Background Chronic myeloid leukemia (CML) is a relatively rare hematological malignancy with a constant incidence of approximately 90 new cases each year in Sweden (0.9 cases/100 000 inhabitants). The etiology is largely unknown but high doses of ionizing radiation are a known but rare risk factor. The treatment options were for a long time limited to chemotherapies i.e. hydroxyurea and busulfan, interferon’s and allogeneic hematopoietic stem cell transplantation and the median survival were only about four years. Since the beginning of the 21st century a new way of treating CML has been introduced, the tyrosine kinase inhibitors (TKI), leading to a rapid decrease in leukemic cells and symptoms. Due to the TKIs, the overall 5-year survival is nowadays approximately 85 % and CML patients have time to develop other diseases, including other malignancies. The aims of this thesis was to investigate the present and future prevalence of CML and the prevalence of other malignancies prior and subsequent to the diagnosis of CML, malignancies among first-degree relatives of persons with CML. In addition, the incidence of autoimmune and chronic inflammatory diseases among patients with CML was also investigated.   Methods From the Swedish CML register, data over nearly all Swedish CML patients from 2002 and forward were obtained for paper II-IV. For paper I, the Swedish cancer register was used to identify all Swedish CML patients since 1970 and the Swedish cause of death register was used to identify an eventual date of death for these patients. With a constant incidence and the relative survival rates for CML patients between 2006 and 2012 as a model, the present and future prevalence was calculated. For paper II-IV, data from the Swedish cancer register was used to identify other malignancies than CML. For paper II, information about autoimmune and chronic inflammatory diseases was retrieved from the Swedish national patient register. For paper II and IV, five controls matched for year of birth, gender and county of residence were randomly selected from the Swedish register of the total population. To calculate odds ratio (OR), conditional logistic regression was used. To calculate the risk of a second malignancy for paper III, Standardized incidence ratio (SIR) was used. In paper IV, first-degree relatives (parents, siblings and offsprings) for both cases and controls were retrieved from the Swedish multi-Generation Register, where persons born later than 1932 and registered in Sweden at some time since 1961 are registered.   Results Prevalence and survival As shown in paper I, the 5-year overall survival for CML patients increased remarkably from 0.18 to 0.82 between 1970 and 2012. The prevalence increased from 3.9 to 11.9 per 100 000 inhabitants in Sweden between 1985 and 2012. By assuming no further improvements in relative survival as compared to the survival rates between 2006 and 2012, the prevalence by 2060 is expected to increase to 22.0 per 100 000 inhabitants. This corresponds to 2 587 CML patients as compared to 1 137 CML patients in 2012.   Malignancies, autoimmune and chronic inflammatory diseases prior to CML In study II, more than 45 000 person-years of follow-up were evaluated in 984 CML patients diagnosed between 2002 and 2012. With an OR of 1.47 (95 % CI 1.20–1.82) and 1.55 (95 % CI 1.21–1.98), respectively, the prevalence of prior malignancies and autoimmune diseases were significantly increased as compared to matched controls. On the other hand, no association between CML and chronic inflammatory diseases was shown.   Second malignancies In 868 CML patients, diagnosed between 2002 and 2011, 52 malignancies were observed in the Swedish cancer register, as shown in paper III. When compared to expected rates in the background population, a significantly increased risk of second malignancies with a SIR of 1.52 (95 % CI 1.13–1.99) was shown. When looking at specific cancer types, gastrointestinal as well as nose and throat cancer were significantly increased.   Familial aggregation of malignancies 984 CML patients were identified in paper IV. However, 184 had a birth date prior to 1932, subsequently only 800 patients were analyzed. Among them, 4 287 first-degree relatives were identified, compared to 20 930 first-degree relatives of the matched controls. 611 malignancies were retrieved; no significant increase of malignancies in first-degree relatives of CML patients was shown (OR 1.06; 95 % CI: 0.96–1.16).   Conclusion Since CML patients nowadays have a high survival rate, the calculations in this thesis shows that the prevalence of CML will almost double by 2060. CML patients have an increased risk of developing malignancies prior and subsequent to the diagnosis of CML, suggesting a hereditary or acquired predisposition to develop cancer. Since there is no familial aggregation of malignancies in CML patients, a hereditary predisposition to develop cancer is unlikely to be part of the pathogenesis of CML, leaving an acquired predisposition more likely.

La leucémie myéloïde chronique (LMC) est une pathologie de la cellule souche hématopoïétique caractérisée par la présence de la translocation chromosomique t(9 :22) conduisant à l’expression de la kinase BCR-ABL responsable de la maladie. Un inhibiteur de l’activité de BCR-ABL a été identifié, l’Imatinib (IM). L’IM a révolutionné la prise en charge de la LMC en bloquant sélectivement la croissance des cellules tumorales, conduisant à la rémission des patients. Cependant, une majorité d’entre eux subissent des récidives en cas d’arrêt du traitement, et environ 15% développent des résistances à l’inhibiteur. BCR-ABL active de multiples voies de signalisation parmi lesquelles figurent les facteurs de signalisation STAT5. Nous avons analysé les rôles respectives des deux facteurs STAT5, STAT5A et STAT5B, dans les cellules souches hématopoïétiques normales et de LMC, par une approche d’ARN interférence. Nos observations indiquent que l’activité des deux facteurs STAT5 permet la survie et le maintien à long terme des cellules souches de patients LMC au diagnostic. Nous avons de plus montré qu’indépendamment de son activité transcriptionnelle, STAT5A aide les cellules normales et leucémiques à limiter leur stress oxydatif. Nous avons aussi pu observer que les cellules de patients présentant des résistances secondaires à l’IM, sans mutations ni surexpression de BCR-ABL, manifestent une dépendance caractéristique vis-à-vis de l’activité STAT5A. Pour mieux comprendre les mécanismes d’action des facteurs STAT5, nous avons recherché les gènes cibles de STAT5 par une approche transcriptomique et avons identifié le récepteur tyrosine kinase Axl dont l’expression est augmentée par STAT5A. L’inhibition d’Axl dans les cellules LMC sensibles à l’IM n’a aucun effet sur leur survie, alors qu’elle diminue fortement la survie des cellules LMC résistantes à l’IM. De plus, Axl contrôle le niveau des réactifs oxygénés dans les cellules de patients LMC. Nous avons analysé l’expression d’un des activateurs d’Axl, le ligand Gas6, et avons observé que son expression diminue fortement dans les cellules primaires de LMC par rapport aux contrôles sains. Ces résultats suggèrent que le tandem Gas6/Axl pourrait participer au processus leucémique de la LMC à différents niveaux. De manière globale, nos travaux montrent que les facteurs STAT5 favorisent le maintien des cellules souches de LMC, leur résistance au stress oxydatif et aux traitements thérapeutiques Ces deux dernières activités sont au moins en partie liées à l’activité d’une nouvelle cible de STAT5, le récepteur Axl, par ailleurs déjà impliqué dans la résistance aux traitements thérapeutiques. Les facteurs STAT5 représentent donc des nouvelles cibles thérapeutiques potentielles dans l’éradication de la maladie résiduelle. / The Chronic Myeloid Leukemia (CML) is a clonal hematopoietic stem cell disorder characterized by the t(9:22) genetic translocation and expression of the oncogenic tyrosine kinase BCR-ABL . A first BCR-ABL Tyrosine Kinase Inhibitor (TKI), Imatinib (IM), was identified that inhibits proliferation of BCR-ABL expressing hematopoietic cells and leads to disease remission. However, BCR-ABL mRNA remains detectable in the most immature HSCs and discontinuation of IM results in clinical relapse. STAT5 factors play a crucial role in the CML pathogenesis of human primary CML cells. However, the contribution of the two related STAT5 genes, STAT5A and STAT5B, was unknown. We used an RNAinterference based strategy to analyze STAT5A or STAT5B roles in normal and CML cells. We showed that STAT5A/5B double knock-down (KD) triggers normal and CML cell apoptosis and suppressed long-term clonogenic potential of immature hematopoietic stem and progenitor cells known to be resistant to TKI treatment and responsible for residual disease. STAT5A loss alone was ineffective at impairing growth of both normal and CML cells under standard conditions. In contrast, STAT5A loss was sufficient to enhance Reactive Oxygen Species (ROS) which correlated with enhanced DNA damages in both normal and leukemic cells. We reported that STAT5A regulates oxidative stress through unconventional mechanisms, in a non-transcriptional-dependent manner. We further showed that, in contrast to primary cells at diagnosis, IM-resistant cells exhibited enhanced STAT5A dependence, by being sensitive to STAT5A single KD. To investigate the molecular basis of STAT5A activity in TKI-resistance and oxidative stress, we performed a transcriptomic analysis of STAT5 regulated genes. We identified Axl, which encodes a receptor tyrosine kinase, recently shown to be crucial in TKI-resistant CML cells. Specifically, Axl expression is enhanced by STAT5A. We investigated the role of Axl and we found that Axl KD did not affect survival of IM-sensitive CML cells. However, Axl KD decreased survival of IM-resistant cells, miming the activity of STAT5A. Moreover, Axl loss increased ROS levels in CML cells, promoting STAT5A anti-oxidant activity. We further sought to determine the expression of the Axl ligand, Gas6. Gas6 expression is dramatically reduced in CML primary cells at diagnosis compared to healthy cells. The strong and consistent down-regulation of Gas6 in CML cells suggested a possible role in the pathophysiology. Collectively, our findings highlight the pro-survival, stress protection and drug resistance roles of STAT5 factors, providing new understanding for medical treatment of CML patients. We suggest that STAT5A acts in synergy with Axl to face exogenous insults and propose a new mechanism by which CML cells increase their proliferation and reduce their motility by down-regulating Gas6 expression.

Chronic myeloid leukaemia (CML) is characterised by the constitutively active tyrosine kinase BCR-ABL. Standard treatment with tyrosine kinase inhibitors (TKI) in the chronic phase (CP) of CML conveys excellent long-term prognosis but is associated with side effects and costs. Treatment free remission (TFR) is possible in a proportion of patients discontinuing treatment after obtaining deep treatment responses but it is not fully known how to select the right patients for stopping attempts. Treatment of accelerated phase (AP) and blast crisis (BC) is more complicated and the prognosis more dismal. In this thesis, we have studied factors of importance for outcome in CML patients with focus on immunological factors and clinical management. In a cohort of 32 newly diagnosed CP-CML patients, evidence of active immune escape mechanisms were found. These declined with the course of TKI treatment and at the same time, effector lymphocyte responses were elicited. These anti-leukaemia immune responses might help in the long-term control of CML. Multiple plasma protein markers were also measured with three multiplex platforms in a smaller cohort of patients (n=14). Inflammatory cytokines and other plasma proteins were affected by TKI treatment and multiplexing seems useful for finding potential biomarkers with biologic or prognostic significance in CML. Patients progressing to AP/BC were studied in a population-based material from the Swedish CML register. Approximately 4% of TKI-treated CP-CML patients transformed to AP/BC within 2 years of diagnosis. Monitoring of treatment responses was suboptimal in 1/3 of these patients and the median survival was 1.4 years after diagnosis of AP/BC. Thus, minimising the risk of disease progression through strict adherence to guidelines for monitoring and treatment is essential. In a cohort of patients (n=50) discontinuing TKI treatment within a large European trial, musculoskeletal pain was reported by 30% of patients, starting within 1- 6 weeks of TKI discontinuation and spontaneously resolving over time in most cases. Patients (n=56) were also evaluated with a multiplex platform with a total of 162 inflammation- and cancer-related plasma proteins. No predictive protein biomarkers for successful TKI discontinuation could be found. However, profound effects of TKI-treatment were seen and plasma proteomics could be useful for understanding effects of long-term TKI-treatment.

La numération plaquettaire est une analyse délicate et le résultat est souvent erroné notamment du fait d’une tendance à l’agrégation in vitro dans certaines espèces animales. Il a ainsi pu être démontré chez le Chat que ce phénomène peut être inhibé par l’association d’un anticoagulant avec des inhibiteurs plaquettaires : le CTAD (Citrate, Théophylline, Adénosine et Dipyridamole). Cette association permet ainsi l’obtention de numérations plaquettaires fiables sans affecter les autres populations sanguines, mais également d’effectuer des analyses d’hémostase et de biochimie. De nouveaux intervalles de référence ont dû être établis pour certaines variables hématologiques avec les analyseurs utilisés en laboratoire et dans les cliniques vétérinaires. Par ailleurs, si les effets antiagrégants du CTAD sont moins nets chez le Chien, il peut également servir d’anticoagulant « universel », permettant de réduire le nombre de prélèvements et d’améliorer ainsi le bien-être des animaux. / The platelet count is a delicate measurement, which may often be erroneous because of the tendency of platelets from some animal species to aggregate in vitro. This study demonstrated that this effect can be inhibited in cats using CTAD (Citrate, Theophylline, Adenosine and Dipyridamole) composed of an anticoagulant and platelet inhibitors. This association provides reliable platelet counts without affecting other blood populations and also allows hemostasis and biochemical analyses. New hematological reference intervals have been established for some variables with analyzers used in clinical pathology laboratories and veterinary clinics. Furthermore, if the antiplatelet clumping effects of CTAD are less marked in canine species, the CTAD can also serve as "universal" anticoagulant, reducing the number of blood samples and thus improving animal welfare.

Made available in DSpace on 2016-01-26T18:55:33Z (GMT). No. of bitstreams: 1 Rivaldo.pdf: 292230 bytes, checksum: a2cbda0e4eeea6a416fde16f3f375530 (MD5) Previous issue date: 2011-09-26 / This study aimed to evaluate the heart and liver biomarkers, hematology and hemostasis in healthy dogs, submitted to therapy with nonsteroidal anti-inflammatory non-selective (NSAID), COX-2 preferential and COX-2 selective drugs. Were used 30 mongrel dogs, adults, males and females, clinically healthy, randomly divided into 5 groups (G) of 6 animals, that received the follow therapies: ketoprofen, nimesulide, meloxican, etodolac and celecoxib. The blood count, hemostatic profile (clotting time (CT), prothrombin time (PT), activated partial thromboplastin time (APTT), platelets and fibrinogen), cardiac biomarkers (CK, CKMB) and liver function (ALT, AST and albumin) were evaluate before, at 5 and 10 days (T0, T5, T10) of treatment in all treatment groups, and at 20 days (T20) treatment in celecoxib. The CT scan showed significant increase in the ketoprofen group at T5, while in the nimesulide group significantly increased at T10, in both groups when compared to T0. In TP, the etodolac group showed significant reduction in the T5 compared to T0, while the platelet count increased at T10 compared to T0 and T5 in the ketoprofen group. The red blood cells and Ht decreased in T10 compared to T0 in the ketoprofen group, while the reduction in the celecoxib group T20 compared to T0. The celecoxib group revealed decreased values of total leukocytes, neutrophils and lymphocytes in the T20. Significant increase in CKMB, LDH, and ALT were observed in the celecoxib group. Reduction of serum albumin occurred in the nimesulide and ketoprofen groups in T5 and T10 and T10, respectively. In conclusion, meloxican was the safest drug to NSAID therapy in dogs. The NSAIDs ketoprofen, nimesulide and etodolac should be used judiciously in patients with dysfunction of coagulation profile, once that promote increase in coagulation parameters. Celecoxib appears to be safe in relation to the coagulation, even under prolonged therapy. Celecoxib and ketoprofen therapy requires attention for use in anemic dogs because they are able to reduce the red series. Ketoprofen is contraindicated in patients with hypoalbuminemia. Long term celecoxib therapy should be used cautiously in dogs with immunosuppressive processes, since it was able to reduce the white blood cell counts. / O presente estudo teve como objetivo avaliar as alterações bioquímicas cardíacas e hepáticas, hematologia e hemostasia de cães saudáveis, submetidos à terapia com anti-inflamatórios não-esteroidais não seletivos (AINEs), COX-2 preferenciais e COX-2 seletivos. Foram utilizados 30 cães, sem raça definida, adultos, machos e fêmeas, clinicamente sadios, divididos aleatoriamente em 5 grupos (G) de 6 animais, que receberam as seguintes terapias: cetoprofeno, nimesulida, meloxican, etodolaco e celecoxibe. O hemograma, perfil hemostático (tempo de coagulação (TC), tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA), plaquetas e fibrinogênio), biomarcadores cardíacos (creatinofosfoquinase (CK) e sua fração MB- CKMB) e função hepática (alanina aminotransferase (ALT), aspartato aminotransferase (AST) e albumina) foram avaliados antes, aos 5, 10 dias (T0, T5 e T10) de tratamento em todos os grupos, e também aos 20 dias (T20) de tratamento no celecoxibe. O TC revelou aumento significativo no T5 no grupo cetoprofeno, enquanto no grupo nimesulida houve aumento significativo no T10, em ambos os grupos em relação ao T0. No TP, o grupo etodolaco revelou redução significativa no T5 em relação ao T0, enquanto a contagem de plaquetas aumentou no T10 em relação ao T0 e T5 no cetoprofeno. As hemáceas e o Ht diminuiram no T10 em relação ao T0 no cetoprofeno, enquanto no grupo celecoxibe houve redução no T20 em relação ao T0. O celecoxibe revelou diminuição dos valores de Leucócitos totais, neutrófilos e linfócitos no T20. No grupo celecoxibe houve aumento significativo de CKMB, CK, e ALT. Redução da albumina sérica ocorreu nos grupos cetoprofeno e nimesulida no T10 e T5 e T10, respectivamente. Em conclusão, o meloxican foi o fármaco que se revelou mais seguro para uso em cães, em relação aos aspectos avaliados. Os AINEs cetoprofeno, nimesulida e etodolaco devem ser usados criteriosamente em pacientes portadores de disfunções do perfil de coagulação, uma vez que promovem prolongamento do mesmo, enquanto o celecoxibe revela-se seguro neste aspecto, mesmo sob terapia prolongada. Celecoxibe e cetoprofeno exigem atenção para uso em cães anêmicos, pois são capazes de reduzir a série vermelha. O uso de cetoprofeno em pacientes com hipoalbuminemia é contra-indicado Celecoxibe em terapia prolongada deve ser usado cautelosamente em portadores de processos imunossupressores, uma vez que foi capaz de reduzir a leucometria.

Made available in DSpace on 2016-07-18T17:53:09Z (GMT). No. of bitstreams: 1 Rivaldo.pdf: 292230 bytes, checksum: a2cbda0e4eeea6a416fde16f3f375530 (MD5) Previous issue date: 2011-09-26 / This study aimed to evaluate the heart and liver biomarkers, hematology and hemostasis in healthy dogs, submitted to therapy with nonsteroidal anti-inflammatory non-selective (NSAID), COX-2 preferential and COX-2 selective drugs. Were used 30 mongrel dogs, adults, males and females, clinically healthy, randomly divided into 5 groups (G) of 6 animals, that received the follow therapies: ketoprofen, nimesulide, meloxican, etodolac and celecoxib. The blood count, hemostatic profile (clotting time (CT), prothrombin time (PT), activated partial thromboplastin time (APTT), platelets and fibrinogen), cardiac biomarkers (CK, CKMB) and liver function (ALT, AST and albumin) were evaluate before, at 5 and 10 days (T0, T5, T10) of treatment in all treatment groups, and at 20 days (T20) treatment in celecoxib. The CT scan showed significant increase in the ketoprofen group at T5, while in the nimesulide group significantly increased at T10, in both groups when compared to T0. In TP, the etodolac group showed significant reduction in the T5 compared to T0, while the platelet count increased at T10 compared to T0 and T5 in the ketoprofen group. The red blood cells and Ht decreased in T10 compared to T0 in the ketoprofen group, while the reduction in the celecoxib group T20 compared to T0. The celecoxib group revealed decreased values of total leukocytes, neutrophils and lymphocytes in the T20. Significant increase in CKMB, LDH, and ALT were observed in the celecoxib group. Reduction of serum albumin occurred in the nimesulide and ketoprofen groups in T5 and T10 and T10, respectively. In conclusion, meloxican was the safest drug to NSAID therapy in dogs. The NSAIDs ketoprofen, nimesulide and etodolac should be used judiciously in patients with dysfunction of coagulation profile, once that promote increase in coagulation parameters. Celecoxib appears to be safe in relation to the coagulation, even under prolonged therapy. Celecoxib and ketoprofen therapy requires attention for use in anemic dogs because they are able to reduce the red series. Ketoprofen is contraindicated in patients with hypoalbuminemia. Long term celecoxib therapy should be used cautiously in dogs with immunosuppressive processes, since it was able to reduce the white blood cell counts. / O presente estudo teve como objetivo avaliar as alterações bioquímicas cardíacas e hepáticas, hematologia e hemostasia de cães saudáveis, submetidos à terapia com anti-inflamatórios não-esteroidais não seletivos (AINEs), COX-2 preferenciais e COX-2 seletivos. Foram utilizados 30 cães, sem raça definida, adultos, machos e fêmeas, clinicamente sadios, divididos aleatoriamente em 5 grupos (G) de 6 animais, que receberam as seguintes terapias: cetoprofeno, nimesulida, meloxican, etodolaco e celecoxibe. O hemograma, perfil hemostático (tempo de coagulação (TC), tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA), plaquetas e fibrinogênio), biomarcadores cardíacos (creatinofosfoquinase (CK) e sua fração MB- CKMB) e função hepática (alanina aminotransferase (ALT), aspartato aminotransferase (AST) e albumina) foram avaliados antes, aos 5, 10 dias (T0, T5 e T10) de tratamento em todos os grupos, e também aos 20 dias (T20) de tratamento no celecoxibe. O TC revelou aumento significativo no T5 no grupo cetoprofeno, enquanto no grupo nimesulida houve aumento significativo no T10, em ambos os grupos em relação ao T0. No TP, o grupo etodolaco revelou redução significativa no T5 em relação ao T0, enquanto a contagem de plaquetas aumentou no T10 em relação ao T0 e T5 no cetoprofeno. As hemáceas e o Ht diminuiram no T10 em relação ao T0 no cetoprofeno, enquanto no grupo celecoxibe houve redução no T20 em relação ao T0. O celecoxibe revelou diminuição dos valores de Leucócitos totais, neutrófilos e linfócitos no T20. No grupo celecoxibe houve aumento significativo de CKMB, CK, e ALT. Redução da albumina sérica ocorreu nos grupos cetoprofeno e nimesulida no T10 e T5 e T10, respectivamente. Em conclusão, o meloxican foi o fármaco que se revelou mais seguro para uso em cães, em relação aos aspectos avaliados. Os AINEs cetoprofeno, nimesulida e etodolaco devem ser usados criteriosamente em pacientes portadores de disfunções do perfil de coagulação, uma vez que promovem prolongamento do mesmo, enquanto o celecoxibe revela-se seguro neste aspecto, mesmo sob terapia prolongada. Celecoxibe e cetoprofeno exigem atenção para uso em cães anêmicos, pois são capazes de reduzir a série vermelha. O uso de cetoprofeno em pacientes com hipoalbuminemia é contra-indicado Celecoxibe em terapia prolongada deve ser usado cautelosamente em portadores de processos imunossupressores, uma vez que foi capaz de reduzir a leucometria.

Submitted by Adriana Martinez (amartinez@unoeste.br) on 2017-12-18T11:39:51Z No. of bitstreams: 1 Rivaldo Marini Filho.pdf: 197818 bytes, checksum: ae8b3afee2f83011a3937b0b0a8b0124 (MD5) / Made available in DSpace on 2017-12-18T11:39:51Z (GMT). No. of bitstreams: 1 Rivaldo Marini Filho.pdf: 197818 bytes, checksum: ae8b3afee2f83011a3937b0b0a8b0124 (MD5) Previous issue date: 2011-09-26 / This study aimed to evaluate hematological and hemostatic parameters, cardiac and hepatic biomarkers in healthy dogs submitted to therapy with non-selective (NSAID) and COX-2 preferential nonsteroidal anti-inflammatory drugs. Were used 24 healthy dogs, randomly divided into 4 groups (G) submitted to therapy with ketoprofen, nimesulide, meloxicam and etodolac. The blood count, hemostatic profile (clotting time (CT), prothrombin time (PT), activated partial thromboplastin time (APTT), platelets and fibrinogen), cardiac biomarkers (CK, CKMB) and liver function (ALT, AST and albumin) were evaluate before, at 5 and 10 days (T0, T5, T10) of treatment. Were observed increase in CT in the ketoprofen and nimesulide groups at T5 and T10, respectivelly, when compared to T0. The etodolac group showed reduction in TP in T5 compared to T0. The platelet count increased at T10 compared to T0 and T5 in the ketoprofen group. The red blood cells and hematocrit decreased in at T10 in the ketoprofen group. Reduction of serum albumin occurred in the ketoprofen (T5 and T10) and nimesulide (T10) groups. In conclusion, meloxican was the safest drug to NSAID therapy in dogs. The NSAIDs ketoprofen, nimesulide and etodolac should be used judiciously in patients with dysfunction of coagulation profile, once that promote increase in coagulation parameters. Ketoprofen therapy requires attention for use in anemic dogs because they are able to reduce the red series, and in patients with hypoalbuminemia is contraindicated. / O presente estudo teve como objetivo avaliar a hemograma, hemostasia, biomarcadores cardíacos e função hepática de cães saudáveis tratados com anti-inflamatórios não-esteroidais (AINEs) não seletivos e COX-2 preferenciais. Foram utilizados 24 cães clinicamente sadios, divididos em 4 grupos (G), que receberam as seguintes terapias: cetoprofeno, nimesulida, meloxicam, e etodolaco, durante 10 dias. O hemograma, perfil hemostático (tempo de coagulação (TC), tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA), plaquetas e fibrinogênio), biomarcadores cardíacos (creatinofosfoquinase (CK) e sua fração MB- CKMB) e função hepática (alanina aminotransferase (ALT), aspartato aminotransferase (AST) e albumina foram avaliados antes, aos 5 e 10 dias (T0, T5 e T10) de tratamento. O TC revelou aumento significativo nos grupos cetoprofeno e nimesulida no T5 e T10, respectivamente, em relação ao T0. O grupo etodolaco revelou redução do TP no T5 em relação ao T0. A contagem de plaquetas aumentou no T10 em relação ao T0 e T5 no grupo cetoprofeno. As hemáceas e o Ht diminuiram no T10 no grupo cetoprofeno. Redução da albumina sérica ocorreu nos grupos cetoprofeno (T5 e T10) e nimesulida (T10). Em conclusão, o meloxican foi o fármaco que se revelou mais seguro para uso em cães, em relação aos aspectos avaliados. Os AINEs cetoprofeno, nimesulida e etodolaco devem ser usados criteriosamente em pacientes com disfunções do perfil de coagulação, uma vez que prolongam do mesmo. O cetoprofeno exige atenção para uso em cães anêmicos, pois é capaz de reduzir a série vermelha, e em pacientes com hipoalbuminemia é contra-indicado.

MSc (Microbiology) / Department of Microbiology / See the attached abstract below

<p>Hyperspectral imaging is widely used for obtaining optical information of light absorbers (e.g. biochemical composition) in a variety of specimens or tissues in a label-free manner. Acquiring and processing spectral data using hyperspectral imaging usually requires advanced instrumentation such as spectrometers, spectrographs or tunable color filters, which are not easily adaptable in developing instrumentation for field-based applications. Also, use of only RGB information from conventional cameras is not sufficient to obtain a reliable correlation with the actual content of the analyte of interest. We propose a new concept of ‘virtual hyperspectral imaging’ to reconstruct the full reflectance spectra from RGB image data. This allows us to use only RGB image data to determine detailed spatial distributions of analytes of interest. More importantly, it simplifies instrumentation without requiring bulky and expensive hardware. Using a data-driven approach, we apply multivariate regression to reconstruct hyperspectral reflectance image data from RGB images obtained using a conventional camera or a smartphone. </p> <p> </p> <p>In developing a reliable reconstruction matrix, it is critical to obtain a training data set of the specimen of study under the same optical geometry since the spectral reflectance and absorbance is sensitive to the detection and illumination parameters. We designed an image-guided hyperspectral system that can acquire both hyperspectral reflectance and RGB data sets under the same imaging configuration to minimize any discrepancies in the hyperspectral reflectance data acquired using different optical sensing geometries. In our technology development, a telecentric lens that is commonly used in machine vision systems but rarely in bioimaging, serves as a key component for reducing unwanted scattering in biological tissue due to its highly anisotropic scattering properties, by acting as a back-directional gating component to suppress diffuse light. We evaluate our spectrometer-less reflectance imaging method using RGB-based hyperspectral reconstruction algorithm for integration into a smartphone application for non-invasive hemoglobin analysis for anemia risk assessment in communities with limited access to central laboratory tests.</p>

La lymphohistiocytose hémophagocytaire (HLH) est une maladie hyper-inflammatoire rare, mais potentiellement mortelle affectant surtout les jeunes enfants. Il existe deux formes de HLH : primaire et secondaire. La HLH primaire est causée par une mutation des gènes impliqués dans la voie cytotoxique médiée par les granules, alors que la HLH secondaire se développe en raison d’une condition préexistante, telle qu’un cancer, une infection chronique ou une transplantation. La HLH est caractérisée par le développement d’inflammation extrême, une production excessive de cytokines inflammatoires ainsi qu’une infiltration tissulaire massive par des lymphocytes T et des macrophages activés. À ce jour, le traitement de la HLH consiste d’abord à réduire l’inflammation à l’aide d’agents de chimiothérapie hautement toxiques et de corticostéroïdes, puis à procéder à une transplantation de cellules souches hématopoïétiques (CSH) chez les patients atteints de HLH primaire, le seul traitement disponible permettant la rémission de ces patients. Toutefois, les thérapies actuelles ne parviennent pas toujours à réduire l’inflammation extrême chez plusieurs patients atteints de HLH, si bien que le taux de mortalité avant la transplantation de CSH est toujours d’environ 20% à 25%. C’est pourquoi le développement de nouveaux traitements anti-inflammatoires, plus efficaces, représenterait une avancée majeure dans le traitement de la HLH. Des études dans des modèles murins avaient déjà démontré que l’utilisation d’anticorps bloquants ciblant l’IFNg (anti-IFNg) ou de ruxolitinib, un inhibiteur de JAK1/2 (« janus activated kinases 1/2 »), pouvait améliorer efficacement, quoique partiellement, les manifestations de la HLH. Nous avons donc émis l’hypothèse que l’utilisation d’une thérapie combinée ciblant des cytokines JAK-dépendantes et indépendantes serait plus efficace qu’une monothérapie pour diminuer les symptômes de la HLH. À l’aide d’un modèle murin déficient pour le gène de la perforine (PKO), nous avons comparé les effets de l’inhibition de l’IL-6 et de l’IL-18, deux cytokines fortement sécrétées dans la HLH, en combinaison avec soit de l’anti-IFNg ou du ruxolitinib. Nous avons aussi vérifié l’efficacité d’une thérapie combinée d’anti-IFNg et de ruxolitinib sur les manifestations de la HLH. Nos travaux ont montré que l’anti-IL-6R et l’anti-IL-18, lorsque combinés avec de l’anti-IFNg ou du ruxolitinib, amélioraient légèrement, mais pas de manière significative, les symptômes de la HLH. Par contre, l’utilisation d’une thérapie combinant du ruxolitinib avec de l’anti-IFNg générait un important effet de synergie sur la résolution des symptômes. Notre étude démontre que l’anti-IFNg et le ruxolitinib, même s’ils sont efficaces par eux-mêmes, devraient être utilisés en combinaison afin de prévenir la progression de la HLH. Cette étude est particulièrement pertinente puisque l’anti-IFNg a récemment été approuvé par la FDA pour le traitement de la HLH tandis que le ruxolitinib est présentement à l’étude chez l’humain. / Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyper-inflammatory disease affecting mainly young children. There are two types of HLH : primary and secondary. Primary HLH is caused by defects in genes of the perforin-granzyme cytotoxic pathway, whereas secondary HLH develops following a pre-existing underlying condition, such as a cancer, a chronic infection or a transplantation. HLH is characterized by extreme inflammation, a very high secretion of inflammatory cytokines and a massive tissue infiltration by activated T cells and macrophages. Currently, treatment for HLH consists of reducing the inflammation with a course of highly toxic chemotherapy agents and corticosteroids, followed by hematopoietic stem cell transplantation (HSCT) for patients with primary HLH, which is the only available curative treatment for these patients. However, current therapies often fail to properly manage the extreme inflammation of HLH in many patients, so that the pre-HSCT fatality still stands around 20% to 25%. Thus, the development of new, more potent anti-inflammatory treatments would be a major advance in the treatment of HLH. It had already been shown in relevant mouse models that blocking antibodies targeting IFNg (anti-IFNg) or ruxolitinib, a Janus activated kinase 1/2 (JAK1/2) inhibitor, could efficiently, but partially, improve the pathological manifestations of HLH. Thus, we hypothesized that combined therapies targeting both JAK-dependent and independent cytokines would be more effective than either one alone to reduce the symptoms of this pathology. Using a perforin knock-out (PKO) mouse model, we compared the effects of targeting IL-6 and IL-18, which are highly expressed cytokines during HLH, in combination with either anti-IFNg or ruxolitinib. We also tested the efficacy of a therapy combining anti-IFNg with ruxolitinib on the manifestations of HLH. We found that anti-IL-6R and anti-IL-18, when used in combination with either anti-IFNg or ruxolitinib, showed small, but not significant improvements on the pathological manifestations of HLH. However, combination therapy using ruxolitinib and anti-IFNg showed a major synergistic effect on the resolution of the symptoms of HLH. Our findings support that anti-IFNg and ruxolitinib, although effective independently, should be used in combination to suppress HLH progression. This is particularly relevant since the former was recently approved for treating HLH while the latter is in clinical trials.