Animais hematófagos possuem em sua saliva substâncias que permitem a fluidez do sangue, para o sucesso de sua alimentação. Com isso, têm sido descritos diversos componentes com atividades nos diferentes processos hemostáticos (coagulação, fibrinólise e agregação plaquetária). O complexo salivar da sanguessuga Haementeria depressa vem sendo estudado através de bioquímica clássica e análises transcriptômica e proteômica deste tecido determinaram o perfil dos transcritos e das proteínas produzidas. Dentre os transcritos mais abundantes foram encontrados três clones (H06A09, H06A02 e L02F02) que apresentaram 45%, 87% e 94% de similaridade ao LAPP, um inibidor de agregação plaquetária da sanguessuga Haementeria officinallis, a produção destes componentes pelo tecido foi confirmada pela análise proteômica. O LAPP é um inibidor que age pela via do colágeno e possui cerca de 14 kDa e pI de 4,0 e inibe a ligação da plaqueta ao colágeno tanto pelo epítopo do FvW quanto pelo domínio <font face=\"Symbol\">a2<font face=\"Symbol\">b1. Assim, o objetivo do presente trabalho foi clonar, expressar e caracterizar a proteína recombinante ativa, a partir do clone H06A09 para estudos de atividade desta molécula. Para obter a proteína recombinante de interesse inicialmente a clonagem do transcrito foi realizada com sucesso em vetor pAE, porém, a expressão em sistema procarioto apresentou alguns obstáculos já que a molécula não tinha atividade. Uma nova estratégia foi proposta, sendo realizada clonagem em vetor pPIC9K e expressão em sistema eucariótico (leveduras Pichia pastoris - GS115). Após a utilização de diferentes metodologias para estabelecimento das melhores condições para expressão neste sistema, foi eleito o protocolo onde a proteína recombinante era expressa a 28 °C, sob agitação de 260 rpm, e indução por 0,5% de Metanol a cada 24h, durante 72h de expressão. A molécula recombinante expressa e secretada foi submetida a diferentes metodologias para purificação, assim, determinou-se que a estratégia utilizada que melhor isolou a proteína foi a submissão do sobrenadante da expressão à diálise e concentração em sistema de ultrafiltração (Amicon 5 kDa Millipore) seguida de uma cromatografia de gel filtração em Superdex 75 (GE), sistema FPLC, com coleta fracionada. Ensaios de agregação plaquetária confirmaram a atividade inibitória da proteína recombinante tanto em sangue total como em PRP (plasma rico em plaqueta) e plaqueta lavada, especificamente quando o agonista era o colágeno, apresentando IC50 para PRP e plaqueta lavada de 20 e 712 ng, respectivamente. Ensaios por citometria de fluxo indicaram que a proteína recombinante, diferente do LAPP, age na inibição da agregação plaquetária induzida por colágeno, pela ligação à subunidade Ib<font face=\"Symbol\">a do complexo GPIb-IX-V, complexo este que usa o FvW como ponte entre a plaqueta e o colágeno, firmando assim a interação da plaqueta ao subendotélio e posterior agregação. Desta forma, o presente trabalho caracteriza o primeiro inibidor recombinante de agregação plaquetária pela via do colágeno proveniente de sanguessugas Haementeria depressa, e comprova que apesar de apresentar 45% de similaridade estrutural ao LAPP é um inibidor com características funcionais diferentes, e com grande potencial a ser estudado. / Hematophagous animals have in their saliva substances that maintain the blood fluidity to the success of their feeding. Therefore, components have been described by their activities in the hemostatic processes (coagulation, fibrinolysis and platelet aggregation).The salivary complex of Haementaria depressa leech has been studied by classical biochemical and transcriptomic and proteomic analysis of this tissue determined the profile of transcripts and proteins produced by it. Among the most abundant transcripts were found three clones (H06A09, H06A02 e L02F02) that showed 45%, 87% e 94% of similarity to LAPP, an inhibitor of platelet aggregation from Haementeria officinallis, the components production was confirmed by proteomic analysis. LAPP is a inhibitor that acts by collagen pathway and has around 14 kDa and pI of 4.0, and inhibits the binding of platelet to collagen by both the epitope domain of vWF as the <font face=\"Symbol\">a2<font face=\"Symbol\">b1. Thereby, the aim of this study was to clone, express and characterize the active recombinant protein from the clone H06A09 for studies of activity of this molecule. To obtain the recombinant protein initially cloning of transcript was successfully performed in pAE vector, however, the protein expressed in prokaryotic system presented some obstacles not presenting activity. A new strategy was proposed, being held in pPIC9K vector and expression in eukaryotic system - yeast Pichia pastoris (GS115). After using different methodologies to establish the best conditions for expression in this system, was elected the protocol where the recombinant protein was expressed in 28 °C, under agitation of 260 rpm, and 0.5% methanol induction every 24 hours during 72 hours of expression. The recombinant molecule was expressed in soluble portion and was subjected to differents methods for purification, so it was determined that the best strategy to isolation of the protein was the concentration and dialysis of the expression supernatant by ultrafiltration system (Amicon 5 kDa Millipore) followed by gel filtration chromatography on Superdex 75 (GE), FPLC system. Tests confirmed the platelet aggregation inhibitory activity of the recombinant protein in whole blood, PRP (platelet rich plasma) and in washed platelets, specifically when the agonist was collagen, with IC50 to PRP and washed platelet of 20 and 712 ng, respectively. Assays by flow cytometry indicated that the recombinant protein, different from LAPP, acts to inhibit platelet aggregation induced by collagen, by the binding to the Ib<font face=\"Symbol\">a subunit of the GPIb-IX-V complex, this complex uses the vWF as a bridge between the platelet and collagen, thus firming the interaction of the subendothelium and subsequent platelet aggregation. Thus, this study characterized the first recombinant inhibitor of platelet aggregation through collagen pathway from Haementeria depressa leeches, and proves that despite having 45% structural similarity to the LAPP is an inhibitor with different functional characteristics, and with great potential to be studied.

Background: Assessment of platelet vitality is important for patients presenting with inherited or acquired disorders of platelet function and for quality assessment of platelet concentrates. Methods: Herein we combined live stains with intra-vital confocal fluorescence microscopy in order to obtain an imaging method that allows fast and accurate assessment of platelet vitality. Three fluorescent dyes, FITC-coupled wheat germ agglutinin (WGA), tetramethylrhodamine methyl ester perchlorate (TMRM) and acetoxymethylester (Rhod-2), were used to assess platelet morphology, mitochondrial activity and intra-platelet calcium levels. Microscopy was performed with a microlens-enhanced Nipkow spinning disk-based system allowing live confocal imaging. Results: Comparison of ten samples of donor platelets collected before apheresis and platelets collected on days 5 and 7 of storage showed an increase in the percentage of Rhod-2positive platelets from 3.6 to 47 and finally to 71%. Mitochondrial potential was demonstrated in 95.4% of donor platelets and in 92.5% of platelets stored for 7 days. Conclusion: Such fast and accurate visualization of known key parameters of platelet function could be of relevance for studies addressing the quality of platelets after storage and additional manipulation, such as pathogen inactivation, as well as for the analysis of inherited platelet function disorders. / Hintergrund: Die Vitalitätsbestimmung von Blutplättchen ist sowohl für die Analyse angeborener Plättchendefekte als auch für die Qualitätsbestimmung von Plättchenkonzentraten von zentraler Bedeutung. Methoden: In der vorliegenden Arbeit stellen wir eine Methode vor, die mittels einer Kombination von Vitalfarbstoffen und konfokaler «Real time»-Mikroskopie neue Einblicke in die Vitalitätsbestimmung lebender Plättchen ermöglicht. Mittels der Zugabe von FITC-gekoppeltem Weizenkeimlektin (WGA), Tetramethylrhodamin-Methylesterperchlorat (TMRM) und Acetoxymethylester (Rhod-2) wurde bei lebenden Blutplättchen deren Morphologie, mitochondriale Aktivität und Veränderungen im Calcium-Haushalt im Rahmen der Lagerung analysiert. Für die Mikroskopie wurde ein Nipkow-System gewählt, das eine konfokale Mikroskopie lebender Zellen ermöglicht. Ergebnisse: Der Vergleich von 10 humanen Blutplättchenproben zu Beginn bzw. nach 5 und 7 Tagen Lagerung zeigte einen Anstieg der Rhod-2-positiven Plättchen von 3,6 über 47 auf 71%. Die Anzahl der Blutplättchen mit TMRM-positiven Mitochondrien hingegen lag vor der Lagerung bei 95,4% und nach den 7 Tagen Lagerung bei 92,5%. Schlussfolgerung: Die hier vorgestellte Methodik der Bildgebung zur Bestimmung vitaler Parameter von Blutplättchen eignet sich als ergänzende Analysemodalität für eine bessere Bestimmung der Blutplättchenqualität. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The conformational conversion of the cellular prion protein (PrPc) to the misfolded isoform (PrPsc) is the central pathogenic event in the transmissible neurodegenerative prion diseases. The recently shown transmissibility of variant Creutzfeldt-Jakob disease by blood transfusion emphasizes the need for better understanding of the PrPc in blood. In the current thesis, we focused on blood platelet PrPc, which has not been very well described so far. In the first part of the thesis, platelet PrPc was characterized as glycosylphosphatidylinositol- anchored glycoprotein with dominant diglycosylated form. Platelet PrPc was shown to be sensitive to cleavage with proteinase K, which is a feature discriminating between cellular and pathological prion protein. We have confirmed that platelet PrPc binds copper ions by its N- terminal octapeptide repeat region. Regarding quantity of PrPc molecules expressed on blood elements we have proved that both platelets and red blood cells express considerable amount of PrPc and thus can not be neglected in the problematic of prions transmission by blood transfusion. The detailed study regarding PrPc localization in blood platelets is presented in the second part of the thesis. PrPc was shown to be expressed in -granules as well as on the cytoplasmic membrane of...

Thrombocytes are important players in hemostasis. There is still much to be explored regarding the molecular basis of the thrombocyte function. In our previous microarray analysis data, we found IFT122 (an intraflagellar transport protein known to be involved in cilia formation) transcripts in zebrafish thrombocytes. Given recent discoveries of non-ciliary roles for IFTs, we examined the possibility that IFT122 affects thrombocyte function. We studied the role of IFT122 in thrombocyte function. We also found that IFT122 plays a central role in thrombocyte activation initiated by the agonists ADP, collagen, PAR-1 peptide and epinephrine. Although the receptors for ADP, PAR-1 peptide and epinephrine are present in the zebrafish genome, the collagen receptor GPVI was missing. In this study, we identified G6fL as a collagen receptor in zebrafish thrombocytes. Furthermore, IFT knockdown results in reduction in Wnt signaling. The Wnt signaling has been shown to be involved in megakaryocyte proliferation and proplatelets production. Therefore, defects in IFT could lead to thrombocytopenia. Splenectomy is performed in humans to treat such conditions. Therefore, in this study we developed a survival surgery protocol for splenectomy. We have shown that number of thrombocytes and their microparticles increase following splenectomy in zebrafish. Thus overall the studies on thrombocyte function in zebrafish could enhance fundamental knowledge on hemostasis and may provide future target candidates for therapies.

Introduction: Whole blood transfusions are indicated for the resuscitation of patients with hemorrhagic trauma. In Sweden, whole blood is stored for 14 days at 4°C. If possible, refrigerated blood is rewarmed to 37°C before transfusion to avoid hypothermia. Platelets contribute to hemostasis and can be activated with several pathways. During storage, shedding of platelet surface receptors takes place. Further research on how platelet storage in whole blood and rewarming before transfusion affect platelets is needed. Aim: The aim was to study how storage in whole blood and rewarming to 37°C affect platelet function, platelet activatability, and changes in platelet surface receptors. Method: Whole blood from two healthy donors was stored for 14 days. During these 14 days, two blood samples were taken on day 0, before and after leukocyte reducing filtration, 1, 3, 7, and 14. One of the two blood samples from each whole blood product was tested at room temperature and the other was rewarmed to 37°C. The blood samples were mixed with antibodies and platelet agonists and analyzed on a flow cytometer. The blood samples were also analyzed on a cell counter. Results: This study shows distinct changes in platelet spontaneous activation, platelet count, and platelet receptor shedding by increased storage time in cold-stored whole blood and even more with rewarming to 37°C. Conclusion: This study shows that during storage, spontaneous platelet activation and shedding of GPIb and GPIIb increases while platelet count decreases. All these factors are likely affecting the platelet function and hemostatic function negatively.

INTRODUÇÃO: Entre os tratamentos existentes para o transtorno obsessivocompulsivo (TOC) os mais eficazes são o farmacológico, com inibidores de recaptura de serotonina (IRS; inibidores seletivos de recaptura de serotonina [ISRS] e clomipramina), e o comportamental, baseado na técnica de exposição com prevenção de resposta (EPR). Ambas apresentam eficácia semelhante para os sintomas obsessivo-compulsivos e estudos demonstram que a EPR produz modificações neurobiológicas semelhantes às provocadas pelo tratamento com ISRS. Essas evidências sugerem que a resposta clínica à EPR está diretamente relacionada a um aumento da biodisponibilidade de 5HT no cérebro. A concentração de 5HT no sangue periférico é uma medida representativa do sistema serotonérgico central, e é utilizada como um marcador biológico indireto. O objetivo deste estudo foi comparar a concentração serotonérgica (basal e variação em 8 semanas) e a resposta à terapia comportamental baseada em EPR. MÉTODOS: Foram incluídos nesse estudo 30 pacientes com diagnóstico operacional de TOC. Destes, 29 iniciaram o tratamento, 27 chegaram até a quarta semana e 24 completaram o protocolo padronizado com 16 sessões (8 semanas) de terapia. As dosagens de 5-HT foram feitas nas semanas 0 e 8 e as avaliações clínicas pelas escalas Y-BOCS e CGI, bem como medidas de sintomas secundários (depressão, ansiedade e incapacidade) nas semanas 0, 4 e 8. RESULTADOS: Encontrou-se correlação positiva entre a concentração basal de 5HT e a resposta clínica em quatro semanas de EPR (p<0,05).Observouse maior concentração basal e maior redução em 8 semanas nos níveis de 5HT em pacientes respondedores comparados aos não respondedores. Entretanto não houve significância estatística. CONCLUSÃO: Na amostra estudada os dados sugerem que a alta concentração basal de 5-HT é um marcador biológico preditor de boa resposta clínica a quatro semanas de EPR. Amostras maiores talvez mostrassem a concentração de 5-HT no plasma rico em plaquetas como um preditor de resposta a 8 semanas de EPR. Protocolos com amostras maiores e com grupos controle são necessários para confirmar esses achados / INTRODUCTION: Both gold standard treatments for obsessive-compulsive disorder (pharmacotherapy with serotonin reuptake inhibitors, and behavioral with exposure and response prevention [ERP]) are equally effective. Studies have demonstrated similar neurobiological changes elicited by these different treatments in OCD patients. These findings are suggestive that the clinical response to ERP is directly related to an increase of the 5-HT concentration in the brain. The platelet 5-HT concentration have been shown as a representative measure of central serotonergic system and used as a biological marker of the synaptic transmition. OBJECTIVE: To compare the platelet 5-HT concentration (basal and variation in 8 weeks) and the clinical response to ERP treatment. METHODS: 30 OCD patients were included and 29 started the treatment. 27 patients compleated at list 4 weeks and 24 completed all 8 weeks (16 sesions) ERP protocol. Patients had the basal and final (after 8 weeks) platelet 5-HT concentrations dosed and the clinical response measured by Y-BOCS, CGI and measures of secondary symptoms as well (depression, anxiety and disability). RESULTS: Data shows a positive correlation between the basal concentration of 5-HT and the 4 week ERP response (p<0,05). There were higher basal concentration and reduction in 8 weeks of platelet 5-HT concentration in the responders group compared with non-responders. Nevertheless, this differences was not significant (p>0,05). CONCLUSION: In the studied sample data suggest that high basal 5-HT platelet concentration is a biologic predictor of fast onset (4 weeks) of clinical response to ERP. Probably larger samples would show the basal 5-HT platelet concentration as a predictor of 8 weeks ERP outcome. Controlled trials are needed to confirm these findings

Les mégacaryocytes sont des cellules de la moelle osseuse, à l’origine de la production des plaquettes sanguines. Quand elles arrivent à maturité, elles grossissent et émettent des prolongements de cytoplasme à travers la paroi des vaisseaux irriguant la moelle. Dans la circulation sanguine, ces prolongements, soumis aux forces de l’écoulement, s’allongent et se rompent pour former des plaquettes. Des techniques microfluidiques capables de produire des plaquettes in vitro existent et sont une alternative prometteuse au don. Mais le rendement reste à améliorer. Pour cela, il est nécessaire de mieux comprendre la fragmentation des mégacaryocytes en plaquettes. Ce travail de doctorat s’inscrit dans ce contexte et sera développé en deux axes principaux dans ce manuscrit. Dans une première partie nous développons une méthode pour trier des cellules en fonction de leur déformabilité, afin de savoir si les propriétés mécaniques d’un mégacaryocyte sont liées à leur stade de maturité. La méthode a d’abord été mise au point avec des microcapsules. Leurs propriétés mécaniques sont déterminées par analyse inverse à partir de la mesure de leur forme en écoulement dans des constrictions droites. Puis le dispositif utilisé a été miniaturisé pour s’adapter à la taille des cellules. Pour la caractérisation de leurs propriétés mécaniques, deux outils ont été utilisés: l’analyse inverse et la microscopie à force atomique sans pointe. Une deuxième partie porte sur l’étude de l’élongation et de la rupture de mégacaryocytes soumis écoulement. Nous avons quantifié les variations spatiotemporelles du taux d’élongation et développé un protocole d’ablation laser pour étudier les mécanismes de rupture de cellules en élongation. / When they mature in the bone marrow, the precursors of platelets, called megakaryocytes, grow and extend protrusions able to join blood circulation. There these protrusions elongate and break into platelets. Microfluidic techniques for in vitro platelet production represent a promising alternative to donation. In order to enhance platelet production and match the needs of clinical applications such as transfusion, we need to better understand the fragmentation of megakaryocytes into platelets. Our contribution will be described in this manuscript in two main axes. First, in order to know if mechanical properties of megakaryocytes can indicate their maturity stage, we develop a cell sorting method based on deformability. The method is first validated with microcapsules. Their mechanical properties are determined by inverse analysis from their shape under flow in straight microchannels. Then the device is downscaled. The characterization of cell mechanical properties are performed using inverse analysis and tipless atomic force microscopy. Second, we study megakaryocyte elongation and rupture in a microfluidic device. We quantify the spatial and temporal variations of the elongation rate and develop a laser ablation protocol to trigger and study the rupture of elongating cells.

A trombocitopenia induzida por heparina (TIH) é uma síndrome imunohematológica mediada por um anticorpo que causa ativação plaquetária na presença de heparina, induz à agregação plaquetária e pode estar associada a graves e paradoxais complicações trombóticas e morte. A freqüência de TIH nos pacientes que recebem heparina por mais de cinco dias é de 1% a 5%, e está relacionada a vários fatores. Este é um estudo pioneiro no Brasil, que objetivou avaliar aqui a freqüência de TIH nos pacientes em uso de heparina, a relação ao gênero, ao tipo de heparina e a associação do genótipo da FcRIIa de receptores plaquetários. Foram selecionados 278 pacientes das Unidades de Terapia Intensiva e Unidades Coronariana do InCor-HCFMUSP, que receberam anticoagulação por heparina não fracionada (HNF) e/ou heparina de baixo peso molecular (HBPM), por pelo menos 5 dias, e excluídas as possíveis causas conhecidas de trombocitopenia. Foi realizada a contagem plaquetária pré e pós terapia com heparina, e o teste de detecção do anticorpo anti-fator 4 plaquetário/heparina (ID-PaGIA, DiaMed; e Asserachrom®-HPIA, Stago). O estudo da genotipagem da FcRIIa de receptores plaquetários foi realizado pelo método de digestão com enzima de restrição alelo específica. A freqüência de TIH encontrada foi de 6 (2,2%), e a freqüência de trombocitopenia com a presença do anticorpo anti-fator 4 plaquetário foi de 24,3%. A análise do gênero do paciente não demonstrou correlação com a TIH, nem com a trombocitopenia e nem com o anticorpo anti-fator 4 plaquetário. As mulheres apresentaram mais trombose do que os homens. A trombocitopenia ocorreu com maior freqüência nos pacientes que utilizaram os dois tipos de heparina (HNF-HBPM) e, com menor freqüência, nos que utilizaram apenas HBPM. O genótipo da FcRIIa de receptores plaquetários não apresentou relação com o gênero, nem com a TIH. Este estudo determinou a freqüência de TIH em uma população brasileira com uso de heparina e auxiliou no diagnostico. O melhor teste para detectar o anticorpo anti-fator 4 plaquetário/heparina, na presença de trombocitopenia e trombose, foi o teste de imunoaglutinação ID-PaGIA (DiaMed). A utilização dos dois tipos de heparina promoveu uma maior freqüência de trombocitopenia. Porém, novos estudos precisam confirmar as relações entre o tipo de heparina, com a trombocitopenia e com a TIH / Heparin induced thrombocytopenia (HIT) is an immune-hematologic syndrome mediated by a heparin dependent antibody that causes platelet activation, platelet aggregation, and can be associated with thrombosis and death. HIT occurs in about 1-5% of patients receiving heparin therapy up to 5 days or more. Many factors influence on the frequency of HIT. This is a pioneer Brazilian study to determine the frequency of HIT on patients under heparin therapy, and the relationship of HIT with gender, heparin type and the FcRIIa platelet receptor genotype. 278 patients from the Intensive Care Unit and Cardiac Care Unit at InCor-HCFMUSP treated with Unfractionated Heparin (UFH) and/or Low Molecular Weight Heparin (LMWH) for 5 or more days were studied. Known causes of thrombocytopenia were excluded. Platelet count was monitored pre and post heparin therapy. All selected patients were tested for detection of anti-heparin/PF4 antibody (ID-PaGIA, DiaMed; and Asserachrom®-HPIA, Stago). HIT frequency found was 6 (2,2%) and the frequency of thrombocytopenia (determined by a decrease in the platelet count below 50%, after the introduction of heparin therapy) and positive anti-heparin/PF4 antibody test was 24,3%. Patients gender was not related to TIH, neither to thrombocytopenia nor to the presence of antiheparin/ PF4 antibody. Thrombosis events were more frequent in women than in men. Thrombocytopenia, related to the type of heparin, was more frequent in patients that had used both types of heparin and less frequent in those that used only LMWH. FcRIIa platelet receptor genotype was associated with neither HIT nor with gender. This study has provided the frequency of HIT in a Brazilian patient population under heparin therapy and auxiliary in the HIT diagnosis. The ID-PaGIA (DiaMed) was shown to be the best test to correlate the presence of anti-heparin/PF4 antibody to thrombocytopenia and thrombosis event. The use of both heparin types promotes more thrombocytopenia. New studies are needed to confirm the relationship between heparin type and thrombocytopenia with HIT

INTRODUÇÃO: Entre os tratamentos existentes para o transtorno obsessivocompulsivo (TOC) os mais eficazes são o farmacológico, com inibidores de recaptura de serotonina (IRS; inibidores seletivos de recaptura de serotonina [ISRS] e clomipramina), e o comportamental, baseado na técnica de exposição com prevenção de resposta (EPR). Ambas apresentam eficácia semelhante para os sintomas obsessivo-compulsivos e estudos demonstram que a EPR produz modificações neurobiológicas semelhantes às provocadas pelo tratamento com ISRS. Essas evidências sugerem que a resposta clínica à EPR está diretamente relacionada a um aumento da biodisponibilidade de 5HT no cérebro. A concentração de 5HT no sangue periférico é uma medida representativa do sistema serotonérgico central, e é utilizada como um marcador biológico indireto. O objetivo deste estudo foi comparar a concentração serotonérgica (basal e variação em 8 semanas) e a resposta à terapia comportamental baseada em EPR. MÉTODOS: Foram incluídos nesse estudo 30 pacientes com diagnóstico operacional de TOC. Destes, 29 iniciaram o tratamento, 27 chegaram até a quarta semana e 24 completaram o protocolo padronizado com 16 sessões (8 semanas) de terapia. As dosagens de 5-HT foram feitas nas semanas 0 e 8 e as avaliações clínicas pelas escalas Y-BOCS e CGI, bem como medidas de sintomas secundários (depressão, ansiedade e incapacidade) nas semanas 0, 4 e 8. RESULTADOS: Encontrou-se correlação positiva entre a concentração basal de 5HT e a resposta clínica em quatro semanas de EPR (p<0,05).Observouse maior concentração basal e maior redução em 8 semanas nos níveis de 5HT em pacientes respondedores comparados aos não respondedores. Entretanto não houve significância estatística. CONCLUSÃO: Na amostra estudada os dados sugerem que a alta concentração basal de 5-HT é um marcador biológico preditor de boa resposta clínica a quatro semanas de EPR. Amostras maiores talvez mostrassem a concentração de 5-HT no plasma rico em plaquetas como um preditor de resposta a 8 semanas de EPR. Protocolos com amostras maiores e com grupos controle são necessários para confirmar esses achados / INTRODUCTION: Both gold standard treatments for obsessive-compulsive disorder (pharmacotherapy with serotonin reuptake inhibitors, and behavioral with exposure and response prevention [ERP]) are equally effective. Studies have demonstrated similar neurobiological changes elicited by these different treatments in OCD patients. These findings are suggestive that the clinical response to ERP is directly related to an increase of the 5-HT concentration in the brain. The platelet 5-HT concentration have been shown as a representative measure of central serotonergic system and used as a biological marker of the synaptic transmition. OBJECTIVE: To compare the platelet 5-HT concentration (basal and variation in 8 weeks) and the clinical response to ERP treatment. METHODS: 30 OCD patients were included and 29 started the treatment. 27 patients compleated at list 4 weeks and 24 completed all 8 weeks (16 sesions) ERP protocol. Patients had the basal and final (after 8 weeks) platelet 5-HT concentrations dosed and the clinical response measured by Y-BOCS, CGI and measures of secondary symptoms as well (depression, anxiety and disability). RESULTS: Data shows a positive correlation between the basal concentration of 5-HT and the 4 week ERP response (p<0,05). There were higher basal concentration and reduction in 8 weeks of platelet 5-HT concentration in the responders group compared with non-responders. Nevertheless, this differences was not significant (p>0,05). CONCLUSION: In the studied sample data suggest that high basal 5-HT platelet concentration is a biologic predictor of fast onset (4 weeks) of clinical response to ERP. Probably larger samples would show the basal 5-HT platelet concentration as a predictor of 8 weeks ERP outcome. Controlled trials are needed to confirm these findings

A new lattice-Boltzmann finite-element method is used to simulate large numbers of deformable red blood cells and platelets in suspension for the investigation of stress-mediated platelet-deposition mechanisms in blood. The coupled lattice-Boltzmann finite-element method provides the novel ability to simulate hundreds of realistic and deformable red blood cells and produce continuum-scale physics at physiologic hematocrit and low arterial-shear rates. The new method is developed and shown to produce single red blood cell deformation consistent with experimental results in flow chambers. Simulations of 77 to 216 cells in unbounded shear flow produce bulk and micro-rheological behavior consistent with experimental results in viscometers and tubes, including shear-thinning behavior at various shear rates. Investigation of the local stress environment in blood indicates that, although the majority of platelets experience a time-averaged shear stress equal to the suspension stress, 25% of platelets experience a localized shear stress greater than twice the suspension stress. The lattice-Boltzmann finite-element method developed in this work has been shown capable of investigating the fundamental gap between cell-level processes and continuum-level function. The complex stress environment in whole blood has been described for simple shear flow and the methodology may be extended to more complex flow geometries and incorporate platelet-adhesion models for adhesion studies. Thus, this research fits into the greater objective of prediction and control of platelet deposition in clinical and engineering applications. Furthermore, the ability to bridge the gap between cell-level processes and continuum-level function is useful in other important cardiovascular areas including leukocyte adhesion, platelet aggregate embolization, and artheriogenesis.