l’association de ces polymorphismes au développement d’ON chez les patients de LLA traités aux GC. / Osteonecrosis (ON) and fractures (FR) are complications that take place in the treatment of children acute lymphoblastic leukemia (cALL). They can be caused by various factors, mainly using glucocorticoids. The corticosteroids, dexamethasone (DXM) and prednisone (PDN) are administered during the treatment of leukemia to initiate apoptosis of malignant cells; while having an anti-inflammatory effect. However, the use of these corticosteroids has severe side effects, including the development of osteonecrosis. Moreover, some patients develop resistance to treatment, and are at risk of developing side effects. The genetic variants predispose some patients at higher risk than others. Several genes have been previously reported as up- or down regulated by the GCs actions. The genetic variations present in gene coding or regulatory regions can affect their function and ultimately determine an increased risk of developing ON associated to ALL therapy. Therefore, we investigated the association between several single nucleotide polymorphisms (SNPs) in six candidate genes: BCL2L11, NFKB1, PARP1, ABCB1, ACP1, and SHMT1. These genes play a role in the mechanisms of action of glucocorticoids, but some have more of a direct effect on the development of osteonecrosis. Our research has shown a correlation between these polymorphisms and the occurrence of osteonecrosis in patients in the QCALL cohort, treated with glucocorticoids. Cumulative incidence of osteonecrosis was assessed retrospectively in 305 children with ALL who underwent treatment with DFCI protocols (87-01, 91-01, 95-01 and 2000-01) in childhood ALL cohort from Quebec (QcALL). Among the eight tag BCL2L11 polymorphisms studied the 891T>G (rs2241843) and 29201C>T (rs724710) were significantly associated with ON (p = 0.01 and p = 0.03, respectively). Association of 891T>G polymorphism was modulated by type of corticosteroid (CS), age, sex and risk group (p ≤ 0.05 and that of 29201C>T was particularly apparent among high risk (p = 0.003) patients. These polymorphisms have shown significant ON association in several QcALL risk groups, mainly in corticosteroid groups, age < 10 years, and high risk (HR) group. Furthermore, the same study was conducted in parallel with patients in the replication (DFCI) cohort (N = 192), and we showed significant genetic association results for all studied polymorphisms. In conclusion, this study identifies that some ALL children have a high incidence of ON during the treatment that is highly associated with polymorphisms in different genes regulated by corticosteroids and ALL prognostic factors.

CAR-T-Zell-Therapie ist eine vielversprechende neuartige Behandlungsform für Patienten mit aggressiven B-Zell Non-Hodgkin-Lymphomen (B-NHL). In dieser Arbeit wurde die anti-CXCR5 CAR-T-Zell-Therapie als Alternative zur anti-CD19 CAR-T-Zell-Therapie für die Behandlung von reifen B-NHLs untersucht. CXCR5 ist ein B-Zell-homing Rezeptor, der von reifen B Zellen und follikulären T-Helferzellen (TFH Zellen) exprimiert wird. TFH Zellen wurden als tumor-unterstützend in chronisch lymphatischer Leukämie (CLL) und im follikulären Lymphom (FL) beschrieben. Dieses Expressionsmuster erlaubt es, auf einzigartige Weise zeitgleich die malignen Zellen und die tumorunterstützende Mikroumgebung mithilfe von CAR-T-Zell-Therapie gerichtet gegen einen Chemokinrezeptor anzugreifen. Die wichtigsten Ergebnisse dieser Arbeit waren, dass (1) die anti-CXCR5 CAR T-Zellen zielgerichtet CXCR5 positive reife B-NHL Zelllinien und Patientenproben in vitro eliminierten und eine starke anti-Tumor Reaktivität in einem immundefizienten Xenotransplantationsmausmodell zeigten, (2) die anti-CXCR5 CAR T-Zellen zielgerichtet die tumorunterstützenden TFH Zellen in CLL und FL Patientenproben in vitro erkannten und dass (3) CXCR5 ein sicheres Expressionsprofil zeigte. CXCR5 war stark und häufig auf B-NHL exprimiert und die Expression auf gesundem Gewebe war auf lymphoide Zellen beschränkt. Zusammenfassend lässt sich sagen, dass die anti-CXCR5 CAR-T-Zell-Therapie eine neue Behandlungsmöglichkeit für Patienten mit reifen B-NHL darstellt, indem durch die anti-CXCR5 CAR-T Zellen sowohl der Tumor als auch ein Anteil der tumorunterstützende Mikroumgebung eliminiert werden. Im zweiten Teil der Arbeit wurde das Eμ-Tcl1 murine CLL Lymphommodell genutzt um die Auswirkung der Lymphomentwicklung auf die CXCR5+ T Zellen zu untersuchen. Mittels RNA-Einzelzell-Sequenzierung konnte ein profunder Einfluss des Lymphomwachstums auf das T Zell-Kompartiment der Mäuse, denen Eμ-Tcl1 Zellen gespritzt wurden, gezeigt werden. / CAR T cell therapy is a promising new treatment option for patients suffering from aggressive B non-Hodgkin lymphomas (NHLs). In CAR T cell therapy, patient-derived T cells are genetically modified to express a chimeric receptor commonly directed towards a surface antigen expressed by neoplastic cells. In this thesis, anti-CXCR5 CAR T cell therapy was investigated as an alternative to anti-CD19 CAR T cell therapy for the treatment of mature B-NHLs. CXCR5 is a B cell homing receptor expressed by mature B cells and follicular helper T (TFH) cells. TFH cells were described to support the tumor cells in chronic lymphocytic leukemia (CLL) and follicular lymphoma (FL). This expression pattern allows simultaneous targeting of the malignant cells and the tumor-supporting microenvironment by CAR T cell therapy against a chemokine receptor in an unprecedented manner. Main findings included that (1) anti-CXCR5 CAR T cells targeted specifically CXCR5 expressing mature B-NHL cell lines and patient samples in vitro and showed strong in vivo anti-tumor reactivity in an immunodeficient xenograft mouse model, (2) anti-CXCR5 CAR T cells targeted tumor-supportive TFH cells derived from CLL and FL patient samples in vitro and (3) CXCR5 showed a safe expression profile. CXCR5 was strongly and frequently expressed by B-NHLs and its expression on healthy tissue was restricted to lymphoid cells. In summary, anti-CXCR5 CAR T cell therapy presents a novel treatment option for patients suffering from mature B-NHLs by eliminating the tumor and part of the tumor-supportive microenvironment. The second part of the project, the Eμ-Tcl1 murine lymphoma model, which mimics human CLL, was used to study the impact of lymphomagenesis on CXCR5+ T cells. Using single cell RNA sequencing, a profound influence of lymphoma growth on the T cell compartment in Eμ-Tcl1 tumor-challenged mice could be shown.