Orientador: Maria Aparecida Custódio Domingues / Resumo: O linfoma difuso de grandes células B (LDGCB) integra o grupo das neoplasias malignas hematopoiéticas classificado como linfomas não-Hodgkin e representa o subtipo mais prevalente no Brasil e no mundo. Ao seu diagnóstico, segue-se um estadiamento clínico denominado Classificação de Ann-Arbor/Lugano, visando estimar o tratamento. Neste estadiamento, além de exames laboratoriais, parâmetros clínicos e imagens radiológicas, faz-se avaliação da medula óssea (MO) para pesquisa de infiltração neoplásica. O presente estudo comparou a análise unicamente morfológica da MO em relação à combinação da morfologia com imunoistoquímica (IHQ) na detecção de infiltração neoplásica medular em pacientes com LDGCB. Para isso, realizou-se levantamento retrospectivo de 113 pacientes diagnosticados com LDGCB submetidos a biópsia/aspirado de MO para estadiamento. Informações clínicas foram levantadas nos prontuários médicos e as lâminas histológicas de biópsias e coágulos de MO foram revisadas quanto a seus aspectos morfológicos. Procedeu-se estudo IHQ com os marcadores CD20 e CD3, sendo este o padrão ouro. A sensibilidade da análise morfológica isolada foi de 42,9%, considerada baixa se considerarmos que esta serviria como um exame de triagem. A quantidade de acúmulos linfoides (AcL) na MO e o aumento de trama reticulínica no acúmulo linfoide mostraram p-valor respectivamente de 0,02, para uma mediana de 2 acúmulos, e 0,01 para uma mediana de trama reticulínica de II, mostrando assim existir uma re... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Diffuse Large B Cell Lymphoma (DLBCL) belongs to a group of hematopoietic malignancies called Non-Hodgkin's Lymphomas, being the most prevalent in Brazil. After the diagnosis is followed a staging, called Ann-Arbor/Lugano classification, aiming to estimate the treatment. This staging, in addition to laboratory exams, clinical parameters and radiological images, includes the histological evaluation of bone marrow (BM) for the investigation of neoplastic infiltration. The present study compared BM morphological analysis only and morphology combined with immunohistochemistry (IHC) to detect BM infiltration in patients with DLBCL. For this, a retrospective survey was performed on 113 patients diagnosed with LDGCB submitted to biopsy / aspiration for BM staging. Clinical information was reviewed from medical records and histological biopsy and clots were reviewed for morphological aspects. The IHQ study was performed with CD20 and CD3 markers. The sensitivity of the isolated morphological analysis was 42.9%, considered low if we remember that this evaluation would serve as a screening test. The amount of lymphoid agreggates in BM and the increase in reticulin stain into the lymphoid agreggates showed p-value respectively of 0.02 and a median of 2 agreggates and 0.01 for a grade II reticulin, thus showing a relation of these two morphological parameters with BM infiltration. After this, we can conclude that the isolated morphological analysis is not recommended, and should always b... (Complete abstract click electronic access below) / Mestre

Les lymphomes B non-Hodgkiniens (LNHB) représentent le type d’hémopathie maligne le plus fréquent. Ces pathologies sont traitées par l’association de chimiothérapies conventionnelles et d’immunothérapies dirigées contre le CD20. Bien qu’efficace, 40% des patients résistent ou rechutent après le traitement. Deux raisons peuvent expliquer ces échecs thérapeutiques : 1) l’absence de cibles thérapeutiques impliquées dans plusieurs processus oncogéniques et 2) l’absence de modèles pré-cliniques de LNHB pertinents pour le test de molécules thérapeutiques et la compréhension de la lymphomagenèse. Le calcium est un messager ubiquitaire qui est impliqué dans de nombreux processus cellulaires en condition physiologique et pathologique. La principale voie d’entrée de calcium dans les lymphocytes B est l’entrée capacitive de calcium médiée par Orai1 et STIM1. Ces deux protéines ont été largement décrites pour être impliquées dans les processus tumoraux de nombreux cancers, cependant leurs rôles dans la lymphomagenèse restait à élucider. Nos travaux ont révélé l'implication de la signalisation calcique dans la mort induite par le GA101, un anti CD20 de nouvelle génération actuellement en essai clinique. De plus, nous avons mis en évidence l’implication des protéines Orai1 et STIM1 dans la migration des cellules cancéreuses de LNHB. De manière intéressante, l’implication de ces deux protéines dans la migration cellulaire est calcium indépendante, suggérant donc un nouveau rôle de ces protéines. Enfin, grâce à la technologie des capsules cellulaires nous avons établi un nouveau modèle 3D de lymphome mimant la niche tumorale en incluant des cellules du microenvironnement et de la matrice extracellulaire. Ce modèle semble particulièrement pertinent pour le screening de molécules et la compréhension des mécanismes de la lymphomagenèse. Ce travail de thèse révèle ainsi le ciblage de Orai1 et STIM1 comme potentiellement intéressant dans le traitement du LNHB. / B-cell non-Hodgkin lymphomas (BNHL) are the most common hematological malignancies, usually treated with a combination of chemotherapy and anti CD20 immunothérapie. However, 40% of patients are resistant or relapse after treatment. These therapeutic failures could be due to 1) lack of therapeutic targets implicated in several oncogenic processes, 2) lack of relevant preclinical BNHL models for drug screening and lymphomagenesis studies. Calcium is an essential second messenger involved in various cell functions. In B cells, calcium entry is mainly due to Orai1 and STIM1 proteins, both of which have been associated with oncogenesis on solid tumors. However, their role in lymphomagenesis still remains to be elucidated. Our work shows that calcium signaling in BNHL cells participates in cell death induced by GA101, a novel anti-CD20 monoclonal antibody. We also demonstrate that Orai1 and STIM1 play a role in BNHL cell migration. Interestingly, both proteins controlled cell migration in a calcium-independent manner, suggesting a new role for these proteins. Finally, using cellular capsule technology, we established a new BNHL 3D model mimicking tumoral niche by including extracellular matrix and stromal cells. This new model could be used for drug screening and understanding lymphomagenesis. In summary, this work suggests that targeting of Orai1 and STIM1 is promising for BNHL treatment.

O linfoma de Burkitt (LB) é neoplasia linfóide de células B de alto grau que apresenta translocação constante envolvendo o proto-oncogene C-MYC. A associação com o vírus de Epstein-Barr (EBV) varia de acordo com a forma clinicopatológica. O presente estudo tem por objetivo analisar as características clinicopatológicas, imunoistoquímicas, incluindo a expressão do fator de transcrição MUM1/IRF4 e das proteínas p53 e p63, e investigar a associação com infecção pelo Herpesvírus humano 8 (HHV-8) e EBV, através de hibridização in situ e PCR, em 234 casos bem caracterizados de LB no Brasil, provenientes das 5 regiões geográficas em pacientes pediátricos e adultos, incluindo casos associados ao HIV. As características clínicas do LB no Brasil, de maneira geral, foram semelhantes às observadas na forma esporádica do LB ocorrendo nos países desenvolvidos. A infecção pelo EBV foi observada em 52,5% dos casos. A maior associação com EBV foi verificada nas regiões Norte e Nordeste e a menor na região Sul. Através de PCR, demonstrou-se predomínio de EBV do tipo A, sendo exceção a região Centro-Oeste. O fator de transcrição MUM1/IRF4 foi expresso em 39,2% dos tumores e apresentou correlação inversa com infecção pelo EBV. A expressão das proteínas p53 e p63 foi observada em 16,2% e 3,8% dos casos, respectivamente. Não se identificou infecção pelo HHV-8. O LB no Brasil apresenta características clinicopatológicas variáveis entre as regiões geográficas. A associação com infecção pelo EBV é intermediária entre a forma endêmica de LB e a forma esporádica ocorrendo em países desenvolvidos, sendo maior em regiões com indicadores sociais menos favoráveis. / Burkitt lymphoma (BL) is a high grade B cell lymphoma with a consistent translocation involving the proto-oncogene C-MYC. The association with the Epstein-Barr virus (EBV) varies depending on the clinicopathological form. This study aims to analyze the clinicopathologic, immunohistochemical features, including the expression of transcription factor MUM1/IRF4 and p53 and p63 proteins, and investigate the association with infection by human herpesvirus-8 (HHV-8) and EBV, by in situ hybridization and PCR, in 234 well-characterized cases of BL in Brazil from the 5 different geographic regions, in adult and pediatric patients, including HIV associated cases. The clinical characteristics of BL in Brazil, in general, were similar to those observed in the sporadic form of BL occurring in developed countries. EBV infection was seen in 52.5% of cases. The strongest association with EBV was found in the North and Northeast and the lowest in the South. PCR study demonstrated predominance of EBV type A, except in the Central-West region. The transcription factor MUM1/IRF4 was expressed in 39.2% of the tumors and showed inverse correlation with EBV infection. The expression of p53 and p63 proteins was observed in 16.2% and 3.8% of cases, respectively. No evidence of HHV-8 infection was found. The BL in Brazil is clinicopathologic diverse and regionally distinct. The association with EBV infection is intermediate between the endemic form of BL and sporadic form occurring in developed countries and is higher in regions with the less favorable social indicators

Pacientes com linfoma difuso de grande célula B (LDGCB) do mesmo grupo de risco pelos critérios do Índice de Prognóstico Internacional (IPI), tratados com quimioterapia convencional à base de antraciclina, podem ter resposta terapêutica não esperada para seu grupo de risco. Isso pode ser explicado pelo fato do prognóstico dos LDGCB, que têm origem no centro germinativo (CG), ser superior aos originados após o CG (NCG). No intuito de aprimorar a avaliação de prognóstico e a abordagem terapêutica em LDGCB de IPI ajustado para a idade (IPIa) de risco intermediário alto e alto, elaboramos projeto de pesquisa, para verificar o papel dos marcadores imuno-histoquímicos (IH) e do transplante de medula óssea autólogo (ATMO), em primeira remissão completa (RC), neste grupo de pacientes. Avaliamos o impacto da expressão dos marcadores CD10, Bcl-6, MUM-1, Bcl-2 e p63 na obtenção de RC, sobrevida livre de doença (SLD) e sobrevida global (SG), isoladamente e de acordo com a origem em CG e NCG. Avaliamos 82 pacientes abaixo dos 60 anos, dos quais 16 (19,5%) receberam ATMO em primeira RC, além de serem comparados com os pacientes tratados com quimioterapia convencional e mantidos em observação após RC. A IH foi avaliável em 73 casos, 24 (32,9%) tiveram origem no CG e 49 (67,1%) NCG, sem diferença de sobrevida entre os grupos. A proteína Bcl-2 foi positiva em 27 (37%) pacientes e foi o único fator preditivo independente para SG à análise multivariada, com tendência de significância para RC. As SG e SLD em cinco anos para os 16 pacientes que receberam ATMO foi de 75% e 85,2%, respectivamente, a taxa de recidiva de 6,5% e diferença estatisticamente significativa para SLD (p = 0,015) em comparação aos pacientes apenas observados. Concluímos que o ATMO foi seguro e capaz de melhorar a sobrevida em LDGCB de risco intermediário alto e alto, e que a expressão de Bcl-2 pode ser utilizada na programação terapêutica inicial desses pacientes. / Diffuse large B cell lymphoma (DLBCL) patients from the same risk group according to the International Prognostic Index (IPI) treated with conventional anthracycline-based chemotherapy may show an unexpected therapeutic response. This can be explained by the fact that the prognosis of DLBCL originating in germinal center (GC) cells is superior than that originating out of germinal center (NGC). In order to improve the prognostic evaluation and the therapeutic approach to DLBCL patients with high intermediate to high age-adjusted IPI (aIPI), a research project was designed for the analysis of immunohistochemical markers and the role of autologous stem cell transplantation (ASCT) in first complete remission (CR) for this group of patients. The impact of the expression of CD10, Bcl-6, MUM-1, Bcl-2 and p63 markers on complete remission (CR), disease-free survival (DFS) and overall survival (OS), either individually and according to cell origin was evaluated by means of immunohistochemistry. Eighty-two patients aged under 60 years old were assessed, of which 16 (19.5%) underwent ASCT in first CR and were compared to patients receiving conventional chemotherapy and being monitored after CR. Immunohistochemistry was assessable in 73 cases, 24 (32.9%) being classified as GC-type and 49 (67.1%) as NGC-type, with no survival difference between the two groups. Bcl-2 expression was found in 37% (27) of the patients and was the single independent predicting factor of OS prognosis according to multivariate analysis. A significant tendency of expression of this protein was also observed for achieving CR, which was essential for longer survival, as shown by multivariate analysis. OS and DFS within 5 years were of 75% and 85.2% respectively for the group of 16 patients treated with ASCT, which resulted in lower relapse rates (6.5%) with statistically significant difference for DFS (p=0.015) when compared to the group of patients who achieved CR and was kept under monitoring. In this study ASCT was found to be a safe procedure for improving survival rates of DLBCL patients with high intermediate to high aIPI risk. Also, the expression of Bcl-2 protein was found to be useful as one of the variables to be analysed in the therapeutic approach to these patients

Linfomas pertencem a um grupo de neoplasias que têm em comum a origem em células linforreticulares, manifestando-se geralmente em tecidos linfóides. Em sua evolução, há uma reação generalizada do organismo de forma não específica contra as alterações sistêmicas que comprometem a homeostase, conhecida como resposta de fase aguda, a qual leva a uma importante alteração na síntese de proteínas pelo fígado, resultando no aumento de algumas proteínas conhecidas como proteínas de fase aguda, sendo as de maior relevância a amiloide sérica A, &alpha;-1 glicoproteína ácida e proteína C reativa. Foram objetivos deste estudo, definir o perfil eletroforético do felino com linfoma e avaliar as concentrações séricas de amilóide sérica A (ASA), &alpha;-1 glicoproteína ácida (GPA) e proteína C reativa (PCR) destes animais durante a quimioterapia, avaliando-se como possíveis indicadores de remissão de doença. Os grupos de estudo foram constituídos por 20 felinos clinicamente normais (controle) e 16 felinos com linfoma (experimental). Foram excluídos pacientes que apresentavam tratamentos prévios e/ou doenças concomitantes. A eletroforese das proteínas séricas foi realizada em tiras de acetato de celulose. Para as mensurações de ASA, GPA e PCR utilizaram-se kits comerciais, sendo as mesmas determinadas no grupo controle, uma única vez e, no grupo experimental, quando do diagnóstico e a cada 2 semanas durante 3 meses de tratamento. A análise estatística foi realizada com testes paramétricos, sendo o teste t não pareado utilizado para comparações entre os grupos controle e experimental no momento do diagnóstico e análise de variância simples (ANOVA), seguida do teste de comparações múltiplas de Tukey, para comparar o grupo experimental no diagnóstico e semanas de tratamento. Foram observadas diferenças significantes entre os grupos controle e experimental no momento do diagnóstico, com relação à GPA (p<0,0001), ASA (p=0,0028), PCR (p=0,0003), globulina (p=0,0087), relação albumina: globulinas (p<0,0001) e &alpha;-2 globulinas (p=0,0082). Quando se compararam os achados do grupo experimental no diagnóstico e nas semanas de tratamento houve diferença nos resultados referente à GPA (p=0,0021) e ASA (p=0,0053), enquanto os níveis de PCR não se alteraram significativamente (p=0,4510). Concluiu-se que os felinos com linfoma apresentaram uma expressiva resposta de fase aguda, caracterizada por aumento das concentrações séricas de &alpha;-1 glicoproteína ácida, amiloide sérica A e proteína C reativa, sendo a amilóide sérica A e &alpha;-1 glicoproteína ácida potenciais indicadores de remissão de doença naqueles pacientes que estavam com suas concentrações elevadas quando do diagnóstico. / Lymphoma belongs to a group of malignancies that have in common their origin in lymphoreticular cells, and is generally manifested in lymphoid tissues. In its evolution, there is a generalized reaction of the organism against a non-specific systemic conditions that compromises the homeostasis, known as acute phase response, which leads to a significant change in protein synthesis by the liver, resulting in an increase of some proteins known as acute phase proteins, and the most relevant are serum amyloid A, &alpha;-1 acid glycoprotein and C-reactive protein. This study was designed to define the electrophoretic profile of feline lymphoma and to evaluate serum concentrations of serum amyloid A (ASA), &alpha;-1 acid glycoprotein (GPA) and C-reactive protein (PCR) of these animals during chemotherapy, evaluated as possible indicators of disease remission. The study groups consisted of 20 clinically normal cats (control) and 16 cats with lymphoma (experimental). We excluded patients who had previous treatments and/or concomitant diseases. Electrophoresis of serum proteins was conducted on strips of cellulose acetate. For measurements of ASA, GPA and PCR we used commercial kits, which are then determined, in the control group, only once and, in the experimental group, at diagnosis and every 2 weeks during 3 months of treatment. Statistical analysis was performed with parametric tests, where unparied t test was used for comparisons between control and experimental groups at diagnosis and simple analysis of variance (ANOVA) test followed by Tukey\'s multiple comparisons to compare the experimental group in the diagnosis and weeks of treatment. There were significant differences between control and experimental groups at diagnosis of &alpha;-1 acid glycoprotein (p<0,0001), serum amyloid A (p=0,0028), C-reactive protein (p=0,0003), total globulin (p=0,0087), albumin: globulin (p<0,0001) and &alpha;-2 globulins (p=0,0082). When comparing the experimental group in the diagnosis and weeks of treatment was significant in the results of &alpha;-1 acid glycoprotein (p=0,0021) and serum amyloid A (p=0,0053), whereas C-reactive protein did not change significantly (p=0,4510). It is concluded that cats with lymphoma have an expressive acute phase response, characterized by increased in serum concentrations of serum amyloid A, &alpha;-1 acid glycoprotein and C-reactive protein, and the serum amyloid A and alpha-1 acid glycoprotein reference potential indicators of remission in those patients who were with their high concentrations at diagnosis.

O acometimento do câncer na infância é relativamente raro, com taxas relevantes de incidência de alguns tumores, como a leucemia linfoblástica aguda (LLA) e o tumor de Wilms (TW). Embora o câncer seja uma das dez primeiras causas de óbito de crianças e adolescentes e a primeira por doença a partir dos cinco anos, nas últimas décadas o progresso da terapêutica tem possibilitado um declínio nas taxas de mortalidade e expansão dos prazos de sobrevida. Desta forma, o acompanhamento efetivo no enfrentamento da doença passou a buscar análises mais amplas dos efeitos orgânicos tardios da doença e da terapêutica, incluindo as condições psicossociais do sobrevivente, como nas avaliações da qualidade de vida relacionada à saúde (QVRS). No sentido de ampliar o conhecimento e alternativas para o acompanhamento ambulatorial e periódico da condição de sobrevivência, este estudo buscou comparar o impacto na QVRS do sobrevivente adulto, dada a diferença na terapêutica de escolha para a remissão da LLA (quimioterapia) e do TW (cirurgia e quimioterapia), utilizando uma avaliação a distância da QVRS (SF-36, via telefone).Objetivos: Analisar e comparar a QVRS de sobreviventes adultos de LLA e TW, entre si e em relação a participantes sadios, acompanhados no Ambulatório Fora de Terapia do ITACI-HC-FMUSP, através da aplicação alternativa (via telefone) do SF-36.Casuística e Método: 90 participantes, acima de 18 anos. Grupo controle(CTRL) (30 sujeitos, fisicamente saudáveis, com ausência de diagnóstico prévio de câncer, recém-ingressos em curso superior) e Grupos experimentais (60 sobreviventes - Ambulatório Fora de Terapia - ITACI - HCFMUSP): grupo LLA (GLLA) - 30 sobreviventes LLA e grupo TW (GTW) 30 sobreviventes TW. A avaliação foi realizada através da aplicação, via telefone, do SF- 36. Após compilação dos domínios do SF-36, os resultados foram analisados através do teste de qui-quadrado, teste t-independente e teste de ANOVA. Resultados: Os participantes não apresentaram diferença significativa quanto a idade, a maioria eram solteiros, sem filhos e provenientes de São Paulo. O nível mais elevado de escolaridade do CTRL decorreu do critério de inclusão, mas com relevante proporção de sobreviventes no nível superior. Nos sobreviventes não houve diferença significativa de idade de diagnóstico e tempo de fora de terapia. Quanto a QVRS, houve melhores resultados dos sobreviventes masculinos em relação às sobreviventes e participantes CTRL. Especificamente, GLLA e GTW para Vitalidade e GLLA para Aspectos sociais, Saúde mental e Aspectos emocionais, no último aspecto detectada diferença também para as sobreviventes GTW. Nos sobreviventes com diagnóstico tardio (acima 53 meses) o GLLA apresentou melhores resultados na Capacidade funcional. Na percepção da própria saúde, houve diferença para todos os domínios, exceto nos Aspectos sociais e emocionais, estando as diferenças circunscritas a percepções positivas (boa, muito boa e excelente) da própria saúde pelos sobreviventes e controles. Conclusão: Particularmente no período do estudo, para a amostra selecionada e os aspectos analisados pelo SF-36 pode-se inferir que, apesar de algumas diferenças encontradas, os sobreviventes não apresentaram evidências de comprometimento de QVRS. O SF-36 (via telefone) pode ser um recurso de acesso e avaliação de QVRS de sobreviventes sob acompanhamento ambulatorial / The involvement of childhood cancer is relatively rare, with relevant incidence rates of some cancers such as Acute Lymphoblastic Leukemia (ALL) and Wilms Tumor (WT). Although cancer is one of the top ten causes of death in children and adolescents and the first disease from the age of five, in recent decades the therapeutic progress has made possible a decline in mortality rates and expansion of the survival periods. In this way, the effective monitoring in the confrontation of the disease passed to seek broader analyses of later organic effects from disease and therapy, including the psychosocial conditions of survivor, as in evaluations of healthrelated quality of life (HRQoL). In order to increase knowledge and alternatives for monitoring outpatient and periodic survival condition, this study sought to compare the impact on HRQoL of adult survivor, given the difference in the choice therapy for the remission of ALL (chemotherapy) and WT (surgery) using a remote assessment of HRQoL (SF -36 via telephone call). Objectives: Analyze and compare the HRQoL of adult survivors of ALL and WT between themselves and in relation to healthy participants, followed at the Ambulatory outside ITACI - HC - USP therapy , by alternative application ( by phone calls) of the SF - 36 . Methods: 90 participants , above 18 years. Control group (CTRL): (30 subjects, physically healthy, no history of oncological diagnosis, newly joined in higher education) and experimental groups (60 survivors - Outpatient Therapy - ITACI - HCFMUSP ): ALL group ( GALL ) - 30 ALL survivors and WT group ( GWT ) 30 WT survivors. The evaluation was performed by applying SF-36, via telephone calls. After compilation of the SF -36 domains, the results were analyzed through chi - square test, independent t test and ANOVA test. Results: Participants showed no significant difference regarding age, most were single, childless and from Sao Paulo. CTRL highest level of schooling resulted from inclusion criterion but with relevant proportion of survivors at the top level. In survivors there was no significant difference in age of diagnosis and time outside therapy. As for HRQoL there have been better results of male survivors in relation to female survivors and CTRL participants. Specifically GALL and GWT for vitality domain and GALL for social aspects, mental health and emotional aspects. In the last domain, it was detected also difference female survivors GWT. In survivors with late diagnosis (above 53 months) the GALL presented better results in functional capacity. In the perception of their own health, there were differences for all domains except in social and emotional aspects, with differences confined to positive perceptions (good, very good and excellent ) of own health by survivors and controls. Conclusion: Particularly during the study period, for the selected sample and the analyzed aspects by SF -36 can be inferred that, despite some differences, survivors did not show evidence of impairment of HRQoL . The SF -36 (via telephone calls) can be a resource of access HRQoL evaluation of survivors under ambulatory followup

La rencontre des lymphocytes B matures avec l’antigène (Ag), au niveau des organes lymphoïdes secondaires, déclenche la maturation terminale, au cours de laquelle deux évènements peuvent avoir lieu : la commutation de classe de l’immunoglobuline (CSR pour Class Switch Recombination) et l’hypermutation somatique (SHM).Dernièrement, notre laboratoire a décrit pour la première fois la recombinaison suicide du locus IgH (LSR pour Locus Suicide Recombination) (Péron et al., 2012). Cette recombinaison engendre une délétion totale de l’ensemble des gènes constants du locus IgH, empêchant ainsi l’expression d’Ig, et donc l’absence du récepteur BCR (B Cell Receptor). La cellule B se retrouve privée des signaux de survie délivrés par ce récepteur, et est induite à l’apoptose. La LSR semble opérer par les mêmes étapes que la CSR : 1- la transcription de régions de l’ADN ciblées, 2- la génération de cassures double brin (CDB) à partir de lésions introduites par AID (Activation-induced cytidine deaminase), 3- la réparation de l’ADN lésé majoritairement par le système classique de ligation des extrémités non homologues (C-NHEJ). Cependant, la réparation au cours de la LSR n’a pas été pleinement décrite, et sa détermination constitue l’objectif principale de mon doctorat. Dans un premier temps, nous avons mis au point un programme bio-informatique « CSReport », afin d’analyser la masse de données générées par le séquençage haut débit de jonctions du locus IgH (CSR et LSR) (Boyer et al., 2017). Cet outil nous a permis d’étudier le système de réparation des CDB, à travers la détermination de la structure au point de jonction. De façon inattendue, nos résultats montrent que la réparation de l’ADN dans la LSR est similaire entre la souris et l’Homme et si la CSR fait intervenir le C-NHEJ, la LSR semble faire appel à l’A-EJ (Alternative End Joining) et/ou la HR (Homologous Recombination). Ces observations sont renforcées par les résultats mettant en évidence une différence de l’association de protéines de réparation, ainsi que des marques épigénétiques particulières entre les segments concernés par la CSR et ceux ciblés par la LSR chez la souris.Nous nous sommes ensuite interrogés sur la LSR dans le lymphome de Hodgkin (HL pour Hodgkin lymphoma), car l’absence de BCR à la surface des cellules de Reed Sternberg pourrait provenir de cet évènement. Les résultats de séquençage haut débit révèlent une réparation différente au cours de la LSR entre le HL et le contrôle (amygdales saines) ce qui nous laisser stipuler que des altérations intrinsèques aux systèmes de réparation de l’ADN dans les cellules tumorales sont en cause.Globalement, nous avons développé « CSReport », un outil qui nous permet d’analyser la structure de réparation de l’ADN en partie, et de montrer une réparation similaire des CDB entre la souris et l’Homme et une différence de réparation de l’ADN entre la recombinaison CSR et LSR. De plus, nous avons mis en évidence une altération de la réparation dans des échantillons de lymphomes B (HL et CLL) comparé à des contrôles (amygdales saines). / Mature B lymphocytes meeting with antigen (Ag) inside secondary lymphoid organs activates their terminal maturation, with occurrence of class switch recombination (CSR) and somatic hyper mutation (SHM).Recently, our laboratory described for the first time IgH locus suicide recombination (LSR) (Péron et al., 2012). This process removes the whole constant genes of the locus, preventing Ig and BCR (B Cell Receptor) expression. The B cell is devoid of survival signals delivered by its receptor and is induced to apoptosis.LSR seems to operate with same molecular steps as CSR : 1- transcription of targeted DNA regions, 2- generation of double strand breaks (DSB) from DNA lesions induced by AID (Activation-induced cytidine deaminase), 3- DNA repair by classical non homologous end joining (C-NHEJ) pathway. However, DNA repair during LSR was not fully understood, and this is the principal objectif of my PhD studies. First, we developped a bioinformatic program « CSReport », to analyse high throughput sequencing (HTS) datas of IgH locus junctions (CSR and LSR) (Boyer, Boutouil et al.,2017). This tool allowed us to study the DSB repair systems, through determination of the structure at the junction site. Unexpectedly, our results show that DNA repair in DNA during LSR is similar between mice and human, and if CSR implicates C-NHEJ, LSR seems to invlove Alternative end joining (A-EJ) and /or homologous recombination (HR). These observations are consolidated by results showing a difference in the association of repair proteins, and in particular epigenitic marks between DNA segments concerned by CSR and those targeted by LSR in mice. We asked ourselves about LSR in HL, because BCR absence on its Reed Sternberg cells surface may be a result of this recombination. HTS results reveal a different repair during LSR between HL and the control (healthy tonsils), which let us stipulate that alterations in DNA repair systems of tumoral cells are the cause.Globaly, we developped « CSReport », a tool which permits us to study DNA repair structure in a part, and to show a similar DSB repair systems between mice and human, and a difference between CSR and LSR repair. Furthermore, we show an alteration in DNA repair of B lymphoma samples (HL and CLL) compared with the control (healthy tonsils).

L'oncogène ALK (Anaplastic Lymphoma Kinase) est une tyrosine kinase constitutivement active, impliquée dans divers cancers, tels que les lymphomes anaplasiques à grandes cellules (LAGC), ou certains carcinomes bronchiques. Ces tumeurs sont traitées par chimiothérapie, ce qui n'est pas un traitement optimal (30% de rechutes, abaissement de la qualité de vie). Dans ce contexte, de nombreux inhibiteurs spécifiques de la tyrosine kinase ALK tels que le Crizotinib ont été développés et ont prouvé leur efficacité à la fois dans des modèles in vitro, in vivo ainsi que chez les patients. Néanmoins, le succès de cette thérapie ciblée est limité par l'apparition de résistances. Il est donc essentiel de mettre au jour de nouvelles stratégies thérapeutiques permettant de contrecarrer ces résistances. Récemment, l'autophagie, un processus catabolique intracellulaire de dégradation lysosomale, a été proposée comme nouvelle cible thérapeutique dans le traitement des cancers résistants aux inhibiteurs de tyrosine kinase. Le premier objectif de mon projet de thèse a été de caractériser ce processus autophagique dans les LAGC ALK+, en réponse à différents traitements. Nous avons montré que (1) l'autophagie était activée dans des lignées de LAGC en réponse à l'inhibition de ALK, (2) que cette autophagie jouait un rôle cytoprotecteur dans ce modèle et (3) que les traitements par chimiothérapies de ces cellules n'induisaient pas de réponse autophagique. Dans un deuxième temps, nous nous sommes intéressés à la régulation potentielle de l'autophagie par les microARNs. Nous avons montré que plusieurs microARNs, dont le miR-7, étaient sous-exprimés en réponse au traitement par le Crizotinib et que la réexpression ectopique de ce miR-7 permettait une potentialisation de l'effet du Crizotinib, par l'induction d'autophagie cytotoxique dans notre modèle. Nous avançons également l'hypothèse que le " switch " autophagique de la cytoprotection à la cytotoxicité, que nous observons pourrait s'expliquer par la régulation de l'expression de plusieurs protéines cibles de miR-7 telles que Bcl-2 ou c-Raf. Ainsi, l'ensemble de nos résultats nous permettent de mieux comprendre le rôle et la régulation de l'autophagie induite en réponse à l'inhibition de ALK dans les LAGC ALK+, et pourrait à terme contribuer à l'amélioration des thérapies actuelles de divers cancers dépendants de l'oncogène ALK. / The ALK oncogene (Anaplastic Lymphoma Kinase) is a constitutively activated tyrosine kinase implied in various cancers including Anaplastic Large Cell Lymphomas (ALCL), or some lung adenocarcinomas. The current operative treatment is standard chemotherapy, which is not optimal (30% of relapses, low quality of life). In this context, new specific ALK inhibitors such as Crizotinib have been developed, and have showed their efficiency in vitro, in vivo and in patients. However, the emergence of resistant mutations has been described. Thus, the identification of alternative therapies targeting new pathways appears as mandatory to counteract those resistances. In this context, autophagy, an intracellular catabolic lysosomal process, has been described as a new therapeutic target in the treatment of cancers resistant to tyrosine kinase inhibitors. The first aim of my project was to characterize the autophagic process in ALK+ ALCL, upon different treatments. We showed that (1) autophagy was activated in ALK+ ALCL cell lines in response to ALK inhibition (2) that this autophagy played a cytoprotective role in our model and (3) that treatment with chemotherapies did not trigger an autophagic response. In a second part of the project, we focused on the potential regulation of autophagy by microRNAs. We showed that several microRNAs including miR-7 were down-regulated upon Crizotinib treatment and that ectopic re-expression of this miR-7 potentiates the effects of Crizotinib by induction of cytotoxic autophagy in our model. We hypothesized that this switch in the role of autophagy from cytoprotection to cytotoxicity observed in our model, could be explained by the regulation of several protein targets of miR-7 such as Bcl-2 or c-Raf. Altogether, these results enable a better understanding of the role and regulation of autophagy induced upon ALK inhibition in ALCL, and could in the longer term, contribute to improvement of current therapies of cancers involving the ALK oncogene.

A Leucemia Linfocítica Aguda na infância e adolescência é uma neoplasia de precursores linfóides de natureza heterogênea. Foi a primeira neoplasia disseminada a tornar-se curável pela quimioterapia. No Brasil os estudos cooperativos para o seu tratamento foram iniciados em 1980 com a criação do primeiro protocolo para o tratamento desta leucemia, denominado Grupo Brasileiro para o Tratamento da Leucemia na Infância. Na seqüência destes estudos foram observadas Sobrevidas Livre de Eventos de 50%, 58% e 70% nos protocolos 80, 82 e 85 respectivamente. Durante as décadas de 1980 e 1990, com a divulgação dos excelentes resultados alcançados com os regimes dos protocolos do grupo Berlin Frankfurt Münster, uma série de instituições em nosso País passou a adotá-los. Apesar de termos conhecimento dos dados referentes a evolução dos pacientes protocolados no GBTLI e dos demais estudos divulgados pelas instituições de origem, não tínhamos, porém, uma avaliação epidemiológica nem o conhecimento dos índices de sobrevivência alcançados no estado do Rio Grande do Sul. Neste trabalho foram avaliados 1472 pacientes com LLA, 833 (56,59%) do sexo masculino, 639 (43,41%) do sexo feminino, com idades entre zero e 20 anos, média de 7,40 anos (desvio padrão 5,14) e mediana de 5,70 anos (amplitude 0,06 a 20,76), no período de 1980 a 2008 provenientes deste Estado. Os dados foram colhidos individualmente dos prontuários dos pacientes admitidos nas principais instituições hospitalares que mantém assistência a pacientes pediátricos com neoplasias hematológicas. No presente estudo 487 pacientes (39,40%) foram registrados oficialmente nos protocolos do GBTLI; 678 (54,85%) receberam tratamento baseados nos regimes do grupo BFM e 71 (5,75%) por outros regimes incluindo os tratados segundo o protocolo UKALL. Os casos não foram, no entanto, protocolados e, na grande maioria não foram observados a totalidade dos itens exigidos para os pacientes registrados oficialmente. A sobrevida livre de eventos dos pacientes protocolados foi significativamente superior comparada aos não protocolados, 62,41% ± 2,43% e 53,86% ± 2,04% respectivamente, em cinco anos. De acordo com a faixa etária os pacientes que apresentavam idade de 15 a 19 anos tiveram um índice de SLE de 37,98% ± 4,72% em cinco anos, inferior quando comparado aos de zero a 4 anos e 5 a 9 anos respectivamente: 62,78% ± 2,28% e 62,43% ± 2,84%. Foi observada, na população estudada, uma SG de 63,73% ± 1,49% e SLE de 57,27% ± 1,57%, o que sugere uma discussão para implementar projetos com a finalidade de elevar estes índices de sobrevida. Epidemiologicamente a incidência da LLA com progenitores B seguiu o padrão observado em países desenvolvidos com um pico de freqüência absoluta entre as idades de 2 a 4 anos. Houve diferença significativa entre a população proveniente da região urbana ou rural sendo a SLE em cinco anos de 61,76% ± 1,76% e 49,81% ± 4,28% respectivamente. A SLE e a SG em lactentes e portadores de Síndrome de Down foi inferior aos resultados obtidos em instituições dos países desenvolvidos o que torna aconselhável uma revisão das condições para a assistência destes pacientes. Este estudo teve como finalidade principal retratar a situação passada e a atual do tratamento da LLA na infância e adolescência no Rio Grande do Sul e acumular dados aqui não interpretados e que poderão ser analisados posteriormente / Acute lymphocytic leukemia in childhood and adolescence is a neoplastic disease of lymphoid precursor of heterogeneous nature, being the first disseminated neoplasia to become curable through Chemotherapy. In Brazil, cooperative studies for the treatment of ALL started in 1980 with the creation of the first protocol by the Grupo Brasileiro para o Tratamento da Leucemia na Infância. According to these studies, Event Free Survival of 50%, 58% and 70% in the protocols of 1980, 1982 e 1985 respectively was observed. During the 80s and 90s many Brazilian institutions adopted the protocols motivated by the excellent results achieved by the Berlin Frankfurt Münster group. In spite of the knowledge provided by data related to the evolution of patients protocoled by the GBTLI and other studies published by medical institutions, there was not an epidemiologic evaluation or knowledge of survival indexes achieved in the state of Rio Grande do Sul. In this work, 1472 patients with ALL from the state of Rio Grande do Sul were evaluated. Among the subjects, 833 (56,59%) were male, 639 (43,41%) female, with age range between 0- 20 y average age of 7,40 (standard deviation 5,14) and median 5,70 years old (amplitude 0,06 to 20,76). Data was collected from the medical registers of patients with hematologic neoplasia in medical institutions, which offered pediatric assistance for ALL comprising the period between 1980 until 2008. In the present study, 487 patients (39,40%) were officially registered in the protocols of GBTLI; 678 (54,85%) received treatment based on the regime of the BFM group and 71 (5,75%) were treated according to other regimens (including the UKALL protocol). The cases, however, were not protocoled and, in most cases, the totality of items required for the patients registered officially were not observed. The EFS of the patients protocoled were significantly superior to those who were not protocoled (62,41% ± 2,43% and 53,86% ± 2,04% respectively) in five years. In respect to the age range, the patients which were between 15-20 years had an EFS index of 37,98% ± 4,72% in five years, which is inferior to the index of patients 0-4 years and 5-9 years: 62,78% ± 2,28% e 62,543± 2,84% respectively. An overall survival (OS) of 63,73% ± 1,49% and EFS of 57,27% ± 1,57% was observed in the population studied. These results indicate that a discussion for the implementation of projects, which can increase the indexes of cure, should be carried out. Epidemiologically, the incidence of ALL in B progenitors followed the pattern observed in developed countries with an absolute frequency peak in the age range of 2-4 years. The outcome was superior for patients coming from urban area in comparison to those from rural area. EFS and OS in infant and Down syndrome patients were inferior to the results obtained in developed countries, showing how important it is to review the conditions of the assistance provided to these patients. The objective of this work is to present the development of ALL treatment in childhood and adolescence in the state of Rio Grande do Sul, Brazil, from its beginning until the current days providing data, which can be analyzed and interpreted posteriorly

INTRODUÇÃO. Os genes da família paraoxonase (PON1, PON2 e PON3) apresentam grande homologia estrutural. PON1 está associada à molécula de HDL e possui funções fisiológicas, sendo a principal a de lactonase. PON1 também pode proteger as moléculas de LDL de modificações oxidativas. Embora o papel biológico mais conhecido das paraoxonases seja a prevenção da aterosclerose, elas também atuam sobre o estresse oxidativo envolvido na patogênese de outras condições como doenças inflamatórias, infecções e neoplasias. Toda a família PON parece estar implicada no desenvolvimento de linfomas. O polimorfismo L55M de PON1 foi relacionado a um maior risco para linfomas em indivíduos da população geral, enquanto PON3 e PON2 foram relacionadas à sobrevida de células tumorais. A Imunodeficiencia comum variável (ICV) é uma doença heterogênea caracterizada pela redução dos niveis de IgG, IgA e/ou IgM e da função de anticorpo. As manifestações clínicas incluem a presença de infecções recorrentes ou crônicas, doenças inflamatórias/autoimunes e incidência aumentada de malignidades como linfomas não-Hodgkin (LNH) e câncer gástrico. OBJETIVO: estudar os polimorfismos de PON1 e PON2 bem como a atividade arilesterase de PON1 e sua relação com o perfil lipídico, morbidade, mortalidade e presença de fatores de risco para linfoma LNH em pacientes com ICV. MÉTODOS/RESULTADOS: Foram avaliadas as frequências alélicas dos polimorfismos de PON1 e PON2, o perfil lipídico e a atividade arilesterase da PON1 em 63 pacientes com ICV e 130 controles saudáveis. No grupo de pacientes foi analisada a presença de fatores de risco para LNH e parâmetros de morbidade e gravidade da doença. O polimorfismo Q192R da PON1 e os polimorfismos de PON2 (S311C e A148G) não diferiram entre os grupos e não apresentaram relação com os parâmetros analisados. O genótipo 55MM e o alelo 55M foram mais frequentes no grupo ICV em relação ao grupo controle. A atividade arilesterase foi similar em pacientes e controles apresentando correlação positiva com os níveis de HDL. Pacientes com o genótipo 55MM apresentaram menor atividade de PON1 associada a maior morbidade da doença representada pela maior frequência de infecções de vias aéreas e maior taxa de internações. O genótipo 55MM também apresentou relação com a presença de fatores de risco para LNH como hiperplasia nodular linfoide (HNL) e linfonodomegalias. Por outro lado, a análise dos alelos demonstrou que a menor morbidade da doença foi associada à presença do alelo 55L, que apresentou relação com menor frequência de HNL e linfonodomegalia e menor ocorrência de óbitos. O alelo 55M apresentou relação com história familiar de imunodeficiências e neoplasias hematológicas. CONCLUSÃO: Este constitui o primeiro relato demonstrando maior frequência do genótipo 55MM e do alelo 55M em pacientes com ICV. Nossos resultados são sugestivos de que a presença do alelo 55L possa estar associado a um melhor prognóstico da doença. Inversamente, sugerem que pacientes com o genótipo 55MM apresentem maior morbidade e, possivelmente, maior risco para LNH / INTRO: The paraoxonase gene family (PON1, PON2 and PON3) has great structural homology. PON1 is associated with the HDL molecule and possess many physiological roles, the major one being of a lactonase. PON1 also protects LDL molecules against oxidative modifications. Although the best known biological role of PONs is the prevention of atherosclerosis, they also act on the oxidative stress involved in the pathogenesis of different conditions such as inflammatory diseases, infections and malignancies. The whole PON family appears to be implicated in the development of lymphomas. The L55M polymorphism of PON1 was related with a higher risk for lymphoma in the general population while PON3 and PON2 were related to survival of tumor cells. The Common Variable Immunodeficiency (ICV) is a heterogeneous disease characterized by reduced levels of IgG, IgA and/or IgM and antibody function. Clinical manifestations include the presence of chronic or recurrent infections, inflammatory/autoimmune diseases and increased incidence of malignancies such as non-Hodgkin lymphoma (NHL) and gastric cancer. OBJECTIVE: to study the PON1 and PON2 polymorphisms and the arylesterase activity of PON1 and its correlation with the lipid profile, morbidity, mortality and the presence of risk factors for NHL in CVID patients. METHODS/RESULTS: We evaluated the allele frequencies of polymorphisms of PON1 and PON2, lipid profile and arylesterase activity of PON1 in 63 patients with CVID and 130 healthy controls. In the group of patients we analyzed the presence of risk factors for NHL and parameters of morbidity and disease severity. The Q192R polymorphism of the PON1 and PON2 polymorphisms (A148G and S311C) did not differ between groups and did not correlate with the parameters analyzed. The 55MM genotype and the 55M allele were more frequent in the CVID group than in control group. The arylesterase activity was similar in patients and controls showing a positive correlation with HDL levels. Patients with genotype 55MM had lower PON1 activity, associated with increased morbidity of the disease represented by the higher frequency of respiratory infections and a higher rate of hospitalization. The 55MM genotype also was correlated with the presence of risk factors for NHL, such as lymphoid nodular hyperplasia (HNL) and lymphadenopathy. Moreover, analysis of the alleles showed that less morbidity of the disease was associated with the presence of the allele 55L, which was correlated with a lower frequency of HNL and lymphadenopathies and fewer deaths. The 55M allele was correlated with a family history of immunodeficiency and hematological malignancies. CONCLUSION: This is the first report showing a greater frequency of 55MM genotype and 55M allele in patients with CVID. Our results suggest that the presence of 55L allele may be associated with a better prognosis. Conversely, these results suggest that patients with the 55MM genotype show higher morbidity and, possibly, higher risk for NHL