L’objectif prioritaire de ce travail était de provoquer un état de tolérance immunologique à des allogreffes cardiaques et cutanées chez des souris injectées avec des cellules souches hématopoïétiques (CSH) transduites avec le gène de l’interleukine 10. Un deuxième but était d’améliorer la survie des greffons cutanés en utilisant des cellules dendritiques immatures tolérogène. Le foie fœtal de souris contient en moyenne 2% de cellules souches capables de se différencier dans toutes les lignées hématolymphoïdes. De plus, leur relativement faible expression des antigènes du CMH fait d’elles un matériel biologique parfois susceptible de s’adapter à un environnement allogénique. L’IL-10 est une cytokine anti-inflamatoires. Produite par les lymphocytes Th2 principalement, elle inhibe la production de cytokines pro-inflamatoires telle l’IL-2. Elle empêche aussi la fonction de présentation des antigènes des CPA. Les cellules dendritiques (DC) dérivent de CSH, elles jouent un rôle central dans l’immunité et sont capables d’interagir avec les cellules du système immunitaire inné et adaptatif. Elles sont essentielles à la mise en place d’une réponse régulatrice ou tolérogène, ceci en fonction des informations fournies par le microenvironnement cellulaire. Les résultats montrent d’une part que les CSH fœtales, de souris C57 BL/6 transduites avec le gène de l’IL-10 et injectées plusieurs fois à des souris allogéniques (BALB/c), induisent une prolongation de survie du greffon cardiaque de même souche. Cette survie est de 86.25+13.8 jours versus 11.5+0.6 jours pour les groupes contrôles. Les DC tolérogènes (tol-DC) de souris DBA1 traitées avec le TNFα sont injectées à des souris allogéniques (BALB/c). Il en résulte une prolongation de survie du greffon cutané de même souche que les tol-DC : 15 jours vs 7.5 jours pour les contrôles. Seuls les animaux transplantés avec des tol-DC présentent un état de tolérance autorisant la prolongation de la survie de greffonsallogéniques / The main objective of this work was to induce a state of immunological tolerance to cardiac and skin allografts in mice injected with hematopoietic stem cells (HSCs) transduced with the gene for interleukin 10 (IL-10). A second goal was to improve the survival of skin grafts using immature dendritic cells well known for their tolerogenic function. Mouse fetal liver contains 2% of stem cells on average that can differentiate into all blood-lymphoid lineages. In addition, their relatively low antigen expression of major histocompatibility complex (MHC) makes them a biological material sometimes capable to adapt to an allogeneic environment. IL-10 is a cytokine with anti-inflammatory properties. Mainly produced by Th2 lymphocytes cells, IL-10 inhibits the production of pro-inflammatory cytokines such as IL-2. It prevents antigen presenting function of APCs. Dendritic cells (DC) derived from HSCs and play a central role in immunity. They are able to interact with cells of the innate and adaptive immune system. They are essential to the establishment of a regulatory or tolerogenic response, this based on the information provided by the cellular microenvironment. Results firstly show that fetal HSC of C57 BL/6 mice transduced with IL-10 gene and injected several times to allogeneic mice (BALB/c) sublethally irradiated induce a prolongation of heart transplant survival of the same strain. This survival is of 86.25+13.8 days in comparison with 11.5+0.6 days for control groups. Tolerogenic dendritic cells (tol-DC) of DBA1 mice treated with TNFα are injected into allogeneic mice (BALB/c) sublethally irradiated. This results in a prolongation of skin graft survival of same strain as tol-DC: 15 days compared to 7.5 days for the control groups. Only tol-DC transplanted animals have a tolerance state allowing prolonged survival of allogeneic skin grafts

A esclerose múltipla (EM) é uma doença autoimune desmielinizante progressiva imunomediada por linfócitos T auto-reativos, que provocam uma cascata imunológica, amplificando a inflamação local. No Diabetes mellitus tipo 1 (DM1), existem linfócitos T auto reativos destroem as células beta do pâncreas, causando deficiência na produção de insulina. O desenvolvimento de terapêuticas específicas fica limitado pela etiologia indefinida destas doenças, apesar de avanços na terapêutica antiinflamatória e imunossupressora. Uma alternativa de tratamento atual para tais doenças é o transplante autólogo de células tronco hematopoéticas (TACTH). O presente estudo, observacional do tipo transversal, com a coleta de dados de caráter retrospectivo, tem como objetivo identificar as reações adversas manifestadas pelos pacientes diabéticos ou de esclerose múltipla, submetidos ao TACTH no período de 2004 a dezembro de 2010. Para a coleta de dados elaborou-se dois instrumentos que foram submetidos à validação aparente e de conteúdo por três juízes. A amostra final do estudo foi constituída pela obtenção dos dados de 72 prontuários, sendo 23 de pacientes diabéticos e 49 de pacientes com EM. Em relação aos pacientes diabéticos 16 pertenciam ao sexo masculino e a idade média foi 18,26 anos. Todos possuíam positividade para o anticorpo anti-carboxilase do ácido glutâmico (antiGAD65). Quanto aos pacientes com EM, trinta e três pertenciam ao sexo feminino e idade média foi de 37,2 anos. O subtipo da doença mais frequente foi o surto-remissivo em 21 (42,9%) pacientes. A escala expandida do estado de incapacidade (EDSS) variou entre 3,0 e 6,5. Em relação às reações adversas manifestadas pelos pacientes diabéticos foram mais frequentes os calafrios, febre, cefaléia, náusea e vômito e nos pacientes com esclerose múltipla foram retenção hídrica e cefaléia. As principais intervenções de enfermagem identificadas para os pacientes diabéticos e com EM foram monitorização dos sinais vitais, coleta de hemocultura, otimização da administração de medicamentos antieméticos, controle da infusão da globulina antitimocitária, orientações sobre alimentação e para reduzir o risco de queda. Os pacientes com DM1 apresentam reações mais agudas e necessitam de monitorização contínua. Já os pacientes com EM são mais dependentes dos cuidados de enfermagem, exigindo maior tempo de cuidados prestados pelo profissional. Embora o DM1 e a EM sejam doenças distintas, percebe-se que na prática clínica, exigem do enfermeiro uma excelência no cuidado, quer pelas particularidades do tratamento realizado ou pelas singularidades de cada uma delas. / Multiple sclerosis (MS) is a progressive demyelinating autoimmune disease, immune- mediated by auto-reactive T lymphocytes, which provoke an immunological cascade, enhancing the local inflammation. In type 1 diabetes mellitus (DM1), self-reactive T lymphocytes exist that destroy ? cells in the pancreas, causing insulin production deficiency. The development of specific therapeutics is limited by these diseases\' undefined etiology, despite advances in anti-inflammatory and immunosuppressive therapy. A current treatment alternative for these diseases is autologous hematopoietic stem cell transplantations (AHSCT). The aim of this observational and cross-sectional study with retrospective data collection is to identify the adverse reactions manifested by diabetic or MS patients who were submitted to AHSCT between 2004 and December 2010. For data collection, two instruments were elaborated, submitted to face and content validation with the help of three experts. The final study sample comprised data from 72 patient files, 23 from diabetic and 49 from MS patients. As for the diabetic patients, 16 were male and the mean age was 18.26 years. All were positive for the anti-glutamic acid decarboxylase (antiGAD65) antibody. Concerning MS patients, 33 were female and the mean age was 37.2 years. The most frequent disease subtype was relapsing-remitting in 21 (42.9%) patients. The expanded disability status scale (EDSS) score ranged between 3.0 and 6.5. As for the adverse reactions the diabetic patients manifested, shivers, fever, migraine, nausea and vomiting were the most frequent, while fluid retention and migraine were the most frequent among multiple sclerosis patients. The main nursing interventions identified for the diabetic and MS patients were vital sign monitoring, blood culture collection, optimization of anti-emetic drug administration, control of anti- thymocyte globulin infusion, dietary orientations and advice to reduce the risk of falls. DM1 patients present more acute reactions and need continuous monitoring. MS patients are more dependent on nursing care, demanding lower professional care time. Although DM1 and MS are distinct conditions, in clinical practice, they demand excellent care from nurses, whether due to the particularities of the treatment or the singularities of each disease.

L’ischémie est une des problématiques majeurs de la transplantation, elle intervient au moment de la déconnexion d’un organe du système vasculaire et dure jusqu’à sa reconnexion chez le receveur. Elle provoque une diminution de la qualité des greffons et seulement un-tiers des pancréas éligibles aboutissent à une transplantation. Ce travail de thèse avait pour objectif d’améliorer la qualité des greffons en préparant les pancréas à subir l’ischémie par le préconditionnement et à améliorer leur préservation après avoir identifié les voies impliquées dans l’ischémie. Des changements métaboliques majeurs au niveau de l’organe ont été mis en évidence dépendant du temps d’ischémie, impliquant des dommages sur la partie endocrine du pancréas, les îlots. Ceci a été empêché par le préconditionnement du pancréas à l’ischémie activant les défenses antioxydantes et par l’utilisation de l’hémoglobine M101 issue de ver marin apportant de l’oxygène au cours de la préservation des pancréas de rat et humains. Ainsi, il est possible d’améliorer la qualité des greffons en agissant en amont du prélèvement et au cours de la préservation, ceci permettant une meilleure fonction. / Ischemia is one of the major problems of transplantation, it occurs at the time of disconnection of an organ of the vascular system and lasts until its reconnection in the recipient. It causes a decrease in graft quality and only one-third of the eligible pancreases results in a transplant. This work aimed to improve the quality of the grafts in preparing the pancreas to undergo ischemia preconditioning and improve their preservation after identifying the pathways involved in ischemia. Major metabolic changes in the organ have been demonstrated that appeared to ischemia time dependent enhancing damages to the endocrine part of the pancreas, the islets. This was prevented by the preconditioning of the pancreas to ischemia activating the antioxidant defenses and by the use of the marine worm M101 hemoglobin providing oxygen during the preservation of rat pancreas and humans. Thus, it is possible to improve the quality of the grafts by acting upstream of the sample and during the preservation, this allowing a better function.

The influence of immunosuppressive drugs on neural stem/progenitor cell fate in vitro.

Fibrolamellar hepatocellular carcinoma (FL-HCC) is a malignant liver tumor which is thought to be a variant of conventional hepatocellular carcinoma (HCC). It accounts for a small proportion of HCC cases and occurs in a distinctly different group of patients which are young and usually not in the setting of chronic liver disease. The diagnosis of FL-HCC requires the integration of clinical information, imaging studies, and histology. In terms of the treatment options, the only potentially curative treatment option for patients who have resectable disease is surgery either liver resection (LR) or liver transplantation (LT). When performed in a context of aggressive therapy, long-term outcomes after surgery, particularly liver resection for FL-HCC, were favorable. The clinical outcome of patients with unresectable disease is suboptimal with median survival of less than 12 months. The aim of this review is to update the available evidence on diagnosis, treatment options, outcome predictors, and recent developments of patients with this rare disease and to provide a summarized overview of the available literature.

Experimental models of a transfer of stem cells for therapeutic purposes Abstract Stem cell therapy currently represents a standard procedure of treating a wide variety of hereditary diseases and serious injuries. Development of the most suitable way of transfer of stem cells into the patient body remains very important question concerning this type of therapy. In our experiments we used nanofiber scaffolds for stem cell cultivation and their subsequent transfer. These nanofibers were prepared by the original needleless electrospun NanospiderTM technology. Allogeneic cornea or skin graft were transplanted from B6 mice to BALB/c mice. The grafts were covered by a nanofibrous scaffold with cultivated stem cells. Stem cells were stained by an imunofluorescent dye to enable us to monitore their migration from nanofibers into tissues and consequent distribution in the body and characterize changes of this distribution in the time. The methods of ELISA and PCR were used to confirm that mesenchymal stem cells support the production of antiinflammatory cytokines IL-4 and IL-10 and contribute to inhibition of production of proinflammatory cytokines IL-1, IFNγ and inducible nitric oxide synthase. We confirmed an important beneficial role of nanofiber scaffolds in transplantation of mesenchymal stem cells. Nanofiber...

Regulatorische CD4+CD25+ T-Zellen (Tregs) stellen eine kleine Zellpopulation dar (1-5% der peripheren Blutzellen), die hauptsächlich für die Regulierung von Immunreaktionen verantwortlich ist. In der vorliegenden Arbeit wurden diese Zellen gemeinsam mit Stammzellen syngen und allogen kotransplantiert, um ihren Effekt auf das Anwachsen der Spenderzellen und die Rekonstitution der Hämatopoese nach Ganzkörperbestrahlung zu untersuchen. Es wurden humanisierte dreifach transgene Empfängermäuse (C57Bl/6-TTG) verwendet (human CD4+, murin CD4-, human HLA-DR+), wodurch sowohl bei syngener als auch bei allogener Transplantation eine Unterscheidung zwischen Spender- und Empfängerzellen möglich ist. Zunächst wurden CD4+CD25+ T-Zellen durch Separation aus Milzzellen bzw. Buffy Coats gewonnen und in vitro mittels Durchflusszytometrie und ELISpot charakterisiert. Anschließend fanden syngene und allogene Transplantationen mit einer Laufzeit von 61 Tagen statt. Überleben und Gewicht wurden täglich ermittelt und außerdem wurden wöchentlich Blutbilder erstellt und durchflusszytometrische Chimärismusanalysen (murines und humanes CD4, CD8, MHC (H2Db, H2Kd)) durchgeführt. Durch die magnetische Separation konnte die FoxP3-Expression der murinen Zellen (Transplantat) von 1,6% in der Ausgangspopulation auf 68,5% in der CD4+CD25+ Population gesteigert werden. In den ELISpot-Assays zeigten diese separierten Zellen, wie für Tregs typisch, keine Produktion von Interleukin-2. Nach syngener Transplantation (Spender: wildtyp C57Bl/6) von 2x106 Knochenmarkzellen und 1x106 CD4+CD25+ T-Zellen überlebten 100% der Tiere, wie zu erwarten war. Dabei setzte bei Tregs-kotransplantierten Tieren die Blutbildung nach bestrahlungsbedingter Leukozytopenie aufgrund bisher nicht bekannter Mechanismen früher wieder ein und der Donor-Zell-Chimärismus war an Tag 19 nach Transplantation signifikant höher als in der Kontrollgruppe. Dies zeigt, dass regulatorische T-Zellen im syngenen Transplantationsmodell einen positiven Effekt auf die Akzeptanz bzw. das Anwachsen des Transplantats haben. Dieses Modell entspricht klinisch einer autologen Transplantation. Nach einer knochenmarkzerstörenden Therapie werden dem Patienten eigene Stammzellen reinfundiert, um die Blutbildung und das Immunsystem wieder in Gang zu bringen. Der Zusatz von regulatorischen T-Zellen zum autologen Stammzelltransplantat könnte das Anwachsen der Zellen beschleunigen und die gefährliche Phase der Immunsuppression, in der es häufig zu Sekundärinfektionen kommt, verkürzen. Die Transplantation der gleichen Zahl von allogenen Spenderzellen (wildtyp Balb/c) führte überraschend zum Tod aller dreifach transgenen Empfängertiere. Der Vergleich zu Experimenten mit wildtyp C57Bl/6-Empfängertieren zeigte, dass dreifach transgene Mäuse sehr viel höhere Zellzahlen im Transplantat zum Überleben benötigen (Daten nicht gezeigt). Das Ausbleiben der Blutbildung nach der Bestrahlung führte zu vermindertem Allgemeinbefinden, gestörter Futter- und Wassseraufnahme und Exsikkose bis zum Tod bzw. aus Tierschutzgründen zur Euthanasie. Durch Erhöhung der Zellzahl im Transplantat auf 1x107 Knochenmark + 5x106 Milzzellen überlebten 25% der Mäuse, bei 3x107 Knochenmark + 5x106 Milzzellen waren es 50%. Anders als im syngenen Modell führte die Kotransplantation 1,5x106 allogener CD4+CD25+ T-Zellen zu 3x107 Knochenmark + 5x106 Milzzellen zum Versterben der Tiere. Dies verdeutlicht, dass regulatorische T-Zellen in diesem allogenen Transplantationsmodell das Anwachsen des Transplantats behindern (Transplantatversagen). Hier gilt es zu klären, ob dieser Effekt spezifisch für die gewählten Mausstämme ist und welche Mechanismen für das Transplantatversagen verantwortlich sind. In einem dreifach transgenen Mausmodell konnte ein positiver Effekt von regulatorischen T-Zellen auf die Rekonstitution der Hämatopoese bei syngener Kotransplantation nachgewiesen werden. Im allogenen Transplantationsmodell hingegen führte die Kotransplantation CD4+CD25+ T-Zellen zum Versterben der Empfänger. Der beschriebene und schon publizierte positive Effekt spenderspezifischer Tregs zur Behandlung von Graft versus Host Disease nach allogener Stammzelltransplantation widerspricht diesen Ergebnissen nicht, da es bei diesen Patienten schon zum Engraftment von hämatopoetischen Stammzellen gekommen ist. Dies hat weitreichende Konsequenzen für die therapeutische Anwendung regulatorischer T-Zellen bei hämatologischen Erkrankungen in der Human- und Veterinärmedizin. / Regulatory CD4+CD25+ T cells (Tregs) represent a small cell population (1-5% of peripheral blood cells) mainly responsible for the regulation of the immune system. In the present work, these cells were cotransplanted with syngeneic and allogeneic stem cells in order to analyze the effect of Tregs on the reconstitution of hematopoiesis after total body irradiation. Humanized triple transgenic hosts (C57Bl/6-TTG) (human CD4+, murine CD4-, human HLA-DR+) were applied allowing differentiation of donor and host cells in syngeneic and allogeneic transplantation settings. Murine and human CD4+CD25+ T cells were magnetically separated out of splenocytes or buffy-coats and characterized in vitro by means of flow cytometry and ELISpot. Afterwards syngeneic and allogeneic transplantation experiments were performed for a period of 61 days. Survival and weight were assessed daily and once a week blood parameters and chimerism analyses (murine and human CD4, CD8, MHC (H2Db/ H2Kd)) were carried out. FoxP3 expression increased from 1,6% in the initial murine cell fraction to 68,5% in the separated CD4+CD25+ T cells. ELISpot assays showed the typical lack of interleukin 2 production of Tregs. After syngeneic transplantation (donor: wildtype C57Bl/6) of 2x106 bone marrow cells and 1x106 CD4+CD25+ T cells, 100% of mice survived what was to be expected. Cotransplanted animals showed earlier reconstitution of hematopoiesis after leukocytopenia and significant higher donor-cell-chimerism on day 19 after transplantation. The mechanisms for this positive effect of Tregs in syngeneic transplantation on the engraftment have to be investigated. This model clinically correspond an autologous transplantation where patients are treated with their own stem cells after a myeloablative treatment (chemotherapy or irradiation). The addition of regulatory T cells to the transplant could accelerate the engraftment and shorten the risky period of immunosuppression. Injection of the same numbers of allogeneic cells (donor: wildtype Balb/c) did not preserve hosts from mortality. Compared to experiments with wildtype recipients, results showed that triple transgenic mice need much higher cell numbers in the transplant for survival (data not shown). The failure of hematopoiesis after irradiation led to reduced general condition, disordered ingestion and exsikkosis leading to death respectively to euthanasia for reasons of protection of animals. By scaling up the cell number in the inoculum to 1x107 bone marrow cells + 5x106 splenocytes 25% of mice survived, with 3x107 bone marrow cells + 5x106 splenocytes survival was 50%. In contrast to syngeneic experiments, cotransplantation of 1,5x106 allogeneic CD4+CD25+ T cells and 3x107 bone marrow cells + 5x106 splenocytes did not prevent animals from mortality. In this allogeneic transplantation model Tregs restrain engraftment (graft failure). It has to be clarified if this effect is specific for the utilized mouse strains and which mechanisms are responsible for the graft failure. In the syngeneic triple transgenic mouse model cotransplantation of CD4+CD25+ T cells showed a positive effect on reconstitution of hematopoiesis after irradiation. In the allogeneic setting however cotransplantation of allogeneic regulatory T cells avoided the engraftment of transplanted cells. The described and published effect of donor-specific Tregs for treatment of graft versus host disease after allogeneic transplantation does not contradict the presented results because treated patients already possessed engrafted hematopoietic stem cells. The results have wide consequences for the therapeutic appliance of regulatory T cells in hematological diseases in human and veterinary medicine.

Degenerative Veränderungen der Lendenwirbelsäule beginnen bereits im Alter von unter 20 Jahren und betreffen vor allem die unteren 3 Bewegungssegmente. Die degenerativen Veränderungen an der Bandscheibe gehen mit einer Kalzifizierung der Grund- und Deckplatten der Wirbelkörper einher, was zu einer Reduktion der Nährstoffversorgung der Bandscheibe und damit zu einem Untergang der matrixbildenden Zellen und konsekutiv zu einem Flüssigkeitsverlust in der Bandscheibe führt. Als Folge nimmt die Belastung der Bandscheibe weiter ab. Die aktuellen Therapieoptionen umfassen sowohl die konservative als auch die operative Therapie, wobei allerdings nur die Folgen der Degeneration behandelt werden. Ziel einer Zelltransplantation ist es, der Bandscheibe wieder matrixbildende Zellen zur Verfügung zu stellen, damit die nutritiven Veränderungen auszugleichen und eventuell reversibel zu machen. Dieser Effekt konnte im Tierversuch nachgewiesen werden, woraufhin eine klinische Studie initiiert wurde. Im Rahmen der publizierten klinischen prospektiven, randomisierten Studie konnte gezeigt werden, dass die Transplantation autologer Chondrozyten, die bei einer notwendigen operativen Therapie eines sequestrierten Bandscheibenvorfalls gewonnen wurden, einen sowohl klinisch als auch bildmorphologisch positiven Effekt auf die degenerierten Bandscheiben hat. Es kam zu einer signifikanten Reduktion der Schmerzsymptomatik und einer Steigerung der Lebensqualität in der Gruppe der transplantierten Patienten. Die Bandscheibenhöhe zeigt sich stabil über den Beobachtungszeitraum von 2 Jahren.

La transplantation pulmonaire est depuis une vingtaine d’années une option thérapeutique valide pour une grande variété de pathologies pulmonaires au stade terminal. Malgré les progrès réalisés ces dernières années en matière de traitement immunosuppresseur, les rejets restent une cause majeure de la perte du greffon. Plusieurs études ont souligné l'importance du rejet aigu comme un facteur contributif important à l’évolution de la dysfonction chronique du greffon (ou CLAD) et, in fine, à la perte du greffon. Par conséquent, des outils diagnostiques fiables de rejet aigu s’imposent pour mieux prévenir le CLAD. Dans notre première étude, nous avons évalué les marqueurs tissulaires de rejet aigu humoral (RAH) pulmonaire. Nous avons montré ainsi que les lésions histologiques dont l’inflammation microvasculaire ne sont pas spécifiques et le marquage C4d est un marqueur utile pour confirmer le diagnostic de RAH. Dans un second temps, nous avons étudié en cytométrie de flux la polarisation des macrophages obtenus par lavage bronchiolo-alvéolaire (LBA) chez des patients transplantés avec et sans rejet. Nos résultats montrent les limites des marqueurs membranaires (HLA-DR et CD206) dans l’évaluation de l’état de polarisation des macrophages au cours des rejets. Ce travail montre l’intérêt des marqueurs tissulaires, en particulier le marquage C4d, dans le suivi des patients transplantés pulmonaires et souligne la nécessité d’identifier des marqueurs appropriés et utilisables en cytométrie de flux pour avancer sur l’état de polarisation des macrophages alvéolaires. / Lung transplantation is considered as a valid therapeutic option for patients with end-stage lung disease. Despite considerable progress in immunosuppressive therapy, allograft rejection remains a major cause of graft loss. Multiple studies have highlighted the importance of acute rejection as an important risk factor for the development of chronic lung allograft dysfunction (CLAD) leading to graft failure. Therefore, the improvement in the diagnosis of acute rejection represents a major challenge to prevent CLAD. In this study, we evaluated the tissue markers of acute antibody-mediated rejection (AMR) in lung transplantation. In our experience, the histopathologic findings including the microvascular inflammation in pulmonary AMR are not specific and C4d staining is a useful marker to confirm the diagnosis of AMR. Secondly, we investigated by flow cytometry the polarization of alveolar macrophage obtained by bronchoalveolar lavage (BAL) from lung transplant patients with and without acute rejection. Our results show the limits of surface markers (CD206 and HLA-DR) in the evaluation of alveolar macrophage polarization. This study shows the interest of tissue markers, especially the C4d staining, in monitoring of lung transplant patients and highlights the need to identify appropriate and available markers for future studies of alveolar macrophage polarization by flow cytometry.

Indiana University-Purdue University Indianapolis (IUPUI) / Sepsis is a clinical syndrome due to a systemic inflammatory response to severe microbial infection. Little is known about the changes in the bone marrow (BM) and how they affect the hematopoietic response to bacterial infection. Using an animal model of severe sepsis induced by Pseudomonas aeruginosa, we have previously reported that hematopoietic stem cells (HSC) undergo a significant expansion in the BM accompanied with myeloid suppression. This bone marrow response was Toll-like Receptor 4 (TLR4)-dependent. TLR4 is activated by bacterial lipopolysaccharide (LPS) and signals through two major independent downstream molecules: TRIF and MyD88. In the present study, I found that the TLR4/TRIF and the TLR4/MyD88 pathways contribute in a distinct manner to the BM response to P. aeruginosa's LPS. TRIF plays a major role in the expansion of the HSC pool, whereas MyD88 is required for myeloid suppression. Following LPS stimulation, HSCs enter in the cell cycle, expand and exhaust when transplanted in healthy mice. Loss of TRIF rescued completely the long-term engraftment and multilineage reconstitution potential of septic HSCs, but did not affect myeloid differentiation. Conversely, MyD88 deficiency prevented completely the myeloid suppression in the myeloid progenitors, but conferred limited protective effects on the HSC function. It is of great therapeutic value to identify the downstream molecules involved in TLR4/MyD88 dependent myeloid suppression. I found miR-21, a microRNA that is involved in inflammation, was up-regulated upon LPS challenge in a MyD88-dependent manner. However, deletion of miR-21 in the BM did not rescue LPS-induced bone marrow dysfunction, demonstrating that miR-21 is not a critical regulator in these processes. Further studies are warranted to determine the precise molecular mechanisms involved in the complex pathogenesis of BM response to sepsis. Taken together, my results show for the first time that the TLR4/TRIF signaling as a key mediator of HSC damage during acute LPS exposure and that activation of the TLR4/MyD88 signaling pathway play a dominant role in myeloid suppression. These results provide novel insights into our understanding of the molecular mechanisms underlying bone marrow injury during severe sepsis and may lead to the development of new therapeutic approaches in this disease.