Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The granulocyte-macrophage colony stimulating factor (GM-CSF) is a cytokine that regulates the proliferation and differentiation of hematopoietic progenitor cells and activates mature granulocytes and macrophages. Clinically is used in enhancing hematopoietic recovery after cancer chemotherapy and bone marrow transplantation. A reversed-phase liquid chromatography (RP-LC) method was validated for the determination of the non-glycosylated recombinant rhGM-CSF (Molgramostim) in biopharmaceutical formulations. The RP-LC method was carried out on a Jupiter C4 column (250 mm x 4.6 mm i.d.), maintained at 45 ºC. The mobile phase A consisted of 0.1% TFA and the mobile phase B consisted of 0.1% TFA in acetonitrile, run at a gradient from: 0.01 34 min, 37% 50% of B; 34 35 min linear back to 37% of B and 35 40 min, 37% of B. The flow rate was 1 mL/min, and using photodiode array (PDA) detection at 214 nm. The chromatographic separation was obtained with the retention time of 29.2 min, and was linear over the concentration range of 2-300 μg/mL (r2 = 0.9992). The procedure was validated evaluating parameters such as the specificity, linearity, precision, accuracy, robustness, limit of detection and limit of quantitation. The specificity was proven through degradation studies, showing that also there was no interference of the excipients. Moreover, the in vitro cytotoxicity test of the degraded products showed significant differences (p<0.05). The proposed method was applied for the analysis of molgramostim and their related proteins, and the results were correlated to the bioassay, showing mean differences of the potency 1.02% higher for the RP-LC method, contributing to establish alternatives to characterize and monitoring its instability, improving the quality control and assuring the therapeutic efficacy. / O fator estimulador da colônia de granulócitos e macrófagos (GM-CSF) é uma citocina que regula a proliferação e diferenciação de células progenitoras hematopoiéticas e ativa granulócitos e macrófagos maduros. É clinicamente indicado após quimioterapia para o câncer e após transplante de medula óssea. No presente trabalho foi validado método por cromatografia líquida em fase reversa (CL-FR) para a avaliação da molgramostima, forma recombinante não-glicosilada do GM-CSF, em formulação biofarmacêutica. Utilizou-se coluna Júpiter C4 (250 mm x 4,6 mm d.i.), mantida a 45 °C. A fase móvel A foi composta de ácido trifluoracético 0,1% e a fase móvel B de ácido trifluoracético 0,1% em acetonitrila, eluídas no gradiente: 0,01 34 min, 37 50% de B; 34 35 min, 50 37% de B, mantendo-se nesta proporção até 40 min. Utilizou-se vazão de 1 mL/min, usando detector de arranjo de diodos (DAD) a 214 nm. A separação cromatográfica foi obtida no tempo de 29,2 min, sendo linear na faixa de concentração de 2 300 μg/mL (r2 = 0,9992). O procedimento foi validado, avaliando-se os parâmetros de especificidade, linearidade, precisão, exatidão, robustez, limite de detecção e quantificação. A especificidade foi comprovada através de estudos de degradação, demonstrando também que não houve interferência dos excipientes. Além disso, realizou-se o teste de citotoxicidade in vitro dos produtos degradados que apresentaram diferença significativa (p<0,05). O método foi aplicado para avaliação de potência de molgramostima e de proteínas relacionadas, e os resultados foram correlacionados com o bioensaio, observando-se diferenças médias de potência 1,02% superiores por CL-FR. Contribuiu-se assim para o estabelecimento de alternativas que aprimoram o controle da qualidade, garantindo a segurança e eficácia terapêutica.

Introdução: Várias são as propostas descritas para tratar farmacologicamente a lesão traumática da medula espinal. A metilprednisolona já foi padronizada para uso clínico. O fator estimulador de colônia de granulócitos (G-CSF) tem sido promissor em estudos experimentais e clínicos. Não há pesquisas quanto ao efeito da associação dos dois fármacos. Objetivo: Avaliar o efeito do tratamento com o fator estimulador de colônia de granulócitos associado a metilprednisolona na lesão medular aguda experimental em ratos. Material e métodos: Foram avaliados 40 ratos Wistar submetidos a lesão medular moderada com o NYU-Impactor. Os animais foram divididos em quatro grupos de 10 ratos. O Grupo Controle não recebeu tratamento; o Grupo G-CSF, foi tratado com G-CSF no momento da lesão e diariamente ao longo dos cinco dias subsequentes; o Grupo Metilprednisolona, com metilprednisolona durante 24 horas; e o Grupo G-CSF/Metilprednisolona, com metilprednisolona durante 24 horas e G-CSF no momento da lesão e ao longo de cinco dias. Os animais foram mantidos vivos durante 42 dias; a avaliação funcional foi realizada com a aplicação da escala funcional de Basso, Beattie e Bresnahan (BBB) nos dias 2, 7, 14, 21, 28, 35 e 42 subsequentes à lesão. A avaliação dos potenciais evocados motores foi realizada no dia 42 e a avaliação histológica da lesão da região da medula espinal lesada, realizada logo após a eutanásia ocorrida no dia 42. Resultados e conclusões: A associação de metilprednisolona e G-CSF no tratamento do traumatismo medular contuso experimental em ratos promoveu melhora neurológica avaliada pela escala BBB superior à melhora promovida pela metilprednisolona e G-CSF quando utilizadas isoladamente. A associação teve também efeito sinérgico que resultou em melhora nos parâmetros histológicos no local da lesão. Não houve diferença entre os grupos quanto à avaliação neurofisiológica / Introduction: There are several proposals to pharmacologically treat traumatic spinal cord injury. Methylprednisolone has already been standardized for clinical use. Granulocyte colony stimulating factor (G-CSF) has been promising in experimental and clinical studies. There is no research on the effect of the association of the two drugs. Objective: to evaluate the effect of combined treatment of the granulocyte colony-stimulating factor (G-CSF) associated with methylprednisolone in experimental acute spinal cord injury in rats. Material and methods: Forty male Wistar rats were submitted to a moderate spinal cord injury with the NYU-Impactor. The animals were divided into four groups of ten rats each. The Control Group was not treated; the G-CSF Group was treated with G-CSF at the time of injury and daily over the next five days; the Methylprednisolone Group was treated with methylprednisolone for 24 hours; the G-CSF/methylprednisolone Group, was treated with methylprednisolone for 24 hours and G-CSF at the time of injury and daily over the next five days. The animals were kept alive for 42 days; Functional evaluation was performed using the Basso, Beattie and Bresnahan (BBB) score on days 2, 7, 14, 21, 28, 35 and 42 following the spinal cord injury. Evaluation of motor evoked potentials was held and histological examination of the lesion of the spinal cord was done immediately after euthanasia on day 42. Results and conclusions: The combination of methylprednisolone and G-CSF in the treatment of experimental spinal cord injury in rats promoted neurological improvement as assessed by BBB scale with greater improvement than with methylprednisolone or G-CSF when used alone. The combination of treatment had also a synergistic effect resulting in improvement in histological parameters at the injury site. There was no difference between groups regarding neurophysiological evaluation

Orientadores: Alessandro dos Santos Farias, Leonilda Maria Barbosa dos Santos / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-23T01:58:27Z (GMT). No. of bitstreams: 1 Pradella_Fernando_M.pdf: 4468527 bytes, checksum: 63d6760bd0ea06c5fcab94d1421da291 (MD5) Previous issue date: 2013 / Resumo: O resumo poderá ser visualizado no texto completo da tese digital / Abstract: The abstract is available with the full electronic document / Mestrado / Imunologia / Mestre em Genética e Biologia Molecular

Les nanomatériaux combinant des fonctions de ciblage, d'imagerie, de thérapie et de détection font l'objet de nombreuses recherches dans le domaine de la santé. Les travaux présentés dans cette thèse concernent la multi‐fonctionnalisation de nanoparticules (NPs) par un procédé de synthèse supportée. Le support solide développé dans cette étude est constitué d'un matériau poreux en verre sur lequel sont greffées de manière temporaire des nanoparticules de silice. La fonctionnalisation de la surface des nanoparticules a été réalisée de façon automatisée par une chimie de synthèse dite aux phosphoramidites. Dans un premier temps, cette technique a permis d'obtenir des densités de greffage de l'ordre de 5000 à 7000 oligonucléotides par nanoparticule, ce qui représente une fonctionnalisation 10 à 20 fois supérieure à celles obtenues par des méthodes de greffage en solution. Les brins d'ADN synthétisés sur les NPs ont montré une bonne accessibilité pour l'hybridation avec un brin d'ADN complémentaire, ouvrant la voie à des applications thérapeutiques ou à l'intégration de ces objets dans des systèmes de détection. La deuxième partie de ces travaux est consacrée à la vectorisation d'une protéine thérapeutique, le G‐CSF (facteur de croissance de colonies de granulocytes), par des nanoparticules présentant également des propriétés d'imagerie. Ces nanovecteurs thérapeutiques ont montré des propriétés de stimulation cellulaire in vitro et de ciblage de la rate, organe réservoir de neutrophiles, in vivo. Enfin il a été démontré que la modification de NPs sur support ouvre des perspectives intéressantes pour la préparation d'assemblages complexes de nanoparticules (dimères et NPs dissymétriques) / Nanomaterials combining targeting, imaging, therapy and sensing properties are of growing interest for biomedical applications. The work reported in this thesis concerns nanoparticle (NP) multifunctionalization by solid phase synthesis. The solid support developed in this study is composed of a porous glass material on which silica NPs are temporarily grafted. Nanoparticle surface functionalization was performed by automated synthesis using phosphoramidite chemistry. Firstly, high surface loadings from 5000 to 7000 oligonucleotides per NP were achieved, representing a functionalization 10 to 20‐fold greater than those obtained by coupling methods in solution. DNA strands synthesized on NPs showed a good accessibility for hybridization with a complementary DNA strand, paving the way for therapeutic applications or integration of these objects in detection systems. The second part of this work was devoted to the vectorization of a therapeutic protein, GCSF (Granulocyte‐Colony Stimulating Factor) by nanoparticles that also exhibited imaging properties. These therapeutic nanocarriers showed cell stimulating properties in vitro and spleen targeting, which is a reservoir of neutrophils, in vivo. Finally, it was demonstrated that the solid phase modification of NPs opens interesting perspectives for the production of complex nanoparticle assemblies (dimers and asymmetric NPs)

Streptococcus suis est un pathogène porcin et un agent de zoonose en émergence causant des maladies invasives graves. Lorsque la bactérie envahit l’hôte et se retrouve dans le sang, des neutrophiles se mobilisent rapidement pour tenter d’éliminer la menace grâce à de nombreux mécanismes anti-microbiens. Ces cellules sont régulées par le granulocyte colony-stimulating factor (G-CSF) produit lors de l’infection. Il pourrait être un acteur clé du contrôle de l’infection par S. suis mais rien n’est connu sur la production et le rôle du G-CSF dans les infections à S. suis. De plus, le recrutement et l’activation des neutrophiles demeurent peu documentés. L’hypothèse de ce projet est que S. suis induit la production du G-CSF par les cellules de l’immunité innée suite à l’infection, et que le facteur module le recrutement et l’activation des neutrophiles. Cependant, S. suis limite l’activation des cellules immunitaires et se soustrait à l’élimination par les neutrophiles grâce à ses facteurs de virulence. Le 1er objectif consistait à caractériser le recrutement et l’activation des neutrophiles en réponse à S. suis dans un modèle d’infection murin (souris C57BL/6). Nous avons démontré que S. suis cause une mobilisation rapide des neutrophiles de la moelle osseuse vers le sang et la rate. Dans le sang, les neutrophiles présentent un phénotype activé. En parallèle, l’infection cause une élévation spectaculaire du G-CSF systémique, selon un patron similaire à celui des neutrophiles, suggérant un rôle du facteur dans la mobilisation de ces cellules. Le 2e objectif visait à comprendre les mécanismes moléculaires de production de G-CSF. Nous avons donc quantifié le G-CSF produit par différentes cellules immunitaires primaires de souris et démontré que les cellules dendritiques et les macrophages produisent du G-CSF en réponse à S. suis. Les cellules reconnaissent la bactérie par l’intermédiaire de leur Toll-like receptor (TLR) 2 et de récepteurs intracellulaires, ce qui engage des voies de signalisation clés pour la production de médiateurs pro-inflammatoires. Le 3e objectif consistait à élucider le rôle du G-CSF dans le recrutement et l’activation des neutrophiles lors de l’infection par S. suis, et les conséquences sur la pathogenèse. Dans unmodèle d’infection murin, nous avons démontré que le G-CSF cause la sortie des neutrophiles de la moelle osseuse vers le sang, sans que cela augmente l’élimination de la bactérie et la réponse inflammatoire. In vitro, S. suis active peu les neutrophiles porcins, et le G-CSF ne permet pas d’augmenter leurs fonctions. Le 4e objectif avait pour but de déterminer si certains facteurs bactériens de S. suis modulent la production de G-CSF et l’activation des neutrophiles. En utilisant des mutants et des composants bactériens purifiés, nous avons démontré que pour produire le G-CSF, les cellules dendritiques et les macrophages murins reconnaissent les lipoprotéines de S. suis. Cependant, celles-ci sont partiellement masquées par la capsule qui entoure la bactérie, limitant la production de la cytokine. De la même manière, la capsule gêne l’activation optimale des neutrophiles porcins ce qui empêche leur effet bactéricide. Une meilleure compréhension de la pathogenèse des infections à S. suis pourrait orienter de nouvelles stratégies thérapeutiques en lien avec les neutrophiles pour lutter contre la bactérie. Par exemple, le G-CSF couplé à des d’autres immunomodulateurs pourra être envisagé comme traitement métaphylactique dans les élevages porcins pour prévenir d’éventuelles éclosions. / Streptococcus suis is a porcine pathogen and an emerging zoonotic agent causing severe invasive diseases. When the bacterium invades the host and enters the bloodstream, neutrophils quickly mobilize to try to eliminate the threat through various antimicrobial mechanisms. These cells are regulated by granulocyte colony-stimulating factor (G-CSF), which is produced during the infection. It could be a key player in controlling S. suis infection, but nothing is known about the production and role of G-CSF in S. suis infections. Furthermore, neutrophil recruitment and activation remain poorly documented. The hypothesis of this project is that S. suis induces G-CSF production by innate immune cells following infection, and the factor modulates the recruitment and activation of neutrophils. Nevertheless, S. suis prevents immune cells activation and evades elimination by neutrophils due to its virulence factors. The first objective was to characterize the recruitment and activation of neutrophils in response to S. suis in a murine infection model (C57BL/6). We demonstrated that S. suis infection causes a rapid release of neutrophils from the bone marrow to the blood and spleen. In the blood, neutrophils exhibit an activated phenotype. Simultaneously, the infection causes a dramatic increase in systemic G-CSF, following a pattern similar to that of neutrophils, suggesting a role for the factor in the mobilization of these cells. The second objective aimed to understand the molecular mechanisms of G-CSF production. We quantified G-CSF produced by different primary mouse immune cells and showed that dendritic cells and macrophages produce G-CSF in response to S. suis. Cells recognize the bacterium through their Toll-like receptor (TLR) 2 and intracellular receptors, engaging key signaling pathways for pro-inflammatory mediator production. The third objective was to elucidate the role of G-CSF in the recruitment and activation of neutrophils during S. suis infection, and its consequences for pathogenesis. In a murine model, we demonstrated that G-CSF causes the release of neutrophils from the bone marrow into the blood, without increasing bacterial clearance and inflammatory response. In vitro, S. suis weakly activates porcine neutrophils, and G-CSF does not enhance the cellular functions. The fourth objective aimed to determine if certain bacterial factors of S. suis modulate G-CSF production and neutrophil activation. Using mutants and purified bacterial components, we demonstrated that dendritic cells and murine macrophages recognize S. suis lipoproteins to produce G-CSF. However, these lipoproteins are partially masked by the bacterium's capsule, limiting cytokine production. Similarly, the capsule hinders optimal activation of porcine neutrophils, preventing their bactericidal effect. A better understanding of the pathogenesis of S. suis infections could guide new therapeutic strategies related to neutrophils to combat the bacterium. For example, G-CSF combined with other immunomodulators could be considered as a metaphylactic treatment in pig farming to prevent potential outbreaks.

Objetivos: Avaliar os resultados das coletas de células hematopoéticas CD34+, por aférese, em crianças portadoras de neuroblastoma tratadas no Serviço de Oncologia e Hematologia do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; estudar os fatores (idade, peso, estimulação com quimioterapia, dose do G-CSF, uso terapêutico de 131I-MIBG e tempo entre exposição à quimioterapia prévia) que influenciaram na mobilização e no rendimento da coleta de células CD34+ no sangue periférico e associar a quantidade de células CD34+ obtidas com a evolução clínica do paciente. Métodos: Trata-se de um estudo retrospectivo de pacientes com neuroblastoma submetidos à coleta de células-tronco hematopoéticas entre janeiro de1989 e junho 2012. Resultados: Avaliados 45 prontuários de crianças com idade mediana de 3,1 anos (0-12 anos), 26 (57%) apresentavam metástase em medula óssea ao diagnóstico. O tempo entre diagnóstico e o início da mobilização foi em média 19,7 ± 12 meses (mediana de 15,8 meses). Dos pacientes estudados, 11/45 (24,4%) receberam 131I-MIBG terapêutico antes da mobilização. Somente cinco pacientes (11,1%) receberam quimioterapia associada ao G-CSF para mobilização; as demais 40 crianças (88,9%) receberam exclusivamente G-CSF na dose média 26,5 ± 5,3 ug/kg/dia (mediana 28 ug/kg/dia). Não houve correlação entre o número máximo de células CD34+ no sangue periférico com a idade (p=0,9), com o peso (p=0,63), com a dose do G-CSF (p=0,46) ou com o intervalo entre o diagnóstico e o início da mobilização (p=0,09). A mediana da quantificação de células CD34+/uL no sangue periférico foi de 36,6 células, média de 45,2 ± 42,6 (mínimo 1,7 e máximo 236,3). Pacientes que haviam recebido 131I-MIBG previamente à mobilização apresentaram menor número de células CD34+/uL no sangue periférico (p=0,04). Em 26 pacientes (57,8%) foi possível coletar mais de 2,0x106 células CD34+/Kg na primeira coleta e em 19 pacientes (42,2%) foram necessárias mais de uma coleta, sendo que, oito pacientes (17,8%) apresentaram falha de mobilização. Os pacientes que apresentaram menor quantidade de células CD34+/uL no sangue periférico (<= 12) não conseguiram número maior ou igual a 2,0x106 células CD34+/Kg em 81,8% das coletas. O número mediano de células infundidas foi de 2,66 x106 células CD34+/Kg (média 3,38 ±1,6; mínimo 1,8; máximo 8,74 x106 CD34+/Kg). Os pacientes apresentaram contagem de leucócitos maior que 1000/mm3 e de plaquetas maior 50000/mm3 por dois dias consecutivos em média, no dia 13 ± 10 e no dia 46 ± 33, respectivamente, após infusão. Conclusões: A coleta de células-tronco hematopoéticas por aférese foi factível em todos os pacientes do estudo. Não houve influência significativa da idade, do peso, da dose do G-CSF e do tempo entre diagnóstico e inicio da mobilização, no número máximo de células. O uso prévio à coleta de 131I-MIBG terapêutico parece influenciar negativamente no pico de células CD34+ no sangue periférico (p=0,04). A contagem de células CD34+ no sangue periférico é importante fator preditivo do resultado das coletas de células progenitoras hematopoéticas CD34+ por aférese / Objectives: To evaluate the results of peripheral hematopoietic CD34+ stem cells harvesting in children with neuroblastoma treated at Serviço de Oncologia e Hematologia do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; regarding age, weight, stimulation with chemotherapy, G-CSF dose, time between diagnosis and the mobilization beginning and therapeutic 131I-MIBG use and the influence in mobilization and peripheral harvesting of autologous hematopoietic stem cells and to associate the amount of CD34+ cells obtained with the patient\'s clinical evolution. Methods: Between January 1989 and June 2012, children with neuroblastoma underwent to mobilization and peripheral hematopoietic stem cell harvesting and were retrospectively analyzed. Results: The charts of 45 children were reviewed. Median age was 3.1 years (0-12years), and 26 (57%) had metastases in bone marrow at diagnosis. Average time between diagnosis and mobilization was 19.7 ± 12 months (median, 15.8 months). 11/45 (24.4%) received therapeutic 131I-MIBG prior to mobilization. The average G-CSF dose was 26.5 ± 5.3mg/kg/day (mean 28mg/kg/day). There was no correlation between the absolute number of peripheral CD34+ cells and age (p=0.9), weight (p=0.63), G-CSF dose (p=0.46) or the range between diagnosis and early mobilization (p=0.09). The median quantification of CD34+ cells/uL in peripheral blood was 36.6, average 45.2 ±42.6 (minimum 1.7 and maximum 236.3 CD34+ cells/uL). Patients who had received therapeutic 131I-MIBG prior to mobilization, showed fewer absolute amount of CD34+/uL cells in peripheral blood (p=0.04). In 26 patients (57.8%) it was possible to harvest more than 2.0 x106 CD34+ cells/kg at first apheresis and in 19 patients (42.2%) more than one collection were necessary, and eight patients (17.8 %) failure to mobilize. Patients presenting less than 12 CD34+ cells/uL in peripheral blood on the harvesting day failed to reach more then 2.0x106 cells CD34+/kg in 81.8% of the apheresis procedures. It was infused a median number of 2.66 x106 CD34+ cells/kg (mean 1.6 ± 3.38; min 1.8; max 8.74 x106 CD34+ cells/kg). After the stem cells infusion, patients had white blood cells count greater than 1000/mm3 and platelet greater than 50,000/mm3 for two consecutive days on average after 13 ±10 and 46 ± 33 days, respectively. Conclusions: The hematopoietic stem cells harvesting was feasible in all patients included in this report. The G-CSF dose, age, weight and the period between harvesting and diagnosis showed no influence in mobilization and harvesting of autologous hematopoietic stem cells, however the absolute number of peripheral blood CD34+ cells/uL is an important predictive factor for the harvesting outcome. Additionally our findings support for the first time the notion that the use of therapeutic 131I-MIBG could have a negative impact in mobilization of peripheral blood stem cells in children with neuroblastoma

Objetivos: Avaliar os resultados das coletas de células hematopoéticas CD34+, por aférese, em crianças portadoras de neuroblastoma tratadas no Serviço de Oncologia e Hematologia do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; estudar os fatores (idade, peso, estimulação com quimioterapia, dose do G-CSF, uso terapêutico de 131I-MIBG e tempo entre exposição à quimioterapia prévia) que influenciaram na mobilização e no rendimento da coleta de células CD34+ no sangue periférico e associar a quantidade de células CD34+ obtidas com a evolução clínica do paciente. Métodos: Trata-se de um estudo retrospectivo de pacientes com neuroblastoma submetidos à coleta de células-tronco hematopoéticas entre janeiro de1989 e junho 2012. Resultados: Avaliados 45 prontuários de crianças com idade mediana de 3,1 anos (0-12 anos), 26 (57%) apresentavam metástase em medula óssea ao diagnóstico. O tempo entre diagnóstico e o início da mobilização foi em média 19,7 ± 12 meses (mediana de 15,8 meses). Dos pacientes estudados, 11/45 (24,4%) receberam 131I-MIBG terapêutico antes da mobilização. Somente cinco pacientes (11,1%) receberam quimioterapia associada ao G-CSF para mobilização; as demais 40 crianças (88,9%) receberam exclusivamente G-CSF na dose média 26,5 ± 5,3 ug/kg/dia (mediana 28 ug/kg/dia). Não houve correlação entre o número máximo de células CD34+ no sangue periférico com a idade (p=0,9), com o peso (p=0,63), com a dose do G-CSF (p=0,46) ou com o intervalo entre o diagnóstico e o início da mobilização (p=0,09). A mediana da quantificação de células CD34+/uL no sangue periférico foi de 36,6 células, média de 45,2 ± 42,6 (mínimo 1,7 e máximo 236,3). Pacientes que haviam recebido 131I-MIBG previamente à mobilização apresentaram menor número de células CD34+/uL no sangue periférico (p=0,04). Em 26 pacientes (57,8%) foi possível coletar mais de 2,0x106 células CD34+/Kg na primeira coleta e em 19 pacientes (42,2%) foram necessárias mais de uma coleta, sendo que, oito pacientes (17,8%) apresentaram falha de mobilização. Os pacientes que apresentaram menor quantidade de células CD34+/uL no sangue periférico (<= 12) não conseguiram número maior ou igual a 2,0x106 células CD34+/Kg em 81,8% das coletas. O número mediano de células infundidas foi de 2,66 x106 células CD34+/Kg (média 3,38 ±1,6; mínimo 1,8; máximo 8,74 x106 CD34+/Kg). Os pacientes apresentaram contagem de leucócitos maior que 1000/mm3 e de plaquetas maior 50000/mm3 por dois dias consecutivos em média, no dia 13 ± 10 e no dia 46 ± 33, respectivamente, após infusão. Conclusões: A coleta de células-tronco hematopoéticas por aférese foi factível em todos os pacientes do estudo. Não houve influência significativa da idade, do peso, da dose do G-CSF e do tempo entre diagnóstico e inicio da mobilização, no número máximo de células. O uso prévio à coleta de 131I-MIBG terapêutico parece influenciar negativamente no pico de células CD34+ no sangue periférico (p=0,04). A contagem de células CD34+ no sangue periférico é importante fator preditivo do resultado das coletas de células progenitoras hematopoéticas CD34+ por aférese / Objectives: To evaluate the results of peripheral hematopoietic CD34+ stem cells harvesting in children with neuroblastoma treated at Serviço de Oncologia e Hematologia do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; regarding age, weight, stimulation with chemotherapy, G-CSF dose, time between diagnosis and the mobilization beginning and therapeutic 131I-MIBG use and the influence in mobilization and peripheral harvesting of autologous hematopoietic stem cells and to associate the amount of CD34+ cells obtained with the patient\'s clinical evolution. Methods: Between January 1989 and June 2012, children with neuroblastoma underwent to mobilization and peripheral hematopoietic stem cell harvesting and were retrospectively analyzed. Results: The charts of 45 children were reviewed. Median age was 3.1 years (0-12years), and 26 (57%) had metastases in bone marrow at diagnosis. Average time between diagnosis and mobilization was 19.7 ± 12 months (median, 15.8 months). 11/45 (24.4%) received therapeutic 131I-MIBG prior to mobilization. The average G-CSF dose was 26.5 ± 5.3mg/kg/day (mean 28mg/kg/day). There was no correlation between the absolute number of peripheral CD34+ cells and age (p=0.9), weight (p=0.63), G-CSF dose (p=0.46) or the range between diagnosis and early mobilization (p=0.09). The median quantification of CD34+ cells/uL in peripheral blood was 36.6, average 45.2 ±42.6 (minimum 1.7 and maximum 236.3 CD34+ cells/uL). Patients who had received therapeutic 131I-MIBG prior to mobilization, showed fewer absolute amount of CD34+/uL cells in peripheral blood (p=0.04). In 26 patients (57.8%) it was possible to harvest more than 2.0 x106 CD34+ cells/kg at first apheresis and in 19 patients (42.2%) more than one collection were necessary, and eight patients (17.8 %) failure to mobilize. Patients presenting less than 12 CD34+ cells/uL in peripheral blood on the harvesting day failed to reach more then 2.0x106 cells CD34+/kg in 81.8% of the apheresis procedures. It was infused a median number of 2.66 x106 CD34+ cells/kg (mean 1.6 ± 3.38; min 1.8; max 8.74 x106 CD34+ cells/kg). After the stem cells infusion, patients had white blood cells count greater than 1000/mm3 and platelet greater than 50,000/mm3 for two consecutive days on average after 13 ±10 and 46 ± 33 days, respectively. Conclusions: The hematopoietic stem cells harvesting was feasible in all patients included in this report. The G-CSF dose, age, weight and the period between harvesting and diagnosis showed no influence in mobilization and harvesting of autologous hematopoietic stem cells, however the absolute number of peripheral blood CD34+ cells/uL is an important predictive factor for the harvesting outcome. Additionally our findings support for the first time the notion that the use of therapeutic 131I-MIBG could have a negative impact in mobilization of peripheral blood stem cells in children with neuroblastoma

No description available.

The societal burden of autoimmune diseases and donor organ transplant rejection in developed countries reflects the lack of effective immune suppressive drugs. The main objective of my thesis was to develop novel fusion proteins targeting receptors linked to autoimmunity; strategies that will allow the suppression of autoreactive cells while sparing resting lymphocytes. Interleukin (IL) 15 has been demonstrated to exert its effects mainly on activated T-cells triggered via their T-cell receptor (TCR). Since we found that the fusion of granulocyte-macrophage colony stimulating factor (GMCSF) to IL15 - aka GIFT15 - paradoxically leads to aberrant signalling downstream of the IL15R and blocks interferon (IFN)-gamma secretion in a mixed lymphocyte reaction (MLR), we hypothesized to use this fusokine in proof-of-principle cell transplantation models and shown that GIFT15 can indeed block the rejection of allogeneic and xenogeneic cells in immunocompetent mice. Additionally, we found that ex vivo GIFT15 treatment of mouse splenocytes lead to the generation of regulatory B-cells (Bregs). These Bregs express high levels of MHCII, IL10 and are capable to block antigen (Ag)-presentation in vitro as third party bystander cells. Moreover, a single injection of these GIFT15-generated Bregs in mice with pre-developed experimental autoimmune encephalomyelitis (EAE) leads to long lasting remission of disease. / Along those lines, we also found that mesenchymal stromal cells (MSCs) lead to the paracrine conversion of CCL2 to an antagonist form capable of specifically inhibiting plasma cells and activated Th17 cells. This mechanistic insight informed the design of a second class of suppression fusokine. Namely, the fusing of antagonist CCL2 to GMCSF - aka GMME1. We tested its potential use in autoimmune diseases such as EAE and rheumatoid arthritis (RA). We demonstrated that GMME1 leads to asymmetrical signalling and inhibition of plasma cells as well as Th17 EAE/RA-reactive CD4 T-cells. The net outcome of these pharmacological effects is the selective depletion of CCR2-reactive T-cells as demonstrated both in vitro and in vivo. / Overall, our data support the use of our fusion proteins as part of a powerful and specific immunosuppressive strategy either as directly injectable protein biopharmaceuticals or through the ex vivo generation of autologous Bregs in the case of GIFT15.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.