Orientador: Clarisse Martins Machado / Resumo: O citomegalovírus (CMV) é uma das principais causas de morbidade e mortalidade em receptores de transplante de células tronco hematopoiéticas. As complicações que podem surgir após o transplante são numerosas e diversas, estando o CMV e a doença do enxerto contra o hospedeiro (DECH) entre as mais importantes. A infecção pelo CMV pode afetar qualquer órgão e células do sistema imunitário e os receptores soropositivos para o CMV estão sob risco de reativação. Receptores de transplante alogênico de células tronco-hematopoiéticas têm um risco significantemente maior de infecção por CMV em comparação com receptores de transplante autólogo em função do uso de imunossupressores na profilaxia da DECH. O trabalho teve como objetivo a implantação e a avaliação da reconstituição imune CMV-específica através de uma técnica de dosagem de interferon-gama (Quantiferon-CMV). Observou-se que a reconstituição imune CMV-específica foi diferente em cada tipo de TCTH. Os pacientes autólogos mantiveram a imunidade até o d+120, diferentemente dos alogênicos. Já nos alogênicos, observou-se que os pacientes que realizaram TCTH do tipo aparentado, obtiveram uma recuperação imune CMV-específica melhor que o não-aparentado e o haploidêntico até o D+60. Nenhum paciente do tipo haploidêntico recuperou a imunidade no D+30. No D+90 observou-se que cerca de 60% dos receptores de transplantes alogênicos recuperaram a imunidade CMV-específica, variando entre 55,5% a 67,5. / Mestre

Human cytomegalovirus (HCMV) is a betaherpesvirus which establishes a lifelong persistent infection, underpinned by its ability to establish latent infection in early myeloid lineage cells, in the infected host. Although well controlled by a healthy immune system, HCMV causes pathological and life threatening disease in individuals with a compromised or immature immune response, which can come from primary HCMV infection or reactivation of latent infection. Although progress is being made in understanding the mechanisms by which HCMV maintains latency and reactivates, a better understanding is essential towards the aim of targeting and killing latently infected cells. In this thesis, I will present evidence that the HCMV-encoded chemokine receptor homologue US28, which is expressed during latent infection of CD14+ monocytes, is necessary for maintaining HCMV latency in these monocytes and, in the absence of US28 protein expression, HCMV undergoes lytic infection. US28 expression was found to attenuate cellular signalling pathways in latently infected cells; in particular, MAP kinase and NFκB. Interestingly, deletion of the US28 gene or inhibition of the US28 protein resulted in the expression of lytic antigens which allowed detection of infected monocytes by the immune system. This observation may lead to a potential new immunotherapeutic strategy against latent HCMV. Having demonstrated that US28 protein is expressed on the surface of latently infected monocytes, I tested whether a new fusion-toxin protein, called F49A-FTP, which binds US28 protein, could be used to target and kill latently infected cells. I developed a protocol for treating latently infected monocytes with F49A-FTP which resulted in a significant reduction in virus reactivation after monocyte differentiation to dendritic cells. I was also able to show that this treatment kills CD34+ progenitor cells, which were experimentally latently infected with HCMV, as well as latently infected monocytes from a healthy, seropositive blood donor. Finally, during my investigations into the role of US28 during HCMV latency, a mass spectrometry screen was performed to measure changes in cellular protein expression when US28 protein is expressed in isolation, in THP-1 monocyte-like cell line. This identified CTCF, a transcription factor which appears to be modified by US28 in THP-1 cells. I showed that CTCF has a repressive effect on the HCMV MIEP, and that CTCF likely plays a role in HCMV latency. In summary, this work provides insights into the role of US28 during HCMV latency, and proposes potential novel therapeutic strategies to kill latently infected cells.

Objetivo: comparar a profilaxia universal com a terapia preemptiva com ganciclovir endovenoso no manejo da citomegalovirose em pacientes transplantados de pulmão em uma coorte retrospectiva. Metodologia: de março de 1999 a dezembro de 2009 foram estudados, no Serviço de Transplante do Complexo Hospitalar Santa Casa de Porto Alegre, todos os pacientes submetidos a transplante pulmonar, procurando-se verificar a ocorrência de citomegalovirose relacionada ao tipo de tratamento profilático anti-viral utilizado (universal e preemptiva). Foram excluídos, em ambos os grupos, os pacientes nos quais não tivesse sido registrada a antigenemia no primeiro mês após o transplante, e os que foram a óbito dentro dos primeiros trinta dias após a cirurgia. Resultados: de 224 pacientes transplantados no período referido, 66 (29,5%) foram excluídos por óbito precoce. Os 158 pacientes que entraram no estudo tinham idade de 51±15 anos (7 anoa-71 anos), e 61,0% eram do sexo masculino; 150 (95%) receberam o órgão de doador cadavérico, e 134 (85,0%) foram submetidos a transplante unilateral. A profilaxia universal para citomegalovirus (CMV) foi realizada em 70 pacientes (44,0%) e a terapia preemptiva em 88 (56,0%). O grupo que recebeu profilaxia universal levou maior tempo para positivar o exame (p<0.001) comparado com o grupo que não a recebeu. Houve associação significativa entre profilaxia e antigenemia positiva no primeiro ano após o transplante (p=0.024). A mortalidade no primeiro e no quinto ano foi respectivamente de 20% e 50%. A sobrevida mediana do grupo com profilaxia universal foi 3.8 anos (IC95% de 2.5 a 5.0) e o grupo com terapia preemptiva de 4,3 anos (IC95% de 2.5 a 6.0), não apresentando diferença significativa. Conclusão: com base nos dados obtidos neste estudo a profilaxia universal e a terapia preemptiva demonstraram-se seguras e efetivas, entretanto os achados desta pesquisa não se demonstraram conclusivos para definir a melhor opção terapêutica. / Objective: To compare the universal prophylaxis and preemptive therapy for the treatment of cytomegalovirus in lung transplant patients in a retrospective cohort. Method: Performed at the Lung Transplant service in Santa Casa de Porto Alegre during the period from March 1999 to December 2009, upon reviewing the records and results of cytomegalovirus detection. Were excluded in both groups the patients who were not registered antigenemia in the first month after lung transplantation, due to death during this period. Results: 224 patients transplanted during the study period, 66 patients were excluded due to death within 30 days after transplantation. Mean age of patients was 51 ± 15 years old, 61.0% were men, 95.0% received organ of cadaveric donors, 85.0% were submited to unilateral transplant. The universal prophylaxis was performed in 44.0% of patients and preemptive therapy in 56.0%. The group receiving prophylaxis universal took longer to make positive antigenemia (p <0.001) when compared with the group not receiving prophylaxis. It was observed significant association between positive antigenemia and prophylaxis in the first year after transplantation (p = 0.024). The general mortality in the first and fifth year was 20.0% and 50.0% respectively. Survival of patients with prophylaxis presented a median of 3.8 (95% CI 2,5 to 5.0) years and the group that received no prophylaxis had a survival of 4,3 years (95% CI 2.5 to 6.0). Conclusion: Based on the data obtained in this study universal prophylaxis and preemptive therapy demonstrated to be safe and effective, however the findings of this research did not prove conclusive to determine the best treatment.

HCMV is a common viral pathogen that infects most of the world's population by early adulthood. It is typically asymptomatic in immunologically healthy individuals but causes severe disease in immunocompromised patients and congenitally infected infants. HCMV glycoproteins are highly polymorphic, and various types of associations have been suggested between glycoprotein types and the pathogenicity of the virus. Several studies on viruses other than HCMV have related the glycosylation of the viral glycoproteins to virulence. This project aimed to determine whether there is a robust relationship between the individual glycoprotein sequence and its glycosylation, how this influences the growth characteristic of the virus and whether this is related to its pathogenicity. Glycosylation patterns of 89 clinical specimens of different infection categories and specimen types were correlated with genetic sequence alterations of the virus glycoproteins (gB, gH, gL, gM, gN, gO), followed by determining whether mutation results in specific changes in glycosylation. The aim was approached using a cell culture model and a quantitative lectin-based assay (ELLA). A significantly increased glycosylation level for the following genotypes: mixed gH, gN4a, gO4, mixed gL was detected. Whereas a decreased pattern was found to be associated with gH1, gH2, gN3a, gO1a and gL2 genotypes (P < 0.05). Glycoproteins of strains isolated from respiratory specimens were significantly highly glycosylated compared to the blood and urine samples, and from blood specimens compared to the urine samples (P < 0.05). Furthermore, strains from congenitally infected infants and urine samples had a significantly higher growth rate than others tested. No direct association between the virus growth and its virulence was found. These findings demonstrate that glycosylation of glycoproteins in HCMV is affected by the glycoprotein polymorphisms and signifies a potentially important mechanism for avoidance of antibody-mediated neutralization, which, in turn, facilitates HCMV pathogenicity. This phenomenon requires further study and may have application for the selection of novel targets for diagnosis, vaccine development and other preventive measures to combat diseases caused by this virus.

Orientador: Maria Cristina Carlan da Silva / Dissertação (mestrado) - Universidade Federal do ABC. Programa de Pós-Graduação em Biossistemas, 2012

Le traitement de cellules par des aminobisphosphonates (ABP) induit une accumulation intracellulaire de molécules activatrices des lymphocytes T Vy9Vd2 (IPP, ApppI). Alors que ces lymphocytes ne semblent pas naturellement activés lors d'une infection par le cytomégalovirus humain (HCMV), le laboratoire a mis en évidence l'existence d'une action synergique entre le HCMV et les ABP sur leur activation. Ma thèse a eu pour objectif d'analyser le mécanisme de cette synergie et d'évaluer le potentiel immuno-thérapeutique des ABP dans le cadre d'une infection HCMV. Nous avons montré qu'après sensibilisation par des ABP in vitro, des cellules infectées sont fortement activatrices des T Vy9Vd2. Les fibroblastes traités par des ABP activent la production d'IFN-y par les T Vy9Vd2 mais pas la production de TNF. L'infection de ces fibroblastes par le HCMV induit une augmentation de la production d'IFN-y et stimule la production de TNF par des T Vy9Vd2. Cette activation a été observée avec des lymphocytes T Vy9Vd2 établis en lignées cellulaires mais aussi avec des cellules Vy9Vd2 isolées directement de sang périphérique. De plus, cette augmentation de production de cytokines est observée avec différentes souches virales (souche de laboratoire et isolats cliniques) et différents types cellulaires permissifs pour HCMV. Nous avons également montré que l'infection par le HCMV entraine une surproduction d'IPP et d'ApppI dans les cellules cibles traitées aux ABP, ce qui explique en partie l'augmentation de la sécrétion de cytokines par les T Vy9Vd2. Enfin, nous avons mis en évidence que ces T Vy9Vd2 sont capables de limiter la réplication et la production virale suite à un traitement par des ABP, tout en préservant les cellules non infectées. Selon nos études, cette activité antivirale implique la production des cytokines IFN-y et TNF et non l'activité cytotoxique des T Vy9Vd2. Par conséquent, mes travaux de thèse fournissent une preuve de concept pour une application thérapeutique des ABP dans le cadre d'une infection par le HCMV. / Aminobisphosphonates (ABP) treatment of cells induces intracellular accumulation of molecules (IPP, ApppI) which stimulate human Vy9Vd2 T cells. Although these lymphocytes do not appear naturally activated during human cytomegalovirus (HCMV) infection, the laboratory demonstrated a synergistic effect of HCMV and ABP on Vy9Vd2 T cell activation. My PhD thesis aimed to analyze the mechanism of this synergy and evaluate the immunotherapeutic potential of ABP in the context of HCMV infection. After ABP treatment of cells in vitro, we showed that HCMV-infected cells strongly activated Vy9Vd2 T cells. ABP-treated fibroblasts activate Vy9Vd2 T cells to produce IFN-y but not TNF. The HCMV infection of these fibroblasts stimulates TNF secretion and an increased production of IFN-y, indicating that Vy9Vd2 cells can sense HCMV infection. Increased cytokine production was observed with Vy9Vd2 T cell lines and "fresh" Vy9Vd2 directly isolated of blood. Moreover, Vy9Vd2 T cell activation was observed with most HCMV strains (laboratory strains or clinical isolates) and different HCMV-permissive cells. We also showed that HCMV infection induces an overproduction of IPP and ApppI in ABP-treated cells, which explains in part the increased cytokine production by Vy9Vd2 T cells. At last, we demonstrated the capacity of Vy9Vd2 T cells to limit viral replication and production after ABP treatment while preserving uninfected cells. Our experiments indicate that this antiviral activity involves IFN-y and TNF secretion by Vy9Vd2 T cells but not their cytotoxicity activity. Consequently, my work provides a proof of concept of the therapeutic potential of ABP in the context of HCMV infection.

Human cytomegalovirus infects approximately 50% of adults in the United States and in most cases is asymptomatic. However, in the case of immune compromised persons such as AIDS patients, transplant patients, and newborn babies, life threatening CMV disease can occur. The HCMV major immediate-early enhancer functions as a master regulatory switch, whose activation is essential for the expression of the major IE transactivating proteins, IE1 p72 and IE2 p86. While critical to the viral lifecycle, regulation of MIE enhancer activation is very complex and not yet fully understood. I characterized the role of cis-acting partners within the MIE enhancer that function to strengthen MIE gene expression and discovered a novel mode of post-IE enhancer regulation. These results add significantly to our understanding the inner workings of the HCMV MIE enhancer/promoter in lytically infected cells. The distal portion of the MIE enhancer is composed of two functionally redundant segments, which are necessary for MIE gene expression at low multiplicity of infection (MOI). Using an unbiased genetic approach I identified a previously unrecognized cis-acting TGGGCA/G repeat that is inextricably linked to GC-box repeats, which together form an enhancer-spanning network. This network of elements (TG network) is conserved in nonhuman primate CMV MIE enhancers. HCMV constructs lacking the entire enhancer TG network inadequately sustain MIE gene expression at low MOI at post-immediate early (IE) times of infection (≥8 h pi). An MIE enhancer-specified mode of post-IE regulation has not been described before and suggests a cis-regulatory code specialization that has evolved to sustain rather than to initiate MIE gene expression. I hypothesized that another cis-acting element(s) function together with the TG network to form a multi-network system that senses and integrates a variety of cellular environmental signals to modulate efficiency in the initiation and/or maintenance of MIE enhancer-dependent gene expression. Using recombinant viruses with mutations in either the cyclic AMP response element (CRE) network, NFkB network, TG network, or a combination of these networks, I show that the TG-C and TG-K partnerships are the most important for conferring the greatest level of MIE enhancer-dependent MIE gene expression, frequency and size of viral plaques in HFF cells, while the TG-K partnership is most important to DNT-2 cells. Additionally, I conclude that the C-K partnership functions through an alternate mechanism than that of the TG network. Together these results suggest that the strength of enhancement by cis-acting network pair interactions forms a multi-network system that modulates efficiency of MIE enhancer-dependent gene expression and which differs in relation to cell type during lytic infection.

Human cytomegalovirus (CMV) is a significant infectious agent causing disease in immunocompromised HIV-infected patients, transplant recipients, and neonates. The current antiviral therapeutic strategy against CMV is limited in its utility due to the inherent toxicity and lack of bioavailability of currently available anti-CMV agents, ganciclovir (GCV), cidofovir (CDV), and foscarnet (FOS). The development of the prodrug of GCV, valganciclovir (val-GCV), has vastly improved the bioavailability profile of GCV. However, val-GCV demonstrates limited effectiveness against tissue-invasive CMV diseases as side effects involved with traditional intravenously administered GCV such as haematologic and reproductive toxicities remain. In addition, the emergence of antiviral resistant CMV mutant strains due to prolonged treatment with currently available antivirals necessitates the development of novel anti-CMV agents with reduced toxicity and improved bioavailability. In this study, select groups of novel compounds were analysed for their potential for further development as anti-CMV agents. Three groups of compounds were identified based on two screening methods which included the computer simulated screening process of compounds known as in silico screening and the traditional method of random screening. The first group of compounds (CATi) were identified by in silico screening against the CMV DNA polymerase catalytic aspartate triad, resulting in the identification of 31 compounds with the potential for inhibitory activity against CMV. The second group of compounds (PRO-i) were identified through in silico screening against the CMV protease, identifying a total of 18 lead compounds exhibiting structural complementarity with CMV protease. The third and final group of compounds (TPEX) were identified through random screening and consisted of plant extracts purified from tropical plants. All three compounds were initially screened for cytotoxicity against human fibroblasts. Plaque reduction assays were performed using compounds with acceptable levels of cytotoxicity to determine the ability of the compounds to inhibit the replication of the laboratory antiviral sensitive CMV strain, Towne. Two of the PRO-i compounds demonstrated good antiviral activity against CMV. Eleven percent (2/18) of the PRO-i compounds inhibited CMV replication, with PRO-i-43 and PRO-i??-44 displaying mean 50% inhibitory concentrations (IC50) of 4.8 ?? 1.2 ??M and 8.04 ??M, respectively. PRO-i-43 and PRO-i-44 are thus good candidates for further development as novel antiviral agents against CMV. The majority of CATi and TPEX compounds displayed significant cytotoxicity against human fibroblasts and compounds with acceptable levels of cytotoxicities did not significantly inhibit CMV replication. However, the identification of compounds with low cytotoxicities provides a good foundation for further development of novel anti-CMV agents with superior antiviral activity. In silico screening against three-dimensional viral protein models is a useful strategy for the identification of novel antiviral agents with the potential for inhibitory activity against CMV. Structural modification to produce potent derivatives of the identified anti-CMV compounds (PRO-i-43 and PRO-i-44) is a good option for the further development of novel antiviral agents against CMV. Such further examination of the identified compounds with anti-CMV activity is required to investigate their activity against not only antiviral sensitive CMV strains but also resistant CMV strains. Further investigations will yield new insights into their target, allowing further identification of compounds with potential anti-CMV activity with pharmaceutical application.

The work presented herein focuses on the activation of the adaptive immune system in order to develop T cell-based immunotherapy for viral infections and cancer. The main goal was to identify and activate viral or tumoral antigen-specific T cells by using different identification, isolation and stimulation techniques. One such approach was that we modified dendritic cells (DCs) with an adenoviral vector encoding the full length pp65 antigen from cytomegalovirus (CMV). Through strategic modification techniques we demonstrate that it is possible to obtain DCs presenting antigen-specific peptides both on major histocompatibility complex (MHC) class I and MHC class II molecules for simultaneous CD8+ and CD4+ T cell activation. We also demonstrate that it is possible to generate prostate antigen-specific CD8+ T cells from a naïve repertoire of T cells by using DCs and HLA-A2-restricted peptides derived from prostate tumor-associated antigens or by using an adenoviral vector encoding the full length prostate tumor-associated antigen STEAP. We further demonstrate that CD8+ T cells directed against several prostate-specific peptide epitopes can be found in peripheral blood and in the prostate tumor area of prostate cancer patients. Furthermore, we have characterized a number of prostate-derived cell lines in terms of HLA haplotype and tumor-association antigen expression. We concluded that our methods for generating T cells restricted to CMV antigen have the ability to be applied for adoptive T cell transfer to patients with CMV disease and that prostate antigen-specific T cells can be found within prostate cancer patients, which enables future development of immunotherapeutic strategies for prostate cancer.

Los objetivos de este trabajo han sido estudiar la expresión de receptores de células NK (NKR), en particular CD94/NKG2C, en relación con la infección por citomegalovirus humano (HCMV). Los resultados descritos constituyen la primera evidencia de que la infección por HCMV modifica el repertorio de NKR. El incremento en la proporción de células CD94/NKG2C+ en donantes seropositivos para HCMV sugiere que participan en la respuesta al patógeno. El receptor CD94/NKG2C no sólo estimula las funciones efectoras y la proliferación de las células NK, sino que también activa a una subpoblación minoritaria de células T CD8+. El estudio de la expansión in vitro de la subpoblación NK CD94/NKG2C+ tras la interacción con fibroblastos infectados por el HCMV, sugiere que el propio receptor está implicado en la proliferación. / The main goals of this work have been to study the influence of human cytomegalovirus (HCMV) infection on the NK cell receptor (NKR) repertoire, mainly on the CD94/NKG2C receptor. Our observations provide a first evidence indicating that human cytomegalovirus (HCMV) may selectively shape the NKR repertoire. The increased proportions of NKG2C+ cells in HCMV-seropositive donors suggest a role in the response against the virus. The CD94/NKG2C receptor triggers the effector functions and proliferation not only in NK cells but also in a subset of CD8+ T lymphocytes. The stimulation of PBL from HCMV+ donors with virus-infected fibroblasts elicited a preferential expansion of CD94/NKG2C+ NK cells; studies carried out in this experimental system suggest that the receptor is involved in driving the proliferation.