Η ολοσωματική ακτινοβόληση με δέσμες ηλεκτρονίων (total skin electron beam treatment-TSEB) θεωρείται διεθνώς ως η θεραπεία εκλογής για το δερματικό λέμφωμα κυττάρων-Τ, είτε σαν θεραπευτική είτε σαν παρηγορητική αγωγή. Σκοπός της είναι να κατανείμει την συνολική δόση σε όλο το δέρμα του ασθενούς χωρίς να επιβαρύνει τα όργανα κάτω από αυτό. Αυτή η ανάγκη για επιφανειακή ακτινοβόληση καθιστά τα ηλεκτρόνια ως την κατάλληλη κλινική δέσμη. Στη μονάδα ακτινοθεραπείας του Π.Γ.Ν. «Αττικόν», μετά από διάφορες μετρήσεις και δοκιμές τεχνικών TSEB (Παράρτημα), επιλέχθηκε ως θέση θεραπείας του ασθενούς η όρθια με δύο δέσμες υπό γωνία, όπως καθορίζει και η τεχνική “Stanford”. Για την τεχνική αυτή χρησιμοποιείται o γραμμικός επιταχυντής Clinac 2100C της VARIAN με δυνατότητα παραγωγής δεσμών ηλεκτρονίων 6 MeV σε υψηλό ρυθμό δόσης. Η συγκεκριμένη προεπιλογή του μηχανήματος επιτρέπει στα διαφράγματα να ανοίξουν σε ένα εύρος 36cm x 36cm χωρίς τη χρήση κώνου. H απόσταση πηγής-δέρματος (SSD) τέθηκε ίση με 380cm, με το gantry του γραμμικού να σχηματίζει δύο γωνίες ±17,5ο από την οριζόντια θέση του (270ο). Η διάταξη αυτή εξασφαλίζει την δημιουργία ενός μεγάλου και ομοιογενούς πεδίου (200cm x 80cm στην απόσταση θεραπείας). Για τη μείωση της ονομαστικής ενέργειας της δέσμης στα 3 MeV άρα και της διεισδυτικότητάς της, καθώς και για την επίτευξη των επιθυμητών διαστάσεων του πεδίου, ένα φύλλο plexiglas (PMMA) πάχους 0,5cm παρεμβάλλεται μεταξύ της κεφαλής του γραμμικού επιταχυντή και του ασθενούς σε απόσταση 30cm από το επίπεδο θεραπείας. Ο ασθενής περιστρέφεται ανά 60ο διαδοχικά για να καλυφθεί όλη του η επιφάνεια ομοιόμορφα, ακτινοβολούμενος συνολικά σε έξι θέσεις. Για τον ακριβή καθορισμό των συνθηκών θεραπείας, πραγματοποιήθηκαν μετρήσεις PDD και Profile των δεσμών με θαλάμους ιονισμού παραλλήλων πλακών σε phantom στερεάς κατάστασης. )οσιμετρική επιβεβαίωση της κατανομής της δόσης στο δέρμα πραγματοποιήθηκε με δοσίμετρα θερμοφωταύγειας (TLD) πάνω σε ανθρωπομορφικό phantom. Τα αποτελέσματα σε αυτές τις συνθήκες έδειξαν μια ομοιογένεια του συνολικού πεδίου στο επίπεδο θεραπείας της τάξης του ± 2% στον διαμήκη άξονα ενώ στον οριζόντιο ±5%. Το βάθος zmax της κάθε επιμέρους δέσμης είναι 0,7gr/cm2 ενώ η συνεισφορά των παραγόμενων ακτίνων-Χ (λόγω φαινομένου πεδήσεως) στην συνολική δόση που παίρνει ο ασθενής από τη θεραπεία είναι 0,3 %. Η ενέργεια της δέσμης στο επίπεδο θεραπείας είναι Εο=3,34 MeV. Τα παραπάνω αποτελέσματα μας οδηγούν στο συμπέρασμα ότι η θεραπεία TSEB μπορεί να εφαρμοστεί με ασφάλεια στο ακτινοθεραπευτικό τμήμα του Π.Γ.Ν «Αττικόν». Ο υψηλός ρυθμός δόσης εξασφαλίζει μικρότερο χρόνο θεραπείας. Οι περιοχές που υποδοσιάζονται καθ’ όλη τη διάρκεια της θεραπείας μπορούν να προσδιοριστούν για κάθε ασθενή με in vivo δοσιμετρία (TLD) και θα επανακτινοβολούνται με συμπληρωματικά (boost) πεδία. / -

Durant les dernières décennies, de plus en plus de types de cellules se sont révélées capables de sonder leur environnement mécanique par l'application de forces. Ce phénomène appelé «Mecanosensing» est lié à l'adhésion et la mécanique cellulaire, et est souvent étudié grâce à l'interaction des cellules avec des substrats artificiels. Dans des études distinctes, des surfaces chimiquement structurées avec une répartition des ligands spécifiques ont montré une forte influence sur l’adhésion et la mécanique cellulaire. Cependant, la relation entre les deux phénomènes n'a pas été beaucoup explorée, en partie parce que la fonctionnalisation de substrats mous s’est révélée être un défi technique.Pour résoudre ce problème, nous avons développé une technique simple et rentable nommée «reverse contact printing», afin de fabriquer des plots de protéines sub-microniques sur un élastomère d'élasticité contrôlée, le polydiméthylsiloxane (PDMS). Mon travail de thèse a focalisé sur la standardisation et la compréhension du procédé de transfert. A l’aide de mesures de forces réalisées par AFM nous avons mesuré l’élasticité du PDMS, ainsi que les forces de cohésion et d'adhésion effectives impliquées dans le processus. Nous avons également étudié l'adhésion cellulaire avec des lymphocytes-T sur des surfaces de PDMS d'élasticité variable. Nous avons montré que contrairement à la plupart des autres types de cellules, les cellules-T s'étalent davantage sur substrat mou que sur dur. Finalement nous avons réalisé des expériences pilotes d'adhésion cellulaire sur PDMS structuré. / In the past decade, more and more types of cells have been shown to be capable of probing the mechanics of their environment by application of forces. The stiffness of the environment strongly influences a host of cellular parameters including cell adhesion and mechanics. In separate studies, the spatial distribution of ligands, modulated by chemical patterning of a target surface, has been shown to strongly influence cell adhesion and mechanics. However, the cross-talk between the two phenomena has not been much explored, partly because patterned functionalization of soft substrates is an engineering challenge. To address this issue, we have developed a simple and technique named "reverse contact printing" for fabrication of nanometric protein patches on PDMS (polydimethylsiloxane) elastomer. My PhD work consisted of deciphering the molecular mechanisms that underlie this technique. We realized that the rate of transfer crucially depended on the molecular groups on the protein and on the nature of the PDMS surface. We used atomic force microscopy (AFM) force measurements to measure PDMS elasticity as well as protein-substrate interactions to understand the molecular mechanism governing the transfer. We have identified that a successful reverse transfer is facilitated by the grafting of appropriate chemical groups on the protein, and depends on the PDMS surface treatment and elasticity. We also studied adhesion and mechanics of T lymphocytes on PDMS. We found that surprisingly T lymphocytes spread more on softer than on harder PDMS. In on-going pilot experiments, cells on patterned soft PDMS seem to exhibit different behavior as compared to cells on patterned glass.

Les cellules souches hématopoïétiques (CSH) assurent la génération de toutes les lignées sanguines. Leur différenciation en cellules T matures se déroule dans un microenvironnement spécialisé, le thymus, orchestrée par des interactions complexes entre cytokines, chimiokines et cellules stromales. Les mutations bloquant la différenciation des cellules T ont un impact sur l'architecture du thymus, soulignant l’importance des interactions entre cellules T en développement et cellules stromales thymiques.Les déficits immunitaires combinés sévères sont généralement traités, avec succès, par transplantation de CSH allogénique par voie intraveineuse. Cependant, des complications peuvent survenir notamment en cas de greffe non compatible. Pour pallier à cela, la thérapie génique a été développée mais son efficacité et son innocuité restent à améliorer. Dans ce but, notre groupe a développé une approche par correction génique des progéniteurs T directement in vivo, via un vecteur lentiviral. Bien qu’efficace, là encore, l’efficacité de traitement reste insuffisante voire extrêmement limitée chez les macaques.Lors de ma thèse, j'ai donc évalué le potentiel de différents sérotypes de vecteur viraux adéno-associés (AAV) pour la transduction des thymocytes. L'administration IT de plusieurs sérotypes de AAV2 engendre une transduction des thymocytes >10 fois plus élevée que celle des vecteurs lentiviraux. Le sérotype AAV2/8 induit la transduction des thymocytes la plus efficace et les cellules transduites représentent jusqu'à 1% des cellules T périphériques d’une souris immunocompétente. En utilisant des souris immunodéficientes ZAP-70-/- comme paradigme, j'ai découvert que l'injection IT de l’AAV2/8-ZAP-70 entraîne une transduction et différentiation lymphocytaire T rapide, associée à la génération d’une medulla thymique. En effet, des cellules épithéliales thymiques de la médulla (mTEC) exprimant le régulateur auto-immun AIRE sont détectées en <2 semaines. Bien que cette reconstitution soit transitoire, les mTECs AIRE+ diminuant 10 semaines post-injection, les cellules T périphériques corrigées persistent >40 semaines et présentent environ 1 copie du vecteur AAV/cellule. Ces cellules T effectrices peuvent sécréter des niveaux élevés de cytokines et un nombre important de cellules T régulatrices est également généré. Ainsi, une seule vague de thymopoïèse à partir de progéniteurs transduits par l’AAV-ZAP-70, permet une restauration, rapide et transitoire de l'architecture thymique mais, à long terme de cellules T périphériques fonctionnelles.Pour évaluer les diverses populations de TEC régissant le développement et la sélection des cellules T, j'ai collaboré avec les groupes de P Jay/J Abramson/I Amit pour établir une cartographie de novo du compartiment stromal thymique. Nos analyses ont mis en évidence quatre populations majeures de mTEC (I-IV) avec des fonctions distinctes. Notamment, les mTEC-IV constituent une population unique présentant des similarités moléculaires et morphologiques avec les cellules tuft intestinales. Comme nous avions précédemment identifié la sécrétion d'IL-25 par les cellules tufts comme un régulateur des interactions entre compartiment épithélial et hématopoïétique dans l'intestin, nous avons évalué ce potentiel dans le thymus. Ainsi, des souris déficientes en cellules tuft intestinales présentent également une déficience spécifique en mTEC-IV et une homéostasie perturbée de diverses populations exprimant l'IL-25R dans le thymus. Notre recherche a donc permis d'identifier une nouvelle population de TEC tuft avec un rôle critique dans la formation de la niche immunitaire du thymus.L’ensemble de mes résultats montrent le potentiel thérapeutique de stratégie intrathymique de thérapie génique pour des patients ayant besoin d’une reconstitution rapide en cellules T et fournissent de nouvelles perspectives sur les populations stromales thymique et leur rôle dans l’équilibre de la niche immunitaire. / Hematopoietic stem cells (HSC) ensure the generation of all blood lineages. Their differentiation to mature T lymphocytes occurs in the specialized microenvironment of the thymus, orchestrated by complex interactions between cytokines, chemokines, and stromal cells. Mutations resulting in a block in T cell differentiation impact on the architecture of the thymus, pointing to the critical crosstalk between developing T cells and thymic stromal components.Genetic severe combined immunodeficiencies (SCID) are generally treated by the intravenous transplantation of healthy allogeneic HSCs. Although this therapy is often successful, complications can occur, especially for patients receiving non-histocompatible HSC transplants. To circumvent these problems , significant efforts have gone into developing gene therapy strategies but adverse events indicate the necessity of exploring other avenues. Our group hypothesized that in situ gene correction of T lymphoid progenitors in the thymus itself may overcome some of the drawbacks of ex vivo gene therapy. While intrathymic (IT) lentiviral vector administration corrected immunodeficient thymocyte precursors in mice, thymus transduction was inefficient and efficacy in macaques was limited.During my PhD, I assessed the in vivo potential of adeno-associated vectors (AAV) to transduce thymocyte precursors. Intrathymic administration of several different scAAV2 serotypes resulted in a >10-fold higher transduction of thymocytes (3-5%) as compared to lentiviral vectors. scAAV2/8 promoted the highest level of gene transfer and strikingly, transduced cells represented up to 1% of peripheral T lymphocytes in immunocompetent mice. Using ZAP-70-/- immunodeficient mice as a paradigm, I found that IT injection of an AAV2/8-ZAP-70 vector resulted in a rapid transduction and T cell differentiation, correlating with a dramatic generation of the thymus medulla. Indeed, medullary thymic epithelial cells (mTEC) expressing the AIRE autoimmune regulator were detected within <2 weeks. While this reconstitution was transient––AIRE+ mTECs decreased by 10 weeks post gene transfer––gene-corrected peripheral T cells, harboring approximately 1 AAV genome/ cell, persisted for >40 weeks. Effector T cells had the potential to secrete high levels of cytokines and significant numbers of gene-corrected regulatory T cells were also generated. Thus, a single wave of thymopoiesis, from intrathymic AAV-ZAP-70-transduced progenitors, allows for a rapid but transient restoration of the thymic architecture and long-term peripheral T cell function.To better assess the diverse TEC populations that orchestrate T cell development and selection, I collaborated with the groups of P. Jay/J. Abramson/I. Amit to combine single cell analysis and in-vivo fate-mapping to de novo characterize the entire stromal compartment of the thymus. Our analyses highlighted four major medullary TEC (mTEC I-IV) populations with distinct lineage regulator function and specifically, we found that mTEC-IV constitutes a highly divergent TEC subset that bears strong molecular and morphological characteristics to intestinal tuft cells. As we previously identified tuft cell secretion of IL-25 as a regulator of the crosstalk between the epithelial and hematopoietic compartments in the gut, we assessed the potential immune-modulatory function of mTEC-IV. Notably, mice deficient in intestinal tuft cells exhibited a specific depletion of mTEC-IV and a perturbed homeostasis of various IL25-R-expressing populations in the thymus. Taken together, our data identify a new tuft TEC population critical for shaping the thymus immune niche.In conclusion, the data generated during my PhD advance the therapeutic potential of intrathymic-based vector strategies for the treatment of patients requiring a rapid T cell reconstitution and provide new insights into thymic stromal subsets that are critical for shaping the thymus immune niche.

Nous avons généré une lignée de souris, R26-βcat, qui exprime une forme stable de la β-caténine dans les cellules T. Les souris R26-βcat présentent un blocage de la différenciation des cellules T aux stades DP du à leur résistance accrue à l’apoptose. De façon intéressante, les souris R26-βcat développent des leucémies T indépendantes de la voie Notch. Nous avons montré que la perte du suppresseur de tumeur Pten et la sur-expression de Myc sont favorisées dans ces leucémies et constituent peut être des événements secondaires contribuant à cette leucémogénése. Nous avons également mis en évidence que les tumeurs R26-βcat sont malignes, hétérogènes et que les cellules souches leucémiques (CSL) sont enrichies dans la fraction DP. De surcroît, l’auto-renouvellement des CSL R26-βcat est affaibli. Nous proposons que le modèle R26-βcat définie un nouveau sous-groupe de leucémie aiguë lymphoblastique T et que la β-catenine pourrait constituer une cible potentielle pour traiter ces leucémies. / We report a murine model, R26-βcat, expressing a stable form of β-catenin in T cells. R26-βcat pre-leukemic mice show a developmental block in T-cell differentiation and exhibit increased resistance to apoptosis. Interestingly, the mice develop T cell lymphomas independent of the Notch pathway. Furthermore, we showed that loss of the tumour suppressor Pten and over-expression of Myc was favoured; and may constitute the secondary events contributing to this leukemogenesis. We also demonstrated that R26-βcat tumours are malignant, heterogeneous and that leukaemia stem cells (LSC) were enriched in DP cells. Furthermore, the self-renewal capapcity of R26-βcat LSCs can to be exhausted.We propose that the R26-βcat model defines a new sub-group of Notch-independent T-ALL and the β-catenin may serve as a potential therapeutic target for these tumours.

Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2017-09-22T15:04:46Z No. of bitstreams: 1 DISS_2014_Samantha Soares Ourives.pdf: 1603897 bytes, checksum: 16aacb8659dc1e9902e5038014c2c0ac (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-26T14:26:40Z (GMT) No. of bitstreams: 1 DISS_2014_Samantha Soares Ourives.pdf: 1603897 bytes, checksum: 16aacb8659dc1e9902e5038014c2c0ac (MD5) / Made available in DSpace on 2017-09-26T14:26:40Z (GMT). No. of bitstreams: 1 DISS_2014_Samantha Soares Ourives.pdf: 1603897 bytes, checksum: 16aacb8659dc1e9902e5038014c2c0ac (MD5) Previous issue date: 2014-04-25 / CNPq / A malária é uma das doenças parasitárias de maior importância global e é responsável pelas principais causas de morbidade e mortalidade nas áreas tropicais e subtropicais do mundo. Apesar dos esforços para o controle da infecção em diferentes áreas endêmicas, a malária continua em expansão, e as medidas tradicionais de controle da transmissão são pouco eficazes. A resposta imune na malária é complexa, e os mecanismos de ativação e regulação de linfócitos T e suas citocinas ainda são pouco compreendidos. O objetivo deste trabalho foi avaliar a correlação da parasitemia com o número de plaquetas e leucócitos, e identificar e quantificar as subpopulações específicas de células Th1, Th2, Th17 e Treg, durante a infecção por P. vivax. Avaliando a parasitemia e o número de plaquetas, foi verificado que existe correlação negativa (p<0,0005) entre esses parâmetros e que, dependendo da quantidade de parasitas, os pacientes com malária vivax apresentavam um maior grau de plaquetopenia (p<0,0001). Avaliando o número de parasitas e de leucócitos totais, foi verificada ausência de correlação entre esses parâmetros em pacientes com malária vivax. Além disso, também não foi detectada alteração no número de leucócitos totais quando comparado aos controles sadios. Posteriormente, foi realizada, por meio de citometria de fluxo, a identificação e quantificação das subpopulações de células T: Th1 (CD3+CD4+IFN-γ+), Th2 (CD3+CD4+IL4+), Th17 (CD3+CD4+IL-17+), Treg (CD4+CD25+CD127-) e citotóxica (CD3+CD8+), em pacientes com malária vivax e em controles sadios após cultura de linfócitos previamente isolados do sangue periférico, para verificar a alteração do número dessas subpopulações de linfócitos pela infecção por P. vivax. O percentual da citocina IL-10 também foi avaliado nas células Treg (CD4+CD25+CD127-IL-10+). Os indivíduos infectados por P. vivax apresentaram percentual de células T citotóxica e Th1 aumentadas. Já o percentual de células Th2, Th17 e Tregs não apresentaram diferenças entre os grupos. Porém, o percentual de células Treg que produziam a citocina IL-10 estava aumentado em pacientes com malária vivax, quando comparado aos controles sadios. Finalmente, a avaliação do número de células T CD4+ e T CD8+, indicou que não houve diferenças entre a proporção desses linfócitos em controles sadios e nem durante o processo infeccioso induzido por P. vivax. Em conclusão, pacientes com malária vivax apresentam um aumento no número de células T citotóxicas, Th1 e de células Treg (CD4+CD25+CD127-) produtoras de interleucina-10, indicando que a infecção por P. vivax ativa células específicas que podem participar na imunorregulação contra esse parasita. / Malaria is a parasitic disease of major global importance and is responsible for leading causes of morbidity and mortality in tropical and subtropical areas of the world. Despite efforts to control the infection in different endemic areas, malaria continues to expand, and the traditional transmission control measures are ineffective. The immune response in malaria is complex, and the mechanisms of activation and regulation of T lymphocytes and their cytokines are still poorly understood. The objective of this study was to evaluate the correlation of parasitemia with the number of platelets and leukocytes, and identify and quantify specific subpopulations of Th1, Th2, Th17 and Treg cells in infection by P. vivax. Evaluating the parasitemia and the number of platelets was verified that there is a negative correlation (p<0,0005) between these parameters and that, dependent of the number of parasites, vivax malaria patients showed higher degree of thrombocytopenia (p<0,0001). Evaluating the number of parasites and total leukocytes was observed no correlation between these parameters in patients with vivax malaria. Moreover, it was also not detected change in the number of total leukocytes when compared to healthy controls. Subsequently, was performed by flow cytometry, identification and quantification of T cell subsets: Th1 (CD3+CD4+IFN-γ+), Th2 (CD3+CD4+IL4+), Th17 (CD3+CD4+IL-17+), Treg (CD4+CD25+CD127-) and cytotoxic (CD3+CD8+) in patients with vivax malaria and healthy controls after lymphocyte culture previously isolated from peripheral blood, to verify the change in the number of these subpopulations lymphocytes by infection with P. vivax. The percentage of IL-10 was also evaluated on Treg cells (CD4+CD25+CD127+IL-10). Individuals infected with P. vivax showed increased percentage of Th1 and cytotoxic T cells. The percentage of Th2, Th17 and Treg cells did not differ between groups. However, the percentage of Treg cells that produce IL-10 cytokine was increased in patients with vivax malaria compared to healthy controls. Finally, the evaluation of the number of CD4+ T and CD8+ T cells indicated that there were no differences between the proportion of these lymphocytes in healthy controls or during the infectious process induced by P. vivax. In conclusion, vivax malaria patients show an increase in the number of cytotoxic T cell, Th1 and Treg cells (CD4+CD25+CD127-) producers of interleukin-10, indicating that infection with P. vivax activate specific cells which can participate in the immunoregulation against this parasite.

Orientador: Maria Terezinha Serrão Peraçoli / Resumo: Introdução: A pré-eclâmpsia (PE) é uma patologia obstétrica e uma das principais causas de morbimortalidade materna e fetal. Na PE ocorre um estado de má adaptação da tolerância imunológica, caracterizada por ativação anormal do sistema imune inato e adaptativo. As células T reguladoras (Treg) representam uma população de linfócitos T responsáveis pela manutenção da tolerância e controle da inflamação, enquanto células Th17 medeiam diferentes tipos de reações inflamatórias. Portanto, o balanço entre células Treg e Th17 pode ser crítico para a tolerância ao feto e prevenção da PE. Objetivo: Avaliar as subpopulações de células T CD4+ (Th1, Th2, Th17 e Treg) e o perfil de citocinas produzido por essas células, em gestantes portadoras de pré-eclâmpsia, classificadas em PE precoce e PE tardia. Métodos: Foram estudadas 60 gestantes, sendo 20 normotensas e 40 portadoras de PE, pareadas pela idade gestacional. As gestantes com PE foram classificadas de acordo com o aparecimento das manifestações clínicas em PE precoce (< 34 semanas de gestação; n=20) e PE tardia (≥ 34 semanas de gestação; n=20). Células mononucleares do sangue periférico (PBMCs), obtidas das gestantes foram avaliadas quanto à produção de citocinas pró e anti-inflamatórias e à expressão de fatores de transcrição envolvidos na caracterização das subpopulações de células T CD4+. A expressão dos fatores de transcrição intracitoplasmáticos de células Th1 (T-bet), Th2 (GATA-3), Th17 (RORc) e Treg (FoxP3) foi avaliada por c... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

O Vírus Linfotrópico de Células T Humanas do tipo 2 (HTLV-2) é considerado pouco patogênico, mas o diagnóstico sorológico é importante para aconselhamento e acompanhamento. Os testes confirmatórios mais utilizados são o Western-Blot (WB) e a reação em cadeia de polimerase (PCR). Entretanto, em populações de alto risco como usuários de drogas intravenosas e a população indígena, cerca de 50% dos resultados indeterminados pelo WB resultaram como positivos para a infecção do HTLV-2, quando testadas pela PCR. Uma hipótese para a insensibilidade do teste WB utilizado no Brasil seria pelo uso de proteínas recombinantes procedentes de cepas que não circulam em nosso país. Outra possibilidade é o nível de imunossupressão, que pode acarretar uma menor produção de anticorpos anti-HTLV-2 circulantes. A carga proviral do HTLV-2 pode ser também um fator da pouca estimulação do sistema imune, o que resulta baixa quantidade de anticorpos circulantes. Este estudo testou três hipóteses e os resultados mostraram uma alta homologia na região do envelope viral quando alinhada com a seqüência de aminoácidos da proteína K55 utilizada no WB, independente do perfil do teste. A carga proviral do HTLV-2, assim como o estado de imunessupressão dos pacientes não foi importante para perfis indeterminados do Western-Blot. / Despite the human T-cell lymphotropic virus type 2 (HTLV-2) is considered low pathogenic, the serological diagnosis is important for counseling and monitoring. The most used confirmatory tests are Western Blot (WB) and PCR. However, in high-risk populations, about 50% of the indeterminate WB results when tested by PCR, in our study, confirmed the presence of HTLV-2. A hypothesis for the insensitivity of the WB used in Brazil would be the use of recombinant proteins from strains that do not circulate in our country. Another possibility is the level of immunosuppression, which may lead to lower production of anti-HTLV-2 circulating. The viral load of HTLV-2 can also be a factor of little stimulation of the immune system, resulting low amount of antibodies. This study tested the three hypothesis and we showed that high homology in the region of immunogenic viral envelope when aligned with the sequence of amino acids of the protein K55 (HTLV-2) of WB kit, the proviral load and immunessupression state were not important for inconclusive WB profiles.

Nas últimas décadas, verificou-se diferenças nas classificações da World Health Organization (WHO) de 2001 e da European Organization for Research and Treatment of Cancer (EORTC) de 1997 para os linfomas cutâneos primários. Em 2005, representantes dessas classificações se reuniram e em consenso estabeleceram a classificação WHO-EORTC que foi adotada pela última classificação da WHO de 2008. O presente estudo visa a avaliar a aplicabilidade dessa nova classificação em casuística retrospectiva de um único centro de referência no diagnóstico e tratamento de linfomas cutâneos. Assim, todos os casos de linfoma cutâneo de células T, excluindo-se micose fungóide (MF) e síndrome de Sézary (SS), no período de 1986 a 2009, foram analisados em relação aos aspectos clínicos, histopatológicos e imunofenotípicos, incluindo-se a realização de novas reações imunoistoquímicas. Os casos foram, então, classificados de acordo com critérios estabelecidos na classificação WHO de 2008. Houve, assim, 33 casos de linfomas cutâneos de células T não-MF e não-SS, sendo 08 (24,2%) de linfoma cutâneo de grandes células anaplásicas, 05 (15,2%) de papulose linfomatóide, 06 (18,1%) de linfoma extranodal de células NK/T tipo nasal, 05 (15,2%) de neoplasia de células dendríticas plasmocitóides blásticas, 05 (15,2%) de linfoma/leucemia de células T do adulto e 04 (12,1%) de linfoma de células T periféricas, sem outra especificação. Portanto, a classificação WHO de 2008 é aplicável à maioria dos casos de linfoma cutâneo de células T não-MF e não-SS. Entretanto, permanecem casos não classificáveis, alguns dos quais com curso clínico agressivo / Recent years have witnessed differences between the World Health Organization (WHO) 2001 and the European Organization for Research and Treatment of Cancer (EORTC) 1997 classification systems of primary cutaneous lymphomas (PCLs). In 2005, a joint WHO-EORTC classification system for PCLs has been reached and was adopted by last WHO 2008 classification. This study was performed to assess the applicability of this new classification to a single referral center. All cutaneous T-cell lymphoma (CTCL) cases, excluding mycosis fungoides (MF) and Sezary syndrome (SS), who were referred from 1986 to 2009 were included. The clinical features, histological and immunohistochemical stainings were reviewed, and additional stains were performed as needed. The cases were then reclassified according to the WHO 2008 classification. There were 33 cases of non-MF and non-SS CTCL, included 08 (24.2%) CD30+ anaplastic large-cell lymphomas, 05 (15.2%) cases of lymphomatoid papulosis, 06 (18.1%) extranodal NK/T-cell lymphoma nasal type, 05 (15.2%) blastic plasmacytoid dendritic cell neoplasm, 05 (15.2%) adult T-cell lymphoma/leukemia and 04 (12.1%) peripheral T-cell lymphomas, unspecified. The new WHO 2008 classification is applicable to most nonMF and non-SS CTCL cases. However, there is still a substantial subset of T-cell PCLs which cannot be classified beyond the unspecified peripheral T-cell category, some of which may have an aggressive course

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-03-10T13:11:37Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese Rafael de Freitas e Silva.pdf: 13510018 bytes, checksum: 080b7ee10e7a8be555cb7a7ca29c10fb (MD5) / Made available in DSpace on 2017-03-10T13:11:37Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese Rafael de Freitas e Silva.pdf: 13510018 bytes, checksum: 080b7ee10e7a8be555cb7a7ca29c10fb (MD5) Previous issue date: 2016-09-06 / As leishmanioses são doenças causadas por protozoários do gênero Leishmania e estão presentes em 98 países e territórios e possuem incidência anual de 2 milhões de casos. A Leishmania (Viannia) braziliensis (L.V. braziliensis) é uma das principais espécies causadoras da leishmaniose cutânea (LC) no Brasil. Apesar disso, ainda não há uma vacina segura e eficaz para ser utilizada em seres humanos. Nesse sentido, o objetivo deste trabalho foi identificar no proteoma predito de L.V. braziliensis, potenciais epítopos de linfócitos T e avaliá-los por meio de ensaios imunológicos. No primeiro capítulo, o proteoma predito de L. braziliensis foi comparado ao de outras espécies e analisado quanto a presença de epítopos. Nessa etapa foram encontrados epítopos derivados de mais de 8 mil proteínas conservadas entre diferentes espécies de Leishmania. Os epítopos foram clusterizados e então utilizados para etapa de docagem molecular com estruturas de MHC I e MHC II depositadas no Protein Data Bank. A docagem molecular resultou em epítopos peptídicos de 15 aminoácidos com alta afinidade de ligação às moléculas de MHC I e MHC II. Os 10 melhores resultados foram então sintetizados e avaliados, in vitro, quanto à capacidade de estimular a proliferação de células mononucleares do sangue periférico (PBMC) de indivíduos com LC após o tratamento (PT). Os resultados indicaram que 50% das moléculas testadas apresentaram capacidade de estimular, significativamente (p<0,05), a proliferação celular quando comparado às células de indivíduos saudáveis que não vivem em região endêmica para LC. No segundo capítulo, os peptídeos foram avaliados quanto à capacidade de estimular a proliferação de PBMC de indivíduos com LC em sua fase ativa (AD) e indivíduos moradores de área endêmica para LC resistentes à infecção (RT). Em paralelo, quantificou-se a expressão do fator de transcrição T-bet em PBMC de indivíduos PT, e citocinas dos perfis Th1, Th2 e Th17 foram mensuradas no sobrenadante de cultura das células de indivíduos PT e AD. Os resultados demonstraram altos níveis de proliferação nas células do grupo RT para todos os peptídeos testados. Além disso, níveis significativos de Tbet foram observados em linfócitos T CD4+ e CD8+ após estímulo com seis peptídeos. Níveis significativos de IFN-γ, TNF e IL-6 foram observados no sobrenadante das células do grupo PT com quatro dos peptídeos testados. Altos níveis dessas citocinas também foram encontrados no sobrenadante do grupo AD. No terceiro capítulo, avaliou-se o efeito dos peptídeos sobre células dendríticas de medula (BMDC) murinas, produção de citocinas de sobrenadante, e células dendríticas esplênicas murinas após estímulo com os peptídeos. Verificou-se altos níveis de MHC II e CD40 em uma subpopulação de BMDC estimuladas com as moléculas e altos níves de TNF e IL-6 após 48h de estímulo. Para as células esplênicas, foram observados altos níveis de subpopulações celulares expressando CD11b+, IL-12p70+, CD205+ e CD11b+ após estímulo com o peptídeo que teve o melhor resultado in silico. Por fim, os resultados indicam o grande potencial imunogênico que os epítopos identificados apresentam, o que dá suporte ao desenvolvimento futuro de abordagens vacinais. / The leishmaniasis are diseases caused by protozoans from the genus Leishmania which are present in 98 countries and territories, with an annual incidence of 2 million cases. Among the other species, Leishmania (Viannia) braziliensis is the main specie implicated with cutaneous leishmaniasis (CL) in Brazil. Besides that, there is no safe and effective vaccine against leishmaniasis to be applied in humans. In this context, the aim of this work was to identify in the predicted proteome of L. braziliensis potential CD4+ and CD8+ T cell epitopes and evaluate them by immunological assays. In the first chapter, the predicted proteome of L. braziliensis was compared with other species and analyzed for the presence of epitopes. In this step, epitopes from more than 8,000 conserved proteins were found among other species of Leishmania. The epitopes were clustered and then used for the molecular docking with MHC I and MHC II structures deposited in the Protein Data Bank. This approach resulted in 15 aminoacids peptide epitopes with high binding affinity for MHC I and MHC II. The 10 best results were synthesized and evaluated in vitro for their capacity to stimulate the proliferation of peripheral blood mononuclear cells (PBMC) of individuals with CL post treatment (PT). The results have shown that 50% of the tested molecules had the capacity to stimulate, significantly (p<0.05), cell proliferation when compared with cells of healthy individuals living in non-endemic regions. For the second chapter, the peptides were evaluated for their capacity to stimulate the proliferation of PBMC from CL individuals with active disease (AD) and of individuals resistant to infection (RT) living in endemic region. In parallel, the T-bet transcription factor expression was quantified in PBMC of PT individuals, and cytokines from the Th1, Th2 and Th17 profiles were measured in culture supernatant of PT and AD groups. High levels of cell proliferation in the RT group were demonstrated for all peptides tested. Moreover, significant levels of T-bet in CD4+ and CD8+ T cells were verified after stimulation with six peptides. For IFN-γ, TNF and IL-6, significant levels were detected in the supernatant of cultures from the PT group with four peptides tested. High levels of these same cytokines were also present in the supernatant of AD group. In the third chapter, the peptide effects over murine bone marrow dendritic cells (BMDC), the production of cytokines in the supernatant and murine spleen dendritic cell subsets were evaluated after peptide stimuli. High levels of MHC II and CD40 were verified for stimulated BMDC and high levels of TNF and IL-6 after 48h of stimuli. For spleen cells, high levels of cells expressing CD11b+, IL-12p70+, CD205+ e CD11b+ were observed after stimulation with the peptide which showed the best in silico result. In conclusion, the results indicate the great immunogenic potential of the identified peptides and support the further development of vaccine approaches using those molecules.

Orientador: José Andres Yunes / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-21T05:50:44Z (GMT). No. of bitstreams: 1 Jotta_PatriciaYoshioka_D.pdf: 8922035 bytes, checksum: 3734371a320410ba431d6e6ce6579e55 (MD5) Previous issue date: 2012 / Resumo: A leucemia linfóide aguda (LLA) é o câncer mais frequente na infância, e destas, 15% são do tipo T (LLA-T). A hiperativação da via PI3K/Akt tem sido amplamente descrita em tumores e em linhagens celulares de LLA-T. PTEN é o principal regulador negativo dessa via e frequentemente encontra-se inativado em cânceres humanos. Com frequência, pacientes com LLA-T apresentam mutações ativadoras de NOTCH1. NOTCH1 pode regular transcricionalmente PTEN, contudo ainda não está claro como as mutações ativadoras de NOTCH1 influenciariam a expressão de PTEN nas LLA-T. Nós encontramos uma ocorrência de 11 (17,7%) mutações no éxon 7 do PTEN em 62 casos de LLA-T estudados consecutivamente. Contudo, nenhuma mutação foi encontrada na análise de 71 casos de LLA-B derivada. A maioria das mutações de PTEN apresentavam inserções/deleções de mais de 3 nucleotídeos. Não encontramos associação entre mutações em PTEN e o gênero, a idade e a contagem de glóbulos brancos ao diagnóstico. Pacientes com alterações no PTEN apresentaram uma tendência a pior sobrevida global (OS, p=0.07). Dentre os pacientes de LLA-T classificados como alto risco (n=56), aqueles possuindo anormalidades no PTEN mostraram-se associados significativamente a menor OS (p=0.019) e sobrevida livre de leucemia (LFS 47% vs 76%; p=0.045). As curvas de LFS foram significativamente diferentes (p=0.003), mesmo considerando apenas pacientes que atingiram a remissão no dia 28 do tratamento para a análise. Nosso estudo também mostrou que pacientes com mutações em NOTCH1 apresentavam aumento na transcrição de MYC e menor expressão de PTEN mRNA comparados a pacientes com NOTCH1 selvagem. Nós recentemente demonstramos que células de LLA-T apresentavam fosforilação de PTEN mediada por CK2, resultando na estabilização e consequentemente inativação da proteína PTEN. Corroborando ao estudo anterior, os casos de LLA-T analisados, independente do status de mutação em NOTCH1, expressam níveis significativamente mais altos de proteína PTEN do que controles normais. Para avaliar o impacto da regulação transcricional de NOTCH e a inativação postranscricional por CK2 de PTEN, nós tratamos as células de LLA-T com inibidores de gamma-secretase (DAPT e de CK2 (DRB/TBB). Nosso estudo enfatiza a relevância biológica e clínica da regulação do PTEN em LLA-T. E sugerimos o uso combinado de inibidores de gamma-secretase e CK2 devem possuir potencial terapêutico nas LLA-T / Abstract: T-cell acute lymphoblastic leukemia (T-ALL) accounts for approximately 15% of pediatric ALL. Patients with T-ALL are at increased risk of relapse compared with children treated for B-cell precursor ALL. Mutations in the phosphatase and tensin homolog (PTEN) gene leading to PTEN protein deletion and subsequent activation of the PI3K/Akt signaling pathway are common in cancer. PTEN is the main negative regulator of the PI3K/Akt survival pathway. T-ALL patients frequently display NOTCH1 activating mutations and Notch can transcriptionally down-regulate the tumor suppressor PTEN. However, it is not clear whether NOTCH1 mutations associate with decreased PTEN expression in primary T-ALL. We report that PTEN exon 7 mutations occurred in 11 (17.7%) out of 62 consecutive pediatric T-cell acute lymphoblastic leukemia (T-ALL) but in none of 71 precursor B-ALL patients. Most PTEN mutations were insertions/deletions of more than 3 nucleotides. No associations were found between PTEN mutation and age, gender, WBC at diagnosis, early response to therapy and remission rate. Patients with PTEN mutation (n=11) had a tendency toward worse overall survival (OS, p=0.07). Remarkably, PTEN mutations were significantly associated with lower OS (p=0.019) and leukemia-free survival (LFS 47% vs 76%, p=0.045) within patients classified in the high risk group (n=56). LFS curves were significantly different (p=0.003) even if only patients who reached remission on day 28 were considered for analysis. We compared patients with or without NOTCH1mutations and report that the former presented higher MYC transcript levels and decreased PTEN mRNA expression. We recently showed that T-ALL cells frequently display CK2-mediated PTEN phosphorylation, resulting in PTEN protein stabilization and concomitant functional inactivation. Accordingly, the T-ALL samples analyzed, irrespectively of their NOTCH1 mutational status, expressed significantly higher PTEN protein levels than normal controls. To evaluate the integrated functional impact of NOTCH transcriptional and CK2 post-translational inactivation of PTEN, we treated TALL cells with both the gamma-secretase inhibitor DAPT and the CK2 inhibitors DRB/TBB. Our data suggest that combined use of gamma-secretase and CK2 inhibitors may have therapeutic potential in T-ALL. And emphasize the biological and clinical relevance of PTEN regulation in pediatric T-ALL / Doutorado / Genetica Animal e Evolução / Doutor em Genetica e Biologia Molecular