Submitted by Sara Ribeiro (sara.ribeiro@ucb.br) on 2018-08-08T17:45:39Z No. of bitstreams: 1 SeverinoLeãodeAlbuquerqueNetoTese2018.pdf: 2484170 bytes, checksum: b4db26e2e2354477363089d9c62b4b72 (MD5) / Approved for entry into archive by Sara Ribeiro (sara.ribeiro@ucb.br) on 2018-08-08T17:46:25Z (GMT) No. of bitstreams: 1 SeverinoLeãodeAlbuquerqueNetoTese2018.pdf: 2484170 bytes, checksum: b4db26e2e2354477363089d9c62b4b72 (MD5) / Made available in DSpace on 2018-08-08T17:46:25Z (GMT). No. of bitstreams: 1 SeverinoLeãodeAlbuquerqueNetoTese2018.pdf: 2484170 bytes, checksum: b4db26e2e2354477363089d9c62b4b72 (MD5) Previous issue date: 2018-05-03 / The search for better sports performance has encouraged studies on the interaction between environmental and genetic factors. In this perspective, while environmental factors stimulate morphofunctional adaptations, genetic polymorphisms modulate the genes responsible for these adaptations. Therefore, the identification of the candidate genes and their respective polymorphisms with potential to influence the phenotypes related to this performance have been the target of the researchers of the area. Among the promising polymorphisms are the I/D of the angiotensin converting enzyme (ACE) gene and the α-actinin-3 (ACTN3) gene R577X. In the field of sports genetics, swimming has been studied, but research on the younger athletes is rare. The objective of this study was to analyze the association between ACE and ACTN3 polymorphisms in sports performance indicators in 120 brazilian swimmers (75 Boys and 45 Girls), aged 15 to 17 years (16.76 ± 0.6 years ), affiliated to the Brazilian Confederation of Aquatic Sports. 102 non-athletes of the same age group (16.51 ± 0.95 years) residing in the Federal District were part of the control group (56 Boys and 46 Girls). These were subdivided by official swimming tests (short: ≤200m vs long: ≥400m), related to the phenotypes of sports performance (strength vs. power) and by the competitive level (elite vs. sub-elite). The elite status (international experiences) and the technical index (TI) were adopted as indicators of performance. It was also evaluated the total genothype score (TGS) associated to the strength / power phenotypes. The technique of scraping buccal mucosa epithelial cells with the aid of a specific swab was used to collect the samples. In the athletes was collected during the XXIV Brazilian Junior Swimming Championship and among the students, in the intervals of the Physical Education classes. The genotyping of the polymorphisms was performed through the polymerase chain reaction technique obeying standardized and scientifically validated protocols. All the volunteers signed the agreement with prior consent of those responsible. Chi-square and Mann-Whitney tests were used when the variables were not normally distributed. Pearson's correlation and t-test for independent samples were used for the parametric data. The groups (athletes and non-athletes) demonstrated Hardy-Weinberg equilibrium for the genotypic and allelic distribution of polymorphisms. Sub-elite athletes (≤200m and ≥ 400m) presented allelic and genotype frequencies in both polymorphisms very close to those observed for the control group. The elite group of athletes was formed by specialists in short competitions (≤200m). Significant primacy of the DD genotype of ACE was observed for elite athletes. The D allele and DD genotype were also predominant among athletes of the same phenotypic (strength/power) group identified in the upper quartile (Q3) of TI, with significant differences especially in favor of elite athletes. Analysis of the ACTN3 polymorphism revealed that the R allele was predominant in all groups, except for the elite group, which had a frequency of the heterozygote RX genotype significantly higher. The best TI’s were verified among the athletes (≤200m) genotyped for RX and RR, with supremacy for the homozygote among elite athletes. In the joint evaluation of the two polymorphisms, the elite group presented significant genotypic supremacy of DD + RX addition compared to the other groups that presented higher occurrence of DD + RR homozygotes. The TGS analysis showed that athletes with better genotype profiles (score ≥75) also had the best TI’s. The results of the study suggest that the elite status and the best TI’s verified among juvenile athletes were influenced positively by the genotype associations typically expected. / A busca pelo melhor desempenho esportivo tem incentivado estudos sobre a interação entre os fatores ambientais e genéticos. Nesta perspectiva, enquanto os fatores ambientais estimulam as adaptações morfofuncionais os polimorfismos genéticos modulam os genes responsáveis por estas adaptações. Por isso, a identificação dos genes candidatos e seus respectivos polimorfismos com potencial de influenciar os fenótipos relacionados a este desempenho têm sido alvo dos pesquisadores da área. Dentre os polimorfismos promissores destacam-se o I/D do gene da enzima conversora da angiotensina (ECA) e o R577X do gene da α-actinina-3 (ACTN3). Na área da genética do esporte a natação tem sido estudada, mas são raras as pesquisas dedicadas aos atletas mais jovens, notadamente na população brasileira. O objetivo do estudo foi analisar a associação entre os polimorfismos da ECA e da ACTN3 aos indicadores de desempenho esportivo em 120 atletas da natação brasileira (75 Rapazes e 45 Moças), na faixa etária dos 15 aos 17 anos (16,76 ± 0,6 anos), filiados à Confederação Brasileira de Desportos Aquáticos (6,46 ± 2,13 anos). 102 jovens escolares (56 Rapazes e 46 Moças) não-atletas da mesma faixa etária (16,51 ± 0,95 anos) residentes no Distrito Federal fizeram parte do grupo controle. Estes foram subdivididos pelas provas oficiais da natação (curtas: ≤200m vs longas: ≥400m), relacionadas tipicamente aos fenótipos opostos do desempenho atlético (respectivamente: força/potência vs resistência) e pelo nível competitivo (elite vs sub-elite). O status de elite (experiências internacionais) e o índice técnico (IT) foram adotados como indicadores de desempenho. Foi avaliado também o score total dos genótipos (TGS) associados aos fenótipos da força/potência. O material genético dos atletas foi coletado durante o XXIV Campeonato Brasileiro Juvenil de Natação e entre os escolares, nos intervalos das aulas de Educação Física. A técnica de raspagem das células epiteliais da mucosa bucal com o auxílio de swab específico foi utilizada para a coleta das amostras. A genotipagem dos polimorfismos foi realizada através da técnica de reação em cadeia da polimerase obedecendo protocolos padronizados e cientificamente validados. Todos os voluntários assinaram o termo de assentimento com prévia anuência dos responsáveis. Os testes do Qui-Quadrado e Mann-Whitney foram utilizados quando as variáveis não apresentavam distribuição normal. A correlação de Pearson e o teste t para amostras independentes foram utilizados para os dados paramétricos. Os grupos (atletas e não-atletas) demonstraram equilíbrio Hardy-Weinberg para a distribuição genotípica e alélica dos polimorfismos. Os atletas sub-elite (≤200m e ≥400m) apresentaram frequências alélicas e genotípicas em ambos os polimorfismos muito próximas às verificadas para o grupo controle. O grupo de atletas de elite foi formado por especialistas em provas curtas (≤200m). Observou-se supremacia significativa do genótipo DD da ECA para os atletas de elite. O alelo D e o genótipo DD foram predominantes também entre os atletas do mesmo grupo fenotípico (força/potência) identificados no quartil superior (Q3) do IT, com diferenças significativas especialmente em prol dos atletas de elite. A análise do polimorfismo da ACTN3 revelou que o alelo R foi predominante em todos os grupos, exceto para o grupo de elite, os quais apresentaram frequência do genótipo heterozigoto RX significativamente superior. Os melhores IT foram verificados entre os atletas (≤200m) genotipados para RX e RR, com supremacia para o homozigoto entre os atletas de elite. Na avaliação conjunta dos dois polimorfismos o grupo de elite apresentou significativa supremacia genotípica da adição DD+RX frente aos demais grupos que apresentaram maior ocorrência dos homozigotos DD+RR. A análise do TGS demonstrou que os atletas com melhores perfis genofenotípicos (score ≥75) apresentaram também os melhores IT. Os resultados do estudo sugerem que o status de elite e os melhores IT verificados entre atletas juvenis sofreram influência positiva das associações genofenotípicas tipicamente esperada.

A hiperplasia adrenal congênita (HAC) por deficiência da enzima 21-hidroxilase (21OH) é uma doença autossômica recessiva que compromete a síntese de cortisol e/ou aldosterona. É a causa mais frequente de distúrbio da diferenciação sexual 46,XX. Apresenta uma diversidade fenotípica, a qual é decorrente de mutações no gene CYP21A2. Observa-se forte correlação do comprometimento da atividade enzimática predita pelo genótipo com a forma de apresentação clínica e com os valores hormonais; entretanto, esta correlação não é observada com o grau de virilização pré-natal da genitália externa em mulheres com a forma clássica. Supomos que variações inter-individuais na ação, síntese e metabolismo dos andrógenos possam influenciar o fenótipo da virilização. Objetivos: avaliar se variantes alélicas em genes relacionados a ação, síntese ou metabolismo de andrógenos na vida fetal possuem um efeito modulatório na variabilidade fenotípica da virilização genital em mulheres com a forma clássica carreando genótipos 21OH semelhantes. Também serão avaliadas se diferenças na expressão tecidual local dos genes HSD17B5, SRD5A1, SRD5A2 e RA influenciariam esta variabilidade fenotípica da forma clássica. Casuística: foram selecionadas 187 mulheres com a forma clássica da HAC 21OH provenientes de 4 centros médicos. Dados clínicos, hormonais e o grau de virilização genital foram obtidos de forma retrospectiva da análise de prontuários. A intensidade de virilização genital foi classificada de acordo com a escala de Prader (P) e as pacientes foram divididas em 4 grupos: P I+II, P III, P IV e P V. As pacientes também foram agrupadas de acordo com o genótipo 21OH: grupo A carreadoras de mutações que predizem < 2% de atividade enzimática residual (n= 122) e grupo B carreadoras de mutações que predizem 3 a 7% de atividade residual (n= 58). Metodologias: foram amplificadas e re-sequenciadas as regiões que flanqueiam os exons dos genes CYP3A7, PXR e CAR. Para as variantes funcionais, foram re-sequenciados os exons 12-13 do POR e a região promotora do HSD17B5. As variantes V89L e A49T do SRD5A2 foram rastreadas por PCR-RFLP e o nCAG do RA por eletroforese capilar e análise pelo GeneScan. A determinação da expressão gênica em pele genital foi feita por PCR em tempo real utilizando os genes endógenos CYC, PGK1 e B2M. Os testes t-test, Mann-Whitney, Kruskal-Wallis, Fisher e regressão linear uni- e múltipla foram utilizados na análise estatística. Resultados: o Prader score no genótipo A variou de II a V (III: III IV) e no genótipo B de I a V (III: II - III) (P< 0,001). Foram encontradas em 2,5% dos alelos a variante CYP3A7*1C, em 24% CYP3A7*2, 31% rs2307424 CAR, 25% A503V POR, 33% -71G HSD17B5, 17% rs2518047 HSD17B5, 31% V89L SRD5A2 e em 1% dos alelos a variante A49T SRD5A2. Foi identificada associação das variantes rs2307424 CAR (P= 0,023 ;r2= 0,253) e rs2518047 HSD17B5 (P= 0,006; r2= 0,144) com o grau de virilização genital, tem sido encontradas em maior frequência no grupo de pacientes com virilização mais intensa. Todas as outras variantes não apresentaram associação com o Prader score (P> 0,05). As diferenças de expressão de todos os genes analisados em amostras de pele genital não foram estatisticamente significantes (P> 0,05), embora observou-se que em 4/7 amostras de pacientes com Prader score IV houve uma super-expressão do gene SRD5A2 em relação a 1/5 pacientes com Prader score III. Conclusão: neste estudo multicêntrico observamos que o genótipo 21OH se correlacionou com a intensidade de virilização genital em mulheres com a forma clássica. A variante rs2307424 do gene CAR, relacionada ao metabolismo pré-natal de andrógenos, e a variante rs2518047 do gene HSD17B5, relacionada à síntese de testosterona, associaram-se à fenótipos de virilização mais intensos. Não identificamos diferenças na expressão tecidual dos genes relacionados à síntese e/ou ação periférica de andrógenos em pacientes com os diferentes graus de virilização / Congenital Adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OH) is an autosomic recessive disorder characterized by an impairment in the cortisol and/or aldosterone synthesis, being the most frequent cause of 46,XX disorder of sex development. The disease presents a wide phenotypic variability resulting from different CYP21A2 gene mutations and a strong correlation has been observed among genotypes, clinical forms and basal hormone levels. However, this correlation is not observed regarding the degree of prenatal external genitalia virilization in females and an interindividual variability in the synthesis, metabolism and/or peripheral action of androgens could corroborate for these findings. Objectives: to evaluate if allelic variants in genes related to the androgen synthesis, metabolism and peripheral action could modulate the genital phenotype in CAH females bearing similar CYP21A2 mutations. Differences in the HSD17B5, SRD5A1, SRD5A2 and RA gene expression in genital skin were evaluated among patients with different degrees of external genital virilization. Patients: were selected 187 CAH females and clinical and hormonal data were retrospectively evaluated. The degree of external genitalia virilization was classified according to Prader (P) scores and patients were divided into 4 groups: P I+II, P III, P IV and P V. Patients were also grouped according to 21OH genotypes: group A bearing mutations predicting < 2% of residual enzymatic activity (n= 122) and group B between 3 to 7% (n= 58). Methodology: the exonic flanking regions of CYP3A7, PXR e CAR genes were PCR amplified and sequenced. The exons 12-13 of POR and the promotor region of HSD17B5 were sequenced to screen the functional polymorphisms. The V89L and A49T SRD5A2 alleles were screened by PCR-RFLP and the CAG polymorphic tract of AR gene by capillary electrophoresis and GeneScan analysis. The differential gene expression in genital skin was evaluated by real time PCR and the CYC, PGK1 e B2M housekeeping genes were used. The t-test, Mann-Whitney, Kruskal-Wallis, Fisher and uni- and multiple linear regression tests were used in statistical analysis. Results: Prader score in group A varied from II to V (III: III - IV) and in group B from I to V (III: II - III) (P< 0,001). The CYP3A7*1C allele was identified in 2.5% of alleles, CYP3A7*2 in 24%, rs2307424 CAR in 31%, A503V POR in 25%, -71G HSD17B5 in 33%, rs2518047 HSD17B5 in 17%, V89L SRD5A2 em 31% and A49T SRD5A2 in 1% of alleles. The rs2307424 CAR (P= 0.023; r2= 0.253) and rs2518047 HSD17B5 variants (P= 0.006; r2= 0.144) were associated with the degree of external genitalia virilization, and they were found in a higher frequency in more virilized patients. The remaining variants were not associated with Prader scores (P> 0.05). The HSD17B5, SRD5A1, SRD5A2 and RA gene expressions did not significantly differ between patients presenting Prader score III and IV (P> 0.05); however, 4/7 samples from patients with Prader IV and just 1/5 patients with Prader III presented an increased SRD5A2 expression. Conclusion: In this multicentric study the 21OH genotypes were correlated with the degree of external genitalia virilization in CAH females. The rs2307424 CAR and the rs2518047 HSD17B5 variants, related to the prenatal androgen metabolism and synthesis, respectively, explained some of the interindividual variability of genital phenotype in CAH females bearing similar CYP21A2 mutations. Differences in the expression of genes involved in the peripheral androgen action did not corroborate for the variability of genital phenotype in CAH

Os alelos HLA-DRB1, que codificam uma sequência de aminoácidos (QKRAA/QRRAA/RRRAA) nas posições 70 a 74 da terceira região hipervariável da cadeia &#61538;1 do gene DRB1, denominada epítopo compartilhado (EC), estão associados com maior susceptibilidade e gravidade para artrite reumatóide (AR) em diversas populações. Uma nova classificação proposta por Du Montcel et al tem sido desenvolvida para apurar a associação entre HLA-DRB1 e AR. Este estudo foi desenhado com o objetivo de determinar a frequência dos alelos HLA-DRB1 em pacientes brasileiros com AR, e sua associação com o fator reumatoide (FR), anticorpos antipeptídeos citrulinados (ACPA) e lesão radiográfica articular e óssea. Quatrocentos e doze pacientes com AR e 215 controles foram incluídos. A tipificação HLA-DRB1 foi realizada pela reação em cadeia de polimerase (PCR) usando primers específicos e hibridação com oligonucleotídeos de sequência específica (SSOP). A pesquisa de ACPA foi determinada pela técnica de ELISA e a do FR por nefelometria, a avaliação radiográfica realizada pelo método do índice de Sharp modificado de Van Der Heijde. Para análises estatísticas foram utilizados os testes do qui-quadrado, t de Student e a regressão logística. Nos pacientes com AR alelos HLA-DRB1*04:01, *04:04, *04:05 se associaram com AR (p<0,05), embora o amplo intervalo de confiança, vale a pena ressaltar a associação observada com o alelo DRB1*09:01 e a doença (p<0,05). Alelos HLA-DRB1 EC+ foram observados em 62,8% dos pacientes e em 31,1% do grupo controle (OR 3,62; p <0,001) e estiveram associados com ACPA (OR 2,03; p<0,001). Alelos DRB1 DERAA mostraram efeito protetor para a AR (OR 0,42; p<0,001). A análise da nova classificação de HLA-DRB1 mostra que S2 e S3P se associaram a AR (p<0,05). Alelos S2 e/ou S3P esteve presente em 65% dos pacientes e 32% do grupo controle (OR 3,86; p<0,001) e estiveram associados a ACPA (OR.2,11; p=0,001). Alelos S3D, S1, X mostraram efeito protetor para a AR. Os resultados obtidos neste estudo demonstram que pacientes brasileiros com AR de etnia majoritariamente mestiça, alelos HLA-DRB1 avaliados segundo a hipótese do EC e a classificação proposta por Du Montcel estiveram associados à suscetibilidade à doença e à presença de ACPA. / HLA-DRB1 alleles that encode an amino acid sequence at positions 70-74 of the third hypervariable region of the B chain of the DRB1 gene, called shared epitope (SE), are associated with increased susceptibility and severity to rheumatoid arthritis (RA) in different populations. A new classification proposed by Du Montcel et al has been developed to determine the association between HLA-DRB1 and RA. This study was designer to determine the frequency of HLA-DRB1 alleles in Brazilian patients with RA, and its association with rheumatoid factor (RF), citrullinated peptide antibodies (ACPA) and radiographic joint damage and bone. Four hundred and twelve patients with RA and 215 controls were included. The HLA-DRB1 typing was performed by polymerase chain reaction (PCR) using specific primers and hybridization with sequence specific oligonucleotides (SSOP). The survey of ACPA was determined by ELISA and the RF by nephelometry, the radiographic evaluation by index method modified Sharp Van Der Heijde. For statistical analysis we used the chi-square, Student and logistic regression. In patients with rheumatoid arthritis HLA-DRB1*04:01, *04:04, *04:05 are associated with RA (p<0,05), although the wide confidence interval, it is worth noting the association observed with the DRB1*09:01 allele and the disease (p<0,05). HLA-DRB1 SE+ were observed in 62.8% of patients and in 31.1% of the control group (OR 3.62, p<0,001) and were associated with ACPA (OR 2.03, p<0,001). DERRA alleles showed a protective effect against RA (OR 0,42, p<0,001). The analysis of the new classification of HLA-DRB1 shows that S2 and S3P were associated with RA (p<0,05). Alleles S2 and/or S3P was present in 65% and 32% of patients in the control group (OR 3,86, p<0,001) and were associated with ACPA (OR 2.11, p=0,001). S3D alleles, S1, X showed a protective effect against RA. The results of this study demonstrate that Brazilian patients with RA from mostly mixed ethnicity, HLA-DRB1 evaluated under the hypothesis of the SE and the classification proposed by Du Montcel et al were associated with disease susceptibility and the presence of ACPA.

Introdução: Polimorfismo é variação genética de ocorrência habitual na população em geral, encontrado em frequência superior a 1%. Há vários polimorfismos conhecidos no gene do receptor estrogênico alfa, alguns dos quais podem modificar a função do receptor e a ação dos estrogênios. Associação de polimorfismos no gene do receptor estrogênico alfa e risco de doenças, incluindo o câncer de mama, tem sido objeto de grande interesse, porém existem poucos estudos publicados sobre a prevalência destes na população brasileira. Objetivos: Verificar em mulheres com mamas densas após a menopausa; 1) A distribuição dos fatores de risco para câncer de mama; 2) A frequência dos polimorfismos do gene do receptor estrogênico alfa Pvull, Xbal e (GT)n; 3) A associação entre os resultados moleculares e os fatores de risco para o câncer de mama. Casuística e métodos: Estudo observacional realizado na divisão de Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, em 308 mulheres com idade entre 45 e 65 anos, mamas densas, que estavam há pelo menos um ano sem menstruar, que não faziam uso de terapia hormonal há 1 ano ou mais e sem antecedente pessoal de câncer de mama e ovário. Caracterizaram-se na história clínica e no exame físico, idade da menarca e da menopausa, paridade, idade ao nascimento do primeiro filho, antecedentes familiares de câncer de mama, hábito de fumar, ingestão de bebida alcoólica e o Índice de Massa Corpórea. Foi coletada amostra de sangue periférico para extração do DNA genômico e determinação dos polimorfismos presentes no intron 1 (Pvull e Xbal) e na região promotora do éxon 1 (GT)n e dosagens de glicemia, colesterol total e frações, insulina, IGF1, TSH, T3, T4, FSH, LH e estradiol. Resultados: Os fatores considerados de risco para o câncer de mama, menarca antes dos 12 anos (35,38%), nuliparidade ou idade ao ter o 1º filho após os 28 anos (41,66%), história familiar de câncer de mama (19,16%) e sobrepeso/obesidade (62,01%) foram mais prevalentes nessa população. A cor branca foi a mais frequente, coincidindo com os resultados de outros estudos, e a menopausa tardia não se mostrou um fator de influência nessa população. As frequências alélica e genotípica para os SNPs no RE?-397-Pvull e Xbal foram: P=43,99%; p=56,01%; pp=32,14%, Pp=47,73% e PP=20,13%; X=41,56%, x=58,44%; xx=33,44%, Xx=50,00% e XX=16,56%, respectivamente. Para o polimorfismo de repetição STRs (GT)n, os genótipos mais frequentes foram 14, 15 e 16, com predomínio da repetição 16. As distribuições alélica e genotípica dos polimorfismos (Pvull, Xbal e GTn), não sofreram influências significativas dos fatores de risco pesquisados. Conclusão: Os fatores de risco para o câncer de mama foram mais prevalentes nessa população de mulheres com mamas densas, embora, não tenham mostrado associações significativas com os polimorfismos estudados. Estudos caso controle adicionais são necessários para melhor compreender a associação destes polimorfismos e o câncer de mama. / Introduction: Polymorphism is genetic variation of usual occurrence in the general population, found with frequency higher than 1%. There are several known polymorphisms in the estrogen receptor alpha (ER?), some of which can modify the receptor function and the action of the estrogen. Association of polymorphisms in the estrogen receptor alpha gene and risk of diseases, including breast cancer, has been a subject of great interest, but there are few published studies on the prevalence of these in the Brazilian population. Objective: Checking on women with high breast density after menopause; 1) the distribution of risk factors for breast cancer; 2) the frequency of polymorphism of the estrogen receptor alpha gene Pvull, Xbal and (GT)n; 3) the association between the molecular results and the risk factors for breast cancer. Methods: Observational study carried out in the Gynecology Department of the Hospital das Clínicas of Medical School of São Paulo University, in 308 women aged between 45 and 65 years-old, high breast density, who were at least one year without menstruating and did not use hormone therapy for 1 year or more and no personal history of breast and ovarian cancer. It was characterized on clinical history and physical examination: age of menarche and menopause, parity, age at birth of first child, family history of breast cancer, smoking, alcohol intake and body mass index. Peripheral blood sample was collected for DNA extraction and determination of genomic polymorphisms present in the intron 1 (Pvull and Xbal), in the promoter region of exon 1 (GT)n, dosages of blood glucose, total cholesterol and fractions, insulin, IGF1, TSH, T3, T4, FSH, LH, and estradiol. Results: The factors considered of risk for breast cancer, menarche before age 12 (35.38%), nulliparity or first child after the 28 years-old (41.66%), family history of breast cancer (19.16%) and Overweight/obesity (62.01%) were more prevalent in this population. The Caucasian were the most frequent, coinciding with the results of other studies, and late menopause was not a factor of influence in this population. The allele and genotypic frequencies for SNPs in ER?-397-Pvull and Xbal were: P = 43.99%; p = 56.01%; pp = 32.14%, Pp = 47.73% and PP = 20.13%; X = 41.56%, x = 58.44%; xx = 33.44%, Xx = 50.00% and XX = 16.56%, respectively. For the STRs repeat polymorphism (GT)n, the most common genotypes were 14, 15 and 16, with a predominance of repeat 16. The allele and genotypic distributions of polymorphisms (Pvull, Xbal and GTn), did not suffer significant influences of the risk factors surveyed. Conclusion: The risk factors for breast cancer were more prevalent in this population of women with high breasts density, although have not shown significant associations with polymorphisms studied. Additional studies case-control are needed to better understand the Association of these polymorphisms and breast cancer.

Bibliography: leaves 93-114. / 114, [43] leaves, [30] leaves of plates : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / This thesis investigates genome analysis of wheat, rye and barley. The objective is to evaluate the feasibility of using polymerase chain reaction (PCR) as a tool for studying cereal genomes. Results are compared for PCR and RFLP (restriction fragment length polymorphism) / Thesis (Ph.D.)--University of Adelaide, Dept. of Plant Science, 1994

Bibliography: leaves 93-114. This thesis investigates genome analysis of wheat, rye and barley. The objective is to evaluate the feasibility of using polymerase chain reaction (PCR) as a tool for studying cereal genomes. Results are compared for PCR and RFLP (restriction fragment length polymorphism)

Stroke is the third leading cause of death and the most common cause of disabilities worldwide. Apolipoprotein A5 gene (APO A5), which encodes a 369 amino acid protein called Apolipoprotein AV (apo AV), has several single nucleotide polymorphisms (SNPs) found to be associated with altered triglyceride (TG) levels. Atherosclerosis is a major cause of ischemic stroke and this pathology may be associated with variability of TG levels. The main objective of this study was to investigate the coding region (c.553G&gt / T) and promoter region (-1131T/C) polymorphisms of the APO A5 gene as a risk factor for ischemic stroke. The study group in Turkish population consisted of 198 unrelated ischemic stroke patients and 130 control subjects. There was no statistically significant difference between the groups with respect to age and gender. Total blood samples were obtained from G&uuml / lhane Military Medical Academy Hospital, Neurology Department, Ankara. In stroke patients, hypertension and diabetes were 2.5 times more common and high-density lipoprotein cholesterol (HDL-C) was significantly lower than controls. Logistic regression analysis showed that hypertension, diabetes and smoking were significant predictors of stroke. The frequency of risky alleles c.553T and -1131C were 0.003 and 0.098, respectively, in patients and were nearly the same with controls. The risk of hypertensive and diabetic individuals having ischemic stroke was higher in -1131C allele carriers (Odds ratio / OR= 3.4 and 6.4, respectively) than -1131TT individuals (OR= 2.3 and 1.9, respectively). Stroke patients with -1131C allele had significantly higher TG levels (1.70 mmol/L) and lower HDL-C levels (1.05 mmol/L) when compared to controls (1.35 mmol/L and 1.20 mmol/L, respectively) with the same genotype. Logistic regression analysis revealed elevated TG level to be associated with 2.2-fold and low levels of HDL-C to be associated with 1.8-fold increase in the risk of ischemic stroke versus control status. This is the first study investigating the relation between APO A5 c.553G&gt / T polymorphism and stroke risk. Additionally, in Turkish population -1131T/C polymorphism was analyzed for the first time in terms of its relation to ischemic stroke. The present study demonstrated that the frequency of risky alleles c.553T and-1131C were nearly the same in stroke patients and control subjects. Consequently, we decided that carrying minor alleles of c.553G&gt / T and-1131T/C polymorphisms do not constitute a risk for ischemic stroke.

Stroke, a major cause of death and disability, is described as interruption or severe reduction of blood flow in cerebral arteries. Oxidative stress plays an important role in the pathogenesis of atherosclerosis and carotid atherosclerosis is a risk factor for stroke. Combination of multiple environmental and genetic risk factors is thought to increase susceptibility to the development of this disease. Therefore, investigation of the polymorphisms of drug metabolizing enzymes is of crucial importance to determine the molecular etiology of the disease. The main objective of this study was to investigate the possible association between polymorphisms of enzymes causing oxidative stress (CYP2E1, FMO3 and NOS3) and enzymes protecting against oxidative stress (GST and NQO1), and the pathogenesis of atherosclerosis and ischemic stroke risk. The study population consisted of 245 unrelated ischemic stroke patients and 145 healthy control subjects. There was no statistically difference between the patient and control groups in terms of age and gender. Hypertension, diabetes, smoking and obesity were found to be at least 2 times more common in stroke patients than controls. While total cholesterol, triglyceride and LDL-cholesterol level were higher in stroke patients, HDL-cholesterol level was lower in stroke patients when compared to controls. In the case-control analyses for the risk of ischemic stroke, CYP2E1*5B mutant allele, *5B was found to be associated with the development of disease (Odds Ratio / OR=7.876, 95%CI=1.025-60.525, P=0.019). In addition, significant difference was observed between stroke patients and controls with respect to CYP2E1*5B genotype distribution (OR=0.869, 95%CI=1.044-62.339, P=0.017). On the other hand, in the NQO1*2 polymorphism, together with NQO1 heterozygote (*1*2), NQO1 homozygote mutant (*2*2) genotype was found protective against ischemic stroke (OR=0.627, 95%CI=0.414-0.950, P=0.027). The risk of hypertensive individuals having stroke was highest in the FMO3 472GA group (OR=6.110, P=0.000). In diabetics, GSTP1 313AG genotype was found to be the highest risk factor for stroke (OR=3.808 P=0.001). On the other hand, NQO1 *1*2 heterozygote genotype was associated with 5 times increased risk for stroke in smokers (OR=5.000, P=0.000). In addition GSTM1 present genotype constituted 8 times increased stroke risk in obese individuals (OR=8.068, P=0.001). Logistic regression analysis revealed that hypertension, diabetes mellitus, obesity and smoking were significant risk factors for stroke. On the other hand, HDL-cholesterol and having NQO1 *1*2 heterozygote genotype were found to be protective factors against stroke.

Epilepsy is neurological disorder affecting 0.5 to 1% of the population all around the world. It is characterized by the seizures, which are the sudden alterations of behavior due to a temporary change in electrical functioning of the brain. Idiopathic generalized epilepsy (IGE) accounts for one-fifth of all the other epilepsy types, and several gene mutations were identified as the causes of IGE. In general, voltage-gated and ligand-gated ion channel mutations are linked with seizure formation. Gamma amino butyric acid (GABA), the most important inhibitory neurotransmitter of the central nervous system, and its receptors are commonly mentioned in the pathophysiology of epilepsies. Decrease in the inhibitory effect of GABA in neurons causes epileptic discharges resulting in seizure development. The study population consisted of a total of 176 idiopathic generalized epilepsy (IGE) patients, 83 subjects having psychogenic non-epileptic seizures (PNES), 86 non-epileptic control subjects from Turkey. Total blood samples were obtained from G&uuml / lhane Military Medical Academy Hospital Neurology Department, Ankara. There was no statistically difference between the patient and control groups in terms of age. Genomic DNA isolations were performed and genotyping of G1465A and C59T polymorphisms of GABAB1 gene / rs1999501, rs967932, rs3780428 and rs944688 polymorphisms of GABAB2 gene were determined by PCR-RFLP technique. In this study, GABAB1 G1465A polymorphic allele was not observed in Turkish population. For GABAB1 C59T polymorphism, polymorphic allele frequencies were found as 0.097 in IGE patients / 0.072 in PNES subjects and 0.105 in non-epileptic control subjects. No significant difference is identified for C59T polymorphism in all three groups. Four SNPs of GABAB2 were studied / rs967932 was found to increase the risk of IGE 3.6-fold (P=0.031) compared to PNES subjects, polymorphic allele frequencies were found as 0.060 in IGE patients / 0.018 in PNES subjects and 0.035 in non-epileptic control subjects. For rs1999501 polymorphism, polymorphic allele frequencies were found as 0.077 in IGE patients / 0.048 in PNES subjects and 0.093 in non-epileptic control subjects. For rs3780428 polymorphism, polymorphic allele frequencies were found as 0.267 in IGE patients / 0.235 in PNES subjects and 0.256 in non-epileptic control subjects. For rs944688 polymorphism, polymorphic allele frequencies were found as 0.196 in IGE patients / 0.260 in PNES subjects and 0.227 in non-epileptic control subjects. No significant difference was identified for rs1999501, rs3780428 and rs944688 polymorphisms among IGE patients, PNES subjects and non-epileptic control groups. IGE risk was 6.54-fold higher for subjects having combined GA genotype for rs967932 and GG genotype for rs3780428 when compared with PNES subjects (P=0.042). The combination of CC genotype for rs1999501, GG genotype for rs967932 and TT genotype for rs944688 had around 9-fold protective effect against IGE when both compared with PNES subjects (P=0.038) and non-epileptic control subjects (P=0.041).

O papel dos polimorfismos genéticos da ECA (PGECA) na insuficiência cardíaca (IC) como preditor de desfechos clínicos e ecocardiográficos ainda não está estabelecido. É necessário identificar o perfil genotípico local para se observar se o impacto clínico desses genótipos é igual entre populações estrangeiras e a brasileira. O objetivo deste trabalho foi determinar a frequência das variantes do PGECA e sua relação com a evolução clínica de pacientes com IC de etiologia não isquêmica de uma população do Rio de Janeiro, utilizando desfechos clínicos, ecocardiográficos e do Seattle Heart Failure Model (SHFM).Para isso, realizou-se análise secundária de prontuários de 111 pacientes, acompanhados de forma prospectiva e retrospectiva, além da análise genética com identificação da variante do PGECA e sua classificação. Os pacientes foram acompanhados em média por 64,93,9 meses, tinham 59,51,3 (26-89) anos, predomínio do sexo masculino (60,4%) e da cor da pele branca (51,4 %), mas com alta prevalência de pretos (36 %). A distribuição do PGECA observada foi: 51,4 % DD, 44,1 % DI e apenas 4,5 % II. Hipertensão arterial foi a comorbidade mais frequentemente observada (70,3 %). O tratamento farmacológico estava bastante otimizado: 98,2 % em uso de betabloqueadores e 89,2 % em uso de inibidores da ECA ou losartana. Nenhuma das características clínicas ou do tratamento medicamentoso variou entre os grupos. Cerca de metade da coorte (49,5 %) apresentou fração de ejeção de VE (FEVE) &#8804;35 %. O diâmetro sistólico do VE (DSVE) final foi a única variável ecocardiográfica isolada significativamente diferente entre os PGECA: 59,21,8 DD x 52,31,9 DI x 59,25,2 (p=0,029). Quando analisadas de maneira evolutiva, todas as variáveis (FEVE, DSVE e DDVE) diferiram de maneira significativa entre os genótipos: p=0,024 para &#8710;FE, p=0,002 para &#8710;DSVE e p=0,021 para &#8710;DDVE. O genótipo DI se associou ao melhor parâmetro ecocardiográfico (aumento de FEVE e diminuição de diâmetros de VE), enquanto que o DD e II apresentaram padrão inverso. Os valores derivados do SHFM (expectativa de vida, mortalidade em um ano e mortalidade em cinco anos) não variaram de forma significativa entre os genótipos, mas notou-se um padrão com o DD associado a piores estimativas, DI a estimativas intermediárias e II a valores mais benignos. Não houve diferença significativa entre desfechos clínicos isolados (óbitos: p=0,552; internação por IC: p=0,602 e PS por IC: p=0,119) ou combinados (óbitos + internação por IC: p=0,559). Na análise multivariada, o peso alelo D foi preditor independente da variação do DSVE (p=0,023). Em relação aos preditores independentes de óbito + internação por IC, foram identificados classe funcional NYHA final (p=0,018), frequência cardíaca final (p=0,026) e uso de furosemida (p=0,041). Em suma, a frequência alélia e das variantes do PGECA foram diferentes da maioria do estudos internacionais. O alelo D foi associado de forma independente à pior evolução ecocardiográfica. Não houve diferenças significativas em relação aos parâmetros derivados do SHFM, embora o genótipo II pareça estar associado com o melhor perfil clínico. Por último, não houve diferenças em relação aos desfechos clínicos entre os PGECA. / The role of angiotensin-converting enzyme polymorphisms (ACEGP) has not yet been established as predictors of clinical outcomes in Heart Failure (HF). The local genotype profile must be identified in order to discover whether the clinical impact of these genotypes is the same in the Brazilian and foreign populations. The objective was to define the frequency of ACEGP variants and its relationship with the clinical progress of HF patients with non-ischemic etiology for a population in Rio de Janeiro, using clinical outcomes, echocardiogram parameters and the Seattle Heart Failure Model (SHFM). The medical records of 111 patients monitored prospectively and retrospectively were studied through a secondary data analysis, in addition to a genetic analysis with identification of the ACEGP variant and its classification. Aged 59.51.3 (26-89) years old, the patients were followed for an average of 64.93.9 months, mainly men (60.4%) and white (51.4%), but with a high prevalence of black (36 %). The observed ACEGP distribution was: 51.4% DD, 44.1% DI and only 4.5% II. High blood Arterial Hypertension was the co- morbidity most frequently observed (70.3%). Pharmacological treatment was highly optimized: 98.2% were taking beta blockers and 89.2% were taking ACE inhibitors or losartan. There was no significant difference in clinical characteristics or medical treatment among the groups. Almost half the cohort (49.5%) presented a left ventricular ejection fraction (LVEF) of &#8804;35%. The final left ventricular systolic diameter (LVSD) was the only isolated echo-cardiographic variable that differed significantly among the ACEGP: 59.21.8 DD x 52.31.9 DI x 59.25.2 (p=0.029). When final and initial echocardiograms were compared, the variation of these variables (LVEF, LVSD and LVDD) differed significantly among the genotypes: p=0.024 for &#8710;EF, p=0.002 for &#8710;LVSD and p=0.021 for &#8710;LVDD. The DI genotype was associated with the best echocardiographic pattern (increased LVEF and smaller LV diameters), while DD and II presented an inverse pattern. The values derived from the SHFM (life expectancy, one-year mortality and five-years mortality) did not vary significantly among the genotypes, although a pattern was noted for DD associated with poorer estimates, intermediate DI estimates and II with the most benign values. There were no significant differences among clinical outcomes separately (deaths: p=0.552; hospitalization for HF: p=0.602 and emergency room visits for HF: p=0.119) or combined (deaths + hospitalization for HF: p=0.559). In the multivariate analysis, each copy of the D allele, was a predictor for LVSD change (p=0.023). In terms of independent predictors of death and hospitalization for HF, the following were identified: final functional class NYHA (p=0.018), final heart rate (p=0.026) and use of furosemide (p=0.041). Hence, the allele and ACEGP frequency differed from most of the international studies. The D allele was associated independently with the worst evolutive echocardiogram pattern. There were no statistically significant differences in terms of SHFM-based parameters, although genotype II seems to be associated with the best clinical profile. Finally, there were no differences in terms of the clinical outcomes among the ACEGP.