Background: The World Health Organisation (WHO) Africa region experiences multiple public health emergencies (PHEs) annually. PHEs have been documented to affect the provision of health services including immunisation. To our knowledge, there is a scarcity of studies characterising PHEs and the performance of national immunisation programmes (NIPs) in countries within the WHO Africa region that have experienced PHEs. This study assessed PHEs (armed conflicts, disasters, and disease outbreaks) and the performance of NIPs in the context of PHEs using global and regional immunisation targets. Methods Countries in the WHO Africa region that were reported to benefit from the African Public Health Emergency Fund (APHEF) were used as case studies. Data on PHEs and immunisation indicators recorded between 2010 and 2019 in the study countries were extracted from different electronic PHE databases (the Emergency Events database, the Uppsala Conflict Data Program, the WHO Emergency Preparedness and Response, and the Program for Monitoring Emerging Diseases Mail) and the WHO/UNICEF immunisation database, respectively. The PHEs and immunisation indicators were stratified by country and summarised using descriptive statistics. The Mann-Whitney U test was carried out to determine the association between the frequency of PHEs and the performance of NIPs in the selected countries from 2010 to 2019. Statistical significance was defined at p-value < 0.05. Results Thirteen countries were included in this study. A total of 175 disease outbreaks, 288 armed conflicts, and 318 disasters were reported to have occurred within the 13 countries from 2010 to 2019. The Democratic Republic of Congo had the highest total PHE count (n=208), while Liberia had the lowest (n=20). Only three of the 13 countries had a median coverage value for the third dose of the combined Diphtheria, Tetanus, and Pertussis vaccine (DTP3) that had attained the target for ≥90% immunisation coverage. Higher counts of armed conflict and total PHEs were statistically significantly (p=0.03) associated with not attaining MNT elimination. Conclusion PHEs are prevalent in the WHO Africa region, irrespective of the level of a country's immunisation maturity. In absence of effective interventions, PHEs have the potential to derail the progress of NIPs in the WHO Africa region. As we enter the Immunisation Agenda 2030 era, this study advocates for the prioritisation of interventions to mitigate the impacts of PHEs on the NIPs.

Un isolat de protéines de lactosérum commercial hydrolysé enzymatiquement (IPL-H), contenant le peptide β-LG f96-99, a été administré à des souris saines pendant 3, 7 et 14 jours selon 3 doses (0, 10 ou 20 mg) pour évaluer son effet au niveau intestinal. Les taux d’IgA sériques ont augmenté significativement uniquement au jour 14 avec 10 mg. Les taux d’IgA fécales ont augmenté considérablement au jour 3. Ces taux ont triplé avec la dose 20 mg comparé au groupe contrôle. Aucune différence significative n’a été observée aux jours suivants pour les taux IgA fécales, ni pour l’expression du gène TGF-β au jour 3. L’IPL-H induirait une réponse rapide et locale via la production d’IgA au niveau intestinal et une réponse lente et faible dans le sérum. Le peptide β-LG f96-99 présent dans cet hydrolysat pourrait être associé aux effets observés.

Yes / Childhood immunization has been globally recognized as the single most effective strategy in preventing childhood diseases and mortality. The perceptions of healthcare workers are important as their behavior and attitudes influence parental decision-making process. This research aimed to explore the factors that influence healthcare workers' experience and perceptions about delivering childhood immunization in Fiji. A qualitative study was conducted in three randomly selected health centers in Suva, Fiji from March 1st to April 5th, 2021. Five focus group discussions were conducted with healthcare workers who were chosen purposively, had worked in the health center for at least 6 months and included either gender. Those that did not consent or did not meet the inclusion criteria were excluded. The interviews were guided by semi-structured open-ended questionnaire and were recorded into a digital voice recorder. The data were coded, sorted, and then categorized into themes, and transcribed onto Microsoft Word. Thematic analysis was utilized to sort the key phrases from the recorded interviews. There were a total of 22 participants for the focus group discussions, with their ages ranging from 25 to 51 years, included 3 medical officers, 1 nurse practitioner and 18 registered nurses. Three major themes emerged, which included: healthcare worker factors, parental factors and health system factors. Subthemes identified from the healthcare worker factors were worker knowledge and attitudes. The subtheme for parental factors that emerged were defaulters, parental attitudes, perceived behavior and religious beliefs. For health system factors the subthemes were service delivery, registration, infrastructure, staff turnover, staff training and changes to the immunization schedule. Some of the perceived barriers reported by the healthcare workers were parental religious beliefs, parental knowledge and attitude, social or physical factors (finances, transportation, childcare and work conflicts), access to health services, immunization services and policies, hours of operation, waiting time and missed opportunities. Health workers acknowledged that they have an important role to play in immunization as they are the source of information and motivation for parents. Further studies are needed to be conducted nationally to determine the perceptions of healthcare workers towards immunization and how the services can be improved on a national level.

Yes / Immunization against common childhood diseases is an important strategy as it is critical for reducing the global child morbidity and mortality. This review explores the perceptions of parents and HCWs toward childhood immunization. The PRISMA guideline was used to search and include the studies. Relevant electronic databases were systemically searched for the years ranging from 2000 to 2021 to identify studies reported in English. Themes were then identified using thematic analysis. A total of 44 studies met the review criteria and were summarized and categorized into 4 themes: barriers to immunization, parental knowledge, attitude and behavior (KAB), health system factors and HCWs’ KAB. This review found that immunization decision-making is a complex process. Parental KAB leads to immunization decisions. HCWs were also noted to be the trusted sources of immunization information. Further research can be conducted on how to improve parents’ perceptions of immunization and immunization practices.

Résumé : Malgré le fait que la vaccination soit reconnue comme l’une des mesures de santé publique les plus efficaces, elle est perçue comme non sécuritaire et non nécessaire par un nombre grandissant de parents. Dans ce contexte, la compréhension du processus décisionnel des parents par rapport à la vaccination de leur enfant serait aidante. Le but de cette étude est d’explorer le processus décisionnel des parents concernant la vaccination de leur nourrisson, selon leur génération d’appartenance, soit la génération X ou Y. Une étude de cas descriptive et comparative a été réalisée avec des entrevues semi-structurées ainsi qu’une analyse des sources d’informations consultées par les participantes. Les mères ont été sélectionnées selon leur intention de vaccination pour leur enfant. Les données ont été codifiées et analysées de façon systématique et rigoureuse au niveau intra-cas et inter-cas, co-analysées et ensuite validées avec les participantes. Quatre mères dans chaque génération ont été interviewées, dont trois participantes par génération à deux reprises. Le processus décisionnel est similaire d’une génération à l’autre. Les composantes du processus sont l’attitude initiale envers la vaccination, le processus cognitif, la recherche d’information, la décision, l’acte et l’évaluation rétrospective de l’expérience vécue. Toutes ces composantes sont influencées par des facteurs intrinsèques et extrinsèques. Certaines trouvailles de cette étude ont peu été documentées dans la littérature telles que la perception positive envers la vaccination, l’inconscience du processus, l’importance du déclencheur et le fait de saisir le moment opportun. Malgré la rigueur de cette étude, la principale limite est la saturation des données qui n’a possiblement pas été atteinte pour tous les aspects du processus décisionnel. Même si la norme sociale est favorable à la vaccination, aucune participante n’avait consciemment réfléchi à l’immunisation de son enfant jusqu’à ce qu’un déclencheur soit introduit. Ceci soulève l’enjeu et l’impact de la transmission de l’information adéquate, au moment opportun, et du soutien donné aux parents qui naviguent dans ce processus. / Abstract : Even though vaccination is known as one of the most efficient public health interventions, it is often perceived as unsafe and unnecessary by parents. In this context, understanding the decisional process of parents towards their child’s vaccination would be helpful. The objective of this study is to explore the decisional process of parents towards their child’s vaccination in regards to parent’s generation of belonging, either generation X or Y. A multiple descriptive and comparative case study was done using semi-structured interviews as well as an analysis of sources consulted by participants. Mothers were selected based on their vaccination intention for their child. Data was codified and analysed systematically as well as rigorously at the intra-case level as well as at the inter-case level, co-analysed and then validated with participants. Four mothers in each generation were interviewed: three were interviewed twice. The decisional process was similar for all participants of both generations. The process components were the initial attitude towards vaccination, the cognitive process, the information research, the decision, the action of vaccinating and the retrospective evaluation of the experience. All these components were influenced by intrinsic as well extrinsic factors. Some of these findings were not well documented in the literature such as the initial positive perception towards vaccination, the unconsciousness of the process, the importance of a trigger and the importance of seizing the moment. Even though this study was rigorous, the main limit is data saturation that might not have been achieved for all aspects of the process. Even if social norm is favorable to vaccination, no participant had consciously thought about their child’s immunization until a trigger had been introduced. This introduces the question of the impact of adequate and timely information giving as well as the support offered to parents that navigate through this process.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

L'Organisation Mondiale de la Santé définit l'infertilité comme une maladie et un échec de l'appareil reproducteur à parvenir à une grossesse après 12 mois ou plus de rapports sexuels réguliers non protégés. De nos jours, l'infertilité est devenue un phénomène commun affectant 1 couple en âge de procréer sur 5. Une origine idiopathique est le plus souvent associée à un système immunitaire actif qui pourrait produire des niveaux élevés d'anticorps anti-liquide séminal ou anti-sperme. L'auto-immunisation, aussi bien que l'iso-immunisation, joue un rôle significatif dans jusqu'à 30% des cas signalés. Le liquide séminal, qui est défini comme un fluide complexe contenant le sperme, les vésicules cellulaires et autres cellules et composantes, pourraient immuniser l'appareil génital féminin. Cette thèse est liée à l'infertilité féminine immune, en particulier à l'iso-immunisation féminine. Une meilleure compréhension de cette manifestation physiopathologique consiste en (1) la détermination des isotypes d'anticorps jouant un rôle significatif dans cette maladie, puis en (2) la caractérisation et l'identification des antigènes de liquide séminal ou de sperme reconnus par ces anticorps, (3) la proposition de marqueurs diagnostiques potentiels afin d'adapter des thérapies spécifiques, et, en outre, la conception d'un outil de diagnostic miniaturisé basé sur les marqueurs sélectionnés, (4) la suggestion d'une éventuelle immuno-intervention. En se fondant sur la distribution des isotypes d'anticorps spécifiques au liquide séminal/sperme, nous suggérons que les immunoglobulines E, M, A1,2, et G3 ne sont pas impliquées dans la sensibilisation physiopathologique chez les femmes. Les IgG4, semblent constituer la sous classe majeure interagissant avec les protéines de sperme. A l’inverse, les IgG1 semblent être principalement impliquées dans la réactivité vis-à-vis des protéines séminales. Nous avons également élargi le groupe déjà existant d’IgGs liés aux protéines de sperme à d’autres protéines, parmi lesquelles la protéine de choc thermique 70 1A/1B, la protéine apparentée aux protéines de choc thermique 71kDa et l’alpha-énolase ont été reconnues, pour la première fois, être liés à l’iso-immunisation féminine. Nous avons mis en évidence le rôle des protéines séminales dans l’iso-immunisation et pas seulement dans l’hypersensibilité au sperme par l’intermédiaire d’IgE. En particulier, l’antigène spécifique de la prostate, la phosphatase acide prostatique et la protéine à doigt de zinc 778 ont été décrites comme immuno-dominants parmi les protéines séminales reconnues par des IgGs liés aux protéines de sperme. La détermination des sous classes d’IgG de sérum féminin, spécifiques au liquide séminal/sperme, pourrait rendre le diagnostic des patients plus complet. Les IgG1 et IgG4 anti-liquide séminal/sperme pourraient présenter un intérêt pour l’immunothérapie. Par ailleurs, les protéines décrites, dans notre étude, pourraient se révéler être des bio marqueurs utiles pour de telles pathologies. Le dispositif miniaturisé pourrait être de type LFIA (Lateral Flow Immuno Assay), se basant sur la détection immuno-chimique d’anticorps spécifiques. L’immuno-intervention envisagée pourrait reposer sur l’effet d’immunoglobulines intraveineuses. / The World health Organization reports infertility as a disease and a failure of reproductive tract to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. Nowadays, infertility has become a common life phenomenon affecting 1 out of 5 couples at reproductive age. Idiopathic cause is mostly associated with active immune system which may produce high levels of anti-seminal and/or anti-sperm antibodies. Auto-immunization as well as iso-immunization has a significant role in up to 30% of reported cases of infertility. Semen that is defined as a complex fluid containing sperm, cellular vesicles and other cells and components, could immunize the female genital tract. This thesis is related to female immune infertility, in particular to female iso-immunization. The better understanding of this pathophysiological event consists of (1) the determination of antibody isotype playing a significant role in this disease, then (2) the characterization and identification of semen antibody-binding proteins, seminal and/or sperm, (3) the proposal of potential diagnostic markers to adapt specific therapy and, in addition, the design of miniaturized diagnostic tool based on the selected markers, (4) the suggestion of potential immuno-intervention. Based on the distribution of seminal/sperm-specific antibody isotypes, we suggest that immunoglobulins E, M, A1,2, G3 are not involved in the primary pathophysiological female sensitization. IgG4 appears to be the major subclass interacting with sperm proteins. On a contrary, IgG1 seems to be the one mainly involved in the reactivity towards seminal proteins. We have also extended the existing group of IgG-binding sperm proteins, among which heat shock protein 70 1A/1B, heat shock cognate protein 71 kDa and alpha-enolase have been shown, for the first time, to be related to female iso-immunization. We have put the emphasis on the role of seminal proteins in iso-immunization and not only in the IgE-mediated semen hypersensitivity as known so far. In particular, prostate-specific antigen, prostatic acid phosphatase and zinc finger protein 778 have been determined as immunodominant among IgG-binding seminal proteins. The determination of female serum seminal/sperm-specific IgG subclasses could make the patient diagnoses more comprehensive. Anti-seminal/sperm IgG1,4 might be of interest for immunotherapy. Furthermore, the herein described proteins could be useful biomarkers of such pathology. The miniaturized chip could be a lateral flow immunoassay-based device acting on the immunochemical detection of specific antibodies. The intended immuno-intervention could consist of the effect of intravenous immunoglobulins.

Purpose: This study aimed to assess the feasibility of implementation of the Health Professions Council of South Africa's (HPCSA) clinic-based hearing screening subsection of its 2007 Position Statement on Early Hearing Detection and Intervention (EHDI) programmes in South Africa. Specific sub-aims included (a) establishing the prevalence of hearing screening conducted at Maternal Child Woman’s Health (MCWH) immunisation clinics; (b) determining the hearing screening procedures and protocols in use at MCWH immunisation clinics; (c) determining and exploring the possible concomitant personnel-associated factors which may influence the implementation of newborn and infant hearing screening programmes; (d) determining and exploring other factors that may have influenced implementation of newborn and infant hearing screening; and lastly, (e) comparing any hearing screening procedures and protocols in use to the HPCSA (2007) EHDI position statement clinic guidelines and associated clinic benchmarks Participants: Thirty primary healthcare immunisation clinic managers/acting managers were interviewed in two South African sample groups, in the North West province (NW) and Gauteng (GP). Design: An exploratory, non-experimental, qualitative research design was employed incorporating both quantitative and qualitative information within the two sample groups. Methods and Materials: An interview using a questionnaire was administered with primary health care (PHC) clinic nursing manager/acting manager, placed within the identified sites. The questionnaire encompassed areas such as work contexts, hearing screening contexts and information management systems, as well as quality control measures in place at these clinics. Data Analysis: Content analysis was used to code emergent themes into specific categories. Frequency calculations of the emergent themes were calculated and results described qualitatively. Results: No PHC clinics placed within the identified sites offered or provided formalised newborn/infant hearing screening and none of these facilities had equipment to do so. Most sites attributed the lack of formalised hearing screening to budgetary and human resource issues, staff training in particular. Non-formalised hearing screening protocols in place demonstrated inconsistencies in application across districts and none complied with HPCSA (2007) clinic guidelines. Most respondents were willing to implement formalised hearing screening to coincide with their immunisation schedules. The immunisation context was considered favourable for implementation of formalised hearing screening. Other factors such as reduced parental awareness of the importance of hearing screening, and caregiver cultural issues were considered surmountable by respondents. Conclusions: HPCSA (2007) implementation of clinic hearing screening protocols at PHC immunization clinics (level one) does not appear to be feasible based on current evidence. Results from the current study have assisted in identifying procedural and logistical assets and barriers to implementation of HPCSA (2007) clinic guidelines for EHDI at immunisation clinics in South Africa. Future research implications include formal investigations of central directorate versus district differences in PHC Package Integrated Management of Childhood Illnesses (IMCI); Otitis Media, and Road to Health Chart (RtHC) protocols; provincial and district inequities in funding as they impinge on hearing health care service delivery; costing of rudimentary protocols in place versus formalised HPCSA (2007) EHDI service delivery; research into parental awareness, education and willingness in specific reference to certain procedures such as otoacoustic emissions; and replication of the current study throughout the country for quantitave data with increased ability to draw causal inferences and generalize findings.

Le développement des anticorps monoclonaux thérapeutiques est en plein essor notamment à cause de leur bénéfice important pour le traitement des cancers. Cependant, à l’heure actuelle, aucun anticorps monoclonal sur le marché ou en phase III ne cible de RCPGs, en dépit de l’implication grandissante de ces récepteurs dans la carcinogenèse. Parmi les RCPGs les plus pertinents pour l’oncologie, souvent cités dans la littérature et dont certains inhibiteurs chimiques sont en phase clinique avancée, on trouve les deux sous-types de récepteurs des endothélines ETAR et ETBR. Dans ce contexte, mon projet de thèse a consisté à produire des anticorps monoclonaux capables de lier spécifiquement les récepteurs des endothélines, puis à les caractériser dans le but d’évaluer leur potentiel antitumoral. Grâce à une stratégie d’immunisation génique, un ensemble de 27 anticorps monoclonaux, tous spécifiques de la forme native d’ETBR, a été obtenu. Un de ces anticorps, nommé rendomab-B1, a fait l’objet d’une caractérisation précise et s’est révélé être un puissant inhibiteur allostérique d’ETBR. De plus, cette propriété antagoniste a permis de bloquer l’action autocrine antiapoptotique de l’ET-1 sur des cellules endothéliales vasculaires, suggérant ainsi que le rendomab-B1 pourrait être utilisé comme agent thérapeutique afin d’inhiber les effets tumorigènes liés à la suractivation de l’axe ET1/ETBR au niveau de l’endothélium vasculaire tumoral. Par ailleurs, le rendomab-B1 a également été testé sur des lignées de mélanomes humains ; l’absence de fixation de l’anticorps malgré la présence de récepteurs ETB fonctionnels à la surface de ces cellules suggère l’existence d’une forme moléculaire atypique du récepteur, potentiellement spécifique aux mélanomes. A la lumière de ces résultats, le rendomab-B1 apparaît comme un outil prometteur, à la fois pour l’étude structurale et fonctionnelle d’ETBR, mais aussi pour une éventuelle thérapie anticancéreuse. Enfin, les 26 autres anticorps monoclonaux anti-ETBR, actuellement en cours de caractérisation, constituent également des molécules potentiellement intéressantes pour un usage fondamental ou thérapeutique impliquant ETBR. Pour conclure, ces travaux ont démontré l’intérêt de la méthode d’immunisation génique pour la production d’anticorps monoclonaux anti-RCPGs à visée thérapeutique. / For a decade, monoclonal antibodies have become increasingly important for the biotherapeutic management of cancer. However, none of the monoclonal antibodies currently on the market or in late stage clinical trial do target a G-protein coupled receptor in spite of the emerging role of these receptors in tumor progression. Among the therapeutically relevant GPCRs for oncology, the endothelin receptors (ETAR and ETBR) are particularly attractive considering their overexpression in a wide range of tumors and their involvement in various stages of tumorigenesis. In this context, my PhD project consisted in producing and characterizing monoclonal antibodies directed against endothelin receptors with a view to use them as anti-tumor agents. Using an original DNA immunization strategy, we produced a panel of 27 monoclonal antibodies which selectively recognized ETBR expressed at the surface of transfected cells. One of these antibodies, named rendomab-B1, was extensively characterized and proved to be a potent allosteric antagonist of ETBR. Moreover, rendomab-B1 was able to disrupt the autocrine ET1-mediated survival loop on vascular endothelial cells, suggesting that this antibody could be used to prevent the pro-tumorigenic effect due to ET-1 and ETBR upregulation in the tumor-surrounding endothelium. Furthermore, rendomab-B1 binding onto ETBR was also assessed on melanoma cell lines and revealed that a tumor-specific form of ETBR may exist, as illustrated by the poor fixation of rendomab-B1 on these cells in spite of the presence of functional ETB receptors. Together, these results present rendomab-B1 as promising agent, not only for the structural and functional study of ETBR, but also for its therapeutic modulation in the case of cancer for instance. Finally, the other 26 monoclonal antibodies, whose characterization is still ongoing, also constitute potential tools for fundamental or therapeutic applications involving ETBR. To conclude, this work has highlighted the relevance of the DNA immunization approach to generate monoclonal antibodies against the native form of GPCRs.

Les anticorps monoclonaux représentent aujourd’hui un outil de choix en thérapeutique et en diagnostic. Les anticorps thérapeutiques sont des biomédicaments en plein essor depuis les années 1970 et représentent 10% du marché des produits pharmaceutiques. Les anticorps monoclonaux sont utilisés dans divers domaines : en cancérologie, pour lutter contre les maladies auto-immunes ou en infectiologie. Le nombre des anticorps monoclonaux en développement ne cesse d’augmenter. Les premiers anticorps monoclonaux utilisés en thérapie étaient d’origine murine et leur administration à l’Homme est susceptible de déclencher des effets secondaires. De nouveaux anticorps visant à limiter voir faire disparaitre ces effets indésirables tels que d’abord les anticorps chimériques, puis les anticorps humanisés et enfin les anticorps totalement humains ont été développés. 9 anticorps totalement humains sont actuellement sur le marché et d’autres sont en cours de développement. Le phage display, les souris transgéniques et l’utilisation de lymphocytes B humains sont les trois stratégies mises en œuvre pour produire des anticorps totalement humains. L’utilisation des lymphocytes B humains, peu étudiée à cause d’un faible rendement et de problèmes de stabilité, a connu ces dernières années un regain d’intérêt grâce à l’immortalisation virale par le virus Epstein-Barr et à la découverte de myélomes humains. Dans ce contexte, l’objectif de mon projet de thèse a été la production d’anticorps monoclonaux humains à partir de lymphocytes B humains. Pour ce faire, deux approches basées sur l’immortalisation virale par le virus Epstein-Barr couplée ou non à une immortalisation cellulaire par des myélomes ont été mises en œuvre. La première approche utilise des lymphocytes B mémoires isolés de sang périphérique de donneurs infectés ou vaccinés. L’entérotoxine B de Staphylococcus aureus (SEB) a été utilisée comme modèle.La deuxième approche implique une immunisation in vitro de lymphocytes B naïfs extraits de sang périphérique. Cette stratégie pourrait permettre la production d’anticorps humains contre des antigènes pour lesquels il n’existe pas de donneurs infectés ou vaccinés. Deux modèles, le peptide N-terminal de la neurotoxine A de Clostridium Botulinium A (BoNT/A) et la protéine de fusion ZZTat101, comportant le domaine ZZ de Staphylococcus aureus lié covalemment à la protéine transactivatrice Tat du virus de l’immunodéficience humaine VIH-1, ont été employés. Nous avons réussi à obtenir des IgMs dirigés contre la neurotoxine Clostridium Botulinium A, ainsi que des IgMs (et peut-être des IgGs) dirigés contre la protéine Tat. L’immortalisation par Epstein-Barr, nous a permis d’isoler 7 lignées de lymphocytes immortalisés sécrétant des anticorps IgMs anti-TBA-Nter humains. L’immunisation in vitro produisant essentiellement des IgMs, la possible production d’IgGs après stimulation par la protéine ZZTat101 se révèle un résultat très intéressant. Nous avons montré que la production d’anticorps par ZZTat101 impliquait les 7 cystéines, la région 22-57 et la liaison aux héparanes sulfates de Tat. / The number of monoclonal antibodies used as drug or under clinical investigation increases rapidly. The first murine monoclonal antibodies (mAbs) used in therapy induces human anti-mouse antibodies (HAMAs) when administered to patients. Such HAMAs hamper the therapeutic efficacy of mAbs and induce side effects. To limit these effects, new antibodies were developed during the, last 30 years. Chimeric, humanized and fully human antibodies were engineered. The use of human monoclonal antibodies (hAbs) appears ideal to solve the problem of HAMAs. Nowadays 9 fully human antibodies are available and others are evaluated in clinical trials or currently investigated in research labs. Three methods exist to produce fully human antibodies: the phage display, the transgenic mice and the use of human B lymphocytes. The majority of fully human antibodies resulted from the phage display and the transgenic mice methods. The use of human B lymphocytes is less investigated due to a poor yield and stability problems. These last years, the immortalization process, thanks to the involvement of the Epstein-Barr virus and human myeloma, induced a rise of interest for human B lymphocytes. In this context we decided to develop fully human monoclonal antibodies using human B lymphocytes through immortalization using the Epstein-Barr virus followed or not by an immortalization with a human/mouse heteromyeloma HM. The first approach is based on hAbs production from peripheral blood memory B lymphocytes isolated from infected or vaccinated donors. The Staphylococcus aureus enterotoxine B (SEB) was used as a model. Memory B lymphocytes were purified and cultured in the presence of Epstein-Barr virus (EBV). The transformation of memory B lymphocytes by EBV allowed the generation of immortalized B lymphocytes lines producing IgGs antibodies directed against SEB. We succeeded in isolating 6 EBV-immortalized memory B lymphocytes lines secreting anti-SEB IgGs antibodies. After many attempts to immortalize EBV immortalized memory B lymphocytes lines secreting anti-SEB antibodies with myeloma, the fusion of a EBV immortalized memory B lymphocytes with the human/mouse heteromyeloma HM led to an hybridoma. Unfortunately this hybridoma has rapidly lost its capacity to secrete d’IgGs anti-SEB. In the second approach the hAbs production implies the in vitro immunization of peripheral blood naïve lymphocytes. This strategy could allow the hAbs production against antigens for which no infected or vaccinated donors may be available. The Clostridium Botulinum neurotoxin A (BoNT/A), the most powerful toxin, and its N-terminal peptide (TBA-Nter) or the fusion protein ZZTat101 were used as models. ZZTat101 is a fusion between the ZZ domain of Staphylococcus aureus and the Tat protein of the human immunodeficiency virus HIV-1. Monocytes, B lymphocytes and T lymphocytes were isolated from human PBMC depleted of Natural killer. These cells were tools to develop efficient in vitro immunization protocols. IgMs directed against TBA-Nter and also IgMs (and possibly IgGs) directed against Tat were obtained. The use of the Epstein-Barr virus induced 7 EBV immortalized lines secreting anti-TBA-Nter IgMs antibodies. Unfortunately, after fusion with the heteromyeloma HM no hybridoma was isolated against TBA-Nter and Tat. The ZZTat101 mechanism involved on humoral response was studied, showing that the 7 cysteines, the region 22-57 and the ability of Tat to bind heparane sulfate are necessary to trigger the humoral response.