The clinicopathological feature of primary cutaneous lymphomas according to WHO/EORTC classification and their relationship to EBV in Taiwan has never been reported. This retrospective study collected the patients with cutaneous lymphomas from 1990 and 2006. The morphology, EBER in situ hybridization and immunohistochemistry of primary cutaneous lymphomas were studied to reclassify based on the WHO/EORTC classification. A total of 54 patients were included. Twenty-nine were primary cutaneous lymphomas and 25 were secondary cutaneous lymphomas. The age ranged from 21 to 86 years old (mean 62 years old). Twenty-one (72.4%) were primary cutaneous T-cell and NK-cell lymphoma, including 5 extranodal NK/T-cell lymphoma, nasal type (17.2%), 5 primary cutaneous peripheral T-cell lymphoma, unspecified (17.2%), 4 mycosis fungoides (13.8%), 1 Sezary syndrome, 3 primary cutaneous anaplastic large cell lymphoma, 2 primary cutaneous small-medium CD4+ T-cell lymphoma and 1 subcutaneous panniculitis-like T-cell lymphoma. Eight cases were primary cutaneous B-cell lymphoma (27.6%) including 3 cutaneous marginal zone B-cell lymphoma (10.3%), 3 cutaneous follicle center B-cell lymphoma (10.3%), and 2 diffuse large B-cell lymphoma, leg type (6.9%). Seventeen cases were secondary cutaneous T-cell and NK -cell lymphoma. Eight cases were secondary cutaneous B-cell lymphoma. All primary and secondary extranodal NK/T-cell lymphoma, nasal type, were positive for EBER, however, one of them (10%) without both angiocentric growth pattern and necrosis in histomorphological examination. This is the first clinicopathological study of cutaneous lymphoma according to recent WHO/EORTC classification in Taiwan. In comparison with the Western countries, mycosis fungoides is less common whereas primary extranodal NK/T-cell lymphoma, nasal type, and peripheral T-cell lymphoma, unspecified, is more common in Taiwan. EBER in situ hybridization study is helpful in the diagnosis of extranodal NK/T-cell lymphoma, nasal type, especially in tumor without both angiocentric growth pattern and necrosis.

This thesis investigated the number and function of natural killer T-cells (NK T-cells) as a function of age, in coeliac disease, Crohn’s disease and ulcerative colitis. NK T-cells are a newly appreciated class of immune cells that are able to regulate the activity of the broader T-cell population. NK T-cells have been implicated in animal models of autoimmune disease and in human autoimmune disease. A subset of NK cells express the T-cell receptor (TCR) and are termed NK T-cells. In humans a further small subset of NK T-cells express an invariant TCR α chain (Vα24Jα18) and contain the immunoregulatory cell population that is distinguished from classical T-cells by promptly producing interleukin-4 (IL-4). Invariant NK T-cells (iNK T-cells) have the surface phenotype of Vα24+ Vβ11+ T-cells and express CD161+ NK markers. They are CD4+ (single positive; SP) or CD4- (double negative; DN), CD1d restricted and are α-galactosylceramide (α-GalCer) reactive. NKT cells have been implicated in numerous autoimmune disorders. Early work showed a major deficiency of NKT cell numbers in nonobese diabetic (NOD) mice, a well-established model of spontaneous, autoimmune T-cell mediated insulin-dependent diabetes. Both the number of NKT cells and function, as assessed by IL-4 release following TCR ligation, are dramatically reduced in NOD mice. NK T-cells have been implicated in other models of autoimmunity such as, experimental allergic encephalomyelitis (EAE). They have since been investigated and shown to be deficient in a number of human autoimmune diseases including, systemic sclerosis (SSc), and systemic lupus erythematosus (SLE), multiple sclerosis, atopic asthma, atopic dermatitis, rheumatoid arthritis, type 1 diabetes mellitus and scleroderma. The basis of the work presented within this thesis originated from the deficiency of NK T-cells in models of autoimmune diseases and human autoimmune diseases. The initial aim of this thesis was to investigate the phenotype and function of Vα24+ NK T-cells in normal healthy control subjects and with respect to age. The original aim was to investigate whether NK cells, T-cells, NK T-like cells and invariant NK T-cells (iNK T-cells) are deficient in coeliac disease, Crohn’s disease and/or ulcerative colitis. Blood was collected for flow cytometry from normal control subjects, subjects with coeliac disease, Crohn’s disease and ulcerative colitis. The number of circulating NK cells, T-cells, NK T-like cells and iNK T-cells was assessed by three-colour flow cytometry. Intracellular cytokine production was measured after in vitro anti-CD3/ anti-CD28 antibodies, gluten fraction 3 and PMA:ionomycin stimulation. Vα24+ T-cells were quantified in ileocolonic biopsies by immunofluorescence and as mRNA by relative and real-time PCR (RT-PCR). The number of circulating Vα24+ T-cells and iNK T-cells decrease with age in normal healthy control subjects. Cytokine production was also affected by age. The work of this thesis has identified a subpopulation of otherwise normal healthy individuals whom have normal numbers of circulating Vα24+ T-cells, reduced numbers of circulating Vα24+ Vβ11+ T-cells and consequently iNK Tcells. Circulating CD161+ NK cells, Vα24+ T-cells and the SP subset of Vα24+ Tcells were reduced in coeliac disease. The low numbers of circulating Vα24+ T-cells was independent of diet. The number of circulating Vα24+ Vβ11+ Tcells were reduced in coeliac disease, and as a consequence, the number of circulating Vα24+ Vβ11+ α-GalCer/CD1d tetramer+ and Vα24+ 6B11+ iNK T-cells were reduced. The deficiency of Vα24+ T-cells was not confined to the blood, but observed within the intestinal mucosa. Intestinal Vα24 mRNA expression from subjects with coeliac disease was reduced compared to levels in normal subjects as assessed by relative and RT-PCR. Thus, Vα24+ T-cells were deficient in coeliac disease both systemically and mucosally. Cytokine production by Vα24+ T-cells, 6B11+ and Vα24+ α-GalCer/CD1d tetramer+ iNK T-cells after 4 h in vitro anti-CD3 stimulation was also impaired in subjects with coeliac disease. Circulating CD56+, CD57+, CD94+, CD161+ NK cells were reduced in Crohn’s disease and ulcerative colitis. Vα24+ T-cells and the SP subset of Vα24+ T-cells were reduced in Crohn’s disease but not in ulcerative colitis. Circulating Vα24+ Vβ11+ T-cells, Vα24+ Vβ11+ α-GalCer/CD1d tetramer+ and Vα24+ 6B11+ iNK T-cells were deficient in both Cohn’s disease and ulcerative colitis. The deficiency of Vα24+ T-cells was also observed within the intestinal mucosa. Intestinal Vα24 mRNA expression from Crohn’s disease and ulcerative colitis was reduced compared to levels in normal subjects as assessed by relative and RT-PCR. Cytokine production by Vα24+ T-cells, 6B11+ and Vα24+ α-GalCer/CD1d tetramer+ iNK T-cells after 4 h in vitro anti-CD3 stimulation was impaired for subjects with Crohn’s disease and ulcerative colitis. In summary, Vα24+ T-cell number and function were affected by age. Further investigations are warranted to see if deficiency of this immunoregulatory population is associated with disease. The decrease and dysfunction in immunoregulatory cells, Vα24 T-cells and iNK T-cells could contribute to the pathogenesis of coeliac disease, Crohn’s disease and ulcerative colitis. Coeliac disease, Crohn’s disease and ulcerative colitis are polygenetic diseases in which environmental factors play a significant role in disease development and state. The reduced numbers of iNK T-cell along with their impaired function may only be two factors. Presumably, other factors are involved. Nevertheless, iNK T-cells offer a potential target for the therapeutic intervention of coeliac disease, ulcerative colitis and Crohn’s disease. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1345088 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2008

This thesis investigated the number and function of natural killer T-cells (NK T-cells) as a function of age, in coeliac disease, Crohn’s disease and ulcerative colitis. NK T-cells are a newly appreciated class of immune cells that are able to regulate the activity of the broader T-cell population. NK T-cells have been implicated in animal models of autoimmune disease and in human autoimmune disease. A subset of NK cells express the T-cell receptor (TCR) and are termed NK T-cells. In humans a further small subset of NK T-cells express an invariant TCR α chain (Vα24Jα18) and contain the immunoregulatory cell population that is distinguished from classical T-cells by promptly producing interleukin-4 (IL-4). Invariant NK T-cells (iNK T-cells) have the surface phenotype of Vα24+ Vβ11+ T-cells and express CD161+ NK markers. They are CD4+ (single positive; SP) or CD4- (double negative; DN), CD1d restricted and are α-galactosylceramide (α-GalCer) reactive. NKT cells have been implicated in numerous autoimmune disorders. Early work showed a major deficiency of NKT cell numbers in nonobese diabetic (NOD) mice, a well-established model of spontaneous, autoimmune T-cell mediated insulin-dependent diabetes. Both the number of NKT cells and function, as assessed by IL-4 release following TCR ligation, are dramatically reduced in NOD mice. NK T-cells have been implicated in other models of autoimmunity such as, experimental allergic encephalomyelitis (EAE). They have since been investigated and shown to be deficient in a number of human autoimmune diseases including, systemic sclerosis (SSc), and systemic lupus erythematosus (SLE), multiple sclerosis, atopic asthma, atopic dermatitis, rheumatoid arthritis, type 1 diabetes mellitus and scleroderma. The basis of the work presented within this thesis originated from the deficiency of NK T-cells in models of autoimmune diseases and human autoimmune diseases. The initial aim of this thesis was to investigate the phenotype and function of Vα24+ NK T-cells in normal healthy control subjects and with respect to age. The original aim was to investigate whether NK cells, T-cells, NK T-like cells and invariant NK T-cells (iNK T-cells) are deficient in coeliac disease, Crohn’s disease and/or ulcerative colitis. Blood was collected for flow cytometry from normal control subjects, subjects with coeliac disease, Crohn’s disease and ulcerative colitis. The number of circulating NK cells, T-cells, NK T-like cells and iNK T-cells was assessed by three-colour flow cytometry. Intracellular cytokine production was measured after in vitro anti-CD3/ anti-CD28 antibodies, gluten fraction 3 and PMA:ionomycin stimulation. Vα24+ T-cells were quantified in ileocolonic biopsies by immunofluorescence and as mRNA by relative and real-time PCR (RT-PCR). The number of circulating Vα24+ T-cells and iNK T-cells decrease with age in normal healthy control subjects. Cytokine production was also affected by age. The work of this thesis has identified a subpopulation of otherwise normal healthy individuals whom have normal numbers of circulating Vα24+ T-cells, reduced numbers of circulating Vα24+ Vβ11+ T-cells and consequently iNK Tcells. Circulating CD161+ NK cells, Vα24+ T-cells and the SP subset of Vα24+ Tcells were reduced in coeliac disease. The low numbers of circulating Vα24+ T-cells was independent of diet. The number of circulating Vα24+ Vβ11+ Tcells were reduced in coeliac disease, and as a consequence, the number of circulating Vα24+ Vβ11+ α-GalCer/CD1d tetramer+ and Vα24+ 6B11+ iNK T-cells were reduced. The deficiency of Vα24+ T-cells was not confined to the blood, but observed within the intestinal mucosa. Intestinal Vα24 mRNA expression from subjects with coeliac disease was reduced compared to levels in normal subjects as assessed by relative and RT-PCR. Thus, Vα24+ T-cells were deficient in coeliac disease both systemically and mucosally. Cytokine production by Vα24+ T-cells, 6B11+ and Vα24+ α-GalCer/CD1d tetramer+ iNK T-cells after 4 h in vitro anti-CD3 stimulation was also impaired in subjects with coeliac disease. Circulating CD56+, CD57+, CD94+, CD161+ NK cells were reduced in Crohn’s disease and ulcerative colitis. Vα24+ T-cells and the SP subset of Vα24+ T-cells were reduced in Crohn’s disease but not in ulcerative colitis. Circulating Vα24+ Vβ11+ T-cells, Vα24+ Vβ11+ α-GalCer/CD1d tetramer+ and Vα24+ 6B11+ iNK T-cells were deficient in both Cohn’s disease and ulcerative colitis. The deficiency of Vα24+ T-cells was also observed within the intestinal mucosa. Intestinal Vα24 mRNA expression from Crohn’s disease and ulcerative colitis was reduced compared to levels in normal subjects as assessed by relative and RT-PCR. Cytokine production by Vα24+ T-cells, 6B11+ and Vα24+ α-GalCer/CD1d tetramer+ iNK T-cells after 4 h in vitro anti-CD3 stimulation was impaired for subjects with Crohn’s disease and ulcerative colitis. In summary, Vα24+ T-cell number and function were affected by age. Further investigations are warranted to see if deficiency of this immunoregulatory population is associated with disease. The decrease and dysfunction in immunoregulatory cells, Vα24 T-cells and iNK T-cells could contribute to the pathogenesis of coeliac disease, Crohn’s disease and ulcerative colitis. Coeliac disease, Crohn’s disease and ulcerative colitis are polygenetic diseases in which environmental factors play a significant role in disease development and state. The reduced numbers of iNK T-cell along with their impaired function may only be two factors. Presumably, other factors are involved. Nevertheless, iNK T-cells offer a potential target for the therapeutic intervention of coeliac disease, ulcerative colitis and Crohn’s disease. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1345088 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2008

No description available.

Le virus de l’hépatite murine de type 3 (MHV3) est un excellent modèle animal pour l’étude des différents désordres immunologiques lors d’infections virales. L’hépatite aiguë fulminante induite par ce virus chez la souris susceptible C57BL/6 se caractérise par la présence de plusieurs foyers nécrotiques et inflammatoires dans le foie associée à une immunodéficience en lymphocytes B et T, tuant les souris entre 3 et 5 jours post-infection. L’évolution rapide de cette maladie virale suggère un débalancement dans les mécanismes de l’immunité naturelle sous le contrôle des cellules NK et NK-T et un bris de l’équilibre entre la tolérance hépatique et la réponse inflammatoire. Afin d’élucider les rôles respectifs des différents mécanismes de la défense innée impliqués dans le développement de l’hépatite aiguë, des infections in vivo ont été réalisées chez des souris C57BL/6 avec la souche pathogène L2-MHV3 ou avec des variants du virus MHV3. Ces derniers possèdent des tropismes différents pour les cellules endothéliales sinusoïdales hépatiques et les cellules de Kupffer, tels que les virus faiblement atténué 51.6-MHV3, fortement atténué CL12-MHV3 et non pathogène YAC-MHV3. Ces études in vivo ont montré une diminution des cellules NK spléniques et myéloïdes suite à une infection avec le virus MHV3. Cette chute en cellules NK spléniques reflète un recrutement de ces cellules au niveau du foie. Par contre, les cellules NK se sont avérées permissives à la réplication virale entraînant un processus d’apoptose suite à la formation de syncétia induits par le virus. Les niveaux de recrutement et d’apoptose des cellules NK et NK-T dans le foie reflètent la pathogénicité des variants MHV3 durant les trois premiers jours de l’infection virale bien que les cellules NK recrutées au niveau du foie maintiennent leur activité cytotoxique. L’ajout des IL-12 et IL-18, qui sont normalement diminués lors de l’hépatite aiguë, provoque une production synergique d’IFN-g par les cellules NK, résultant d’une interaction entre l’activation de la voie p38 MAPK et la réplication virale. Par ailleurs, le récepteur viral CEACAM1a (carcinoembryonic antigen cell adhesion molecule 1a) serait essentiel à cette synergie, mais exercerait aussi une action inhibitrice dans la production de l’IFN-g. D’autre part, les niveaux de production des cytokines immunosuppressives IL-10, TGF-b et PGE2, impliquées dans la tolérance hépatique et particulièrement produites par les cellules de Kupffer et les cellules endothéliales sinusoïdales, sont en relation inverse avec le degré de pathogénicité des variants du virus MHV3. Finalement, le virus pathogène L2-MHV3 déclenche la production de cytokines inflammatoires par les macrophages, tels que l’IL-6 et le TNF-a. L’induction de ces cytokines par les macrophages serait indépendante de la présence de la molécule CEACAM1a. Cette stimulation est plutôt reliée à la fixation des particules virales sur des récepteurs TLR2, en association avec les régions riches en héparanes sulfates. Tous ces résultats mettent en évidence de nouveaux mécanismes par lesquels le virus MHV3 peut diminuer l’efficacité des mécanismes de l’immunité naturelle sous le contrôle des cellules NK et NK-T intrahépatiques, suite à une stimulation de l’inflammation résultant du bris de la tolérance hépatique. / Mouse hepatitis virus type 3 (MHV3) is an excellent model to study immunological disorders related to viral infections. The fulminant acute hepatitis induced in susceptible C57BL/6 mice is characterized by the presence of necrotic and inflammatory foci in the liver associated with B and T cell immunodeficiencies leading to the death of the animals in 3 to 5 days post-infection. The fulminance of this viral infection suggests a deficiency in the natural immunity mechanisms under control of NK and NK-T cells and an imbalance between the hepatic tolerance and the inflammatory responses. To understand the different mechanisms involved in the acute hepatitis, in vivo infections have been done in C57BL/6 mice with either the pathogenic L2-MHV3, or with its attenuated variants: the weak attenuated 51.6-MHV3, the highly attenuated CL12-MHV3 or the non-pathogenic YAC-MHV3 viruses, possessing different tropisms for liver sinusoidal endothelial cells and Kupffer cells. The results demonstrate that splenic and myeloid NK cells are impaired during a MHV3 infection. This impairment is due to a recruitment of these cells in the liver and a virus-induced apoptotic phenomenon. The recruitment and the subsequent apoptosis of NK and NK-T cells during the first three days of infection are in relation with the pathogenicity of the MHV3 variants. In spite of the fact that hepatic recruited NK cells are still cytotoxic, these cells undergo apoptosis due to viral replication via the formation of syncytia. Addition of IL-12 and IL-18, which are impaired during the acute hepatitis, promote a synergistic IFN-g production by NK cells depending of both the p38 MAPK pathway and the viral replication. Moreover, the specific viral receptor CEACAM1a (carcinoembryonic antigen cell adhesion molecule 1a) is essential for this response but also exerts an inhibitory action. Levels of the immunosuppressive cytokines IL-10, TGF-b and PGE2, mainly produced by Kupffer cells and sinusoidal endothelial cells, and implicated in the natural hepatic tolerance, are in inverse correlation with the pathogenicity of the MHV3 variants. Finally, viral infection promotes the secretion of IL-6 and TNF-a by macrophages, triggered by the fixation of viral particules to TLR2 and heparan sulfate receptors rather than the engagement of CEACAM1a receptor and viral replication. In conclusion, our results suggest new mechanisms by which the MHV3 virus disturbs the innate immunity under control of NK and NK-T cells, as well as the cytokines involved in the hepatic tolerance to the detriment of the inflammatory response.

Le virus de l’hépatite murine de type 3 (MHV3) est un excellent modèle animal pour l’étude des différents désordres immunologiques lors d’infections virales. L’hépatite aiguë fulminante induite par ce virus chez la souris susceptible C57BL/6 se caractérise par la présence de plusieurs foyers nécrotiques et inflammatoires dans le foie associée à une immunodéficience en lymphocytes B et T, tuant les souris entre 3 et 5 jours post-infection. L’évolution rapide de cette maladie virale suggère un débalancement dans les mécanismes de l’immunité naturelle sous le contrôle des cellules NK et NK-T et un bris de l’équilibre entre la tolérance hépatique et la réponse inflammatoire. Afin d’élucider les rôles respectifs des différents mécanismes de la défense innée impliqués dans le développement de l’hépatite aiguë, des infections in vivo ont été réalisées chez des souris C57BL/6 avec la souche pathogène L2-MHV3 ou avec des variants du virus MHV3. Ces derniers possèdent des tropismes différents pour les cellules endothéliales sinusoïdales hépatiques et les cellules de Kupffer, tels que les virus faiblement atténué 51.6-MHV3, fortement atténué CL12-MHV3 et non pathogène YAC-MHV3. Ces études in vivo ont montré une diminution des cellules NK spléniques et myéloïdes suite à une infection avec le virus MHV3. Cette chute en cellules NK spléniques reflète un recrutement de ces cellules au niveau du foie. Par contre, les cellules NK se sont avérées permissives à la réplication virale entraînant un processus d’apoptose suite à la formation de syncétia induits par le virus. Les niveaux de recrutement et d’apoptose des cellules NK et NK-T dans le foie reflètent la pathogénicité des variants MHV3 durant les trois premiers jours de l’infection virale bien que les cellules NK recrutées au niveau du foie maintiennent leur activité cytotoxique. L’ajout des IL-12 et IL-18, qui sont normalement diminués lors de l’hépatite aiguë, provoque une production synergique d’IFN-g par les cellules NK, résultant d’une interaction entre l’activation de la voie p38 MAPK et la réplication virale. Par ailleurs, le récepteur viral CEACAM1a (carcinoembryonic antigen cell adhesion molecule 1a) serait essentiel à cette synergie, mais exercerait aussi une action inhibitrice dans la production de l’IFN-g. D’autre part, les niveaux de production des cytokines immunosuppressives IL-10, TGF-b et PGE2, impliquées dans la tolérance hépatique et particulièrement produites par les cellules de Kupffer et les cellules endothéliales sinusoïdales, sont en relation inverse avec le degré de pathogénicité des variants du virus MHV3. Finalement, le virus pathogène L2-MHV3 déclenche la production de cytokines inflammatoires par les macrophages, tels que l’IL-6 et le TNF-a. L’induction de ces cytokines par les macrophages serait indépendante de la présence de la molécule CEACAM1a. Cette stimulation est plutôt reliée à la fixation des particules virales sur des récepteurs TLR2, en association avec les régions riches en héparanes sulfates. Tous ces résultats mettent en évidence de nouveaux mécanismes par lesquels le virus MHV3 peut diminuer l’efficacité des mécanismes de l’immunité naturelle sous le contrôle des cellules NK et NK-T intrahépatiques, suite à une stimulation de l’inflammation résultant du bris de la tolérance hépatique. / Mouse hepatitis virus type 3 (MHV3) is an excellent model to study immunological disorders related to viral infections. The fulminant acute hepatitis induced in susceptible C57BL/6 mice is characterized by the presence of necrotic and inflammatory foci in the liver associated with B and T cell immunodeficiencies leading to the death of the animals in 3 to 5 days post-infection. The fulminance of this viral infection suggests a deficiency in the natural immunity mechanisms under control of NK and NK-T cells and an imbalance between the hepatic tolerance and the inflammatory responses. To understand the different mechanisms involved in the acute hepatitis, in vivo infections have been done in C57BL/6 mice with either the pathogenic L2-MHV3, or with its attenuated variants: the weak attenuated 51.6-MHV3, the highly attenuated CL12-MHV3 or the non-pathogenic YAC-MHV3 viruses, possessing different tropisms for liver sinusoidal endothelial cells and Kupffer cells. The results demonstrate that splenic and myeloid NK cells are impaired during a MHV3 infection. This impairment is due to a recruitment of these cells in the liver and a virus-induced apoptotic phenomenon. The recruitment and the subsequent apoptosis of NK and NK-T cells during the first three days of infection are in relation with the pathogenicity of the MHV3 variants. In spite of the fact that hepatic recruited NK cells are still cytotoxic, these cells undergo apoptosis due to viral replication via the formation of syncytia. Addition of IL-12 and IL-18, which are impaired during the acute hepatitis, promote a synergistic IFN-g production by NK cells depending of both the p38 MAPK pathway and the viral replication. Moreover, the specific viral receptor CEACAM1a (carcinoembryonic antigen cell adhesion molecule 1a) is essential for this response but also exerts an inhibitory action. Levels of the immunosuppressive cytokines IL-10, TGF-b and PGE2, mainly produced by Kupffer cells and sinusoidal endothelial cells, and implicated in the natural hepatic tolerance, are in inverse correlation with the pathogenicity of the MHV3 variants. Finally, viral infection promotes the secretion of IL-6 and TNF-a by macrophages, triggered by the fixation of viral particules to TLR2 and heparan sulfate receptors rather than the engagement of CEACAM1a receptor and viral replication. In conclusion, our results suggest new mechanisms by which the MHV3 virus disturbs the innate immunity under control of NK and NK-T cells, as well as the cytokines involved in the hepatic tolerance to the detriment of the inflammatory response.