O fator CIITA é a proteína responsável por controlar a transcrição de genes do complexo principal de histocompatibilidade de classe II (MHC II) envolvidos na apresentação antigênica a linfócitos T CD4+. A expressão desta proteína é complexa e célula-específica, dependendo de mecanismos de regulação transcricionais e póstranscricionais. Com o intuito de investigar o potencial do fator CIITA como adjuvante molecular, no presente estudo desenvolvemos e validamos sistemas de transferência gênica capazes de promover a eficiente expressão de CIITA em vários tipos celulares. Além disso, investigamos a regulação pós-traducional deste fator em células não hematopoéticas. Desta forma, foram produzidos um vetor plasmidial e um vetor lentiviral, ambos carreando a sequência do fator CIITA humano desenhada in silico visando a eliminação de elementos cis-reguladores, e otimizada para eficiente expressão em células humanas. A transfecção/transdução de três linhagens de células humanas não hematopoéticas resultou na eficiente expressão de CIITA com localização nuclear apropriada. Células expressando CIITA apresentaram síntese de novo do MHC II, confirmando a funcionalidade da proteína e validando ambos os vetores para a análise futura da atividade adjuvante do CIITA em imunizações gênicas. Ensaios preliminares de inoculação de explantes de pele humana com o vetor lentiviral evidenciaram a eficiente transdução e expressão do CIITA exógeno em células primárias. Em seguida, células dendríticas (DCs) derivadas de monócitos de indivíduos saudáveis ou infectados com HIV-1 foram transduzidas com o vetor lentiviral para confirmar a expressão do CIITA em células primárias e avaliar a aplicação desse sistema adjuvante no aprimoramento da vacina de DCs anti-HIV. DCs de indivíduos saudáveis ou infectados foram transduzidas com sucesso pelo lentivírus, o qual induziu uma produção prolongada do mRNA codificando CIITA. Entretanto, os vetores lentivirais induziram um aumento inespecífico da expressão de marcadores fenotípicos das DCs, incluindo as moléculas do MHC II, o que impediu a avaliação indireta da expressão e atividade do fator CIITA através da detecção da expressão aumentada do MHC II. Ensaios futuros irão avaliar se o fator transcricional é expresso pelas DCs transduzidas ou se essas células apresentam um controle mais restrito da expressão do CIITA comparadas às linhagens celulares avaliadas. Interessantemente, ensaios de western blot comparativos entre as três linhagens de células humanas transfectadas/transduzidas, juntamente com ensaios de inibição da degradação protéica pelo inibidor do proteassoma, nos permitiu descrever um novo mecanismo de regulação pós-traducional do CIITA. Aqui, nós identificamos que cada tipo de célula não hematopoética mantém níveis específicos da proteína, e portanto, da sua atividade transcricional, através da regulação da degradação do CIITA pelo proteassoma. Essa regulação é mediada pela modulação dos níveis das proteínas da leucemia promielocítica (PML) acopladas a proteínas SUMO (modificadores pequenos similares à ubiquitina), modificação pós-traducional requerida para a interação PML-CIITA que impede a degradação pelo proteassoma. Esse novo mecanismo aqui descrito contribui para o entendimento ainda incipiente da regulação pós-traducional do fator CIITA em células não hematopoéticas e pode ter implicações importantes na aplicação dessa proteína como adjuvante molecular para imunoterapias / The CIITA factor is a protein responsible for controlling the transcription of major histocompatibility complex class II (MHC II) genes involved on antigen presentation to CD4+ T helper cells. The expression of this transcription factor is complex and differs in various cell types depending on transcriptional and post-transcriptional regulatory mechanisms. In order to investigate the CIITA factor potential as molecular adjuvant, here we developed and validated two gene delivery systems capable of promoting efficient CIITA expression in various human cell types. Additionally, we applied the delivery systems to investigate the post-translational regulation of this factor in nonimmune cells. A DNA plasmid and a lentiviral vector were produced, both carrying the human CIITA DNA sequence in silico designed to avoid cis-regulatory elements, and genetic optimized for expression efficacy in human cells. Transfection or transduction of three different non-immune human cell lines resulted in efficient CIITA expression with proper nuclear localization. The CIITA-expressing cells presented de novo MHC II molecules expression confirming the functionality of the exogenous protein, and validating both delivery systems for the future analysis of the CIITA adjuvant activity in genetic immunizations. Preliminary assays involving the inoculation of the lentiviral vector into human skin explants showed efficient transduction and expression of exogenous CIITA in primary cells. Next, monocyte-derived dendritic cells (DCs) from healthy individuals and HIV-1-infected patients were transduced with the lentiviral vector to confirm the exogenous CIITA expression in primary human cells and also evaluate the applicability of this adjuvant system to improve the DC-based vaccines against HIV. DCs from healthy and infected individuals were successfully transduced by the lentivirus, which induced a sustained CIITA mRNA production. However, the vector particles by themselves induced an unspecific upregulation of DC`s phenotypic surface markers, including the MHC II molecules, impairing our strategy to indirectly evaluate CIITA expression and activity through the detection of MHC II enhanced expression. Further investigations are necessary to confirm whether the transcription factor is efficiently expressed in transduced DCs or if these cells present a more restrict control of CIITA protein expression than the evaluated non-immune cells. Interestingly, western blot assays comparing the three human cell lines, transfected or transduced, along with inhibition of protein degradation by proteasome inhibitor treatments, allowed us to describe a new and intricate mechanism of CIITA post-translational regulation. Here we identified that each non-immune cell type maintain specific protein levels, and hence transcriptional activity, by modulating the rate of CIITA proteasomal degradation. This modulation is achieved by controlling the levels of Promyelocytic Leukemia (PML) proteins attached to Small Ubiquitin-like Modifier (SUMO) proteins, a post-translational modification required for the PML-CIITA interaction, which impairs the proteasomal degradation. This new mechanism described here contributes to the developing understanding of the CIITA post-translational regulation in non-immune cells, and might have important implications in the use of this transcription factor as a molecular adjuvant for immunotherapies

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that leads to degradation of cartilage and bone mainly in peripheral joints. In collagen-induced arthritis (CIA), a mouse model for RA, activation of autoimmune CD4+ T cells depends on a molecular recognition system where T-cell receptors (TCRs) recognize a complex between the class II MHC Aq protein and CII259-273, a glycopeptide epitope from type II collagen (CII). Interestingly, vaccination with the Aq/CII259-273 complex can relieve symptoms and cause disease regression in mice. This thesis describes the use of modified glycopeptides to explore interactions important for binding to the Aq protein and recognition by autoimmune T-cell hybridomas obtained from mice with CIA. The CII259-273 glycopeptide was modified by replacement of backbone amides with different amide bond isosteres, as well as substitution of two residues that anchor the glycopeptide in prominent pockets in the Aq binding site. A three-dimensional structure of the Aq/glycopeptide complex was modeled to provide a structural basis for interpretation of the modified glycopeptide’s immunological activities. Overall, it was found that the amide bond isosteres affected Aq binding more than could be explained by the static model of the Aq/glycopeptide complex. Molecular dynamics (MD) simulations, however, revealed that the introduced amide bond isosteres substantially altered the hydrogen-bonding network formed between the N-terminal 259-265 backbone sequence of CII259-273 and Aq. These results indicated that the N-terminal hydrogen-bonding interactions follow a cooperative model, where the strength and presence of individual hydrogen bonds depended on the neighboring interactions. The two important anchor residues Ile260 and Phe263 were investigated using a designed library of CII259-273 based glycopeptides with substitutions by different (non-)natural amino acids at positions 260 and 263. Evaluation of binding to the Aq protein showed that there was scope for improvement in position 263 while Ile was preferred in position 260. The obtained SAR understanding provided a valuable basis for future development of modified glycopeptides with improved Aq binding. Furthermore, the modified glycopeptides elicited varying T-cell responses that generally could be correlated to their ability to bind to Aq. However, in several cases, there was a lack of correlation between Aq binding and T-cell recognition, which indicated that the interactions with the TCRs were determined by other factors, such as presentation of altered epitopes and changes in the kinetics of the TCR’s interaction with the Aq/glycopeptide complex. Several of the modified glycopeptides were also found to bind well to the human RA-associated DR4 protein and elicit strong responses with T-cell hybridomas obtained from transgenic mice expressing DR4 and the human CD4 co-receptor. This encourages future investigations of modified glycopeptides that can be used to further probe the MHC/glycopeptide/TCR recognition system and that also constitute potential therapeutic vaccines for treatment of RA. As a step towards this goal, three modified glycopeptides presented in this thesis have been identified as candidates for vaccination studies using the CIA mouse model.

L’infection par le VIH-1 est caractérisée par une déplétion progressive des cellules T CD4+ ainsi que par un dysfonctionnement des cellules T qui, en l’absence de traitements anti-rétroviraux, conduit inéluctablement à la progression de la maladie vers le stade SIDA. Certains des mécanismes impliqués dans ce dysfonctionnement de la réponse cellulaire T ont été élucidés et ont révélé un rôle important de la molécule PD-1 dans l’exhaustion des cellules T en phase chronique de l’infection. En effet, des niveaux élevés de PD-1 ont été associés à une charge virale élevée ainsi qu’à une diminution de la production de cytokines et de la capacité de proliférer des cellules T spécifiques du virus. De plus, bloquer in vitro l’interaction de PD-1 avec son ligand PD-L1 en utilisant un anticorps bloquant rétabli la fonction de ces cellules. De façon intéressante, notre groupe ainsi que d’autres équipes, ont montré que l’expression de PD-1 était non seulement augmentée sur les cellules spécifiques de l’antigène mais aussi sur les cellules T totales. Cependant, peu de choses sont connues quant à l’impact de l’expression de PD-1 sur le renouvellement et la différenciation des cellules T qui expriment PD-1, et ce au cours de l’infection. L’expression de PD-1 n’a notamment pas été étudiée en phase aigue de l’infection. Nous montrons clairement que, aussi bien chez les individus en phase aigue qu’en phase chronique de l’infection, l’expression de PD-1 est augmentée sur toutes les sous-populations T, y compris les cellules naïves. Nous avons également mis en relief une distribution anormale des sous-populations T, ces cellules ayant un phénotype plus différencié, et ce à tous les stades de la maladie. Dans cette thèse, nous discutons le rôle possible de PD-1 dans l’homéostasie des cellules T chez les individus infectés par le VIH-1. En étudiant la transition de la phase aigue à la phase chronique de l’infection, nous avons trouvé que les sous-populations T CD8+ des individus récemment infectés exprimaient moins de PD-1 que celles des individus à un stade plus avancé de la maladie. Ces niveaux plus élevés de PD-1 sur les cellules T CD8+ en phase chronique sont associés à des niveaux réduits de prolifération in vivo – comme mesuré par l’expression de Ki67 – suggérant que l’expression de PD-1 est partiellement impliquée dans cette perte de fonction des cellules T CD8+. De plus, les cellules naïves s’accumulent en fréquence lors de la transition de la phase aigue à la phase chronique de l’infection. Considérant que les cellules naïves expriment déjà des hauts niveaux de PD-1, nous avons émis l’hypothèse que l’activation initiale des cellules T chez les individus chroniquement infectés est affectée. En résumé, nous proposons un modèle où des hauts niveaux d’expression de PD-1 sont associés à (1) un dysfonctionnement de la réponse cellulaire T CD8+ et (2) un défaut d’activation des cellules naïves ce qui contribue non seulement à la progression de la maladie mais aussi ce qui va limiter l’efficacité de potentiels vaccins dans l’infection par le VIH-1 en empêchant toute nouvelle réponse d’être initiée. Afin de mieux disséquer la réponse immunitaire mise en place lors d’une infection comme celle du VIH-1, nous avons développé un outil qui permet de détecter les cellules T CD4+ i.e. des tétramères de CMH de classe II. Ces réactifs ont pour but d’augmenter l’avidité du CMH de classe II pour son ligand et donc de détecter des TCR de faible affinité. Dans cette thèse, nous décrivons une méthode originale et efficace pour produire diverses molécules de HLA-DR liant de façon covalente le peptide antigénique. Mieux déterminer les mécanismes responsables de l’exhaustion des cellules T dans l’infection par le VIH-1 et de la progression de la maladie, ainsi que développer des outils de pointe pour suivre ces réponses T, est central à une meilleure compréhension de l’interaction entre le virus et le système immunitaire de l’hôte, et permettra ainsi le développement de stratégies pertinentes pour lutter contre l’infection par le VIH-1. / HIV-1 infection leads to a progressive CD4+ T cell depletion and T cell dysfunction, which in the absence of successful anti-retroviral therapy, results in individuals progressing to AIDS. Some of the underlying mechanisms for this T cell dysfunction have been elucidated and reveal an important role for the inhibitory receptor program death-1 (PD-1) in T cell exhaustion during chronic HIV-1 infection. Indeed, PD-1 up regulation correlates with increased viral load as well as decreased cytokine production and proliferative capacity of HIV-1 specific T cells. Moreover, blocking in vitro the interaction of PD-1 with its counter-receptor PD-L1 using antibodies restores HIV-1 specific T cell effector functions. Interestingly, our group and others have shown that levels of PD-1 during chronic HIV-1 infection are not only up regulated on virus-specific T cells but also on the total pool of CD4+ and CD8+ T cells. However, little is known about the impact of PD-1 expression on the turnover and maturation status of the PD-1 expressing cells during the course of the disease. Of note, PD-1 expression has never been investigated in acute HIV-1 infection. In this thesis, we clearly show that, in both acutely and chronically HIV-1 infected individuals, PD-1 is up regulated on all T cell subsets, including naïve T cells. We also uncovered an abnormal distribution of T cell subsets toward a more differentiated phenotype at all stages of the disease. In this thesis, we discuss the possible role of PD-1 in the homeostasis breakdown observed in HIV-1 infected individuals. More interestingly, if we focus on the transition from the acute to the chronic phase of the infection, we found that PD-1 is expressed at much lower levels on total CD8+ T cell subsets from acutely infected individuals than chronically infected individuals. These augmented PD-1 expression levels on CD8+ T cell in chronic infection are associated with reduced levels of in vivo cell proliferation - as monitored by Ki67 expression - suggesting that PD-1 expression may be partially responsible for the loss of CD8+ T cell function. In addition, naïve T cells accumulate in frequency during the transition from the acute to the chronic phase of the infection. Considering that naïve T cells already express high levels of PD-1, we hypothesize that priming of T cell might be impaired in chronically infected individuals. Altogether, we propose a model where high PD-1 expression is associated with (1) impaired CD8+ T cell function in chronic HIV-1 infection and suggest that lower levels of PD-1 may partially preserve the CD8+ T cell function and (2) impaired priming of T cells contributing to the progressive immunodeficiency in HIV-1 infection but also limiting the effectiveness of vaccine strategies by preventing any new responses to be triggered. To better understand immune responses in infection such as HIV-1 disease, we next developed multimeric reagents for the detection of CD4+ T cells, namely tetramers of HLA-DR molecules. These reagents aim at increasing the overall avidity of peptide-MHC class II complexes to detect low affinity TCRs. In this thesis, we describe a versatile and efficient method to produce different soluble HLA-DR molecules covalently linked to antigenic peptides. Gaining further insights into mechanisms underlying T cell exhaustion and disease progression, in addition to the development of state-of-the-art immune monitoring tools, will be crucial in better understanding of the interplay between the virus and the host immune system, leading to rational strategies in the fight against the AIDS epidemic.

Les vaccins à base de cellules dendritiques (DCs) constituent une avenue très populaire en immunothérapie du cancer. Alors que ces cellules peuvent présenter des peptides exogènes ajoutés au milieu, l’efficacité de chargement de ces peptides au le complexe majeur d'histocompatibilité (CMH) de classe II est limitée. En effet, la majorité des molécules du CMH II à la surface des DCs sont très stable et l’échange de peptide spontané est minime. Confinée aux vésicules endosomales, HLA-DM (DM) retire les peptides des molécules du CMH II en plus de leur accorder une conformation réceptive au chargement de peptides. Il est possible, cependant, de muter le signal de rétention de DM de façon à ce que la protéine s’accumule en surface. Nous avons émis l’hypothèse que ce mutant de DM (DMY) sera aussi fonctionnel à la surface que dans la voie endosomale et qu’il favorisera le chargement de peptides exogènes aux DCs. Nous avons utilisé un vecteur adénoviral pour exprimer DMY dans des DCs et avons montrer que la molécule augmente le chargement de peptides. L’augmentation du chargement peptidique par DMY est autant qualitatif que quantitatif. DMY améliore la réponse T auxiliaire (Th) du coté Th1, ce qui favorise l’immunité anti-cancer. Du côté qualitatif, le chargement de peptides résulte en des complexes peptide-CMHII (pCMH) d’une conformation supérieure (conformère). Ce conformère (Type A) est le préféré pour la vaccination et DMY édite avec succès les complexes pCMH à la surface en éliminant ceux de type B, lesquels sont indésirables. La fonction de DM est régulée par HLA-DO (DO). Ce dernier inhibe l’habilité de DM à échanger le peptide CLIP (peptide dérivée de la chaîne invariante) en fonction du pH, donc dans les endosomes tardifs. Mes résultats indiquent que la surexpression de DO influence la présentation des superantigènes (SAgs) dépendants de la nature du peptide. Il est probable que DO améliore indirectement la liaison de ces SAgs au pCMH dû à l’accumulation de complexe CLIP-CMH, d’autant plus qu’il neutralise la polarisation Th2 normalement observée par CLIP. Ensemble, ces résultats indiquent que DMY est un outil intéressant pour renforcer le chargement de peptides exogènes sur les DCs et ainsi générer des vaccins efficaces. Un effet inattendu de DO sur la présentation de certains SAgs a aussi été observé. Davantage de recherche est nécessaire afin de résoudre comment DMY et DO influence la polarisation des lymphocytes T auxiliaires. Cela conduira à une meilleure compréhension de la présentation antigénique et de son étroite collaboration avec le système immunitaire. / Dendritic cell peptide-based vaccines are the most common immunotherapy approach in cancer therapy. While, in principle, dendritic cells (DCs) could be loaded efficiently by exogenously added tumor peptides, their loading efficacy is severely reduced due to low number of peptide-receptive MHC II on cell surface. Most surface MHC II molecules are either occupied by endogenous peptides or are inactive due to a conformation that is not receptive for free peptides. In MHC II antigen presentation pathway, HLA-DM (DM) in acidic endosomal vesicles removes the self-peptides and grants a peptide receptive conformation to MHC II. Mutating of an intracellular sorting motif in DM, renders its accumulation on cell surface. We hypothesized that the mutant DM (DMY) is functional on cell surface and can generate peptide receptive MHC II on surface of DCs for exogenous peptide loading. By using an adenoviral vector that expresses DMY, we found that DMY is functional on surface of DCs. DMY supplied peptide receptive MHC II on surface of DCs and improved exogenous peptide loading. The improvement of peptide loading by DMY is both quantitative and qualitative. DMY improves helper T cell (Th) response in Th1 direction that favors anti-cancer immunity. The qualitative improvement of peptide loading extends to loading of superior conformational isomer (conformer) of peptide-MHC complexes. This superior conformer (type A) is the favourite type for vaccination approaches and DMY successfully edits peptide-MHC conformers on cell surface level by eliminating undesirable one (type B). Function of DM is regulated by HLA-DO (DO) and it is well accepted that in acidic pH of late endosomes, DO inhibits function of DM by preventing removal of class II associated invariant chain peptide (CLIP) from peptide binding groove of MHC II. My results indicate that DO overexpression, changes binding of peptide-dependent superantigens to MHC II molecules. Superantigens (SAgs) are small microbial proteins that bind out side peptide binding groove of MHC II. DO probably enhances binding of peptide-dependent SAgs by forcing the accumulation of CLIP on the cell surface of antigen presenting cells. DO also neutralizes Th2 polarization by CLIP. Collectively, these results indicate that DMY is a valuable tool for improvement of exogenous peptide loading in DCs vaccines. An unnoticed effect of DO on SAgs binding was also recognized. Further investigations are needed to clarify the mechanisms by which, DMY and DO influence Th polarization. This would provide a better understanding of antigen presentation pathway and its interaction with immune system.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Pacientes portadores de deformidades dentofaciais podem relatar dificuldades de mastigação e fala, desordens temporomandibulares, preocupação com a imagem corporal e baixa autoestima. Frequentemente, buscam tratamento orto-cirúrgico pela motivação de obter melhora notável nos aspectos estético, funcional e psicossocial. A evidência atualmente disponível sobre os benefícios na qualidade de vida relacionada à saúde bucal desta modalidade terapêutica ainda não é conclusiva, devido à diversidade de metodologias adotadas entre os estudos existentes, majoritariamente realizados na América do Norte, Europa, Oriente Médio e Ásia. Logo, é essencial utilizar instrumentos específicos para avaliar os efeitos desta modalidade de tratamento também na vida diária dos pacientes brasileiros. O propósito do presente estudo transversal foi determinar o impacto que o tratamento orto-cirúrgico exerce sobre a percepção de qualidade de vida dos pacientes portadores de deformidades dentofaciais, bem como a influência exercida pelo gênero, idade, renda, escolaridade e características da má oclusão, nas quatro etapas inerentes a esta modalidade de tratamento: (1) Inicial; (2) Preparo ortodôntico para a cirurgia; (3) Pós-cirúrgico; e (4) Contenção (pós-tratamento). Duzentos e cinquenta e quatro pacientes foram entrevistados em três importantes centros de atendimento na cidade do Rio de Janeiro. A qualidade de vida foi avaliada pelos questionários OHIP-14 (Oral Health Impact Profile - Short Version) e pelo OQLQ (Orthognathic Quality of Life Questionnaire) em suas versões traduzidas e validadas para o português. A gravidade da má oclusão e autopercepção estética foram avaliadas com base no Índice de Necessidade de Tratamento Ortodôntico (IOTN) e pelo Índice de Estética Dental (DAI). A análise dos dados foi efetuada pelos testes qui-quadrado, Kruskal-Wallis e modelos de regressão binomial negativa múltipla. Os pacientes dos quatro grupos foram semelhantes em relação ao gênero (p = 0,463), escolaridade (p = 0,276) e renda familiar (p = 0,100). Entre os entrevistados houve o predomínio de mulheres, com ensino médio completo e renda familiar entre 2 e 3 salários mínimos, portadores de má oclusão de Classe III de Angle grave. No modelo de regressão binomial negativa ajustado para os fatores gênero, idade, renda familiar e escolaridade, a qualidade de vida aferida pelo OHIP-14 demonstrou que o grupo Inicial sofreu impactos mais negativos do que os grupos Pós-cirúrgico, Preparo e Contenção; o OQLQ indicou que o grupo Inicial sofreu impactos mais negativos do que os grupos Preparo, Pós-cirúrgico e Contenção, nesta sequência. Não foi detectada influência da idade, renda e escolaridade nestes resultados. Foi observado que o gênero feminino sofreu mais impacto negativo na qualidade de vida, principalmente nas dimensões relativas à função e a aspectos sociais. Concluiu-se que os pacientes que finalizaram o tratamento orto-cirúrgico apresentaram como benefícios menores impactos na qualidade de vida específica e relacionada à saúde bucal, melhor autopercepção estética e menor gravidade da má oclusão, em comparação aos pacientes nas etapas pré e pós-cirúrgica e aos pacientes portadores de deformidades dentofaciais em busca de tratamento. / Patients with dentofacial deformities may complain about having trouble chewing and speaking, temporomandibular joint disorders, dissatisfaction with their own appearance and low self-esteem. They frequently seek out orthosurgical treatment motivated by an expectation of a significant aesthetic, functional and psychosocial improvement. Evidence currently available is not yet conclusive about the benefits of orthognathic surgery towards Oral Health-Related Quality of Life (OHRQoL). This is due to a lack of consensus among the various methods used to measure the changes among the existing studies, mainly performed in North America, Europe, Middle East and Asia. Therefore the use of specific tools is important to evaluate the effects of this therapeutic modality on the daily life of Brazilian patients. The aim of this cross-sectional study was to assess the impact of orthosurgical treatment on patients perceptions of their OHRQoL, and the influence of gender, age, socioeconomic status, schooling and occlusal characteristics, at the four stages of this treatment modality: (1) Initial; (2) Pre-surgical orthodontic treatment; (3) Post-surgical; and (4) Retention (post-treatment). Two hundred and fifty-four patients were interviewed at three important local attendance centers in the city of Rio de Janeiro. Quality of life was evaluated by OHIP-14 (Oral Health Impact Profile - Short Version) and OQLQ (Orthognathic Quality of Life Questionnaire) translated and validated into Brazilian Portuguese. The severity of Malocclusion and aesthetic self-perception were assessed by IOTN (Index of Orthodontic Treatment Need) and DAI (Dental Aesthetic Index). Data analysis was performed using Chi-square and Kruskal-Wallis tests and negative binomial regression models. The four groups shared similar make up in terms of gender (p = 0.463), schooling (p = 0.276) and economic status (p = 0.100). Among those interviewed, there was a predominance of women, who had graduated from high school, and with family income of between two and three minimum wages, presenting severe Class III malocclusion. In the negative binomial regression model, adjusted for gender, age, family income and schooling, the OHRQoL evaluated by OHIP-14 demonstrated that the Initial group presented more negative impact than the Postsurgical, Pre-surgical or Retention groups; OQLQ showed that the Initial group suffered more negative impacts than the Pre-surgical, Post-surgical and Retention groups, in this sequence. Any influence of age, family income and schooling was not detected. The female gender showed more negative impact on the OHRQoL, primarily concerning dental function and social aspects. It was concluded that patients who completed orthosurgical treatment presented the benefit of less acute impacts on the OHRQoL, better self-perception of the aesthetic and less severe malocclusion, when compared to patients at pre and post-surgical stages and those individuals not treated for dentofacial deformities.

Made available in DSpace on 2016-08-03T16:31:16Z (GMT). No. of bitstreams: 1 RESUMO.pdf: 50043 bytes, checksum: a040447349c295ed19468127953c7944 (MD5) Previous issue date: 2011-03-31 / O objtivo deste estudo pros

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Pacientes portadores de deformidades dentofaciais podem relatar dificuldades de mastigação e fala, desordens temporomandibulares, preocupação com a imagem corporal e baixa autoestima. Frequentemente, buscam tratamento orto-cirúrgico pela motivação de obter melhora notável nos aspectos estético, funcional e psicossocial. A evidência atualmente disponível sobre os benefícios na qualidade de vida relacionada à saúde bucal desta modalidade terapêutica ainda não é conclusiva, devido à diversidade de metodologias adotadas entre os estudos existentes, majoritariamente realizados na América do Norte, Europa, Oriente Médio e Ásia. Logo, é essencial utilizar instrumentos específicos para avaliar os efeitos desta modalidade de tratamento também na vida diária dos pacientes brasileiros. O propósito do presente estudo transversal foi determinar o impacto que o tratamento orto-cirúrgico exerce sobre a percepção de qualidade de vida dos pacientes portadores de deformidades dentofaciais, bem como a influência exercida pelo gênero, idade, renda, escolaridade e características da má oclusão, nas quatro etapas inerentes a esta modalidade de tratamento: (1) Inicial; (2) Preparo ortodôntico para a cirurgia; (3) Pós-cirúrgico; e (4) Contenção (pós-tratamento). Duzentos e cinquenta e quatro pacientes foram entrevistados em três importantes centros de atendimento na cidade do Rio de Janeiro. A qualidade de vida foi avaliada pelos questionários OHIP-14 (Oral Health Impact Profile - Short Version) e pelo OQLQ (Orthognathic Quality of Life Questionnaire) em suas versões traduzidas e validadas para o português. A gravidade da má oclusão e autopercepção estética foram avaliadas com base no Índice de Necessidade de Tratamento Ortodôntico (IOTN) e pelo Índice de Estética Dental (DAI). A análise dos dados foi efetuada pelos testes qui-quadrado, Kruskal-Wallis e modelos de regressão binomial negativa múltipla. Os pacientes dos quatro grupos foram semelhantes em relação ao gênero (p = 0,463), escolaridade (p = 0,276) e renda familiar (p = 0,100). Entre os entrevistados houve o predomínio de mulheres, com ensino médio completo e renda familiar entre 2 e 3 salários mínimos, portadores de má oclusão de Classe III de Angle grave. No modelo de regressão binomial negativa ajustado para os fatores gênero, idade, renda familiar e escolaridade, a qualidade de vida aferida pelo OHIP-14 demonstrou que o grupo Inicial sofreu impactos mais negativos do que os grupos Pós-cirúrgico, Preparo e Contenção; o OQLQ indicou que o grupo Inicial sofreu impactos mais negativos do que os grupos Preparo, Pós-cirúrgico e Contenção, nesta sequência. Não foi detectada influência da idade, renda e escolaridade nestes resultados. Foi observado que o gênero feminino sofreu mais impacto negativo na qualidade de vida, principalmente nas dimensões relativas à função e a aspectos sociais. Concluiu-se que os pacientes que finalizaram o tratamento orto-cirúrgico apresentaram como benefícios menores impactos na qualidade de vida específica e relacionada à saúde bucal, melhor autopercepção estética e menor gravidade da má oclusão, em comparação aos pacientes nas etapas pré e pós-cirúrgica e aos pacientes portadores de deformidades dentofaciais em busca de tratamento. / Patients with dentofacial deformities may complain about having trouble chewing and speaking, temporomandibular joint disorders, dissatisfaction with their own appearance and low self-esteem. They frequently seek out orthosurgical treatment motivated by an expectation of a significant aesthetic, functional and psychosocial improvement. Evidence currently available is not yet conclusive about the benefits of orthognathic surgery towards Oral Health-Related Quality of Life (OHRQoL). This is due to a lack of consensus among the various methods used to measure the changes among the existing studies, mainly performed in North America, Europe, Middle East and Asia. Therefore the use of specific tools is important to evaluate the effects of this therapeutic modality on the daily life of Brazilian patients. The aim of this cross-sectional study was to assess the impact of orthosurgical treatment on patients perceptions of their OHRQoL, and the influence of gender, age, socioeconomic status, schooling and occlusal characteristics, at the four stages of this treatment modality: (1) Initial; (2) Pre-surgical orthodontic treatment; (3) Post-surgical; and (4) Retention (post-treatment). Two hundred and fifty-four patients were interviewed at three important local attendance centers in the city of Rio de Janeiro. Quality of life was evaluated by OHIP-14 (Oral Health Impact Profile - Short Version) and OQLQ (Orthognathic Quality of Life Questionnaire) translated and validated into Brazilian Portuguese. The severity of Malocclusion and aesthetic self-perception were assessed by IOTN (Index of Orthodontic Treatment Need) and DAI (Dental Aesthetic Index). Data analysis was performed using Chi-square and Kruskal-Wallis tests and negative binomial regression models. The four groups shared similar make up in terms of gender (p = 0.463), schooling (p = 0.276) and economic status (p = 0.100). Among those interviewed, there was a predominance of women, who had graduated from high school, and with family income of between two and three minimum wages, presenting severe Class III malocclusion. In the negative binomial regression model, adjusted for gender, age, family income and schooling, the OHRQoL evaluated by OHIP-14 demonstrated that the Initial group presented more negative impact than the Postsurgical, Pre-surgical or Retention groups; OQLQ showed that the Initial group suffered more negative impacts than the Pre-surgical, Post-surgical and Retention groups, in this sequence. Any influence of age, family income and schooling was not detected. The female gender showed more negative impact on the OHRQoL, primarily concerning dental function and social aspects. It was concluded that patients who completed orthosurgical treatment presented the benefit of less acute impacts on the OHRQoL, better self-perception of the aesthetic and less severe malocclusion, when compared to patients at pre and post-surgical stages and those individuals not treated for dentofacial deformities.

Les exosomes sont des vésicules membranaires de 30 à 100 nm de diamètre, formées dans les endosomes multivésiculaires et sécrétées par la plupart des cellules. Les propriétés biophysiques et biochimiques des exosomes ainsi que les mécanismes permettant leur biogénèse et sécrétion ont fait l’objet de nombreuses études. Cependant, ces derniers sont encore méconnus, limitant l'analyse des fonctions des exosomes in vivo. Au moins deux mécanismes ont été proposés pour la biogénèse des exosomes : un mécanisme nécessiterait l’action de protéines impliquées dans le tri endosomal, les ESCRT (« endosomalsorting complex required for transport »). Un autre mécanisme serait indépendant de leur fonction. La sécrétion des exosomes, une fois générés dans les endosomes, requiert la petite GTPase, Rab27a, comme montré dans un modèle cellulaire humain. Mes travaux de thèse ont porté sur l’étude des mécanismes moléculaires impliqués dans la biogénèse et la sécrétion des exosomes. Une première étude visant à analyser la fonction de Rab27a dans des cellules murines, m’a permis de mettre en évidence l’existence de différentes populations d’exosomes, dont la sécrétion dépend ou non de Rab27a. Une deuxième étude a eu pour objectif d’analyser l’implication des ESCRT dans la biogénèse des exosomes dans des cellules HeLa CIITA. Le criblage d’une librairie d’ARN d’interférence dirigés contre les différentes protéines ESCRT, a permis l’identification de 7 molécules potentiellement impliquées dans cette voie : HRS, STAM1, TSG101, leur inactivation induisant la diminution de la sécrétion des exosomes. L’inactivation de CHMP4C, VPS4B,VTA1 et ALIX, au contraire, l’augmente. L’inhibition de l’expression de ces candidats suivie de l’analyse des exosomes sécrétés a démontré l’hétérogénéité des vésicules sécrétées, et une modification de leur taille et de leur composition protéique par rapport aux cellules contrôle. Plus particulièrement, l’inactivation d’ALIX induit une augmentation de lasécrétion d‘exosomes de plus grande taille, et l’enrichissement sélectif en molécules de CMH de classe II. En accord, j’ai montré que les cellules inactivées pour ALIX, aussi bien des cellules HeLa que des cellules dendritiques humaines ont une plus forte expression de CMH de classe II à la surface et dans des compartiments intracellulaires. Ces résultats suggèrent l’implication de certains membres de la famille ESCRT dans la voie de biogenèse et sécrétion des exosomes, ainsi qu’un rôle potentiel d’Alix dans le trafic des molécules CMH de classe II, et dans la modulation de la composition protéique des exosomes. / Exosomes are small membrane vesicles with sizes ranging from 30 to 100 nm in diameter, which are formed in multivesicular endosomes and secreted by most cell types. Numerous studies have focused on the biophysical and biochemical properties of exosomes, as well as the mechanisms of biogenesis and secretion of these vesicles. However, these aspects are not fully understood, which limits the analysis of the functions of exosomes in vivo. At least two mechanisms have been proposed for the biogenesis of exosomes : one would rely on the function of proteins involved in endosomal sorting, the ESCRT family (for “endosomal sorting complex required for transport”). Another mechanism would be independent of their activity. Once exosomes are formed in endosomes, their secretion requires the small GTPase RAB27A, as shown in a human cell line. The objective of my PhD project was to gain insights into the molecular mechanisms that drive exosome biogenesis and secretion. A first study performed to analyze the function of Rab27a in murine cells allowed me to show the existence of different populations of exosomes, dependent or not on Rab27a for their secretion. A second study was aimed at analyzing the involvement of ESCRT proteins in exosome biogenesis in HeLa-CIITA cells. Seven molecules potentially involved in this process were identified on the basis of the screening of an RNA interference library directed against the different ESCRT proteins: the inactivation of HRS, STAM1 and TSG101 induced a decrease in exosome secretion, whereas the down regulation of CHMP4C, VPS4B, VTA1 and ALIX increased it. Gene expression of the different candidate proteins was inhibited and exosomes secreted by these cells were analyzed: we showed the heterogeneity of the secreted vesicles, as well as an alteration of their size and protein composition, as compared to control cells. In particular, the inactivation of ALIX induced an increase in the secretion of larger vesicles, and the selective enrichment of these vesicles in MHC class II molecules. Accordingly, I showed that both HeLa-CIITA and human primary dendritic cells inactivated for ALIX possess a higher expression of MHC class II molecules at the cell surface and in intracellular compartments. These results suggest that some members of the ESCRT family are involved in the exosome biogenesis and secretion pathway, and propose a potential role of ALIX in the trafficking of MHC class II molecules and in the modulation of the protein composition of exosomes.

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Background: Arterial allografts are used as vascular conduits in the treatment of prosthetic graft infection. Immunosuppression decreases their rupture risk rate. However, immunosuppression can be unprofitable in florid infection. Previously, we confirmed inhibition of cell-mediated destruction of rat aortic grafts by delayed use of tacrolimus. In this work, we studied the influence of this protocol on the antibody-mediated rejection.