A fibrose hepática é uma patologia que acompanha outras doenças crônicas do fígado como a cirrose e o hepatocarcinoma. As células estreladas hepáticas (HSC, do inglês hepatic stellate cells) compõem uma população celular heterogênea que se caracteriza por transitar entre dois fenótipos. As células com fenótipo quiescente possuem a capacidade de armazenar vitamina A em gotas lipídicas. Os insultos ao fígado desencadeiam uma resposta inflamatória que gera estímulos parácrinos e autócrinos mediados por citocinas e espécies reativas. Neste contexto, as HSC assumem um fenótipo ativado fibrogênico e tornam-se responsáveis pela cicatrização hepática. Danos crônicos ao fígado levam a uma deposição de matriz extracelular exagerada que configura o estado patológico da fibrose. O resveratrol (RSV – 3,4’,5-tri-hidroxi-trans-estilbeno) é uma fitoalexina produzida por algumas espécies de plantas. Inúmeros efeitos benéficos à saúde são atribuídos ao RSV por causa do seu potencial antioxidante, antiinflamatório e pró-apoptótico. Estudos anteriores mostraram que tratamento da GRX, uma linhagem murina de HSC ativadas, com concentrações de RSV próximas as biodisponíveis (0,1 a 1 μM) resultou em parada do ciclo na fase S com consequente inibição de proliferação celular, um efeito associado à citotoxicidade e que pode favorecer a resolução da fibrose hepática. Neste estudo, por técnicas espectrofotométricas, foi demonstrado que tratamento da GRX por 24 horas com concentrações entre 0,1 a 50 μM de RSV promoveu um efeito pró-oxidante que causa uma citotoxicidade dependente da dose, bastante aumentada no grupo tratado com a concentração mais alta. Os efeitos citotóxicos atenuados encontrados nas células tratadas por 120 horas sugerem que a GRX pode se tornar resistente a estes efeitos. O potencial pró-oxidante do RSV foi o ponto de partida para investigar a possibilidade de que esta fitoalexina provocasse uma alteração no metabolismo mitocondrial da GRX. Para isso, os efeitos do RSV (1 a 50 μM) na função mitocondrial, na indução de morte mediada por estas organelas e na autofagia/mitofagia foram investigados por técnicas de espectrofotometria, de imunocitoquímica, de citometria de fluxo, de microscopia confocal e de microscopia eletrônica de transmissão em GRX tratadas por 24 e 120 horas. Foi demonstrado que todas as concentrações de RSV promovem apoptose por meio da ativação de caspases, alteram a dinâmica/função mitocondrial e induzem o aumento de autofagia/mitofagia na GRX. No entanto, o RSV provocou biogênese de mitocôndrias nos grupos tratados com 1 e 10 μM, enquanto que o tratamento com 50 μM causou dano celular evidente na GRX, sem induzir biogênese de mitocôndrias. Desta forma, é possível que a citotoxicidade “dose-dependente” do RSV, que causa a morte celular e dano oxidativo em 24 horas de tratamento, esteja relacionada com o desequilíbrio entre a indução concomitante de apoptose mediada por dano mitocondrial, autofagia/mitofagia e biogênese de mitocôndrias. Por fim, foi investigada a liberação de TNF-α, Interleucina-6 e Interleucina-10 pela GRX tratada por 24 e 120 horas com RSV (0,1 a 50 μM), considerando o papel antiinflamatório do RSV e o papel das HSC ativadas na sinalização autócrina que contribui para a modulação fenotípica destas células. Foi demonstrado que o tratamento da GRX com RSV por 24 e 120 horas induziu a redução da liberação de Interleucina-6; enquanto que a liberação de TNF-α e Interleucina-10 foi aumentada. Estes resultados confirmam um efeito antiinflamatório do RSV que deve contribuir na prevenção da ativação ou da perpetuação do estado ativado das HSC por meio de sinalização autócrina. Ainda que a concentração do RSV seja importante para efetivamente induzir a morte das HSC ativadas, o tratamento com esta fitoalexina pode ser promissor para a resolução da fibrose hepática por diminuir a população de células ativadas e, possivelmente, prevenir a perpetuação do estado fenotípico ativado. Estudos avaliando indicadores de quiescência em células tratadas são ainda necessários para desvendar completamente os efeitos do RSV quanto às possibilidades de inibição da perpetuação ou reversão fenotípica das HSC ativadas. / Liver fibrosis is a disease that accompanies other hepatic chronic diseases such as cirrhosis and hepatocellular carcinoma. Hepatic stellate cells (HSC) are a heterogeneous cell population characterized by transiting between two phenotypes. Cells with a quiescent phenotype are able to store vitamin A into lipid droplets. Damage to the liver trigger an inflammatory response that generates paracrine and autocrine stimulation mediated by cytokines and reactive species. In this context, HSC assume an activated and fibrogenic phenotype responsive for hepatic wound-healing. Chronic insults to the liver lead to an excessive deposition of extracellular matrix that configures the pathological state of fibrosis. Resveratrol (RSV – 3,4’,5-tri-hidroxi-trans-stilbeno) is a phytoalexin produced by some species of plants. Several beneficial effects are attributed to this molecule due to its antioxidant, antiproliferative and pro-apoptotic potential. Previous studies showed that treatment with bioavailable concentrations of RSV (0.1 to 1 μM) promoted an arrest cycle at the S phase in GRX, a murine activated HSC model, leading to cell proliferation inhibition, a cytotoxic effect that contributes to the liver fibrosis resolution. In this study, it was shown by spectrophotometric techniques that GRX treatment for 24 hours at concentrations between 0.1 to 50 μM of RSV promoted a fairly clear pro-oxidant effect that causes a dose-dependent cytotoxicity that was higher in the group treated with 50 μM. The attenuated cytotoxicity found after 120 hours of GRX treatment suggest that these cells became resistant to this effect. The pro-oxidant potential of RSV was the starting point for investigating the possibility that this phytoalexin would cause a change in the GRX mitochondrial metabolism. Thus, the effects of RSV (1 to 50 μM) on altering the mitochondrial function, on inducing mitochondrial-mediated cell death, and autophagy/mitofagia were investigated in GRX treated for 24 and 120 hours by spectrophotometric techniques, immunocytochemistry, flow cytometry, confocal microscopy, and transmission electron microscopy. All the RSV concentrations promote cell apoptosis through caspases activation, alter the mitochondrial dynamics and function, and induce an increase of autophagy/mitofagia. Curiously, only 1 and 10 μM of RSV induced mitochondrial biogenesis in GRX, while the highest concentration caused an evident cell damage without inducing mitochondrial biogenesis. Thus, it is possible that the "dose-dependent" cytotoxicity of RSV, which causes cell death and oxidative damage in 24 hours of treatment, is related to an imbalance between the concomitant induction of mitochondrial-mediated apoptosis, autophagy/mitofagia, and mitochondrial biogenesis. Finally, it was investigated the release of TNF-α, Interleukin-6 and Interleukin-10 by GRX treated for 24 and 120 hours with RSV (0.1 to 50 μM), considering the anti-inflammatory role of RSV and the autocrine signalling role of HSC that contributes to the perpetuation of its activated phenotype. It was demonstrated that GRX treatment with RSV for 24 and 120 hours reduced the release of Interleukin-6 in the culture medium; whereas the release of TNF-α and Interleukin-10 was increased. These results confirm the anti-inflammatory properties of RSV and may contribute to the prevention of HSC activation through autocrine signalling. Although RSV concentration is important to effectively induce activated HSC death, cells treatment with this phytoalexin may be promising for liver fibrosis resolution through decreasing the population of activated cells or through preventing the perpetuation of activated state of HSC. Future studies evaluating the quiescence indicators of GRX under RSV treatment are still needed to fully unravel the effects of this phytoalexin on inhibiting the perpetuation of activated HSC or reversing its activated phenotype.

A hipóxia-isquemia (HI) neonatal é uma causa importante de deficits neurológicos. Estimativas relatam que 3-5 em cada 1.000 nascidos vivos ocorrem encefalopatia neonatal, sendo que, encefalopatia hipóxico-isquêmica (EHI) moderada ou grave acomete 0,5-1/1000 dos nascidos vivos. Aproximadamente 10 a 60% das crianças com EHI morrem, e pelo menos 25% dos que sobrevivem, apresentam deficiência permanente, como paralisia cerebral, epilepsia e dificuldades na aprendizagem. Evidências clínicas e experimentais sugerem que a exposição a estímulos nocivos no início da vida pode resultar em mudanças duradouras no processamento sensorial. Apesar da magnitude do problema, pouco se conhece sobre a modulação da dor e mecanismos envolvidos durante um processo hipóxico-isquêmico em neonatos e suas conseqüências ao longo da vida. Sendo assim, a presente tese objetivou avaliar respostas comportamentais e bioquímicas de filhotes de ratos submetidos à hipóxia/isquemia no 7°dia de vida, avaliados em diferentes idades. Ninhadas de ratos Wistar machos foram randomizadas em 6 grupos experimentais: controle, hipóxia-isquemia, isquemia, hipóxia, sham-ischemia, sham-hipóxia. O modelo experimental utilizado foi de HI unilateral descrito por Levine (1960) e adaptado por Rice e colaboradores (1981), realizando-se isquemia através da oclusão da carótida esquerda e hipóxia com câmara hipóxica de 92% de nitrogênio e 8% de oxigênio. Avaliaram-se os animais no 14° (P14), 30°(P30) e 60° (P60) dias de vida. Para avaliação da (s) resposta (s): nociceptiva térmica foram utilizados testes de tail-flick e placa quente; e alodinia mecânica utilizou-se teste de Von Frey eletrônico. Para as avaliações dos biomarcadores foram utilizados kits comerciais de BDNF e TNF por métodos ELISA e LDH por espectrofotometria. A ativação neuronal foi quantificada em lâminas de imunoistoquímica de c-fos em regiões CA1 e giro dentado de hipocampo bilateral. Foi observado que ratos com hypoxia e/ou isquemia tiveram diminuição irreversível de neurônios com ativação por c-fos em área CA1 do hipocampo, região ipsilateral do insulto. Maior sensibilidade em animais com HI em P14 foi observado no teste do Von Frey, mas não foi observada em P30 e P60. Independentemente do grupo experimental, a idade do animal desempenhou um papel significativo na resposta de comportamento nociceptivo, bem como sobre o BDNF e dos níveis séricos de TNF-α, mas não sobre os níveis séricos de LDH. Em conclusão, o insulto cerebral da HI induz uma redução significativa e irreversível sobre a ativação neuronal ipisilateral à lesão, com a evidência de uma alteração da resposta comportamental nociceptiva manifestada no curto, mas não a médio ou longo prazo. Biomarcadores de neuroplasticidade, inflamação e danos celulares apresentaram poucas alterações sobre o insulto cerebral, mas mudanças mais pronunciadas foram observadas com relação à idade. / Neonatal hypoxia-ischemia (HI) is an important cause of neurological deficits. It is estimated that 3-5 in 1000 newborns suffer neonatal encephalopathy, and moderate or severe hypoxic-ischemic encephalopathy (HIE) in 0,5-1/1000 of the newborns. Approximately 10 to 60% of the children with HIE die, and at least 25% of the survivors present permanent deficits such as cerebral palsy, epilepsy and learning difficulties. Clinical and experimental evidence suggest that the exposure to noxious stimuli at the beginning of the life might result in long lasting changes in sensorial processing. Despite the magnitude of the problem, few is known regarding pain modulation and its involved mechanisms during the HI process in neonates and its life lasting consequences. Hence, the present thesis aimed to evaluate behavioral and biochemical responses in rats’ litters submitted to HI during their seventh day of life, evaluated at different ages. Male Wistar rats’ litters were randomized into 6 experimental groups: control, HI, ischemia, hypoxia, sham-ischemia and sham-hypoxia. The experimental model was the one of unilateral HI described by Levine (1960) and adapted by Rice et al (1981), inducing ischemia by occlusion of the left carotid artery, and hypoxia using hypoxic chamber with nitrogen 92% and oxygen 8%. Animals were evaluated in their 14th (P14), 30th(P30) and 60th (P60) postnatal day. To assess the thermal nociceptive response the tail flick and hot plate test were employed; and mechanical allodynia was assessed by means of the digital Von Frey test. To evaluate biomarkers, commercial BDNF and TNF kits with ELISA, and LDH kits with spectrophotometry were used. Neuronal activation was quantified by c-fos immunohistochemistry in CA1 and dentate gyrus of bilateral hippocampi. It was observed that rats with hypoxia and/or ischemia had irreversible diminution of neurons with c-fos activation in the CA1 area of the hippocampus ipsilateral to the insult. Higher sensitivity in animals with HI at P14 was observed in the Von Frey test, but was not observed at P30 or at P60. Irrespective of the experimental group, animals’ age played a significant role in the nociceptive behavioral response, as well as on the BDNF and TNF-α serum levels, but not on the LDH serum levels. In conclusion, cerebral HI insult induces a significant and irreversible reduction on neuronal activation ipsilateral to the insult, with evidence of a significant alteration on the nociceptive behavioral response manifested in the short, but not in the medium or long term. Biomarkers of neuroplasticity, inflammation and cellular damage present few alterations after the cerebral insult, however more pronounced changes were observed related with age.

A dor neuropática (DN) é causada por uma lesão primária ou por uma disfunção no sistema nervoso periférico (SNP) ou central (SNC), sendo que os principais sintomas são a alodinia mecânica e a hiperalgesia a estímulos térmicos e mecânicos. A DN apresenta resposta analgésica insuficiente com terapeuticas farmacológicas clássicas, sendo um desafio para o tratamento clínico. Técnicas de neuromodulação central, como a estimulação transcraniana por corrente contínua (ETCC), representam um recurso promissor no manejo da dor, uma vez que promovem neuroplasticidade em vias envolvidas com o processo doloroso, sendo um método não-invasivo que pode ser combinado com outras terapias. Sendo assim, o objetivo deste estudo foi investigar os efeitos do tratamento repetido com ETCC na resposta hiperalgésica térmica e mecânica em modelo experimental de DN. Adicionalmente, foram avaliados os níveis de IL-1β, IL-10, TNF-α e NGF em estruturas do SNC destes animais. Todos os procedimentos foram aprovado pela Comissão de Ética no Uso de Animais (CEUA/HCPA:120512). Oitenta e quatro ratos machos Wistar foram divididos em 7 grupos: controle, dor neuropática, dor neuropática+ETCC, dor neuropática+sham ETCC, sham dor neuropática, sham dor neuropática+ETCC e sham dor neuropática+sham ETCC. O modelo de DN foi induzido por meio de ligura parcial do nervo isquiático na pata esquerda. O sham do modelo de DN seguiu o mesmo protocolo, com simulação da ligadura parcial do nervo isquiático e o grupo controle não sofreu nenhuma manipulação. O tratamento com ETCC consistiu em 20minutos/dia/8 dias, com intensidade de 0,5mA. Para o sham do tratamento, os eletrodos foram apenas fixados à cabeça do animal durante 20 minutos/dia/8 dias, sem nenhuma estimulação. A hiperalgesia térmica e mecânica foi avaliada por meio dos testes da Placa Quente e de Von Frey, respectivamente, no tempo basal, 7 e 14 dias após a cirurgia e imediatamente, 24 horas e 7 dias após o final do tratamento. Os níveis de IL-1β, IL-10, TNF-α e NGF no cortex cerebral, medula espinhal e tronco cerebral foram determinados por ELISA 48 horas e 7 dias após o final do tratamento. A análise estatística para os testes nociceptivos foi realizada através da Generalized Estimation Equation (GEE)/Bonferroni e para as análises bioquímicas por ANOVA de uma via (IL-1β, IL-10, TNF-α ) e ANOVA de três vias (NGF). Os dados estão expressos como media+erro padrão da média, sendo considerado significativo p<0.05. Nossos resultados demonstraram que a DN altera os níveis de IL-1β, IL-10, TNF-α e NGF no SNC em curto e longo prazo. Além disso, a ETCC reduz a resposta nociceptiva a curto e longo prazo e na modulação dos níveis de citocinas no sistema nervoso central neste modelo. Evidencia-se a importância do papel do sistema imune central nos processos de continuidade da dor neuropática, que pode estar envolvido com as alterações neuroplásticas maladaptativas características dessa patologia. / Neuropathic pain (NP) is caused by a primary insult or dysfunction in the central or peripheral nervous system and its prevalence depends on the type of trauma and related dysfunction. The main symptoms are mechanical allodynia and hyperalgesia to both mechanical and thermal stimuli. NP often shows insufficient response to classic analgesics and remains a challenge to medical treatment and scientific research; and the search for new therapies for this pathology is of fundamental important. Central neuromodulation techniques, such as transcranial direct current stimulation (tDCS), represent a promising resource to pain management since they promote neuroplasticity in the central system of pain. Moreover, tDCS has the advantages of being a noninvasive technique and can be combined with other interventions. The aim of this study was investigated the effects of tDCS in the thermal and mechanical hyperalgesia induced by chronic constriction injury (CCI) of sciatic nerve and measured its effect on the neurochemical markers (IL-1β, IL-10, TNF-α, and NGF levels) on central nervous system structures. All experiments and procedures were approved by the Institutional Animal Care and Use Committee (GPPG-HCPA No.120512) and performed in accordance with the Guide for the Care and Use of Laboratory Animals 8th ed. The CCI of sciatic nerve was used for the induction of NP. For sham surgery, the sciatic nerve was exposed similarly, but it was not ligated. The control group did not undergo surgical procedure. After the establishment of NP, the rats of treated groups were subjected to a 20 minutes session of anodal tDCS, every afternoon for eight days, under a direct constant current of 0.5 mA intensity. The thermal and mechanical hyperalgesia was assessed by Hot plate and Von Frey test, respectively, and evaluated on baseline, 7 and 14 days after surgery; immediately, 24 hours and 7 days after treatment. The IL-1β, IL-10, TNF-α and NGF levels on cortex, spinal cord and brainstem were determined by sandwich-ELISA at 48 hours and 7 days after the end of treatment. Data were expressed as the mean±standard error of the mean (S.E.M). Generalized Estimating Equation (GEE) followed by Bonferroni was performed to compare all groups in different times of nociceptive tests and to biochemical data the one-way ANOVA was used to compare the IL-1β, IL-10, TNF-α and three-way ANOVA was used to compare the NGF levels. P-values less than 0.05 were considered significant. SPSS 19.0 for Windows was used for statistical analysis. In summary, we showed that anodal tDCS is effective to relieve NP and modulate cytokine in CCI rat model, and its effect is observed at long-term. In addition, the CCI model induced increased NGF levels in cerebral cortex and spinal cord at long-lasting time, evidencing the important feature of this neurotrophin in neuropathic pain condition. Additionally, we observed an important role of the central immune system in the neuropathic process, which can be involved with the maladaptative neuroplastic changes.

Estudos epidemiológicos e moleculares têm sugerido que o HPV é o principal fator de risco para o desenvolvimento de lesões malignas na cérvice uterina. E, sendo o número de infecções extremamente maior do que o número de casos de câncer cervical, este fato nos leva à investigação de outros fatores associados, como por exemplo, a predisposição imunológica do hospedeiro. Este estudo tem como objetivo avaliar a associação dos polimorfismos (-1082A/G) e (-308 A/G), localizados nos genes da IL-10 e TNF-α, respectivamente, com a infecção genital pelo Papilomavírus Humano (HPV), incluindo os tipos oncogênicos HPV-16, 18 e 31, visto que, estas citocinas são moléculas importantes na resposta imune contra infecções virais. Trata-se de um estudo de casos e controles. O grupo controle foi composto por 211 mulheres, que apresentavam resultado negativo para infecção genital por HPV, identificada através da técnica de Reação em Cadeia da Polimerase (PCR) e exame citopatológico sem alterações. Já os casos, corresponderam a 84 mulheres com infecção genital por HPV e resultado anatomopatológico alterado. A técnica de amplificação refratária de mutações (ARMS-PCR) foi utilizada para a identificação dos polimorfismos. Regressão logística múltipla foi utilizada para verificar a associação das variáveis estudadas com o desfecho (infecção genital pelo HPV).O cálculo de Equilíbrio de Hardy-Weinberg foi utilizado para verificar se as freqüências alélicas e gentotípicas observadas estão de acordo com as esperadas na população em estudo. Para os resultados de IL-10, a freqüência genotípica observada nos casos foi de 11,9% (AA), 28,6% (AG) e 59,5% (GG); a freqüência alélica foi de 26,0% para A e 74,0% para G. No grupo controle, a freqüência genotípica encontrada foi 22,8% (AA), 48,8% (AG) e 28,4% (GG); a freqüência alélica foi de 47,0% para A e 53,0% para G. Houve diferença significativa entre os grupos estudados, tanto para a freqüência alélica quanto para a genotípica (p<0,0001). Entre as mulheres com infecção, encontramos associação das lesões intraepiteliais escamosas de baixo grau (LGSIL) com o genótipo GG (p=0,02). As variáveis idade (RC=4,70; IC95%: 2,61-8,40), co-infecção por HIV (RC=11,21; IC95%:1,002-125,33) e o genótipo GG (RC=4,22; IC95%: 1,84-9,61) permaneceram independentemente associados ao desfecho (infecção genital pelo HPV). Para TNF-α, a homozigosidade do alelo G (genótipo GG) foi encontrada em maior freqüência nos casos (36,9%), seguido por 35,7% do genótipo AA e 27,4% do genótipo AG. Houve diferença significativa entre os grupos estudados, tanto para a freqüência alélica (p<0,0002) quanto para a genotípica: AA (p=0,03), AG e GG (p<0,0001). Analisando a associação com lesões cervicais e tipos oncogênicos, encontramos associação entre o genótipo GG e LGSIL (p<0,01). O genótipo GG está associado ao tipo oncogênico HPV-16 (p<0,05), e à co-infecção pelo vírus HIV (p<0,001). As variáveis idade (RC=3,46; IC95%: 1,89-6,33), os genótipos AG (RC=9,21; IC95%: 4,29-19,75) e AA (RC=2,73; IC95%: 1,25-6,00) permaneceram independentemente associados ao desfecho (infecção genital pelo HPV). Com estes resultados, é possível sugerir que a predisposição determinada geneticamente para a produção de altos níveis de IL-10 e TNF-α parece estar associada à infecção genital pelo HPV, mostrando a importância da resposta imunológica do hospedeiro no processo de infecção e na progressão das lesões cervicais geradas pelo Papilomavírus Humano. / Molecular and epidemiological studies have suggested that HPV is the most important risk factor for the development of malignant lesions in the uterine cervix. The fact that the number of HPV infections is extremely greater than the number of cervical cancer cases leads us to the investigation of other risk factors, such as the predisposition of the host immune. The present study aimed to evaluate the influence of genetic polymorphisms (-1082A/G) and (-308A/G), located in the genes of IL-10 and TNF-α, respectively, with the genital HPV infection, including oncogenic HPV-16, 18 and 31, since these cytokines are important molecules in the immune response against viral infections. This is a case-control study. The control group was composed by 211 women, who have tested negative for HPV genital infection by the Polymerase Chain Reaction (PCR) technique, and who had normal cytologic results. Cases were 84 women with HPV genital infection and abnormal anatomopathological results. The technique of amplification refractory mutation system (ARMS-PCR) was used to identify the polymorphisms. Multiple logistic regression was used to verify the association between the study factors and the outcome (genital infection by HPV). The Hardy-Weinberg equilibrium was used to verify whether the observed allelic and genotypic frequencies were according with the expected in the studied population. For the results of IL-10, the genotypic frequencies observed in the group of women with infection was 11.9% (AA), 28,6% (AG) and 59.5% (GG), the allelic frequency was 26.0% for 74.0% for A and G. In the control group, the frequency was found genotypical 22.8% (AA), 48.8% (AG) and 28.4% (GG), the allelic frequency was 47.0% to 53.0% for A and G. There were significant differences between groups, both for the allelic frequency as for the genotypic (p<0.0001). Among women with infection, we found association of injuries LGSIL with the GG genotype (p=0021). The variables age (OR=4.70; 95%IC: 2.61-8.40), HIV co-infection (OR=11.21; 95%IC: 1.002-125,33), and genotype GG (OR=4.22; 95%IC: 1.84-9.61) remained independently associated to the outcome (genital HPV infection). For TNF-α analysis, the genotypic frequencies observed in the group of patients was 22.0% (AA), 69.0% (AG) and 8.0% (GG), the allelic frequency was 57.0% and 43.0% for A to G. In the control group, the frequency genotype was found 35.0% (AA), 27.0% (AG) and 36.0% (GG), the allelic frequency was 49.0% for A and 51.0% for G. There were significant differences between groups, both for the allelic frequency (p<0.0002) and to the genotypic: AA (p=0.03), AG e GG (p<0.0001). Analysing the association with cervical lesions and with high-risk type, there was found a significant association, between the genotype GG and LGSIL (p<0.01). The genotype GG is associated with the HPV-16 infection (p<0.05) and with the HIV virus co-infection (p<0001). The variables age (OR=3.46; 95%IC: 1.89-6.33), genotypes AG (OR=9.21; 95%IC: 4.29-19.75) and AA (OR=2.73; 95%IC: 1.25- 6.00) remained independently associated to the outcome (genital HPV infection). The results suggest that the genetically determined predisposition to produce high levels of IL- 10 and TNF-α may be related to the genital HPV infection showing the importance of the host immune response in the progression of cervical lesions caused by the Human Papillomavirus.

A dor neuropática (DN) é causada por uma lesão primária ou por uma disfunção no sistema nervoso periférico (SNP) ou central (SNC), sendo que os principais sintomas são a alodinia mecânica e a hiperalgesia a estímulos térmicos e mecânicos. A DN apresenta resposta analgésica insuficiente com terapeuticas farmacológicas clássicas, sendo um desafio para o tratamento clínico. Técnicas de neuromodulação central, como a estimulação transcraniana por corrente contínua (ETCC), representam um recurso promissor no manejo da dor, uma vez que promovem neuroplasticidade em vias envolvidas com o processo doloroso, sendo um método não-invasivo que pode ser combinado com outras terapias. Sendo assim, o objetivo deste estudo foi investigar os efeitos do tratamento repetido com ETCC na resposta hiperalgésica térmica e mecânica em modelo experimental de DN. Adicionalmente, foram avaliados os níveis de IL-1β, IL-10, TNF-α e NGF em estruturas do SNC destes animais. Todos os procedimentos foram aprovado pela Comissão de Ética no Uso de Animais (CEUA/HCPA:120512). Oitenta e quatro ratos machos Wistar foram divididos em 7 grupos: controle, dor neuropática, dor neuropática+ETCC, dor neuropática+sham ETCC, sham dor neuropática, sham dor neuropática+ETCC e sham dor neuropática+sham ETCC. O modelo de DN foi induzido por meio de ligura parcial do nervo isquiático na pata esquerda. O sham do modelo de DN seguiu o mesmo protocolo, com simulação da ligadura parcial do nervo isquiático e o grupo controle não sofreu nenhuma manipulação. O tratamento com ETCC consistiu em 20minutos/dia/8 dias, com intensidade de 0,5mA. Para o sham do tratamento, os eletrodos foram apenas fixados à cabeça do animal durante 20 minutos/dia/8 dias, sem nenhuma estimulação. A hiperalgesia térmica e mecânica foi avaliada por meio dos testes da Placa Quente e de Von Frey, respectivamente, no tempo basal, 7 e 14 dias após a cirurgia e imediatamente, 24 horas e 7 dias após o final do tratamento. Os níveis de IL-1β, IL-10, TNF-α e NGF no cortex cerebral, medula espinhal e tronco cerebral foram determinados por ELISA 48 horas e 7 dias após o final do tratamento. A análise estatística para os testes nociceptivos foi realizada através da Generalized Estimation Equation (GEE)/Bonferroni e para as análises bioquímicas por ANOVA de uma via (IL-1β, IL-10, TNF-α ) e ANOVA de três vias (NGF). Os dados estão expressos como media+erro padrão da média, sendo considerado significativo p<0.05. Nossos resultados demonstraram que a DN altera os níveis de IL-1β, IL-10, TNF-α e NGF no SNC em curto e longo prazo. Além disso, a ETCC reduz a resposta nociceptiva a curto e longo prazo e na modulação dos níveis de citocinas no sistema nervoso central neste modelo. Evidencia-se a importância do papel do sistema imune central nos processos de continuidade da dor neuropática, que pode estar envolvido com as alterações neuroplásticas maladaptativas características dessa patologia. / Neuropathic pain (NP) is caused by a primary insult or dysfunction in the central or peripheral nervous system and its prevalence depends on the type of trauma and related dysfunction. The main symptoms are mechanical allodynia and hyperalgesia to both mechanical and thermal stimuli. NP often shows insufficient response to classic analgesics and remains a challenge to medical treatment and scientific research; and the search for new therapies for this pathology is of fundamental important. Central neuromodulation techniques, such as transcranial direct current stimulation (tDCS), represent a promising resource to pain management since they promote neuroplasticity in the central system of pain. Moreover, tDCS has the advantages of being a noninvasive technique and can be combined with other interventions. The aim of this study was investigated the effects of tDCS in the thermal and mechanical hyperalgesia induced by chronic constriction injury (CCI) of sciatic nerve and measured its effect on the neurochemical markers (IL-1β, IL-10, TNF-α, and NGF levels) on central nervous system structures. All experiments and procedures were approved by the Institutional Animal Care and Use Committee (GPPG-HCPA No.120512) and performed in accordance with the Guide for the Care and Use of Laboratory Animals 8th ed. The CCI of sciatic nerve was used for the induction of NP. For sham surgery, the sciatic nerve was exposed similarly, but it was not ligated. The control group did not undergo surgical procedure. After the establishment of NP, the rats of treated groups were subjected to a 20 minutes session of anodal tDCS, every afternoon for eight days, under a direct constant current of 0.5 mA intensity. The thermal and mechanical hyperalgesia was assessed by Hot plate and Von Frey test, respectively, and evaluated on baseline, 7 and 14 days after surgery; immediately, 24 hours and 7 days after treatment. The IL-1β, IL-10, TNF-α and NGF levels on cortex, spinal cord and brainstem were determined by sandwich-ELISA at 48 hours and 7 days after the end of treatment. Data were expressed as the mean±standard error of the mean (S.E.M). Generalized Estimating Equation (GEE) followed by Bonferroni was performed to compare all groups in different times of nociceptive tests and to biochemical data the one-way ANOVA was used to compare the IL-1β, IL-10, TNF-α and three-way ANOVA was used to compare the NGF levels. P-values less than 0.05 were considered significant. SPSS 19.0 for Windows was used for statistical analysis. In summary, we showed that anodal tDCS is effective to relieve NP and modulate cytokine in CCI rat model, and its effect is observed at long-term. In addition, the CCI model induced increased NGF levels in cerebral cortex and spinal cord at long-lasting time, evidencing the important feature of this neurotrophin in neuropathic pain condition. Additionally, we observed an important role of the central immune system in the neuropathic process, which can be involved with the maladaptative neuroplastic changes.

Objetivo: este estudo teve como objetivo avaliar as infecções por papilomavírus humano (HPV) e Chlamydia trachomatis (CT) em pacientes com artrite reumatoide (AR) pré e pós-terapia anti-TNF. Método: foram avaliadas 50 pacientes do sexo feminino com AR (preenchiam os critérios do Colégio Americano de Reumatologia) que eram elegíveis para terapia anti-TNF. Cinquenta pacientes foram incluídas no estudo de forma prospectiva. Destas, 45 pacientes foram reavaliadas após 6 meses de terapia anti-TNF. Inicialmente as 50 pacientes com AR foram comparadas com 50 controles saudáveis pareadas por idade. Foram avaliados dados demográficos, avaliação ginecológica (citologia cervical e avaliações histológicas), função sexual, parâmetros de doença e tratamento atual da AR. Os testes para detecções dos DNAs do HPV e CT nas espécimes cervicais foram realizados utilizando a captura híbrida II. Resultados: na avaliação inicial, a mediana da idade das pacientes com AR e controles foi de 49 (18-74) vs. 49 (18-74) anos, p = 1,0. Observou-se uma tendência de menor frequência de infecção por HPV nas pacientes com AR pré anti-TNF em relação aos controles (14% vs. 30%, p = 0,054). Adicionalmente, realizou-se avaliação das pacientes com AR com infecção positiva e negativa por HPV antes da terapia anti-TNF que demonstrou que o primeiro grupo apresentou maior frequência de relações sexuais (100% vs. 48%, p = 0,014), maior número de parceiros sexuais [1 (1-1) vs. 0 (0-1), p = 0,032] e maior frequência de citologia cervical anormal (43% vs. 7%, p = 0,029). A idade atual, a duração da doença, os parâmetros da doença e os tratamentos foram semelhantes em ambos os grupos (p > 0,05). Após 6 meses de terapia anti-TNF, a infecção por HPV permaneceu inalterada em cinco pacientes, enquanto que dois tornaram-se negativos e uma paciente adicional tornou-se positiva (p = 1,0). A infecção por CT foi uniformemente negativa nas pacientes com AR pré e pós-TNF, assim como nas controles. Conclusões: a infecção por HPV observada nas pacientes sexualmente ativas com AR antes da terapia anti-TNF foi leve, sem evidência de infecção por CT. A terapia anti-TNF não aumentou o risco de exacerbação e/ou progressão das infecções por HPV e CT em pacientes com AR / Objective: to evaluate human papillomavirus (HPV) and Chlamydia trachomatis (CT) infections in rheumatoid arthritis (RA) patients pre- and post-TNF blocker. Methods: fifty female RA patients (American College of Rheumatology criteria), who were eligible to anti-TNF therapy, [n = 50 at baseline (BL) and n = 45 after 6 months of treatment (6M)] and 50 agematched healthy controls were prospectively enrolled. They were assessed for demographic data, gynecologic, sexual, cervical cytology and histological evaluations, disease parameters and current treatment. HPV DNA and CT DNA testing in cervical specimens were done using Hybrid Capture II assays. Results: at BL, the median current age of RA patients and controls was 49(18-74) vs. 49(18-74) years, p = 1.0. A trend of lower frequency of HPV infection was observed in AR patients pre anti-TNF compared to controls (14% vs. 30%, p = 0.054). Further evaluation of AR patients with and without HPV infection before anti-TNF therapy showed that the former group had higher frequency of sexual intercourses (100% vs. 48%, p = 0.014), higher median number of sexual partners [1(1-1) vs. 0(0-1), p=0.032] and higher frequency of abnormal cervical cytology (43% vs. 7%, p = 0.029). Current age, disease duration, disease parameters and treatments were alike in both groups (p > 0.05). At 6M after TNF blockage, HPV infection remained unchanged in five patients, whereas two became negative and one additional patient turn out to be positive (p = 1.0). CT infection was uniformly negative in RA patients pre- and post-TNF blockage and in controls. Conclusions: anti-TNF does not seem to increase short-term risk of exacerbation and/or progression of HPV and CT infections in RA patients

Il est maintenant admis que l’activité anti-tumorale du TNF implique une destruction de la vascularisation de la tumeur par induction d’apoptose des cellules endothéliales. Si le traitement au TNF en thérapie humaine permet des rémissions complètes, il n’est applicable qu’aux membres isolés de la circulation systémique car les doses requises de TNF sont létales pour le patient. Mettre en évidence les mécanismes qui contrôlent l’apoptose de la cellule endothéliale devrait permettre de développer de nouvelles stratégies thérapeutiques favorisant l’effet thérapeutique du TNF tout en évitant le choc septique qu’il engendre.<p><p>Nous avons abordé cette question en utilisant le modèle de la cellule endothéliale d’aorte bovine (BAEC) stimulée au TNF afin d’étudier les mécanismes qui contrôlent le processus apoptotique et ce au cours des phases précoces de celui-ci.<p><p>D’une part, nous avons identifié par une approche pharmacologique au moins trois voies de contrôle négatif d’induction de mort cellulaire par le TNF dans les cellules endothéliales :la première faisant intervenir une des protéines kinases C, une seconde la PI3-kinase et une troisième la protéine kinase p38. Cette dernière semble spécifiquement activée par le TNF et pourrait donc constituer une nouvelle cible pharmacologique visant à sensibiliser les cellules endothéliales de la vascularisation de la tumeur à l’action apoptotique du TNF. <p>D’autre part nous avons mis en évidence et identifié par une approche protéomique au moins deux protéines montrant une rapide diminution de phosphorylation lorsque les cellules endothéliales sont stimulées par le TNF en présence de cycloheximide. Ces deux événements semblent en aval de l’activation d’une protéase de la famille des caspases. La première protéine est la sous-unité régulatrice de type II alpha (RIIα) de la protéine kinase A. Cependant, la relation entre cette déphosphorylation et le processus d’apoptose n’a pas pu être mise en évidence, une stimulation de l’activité PKA n’affectant pas l’induction d’apoptose des BAEC. La seconde est la protéine HDGF, connue pour être sur-exprimée dans certains cancers, mais dont la régulation par phosphorylation ainsi que son implication éventuelle lors du processus apoptotique n’avaient encore jamais été envisagées.<p><p>Enfin, nous avons voulu mettre en évidence le rôle potentiel de la protéine hnRNP K qui subit une modification post-traductionnelle précoce lors de l’apoptose des BAEC. Notre étude, menée après surexpression de la protéine étiquetée, suggère une modification autre qu’une dégradation. Cependant, il ne nous a pas été permis de lui attribuer un rôle puisque la surexpression de cette protéine n’affecte pas l’apparition de différents marqueurs associés à l’apoptose. / Doctorat en sciences, Spécialisation biologie moléculaire / info:eu-repo/semantics/nonPublished

The redox state in the cell plays a major role in determining vital functions and its major imbalance can lead to severe cell injury or death. Redox active proteins and cytokines involved in this process includes thioredoxin (Trx), protein disulfide isomerase (PDI), and tumor necrosis factor (TNF) superfamilies. Trx is a multipotent protein and key regulator of cellular redox balance operating in synergy with Trx reductase and NADPH (the Trx system). Trx has gene regulatory activity of several transcription factors. It also controls in a fascinating way redox-sensitive “on-off” decisions for apoptotic or hypertrophic pathways. Trx protects against H2O2 and TNFmediated cytotoxicity, a pathway in which TNF receptor-binding generates ROS. TNF is an autocrine growth factor and survival factor in vitro and in vivo for B-type of chronic lymphocytic leukemia (B-CLL) cells. The overall aim of this study was to investigate the importance of redox active proteins and cytokines in inflammation and cancer. We focused on: i) the role of Trx, TrxR, and selenium in carcinogenesis and in resistant cancer cells. ii) the importance of Trx in cancer cells and the redox regulation of TNF and its receptors TNFR1 and TNFR2. iii) the potential role of Trx as a key regulator in cellular redox balance, in the pathogenesis of cardiac dysfunction; its relationship to stress response parameters. iv) whether unmutated CLL (UCLL) responses to PKC and ROS pathways were different from mutated CLL (M-CLL) responses. Our results demonstrate pronounced selective selenium-mediated apoptosis in therapy resistant cells and suggest that redox regulation through the Trx system is an important target for cancer therapy. Trx was strikingly elevated in heart failure cases compared with controls signifying an adaptive stress response that is higher the more severe the disease. TNF autocrine release was redox modulated and the TNF receptors interacted at the cell surface membrane with the redox-active PDI, which excerted a stringent redox-control of the TNFR signaling. The proliferative response as well as increase of autocrine TNF and Trx were higher in U-CLL than in M-CLL. The overall conclusion of the four papers included in this thesis is that redox-active proteins and cytokines plays an important role in control and regulation of cancer and inflammation. Furthermore, redox regulation via thioredoxin by selenium, may offer novel treatment possibilities for resistant tumors disease.

Abstract Apoptosis plays a crucial part in human ovarian function from fetal development to the end of reproductive potential. Failures in the regulation of ovarian apoptosis are associated with many pathological conditions such as premature ovarian insufficiency, infertility and cancer. The purpose of the present study was to analyze the factors regulating cell survival in human fetal and adult ovaries. The fetus is exposed to maternal- and placental-derived estrogens and insufficient estrogen action has destructive effects on rodent ovarian development. We detected estrogen receptors and estrogen-converting enzymes in human fetal ovaries after primordial follicle formation, indicating that estrogens participate in human fetal ovarian development, especially after folliculogenesis. The WNT4 gene is crucial for female sexual differentiation, follicle formation and oocyte survival. We detected WNT4 in follicular cells of fetal and adult human ovaries. In addition, Wnt4- knockout mice demonstrated a dramatic loss of oocytes before birth. However, no changes were detected in protein expression patterns of common apoptosis-related proteins. The results support the possible role of WNT4 in human ovarian function and strengthen previous knowledge on the antiapoptotic role of Wnt4. Apoptosis signaling is mediated by extracellular- and mitochondria-associated- pathways, ending in caspase cascade activation and fragmentation of cellular structures. In the present study we analyzed the expression of several apoptosis-related factors and detected TRAIL, TNF, Bcl-XL, Bok and caspase-3 in human ovaries. In addition, TRAIL was found to be a potent and rapid inducer of human granulosa tumor cell (KGN) apoptosis. Lentiviral downregulation of Bok or Bcl-XL protein expression in KGN cells also resulted in significant changes in cell vulnerability to apoptosis. The results show for the first time the spatiotemporal expression patterns of TRAIL, TNF, Bcl-XL, Bok and caspase-3 in human ovaries and suggest an important functional role of TRAIL, Bok and Bcl-XL in regulation of human ovarian apoptosis. The present study offers novel information on the expression and function of cell survival factors in human ovaries. These new findings open possibilities for future clinical research in attempts to understand and treat ovarian diseases caused by imbalanced regulatory pathways of apoptosis.

Le développement de la réponse immunitaire innée de l’hôte au cours des infections respiratoires nécessite la mise en place rapide d'un réseau moléculaire et cellulaire relativement complexe ayant pour but de contrôler la croissance microbienne ainsi que permettre son éradication. Dans certaines circonstances, et malgré l’existence de vaccins et d'antibiotiques efficaces, l’infection par Streptococcus pneumoniae peut aboutir à des pathologies graves telles qu'une pneumonie, une méningite et/ou une septicémie. Ainsi, à l'heure actuelle, les maladies associées au pneumocoque sont encore loin d'être sous contrôle. Dans ce contexte, une meilleure compréhension de la réponse immunitaire innée de l’hôte contre ce pathogène est nécessaire.Mes travaux de thèse ont permis pour la première fois de mettre en évidence la fonctionnalité et la relevance biologique de l’inflammasome NLRP3 au sein des neutrophiles pulmonaires in vivo dans un modèle d’infection respiratoire par S. pneumoniae.Ainsi, de façon inattendue, les neutrophiles jouent un rôle accessoire original à des temps précoces de l’infection via leur capacité à produire de l’IL-1β. Cette synthèse protéique est possible grâce à la combinaison de 2 signaux à la fois dérivés de l’hôte (TNF-α des macrophages alvéolaires) et de la bactérie (toxine). Ces deux signaux permettent l’assemblage et l’activation de l’inflammasome NLRP3 neutrophilique. D’un point de vue translationnel, nous avons été capables de démontrer un mécanisme similaire avec des neutrophiles humains.Cette production d’IL-1β par les neutrophiles participe à l’activation des lymphocytes T γδ producteurs d’IL-17; une cytokine essentielle dans le contrôle de l’infection bactérienne via sa capacité à induire rapidement le recrutement d’une deuxième vague de neutrophiles participant directement à l’élimination et la clairance bactérienne.Sur la base de ces travaux fondamentaux, nous avons émis l’hypothèse qu’une augmentation du pool de cellules innées sécrétrices d’IL-17A pourrait avoir un effet bénéfique sur le contrôle d’une infection respiratoire à pneumocoque. Ainsi via l’administration prophylactique et locale d’IL-7, nous avons été capables d’augmenter la fréquence et le nombre de lymphocytes innés producteurs d’IL-17A résultant en un meilleur contrôle de la charge bactérienne pathogène associée à une augmentation du recrutement neutrophilique. A ce stade, ces résultats encourageants, nous pousse à mieux comprendre les mécanismes moléculaires et cellulaires associés à cet effet dans l’éventualité de proposer à terme une nouvelle approche thérapeutique dans le contrôle des infections respiratoires pulmonaires basée sur la manipulation de la biologie de l’IL-7. / The mounting of an appropriate host innate immune response in the lungs requires the rapid establishment of a complex cellular and molecular networking that allows the containment and clearance of pathogens during respiratory infections. Both neutrophils and γδT cells are central players in the host response during mucosal infections. Using a model of invasive pneumococcal disease, we illustrated a role for Interleukin-17A in controlling neutrophil recruitment, bacterial loads and survival. Following Streptococcus pneumoniae infection, we defined pulmonary γδT cells, especially the lung resident Vγ6Vδ1+ subset, as the primary source of IL-17A in an IL-23/IL- 1β-dependent manner. Using gene-targeted mice, we demonstrated that γδT cells largely contributed to neutrophilia and to the control of the pathology. Furthermore, we now defined a second and unexpected early role for neutrophils as accessory cells in γδT17 cell activation through IL-1β secretion. Neutrophil-derived IL-1β was dependent on NLRP3 inflammasome activity and required alveolar macrophage-secreted TNF-α for priming and bacterial pneumolysin for NLRP3- dependent caspase-1 activation. This report thus brings to light the sequential molecular/cellular events leading to γδT17 cell activation and highlights the existence of a biologically relevant and fully functional NLRP3 inflammasome in pulmonary neutrophils that regulates a key immune axis in the development of protective innate response to respiratory bacterial infection.Based on these observations, we hypothesized that an increase in the pool of IL-17A-producing innate-like T lymphocytes might play a protective role during pneumococcal infection. As recently suggested, we demonstrated that intranasal IL-7/M25 complex administration into naïve mice allowed the expansion of the cellular pool of innate immune cells presenting a Th17-like phenotype in the lungs especially T cells. Moreover, we showed during S. pneumoniae infection that prophylactic IL-7/M25 treatment increased the capacity of Vγ6Vδ1+ T cells to produce IL-17A. Interestingly, this phenotype led to higher neutrophil recruitment and a better control of bacterial burden in the lungs as well as systemic dissemination. Thus, we report a critical role of IL-7 in creating an IL-17-enriched microenvironment which improves the early development of host innate immune response to respiratory bacterial infection. This observation might pave the way to the development of future innovative cytokine/cell-based strategies against Streptococcus pneumoniae.