Orientador: Hamilton Almeida Rollo / Coorientador: Marcone Lima Sobreira / Resumo: Pentasaccharides para o tratamento da trombose venosa profunda Questão da revisão: Os novos anticoagulantes da classe dos pentasaccharides podem ser uma alternativa eficaz e segura aos anticoagulantes convencionais utilizados na terapia padrão do tratamento da trombose venosa profunda? Visão geral: Trombose venosa profunda (TVP) é uma doença grave e potencialmente fatal que se caracteriza pela formação aguda de um coágulo de sangue nas veias profundas. Sua incidência aumenta exponencialmente com a idade e estima-se que na população geral, sua incidência seja de 5 casos em 10,000 habitantes. O tratamento padrão se faz por meio de medicamentos anticoagulantes, inicialmente pela administração de medicamentos injetáveis, as heparinas, por 5 a 7 dias e em seguida pelo uso prolongado de medicamentos de uso oral, os antagonistas da vitamina K. Entretanto, o alto risco de sangramento e a necessidade de um rigoroso controle laboratorial, permanecem como importantes limitações à terapia padrão. Os pentasaccharides são anticoagulantes sintéticos que podem apresentar vantagens em relação ao tratamento convencional como um efeito mais previsível, um regime de dosagem mais conveniente, a ausência da necessidade de controle laboratorial, ausência de interações com medicamentos e/ou alimentos, ausência da temida diminuição das plaquetas induzida pela heparina e em muitos casos melhor custo-benefício. Características chaves e resultados: Nossas buscas, realizadas até julho de 2015, iden... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Deep vein thrombosis (DVT) is a severe disorder caused by acute formation of a clot or thrombus in the deep vein system. The incidence of DVT increases with age: from 2 to 3/10,000 in adults aged 30 to 49 years to 20/10,000 in adults aged 70 to 79 years. If left untreated, the clot can travel up to the lungs and cause a potentially life-threatening pulmonary embolism (PE). Standard treatment is based on antithrombotic therapy, initially with parenteral administration of unfractionated heparin or low molecular weight heparins (LMWH) for five to seven days, then subsequent long-term oral vitamin K antagonists (e.g. warfarin) therapy. However, hemorrhagic complications are a major concern associated with warfarin treatment. Indeed, the hemorrhagic risk of warfarin and the required laboratory control remain the Achilles' heel of vitamin K antagonist management. The pentasaccharides have characteristics that may be favourable over conventional treatment, including a predictable effect, lack of frequent monitoring or re-dosing and few known drug interactions and absence of heparin-induced thrombocytopenia. To date, no systematic review has measured the effectiveness and safety of these drugs in the treatment of DVT. Objectives: To assess the efficacy and harms of pentasaccharides for the treatment of deep venous thrombosis. Search strategy: 1 The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched... (Complete abstract click electronic access below) / Doutor

Les adénovirus humains (HAdV) provoquent un large spectre de maladies cliniques chez les patients immunodéprimés et immunocompétents et sont également des outils polyvalents pour le transfert de gènes et la vaccination. L’immunité humorale acquise peut être en partie responsable des réactions indésirables envers les vecteurs AdV révélées dans plusieurs essais cliniques de vaccination. De plus, plusieurs protéines de l'hôte comme le facteur X de coagulation de la souris (FX) ou les immunoglobulines de type G se lient aux HAdV et exacerbent la réponse pro-inflammatoire. L’évaluation des risques précliniques se fait souvent chez la souris, même s’il existe plusieurs différences entre les humains et les souris dans l'interaction avec les HAdV. La liaison de FX aux HAdV active une réponse pro-inflammatoire chez la souris par l'intermédiaire des récepteurs Toll-like 4. Dans un autre scénario clinique pertinent, le complexe immun HAdV (IC-HAdV-C5) induit une activation plus forte de l’inflammasome dans les phagocytes humains que l’HAdV-C5 non complexé, mais par un mécanisme inconnu. Dans ce contexte, j’ai participé à deux études. Premièrement, nous avons étudié le rôle potentiel de FX et de TLR4 dans la réponse innée à l ‘HAdV-C5 en utilisant uniquement des cellules et des protéines d’origine humaine. Nous avons constaté qu'il n'y a pas d’activation de la voie de signalisation via TLR4 chez l’homme en présence de FX-HAdV. De plus, le FX n'a pas affecté la forte réponse immunitaire innée induite par IC-HAdV-C5 dans les phagocytes humains. Deuxièmement, nous avons abordé le mécanisme sous-jacent de l'inflammation induite par IC-HAdV-C5. Nous avons démontré que l‘IC-HAdV-C5 induit la formation de l’inflammasome dans les cellules dendritiques dérivées de monocytes et cela dépend de l’échappement endosomal dépendant de la protéine VI et de l'activation des récepteurs cytosoliques de l’inflammasome. Nos résultats nous aident à mieux comprendre les différences entre les tests précliniques réalisés chez la souris et les essais cliniques réalisés chez l'homme. De plus, cela nous permet de mieux comprendre comment l’immunité préexistante façonne la réponse immunitaire innée face aux HAdV, afin d’améliorer le traitement des maladies liées aux HAdV ainsi que l’efficacité des vecteurs HAdV. / Human adenoviruses (HAdV) cause a broad spectrum of clinical diseases in immunocompromised and –competent patients and are also versatile tools for gene transfer and vaccination. Pre-existing humoral immunity may be in part responsible for the adverse responses towards AdV vectors seen in several clinical vaccine trials. Furthermore, a variety of host proteins like mouse coagulation factor X (FX) or immunoglobulin G bind HAdV exacerbate the pro-inflammatory response. Pre-clinical risk assessment is often done in mice, albeit there are multiple differences between human and mice in the interaction with HAdV. The binding of FX to HAdV activates a pro-inflammatory response in mouse via Toll-like receptor 4. In another clinical relevant scenario, immune complexed-HAdV (IC-HAdV-C5) induces more inflammasome activation in human phagocytes than HAdV-C5 alone but by unknown mechanism. In this regard, I participated in two studies. First, we investigated a potential role of FX and TLR4 in the innate response to HAdV-C5 by using only human components. We found that there is no detectable FX-HAdV-TLR4 axis in human and FX did not affect the innate immune response elevated by IC-HAdV-C5 in human phagocytes.Second, we addressed the underlying mechanism of IC-HAdV-C5-induced inflammation. We found that IC-HAdV-C5 induces inflammasome formation in monocyte-derived dendritic cells and this is dependent on pVI-mediated endosomal escape and activation of cytosolic inflammasome sensors. Our findings help us to better understand the differences in preclinical testing in mice and clinical use in humans and how pre-existing immunity shapes the innate immune response to HAdV to improve treatment for HAdV diseases and HAdV vector effectiveness.

Neste trabalho estudou-se a purificação de fator VIII de coagulação (FVIII) e da Proteína C (PC) por cromatografia. Em coluna ANX Sepharose FF como primeira etapa de purificação do plasma permite a eluição do FVIII e da PC com bom fator de purificação, mas não a separação destas. Propomos a separação de FVIII e PC empregando cromatografia de afinidade a metal (IMAC) empregando Cu2+, Ni2+, Zn2+, Co2+ e Fe3+ e dessorção empregando imidazol, cloreto de amônio e variação de pH. Em colunas de Fe3+ e Ni2+ as proteínas praticamente não se ligaram à resina. Em IMAC-Co2+, a PC não é adsorvida pela resina enquanto o FVIII pode ser eluído com imidazol 100 mM. Em IMAC-Cu2+ a PC eluiu com imidazol 10mM e o FVIII com 200mM. Não foi possível eluir as proteínas nem com NH4Cl 1M nem quando o pH foi abaixado até 4,0. Em IMAC-Zn2+ a PC não é adsorvida e o FVIII eluiu com imidazol 200mM ou NH4Cl 1M. Diminuindo-se o pH, a recuperação da atividade do FVIII foi baixa. Concluímos que IMAC-Co2+ apresentou os melhores rendimentos e melhores fatores de purificação para as 2 protéinas. / In this work purification methods for the coagulation factor VIII (FVIII) and Protein C (PC) by chromatography was studied. The use of ANX Sepharose FF column as the first purification step allows the elution of FVIII and PC with good purification factors, but not its separation. We propose the separation of FVIII and PC using immobilized metal ion affinity chromatography (IMAC) using Cu2+, Ni2+, Zn2+, Co2+ and Fe3+ and desorption employing imidazole, ammonium chloride and pH variation. In the columns containing Fe3+ and Ni2+ metal ions, proteins did not adsorb to the resin. In IMAC-Co2+, PC was not adsorbed to the resin, while FVIII could be eluted with 100 mM imidazole. In IMAC-Cu2+ PC could be eluted with 10 mM imidazole and FVIII with 200 mM. It was not possible to elute the proteins from IMAC-Cu2+ column with either 1M NH4Cl or when pH was descreased to 4,0. In IMAC-Zn2+, PC was not adsorbed and FVIII could be eluted with 200 mM imidazole or 1 M NH4Cl. We conclude that IMAC-Co2+ presented the best yield and purification factors for the 2 proteins.

Haemostasis is a complex physiological process involving cellular and plasma protein components that interact to keep the blood fluid under normal conditions and prevent blood loss after vessel injury by promoting clot formation. Primary haemostasis encompasses the activation and aggregation of platelets and is supported by secondary haemostasis, in which the coagulation factors of the plasma interact in a complex series of reactions. Secondary haemostasis is initiated by the exposure of tissue factor (TF) to the blood after vessel injury. TF forms a complex with activated factor VII (FVIIa), which in turn activates factor X (FXa) and ultimately results in fibrin formation. The TF-FVIIa complex and FXa are tightly regulated by tissue factor pathway inhibitor (TFPI), a trivalent Kunitz-type protease inhibitor. The endothelium, consisting of endothelial cells (ECs), constitutes the inner lining of all blood vessels. As such, it is in constant contact with the blood and plays a major role in haemostasis by synthesising and storing both pro- and anti- coagulant substances, including TF and TFPI. Release of TFPI from ECs is increased after exposure to both unfractionated and low molecular weight heparins, though the mechanisms are not clearly defined. TFPI circulates in plasma, predominantly bound to lipoproteins, though the effect of the three major lipoproteins [low density (LDL), very low density (VLDL) and high density (HDL)] on the release of TFPI from ECs is not well established. Furthermore, previous studies have not systematically investigated the effect of these lipoproteins on both TF and TFPI. The initial aim of this project was to establish assays for the measurement of TF activity and TFPI antigen to supplement the TFPI activity assay that is well established in our laboratory. / These assays were then used to determine the effects of heparin and the major lipoproteins on the expression of TF and the release of TFPI on/from ECs. Human umbilical vein endothelial cells (HUVECs) were used as the EC model because their collection and isolation is well established and they have biochemical and physiological properties representative of in vivo conditions. A TF activity assay, based on a previously published method, was successfully modified and validated for the measurement of cell surface TF (standard curve R2 = 0.997). Despite exhaustive attempts, adaptation of this assay for plasma TF was unsuccessful, raising doubts regarding the plasma fractionation procedure of the originally published assay [Fukuda, C., Iijima, K. and Nakamura, K. (1989). "Measuring tissue factor (factor III) activity in plasma." Clinical Chemistry 35(9): 1897‐1900]. A novel insect cell expression system was used to produce well defined recombinant TFPI standards for use in TFPI activity and antigen assays. For the first time, truncated TFPI variants, containing the first Kunitz domain only, the first and second Kunitz domains only, and the first through third Kunitz domains minus the carboxyl terminus, were successfully produced in insect cells, though the full length molecule was not. Possible reasons for this include codon bias, protein instability and/or the signal peptide used. An ELISA to measure TFPI antigen was designed using a monoclonal anti‐TFPI antibody directed against the N‐terminus for protein capture and a polyclonal anti‐ TFPI antibody for detection. The assay was successfully optimised (standard curve R2 = 0.978, intra‐assay CV = 4.8%), however it produced inaccurate results (normal range = 498.7 ± 156.3 ng/mL), probably due to the antibody combination used. / TF and TFPI activity assays were used to determine the effect of both unfractionated and low molecular weight heparins (UFH and LMWH, respectively) on the release of TFPI and the expression of TF from/on ECs. A significant increase in the secretion of functional TFPI from ECs due to heparin (0 U/ml vs 1 and 10 U/mL) was demonstrated only in the presence of serum (UFH: 9.0 mU/mL vs 18.3 and 18.4 mU/mL, p < 0.0001; LMWH: 8.8 mU/mL vs 13.3 and 21.4 mU/mL, p < 0.05), suggesting, for the first time, that a component of serum is required for the heparin‐dependent release of TFPI. The effect of LDL, VLDL and HDL on the release of TFPI and the expression of TF from/on ECs was also investigated. All three lipoprotein fractions increased the secretion of functional TFPI after one hour incubation (LDL: 12.5 μg/mL, p < 0.01; 25 μg/mL, p < 0.05; VLDL: 50 μg/mL, p < 0.01; HDL: 50 μg/mL, p < 0.05). This is the first data to demonstrate a HDL‐dependent increase in released TFPI. After 24 hours, both LDL and VLDL decreased levels of secreted functional TFPI (LDL: 25 μg/mL, p < 0.01; 50 μg/mL, p < 0.01; VLDL: 12.5 μg/mL, p < 0.01), probably due to the oxidation and subsequent association of both lipoprotein species with TFPI. Surprisingly, both LDL and VLDL decreased cell surface TF, though this effect was not dose dependent. These results suggest that the major lipoproteins have a short term anticoagulant effect which is reversed in the longer term due to lipid oxidation. In summary, this thesis describes the successful adaptation of a chromogenic assay for the measurement of cell surface TF activity and the production of truncated TFPI variants. / Both will be used for the measurement of TF and TFPI, their association with thrombus formation and propagation, and investigations into potential therapeutic applications of TFPI. The results presented in this thesis extend the current knowledge on the expression and release of TF and TFPI on/from ECs by heparin, highlighting the importance of serum in the heparin dependent release of TFPI in vitro. Furthermore, it describes for the first time the effects of the major lipoprotein fractions on TFPI release and TF expression. The data support novel mechanisms by which LDL and VLDL are procoagulant, and HDL anticoagulant. This study provides a foundation for future research of the TF pathway in cellular models, which is critical in increasing the understanding of the pathogenesis and treatment of thrombotic disease. vitro. Furthermore, it describes for the first time the effects of the major lipoprotein fractions on TFPI release and TF expression. The data support novel mechanisms by which LDL and VLDL are procoagulant, and HDL anticoagulant. This study provides a foundation for future research of the TF pathway in cellular models, which is critical in increasing the understanding of the pathogenesis and treatment of thrombotic disease.

A mathematical model of blood coagulation under defined flow conditions, initiated and modulated by spatially discrete regions of surface bound tissue factor (TF) and thrombomodulin (TM), respectively, is presented. The model incorporates fluid phase and surface-associated reactions of the extrinsic, intrinsic, and common pathways, as well as three inhibitory pathways. The spatially heterogeneous model is formulated by finite element method, and an effective prothrombotic zone, which quantifies the spatial propagation of thrombin generation is defined. Characteristic features of coagulation are simulated under physiologic conditions, and the behavior of the system in response to perturbations in TF and TM surface densities, TF site dimensions, and wall shear rate is explored. The major findings of these studies include: (i) The model system responds in an 'all-or-none', threshold-like manner to changes in model parameters. (ii) It was found that prothrombotic effects may extend significantly beyond the dimensions of the spatially discrete site of TF expression in both axial and radial directions. (iii) The relationship between the length of the effective prothrombotic zone and the interval distance between tandem sites of TF expression dictate the net response of the system. Additive prothrombotic effects of sub-clinical lesions as well as suppressive antithrombotic effects of intervening TM-containing regions were observed. Secondly, the computational model is applied to calculate an individualized, systems-based metric of clotting potential for 210 pre-menopausal women in the Leiden Thrombophilia Study (LETS). The simulated variable was found to be a highly predictive parameter for deep venous thrombosis risk.

M.Sc. (Zoology) / A number of chemical substances in mining, industrial, agricultural and domestic effluents are likely to contaminate watercourses. These toxicants have a definite effect on all aquatic life, even at sublethal concentrations. Due to the extensive copper mining activities in the Phalaborwa region, there is concern that the sublethal effect of copper might affect the physiology of fish in the Olifants River, Kruger National Park, Transvaal. Copper can be found as an essential micronutrient in nearly all waters, although anthropogenic sources such as metals from mining and planting industries might produce environmental concentrations causing toxic effects to fish. Several effects of exposure to sublethal concentrations of copper have already been reported in fish, In the present study, the blood coagulation, general haematology, osmoregulation and differential white blood cell counts of the Mozambique tilapia, Oreochromis mossambicus were investigated after the exposures to sublethal concentrations of copper, for a short-term (96 hours) exposure as well as a long-term (four weeks) exposure in experimental flow through systems, at both 29 ± I°C and 19 ± I°C. After the respective sublethal exposures, changes in the values of blood coagulation, general haematology, osmoregulation and differential white blood cell counts were obtained, to determine the effects of the chosen copper concentrations on the blood physiology of O. mossambicus, at 29 + 10 and 19 ± I°C, respectively. After a photographic observation of blood, during all the phases of coagulation was made, it was evident that the exposure to copper, at both temperatures, resulted in delays of the blood coagulation times as well as decreases in the elasticity of the clots that formed. Copper was found to induce haemophilia at 29 ± I°C and 19 ± l°C. whilst at 19 ± I°C it also induced thrombocytopenia. Thus exposure to copper lead to coagulation defects which caused haemorrhage which can eventually cause the death of these fish...

Neste trabalho foram estudados diversos métodos cromatográficos para a purificação de fatores recombinantes de coagulação VII (FVIIr) e VIII (FVIIIr) derivados de linhagens celulares humanas SK-Hep. O FVIIIr é utilizado para o tratamento da Hemofilia A, enquanto o FVIIr é utilizado para o tratamento da Hemofilia B e também a Hemofilia A. Produzir estes fatores em linhagens celulares humanas faz com os padrões de glicosilação, sulfatação e enovelamento destas proteínas sejam extremamente parecidos com os fatores endógenos produzidos no organismo humano. A purificação do FVIIIr através de técnicas de cromatografia multimodais usando a resina CaptoMMC, afinidade usando a resina FVIIISelect e troca iônica (SP-Sepharose) permitiu obter um produto bastante homogêneo e com perfil de banda (por SDS-PAGE) bem definido que demonstrou a presença esperada das cadeias leve e pesada (o Westen-Blott indicou que os anticorpos comerciais reconheceram a cadeia pesada da molécula estudada). As técnicas permitiram uma alta reprodutibilidade do processo onde sequencias de purificação indicaram o mesmo comportamento de perfis cromatográficos e o processo eliminou 99.5% ± 0,5% de proteínas inespecíficas, recuperando até 64% de FVIIIr. O FVIIr foi purificado com apenas uma única técnica cromatográfica usando a resina FVIISelect que isolou a proteína de interesse eliminando cerca de 99% de impurezas, recuperando praticamente todo o produto. O eluido da cromatografia de afinidade foi dialisado em membranas de 5 kDa o que resultou no processo de auto ativação da molécula de FVIIr, resultando em um aumento de sinal de até 5x em relação a quantidade inicial. O gel de SDS-PAGE e o Westen-Blott comprovaram o processo de auto-ativação no qual uma migração de banda de 50 kDa para 30kDa foi observada e os anticorpos comerciais contra FVII foram capazes de detecta-la. O método de purificação também foi bastante reproduzível e o perfil de banda muito semelhante se comparado ao produto comercial existente no mercado. Sendo assim, foi possível obter plataformas de purificação para as proteínas FVIIr e FVIIIr. / In this work, several chromatographic methods were studied for the purification of recombinant clotting factors VII (FVIIr) and VIII (FVIIIr) derived from human SK-Hep cell lines. The FVIIIr is used for the treatment of Hemophilia A, while the FVIIr is used for the treatment of Hemophilia B and Hemophilia A. Producing these factors in human cell lines results in glycosylation, sulphation and folding patterns similar to the endogenous factors produced in the human organism. Purification of FVIIIr by multimodal chromatography techniques using CaptoMMC resin, affinity using FVIIISelect resin and ion exchange (SP-Sepharose) yielded a fairly homogeneous and well-defined band profile (by SDS-PAGE) which demonstrated the expected presence of the light and heavy chains, Westen-Blott indicated that commercial antibodies recognized the heavy chain of the studied molecule. The techniques allowed a high reproducibility of the process where purification sequences indicated the same behavior of chromatographic profiles and the process eliminated 99.5% ± 0.5% nonspecific proteins and recovering up to 64% FVIIIr. FVIIr was purified with only a single chromatographic technique using the FVIISelect resin which isolated the protein by removing about 99% impurities and recovering virtually the entire product. The affinity chromatography eluate was dialyzed on 5 kDa membranes which resulted in the autoactivation process of the FVIIr molecule resulting in a signal increase of up to 5 fold over the initial amount. The SDS-PAGE gel and Westen-Blott demonstrated the auto-activation process where a migration of 50 kDa to 30 kDa band was observed and the commercial antibodies against FVII were able to detect the band. The purification method was also quite reproducible and the band profile very similar compared to the commercial products. Thus, it was possible to obtain purification platforms for the FVIIr and FVIIIr proteins.

Made available in DSpace on 2016-08-10T10:38:46Z (GMT). No. of bitstreams: 1 VINICIUS MONTENEGRO TORRES.pdf: 1768646 bytes, checksum: 07597e8ad4cdc3a2b202a13efcd25a60 (MD5) Previous issue date: 2014-03-13 / Cerebral Palsy is the most common motor disorder in childhood. Its prevalence in Brazil is estimated at around 30,000 to 40,000 new cases a year. The advancement in diagnostic methods in recent years has changed the profile of the PC and etiological genetic causes are considered to be an important etiology. The objective of the present study was to conduct a literature review on the latest advances in the knowledge of the genetic changes associated with the etiology of the PC. The terms Cerebral Palsy, coagulation factors, cytokines, genetic mutations, genetic polymorphisms and pediatric stroke were searched in electronic databases in order to select important publications on the subject (Medline, Scielo, PubMed, OVID, Web of Science, Elsevier Science Direct and CAPES Journals). Direct searches in the collections of the libraries of the PUC-Goiás and Federal University of Goiás also were held. Searches in databases identified 1,731 articles with potential for inclusion in the study and, after reading the summaries, 164 articles were selected for inclusion. The dates of the publications were limited from 1993 to 2013. The languages accepted for reading were Portuguese, English, French and Spanish. A large number of numeric and structural chromosomal mutations, affecting different metabolic pathways, was associated with the signs and symptoms of PC. In the studies reviewed, mutations in several genes with different functions, located on several chromosomes and with different inheritance patterns were described, highlighting the complexity of the etiology of PC. Mutations in complex AP4 (adaptor protein Complex 4), which participates in the transmembrane transport of glutamate receptor vesicles, suggest the existence of a complex AP4 syndrome, with characteristic symptoms, representing one of the few mutations with pathophysiology partially elucidated on PC. Studies correlating the PC with mutations in genes involved in the glutamate metabolism were also reviewed, which emphasizes the importance of this neurotransmitter in the PC. In the evaluated period, mutations in genes encoding factors related to the coagulation cascade, leading to hereditary thrombophilia, were the most widely studied, however, the role of these mutations on PC seems to be discreet. PC is a multifactorial and complex manifestation and different cellular mechanisms must be involved in its occurrence, reflecting various types of mutations involved in its etiology. Multicenter studies, with the largest number of individuals evaluated, are necessary in order to elucidate the complex role of genetic changes in the pathophysiology of PC. / A Paralisia Cerebral é a desordem motora mais comum na infância. Sua prevalência no Brasil é estimada em cerca de 30.000 a 40.000 novos casos por ano. O avanço nos métodos de diagnóstico nos últimos anos mudou o perfil etiológico da PC, sendo as causas genéticas consideradas como uma etiologia importante. O objetivo do presente estudo foi realizar uma revisão bibliográfica sobre os últimos avanços no conhecimento das alterações genéticas associadas ao aparecimento da PC. Os termos acidentes vasculares cerebrais pediátricos, citocinas, fatores da coagulação, mutações genéticas, Paralisia Cerebral e polimorfismos genéticos foram pesquisados nas bases de dados eletrônicas para a busca de publicações sobre o assunto (Medline, PubMed, Scielo, OVID, Web of Science, Elsevier Science Direct e Periódicos CAPES). Pesquisas diretas nos acervos das bibliotecas da PUC-Goiás e Universidade Federal de Goiás também foram realizadas. As pesquisas nas bases de dados identificaram 1.731 artigos com potencial de inclusão no estudo e, após a leitura dos resumos, foram selecionados 164 artigos para inclusão. As datas das publicações foram limitadas de 1993 a 2013. Os idiomas aceitos para leitura foram Português, Inglês, Francês e Espanhol. Um grande número de mutações cromossômicas numéricas e estruturais, que afetam diferentes vias metabólicas, foi associado aos sinais e sintomas da PC. Nos estudos revisados foi observado o envolvimento de mutações em genes localizados em diferentes cromossomos e com padrões de herança distintos, o que evidencia a complexidade da etiologia da PC. As mutações no complexo AP4 (Complexo de proteínas adaptadoras 4), que participa no transporte de transmembranar de vesículas dos receptores de glutamato, indicam a existência de uma síndrome do complexo AP4, com sintomas característicos, representando uma das poucas mutações com fisiopatologia parcialmente elucidada na PC. Estudos correlacionando a PC com mutações em genes envolvidos no metabolismo do glutamato, também foram revisados, o que evidencia a importância deste neurotransmissor na PC. No período avaliado, mutações em genes que codificam fatores relacionados à cascata de coagulação, levando às trombofilias hereditárias, foram os mais amplamente estudados, porém, o papel dessas mutações na PC parece ser discreto e secundário. A PC é uma manifestação multifatorial e complexa e diferentes mecanismos celulares devem estar envolvidos no seu aparecimento, refletindo vários tipos de mutações envolvidas na sua etiologia. Estudos multicêntricos, com maior número de indivíduos avaliados, são necessários para que o papel das alterações genéticas seja melhor elucidado na fisiopatologia da PC.

Orientador: Joyce Maria Annichinno-Bizzacchi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T02:29:39Z (GMT). No. of bitstreams: 1 Mello_TayanaBezerraTeixeira_D.pdf: 2343820 bytes, checksum: be3d8e4b057cd84ec6771c67b8b1407d (MD5) Previous issue date: 2006 / Resumo: Nos últimos anos tem sido demonstrada uma associação entre níveis elevados de certos fatores da coagulação e risco de tromboembolismo venoso (TEV). Entretanto, o número de estudos é pequeno e a maioria estão restritos a populações caucasóides. Neste estudo caso-controle emparelhado por idade, sexo e etnia investigamos os níveis plasmáticos do fibrinogênio, FVII, FVIII, FIX, FX, FXI, FvW e grupo sanguíneo (GS) ABO no risco trombótico. Foram analisados 175 pacientes com TEV (122 mulheres e 53 homens), com idade mediana de 36 anos (13-63), acompanhados no Ambulatório de Hemostasia da Unicamp no período de julho de 2002 a julho de 2005. Na análise univariada, níveis elevados de FVIII (OR: 5,3 IC95% 2,9-9,6), FvW (OR: 4,9 IC95% 2,7-8,9), FIX (OR: 2,4 IC95% 1,3-4,4), FXI (OR: 2,1 IC95% 1,1-4,0) e GS não O (OR: 3,0 IC95% 1,9-4,6) foram fatores de risco para TEV. O FVIII, FvW e GS não O foram associados ao risco tanto em membro inferior como em sítio incomum da doença. A análise de todas estas variáveis, segundo critério de seleção ¿stepwise¿, mostrou o FVIII (OR: 3,1 IC95% 1,6-6,0), FvW (OR:2,8 IC95% 1,4-5,4) e o GS não-O (OR:2,2 IC95% 1,3-3,5) como fatores de risco independentes para TEV e que o FIX e FXI agiram sinergicamente a estas variáveis no acréscimo do risco trombótico. Risco de recorrência foi conferido por elevações do FIX (OR: 4,7 IC95% 1,8-11,9) e FXI (OR: 3,4 IC95% 1,8-8,7). Os determinantes dos níveis plasmáticos do FVIII não estão totalmente esclarecidos. Como a LRP (Low density lipoprotein receptor related protein) tem um papel no catabolismo do FVIII, foram pesquisados os polimorfimos C200T, o A775P e o D2080N no gene codificador dessa proteína, como fator de risco para TEV e a influência dos mesmos sobre os níveis do FVIII e FvW. Não houve diferença nas prevalências destes polimorfismos entre pacientes e controles. No entanto, no grupo-controle, o genótipo DN, do polimorfismo D2080N, foi associado a menores concentrações do FVIII (77,4 UI/dl) e FvW (70,2 UI/dl), quando comparado ao genótipo DD (127 UI/dl e 108,4 UI/dl, respectivamente p<0,05). Em conclusão, nesta população brasileira miscigenada, o FVIII, FvW , FIX, FXI e GS não O foram associados ao risco de TEV e o polimorfismo D2080N, no gene da LRP, interferiu com os níveis plasmáticos de FVIII e FvW / Abstract: During the last years an association between high levels of certain coagulation factors and the risk for venous thromboembolism (VTE) has been demonstrated. The number of studies, however, is small, and most of them are restricted to Caucasian populations. In this case control study, matched for age, sex and ethnicity, we investigated the plasma levels of fibrinogen, FVII, FVIII, FIX, FX, FXI, vWF and the ABO blood group (BG) in the thrombotic risk. It was analyzed 175 patients with VTE (122 women and 53 men), median age 36 years (13-63), followed at the hemostasis outpatient clinic at the State University of Campinas ¿ UNICAMP, between July 2002 and July 2005. In univariate analysis, elevated levels of FVIII (OR: 5.3 95%CI 2.9-9.6), FvW (OR: 4.9 95%CI 2.7-8.9), FIX (OR: 2.4 95%CI 1.3-4.4), FXI (OR: 2.1 95%CI 1.1-4.0) and non O BG (OR: 3.0 95%CI 1.9-4.6) were risk factors for VTE. FVIII, FvW and non O BG were associated with the risk both in lower limbs and unusual sites of disease. Analysis of all these variables by stepwise selection criteria showed FVIII (OR:3.1 95%CI 1.6-6.0), FvW (OR:2.8 95%CI 1.4-5.4) and non O BG (OR:2.2 95%CI 1.3-3.5) as independent risk factors for VTE, and FIX and FXI increased synergistically the risk of thrombosis of these variables. Risk of recurrence was conferred by FIX (OR:4.7 IC95% 1.8-11.9) and FXI (OR:3.4 IC95% 1.8-8.7). The FVIII plasma levels determinants are not well established. Since LRP (Low density lipoprotein receptor related protein) has a role in the catabolism of FVIII, we evaluated the C200T, A775P and, D2080N polymorphisms in the gene coding of this protein, as risk factor for VTE and their influence upon the levels of FVIII and vWF. There was no difference regarding the prevalence of these polymorphisms between patients and controls. However, in the control group, the DN genotype, of the D2080N polymorphism, was associated with lower concentrations of FVIII (77.4 UI/dl) and vWF (70.2 UI/dl), when compared to DD genotype (127 UI/dl e 108.4 UI/dl, respectively p<0.05). In conclusion, in these Brazilian miscigenous population, increased levels of FVIII, FvW, FIX, FXI and non O BG were associated with VTE risk and the D2080N polymorphism, in the LRP gene, influenced plasma levels of FVIII and vWF / Doutorado / Biologia Estrutural, Celular, Molecular e do Desenvolvimento / Doutor em Fisiopatologia Medica

Neste trabalho foram estudados diversos métodos cromatográficos para a purificação de fatores recombinantes de coagulação VII (FVIIr) e VIII (FVIIIr) derivados de linhagens celulares humanas SK-Hep. O FVIIIr é utilizado para o tratamento da Hemofilia A, enquanto o FVIIr é utilizado para o tratamento da Hemofilia B e também a Hemofilia A. Produzir estes fatores em linhagens celulares humanas faz com os padrões de glicosilação, sulfatação e enovelamento destas proteínas sejam extremamente parecidos com os fatores endógenos produzidos no organismo humano. A purificação do FVIIIr através de técnicas de cromatografia multimodais usando a resina CaptoMMC, afinidade usando a resina FVIIISelect e troca iônica (SP-Sepharose) permitiu obter um produto bastante homogêneo e com perfil de banda (por SDS-PAGE) bem definido que demonstrou a presença esperada das cadeias leve e pesada (o Westen-Blott indicou que os anticorpos comerciais reconheceram a cadeia pesada da molécula estudada). As técnicas permitiram uma alta reprodutibilidade do processo onde sequencias de purificação indicaram o mesmo comportamento de perfis cromatográficos e o processo eliminou 99.5% ± 0,5% de proteínas inespecíficas, recuperando até 64% de FVIIIr. O FVIIr foi purificado com apenas uma única técnica cromatográfica usando a resina FVIISelect que isolou a proteína de interesse eliminando cerca de 99% de impurezas, recuperando praticamente todo o produto. O eluido da cromatografia de afinidade foi dialisado em membranas de 5 kDa o que resultou no processo de auto ativação da molécula de FVIIr, resultando em um aumento de sinal de até 5x em relação a quantidade inicial. O gel de SDS-PAGE e o Westen-Blott comprovaram o processo de auto-ativação no qual uma migração de banda de 50 kDa para 30kDa foi observada e os anticorpos comerciais contra FVII foram capazes de detecta-la. O método de purificação também foi bastante reproduzível e o perfil de banda muito semelhante se comparado ao produto comercial existente no mercado. Sendo assim, foi possível obter plataformas de purificação para as proteínas FVIIr e FVIIIr. / In this work, several chromatographic methods were studied for the purification of recombinant clotting factors VII (FVIIr) and VIII (FVIIIr) derived from human SK-Hep cell lines. The FVIIIr is used for the treatment of Hemophilia A, while the FVIIr is used for the treatment of Hemophilia B and Hemophilia A. Producing these factors in human cell lines results in glycosylation, sulphation and folding patterns similar to the endogenous factors produced in the human organism. Purification of FVIIIr by multimodal chromatography techniques using CaptoMMC resin, affinity using FVIIISelect resin and ion exchange (SP-Sepharose) yielded a fairly homogeneous and well-defined band profile (by SDS-PAGE) which demonstrated the expected presence of the light and heavy chains, Westen-Blott indicated that commercial antibodies recognized the heavy chain of the studied molecule. The techniques allowed a high reproducibility of the process where purification sequences indicated the same behavior of chromatographic profiles and the process eliminated 99.5% ± 0.5% nonspecific proteins and recovering up to 64% FVIIIr. FVIIr was purified with only a single chromatographic technique using the FVIISelect resin which isolated the protein by removing about 99% impurities and recovering virtually the entire product. The affinity chromatography eluate was dialyzed on 5 kDa membranes which resulted in the autoactivation process of the FVIIr molecule resulting in a signal increase of up to 5 fold over the initial amount. The SDS-PAGE gel and Westen-Blott demonstrated the auto-activation process where a migration of 50 kDa to 30 kDa band was observed and the commercial antibodies against FVII were able to detect the band. The purification method was also quite reproducible and the band profile very similar compared to the commercial products. Thus, it was possible to obtain purification platforms for the FVIIr and FVIIIr proteins.