El documento digital no refiere un asesor / Publicación a texto completo no autorizada por el autor / Evalúa si la asociación entre el PTCL-NOS y la infección por el EBV es un factor pronóstico independiente en la sobrevida global (OS) en pacientes con PTCL-NOS atendidos en el Instituto Nacional de Enfermedades Neoplásicas (INEN). Se revisan 100 historias clínicas del INEN con diagnóstico de PTCL-NOS y se reevalúa el diagnóstico histopatológico e inmunofenotípico determinado con inmunohistoquímica. Se seleccionan 65 casos. Se realiza la determinación de EBV en las muestras parafinadas con la técnica de hibridación in situ (ISH-EBER). Existe 45% de los casos positivos para ISH-EBER. El promedio de edad es de 50 años y 29% son mujeres. La proporción de pacientes con síntomas B y sin síntomas B es similar. Los estadios son usualmente avanzados, con lactato deshidrogenasa (DHL) elevada. El índice pronóstico internacional (IPI) es intermedio-alto o alto en la mayor parte de los casos. La respuesta al tratamiento es generalmente pobre. Histológicamente, todos los casos tienen un patrón difuso y polimorfo de células T maduras, con atipia variable. 67% de casos tienen fenotipo CD4 y 23% fenotipo citotóxico. / Tesis

Epstein-Barr virus (EBV) BKRF4 gene product is a tegument protein encoded by a gene with no sequence homology outside of the gamma subfamily of Herpesviridae. Its positional homologs are necessary for an efficient viral lytic program, in particular viral progeny egress and primary infection. To characterize BKRF4 in this regard, EBV recombinant viruses deficient for BKRF4 were developed using site-directed mutagenesis and a bacterial artificial chromosome (BAC)-based recombineering system. Stable human embryonic kidney (HEK) 293 cell lines containing these genomes were generated and the phenotypes of these mutants were analyzed following stimulation of the viral lytic cycle. During the lytic program, BKRF4-null cell lines showed decreased protein expression of various EBV lytic genes that were analyzed using immunostaining and flow cytometry. Reduced amounts of extracellular viral progeny were observed when quantified by real-time PCR and infectivity assays as compared to wild type. These findings suggest an active role of BKRF4 in EBV infection, possibly in viral egress.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-04-08T22:35:40Z No. of bitstreams: 1 MarioEmilioTeixeiraDouradoJunior_TESE.pdf: 5285105 bytes, checksum: 0100fd5d41dfba7610de03558937e498 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-04-11T20:37:08Z (GMT) No. of bitstreams: 1 MarioEmilioTeixeiraDouradoJunior_TESE.pdf: 5285105 bytes, checksum: 0100fd5d41dfba7610de03558937e498 (MD5) / Made available in DSpace on 2016-04-11T20:37:08Z (GMT). No. of bitstreams: 1 MarioEmilioTeixeiraDouradoJunior_TESE.pdf: 5285105 bytes, checksum: 0100fd5d41dfba7610de03558937e498 (MD5) Previous issue date: 2015-03-17 / Indrodu??o. A S?ndrome de Guillain-Barr? (SGB) ? uma polineuropatia imunomediada, sendo, atualmente, a mais frequente causa de paralisia aguda neuromuscular. As principais variantes dessa s?ndrome s?o: a polineuropatia desmielinizante inflamat?ria aguda (PDIA), a neuropatia axonal motora aguda (NAMA), a neuropatia axonal motora e sensitiva aguda (NAMSA), e a s?ndrome de Miller-Fisher. H? tamb?m diferen?as na distribui??o geogr?fica destas variantes. A resposta imune aberrante, p?s infec??o, parece ser resultante de um mimetismo molecular, devido a forma??o de autoanticorpos e ativa??o do sistema complemento e de citocinas. S?o encontrados polimorfismos bial?licos nos genes codificadores dos receptores das fra??es Fc das imunoglobulinas (FcRIIa, FcRIIIa e FcRIIIb) que afetam a afinidade e efici?ncia na resposta imune celular, sugerindo a exist?ncia de susceptibilidade individual no risco de desenvolver a SGB. No Brasil, h? poucos estudos epidemiol?gicos sobre a SGB e nenhum relato sobre a frequ?ncia das variantes e suas manifesta??es cl?nicas. Os objetivos deste estudo foram: (1) caracterizar a SGB e suas manifesta??es cl?nicas em uma coorte de pacientes com SGB oriundos do Estado do Rio Grande do Norte (RN); (2) determinar se polimorfismos em receptores FcR est?o envolvidos com o risco de doen?a, e (3) avaliar a express?o g?nica global buscando identificar poss?veis vias que poderiam ser moduladas na fase inicial da doen?a e, consequentemente, diminuir o tempo de doen?a. Metodologia. Foram recrutados 149 casos de SGB diagnosticados entre 1994- 2013 no RN, tendo sido avaliados os dados cl?nicos e laboratoriais visando a determinar a evolu??o. DNA e RNA foram extra?dos do sangue perif?rico e anticorpos antiganglios?deos foram determinados em amostras de soro. Foram genotipados polimorfismos nos genes FCGR2A e FCGR3A, em pessoas com SGB (n=141) e controles saud?veis (n=364), sendo ainda analisadas as express?es g?nicas globais de 12 pacientes com SGB, por RNAseq. As amostras de sangue para os estudos de express?o g?nica foram coletadas ao diagn?stico e p?srecupera??o. Resultados. A incid?ncia de SGB foi de 0,3/100 mil pessoas no RN, sem presen?a de sazonalidade, com os casos ocorrendo em uma idade mais jovem. A SGB foi precedida por infec??es em 63,7%, sendo a diarreia associada a variante axonal (p=0,025). A PDIA foi a variante mais frequente (81,8%), seguida de NAMA (14,7%) e de NAMSA (3,3%). A distribui??o da fraqueza muscular correlacionou com as variantes, sendo a proximal mais frequente na PDIA, enquanto a distal predominou na variante axonal. O nadir < 10 dias ocorreu em 84,6% dos indiv?duos na variante axonal e 42,4% dos casos com PDIA (P<0,0001). A forma desmielinizante apresentou uma recupera??o na deambula??o mais r?pida do que a variante axonal (P<0,0001). A mortalidade de SGB foi de 5,3%. O pior progn?stico aos 12 meses estava associado com a variante axonal (OR 17,063; P = 0,03) e no tempo de melhora um ponto na escala funcional de Hughes (OR 1,028; P = 0.03). As distribui??es dos gen?tipos e alelos em FCGR2A (p=0,367) e em FCGR3A (p=0,2430) n?o foram diferentes entre os pacientes com SGB e controles. A an?lise da express?o g?nica global mostrou varia??o na express?o dos mRNAs de isoformas de prote?nas associadas ? fase sintom?tica da doen?a. Conclus?es. N?o h? sazonalidade na ocorr?ncia da SGB no RN, havendo um predom?nio da variante desmielinizante e 50% dos casos tinham idade inferior a 20 anos. A variante axonal est? associada ao mau progn?stico. O diagn?stico precoce e a identifica??o da variante, acompanhada de interven??es adequadas, levam a diminui??o da morbidade a longo prazo. Varia??es polim?rficas nos genes de FCGR parecem n?o influenciar a susceptibilidade ou o curso da SGB nessa popula??o. Varia??es na express?o g?nica apontam para vias de desregula??o e altera??es em intera??es transcricionais, que podem ser utilizadas como potenciais alvos de modula??o. / Introduction. Guillain-Barr? syndrome (GBS) is an immune-mediated polyneuropathy and the principal cause of acute neuromuscular paralysis. The most prominent GBS subtypes are: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Fisher syndrome (FS). Differences in geographical distribution of variants have been reported. In Brazil, there are few studies describing the characteristics of GBS, but none on the frequency of GBS variants and their clinical manifestations. Infection-induced aberrant immune response resulting from molecular mimicry and formation of cross-reacting antibodies, contribute to complement activation. Functional biallelic polymorphism in immunoglobulin receptors that influence the affinity of IgG subclasses and the type of immune response have been described, suggesting genetic susceptibility to developing disease. It remains unclear whether individuals carrying different FCGR alleles have differential risk for GBS and?or disease severity. The goals of this study were: (1) To characterize GBS and describe the clinical findings in a cohort of patients with GBS from the state of Rio Grande do Norte, Brazil; (2) to determine whether polymorphism in FCGR were associated with development of GBS, and (3) to tease out whether the global gene expression studies could be a tool to identify pathways and transcriptional networks which could be regulated and decrease the time of disease. Methods. Clinical and laboratory data for 149 cases of GBS diagnosed from 1994 to 2013 were analyzed. Genomic DNA and total RNA were extracted from whole blood. Antigangliosides antibodies were determined in the sera. In addition, we also assessed whether FCGR polymorphism are present in GBS (n=141) and blood donors (n=364), and global gene expressions were determined for 12 participants with GBS. Blood samples were collected at the diagnosis and post-recovery. Results. AIDP was the most frequent variant (81.8%) of GBS, followed by AMAN (14.7%) and AMSAN (3.3%). The incidence of GBS was 0.3 ? 100,000 people for the state of Rio Grande do Norte and cases occurred at a younger age. GBS was preceded by infections, with the axonal variant associated with episodes of diarrhea (P = 0.025). Proximal weakness was more frequent in AIDP, and distal weakness predominant in the axonal variant. Compared to 42.4% of cases with AIDP (P<0.0001), 84.6% of cases with the axonal variant had nadir in <10 days. Individuals with the axonal variant took longer to recover deambulation (P<0.0001). The mortality of GBS was 5.3%. A worse outcome was related to an axonal variant (OR17.063; P=0.03) and time required to improve one point in the Hughes functional scale (OR 1.028; P=0.03). The FCGR genotypes and allele frequencies did not differ significantly between the patients with GBS and the controls (FCGR2A p=0.367 and FCGR3A p=0.2430). Global gene expression using RNAseq showed variation in transcript coding for protein isoforms during acute phase of disease. Conclusions. The annual incidence of GBS was 0.3 per 100,00 and there was no seasonal pattern. A predominance of the AIDP variant was seen, and the incidence of the disease decreased with age. The distribution of weakness is a function of the clinical variants, and individuals with the axonal variant had a poorer prognosis. Early diagnosis and variant identification leads to proper intervention decreasing in long-term morbidity. FCGR polymorphisms do not seem to influence susceptibility to GBS in this population. This study found deregulated genes and signs of transcriptional network alterations during the acute and recovery phases in GBS. Identification of pathways altered during disease might be target for immune regulation and with potential to ameliorate symptoms.

Submitted by Susimery Vila Nova (susimery.silva@ufpe.br) on 2015-04-10T19:19:57Z No. of bitstreams: 2 tese final para impressão 1.pdf Joacilda.pdf: 3160703 bytes, checksum: 77f3910f7f992488c2ed2eada2b36dcf (MD5) license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) / Made available in DSpace on 2015-04-10T19:19:57Z (GMT). No. of bitstreams: 2 tese final para impressão 1.pdf Joacilda.pdf: 3160703 bytes, checksum: 77f3910f7f992488c2ed2eada2b36dcf (MD5) license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Previous issue date: 2012-05-30 / Leucemia linfoide aguda (LLA) é o câncer pediátrico mais comum e etiologicamente não apresenta um modelo definido, uma vez que apresenta uma história natural biologicamente diversificada. Fatores têm sido relacionados ao sistema imunológico como risco/proteção ao desenvolvimento de LLA, considerando-se como plausíveis o papel do sistema imune frente às infecções na infância, e a inter-relação dessas infecções com mecanismos envolvendo as Hipóteses da Higiene e da Adrenal. A proposta desse estudo foi investigar uma possível associação entre alergia prévia, bem como a ativação do eixo adrenal, pautado na Hipótese da Adrenal, com o desenvolvimento de leucemia linfoide aguda na infância e adolescência. Trata-se de um estudo do tipo caso-controle não pareado de base hospitalar, cuja amostra foi constituída de 60 crianças e adolescentes com diagnóstico incidente de leucemia linfoide aguda não T, classificadas pela avaliação da medula óssea através do mielograma e imunofenotipagem e 120 controles selecionados com proporcionalidade com relação à idade e sexo a partir dos casos e oriunda dos estados de Pernambuco e Paraíba no nordeste brasileiro, entre 2008 e 2011. A coleta dos dados consistiu na aplicação de questionário estruturado para identificação de alergias como asma, rinite alérgica, antecedente de urticária e dermatite atópica, uso prévio de glicocorticoides, além de exame clínico e coleta de sangue para dosagem de IgE total, cortisol basal, ACTH, marcador de infecção prévia pelo EBV e parvovírus B19 através da dosagem de IgG. Outras variáveis como aleitamento materno, peso ao nascer, escolaridade materna, infecção materna na gestação e número de pessoas no domicílio também foram analisadas. Para a análise estatística foram utilizados Teste de associação de 2, Teste Exato de Fisher, Odds Ratio, Regressão Logística Binária e Regressão Logística Múltipla. Os resultados encontrados na análise univariada (p < 0,20) foram: Asma ( pvalor = 0,116), Rinite Alérgica (p-valor=0,032), Antecedente de Urticária (p-valor = 0,011), Dermatite Atópica (p-valor = 0,086), Nível Sérico Elevado de IgE Total (p-valor = 0,00), Nível Elevado de Cortisol Basal (p-valor = 0,004), Infecção Prévia pelo EBV (p-valor = 0,143), Infecção Prévia por Parvovírus B19 (p-valor = 0,068). Após o modelo ajustado através da análise de regressão logística múltipla persiste a significância de uma relação inversa entre Asma com p-valor = 0,044 e OR/IC 95% 0,14 (0,02 – 0,95), Nível Sérico Elevado de IgE Total com p-valor = 0,001 e OR/IC 95% 0,10 (0,02 – 0,41), além de Níveis Elevados de Cortisol apresentando p-valor 0,004 e OR/IC 95% 0,16 (0,04 – 0,56); Para infecção Prévia pelo Parvovírus B 19 o resultado expressa risco p-valor = 0,037 e OR/IC 95% 2,19 (1,05 – 4,57). Asma e Níveis Séricos Elevados de IgE Total e ainda Níveis Elevados de Cortisol Basal, parecem estar relacionados com modificações na resposta imune e como consequência promoveriam uma diminuição de clones leucêmicos, desempenhando um papel de proteção a crianças e adolescentes contra LLA. A infecção prévia pelo parvovírus B 19 está associada com aumento de risco de LLA.

Orientador: Sandra Cecilia Botelho Costa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T03:22:40Z (GMT). No. of bitstreams: 1 Pasquotto_Juliana_M.pdf: 2465167 bytes, checksum: dcd2cc122494bab62d8ab495927b1f0e (MD5) Previous issue date: 2008 / Resumo: O Vírus Epstein-Barr (EBV) e o Citomegalovírus (HCMV) são membros da família Herpesvírus. São encontrados em aproximadamente 90% dos indivíduos em idade adulta. A infecção ocorre, geralmente, na infância e é assintomática na maioria dos casos, persistindo de forma latente durante toda a vida do indivíduo. A transmissão destes vírus ocorre principalmente pela saliva, sangue e órgãos transplantados. O EBV está relacionado com a mononucleose infecciosa, doença linfoproliferativa (PTLD), leucemia de células pilosas em pacientes com imunodeficiência congênita ou adquirida e doença de Hodgkin. O risco de um paciente transplantado desenvolver linfoma é 28 a 50 vezes maior do que os indivíduos da população geral. Um dos fatores de risco para o desenvolvimento da PTLD são a variedade e intensidade da imunossupressão utilizada no paciente pós-transplante, idade do receptor e sorologia viral (EBV, CMV). Dependendo da idade do receptor, do tipo de transplante e dos fatores de risco, a prevalência da PTLD pode variar de 0.5% a 22%. Em transplantados pediátricos renais a prevalência chega a atingir 37%. A principal medida terapêutica para o controle da PTLD é a diminuição ou mesmo a retirada total da imunossupressão. Portanto a rejeição do enxerto se torna um problema bastante comum, que compromete a qualidade e/ou expectativa de vida dos pacientes. A introdução de testes laboratoriais rápidos e precoces permite aos clínicos detectar a replicação viral do EBV e diagnosticar, consequentemente, a infecção ativa antes do início da doença. Isso proporciona a oportunidade de iniciar o tratamento específico precocemente. Foram estudadas amostras de sangue e soro de 46 pacientes submetidos a transplantes de células hematopoéticas, acompanhados no Serviço de Transplante de Medula Óssea (STMO) do Hospital das Clínicas da UNICAMP/HEMOCENTRO. Trabalhamos no estudo para diagnosticar a infecção ativa e quantificar a carga viral do vírus Epstein-Barr (EBV) em pacientes transplantados de células hematopoéticas. Relacionar infecção ativa do vírus Epstein-Barr com o Citomegalovírus (CMV) e verificar a incidência da Doença linfoproliferativa e a Doença do enxerto contra o hospedeiro (GVHD) nos pacientes estudados. Diagnosticamos infecção ativa pelo EBV em 22 (47,8%) pacientes que apresentaram uma carga viral muito baixa (média de 29 cópias/ul). Co-infecção entre EBV e CMV ocorreu em 15/46 pacientes (32,6%). Doença por CMV ocorreu em 7/46 (15,2%) pacientes no trato gastrintestinal. Todos estes doentes apresentaram infecção ativa pelo CMV e 4/7 (57%) apresentaram infecção ativa pelo EBV. Um destes pacientes foi a óbito por doença por CMV. Verificamos que nenhum dos pacientes apresentou doença linfoproliferativa relacionada ao EBV. Os casos de co-infecção ativa EBV+CMV em relação à ocorrência de GVHD foram estatisticamente significantes (p=0.001). Concluímos que a infecção pelo CMV ainda é a maior causa de morbidade e mortalidade nos pacientes após o transplante. A qPCR é uma ferramenta útil para verificar os pacientes que reativaram pelo EBV após o transplante e pode auxiliar na prevenção da doença linfoproliferativa causada pelo EBV juntamente com a identificação dos fatores de risco associados. Verificamos a ocorrência e significância do GVHD e infecção ativa pelo CMV, mas não observamos esses mesmos resultados comparados ao EBV / Abstract: Epstein-Barr Virus (EBV) and Cytomegalovirus (CMV) are members of herpesvirus family. They are found in approximately 90% of the individuals in adult age. The infection generally occurs subclinicaly during the childhood in the major of the cases persisting in latent form during all the life of the individual. The transmission of these viruses occurs mainly for the saliva, blood and transplanted organs. EBV is related with mononucleose infectious, lynfoproliferative disease (PTLD), leukemia of hair cells in patients with congenital or acquired immunodeficiency and Hodgkin¿s disease. The risk of a transplanted patient to develop linfoma is 28 to 50 % more than other individuals of the general population. One of the risk factor for the development of the PTLD is the variety and intensity of the imunossupression used in the patient after-transplant, age of the recipient and viral serology (EBV, CMV). Depending on the age of the recipient, the type of transplant and the risk factor, the prevalence of the PTLD can vary of 0.5% 22%. In renal pediatric transplantation, the prevalence can arrives to reach 37%. The main therapeutical measure for the control of the PTLD is the reduction or total withdrawal of the imunossupression. Therefore the lost of graft is a common problem, that compromises the quality and/or life expectancy of the patients. The introduction of early and rapid laboratorial tests can permit to the physicians to detect the viral response and detect the active EBV infection before the disease. This provides the chance to initiate the specific treatment. We studied samples of blood and serum of 46 patients submitted to hematopoietic stem cell transplantation at the Bone Marrow Transplant unit of the University Hospital of the UNICAMP/HEMOCENTRO. We worked in the study to diagnosis the active infection and quantify the viral load of the Epstein-Barr virus (EBV) in transplanted patients of hematopoetic stem cells, to relate active EBV infection with active CMV infection and to verify the incidence of the lynfoproliferative disease and graft versus host disease (GVHD) in the studied patients. Active EBV infection detected by Real-Time PCR occurred in 22 patients (47,8%). The viral load found was very low (range 29 copies/ul). Co-infection between EBV and CMV occurred in 15/46 patients (32,6%). CMV disease occurred in 7/46 (15,2%) patients in the gastrointestinal tract. All these patients had active CMV infection and 4/7 patients (57%) had active EBV infection. One of these patients died by CMV disease. No patient presented lymphoproliferative disease related to the EBV. The cases of active EBV and CMV (co-infection) infection in relation to the occurrence of GVHD had been statisticaly significant (p=0.001). We conclude that the active CMV infection is already the most cause of morbidity and mortality of the patients after the transplant. The qPCR is a useful tool to verify the patients who had active EBV infection after the transplant and the identification of the risk factors associates prevention the development of the lymfoproliferative disease caused by the EBV. We verify the occurrence and significance of the GVHD and active CMV infection, but we do not observe these same results related to the EBV / Mestrado / Mestre em Farmacologia

Made available in DSpace on 2014-06-12T18:30:24Z (GMT). No. of bitstreams: 2 arquivo8067_1.pdf: 2863981 bytes, checksum: c052a8dab422808863f0e213e2a49701 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2004 / INTRODUÇÃO: O vírus Epstein-Barr, um herpesvírus que infecta mais de 90% da população mundial, pode desencadear ou agravar alterações auto-imunes, assim como pode anteceder o aparecimento das manifestações clínicas e imunológicas do Lúpus Eritematoso Sistêmico (LES). Como os auto-anticorpos parecem exercer papel central na patogênese do LES, é importante correlacionar a presença e o título de anticorpos anti-EBV com a atividade do LES. OBJETIVO: Verificar a associação entre atividade do Lúpus Eritematoso Sistêmico, por meio dos critérios do SLEDAI, e a avidez das imunoglobulinas IgG anti-EBV. PACIENTES E MÉTODOS: Foi realizado estudo tipo caso-controle, envolvendo 66 pacientes, atendidos no ambulatório de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), no período janeiro de 2002 a fevereiro de 2003, distribuídos em dois grupos: caso, composto por 22 pacientes com LES em atividade e SLEDAI > 4, e controle, integrado por 44 pacientes com doença inativa, diagnosticada por SLEDAI ? 4. A presença e o índice de avidez de anticorpos IgG anti-EBV foram determinados pela técnica de ELISA. (Enzygnost? anti-ebv Dade Behring), no Setor de Virologia do Laboratório de Imunologia Keizo Asami (LIKA). Os índices de avidez e respectivas classificações da infecção foram: < 20, infecção reativada; entre 20 e 40, infecção indeterminada, > 40, infecção passada. RESULTADOS: Identificou-se positividade no teste de detecção de IgG para EBV em 21 (95,5%) casos e em 40 (90,9%) controles. O índice de avidez alcançou valores ?40 em 54 (88,5%) pacientes, sendo 34 (85%) do grupo controle e 20 (95,2%) do grupo caso; esteve entre 20 e 40 exclusivamente em 5 (12,5%) pacientes do grupo controle, e foi inferior a 20 em 2 (3,3%) pacientes. Adotando-se 20, 30 ou 40 como ponto de corte do índice de avidez, para diagnóstico de reativação da infecção por EBV, detectou-se terem sido classificados como infecção reativada, respectivamente, 1 (4,8%) paciente do grupo caso e 1 (2,5%) do grupo controle; 1 (4,8%) do grupo caso e 4 (10%) do grupo controle, 1 (4,8%) no grupo caso e 5 (12,5%) no grupo controle. CONCLUSÃO: A modificação do ponto de corte não alterou a distribuição dos pacientes com infecção ativa do grupo caso, mas o fez no grupo controle. Não ter sido possível demonstrar, no presente trabalho, associação entre a atividade do EBV e a do LES corroborou relatos semelhantes na literatura consultada. Esse fato parece indicar que a não eliminação dos linfócitos B infectados se deve a falha no mecanismo de apoptose ou na ação de linfócitos T citotóxicos permitindo a progressão do LES

Les lymphoproliférations survenant après transplantation sont une situation rare mais préoccupante car mettant en jeu la survie des patients. Ces hémopathies ont des caractéristiques épidémiologiques et physio-pathologiques qui les distinguent des lymphomes du sujet immunocompétent. Nous nous sommes intéressé à l’analyse des facteurs de risque associés aux lymphomes post-greffe et à la recherche de facteurs pronostiques de survie des patients par l’analyse détaillée des registres américain et français de patients transplantés rénaux. Le Registre Français des lymphomes survenant après transplantation rénale a permis de recenser tous les cas de syndromes lymphoprolifératifs se développant chez des patients adultes survenant entre le 1er janvier 1998 et le 31 décembre 2007. Tous les centres français de Transplantation rénale ont participé. Nous avons recensé 500 cas de lymphomes sur une période de 10 ans. Les différentes analyses de cette base de données ont donné lieu à la publication d’une analyse intermédiaire sur les 230 premiers cas, à une publication consacrée à l’incidence et aux facteurs de risque de développement des lymphomes surla cohorte complète et à une publication concernant les facteurs pronostiques de décès des patients porteurs d’une lymphoprolifération avec établissement d’un score de risque spécifique de cette population. D’autre part, cette base de données unique au monde représente un support intéressant pour le développement de travaux de recherche: étude de l’origine des cellules tumorales, étude des facteurs de susceptibilité pharmacogénétique au développement des lymphoprolifération post-greffe, étude des microRNA de l’EBV dans les lymphomes post-greffe. / Post transplant lymphoproliferative disorders (PTLD) are a rare but serious complication occurring after kidney transplantation. Features of PTLD are specific and different of those of immunocompetent patients. We studied incidence, risk factors for development of PTLD and prognostic factors of patients with PTLD using two databases: American and French. The French Registry of PTLD enrolled all adult patients with PTLD occurring between the 1st January 1998 and the 31st December 2007 from all transplant centers in France. Five hundred patients were included in the Registry. This enables us to analyse first the incidence and risk factors of PTLD and second the risk factors of kidney recipients’ survival. We constructed a new prognostic score specific of transplant patients. Finally, the French Registry gave us the opportunity to support others research projects: determination of the origin of tumoral cells, analysis of pharmacogenetic factors associated with the risk of developing PTLD, study of EBV microRNA in lymphoproliferations.

Aims: To explore the clinical significance of EBV infection in adult renal transplant recipients when detected in the late post-transplant period. Methods: (1) A prospective observational study recruiting 499 stable adult kidney transplant recipients with serial blood sampling for EBV DNAemia and assessment of clinical outcomes and associated factors. (2) A retrospective analysis of PTLD incidence, timing and outcomes in relation to EBV infection. Results: EBV DNAemia in stable kidney transplant recipients is common, found in 46% of recruited individuals screened over 1 year, with persistent DNAemia seen in 10%. DNAemia prevalence increased significantly with time from transplant (p<0.0001) from 16% within 1 year of transplant to 66% in those transplanted for 20-24 years. High baseline DNA levels predicted persistence of DNAemia. Time adjusted analyses showed significant association of DNAemia with EBV seronegative status and previous PTLD and low DNAemia rates with Mycophenolate Mofetil (MMF) use and lymphopenia. The mechanism did not appear to be directly linked to MMF induced B cell depletion. Chronic high viral load detection was significantly associated with time from transplant, EBV seronegative status at transplant, ciclosporin use and plasma detection of DNA. No significant differences in overall patient survival at 3 years, clinical symptoms or clinical findings such as anaemia, thrombocytopenia or rate of decline in renal function were seen between stable transplant recipients with and without EBV DNAemia. PTLD incidence also increases with time from transplant and was greatest during the 10th-14th post-transplant years. Disease was EBV positive in 68% cases. No statistically significant differences in overall patient survival, or overall disease complete response rates were seen in relation to recipient EBV serostatus or EBV status of PTLD histology. Conclusions: EBV DNAemia prevalence increases with time from transplant but was not associated with worse patient or graft survival or specific symptoms. PTLD incidence including EBV negative disease also increases with time from transplant but response rates and survival were not influenced by EBV serostatus or histological status.

Plasmablastic lymphoma (PBL) was originally described in 1997 as an AIDS associated tumour although cases have been described in individuals not infected with HIV. Due to the high number of people living with HIV in South Africa, a substantial number of cases are diagnosed annually and 45 cases were included in this study. This represented the largest cohort of PBL affecting the oral mucosa published to date. Three main aspects of PBL were investigated: pathological features, viral status and certain genetic characteristics. The results from the genetic studies were the most important and interesting. These included rearrangements of the IGH gene in 63% and MYC- rearrangements in 62% of PBL’s. Seven of 43 cases (16%) showed rearrangement of both the IGH gene alleles, a finding never described before. New genetic findings also included increased CCND1 gene copy numbers in 17/41 (42%) and increased IGH gene copy numbers in 6/41 (15%) of cases. The exact role of MYC-rearrangements in the development of PBL is unclear. Many factors may be responsible for MYC deregulation but in the case of PBL of the oral cavity the possible role of Epstein Barr Virus (EBV) infection was considered. All but one of the patients with known HIV-status (32/45) was HIV positive and I supported the proposal that the diagnosis of PBL should serve as a sign of immunodeficiency, either as diagnostic thereof or as a predictor of a progressive state of immunodeficiency in patients with known HIV/AIDS status. The HIV-negative patient in this study was the only one that presented with an EBV-negative PBL on in situ hybridisation. The clinico-pathological features of the current study therefore strongly suggested an association between EBV, PBL and HIV/AIDS although the exact nature thereof remains uncertain. Routine genetic evaluation of tumours diagnosed as PBL should be introduced, as this may have prognostic and eventually treatment implications in the future. The exact panel of genes to be evaluated with a possible diagnosis of PBL should still be determined but examination of IGH and MYC for rearrangements should be included. This study proved the histomorphological features including the degree of plasmacytic differentiation not to have any diagnostic role although its prognostic value should be determined. The results of the immunohistochemical investigations performed in this study confirmed PBL always to be negative for CD20 but proved PBL not to be a morphological or immunohistochemical diagnosis by any means. In conclusion, it became clear that PBL should never be diagnosed without thorough clinical, systemic, pathological and genetic investigations, especially in the backdrop of HIV/AIDS. No pathologist should make the diagnosis of PBL and no clinician should accept such a diagnosis or decide on the treatment modality for the patient involved unless all other possibilities of systemic plasma cell disease have been excluded. / Thesis (PhD)--University of Pretoria, 2011. / Oral Pathology and Oral Biology / unrestricted

Acute viral infections induce CD8 memory T cells that play an important role in the protection of the host upon re-infection with the same pathogen. These virus epitope-specific memory CD8 T cells develop complex TCR repertoires that are specific for that epitope. As individuals age virus-specific immunity appears to wane. Older people have difficulty controlling infection with common viruses such as influenza A (IAV), a RNA virus which causes recurrent infections due to a high rate of genetic mutation, and Epstein Barr virus (EBV), a DNA virus which persists in B cells for life in the 95% of people that become acutely infected. Many factors may contribute to this waning immunity including changes in virus-specific TCR repertoires. We hypothesize that epitope-specific memory CD8 TCR repertoires to these two common viruses change with increasing age and that CD8 T cell cross-reactivity may be one of the mechanisms mediating these changes. To address this hypothesis in our first study, we compared epitope-specific CD8 memory TRBV repertoires directly ex vivo for these two common human viruses. In cross-sectional and longitudinal studies of EBV seropositive, HLA-A2+, young (18-22 years), middle age (25-59 years), and older (>60 years) donors, we demonstrated that CD8 memory TCR repertoires to three immunodominant epitopes, known to have cross-reactive responses, IAV-M158-66, EBV-BM280-288, and EBV-BR109-117 co-evolve as individuals age. Cross-sectional studies showed that IAV-M1-and both EBV-specific repertoires narrowed their TRBV usage by middle-age. In fact, narrowing of EBV-BM and EBV-BR-specific TRBV usage correlated with increasing age. Although narrowing of IAV-M1-specific TRBV did not directly correlate with increasing age there was clear evidence that the TRBV usage was changing with age. The dominant TRBV19 usage appeared to become bimodal in the older age group and interestingly TRBV30 usage did directly correlate with age. For the EBV epitope-specific responses there was preferential usage of particular TRBV and changes in the hierarchy of TRBV usage in the different age groups. Longitudinal studies tracking 3 donors over 10-15 years (middle age to older) showed that there were changes in the TCR repertoire of IAV-M1, EBV-BM and -BR-specific responses over time. In two of the donors who experienced acute IAV infection there was evidence these repertoire changes may be influenced by TCR cross-reactivity, which is enhanced during acute IAV infection. The results of this first ex vivo study are consistent with our hypothesis. They suggest that virus-specific TCR repertoires change over time as an individual ages leading to narrowing of the repertoire and may co-evolve in the presence of CD8 T cell cross-reactivity. To further test our hypothesis in a second study we compared CD8 memory TRAV and TRBV repertoires to the three immunodominant epitopes IAV-M1, EBV-BM, and EBV-BR in the two extreme age groups, young donors (YSP) (18-22 years) and older donors (OSP) (>60 years) using the same donors as in the first study. Since these three epitopes are known to generate cross-reactive CD8 T cell responses and humans during their lifetime are frequently infected with both viruses at the same time these studies were also designed to more closely examine if TCR cross-reactivity could contribute to changes in TCR repertoire with increasing age. We examined the differences in both TRAV and TRBV in these two age groups by monoclonal antibody (mAb) staining and by deep sequencing and single cell sequencing in tetramer positive sorted cells from short-term cultures. Our initial studies showed that there were strong correlations in TRBV usage between short-term cultured and ex vivo antigen-specific responses; functional differences as well as differences in TRBV usage and diversity as measured by mAb staining particularly for the EBV epitope-specific responses between YSP and OSP donors. The TCR deep sequencing data also showed significant differences in TRBV usage between YSP and OSP. However, there were many more differences in TRAV and TRAJ usage than TRBV between the age groups suggesting that TRAV may play a greater role in evolution of the TCR repertoire. With increasing age, there was a preferential selection or retention of TCR for all three epitopes that have features in their CDR3a and b that increase their ease of generation, such as greater usage of convergent recombinant amino acids, and increase cross-reactive potential, such as multiple glycines. YSP and OSP differed in the patterns of TRAV/AJ and TRBV/BJ pairings and usage of dominant CDR3 motifs in all three epitope responses. Both YSP and OSP had cross-reactive responses between these 3 epitopes which were unique and differed from the cognate responses. Analyses of single cell sequencing data suggested that unique combinations of TRAV and TRBV are occurring, where one chain has features consistent with interaction with antigen one and the other chain had features consistent with interaction with antigen two. Interestingly, both the deep sequencing and single cell data show an increased tendency for the classic IAV-M1 specific clone BV19-IRSS-BJ2.7/AV27-CAGGGSQGNLIF-AJ42 to appear among the cross-reactive clones, suggesting that the dominance of this highly public clone may relate to its cross-reactivity with EBV. These results suggest that although OSP and YSP retain some of the classic TCR features for each epitope the TCR repertoire is gradually changing with age retaining TCR that are cross-reactive between these two common human viruses that we are exposed to frequently, one with recurrent infections and the other a persistent virus which frequently reactivates. These results are highly supportive our hypothesis and their importance in relation to viral immune-pathogenesis and potential novel immunotherapies will be discussed. These studies further emphasize the complexity and potential importance of human virus-specific T cell responses and TCR repertoires as people age and the need for a better understanding of TCR cross-reactivity between different viruses. For instance, at the present time these studies are highly relevant to better understanding the immune-pathogenesis observed during the COVID19 pandemic.