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Action du CTLA4-Ig sur la réponse humorale en Transplantation

Abstract : Generation of de novo DSAs (dnDSAs) after renal transplantation is recognized as the leading cause of late transplant failure. Hence there is a need to define the best immunosuppressive strategies to limit their development. Recent clinical trials using the novel co-stimulatory blockade agent CTLA4-Ig (Belatacept) have shown that kidney transplanted recipients (KTR) treated with Belatacept exhibit better graft survival and function, and lower proportion of dnDSAs compared with control recipients. Mechanisms involved in the control of humoral responses by CTLA4-Ig remain to be investigated. Here, we analyzed the effect of CTLA4-Ig on different steps of the B cell mediated response in human. In vitro, we showed that CTLA4-Ig reduced plasmablast differentiation and immunoglobulin production in a T cell-independent manner. The expression of the transcription factor Blimp-1, mainly involved in plasma cell differentiation and function, was significantly decreased in the presence of CTLA4-Ig. Moreover the reduced expression of CD86 after CTLA4-Ig treatment suggested a direct intracellular signaling in B cells. Additionally, we showed that CTLA4-Ig blocked CD28-mediated activation of T follicular helper cells (Tfh) in an autologous Tfh-memory B cells model. We validated these observations in KTR treated with Belatacept by showing reduced proportion of blood effector B-cells and activated Tfh (PD1+ICOS+) compared with control recipients. Our in-vitro and in-vivo results suggest that CTLA4-Ig modulates B-cells function at two levels, directly on B cells and at the B cell-Tfh crosstalk level. These mechanisms likely account for the optimal control of humoral responses observed in KTR treated with Belatacept.
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Submitted on : Monday, March 26, 2018 - 4:26:53 PM
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Claire Leibler-Romand. Action du CTLA4-Ig sur la réponse humorale en Transplantation. Médecine humaine et pathologie. Université Paris-Est, 2017. Français. ⟨NNT : 2017PESC0015⟩. ⟨tel-01743716⟩

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