L’immunothérapie allergénique (ITA) est la seule thérapie capable d’agir sur l’étiologie des allergies. La compréhension des mécanismes d’action de ce traitement et la mise en évidence de biomarqueurs d’efficacité favoriserait l’optimisation de l’ITA. A l’aide des tétramères de classe II, nous avons suivi les lymphocytes T CD4 périphériques spécifiques d’allergènes, acteurs centraux de la réaction allergique, dans des conditions normales, pathologiques ou en cours d’ITA, afin d’établir un lien entre ces trois situations physiologiques. Nous avons mis en évidence des différences entre les réponses lymphocytaires T CD4 spécifiques d’allergènes saisonniers et perannuels, chez les individus sains et allergiques. Puis, lors de 2 études cliniques d’ITA sublinguale, l’une menée chez des adultes allergiques aux pollens de graminées traités pendant 4 mois et l’autre menée chez des enfants allergiques aux acariens traités pendant 1, nous avons respectivement observé une diminution des lymphocytes Th2A et une augmentation de la production d’IFN- γ liées au traitement. Toutefois, ces variations ne corrèlent pas avec l’efficacité clinique de l’ITA observée dans ces deux études. Les limites d’utilisation des tétramères de classe II nous ont amené à rechercher si l’expression de marqueurs d’activation membranaires pouvait remplacer un marquage « tétramère ». Alors qu’une corrélation insuffisante a été observée entre le marquage « tétramère » et l’expression des marqueurs d’activation testés, nous avons mis en évidence 3 populations cellulaires aux propriétés fonctionnelles diverses, soulignant l’hétérogénéité des réponses lymphocytaires spécifiques d’allergènes. De plus, la découverte des lymphocytes Th2A pourrait être une approche prometteuse pour le suivi des réponses lymphocytaires T CD4 spécifiques d’allergènes lors d’ITA à plus long terme. / Allergenic immunotherapy (AIT) is currently the only curative treatment for allergic disease. Whereas efficacy of this treatment is well established, its mechanisms of action are not clearly understood and predictive as well as surrogate biomarkers are needed to further support AIT development. We focused on allergen specific CD4 T cells, highly involved in allergic inflammation, and monitored their responses both in normal and pathologic conditions, or during AIT. Using MHC class II tetramers, we highlighted distinct patterns of polarization between seasonal and perennial allergen-specific CD4 T cells as well as between healthy and allergic individuals. Then, allergen-specific CD4 T cell responses were monitored during 2 double-blind placebo-controlled sublingual AIT clinical trials. After short term AIT (4 months), we observed a decrease of Th2A cells, a newly define subset, thought to contain most allergen-specific CD4+ T cells. IFN-γ production was increased after one year of treatment. However, these variations were not related to AIT clinical efficacy. We further compared the expression of various activation markers and MHC class II tetramer staining following in vitro stimulation in order to circumvent inherent limitation of tetramers. No correlation could be established between tetramer staining and the expression of multiple activation markers in allergen-stimulated CD4 T cells. Combining these methods helps understanding patient heterogeneity regarding CD4 T cell responses. Moreover, Th2A cells detection is likely a promising approach to identify allergen-specific CD4 T cell during long-term AIT.

Os alelos HLA-DPB1*04 e HLA-DRB1*15 estão fortemente associados à Granulomatose com poliangeíte (GPA). Neste estudo, analisamos se os pacientes brasileiros com diagnóstico de GPA apresentam uma base genética na região HLA. Conduzimos um estudo caso-controle, em que analisamos os alelos da região HLA classe I e II em 55 pacientes com diagnóstico de GPA, atendidos no ambulatório de Vasculites Pulmonares do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, e comparamos com os resultados de 110 controles saudáveis. Comparamos também quatro diferentes apresentações clínicas da GPA e a positividade do anticorpo anticitoplasma de neutrófilos (ANCA) com os alelos da região HLA classe I e II. Foi também construída uma árvore de decisões, usando o algoritmo de CART, para a verificação da associação entre os alelos HLA e GPA. Como resultados, observamos que a GPA esteve fortemente associada à presença dos alelos DPB1*04 e DRB1*15 (p = 0,007, odds ratio [OR]: 2,9, 95% intervalo de confiança [IC]: 1,09-3,8; p = 0,006, OR: 2,87, 95% IC: 1,44-4,75, respectivamente) e não à presença do alelo DRB1*04. O alelo DRB1*13 esteve associado com proteção contra GPA (p = 0,042, OR: 0,42, 95% CI: 0,21-0,99). O alelo DPB1*04 esteve significativamente associado a GPA e ANCA-C positivo (OR: 5,47) e à presença de insuficiência renal aguda (p = 0,01037). Concluímos que houve uma interdependência significativa entre os alelos DPB1*0401, DPB1*0402, DRB1*13, C*2 e GPA. Na população estudada, quando o alelo DPB1*04 esteve presente em homozigose, o risco de GPA foi de 81%. Quando o alelo DPB1*0401 esteve ausente ou em heterozigose com o DPB1*0402, como o outro alelo, ou DPB1*0402 esteve em homozigose, o risco da GPA foi de 52,9%. No caso de ausência dos alelos DPB1*0401, DPB1*0402 e DRB1*13, a presença do alelo C*2 aumentou o risco da GPA para 62,5%. Finalmente, na ausência do alelo DPB1*0401 e DPB1*0402 e na presença do alelo DRB1*13, o risco de GPA diminuiu para 0% / The alleles HLA-DPB1*04 and HLA-DRB1*15 are strongly associated with granulomatosis with polyangiitis (GPA). In this study, we examined whether Brazilian patients with GPA had an HLA region genetic background. We conducted a case-control study, in which we analysed alleles of HLA region class I and II from 55 patients with GPA (at the Pulmonary Vasculitis Clinic of the University of São Paulo) and compared the results with those from 110 healthy controls. Comparisons were also performed for 4 different clinical presentations of GPA and anti-neutrophil cytoplasmic antibody (ANCA) positivity and the HLA class I and II region alleles. A tree model decision analysis was conducted using CART algorithm. Our results showed that GPA was strongly associated with alleles DPB1*04 and DRB1*15 (p = 0.007, odds ratio [OR]: 2.9, 95% confidence interval [CI]: 1.09-3.8; p = 0.006, OR: 2.87, 95% CI: 1.44-4.75, respectively) and not with the allele DRB1*04. DRB1*13 allele was associated with protection against GPA (p = 0.042, OR: 0.42, 95% CI: 0.21-0.99). DPB1*04 was significantly associated with GPA plus positive C-ANCA (OR: 5.47) and acute renal failure (p = 0.01037). We concluded that there was a significant interdependence among alleles and GPA. In our population, when allele DPB1*04 was presented in homozygous, the risk of GPA was 81%. When DPB1*0401 allele was absent or heterozygous with DPB1*0402 as the other allele, or DPB1*0402 was homozygous, the risk of disease was 52.9%. If DPB1*0401, DPB1*0402, and DRB1*13 were absent, the presence of C*2 increased the risk of GPA to 62.5%. Finally, in the absence of DPB1*0401 and DPB1*0402 and the presence of DRB1*13, the risk of GPA decreased to 0%

Le lupus érythémateux disséminé est une maladie autoimmune systémique déclenchée par une combinaison de facteurs génétiques, hormonaux et environnementaux. Il se caractérise notamment par la présence d’autoanticorps dirigés principalement contre des éléments nucléaires. Les traitements proposés aux patients sont essentiellement palliatifs et non curatifs et engendrent de nombreux effets secondaires indésirables. Des nouvelles stratégies thérapeutiques plus spécifiques sont basées sur l’utilisation de peptides dérivés d’autoantigènes. Le peptide P140, découvert au laboratoire, est un candidat prometteur dans ce domaine. Il correspond à la séquence 131-151 de la protéine splicéosomale U1-70K et est chimiquement phosphorylé sur le résidu sérine 140. Son administration à des souris lupiques MRL/lpr diminue la sévérité des symptômes sans effet immunosuppresseur. Il est actuellement évalué chez l’homme dans un essai clinique de phase III. Le mécanisme d’action du peptide P140 commence à être bien connu chez la souris lupique. Récemment, mon équipe à montré que le peptide P140 affecte directement ou indirectement deux formes d’autophagie, la macroautophagie et l’autophagie médiée par les chaperonnes (CMA). De plus, il réduit l’expression des molécules du CMH-II ce qui conduirait à une baisse de la présentation antigénique et à une diminution de l’activation des LT autoréactifs. Finalement, une baisse de la production des autoanticorps, notamment des anticorps reconnaissant l’ADN double brin est observée suite à l’injection du peptide aux souris. L’objectif de mon projet de thèse a été de consolider ces résultats et également d’étudier le mode d’action du peptide chez l’homme puisque ceci n’avait pas encore été fait. Nous avons démontré que comme chez la souris, le peptide P140 réduit l’expression des molécules du CMH-II à la surface des LB de patients lupiques. De plus, nous avons montré que plus le score d’activité de la maladie est élevé, plus l’effet du peptide sur l’expression du CMH-II est important. En revanche, bien que nous ayons confirmé la dérégulation de la macroautophagie dans les LT CD8+ de patients, le peptide P140 ne semble pas affecter ce processus cellulaire. Nous étudions actuellement l’effet du peptide sur la CMA. Enfin, nous avons montré que chez la souris MRL/lpr et chez l’homme, le peptide P140 réduit le nombre de plasmablastes. Cette altération de la différenciation des LB conduit à une baisse de la production des IgM et des IgG, ce qui explique son effet bénéfique sur la maladie lupique. / Systemic lupus erythematosus (SLE) is a systemic autoimmune disease triggered by genetic, hormonal and environmental factors. It is mainly characterized by the presence of autoantibodies directed against nuclear elements. Most of current treatments proposed to patients are palliative and not curative and lead to numerous side effects. New therapeutical strategies are based on the use of peptides derivated from autoantigens. The P140 peptide discovered in our laboratory is a promising candidate. It corresponds to the 131-151 sequence of the U1-70K spliceosomal protein and is phosphorylated on ser140 residue. Its administration to MRL/lpr lupus-prone mice reduces symptom severity without immunosuppressive effect. It is currently evaluated in phase III of clinical trial. The mechanism of action of P140 peptide has been mostly elucidated in lupus mice. Recently, my team has shown that P140 peptide affects direclty or indireclty macroautophagy and chaperone-mediated autophagy (CMA), two major forms of autophagy. Furthermore, it reduces the expression of MHC class II molecules, which leads to the decrease of antigenic peptide presentation and activation of autoreactive T cells. Finally, a reduction of autoantibodies levels against double stranded DNA is shown after P140 injection in mice. The aim of my thesis project was to consolidate these data and to study the mode of action of P140 in humans since this was not done until now. We have shown that like in lupus-prone mice, P140 peptide reduces expression of MHC-II molecules on the surface of B cells from SLE patients. Furthermore, we have demonstrated that higher the disease activity score was, higher the effect of P140 peptide was. Unfortunately, although we confirmed the dysregulation of macroautophagy in CD8+ T cells from SLE patients, P140 peptide does not seem to affect this cellular process. We are currently studying the effect of the peptide on CMA. Finally, we have shown that in both MRL/lpr mice and humans, P140 peptide reduces the number of plasmabasts. This alteration of B cell differentiation lead to the decrease of IgM and IgG production, thus explaining the P140’ benefical effect on the course of lupus disease.

Os alelos HLA-DPB1*04 e HLA-DRB1*15 estão fortemente associados à Granulomatose com poliangeíte (GPA). Neste estudo, analisamos se os pacientes brasileiros com diagnóstico de GPA apresentam uma base genética na região HLA. Conduzimos um estudo caso-controle, em que analisamos os alelos da região HLA classe I e II em 55 pacientes com diagnóstico de GPA, atendidos no ambulatório de Vasculites Pulmonares do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, e comparamos com os resultados de 110 controles saudáveis. Comparamos também quatro diferentes apresentações clínicas da GPA e a positividade do anticorpo anticitoplasma de neutrófilos (ANCA) com os alelos da região HLA classe I e II. Foi também construída uma árvore de decisões, usando o algoritmo de CART, para a verificação da associação entre os alelos HLA e GPA. Como resultados, observamos que a GPA esteve fortemente associada à presença dos alelos DPB1*04 e DRB1*15 (p = 0,007, odds ratio [OR]: 2,9, 95% intervalo de confiança [IC]: 1,09-3,8; p = 0,006, OR: 2,87, 95% IC: 1,44-4,75, respectivamente) e não à presença do alelo DRB1*04. O alelo DRB1*13 esteve associado com proteção contra GPA (p = 0,042, OR: 0,42, 95% CI: 0,21-0,99). O alelo DPB1*04 esteve significativamente associado a GPA e ANCA-C positivo (OR: 5,47) e à presença de insuficiência renal aguda (p = 0,01037). Concluímos que houve uma interdependência significativa entre os alelos DPB1*0401, DPB1*0402, DRB1*13, C*2 e GPA. Na população estudada, quando o alelo DPB1*04 esteve presente em homozigose, o risco de GPA foi de 81%. Quando o alelo DPB1*0401 esteve ausente ou em heterozigose com o DPB1*0402, como o outro alelo, ou DPB1*0402 esteve em homozigose, o risco da GPA foi de 52,9%. No caso de ausência dos alelos DPB1*0401, DPB1*0402 e DRB1*13, a presença do alelo C*2 aumentou o risco da GPA para 62,5%. Finalmente, na ausência do alelo DPB1*0401 e DPB1*0402 e na presença do alelo DRB1*13, o risco de GPA diminuiu para 0% / The alleles HLA-DPB1*04 and HLA-DRB1*15 are strongly associated with granulomatosis with polyangiitis (GPA). In this study, we examined whether Brazilian patients with GPA had an HLA region genetic background. We conducted a case-control study, in which we analysed alleles of HLA region class I and II from 55 patients with GPA (at the Pulmonary Vasculitis Clinic of the University of São Paulo) and compared the results with those from 110 healthy controls. Comparisons were also performed for 4 different clinical presentations of GPA and anti-neutrophil cytoplasmic antibody (ANCA) positivity and the HLA class I and II region alleles. A tree model decision analysis was conducted using CART algorithm. Our results showed that GPA was strongly associated with alleles DPB1*04 and DRB1*15 (p = 0.007, odds ratio [OR]: 2.9, 95% confidence interval [CI]: 1.09-3.8; p = 0.006, OR: 2.87, 95% CI: 1.44-4.75, respectively) and not with the allele DRB1*04. DRB1*13 allele was associated with protection against GPA (p = 0.042, OR: 0.42, 95% CI: 0.21-0.99). DPB1*04 was significantly associated with GPA plus positive C-ANCA (OR: 5.47) and acute renal failure (p = 0.01037). We concluded that there was a significant interdependence among alleles and GPA. In our population, when allele DPB1*04 was presented in homozygous, the risk of GPA was 81%. When DPB1*0401 allele was absent or heterozygous with DPB1*0402 as the other allele, or DPB1*0402 was homozygous, the risk of disease was 52.9%. If DPB1*0401, DPB1*0402, and DRB1*13 were absent, the presence of C*2 increased the risk of GPA to 62.5%. Finally, in the absence of DPB1*0401 and DPB1*0402 and the presence of DRB1*13, the risk of GPA decreased to 0%

La réaction allergique de type I est caractérisée par une réponse immunitaire inappropriée de type Th2, et /ou par l'absence d'une tolérance immunologique contre un antigène habituellement toléré par la plupart des individus : l'allergène. Des études récentes soulignent le rôle central joué par les lymphocytes T CD4+ spécifiques de l'allergène dans le contrôle des réponses allergiques. Néanmoins, l'étude des mécanismes immunologiques impliqués se doit d'être approfondie. Elle pourrait ainsi fournir d'importants renseignements concernant l'induction de tolérance périphérique contre l'allergène observée chez les individus sains. L'examen de ces réponses spécifiques apparaît alors comme primordial pour améliorer les approches thérapeutiques actuelles, dans l'hypothèse que l'immunothérapie spécifique de l'allergène puisse reproduire une telle réponse immunitaire naturelle protectrice de l'allergène. Durant cette thèse, nous avons conçu et développé des tétramères MHC classe II afin d'analyser à l'échelle de la cellule les réponses lymphocytaires T CD4+ spécifiques de l'allergène à la fois chez les patients allergiques et les volontaires sains. Pour ce faire, nous avons déterminé les conditions expérimentales nécessaires pour s'assurer d'une détection efficace des cellules T CD4+ spécifiques de l'allergène par cet outil. Ce travail a été réalisé dans le cadre d'une analyse des réponses T CD4+ induites d'une part contre l'allergène majeur du pollen de bouleau (Bet v 1) ou d'autre par contre les allergènes majeurs des acariens (Der p 1 et Der p 2). Nous avons ainsi démontré que la tolérance périphérique observée chez les sujets sains est associée à la présence et l'expansion de lymphocytes T CD4+ spécifiques de l'allergène. Nous avons également développé des méthodes expérimentales permettant de caractériser fonctionnellement les cellules tétramères positives. Nous avons ainsi démontré que les cellules T CD4+ spécifiques de l'allergène des volontaires sains sécrètent principalement de l'IFN-γ et de l'IL-10 en réponse à l'allergène et expriment très fortement le marqueur CTLA-4, un marqueur associé aux cellules T régulatrices. A l'inverse, chez les patients allergiques, ces cellules sont clairement de type Th2 confirmant leur rôle dans l'induction et l'amplification des réponses allergiques. Le développement des tétramères MHC classe II dans le contexte de l'allergie fournit une approche pertinente pour définir clairement le rôle joué par les cellules T CD4+ spécifiques de l'allergène. Ce travail, réalisé à la fois chez les individus sains, allergiques ou en cours de désensibilisation, s'inscrit pleinement dans un projet d'entreprise. Ces outils faciliteront le développement de nouveaux candidats vaccins en permettant d'identifier des marqueurs biologiques associés à un bénéfice clinique.

As individuals and populations diverge ecologically, they become exposed to new parasites and pathogens with potentially harmful fitness consequences. Populations are therefore expected to evolve resistance, possibly at a cost of less resistance to parasites rarely encountered parasites. This trade-off in resistance should generate local adaptation to parasites in different habitats. In chapter one, I show how local adaptation can potentially evolve in response to variation in parasite exposure among eighteen ecologically variable populations of threespine stickleback (Gasterosteus aculeatus). Within populations infection appeared to reflect morphology/diet based exposure differences among individuals. Among populations, however, these patterns were absent or reversed, consistent with the evolution of local adaptation. In chapters two and three I set out to test whether variation major histocompatibility (MHC) genes can underly such local adaptation in stickleback. MHC genes are important components of vertebrate immunity; however, there is little direct empirical support for spatially divergent selection driving local adaptation on MHC loci in the wild. In chapter two I tested for the action of parasite mediated balancing and divergent selection on on MHC loci using naturally infected stickleback in three replicate lake-stream pairs. Despite consistent divergence in parasites and MHC alleles, lakes tended to show decreased parasite burdens with increased allelic richness (consistent with balancing selection), while streams showed some support for divergent selection between lake and stream types. In chapter three I use the same lake-stream pairs to investigate how divergent selection could instead be reflected in variation in the effects of individual MHC alleles among populations. When comparing parapatric populations experiencing gene flow, MHC alleles maintained at relatively high frequency in one population were more likely to be associated with reduced, rather than increased, parasite abundances in that population. Allopatric populations experiencing no gene flow showed no such general relationship between allele frequency and resistance. These results are only consistent with spatially divergent selection, and imply that gene flow and environmental heterogeneity can be important for maintaining MHC diversity. / text

No description available.

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 106-140).

No description available.

A doença de Crohn (DC) e a Retocolite Ulcerativa (RCUI) são enfermidades inflamatórias crônicas do intestino e têm origem desconhecida. Exposição a fatores ambientais específicos em indivíduos geneticamente suscetíveis, levando a uma resposta inadequada do sistema imunitário, é uma das possíveis explicações para a ocorrência dessas doenças. As células natural killer fazem parte do sistema imune inato e reconhecem as moléculas HLA (antígeno leucocitário humano) de classe I em células‐alvo através de seus receptores de membrana. Os receptores principais das células natural killer são conhecidos como receptores “killer” do tipo imunoglobulina (KIR). Nosso estudo teve como objetivo avaliar a associação entre os genes KIR em pacientes com doença inflamatória intestinal e controles saudáveis. Na pesquisa atual, analisamos 15 genes KIR e os alelos do sistema HLA classe I em 248 pacientes caucasóides brasileiros, nos quais 111 tinham RCUI e 137 tinham DC e em 250 controles saudáveis, usando a técnica de PCR com primers específicos (PCR‐SSP). Observamos um aumento significativo do gene inibidor KIR2DL2 no grupo controle (doença inflamatória intestinal [DII]: p<0.001; RCUI: p=0.01; DC: p= não significativo [NS]). O genótipo 2DL2+/HLA‐C lys(80)+ também foi mais freqüente nos controles (DII: p= 0.005; UC: p= 0.01; CD: p= NS); além do 2DL1+/HLA‐C Asn(80)+ (DII: p=0.026; UC: p= NS; CD: p= NS). A disparidade entre os KIR ativadores e inibidores pode explicar, ao menos em parte, a patogênese destas doenças inflamatórias intestinais. / Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the bowel, of unknown origin. Exposure to specific environmental factors by genetically susceptible individuals, leading to an inadequate response of the immune system, is one of the potential explanations for the occurrence of these diseases. Natural killer cells are part of the innate immune system recognizing class I HLA (human leukocyte antigen) molecules on target cells through their membrane receptors. The main receptors of the natural killer cells are the killer immunoglobulin like receptors (KIRs). We typed 15 KIR genes and HLA class I ligands in 248 unrelated Brazilian Caucasians, of which 111 had UC and 137 had CD, and 250 healthy controls by polymerase chain reaction using sequence‐specific oligonucleotides and sequence specific primers. We found an increase in KIR2DL2 in controls (inflammatory bowel disease [IBD]: p<0.001; UC: p=0.01; CD: p= not significant [NS]). The genotype 2DL2+/HLA‐C lys(80)+ was also more common in controls (IBD: p= 0.005; UC: p= 0.01; CD: p= NS); as well as 2DL1+/HLA‐C Asn(80)+ (IBD: p=0.026; UC: p= NS; CD: p= NS). The imbalance between activating and inhibitory KIR and HLA ligands may explain, at least in part, the pathogenesis of these inflammatory bowel diseases.