Objetivos. Avaliar o papel do transplante de células hematopoiéticas (TCH) e da interleucina 6 (IL – 6) sobre vários parâmetros de estresse oxidativo em pacientes com Adrenoleucodistrofia ligada ao cromossomo X (X-ALD). Métodos. A concentração de malondialdeído (MDA), o conteúdo de carbolinas e sulfidrilas e a concentração de ácido hexacosanóico (C26:0) foram quantificados no plasma de pacientes X-ALD antes e após serem submetidos ao TCH. E, a concentração de MDA, a formação de carbonilas e a concentração de IL-6 foram quantificados em plasma e o conteúdo de glutationa reduzida (GSH) foi quantificado em eritrócitos de pacientes X-ALD com fenótipos cerebral infantil (cALD) ou assintomáticos no momento diagnóstico. Resultados. Observamos um aumento significativo na concentração de MDA em plasma de pacientes X-ALD antes e após o TCH em comparação ao grupo controle e uma redução significativa nesses valores após o transplante em comparação aos anteriores ao procedimento. Verificamos uma redução significativa no conteúdo de sulfidrilas no plasma de pacientes X-ALD antes do TCH em comparação ao grupo controle e um aumento significativo desses níveis após o TCH. Não observamos diferenças significativas no conteúdo de carbonilas no plasma de X-ALD antes e após o TCH, em comparação aos controles, apesar de observarmos uma redução significativa nesta determinação nos pacientes após o transplante em relação a antes do TCH. Os pacientes X-ALD apresentam níveis plasmáticos de C26:0 significativamente aumentados antes do TCH em comparação aos controles e, após o TCH, as concentrações de C26:0 foram reduzidas. Observamos uma correlação negativa significativa entre a medida do conteúdo de sulfidrilas e os níveis plasmáticos de C26:0 de indivíduos X-ALD antes do TCH. Também evidenciamos elevados níveis de MDA e da formação de carbonilas no plasma de pacientes cALD e assintomáticos em comparação ao grupo controle. Ainda, observamos redução significativa do conteúdo de GSH nos dois grupos testados comparados aos controles. A quantificação de IL-6 foi significativamente maior nos pacientes cALD, o que não foi observado nos pacientes assintomáticos, apesar destes mostrarem uma tendência de aumento da concentração de IL-6. Conclusões. Os resultados obtidos a partir do plasma de pacientes X-ALD antes e após o TCH demonstram que esta terapia, quando bem indicada e bem sucedida, tem alta efetividade em reduzir a concentração plasmática de C26:0 e é eficaz em reduzir a peroxidação lipídica e o dano oxidativo às proteínas nos pacientes X-ALD. Ainda, é possível relacionar o acúmulo de C26:0 e o dano oxidativo na patogênese da X-ALD. Nossos dados permitem sugerir que a lipoperoxidação e o dano oxidativo às proteínas possam de alguma forma estar envolvidos na fisiopatologia da X-ALD. Além disso, podemos presumir que, nos pacientes X-ALD assintomáticos estudados, o dano oxidativo e os aspectos inflamatórios desempenham papéis importantes na evolução e nas futuras manifestações do fenótipo neuronal. Também podemos supor que a administração de antioxidantes deve ser considerada como uma terapia adjuvante potencial para os pacientes assintomáticos e sintomáticos afetados pela X-ALD, inclusive para aqueles submetidos ao TCH. / Objective. We aimed to evaluate the role of hematopoietic stem cell transplantation (HSCT) and interleukin 6 (IL – 6) on various parameters of oxidative stress in X-linked adrenoleukodystrophy (X-ALD) patients. Methods. Malondialdehyde (MDA), sulfhydryl, carbonyl and hexacosanoic acid (C26:0) levels were measured in plasma from X-ALD patients before and after HSCT. And, MDA, carbonyl and IL-6 levels were measured in plasma and reduced glutathione (GSH) content was measured in erythrocytes from X-ALD patients with different phenotype (asymptomatic and childhood cerebral (CCER patients) at diagnosis moment. Results. We observed increased levels of MDA in plasma from X-ALD before and after HSCT compared to control group, but there was a significant reduction in MDA values after transplantation compared to levels found before the procedure. We verified a significant decrease in sulfhydryl content in plasma of X-ALD patients before HSCT compared with the control group and we also verified a significant increase in the levels of sulfhydryl content after HSCT. No significant differences were observed in carbonyl content in plasma of X-ALD before and after HSCT, compared to controls. However, we observed a significant reduction of plasma carbonyl content from X-ALD patients after HSCT compared to before HSCT. X-ALD patients presented a significant increase of C26:0 plasma level before HSCT when compared to controls and an important reduction of C26:0 plasma concentration in X-ALD patients after HSCT when compared to before HSCT C26:0 levels. We observed an inverse significant correlation between sulfhydryl content and plasma C26:0 levels of X-ALD individuals before HSCT. We also evidenced high levels of MDA and carbonyl formation in plasma from CCER and asymptomatic patients compared to controls. Still, we observed a significant decrease of GSH content in both groups tested compared to controls. The quantification of IL-6 is significantly higher in CCER patients, which is not observed in asymptomatic patients, despite these patients show a tendency of increased concentration of IL-6. Conclusions. The results obtained from plasma of X-ALD patients before and after HSCT demonstrate that this therapy, when well indicated and successful, has high effectiveness in reducing C26:0 plasma and is effective in reducing lipid peroxidation and oxidative damage to proteins in X-ALD patients. Still, it is possible to relate the accumulation of C26:0 and oxidative damage in the pathogenesis of X-ALD. Our data also suggest that lipid peroxidation and protein damage may somehow be involved in the pathophysiology of X-ALD. Moreover, we can assume that in our asymptomatic X-ALD patients, oxidative damage and inflammatory issues seem to play an important role in the evolution and future manifestations of neuronal phenotype. We can also assume that the administration of antioxidants should be considered as a potential adjuvant therapy for asymptomatic and symptomatic patients affected by X-ALD, including those that are submitted to HSCT.

Purpose: This study seeks to determine the incidence of vancomycin-resistant enterococci (VRE) infection in high-risk neutropenic fever patients colonized with VRE and to determine patient characteristics associated with VRE infection. Methods: We conducted a retrospective, single-center, unmatched case-control study. Fifty-three VRE-colonized, high-risk patients with neutropenic fever were identified between January 2006 and February 2009. The two most common diagnoses/conditions included acute myeloid leukemia and hematopoietic stem cell transplantation. Data collected included days of neutropenia, days of fever, demographic data, culture results, and antimicrobial therapy. Results: Twenty of the 53 patients (38%) with VRE colonization developed a VRE infection. The most common VRE infections were bacteremias (26%). The presence of neutropenia lasting longer than 7 days was associated with the development of VRE infection in this high-risk population colonized with VRE. The timeframe to develop VRE infection varied from 1 day to 2 weeks. Conclusion: For patients colonized with VRE, approximately 38% of high-risk neutropenic patients developed a VRE infection. This is the first study to specifically evaluate the incidence of VRE infections in febrile neutropenic patients colonized with VRE. Future research into the use and efficacy of empiric VRE coverage is needed.

When a multicellular organism suffers damages to tissues/organs it heals itself by either substituting the lost cellular matrix by scar formation or by regenerating the lost tissue. Regeneration likely occurs by a recapitulation of the developmental process that formed the organ. Many processes regulating organ development are based on epithelial-mesenchymal interactions and a strict control of organ specific stem/progenitor cells. Elucidation of the molecular basis of these processes is therefore vital in order to develop novel therapies in regenerative medicine. The LIM homebox gene Lhx2 is interesting in this context since Lhx2 has been shown to be important for the formation of several organs by regulating epithelial-mesenchymal interactions and progenitor cell function. Targeted inactivation of Lhx2 leads to a lethal anemia due to malformed liver and severe neural abnormalities such as hypoplasia of the forebrain and anophtalmia. Thus, elucidation of the mechanisms of the function of Lhx2 in different organ systems would give important insights into the molecular mechanisms regulating epithelial-mesenchymal interactions and stem/progenitor cell function. To elucidate the function of Lhx2 in the hematopoietic system Lhx2 was initially expressed in hematopoietic progenitor cells derived from ES cells differentiated in vitro using retroviral vectors. This approach led to the generation of hematopoietic stem cell (HSC)-like cell lines suggesting that Lhx2 could impact HSC function. However neither the specificity nor the efficiency of the Lhx2-induced phenotype could be determined using this approach. To be able to elucidate the function of Lhx2 in the hematopoietic system, an ES cell line with inducible Lhx2 expression was generated. Lhx2 expression induces self-renewal of a distinct hematopoietic progenitor cell from which HSC-like cell lines were established. Down-regulation of Lhx2 in these HSC-like cell lines leads to a rapid loss of stem cell character, providing a good model to study the molecular function of Lhx2 in hematopoietic stem/progenitor cells. A global gene expression analysis was performed comparing the Lhx2+ stem cell population to the Lhx2- differentiated progeny. This approach identified genes putatively linked to self-renewal/differentiation of HSCs. A considerable proportion of the genes showed an overlapping gene expression pattern with Lhx2 expression in tissue of non-hematopoietic origin suggesting that Lhx2 function in stem/progenitor cells partly overlap with Lhx2 function during organ development. In order to define other Lhx2-dependent progenitor cell populations and to generate a tool to analyze the function of Lhx2 in organ development a new transgenic mouse model was generated. By using a specific part of the Lhx2 promoter to drive expression of Cre recombinase in vivo (Lhx2-Cre mice) we have been able to define the first eye committed progenitor cells in the forebrain. By using the Lhx2-Cre mice it will be possible to distinguish the function of genes during eye development from their function in the patterning of the forebrain e.g. the eye field transcription factors. Conditional inactivation of Lhx2 in these eye specific progenitor cells causes an immediate developmental arrest. The transgene is also active in Lhx2-/- embryonic forebrain, but re-expression of Lhx2 in Lhx2-/- progenitor cells only promote formation of retinal pigment epithelium cells. Analysis of genes expressed by the Lhx2+ stem cell population allowed us to define novel genes putatively linked to Lhx2 function in eye development. Thus, we have defined the progenitor cells in the forebrain committed to eye development and the expansion and patterning of these progenitors are dependent on Lhx2. Although commitment to eye development is Lhx2-independent, Lhx2 might be important for the acquisition of the oligopotent fate of these progenitor cells.

Bakgrund:Oral mukosit (OM) är en toxisk biverkan efter högdos cytostatikabehandling (HDC) och hematopoietisk stemcellstransplantation (HSCT). OM orsakar kliniska komplikationer samt negativa följder för patienten, som längre sjukhusvistelse, oral smärta, viktförlust och parenteral nutrition (PN).Syfte:Att undersöka om det föreligger skillnad i viktförändring och nutritionsstatus hos patienter som använder munsköljmedlet, Caphosol ® i tillägg till standardbehandling i jämförelse med standardbehandling vid behandling med HDC och HSCT.Metod:En randomiserad kontrollerad öppen studie där patienter > 16 år (n=40), behandlades med HDC, inför HSCT på Akademiska universitetssjukhuset, Uppsala. Patienterna randomiserades, 1:1, till oral standardbehandling och munsköljmedlet Caphosol® (EXP n=20) eller oral standardbehandling (KTR n=20). OM, oral smärta, viktförlust och dagar av PN registrerades och analyserades från baseline till 21 dagar efter avslutad HDC.Resultat:Caphosol ® hade ingen signifikant betydelse för viktförändringar mellan EXP- och KTR-grupperna. OM-smärta debuterade senare i EXP än i KTR-gruppen. KTR gruppen använde mer PN jämfört med EXP-gruppen.Konklusion:Caphosol ® hade obetydlig inverkan på förekomst, duration och svårighetsgrad av OM under HCT vid HSCT och därmed liten effekt på nutrition och vikt. Det förelåg ingen fördel att addera Caphosol ® till oral standardbehandling. / Background:Oral mucositis (OM) is a result of cytotoxic effects of high dose chemotherapy (HDCT) administered before hematopoietic stem cell transplantation (HSCT). It is a source of negative consequences for the patient, such as longer hospitalization, oral pain, weight loss, and use of parenteral nutrition (PN).Objective:To investigate whether there is differences in weight changes and nutritional status in patients receiving mouth rinse, Caphosol®, in addition to standard oral care (OC) compared to standard OC for HDCT and HSCT.Method:A randomized, controlled open study with patients > 16 years, treated with HDCT before HSCT at Akademiska University Hospital, Uppsala, Sweden. Patients randomized 1:1 to standard OC and Caphosol® (EXP, n=20) or standard OC (CTR n = 20). Oral pain, weight loss and days of PN was recorded and analysed from baseline to day 21 post HDCT.Result:Caphosol ® had no significant impact on weight changes between EXP and CTR groups. OM-pain peaked later in the EXP group than in CTR. No significance in weight change between settings. CTR group had higher use of PN compared to EXP.Conclusion:Caphosol® had little effect on frequency, duration and severity of OM and thereby little effect on nutrition and weight. There was no advantage to add Caphosol ® to standard OC.

L’infection primaire au VZV et la réactivation du VZV latent sont fréquemment observées à la suite d’une GMO ou d’une GSCO, ce qui cause de sérieuses complications chez le patient. Pour prévenir ces infections, une prophylaxie antivirale est administrée systématiquement chez tous les greffés de MO ou de SCO, alors qu’il n’existe aucun consensus sur la durée optimale d’une telle prophylaxie. Pour résoudre ce problème, notre objectif est de développer et valider une méthode ELISpot-VZV-IFN- qui permettra de suivre la reconstitution de l’immunité à médiation cellulaire anti-VZV chez les receveurs de GMO ou de GSCO et ainsi déterminer le moment opportun pour réduire ou interrompe la prophylaxie chez les receveurs de greffes de CSH. Dans un premier temps, des valeurs-seuil de la réponse à médiation cellulaire anti-VZV chez la population pédiatrique saine ont dû être générées. À la lumière de nos résultats, un enfant avec un résultat ELISpot-VZV-IFN- > 190.0 SFU/106 PBMC devrait être protégé contre une possible infection à VZV. Pour valider cette étude, une étude prospective de la reconstitution immunitaire anti-VZV a été effectuée chez 9 enfants greffés de MO ou de SCO. Nos résultats préliminaires ont montré qu’il n’y avait eu aucune reconstitution significative de l’immunité à médiation cellulaire anti-VZV dans les 18 premiers mois post-transplantation chez 8 de ces 9 enfants. Les résultats de ces expériences vont fournir d’importantes informations quant à la reconstitution de l’immunité anti-VZV à la suite d’une GMO ou d’une GSCO et pourraient permettre l’amélioration des soins apportés aux receveurs de GMO ou de GSCO. / Primary infection with VZV and reactivation of latent VZV are commonly observed following BMT and UCBT, leading to serious complications in patients. As a result, antiviral prophylaxis is systematically administered to BMT and UCBT recipients, yet there is no consensus that defines its optimal duration. To resolve this problem, our objective was to develop and validate a VZV-IFN--ELISpot with which reconstitution of VZV immunity can be followed in BMT and UCBT recipients, providing clinicians a practical tool to gauge the need for and adjust antiviral prophylaxis in individual HSCT recipients. First of all, threshold values for anti-VZV immunity in healthy pediatric subjects were generated. Based on our results, a child exhibiting > 190.0 VZV-specific SFU /106 PBMC should be protected against a possible VZV infection. To validate these results, a prospective study on the recovery of VZV-specific T cell immunity was performed on 9 children following BMT or UCBT. Preliminary results demonstrated that there was no significant recovery of VZV-specific T cell immunity in the first 18 months post-transplantation in 8 of 9 cases. Results of these experiments will yield important new information regarding reconstitution of anti-VZV immunity following BMT and UCBT and could lead to improvements in clinical management of BMT and UCBT recipients.

Le busulfan (Bu) est un composé clé de la phase de conditionnement chez les enfants subissant une transplantation des cellules souches hématopoïétiques (TCSH). Les différences inter-individuelles de la pharmacocinétique (PK) du Bu pourraient affecter son efficacité et sa toxicité. Le Bu est principalement métabolisé par la glutathion-S-transférase (GST). Nous avons étudié la relation des génotypes GSTA1, GSTM1 et GSTP1 avec la PK de la première dose de Bu et la relation avec les résultats de la TCSH chez 69 enfants recevant un régime de conditionnement myéloablatif. Le génotype GSTM1 nul a corrélé avec une exposition élevée du Bu et une faible clairance (CL) chez les patients âgés de 4 ans (p ≤ 0,04). Dans le respect du rôle fonctionnel suggéré d’haplotype GSTA1 *A2, il a été associé à des niveaux plus faibles de médicaments et des niveaux élevés de CL (p ≤ 0,03). L’effet Gène-dose a également été observé (p = ≤ 0,007). L’haplotype de GSTA1 était associé avec les résultats de la TCSH. Les porteurs de deux copies d’haplotype *A2 avaient une meilleure survie sans événement (p = 0,03). En revanche, les individus homozygotes pour haplotypes * B et *B1 ont un risque plus élevé d’atteindre la maladie veino-occlusive (MVO) (p = 0,009). Les individus porteurs de GSTM1 nul âgés de 4 ans possèdent un risque plus fréquent d’avoir la maladie du greffon contre l'hôte (GvHD) (p = 0,03). En conclusion, nous avons montré que les variantes génétiques de GST influencent la PK du BU et les résultats de la TCSH chez les enfants. Pour l'ajustement de la posologie, un modèle avec l'inclusion des facteurs génétiques et non génétiques devrait être évalué et validé dans une étude prospective. / Busulfan (Bu) is a key compound of conditioning regimen in children undergoing hematopoietic stem cell transplantation (HSCT). Inter-individual differences in Bu pharmacokinetics might affect Bu efficacy and toxicity. Since Bu is mainly metabolized by glutathione S-transferase (GST), we investigated the relationship between GSTA1, GSTM1 and GSTP1 genotypes with first-dose Bu pharmacokinetics (PK), and relationship with HSCT outcomes in 69 children receiving myeloablative conditioning regimen. GSTM1 null genotype correlated with higher Bu exposure and lower clearance in patients older than 4 years (p≤0.04). In accordance with the suggested functional role GSTA1*A2 haplotype was associated with lower drug levels and higher drug clearance (p≤0.03). Gene-dosage effect was also observed (p=≤0.007). GSTA1 haplotypes were associated with HSCT outcomes Patients with two copies of haplotype *A2 had better event free survival (p=0.03). In contrast, homozygous individuals for haplotypes *B and *B1 had higher occurrence of veno-occlusive disease (p=0.009). GSTM1 null individuals older than 4 years had more frequently graft versus host disease (p=0.03). In conclusion, we showed that GST gene variants influence Bu PK and outcomes of HSCT in children. A model for the dosage adjustment with the inclusion of genetic and non-genetic factors should be evaluated in a future prospective validation cohort.

Les modifications post-transcriptionnelles de l’ARN messager (ARNm), comme l’épissage alternatif, jouent un rôle important dans la régulation du développement embryonnaire, de la fonction cellulaire et de l’immunité. De nouvelles évidences révèlent que l’épissage alternatif serait également impliqué dans la régulation de la maturation et de l’activation des cellules du système hématopoïétique. Le facteur hnRNP L a été identifié comme étant le principal régulateur de l’épissage alternatif du gène codant pour le récepteur CD45 in vitro. Le récepteur CD45 est une tyrosine phosphatase exprimée par toutes les cellules du système hématopoïétique qui contrôle le développement et l’activation des lymphocytes T. Dans un premier temps, nous avons étudié la fonction du facteur hnRNP L dans le développement des lymphocytes T et dans l’épissage de l’ARNm de CD45 in vivo en utilisant des souris dont le gène de hnRNP L a été supprimé spécifiquement dans les cellules T. La délétion de hnRNP L dans les thymocytes résulte en une expression aberrante des différents isoformes de CD45 avec une prédominance de l'isoforme CD45RA qui est généralement absent dans le thymus. Une conséquence de la délétion de hnRNP L est une diminution de la cellularité du thymus causée par un blocage partiel du développement des cellules pré-T au stade DN4. Cette réduction du nombre de cellules dans le thymus n’est pas liée à une hausse de la mort cellulaire. Les thymocytes déficients pour hnRNP L démontrent plutôt une prolifération augmentée comparée aux thymocytes sauvages due à une hyper-activation des kinases Lck, Erk1/2 et Akt. De plus, la délétion de hnRNP L dans le thymus cause une perte des cellules T en périphérie. Les résultats des expériences in vitro suggèrent que cette perte est principalement due à un défaut de migration des thymocytes déficients pour hnRNP L du thymus vers la périphérie en réponse aux chimiokines. L’épissage alternatif de CD45 ne peut expliquer ce phénotype mais l’identification de cibles par RNA-Seq a révélé un rôle de hnRNP L dans la régulation de l’épissage alternatif de facteurs impliqués dans la polymérisation de l’actine. Dans un second temps, nous avons étudié le rôle de hnRNP L dans l’hématopoïèse en utilisant des souris dont la délétion de hnRNP L était spécifique aux cellules hématopoïétiques dans les foies fœtaux et la moelle osseuse. L’ablation de hnRNP L réduit le nombre de cellules progénitrices incluant les cellules progénitrices lymphocytaires (CLPs), myéloïdes (CMPs, GMPs) et mégakaryocytes-érythrocytaires (MEPs) et une perte des cellules hématopoïétiques matures. À l’opposé des cellules progénitrices multipotentes (MPPs) qui sont affectées en absence de hnRNP L, la population de cellules souches hématopoïétiques (HSCs) n’est pas réduite et prolifère plus que les cellules contrôles. Cependant, les HSCs n’exprimant pas hnRNP L sont positives pour l'Annexin V et expriment CD95 ce qui suggère une mort cellulaire prononcée. Comme pour les thymocytes, une analyse par RNA-Seq des foies fœtaux a révélé différents gènes cibles de hnRNP L appartenant aux catégories reliées à la mort cellulaire, la réponse aux dommages à l’ADN et à l’adhésion cellulaire qui peuvent tous expliquer le phénotype des cellules n’exprimant pas le gène hnRNP L. Ces résultats suggèrent que hnRNP L et l’épissage alternatif sont essentiels pour maintenir le potentiel de différenciation des cellules souches hématopoïétiques et leur intégrité fonctionnelle. HnRNP L est aussi crucial pour le développement des cellules T par la régulation de l’épissage de CD45 ainsi que pour leur migration. / Post-transcriptional modifications of pre-mRNA by alternative splicing are important for cellular function, development and immunity. New evidence reveals that alternative splicing is implicated in the regulation of maturation and activation of hematopoietic cells. HnRNP L has been identified as the main regulator of alternative splicing of CD45 in vitro. The receptor tyrosine phosphatase CD45, which is expressed on all hematopoietic cells, is known for its role in the development and activation of T cells. First, we have investigated the function of hnRNP L in T cell development and CD45 pre-mRNA splicing in vivo using T cell specific deletion of hnRNP L in mice. The hnRNP L deletion results in aberrant expression of CD45 isoforms, predominantly CD45RA, which is usually absent from the thymus. Ablation of hnRNP L results in a partial block in pre-T cell development at the DN4 stage. This reduction in thymic cellularity is not due to an increase in cell death. In fact, hnRNP L deficient thymocytes demonstrate accelerated proliferation compared to wild-type cells due principally to a hyper-activation of the kinases Lck, Erk1/2 and Akt. Moreover, hnRNP L deletion results in a loss of peripheral T cells. In vitro studies suggest that this loss of peripheral cells is caused by a defect in response to chemokine signals. Since CD45 pre-mRNA splicing cannot explain this phenotype, the identification of hnRNP L targets by RNA-Seq has shown that hnRNP L plays a role in the regulation of alternative splicing of factors involved in actin polymerization. Secondly, we studied the role of hnRNP L in hematopoiesis using knockout mice in which hnRNP L is conditionally deleted specifically in fetal liver and bone marrow hematopoietic cells. Ablation of hnRNP L reduces the number of cell lineage committed progenitors including the common lymphoid progenitors (CLPs), common myeloid and granulocyte progenitors (CMPs, GMPs) and the megakaryocyte-erythrocyte progenitors (MEPs) as well as the mature hematopoietic cells. In contrast to multipotent progenitors (MPPs) that are affected by the absence of hnRNP L, the hematopoietic stem cell (HSC) population is not reduced. In fact, HSCs from hnRNP L deleted mice demonstrate increased cell cycling. However, hnRNP L deficient HSCs express high levels of Annexin V and CD95, which suggests an increased cell death. As for the thymus, a RNA-Seq analysis of fetal livers revealed different targets of hnRNP L among gene categories related to cell death, DNA damage responses and cell adhesion that may explain the phenotype observed in the hnRNP L deficient HSCs. These results suggest that hnRNP L and alternative splicing are essential for the survival and maintenance of the differentiation potential of HSCs. HnRNP L is also crucial for the development of T cells by regulating both their migration and the splicing of CD45.

Les cellules souches hématopoïétiques (CSH) assurent la génération de toutes les lignées sanguines. Leur différenciation en cellules T matures se déroule dans un microenvironnement spécialisé, le thymus, orchestrée par des interactions complexes entre cytokines, chimiokines et cellules stromales. Les mutations bloquant la différenciation des cellules T ont un impact sur l'architecture du thymus, soulignant l’importance des interactions entre cellules T en développement et cellules stromales thymiques.Les déficits immunitaires combinés sévères sont généralement traités, avec succès, par transplantation de CSH allogénique par voie intraveineuse. Cependant, des complications peuvent survenir notamment en cas de greffe non compatible. Pour pallier à cela, la thérapie génique a été développée mais son efficacité et son innocuité restent à améliorer. Dans ce but, notre groupe a développé une approche par correction génique des progéniteurs T directement in vivo, via un vecteur lentiviral. Bien qu’efficace, là encore, l’efficacité de traitement reste insuffisante voire extrêmement limitée chez les macaques.Lors de ma thèse, j'ai donc évalué le potentiel de différents sérotypes de vecteur viraux adéno-associés (AAV) pour la transduction des thymocytes. L'administration IT de plusieurs sérotypes de AAV2 engendre une transduction des thymocytes >10 fois plus élevée que celle des vecteurs lentiviraux. Le sérotype AAV2/8 induit la transduction des thymocytes la plus efficace et les cellules transduites représentent jusqu'à 1% des cellules T périphériques d’une souris immunocompétente. En utilisant des souris immunodéficientes ZAP-70-/- comme paradigme, j'ai découvert que l'injection IT de l’AAV2/8-ZAP-70 entraîne une transduction et différentiation lymphocytaire T rapide, associée à la génération d’une medulla thymique. En effet, des cellules épithéliales thymiques de la médulla (mTEC) exprimant le régulateur auto-immun AIRE sont détectées en <2 semaines. Bien que cette reconstitution soit transitoire, les mTECs AIRE+ diminuant 10 semaines post-injection, les cellules T périphériques corrigées persistent >40 semaines et présentent environ 1 copie du vecteur AAV/cellule. Ces cellules T effectrices peuvent sécréter des niveaux élevés de cytokines et un nombre important de cellules T régulatrices est également généré. Ainsi, une seule vague de thymopoïèse à partir de progéniteurs transduits par l’AAV-ZAP-70, permet une restauration, rapide et transitoire de l'architecture thymique mais, à long terme de cellules T périphériques fonctionnelles.Pour évaluer les diverses populations de TEC régissant le développement et la sélection des cellules T, j'ai collaboré avec les groupes de P Jay/J Abramson/I Amit pour établir une cartographie de novo du compartiment stromal thymique. Nos analyses ont mis en évidence quatre populations majeures de mTEC (I-IV) avec des fonctions distinctes. Notamment, les mTEC-IV constituent une population unique présentant des similarités moléculaires et morphologiques avec les cellules tuft intestinales. Comme nous avions précédemment identifié la sécrétion d'IL-25 par les cellules tufts comme un régulateur des interactions entre compartiment épithélial et hématopoïétique dans l'intestin, nous avons évalué ce potentiel dans le thymus. Ainsi, des souris déficientes en cellules tuft intestinales présentent également une déficience spécifique en mTEC-IV et une homéostasie perturbée de diverses populations exprimant l'IL-25R dans le thymus. Notre recherche a donc permis d'identifier une nouvelle population de TEC tuft avec un rôle critique dans la formation de la niche immunitaire du thymus.L’ensemble de mes résultats montrent le potentiel thérapeutique de stratégie intrathymique de thérapie génique pour des patients ayant besoin d’une reconstitution rapide en cellules T et fournissent de nouvelles perspectives sur les populations stromales thymique et leur rôle dans l’équilibre de la niche immunitaire. / Hematopoietic stem cells (HSC) ensure the generation of all blood lineages. Their differentiation to mature T lymphocytes occurs in the specialized microenvironment of the thymus, orchestrated by complex interactions between cytokines, chemokines, and stromal cells. Mutations resulting in a block in T cell differentiation impact on the architecture of the thymus, pointing to the critical crosstalk between developing T cells and thymic stromal components.Genetic severe combined immunodeficiencies (SCID) are generally treated by the intravenous transplantation of healthy allogeneic HSCs. Although this therapy is often successful, complications can occur, especially for patients receiving non-histocompatible HSC transplants. To circumvent these problems , significant efforts have gone into developing gene therapy strategies but adverse events indicate the necessity of exploring other avenues. Our group hypothesized that in situ gene correction of T lymphoid progenitors in the thymus itself may overcome some of the drawbacks of ex vivo gene therapy. While intrathymic (IT) lentiviral vector administration corrected immunodeficient thymocyte precursors in mice, thymus transduction was inefficient and efficacy in macaques was limited.During my PhD, I assessed the in vivo potential of adeno-associated vectors (AAV) to transduce thymocyte precursors. Intrathymic administration of several different scAAV2 serotypes resulted in a >10-fold higher transduction of thymocytes (3-5%) as compared to lentiviral vectors. scAAV2/8 promoted the highest level of gene transfer and strikingly, transduced cells represented up to 1% of peripheral T lymphocytes in immunocompetent mice. Using ZAP-70-/- immunodeficient mice as a paradigm, I found that IT injection of an AAV2/8-ZAP-70 vector resulted in a rapid transduction and T cell differentiation, correlating with a dramatic generation of the thymus medulla. Indeed, medullary thymic epithelial cells (mTEC) expressing the AIRE autoimmune regulator were detected within <2 weeks. While this reconstitution was transient––AIRE+ mTECs decreased by 10 weeks post gene transfer––gene-corrected peripheral T cells, harboring approximately 1 AAV genome/ cell, persisted for >40 weeks. Effector T cells had the potential to secrete high levels of cytokines and significant numbers of gene-corrected regulatory T cells were also generated. Thus, a single wave of thymopoiesis, from intrathymic AAV-ZAP-70-transduced progenitors, allows for a rapid but transient restoration of the thymic architecture and long-term peripheral T cell function.To better assess the diverse TEC populations that orchestrate T cell development and selection, I collaborated with the groups of P. Jay/J. Abramson/I. Amit to combine single cell analysis and in-vivo fate-mapping to de novo characterize the entire stromal compartment of the thymus. Our analyses highlighted four major medullary TEC (mTEC I-IV) populations with distinct lineage regulator function and specifically, we found that mTEC-IV constitutes a highly divergent TEC subset that bears strong molecular and morphological characteristics to intestinal tuft cells. As we previously identified tuft cell secretion of IL-25 as a regulator of the crosstalk between the epithelial and hematopoietic compartments in the gut, we assessed the potential immune-modulatory function of mTEC-IV. Notably, mice deficient in intestinal tuft cells exhibited a specific depletion of mTEC-IV and a perturbed homeostasis of various IL25-R-expressing populations in the thymus. Taken together, our data identify a new tuft TEC population critical for shaping the thymus immune niche.In conclusion, the data generated during my PhD advance the therapeutic potential of intrathymic-based vector strategies for the treatment of patients requiring a rapid T cell reconstitution and provide new insights into thymic stromal subsets that are critical for shaping the thymus immune niche.

Introdução: Células-troco mesenquimais (CTM) vêm mostrando seus benefícios na doença do enxerto-versus-hospedeiro (DECH), observada no transplante de células tronco hematopoéticas (TCTH), existem três questões em aberto: (1) Expansão de CTM em meio de cultura suplementado com soro fetal bovino (SFB), pelo o risco de xenorreação; (2) Otimização de condições de cultura para a obtenção, em tempo hábil, de um numero que permita de 4 a 6 infusões de 2x106cells/kg do receptor; (3) Obter células do doador de medula óssea, evitando assim a utilização de um terceiro doador. Objetivos: Este estudo foi desenhado para comparar o lisado de plaquetas (LP) e o SFB na expansão de CTM, a densidade de plaqueamento das células e os dias entre cada passagem, e para investigar se as células nucleadas totais obtidas da bolsa e filtro do TCTH, podem ser utilizadas para expansão de CTM para utilização clínica. Métodos: Células residuais foram removidas do filtro e da bolsa utilizados para o TCTH, plaqueadas e depois da primeira passagem foram cultivadas em diferentes concentrações com SFB ou LP e observado o número de dias que levaram para chegar a 80% de confluência. Em seguida, as culturas com as mesmas densidades de plaqueamento foram suplementadas com LP ou SFB e depois de sete dias contou-se o número de células para analisar o quanto elas cresceram nesse período. Resultados: A proliferação de CTM, na presença de LP e SFB foi em média 11,88 e 2,5 vezes, respectivamente, num período de 7 dias. A concentração mais elevada de células usando LP demorou menos tempo para atingir a confluência, em comparação com os três inferiores. Este estudo sugere que o LP é a melhor escolha como suplemento para expandir CTM, e permite a proliferação de um número suficiente de CTM de doadores para uso clínico. / Introduction: Mesenchymal stromal cells (MSC) have shown their benefits in graft-versus-host disease (GVHD), with three unsettled matters:(1) MSCs expansion in medium with Fetal Calf Serum (FCS) and its risk of xenoreaction; (2) The number of cells indicated for therapy is 2x106cells/Kg with the need to optimize expansion, number and time wise; and (3) the utilization of third party donors. Aims: This study was designed to compare the platelet lysate (LP) and FCS on the expansion of MSC, the optimal cell plating density and days between each pass, and to investigate if donor total nucleated cells (TNC) obtained from the washouts of hematopoietic stem cell transplantation (HSCT) explants can be expanded to be used at clinical grade. Methods: TNC were removed, plated and after the first passage were cultivated in different concentrations with FCS or PL and the number of days reach 80% of confluence was observed. Next, cultures with the same plating density were fed either with PL or FCS and after seven days counted to analyze how much they have grown in that period. Results: The proliferation of mesenchymal stromal cells in the presence of PL and SFB was averaged 11.88 and 2.5 times, respectively, in a period of 7 days. The highest concentration of plating cells using PL, took less time to reach confluence as compared with the three lower ones. This study suggests that the PL is the best choice as a supplement to expand MSC, and allows the proliferation of a sufficient number of donors MSC at P2 for clinical use.

Objetivos. Avaliar o papel do transplante de células hematopoiéticas (TCH) e da interleucina 6 (IL – 6) sobre vários parâmetros de estresse oxidativo em pacientes com Adrenoleucodistrofia ligada ao cromossomo X (X-ALD). Métodos. A concentração de malondialdeído (MDA), o conteúdo de carbolinas e sulfidrilas e a concentração de ácido hexacosanóico (C26:0) foram quantificados no plasma de pacientes X-ALD antes e após serem submetidos ao TCH. E, a concentração de MDA, a formação de carbonilas e a concentração de IL-6 foram quantificados em plasma e o conteúdo de glutationa reduzida (GSH) foi quantificado em eritrócitos de pacientes X-ALD com fenótipos cerebral infantil (cALD) ou assintomáticos no momento diagnóstico. Resultados. Observamos um aumento significativo na concentração de MDA em plasma de pacientes X-ALD antes e após o TCH em comparação ao grupo controle e uma redução significativa nesses valores após o transplante em comparação aos anteriores ao procedimento. Verificamos uma redução significativa no conteúdo de sulfidrilas no plasma de pacientes X-ALD antes do TCH em comparação ao grupo controle e um aumento significativo desses níveis após o TCH. Não observamos diferenças significativas no conteúdo de carbonilas no plasma de X-ALD antes e após o TCH, em comparação aos controles, apesar de observarmos uma redução significativa nesta determinação nos pacientes após o transplante em relação a antes do TCH. Os pacientes X-ALD apresentam níveis plasmáticos de C26:0 significativamente aumentados antes do TCH em comparação aos controles e, após o TCH, as concentrações de C26:0 foram reduzidas. Observamos uma correlação negativa significativa entre a medida do conteúdo de sulfidrilas e os níveis plasmáticos de C26:0 de indivíduos X-ALD antes do TCH. Também evidenciamos elevados níveis de MDA e da formação de carbonilas no plasma de pacientes cALD e assintomáticos em comparação ao grupo controle. Ainda, observamos redução significativa do conteúdo de GSH nos dois grupos testados comparados aos controles. A quantificação de IL-6 foi significativamente maior nos pacientes cALD, o que não foi observado nos pacientes assintomáticos, apesar destes mostrarem uma tendência de aumento da concentração de IL-6. Conclusões. Os resultados obtidos a partir do plasma de pacientes X-ALD antes e após o TCH demonstram que esta terapia, quando bem indicada e bem sucedida, tem alta efetividade em reduzir a concentração plasmática de C26:0 e é eficaz em reduzir a peroxidação lipídica e o dano oxidativo às proteínas nos pacientes X-ALD. Ainda, é possível relacionar o acúmulo de C26:0 e o dano oxidativo na patogênese da X-ALD. Nossos dados permitem sugerir que a lipoperoxidação e o dano oxidativo às proteínas possam de alguma forma estar envolvidos na fisiopatologia da X-ALD. Além disso, podemos presumir que, nos pacientes X-ALD assintomáticos estudados, o dano oxidativo e os aspectos inflamatórios desempenham papéis importantes na evolução e nas futuras manifestações do fenótipo neuronal. Também podemos supor que a administração de antioxidantes deve ser considerada como uma terapia adjuvante potencial para os pacientes assintomáticos e sintomáticos afetados pela X-ALD, inclusive para aqueles submetidos ao TCH. / Objective. We aimed to evaluate the role of hematopoietic stem cell transplantation (HSCT) and interleukin 6 (IL – 6) on various parameters of oxidative stress in X-linked adrenoleukodystrophy (X-ALD) patients. Methods. Malondialdehyde (MDA), sulfhydryl, carbonyl and hexacosanoic acid (C26:0) levels were measured in plasma from X-ALD patients before and after HSCT. And, MDA, carbonyl and IL-6 levels were measured in plasma and reduced glutathione (GSH) content was measured in erythrocytes from X-ALD patients with different phenotype (asymptomatic and childhood cerebral (CCER patients) at diagnosis moment. Results. We observed increased levels of MDA in plasma from X-ALD before and after HSCT compared to control group, but there was a significant reduction in MDA values after transplantation compared to levels found before the procedure. We verified a significant decrease in sulfhydryl content in plasma of X-ALD patients before HSCT compared with the control group and we also verified a significant increase in the levels of sulfhydryl content after HSCT. No significant differences were observed in carbonyl content in plasma of X-ALD before and after HSCT, compared to controls. However, we observed a significant reduction of plasma carbonyl content from X-ALD patients after HSCT compared to before HSCT. X-ALD patients presented a significant increase of C26:0 plasma level before HSCT when compared to controls and an important reduction of C26:0 plasma concentration in X-ALD patients after HSCT when compared to before HSCT C26:0 levels. We observed an inverse significant correlation between sulfhydryl content and plasma C26:0 levels of X-ALD individuals before HSCT. We also evidenced high levels of MDA and carbonyl formation in plasma from CCER and asymptomatic patients compared to controls. Still, we observed a significant decrease of GSH content in both groups tested compared to controls. The quantification of IL-6 is significantly higher in CCER patients, which is not observed in asymptomatic patients, despite these patients show a tendency of increased concentration of IL-6. Conclusions. The results obtained from plasma of X-ALD patients before and after HSCT demonstrate that this therapy, when well indicated and successful, has high effectiveness in reducing C26:0 plasma and is effective in reducing lipid peroxidation and oxidative damage to proteins in X-ALD patients. Still, it is possible to relate the accumulation of C26:0 and oxidative damage in the pathogenesis of X-ALD. Our data also suggest that lipid peroxidation and protein damage may somehow be involved in the pathophysiology of X-ALD. Moreover, we can assume that in our asymptomatic X-ALD patients, oxidative damage and inflammatory issues seem to play an important role in the evolution and future manifestations of neuronal phenotype. We can also assume that the administration of antioxidants should be considered as a potential adjuvant therapy for asymptomatic and symptomatic patients affected by X-ALD, including those that are submitted to HSCT.