The lymphoid tissues consist of distinct cell subpopulations of B and T cell lineages and possess complex signaling pathways that are controlled by a myriad of molecular interactions. During the fine-tuned developmental process of the lymphoid system, inappropriate activation of oncogenes and loss of tumor suppressor gene activity can push lymphocytes into uncontrolled clonal expansion, causing several lymphoid malignancies. V(D)J recombination is one such essential process, important for the proper development of the mammalian immune system. However, mistakes in normal V(D)J recombination can lead to deletion of tumor suppressor genes or activation of proto-oncogenes. In the first part of the study, the physiological and pathological roles of DNA binding domain of RAG1 have been characterized. RAG (Recombination Activating Gene) complex consisting of RAG1 and RAG2, is a site specific endonuclease responsible for the generation of antigen receptor diversity. It cleaves a specific DNA sequence termed as recombination signal sequence (RSS), comprising of a conserved heptamer and nonamer. Recent studies have shown that RAGs can also act as a structure-specific nuclease by cleaving flaps, heterologous loops, bubbles, hairpins etc. Nonamer binding domain (NBD) of RAG1 plays a central role in the recognition of RSS during its sequence specific activity. To investigate its DNA binding properties, NBD of murine RAG1 was cloned, overexpressed and purified from E. coli. Electrophoretic mobility shift assays showed that NBD binds with high affinity to nonamer in the context of 12/23 RSS. However, it did not bind to heteroduplex DNA, irrespective of the sequence of the single-stranded region. Interestingly, when a nonamer was present next to a heteroduplex DNA, NBD exhibited robust binding. NBD binding was specific to thymines when single stranded DNA containing poly A, C, G and T were used. Biolayer interferometry studies showed that the observed poly T binding to NBD was robust with a binding constant of 0.45±0.16 µM. >23 nt was essential for NBD binding at homothymidine stretches. On a double-stranded DNA, NBD could bind to A:T stretches, but not G:C stretches or random sequences. Although NBD is indispensable for sequence-specific activity of RAGs, external supplementation of purified nonamer binding domain to NBD deleted cRAG1/cRAG2 did not restore the sequence specific activity, suggesting that the overall domain architecture of RAG1 is important for maintaining its properties. Therefore, we define the sequence requirements of NBD binding to double- and single-stranded DNA, which will have implications in generation of chromosomal rearrangement and genomic instability in lymphoid cells. Genetic alterations are one of the hallmarks of lymphoid malignancies. Many genes involved in chromosomal abnormalities are known to play central roles in the development of normal lymphocytes. In the second part of the study, molecular mechanism associated with fragility of the transcription factor, B cell leukemia 11B (BCL11B) that drives malignant transformation of T-cells has been studied. BCL11B is a zinc finger protein transcription factor with multiple functions. It plays a key role in both development and subsequent maintenance of T-cells. BCL11B gene alterations are implicated in a number of diseases including T-cell malignancies. It acts as a haplo-insufficient tumor suppressor and loss of BCL11B allele leads to susceptibility to mouse thymic lymphoma and human T-ALL. Recent studies reveal heterozygous BCL11B mutations and deletions across each of the major molecular subtypes of T-ALL (15% of patients). Most of the BCL11B missense mutations identified so far affected the residues within BCL11B zinc finger domains of the exon 4. However, mechanism of generation of such specific mutations leading to altered functions of BCL11B remains to be explored. In the present study, we address the potential mechanism of fragility of BCL11B gene during leukemia genesis. Firstly, we have evaluated different regions of BCL11B gene for presence of non-B DNA sequence motifs. Studies using non-B DB database reveal clustering of several non-B DNA forming motifs at the region spanning exon 4 of BCL11B gene. In order to biochemically evaluate the potential of non-B DNA structure formation, two different regions of exon 4 were PCR amplified and cloned. Using bisulfite modification assay we demonstrate that, single strandedness exists at both region I and II of BCL11B exon 4, when the region is present on a plasmid DNA. Bisulfite reactivity on chromosomal DNA confirmed existence of such altered DNA structures in the context of human genome. In vitro gel shift assays showed formation of both intra and intermolecular G-quadruplexes. Primer extension studies revealed that non-B DNA structures could block polymerization during replication on a plasmid, leading to DNA replication arrest. Extrachromosomal assays showed that non-B DNA structure motifs, in contrast to its mutants, blocked transcription leading to reduced expression of green fluorescent protein (GFP) within cells. Many non-B DNA-forming sequences have been mapped to regions of common chromosomal breakpoints in human tumors, known as “hotspots”, which are associated with leukemia, lymphomas and genomic disorders. Thus, alternative DNA conformations are believed to contribute to mutations, deletions and other genetic instability, leading to the deregulation of cancer-related genes in malignant diseases such as leukemia and lymphoma. Activation induced cytidine deaminase (AID), is an essential enzyme involved in antibody diversification of immunoglobulin genes. However, aberrant AID expression in B- cell and non-B cell background is reported in various cancers including leukemia and lymphoma. AID activity requires single stranded DNA (ssDNA) as a substrate. Since activation induced cytidine deaminase (AID) deaminates cytosines when present on a single stranded DNA and its expression is deregulated in many cancers, we investigated the role of AID in BCL11B gene mutagenesis. We observed substantial AID expression in many T-cell leukemic cell lines. Thus, we hypothesize that AID might be targeted to single stranded DNA present at BCL11B exon 4 due to formation of non-B DNA structures such as G-quadruplexes causing AID mediated deamination, further leading to nucleotide alterations and the mutational signature observed at BCL11B exon 4 resulting in T-ALL. Based on our findings, we propose that single strandedness resulted due to formation of non-B DNA structures such as G-quadruplex DNA, triplex DNA or cruciform DNA during physiological processes like DNA replication and transcription at exon 4 of BCL11B, can act as the target for AID. Thus, our findings uncover a new possible link between non-B DNA structure motifs and AID expression in causing mutations at BCL11B exon 4 which could lead to T cell leukemia genesis. BCL11B is a bifunctional transcriptional regulator that can act as a repressor and transactivator, and is known to differentially control the expression of specific genes in a context-dependent manner. In order to understand the transcriptional network involving BCL11B, it was cloned, overexpressed and purified from E. coli. To investigate the DNA binding properties of BCL11B protein, electrophoretic mobility shift assays were performed. Our results lead to identification of a specific sequence motif that is responsible for DNA binding. Competition experiments in presence of specific and nonspecific oligomers further confirmed the binding specificity. Thus, in the present study, we have characterized the binding properties of nonamer binding domain of RAG1, emphasizing its pathological relevance in causing genomic instability in lymphoid cells. The study may help in better understanding of RAG induced genomic instability in lymphoid tissues and role of aberrant AID expression in inducing mutations at BCL11B Zinc finger domain, leading to its deregulation and culminating into T-cell leukemia

In today’s medical science studies, many tumor markers are being used to monitor cancer cell proliferation, but the number of assays for analysis of these markers are few. The aim of this study was to find an easier and more time-efficient way to measure the activity of a specific tumor marker called tymidine kinase 1 (TK1). This tumor marker is an important enzyme involved in cell proliferation and is a key enzyme in the salvage pathway. TK1 activity is related to the occurrence of hematological malignancies and cell activity and therefore have been used as a marker when monitoring this group of patients in treatment. Measurement of the enzyme activity in this study was performed by using an oligonucleotide assay. Detection of the enzyme activity in whole blood and in plasma has not previously been shown. The TK1 activity measured in whole blood and plasma correlated with TK1 activity measured in serum (R2=0,8651 and R2 =0,9845, respectively). It was found that it is possible to determine the TK1 activity in whole blood but only if the activity was measured on the same day as the blood samples were taken. The results shows that the activity measurement of TK1 in plasma and whole blood can be used as a marker to verify patients' therapy in cancer care. This study is only the beginning and further investigations should be made in the future to determine if the method that is subject to this study has the requested effects.

A neutropenia induzida pela quimioterapia é o mais comum efeito adverso da quimioterapia sistêmica para o câncer e é frequentemente complicada por neutropenia febril (NF). O uso profilático de fatores de crescimento hematopoiéticos pode reduzir o risco, a severidade e a duração da NF. Na prática clínica atual, a decisão de administrar ao paciente profilaxia com fatores de crescimento é baseada principalmente no potencial mielotóxico dos esquemas de QT, mas riscos específicos dos regimes não são definidos. Em muitos estudos, a toxicidade da quimioterapia é analizada em termos de alta dosagem versus baixa dosagem, sem uma regra geral que considere os diferentes esquemas de QT em uma única escala. O objetivo desse estudo é validar uma classificação de toxicidade de um esquema de QT e avaliar sua utilidade em um modelo de predição de risco de neutropenia febril em pacientes com câncer hematológico no começo de um ciclo de quimioterapia. Foram avaliados prospectivamente duzentos e sessenta e oito pacientes e acompanhados durante 1053 ciclos de quimioterapia na Bélgica, entre 2001 e 2005. Informações relevantes foram coletadas no começo do primeiro ciclo e o número de dias de neutropenia febril foi contabilizado no acompanhamento dos pacientes [dicotomizada (sem neutropenia versus >= dia de NF)]. A relação entre o desfecho e as co-variáveis foi analisada usando a Equação de Estimativa Generalizada (GEE). Um regime de quimioterapia agressiva é o maior preditor de NF [razão de chances (OR) 5.2 (3.2-8.4)]. Os outros preditores independentes são: doença subjacente, o comprometimento de medula óssea, superfície corporal <= 2m², uma contagem pré-tratamento de monócitos <150µl e a interação entre o primeiro ciclo na mesma linha de tratamento e uma dosagem de hemoglobina pré-tratamento. Usando as estimativas dos coeficientes de regressão, uma regra de predição clínica de NF foi desenvolvida com essas características: sensibilidade 78.6%, especificidade 62.3%, valor preditivo positivo de 42.7%% e um valor preditivo negativo de 89.1%. Estudos posteriores são necessários para validar esse escore bem como investigar novos potenciais fatores com o intuito de melhor prever a NF. / Chemotherapy-induced neutropenia is the most common adverse effect of chemotherapy and is often complicated by febrile neutropenia (FN). As prophylactic use of colonystimulating factors (CSF) can reduce the risk, severity, and duration of FN, it is of great importance to identify as soon as possible after or even before the start of chemotherapy, the patients who will develop FN. In the current clinical practice, the decision to give to the patient a colony-stimulating factor (CSF) prophylaxis is mainly based on the myelosuppressive potential of the chemotherapy regimen. The objective of this study is to validate a classification of aggressiveness of a chemotherapy regimen and to evaluate its usefulness in a risk prediction model of FN in patients with hematological cancer at the beginning of a chemotherapy cycle. Two hundred and sixty-six patients were prospectively enrolled and followed during 1053 cycles. Relevant patient informations were collected at the beginning of the first cycle and the number of days of FN were counted in the follow-up [dichotomized (no FN versus>= 1 day of FN)]. Aggressive chemotherapy regimen is the major predictor of FN [odds ratio 5.2 (3.2 - 8.4)]. The other independent predictors are the underlying disease, an involvement of bone marrow, body surface<= 2m², a baseline monocyte count <150/µl and the interaction between the first cycle in the same treatment line and a baseline hemoglobin dosage. A rule of prediction of FN was computed with these characteristics: sensitivity 78.6%, specificity 62.3%, positive predictive value 42.7% and negative predictive value 89.1%. Further studies are needed to validate this score.

A caquexia associada ao câncer deflagra, entre outros sintomas, uma acentuada redução de peso, além de um estado sistêmico inflamatório. O tecido adiposo branco é um importante órgão endócrino, capaz de sintetizar mediadores pró-inflamatórios, que contribuem para tal inflamação sistêmica. Há uma relação direta entre o aumento da ativação da via do receptor Toll-like 4 (TLR-4) dependente do fator 88 de diferenciação mielóide (MyD88) e a inflamação, e portanto, foi objetivo do presente estudo examinar o papel desta via no TAB subcutâneo de pacientes com câncer e caquexia. Os dados obtidos apontam que a via do TLR-4 dependente do MyD88 mostrou estar afetada no TAB destes pacientes. / Cancer cachexia triggers, among other symptoms, severe weight loss, as well as chronic systemic inflammation. The white adipose tissue (WAT) is an important endocrine organ, capable of synthesising pro-inflammatory mediators, which contribute to systemic inflammation. Pro-inflammatory cytokines are pointed out to be responsible for WAT catabolism activation, increasing lipolysis and also contributing to cachexia associated systemic inflammation. There is parallelism between increased activation of the myeloid differentiation primary response 88 (MyD88) dependent Toll-like receptor 4 (TLR-4) pathway and inflammation, and thus, the objective of this study was to examine the role of one such pathway in the inflammation of subcutaneous WAT in cachectic cancer patients. The data show that MyD88 dependent TLR-4 pathway is affected during cachexia.

Introduction: Haematological malignancies (HMs) are a rare and diverse group of malignancies accounting for 9% of cancers globally. These group of malignancies differ by age, sex, subtypes, morphology and geography. The burden and the patterns of diversity of HMs is poorly understood in low and middle-income countries including Kenya. Aim: To analyse the time trends of incidence of haematological malignancies in Kenya by broad subtypes from 2000–2013 and to compare differences in trends of HMs between Nairobi and Uasin Gishu counties for the period 2007-2013. Methods: A retrospective study including all HMs for all ages and sex diagnosed in the period of 2000-2013. Information used was from two population based cancer registries; Eldoret and Nairobi cancer registry. Crude incidence rates were directly standardized with the world population to obtain the age-standardized rates (ASR). Sex rate ratios (SRR) and incident rate ratios (IRR) were then calculated to compare the number of excess cases between sexes and counties. Ms Excel and STATA13 software were used to conduct a time trend analysis of haematological malignancies by broad subtypes of non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), myeloma and leukaemia. Using the estimated annual percentage change (APC), increase or decrease in trends of HMs was determined. Results: In Kenya, the mean age at diagnosis for all HMs was 32 years. NHL was the most commonly diagnosed HM in Kenya accounting for 43.6% of the cases. The main basis of diagnosis for NHL and HL cases was by cytology while for myeloma and leukaemia was by histology. A male excess was noted in the NHL, myeloma and leukaemia cases with an exemption of a female excess in the HL cases. Trends in incidence of HMs in Kenya increased by 9.8% with the myeloma subtype contributing greatly to the observed increase. By counties, Uasin Gishu county reported a higher number of HM cases per 100000 than Nairobi county (Uasin Gishu-97.6 per 100000 and Nairobi-69.9 per 100000). On the contrary, Nairobi marked a higher increase in trends of HMs than Uasin Gishu county. Conclusion: Trends of haematological malignancies are increasing in Kenya and special attention needs to be given to these under-reported group of malignancies. Finally, this study does support the dire need for a national cancer registry in the country.

(English) Using flow cytometry we analyzed absolute and relative proportions of hematopoietic stem and progenitors cells (HSPC) populations including hematopoietic stem cells (HSC), multipotent progenitors (MPP), multilymphoid progenitors (MLP) and pro B cells from bone marrow of patients with mature B cell malignancies and in healthy controls. We found lower absolute and relative numbers of MLP and higher relative numbers of HSC were observed in patients when compared to age-matched controls irrespective of bone marrow (BM) involvement. On the other hand significantly decreased absolute numbers of MPP were observed only in patients who had their BM infiltrated by disease. We also confirmed published data showing increasing absolute and relative percentages of MLP with increasing age, decreasing relative percentages of HSC with increasing age, and decreasing absolute and relative pro B cell frequencies with increasing age in healthy subjects. While decreased absolute and relative pro B cell numbers were also found in patient samples as age increased, no significant correlations were detected in patients HSC, MPP or MLP populations. Age-related sub-analysis of PTs samples demonstrated that most of the disease associated changes in HSPC frequencies were observable more prominently in the elderly (>45...

Résumé : Cette thèse porte sur le rôle de deux expositions environnementales encore peu étudiées et pouvant influer sur l’incidence des hémopathies malignes (HME) de l’enfant : les rayons ultraviolets (UV) et les pesticides liés aux activités agricoles.Les leucémies (LA) et lymphomes de l’enfant sont les deux types principaux de HME et représentent respectivement environ 470 et 200 nouveaux cas par an en France. Leur prise en charge thérapeutique et leur survie ont fait d’immenses progrès, cependant la connaissance de leurs facteurs de risque est encore très partielle.Les études sur les effets des UV dans les cancers de l’enfant sont peu développées. Plusieurs méta-analyses récentes concluent à une augmentation du risque de LA chez l’enfant lors d’une exposition professionnelle ou domestique de la mère aux pesticides pendant la grossesse. L’exposition aux pesticides d’origine agricole a été moins étudiée, et les résultats sont hétérogènes.La première partie, écologique, de ce travail s’intéresse à l’exposition résidentielle aux UV. Une étude a été réalisée à partir des observations du Registre National des Hémopathies malignes de l’Enfant (RNHE) faites sur une longue période, entre 1990-2009 et sur l’ensemble de la France métropolitaine (9 082 cas de LA et 3 563 cas de lymphomes). Les données de l’exposition aux UV résidentiels étaient issues de la base EUROSUN. Une moyenne quotidienne d’exposition aux UV résidentiels sur l’ensemble de la période 1988-2007 à l’échelle communale a été considérée. Une augmentation significative de l’incidence des leucémies aiguës lymphoblastiques à précurseurs B (LAL-Pré B) chez les moins de 5 ans a été observée avec l’exposition aux UV résidentiels au moment du diagnostic. L’association n’était pas modifiée après une stratification par périodes ; par tranches d’unités urbaines ; par grandes régions, et par un indice de défaveur français. Une deuxième étude, individuelle, sur les UV ne trouvait pas de modification de l’association en prenant en compte le rôle de facteurs individuels soupçonnés d’être associés aux LAL et en regardant l’exposition à la naissance. Les données individuelles de ces facteurs provenaient de deux études cas-témoins en population générale, l’enquête ESCALE (2003-2004) et l’enquête ESTELLE (2010-2011).La dernière partie de la thèse se penche sur l’exposition résidentielle aux pesticides liés aux activités agricoles. Cette étude s’appuie sur les données du RNHE, recueillant 10 994 cas de LA et 4 301 cas de lymphomes sur la période 1990-2013. L’intensité de l’activité agricole dans le canton de résidence au moment du diagnostic a été choisie comme proxy de l’exposition aux pesticides. Cette intensité a été à partir des données cantonales du Recensement général Agricole de 2000. Dans cette première approche aucune association n’a été mise en évidence entre les HME et la part de Surface Agricole Utile (SAU) totale. Les analyses par grands types de cultures montrent, dans cette première approche, une association positive et significative entre l’intensité de cultures en oléagineux et l’incidence des LAL Pré-B et des lymphomes de Burkitt. Des analyses de sensibilité montraient des résultats hétérogènes par période d’étude. / Abstract: This thesis deals with the role of two environmental exposures not much studied and that could have an impact on the incidence of childhood hematological malignancies (CHM): ultraviolet radiation (UV) and agricultural pesticides.The two major diagnostic groups are acute leukemia (AL) and lymphomas and represent respectively around 470 and 200 new cases per year in France. Despite the progress made in improving therapeutic caring and survival, the etiology of these cancers remains largely unknown.There are very few studies on the association between UV and these cancers. Meta-analyses found a coherent association between childhood AL and parental professional or domestic pesticides exposure during pregnancy. However the association with residential exposure to agricultural pesticides has been less studied and results are heterogeneous.The first, ecological, part of the thesis addressed the associations between residential UV exposure at diagnosis and the incidence of types and subtypes of CHM in France. The 9,082 cases of acute leukemia (AL) and 3,563 cases of lymphoma diagnosed before the age of 15 years from 1990 to 2009 were provided by the French National Registry of Childhood Hematological Malignancies. UV data from 1988 to 2007 were extracted from the EUROSUN database. The annual daily average UV exposure of the children estimated at the municipalities of residence was considered. There was a significant increase in precursor B-cell acute lymphoblastic leukemia (PBC-ALL) in children aged less than 5 years with residential exposure to UV. The results remained stable in analyses stratifying by deprivation index or degree of urbanization of the municipalities.A second, individual, study found no change in the association between UV and PBC-ALL after taking into account the influence of suspected individual risk factors for ALL, and evaluated this association at birth. Individual data were collected by interviews in the ESCALE (2003-2004) and ESTELLE (2010-2011) nationwide case-control studies.The last part of this work focused on the residential exposure to agricultural pesticides. The 10,994 cases of AL and the 4,301 cases of lymphomas diagnosed among children less than 15 years old were obtained from the French National Registry of Childhood Hematological Malignancies over the period 1990-2013. Intensity of agricultural activities by Canton was used as a proxy of residential agricultural pesticides exposure. This proxy was estimated from the 2000 French agricultural census data. At this first step of the analysis, no associations were found between total agricultural area and incidence of CHM. Analyses by types of crops showed, at this first step, a significant association between oilseeds and PBC-ALL and Burkitt lymphoma. Sensitivity analyses evidenced heterogeneous results by time period.

Immunotherapy based on chimeric antigen receptor (CAR)-expressing T lymphocytes has proven to be highly successful in the treatment of acute lymphoblastic leukemia (ALL), leading to development of CAR-based immunotherapies for other hematologic malignancies. Currently, efforts are underway to refine T cell modifications to make patient treatment more effective. Each time, this modification then needs to be empirically validated in in vitro experiments. We decided to study the effect of the cytokine IL-21 on the antitumor function of CD19-specific CAR T cells using in vitro assays. A construct that co-expressed IL-21 under the control of the inducible NFAT promoter together with CARs against CD19 was introduced into T cells. In a series of experiments, the properties of these cells were compared after coculture with tumor B cell lines and CLL cells obtained from patients. The results showed that CAR T cells that express IL-21 proliferate and activate better, even after repeated stimulation with leukemia cells. In addition to CARs specific against the CD19 molecule, we also investigated CARs specific against the CLL1 molecule, which has been described in the literature as one of the promising targets for the treatment of AML. We prepared CAR T cells against CLL1 producing IL-21. For this purpose, we...

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Les lymphocytes B mémoires circulants incluant ceux infectés par EBV de façon latente retournent périodiquement vers les territoires lymphoïdes secondaires où ils subissent une différenciation en cellules productrices d'immunoglobulines permettant au virus d'initier la réplication virale. Cependant, le suivi et la gestion de la réactivation de EBV et son association avec des néoplasies lymphoïdes chez les sujets infectés par le VIH restent un sujet de controverse et nécessite une meilleure compréhension des mécanismes impliqués. Dans cette étude, nous avons proposé de nouveaux outils biologiques pour la quantification de l'ADN EBV permettant la discrimination entre le réservoir latent et le cycle lytique du virus. Nous avons montré que la taille de ces réservoirs est étroitement associée à une activation polyclonale plus ou moins importante des cellules B. Nous avons également observé une association entre les marqueurs d'activation immunitaire et de réactivation de EBV avec la survenue de lymphome B. En outre, nous avons décrit l'évolution de gammapathies monoclonales chez des sujets infectés par le VIH sous traitement antirétroviral, et la persistante du pic monoclonal d'immunoglobulines était associée à des charges virales EBV plus élevés. Par conséquent, l'activation des lymphocytes B et subséquemment la réactivation EBV joueraient vraisemblablement les rôles principaux dans la survenue de tumeurs bénignes ou malignes des lymphocytes B au cours de l'infection VIH. / It is assumed that circulating memory B cells including those latently infected by EBV return periodically to lymphoid nodes where they are stimulates and undergo differentiation into immunoglobulin-producing cells allowing the virus to initiate viral replication. However, the monitoring and the management of EBV reactivation and it association with lymphoid malignancies in HIV-infected patients are still being controversies and need a better understanding of the probable mechanisms involved. In this study, we proposed novel biological tools for EBV DNA quantification allowing discriminating latent and lytic reservoir. We showed that the EBV reservoir levels are closely associated with the polyclonal B-cell activation. We also observed an association between immune activation and EBV reactivation markers with the occurrence of B-cell lymphoma. Moreover, we described a long term evolution of monoclonal gammapathies in HIV-infected subjects and the persistence of the immunoglobulis monoclonal pike was found to be associated with higher EBV reservoir levels. Therefore, the B-cell activation and subsequently EBV reactivation likely play the main roles on the occurrence of B lymphocytes malignancies during HIV infection.