[Truncated abstract] Fetal inflammatory response syndrome (FIRS) has only recently been recognised as an important cause of spontaneous preterm delivery (PTD). In addition, it has been associated with a number of other short-term and long-term adverse neonatal outcomes, including early onset neonatal sepsis, necrotising enterocolitis, periventricular leucomalacia, cerebral palsy, and bronchopulmonary dysplasia, although the causal mechanisms are unclear. The hallmark of FIRS is histologic chorioamnionitis (HCA). Mothers with HCA are often asymptomatic and it remains unclear whether elevated maternal inflammatory markers, such as C-reactive protein (CRP) and procalcitonin (PCT), are predictive of preterm birth. Furthermore neonatal inflammatory markers such as CRP, PCT, white cell count (WCC) and absolute neutrophil count (ANC), are commonly used in clinical practice to diagnose infection in the neonatal period. Although both intrauterine inflammation and FIRS may have effects on inflammatory markers for up to 10 days following delivery, the extent to which intrauterine infection and FIRS confound these diagnostic surrogates of neonatal infection is unknown. This work addressed the hypothesis that HCA is associated with inflammatory changes that may be detected in the: (a) maternal circulation at the time of delivery, (b) umbilical cord blood at delivery and (c) post-natal circulation within the first 48 hours of life. The primary aim of this study was to investigate the relationship between the presence of HCA and maternal inflammatory markers (serum CRP and PCT on the day of delivery) as well as neonatal inflammatory markers (haematological parameters, CRP and PCT up to 48 hours following delivery). ... Cord platelet counts were likely affected by platelet activation. For both intra-rater and inter-rater reproducibility, the corrected WCC, ANC and NRBC were shown to be reliable with an ICC of >0.90 for all comparisons. However, I:T ratio was poorly reproducible. HCA appears to be a minor inflammatory insult for the mother. In the majority of cases it is asymptomatic and results in minor increases in PCT and CRP levels on the day of delivery. Conversely HCA results in significant inflammatory changes in the newborn that can be seen in the cord blood. Sensitive markers of inflammation in the cord blood are significantly higher in affected infants (CRP and PCT), while less sensitive markers, such as WCC and ANC are not significantly different. This study has shown that fetal inflammation has sustained effects on CRP and haematological parameters in early neonatal life; CRP, WCC and ANC are significantly higher in newborns exposed to HCA, peaking 24 hours following delivery. These effects may confound the interpretation of common diagnostic tests for early onset neonatal sepsis. Conclusion: HCA results in mild elevations in CRP and PCT in the cord blood. Over the subsequent 24 hours CRP, WCC and ANC increase significantly in these neonates. Intrauterine exposure to HCA may influence surrogate diagnostic markers for early onset sepsis in newborn infants. Future research to investigate novel diagnostic markers, such as CD64 and soluble triggering receptor expressed on myeloid cells (TREM-1), or enhanced microbiological molecular diagnosis, will help distinguish true invasive infection from HCA-driven inflammation in the newborn infant.

[Truncated abstract] Glucocorticoids are critical for the maturation of the fetus late in pregnancy. Indeed, clinical administration of glucocorticoids is used to accelerate fetal lung maturation in mothers at risk of pre-term delivery. Increased glucocorticoid exposure, however, can have detrimental effects on fetal and placental growth and increase the risk of disease in later life. Many studies have focused on the effect of an increase in the transplacental passage of glucocorticoids on both fetal growth and subsequent postnatal development. But there is a growing body of evidence to suggest that the impact of glucocorticoids on fetal growth is mediated, in part, via their direct effects on the placenta . . . Overall, these studies quantify the labyrinth zone-specific increases in placental expression of PPARG and VEGF in association with a marked increase in vascularisation observed near term. Furthermore, this study demonstrates for the first time that these increases in gene expression are prevented by maternal dexamethasone treatment which also inhibits growth of the fetal capillary network. Elevated expression of SFRP4 in the regressing basal zone late in gestation and in both placental zones after dexamethasone-induced placental growth restriction is consistent with a role for SFRP4 in glucocorticoid-mediated inhibition of wnt signalling. Collectively, the data presented in this thesis show that glucocorticoid inhibition of fetal growth is mediated in large part via effects on the placenta, specifically through inhibition of signals that promote proliferation and vascularisation.

Le placenta assure les échanges materno-fœtaux et possède une fonction endocrine autonome. Les hormones placentaire lactogène (hPL) et chorionique gonadotrope (hCG) sont synthétisées par le syncytiotrophoblaste. A ce jour, les mécanismes impliqués dans le contrôle de la sécrétion de ces deux hormones ne sont pas connus. In vitro, l’influx d’ions Ca2+ entraîne une augmentation immédiate et soutenue de la libération d’hPL et d’hCG à partir d’explants de placentas à terme. En outre, l’élévation de la concentration extracellulaire en albumine, principale protéine maternelle circulante en contact direct avec le trophoblaste, stimule de manière immédiate et transitoire la libération d’hPL et d’hCG.<p><p>L’objectif de nos travaux a été de vérifier la spécificité de l’activité sécrétagogue de l’albumine au niveau du placenta, de caractériser les messagers cellulaires potentiellement impliqués dans la libération d’hPL et d’hCG, et de définir l’interaction entre l’albumine et le trophoblaste, en utilisant des explants provenant de placentas humains à terme.<p> <p>Nos travaux démontrent que la riposte sécrétoire à l’albumine (5%, m/v) est largement mimée par d’autres agents colloïdaux (dextran et polygéline). Cette stimulation colloïdale de la libération d’hPL et d’hCG impliquerait une mobilisation de Ca2+ à partir de réserves intracellulaires. L’intervention de 3 messagers cellulaires a été envisagée: les IPs/DAG, l’AMPc, et le GMPc. Le fluorure de sodium, la forskoline, ou le nitroprussiate sodique, activateurs connus de la production respective des IPs, de l’AMPc, et du GMPc, augmentent de manière significative les taux placentaires de chacun de ces messagers, sans toutefois affecter la libération d’hPL ou d’hCG. De plus, l’élévation de la concentration extracellulaire en albumine (5%, m/v) ne modifie pas les taux des IPs, de l’AMPc et du GMPc dans les explants placentaires, tandis qu’elle stimule la sécrétion hormonale. Ces systèmes de signalisation, bien que fonctionnels au niveau du trophoblaste, ne joueraient donc pas un rôle majeur dans la régulation de la libération d’hPL et d’hCG. <p><p>Nos résultats mettent en évidence une internalisation rapide d’albumine marquée, avec de l’125I ou de la fluorescéïne, dans le syncytiotrophoblaste. Une large fraction de cette albumine est recyclée, intacte, vers la circulation maternelle selon un processus sensible à l’abaissement de la température et indépendant du cytosquelette. L’albumine marquée restant dans les explants placentaires est partiellement dégradée. Trois mécanismes ont été envisagés pour expliquer ces mouvements d’entrée et de sortie de l’albumine au sein du placenta humain: l’endocytose médiée par l’albondine via les caveolae, le système des coated pits clathrine-dépendant, et l’endocytose médiée par la mégaline. Par immunohistochimie, nous avons montré que, dans le tissu placentaire, la caveoline-1, protéine caractéristique des caveolae, est localisée uniquement dans l’endothelium des capillaires fœtaux. La clathrine, au niveau des coated pits, et la mégaline se trouvent au contraire dans le syncytiotrophoblaste. La méthyl-b-cyclodextrine et l’hydrochlorure de chlorpromazine, inhibiteurs d’une endocytose dépendant de la clathrine, réduisent significativement l’internalisation placentaire de l’albumine marquée. Par contre, le DIDS ou le NPPB, susceptibles de perturber l’endocytose médiée par la mégaline, n’affectent pas la captation d’albumine marquée par les explants placentaires. L’albumine pénétrerait donc dans le syncytiotrophoblaste principalement par un processus clathrine-dépendant. La mégaline ne jouerait ici qu’un rôle mineur dans l’entrée de la protéine. Un tel processus de recyclage de l’albumine pourrait être similaire à celui décrit pour les immunoglobulines G au niveau du syncytiotrophoblaste.<p><p>Ces mouvement d’entrée et de sortie de l’albumine ne semblent pas associés à la stimulation de la libération d’hPL et d’hCG par l’albumine. Ils pourraient par contre participer significativement, étant donné leur ampleur, à la nutrition fœtale. L’albumine est en effet un transporteur notoire d’ions et d’acides gras, molécules qui pourraient être acheminées au fœtus via le phénomène de recyclage placentaire de l’albumine mis en évidence par ce travail. /<p><p>The human placenta is the site of all maternal-fetal exchanges, and is also an active endocrine organ. Placental lactogen (hPL) and chorionic gonadotrophin (hCG) hormones are synthesized by the syncytiotrophoblast. So far, the mechanisms involved in the regulation of both hormones secretion remain elusive. In vitro, calcium inflow causes an immediate and sustained rise in the hPL and hCG releases from human term placenta explants. Moreover, increasing the extracellular concentration of albumin, the major maternal plasma protein in direct contact with the human trophoblast, stimulates the hPL and hCG releases in an immediate and transient way.<p><p>Our study have aimed to check the specificity of this secretory effect of albumin, to investigate the potential cellular messengers involved in the hPL and hCG releases, and to define the interaction between albumin and the throphoblast layer, using human term placenta explants.<p><p>Our results indicate that the triggering effect of albumin (5%, w/v) is largely mimicked by two other colloidal agents (dextran and polygelin). This “colloidal” stimulation of the hPL and hCG releases would involve the mobilization of calcium from intracellular pools. Three cellular messengers have been considered to mediate this process: the IPs/DAG, the cAMP, and the cGMP. Sodium fluoride, forskolin, or sodium nitroprusside, known activators of respectively the IPs, cAMP, and cGMP production, significantly increase the placental content of each of those messengers, without modifying the hPL and hCG releases. In addition, raising the extracellular concentration of albumin does not cause any change in the placental level of IPs, cAMP, and cGMP, while stimulating the hormonal release. These three signaling pathways are thus functional in human term trophoblast but do not appear to significantly modulate the hPL and hCG secretions. <p><p>Our findings show that albumin, labeled with 125I or with fluorescein, is rapidly internalized into the syncytiotrophoblast. Thereafter, the intact protein is largely recycled to the maternal circulation, through a temperature-sensitive and cytoskeleton-independent process. The labeled albumin remaining in placental explants is partially degraded. Three different mechanisms could participate to the albumin entry into the human placenta: the albondin-mediated endocytosis via the caveolae, the clathrin-dependent coated pits system, and the megalin-mediated endocytosis. Using immunohistochemistry, caveolin-1, marker of the caveolae, is localized in the endothelium of the fetal capillaries and not in the syncytiotrophoblast. By contrast, clathrin and megalin are observed only in the syncytiotrophoblast. Methyl-b-cyclodextrin, and chlorpromazine hydrochloride, known inhibitors of the clathrin-dependent endocytotic process, significantly reduce the placental uptake of labeled albumin. On the other hand, DIDS or NPPB, able to perturb the megalin-mediated endocytosis, do not affect the labeled albumin uptake. Thus, albumin seems to be internalized into the syncytiotrophoblast mainly through a clathrin-dependent mechanism. Megalin would only play a minor role in this process. Such movements of albumin in the human placenta may be similar to the recycling process reported for IgG at that site.<p><p>The placental apical recycling of albumin is not associated to the albumin triggering effect on the hPL and hCG releases. This quantitatively significant internalization process may participate to the fetus’ nutrition. Indeed, Albumin carries ions and fatty acid, which could be brought to the fetus via the protein recycling evidenced by our study.<p><p><p> <p> / Doctorat en sciences biomédicales / info:eu-repo/semantics/nonPublished

Estudou-se prospectivamente o comportamento das calcificações, da atrofia, das alterações da substância branca e alterações vasculares nas imagens de tomografia computadorizada de crânio de 162 crianças e adolescentes infectados pelo vírus da imunodeficiência humana (HIV) por transmissão vertical e que estavam ou estiveram em acompanhamento clínico no Ambulatório de Infectologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 1992 e 2002. Analisaram-se as possíveis correlações entre estas alterações e seu aspecto evolutivo. Para tal finalidade, foram avaliadas 606 tomografias computadorizadas de crânio (média de 3,74 exames por paciente), as quais constituíram o grupo de estudo. Após a caracterização quanto à presença ou não das alterações supracitadas, e suas possíveis inter-relações, realizou-se a análise estatística dos resultados obtidos através do teste exato de Fisher com nível de significância de 5%. Posteriormente, os mesmo aspectos foram avaliados em função do seu comportamento evolutivo em um subgrupo de 61 pacientes (média, 4,18 exames por paciente, totalizando 321 exames tomográficos). Estes pacientes tinham, pelo menos, quatro estudos tomográficos seriados (com intervalo mínimo de noventa dias entre os exames subseqüentes e pelo menos dois anos de intervalo total entre o primeiro e o último exame). As alterações tomográficas foram abordadas individual e qualitativamente segundo o critério de presença e intensidade. Inicialmente, o conjunto dos resultados foi tratado de forma individual (para cada paciente) e, depois, em relação à totalidade do grupo em questão. As calcificações foram encontradas em 46,30% dos pacientes; a atrofia, em 37,65%; as alterações da substância branca, em 25,93%; as anomalias vasculares, em 25,19%. Constatou-se uma correlação significativa entre as alterações de substância branca e a atrofia, bem como entre as calcificações e as alterações vasculares. A análise evolutiva destas características demonstrou haver um acréscimo significativo das alterações entre o momento inicial e o quarto momento no conjunto das alterações, sobretudo para as calcificações e para as alterações vasculares. Concluiu-se que as calcificações e a atrofia foram as alterações mais freqüentes nesta série de crianças e adolescentes com HIV adquirido por transmissão vertical. A atrofia e as alterações da substância branca apresentaram uma inter-relação importante na amostra descritiva, assim como as alterações vasculares e as calcificações mostraram uma associação evolutiva significativa em relação à sua progressão / We prospectively studied the behavior of calcifications, atrophy, white matter and vascular abnormalities on the images of computed tomography (CT) of 162 children and adolescents infected with the human immunodeficiency virus (HIV) acquired by vertical transmission, who are or were clinically followed in the Ambulatory of Pediatric Infectology of the Children Institute at the Clinics Hospital of University of São Paulo Medical School, from 1992 to 2002. We analyzed the possible correlation between these abnormalities, as well as, their evolutive aspects. For this purpose, we evaluated 606 CT scans (mean 3.74 exams per patient), which composed the group of study. After the characterization according to the presence or not of the anomalies mentioned above, and their possible inter-relations, we performed a statistical analysis of the obtained results with the Fisher test with a level of significance below 5%. Later, these aspects were evaluated regarding its evolutive behavior in a subgroup of 61 patients (mean, 4.18 exams per patient, summing 321 exams). These patients had, at least, four serial cranial CT (with minimum interval of ninety days between the subsequent exams and, at least, two years of total interval between the first and the fourth exam). The cranial CT abnormalities presented were assessed individually as absent or present. Initially, the set results were assessed individually (for each patient) and, later in relation to the totality of the group. Calcifications were found in 46.30% of all patients, atrophy in 37.65%, white matter abnormalities in 25.93% and vascular anomalies in 25.19%. We found a significant correlation between white matter abnormalities and atrophy, as well as, between calcifications and vascular anomalies. Evolutive analysis of these characteristics demonstrated a significant increase of the abnormalities between the first and the fourth moment, with emphasis to the calcifications and vascular anomalies. We concluded that, calcifications and atrophy were the most frequent abnormalities in this series of children and adolescents with HIV acquired by vertical transmission. Atrophy and white matter abnormalities presented a significant correlation in the descriptive sample, as well as, vascular anomalies and calcifications that also demonstrated a significant evolutive association regarding its progression

Estudou-se prospectivamente o comportamento das calcificações, da atrofia, das alterações da substância branca e alterações vasculares nas imagens de tomografia computadorizada de crânio de 162 crianças e adolescentes infectados pelo vírus da imunodeficiência humana (HIV) por transmissão vertical e que estavam ou estiveram em acompanhamento clínico no Ambulatório de Infectologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 1992 e 2002. Analisaram-se as possíveis correlações entre estas alterações e seu aspecto evolutivo. Para tal finalidade, foram avaliadas 606 tomografias computadorizadas de crânio (média de 3,74 exames por paciente), as quais constituíram o grupo de estudo. Após a caracterização quanto à presença ou não das alterações supracitadas, e suas possíveis inter-relações, realizou-se a análise estatística dos resultados obtidos através do teste exato de Fisher com nível de significância de 5%. Posteriormente, os mesmo aspectos foram avaliados em função do seu comportamento evolutivo em um subgrupo de 61 pacientes (média, 4,18 exames por paciente, totalizando 321 exames tomográficos). Estes pacientes tinham, pelo menos, quatro estudos tomográficos seriados (com intervalo mínimo de noventa dias entre os exames subseqüentes e pelo menos dois anos de intervalo total entre o primeiro e o último exame). As alterações tomográficas foram abordadas individual e qualitativamente segundo o critério de presença e intensidade. Inicialmente, o conjunto dos resultados foi tratado de forma individual (para cada paciente) e, depois, em relação à totalidade do grupo em questão. As calcificações foram encontradas em 46,30% dos pacientes; a atrofia, em 37,65%; as alterações da substância branca, em 25,93%; as anomalias vasculares, em 25,19%. Constatou-se uma correlação significativa entre as alterações de substância branca e a atrofia, bem como entre as calcificações e as alterações vasculares. A análise evolutiva destas características demonstrou haver um acréscimo significativo das alterações entre o momento inicial e o quarto momento no conjunto das alterações, sobretudo para as calcificações e para as alterações vasculares. Concluiu-se que as calcificações e a atrofia foram as alterações mais freqüentes nesta série de crianças e adolescentes com HIV adquirido por transmissão vertical. A atrofia e as alterações da substância branca apresentaram uma inter-relação importante na amostra descritiva, assim como as alterações vasculares e as calcificações mostraram uma associação evolutiva significativa em relação à sua progressão / We prospectively studied the behavior of calcifications, atrophy, white matter and vascular abnormalities on the images of computed tomography (CT) of 162 children and adolescents infected with the human immunodeficiency virus (HIV) acquired by vertical transmission, who are or were clinically followed in the Ambulatory of Pediatric Infectology of the Children Institute at the Clinics Hospital of University of São Paulo Medical School, from 1992 to 2002. We analyzed the possible correlation between these abnormalities, as well as, their evolutive aspects. For this purpose, we evaluated 606 CT scans (mean 3.74 exams per patient), which composed the group of study. After the characterization according to the presence or not of the anomalies mentioned above, and their possible inter-relations, we performed a statistical analysis of the obtained results with the Fisher test with a level of significance below 5%. Later, these aspects were evaluated regarding its evolutive behavior in a subgroup of 61 patients (mean, 4.18 exams per patient, summing 321 exams). These patients had, at least, four serial cranial CT (with minimum interval of ninety days between the subsequent exams and, at least, two years of total interval between the first and the fourth exam). The cranial CT abnormalities presented were assessed individually as absent or present. Initially, the set results were assessed individually (for each patient) and, later in relation to the totality of the group. Calcifications were found in 46.30% of all patients, atrophy in 37.65%, white matter abnormalities in 25.93% and vascular anomalies in 25.19%. We found a significant correlation between white matter abnormalities and atrophy, as well as, between calcifications and vascular anomalies. Evolutive analysis of these characteristics demonstrated a significant increase of the abnormalities between the first and the fourth moment, with emphasis to the calcifications and vascular anomalies. We concluded that, calcifications and atrophy were the most frequent abnormalities in this series of children and adolescents with HIV acquired by vertical transmission. Atrophy and white matter abnormalities presented a significant correlation in the descriptive sample, as well as, vascular anomalies and calcifications that also demonstrated a significant evolutive association regarding its progression

Trypanosoma cruzi est un parasite protozoaire à multiplication intracellulaire, agent de la maladie de Chagas, infectant 16 à 18 millions de personnes en Amérique latine. Il peut être transmis de la mère infectée au fœtus dans 2 à 10 % des cas, mais ses autres effets sur la gestation ont été peu étudiés. Par ailleurs, les cytokines ont des effets sur la gestation. Certaines d’entre elles, comme l’interleukine-1, l’IL-4, l’IL-5, l’IL-10, le GM-CSF et le TGF-b2, sont bénéfiques pour la gestation, tandis que d’autres, comme l’IL-2, l’IL-12, l’IFN-g et le TNF-a ont des effets nocifs sur celle-ci. L’impact de l’infection à T. cruzi, stimulant la production de TNF-a et d’IFN-g, sur l'implantation et la croissance fœtale n’a pas été étudié.<p><p>Le but de notre travail était d’étudier les effets de l’infection aiguë à T. cruzi sur la capacité de reproduction de la souris. Nous avons ainsi évalué les effets de cette infection sur la fertilité, le développement et la viabilité des fœtus de souris et le rôle de l’IFN-g et du TNF produits au cours de l’infection sur le développement de la gestation. <p><p>Nous avons montré que l’infection aiguë à T. cruzi :i) diminue la capacité de reproduction de la souris ;ii) provoque une mortalité fœtale massive précoce (résorptions), tardive et néonatale associée à un retard de croissance intra-utérin, et ce, iii) en dehors de toute transmission congénitale du parasite. <p>Par ailleurs nos travaux montrent que la mortalité fœtale/néonatale est associée à une invasion parasitaire massive du placenta qui présente d’importantes lésions à type d’infiltrats inflammatoires, de nécrose ischémique, de dépôts de fibrine et de thromboses vasculaires. Nous avons noté qu’il existe une relation inverse entre la charge parasitaire des unités utéro-placentaires et la viabilité du conceptus, suggérant que ces lésions placentaires contribuent à la mortalité fœtale en limitant les échanges materno-fœtaux. <p>Enfin, nous avons également étudié le rôle de cytokines abortogènes comme le TNF et l’IFN-g, produites abondamment pendant l’infection aiguë de la souris par T. cruzi. Les taux sanguins maternels d’IFN-g étaient augmentés au 9ième mais pas aux 17ième et 19ième jours de gestation, alors que les taux de TNF sanguin et la production placentaire de cette cytokine augmentaient aux 17ième et 19ième jours de gestation. Afin d’évaluer le rôle de ces deux cytokines dans la mortalité fœtale, des souris ont été traitées par la pentoxifylline, pour inhiber la transcription du gène de TNF-a et diminuer la production d’IFN-g. Ces souris montraient une réduction de la mortalité fœtale à mi-gestation, associée à une diminution de la production du TNF placentaire, sans modifications des taux systémiques et sans effets sur l’IFN-g, suggérant la contribution du TNF dans la mortalité fœtale associée à l’infection aiguë par T. cruzi. <p><p>En conclusion, notre travail montre que l’infection aiguë à Trypanosoma cruzi exerce un effet particulièrement néfaste sur la capacité de reproduction et le développement de la gestation chez la souris et que les lésions placentaires liées à l’infection et la production de TNF par le placenta infecté contribuent à cet effet.<p> / Doctorat en sciences biomédicales / info:eu-repo/semantics/nonPublished

Indiana University-Purdue University Indianapolis (IUPUI) / The maternal liver shows marked growth during pregnancy to accommodate the development and metabolic needs of the placenta and fetus. Previous study has shown that the maternal liver grows proportionally to the increase in body weight during gestation by hyperplasia and hypertrophy of hepatocytes. As the maternal liver is enlarged, the transcript level of Ascl1, a transcription factor essential to progenitor cells of the central nervous system and peripheral nervous system, is highly upregulated. The aims of the study were to (1) identify hepatic Ascl1-expressing cells, and (2) study the functions of Ascl1 in maternal liver during pregnancy. In situ hybridization shows that most cell types (parenchymal, nonparenchymal, and mesothelial cells) express Ascl1 mRNA in maternal livers during gestation and in male regenerating livers. Notably, hepatic mesothelial cells abundantly express Ascl1 during pregnancy and liver regeneration. Inducible ablation of Ascl1 gene during pregnancy results in maternal liver enlargement, litter size reduction, and fetal growth retardation. In addition, maternal hepatocytes deficient in Ascl1 gene lack majority of their cytosols and exhibit β-catenin nuclear translocation, while maintaining their cellular boundary and identity. In summary, in both maternal liver during pregnancy and regenerating liver, the expression of Ascl1 is induced in most cell types. Mesothelial cells are potential origin of Ascl1-expressing cells. Ascl1 gene is essential for the progression of normal pregnancy

L’activation des lymphocytes T nécessite un double signal. Le premier est antigénique et permet la reconnaissance d’un peptide spécifique présenté à la surface de cellules présentatrices d’antigène (APC). Le second signal est co-stimulateur et implique l’interaction avec des molécules activatrices exprimées par les APC et la présence de cytokines proinflammatoires. Les cellules dendritiques (DC) sont les uniques APC capables de délivrer ce double signal et d'activer les lymphocytes T naïfs, initiant ainsi les réponses immunes primaires. L’immaturité du système immunitaire du nouveau-né est responsable d’une plus grande susceptibilité aux maladies infectieuses ainsi qu’une faible réponse vaccinale. Des déficiences tant au niveau de l’immunité innée que de l’immunité acquise participe à une faible défense face aux agressions. A la naissance, les DC expriment des niveaux faibles de molécules co stimulatrices et présentent un défaut majeur de synthèse d'IL 12, cytokine cruciale pour l’établissement de réponses de type Th1. Le but de ce travail est d’évaluer la capacité des DC du nouveau-né humain à activer les lymphocytes T CD8+.<p>Dans une première approche, nous avons utilisé un modèle unique d’induction de réponse primaire in vitro qui permet d'étudier l'activation de lymphocytes T CD8+ spécifiques de l’antigène Melan-A, une protéine du soi exprimée par les mélanocytes. Ces lymphocytes existent à des fréquences particulièrement élevées chez les individus sains HLA-A2 et présentent les caractéristiques de lymphocytes T naïfs. Dans ce modèle, nous avons d’abord analysé les capacités immunostimulatrices de différentes populations de DC différenciées in vitro. Nous avons observé que les DC différenciées par la culture de monocytes purifiés en présence d'IL-3 et d’IFN-beta sont capables d’initier une réponse fonctionnelle des lymphocytes T CD8+, analogue à celle induite par les DC différenciées en présence de GM-CSF et d’IL-4. Ce même modèle nous a permis de démontrer que, en dépit de leur défaut de production d’IL 12, les DC du nouveau-né sont capables d'induire efficacement une réponse lymphocytaire T CD8+ cytotoxique.<p><p>Afin dévaluer la relevance in vivo de nos observations, nous avons étudié le phénotype et la fonction des DC circulantes chez des nouveau-nés infectés par le cytomégalovirus (CMV). L’infection par le CMV au cours de la vie fœtale représente une situation clinique où le nouveau-né développe une réponse mature et fonctionnelle des lymphocytes T CD8+, alors que celle des lymphocytes T CD4+ est déficiente. Ces expériences ont montré que le phénotype, la fonction et la réponse à différents stimuli des APC présentes en périphérie ne sont pas affectés par l’infection congénitale par le CMV. Ces résultats suggèrent que l’observation des DC circulantes des nouveau-nés infectés par le CMV ne permet pas d’analyser l’influence du virus sur la fonction des DC néonatales. Dans ce but, nous avons reproduit un modèle d’infection in vitro de DC par une souche primaire du CMV. L’utilisation de micropuces à ADN nous a permis de comparer l’expression de gènes différentiellement induits par l’infection des DC d’adultes et de nouveau-nés. Nous avons ainsi révélé une proportion importante de gènes différentiellement induits, parmi lesquels celui de l’IFN-beta. Nous avons confirmé ce défaut au niveau protéique et mis en évidence une production d’IL 12 déficiente en réponse à l’infection par CMV.<p>L’ensemble de nos résultats indique que malgré leur immaturité, les DC du nouveau-né sont capables, dans certaines circonstances, d’induire une réponse lymphocytaire T CD8+ cytotoxique. Cependant, le défaut de production de certaines cytokines co-stimulatrices pourrait être impliqué dans la faible réponse des lymphocytes T CD4+ à l’infection par CMV. Ces observations ont d’importantes implications pour la compréhension de l’induction de réponses cytotoxiques au cours d’infections virales et pour l’élaboration de stratégies vaccinales en début de vie.<p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished