Introduktion: Torra ögon (DES) och Sjögrens syndrom (SjS) är inflammatoriska sjukdomar som drabbar ögonen. DES drabbar tårkörtelns funktionella del vilket ger ögonsmärta och suddig syn. SjS är en kronisk autoimmun sjukdom som ger skada på tår- och salivproducerande körtlar. Det leder till kliniska symtom i form av mun- och ögontorrhet. Essentiella fettsyror bildar proinflammatoriska och antiinflammatoriska cytokiner som kan hjälpa vid behandling av dessa sjukdomar. Metod och syfte: En litteraturstudie genomfördes för att ta reda på om fleromättade fetter kan lindra symtomen vid SjS och DES. Resultat: Resultaten för studierna visade resultat på OSDI, Schirmers test, BUT, IL-17, tårosmolaritet, tårvolym, ostimulerat salivflöde, stimulerat salivflöde, sonderingsdjup, PGE1, van Bijstervelds poäng och flourscein infärgning. Diskussion: Resultatet visar signifikanta skillnader för vissa doser av n-3 och n-6. Det som skiljer resultaten åt är de olika doserna av fettsyror samt vad dess placebokontroller intog. OSDI visade främst skillnader på de patienter med DES men endast på en grupp med SjS som intog n-3 för behandling av torr mun. Schirmers test och BUT visade en ökning hos patienterna med mild och måttlig DES men inte på patienterna med SjS. Patienterna med SjS visade förbättringar på stimulerat salivflöde och OSDI för torr mun samt PGE1 nivåer och flourscein infärgning samtidigt som en del studier inte visade några signifikanta förbättringar på några mätvariabler. Det kan grunda sig i intaget av fettsyror, sjukdomstillstånd eller längden på behandling. Slutsats: En del personer kan få förbättrade symtom av att inta n-3 eller n-6 tillskott men skillnaderna är inte alltid statistiskt signifikanta för studierna. / Introduction: Dry eye syndrome (DES) and Sjögren ́s syndrome (SjS) are inflammatory diseases that affect the eyes. DES affects the lacrimal glands functional unit, causing eye pain and blurred vision. SjS is a chronical autoimmune disease that causes damage to tear and salivary glands. It leads to clinical symptoms in the form of mouth and eye irritation. Essential fatty acids form pro-inflammatory and anti-inflammatory cytokines that can help in the treatment of these diseases. Method and purpose: A literature study was performed to study if essential fatty acids can relieve the symptoms of DES and SjS. Results: The results for the studies showed results on OSDI, Schirmer ́s test, BUT, IL- 17, tear osmolarity, tear volume, unstimulated salivary flow, stimulated salivary flow, depth of probing, van Bijsterveld ́s score and flourscein staining. Discussion: The result shows significant differences for certain doses of n-3 and n-6. What separates the results are the different doses of fatty acids and what their placebo controls took. OSDI showed major differences in patients with DES but only in one group of patients with SjS who took n-3 for treating dry mouth. Schirmer ́s test and BUT showed an increase in patients with mild and moderate DES but not in patients with SjS. Patients with SjS showed improvements in stimulated salivary flow, dry mouth OSDI, PGE1 levels and flourscein staining, while some studies did not show any significant improvements in any measurement variables. It may be due to the intake of fatty acids, disease states or the length of treatment. Conclusion: Some people may get improved symptoms of taking n- 3 or n-6 supplements, but the differences are not always statistically significant for the studies.

Portadores de diabetes parecem ter mais queixas de olho seco do que o resto da população. Acredita-se que isto possa estar associado a uma forma de neuropatia diabética expressa por uma redução na sensibilidade corneana desses pacientes. Nossos principais objetivos neste estudo foram avaliar a influência da diabetes melito tipo 2 na sensibilidade corneana central e verificar se há uma associação entre a sensibilidade corneana central e a síndrome do olho seco em indivíduos com a doença. Assim, 62 portadores de diabetes tipo 2 foram submetidos a um exame oftalmológico de rotina, a uma ceratoestesiometria e a testes específicos para avaliar olho seco e polineuropatia distal simétrica. Num outro grupo, 20 voluntários saudáveis tiveram seus olhos avaliados da mesma forma, exceto pela não realização dos testes específicos para disfunção lacrimal. Entre os indivíduos diabéticos avaliados, foram observados 53.2% com hipoestesia corneana, 54.2% com retinopatia diabética, 45.9% com polineuropatia distal simétrica e 51.6% com a síndrome do olho seco. Entre os principais achados, observamos associações significativas envolvendo: diabetes tipo 2 e hipoestesia corneana central, síndrome do olho seco e hipoestesia corneana central, produção lacrimal reflexa (avaliada pelo teste de Schirmer II) e sensibilidade corneana central e retinopatia diabética proliferativa e sensibilidade corneana central. Uma possível associação foi encontrada envolvendo síndrome do olho seco retinopatia diabética proliferativa. Os autores discutem os resultados obtidos e os mecanismos envolvidos. / Diabetes bearers seem to have more complaints of dry eye than the rest of the population. It`s believed that this fact might be associated to a kind of diabetes neuropathy wich is represented by a reduction in corneal sensibility of these patients. Our main target in this study was to evaluate the influence of type 2 diabetes mellitus in central corneal sensibility and to determine if there is an association among central corneal sensibility and the dry eye syndrome in individuals suffering of this disease. Therefore, 62 type 2 diabetic patients were submitted to an ophthalmological routine examination, to corneal esthesiometry and to specific tests to evaluate dry eye and peripheral polineurophaty. In other group, 20 healthy volunteers had their eyes evaluated in the same way, except for the non accomplishment of the specific tests for dry eye. Among the examined diabetic individuals, 53.2% had corneal hypoesthesia, 54.2% presented diabetic retinopathy, 45.9% presented periferal polineuropathy and 51.6% presented the dry eye syndrome. Among the main findings, we observed associations between: type 2 diabetes and central corneal hypoesthesia, dry eye syndrome and central corneal hypoesthesia, reflex tear production (evaluated by Schirmer 2 test) and central corneal esthesiometry and also between proliferative diabetic retinopathy and central corneal sensibility. A possible association was found involving dry eye syndrome and proliferative diabetic retinophaty. The authors discuss the results obtained and the involved mechanisms.

Portadores de diabetes parecem ter mais queixas de olho seco do que o resto da população. Acredita-se que isto possa estar associado a uma forma de neuropatia diabética expressa por uma redução na sensibilidade corneana desses pacientes. Nossos principais objetivos neste estudo foram avaliar a influência da diabetes melito tipo 2 na sensibilidade corneana central e verificar se há uma associação entre a sensibilidade corneana central e a síndrome do olho seco em indivíduos com a doença. Assim, 62 portadores de diabetes tipo 2 foram submetidos a um exame oftalmológico de rotina, a uma ceratoestesiometria e a testes específicos para avaliar olho seco e polineuropatia distal simétrica. Num outro grupo, 20 voluntários saudáveis tiveram seus olhos avaliados da mesma forma, exceto pela não realização dos testes específicos para disfunção lacrimal. Entre os indivíduos diabéticos avaliados, foram observados 53.2% com hipoestesia corneana, 54.2% com retinopatia diabética, 45.9% com polineuropatia distal simétrica e 51.6% com a síndrome do olho seco. Entre os principais achados, observamos associações significativas envolvendo: diabetes tipo 2 e hipoestesia corneana central, síndrome do olho seco e hipoestesia corneana central, produção lacrimal reflexa (avaliada pelo teste de Schirmer II) e sensibilidade corneana central e retinopatia diabética proliferativa e sensibilidade corneana central. Uma possível associação foi encontrada envolvendo síndrome do olho seco retinopatia diabética proliferativa. Os autores discutem os resultados obtidos e os mecanismos envolvidos. / Diabetes bearers seem to have more complaints of dry eye than the rest of the population. It`s believed that this fact might be associated to a kind of diabetes neuropathy wich is represented by a reduction in corneal sensibility of these patients. Our main target in this study was to evaluate the influence of type 2 diabetes mellitus in central corneal sensibility and to determine if there is an association among central corneal sensibility and the dry eye syndrome in individuals suffering of this disease. Therefore, 62 type 2 diabetic patients were submitted to an ophthalmological routine examination, to corneal esthesiometry and to specific tests to evaluate dry eye and peripheral polineurophaty. In other group, 20 healthy volunteers had their eyes evaluated in the same way, except for the non accomplishment of the specific tests for dry eye. Among the examined diabetic individuals, 53.2% had corneal hypoesthesia, 54.2% presented diabetic retinopathy, 45.9% presented periferal polineuropathy and 51.6% presented the dry eye syndrome. Among the main findings, we observed associations between: type 2 diabetes and central corneal hypoesthesia, dry eye syndrome and central corneal hypoesthesia, reflex tear production (evaluated by Schirmer 2 test) and central corneal esthesiometry and also between proliferative diabetic retinopathy and central corneal sensibility. A possible association was found involving dry eye syndrome and proliferative diabetic retinophaty. The authors discuss the results obtained and the involved mechanisms.

Le syndrome de Sjögren primitif (SJp) est une pathologie auto-immune caractérisée par une sécheresse occulobuccale, un infiltrat lymphocytaire des glandes salivaires, ainsi qu'une production d'auto-anticorps. Les cellules épithéliales salivaires (SGEC) des patients atteints de SSp expriment les molécules impliquées dans les réponses immunitaires et jouent le rôle des cellules présentatrices d’antigènes. Les lymphocytes T folliculaires (LTf) jouent un rôle important en activant les lymphocytes B via la sécrétion d’interleukine (IL)-21. Une augmentation de la proportion de LTf est observée dans le sang des patients ayant un SJp. Nous avons fait l’hypothèse que les SGECs des patients pouvaient induire la différenciation des lymphocytes T naïfs (LTn) en LTf. Nous avons montré que les SGECs sont capables d’induire la différenciation des LTn en LTf via des facteurs solubles tel l’IL-6. La sécrétion d’IL-21 par les LTf nécessite un contact cellulaire impliquant en partie ICOSL.La voie de costimulation OX40/OX40L est impliquée dans plusieurs maladies autoimmunes. Les polymorphismes d’OX40L sont une prédisposent au SJp. Nous avons étudié le rôle pathogène de la voie OX40/OX40L chez les patients SJp. Notre résultats ont montrés une surexpression d’OX40L et d’OX40 dans les glandes salivaires des patients atteint de SJp. Les cocultures des LTn avec les SS SGECs ou contrôle SGECs augmentent l'expression d’OX40 par les LT. Les SS SGECs favorisent la survie et la prolifération des LT via la voie d’OX40/OX40L. Ces résultats démontrent l'implication d’OX40 et d’OX40L dans la pathogénie du SJp et confirment le rôle important des SGECs dans l’épithelite auto-immune du SJp. / The primary Sjögren's syndrome (pSS) is an autoimmune disease characterized by dry mouth and dry eyes. Salivary gland epithelial cells (SGECs) of patients with pSS express the molecules involved in immune responses and act as antigen presenting cells. Follicular helper T cells (Tfh) secrete IL-21 whose augmented secretion is a hallmark of several autoimmunediseases. Here we investigated whether SGECs were capable to induce Tfh differentiation. We report that IL-6 and ICOSL expression by SGECs contributes to naïve CD4+ T differentiation into Tfh cells, as evidenced by their acquisition of a specific phenotype, characterized by Bcl-6, ICOS and CXCR5 expression and IL-21 secretion, but also but by their main functional feature: the capacity to enhance B lymphocytes survival. OX40/OX40L interaction is a pivotal costimulatory pathway. Polymorphisms of OX40L are involved in the genetic predisposition to pSS. We therefore investigated the pathogenic role of OX40/OX40L pathway in pSS. We demonstrated that the proportion of circulating CD4+ T cells expressing OX40 was elevated in patients with pSS and correlated with systemic disease activity. In salivary glands of patients with pSS, epithelial cells overexpressed OX40L and the expression of OX40L and OX40 was respectively evidenced on infiltrating B and T cells. Coculture of T cells with SGECs increased the expression of OX40 by CD4+ T cells promoted T cell survival and proliferation through OX40/OX40L interaction. These studies demonstrate emphasizes unknown pathogenic roles of SGECs and suggests that Tfh, IL-21 and OX40L might be therapeutic targets in pSS.

O objetivo do estudo foi avaliar a prevalência de Disfunção Temporomandibular e fazer uma análise comparativa do perfi l psicoemocional, da qualidade de vida e da presença de dores orofaciais em mulheres com Síndrome de Sjögren (SS) primária. Cinquenta e três pacientes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) diagnosticadas de acordo com os critérios propostos pelo American-European Consensus Group (AECG) foram selecionadas e aceitaram participar da pesquisa. Foram aplicados os questionários RDC/TMD para diagnosticar a Disfunção Temporomandibular, DN4 para classifi car o tipo de dor quando presente, BDI para avaliar de forma global a intensidade e localização da dor presente e sua interferência nas atividades de vida diária, SF-36 para avaliar a percepção da paciente quanto ao seu estado geral e sua qualidade de vida, EADS- 21 para diagnosticar fenômenos de ansiedade, estresse e depressão e EPCD para verifi car os pensamentos catastrófi cos para a dor. As pacientes também foram classifi cadas de acordo com ESSDAI para avaliar a atividade da doença SS e de acordo com ESSPRI para avaliar os sintomas de fadiga, secura e dor. Segundo o questionário RDC/TMD, 49,1% das pacientes com SS têm dor miofascial, 9,37% têm deslocamento de disco e 13,2% têm artralgia, 50,9% têm dor na face, 58,5% têm dor de cabeça, 35,8% têm estalo, 17% têm crepitação, 45,3% têm bruxismo, 60,4% têm apertamento diurno e 41,5% têm zumbido. Quanto ao questionário BPI, 74,53% das pacientes relataram melhora da dor com o tratamento instituído. Quanto ao questionário DN4, 11,3% têm dor neuropática. Quanto ao questionário SF-36, todos os domínios tiveram pontuação menor que 50 pontos, exceto os Domínios Capacidade Funcional (52,45 pontos), Aspectos Sociais (60,57 pontos) e Saúde Mental (65,96 pontos). De acordo com o EADS-21, o Domínio Estresse teve maior média (6,02 pontos), seguido por Ansiedade (4,51 pontos) e Depressão (3,53 pontos). O Score EPCD foi de 1,26 pontos e a maioria dos pacientes (83%) teve baixa catastrofi zação. Cerca de 51% das pacientes têm baixa atividade da doença SS (Score ESSDAI =2,7) e 67,9% têm alto nível de sintoma incapacitante (Score ESSPRI>=5). O estudo mostrou que os principais fatores contribuintes para a pior qualidade de vida em pacientes com SS primária são fadiga, depressão, ansiedade, xerose, dor e estresse. / Sjögren\'s Syndrome (SS) is a chronic autoimmune disease with progressive evolution, whose clinical manifestations are extremely variable, aff ecting local and specifi c organs or presenting as a systemic condition. Dryness, pain, somatic and mental fatigue are the main symptoms in caucasian women aged between 40 to 60 years.The aim of this study was to evaluate the prevalence of Temporomandibular Disorders and make a comparative analysis of the psychoemotional profi le, quality of life and the presence of orofacial pain in women with primary Sjögren\'s Syndrome. Fifty-three patients of the Clinics Hospital of Medical School of University of São Paulo diagnosed according to the AECG criteria for primary SS were selected and examined with RDC/TMD to diagnose Temporomandibular Disorders, DN4 to diagnose neurophatic pain, BPI to assess globally the intensity and location of pain and how this symptom interferes with activities of daily living, SF-36 to evaluate the perception of the patient about their general health and quality of life, EADS-21 to diagnose anxiety, stress and depression and PCS to check the catastrophic thoughts for pain.The patients were also classifi ed according to ESSDAI to evaluate the activity of primary SS and to ESSPRI symptoms of fatigue, dryness and soreness. According to the RDC / TMD, 49.1% of patients with Sjögren\'s syndrome have myofascial pain, 9.37% have disc displacement and 13.2% have arthralgia; 50.9% have pain in the face, 58.5% headache, 35.8% clicking, 17% crepitus, 45.3% bruxism, 60.4% daytime clenching and 41.5% tinnitus. The BPI showed that 74.53% of patients reported improvement in pain with the treatment. According to DN4, 11.3% have neuropathic pain. As for the SF-36, all areas have lower scores 50 points, except the Functional Capacity (52.45 points), Social Aspects (60.57 points) and Mental Health (65.96 points). According to DASS-21, Stress had higher mean (6.02 points), followed by Anxiety (4.51 points) and Depression (3.53 points). The PCS score was 1.26 points and the majority of patients (83%) had low catastrophizing. Nearly 51% have low disease activity (Score ESSDAI = 2.7) and 67.9% has a high level of incapacitating symptom (Score ESSPRI>=5). The study showed that the main factors contributing to the worst quality of life in patients with primary Sjögren\'s Syndrome are fatigue, depression, anxiety, xerosis, pain and stress.

Portadores de diabetes parecem ter mais queixas de olho seco do que o resto da população. Acredita-se que isto possa estar associado a uma forma de neuropatia diabética expressa por uma redução na sensibilidade corneana desses pacientes. Nossos principais objetivos neste estudo foram avaliar a influência da diabetes melito tipo 2 na sensibilidade corneana central e verificar se há uma associação entre a sensibilidade corneana central e a síndrome do olho seco em indivíduos com a doença. Assim, 62 portadores de diabetes tipo 2 foram submetidos a um exame oftalmológico de rotina, a uma ceratoestesiometria e a testes específicos para avaliar olho seco e polineuropatia distal simétrica. Num outro grupo, 20 voluntários saudáveis tiveram seus olhos avaliados da mesma forma, exceto pela não realização dos testes específicos para disfunção lacrimal. Entre os indivíduos diabéticos avaliados, foram observados 53.2% com hipoestesia corneana, 54.2% com retinopatia diabética, 45.9% com polineuropatia distal simétrica e 51.6% com a síndrome do olho seco. Entre os principais achados, observamos associações significativas envolvendo: diabetes tipo 2 e hipoestesia corneana central, síndrome do olho seco e hipoestesia corneana central, produção lacrimal reflexa (avaliada pelo teste de Schirmer II) e sensibilidade corneana central e retinopatia diabética proliferativa e sensibilidade corneana central. Uma possível associação foi encontrada envolvendo síndrome do olho seco retinopatia diabética proliferativa. Os autores discutem os resultados obtidos e os mecanismos envolvidos. / Diabetes bearers seem to have more complaints of dry eye than the rest of the population. It`s believed that this fact might be associated to a kind of diabetes neuropathy wich is represented by a reduction in corneal sensibility of these patients. Our main target in this study was to evaluate the influence of type 2 diabetes mellitus in central corneal sensibility and to determine if there is an association among central corneal sensibility and the dry eye syndrome in individuals suffering of this disease. Therefore, 62 type 2 diabetic patients were submitted to an ophthalmological routine examination, to corneal esthesiometry and to specific tests to evaluate dry eye and peripheral polineurophaty. In other group, 20 healthy volunteers had their eyes evaluated in the same way, except for the non accomplishment of the specific tests for dry eye. Among the examined diabetic individuals, 53.2% had corneal hypoesthesia, 54.2% presented diabetic retinopathy, 45.9% presented periferal polineuropathy and 51.6% presented the dry eye syndrome. Among the main findings, we observed associations between: type 2 diabetes and central corneal hypoesthesia, dry eye syndrome and central corneal hypoesthesia, reflex tear production (evaluated by Schirmer 2 test) and central corneal esthesiometry and also between proliferative diabetic retinopathy and central corneal sensibility. A possible association was found involving dry eye syndrome and proliferative diabetic retinophaty. The authors discuss the results obtained and the involved mechanisms.

Le syndrome de Sjögren (SS) est une maladie auto-immunitaire caractérisée par une infiltration lymphocytaire des glandes exocrines menant le plus souvent, à une xérophtalmie et à une xérostomie. La physiopathologie de la maladie est complexe et malgré les progrès realisés, il existe beaucoup de questions à repondre. Classiquement, le syndrome sec qui caractérise la maladie résulterait d’un double processus où dans un premier temps, la glande serait envahie par des cellules lymphoplasmocytaires puis secondairement détruite. Des avancées récentes dans la physiopathologie de la maladie ont démontré le rôle de nouvelles molécules, Aquaporine 5 (AQP5) et anticorps muscariniques, qui peuvent contribuer au syndrome sec. Dans ce travail, nous avons étudié des marqueurs diagnostiques de la maladie. Nous avons montré que 2 alarmines, HMGB1 et S100A8/A9 sont augmentés mais ne présentent pas de corrélation avec le score d’activité de la maladie. Utilisant différents modèles animaux de SS, nous avons montré une modification de la distribution de l’AQP5. De plus, nous avons montré que la modification de la distribution de l’AQP5 dans les glandes salivaires était liée à la présence des infiltrats inflammatoires. Utilisant un modèle non-immun de souris qui présente un syndrome sec, l’expression de l’AQP5 n’était pas modifiée en l’absence d’infiltrats inflammatoires. Ces résultats montrent que la modification de l’AQP5 dans le SS est liée à la présence des infiltrats inflammatoires. / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

Le syndrome de Gougerot-Sjögren (SGS) est une maladie autoimmune (MAI) systémique inflammatoire chronique caractérisée principalement par la diminution des secrétions salivaires et lacrymales, aboutissant à une sécheresse de la bouche et des yeux. Elle affecte principalement les femmes autour de la ménopause. Au niveau physiologique, le tissu épithélial des glandes salivaires (GS) est infiltré par des lymphocytes, ce qui provoque l’apoptose des cellules épithéliales (CE). L’épigénétique pouvant jouer un rôle important dans le développement des MAI comme le SGS, nous avons analysé l’expression d’éléments rétroviraux endogènes humains (HERV) et des microARN. Par ailleurs, afin de mieux comprendre les mécanismes cellulaires et moléculaires impliqués dans les interactions lymphocytes-CE au niveau de la GS pathologique, nous avons mis en place un modèle de co-culture in vitro entre des CE et des lymphocytes B ou T (LB, LT). Nous avons également étudié le rôle de BAFF sur les CE qui expriment l’un de ses récepteurs, BR3.Dans un premier temps, nous avons montré que dans les GS des patients, les HERV et les miARN ont un profil d’expression distinct de celui des personnes saines, montrant ainsi une participation de l’épigénétique dans la pathologie. Dans un deuxième temps, nous avons montré que les CE entrent en apoptose suite à l’interaction directe avec les lymphocytes B etT, en faisant intervenir la voie Fas pour les LT et la voie de la PKCδ pour les LB. En lien avec l’apoptose induite par les LB, nous avons démontré que BAFF est impliqué dans la survie des CE, et que le blocage de sa signalisation ou la sous-expression de son récepteur conduit à la mort des CE. Nous pouvons supposer que les LB entrent en compétition avec les CE pour le signal de survie apporté par BAFF, et que les CE qui s’en trouvent privées meurent. Finalement, nous avons montré que plusieurs formes de BAFF sont produites parles CE et reconnues de manière différente par les anticorps anti-BAFF. Il pourrait s’agir d’isoformes plus ou moins glycosylés ou de variants de BAFF. Cependant d’autres études sont nécessaires afin de les identifier. / Sjögren’s syndrome (SS) is an inflammatory systemic autoimmune disease (AID), mainly characterized by the decrease of salivary and lachrymal secretions. This leads to dry mouthand dry eyes. This chronic disease principally affects women around menopause. At the physiological level, salivary gland (SG) epithelial tissue is infiltrated by lymphocytes, leading to epithelial cells (EC) apoptosis. As epigenetics can play an important role in AID- such asSS development, we investigated human endogenous retroviral elements (HERV) and microRNA expression. Furthermore, in order to better understand the cellular and molecular mechanisms implied in lymphocyte-EC interactions in pathological SG, we set up an in vitroco-culture model between EC and B and T cells. We also studied BAFF role on EC which express one of its receptors, BR3. First, we demonstrated that in SS SG, HERVs and miRNAs show a distinct profile from healthy controls, indicating that epigenetics is implied in the pathology. Secondly, we showed that EC undergo apoptosis following direct interaction with T and B cells, via two distincts ignaling pathways: Fas pathway for T cells and PKCδ pathway for B cells. Linked with Bcell-induced apoptosis, we demonstrated that BAFF is implied in EC survival, and that BAFFsignaling blocking or BR3 down-regulation leads to EC death. We may suppose that B cells compete with EC for survival signaling from BAFF, and that EC die from lack of it. Finally, we showed that several forms of BAFF are expressed by EC and that they are differentially recognized by anti-BAFF antibodies. These may be more or less glycozylated BAFF isoformsor BAFF variants. Further studies are needed to identify them.

Les maladies auto-immunes et systémiques sont des maladies sur lequel le champ de la recherche pose son œil de façon appuyée depuis 15 ans, du fait de l’émergence de thérapies biologiques ciblées. Ces pathologies sont volontiers hétérogènes, au mieux de fréquence ou caractéristiques particulières dans les populations d’origine Africaine. La connaissance de l’épidémiologie, et des caractéristiques de ces maladies est un préalable essentiel à la mise en place de recherche plus fondamentale pour aider à décomposer leurs physiopathologies souvent extrêmement complexes. En effet, la comparaison de différences marquées entre deux expressions dans des populations différentes d’une même maladie peut permettre d’aider à en dénouer le fil. Nous proposons dans ce travail une estimation des caractéristiques du lupus cutané et du lupus systémique en Guyane Française qui retrouve une faible fréquence de la maladie, la plus faible jamais retrouvée dans une population subsaharienne. Nous décrivons en Martinique sur le plan épidémiologique comme clinique une forme rare de myosite appelée syndrome des anti-synthétases semblant très particulière, l’épidémiologie et la description de la maladie de Kikuchi-Fujimoto pour la première fois dans la littérature, l’épidémiologie et les caractéristiques à base de population de la maladie de Behcet, des principales vascularites (périartérite noueuse, micropolyangéite, granulomatose éosinophile avec polyangéite, granulomatose avec polyangéite), de l’hypertension pulmonaire des connectivites qui semblent plus fréquentes que chez les Européens. Les néphropathies du lupus systémiques sont décrites dans la population Guadeloupéenne montrant une grande fréquence des néphropathies prolifératives. Le protocole EUROLUPUS qui permet le traitement de ces néphropathies prolifératives du lupus systémique avec de faibles doses de cyclophosphamide et de corticoïdes, est évalué en Martinique sur 30 patients alors qu’il ne l’a jamais été dans une population d’origine Africaine. Il semble y être aussi efficace que chez les patients d’origine Européenne, alors que les néphropathies y ont un pronostic meilleur. La maladie de Sjögren primaire est décrite en Martinique très proche de ce qu’on trouve en Europe sur le plan du tableau clinique et évolutif alors que cela n’est l’objet d’aucune étude dans une population d’origine noire Africaine. Nous avons par ailleurs montré en Martinique l’amélioration de la prise en charge du lupus systémique en Martinique au travers de la régression au fil du temps d’une des complications de la corticothérapie les plus pénibles pour les patients, l’ostéonécrose aseptique. La sclérodermie systémique est décrite à base de population avec épidémiologie dans les deux départements de Guadeloupe et Martinique, montrant des caractéristiques proches de celles retrouvées chez les AfroAméricains. Nous avons aussi montré la fréquence et la gravité des atteintes ORL des myopathies inflammatoires sur ces 2 départements avec une fréquence inhabituelle de certaines maladies auto-immunes dont le lupus systémique et les myosites inflammatoires associées aux anticorps anti-SRP, et l’absence de myosite à inclusion. Au total, nous apportons une somme de connaissance descriptive de ces maladies auto-immunes et systémiques permettant la mise en place de recherches plus fondamentales avec des bases solides par rapport aux profils hétérogènes de ces maladies. / Auto-immunes and systemic diseases are priorities for researchers since 15 years. This is related to the emergence of biological therapies, associated to great efficacy. Although, these diseases are heterogeneous, depending of different parameters such as ethnicity or geography. In the African descent population, we encounter unusual or particular manifestations of these diseases. Also, the knowledge of epidemiology and population based descriptions are crucial to properly initiate works on these populations, but also to understand a particularly complex physiopathology by using differences between populations. We describe in this work the population based characteristics of pure cutaneous lupus and systemic lupus, including an epidemiology of the incidence of the lowest incidence ever found in a population of African heritage. We also describe a population based series of anti-synthetase syndrome, confirming that the presentation is totally different compared to caucasians, and allows in Martinique the incidence, never explored before. We also provide the first evaluation of Kikuchi-Fujimoto disease in a population of African origin, and the first incidence ever realized. We do the same evaluation of the epidemiology of Behcet’s disease in a black origin population that shows that this disease was at a similar frequency in Martinique and in Europe. Micropolyangeitis, polyarteritis, eosinophilic granulomatosis with polyangeitis and Granulomatosis with polyangeitis were evaluated in an epidemiologic study in Martinique, with addition of some cases from other French American region for a more powerful characteristics description. These diseases seem less frequent than in Europe, associated with less severity except for micropolyangeitis. EUROLUPUS, a protocol with low dose IV cyclophosphamide and low dose steroids, used to treat proliferative nephritis of systemic lupus is shown to have the same efficacy in Martinique than in patients of European origin. Primary Sjögren syndrome, evaluated in Martinique, is very similar in expression than what is found in Europe. The decrease overtime of aseptic osteonecrosis, a steroid side effect, is a witness of better control of systemic lupus activity with less usage permitted by protocols and new immunosuppressive drugs such as mycophenolate. Systemic sclerosis is described as very close to African American in a population based study in Martinique and Guadeloupe. We finally show that the rare ENT involvement of idiopathic inflammatory myositis is frequent in our population, associated with poor outcome, and surprisingly frequently related to systemic lupus and necrotizing myositis associated to SRP antibody but not to inclusion body myositis. To conclude, we allow an amount of description of these diseases in our region, including pioneer studies. This works tends to be the basis for studies to be continued in a more fundamental way in our countries.

Le virus d'Epstein-Barr (EBV), est un gamma herpes virus exclusivement humain qui infecte près de 95% de la population adulte. EBV établit un cycle de latence dans les cellules B mémoires et les cellules épithéliales. EBV entre périodiquement dans une réplication lytique avec sécrétion des virions dans la salive. L’infection EBV est associée à l’apparition de lymphomes, de cancers et de maladies auto-immunes. Les conditions favorisant le développement de ces pathologies restent mal connues mais l’immunodépression et potentiellement l’activation des lymphocytes B nécessaire à la réplication d’EBV jouent un rôle clé.Nous avons examiné l’association entre activation des cellules B dans le compartiment systémique et le contrôle sur le réservoir de l’EBV. Deux situations cliniques d’activation chronique des cellules B ont été explorées ; le syndrome de Gougerot-Sjögren et la mastite subclinique dans le contexte de l’infection par le VIH.Dans ce travail de thèse, nous avons tout d’abord développé une PCR en temps réel pour la quantification de l'ADN de EBV ciblant la région répétée BamHI-W du génome. Le travail de validation de la technique a permis d’évaluer précisément le gain de sensibilité comparativement à une qPCR LMP2 (cible unique). L’impact des variations de répétition de la séquence BamHI-W suivant les souches et isolats EBV a également été analyse.Dans un deuxième travail, nous avons montré que, la mastite subclinique était fréquente au cours de l’allaitement et qu’elle était un facteur indépendant associé à une augmentation de l'excrétion EBV par le lait maternel. Cette sécrétion est associée localement à l’inflammation et à l’excrétion du VIH ce qui témoigne de phénomène de synergie entre les deux virus. Nous avons également démontré que l'ADN EBV dans le lait maternel peut être résistant à la DNase et que le virus était est probablement encapsidé dans le lait, donc potentiellement infectieux.Enfin, bénéficiant d’un accès aux prélèvements de la cohorte ASSESS nous avons recherché de possible anomalie du contrôle de l’infection EBV dans le compartiment sanguin au cours du syndrome de Gougerot-Sjögren primaire dans lequel les lésions glandulaires salivaires et lacrymales sont associées à la présence d’EBV. Nous avons démontré que le réservoir EBV et la réplication EBV dans le compartiment systémique sont bien contrôlées au cours du syndrome de Gougerot-Sjögren primaire. La réponse anticorps contre l’antigène précoce d’EBV (EA) n'était pas associée à une augmentation de l'ADN de EBV.Ce travail de thèse, souligne le lien entre l'activation des lymphocytes B, l'inflammation chronique et le contrôle sur le réservoir d’EBV. Dans la glande mammaire le contrôle de l’infection EBV est perturbé en cas de mastite subclinique. Au contraire dans le syndrome de Gougerot-Sjögren l’infection reste bien contrôlée dans le compartiment sanguin malgré l’activation des lymphocytes B et la présence renforcée du virus dans les lésions glandulaires. / TEpstein-Barr virus (EBV), an ubiquitous human gammaherpesvirus affects 95% of adult human population and establishes a lifelong latency in memory B cells periodically entering into lytic replication with further propagation in oropharyngeal epithelia and shedding through saliva. Latent EBV infection is associated with lymphomas, carcinomas and autoimmune diseases. Although the conditions favoring the development of these pathologies are not completely understood, the immunosuppression and B cell activations play an important role in EBV-associated diseases.We examined the control over the EBV reservoir in a diseases associated with B cell activation. Two clinical situations associated with altered B cell activation were explored: primary Sjogren’s syndrome and subclinical mastitis in HIV-infected mothers.Primarily, we developed an in-house real-time PCR for EBV DNA quantification targeting the repetitive BamHI-W region of EBV DNA. The validation analyses enabled to evaluate the gain in sensitivity of the BamHI-W test relative to single repeat LMP2 qPCR. The impact of the variations in BamHI-W reiteration on EBV DNA quantification was further assessed on different EBV strains and clinical samples.In a second study, we showed that subclinical mastitis was common during breastfeeding, and it was an independent factor associated with increased EBV breast milk shedding. This secretion was associated with local inflammation and HIV shedding, reflecting synergy between the two viruses. We have also demonstrated that breast milk EBV DNA may be resistant to DNase, and the virus was probably encapsidated in the breast milk and thus potentially infectious.Finally, with an access to ASSESS cohort we looked for possible abnormal control over EBV infection in the blood compartment in primary Sjögren's syndrome, where salivary and lacrimal gland lesions were shown to be associated with the local activation of EBV. We have demonstrated that in primary Sjogren's syndrome EBV reservoir and replication in the systemic compartment are well controlled. The antibody response against EBV early antigen (EA) was not associated with increased DNA EBV.This thesis points out the link between the activation of B cells, chronic inflammation and control over the reservoir of EBV. In the mammary gland disturbed control of EBV infection is linked with subclinical mastitis. In contrast, in primary Sjogren’s syndrome EBV infection remains well controlled in the blood compartment despite the activation of B cells and the increased presence of the virus in glandular lesions.