Submitted by ANA LETICIA SGAVIOLLI null (ana.lsgaviolli@sp.senac.br) on 2016-10-25T21:37:48Z No. of bitstreams: 1 Submissão - 25.10.16.pdf: 954213 bytes, checksum: f27af9c710378005f768acd829e6aae3 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-11-01T19:55:43Z (GMT) No. of bitstreams: 1 serignolli_als_me_bot.pdf: 954213 bytes, checksum: f27af9c710378005f768acd829e6aae3 (MD5) / Made available in DSpace on 2016-11-01T19:55:43Z (GMT). No. of bitstreams: 1 serignolli_als_me_bot.pdf: 954213 bytes, checksum: f27af9c710378005f768acd829e6aae3 (MD5) Previous issue date: 2016-09-02 / A Doença Enxerto Contra o Hospedeiro (DECH) é uma das principais complicações em pacientes pós transplante de células tronco hematopoiéticas (TCTH), onde as células T do doador agridem os tecidos do receptor resultando em uma das principais causas de mortalidade e morbidade. Ocorre em cerca de metade dos pacientes que realizaram transplante de células tronco hematopoiéticas (TCTH). A pele é um dos órgãos mais acometidos. A DECH é dividida da forma aguda (DECH-a) e crônica (DECH-c), de acordo com o tempo de aparecimento dos achados clínicos e histopatológicos. A DECH de pele é classificada em graus variados, de I a IV, de acordo com o comprometimento. O presente estudo teve como objetivo avaliar a incidência de DECH-a cutânea entre os pacientes submetidos ao TCTH alogênico, aparentado, no Serviço de Transplante de Medula Óssea do Hospital Amaral Carvalho em Jaú/SP. Também foi objetivo do estudo a análise do perfil destes pacientes, a incidência e o impacto da doença na mortalidade precoce nos 100 primeiros dias pós TCTH. Os procedimentos metodológicos envolveram análise retrospectiva de dados retirados de planilhas do setor administrativo do Serviço de Transplante de Medula Óssea do Hospital Amaral Carvalho em Jaú/SP, contendo informações de 1113 pacientes que estiveram internados para a realização de transplante de medula óssea alogênico, aparentado, no período de agosto de 1996 a dezembro de 2013. Foram incluídos 582 pacientes cujas as doenças eram de linhagem mielóide - as mielopatias malignas (Leucemia Mieloide Aguda, Leucemia Mieloide Crônica, Síndrome Mielodisplásica e Doença Mieloproliferativa Crônica) para que o grupo pesquisado se tornasse homogêneo em termos de drogas e condicionamento. Esses 582 pacientes englobaram 2 grupos: pacientes que apresentaram DECH-a exclusiva de pele e pacientes que não apresentaram nenhum tipo de DECH. Todos os dados foram revisados e submetidos a análise estatística univariada e multivariada. Na análise univariada, observa-se maior sobrevida em 10 anos para os indivíduos com DECH-a de pele grau I e II (p=0.039) e para os transplantados com células de Medula Óssea (0.018). Essa significância estatística foi mantida na análise multivariada. A principal causa da mortalidade nos primeiros 100 primeiros dias do transplante foi a recidiva da doença de base, sendo a DECH aguda responsável por 6% dos óbitos nesse período. Não houve diferença significativa para os outros dados pesquisados. Conclui-se então que uma escolha adequada de doadores, além do uso de fonte de medula óssea como principal escolha para realização de transplante de medula óssea, podem diminuir a incidência de DECH-a de pele, além de aumentar a sobrevida dos pacientes transplantados. / Graft versus host disease (GVHD) is a major complication occurred in patients posttransplantation hematopoietic stem cell transplantation (HSCT), where the donor's T cells attack the recipient's tissues resulting in a major cause of mortality and morbidity.This is a recurrent and severe event, which occurs in about half of patients who underwent hematopoietic stem cell transplantation (HSCT), the skin is one of the most affected organs. GVHD is divided as acute (GVHD) and chronic (chronic GVHD), according to the time, clinical and histopathological findings. This study aimed to evaluate the incidence of GVHDskin among patients undergoing allogeneic HSCT, akin in Marrow Transplant Service Bone Amaral Carvalho Hospital, Jaú / SP, the profile of this patient and the impact of the disease in early mortality in the first 100 days after HSCT. The methodological procedures involved retrospective analysis of data from spreadsheets in the administrative sector of the Bone Marrow Transplant Service, Hospital Amaral Carvalho - Jau, containing information of 1,113 patients who were hospitalized for performing allogeneic bone marrow transplantation, related in the period August 1996 to December 2013. to equalize the analysis were included only 582 patients whose diseases were of myeloid lineage - malignant myelopathy (Acute myeloid Leukemia, Chronic myeloid Leukemia, Myelodysplastic Syndrome and Chronic myeloproliferative disease) so that the study group became homogeneous in terms of drugs and conditioning. These 582 patients were divided into 2 groups: patients with GVHDexclusive skin and patients without any GVHD. All data were reviewed and subjected to statistical analysis. In univariate analysis, there is greater survival at 10 years for patients with GVHD to skin grade I and II (p = 0.039) and the transplanted cells Bone Marrow (0018). This significance was maintained in multivariate analysis. The main cause of mortality in the first 100 early days of transplantation was the recurrence of the underlying disease, and acute GVHD responsible for 6% of deaths in this period. There was no significant difference for the other surveyed data. It was concluded that a suitable choice of donors, and the use of bone marrow source as the primary choice for bone marrow transplantation, can reduce the incidence of GVHD, the skin, and increase the survival rate of transplant patients.

Mesenchymal stem cells and their regenerative and immunomodulatory potential Abstract Mesenchymal stem cells (MSCs) possess multidirectional regenerative ability, which, together with their immunomodulatory potential, makes them promising cell type for therapy of wide variety of diseases. Despite ongoing research, which proved MSCs application to be safe, reported effect of MSCs administration on patients is not convincingly beneficial yet. In our work we focused on elucidation of MSCs role in regeneration of vital organs, heart and liver, where a large damage is life threatening for patients and any improvement in therapy would save many lives. Similar situation is in Graft versus host disease (GVHD), where MSCs immunomodulatory properties could be beneficial. Role of MSCs in heart regeneration was examined in vitro. Primary adult swine cardiomyocytes (CMCs) were co-cultured with or without swine MSCs for 3 days and morphological and functional parameters (contractions, current, respiration) of CMCs were measured. MSCs showed supportive effect on CMCs survival, especially at day 3 of the experiment, where in co-culture was significantly higher number of viable CMCs with physiological morphology and maintained function. Effect of MSCs on liver regeneration was observed in swine model of chronic liver...

Die akute Graft-versus-Host-Krankheit (GvHD) ist eine der Hauptkomplikationen nach einer allogenen hämatopoetischen Stammzelltransplantation, die die Effizienz der Therapie und deren Einsatz limitiert. Aktuelle Präventionsstrategien und Therapien beinhalten systemisch wirkende Immunsuppressiva. Diese haben oft zahlreiche Nebenwirkungen und erhöhen die Rate von Tumorrezidiven und schweren Infektionen. Therapierefraktäre Verläufe der GvHD sind häufig und können mit einer schlechten Prognose vergesellschaftet sein. Neuartige Präventions- und Behandlungsansätze sind daher Gegenstand intensiver Forschung. Eine zentrale Rolle in der Pathogenese der akuten GvHD spielen CD4+ T Zellen. Alloreaktive T Zellen vermitteln eine proinflammatorische Immunantwort, produzieren entsprechende Zytokine und aktivieren weitere Effektorzellen. Diese Immunkaskade induziert eine systemische Entzündungsreaktion und führt zu Organ- und Gewebsschädigung. Der spezifischen Modulation dieser alloreaktiven CD4+ T Zellen hin zu einer Toleranzentwicklung gegenüber dem Empfängergewebe wird eine große Bedeutung in der Entwicklung innovativer GvHD-Präventionsstrategien beigemessen. Es konnte in murinen Modellen gezeigt werden, dass die ex vivo-Behandlung eines allogenen bzw. xenogenen Transplantats mit dem CD4-gerichteten nicht-depletierenden Antikörper MAX.16H5 zu einer verminderten GvH-Reaktion führte. Eine Beeinträchtigung des Graft-versus-Leukämie-Effekts war nicht nachweisbar. Toleranzinduktionen durch monoklonale Antikörper gegen Oberflächenrezeptoren von Immunzellen im Rahmen von Autoimmunerkrankungen und GvHD werden in zahlreichen Studien untersucht. Darüber hinaus ist bekannt, dass in der GvHD-Pathogenese bestimmte microRNAs, 17 bis 25 Nukleotide lange, nicht kodierende, einzelsträngige RNA-Moleküle, eine Schlüsselrolle spielen. Die molekularen Mechanismen, die der Toleranzentwicklung des MAX.16H5 Antikörpers zugrunde liegen, sind jedoch nicht abschließend geklärt. Daher war es Ziel der vorliegenden Doktorarbeit (i) ein in vitro Stimulationsmodell für weitergehende Untersuchungen am MAX.16H5 Antikörper zu etablieren und (ii) durch Quantifizierung der microRNA-Expression unter T Zellstimulierung zur Aufklärung von molekularen Mechanismen der Toleranzinduktion des Antikörpers beizutragen. Das etablierte in vitro Stimulationsmodell diente zur Analyse und Phänotypisierung von CD4+ T Zellen nach Antikörperinkubation und Stimulation. Es konnte gezeigt werden, dass eine MAX.16H5-Behandlung zu einer verminderten Aktivierung (CD25-Expression) von T Zellen nach 24 h und 72 h in Kokultur mit murinen Milzzellen bei einem 10:1 bzw. 8,2:1 Verhältnis (humane CD4+ T Zellen zu murinen Milzzellen) führte. Dieses Modell kann als Grundlage für weitere in vitro Studien dienen, um Prozesse der Toleranzinduktion durch monoklonale Antikörper zu untersuchen, und liefert einen wichtigen Beitrag für die präklinische Analyse des MAX.16H5 Antikörpers im Hinblick auf die Entwicklung funktioneller Tests. Weiterhin wurde in dieser Arbeit die Expression von microRNAs in CD4+ T Zellen nach Bindung des MAX.16H5 Antikörpers untersucht. Hierzu wurden humane CD4+ T Zellen mit dem MAX.16H5 Antikörper behandelt und (i) ohne Stimulation, (ii) mit murinen Milzzellen bzw. (iii) mit Phytohämagglutinin inkubiert. Das microRNA-Expressionsprofil wurde mit Next Generation Sequencing bestimmt. In dieser Screeninganalyse wurden zahlreiche microRNAs gefunden, die unter den verschiedenen Stimulationsbedingungen nach MAX.16H5-Inkubation differentiell exprimiert waren. Die Expression der miR-18a-3p und miR-598-3p wurde anschließend mit qPCR näher untersucht. Eine statistisch signifikante Regulation konnte für miR-598-3p nach 72 h Inkubation nachgewiesen werden. Es ist der bisher einzige Hinweis auf einen molekularen Effekt der MAX.16H5-Behandlung auf CD4+ T Zellen. Ob dieser Unterschied funktioneller Natur, im Sinne eines Toleranz-induzierenden Phänotyps ist, werden zukünftige Studien zeigen. Zudem wird aktuell die miR-598-3p als potenzieller Biomarker für den Nachweis einer erfolgreichen Inkubation mit MAX.16H5 untersucht, was für zukünftige klinische Studien von großer Wichtigkeit ist.:1. Einleitung 1 1.1 Literaturübersicht 1 1.1.1 Die hämatopoetische Stammzelltransplantation 1 1.1.2 Die allogene Stammzelltransplantation 2 1.1.3 Die Graft-versus-Host-Krankheit 5 1.1.4 Die Prävention und Behandlung der akuten GvHD 8 1.1.5 Neue Strategien zur GvHD-Behandlung und -Prävention 10 1.1.6 Der Graft-versus-Leukämie-Effekt 13 1.1.7 Der CD4-gerichtete MAX.16H5 Antikörper zur Prävention der GvHD 14 1.1.8 Die Toleranzinduktion durch monoklonale Antikörper 16 1.1.9 Die microRNA 19 1.1.10 Die Rolle von miRNAs in der GvHD 20 1.1.11 Die Rationale für die Untersuchung von miR-18a-3p 21 1.1.12 Die Rationale für die Untersuchung von miR-598-3p 22 2 Fragestellung und Experimentdesign 23 3 Material und Methoden 25 3.1 Materialien 25 3.1.1 Verwendete Zellen 25 3.1.2 Geräte 25 3.1.3 Chemikalien, Medien und Reagenzien 26 3.1.4 Verbrauchsmaterialien 27 3.1.5 Oligonukleotide 28 3.1.6 Antikörper 28 3.1.6.1 Antikörper für Durchflusszytometrie 28 3.1.6.2 Antikörper für Zellinkubation 29 3.2 Methoden 29 3.2.1 Schematische Darstellung der methodischen Arbeitsschritte 29 3.2.2 Zellkulturarbeiten 31 3.2.2.1 Auftauen von Zellen 31 3.2.2.2 Konservierung von Zellen 31 3.2.2.3 Bestimmung der Zellzahl von PBMCs und Splenozyten 32 3.2.3 Isolation humaner PBMCs aus Spenderblut 32 3.2.4 Isolation muriner Milzzellen 33 3.2.5 Isolation humaner CD4+ T Zellen und MACS-Separation humaner und muriner Zellen 33 3.2.6 Inkubation mit dem murinem MAX.16H5 IgG1 Antikörper 35 3.2.7 Inkubation humaner CD4+ T Zellen 35 3.2.8 Durchflusszytometrie 36 3.2.9 RNA-Isolation 37 3.2.10 RNA-Fällung 38 3.2.11 Next Generation Sequencing von miRNAs 38 3.2.12 Next Generation Sequencing – Analyseschema 41 3.2.13 Reverse Transkription und qPCR 41 3.2.13.1 Reverse Transkription 42 3.2.13.2 qPCR 43 3.2.14 Statistische Analyse, Tabellen und Abbildungen 44 4. Ergebnisse 46 4.1 Etablierung eines in vitro Stimulationsmodells zur Analyse humaner CD4+ T Zellen nach Antikörperinkubation 46 4.2 Next Generation Sequencing zur miRNA-Expressionsanalyse in CD4+ T Zellen nach MAX.16H5 IgG1-Inkubation 50 4.2.1 FACS-Analyse isolierter CD4+ T Zellen vor und nach Antikörperinkubation 50 4.2.2 Separation muriner Milzzellen von humanen CD4+ T Zellen 53 4.2.3 NGS-miRNA-Expressionsanalyse in stimulierten und unstimulierten CD4+ T Zellen nach 72 h Inkubation 55 4.2.3.1 MiRNA-Expression nach MAX.16H5 IgG1-Inkubation und PHA-Stimulation 57 4.2.3.2 MiRNA-Expression nach MAX.16H5 IgG1-Inkubation und Stimulation mit murinen Milzzellen 59 4.2.3.3 MiRNA-Expression nach MAX.16H5 IgG1-Inkubation und ohne Stimulation 61 4.2.4 Zusammenfassung der Ergebnisse der NGS-Analyse 63 4.3 FACS-Analyse von CD4+ T Zellen nach 24 h und 72 h Inkubation 64 4.3.1 FACS-Analyse von CD4+ T Zellen nach 24 h Inkubation 64 4.3.2 FACS-Analyse von CD4+ T Zellen nach 72 h Inkubation 67 4.4 Validierung der Kandidaten-miRNA mittels qPCR 72 4.4.1 Expression von miR-18a-3p und miR-598-3p nach MAX.16H5 IgG1-Inkubation in CD4+ T Zellen nach 72 h 72 4.4.1.1 FACS-Analyse isolierter CD4+ T Zellen vor und nach Antikörperinkubation 72 4.4.1.2 FACS-Analyse der CD4+ T Zellen nach 72 h Inkubation 74 4.4.1.3 Separation muriner Milzzellen von humanen CD4+ T Zellen 78 4.4.1.4 Expression von miR-18a-3p und miR-598-3p 80 5. Diskussion 85 5.1 Die Expression von miR-18a-3p und der miR-17–92 Cluster 86 5.2 Die Expression von miR-598-3p 88 5.3 Die Differentielle Expression weiterer miRNAs 90 5.3.1 miR-223 90 5.3.2 Let-7d 91 5.3.3 miR-21 91 5.3.4 miR-181c 91 5.3.5 miR-10a 92 5.3.6 miR-150 92 5.3.7 miR-199a 92 5.3.8 miR-155 93 5.4 Die miRNA-Expressionsanalyse mit Next Generation Sequencing 93 5.5 Die Etablierung eines in vitro Stimulationsmodells 96 5.6 Verminderte T Zell-Aktivierung durch MAX.16H5 IgG1 98 6 Zusammenfassung der Arbeit 101 7 Literaturverzeichnis 104 A Erklärung über die eigenständige Abfassung der Arbeit 129 B Erklärung über die Vorbehaltlichkeit der Verfahrenseröffnung zur Verleihung des Titels Dr. med. 130 C Darstellung des wissenschaftlichen Werdegangs 131 D Danksagung 133

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京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21018号 / 医博第4364号 / 新制||医||1028(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小川 誠司, 教授 柳田 素子, 教授 江藤 浩之 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Mesenchymal stem cells and their regenerative and immunomodulatory potential Abstract Mesenchymal stem cells (MSCs) possess multidirectional regenerative ability, which, together with their immunomodulatory potential, makes them promising cell type for therapy of wide variety of diseases. Despite ongoing research, which proved MSCs application to be safe, reported effect of MSCs administration on patients is not convincingly beneficial yet. In our work we focused on elucidation of MSCs role in regeneration of vital organs, heart and liver, where a large damage is life threatening for patients and any improvement in therapy would save many lives. Similar situation is in Graft versus host disease (GVHD), where MSCs immunomodulatory properties could be beneficial. Role of MSCs in heart regeneration was examined in vitro. Primary adult swine cardiomyocytes (CMCs) were co-cultured with or without swine MSCs for 3 days and morphological and functional parameters (contractions, current, respiration) of CMCs were measured. MSCs showed supportive effect on CMCs survival, especially at day 3 of the experiment, where in co-culture was significantly higher number of viable CMCs with physiological morphology and maintained function. Effect of MSCs on liver regeneration was observed in swine model of chronic liver...

Background: Patients with steroid-refractory intestinal acute graft-versus-host disease (aGvHD) and bronchiolitis obliterans syndrome (BOS) represent a population with a high need for alternative and effective treatment options. Methods: We report real-life data from 18 patients treated with extracorporeal photopheresis (ECP). This cohort consisted of nine patients with steroid-refractory intestinal aGvHD and nine patients with BOS. Results: We document partial or complete clinical response and reduction of symptoms in half of the patients with intestinal acute GvHD and patients with BOS treated ECP. Responding patients tended to stay on treatment longer. In patients with BOS, stabilization of lung function and forced expiratory volume was observed, whereas, less abdominal pain, less diarrhea, and a reduction of systemic corticosteroids were seen in patients with intestinal acute GvHD. Conclusions: ECP might not only abrogate symptoms but also reduce mortality caused by complications from high-dose steroid treatment. Taken together, ECP offers a serious treatment avenue for patients with steroid-refractory intestinal acute GvHD and BOS.

La maladie du greffon contre l’hôte (GVHD) reste la complication majeure de l’allogreffe de cellules soucheshématopoïétiques (allo-CSH). La GVHD résulte de l’activation de la réponse immunitaire et de la reconnaissanced’alloantigènes par les lymphocytes T (LT) du donneur, entrainant ainsi des lésions tissulaires principalement auniveau de la peau, des intestins et du foie. L’interleukine-22 (IL-22) est une cytokine sécrétée par les LT Th1,Th17 et les cellules de l’immunité innée (ILC). Compte tenu des propriétés de l’IL-22 dans les tissus cibles de laGVHD, nous avons évalué sa contribution dans la physiopathologie de la maladie à l’aide de modèlesexpérimentaux murins. Il apparaît que les souris qui reçoivent des lymphocytes T invalidés pour l’IL-22développent une maladie moins sévère, et leur mortalité est diminuée. L’IL-22 issue du greffon participe donc à lasévérité de la GVHD en favorisant l’inflammation systémique, mais aussi locale au niveau des organes cibles. Deplus, dans les intestins, l’IL-22 agit en synergie avec les interférons de type I pour amplifier l’inflammation de typeTh1 au cours de la GVHD. Chez l’homme, la GVHD est associée à une modification du microbiote intestinal.Nous avons montré que l’absence d’IL-22 semble favoriser la colonisation de lactobacilles au détriment declostridiums, ce qui pourrait également participer à la diminution de la GVHD intestinale. Enfin, nous avonsmontré que l’effet anti-tumoral est préservé malgré l’absence d’IL-22. Ces résultats permettent donc d’envisagerde nouvelles perspectives thérapeutiques dans le traitement de la GVHD. / Graft-versus-host disease (GVHD) is still the major complication after allogeneic stem cell transplantation. GVHDresults from the activation of the immune response and the recognition by donor T cells of alloantigens leading totissue injury, especially in skin, gut and liver. Interleukin-22 (IL-22) is a cytokine secreted by CD4+ T cells Th1 andTh17 but also by innate lymphoid cells (ILC). Given that IL-22 functions in the GVHD target tissues, weinvestigated its contribution in GVHD physiopathology using mouse experimental models. We showed that IL-22deficiency in donor cells reduced the severity of GVHD by limiting systemic and local inflammation. Moreover, inthe large intestine, IL-22 acts in synergy with type I interferon to increase Th1-like inflammation. In humans,GVHD severity is associated with microbiotal modification in the intestine. We demonstrated that IL-22 deficiencyin donor cells seems to favor lactobacillus colonization instead of clostridium. These changes of microbiotacomposition may reduce the severity of intestinal GVHD. Finally, we showed that the antitumor effect is preservedeven in absence of IL-22 donor cells. Overall, our data support the design of new clinical approaches aiming totarget IL-22 pathways in GVHD patients.

O principal fator de risco para tuberculose (TB) em receptores de transplante de células-tronco hematopoiéticas (TCTH) é viver em regiões de alta endemicidade da doença, uma vez que a imunossupressão favorece a reativação da tuberculose latente (TBL). O diagnóstico da TBL pela prova tuberculínica (PT) tem limitações nos imunocomprometidos e testes de detecção de interferon gama podem ser vantajosos. Os objetivos do presente estudo foram comparar a PT com o QuantiFERON® TB-Gold In-Tube (QFT-GIT) no diagnóstico da TBL e determinar a incidência de TB em duas coortes de pacientes submetidos ao TCTH. Duas coortes foram analisadas prospectivamente. Coorte1: receptores de TCTH incluídos desde o período pré-transplante. Coorte 2: receptores de TCTH com doença do enxerto contra o hospedeiro (DECH) crônica em atividade. A PT e o QFT-GIT foram realizados imediatamente após a inclusão em ambas as coortes. Pacientes na coorte 1 com diagnóstico de TBL receberam profilaxia com isoniazida (INH) por nove meses. Na coorte 2, os pacientes foram acompanhados clinicamente, sem receber profilaxia. TB ativa foi investigada prospectivamente de acordo com definição de caso e por coletas periódicas de escarro. Entre os candidatos ao TCTH, a prevalência de TBL detectada pela PT foi de 4,7% e de 7,1% pelo QFT-GIT. Entre os receptores com DECH crônica a prevalência de TBL detectada pela PT foi de 5,3% e de 12,5% pelo QFT-GIT. A comparação entre as técnicas revelou boa concordância (kappa=0.60). Não houve casos de TB na coorte 1. A incidência cumulativa de TB na coorte 2 foi de 3%. Em comparação com alguns estudos, nossos resultados apresentaram menor prevalência de TB, com menos resultados indeterminados pelo QFT-GIT e melhor concordância entre ambos os testes. É provável que a introdução de profilaxia com INH seja benéfica também para os pacientes com DECH crônica. / The main risk factor for tuberculosis (TB) in hematopoietic stem cell transplant recipients (HSCT) is to live in regions of high endemicity of the disease, since immunosuppression favors the reactivation of latent tuberculosis infection (LTBI). The diagnosis of LTBI by the tuberculin test (TT) has limitations in the immunocompromised hosts and the interferon gamma release assays (IGRAs) may be advantageous. The objectives of the present study were to compare the TT with QuantiFERON® TB-Gold In-Tube (QFT-GIT) in the diagnosis of LTBI and to determine the incidence of TB in two cohorts of patients undergoing HSCT. Two cohorts were analyzed prospectively. Cohort 1: HSCT recipients included since the pre-transplant period. Cohort 2: TCTH recipients with active chronic graft versus host disease (GVHD). TT and QFT-GIT were performed immediately after inclusion in both cohorts. Patients in cohort 1 with diagnosis of LTBI received prophylaxis with isoniazid (INH) for 9 months. In cohort 2, the patients were followed up clinically, without receiving prophylaxis. Active TB was investigated prospectively according to a case definition criteria and periodic sputum sampling. Among the HSCT candidates, the prevalence of LTBI detected by TT was 4.7% and 7.1% by QFT-GIT. Among the recipients with chronic GVHD, the prevalence of LTBI detected by TT was 5.3% and 12.5% by QFT-GIT. The comparison between the techniques showed good agreement (kappa = 0.60). There were no cases of TB in cohort 1. The cumulative incidence of TB in cohort 2 was 3%. Compared with some studies, our results showed a lower prevalence of LTBI, with less indeterminate results by QFT-GIT and better agreement between both tests. It is likely that prophylaxis with INH is also beneficial for patients with chronic GVHD.

O requisito fundamental na seleção do par doador-receptor em Transplantes de Medula Óssea (TMO) é regido pelo sistema do Complexo Principal de Histocompatibilidade, ou seja, pelos mecanismos imunológicos mediados pelas moléculas dos Antígenos Leucocitários Humanos (HLA). No entanto as incompatibilidades HLA, podem influenciar de forma negativa ou positiva os resultados dos transplantes, através da Doença do Enxerto versus Hospedeiro e o efeito do enxerto versus Leucemia (EvL) respectivamente. Ainda é desconhecido o impacto do locus HLA-DPB1* neste contexto. Assim o presente projeto tem como objetivo a avaliação do impacto do HLA-DPB1* em transplantes de pacientes consanguíneos e a ocorrência de DECH. Para a tal finalidade, tipificamos o locus em questão utilizando a metodologia PCR-SSO, onde após a reação de amplificação da cadeia pela polimerase, realizamos a hibridização com uma sequência específica de oligonucleotídeos para tipificação do Loco HLA-DPB1*. Foram analisadas 826 amostras, sendo 413 pares de receptores e seus respectivos doadores familiares, submetidos a Transplantes de Células Tronco Hematopoiéticas, realizados na Unidade de Transplante de Medula Óssea de Curitiba da Universidade Federal do Paraná e da Faculdade de Medicina de Ribeirão Preto- USP. Observou-se que a presença de incompatibilidades HLA-DPB1* aumentam a chance dos receptores desenvolverem a doença do enxerto versus hospedeiro aguda, em graus mais graves. Assim, concluímos que a avaliação deste loco pode prevenir esta doença, e caso não haja outro doador, alerta o clínico quanto à utilização de medidas profiláticas. / The key requirement in the selection of the receptor-donor pair for bone marrow transplant is is defined by the Major Histocompatibility Complex, or by immunologic mechanisms mediated by molecules of the Human Leukocyte Antigens (HLA). However the post transplant complications due to HLA mismatches, as Graft versus Host Disease (GVHD) and graft failure are fundamental to the success of these transplants. Still unknown is the impact of loci HLA DPB1*, so this project aims to assess the impact of HLA - DPB1* in transplant patients consanguineous and assessing the impact of incompatibilities in HLA - DPB1 * GVHD. For this purpose, analyzed the loco in question using the PCR-SSO method, where after the amplification reaction polymerase chain, we performed hybridization with a sequence -specific primers for typing of HLA - DPB1* Loco. We analyzed 826 samples, 413 pairs of recipients and their respective donors, patients undergoing Hematopoietic Stem Cell Transplants performed in the Unit for Bone Marrow Transplantation in Curitiba, Federal University of Paraná and the Faculty of Medicine of Ribeirão Preto - USP. It was observed that the presence of mismatches HLA- DPB1* increase the chance of recipients develop chronic graft versus host disease, in more severe degrees. Thus, we conclude that the evaluation of this loci can prevent this disease and if no other donors alert the clinician to the use of prophylactic measures.