Allergic asthma is an immunological disease, mediated by CD4+ Th2 cells, and its prevalence has increased over recent decades. Features of allergic asthma include airway hyperresponsiveness (AHR), airway eosinophilia, excessive airway mucus production, and increased IgE and Th2 cytokine levels. Airway remodeling with pulmonary fibrosis is noted in the progress of asthma. In this thesis, a murine model of allergic asthma was used to investigate the effect of cyclophosphamide (CY) on asthma and the involvement of regulatory T cells (Treg), and the role of Granulocyte-macrophage colony stimulating-factor (GM-CSF) in allergic asthma by using GM-CSF knockout mice. CY is a cytotoxic agent, which paradoxically augments several immune responses. The first part of this thesis was aimed to study the effects of CY in a murine model of allergic airway inflammation. BALB/c mice were immunized with ovalbumin (OVA) on days 0 and 14, and challenged with aerosolized OVA from days 21 to 27. Some mice additionally received CY on days -2 and 12. In the CY-treated animals, pronounced worsening of inflammatory features was noted, including increases in eosinophil infiltration, epithelial thickness, mucus occlusion and eosinophil numbers in bronchoalveolar lavage fluid (BALF). Increased total and OVA-specific serum IgE were also noted in the CY-treated animals. In cell cultures from peritracheal lymph nodes, the Th2 cytokines IL-4 and IL-5 were elevated in animals treated with CY. It was hypothesized that the effects of CY could be caused by reduced immunosuppression mediated by Treg. mRNA expression of the immunosuppressive cytokines IL-10 and TGF-beta was reduced in the lungs of CY-treated mice. The expression of FoxP3, a marker of naturally occurring Treg, was significantly reduced in spleens, thymuses and peritracheal lymph nodes after the second injection of CY, and in the lung tissue after allergen challenge in CY-treated mice. Furthermore, lung IL-10-producing CD4+ T cells and CTLA-4+-bearing CD4+ T cells were reduced after allergen aerosol challenge in CY-treated mice. Thus CY worsened the features of allergic pulmonary inflammation in this model, in association with increased production of IgE and Th2 cytokines. The reduction in expression of FoxP3 and immunosuppressive cytokines by CY suggests that toxicity to Treg may contribute to the increased inflammation. GM-CSF plays a role in the growth, development, and maturation of bone marrow hemopoietic cells into mature blood cells, and has been proposed to be involved in potentiating the function of inflammatory cells in allergic inflammation. In the second part of this thesis, GM-CSF knockout (KO) mice were used to investigate the role of GM-CSF. In allergic KO mice, airway eosinophils were only shown in the perivascular, but not peribronchial areas in the lung, compared to the allergic wild-type (WT) mice in which eosinophil infiltration appeared in both areas. Eosinophil numbers were drastically reduced in the bronchoalveolar lavage fluid (BALF) of KO mice. IL-5 production in the lung tissue and BALF in allergic KO mice was reduced; similar results were also found in peritracheal draining lymph nodes after in vitro stimulation assays. However, IL-4 and IL-13 production, airway hyperresponsiveness (AHR), and serum IgE production were not affected in allergic KO mice. Surprisingly, lung IFN-gamma mRNA and BALF levels were increased in allergic KO mice. Lung mRNA levels of CCR3, a key chemokine receptor on eosinophils, were significantly reduced in allergic KO mice, whereas expression of the chemokines eotaxin and RANTES were at similar levels in allergic KO and WT mice. Lung mRNA levels of the IFN-gamma-inducible chemokines Mig (CXCL9) and IP-10 (CXCL10), which are antagonists of CCR3, and their receptor CXCR3 were increased in allergic KO mice, compared with allergic WT mice. Data obtained from flow cytometry showed more eosinophils survived in the lung of WT mice than KO mice. Another allergy model, a peritoneal allergy model was performed to investigate inflammation in a different model. Leukocyte subpopulations such as neutrophils, eosinophils, macrophages, and lymphocytes were reduced in the peritoneal lavage fluid of allergic KO mice. The findings revealed that GM-CSF is essential for IL-5 production, pulmonary airway eosinophilia and eosinophil survival. In the absence of GM-CSF, over-production of IFN-???? may induce chemokines, including Mig and IP-10, which are antagonists for CCR3 and may reduce airway eosinophil infiltration. In this thesis, a murine model of allergic asthma has been used to obtain novel findings on the regulation of allergic inflammation. The results with CY are relevant to the treatment of asthma patients with CY and other cytotoxic agents. The findings in the GM-CSF KO mice suggest that GM-CSF is a potential therapeutic target in asthma, and that in assessment of new therapeutic agents for asthma, effects on GM-CSF should be considered.

<p>T lymphocytes regulate the initiation, duration, and magnitude of adaptive immune responses and function as effector cells in cell mediated immunity. To become immunologically competent they must generate functional antigen receptors. This process takes place in the thymus and requires somatic recombination of T cell receptor (TCR) genes. It is mediated by the endonucleases recombination activating gene-1 (RAG1) and RAG2. Although the thymus regresses at puberty, T cells are present throughout life implying that other tissues must provide the proper milieu for T cell development. This thesis describes extrathymic T cell maturation in man. RAG1, RAG2, and the preTα-chain (pTα), which is exclusively utilized in developing T cells, were used as markers for TCR gene rearrangement. Two new exons (1A and 1B) encoding sequences in the 5’ untranslated region (5’UTR) of mRNA were discovered in the human RAG1 gene. The previously described 5’UTR exon (renamed 1C) was located between the new exons and exon 2, the latter containing the entire coding sequence. We found that small intestinal lymphocytes of the T cell lineage expressed the new exons in three different splice forms. RAG1 mRNA containing the 1C exon was not expressed in small intestinal lymphocytes. In contrast, splice forms containing the 1A exon were not expressed in thymocytes. RAG1 and pTα mRNA expressing lymphocytes were seen both within the epithelium and in lamina propria. Thymocyte-like CD2⁺CD7⁺CD3^-, CD4⁺CD8⁺, CD1a⁺, and IL7-R+ lymphocytes were identified in the small intestinal mucosa. CD2⁺CD7⁺CD3^- cells had the highest expression levels of mRNA for RAG1 and pTα, suggesting that the small intestinal mucosa is indeed a site for T cell maturation. Small intestinal T lymphocytes were also shown to kill via the Fas/FasL pathway in a TCR/CD3 independent manner and via the perforin/granzyme pathway in a TCR/CD3 dependent manner. The Fas/FasL-mediated cytotoxicity may reflect an ongoing selection process of extrathymically maturated T cells. </p><p>The nasopharyngeal tonsil is the major inductive site for immune reactions against inhaled antigens. Previous demonstration of RAG1 expression in tonsillar B cells was interpreted as antigen driven receptor revision. The present study confirms the expression of RAG1 in B cells. We also found that RAG1, RAG2, and pTa mRNAs were expressed in lymphocytes of the T cell lineage. A small population of cells with the immature phenotype CD2+CD7+CD3- was demonstrated. This population had the highest expression levels of mRNA for RAG1, RAG2, pTα and terminal deoxynucleotidyl transferase. All four splice-forms of RAG1 mRNA were expressed. RAG1 and pTα mRNA expressing cells were mainly located in the proximity of the surface epithelium and in the outer rim of the follicles. These results suggest that the nasopharyngeal tonsil is a site where extrathymic T cell development and antigen driven TCR revision are occurring in parallel. </p><p>Celiac disease (CD) is a small intestinal enteropathy characterized by permanent intolerance to gluten. Gluten reactive intestinal T cells are central in the pathogenesis and CD can be regarded as a failure to maintain tolerance to this food antigen. Expression of the RAG1 1A/2 splice form was significantly decreased in small intestinal T cell subsets of CD patients suggesting that impaired TCR gene rearrangement could contribute to failure of maintain tolerance in CD. </p><p>Together, these findings show that both small intestinal and nasopharyngeal tonsillar lymphocytes of T cell lineage have the molecular machinery for antigen receptor rearrangement and that thymocyte-like lymphocytes are present in both tissues. Thus these organs are likely sites of T lymphocyte ontogeny as well as for secondary T cell receptor rearrangement in man. </p>

<p>This thesis describes stereoselective syntheses of four amino acids, three of which are C-glycosidic analogues of glycosylated amino acids. The overall goal of the project was to probe the interactions between MHC molecules, glycopeptide antigens and T cell receptors, that are essential for development of collagen induced arthritis. Collagen induced arthritis is a frequently used mouse model for rheumatoid arthritis, an autoimmune disease that attacks joint cartilage and leads to a painful and eventually crippling condition.</p><p>The thesis is based on four studies. The first study describes the synthesis of hydroxylysine, an amino acid that is found in collagen and is an important constituent of the glycopeptide proposed as an antigen in collagen induced arthritis. During the synthesis of hydroxylysine some new insight into the mechanism of the reductive opening of <i>p</i>-methoxybenzylidene acetals was obtained.</p><p>The remaining three studies deals with the synthesis of C-glycosidic analogues of glycosylated amino acids, hydroxy norvaline, threonine and hydroxylysine.The synthesis of each amino acid required control of several stereogenic centra and utilizes a variety of approaches such as use of stereoselective reactions, chiral auxilaries, chiral templates and asymmetric catalysis.</p><p>The C-glycosidic analogues of galactosylated hydroxynorvaline and hydroxylysine were incorporated in glycopeptides from type II collagen and evaluated in T cell response assays. It was found that the T cells were stimulated by the C-glycopeptides, but that higher concentrations were required than for the native O-glycopeptide</p>

<p>Rheumatoid arthritis (RA) is an autoimmune disease affecting approximately 1% of the population in the western world. It is characterised by a tissue specific attack of cartilage in peripheral joints. Collagen induced arthritis (CIA) is one of the most commonly used animal models for (RA), with similar symptoms and histopathology. CIA is induced by immunisation of mice with type II collagen (CII), and the immunodominant part was previously found to be located between residues 256-270. This thesis describes the interaction between the MHC molecule, glycopeptide antigens from CII and the T cells that is essential in development of CIA. The glycopeptide properties for binding to the mouse MHC molecule Aq have been studied, as well as interaction points in the glycopeptide that are critical for stimulation of a T-cell response.</p><p>The thesis is based on five studies. In the first paper the minimal glycopeptide core, that is required for binding to the Aq molecule while still giving a full T cell response was determined. The second paper studied the roles of amino acid side-chains and a backbone amide bond as T-cell contact points. In the third paper the hydrogen bond donor-acceptor characteristics of the 4-OH galactose hydroxyl group of the glycopeptide was studied in detail. In the fourth paper we established a structure activity relationship (QSAR model) for (glyco)peptide binding to the Aq molecule. Finally, the stereochemical requirements for glycopeptide binding to the Aq molecule and for T-cell recognition was studied in the fifth paper.</p><p>The study was performed using collagen glycopeptide analogues, which were synthesised on solid phase. Amide bond and hydroxyl group isosteres were introduced for study of hydrogen bond donor-acceptor characteristics. Statistical methods were used to design a representative peptide test set and in establishing a QSAR model.</p><p>The results give a deeper understanding of the interactions involved in the ternary MHC-glycopeptide-T cell complex. This information contributes to research directed towards finding new treatments for RA.</p>

<p>One of the main obstacles to maintaining patients with short bowel syndrome on parenteral nutrition, or successfully transplanting these patients with a small bowel graft, is the many severe infections that occur. Evidence is accumulating that translocating bacteria from the patient’s bowel causes a significant part of these infections. In this thesis bacterial translocation is studied in a Thiry-Vella loop of defunctionalised small bowel in the rat. </p><p>Bacterial translocation to the mesenteric lymph nodes (MLNs) occurs in almost 100% of the rats after three days. No systemic spread of bacteria is observed unless there is additional immunosupression with depletion of Kupffer cells in the liver. However, blocking the function of α/β T cells does not increase the translocation. Removal of MLNs does not either aggravate bacterial translocation in the Thiry-Vella loop model. Conversely, after small bowel transplantation translocating bacteria spread systemically if the MLNs are removed. </p><p>The Thiry-Vella loop should also be a suitable model for the testing of potentially translocation-inhibiting substances. Reinforcement of the intestinal barrier with glutamine or phosphatidylcholine proved insufficient in decreasing bacterial translocation. Even selective bowel decontamination with tobramycin failed to abolish bacterial translocation. Thus, it seems that the driving force for translocation in this model is strong regardless of the relatively small trauma of intestinal defunctionalisation.</p><p>Flow cytometric studies of the immune cells in the spleen MLNs showed a decrease in MHC class II positive T cells in the MLNs of the Thiry-Vella loop. Concurrently the number of macrophages increased with time as observed by immunohistochemistry. The fraction of MHC class II negative macrophages increased in the spleens of rats treated with glutamine. </p><p>In conclusion, the Thiry-Vella loop model offers possibilities of immunological as well as mechanistic studies on bacterial translocation from small intestine.</p>

<p>Cytokines are soluble signalling mediators within the immune system, and have been shown to be of importance in the development of type 1 diabetes (T1D). This thesis studied the production of cytokines in experimental models of T1D and during transplantation of insulin-producing islets of Langerhans. </p><p>We have demonstrated that the transcriptional TNFα-inhibitor MDL 201,449A, previously shown to reduce immune-mediated diabetes induced in mice by multiple low doses of streptozotocin, was not TNFα-specific, but also inhibited IFNγ and IL-10 in spleen cells. Furthermore, when the inhibitor was removed from in vitro cultures, a rebound phenomenon of increased cytokine secretion occurred.</p><p>The thesis also investigated whether plastic adhesion, a method generally employed to deplete macrophages, influenced cytokine production in spleen cells. We observed that plastic adhesion increased TNFα, IFNγ and IL-10 release, and decreased IL-4 secretion. Plastic adhesion depleted only ~30% of the macrophages, but as much as ~60% of the regulatory T cells. </p><p>Thirdly, we found that “control” treatments for islet transplantations, i.e. syngeneic and sham transplantations, exerted a clear effect on cytokine production from spleen cells, possibly due to a decrease in regulatory T cells that may be caused by the surgery and/or anaesthesia. Moreover, spleen cells from mice exposed to surgery exhibited a decreased proliferative capacity to concanavalin A stimulation. We also perceived a marked difference in cytokine response depending on the mouse strain used in the experiments.</p><p>Finally, we aimed to elucidate if, besides autoimmune activities, also high glucose- and free fatty acid concentrations as seen in diabetes could cause changes in cytokine production. We observed that spleen cells cultured in varying glucose concentrations had different cytokine production profiles. The free fatty acid palmitate might also influence cytokine release, but this effect was obscured by the cytokine-suppressive action of the ethanol used to dissolve the palmitate.</p>

Les tumeurs spontanées de souris ne sont pas immunogéniques. Néanmoins la mutagenèse de la leucémie spontanée LEC a permis d'isoler des variants immunogéniques qui confèrent une protection contre la tumeur parentale. Des clones de lymphocytes T cytolytiques (CTL) reconnaissant les cellules LEC ont été isolés à partir des lymphocytes de souris immunes. Au cours de ce travail, nous avons isolé et caractérisé la séquence codant l'antigène LEC A reconnu par le clone CTL-LEC1:5 à la surface des cellules LEC. Pour cloner ce gène, nous avons suivi une démarche similaire à celle ayant permis l'isolement de plusieurs gènes codant des antigènes reconnus par des clones CTL à la surface du mastocytome murin P815. Cette approche est basée sur la transfection de bibliothèques de cosmides construites avec l'ADN des cellules exprimant les antigènes à analyser et sur la détection des transfectants exprimant ces antigènes grâce à leur capacité de stimuler la prolifération du clone CTL adéquat. Une bibliothèque de cosmides a été construite avec l'ADN des cellules LEC et a été transfectée dans les cellules P1.HTR.KkDk. Plusieurs transfectants stimulant la prolifération des CTL LEC1:5 ont été identifiés. Un cosmide capable de transférer l'expression de l'antigène LEC A a été obtenu en encapsidant l'ADN génomique d'un transfectant dans des têtes de phage lambda. Un fragment de 4,38 kb codant l'antigène LEC A a été isolé à partir de ce cosmide. La séquence nucléotidique de ce fragment a été comparée aux séquences répertoriées dans les banques de données. Cette séquence présente de fortes homologies avec les rétrovirus endogènes défectifs appartenant à la famille IAP (intracisternal A particle, ou particule intraciternale de type A). La séquence codant l'antigène LEC A a été appelée LEC A IAP. Les CTL LEC1:5 reconnaissent un peptide antigénique dérivant de la région gag de l'élément LEC A IAP en association avec la molécule H 2 Dk. Pour comprendre le mécanisme responsable de l'expression de l'antigène LEC A par les cellules LEC, nous avons comparé les ADN génomiques des cellules LEC, de deux tumeurs syngéniques non reconnues par les CTL-LEC1:5 et de cellules normales provenant de souris syngéniques. Un Southern blot et des réactions de polymérisation en chaîne (PCR) ont permis d'établir que l'élément LEC A IAP s'est transposé dans la tumeur LEC. L'analyse de l'ADN génomique de variants des cellules LEC n'exprimant plus l'antigène LEC A ont établi que la transposition de l'élément LEC A IAP était responsable de l'expression de cet antigène. Il paraît probable que la transposition a pour conséquence d'activer la transcription de cet élément IAP, ce qui entraîne la production de l'antigène. / Cytolytic T lymphocyte (CTL) clones directed against spontaneous mouse leukemia LEC have been obtained. By transfecting a cosmid library into cells which were then tested for their ability to stimulate the CTL, we identified the gene coding for the antigen recognized by one of these CTL clones. It is the gag gene of an endogenous defective retrovirus that belongs to the intracisternal A particle (IAP) family. A gag-encoded nonapeptide presented by the H-2 Dk molecule caused recognition by the anti-LEC CTL clone. Southern blot and polymerase chain reaction analyses indicated that the expression of the antigen by the LEC tumor cell line resulted from the transposition of an IAP sequence into a new genomic location.

La variante lymphocytaire du syndrome hyperéosinophilique (L-SHE) est une pathologie extrêmement rare caractérisée par une prolifération monoclonale de lymphocytes T surproduisant l’interleukine IL-5, responsable d’une hyperéosinophilie persistante. En outre, un immunophénotype aberrant CD3−CD4+ est fréquemment observé à la surface des cellules T clonales. Cette pathologie se distingue par une lymphoprolifération chronique indolente habituellement révélée par une hyperéosinophilie sanguine et une infiltration éosinophilique des tissus cutanés. Toutefois, l’évolution vers un lymphome T observée chez certains patients suggère la présence d’un potentiel malin des cellules T. Ce modèle représente donc une rare opportunité d’identifier les changements moléculaires liés aux différentes étapes du processus transformant lymphoïde T. Dans le cadre de ce travail, nous avons cherché à établir les caractéristiques cytogénétiques et moléculaires des cellules T CD3−CD4+ d’une cohorte de patients L-SHE. L’analyse cytogénétique de cellules T CD3−CD4+ isolées au moment du diagnostic chez deux patientes (P1 et P2) a révélé la présence d’une délétion similaire 6q13-q22.1. En étudiant les stades cliniques successifs de P1 et P2, nous avons montré la persistance des cellules porteuses de la délétion 6q au cours de la progression chronique et leur prédominance lors du développement d’un lymphome T chez P1. Ces résultats suggèrent l’implication précoce et potentiellement critique de la délétion 6q dans cette pathologie lymphoproliférative T. L’analyse des dérégulations transcriptionnelles résultant de ce remaniement a montré une réduction de l’expression des gènes pro-apototiques BACH2 et PA26 dans les cellules T CD3−CD4+ de P1 et P2. En particulier, BACH2, dont l’expression diminue continuellement au cours de l’évolution de P1, jouerait un rôle oncosuppresseur dans la lymphogenèse T. Afin d’identifier les modifications moléculaires des cellules T clonales, nous avons analysé l’expression de 95% des gènes humains dans les cellules T CD3−CD4+ de trois patients en phase chronique (P1, P2 et P3). La grande homologie des changements transcriptionnels chez les trois patients indique une altération des mêmes mécanismes moléculaires. Ainsi, un profil immunophénotypique exhaustif, validé chez trois patients supplémentaires, a pu être établi. En outre, les dérégulations des voies apoptotiques, TGFβ ou 9 encore de signalisation intracellulaire altèrent l’homéostasie des cellules T CD3−CD4+ pouvant favoriser la perte de la capacité apoptotique et/ou la croissance cellulaire. Cette signature moléculaire a été étendue par l’identification de 20 microARNs dont l’expression est dérégulée dans les cellules T CD3−CD4+ d’une cohorte de 6 patients. Par ailleurs, la modification de l’expression des récepteurs impliqués dans la migration leucocytaire au cours de l’évolution de P1 pourrait expliquer l’infiltration ganglionnaire des cellules T clonales et la progression du lymphome. La caractérisation des désordres cytogénétiques et moléculaires des cellules T CD3−CD4+ chez les patients L-SHE permettrait à terme d’identifier de nouveaux marqueurs diagnostiques et contribuer ainsi au développement de nouvelles cibles thérapeutiques dans une grande diversité de pathologies lymphoprolifératives de type Th2.

This thesis describes stereoselective syntheses of four amino acids, three of which are C-glycosidic analogues of glycosylated amino acids. The overall goal of the project was to probe the interactions between MHC molecules, glycopeptide antigens and T cell receptors, that are essential for development of collagen induced arthritis. Collagen induced arthritis is a frequently used mouse model for rheumatoid arthritis, an autoimmune disease that attacks joint cartilage and leads to a painful and eventually crippling condition. The thesis is based on four studies. The first study describes the synthesis of hydroxylysine, an amino acid that is found in collagen and is an important constituent of the glycopeptide proposed as an antigen in collagen induced arthritis. During the synthesis of hydroxylysine some new insight into the mechanism of the reductive opening of p-methoxybenzylidene acetals was obtained. The remaining three studies deals with the synthesis of C-glycosidic analogues of glycosylated amino acids, hydroxy norvaline, threonine and hydroxylysine.The synthesis of each amino acid required control of several stereogenic centra and utilizes a variety of approaches such as use of stereoselective reactions, chiral auxilaries, chiral templates and asymmetric catalysis. The C-glycosidic analogues of galactosylated hydroxynorvaline and hydroxylysine were incorporated in glycopeptides from type II collagen and evaluated in T cell response assays. It was found that the T cells were stimulated by the C-glycopeptides, but that higher concentrations were required than for the native O-glycopeptide

T lymphocytes regulate the initiation, duration, and magnitude of adaptive immune responses and function as effector cells in cell mediated immunity. To become immunologically competent they must generate functional antigen receptors. This process takes place in the thymus and requires somatic recombination of T cell receptor (TCR) genes. It is mediated by the endonucleases recombination activating gene-1 (RAG1) and RAG2. Although the thymus regresses at puberty, T cells are present throughout life implying that other tissues must provide the proper milieu for T cell development. This thesis describes extrathymic T cell maturation in man. RAG1, RAG2, and the preTα-chain (pTα), which is exclusively utilized in developing T cells, were used as markers for TCR gene rearrangement. Two new exons (1A and 1B) encoding sequences in the 5’ untranslated region (5’UTR) of mRNA were discovered in the human RAG1 gene. The previously described 5’UTR exon (renamed 1C) was located between the new exons and exon 2, the latter containing the entire coding sequence. We found that small intestinal lymphocytes of the T cell lineage expressed the new exons in three different splice forms. RAG1 mRNA containing the 1C exon was not expressed in small intestinal lymphocytes. In contrast, splice forms containing the 1A exon were not expressed in thymocytes. RAG1 and pTα mRNA expressing lymphocytes were seen both within the epithelium and in lamina propria. Thymocyte-like CD2+CD7+CD3-, CD4+CD8+, CD1a+, and IL7-R+ lymphocytes were identified in the small intestinal mucosa. CD2+CD7+CD3- cells had the highest expression levels of mRNA for RAG1 and pTα, suggesting that the small intestinal mucosa is indeed a site for T cell maturation. Small intestinal T lymphocytes were also shown to kill via the Fas/FasL pathway in a TCR/CD3 independent manner and via the perforin/granzyme pathway in a TCR/CD3 dependent manner. The Fas/FasL-mediated cytotoxicity may reflect an ongoing selection process of extrathymically maturated T cells. The nasopharyngeal tonsil is the major inductive site for immune reactions against inhaled antigens. Previous demonstration of RAG1 expression in tonsillar B cells was interpreted as antigen driven receptor revision. The present study confirms the expression of RAG1 in B cells. We also found that RAG1, RAG2, and pTa mRNAs were expressed in lymphocytes of the T cell lineage. A small population of cells with the immature phenotype CD2+CD7+CD3- was demonstrated. This population had the highest expression levels of mRNA for RAG1, RAG2, pTα and terminal deoxynucleotidyl transferase. All four splice-forms of RAG1 mRNA were expressed. RAG1 and pTα mRNA expressing cells were mainly located in the proximity of the surface epithelium and in the outer rim of the follicles. These results suggest that the nasopharyngeal tonsil is a site where extrathymic T cell development and antigen driven TCR revision are occurring in parallel. Celiac disease (CD) is a small intestinal enteropathy characterized by permanent intolerance to gluten. Gluten reactive intestinal T cells are central in the pathogenesis and CD can be regarded as a failure to maintain tolerance to this food antigen. Expression of the RAG1 1A/2 splice form was significantly decreased in small intestinal T cell subsets of CD patients suggesting that impaired TCR gene rearrangement could contribute to failure of maintain tolerance in CD. Together, these findings show that both small intestinal and nasopharyngeal tonsillar lymphocytes of T cell lineage have the molecular machinery for antigen receptor rearrangement and that thymocyte-like lymphocytes are present in both tissues. Thus these organs are likely sites of T lymphocyte ontogeny as well as for secondary T cell receptor rearrangement in man.