Abstract The aims of this study were to investigate the clinical features, the endoscopic and histological abnormalities of ileocolonic and gastroduodenal mucosa and immunogenetic background of microscopic colitis (MC) and its subtypes collagenous colitis (CC) and lymphocytic colitis (LC). 30 patients with CC and 54 with LC were examined with different control groups used according to the study. The mean age at diagnosis was in the sixties in both CC and LC, with a female preponderance in both Autoimmune conditions such as celiac diseased (CD) were common in MC. Bronchial asthma associated with LC. Lactose intolerance associated with MC but colonic diverticulosis was rare. Ileal histological changes were common in MC. Focal gastritis did not associate with MC. Lymphocytic gastritis was found only in LC. Gastric endoscopic erosions were more prevalent in CC than in LC. The age at diagnosis of MC was higher in H. pylori positive than negative patients. The patients with MC had shorter duodenal villi than controls even when patients with CD were excluded. HLA-DR3-DQ2 haplotype and TNF2 allele carriage were more frequent in patients with MC compared to controls. The genotype GG of IL-6-174 was more prevalent in MC compared to the controls. IL-6 genotype did not associate with the serum IL-6 concentration. The concentration of IL-6 was higher in patients with CC than in LC. In conclusion, in addition to colonic typical inflammation, histological abnormalities were detected also in gastric, duodenal and ileal mucosa. CD was common in MC, but there was no association with specific types of gastritis. HLA association was found in MC. Polymorphism in the proinflammatory IL-6-174 gene displayed a possible association with MC. Although CC and LC share many clinical features, the differences in the occurrence of immune conditions, gastric abnormalities and IL-6 response point to differences in their pathogenesis. / Tiivistelmä Tutkimuksen tavoitteena oli tutkia mikroskooppisen koliitin sekä sen alaryhmien, kollageenikoliitin ja lymfosyyttisen koliitin kliinisiä piirteitä, mahalaukun ja ohutsuolen limakalvon muutoksia sekä immunogeneettistä taustaa. Tutkimukseen osallistui 30 kollageeni- ja 54 lymfosyyttikoliittipotilasta sekä verrokkeja. Sekä kollageenikoliitti että lymfosyyttinen koliitti diagnosoitiin keskimäärin 50–60 v iässä, ja molemmissa tautiryhmissä naisia oli enemmän kuin miehiä. Autoimmuunisairaudet kuten keliakia olivat yleisiä liitännäissairauksia. Astmaa esiintyi lymfosyyttistä koliittia sairastavilla verrokkeja enemmän. Laktoosi-intoleranssi oli yleistä, mutta paksusuolen divertikuloosia oli harvoin mikroskooppista koliittia sairastavilla potilailla. Ileumin muutokset olivat yleisiä. Mikroskooppinen koliitti ei assosioitunut fokaaliseen gastriittiin. Lymfosyyttigastriittia todettiin vain lymfosyyttisessä koliitissa. Mahalaukun eroosioita esiintyi enemmän kollageenikoliitissa kuin lymfosyyttisessa koliitissa. Mikroskooppinen koliitti ilmeni iäkkäämpänä niillä, joilla todettiin helikobakteeri. Pohjukaissuolen suolinukka oli keliakiasta riippumatta matalampaa kuin verrokeilla. HLA-DR3-DQ2 haplotyyppiä, TNF-2 alleelia ja IL-6-174-GG genotyyppiä esiintyi enemmmän mikroskooppista koliittia sairastavilla potilailla kuin verrokeilla. IL-6 genotyyppi ei vaikuttanut seerumin IL-6-pitoisuuteen. IL-6 pitoisuus oli korkeampi kollageenikoliitissa kuin lymfosyyttisessä koliitissa. Havainnot osoittavat, että mikroskooppisessa koliitissa limakalvomuutoksia on paksusuolen lisäksi myös muualla mahasuolikanavassa. Keliakia on tavallinen liitännäistauti. HLA-DR3-DQ2 on yleinen mikroskooppista koliittia sairastavilla myös ilman keliakiaa. IL-6-174-GG genotyypin yleisyys viittaa siihen, että tämä polymorfismi saattaa altistaa mikroskooppiselle koliitille. Vaikka kollageenikoliitti ja lymfosyyttinen koliitti ovat kliinisesti samankaltaisia sairauksia, erot tautiassosiaatioissa, mahan limakalvon muutoksissa ja seerumin IL-6-tasoissa viittaavat erilaisiin syntymekanismeihin.

La leucémie lymphoïde chronique (LLC) est la plus fréquente des leucémies qui touchent le monde occidental. Cette pathologie est toujours incurable et se caractérise par une hétérogénéité d’évolution clinique marquée par une survie globale oscillant de quelques mois à des dizaines d’années. Il est donc primordial de savoir à quel type d’évolution le patient sera confronté afin d’adapter au mieux le suivi de la maladie et la précocité ou non du traitement.<p><p>\ / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

The AKR strain of mice have a genetic trait for spontaneous development of lymphocytic leukemia. In this study, leukemic mice were found to have significantly larger (p<0.01) thymuses and spleens than preleukemic mice. The enlarged leukemic tissues were densely packed with a light staining cell, with a hollow-appearing nucleus. Tissues from preleukemic mice were observed to be infiltrated with a smaller, darker-staining lymphocyte. Fluorescent antibody staining was done on preleukemic and leukemic tissues, using three antisera against murine lymphocyte theta antigen, and an antiserum against murine IgG. Significantly brighter fluorescence, (p <0.05) with theta-specific antisera, was found in leukemic thymuses,spleens, and kidneys than in the same preleukemic tissues. Leukemic tissues had significantly brighter fluorescence (p <0.05) than preleukemic tissues with IgG antiserum.

CHARLES UNIVERSITY IN PRAGUE Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Study program: Health Care Bioanalytics Candidate: Bc. Nikola Fučíková Supervisor: doc. MUDr. Lukáš Smolej, Ph.D. Title of diploma thesis: Prognostic significance of atypical leukemic cell morphology in chronic lymphocytic leukemia The aim of this thesis is to evaluate the prognostic significance of atypical cell morphology and smudge cells in patients with untreated chronic lymphocytic leukemia. We performed differential leukocytes count and classified lymphocytes as typical and atypical in a cohort of 101 patients (median age, 66 years; males, 69%, Rai III/IV stages, 18%). For atypical CLL, we used the 15% threshold and 59% of patients were classified as atypical CLL (aCLL). For smudge cells, we chose the 30% threshold and 33% of patients were classified as smudge cells positive. Patients in early clinical Rai stage (0) had significantly higher number of smudge cells (p=0.04). We didn't find a significant association between aCLL / smudge cells with modern prognostic indicators. We didn't find a relationship between aCLL and the time to first-line therapy (p=0.394). However, patients with aCLL had a significantly shorter overall survival (p=0.0397). There was a trend toward shorter...

La leucémie lymphoïde chronique (LLC), hémopathie lymphoïde fréquente, se caractérise par une évolution clinique extrêmement variable. Bien que les marqueurs de pronostic soient nombreux dans la LLC, aucun n'est univoque. Dans ce contexte, identifier de nouveaux facteurs prédictifs et comprendre la pathophysiologie de marqueurs pronostiques déjà établis constituent deux objectifs importants pour améliorer la prise en chargethérapeutique de cette hémopathie. Nous avons tout d'abord choisi d'étudier la valeur pronostique et les mécanismes de régulation de l'expression du gène anti-apoptotique MCL1. Nous avons montré que l'expression de MCL1 est un marqueur prédictif de la survie globale parmi l'ensemble despatients et parmi les stades précoces ; ce marqueur est également prédictif de la survie sans traitement des patients en stade A. Ainsi, l'expression de MCL1 permet d'identifier précocement les formes de LLC à haut risque et faible risque d'évolution défavorable. Nous avons également démontré que l'expression de MCL1 est fortement corrélée à l'expression de VEGF, confirmant le rôle de cette voie de signalisation dans la survie des lymphocytes tumoraux et suggérant que VEGF pourrait réguler positivement l'expression de MCL1 selon un mode autocrine. Nous avons ensuite exploré la fonction télomérique en rapport avec les anomalies chromosomiques à valeur pronostique, reflets de l'instabilité génomique. Notre travail a contribué à démontrer la relation entre l'instabilité génomique et le statut télomérique, évalué par la longueur des télomères et l'expression de hTERT et des gènes du complexe shelterin. Nous avons ainsi mis en évidence trois groupes de patients présentant des profilscytogénétiques et télomériques distincts : le premier groupe combine une cytogénétique favorable, des télomères longs, une expression faible ou absente de hTERT et une expression forte des gènes du complexe shelterin ; le troisième groupe se caractérise par de multiples aberrations chromosomiques (notamment délétions 17p et 11q), une augmentation de l'expression de hTERT et une diminution de la longueur des télomères et des niveaux d'expression de TRF1, TRF2 et POT1 ; le deuxième groupe est intermédiaire. Ces résultats confirment l'existence d'un lien entre statut télomérique et instabilité génomique au cours de la LLC et soulignent le rôle de la perte de TP53 ou ATM dans cette dysfonction télomérique. L'altération du statut télomérique est par ailleurs associée à des caractéristiques de pronostic défavorable, comme l'absence de mutation des IgVH, l’expression de CD38 et le doublement rapide de la lymphocytose. Enfin, nous avons évalué l’intérêt de la technique de MLPA pour la mise en évidence des anomalies cytogénétiques récurrentes à valeur pronostique de la LLC. Nous avons montré qu'il existe une bonne concordance entre la technique de référence et la MLPA, qui constitue une approche rapide et peu coûteuse pour la recherche d'anomalies génomiques présentes dans une majorité de cellules malignes. Nous avons cependant mis en évidence des cas intéressants de faux-positifs et de faux-négatifs avec la MLPA, indiquant que cette méthode ne peut pas remplacer les techniques classiques, mais constitue une approche complémentaire permettant une évaluation simultanée de divers déséquilibres. / Chronic lymphocytic leukemia (CLL) is a frequent lymphoid hemopathy characterized by an extremely variable clinical course. Although there are numerous prognostic markers in CLL, none is univocal. In this context, identifying new predictive factors and understanding the pathophysiology of previously established prognostic markers represent two important aims to improve therapeutic management of this hemopathy. We first chose to study the prognostic value and mechanisms of regulation of antiapoptotic MCL1 gene expression. We showed that MCL1 expression is a predictive marker of overall survival within the whole patient cohort and among early stages; this marker is also a predictor of treatment free survival of stage A patients. Thus, MCL1 expression allows early identification of CLL forms with high risk and low risk of unfavourable evolution. We alsodemonstrated that MCL1 expression is strongly correlated to VEGF expression, confirming the role of this signalling pathway in tumour lymphocytes survival and suggesting that VEGF may be a positive autocrine regulator of MCL1 expression. We then explored telomeric function regarding prognosis-related chromosomal anomalies, reflecting genomic instability. Our work contributed to demonstrate the relationship between genomic instability and telomeric status, evaluated by telomere length and expression of hTERT and shelterin complex genes. We described three groups of patients with distinct cytogenetic and telomeric profile: first group combines good-prognosis cytogenetics, long telomeres, low or negative hTERT expression and high expression of the shelterin complex genes; third group displays multiple chromosome aberrations (particularly 17p and 11q deletions), increased hTERT expression and decreased telomere length and TRF1, TRF2 and POT1 expression levels; second group is intermediate. These results confirm the relationship between telomeric status and genomic instability in CLL and underline the role of TP53 or ATM loss in this telomeric dysfunction. The alteration of telomeric status is also associated with poor-prognosis features, such as unmutated IgVH, CD38 expression and rapid lymphocytosis doubling time. Finally, we evaluated the contribution of MLPA approach for detection of recurrent prognosis-related cytogenetic anomalies. We found a good concordance between the goldstandard technique and MLPA, which represent a time and cost-effective approach for the detection of genomic aberrations affecting most malignant cells. We however described interesting MLPA false-positive and false-negative cases, indicating that this method may not replace classic techniques, but may constitute a complementary approach allowingsimultaneous evaluation of various imbalances.

L’expression de ZAP-70 dans la leucémie lymphoïde chronique (LLC) est associée à une hypersignalisation du BCR et à la survenue de cytopénies auto-immunes (CAI). Les LB non tumoraux expriment aussi ZAP-70, expression corrélée à celle dans les LB tumoraux et aux CAI. Nous avons montré que ces LB non tumoraux ZAP-70+ sont polyclonaux, sans lien moléculaire entre eux ni avec le clone tumoral et qu’il n’existe pas de stéréotypie de leur BCR. Ces LB présentent par contre un enrichissement en BCR autoréactifs. Notre modèle murin knock in Zap-70+/- // Mb1-Cre+/- a montré qu’une forte expression précoce de ZAP-70 dans les LB est associée à un avantage sélectif médullaire, un enrichissement en cellules potentiellement autoréactives de type zone marginale, à un blocage partiel de la maturation et de la différentiation périphérique, ainsi qu’au développement de caractéristiques de la LLC : hypogammaglobulinémie, enrichissement en auto-anticorps circulants, hyperactivation et prolifération cellulaires augmentées. Ces résultats ouvrent de nouvelles perspectives impliquant ZAP-70 dans la compréhension du développement B et de la physiopathologie de la rupture de tolérance et de la transformation néoplasique. / ZAP-70 expression in chronic lymphocytic leukemia (CLL) is associated with BCR hypersignalling and autoimmune cytopenia (AIC) occurrence. Non tumoral B cells also express ZAP-70, which is correlated with those in tumoral B cells and AIC. We have shown that these non tumoral B cells ZAP-70+ are polyclonal, without molecular link between each other and tumoral B cells, and without BCR stereotypy. These cells are however enriched in autoreactive BCR. Our mouse model knock in Zap-70+/- // Mb1-Cre+/- revealed that a high and early ZAP-70 expression is associated with medullar selective advantage, enrichment in potential autoreactive B cells of marginal zone subtype, partial block for peripheral maturation and differentiation, along with some LLC characteristics: hypogammaglobulinemia, enrichment in circulating auto-antibodies, increase in cellular activation and proliferation. These results open new opportunities involving ZAP-70 in the understanding of B cell development and physiopathology of tolerance breakdown and neoplastic transformation.

Student Number : 9708297R - MSc (Med) dissertation - School of Medicine - Faculty of Health Sciences / B chronic lymphocytic leukaemia (B-CLL) is a monoclonal haematopoietic disorder with expansion of small lymphocytes of B-cells. B-CLL cells accumulate in blood, bone marrow, lymph nodes and spleen, resulting in enlargement of these organs and decreased bone marrow function. B-CLL is the most common leukaemia, with an annual incidence of 1.8 to 3.0 per 100 000 population in the United States. It is characterised by the accumulation of long-lived monoclonal CD5+ B lymphocytes. In vivo normal B-lymphocytes derive growth factors through interactions with T-cells and monocytes. In culture however, survival and growth of activated B-cells depends on the availability of external factors such as interleukins. B-CLL cells populations are unable to survive in culture long enough to respond to the addition of growth factors. Such factors are important for the proliferation and survival of many cell types and in the absence of cytokines, these cells die as a result of apoptosis. Chronic lymphocytic leukaemia cells are influenced in vitro by a number of exogenously added cytokines that include IFN- α, IFN-γ, IL-2, IL-4, IL-10, IL-13, IL-15, TGF- β and TNF- α. The aim of this study was to investigate the effect of cytokines e.g., IFN, IL-2, IL-6, IL7 and IL-10 on the proliferation and survival of B-CLL cells and furthermore to compare the induction and reduction of spontaneous and induced apoptosis in vitro. Patients with B-CLL were recruited from three centres. Thirty blood samples were collected, separated using Ficoll Hypaque Gradient and purified by rosetting with AET treated SRBC. The proliferation and survival of B-CLL cells were studied in vitro in response to GM-CSF, IFN, IL-2, IL-6, IL7 and IL-10,. The survival and apoptosis of B-CLL cells in cultures with or without interleukins and other growth factors were studied under microscopic examinations and DNA agarose gel electrophoresis. It was observed in B-CLL cells cultures that IFN and IL-2 enhanced proliferation significantly. IL6, IL-7 and GM-CSF also enhanced proliferation of B-CLL cells but not to the greater extent than IL2 and IFN. IL-10 inhibited proliferation of B-CLL cells when compared to controls. In a long-term (5-day) culture, survival of B-CLL cells was greatly enhanced by IFN and followed by IL-2. Therefore it appeared that IFN and IL-2 are the two most potent growth factors tested in this study to promote B-CLL cells proliferation and survival. The combination of these mitogens did not further enhanced proliferation. IL-6 and GM-CSF enhanced proliferation and survival of B-CLL cells. IL-7 promoted proliferation but had no effect on survival of B-CLL cells in-vitro. IL-10 enhanced apoptosis and did not promote survival of B-CLL cells in-vitro. IFN and IL2 are survival and promoting growth factors for B-CLL cells in culture. In contrast, IL-10 has demonstrated to induce apoptotic cell death of B-CLL cells. In conclusion B-CLL cells proliferated equally well with IFN and IL-2. IL-6, IL-7 and GM-CSF had a much lower proliferation and survival effect with noticeable antiapototic activity when compared to IFN and IL-2. IL-7 was found not to promote survival of B-CLL cells and IL-10 enhanced cell death by apoptosis.

LLC-B é uma neoplasia hematológica derivada de uma população de linfócitos B maduros CD5+ localizados na zona do manto dos folículos linfóides e é a mais comum das doenças linfoproliferativas. É uma doença clinicamente heterogênea na qual certos pacientes apresentam quadros indolentes que durante muitos anos podem ser controlados com pouco ou nenhum tratamento. Relatos da literatura sugerem que os linfócitos T na LLC-B podem ser incapazes de iniciar, manter e concluir uma resposta imune para a célula B maligna e outros antígenos, e podem estar diretamente envolvidos na manutenção do tumor. Os linfócitos são ativados, proliferam e polarizam sua resposta para padrões pro-inflamatórios ou antiinflamatórios, aumentando sua população e tornando-se capazes para realizar suas funções efetoras. Embora o processo de ativação dos linfócitos Th seja indispensável para a defesa do hospedeiro, é necessário que haja um equilíbrio homeostático, onde as células auto-reativas ou recorrentemente ativadas sejam eliminadas. A esse último mecanismo de manutenção do equilíbrio imunológico, dá-se o nome de Tolerância Periférica, sendo que o processo de morte celular induzida por ativação (AICD) constitui um dos principais mecanismos para sua manutenção. Assim, neste estudo também foram analisados membros do grupo de receptores de membrana da superfamília dos receptores de fatores de necrose tumoral (tumor necrosis factor receptor, TNFR). Esta família TNFR inclui diversos receptores, entre eles o FAS (CD95) e seu ligante FASL. O objetivo central deste trabalho é investigar alterações no compartimentos de linfócitos T como, Th1, Th2, Th17 e Treg, bem como membros da via extrínseca de morte, FAS e FASL nos linfócitos T CD4+. Os resultados mostraram que o número absoluto dos linfócitos T CD4+, CD8+ e Th1 é heterogêneo, sendo que alguns pacientes apresentaram aumento e outros diminuição destas células quando comparados com o grupo controle do estudo. Em relação a expressão de FAS e FASL os resultados também apresentaram heterogeneidade. Sendo assim foi analisado cada paciente e comparados com os fatores de prognósticos e dados clínicos em cada caso. Ainda há muito para ser investigado, mas este trabalho tem como perspectivas buscar melhor entendimento da participação dos linfócitos T CD4+ nas LLC-B, expandindo as possibilidade de tratamento e busca de novos alvos terapêuticos. / B-CLL is a hematologic malignancy derived from a mature population of CD5+ Blymphocytes located in the mantle zone of the lymphoid follicles and is the most common lymphoproliferative disorders. It is a clinically heterogeneous disorder in which patients have certain frames idle for many years that can be controlled with little or no treatment. Literature reports suggest that T lymphocytes in B-CLL may be unable to initiate, sustain and complete an immune response to the malignant B cell and other antigens, and may be directly involved in tumor maintenance. The lymphocytes are activated, proliferate and polarize their response patterns to pro-inflammatory or anti-inflammatory, increasing its population and becoming able to perform their effector functions. Although the process of Th lymphocyte activation is essential for host defense, there must be a homeostatic balance, where autoreactive cells are eliminated or recurrently activated. The latter mechanism of maintenance of immune balance, gives the name of Peripheral Tolerance, and the process of activation-induced cell death (AICD) is a major mechanism for its maintenance. In this study group members of the superfamily of membrane receptors of tumor necrosis factor (tumor necrosis factor receptor, TNFR) receptors were also analyzed. The TNFR family includes many receptors, including FAS (CD95) and its ligand FasL. The central objective of this study is to investigate changes in T lymphocyte compartments as Th1, Th2, Th17 and Treg as well as members of the extrinsic death pathway, FAS and FASL in CD4+ lymphocytes. The results showed that the absolute number of CD4+, CD8+ and Th1 lymphocytes is heterogeneous, with some patients showed an increase and others decrease of these cells when compared with the control group of the study. Regarding the expression of FAS and FASL results also showed heterogeneity. Thus each patient was analyzed and compared to the prognostic factors and to clinical data in each case. Much remains to be investigated, but this work has the prospects look better understanding of the role of the B-CLL CD4+ T lymphocytes, expanding the possibilities of treatment and the search for new therapeutic targets.

Leucemia Linfóide Crônica (LLC) é a leucemia mais comum em países ocidentais, tem apresentação clínica e evolução heterogênea. Especula-se que todos os casos sejam precedidos por Linfocitose B Monoclonal (LBM). Não são bem conhecidos os mecanismos moleculares responsáveis por esta evolução. Alterações na expressão de miRNAs e em comprimento telomérico podem contribuir para desencadear esta neoplasia. O objetivo deste estudo foi identificar diferenças em comprimento telomérico e expressão de miRNAs entre pacientes com LLC, portadores de LBM clínica e populacional e controles saudáveis. Estudamos 21 pacientes com LLC, 11 portadores de LBM clínica, 6 de LBM populacional e 10 voluntários saudáveis. Para o controle de comprimento telomérico, utilizamos dados de estudo anterior do nosso serviço com grupo de 261 voluntários saudáveis de 0 a 86 anos. Realizamos separação de células CD19+CD5+ por citometria de fluxo nos grupos de estudo e de linfócitos B no grupo controle. Analisamos expressão dos miRNAs 15a, 16-1, 29b, 34a, 155, 181a e 181b por RT-qPCR e comprimento telomérico por qPCR. O miR- 155 foi o único que demonstrou expressão diferente entre os grupos LLC e LBM, sendo maior nos pacientes com LLC. Este miRNA e o miR-34a têm aumento de expressão nas células com fenótipo anormal, apesar desta diferença não ter tido significância estatística quando considerada a expressão do miR-155 na LBM. Os miRNAs 15a, 16-1, 181a e 181b são hipoexpressos nas células com fenótipo anormal. O miR-29b teve expressão semelhante nos grupos estudados. O comprimento telomérico foi semelhante nos 3 grupos de estudo e menor quando comparados ao grupo controle. O miR-155 tem diferente expressão em LBM e LLC, podendo ser um dos responsáveis por esta evolução. Alterações nos miRNAs 34a, 15a, 16-1, 181a e 181b contribuem para expansão clonal de linfócitos B CD5+. O papel do miR-29b na fisiopatogênese e evolução da LLC ainda não está bem definido. O comprimento telomérico diminuído em LLC e LBM pode fazer parte dos eventos iniciais da fisiopatogênese desta leucemia. / Chronic Lymphocytic Leukemia (CLL) is the most common leukemia on Western countries, it has an heterogeneous clinical presentation and outcome. Monoclonal BCell Lymphocytosis (MBL) may precede all CLL cases. The molecular mechanisms responsible for this evolution are not known. Aberrant miRNA expression and telomere shortening may contribute for the pathophysiology of this disease. The objective of this study was to identify differences on telomere length and miRNA expression between CLL patients, subjects with clinical and population-screening MBL and healthy volunteers. 21 CLL patients, 11 subjects with clinical MBL, 6 with population-screening MBL and 10 healthy volunteers were enrolled on this study. As control for telomere length, we used a group of 261 healthy volunteers aged 0 to 86 years old that had been enrolled on a previous study from our group. After diagnosis confirmation, it has been done a flow citometry CD19+CD5+ cell sorting for the study groups and CD19+ cell sorting for the control group. The expression of the miRNAs 15a, 16-1, 29b, 34a, 155, 181a and 181b was determined by RT-qPCR. The telomere length was determined by qPCR. miR-155 was the only one with different expression between the CLL and MBL groups, presenting higher expression on the CLL group. This miRNA and the miR-34a are overexpressed on the study groups when compared to the control group, although this difference did not reach statistical significance when the miR-155 expression in MBL is considered. miRNAs 15a, 16-1, 181a and 181b are underexpressed on the study groups. The miR-29b was the only one with similar expression on all groups. The telomere length was similar on the 3 study groups and shorter on these groups when compared to normal subjects. The expression of miR-155 is different in CLL and MBL, it may contribute for this evolution. Aberrant expression of miR 34a, 15a, 16-1, 181a and 181b may contribute for the clonal expansion of CD5+ B lymphocytes. The role of miR-29b on the CLL pathogenesis and evolution is still not understood. The reduced telomere length on CLL and MBL may be part of the initial events of this leukemia pathogenesis.

LLC-B é uma neoplasia hematológica derivada de uma população de linfócitos B maduros CD5+ localizados na zona do manto dos folículos linfóides e é a mais comum das doenças linfoproliferativas. É uma doença clinicamente heterogênea na qual certos pacientes apresentam quadros indolentes que durante muitos anos podem ser controlados com pouco ou nenhum tratamento. Relatos da literatura sugerem que os linfócitos T na LLC-B podem ser incapazes de iniciar, manter e concluir uma resposta imune para a célula B maligna e outros antígenos, e podem estar diretamente envolvidos na manutenção do tumor. Os linfócitos são ativados, proliferam e polarizam sua resposta para padrões pro-inflamatórios ou antiinflamatórios, aumentando sua população e tornando-se capazes para realizar suas funções efetoras. Embora o processo de ativação dos linfócitos Th seja indispensável para a defesa do hospedeiro, é necessário que haja um equilíbrio homeostático, onde as células auto-reativas ou recorrentemente ativadas sejam eliminadas. A esse último mecanismo de manutenção do equilíbrio imunológico, dá-se o nome de Tolerância Periférica, sendo que o processo de morte celular induzida por ativação (AICD) constitui um dos principais mecanismos para sua manutenção. Assim, neste estudo também foram analisados membros do grupo de receptores de membrana da superfamília dos receptores de fatores de necrose tumoral (tumor necrosis factor receptor, TNFR). Esta família TNFR inclui diversos receptores, entre eles o FAS (CD95) e seu ligante FASL. O objetivo central deste trabalho é investigar alterações no compartimentos de linfócitos T como, Th1, Th2, Th17 e Treg, bem como membros da via extrínseca de morte, FAS e FASL nos linfócitos T CD4+. Os resultados mostraram que o número absoluto dos linfócitos T CD4+, CD8+ e Th1 é heterogêneo, sendo que alguns pacientes apresentaram aumento e outros diminuição destas células quando comparados com o grupo controle do estudo. Em relação a expressão de FAS e FASL os resultados também apresentaram heterogeneidade. Sendo assim foi analisado cada paciente e comparados com os fatores de prognósticos e dados clínicos em cada caso. Ainda há muito para ser investigado, mas este trabalho tem como perspectivas buscar melhor entendimento da participação dos linfócitos T CD4+ nas LLC-B, expandindo as possibilidade de tratamento e busca de novos alvos terapêuticos. / B-CLL is a hematologic malignancy derived from a mature population of CD5+ Blymphocytes located in the mantle zone of the lymphoid follicles and is the most common lymphoproliferative disorders. It is a clinically heterogeneous disorder in which patients have certain frames idle for many years that can be controlled with little or no treatment. Literature reports suggest that T lymphocytes in B-CLL may be unable to initiate, sustain and complete an immune response to the malignant B cell and other antigens, and may be directly involved in tumor maintenance. The lymphocytes are activated, proliferate and polarize their response patterns to pro-inflammatory or anti-inflammatory, increasing its population and becoming able to perform their effector functions. Although the process of Th lymphocyte activation is essential for host defense, there must be a homeostatic balance, where autoreactive cells are eliminated or recurrently activated. The latter mechanism of maintenance of immune balance, gives the name of Peripheral Tolerance, and the process of activation-induced cell death (AICD) is a major mechanism for its maintenance. In this study group members of the superfamily of membrane receptors of tumor necrosis factor (tumor necrosis factor receptor, TNFR) receptors were also analyzed. The TNFR family includes many receptors, including FAS (CD95) and its ligand FasL. The central objective of this study is to investigate changes in T lymphocyte compartments as Th1, Th2, Th17 and Treg as well as members of the extrinsic death pathway, FAS and FASL in CD4+ lymphocytes. The results showed that the absolute number of CD4+, CD8+ and Th1 lymphocytes is heterogeneous, with some patients showed an increase and others decrease of these cells when compared with the control group of the study. Regarding the expression of FAS and FASL results also showed heterogeneity. Thus each patient was analyzed and compared to the prognostic factors and to clinical data in each case. Much remains to be investigated, but this work has the prospects look better understanding of the role of the B-CLL CD4+ T lymphocytes, expanding the possibilities of treatment and the search for new therapeutic targets.