Orientador: Albina Messias de Almeida Milani Altemani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T08:50:10Z (GMT). No. of bitstreams: 1 Barreto_IcleiaSiqueira_M.pdf: 3099004 bytes, checksum: e7104aa2bedc2fa4b0a6e9751cf9a4d1 (MD5) Previous issue date: 2006 / Resumo: Pólipos linfóides tonsilares são lesões pouco comuns que têm sido raramente estudadas. Nosso objetivo foi descrever as características clínicas, histopatológicas e imunoistoquímicas em seis pólipos tonsilares, cujo tecido linfóide representava mais que 80 % da lesão, comparando-as com as tonsilas palatinas-controles. Os sintomas apresentados foram de massa tonsilar e/ou disfagia. Não foram detectados fatores predisponentes. Microscopicamente, todos os pólipos continham folículos com centros germinativos, criptas revestidas por linfoepitélio e pequena quantidade de tecido fibroso no centro da lesão. Células B (CD 20+), células T (CD45RO+), plasmócitos (kappa+ e lambda+) e vasos (linfáticos ¿D2-40+ e sanguíneos ¿CD34+), apresentaram distribuição e padrão arquitetural como o esperado para o tecido linfóide da tonsila palatina. Pólipos linfóides tonsilares são, provavelmente, hamartomas caracterizados por um crescimento exagerado dos elementos linfóides, mantendo um padrão arquitetural e uma composição celular similar àquela da tonsila palatina / Abstract: Tonsillar lymphoid polyps are uncommon lesions which have rarely been studied. We aim to describe the clinical, histopathologic, and immunohistochemical features of six tonsillar polyps in which lymphoid tissue represented more than 80% of the lesion, comparing them with sixteen control tonsils. Presenting symptoms were tonsillar mass and/or dysphagia. No predisposing factor was detected. Microscopically all polyps contained follicles with germinal centers, crypts lined by lymphoepithelium and a small amount of fibrous tissue in the centre of the lesion. B cells (CD20+), T cells (CD45RO+), plasma cells (kappa+ and lambda+) and vessels (lymphatic - D2-40+ and blood ¿ CD34+) presented distribution and architectural patterns as expected for lymphoid tissue of a palatine tonsil. Tonsillar lymphoid polyps are possibly hamartomas characterized by overgrowth of lymphoid elements which maintain an architectural pattern and cellular composition similar to those of the palatine tonsil / Mestrado / Anatomia Patologica / Mestre em Ciências Médicas

Marginal zone (MZ) lymphomas (MZLs) represent a group of lymphomas originating from B lymphocytes of the “marginal zone” which is the external part of the secondary lymphoid follicles. The WHO classifies MZL into 3 entities; extranodal MZL, splenic MZL and nodal MZL. Extranodal marginal zone lymphoma (EMZL) can arise in different tissues, including the stomach, salivary gland, lung, small bowel, thyroid, ocular adnexa and skin. We present a 25 years old female with a history of angioedema and chronic cutaneous eczema who developed an unusual EMZL. Patient presented with a history of rapidly enlarging skin nodule on her left elbow that had been present for almost one year. Over a period of 2-3 weeks she felt the nodule rapidly changed in size and shape. Excisional biopsy of the mass revealed a lymphoid infiltrate based in the reticular dermis and focally extending into the subcutaneous adipose tissue with formation of disrupted lymphoid follicles positive for CD20, CD23 and BCL2 but negative for CD10, Cyclin D1 and SOX11. Diagnosis was consistent with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). Patient on presentation did not have any B symptoms other cutaneous lesions, lymphadenopathy or hepatosplenomegaly. PET scan revealed no evidence of abnormal uptake leading to a final Stage IE definition. Patient initiated definitive radiation therapy. EMZL accounts for 5 -10 % of non-Hodgkin lymphoma. It has been described often in organs that are normally devoid of germinal centers. It may arise in reactive lymphoid tissue induced by chronic inflammation in extranodal sites. Primary cutaneous marginal zone lymphoma (PCMZL) is associated with infectious etiologies such as Borrelia burgdorferi and less commonly with viral infections or in relation to autoimmune disorders. Autoimmune disorders, specifically Sjögren's syndrome is associated with a 30-fold increased risk of marginal zone lymphoma. Localized disease can be treated by local radiotherapy, intralesional injections or excision. Widespread skin disease is usually treated with a CD20 directed monoclonal antibody-Rituximab. Patients with PCMZL usually have an indolent clinical course. Extracutaneous dissemination of MALT Lymphoma is uncommon and happens in 6-8 % of patients. The 5 years overall survival is between 98-100%. Family physicians and dermatologists should have a high index of suspicion for this rare lymphoma subtype especially in patients with inflammatory chronic skin conditions and atopy.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20246号 / 医博第4205号 / 新制||医||1020(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 杉田 昌彦, 教授 髙折 晃史 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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

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

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 112-132).

During virus infections, activation of CD8 T cells takes place in secondary lymphoid organs including spleen and lymph nodes. The kinetics of the T cell response in lymphoid tissues has been clearly studied. However, a large number of virus-specific T cells disseminate into various nonlymphoid tissues. As reservoirs for effector and memory cells, nonlymphoid organs play an important role for defending against infections. T cell responses in nonlymphoid organs may differ from lymphoid organs. T cell repertoire usage in lymphoid and nonlymphoid tissues was studied in an acute lymphocytic choriomeningitis virus (LCMV)-infected murine model. The hierarchy of CD8 T cell specificities was examined with cytotoxic T lymphocyte (CTL) sodium 51 chromate (51Cr) release assays and intracellular interferon (IFN)γ assays. T cell receptor (TCR) repertoire usage was determined by complementarity determining region (CDR)3 length spectratyping analysis. Both T cell specificity and TCR repertoire usage revealed some similarities and differences between several organs. Within an epitope-specific CD8 T cell population, the TCR repertoire usage was similar in different organs of the same mouse, but highly heterogeneous between individual mice with genetically identical backgrounds. A very restricted CD4 TCR repertoire was observed in BALB/c mice after secondary respiratory syncytial virus (RSV) infection. Most of the CD4 T cells of BALB/c mice pre-immunized with RSV glycoprotein (GP) predominantly express Vβ14 TCR with discrete oligoclonal CDR3 regions. Depletion of Vβ14 CD4 T cells dramatically reduced immunopathology. The apoptotic phenotype of LCMV-specific CD8 T cells was studied in various lymphoid and nonlymphoid tissues during acute and memory stages of infections. Peripheral tissues (peritoneal cavity (PEC), fat pad, and lung) reacted with a much lower frequency with the early apoptotic marker Annexin V than those in spleen and lymph nodes. This was not due to a TCR-based selection because similar TCR spectratypes were seen in different organs. Activated lymphoid and nonlymphoid T cells from LCMV GP33 transgenic mice, which have identical TCR α and β chains on all T cells, had differential Annexin V binding. When incubated shortly in vitro, most Annexin V+ T cells rapidly fragmented their DNA and became terminal transferase-mediated dUTP nick end-labeling positive (TUNEL+), while much fewer Annexin V- cells became TUNEL+. Therefore, those Annexin-V+ cells were truly in a pre-apoptotic stage. The differential spontaneous apoptosis in different tissues is independent of several death/survival-related molecules, including Fas/Fas ligand (FasL), turner necrosis factor (TNF)α, interleukin (IL-15), perforin, B cell lymphoma (Bcl)-2 and independent of virus tropism. I further investigated the significance of the high Annexin V reactivity of lymphoid T cells. Pre-apoptotic cells were prevented from fragmenting their DNA by anti-CD3 or IL-2 stimulation in vitro. However, this pre-apoptotic phenotype precluded generation of memory. Annexin V reactive cells did not give rise to long-lived memory after being transferred into naïve hosts. The pre-apoptotic phenotype is also an intrinsic property of the epitope. Different proportions of apoptotic cells were found in LCMV effector and, memory T cells specific to two different epitopes, nucleoprotein (NP)396 and GP33. Higher Annexin V reactivity of NP396-specific CD8 T cells was independent of virus tropism and duration of encounter with antigen. Higher expression of IL-7R was found in peripheral, Annexin V- and GP33-specific CD8 T cells, indicating that IL-7-dependent signals may inhibit apoptosis. Nonlymphoid T cells were more resistant than lymphoid T cells to activation-induced cell death (AICD). When stimulated with anti-CD3 in vitro for 40 hours (hr), a significantly reduced number of splenic transgenic T cells were recovered with much higher frequency of Annexin V reactivity and TUNEL staining than transgenic T cells from PEC. Consistent with the finding that Fas and FasL regulates AICD, a much lower expression of Fas and FasL was observed in PEC and lung transgenic T cells than spleen and lymph nodes after short time stimulation. FasL blockage largely increased cell-number recovery and reduced Annexin V and TUNEL staining of spleen transgenic T cells. Interestingly, the leukocyte environment played an important role of deciding the fate of transgenic T cells. When placing activated spleen transgenic T cells with excess infected PEC cells, spleen transgenic cells rapidly reduced their Annexin V staining and TUNEL staining and were recovered with greater number after stimulation. Vice versa, PEC transgenic T cells became Annexin V and TUNEL positive with lower numbers of cells recovered when placed with excess splenocytes. Less detection of Annexin V+ cells in peripheral tissues was not due to rapid phagocytosis by macrophages, because Cytochalasin D, which can inhibit phagocytosis, did not induce equal amount of pre-apoptotic cells in spleen and PEC. This reduced death in the periphery may contribute to the long-term maintenance of nondividing nonlymphoid memory T cells, enabling them to efficiently function without being driven into apoptosis. Overall, this study characterizes in detail the different T cell repertoire usage and apoptosis of virus-specific T cells based on their organ localization and specificities and helps to better understand T cell immunity after infections and vaccine design.

L’atteinte de l’âge sur les populations lymphocytaires T conventionnelles CD4 et CD8 avec l’avancée en âge est relativement bien décrite en périphérie lymphoïde secondaire chez la souris, et dans le sang périphérique chez l’homme. Deux paramètres sont observés : réduction du nombre de ces cellules et altération du ratio naïve/mémoire. À l’inverse, l’évaluation des tissus lymphoïdes tertiaires et des tissus extra lymphoïdes dans les réponses immunes, reste à affiner. Notre étude au cours du vieillissement physiologique du compartiment T fut menée dans des tissus lymphoïdes et non lymphoïdes de souris C57BL/6 wild-type, âgées entre 2 et 6 mois, entre 10 et 14 mois et entre 22 et 26 mois. Nous avons démontré que la lymphopénie T classiquement décrite liée au vieillissement dans les organes lymphoïdes secondaires ne s’applique pas à tout l’organisme : les compartiments intestinaux étudiés présentent une accumulation de cellules TCRαβ+ CD4+ (TCD4) et CD8+ (TCD8). Nos résultats dévoilent un impact différentiel du vieillissement sur le nombre absolu des différents compartiments cellulaires TCRαβ+ dans les organes lymphoïdes et la muqueuse intestinale. Ces résultats suggèrent donc que la lymphopénie T décrite dans les organes lymphoïdes s’établissant au cours du vieillissement pourrait être essentiellement liée à une redistribution des lymphocytes. A l’inverse, la persistance des cellules T régulatrices dans les organes lymphoïdes secondaires pourrait être liée à une production locale dans la muqueuse intestinale. Il semble donc que l’équilibre TCD8/TCD4 peut être différemment affecté selon le site considéré et cette observation peut fournir une justification pour la plus grande susceptibilité aux infections observée avec l’âge. / Consequences of ageing on conventional CD4 and CD8 T lymphocytes populations is relatively well described in murine secondary lymphoid organs and in human peripheral blood: reduction the number of these cells and alteration of naïve/effector-memory ratio in favour of effector-memory cells. Conversely, evaluation in tertiary lymphoid tissues and non-lymphoid tissues remains to be refined. We conducted an exhaustive analysis of T cell compartments during physiological aging in lymphoid and non-lymphoid tissues isolated from wild-type C57BL/6 mice aged of 2 to 6 months, 10 to 14 months and 22 to 26 months. We demonstrated that T lymphopenia described classically associated with aging in the secondary lymphoid organs does not apply to the whole organism: intestinal compartments studied show an accumulation of TCRαβ+ CD4+ cells (TCD4) and CD8+ (TCD8). Our results reveal a differential impact of aging on the absolute number of different TCRαβ+ cellular compartments in lymphoid organs and intestinal mucosa. T cell lymphopenia in secondary lymphoid organs currently associated to ageing may essentially reflect T cell redistribution. TCD8/TCD4 balance may be affected differently depending on the site considered and this observation may provide a rationale for the greater susceptibility to infection observed with age.

La première étape de la réponse immune est réalisée par des cellules "sentinelles": les cellules dendritiques (DC). Elles ont à la fois un rôle de surveillance de l’organisme et une capacité unique à alerter les lymphocytes T naïfs. Leur efficacité à présenter des antigènes rencontrés en périphérie à des lymphocytes résidant dans les organes lymphoïdes résulte d’une spécialisation de fonction au cours du temps. A l’état immature, elles capturent et apprêtent les antigènes protéiques au niveau de divers organes, mais ont une faible capacité stimulatrice. Par contre, à l’état mature, elles perdent la capacité de capturer des antigènes, acquièrent celle de sensibiliser des lymphocytes T et migrent vers les organes lymphoïdes. <p>Cependant, des DC immatures sont présentes dans les organes lymphoïdes en contact avec les cellules T laissant supposer qu’elles pourraient jouer d’autres rôles que celui de sentinelles. <p><p>L’immunisation de souris par injection de DC immatures ou matures nous a permis de mettre en évidence un rôle potentiel des DC immatures. Ces dernières induisent en effet une prolifération des cellules T CD4 et leur différenciation en cellules de mémoire en absence de réponse primaire effectrice (absence d’IFN-& / Doctorat en sciences, Spécialisation biologie moléculaire / info:eu-repo/semantics/nonPublished

Keloid disease (KD) is a benign fibroproliferative dermal disease of unknown aetiopathogenesis that occurs in genetically susceptible individuals. KD shows high heterogeneity within the lesion, harbouring different immune cell profiles, which are poorly characterised in KD at different lesional sites. Although, it has long been appreciated that chronic inflammation and dermal fibrosis is associated with other fibrotic diseases (e.g. scleroderma), this link has not, yet, been established in KD through direct evidence. Additionally, the limited availability of a simple KD animal model has hindered our understanding of the underlying pathogenesis of KD. Therefore, the main objectives were a) to identify and profile different immune cells at defined KD lesional and histological sites, b) to further characterize the potential contribution of viral particles in KD by investigating the gene and protein expression profile of toll like receptors that recognise viral particles in KD, and c) to develop an optimized long-term serum-free organ culture (OC) model for KD research as a tool for probing novel hypotheses in KD pathobiology deduced from a) and b) and to also validate the reliability and instructiveness of this novel ex vivo KD model with conventional (e.g. dexamethasone) and potential future anti-KD compounds [(-)-epigallocatechin-3-gallate (EGCG) and plasminogen activator inhibitor-1 (PAI-1) knock-down by siRNA]. To achieve above objectives, different cellular and molecular techniques were applied. Immune profiling of KD (chapter 2) at defined lesional and histological sites generated the first comprehensive analysis of KD-associated inflammatory cell infiltrates. This work demonstrated for the first time the presence of specific type of chronic inflammation in KD that resembles the formation of tertiary lymphoid tissues (TLTs) (in 14.7%, out of 68 KD cases). Although, these TLTs are not strictly linked to defined lesional sites within the KD, they are similar in structure to mucosa-associated lymphoid tissue (MALT). Therefore, we named this phenomenon as keloid-associated lymphoid tissue (KALT). Immunophenotyping of KD lesional sites also showed a predominance of T-cells, B-cells, M2 macrophages and OX40L+ degranulated mast cells in intralesional and perilesional sites of KD compared to normal skin and normal scar tissue. In the epidermis, Langerhans cells showed no changes, whereas the intra-epidermal T-cells were significantly increased in both the intralesional and perilesional sites of KD with an increased CD4:CD8 ratio. Intra-epidermal B-cells were only rarely found in KD. Interestingly, there was no significant statistical difference between intralesional and perilesional sites of KD immunophenotyping. These abnormal immune profiles suggest the persistence of non-resolving inflammation presence towards unknown stimuli, which require further investigation. The chronic inflammation could be followed by a reparative phase in a repetitive manner leading to KD formation. Evaluation of toll-like receptor (TLR) gene and protein expression in KD showed a significant increase in the expression of intra-epidermal TLR-6, -7 and dermal TLR-8. Since these TLRs are typically up regulated during anti-viral responses, these results further support the hypothesis that certain viruses or yet unidentified ligand may play a role in KD pathogenesis (chapter 3). A successful long-term, serum-free keloid OC model was established using a 4 mm sized punch biopsy embedded in collage matrix as air liquid interface in supplemented William’s E medium for up to 6 weeks (Chapter 4).