Orientador: Angélica Zaninelli Schreiber / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T21:59:44Z (GMT). No. of bitstreams: 1 ReichertLima_Franqueline_M.pdf: 2034183 bytes, checksum: 203b846210e23f42a824280eb3cadda2 (MD5) Previous issue date: 2014 / Resumo: O gênero Cryptococcus engloba duas espécies consideradas patogênicas: C.neoformans e C.gattii. Apesar dos avanços na área médica, a criptococose permanece uma das infecções fúngicas sistêmicas mais importantes no Brasil. Anfotericina B (AMB) associada a flucitosina (5FC) é a terapia de indução indicada porém, no Brasil, 5FC não está disponível e o tratamento segue somente com AMB ou em associação com fluconazol (FCL). Este trabalho avaliou a ocorrência de espécies e os genótipos de isolados clínicos de pacientes atendidos no Hospital de Clínicas da UNICAMP em um período de 5 anos; isolados ambientais coletados na cidade de Campinas-SP e o perfil de suscetibilidade aos antifúngicos sozinhos contra isolados clínicos e ambientais e o efeito de combinações de antifúngicos frente a isolados clínicos de Cryptococcus spp.. A identificação de espécies e genótipos foi realizada por testes bioquímicos, Restriction Fragment Length Polymorphism do gene URA5 (URA5-RFLP) e sequenciamento da região Internal Transcribed Spacer (ITS) do DNA ribossomal. Testes de suscetibilidade para AMB, 5FC, FCL, voriconazol (VRC), itraconazol (ITC) e terbinafina (TRB) isolados foram realizados conforme CLSI M27-A3 (2008). Os testes com antifúngicos combinados (AMB+5FC; AMB+FCL; AMB+TRB; FCL+TRB), foram realizados pelo método do "tabuleiro de xadrez" para determinação do Coeficiente de Inibição Fracional (CIF) para avaliar o tipo de interação entre as substâncias (sinergismo, indiferença ou antagonismo). Dentre 75 isolados clínicos reativados, foram identificados 66 C.neoformans e 9 C.gattii. Todos C.gattii pertenceram ao genótipo VGII enquanto que 62 isolados de C.neoformans ao genótipo VNI e apenas 4 ao genótipo VNII. Foram obtidos 92 isolados ambientais de Cryptococcus, pertencentes às espécies C.neoformans (genótipo VNI), C.laurentii, C.albidus, C.flavescens e Cryptococcus spp.. Os valores dos intervalos de CIM para C.neoformans clínicos foram AMB: ? 0,125-1 µg/mL; 5FC: ? 0,125-2 µg/mL; FCL: 0,25-8 µg/mL; VRC: ? 0,015-0,125 µg/mL; ITC: 0,03-0,25 µg/mL e TRB: 0,125-2 µg/mL. Intervalos de CIM para C.gattii variaram de 0,25-1 µg/mL para AMB; 0,5-4 µg/mL para 5FC; 2-16 µg/mL para FCL; 0,06-0,25µg/mL para VRC; 0,06-0,5 µg/mL para ITC e 0,5-4 µg/mL para TRB. Foram observados elevados valores de CIM para os antifúngicos 5FC e FCL frente aos isolados ambientais de C.albidus e C.laurentii. O genótipo VNI de C.neoformans clínico mostrou 75,80% de interação sinérgica para AMB+5FC; 79,03% para AMB+FCL; 77,42% para AMB+TRB e 95,16% para FCL+TRB. O genótipo VNII apresentou 100% de sinergismo em todas as combinações. C.gattii (VGII) apresentou 88,9% de sinergismo nas combinações AMB+5FC e AMB+FCL; 100% para AMB+TRB e FCL+TRB. Não foi observado efeito antagônico nas combinações de antifúngicos. Foi observado bom desempenho nas combinações realizadas, especialmente naquelas envolvendo a TRB para ambas as espécies C.neoformans e C.gattii. O genótipo VNI foi o predominante entre os genótipos que afetam os pacientes com criptococose na região de Campinas. Em infecções de difícil tratamento ou que não respondem aos antifúngicos convencionais, a combinação de diferentes antifúngicos como AMB+TRB ou FCL+TRB podem vir a ser uma alternativa em países onde 5FC não está disponível, como no Brasil. Mais estudos são necessários para avaliar o papel dos genótipos na sensibilidade aos antifúngicos, assim como estudos de combinações de antifúngicos in vitro e in vivo para que novas estratégias possam ser empregadas no tratamento da criptococose / Abstract: Cryptococcus genus comprises two species considered pathogenic: C.neoformans and C.gattii. Despite advances in the medical field, cryptococcosis remains one of the most important systemic fungal infections in Brazil. Amphotericin B (AMB) associated with flucytosine (5FC) induction therapy is indicated but, in Brazil, 5FC is not available and treatment follows only with AMB or in combination with fluconazole (FCL). This study evaluated the prevalence of species and molecular subtypes of clinical isolates from patients treated at the Hospital of UNICAMP in a period of 5 years; environmental isolates collected in Campinas ¿ SP and in vitro antifungal susceptibility profile of antifungal agents alone against clinical and enviromental isolates of Cryptococcus spp. and the effect of combinations of antifungal agents against clinical isolates of Cryptococcus spp.. The species identification and subtyping was performed by biochemical tests, Restriction Fragment Length Polymorphism of URA5 gene (RFLP - URA5) and sequencing of the Internal Transcribed Spacer region (ITS) of ribosomal DNA. Susceptibility tests for AMB, 5FC, FCL, voriconazole (VRC), itraconazole (ITC) and terbinafine (TRB) isolated were performed according to CLSI M27-A3 (2008). Combined antifungals tests (AMB +5FC; AMB+FCL; AMB +TRB, FCL+TRB), were performed by the "Checkerboard" method to determine the Fractional Inhibitory Coefficient index (FIC) to assess the type of interaction between substances (synergism, indifference or antagonism). Among the 75 viable clinical isolates, 66 were identified as C.neoformans and 9 as C.gattii. All C.gattii belonged to subtype VGII while 62 isolates belonged C.neoformans VNI genotype and only 4 VNII. 92 environmental isolates of Cryptococcus were obtained. The species C.neoformans (subtype VNI) C.laurentii, C.albidus, C.flavescens and Cryptococcus spp.were identified. The MIC range values of clinical C.neoformans for AMB were: ? 0.125 -1 µg/mL; 5FC: ? 0.125 to 2 µg/mL; FCL: 0.25-8 µg/mL; VRC: ? 0.015 to 0.125 µg/mL; ITC: 0.03 to 0.25 µg/mL and TRB: 0.125 to 2 µg/mL. MIC for C.gattii ranged from 0.25-1 µg/mL for AMB; 0.5-4 µg/mL for 5FC; 2-16 µg/mL for FCL; 0.06 to 0.25 µg/mL for VRC; 0.06 to 0.5 µg/mL for ITC and 0.5-4 µg/mL for TRB. High MIC values were observed for FCL and 5FC against environmental isolates of C.albidus and C.laurentii. The VNI C.neoformans genotype showed 75.80 % of synergistic interaction for AMB+5FC; 79.03 % for AMB + FCL; 77.42 % for AMB + TRB and 95.16 % for FCL+TRB. The VNII genotype showed 100% synergism in all combinations. C.gattii (VGII) showed 88.9 % of synergism in combinations AMB+5 FC and AMB+FCL; 100 % for AMB+TRB and TRB+FCL. No antagonistic effect was observed in all evaluated antifungal combinations. Good performance was observed in all combinations performed, especially those involving TRB for both C.neoformans and C.gattii species. The VNI was the predominant genotype among genotypes affecting patients with cryptococcosis in Campinas region. In difficult to treat infections or unresponsive to conventional antifungal agents, the combination of different antifungals so as AMB+FCL or TRB+TRB may become an alternative in countries where 5FC is not available, as in Brazil. More studies are needed to evaluate the role of genotypes in sensitivity to antifungal agents, as well as antifungal agents combination studies in vitro and in vivo so that new strategies can be employed in the treatment of cryptococcosis / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Cryptococcus laurentii and Cryptococcus flavescens are nonfermenting yeasts forming extracellular polysaccharide capsule. Both species are mainly saprofytic but Cr. laurentii is also known to be an opportunistic pathogen in immunocompromised patients. Cr. flavescens used to be considered a synonym of Cr. laurentii but nowadays it is classified as a separate species that belongs to the phylogenetic group I of the Cr. laurentii group. In the experimental part 28 strains of species Cr. laurentii, Cr. flavescens a Cr. victoriae were biotyped using MALDI-TOF MS. The yeasts were cultivated on three different media (Sabouraud, YPD and potato agar) and three methods were used for the protein extraction. The impact of growth medium composition from which the strains were inoculated on the quality of spectra was studied together with the suitability of individual methods for use on different media. Then the impact of growth medium composition on the quality of acquired spectra was evaluated. Finally, all strains were compared mutually and with the type strain of Cr. laurentii CCY 17 3-2. The composition of the medium cells were inoculated from was found to have little impact on the spectra quality. The same result was determined for the composition of the actual growth medium cells were cultivated on. Crucial for the quality of mass spectrum is the method of cells preparation. Best results were acquired when cultivating cells on YPD agar, washing the cells with ethanol and using mix of sinapinic and ferulic acid as a matrix. Potato agar was found not suitable for cultivating yeasts of the Cryptococcus genus due to significant production of extracellular polysaccharides which complicate the protein isolation process. All strains were compared to Cr. laurentii type strain CCY 17-3-2 and MSP dendrograms were created based on the spectra similarity. In the MSP dendrograms all strains were successfully divided into relevant species on all tested media. Finally sequences of D1/D2 domain of LSU gene were compared and phylogenetic tree was created. This tree was then compared to the MSP dendrograms.

N/A / Thesis / Master of Science (MS)

Thesis (M.Med. (Internal Medicine))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Background Cryptococcus is a life-threatening opportunistic infection; data is limited regarding early infection. Treatment of cryptococcal antigenaemia may impact on disease progression. Screening those most at risk for cryptococcal antigenaemia is necessary to be cost effective. The prevalence of cryptococcal antigenaemia in patients hospitalised with community acquired pneumonia (CAP) at Chris Hani Baragwanath Academic Hospital (CHBAH) was evaluated. Methods 200 patients admitted to CHBAH with presumed CAP were enrolled. Clinical and laboratory data were collected and a Cryptococcal Lateral Flow Immunoassay was done on whole blood. Results Of the 200 patients, 185 (92.5%) were HIV-infected. Amongst the HIV-infected group, the median CD4 cell count was 47 cells/mm3 and 111 subjects (60%) had a CD4 cell count < 100 cells/mm3. The prevalence of cryptococcal antigenaemia was 0.5% (CI 0.01-2.75). Conclusion The prevalence of cryptococcal antigenaemia amongst inpatients with CAP was low. Routine screening of this group would not be cost-effective.

Interações patógeno-hospedeiro geram alterações em diversos mecanismos, tanto no hospedeiro quanto no patógeno. Neste contexto, nas células do sistema imune do hospedeiro ocorre modulação para impedir o desenvolvimento de patógenos, culminado em sua eliminação, como no caso de infecções por Cryptococcus neoformans. Macrófagos alveolares constituem o primeiro tipo celular a responder à levedura, a qual, após a fagocitose, é capaz de se proliferar e disseminar no hospedeiro. Como mecanismo de defesa, células hospedeiras podem reduzir a concentração de micronutrientes essenciais para o patógeno, mecanismo conhecido por imunidade nutricional. Zinco (Zn) é o segundo metal de transição mais abundante e um micronutriente essencial para todos os organismos e, com isto, macrófagos podem responder a patógenos com redução dos níveis de Zn para auxiliar na eliminação de patógenos. A fim de avaliar se macrófagos respondem com privação de Zn a a fungos, a alteração na homeostase de Zn em macrófagos infectados por C. neoformans foi avaliada bem como a influência da ativação celular nesta resposta. Demonstramos que macrófagos respondem com privação de Zn à infecção por C. neoformans uma vez que ocorreu (i) diminuição nos níveis intracelulares de Zn livre em macrófagos infectados com a levedura viável, (ii) redução na expressão de importadores do metal, (iii) redução nos níveis de Zn livre em leveduras após exposição a macrófagos, (iv) aumento na proliferação no interior de macrófagos e diminuição da taxa de exocitose de C. neoformans em condições de disponibilidade de Zn. Tal modulação de Zn na resposta a C. neoformans foi exercida por alguns transportadores de Zn que respondem significativamente a condições de privação de Zn, principalmente os da família ZnT, e a privação de Zn como mecanismo de imunidade nutricional foi evidente em macrófagos ativados com IFN- e LPS. Macrófagos ativados com PMA não mostraram redução nos níveis intracelulares de Zn em reposta a C. neoformans ou modulação significativa nos níveis de transcritos de transportadores de Zn, como ZIP2 e ZnT7, em comparação a macrófagos ativados com IFN- e LPS. Além disso, de forma geral, macrófagos ativados continham maiores níveis intracelulares de Zn livre em comparação a macrófagos não ativados, sugerindo modulação do processo de ativação na homeostase de Zn em macrófagos J774.A1. / Host-pathogen interactions cause alterations on several mechanisms in both host and pathogen. In this context, host immune system cells are modulated to prevent pathogens growth, aiding in their elimination, as it occurs during Cryptococcus neoformans infections. Alveolar macrophages are the first cell type to respond to yeast infection. Once phagocytosed, cryptococcal cells are capable to proliferate and disseminate in the host. As a defense mechanism, host cells can reduce essential micronutrients concentration to the pathogen, a mechanism known as nutritional immunity. Zinc (Zn) is the second most abundant transition metal and an essential micronutrient for all organisms and thus, macrophages may respond to pathogens with reduced levels of Zn to aid pathogens elimination. In order to evaluate whether macrophages respond with Zn deprivation to fungi, alterations on Zn homeostasis in C. neoformans-infected macrophages was evaluated as well as the influence of cellular activation in this response. We demonstrate that macrophages respond with Zn deprivation to C. neoformans infection, as we could observe (i) a reduction of free intracellular Zn levels in macrophages infected with viable yeast, (ii) a reduced expression of Zn importers, (iii) a decreased free Zn concentration in yeasts exposed to macrophages, (iv) increased yeast proliferation within macrophages and decreased yeast exocytosis under Zn rich conditions. This Zn modulation in response to C. neoformans was exerted by some Zn transporters which respond significantly to Zn deprivation conditions, especially those of the ZnT family, and Zn deprivation as a nutritional immunity mechanism was evident in IFN- and LPS-activated macrophages. PMA-activated macrophages showed no reduction in intracellular Zn levels in response to C. neoformans or a significant modulation in Zn transporters transcript levels, such as ZIP2 and ZnT7, in comparision to IFN-- LPS-activated macrophages. In addition, in general, activated macrophages contained increased free intracellular Zn levels in comparision to non-activated macrophages, suggesting activation process modulation on Zn homeostasis in J774.A1 macrophages.

A imunidade nutricional é um importante mecanismo de defesa do hospedeiro. A mesma é caracterizada pela privação de nutrientes durante interação patógeno e hospedeiro, mostrando-se essencial tanto para eliminar quanto para conter a disseminação de micro-organismos patogênicos. Dentre os nutrientes sequestrados pelo hospedeiro, está o metal zinco, é um micronutriente essencial para o metabolismo de todos os seres vivos. Em contrapartida, micro-organismos patogênicos desenvolveram mecanismos para capturar esse metal. O nosso modelo de estudo, a levedura encapsulada Cryptococcus gattii, é um dos principais agentes causadores da criptococose. A doença inicia pela inalação de propágulos fúngicos, os quais irão depositar-se no interior dos alvéolos pulmonares onde irão encontrar células fagocíticas, representando a primeira linha de defesa do hospedeiro e onde possivelmente seja empregada a imunidade nutricional para conter a disseminação desta levedura. No presente trabalho, objetivamos avaliar o papel da biodisponibilidade de zinco na virulência de C. gattii. No primeiro capítulo, descrevemos a caracterização da função de dois transportadores de zinco da família ZIP em C. gattii. O transportador de zinco Zip1 é o principal envolvido na captação de zinco, já que linhagens mutantes para o seu gene codificador, assim como a linhagem duplo mutante zip1Δzip2Δ, apresentaram baixo nível de zinco intracelular, crescimento reduzido quando na condição de privação de zinco e altos níveis de espécies reativas de oxigênio (EROs) quando cultivados na condição de privação do metal. Tais características não foram observadas na linhagem zip2Δ. Ensaios de virulência demonstraram que zip1Δ e zip1Δzip2Δ são mais susceptíveis à fagocitose por macrófagos, ao passo que ensaios de infecção em modelo murino demonstraram que apenas a linhagem duplo mutante possui virulência atenuada. Tais dados evidenciam que a homeostase de zinco, mais especificamente o transporte, é essencial para a patogenicidade de C. gattii. No segundo capítulo do presente trabalho, abordamos homeostase de zinco durante a interação C. gattii com macrófagos. Por meio de analises de microscopia, demonstramos que leveduras contidas em fagossomos apresentam eventos de aumento transitório na concentração de zinco, o que parece estar diretamente envolvido com a permeabilização dos fagossomos. Adicionalmente, determinamos que macrófagos infectados com C. gattii apresentam uma compartimentalização de zinco, provavelmente no complexo de Golgi, dessa maneira reduzindo a disponibilidade do metal em fagossomos infectados. Concluindo, o presente trabalho demonstrou que o metal zinco é essencial para a patogenicidade de C. gattii, e que transportadores do metal estão diretamente envolvidos com a virulência deste patógeno. Além disto, levantamos importantes dados quanto à imunidade nutricional de macrófagos contra C. gattii, sugerindo que um processo de privação de zinco é realizado por parte do macrófago. / Nutritional immunity is an important defence mechanism used by host. It is characterised by nutrients deprivation during host-pathogen interaction and has important role in growth hampering and microbe killing. Among the nutrients sequestered by host is the metal zinc, which plays essential role in cell metabolism of all living organisms. However, microorganisms developed diverse mechanisms for zinc acquisition. Our model of study is the intracellular fungal pathogen Cryptococcus gattii, one of the main agents of cryptococcal disease. The disease starts with inhalation of fungal propagules, which will deposit inside the lug alveoli and being in contact with phagocytes, representing the first line of host defence. In such host cells, nutritional immunity occur in order to hamper cryptococcal growth. In the present work, we sought to determine the role of zinc availability on the C. gattii virulence. In the first chapter, we describe the functional characterization of two of zinc transporters in C. gattii of the ZIP family. Zip1 transporter is the pivotal zinc transporter in C. gattii, as mutant strains zip1Δ and double mutant strain zip1Δ zip2Δ had lower intracellular content, reduced growth under zinc limitation and higher reactive oxygen species than wild type strain. Such characteristics were not observed in zip2Δ strain. Virulence tests demonstrated that zip1Δ and zip1Δzip2Δ are more susceptible to macrophage phagocytosis, and murine infection assay showed that only double knockout strain had alterations in virulence. Such data lead us to conclude that zinc, acquired by zinc transporters, is essential for C. gattii pathogenicity. In the second chapter, we demonstrated important data about zinc homeostasis during C. gattii and macrophage interaction. Microscopy analysis demonstrated that internalised yeasts cells have events of temporary increase on zinc concentration. These events are directly associated with phagosomal permeabilisation. Moreover, C. gattii infected macrophages have a zinc content compartmentalisation, most probably in the Golgi apparatus. Thus, we conclude that zinc is essential for C. gattii virulence and zinc transporters play an important role on its pathogenicity. In addition, we described important data about zinc nutritional immunity during macrophage and C. gattii interaction.

Mycoses refer to infections caused by different fungal infections. Some mycoses can be defeated by the hosts themselves attributed to the functional immune systems before severe symptoms appear. However, in immune-compromised patients, including those suffering from AIDS or receiving chemotherapies, those mycoses become lethal. They are called opportunistic systemic mycoses. Among them, two types of the most deadly mycoses, especially for AIDS patients in Southeast Asia, are cryptococcsis and penicillosis, caused by Cryptococcus neoformans (C. neoformans) and Penicillium marneffei (P. marneffei), respectively. Both of them have their own virulence factors to enhance their pathogenicities and survival in hosts. Active research to explore these virulence factors in these two funguses is ongoing. Two proteins from these two pathogens were found to be putative novel virulence factors, MP1p from P. marneffei, and CPL1 from C. neoformans. Collaborators have successfully found that MP1p strongly bound arachidonic acids (AA), the sole precursor of paracrine signaling molecules essential to the onset of inflammatory responses, by various functional studies. This led to the hypothesis that MP1p might be able to suppress inflammatory responses and subsequent immune responses via removal of AA from macrophages engulfed P. marneffei. In this work, X-ray crystal structures of MP1p’s ligand-binding domain 2 (LBD2) from P. marneffei (strain MP1) overexpressed in E. coli, in complex with one and two AA molecules, were successfully solved by molecular replacement method. The resolutions were up to 1.45 Å and 1.50 Å respectively. These structures revealed detailed interactions between MP1p-LBD2 and AA.A possible ligands-dependent dimer-monomer transition in LBD2 was also revealed by both analytical size exclusion chromatography and crystallography. Full length CPL1 overexpressed in yeast was also successfully purified and crystallized. A 3.0 Å native dataset was collected. Heavy atoms derivatives of the crystals would be produced in order to solve the structure via experimental phasing methods. The structural determination of these virulence factors may provide molecular bases at atomic resolution for the developments of drugs targeting MP1p and CPL1 by structure-based drug design to treat, particularly, penicillosis and cryptococcsis in immune-compromised patients. / published_or_final_version / Physiology / Master / Master of Philosophy

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Thesis (MSc (Paravet. Studies))--University of Pretoria, 2007. / Includes bibliographical references. Also available as hard copy.