La zone marginale de la rate apparaît comme un lieu stratégique de détection des antigènes et agents pathogènes véhiculés par le sang. Ces propriétés sont principalement liées à la présence de cellules appartenant au système immunitaire inné parmi lesquelles se trouvent des nombreuses cellules présentatrices d’antigènes (APC), comme les macrophages, les lymphocytes B de la zone marginale (MZB) ou encore les cellules dendritiques (DC). Ces cellules représentent une première ligne de défense contre les pathogènes véhiculés par le sang et sont importantes pour l’initiation des réponses immunes. Il a fortement était suggéré la localisation dans la zone marginale d’une autre population appartenant au système immunitaire inné : les lymphocytes T Natural Killer invariants ou iNKT. Ces lymphocytes T non conventionnels sont caractérisés par l’expression de marqueurs de cellules NK et de lymphocytes T conventionnels notamment le TCR. Contrairement aux lymphocytes T conventionnels, les iNKT reconnaissent des antigènes (Ag) lipidiques (d’origine exogène ou endogène) présentés par l’intermédiaire de la molécule CD1d exprimée à la surface des APC, notamment les DC. En réponse à ces lipides, et notamment l’α-galactosylceramide (α-GalCer), les cellules iNKT ont la capacité unique de sécréter rapidement de grandes quantités de cytokines immunomodulatrices comme l’IFN-γ et/ou l’IL-4 qui, en retour, permettent l’activation d’autres populations immunes telles que les DC, les cellules NK, les lymphocytes B et lymphocytes T conventionnels. Les DC, en tant qu’APC professionnelles, sont de puissantes cellules activatrices des lymphocytes T conventionnels mais également des iNKT. Cependant, bien que souvent souligné dans la littérature, le rôle des autres APC dans l’activation des lymphocytes T conventionnels mais surtout des iNKT restait relativement obscur lorsque ce travail de thèse a débuté. Parmi les APC, les MZB représentaient des cibles idéales puisqu’elles ont la particularité d’exprimer fortement les molécules de présentation telle que les molécules du CMH de classe II, la molécule CD1d mais aussi les molécules de co-stimulation. Nous avons donc débuté notre travail par l’étude du rôle des MZB dans l’activation des lymphocytes conventionnels et des iNKT. Nous montrons que les MZB sensibilisés avec un peptide de l’ovalbumine sont capables d’activer les lymphocytes T CD4+, dont la réponse est orientée vers un profil Th1 après l’activation des MZB par le CpG-ODN (agoniste du TLR-9). Ainsi, les MZB se comportent comme de véritables APC. Nous avons ensuite étudié l’activation des iNKT en réponse à lα’-GalCer. De façon surprenante, bien que les MZB expriment fortement la molécule CD1d, elles sont incapables d’activer in vitro les iNKT primaires en réponse l’α-GalCer libre. Elles sont cependant capables de présenter l’α-GalCer aux iNKT suggérant qu’il manque aux MZB des facteurs (solubles ou non) pour induire l’activation des iNKT. De façon intéressante, l’ajout de DC non sensibilisées restaure la production d’IFN-γ et d’IL-4 par les iNKT co-cultivés en présence de MZB sensibilisés avec l’α-GalCer. Nous montrons que les DC participent à cette activation via un mécanisme de présentation croisée mais également via l’apport de facteurs nécessaires aux MZB pour induire l’activation des iNKT. Il existe une réelle coopération entre ces deux types d’APC pour une activation optimale des iNKT. Finalement, nous montrons que les MZB sensibilisés avec l’α-GalCer induisent l’activation des lymphocytes iNKT et NK in vivo. Nous nous sommes ensuite concentrés sur les DC qui comme indiqué ci-dessus, sont des APC professionnelles. Cependant, dans la rate, les DC représentent une population très hétérogène dont le rôle de chaque sous-population notamment dans l’activation des iNKT était également très peu connu lorsque ce travail a débuté. / The spleen, with its highly specialized lymphoid compartments, plays a central role in clearing blood-borne pathogens. Innate immune cells, that are mainly present in the marginal zone of the spleen, are strategically located to respond to blood-borne microorganisms and viruses. Among innate cells, macrophages and marginal zone B (MZB) cells represent the first line of defense against blood-borne pathogens and with dendritic cells (DC) are important for initiation of the immune response. Along with these populations of antigen-presenting cells (APC), it was also suggested that invariant Natural Killer T (iNKT), a population of innate-like T lymphocytes, were also located in the marginal zone of the spleen. Unlike conventional T lymphocytes, iNKT cells recognize exogenous and self (glyco)lipid antigens (Ag) presented by the non-classical class I Ag presenting molecule CD1d expressed on APC, in particular DC. Upon lipid recognition, in particular in response to the non-mammalian glycolipid, α-galactosylceramide (α-GalCer), iNKT cells have the unique capacity to rapidly produce large amounts of immunoregulatory cytokines, including IFN-γ and IL-4, which lead to downstream activation of other immune populations (DC, NK cells, B cells and conventional T cells). Through this property, iNKT cells influence the strength and quality of the ensuing immune response. Dendritic cells, as professional APC, are potent activators of conventional T lymphocytes and iNKT cells. When we started our PhD, the role of APC other than DC in the priming of T lymphocytes including iNKT cells remained unclear. Among them, MZB cells represented good candidates since they express high levels of MHC class II and CD1d molecules and their ability to activate and orientate conventional and innate-like T lymphocytes, such as iNKT cells, were elusive. We show that MZB cells, when loaded OVA peptide promote the release of IFN-γ and IL-4 by antigen specific CD4+ T lymphocytes and their stimulation with CpG-ODN biases them toward more Th1 inducers. Surprisingly, although able to activate iNKT hybridomas, MZB cells sensitized with free α-GalCer do not directly activate ex vivo sorted iNKT cells unless DC are added to the culture system. Dendritic cells help MZB cells to promote iNKT cell activation in part through α-GalCer cross-presentation and also through DC-expressed co-factors. Interestingly, MZB cells amplify the DC-mediated activation of iNKT cells and depletion of MZB cells from total splenocytes strongly reduces iNKT cell activation in response to α-GalCer. Thus, DC and MZB cells provide help to each other to optimize iNKT cell stimulation. Finally, in vivo transfer of α-GalCer-loaded MZB cells potently activates iNKT and NK cells. Thus, we show for the first time a role of MZB cell in iNKT cell activation in response to free α-GalCer, an important finding to better understand the modalities of iNKT cell activation. As mentioned above, DC are professional APC and thus are strong activators of conventional and unconventional T lymphocytes. However, DC in the spleen represent an heterogeneous cell population and when we started our study, the role of DC subsets in T lymphocyte priming was still unclear. Among DC subsets, we concentrated on the major splenic DC subset located in the marginal zone, the CD8α- DC. This DC subset was further subdivided in CD4+ and CD4- subtypes. We provide evidences that CD4+ and CD4- DC are equally efficient at priming CD4+ T lymphocytes when loaded with OVA peptide and whole OVA, leading to a mixed Th1/Th2 response, and also CD8+ T lymphocytes when pulsed with OVA peptide (but not whole OVA).

La prolifération, la différenciation ainsi que les fonctions des cellules du système immunitaire sont contrôlées en partie par les cytokines. Lors de l’infection par le VIH-1, les défauts observés dans les fonctions, la maintenance, ainsi que la consistance des cellules du système immunitaire sont en large partie attribués à une production altérée des cytokines et à un manque d’efficacité au niveau de leurs effets biologiques. Durant ces études, nous nous sommes intéréssés à la régulation et aux fonctions de deux cytokines qui sont l’IL-18 et l’IL-21. Nous avons observé une corrélation inversée significative entre les concentrations sériques d’IL-18 et le nombre des cellules NK chez les patients infectés par le VIH-1. Nos expériences in vitro ont démontré que cette cytokine induit l’apoptose des cellules NK primaires et que cette mort peut être inhibée par des anticorps neutralisants spécifiques pour FasL et TNF-α. Cette mort cellulaire est due à l’expression de FasL sur les cellules NK et à la production de TNF-α par ces cellules. L’IL-18 augmente aussi la susceptibilité à la mort des cellules NK par un stimulus pro-apoptotique, en diminuant l’expression de la protéine anti-apoptotique Bcl-XL. Nous démontrons aussi que, contrairement à l’IL-18, les niveaux d’IL-18BP sont plus faibles dans les sérum de patients infectés. Ceci résulte sur une production non coordonnée de ces deux facteurs, aboutissant à des niveaux élevés d’IL-18 libre et biologiquement active chez les patients infectés. L’infection de macrophages in vitro induit la production d’IL-18 et réduit celle d’IL-18BP. De plus, l’IL-10 et le TGF-β, dont les concentrations sont élevées chez les patients infectés, réduisent la production d’IL-18BP par les macrophages in vitro. Finalement, nous démontrons que l’IL-18 augmente la réplication du VIH-1 dans les lymphocytes T CD4+ infectés. Les niveaux élevés d’IL-18 libres et biologiquement actives chez les patients infectés contribuent donc à l’immuno-pathogénèse induite par le VIH-1 en perturbant l’homéostasie des cellules NK ainsi qu’en augmentant la réplication du virus chez les patients. Ces études suggèrent donc la neutralisation des effets néfastes de l’IL-18 en utilisant son inhibiteur naturel soit de l’IL-18BP exogène. Ceci permettrait de moduler l’activité de l’IL-18 in vivo à des niveaux souhaitables. L’IL-21 joue un rôle clef dans le contrôle des infections virales chroniques. Lors de ces études, nous avons déterminé la dynamique de la production d’IL-21 lors de l’infection par le VIH-1 et sa conséquence sur la survie des cellules T CD4+ et la fréquence des cellules T CD8+ spécifiques au VIH-1. Nous avons démontré que sa production est compromise tôt au cours de l’infection et que les concentrations d’IL-21 corrèlent avec le compte de cellules T CD4+ chez les personnes infectées. Nos études ont démontré que le traitement antirétroviral restaure partiellement la production d’IL-21. De plus, l’infection par le VIH-1 de cellules T CD4+ humaines inhibe sa production en réduisant l’expression du facteur de transcription c-Maf. Nous avons aussi démontré que la fréquence des cellules T CD4+ spécifiques au VIH-1 qui produisent de l’IL-21 est réduite chez les patients virémiques. Selon nos résultats, l’IL-21 empêche l’apoptose spontanée des cellules T CD4+ de patients infectés et l’absence d’IL-21 réduit la fréquence des cellules T CD8+ spécifiques au VIH-1 chez ces patients. Nos résultats démontrent que l'IL-21R est exprimé de façon égale sur tous les sous-types de cellules NK chez les donneurs sains et chez les patients infectés. L’IL-21 active les protéines STAT-3, MAPK et Akt afin d'augmenter les fonctions effectrices des cellules NK. L'activation de STAT-3 joue un rôle clef dans ces fonctions avec ou sans un traitement avec de l'IL-21. L'IL-21 augmente l'expression des protéines anti-apoptotiques Bcl-2 et Bcl-XL, augmente la viabilité des cellules NK, mais ne possède aucun effet sur leur prolifération. Nous démontrons de plus que l'IL-21 augmente l'ADCC, les fonctions sécrétrices et cytotoxiques ainsi que la viabilité des cellules NK provenant de patients chroniquement infectés par le VIH-1. De plus, cette cytokine semble présenter ces effets sans augmenter en contrepartie la réplication du VIH-1. Elle permet donc d'inhiber la réplication virale lors de co-cultures autologues de cellules NK avec des cellules T CD4+ infectées d'une manière dépendante à l'expression de perforine et à l'utilisation de la protéine LFA-1. Les niveaux d’IL-21 pourraient donc servir de marqueurs biologiques pour accompagner les informations sur le taux de cellules T CD4+ circulantes en nous donnant des informations sur l’état de fonctionnalité de ce compartiment cellulaire. De plus, ces résultats suggèrent l’utilisation de cette cytokine en tant qu’agent immunothérapeutique pour restaurer les niveaux normaux d’IL-21 et augmenter la réponse antivirale chez les patients infectés par le VIH-1. / The proliferation, differentiation, function and maintenance of immune cells is controlled in large part by cytokines. HIV-induced dysfunctions of the antiviral immunity is in part related to defects in the cytokine network, as manifested by altered cytokine secretion and responsiveness to these cytokines. In these studies, we investigated the regulation and the functions of two cytokines, IL-18 and IL-21, during HIV-1 infection. In our studies, we observed an inverse correlation between IL-18 concentrations and absolute numbers of various subsets of NK cells in infected persons. IL-18 caused increased death of a human NK cell line, as well as of primary human NK cells in vitro. The IL-18-mediated cell death was dependent upon Fas-FasL interactions and TNF- secretion. IL-18 induced the expression of TNF-, induced the expression of FasL on NK cells, increased the transcription from the human FasL promoter, reduced the expression of Bcl-XL in NK cells, and increased their sensitivity to FasL-mediated cell death. In contrast to IL-18 levels, IL-18BP levels decreased in the serum of HIV-infected patients. This decrease resulted in enhanced levels of free IL-18 in the serum of such patients. The infection increased production of IL-18 but decreased that of IL-18BP in monocyte-derived macrophages (MDM). Furthermore, IL-10 and TGF-β, two cytokines for which concentrations are increased in HIV-infected persons, also decreased production of IL-18BP by human MDM. Finally, recombinant human IL-18 enhanced HIV-1 replication in human CD4+ T cells. The uncoordinated production of these two cytokines represents an imbalance between these two soluble factors in HIV-infected patients. Our study shows that enhanced IL-18 bioactivity in HIV-infected patients may contribute to the pathogenesis of AIDS by disrupting NK cell homoeostasis and increasing viral replication. This uncoordinated production of IL-18 and IL-18BP contribute to IL-18-induced immunopathology and pathogenesis in HIV-infected AIDS patients. Therefore, these studies suggest that the neutralization of IL-18 may represent an appropriate and useful immunotherapeutic strategy in these patients. It may delay AIDS progression and improve the immune status of infected persons. The best way to achieve this goal may be using exogenous interleukin-18 binding protein. IL-21 is a relatively newly discovered immune enhancing cytokine, which plays an essential role in controlling chronic viral infections. Therefore, we sought to determine the dynamics of the cytokine production and its potential consequences on the viability of CD4+ T cells in HIV-infected persons. We show here that the cytokine production is compromised early in the course of the infection. The serum cytokine concentrations correlated with CD4+ T cell counts in the infected persons. Among different groups of HIV-infected persons, only Elite Controllers maintain normal production of the cytokine. The HAART partially restores production of this cytokine. Interestingly, HIV-1 infection of human PBMC as well as of purified CD4+ T cells inhibits the production of the cytokine by decreasing the expression of c-Maf, a transcription factor involved in the activation of the cytokine gene, in the virus-infected cells but not in uninfected bystander cells. We also show that the frequencies of IL-21 producing HIV-specific antigen experienced CD4+ T cells are decreased in HIV-infected viremic patients. Furthermore, we show that recombinant human IL-21 acts as pro-survival factor and prevents enhanced spontaneous apoptosis of ex vivo cultured CD4+ T cells from HIV-infected patients and that increased serum levels of the cytokine are associated with higher frequencies as well as with better functions of HIV-specific CTL in HIV-infected individuals. We show that the cytokine receptors are expressed equally on all NK cell subsets. We demonstrate that the cytokine activates STAT-3, MAPK and Akt to enhance NK cell functions. IL-21 increases expression of anti-apoptotic proteins Bcl-2 and Bcl-XL, and enhances viability of NK cells, but has no effect on their proliferation. We further show that the cytokine enhances HIV-specific ADCC, secretory and cytotoxic functions as well as viability of NK cells from HIV-infected persons. Furthermore, it exerts its biological effects on NK cells with minimal enhancement of HIV-1 replication, and the cytokine-activated NK cells inhibit viral replication in co-cultured HIV-infected autologous CD4+ T cells in a perforin- and LFA-1-dependent manner. These studies suggest that serum IL-21 concentrations may serve as useful biomarker to accompany CD4+ T cell counts for monitoring HIV-1 disease progression and the fitness of the antiviral immunity. Furthermore, the cytokine may be considered for immunotherapy in HIV-infected patients in order to restore the physiological levels of the cytokine and promote their antiviral immunity.

Cytotoxiques en lysant différents types de cellules et régulent la réponse immunitaire. Leur rôle dans l’asthme et ses exacerbations reste encore à identifier même si des modifications phénotypiques ont été observées chez des patients asthmatiques et qu’il a été récemment montré dans un modèle murin qu’elles n’intervenaient pas dans le développement de l’asthme allergique. L’objectif de la thèse était de mieux comprendre la place des cellules NK dans la pathologie asthmatique en se focalisant sur deux aspects : l’exacerbation viro-induite et l’inhibition par des composants microbiens.L’hypothèse pour la 1ère partie de la thèse était que les cellules NK de patients asthmatiques pouvaient présenter une dysfonction dans leur réponse à des agents microbiens qui pourrait favoriser l’exacerbation de la réaction asthmatique. Pour cela, nous avons analysé l’activation, la cytotoxicité et la production de cytokines de cellules NK provenant de patients asthmatiques sévères stimulées avec des molécules mimant des microorganismes ou un rhinovirus vivant (HRV), en comparaison avec des donneurs sains. Nous avons montré que les cellules NK de patients sévères étaient moins cytotoxiques que les cellules NK de donneurs sains en réponse à la stimulation avec un agoniste de Toll-Like Receptor 3 ou du TLR7/8 et avec HRV. En outre, lorsqu’elles sont stimulées avec de l’IL-12 et de l’IL-15, des cytokines produites pendant l’infection virale, les cellules NK de patients asthmatiques sévères expriment moins d’IFN-γ que les cellules NK de donneurs sains. Nos résultats suggèrent que l’activation des cellules NK de patients asthmatiques pourrait être insuffisante pendant les infections respiratoires et pourraient participer à l’aggravation de l’asthme.L’hypothèse pour la 2ème partie de la thèse était que les cellules NK pourraient participer à l’inhibition de la réaction asthmatique allergique dans un modèle murin. Dans des souris C57BL/6 sensibilisées à l’ovalbumine, l’instillation de FSL1, un agoniste de TLR2/6 inhibe la réaction asthmatique allergique. Cette inhibition étant associée à des modifications de la population des cellules NK, nous avons analysé leur rôle grâce à des souris déficientes en cellules NK. En l’absence de cellules NK, les souris développent un asthme allergique, et l’inhibition par FSL1 est maintenue. Par conséquent, les cellules NK ne jouent pas de rôle dans le développement de l’asthme allergique expérimental, ni dans son inhibition induite par un agent microbien. Cependant, elles pourraient être modifiées par l’environnement allergique, et avoir ainsi un rôle dans les exacerbation viro-induites. Cette question cruciale rejoint le travail réalisé dans la première partie de la thèse.En conclusion, nos résultats suggèrent que les fonctions des cellules NK seraient modifiées dans la pathologie asthmatique, qu’elle soit allergique ou non. Notre hypothèse est que le défaut d’activation des cellules NK participerait aux exacerbations viro-induites de l’asthme. Les perspectives de ces travaux sont de poursuivre la caractérisation des cellules NK chez les patients asthmatiques sévères et d’évaluer le rôle des cellules NK dans un modèle murin d’exacerbation de la réaction asthmatique.L’hypothèse pour la première partie de la thèse était que les cellules NK de patients asthmatiques pouvaient présenter une dysfonction dans leur réponse à des agents microbiens qui pourrait favoriser l’exacerbation de la réaction asthmatique. Pour cela, nous avons analysé l’activation, la cytotoxicité et la production de cytokines de cellules NK provenant de patients asthmatiques sévères stimulées avec des molécules mimant des microorganismes ou un rhinovirus vivant (HRV), en comparaison avec des donneurs sains. Nous avons montré que les cellules NK de patients sévères étaient moins cytotoxiques que les cellules NK de donneurs sains en réponse à la stimulation avec un agoniste de Toll-Like Receptor 3 ou du TLR7/8 et avec HRV [...] / Asthma is a chronic inflammatory disease of the airways affecting 334 million of people worldwide. Among asthma patients, 5% suffers from severe asthma. Severe asthma represents a major unmet need because, despite heavy treatments, patients still suffer from uncontrolled asthma symptoms, frequent exacerbations and a dramatic decrease in their respiratory capacity. The role of microorganisms in asthma is complex. On one hand, a group of epidemiologic and experimental studies have shown that chronic exposure with bacteria or microbial compounds, particularly during early childhood, would provide protection against allergic asthma. On the other hand, respiratory viruses are responsible for 80% of exacerbations and are associated with an increasing risk of developing asthma in children, whether allergic or not. Natural Killer cells (NK) are lymphocytes involved in innate antiviral immunity. They have cytotoxic functions by lysing different types of cells but also regulatory functions by producing cytokines and activating other immune cells. Their role in asthma and its exacerbations has yet to be identified, although phenotypic changes have been observed in asthmatic patients and it has recently been shown in a mouse model that they are not involved in the development of allergic asthma. The objective of the thesis was to better understand the role of NK cells in asthmatic pathology by focusing on two aspects : virus-induced exacerbation and inhibition by microbial compounds.The hypothesis for the first part was that NK cells from asthma patients may present a dysfunction in their response to microbial agents that could promote the exacerbation of the asthmatic reaction. To do this, we analysed NK cell activation, cytotoxicity and production of cytokines from severe asthmatic patients stimulated with molecules mimicking microbes or a human rhinovirus (HRV), compared to healthy donors. We showed that NK cells from severe asthma patients were less cytotoxic than NK cells from healthy donors in response to stimulation with a Toll-like Receptor 3 or TLR7/8 agonist and HRV. Moreover, when stimulated with IL-12 and IL-15, cytokines produced during viral infections, NK cells from severe asthma patient express less IFN-γ than NK cells from healthy donors. Our results suggest that the activation of NK cells in asthma patients may be insufficient during respiratory infections and may contribute to the worsening of asthma.The hypothesis for the second part was that NK cells may participate to the inhibition of a mouse model of allergic asthma. In C57BL/6 mice sensitized with ovalbumin, instillation of FSL1, agonist of TLR2/6, inhibits the features of experimental asthma. Since this inhibition is associated with changes in the population of NK cells, we analysed their role using mice deficient in NK cells. In the absence of NK cells, mice develop allergic asthma, and inhibition by FSL1 is maintained. Therefore, NK cells do not play a role in the development of experimental allergic asthma or in its inhibition induced by a microbial agent. However, they may be modified by the allergic environment, and thus have a role in viro-induced exacerbations. This crucial question is in line with the work done in the first part of the thesis.In conclusion, our results suggest that the functions of NK cells may be modified in asthmatic pathology, whether allergic or not. Our hypothesis is that the defect in NK cell activation may participate to virus-induced asthma exacerbations. Perspectives of this work are to further characterize NK cells in severe asthma patients and to evaluate the role of NK cells in a mouse model of asthma exacerbation.

Embora a obesidade esteja associada à disfunção imune, com incidência aumentada de infecções e alguns tipos de cânceres, há poucos estudos que avaliaram parâmetros imunológicos em pacientes obesos graves. Além disso, há um número limitado de trabalhos analisando o efeito da perda de peso sobre parâmetros imunológicos na obesidade grave. Desta forma, o objetivo do presente trabalho foi avaliar a influência da perda de peso de pacientes com obesidade grau III submetidos à cirurgia de derivação gastrojejunal em Y de Roux (DGJYR) em parâmetros imunológicos. A produção de citocinas associadas com a resposta imune adquirida (IL-2, IL-4, IL-10 e IFN-) e inata (TNF- e IL-6) por células mononucleares de sangue periférico (PBMC), o perfil das populações de linfócitos e a atividade citotóxica de células natural killer (NK), além de citocinas associadas a sua função e desenvolvimento (IL-12 e IL-18), foram avaliados em vinte e oito pacientes não diabéticos, sedentários, com obesidade grau III (20 mulheres e 8 homens, com média de idade de 39,9 ± 10,9 anos e IMC de 49,5 ± 7,1kg/m2) no pré-operatório e 6 meses após a cirurgia. As PBMC foram estimuladas com o mitógeno fitohemaglutinina (PHA) e as citocinas produzidas foram quantificadas por ELISA. O perfil das populações de linfócitos foi avaliado por citometria de fluxo. A citotoxicidade mediada por células NK foi determinada pelo ensaio de liberação de LDH por células alvo K562. A perda de peso foi de 35,3 ± 4,5 kg, com uma significativa redução no IMC seis meses após a cirurgia (-12,9 ± 0,9 kg/m2, p< 0,001). Nenhuma das populações de linfócitos analisadas apresentou modificação no 6º mês após a cirurgia. Observou-se aumento significativo da proliferação de linfócitos seis meses após a cirurgia (p= 0,0026). Houve aumento pósoperatório nas concentrações de IFN-, IL-12 e IL-18 produzidas por PBMC após estímulo com PHA, enquanto a IL-2 apresentou uma tendência ao aumento (p= 0,07). As demais citocinas não apresentaram variação significativa. A atividade citotóxica das células NK aumentou seis meses após a cirurgia [17,1 ± 14,7% no pré vs 51,8 ± 11,3% 6 meses pósoperatório, na proporção 40:1 (célula NK:célula alvo); p< 0,001], mostrando recuperação quando se compara aos valores obtidos em indivíduos controle, pareados por idade e sexo, de peso normal [proporção 40:1 (célula NK:célula alvo) de 45,4 ± 7,8%]. Houve aumento de atividade citotóxica em todos os pontos da curva no pós-operatório em cerca de 79% da amostra (22 pacientes). Os resultados obtidos demonstram que a perda de peso induzida por DGJYR aumenta a produção de algumas citocinas relacionadas com a função das células NK e melhora a sua atividade citotóxica. As alterações na função de células NK e do nível de citocinas envolvidas com a atividade destas células podem explicar a propensão ao desenvolvimento de infecções e cânceres associados com a obesidade. Os dados obtidos neste estudo sugerem que a cirurgia bariátrica pode ter impacto positivo sobre estes fatores. / Although obesity is related to immune dysfunction, with a higher incidence of infections and some types of cancer, few studies have evaluated immunological parameters in severely obese patients. Moreover, a limited set of studies have analyzed the effect of weight loss in immunological parameters in severely obese patients. Thus, the objective of this thesis was to evaluate the influence of weight loss induced by Roux en-Y gastric bypass in patients with grade III obesity in immunological parameters. The production of cytokines associated with acquired (IL-2, IL-4, IL-10 and IFN-) and innate (TNF- e IL-6) immune responses from peripheral blood mononuclear cells (PBMCs), the profile of lymphocytes populations and the cytotoxic activity of natural killer cells (NK), besides cytokines related with NK cell cytotoxic function and development (IL-12 e IL-18), were analyzed in 28 non-diabetic and sedentary patients with grade III obesity (20 women and 8 men, 39,9 ± 10,9 years and BMI 49,5 ± 7,1 kg/m2) before and 6 months after RYGB. PBMCs were stimulated with the mitogen phytohemagglutinin (PHA) and cytokines were measure by ELISA. The profile of lymphocytes populations was evaluated by flow cytometry. NK cell cytotoxicity was determined by the lactate dehydrogenase release assay from K562 lysed target cells. The weight loss 6 months after surgery was 35.3±4.5 kg and there was a significant post-surgical decrease in BMI at this point (-12.9±0.9 kg/m2, p<0.001). No significant differences were found in the lymphocytes populations after surgery. It was observed a significant increase in the lymphocytes proliferation six months after surgery (p= 0.0026). There was also a post-surgical increase in the production of IFN-, IL-12 e IL-18 from PBMC stimulated with PHA, while there was a trend towards the increase of the IL-2 production (p=0.07). The other cytokines analyzed were not altered. Cytotoxic activity of NK cells was significantly enhanced 6 months after RYGB [17.1±14.7% before RYGB vs 51.8±11.3% at 6 months after, at effector to target cell (NK cell:K562 cell) ratio 40:1; p<0.001], and it was in the same range when compared to data obtained from controls with normal BMI matched for age and gender (45,4 ± 7,8% at NK cell:K562 cell ratio 40:1). There was a significant post-surgical improvement in all points of the cytotoxic activity curve in almost 79% of the sample (22 patients). In conclusion, the data obtained show that the weight loss induced by RYGB increases the production of cytokines related with NK cell cytotoxic function and improves its activity. The impairment in NK cells cytotoxic activity and cytokines observed in patients with severe obesity may explain their propensity to develop infections and cancer. Our data suggests that the weight loss induced by bariatric surgery can positively impact these factors.

Orientador: Erick da Cruz Castelli / Resumo: O gene KIR2DL4 codifica um importante receptor de células Natural Killer (NK). O único ligante de KIR2DL4 conhecido é a molécula HLA-G, expressa principalmente na placenta, modulando a ação das células NK durante a gestação. O gene KIR2DL4 parece ser bastante variável, quando considerado os bancos de dados que armazenam suas sequências conhecidas, porém não está claro o nível de diversidade deste gene em populações reais e heterogêneas. Polimorfismos presentes no gene KIR2DL4 poderiam influenciar a interação entre KIR2DL4 e HLA-G, modificando a ação das células NK. Neste estudo exploramos a variabilidade genética de KIR2DL4 em 157 indivíduos oriundos do Estado de São Paulo/Brasil. Devido à alta similaridade de sequências entre os genes KIR, erros de genotipagem são esperados quando se utiliza sequenciamento de segunda geração. Por este motivo, desenvolvemos uma abordagem para classificar cada leitura com base em sequências KIR conhecidas, endereçando-as ao gene mais provável. Também utilizamos o painel SNPforID 34-plex para avaliar a ancestralidade dessas amostras. Considerando o segmento completo desse gene, indo da região 5’URR até a 3’UTR, com aproximadamente 13kb, o gene KIR2DL4 se mostrou pouco polimórfico, com 152 pontos de variações identificados (MAF 1%). Esses pontos de variação estão organizados em 32 haplótipos estendidos que codificam 13 proteínas diferentes. Foram encontrados 11 haplótipos na região promotora, sendo que 8 possuem MAF maior que 1%. Na região codif... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: KIR2DL4 is the most unusual Killer Cell Immunoglobulin-Like receptor (KIR) family member in terms of structure, expression, and signaling properties. The only known KIR2DL4 ligand is HLA-G, and polymorphisms might disrupt this interaction. KIR2DL4 variability is not well explored in admixed populations. Here we explored KIR2DL4 exon variability in 157 individuals from the State of São Paulo/Brazil. Because of sequence similarity with other KIR genes, it is expected genotyping errors when using secondgeneration sequencing. We developed an approach to score each read based on known KIR sequences, addressing them to the most likely locus. We evaluated the SNPforID 34-plex panel to assess ancestry. The methodology was applied to survey the variability of a very admixed population, such as Brazilian, counting with 157 samples of São Paulo State. Considering a segment of about 13-kb, KIR2DL4 gene was conserved with few different and frequent sequences. Overall, 152 variable sites were detected, arranged in 32 haplotypes codifying 13 protein. We found 11 promoter haplotypes, 8 with a frequency greater than 1%. In the coding region we detected 70 haplotypes, four of which correspond to 50% of the coding sequences (KIR2DL4 * 0080204, * 008105, * 001, * 005). In the 3'UTR region, 14 haplotypes were identified with MAF greater than 1%. The KIR2DL4 coding region was the most variable segment. We observed that KIR2DL4 variability is strongly influenced by the sample ancestry background. K... (Complete abstract click electronic access below) / Mestre

A sepse é caracterizada por ser um processo inflamatório sistêmico devido a uma infecção, levando a lesão pulmonar aguda, síndrome do desconforto respiratório agudo e a falência múltipla dos orgãos. São achados histopatológicos da sepse: edema intersticial e alveolar, acúmulo de neutrófilos e macrófagos, hemorragia, lesão endotelial e do epitélio alveolar, e colapso alveolar. Acredita-se que a prolactina, hormônio produzido nas células lactotróficas da hipófise interfira no processo inflamatório, ora estimulando-o, ora inibindo-o. Além da relação direta com a lactação, este hormônio tem sido considerado um importante modulador do sistema imune, estimulando a proliferação e a sobrevivência celular. No presente estudo, buscou-se determinar os aspectos morfofuncionais do pulmão comprometido pela sepse induzida pela ligação e perfuração do ceco (CLP) em ratos com hiperprolactinemia induzida por sulpiride, um antagonista da dopamina. O presente estudo mostrou que os ratos pré-tratados com salina e submetidos a CLP, desenvolveram o padrão morfológico da sepse como por exemplo, aumento nas células inflamatórias com predomínio dos polimorfonucleares (neutrófilos), edema intersticial e colapso alveolar. Além disso, o presente estudo mostrou que a sepse induzida por CLP produziu diminuição da pressão arterial média bem como queda em alguns parâmetros ventilatórios como por exemplo, volume corrente e volume pulmonar em ratos não anestesiados. Interessante observação foi que grupos de ratos pré-tratados com sulpiride e submetidos a CLP apresentaram um maior comprometimento nos achados morfológicos bem como uma potencialização na queda do volume corrente durante a análise ventilatória. O presente estudo sugere que a hiperprolactinemia deve ser atentamente observada, pela estreita relação com o agravamento do processo inflamatório provocado por uma infecção pré-existente, que resultaria no aumento do número de óbitos em pacientes sépticos. / Sepsis is characterized as a systemic inflammatory process due to an infection, leading to acute lung injury, acute respiratory distress syndrome and multiple organs failure. Histopathological findings of sepsis are: interstitial and alveolar edema, accumulation of neutrophils and macrophages, hemorrhage, endothelial and alveolar epithelial injury and alveolar collapse. It is believed that prolactin, a hormone produced by pituitary lactotroph cells, interferes on the inflammatory process, sometimes stimulating it and sometimes inhibiting it. In addition to the direct relationship on lactation, this hormone has been observed to play important role on the modulation of the immune system, stimulating the cell proliferation and cell survival. In the present study, we sought to determine the morphofunctional aspects of compromised lung during sepsis induced by cecal ligation and perforation (CLP) in rats with hyperprolactinemia induced by sulpiride, a dopamine antagonist. The present study showed that pretreated rats with saline and subjected to CLP developed the morphogical pattern of sepsis such as increase in inflammatory cells with predominance of polymorphonuclear cells, interstitial edema and alveolar collapse. In addition, this study showed that sepsis induced by CLP produced a decrease in mean arterial pressure and decrease in ventilatory parameters such as tidal and pulmonary volume in unanesthetized rats. An interesting observation was that pretreated rats with sulpiride and subjected to CLP had a greater impairment in the morphological findings as well as an increase in the fall of the tidal volume during the ventilation analysis. The present study suggests that the hyperprolactinemia should be closely observed by a close relationship with the worsening of the inflammatory process caused by a pre-existing infection, which would result in increasing the number of deaths in septic patients.

Lytic effector function of Natural Killer (NK) cells and CD8+ T cells occurs through discrete and regulated cell biological steps triggered by recognition of diseased cells. Recent studies of the NK cell synapse support the idea that dynamic nanoscale rearrangements in cortical filamentous (F)-actin are a critical cell biological checkpoint for lytic granule access to NK cell membrane. Loss of function mutations in the LYST gene, a well-characterised cause of Chediak- Hegashi syndrome (CHS), result in the formation of giant lysosomal organelles including lytic granules. Here, we report a mismatch between the extent of cortical F-actin remodelling and enlarged lytic granules that limits the functionality of LYST- deficient NK cells in a human model of CHS. Using super-resolution stimulated emission depletion (STED) microscopy we found that LYST-deficient NK cells had nanoscale rearrangements in the organisation of cortical actin filaments that were indistinguishable from control cells- despite a 2.5-fold increase in the size of polarised granules. Importantly, treatment of LYST-deficient NK cells with actin depolymerising drugs increased the formation of small secretory domains at the synapse and restored their ability to lyse target cells. These data establish that sub-synaptic F-actin is the major factor limiting the release of enlarged lytic granules from CHS NK cells, and reveal a novel target for therapeutic interventions. While the importance of cortical actin filaments in NK cell cytotoxicity have been established, its persistence at the early stages of T cell synapse formation is disputed. We studied the organisation of cortical actin filaments in synapses formed by primary human T cells using STED microscopy and detected intact cortical actin filaments in key T cell effector subsets including memory CD8+ T cells as early as 5-minutes post-activation. Quantitative analysis revealed that activation specific rearrangements in cortical actin filaments at both CD4+ and CD8+ T cell synapses serve to increase the space between filaments. Additionally, comparison of cytolytic T cells with freshly isolated and IL-2 activated primary NK cells revealed that rapid maturation of the cortical actin meshwork is a specific feature of CD8+ T cell lytic synapses. Using chemical inhibition of actin nucleators, we show that increased cortical relaxation is mediated primarily by the activity of actin related proteins (Arp) -2/3. Taken together, these data establish the critical requirement for dynamic rearrangements in cortical actin filaments at lytic synapses but underscore cell-specific differences in its regulation.

Base teórica: A sepse é uma síndrome heterogênea, definida como disfunção orgânica que ameaça à vida, causada por uma resposta desregulada do hospedeiro à infecção. É um problema de saúde mundial, graças à sua alta prevalência, morbimortalidade associada, além de custos para seu tratamento. As células Natural Killer (NK) fazem parte do sistema imune inato reconhecendo moléculas de HLA de classe I em células alvo, através de seus receptores de membrana killer cell immunoglobulin-like receptors (KIR). A intensidade da resposta à infecção pode variar entre indivíduos, logo pode-se considerar que esta seja determinada por bases genéticas, e estas influenciem na ocorrência de sepse e variabilidade nos desfechos. Objetivos: Avaliar a associação entre os genes KIR e os ligantes HLA em pacientes críticos, comparando pacientes com sepse e controles não sépticos internados na mesma UTI. Métodos: Foi examinado o polimorfismo de 16 genes KIR e seus ligantes HLA em 271 pacientes críticos, caucasóides, sendo 211 pacientes com sepse e 60 controles, pela técnica de PCR-SSO e PCR-SSP, respectivamente. Resultados: Os genes ativadores KIR2DS1 e KIR3DS1 foram mais frequentes nos controles que nos pacientes com sepse (41,23% versus 55,00%, e 36,49% versus 51,67%; p = 0.041 e 0,025, respectivamente). Estes resultados fornecem informação inicial sobre o papel de polimorfismos de KIR na sepse, sugerindo que este possa ser um potencial marcador diagnóstico ou prognóstico da doença. / Background: Sepsis is a heterogeneous syndrome, defined a life-threatening organic dysfunction caused by a dysregulated host response to infection. Sepsis is a global health problem, due to its high prevalence, associated morbidity and mortality, and costs for its treatment. Cells Natural Killer (NK) cells are part of the innate immune system that recognize HLA class I molecules on target cells via membrane receptors called killer cell immunoglobulin-like receptors (KIR). The intensity of the response to an infection may vary among individuals and might be influenced genetic features affecting sepsis occurrence and variability in outcomes. Objectives: To evaluate the association between KIR genes and HLA ligands in critically ill patients, comparing patients with sepsis and without sepsis admitted to the same ICU. Methods: We examined the polymorphism of 16 KIR genes and their HLA ligands in 271 critically ill patients, Caucasians, and 211 patients with sepsis and 60 controls by PCR-SSO and PCR-SSP, respectively. Results: Activating KIR2DS1 and KIR3DS1 genes were more common in controls than in patients with sepsis (41.23% versus 55.00% and 36.49% versus 51.67%, p = 0.041 and 0.025, respectively). These results provide initial information on the role of polymorphism of KIR in sepsis, suggesting that this may be a potential diagnostic or prognostic marker of the disease.

OBJETIVOS: Avaliar o perfil e o número absoluto e percentual de células NK verdadeiras (CD56+CD16+CD3-) e de células NK e NKT (CD56+) no sangue periférico de uma coorte de pacientes com artrite reumatóide (AR) antes e durante o tratamento com rituximabe (RTX). MÉTODOS: Foram analisados dez pacientes do grupo controle (doadores de sangue) e dez pacientes com AR que receberam duas infusões de RTX 1g separadas por intervalo de 14 dias. As análises imunofenotípicas para avaliação do perfil e quantificação de células NK foram realizadas pré e após a infusão ou até a recaída clínica. Pacientes respondedores e não respondedores foram classificados de acordo com os critérios do Colégio Americano de Reumatologia (ACR) em 6 meses. RESULTADOS: A quantidade de células NK verdadeiras não demonstrou variação significativa pré e após o tratamento com RTX. Contudo, houve aumento percentual de células CD56+ entre o primeiro e o segundo mês após a infusão com RTX. Além disso, os pacientes respondedores apresentaram uma tendência de aumento do número absoluto de células NK verdadeiras após dois meses de tratamento. Já em relação ao grupo controle, observou-se um aumento significativo do número de células NK basais nos pacientes com AR (p<0,05). CONCLUSÕES: Foi identificada uma tendência de aumento nos valores absolutos de células NK verdadeiras entre os pacientes respondedores no segundo mês após a infusão com RTX. Não foi identificada uma variação significativa no perfil e quantidade de células NK nos pacientes com AR pré e após o tratamento com RTX. Contudo, foi observado que os pacientes com AR possuem uma quantidade maior de células NK do que os controles, sugerindo um possível envolvimento destas células na AR. / OBJECTIVES: To assess the profile as well as the absolute number and percentage of true NK cells (CD56+CD16+CD3-), and NK and NKT cells (CD56+) in the peripheral blood of a cohort of patients with rheumatoid arthritis (RA) before and during rituximab (RTX) therapy. METHODS: Ten control patients (blood donors) and ten patients with RA were assessed. The latter group received two intravenous infusions of 1g RTX, separated by a 14 day interval. Immunophenotypic analyses of NK cells were conducted before and after infusion, or until clinical relapse. After six months, respondents and nonrespondents were reassessed according to American Rheumatology Criteria (ARC). RESULTS: The number of true NK cells did not significantly change after treatment with RTX. However, an increase in the percentage of CD56+ cells was observed between the first and second month after RTX infusion. Respondents also displayed a tendency toward an increased number of true NK cells after two months of treatment. At baseline, the number of NK cells was also found to be significantly higher in patients with RA than in control individuals (p<0.05). CONCLUSIONS: Respondents displayed a tendency toward an increase in the absolute number of true NK cells in the second month after RTX infusion. No significant changes in the profile and frequency of NK cells were found between preand post-RTX treatment assessments of patients with RA. However, it was found that patients with RA have a higher number of NK cells than control partcipants, suggesting a possible role of these cells in RA.

The purpose of this study was to identify the effects of the neurotransmitter, serotonin (SE), on the immune function of peripheral blood mononuclear cells (PBMC) of normal, healthy subjects. This was done as a preliminary investigation to studies on the association of SE with immune changes in autistic subjects. The PBMC isolated from normal male subjects were treated with various concentrations of SE for 48 hrs. Their incubation in SE at a concentration of 10-3 M induced about a 35% decrease in DNA synthesis. However, incubation of the cells in lower concentrations (10-4 to 10-10) of SE produced no significant effect. The ability of natural killer (NK) cells to lyse K562 target cells was also examined after incubation with SE for 48 hrs. The NK activity was almost completely eliminated following incubation in 10-3M of SE, but the activity was not significantly decreased by exposure to lower concentrations of SE. The viability of PBMC was not altered following incubation with SE under identical conditions as those utilized in the NK assay. Preliminary analysis using a fluorescence-activated cell sorter (FACS) of monoclonal antibodies directed against Tll (total T cell), T4 (helper T cell), T8 (suppressor and cytotoxic T cells), B-cell and NK cell markers indicated that the suppressive effect exerted by SE could be attributed to a decrease in the density of these markers or receptors on the cell surface. These findings provide additional evidence for a possible link between neurotransmitters, specifically SE, and immune function.