Malária, causada por parasitas Plasmodium spp., ainda contribui com cerca de 400 mil mortes anuais sendo uma das mais vastas doenças de nosso tempo. Plasmodium falciparum, que causa a malária tropical, leva a forma mais severa da doença. Não obstante, há alguns grupos com resistência nativa conhecidas como, por exemplo, a siclemia ou enzimopatias como no caso da deficiência da glicose 6-fosfato desidrogenase. Apesar dos anos de pesquisa, até hoje os exatos mecanismos que conferem proteção, permanecem desconhecidos. Contudo, várias hipóteses, como o aumento da resposta imune inata ou a resposta melhorada contra os danos oxidativos dentro dos eritrócitos são discutidos. Este trabalho foca nos sistemas de defesa contra danos oxidativos em Plasmodium falciparum usando parasitas geneticamente modificados em células sanguíneas vermelhas anormais. O aumento de diferentes sistemas antioxidantes deveria fornecer um olhar aprofundado dos mecanismos de proteção destes eritrócitos modificados. Neste trabalho demonstramos a importância da Glutationa-S-Transferase para a sobrevivência do parasita em eritrócitos com a deficiência da glicose 6-fosfato desidrogenase. Isso leva a hipótese de que níveis aumentados de ROS nas células vermelhas geram uma alta quantidade de xenobióticos no parasita, resultando na morte da célula. / Malaria, caused by Plasmodium spp., remains with more than 400.000 deaths annually one of the vastest diseases of our time. Plasmodium falciparum, is the most dangerous species leading to severe malaria. Nevertheless, there are some native resistances known like sickle cell trait or enzymopathies such as glucose-6-phosphate dehydrogenase deficiency. However, the protection mechanism is still unknown. Hypotheses like a better innate immune response or the increased oxidative stress inside the altered erythrocytes are discussed. This work is focusing on the oxidative defence system of P. falciparum using transgenically modified parasites cultured in wild-type and abnormal red blood cells. Elevated expression levels of different anti-oxidative systems in P. falciparum should give a deeper insight of the protection mechanism of the altered erythrocytes. In this work, we show the importance of the Glutathione-S-Transferase (GST) for the proliferation of the malaria pathogen in erythrocytes with glucose-6-phosphate dehydrogenase deficiency. This leads to the hypothesis that the increased ROS level in these red blood cells generating a high amount of xenobiotics within the parasite which results in cell death.

Made available in DSpace on 2014-06-11T19:32:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-08-28Bitstream added on 2014-06-13T20:03:26Z : No. of bitstreams: 1 ondei_ls_dr_sjrp_parcial.pdf: 292639 bytes, checksum: 9c76afbfba65412651952af8454cb31d (MD5) Bitstreams deleted on 2015-01-16T10:37:50Z: ondei_ls_dr_sjrp_parcial.pdf,Bitstream added on 2015-01-16T10:38:34Z : No. of bitstreams: 1 000603676.pdf: 889558 bytes, checksum: df390d92da0411515e31635f99e1d76d (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Ministério da Saúde / Na talassemia beta, o acúmulo das cadeias alfa livres, bem como a liberação do grupo heme e do ferro durante o processo hemolítico, ocasionam aumento de danos oxidativos que podem resultar em lipoperoxidação de membranas celulares, desnaturação de proteínas e oxidação da hemoglobina. Na deficiência de glicose- 6-fosfato desidrogenase (G6PD), esse aumento é decorrente da diminuição da produção de nicotinamida adenina dinucleotídeo fosfato reduzido (NADPH) que pode resultar em hemólise intravascular. Diante da possibilidade de estresse oxidativo nos portadores de beta talassemia heterozigota e nos indivíduos com deficiência de G6PD, neste trabalho avaliou-se a expressão fenotípica das afecções genéticas por meio da identificação das mutações e análise de marcadores para estresse oxidativo. Para o estabelecimento dos grupos controle e com deficiência de G6PD foram avaliadas 544 amostras de sangue periférico de indivíduos da região Noroeste do Estado de São Paulo, sendo 426 doadores de sangue e 118 indivíduos de uma instituição de ensino superior. Para a composição do grupo com talassemia beta heterozigota foram avaliadas 46 amostras de sangue de indivíduos com diagnóstico clínico de talassemia beta da cidade de São Carlos/SP. Foram realizados métodos de triagem e confirmatórios para a identificação da talassemia beta heterozigota e da deficiência de G6PD, e dosagens bioquímicas para quantificação das espécies reativas ao ácido tiobarbitúrico (TBARS), utilizado como marcador de estresse oxidativo, e para a determinação da capacidade antioxidante em equivalência ao Trolox (TEAC). Os polimorfismos da glutationa S-transferase (GST) GSTM1 e GSTT1 foram avaliados por PCR multiplex o de GSTP1 por PCR/RFLP. No grupo com talassemia beta heterozigota foram encontradas 18 (39%) amostras com a mutação CD39; 22 (48%) com a mutação... / In beta thalassemia, the excess of unpaired alpha chains, as well as the heme group and iron released during the hemolytic process increase the oxidative damage. In G6PD deficiency, this increase is caused by a reduced production of NADPH that results in an intravascular hemolysis. Thus, facing the oxidative stress possibility in beta thalassemia carriers and G6PD deficiency individuals, it was aimed to evaluate the fenotypic expression of this genetic disorders through the mutation identification, as well as the oxidative stress marker analysis. We used 544 peripheral blood samples of individuals from São Paulo’s northwestern to control group and to G6PD deficiency group establishment. For beta thalassemia heterozygote group were evaluated 48 blood samples of São Carlos/SP city. Tests were carried out aiming the screening and confirmation of beta thalassemia and G6PD deficiency, as well as the analysis of lipid peroxidation products measured as thiobarbituric acid reactive species (TBARS) and Trolox equivalent antioxidant capacity (TEAC). Were determined the frequencies of GSTM1, GSTT1 and GSTP1 polymorphisms. The analysis with beta thalassemia carriers allowed to establish in the study group a frequency of 39% for CD39 mutation, 48% for IVS-I-110 mutation and 2% for IVS-I-6 mutation. For G6PD deficiency was founded a frequency of 3.86%. The beta thalassemic group evaluation showed an increase of TBARS and TEAC values, when compared to the control group. There was a tendency to increase lipid peroxidation in beta0 CD39 mutants compared to beta+ IVS-I-110 mutants, because there is more free chains amount in beta0 thalassemia than beta+ thalassemia. In the G6PD deficiency analysis was found a lower G6PD activity in men than in women, but there was no interference of gender in the TBARS and TEAC assays results. The comparison between the control group and the G6PD deficiency group... (Complete abstract click electronic access below)

Orientador: Claudia Regina Bonini Domingos / Banca: Antonio Fabron Junior / Banca: Luiz Carlos de Mattos / Banca: Sonia Maria Oliani / Banca: Wilson Araújo Silva Junior / Resumo: Na talassemia beta, o acúmulo das cadeias alfa livres, bem como a liberação do grupo heme e do ferro durante o processo hemolítico, ocasionam aumento de danos oxidativos que podem resultar em lipoperoxidação de membranas celulares, desnaturação de proteínas e oxidação da hemoglobina. Na deficiência de glicose- 6-fosfato desidrogenase (G6PD), esse aumento é decorrente da diminuição da produção de nicotinamida adenina dinucleotídeo fosfato reduzido (NADPH) que pode resultar em hemólise intravascular. Diante da possibilidade de estresse oxidativo nos portadores de beta talassemia heterozigota e nos indivíduos com deficiência de G6PD, neste trabalho avaliou-se a expressão fenotípica das afecções genéticas por meio da identificação das mutações e análise de marcadores para estresse oxidativo. Para o estabelecimento dos grupos controle e com deficiência de G6PD foram avaliadas 544 amostras de sangue periférico de indivíduos da região Noroeste do Estado de São Paulo, sendo 426 doadores de sangue e 118 indivíduos de uma instituição de ensino superior. Para a composição do grupo com talassemia beta heterozigota foram avaliadas 46 amostras de sangue de indivíduos com diagnóstico clínico de talassemia beta da cidade de São Carlos/SP. Foram realizados métodos de triagem e confirmatórios para a identificação da talassemia beta heterozigota e da deficiência de G6PD, e dosagens bioquímicas para quantificação das espécies reativas ao ácido tiobarbitúrico (TBARS), utilizado como marcador de estresse oxidativo, e para a determinação da capacidade antioxidante em equivalência ao Trolox (TEAC). Os polimorfismos da glutationa S-transferase (GST) GSTM1 e GSTT1 foram avaliados por PCR multiplex o de GSTP1 por PCR/RFLP. No grupo com talassemia beta heterozigota foram encontradas 18 (39%) amostras com a mutação CD39; 22 (48%) com a mutação... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In beta thalassemia, the excess of unpaired alpha chains, as well as the heme group and iron released during the hemolytic process increase the oxidative damage. In G6PD deficiency, this increase is caused by a reduced production of NADPH that results in an intravascular hemolysis. Thus, facing the oxidative stress possibility in beta thalassemia carriers and G6PD deficiency individuals, it was aimed to evaluate the fenotypic expression of this genetic disorders through the mutation identification, as well as the oxidative stress marker analysis. We used 544 peripheral blood samples of individuals from São Paulo's northwestern to control group and to G6PD deficiency group establishment. For beta thalassemia heterozygote group were evaluated 48 blood samples of São Carlos/SP city. Tests were carried out aiming the screening and confirmation of beta thalassemia and G6PD deficiency, as well as the analysis of lipid peroxidation products measured as thiobarbituric acid reactive species (TBARS) and Trolox equivalent antioxidant capacity (TEAC). Were determined the frequencies of GSTM1, GSTT1 and GSTP1 polymorphisms. The analysis with beta thalassemia carriers allowed to establish in the study group a frequency of 39% for CD39 mutation, 48% for IVS-I-110 mutation and 2% for IVS-I-6 mutation. For G6PD deficiency was founded a frequency of 3.86%. The beta thalassemic group evaluation showed an increase of TBARS and TEAC values, when compared to the control group. There was a tendency to increase lipid peroxidation in beta0 CD39 mutants compared to beta+ IVS-I-110 mutants, because there is more free chains amount in beta0 thalassemia than beta+ thalassemia. In the G6PD deficiency analysis was found a lower G6PD activity in men than in women, but there was no interference of gender in the TBARS and TEAC assays results. The comparison between the control group and the G6PD deficiency group... (Complete abstract click electronic access below) / Doutor

Over a third of the world’s population lives at risk of potentially severe Plasmodium vivax malaria. Unique aspects of this parasite’s biology and interactions with its human host make it harder to control and eliminate than the better studied Plasmodium falciparum parasite. Spatial mapping of two human genetic polymorphisms were developed to support evidence-based targeting of control interventions and therapies. First, to enumerate and map the population at risk of P. vivax infection (PvPAR), the prevalence of this parasite’s human blood cell receptor – the Duffy antigen – was mapped globally. Duffy negative individuals are resistant to infection, and this map provided the means to objectively model the low endemicity of P. vivax across Africa. The Duffy maps helped resolve that only 3% of the global PvPAR was from Africa. The second major research focus was to map the spatial distribution of glucose-6-phosphate dehydrogenase enzyme deficiency (G6PDd), the genetic condition which predisposes individuals to potentially life-threatening haemolysis from primaquine therapy. Despite this drug’s vital role in being the only treatment of relapsing P. vivax parasites, risks of G6PDd-associated haemolysis result in significant under-use of primaquine. G6PDd was found to be widespread, with an estimated frequency of 8.0% (50% CI: 7.4-8.8%) across malarious regions. Third, it was important to represent more detailed descriptions of the genetic diversity underpinning this enzyme disorder, which ranges in phenotype from expressing mild to life-threatening primaquine-induced haemolysis. These variants’ spatial distributions were mapped globally and showed strikingly conspicuous distributions, with widespread A- dominance across Africa, predominance of the Mediterranean variant from the Middle East across to India, and east of India diversifying into a different and diverse array of variants, showing heterogeneity both at regional and community levels. Fourth, the G6PDd prevalence and severity maps were synthesised into a framework assessing the spatial variability of overall risk from G6PDd to primaquine therapy. This found that risks from G6PDd were too widespread and potentially severe to sanction primaquine treatment without prior G6PDd screening, particularly across Asia where the majority of the population are Duffy positive and G6PDd was common and severe. Finally, the conclusions from these studies were discussed and recommendations made for essential further research needed to support current efforts into P. vivax control.

Die Infektion mit dem Erreger der Malaria tropica, Plasmodium falciparum, verläuft individuell unterschiedlich. Während manche der Infizierten rasch an einer komplizierten Malaria versterben, zeigen andere keinerlei Symptomatik, obwohl jahrelang eine Parasitämie besteht. Was diese Individuen voneinanderen unterscheidet, ist weitgehend unbekannt. Morbidität und Mortalität der Erkrankung sind von der Auseinandersetzung zwischen Wirt und Parasit abhängig, die von exogenen und endogenen Faktoren beeinflußt wird. Unter den endogenen Faktoren spielen die genetischen Determinanten, die sowohl an angeborenen als auch an erworbenen Resistenz- und Immunmechanismen beteiligt sind, eine besondere Rolle. In den hier zusammengefaßten Arbeiten wurden als Determinanten der angeborenen Resistenz gegenüber Malaria die Sichelzellanämie, Alpha-Thalassämie, G6PD-Mangel und der HLA-Klasse-II-Polymorphismus und als genetische Einflußfaktoren von erworbenen Immunmechanismen Varianten des TNF-Promotors, von ICAM-1 und iNOS untersucht. Die Arbeiten unterstützen die Hypothese, daß die Interaktion von Mensch und Plasmodien zu einer ständigen gegenseitigen Beeinflussung und Anpassung geführt hat. Die koevolutonäre Veränderung der Genome der beiden Organismen ist wahrscheinlich mitverantwortlich für die unterschiedliche geographische Verteilung von Genvarianten sowohl des Menschen als auch der Plasmodien und scheint auch heute noch Teil einer komplexen und dynamischen Anpassung von Wirt und Parasit zu sein. / The manifestation of an infection with Plasmodium falciparum, the pathogen of malaria, is individually different. Some indiviuals have a high risk of developing severe malaria, whereas others remain asymptomatic despite a long-lasting parasitemia. The basis of these differences is unknown. Morbidity and mortality of malaria are dependent on the interaction between the host and the parasite which is influenced by exogenic and endogenic factors. The latter are determined by genetic elements involved in innate and acquired mechanisms of resistance and immunity. The studies summerized here address genetic determinants of innate resistance against malaria (sickle cell trait, alpha-thalassemia, G6PD deficiency, blood groups and HLA class II alleles) and those of acquired immunity (variants of the TNF promoter, ICAM-1, and iNOS). The results support the view that the interaction between humans and plasmodia has led to continuous mutual influences and adaptations. Probably, the co-evolution of the genomes of both organisms is jointly responsible for the different geographical distribution of parasitic and human gene variants. This process seems to be part of an ongoing complex and dynamic adaptation of the host and the parasite.