Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by autoantibody production, which can eventually lead to immune complex (IC)-mediated organ damage. Due to the stimulation of plasmacytoid dendritic cells (pDC) by nucleic acid-containing ICs (DNA- or RNA-IC), patients with SLE have an ongoing interferon (IFN)-α production. IFN-α induces a general activation of the immune system that may initiate or propagate an autoimmune process if not properly regulated. Previous studies have shown that natural killer (NK) cells potently enhance the IFN-α production by pDCs. In study I, the mechanisms behind the NK cell-mediated increased IFN-α production by RNA-IC-stimulated pDCs were investigated. ICs triggered CD56dim NK cells via FcγRIIIA to the secretion of cytokines (e.g. MIP-1β) that promoted IFN-α production. Additionally, an LFA-1-dependent cell-cell interaction between pDCs and NK cells strongly contributed to the increased production of IFN-α. In study II, the RNA-IC-induced regulation of surface molecules on pDCs and NK cells was investigated. The expression of CD319 and CD229, which are two SLAM family receptors genetically associated with SLE, was induced on pDCs and NK cells by RNA-IC. IFN-α-producing pDCs displayed an increased expression of CD319 and CD229, whereas pDCs from patients with SLE had a decreased expression of CD319. In study III, we serendipitously identified an SLE patient harboring autoantibodies to the NK cell receptor CD94/NKG2A. In study IV, sera from 203 patients with SLE were analyzed for autoantibodies to the CD94/NKG2A, CD94/NKG2C and NKG2D receptors. Seven patients harbored anti-CD94/NKG2A autoantibodies, and two of these patient’s autoantibodies also reacted with CD94/NKG2C. Anti-CD94/NKG2A and anti-CD94/NKG2C autoantibodies both interfered with the HLA-E-mediated regulation of NK cell cytotoxicity, and facilitated the elimination of target cells expressing these receptors. Furthermore, these autoantibodies were found in a group of severely diseased SLE patients and their titers closely followed disease activity. In conclusion, this thesis provides insights to molecular mechanisms whereby NK cells regulate the IFN-α production, it further links the SLAM receptors to SLE, and it describes novel autoantibodies to receptors regulating NK cell cytotoxicity. Together these findings strengthen the assumption that NK cells are involved in the pathogenesis of SLE.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The definitive diagnosis of strongyloidiasis is normally done by detection of larvae on faecal samples; however, the number of parasites is limited in most cases and the elimination of larvae is irregular. Thus, developing reliable serological methods for the diagnosis of strongyloidiasis becomes imperative. The aim of this study was to establish a coproantigen ,antigen, antibody and immune complex detection by enzyme-linked immunosorbent assay in serum and bronchoalveolar lavage fluid (BALF) samples of non immunosuppressed or immunosuppressed rats experimentally infected with Strongyloides venezuelensis. For kinetics of coproantigen detection (0 and 5, 8, 13 and 21 days post-infection (d.p.i)), we used an anti-L3 polyclonal antibody produced in rabbits. For antigen and immune complex detection in serum and BALF samples (0 and 2, 5, 8, 13 and 21d.p.i), the microtitre plates were coated with IgG anti-S. venezuelensis and with alkaline parasite extract for antibody detection. The statistical analysis were analyzed using Two Way ANOVA, followed by the Bonferroni test. The criterion for statistical significance was set at p<0,05. The number of eggs/g of faeces recovered at 8 d.p.i was significantly higher for non immunosuppressed and immunosuppressed animals (p<0.01). The coproantigen detection was significantly higher at 13° d.p.i in non immunosuppressed (p<0.05) and in immunosuppressed it was anticipated to the 5th d.p.i. It was observed that antigen detection in serum samples was not a good approache for evaluating the infection however in BALF samples it showed superior results. In immunosuppressed animals, IgG specific for S. venezuelensis was preferentially detected during the 5° and 13° d.p.i and in immunosuppressed animals, during the entire experimental kinetics. In BALF samples, antibodies detection was observed from the 8° to the 21° d.p.i in non immunosuppressed animals and in immunosuppressed animals it was anticipatedto the 2° d.p.i, with higher reactivity at 5° d.p.i (p<0.05). The immune complex detection in serum samples of the non immunosuppressed animals was observed from the 5° to the 13° d.p.i and in immunosuppressed animals, during the entire kinetics. In BALF samples, immune complex detection was higher in non immunosuppressed animals. In conclusion, coproantigen and immune complex detection in serum and BALF samples are alternatives for early strongyloidiasis diagnosis, mainly in immunocompromised cases. / O diagnóstico definitivo da estrongiloidíase normalmente é realizado mediante a detecção de larvas nas fezes; porém a quantidade de parasitos é limitada e a eliminação de larvas é reduzida e irregular. Sendo assim, o desenvolvimento de testes sorológicos confiáveis para o diagnóstico da estrongiloidíase torna-se uma alternativa necessária. O objetivo deste estudo foi demonstrar a cinética de detecção de coproantígenos e de antígenos, anticorpos e imunocomplexos circulantes em amostras de soro e de lavado bronco alveolar (LBA) de ratos imunossuprimidos e experimentalmente infectados por Strongyloides venezuelensis. Para a cinética (0 e 5, 8, 13 e 21 dias pós-infecção (d.p.i)) de coproantígenos utilizou-se anticorpo policlonal anti-L3 produzido em coelhos. Para a detecção de antígenos e de imunocomplexos em amostras de soro e de LBA (0 e 2, 5, 8, 13 e 21 d.p.i), placas de microtitulação foram sensibilizadas com IgG anti-S. venezuelensis e com extrato alcalino de larvas para a detecção de anticorpos. A análise estatística foi realizada por Two Way ANOVA, seguida pela teste de Bonferroni, considerando p<0,05 significativo. A cinética de eliminação de ovos/g de fezes mostrou que o pico ocorre no 8° d.p.i sendo significativamente maior nos animais imunossuprimidos (p<0,01). O pico de detecção de coproantígenos nos animais não imunossuprimidos foi no 13° d.p.i (p<0,05), sendo que nos animais imunossuprimidos a detecção foi antecipada para o 5° d.p.i. A detecção de antígeno em amostras de soro não foi uma boa ferramenta diagnóstica para avaliar a infecção enquanto que em amostras de LBA mostrou ser ferramenta auxiliar. A detecção de IgG específica para S. venezuelensis em amostras de soro de animais não imunossuprimidos foi preferencialmente durante o 5° e o 8° d.p.i. e em animais imunossuprimidos, durante toda a cinética experimental. Nas amostras de LBA, a detecção de anticorpos ocorreu do 8° ao 21° d.p.i em animais não imunossuprimidos e em animais imunossuprimidos, foi antecipada para o 2° d.p.i, como pico de reatividade no 5° d.p.i (p<0,05). A detecção de imunocomplexos em amostras de soro de animais não imunossuprimidos foi possível do 5° aos 13° d.p.i e em animais imunossuprimidos, durante toda a cinética. Em amostras de LBA, a detecção de imunocomplexo foi maior em animais não imunossuprimidos. Concluiu-se que a detecção de coproantígeno e de imunocomplexos circulantes em amostra de soro e em amostras de LBA são uma alternativa para o diagnóstico precoce da estrongiloidíase principalmente nos casos de imunossupressão. / Doutor em Imunologia e Parasitologia Aplicadas

Os neutrófilos são os leucócitos mais abundantes na circulação sanguínea, sendo recrutados rapidamente para os locais de infecção e inflamação. Em condições fisiológicas, os neutrófilos circulantes possuem tempo de vida curto, de cerca de 6 a 8 horas, mas a sua sobrevida pode aumentar em condições inflamatórias. O papel dos neutrófilos em diversas doenças foi negligenciado por muito tempo, em parte devido àsdificuldades em seu estudo e manipulação, pois os mesmos são facilmente ativados e difíceis de serem mantidos em cultura. Nos últimos anos, o advento de novas técnicas e o aprimoramento de condições laboratoriais têm possibilitado uma investigação mais ampla da fisiopatologia dos neutrófilos e revelado a diversidade de funções e interações dessas células. Para dar continuidade aos estudos visando o entendimento de como as funções efetoras dos neutrófilos podem ser moduladas por produtos naturais e sintéticos, e a aplicação desse conhecimento no tratamento de patologias nas quais tais leucócitos participam, o presente trabalho estabeleceu, primeiramente, as condições experimentais para a cultura de neutrófilos humanos. As células mantiveram-se viáveis e em estado de repouso por até 24 horas, tanto em solução balanceada de Hank\'s quanto em meio RPMI. A funcionalidade dos neutrófilos foi avaliada através da sua capacidade de produzir espécies reativas de oxigênio (ERO), medida por quimioluminescência dependente de luminol (QLlum). Diferentemente do meio RPMI, a solução balanceada de Hank\'s não interferiu no ensaio de QLlum, possibilitando a análise da funcionalidade das células. Durante o período de cultura celular de 24 horas, os neutrófilos mantiveram a sua capacidade de produzir ERO em quantidades suficientes para serem detectadas e permitirem a avaliação do efeito inibitório de substâncias antioxidantes. Em seguida, este trabalho avaliou o efeito de dois antioxidantes - a 3-fenilcumarina 6,7-diidroxi-3-(3\',4\'-metilenodioxifenil)-cumarina (C13) e o flavonol galangina - na produção de ERO pelos neutrófilos. Ambas as substâncias inibiram esta função efetora dos neutrófilos durante todo o período de cultura analisado, indicando que as mesmas não foram degradadas a ponto de perderem a sua atividade antioxidante. As condições de cultura padronizadas possibilitaram também a avaliação do efeito da galangina e da C13 na viabilidade celular. Na maior concentração analisada (20 ?M), ambas as substâncias não alteraram a porcentagem de células viáveis (aproximadamente 80%), mas modularam os estágios de sobrevivência dos neutrófilos, reduzindo a porcentagem de células em apoptose e aumentando a porcentagem de células em necrose, principalmente após 18 horas de cultura. Portanto, a solução balanceada de Hank´s é adequada para manter neutrófilos humanos em cultura por até 24 horas, possibilitando a avaliação do efeito de substâncias antioxidantes na produção de ERO por estas células e na sua viabilidade. / Neutrophils are the most abundant leukocytes in blood, which are rapidly recruited to sites of infection and inflammation. Circulating neutrophils have a short lifetime of about 6 to 8 hours under physiological conditions, but their survival can be increased under inflammatory conditions. The role that neutrophils play in various diseases was long neglected, partially due to the difficulties to study and manipulate these cells, which are easy to activate and hard to maintain in culture. In recent years, the development of new techniques and improvement of laboratory conditions have broadened the investigation of neutrophil physiopathology and revealed the variety of functions and interactions of these cells. To continue the studies to understand how the effector functions of neutrophils can be modulated by natural and synthetic products, and to apply such knowledge to treat diseases in which these leukocytes participate, the first part of the present work established the experimental conditions to culture human neutrophils. Cells cultured in either Hank\'s balanced solution or RPMI medium remained viable and in the resting state for up to 24 hours. Neutrophil functionality was evaluated through its ability to produce reactive oxygen species (ROS), assessed by the luminol-enhanced chemiluminescence assay (CL-lum). In contrast to RPMI medium, Hank\'s balanced solution did not interfere in the CL-lum assay and thereby allowed analysis of neutrophil functionality. During the 24-hour cell culture period, neutrophils maintained their capacity to produce ROS in detectable amounts that were sufficient to assess the inhibitory effect of antioxidant compounds. Next, this work examined the effect of two antioxidants - the 3-phenylcoumarin 6,7-dihydroxy-3-[3\',4\'-methylenedioxyphenyl]-coumarin (C13) and the flavonol galangin - on ROS production by neutrophils. Both compounds suppressed this effector function of neutrophils during the whole culture period studied, indicating that they were not degraded to the point of losing their antioxidant activity. The standardized culture conditions also allowed assessing whether galangin and C13 affected cell viability. At the highest concentration tested (20 ?M), both compounds did not alter the cell viability percentage (around 80%) but modulated the neutrophil survival stages by reducing the percentage of apoptotic cells and increasing the percentage of necrotic cells, particularly after 18 hours of culture. Therefore, Hank\'s balanced solution is suitable to culture human neutrophils for up to 24 hours, and enables to assess the effect of antioxidant compounds on neutrophil ROS production and viability.

<p>In sera remitted for anti-nuclear antibody (ANA) analysis, the supplement of a sensitive anti-SSA/Ro ELISA to the conventional ANA screening by immunofluorescence (IF) revealed that one fourth of the individuals with IF-ANA negative, but SSA/Ro ELISA positive sera, had systemic lupus erythematosus (SLE) or cutaneous LE. Consequently, adding a sensitive anti-SSA/Ro ELISA to the ANA screening is valuable for the serological detection of ANA negative SLE/LE patients.</p><p>SLE patients often have measurable interferon-alpha (IFN-α) levels in serum, and IFN-α treatment of patients with non-autoimmune diseases can induce SLE. Thus, the type I IFN system seems to be important in SLE and was therefore investigated. Initially, a decreased IFN-α producing capacity, due to a 70-fold reduction in the number of circulating natural IFN-α producing cells (NIPC), was noted in peripheral blood mononuclear cells (PBMC) from SLE patients. SLE-sera contained an endogenous IFN-α inducing factor (SLE-IIF), consisting of IgG and DNA in the form of small immune complexes (300-1000 kD). The SLE-IIF selectively activated NIPC and was more common in sera from patients with active disease compared to individuals with inactive disease. IFN-α producing cells could be detected by immunohistochemistry in both lesional and unaffected skin from SLE patients, and IFN-α gene transcription could be verified by in situ hybridisation in some of the skin biopsies. A reduced number of NIPC, detected by expression of the blood dendritic cell antigen (BDCA)-2, was noted among SLE-PBMC. The IFN-α production triggered by SLE-IIF in SLE-PBMC was inhibited by monoclonal antibodies (mAbs) to BDCA-2 and markedly decreased by anti-BDCA-4 mAbs. </p><p>The observations in the present thesis may explain the ongoing IFN-α production in SLE patients, indicate an important role for the activated type I IFN system in the pathogenesis, and suggest that direct targeting of SLE-NIPC may constitute a new therapeutic principle in SLE.</p>

In sera remitted for anti-nuclear antibody (ANA) analysis, the supplement of a sensitive anti-SSA/Ro ELISA to the conventional ANA screening by immunofluorescence (IF) revealed that one fourth of the individuals with IF-ANA negative, but SSA/Ro ELISA positive sera, had systemic lupus erythematosus (SLE) or cutaneous LE. Consequently, adding a sensitive anti-SSA/Ro ELISA to the ANA screening is valuable for the serological detection of ANA negative SLE/LE patients. SLE patients often have measurable interferon-alpha (IFN-α) levels in serum, and IFN-α treatment of patients with non-autoimmune diseases can induce SLE. Thus, the type I IFN system seems to be important in SLE and was therefore investigated. Initially, a decreased IFN-α producing capacity, due to a 70-fold reduction in the number of circulating natural IFN-α producing cells (NIPC), was noted in peripheral blood mononuclear cells (PBMC) from SLE patients. SLE-sera contained an endogenous IFN-α inducing factor (SLE-IIF), consisting of IgG and DNA in the form of small immune complexes (300-1000 kD). The SLE-IIF selectively activated NIPC and was more common in sera from patients with active disease compared to individuals with inactive disease. IFN-α producing cells could be detected by immunohistochemistry in both lesional and unaffected skin from SLE patients, and IFN-α gene transcription could be verified by in situ hybridisation in some of the skin biopsies. A reduced number of NIPC, detected by expression of the blood dendritic cell antigen (BDCA)-2, was noted among SLE-PBMC. The IFN-α production triggered by SLE-IIF in SLE-PBMC was inhibited by monoclonal antibodies (mAbs) to BDCA-2 and markedly decreased by anti-BDCA-4 mAbs. The observations in the present thesis may explain the ongoing IFN-α production in SLE patients, indicate an important role for the activated type I IFN system in the pathogenesis, and suggest that direct targeting of SLE-NIPC may constitute a new therapeutic principle in SLE.