As células dendríticas (DCs) são as principais células apresentadoras de antígeno do sistema imune, e há evidências da participação na tolerância imunológica. Neste estudo avaliamos as alterações ocorridas na população de células CD4+CD25+Foxp3+ após co-cultura de células de linfonodo com BMDCs, na presença de timócitos alogênicos ou singênicos em apoptose. Após cultura na presença de células alogênicas a população de Tregs mostra-se aumentada, e essa expansão é dependente de contato entre a DC e o linfócito T, já que o isolamento das culturas diminuiu a expressão destes marcadores. A internalização de células em apoptose foi induziu caráter tolerogênico nas DCs com baixa expressão de moléculas co-estimuladoras e resistência à maturação por LPS. As células CD4+CD25+ geradas in vitro foram capazes de conter a proliferação de esplenócitos de camundongos BALB/c estimulados por esplenócitos de C57BL/6 irradiados, anti-CD3 e OVA. No ensaio in vivo, as Tregs geradas in vitro também foram capazes de suprimir a proliferação de células CD25- quando transferidas para animais Nude, impedindo também o infiltrado inflamatório no estômago, cólon, fígado e rins, sendo assim capazes de suprimir a resposta imune in vitro e in vivo. / The dendritic cell (DC) plays a very important role in antigen presentation in the immune system and recent articles have shown the involvement in maintaining peripheral tolerance. Here we evaluated the changes in the CD4+CD25+Foxp3+ after co culture of DCs with lymph node cells. BMDCs were pulsed with apoptotic cells and co-cultured with lymph-node cells. Our results show an increase of CD4+CD25+Foxp3+ T cells after co-culture with DCs pulsed with apoptotic cells. Furthermore, the DCs did not change the pattern of co-stimulatory molecules expression due to phagocytosis of syngeneic or allogeneic apoptotic cells and further stimulation with LPS. The CD4+CD25+ cells sorted from the in vitro culture were able to suppress the proliferation of splenocytes in vitro in a specific and non-specific manner. As expected, the co-transfer of CD4+CD25- and CD4+CD25+, both sorted from the in vitro culture, was able to control the cell infiltrates in the target organs and the total cell count in the lymph-nodes. Thus, the Tregs expanded in vitro are able to suppress the immune response in vitro and in vivo assays.

O veneno da subespécie de cascavel Crotalus durissus terrificus (C.d.terrificus) altera a coagulação, tem ação neurotóxica, miotóxica e efeito imunossupressivo. O veneno de C.d.terrificus e a sua fração majoritária, crotoxina (CTX), inibem a resposta celular e humoral, sendo esse efeito independente da indução de morte celular. O objetivo foi investigar os mecanismos envolvidos na imunossupressão exercida pela CTX. A CTX induz a produção de IL-10, TGF-<font face=\"Symbol\">&#946 e prostaglandina E2 (PGE2) pelas células dos camundongos que a receberam. Menor secreção de IFN-<font face=\"Symbol\">&#947 e IL-12 foi observada nas culturas de células de camundongos imunizados e que receberam CTX. A CTX aumenta a expressão da enzima indoleamina 2,3 dioxigenase e a geração de células T reguladoras em camundongos imunizados com OVA e que receberam CTX. A CTX foi capaz de inibir a expressão de CD40, CD80, CD86 e de MHC de classe II em células de camundongos imunizados e nas células dendríticas (DCs) purificadas destes animais. Em culturas de DCs, a CTX induz alta secreção de IL-10, TGF-<font face=\"Symbol\">&#946 e PGE2 e menor de IL-12. / The venom of the rattlesnake Crotalus durissus terrificus (C.d.terrificus) changes the coagulation system and presents neurotoxic, myotoxic and immunosuppressive effect. The venom and its main fraction, crotoxin (CTX) inhibited both the cellular and humoral response. This effect is not due to induction of cell death. The objective was to investigate the immunosuppressive mechanisms of CTX. CTX induces production of IL-10, TGF-<font face=\"Symbol\">&#946 and prostaglandin E2 (PGE2) by cells of mice that received it. Lower secretion of IFN-<font face=\"Symbol\">&#947 and IL-12 was observed in the cultured cells from mice immunized that received CTX. CTX promotes increased expression of the enzyme indoleamine 2,3 dioxygenase and generation of regulatory T cells in mice immunized with OVA and receiving the toxin. CTX was able to inhibit the expression of CD40, CD80, CD86 and MHC II in mice immunized and in dendritic cells (DCs) purified from these animals. In cultures of DCs, CTX increased secretion of IL-10, TGF-<font face=\"Symbol\">&#946 and PGE 2 and lower IL-12.

Les cellules dendritiques (DC), principales cellules présentatrices d’antigène, jouent un rôle crucial dans la régulation de la réponse immunitaire. Leur état d’activation et de maturation conditionne notamment la réponse immunitaire anti-tumorale. Ainsi à un stade immature, les DC sont incapables d’activer la réponse immunitaire. Notre équipe a montré qu’en plus d’être inefficaces, les DC intra-tumorales acquièrent des propriétés immunosuppressives et inhibent l’activation lymphocytaire. A l’inverse, activées et matures, les DC peuvent être utilisées en immunothérapie des cancers. Notre équipe a montré que les DC peuvent dans certaines conditions devenir tumoricides et que ces DC tumoricides combinent une activité cytotoxique contre les cellules tumorales et la capacité d’activation des lymphocytes T spécifiques de la tumeur. Avant d’utiliser ces DC tumoricides en phase clinique, nous avons voulu étudier les interactions de ces cellules avec des cellules immunosuppressives générées par les tumeurs, les lymphocytes T régulateurs (Treg). Notre étude montre que les DC cytotoxiques (KDC), générées à partir du sang de patients atteints de tumeurs, sont capables d’inhiber la génération des lymphocytes T régulateurs, impliqués dans l’immunosuppression induite par les tumeurs. Elles sont également à l’origine de la polarisation des lymphocytes T naïfs en des lymphocytes T helper 1, principaux acteurs de la réponse immunitaire anti-tumorale. Sans parvenir à identifier les molécules impliquées, nous avons établi que l’inhibition de la génération des Treg par les KDC n’implique ni l’IL-6, ni le NO, mais est partiellement dépendante d’un contact cellulaire. La rate joue un rôle central dans les mécanismes de tolérance immunitaire, lors des cancers, mais également lors des maladies auto-immunes (MAI). Une meilleure compréhension de la réponse immunitaire au cours de ces 2 types de pathologies au niveau d’un organe lymphoïde majeur tel que la rate est indispensable pour adapter au mieux les thérapeutiques. Cependant, il n’existe que très peu d’études portant sur les DC spléniques humaines. Nos travaux sur les DC au sein de rates provenant de patients atteints de divers cancers et MAI mettent en évidence une répartition des sous populations de DC qui diffère selon les pathologies. Bien que limité par le nombre d’échantillons humains, nous avons également déterminé le profil d’activation de ces sous populations de DC après stimulation par différents TLR. Etant donné le rôle clé des DC dans l’initiation de la réponse immunitaire spécifique, ces nouvelles connaissances pourraient permettre de cibler certains sous-types de DC afin de les activer ou de les inhiber lors de ces différentes pathologies. Ces observations offrent d’importantes perspectives pour la future utilisation des DC dans les stratégies d'immunothérapie. / Known for years as professional antigen presenting cells (APC), dendritic cells (DC) play a crucial role in immune response regulation. Their state of activation and maturation conditions the antitumor immune response. Thus, at an immature stage, the DC are unable to activate the immune response. Our team demonstrated that besides being ineffective, intra-tumoral DC acquire immunosuppressive properties and inhibit T cell activation. Conversely, activated and mature DC can be used in cancer immunotherapy. Previous reports from our research team deciphered that under certain conditions DC can become tumoricidal. These DC combine a cytotoxic activity against tumor cells and the capacity to activate tumor specific T cells. Prior launching the possibility of the application of such cytotoxic DC (referred as KDC for Killer DC) in clinic, we explored the interactions of these cells with regulatory T cells (Treg), -major immunosuppressive cells promoted by tumor microenvironment. Our study revealed that KDC, generated from the blood of cancer patients, can inhibit Treg generation and deviate naive T cell polarization into T helper 1 cells, key players in the anti-tumor immune response. We have further established that the inhibition of Treg generation by the KDC requires cell to cell contact, though implies neither IL-6 nor NO, but the mechanism still to be deciphered. Spleen, a major lymphoid organ, drives foremost mechanisms in immune tolerance during cancer and autoimmune diseases (AID). A better understanding of the immune response specifications during these 2 types of diseases in the spleen is therefore essential goal for therapeutic developments. Nevertheless, there is negligible volume of studies on human splenic immune cells, in particular DC. Our research on splenic DC, derived from patients with various cancers and AID, display distinct DC subset distribution respective to the disease. Although limited by the availability of human splenic samples, we also determined the activation profile of DC subsets after stimulation by different TLR ligands. Given the key role of DC in initiating specific immune response, this novel findings could be implemented to target certain DC subset activation or inhibition in these pathologies. These investigations provide important knowledge for more refine exploitation of DC in immunotherapeutic strategies as treatment tools or as targets.

IntroducciónEn la actualidad se buscan marcadores para identificar pacientes trasplantados que alcancen cierto grado de tolerancia. El más estudiado recientemente se engloba como células T reguladoras (Tregs), capaces de controlar la respuesta alogénica in vitro y con capacidad tolerogénica en modelos animales. En este trabajo se ha estudiado el comportamiento de Tregs en trasplantados renales y la implicación de procesos inflamatorios y fármacos inmunosupresores más comunes en estos pacientes. Material y MétodosSe midieron las Tregs sanguíneas en los pacientes trasplantados renales mediante citometría de flujo y su función in vitro en cultivos mixtos linfocitarios cada 6 meses post-trasplante hasta los 2 años. Resultados y conclusionesLos pacientes con enfermedad renal terminal presentan un número similar de Tregs que donantes sanos. A los 6 meses del trasplante se observa un descenso de Tregs, recuperándose posteriormente. Se observó una mayor frecuencia de Tregs en los pacientes tratados durante un año con inhibidores de mTOR que los tratados con inhibidores de calcineurina (CNI). Así mismo se observó cómo los niveles sanguíneos de los CNI tenían un efecto deletéreo sobre la función de las Tregs. / IntroductionKidney transplantation has become a therapeutic option choice in patients with chronic renal failure. With the advance of new immunosuppressive agents has been a lower incidence of acute rejection, but still persist long-term problems, largely associated with chronic treatment with immunosuppressive agents. Currently, are looking for markers to identify patients who reach a certain degree of tolerance in order to reduce immunosuppressive load avoiding side effects long term. The most studied biomarker in the last decade includeswith the name of regulatory T cells (Tregs), these cells are able to control allogeneic response in vitro and has tolerogenic capacity demonstrated in many transplant models. Prior to validate this biomarker of transplant tolerance, this work has studied the behavior of Treg cells in renal transplant recipients and their coexistence in the most common inflammatory processes in these patients. In addition, we assess the role of drugs immunosuppressants on these cells.ObjectivesMonitor the levels of Tregs in renal transplant patients and consider the involvement of different events inflammatory on the number of Tregs and to determine the involvement of different immunosuppressive treatments on the number and Tregs function.Material and MethodsThere were two parallel studies, one prospective, in which Treg cells were measured in kidney transplants patients by flow cytometry and theirfunction in vitro by mixed lymphocyte cultures. The samples were collected every 6 months post-transplant until 2 years. In another retrospective study enrolled 64 patients transplantation with a follow-up exceeding one year, dividedin terms of maintenance therapy with calcineurin inhibitors (CNI) or mTOR inhibitors.Results and conclusions At the time prior to transplantation, patients with ESRD have a similar number of Treg cells circulating than healthy donors, excluding retransplantated patients. At 6 months after transplantation there is a dramatic decrease in Treg cell numbers, when the immunosuppressive load is higher. Later the levels of Tregs were recovered. Within the immunosuppressive used in maintenance treatment, there was a higher frequency of Tregs in patients treated for one year with mTOR inhibitors when compared with patients received in the same period calcineurin inhibitors (CNI). Also it was observed that blood levels of the CNI had a deleterious effect on the function of Treg cells.

Inflammatory bowel disease (including Crohn’s disease and ulcerative colitis) and coeliac disease are debilitating gastrointestinal diseases that seriously affect the quality of life of those affected. Under normal circumstances, the intestinal immune system is maintained in a state of controlled inflammation, whereby balance exists between protective immunity, mediated by effector cells, and tolerance mediated by cells with regulatory function. However, an aberrant immune response is believed to contribute to the intestinal inflammation present in individuals afflicted by these diseases. This thesis investigated the involvement of CD4⁺ CD25[superscript]high Foxp3⁺ Regulatory T cells (Treg) and Th17 Effector cells in both inflammatory bowel disease (IBD) and coeliac disease. The reciprocal relationship between Treg and Th17 cells under certain cytokine conditions, has prompted the exploration of these two cell types in IBD and coeliac disease. Previous studies have examined these factors individually in a range of diseases, however, to our knowledge the study of both Treg and Th17 in IBD and coeliac disease subjects represents a novel area of research. Crohn’s disease (CD), ulcerative colitis (UC) and coeliac disease subjects were recruited through the Department of Gastroenterology and Hepatology at The Queen Elizabeth Hospital (QEH) in Adelaide, South Australia. In total, one-hundred and seventeen subjects were enlisted in this study to donate blood samples. In addtion, intestinal biopsy samples were collected from fifty-six subjects undergoing colonoscopy at the QEH Department of Gastroenterology and Hepatology. All subjects participated, with informed consent and ethics approval. Treg and Th17 cell numbers were investigated in the peripheral blood of Crohn’s disease, ulcerative colitis, coeliac disease and control subjects using multi-colour, intracellular flow cytometry. A decrease in Treg cell numbers and an increase in Th17 cell numbers was observed in IBD, but not in coeliac disease. Closer investigation into the ratio of Treg and Th17 cells within patients identified a near 1:1 Treg/Th17 ratio in control subjects, but a lower Treg/Th17 ratio in IBD patients. This suggested a disturbance in regulatory and effector cell equilibrium. Furthermore, the excess of Th17 cells and deficiency of Tregs could contribute to the pathologies observed in IBD. The discovery of an imbalance in Treg and Th17 cell numbers in IBD prompted further investigation of these cells in intestinal biopsies collected from IBD, coeliac and control subjects. Real time RT-PCR of intestinal biopsy samples demonstrated increased expression of the Th17 cytokine, IL-17a, in both IBD and coeliac disease. Elevated levels of the Treg transcription factor Foxp3 were also identified in intestinal biopsies from IBD subjects. It was therefore hypothesised that Treg cells may have been actively recruited from the periphery in an attempt to control inflammation in the gut; however, the intestinal cytokine microenvironment may have restricted the regulatory function of these cells. Cytokines known to promote human Th17 differentiation, namely IL-1β, IL-6, TGF-β, IL-21 and IL-23, were explored in intestinal biopsy samples from IBD, coeliac and control subjects. High levels of IL-1β and IL-6 were detected in IBD patient samples, however, no change in levels of IL-21 or IL-23 were observed in IBD or coeliac disease subjects. Elevated levels of TGF-β were only identified in UC. No changes in cytokine expression were observed between control and coeliac subjects, except a significant decrease in IL-6 levels was identified in coeliac disease sufferers. The pro-inflammatory microenvironment identified in intestinal biopsies from IBD subjects may have promoted the continual differentiation and development of Th17 cells, whilst restricting Treg activity. Moreover, the observed deficiency of Treg in IBD patients may have impaired the ability of the immune system to limit excessive pathogenic Th17 driven immune responses in the intestinal mucosa. Therefore, therapeutic approaches that aim to re-establish regulatory and effector cell homeostasis by increasing Treg numbers in IBD patients, and specifically targeting Th17 cells, may prove effective in the treatment of IBD. Approaches such as these could provide greater focus to treatment strategies for IBD management compared to current broad-spectrum immunosuppressive therapies that could increase susceptibility to cancer or infection in IBD patients. In addition, the imbalance of regulatory and effector cells demonstrated in the peripheral blood of IBD patients may potentially provide new options for a noninvasive diagnostic tool. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1457580 / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2009

Inflammatory bowel disease (including Crohn’s disease and ulcerative colitis) and coeliac disease are debilitating gastrointestinal diseases that seriously affect the quality of life of those affected. Under normal circumstances, the intestinal immune system is maintained in a state of controlled inflammation, whereby balance exists between protective immunity, mediated by effector cells, and tolerance mediated by cells with regulatory function. However, an aberrant immune response is believed to contribute to the intestinal inflammation present in individuals afflicted by these diseases. This thesis investigated the involvement of CD4⁺ CD25[superscript]high Foxp3⁺ Regulatory T cells (Treg) and Th17 Effector cells in both inflammatory bowel disease (IBD) and coeliac disease. The reciprocal relationship between Treg and Th17 cells under certain cytokine conditions, has prompted the exploration of these two cell types in IBD and coeliac disease. Previous studies have examined these factors individually in a range of diseases, however, to our knowledge the study of both Treg and Th17 in IBD and coeliac disease subjects represents a novel area of research. Crohn’s disease (CD), ulcerative colitis (UC) and coeliac disease subjects were recruited through the Department of Gastroenterology and Hepatology at The Queen Elizabeth Hospital (QEH) in Adelaide, South Australia. In total, one-hundred and seventeen subjects were enlisted in this study to donate blood samples. In addtion, intestinal biopsy samples were collected from fifty-six subjects undergoing colonoscopy at the QEH Department of Gastroenterology and Hepatology. All subjects participated, with informed consent and ethics approval. Treg and Th17 cell numbers were investigated in the peripheral blood of Crohn’s disease, ulcerative colitis, coeliac disease and control subjects using multi-colour, intracellular flow cytometry. A decrease in Treg cell numbers and an increase in Th17 cell numbers was observed in IBD, but not in coeliac disease. Closer investigation into the ratio of Treg and Th17 cells within patients identified a near 1:1 Treg/Th17 ratio in control subjects, but a lower Treg/Th17 ratio in IBD patients. This suggested a disturbance in regulatory and effector cell equilibrium. Furthermore, the excess of Th17 cells and deficiency of Tregs could contribute to the pathologies observed in IBD. The discovery of an imbalance in Treg and Th17 cell numbers in IBD prompted further investigation of these cells in intestinal biopsies collected from IBD, coeliac and control subjects. Real time RT-PCR of intestinal biopsy samples demonstrated increased expression of the Th17 cytokine, IL-17a, in both IBD and coeliac disease. Elevated levels of the Treg transcription factor Foxp3 were also identified in intestinal biopsies from IBD subjects. It was therefore hypothesised that Treg cells may have been actively recruited from the periphery in an attempt to control inflammation in the gut; however, the intestinal cytokine microenvironment may have restricted the regulatory function of these cells. Cytokines known to promote human Th17 differentiation, namely IL-1β, IL-6, TGF-β, IL-21 and IL-23, were explored in intestinal biopsy samples from IBD, coeliac and control subjects. High levels of IL-1β and IL-6 were detected in IBD patient samples, however, no change in levels of IL-21 or IL-23 were observed in IBD or coeliac disease subjects. Elevated levels of TGF-β were only identified in UC. No changes in cytokine expression were observed between control and coeliac subjects, except a significant decrease in IL-6 levels was identified in coeliac disease sufferers. The pro-inflammatory microenvironment identified in intestinal biopsies from IBD subjects may have promoted the continual differentiation and development of Th17 cells, whilst restricting Treg activity. Moreover, the observed deficiency of Treg in IBD patients may have impaired the ability of the immune system to limit excessive pathogenic Th17 driven immune responses in the intestinal mucosa. Therefore, therapeutic approaches that aim to re-establish regulatory and effector cell homeostasis by increasing Treg numbers in IBD patients, and specifically targeting Th17 cells, may prove effective in the treatment of IBD. Approaches such as these could provide greater focus to treatment strategies for IBD management compared to current broad-spectrum immunosuppressive therapies that could increase susceptibility to cancer or infection in IBD patients. In addition, the imbalance of regulatory and effector cells demonstrated in the peripheral blood of IBD patients may potentially provide new options for a noninvasive diagnostic tool. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1457580 / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2009

Inflammatory bowel disease (including Crohn’s disease and ulcerative colitis) and coeliac disease are debilitating gastrointestinal diseases that seriously affect the quality of life of those affected. Under normal circumstances, the intestinal immune system is maintained in a state of controlled inflammation, whereby balance exists between protective immunity, mediated by effector cells, and tolerance mediated by cells with regulatory function. However, an aberrant immune response is believed to contribute to the intestinal inflammation present in individuals afflicted by these diseases. This thesis investigated the involvement of CD4⁺ CD25[superscript]high Foxp3⁺ Regulatory T cells (Treg) and Th17 Effector cells in both inflammatory bowel disease (IBD) and coeliac disease. The reciprocal relationship between Treg and Th17 cells under certain cytokine conditions, has prompted the exploration of these two cell types in IBD and coeliac disease. Previous studies have examined these factors individually in a range of diseases, however, to our knowledge the study of both Treg and Th17 in IBD and coeliac disease subjects represents a novel area of research. Crohn’s disease (CD), ulcerative colitis (UC) and coeliac disease subjects were recruited through the Department of Gastroenterology and Hepatology at The Queen Elizabeth Hospital (QEH) in Adelaide, South Australia. In total, one-hundred and seventeen subjects were enlisted in this study to donate blood samples. In addtion, intestinal biopsy samples were collected from fifty-six subjects undergoing colonoscopy at the QEH Department of Gastroenterology and Hepatology. All subjects participated, with informed consent and ethics approval. Treg and Th17 cell numbers were investigated in the peripheral blood of Crohn’s disease, ulcerative colitis, coeliac disease and control subjects using multi-colour, intracellular flow cytometry. A decrease in Treg cell numbers and an increase in Th17 cell numbers was observed in IBD, but not in coeliac disease. Closer investigation into the ratio of Treg and Th17 cells within patients identified a near 1:1 Treg/Th17 ratio in control subjects, but a lower Treg/Th17 ratio in IBD patients. This suggested a disturbance in regulatory and effector cell equilibrium. Furthermore, the excess of Th17 cells and deficiency of Tregs could contribute to the pathologies observed in IBD. The discovery of an imbalance in Treg and Th17 cell numbers in IBD prompted further investigation of these cells in intestinal biopsies collected from IBD, coeliac and control subjects. Real time RT-PCR of intestinal biopsy samples demonstrated increased expression of the Th17 cytokine, IL-17a, in both IBD and coeliac disease. Elevated levels of the Treg transcription factor Foxp3 were also identified in intestinal biopsies from IBD subjects. It was therefore hypothesised that Treg cells may have been actively recruited from the periphery in an attempt to control inflammation in the gut; however, the intestinal cytokine microenvironment may have restricted the regulatory function of these cells. Cytokines known to promote human Th17 differentiation, namely IL-1β, IL-6, TGF-β, IL-21 and IL-23, were explored in intestinal biopsy samples from IBD, coeliac and control subjects. High levels of IL-1β and IL-6 were detected in IBD patient samples, however, no change in levels of IL-21 or IL-23 were observed in IBD or coeliac disease subjects. Elevated levels of TGF-β were only identified in UC. No changes in cytokine expression were observed between control and coeliac subjects, except a significant decrease in IL-6 levels was identified in coeliac disease sufferers. The pro-inflammatory microenvironment identified in intestinal biopsies from IBD subjects may have promoted the continual differentiation and development of Th17 cells, whilst restricting Treg activity. Moreover, the observed deficiency of Treg in IBD patients may have impaired the ability of the immune system to limit excessive pathogenic Th17 driven immune responses in the intestinal mucosa. Therefore, therapeutic approaches that aim to re-establish regulatory and effector cell homeostasis by increasing Treg numbers in IBD patients, and specifically targeting Th17 cells, may prove effective in the treatment of IBD. Approaches such as these could provide greater focus to treatment strategies for IBD management compared to current broad-spectrum immunosuppressive therapies that could increase susceptibility to cancer or infection in IBD patients. In addition, the imbalance of regulatory and effector cells demonstrated in the peripheral blood of IBD patients may potentially provide new options for a noninvasive diagnostic tool. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1457580 / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2009

Πρόσφατες μελέτες υποδεικνύουν ότι τα Τ ρυθμιστικά κύτταρα (Tregs), προάγουν την ανοσολογική ανοχή στην μεταμόσχευση. Σκοπός της παρούσας μελέτης ήταν να προσδιοριστούν τα επίπεδα των Τregs σε 39 ασθενείς, οι οποίοι είχαν υποβληθεί σε μεταμόσχευση νεφρού και ήταν σε σταθερή κατάσταση, και να καθοριστούν οι αριθμητικές αναλογίες των Τregs πληθυσμών, όπως και η δράση των ανοσοκατασταλτικών φαρμάκων σ’ αυτούς τους κυτταρικούς πληθυσμούς. Όλοι οι ασθενείς (19 ασθενείς είχαν καλή νεφρική λειτουργία, ενώ 20 ασθενείς είχαν χρόνια νεφροπάθεια του μοσχεύματος), είχαν λάβει ως θεραπεία επαγωγής basiliximab και ήταν σε τριπλό ανοσοκατασταλτικό σχήμα με αναστολείς της καλσινευρίνης (κυκλοσπορίνη ή tacrolimus), μουκοφαινολικό οξύ (MMF) ή everolimus και στεροειδή. Ως ομάδα ελέγχου μελετήθηκαν 20 υγιείς εθελοντές. Δείγματα από αίμα σημάνθηκαν με αντι-CD4, CD25, CD127 και foxp3 αντισώματα και αναλύθηκαν με κυτταρομετρία ροής, με σκοπό να καθοριστούν τα επίπεδα των CD4+CD25+Foxp3± και CD4CD25highCD127-/low Treg. Όλοι οι ασθενείς είχαν στατιστικά σημαντικά μειωμένα επίπεδα CD4+CD25highFoxP3± , άλλα όχι όμως και CD4+CD25highCD127-/low Treg, σε σύγκριση με την ομάδα ελέγχου. Η νεφρική λειτουργία των μοσχευμάτων δεν συσχετιζόταν με τα επίπεδα των Τregs. Ανευρέθει σημαντική στατιστική συσχέτιση μεταξύ των επιπέδων CD4+CD25highFoxp3+ Tregs και των επιπέδων του tacrolimus, όπως επίσης και των CD4+CD25highFoxp3- Tregs με τα HLA-DR μη συμφωνούντα (mismatching) αλλοαντιγόνα. Οι ασθενείς οι οποίοι ελάμβαναν MMF είχαν στατιστικά σημαντικά υψηλότερα επίπεδα CD4+CD25highFoxp3+ Tregs σε σύγκριση με τους ασθενείς οι οποίοι ελάμβαναν everolimus, παρά το γεγονός ότι οι ασθενείς της ομάδας του everolimus ελάμβαναν και χαμηλότερες δόσεις αναστολέων της καλσινευρίνης. Συμπερασματικά, τα ανοσοκατασταλτικά φάρμακα μειώνουν στατιστικά σημαντικά τα επίπεδα των CD4+CD25highFoxP3± Treg στην περιφέρεια στους ασθενείς πού έχουν υποβληθεί σε νεφρική μεταμόσχευση. Επιπλέον, τα διάφορα ανοσοκατασταλτικά φάρμακα έχουν διαφορετική επίδραση στα CD4+CD25highFoxP3+ Tregs, και το γεγονός αυτό θα μπορούσε να επηρεάσει την μακροχρόνια επιβίωση των άλλο-μοσχευμάτων. / Recent studies indicate that regulatory T-cells (Tregs) promote transplant tolerance. We studied Tregs levels in 39 stable renal transplant recipients, to determine the sizes of Tregs populations and the effects of treatment regimens thereof. All patients (19 with good graft function and 20 with chronic allograft nephropathy) had received induction therapy (basiliximab) and were on triple immunosuppressive regimens with calcineurin inhibitors (cyclosporine or tacrolimus), mycophenolate mofetil (MMF) or everolimus and steroids. Twenty healthy subjects served as controls. Whole blood samples were stained with anti-CD4, CD25, CD127, and FoxP3 antibodies and analyzed by flow cytometry to determine CD4+CD25highFoxP3± and CD4+CD25highCD127-/low Tregs levels. All patients had significantly reduced CD4+CD25highFoxP3± but no CD4+CD25highCD127-/low Tregs levels compared to controls. Renal allograft function did not correlate with Tregs levels. Statistically significant correlations between CD4+CD25highFoxp3+ Tregs and tacrolimus levels and CD4+CD25highFoxp3- Tregs and HLA-DR mismatching were detected. Patients receiving MMF had significantly higher CD4+CD25highFoxp3+ Tregs compared to patients on everolimus who were also receiving lower doses of calcineurin inhibitors. Overall, immunosuppression lowers CD4+CD25highFoxP3± Tregs levels significantly in the periphery in renal transplant recipients. In addition, different immunosuppressive regimens have different impact on CD4+CD25highFoxP3+ Tregs, a fact that may influence long-term allograft survival.

Atopic dermatitis (AD) is a common, chronic relapsing inflammatory skin disease associated with cutaneous hyper-reactivity to environmental triggers that are innocuous to normal nonatopic individuals. AD affects 10% to 15% of children and 2% to 10% of adults in industrialized countries. There has been increasing interest in this disease triggered by its increasing prevalence in western societies and its contribution to the increasing health care costs. Yet, the underlying pathophysiologic and genetic mechanisms leading to the manifestation of AD are not clear. AD results from a complex interplay between environmental triggers, susceptibility genes including mutations in the keratinocyte protein filaggrin and altered immune responses resulting in allergic CD4+ T cell (Th2) immunity to epidermally encountered antigens. Regulatory T cells (Tregs) play an important role in controlling responsiveness to self-antigens and preventing autoimmune diseases, as well as in limiting inflammatory responses during inflammation and infection. Currently, studies investigating the number and function of Tregs in patients with AD have shown controversial results. It has been long established that symptoms of AD improve on exposure to sunlight. Narrowband UVB (NB-UVB) phototherapy is a common treatment modality for a variety of skin diseases. Considering the adverse effects for systemic treatment for severe adult AD, phototherapy, especially NB-UVB phototherapy may be a more practical long-term treatment. However, approximately 50% of patients over an 8-week treatment course do not improve after NB-UVB phototherapy. Therefore, it is important to identify characteristics of AD patients to determine whether they will respond to phototherapy and to avoid adverse effects for unresponsive patients. UVB exposure has also been associated with induction of Tregs in mice and increasing their numbers and/or functional capacity may offer benefit to patients with chronic AD. Active vitamin D (1,25(OH)2D3), one of the factors induced by UV-B radiation induces Tregs and is suggested to contribute to the suppressive effect of NB-UVB phototherapy. However, UV radiation could also have beneficial effects through other pathways known to affect immunoregulation. UVB exposure upregulates production of nitric oxide (NO) in the skin which also affects immune cell function. The protein filaggrin is broken down in differentiating keratinocytes to form the natural moisturizer of the skin. The gene encoding filaggrin (FLG) has been shown to be a major predisposing factor for AD. A key breakdown product is urocanic acid (UCA) which also acts as a natural sunscreen and undergoes trans-cis isomerisation on exposure to UV-B. Cis-UCA is known to modulate immune responses, however, the mechanisms of its action remain elusive. The production of all three compounds, vitamin D, cis-UCA and NO might all increase in the circulation of patients undergoing UVB phototherapy. While the immunomodulatory effect of Vitamin D is well described, cis-UCA and NO may also affect the behaviour of T lymphocytes systemically. Therefore, I investigated the effect of NO and cis-UCA on the phenotype and function of CD4+T cells and monocyte-derived dendritic cells (Mo-DCs) derived from peripheral blood mononuclear cells (PBMCs) from healthy volunteers. I also investigated the correlation between plasma concentration of 25(OH) vitamin D and nitrate, FLG genotype, circulating Tregs and clinical efficacy of NB-UVB phototherapy. My results showed that NO did not affect the phenotype of human mo-DCs and directly affected peripheral CD4+ T cells by inducing functional CD25+Foxp3+CD127-Tregs from CD4+CD25lo/- effector T cells. Moreover, NO increased expression of the of skin homing marker CLA on these Tregs, suggesting an increased ability of NO-induced Tregs to migrate to the skin. These NO-induced CD25+Foxp3+CD127-Tregs had immunosuppressive functions and inhibited autologous CD4+ T cell proliferation. Cytokines, at least IL-10, secreted by NO-treated CD4+ T cells were not sufficient for the suppressive function of NOinduced Foxp3+Tregs. The immune regulatory function of NO-induced Fopx3+Tregs required cell-cell contact and was mediated by membrane bound TGFβ and PD-1/PD-L1 but not CTLA-4. Results also showed that cis-UCA might have both pro- and anti-inflammatory effects. Cis- UCA significantly decreased the proportion of CD25hi Foxp3+ cells from activated CD4+ T cells. It also decreased the expression of vitamin D receptor in CD4+ T cells which may interfere with the immune regulatory function of vitamin D. These results suggested that there might be a fine balance between UV-induced anti-inflammatory molecules’ effect on CD4+ T cells. However, Cis-UCA also modulated CD4+ T cell directly by decreasing CD4+ T cell proliferation, decreasing phosphorylation of ERK after TCR activation, enhancing immune suppressive cytokines secretion, and inhibiting the percentage of CLA+CD4+T cells suggesting a decreased ability to migrate to the skin, . Cis-UCA also affected the phenotype and function of antigen presenting cells by decreasing the expression of HLA-DR, CD86 and CD40 on immature mo-DCs, which led to increased proportion of CD25+Foxp3+CD127- T cells when co-cultured with allogenic CD4+ T cells. Results generated from the clinical study in which all 29 patients got better after phototherapy suggested although circulating 25 (OH) vitamin D concentration was significantly increased after NB-UVB phototherapy, the change of circulating 25 (OH) vitamin D concentration did not correlate with disease improvement. This suggests that vitamin D is not the only pathway involved and that other molecules contribute to UVB-induced immune-regulation. The data also show that of the levels of circulating nitrate and the FLG genotype did not correlate with improvement / change with phototherapy. However, the expression of CD69 and CLA on circulating CD4+ T cells was decreased after treatment suggesting that UVB affected T cell activation and migration to the skin, and their importance in determining clinical responses requires further investigation. Taken together, the results from my study provide evidence that vitamin D is not the only molecule responsible for the beneficial effect of NB-UVB phototherapy. NO and cis-UCA may down-regulate immune responses by affecting human peripheral CD4+ T cells and mo- DCs phenotype and function. A further understanding of the effect of NO and cis-UCA on skin resident immune cells will provide more insights for narrowing NB-UVB phototherapy which will help to select patients that most likely to benefit from a mechanism-based treatment.

As células dendríticas (DCs) são as principais células apresentadoras de antígeno do sistema imune. No entanto, trabalhos têm demonstrado seu envolvimento na manutenção da tolerância imunológica. As células T CD4+CD25+Foxp3+ possuem a capacidade de suprimir respostas imunes. Neste estudo avaliamos as alterações ocorridas na população de células T CD4+CD25+Foxp3+ após co-cultura de células de linfonodo com DCs. Nossos resultados demonstram que após a co-cultura há um aumento da população de células CD4+CD25+Foxp3+ de maneira independente do estado de ativação das DCs ou da presença de antígenos exógenos. No entanto, o aumento observado é maior quando DCs imaturas são incubadas com antígenos exógenos. Notamos ainda que há presença de TGF-ß em todas as condições experimentais em que observamos aumento da população de células CD4+CD25+Foxp3+. Nossos dados sugerem ainda que este aumento se deve à proliferação das células T CD4+CD25+Foxp3+. / Dendritic cells (DCs) are the most important antigen-presenting cells of the immune system. However, DCs have also been implicated in maintaining immunologic tolerance. CD4+CD25+Foxp3+ T lymphocytes are known as cells with regulatory properties. In this study we evaluated the changes in the CD4+CD25+Foxp3+ T cell population after co-culture of lymph-node cells with DCs. Our results show an increase in the CD4+CD25+Foxp3+ T cell population after co-culture and occurs regardless of the activation state of DCs and the presence of exogenous antigens; however it is greater when immature DCs are previously pulsed with exogenous antigen. We also noticed that TGF-? is present in all cultures conditions in which the CD4+CD25+Foxp3+ T cell population increases. Our data also suggests that the increase of the CD4+CD25+Foxp3+ T cell population may be due to the proliferation of these cells.