Les basophiles sont les granulocytes les plus rares. Ils sont impliqués dans la polarisation des réponses immunitaires de type Th2, dans la différenciation des lymphocytes B et dans la protection contre les infections helminthiques. Les basophiles sont impliqués dans la modulation des réponses immunitaires, en particulier dans les maladies auto-immunes et inflammatoires. Des études récentes ont montré que les basophiles murins sont cellules présentatrices d’antigène (CPA) et induisent des réponses Th2 et IgE contre les allergènes et les infections helminthiques.Par conséquent, Nous avons exploré les fonctions des basophiles humains, en particulier comme CPA professionnelles. Les résultats montrent que les basophiles, contrairement aux cellules dendritiques et monocytes, n’expriment pas HLA-DR et les marqueurs de co-stimulations CD80 et CD86. De plus, la stimulation des basophiles par divers allergènes, comme des ligands de TLR et IgE, n’induit pas des changements dans l’expression de ces marqueurs. Enfin, nos résultats montrent que les basophiles ne favorise pas les réponses immunitaire de type Th2 ou Th17. Ainsi,notre étude montre que les basophiles humains circulant ne possèdent pas des fonctions de CPA professionnelles. Des plus, les basophiles sont impliqués dans la pathogenèse de maladies auto-immunes et inflammatoires dépendantes des réponses Th2 et médiées par les lymphocytes B. Puisque la dérégulation des basophiles joue un rôle important dans le développement des réponses immunitaires dans différentes conditions pathologiques, nous avons exploré les mécanismes de régulations qui modulent les fonctions les basophiles. En particulier, nous avons étudié le rôle suppresseur des lymphocytes T régulateurs (Tregs) CD4+CD25+FoxP3, des cellules clés dans la maintenance de l’homéostasie immune, sur les fonctions des basophiles. Nos résultats montrent que les fonctions des basophiles, contrairement à la majorité des cellules immunes, ne sont pas régulées par les Tregs. Bien au contraire, nos résultats montrent que les lymphocytes T favorisent l’activation des basophiles. En résumé, nous avons exploré de nouveaux mécanismes cellulaires et moléculaires impliqués dans la régulation des fonctions des basophiles humains. Ces résultats nous permettent de mieux comprendre le rôle des basophiles dans les conditions inflammatoires et dans le développement de nouvelles stratégies thérapeutiques. / Basophils are the rare granulocytes and play an important role in the polarization of Th2 responses, differentiation of B cells and protection against helminths. Basophils have a major influence on immune responses and various roles of these cells in autoimmune and inflammatory diseases are emerging. Recent reports showed that murine basophils function as antigen presenting cells (APCs) to induce Th2 and IgE responses to allergens and helminths. Therefore, I explored whether human basophils possess the features of APCs. I found that unlike dendritic cells (DCs) and monocytes, steady-state circulating human basophils did not express HLA-DR and co-stimulatory molecules CD80 and CD86. Basophils remained negative for these molecules following stimulation with various allergens, toll-like receptor ligands and IgE cross-linking.Unlike DCs, basophils did not promote Th2 and Th17 responses. Together, these results demonstrate the inability of circulating human basophils to function as professional APC. Further, basophils were also reported to be implicated in the pathogenesis of Th2 –associated and B cell-mediated autoimmune and inflammatory diseases. Considering the impact of dysregulated function of basophils on the outcome immune responses in various pathological conditions, it was essential to investigate the regulatory mechanisms by which basophil functions are kept in check. As CD4+CD25+FoxP3+ regulatory T cells (Tregs) are critical for the maintenance of immune homeostasis, I sought to investigate the interaction of Tregs with human basophils and its repercussion on basophil functions. My results indicated that unlike other immune cells that aresusceptible to Treg-mediated suppression, basophils are refractory to regulatory mechanism of Tregs. On the contrary I found that T cells could promote activation of basophils. My results thus provided an insight on cellular and molecular basis of regulation of human basophil functions. These data will have a repercussion in understanding role of basophils ininflammatory conditions and in designing therapeutic strategies.

L'inflammation allergique de la peau est un état dans lequel l'hôte réagit de manière excessive à des allergènes en induisant une inflammation de type Th2. Un certain nombre d’acteurs cellulaires et moléculaires ont été impliqués dans cette pathologie, mais la façon dont ils agissent dans le réseau inflammatoire demeure largement inconnue. Les basophiles ont été reconnus pour leurs fonctions effectrices en allergie, cependant, comment ils sont recrutés et activés, ainsi que comment ils interagissent avec d'autres cellules dans l’inflammation allergique cutanée demeurent mal caractérisés. L'objectif de ce travail de thèse est d'étudier le recrutement, l'activation et la fonction des basophiles dans le réseau inflammatoire de la peau allergique. En employant un modèle expérimental murin de dermatite de contact allergique, combiné à des outils génétique de souris, d’immunologie et d’approches biologiques cellulaires/moléculaires, l’étude de ma thèse a démontré que l’IL-3 joue un rôle crucial dans l’extravasation des basophiles dans la peau allergique des souris (Partie I), et que l’invalidation des basophiles chez les souris Mcpt8DTR entraîne une réduction systémique des éosinophiles et des neutrophiles (Partie II). Ces études fournissent ainsi de nouvelles connaissances sur le recrutement, l'activation et la fonction des basophiles dans l'inflammation allergique de la peau. / Allergic skin inflammation is a state in which the host overreacts to otherwise innocuous allergens by inducing T helper type 2 inflammation. A number of cellular and molecular players have been implicated in the generation of allergic skin inflammation, but how they act and crosstalk in the inflammatory network remains largely unknown. Basophils have been recognized for their effector functions in allergy, however, how they are recruited to the inflamed tissue, get activated and crosstalk with other cells in inflammatory skin remain still incompletely understood. The objective of this PhD study is to investigate the recruitment, activation and function of basophils in the inflammatory network of allergic skin. Using experimental mouse model for allergic contact dermatitis, combined with mouse genetic tools, immunology and cellular/molecular biology approaches, the study of my thesis discovered that IL-3 plays a crucial role in basophil extravasation to mouse allergic skin (Part I), and that the depletion of basophils in Mcpt8DTR mice leads to a systemic reduction of eosinophils and neutrophils (Part II). These studies provide novel insights into the recruitment, activation and function of basophils in allergic skin inflammation.

La leucémie aiguë à basophile du Nourrisson est un sous-type rare de leucémie aiguë myéloïde.Notre équipe avait précédemment participé à la caractérisation moléculaire de la translocationrécurrente t(X;6)(p11;q23) générant un gène de fusion MYB-GATA1 chez les nourrissons desexe masculin. Pour mieux comprendre son rôle, le facteur de transcription MYB-GATA1résultant de cette fusion a été exprimé dans des cellules progénitrices de l’hématopoïèsehumaine, CD34+ avant xénogreffe chez des souris immunodéficientes. Les cellules exprimantMYB-GATA1 présentaient une augmentation de l’expression des marqueurs d’immaturité(CD34), des marqueurs de la lignée granuleuse (CD33, CD117) et des signes de différenciationbasophile (CD203c, FcƐRI). Des cellules de lignée UT-7 ont également montré descaractéristiques de différenciation basophile après transduction par MYB-GATA1. Une analysetranscriptomique a permis de mettre en évidence 9 gènes dérégulés à la fois par la présence deMYB-GATA1 et par la différenciation basophile. L’augmentation de l’expression de 3 de cesgènes (CCL23, IL1RL1 et NTRK1) a été confirmée en RT-PCRq dans des cellules CD34+transduites avec MYB-GATA1. L’IL-33 (Interleukine 33) et le NGF (Nerve Growth Factor),les ligands respectifs de IL1RL1 et NTRK1, augmentent la différenciation basophile de cellulesUT-7 exprimant MYB-GATA1, démontrant l’importance de ces voies de signalisation dans ladifférenciation basophiles de cellules leucémiques et de cellules primaires de l’hématopoïèsehumaine CD34+. Enfin une expérience utilisant la luciférase a confirmé que MYB et MYBGATA1augmentaient l’activité des facteurs de transcription NTRK1 et IL1RL1 conduisant àl’acquisition de caractéristiques basophiles. Nos résultats soulignent ainsi l’importance desrécepteurs à l’IL-33 et au NGF dans la différenciation basophile des cellules normales etleucémiques. / Acute basophilic leukaemia (ABL) is a rare subtype of acute myeloblastic leukaemia. Wepreviously described a recurrent t(X;6)(p11;q23) translocation generating a MYB-GATA1fusion gene in male infants with ABL. To better understand its role, the chimeric MYB-GATA1transcription factor was expressed in CD34-positive hematopoietic progenitors which weretransplanted into immunodeficient mice. Cells expressing MYB-GATA1 showed increasedexpression of markers of immaturity (CD34), of granulocytic lineage (CD33, CD117) and ofbasophilic differentiation (CD203c, FcƐRI). UT-7 cells also showed basophilic differentiationafter MYB-GATA1 transfection. A transcriptomic study identified 9 genes deregulated by bothMYB-GATA1 and by basophilic differentiation. Induction of three of these genes (CCL23,IL1RL1 and NTRK1) was confirmed in MYB-GATA1-expressing CD34-positive cells byRTqPCR. IL-33 and NGF (Nerve Growth Factor), the ligands of IL1RL1 and NTRK1,respectively, enhanced the basophilic differentiation of MYB-GATA1-expressing UT-7 cells,thus demonstrating the importance of this pathway in basophilic differentiation of leukemiccells and CD34 positive primary cells. Finally, gene reporter assays confirmed that MYB andMYB-GATA1 activated NTRK1 and IL1RL1 transcription leading to basophilic skewing ofthe blasts. Our results highlight the role of IL-33 and NGF receptors in basophilic differentiationof normal and leukemic cells.

L’allergie de type I, une réaction de type hypersensibilité immédiate (HIS), a considérablement augmenté au cours des dernières décades dans les pays industrialisés. Le rôle des lymphocytes T régulateurs (Treg) dans le contrôle des maladies allergiques a été récemment apprécié. Cependant, il n’existe actuellement aucune connaissance précise si et comment les CD4+ Treg peuvent réguler l’allergie de type I. Le but du projet était d’étudier la contribution de cellules Treg dans le contrôle de l’allergie de type I chez la souris et chez l’homme. En utilisant un modèle murin d’HSI aux protéines de lait de vache, ß-lactoglobuline(BLG), nous avons montré que l’absence de Treg augmentait les réponses des cytokines Th1et Th2 et des anticorps IgE, IgG1 et IgG2a spécifique de la BLG. De plus, l’absence de Treg a augmenté la sévérité de l’anaphylaxie chez les souris sensibilisées lors de l’épreuve orale avec la BLG, avec une augmentation concomitante de la protéase des mastocytes muqueux 1(mMCP-1) dans le sérum. La contribution des cellules Treg dans un modèle murin d’anaphylaxie systémique passive (PSA) a été également étudiée. Une anaphylaxie plus sévère a été observée chez les souris déficientes en CHM de classe II ainsi que chez des souris B6 traitées avec un anti-CD4. En revanche, la déplétion sélective des Foxp3+ Treg chez des souris Tg DEREG n’a pas d’effet sur l’anaphylaxie.La capacité des Treg à contrôler la dégranulation des basophiles a été étudiée chez l’homme. Les données préliminaires ont montré que les Treg ont été incapables de contrôler la dégranulation des basophiles chez les donneurs sains. En revanche, une légère mais reproductible down-regulation de la dégranulation/activation des basophiles a été observée dans l’allergie induite par les médicaments chez l’homme. Dans l’ensemble, notre travail met en évidence un nouveau rôle encore non identifié des Treg dans le contrôle de l’HSI et souligne que chez la souris et l’homme, les Treg peuvent dans certaines conditions, limiter la sévérité de l’HSI en agissant sur les mastocytes et/ou basophiles effecteurs / Type I allergy, an immediate type hypersensitivity reaction (ITH), has dramatically increased during the past decades affecting up to 30% of the population in industrialized countries. The role of regulatory T cells (Treg) in the control of allergic diseases has been recently appreciated. However, there is currently no precise knowledge of whether and howCD4+ Treg can regulate type I allergy. The aim of this project was to investigate the contribution of Treg in the control of type I allergy. Using a murine model of ITH to cow’s milk protein the ß-lactoglobulin (BLG), we showed that lack of Treg increased BLG-specific Th2 and Th1 cytokine response and BLG-specific IgE, IgG1 and IgG2a antibodies.Furthermore, absence of Treg enhanced the severity of the anaphylaxis with concomitant increase in serum mucosal mast cell protease 1 (mMCP-1) in sensitized mice upon oral challenge with BLG. Furthermore, we investigated the contribution of Treg in a murine model of passive systemic anaphylaxis (PSA). More sever anaphylaxis was observed in both MHCclass II KO mice and after anti-CD4 mAb treatment. Alternatively, selective depletion of Foxp3+ Treg in DEREG Tg mice did not show changes in anaphylaxis.The capacity of Treg to control basophils degranulation was investigated in humans. Preliminary data showed that Treg were unable to control basophils degranulation in healthy donors. In contrast, a slight butreproducible downregulation of basophils activation/ degranulation was observed in allergic individuals. Taken together, our work points out to a novel as yet unidentified role of Treg in the control of ITH and emphasizes that both mouse and human Treg can, in certain conditions, limit the severity of ITH by acting on mast cells and/or basophils effectors of ITH

INTRODUÇÃO: A Urticária Crônica é caracterizada pelo aparecimento de pápulas eritematosas, pruriginosas recorrentes e transitórias que duram por mais de seis semanas. Na maioria dos pacientes a causa é indeterminada, definida como idiopática (UCI), entretanto, um sub-grupo apresentam autoanticorpos contra a cadeia alfa do receptor de alta afinidade para IgE (FceRI), que são expressos na superfície de mastócitos e basófilos, tornando-os células alvo nesta doença. OBJETIVOS: Avaliar em pacientes com UCI, submetidos ao teste intradérmico de soro autólogo (ASST), o perfil de ativação dos basófilos, pela intensidade de expressão de marcadores de ativação/desgranulação e pela capacidade dos basófilos em responder aos estímulo com a IL-3 e anticorpo anti-IgE. Além disto, a presença de fator liberador de histamina foi avaliado nos soros dos pacientes. METODOLOGIA: Pacientes com UCI (n= 37) foram selecionados no Ambulatório de Urticária do Departamento de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da USP e submetidos ao ASST. O grupo controle foi constituído por indivíduos saudáveis (n=38). A análise da expressão de FceRI, CD63, CD123 e CD203c em basófilos de sangue periférico foi realizada por citometria de fluxo. No ensaio in vitro de estimulação dos basófilos com anti-IgE, as células foram previamente incubadas com IL-3. O ensaio de liberação de histamina mediada por soros de pacientes com UCI foi realizado com três diferentes doadores de leucócitos e a histamina liberada dosada por ELISA de competição. RESULTADOS: Há um baixo número de basófilos no sangue periférico nos pacientes com UCI, coincidente com o baixo nível sérico de histamina. Os escassos basófilos no sangue periférico mostram elevada expressão de FceRI e uma regulação positiva da expressão de CD203c e CD63, independentemente do ASST. A análise funcional dos basófilos, mostra que somente a incubação com IL-3 recombinante já induz aumento significante da expressão de CD203c e da liberação de histamina dos basófilos de pacientes com UCI, que são intensificados com o estímulo por anticorpos anti-IgE após 15 e 40 minutos em relação ao grupo controle. Já a expressão de CD63 em basófilos após estímulo com anti-IgE, aumentou somente nos basófilos de indivíduos sadios, uma vez que os níveis de expressão basal estavam previamente aumentados. A presença de autoanticorpos liberadores de histamina foi analisada nos soros de pacientes com UCI. Três experimentos independentes foram realizados, evidenciando a ocorrência de 17% de positividade. CONCLUSÕES: Os resultados mostram que na UCI, os basófilos são sensibilizados in vivo, por fatores além dos autoanticorpos anti-FceRI e que funcionalmente, estão hiper-reativos a estímulos imunológicos. A presença de fatores séricos liberadores de histamina, independente do ASST, enfatiza que o teste intradérmico é sugestivo de autorreatividade e não de autoimunidade na UC / INTRODUCTION: Chronic Urticaria is characterized by recurrent, transitory, pruritic and erythematous wheals present for at least six weeks. In most patients the cause is unknown, defined as idiopathic (CIU), however, a sub-group has autoantibodies against the alfa chain of the high affinity IgE receptor (FceRIa) expressed on mast cells and basophils surface making it the target cells in this disease. OBJECTIVES: To evaluate in CIU patients, undergone autologous serum skin test (ASST), the activation profile of the basophils assessed by the expression of activation/degranulation markers and by the ability to release histamine in response to IL-3 priming and cross-linking with anti-IgE antibodies. Furthermore, the presence of histamine releasing factor in sera of patients was evaluated. METHODS: CIU patients (n = 37) were selected from the Dermatological Outpatient Clinic of the Hospital das Clínicas de São Paulo (HC-FMUSP) and submitted to the ASST. The control group consisted of healthy subjects (n=38). The analysis of the expression of FceRI, CD63, CD123 and CD203c on basophils from peripheral blood was assessed by flow cytometry. For the in vitro stimulation with anti-IgE antibodies, the cells were previously primed with human recombinant IL-3. The histamine release assay mediated by sera from patients with CIU was performed with three different donors of leukocytes and released histamine measured by competition ELISA. RESULTS: There is a low number of basophils in peripheral blood of patients with CIU, reflecting a low serum levels of histamine. The scarce basophils in peripheral blood show high expression of FceRI and an up-regulation of CD203c and CD63 marker expression, independently of the ASST. The functional analysis of basophils, revealed that recombinant IL-3 per se induces a significant increase in CD203c expression and the histamine release from basophils of patients with CIU, which are enhanced followed for 15 and 40 minutes of anti-IgE estimulation. The expression of CD63 in basophils upon anti-IgE stimulation, increased only in basophils of healthy individuals, since the baseline levels of CD63 expression on basophils of patients was already up-regulated. The presence of histamine release factors was examined in sera from CIU patients. Three independent experiments were performed, showing the occurrence of 17% of positivity. CONCLUSION: The results show that in CIU, the basophils are primed in vivo due to factor other than autoantibodies anti-FceRI and they have an hyperactive status to the immunological stimuli. The presence of serum histamine releasing factors, independent of the ASST, emphasizes that the intradermal test is suggestive of autorreactivity and not for autoimmunity in UC

INTRODUÇÃO: A Urticária Crônica é caracterizada pelo aparecimento de pápulas eritematosas, pruriginosas recorrentes e transitórias que duram por mais de seis semanas. Na maioria dos pacientes a causa é indeterminada, definida como idiopática (UCI), entretanto, um sub-grupo apresentam autoanticorpos contra a cadeia alfa do receptor de alta afinidade para IgE (FceRI), que são expressos na superfície de mastócitos e basófilos, tornando-os células alvo nesta doença. OBJETIVOS: Avaliar em pacientes com UCI, submetidos ao teste intradérmico de soro autólogo (ASST), o perfil de ativação dos basófilos, pela intensidade de expressão de marcadores de ativação/desgranulação e pela capacidade dos basófilos em responder aos estímulo com a IL-3 e anticorpo anti-IgE. Além disto, a presença de fator liberador de histamina foi avaliado nos soros dos pacientes. METODOLOGIA: Pacientes com UCI (n= 37) foram selecionados no Ambulatório de Urticária do Departamento de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da USP e submetidos ao ASST. O grupo controle foi constituído por indivíduos saudáveis (n=38). A análise da expressão de FceRI, CD63, CD123 e CD203c em basófilos de sangue periférico foi realizada por citometria de fluxo. No ensaio in vitro de estimulação dos basófilos com anti-IgE, as células foram previamente incubadas com IL-3. O ensaio de liberação de histamina mediada por soros de pacientes com UCI foi realizado com três diferentes doadores de leucócitos e a histamina liberada dosada por ELISA de competição. RESULTADOS: Há um baixo número de basófilos no sangue periférico nos pacientes com UCI, coincidente com o baixo nível sérico de histamina. Os escassos basófilos no sangue periférico mostram elevada expressão de FceRI e uma regulação positiva da expressão de CD203c e CD63, independentemente do ASST. A análise funcional dos basófilos, mostra que somente a incubação com IL-3 recombinante já induz aumento significante da expressão de CD203c e da liberação de histamina dos basófilos de pacientes com UCI, que são intensificados com o estímulo por anticorpos anti-IgE após 15 e 40 minutos em relação ao grupo controle. Já a expressão de CD63 em basófilos após estímulo com anti-IgE, aumentou somente nos basófilos de indivíduos sadios, uma vez que os níveis de expressão basal estavam previamente aumentados. A presença de autoanticorpos liberadores de histamina foi analisada nos soros de pacientes com UCI. Três experimentos independentes foram realizados, evidenciando a ocorrência de 17% de positividade. CONCLUSÕES: Os resultados mostram que na UCI, os basófilos são sensibilizados in vivo, por fatores além dos autoanticorpos anti-FceRI e que funcionalmente, estão hiper-reativos a estímulos imunológicos. A presença de fatores séricos liberadores de histamina, independente do ASST, enfatiza que o teste intradérmico é sugestivo de autorreatividade e não de autoimunidade na UC / INTRODUCTION: Chronic Urticaria is characterized by recurrent, transitory, pruritic and erythematous wheals present for at least six weeks. In most patients the cause is unknown, defined as idiopathic (CIU), however, a sub-group has autoantibodies against the alfa chain of the high affinity IgE receptor (FceRIa) expressed on mast cells and basophils surface making it the target cells in this disease. OBJECTIVES: To evaluate in CIU patients, undergone autologous serum skin test (ASST), the activation profile of the basophils assessed by the expression of activation/degranulation markers and by the ability to release histamine in response to IL-3 priming and cross-linking with anti-IgE antibodies. Furthermore, the presence of histamine releasing factor in sera of patients was evaluated. METHODS: CIU patients (n = 37) were selected from the Dermatological Outpatient Clinic of the Hospital das Clínicas de São Paulo (HC-FMUSP) and submitted to the ASST. The control group consisted of healthy subjects (n=38). The analysis of the expression of FceRI, CD63, CD123 and CD203c on basophils from peripheral blood was assessed by flow cytometry. For the in vitro stimulation with anti-IgE antibodies, the cells were previously primed with human recombinant IL-3. The histamine release assay mediated by sera from patients with CIU was performed with three different donors of leukocytes and released histamine measured by competition ELISA. RESULTS: There is a low number of basophils in peripheral blood of patients with CIU, reflecting a low serum levels of histamine. The scarce basophils in peripheral blood show high expression of FceRI and an up-regulation of CD203c and CD63 marker expression, independently of the ASST. The functional analysis of basophils, revealed that recombinant IL-3 per se induces a significant increase in CD203c expression and the histamine release from basophils of patients with CIU, which are enhanced followed for 15 and 40 minutes of anti-IgE estimulation. The expression of CD63 in basophils upon anti-IgE stimulation, increased only in basophils of healthy individuals, since the baseline levels of CD63 expression on basophils of patients was already up-regulated. The presence of histamine release factors was examined in sera from CIU patients. Three independent experiments were performed, showing the occurrence of 17% of positivity. CONCLUSION: The results show that in CIU, the basophils are primed in vivo due to factor other than autoantibodies anti-FceRI and they have an hyperactive status to the immunological stimuli. The presence of serum histamine releasing factors, independent of the ASST, emphasizes that the intradermal test is suggestive of autorreactivity and not for autoimmunity in UC

Introdução: Atualmente, o diagnóstico das reações de hipersensibilidade a anti-inflamatórios não esteroidais (AINEs) baseia-se na história relatada pelo paciente e, em determinados casos, é realizado o Teste de Provocação. Todavia, este teste pode expor os pacientes a riscos graves, inclusive anafilaxia. Em busca de ferramenta mais segura, tem-se estudado o Teste de Ativação de Basófilos (BAT). Trata-se de um teste in vitro, no qual é possível testar diversos estímulos em uma única amostra de sangue, avaliando a ativação dos basófilos (indicativo de reação de hipersensibilidade), através do aumento da expressão de moléculas na superfície desses leucócitos, como o CD63. Objetivo: Padronizar e validar o BAT para ácido acetilsalicílico (AAS), diclofenaco, dipirona e paracetamol em pacientes com hipersensibilidade a AINEs. Metodologia: Participaram 20 (testados com os quatro AINEs) + 33 (testados somente com AAS) pacientes atendidos no Serviço de Imunologia Clínica e Alergia do HCFMUSP, que apresentaram manifestações cutâneas em até 24 horas após exposição a um ou múltiplos AINEs, bem como 13 (quatro AINEs) + 26 (AAS) controles. A técnica consistiu em incubar sangue total com os AINEs já mencionados e, depois, marcar as amostras com anticorpos monoclonais (CD45, anti-IgE e CD63) para posterior leitura por citometria de fluxo. Os resultados obtidos foram comparados com as histórias clínicas e os testes de provocação oral, quando realizados. Resultados: Utilizando os critérios de positividade do BAT empregados na literatura (isto é, porcentagem de CD45+IgE+highCD63+ e índice de estimulação), a sensibilidade e a especificidade variaram de acordo com o AINE: para ácido acetilsalicílico foram 75,0% e 16,7%, respectivamente, diclofenaco, 100% e 0%, dipirona, 23,5% e 66,7%, paracetamol, 40,0% e 42,9%. Após a realização de curvas dose-resposta e tempo-resposta somente com AAS, foi encontrado novo critério de positividade: média de intensidade de fluorescência (MFI) menor do que 6575 representava BAT positivo; com isso, os valores de sensibilidade e especificidade foram: 84,4% e 34,6%, respectivamente. O BAT foi mais sensível em pacientes cuja última reação ocorreu há menos de um ano da data de execução do BAT (93,7%). Conclusão: Devido aos baixos valores de sensibilidade e/ou especificidade, não foi possível padronizar e, por conseguinte, validar o BAT para ácido acetilsalicílico, diclofenaco, dipirona e paracetamol. / Introduction: Currently, the diagnosis of nonsteroidal antiinflammatory drugs (NSAIDs) hypersensivitity is based on patients´ clinical history and drug provocation tests, which are done in selected cases. Nevertheless, this test may expose patients to severe risks, including anaphylaxis. Looking for a safer tool, Basophil Activation Test (BAT) for allergy diagnosis has been studied in the last years. It is an in vitro method where a wide variety of stimuli can be tested, incubating them with the patient\'s blood sample, and observing basophil activation (indication of hypersensitivity) through upregulation of CD63 (or other basophil activation markers) on this leucocyte\'s membrane. Objective: To standardize and validate BAT stimulated with acetylsalicylic acid (ASA), diclophenac, dipyrone and paracetamol in NSAID hypersensitive patients. Methods: Patients which reported immediate reactions (less than 24 hours) after exposure to one or multiple NSAIDs, with cutaneous symptoms were enrolled from Clinical Immunology and Allergy outpatient clinic from HC-FMUSP. BAT with the four NSAIDs was tested on 20 patients and 13 controls and BAT with ASA only, on 33 patients and 26 controls. BAT consisted of incubating whole blood with NSAIDs, then triple-labeled with monoclonal antibodies (CD45, anti-IgE, CD63) for analysis by flow cytometry. BAT results were compared to clinical history and oral provocation tests, when available. Results: According to literature\'s positivity criteria (percentage of CD45+IgE+highCD63+ and stimulation index), sensitivity and specificity varied according to the NSAID tested: for ASA was 75.0% and 16.7% respectively, diclophenac, 100.0% and 0.0%, dipyrone, 23.5% and 66.7%, paracetamol, 40.0% and 42.9%. A new positivity criterion was possible to be defined after further dose-response and time-response curves only for ASA: Mean Fluorescence Intensity lower than 6575 (positive BAT). Accordingly, new sensitivity and specificity for BAT in ASA hypersensitivity were 84,4% and 34,6%. Patients that presented the last reaction in the last year were more likely to present a positive BAT (93.7%). Conclusion: Due to low values for sensitivity and/or specificity, it was not possible to standardize and validate BAT for ASA, diclophenac, dipyrone and paracetamol.

Introdução: Atualmente, o diagnóstico das reações de hipersensibilidade a anti-inflamatórios não esteroidais (AINEs) baseia-se na história relatada pelo paciente e, em determinados casos, é realizado o Teste de Provocação. Todavia, este teste pode expor os pacientes a riscos graves, inclusive anafilaxia. Em busca de ferramenta mais segura, tem-se estudado o Teste de Ativação de Basófilos (BAT). Trata-se de um teste in vitro, no qual é possível testar diversos estímulos em uma única amostra de sangue, avaliando a ativação dos basófilos (indicativo de reação de hipersensibilidade), através do aumento da expressão de moléculas na superfície desses leucócitos, como o CD63. Objetivo: Padronizar e validar o BAT para ácido acetilsalicílico (AAS), diclofenaco, dipirona e paracetamol em pacientes com hipersensibilidade a AINEs. Metodologia: Participaram 20 (testados com os quatro AINEs) + 33 (testados somente com AAS) pacientes atendidos no Serviço de Imunologia Clínica e Alergia do HCFMUSP, que apresentaram manifestações cutâneas em até 24 horas após exposição a um ou múltiplos AINEs, bem como 13 (quatro AINEs) + 26 (AAS) controles. A técnica consistiu em incubar sangue total com os AINEs já mencionados e, depois, marcar as amostras com anticorpos monoclonais (CD45, anti-IgE e CD63) para posterior leitura por citometria de fluxo. Os resultados obtidos foram comparados com as histórias clínicas e os testes de provocação oral, quando realizados. Resultados: Utilizando os critérios de positividade do BAT empregados na literatura (isto é, porcentagem de CD45+IgE+highCD63+ e índice de estimulação), a sensibilidade e a especificidade variaram de acordo com o AINE: para ácido acetilsalicílico foram 75,0% e 16,7%, respectivamente, diclofenaco, 100% e 0%, dipirona, 23,5% e 66,7%, paracetamol, 40,0% e 42,9%. Após a realização de curvas dose-resposta e tempo-resposta somente com AAS, foi encontrado novo critério de positividade: média de intensidade de fluorescência (MFI) menor do que 6575 representava BAT positivo; com isso, os valores de sensibilidade e especificidade foram: 84,4% e 34,6%, respectivamente. O BAT foi mais sensível em pacientes cuja última reação ocorreu há menos de um ano da data de execução do BAT (93,7%). Conclusão: Devido aos baixos valores de sensibilidade e/ou especificidade, não foi possível padronizar e, por conseguinte, validar o BAT para ácido acetilsalicílico, diclofenaco, dipirona e paracetamol. / Introduction: Currently, the diagnosis of nonsteroidal antiinflammatory drugs (NSAIDs) hypersensivitity is based on patients´ clinical history and drug provocation tests, which are done in selected cases. Nevertheless, this test may expose patients to severe risks, including anaphylaxis. Looking for a safer tool, Basophil Activation Test (BAT) for allergy diagnosis has been studied in the last years. It is an in vitro method where a wide variety of stimuli can be tested, incubating them with the patient\'s blood sample, and observing basophil activation (indication of hypersensitivity) through upregulation of CD63 (or other basophil activation markers) on this leucocyte\'s membrane. Objective: To standardize and validate BAT stimulated with acetylsalicylic acid (ASA), diclophenac, dipyrone and paracetamol in NSAID hypersensitive patients. Methods: Patients which reported immediate reactions (less than 24 hours) after exposure to one or multiple NSAIDs, with cutaneous symptoms were enrolled from Clinical Immunology and Allergy outpatient clinic from HC-FMUSP. BAT with the four NSAIDs was tested on 20 patients and 13 controls and BAT with ASA only, on 33 patients and 26 controls. BAT consisted of incubating whole blood with NSAIDs, then triple-labeled with monoclonal antibodies (CD45, anti-IgE, CD63) for analysis by flow cytometry. BAT results were compared to clinical history and oral provocation tests, when available. Results: According to literature\'s positivity criteria (percentage of CD45+IgE+highCD63+ and stimulation index), sensitivity and specificity varied according to the NSAID tested: for ASA was 75.0% and 16.7% respectively, diclophenac, 100.0% and 0.0%, dipyrone, 23.5% and 66.7%, paracetamol, 40.0% and 42.9%. A new positivity criterion was possible to be defined after further dose-response and time-response curves only for ASA: Mean Fluorescence Intensity lower than 6575 (positive BAT). Accordingly, new sensitivity and specificity for BAT in ASA hypersensitivity were 84,4% and 34,6%. Patients that presented the last reaction in the last year were more likely to present a positive BAT (93.7%). Conclusion: Due to low values for sensitivity and/or specificity, it was not possible to standardize and validate BAT for ASA, diclophenac, dipyrone and paracetamol.

Lyme borreliosis is a multisystemic disease affecting skin, joints, heart and central nervous system. The disease is caused by spirochetes of Borrelia burgdorferi sensu lato complex. These bacteria are spread by ticks of Ixodes genus. In 2016 there were almost 4,000 newly infected individuals reported in the Czech Republic. Contemporary serological diagnostics of Lyme borreliosis is not sensitive nor specific enough and does not even correlate with the pathology of the disease in the early or late phases. For the correct diagnosis of the disease it is necessary to detect the pathogen and its genotype. For this reason we had aimed at two goals. Through the digital droplet PCR (ddPCR) method we detected Borrelia-specific DNA and its genotype. The detection limit of borrelial DNA was set on gDNA samples isolated from the tick. Detection threshold for the initial amount of 1 ng of tick gDNA is at the range of 10-17 g of specific borrelial DNA. Borrelia spp. coinfection was detected in 5 out of 12 tested samples. The most frequent type was B. garinii which was detected in 5 samples. On the basis of published sequences for virulent factors we have designed specific primers in conserved regions of the genes flanking their variable segments to be PCR amplified. Gene variability will be monitored through...