Orientador: Edgard Graner / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-07-27T09:39:40Z (GMT). No. of bitstreams: 1 Silva_HannahCarmemCarlosRibeiro_D.pdf: 2966581 bytes, checksum: 18a22acf8512cc1abc03572e8071674e (MD5) Previous issue date: 2000 / Resumo: A Ciclosporina A (CSA) é uma droga imunossupressora, que atua de forma específica e reversível, principalmente em linfócitos T CD4. O objetivo deste trabalho foi verificar o efeito da CSA sobre a produção e atividade de metaloproteinases de matriz (MMPs) associadas ao processo de reparação alveolar de molares de ratos Wistar, através de análise zimográfica. Foram utilizados 30 ratos tratados diariamente com CSA na concentração de 10 mg/kg de peso corporal por via subcutânea, com o início do tratamento ocorrendo 7 dias antes das exodontias e permanecendo após as cirurgias por períodos de 1 a 10 dias, quando os grupos foram sacrificados. Como grupo controle foram utilizados 30 ratos aplicados com solução salina a 0,9%. Verificou-se a presença de enzimas gelatinolíticas com comportamento, frente a ação de inibidores específicos e massa molecular semelhantes às das enzimas pertencentes ao grupo das MMPs. A análise nos diversos períodos de reparação alveolar demonstrou que este processo é acompanhado por secreção e atividade gelatinolítica, principalmente de MMP-9 e MMP-2. A produção e atividade gelatinolítica total e das MMP-9 e MMP-2 dos meios de cultura condicionados com o tecido de granulação dos alvéolos dos ratos foi menor nos animais tratados com CSA do que no grupo controle. Estes resultados indicam que a CSA reduz a produção e atividade de enzimas pertencentes ao grupo das MMPs, que participam no processo de reparo alveolar / Abstract: Cyclosporin A (CSA) is a potent immunosuppressive agent which acts in a specific and reversible way, mainly in T CD4 Iymphocytes. The aim of this study was to investigate the production and activity of matrix metalloproteinases (MMPs) through zymography during alveolar wound healing of inferior molars of Wistar's rats treated with CSA. Thirty Wistar rats where daily injected subcutaneously with 10 mg/kg/body weight of CSA starting seven days before the extraction and continuing from 1 to 10 days after surgery. The same numbers of rats were injected with the same volume of saline solution as a control group. Specific inhibitors were used to identify MMPs enzymes group. The data obtained from different healing periods, showed secretion and gelatinolytic activity, mainly by MMP-9 and MMP-2. The total gelatinolytic activity of MMP-9 and MMP-2 of the cell culture medium incubated with granulation tissue from the healing area, were lower in the CSA group than in the control group. The results showed that CSA use reduced the MMPs enzyme activity, which may have an important role in the alveolar wound healing process / Doutorado / Doutor em Biologia e Patologia Buco-Dental

O uso de ciclosporina A (CsA) tem sido associado com aumento na reabsorção óssea como efeito adverso. Porém, há controvérsia sobre quais mecanismos são responsáveis por esta associação. Objetivo: Este estudo investigou o efeito da exposição prévia a CsA sobre a expressão de RANK e perda óssea na periodontite experimental em ratos. Método: Quarenta ratos Wistar, com aproximadamente três semanas de idade, foram divididos em quatro grupos com dez animais cada: Grupo Controle (GC); Grupo CsA (GCsA), Grupo Ligadura (GL) e Grupo Ligadura e CsA (GCsAL). GCsA e GCsAL receberam doses diárias de CsA (10mg / kg) durante sessenta dias desde o início do experimento. Em GL e GCsAL, a ligadura foi colocada em torno do segundo molar superior direito, trinta dias após o início do experimento. Após sessenta dias os animais foram eutanasiados por perfusão cardíaca e as maxilas foram removidas e processadas para análise imunohistoquímica e histomorfométrica da remodelação óssea através da expressão da marcação do RANK (escore) e perda óssea mensurada da junção cemento-esmalte à crista óssea (μm). Os dados foram analisados por Kruskal-Wallis ao nível de 5% de significância. Resultados: Os resultados da marcação de RANK não apresentaram diferença estatística significativa entre os grupos (p=0,122). Em relação à perda óssea, não foi observada influência significativa quanto à aplicação da CsA. GL (735,88 121,82) apresentou perda óssea significativamente superior (p=0,01) a GC (569,13 89,76) e, GCsAL (759,38 198,23) superior (0,001) a GCsA (410,90 105,95). Conclusão: Os resultados sugerem que a exposição prévia a CsA não influenciou a expressão de RANK ou a perda óssea na periodontite experimental em ratos. / The use of cyclosporin A (CsA) has been associated with increased bone resorption as adverse effect. However the mechanisms responsible for this association remains controversy. Aim: The study investigated the effect of prior exposure to CsA on expression of RANK and bone loss in experimental periodontitis in rats. Methods: Forty Wistar rats were divided into four groups with ten animals each: Control Group (CG) CsA group (GCsA), Group Ligation (GL) and Group ligated and CsA (GCsAL). GCsA and GCsAL received daily doses of CsA (10mg / kg) for sixty days from in the beginning of the experiment. In GL and GCsAL, ligature was placed around the upper right second molar, thirty days after in the beginning of the experiment. After sixty days the animals were euthanized by cardiac perfusion and the jaws were removed and processed for immunohistochemistry and histomorphometric analysis of bone remodeling through the expression of RANK marking (score) and bone loss measured from the cemento-enamel junction to bone crest (mm). Data were analyzed by Kruskal-Wallis test at 5% significance level. Results: The results of the marking of RANK showed no statistically significant difference between groups (p = 0.122). In relation to bone loss, there was no significant influence on the application of CsA. GL (735.88 121.82) had significantly higher bone loss (p = 0.01) GC (569.13 89.76) and GCsAL (759.38 198.23) higher (0.001) GCsA (410.90 105.95). Conclusions: The results suggest that prior exposure to CsA did not influence the expression of RANK in bone loss or periodontitis in rats.

The one-way mixed lymphocyte culture (MLC) is used to assess histocompatibility between donor and recipient. First introduced in 1966, this method involves the co-culture of lymphocytes from the peripheral blood of the donor and the recipient for a period of 6 to 7 days: antigen disparities, primarily in the HLA-DR region, stimulate proliferation of the responding cells, which is detected by addition of 3H-labelled thymidine and subsequent measurement of radioactivity. The lymphocytes of either the donor, used to predict graft-versus-host disease (GVHD) or recipient, used to predict host-versus-graft disease (HVGD)/graft rejection, are inactivated by exposure to radiation or mitomycin C, so that the observed proliferation is that of the other set of lymphocytes, hence the name “one-way” MLC. The amount of measured radioactivity is directly proportional to the amount of DNA synthesized, which is a reflection of the number of disparities at the major histocompatibility complex (MHC).Previous studies have established that inactivation of the lymphocytes by radiation and mitomycin C, has a negative effect on the structure/expression of HLA-DR molecules on the cell surface, which provides the primary stimulus for the MLC reaction. The laboratory research presented in this dissertation was designed i) to compare the viabilities and HLA-DR levels on stimulator cells exposed to cyclosporin A, mitomycin C and ionizing irradiation , in order to determine whether cyclosporin A can be used as an alternative to mitomycin C or radiation as inactivator of the stimulator cells in the one-way MLC; ii) to improve sensitivity and accelerate the MLC reaction by addition of IL-2; iii) establish a flow cytometric mixed lymphocyte assay using the fluorochrome 5,6 carboxyfluorescein diacetate succinimidyl ester (CFSE). Cyclosporin A showed striking similarities to mitomycin C and ionizing radiation in its effect on viability and reduction/structural changes in HLA-DR molecules of the stimulator cells. Exposure of the stimulator cells to 20ìM cyclosporin A, demonstrated a significant loss of both cell viability and HLA-DR molecule cell surface expression. Thus, in evaluating these three methods of inactivation of the stimulator cells in the one-way MLC, it was concluded that a one-way MLC may not in fact be an accurate and qualitative reflection of the histocompatibility between donor and recipient. Instead the two-way MLC , in which neither the donor’s nor recipient’s cells are inactivated, may be a more reliable alternative. The only limitation associated with a two-way MLC is the inability to distinguish between a host-versus-graft-rejection and a graft-versus-host reaction in the observed allogeneic response Addition of 5 and 10 IU/ml IL-2 to the MLC showed the opposite effect to that intended, inhibiting proliferation in the MLC. Previous studies have shown that an excess of IL-2 results in the production of suppressor T cells. The amount of IL-2 produced during the MLC depends on the number of disparities in the MLC between donor and recipient, which will be different for each MLC reaction. Since the number of allogeneic T cells involved in the MLC reaction is not known, the amount of IL-2 produced during the allogeneic immune response in the MLC can not be predicted and addition of exogenous IL-2 may result in production of suppressor T cells and an inhibition of proliferation. The two-way MLC was modified by staining one of the participating set of lymphocytes (donors or recipients) with CFSE and tracking proliferation in this population, using flow cytometry. The two-way CFSE-based MLC analyzed in this study were counterstained with CD25 (IL-2R). An increase in CD25 expression on the cell surface is an indicator of cell activation and proliferation. Proliferation, as indicated by a progressive loss of CFSE fluorescence correlated well with the corresponding increase in CD25 expression and accumulated daughter cells. In addition, by loading only one of the participating donors in the two-way MLC, the responder/stimulator interaction, observed in the one-way MLC, is re-established. Thus the modified, CFSE-based two-way MLC can be used to predict GVHD. To conclude, the use of CFSE labeling and flow-cytometry to measure proliferation in a two-way MLC, together with CD25 counterstaining provides an alternative, reliable and probably superior method to 3H thymidine uptake. / Dissertation (MSc)--University of Pretoria, 2009. / Immunology / unrestricted

No description available.

Der Haarfollikel ist zugleich Quelle und Wirkort verschiedener Zytokine und Neurotrophine. Zytokine können die Expression von Neurotrophinen und ihrer Rezeptoren in verschiedenen extrakutanen Geweben modifizieren. Daher wurde untersucht, ob Zytokine diese Wirkung auch am Haarfollikel entfalten können. Mittels Immunfluoreszenz wurden Kryostatschnitte von Rückenhaut der C57BL/6-Maus dahingehend untersucht, ob die intradermale Injektion von proinflammatorischen Zytokinen (IL-1 beta, TNF-alpha, IFN-gamma), topische Gabe von Dexamethason oder die intraperitoneale Behandlung mit Cyclosporin A (CsA) die intra- und extrafollikuläre Immunreaktivität von NGF, BDNF, NT-4, NT-3 oder ihrer hochaffinen Rezeptoren Trk-A (NGF), Trk-B (BDNF, NT-4), Trk-C (NT-3) oder des niedrigaffinen Rezeptors p75NTR verändert. Alle Haarfollikel befanden sich im Wachstumsstadium des Haarzyklus (Anagen VI). Alle drei untersuchten Zytokine sowie ein Cocktail von IL-1 beta, TNF-alpha und IFN-gamma regulierten die NGF-Immunreaktivität (IR) in der proximalen äußeren Wurzelscheide (ÄWS) und in der Haarmatrix (HM) von Anagen-VI-Haarfollikeln hoch. Der Zytokincocktail regulierte ebenfalls sehr deutlich die NT-3- und NT-4-IR in der murinen Epidermis hoch. Zusätzlich erhöhte dieser Cocktail die NT-4-IR in spezifischen Zellpopulationen von HM und proximaler ÄWS sowie die p75 NTR-Expression in der dermalen Papille. Interessanterweise erhöhte die Behandlung mit CsA in gleicher Weise wie die einzelnen Zytokine und der Zytokincocktail die NGF-IR in HM und proximaler ÄWS. Dexamethason bewirkte in dieser Arbeit keine Veränderungen der Expression von Neurotrophinen bzw. ihrer Rezeptoren. Somit konnte gezeigt werden, daß sowohl bestimmte proinflammatorische Zytokine als auch CsA die intra- und extrafollikuläre Expression von Neurotrophinen und ihrer Rezeptoren verändern. / The hair follicle is both, source and target of various cytokines and neurotrophins (NTs), and various cytokines are recognized to alter expression of NTs and their receptors. Therefore I examined, whether cytokines can alter the expression of NTs also in the hair follicle. By means of immunofluorescence, it was investigated on cryostat sections of murine back skin (C57BL/6- mice), whether and how the intradermal injection of proinflammatory cytokines (IL-1 beta, TNF-apha, IFN-gamma, topical dexamethasone or cyclosporin A (CsA) treatment i.g. alter the intra- and extrafollicular immunoreactivity (IR) of NGF, BDNF, NT-4, NT-3 or that of the corresponding high affinity receptors Trk-A (NGF), Trk-B (BDNF, NT-4), Trk-C (NT-3) or their common low affinity receptor p75NTR. All hair follicles were in the growth stage of the hair cycle (Anagen VI). All these cytokines as well as a cocktail of IFN-gamma, IL-1 beta and TNF-alpha increased the NGF-IR in the proximal outer root sheath (ORS) and in the hair matrix (HM) of Anagen VI hair follicles. The cytokine cocktail upregulated NT-3 and NT-4-IR in murine epidermis, increased NT-4-IR in selected cell populations of the HM and the proximal ORS. It enhanced also the p75NTR expression in the dermal papilla. Surprisingly, intraperitoneal treatment with CsA also increased the NGF-IR in HM and ORS, while dexamethasone showed no effect. This demonstrates that selected proinflammatory cytokines and CsA alter the cutaneous intra- and extrafollicular expression of NTs and their receptors.

Einleitung Der Einsatz von Stammzellen als Grundlage neuer therapeutischer Strategien wird bereits seit über 25 Jahren intensiv erforscht. Stammzellen sind in der Lage, in verschiedene funktionale Zelltypen auszudifferenzieren und verfügen über ein enormes Proliferationspotential (NAM et al. 2015). Ausgehend von den Fähigkeiten von Stammzellen sehen Forscher und Kliniker erstmals eine realistische Möglichkeit, kurative Therapieoptionen für Erkrankungen zu entwickeln, die bisher als schwer behandelbar oder sogar unheilbar angesehen wurden. Davon könnten insbesondere Patienten chronisch-degenerativer neurologischer und zerebrovaskulärer Erkrankungen, einschließlich der großen Anzahl an Schlaganfallopfern, profitieren. Schlaganfälle repräsentieren eine der häufigsten Todesursachen in der westlichen Welt (LOPEZ et al. 2006). Ein Drittel der betroffenen Patienten verstirbt innerhalb eines Jahres, während etwa 40% von dauerhaften Behinderungen betroffen sind (MOZAFFARIAN et al. 2015). Trotz intensiver Forschung existieren neben der systemischen Thrombolyse, die auf einen engen Zeitraum von maximal 4,5 Stunden nach dem Akutereignis beschränkt ist, keine zugelassenen Therapieoptionen (HACKE et al. 2008, SAVER et al. 2009). Zelltherapeutische Strategien zur Behandlung des Schlaganfalls werden daher als besonders vielversprechend angesehen (ANDRES et al. 2011). Neben den bereits gesicherten Erkenntnissen zur stammzelltherapeutischen Sicherheit und Wirksamkeit aus Studien unter Einsatz gängiger Nagermodellen (BLISS et al. 2006, JOO et al. 2013) wird insbesondere die Überprüfung der Wirksamkeit an geeigneten Großtiermodellen gefordert, die die Situation des menschlichen Schlaganfallpatienten möglichst realistisch wiedergeben sollen (SAVITZ et al. 2011). Eine Voraussetzung für die erfolgreiche Testung eines zelltherapeutischen Ansatzes in einem Großtiermodell mit fokaler zerebraler Ischämie besteht darin, ein langfristiges Überleben xenogener Zelltransplantate durch ein geeignetes Immunsuppressionsprotokoll zu erreichen. Die Notwendigkeit einer Immunsuppression besteht darin, dass sowohl allo- als auch xenogene Transplantate eine Immunantwort beim Empfänger auslösen und somit zu einer Abstoßungsreaktion führen können (JANEWAY 2002). Die Anwendung von immunsuppressiven Medikamenten geht dabei aber häufig mit Nebenwirkungen einher. Insbesondere beim Schaf existiert jedoch nur eine limitierte Datenlage zu immunsuppressiven Protokollen und deren Nebenwirkungen. Ziele der Untersuchung Das Ziel der vorliegenden Studie bestand darin, eine xenogene Transplantation von fetalen humanen neuralen Progenitorzellen (fhNPZ) in einem gesunden Schafsmodell durchzuführen, um die Wirksamkeit in Hinblick auf das Transplantatüberleben und die Nebenwirkungen einer Immunsuppression mittels Cyclosporin A (CsA) zu untersuchen. Materialien und Methoden Hierfür wurden je 5 Schafe in zwei Gruppen über einen Zeitraum von 64 Tagen immunsupprimiert (iCsA: 3 mg CsA/kg 2x tägl. bis einschließlich Tag 36, danach 3 mg CsA/kg 1x tägl. jeden 3. Tag; kCsA: kontinuierlich 3 mg CsA/kg 2x tägl.), während eine Kontrollgruppe (Kon) von ebenfalls 5 Tieren keine Immunsuppression erhielt. Am Versuchstag 22 wurde den Schafen eisenmarkierte fhNPZ (Eisenkonzentration: 3,0 mM, ca. 200.000 Zellen pro Transplantationsposition) stereotaktisch in das gesunde Gehirn transplantiert. Aufgrund der Eisenmarkierung der Stammzellen konnten diese an den Versuchstagen 23, 36 und 64 mittels 3,0 MRT-Aufnahmen in vivo überwacht und anschließend ex vivo das Überleben der fhNPZ im Schafhirn 42 Tage nach Transplantation histologisch untersucht werden. Für die Untersuchungen zu Wirkspiegeln und Nebenwirkungen von CsA im Schaf wurden den Versuchstieren innerhalb des Versuchszeitraums regelmäßig Blutproben entnommen und am Versuchsende eine pathologische und histologische Untersuchung von Leber und Nieren durchgeführt. Ergebnisse Bei den durchgeführten Untersuchungen konnte festgestellt werden, dass die CsA-Wirkspiegel im Blut bei der kCsA (424,0 ± 135,0 ng/ml) signifikant höher waren im Vergleich zur iCsA (198,5 ± 155,9 ng/ml). Diese Unterschiede besaßen jedoch keinen Einfluss auf das Langzeitüberleben der transplantierten fhNPZ. In keiner der drei Versuchsgruppen konnten vitale Zellen 42 Tage nach der Transplantation aufgefunden werden. Die Untersuchung der Nebenwirkungen von CsA ergab, dass die Langzeitgabe von CsA Anzeichen für einen hämatologischen Einfluss zeigt. Ebenso konnte sowohl eine hepatotoxische, als auch eine nephrotoxische Wirkung von CsA beim Schaf nachgewiesen werden. Schlussfolgerungen Schlussfolgernd kann zusammengefasst werden, dass die Gabe von 3 mg CsA/kg 2x tägl. nicht suffizient einer Abstoßungsreaktion xenogener ins Schafhirn transplantierter fhNPZ entgegenwirkt. Für das Ziel einer suffizienten zelltherapeutischen Anwendung im Schaf nach einem Schlaganfall sind somit weitere Untersuchungen zu einer wirksamen Immunsuppression beim Schaf und zu einem verbesserten Transplantatüberleben notwendig. Desweiteren konnten klinische und pathologische Nebenwirkungen beim Schaf durch die Langzeitgabe des Immunsuppressivums CsA festgestellt werden.

A Ciclosporina A (CsA) faz parte de um grupo de oligopeptidios cíclicos e hidrofóbicos, produzida naturalmente por fungos. Este composto além de ser um potente imunossupressor pode também apresentar uma série de outros efeitos fisiológicos como atividade antiinflamatória e antialérgica, ou mesmo efeitos anti fúngicos e antiparasitários. Partimos de uma genoteca genômica de L. (L.) major cepa Friedlin A1 (LmFA1) construída no cosmídio cLHYG, que teve o seu DNA transfectado em promastigotas para em seguida as células serem submetidas aos experimentos de superexpressão gênica em presença de concentrações crescentes de CsA. Foram selecionados dois loci capazes de conferir resistência a CsA. Um desses loci (contendo cerca de 30 - 40 kb) foi mapeado e caracterizado após análises do perfil de digestão com diferentes enzimas de restrição, e da transfecção de algumas deleções em células LmFA1, que após amplificação gênica, foram submetidas a testes funcionais em presença de CsA. Apesar de valores baixos dos índices de resistência obtidos com os testes funcionais, foi possível identificar nesse locus um gene que após seqüenciamento parcial de nucleotídeos e análises comparativas no banco genômico de leishmânia, revelou a presença de uma fase aberta de leitura contendo 1 844 aminoácidos que codifica para uma proteína de membrana pertencente a família das transportadoras ABC e que parece estar relacionada com a resistência a CsA. Essa proteína, denominada LmABC-CR1, possui alta identidade com uma transportadora ABC de L. (L.) tropica (95,5%), e baixa identidade (27,2%) com uma outra transportadora ABC de LmFA1 isolada por nosso grupo e relacionada com a resistência a Pentamidiana (PRP1). A análise molecular dos DNAs das espécies, L. (L.) amazonensis, L. (V.) braziliensis, L. (L.), chagasi e L. (L.) major demonstrou um relativo polimorfismo do gene LmABC-CR1 nestas espécies. O papel dessa nova proteína na resistência a CsA frente a diferentes espécies de leishmânia deverá ser melhor estudado / Cyclosporin A (CsA) is a cyclic hydrophobic oligopeptide naturally produced by fungus. Besides this drug is usually known as a potent immunosupressor, it also presents a couple of other physiologic activities as anti-inflammatory, anti-allergic, or even acting as fungicidal and anti-parasitic. Starting from an L. (L.) major Friedlin A1 (LmFA1) genomic library constructed into the cLHYG shuttle vector, DNA was transfected on promastigotes, and cells submitted to over expression in the presence of increasing concentrations of CsA. Two loci were selected capable to render cells CsA resistance after transfection.One of those loci (containing about 30 - 40 kb) was mapped after analyses of the restriction enzymes pattern, and characterized by transfection of its deletions in LmFA1 cells, which after gene amplification, were submitted to functional tests in the presence of CsA. In spite of low of resistance indexes values after functional tests, it was possible to identify a gene that after partial nucleotides sequencing and comparison with leishmania genomic bank data indicated the presence of an open reading containing 1 844 amino acids codifying a membrane protein from the ABC transporter family that seems to be related with CsA resistance (LmABC-CR1). LmABC-CR1 presents high identity (95,5%) with a L. (L.) tropica ABC transporter protein, and low identity (27,2%) with another LmFA1 ABC transporter (PRP1) isolated by us, and related with Pentamidine resistance. Southern blot analysis with L. (L.) amazonensis, L. (V.) braziliensis, L. (L.), chagasi and L. (L.) major genomic DNA shown a relative polymorphism of LmABC-CR1 gene in this species. The role of this new protein on the CsA resistance in leishmania species should be further studied

Níveis sangüíneos de ciclosporina A (CSA) que minimizam a rejeição celular aguda (RCA) no transplante renal com o menor efeito tóxico vêm sendo o alvo de recentes pesquisas. A escolha de terapia imunossupressora com várias drogas permite o uso de doses mais baixas e com menores efeitos colaterais. Níveis de CSA necessários para evitar RCA podem variar com diferentes esquemas terapêuticos. Este estudo prospectivo realizado em um único centro avaliou a eficácia e segurança de dois diferentes níveis sangüíneos de CSA através da área sob a curva de doze horas (AUC 0-12). Cinqüenta e oito receptores de transplante renal foram randomizados para dois grupos, 25 para o grupo AUC0-12 alta (9000-11000 ng.h/mL) e 33 para o grupo AUC0-12 baixa (5000-7000 ng.h/mL). Após a introdução da CSA, a AUC foi avaliada nos dias 4, 7, 14, 21, 28, 42, 56, 70, 84 e 90. Os grupos foram comparáveis em idade, sexo, cor, tipo de doador, uso de indução e outras drogas imunossupressoras. Não houve diferença estatística na incidência de RCA. Foi realizada análise dos pacientes que apresentaram RCA em comparação com os pacientes livres de RCA. A análise de regressão logística mostrou que é necessária uma AUC 0-12 >- 9500 ng.h/mL com especificidade de 84% e sensibilidade de 76%, AUC 0-4 4000 ng.h/mL com especificidade de 91% e sensibilidade de 84% e C2 (concentração sangüínea na segunda hora pós- 6 dose) com especificidade de 92% e sensibilidade de 84% >- 1450 ng/ml, para predizer ausência de RCA. Quando utilizada terapia de indução, níveis mais baixos de AUC0-12, AUC0-4 e C2 (8160 3636 ng.h/ml, 3146 +- 262 ng.h/ml, 1043 +- 151 ng/mL, respectivamente) foram necessários para evitar RCA, em relação aos pacientes que não rejeitaram e não receberam indução (11072 +- 3809 ng.h/ml, 5403 +- 1782 ng.h/ml e 1816 +- 151ng/mL, respectivamente). Esses dados confirmam a necessidade de altos níves de CSA, na ausencia de indução para prevenção de RCA nos três primeiros meses pós-transplante renal e, o emprego de indução permite que níveis sangüíneos mais baixos de CSA sejam empregados com o intuito de prevenir RCA nos primeiros 90 dias após transplante renal / Multiple-drug therapy allows the use of lower doses with fewer side effects. Cyclosporin A (CSA) levels necessary to avoid rejection may vary with different drug combinations. To address this issue, fifty-eight kidney transplant recipients were randomized into two groups: 25 patients to the twelve-hour area under the curve (AUC0-12) high arm (9000-11000 ng.h/mL) and 33 to the AUC0-12 low arm (5000-7000 ng.h/mL). After CSA introduction, AUC0-12 was measured at days 4, 7, 14, 21, 28, 42, 56, 70, 84, and 90. The two groups were comparable regarding age, gender, race, donor type, induction therapy and other immunosuppressive drugs. There was no significant difference in the rate of acute cellular rejection episodes between the two groups. A retrospective analysis was carried out comparing rejectors to non-rejectors, related to induction therapy status. Logistic regression analysis revealed that an AUC0-12 >- 9000 ng.h/mL or AUC0-4 >-4000ng.h/mL or two-hour post-dose cyclosporin level (C2) of >- 1450 ng/mL predicted a rejection-free course. Lower levels of C2 and AUC 0-4 (1043 +-151 ng/mL and 3146 +- 262ng/mL, respectively) were required in non-rejecting patients when induction therapy was used

A proposta do nosso estudo foi comparar o número de células apresentadoras de antígenos (CAAs) presentes em biópsias de gengivite (G) e de hiperplasia gengival induzida por ciclosporina (HGIC). Vinte e oito biópsias de pacientes com G e 14 biópsias de HGIC foram analisadas no epitélio de revestimento bucal (ERB), epitélio sulcular (ES) e no tecido conjuntivo (TC). O número de macrófagos (CD68+), de células de Langerhans (CD1a+) e de células dendríticas intersticiais (CDIs) (FXIIIA+) foi investigado por técnica imunoistoquímica. Células CD1a+/mm2 foram significantemente aumentadas na G quando comparada com HGIC, no TC, no ES e no ERB (p<0,05). Em contrapartida, o número de células CD68+ no TC e no ERB, e o número de células FXIIIA+/mm2 no TC foram aumentadas no grupo de HGIC (p<0,05). Ciclosporina A está relacionada com a diminuição de células de Langerhans. Podemos sugerir que este fato aumenta as infecções oportunistas, conseqüentemente, um maior número de macrófagos é necessário para combater os microorganismos. / The aim of this study was to compare the number of antigen-presenting cells (APCs) observed in biopsies of gingivitis (G), and in cyclosporine-induced gingival overgrowth (CIGO). Twenty eight biopsies from patients with G, and 14 with CIGO were analyzed in oral epithelium (OE), sulcular/junctional epithelium (SJE), and connective tissue (CT). The number of macrophages (CD68+), Langerhans’cells (CD1a+), and interstitial dendritic cells (FXIIIA+) was investigated by immunohistochemistry. CD1a+ cells/mm2 were significantly increased in G when compared with CIGO, in CT, in SJE, and in OE (p<0.05). In contrast, the number of CD68+ in CT, and in OE, and FXIIIA+ cells/mm2 in CT were increased in CIGO group (p<0.05). Cyclosporine is related with the diminution of Langerhans’ cells. We can suggest that this fact increase opportunistic infections, consequently, a greater number of macrophages is necessary in order to combat the microorganisms.

A proposta do nosso estudo foi comparar o número de células apresentadoras de antígenos (CAAs) presentes em biópsias de gengivite (G) e de hiperplasia gengival induzida por ciclosporina (HGIC). Vinte e oito biópsias de pacientes com G e 14 biópsias de HGIC foram analisadas no epitélio de revestimento bucal (ERB), epitélio sulcular (ES) e no tecido conjuntivo (TC). O número de macrófagos (CD68+), de células de Langerhans (CD1a+) e de células dendríticas intersticiais (CDIs) (FXIIIA+) foi investigado por técnica imunoistoquímica. Células CD1a+/mm2 foram significantemente aumentadas na G quando comparada com HGIC, no TC, no ES e no ERB (p<0,05). Em contrapartida, o número de células CD68+ no TC e no ERB, e o número de células FXIIIA+/mm2 no TC foram aumentadas no grupo de HGIC (p<0,05). Ciclosporina A está relacionada com a diminuição de células de Langerhans. Podemos sugerir que este fato aumenta as infecções oportunistas, conseqüentemente, um maior número de macrófagos é necessário para combater os microorganismos. / The aim of this study was to compare the number of antigen-presenting cells (APCs) observed in biopsies of gingivitis (G), and in cyclosporine-induced gingival overgrowth (CIGO). Twenty eight biopsies from patients with G, and 14 with CIGO were analyzed in oral epithelium (OE), sulcular/junctional epithelium (SJE), and connective tissue (CT). The number of macrophages (CD68+), Langerhans’cells (CD1a+), and interstitial dendritic cells (FXIIIA+) was investigated by immunohistochemistry. CD1a+ cells/mm2 were significantly increased in G when compared with CIGO, in CT, in SJE, and in OE (p<0.05). In contrast, the number of CD68+ in CT, and in OE, and FXIIIA+ cells/mm2 in CT were increased in CIGO group (p<0.05). Cyclosporine is related with the diminution of Langerhans’ cells. We can suggest that this fact increase opportunistic infections, consequently, a greater number of macrophages is necessary in order to combat the microorganisms.