京都大学 / 新制・課程博士 / 博士(医学) / 甲第24795号 / 医博第4987号 / 新制||医||1066(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 小林 恭, 教授 波多野 悦朗, 教授 羽賀 博典 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Bladder cancer, as one of the most common cancer types and with high recurrence risk, is considered a candidate for novel immunotherapy strategies. An important aspect of the research for immunotherapy drug development for bladder cancer is to study the tumor microenvironment (TME) and it’s immune contexture. Besides tumor-infiltrating lymphocytes (TILs) as the main drivers of anti-tumor response, recent studies revealed the importance of tumor-associated tertiary lymphoid structures (TLSs) and high endothelial venules (HEVs) in the TME. Structures similar to these were found to spontaneously form in the orthotopic MB49 model used for bladder cancer research in our group. The aim of this study was to perform a deeper characterization of the TME in this model, by using immunofluorescent staining and microscopy. Specifically, the co-localization of tumor infiltrating lymphocytes (CD8+ and CD4+ T cells, CD19+ B cells), CD11c+ dendritic cells and HEVs along with CCL21 signaling were analyzed within orthotopic MB49 tumors, with and without immune stimulation. The quantification of cells expressing CD8, CD19 and CD11c immune markers, CCL21 levels, vascular density and numbers of HEVs, showed higher densities within the immune-stimulated tumors, indicating a rapid effect of immune stimulation on increasing immune cell infiltration and vascular density after only 24 hours post CpG therapy. Also, the highest frequency of TILs, CCL21 chemokine and vascular density was located in regions of the tumor border indicating that these regions should be studied further in depth as a potential target for entry of cells to the tumor with immunotherapy or as a model of the tumor microenvironment since tumor cell density is maintained high in these locations.

Follicular dendritic cells (FDCs) reside in the lymphoid follicles of the secondary lymphoid tissues (sLTs). Following the infection of an individual with human immunodeficiency virus type 1 (HIV-1), viral particles are trapped in massive quantities on the surfaces of FDCs. HIV-1 viral compartments are cell types or tissues between which there is a restriction of virus flow. Compartmentalization of HIV-1 creates numerous sites within the body in which the virus can undergo independent evolution, giving rise to a more diverse total viral population. Given the sessile nature of the FDC, I hypothesized that contrary to common assumptions, FDC-trapped HIV-1 is compartmentalized between different sLTs. Furthermore, given that FDC-trapped HIV-1 represents the major source of virus in the host, I postulated that this compartmentalization would likely impact the diversity of HIV-1 associated with the sLTs. I isolated FDCs, macrophages, and T cells from various sLTs, and sequenced cloned HIV-1 associated with these three cell populations. I subjected the resulting DNA and cDNA sequence data to phylogenetic and other statistical analyses. In support of my hypothesis, I demonstrate that both HIV-1 gp120 and pol sequences cloned from FDCs are compartmentalized between different sLTs. This compartmentalization is even apparent between lymph nodes taken from the same lymph node chain. One of the apparent effects of this compartmentalization is to significantly increase the viral genetic diversity in multiple sLTs when compared with diversity in a single sLT. It also appears that the selective pressures on HIV-1 differ among the sLTs. In addition, when proviruses isolated from macrophages from different sLTs were compared, it was also evident that there is compartmentalization of HIV-1 associated with this cell type as well. Finally, I demonstrate that HIV-1 isolated from an unfractionated population of cells from a single sLT, may be an inadequate representation of the total viral population in that sLT. Taken together, my data suggest that the nature of HIV-1 in the sLTs may be more complex than currently appreciated.

Primär myelofibros (PMF) är en typ av myeloproliferativ neoplasm (MPN) som leder till en progressiv och irreversibel benmärgsfibros. En somatisk mutation, Jak2V617F, har hittats hos 50 % av patienterna med MPN i hematopoetiska stamceller. Nyligen har man upptäckt grupp 2 av medfödda lymfoida celler (ILC2) som tillhör det medfödda systemet. De är T-cellernas motsvarighet men saknar TCR-receptorn. ILC2 reagerar på IL-33 och producerar Il-13. Under de senaste åren har man upptäckt att dessa två cytokiner är inblandade i PMF. För att undersöka ILC2:s roll i utvecklingen av benmärgsfibros in vivo producerade vi retrovirus som uttrycker Jak2 vildtyp (JAK2_WT) eller Jak2V617F (JAK2_V617F) och transducerade benmärg vildtyp (BM_WT) eller benmärg ILC2KO (BM_ILC2KO). Benmärgen transplanterades till subletalt bestrålade immunbristande möss (NOG). Klinikopatologiska drag som är karakteristiska för sjukdomens första stadier, som förhöjda hemoglobinnivåer, megakaryocythyperplasi och betydande trombocytos, uppstod inte under studieperioden. Ökade vita blodkroppar uppstod dock på grund av avsaknaden av ILC2 i JAK2_V617F-expressiva möss. Flödescytometeranalys visade ursprunget till den markerade leukocytosen som ett resultat av expansionen från lymfocytlinjen, mer specifikt B-celler, men resultaten är inte entydiga eftersom de förhöjda nivåerna av B-celler kan vara en följd av ILC2 knock-out fenotypen som förvärras av närvaron av mutationen. Granulocytnivåerna från de inympade cellerna hölls låga till följd av att stamcellerna i värdens benmärg var inblandade på grund av subletal bestrålning. Vi drar slutsatsen att frånvaron av ILC2 i JAK2_V617F-uttryckta benmärgsprogenitorer har en tendens att förvärra den myeloproliferativa fenotypen i sjukdomens tidiga skeden, vilket tyder på en möjlig skyddande roll för ILC2 vid utvecklingen av MPN. / Primary myelofibrosis (PMF) is one type of myeloproliferative neoplasm (MPN) that leads to a progressive and irreversible bone marrow fibrosis. A somatic mutation, Jak2V617F has been found in 50% of patients with MPN in hematopoietic stem cells. Group 2 innate lymphoid cells (ILC2) belonging to the innate system has been recently discovered. They are the counter part of T cells but lacking the TCR receptor. ILC2 response to IL-33 producing Il-13. In recent years, the involvement of these two cytokines in the PMF has been uncovered. To investigate the role of ILC2 in the progression of bone marrow fibrosis in vivo we produced retrovirus expressing Jak2 wild-type (JAK2_WT) or Jak2V617F (JAK2_V617F) and transduced bone marrow wild type (BM_WT) or bone marrow ILC2KO (BM_ILC2KO). The bone marrow was transplanted into sub-lethally irradiated immunodeficient mice (NOG). Clinicopathologic features characteristic from the first stages of the disease, as elevated hemoglobin levels, megakaryocyte hyperplasia and significant thrombocytosis did not emerge during the study period. However, increased in white blood cells arise from the absence of ILC2 in JAK2_V617F expressing mice. Flow cytometer analysis revealed the origin of the marked leukocytosis as a result of the expansion from the lymphocyte lineage, more specifically B cells, but the results are inconclusive as the elevated levels of B-cells could be a consequence of the ILC2 knock-out phenotype aggravated by the presence of the mutation. Granulocyte levels from engrafted cells were kept low because of the involvement of host bone marrow stem cells due to sublethal irradiation. We conclude that the absence of ILC2 in JAK2_V617F-express bone marrow progenitors has a tendency to aggravate the myeloproliferative phenotype in the early stages of the disease, indicating a possible protective role of ILC2 in the development of MPNs.

Asthma is an inflammatory airways disease affecting over 339 million people of all ages worldwide. More than 10% of asthmatics have uncontrolled severe disease which is insensitive to high doses of oral corticosteroid treatment. Type 2 innate lymphoid cells (ILC2) are pro-inflammatory lymphomononuclear cells proposed as critical drivers of eosinophilic inflammatory disease of the upper and lower airways. Controlling this activity may provide novel therapies for asthma. This thesis aimed to investigate factors that affect the local activation and expansion of ILC2 in the airways including anti-inflammatory medications such as (i) corticosteroids, (ii) neuro-immune regulation of ILC2, and (iii) effect of locally generated cytokines on ILC phenotypes and the relationship to the ongoing airway inflammatory profile. We firstly investigated the effect of intranasal corticosteroids on activation levels of ILC2 in the upper airway of allergic rhinitics with mild asthma following controlled nasal allergen challenge (Chapter 2). Following pre-treatment with intranasal corticosteroid there was an attenuation in the allergen-induced increase in total ILC2 and IL-5/13+ ILC2 in the nasal mucosa. In addition, HLA-DR expression on ILC2 in the nasal mucosa was down-regulated. Overnight culture with IL-2, TSLP or IFN-γ up-regulated HLA-DR expression on ILC2, in vitro; an effect that is inhibited in the presence of corticosteroids. Attenuation of HLA-DR expression by ILC2 may be an additional mechanism by which corticosteroids modulate adaptive immune responses in the airways. We have previously reported that lung ILC2 are activated within 7h following allergen-inhalation challenge. Since airway mucosal tissue is highly innervated, we investigated whether neuroimmune interactions may trigger early and rapid host immune responses (Chapter 3). In a diluent-controlled allergen-inhalation challenge cross-over study, where mild asthmatics developed early and late bronchoconstrictor responses with sputum eosinophilia (>3%), NMUR1, a receptor for the neuropeptide, neuromedin-U, was up-regulated on sputum ILC2 in 7h post allergen challenge. This was associated with increased expression of IL-5/IL-13 by sputum ILC2 post-allergen and following in vitro culture. ILC2 activation was mediated through a MAPK/PI3 kinase dependent-signaling pathway that was attenuated in the presence of dexamethasone. Co-culture with IL-33 and TSLP, in vitro up-regulated NMUR1 expression on ILC2 at the protein and transcriptomic level which was attenuated by dexamethasone. The close interplay between neuropeptide signalling and tissue-derived alarmin cytokines may be important interactions for rapid ILC2 activation in airway inflammatory responses in asthma. We have reported increased ILC2 with the highest level of IL-5/13+ ILC2 in the airways of severe asthma with uncontrolled eosinophilia (>3%). The prevalence and phenotypic analyses of innate lymphoid cells subsets in severe asthma with neutrophilic or mixed granulocytic airway inflammatory endotypes remains unclear and was investigated in Chapter 4. Sputum ILC3 were most abundant in severe asthma with neutrophilic airway inflammation where IL-17A+ ILC3 correlated with airway neutrophilia. ILC2 were predominant in severe asthma with airway eosinophilia. Importantly, we identified an intermediate ILC2 phenotype displaying ILC3-like markers (c-kit and IL-17A) in severe asthma with neutrophilic and mixed granulocytic airway inflammation. Inflammasome related cytokines, IL-1β and IL-18 were significantly increased in the airways of these patients. At both proteomic and transcriptomic levels, flow sort-purified ILC2 trans-differentiated to the intermediate phenotype when co-cultured with IL-1β+IL-18. Blocking inflammasome-related cytokines may control T2-low severe asthma exacerbations. Collectively, the findings of this thesis highlight the role of corticosteroids, neuropeptides and airway inflammasome related cytokines as modulators of ILC fate and activity in asthma. / Thesis / Doctor of Philosophy (PhD) / Asthma is a disease of the airways that makes breathing difficult. About 10% of asthma patients have uncontrolled severe symptoms despite treatment with high doses of corticosteroids which imposes many unwanted side effects. Investigating processes that worsen the disease will help to discover new treatments for asthma. Type 2 innate lymphoid cells (ILC2) are novel cells that produce large quantities of factors which attract and activate effector cells to the lungs which in turn make breathing difficult. This thesis investigated whether controlling ILC2 activity reduces asthma symptoms by studying i) responsiveness of ILC2 to corticosteroids using a controlled allergen exposure through the nose in people with allergic rhinitis and mild asthma, ii) the role of airway nerves and mediators on ILC2 activation, and iii) the ability of signals produced by the lungs to impact factors released by ILC2 and the relationship to effector cells found in the airways of severe asthma. Overall, ILC2 activation can be modulated by corticosteroids, nerve derived factors and lung tissue derived cytokines, and this is associated with changes in the number and type of effector cells in the lungs.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25004号 / 医博第5038号 / 新制||医||1070(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 長船 健二, 教授 生田 宏一, 教授 上野 英樹 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

In recent years, the genetic landscape of B-cell derived lymphoid malignancies, including chronic lymphocytic leukemia (CLL), has been rapidly unraveled, identifying recurrent genetic mutations with potential clinical impact. Interestingly, ~30% of all CLL patients can be assigned to more homogeneous subsets based on the expression of a similar or “stereotyped” B-cell receptor (BcR). Considering that biased distribution of genetic mutations was recently indicated in specific stereotyped subsets, in paper I, we screened 565 subset cases, preferentially assigned to clinically aggressive subsets, and confirm the SF3B1 mutational bias in subset #2 (45%), but also report on similarly marked enrichment in subset #3 (46%). In contrast, NOTCH1 mutations were predominantly detected in subsets #1, #8, #59 and #99 (22-34%). This data further highlights a subset-biased acquisition of genetic mutations in the pathogenesis of at least certain subsets. Aberrant NF-κB signaling due to a deletion within the NFKBIE gene previously reported in CLL warranted extended investigation in other lymphoid malignancies. Therefore, in paper II, we screened 1460 patients with various lymphoid malignancies for NFKBIE deletions and reported enrichment in classical Hodgkin lymphoma (27%) and primary mediastinal B-cell lymphoma (PMBL) (23%). NFKBIE-deleted PMBL cases had higher rates of chemorefractoriness and inferior overall survival (OS). NFKBIE-deletion status remained an independent prognostic marker in multivariate analysis. EGR2 mutations were recently reported in advanced stage CLL patients; thus, in paper III we screened 2403 CLL patients for mutations in EGR2. An overall mutational frequency of 3.8% was reported and EGR2 mutations were associated with younger age, advanced stage and del(11q). EGR2 mutational status remained an independent marker of poor outcome in multivariate analysis, both in the screening and validation cohorts. Whole-genome sequencing (WGS) of 70 CLL cases, assigned to poor-prognostic subsets #1 and #2 and indolent subset #4, were investigated in Paper IV and revealed a similar skewing of SF3B1 mutations in subset #2 and NOTCH1 mutations in subset #1 to that reported in Paper I. Additionally, an increased frequency of the recently proposed CLL driver gene RPS15 was observed in subset #1. Finally, novel non-coding mutational biases were detected in both subset #1 and #2 that warrant further investigation.

Dans les organes lymphoïdes secondaires, les lymphocytes B acquièrent des antigènes immobilisés à la surface de cellules voisines. L’engagement du BCR (récepteur des cellules B) avec de tels antigènes induit la formation d’une synapse immunologique et la polarisation des lymphocytes B. Cette polarisation inclut le repositionnement du centrosome à la synapse immunologique ainsi que le recrutement et la sécrétion locale des lysosomes qui sont nécessaires à l’extraction, l’apprêtement et la présentation des antigènes sur les molécules du complexe majeur d’histocomptabilité de classe II (CMH-II) aux lymphocytes T CD4+ pré-activés. Des travaux précurseurs menés dans le laboratoire ont permis de mettre en évidence les premiers acteurs moléculaires impliqués dans ce processus. Cependant, le mécanisme précis gouvernant la polarisation du centrosome demeure encore aujourd’hui inconnu. Le travail réalisé pendant cette thèse avait pour objectif d’identifier de nouveaux régulateurs contrôlant la polarisation du centrosome dans les lymphocytes B après engagement du BCR avec des antigènes immobilisés. De plus, au regard du rôle grandissant joué par le microenvironnement tissulaire dans l’activation des lymphocytes B ainsi que dans la modulation de leurs fonctions, nous avons étudié l’effet de la protéine extracellulaire Galectine-8 sur la régulation de la capacité des lymphocytes B à se polariser et à extraire et présenter des antigènes immobilisés. Le travail présenté dans ce manuscrit montre que la présence du complexe Arp2/3 au centrosome des lymphocytes B non activés permet la nucléation locale de filaments d’actine qui permettent, grâce à leur interaction avec le complexe LINC, de lier le centrosome au noyau. L’activation des lymphocytes B induit la déplétion partielle du complexe Arp2/3 du centrosome qui est recruté à la synapse immunologique par la protéine HS1. Ceci induit une diminution de la nucléation d’actine au centrosome entraînant la séparation entre le centrosome et le noyau et permettant la polarisation du centrosome vers la synapse. De plus, nous montrons que la présence de la protéine Galectine-8 dans le milieu extracellulaire favorise le recrutement et la sécrétion des lysosomes à la synapse immunologique, conférant aux lymphocytes B une meilleure capacité à extraire et présenter des antigènes immobilisés. Nos résultats mettent en évidence des mécanismes inattendus régulant la polarisation des lymphocytes B en réponse à une stimulation antigénique et soulèvent des questions intéressantes concernant la régulation coordonnée de ces mécanismes qui confèrent aux lymphocytes B la capacité d’extraire, d’apprêter et de présenter des antigènes immobilisés efficacement. / In secondary lymphoid organs, B cells acquire antigens that are tethered at the surface of neighboring cells. Engagement of the B cell receptor (BCR) with such immobilized antigens leads to the formation of an immune synapse and the subsequent polarization of B cells. This includes the repositioning of the centrosome towards the immune synapse as well as the recruitment and local secretion of lysosomes required for efficient antigen extraction, processing and presentation onto class II major histocompatibility complex (MHC-II) molecules to primed CD4+ T cells. Pioneer work performed in the lab has highlighted the first molecular players involved in this process. However, the precise mechanism governing centrosome polarization remains to be fully elucidated. The work performed during this thesis aimed at identifying new regulators supporting centrosome polarization in B lymphocytes upon BCR engagement with immobilized antigens. In addition, in view of the emerging role played by the tissue microenvironment in shaping B cell activation and functions we investigated whether extracellular Galectin-8 modulates the ability of B cells to polarize, extract and present immobilized antigens. We show here that, in resting lymphocytes, centrosome-associated Arp2/3 (actin related protein-2/3) locally nucleates F-actin, which is needed for centrosome tethering to the nucleus via the LINC (linker of nucleoskeleton and cytoskeleton) complex. Upon lymphocyte activation, Arp2/3 is partially depleted from the centrosome as a result of its HS1-dependent recruitment to the immune synapse. This leads to a reduction in F-actin nucleation at the centrosome and thereby allows its detachment from the nucleus and polarization to the synapse. In addition, we show that extracellular Galectin-8 favors lysosome recruitment and secretion at the immune synapse, hence providing B cells with an enhanced capacity to extract and present immobilized antigens. Our findings highlight unexpected mechanisms that tune B cell polarity in response to antigenic stimulation and raise exciting questions concerning the coordinated regulation of these mechanisms to provide B cells with the capacity to efficiently extract, process and present surface-tethered antigens.

Introdução: A leucemia linfoide aguda (LLA) \"BCR-ABL1-like\" exibe um perfil de expressão gênica semelhante ao observado em pacientes com LLA BCR-ABL1+. Este subtipo representa até 15% de todos os casos de LLA de linhagem B na população pediátrica e é frequentemente associado à presença de deleção total ou parcial do gene IKZF1. As isoformas de domínio negativo têm sido associadas a um aumento na chance de falha de resposta ao tratamento e tem sido associada com pior prognóstico. Objetivos: Analisar a presença de deleções do gene IKZF1 e a expressão de suas isoformas em amostras de medula óssea ao diagnóstico de crianças com LLA por técnica simplificada e de baixo custo de RT-PCR (reverse transcription polymerase chain reaction) e avaliar a associação desta alteração com fatores clínicos, biológicos e sobrevida. Metodologia: Foram analisadas 137 amostras de medula óssea colhidas ao diagnóstico de crianças com LLA, sendo 100 amostras de LLA de linhagem B, 35 de linhagem T e 2 na qual não foi possível a definição do imunofenópo, todas classificadas e tratadas segundo o protocolos GBTLI-99. A presença de deleções das isoformas do gene IKZF1 foi analisada por técnica de RT-PCR e confirmadas por sequenciamento automático. Associação entre deleção do IKZF1 e as variáveis idade, número de glóbulos brancos, grupo de risco, subgrupo molecular, presença de doença residual mínima e evento (recidiva ou óbito) foi analisada pelo teste exato de Fisher. Sobrevida livre de eventos, sobrevida livre de doença e sobrevida global foram avaliadas por curvas de Kaplan-Meier e teste log-rank. Análise multivariada por modelo de regressão de Cox foi utilizada para testar a independência dos fatores prognósticos. Resultados: Deleção total ou parcial no gene IKZF1 foi observada em 27/100 amostras de LLA B-derivada, sendo 15 evidenciando hiperexpressão das isoformas 6 ou 10, em 9 a expressão das isoformas foi de fraca intensidade e em 3 houve deleção total do gene. Nas amostras de LLA T-derivada foram observadas 3 alterações sendo 2 hiperexpressões da isoforma Ik6 e uma deleção total do gene. Presença de expressão forte das isoformas Ik6/Ik10 de IKZF1 foi associada na LLA B-derivada com pior sobrevida livre de eventos (SG), sobrevida livre de doença (SLD) e sobrevida global (SG)(P<0,001)). A presença de qualquer deleção do gene teve impacto apenas na SG (P=0,003). A sobrevida livre de eventos em 5 anos foi de 78,1 ± 4,6% versus 32 ± 12,4 % (P< 0,001), para os grupos sem e com expressão forte das isoformas Ik6/Ik10 forte de IKZF1 respectivamente, com risco relativo de evento desfavorável de 6.034 (95% IC: 2,105 - 17,295) para a presença da deleção. Análise multivariada por modelo de regressão de Cox nas LLA de linhagem B mostrou que expressão forte das isoformas Ik6/Ik10 foi o principal fator prognóstico independente (P<0.001) quando analisada em associação com idade, imunofenótipo (ausência de CD10), status da medula óssea no D28 da terapia de indução (M2/M3) e presença de DRM no D28 da indução tanto para SLE, quanto para SLD e SG. Nossos dados sugerem que o uso de técnica simplificada e de baixo custo para análise de deleções do gene IKZF1 é capaz de detectar pacientes com maior risco de recidiva, podendo ser útil na estratificação de pacientes com LLA de linhagem B em futuros protocolos de tratamento. Estudos multicêntricos com maior número de casos são necessários para confirmação destes resultados. / Introduction: Acute lymphoblastic leukemia (ALL) \"BCR-ABL1-like\" exhibits a gene expression profile similar to that observed in patients with BCR-ABL1 + ALL. This subtype accounts for up to 15% of all B lineage ALL cases in the pediatric population and is often associated with the presence of total or partial deletion of the IKZF1 gene. Negative domain isoforms have been associated with an increased chance of treatment failure and have been associated with poorer prognosis. Objectives: To analyze the presence of deletions of the IKZF1 gene and the expression of its isoforms in bone marrow samples to the diagnosis of children with ALL by simplified technique and lowcost RT-PCR (reverse transcription polymerase chain reaction) and to evaluate the association of this with clinical, biological and survival factors. Methodology: It has been analyzed 137 bone marrow samples collected at the diagnosis of children with ALL, 100 samples of ALL B lineage , 35 of T lineage and 2 in which it was not possible to define the immunophenotype, all classified and treated according to GBTLI protocols -99. The presence of deletions of the IKZF1 gene isoforms was analyzed by RT-PCR technique and confirmed by automatic sequencing. The association between IKZF1 deletion and the variables age, white blood cell count, risk group, molecular subgroup, presence of minimal residual disease and event (recurrence or death) were analyzed by the Fisher exact test. Event-free survival, disease-free survival and overall survival were assessed by Kaplan-Meier curves and log-rank test. Multivariate analysis by Cox regression model was used to test the independence of prognostic factors. Results: Total or partial deletion in the IKZF1 gene was observed in 27/100 samples of B-derived ALL, 15 of which showed hyperexpression of isoforms 6 or 10, in 9 the expression of the isoforms was of low intensity and in 3 there was total deletion of the gene . In the T- derived ALL samples, 3 alterations were observed, 2 hyperexpressions of the Ik6 isoform and a total deletion of the gene. The presence of strong Ik6/Ik10 isoform expression was associated in B-derived ALL with worse event-free survival (SLE), disease-free survival (SLD), and overall survival (OS) (P <0.001). The presence of any deletion of the gene had an impact only on the SLE (P = 0.003). The 5-year event-free survival was 78.1 ± 4.6% versus 32 ± 12.4% (P <0.001), for the groups with and without a strong deletion of IKZF1 respectively, with relative risk of unfavorable event of 6,034 (95% CI: 2,105 - 17,295) for the presence of the deletion. Multivariate analysis by Cox regression model in B lineage ALL showed that the strong expression of Ik6 / Ik10 isoforms was the main independent prognostic factor (P <0.001) when analyzed in association with age, immunophenotype (absence of CD10), marrow status bone in D28 of induction therapy (M2 / M3) and presence of DRM in induction D28 for both SLE, SLD and SG. Our data suggest that the use of simplified and low-cost IKZF1 gene deletion analysis is capable of detecting patients at higher risk of relapse and may be useful in the stratification of patients with B lineage ALL in future treatment protocols. Multicentric studies with a greater number of cases are necessary to confirm these results.

Compreender a função das diferentes proteínas e citocinas durante a vigência de alterações inflamatórias pode contribuir para um melhor conhecimento do sistema imunológico dos mamíferos marinhos e sua relação com os processos patológicos. A toninha, Pontoporia blainvillei, é um cetáceo costeiro e o único golfinho brasileiro considerado ameaçado de extinção devido às atividades antrópicas. O objetivo desse trabalho foi avaliar as imunoexpressões das citocinas TGF-&beta;, TNF-&alpha; e IL-12 e proteínas S-100 e lisozima em amostras pulmonares e esplênicas de 34 espécimes de P. blainvillei. Com base nas alterações histopatológicas, os animais foram divididos em dois grupos: G1 (n = 8) - animais sem doença inflamatória pulmonar; G2 (n = 26) - animais com doenças inflamatórias pulmonares. Os fragmentos de pulmão e baço foram processados de acordo com os protocolos de rotina. A padronização das reações de imuno-histoquímica e análise morfométrica foram realizadas conforme procedimentos descritos na literatura. Os nossos dados demonstram que as P. blainvillei pertencentes ao G2 apresentam imunoexpressão pulmonar das citocinas TGF-&beta;, TNF-&alpha; e IL-12 e proteínas S-100 e lisozima significativamente maior que os animais do G1. Tais resultados corroboram os dados disponíveis na literatura, indicando que a P. blainvillei apresenta citocinas com funções semelhantes às encontradas em outros mamíferos.Evidenciamos também, que as P. blainvillei pertencentes ao G2 não apresentam imunoexpressão esplênica das citocinas TGF-&beta;, TNF-&alpha; e IL-12 e da proteína lisozima significativamente maior que os animais do G1. Estudos mais detalhados, incluindo aqueles relacionados com os métodos utilizados, são necessários para a adequada compreensão destes resultados. E finalmente, apesar de tratar-se de dados ainda preliminares, observou-se uma possível associação entre elevadas concentrações de organoclorados no tecido adiposo subcutâneo de parcela dos exemplares de P. blainvillei estudados na presente investigação e a ocorrência de depleção linfóide esplênica nestes animais. Tais dados ratificam a importância do desenvolvimento de análise mais detalhada sobre estes tópicos em futuras investigações científicas. / The understanding of the role of different proteins and cytokines during the inflammatory diseases could lead to better knowledge of the marine mammal immune system and its relation to pathological process. Franciscana dolphin, Pontoporia blainvillei, is a coastal cetacean and the only Brazilian dolphin considered threatened with extinction, due to the human activities. The aim of the current study was to investigate the immunoexpression of TGF-&beta;, TNF-&alpha; and IL-12 cytokines, and S-100 and Lysozyme proteins in pulmonary and splenic samples of 34 Pontoporia blainvillei. Based on histopathological examination, the animals were divided in two groups: G1 (n = 8) animals without pulmonary inflammatory disease; G2 (n = 26) animals with pulmonary inflammatory diseases. Fragments of lung and spleen were processed according to routine protocols. The immunohistochemistry and morphometric procedures were tested and optimized according to proceedings described in literature. Our results showed that P. blainvillei from G2 presented significant increase in the pulmonary immunoexpression of TGF-&beta;, TNF-&alpha; and IL-12 cytokines, and S-100 and Lysozyme proteins in comparison with animals from G1. These results are according to the literature and suggest that P. blainvillei presents same cytokines observed in other mammals. We evidenced also that the P. blainvillei belonging to the G2 did not show splenic immunoexpression to TGF-&beta;, TNF-&alpha; and IL- 12 cytokines and Lysozyme protein significantly higher than animals from G1. Further studies, including those related to the methods used, are necessary for the proper understanding of these results. And finally, although these are still preliminary data, we observed a possible association between high concentrations of organochlorines in subcutaneous adipose tissue of a portion of P. blainvillei studied in this research and the occurrence of splenic lymphoid depletion in these animals. These data confirm the importance of developing more detailed analysis on these topics in future scientific investigations.