L’adaptateur LNK est un régulateur négatif des voies de signalisation, dont la voie JAK/STAT,essentielle au développement du système hématopoïétique. Son implication dans les hémopathies chroniques, notamment les Néoplasmes Myéloprolifératifs (NMP), a été mise en évidence par l’analyse de souris invalidées pour cet adaptateur et l’identification de mutations de LNK chez les patients atteints de ces pathologies. Toutefois, le mécanisme permettant la régulation de ses partenaires, dont la kinase JAK2, et l’implication fonctionnelle des mutations de LNK dans les NMP, restent à définir. Ainsi, mon projet de thèse a porté sur l’analyse structurale et fonctionnelle des complexes de signalisation LNK/JAK2 et sur le développement d’une stratégie moléculaire pour l’utilisation thérapeutique de LNK dans les NMP. Nos résultats ont montré pour la première fois, la fonction inhibitrice de la région N-terminale incluant le domaine d’homologie à la Pleckstrine deLNK sur JAK2 normale et de manière plus importante, sur la forme mutée JAK2-V617F, retrouvée chez les patients atteints de NMP. De plus, nos études sur les mutations de LNK localisées dans cette région régulatrice, ont permis de comprendre leur contribution dans le développement de ces hémopathies et de proposer un mécanisme d’inhibition de l’activation de JAK2 par LNK. Nos résultats permettent d’utiliser le ciblage de la région N-terminale de LNK comme stratégie moléculaire inhibant spécifiquement la forme oncogénique JAK2-V617F à l’aide de peptides pénétrants (CPP). A long terme, cette approche pourrait être utilisée comme outil thérapeutique dans le traitement de patients atteints de NMP positifs pour JAK2-V617F. / The LNK adaptor protein is a key negative regulator of signalling pathways, such as JAK/STAT, important in the development of the hematopoietic system. Its implication in chronic blood diseases, such as Myeloproliferative Neoplasms (MPN) has been confirmed by studies on Lnk-deficient mice, as well as the identification of LNK mutations in MPN patients. However, the LNK mechanism of regulation on its partners and the functional implication of LNK mutations in MPN pathogenesis, are still unclear. Therefore, my PhD project covers the structural and functional analysis of theLNK/JAK2 signalling complex and the development of a molecular strategy to use LNK as a therapeutic tool for the treatment of MPN patients. Our study showed, for the first time, the inhibitory function of the N-terminal region and the pleckstrin homology domain of LNK on JAK2 activity, which occurs more importantly on JAK-V617F than JAK2 wild type form. Moreover, our study provided evidence on how LNK mutations located in this LNK region could contribute to these haematological diseases and has allowed us to propose a model for LNK regulatory function on JAK2activity. Furthermore, we developed a cell penetrating peptide-based strategy to deliver this regulatory region of LNK in hematopoietic cells to specifically inhibit JAK2-V617F oncogenic form. The finalaim is to use this region as a therapeutic molecule to treat JAK2-V617F-positive MPN patients.

As neoplasias mieloproliferativas (NMPs) são um grupo de doenças derivadas de uma transformação clonal de célula tronco hematopoiéticas no qual a linhagem celular mielóide é predominantemente expandida no sangue periférico. As NMPs Philadelphia-negativas incluem policitemia vera (PV), trombocitemia essencial (TE) e mielofibrose primária (MFP) que compartilham muitas características hematológicas, clínicas e evolutivas. A mutação da JAK2 (JAK2V617F) está presente em cerca de 95% dos pacientes com PV, entre 50 a 70% com TE e 40 a 50% com MFP. No entanto, os testes moleculares para diagnóstico são muitas vezes um desafio devido ao alto custo e a disponibilidade de equipamentos especializados. Objetivo: Verificar o impacto do teste molecular da mutação JAK2V617F para o diagnóstico de NMPs nos pacientes atendidos no Hospital de Clínicas de Porto Alegre. Métodos: Foram avaliados 87 pacientes com suspeita de NMPs. As amostras de sangue periférico foram analisadas para a mutação JAK2V617F pelo método genético molecular de PCR alelo-específico e os resultados correlacionados com os dados clínico-laboratoriais. Para estabelecimento do diagnóstico, foram utilizados os critérios da Organização Mundial da Saúde (OMS) de 2016. Resultados: Dos 87 pacientes avaliados, 27,6% foram diagnosticados como PV, 39,1% como TE, 4,6% como MFP e 28,7% não contemplavam os critérios para o diagnóstico NMPs. A comparação da utilização do teste da mutação JAK2V617F mostrou que, apenas 41,7% dos pacientes com PV sem utilizar o teste, teriam sido diagnosticados comparados a 91,7% utilizando este teste como um dos critérios no diagnóstico final (p = 0,004). Na TE e na MFP, este critério não foi estatisticamente significativo. Conclusão: O teste molecular para a mutação de JAK2V617F no nosso hospital teve um impacto significativo no diagnóstico dos pacientes com PV, mostrando ser uma ferramenta importante para o diagnóstico final desta NMP. / Myeloproliferative neoplasms (MPNs) are a group of disorders derived from a clonal transformation of stem cell on which myeloid cell lineage is predominantly expanded in the peripheral blood. Philadelphia-negative MPNs include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) which share many hematological, clinical, and evolutionary characteristics. The JAK2 mutation (JAK2V617F) is present in about 95% of patients with PV, between 50 to 70% with ET and 40 to 50% PMF. However, the molecular diagnostic tests are often a challenge due to the high cost and the availability of specialized equipment. Objective: To verify the impact of molecular testing of the JAK2V617F mutation for the diagnosis of MPNs in patients attended at Hospital de Clinics, Porto Alegre. Methods: A total of 97 patients were evaluated with suspected of MPNs. The peripheral blood samples were analyzed for the JAK2V617F mutation by the molecular genetic allelespecific PCR method and the results correlated with the clinical-laboratory data. To establish the diagnosis, the 2016 World Health Organization (WHO) criteria were used. Results: Of the 87 patients evaluated, 27.6% were diagnosed as PV, 39.1% as ET, 4.6% as PMF and 28.7% did not meet criteria for MPNs diagnosis. Comparison of the use of the JAK2V617F test showed that only 41.7% of patients with PV without the mutation test were diagnosed compared to 91.7% using this test as one of the criteria for the final diagnosis (p = 0.004). In the ET and the PMF, this criterion was not statistically significant. Conclusion: The molecular test for the JAK2V617F mutation in our hospital had a significant impact in the diagnosis of patients with PV, showing to be an important tool for the final diagnosis of this MPN.

As neoplasias mieloproliferativas (NMPs) negativas para o rearranjo t(9;22)/BCRABL1, incluindo Policitemia Vera (PV), Trombocitemia Essencial (TE) e Mielofibrose Primária (MFP), são doenças hematopoéticas clonais e estão frequentemente associadas à mutação JAK2V617F. Apesar dos avanços no conhecimento da fisiopatologia após a descoberta da mutação JAK2V617F e do desenvolvimento de inibidores da JAK2, o tratamento permanece não curativo. Sabe-se que as célulastronco mais primitivas nas NMPs são responsáveis pela iniciação da doença e que a expansão dos precursores mieloeritróides contribui para o fenótipo clínico. Dados recentes obtidos com ensaios in vitro mostram que as proteínas da família BCL2, reguladoras da apoptose mitocondrial, desempenham um papel relevante na patogênese das NMPs. Acreditamos que a expressão anômala de BCL2 nas células progenitoras hematopoéticas (CPH) das NMPs pode contribuir para a patogênese desse grupo de doenças. Avaliamos a expressão gênica, por meio de PCR em Tempo Real, da família BCL2 (genes antiapoptóticos BCL-xL e BCL2 e o pró-apoptótico BIM) nas diferentes subpopulações de progenitores hematopoéticos murinos (de um modelo condicional knockin de expressão heterozigótica condicional da Jak2V617F) e de pacientes portadores de NMPs bem como sua contribuição para o fenótipo da doença e resposta ao inibidores da JAK2 (com a droga ruxolitinibe) e/ou inibição da família BCL2 (com o inibidor de BCL2 obatoclax). Não encontramos diferença de expressão basal dos genes BCL2, BCL-xL e BIM nas células CD34+ bem como nas subpopulações de células CD34+38-/+ de pacientes com NMPs, independente da presença da mutação JAK2V617F, em relação às células CD34+ e subpopulações CD34+38-/+ dos controles (p>0.05). Nas células CD34+ de pacientes com TE encontramos aumento de expressão de BCL2 em relação às células CD34+ pacientes com MFP (p=0.03). No modelo transgênico de camundongos Jak2 wt/VF (que apresentam uma NMP semelhante à PV) e Jak2 wt/wt (controles), comparamos a expressão diferencial dos genes da família Bcl2 em precursores hematopoéticos imaturos (LSKs) e progenitores mieloides mais maduros (MPs). A expressão do BclxL em MPs de camundongos wt/VF foi maior em relação à subpopulação de células LSKs e em relação as duas subpopulações de células dos controles (p=0.0011). Não houve diferença significativa de expressão do Bcl2 nas subpopulações de células LSKs e MPs de animais wt/VF e wt/wt (p=0.12). Observou-se menor expressão de Bim em LSKs em relação às células MPs dos animais mutados (p=0.026), diferença essa não observada entre os controles Jak2 wt/wt. O tratamento isolado com inibidor de JAK2 ou de BCL2 resultou em aumento de expressão do Bim nas CPH (LSKs e MPs) de camungongos Jak2 wt/VF em relação aos animais Jak2 wt/wt. Este aumento da expressão de Bim foi ainda mais evidente após o tratamento das células com a combinação das duas drogas quando comparadas às células não tratadas ou tratadas com um dos dois inibidores, sendo maior em animais doentes do que em animais controles (p<0.0001). A análise do efeito do tratamento com os inibidores de JAK2 e BCL2 na indução de apoptose por meio de citometria de fluxo (marcação com anexina/7-AAD) revelou que as células LSKs foram mais resistentes à apoptose tardia do que as células MPs independentemente da mutação da JAK2 (p<0.05). O tratamento com obatoclax resultou em indução de apoptose diferentemente do que foi observado com o tratamento com ruxolitinibe (p=0.594) nas células MPs de animais Jak2 wt/VF. Ademais, o tratamento combinado com ruxolitinibe e obatoclax resultou no aumento da apoptose nas células MPs dos animais com fenótipo de PV (Jak2 wt/VF) em relação aos animais Jak2 wt/wt (p=0.05). Em conclusão, demonstramos que a resistência à apoptose nas NMPs ocorre desde as CPH iniciadoras da doença. Nossos resultados sugerem que a modulação da apoptose mitocondrial pode ser uma nova estratégia terapêutica para pacientes com NMP em combinação aos inibidores de JAK2, na medida em que atua tanto nas CPH que iniciam a doença como nos MPs, responsáveis pelos sinais e sintomas de mieloproliferação. / Myeloproliferative Neoplasms (MPNs) negative for t(9;22)/BCR-ABL1 rearrangement, including Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF), are clonal hematopoietic diseases and are often associated with the JAK2V617F mutation. Despite advances in the pathophysiology knowledge after the discovery of the JAK2V617F mutation and the development of JAK2 inhibitors, treatment remains non-curative. It is known that MPN primitive stem cells are essential for the initiation of the disease and that the expansion of the myeloeritroid precursors contributes to the clinical phenotype. Recent data, obtained with in vitro assays, showed that BCL2 family proteins, regulators of mitochondrial apoptosis, play a relevant role in the pathogenesis of MPNs. We believe that the anomalous expression of BCL2 in hematopoietic progenitor cells (HPCs) of MPNs may contribute to their pathogenesis. We evaluated BCL2 family (antiapoptotic genes BCL-xL and BCL2 and the pro-apoptotic BIM) gene expression by real-time PCR in different subpopulations of hematopoietic progenitors from a conditional Jak2V617F knockin murine model and from patients with MPNs as well as their contribution to the disease phenotype and response to JAK2 inhibitors (with ruxolitinib) and/or to the inhibition of the BCL2 family (with the BH3-mimetic obatoclax). We found no difference in the basal expression of the BCL2, BCL-xL and BIM in CD34+ cells as well as in subpopulations of CD34+ 38-/+ cells from patients with MPNs, regardless of the presence of the JAK2V617F mutation. In CD34+ cells obtained from patients with ET, we found an increase of BCL2 expression when compared to CD34+ cells with PMF (p=0.03). In the Jak2 wt/VF transgenic mice (that develop a MPN similar to PV) and Jak2 wt/wt controls, we compared the differential expression of Bcl2 family genes in immature hematopoietic precursors (LSKs) and more mature myeloid progenitors (MPs). Expression of Bcl-xL in MPs of wt/VF mice was greater when compared to LSKs and to the two progenitor subpopulations of control cells (p=0.0011). There was no significant difference in Bcl2 expression between the subpopulations of LSKs and MPs from wt/VF and wt/wt animals (p=0.12). Lower Bim expression in LSKs than in MPs was observed in samples from JAK2-mutated animals (p=0.026). Such difference was not observed between the Jak2 wt/wt subpopulations. Treatment with JAK2 or BCL2 inhibitors alone resulted in increased Bim expression in LSKs and MPs of the Jak2 wt/VF mice when compared to Jak2 wt/wt animals. This increase in Bim expression was even more evident when these cells were treated with the combination of the two drugs as compared to single treatment with one of the two inhibitors, being higher in mutaded than control animals (p<0.0001). The analysis of apoptosis by flow cytometry (annexin / 7-AAD labeling) revealed that LSK cells were more resistant to late apoptosis than MP cells regardless of the JAK2 mutation (p<0.05). Treatment with obatoclax resulted in greater apoptosis induction than it was observed with ruxolitinib treatment (p=0.594) on MP cells of Jak2 wt/VF animals. In addition, the combined treatment with ruxolitinib and obatoclax resulted in increased apoptosis in MP cells of animals with the PV phenotype (Jak2 wt/VF) as compared to the Jak2 wt/wt animals (p=0.05). In conclusion, we demonstrated that resistance to apoptosis in MPNs occurs at the level of the hematopoietic progenitors that initiate the disease. Our results suggest that modulation of mitochondrial apoptosis may be a new therapeutic strategy for MPN patients in combination with JAK2 inhibitors, as it acts on both the disease initiating and more mature progenitors, responsible for the clinical findings of myeloproliferation.

Doenças Mieloproliferativas Crônicas são desordens hematológicas malignas caracterizadas pela alteração na célula-tronco hematopoética e independência ou hipersensibilidade dos progenitores hematopoéticos a citocinas. Em 2008 a OMS renomeou esse grupo como Neoplasias Mieloproliferativas (NMPs), no qual estão inclusas as entidades nosológicas Policitemia Vera (PV), Trombocitemia Essencial (TE) e Mielofibrose Primária (MFP), doenças alvo desse estudo. Apesar dos avanços no diagnóstico das NMPs e nos mecanismos envolvidos com a fisiopatologia dessas doenças, sua patogênese permanece desconhecida. Alterações na maquinaria apoptótica parecem estar envolvidas em na fisiopatologia das NMP e por isso a compreensão dos mecanismos de regulação da apoptose e a interferência das galectinas-1 e 3 nesse processo, em pacientes com NMPs, é relevante para a busca de novos alvos terapêuticos. Neste contexto, os objetivos deste trabalho foram: avaliar em leucócitos de sangue periférico e células tronco hematopoéticas CD34+ de medula óssea dos pacientes com PV, TE e MFP os níveis de expressão das LGALS1 e LGALS3 e a concentração de galectina-3 plasmática. Foram determinadas as correlações dos níveis de expressão de LGALS1 e LGALS3 e da concentração da galectina-3 plasmática com os níveis de expressão do RNAm das moléculas reguladoras da apoptose e com os dados clínico-laboratoriais dos pacientes como a concentração de hemoglobina, percentagem de hematócrito, porcentagem de alelos mutados JAK2V617F, contagem de leucócitos e esplenomegalia. A expressão de LGALS1 estava diminuída em células CD34+ em PV e MFP e em leucócitos de sangue periférico de pacientes com MFP. Os pacientes de TE apresentaram aumento na expressão de LGALS3 em leucócitos de sangue periférico e alta concentração de galectina-3 no plasma. Houve correlação entre os níveis de expressão de LGALS1 e a porcentagem de alelos mutados e a contagem de leucócitos, em pacientes com PV. Foi detectada a correlação entre os níveis de expressão de LGALS3 a porcentagem de alelos mutados e o tamanho do baço, em pacientes com MFP. Com relação aos genes reguladores da apoptose, foram observadas correlações entre os níveis de expressão de LGALS1 e BCL-2 em células CD34+ de pacientes PV e entre LGALS3 e A1, MCL-1, BAX e C-FLIP em leucócitos de de pacientes com TE. Os resultados obtidos indicam que as NPM apresentam expressão diferencial de LGALS1 e LGALS3 e sugerem a associação entre a expressão de galectinas e o status da mutação JAK2V617F, principalmente em pacientes com MFP / Chronic myeloproliferative diseases are haematological malignant disorders characterized by the presence of an altered haematopoietic stem cell and independence or hypersensibility of their hematopoietic progenitors to cytokines. In 2008, WHO renamed this group of diseases as Myeloproliferative Neoplasms (MPN) in which is included Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF). There have been advances concerning the knowledge about the mechanisms involved in MPN pathophysiology, however their pathogenesis remains unknow. Deregulation in apoptotic machinery seems to be involved in MPN pathophysiology. Fully understanding of apoptotic machinery and the influence of galectin-1 and 3 in this process in NMP patients might unveil novel targets for manipulation. The aims of the present study were to evaluate in leukocytes and CD34+ hematopoietic stem cells from PV, ET and PMF patients the LGALS1 and LGALS3 expression levels, the Galectin-3 plasma levels and to correlate LGALS1 and LGALS3 expression levels with galectin-3 plasma levels, apoptosis-related genes expression, JAK2 mutation status and clinic-laboratorial parameters. PV and PMF patients showed decreased expression levels of LGALS1 in CD34+ cells and also decreased LGALS1 expression levels in PMF leukocytes. ET patients presented an increased expression level of galectin-3 in leukocytes and plasma. We detected the correlations between LGALS3 gene expression with JAK2 allele burden and with leukocytes number in PV patients. We also observed in PMF patients the correlation between LGALS3 expression levels with JAK2 allele burden and spleen size. We also detected the correlation between LGALS1 expression levels BCL-2 gene expression in PV CD34+ HSC cells and between LGALS3 expression and A1, MCL-1, BAX and C-FLIP gene expression in TE leukocytes. Taken together, the results suggest the LGALS1and LGALS3 differential expression in NMP and the relation between JAK2V617F status with galectins expression, especially in PMF patients.

As células Natural Killer (NK), quando estimuladas por meio de seus receptores, rapidamente produzem citocinas e quimiocinas, incluindo IFN?, TNF?, TGF?, GMCSF, MIP1?, MIP1?, IL-10 e outras, as quais podem afetar a função de outras células hematopoéticas. Considerando as evidências recentes de que as célulastronco hematopoéticas (CTH) respondem diretamente à sinalização de várias citocinas, acreditamos que a produção de citocinas mediada pelas células NK possa regular a função da CTH e que a sua desregulação possa favorecer a transformação maligna. As neoplasias mieloproliferativas (NMP) negativas para o rearranjo t(9;22)/BCR-ABL1, incluindo as entidades Policitemia Vera (PV), Trombocitemia Essencial (TE) e Mielofibrose Primária (MFP), são doenças hematopoéticas originadas de alteração clonal da CTH, e podem servir de modelo para o estudo dessa regulação NK-CTH. Além de mutações que ativam vias de proliferação e sobrevivência celular, como a mutação JAK2V617F, presente em mais da metade das NMP, outros mecanismos contribuem para a patogênese e manutenção da doença, tais como mutações adicionais e regulação da hematopoese neoplásica pelo microambiente da medula óssea. Este último inclui não apenas células do estroma, mas também células do sistema imune. Dessa forma, com objetivo de investigar a potencial contribuição das células NK para a patogênese das NMP, caracterizamos células do sangue periférico de pacientes com NMP do Ambulatório de Hematologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, bem como células esplênicas obtidas de animais de um modelo murino condicional knockin de expressão heterozigótica da Jak2V617F (Jak2VF) quanto à frequência, expressão de receptores e função das células NK. Observamos menor porcentagem de células NK e maior expressão do receptor inibitório NKG2A nos animais Jak2 wt/VF. Pacientes portadores de NMP apresentaram número absoluto de células NK-CD16+ reduzido em relação aos controles saudáveis. O número de células NK-CD16+ foi menor na MFP em relação aos controles e à TE, particularmente naqueles portadores da mutação JAK2V617F. Encontramos menor expressão do receptor de ativação NKG2D nos portadores de PV positivos para a mutação JAK2V617F. Houve menor expressão do receptor de ativação NKp46 nos portadores de NMP, particularmente nos portadores da mutação JAK2V617F, e nos pacientes com MFP. Observamos também menor expressão do receptor NKG2A nos portadores de TE negativos para a mutação JAK2V617F. Em concordância com a redução de células NK, a porcentagem de linfócitos totais mostrou-se reduzida nos pacientes com NMP, particularmente nos portadores de MFP, independentemente da mutação JAK2V617F. Encontramos redução percentual e absoluta do subtipo de células NK CD56brightCD16- (cuja principal função é secretória) nos pacientes com NMP, especialmente na presença da mutação JAK2V617F, nos pacientes com PV e MFP, e menor frequência absoluta do subtipo CD56-CD16bright (com função primariamente citotóxica) nos portadores de MFP. Em contraste, não verificamos deficiência citotóxica das células NK dos animais Jak2 wt/VF em relação aos controles Jak2 wt/wt. Adicionalmente, as células NK dos animais Jak2-mutados demonstraram menor capacidade de secreção da citocina MIP-1?, reconhecida por regular a função de CTH, em relação aos animais controle. Finalmente, houve expressão significativamente aumentada do gene MyD88 nos animais mutados em relação aos controles, sugerindo que a via de sinalização dos receptores do tipo Toll (TLR) pode estar envolvida na regulação NKCTH nas NMP. Em resumo, detectamos deficiência numérica e funcional de células NK em células primárias murinas e humanas de NMP. Nossos achados sugerem potencial regulação da hematopoese maligna pelas células NK nestas neoplasias e podem contribuir para a identificação de novas estratégias terapêuticas que possam interferir nesta complexa interação. / Natural Killer (NK) cells, when stimulated by their receptors, rapidly produce cytokines and chemokines, including IFN?, TNF?, TGF?, GM-CSF, MIP1?, MIP1?, IL-10 and others, which may affect the function of other hematopoietic cells. Considering the recent evidence that hematopoietic stem cells (HSC) directly respond to cytokine signaling, we hypothesized that NK cells mediated cytokine production can regulate HSC function and that their dysregulation may favor malignant transformation. BCR-ABL1-negative myeloproliferative neoplasms (MPN), including Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF), are hematopoietic diseases originated from HSC clonal transformation, and thus can serve as a model for studying this NK-HSC regulation. In addition to mutations that activate cell proliferation and survival pathways, such as the JAK2V617F mutation, present in more than half of MPN cases, other mechanisms contribute to the pathogenesis and maintenance of the disease, such as additional mutations and regulation of neoplastic hematopoiesis by the bone marrow microenvironment. This latter includes not only stromal cells but also cells of the immune system. Therefore, in order to investigate the potential contribution of NK cells to the pathogenesis of MPN, we characterized the frequency, receptor expression and function of NK cells from patients with MPN from the Clinical Hospital of the Medical School of Ribeirão Preto, University of São Paulo, as well as from splenic cells obtained from animals of a conditional knockin murine model of Jak2V617F heterozigous expression. Lower percentage of NK cells and higher NKG2A inhibitory receptor expression was observed in Jak2 wt/VF animals as compared to Jak2 wt/wt controls. In agreement, patients with MPN presented reduced absolute numbers of NK-CD16+ cells when compared to healthy controls. The number of NKCD16+ cells was lower in the PMF than in controls or ET patients, particularly in those bearing the JAK2V617F mutation. We found lower expression of the NKG2D activatory receptor in PV patients with the JAK2V617F mutation. There was lower expression of the NKp46 activatory receptor in MPN patients, particularly in those with the JAK2V617F mutation, and in PMF patients. We also observed reduced expression of the NKG2A receptor in non-JAK2 mutated ET patients. In agreement with the NK cell reduction, the percentage of total lymphocytes was reduced in patients with MPN, particularly in PMF, regardless of the JAK2V617F mutation. We found an absolute decrease of the CD56brightCD16- NK subtype (whose main function is secretory) in patients with MPN, especially when the JAK2V617F mutation was present, in patients with PV and PMF. Also, lower absolute frequency of CD56-CD16bright NK subtype (primarily cytotoxic) was found in PMF patients. In contrast, we did not find cytotoxic deficiency in the Jak2 wt/VF NK cells as compared to the Jak2 wt/wt controls. In addition, Jak2-mutated NK cells presented reduced ability of secreting the cytokine MIP-1?, known to regulate HSC function. Finally, there was significantly increased expression of the MyD88 gene in the Jak2-mutated animals as compared to controls, suggesting that the Toll-like receptors (TLR) signaling pathway may be involved in NK-HSC regulation in MPN. In summary, we detected numerical and functional deficiency of NK cells in murine and human primary cells of MPN. Our findings suggest a potential regulation of malignant hematopoiesis by NK cells in these neoplasms and may contribute to the identification of new therapeutic strategies that may target this complex interaction.

As células Natural Killer (NK), quando estimuladas por meio de seus receptores, rapidamente produzem citocinas e quimiocinas, incluindo IFN?, TNF?, TGF?, GMCSF, MIP1?, MIP1?, IL-10 e outras, as quais podem afetar a função de outras células hematopoéticas. Considerando as evidências recentes de que as célulastronco hematopoéticas (CTH) respondem diretamente à sinalização de várias citocinas, acreditamos que a produção de citocinas mediada pelas células NK possa regular a função da CTH e que a sua desregulação possa favorecer a transformação maligna. As neoplasias mieloproliferativas (NMP) negativas para o rearranjo t(9;22)/BCR-ABL1, incluindo as entidades Policitemia Vera (PV), Trombocitemia Essencial (TE) e Mielofibrose Primária (MFP), são doenças hematopoéticas originadas de alteração clonal da CTH, e podem servir de modelo para o estudo dessa regulação NK-CTH. Além de mutações que ativam vias de proliferação e sobrevivência celular, como a mutação JAK2V617F, presente em mais da metade das NMP, outros mecanismos contribuem para a patogênese e manutenção da doença, tais como mutações adicionais e regulação da hematopoese neoplásica pelo microambiente da medula óssea. Este último inclui não apenas células do estroma, mas também células do sistema imune. Dessa forma, com objetivo de investigar a potencial contribuição das células NK para a patogênese das NMP, caracterizamos células do sangue periférico de pacientes com NMP do Ambulatório de Hematologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, bem como células esplênicas obtidas de animais de um modelo murino condicional knockin de expressão heterozigótica da Jak2V617F (Jak2VF) quanto à frequência, expressão de receptores e função das células NK. Observamos menor porcentagem de células NK e maior expressão do receptor inibitório NKG2A nos animais Jak2 wt/VF. Pacientes portadores de NMP apresentaram número absoluto de células NK-CD16+ reduzido em relação aos controles saudáveis. O número de células NK-CD16+ foi menor na MFP em relação aos controles e à TE, particularmente naqueles portadores da mutação JAK2V617F. Encontramos menor expressão do receptor de ativação NKG2D nos portadores de PV positivos para a mutação JAK2V617F. Houve menor expressão do receptor de ativação NKp46 nos portadores de NMP, particularmente nos portadores da mutação JAK2V617F, e nos pacientes com MFP. Observamos também menor expressão do receptor NKG2A nos portadores de TE negativos para a mutação JAK2V617F. Em concordância com a redução de células NK, a porcentagem de linfócitos totais mostrou-se reduzida nos pacientes com NMP, particularmente nos portadores de MFP, independentemente da mutação JAK2V617F. Encontramos redução percentual e absoluta do subtipo de células NK CD56brightCD16- (cuja principal função é secretória) nos pacientes com NMP, especialmente na presença da mutação JAK2V617F, nos pacientes com PV e MFP, e menor frequência absoluta do subtipo CD56-CD16bright (com função primariamente citotóxica) nos portadores de MFP. Em contraste, não verificamos deficiência citotóxica das células NK dos animais Jak2 wt/VF em relação aos controles Jak2 wt/wt. Adicionalmente, as células NK dos animais Jak2-mutados demonstraram menor capacidade de secreção da citocina MIP-1?, reconhecida por regular a função de CTH, em relação aos animais controle. Finalmente, houve expressão significativamente aumentada do gene MyD88 nos animais mutados em relação aos controles, sugerindo que a via de sinalização dos receptores do tipo Toll (TLR) pode estar envolvida na regulação NKCTH nas NMP. Em resumo, detectamos deficiência numérica e funcional de células NK em células primárias murinas e humanas de NMP. Nossos achados sugerem potencial regulação da hematopoese maligna pelas células NK nestas neoplasias e podem contribuir para a identificação de novas estratégias terapêuticas que possam interferir nesta complexa interação. / Natural Killer (NK) cells, when stimulated by their receptors, rapidly produce cytokines and chemokines, including IFN?, TNF?, TGF?, GM-CSF, MIP1?, MIP1?, IL-10 and others, which may affect the function of other hematopoietic cells. Considering the recent evidence that hematopoietic stem cells (HSC) directly respond to cytokine signaling, we hypothesized that NK cells mediated cytokine production can regulate HSC function and that their dysregulation may favor malignant transformation. BCR-ABL1-negative myeloproliferative neoplasms (MPN), including Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF), are hematopoietic diseases originated from HSC clonal transformation, and thus can serve as a model for studying this NK-HSC regulation. In addition to mutations that activate cell proliferation and survival pathways, such as the JAK2V617F mutation, present in more than half of MPN cases, other mechanisms contribute to the pathogenesis and maintenance of the disease, such as additional mutations and regulation of neoplastic hematopoiesis by the bone marrow microenvironment. This latter includes not only stromal cells but also cells of the immune system. Therefore, in order to investigate the potential contribution of NK cells to the pathogenesis of MPN, we characterized the frequency, receptor expression and function of NK cells from patients with MPN from the Clinical Hospital of the Medical School of Ribeirão Preto, University of São Paulo, as well as from splenic cells obtained from animals of a conditional knockin murine model of Jak2V617F heterozigous expression. Lower percentage of NK cells and higher NKG2A inhibitory receptor expression was observed in Jak2 wt/VF animals as compared to Jak2 wt/wt controls. In agreement, patients with MPN presented reduced absolute numbers of NK-CD16+ cells when compared to healthy controls. The number of NKCD16+ cells was lower in the PMF than in controls or ET patients, particularly in those bearing the JAK2V617F mutation. We found lower expression of the NKG2D activatory receptor in PV patients with the JAK2V617F mutation. There was lower expression of the NKp46 activatory receptor in MPN patients, particularly in those with the JAK2V617F mutation, and in PMF patients. We also observed reduced expression of the NKG2A receptor in non-JAK2 mutated ET patients. In agreement with the NK cell reduction, the percentage of total lymphocytes was reduced in patients with MPN, particularly in PMF, regardless of the JAK2V617F mutation. We found an absolute decrease of the CD56brightCD16- NK subtype (whose main function is secretory) in patients with MPN, especially when the JAK2V617F mutation was present, in patients with PV and PMF. Also, lower absolute frequency of CD56-CD16bright NK subtype (primarily cytotoxic) was found in PMF patients. In contrast, we did not find cytotoxic deficiency in the Jak2 wt/VF NK cells as compared to the Jak2 wt/wt controls. In addition, Jak2-mutated NK cells presented reduced ability of secreting the cytokine MIP-1?, known to regulate HSC function. Finally, there was significantly increased expression of the MyD88 gene in the Jak2-mutated animals as compared to controls, suggesting that the Toll-like receptors (TLR) signaling pathway may be involved in NK-HSC regulation in MPN. In summary, we detected numerical and functional deficiency of NK cells in murine and human primary cells of MPN. Our findings suggest a potential regulation of malignant hematopoiesis by NK cells in these neoplasms and may contribute to the identification of new therapeutic strategies that may target this complex interaction.

Tumor heterogeneity has been recognized for decades. The molecular mechanisms impacting clonal heterogeneity in hematological diseases, specifically myeloproliferative neoplasms (MPN) and mantle cell lymphoma, with the focus on several inherited genetic factors, inflammation, the protective mechanisms of DNA damage response (DDR) in the leukemic transformation and the treatment strategies are the focus of this thesis. Firstly, I focus on studying germline JAK2 variants and how these may influence the initiation and progression of MPN diseases, and even contribute to further genomic alterations in the mutated clone. A study performed by our cooperating lab in Utah, USA,1 analyzing the mutational landscape of 31 JAK2 V617F-positive polycythemia vera (PV) patients identified two novel germline mutations in JAK2 gene, JAK2 T108A and JAK2 L393V. Another study2 , performed by our cooperating lab in Olomouc, Czech Republic, characterized two germline JAK2 mutations, E846D and R1063H, in a case of hereditary erythrocytosis accompanied by megakaryocytic atypia. The JAK2 R1063H variant was initially described in 3 out of 93 PV patients that were JAK2 V617F-positive.3 Our aim was to identify the role of selected inherited mutations in JAK2 gene in the initiation and progression of myeloproliferative...

La myélofibrose primitive (MFP) est un néoplasme myéloprolifératif (NMP) classique BCR-ABL négatif associé à une forte altération de la qualité de vie et à une augmentation de la mortalité. Les traitements conventionnels réduisent les symptômes mais ont peu d’effet sur l’histoire naturelle de la maladie. La MFP résulte d’interactions complexes entre le développement du clone hématopoïétique malin, l’installation d’un contexte inflammatoire et le remodelage du microenvironnement médullaire. Chacun de ces axes est une cible thérapeutique potentielle. Dans ce travail, nous avons évalué le potentiel thérapeutique de l’activation de PPARγ dans trois modèles murins de myélofibrose et nous montrons que les ligands de PPARγ permettent d’améliorer les paramètres hématologiques et histologiques en rapport avec l’installation du phénotype de myélofibrose. Chacun des axes de la physiopathologie a ensuite été exploré. Les ligands de PPARγ ont une action anti-proliférative sur le clone malin, tant dans les modèles murins de NMPs que dans les cellules JAK2V617F de lignée et dans les progéniteurs hématopoïétiques issus de patients atteints de NMPs. Le traitement atténue également l’hyperleucocytose associée au phénotype inflammatoire des NMPs et modifie la transcription de gènes de l’inflammation. Enfin, les ligands de PPARγ ont un effet protecteur sur le stroma médullaire, dépendant de la capacité de PPARγ à contrecarrer la voie de signalisation du TGF-β1, cytokine majeure du développement de la fibrose médullaire, par déplacement du cofacteur de transcription p300 de la voie du TGF-β1 vers la voie PPARγ. Par son action sur les trois composantes de la physiopathologie, l’activation de PPARγ constitue une cible thérapeutique pertinente dans la prise en charge de la MFP. / Primary myelofibrosis (PMF) is a non BCR-ABL myeloproliferative neoplasm (MPN) associated with poor quality of life and reduced survival. Current treatments are mainly symptomatic and have little effect on the natural history of the disease. PMF results from complex interactions between the emergence of a hematopoietic malignant clone, an inflammatory context and the remodeling of the bone marrow (BM) microenvironment. Each of these axes is a potential therapeutic target. Here, we evaluated the therapeutic potential of PPARγ ligands in three murine models of myelofibrosis and we showed that PPARγ ligands improve hematological and histological changes related to myelofibrosis phenotype. Then, we explored each axis of the pathophysiology. We showed that PPARγ ligands have an anti-proliferative effect and limit the proliferation of the malignant clone in murine models of MPNs, in JAK2V617F cell lines and in hematopoietic progenitors from MPNs patients. PPARγ ligands also decrease leukocytosis related to the inflammatory phenotype of MPNs and modify the transcription of inflammatory genes. Finally, we demonstrated that PPARγ ligands have a protective effect on BM stroma. They counteract the signaling pathway of TGF-β1, a major cytokine in BM fibrosis development, by moving the p300 cofactor of transcription from the TGF-β1 pathway to the PPARγ pathway. By its action on the three components of the pathophysiology, activation of PPARγ pathway is a relevant therapeutic target in PMF.

Fast and high quality classifications of cells inflicted with malignant mutations is essential for diagnosing patients with different forms of leukemia, to quickly be able give patients the crucial care they need. Convolutional neural networks (CNNs) can be trained and used for this purpose. This thesis studies CNNs and the application of regularization to create better performing and generalised models, with the purpose of generating highly accurate classifications for nine different forms of malignant white blood cells from the myeloid lineage. This is done to asses what method of dropout regularization is best suited for this type of cell data. To achieve this, three different methods of dropout regularization were studied: Bernoulli dropout; Gaussian dropout; and spatial dropout. This was conducted using a dataset consisting of 106,472 images from 945 patients. The results indicate that models using Gaussian dropout and Bernoulli dropout, respectively, produce the best results, with 87.39\% being the highest accuracy achieved. These two models are also statistically different from a benchmark model not utilizing any form of dropout. This suggests that one of these techniques may be optimal for this type of data. Further studies may be needed to determine which is the best of the two.

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