A utilização das células progenitoras hematopoéticas (CPH) obtidas do sangue de cordão umbilical e placentário (SCUP) apresenta vários benefícios para o transplante de CPH em comparação às células provenientes de outras fontes. Dentre eles, a maior disponibilidade e a maior imaturidade imunológica das CPH, o que permite certa flexibilidade nos critérios de compatibilidade entre doador e receptor e uma menor taxa de reação do enxerto-versus-hospedeiro. A legislação brasileira e órgãos internacionais exigem a realização de vários testes para garantir a qualidade do produto hemoterápico contendo CPH a ser transplantado. O objetivo deste estudo foi confirmar que o teste para quantificação de CPH com elevada atividade da enzima ALDH1(ALDHbr) pode ser considerado um teste de adequado ou seja, é capaz de predizer quais produtos tem melhor capacidade de repopular a medula óssea do recipiente após o transplante. Para isso, foram utilizadas 40 unidades de SCUP coletadas e processadas pelo Banco de Sangue de Cordão Umbilical e Placentário do Cetebio / Fundação Hemominas. As unidades foram processadas por método automatizado e amostras do creme leucocitário (buffy coat) foram coletadas para a realização da quantificação de células ALDHbr, quantificação de células CD34+, ensaio clonogênico (CFU), hemograma e cálculo do total de células nucleadas (TCN). A citometria de fluxo foi utilizada para a quantificação das CPH ALDHbr e CD34+ e das subpopulações CD45dim e CD38+. Outras informações como idade materna, idade gestacional e sexo do recém-nascido também foram coletadas para descrição das unidades. Para verificar a viabilidade da utilização do teste de ALDH pelos BSCUP foi realizado o levantamento do seu custo. A capacidade funcional das CPH em proliferar e se diferenciar em tecido hematopoético foi avaliada por meio do ensaio clonogênico. Detectou-se correlação entre a quantidade de células ALDHbr e o número de colônias no ensaio clonogênico (p<0,001), entre o número de células ALDHbr e de células CD34+ (p=0,001) e entre o número de colônias no ensaio clonogênico e o número de células CD34+ (p<0,001). A imunofenotipagem mostrou que 46,25% das células ALDHbr eram CD45dimCD38+CD34+. Os dados sugerem que a quantificação de células ALDHbr em unidades de SCUP pode ser considerada teste adequado, de baixo custo, de execução simples, rápida e menos dependente do operador em relação ao ensaio clonogênico. / The use of the umbilical cord blood cells presents numberless benefits when compared to the cells from different sources. Among them, the ease of availability, the bigger immunological immaturity, which allows some flexibility in the compatibility between donor and receptor and less induction of reaction of graft-versus-host. The Brazilian legislation and international organizations demand the practice of various tests to guarantee the quality of the product to be transplanted. The aim of this research was to confirm that the test used to quantify ALDHbr cells can be considered a power test, meaning that it tests the ability to repopulate the bone marrow after transplant. For this study, it has been used 40 units of SCUP collected and processed by the Cetebio Umbilical Cord Blood Bank - Fundação Hemominas. The units were processed by the automatized method and the samples of the final product (buffy coat) were collected for the quantification of ALDHbr cells, quantification of CD34+ cells, clonogenic essay (CFU), hemogram and the total number of nucleated cells (TNC). It was used the flow cytometry to perform ALDH and CD34+ tests. Besides that, it was also performed the association of antibodies anti-CD34, anti-CD45 and anti-CD38 for the immunophenotyping of the units. Other information such as maternal age, fertilization age and the newborn gender were also collected for description of the units. In order to verify the viability of the use of the ALDH test by BSCUP its costs were calculated, as well as of the clonogenic essay. The results showed a significant correlation between ALDHbr cells and the clonogenic essay (p<0.001), between ALDHbr and CD34+ cells (p=0,001) and between the clonogenic essay and the quantification of CD34+ cells (p<0,001). The immunophenotyping revealed that 46,25% of ALDHbr cells were CD45dimCD38+CD34+. The data indicated that the quantification of ALDHbr cells in the SCUP units can be considered a powerful and low cost procedure, of easier and quicker execution and less operator dependent.

Os pacientes submetidos ao transplante de células-tronco hematopoéticas (TCTH) necessitam da inserção do cateter venoso central (CVC) de longa permanência e semi-implantado. No entanto, a obstrução trombótica do CVC é uma complicação que pode ocasionar o funcionamento inadequado do dispositivo intravascular e levar sua remoção precoce. Este estudo trata-se de uma revisão integrativa da literatura, com o objetivo de sintetizar as medidas relacionadas à prevenção e tratamento da obstrução trombótica relacionada ao CVC de longa permanência e semi-implantado, nos pacientes submetidos ao TCTH. A amostra constituiu-se de sete estudos primários, sendo dois ensaios clínicos randomizados, três estudos de coorte e duas séries de casos. Quanto as categorias temáticas, quatro estudos abordaram medidas de prevenção da obstrução trombótica relacionada ao CVC, dois estudos abordaram as medidas de tratamento e um abordou as medidas de prevenção e tratamento. Dentre os estudos que abordaram medidas de prevenção, obteve-se um único que se mostrou efetivo na prevenção da obstrução, trata-se de um coorte sobre o uso da varfarina oral, iniciado no dia da inserção do dispositivo venoso central. Os demais estudos não evidenciaram diferenças estatisticamente significantes entre o tratamento padrão e a intervenção testada. Quanto às medidas de tratamento, três estudos evidenciaram sucesso, sendo que um apontou a eficácia do uso de estreptoquinase ou uroquinase, outro estudo mostrou benefício no uso de heparina de baixo peso molecular e outro tratou a obstrução com heparina e uroquinase com sucesso. Nota-se que a evolução da pesquisa referente a perviedade do CVC foi restrita, não acompanhando a evolução da terapia com CTH, principalmente, no que tange os cuidados de enfermagem, visto que todos tratam de intervenções medicamentosas, sem abordar os aspectos não medicamentosos, como, por exemplo, volume e freqüência do flush com solução fisiológica, descrição da técnica com pressão positiva, tamanho ideal da seringa, pressão exercida durante a infusão de medicamentos e dispositivos para vedação dos lumens do cateter com pressão positiva. Tais resultados mostram a necessidade da realização de novos estudos controlados, para testar as intervenções de enfermagem na prevenção da obstrução trombótica relacionada ao cateter. / Patients submitted to hematopoietic stem cell transplantation (HSCT) need indwelling and semi-implanted central venous catheterization. Thrombotic obstruction of CVC, however, is a complication that can lead to the inadequate functioning of the intravascular device and its early removal. This integrative literature review aimed to summarize measures for the prevention and treatment of thrombotic obstruction related to indwelling and semi-implanted CVC, in patients submitted to HSCT. The sample included seven primary studies, with two randomized clinical trials, three cohorts and two case series. As for the theme categories, four studies discussed CVC-related thrombotic obstruction prevention measures, two addressed treatment measures and one prevention and treatment measures. Among the studies that discussed prevention measures, one single research showed effective obstruction prevention, which was a cohort on the use of oral warfarin, started on the day the central venous device was inserted. The other studies showed no statistically significant differences between standard treatment and the tested intervention. Regarding treatment measures, three studies showed to be successful: one appointed the efficacy of streptokinase or urokinase use, another showed the benefits of using low molecular weight heparin and the third successfully treated the obstruction with heparin and urokinase. The restricted evolution of research regarding CVC patency was observed, which did not accompany the evolution of HSC therapy, mainly regarding nursing care, as all addressed discuss medication interventions, without discussing non-medication aspects, such as the flush volume and frequency with physiological salt solution, description of positive pressure technique, ideal syringe size, pressure exerted during medication infusion and catheter lumen sealing devices with positive pressure. These results show the need for further controlled studies to test nursing interventions in the prevention of catheter-related thrombotic obstruction.

Mit der vorliegenden Habilitationsschrift habe ich den Versuch unternommen, die beiden Themenkomplexe meiner bisherigen wissenschaftlichen Tätigkeit als Beispiele für die Rolle von Modellen in der klinischen Forschung zu verwenden. Den Ansto§ dazu gaben Diskrepanzen, die mir in der Auseinandersetzung mit eigenen Ergebnissen und Beobachtungen im Umfeld dieser Themenkomplexe aufgefallen sind: der Rolle kontaminierender Tumorzellen in der Hochdosistherapie maligner Tumoren einerseits und dem Enzym Dipeptidylpeptidase IV (DPP IV) andererseits. Die beobachteten Diskrepanzen sind Ausdruck konkurrierender pathophysiologischer oder therapeutischer Modelle, und die Präferenz eines bestimmten Modells scheint nicht rein rational erklärbar. Welche Faktoren tragen jedoch zur Entscheidung für oder gegen ein bestimmtes Modell bei? Ich möchte den Umgang mit wissenschaftlichen Modellen anhand der genannten Themenkomplexe aus meiner Sicht erörtern. Anschlie§end soll ein Entwurf skizziert werden, in dem die der Entscheidung für oder gegen ein therapeutisches Modell zugrundeliegende Motivationslage besser verständlich wird und die Intentionalität klinischer Forschung auf den Patienten hin berücksichtigt. / In the thesis presented here, I have taken the challenge to use the topics of my scientific work to discuss the role that models appear to exert in clinical science. This decision arose from discrepancies that became evident in the comparative assessment of my own studies in relation with the surrounding scientific context: the role of tumor cells contaminating peripheral blood or progenitor cell harvests as part of a high-dose chemotherapy regimen on the one hand, and the enzyme dipeptidyl peptidase IV (DPP IV) on the other. The observed discrepancies appear to result from competing pathophysiological or therapeutic models, and the preference or rejection of one model apparently cannot be explained solely by rational factors. I will discuss the application of models in the context of the topics which my scientific work has been focusing on, and I will develop a draft proposal which will render the individual motivational status underlying the decision in favor of or against a distinct model easier to understand, with attention to the intentionality of clinical research towards the patient.

Die Gentherapie hämatopoetischer Stammzellen (HSCs) besitzt das Potenzial, verschiedene erbliche, nur symptomatisch behandelbare, Erkrankungen dauerhaft zu heilen. Die Mehrheit der aktuell angewandten Verfahren dazu, basiert auf der Isolation von hämatopoetischen Stammzellen, der ex vivo Modifikation dieser Zellen durch retrovirale Vektoren und der Reinfusion der modifizierten Zellen in den immunsupprimierten Patienten. Dieser Ansatz ist mit einer Reihe von Nachteilen verbunden, unter anderem einem teilweisen Verlust des Rekonstitutionsvermögens der Stammzellen nach ex vivo Kultur oder der Gefahr der Transformation durch Integration des retroviralen Vektorgenoms. Darüber hinaus sind aktuelle Gentherapieansätze mit hohen Kosten und großem logistischem Aufwand verbunden, was den Zugang zu diesen Behandlungen für potentielle Patienten stark einschränkt. Die vorliegende Arbeit verfolgt einen neuen Ansatz zur Gentherapie von HSCs, der auf der Mobilisierung von Stammzellen aus dem Knochenmark in den peripheren Blutstrom und der Transduktion dieser Stammzellen mit adenoviralen Vektoren basiert. Hierbei codieren die Vektoren sowohl ein Transgen als auch eine Integrationsmaschinerie. Der erste Teil der Arbeit belegt in einem humanen CD46-transgenen Mausmodell, dass adenovirale Vektoren der ersten Generation in der Lage sind, mobilisierte HSCs im Blut zu transduzieren und dass es den so transduzierten Stammzellen möglich ist, zurück ins Knochenmark zu migrieren und dort das Transgen zu exprimieren. Allerdings wurde im Verlauf von zwei Wochen ein Rückgang der Transgenexpression beobachtet. Um dies zu umgehen, wurde ein adenovirales Vektorsystem der dritten Generation genutzt, das eine hochaktive Sleeping Beauty Transposase, zum Zweck der Transgenintegration, codiert. Dieses System ermöglichte die stabile Genmodifikation mobilisierter hämatopoetischer Stammzellen nach intravenöser Injektion. Die Expression des Transgens konnte über längere Zeitspannen (bis 12 Wochen) beobachtet werden. Die modifizeirten Stammzellen waren darüber hinaus in der Lage, genmodifizierte Kolonien in vitro zu bilden und das hämatopoetische System letal bestrahlter Mäuse nach Knochenmarkstransplantation zu rekonstituieren. Es wurde somit gezeigt, dass HSCs nach in vivo Modifikation weiterhin funktional waren. / The gene therapy of hematopoietic stem cells holds the potential for curative treatment of several otherwise incurable inherited diseases. The majority of current gene therapy treatments relies on the collection of hematopoietic stem cells, their ex vivo modification with retroviral vectors and their transplantation into a myeloconditioned patient. This approach entails several disadvantages, including a reduction of stem cell engraftment potential after ex vivo culture and the potential danger of integrational mutagenesis. In addition, the high costs and complex logistics of this approach limit the access of patients to gene therapeutic regimens. This work explores an alternative approach to hematopoietic stem cell (HSC) gene therapy, termed stem cell in vivo transduction. This approach is based on the mobilization of HSCs from the bone marrow into the peripheral blood and the transduction of the stem cells with adenoviral vectors delivering a transgene as well as a transgene integration machinery. In the first part of this work, it was shown that first-generation adenoviral vectors could be used for the transduction of mobilized HSCs in the periphery of human CD46-transgenic mice. Further, the transduced HSCs were able to home back to the bone marrow and express the transgene. However, over the course of 14 days, a loss of transgene expression in HSCs was observed. To ameliorate these shortcomings, helper-dependent adenoviral vectors encoding a hyperactive Sleeping Beauty transposase for transgene integration were used for stable gene modification of hematopoietic stem cells following intravenous vector administration in mobilized human CD46-transgenic mice. Using this improved vector platform, gene marking of bone marrow HSCs could be observed for extended periods of time (up to 12 weeks). Further, the functionality of the modified HSCs was demonstrated both in colony-forming progenitor assays as well as through the transplantation of gene-modified HSCs into lethally irradiated recipients. Transplantation of modified HSCsled to long-term multi-lineage reconstitution showing that gene-modified stem cells were fully functional. Subsequently the safety of systemic vector administration in mobilized hosts as well as of the Sleeping Beauty-mediated transgene integration was assessed in human CD46- transgenic mice. Lastly, the stem cell in vivo transduction approach was employed in NOG mice transplanted with human CD34+ cells, as well as in Macaca nemestrina non-human primates.

DNS-Methylierung ist ein zentraler epigenetischer Prozess, der essentiell für die Differenzierung embryonaler Stammzellen ist, über dessen Funktion in somatischen Zellen allerdings wenig bekannt ist. In der vorliegenden Doktorarbeit wurden zwei Mausmodelle analysiert, um die Rolle der durch DNS Methyltransferase 1 (DNMT1) hergestellten DNS-Methylierung im adulten hämatopoetischen System zu untersuchen. Als erstes wurde ein „Knockout“-Modell gewählt, um DNMT1 im hämatopoetischen System zu eliminieren. Des Weiteren wurde eine Mausmutante mit reduzierter DNMT1 Expression analysiert. Die vollständige Entfernung von DNMT1 aus dem hämatopoetischen System adulter Mäuse resultierte in Zytopenie und Anämie, gefolgt vom raschen Tod aller Tiere. Die Analyse des Knochenmarks dieser Mäuse zeigte einen fast vollständigen Verlust von hämatopoetischen Stamm- sowie Vorläuferzellen. Dies zeigt, dass die durch DNMT1 erzeugte DNS-Methylierung essentiell für Homöostase und Differenzierung von hämatopoetischen Stammzellen ist. Mäuse mit reduzierter DNMT1 Expression hingegen sind lebensfähig und zeigen einen niedrigen Grad an DNS-Methylierung in verschiedensten Geweben, einschließlich des hämatopoetischen Systems. Durch eine detaillierte phänotypische und funktionelle Analyse der hämatopoetischen Stammzellen zeigte sich, dass der veränderte DNS-Methylierungsgrad ein vermindertes Selbsterneuerungspotenzial zur Folge hat. Interessanterweise fehlen DNMT1 hypomorphen Mäusen lymphoide Vorläuferzellen sowie reife lymphoide Zellen, wohingegen myeloide und erythroide Zellpopulationen keine Veränderungen zeigten. Genomweite Expressionsanalysen von Stammzellen sowie myeloiden Vorläuferzellen zeigten, dass hypomethylierte Stammzellen eine verfrühte myeloerythroide Entwicklung vollziehen und liefern damit eine Erklärung für den Verlust des Selbsterneurungspotenzials und der lymphoiden Entwicklung. Diese Resultate identifizieren eine bis hierhin unbekannte Funktion von spezifischen DNS-Methylierungsgraden für die Steuerung von funktionellen Programmen wie Selbsterneuerung und Differenzierung in hämatopoetischen Stammzellen. / DNA methylation is one of the major epigenetic mechanisms which is known to play a role in embryonic stem cell fate, but its function in somatic stem cells is not well understood. In this thesis two different genetic mouse models were chosen to address the role of DNA methyltransferase 1 (DNMT1) controlled DNA methylation in adult hematopoiesis. First, a conditional knockout approach was used to delete DNMT1 in the adult hematopoietic system. Second, DNMT1 hypomorphic mice with reduced DNMT1 expression were analyzed. Complete DNMT1 deletion in hematopoietic cells led to severe cytopenia and anemia causing rapid lethality of all animals. Bone marrow analysis revealed an almost complete absence of hematopoietic stem and progenitor cells in DNMT1 ablated primary mice as well as in secondary chimeric mice. These results indicated that DNMT1 controlled maintenance of DNA methylation is indispensable for HSCs preservation and differentiation. In contrast to complete DNMT1 deletion, mice with hypomorphic DNMT1 expression were viable, but showed low methylation levels in multiple tissues including the hematopoietic system. Detailed phenotypical and functional analysis of the hypomethylated hematopoietic stem cell (HSCs) compartment revealed an impaired homeostasis and self-renewal capacity. Intriguingly, mutant animals had profoundly reduced lymphoid cell compartments, whereas myeloid and erythroid compartments were unchanged. Expression profiling of stem and myeloid progenitor cells unexpectedly demonstrated that reduced DNA methylation forces the HSC to adopt a myeloid lineage identity. These results, showing the inability of hypomethylated HSCs to maintain an undifferentiated state, provided an explanation for their disturbed capability to self-renew and produce lymphocytes. Taken together, these findings suggest that distinct levels of DNA methylation are required to control different functional programs such as self-renewal and alternative lineage choices in HSCs, thus uncovering a previously unrecognized function for DNMT1 activity.

Contexte :Le conditionnement précédant la greffe de cellules souches hématopoïétiques (CSH) a été associé avec des taux élevés de malnutrition meme à 100 jours après la greffe. Objectif: Cette étude évalua l'impact du conseil nutritionel fournie à la sortie de l'hôpital sur l'état nutritionnel,100 jours après la greffe de CSH (dit T4).Conception: Il s'agissait d'un essai contrôlé randomisé monocentrique. Les patients adultes étaient randomisés à un groupe témoin (GT) recevant des soins habituels et un groupe d'intervention (GI) recevant des conseils nutritionnels mensuels après la sortie de l’hôpital. Le résultat principal était le score de l'évaluation globale subjective générée par le patient (PGSGA) à T4. La malnutrition était évalué aussi par le score de la société américaine de nutrition parentérale et entérale/Académie de nutrition et diététique (AND-ASPEN).Résultats: 52 participants ont été randomisés (août 2016 jusqu'en août 2017) et 46 ont été analysés [65% d'hommes, 63% de greffes autologues, GI (n = 22), GT (n = 24)]. Les deux groupes etaient comparable au moment de randomization.A T4, le pourcentage de patients bien nourris n'était pas significativement différent entre les groupes selon le PGSGA (72% GI vs 43% GT, p = 0,063). Le pourcentage de patients bien nourris selon AND-ASPEN s'est améliorré à T4 dans le GI (50% vs 14%, p = 0,02) et non pas dans le GT par rapport aux valeurs d'admission. A T4, le GI avait un apport de protéines et de calories plus élevé que le GT(p<0.05).Conclusion:Le conseil nutritionnel après la greffe de CSH a amélioré l’apport en protéines et calories ainsi que le score AND-ASPEN mais non pas le score PGSGA. / Background: Conditioning preceding Hematopoietic Stem Cell Transplantation (HSCT) has been associated with elevated rates of malnutrition until 100 days post HSCT.Objective: This study aimed to assess the impact of nutritional counseling provided at hospital discharge on nutritional status 100 days post HSCT (defined as T4). Design: This was a single center randomized controlled trial among adult HSCT patients. Around discharge from the hospital, recruited patients were randomized to a Control Group (CG) receiving usual care and to an Intervention Group (IG) receiving nutritional counseling on a monthly basis post discharge.The primary outcome was the Patient Generated Subjective Global Assessment (PGSGA) scores at T4. Malnutrition was also assessed though the American Society for Parenteral and Enteral Nutrition/ Academy of Nutrition and Dietetics malnutrition score.Results: 52 participants were randomized (August 2016 until August 2017) and 46 were analyzed [65% males, 63% autologous HSCT, IG (n=22), CG (n=24)]. Groups were comparable at randomization. At T4, the percent of well-nourished patients was not significantly different between groups when assessed via PGSGA (72% IG vs. 43% CG, p=0.063).The percent of wellnourished patients as per AND-ASPEN criteria improved in IG at T4 (14% vs. 50%, p=0.02) and remained the same in CG (48% vs. 50%, p=1) compared to admission values. IG had higher protein and caloric intake (p<0.05). Conclusion:Nutritional counseling post HSCT improved patients’ protein and caloric intake and AND-ASPEN score but did not significantly improve PGSGA score.

Les protéines de liaison à l’ARN PUMILIO 1 et 2 (PUM1/2) exercent un rôle central dans le maintien des cellules souches chez les Invertébrés en se fixant, en association avec des partenaires protéiques, sur la région 3’ UTR de certains ARNm, régulant ainsi leur devenir. A ce jour, le rôle de PUM1/2 dans les cellules souches/progénitrices hématopoïétiques (CSPHs) a été peu étudié. La perte de la coordination entre auto-renouvellement et différenciation des CSPHs peut aboutir à des hémopathies chez l'Homme, d’où la nécessité de comprendre les mécanismes sous-jacents. Notre équipe a mis en évidence, par une approche de shARN, que l’invalidation des protéines PUM1/2 dans les CSHs humaines et murines conduit à une réduction de leur expansion, associée à une apoptose accrue et un arrêt du cycle cellulaire en phase G0/G1, et aussi à une perte du potentiel clonogénique in vitro et du potentiel de reconstitution in vivo. L’objectif de notre travail a consisté à : a/ évaluer les effets de la surexpression de PUM1/2 dans les CSPHs, b/ déterminer l’implication de PUM1/2 dans les processus leucémiques, c/ étudier les mécanismes moléculaires responsables de l’activité de PUM1/2 en identifiant les cibles et les partenaires protéiques par une approche de protéomique globale. Nos résultats suggèrent qu’une surexpression modérée de PUM1 (2/3 fois) dans les cellules CD34+ limite la perte du potentiel clonogénique alors qu’une expression plus élevée (5/10 fois et plus) est toxique. L’analyse de l’expression de PUM1/2 par RT-qPCR dans les échantillons de Leucémies Aigue Myeloïdes (LAM) (GOELAMSthèque) montre une augmentation significative dans les échantillons les plus immatures (LAM0-2) comparés aux contrôles sains. La perte de PUM1/2 par shARN dans les cellules primaires de leucémies ainsi que dans des lignées issues de différents processus leucémiques réduit fortement leur survie. La recherche des partenaires associés à PUM par spectrométrie de masse a permis de découvrir Argonaute2 et MOV10 (tous les 2 impliqués dans la machinerie des miRNA), ainsi que des protéines de liaison aux ARNs, ELAV1 déjà connue pour son implication dans le maintien des CSH murines et IMP3, impliqué dans de nombreux cancers et dans la régulation du cycle cellulaire. L’invalidation de IMP3 ou ELAV1 dans les CSPHs conduisent, in vitro, aux mêmes effets observés avec la perte du PUM 1/2, une diminution de l’expansion avec une augmentation de l’apoptose, et la perte du potentiel clonogénique. Enfin, nous avons identifié FoxP1 (Forkhead box P1) comme nouvelle cible directe de PUM1/2, dont le rôle est encore très peu décrit dans l’hématopoïèse. L’étude fonctionnelle de FoxP1 sur les CSPHs par shARN mime les effets observés avec les facteurs PUM1/2. De plus, la surexpression de FoxP1 restaure partiellement les activités antiprolifératives et pro-apoptotiques générées par les shPUM1/2. Enfin, le profil d’expression de FoxP1 dans les LAM corrèle avec le profil d’expression de PUM1/2. Nos résultats confirment le rôle majeur joué par les protéines PUM1/2 en partie via la régulation positive de FoxP1 qui contribue au maintien les CSPHs normales et pathologiques. / Pumilio 1 and 2 (PUM1/2) RNA-binding proteins exert a central role in stem cell maintenance among Invertebrates by binding the 3'UTR of mRNA targets in association with protein partners, thus regulating mRNA stability/translation. Nothing is known regarding normal and pathologic hematopoietic stem and progenitor cells (HSPCs). Loss of coordination between self-renewal and differentiation of HSPCs can lead to leukemia in humans, hence the need to understand the mechanisms. Our team has highlighted the fundamental role played by the post-transcriptional regulators Pumilio (PUM) 1/2 on normal HSPC properties. By a shRNA approach, PUM 1/2 knockdown in human and murine HSPCs leads to: a/ a reduced expansion associated with an increased apoptosis and a cell cycle arrest in G0/G1 phase, b/ the loss of their clonogenic capacity and their in vivo reconstitution potential. The objective of our work is to: a/ evaluate the effects of PUM 1/2 overexpression in HSPC, b/ determine PUM1/2 involvement in leukemic processes; c/ investigate the molecular mechanisms responsible of PUM activity in HSPC by identifying protein targets and partners. Our results showed that a moderate overexpression of PUM1 (2 to 3 fold) in normal CD34+ HSPCs limits the loss of their clonogenic potential, while a higher expression (5 to 10 fold or more) is toxic. The expression analysis of PUM1/2 transcripts in Acute Myeloid Leukemia (AML) (GOELAMSthèque) showed a significant increase in the most immature samples (AML0-2) as compared to healthy controls. PUM1/2 knockdown by shRNA in AML cells significantly reduced their survival. The same effect was observed in cell lines from several leukemic processes. We identified various PUM-associated partners by mass spectrometry, Argonaute2 and MOV10 (involved in the miRNA machinery), and the RNA-binding proteins IMP3 (involved in several cancer and in cell cycle regulation) and HuR/ELAV1 (already known to be involved in murine HSPCs maintenance). IMP3 or ELAV1 knockdown in HSPCs in vitro lead to the same effect of a PUM1/2 invalidation, a decreased expansion with an increased apoptosis and the loss of clonogenic potential. Finally, we identify the forkhead box P1 (FOXP1) transcription factor as a new direct target up-regulated by PUM1 and PUM2. Functional study of FoxP1 knockdown by shRNA in HSPCs mimic PUM1/2 activities. Moreover, FOXP1 overexpression partially rescued shPUM antiproliferative and pro-apoptotic effects. Also, the PUM1/2 and FOXP1 expression levels in leukemic primary cells were measured by RT-qPCR and revealed a positive correlation. Our results reveal that PUM1/2 are direct positive regulators of FOXP1 which contributes to the maintenance of normal and leukemic HSPCs.

Les syndromes myélodysplasiques (SMD) forment un groupe de pathologies clonales de la cellule souche hématopoïétique (CSH) caractérisées par une hématopoïèse inefficace. La présence d’au moins une anomalie génétique (anomalie cytogénétique ou mutation somatique) est observée dans plus de 90% des cas. Ainsi, plusieurs clones moléculaires pouvaient coexister au moment du diagnostic de la maladie. Dans les SMD avec délétion du chromosome 5 (del(5q)), il a récemment été montré que les anomalies étaient présentes dès le stade de la CSH. Dans les SMD, la pénétrance des anomalies génétiques décrites est incomplète. De plus, peu de choses sont actuellement connues sur l’ordre d’apparition des mutations et leur impact fonctionnel sur les différents clones moléculaires dans le cas des SMD non-del(5q). Grâce au séquençage d’exome entier (WES) de patients ne présentant aucune mutation dans les gènes décrits dans les SMD, nous avons décrit l’existence de mutations dans les gènes BCOR et BCORL1, chez respectivement 4,2% et 0,8% des patients. Les mutations du gène BCOR arrivent tardivement au cours de l’évolution de la maladie et affectent le pronostic des patients. Des approches à l’échelle unicellulaire nous ont également permis d’observer que la majeure partie des mutations identifiées chez les patients sont retrouvées dès le stade CD34+CD38-. Chez les patients, plusieurs clones moléculaires coexistent à ce stade. De plus, les mutations des gènes de l’épissage et de la régulation épigénétique sont fréquemment acquises en premier dans les cellules hématopoïétiques les plus immatures des patients porteurs de SMD. Nous avons observé que certaines mutations, acquises secondairement, sont réparties inégalement dans les différents compartiments hématopoïétiques et peuvent avoir un impact sur la différenciation hématopoïétique. Enfin, nous montrons que la répartition des clones moléculaires évolue au cours du temps. En réponse au traitement par Lenalidomide, on observe également une évolution rapide de l’architecture clonale qui peut être liée au statut de réponse des patients. Ces résultats tendent à confirmer l’hétérogénéité génétique mais aussi fonctionnelle des SMD. Nous avons pu identifier de nouvelles mutations impliquées secondairement dans la physiopathologie des SMD. Il existe une dominance clonale précoce dans les SMD du fait de l’acquisition de toutes les mutations dans les cellules hématopoïétiques immatures. Cependant, les différentes populations hématopoïétiques peuvent présenter des génotypes différents. Enfin cette architecture est variable au cours de l’évolution de la maladie. / Myelodysplastic syndromes (MDS) are a group of clonal disorders of the hematopoietic stem cell (HSC) characterized by ineffective hematopoiesis. At least one genetic abnormality (cytogenetic abnormality or somatic mutation) is observed in more than 90% of cases. Thus, it has been observed several molecular clones which could coexist at diagnosis of the disease. In MDS with deletion of chromosome 5 (del (5q)), it has recently been shown that defects were present in the HSC. In MDS, the penetrance of genetic abnormalities described is incomplete. In addition, little is currently known about the order of appearance of mutations and their functional impact on different molecular clones in the case of non-del (5q) MDS. Through the whole exome sequencing (WES) of patients without mutation in the genes described in MDS, we described the existence of mutations in genes BCOR and BCORL1, in respectively 4.2% and 0.8% of patients. Mutations in the gene BCOR were acquired lately during the course of the disease and affect the prognosis of patients. Approaches at the single cell level have also allowed us to observe that most of the mutations identified in patients are found at the immature differentiation stage CD34+CD38-. In patients, several molecular clones could coexist at this stage. In addition, mutations in gene splicing and epigenetic regulation are frequently first acquired in the most immature hematopoietic cells of MDS patients. We found that certain mutations, acquired in a second time, are distributed unevenly in different hematopoietic compartment and may have an impact on hematopoietic differentiation. Finally, we showed that the distribution of molecular clones evolves over time. In response to treatment with Lenalidomide, it has also been observed a rapid evolution of clonal architecture that can be linked to patient response status. These results tend to confirm the genetic but also functional heterogeneity in MDS. We have identified new mutations involved in the pathogenesis of MDS. We observed an early clonal dominance in MDS because of the acquisition of all mutations in immature hematopoietic cells. However, different hematopoietic populations can have different genotype. Finally, the architecture of mutations could be modifying during the course of the disease.

Le maintien de l'intégrité génomique est crucial pour la préservation du potentiel des cellules souches hématopoïétiques (CSH). Les lésions de l'ADN dans les CSH sont associées à une capacité réduite à reconstituer l'hématopoïèse, à altérer le potentiel de différentiation et à accroître le risque de développer des tumeurs myéloïdes. Les éléments rétrotransposables (ER), se propageant dans le génome à travers un ARN intermédiaire, ont été associés à la perte d'auto-renouvellement, au vieillissement et aux dommages à l'ADN. Cependant, leur rôle dans les CSH n'avait pas été abordé. Dans cette étude, nous avons constaté que les CSH expriment des niveaux élevés d'ARNm de plusieurs ER comprenant des rétrovirus endogènes (ERV) et des L1 (LINE-1: Long Interspersed Nuclear Elements 1). Leur expression augmente avec l'irradiation. En utilisant des souris transgéniques L1-EGFP, on a montré que la rétrotransposition de L1 se produit dans les CSH in vivo. En outre, les inhibiteurs de la transcriptase inverse Efavirenz et ddC sauve à la fois les CSH des dommages persistants à l'ADN induit par l’irradiation et de la perte de prolifération in vitro. Ceci démontre que la rétrotransposition endogène joue un rôle important dans l'instabilité génomique de CSH induite par l’irradiation et dans leur perte de fonction. Nous avons précédemment montré que la thrombopoïétine (TPO), un facteur d'auto-renouvellement critique pour le CSH, limite les lésions de l'ADN induites par l’irradiation en améliorant la réparation de l'ADN. Nous avons découvert que le traitement par TPO empêche également l'expression et la mobilisation d’ER induite par l’irradiation. Nous avons aussi constaté que l’expression et la retrotransposition de L1 augmente dans les CSH provenant de souirs Mpl-/- et L1-EGFPxMpl-/-. Cela montre que la signalisation TPO in vivo est nécessaire pour restreindre l’expression et la retrotransposition d’ER dans les CSH au niveau basal et dans des conditions de stress. L'analyse transcriptomique a révélé que la TPO induit une réponse d'expression génique antivirale d'interféron (IFN) de type I dans les CSH. En utilisant des souris déficientes en STAT1/STAT2, nous démontrons que cette réponse est dépendante à la fois de STAT1 et de STAT2 et est requise pour l'inhibition de l'expression d’ER. En conclusion, cette étude montre que les ER représentent une importante source d’instabilité génomique dans les CSH. Les CSH sont capables de monter une réponse antivirale en réponse à la TPO comme un nouveau mécanisme pour limiter les dommages à l'ADN. Bien que la sécrétion constitutive d'IFN-I se produise chez des souris saines, les IFN sont produits abondamment principalement pendant les infections. Ainsi, la réponse d'expression de gène d'IFN induite par la TPO peut représenter un signal constitutif important et CSH-dédié; permettant à ces cellules de résister aux lésions de l'ADN induites par ER, tout en préservant leur capacité d'auto-renouvellement. / Maintenance of genomic integrity is crucial for the preservation of hematopoietic stem cell (HSC) potential. DNA damage in HSCs is associated with reduced ability to reconstitute hematopoiesis, altered lineage potential and accrued risk of developing myeloid malignancies. Retrotransposable elements (RE), spreading in the genome through an RNA intermediate, have been associated with loss of self-renewal, aging and DNA damage. However, their role in HSCs has not been addressed. In this study, we found that HSCs express high mRNA levels of several REs, including evolutionary recent long interspersed element-1 (L1) and endogenous retroviruses (ERV). Their expression further increases upon total body irradiation (TBI). Using L1EGFP transgenic reporter mice, we show that productive L1 retransposition occurs in HSCs in vivo. Furthermore, the reverse transcriptase inhibitors Efavirenz and ddC rescue TBI-induced both persistent DNA damage and HSC loss of proliferation in vitro. This demonstrates that endogenous retrotransposition plays an important role in TBI-induced HSC genomic instability and their loss of function. We have previously shown that thrombopoietin (TPO), a critical HSC self-renewal factor limits TBI-induced HSC DNA damage by improving DNA repair. We found that TPO treatment also prevents TBI-induced RE expression and mobilization. In addition, L1 expression and retrotransposition are increased in Mpl-/- and L1-EGFPxMpl-/- HSCs, showing that TPO signaling in vivo is required to restrain RE in HSCs, under both steady state and stress conditions. Transcriptomic analysis revealed that TPO induces an anti-viral, interferon (IFN) type-I like, gene expression response in HSCs. Using STAT1/STAT2-deficient mice, we demonstrate that this response is dependent on both STAT1 and STAT2 and is required for TPO-mediated RE expression inhibition in HSCs. Overall, this study shows that REs represent an important HSC intrinsic source of genomic instability and uncovers the ability of HSCs to mount an anti-viral innate immune state in response to TPO as a novel mechanism to minimize DNA damage. Although constitutive IFN-I secretion occurs in healthy mice, IFNs are produced abundantly mainly during infections. Thus, TPO-induced IFN gene expression response may represent an important constitutive, and HSC-dedicated, signal allowing HSCs to resist RE-induced DNA damage while preserving their self-renewal ability.

Als Schlüsselfaktor des hämatopoietischen Systems spielt PU.1 eine ent-scheidende Rolle in der Entwicklung der meisten hämatopoietischen Li-nien. Das PU.1 Expressionslevel bestimmt das Differenzierungspotential hämatopoietischer Stammzellen und Vorläufer. In den unterschiedlichen Zelltypen werden verschiedene Expressionsstärken etabliert. Wie diese zelltypischen Expressionslevel vonPU.1 generiert werden, ist bisher weit-gehend unbekannt. In der vorliegenden Doktorarbeit wurde mit Hilfe eines transgenen Maus-modells die cis-regulatorische Einheit von PU.1 definiert, um mit nachfol-genden molekularbiologischen und genomweiten Ansätzen Mechanismen der zellspezifischen Regulation von PU.1 zu aufzuzeigen. Die Definition der cis-regulatorischen Einheit von PU.1 erfolgte mit Hilfe eines transgenen Mausmodells, welches ein humanes PU.1 BAC Kons-trukt trägt. Es konnte gezeigt werden, dass humanes und murines PU.1 substituierbar sind und den gleichen Regulationsmechanismen unterlie-gen. Mit Hilfe genomweite DNaseI hypersensitivity Analysen, Methylie-rungs- und Bindungsstudien konnte ein neuer Regulationsmechanismus beschrieben werden, der eine spezifische kombinatorische Interaktion verschiedener cis-regulatorischer Elemente erfordert. Durch Reportergenassays in verschiedenen Zelltypen war es möglich, einen myeloischen Enhancer zu identifizieren. Es konnte gezeigt werden, dass PU.1 mit zelltyp-spezifischen Transkriptionsfaktoren interagiert, um unterschiedliche Bindungsmuster an seinen regulatorischen Elementen zu etablieren. Dadurch kommt es zu den spezifischen Expressionstärken von PU.1 / The transcription factor PU.1 occupies a central role in controlling myeloid and early B cell development and its correct lineage-specific expression is critical for the differentiation choice of hematopoietic progenitors. However, little is known of how this tissue-specific pattern is established. We previously identified an upstream regulatory cis-element (URE) whose targeted deletion in mice decreases PU.1 expression and causes leukemia. We show here that the URE alone is insufficient to confer physiological PU.1 expression, but requires the cooperation with other, previously unidentified elements. Using a combination of transgenic studies, global chromatin assays and detailed molecular analyses we present evidence that PU.1 is regulated by a novel mechanism involving cross-talk between different cis-elements together with lineage-restricted autoregulation. In this model, PU.1 regulates its expression in B cells and macrophages by differentially associating with cell-type specific transcription factors at one of its cis-regulatory elements to establish differential activity patterns at other elements.