Submitted by Pedro Barros (pedro.silvabarros@ufpe.br) on 2018-07-04T21:58:08Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE Joanne Elizabeth Ferraz da Costa.pdf: 2278940 bytes, checksum: 1c859c1af00d5a7b77cc6bfc186c9e49 (MD5) / Made available in DSpace on 2018-07-04T21:58:08Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE Joanne Elizabeth Ferraz da Costa.pdf: 2278940 bytes, checksum: 1c859c1af00d5a7b77cc6bfc186c9e49 (MD5) Previous issue date: 2017-02-23 / CAPES / Estudos têm reportado maiores prevalências de marcadores sorológicos do vírus da hepatite B (HBV) e da hepatite C (HCV) em pacientes hansênicos e sua associação com os episódios reacionais. Por outro lado, a deficiência imune apresentada por esses pacientes pode predispor à ocorrência de infecção oculta pelo HBV. O objetivo desta pesquisa foi determinar a prevalência e fatores de risco para os marcadores sorológicos do HBV e do HCV e para a infecção oculta pelo HBV em pacientes com hanseníase. Foi realizado estudo transversal no período de fevereiro de 2015 a janeiro de 2016 em pacientes de Centro de Referência em hanseníase na Paraíba, que após assinatura de termo de consentimento livre e esclarecido foram submetidos à entrevista e coleta de amostras sanguíneas. Os testes sorológicos (ELISA) foram realizados no Setor de Virologia do Laboratório de Imunopatologia Keizo Asami (LIKA) da Universidade Federal de Pernambuco (UFPE). Amostras de plasma foram encaminhadas ao Laboratório Central de Saúde Pública do Estado da Paraíba para estudo molecular (HBV DNA; HCV RNA) por PCR em tempo real. Foram incluídos 403 pacientes no estudo sorológico e 114 pacientes na pesquisa da infecção oculta (HBV DNA). Foi observada frequência de anti-HBc de 14,1% (57/403), de HBsAg 0% (0/403), de anti-HBs isolado 14,1% (57/403), de anti-HCV 0,5% (2/403) e de infecção oculta por HBV 5,3% (6/114). Quanto aos fatores de risco, identificou-se associação do anti-HBc com ter trabalhado na área de saúde e com um menor número de anos de estudo (até nove anos). Não foi observada associação do anti-HBc ou anti-HCV com episódios reacionais, porém identificou-se associação da infecção oculta pelo HBV com história de episódio reacional tipo 2. Assim, as prevalências dos marcadores do HBV e do HCV em hansênicos de Centro de Referência na região Nordeste foram semelhantes às da população geral da mesma região, sugerindo que estes pacientes não apresentam propensão para a infecção crônica por esses vírus. Este foi o primeiro estudo no Brasil sobre a infecção oculta pelo HBV em hansênicos, demonstrando que a pesquisa do HBV DNA deve ser considerada durante o acompanhamento do paciente com hanseníase, tendo em vista a possibilidade de ocorrência de infecção oculta nesses indivíduos. Estudos prospectivos que incluam maior número de pacientes poderão contribuir para uma melhor compreensão da influência da infecção oculta na evolução da hanseníase e em seu tratamento. / Studies have reported higher prevalence of serological markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) in leprosy patients and its association with reactional episodes. On the other hand, the immune deficiency presented by these patients may predispose to occult HBV infection. The objective of this study was to determine the prevalence and risk factors for HBV and HCV serological markers and for occult HBV infection in leprosy patients. A cross-sectional study was carried out from February 2015 to January 2016 with patients from a Leprosy Reference Center in Paraíba. After signing a free and informed consent form, these patients were interviewed and submitted to collection of blood samples. Serological tests (ELISA) were carried out in the Virology Sector of the Keizo Asami Immunopathology Laboratory (LIKA), Federal University of Pernambuco (UFPE), using commercial kits (HBsAg, Wiener; anti-HBc and anti-HBs, DiaSorin). Plasma samples were sent to the Central Public Health Laboratory of the State of Paraíba for molecular tests (HBV DNA; HCV RNA), using real-time PCR. A total of 403 patients were enrolled in the serological study and 114 patients in the occult HBV infection study. Anti-HBc frequency was 14.1% (57/403), HBsAg 0% (0/403), anti-HBs alone 14.1% (57/403), anti-HCV 0.5% (2/403) and occult HBV infection 5.3% (6/114). Regarding risk factors, we identified an association between anti-HBc and multibacillary leprosy classification, with health-related job and with fewer years of study (up to nine years). No association of anti-HBc or anti-HCV with reactional episodes was observed, but the association of occult HBV infection with a history of type 2 reaction episode was identified. Thus, the prevalence of HBV and HCV markers in leprosy patients of a Reference Center in Northest region were similar to that of the general population, suggesting that these patients are not prone to chronic infection by these viruses. This was the first study on occult HBV infection in leprosy patients in Brazil, demonstrating that HBV DNA screening should be considered during follow-up of leprosy patients, considering the possibility of occult infection in these individuals. Further prospective studies involving greater number of patients may contribute to a better understanding of the influence of occult HBV infection on leprosy evolution and its treatment.

Background: A third of HIV-infected patients are co-infected with HCV in the developed world, and more of co-infected patients than ever before are dying because of liver related diseases today. Drug-related hepatotoxicity is a growing concern among human immunodeficiency virus (HIV) / hepatitis C virus (HCV) co-infected population. Nucleotide analogues containing HIV antiretroviral therapy, namely highly active anti-retroviral therapy (HAART), can induce mitochondrial toxicity. However, little is known about the effect of nucleotide analogues on the liver at the cellular and molecular level, and how it may affect treatment. Objective: To investigate whether liver tissue from HIV/HCV co-infected individuals will show greater liver mitochondrial toxicity if currently receiving antiviral HIV medication, compared to those who are not taking it. Methods: Liver biopsies were collected from 23 HIV/HCV co-infected males. Fourteen patients were on stable HAART (ON-HAART) and 9 were OFF-HAART, including 4 who stopped HAART >6 months prior and 5 who were HAART-nave. Liver mitochondrial toxicity was assessed by transmission electron microscopy-based quantitative stereological analyses of hepatocyte and mitochondrial morphometry, as well as by mitochondrial DNA (mtDNA) and mtRNA (COX1/(ß-actin) real-time-PCR quantification. Results: Hepatocytes tended to be larger in the ON-HAART group than in the OFF-HAART group (p=0.05), but they both showed similar mitochondrial volume fraction of the cell and mitochondrial crista density. Liver mtDNA and mtRNA levels were not significantly differentbetween ON-HAART and OFF-HAART. Hepatocyte lipid accumulation was significantly higher in HCV genotype 3 compared to genotype 1 infection ()=0.002), but was not associated with HAART status. Conclusions: We found no evidence or trend of increased mitochondrial toxicity in HIV/HCV co-infected individuals currently on HAART compared to those who are not. This finding could be relevant to the decision-making process with respect to initiating HCV therapy in this population. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate

RESUMO Cavalheiro, NP. Hepatite C: transmissão entre casais. São Paulo, 2004. 111p. Tese (Doutorado) - Faculdade de Medicina, Universidade de São Paulo. Introdução: A ocorrência e eficiência da transmissão sexual do VHC na ausência de outros fatores de risco ainda é muito controversa. Foram investigados e analisados 24 casais, ambos cônjuges infectados com o VHC. Destes, 22 apresentaram o mesmo subtipo viral e a análise filogenética de parte da região NS5b mostrou altos índices de homologia nas seqüências entre os vírus dos casais infectados. Objetivo: Análise da transmissão da Hepatite C entre casais heterossexuais. Método: O estudo recrutou 45 casais. Destes, 24 foram selecionados e incluídos na pesquisa, com diagnóstico clínico e laboratorial para a Hepatite C crônica. A infecção foi diagnosticada por testes imunoenzimáticos de terceira geração e pela presença da partícula viral circulante detectada pela PCR. As amostras de sangue foram coletadas entre os anos de 1999 e 2002. Foram seqüenciadas partes das regiões 5’NC e NS5b do VHC, para determinação dos subtipos virais. Os testes utilizados para as PCRs estão disponíveis para pesquisa e foram respectivamente TRUGENE 5’NC Test (Bayer Health Care Diagnostics, Tarrytown, NY, USA) e Titan One Tube RT-PCR Kits (Roche Molecular, Mannheim, Germany). Para as PCRs dos seqüenciamentos foi utilizado o kit CLIP sequencing test (Bayer Health Care Diagnostics, Tarrytown, NY, USA). As seqüências foram analisadas com o sistema de seqüenciamento Open Gene DNA, software na Versão 3.1, biblioteca específica (Bayer Health Care Diagnostics, Tarrytown, NY, USA). Para o alinhamento das seqüências, referentes a região NS5b, foi utilizado o programa Clustal W (Clustal W Multiple Sequence Alignment Program, v1.7, June 1997) e a árvore filogenética foi gerada pelo método Neighbor Joining. Um questionário padrão e entrevistas foram usados para coleta de dados sobre fatores de risco para aquisição da doença e comportamento sexual. Os pacientes desta pesquisa foram recrutados no Ambulatório de Hepatite do Hospital das Clínicas da Universidade de São Paulo e Ambulatório de Hepatite do Hospital Guilherme Álvaro, da cidade de Santos. Resultados: Entre os 24 casais selecionados, 22 apresentaram o mesmo subtipo viral e altas porcentagens de homologia (região NS5b) entre 93,0% e 99,4%. Os subtipos HCV apresentados foram dois (9,1%) casais infectados por 1a, nove (40,9%) com subtipo 1b, um (4,6%) com subtipo 2b e dez (45,5%) dos casais pelo subtipo HCV 3a. Os dois casais discordantes apresentaram índices de 70,1% e 82,2% e foram infectados pelos subtipos 2b e 1b, e 1b e 1a respectivamente. A média de tempo de convivência foi de 22,4 anos, variando de 2 a 45 anos e a renda per capta anual foi em média US$2,270/ano. Com base nos questionários e entrevistas os fatores de risco apresentados pelos casais foram: 9 (37,5%) transfusão de sangue, 17 (70,8%) U.D. endovenosa e 15 (62,5%) U.D. inalatória, 4 (16,7%) acupuntura e 5 (20,8%) tatuagem. O compartilhar de utensílios de higiene pessoal relatado pelos casais apresentou altos índices e 6 (25,0%) dos casais assumiram o uso comum de escova de dente, 16 (66,7%) lâmina de barbear, 21 (87,5%) cortador de unhas e 14 (58,3%) alicate de manicure. Os dois casais discordantes relataram fatores de risco como transfusão de sangue e U.D. Conclusão: A alta similaridade encontrada entre as cadeias genômicas do VHC pode dar suporte a hipótese de transmissão do VHC entre esses casais. O uso compartilhado de utensílios de higiene pessoal e o tempo de convivência tornam difícil a interpretação dos dados. O uso compartilhado de utensílios de higiene pessoal pode dificultar a interpretação dos dados em relação à transmissão sexual do VHC. A hipótese do sentido mais provável de transmissão do VHC, de homem para mulher, foi reforçada neste trabalho. / ABSTRACT Cavalheiro, NP. Hepatitis C: transmission between couples. São Paulo, 2004. 111p. Thesis (Doctoral) - Faculdade de Medicina, Universidade de São Paulo. Introduction: The occurrence and the efficiency of HCV sexual transmission in the absence of other risk factors are still very controversial. I investigated and analyzed 24 couples, both infected with HCV, of whom 22 shared the same viral subtype. A phylogenetic analysis of NS5b region showed high sequence homology among the infected couples. Objective: Analysis of the Hepatitis C transmission between heterosexuals couples. Methods: The study recruited 45 couples, 24 were included, with anti-HCV positive and clinical diagnosis of active chronic hepatitis. HCV infection was diagnosed by positivity of serum samples for anti HCV (third-version enzyme immunoassay) and by circulating HCV-RNA detected by Polymerase Chain Reaction (PCR). All blood samples were collected between 1999 and 2002. Sequencing of the 5’NC region was performed utilizing the research available TRUGENE HCV 5’NC Test (Bayer Health Care Diagnostics, Tarrytown, NY, USA). Sequencing of the NS5B region was performed by RT-PCR amplification with Titan One Tube RT-PCR Kits (Roche Molecular, Mannheim, Germany) and CLIP sequencing using a prototype NS5B genotyping assay (Bayer Health Care Diagnostics, Tarrytown, NY, USA). Sequence analysis was completed using the Open Gene DNA Sequencing System, Gene Objects software package (Version 3.1), and Gene Librarian module (Bayer Health Care Diagnostics, Tarrytown, NY, USA). Multiple sequence alignments of the NS5B region were performed with Clustal W (Clustal W Multiple Sequence Alignment Program, v1.7, June 1997), and phylogenetic trees were generated using the Neighbor Joining Method. A standardized questionnaire and interview was used to collect data concerning risk factors and sexual behaviors. Follow up of all subjects was conducted at the hepatitis clinic of the Clinical Hospital of the University of Sao Paulo and at the Hospital Guilherme Alvaro in the city of Santos, in the state of Sao Paulo, Brazil. Results: Among the 24 couples, 22 had matching viral subtypes with homology scores (NS5b) ranging from 93.0% to 99.4%. Of the 22 couples with matching subtype, two (9.1%) where infected with subtype 1a, nine (40.9%) with subtype 1b, one (4.6%) with subtype 2b and ten (45.5%) with subtype 3a. The two couples that did not show matching viral subtypes had scores of 70.1% and 82.2%, and were infected with subtypes 2b and 1b, and 1b and 1a, respectively. The average of duration of marriage was 22.4 years (range 2-45 years) and the per capita income was an average of US$2,270/year. Based on the questionnaire and interviews, cause of infection of the 24 couples could be attributed to: blood transfusions 9 (37.5%), drug use, I.V. 17(70.8%) and inhalation 15 (62.5%), acupuncture 4 (16.7%) and tattooing 5 (20.8%). Shared hygienic utensils showed a much higher correlation of possible route of transmission, and are better explained by the sequence homology data than by the other associated risk factors. A total of 6 (25.0%) couples shared tooth brushes, 16 (66.7%) shared shaving blades, 21 (87.5%) shared nail clippers and 14 (58.3%) shared manicure cutters. The two couples that had different subtypes, both of them related transfusion blood and I.V. drug use. Conclusions: The high similarity found among the genome chains of HCV supports the hypothesis of transmission between these couples. The shared use of personal hygiene utensils and the amount of time spent living together made it difficult to interpret the data. Also, the shared use of personal hygiene utensils can make it difficult to interpret the data in relation to the sexual transmission of HCV. The hypothesis in relation to the direction of the HCV transmission, from man to woman, was reinforced in this work.

CAVALHEIRO, N.P. Análise dos sorotipos do VHC identificados em pacientes da cidade de São Paulo, através de método imunoenzimático. São Paulo, 1999. 97p. Dissertação de mestrado - Faculdade de Medicina, Universidade de São Paulo. Com o objetivo de analisar a prevalência dos diferentes tipos do vírus da Hepatite C (VHC) em uma população de pacientes portadores crônicos do VHC, através de um método sorológico (MUREX HCV Serotyping Assay), foram estudados 219 pacientes, que apresentaram positiva a Reação em Cadeia da Polimerase (PCR), nested-PCR. Estes soros foram submetidos ao teste imunoenzimático para detecção dos anticorpos contra os tipos 1,2,3,4,5,6 do VHC. As amostras foram diluídas e incubadas na presença de peptídeos heterólogos de competição, com antígenos sorotipo-específicos do VHC. Dos 219 pacientes, foi possível detectar o sorotipo do VHC em 166, revelando uma sensibilidade de 75,8%. Os resultados apresentaram a predominância do tipo 1 (70,0%) em nosso meio, seguido pelo tipo 3 (22,3%) e tipo 2 (4,2%). Os sorotipos 4 e 5 estiveram presentes para 1,8% dos pacientes, sempre associados com o sorotipo 1. Estas amostras, apesar de cumprirem os quesitos de validade do teste, apresentaram leituras de Densidade Ótica muito altas para todos os tipos virais testados, inclusive controles positivo e negativo e a possibilidade de reações cruzadas, nestes casos, deve ser considerada. A confirmação por genotipagem e uma investigação mais detalhada sobre a procedência e formas de aquisição do VHC destes pacientes devem ser pesquisados. O tipo 6 não foi confirmado em nenhuma das amostras testadas e provavelmente não estava presente nesta coleção de amostras avaliadas. Os parâmetros epidemiológicos avaliados foram: idade, sexo e vias de transmissão. Dos 166 pacientes com diagnóstico para o tipo do VHC, 108 (65,1%) eram homens e 58 (34,9%) mulheres. A idade dos pacientes variou de 12 a 73 anos (média 41,1). As formas de transmissão mencionadas foram 52 (31,3%) transfusão de sangue, 18 (10,8%) uso de drogas injetáveis, 8 (4,8%) tatuagens, 6 (3,6%) provável via sexual, 3 (1,8%) acidente com agulha, 2 (1,2%) trabalho em área de saúde, 1 (0,6%) acupuntura, 1 (0,6%) hemofílico. Sessenta e um pacientes (36,7%) não apresentaram fatores de risco que justificassem a aquisição da infecção pelo VHC. Não foi verificada diferença significativa entre os tipos do VHC encontrados e os parâmetros epidemiológicos estudados. A predominância dos tipos 1, 3 e 2 é compatível com outros estudos, de genotipagem, que envolveram amostras brasileiras, particularmente da cidade de São Paulo. As amostras que apresentaram leituras de Densidade Ótica altas ou baixas, para todos os poços de uma mesma amostra testada, inclusive controles positivo e negativo, sugerem a possibilidade de reações inespecíficas ou cruzadas e devem ser confirmadas por outras técnicas de genotipagem ou seqüenciamento. A praticidade oferecida pelo teste de sorotipagem do VHC, apesar de não identificar os subtipos, pode ser útil na prática clínica e auxiliar no prognóstico da doença, não necessitando da tecnologia exigida pelos testes que envolvem biologia molecular. / CAVALHEIRO, N.P. Analysis of serotypes of HCV in patients from the city of São Paulo, by means of a enzyme-immunoassay method. São Paulo, 1999. 97p. Dissertação de Mestrado - Faculdade de Medicina, Universidade de São Paulo. With the objetive of analysing the prevalence of the different types of Hepatitis C Virus (HCV) in a population of chronic carriers of HCV, through a sorologic method (MUREX HCV Serotyping Assay), 219 patients were studied who showed a positive polymerase chain reaction. This sera were submitted to immunoenzimatic tests for the detection of antibodies in relation to HCV types 1, 2,3,4,5 and 6. The samples were diluted and incubated in the presence of heterologous competing peptides, with microwells coated with serotype-specific antigens of HCV. Of the 219 patients, it was possible to detect the HCV serotype in 166, revealing a sensitivity of 75.8%. The results showed a predominance of type 1 (70.0%) in our medium, followed by type 3 (22.3%) and type 2 (4.2%). Serotypes 4 and 5 were present in 1.8% of the patients, but always associated with serotype 1. These samples, in spite of fulfilling the prerequisites of validity for testing, showed a very high optical density reading for all types of viruses tested, including positive and negative controls. The possibility of cross reactions in these cases should be considered. Confirmation by genotyping and a more detailed investigation on the origin and mode of acquisition of the HCV of these patients should be researched. Type 6 was not confirmed in any of the samples tested and probably was not present in this particular collection. The epidemiological parameters evaluated were: age, sex and means of transmission. Of the 166 patients diagnosed with the HCV, 108 (65.1%) were men and 58 (34.9%) were women. The age of the patients varied from 12 to 73 years, the average being 41.1 years. The means of transmission mentioned were blood transfusion in 52 (31.3%) cases, intravenous drug use in 18 (10.8%) cases, by tatoos in 8 (4.8%) cases, 6 (3.6%) cases were sexually transmitted, 3 (1.8%) were by accident with a needle, 2 (1.2%) through work in the health field, one (0.6%) through acupunture and one by being hemophiliac. Sixty one (36.7%) patients were not able to offer any risk factor which justified the acquisition of the HCV infection. No significant difference was verified among the different types of HCV found and the different epidemiological parameters studied. The predominance of types 1, 3 and 2 is compatible with other genotyping studies which involved Brazilian samples, particularly in the city of São Paulo. The samples which showed high or low dense optical reading for all the wells of the same samples tested even the positive or negative controls, suggested confirmation by sequecing or genotyping. The praticality obtained by the HCV serotyping test, in spite of the fact that it does not identify the sub type, can be useful in clinical pratice and helpful in the prognostication of the disease, not needing the tecnology demanded by the tests which involve molecular biology.

RESUMO Cavalheiro, NP. Hepatite C: transmissão entre casais. São Paulo, 2004. 111p. Tese (Doutorado) - Faculdade de Medicina, Universidade de São Paulo. Introdução: A ocorrência e eficiência da transmissão sexual do VHC na ausência de outros fatores de risco ainda é muito controversa. Foram investigados e analisados 24 casais, ambos cônjuges infectados com o VHC. Destes, 22 apresentaram o mesmo subtipo viral e a análise filogenética de parte da região NS5b mostrou altos índices de homologia nas seqüências entre os vírus dos casais infectados. Objetivo: Análise da transmissão da Hepatite C entre casais heterossexuais. Método: O estudo recrutou 45 casais. Destes, 24 foram selecionados e incluídos na pesquisa, com diagnóstico clínico e laboratorial para a Hepatite C crônica. A infecção foi diagnosticada por testes imunoenzimáticos de terceira geração e pela presença da partícula viral circulante detectada pela PCR. As amostras de sangue foram coletadas entre os anos de 1999 e 2002. Foram seqüenciadas partes das regiões 5’NC e NS5b do VHC, para determinação dos subtipos virais. Os testes utilizados para as PCRs estão disponíveis para pesquisa e foram respectivamente TRUGENE 5’NC Test (Bayer Health Care Diagnostics, Tarrytown, NY, USA) e Titan One Tube RT-PCR Kits (Roche Molecular, Mannheim, Germany). Para as PCRs dos seqüenciamentos foi utilizado o kit CLIP sequencing test (Bayer Health Care Diagnostics, Tarrytown, NY, USA). As seqüências foram analisadas com o sistema de seqüenciamento Open Gene DNA, software na Versão 3.1, biblioteca específica (Bayer Health Care Diagnostics, Tarrytown, NY, USA). Para o alinhamento das seqüências, referentes a região NS5b, foi utilizado o programa Clustal W (Clustal W Multiple Sequence Alignment Program, v1.7, June 1997) e a árvore filogenética foi gerada pelo método Neighbor Joining. Um questionário padrão e entrevistas foram usados para coleta de dados sobre fatores de risco para aquisição da doença e comportamento sexual. Os pacientes desta pesquisa foram recrutados no Ambulatório de Hepatite do Hospital das Clínicas da Universidade de São Paulo e Ambulatório de Hepatite do Hospital Guilherme Álvaro, da cidade de Santos. Resultados: Entre os 24 casais selecionados, 22 apresentaram o mesmo subtipo viral e altas porcentagens de homologia (região NS5b) entre 93,0% e 99,4%. Os subtipos HCV apresentados foram dois (9,1%) casais infectados por 1a, nove (40,9%) com subtipo 1b, um (4,6%) com subtipo 2b e dez (45,5%) dos casais pelo subtipo HCV 3a. Os dois casais discordantes apresentaram índices de 70,1% e 82,2% e foram infectados pelos subtipos 2b e 1b, e 1b e 1a respectivamente. A média de tempo de convivência foi de 22,4 anos, variando de 2 a 45 anos e a renda per capta anual foi em média US$2,270/ano. Com base nos questionários e entrevistas os fatores de risco apresentados pelos casais foram: 9 (37,5%) transfusão de sangue, 17 (70,8%) U.D. endovenosa e 15 (62,5%) U.D. inalatória, 4 (16,7%) acupuntura e 5 (20,8%) tatuagem. O compartilhar de utensílios de higiene pessoal relatado pelos casais apresentou altos índices e 6 (25,0%) dos casais assumiram o uso comum de escova de dente, 16 (66,7%) lâmina de barbear, 21 (87,5%) cortador de unhas e 14 (58,3%) alicate de manicure. Os dois casais discordantes relataram fatores de risco como transfusão de sangue e U.D. Conclusão: A alta similaridade encontrada entre as cadeias genômicas do VHC pode dar suporte a hipótese de transmissão do VHC entre esses casais. O uso compartilhado de utensílios de higiene pessoal e o tempo de convivência tornam difícil a interpretação dos dados. O uso compartilhado de utensílios de higiene pessoal pode dificultar a interpretação dos dados em relação à transmissão sexual do VHC. A hipótese do sentido mais provável de transmissão do VHC, de homem para mulher, foi reforçada neste trabalho. / ABSTRACT Cavalheiro, NP. Hepatitis C: transmission between couples. São Paulo, 2004. 111p. Thesis (Doctoral) - Faculdade de Medicina, Universidade de São Paulo. Introduction: The occurrence and the efficiency of HCV sexual transmission in the absence of other risk factors are still very controversial. I investigated and analyzed 24 couples, both infected with HCV, of whom 22 shared the same viral subtype. A phylogenetic analysis of NS5b region showed high sequence homology among the infected couples. Objective: Analysis of the Hepatitis C transmission between heterosexuals couples. Methods: The study recruited 45 couples, 24 were included, with anti-HCV positive and clinical diagnosis of active chronic hepatitis. HCV infection was diagnosed by positivity of serum samples for anti HCV (third-version enzyme immunoassay) and by circulating HCV-RNA detected by Polymerase Chain Reaction (PCR). All blood samples were collected between 1999 and 2002. Sequencing of the 5’NC region was performed utilizing the research available TRUGENE HCV 5’NC Test (Bayer Health Care Diagnostics, Tarrytown, NY, USA). Sequencing of the NS5B region was performed by RT-PCR amplification with Titan One Tube RT-PCR Kits (Roche Molecular, Mannheim, Germany) and CLIP sequencing using a prototype NS5B genotyping assay (Bayer Health Care Diagnostics, Tarrytown, NY, USA). Sequence analysis was completed using the Open Gene DNA Sequencing System, Gene Objects software package (Version 3.1), and Gene Librarian module (Bayer Health Care Diagnostics, Tarrytown, NY, USA). Multiple sequence alignments of the NS5B region were performed with Clustal W (Clustal W Multiple Sequence Alignment Program, v1.7, June 1997), and phylogenetic trees were generated using the Neighbor Joining Method. A standardized questionnaire and interview was used to collect data concerning risk factors and sexual behaviors. Follow up of all subjects was conducted at the hepatitis clinic of the Clinical Hospital of the University of Sao Paulo and at the Hospital Guilherme Alvaro in the city of Santos, in the state of Sao Paulo, Brazil. Results: Among the 24 couples, 22 had matching viral subtypes with homology scores (NS5b) ranging from 93.0% to 99.4%. Of the 22 couples with matching subtype, two (9.1%) where infected with subtype 1a, nine (40.9%) with subtype 1b, one (4.6%) with subtype 2b and ten (45.5%) with subtype 3a. The two couples that did not show matching viral subtypes had scores of 70.1% and 82.2%, and were infected with subtypes 2b and 1b, and 1b and 1a, respectively. The average of duration of marriage was 22.4 years (range 2-45 years) and the per capita income was an average of US$2,270/year. Based on the questionnaire and interviews, cause of infection of the 24 couples could be attributed to: blood transfusions 9 (37.5%), drug use, I.V. 17(70.8%) and inhalation 15 (62.5%), acupuncture 4 (16.7%) and tattooing 5 (20.8%). Shared hygienic utensils showed a much higher correlation of possible route of transmission, and are better explained by the sequence homology data than by the other associated risk factors. A total of 6 (25.0%) couples shared tooth brushes, 16 (66.7%) shared shaving blades, 21 (87.5%) shared nail clippers and 14 (58.3%) shared manicure cutters. The two couples that had different subtypes, both of them related transfusion blood and I.V. drug use. Conclusions: The high similarity found among the genome chains of HCV supports the hypothesis of transmission between these couples. The shared use of personal hygiene utensils and the amount of time spent living together made it difficult to interpret the data. Also, the shared use of personal hygiene utensils can make it difficult to interpret the data in relation to the sexual transmission of HCV. The hypothesis in relation to the direction of the HCV transmission, from man to woman, was reinforced in this work.

CAVALHEIRO, N.P. Análise dos sorotipos do VHC identificados em pacientes da cidade de São Paulo, através de método imunoenzimático. São Paulo, 1999. 97p. Dissertação de mestrado - Faculdade de Medicina, Universidade de São Paulo. Com o objetivo de analisar a prevalência dos diferentes tipos do vírus da Hepatite C (VHC) em uma população de pacientes portadores crônicos do VHC, através de um método sorológico (MUREX HCV Serotyping Assay), foram estudados 219 pacientes, que apresentaram positiva a Reação em Cadeia da Polimerase (PCR), nested-PCR. Estes soros foram submetidos ao teste imunoenzimático para detecção dos anticorpos contra os tipos 1,2,3,4,5,6 do VHC. As amostras foram diluídas e incubadas na presença de peptídeos heterólogos de competição, com antígenos sorotipo-específicos do VHC. Dos 219 pacientes, foi possível detectar o sorotipo do VHC em 166, revelando uma sensibilidade de 75,8%. Os resultados apresentaram a predominância do tipo 1 (70,0%) em nosso meio, seguido pelo tipo 3 (22,3%) e tipo 2 (4,2%). Os sorotipos 4 e 5 estiveram presentes para 1,8% dos pacientes, sempre associados com o sorotipo 1. Estas amostras, apesar de cumprirem os quesitos de validade do teste, apresentaram leituras de Densidade Ótica muito altas para todos os tipos virais testados, inclusive controles positivo e negativo e a possibilidade de reações cruzadas, nestes casos, deve ser considerada. A confirmação por genotipagem e uma investigação mais detalhada sobre a procedência e formas de aquisição do VHC destes pacientes devem ser pesquisados. O tipo 6 não foi confirmado em nenhuma das amostras testadas e provavelmente não estava presente nesta coleção de amostras avaliadas. Os parâmetros epidemiológicos avaliados foram: idade, sexo e vias de transmissão. Dos 166 pacientes com diagnóstico para o tipo do VHC, 108 (65,1%) eram homens e 58 (34,9%) mulheres. A idade dos pacientes variou de 12 a 73 anos (média 41,1). As formas de transmissão mencionadas foram 52 (31,3%) transfusão de sangue, 18 (10,8%) uso de drogas injetáveis, 8 (4,8%) tatuagens, 6 (3,6%) provável via sexual, 3 (1,8%) acidente com agulha, 2 (1,2%) trabalho em área de saúde, 1 (0,6%) acupuntura, 1 (0,6%) hemofílico. Sessenta e um pacientes (36,7%) não apresentaram fatores de risco que justificassem a aquisição da infecção pelo VHC. Não foi verificada diferença significativa entre os tipos do VHC encontrados e os parâmetros epidemiológicos estudados. A predominância dos tipos 1, 3 e 2 é compatível com outros estudos, de genotipagem, que envolveram amostras brasileiras, particularmente da cidade de São Paulo. As amostras que apresentaram leituras de Densidade Ótica altas ou baixas, para todos os poços de uma mesma amostra testada, inclusive controles positivo e negativo, sugerem a possibilidade de reações inespecíficas ou cruzadas e devem ser confirmadas por outras técnicas de genotipagem ou seqüenciamento. A praticidade oferecida pelo teste de sorotipagem do VHC, apesar de não identificar os subtipos, pode ser útil na prática clínica e auxiliar no prognóstico da doença, não necessitando da tecnologia exigida pelos testes que envolvem biologia molecular. / CAVALHEIRO, N.P. Analysis of serotypes of HCV in patients from the city of São Paulo, by means of a enzyme-immunoassay method. São Paulo, 1999. 97p. Dissertação de Mestrado - Faculdade de Medicina, Universidade de São Paulo. With the objetive of analysing the prevalence of the different types of Hepatitis C Virus (HCV) in a population of chronic carriers of HCV, through a sorologic method (MUREX HCV Serotyping Assay), 219 patients were studied who showed a positive polymerase chain reaction. This sera were submitted to immunoenzimatic tests for the detection of antibodies in relation to HCV types 1, 2,3,4,5 and 6. The samples were diluted and incubated in the presence of heterologous competing peptides, with microwells coated with serotype-specific antigens of HCV. Of the 219 patients, it was possible to detect the HCV serotype in 166, revealing a sensitivity of 75.8%. The results showed a predominance of type 1 (70.0%) in our medium, followed by type 3 (22.3%) and type 2 (4.2%). Serotypes 4 and 5 were present in 1.8% of the patients, but always associated with serotype 1. These samples, in spite of fulfilling the prerequisites of validity for testing, showed a very high optical density reading for all types of viruses tested, including positive and negative controls. The possibility of cross reactions in these cases should be considered. Confirmation by genotyping and a more detailed investigation on the origin and mode of acquisition of the HCV of these patients should be researched. Type 6 was not confirmed in any of the samples tested and probably was not present in this particular collection. The epidemiological parameters evaluated were: age, sex and means of transmission. Of the 166 patients diagnosed with the HCV, 108 (65.1%) were men and 58 (34.9%) were women. The age of the patients varied from 12 to 73 years, the average being 41.1 years. The means of transmission mentioned were blood transfusion in 52 (31.3%) cases, intravenous drug use in 18 (10.8%) cases, by tatoos in 8 (4.8%) cases, 6 (3.6%) cases were sexually transmitted, 3 (1.8%) were by accident with a needle, 2 (1.2%) through work in the health field, one (0.6%) through acupunture and one by being hemophiliac. Sixty one (36.7%) patients were not able to offer any risk factor which justified the acquisition of the HCV infection. No significant difference was verified among the different types of HCV found and the different epidemiological parameters studied. The predominance of types 1, 3 and 2 is compatible with other genotyping studies which involved Brazilian samples, particularly in the city of São Paulo. The samples which showed high or low dense optical reading for all the wells of the same samples tested even the positive or negative controls, suggested confirmation by sequecing or genotyping. The praticality obtained by the HCV serotyping test, in spite of the fact that it does not identify the sub type, can be useful in clinical pratice and helpful in the prognostication of the disease, not needing the tecnology demanded by the tests which involve molecular biology.

Hepatitis C virus (HCV), a blood-borne pathogen, is a small enveloped RNA virus belonging to the Hepacivirus genus of the Flaviviridae family. HCV infection represents one of the major health concerns affecting approximately 170 million people globally. Patients with chronic HCV infection are at risk of developing hepatic fibrosis, cirrhosis and hepatocellular carcinoma. No protective anti-HCV vaccine is available yet. Until recently, standard therapy based on pegylated interferon plus ribavirin, was inadequate in treating all the patients as it results in a sustained virological response in only 40 to 50 percent of patients infected with the most common genotype (gt 1). Advances in understanding host-HCV interactions have helped developing newer anti-HCV agents such as telaprevir and boceprevir. However, treatment success is still limited due to different factors including genotype specificity, high cost, potential drug-drug interactions, substantial side effects etc. The positive-sense single-stranded RNA genome of HCV is approximately 9.6kb long which is flanked by highly structured and conserved 5’ and 3’ untranslated regions (UTRs) at both ends. Unlike cap-dependent translation of host cell mRNAs, HCV translation is mediated by an internal ribosomal entry site (IRES) present majorly within the 5’UTR. Several reports have demonstrated the interaction of different cellular proteins with HCV-5’UTR and/or 3’UTR, which include human La protein, polypyrimidine tract binding protein (PTB), poly (rC)-binding protein 2 (PCBP2) etc. These interactions of trans-acting factors with the UTRs may be important for HCV translation and/or replication. Earlier study from our laboratory revealed the importance of interaction of human La protein, by its central RNA recognition motif (RRM), with the HCV IRES around a tetranucleotide sequence GCAC near initiator AUG in influencing HCV translation. However, the role of this interaction, if any, in HCV RNA replication was not known. In the first part of the thesis, we characterized the interaction between human La protein and the GCAC to understand its role in HCV replication. We incorporated mutation, which altered the binding of La, in the GCAC motif in HCV monocistronic replicon and checked HCV RNA replication by reverse transcriptase polymerase chain reaction (RT-PCR). The mutation drastically inhibited HCV replication. Interestingly, overexpression of La could reverse the effect of this mutation and significantly enhanced HCV RNA levels. Using a bicistronic replicon, we observed that decrease in replication was independent of translation inhibition. Furthermore, mutation at the GCAC motif reduced the association between La and viral polymerase, NS5B as seen in co-immunoprecipitation assays. Moreover, this mutation affected translation to replication switch regulated by the interplay between HCV-NS3 protease and human La protein. Our analyses of point mutations, based on RT-PCR and luciferase assays, revealed distinct roles of each nucleotide of the GCAC motif in HCV replication and translation. Finally, 5’-3’ crosslink assays revealed that specific interaction of the GCAC motif with human La protein is important for linking 5’ and 3’ends of HCV genome. Results clearly demonstrate the mechanism of regulation of HCV replication by interaction of cis-acting element GCAC within the HCV IRES with human La protein. HCV is highly species-specific. Under natural conditions, HCV infects only humans and chimpanzees. This restricted host-tropism has prevented the development of a small animal model to study HCV infection in vivo. Although several human-specific entry factors have been identified to be responsible for this species selectivity, full multiplication of the HCV in animals (other than humans and chimpanzees) is still not possible. In the second part of the thesis, we showed that a post-entry host factor –‘La protein’ may also contribute in determining HCV host tropism. We aligned La protein sequences from different species and interestingly we found that HCV RNA interacting beta-turn sequence (KYKETDL) in central RRM (residues 112-184) is conserved only in human and chimpanzee. Earlier, it was shown from our laboratory that a heptameric peptide comprising of this sequence (derived from human La) could inhibit HCV translation by competing with La interaction with the IRES element. However, in the current study, another peptide corresponding to the mouse La sequence (KYKDTNL) was unable to inhibit HCV RNA translation. Similarly, wild-type mouse La (mLa) failed to stimulate HCV IRES function, but addition of chimeric mouse La protein bearing human beta-turn sequence (mLahN7) significantly increased HCV IRES mediated translation in vitro. Also, exogenous supplementation of mLahN7 enhanced HCV translation in cell culture system. Moreover, quantitative as well as tagged RT-PCR analyses showed an enhanced HCV replication upon overexpression of mLahN7. The findings obtained in this part raise a possibility of creating HCV mouse model using human specific cellular entry factors and a humanized form of La protein. Hepatitis C has emerged as a major challenge to the medical community. Developing more potent and safe anti-HCV regimens is need of the hour. As described above, a linear hepatapeptide (KYKETDL) was synthesized and shown to reduce HCV translation. However, this linear peptide was stable only for a shorter time scale. Therefore, in the third part of the thesis, effect of a more stable cyclic form of this peptide has been described. NMR spectroscopy suggested that the beta turn conformation is preserved in cyclic peptide as well. Also, using in vitro bicistronic reporter assay, we demonstrated that cyclic peptide inhibits HCV translation in a dose dependent manner. In fact, due to its higher stability, cyclic peptide reduced HCV translation and replication more efficiently than the corresponding linear peptide at longer post-treatment time point. Additionally, we observed that cyclic peptide is non-toxic in cell culture system. Our results suggest that cyclic peptide might emerge as a promising lead compound against hepatitis C. Due to availability of only partially effective liver protective drugs in modem medicine, complementary and alternative medicine approach, based on plant derived compounds, is also being utilised against HCV. Plant derived compounds have advantages of having high chemical diversity, drug-likeliness properties and ability of being metabolized by the body with little or no toxicity than synthetic ones. Different studies have shown that phytochemicals may exert anti-HCV activities by acting as direct-acting antivirals and play a potential therapeutic role in treating HCV infection. Also, from our laboratory, it was shown that methanolic extract of Phyllanthus amarus (P. amarus) plant inhibited HCV replication. The fourth part of the thesis describes the study on the anti-HCV properties of several bioactive components from P. amarus extract. Using a fluorimetric assay, we demonstrated that two principal components of this extract, phyllanthin and corilagin reduced the HCV NS3 protease activity significantly in vitro. We also observed a sharp reduction in HCV negative sense RNA levels in cell culture system. Structural knowledge-based molecular docking studies showed interactions of phyllanthin and corilagin with the amino acid residues of the catalytic triad of NS3 protease. Further, these compounds were found to be non-toxic in cell culture. Also, phyllanthin and corilagin displayed antioxidant properties by blocking HCV induced oxidative stress generated by reactive oxygen species suggesting their hepatoprotective nature. More importantly, our in vivo toxicity analyses and pharmacokinetics studies proved their safety, tolerability, metabolic stability, and systemic oral bioavailability and support their potential as novel anti-HCV therapeutic candidates. Altogether, the study deciphers mechanistic details of translation and replication of HCV RNA and demonstrates novel antiviral agents targeting these important viral processes.

Hepatitis C Virus (HCV) is a positive-strand RNA virus that has infected more than 3% of the world population. Chronic infections by the virus lead to cirrhosis and hepatocellular carcinoma. HCV is currently the leading cause for liver transplantation in the US. The nonstructural protein NS5B of HCV is the RNA-dependent RNA polymerase (RdRp) that replicates the viral RNA on host derived membranous structures. Structurally NS5B has the characteristic fingers, thumb and palm domains seen in all polymerase proteins. However, extensive interactions between the fingers and thumb domains completely encircle the active site of NS5B as seen in solved X-ray diffraction crystal structures. These interactions are primarily mediated by a short (35 residues) flexible loop called the Delta 1 loop. NS5B produced from heterologous systems can initiate RNA synthesis by a de novo initiation mechanism from 3?ends of RNA templates or can also extend from 3'ends of primers that are annealed stably to a template RNA in biochemical assays. The closed conformation of NS5B as per X-ray crystal structures can only accommodate a ssRNA but not a dsRNA, hence necessitating a conformational change between de novo initiation and elongation. The details of these conformational changes are not known and will prove to be important to design potent polymerase inhibitors. The study performed for this dissertation focused on the conformational requirements of NS5B during de novo initiation and primer extension (or elongation). Biochemical assays utilizing template RNAs that can lead to both de novo initiation and primer extension products were utilized, and a systematic mutational analysis of the template channel of the RdRp was performed. Mutants W397A and H428A were identified that showed only primer extension but no de novo initiation. Structural analysis of NS5B suggested that these residues were important contact points in the Delta 1 loop and thumb domain interactions. A deletion mutant, m26-30 with a five amino acid deletion at the apex of the Delta 1 loop also failed in de novo initiation but not primer extension reactions. Biophysical and gel shift assays showed that m26-30 was in a more open conformation than the WT enzyme. Furthermore, oligomerization of NS5B was demonstrated and its role in RNA synthesis was examined. It was found that the de novo initiation competent conformation of NS5B is maintained by oligomeric contacts between individual subunits, likely by stabilizing the Delta 1 loop and thumb domain interactions. Mutations disrupting the Delta 1 loop and thumb domain interactions as well as those in the allosteric GTP binding site induced conformational changes in the protein partially explaining the defect in de novo initiation activity in enzymes carrying those mutations. These results not only contribute to the overall mechanism of RNA synthesis in viral RdRps but also open new avenues for developing HCV polymerase inhibitors.

Hepatitis C virus (HCV) infects an estimated 200,000 people in Canada, and is the leading cause of liver transplants in North America. Viral infection usually leads to chronic infection, and complications include liver fibrosis, steatosis and hepatocellular carcinoma (HCC). The HCV non-structural proteins 3 and 4A (NS3/4A), is a multifunctional protein complex with roles in RNA replication and polyprotein processing. Additionally, the NS3 protease has been shown to induce advanced cellular transformation in vivo and tumour formation in nude mice. However, the mechanism by which transformation occurs remains unknown. The objective of this study was to determine if the naturally occurring NS3/4A protein complex, rather than the NS3 protease domain on its own, could also induce cellular transformation and to determine the changes that NS3/4A expression had on the host cell proteome.

Made available in DSpace on 2014-06-12T15:52:33Z (GMT). No. of bitstreams: 2 arquivo415_1.pdf: 1541390 bytes, checksum: 2ab8d4738aeb89e4edfdfacd804ccf72 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2010 / Faculdade de Amparo à Ciência e Tecnologia do Estado de Pernambuco / A lectina ligadora de manose (mannan binding lectin - MBL) é membro das glicoproteínas plasmáticas, um grupo de proteínas que se caracteriza pela interação com um ou mais resíduos de açúcares específicos expressos em vários sistemas biológicos. Concentrações reduzidas de MBL tem sido relacionadas com a diminuição na resposta a varias doenças infecciosas. Inúmeras formas oligoméricas da MBL, com diferentes capacidades funcionais, são encontradas no sangue humano. Estudos controversos lidam com a possível associação entre mutações no gene da MBL e a infecção com o vírus da hepatite C (hepatitis C vírus - HCV). Não existem associações significativas entre pacientes com baixos níveis séricos de MBL e as características de desenvolvimento da doença, incluindo a resposta a terapia antiviral. O presente estudo teve como objetivo propor um ensaio prático para purificação de formas moleculares de MBL em amostras de soro de pacientes infectados com HCV visando investigar a estrutura e o genótipo desta lectina. Os resultados do ensaio de dot-N-man demonstraram uma boa eficiência na separação da MBL utilizando membrana de nitrocelulose revestida de manana. A identificação de MBL foi confirmada em todos os genótipos por método convencional de dot-ELISA. Bandas protéicas em gel de eletroforese revelaram diferentes padrões de migração entre os genótipos AA, A0 e 00, entre 50-90 KDa, e 270 KDa, relacionadas com a variação de baixa e alta massa molecular da subunidade estrutural de MBL, respectivamente. Nas amostras de SDS-PAGE não redutora observou-se uma maior variedade de massas moleculares, como dímeros, trímeros, e as unidades estruturais de MBL, principalmente em indivíduos AA. A analise de western blotting confirmou a presença de alta (128 KDa) e baixa (32KDa) massas moleculares da MBL. Foi também observada a presença de MBL com massa molecular de 128 KDa, a qual não é muito comum. Os resultados mostraram que ambas, baixa e alta formas moleculares, foram identificadas e também houve variação com a genotipagem dos pacientes. Os resultados descrevendo o proteoma das formas moleculares de MBL em pacientes com HCV contribuíram para melhor compreensão da estrutura/genótipo da MBL nesta patologia que pode estar associada à resposta ao tratamento