Une infiltration médullaire par des cellules plasmocytoïdes CD123+ est présente chez certains patients atteints de leucémie myélomonocytaire chronique (LMMC), mais les mécanismes aboutissant à la génération de ces cellules, et leur impact sur l'évolution de la maladie n'ont jamais été explorés. En cytométrie en flux, nous avons détecté un excès de cellules mononucléées négatives pour les marqueurs de lignée lymphocytaires, monocytaires et granulocytaires, et exprimant CD123, HLA-DR, BDCA-2, BDCA-4 et CD4 dans la moelle de 39/161 patients(24%) . L'analyse de ces cellules en microscopie conventionnelle et électronique, en cytométrie en flux et leur analyse transcriptomique identifient ces cellules comme d'authentiques cellules dendritiques plasmocytoïdes (pDCs). Ces pDCs répondent à la stimulation par des agonistes de Toll-like receptor 9 (TLR9) et de TLR7 en produisant respectivement de faibles quantités d'interféron alpha et de grandes quantités d'interleukine 8. Le séquençage d'exome complet de monocytes et de pDCs triés détecte une ou plusieurs mutations qui activent constitutivement la voie Ras chez tous les patients riches en pDCs, avec un certain niveau d'hétérogénéité sous-clonale. Les cellules CD34+ de patients LMMC riches en pDCs génèrent de grandes quantités de pDCs en culture ex vivo, y compris en l'absence de FMS-like tyrosine kinase 3-ligand (Flt3-L). Dans des expériences de coculture, les pDCs extraites de moelles de LMMC riches en pDC diminuent la prolifération des cellules CD34+ de manière dose-dépendante. L'augmentation des pDCs est associée à une expansion des lymphocytes T régulateurs (Tregs). L'analyse rétrospective d'une cohorte de 212 patients atteints de LMMC a montré un effet mitigé de l'infiltration médullaire par des cellules CD123+ TCL1+ sur la survie, avec une tendance à une meilleure survie globale chez les patients riches en pDCs, mais également un risque accru de transformation en leucémie aigüe. / Bone marrow infiltration with plasmacytoid CD123high cells was identified in a fraction of patients with a chronic myelomonocytic leukemia (CMML), but the mechanisms promoting the generation of these cells and their impact on disease evolution remain poorly known. Using a multiparametric flow cytometry assay, we detect an excess of lineage-negative mononucleated cells expressing CD45, CD123, HLA-DR, BDCA-2, BDCA-4 and CD4 in the bone marrow of 39/161 (24%) CMML patients. Conventional and electron microscopy, flow cytometry and gene expression analyses identify these cells as authentic plasmacytoid dendritic cells (pDCs). These pDCs respond to Toll-like receptor-9 (TLR9) and TLR7 agonists by producing low levels of interferon alpha and high levels of interleukin-8 (IL-8), respectively. Whole exome sequencing of sorted monocytes and pDCs detects one or several mutations that constitutively activate the Ras pathway in every pDC-rich patient, with some subclonal heterogeneity. CD34+ cells from pDC-rich CMML produce high level of pDCs in ex vivo culture, even in the absence of FMS-like tyrosine kinase 3 ligand (FLT-3L). In co-culture experiments, pDCs collected from the bone marrow of pDC-rich CMML decrease the proliferation of CD34+ cells in a dose-dependent manner. pDC increase is associated with an expansion of CD4+ regulatory T cells (Tregs). Retrospective analysis of a cohort of 216 CMML patients detected a mitigated effect of bone marrow infiltration with CD123high, TLC1+ cells on disease outcome, including a trend for a better overall survival of patients with a pDC excess but also an increased risk of leukemic transformation.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive, rare malignancy. Exact incidence is unknown due to lack of diagnostic criteria. Typically, it involves skin and bone marrow and less likely, lymph nodes and visceral organs. We present a 76 year old male who started having a lesion on the left side of his back that was progressively enlarging. He initially started on antibiotic and topical medications for more than a month which did not help. Punch biopsy of the lesion was consistent with blastic plasmacytoid dendritic cell neoplasm, positive for CD2, CD5, CD7, CD43, weak CD58,Tdt, bcl-6. Patient denies fever, chills, night sweats, weight loss, change in appetite. Physical exam revealed a purplish lesion raised in the left upper back with multiple satellite-like purple lesions throughout the back. Laboratory showed white cell count 3.2 K/uL, hemoglobin 13 g/dL, platelet 135 K/uL. Bone marrow biopsy shows immature blastic neoplasm involving 15% of the bone marrow. Cytogenetics showed normal karyotype. Flow cytometry shows an immature lymphoid population with expression of CD4, CD56, and CD 123, negative for FLT3, IDH1, IDH2, NPM1 mutations. Positron emission tomography (PET) scan showed skin thickening with minimal FDG uptake in left posterior skin soft tissue of the chest near the shoulder with no other abnormal focal uptake and splenomegaly. BPDCN is a rare aggressive malignancy that is more common in older populations. The origin is from type 2 dendritic cells. Typical presentations are skin lesions, cytopenia, lymphadenopathy, and splenomegaly. Some of the cytological features of BPDCN include cloudy sky (blue cytoplasm with clearer areas), pseudopods, and microvacuoles. Confirmation of diagnosis is with immunophenotyping. Workup after diagnosis include complete blood count, liver and renal function, hepatitis panel, peripheral blood smear, bone marrow evaluation, systemic imaging, cerebrospinal fluid cytology. Treatment of BPDCN is challenging in this era. Most patients respond to chemotherapy, although they relapse. Tegraxofusp is suggested for remission induction therapy following allogeneic hematopoietic cell transplantation. Median overall survival is about one year. Only patients who underwent hematopoietic stem cell transplant had prolonged survival. Myelemia, old age and altered general state have worse prognosis.

No description available.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease that affects at least five million people worldwide. An increased expression of type I interferon (IFN) regulated genes is a hallmark of SLE, but the precise etiology of SLE initiation and flares is poorly understood. Because plasmacytoid dendritic cells (pDCs) are the primary type I IFN producers, their role in SLE has long been suspected, with murine pDC depletion models successfully delaying the progression of murine lupus-like disease. However, the mechanism behind how exactly how pDCs contribute to lupus autoimmunity is unknown, contributing to the current dearth lack of disease modifying treatments; current treatments only succeed in suppressing symptoms, and do not halt disease progression. In this study, we take a multifactorial approach to understanding the biology of pDCs in the context of lupus autoimmunity. Although the exact etiology of lupus is unknown, infections are an important environmental trigger for / Infectious Disease & Immunity

Les pDC représentent la première ligne de défense de l’organisme contre les pathogènes et établissent le lien essentiel entre l’immunité innée et adaptative. Les pDC endocytent et détruisent les particules virales et ainsi détectent leur matériel génétique grâce à des senseurs antiviraux de la famille des Toll-Like Receptors (TLR). L’activation des TLR7/9 induit la production massive d’interféron de type I (IFN-I), un antiviral puissant indispensable au contrôle de la propagation virale lors des phases aigues de l’infection. Cependant, l’IFN-I peut s’avérer avoir des effets délétères dans un grand nombre d’infections chroniques et de maladies auto-immunes. Ainsi, il semble indispensable de découvrir les mécanismes régulateurs des pDC ainsi que des modulateurs de l’activation des pDC. Nous avons ainsi montré que les monoamines (histamine, dopamine, sérotonine) et les polyamines (spermine et spermidine) inhibent l’activation complète des pDC stimulées par divers virus. Par la suite, nous avons identifié CXCR4 comme étant le récepteur des amines sur les pDC. Ainsi nous avons pu montrer que les amines pouvaient réguler les pDC en passant par CXCR4 et que ce récepteur était un interrupteur d’activation potentiel des pDC lors des infections virales. Afin de comprendre le mécanisme des amines, nous avons développé une nouvelle technologie : la transfection de siRNA dans les pDC primaires humaines. D’autre part, nous avons détecté des cellules géantes multinucléées en forme de roue de bicyclette lorsque les pDC sont cultivées in vitro avec de grandes quantités de virus VIH. Ainsi, comme les monocytes et les macrophages, les pDC peuvent former in vitro des cellules géantes multinucléées exprimant de hauts niveaux de protéines virales p24 de VIH-1. Cependant, les pDC ne sont que très peu infectées (moins de 5%). Nous nous sommes alors demandé si le corécepteur CXCR4 du virus VIH était aussi important que le récepteur CD4 pour la reconnaissance de ce dernier lors de l’activation des pDC. / PDC are the first line of defense of our organism against pathogens and establish the essential link between the innate and adaptive immunity. pDC endocyte and destroy the viral particles and thus, detect the genetic material with their antiviral sensors from the Toll-Like Family (TLR). The activation of TLR7/9 induces massive production of type I interferon (IFN-I), a powerful antiviral molecule, essential to control viral propagation during the acute phases of the infection. However, type I IFN can have deleterious effects in a large number of chronic infections and autoimmune diseases. Thus, it seems essential to discover the regulatory mechanism of pDC as well as pDC activation modulators. We showed that monoamines (histamine, dopamine and serotonin) and polyamines (spermine and spermidine) inhibit completely the activation of virus-stimulated pDC. Thus, we showed that amines regulated pDC activation through CXCR4 engagement and that this receptor was a potential switch "on-off" for pDC during viral infections. To better understand the mechanism of action by which amines inhibit pDC activation, we developed a new technology: siRNA transfection in human primary pDC. Furthermore, we detected multinuclear giant cells bearing the shape of a bicycle wheel when pDC are cultured in vitro with high quantities of HIV virus. Thus, on top of monocytes and macrophages, pDC can form in vitro multinuclear giant cells with high levels of p24 viral protein of HIV-1. However, pDC barely get infected (less than 5%). We then wondered if the receptors and co-receptors of the virus were important for the viral recognition during HIV-activation of pDC.

<p>Vaccinia virus (VV) is the most thoroughly studied member of the Poxviridae family and the vaccine used to achieve the only successful eradication of a human disease. Over the years, it has proven itself as a useful tool for the study of antiviral immunity, vaccine development, and potentially cancer immunotherapy. VV is capable of eliciting a robust immune response; however the mechanisms by which VV accomplishes this task remain unknown. The overall goal of this thesis project is to determine how VV activates the innate immune system, and how this activation contributes to viral clearance in vivo. We determined that VV or VV-DNA activated the TLR8-MyD88 pathway in plasmacytoid dendritic cells (pDC), resulting in the production of type I interferons (IFN). We also demonstrated that TLR8-mediated production of type I IFN by pDC was crucial to efficient VV control and clearance in vivo. Moreover, we identified the polyA- and polyT-rich sequences in VV-DNA was the possible motif recognize by TLR8. Type I IFN, known for ability to establish the "antiviral state", are also critical mediators of NK cell activation. In the setting of VV infection, we demonstrated that direct action of type I IFN on NK cells, but not accessory cells such as DC, was necessary for NK cell activation in vivo. We further demonstrated that type I IFN-dependent activation of NK cells was required for optimal VV clearance in vivo. Given the importance of NK cells in anti-VV innate immunity, we next examined what role the TLR2-MyD88 pathway, critical for activation of cDC, played in the activation of NK cells. NK cells from TLR2-/- or MyD88-/- mice displayed a reduction in activation and cytolytic function, and this defect was independent of pro-inflammatory cytokine signaling. We were able to demonstrate that direct TLR2 signaling on NK cells was required for their optimal activation and function in response to VV infection. Moreover, we were able to demonstrate that TLR2-MyD88 signaling resulted in the activation of the PI3K-ERK pathway, which was necessary for NK cell cytotoxicity. In addition, we identified the NKG2D pathway as critical for efficient NK cell activation and function in response to VV infection, independent of the TLR2 pathway. Both the NKG2D and TLR2 pathways were crucial for optimal VV clearance and control in vivo. Collectively, this project illuminates the roles and mechanisms of the innate immune system in the control of VV in vivo.</p> / Dissertation

Systemic lupus erythematosus (SLE) is an autoimmune, inflammatory disease characterized by autoantibody production and an activated type I interferon system. Cardiovascular disease (CVD) is as a major cause of morbidity and mortality. The aim of this thesis was to identify genetic risk factors for CVD in SLE. The role of T cells in regulation of the interferon-α (IFNα) production by plasmacytoid dendritic cells (pDCs) was also investigated.    In paper I, a thicker intima, thinner media and increased intima/media ratio was found in young premenopausal women with SLE compared to healthy controls indicating increased cardiovascular risk. As traditional ultrasound assessment of the common carotid intima-media thickness (CCA-IMT) in SLE has given conflicting results separate measurement of the intima and media can be a useful tool to identify SLE patients at increased risk of CVD.    In paper II, an association was demonstrated in SLE between a STAT4 risk allele and ischemic cerebrovascular disease and presence of anti-phospholipid antibodies (aPL). The association remained after adjustment for traditional CVD risk factors. A possible mechanism for this association is that the risk allele leads to increased production of aPL, which promotes thromboembolism.    In paper III, a genetic locus in IRF8 was identified to be associated to coronary heart disease (CHD) in SLE. The association remained after adjustment of other CHD risk factors.  Patients with the IRF8 risk variant had increased CCA-IMT, more carotid plaques and reduced frequency of circulating B cells. Weaker binding of nuclear protein to the risk allele was demonstrated, suggesting a regulatory function of the IRF8 risk variant.    In paper IV, activated T cells were found to strongly enhance the IFNα production by pDC stimulated with RNA-containing immune complexes via GM-CSF and IL-3. Activated SLE T cells enhanced the IFNα production to the same extent as T cells from healthy controls. This finding together with previous observations in SLE of increased levels of GM-CSF and IL-3 suggests that T cells contribute to the activated type I interferon system in SLE.    In conclusion, this thesis demonstrates that genetic predisposition is important for CVD in SLE and describes a new role for T cells in the pathogenesis of SLE.

Dendritic cells (DC) are antigen-presenting cells that are critical for the initiation and regulation of the immune response. Several DC subtypes within mouse spleen have previously been characterised and these include the plasmacytoid (pDC), and conventional DC (cDC) of the CD8+ and CD8- subtypes. Each subtype appears to have a specialised role in the various arms of immunity and tolerance. Less clear is the process by which these DC develop from haematopoietic precursors, of the precursor stages and branch points from bone marrow (BM) stem cells to each of the peripheral DC subtypes. The research described herein had the aim of identifying and isolating some of the intermediate precursors of DC, downstream of stem cells, and determining whether these differed in the steady-state versus inflammation. Particular was given to DC of the spleen. Experiments that sought the identity of such precursors involved both i) transfer of cell fractions that contained DC precursors into steady-state or inflamed recipient mice to assess their in vivo development at later times, and ii) analysis of an in vitro culture system to question whether it reflected development of the steady-state DC subtypes.

Les cellules dendritiques plasmacytoïdes (pDC) sont infectées par le VIH-1 et la diminution de leur nombre dans la circulation sanguine est corrélée avec la virémie des patients. Au cours de mes travaux de thèse, nous avons montré que les anticorps neutralisants (AcN) spécifiques du VIH-1 inhibent l’infection des pDC par des isolats primaires de VIH-1. Contrairement aux mDC, le mécanisme d’inhibition de l’infection des pDC est indépendant du RFcγII présent à leur surface. En parallèle, nos résultats indiquent que les pDC produisent de l’interféron-α et d’autres cytokines et chimiokines en réponse au VIH-1, même lorsque l’infection des cellules est inhibée par les AcN. Enfin, nous avons observé l’inhibition du transfert en cis et en trans du VIH-1 des pDC aux lymphocytes T CD4 par les AcN.Dans un contexte d’induction d’AcN par vaccination, l’inhibition de la réplication du VIH-1 dans les pDC associé au maintien de la sécrétion de cytokines pro-inflammatoire par ces cellules pourrait favoriser l’élimination du virus et ralentir sa dissémination dans l’organisme. / Plasmacytoid dendritic cells (pDC) are able to replicate HIV-1, and the decrease of pDC number in blood is correlated with HIV-1 viremia in patients. During my thesis, we showed that HIV-1-specific neutralizing antibodies (NAb) inhibited the infection of pDC by HIV-1primary isolates. Unlike mDC, the mechanism of inhibition of pDC infection was independent of FcγRII expressed on these cells. In parallel, our results indicated that pDC produce interferon-α and other cytokines and chemokines in response to HIV-1, even when HIV-1 infection of these cells was inhibited by NAb. Finally, we showed that NAb were able to inhibit HIV-1 transfer in cis and trans from pDC to CD4 T cells.In the context of antibodies induction by vaccination, the inhibition of HIV-1 replication in pDC associated with the maintenance of pro-inflammatory cytokines released by these cells may help to eliminate the virus and impede its dissemination in the body.

Le cancer de l’ovaire est immunogène et constitue un bon modèle pour étudier l’immunité antitumorale. Nous avons effectué une étude comparative et systématique de la fréquence, du phénotype, de la fonction et de l’impact sur la survie des cellules dendritiques plasmacytoïdes (pDC) et des lymphocytes T régulateurs (Treg) dans le sang, l’ascite et la tumeur. Nous avons observé que les pDC s’accumulent dans les ascites et sont présentes dans certaines tumeurs alors qu’elles sont profondément déplétées dans le sang des patientes. La présence de pDC associées aux tumeurs (TApDC) est un facteur pronostique indépendant associé à une survie sans progression (SSP) plus courte. De plus, les TApDC, mais pas les pDC d’ascite, sont altérées dans leur fonction innée principale de production d’IFN-α en réponse aux TLR ligands in vitro et induisent le développement de lymphocytes T CD4+ producteurs d’IL-10 responsables d’une tolérance immune favorisant la progression tumorale. Les Treg s’accumulent dans les ascites et les tumeurs de l’ovaire mais leur taux dans le sang est comparable aux donneurs sains. Leur accumulation dans les tumeurs et non dans les ascites est un facteur pronostique indépendant associé à une SSP plus longue. Les TATreg ont un phénotype activé et inhibent la production d’IL-10 par les lymphocytes T CD4+ conventionnels associés aux tumeurs. De façon intéressante, les patientes dont les tumeurs augmentent l’infiltration par les Treg Foxp3+ après chimiothérapie néoadjuvante ont une rechute retardée suggérant qu’en plus d’un effet antitumoral direct, la chimiothérapie induit une réponse immune / Ovarian cancer (OC) is an immunogenic disease and represents a good model for studying antitumoral immunity. We performed a systematic comparison between plasmacytoid dendritic cells (pDC) and regulatory T cells (Treg) in blood, ascites, and tumors in term of frequencies, phenotypes, functions, and impact on outcome of OC patients. We found that pDC accumulate in ascites and are present in some tumors whereas they are profoundly depleted in patients’ blood. Their presence within tumors (but not ascites) is deleterious because associated with early relapse of OC patients. Moreover, Tumor associated pDC (TApDC) but not ascite pDC were altered in their innate function, i.e. the production of IFN-α in response to TLR ligands in vitro, and they induce the development of IL-10+ CD4+T cells. All these results suggest that TApDC but not ascite pDC induce immune tolerance allowing cancer progression. Treg accumulate in ascites and tumors but their levels in patients’ blood were not increased. Their accumulation in tumors, but not ascites, was an independent prognostic factor associated with delayed relapse. TATreg showed an activated phenotype and inhibit IL-10 production by CD4+conventional TAT cells. Interestingly, patients whose tumor infiltration by Foxp3+ Treg is increased after neoadjuvant chemotherapy showed delayed relapse suggesting that chemotherapy, in addition to its direct antitumoral effect, induces an immune response