La protéine D393-CD20, codée par un transcrit alternatif du gène cd20 découvert au laboratoire en 2010, est expriméedans les lymphocytes B (LB) tumoraux et surexprimée lors de résistance et rechute aux traitements par Rituximab(Henry et al, Blood 2010).Lors de nos travaux, cinq variants alternatifs de cd20, homologues à la séquence sauvage mais délétés d'une portioninterne, ont été identifiés par séquençage à partir de LB tumoraux. En plus de D393-CD20, 4 nouveaux variantsexistent : D657-, D618-, D480- et D177-CD20.Les variants D657- et D618-CD20 sont faiblement exprimés dans les LB de donneurs sains et surexprimés lors de lasurvenue de pathologies impliquant les LB, alors que D393-CD20 n'est exprimé que dans les LB tumoraux.L'étude par PCR quantitative du profil d'épissage de patients atteints de pathologies B ainsi que chez des donneurssains, a révélé une dérégulation de l'épissage de cd20 lors de la survenue de pathologies impliquant le LB.L'expression spécifique aux LB tumoraux de D393-CD20 suggère une dérégulation spécifique de l'épissage lors de lasurvenue de cancers, particulièrement au niveau des centres germinatifs.Si nos modèles in vitro de résistance démontrent que la présence de D393-CD20 n'est pas directement associée à larésistance aux AcMo, nous avons montré que ces derniers peuvent moduler l'épissage de cd20 par l'intermédiaire devoies de signalisation intra cellulaires.Ces résultats ouvrent donc la voie à une étude plus approfondie du potentiel biomarqueur et du rôle pronostique de la dérégulation de l'épissage du gène codant CD20, cible prépondérante des stratégies thérapeutiques des pathologies impliquant le lymphocyte B. / D393-CD20 is a protein encoded by an alternatively spliced transcript of human cd20 gene, expressed only on tumoralB lymphocyte (Henry et al, Blood2010).Based on this results, we decided to study the cd20 splicing in pathologies involving B cells.During this work, we identified 5 cd20 alternative transcripts, among them the D393-CD20 variant. The 4 others werenamed according to their size: D657-, D618-, D480- and D177-CD20.D657- and D618-CD20 are weakly expressed in healthy donor and overexpressed in pathologies involving Blymphocytes, whereas D393-CD20 is only expressed in B malignancies.Splicing pattern of patients suffering from pathologies involving B lymphocyte (cancers, auto-immune diseases, EBVinfection) were performed by quantitative PCR, and these patterns revealed a splicing deregulation in these pathologieswith a higher proportion of alternative variants compared with healthy dormors.The observation of a specifie expression of D393-CD20 in tumoral cells suggests a splicing deregulation associatedwith oncogenesis, particularly in lymphoma derived from germinal center.If in our in vitro models, no direct correlation between D393-CD20 expression and resistances to anti-CD20 antibodiestreatments hâve been observed, when shown that these antibodies induced cd20 splicing modulation.These results open the way to a deeper study to determine the interest ofcd20 splicing deregulation as a biomarker, andthe impact of theses deregulations on CD20 protein expression since these protein is a preponderant target of therapeuticstrategies used in pathologies involving B cells.

B-Zellen spielen eine wichtige Rolle in der Pathogenese der Rheumatoiden Arthritis. Seit dem Jahr 2006 ist der Anti-CD20-Antikörper Rituximab, welcher eine passagere B-Zell-Depletion induziert, zur Therapie der Rheumatoiden Arthritis zugelassen. In dieser Arbeit wurde das variable Kappa- und Lambda-Leichtkettenrepertoire der CD19+CD27+ B-Gedächtniszellen bei einer Patientin mit aktiver Rheumatoider Arthritis vor und nach B-Zell-Depletion durch Rituximab verglichen. Hierzu wurden nach der Einzelzellsortierung von mononuklären Zellen des peripheren Blutes die Rearrangements des Kappa- und Lambda-Leichtkettenrepertoires amplifiziert, sequenziert und analysiert. Die gefundenen Daten sprechen für die Neubildung eines diversen, polyklonalen und hochmutierten Kappa- und Lambda-Leichtkettenrepertoires. Somit ist davon auszugehen, dass nach der CD20+ B-Zell-Depletion ein funktionsfähiges Repertoire entsteht, welches keine Restriktion für die Infektabwehr aufweist. / B cells play an important roll in the pathogenesis of rheumatoid arthritis. The anti-CD20 antibody rituximab induces a temporal B cell depletion and is approved for the therapy of rheumatoid arthritis since 2006. In this thesis a rheumatoid arthritis patient's variable kappa and lambda light chain repertoire of CD19+CD27+ memory B cells was analyzed before and after rituximab therapy. After single cell sorting of peripheral blood mononuclear cells the kappa and lambda light chain rearrangements were amplified, sequenced and analyzed. The results show the regeneration of a diverse, polyclonal and highly mutated kappa and lambda light chain repertoire. This indicates that after rituximab induced B cell depletion a functional repertoire is emerging with no signs of restriction for infect defense.

Monoclonal antibody-based immunotherapy has been widely used as a strategy to treat cancer. Successful treatment of B-cell lymphoma with the monoclonal antibody (mAb) Rituximab (RTX) in combination with chemotherapy has increased the survival of patients and minimized the side effects of the treatment. However, many patients do not react to the treatment with RTX or gain resistance quickly. Thus, strategies to enhance the tumor cell killing and improve the response rates of mAb-based immunotherapy are a fundamental goal. In this study, I use four different B-cell lymphoma cell lines grown into 3D structures, called spheroids, as a model organism. Those spheroids, which are closer to the in vivo situation of B-cell lymphoma in patients compared to conventional in vitro 2D cell cultures, in combination with RTX, are tested for the activation of effector functions to eliminate tumor cells and compared to experiments conducted in the same cell lines in 2D cell cultures. Moreover, the therapeutic mAb RTX is only approved by the FDA in an IgG1 isotype form. Here, I test different isotype forms of RTX on their efficacy to kill cancer cells by the complement system and also by the activation of monocytes to engulf them in the process of phagocytosis. Interestingly, the IgG3 isotype form of RTX can induce both effector functions most efficiently while the IgG1 isotype form, used in clinical approaches, is only second most efficient in eradicating cancer cells. In addition, when grown into spheroids, the efficacy of both effector functions is reduced compared to 2D cell cultures. Furthermore, the efficacy of the complement system to kill the different B-cell lymphoma cell lines was directly correlated with the expression of the complement regulatory surface protein CD59. By blocking CD59, the efficacy of the complement system could be partially enhanced when cells were treated in 2D cell cultures but not when grown into 3D spheroids. In addition, the antibody-dependent phagocytosis (ADP) of cancer cells by monocytes might correlate with the expression of the RTX target surface protein CD20. Also, the previous incubation of B-cell lymphoma cells with a chemotherapy agent can enhance the efficacy of ADP by presumably providing an “eat me” signal to the effector cells.  In summary, this work shows that the outcome of a treatment with RTX in B-cell lymphoma patients could be improved by the detection of the specific features of the cancer cells, for example the expression of CD59 and CD20 and the structure of the tumor. Moreover, the different isotypes of RTX can activate effector functions in different intensities. The IgG3 isotype form might be able to overcome resistance or lack of reaction to the treatment in B-cell lymphoma patients but further experiments will be needed to investigate these possibilities.

Objective: To systematically review and summarize the available literature regarding the effectiveness and safety of biologics in the treatment of juvenile-onset systemic lupus erythematosus. Methods: PubMed was systematically searched for relevant literature (2012–2017 inclusive) using the following criteria: (1) patients diagnosed with juvenile-onset systemic lupus erythematosus (≤18 years at diagnosis); (2) treatment with any biological agent; and (3) outcome measures assessing effectiveness and safety. Systematic literature reviews, meta-analyses, randomized controlled trials, cohort studies, case control studies, cross sectional surveys and case-series with ≥3 patients were included. Independent extraction of articles by two authors using predefined criteria was performed. The quality of each study was assessed using CASP tools and Oxford CEBM Levels of Evidence. Results: Nine articles met inclusion criteria: six cohort studies, two case series and one pilot study, totalling 230 patients. All but one article reported the effects of rituximab, the other those of belimumab. Overall, patients had active disease refractory to standard of care regimens using corticosteroids and immunosuppressants. Available evidence for rituximab demonstrated improvements in disease activity, complement levels and anti-dsDNA titres accompanying a steroid-sparing effect. Conclusion: Rituximab can be considered an effective treatment in juvenile-onset systemic lupus erythematosus patients with severe disease manifestations and/or refractory disease. Based on current evidence, use of belimumab in juvenile-onset systemic lupus erythematosus patients cannot be recommended. The long-term safety of these biological agents remains uncertain. Further prospective studies, ideally robust randomized controlled trials, are urgently needed to obtain more accurate data on the effectiveness and long-term safety of rituximab, belimumab and other biologics in juvenile-onset systemic lupus erythematosus.

No description available.

Introduktion: Immunologisk trombocytopeni, ITP är en autoimmun sjukdom. Hos ITP patienter bildas autoantikroppar mot trombocyter som leder till trombocyt eliminering och därmed till trombocytopeni. ITP kan delas in i olika grupper beroende på durationen. Duration i mindre än tre månader kallas för nydiagnostiserad ITP, duration mellan 3 och 12 månader kallas för persistent ITP och duration i mer än 12 månader kallas för kronisk ITP. ITP kan behandlas med olika terapier som anti-CD20-antikroppar som rituximab och trombopoietin-receptor-agonister eltrombopag.  Syfte: Examensarbetes syfte är att undersöka samt jämföra effektivitet mellan rituximab och eltrombopag mot kronisk ITP patienter. Metod: Det här arbetet är baserat på en litteratursökning via databasen PubMed med sökord ”eltrombopag and immune thrombocytopenia” och ” rituximab and immune thrombocytopenia” och därefter valdes 4 Randomized Controlled Trial studier.  Resultat: Studie 1 visade bra effektivitet av rituximab mot kronisk ITP och 28% av patienter kunde nå trombocytantal över 50 x109/L i över 6 månader efter behandlingens slut. Studie 2 visade bra effektivitet av rituximab mot kronisk ITP och 30,8% av patienter kunde nå trombocytantal över 50 x109/L i över 6 månader efter behandlings slut. Studie 3 visade mycket bra effektivitet av eltrombopag mot kroniskt ITP och 60% av patienter kunde nå trombocytantal över 50 x109/L under behandlingstiden. Effekten försvann efter 2 veckor av behandlingens slut.  Studie 4 visade mycket bra effektivitet av eltrombopag mot kroniskt ITP och 59% av patienter kunde nå trombocytantal över 50 x109/L under behandlingstiden. Effekten försvann efter 2 veckor av behandlingens slut.  Slutsats: Både rituximab och eltrombopag visade bra effekt hos ITP patienter, men eltrombopag visade bättre effekt mot kronisk ITP än rituximab. Eltrombopag kunde ge bättre effektivitet samt snabbare svar på ökning av trombocytantalet hos de flesta patienter som behandlades i jämförelse med rituximab. Dock försvann effekten av eltrombopag snabbare efter utsatt behandling. / Introduction: Immunological thrombocytopenia, ITP is an autoimmune disease that can develop in our bodies. Autoantibodies develop in ITP patients against platelets, which are small cells without a nucleus and are formed from the megakaryocytes and play an important role in hemostasis and blood clotting. This leads to platelet elimination and thus to thrombocytopenia. Thrombocytopenia is a condition that means low levels of platelets in the individual and which can lead to various severe symptoms such as bleeding and can even cause death. The cause of ITP may be unknown and then it is called primary ITP. Other reasons can be such as acquired immune deficiency syndrome (AIDS) and then the immune system against platelets is triggered, this is called secondary ITP. ITP can also be divided into different groups depending on the duration in each patient. Duration of less than three months is called newly diagnosed ITP, duration between 3 and 12 months is called persistent ITP and duration of more than 12 months is called chronic ITP. ITP can be treated with various therapies. First line therapy is glucocorticoids, and second line therapy is splenectomy, anti-CD20 antibodies rituximab and thrombopoietin receptor agonists such as eltrombopag. Aim: The purpose of the study is to investigate and compare the efficacy of rituximab and eltrombopag patients with chronic ITP. Method: This work is based on a literature search via the database PubMed with the keywords "eltrombopag and immune thrombocytopenia" and "rituximab and immune thrombocytopenia" and then 4 Randomized Controlled Trial studies were selected, 2 studies deal with rituximab and 2 studies deal with eltrombopag. Results: Study 1 showed good efficacy of rituximab compared to placebo against chronic ITP and 28% of patients were able to reach platelet counts above 50 x109/L for more than 6 months after cessation of treatment. Study 2 showed good efficacy of rituximab in chronic ITP and 30.8% of patients were able to reach platelet counts above 50 x109/L for more than 6 months after treatment. Study 3 showed very good efficacy of eltrombopag against chronic ITP and 60% of patients were able to reach platelet counts above 50 x109/L during the treatment period. The effect disappeared after 2 weeks of treatment discontinuation. Study 4 showed very good efficacy of eltrombopag against chronic ITP and 59% of patients were able to reach platelet counts above 50 x109/L during the treatment period. The effect disappeared after 2 weeks of treatment discontinuation. Conclusion: Both rituximab and eltrombopag showed good efficacy against ITP patients, but eltrombopag showed better efficacy against chronic ITP than rituximab. The NNT number showed that more patients need to be treated with rituximab compared to eltrombopag in order for only one of the patients to be able to achieve a platelet count above 50 x109/L, which means a greater chance for those treated with eltrombopag to achieve a platelet count above 50 x109/L. Eltrombopag was able to provide better efficacy and a faster response to increase in platelet count in most patients treated compared to rituximab.

Background: Epstein-Barr virus(EBV)-associated posttransplant lymphoproliferative disease (PTLD) is a serious complication after allogeneic hematopoietic stem cell transplantation (HSCT). Especially in cases with involvement of the central nervous system (CNS) treatment is difficult because the efficacy of most chemotherapeutic agents as well as EBV-specific cytotoxic donor T cells in liquor is uncertain. In the last years the anti-CD20 monoclonal antibody Rituximab was intensively investigated in the treatment of EBV-PTLD. However, only 8 patients with B-cell lymphoma and CNS involvement treated with Rituximab were reported. Case Report: A 24-year-old female patient with acute T-lymphoblastic leukemia in second complete remission had received allogeneic, unrelated, T-cell depleted HSCT. 10 months later an EBV-associated PTLD was diagnosed. Beside peripheral lymphomas and B symptoms the patient showed neurological symptoms. Examination of the cerebrospinal fluid (CSF) revealed a meningeosis lymphoblastica caused by the EBV lymphoma. Treatment with Rituximab and the antiviral drug Cidofovir led to complete remission with regression of the peripheral lymphomas and disappearance of the neurological symptoms. In addition, the PCR control on EBV DNA became negative in the plasma as well as in CSF. Conclusion: The combination of Rituximab and Cidofovir appears as an interesting alternative treatment in patients with EBV-associated PTLD and CNS involvement. / Hintergrund: Die Epstein-Barr-Virus(EBV)-assoziierte Posttransplantations-lymphoproliferative Disease (PTLD) ist eine gefürchtete Komplikation nach allogener hämatopoetischer Stammzelltransplantation (HSCT). Insbesondere bei Befall des zentralen Nervensystems (ZNS) ist die Behandlung auf Grund der unsicheren Liquorwirksamkeit der meisten Chemotherapeutika als auch von EBV-spezifischen zytotoxischen T-Spenderzellen schwierig. Der monoklonale Anti-CD20-Antikörper Rituximab wurde in den letzten Jahren bei Patienten mit EBV-PTLD intensiv untersucht. Allerdings wurde bislang lediglich von 8 Patienten mit ZNS-Befall eines B-Zell-Lymphoms berichtet, bei denen eine Therapie mit Rituximab erfolgte. Kasuistik: Eine 24-jährige Patientin hatte wegen einer akuten T-lymphoblastischen Leukämie in zweiter kompletter Remission eine allogen-unverwandte, T-Zelldepletierte HSCT erhalten. 10 Monate später wurde eine EBV-assoziierte PTLD diagnostiziert. Neben peripheren Lymphomen und B-Symptomen zeigte die Patientin neurologische Symptome. Die Liquoruntersuchung erbrachte den Befund einer Meningeosis lymphoblastica im Rahmen des EBV-Lymphoms. Die Behandlung mit Rituximab und dem Virustatikum Cidofovir führte zu einer kompletten Remission mit Rückbildung der peripheren Lymphome und Verschwinden der neurologischen Symptomatik. Außerdem wurde die PCR-Kontrolle auf EBV-DNA sowohl im Plasma als auch im Liquor negativ. Schlussfolgerung: Die Kombination von Rituximab und Cidofovir erscheint als eine interessante Therapiealternative für Patienten mit EBV-assoziierter PTLD und ZNS-Befall. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The time-course of interaction formation or breaking can be studied using LigandTracer, and the data obtained from an experiment can be analyzed using a model of ligand-target binding kinetics. There are different kinetic models, and the choice of model is currently motivated by knowledge about the interaction, which is problematic when the knowledge about the interaction is unsatisfactory. In this project, a Bayesian model selection procedure was implemented to motivate the model choice using the data obtained from studying a biological system. The model selection procedure was implemented for four kinetic models, the 1:1 model, the 1:2 model, the bivalent model and a new version of the bivalent model.Bayesian inference was performed on the data using each of the models to obtain the posterior distributions of the parameters. Afterwards, the Bayes factor was approximated from numerical calculations of the marginal likelihood. Four numerical methods were implemented to approximate the marginal likelihood, the Naïve Monte Carlo estimator, the method of Harmonic Means of the likelihood, Importance Sampling and Sequential Monte Carlo. When tested on simulated data, the method of Importance Sampling seemed to yield the most reliable prediction of the most likely model. The model selection procedure was then tested on experimental data which was expected to be from a 1:1 interaction and the result of the model selection procedure did not agree with the expectation on the experimental test dataset. Therefore no reliable conclusion could be made when the model selection procedure was used to analyze the interaction between the anti-CD20 antibody Rituximab and Daudi cells. / Interaktioner kan analyseras med hjälp av LigandTracer. Data från ett LigandTracer experiment kan sedan analyseras med avseende på en kinetisk modell. Det finns olika kinetiska modeller, och modellvalet motiveras vanligen utifrån tidigare kunskap om interaktionen, vilket är problematiskt när den tillgängliga informationen om en interaktion är otillräcklig. I det här projektet implementerades en Bayesiansk metod för att motivera valet av modell utifrån data från ett LigandTracer experiment. Modellvalsmetoden implementerades för fyra kinetiska modeller, 1:1 modellen, 1:2 modellen, den bivalenta modellen och en ny version av den bivalenta modellen. Bayesiansk inferens användes för att få fram aposteriorifördelningarna för de olika modellernas parametrar utifrån den givna datan. Sedan beräknades Bayes faktor utifrån numeriska approximationer av marginalsannolikeheten. Fyra numeriska metoder implementerades för att approximera marginalsannolikheten; Naïve Monte Carlo estimator, det harmoniska medelvärdet av likelihood-funktionen, Importance Sampling och Sekventiell Monte Carlo. När modellvalsmetoden testades på simulerad data gav metoden Importance Sampling den mest tillförlitliga förutsägelsen om vilken modell som generade datan. Metoden testades också på experimentell data som förväntades följa en 1:1 interaktion och resultatet avvek från det förväntade resultatet. Följaktligen kunde ingen slutsas dras av resultet från modelvalsmetoden när den sedan används för att analysera interaktionen mellan anti-CD antikroppen Rituximab och Daudi-celler.

Les anticorps monoclonaux (AcM) anti-CD20 sont essentiels pour le traitement du lymphome non hodgkinien et de la leucémie lymphoïde chronique (LLC). Les AcM agissent soit en activant directement la signalisation apoptotique dans les cellules cibles, soit via le système immunitaire. Dans une étude préclinique, nous avons montré que le traitement avec AcM anti-CD20, rituximab et GA101, induit l'expression de la protéine early growth response 1 (EGR-1) (Dalle et al., 2011). EGR-1 est un facteur de transcription régulé par le calcium (Ca2+) et CD20 est impliqué dans la régulation du flux calcique transmembranaire. Nous avons donc étudié le rôle d'EGR-1 et du flux Ca2+ dans l'activité cytotoxique des AcM anti-CD20. Nous avons montré qu'EGR-1 est rapidement induit suite à l'exposition au rituximab et à GA101. La baisse de l'expression d'EGR-1 par shRNA a supprimé l'effet cytotoxique du GA101 à la fois in vitro et in vivo, indiquant qu'EGR-1 est requis pour la mort cellulaire médiée par CD20. De plus, la surexpression d'EGR-1 augmente la sensibilité au GA101 in vitro et in vivo. En outre, nos résultats indiquent que les AcM anti-CD20 induisent un flux Ca2+. Le blocage du flux Ca2+ par inhibiteurs de canaux calciques (ICC) a aboli l'induction d'EGR-1 ainsi que l'efficacité du GA101 in vivo et ex vivo dans des échantillons de LLC. Plus important, nos données indiquent que les patients recevant des ICC ont une moins bonne réponse au traitement par les AcM anti-CD20. En conclusion, nous avons identifié EGR-1 comme potentiel biomarqueur pour prédire la réponse à la thérapie anti-CD20 et démontré que les ICC ont un impact négatif sur l'efficacité des AcM anti-CD20 chez les patients / Anti-CD20 monoclonal antibodies (mAbs) are an essential component of the treatment of patients with non-Hodgkin's lymphoma and chronic lymphocytic leukemia (CLL). They mediate their antitumor effects by activating the immune system or by direct apoptotic signaling in target cells. In a previous preclinical study, we showed that treatment with anti-CD20 mAbs, rituximab and GA101, resulted in upregulated expression of early growth factor 1 (EGR-1) (Dalle et al. 2011). EGR-1 is a calcium (Ca2+) regulated transcription factor and CD20 is hypothesized to regulate transmembrane Ca2+ flux. Therefore, we aimed to assess the role of EGR-1 and Ca2+ flux in the cytotoxic activity of anti-CD20 mAbs. We have shown that EGR-1 expression is rapidly upregulated in CD20+ cells following rituximab and GA101 exposure. Decreasing EGR-1 expression by shRNA abolishes the direct cytotoxic effect of GA101 both in vitro and in vivo, indicating that EGR-1 is required for CD20-mediated cell death. Additionally, the overexpression of EGR-1 enhances the cytotoxic activity of GA101 both in vitro and in vivo. Furthermore, our results indicate that anti-CD20 mAbs induce calcium influx. Blocking the Ca2+ flux with calcium channel blockers (CCB) abolishes EGR-1 induction and impaires the GA101 efficacy in vivo and ex vivo in CLL blood samples. More importantly, our data indicate that patients receiving CCBs and anti-CD20 therapy have worst progression free survival and overall survival. In conclusion we have identified EGR-1 as a potential biomarker to predict response to anti-CD20 therapy. We demonstrated that co-treatement with CCBs negatively impacts the outcome of patients receiving anti-CD20 mAbs

La pathogénie du syndrome néphrotique idiopathique est inconnue, mais de nombreux arguments clinques et expérimentaux favorisent l’hypothèse d’une pathogénie dys-immunitaire à expression immunologique et rénale, au cours de laquelle on observerait une altération des lymphocytes T. Cependant, le mécanisme exact reste encore mal connu. Récemment, le Rituximab, un anticorps dirigé contre l’antigène CD20, a montré une efficacité à induire une rémission à moyen et long terme suggérant l’implication d’une dysfonction des lymphocytes B et/ou un défaut de coopération T-B. Notre laboratoire a isolé un nouveau gène C-MIP dont l’expression est induite dans certaines sous-populations lymphocytaires T et B, ainsi que dans les podocytes de patients atteints de SNI en phase de poussée mais quasiment indétectable chez les sujets sains.Dans ces travaux, ancillaires au PHRC NEPHRUTIX, nous avons étudié les perturbations lymphocytaires T, avant, au moment de la rechute et en période de rémission au cours de syndrome néphrotique à lésions glomérulaires minimes et l’effet du traitement par le Rituximab. Dans cette étude, nous avons mis en évidence que la rechute était associée à un effondrement des lymphocytes T régulateurs, une baisse profonde de l’interleukine-2 ainsi qu’à une surexpression significative de C-MIP, précédant la survenue de la rechute. Ces modifications se restaurent en rémission. Enfin, la rémission obtenue dans le bras Rituximab, entraîne une diminution des lymphocytes T folliculaires (Tfh), des iNKT et des cellules double-négatives DN-TCR Vα24, suggérant que le SNLGM implique un défaut des réponses immunitaires innées et adaptatives, qui peut être stabilisé par un traitement par Rituximab.Afin d’étudier le rôle de C-MIP, nous avons généré des souris transgéniques sur-exprimant ce gène dans les lymphocytes T matures périphériques. Cette surexpression est à l’origine d’un phénotype lymphocytaire altéré marqué par une accumulation de lymphocytes T naïfs, un effondrement des cytokines activatrices de type Th1 et Th2 et une accumulation des formes inactives des Src kinases. Ces résultats suggèrent que C-MIP, en inhibant les Src kinases, est un régulateur négatif de l’activation T impliqué dans la signalisation proximale et pourrait être impliqué dans l’hypo-réactivité lymphocytaire T observée chez les patients atteints de SNLGM actif. / The pathogenesis of minimal-change nephrotic syndrom (MCNS) is unknown, but, supported by many clinical and experimental arguments, it was suggested that MCNS is a dys-immune disorder with immunogical and renal expression, during which T-cell alteration would be observed. However, the exact mechanism remains unknown. Recently, Rituximab, a B-cell depleting agent, is effctive in inducing mid- and long-term remission suggesting involvement of B-cell dysfunction and/or lack of T-B cooperation. Our laboratory identified a new gene: C-MIP. We have shown that C-MIP abundance is increased in some T and B lymphocyte subpopulations, as well as in podocytes of MCNS patients during relapse phase but undetectable in healthy subjects.In this work, ancillary to the NEPHRUTIX PHRC, we studied T-cell disturbances before and during the relapse or during the remission time in MCNS and the effect of Rituximab therapy. In this study, we found that relapses were associated with significant decrease in regulatory T cell and interleukin-2 expression, while C-MIP abundance was significantly increased. These changes are restored during remission time. Finally, remission after Rituximab therapy leads to a decrease in follicular T cells (Tfh), iNKT and double-negative (CD4- CD8-) T cells expressing the invariant Vα24 chain, suggesting that MCNS involves a disorder of innate and adaptative immune response, which can be stabilized by Rituximab treatment.In order to study the C-MIP role, we generated transgenic mice overexpressing this gene in the peripheral mature T-cells. This overexpression leads to an altered lymphocyte phenotype with an accumulation of naive T lymphocytes, a significant decrease of Th1 and Th2 activating cytokines and accumulation of inactive Src kinases. These results suggest that, by inhibiting Src kinases, C-MIP is a negative regulator of activation T involved in proximal signalling and may be responsable of the lymphocyte T hypo-reactivity observed in patients with active MCNS.