Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Em estudo anterior, as espécies de enterobactérias apresentando perfis variados de resistência aos antimicrobianos foram detectadas em 20% dos sítios com lesões periodontais de pacientes sadios do ponto de vista sistêmico. Tais cepas microbianas foram submetidas a investigações com o intuito de determinar à expressão de enzimas hidrolíticas para substratos diversos, a multirresistência aos agentes antimicrobianos e os mecanismos de resistência aos antimicrobianos da classe dos β lactâmicos. A maioria das amostras expressou atividade de gelatinase (65%), caseinase (30%) e elastase (10%). Lipase, lecitinase e DNase foram observadas apenas para Serratia marcescens. A multirresistência (considerado como a resistência a pelo menos dois agentes antimicrobianos de famílias diferentes) foi observada em 56% das amostras isoladas. A maioria das cepas foi resistentes à ampicilina (93,75%) e amoxicilina/ácido clavulânico (81,25%). Investigações sobre a resistência aos antibióticos β-lactâmicos mostraram que três amostras resistentes à cefalosporinas de 2 geração, apresentaram perfis plasmidiais de diferentes pesos moleculares. A expressão fenotípica de β-lacatamases, foi detectada nas cepas de Enterobacter cloacae (PcOM46 e PcOM5) e S. marcescens (PcOM63). No entanto, na análise molecular, não foi possível confirmar a expressão fenotípica de diferentes β-lactamases, com exceção do E. cloacae PcOM46, que apresentou amplificação para AmpC e blaTEM. Embora sensível à maioria dos antibióticos β-lactâmicos (exceção feita à ampicilina e amoxicilina / ácido clavulânico), amostra de S. marcescens PcOM68 apresentou amplificação para o gene blaSHV. Os experimentos de conjugação não detectaram a transferência de plasmídios para uma cepa de Escherichia coli K12 sensívei aos β-lactâmicos, o mesmo ocorreu nos procedimentos de transformação por eletroporação e por CaCl2, sugerindo uma resistência dependente de genes cromossomiais. A expressão de diferentes atividades enzimáticas, juntamente com a resistência aos antimicrobianos, aponta estes grupos de bactérias como agentes patogênicos potenciais capazes de contribuir para a patogênese e resposta à quimioterapia antimicrobiana nas doenças periodontais, além da disseminação sistêmica para outros locais do corpo, especialmente em indivíduos imunocomprometidos. A colonização prévia de lesões periodontais por espécies resistentes aos β-lactâmicos, pode contribuir para a disseminação destes genes relacionados à resistência aos antimicrobianos em ambientes hospitalares. / In a previous study, the enterobacterial species were detected in 20% of systemically healthy patients presenting periodontal lesions, with different profiles of antimicrobial resistance. These microbial strains were investigated in view to determine the expression of hydrolytic enzymes for diverse substrates, multiresistance to antimicrobial agents, and the mechanisms of resistance to beta-lactam antibiotics. The enzymes related to bacterial virulence were detected phenotypically in 90% isolates. The proteolytic activity displayed by the isolates against gelatin, casein and elastin was detected in 65%, 30% and 10%, respectively. Lipase, lecithinase, and DNase were observed only for Serratia marcescens strains. Multi-resistant phenotypes (considered as the resistance to at least two antimicrobial agents from different families) were observed for 56% enterobacterial isolates. Most of the strains were resistant to ampicillin (93.75%) and amoxicillin/clavulanic acid (81.25%). Investigations concerned to the resistance to beta-lactam antibiotics demonstrated that three bacterial strains resistant to penicilins and 2nd generation cephalosporins, had detectable plasmids. The extended resistance to β-lactams was detected phenotypically for E. cloacae PcOM46 and PcOM5) and S. marcescens (PcOM63) strains. However, the molecular detection of extended spectrum beta-lactamase failed to confirm the phenotypic expression of different β-lactamases, with exception to the E. cloacae PcOM46 isolate, which presented amplification for both ampC and blaTEM. Although sensitive to most of the β-lactam antibiotics (exception made to ampicilin and ampicilin/clavulanate), the strain S. marcescens PcOM68 was shown to amplify the blaSHV gene. Plasmid transference by both conjugation and transformation procedures failed to detect the resistance by a β-lactam-sensitive strain (E. coli K12), suggesting a chromosomal dependent resistance. The expression of varied enzymatic activities along with the resistance to antimicrobial agents point these group of bacteria as potential pathogens that may contribute to both pathogenesis and antimicrobial management of periodontal diseases, and systemic dissemination to other body sites, specially in immunocompromised host. The previous colonization of periodontal lesions by β-lactam resistant species may represent a threat for dissemination of genes related to antimicrobial resistance inside hospital environments.

Introdução: estudos de farmacocinética/farmacodinâmica (FC/FD) observaram que a probabilidade de alcançar o alvo FC/FD é maior quando a dose do beta-lactâmico é otimizada. Porém, poucos estudos demonstraram que a otimização de dose resulta em melhores desfechos clínicos. Métodos: Fatores associados com mortalidade em 30 dias foram avaliados em 100 pacientes com bacteremia por enterobactérias tratados com cefepime, piperacilina-tazobactam ou meropenem em um estudo de coorte prospectivo. Posologia dos antibióticos foi classificada em otimizada, apropriada e potencialmente inapropriada. Resultados: Cinquenta e dois (52%) episódios foram causados por E. coli, seguidos por K. pneumoniae (10%). Dezesseis (16%) episódios foram causados por isolados resistentes à cefepime e não houve nenhum caso de resistência à carbapenêmicos. A maioria dos isolados apresentou concentrações inibitórias mínimas (CIMs) baixas para as drogas prescritas (≤0.5, ≤1.0, ≤1/4 mg/L, para meropenem, cefepime e piperacilina-tazobactam respectivamente). Cefepime foi o antimicrobiano mais frequentemente prescrito para tratamento empírico e definitivo. Terapia otimizada foi observada em 42% dos pacientes e terapia adequada em 58%. A mortalidade em 30 dias foi 37%. Escore de Pitt, Charlson e apresentação com sepse severa foram independentemente associados à mortalidade. Não houve diferença em mortalidade entre os pacientes que receberam terapia otimizada e terapia adequada. Conclusões: os resultados mostram que a otimização das doses de cefepime, piperacilina-tazobactam e meropenem não teve impacto em mortalidade Em pacientes recebendo terapia empírica apropriada para bacteremias por Enterobacteriaceae. Este achado pode ser devido aos baixos valores de CIM apresentados pelas bactéria. Comorbidades e a severidade da apresentação são fatores associados à pior evolução. / Background: Pharmacokinetic/pharmacodynamic (PK/PD) studies have shown that the probability of PK/PD target attainment is higher when optimized dosage regimes of beta-lactams are employed, but few studies have shown clinical benefit of such strategy. Methods: We investigated the effect of dosage regimes in 30-day mortality in 100 patients with Enterobacteriaceae bloodstream infections (BSIs) receiving appropriate empirical therapy with cefepime, piperacillin-tazobactam or meropenem. Posology of antibiotic was classified as optimized, adequate and possibly inadequate. Results: Most isolates presented relatively low MIC for the prescribed drugs (≤0.5, ≤1.0, ≤1/4 μg/mL, for meropenem, cefepime and piperacillin-tazobactam respectively). Cefepime was the most common prescribed drug for empirical and main therapy. Optimized posology was prescribed in 42% of patients and adequate in 58%. The overall 30-day mortality was 27.0%. Charlson score, Pitt score and presentation with severe sepsis were independently associated with the 30-day mortality. Patients receiving optimized dosage regime presented no distinct 30-day mortality of those with adequate ones (25.0% versus 28.3%, P=0.89), even after inclusion in multivariate model. Conclusion: Our results suggest that dosage regime optimization of cefepime, piperacillin-tazobactam and meropenem may have no effect on mortality when infecting bacteria with low MICs for these drugs. In patients receiving appropriate empirical therapy for Enterobacteriaceae BSI, baseline comorbidity is an independent predictor of death and the severity of BSI presentation is also significantly associated with this outcome is such patients. Studies in population with higher MIC heterogeneity are required to evaluate the role of optimized doses in clinical setting.

Introdução: estudos de farmacocinética/farmacodinâmica (FC/FD) observaram que a probabilidade de alcançar o alvo FC/FD é maior quando a dose do beta-lactâmico é otimizada. Porém, poucos estudos demonstraram que a otimização de dose resulta em melhores desfechos clínicos. Métodos: Fatores associados com mortalidade em 30 dias foram avaliados em 100 pacientes com bacteremia por enterobactérias tratados com cefepime, piperacilina-tazobactam ou meropenem em um estudo de coorte prospectivo. Posologia dos antibióticos foi classificada em otimizada, apropriada e potencialmente inapropriada. Resultados: Cinquenta e dois (52%) episódios foram causados por E. coli, seguidos por K. pneumoniae (10%). Dezesseis (16%) episódios foram causados por isolados resistentes à cefepime e não houve nenhum caso de resistência à carbapenêmicos. A maioria dos isolados apresentou concentrações inibitórias mínimas (CIMs) baixas para as drogas prescritas (≤0.5, ≤1.0, ≤1/4 mg/L, para meropenem, cefepime e piperacilina-tazobactam respectivamente). Cefepime foi o antimicrobiano mais frequentemente prescrito para tratamento empírico e definitivo. Terapia otimizada foi observada em 42% dos pacientes e terapia adequada em 58%. A mortalidade em 30 dias foi 37%. Escore de Pitt, Charlson e apresentação com sepse severa foram independentemente associados à mortalidade. Não houve diferença em mortalidade entre os pacientes que receberam terapia otimizada e terapia adequada. Conclusões: os resultados mostram que a otimização das doses de cefepime, piperacilina-tazobactam e meropenem não teve impacto em mortalidade Em pacientes recebendo terapia empírica apropriada para bacteremias por Enterobacteriaceae. Este achado pode ser devido aos baixos valores de CIM apresentados pelas bactéria. Comorbidades e a severidade da apresentação são fatores associados à pior evolução. / Background: Pharmacokinetic/pharmacodynamic (PK/PD) studies have shown that the probability of PK/PD target attainment is higher when optimized dosage regimes of beta-lactams are employed, but few studies have shown clinical benefit of such strategy. Methods: We investigated the effect of dosage regimes in 30-day mortality in 100 patients with Enterobacteriaceae bloodstream infections (BSIs) receiving appropriate empirical therapy with cefepime, piperacillin-tazobactam or meropenem. Posology of antibiotic was classified as optimized, adequate and possibly inadequate. Results: Most isolates presented relatively low MIC for the prescribed drugs (≤0.5, ≤1.0, ≤1/4 μg/mL, for meropenem, cefepime and piperacillin-tazobactam respectively). Cefepime was the most common prescribed drug for empirical and main therapy. Optimized posology was prescribed in 42% of patients and adequate in 58%. The overall 30-day mortality was 27.0%. Charlson score, Pitt score and presentation with severe sepsis were independently associated with the 30-day mortality. Patients receiving optimized dosage regime presented no distinct 30-day mortality of those with adequate ones (25.0% versus 28.3%, P=0.89), even after inclusion in multivariate model. Conclusion: Our results suggest that dosage regime optimization of cefepime, piperacillin-tazobactam and meropenem may have no effect on mortality when infecting bacteria with low MICs for these drugs. In patients receiving appropriate empirical therapy for Enterobacteriaceae BSI, baseline comorbidity is an independent predictor of death and the severity of BSI presentation is also significantly associated with this outcome is such patients. Studies in population with higher MIC heterogeneity are required to evaluate the role of optimized doses in clinical setting.

Objetivos: Avaliar a adequabilidade do modelo farmacocinético-farmacodinâmico (PK-PD) (NOLTING et al., 1996b) para modelar o efeito bactericida da piperacilina (PIP) em ratos Wistar infectados experimentalmente com Escherichia coli ATCC 25922. Metodologia: Experimentos de Farmacocinética: Determinou-se as concentrações plasmáticas totais e livres teciduais de PIP, através de microdiálise (MD), após administração de 240 mg/kg i.v. bolus a ratos Wistar granulocitopênicos (ciclofosfamida) infectados no músculo esquelético (105 UFC/mL) com E. coli. As amostras de plasma e de MD foram analisadas por CLAE. As sondas de MD foram calibradas por retrodiálise. Experimentos de Farmacodinâmica: Os animais imunodeprimidos e infectados foram tratados com PIP nas doses de 120 ou 240 mg/kg, em intervalos de 4/4, 6/6 e 8/8 horas por 24 h. Em tempos pré-determinados, os animais foram sacrificados (n = 3/tempo), o músculo infectado foi retirado, homogeneizado e o número de UFC/mL foi determinado em placas de ágar-sangue, após diluições sucessivas. Um grupo não tratado foi utilizado como controle. Modelagem PK-PD: A partir dos dados farmacocinéticos e farmacodinâmicos obtidos, avaliou-se efeito de morte bacteriana em função do tempo com o auxílio do programa de regressão não-linear SCIENTIST® v.2.0. Resultados e Discussão: Os parâmetros farmacocinéticos após a administração de PIP (240 mg/kg) foram t½ de 40 ± 8 min; CL de 0,46 ± 0,021 (L/h/kg) e um Vdss de 0,30 ± 0,06 L/kg. O perfil de PIP livre tecidual foi previsto a partir dos parâmetros plasmáticos utilizando ajuste simultâneo dos dados de plasma e tecido e um fator de proporcionalidade de 0,342 ± 0,101. Os parâmetros do modelo PK-PD obtidos foram: EC50 de 1,31 ± 0,27 μg/mL e kmax 1,39 ± 0,20 h-1. Os valores dos parâmetros da modelagem PK-PD obtidos in vivo diferiram dos descritos na literatura para o mesmo antibiótico e bactéria quando simulados in vitro. Conclusões: O modelo Emax-modificado descreveu os perfis de crescimento e morte bacteriana em função do tempo obtidos nas diferentes posologias testadas sendo adequado para modelagem PK-PD da piperacilina nas condições experimentais investigadas. / Purpose: The objective of this study was to model the killing effect of a β-lactam antibiotic, piperacillin (PIP), in neutropenic and E. coli ATCC 25922 infected rats after different dosing regimens using a modified Emax PK-PD model. Methodology: Pharmacokinetic studies: Total plasma and free tissue concentrations of PIP, determined by microdialysis, were investigated after i.v. bolus of 240 mg/kg of the drug to immunecompromised (cyclophosphamide) and E. coli infected (107 CFU) Wistar rats. Microdialysis probes recoveries were determined by retrodialysis. Plasma and tissue samples were analyzed by HPLC. Pharmacodynamic studies: The infected rats were treated with iv bolus PIP 120 mg/kg or 240 mg/kg q8h, q6h, q4h. Three animals were sacrificed at predetermined times up to 24 hours. The infected muscle was removed, homogenized and the number of CFU/mL was determined by plate counting after 24 hours of incubation at 37ºC. A control group without treatment was used. PK-PD modeling: PIP killing effect as a function of time was fitted using the Emax-modified model with the aid of a non-linear regression computer program SCIENTIST® v.2.0. Results and Discussion: The pharmacokinetic parameters determined for PIP 240 mg/kg iv bolus were: t½ of 40 ± 8 min; CL of 0.46 ± 0.021 (L/h/kg) and Vdss of 0.30 ± 0.06 L/kg. Piperacillin free tissue levels were predicted using plasma data ina a simultaneous fitting with a proportionality factor of 0.342 ± 0.101. The parameters derived from PK-PD modeling were: bacterial killing rate (kmax) of 1.39 ± 0.20 h-1 concentration to produce 50% of de maximum effect (EC50) of 1.31 ± 0.27 μg/mL. The PK-PD parameters determined in vivo were different from those reported for the same bacteria and drug in vitro. Conclusions: The Emax model adequately described PIP antibacterial effect in animals for the different dosing regimens investigated.

Orientador: Francisco Carlos Groppo, Pedro Luiz Rosalen / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T02:16:09Z (GMT). No. of bitstreams: 1 Baglie_Sinvaldo_D.pdf: 818069 bytes, checksum: 1c0d1eb4621ca27afda369d7e188a9a7 (MD5) Previous issue date: 2005 / Resumo: As concentrações de amoxicilina (AMO)em plasma e saliva e seus efeitos na microbiota oral de voluntários sadios foram analisados, em um estudo aberto, de forma aleatória, cruzado com dois períodos. AMO875 mg (Amoxicilina-EMS- medicamento teste e Amoxil@- medicamentoreferência) foi administrada para todos os voluntários com 1 semana de intervalo entre as doses. Amostras de plasma e saliva foram colhidas em um intervalo de até 12h após a administração. As concentrações plasmáticas de AMOforam obtidas por cromatografia líquida e espectrometria de massas com ionização por electrospray (LC-ESI-MS). As concentrações de amoxicilina em saliva foram analisadas por cromatografia líquida de alta eficiência (HPLC).As contagens dos microrganismos totais, anaeróbios e estreptococos foram obtidas em diferentes condições de cultura. ASC foi calculada pelo método de extrapolação dos trapezóides. Cmaxe Tmaxforam compilados dos dados de concentração-tempo. Análise de variância foi realizada usando dados logaritmicamente transformadospara ASCo-inf, ASCO-12h, Cmax e não transformados para Tmax.As médias (:1:dp) para ASCO-12h (jJg.h.mL-1),ASCo-inf (jJg.h.mL-1),Cmax (jJg.mL-1)and Tmax(h), foram respectivamente: 55,42(:1:16,85), 55,42 (:1:16,85), 18,59 (:1:6,3), 2,04(:1:0,75) para o medicamento teste e 51,11 (:1:18,9), 51,29 (:1:19,12), 17,83 (:1:5,86),2,02 (:i:O,87)para o medicamento referência. Intervalos de confiança (90%) para a razão das médias de AMO(testejreferência) para ASCO-12he Cmaxforam: 0,961-1,149 e 0,914 - 1,142, respectivamente. Tanto para as concentrações plasmáticas quanto para as salivares não foram observadas diferenças estatisticamente significantes entre os dois medicamentos (Teste t pareado, p>0.05). As contagens de microrganismos provindos da saliva não mostraram diferenças estatísticas (ANOVAde medidas repetidas, p>0.05) entre as duas formulações durante cada tempo. A partir de 60 min, uma redução estatisticamente significante (ANOVAde medidas repetidas, p<0.05) foi observada para todos os microrganismos. Os dois medicamentos foram considerados bioequivalentes baseado na razão e extensão de absorção e foram eficazes na redução dos microrganismos da microbiota oral avaliados até 12 horas / Abstract: The plasmatic and salivary concentration of amoxicillin(AMO)875mg and its effects on oral microbiota in healthy volunteers were assessed in an open, randomized, two-period crossover designo A single 875 mg oral dose of AMO (Amoxicillin-EMS- test formulation and Amoxil@- reference formulation) was administered to ali volunteers observing 1-week intervaI between doses. Blood and saliva samples were collected from pre-dose to 12 h. The concentrations of AMO, in plasma and saliva, were quantified by LC-ESI-MSand LCmethod, respectively. AUC was calculated by the trapezoidal rule extrapolation method. Cmaxand Tmax were compiled from the plasmatic concentration-time data. Streptococci, anaerobe, and total microorganisms' counts were obtained in different culture conditions. The mean values (:1:SD) for AUCO-12(lh1g.h.mL-1),AUCO-í(nlf1g.h.mL-1),Cmax(l1g.mL-1) and Tmax(h), were respectively: 55.42(:1:16.85), 55.42 (:I:16.85), 18.59 (:I:6.3), 2.04{:I:0.75) concerning the test formulation and 51.11 (:I:18.9), 51.29 (:I:1,9.12), 17.83 (:I:5.86), 2.02 (:1:0.87) concerning the reference formulation. Confidence intervals (90%) of amoxicillinmeans of AUCO-12ahnd Cmaxratios (testjreference) were: 0.961 - 1.149 and 0.914 - 1.142, respectively. No statistically significant differences were observed between the two formulations (t test, p>0.05) regarding AMOplasmatic and saliva concentrations. Saliva microorganisms counts did not show statistical differences (ANOVArepeated measures, p>0.05) between the two groups during each sampling time. Starting at 60 min, a statistically significant decrease (ANOYArepeated measures, p<0.05) was also observed for all microorganisms. Both formulations were bioequivalent based on both the rate and extent of absorption, and were effective in reduce microorganisms until 12 hours / Doutorado / Farmacologia, Anestesiologia e Terapeutica / Doutor em Odontologia

Pyrrolo [2,1-c] [1,4] benzodiazepine (PBD) is a class of natural products obtained from various actinomycetes which have both anti-tumor and antibiotic activities and can bind to specific sequences of DNA. PBD-dilactam was initially produced using isatoic anhydride and (L)-proline which was then converted to the PBD-thiolactam using Lawesson's reagent. Reaction of thiolactam with hydrazine in ethanol afforded PBD-11-hydrazinyl. Condensation of 11-hydrazinyl PBD with aldehydes possessing various substitutions was performed to obtain (S,E)-11-[2-(arylmethylene) hydrazono] pyrrolo [2,1-c] [1,4] benzodiazepine derivatives. 1HNMR, 13C-NMR, DEPT, IR, GC-MS and X-ray crystallography were used for the characterization. Inhibition activity of the products were carried out using TEM-1, AmpC and P99 β-lactamases. A minimal inhibition growth of 25% was observed for one of the selected PBDs on cancer cell line. A promising result was observed on preliminary cannabinoid binding activity test on one of the compounds.

Kritiskt sjuka patienter med infektioner är en börda för sjukvården och 70 % av alla patienter på intensivvårdsavdelningar är ordinerade antibiotika. Antibiotika binder till proteiner i blodet, men enbart den icke-proteinbundna (fria) fraktionen kan diffundera över kapillära membran och binda till receptorer. Standardproteinbindningsgrad för olika antibiotika har utvecklats från studier på friska frivilliga och doseringen av läkemedlen är anpassade därefter. Den totala koncentrationen av antibiotika i patienters blod är vanligen representativ för den farmakologiska effekten. Dock kan vissa sjukdomar påverka proteinbindningsgraden vilket resulterar i en större eller mindre mängd fria antibiotika i blodcirkulationen. Det här kan i sin tur resultera i toxicitet eller otillräcklig effekt av läkemedlet. Syftet med det här projektet var att utveckla en analytisk metod för att bestämma den fria koncentrationen av Beta-Lactam antibiotikan cefotaxim, flukloxacillin, kloxacillin och piperacillin i plasma. En metod utvecklades med ultrafiltrering för extraktion av den fria fraktionen och högupplösande vätskekromatografi och tandem masspektrometri, UHPLC-MS/MS, för kvantifiering av analyterna. Metoden validerades delvis enligt den Europeiska Läkemedelsmyndighetens riktlinjer för bioanalytisk metodvalidering. / Infections in critically ill patients are a problem for the healthcare system and at any one time, 70 % of all intensive care unit (ICU) patients are treated with antibiotics. Antibiotics bind to proteins in the blood, but only unbound drug can diffuse over capillary membranes and bind to the targeted receptor. Standard protein binding percentages for antibiotics have been developed from studies on healthy volunteers and dosing regimens for patients are adapted accordingly. The determination of the total concentration of antibiotics in patients’ blood samples is, based on the standard percentages, ordinarily representative for the pharmacological effect of the antibiotic. However, certain conditions that are common in critically ill patients can alter protein binding percentages, resulting in a larger or smaller unbound fraction. This in turn can result in toxicity or therapeutic failure. The aim of this project was to develop an analytical method for the determination of the unbound concentration of the Beta-Lactam antibiotics cefotaxime, flucloxacillin, cloxacillin and piperacillin in plasma. A method was successfully developed using ultrafiltration for the extraction of unbound analytes and ultra high performance liquid chromatography tandem mass spectrometry, UHPLC-MS/MS, for their quantification. The method was partly validated according to the European Medicines Agency’s guidelines on bioanalytical method validation.

Les accouchements prématurés restent un défi pour la médecine moderne. Malgré les efforts de préventions déployés, les taux de naissances prématurés sont en constante augmentation dans les pays industrialisés. Le récepteur interleukine-1 (IL-1R) a été étudié dans le but de développer des agents thérapeutiques pouvant prolonger la gestation et mener à des prognostiques néonataux. Dans cette optique, il y a été démontré que le peptide 101.10 possède a démontré une capacité à moduler le récepteur IL-1R, retarder les accouchements prématurés et réduire l’incidence de la rétinopathie prématurée par un mécanisme allostérique impliquant une signalisation biaisée. Dans le but d’étudier la conformation active du peptide 101.10 et d’en améliorer l’activité, nous avons développé une méthode pour introduire des α-amino γ-lactames β-substituées dans des séquences peptidiques. Appliquer cette stratégie au peptide 101.10 a permis d’améliorer la compréhension de la relation structure-activité pour la modulation allostérique du récepteur IL-1R. Les composés peptidomimétiques ont le potentiel de mimer la conformation et l’activité des peptides bioactifs. Ils offrent le potentiel d’améliorer la reconnaissance moléculaire, d’optimiser le transport à travers des différentes membranes biologiques et d’augmenter la résistance métabolique. Parmi les différentes classes de composés peptidomimétiques, les α-amino γ-lactames (Agl) permet de rigidifier par des liens covalents la chaine peptidique principale favorisant les structures secondaires de type tour β. Les analogues Agl β-substituées mimer et rigidifier la chaine latérale des acides aminés. Cette thèse introduit des méthodes efficaces pour la synthèse stéréocontrolée des résidus α-amino γ-lactames β-substituées possédant diverses fonctionnalités. L’introduction de ces résidus dans différents peptides bioactifs a été effectuée pour étudier leur relation structure-activité. En utilisant le peptide modulateur du récepteur IL-1R 101.10 comme peptide représentatif, la présente recherche a permis d’identifier de nouveaux agents tocolytiques qui peuvent prolonger la gestation et améliorer le pronostique néonatal. Dans le chapitre 2, des stéréo-isomères de (Agl) et β-hydroxy-α-amino-γ-lactam (Hgl) ont été utilisés pour étudier l’influence de la configuration du groupement hydroxyle sur la conformation et l’activité du peptide 101.10. L’orientation de ce groupement dans les peptides Agl et Hgl s’est avéré avoir une influence conformationnelle et sur l’activité. La spectroscopie par dichroïsme circulaire (CD) a illustré la propension de certains analogues, comme le [(3R,4S)-Hgl3]-101.10, à adopter des tours β. Les analogues Agl et Hgl ont été examinés dans une série d’essais in vitro et in vivo modélisant les accouchements prématurés. Dépendant de leur structure et configuration, les analogues lactames ont démontré une sélectivité fonctionnelle différente dans diverse processus biologiques, démontrant les particularités de divers phénotypes. Par exemple, l’inhibition des JNK et ROCK kinases s’est avérée importante respectivement dans leurs effets tocolytiques et dans la diminution de la vaso-oblitération. Notamment, parmi les douze analogues testés, [(3R,4S)-Hgl3]-101.10 s’est avéré démontrer la même activité in vitro et in vitro que le peptide parent. Dans le chapitre 3, des méthodes de déplacement du groupement hydroxyle des résidus Hgl ont permis l’introduction stéréosélective de substituent en position β des résidus Agl. Une combinaison de réaction de Mitsunobu sur les résidus trans Hgl et une ouverture nucléophile les sulfamidates cycliques dérivés des lactames cis, ont mené à l’obtention de mime rigidifiés de résidus Ser, Thr, Cys, Dap, Dab, His et Met. Dans le chapitre 4, différentes lactames β-substitués ont été introduits dans la séquence du peptide 101.10 par une combinaison de chimie en solution et sur support solide pour étudier d’avantage les éléments structurels nécessaire pour réguler l’activité et la signalisation de cette cytokine clef dans la médiation de l’inflammation. Considérant l’activité de l’analogue [(3R,4S)-Hgl3]-101.10, plusieurs analogues β-substitués possédant une orientation similaire pour la chaine principale et latérale ont été synthétisés. Certains analogues ont démontré une activité biologique prometteuse dans des modèles de rétinopathie et seront étudiés dans le futur. En conclusion, des méthodes de synthèse d’α-amino-γ-lactames et de leur contrepartie β-substitués et leur introduction dans des peptides d’intérêt pour étudier leur relation structure-activité ont été développés. En utilisant ces méthodologies sur le modulateur allostérique du récepteur IL-1R 101.10, le conformère actif in vivo responsable de l’activité tocolytique et protectrice contre la rétinopathie associée aux accouchements prématures ont été identifiés. Considérant l’utilité de la synthèse de lactames pour le développement d’agents susceptibles de prolonger la gestation et d’améliorer le prognostique associé aux accouchements prématurés, cette thèse a permis la conception de prototypes de médicaments pour traiter les accouchements prématurés ainsi que l’évaluation des contraintes structurelles pertinentes pour la biologie des peptides. / Preterm birth (PTB) is an unmet biomedical need. Despite efforts to counter the onset of preterm labor, the rate of premature birth has increased steadily in developed countries. The interleukin-1 receptor (IL-1R) has been pursued as a target for designing agents which can prolong labor and improve neonatal outcomes. Towards these goals, a lead peptide 101.10 had been shown to modulate the IL-1R, to delay PTB and to mitigate associated retinopathy of prematurity (ROP) by an allosteric mechanism featuring biased signaling. With the goals of understanding the active conformers and improving the activity of 101.10, methods were conceived for the synthesis and introduction of β-substituted α-amino γ-lactams into peptides. Applying such methods on 101.10 has provided insight into the structure-activity relationships required for allosteric modulation of the IL-1R. Peptidomimetics are promising structures that replicate peptide function and conformation. They offer the potential to improve molecular-recognition, to enhance transport across biological membranes, and to resist metabolism. Among peptidomimetic classes, α-amino γ-lactam (Agl) residues introduce covalent constraint to rigidify the peptide backbone and have been employed to favor turn secondary structures. β-Substituted Agl analogs offer additional potential to mimic and restrict peptide side-chain geometry. This thesis introduces effective methods for the stereo-controlled synthesis of β-substituted α-amino γ-lactams residues having various side chain functionality. Introduction of the parent Agl residue and β-substituted counterparts into biologically active peptides has been explored to study structure-activity relationships. Employing the IL-1R modulator 101.10 as a representative peptide, the described research has furnished novel labor delaying agents that can improve neonatal outcomes. In chapter 2, α-amino-γ-lactam (Agl) and β-hydroxy-α-amino-γ-lactam (Hgl) stereoisomers were employed to study the influence of configuration and hydroxyl group side chain on conformation and activity of the interleukin-1 receptor modulator peptide 101.10. The configuration and hydroxyl group side chain influenced the conformation and biological activity of Agl and Hgl-101.10 analogs. Circular dichroism (CD) spectroscopy illustrated β-turn conformers for specific analogs, such as [(3R,4S)-Hgl3]-101.10. The Agl and Hgl analogs were examined in a series of in vitro assays and in vivo models of PTB. Contingent on their structure vi and configuration, the lactam analogs exhibited different functional selectivity in the various biological pathways, and indicated the requirement for specific phenotypes. For example, inhibition of the JNK and ROCK kinase pathways were respectively shown to be important for delaying labor and diminishing vaso-obliteration in the PTB and ROP models. Notably, among the twelve analogs, [(3R,4S)-Hgl3]-101.10 was found to exhibit identical in vitro and in vivo activity as the parent peptide. In chapter 3, methods were developed for displacement of the β-hydroxy-α-amino-γ-lactam (Hgl) residue alcohol to introduce stereo-selectively different β-substituents on Agl residues. A combination of Mitsunobu chemistry on the trans Hgl residue, and nucleophilic ring opening of the cyclic sulfamidate derived from the cis lactam counterpart provided constrained mimics of Ser, Thr, Cys, Dap, Dab, His and Met residues. In chapter 4, various β-substituted lactams were introduced into the sequence of 101.10 by combination of solution and solid phases chemistry to further study the structural requirements for regulating the activity and signaling of this key cytokine mediator of inflammasome activation. Considering the activity of [(3R,4S)-Hgl3]-101.10, the β-substituted Agl analogs were synthesized possessing similar backbone and side chain configurations. Certain analogs exhibited promising biological activity in the ROP model meriting further study. In sum, methods were conceived for the synthesis and application of α-amino-γ-lactams and their β-substituted analogs to study peptide structure-activity relationships. Employing this chemistry on the IL-1R allosteric modulator 101.10 has identified the active conformer and in vitro activity responsible for ability to delay labor and mitigate retinopathy of prematurity. Considering the utility of the lactam synthesis methods for the development of improved agents for delaying labor and improving neonatal outcomes, this thesis has conceived useful prototypes for drugs to treat PTB, as well as useful methods for dissecting the structural requirements for peptide chemical biology.

Les taux de multi-résistance aux antibiotiques chez les entérobactéries sont croissants en milieu hospitalier en Tunisie. Cette évolution remet notamment en cause l'efficacité de certaines molécules d'importance clinique majeure telles que les ß-lactamines.Par ailleurs, la résistance aux ß-lactamines n'est pas restreinte aux bactéries responsables d'infections humaines, elleest également rencontrée chez les bactéries issues du milieu vétérinaire. C'est dans ce cadre que s'est inscrit ce travail de thèse, qui avait pour objectif d'identifier les mécanismes de résistance aux céphalosporines de dernière génération chez des souches bactériennes isolées des deux contextes (humain et animal), et de faire une caractérisation moléculaire des plasmides responsables dans le but de contribuer à une meilleure connaissance de l'épidémiologie comparée Homme/animal.La caractérisation génotypique a montré que, dans les deux contextes, l'enzyme CTX-M est largement dominante parmi les?-lactamases à spectre étendu (BLSE) identifiées. Plus spécifiquement, le plasmide CTX-M-1/IncI1/ST3, déjà bien implanté chez l'animal en Europe, est également très prévalent chez l'animal en Tunisie, qu'il s'agisse d'animaux de production ou de compagnie. Chez l'Homme, les souches hospitalières de K. pneumoniaeproduisent principalement l'enzyme CTX-M-15, dont le gène codant est porté par des plasmides de type IncFII.Egalement, une carbapénémase très récemment décrite (OXA-204) a été identifiée dans notre hôpital, associée à un plasmide du type IncA/C. Des gènes de résistance plasmidique aux fluoroquinolones ont également été décrits.Ces résultats d'épidémiologie moléculaire sont essentiels pour une meilleure compréhension des risques de transmission croisée entre l'Homme et l'animal, ainsi qu'entre différents contextes de soins (communauté et hôpital) en Tunisie / Multidrug resistance in Enterobacteriaceae is rising up dramatically at hospital in Tunisia. Such an evolution impairs the clinical efficacy of antibiotics for humans, in particular of the widely used ß-lactams.On the other hand, resistance to ß-lactamsis not restricted to bacteria affecting humans but has also been abundantly recognized in bacteria isolated in veterinary medicine. The aimof this thesis was to identify the resistance mechanisms to broad-spectrum cephalosporins in bacteria isolated from humans and animals and to fully characterize the plasmids carrying those genes in order to contribute to a better knowledge of the molecular epidemiology of resistance in both contexts.Genotypic characterization showed that the CTX-M was the Extended-Spectrum Beta-Lactamases (ESBL) dominant type in both cases. In particular, the CTX-M-1/IncI1/ST3 plasmid, which was already found to circulate in animals in Europe, was also found very prevalent both in food- and companion animals in Tunisia. On the other hand, in humans at hospital, we highlighted the dominance ofK. pneumoniaeisolates producing CTX-M-15 associated with the spread of IncFIIk-type plasmids. We also reported the recently described blaOXA-204carbapenemasegene located on an IncA/C-type plasmid. In addition, plasmid-mediated fluoroquinolone resistance genes were reported.Those data are essential for a better understanding of the comparative molecular epidemiology of resistance to ß-lactams (in particular to broad-spectrum cephalosporins) in Tunisia in order to accurately assess the risk of inter-transmission between humans and animals

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No. of bitstreams: 2 Dissertação - Lara Barroso Brito - 2016.pdf: 19284674 bytes, checksum: 73aa3e2fc34b886b960712220045839d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-03-23 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Pharmaceuticals can be introduced directly into the environmental by household disposal or pharmaceutical industry waste and indirectly through the excretion of humans and animals. Antibiotics are considered emerging contaminants because they are typically present at very low levels in the environmental and their human or ecological health effects are unclear. β-lactams represent more than 70% of antibiotics consumed in Brazil. Thus, in this context, this work evaluated the environmental impact of antibiotic amoxicillin (AMX) in different organisms, considering its presence in water. For that, we used the phytotoxicity test with seeds of tomato (Lycopersicon esculentum), cucumber (Cucumis sativus) and lettuce (Lactuca sativa), brine shrimp toxicity assay (Artemia salina), and embryo-larval toxicity test zebrafish (D. rerio), considering the lethal and sublethal effects and biomarkers determinations. AMX showed no toxicity to seeds of tomato, cucumber and lettuce in relation to seed germination and root elongation endpoints. For microcrustacean A. salina, AMX did not induce significant mortality after 24 h and 48 h exposure (LC50 > 100 mg/L) and it was classified as non-toxic (not categorized) according to the Globally Harmonized System (GHS). AMX also did not cause significant mortality in embryos and larvae zebrafish during 168 h of exposure. It had no significant effect on embryos hatching and larvae equilibrium. However, AMX significantly increased the larvae size at 6.25, 12.5 and 25 mg/L. Catalase (CAT), glutathione S-transferase (GST) and lactate dehydrogenase (LDH) activities in embryos and larvae of zebrafish were inhibited at 12.5 mg/L of AMX, 6.25, 12.5, 25, 50 and 100 mg/L of AMX and 1.5, 3.0, 6.25 and 12.5 mg/L of AMX, respectively. Therefore, AMX showed no significant acute toxicity to tested organisms, but it induced sublethal effects on larvae zebrafish in concentrations greater than those found in the aquatic environment, indicating that long-term chronic exposures must be investigated. / Os fármacos e insumos farmacêuticos podem ser introduzidos no ambiente de forma direta, ou seja, através do descarte doméstico ou por efluentes da indústria farmacêutica, e ainda indiretamente, por meio da excreção humana e animal. Os antibióticos são considerados contaminantes emergentes, uma vez que são detectados em concentrações muito baixas no ambiente e seus efeitos sobre o ambiente e saúde humana permanecem incertos. Os β- lactâmicos representam mais de 70% dos antibióticos consumidos no Brasil. Assim, dentro deste contexto, este trabalho propôs avaliar o impacto ambiental do antibiótico amoxicilina (AMX) em diferentes organismos, considerando a sua presença nos recursos hídricos. Para tanto foram utilizados os ensaios de fitotoxicidade com sementes de tomate (Lycopersicon esculentum), pepino (Cucumis sativus) e alface (Lactuca sativa) e de toxicidade aguda com Artemia salina, assim como o teste com o estágio embriolarval de zebrafish (Danio rerio), considerando os efeitos letais, subletais e atividade de biomarcadores enzimáticos. A AMX não foi tóxica para as sementes de tomate, pepino e alface, não apresentando diferenças estatísticas significativas para os parâmetros de germinação das sementes e do desenvolvimento das raízes. Para o microcrustáceo A. salina, a AMX não induziu mortalidade significativa com valores de CL50 maior que 100 mg/L para 24 h e 48 h de exposição, sendo classificada como não tóxica (não categorizada) de acordo com o Globally Harmonized System (GHS). A AMX não provocou mortalidade significante nos embriões e larvas de zebrafish durante as 168 h de exposição, assim como não alterou significativamente a eclosão dos embriões e o equilíbrio de larvas de zebrafish. Entretanto, o antibiótico aumentou significativamente o tamanho das larvas desse peixe nas concentrações de 6,25; 12,5 e 25 mg/L. As atividades da catalase (CAT), da glutationa Stransferase (GST) e da lactato desidrogenase (LDH) de embriões e larvas de peixezebra foram inibidas significativamente nas exposições à 12,5 mg/L de AMX, 6,25; 12,5; 25; 50 e 100 mg/L de AMX e 1,5; 3,0; 6,25 e 12,5 mg/L de AMX, respectivamente. Portanto, o antibiótico AMX não apresenta toxicidade aguda relevante para os organismos testados, mas causa alguns efeitos subletais em larvas de zebrafish em concentrações superiores às encontradas no ambiente aquático, o que indica a necessidade de se investigar exposições a esse composto a longo prazo.