Abstract Both immunosuppressive and nifedipine medication have been associated with drug-induced gingival overgrowth. There are several hypothetical mechanisms for drug-induced gingival overgrowth, such as the influence of genetic predisposition, alterations in gingival tissue homeostasis, especially in the function of fibroblasts, and drug-induced action on growth factors. Clinical studies have also shown that, those with poor oral hygiene status drug-induced gingival overgrowth is more prevalent and severe than those with good oral hygiene status. The working hypothesis was that immunosuppressive medication and/or nifedipine medication affects inflammatory cell profile and mitotic activity of keratinocytes in human overgrown gingiva. We studied gingival samples, collected from nifedipine-medicated cardiac outpatients and immunosuppression-medicated organ-transplant recipients. Patients were placed into four groups: 1) the immunosuppression group, patients receiving cyclosporin-A (CsA), azathioprine (AZA) and prednisolone (Pred) 2) the immunosuppression plus nifedipine group, patients receiving CsA, AZA, Pred. and nifedipine 3) the nifedipine group patients receiving only nifedipine and 4) the non-medicated control group. All of the samples related to moderate to severe degrees of gingival overgrowth, covering half to two thirds of the clinical crown. The aim of the study was to investigate the occurrence of Langerhans cells, macrophages, mast cells and mitotic activity of keratinocytes in human drug-induced overgrown gingiva, and consequently to assess their possible role in the pathogenesis of drug-induced gingival overgrowth. We found that immunosuppressive medication increased the numbers of reparative macrophages (RM3/1) and decreased the numbers of tryptase- and chymase-positive mast cells (MCTC) cells. We have also shown that immunosuppressive and nifedipine medication decreased the numbers of Langerhans cells (CD1a) and increased the numbers of 27E10-macrophages parallelly. Additionally we found increase in the mitotic activity of gingival keratinocytes and even two-fold thickening of gingival epithelium in immunosuppressive and nifedipine medication-induced gingival overgrowth as compared with healthy gingiva. Immunosuppressive medication activated gingival epithelium (27E10 expression in gingival keratinocytes) more than nifedipine medication. In conclusion, our results suggest that gingival overgrowth among immunosuppressive- and nifedipine-medicated patients is related to alteration of tissue homeostasis. First, this suggestion is supported by changes found in the numbers of cells that directly affect connective tissue turnover, e.g. reparative macrophages (RM3/1) and mast cells. Changes in the numbers of these cells could alter the cytokine- and growth factor-profile, which affects fibroblast function. Secondly, we found changes in the numbers of cells involved in regulation of inflammation, e.g. Langerhans cells and monocytes as compared with healthy controls. Immunosuppressive medication could directly activate gingival keratinocytes. We suggest that our findings mainly reflect the effects of immunosuppressive medication, but the role of inflammation cannot be excluded. The changes observed above represent differences of the pathogenesis of drug-induced gingival overgrowth between immunosuppressive and nifedipine medication. It must be however remembered that drug-induced gingival overgrowth is a result of multicausal intrinsic and extrinsic factors. Age, gender, concomitant medication with multiple drugs, plaque accumulation, and genetic disposition are additional risk factors. The abnormal distribution of specific immune system cell subpopulations does not alone prove a functional relationship to gingival overgrowth.

Submitted in partial fulfillment of the requirements for the degree of Master of Health Sciences in Clinical Technology, Durban University of Technology, Durban, South Africa, 2017. / Introduction The prevalence of infertility is increasing at an alarming rate globally. Many couples are afflicted with infertility due to an array of diseases, trauma and psychological stresses. Renal disease is one such pathophysiological condition which is increasing amongst the younger age group. Often the progression of chronic renal disease leads to end stage renal failure that requires a renal transplantation. Post renal transplant, immunosuppressive agents are routinely prescribed to prevent allograft rejection. Immunosuppressive agents are potent drugs that can have deleterious side effects on semen parameters. However, the effects of the immunosuppressive agents on semen parameters in the literature are unclear and require further investigation. It is, therefore, important to assess the effects of immunosuppressive agents on semen, especially the three vital aspects of sperm concentration, motility and morphology which form the basis of male reproduction. Aims and Objectives of study This was a prospective observational study evaluating the effects of different immunosuppressive regimens on sperm parameters in post renal transplant male patients. The main aspects of semen parameters such as sperm concentration, motility and morphology that determine reproductive potential were assessed in the study patients and compared to the gold standard of semen analysis according to the World Health Organisation (WHO) reference values. Methodology Thirty-four renal transplant patients were recruited from the databases of both private nephrologists in the greater Durban area and the academic renal unit at Inkosi Albert Luthuli Central Hospital. Following bioethical approval and informed consent, patients were required to produce a semen sample by masturbation. A questionnaire documenting the patient’s lifestyle, aetiology of renal disease, transplant date and immunosuppressive duration and regimen were recorded. The semen samples were analysed comprehensively according to the protocol on semen analysis recommended by the WHO. This included the macroscopic investigation (volume, appearance, colour, viscosity, liquefaction time and pH) and microscopic evaluation (sperm concentration, total motility, morphology, IgG/IgA and vitality). Sperm concentration, total motility, morphology and vitality were examined and recorded in duplicate to strengthen the validity of the results. A biostatistician analysed the data and determined the statistical analysis. Descriptive statistics determined values of semen parameters in renal transplanted males and in each race demographic. The one sample t-test analysed the statistical significance between the mean study values and the WHO reference values. The effect of the immunosuppressive agent on semen parameters was determined using multiple linear regressions whilst ROC analysis determined the sensitivity and specificity of sperm concentration, total motility and morphology in predicting pregnancy from the patients that fathered children post renal transplant. Results The mean sperm concentration and morphology in the study patients were 14.0 mill/ml (95% Confidence Interval (CI) 10.2 – 17.7) and 3.3% (95% CI 2.7 – 3.9), respectively. Although values obtained were minimally lower than the WHO reference values, these results were within the 95% CI of the WHO guidelines. Motility evaluation revealed higher values of 43.2% (95% CI 36.6 – 49.7). In contrast, sperm vitality was considerably decreased, 47.5% (95% CI 40.6 – 54.4). All semen parameters exhibited no statistical significance (one sample t-test) when analysed against the WHO reference values except for sperm morphology, (p = 0.025; p< 0.05) which showed decreased morphology irrespective of immunosuppressive regimen. Semen volume 1.7 ml (95% CI 1.3 – 2.0) and pH 7.7 (95% CI 7.6 – 7.9) were both within the WHO guidelines. Descriptive statistics according to racial demographics showed no differences in semen values. An almost perfect linear relationship existed between total sperm motility and vitality (r = 0.967). Multiple linear regressions of duration and dosages of immunosuppressive drugs tacrolimus and mycophenolate mofetil, could not predict the effect of the immunosuppressive agents on sperm concentration, total motility and morphology. There was a significant difference in morphology between those with and without children post renal transplant. Those with children post renal transplant exhibited a higher morphology value, (p = 0.001; p< 0.05). Sensitivity and specificity analysis of the patients with children post renal transplant concluded that morphology is the most optimal indicator and predictor of pregnancy (AUC = 0.854). Tacrolimus was the common immunosuppressive agent used in the four patients that fathered children. This was more evident in patients that underwent therapy with Sirolimus followed by Cyclosporin A (CsA) and changed to Tacrolimus as the last immunosuppressive agent used for maintenance therapy. Conclusion The ability to procreate in renal transplanted males has become increasingly difficult and emotionally challenging. In this study sperm concentration and morphology of renal transplanted males exhibited parameters similar to the general fertile population. Total motility possessed a higher range of values in contrast to sperm vitality which showed a significant decrease from the WHO reference values. The effect of immunosuppressive treatment on semen parameters could not be clearly defined due to the number of immunosuppressive regimens that patients were subjected to intermittently resulting in small sample sizes within each immunosuppressive regimen grouping. The majority of patients underwent a triple maintenance therapy of tacrolimus, MMF and prednisone. The dosage and duration of these tacrolimus and MMF was inconclusive in determining a beneficial or detrimental relationship on semen parameters. Morphology was shown to be the most significant indicator in predicting pregnancy in patients that fathered children. Tacrolimus was a common immunosuppressive agent used in the majority of patients that fathered children. It may have protective effects on sperm parameters as shown in patients that fathered children. This was a study with a small sample size and further investigations are required in a larger cohort of patients to assess individualized effects of the different immunosuppressive agents on sperm parameters. / M

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22883号 / 医博第4677号 / 新制||医||1048(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 平井 豊博, 教授 川上 浩司, 教授 椛島 健治 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Due to their immunomodulatory and regenerative potential, mesenchymal stem cells (MSCs) represent a promising therapeutic tool for cell-based therapy, organ transplantation or tissue engineering. To improve clinical applicability of MSCs, new methods to increase their delivery and efficacy have been tested in the latest years but the mechanism of observed alterations has not yet been described. In the present project we focused on studying the effect of several factors that can significantly affect the therapeutic success of MSC-based treatment. Initially, we analysed the therapeutic effect of MSCs applied locally on nanofiber scaffold with incorporated cyclosporine A (CsA) in a mouse model of allogeneic skin transplantation. Our results indicate that application of MSCs in the presence of CsA direct M1/M2 macrophage polarization towards regulatory phenotype. This phenotype switching is accompanied by decreased production of nitric oxide (NO) and interferon  (IFN-) and increase production of interleukin 10 (IL-10), and may result in suppression of the local inflammatory reaction. The next goal of proposed study was to analyse the effect of the treatment based on MSCs combined with immunosuppressive drugs with different mechanism of action on the balance among distinct T cell subpopulations. We...

RUNX1 overlapping RNA (RUNXOR) is a long noncoding RNA and a key regulator of myeloid-derived suppressor cells (MDSCs) via targeting runt-related transcription factor 1 (RUNX1). We and others have previously reported MDSC expansion and inhibition of host immune responses during viral infections; however, the mechanisms regulating MDSC differentiation and suppressive functions, especially the role of RUNXOR-RUNX1 in the regulation of MDSCs in people living with HIV (PLHIV), remain unknown. In this study, we demonstrate that RUNXOR and RUNX1 expressions are upregulated in MDSCs that expand and accumulate in human PBMCs derived from PLHIV. We found that the upregulation of RUNXOR and RUNX1 is associated with the expressions of several key immunosuppressive molecules, including arginase 1, inducible NO synthase, STAT3, IL-6, and reactive oxygen species. RUNXOR and RUNX1 could positively regulate each other's expression and control the expressions of these suppressive mediators. Specifically, silencing RUNXOR or RUNX1 expression in MDSCs from PLHIV attenuated MDSC expansion and immunosuppressive mediator expressions, whereas overexpressing RUNXOR in CD33+ myeloid precursors from healthy subjects promoted their differentiation into MDSCs and enhanced the expression of these mediators. Moreover, loss of RUNXOR-RUNX1 function in MDSCs improved IFN-γ production from cocultured autologous CD4 T cells derived from PLHIV. These results suggest that the RUNXOR-RUNX1 axis promotes the differentiation and suppressive functions of MDSCs via regulating multiple immunosuppressive signaling molecules and may represent a potential target for immunotherapy in conjunction with antiviral therapy in PLHIV.

Background: The aim of this study was to compare the direct impact of different agents for immunosuppressive therapy on mouse fibroblasts as a possible cause of drug-induced gingival overgrowth (DIGO). Methods: 3T3 mouse fibroblasts were cultivated in cell-specific media (2 × 104 cells/mL) and treated for 6, 24, 48 and 72 h with one of three immunosuppressive drugs (IsDs): cyclosporin a (CsA), tacrolimus (TaC) and sirolimus (SiR). Different concentrations (10–750 ng/mL) were used to mimic serum levels under active immunosuppressive therapy conditions. Cell population characteristics (cell number, viability and morphology) were assessed using computer-assisted cell analysis. Expression of pro-collagen type I carboxy-terminal propeptide (PICP) was identified using an ELISA assay. Results: The influence of IsDs on the biological status of 3T3 fibroblasts was time- and dose-dependent. Comparing CsA and TaC, the total cell amount was enhanced using concentrations in the range of 10–150 ng/mL (p > 0.05). In contrast, treatment with SiR resulted in a decrease in the average cell number (p < 0.01). PICP and cell diameter of fibroblasts were not susceptible to IsD treatment (p > 0.05). Conclusions: Our results revealed time-dependent effects of IsDs, with distinct influences on cell number. The cell morphology and the PICP balance of the investigated fibroblast cell line remained unaffected. Hence, the potential role of IsDs is not a unilateral mechanism of action but rather a multifactorial process.

As infecções são a causa mais freqüente de morbidade e mortalidade observadas tanto aguda como tardiamente nos pacientes receptores de transplante pulmonar, o que pode estar diretamente relacionado a uma deficiência no transporte mucociliar do sistema respiratório. Nosso objetivo foi avaliar a influência de dois fatores envolvidos com o transplante pulmonar sobre o transporte mucociliar de ratos: a secção e anastomose brônquica e a imunossupressão pela ciclosporina A. Setenta e dois ratos foram distribuídos aleatoriamente em cinco grupos de acordo com: i) procedimento operatório e ii) terapia a que seriam submetidos. Os resultados mostram que houve uma diminuição significativa da Freqüência de Batimento Ciliar in situ, da Transportabilidade do Muco in vitro e da Velocidade de Transporte Mucociliar in situ medidos a partir do brônquio principal esquerdo dos ratos tratados com ciclosporina A (p<0,001). A Freqüência de Batimento Ciliar in situ dos brônquios operados mostrou-se diminuída também no grupo tratado com solução salina e sacrificado no 30º dia após a operação (p=0,001). Já a Velocidade de Transporte Mucociliar in situ mostrou uma diminuição significativa em todos os grupos submetidos à secção brônquica (p<0,001). Houve um efeito sinérgico entre a terapia com ciclosporina A e a secção brônquica, causando um prejuízo ao transporte mucociliar ainda maior do que quando analisados isoladamente. Concluímos que a Velocidade de Transporte Mucociliar in situ foi agudamente prejudicada após a secção brônquica e terapia imunossupressora pela ciclosporina A, havendo diminuição da freqüência de batimento dos cílios e alteração das propriedades viscoelásticas do muco respiratório. / Infections are the most common cause of early and late morbidity and mortality in lung transplant recipient, and can be directly related to impaired mucociliary transport. Our aim was to assess the influence of bronchial section and imunossupression on mucociliary transport in rats. Seventy two rats were randomly distributed in five groups according to i) surgical procedure and ii) drug therapy. There was a significant impairment on Ciliary Beating Frequency in situ, Mucus Transportability Rate in vitro and Mucociliary Transport Speed in situ from operated bronchus of cyclosporine A-treated rats (p<0.001). Ciliary Beating Frequency from operated bronchus was also impaired in saline-treated rats that were killed on 30th postoperative day (p=0.001). Mucociliary Transport Speed was impaired in all bronchi underwent to section (p<0.001). We conclude that bronchial section and cyclosporine therapy impaired all factors analyzed. Also there was a synergic effect between cyclosporine therapy and bronchial section on ciliary beating frequency.

Thesis (MScMedSc (Pathology. Medical Microbiology))--University of Stellenbosch, 2005. / The aim of this study was to investigate the anti-inflammatory and immunosuppressive effects of the synthetic progestins, MPA and NET-A on human cells in vitro. These injectable contraceptives are used extensively throughout the world, including Africa. The potential of these two synthetic hormones to have certain immunosuppressive and GC properties have previously been shown. Therefore, it was of concern to us to investigate whether these two hormones could possibly demonstrate any of these GC-like properties at contraceptive doses. This was achieved by determining the effects of these two synthetic hormones in vitro on certain immunologic parameters. Chapter 1 is a literature review on MPA, NET and GCs. This chapter starts with a short introduction that sets the scene. The mode of action, effectiveness, sideeffects as well as previously reported relevant data on both MPA and NET-A is portrayed in this review. Research on the known GC, Dex, is also included in the section dealing with GCs, because this synthetic hormone was used as a comparative GC in all our experiments. This chapter soon makes the reader realize how much evidence exists that indicate the possible immunosuppressive effects these two contraceptive hormones, in particular MPA, could have. The possible anti-inflammatory or pro-inflammatory effects of MPA and NET-A are investigated in Chapter 2. This was done in vitro by measuring the effects of these two synthetic hormones on the inflammatory markers, IL-6 and TNFα, by means of ELISA. In this chapter we demonstrate that MPA, even at contraceptive doses, exhibits significant anti-inflammatory properties on both cytokines tested, while NETA displayed considerably less anti-inflammatory tendencies. In its true antiinflammatory manner, we found that Dex significantly inhibited the release of both inflammatory markers from human monocytes. In Chapter 3, we investigated the effects of MPA and NET-A on the activation of human lymphocytes. This was achieved by flow cytometric measurement of the expression of the activation membrane marker CD69 by CD4 and CD8 T cells. Here we discovered that MPA had a very significant inhibitory effect on the activation of both CD4+ and CD8+ T cells, while NET-A only significantly inhibited the activation of CD8+ T cells. In addition, we found that the inhibition of CD4+ and CD8+ T cell activation by MPA was more or less the same as the known GC, Dex, and in some cases even more potent. Chapter 4 consists of an investigation of the effects of MPA and NET-A on the cytokines belonging to TH1 and TH2 subsets of CD4 T cells. This was achieved by determining whether MPA and/or NET-A targeted specific subsets of T helper cells by measuring the distinct regulatory cytokines, IFNγ and IL-4. The mechanism and role of the T helper subsets are discussed in the introduction of this chapter. Our results were portrayed as a ratio of TH2: TH1 on which the statistical analysis was done. In addition to the analysis done on the ratio, we analyzed the helper subsets separately in order to determine which subset(s) were influenced. The results of this chapter showed that neither MPA nor NET-A significantly affected either one of the helper subsets, while Dex significantly decreased this ratio. After our observed effects of MPA and NET-A on CD8 T cells, it became of interest in Chapter 5 to investigate the effects of these two synthetic hormones on the CD8 T cell-specific chemokine, RANTES. This was achieved by measuring the effects MPA and NET-A had on RANTES production in vitro by means of ELISA. Surprisingly, we discovered in this chapter that MPA and NET-A enhanced RANTES production before and after activation of CD8 T cells. We also found that Dex had the same effect on RANTES production, but to a lesser degree. Finally, a general conclusion depicting the significance and implications of our results as well as possible future research that is required is presented in Chapter 6. It was of great importance to discuss and interpret the magnitude of data generated out of all our experiments to the utmost of our capabilities. We found that MPA, even at contraceptive doses, displayed significant immunosuppressive as well as anti-inflammatory properties. NET-A, on the other hand, demonstrated weaker immunosuppressive properties in our research and no significant anti-inflammatory properties. These findings could have clinical implications in females being treated with these synthetic contraceptives. We also demonstrated significant variation found amongst genders in response to MPA, NET-A and Dex.

Introdução: Há poucos dados na literatura sobre a neuropatia periférica (NP) associada ao lúpus eritematoso sistêmico (LES). Objetivo: Descrever a NP atribuída exclusivamente ao LES e avaliar suas características clínicas, laboratoriais, tratamento e evolução a curto e longo prazo. Métodos: Pacientes com LES segundo critérios do American College of Rheumatology (ACR) de 1997, que tiveram NP sintomática comprovada por eletroneuromiografia foram identificados através de revisão do prontuário eletrônico. A NP foi classificada de acordo com a nomenclatura do ACR para síndromes neuropsiquiátricas do LES de 1999. Os critérios de exclusão foram qualquer outra condição clínica associada à ocorrência de NP: comorbidades, deficiência de vitamina B12, uso de drogas (álcool, talidomida, leflunomida, estatinas), infecções e outras doenças autoimunes. Controles com LES sem NP, pareados por idade e sexo, com duração de doença semelhante, foram selecionados. Resultados: NP devido exclusivamente ao LES foi identificada em 38 de 2074 pacientes (1,8%), sendo dois terços nos primeiros cinco anos da doença (63,2%). O tipo mais comum de NP foi a polineuropatia (71,1%), de padrão sensitivo-motor (68,4%). Pacientes com NP relacionada ao LES apresentaram maiores frequências de vasculite cutânea (50% vs. 21,1%, p=0,002), linfopenia (60,5% vs. 36,8%, p=0,027), anti-Sm (52,6% vs. 27,6%, p=0,013) e maiores escores de Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (11,5±10,5 vs. 4,9±6,7; p < 0,0001) comparados aos controles. Os escores de SLEDAI foram ainda mais altos em pacientes com início precoce da NP, com menos de um ano de diagnóstico da doença, comparados a pacientes com NP entre um e cinco anos e após cinco anos do início do LES (21,3±9,1 vs. 8,2±6,6 vs. 3,9±5,3; p < 0,001). Todos os pacientes com NP atribuída ao LES foram tratados com corticóides e 97,4% com terapia imunossupressora: ciclofosfamida intravenosa em 50% e azatioprina em 42,1% dos pacientes. Após um ano de acompanhamento, 92,1% dos pacientes apresentaram uma evolução favorável, com remissão total (36,8%) ou parcial (55,2%) do quadro neuropático, associada a redução da dose de prednisona (48,3±17,9 vs. 15,3±13,4mg/dia; p < 0,0001), da terapêutica sintomática (57,9% vs. 29,7%; p=0,02) e do escore SLEDAI (11,5±10,5 vs. 1,7±3,7; p < 0,0001). O grupo com início precoce da NP teve melhor resposta ao tratamento do que o grupo com início tardio (remissão completa após um ano: 61,5% vs. 25%, p=0,039). Após cinco anos de seguimento, 89,3% mantiveram remissão completa/parcial do quadro. Na análise multivariada, foi confirmada a associação significante entre NP e vasculite cutânea (OR 3,91; IC95% 1,59-9,54; p=0,003), anti-Sm (OR 2,77; IC95% 1,16-6,61; p=0,022) e linfopenia (OR 2,48; IC95% 1,05-5,89; p=0,039). Conclusão: a NP associada exclusivamente ao LES é uma manifestação incomum, caracterizada por um padrão bimodal, com um grupo de início precoce, associado a alta atividade de doença e maior taxa de remissão completa e um grupo de início mais tardio, com resposta parcial ao tratamento imunossupressor. Há um prognóstico geral favorável após um ano de tratamento, sem alterações significativas após cinco anos de seguimento / Introduction: There are few information in the literature regarding peripheral neuropathy (PN) associated to systemic lupus erythematosus (SLE). Objective: To describe PN attributed exclusively to SLE and evaluate its clinical, laboratorial characteristics, treatment, short and long-term outcome. Methods: SLE patients according to 1997 American College of Rheumatology (ACR) criteria were identified using an electronic medical record database. PN diagnosis was defined by neurological abnormalities associated with an altered electroneuromyography and classified according to 1999 ACR nomenclature for neuropsychiatric SLE syndromes. Clinical and laboratory data were evaluated at PN onset and after one and five years. Exclusion criteria were other conditions associated with PN: comorbidities, vitamin B12 deficiency, drugs (alcohol, thalidomide, leflunomide, statin), infections, and other autoimmune diseases. Age- sex- and disease duration-matched SLE patients without PN were selected as controls. Results: Lupus PN was identified in 38 of 2,074 patients (1.8%) and almost two-thirds had PN onset in the first five years of disease (63.2%). The most common type was polyneuropathy (71.1%) with sensory-motor pattern (68.4%). PN SLE had higher frequencies of cutaneous vasculitis (50% vs. 21.1%, p=0.002), lymphopenia (60.5% vs 36.8%, p=0.027), anti-Sm (52.6% vs. 27.6%, p=0.013) and higher Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores (11.5±10.5 vs. 4.9±6.7, p < 0.0001) compared to controls. SLEDAI scores were higher in patients who had PN with less than one year of disease diagnosis, compared to those with PN onset between one and five years or more than five years of SLE (21.3±9.1 vs. 8.2±6.6 vs. 3.9±5.3; p < 0.001). At PN diagnosis, all patients received glucocorticoids and 97.4% started immunosuppressive therapy (50% intravenous cyclophosphamide, 42.1% azathioprine). After one-year follow-up, 92.1% had a favorable outcome with complete (36.8%) or partial remission (55.2%), in parallel with a decrease in prednisone dose (48.3±17.9 vs. 15.3±13.4mg/d, p < 0.0001), symptomatic therapy (57.9% vs. 29.7%, p=0.02), and SLEDAI scores (11.5±10.5 vs. 1.7±3.7, p < 0.001). Early PN onset group had a better response to treatment compared to late PN onset (complete remission at one-year follow-up 61.5% vs. 25%, p=0.039). At five-year, 89.3% remained with complete/partial remission. In multivariate analysis, PN was associated to cutaneous vasculitis (OR 3.91; 95%CI 1.59-9.54; p=0.003), anti-Sm (OR 2.77; 95%CI 1.16-6.61; p=0.022), and lymphopenia (OR 2.48; 95%CI 1.05-5.89; p=0.039). Conclusion: PN attributed to SLE itself is a rare manifestation with a bimodal pattern, characterized by an early onset group associated with high disease activity and a higher rate of complete remission, and a late onset group with low disease activity and a partial therapy response. This study reveals a favorable outcome after one year of immunosuppressive therapy in most PN SLE patients, without significant changes at five years of follow-up

Selon les facteurs solubles de l’environnement (cytokines), les monocytes peuvent se différencier en macrophages (Mφ) ou en cellules dendritiques. Mes travaux de thèse montrent que l’IL-34, un second ligand du M-CSF-R (c-fms ou CD115), induit la différenciation de monocytes humains en macrophages CD14+ CD163+ (IL-34-Mφ), phénotypiquement et fonctionnellement similaires aux M-CSF-Mφ et aux macrophages associés aux tumeurs (TAM) isolés du cancer de l’ovaire. Ils possèdent des propriétés immunosuppressives et diminuent la prolifération des lymphocytes T CD4+ activés. Comme les Mφ orchestrent la réponse immunitaire, j’ai évalué la capacité des M-CSF-Mφ, IL-34-Mφ et des TAM à polariser les LT CD4+ mémoires. Les résultats montrent qu’ils polarisent des LT non-Th17 mémoires en LTh17 CCR4+ CCR6+ CD161+ conventionnels exprimant ou non de l’IFN. Ce processus est médié par l’expression constitutive de l’IL-1α membranaire exprimées sur ces macrophages.Dans le but d’identifier des stratégies pour prévenir l’accumulation de ces Mφ dans le cancer, j’ai montré que (i) l’IFNγ et le GM-CSF inhibent la différenciation des M-CSF-Mφ et IL-34-Mφ et que (ii) l’IFNγ permet la réversion des M-CSF-Mφ et IL-34-Mφ en Mφ immunostimulants. En conclusion, mes travaux montrent que les M-CSF-Mφ, IL-34-Mφ et les TAM, considérés initialement comme anti-inflammatoires, induisent la génération de lymphocytes Th17 via une expression constitutive de l’IL-1α. Ce processus pourrait contribuer à maintenir, localement, une inflammation modérée nécessaire au développement tumoral. / According to the soluble factors in the environment (cytokines), monocytes differentiate into macrophages (Mϕ) or dendritic cells. This project demonstrates that IL-34, a second ligand of the M-CSF receptor (c-fms or CD115), induces the differentiation of human monocytes into CD14high CD163 high Mφ (IL-34-Mφ), phenotypically and functionally similar to M-CSF-Mφ and to tumorassociated macrophages (TAM) isolated from the ovarian cancer. They exhibit potent immunosuppressive properties and decrease the proliferation of stimulated Tcells. As Mφ orchestrate the immune response, I have evaluated the capacity of M-CSF-Mφ, IL-34-Mφ and TAM to polarize human memory CD4+ T cells. Unexpectedly, results showed that they switch non- Th17 memory CD4+ T cells into conventional CCR4+ CCR6+ CD161+ Th17 cells, expressing or not IFNγ. This process is mediated by the constitutive expression of membrane IL-1α on these Mϕ subsets. In an attempt to identify strategies to prevent an accumulation of immunomodulatory Mϕ in cancer, I have shown that (i) IFNγ and GM-CSF prevent M-CSFandIL-34-induced monocyte differentiation into immunosuppressive Mφ and (ii) that IFNγ switchesestablished M-CSF-Mφ and IL-34-Mφ into immunostimulatory Mφ. In conclusion, this study demonstrates that human MCSF- Mφ, IL-34-Mφ and TAM initially considered as antiinflammatorycells, induce in vitro Th17 cell generation via a constitutive expression of membrane IL-1α. This process may contribute to maintain locally a restrained and smoldering inflammation required for angiogenesis and metastasis in tumors.