A uremia é uma desordem sistêmica que pode estar associada à disfunção plaquetária adquirida, levando a alterações na hemostasia primária. Vários modelos de interferência entre a uremia e a falha na hemostasia já foram propostos, porém o mecanismo exato é desconhecido, e a tendência ao sangramento parece ser de origem multifatorial. O teste do tempo de sangramento da mucosa oral (TSMO) pode ser utilizado na avaliação da hemostasia primária em animais. O fator de von Willebrand (FvW:Ag) normal ou aumentado, observado na maioria dos cães urêmicos, contribui para o diagnóstico de uma alteração plaquetária adquirida. A contagem de plaquetas e os testes de coagulação normais associados a um aumento no TSMO dão suporte à suspeita de um defeito qualitativo. O objetivo deste trabalho foi investigar possíveis anormalidades na hemostasia, buscando estabelecer uma relação entre os resultados de exames laboratoriais e alterações no tempo de sangramento. A hemostasia foi avaliada em quarenta cães azotêmicos, urêmicos ou não. O aumento no TSMO foi observado em 35% dos cães azotêmicos. O teste de Spearman demonstrou haver correlação entre o TSMO e os valores de creatinina, uréia e hematócrito, porém, o ajuste pela Regressão Linear Múltipla evidenciou o hematócrito como única variável associada com o TSMO. Valores de hematócrito abaixo do intervalo de referência para a espécie foram observados em 92,86% dos pacientes que apresentaram aumento no TSMO. Esses valores reduzidos parecem contribuir para a tendência ao sangramento, embora não possam ser considerados como fator determinante preditivo, uma vez que sua ocorrência nem sempre se associou com interferências no TSMO. / Uremia is a systemic disorder that may be associated with acquired platelet dysfunction, leading to changes in primary hemostasis. Several interference models between uremia and hemostasis failure have been proposed, but the exact mechanism is unknown, and bleeding tendencies seem to have a multifactorial origin. The buccal mucosal bleeding time (BMBT) test can be used in the assessment of primary hemostasis in animals. Normal or increased von Willebrand factor (vWF:Ag), observed in most uremic dogs, contributes to the diagnosis of an acquired platelet alteration. Normal platelet counts and coagulation tests associated with BMBT raises support the suspicion of a qualitative defect. The aim of this study was to investigate possible hemostasis abnormalities, trying to establish a relation between the results of laboratory tests and changes in bleeding times. Hemostasis was evaluated in forty azotemic dogs, uremic or not. Increase in BMBTs was observed in 35% of the azotemic dogs. Spearman’s test showed a correlation between BMBT and the values of creatinine, urea and hematocrit; however, adjusting for Multiple Linear Regression showed hematocrit as the only variable associated with BMBT. Hematocrit values below reference range for the species was observed in 92,86% of the patients showed an increase in BMBT. These low values appear to contribute to the tendency to bleed, although they cannot be considered as a preditive determining factor, since their occurrence is not always associated with interference in BMBT.

A uremia é uma desordem sistêmica que pode estar associada à disfunção plaquetária adquirida, levando a alterações na hemostasia primária. Vários modelos de interferência entre a uremia e a falha na hemostasia já foram propostos, porém o mecanismo exato é desconhecido, e a tendência ao sangramento parece ser de origem multifatorial. O teste do tempo de sangramento da mucosa oral (TSMO) pode ser utilizado na avaliação da hemostasia primária em animais. O fator de von Willebrand (FvW:Ag) normal ou aumentado, observado na maioria dos cães urêmicos, contribui para o diagnóstico de uma alteração plaquetária adquirida. A contagem de plaquetas e os testes de coagulação normais associados a um aumento no TSMO dão suporte à suspeita de um defeito qualitativo. O objetivo deste trabalho foi investigar possíveis anormalidades na hemostasia, buscando estabelecer uma relação entre os resultados de exames laboratoriais e alterações no tempo de sangramento. A hemostasia foi avaliada em quarenta cães azotêmicos, urêmicos ou não. O aumento no TSMO foi observado em 35% dos cães azotêmicos. O teste de Spearman demonstrou haver correlação entre o TSMO e os valores de creatinina, uréia e hematócrito, porém, o ajuste pela Regressão Linear Múltipla evidenciou o hematócrito como única variável associada com o TSMO. Valores de hematócrito abaixo do intervalo de referência para a espécie foram observados em 92,86% dos pacientes que apresentaram aumento no TSMO. Esses valores reduzidos parecem contribuir para a tendência ao sangramento, embora não possam ser considerados como fator determinante preditivo, uma vez que sua ocorrência nem sempre se associou com interferências no TSMO. / Uremia is a systemic disorder that may be associated with acquired platelet dysfunction, leading to changes in primary hemostasis. Several interference models between uremia and hemostasis failure have been proposed, but the exact mechanism is unknown, and bleeding tendencies seem to have a multifactorial origin. The buccal mucosal bleeding time (BMBT) test can be used in the assessment of primary hemostasis in animals. Normal or increased von Willebrand factor (vWF:Ag), observed in most uremic dogs, contributes to the diagnosis of an acquired platelet alteration. Normal platelet counts and coagulation tests associated with BMBT raises support the suspicion of a qualitative defect. The aim of this study was to investigate possible hemostasis abnormalities, trying to establish a relation between the results of laboratory tests and changes in bleeding times. Hemostasis was evaluated in forty azotemic dogs, uremic or not. Increase in BMBTs was observed in 35% of the azotemic dogs. Spearman’s test showed a correlation between BMBT and the values of creatinine, urea and hematocrit; however, adjusting for Multiple Linear Regression showed hematocrit as the only variable associated with BMBT. Hematocrit values below reference range for the species was observed in 92,86% of the patients showed an increase in BMBT. These low values appear to contribute to the tendency to bleed, although they cannot be considered as a preditive determining factor, since their occurrence is not always associated with interference in BMBT.

A uremia é uma desordem sistêmica que pode estar associada à disfunção plaquetária adquirida, levando a alterações na hemostasia primária. Vários modelos de interferência entre a uremia e a falha na hemostasia já foram propostos, porém o mecanismo exato é desconhecido, e a tendência ao sangramento parece ser de origem multifatorial. O teste do tempo de sangramento da mucosa oral (TSMO) pode ser utilizado na avaliação da hemostasia primária em animais. O fator de von Willebrand (FvW:Ag) normal ou aumentado, observado na maioria dos cães urêmicos, contribui para o diagnóstico de uma alteração plaquetária adquirida. A contagem de plaquetas e os testes de coagulação normais associados a um aumento no TSMO dão suporte à suspeita de um defeito qualitativo. O objetivo deste trabalho foi investigar possíveis anormalidades na hemostasia, buscando estabelecer uma relação entre os resultados de exames laboratoriais e alterações no tempo de sangramento. A hemostasia foi avaliada em quarenta cães azotêmicos, urêmicos ou não. O aumento no TSMO foi observado em 35% dos cães azotêmicos. O teste de Spearman demonstrou haver correlação entre o TSMO e os valores de creatinina, uréia e hematócrito, porém, o ajuste pela Regressão Linear Múltipla evidenciou o hematócrito como única variável associada com o TSMO. Valores de hematócrito abaixo do intervalo de referência para a espécie foram observados em 92,86% dos pacientes que apresentaram aumento no TSMO. Esses valores reduzidos parecem contribuir para a tendência ao sangramento, embora não possam ser considerados como fator determinante preditivo, uma vez que sua ocorrência nem sempre se associou com interferências no TSMO. / Uremia is a systemic disorder that may be associated with acquired platelet dysfunction, leading to changes in primary hemostasis. Several interference models between uremia and hemostasis failure have been proposed, but the exact mechanism is unknown, and bleeding tendencies seem to have a multifactorial origin. The buccal mucosal bleeding time (BMBT) test can be used in the assessment of primary hemostasis in animals. Normal or increased von Willebrand factor (vWF:Ag), observed in most uremic dogs, contributes to the diagnosis of an acquired platelet alteration. Normal platelet counts and coagulation tests associated with BMBT raises support the suspicion of a qualitative defect. The aim of this study was to investigate possible hemostasis abnormalities, trying to establish a relation between the results of laboratory tests and changes in bleeding times. Hemostasis was evaluated in forty azotemic dogs, uremic or not. Increase in BMBTs was observed in 35% of the azotemic dogs. Spearman’s test showed a correlation between BMBT and the values of creatinine, urea and hematocrit; however, adjusting for Multiple Linear Regression showed hematocrit as the only variable associated with BMBT. Hematocrit values below reference range for the species was observed in 92,86% of the patients showed an increase in BMBT. These low values appear to contribute to the tendency to bleed, although they cannot be considered as a preditive determining factor, since their occurrence is not always associated with interference in BMBT.

A. A study of Stichodactyla helianthus toxin’s potential to penetrate the buccal mucosa Introduction:  Buccal mucosa is an alternative route for drug administration and has advantages over other conventional routes by avoiding both enzymes in the gastro intestinal system and the hepatic first passage mechanism. Stichodactyla helianthus toxin (ShK) is a peptide toxin that blocks potassium channels in T lymphocytes and could be a future treatment for autoimmune diseases when finding a suitable way of administration. Aim:  The purpose of this part of the study was to develop a robust and reproducible assay for identification and quantification of ShK. The method was then employed for a proof of principle study; determining the concentration of ShK following an in vitro permeability experiment, to evaluate the potential of ShK penetrating the buccal mucosa in porcine tissue.  Materials and Methods:  An HPLC method was developed and validated. A piece of porcine buccal mucosa was used as a membrane because of its similarities with human buccal mucosa, and cinched in between a modified Ussing Chamber consisting of a donor and a receptor chamber. Samples were withdrawn from the receptor chamber to determine the amount of ShK that had penetrated the membrane. Results: The HPLC method developed for quantification of ShK demonstrated high accuracy and precision. No concentrations of ShK were able to be quantified from the receptor chambers. Conclusions:  A robust assay for quantification of ShK was developed but the results from the experiment indicated that ShK could not penetrate the buccal mucosa membrane. B. An investigation of the permeability alterations in the blood-brain barrier associated with Alzheimer’s disease   Introduction:  The blood brain barrier (BBB) protects the brain from potential dangerous substances by different barrier properties such as tight junctions and efflux transporters such as P-glycoprotein. Previous studies have showed that the barrier functions may be altered in Alzheimer’s disease and thereby increase the exposure to substances that are normally excluded from the brain parenchyma. This could be an issue regarding safety and toxicity of medications used among Alzheimer patients. Aim:  The aim of this part of the study was to investigate the difference in brain uptake of verapamil, digoxin, loperamide, propanolol, diazepam and sucrose between 3xTg-AD mice and wild type control mice. Materials and Methods: Female 3xTg-AD mice and control mice of the age 11.5-13.5 months were used. In Situ brain perfusion with radiolabeled substances (n=5-12) was performed and the brain uptake ratio of the substances was compared and statistically analyzed.  Results: No difference in the vascular volume was found when comparing 3xTg-AD with control mice. The ratio of diazepam was observed to be higher in the cortex and propranolol higher in the hippocampus, of 3xTg-AD mice. The uptake ratio of verapamil was higher in both the hippocampus and cortex of 3xTg-AD mice whereas digoxin appeared to be lower in the cortex of 3xTg-AD mice. There was no difference in uptake ratio of loperamide between 3xTg-AD and control mice. Conclusions:  This study in addition to previously executed studies in our laboratory, showed that the membrane thickness is age dependent in 3xTg-AD and that further studies needs to be conducted on the expression of P-glycoprotein in the BBB in 3xTg-AD and control mice.

Magister Chirurgiae Dentium (MChD) / The South African population is made up of Blacks, Whites, Coloureds and Asians. Since each population group is distinct in its culture and habits and have widely differing life styles and socioeconomic levels an ideal oppurtunity exists for the study of environmental influences on the aetiology of particular cancers. In addition accurate epidemiological data is essential in order to assess changing .patterns of the disease and the efficacy of the prevention programmes. The aim of this study was to etermine age standardised incidence rates and age specific morbidity rates of intra-oral squamous cell carcinoma for Blacks on the Witwatersrand. All new cases of intra-oral cancer during the period (1971-1980) were traced. The population at risk was determined from the National Population Censuses of 1970 and 1980. According to the method used in the International Union Against Cancers (U.I.C.C.) publication (Waterhouse et al 1976 and 1982) age standardised incidence rates and age specific morbidity rates were calculated for tongue, floor of mouth, buccal mucosa, hard and soft palates and gingivae and alveolar ridge using standard World, European and African populations. These results indicate that in the population group studied intra-oral cancer is much more common in males and than females (5,55:1 standardised rates) most commonly affects the tongue followed by the floor of mouth, palate, buccal mucosa and gingivae and alveolar ridge and is a disease of the elderly occurring most commonly in the seventh decade in males and in the sixth decade in females. When compared with standardised rates reported, either for Blacks in other geographic locations in South Africa, or for other population groups in this country, or for selected countries elsewhere in the World, important differences have emerged which probably reflect differences in exposure to specific aetiological agents amongst the various population groups compared.

Based on the biochemical composition and structure of the buccal mucosa, drugs can permeate by the lipoidal and/or aqueous pathways. In this regard, the buccal mucosa is similar to skin. As the unionized drug form is the major permeant across skin, flux depends predominantly on the thermodynamic activity of this species. In contrast, ionized drug has been demonstrated to contribute significantly to the permeability across the buccal mucosa due to the presence of large amounts of polar lipids. The contributions of the individual activities of these species is however, not known. Therefore, the first objective of this study was to delineate the thermodynamic activities of ionized and unionized species and to determine their role in governing the total flux across buccal membrane. The flux of model acidic (nimesulide) and basic (bupivacaine) drugs across buccal mucosa either increased (nimesulide) or decreased (bupivacaine) with pH under saturated conditions depending on an increase (nimesulide) or decrease (bupivacaine) in the degree of saturation of ionized species (DS ionized ). At sub-saturated drug concentrations, a decrease in nimesulide flux and an increase in bupivacaine flux were observed with pH due to corresponding changes in DS unionized . For nimesulide and bupivacaine, the contributions of the ionized and unionized species to total flux are equal when 90% of the drug is in the ionized form. In conclusion, the contribution of the ionized form activity to flux was significant. A lack of a specific model for predicting buccal permeability has led to the use of transdermal models such as the Potts-Guy model. However, it is hypothesized that based on the above conclusion, this model might lead to erroneous permeability predictions. In the second part of this dissertation, a specific model was developed and validated by performing permeation studies of 15 small molecules across porcine buccal mucosa. Molecular volume, lipophilicity, number of hydrogen bond donors and number of rotatable bonds were found to be the most significant descriptors governing buccal permeability (logK p ) based on stepwise regression analysis. An excellent fit with an adjusted R 2 of 0.946 and a Q 2 of 0.882 were obtained. A good correlation was observed between the observed and predicted logK p values for an external data set.

Introdução: O melanoma mucoso de cabeça e pescoço (MMCP) é mais agressivo do que o melanoma cutâneo, marcadores prognósticos desta patologia não foram completamente esclarecidos devido a sua raridade. Em recentes estudos, algumas vias moleculares foram descritas na fisiopatologia destes tumores. Entre estas vias, existe a via da MAPK (Mitogen Activated Protein Quinase). Esta via de sinalização está envolvida no controle do crescimento celular, proliferação e migração, com um papel no desenvolvimento e progressão do melanoma. Além disso, a mutação do gene KIT foi identificada em melanomas, indicando a possibilidade de benefícios terapêuticos com o uso dos inibidores de tirosino-quinase. Objetivos: descrever a prevalência e características de mutações ativadoras do gene KIT em 28 pacientes com MMCP tratados no Instituto Nacional do Câncer-INCa; avaliar a relação entre a presença de mutação ativadora do gene KIT e evolução clínica dos pacientes tratados em relação ao estadiamento, sobrevida livre de doença e sobrevida global. Métodos: Estudo retrospectivo de coorte, foram incluídos 28 pacientes com MMCP tratados no INCA, entre 1998 e 2009. Foram analisados: estadiamento, tratamento primário, sobrevida livre de doença (SLD) e sobrevida global (SG). As curvas de sobrevida foram analisados utilizando o método de Kaplan-Meier, com software SPS 11.0. Análise KIT: O DNA foi extraído a partir de tecido incluído e fixado em parafina. O procedimento consiste de múltiplas etapas de desparafinização com xilol. Os restos celulares são precipitados por centrifugação e o DNA, no sobrenadante é utilizado nas reações de PCR (direto ou diluído). A análise mutacional do gene foi realizada utilizando-se a amplificação por PCR seguida pelo sequenciamento genômico. As análises são iniciadas pelo éxon 11, seguidas do éxon 9, 17 e 13. Resultados: Os pacientes eram predominantemente do sexo feminino (57%). A idade de apresentação variou de 27 a 85 anos. A região nasossinusal foi o sítio primário mais frequente (75%). Todos os pacientes foram submetidos a ressecção cirúrgica. Dezessete pacientes receberam radioterapia adjuvante (37%). As recorrências ocorreram em 82% dos pacientes. Presença de mutação de KIT foi encontrada em 7 casos (25%), três no éxon 9, 3 no éxon 11 e 1 no éxon 13. Fatores preditivos de recorrência foram índice mitótico (p = 0,05), invasão vascular (p = 0,043), e a disseminação perineural (p = 0,034). Não houve diferenças significativas na SLD e SG de acordo com a mutação KIT. Conclusão: A presente série incluiu 28 casos tratados. Sete casos (25%) tinham mutações ativadoras KIT. Esta descoberta sugere que existe um grupo de pacientes que poderiam se beneficiar com a terapia-alvo adequado com inibidores de tirosino-quinase / Unlike their cutaneous counterparts, head and neck mucosal malignant melanomas (HNMM) behave much more aggressively and their prognostic markers have not been fully elucidated. In recent studies, some molecular pathways have been found to be involved in the pathogenesis of melanomas. Among these, there is a proliferative MAPK pathway (\"Mitogen Activated Protein Kinase\"). This signaling pathway is involved in controlling cell growth, proliferation and migration, with a role in the development and progression of melanoma. In addition, KIT gene mutation has been identified in melanomas, indicating that there may be potential therapeutic benefits of tyrosine kinase inhibitors. Objectives: Evaluation of KIT mutation prevalence in a subset of 28 patients with HNMM treated at a single institution, establishing the relationship between different mutations and outcome (DFS and OS). The primary end-point of the study was to define the incidence of KIT mutations in HNMM, including the relationship between KIT mutations with disease-free survival (DFS) and overall survival (OS) in HNMM. Secondary end-points were correlation among therapeutic options, histopathological findings, demographic data and clinical response. Methods: This retrospective study comprised data of 28 patients with HNMM treated at Brazilian National Cancer Institute (INCA) between 2000 and 2011. Clinical analysis included patients characteristics, staging, primary and palliative treatments, disease free survival and overall survival. Progression-free survival and overall survival were analyzed using the Kaplan-Meier method, with SPS 11.0 software. KIT analysis: paraffin blocks were selected following analyses of histologic preparations, enabling DNA extraction. Different DNA concentrations were employed in PCR amplifications, based on DNA integrity. PCR amplification of exon, 9, 11, 13 and 17 was performed. . Results: Patients were predominantly females (57%). The age of presentation ranged from 27 to 85 years. The sinonasal region was the most frequent primary site (75%). All patients underwent surgical resection. Seventeen patients received adjuvant radiotherapy (37%). Recurrences occurred in 82% patients. Oncologic mutations in KIT were found in 7 (25%) of seven tumors, 3 in exon 9, 3 in exon 11 and 1 in exon 13. Predictive factors for recurrence were mitotic rate (p=0.05), vascular invasion (p=0.043), and perineural spread (p=0.034). There were no significant differences in DFS and OS according to KIT mutation. Conclusion: HNMM remains a rare disease. The present single-institution series includes 28 cases treated in single institution. Seven cases (25%) had activating KIT mutations, which is an increased prevalence of activating KIT mutations in this specific subset of mucosal melanomas. This finding suggests that there is a group of patients who might benefit with appropriate targeted therapy with kinase inhibitors

Made available in DSpace on 2015-05-14T12:56:02Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1722534 bytes, checksum: d8557488d35ade21ba45951fd8412a2f (MD5) Previous issue date: 2014-02-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / DNA methylation, characterized by the addition of a methyl group in cytosines within CpG dinucelotides can modified gene transcription, leading to decrease or even silence a gene. The ability of the environmental factors to induce epigenetic changes has been investigated and many studies have shown a relationship between them. Studies show that pesticides, metal ions, drugs, diet, alcohol dependence and smoking are associated with epigenetic changes. Smoking is often associated with the risk of cancer in various tissues and cardiovascular diseases, being considered the leading cause of preventable death. The MLH1 gene is related to the repair of badly paired bases of DNA (DNA mismatch repair (MMR)). The hTERT gene comprises the catalytic subunit of telomerase enzyme, which is considered a biological clock, a marker indicating that the cellular senescence can be installed inevitably form. The TP53 is a tumor suppressor gene and its hypermethylation is related to the development of various cancers. The aim of this work was to investigate the smoking habit influence on DNA methylation status in the promoter of cancer-related genes, MLH1, hTERT and TP53 in oral epithelial cells of healthy subjects. Samples of oral epithelium of smokers, nonsmokers and former smokers were collected by rinsing and DNA was extracted. After, DNA Methylation analysis was performed by Methylation Sensitive Restriction Enzymes, using two restriction enzymes, the HpaII and HhaI, which cleave different sites. Following the enzymatic digestion, DNA was amplified by PCR, subjected to electrophoresis on a 6% polyacrylamide gel and stained with silver nitrate. Statistical analysis was performed by Chi-square test at a significance level of 5%. The investigated CpG dinucleotides located at HhaI and HpaII sites in the MLH1 gene promoter were observed to be fully methylated in DNA majority samples from the smoker group and statistical differences were found between nonsmokers and smokers and between smokers and former smokers (p<0.05). The same was observed in the hTERT gene promoter at HhaI site (p<0.05) and for HpaII site the unmethylated condition was more frequent in smoker in comparison to nonsmokers (p<0.05). For TP53 no differences were found among groups (p>0.05) which the fully methylated condition was found to be an usual event in healthy oral epithelial cells. We conclude that smoking may induce changes in DNA methylation status in cancer-related genes, such as MLH1 and hTERT of healthy oral epithelial cells and the cessation of smoking reversed the process. / A metilação de DNA é uma modificação química na molécula de DNA, e consiste na presença de um radical metil em dinucleotídeos CpG, presente principalmente em regiões promotoras do gene. Uma das principais funções da metilação de DNA é regular a transcrição gênica, sendo que a presença do radical metil pode suprimir por completo a expressão gênica. Estudos mostram que o meio ambiente pode modular a metilação de DNA. Como exemplo de fatores ambientais temos: a radiação ultravioleta, agrotóxicos, dieta, fármacos, uso crônico do álcool e o hábito de fumar. O fumo é frequentemente associado ao risco de câncer em diversos tecidos e doenças cardiovasculares, sendo considerado a maior causa de morte evitável. O gene MLH1 está relacionado ao reparo de bases mal pareadas do DNA (DNA mismatch repair (MMR)). O gene hTERT compõe a subunidade catalítica da enzima telomerase, a qual é considerada um relógio biológico, um marcador que indica que a senescência celular poderá se instalar de forma inevitável. O TP53 é um gene supressor tumoral e sua hipermetilação está relacionada ao desenvolvimento de diversos tipos de câncer. Assim, o objetivo deste estudo foi investigar o efeito do tabagismo no perfil de metilação de DNA em genes relacionados ao câncer, MLH1, hTERT e TP53 em células da mucosa bucal de indivíduos saudáveis. Para tanto, amostras de epitélio da mucosa bucal de indivíduos fumantes, não fumantes e ex-fumantes foram coletadas por bochecho e o DNA dessas células foi extraído. Após esse processo, a análise de metilação de DNA foi feita utilizando o método de Digestão Enzimática Sensível à Metilação, utilizando-se de duas enzimas de restrição, a HhaI e a HpaII, as quais clivam sítios diferentes. Em seguida à digestão enzimática, DNA foi amplificado por PCR, submetido à eletroforese em gel de poliacrilamida a 6% e corado pelo nitrato de prata. A análise estatística foi realizada pelo Teste de Qui-Quadrado ao nível de significância de 5%. Os dinucleotídeos CpG localizados nos sítios HhaI e HpaII no promotor do gene MLH1 mostraram-se totalmente metilados na maioria dos indivíduos do grupo fumante e diferenças significativas foram observadas entre fumantes e não fumantes e entre fumantes e ex-fumantes (p<0,05). O mesmo foi observado para o sítio HhaI no promotor do gene hTERT (p<0,05) e para o sítio HpaII a condição não metilada foi mais frequente em fumantes em comparação com não fumantes (p<0,05). Para o gene TP53 não foram encontradas diferenças entre os grupos (p>0,05), sendo a condição totalmente metilada um evento usual das células saudáveis da mucosa bucal. Assim, concluímos que o fumo está associado a alterações no perfil de metilação de DNA em genes relacionados ao câncer, como MLH1 e hTERT em células epiteliais saudáveis da mucosa bucal e a cessação do hábito de fumar reverteu o processo.

Submitted by Celso Muller Bandeira null (bandeiracmu@yahoo.com.br) on 2018-04-03T17:36:10Z No. of bitstreams: 1 Tese Final Celso - 03 abril 2018.pdf: 2506611 bytes, checksum: b9c0f4bdc54870bf45bce9d43f49f2f0 (MD5) / Approved for entry into archive by Silvana Alvarez null (silvana@ict.unesp.br) on 2018-04-03T21:10:57Z (GMT) No. of bitstreams: 1 bandeira_cm_dr_sjc.pdf: 2506611 bytes, checksum: b9c0f4bdc54870bf45bce9d43f49f2f0 (MD5) / Made available in DSpace on 2018-04-03T21:10:57Z (GMT). No. of bitstreams: 1 bandeira_cm_dr_sjc.pdf: 2506611 bytes, checksum: b9c0f4bdc54870bf45bce9d43f49f2f0 (MD5) Previous issue date: 2018-02-06 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Tabaco e álcool são considerados os principais fatores de risco para o carcinoma de células escamosas (CCE) bucal contribuindo de maneira desfavorável para o tratamento e desfecho clínico. Seus carcinógenos são metabolizados em duas fases, sendo a segunda fase realizada pelas Glutationa S-transferases (GSTs). O objetivo do presente estudo foi avaliar a expressão gênica da forma selvagem dos genes GSTM1, GSTP1 e GSTT1 por qPCR em 33 amostras de CCE bucal de fumantes, ex-fumantes e não fumantes, e 15 controles em busca de uma correlação clínica com consumo de tabaco, álcool e estadiamento clínico. A dependência nicotínica foi avaliada pelo Teste de Fagerström pra Dependência a Cigarros (TFDC) e para consumo de etílicos o Teste AUDIT. Foi observado aumento da expressão de GSTM1 no Grupo CCE fumante em relação ao Grupo Controle (p=0,0161). Contrariamente, foi encontrada uma menor expressão de GSTT1 no Grupo CCE fumante em relação ao Grupo Controle fumante (p=0,0183). No grupo CCE fumante não foi encontrada uma correlação entre a expressão dos genes estudados e fatores ligados ao tabagismo, etilismo e estadiamento clinico. No grupo Controle fumante, houve correlação entre teste AUDIT e a expressão de GSTM1 (p=0,0000). Para GSTP1 e GSTT1 houve correlação entre a expressão quando comparada a idade do paciente (p=0,0008; p=0,0095), idade de inicio do tabagismo (p=0,0033; p=0,0081), TFDC (p=0,0102; p=0,0085) e AUDIT (p=0,0052; p=0,0219) respectivamente. Para GSTT1 foi encontrada uma correlação entre a expressão e número de cigarros/dia (p=0,0175). Concluímos que as formas selvagens das GSTs estudadas apresentaram uma alta expressão nas amostras de CCE bucal, entretanto, quantitativamente essa expressão foi baixa, com grande variabilidade interindividual. Outrossim, não houve uma correlação direta entre níveis de expressão, carga tabágica, TFDC, teste AUDIT e estadiamento clínico. O aumento da expressão de GSTM1 e GSTP1 parece não ter tido um efeito protetor. A baixa expressão de GSTT1 em pacientes fumantes com CCE bucal se mostrou um potencial marcador a ser avaliado em pacientes fumantes que ainda não desenvolveram uma neoplasia maligna. / Tobacco and alcohol are considered to be the main risk factors for oral squamous cell carcinoma (SCC), contributing to treatment and clinical outcome. Its carcinogens are metabolized in two phases, being the second phase carried out by Glutathione Stransferases (GSTs). The objective of the present study was to evaluate the wild-type gene expression of the GSTM1, GSTP1 and GSTT1 genes by qPCR in 33 samples of oral SCC from smokers, former smokers and nonsmokers, and 15 controls looking for a clinical correlation with tobacco and alcohol consumption and clinical staging. Nicotinic dependence was assessed by the Fagerström Test for Cigarette Dependence (TFCD) and alcohol consumption by the AUDIT Test. Increased expression of GSTM1 in the Smoker SCC Group was observed in relation to the Control Group (p=0.0161). Conversely, a lower expression of GSTT1 was found in the smoker SCC group compared to the Smoker Control Group (p=0.0183). In the smoker SCC group, no correlation was found between the genes expression studied and factors related to smoking, alcoholism and clinical staging. In the Smoker Control Group, there was a correlation between the AUDIT test and the GSTM1 expression (p=0.0000). For GSTP1 and GSTT1, there was a correlation between the expression compared with the patient's age (p=0.0008, p=0.0095), age of starting smoking (p=0.0033, p=0.0081), FTCD (p=0.0102, p=0.0085) and AUDIT (p=0.0052, p=0.0219) respectively. For GSTT1 a correlation was found between expression and number of cigarettes/day (p=0.0175). We concluded that the wild forms of the GSTs studied presented a high expression in the samples of oral SCC; however, quantitatively this expression was low, with great interindividual variability. Also, there was no direct correlation between levels of expression, pack-years, FTCD, AUDIT Test and clinical stage. Increased expression of GSTM1 and GSTP1 appears to have had no protective effect. The low GSTT1 expression in smokers with oral SCC was shown to be a potential marker to be evaluated in smoker patients who have not yet developed a malignant neoplasm. / FAPESP: 2016/08633-0

Introdução: O melanoma mucoso de cabeça e pescoço (MMCP) é mais agressivo do que o melanoma cutâneo, marcadores prognósticos desta patologia não foram completamente esclarecidos devido a sua raridade. Em recentes estudos, algumas vias moleculares foram descritas na fisiopatologia destes tumores. Entre estas vias, existe a via da MAPK (Mitogen Activated Protein Quinase). Esta via de sinalização está envolvida no controle do crescimento celular, proliferação e migração, com um papel no desenvolvimento e progressão do melanoma. Além disso, a mutação do gene KIT foi identificada em melanomas, indicando a possibilidade de benefícios terapêuticos com o uso dos inibidores de tirosino-quinase. Objetivos: descrever a prevalência e características de mutações ativadoras do gene KIT em 28 pacientes com MMCP tratados no Instituto Nacional do Câncer-INCa; avaliar a relação entre a presença de mutação ativadora do gene KIT e evolução clínica dos pacientes tratados em relação ao estadiamento, sobrevida livre de doença e sobrevida global. Métodos: Estudo retrospectivo de coorte, foram incluídos 28 pacientes com MMCP tratados no INCA, entre 1998 e 2009. Foram analisados: estadiamento, tratamento primário, sobrevida livre de doença (SLD) e sobrevida global (SG). As curvas de sobrevida foram analisados utilizando o método de Kaplan-Meier, com software SPS 11.0. Análise KIT: O DNA foi extraído a partir de tecido incluído e fixado em parafina. O procedimento consiste de múltiplas etapas de desparafinização com xilol. Os restos celulares são precipitados por centrifugação e o DNA, no sobrenadante é utilizado nas reações de PCR (direto ou diluído). A análise mutacional do gene foi realizada utilizando-se a amplificação por PCR seguida pelo sequenciamento genômico. As análises são iniciadas pelo éxon 11, seguidas do éxon 9, 17 e 13. Resultados: Os pacientes eram predominantemente do sexo feminino (57%). A idade de apresentação variou de 27 a 85 anos. A região nasossinusal foi o sítio primário mais frequente (75%). Todos os pacientes foram submetidos a ressecção cirúrgica. Dezessete pacientes receberam radioterapia adjuvante (37%). As recorrências ocorreram em 82% dos pacientes. Presença de mutação de KIT foi encontrada em 7 casos (25%), três no éxon 9, 3 no éxon 11 e 1 no éxon 13. Fatores preditivos de recorrência foram índice mitótico (p = 0,05), invasão vascular (p = 0,043), e a disseminação perineural (p = 0,034). Não houve diferenças significativas na SLD e SG de acordo com a mutação KIT. Conclusão: A presente série incluiu 28 casos tratados. Sete casos (25%) tinham mutações ativadoras KIT. Esta descoberta sugere que existe um grupo de pacientes que poderiam se beneficiar com a terapia-alvo adequado com inibidores de tirosino-quinase / Unlike their cutaneous counterparts, head and neck mucosal malignant melanomas (HNMM) behave much more aggressively and their prognostic markers have not been fully elucidated. In recent studies, some molecular pathways have been found to be involved in the pathogenesis of melanomas. Among these, there is a proliferative MAPK pathway (\"Mitogen Activated Protein Kinase\"). This signaling pathway is involved in controlling cell growth, proliferation and migration, with a role in the development and progression of melanoma. In addition, KIT gene mutation has been identified in melanomas, indicating that there may be potential therapeutic benefits of tyrosine kinase inhibitors. Objectives: Evaluation of KIT mutation prevalence in a subset of 28 patients with HNMM treated at a single institution, establishing the relationship between different mutations and outcome (DFS and OS). The primary end-point of the study was to define the incidence of KIT mutations in HNMM, including the relationship between KIT mutations with disease-free survival (DFS) and overall survival (OS) in HNMM. Secondary end-points were correlation among therapeutic options, histopathological findings, demographic data and clinical response. Methods: This retrospective study comprised data of 28 patients with HNMM treated at Brazilian National Cancer Institute (INCA) between 2000 and 2011. Clinical analysis included patients characteristics, staging, primary and palliative treatments, disease free survival and overall survival. Progression-free survival and overall survival were analyzed using the Kaplan-Meier method, with SPS 11.0 software. KIT analysis: paraffin blocks were selected following analyses of histologic preparations, enabling DNA extraction. Different DNA concentrations were employed in PCR amplifications, based on DNA integrity. PCR amplification of exon, 9, 11, 13 and 17 was performed. . Results: Patients were predominantly females (57%). The age of presentation ranged from 27 to 85 years. The sinonasal region was the most frequent primary site (75%). All patients underwent surgical resection. Seventeen patients received adjuvant radiotherapy (37%). Recurrences occurred in 82% patients. Oncologic mutations in KIT were found in 7 (25%) of seven tumors, 3 in exon 9, 3 in exon 11 and 1 in exon 13. Predictive factors for recurrence were mitotic rate (p=0.05), vascular invasion (p=0.043), and perineural spread (p=0.034). There were no significant differences in DFS and OS according to KIT mutation. Conclusion: HNMM remains a rare disease. The present single-institution series includes 28 cases treated in single institution. Seven cases (25%) had activating KIT mutations, which is an increased prevalence of activating KIT mutations in this specific subset of mucosal melanomas. This finding suggests that there is a group of patients who might benefit with appropriate targeted therapy with kinase inhibitors