Malgré les bénéfices de l’hormonothérapie adjuvante (HA) pour réduire les risques de récidive et de mortalité suite à un cancer du sein hormono dépendant, l’adhésion à l’HA est sous-optimale pour une grande proportion de femmes. Toutefois, les connaissances sur les patrons longitudinaux d’adhésion à l’HA demeurent limitées. Cette étude visait à : 1)identifier les trajectoires d’adhésion à l’HA pour les cinq ans suivant l’initiation; 2) décrire les trajectoires en utilisant des mesures traditionnelles d’adhésion (p.ex. la proportion de jours couverts (PJC)); 3) explorer les facteurs associés aux trajectoires. Une étude de cohorte a été réalisée à partir d’une enquête nationale française incluant des données administratives de dispensation d’HA. Les femmes ayant un diagnostic de cancer du sein non-métastatiqueet ≥1 dispensation d’HA au cours des 12 mois suivant le diagnostic ont été incluses. Le Group-based trajectory modeling a permis d’identifier les trajectoires d’adhésion en regroupant des patrons similaires de dispensations mensuelles d’HA. Des régressions logistiques polytomiques ont permis d’identifier les facteurs associés aux trajectoires. Parmi les 674 femmes incluses, cinq trajectoires d’adhésion à l’HA ont été identifiées : 1) déclin rapide et arrêt (5,2%), 2) déclin modéré et arrêt (6,4%), 3) déclin lent (17,2%), 4) adhésion élevée (30,0%), 5) maintien d’une adhésion très élevée (41,2%). La PJC moyenne pour les cinq ans était de 80%, mais variait de 10% à 97% selon les trajectoires. Les femmes n’ayant pas reçu de chimiothérapie ou de programme personnalisé de soins étaient plus susceptibles d’appartenir à des trajectoires présentant un déclin de l’adhésion suivi de l’arrêt de l’HA. Nos résultats fournissent des informations sur les patrons longitudinaux de l’adhésion à l’HA, les facteurs associés à ceux-ci et les moments critiques pour l’adhésion qui pourront être utilisés par les professionnels de la santé impliqués auprès de ces femmes. / Despite the benefits of adjuvant endocrine therapy (AET) for reducing recurrence andmortality risks after hormone-sensitive breast cancer, AET adherence is sub-optimal for ahigh proportion of women. However, little is known about long-term patterns of AETadherence over the minimally recommended 5 years. Our objectives were to: 1) identify fiveyear AET adherence trajectory groups; 2) describe trajectory groups according to adherencemeasures traditionally used (i.e. the proportion of days covered (PDC)); 3) explore factorsassociated with trajectories. We conducted a five-year cohort study using data from a Frenchnational study that included AET dispensing administrative data. Women diagnosed withfirst non-metastatic breast cancer and having ≥1 AET dispensing in the 12 months afterdiagnosis were included. Group-based trajectory modeling was used to identify adherencetrajectory groups by clustering similar patterns of monthly AET dispensing. Multinomiallogistic regressions were used to identify factors associated with trajectories. Among 674women, five AET adherence trajectory groups were identified: 1) quick decline and stop(5.2% of women); 2) moderate decline and stop (6.4%); 3) slow decline (17.2%); 4) highadherence (30.0%); 5) maintenance of very high adherence (41.2%). Mean 5-year PDCvaried from 10% to 97% according to trajectories. Women who did not receive chemotherapyor a personalized care plan were more likely assigned to trajectories where AET adherencedeclined and stopped. Our results provide information on the diversity of longitudinal AETadherence patterns, the timing of decline and discontinuation and associated factors thatcould inform healthcare professionals.

Les tumeurs des cellules de la granulosa (GCTs) sont des tumeurs avec un potentiel malin ayant tendance à récidiver, provoquant ainsi la mort dans 80% des cas de stade avancé consécutif à une rechute. Bien que les GCTs représentent 5% des tumeurs ovariennes, peu d’études ont évalué les protocoles de traitement adjuvant pour la maladie avancée ou récurrente. Notre but était d’évaluer l’efficacité de la voie de signalisation du facteur de croissance de l’endothélium vasculaire A (VEGFA) comme cible pour le traitement de la GCT utilisant le modèle murin transgénique Ptentm1Hwu/tm1Hwu; Ctnnb1tm1Mmt/+; Amhr2tm3(cre)Bhr/+ (PCA) qui reproduit le stade avancé de la maladie humaine. Un anticorps anti-VEGFA a été administré une fois par semaine par voie intrapéritonéale (IP) à partir de 3 semaines d’âge. La thérapie anti-VEGFA a permis une réduction de la taille des tumeurs à 6 semaines d’âge (p<0.05) et une prolongation de la survie des animaux traités, lorsque comparé aux animaux contrôles. L’analyse des GCTs a montré une réduction significative de la prolifération cellulaire (p<0.05) et de la densité microvasculaire (p<0.01) mais aucune différence significative n’a été détectée dans l’apoptose cellulaire. p44/p42 MAPK, un effecteur de la signalisation pour le récepteur 2 de VEGFA (VEGFR2) associé à la prolifération cellulaire, était moins activé dans les tumeurs traitées (p<0.05). Par contre, l’activation d’AKT, un effecteur impliqué dans la survie cellulaire, était similaire d’un groupe à l’autre. Ces résultats suggèrent que l’anticorps anti-VEGFA réduit la prolifération cellulaire et la densité microvasculaire chez les souris PCA par inhibition de la voie de signalisation VEGFR2-MAPK, inhibant ainsi la croissance tumorale. En conclusion, l’efficacité de la thérapie anti- VEGFA mérite d’être évaluée en essais contrôlés randomisés pour le traitement des GCTs chez l’homme. / Ovarian granulosa cell tumors (GCTs) are potentially malignant tumors that have a tendency for late recurrence and cause death in 80% of women with advanced GCT due to recurrent disease. Although GCTs represent 5% of ovarian tumors in women, few studies have evaluated adjuvant treatment protocols for advanced or recurrent disease. Our goal was to determine the potential of targeting the vascular endothelial growth factor A (VEGFA) signaling pathway for the treatment of GCT. We used a genetically engineered mouse model, Ptentm1Hwu/tm1Hwu; Ctnnb1tm1Mmt/+; Amhr2tm3(cre)Bhr/+ (PCA), which imitates the advanced human disease. A monoclonal anti-VEGFA antibody was administered by intra-peritoneal injection once a week beginning at 3 weeks of age. Anti-VEGFA therapy significantly decreased tumor weights by 6 weeks of age (p<0.05) and increased survival in treated animals in comparison to controls. Significant decreases in tumor cell proliferation (p<0.05) and microvessel density (p<0.01), but no significant difference in apoptosis was found in PCA tumors. p44/p42 MAPK, a VEGFA receptor 2 (VEGFR2) signaling effector associated with cell proliferation, was significantly less activated in anti-VEGFA-treated tumors (p<0.05). In contrast, AKT activation, a VEGFR2 signaling effector associated with cell survival was similar among all groups. These results suggest that anti-VEGFA therapy effectively reduces cell proliferation and microvessel density in PCA mice by inhibition of the VEGFR2-MAPK pathway, resulting in inhibition of GCT growth. We conclude that anti-VEGFA therapy merits further investigation in the form of controlled randomized trials for the treatment of human GCT.

Les tumeurs des cellules de la granulosa (GCTs) sont des tumeurs avec un potentiel malin ayant tendance à récidiver, provoquant ainsi la mort dans 80% des cas de stade avancé consécutif à une rechute. Bien que les GCTs représentent 5% des tumeurs ovariennes, peu d’études ont évalué les protocoles de traitement adjuvant pour la maladie avancée ou récurrente. Notre but était d’évaluer l’efficacité de la voie de signalisation du facteur de croissance de l’endothélium vasculaire A (VEGFA) comme cible pour le traitement de la GCT utilisant le modèle murin transgénique Ptentm1Hwu/tm1Hwu; Ctnnb1tm1Mmt/+; Amhr2tm3(cre)Bhr/+ (PCA) qui reproduit le stade avancé de la maladie humaine. Un anticorps anti-VEGFA a été administré une fois par semaine par voie intrapéritonéale (IP) à partir de 3 semaines d’âge. La thérapie anti-VEGFA a permis une réduction de la taille des tumeurs à 6 semaines d’âge (p<0.05) et une prolongation de la survie des animaux traités, lorsque comparé aux animaux contrôles. L’analyse des GCTs a montré une réduction significative de la prolifération cellulaire (p<0.05) et de la densité microvasculaire (p<0.01) mais aucune différence significative n’a été détectée dans l’apoptose cellulaire. p44/p42 MAPK, un effecteur de la signalisation pour le récepteur 2 de VEGFA (VEGFR2) associé à la prolifération cellulaire, était moins activé dans les tumeurs traitées (p<0.05). Par contre, l’activation d’AKT, un effecteur impliqué dans la survie cellulaire, était similaire d’un groupe à l’autre. Ces résultats suggèrent que l’anticorps anti-VEGFA réduit la prolifération cellulaire et la densité microvasculaire chez les souris PCA par inhibition de la voie de signalisation VEGFR2-MAPK, inhibant ainsi la croissance tumorale. En conclusion, l’efficacité de la thérapie anti- VEGFA mérite d’être évaluée en essais contrôlés randomisés pour le traitement des GCTs chez l’homme. / Ovarian granulosa cell tumors (GCTs) are potentially malignant tumors that have a tendency for late recurrence and cause death in 80% of women with advanced GCT due to recurrent disease. Although GCTs represent 5% of ovarian tumors in women, few studies have evaluated adjuvant treatment protocols for advanced or recurrent disease. Our goal was to determine the potential of targeting the vascular endothelial growth factor A (VEGFA) signaling pathway for the treatment of GCT. We used a genetically engineered mouse model, Ptentm1Hwu/tm1Hwu; Ctnnb1tm1Mmt/+; Amhr2tm3(cre)Bhr/+ (PCA), which imitates the advanced human disease. A monoclonal anti-VEGFA antibody was administered by intra-peritoneal injection once a week beginning at 3 weeks of age. Anti-VEGFA therapy significantly decreased tumor weights by 6 weeks of age (p<0.05) and increased survival in treated animals in comparison to controls. Significant decreases in tumor cell proliferation (p<0.05) and microvessel density (p<0.01), but no significant difference in apoptosis was found in PCA tumors. p44/p42 MAPK, a VEGFA receptor 2 (VEGFR2) signaling effector associated with cell proliferation, was significantly less activated in anti-VEGFA-treated tumors (p<0.05). In contrast, AKT activation, a VEGFR2 signaling effector associated with cell survival was similar among all groups. These results suggest that anti-VEGFA therapy effectively reduces cell proliferation and microvessel density in PCA mice by inhibition of the VEGFR2-MAPK pathway, resulting in inhibition of GCT growth. We conclude that anti-VEGFA therapy merits further investigation in the form of controlled randomized trials for the treatment of human GCT.

Dans Le Père Goriot de Balzac (1835) et Bel-Ami de Maupassant (1885), romans d’éducation réalistes, certains personnages féminins jouent un rôle d’adjuvants auprès du héros en l’aidant dans son ascension sociale. Si les héros exercent un pouvoir sur leurs adjuvants féminins afin de parvenir à leurs fins, ces derniers sont également puissants à la fois avec les héros et au sein de leur milieu social. L’hypothèse de départ de cette étude est que la nature des relations entre les héros et les adjuvants féminins a une influence sur le partage des pouvoirs entre les sexes. En utilisant des approches sociocritique et historique, cette étude montre que dans les deux romans, les adjuvants féminins possèdent des capitaux à la fois économique, social, culturel et symbolique qui leur permettent d’aider les héros dans leur quête. Les adjuvants féminins peuvent être placés dans deux catégories : les « femmes-mentor » et les « femmes-escalier » . Les relations entre les héros et les adjuvants féminins sont caractérisées d’une part par le renversement des pouvoirs dans les deux romans et par la violence dans Bel-Ami. Tandis que dans le roman de Balzac, la dynamique des pouvoirs entre Eugène de Rastignac et ses adjuvants féminins demeure la même tout au long du récit, celle entre Georges Duroy et ceux-ci varie au cours du roman de Maupassant. Bien que les adjuvants féminins retirent des bénéfices de leur pouvoir sur le héros, leur capital économique est limité. De plus, dans Bel-Ami, si certains adjuvants restent puissants à la fin des romans, d’autres connaissent un destin tragique et s’épuisent en aidant le héros. / In Le Père Goriot by Balzac (1835) and Bel-Ami by Maupassant (1885), two realist coming-of-age novels, female characters play the role of adjuvants with respect to the protagonist, assisting in his social ascension. While these male characters exert power on their female adjuvants in order to achieve their objectives, the latter also hold their own in the relationship as well as within their social environment. The hypothesis of this study is that the nature of the relationships between the heroes and the female adjuvants in these works bears a significant influence on the negotiation of power dynamics between the sexes. By using socio-critical and historical approaches, this study shows that in both novels, female adjuvants possess economic, social, cultural and symbolic capitals that enable them to help the heroes in their quest. Female adjuvants in this context may be placed in two categories : the « woman-mentor » and the « woman-stepping stone » . The relationships between heroes and female adjuvants are characterized here on one hand as being the vehicle of shifting power dynamics in both novels, but also of violence in the case of Bel-Ami. Whereas in Balzac’s novel the dynamics of power between Eugène de Rastignac and his female adjuvants stay the same throughout the whole story, those between Georges Duroy and his own vary in the course of Maupassant’s novel. Although these adjuvants benefit from their vantage with respect to the heroes, their economic capital is limited. Furthermore, in Bel-Ami, while some tend to remain powerful at the end of the novels, others meet a tragic destiny and exhaust themselves, specifically by helping the hero.

Indiana University-Purdue University Indianapolis (IUPUI) / Colorectal cancer is the third most common type of cancer and the third most common cause of cancer-related mortality. There are three types of treatment available to patients, either individually or in combination. Treatments are radiation, chemotherapy, and surgery. In a Phase II clinical trial at IUSM, a multimodality approach was chosen. The patients with locally advanced rectal cancer received preoperative treatment with capecitabine and irinotecan (CPT-11) combination followed by chemoradiation with capecitabine and finally surgery to improve response and decrease local recurrence. Irinotecan and Capecitabine are both prodrugs activated in vivo to SN-38 and 5-FU, respectively. Identification of the molecular markers for 5-FU and Irinotecan efficacy and toxicity is important for the development of more efficient and less toxic treatment strategies for patients with colorectal cancer. The goal of this study was to determine the expression levels of the genes involved in activation and metabolism of capecitabine and irinotecan in pre and post treatment specimens from these patients. The genes quantitated by real-time PCR were carboxylesterase 1 and 2 (CES1 and CES2), thymidylate synthase (TS), β-glucoronidase (β-GUS), thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD) and topoisomerase I (Topo I). The UGT1A1*28 polymorphism in UDP glucuronosyltransferase 1 is associated with SN-38 toxicity. Therefore, the UGT1A1*28 polymorphism status in patients was determined by PCR-sequencing. Correlative analysis of gene expression and UGT1A1*28 mutation with clinical outcome in this Phase II study was completed.

Ce travail de recherche porte sur le retrait plastique et la fissuration induite pour les matériaux cimentaires présentant une grande surface libre par rapport au volume. Le retrait plastique est une déformation du matériau cimentaire qui se produit avant durcissement. Le mortier de référence considéré pour cette étude est une formulation par ailleurs exploitée dans le cadre des travaux initiés par le projet CEReM (Consortium pour l'Etude et la Recherche sur les Mortiers). Dans le cadre de cette thèse, un ensemble de moyens expérimentaux a été mis en place de façon à étudier le comportement du mortier au très jeune âge dans des conditions de retrait libre et de retrait empêché. La mesure sans contact du retrait surfacique est réalisée au moyen d'une instrumentation optique. Une nouvelle technique de retrait empêché a été également mise en place : elle se distingue des autres couramment rencontrées dans la littérature par sa simplicité et elle permet d'avoir directement l'évolution de la contrainte interne de traction dans le matériau au cours du retrait. L'ensemble de ces protocoles expérimentaux ont permis d'étudier l'influence des fibres (fibres de verre, fibres de polypropylène), de l'adjuvant anti-retrait (type Glycol), des poudres de polymère (éther de cellulose, le latex “EVA”) sur le comportement au très jeune âge du matériau cimentaire. Une partie de la thèse est consacrée à la modélisation numérique du comportement du matériau cimentaire pendant la prise. Dans cette partie, un modèle élastoplastique est proposé. La plasticité est décrite par le critère isotrope de Von Mises dans lequel nous avons introduit une évolution de la surface de charge en fonction de la maturation du matériau. L'implantation de ce modèle de comportement dans un code de calcul a conduit à la simulation numérique de l'essai de retrait empêché : une comparaison entre modèle et expérience est ensuite discutée.

This study aimed to understand how the identity of Manitobans with early malignancy is affected through diagnosis, decision making and treatment. Using grounded-theory methodology, semi-structured interviews were conducted with 18 adult patients with early breast, colon, lung, prostate and gynecological cancers, before and after adjuvant treatment decision making. 15 adult friends and family members were also interviewed. Significant findings include: 1) After diagnosis, the “cancer identity” emerged as a new aspect of the patient’s identity; 2) Establishing a post-diagnosis routine was a significant source of distress for patients; 3) Ability to re-establish routine post-diagnosis may be enhanced by providing earlier notification of medical appointment times and information regarding how different treatment options will affect the patient’s identity. This study provides new insight into the experience of patients with malignancy in Manitoba. Additionally, it presents recommendations, based on the insights and concerns of its participants, for improving the cancer journey of Manitobans. / May 2017

A busca pelo entendimento da etiofisiopatogênese da esquizofrenia permanece desafiadora e tratamentos convencionais com medicações antipsicóticas que agem principalmente através da modulação da neurotransmissão dopaminérgica mostramse insuficientes, vistos os elevados índices de refratariedade e superrefratariedade nesta população. Estudos recentes apontam resultados promissores de moduladores do sistema glutamatérgico com ação em receptores NMDA, como o nitroprussiato de sódio (NPS), um doador de óxido nítrico, capaz de reduzir sintomas positivos, negativos e cognitivos do transtorno. O objetivo do presente estudo foi estudar os efeitos da administração repetida de NPS sobre a sintomatologia de pacientes com esquizofrenia. Recrutados 17 pacientes portadores de esquizofrenia acompanhados no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, em idade entre 18-45 anos, submetidos ao protocolo experimental com delineamento cruzado, duplo-cego, randomizado e controlado por placebo. Cada participante recebeu oito infusões intravenosas, sendo destas, quatro de NPS (0,5 ?g/kg/min por 4 horas/sessão) e quatro de placebo, em intervalo de 15 dias entre as sessões. A avaliação dos sintomas positivos, negativos e cognitivos foi feita através dos seguintes instrumentos: Escala de Avaliação das Síndromes Positiva e Negativa para Esquizofrenia (PANSS), Escala de Avaliação Psiquiátrica Breve (BPRS), Escala de Impressão Clínica Geral - Esquizofrenia (CGI-SCH), Stroop Color Word Test (SCWT), N-back, Teste de Fluência Verbal (FAS). Para avaliação de efeitos colaterais das medicações foi usada a Escala de Avaliação de Efeitos Colaterais (UKU). A análise dos dados demográficos e clínicos da amostra foi realizada através de estatística descritiva. As análises estatísticas foram feitas com o programa Statistical Package for the Social Sciences versão 17.0. Para avaliar o efeito do NPS nos escores BPRS, PANSS, SCWT, N-back e FAS, os dados foram submetidos a análise de variância de medidas repetidas para modelos de estudo crossover. Análises independentes para sessões de nitroprussiato de sódio e placebo foram realizadas quando houve significância estatística, seguidas de teste t de Student, que também foi empregado para avaliações pareadas entre dados do ínicio e final das sessões. Para análise da CGI-SCH, foi utilizado o teste de Friedman para medidas não-paramétricas. O nível de significância adotado foi de p<0,05. A população amostral que completou o estudo foi de 14 indivíduos portadores de esquizofrenia crônica, refratária ou superrefratária, com bom nível de escolaridade, idade média de 32,94 anos e quase na totalidade usuários de clozapina. Foram realizadas 121 infusões. Observou-se diminuição estatisticamente significativa nos escores iniciais da BPRS, PANSS positiva e negativa e CGI-SCH, com manutenção da redução dos escores nos dias 15, 30 e 60 após término das sessões experimentais. Nas avaliações cognitivas, houve diferença significativa entre as sessões nos escores da SCWT e não houve diferença na análise da FAS e da Nback. Os resultados confirmaram achados anteriores de que o NPS, doador de NO, pode proporcionar melhora clínica significativa nos sintomas positivos e negativos daesquizofrenia, além de melhora parcial nos sintomas cognitivos. Além disso, o ensaio com administração repetida sugere que a droga é segura, não apresenta efeitos colaterais significativos na maioria dos casos e leva a uma melhora sustentada por até 60 dias nos sintomas da esquizofrenia / The knowledge about etiology of schizophrenia remains challenging and conventional treatments with antipsychotic medications that act mainly through the modulation of dopaminergic neurotransmission have proven insufficient, considering the high rates of treatment resistance in this population. Recent studies point to promising results of modulators of the glutamatergic system with action on NMDA receptors such as sodium nitroprusside (SNP), a nitric oxide donor, capable of reducing the positive, negative and cognitive symptoms of the disorder. The aim of the present study was to study the effects of repeated NPS administration on the symptomatology of patients with schizophrenia. A total of 17 schizophrenia patients were enrolled at the Ribeirão Preto Medical School University Hospital, aged 18-45 years took part in a double-blind, randomized, placebo-controlled, double-blind, experimental design. Each participant received eight intravenous infusions, four of SNP (0.5 ?g/kg/min for 4 hours/session) and four of placebo, with a 15-day interval between sessions. The Positive and Negative Syndromes Scale for Schizophrenia (PANSS), BPRS (Brief Psychiatric Rating Scale), Clinical Global Impression scale - Schizophrenia (CGI-SCH), in addition to the Stroop Color Word Test (SCWT), Nback, and the Verbal Fluency Test (FAS). The Side Effects Assessment Scale (UKU) was used to evaluate side effects. The analysis of the demographic and clinical data of the sample was performed through descriptive statistics. Statistical analyses were performed with the Statistical Package for Social Sciences. To evaluate the effect of SNP on BPRS, PANSS, SCWT, N-back and FAS scores, the data were subjected to repeated measures analysis of variance for crossover studies. Independent analyses for SNP and placebo sessions were performed when there were statistically significant differences between the conditions, followed by Student\'s t-test, which was also used for paired evaluations between data from the beginning and end of the sessions. For the analysis of CGI-SCH data, the Friedman test was used. The level of significance was set at p <0.05. The sample that completed the study consisted of 14 individuals with chronic, refractory or superrefractory schizophrenia, with a good level of education and mean age of 32.94 years . Almost all patients were in treatment with clozapine. A total of 121 infusions were performed. A statistically significant decrease was observed in the initial BPRS, PANSS positive and negative subscales, and CGI-SCH scores, which persisted on days 15, 30 and 60 after the end of the experimental sessions. In the cognitive assessments, there was a significant difference between the sessions in SCWT scores and no difference in respect to the FAS and N-back. The results confirmed earlier findings that SNP, an NO donor, can provide significant clinical improvement in the positive and negative symptoms of schizophrenia, as well as partial improvement in cognitive symptoms. In addition, the repeated administration trial suggests that the drug is safe, has no significant side effects in most cases and leads to sustained improvement for up to 60 days in the symptoms of schizophrenia

Os micro-organismos podem infectar seu hospedeiro por diferentes vias, sendo a principal o trato respiratório. O reconhecimento pela mucosa dessas vias pode desencadear inibição da proliferação e bloqueio da entrada microbiana, assim como estimular resposta direcionada a memória imunológica para prevenir posteriores infecções. Alguns micro-organismo, como as bactérias Neisseria meningitidis e Neisseria lactamica, são capazes de modular a resposta imune de mucosa diretamente, ou por meio das células epiteliais respiratórias. Este trabalho propôs, então, a avaliação das porinas B provenientes destas bactérias como moduladoras da produção de IL-8 nas linhagens BEAS-2B e Detroit 562. Também foi avaliada a dependência deste estímulo ao receptor TLR2. Ambas as porinas se ligaram a TLR2 e por este receptor estimularam a produção de IL-8. O perfil de produção foi dependente da expressão de TLR2 pelas células. A porina lactâmica induziu menos IL-8 por regular negativamente a expressão de TLR2, mas sua afinidade pelo receptor se mostrou maior que a da porina meningocócica. As porinas são então moduladoras das células de mucosa, fato que somado a atividade adjuvante destas proteínas por via parenteral estimulou a avaliação destas como adjuvantes de mucosa. O modelo escolhido para a avaliação foi o de inoculação intranasal de camundongos, utilizando como antígeno o lipopolissacarídio pouco imunogênico de Franciscella tularensis atenuada (Ft-LPS). A análise foi baseada no título de anticorpos IgG e IgM séricos. A porina meningocócica se mostrou a mais imunogênica, mas por ser originária de patógeno acarreta maior risco biológico em sua produção. Para viabilizar a porina meningocócica como adjuvante, a mesma foi substituída por porina homóloga produzida de modo recombinante em Escherichia coli não patogênica. A porina recombinante foi avaliada pelo mesmo sistema in vivo e comparada a adjuvantes experimentais de ação conhecida (rCTB, QS-21 e ODN 1826). A porina apresentou o melhor desempenho entre todos os adjuvantes, principalmente dois meses após o fim do esquema vacinal. O mesmo adjuvante foi adicionado ao vírus da raiva para caracterizar a amplitude de antígenos para sua aplicação e o efeito biológico dos anticorpos induzidos. Os resultados obtidos por via intranasal com antígeno da raiva confirmaram a propriedade de adjuvante de mucosa da porina recombinante, aumentando os títulos de IgG séricos. O ensaio biológico dos anticorpos por RFFIT comprovaram a funcionalidade dos anticorpos gerados, neutralizando a infectividade viral em células BHK-21. O uso da porina por via subcutânea não aumentou o nível de anticorpos neutralizantes, mas aumentou o de IgG. Não foi detectada imunidade celular específica de linfócitos do baço ao vírus da raiva nos parâmetros avaliados, independente da adição de adjuvantes. Em resumo, as porinas foram caracterizadas como relevantes na imunomodulação de células da mucosa respiratória por infecção meningocócica. A modulação também foi relevante para o aumento de resposta humoral frente a diferentes antígenos, por diferentes vias de administração, o que demonstra a eficiência e versatilidade da porina recombinante como adjuvante imunológico. / Microorganisms can invade the host through many routes, specially the respiratory tract. The respiratory mucosa is responsible for recognition, inhibition, proliferation and entry blockade of microorganisms, besides incitation of immunological memory to prevent further infections. Some microorganisms, such as Neisseria meningitidis and Neisseria lactamica, can modulate the mucosa immune response directly or through stimulation of respiratory epithelial cells. The present work proposed the evaluation of porin B proteins, derived from these microorganisms, as modulators of IL-8 production on respiratory epithelial cell strains BEAS-2B and Detroit 562. TLR2 receptor dependency for the modulation was also evaluated. Both porins bounded to TLR2 and through this receptor were able to stimulate IL-8 production, whereas this profile was correlated with TLR2 expression. Lactamica porin (Nlac PorB) induced less IL-8 and TLR2 expression, also for a shorter period of time. The effect caused by Nlac PorB was attributed to TLR2 down regulated expression, since its binding affinity to the receptor is greater than meningococcal porin (Nmen PorB). Porins were therefore able to immune modulate mucosal cells, fact that allied with their parenteral adjuvant activity incited evaluation of porins as potential mucosal adjuvants. The model chosen for the evaluation was intranasal immunization of mice, using as the antigen a low immunogenic lipopolysaccharide extracted from attenuated Franciscella tularensis (Ft-LPS). The evaluation was based on IgG and IgM serum titers. After the immunization scheme, Nmen PorB induced higher IgG and IgM titers than Nlac PorB. Although Nmen PorB was more efficient, it comes from a pathogen. To overcome the risk of its production, it was replaced by recombinant porin (rPorB) produced by Escherichia coli. rPorB was evaluated by the same model and compared with well known experimental adjuvants (rCTB, QS-21 e ODN 1826). rPoB had the highest IgM and IgG titers among all adjuvants tested, specially two months after vaccination. The same adjuvant was also combined with a viral antigen to characterize its application wideness and biological function of incited antibodies. Results obtained with rabies antigen by intranasal route confirmed the mucosal adjuvant properties of rPorB, increasing IgG titers induced by the antigen. These antibodies were also capable of virus neutralization, as demonstrated in RFFIT assays. rPoB didn´t raise neutralizing antibody titers by subcutaneous route, but increased IgG titers. Cellular immunity was undetectable in spleen lymphocytes with the screening method used, regardless of adjuvant addition. In conclusion, porins were characterized as revelant for immunomodulation of the respiratory mucosal cells, caused by infection with meningococcus. The immunomodulation was also revelant for increase of humoral reponse to different antigens and by different routes, pointing out recombinant porin B as an efficient and versatile immunological adjuvant.

Das Neuroblastom ist ein vom sympathischen Nervensystem ausgehender neuroektodermaler maligner Tumor des Kleinkindesalters. Bei über 50% der Neuroblastom-Ersterkrankungen liegt bereits das disseminierte Stadium 4 vor, das eine infauste Prognose hat. Eine wirksame Behandlung des Stadium 4 Neuroblastoms stellt deshalb nach wie vor eine der größten Herausforderungen der pädiatrischen Onkologie dar: Die Gesamtüberlebensrate von 20-25% der Kinder, die an dieser bösartigen Krankheit leiden, konnte während der letzten zwei Jahrzehnte trotz neuer Chemotherapie-Protokolle nicht wesentlich verbessert werden. Aus diesem Grund gibt es zunehmend Bestrebungen sich um Therapiealternativen zu bemühen. In dieser Arbeit werden die derzeit möglichen immunologischen Strategien zur Behandlung des Neuroblastoms abgehandelt. / Neuroblastoma is a neuroectodermal malignancy of early childhood derived from sympathetic nervous tissue. At initial diagnosis over 50% of patients present with disseminated stage 4 disease which has a dismal prognosis. Effective treatment of patients with stage 4 neuroblastoma remains a major challenge in pediatric oncology. Despite novel therapeutic approaches including chemotherapy and autologous stem cell transplantation the overall survival rate of only 20-25% did not improve over the last two decades. Therefore, a lot of effort has been made to develop novel alternative therapies. This thesis summarizes possible immunotherapeutic strategies for the treatment of neuroblastoma.