O objetivo deste estudo foi avaliar a qualidade de vida de pacientes oncológicos, diagnosticados com câncer de mama e câncer de intestino, no início do tratamento quimioterápico adjuvante e três meses após, de instituições ou clínicas da cidade de Ribeirão Preto/SP. Trata-se de estudo descritivo exploratório, longitudinal do tipo, estudo de acompanhamento, de abordagem quantitativa, tendo sido utilizado um instrumento contendo duas partes: dados sócio-demográficos e clínicos e, itens referentes ao instrumento que avalia QV em pacientes oncológicos, o EORTC QLQ-C- 30. A amostra constou de 21 pacientes atendidos em três diferentes clínicas: Clínica de Tratamento Oncológico (CTO), Centro Especializado de Oncologia (CEON) e Fundação para Pesquisa, Prevenção e Tratamento do Câncer (Fundação Sobeccan), localizadas na cidade de Ribeirão Preto/ São Paulo, no período de outubro de 2005 a junho de 2006. O instrumento mostrou propriedades psicométricas satisfatórias quanto à consistência interna e validade do construto. Quanto às características sóciodemográficas e clínicas, verificou-se que 61,9% eram do sexo feminino e 38,1% do sexo masculino. A média de idade foi de 55,5 anos, com desvio padrão de 12 anos. Pacientes diagnosticados com câncer de mama correspondeu a 47,6% e com câncer de intestino, os restantes 52,4%. Foi ainda verificado que apenas 9,5% do total de 21 pacientes, apresentavam metástases. Nos pacientes com câncer de mama, os tratamentos utilizados foram: 70% tratados com Fluorouracil, Adriamicina, Ciclofosfamida (FAC), 20% com Ciclofosfamida, Metotrexate, Fluorouracil (CMF) e 10% 7 com Adriamicina, Ciclofosfamida (AC). Para os pacientes com câncer de intestino, o protocolo utilizado para tratamento adjuvante foi o Fluorouracil (5-FU)+leucovorin em 100% dos pacientes. Radioterapia concomitante à quimioterapia foi realizada em apenas 9,5% dos pacientes. A análise de QV da amostra estudada para o EORTC QLQ-C30 revelou que a média foi de 60,8 com desvio padrão (DP) igual a 28,9 no início e, 73,4 (DP=29,6) após três meses, referente ao estado geral de saúde para pacientes com câncer de mama. Foram estatisticamente significantes as escalas: função física, desempenho de papel, função emocional, função cognitiva, função social, fadiga, náuseas e vômitos, dor, insônia, perda de apetite, constipação e estado geral de saúde. Em relação aos pacientes com câncer de intestino, a média referente ao estado geral de saúde no início foi de 78,0 (DP=16,0) e três meses após foi de 78,2 (DP=19,5). Foram estatisticamente significativos os resultados obtidos nas escalas: função física, desempenho de papel, função emocional, função cognitiva, função social, fadiga, dificuldade financeira e estado geral de saúde. Concluindo, o conjunto de resultados apresentados permitiu visualizar o impacto positivo da QV em pacientes com câncer de mama e câncer de intestino tratados com quimioterapia adjuvante, ao final dos três meses. / The objective of this study was to evaluate the quality of life of patients who had been breast and bowels cancer diagnosed, during initial disease adjuvant chemotherapy treatment and also after three months treatment in the city of Ribeirão Preto. This study is a longitudinal exploratory descriptive one , classified as following study, based on approaching quantity in which an instrument containing two parts was utilized : social and clinic demographic data and items referring to the instrument for evaluation of QV in oncologic patients ? the EORTC QLQ-C 30. A sample of 21 patients medicated in three different clinics which were :Clinica de Tratamento Oncológico (CTO) Centro Especializado de Oncologia (CEON) and Fundação para Pesquisa , Prevenção e Tratamento do Câncer ( Fundação Soberccan) all of them located in the city of Ribeirão Preto, from October 2005 to June 2006. Concerning internal consistency and also constructo´s validity, the instrument showed satisfactory psychometric properties. Concerning social demography and clinic characteristics, 61,9% were female and 38,1% male. Medium age was 55,5 years old, considering standard deviation of 12 years. Breast cancer diagnosed patients amounted 47,6% and bowels cancer patients the remaining 52,4%. The study also revealed that only 9,5% from the whole 21 patients presented metastasis. Treatments for breath cancer patients were : 70% - FAC treatment - 20% CMF treatment ? 10% - AC treatment. or patients with bowels cancer the protocol utilized for adjuvant treatment was 5-FU+leucovorin in all 10% patients. 9 Radiotherapy concomitant to chemotherapy was applied in only 9,5% from the whole patients. QV analysis of the studied sample for EORTC QLQ-C30 has revealed that medium average was 60.8 with standard deviation (DP) equal to 28.9 at the begining and 73.4 (DP=29.6) after three months treatment referring to general health for breast cancer patients. The following scales were statistically significant : physical function, role performance, emotional function, cognitive function, social function, fatigue, nausea and vomit, pain, sleepleness, lack of hunger , constipation and general health. Concerning bowels cancer patients the medium average of general health at the beginning was 78.2 (DP=19.8). The results statistically obtained were significant in the following scales : physical function, role performance, emotional function, cognitive function, social function, fatigue, financial problems and general health. Conclusion the whole above presented results lead us to visualize the positive QV impact on breast and bowels cancer patients submitted to an adjuvant chemotherapy at the beginning and three months later.

Esporos de Bacillus subtilis apresentam propriedades adjuvantes, sendo capazes de aumentar a resposta humoral após a sua coadministração com antígenos misturados ou adsorvidos à sua superfície. Mas, para isso, é necessária a produção de esporos altamente purificados e com rendimentos elevados. Neste trabalho, realizamos com sucesso uma análise quantitativa das condições de esporulação e dos métodos de purificação, o que melhorou a reprodutibilidade do processo e a obtenção de amostras com elevado grau de pureza e rendimento. Avaliamos também as propriedades imunomodulatórias destes esporos, utilizando como antígeno modelo a proteína recombinante Gag-p24 do HIV-1. A coadministração, mas não a adsorção à superfície do esporo, aumentou a imunogenicidade do antígeno sem induzir efeitos deletérios após a administração parenteral em camundongos BALB/c e C57BL/6. Além de promoveram a ativação das APCs, os esporos interagem com receptores relacionados à imunidade inata, devido à ausência do efeito adjuvante em camundongos nocautes para TLR2. Esses resultados abrem perspectivas interessantes para a utilização de esporos como adjuvantes vacinais. / Bacillus subtilis spores have been shown to behave as vaccine adjuvants, promoting the increase of antibody responses after co-administration with antigens either admixed or adsorbed on the spore surface. Nonetheless, such specialized application requires highly purified spore preparations at high yields. In this work, we successfully performed a systematic quantitative analysis of sporulation conditions and spore purification methods, which improved the reproducibility of the process and the obtainment of samples with high purity and yield. Afterwards, we further evaluated the immune modulatory properties of these spores using a recombinant HIV-1 Gag-p24 protein as a model antigen. The co-administration, but not adsorption to the spore surface, enhanced the immunogenicity of that target antigen, without inducing deleterious effects, after subcutaneous administration to BALB/c and C57BL/6 mice. Besides promoting activation of antigen presenting cells, spores interact with receptors related to innate immunity, due to the absence of the adjuvant effect on TLR2 knockout mice. These results open interesting perspectives for the use of B. subtilis spores as vaccine adjuvants.

Em decorrência da importância da leptospirose nas criações zootécnicas pelos prejuízos econômicos, principalmente pelas infecções crônicas, forma mais importante na propagação e permanência da bactéria no ambiente, este trabalho pretendeu estudar o curso da leptospirose e a formação do portador pela infecção experimental de hamsters com Leptospira interrogans sorvar Canicola, estirpe LO4, autóctone, pelas vias conjuntiva-nasal (CN) e cérvico-vaginal (CV) comparadas a via controle, intraperitonial (IP) com duas concentrações de inóculo (20-30 e 100-200 leptospiras/campo microscópico) e ainda estabelecer a eficácia conferida por cinco vacinas experimentais formuladas com dois tipos de adjuvantes (saponina e hidróxido de alumínio), pelo desafio de hamster. No preparo das vacinas foi considerada a virulência da estirpe LO4 submetida a duas e cinco passagens in vitro, que foi comparada com duas vacinas controle produzidas com a estirpe de referência, Hond Utrecht IV, com indeterminado número de passagens in vitro. Foram também avaliadas a indução de anticorpos aglutinantes e neutralizantes e as lesões histopatológicas por HE e Warthin-Starry. A detecção das leptospiras nos órgãos de hamsters mortos pela leptospirose ou eutanasiados foi realizada pela visualização direta, cultivo e PCR, considerando qualquer um dos resultados positivo. A visualização direta foi o melhor método de detecção na suspensão de órgãos. A via CN mostrou-se tão letal quanto IP na maior concentração de inóculo (p<0,01) e também mais letal que CV nas duas concentrações (p<0,01). A via CV induziu o portador renal e genital, não havendo diferença entre as duas concentrações. Pela via CN, não houve diferença entre sexos na indução da letalidade e da formação do portador, para ambos os inóculos. Todos os hamsters que morreram pós-inoculação apresentaram grande quantidade de leptospiras nos rins e genitais com necrose e hemorragias. Os animais eutanasiados após 21 dias de infecção, apresentaram leptospiras em rins e genitais sem lesões aparentes, caracterizando o portador. Pela SAM, tanto os animais que vieram a óbito, quanto os sobreviventes à inoculação com ambas as concentrações de leptospiras pelas vias CN, CV e IP, mostraram-se não reagentes na SAM (<25) para as estirpes LO4 e Hond Utrecht IV. As vacinas com ambas as estirpes e adjuvantes induziram baixos títulos de anticorpos aglutinantes e neutralizantes. Os maiores títulos de anticorpos neutralizantes e aglutinantes foram observados nos animais vacinados com a estirpe referência, Hond Utrecht IV. Os anticorpos neutralizantes não tiveram correspondência com o teste desafio em hamsters. As vacinas produzidas com ambas as estirpes protegeram os animais contra a letalidade da leptospirose causada pela infecção com a estirpe LO4, e, portanto a virulência da estirpe não interferiu na eficácia, porém as bacterinas não foram capazes de proteger os hamsters contra a formação do portador renal e genital. / Leptospirosis is important in production systems due to its negative economic impact, and chronic infections are the most relevant type of propagation and permanence of the bacteria in the environment. The objectives of this study were to study the occurrence of leptospirosis, and the formation of carriers animals, by the experimental infection of hamsters with Leptospira interrogans serovar Canicola, LO4 autochthon strain through conjunctive-nasal (CN) and cervix-vaginal (CV) via versus control and intra-peritoneum (IP) via with two inoculum concentrations (20-30 and 100-200 leptospiras/microscopic area). In addition, the efficacy of five experimental vaccines formulated with two types of adjuvants (saponine and aluminum hydroxide) was evaluated. In the vaccine preparation, the virulence of LO4 autochthon strain manipulated in two and five in vitro passages was compared with two control vaccines produced with the reference strain, Hond Utrecht IV with undeterminated number of in vitro passages. It was also evaluated the induction of agglutinating and neutralizing antibody production and the histopathological lesions by HE and Warthin-Starry. The leptospira detection in the hamsters organs killed by the leptospira or euthanized was done by direct visualization or culture or PCR. The direct visualization was the best method of detection in the organs suspensions. The CN via has shown to be as lethal as IP in the highest inoculum concentration (p<0.01) and also more lethal than the CV in the two concentrations (p<0.01). The CV via has induced the occurrence of renal and genital carrier with no difference between the two concentrations. By the CN via, with the two inoculum, there has no difference detected between sex in the lethality induction as well as in the formation of carrier. All hamsters that died following inoculation presented a great amount of leptospiras in the kidneys and genitals with necrosis and hemorrhage. After 21 days of infection, the euthanized animals presented leptospiras in the kidneys and genitals without any apparent lesion, characterizing a carrier. By the SAM, the animals that died, as well as the ones that survived the inoculations by CN, CV and IP via with the two inoculum concentrations were not reactive to the SAM (<25) to the strain LO4 and Hond Utrecht IV. The two vaccines for the two strains and adjuvant have induced low agglutinating and neutralizing antibody titers. The highest agglutinating and neutralizing antibody titers were observed in animals vaccinated with the reference strain, Hond Utrecht IV. The neutralizing antibodies did not correspond to the hamster challenge test. The two vaccines produced with the two strains protected the animals against the leptospira lethality caused by the LO4 strain; therefore, the strain virulence did not affect the efficacy. However, the bacterines were not capable to protect the hamsters against the formation of renal and genital carrier.

Les vaccins des muqueuses s'administrent facilement et favorisent une immunité humorale et cellulaire au niveau des muqueuses. Ainsi, ils offrent une protection optimale contre les pathogènes envahissant par les muqueuses. Cependant, la mise sur le marché de nouveaux vaccins des muqueuses est entravée par le manque d'adjuvants des muqueuses efficaces et sans effets secondaires. La toxine cholérique (CT) est une entérotoxine à fort pouvoir adjuvant mais sa toxicité empêche son utilisation chez l'homme. En tant que modèle expérimental, elle a permis de comprendre l'importance de l'activité enzymatique et des récepteurs dans l'adjuvanticité. Notre travail se base sur l'observation que des doses sublétales de la toxine œdémateuse de Bacillus anthracis (EdTx) n'inhibent pas la réponse immune à des vaccins « nasaux » contenant CT comme adjuvant. Nous avons montré que les dérivés EdTx représentent une nouvelle classe d'adjuvants qui donnent des réponses systémiques et des muqueuses à des protéines vaccinales administrées par de multiples voies, notamment nasale. Contrairement à CT qui se fixe aux gangliosides, EdTx se fixe aux récepteurs des toxines de l'anthrax et ne cible pas les tissus du système nerveux central après administration nasale. Le facteur inné nerve growth factor intervient dans les réponses des muqueuses induites par CT mais n'affecte pas l'adjuvanticité d'EdTx in vivo. L'activité adjuvante d'EdTx implique aussi l'augmentation des fonctions de présentation de l'antigène. Enfin, nous avons montré qu'EdTx est un adjuvant efficace par les voies transcutanée et sublinguale, bien que les IgA des muqueuses ne soient induits qu'après immunisation sublinguale.

Le système immunitaire des mammifères possède deux composantes, l'immunité innée, première ligne de défense de l'hôte, et l'immunité adaptative, phase plus tardive et spécifique à de multiples antigènes. Dans le contexte infectieux, toute réponse immunitaire commence par la détection du pathogène par des récepteurs de l'immunité innée comme les "Toll-Like Receptors" ou TLR qui reconnaissent des motifs moléculaires conservés chez de nombreux microorganismes. Au cours de ce travail, j'ai étudié un motif microbien en particulier, la flagelline de Salmonella typhimurium, molécule structurale du flagelle et agoniste de TLR5. Les muqueuses respiratoires, digestives ou urogénitales sont donc des sites majeurs d'immunité anti-microbienne car la plupart des pathogènes les ciblent et les colonisent. Mon travail a consisté à disséquer les réponses immunitaires muqueuses induites par la signalisation TLR5 dans deux modèles expérimentaux : (1) une administration locale de la flagelline mimant la colonisation microbienne épithéliale et (2) une administration systémique simulant l'invasion d'un pathogène dans les tissus muqueux. L'instillation de flagelline par voie respiratoire active l'épithélium broncho-alvéolaire. Nos travaux ont montré que la signalisation épithéliale peut avoir un effet thérapeutique par le recrutement de neutrophiles. La contribution de l'épithélium dans l'immunité adaptative muqueuse a été analysée. Lors d'une instillation nasale de flagelline, les animaux développent une réponse en anticorps et une réponse Th1-Th2 à la fois locale et systémique. Nos résultats indiquent que la signalisation TLR dans les cellules épithéliales du poumon est nécessaire et suffisante pour promouvoir cette immunité. Ces observations ouvrent de nouvelles perspectives pour le développement d'adjuvant muqueux à activité épithéliale et la caractérisation des interactions hôte-pathogène. L'administration systémique de flagelline induit dans l'intestin et les poumons la transcription immédiate mais transitoire des gènes codant les interleukines IL-17A, IL-17F et IL-22, cytokines essentielles à l'élaboration d'une défense anti-microbienne muqueuse. Nous avons identifié comme source de ces cytokines, une nouvelle population de cellules lymphoïdes innées CD3negCD127+. Leur activation est associée à la protection contre une infection orale à Yersinia pseudotuberculosis. Nos données suggèrent donc que les cellules CD3negCD127+ sont cruciales pour les défenses précoces contre l'invasion des tissus muqueux par les pathogènes et leur manipulation pourrait être envisagées à des fins thérapeutiques.

<p>Antibodies are a central part of the immune defense system, and a large variability in their specificity is needed in order to be able to react against all possible foreign substances we may encounter during our lives. In this thesis, results are presented from investigations into how an egg-laying mammal, the Australian duck-billed platypus (<i>Ornithorhynchus anatinus</i>) creates antibody variability. Our results show that despite the lack of many V gene families the antibody repertoire in the platypus seems to be well developed. A long and highly variable complementarity-determining region (CDR) 3 compensates for the limited germline diversity. Interestingly, the presence of additional cysteine residues in the CDRs may form stabilizing disulfide bridges in the antigen binding loops and thereby increasing the affinity of the antibody-antigen interaction. </p><p>Although the immune system is necessary for survival, it must be strictly controlled since it may otherwise over-react and cause more harm than benefits. Allergies and autoimmune diseases are examples of such over-reactions by the immune system. Allergies are increasing in the western world and have become one of the main medical issues of the 21^st century. IgE is the central mediator in atopic allergies such as hay fever, eczema and asthma; it is therefore a prime target in the development of allergen-independent preventative treatments. Here we present results from several studies of a novel vaccine strategy aimed at reducing the levels of IgE antibodies. The vaccine results in the induction of anti-IgE antibodies, and the skin reactivity upon allergen challenge was significantly reduced in vaccinated animals. Our results suggest that active immunization against IgE has the potential to become a therapeutic method for humans. In addition, an evaluation of possible adjuvants that could be used as immune stimulators and thus help break self-tolerance at the time of vaccination is presented.</p>

Antibodies are a central part of the immune defense system, and a large variability in their specificity is needed in order to be able to react against all possible foreign substances we may encounter during our lives. In this thesis, results are presented from investigations into how an egg-laying mammal, the Australian duck-billed platypus (Ornithorhynchus anatinus) creates antibody variability. Our results show that despite the lack of many V gene families the antibody repertoire in the platypus seems to be well developed. A long and highly variable complementarity-determining region (CDR) 3 compensates for the limited germline diversity. Interestingly, the presence of additional cysteine residues in the CDRs may form stabilizing disulfide bridges in the antigen binding loops and thereby increasing the affinity of the antibody-antigen interaction. Although the immune system is necessary for survival, it must be strictly controlled since it may otherwise over-react and cause more harm than benefits. Allergies and autoimmune diseases are examples of such over-reactions by the immune system. Allergies are increasing in the western world and have become one of the main medical issues of the 21st century. IgE is the central mediator in atopic allergies such as hay fever, eczema and asthma; it is therefore a prime target in the development of allergen-independent preventative treatments. Here we present results from several studies of a novel vaccine strategy aimed at reducing the levels of IgE antibodies. The vaccine results in the induction of anti-IgE antibodies, and the skin reactivity upon allergen challenge was significantly reduced in vaccinated animals. Our results suggest that active immunization against IgE has the potential to become a therapeutic method for humans. In addition, an evaluation of possible adjuvants that could be used as immune stimulators and thus help break self-tolerance at the time of vaccination is presented.

Synthetic CpG containing oligodeoxynucleotides (ODNs) are recognized by Toll like Receptor 9 (TLR9) and induce a strong pro-inflamatory immune response. To date, four different CpG ODN classes have been described. K-Class ODNs (also known as B-ODN) are potent B cell activators and stimulate TNF

La protection contre certains agents infectieux ainsi que le traitement de cancers nécessite l'induction d'une réponse cellulaire. Le développement de vaccins induisant une réponse T CD8 efficace est donc essentiel. La présentation croisée de l'antigène est importante pour l'activation de lymphocytes T CD8 spécifiques et de nombreux facteurs participent au développement d'une réponse lymphocytaire T efficace. Nous nous sommes intéressés à deux d'entre eux : la voie d'immunisation et la séquence d'aministration de l'antigène et d'un adjuvant. Nous avons développé une technique d'enrichissement des lymphocytes T CD8 spécifiques d'un antigène, ce qui a permis une étude précise de la réponse T CD8 endogène. Nous avons ensuite étudié l'influence de la voie d'immunisation sur l'efficacité de la réponse T CD8. Nous avons observé que l'injection intradermique d'un antigène cellulaire induit une réponse T CD8 plus tardive, comparée à une administration par voie systémique. Cependant, la réponse T CD8 induite par une injection locale de l'antigène est plus efficace. Puis, nous avons évalué l'influence de l'administration d'un adjuvant - le poly I:C connu pour induire la production d'interférons (IFN) de type I - en parallèle de celle de l'antigène. Nous avons montré que le moment optimal d'administration de l'adjuvant dépend de la voie d'immunisation. De plus, il existe une durée limitée durant laquelle l'adjuvant induit des effets positifs sur l'activation des lymphocytes T CD8. Nous avons identifié plusieurs effets du poly I:C et des IFN de type I sur les cellules du système immunitaire

Les vecteurs nanoparticulaires comme systèmes de relargage contrôlé pour des applications vaccinales font l'objet d'intenses recherches, notamment dans le domaine du VIH1. Une approche novatrice consiste à co-administrer des molécules immuno-stimulatrices avec les antigènes d'intérêt, afin d'amplifier le recrutement et l'activation des cellules dendritiques (DCs). Un tel vecteur vaccinal stimulerait l'intensité de la réponse immunitaire et une immunité au niveau des muqueuses vaginales et anales pourrait être obtenue après vaccination. Des nanoparticules de poly(acide lactique) (NP-PLA) ou de chitosane/sulfate de dextrane (NP-CSD) ont été utilisées comme véhicules et adjuvants de protéines du VIH1, gp140 et p24. Le poly(I:C), ligand de TLR3 est la molécule immuno-stimulatrice retenue pour ses propriétés adjuvantes. Les NP-PLA et NP-CSD présentent un potentiel équivalent pour l'adsorption de protéines. Par contre, si les NP-CSD permettent l'adsorption du poly(I:C) (95%), elle est moins reproductible sur les NP-PLA. Pour chaque formulation, la capacité à induire in vitro la maturation des DCs a été évaluée en suivant les marqueurs CD25, CD80, CD83, par cytométrie en flux. L'adsorption de poly(I:C) sur les NP-PLA ou les NP-CSD amplifie les capacités de maturation de ces nanoparticules, un effet synergique étant observé avec les NP-CSD. Nos travaux montrent que la co-adsorption d'un TLR ligand, avec des antigènes protéiques du VIH sur des nanoparticules biodégradables, est possible et confère à la formulation vaccinale un effet immuno-stimulant in vitro. In vivo, les formulations vaccinales contenant du poly(I:C) induisent de très forts taux d'anticorps sériques chez la souris.