<p>Multiple myeloma (MM) is a virtually incurable B cell malignancy of the bone marrow. One important part of tumor progression and an obstacle for successful therapy is resistance to apoptosis. To combat this resistance, the mechanisms of apoptosis and survival in MM must be better defined. </p><p>In this thesis, we identified Fas up-regulation as a mechanism underlying interferon (IFN)-mediated sensitization to Fas-induced apoptosis in the MM cell line U-266-1970. IFN treatment induced activation of signal transducer and activator of transcription (Stat)1 but, intriguingly, also attenuated activation of MM survival factor Stat3. </p><p>Exploring the role of Stat1 further, we established sub-lines of U-266-1970 with a stable over-expression of Stat1 and of its active mutant Stat1C. These sub-lines displayed a decreased expression and activation of Stat3, and an altered expression of apoptosis-related genes Harakiri, Bcl-2 and Mcl-1. In a drug library screening, Stat1 over-expression was associated with an increased sensitivity to Fas-induced apoptosis and, conversely, an increased resistance to several drugs, including the cyclin dependent kinase (cdk)1 inhibitor CGP74514A. We conclude that Stat1 over-expression does not confer a general resistance or sensitivity to apoptosis in MM, but may strongly affect the response to some specific drugs.</p><p>We also explored the effects of picropodophyllin (PPP), an inhibitor of the insulin-like growth factor I (IGF-I) receptor tyrosine kinase (RTK), in MM. PPP selectively inhibited the IGF-I RTK activity without inhibiting the insulin RTK activity. Furthermore, PPP potently induced cell cycle arrest and apoptosis in all MM cell lines and patient samples tested, also in the presence of survival factors IGF-I and IL-6. We conclude that PPP has great therapeutic potential in MM </p><p>Finally, we examined the expression and regulation of the inhibitors of apoptosis proteins (IAPs) in a panel of MM cell lines and patient samples. The glucocorticoid dexamethasone, which is used in MM therapy, induced a transient up-regulation and a subsequent down-regulation of c-IAP2, as well as a down-regulation of XIAP, possibly influencing the sensitivity to apoptosis induced by this drug. Supporting this notion, abrogation of IGF-IR signaling by PPP, which sensitizes MM cells to dexamethasone-induced apoptosis, enhanced the down-regulation of c-IAP2 and XIAP.</p>

Multiple myeloma (MM) is an incurable B-cell malignancy mainly localized to the bone marrow. Our aim was to examine the growth- and survival-promoting role of the IGF-IR and its downstream signaling components in MM cells to identify potential targets for therapy. Octreotide, a somatostatin analog that has been demonstrated to interfere with the actions of IGF-I, induced growth inhibition in both IL-6-dependent and IL-6-independent MM cell lines expressing the somatostatin receptors sst2, sst3 and sst5. Additionally, a slight pro-apoptotic effect could be observed in a few cell lines. In primary MM cells octreotide induced apoptosis, an effect that was abrogated by exogenously added IGF-I, but not by IL-6. Inhibition of IGF-I signaling in Karpas 707 cells, using either the anti-IGF-IR antibody αIR3 or the PI 3-K inhibitors LY294002 and wortmannin, increased sensitivity to apoptosis induced by dexamethasone. Exogenously added IGF-I prevented dexamethasone-induced apoptosis, an effect that could partly be mimicked by the pharmacological GSK-3β inhibitors LiCl and SB415286. Thus, we suggest the GSK-3β as an important mediator of the anti-apoptotic effects of IGF-IR signaling in MM. Using rapamycin we selectively inhibited mTOR, a phosphoprotein downstream of the IGF-IR. In MM cell lines rapamycin induced G0/G1-arrest, an effect being associated with an increase of the cyclin-dependent kinase inhibitor p27 and a decrease of the cyclins D2, D3 and E. Interestingly, in primary MM cells rapamycin induced apoptosis. Moreover, rapamycin potentiated dexamethasone-induced apoptosis, an effect that was associated with a downregulation of the anti-apoptotic protein survivin. Strikingly, the combinatorial treatment with rapamycin and dexamethasone suppressed the anti-apoptotic effects of exogenously added IGF-I and IL-6, thus suggesting this drug-combination to be active also in vivo. Two newly developed, selective IGF-I RTK inhibitors proved to be very effective in MM cell lines and in primary MM cells providing 50-90% growth inhibition within 48 h of incubation. The inhibitors induced massive apoptosis together with a prominent cell cycle arrest in the G2/M-phase. Importantly, the IGF-I RTK inhibitors downregulated the tyrosine phosphorylation of the IGF-IR β-chain but not of the insulin receptor β-chain. In conclusion, the IGF-IR potently promotes growth and survival of MM cells. Therefore, interfering with the IGF-IR signaling pathway might be a suitable strategy to improve MM treatment.

Multiple myeloma (MM) is a virtually incurable B cell malignancy of the bone marrow. One important part of tumor progression and an obstacle for successful therapy is resistance to apoptosis. To combat this resistance, the mechanisms of apoptosis and survival in MM must be better defined. In this thesis, we identified Fas up-regulation as a mechanism underlying interferon (IFN)-mediated sensitization to Fas-induced apoptosis in the MM cell line U-266-1970. IFN treatment induced activation of signal transducer and activator of transcription (Stat)1 but, intriguingly, also attenuated activation of MM survival factor Stat3. Exploring the role of Stat1 further, we established sub-lines of U-266-1970 with a stable over-expression of Stat1 and of its active mutant Stat1C. These sub-lines displayed a decreased expression and activation of Stat3, and an altered expression of apoptosis-related genes Harakiri, Bcl-2 and Mcl-1. In a drug library screening, Stat1 over-expression was associated with an increased sensitivity to Fas-induced apoptosis and, conversely, an increased resistance to several drugs, including the cyclin dependent kinase (cdk)1 inhibitor CGP74514A. We conclude that Stat1 over-expression does not confer a general resistance or sensitivity to apoptosis in MM, but may strongly affect the response to some specific drugs. We also explored the effects of picropodophyllin (PPP), an inhibitor of the insulin-like growth factor I (IGF-I) receptor tyrosine kinase (RTK), in MM. PPP selectively inhibited the IGF-I RTK activity without inhibiting the insulin RTK activity. Furthermore, PPP potently induced cell cycle arrest and apoptosis in all MM cell lines and patient samples tested, also in the presence of survival factors IGF-I and IL-6. We conclude that PPP has great therapeutic potential in MM Finally, we examined the expression and regulation of the inhibitors of apoptosis proteins (IAPs) in a panel of MM cell lines and patient samples. The glucocorticoid dexamethasone, which is used in MM therapy, induced a transient up-regulation and a subsequent down-regulation of c-IAP2, as well as a down-regulation of XIAP, possibly influencing the sensitivity to apoptosis induced by this drug. Supporting this notion, abrogation of IGF-IR signaling by PPP, which sensitizes MM cells to dexamethasone-induced apoptosis, enhanced the down-regulation of c-IAP2 and XIAP.

Inhibiting therapeutically important protein-protein interactions has been a tremendous challenge for medicinal chemists. The folded 3D structures of peptides and proteins, mainly comprise secondary structural elements i.e α-helices and β-sheet have created an opportunity to design small molecules and peptidomimetic inhibitors of protein-protein interaction (PPI). Hence, information about the formation and stabilization of these secondary structures is vital for designing future drugs. In this dissertation, several cyclic beta-hairpin peptidomimetics that mimic the recognition surface have been designed and synthesized as inhibitors for different targets such as integrin mediated extracellular matrix -cell adhesion in multiple myeloma, p53-MDM2 PPI, amyloid beta fibrillogenesis inhibitor. Cyclization of linear peptides to restrict the number of conformations available to the linear peptide can increase its affinity for the target as well as increase its proteolytic resistance. In this study, different beta turn promoters that increase the propensity of cyclic peptides to adopt beta-sheet structures have been designed and synthesized. Chapter two discusses the design and synthesis of several cyclic III (Integrin Interaction Inhibitor) peptides that block adhesion of integrins to extracellular matrix components in Multiple Myeloma tumor cells. These cyclic peptides, as assayed by TOPRO 3 assay were more potent than the parent linear peptide with a bio-activity of 1.08 μM. We have also studied structure activity relationships (SAR) of these cyclic III peptide analogs to increase the potency and bioavailability of these peptides. Chapter three describes the application of cyclic beta-hairpin peptidomimetics to inhibit abeta fibrillogenesis that is responsible for Alzheimer’s disease. We have successfully designed and synthesized cyclic peptides that target the hydrophobic region (17-21) of abeta fibril which is believed to cause self aggregation and plaque formation. We have also successfully explored these cyclic beta-hairpin peptides to disrupt p53-MDM2 interactions. Chapter five discusses the design and synthesis of novel cysteine based Peptide Nucleic Acid (PNA) monomers that are aimed to increase cellular uptake by introducing positively charged species attached to the cysteine side chain. We have successfully synthesized CPNA monomers and made efforts to make PNA oligomers.

Η σεργλυκίνη (SG) είναι μια πρωτεογλυκάνη που εκφράζεται και εκκρίνεται από το σύνολο σχεδόν των αιμοποιητικών κυττάρων, ενώ αποτελεί την κύρια πρωτεογλυκάνη η οποία εκκρίνεται από τις κυτταρικές σειρές πολλαπλού μυελώματος (ΠΜ). Έχει βρεθεί ότι η SG συμμετέχει στη ρύθμιση πληθώρας παραγόντων που εμπλέκονται σε αντιδράσεις φλεγμονής. Τα αποτελέσματά μας δείχνουν ότι η SG που εκκρίνεται από τα μυελωματικά κύτταρα έχει την ικανότητα να αναστέλλει τόσο την κλασσική όσο και τη λεκτινική οδό του συστήματος του συμπληρώματος, ενώ δε φαίνεται να έχει καμία επίδραση στο εναλλακτικό μονοπάτι. Επιπρόσθετα η SG δεν έχει την ικανότητα να προκαλεί την ενεργοποίηση κάποιου από τα τρία μονοπάτια του συμπληρώματος. Βρέθηκε ότι η ανασταλτική δράση της SG εκδηλώνεται μέσω της αλληλεπίδρασής της με τους παράγοντες C1q και MBL. Οι γλυκοζαμινογλυκανικές (GAGs) αλυσίδες της SG είναι υπεύθυνες για τη δέσμευση με την κολλαγονούχα ουρά του παράγοντα C1q, ενώ στη δέσμευση με την MBL πρωτεΐνη πέρα από τη συμμετοχή των GAG αλυσίδων απαιτείται και ο πρωτεϊνικός κορμός της SG. Επιπλέον βρέθηκε ότι αλυσίδες CS-E ελαττώνουν την ικανότητα δέσμευσης της SG με τα μόρια C1q και MBL. Οι αλληλεπιδράσεις της SG με τον C1q και την MBL βρέθηκε ότι είναι ιοντικού χαρακτήρα και σε αντίθεση με τη δέσμευση της SG με την MBL, που εξαρτάται από την παρουσία των ιόντων Ca2+, η αλληλεπίδραση της SG με τον C1q είναι ανεξάρτητη των ιόντων αυτών. Αν και τα επίπεδα της SG στον ορό των ασθενών με ΠΜ εμφανίζονται αυξημένα σε σχέση με τους φυσιολογικούς μάρτυρες, δεν εντοπίστηκαν στατιστικά σημαντικές διαφορές στην δραστικότητα της κλασσικής και της εναλλακτικής οδού του συμπληρώματος στους ασθενείς με ΠΜ και στους φυσιολογικούς δότες. Ωστόσο ενδιαφέρον αποτελεί το γεγονός ότι στους ασθενείς με ΠΜ τα υψηλά επίπεδα SG στον ορό εμφάνισαν τάση συσχέτισης με ελαττωμένη δραστικότητα της κλασσικής οδού του συμπληρώματος. Επιπρόσθετα, η SG που εκκρίνεται απ τα μυελωματικά πλασματοκύτταρα έχει την ικανότητα να προστατεύει τα κύτταρα αυτά από την επίδραση του συμπληρώματος, μετά την ενεργοποίησή του με τη χρήση φαρμάκων. Φαίνεται ότι και η SG της μεμβράνης των μυελωματικών κυττάρων παρουσιάζει προστατευτική δράση έναντι του συμπληρώματος, μιας και κύτταρα που δεν εκφράζουν SG στην επιφάνειά τους είναι δύο με τρείς φορές περισσότερο ευαίσθητα στη δράση του συμπληρώματος, σε σχέση με κύτταρα που την εκφράζουν. Προτείνουμε ότι τόσο η εκκρινόμενη όσο και η δεσμευμένη στην κυτταρική επιφάνεια SG προστατεύουν τα μυελωματικά πλασματοκύτταρα κατά την ανοσοθεραπεία και συμβάλουν στην επιβίωσή τους. Στην παρούσα μελέτη δείξαμε ότι η SG αλληλεπιδρά με το κολλαγόνο τύπου Ι, την πιο άφθονη μορφή κολλαγόνου στο οστό. Επιπλέον βρέθηκε ότι η SG της κυτταρικής επιφάνειας συμμετέχει στην προσκόλληση των μυελωματικών κυττάρων στο κολλαγόνο τύπου Ι. Η αλληλεπίδραση αυτή φαίνεται ότι επάγει την έκφραση από τα μυελωματικά πλασματοκύτταρα των ΜΜΡ-2 και ΜΜΡ-9. Επιπρόσθετα, υπολογίστηκαν τα επίπεδα των ΜΜΡ-2 και ΜΜΡ-9 στον ορό και στο μυελό ασθενών με ΠΜ. Βρέθηκε ότι στον ορό των ασθενών με ΠΜ τα επίπεδα των δύο ενζύμων εμφανίζονται ελαττωμένα σε σχέση με τα φυσιολογικά δείγματα, ενώ αντίθετα στον μυελό των ασθενών η ΜΜΡ-2 βρέθηκε σημαντικά αυξημένη σε σχέση με τους φυσιολογικούς δότες. Καμία μεταβολή δεν παρατηρήθηκε στα επίπεδα της ΜΜΡ-9. Τέλος τα επίπεδα της ΜΜΡ-2 του μυελού ασθενών με ΠΜ βρέθηκε ότι σχετίζονται τόσο με τα επίπεδα του ενζύμου στον ορό, όσο και με τον δείκτη οστικής απορρόφησης ΝΤx, υποδηλώνοντας τη συμμετοχή της στην παθοβιοχημεία της οστικής νόσου που εμφανίζεται στο ΠΜ. Αντιθέτως καμία συσχέτιση δεν βρέθηκε για την ΜΜΡ-9, δηλώνοντας ότι ίσως το ένζυμο αυτό να εμπλέκεται σε άλλες διεργασίες που επιτελούνται στο ΠΜ. / Serglycin (SG) is a proteoglycan expressed by hematopoietic cells and is constitutively secreted by multiple myeloma (MM) cells. SG participates in the regulation of various inflammatory events. We found that SG secreted by human MM cell lines inhibits both the classical and lectin pathways of complement, without influencing alternative pathway activity. It was also shown that SG could not initiate any activation of the complement system. The inhibitory effect of SG is due to direct interactions with C1q and mannose binding lectin (MBL). C1q-binding is mediated through the glycosaminoglycan moieties of SG, whereas binding to MBL requires the presence of SG protein core. Interactions between SG and C1q as well as MBL are diminished in the presence of chondroitin sulfate type E. In addition, we localized the SGbinding site to the collagen-like stalk of C1q. Interactions between SG and C1q as well as MBL are ionic in character and only the interaction with MBL was found to be partially dependent on the presence of calcium. Although we found the serum levels of SG to be elevated in patients with MM compared to healthy controls, no statistical significant differences were observed for classical and alternative pathway activity in sera between MM patients and healthy donors. Despite that, it is proved that increase levels of SG show a tendency to correlate with decreased levels of classical pathway activity in serum of MM patients. Moreover, we found that SG expressed from myeloma plasma cells protects these cells from complement activation induced by treatment with anti-thymocyte immunoglobulins. It is also demonstrated that SG on the surface of MM cells inhibits complement deposition on the membrane of these cells. Cells which do not express SG on its’ surface are 2-3 times more sensitive to complement attack compared with cells expressing high levels of SG. This might protect myeloma cells during immunotherapy and promote survival of malignant plasma cells. Moreover, it is shown that SG from MM cells is capable to interact with collagen type I, the most abundant collagen in bone. Furthermore, SG is present on the surface of myeloma plasma cells and it is involved in the adhesion of MM cells to collagen type I in bone marrow microenvironment. In addition, it is shown that the interaction of myeloma plasma cells to collagen type I, mediated by cell surface SG, induces expression and secretion of both MMP-2 and MMP-9 from MM cells. Along the process, we have investigated levels of MMP-2 and MMP-9 in serum and marrow of patients with MM. Decreased levels of both MMP-2 and MMP- 9 in serum of MM patients have been observed compared to healthy donors. Instead, MMP-2 was found to be increased in bone marrow of MM patients compared to control samples, while no differences observed for MMP-9. Finally, marrow levels of MMP-2 seem to correlate with serum levels of the enzyme along with a marker of bone resorption, NTx. This might indicate the implication of MMP-2 in the pathogenesis of bone disease in MM. Even though, no correlation of MMP-9 with NTx was observed, proving that MMP-9 may play a significant role in different pathogenetic mechanism occurring in MM.

La réduction des inégalités d'accès aux soins a toujours été un axe majeur des politiques de lutte contre le cancer. Alors qu'il existe de nombreuses études en cancérologie solide, peu d'études avec une méthodologie correcte existent en onco-hématologie, notamment chez les patients atteints de Myélome Multiple (MM). Cette maladie a vu son pronostic transformé par l'arrivée de nouvelles thérapeutiques dont l'usage a été rapidement intégré dans les recommandations de la Société Française d'Hématologie. L'objectif de travail intitulé Parcours de Soins des patients atteints d'hémopathie maligne en Poitou Charentes était donc de décrire et d'analyser les écarts aux recommandations, en prenant le MM comme premier exemple. Grâce au registre des Cancers Poitou-Charentes et à l'exhaustivité des cas qu'il assure, notre travail a permis de déterminer des variables associées à une inégalité d'accès aux soins. Ces variables sont démographiques (âge, distance entre le domicile et l'hôpital), liées à la tumeur (maladie symptomatique ou non), mais aussi organisationnelles (niveau de l'hôpital, passage en réunion de concertation pluridisciplinaire). De plus nous avons pu montrer que ces inégalités avaient un impact sur la survie globale des patients, notamment chez les plus âgés. Notre travail se poursuit par une analyse plus fine de la survie globale et l'étude des longs survivants du Myélome Multiple. A plus long terme, nous souhaitons appliquer cette approche à d'autres hémopathies. / French national Cancer plans aimed to reduce health care inequalities. These inequalities are well known in solid cancers but few data with correct methodology exist in Hematology, especially in Multiple Myeloma (MM). The new treatments in this disease have dramatically improved Overall Survival. So guidelines of the Société Française d'Hématologie have quickly recommended the use of these new drugs. The aim of our work: Care Pathway of patients with hematological malignancies in Poitou Charentes area was to describe and analyze non compliance to guidelines. Based on the exhaustivity of the Poitou Charentes Cancer Registry, our work revealed variables associated with healthcare inequalities. They were demographical (age, distance between home and hospital), tumor-related (symptomatic MM or not) but also organizational (level of the hospital, multidisciplinary meeting). Moreover we showed that those inequalities had a negative impact on overall survival, especially in elderly people. Our work continues with more accurate analysis of overall survival and a study on MM long survivors. Longer-term studies would be to transfer this approach to other hemopathies.

Comme dans tout cancer, l'association entre myélome multiple et maladie thrombo-embolique veineuse est bien établie. Son incidence au cours du myélome est en moyenne de 10 à 20%. Elle semble plus élevée en cas de myélome de novo et lors de l’utilisation de traitements immunomodulateurs comme le thalidomide. Pourtant, la part de surcroît du risque de thrombose dû à ce traitement n’est pas encore très bien définie. Tout d’abord, nous avons réalisé un bilan de ces pathologies afin de délimiter le champ d’étude grâce à une revue de la littérature. Nous avons ensuite évalué l’incidence de la maladie thrombo-embolique veineuse, identifié les facteurs de risque thrombotique et évalué le classement en groupe de risque des patients présentant un myélome et traités par immunomodulateur grâce à une étude observationnelle, multicentrique, prospective, de la prise en charge des myélomes par les hématologues en France. Par la suite, nous avons réalisé l’analyse médico-économique du seul essai randomisé réalisé à ce jour sur la thrombophylaxie chez les malades présentant un myélome multiple traités par thalidomide en première ligne. Cette étude montre un gain de qualité de vie associé à des économies majeures lors de la prévention de la thrombose par aspirine plutôt que par héparine. Enfin nous avons réalisé 2 études médicales utilisant la génération de thrombine, test biologique de recherche. La première a été effectuée afin d’essayer de prédire les patients qui vont présenter une thrombose. La deuxième a pour but de rechercher l’existence d’une résistance à l’héparine aux doses habituelles utilisées dans cette pathologie / The association between multiple myeloma and venous thromboembolic disease is well established. This incidence in myeloma is on average from 10 to 20%. It appears to be higher in newly diagnosed myeloma and immunomodulatory drugs such as thalidomide might significantly increase the risk. However, the risk of thrombosis due to these treatments is not yet well defined. First, we performed a review of these diseases in order to delimit the field of this study through a literature review. Then, we evaluated the incidence of venous thromboembolic disease in patients with myeloma and treated with immunomodulatory, identified the thrombotic risk factors and evaluated the thrombotic risk assessment based on the physicians choice, through an observational, multicenter, prospective French study. Moreover, we performed the medico-economic analysis of the only randomized trial conducted to date on the thrombophylaxis in patients with multiple myeloma treated with thalidomide in the first line of chemotherapy. This analysis showed a gain in quality of life associated with significant cost savings in the prevention of thrombosis by aspirin rather than heparin. Finally we performed two medical studies using thrombin generation test, a global assay that measures the overall tendency of a plasma sample to form thrombin. The first study was conducted to predict patients who will have thrombosis. The second is performed to know if a heparin resistance with the usual doses in this pathology, exists

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23382号 / 医博第4751号 / 新制||医||1052(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 伊藤 貴浩, 教授 滝田 順子, 教授 江藤 浩之 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background Monoclonal Gammopathy of Undetermined Significance (MGUS) is an understudied precursor of multiple myeloma (MM), the second most prevalent hematologic malignancy in the United States. This dissertation was designed to: (1) Describe the trajectories of serum biomarkers over time in patients with an MGUS diagnosis, (2) Determine if an MGUS diagnosis is associated with changes in healthcare service utilization, and (3) explore the patient- and provider-level drivers of healthcare utilization in patients with MGUS. Methods Data sources include health claims and electronic health records from a community-based population of patients seeking care in central Massachusetts and primary qualitative data collected from providers and patients’ interviews. The analyses included descriptive statistics, group-based trajectory modeling, conditional Poisson regression, and qualitative data analyses. Results (1) Three distinct multi-trajectory groups of creatinine and hemoglobin were identified. (2) The rates of emergency room, hospital, and outpatient visits were higher for patients with MGUS than patients without MGUS. (3) Patients have a basic understanding of MGUS; however, some patients feel anxiety, which may affect other aspects of their lives. Patients primarily see hematologists for follow-up care; other providers have less knowledge about MGUS. Conclusions Biomarker trajectories characterize specific subpopulations of patients with MGUS over time. We found that an MGUS diagnosis is associated with higher healthcare utilization, especially during the months surrounding the diagnosis date. Finally, our study suggests that some patients with MGUS may need psychosocial support services and identifies a gap in knowledge around caring for MGUS patients among primary care providers.

La génération de plasmocytes (PC) à longue durée de vie sécrétant des anticorps hautement affins spécifiques de l’antigène, caractéristique de la réponse immune adaptative, est l’étape ultime de la différenciation des lymphocytes B au sein des centres germinatifs des organes lymphoïdes secondaires. La transition d’un lymphocyte B naïf vers un PC est associée au passage d’un programme transciptionnel des gènes de l’identité B vers l’expression des gènes de l’indentité plasmocytaire. Ce travail de thèse s’est concentré sur la caractérisation de cette étape terminale de la différenciation lymphocytaire B humaine tant au niveau transcriptomique qu’épigénétique. A l’aide d’un modèle de différenciation in vitro à partir de lymphocytes B naïfs humains, nous avons identifié les cellules engagées dans ce processus. Ces précurseurs des plasmablates sont notamment caractérisés par une répression de la voie de signalisation de l’IL-4 aboutissant à la perte du marqueur CD23, le récepteur de faible affinité à l’IgE mais aussi à l’apposition de 5hmC, l’hydroxyméthylcytosine, au niveau des gènes de l’identité PC. L’étude de cette marque épigénétique dans un contexte pathologique, le myélome multiple, a fait l’objet du second axe de recherche de notre projet et a révélé le rôle du gène FAM72D dans la prolifération cellulaire. / The generation of long-lived plasma cells (PCs) secreting protective, antigen-specific, high-affinity antibodies as a part of adaptative immunity, is the ultimate step of the terminal differentiation of B cells within germinal centers of secondary lymphoid organs. The transition of a naïve B cell into a PC is associated with the switch from a B cell identity programm to PC identity programm. The focus of this thesis project was to characterise the transcriptomic and épigenetic profile of cells commited to this ultimate step of the B cell differentiation. Thanks to an in vitro model of human naïve B cell differentiation into PCs, we identify cells commited to this process. These plasmablasts founder cells are caracterised by a downregulation of the IL-4 pathway leading to the loss of CD23, the low-affinity receptor for IgE, but also to the hydroxymethylation (5hmC apposition) of PC identity genes. The study of 5hmC in multiple myeloma samples was the subject of the second research axis of our project and revealed the role of FAM72D gene as a marker of cell proliferation.