Made available in DSpace on 2016-08-17T18:39:44Z (GMT). No. of bitstreams: 1 4594.pdf: 3287424 bytes, checksum: 45ec60b0a38c4b296ddba2d66d8cd69c (MD5) Previous issue date: 2011-10-27 / Universidade Federal de Minas Gerais / Schistosomiasis mansoni is a major problem affecting public health, according to World Health Organization (WHO), 210 million individuals worldwide. In the infected host, the disease is characterized by the presence of granuloma, immunopathological outcome of the cellular infiltrate and in many cases a consequence of tissue fibrosis. Thus, the host-parasite relationship may lead to morbidity from the disease result in hepatosplenomegaly, hepatic fibrosis and ascites. The granulomatous process in schistosomiasis is dependent on CD4 + and requires recruitment and accumulation of inflammatory cells at the site of deposition of eggs. Schistosomal fibrosis is the result of granulomatous reaction that develops in response to antigens released by eggs of Schistosoma mansoni retained in the portal veins of smaller caliber. A host of disease caused by S. mansoni is mediated by the immune response by T cells through the dissemination of eggs that are housed in the liver and intestine. Manipulation of the interaction between B7 molecules of antigen presenting cells (APC) and T cell receptors CD28/CTLA4 modulate, and in some circumstances block the immunological response in vivo. The CTLA4 is structurally homologous to CD28 but is expressed in CD4 + and CD8 + newly activated, and its function is to inhibit T cell activation by inhibiting the signals released by CD28. Thus, CTLA4 is involved in the completion of T cell responses The way in which the two receptors release opposite signs and recognize the same molecule B7 of APC is an intriguing question and a matter of research. Coestimulatory these signals may have different roles in various types of immune response. Thus the treatment strategy of using monoclonal antibodies (mAb) anti-CTLA4, anti-CD28 in murine schistosomiasis was to evaluate the modulation of inflammatory response and parasite-induced S. mansoni as CTLA4 and CD28 were blocked. Our results showed that treatment with (mAb) anti CD28 and CTLA4 molecules coestimulatory favored changes in the number of leukocytes, modulations in the levels of circulating antibodies, cytokines, and the response profile of T helper (Th) and change in the parasitic activity. Our data showed that the reduction of parasite burden was 21.3% in the group treated with anti-CTLA4 mAb and 46.2% in the group treated with anti-CD28. Suggesting that these treatments should be considered interesting candidates for immunotherapy and for further investigation, since it is necessary to better understand the response of these molecules in schistosomiasis mansoni that when blocked or did not show the hypothetical anti-parasitic and anti-inflammatory activity in this model. / A esquistossomose mansônica representa um dos grandes problemas de Saúde Pública acometendo, segundo a Organização Mundial de Saúde (OMS), 210 milhões de indivíduos no mundo todo. No hospedeiro infectado, a doença é caracterizada pela presença de granuloma, resultado imunopatológico do infiltrado celular e em muitos casos consequência de fibrose tecidual. Dessa forma, a relação parasito-hospedeiro pode levar a morbidade devido à doença resultar em hepatoesplenomegalia, fibrose hepática e ascite. O processo granulomatoso na esquistossomose é dependente de linfócitos T CD4+ e requer recrutamento e acumulo de células inflamatórias no sítio de deposição dos ovos. A fibrose esquistossomótica é resultado da reação granulomatosa que se desenvolve em resposta a antígenos liberados pelos ovos do Schistosoma mansoni retidos nas veias portais de menor calibre. A patologia causada em hospedeiros com S. mansoni é mediada pela resposta imune, por células T através da disseminação dos ovos que são alojados no fígado e intestino. Manipulações para a interação entre moléculas B7 de células apresentadoras de antígenos (APC) e receptores CD28/CTLA4 de células T modulam, e em algumas circunstâncias, bloqueiam a resposta imunopatológica in vivo. O CTLA4 é estruturalmente homólogo ao CD28, mas é expresso nas células T CD4+ e CD8+ recém ativadas, e sua função é inibir a ativação de células T pela inibição dos sinais liberados pelo CD28. Assim, o CTLA4 está envolvido na finalização das respostas das células T. A maneira pelos quais os dois receptores liberam sinais opostos e reconhecem a mesma molécula B7 das APC é uma intrigante questão e motivo de pesquisa. Esses sinais coestimulatórios podem ter diferentes papéis nos vários tipos de resposta imune. Dessa forma a estratégia de utilizar o tratamento com anticorpos monoclonais (mAb) anti-CTLA4 e anti-CD28 na esquistossomose mansônica murina foi de avaliar a modulação da resposta inflamatória e parasitária induzida pelo S. mansoni quando CTLA4 e CD28 fossem bloqueados. Nossos resultados mostraram que o tratamento com (mAb) anti moléculas coestimulatórias CTLA4 e CD28 favoreceram alterações no número de leucócitos, modulações nos níveis de anticorpos circulantes, citocinas, e do perfil da resposta T helper (Th) e alteração na atividade parasitária. Nossos dados demonstraram que, a redução da carga parasitária foi de 21,3% no grupo tratado com mAb anti- CTLA4 e 46,2% no grupo tratado com anti-CD28. Sugerindo que, estes tratamentos devem ser considerados interessantes candidatos para imunoterapia e para maiores investigações, uma vez que se faz necessário conhecer melhor a resposta destas moléculas na esquistossomose mansônica que quando bloqueadas ou não apresentaram a hipotética atividade antiparasitária e antiinflamatória nesse modelo.

La réponse alloimmune de type humorale et en particulier l'apparition de novo d’anticorps anti HLA dirigés contre le donneur (dnDSA) après une transplantation rénale sont maintenant reconnues comme la principale cause de perte de greffon d’origine immunologique. Définir les meilleures stratégies immunosuppressives pour prévenir ou limiter leur apparition est donc devenu un objectif majeur en pratique clinique. Des études cliniques récentes utilisant le nouvel agent immunosuppresseur bloquant le signal de co-stimulation, le CTLA4-Ig (Belatacept), ont montré que les patients transplantés rénaux traités par Belatacept présentaient de meilleures survies et fonctions des greffons associées à une incidence réduite de dnDSA par rapport aux receveurs contrôles traités par anticalcineurines. Les mécanismes impliqués dans le contrôle des réponses humorales par le CTLA4-Ig n’ont pas encore été élucidés. Notre travail de thèse a pour objectif d’analyser l'effet du CTLA4-Ig sur différentes étapes de la réponse B in vitro et in vivo chez l'homme. Nous montrons d'abord que le CTLA4-Ig diminue la différenciation des plasmablastes et la production d'immunoglobulines, sans intervention des lymphocytes T in vitro. L'expression du principal facteur de transcription impliqué dans différenciation et la fonction des plasmablastes, Blimp-1, est également significativement diminuée en présence du CTLA4-Ig. De plus, l'expression de CD86 sur les plasmablastes après activation est également significativement diminuée en présence de CTLA4-Ig. Dans un second temps, nous nous sommes attachés à étudier l’effet du CTLA4-Ig sur la collaboration entre les TFH et les lymphocytes B. Nous montrons que le CTLA4-Ig bloque l'activation des TFH dépendante de la molécule CD28 en présence de lymphocytes B mémoires. Enfin, nous confirmons in vivo que les patients traités par CTLA4-Ig présentent une expression significativement plus faible de CD80 à la surface des LB comparativement au groupe de patients traités par CNI. De plus, la fréquence et le nombre de TFH circulants totaux et activés (TFH PD1+ICOS+) sont significativement diminués dans le groupe de patients traités par CTLA4-Ig par rapport aux patients traités par anticalcineurines. Au total, nos résultats suggèrent deux modes d’action originaux permettant au CTLA4-Ig de contrôler efficacement les réponses humorales allogéniques (i) d’une part par leur action sur la capacité de sécrétion d’Ig des LB effecteurs exprimant le CD86, et donc en particulier des plasmablastes mais également (ii) par leur action sur la synapse TFH-LB permettant de diminuer l’activation des TFH et d’inhiber la différenciation terminale des LB. Ces résultats ouvrent des perspectives thérapeutiques en transplantation mais également dans le domaine de l’autoimmunité. / Generation of de novo DSAs (dnDSAs) after renal transplantation is recognized as the leading cause of late transplant failure. Hence there is a need to define the best immunosuppressive strategies to limit their development. Recent clinical trials using the novel co-stimulatory blockade agent CTLA4-Ig (Belatacept) have shown that kidney transplanted recipients (KTR) treated with Belatacept exhibit better graft survival and function, and lower proportion of dnDSAs compared with control recipients. Mechanisms involved in the control of humoral responses by CTLA4-Ig remain to be investigated. Here, we analyzed the effect of CTLA4-Ig on different steps of the B cell mediated response in human. In vitro, we showed that CTLA4-Ig reduced plasmablast differentiation and immunoglobulin production in a T cell-independent manner. The expression of the transcription factor Blimp-1, mainly involved in plasma cell differentiation and function, was significantly decreased in the presence of CTLA4-Ig. Moreover the reduced expression of CD86 after CTLA4-Ig treatment suggested a direct intracellular signaling in B cells. Additionally, we showed that CTLA4-Ig blocked CD28-mediated activation of T follicular helper cells (Tfh) in an autologous Tfh-memory B cells model. We validated these observations in KTR treated with Belatacept by showing reduced proportion of blood effector B-cells and activated Tfh (PD1+ICOS+) compared with control recipients. Our in-vitro and in-vivo results suggest that CTLA4-Ig modulates B-cells function at two levels, directly on B cells and at the B cell-Tfh crosstalk level. These mechanisms likely account for the optimal control of humoral responses observed in KTR treated with Belatacept.

The current field of cancer treatment is undergoing a revolution. The influx of novel therapies derived from basic research on the immune system has shifted the landscape of modern medicine. Immunotherapy seeks to use the body’s own immune system as a medium to terminate neoplastic cells. This is performed by manipulating the immune system into either targeting cancer antigens or breaking down barriers towards T cell infiltration. The former mechanism uses CAR-T cells as an instrument to target specific cancer neo-antigens. CAR-T cells begin as T cells derived from a patient’s immune system. These cells are removed from the body and engineered to express a chimeric antigen receptor (CAR) through a process of viral transduction. This CAR allows the T cell to recognize and bind to a specific antigen of interest. In most cases, the antigen is present on cancer cells. The T cells, now expressing the CAR receptor, are transplanted back into the body of the patient and proceed to target cancer cells. This therapy has been used in hematological malignancies to great effect. Applying CAR-T cells to solid tumors is an ongoing process, but has been difficult to establish due to the immunosuppressive aspects of the tumor microenvironment. As such, combining CAR-T cells with traditional anti-cancer therapies has been proven to be efficacious in treating patients with solid tumors. In general, immunosuppression is a large problem in the treatment of cancer. Cancer cells and the tumor microenvironment express receptors that downregulate tumor-targeting actions of the immune system. The discovery of the programmed cell death protein 1 (PD1) allowed researchers to create novel antibodies that inhibit immunosuppression. PD1 located on T cells, binds to PDL1 on cancer and stromal cells. This interaction induces exhaustion and anergy in infiltrating T cells, thereby prevent T cells from targeting cancer cells. As such, the newly approved checkpoint blockade antibodies, Nivolumab and Pembrolizumab, block this interaction and allow T cells to carry out their targeting function. CAR-T cells and checkpoint blockade have both seen immense success in clinical trials and are currently being used the clinic. Nonetheless, development of these therapies for different types of cancers is an ongoing process and one that will require immense effort on behalf of the medical and pharmaceutical establishment

No description available.

Le CTLA4 permet de maintenir la tolérance du soi et prévient le développement d’auto-immunités. Contenu au sein de vésicules intra-cytoplasmiques des lymphocytes T au repos, le CTLA4 est exprimé à la membrane plasmique suite à l’activation du TCR, on le qualifie de rétrocontrôle inhibiteur du système immunitaire (ICB). L’anticorps bloquant le CTLA4, l’ipilimumab induit un contrôle immunitaire à long terme chez une fraction de patients atteints de mélanomes métastatiques. Deux études cliniques de phase III ont conduit à son autorisation de mise sur le marché dans le traitement du mélanome métastatique par la FDA et l’EMA en 2011. Cependant le blocage du CTLA4 est souvent associé au développement d’effets indésirables liés à l’immunité, irAEs, majoritairement au niveau de la peau et de l’intestin, deux sites colonisés par la flore microbienne. Afin de continuer le développement des ICB et des combinaisons de traitements, de nombreux efforts visent à découpler l’efficacité anti-tumorale de la toxicité associée à l’anti-CTLA4. Bien que la stimulation du système immunitaire soit responsable des effets thérapeutiques de l’anti-CTLA4, aucun biomarqueur immunologique d’efficacité n’a été décrit. Dans notre première étude nous avons étudié le mécanisme d’action de l’anti-CTLA4 et nous avons décrit un rôle de l’IL-2 et de ses récepteurs dans l’activité anti-tumorale de l’anticorps. Nous avons également décrit la fraction soluble du récepteur à l’IL-2, le sCD25 comme un biomarqueur potentiel de résistance au traitement. Une concentration élevée de sCD25 dans le sérum des patients atteints de mélanome prédit la résistance à l’ipilimumab. Dans notre second projet, nous avons révélé le rôle du microbiote intestinale et particulièrement de bactéries Gram négatives, des Bacteroides, dans l’efficacité anti-tumorale de l’anti-CTLA4. L’absence d’efficacité du blocage du CTLA4 chez les animaux dépourvus de flore intestinale peut être rétablie par l’administration de Bacteroides fragilis, ou bien de DC, ou encore de lymphocytes T spécifiques de B. fragilis, sans déclencher de colites. Ces travaux suggèrent de nouvelles stratégies thérapeutiques pour espérer améliorer la balance bénéfice / toxicité / coût de l’ipilimumab. / CTLA4, cytotoxic T lymphocyte antigen-4, which is present in the intracytoplasmic vesicles of resting T cells, is upregulated at the surface of activated T cells where it maintains self-tolerance and prevents autoimmunity. The CTLA4-blocking antibody, ipilimumab, induces immune-mediated long term control of metastatic melanoma in a fraction of patients, leading to its approval by the US Food and Drug Administration (FDA) and the European Medical Agency (EMA) in 2011 for the treatment of advanced metastatic melanoma. However, blockade of CTLA4 by ipilimumab often results in immune-related adverse events (irAEs) at sites that are exposed to commensal flora, namely the gut and the skin. Uncoupling efficacy from toxicity is a challenge for the development of immune checkpoint blockers and therapeutic combinations. Although ipilimumab undoubtedly exerts its therapeutic effects via immunostimulation, relevant immune biomarkers that predict treatment efficiency remain elusive. Firstly, we unravel a role for IL-2 and IL-2 receptors in the anticancer activity of CTLA-4 blockade. Importantly, our study provides an immunologically relevant biomarker, elevated serum sCD25, which predicts resistance to CTLA-4 blockade in patients with melanoma. Secondly, we show that the antitumor effects of CTLA4 blockade depend upon intestinal Gram-negative bacteria, mostly Bacteroides species. These bacteria accumulate at the bottom of the intestinal crypts and elicit an IL-12-dependent Th1 immune response specific for distinct Bacteroides species, both in tumor bearing mice and in cancer patients. CTLA4 blockade lost its anticancer efficacy in antibiotic-treated or germ-free mice. This defect could be overcome by oral administration of Bacteroides fragilis (Bf), immunization with Bf polysaccharides, or adoptive transfer of Bf-specific T cells, all of which in the absence of colitis. Our study unravels the key role of Bacteroides in the immunostimulatory effects of CTLA4 blockade, suggesting novel strategies for safely broadening its clinical use

INTRODUÇÃO: Manifestações auto-imunes são frequentes na infecção pelo vírus da hepatite C (VHC). Apesar da associação com doenças auto-imunes de tireóide (DAIT) ser controversa, sabe-se que distúrbios tireoidianos podem surgir ou piorar com tratamento com IFN e ribavirina. Os objetivos deste estudo foram avaliar a função tireoidiana em pacientes infectados pelo VHC, caracterizar distúrbios tireoidianos antes, durante e após tratamento com IFN e estudar as frequências dos genótipos dos polimorfismos do gene CTLA4, correlacionando-os com características clínicas e laboratoriais, presença de disfunção tireoidiana e evolução durante tratamento com IFN. MÉTODOS: Avaliação prospectiva de 112 indivíduos com infecção crônica pelo VHC, 30 tratados com IFN, e 183 controles. Realizaram-se avaliações clínica, hormonal e de auto-imunidade tireoidiana e ultra-sonografia de tireóide no início e durante tratamento. Avaliações de globulina transportadora de hormônios tireoidianos (TBG), de CXCL10 e de biópsia hepática foram feitas pré-tratamento. Análises dos polimorfismos do gene CTLA4 -318C>T, A49G e CT60 foram realizadas por PCR-RFLP e de AT(n) por análise de fragmento através de eletroforese capilar. RESULTADOS: A frequência de DAIT entre infectados por VHC não diferiu dos controles (10,7 vs 13,5%, p=0,585). Os limites de distribuição dos níveis de T3 (T3T) e T4 (T4T) totais foram superiores aos de referência (T3T 112-246 ng/dL; T4T 7,8-15,2 g/dL), assim como de TBG (17-47 mg/L). TBG correlacionou-se com T3T (r=0,654, p<0,001) e T4T (r=0,741, p<0,001). Heterogeneidade (p=0,027) e hipoecogenicidade de parênquima (p=0,002) foram mais frequentes nos pacientes com DAIT. Aumento de vascularização esteve presente em 49,2% dos infectados sem distúrbio tireoidiano. CXCL10 esteve aumentada nos infectados (p=0,006), mas não se relacionou com disfunção tireoidiana. Sua elevação correspondeu ao grau de atividade necro-inflamatória na biópsia hepática (p=0,006) e correlacionou-se com T3T (r=0,388, p=0,003), T4T (r=0,444, p=0,001) e TBG (r=0,551, p<0,001). Dezenove por cento dos pacientes desenvolveram tireoidites auto-imunes por IFN e 16% não auto-imunes. Em 14 pacientes sem alteração tireoidiana durante o uso de IFN, T3T diminuiu ao longo de 12 meses (p=0,038) concomitante à queda de ALT (p=0,055). T4T diminuiu com 3 (p=0,039) e 12 meses (p=0,008), T4 livre e TSH permaneceram estáveis. Encontrou-se maior frequência de oito repetições AT na região 3UTR do gene CTLA4 nos infectados por VHC (p=0,019). O alelo C do polimorfismo -318C>T esteve relacionado com infecção pelos genótipos 1 (p=0,020, OR 0,19) e 3 (p=0,008, OR 9,13), assim como o alelo G do polimorfismo A49G (p=0,002, OR 0,38 e p=0,004, OR 2,49, respectivamente). Não se identificou relação dos polimorfismos do gene CTLA4 com distúrbios tireoidianos, antes ou após tratamento com IFN. CONCLUSÕES: Não foi encontrada associação entre infecção por VHC e doenças tireoidianas. Indivíduos infectados por VHC têm maiores níveis de T3T e T4T, correlacionados com TBG. Aumento de CXCL10 não se associou com disfunção tireoidiana, mas se correlacionou com TBG, T3T e T4T. IFN provocou tireoidites auto-imunes e não auto-imunes, além de reduzir T3T e T4T coincidente com melhora de lesão hepática. Não se encontrou relação dos polimorfismos do gene CTLA4 com características clínicas e laboratoriais ou presença de disfunção tireoidiana prévia ou induzida por IFN / INTRODUCTION: Autoimmune disorders are frequent in patients infected by the hepatitis C virus (HCV). Although the association with autoimmune thyroid diseases (AITD) is controversial, thyroid disturbance could occur or worsen with IFN and ribavirin treatment. The aims of the study were evaluate thyroid function in HCV-infected patients, characterize thyroid disturbance prior and after IFN treatment and analyze the frequency of the genotypes of the polymorphisms of CTLA4 gene, and their relation to clinical and laboratorial features, presence of thyroid dysfunction and disturbance along IFN treatment. METHODS: Prospective evaluation of 112 chronically HCV-infected subjects, 30 treated with IFN, and 183 controls. Clinical, hormonal, thyroid autoimmunity and ultrasound exams were performed before and during treatment. Thyroxine-binding globulin (TBG), CXCL10 and hepatic biopsies were also evaluated before treatment. Analysis of polymorphisms of CTLA4 gene -318C>T, A49G and CT60 were made by PCR-RFLP and AT(n) polymorphism analysis by capillary electrophoresis in automatic sequencer. RESULTS: The frequency of AITD among HCV-infected subjects was similar to the rate among controls (10.7 vs 13.5%, p=0.585). Total T3 (T3T) and T4 (T4T) distributions were right shifted (T3T 112-246 ng/dL; T4T 7.8-15.2 g/dL), as was TBG (17-47 mg/L). TBG correlated to both T3T (r=0.654, p<0.001) and T4T (r=0.741, p<0.001). Thyroid heterogeneity (p=0.027) and hipoechogenicity (p=0.002) were associated with AITD and, most notably, increased vascularization was present in 49.2% of HCV-infected patients without thyroid disturbance. CXCL10 was higher in HCV-infected group (p=0.006) but was not related to thyroid dysfunction. Increase in CXCL10 levels were consistent with hepatic necroinflammatory activity (p=0.006) and correlated to T3T (r=0.388, p=0.003), T4T (r=0.444, p=0.001) and TBG (r=0.551, p<0.001). Nineteen percent of subjects treated with IFN presented autoimmune thyroiditis and 16% had non-autoimmune thyroiditis. In 14 subjects without IFN-induced thyroid dysfunction, T3T decreased along 12 months of follow-up (p=0.038) concomitant to ALT decrease (p=0.055). T4T decreased within 3 (p=0.039) and 12 months (p=0.008), while both free T4 and TSH remained stable. Eight AT repetitions in 3UTR site of the CTLA4 gene were more frequent among HCV-infected subjects. The C allele of -318C>T polymorphism was associated with genotype 1 (p=0.020, OR 0.19) and 3 infections (p=0.008, OR 9.13), similar to allele G of A49G polymorphism (p=0.002, OR 0.38 and p=0.004, OR 2.49, respectively). No association of the polymorphisms of CTLA4 gene and thyroid disorders, prior or induced by IFN treatment, was found. CONCLUSIONS: No association between HCV-infection and thyroid diseases was found. HCV-infected subjects had higher T3T and T4T which were correlated to TBG. Increased CXCL10 was not associated to thyroid dysfunction, but correlated to TBG, T3T and T4T. IFN induced autoimmune and non-autoimmune thyroiditis. IFN also reduced T3T and T4T levels commensurately with liver improvement. The polymorphisms of CTLA4 gene were not associated with clinical and laboratorial features or presence of thyroid dysfunction, prior or induced by IFN

INTRODUÇÃO: Manifestações auto-imunes são frequentes na infecção pelo vírus da hepatite C (VHC). Apesar da associação com doenças auto-imunes de tireóide (DAIT) ser controversa, sabe-se que distúrbios tireoidianos podem surgir ou piorar com tratamento com IFN e ribavirina. Os objetivos deste estudo foram avaliar a função tireoidiana em pacientes infectados pelo VHC, caracterizar distúrbios tireoidianos antes, durante e após tratamento com IFN e estudar as frequências dos genótipos dos polimorfismos do gene CTLA4, correlacionando-os com características clínicas e laboratoriais, presença de disfunção tireoidiana e evolução durante tratamento com IFN. MÉTODOS: Avaliação prospectiva de 112 indivíduos com infecção crônica pelo VHC, 30 tratados com IFN, e 183 controles. Realizaram-se avaliações clínica, hormonal e de auto-imunidade tireoidiana e ultra-sonografia de tireóide no início e durante tratamento. Avaliações de globulina transportadora de hormônios tireoidianos (TBG), de CXCL10 e de biópsia hepática foram feitas pré-tratamento. Análises dos polimorfismos do gene CTLA4 -318C>T, A49G e CT60 foram realizadas por PCR-RFLP e de AT(n) por análise de fragmento através de eletroforese capilar. RESULTADOS: A frequência de DAIT entre infectados por VHC não diferiu dos controles (10,7 vs 13,5%, p=0,585). Os limites de distribuição dos níveis de T3 (T3T) e T4 (T4T) totais foram superiores aos de referência (T3T 112-246 ng/dL; T4T 7,8-15,2 g/dL), assim como de TBG (17-47 mg/L). TBG correlacionou-se com T3T (r=0,654, p<0,001) e T4T (r=0,741, p<0,001). Heterogeneidade (p=0,027) e hipoecogenicidade de parênquima (p=0,002) foram mais frequentes nos pacientes com DAIT. Aumento de vascularização esteve presente em 49,2% dos infectados sem distúrbio tireoidiano. CXCL10 esteve aumentada nos infectados (p=0,006), mas não se relacionou com disfunção tireoidiana. Sua elevação correspondeu ao grau de atividade necro-inflamatória na biópsia hepática (p=0,006) e correlacionou-se com T3T (r=0,388, p=0,003), T4T (r=0,444, p=0,001) e TBG (r=0,551, p<0,001). Dezenove por cento dos pacientes desenvolveram tireoidites auto-imunes por IFN e 16% não auto-imunes. Em 14 pacientes sem alteração tireoidiana durante o uso de IFN, T3T diminuiu ao longo de 12 meses (p=0,038) concomitante à queda de ALT (p=0,055). T4T diminuiu com 3 (p=0,039) e 12 meses (p=0,008), T4 livre e TSH permaneceram estáveis. Encontrou-se maior frequência de oito repetições AT na região 3UTR do gene CTLA4 nos infectados por VHC (p=0,019). O alelo C do polimorfismo -318C>T esteve relacionado com infecção pelos genótipos 1 (p=0,020, OR 0,19) e 3 (p=0,008, OR 9,13), assim como o alelo G do polimorfismo A49G (p=0,002, OR 0,38 e p=0,004, OR 2,49, respectivamente). Não se identificou relação dos polimorfismos do gene CTLA4 com distúrbios tireoidianos, antes ou após tratamento com IFN. CONCLUSÕES: Não foi encontrada associação entre infecção por VHC e doenças tireoidianas. Indivíduos infectados por VHC têm maiores níveis de T3T e T4T, correlacionados com TBG. Aumento de CXCL10 não se associou com disfunção tireoidiana, mas se correlacionou com TBG, T3T e T4T. IFN provocou tireoidites auto-imunes e não auto-imunes, além de reduzir T3T e T4T coincidente com melhora de lesão hepática. Não se encontrou relação dos polimorfismos do gene CTLA4 com características clínicas e laboratoriais ou presença de disfunção tireoidiana prévia ou induzida por IFN / INTRODUCTION: Autoimmune disorders are frequent in patients infected by the hepatitis C virus (HCV). Although the association with autoimmune thyroid diseases (AITD) is controversial, thyroid disturbance could occur or worsen with IFN and ribavirin treatment. The aims of the study were evaluate thyroid function in HCV-infected patients, characterize thyroid disturbance prior and after IFN treatment and analyze the frequency of the genotypes of the polymorphisms of CTLA4 gene, and their relation to clinical and laboratorial features, presence of thyroid dysfunction and disturbance along IFN treatment. METHODS: Prospective evaluation of 112 chronically HCV-infected subjects, 30 treated with IFN, and 183 controls. Clinical, hormonal, thyroid autoimmunity and ultrasound exams were performed before and during treatment. Thyroxine-binding globulin (TBG), CXCL10 and hepatic biopsies were also evaluated before treatment. Analysis of polymorphisms of CTLA4 gene -318C>T, A49G and CT60 were made by PCR-RFLP and AT(n) polymorphism analysis by capillary electrophoresis in automatic sequencer. RESULTS: The frequency of AITD among HCV-infected subjects was similar to the rate among controls (10.7 vs 13.5%, p=0.585). Total T3 (T3T) and T4 (T4T) distributions were right shifted (T3T 112-246 ng/dL; T4T 7.8-15.2 g/dL), as was TBG (17-47 mg/L). TBG correlated to both T3T (r=0.654, p<0.001) and T4T (r=0.741, p<0.001). Thyroid heterogeneity (p=0.027) and hipoechogenicity (p=0.002) were associated with AITD and, most notably, increased vascularization was present in 49.2% of HCV-infected patients without thyroid disturbance. CXCL10 was higher in HCV-infected group (p=0.006) but was not related to thyroid dysfunction. Increase in CXCL10 levels were consistent with hepatic necroinflammatory activity (p=0.006) and correlated to T3T (r=0.388, p=0.003), T4T (r=0.444, p=0.001) and TBG (r=0.551, p<0.001). Nineteen percent of subjects treated with IFN presented autoimmune thyroiditis and 16% had non-autoimmune thyroiditis. In 14 subjects without IFN-induced thyroid dysfunction, T3T decreased along 12 months of follow-up (p=0.038) concomitant to ALT decrease (p=0.055). T4T decreased within 3 (p=0.039) and 12 months (p=0.008), while both free T4 and TSH remained stable. Eight AT repetitions in 3UTR site of the CTLA4 gene were more frequent among HCV-infected subjects. The C allele of -318C>T polymorphism was associated with genotype 1 (p=0.020, OR 0.19) and 3 infections (p=0.008, OR 9.13), similar to allele G of A49G polymorphism (p=0.002, OR 0.38 and p=0.004, OR 2.49, respectively). No association of the polymorphisms of CTLA4 gene and thyroid disorders, prior or induced by IFN treatment, was found. CONCLUSIONS: No association between HCV-infection and thyroid diseases was found. HCV-infected subjects had higher T3T and T4T which were correlated to TBG. Increased CXCL10 was not associated to thyroid dysfunction, but correlated to TBG, T3T and T4T. IFN induced autoimmune and non-autoimmune thyroiditis. IFN also reduced T3T and T4T levels commensurately with liver improvement. The polymorphisms of CTLA4 gene were not associated with clinical and laboratorial features or presence of thyroid dysfunction, prior or induced by IFN

Emerging evidence suggests the immune system has a role in preventing cancer, and in advanced cancer evidence of immune dysfunction is widespread. This project focused on cytotoxic T lymphocyte antigen 4 (CTLA4), a key negative regulator of T cell activation found on dedicated regulatory T cells (Treg) and activated T lymphocytes, and asked whether modulation of immune control with anti-CTLA4 blockade led to significant anti-tumour activity. Clinical and laboratory investigation of anti-CTLA4 blockade using tremelimumab in a phase II trial of second-line therapy in advanced oesophageal and gastric adenocarcinomas was combined with an attempt to establish a suitable pre-clinical model based on therapeutic vaccination against the tumour associated antigen (TAA) 5T4.Eighteen patients received tremelimumab. Most drug-related toxicity was mild but there was a single death due to bowel perforation. Four patients had stable disease with clinical benefit; one achieved a partial response after eight cycles (25.4 months) and remains well on study after four years. Markers of regulatory phenotype, forkhead box protein 3 (FoxP3) and CTLA4, doubled transiently in CD4+CD25high lymphocytes in the first month after tremelimumab before returning to baseline. In contrast, CTLA4 increased in CD4+CD25low/negative lymphocytes throughout the cycle of treatment. Post-treatment expanded Treg expressed FoxP3 without interleukin-2 and their defining suppressive function was not abolished despite prolonged anti-CTLA4 blockade. De novo proliferative responses to TAA 5T4 (8 of 18 patients) and carcinoembryonic antigen (CEA; 5 of 15) were detected. Patients with a post-treatment CEA proliferative response had median survival of 17.1 months compared to 4.6 months for non-responders (p=0.002). Baseline interleukin-2 release after T lymphocyte activation was higher in patients with clinical benefit and toxicity. Heterologous mouse 5T4 (m5T4) vaccination showed some evidence of weak therapeutic benefit, but all tumour models investigated had rapidly lethal kinetics. Specific m5T4 immune responses could be detected by serum antibody ELISA and IFN-gamma ELISPOT assays in naive animals but were lower frequency than published responses to h5T4, and were further attenuated in tumour-bearing animals. The addition of anti-CTLA4 blockade did not result in significant augmentation of m5T4 specific immunity after vaccination in non tumour-bearing animals and combination treatment was ineffective as therapy in this autologous model. Results are discussed in the context of emerging immunotherapeutics in melanoma and prostate cancer. In the absence of supportive data from the model system it would not be appropriate to pursue combination heterologous 5T4 vaccine with anti-CTLA4 blockade, but in view of the unusual durability of the best response to tremelimumab, and in vitro evidence of enhanced proliferative responses to relevant TAA, further investigation of drug activity may be warranted in metastatic gastric and oesophageal second-line treatment.

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Ultraviolet radiation (UVR) stimulates melanogenesis in melanocytes, primarily via release of alpha-melanocyte stimulating hormone from keratinocytes. UVR also induced an inflammatory response in the skin in which Interferon-gamma (IFNγ) cytokine plays an important orchestrating role. Here we report that recombinant IFNγ induces a temporal increase of melanogenesis in mouse melanoma cells. IFNγ elevates expression of microphthalmia-associated transcription factor (Mitf), which is the master regulator of melanogenesis by initiating transcription of melanogenic enzymes, tyrosinase (Tyr), tyrosinese-related protein 1 (Tyrp1) and dopachrome tautomerase (Dct). Interestingly, tyrosinase protein, but not mRNA expression, accumulated in response to IFNγ treatment and was consistent with tyrosinase activity. In addition, glycosidase digestion showed that IFNγ induced ER-resistant, fully mature tyrosinase via post-transcriptional mechanisms, rather than increased de novo synthesis or early processing in the ER. Most strikingly, IFNγ mediated alkalization of melanosomes by elevating Oca2 expression, which leads to facilitate melanosome maturation and sequential accumulation of mature tyrosianse. Both Jak1/Jak2 inhibitor Ruxolitinib and knockout of Stat1 mediated by CRISPR-CAS9 blocked the IFNγ-induced Mitf, tyrosinase, Oca2 expressions and melanin biosynthesis. Our data reveals that IFNγ-Jak1/2-Stat1 axis regulates melanogenesis by inducing maturation of melanosomes and accumulation of mature tyrosinase via post-translational mechanisms. CTLA4 is a cell surface receptor on T cells that functions as an immune checkpoint molecule to enforce tolerance to cognate antigens. Anti-CTLA4 immunotherapy is highly effective at reactivating T cell responses against melanoma, which is postulated to be due to targeting CTLA4 on T cells. Here we report that CTLA4 is also highly expressed by most human melanoma cell lines, as well as in normal human melanocytes. Interferon-gamma (IFNγ) signaling activated the expression of the human CTLA4 gene in a melanocyte and melanoma cell-specific manner. Mechanistically, IFNγ activated CTLA4 expression through JAK1/2-dependent phosphorylation of STAT1, which bound a specific gamma-activated sequence (GAS) site on the CTLA4 promoter, thereby licensing CBP/p300-mediated histone acetylation and local chromatin opening. In melanoma cell lines, elevated baseline expression relied upon constitutive activation of the MAPK pathway. Notably, RNA-seq analyses of melanoma specimens obtained from patients who had received anti-CTLA4 immunotherapy (ipilimumab) showed upregulation of an IFNγ -response gene expression signature, including CTLA4 itself, which correlated significantly with durable response. We also show that ectopic expression of Ctla4 in mouse melanoma cells promotes tumor growth in immunocompetent mice. Ctla4-enhanced melanomagenesis is blocked in immunodeficient NSG mice. In addition, ligation of CD86 (one of Ctla4 ligands) in T cells inhibits CD8 T cells proliferation in vitro. Expression of Ctla4 in melanoma cells are resistant to CD8 T cell cytoxicity in vitro. Our data demonstrates and highlights the novel and unrecognized functions of CTLA4 in melanoma cells that aids their survival, immunoevasion and tumorigenic capabilities. Taken together, these findings have potential implications for the conventional and prototypical roles of the IFNγ signaling pathway and CTLA4 in tumor immunosurveillance and tumor immunoevasion. More importantly, our results raise the possibility that CTLA4 targeting on melanoma cells may contribute to the clinical immunobiology of anti-CTLA4 responses. / Biomedical Sciences