Made available in DSpace on 2014-12-17T14:13:52Z (GMT). No. of bitstreams: 1 RigobertoGC_DISSERT.pdf: 2462609 bytes, checksum: 1753126d41dc7df59645485b6308c3f5 (MD5) Previous issue date: 2011-05-30 / Background. Gaucher Disease (GD) is a hereditary lysosomal storage disorder characterized by the accumulation of glucosylceramide, mainly in the cells of the reticuloendothelial system, due to a deficiency of the enzyme acid &#946;-glucosidase (GBA). Diagnosis is usually based on measurement of GBA activity in peripheral leukocytes. The purpose of this study was to evaluate the ability of screening for GBA and chitotriosidase activity using Dried Blood Spots on Filter Paper (DBS-FP) to identify individuals at high risk for GD in high-risk populations such as that of Tabuleiro do Norte, a small town in Northeastern Brazil. Methods. Between June 1, 2007 and May 31, 2008, 740 consented residents and descendants of traditional families from Tabuleiro do Norte were submitted to screening with DBS-FP. Subjects with GBA activity <2.19 nmol/h/mL were referred to analysis of GBA and chitotriosidase activity in peripheral leukocytes and in plasma, respectively. Subjects at highest risk for GD (GBA activity in peripheral leukocytes <5.6 nmol/h/mg protein) were submitted to molecular analysis to confirm diagnosis. Results. Screening with DBS-FP identified 135 subjects (18.2%) with GBA activity <2.19 nmol/h/mL, 131 of whom remained in the study. In 10 of these (7.6%), GBA activity in leukocytes was 2.6 5.5 nmol/h/mg protein. Subsequent molecular analysis confirmed 6 cases of heterozygosity and 4 normals for GD. Conclusion. DBS-FP assay was shown to be an effective initial GD screening strategy for high-prevalence populations in developing regions. Diagnosis could not be established from GBA activity in leukocytes alone, but required confirmation with molecular analysis / A doen?a de Gaucher (DG) ? uma patologia de dep?sito de gordura nos lisossomos, de heran?a autoss?mica recessiva, caracterizada pelo ac?mulo do substrato glicosilceramida, principalmente nas c?lulas do sistema reticuloendotelial, em raz?o da defici?ncia da enzima &#946;-glicosidase ?cida (GBA). O diagn?stico, comumente, ? feito pela dosagem da atividade da GBA em leuc?citos perif?ricos. Tabuleiro do Norte (TN), Cear?, Brasil, ? um munic?pio com cerca de 28.000 habitantes com a preval?ncia da DG de 1:4.000 habitantes, possivelmente a mais elevada do Brasil. O objetivo da disserta??o ? avaliar o rastreamento para DG realizado em TN com base na an?lise das atividades enzim?ticas da GBA e da quitotriosidase em amostras Sangue Seco em Papel de Filtro (SSPF). Entre 01 de junho de 2007 a 31 de maio de 2008, 740 indiv?duos residentes e descendentes de fam?lias de TN participaram do rastreamento para DG a partir de amostras de SSPF. Indiv?duos com atividade GBA<2,19 nmol/h/mL foram selecionados para an?lise da atividade da GBA e da quitotriosidase em leuc?citos perif?ricos e no plasma, respectivamente. Os indiv?duos com maiores riscos de DG (atividade de GBA em leuc?citos perif?ricos <5,6 nmol/h/mg de prote?na) foram referenciados para an?lise molecular para confirma??o diagn?stica. A triagem com amostras de SSPF identificou 135 indiv?duos (18,2%) com atividade da GBA<2,19 nmol/h/mL, dos quais 131 permaneceram no estudo. Em dez destes (7,6%), a atividade da GBA em leuc?citos variou de 2,6-5,5 nmol/ h/mg de prote?na, considerados suspeitos da DG. A an?lise molecular subsequente revelou, entretanto, que se tratava de seis indiv?duos heterozigotos para a muta??o G377S e, em quatro deles, n?o foram identificadas muta??es da DG. A an?lise enzim?tica de amostras de SSPF mostrou ser uma estrat?gia eficaz de triagem da DG em popula??es com alto risco, mas a medida da atividade da GBA em leuc?citos deve ser realizada para confirma??o diagn?stica. O diagn?stico de DG em indiv?duos assintom?ticos n?o deve ser firmado baseando-se apenas na an?lise da atividade da GBA em leuc?citos, sendo necess?ria, tamb?m, a confirma??o diagn?stica pela an?lise molecular

A mucopolissacaridose tipo VI (MPS VI) ou Síndrome de Maroteaux-Lamy, é uma doença autossômica recessiva causada pela deficiência da enzima lisossomal Nacetilgalactosamina- 4-sulfatase (ARSB), a qual resulta no armazenamento lisossômico de dermatan sufato em vários tecidos e órgãos, dando origem a uma condição clínica de espectro variável, desde formas mais graves até formas mais atenuadas. O acúmulo de substrato não degradado causa um importante comprometimento ósseo, problemas respiratórios, baixa estatura e outros problemas, afetando os olhos, o coração e outros órgãos. Embora a síndrome de Maroteaux-Lamy não tenha uma incidência definida no Brasil, é reconhecido que, no nosso meio, é muito mais freqüente do que em outros países e regiões. Ela é particularmente freqüente no município de Monte Santo (Bahia), de aproximadamente 50.000 habitantes e onde já foram registrados 13 casos da doença. O diagnóstico é importante porque existe hoje um tratamento específico para a doença, a terapia de reposição enzimática (TRE), que vem mostrando bons resultados, especialmente quando iniciada em idade precoce. Descrevemos neste trabalho uma adaptação para microplacas da medida fluorimétrica da atividade de ARSB, e uma nova metodologia de análise molecular, ambas padronizados para sangue total impregnado em papel-filtro (STIPF). Essas técnicas foram desenvolvidas para incluir um teste de triagem neonatal para MPS VI, realizado nas amostras coletadas para o “teste do pezinho” nos neonatos do município de Monte Santo. Esses métodos permitem a detecção de pacientes com MPS VI e dos portadores da mutação específica que parece ser responsável pela alta incidência de MPS VI nessa localidade, uma vez que todos os pacientes lá diagnosticados apresentavam a mesma mutação (p.H178L) em homozigose. O trabalho foi desenvolvido em três etapas: na primeira foi realizada a padronização das técnicas em 100 amostras de STIPF; na segunda foi feito um teste-piloto com amostras de neonatos de Monte Santo, para avaliação das técnicas padronizadas e para o estudo de termoestabilidade em controles hígidos; na terceira foram analisadas amostras de STIPF de neonatos provenientes de Monte Santo pelos dois métodos (bioquímico e molecular). A padronização para realização da medida fluorimétrica da atividade enzimática de ARSB em microplacas indicou que o método é sensível, permitiu diferenciar os valores da população normal dos valores dos pacientes afetados e possibilitou a identificação segura de pacientes com MPS VI. Nas padronizações da análise molecular da mutação p.H178L em STIPF foi possível diferenciar os indivíduos normais, heterozigotos e homozigotos. Os resultados preliminares disponíveis indicam que o protocolo de triagem neonatal para MPS VI desenvolvido no presente trabalho poderá ser facilmente incorporado por laboratórios de referência, contribuindo para a detecção e tratamento precoce dos pacientes afetados por MPS VI. / Mucopolysaccharidosis type VI (MPS VI) or Maroteux-Lamy syndrome, is an autosomal recessive disorder caused by deficiency of the lysosomal enzyme Nacetylgalactosamine- 4-sulfatase (ARSB), which results in lysosomal storage of dermatan sufate in various tissues and organs and leads to a variable clinical spectrum, including more severe and attenuated forms. The accumulation of undegraded substrate causes bone involvement, respiratory problems and short stature, among other signs and symptoms, affecting the eyes, heart and other organs. Although the Maroteaux-Lamy syndrome does not have a defined incidence in Brazil, it is recognized that in our environment it is much more frequent than in other countries and regions. It is particularly frequent in the municipality of Monte Santo (Bahia) approximately 50,000 inhabitants and where there have already been 13 cases of the disease. The diagnosis is important because today there is a specific treatment for the disease, enzyme replacement therapy (ERT) which has shown good results, especially when started at an early age. We describe herein the standardization of the microplate fluorometric method for the ARSB test and a new methodology of molecular analysis, both adapted for dried blood spots (DBS) samples. These techniques were developed for inclusion of MPS VI in the newborn screening program that already tests the neonates of the city of Monte Santo, Bahia, Brasil for metabolic diseases. The methods were developed to detect patients with MPS VI and also for carriers, once the disease seems to have a high incidence (around 1:5.000) at this location. Also, all patients that have already been diagnosed in this city presented the same mutation (p.H178L) in homozygosis. The study was conducted in three stages: in the first was performed in 100 DBS samples an standardization of the techniques; in the second was done a pilot test with samples of newborns of Monte Santo, for the evaluation of standardized techniques and for the thermostability study in healthy controls; in the third were analyzed newborns samples from Monte Santo for both biochemical and molecular methods. Standardization on microplate for fluorimetric enzyme activity of the ARSB showed the assay sensitivity, differentiating values between normal and affected and allowing a reliable detection of patients with MPS VI. On the standardization for molecular analysis in DBS it was possible to differentiate the results for normal individuals, heterozygous and affected for the mutation p.H178L. The preliminary results available indicate that the protocol of neonatal screening for MPS VI developed in this work can be easily incorporated by reference laboratories, contributing to the detection and premature treatment of MPS VI affected patients.

A mucopolissacaridose tipo VI (MPS VI) ou Síndrome de Maroteaux-Lamy, é uma doença autossômica recessiva causada pela deficiência da enzima lisossomal Nacetilgalactosamina- 4-sulfatase (ARSB), a qual resulta no armazenamento lisossômico de dermatan sufato em vários tecidos e órgãos, dando origem a uma condição clínica de espectro variável, desde formas mais graves até formas mais atenuadas. O acúmulo de substrato não degradado causa um importante comprometimento ósseo, problemas respiratórios, baixa estatura e outros problemas, afetando os olhos, o coração e outros órgãos. Embora a síndrome de Maroteaux-Lamy não tenha uma incidência definida no Brasil, é reconhecido que, no nosso meio, é muito mais freqüente do que em outros países e regiões. Ela é particularmente freqüente no município de Monte Santo (Bahia), de aproximadamente 50.000 habitantes e onde já foram registrados 13 casos da doença. O diagnóstico é importante porque existe hoje um tratamento específico para a doença, a terapia de reposição enzimática (TRE), que vem mostrando bons resultados, especialmente quando iniciada em idade precoce. Descrevemos neste trabalho uma adaptação para microplacas da medida fluorimétrica da atividade de ARSB, e uma nova metodologia de análise molecular, ambas padronizados para sangue total impregnado em papel-filtro (STIPF). Essas técnicas foram desenvolvidas para incluir um teste de triagem neonatal para MPS VI, realizado nas amostras coletadas para o “teste do pezinho” nos neonatos do município de Monte Santo. Esses métodos permitem a detecção de pacientes com MPS VI e dos portadores da mutação específica que parece ser responsável pela alta incidência de MPS VI nessa localidade, uma vez que todos os pacientes lá diagnosticados apresentavam a mesma mutação (p.H178L) em homozigose. O trabalho foi desenvolvido em três etapas: na primeira foi realizada a padronização das técnicas em 100 amostras de STIPF; na segunda foi feito um teste-piloto com amostras de neonatos de Monte Santo, para avaliação das técnicas padronizadas e para o estudo de termoestabilidade em controles hígidos; na terceira foram analisadas amostras de STIPF de neonatos provenientes de Monte Santo pelos dois métodos (bioquímico e molecular). A padronização para realização da medida fluorimétrica da atividade enzimática de ARSB em microplacas indicou que o método é sensível, permitiu diferenciar os valores da população normal dos valores dos pacientes afetados e possibilitou a identificação segura de pacientes com MPS VI. Nas padronizações da análise molecular da mutação p.H178L em STIPF foi possível diferenciar os indivíduos normais, heterozigotos e homozigotos. Os resultados preliminares disponíveis indicam que o protocolo de triagem neonatal para MPS VI desenvolvido no presente trabalho poderá ser facilmente incorporado por laboratórios de referência, contribuindo para a detecção e tratamento precoce dos pacientes afetados por MPS VI. / Mucopolysaccharidosis type VI (MPS VI) or Maroteux-Lamy syndrome, is an autosomal recessive disorder caused by deficiency of the lysosomal enzyme Nacetylgalactosamine- 4-sulfatase (ARSB), which results in lysosomal storage of dermatan sufate in various tissues and organs and leads to a variable clinical spectrum, including more severe and attenuated forms. The accumulation of undegraded substrate causes bone involvement, respiratory problems and short stature, among other signs and symptoms, affecting the eyes, heart and other organs. Although the Maroteaux-Lamy syndrome does not have a defined incidence in Brazil, it is recognized that in our environment it is much more frequent than in other countries and regions. It is particularly frequent in the municipality of Monte Santo (Bahia) approximately 50,000 inhabitants and where there have already been 13 cases of the disease. The diagnosis is important because today there is a specific treatment for the disease, enzyme replacement therapy (ERT) which has shown good results, especially when started at an early age. We describe herein the standardization of the microplate fluorometric method for the ARSB test and a new methodology of molecular analysis, both adapted for dried blood spots (DBS) samples. These techniques were developed for inclusion of MPS VI in the newborn screening program that already tests the neonates of the city of Monte Santo, Bahia, Brasil for metabolic diseases. The methods were developed to detect patients with MPS VI and also for carriers, once the disease seems to have a high incidence (around 1:5.000) at this location. Also, all patients that have already been diagnosed in this city presented the same mutation (p.H178L) in homozygosis. The study was conducted in three stages: in the first was performed in 100 DBS samples an standardization of the techniques; in the second was done a pilot test with samples of newborns of Monte Santo, for the evaluation of standardized techniques and for the thermostability study in healthy controls; in the third were analyzed newborns samples from Monte Santo for both biochemical and molecular methods. Standardization on microplate for fluorimetric enzyme activity of the ARSB showed the assay sensitivity, differentiating values between normal and affected and allowing a reliable detection of patients with MPS VI. On the standardization for molecular analysis in DBS it was possible to differentiate the results for normal individuals, heterozygous and affected for the mutation p.H178L. The preliminary results available indicate that the protocol of neonatal screening for MPS VI developed in this work can be easily incorporated by reference laboratories, contributing to the detection and premature treatment of MPS VI affected patients.

As Mucopolissacaridoses são erros inatos do metabolismo, fazem parte das doenças lisossômicas de depósito e ocorrem devido à deficiência na atividade de enzimas que catalisam a degradação de glicosaminoglicanos. O objetivo desse estudo foi aperfeiçoar o diagnóstico bioquímico das Mucopolissacaridoses dos tipos I, VI e VII, estabelecendo o uso do tampão fosfato de sódio 20 mmol/L pH 7,0 (tampão universal - TU) e outros parâmetros bioquímicos. Nesse trabalho foi aprimorada a técnica de medida de atividade da beta-glicuronidase (GUSB), enzima deficiente na MPS VII, reduzindo a quantidade de reagentes em 4 vezes e a utilização do tamanho dos picotes de sangue impregnado em papel filtro (SPF) para 1,2 mm. Estudamos a cinética da atividade da GUSB determinando o pH ótimo (4,4), Km (1,25 mM), Vmáx (594,48 nmol/h/mL), termoestabilidade (inativação significante da enzima a partir de 60 min a 60 ºC) e tempo e temperatura de armazenamento (até 30 dias à 4, 25 e 37 ºC, acima de 60 dias à -20 ºC) e estabelecemos um intervalo de referência para a atividade da GUSB em amostras de indivíduos saudáveis nessa metodologia (174,4 nmol/h/mL a 781,9 nmol/h/mL). Estabelecemos o uso do TU para determinação das atividades da alfa-iduronidase (IDUA), arilsulfatase B (ASB) e GUSB medindo a atividade enzimática em SPF eluído nesse tampão e correlacionamos com a técnica espectrofluorimétrica já padronizada para cada enzima em SPF de 1,2 mm em amostras de indivíduos saudáveis As correlações foram positivas e os coeficientes de validação da técnica estavam dentro dos limites aceitáveis. As médias de atividade determinadas para indivíduos saudáveis foram: 14,65 + 4,35 nmol/h/mL (IDUA), 22,51 + 5,09 nmol/h/mL (ASB) e 531,92 + 121,05 nmol/h/mL (GUSB). Foram analisados parâmetros bioquímicos envolvidos em estresse oxidativo no plasma de indivíduos com MPS VI e comparados com MPS I e controles saudáveis. A medida da atividade da SOD não diferiu entre os grupos, a atividade de CAT encontrava-se diminuída tanto em MPS VI quanto em MPS I e a dosagem de TBARS estava aumentada em ambas as MPS em relação aos controles. A partir desse estudo, foi possível padronizarmos e aperfeiçoarmos novas técnicas para o diagnóstico laboratorial para a MPS I, VI e VII além de introduzir o estresse oxidativo como um possível marcador no uso da terapia de reposição enzimática. / Mucopolysaccharidoses are inborn errors of metabolism, being part of lysosomal storage diseases and occuring due to deficiency in the activity of enzymes that catalyze the degradation of glycosaminoglycans. The aim of this study was to improve the biochemical diagnosis of Mucopolysaccharidoses of types I, VI and VII, establishing the use of 20 mmol/L sodium phosphate buffer pH 7.0 (universal extraction buffer - UEB) and other biochemical parameters. In this work, the activity measurement technique of beta-glucuronidase (GUSB), enzyme deficient in MPS VII, has been improved, reducing the amount of reagents in 4 times and using the size of dried blood spots (DBS) for 1.2 mm. We studied the kinetics of GUSB activity by determining the optimum pH (4.4), Km (1.25 mM), Vmax (594.48 nmol/h/mL), thermostability (significant inactivation of the enzyme from 60min at 60 ºC) and storage time and temperature (up to 30 days at 4, 25 and 37 °C, above 60 days at -20 °C) and established a reference range for GUSB activity in samples from healthy subjects in this methodology (174.4 nmol/h/mL at 781.9 nmol/h/ mL). We established the use of TU to determine the activities of alpha-iduronidase (IDUA), arylsulfatase B (ASB) and GUSB by measuring the enzymatic activity in DBS eluted in this buffer and correlated with the standardized spectrofluorometric technique for each enzyme in DBS of 1.2 mm in samples from healthy individuals Correlations were positive and the validation coefficients of the technique were within acceptable limits. The activity means determined for healthy individuals were 14.65 ± 4.35 nmol/h/mL (IDUA), 22.51 ± 5.09 nmol/h/mL (ASB) and 531.92 ± 121.05 nmol/h/mL (GUSB). Biochemical parameters involved in oxidative stress in the plasma of individuals with MPS VI and compared to MPS I and healthy controls were analyzed. Measurement of SOD activity did not differ between groups, CAT activity was decreased in both MPS VI and MPS I and the TBARS dosage was increased in both MPS compared to controls. From this study, it was possible to standardize and improve new techniques for laboratory diagnosis for MPS I, VI and VII, besides introducing oxidative stress as a possible marker in the use of enzyme replacement therapy.

This thesis describes bioanalytical methods for drug determination in biological matrixes, with drugs in focus used against diseases largely affecting low-income countries. Solid-phase extraction is used for sample cleanup, and processed samples are analyzed by liquid chromatography. Developed bioanalytical methods are validated according to international guidelines. Eflornithine (DFMO) is a chiral drug, used for treating human African trypanosomiasis. A bioanalytical method for determination of DFMO enantiomers in plasma is presented. The enantiomers are detected by evaporative light-scattering detection. The method has been applied to determination of D-DFMO and L-DFMO in rats, after intravenous and oral administration of racemic DFMO. It is concluded that DFMO exhibits enantioselective absorption, with the more potent enantiomer L-DFMO being less favored. Sulfadoxine (SD) and sulfamethoxazole (SM) are sulfa-drugs used for malaria and pneumonia respectively. Two methods are described for simultaneous determination of SD and SM in capillary blood sampled on filter paper. The former method allows direct injection of extracts from dried blood spots (DBS), while for the latter method solid-phase extraction is added. Pre-analytical factors contributing to measurement uncertainty is also discussed, and it is concluded that it is of high importance that homogeneity in type of sampling paper and sampling volume is assured. Piperaquine (PQ) is an antimalarial, increasingly used in artemisinin combination therapy. A method for determination of piperaquine in DBS is presented. By using a monolithic LC column, a very short LC analysis of two minutes per sample is achieved. A method for simultaneous determination of three antiretroviral drugs i.e. lamivudine (3TC), zidovudine (AZT) and nevirapine (NVP), in DBS samples is described. The method is applied to drug determination in two subjects after receiving standard antiretroviral treatment. Conclusion is that the method is suitable for determination of 3TC and NVP, and to some extent for AZT.

As Mucopolissacaridoses são erros inatos do metabolismo, fazem parte das doenças lisossômicas de depósito e ocorrem devido à deficiência na atividade de enzimas que catalisam a degradação de glicosaminoglicanos. O objetivo desse estudo foi aperfeiçoar o diagnóstico bioquímico das Mucopolissacaridoses dos tipos I, VI e VII, estabelecendo o uso do tampão fosfato de sódio 20 mmol/L pH 7,0 (tampão universal - TU) e outros parâmetros bioquímicos. Nesse trabalho foi aprimorada a técnica de medida de atividade da beta-glicuronidase (GUSB), enzima deficiente na MPS VII, reduzindo a quantidade de reagentes em 4 vezes e a utilização do tamanho dos picotes de sangue impregnado em papel filtro (SPF) para 1,2 mm. Estudamos a cinética da atividade da GUSB determinando o pH ótimo (4,4), Km (1,25 mM), Vmáx (594,48 nmol/h/mL), termoestabilidade (inativação significante da enzima a partir de 60 min a 60 ºC) e tempo e temperatura de armazenamento (até 30 dias à 4, 25 e 37 ºC, acima de 60 dias à -20 ºC) e estabelecemos um intervalo de referência para a atividade da GUSB em amostras de indivíduos saudáveis nessa metodologia (174,4 nmol/h/mL a 781,9 nmol/h/mL). Estabelecemos o uso do TU para determinação das atividades da alfa-iduronidase (IDUA), arilsulfatase B (ASB) e GUSB medindo a atividade enzimática em SPF eluído nesse tampão e correlacionamos com a técnica espectrofluorimétrica já padronizada para cada enzima em SPF de 1,2 mm em amostras de indivíduos saudáveis As correlações foram positivas e os coeficientes de validação da técnica estavam dentro dos limites aceitáveis. As médias de atividade determinadas para indivíduos saudáveis foram: 14,65 + 4,35 nmol/h/mL (IDUA), 22,51 + 5,09 nmol/h/mL (ASB) e 531,92 + 121,05 nmol/h/mL (GUSB). Foram analisados parâmetros bioquímicos envolvidos em estresse oxidativo no plasma de indivíduos com MPS VI e comparados com MPS I e controles saudáveis. A medida da atividade da SOD não diferiu entre os grupos, a atividade de CAT encontrava-se diminuída tanto em MPS VI quanto em MPS I e a dosagem de TBARS estava aumentada em ambas as MPS em relação aos controles. A partir desse estudo, foi possível padronizarmos e aperfeiçoarmos novas técnicas para o diagnóstico laboratorial para a MPS I, VI e VII além de introduzir o estresse oxidativo como um possível marcador no uso da terapia de reposição enzimática. / Mucopolysaccharidoses are inborn errors of metabolism, being part of lysosomal storage diseases and occuring due to deficiency in the activity of enzymes that catalyze the degradation of glycosaminoglycans. The aim of this study was to improve the biochemical diagnosis of Mucopolysaccharidoses of types I, VI and VII, establishing the use of 20 mmol/L sodium phosphate buffer pH 7.0 (universal extraction buffer - UEB) and other biochemical parameters. In this work, the activity measurement technique of beta-glucuronidase (GUSB), enzyme deficient in MPS VII, has been improved, reducing the amount of reagents in 4 times and using the size of dried blood spots (DBS) for 1.2 mm. We studied the kinetics of GUSB activity by determining the optimum pH (4.4), Km (1.25 mM), Vmax (594.48 nmol/h/mL), thermostability (significant inactivation of the enzyme from 60min at 60 ºC) and storage time and temperature (up to 30 days at 4, 25 and 37 °C, above 60 days at -20 °C) and established a reference range for GUSB activity in samples from healthy subjects in this methodology (174.4 nmol/h/mL at 781.9 nmol/h/ mL). We established the use of TU to determine the activities of alpha-iduronidase (IDUA), arylsulfatase B (ASB) and GUSB by measuring the enzymatic activity in DBS eluted in this buffer and correlated with the standardized spectrofluorometric technique for each enzyme in DBS of 1.2 mm in samples from healthy individuals Correlations were positive and the validation coefficients of the technique were within acceptable limits. The activity means determined for healthy individuals were 14.65 ± 4.35 nmol/h/mL (IDUA), 22.51 ± 5.09 nmol/h/mL (ASB) and 531.92 ± 121.05 nmol/h/mL (GUSB). Biochemical parameters involved in oxidative stress in the plasma of individuals with MPS VI and compared to MPS I and healthy controls were analyzed. Measurement of SOD activity did not differ between groups, CAT activity was decreased in both MPS VI and MPS I and the TBARS dosage was increased in both MPS compared to controls. From this study, it was possible to standardize and improve new techniques for laboratory diagnosis for MPS I, VI and VII, besides introducing oxidative stress as a possible marker in the use of enzyme replacement therapy.

As Mucopolissacaridoses são erros inatos do metabolismo, fazem parte das doenças lisossômicas de depósito e ocorrem devido à deficiência na atividade de enzimas que catalisam a degradação de glicosaminoglicanos. O objetivo desse estudo foi aperfeiçoar o diagnóstico bioquímico das Mucopolissacaridoses dos tipos I, VI e VII, estabelecendo o uso do tampão fosfato de sódio 20 mmol/L pH 7,0 (tampão universal - TU) e outros parâmetros bioquímicos. Nesse trabalho foi aprimorada a técnica de medida de atividade da beta-glicuronidase (GUSB), enzima deficiente na MPS VII, reduzindo a quantidade de reagentes em 4 vezes e a utilização do tamanho dos picotes de sangue impregnado em papel filtro (SPF) para 1,2 mm. Estudamos a cinética da atividade da GUSB determinando o pH ótimo (4,4), Km (1,25 mM), Vmáx (594,48 nmol/h/mL), termoestabilidade (inativação significante da enzima a partir de 60 min a 60 ºC) e tempo e temperatura de armazenamento (até 30 dias à 4, 25 e 37 ºC, acima de 60 dias à -20 ºC) e estabelecemos um intervalo de referência para a atividade da GUSB em amostras de indivíduos saudáveis nessa metodologia (174,4 nmol/h/mL a 781,9 nmol/h/mL). Estabelecemos o uso do TU para determinação das atividades da alfa-iduronidase (IDUA), arilsulfatase B (ASB) e GUSB medindo a atividade enzimática em SPF eluído nesse tampão e correlacionamos com a técnica espectrofluorimétrica já padronizada para cada enzima em SPF de 1,2 mm em amostras de indivíduos saudáveis As correlações foram positivas e os coeficientes de validação da técnica estavam dentro dos limites aceitáveis. As médias de atividade determinadas para indivíduos saudáveis foram: 14,65 + 4,35 nmol/h/mL (IDUA), 22,51 + 5,09 nmol/h/mL (ASB) e 531,92 + 121,05 nmol/h/mL (GUSB). Foram analisados parâmetros bioquímicos envolvidos em estresse oxidativo no plasma de indivíduos com MPS VI e comparados com MPS I e controles saudáveis. A medida da atividade da SOD não diferiu entre os grupos, a atividade de CAT encontrava-se diminuída tanto em MPS VI quanto em MPS I e a dosagem de TBARS estava aumentada em ambas as MPS em relação aos controles. A partir desse estudo, foi possível padronizarmos e aperfeiçoarmos novas técnicas para o diagnóstico laboratorial para a MPS I, VI e VII além de introduzir o estresse oxidativo como um possível marcador no uso da terapia de reposição enzimática. / Mucopolysaccharidoses are inborn errors of metabolism, being part of lysosomal storage diseases and occuring due to deficiency in the activity of enzymes that catalyze the degradation of glycosaminoglycans. The aim of this study was to improve the biochemical diagnosis of Mucopolysaccharidoses of types I, VI and VII, establishing the use of 20 mmol/L sodium phosphate buffer pH 7.0 (universal extraction buffer - UEB) and other biochemical parameters. In this work, the activity measurement technique of beta-glucuronidase (GUSB), enzyme deficient in MPS VII, has been improved, reducing the amount of reagents in 4 times and using the size of dried blood spots (DBS) for 1.2 mm. We studied the kinetics of GUSB activity by determining the optimum pH (4.4), Km (1.25 mM), Vmax (594.48 nmol/h/mL), thermostability (significant inactivation of the enzyme from 60min at 60 ºC) and storage time and temperature (up to 30 days at 4, 25 and 37 °C, above 60 days at -20 °C) and established a reference range for GUSB activity in samples from healthy subjects in this methodology (174.4 nmol/h/mL at 781.9 nmol/h/ mL). We established the use of TU to determine the activities of alpha-iduronidase (IDUA), arylsulfatase B (ASB) and GUSB by measuring the enzymatic activity in DBS eluted in this buffer and correlated with the standardized spectrofluorometric technique for each enzyme in DBS of 1.2 mm in samples from healthy individuals Correlations were positive and the validation coefficients of the technique were within acceptable limits. The activity means determined for healthy individuals were 14.65 ± 4.35 nmol/h/mL (IDUA), 22.51 ± 5.09 nmol/h/mL (ASB) and 531.92 ± 121.05 nmol/h/mL (GUSB). Biochemical parameters involved in oxidative stress in the plasma of individuals with MPS VI and compared to MPS I and healthy controls were analyzed. Measurement of SOD activity did not differ between groups, CAT activity was decreased in both MPS VI and MPS I and the TBARS dosage was increased in both MPS compared to controls. From this study, it was possible to standardize and improve new techniques for laboratory diagnosis for MPS I, VI and VII, besides introducing oxidative stress as a possible marker in the use of enzyme replacement therapy.

L'une des principales barrières à la prise en charge optimale des patients sous traitement antirétroviral est l'accès limité aux tests de charge virale (CV) et de génotypage particulièrement en milieu décentralisé. Ces tests ne sont généralement disponibles qu'au niveau des structures sanitaires centrales de grandes villes et le plasma en est l'échantillon de référence. Or, son transfert des régions périphériques vers les laboratoires de références est difficile, voire impossible. Pour rapprocher les patients du laboratoire, nous avons démontré la possibilité d'assurer un suivi virologique complet (CV et génotypage) à partir des DBS collectés et acheminés dans des conditions de terrain. Nous avons également pour la première fois, documenté la réponse virologique au traitement antirétroviral et la diversité génétique du VIH-1 chez des patients adultes suivis en milieux décentralisés au Sénégal, au Mali et en Guinée Conakry. Globalement, malgré les défauts d'observance au traitement souligné, les résultats de nos travaux ne montrent pas de différences significatives dans la survenue de l'échec virologique entre patients suivis dans les structures sanitaires centrales et périphériques, ceci quelque soit le pays considéré. Au Sénégal, chez les enfants nés de mères séropositives, la résistance vis à vis des INNTI était plus prépondérante, probablement du fait de l'utilisation systématique de la Névirapine durant la PTME. Par ailleurs, aucune mutation de résistance aux inhibiteurs d'intégrase n'a été observée malgré des taux de résistance élevés chez des patients en échec de première et deuxième ligne de traitement. Nos travaux confirment également une grande diversité génétique des sous-types viraux avec cependant la prédominance du CRF02_AG dans la sous région Ouest Africaine. Ces travaux de thèse mettent en évidence la faisabilité et la pertinence du DBS comme support pour le suivi virologique des patients en milieux décentralisés. Son utilisation a permis de montrer d'autre part des taux d'échecs virologiques élevés indiquant la nécessité de renforcer l'adhérence au traitement. Enfin, nos résultats soulignent l'utilité de prendre davantage en considération les profils de résistance pour initier un traitement de relais. / One of the major barriers to the optimal care of patients undergoing antiretroviral therapy is the limited access to viral load (VL) and genotyping tests, especially in remote areas. These technologies are usually available only at central health facilities in larger cities and plasma is the reference sample. However, plasma or whole blood samples shipment from remote areas to reference lab faces several constraints or even impossible. In order to bring closer patients to reference lab, we have demonstrated the ability of DBS (Dried Blood Spots) collected and shipped in field conditions to provide complete virological monitoring (VL and genotyping). We also documented for the first time, virological outcome of ART and HIV-1 genetic diversity in adult patients followed up in decentralized settings in Senegal, Mali and Guinea Conakry. Overall, despite the low treatment adherence noted sometimes, our findings show no significant differences in the occurrence of virological failure among patients followed up in the central and peripheral health facilities, whatever the country. In Senegal, no integrase inhibitors associated DRM has been found despite the high rate of resistance in patients failing first and second-line treatment. Furthermore, among children born to HIV infected mothers, NNRTI-associated drug resistant mutations (DRM) were more predominant, probably because of systematic use of Nevirapine in MTCT. Our studies also confirm the high genetic diversity of viral subtypes, with the dominance of CRF02_AG in West Africa. This work presented here highlights the feasibility and relevance of DBS as support for the virological monitoring of patients in decentralized settings in West Africa. Furthermore, its use showed high rate of virological failure indicating the need to reinforce adherence to treatment. Finally, our results highlight the utility to considering carefully drug resistance patterns before switching to another ART regimen.

This thesis focuses on low-cost microextraction techniques and their application for purification and preconcentration of biological samples, specifically on the experimental study of supported liquid membrane (SLM) extraction. The described microextraction technique uses commercially available filtration plates as the extraction units and allows the extraction of basic drugs from biological samples of urine and blood (in the form of dried blood spots). The experimental part includes the optimization of microextraction conditions of basic drugs from real samples through a SLM coupled in-line to lab-made capillary electrophoresis. The basic optimization of microextraction conditions involved selecting the appropriate organic phase for membrane impregnation (1:1 mixture of ENB and DHE), appropriate agitation speed for sample convection during extraction (1000 rpm), and optimal ratio of donor to acceptor volumes for high preconcentration of the analytes (400:15 µL). After basic optimization, the effect of donor alkalization with NaOH on extraction recovery (ER) was investigated. For all matrices used (saline solution, undiluted human urine samples, human capillary blood eluted from dry blood spots with deionized water), the highest ER values were achieved using a neutral donor and an acidic acceptor. The extraction time (60 minutes) was optimized based on the time profile of the microextraction for 120 minutes. This optimized microextraction method is suitable for the determination of basic drugs in real matrices with sufficient sample clean-up, preconcentration and ER values.

Purines are organic compounds with miscellaneous functions that are found in all living organisms in complex molecules such as nucleotides, nucleosides or as purine bases. The natural balance of purine levels is maintained by their synthesis, recycling and degradation. Excess purines are excreted in the urine as uric acid. Purine nucleotides may be recycled by salvage pathways catalysing the reaction of purine base with phosphoribosyl pyrophosphate. A completely new central molecule of purine metabolism, inosine monophosphate, can be synthesized from precursors during the de novo purine synthesis (DNPS). DNPS involves ten steps catalysed by six enzymes that form a multienzymatic complex, the purinosome, enabling substrate channelling through the pathway. DNPS is activated under conditions involving a high purine demand such as organism development. Currently, three DNPS-disrupting disorders have been described: ADSL deficiency, AICA-ribosiduria and PAICS deficiency. All three disorders are caused by genetic mutations leading to the impaired function of particular enzyme causing insufficient activity of respective DNPS step, manifested biochemically by accumulation of substrate of deficient enzyme, biologically by disruption of purinosome formation and clinically by unspecific neurological features,...