Introdução: O fragmento C4d e os anticorpos anti-HLA doador específicos (DSA) são marcadores de resposta humoral em enxertos renais com rejeição, mas o papel das células B nesse processo ainda não é claro. Neste estudo foi avaliada a correlação entre C4d, DSA e células B de enxertos com disfunção e sua associação com aspectos morfológicos, função e sobrevida do rim transplantado. Material e Métodos: A marcação para C4d, células B CD20+ e plasmócitos CD138+ foi realizada por imunoperoxidase em biópsias por indicação de 110 receptores de transplante renal. Positividade para CD20 e CD138 foi definida por curva ROC (≥5 céls./mm2). O soro coletado concomitante a biópsia foi testado para DSA classe I e classe II. Estes marcadores foram correlacionados com dados clínicos e do transplante, a histopatologia de Banff e a evolução do rim transplantado. Resultados: Depósitos de C4d e DSA circulantes foram detectados em 100% e 70% dos pacientes com rejeição mediada por anticorpos (RMA) respectivamente, e nos casos de rejeição aguda celular (RAC) em 42% (p<0,001, vs. RMA) e 28% (p=0,003, vs. RMA). Estes dois marcadores correlacionaram-se positivamente (r=0,31, p=0,016). Houve correlação significativa entre DSA e plasmócitos CD138+ (r=0.32 p=0,006), mas as células CD20 e CD138 não se correlacionaram entre si. As células CD138+ predominaram na RMA, associadas com maior painel pré-transplante e DSA, mas não a C4d, e as células CD20+ predominaram na RAC e nas biópsias com fibrose intersticial/atrofia tubular, associadas a maior incompatibilidade HLA e a retransplantes. Pacientes com C4d+ tiveram pior função e sobrevida do enxerto em três anos de transplante, e aqueles com DSA+ uma pior 7 sobrevida do enxerto. Positividade para CD20 ou CD138 não foi preditiva da função ou sobrevida do enxerto. Na análise multivariada, somente o C4d foi fator de risco para perda do enxerto. Conclusões: Esses resultados confirmam o valor prognóstico do C4d e dos DSA para uma pior evolução do enxerto renal, e sugerem uma associação das células B CD20+ com parâmetros de rejeição celular e dos plasmócitos CD138+ com marcadores de resposta humoral. Entretanto, nesse estudo o infiltrado de células B na biópsia do enxerto não foi preditivo de uma pior evolução do rim transplantado. / Introduction: The fragment C4d and the donor specific anti-HLA antibodies (DSA) are markers of the humoral response in rejecting kidney grafts, but the role of B cells in this process is still unclear. In this study we evaluated the correlation between C4d, DSA and B cells in dysfunctional grafts, and their association with morphological features, and graft function and survival. Material and Methods: The staining for C4d, CD20+ B cells and CD138+ plasmocytes were done by immunoperoxidase in 110 kidney graft biopsies for cause. Positivity for CD20 and CD138 were established by ROC curve (≥5 cells/mm2). Serum collected at biopsy were tested for anti-HLA class I and II antibodies. These markers were correlated with clinical and transplant characteristics, Banff histopathology and graft outcomes. Results: C4d deposits and circulating DSA were detected in 100% and 70% of the patients with antibody-mediated rejection (AMR) respectively, and in cases with acute cellular rejection (ACR) in 42% (p<0.001, vs. AMR) and 28% (p=0.003, vs. AMR), respectively. Both markers were positively correlated (r=0.31, p=0.016), and there was also a significant correlation between DSA and plasmocytes CD138+ (r=0.32 p=0.006). CD20 and C138 cells were not siginificantly correlated. Plasmocytes CD138+ predominated in AMR, and were associated with higher pre transplant PRA and DSA positivity, but not with C4d. CD20+ B cells were highly expressed in ACR and in biopsies with interstitial fibrosis and tubular atrophy, in association with more HLA mismatches and re-transplants. Patients with C4d had poorer graft function and survival, and those 9 with DSA + also had a worse graft survival in three years of transplant. CD20 or CD138 cells were not predictive of graft outcomes. In multivariated analysis, only C4d remained a risk factor for graft loss. Conclusion: These results confirm the prognostic value of C4d and circulating DSA for a worse kidney graft outcome, and suggest an association of CD20+ B cells with parameters of cellular rejection whereas CD138+ plasmocytes correlated with markers of the humoral response. However, in this study the B cell infiltrate in graft biopsy was not predictive of adverse outcomes to the transplanted kidney.

Introdução: O fragmento C4d e os anticorpos anti-HLA doador específicos (DSA) são marcadores de resposta humoral em enxertos renais com rejeição, mas o papel das células B nesse processo ainda não é claro. Neste estudo foi avaliada a correlação entre C4d, DSA e células B de enxertos com disfunção e sua associação com aspectos morfológicos, função e sobrevida do rim transplantado. Material e Métodos: A marcação para C4d, células B CD20+ e plasmócitos CD138+ foi realizada por imunoperoxidase em biópsias por indicação de 110 receptores de transplante renal. Positividade para CD20 e CD138 foi definida por curva ROC (≥5 céls./mm2). O soro coletado concomitante a biópsia foi testado para DSA classe I e classe II. Estes marcadores foram correlacionados com dados clínicos e do transplante, a histopatologia de Banff e a evolução do rim transplantado. Resultados: Depósitos de C4d e DSA circulantes foram detectados em 100% e 70% dos pacientes com rejeição mediada por anticorpos (RMA) respectivamente, e nos casos de rejeição aguda celular (RAC) em 42% (p<0,001, vs. RMA) e 28% (p=0,003, vs. RMA). Estes dois marcadores correlacionaram-se positivamente (r=0,31, p=0,016). Houve correlação significativa entre DSA e plasmócitos CD138+ (r=0.32 p=0,006), mas as células CD20 e CD138 não se correlacionaram entre si. As células CD138+ predominaram na RMA, associadas com maior painel pré-transplante e DSA, mas não a C4d, e as células CD20+ predominaram na RAC e nas biópsias com fibrose intersticial/atrofia tubular, associadas a maior incompatibilidade HLA e a retransplantes. Pacientes com C4d+ tiveram pior função e sobrevida do enxerto em três anos de transplante, e aqueles com DSA+ uma pior 7 sobrevida do enxerto. Positividade para CD20 ou CD138 não foi preditiva da função ou sobrevida do enxerto. Na análise multivariada, somente o C4d foi fator de risco para perda do enxerto. Conclusões: Esses resultados confirmam o valor prognóstico do C4d e dos DSA para uma pior evolução do enxerto renal, e sugerem uma associação das células B CD20+ com parâmetros de rejeição celular e dos plasmócitos CD138+ com marcadores de resposta humoral. Entretanto, nesse estudo o infiltrado de células B na biópsia do enxerto não foi preditivo de uma pior evolução do rim transplantado. / Introduction: The fragment C4d and the donor specific anti-HLA antibodies (DSA) are markers of the humoral response in rejecting kidney grafts, but the role of B cells in this process is still unclear. In this study we evaluated the correlation between C4d, DSA and B cells in dysfunctional grafts, and their association with morphological features, and graft function and survival. Material and Methods: The staining for C4d, CD20+ B cells and CD138+ plasmocytes were done by immunoperoxidase in 110 kidney graft biopsies for cause. Positivity for CD20 and CD138 were established by ROC curve (≥5 cells/mm2). Serum collected at biopsy were tested for anti-HLA class I and II antibodies. These markers were correlated with clinical and transplant characteristics, Banff histopathology and graft outcomes. Results: C4d deposits and circulating DSA were detected in 100% and 70% of the patients with antibody-mediated rejection (AMR) respectively, and in cases with acute cellular rejection (ACR) in 42% (p<0.001, vs. AMR) and 28% (p=0.003, vs. AMR), respectively. Both markers were positively correlated (r=0.31, p=0.016), and there was also a significant correlation between DSA and plasmocytes CD138+ (r=0.32 p=0.006). CD20 and C138 cells were not siginificantly correlated. Plasmocytes CD138+ predominated in AMR, and were associated with higher pre transplant PRA and DSA positivity, but not with C4d. CD20+ B cells were highly expressed in ACR and in biopsies with interstitial fibrosis and tubular atrophy, in association with more HLA mismatches and re-transplants. Patients with C4d had poorer graft function and survival, and those 9 with DSA + also had a worse graft survival in three years of transplant. CD20 or CD138 cells were not predictive of graft outcomes. In multivariated analysis, only C4d remained a risk factor for graft loss. Conclusion: These results confirm the prognostic value of C4d and circulating DSA for a worse kidney graft outcome, and suggest an association of CD20+ B cells with parameters of cellular rejection whereas CD138+ plasmocytes correlated with markers of the humoral response. However, in this study the B cell infiltrate in graft biopsy was not predictive of adverse outcomes to the transplanted kidney.

La commutation de classe (CSR) est une étape clef de la réponse immunitaire. Ce phénomène va permettre de changer le type d’immunoglobuline (Ig) produite en réponse à un antigène donné. Ces Ig seront ensuite produites par les plasmocytes, qui constituent le stade ultime de la différenciation de la lignée cellulaire B. Lors de dérèglements de la prolifération de ces cellules, certaines Ig monoclonales anormales peuvent être produites et conduire à des situations pathologiques. La première partie de ce travail s’inscrit dans une logique de compréhension des éléments minima requis pour l’établissement de ce phénomène de CSR. Grace à un modèle animal d’insertion dirigée dans le locus kappa murin, naturellement ciblé par l’enzyme AID responsable de ce phénomène, nous avons mis en évidence que la présence de deux régions « switch » transcrites et fortement mutées par AID, n’était pas suffisante pour permettre ce phénomène. Un modèle murin reproduisant une maladie due à une Ig anormale a aussi été établi. Ce modèle de HCDD (Heavy Chain Deposition Disease) nous a permis de mettre en évidence la nécessité de la délétion du CH1 des chaînes lourdes d’Ig pour la génération des dépôts et nous a également permis de montrer que l’efficacité des thérapies à base d’inhibiteur de protéasome observée chez les patients atteint de HCDD, était en partie due à l’Ig pathogène elle-même, qui induit une élévation du stress du réticulum endoplasmique (UPR) au sein des plasmocytes producteurs de ces Ig. / Class Switch Recombination (CSR) is a key step during the immune response. CSR results in a switch to a more specific Ig isotype in response to a specific antigen. Plasma cells, the ultimate stage of B cell lineage differentiation, will synthesize this Ig. During plasma cell disorders, the production of an abnormal monoclonal Ig can lead to pathogenic situations. The aim of the first part of this study is to determine the minimal requirements for CSR induction with a mouse model in which we inserted a “switch cassette” composed of two transcribed S regions into a kappa locus which is naturally targeted by AID. However, despite efficient transcription and AID targeting of S regions, the “switch cassette” was not sufficient to induce effective CSR. We also developed a mouse model of HCDD (Heavy Chain Deposition Disease) which reproduced typical Randall-type renal lesions due to production of a pathogenic truncated heavy chain. This model demonstrated that the effective response to proteasome inhibitors observed in patients, is the consequence of the presence of a truncated HC that sensitizes plasma cells to this type of therapy through an elevated unfolded protein response (UPR).

Le sepsis est un problème mondial de santé publique du fait de son incidence croissante et de sa mortalité importante. Après une première phase très inflammatoire, les patients septiques présentent une profonde immunodépression, objectivée par un risque accru d’infections secondaires et de décès. Dans ce contexte, des thérapeutiques immunostimulantes sont actuellement testées. Afin d’identifier des cibles thérapeutiques pertinentes et des biomarqueurs permettant l’individualisation des traitements, la description exhaustive des mécanismes immunosuppresseurs mis en jeu est primordiale. Les lymphocytes B ont été peu étudiés au cours du sepsis. Des données récentes ont révélé l’existence de cellules B régulatrices dans différents contextes cliniques. Ainsi, nous avons fait l’hypothèse que des lymphocytes B / plasmocytes régulateurs pouvaient être impliqués dans l’établissement de l’immunodépression induite par le sepsis.Chez les patients en choc septique, nous avons montré que les lymphocytes B présentent une perte de leur fonction de prolifération et un phénotype d’épuisement cellulaire. Ils produisent de l’IL-10, cytokine suppressive (Journal of Immunology 2018). Enfin, une plasmocytose circulante apparait, confirmée par cytométrie de masse (Scientific Reports 2018). Dans un modèle murin de sepsis, ces plasmocytes inhibent la prolifération des lymphocytes T ex vivo et expriment des marqueurs phénotypiques suggérant pour la première fois la présence de plasmocytes régulateurs dans le sepsis.L’importance clinique des plasmocytes régulateurs reste à définir (mécanismes régulateurs, liens avec les paramètres cliniques, association avec les réactivations virales…). Elle pourrait conduire à l’établissement de nouveaux biomarqueurs pour le suivi immunitaire des patients et à de nouvelles approches thérapeutiques / Sepsis in a major health problem associated with rising incidence and high mortality rate. In septic patients, an initial proinflammatory response causing life-threatening organ failures is followed by the development of a deep immunosuppression, associated with increased risk of secondary infections and death. In this context, immunostimulating therapies are currently tested. However, success of this strategy requires identification of relevant therapeutical targets and biomarkers allowing individualisation of treatments. B lymphocytes have been poorly studied in sepsis. Moreover, existence of regulatory B cells was recently revealed in several clinical contexts. Thus, we made the assumption that regulatory B lymphocytes or plasma cells could be implied in sepsis-induced immunosuppression establishment.In septic shock patients, we showed that B cells present with decreased proliferation capacity and exhausted-like profile, and are able to produce immunosuppressive IL-10 (Journal of Immunology 2018). We also observed blood plasmacytosis in patients, confirmed by mass cytometry analysis (Scientific Reports 2018). In a murine model of sepsis, the ability of plasma cells to inhibit T cell proliferation ex vivo, and their phenotypic profile suggest for the first time the existence of regulatory plasma cells in sepsis.The role of regulatory plasma cells within sepsis-induced immunosuppression has to be further explored in patients (underlying regulatory mechanisms, associations with clinical outcomes and viral reactivations…). It could highlight novel biomarkers for patients’ monitoring and innovative therapeutical approaches

La prévalence de Streptococcus suis, notamment du sérotype 2, à l’échelle mondiale pose de grands problèmes à l’industrie porcine ainsi qu’à la santé publique. La compréhension des mécanismes immunitaires permettant alors de lutter contre cette bactérie devient un atout majeur dans le développement des vaccins. S. suis dispose cependant d’un puissant arsenal pour contrer ces mécanismes. Enveloppé d’une capsule polysaccharidique (CPS), cette bactérie résiste à la phagocytose, à moins que certaines cellules soient en mesure de produire des anticorps opsonisants. Par chance, au sein de la rate, en périphérie du follicule, une zone nommée la « zone marginale » regroupe des lymphocytes B spécialisés dans la réponse aux bactéries encapsulées et aux antigènes polysaccharidiques. Ceci sans l’intervention des lymphocytes T auxiliaires, contrairement aux lymphocytes B se trouvant à l’intérieur du follicule, qui interviennent dans une réponse plus dirigée contre des antigènes protéiques. L’objectif général de ce mémoire est donc l’étude de la réponse anticorps dite « extrafolliculaire » que les LB-MZ sont suspectés d’orchestrer lors d’une infection à S. suis. En premier lieu nous avons déterminé la cinétique de différentiation en plasmocytes des LB-MZ (LB-MZ) lors de l’infection par S. suis. Puis nous avons étudié la fonctionnalité et le type d’anticorps produits par ces LB-MZ. Les présents travaux ont démontré toute l’importance des LB-MZ dans l’élimination de la bactérie ou dans le ralentissement de sa dissémination systémique durant les premiers stades de l’infection, notamment grâce à un environnement propice à la différenciation en plasmocytes. Les principaux anticorps produits à cet effet étaient de classe IgM et dirigés contre des antigènes de la CPS. Nos résultats éclairent un peu plus la voie, et permettent d’imaginer des options pour le développement des vaccins qui activeraient spécifiquement cette réponse extrafolliculaire efficace. / The worldwide prevalence of Streptococcus suis, particularly serotype 2, poses major problems for the pig industry and public health. Understanding the immune mechanisms involved in combating this bacterium is becoming a major asset in the development of vaccines. However, S. suis has a powerful arsenal at its disposal to counter these mechanisms. Enveloped in a polysaccharide capsule (CPS), this bacterium resists phagocytosis unless certain cells can produce opsonising antibodies. Fortunately, within the spleen, at the periphery of the follicle, a zone known as the "marginal zone" contains B lymphocytes specialised in responding to encapsulated bacteria and polysaccharide antigens. This is without the intervention of T helper lymphocytes, unlike the B lymphocytes inside the follicle, which are involved in a response more directed against protein antigens. The general objective of this thesis is therefore to study the so-called 'extrafollicular' antibody response that LB-MZ are thought to orchestrate during S. suis infection. We first determined the kinetics of LB-MZ differentiation into plasma cells during S. suis infection. We then studied the functionality and type of antibodies produced by these LB-MZs. This work has demonstrated the importance of LB-MZ in eliminating the bacterium or slowing down its systemic dissemination during the early stages of infection, thanks to an environment conducive to differentiation into plasma cells. The main antibodies produced for this purpose were IgM class antibodies directed against CPS antigens. Our results shed a little more light on the pathway, and allow us to imagine options for the development of vaccines that would specifically activate this effective extrafollicular response.

Le processus de recombinaison V(D)J des gènes d’immunoglobulines (Ig) est caractérisé par une grande imprécision des jonctions entre les segments variables (V), de diversité (D) et de jonction (J). Deux fois sur trois, un décalage du cadre de lecture apparaît, aboutissant à une jonction non productive dite « hors phase ». Plusieurs études ont démontré que les deux allèles productifs et non-productifs sont activement transcrits. Les transcrits matures issus des allèles non-productifs sont pris en charge par un mécanisme de surveillance des ARNm appelé NMD « Nonsense-Mediated mRNA Decay ». En dégradant efficacement les ARNm d’Ig contenant des codons non-sens, ce mécanisme prévient l’apparition des Ig tronquées au cours de l’ontogénie B. Néanmoins, aucune étude n’a jusqu’ici analysé l’impact de l’épissage alternatif des transcrits d’Ig non-productifs. Ce phénomène appelé NAS « Nonsense-associated Altered Splicing » peut conduire à une production d’Ig tronquées présentant des délétions internes du domaine variable (V).Les projets développés lors de cette thèse ont montré que la présence d’un codon non-sens, au niveau de l’exon variable (VJ) des transcrits Igκ, favorise le saut d’exon et la production de chaînes légères dépourvues de domaine variable (ΔV-κLCs). De façon intéressante, ces Ig tronquées provoquent un stress cellulaire et conduisent à l’apoptose des plasmocytes (Article 1). Ces observations ont permis d’identifier un nouveau point de contrôle agissant tardivement lors de la différenciation plasmocytaire : le TIE « Truncated-Ig Exclusion » checkpoint. Ce processus de contrôle provoque l’élimination des plasmocytes qui produisent des chaînes d’Ig tronquées. Nous avons également étudié l’épissage alternatif des transcrits d’Ig non-productifs en l’absence de TIE-checkpoint (Article 2). Cette étude a révélé que l’hypertranscription des gènes d’Ig dans les plasmocytes favorise l’épissage alternatif des transcrits d’Ig non-productifs. En utilisant un modèle d’expression forcée d’Ig tronquées, nous avons mis en évidence une coopération entre les mécanismes assurant la surveillance des ARNm (NMD) et la surveillance au niveau protéique (UPR : « Unfolded Protein Response », autophagie) (Article 3). Sur la base de ces résultats, nous avons mis au point une nouvelle approche thérapeutique qui consiste à forcer la production d’Ig tronquées en utilisant des oligonucléotides anti-sens (AON) capables de provoquer l’élimination de l’exon variable lors de l’épissage. Cette invention pourrait ouvrir des perspectives thérapeutiques pertinentes dans le traitement du Myélome Multiple et d’autres pathologies touchant les plasmocytes. / The recombination process V(D)J of immunoglobulin (Ig) genes is characterized by random junctions between the variable (V), diversity (D) and joining (J) segments. A frameshift mutation appears in two-third of cases, generating a non-productive or « out of frame » junction. Several studies have shown that both productive and non-productive alleles are actively transcribed. The mature transcripts from nonproductive alleles are usually considered sterile and innocuous as a result of an mRNA surveillance mechanism called NMD « Nonsense-Mediated mRNA Decay ». By degrading aberrant mRNA, this mechanism prevents the appearance of truncated Ig during B cell ontogeny. However, less is known about the impact of alternative splicing on non-productive Ig transcripts. This mechanism, called NAS « Nonsense-associated Altered Splicing » can lead to the production of truncated Ig with internal deletions of variable domain (V). During my thesis, we have shown that the presence of a stop codon, within the variable exon (VJ) of Igκ transcripts, promotes exon skipping and synthesis of V domain-less κ light chains (ΔV-κLCs). Interestingly, such truncated Ig causes cellular stress and leads to plasma cells apoptosis (Article 1). These findings have identified a new checkpoint acting late during plasma cell differentiation: TIE « Truncated-Ig Exclusion » checkpoint. This process ensures counter-selection of plasma cells producing truncated-Ig. We also studied the alternative splicing of non-productive Ig transcripts in the absence of TIE-checkpoint (Article 2). We found that hypertranscription of Ig genes in plasma cells promote alternative splicing of non-productive Ig transcripts. Using a model forcing the expression of truncated Ig, we identified a cooperative action between mRNA surveillance mechanisms (NMD) and those of protein surveillance (UPR « Unfolded Protein Response », autophagy) (Article 3). Based on these results, we have developed a new therapeutic approach by increasing the production of truncated Ig using antisense oligonucleotides (AON) that leads to the elimination of the variable exon during splicing. This invention could open new avenues for the treatment of Multiple Myeloma patients and other pathologies affecting plasma cells.