Introdução: Dermatite atópica (DA) é uma doença cutânea crônica, predominante na infância, cujo sintoma principal é o prurido de intensidade variável, e os sinais são classicamente as lesões de padrão eczematoso. Há anormalidades na formação e função da barreira cutânea, que estão presentes não somente nas lesões cutâneas como na pele clinicamente não afetada. Objetivo: Analisar a correlação entre as medidas biofísicas da função de barreira cutânea e os critérios clínicos e intensidade da dermatite, de acordo com os critérios de Rajka e Langeland. Métodos: 231 doentes do Departamento de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com diagnóstico clínico de dermatite atópica segundo os critérios diagnósticos de Rajka e Langeland foram avaliados por exame físico, anamese, medidas biofísicas de grau de hidratação de camada córnea pelo método de capacitância (corneometria) e pelo método de perda de água transepidérmica (TEWL); a medida sérica de IgE também foi solicitada no ato do exame. Resultados: Houve uma relação significativa entre as medidas de corneometria, TEWL e gravidade clínica da dermatite atópica. Os dados demonstraram uma correlação inversamente proporcional entre a corneometria e o TEWL, e houve uma diferença estatisticamente significativa (p<0,001) entre as médias de corneometria e TEWL e grau de DA (leve, moderada ou intensa). Com relação aos níveis séricos de IgE, as medidas de corneometria apresentaram uma correlação negativa significativa; para TEWL, a correlação positiva foi estatisticamente significativa (p<0,001). Conclusão: As medidas biofísicas de barreira cutânea na DA, mesmo em pele aparentemente não lesada, podem funcionar como fator de avaliação do grau clínico da DA e da intensidade do prurido. / Background: Atopic dermatitis (AD) is a chronic dermatosis, predominant in childhood, characterized by pruritus and eczematous type lesions with xerosis as the proeminent clinical sign. Objectives: To analyze the correlation between biophysical measurements of skin barrier function and other assessment criteria of clinical severity according to Rajka and Langelands criteria. Methods: Biophysical measurements (Transepidermal water loss and corneometry) were obtained from 231 patients from the department of dermatology, Hospital das Clinicas FMUSP with the diagnsosis of atopical dermatitis. Serum levels of IgE were also evaluated. Results: A significant correlation between corneometry, TEWL and clinical severity of atopic dermatitis were found. Data showed an inverse correlation between corneometry, TEWL, and AD severity, and a significant difference (p<0,001) between means of corneometry and TEWL and AD severity (mild, moderate and severe). As for IgE levels, corneometry had significant negative correlation, in contrast with TEWL, wich showed a significant positive correlation (p<0,001). Conclusion: Biophysical measurements of skin barrier in non lesional skin of atopic dermatitis may work as an evaluation factor for AD severity and pruritus.

Les troubles du comportement alimentaire (TCA) touchent une part importante de la population et constitue un réel problème de santé publique, il est indispensable d’approfondir nos connaissances sur la physiopathologie des TCA afin d’identifier des perspectives thérapeutiques. L’écriture d’une revue systématique a permis d’évaluer la prévalence des TCA selon le sexe, l’origine géographique ou l’âge de la population étudiée et confirme son augmentation au cours des 15 dernières années. L’analyse des données épidémiologiques des patients avec un TCA de la cohorte Eating Disorder and Longitudinal Survey (EDILS) a souligné le stress et le régime alimentaire comme facteurs de survenue et des similarités entre les comorbidités des 3 catégories larges de TCA (Restrictive, boulimique et compulsive). Ces comorbidités étaient fortement associées entre elles et, selon un cercle vicieux pourrait contribuer au maintien de la physiopathologie des TCA. La littérature suggère l’implication d’une dérégulation peptidergique de la prise alimentaire au cours des TCA qui pourrait inclure un mécanisme immunitaire. Les analyses des échantillons plasmatiques de la cohorte ont permis de mieux définir les profils biologiques de peptides et immunoglobulines associés aux 3 catégories larges de TCA et d’évaluer leur utilité pour le phénotypage des patients. La collecte de selles dans la cohorte offre également la possibilité de préciser les profils de microbiote au cours des différents types de TCA. Cette thèse a donc permis de mieux définir les caractéristiques cliniques des TCA et les perturbations de l’axe microbiote-intestin-cerveau associées, en particulier les dérèglements biologiques. / Eating disorders (ED) affect a large population and are a serious public health issue. It is thus essential to deepen our knowledge of ED pathophysiology in order to open new therapeutic perspectives. The prevalence of ED according to sex, geographical origin or age of the study population and its increase over the last 15 years has been highlighted in a systematic review. The analysis of patients with ED from the Eating Disorder and Longitudinal Survey (EDILS) cohort underlined stress and / or diet as triggering factors and noted similarities between the comorbidities of the 3 broad categories of ED (Restrictive, bulimic and compulsive). These comorbidities were strongly associated with each other, and contributed in a vicious circle to the perpetuation of ED. The literature suggests during ED a dysregulation of neuropeptide signaling of food intake that may include some immunological mechanisms. Analyzes of plasma samples from the EDILS cohort allowed a better definition of the peptides and immunoglobulins profiles associated with the 3 broad categories of ED and to evaluate their utility for phenotyping patients. The collection of feces in the cohort offers the possibility of refining the specificity of the microbiota according to different type of ED. This thesis allows to better define the clinical characteristics of 3 broad categories of ED and disturbances of the microbiota-intestine-brain axis, particularly the associated biological dysregulations of neuropeptide signaling.

Le processus de la commutation de classe ou commutation isotypique (CSR) des gènes d’immunoglobulines caractérise les cellules de la lignée B et implique principalement les régions switch précédant les gènes constants au sein du locus IgH. Des jonctions entre la région switch donneuse Sμ et celle acceptrice Sx sont crées pendant ce processus. Plusieurs études ont démontré que le destin des cellules de la lignée B était largement modulé en fonction de la classe de l’immunoglobuline qu’elles produisent et en particulier selon les signaux transmis par leur BCR (qui peuvent par exemple pour la classe IgE, comporter des signaux pro-apoptotiques). Nous avons utilisé plusieurs modèles visant à l’étude de la physiologie et de la mécanistique du switch vers différentes classes de BCR et d’immunoglobulines peu exprimées. Nous avons cherché à forcer l’expression de l’isotype IgA2 grâce à un modèle transgénique dédié, dans le but d’approfondir les spécificités du signal BCR transduit par cet isotype en comparaison avec le BCR IgA1. En outre, et d’une façon très intéressante, nous avons découvert l’existence (jusqu’ici ignorée et masquée par les 4 autres sous-classes plus abondantes) d’une cinquième sous-classe d’IgG humaine, l’IgG5 qui est codé par un gène jusqu’ici faussement classifié pseudo-gène. Ainsi nous avons étudié les modalités d’expression du gène correspondant après un switch non-canonique,le répertoire normal des IgG5, leur représentation parmi les IgG humaines monoclonales ainsi que leurs fonctions immunitaires grâce à un IgG5 fabriquée artificiellement portant une activité anti-CD20 humaine. Enfin, nous avons testé des produits pharmaceutiques (RHPS4 : stabilisant des structures G-quadruplex au niveau d’ADN et JQ1 : inhibiteur des facteurs de transcription à bromodomaines), montrant leur capacité à retarder ou inhiber la commutation de classe in vitro mais aussi in vivo dans des souris allergiques. / The process of class switch recombination (CSR) or isotypic switching of immunoglobulin genes characterizes the B cell lineage and primarily involves switch regions preceding the constant genes within the IgH locus. Junctions between donor switch region Sμ and acceptor Sx are generated during this process. Several studies have shown that the fate of B cells is largely modulated according to the class of immunoglobulin they produce and in particular the signals transmitted by their BCR « for example for IgE, BCRs can combine proapoptotic signals. We used several relevant mouse models to study the physiological aspect and the B cell compartment after switching to IgA2 (a dedicated transgenic model expressing IgA2) since IgA2 conveys a membrane signal different from tht of IgA1. In addition, we tested two pharmaceuticals drugs(RHPS4: stabilizer of G-quadruplex structures at the DNA level and JQ1: inhibitor of bromodomain proteins) showed their ability to delay or inhibit class switching towards IgE in vitro but also in vivo in allergic mice. Interestingly, we also demonstrated the existence (till now ignored and maybe masked by the other 4 more abundant IgG subclasses) of a fifth subclass of human IgG, IgG5 which is encoded by a gene classified as a pseudo-gene. We studied the expression modalities of the corresponding gene after a non-canonical switch, the normal IgG5 repertoire, their representation among the monoclonal human IgGs as well as their immune functions through an artificially synthesited IgG5 with human anti-CD20 activity.

Indiana University-Purdue University Indianapolis (IUPUI) / Germinal Centers (GCs) are transient lymphoid structures that arise in lymphoid organs in response to T cell-dependent antigen. Within the GC, follicular T helper (TFH) cells promote GC B cell differentiation and in turn the proper antibody production to protect us from invading pathogens. We wished to study the regulation of this process by transcription factors STAT3 and Bcl6. STAT3 is important for both TFH cell differentiation and IL-4 production by Th2 cells. IL-4 is a major functional cytokine produced by TFH cells. To dissect the role of STAT3 in IL-4 production by TFH cells, we generated T cell-specific conditional STAT3 knockout mice (STAT3KO). Compared to WT mice, TFH cell differentiation in STAT3KO mice was partially impaired, both in spleen following sheep red blood cells (SRBC) immunization and in Peyer's patches (PPs). In STAT3KO mice, the numbers of splenic GC B cells were markedly decreased, whereas PP GC B cells developed at normal numbers and IgG1 class switching was greatly increased. Unexpectedly, we found that STAT3 intrinsically suppressed the expression of IL-4 and Bcl6 in TFH cells. Mechanistically, in vitro repression of IL-4 expression in CD4 T cells by Bcl6 required STAT3 function. Apart from TFH cells, the GC reaction is also controlled by regulatory follicular T helper (TFR) cells, a subset of Treg cells. To study the mechanism of how TFR cells regulate the GC reaction, we generated mice specifically lacking TFR cells by specifically deleting Bcl6 in Treg cells. Following immunization, these "Bcl6FC" mice developed normal TFH and GC B cell populations. However, Bcl6FC mice produced altered antigen-specific antibody responses, with reduced titers of IgG and increased IgA. Bcl6FC mice also developed IgG antibodies with significantly decreased avidity to antigen in an HIV-1 gp120 "prime-boost" vaccine model. Additionally, TFH cells from Bcl6FC mice produced higher levels of Interferon-γ, IL-10 and IL-21. Loss of TFR cells therefore leads to highly abnormal TFH and GC B cell responses. Overall, our studies have uncovered unexpected regulatory roles of STAT3 in TFH cell function as well as the novel regulatory roles of TFR cells on cytokine production by TFH cells and on antibody production.

A Imunodeficiência Comum Variável (ICV) e a Deficiência Seletiva de Imunoglobulina A (DIgA) são as imunodeficiências primárias humorais de maior freqüência na população mundial. Ambas as doenças são caracterizadas pela ausência ou redução significativa de imunoglobulinas no soro. Embora diversas anormalidades imunológicas tenham sido associadas a estas doenças, nenhuma hipótese unificadora a respeito das bases moleculares das mesmas foi proposta até o presente momento, sendo que o único defeito comum a todos os pacientes é a falha na diferenciação de células B em plasmócitos e conseqüente secreção de anticorpos. Devido à alta incidência de auto-imunidade e alergia em pacientes com ICV e DIgA, no presente trabalho, visamos analisar por citometria de fluxo a população de linfócitos CD4+ com potencial regulador nesses pacientes, para avaliar se possíveis defeitos quantitativos ou funcionais nesta população reguladora poderiam explicar a alta incidência de doenças auto-imunes ou alérgicas associadas a estas imunodeficiências. / Common Variable Immunodeficiency (CVID) and Selective Immunoglobulin A deficiency (IgAD) are the humoral primary immunodeficiencies with the highest incidence in the population. Both diseases are characterized by the absence or significant reduction of serum immunoglobulins. Although several immunological abnormalities have been associated with these diseases, no unifying hypothesis regarding the molecular basis of CVID and IgAD have been proposed to date, and the only defect common to all patients is the failure in differentiation of B cells into plasma cells and consequent secretion of antibodies. Due to the high incidence of autoimmunity and allergy in patients with CVID and IgAD, in the present work we analyzed by flow cytometry the population of CD4+ lymphocytes with regulatory potential in these patients to assess whether possible quantitative or functional defects in this regulatory population could explain the high incidence of autoimmune diseases or allergic reactions associated with these immunodeficiencies.

A Imunodeficiência Comum Variável (ICV) e a Deficiência Seletiva de Imunoglobulina A (DIgA) são as imunodeficiências primárias humorais de maior freqüência na população mundial. Ambas as doenças são caracterizadas pela ausência ou redução significativa de imunoglobulinas no soro. Embora diversas anormalidades imunológicas tenham sido associadas a estas doenças, nenhuma hipótese unificadora a respeito das bases moleculares das mesmas foi proposta até o presente momento, sendo que o único defeito comum a todos os pacientes é a falha na diferenciação de células B em plasmócitos e conseqüente secreção de anticorpos. Devido à alta incidência de auto-imunidade e alergia em pacientes com ICV e DIgA, no presente trabalho, visamos analisar por citometria de fluxo a população de linfócitos CD4+ com potencial regulador nesses pacientes, para avaliar se possíveis defeitos quantitativos ou funcionais nesta população reguladora poderiam explicar a alta incidência de doenças auto-imunes ou alérgicas associadas a estas imunodeficiências. / Common Variable Immunodeficiency (CVID) and Selective Immunoglobulin A deficiency (IgAD) are the humoral primary immunodeficiencies with the highest incidence in the population. Both diseases are characterized by the absence or significant reduction of serum immunoglobulins. Although several immunological abnormalities have been associated with these diseases, no unifying hypothesis regarding the molecular basis of CVID and IgAD have been proposed to date, and the only defect common to all patients is the failure in differentiation of B cells into plasma cells and consequent secretion of antibodies. Due to the high incidence of autoimmunity and allergy in patients with CVID and IgAD, in the present work we analyzed by flow cytometry the population of CD4+ lymphocytes with regulatory potential in these patients to assess whether possible quantitative or functional defects in this regulatory population could explain the high incidence of autoimmune diseases or allergic reactions associated with these immunodeficiencies.

Le processus de recombinaison V(D)J des gènes d’immunoglobulines (Ig) est caractérisé par une grande imprécision des jonctions entre les segments variables (V), de diversité (D) et de jonction (J). Deux fois sur trois, un décalage du cadre de lecture apparaît, aboutissant à une jonction non productive dite « hors phase ». Plusieurs études ont démontré que les deux allèles productifs et non-productifs sont activement transcrits. Les transcrits matures issus des allèles non-productifs sont pris en charge par un mécanisme de surveillance des ARNm appelé NMD « Nonsense-Mediated mRNA Decay ». En dégradant efficacement les ARNm d’Ig contenant des codons non-sens, ce mécanisme prévient l’apparition des Ig tronquées au cours de l’ontogénie B. Néanmoins, aucune étude n’a jusqu’ici analysé l’impact de l’épissage alternatif des transcrits d’Ig non-productifs. Ce phénomène appelé NAS « Nonsense-associated Altered Splicing » peut conduire à une production d’Ig tronquées présentant des délétions internes du domaine variable (V).Les projets développés lors de cette thèse ont montré que la présence d’un codon non-sens, au niveau de l’exon variable (VJ) des transcrits Igκ, favorise le saut d’exon et la production de chaînes légères dépourvues de domaine variable (ΔV-κLCs). De façon intéressante, ces Ig tronquées provoquent un stress cellulaire et conduisent à l’apoptose des plasmocytes (Article 1). Ces observations ont permis d’identifier un nouveau point de contrôle agissant tardivement lors de la différenciation plasmocytaire : le TIE « Truncated-Ig Exclusion » checkpoint. Ce processus de contrôle provoque l’élimination des plasmocytes qui produisent des chaînes d’Ig tronquées. Nous avons également étudié l’épissage alternatif des transcrits d’Ig non-productifs en l’absence de TIE-checkpoint (Article 2). Cette étude a révélé que l’hypertranscription des gènes d’Ig dans les plasmocytes favorise l’épissage alternatif des transcrits d’Ig non-productifs. En utilisant un modèle d’expression forcée d’Ig tronquées, nous avons mis en évidence une coopération entre les mécanismes assurant la surveillance des ARNm (NMD) et la surveillance au niveau protéique (UPR : « Unfolded Protein Response », autophagie) (Article 3). Sur la base de ces résultats, nous avons mis au point une nouvelle approche thérapeutique qui consiste à forcer la production d’Ig tronquées en utilisant des oligonucléotides anti-sens (AON) capables de provoquer l’élimination de l’exon variable lors de l’épissage. Cette invention pourrait ouvrir des perspectives thérapeutiques pertinentes dans le traitement du Myélome Multiple et d’autres pathologies touchant les plasmocytes. / The recombination process V(D)J of immunoglobulin (Ig) genes is characterized by random junctions between the variable (V), diversity (D) and joining (J) segments. A frameshift mutation appears in two-third of cases, generating a non-productive or « out of frame » junction. Several studies have shown that both productive and non-productive alleles are actively transcribed. The mature transcripts from nonproductive alleles are usually considered sterile and innocuous as a result of an mRNA surveillance mechanism called NMD « Nonsense-Mediated mRNA Decay ». By degrading aberrant mRNA, this mechanism prevents the appearance of truncated Ig during B cell ontogeny. However, less is known about the impact of alternative splicing on non-productive Ig transcripts. This mechanism, called NAS « Nonsense-associated Altered Splicing » can lead to the production of truncated Ig with internal deletions of variable domain (V). During my thesis, we have shown that the presence of a stop codon, within the variable exon (VJ) of Igκ transcripts, promotes exon skipping and synthesis of V domain-less κ light chains (ΔV-κLCs). Interestingly, such truncated Ig causes cellular stress and leads to plasma cells apoptosis (Article 1). These findings have identified a new checkpoint acting late during plasma cell differentiation: TIE « Truncated-Ig Exclusion » checkpoint. This process ensures counter-selection of plasma cells producing truncated-Ig. We also studied the alternative splicing of non-productive Ig transcripts in the absence of TIE-checkpoint (Article 2). We found that hypertranscription of Ig genes in plasma cells promote alternative splicing of non-productive Ig transcripts. Using a model forcing the expression of truncated Ig, we identified a cooperative action between mRNA surveillance mechanisms (NMD) and those of protein surveillance (UPR « Unfolded Protein Response », autophagy) (Article 3). Based on these results, we have developed a new therapeutic approach by increasing the production of truncated Ig using antisense oligonucleotides (AON) that leads to the elimination of the variable exon during splicing. This invention could open new avenues for the treatment of Multiple Myeloma patients and other pathologies affecting plasma cells.

Indiana University-Purdue University Indianapolis (IUPUI) / CD4 T helper cells control immunity to pathogens and the development of inflammatory disease by acquiring the ability to secrete effector cytokines. Cytokine responsiveness is a critical component of the ability of cells to respond to the extracellular milieu by activating Signal Transducer and Activator of Transcription factors that induce the expression of other transcription factors important for cytokine production. STAT4 is a critical regulator of Th1 differentiation and inflammatory disease that attenuates the gene-repressing activity of Dnmt3a. In the absence of STAT4, genetic loss of Dnmt3a results in de-repression of a subset of Th1 genes, and a partial increase in expression that is sufficient to observe a modest recovery of STAT4-dependent inflammatory disease. STAT4 also induces expression of the transcription factors Twist1 and Etv5. We demonstrate that Twist1 negatively regulates Th1 cell differentiation through several mechanisms including physical interaction with Runx3 and impairing STAT4 activation. Following induction by STAT3-activating cytokines including IL-6, Twist1 represses Th17 and Tfh differentiation by directly binding to, and suppressing expression of, the Il6ra locus, subsequently reducing STAT3 activation. In contrast, Etv5 contributes only modestly to Th1 development but promotes Th differentiation by directly activating cytokine production in Th9 and Th17 cells, and Bcl6 expression in Tfh cells. Thus, the transcription factors Twist1 and Etv5 provide unique regulation of T helper cell identity, ultimately impacting the development of cell-mediated and humoral immunity.