No description available.

Measles virus (MV) causes an acute childhood disease, associated in certain cases with the infection of the central nervous system (CNS). MV induces a profound immunosuppression, resulting in high infant mortality. The major cellular receptor for MV is CD150, which binds MV hemagglutinin (MV-H). As dendritic cell (DC) dysfunction is considered to be essential for the MV immunopathogenesis, we analyzed consequences of MV-H interaction with DCs. We developed an experimental model allowing us to analyze the direct CD150-MV-H interaction in the absence of infectious context. This interaction caused the downregulation of surface expression of CD80, CD83, CD86 and HLA-DR molecules and inhibition of IL-12 production in DCs. DCs also failed to activate T cell proliferation. The CD150-MV-H interaction in DCs and B cells decreased the phosphorylation of JNK1/2, but not ERK1/2 kinases, after subsequent CD150 ligation with anti-CD150 antibodies. Moreover, MV-H by itself induced Akt phosphorylation via CD150 in DCs and B cells. Engagement of CD150 by MV-H in mice transgenic for human CD150 decreased the inflammatory reaction, contact hypersensitivity response, confirming the immunosuppressive effect of CD150-MV-H interaction in vivo. Furthermore, our studies revealed the CD150 expression in CNS tumors and identified the novel CD150 isoform, containing an additional 83bp exon expressed in lymphoid cells, DCs and CNS tumors. Although its isoforms remain intracellular in tumor cells, CD150 may represent a new marker for human brain tumors. Novel mechanism of CD150-induced immunosuppression and new CD150 isoform identified in these studies shed new light on its immunoregulatory role and CD150 isoform diversity and open perspectives for their clinical applications.

L’immunosuppression optimale après greffe d’organe solide est une balance délicate et propre à chaque individu entre le risque de rejet et les risques liés à une surexposition au traitement immunosuppresseur. L’évaluation de la fonction résiduelle des lymphocytes T après stimulation par un mitogène (pharmacodynamie effective) devrait permettre de mesurer l’effet direct des médicaments immunosuppresseurs sur leur cible. Nous avons étudié différents paramètres de pharmacodynamie effective chez 34 receveurs pédiatriques de greffe d’organes solides traités par tacrolimus et mycophénolate. Les tests proposés dans ce travail sont adaptés au milieu pédiatrique et à une réalisation en temps réel. La quantification du CD25 parmi les CD4 activés par l’OKT3 permet de distinguer deux groupes de patients selon leur degré d’immunosuppression. L’âge médian est plus bas et la concentration plasmatique médiane en MPA plus élevée dans le groupe de patients plus fortement immunosupprimés. L’étude des paramètres immunologiques pouvant influencer la réponse (sécrétion des interleukines, proportion des sous-populations lymphocytaires CD4, CD8, T naïfs et Trég) ainsi que l’étude du pouvoir de restauration de la fonction lymphocytaire par l’Il-2, la guanosine ou la xanthosine, ne permettent pas de mieux comprendre les variabilités interindividuelles observées. Ces résultats devront être confirmés sur une cohorte plus grande de patients afin de juger de leur intérêt en pratique clinique. / Optimal immunosuppression following solid organ transplantation is unique to each individual and requires a balance between risks of rejection and overexposure to immunosuppressive therapy. The evaluation of residual function of T lymphocytes after mitogen stimulation (effective pharmacodynamic monitoring) should allow measurement of the direct effect of immunosuppressive drugs on their target. We studied various parameters of effective pharmacodynamic monitoring in 34 paediatric patients receiving solid organ transplants and treated with tacrolimus and mycophenolate (MPA). The tests proposed in this work are adapted to the paediatric setting in real time. Quantification of CD25 among CD4 cells activated by OKT3 can differentiate two groups of patients according to their degree of immunosuppression. Median values for age and MPA plasma concentration are lower and higher, respectively, in the patient group most heavily immunosuppressed. Neither study of the parameters that may influence the response (secretion of interleukins, proportion of lymphocyte subpopulations CD4, CD8, naive and regulatory T cells) nor study of the restoration of basal cell function brought about by Il2, guanosine or xanthosine, helped to explain the observed inter-individual variability. These results should be confirmed in a larger cohort of patients in order to test their relevance in clinical practice.

Introdução: A doença vascular do coração transplantado, consiste em um processo inflamatório proliferativo que compromete o sucesso a longo prazo do transplante cardíaco e não há prevenção ou tratamentos efetivos. Uma nanoemulsão lipídica (LDE) pode carregar agentes quimioterápicos na circulação e concentrá-los nos enxertos cardíacos dos coelhos. O objetivo deste estudo foi investigar os efeitos do paclitaxel combinado a LDE;do metotrexate combinado ao LDE e a associação de ambos quimioterápicos ao LDE nos corações transplantados. Método: 28 coelhos alimentados com dieta com teor de 0,5% de colesterol e submetidos a transplante cardíaco herotópico foram tratados com ciclosporina (dose 10 mg/kg/ dia por via oral) e alocados em 4 grupos de 7 animais.Um grupo recebeu a associação de Metotrexate e LDE endovenosa (4 mg/kg/semana); segundo grupo recebeu por via endovenosa a combinação de Paclitaxel e LDE; o terceiro grupo recebeu a associação de LDE com metotrexate e paclitaxel; grupo controle que recebeu somente solução salina intravenosa. Os animais foram sacrificados 6 semanas após o procedimento. Foram realizadas análises da morfologia,histologia,imunohistoquímica e análise da expressão gênica do enxerto e dos corações nativos. Resultado: Em comparação com o grupo controle,coelhos transplantados e tratados com paclitaxel associado ao LDE apresentaram redução em 50% de estenose em artérias coronárias. Já nos grupos que usaram metotrexate associado a LDE ou paclitaxel combinado com metotrexate e associado a LDE, houve redução em 18% da estenose coronariana em relação ao grupo controle,mas a diferença não apresentou significância estatística.Nos três grupos tratados, houve redução do infiltrado macrofágico. No grupo que recebeu metotrexate associado a LDE,a expressão gênica de fatores pró-inflamatórios( TNF-alfa; MCP1; IL 18; VCAM-1 e MMP-12) foi reduzida drasticamente; enquanto a expressão de agentes anti-inflamatórios(IL 10 por exemplo) aumentou. Nos outros dois grupos (LDE+paclitaxel e LDE+paclitaxel e metotrexate) não houve influência consistente na expressão de genes pró e anti-inflamatórios. Conclusão: A associação paclitaxel e LDE promoveu melhora importante na vasculopatia dos enxertos.A associação metotrexate e LDE e a metotrexate mais palcitaxel e LDE reduziram a estenose de coronárias porém sem significância estatística. O infiltrado macrofagocítico foi reduzido nos três grupos tratados. Tais resultados podem servir de ponte para novos ensaios clínicos / Background: Coronary allograft vasculopathy is an inflammatory-proliferative process that compromises the long-term success of heart transplantation and currently has no effective prevention and treatment. A lipid nanoemulsion (LDE) can carry chemotherapeutic agentsin the circulation and concentrates them in the heart graft in rabbits. The aim of this study was to investigate the effects of paclitaxel (PACLI) binded tire parentesis to LDE, methotrexate (MTX) binded to LDE and the association of both particles in transplanted heart. Methods: Twenty eight rabbits fed 0,5% cholesterol diet and submitted to heterotopic heart transplantation were treated with cyclosporine A (10mg/kg/daily orally) and allocated to four groups of 7 animals. One group was treated with intravenous LDE-MTX (4mg/kg B.W., weekly); a second with LDE-paclitaxel, the third one with association of LDE-PACLI with LDE-MTX and the control group received only weekly intravenous saline solution. Animals were sacrificed 6 weeks later for morphometric, histological, immunohistochemical and gene expression analysis of the graft and native hearts. Results: Compared to controls, grafts of LDE-PACLI treated rabbits showed 50%reduction of coronary stenosis and in the LDE-MTX and LDE-MTX/PACLIstenosiswas around 18% less than control but this difference was not statistically significant. In the 3 treatment groups macrophage infiltration was decreased. In LDE-MTX group, gene expression of pro-inflammatory factors TNF-?, MCP-1, IL-18 and VCAM-1, and MMP-12 was strongly diminished whereas expression of anti-inflammatory IL-10 increased. In the other two treatment, groups (LDE-PACLI and LDE-PACLI/MTX) there was not a consistent influence in pro and anti-inflammatory gene expression. Conclusions: LDE-PACLI promoted strong improvement of the cardiac allograft vasculopathy. LDE- MTX and LDE -MTX/PACLI decreased coronary stenosis but without statistic significance. Macrophage infiltration was decrease in the three treatment groups. This new preparation maybe candidate for future clinical trials

A pandemia de AIDS é um dos principais problemas de saúde pública no mundo e demanda o desenvolvimento de uma vacina eficaz. Uma abordagem vacinal ideal, baseada em resposta celular contra o HIV-1, deveria induzir uma resposta imune mediada tanto por células T CD4+ quanto CD8+. A diversidade genética do HIV-1 é uma grande preocupação para o desenvolvimento de uma vacina e sequências consenso têm sido utilizadas a fim de contornar a barreira imposta por essa diversidade. A escolha apropriada dos antígenos a comporem as construções vacinas também é relevante, visto que proteínas como Gag e Vif têm se mostrado bastante imunogênicas, enquanto alguns trabalhos têm demonstrado que Env possui características imunossupressoras e que respostas celulares contra esse antígeno podem ser danosas aos indivíduos vacinados. Nosso grupo demonstrou que uma vacina de DNA (HIVBr18) codificando 18 peptídeos para linfócitos T CD4+, promíscuos (capazes de se ligarem a múltiplas moléculas HLA-DR) e conservados na sequência consenso do subtipo B do HIV-1 foi capaz de induzir uma resposta celular ampla, polifuncional e de longa duração em camundongos BALB/c e transgênicos para moléculas HLA. Neste trabalho identificamos 34 peptídeos potencialmente reconhecidos por linfócitos T CD4+, promíscuos e conservados na sequência consenso dos consensos do grupo M do HIV-1. Uma vacina de DNA (HIVBr27) codificando 27 dos 34 peptídeos (exceto os 7 peptídeos de Env identificados) induziu uma resposta mais ampla e de maior magnitude que a vacina HIVBr18 em camundongos BALB/c. Além disso, a vacina HIVBr27 induziu maior frequência de linfócitos T CD4+ e CD8+ polifuncionais, capazes de proliferar e produzir as citocinas IFN-gama e TNF-alfa. Desenvolvemos também uma vacina de DNA (HIVenv7) codificando os 7 peptídeos de Env do HIV-1 identificados. A co-imunização de HIVenv7+HIVBr27 reduziu a amplitude da resposta celular contra peptídeos codificados pela vacina HIVBr27. Além disso, a co-imunização reduziu a magnitude da resposta e a frequência de linfócitos T CD4+ e CD8+ polifuncionais contra o pool de 27 peptídeos codificados por essa vacina. A vacina HIVBr27, desenhada para induzir uma resposta de linfócitos T CD4+ ampla e intensa contra peptídeos promíscuos e conservados da sequência consenso dos consensos do grupo M do HIV-1, é mais imunogênica e mais completa que a vacina HIVBr18, tendo potencial de conferir, em grande cobertura populacional, imunidade contra os diversos subtipos circulantes do vírus. O fenômeno observado na co-imunização com HIVenv7 sugere que a inclusão do envelope em imunógenos contra o HIV-1 possa ser prejudicial. Por outro lado, isto faz desse plasmídeo um alvo promissor para terapias imunológicas que visem indução de imunossupressão / The AIDS pandemic is a worldwide major public health problem and requires the development of an effective vaccine. An ideal vaccine approach based on cellular immune responses against HIV-1 should induce an immune response mediated by both CD4+ and CD8+ T cells. HIV-1 genetic diversity is a major concern for developing a vaccine and consensus sequences have been used to circumvent the barrier posed by this diversity. The appropriate choice of antigens to compose the vaccines is also relevant, since proteins such as Gag and Vif have been shown to be immunogenic, while some studies have shown that Env has immunosuppressive characteristics and cellular responses against this antigen can be harmful to vaccinated individuals. Our group has demonstrated that a DNA vaccine (HIVBr18) encoding promiscuous multiple HLA-DR binding, conserved B-subtype HIV-1 CD4+ T cell epitopes was able to induce a broad, polyfunctional and long lasting T cell response in BALB/c and HLA transgenic mice. In this work we identified 34 promiscuous and conserved sequences within the group M HIV-1 consensus of the consensus sequence, potentially recognized by CD4+ T cells. A DNA vaccine (HIVBr27) encoding 27 of the 34 peptides (except the 7 Env identified peptides) induced a broader and higher magnitude T cell response than HIVBr18 vaccine in BALB/c mice. Moreover, the vaccine HIVBr27 induced a higher frequency of polyfunctional CD4+ and CD8+ T cells, able to proliferate and produce the cytokines IFN-gama and TNF-alfa. We also developed a DNA vaccine (HIVenv7) encoding the 7 HIV-1 Env identified peptides. Co-immunization with HIVenv7+HIVBr27 reduced the breadth of the cellular immune response against the HIVBr27 encoded peptides. Besides, co-imunization reduced the magnitude of the response and the frequency of polyfunctional CD4+ and CD8+ T cells against the pool of 27 peptides encoded by this vaccine. The HIVBr27 vaccine, designed to induce a broad and intense CD4+ T cell response against promiscuous and conserved peptides within the group M HIV-1 consensus of the consensus sequence, is more immunogenic and more complete than the vaccine HIVBr18, having the potential to provide, with wide population coverage, immunity against various circulating subtypes of the virus. The phenomenon observed in the co-immunization with HIVenv7 suggests that the inclusion of the envelope in immunogens against HIV-1 may be harmful. On the other hand, these results suggest that HIVenv7 is a promising target for immune therapies aimed at inducing immunosuppression

Einleitung: CTLA-4Ig blockiert CD28-vermittelte co-stimulatorische Signale und inhibiert kompetitiv in vitro und in vivo immunologische Reaktionen. Der signifikante immunsuppressive Effekt von CTLA4-IG konnte in verschiedenen tierexperimentellen Untersuchungen zur Entwicklung von Toleranz nach Organtransplantation aufgezeigt werden. Allerdings waren die Ergebnisse nach CTLA-4Ig Therapie in den nachfolgenden Untersuchungen variable und ein Großteil der transplantierten Organe wurde letztendlich abgestoßen. Neuere Studien zeigen das die Effizienz der CTLA-4Ig Therapie von dem Zeitpunkt der Gabe abhängen. Weiterhin gibt es Anhalte dafür, daß dieser Effekt durch spenderabgeleitete Transfusionen noch verstärkt werden kann. Für uns stellte sich daher die Frage ob durch die Kombination von CTLA-4IG und Applikation spenderabgeleiteter Splenozyten ein additiver immunsuppressiver Effekt zu erreichen ist und untersuchten dies im Modell der Rattenlebertransplantation (ORLT). Methodik: Wir führten Rattenlebertransplantationen (ORLT) im arterialisierten, voll allogenen Modell Da (RT1a) auf Lew (RT1l) in Standardtechnik durch. Die Ratten erhielten in verschiedenen Gruppen vor/nach der Transplantation CTLA-4Ig oder die Kombination von CTLA-4Ig mit spenderabgeleiteten oder unspezifischen Milzzellen. Ergebnisse: Bei der Vorbehandlung der Empfänger, entweder mit spenderabgeleiteten Zellen oder CTLA-4Ig, ließ sich eine Verbesserung des Transplantatüberlebens, aber keine Langzeitakzeptanz des Transplantates erreichen. Erst die Kombinationstherapie vor der Transplantation gewährleistete ein langfristiges Organüberleben ohne Zeichen für chronische Rejektionen nach mehr als 150 Tagen. Die Therapie mit spenderabgeleiteten Zellen am Tag der Transplantation oder verzögert nach 4 Tagen nach Transplantation veränderte die Überlebenszahlen nicht. Die verzögerte postoperative Therapie mit CTLA-4Ig, wie sie auch von anderen Gruppen durchgeführt wurde, resultierte in unseren Versuchen in einem verlängertem Überleben, führte aber nur bei 2/7 Tieren zur langfristigen Transplantatakzeptanz. Die zusätzliche Applikation nicht abgeleiteter Milzzellen verbesserte die Ergebnisse nicht signifikant. Transplantatakzeptanz bei allen Tieren ließ sich wiederum nur durch die Kombination spenderabgeleiteter Zellen und CTLA-4Ig erreichen. Spenderabgeleiteter Mikrochimärismus trat bei allen Tieren, also auch bei Kontrolltieren trotz ablaufender Abstoßung am 6. POD nach ORLT auf. Am 12. POD zeigten tolerante Gruppen noch spenderabgeleitete Zellen, wohingegen diese bei abstoßenden Gruppen nicht mehr nachweisbar waren. Im Langzeitverlauf waren diese spenderabgeleiteten Zellen auch in toleranten Tieren nur noch vereinzelt nachzuweisen. Eine Verschiebung der Zytokinantwort von TH1- Richtung TH2-Zytokinen konnte bei langfristig überlebenden Tieren nicht aufgezeigt werden. Im Gegenteil, die TH1-Antwort mit INF-g und IL-12b war bei toleranten, kombiniert mit CTLA-4Ig und adoptivem Zelltransfer behandelten Ratten früher und stärker ausgeprägt, aber schneller wieder rückläufig als bei unbehandelten Kontrollen. Dies galt nicht für IL-2, das in allen Gruppen, die mit CTLA-4Ig behandelt wurden, stark unterdrückt war. Langfristig überlebende Tiere zeigten mehr als 150 Tage nach ORLT nahezu keine Expression dieser TH1-Zytokine mehr, wohingegen IL-4 deutlich exprimiert wurde. Dies spricht gegen eine ausschließliche Verschiebung der Zytokinantwort nach TH2 und betont die Bedeutung von TH1-Zytokinen in der initialen Phase der Toleranzentwicklung. In toleranten Tieren mit adoptivem Zelltransfer zeigte sich im Vergleich zu abstoßenden Tieren eine stärkere Ausprägung von Apoptose in den Transplantaten, die zeitlich parallel zu der mRNA-Expression der TH1-Zytokine verlief. Dies läßt darauf schließen, daß Apoptose aktivierter T-Zellen der Mechanismus ist, der die additiven Effekte der CTLA-4Ig-Behandlung und des adoptiven Zelltransfers vermittelt. Die CTLA4-Ig Behandlung verhindert effektiv Abstoßungsepisoden nach ORLT. Die Effizienz der Behandlung kann durch die Applikation von spenderabgeleiteten Zellen noch signifikant verbessert werden. Hierbei spielt die Herunterregulation von IL-2 und Hochregulierung von INF-g eine maßgebliche Rolle, wohingegen der spenderabgeleitete Chimärismus von nachgeordneter Rolle zu sein scheint. Parallel zu dem Nachweis von IFN-g finden sich mehr apoptotische Zellen am Tag 6 in den Transplantaten der später toleranten Ratten, verglichen mit den abstoßenden Kontrolltieren. Dies weist in diesem Modell, im Gegensatz zu anderen Theorien, auf einen immunaktivierten Mechanismus mit nachfolgender Apoptose aktivierter Lymphozyten hin / Blockage of co-stimulatory CD28-mediated signals by CTLA4-Ig inhibits in vitro and in vivo immune responses. However, in recent trials monotherapy with CTLA4-Ig failed to introduce long-term survival in several animal transplant models. The study was conducted to investigate the effectiveness of CTLA-4Ig treatment with additional application of donor splenocytes in preventing rejection and improving graft function in rat liver allografts. DA rats (RT1a) were used as donors and Lew (RT1l) rats as recipients in an orthotopic liver transplantation model (ORLT). Recipients were divided in 3 groups depending on the start of treatment: The first group was treated prior to transplantation with CTLA-4Ig (0.5 mg i.p.) alone or in combination with donor derived or donor unspecific 2.5 x 108 splenocytes. The second group was treated simultaneously at transplantation with CTLA-4Ig or received no further treatment and served as controls. The third group received an ORLT and was treated postoperatively on day 3 and 4 with CTLA4-Ig alone or in combination with donor derived or unspecific spleen cells. Only the combination of CTLA-4Ig and donor derived cells pre- or postoperatively led to a 100% graft survival in the long-term. The treatment with CTLA-4Ig alone at each time point led to prolonged graft survival but not to a long-term graft survival. The additional administration of donor unspecific cells could improve these results, however, the differences were not significantly different between these groups. All rats without any treatment died within 12 days after ORLT. When treating the rats with donor derived spleen cells prior to transplantation the survival was significantly prolonged. The application of donor unspecific cells alone pre- and postoperatively had no effect on the survival rates. Microscopic and macroscopic studies of the liver demonstrated no signs of ongoing rejection after 150 days in rats treated with the combination of CTLA4-Ig and donor derived cells. All other long term survivors demonstrated signs of chronic rejection with bile duct loss. Immunohistological staining for DA specific surface antigen demonstrated donor specific chimerism with no predominance in any group. In the early postoperative course, the expression of IL-2 in liver specimen was significantly reduced in all groups receiving CTLA-4Ig. In contrast to this the tolerant rats surviving long-term showed a marked expression of IFN-g in the early course after ORLT. Additionally, these rats showed on day 6 after ORLT more apoptosis in the liver graft specimens compared to rejecting controls. CTLA4-Ig treatment is highly effective in rat liver transplantation and ensure long term survival. Pretransplant or delayed treatment with CTLA4-Ig alone prolongs survival but does not introduce long term tolerance. The effectiveness of the treatment can be markedly improved by the additional application of donor derived cells. The downregulation of IL-2 is mainly involved in the development of tolerance whereas detection of donor specific chimerism is not correlated to the development of tolerance in our study. Additionally an activation induced cell death via IFN-g may be involved in the tolerance induction. Although the mechanisms are still not completely understood immunomodulation by adaptive cell transfer and costimulatory blockage is an interesting and promising option for the future of clinical liver transplantation.

Bactérias probióticas, como Lactobacillus sp, são conhecidas como inibidoras do crescimento de microrganismos patogênicos, têm a capacidade de modificar o equilíbrio microbiológico do hospedeiro e reduzir o crescimento de patógenos, como o microoganismo Candida albicans. Para avaliar a colonização oral experimental e o seu tratamento com probióticos, 152 camundongos DBA/2 imunossuprimidos foram inoculados oralmente com uma suspensão (108 células viáveis) de C. albicans. Os animais foram divididos em 4 grupos: controle positivo (sem tratamento), tratados oralmente com nistatina, com Lactobacillus acidophilus e Lactobacillus rhamnosus. No grupo que recebeu nistatina, o tratamento foi iniciado um dia após a inoculação por Candida, já nos grupos que receberam as bactérias probióticas, os tratamentos foram iniciados 14 dias antes da inoculação. Tratamentos com nistatina e probióticos foram diários e duraram 13 dias. As avaliações foram realizadas 1, 3, 5, 7, 9, 11 e 13 dias após a inoculação inicial e feitas através de análises microbiológicas da mucosa oral dos animais. A colonização por C. albicans iniciou-se um dia após a inoculação, sendo o aumento das unidades formadoras de colônia progressivo e significante até o sétimo dia. Após este período, observou-se uma redução significativa no isolamento de leveduras. Todos os tratamentos probióticos reduziram significativamente a colonização de C. albicans na mucosa oral dos animais, comparada com a do grupo de animais não tratados. No grupo tratado com L. rhamnosus, a redução da colonização de levedura foi significativamente maior comparado ao grupo nistatina. Concluiu-se que o modelo animal DBA/2 imunossuprimidos é um bom modelo experimental para o estudo da colonização oral e o tratamento com probióticos, no presente modelo, pode ser uma alternativa eficaz para a redução da Candida na cavidade oral. / To evaluate experimental oral candidiasis and the treatment using probiotics, 152 DBA/2 mice after being immunosuppressed were orally inoculated with a suspension of C. albicans containing 108 viable cells of yeast. The animals were devided into four groups: positive control (untreated), trated oraly with nystatin, with Lactobacillus acidophilus and with Lactobacillus rhamnosus. In the group that received nystatin, the treatment was initiated one day after Candida inoculation, and in the groups that received the probiotic bacteria, the treatment began fourteen days before inoculation. Treatments with nystatin and probiotics were daily and lasted 13 days. Evaluations were performed at 1, 3, 5, 7, 9, 11 and 13 days (after the initial inoculation) and made by microbiological analysis of the oral mucosa of these animals. The colonization of C. albicans in the oral mucosa animals began one day after the initial challenge and it was progressive and significant until the seventh day, when there was a significant reduction in the isolation of yeast. All treatments with probiotic bacteria significantly reduced the colonization of C. albicans in oral mucosa of the animals, compared to the untreated animal group. In group treated with L. rhamnosus the reduction of colonization of yeast was significantly higher compared to the group receiving nystatin. Based on the findings of this study we suggest that animal model DBA/2 immunosuppressed is a good model for experimental oral candidiasis and the treatment with probiotics in this model may be an effective alternative to the treatment of oral candidiasis.

INTRODUÇÃO: 50-86% dos pacientes recidivam a hepatite autoimune (HAI) após a suspensão do tratamento imunossupressor. A manutenção da imunossupressão em longo prazo diminui o risco de recidiva, entretanto é necessário ajuste da dose/suspensão do tratamento em 10-30%, em razão do maior risco de neoplasias e infecções. O difosfato de cloroquina (CQ) é droga imunomoduladora que foi utilizada anteriormente em monoterapia para manutenção da remissão da HAI com diminuição da recidiva quando comparada com controle histórico. O objetivo desse estudo foi investigar a eficácia e segurança do CQ na manutenção da remissão em estudo duplo cego e randomizado e avaliar se há um subgrupo com maior benefício ao seu uso. METODOLOGIA: 61 pacientes com diagnóstico provável ou definitivo de HAI em remissão histológica, 90,1% HAI tipo 1; 23% com reatividade do anti-SLA/LP, 56,6% com fibrose avançada (F3/4) à inclusão no estudo, mas com doença hepática compensada, foram randomizados de forma duplo cego e aleatória para receber CQ 250 mg/d ou placebo, durante 36 meses ou até recidiva da doença. No primeiro mês a droga foi utilizada em combinação com a imunossupressão que induziu remissão; com posterior desmame semanal da prednisona, suspensão imediata da azatioprina e manutenção do CQ/placebo até 36 meses. As curvas de sobrevida livre de recidiva foram estimadas pelo método de Kaplan-Meyer e comparadas pelo teste de Log-Rank; as razões de risco e seus respectivos intervalos de confiança foram estimados por regressão simples de Cox. Na regressão múltipla foram avaliadas co-variáveis clinicamente relevantes para recidiva. Para investigar o subgrupo com maior benefício, as interações entre a droga e reatividade de autoanticorpos e perfil de HLA foram analisadas por regressão múltipla de Cox. As variáveis categóricas foram comparadas pelo teste exato de Fisher e as quantitativas pelo teste-t ou teste de Mann-Whitney. Foi considerado estatisticamente significante um valor de p < 0,05. RESULTADOS: 31 pacientes receberam CQ e 30 placebo. Não houve diferenças entre os grupos em relação aos achados clínicos, laboratoriais, histológicos e perfil de HLA. A sobrevida livre de recidiva foi significativamente maior no grupo CQ quando comparada ao placebo (59,3% X 19,9%, p=0,039). Após a suspensão da medicação ao término do estudo, houve 41,6% de recidiva no grupo CQ e 0% no placebo. Na regressão simples de Cox, os fatores associados com recidiva da HAI foram uso placebo, reatividade do anticorpo anti-SLA/LP, perfil de HLA DR3 e DR8. Na regressão múltipla, o uso de placebo (razão de risco de 2,4[IC 95%:1,05- 5,5], p=0,039) e reatividade do anticorpo anti-SLA/LP (razão de risco= 5.4 [IC 95%:1,91-15,3], p=0,002) associaram-se a maior risco de recidiva. Não foi possível definir subgrupo de maior benefício com uso de CQ no que se refere à reatividade do anti-SLA/LP ou perfil de HLA, embora a recidiva tenha ocorrido em 100% dos pacientes anti-SLA/LP(+) no grupo placebo e 50% no grupo CQ. No grupo CQ, 54,8% apresentaram efeitos colaterais, com suspensão da droga em 19,3%. Os efeitos colaterais mais comuns foram prurido e hiperpigmentação cutânea. CONCLUSÕES: O CQ reduziu com segurança o risco de recidiva de HAI, mas não foi possível definir subgrupo com maior benefício com essa medicação / INTRODUCTION: 50-86% of patients relapse autoimmune hepatitis (AIH) after immunosuppressive treatment withdrawal, with a higher risk of progression to liver cirrhosis, death due to liver disease and liver transplantation. The maintenance of long-term immunosuppression decreases the risk of relapse, however, treatment dose adjustment and/or interruption is required in 10-30%, with increased risk of neoplasias and infections. Chloroquine diphosphate (CQ) is an immunomodulatory drug used previously in monotherapy to maintain AIH remission with a decrease risk in relapse rates when compared to a historical control. The aims of this study were to investigate the efficacy and safety of CQ in the maintenance of remission in a double-blind and randomized study, and to evaluate if there is a subgroup with a greater benefit of its use. METHODS: 61 patients with probable or definitive diagnosis of AIH in histological remission, 90.1% type 1; 23% with anti-SLA / LP seropositivity, 56.6% with advanced fibrosis [F3 / 4] at inclusion in the study and with compensated liver disease were randomized double-blindly to receive either CQ 250 mg/day or placebo for 36 months or until relapse. In the first month, the drug was used in combination with the immunosuppressive regimen that induced the remission; with subsequent weekly weaning of prednisone, immediate withdrawal of azathioprine and maintenance of CQ/placebo for up to 36 months. Recurrence-free survival curves were estimated by the Kaplan-Meyer method and compared by the Log-Rank test; the hazard ratios and their respective confidence intervals were estimated by simple Cox regression. Clinically relevant covariables for relapse were re-evaluated bymultiple Cox regression. To investigate the existence of a subgroup with a greater benefit, interactions between the drug and autoantibody reactivity and HLA profile were analyzed by the Cox multiple regression. Categorical variables were compared by Fisher\'s exact test and the quantitative by the t-test or Mann- Whitney test. A p value of < 0.05 was considered statistically significant. RESULTS: 31 patients received CQ and 30 placebo. There were no differences between the two groups in relation to clinical, laboratory, histological and HLA profiles. Relapse-free survival was significantly higher in the CQ group when compared to placebo (59.3% X 19.9%, p=0.039). After antimalarial withdrawal at the end of the study, there was 41.6% relapse in the CQ group and 0% in the placebo. In the Cox simple regression, factors associated with AIH relapse were placebo use, anti-SLA/LP seropositivity, and HLA DR3 and DR8 profiles. In multiple regression, placebo use (Hazard Ratio = 2.4 [95% CI: 1.05-5.5], p = 0.039) and anti-SLA/LP seropositivity (Hazard Ratio = 5.4 [95% CI: 1.91-15.3], p = 0.002) were associated with a higher risk of relapse. It was not possible to define a subgroup with a greater benefit of CQ with respect to anti-SLA/LP positivity or HLA profile, although all anti-SLA/LP(+) patients in placebo group relapsed, compared to 50% in CQ group. In the CQ group, 54.8% had side effects, but 19.3% had drug withdrawal. The most common side effects were pruritus and cutaneous hyperpigmentation. CONCLUSIONS: Chloroquine safely reduced the risk of relapse of AIH, but it was not possible to define a subgroup with greater benefit with medication use

Em alguns casos, pacientes que sobreviveram a uma sepse grave podem desenvolver um quadro de imunossupressão, caracterizado pela expansão dos linfócitos T reguladores (Tregs). Porém, apesar de inúmeros avanços, os mecanismos associados à expansão das Tregs, ainda não estão completamente esclarecidos. Nesse sentido, trabalhos recentes demonstraram que a atividade da enzima Indoleamina 2,3-Dioxigenase (IDO), responsável pela formação da quinurenina a partir da degradação do aminoácido essencial triptofano, está relacionada à diferenciação das Tregs e com o desenvolvimento de um quadro de tolerância. Dessa forma, o objetivo deste estudo foi investigar o papel da IDO no desenvolvimento da imunossupressão induzida pela sepse. Os resultados demonstraram um aumento da expressão proteica e da atividade enzimática da IDO no baço de camundongos que sobreviveram à sepse grave. Para avaliar o desenvolvimento da imunossupressão, os camundongos foram desafiados com células do melanoma B16-F10. A inibição farmacológica da IDO promoveu redução do crescimento tumoral nos camundongos que sobreviveram à sepse, por um mecanismo dependente da redução na diferenciação das Tregs e das células C11b+ Ly6G+ no baço e da ativação de células CD8+ produtoras de IFN- ?, no linfonodo drenate da região tumoral. Adicionalmente, foi demonstrado que, o receptor de hidrocarbonetos de arila (AhR) está associado ao aumento da expressão da IDO, nos camundongos que sobreviveram à sepse. Ainda, os resultados demonstraram que células CD11C+ são as principais responsáveis por expressar a IDO no baço de camundongos que sobreviveram à sepse. Por fim, células CD11C+ isoladas do baço de camundongos que sobreviveram a sepse, foram mais efetivas em induzir a diferenciação das Tregs quando comparadas a células CD11C+ provenientes de camundongos naive. Em conjunto, os resultados sugerem que a ativação do AhR pela quinurenina é importante para expressão da IDO nas células CD11C+ encontradas no baço de camundongos que sobreviveram à sepse, o que por sua vez, está associado com a expansão das Tregs e com o desenvolvimento do quadro de imunossupressão. / Immunosuppression has been shown to be one long-term sequels of severe sepsis, which is mainly characterized by the expansion of regulatory T cells (Tregs). However, the mechanisms underlying Tregs expansion after sepsis remain poor understood. Indoleamine 2,3-dioxygenase (IDO), an enzyme that initiates the kynurenine pathway of tryptophan degradation, has been implicated in promoting Tregs generation. Therefore, we propose to investigate the role of IDO in the development of sepsis-induced immunosuppression. The results presented here demonstrated that there is an increase in both IDO protein expression and IDO enzymatic activity in spleen of sepsis-surviving mice. Employing a melanoma mouse model as a second challenge in sepsis-surviving mice, we found that pharmacological inhibition of IDO suppressed the enhanced tumor growth observed in sepsis-surviving mice. Importantly, inhibition of IDO decreased the expansion of Tregs in sepsis-surviving mice, leading to reduced CD11b+ Ly6G+ cells frequency in spleen and activation of INF-? production by CD8+ in draining lymph, after tumor challenge. Moreover, the results suggest that aryl hydrocarbon receptor (AhR) is associated with increased IDO expression found in sepsis-surviving mice. Furthermore, we identified that a CD11C+ population of cells are expressing IDO in spleen of sepsis surviving mice. In addition, CD11C+ cells isolated from spleen of sepsis-surviving mice, presented a higher capacity to induce a regulatory phenotype in naïve CD4+ CD25- T than CD11C+ isolated from naïve mice. Taken together, our results suggest that AhR activation by kynurenine during acute phase of sepsis is important to IDO expression in a specific CD11C+. This new sepsis-induced CD11C+ IDO+ population is important to Treg cells expansion and immunosuppression development in sepsis-surviving mice.

Em alguns casos, pacientes que sobreviveram a uma sepse grave podem desenvolver um quadro de imunossupressão, caracterizado pela expansão dos linfócitos T reguladores (Tregs). Porém, apesar de inúmeros avanços, os mecanismos associados à expansão das Tregs, ainda não estão completamente esclarecidos. Nesse sentido, trabalhos recentes demonstraram que a atividade da enzima Indoleamina 2,3-Dioxigenase (IDO), responsável pela formação da quinurenina a partir da degradação do aminoácido essencial triptofano, está relacionada à diferenciação das Tregs e com o desenvolvimento de um quadro de tolerância. Dessa forma, o objetivo deste estudo foi investigar o papel da IDO no desenvolvimento da imunossupressão induzida pela sepse. Os resultados demonstraram um aumento da expressão proteica e da atividade enzimática da IDO no baço de camundongos que sobreviveram à sepse grave. Para avaliar o desenvolvimento da imunossupressão, os camundongos foram desafiados com células do melanoma B16-F10. A inibição farmacológica da IDO promoveu redução do crescimento tumoral nos camundongos que sobreviveram à sepse, por um mecanismo dependente da redução na diferenciação das Tregs e das células C11b+ Ly6G+ no baço e da ativação de células CD8+ produtoras de IFN- ?, no linfonodo drenate da região tumoral. Adicionalmente, foi demonstrado que, o receptor de hidrocarbonetos de arila (AhR) está associado ao aumento da expressão da IDO, nos camundongos que sobreviveram à sepse. Ainda, os resultados demonstraram que células CD11C+ são as principais responsáveis por expressar a IDO no baço de camundongos que sobreviveram à sepse. Por fim, células CD11C+ isoladas do baço de camundongos que sobreviveram a sepse, foram mais efetivas em induzir a diferenciação das Tregs quando comparadas a células CD11C+ provenientes de camundongos naive. Em conjunto, os resultados sugerem que a ativação do AhR pela quinurenina é importante para expressão da IDO nas células CD11C+ encontradas no baço de camundongos que sobreviveram à sepse, o que por sua vez, está associado com a expansão das Tregs e com o desenvolvimento do quadro de imunossupressão. / Immunosuppression has been shown to be one long-term sequels of severe sepsis, which is mainly characterized by the expansion of regulatory T cells (Tregs). However, the mechanisms underlying Tregs expansion after sepsis remain poor understood. Indoleamine 2,3-dioxygenase (IDO), an enzyme that initiates the kynurenine pathway of tryptophan degradation, has been implicated in promoting Tregs generation. Therefore, we propose to investigate the role of IDO in the development of sepsis-induced immunosuppression. The results presented here demonstrated that there is an increase in both IDO protein expression and IDO enzymatic activity in spleen of sepsis-surviving mice. Employing a melanoma mouse model as a second challenge in sepsis-surviving mice, we found that pharmacological inhibition of IDO suppressed the enhanced tumor growth observed in sepsis-surviving mice. Importantly, inhibition of IDO decreased the expansion of Tregs in sepsis-surviving mice, leading to reduced CD11b+ Ly6G+ cells frequency in spleen and activation of INF-? production by CD8+ in draining lymph, after tumor challenge. Moreover, the results suggest that aryl hydrocarbon receptor (AhR) is associated with increased IDO expression found in sepsis-surviving mice. Furthermore, we identified that a CD11C+ population of cells are expressing IDO in spleen of sepsis surviving mice. In addition, CD11C+ cells isolated from spleen of sepsis-surviving mice, presented a higher capacity to induce a regulatory phenotype in naïve CD4+ CD25- T than CD11C+ isolated from naïve mice. Taken together, our results suggest that AhR activation by kynurenine during acute phase of sepsis is important to IDO expression in a specific CD11C+. This new sepsis-induced CD11C+ IDO+ population is important to Treg cells expansion and immunosuppression development in sepsis-surviving mice.