Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / C. difficile toxin A (TxA) plays an important pathogenic role in antibiotic-induced diarrhea and pseudomembranous colitis, a condition characterized by intense mucosal inflammation and secretion. Agonist activity at A2A adenosine receptors (A2A ARs) attenuates inflammation and damage in many tissues. This study evaluated the effect of a new selective A2A AR agonist (4-{3-[6-amino-9-(5-cyclopropylcarbamoyl-3,4-dihydroxytetrahydrofuran-2-yl)-9H-purin-2-yl]prop-2-ynyl}piperidine-1-carboxylic acid methyl ester; ATL313) on TxA-induced enteritis in murine ileal loops. ATL313 (0.05-5 nM) and/or the A2A AR antagonist (ZM241385; 5 nM) or PBS were injected inside ileal loops immediately prior to challenge with TxA (1-10 mg/loop) or PBS. Intestinal fluid volume/length and weight/length ratios were calculated 3 h later. Ileal tissue samples were collected for measurement of myeloperoxidase (MPO) content, evaluation of ADA activity, for histopathology and apoptotic immunohistochemistry (ApopTagÃ) and for assessment of TNF-&#945; levels by ELISA. TxA (1-10 Âg/loop) significantly (p<0.05) increased volume/length and weight/length, reaching maximum values at 5Âg/loop dosage. ATL313 (5 nM) treatment significantly (p<0.05) reduced TxA-induced volume/length and weight/length, as well as prevented mucosal disruption and TxA-induced apoptosis. These protective effects were reversed by ZM241385 (5 nM), the A2A AR antagonist. ATL313 (5 nM) also reduced neutrophil infiltration, as measured by MPO content; reduced the toxin A-induced increase in ADA activity. Prior to the challenge with TxA, a systemic injection of fucoidin, but not PBS, also reduced tissue destruction and toxin A-induced increase in ADA activity. In conclusion, the A2A AR agonist ATL313 has a great antiinflammatory effect in TxA-induced mice enteritis, significantly reducing tissue destruction and ADA activity. In addition, our data suggested that TxA-induced increase in ADA activity and tissue damage in murine ileal loops are related to the neutrophil infiltration induced by this toxin. / A toxina A do Clostridium difficile (TxA) desempenha um importante papel na patogÃnese da diarrÃia induzida por antibiÃticos e na colite pseudomembranosa, uma condiÃÃo caracterizada por intensa secreÃÃo e inflamaÃÃo da mucosa. A estimulaÃÃo de receptores A2A da adenosina reduz a inflamaÃÃo e o dano tecidual. Neste estudo, avaliou-se o efeito de um novo agonista seletivo para receptores A2A da adenosina (metil Ãster do Ãcido 4-{3-[6-amino-9-(5-ciclopropilcarbamoil-3,4- dihidroxitetrahidrofuran-2-il)-9H-purin-2-il]prop-2-inil}piperidina-1-carboxÃlico; ATL313) na enterite induzida pela TxA em alÃas ileais de camundongos. O ATL313 (0,05-5 nM) e/ou o antagonista dos receptores A2A da adenosina (ZM241385; 5 nM) ou PBS foram injetados em alÃas ileais imediatamente antes da injeÃÃo de TxA (1-10 Âg/alÃa) ou PBS. As razÃes volume de secreÃÃo/comprimento da alÃa e peso/comprimento da alÃa foram calculadas 3h depois. Amostras de tecido foram coletadas para dosagem de atividade de mieloperoxidade (MPO), atividade de ADA, histopatologia, imunohistoquÃmica para apoptose (ApopTag_) e dosagem de TNF-a_ por ELISA. A injeÃÃo de TxA (1-10 Âg) nas alÃas ileais aumentou significativamente (p<0,05) as razÃes volume de secreÃÃo/comprimento da alÃa e peso/comprimento da alÃa com pico em 5Âg. O tratamento das alÃas com ATL313 (5 nM) reduziu significativamente (p<0,05) a secreÃÃo e o edema, preveniu a destruiÃÃo da mucosa e a apoptose induzidos por TxA. Tais efeitos protetores foram revertidos pelo antagonista dos receptores A2A de adenosina, o ZM241385 (5 nM). O tratamento com ATL313 (5 nM), reduziu ainda a infiltraÃÃo neutrofÃlica, avaliada pela dosagem de MPO, e reduziu o aumento da atividade de ADA induzidos pela TxA, bem como a dosagem de TNF-a no tecido das alÃas ileais. O prÃ-tratamento sistÃmico com fucoidina, mas nÃo com PBS, tambÃm reduziu o dano na mucosa e atividade de ADA no tecido das alÃas ileais tratadas com TxA. Assim, conclui-se que na enterite induzida pela TxA em camundongos, o agonista dos receptores A2A da adenosina (ATL313) possui um potente efeito antiinflamatÃrio, reduzindo consideravelmente a lesÃo tecidual e a atividade de ADA. Nossos resultados tambÃm indicam que o aumento da atividade de ADA e o dano tecidual induzido pela TxA em alÃa ileal de camundongos està relacionado com a infiltraÃÃo neutrofÃlica induzida por esta toxina.

Clostridium difficile est une bactérie anaérobie sporulante responsable de 15 à 25% des diarrhées post-antibiotiques. Les N-déacétylases sont largement distribuées parmi les bactéries à Gram positif et elles sont impliquées dans différentes fonctions de surface. L'analyse du génome de C. difficile montre que 13 gènes codent pour des N-déacétylases potentielles, et nous avons caractérisé l’ensemble de ces N-déacétylases.Le peptidoglycane de la cellule végétative de C. difficile est N-déacétylé sur 93% des glucosamines, et cette modification participe à la résistance de la bactérie au lysozyme, un composant majeur de l’immunité innée. Nous avons identifié les N-déacétylases PgdA, PgdB et PdaV responsables de cette N-déacétylation, et nous avons évalué leur impact au sein de la virulence de C. difficile. Nous avons également défini le rôle de deux N-déacétylases NagA dans le recyclage du peptidoglycane.Le peptidoglycane de la spore, ou cortex, a été analysé lors de ce travail et sa structure chez C. difficile est atypique par rapport au cortex décrit pour d’autres espèces bactériennes. Nous avons défini les N-déacétylases responsables de la N-déacétylation de la glucosamine du cortex. Nous avons également caractérisé les deux N-déacétylases PdaA1 et PdaA2 responsables de la synthèse des δ-lactames, une modification spécifique du cortex, ainsi que leur influence dans la virulence de C. difficile. Dans ce cadre, nous avons montré que les δ-lactames ont un rôle physiologique plus large pour C. difficile que chez Bacillus subtilis. De plus, nous avons identifié deux N-déacétylases potentiellement impliquées dans la synthèse de ce cortex.À travers ces résultats, ce travail apporte de nouvelles connaissances dans le rôle des N-déacétylases bactériennes. / Clostridium difficile is an anaerobic and spore-forming bacteria responsible for 15 to 25% of post-antibiotic diarrhea. N-deacetylases are largely distributed among Gram positive bacteria and are involved in many surface processes. C. difficile genome analysis showed that 13 genes potentially encode N-deacetylases. In this work, we have characterized all of these enzymes.The vegetative cell peptidoglycan of C. difficile is deacetylated on 93% its glucosamine, and this modification is involved in the resistance of C. difficile against lysozyme, a major component of the innate immunity. We identified the N-deacetylases PgdA, PgdB and PdaV responsible for this N-deacetylation, and we assessed their impact on C. difficile virulence. The role of two N-deacetylases involved in peptidoglycan recycling has also been assessed.The spore peptidoglycan, known as the cortex, has also been characterized during this work, and its structure is atypical in C. difficile compared to other bacterial species. We showed that N-deacetylation of the glucosamine is present in the cortex peptidoglycan, and we identified the N-deacetylases responsible for this modification. Additionally, we characterized the N-deacetylases PdaA1 and PdaA2 responsible for the synthesis of muramic-δ-lactams, a cortex specific modification, as well as their impact on C. difficile virulence. In his context, we determined that muramic-δ-lactams have a broader role in C. difficile compared to their role in Bacillus subtilis. Moreover, two N-deacetylases involved in cortex synthesis have been identified.This work adds a contribution in the knowledge of the roles of bacterial N-deacetylases.

Clostridium difficile infection (CDI) is the most common cause of health-care-associated infectious diarrhea. Recurrence rates are as high as 20–30% after standard treatment with metronidazole or vancomycin, and appear to be reduced for patients treated with fidaxomicin. According to the literature, the risk of CDI recurrence increases after the second relapse to 30–65%. Accurate data for Germany are not yet available. Methods: Based on the research database of arvato health analytics (Munich, Germany), a secondary data analysis for the incidence, treatment characteristics and course of CDI was performed. The database included high granular accounting information of about 1.46 million medically insured patients covering the period 2006–2013, being representative for Germany. The analysis was based on new-onset CDI in 2012 in patients which either received outpatient antibiotic therapy for CDI or were hospitalized. Results: The ICD-10 coded incidence of CDI in 2012 was 83 cases per 100,000 population.

[Truncated abstract] The prinicipal aim of this thesis was to explore the relationship between 3rd generation cephalosporin antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea (CDAD). This antibiotic class has been implicated in the aetiology of CDAD; therefore restriction of these antibiotics via antibiotic policies represents a potential strategy for prevention and control of CDAD. Successful control of CDAD in hospitals translates to improved quality of care for patients, and a reduction of pressure on hospital resources. Therefore, the objectives of this study were to determine whether 3rd generation cephalosporins were related to CDAD, to evaluate the effect of changes to antibiotic policy on the incidence of CDAD, and to determine the impact of CDAD on patient length of stay and hospital costs. The study was conducted in Sir Charles Gairdner Hospital (SCGH), a public teaching hospital located in Perth, the capital city of the state of Western Australia. Evidence for an association between 3rd generation cephalosporins and CDAD was obtained from studies of ecologic- and individual-level data. A time series analysis of the relationship between monthly consumption of 3rd generation cephalosporins and the incidence of CDAD in SCGH was undertaken covering the period 1994 to 2000. The results demonstrated a positive relationship between the use of 3rd generation cephalosporins and CDAD. A matched case-control study that involved 193 adult inpatients diagnosed with CDAD and 386 adult inpatients without CDAD, selected from the period 1996 to 2000, was conducted. Information was collected on exposure to 3rd generation cephalosporin antibiotics during hospitalisation, as well as exposure to other antibiotics and medications, procedures, and comorbidities. Results from conditional logistic regression analyses found CDAD cases were six times more likely to be exposed to 3rd generation cephalosporins during their admission, prior to the onset of diarrhoea, than controls (adjusted odds ratio [OR] = 6.17, 95% confidence interval [CI] = 1.56-24.37). Approximately one third of CDAD in the study population could be attributed to 3rd generation cephalosporins. CDAD cases were also four times more likely to have been exposed to either amoxicillin-clavulanate or ticarcillin-clavulanate (adjusted OR=4.23, 95% CI=1.81-9.93). In October 1998, an antibiotic policy was introduced at SCGH that restricted the use of ceftriaxone, the 3rd generation cephalosporin most commonly used by the hospital. During 1999 and 2000, the incidence of CDAD halved as ceftriaxone consumption fell in response to this policy. The effect of this policy was demonstrated in the time series model; during the post-policy period the relationship between ceftriaxone and CDAD that was evident prior to the policy was cancelled out. From the individual-level data, obtained from the case-control study, a reduction in the prevalence of exposure to 3rd generation cephalosporins from 11% to 1% accounted for a 30% reduction in the incidence of CDAD. Data from the case-control study was also used to analyse the independent contribution of CDAD to length of stay and admission costs using multiple linear regression

Introduktion: Clostridium difficile är en bakterie som bildar tåliga sporer som kan överleva länge i sjukhusmiljön trots goda rutiner. De flesta Clostridium difficile-infektioner (CDI) är sjukhusförvärvade. Att tarmen koloniseras av sporer eller bakterier är en förutsättning för infektion, risken att sedan insjukna beror på tarmflorans och immunförsvarets tillstånd. I modern sjukvård sker regelmässigt patientomflyttningar inom och mellan avdelningar, vilket gör att patienten exponeras mot en större del av sjukhusmiljön där C. difficile-sporer kan finnas. Syfte: Att undersöka om byte av vårdplats inom och/eller mellan avdelningar är en riskfaktor för att insjukna i CDI när hänsyn tas till andra kända riskfaktorer. Metod: En fall-kontroll-studie på alla sjukhusförvärvade fall hos vuxna på Södra Älvsborgs Sjukhus i Borås under två år, 2012 och 2015. Beräkning av odds ratio med univariat logistisk regression följt av multivariat logistisk regression för statistiskt signifikanta variabler. Resultat: Vårdplatsbyten var inte vanligare i fallgruppen när hänsyn togs till övriga riskfaktorer. I den multivariata modellen var vårdtid innan provtagning den enda variabel som utföll statistiskt signifikant (OR per vårddygn: 1,07, konfidensintervall: 1,02–1,12). Slutsats: Studien kunde inte påvisa att vårdplatsbyten är en oberoende riskfaktor för CDI, men att genomföra undersökningen på ett större studiematerial kan vara av värde. / Introduction: Clostridium difficile is a spore-forming bacterium; the spores are highly resilient and can survive for long periods of time in the hospital environment. Most Clostridium difficile infections (CDI) are hospital-acquired. Colonization of spores or vegetative bacteria in the large intestine is necessary for infection to occur; the risk of infection is modulated by the state of the intestinal microbiome and the host´s immune status. Patient-to-patient transmission within and between wards are commonplace in modern healthcare, exposing patients to more of the hospital environment where spores may exist. Aim: To determine whether changing room and/or ward is a risk factor for developing CDI when adjusted for other known risk factors. Method: A case-control study of all hospital-acquired CDI cases at Södra Älvsborg Hospital, Borås, Sweden, during two years: 2012 and 2015. Odds ratios were calculated using univariate logistic regression analysis followed by multivariate logistic regression analysis to evaluate statistically significant (p&lt;0,05) variables identified by the univariate analysis. Results: Patient transfers were not more common in the case group when data was adjusted for other known risk factors. In the multivariate model, length of stay [A1] alone was the only statistically significant variable (OR per additional day of care: 1.07, 95 % confidence interval: 1.02-1.12). Conclusion: The study could not demonstrate patient transfers as an independent risk factor for CDI, though replicating the study on a larger patient sample might be valuable.

The challenge of combating Clostridium difficile infections (CDI) is a major problem within many health care organizations as CDI adds to the cost of care and is an uncomfortable and sometimes fatal complication of hospitalization for the patient. The practice-focused question for this doctoral project was targeted at patients in hospital settings on a medical surgical floor and asked if clostridium difficile preventive bundles reduce the incidence of CDI compared with nonstandardized preventative methods. Using the plan-do-study-act framework, the purpose of this DNP project was to use a clostridium difficile bundle approach to study the effects of clostridium difficile incidence (CDI) decrease on a medical-surgical unit with high CDI incidences. Standardized environmental cleaning practices resulted in improvement of the patient environment. High-touch cleaning improved from 43.7% to 83.3%. Time between CDI events lengthened from 19.9 days to 30.2, environmental cleaning with the use of Dazo auditing improved from 33.4% to 81.6%, isolation practices improved from 62.7% to 90%, and with the implementation of the nurse-driven CD testing protocol, unnecessary testing improved. Results showed that the CDI incidence on an acute care medical surgical unit was reduced through the use of a clostridium difficile preventive bundle in this DNP project. Reducing the incidence of CDI is a significant contribution to social change as this unwanted complication of hospitalization causes discomfort and pain and adds unnecessary cost to health care.

Hensikt: Hensikten med studien var å undersøke om enerom reduserer forekomsten av Clostridium difficile hos innlagte pasienter i sykehus. Metode: En deskriptiv epidemiologisk undersøkelse som benyttes for å kartlegge insidensen av C.difficile infeksjon hos innlagte pasienter på fire norske sykehus i perioden 2001-2010 knyttet til antall enerom. Det ble i tillegg gjennomført en retrospektiv undersøkelse der vi så på risikoen for C. difficile infeksjon i en avdeling før flytting i gammelt sykehus med få enerom, til nytt sykehus med bare enerom for nesten alle pasienter. Resultat: I denne studien fant vi ingen sammenheng mellom insidens av C. difficile og økt tilgang på enerom. Det var stor forskjell i insidens av C. difficile mellom fire store norske sykehus. Det ser ut til at risikoen for C. difficile infeksjon var høyere i gammelt sykehusbygg enn nytt sykehus i en avdeling med en høy forekomst av C. difficile infeksjon, men dette var ikke statistisk signifikant. Denne undersøkelsen kan ikke vise lavere risiko for C. difficile infeksjon for pasienter som ligger på enerom. Konklusjon: Andel enerom har økt ved flere sykehus i løpet av studieperioden, men denne studien har ikke klart å vise om enerom har en smitteforebyggende effekt i sykehus ved C. difficile infeksjon. Enerom kan sannsynlig tilrettelegge for bedre smitteforbyggende atferd hos helsepersonell. Det må til flere forebyggende tiltak, som blant annet enerom, for å forbygge spredning av C. difficile infeksjon. / Aims: This study aimed to investigate whether single-occupancy rooms reduce the incidence of Clostridium difficile (C. difficile) among hospitalized patients. Methods: The study used a descriptive epidemiologic approach to investigate the incidence of C. difficile infection in patients in four hospitals during 2001–2010, in relation to the number of single rooms. In addition, we conducted a retrospective study to investigate the risk for C. difficile infection in a hospital ward, in relation to the transfer of a hospital department from old hospital premises that contained only a few single rooms to a new hospital building containing single-occupancy rooms for almost all patients. Results: This study determined no correlation between the incidence of C. difficile infection and increased access to single-occupancy rooms. However, the incidence of C. difficile infection was considerably different in the four hospitals. The old hospital buildings showed higher but insignificant risk of C. difficile infection compared to the new hospital building. We were unable to demonstrate a lower risk of C. difficile infection among patients in single-occupancy rooms. Conclusions: Although the proportion of single-occupancy rooms increased in several of the hospitals during the study period, we were unable to show that the single-occupancy rooms prevent C. difficile infection in hospitalized patients. Single-occupancy rooms likely facilitate improved infection prevention behaviours in health professionals. Preventing the spread of C. difficile infection requires a collection of several preventive measures, including single-occupancy rooms. / <p>ISBN 978-91-86739-21-8</p>

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A vitamina A (retinol) à um nutriente essencial necessÃrio em pequenas quantidades para o funcionamento normal do sistema visual, funÃÃo imune e reproduÃÃo. Nosso grupo de pesquisa investigou o efeito de altas doses por via oral em crianÃas com diarrÃia em estudos prospectivos em comunidade em Ãreas endÃmicas no Nordeste do Brasil e encontrou benefÃcios terapÃuticos com a utilizaÃÃo do retinol na reduÃÃo da mÃdia de duraÃÃo da diarrÃia, porÃm nÃo houve diminuiÃÃo da incidÃncia de episÃdios diarrÃicos. Esse estudo explorou o papel da suplementaÃÃo do retinol em linhas de cÃlulas intestinais frente ao dano citotÃxico da Toxina A do C. difficile (TxA). O C. difficile à principal patÃgeno causador da diarrÃia associada ao uso de antibiÃticos e da colite pseudomembranosa. Investigou-se alteraÃÃes da resistÃncia elÃtrica transepitelial (TER) em cÃlulas Caco-2, e nos modelos de proliferaÃÃo, migraÃÃo e morte celular em IEC-6, apÃs a injÃria induzida pela TxA. Os resultados mostraram que a suplementaÃÃo do retinol, principalmente no meio sem glutamina, aumentou a TER, migraÃÃo celular, como tambÃm promoveu uma reduÃÃo significativa da apoptose e necrose, porÃm este efeito nÃo foi visto no modelo de proliferaÃÃo celular. Para estudar a modulaÃÃo do retinol na diminuiÃÃo da TER induzida pela TxA, as cÃlulas foram expostas a TxA (0,1&#956;g/mL) durante 24h. O retinol aumentou a TER (% do valor inIcial) nas concentraÃÃes de 0,1 e 0,3nM Ãs 3h (59,3Â1,3; 69,8Â0,6vs 59,3Â1,3&#937;cm2,respectivamente), e Ãs 4h (36,1Â0,02; 33,5Â1,8 vs 27,3Â0,2&#937;cm2,respectivamente) em relaÃÃo ao controle sem retinol e com TxA. Nesses intervalos de tempo nÃo houve influÃncia da proliferaÃÃo celular nas cÃlulas Caco-2. O retinol aumentou a proliferaÃÃo celular na lesÃo induzida pela TxA (0,1&#956;g/mL) em 14,2; 23,8; 59,8; 8,4; 30,2; 44,1% (0,01; 0,03; 0,1; 1,0; 10; 100nM de retinol, respectivamente), apÃs 24h comparado com controle com TxA. Depois de 12 e 24h de exposiÃÃo a TxA (0,01&#956;g/mL), seguido do arranhÃo na monocamada da cÃlulas IEC-6, a suplementaÃÃo do retinol aumentou significantemente a migraÃÃo nas concentraÃÃes de 0,1-100nM em uma taxa de 30-80% e 60-100%, nas 12h e 24h, respectivamente. O retinol reduziu a apoptose e a necrose induzida pela TxA nas concentraÃÃes de 0,03-100nM, em comparaÃÃo com controle com a TxA. Os resultados sugerem que o retinol exerce um importante papel na reduÃÃo da apoptose, em aumentar a migraÃÃo e proliferaÃÃo e em prevenir a reduÃÃo da TER, na lesÃo pela TxA, sugerindo que a vitamina A à um nutriente essencial na proteÃÃo na barreira funcional epitelial / Vitamin A (retinol) is an essential nutrient that is necessary in small amounts for normal functioning of the visual system, immune function and reproduction. Our group has investigated the effect of oral dosis of vitamin A on the early childhood diarrhea in our prospective community-based studies in high endemic areas in the Northeast of Brazil and has found a benefit of retinol therapy in reducing the mean duration but not the incidence of diarrheal episodes. In this study, we have explored the role of retinol supplementation in intestinal cell lines, following Clostridium difficile toxin A (TxA) cytotoxic challenge. C. difficile is the most common anaerobic pathogen that causes antibiotic-associated diarrhea and pseudomembranous colitis. We have focused on changes in transepithelial electrical resistance (TER) in Caco-2, a more differentiated intestinal cell line, and on models of proliferation, migration and cell death in IEC-6 cells, an undifferentiated crypt cell line, following or not by TxA-induced cell injury. The results showed retinol alone increased the TER, cell migration and proliferation, and also promoved significant reduction of apoptosis and necrosis, however this effect was not observed at the cell proliferation. To study the retinol effect on the TxA-induced loss of TER, cells were exposed during 24h to 0,1&#956;g/mL TxA. Retinol improved TER (% of initial value) at the concentrations of 0,1nM and 0,3nM at 3h (59,3Â1,3; 69,8Â0,6 vs 59,3Â1,3&#937;cm2, respectively), and at 4h (36,1 0,02; 33,5 1,8 vs 27,3Â0,2&#937;cm2, respectively) in relation to the untreated control challenged with TxA. During this time there was no influence of the cell proliferation in the Caco-2 cells. Retinol increased cell proliferation after TxA-induced cell damage (0,1&#956;g/mL) at a rate of 14,2%, 23,8%, 59,8%; 8,4%; 30,2%; 44,1% after 24h (doses of 0,01; 0,03; 0,1; 1,0; 10; 100nM of retinol, respectively), compared to controls only with TxA. After 24h of TxA exposure (0,01&#956;g/ml), following plate scraping, the retinol supplementation improved significantly IEC-6 migration at the concentrations of 0,1-100nM in rate of 30-80% and 60-100%, in 12h and 24h, respectively. Retinol reduced TxA-induced apoptosis and necrosis at the concentration of 0,03: 0,1; 1; 10 and 100nM, p<0.05, in comparison to the control with TxA. These results suggest that retinol has a critical role in reducing apoptosis, improving cell migration and proliferation and preventing the reduction in TER, following TxA challenge, suggesting that vitamin A is an essential nutrient to protect the intestinal epithelial barrier function

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / O Clostridium difficile tem como principal fator de virulÃncia a toxina A (TxA), a qual provoca inflamaÃÃo e destruiÃÃo tecidual aguda em intestinos de animais experimentais e de pacientes com a doenÃa induzida por esta bactÃria. Em locais de injÃria tecidual, adenosina à produzida em altas concentraÃÃes, onde exerce uma sÃrie de efeitos antiinflamatÃrios, limitados por sua rÃpida degradaÃÃo pela enzima adenosina desaminase. O objetivo deste trabalho foi investigar o efeito da inibiÃÃo da enzima adenosina desaminase pelo EHNA (eritro-9-(2-hidrÃxi-3-nonil)-adenina) sobre a enterite induzida pela TxA do C. difficile em alÃa ileal de camundongos. Para isto, injetamos EHNA (90 &#956;mol/kg) ou PBS i.p. 30 minutos antes da administraÃÃo de TxA (10 a 100 &#956;g) ou PBS na alÃa ileal isolada. Os animais foram sacrificados 3 horas depois da induÃÃo da enterite e as alÃas foram retiradas para estudo. As razÃes peso/comprimento da alÃa e volume de secreÃÃo/comprimento da alÃa foram calculadas e amostras de tecido foram coletadas para histopatologia, dosagem de atividade de mieloperoxidase (MPO), dosagem de TNF-&#945;, IL-1&#946; e IL-10 por ELISA, imunohistoquÃmica para TNF-&#945;, IL-1&#946;, NOS induzÃvel e PTX3, e PCR para TNF-&#945;, IL-1&#946; e PTX3. A injeÃÃo de TxA (10 a 100 &#956;g) nas alÃas ileais aumentou significativamente (p<0,05) as razÃes peso/comprimento da alÃa e volume de secreÃÃo/comprimento da alÃa com resultados consistentes a partir de 50 &#956;g. A TxA promoveu significativa (p<0,05) destruiÃÃo tecidual, edema, infiltraÃÃo de cÃlulas inflamatÃrias, aumento das citocinas TNF-&#945; e IL-1&#946;, e elevaÃÃo de iNOS e PTX3. Todos esses parÃmetros foram significativamente revertidos com o uso do EHNA (p<0,05). Em adiÃÃo, a TxA nÃo alterou os nÃveis de IL-10 em relaÃÃo ao controle, mas o prÃ-tratamento com EHNA promoveu uma elevaÃÃo nos nÃveis desta citocina. Assim, concluÃmos que na enterite induzida pela TxA em camundongos o EHNA demonstrou um potente efeito antiinflamatÃrio, reduzindo consideravelmente a lesÃo tecidual, a migraÃÃo neutrofÃlica, a expressÃo e os nÃveis de citocinas prÃinflamatÃrias (TNF-&#945;, IL-1&#946;) e produzindo um aumento nos nÃveis de IL-10. AlÃm disso, a administraÃÃo de TxA induziu um aumento na expressÃo da proteÃna PTX3 e no nÃmero de cÃlulas imunomarcadas para iNOS no tecido ileal, ambos revertidos pelo EHNA / The main factor of virulence in Clostridium difficile is toxin A (TxA), which can induce inflammation and acute tissue injury in the bowels of animals and humans affected by this organism. The high concentration of adenosine generated upon injury produces a number of antiinflammatory effects limited by rapid degradation by adenosine deaminase. The objective of this study was to determine the effect of EHNA (erythro-9-(2-hydroxy-3-nonyl)-adenine) inhibition of adenosine deaminase upon TxA-induced ileal loop enteritis in mice. EHNA (90 &#956;mol/kg) or PBS was injected i.p. 30 minutes prior to TxA (10-100 &#956;g) or PBS instillation into the ligated ileal loop. The animals were euthanized 3 hours after enteritis induction and the ileal loops were retrieved for analysis. The weight/length ratio and the secretion volume/length ratio were calculated and tissue samples were submitted to histopathological study, myeloperoxidase assay (MPO), measurement of TNF-&#945;, IL-1&#946; and IL-10 levels with ELISA, immunohistochemical tests for TNF-&#945;, IL-1&#946;, inducible NOS and PTX3, and PCR assay for TNF-&#945;, IL-1&#946; and PTX3. The instillation of TxA (10-100 &#956;g) into the ileal loop significantly increased (p<0.05) the weight/length ratio and the secretion volume/length ratio with consistent results above 50 &#956;g. TxA induced a significant amount (p<0.05) of histological damage, edema and inflammatory cell infiltration and increased the production of TNF-&#945;, IL-1&#946;, iNOS and PTX3. All changes were significantly reverted by treatment with EHNA (p<0.05). Moreover, IL-10 levels remained unchanged in animals treated with TxA, but increased in animals receiving EHNA. In conclusion, in mice with TxA-induced enteritis EHNA produced considerable antiinflammatory effects, reducing tissue injury, neutrophil migration, the expression and levels of proinflammatory cytokines (TNF-&#945; and IL-1&#946;) and producing an increase in IL-10 levels. In addition, TxA instillation increased PTX3 expression and the number of cells immunolabeled for iNOS in the ileal tissue, both of which were reverted by EHNA

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