As Anemias Hemolíticas compreendem um grupo de doenças em que há redução acentuada na sobrevivência dos glóbulos vermelhos circulantes e a medula óssea não é capaz de compensação, mesmo aumentando sua produção, o que causa anemia desde os primeiros anos da vida da pessoa. Dentre as doenças deste grupo, a Anemia Falciforme (SCA) e a Esferocitose Hereditária (HS) destacam-se por se tratarem de enfermidades com defeitos genéticos intrínsecos das células vermelhas (RBCs) que geram complicações multissistêmicas agudas e crônicas em seus portadores. Por vias patofisiológicas distintas, reticulócitos e respectivas hemácias defeituosas de tais doenças, falciformes e esferócitos, são continuamente aprisionados e fagocitados no baço, importante órgão de destruição de células velhas e/ou defeituosas via hemólise extravascular, o que leva progressivamente à disfunção e eventual perda da função esplênica. O objetivo desse trabalho é avaliar o papel do baço em relação à habilidade e ao fenótipo adesivos de reticulócitos (ret) e eritrócitos (erit) em pacientes com SCA e HS, com e sem função esplênica preservada. Amostras de sangue de 37 pacientes (22 SCA and 15 HS) com função esplênica e 19 pacientes (13 SCA e 6 HS) sem ela foram avaliadas. Ainda, sangue de 22 crianças com SCA foi coletado em estudo longitudinal dos 6 e 29 meses de vida. Todas as amostras de sangue foram analisadas quanto à função esplênica (Contagem de células PIT e de corpúsculos de Howell-Jolly - HJB), quanto ao perfil imunofenotípico celular (em % e em média de intensidade de fluorescência - MFI) e quanto à habilidade de adesão das células vermelhas à laminina e à linhagem celular endotelial HMEC-1. A análise da transição da perda de função esplênica demonstrou que a mesma se intensificou a partir dos 3 anos de idade (PIT: r=0,8; p<0,0001; HJB: r=0,7; p<0.0001). Quanto à imunofenotipagem celular, a contagem PIT se correlacionou positivamente, principalmente com os marcadores CD147 (%ret: r=0,6; p<0,0001; MFIret: r=0,6; p<0,0001; %erit: r=0,7; p<0,0001; MFIerit: r=0,6; p<0,0001), LuBCAM (%ret: r=0,5; p=0,004; MFIret: r=0,6; p<0,0001; %erit: r=0,6; p<0,0003; MFIerit: r=0,4; p<0,004) and CD58 (%ret: r=0,4; p=0,006; MFIret: r=0,5; p<0,0013; %erit: r=0,4; p<0,009; MFIerit: r=0,6; p<0,0001). Na comparação entre ausência ou presença do baço, a perda de sua função exerceu influência no aumento da expressão de adesão de RBCs em SCA, principalmente CD147 (%ret: p=0,002; MFIret: p=0,003; %erit: p<0,0001; MFIerit: p=0,005), LuBCAM (%ret: p=0,0001; MFIret: p<0,0001; %erit: p<0,0001; MFIerit: p<0,0001) e CD58 (%ret: p=0,007; MFIret: p=0,006; %erit: p=0,003; MFIerit: p=0,0004), embora a adesão celular tenha diminuído em pacientes HS esplenectomizados. Na comparação entre as doenças, pacientes HS com o baço apresentaram maior freqüência de adesão celular em relação aos SCA, notavelmente em relação ao LuBCAM (%ret: p=0,0008; MFIret: p=0,03; %erit: p<0,0001; MFIerit: p=0,0002), CD58 (%ret: p=0,0009; %erit: p=0,003) e CD44 (%ret: p=0,009; %erit: p<0,003). No entanto, as amostras SCA sem função esplênica tiveram maior expressão de adesão celular para CD147 (%ret: p=0,006; MFIret: p=0,02; %erit: p=0,02), LuBCAM (%ret: p=0,004; MFIret: p<0,0001), CD36 (%ret: p=0,0002; MFIret: p=0,01), CD242 (%ret: p=0,0008; %erit: p=0,05) e CD49d (%ret: p=0,04). Em relação ao Ensaio de Adesão in vitro, na ausência de baço, os RBCs SCA apresentaram maior adesividade à laminina do que os RBCs SCA com função esplênica preservadaem todas as taxas de fluxo de tensão de cisalhamento empregadas (0,5 dyne/cm2: p=0,01; 1 dyne/cm2: p=0,02; 2 dynes/cm2: p=0,03; 3 dynes/cm2: p=0,03; 5 dynes/cm2: p=0,04 e 7 dynes/cm2: p=0,03). Especialmente, reticulócitos de pacientes sem baço apresentaram maior adesividade à HMEC-1 em baixas tensões de cisalhamento (1 dyne/cm2) em ambas as doenças (SCA: p=0,03; HS: p=0,03). Por fim, reticulócitos apresentaram maior habilidade adesiva à células endoteliais em indivíduos SCA do que em pacientes HS, com (0,5 dyne/cm2: p=0,04; 1 dyne/cm2: p=0,03) ou sem baço (0,5 dyne/cm2: p=0,02; 2 dynes/cm2: p=0,01; 3 dynes/cm2: p=0,03; 5 dynes/cm2: p=0,02 e 7 dynes/cm2: p=0,03). Nossos resultados indicam que embora pertençam ao grupo de Anemias Hemolíticas, as patofisiologias e evoluções clínicas distintas de SCA e de HS levam a padrões imunofenotípicos diferentes de expressão da adesão celular. Na SCA, a ausência de função esplênica teria direta relação com o aumento do fenótipo pró-adesivo e com a adesividade de RBCs SCA, o que traz sérias consequências clínicas aos pacientes, enquanto na HS sem baço, de maneira geral, os eventos de adesão celular são minimizados, embora ainda apresentem reticulócitos e eritrócitos adesivos circulantes após a esplenectomia. / Hemolytic Anemias comprise a group of diseases in which there is marked reduction in the survival of circulating erythrocytes and the bone marrow is not capable of compensation, even by increasing its production, which causes anemia from the first years of the person\'s life on. Among the diseases of this group, Sickle Cell Anemia (SCA) and Hereditary Spherocytosis (HS) stand out for being diseases with intrinsic genetic defects of red blood cells (RBCs) that generate acute and chronic multisystemic complications in their patients. By distinct pathophysiological pathways, reticulocytes and these disease\'s respective defective erythrocytes, sickle and spheroid ones, are continuously trapped and phagocytosed in the spleen, important organ of destruction of old and/or defective cells via extravascular hemolysis, which progressively leads to dysfunction and eventual loss of splenic function. The objective of this study was to evaluate the role of the spleen in relation to the reticulocyte (ret) and erythrocyte (eryt) adhesive ability and adhesion phenotype in patients with SCA and HS, with and without preserved splenic function. Blood samples from 37 patients (22 SCA and 15 HS) with splenic function and 19 patients (13 SCA and 6 HS) without it were evaluated. Still, blood from 22 children with SCA was collected in a longitudinal study from 6 to 29 months of age. All blood samples were analyzed for splenic function [pitted cells (PIT) and Howell-Jolly bodies (HJB) counting], for the cellular immunophenotypic profile (in % and in mean fluorescence intensity - MFI) and for the adhesive ability of RBCs to laminin and to endothelial cell line HMEC-1. Analysis of the splenic function loss transition showed that it intensified from 3 years of age on (PIT: r=0.8, p<0.0001; HJB: r=0.7, p<0.0001). Regarding the cellular immunophenotyping, PIT count correlated positively, mainly with CD147 markers (%ret: r=0.6, p<0.0001; MFIret: r=0.6, p<0.0001; %eryt: r=0.7, p<0.0001; MFIeryt: r=0.6, p<0.0001), LuBCAM (%ret: r=0.5, p=0.004; MFIret: r=0.6, p<0.0001; %eryt: r=0.6, p<0.0003; MFIeryt: r=0.4, p<0.004) and CD58 (%ret: r=0.4, p=0.006; MFIret: r=0.5, p<0.0013; %eryt: r=0.4, p<0.009; MFIeryt: r=0.6, p<0.0001). In the comparison between spleen absence or presence, the loss of its function exerted influence on the increase of RBCs adhesion expression in SCA, mainly on CD147 (%ret: p=0.002; MFIret: p=0.003; %eryt: p<0.0001; MFIeryt: p=0.005), LuBCAM (%ret: p=0.0001; MFIret: p<0.0001; %eryt: p<0.0001; MFIeryt: p<0.0001) e CD58 (%ret: p=0.007; MFIret: p=0.006; %eryt: p=0.003; MFIeryt: p=0.0004), although cell adhesion has been decreased in splenectomized HS patients. In the comparison between diseases, HS patients with spleen showed higher cell adhesion frequency compared to SCA, notably in relation to LuBCAM (%ret: p=0.0008; MFIret: p=0.03; %eryt: p<0.0001; MFIeryt: p=0.0002), CD58 (%ret: p=0.0009; %eryt: p=0.003) and CD44 (%ret: p=0.009; %eryt: p<0.003). However, SCA samples without splenic function had higher cell adhesion expression for CD147 (%ret: p=0.006; MFIret: p=0.02; %eryt: p=0.02), LuBCAM (%ret: p=0.004; MFIret: p<0.0001), CD36 (%ret: p=0.0002; MFIret: p=0.01), CD242 (%ret: p=0.0008; %eryt: p=0.05) and CD49d (%ret: p=0.04). Concerning the in vitro Adhesion Assay, in the spleen absence, SCA RBCs showed greater adhesiveness to laminin than SCA RBCs with preserved splenic function did at all shear stress flow rates applied (0.5 dyne/cm2: p=0.01, 1 dyne/cm2: p=0.02, 2 dynes/cm2: p=0.03, 3 dynes/cm2: p=0.03, 5 dynes/cm2: p=0.04 and 7 dynes/cm2:p=0.03). Especially, reticulocytes from patients without spleen showed higher adhesiveness to HMEC-1 at low shear stresses (1 dyne/cm2) in both diseases (SCA: p=0.03; HS: p=0.03). Finally, reticulocytes showed greater adhesion ability to endothelial cells in SCA subjects than in HS patients, with (0.5 dyne/cm2: p=0.04 and 1 dyne/cm2: p=0.03) or without spleen (0.5 dyne/cm2: p=0.02, 2 dynes/cm2: p=0.01, 3 dynes/cm2: p=0.03, 5 dynes/cm2: p=0.02 and 7 dynes/cm2: p=0.03). Our results indicate that although both diseases belong to the Hemolytic Anemias group, SCA and HS distinct pathophysiologies and clinical evolution lead to different immunophenotypic patterns of cell adhesion expression. In SCA, the absence of splenic function may have a direct relation with the increase of SCA RBCs proadhesive phenotype and adhesiveness, which brings serious clinical consequences to the patients, whereas in HS without spleen, in general, cellular adhesion events are minimized, although they still present adhesive circulating reticulocytes and erythrocytes after splenectomy.

Malaria, caused by the apicomplexan parasite Plasmodium, is a major cause of morbidity and mortality throughout the world. This study has focused on the role of the spleen in the control of the blood stage of infection. Three aspects have been examined specifically: the effect of infection on the architecture of the spleen, the role of the spleen in parasite clearance and the formation of B cell memory. Firstly, the effect of infection on the splenic microarchitecture was examined. An essential component of the splenic architecture is the marginal zone (MZ), an area of the spleen that separates the reticuloendothelial red pulp of the spleen from the lymphoid white pulp compartment. Two unique populations of macrophages are found in the marginal zone: marginal zone macrophages (MZM) and marginal metallophilic macrophages (MMM). In the current study, parasitised red blood cells (pRBC) as well as normal RBC located to the MZ thirty minutes after intravenous injection and formed close associations with both MMM and MZM. Eight days after infection, at the time of peak parasitemia, a complete loss of both MMM and MZM was observed. Assays to detect cell death revealed that the loss of both MMM and MZM appeared to occur as a result of apoptosis. The apoptosis was not induced by up regulation of the inflammatory cytokines tumour necrosis factor or interferon-γ and could not be blocked by over expression of the apoptosis inhibitor Bcl2. Significantly, MMM were retained in the absence of CD8+ T cells implicating CD8+ T cells in the loss of MMM. Finally, infection of CD95-/- mice demonstrated that CD95/CD95-ligand (Fas/Fas-ligand) interactions were responsible for some of the CD8+ T cell-mediated loss of MMM. These data provide evidence for a novel interaction between MMM and CD8+ T cellsfollowing infection with Plasmodium. Secondly, the role of the spleen in the control of parasitemia and disease was monitored with an emphasis on determining the role of splenic macrophage populations (MMM, MZM and red pulp macrophages [RPM]) in parasite clearance. A clodronate liposome-mediated macrophage depletion technique was used, and caused a complete loss of all three macrophage sub-populations, as well as 50% of splenic dendritic cells, within 24 hours of administration. Each of the macrophage populations, as well as splenic DC, demonstrated different repopulation kinetics following their depletion from the spleen and these kinetics were utilised to examine each cell population in isolation. RPM depleted mice had significantly higher peak parasitemias than the controls. This peak returned to the level observed in undepleted control animals only after the repopulation of RPM was complete, suggesting that RPM play a role in the control of peak parasitemia following infection. Neither MMM nor MZM played a role in the control of parasitemia. The role of non-splenic macrophages and splenic dendritic cells also was investigated and shown to be insignificant in the absence of splenic macrophages. Finally, the role of RPM in mice immune to infection was investigated and their role shown to be dispensable, with immune mice clearing parasitemia efficiently in the absence of RPM. RPM therefore are important for the innate control of infection with P. chabaudi but are dispensible once adaptive immunity is established. Finally, the role of the spleen in the development of parasite-specific B cell memory was examined. Initial studies demonstrated that germinal centre (GC) development was compromised following infection with P. chabaudi, with an involution of B cell follicles noted early in infection. Adoptive transfer of memory B cells from immunised to naïve mice demonstrated that some protection was conferred on recipient mice by parasite-specific memory B cells. But, the memory B cells could not protect the host from developing parasitemia and did not produce significant amounts of parasite-specific immunoglobulin within seven days of challenge infection. Memory B cells could not be detected ten weeks after infection, indicating that the development, or survival, of parasite-specific memory B cells was compromised. The development of bystander memory B cells was not affected by infection. Finally, long-lived plasma cells were shown to develop in response to infection, although re-exposure of the cells to parasites in the form of recrudescent parasitemia resulted in their loss. This study therefore has identified a defect in the development of long-term, B cell-mediated, protection against infection with P. chabaudi. Each of these factors has significant implications for the understanding of how the spleen contributes to the control of infection with Plasmodium and potential applications for the further development of malaria vaccines and treatment regimens.

La sénescence est un important mécanisme cellulaire qui prévient la tumorigenèse et se caractérise par un arrêt permanent du cycle cellulaire orchestré principalement par les inhibiteurs des cycline-kinases dépendantes (i.e p16INK4a). La sénescence est une caractéristique importante du vieillissement, mais un déséquilibre dans son induction peut être délétère pour la régénération tissulaire et paradoxalement pour la progression tumorale. L'irradiation (IR) est couramment utilisée comme approche thérapeutique dans le cancer. Chez les enfants survivants du cancer, l’exposition à l’irradiation et à la chimiothérapie entrainent le développement d’importants effets secondaires, lesquels sont associés à une forme de vieillissement prématuré. La formation de cellules sénescentes, en inhibant la prolifération tissulaire et en sécrétant des cytokines proinflammatoires, pourrait être en être responsable. Notre groupe a précédemment démontré que le gène p16INK4a est augmenté de manière tardive (environ 8 semaines) suite à une exposition à l’irradiation. Il n'a pas encore été étudié si cette expression retardée survient en réponse aux dommages causés par l'irradiation sur l’homéostasie tissulaire ou à titre de mécanismes de suppression tumorale. Un objectif de cette thèse visait donc à déterminer s’il était possible de moduler/inhiber l’expression de p16INK4a dans le but d’accroitre la régénération tissulaire sans nécessairement accroitre les risques d’incidence du cancer. En effet, ceci pourrait être possible dans la mesure ou la sénescence induite par p16INK4a est également irréversible in vivo. Nos résultats ont démontré que l’inhibition de l’expression de p16INKa (suite à l’administration de tamoxifen chez les souris p16L/LCre), induit à la fois une augmentation de la régénération tissulaire mais malheureusement également une augmentation de l’incidence du cancer. Nous voulions également connaitre l’impact de l’accumulation de ces cellules sénescentes sur les tissus, plus spécifiquement sur la fonction des cellules immunitaires de la rate. Nous avons démontré que des altérations (dépendantes de p16INK4a) au sein du microenvironnement splénique pouvaient altérer les fonctions intrinsèques des macrophages, des cellules dendritiques et des lymphocytes T. En outre, l'élimination systémique des cellules p16INK4a positives (modèle de sourie p16-3MR) a conduit à une restauration partielle de la fonction de ces cellules immunitaires. La combinaison de ces données nous permet de mieux comprendre le rôle et la fonction du gène p16INK4a dans le processus de sénescence induite par l’irradiation. Nos résultats suggèrent qu’il est envisageable d’utiliser des agents pharmacologiques tels que des composés sénolytiques, capables d’induire l’apoptose chez les cellules sénescentes spécifiquement, afin de potentiellement diminuer les effets du vieillissement prématuré induit par la sénescence cellulaire chez les survivants du cancer. / Senescence is an important cellular mechanism that prevents tumorigenesis and is characterized by a permanent cell cycle arrest orchestrated by cyclin-dependent kinases inhibitors (i.e p16INK4a). Senescence is an important hallmark of aging and unbalanced levels of senescence is considered deleterious for tissue regeneration, and paradoxically for tumor progression. Irradiation (IR) is commonly used therapeutic approach in cancer treatment. Together with surgery and chemotherapy, it has helped to increase the life expectancy of patients and, in some cases, leads to complete remission. However, long-after therapy, children who survive cancer encounter alterations in the integrity of tissues/organs associated with premature aging. The accumulation of senescent cells may be responsible for this accelerated aging by limiting tissue proliferation and secreting pro-inflammatory cytokines. Our group has previously demonstrated that the p16INK4a gene is increased in a delayed manner (approximately 8 weeks) following exposure to IR. It has not yet been investigated whether this delayed expression occurs in response to IR-induce damage of tissue homeostasis or as tumor suppression mechanisms. One objective of this thesis was to determine whether it was possible to modulate / inhibit the expression of p16INK4a in order to increase tissue regeneration without necessarily increasing the risk of cancer incidence. Indeed, this may be possible since p16INK4a-induced senescence is also irreversible in vivo. Our results demonstrated that the inhibition of p16INK4a expression in conditional-p16INK4a null mice , induces both an increase in tissue regeneration but unfortunately also an increase in the incidence of cancer. We also wanted to know the impact of the accumulation of these senescent cells on the tissues, more specifically on the function of the immune cells in the spleen. We have demonstrated that alterations (p16INK4a-dependent) within the splenic microenvironment can alter the intrinsic functions of macrophages, dendritic cells and T cells. In addition, the systemic elimination of p16INK4a positive cells (mouse model p16-3MR) has led to a partial restoration of the function of these immune cells. The combination of these data allows us to better understand the role and function of the p16INK4a gene in the irradiation-induced senescence process. Our results suggest that it is conceivable to use pharmacological agents such as senolytic compounds, capable of inducing apoptosis in senescent cells specifically, in order to potentially reduce the effects of premature aging induced by cellular senescence in cancer survivors.