Le long de la frontière entre la Thaïlande et le Myanmar (TMB), le paludisme se caractérise par une forte hétérogénéité de la transmission, une forte prévalence en porteurs sub-microscopiques et par l’émergence de la résistance à l’artémisinine chez Plasmodium falciparum. L'identification précoce des « foyers » infectieux et leurs éliminations sont nécessaires pour contenir la résistance à l'artémisinine. L'objectif de cette thèse était de démontrer l’intérêt d’utiliser des biomarqueurs sérologiques de l'exposition humaine aux piqûres d'anophèles (gSG6-P1) et au Plasmodium (CSP & MSP1-19) pour quantifier le contact homme-vecteur et identifier les foyers résiduels de transmission. Des papiers filtres contenant du sang ont été prélevés sur une cohorte de 2600 personnes suivie tous les 3 mois jusqu'à 18 mois et analysés par dosage immuno-enzymatique (ELISA). Nos résultats ont montré que les niveaux de réponse IgG à l'antigène gSG6-P1 variaient selon le village, la saison et l'âge et étaient positivement corrélés à l'abondance des espèces anophèles et des vecteurs primaires de paludisme. Une association significative et positive a été observée entre la réponse de l'anticorps au gSG6-P1 et le taux d'inoculation entomologique (EIR), démontrant ainsi que l'hétérogénéité de la transmission du paludisme était directement associée à un comportement de piqûre hétérogène. Des études complémentaires ont montré que le biomarqueur salivaire était pertinent pour détecter des variations micro géographiques dans la transmission à P. falciparum. Cela s’est traduit par des chevauchements significatifs entre les foyers infectieux à P. falciparum et ceux à forts répondeurs en anticorps anti-salive d’anopheles (gSG6-P1). Dans l'ensemble, ces résultats indiquent que le biomarqueur salivaire d'Anopheles est prometteur pour les études épidémiologiques et pourrait guider la mise en œuvre d’interventions de lutte antivectorielle « ciblées » afin d'éliminer les foyers résiduels de paludisme. / Malaria along the Thailand-Myanmar border (TMB) displays geographical heterogeneity and is characterized by high prevalence of submicroscopic carriage and the emergence artemisinin resistance in P. falciparum. Timely identification and elimination of remaining P. falciparum transmission “hotspots” is essential to contain artemisinine resistance. The aim of this study was to address the relevance of using serological biomarkers of human exposure to anopheles bites (gSG6-P1) and Plasmodium antigens to identify remaining sources of transmission and to measure spatial and temporal changes in human vector contact along the TMB. Blood spots were collected in filter papers among a cohort of 2600 people followed every 3 months up to 18 months, and used for analysis by enzyme-linked immunosorbent assay (ELISA). Our findings showed that the levels of IgG responses to gSG6-P1 antigen varied according to village, season, and age and were positively associated with the abundance of total Anopheles species and primary malaria vectors. A significant and positive association was noted between the Antibody response to gSG6-P1 and the entomological inoculation rate (EIR) hence demonstrating that heterogeneity in malaria transmission was directly associated with heterogeneous biting behavior. Further investigations showed that salivary biomarker was relevant to detect small scale variations in P. falciparum malaria. This was supported by scan statistics showing that P. falciparum clusters partially overlap the gSG6-P1 clusters. Altogether, these findings indicates Anopheles salivary biomarker as great potential for epidemiological studies and could be useful to guide the implementation of hotspot–targeted vector control interventions with the aim to achieve malaria elimination.

BACKGROUND: Distinguishing patients with axial spondyloarthritis (axial SpA) from patients with other causes of chronic back pain remains a challenge. The lack of reliable biomarkers contributes to the diagnostic delay in axial SpA. Recently, macrophage migration inhibitory factor (MIF) has been proposed as a candidate diagnostic and prognostic biomarker. MIF is a proinflammatory cytokine that was shown to be upregulated in several autoimmune diseases, including axial SpA. The putative role of CD8+ T cells in the disease process suggests further that serum markers of cytotoxicity might have value as serological biomarkers in axial SpA, and that subpopulations of cytotoxic lymphocytes might deserve attention as candidate cellular biomarkers. OBJECTIVE: The goal of this study was to compare serum levels of MIF and other candidate serum proteins in patients with axial SpA and controls, and to develop a flow cytometry panel to analyze cytotoxic lymphocyte cell subpopulations in these cohorts, including KIR+CD8+ T cells, Granzyme B+ CD8+ T cells, MAIT cells, and InEx cells. METHODS: Study subjects were recruited from the Brigham and Women’s Hospital Orthopedic and Arthritis Center. Four cohorts were compared: healthy controls (HC), patients with chronic low back pain (cLBP), axial SpA patients not on a biologic (axSpA/-), and axial SpA patients treated with a TNF inhibitor (axSpA/TNFi). Study subjects were matched for age, sex, and race, when possible. Serum was evaluated using the LEGENDplex Human CD8/NK panel (BioLegend) for thirteen markers including IL-17A, IL-6, TNF, granzyme B, and perforin. CRP and MIF were evaluated by DuoSet ELISA (R&D Systems). A high-dimensional flow cytometry panel was designed to evaluate 14 cell populations of interest. RESULTS: The severity of back pain in the cLBP controls and axSpA/- patients was comparable (BASDAI Q2 mean 5.0 +/- 1.9 vs. 5.0 +/- 3.0). axSpA/- patients had higher back pain, BASDAI and ASDAS scores than axSpA/TNFi patients consistent with higher disease activity in the biologic naïve group. Serum CRP values were significantly higher in axSpA/- patients compared with HC, cLBP controls, and axSpA/TNFi patients (P= 0.01, P=0.0029, P=0.004 respectively). Serum MIF levels were not statistically different between all four groups (P= 0.8069). Additionally, there were no statistically significant differences between the groups for any of the markers included in the LEGENDplex Human CD8/NK panel. A 32-color staining panel was developed to evaluate cytotoxic cell populations. CONCLUSION: In contrast to a previous study, we did not find differences in serum MIF levels between axial SpA patients and controls. Of the evaluated serum biomarkers, only CRP values correlated with active axial SpA. We have developed a promising flow cytometry panel that will help analyze subpopulations of cytotoxic cells. This ultimately could shed light on a candidate cellular biomarker. Our results underscore the need for more research into diagnostic biomarkers in axial SpA.