Orientador: Haroldo Wilson Moreira / Banca: Ivan de Lucena Angulo / Banca: Ana Maria de Souza / Banca: Luiz Carlos de Mattos / Banca: Amauri Antiquera Leite / Resumo: As hemoglobinopatias constituem um grupo de alterações hereditárias prevalentes em muitas regiões do mundo, atingindo a população brasileira de forma significativa; sendo decorrentes de alterações em genes estruturais, responsáveis pelo aparecimento das hemoglobinas variantes ou em genes reguladores, resultando as talassemias. Sendo assim, foram propósitos do presente trabalho estabelecer metodologia laboratorial embasada em estudo molecular que possibilite o auxílio diagnóstico de hemoglobinas anormais observadas na população brasileira e sem caracterização completa ou pouco informativa; utilizar primers que se acoplem exatamente na posição da mutação do alelo mutante e na respectiva posição do alelo normal, com possibilidade da realização de amplificação gênica alelo específica e com esses conhecimentos, estabelecer protocolos de aplicação laboratorial para uso na rotina. As amostras de estudo foram constituídas por 20 modelos de mutações pertencentes a portadores das mesmas e que inicialmente apresentavam alterações em seu perfil eletroforético, sendo coletadas ou do próprio sujeito da pesquisa ou obtidas de banco de amostras. Os indivíduos eram de ambos os sexos, com diferentes idades e características raciais (caucasóides e não caucasóides) e pertencentes às diversas classes econômicas. Os resultados obtidos permitem concluir que foi possível padronizar um teste diagnóstico, baseado na amplificação gênica alelo específica (PCR-AE) e na amplificação gênica multiplex (PCR-Multiplex). / Abstract: The hemoglobinopathies are a group of hereditary hemoglobin disorders with worldwide distribution, meeting Brazilian population significantly; being decurrent from structural genes alterations, responsible for hemoglobin variants or in regulatory genes, results the thalassemia. The results permit us to conclude that it was possible to standardize a diagnostic test, based on allele-specific amplification (PCR-AE) and multiplex PCR assay. The applicability of these methodologies give us confidence on results interpretation, and it is easy of execution, and with cost around 25% less of methods that uses restriction enzyme analysis, and can offer us a laboratory diagnostic in a short time. The methodologies or association of obtained knowledge gave us the possibility to identify homozygous, heterozygous and interactions, and was possible to establish specific protocols to identify hemoglobinopathies that attacks our population, and can be used on laboratorial routines. / Doutor

Made available in DSpace on 2014-06-11T19:30:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-11-16Bitstream added on 2014-06-13T18:40:37Z : No. of bitstreams: 1 bertholo_lc_dr_arafcf.pdf: 784726 bytes, checksum: 896d3466d9d683acd711a4c3515e98a6 (MD5) / Universidade Estadual Paulista (UNESP) / As hemoglobinopatias constituem um grupo de alterações hereditárias prevalentes em muitas regiões do mundo, atingindo a população brasileira de forma significativa; sendo decorrentes de alterações em genes estruturais, responsáveis pelo aparecimento das hemoglobinas variantes ou em genes reguladores, resultando as talassemias. Sendo assim, foram propósitos do presente trabalho estabelecer metodologia laboratorial embasada em estudo molecular que possibilite o auxílio diagnóstico de hemoglobinas anormais observadas na população brasileira e sem caracterização completa ou pouco informativa; utilizar primers que se acoplem exatamente na posição da mutação do alelo mutante e na respectiva posição do alelo normal, com possibilidade da realização de amplificação gênica alelo específica e com esses conhecimentos, estabelecer protocolos de aplicação laboratorial para uso na rotina. As amostras de estudo foram constituídas por 20 modelos de mutações pertencentes a portadores das mesmas e que inicialmente apresentavam alterações em seu perfil eletroforético, sendo coletadas ou do próprio sujeito da pesquisa ou obtidas de banco de amostras. Os indivíduos eram de ambos os sexos, com diferentes idades e características raciais (caucasóides e não caucasóides) e pertencentes às diversas classes econômicas. Os resultados obtidos permitem concluir que foi possível padronizar um teste diagnóstico, baseado na amplificação gênica alelo específica (PCR-AE) e na amplificação gênica multiplex (PCR-Multiplex). / The hemoglobinopathies are a group of hereditary hemoglobin disorders with worldwide distribution, meeting Brazilian population significantly; being decurrent from structural genes alterations, responsible for hemoglobin variants or in regulatory genes, results the thalassemia. The results permit us to conclude that it was possible to standardize a diagnostic test, based on allele-specific amplification (PCR-AE) and multiplex PCR assay. The applicability of these methodologies give us confidence on results interpretation, and it is easy of execution, and with cost around 25% less of methods that uses restriction enzyme analysis, and can offer us a laboratory diagnostic in a short time. The methodologies or association of obtained knowledge gave us the possibility to identify homozygous, heterozygous and interactions, and was possible to establish specific protocols to identify hemoglobinopathies that attacks our population, and can be used on laboratorial routines.

Submitted by Nathan da Rocha Neves Cruz (nathan_cruz@hotmail.com) on 2016-05-23T20:27:08Z No. of bitstreams: 1 CRUZ, N R N Dissertação FCAV 2016.pdf: 1407515 bytes, checksum: fedc8b43e90de16bd74b61d1621c28ad (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-05-25T18:00:38Z (GMT) No. of bitstreams: 1 cruz_nrn_me_jabo.pdf: 1407515 bytes, checksum: fedc8b43e90de16bd74b61d1621c28ad (MD5) / Made available in DSpace on 2016-05-25T18:00:38Z (GMT). No. of bitstreams: 1 cruz_nrn_me_jabo.pdf: 1407515 bytes, checksum: fedc8b43e90de16bd74b61d1621c28ad (MD5) Previous issue date: 2016-02-29 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A hemoglobina é uma proteína globular composta por fração protéica (cadeias de globina), fração heme onde ocorre a ligação do íon bivalente de ferro, sendo que, as globinas combinadas ajudam a tipificar as hemoglobina em Hb Adulta (Hb A), Fetal (Hb F) e Adulta 2 (Hb A2). Na deficiência de ferro, que pode culminar anemia por disfunção eritropoiética, prevalente em leitões e seres humanos, a hemoglobina pode ter alterações estruturais denominadas hemoglobinopatias. O estudo determinou a influência do ferro nos tipos de hemoglobina de leitões neonatos. Perante os resultados se verificou que hemoglobina do leitão tem corrida semelhante à humana, e nos animais que apresentaram anemia ferropriva não houve aparecimento do traçado Hb A2, que pode estar diminuída em casos de deficiência de ferro em seres humanos. / Hemoglobin is a globular protein consisting of the protein fraction (globin chains), heme fraction which is the binding of the bivalent iron ion, and the combined globin help classify the hemoglobin in Hb Adult (Hb A), Fetal (Hb F) and Adult 2 (Hb A2). The iron deficiency can predispose anemia by erythropoietic dysfunction, prevalent in pigs and humans and the hemoglobin may have structural changes denominated hemoglobinopathies. The study determined the influence of iron to the types of hemoglobin neonate pigs. On the results was found that the pig hemoglobin is similar to human in electrophoresis. The piglets showed deficiency anemia there was appearance of line Hb A2, which may be diminished in cases of iron deficiency in humans. / CNPq: 158890/2015-9 / CNPq: 130399/2014-0 / CAPES: 23028003201-2014-41

Made available in DSpace on 2016-08-10T10:39:07Z (GMT). No. of bitstreams: 1 MARIANA SCHWENGBER RABELO.pdf: 832715 bytes, checksum: 2706eef7f6a3e8662625069e50c1529d (MD5) Previous issue date: 2014-10-09 / The hemoglobinopathies are a group of heritable changes prevalent in various regions of the world, but significantly affect the Brazilian population for its abundant miscegenation. Are changes in structural genes that cause the formation of hemoglobin variants, and - or regulatory genes, causing thalassemias. Currently, the number of identified abnormal hemoglobin has increased due to improvements in methods of analysis, however, many routine laboratories are not prepared for the correct identification of these changes. In the present study aimed to assess the prevalence of hemoglobinopathies using classical methods and make the molecular characterization of mutations S, C, beta thalassemia IVS-110, IVS-1, IVS-6 and CD-39 by gene amplification using the PCR technique (Polymerase Chain Reaction). The molecular study used specific primers that bind promptly at the position of the mutated allele in position and the normal allele can thereby carry out gene allele specific amplification. 200 peripheral blood samples of patients of the Clinical Laboratory at PUC-Goiás were collected during July - December 2012-2012. The results showed the validity of the methodology in the molecular characterization of mutations, two (1%) AC patients, an one (0,5%) AS, two (1%) with mutation IVS-6 and one (0,5%) IVS-1 observed. The codon 39 and IVS-110 were not detected in any of the patients investigated. / As hemoglobinopatias formam um grupo de alterações hereditárias prevalentes em várias regiões do mundo, mas atingem significativamente a população brasileira por sua miscigenação abundante. São alterações em genes estruturais, que ocasionam a formação de hemoglobinas variantes, e-ou em genes reguladores, causando as talassemias. Atualmente, o número de hemoglobinas anormais identificadas tem aumentado devido à melhoria nas metodologias de análises, no entanto, muitos laboratórios de rotina não estão preparados para a correta identificação destas alterações. No presente estudo objetivamos avaliar a prevalência das hemoglobinopatias por meio de métodos clássicos e fazer a caracterização molecular das mutações S, C, beta talassemia IVS-110, IVS-1, IVS-6 e CD-39 pela amplificação gênica utilizando a técnica do PCR-AE. O estudo molecular utilizou primers específicos que se ligam pontualmente na posição do alelo mutado e na respectiva posição do alelo normal, podendo assim realizar amplificação gênica alelo específica. Foram coletadas 200 amostras de sangue periférico de pacientes do Laboratório Clínico da PUC-Goiás no período de julho-2012 a dezembro-2012. Os resultados evidenciaram a validade da metodologia molecular na caracterização das mutações, sendo observados dois pacientes (1%) AC, um (0,5%) AS, dois (1%) com mutação IVS-6 e um (0,5%) IVS-6. O códon 39 e IVS-110 não foram detectados em nenhum dos pacientes investigados.

<p>The interaction between nutritional status and malaria disease is complex and often controversial. Nutritional deficiencies (macro- or micro-nutrient) are thought to lead to malnutrition with subsequent susceptibility to malaria infection. On the other hand severe malaria or repeated malaria infections lead to malnutrition. While the cause and effect are difficult to attribute, micronutrient deficiencies such as iron deficiency and malaria infection often co-exist and show complex interactions leading to mutually reinforced detrimental clinical effects.</p><p>That iron deficiency has adverse effects on human health is widely recognized. Iron plays a crucial role in processes of growth and cell division and in the transport of oxygen throughout the body. It is also important for the proliferation of cells of the immune system as well as for microorganisms including the malaria parasite. Iron deficiency results in a decrease in hemoglobin concentrations and subsequent anemia. However, the etiology of anemia is multi-factorial and may be affected, in addition, by several factors including malaria and host factors, especially hemoglobinopathies such as alpha-thalassemia and sickle cell trait. These hemoglobinopathies are also common in malaria endemic areas.</p><p>In this thesis, we have investigated the relationship between nutritional status, immunity, hemoglobinopathies and <i>falciparum</i> malaria in a cohort of children less than 8 years old living on the coast of Kenya. We have found that malaria was associated with malnutrition in an age-dependent fashion. Malaria was associated with subsequent underweight or stunting in children under the age of 2 years, but this effect was not there in older children. Also, we observed that iron deficiency was associated with protection of children against clinical malaria. Children who were iron deficient had a lower incidence of malaria episodes as compared to those who were iron replete.</p><p>While studies on the effects of single micronutrient deficiencies on components of the immune system are difficult to design and interpret, there is ample evidence that micronutrient deficiencies, in general, affect all components of immunity. In line with this, we found that nutritional iron status was associated with certain malaria-specific immunoglobulins and interleukin-4 mRNA levels. Iron deficient children had lower levels of malaria-specific IgG2 and IgG4 but higher expression levels of IL-4 mRNA as compared to the iron replete children. Finally, we observed a tendency towards a higher prevalence of iron deficiency in children carrying either alpha-thalassemia or sickle cell trait.</p>

The interaction between nutritional status and malaria disease is complex and often controversial. Nutritional deficiencies (macro- or micro-nutrient) are thought to lead to malnutrition with subsequent susceptibility to malaria infection. On the other hand severe malaria or repeated malaria infections lead to malnutrition. While the cause and effect are difficult to attribute, micronutrient deficiencies such as iron deficiency and malaria infection often co-exist and show complex interactions leading to mutually reinforced detrimental clinical effects. That iron deficiency has adverse effects on human health is widely recognized. Iron plays a crucial role in processes of growth and cell division and in the transport of oxygen throughout the body. It is also important for the proliferation of cells of the immune system as well as for microorganisms including the malaria parasite. Iron deficiency results in a decrease in hemoglobin concentrations and subsequent anemia. However, the etiology of anemia is multi-factorial and may be affected, in addition, by several factors including malaria and host factors, especially hemoglobinopathies such as alpha-thalassemia and sickle cell trait. These hemoglobinopathies are also common in malaria endemic areas. In this thesis, we have investigated the relationship between nutritional status, immunity, hemoglobinopathies and falciparum malaria in a cohort of children less than 8 years old living on the coast of Kenya. We have found that malaria was associated with malnutrition in an age-dependent fashion. Malaria was associated with subsequent underweight or stunting in children under the age of 2 years, but this effect was not there in older children. Also, we observed that iron deficiency was associated with protection of children against clinical malaria. Children who were iron deficient had a lower incidence of malaria episodes as compared to those who were iron replete. While studies on the effects of single micronutrient deficiencies on components of the immune system are difficult to design and interpret, there is ample evidence that micronutrient deficiencies, in general, affect all components of immunity. In line with this, we found that nutritional iron status was associated with certain malaria-specific immunoglobulins and interleukin-4 mRNA levels. Iron deficient children had lower levels of malaria-specific IgG2 and IgG4 but higher expression levels of IL-4 mRNA as compared to the iron replete children. Finally, we observed a tendency towards a higher prevalence of iron deficiency in children carrying either alpha-thalassemia or sickle cell trait.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Orientador: Claudia Regina Bonini Domingos / Banca: Ricardo Luiz Dantas Machado / Banca: Paula Rahal Liberatore / Resumo: A talassemia beta constitui um grupo heterogêneo de distúrbios genéticos da síntese de hemoglobina sendo uma das doenças monogênicas mais comums, identificada e estudada por várias décadas. É originária da região do Mediterrâneo porém, atualmente apresenta-se amplamente distribuída pelo mundo devido ao fluxo gênico pela migração das populações. No Brasil, os tipos de talassemia mais prevalentes são as talassemias alfa e beta e apresentam número variável de indivíduos portadores devido ao alto grau de miscigenação da população. As formas graves de talassemia beta são facilmente diagnosticadas entretanto, as formas mais suaves muitas vezes são interpretadas e tratadas como anemia ferropriva. O presente estudo teve como objetivo caracterizar as formas talassêmicas do tipo beta e verificar os interferentes na expressão do fenótipo como a possível co-herança com hemocromatose hereditária. Através da associação de análise hematimétrica, metodologias clássicas e análise por HPLC analisamos 332 amostras de sangue com suspeita de talassemia beta. Um total de 70 amostras foram identificadas como portadores de hemoglobinas normais (AA), 145 portadores de talassemia beta heterozigota (BTH) e 117 portadores de talassemia alfa/beta (ABT). A análise estatística por regressão linear entre as metodologias clássicas e HPLC para quantificação de hemoglobina A2 e Fetal para os três grupos foram estatisticamente significativas. A análise molecular por PCR-ASO para identificação dos mutantes para hemocromatose hereditária mostraram 11,76% de mutação C282Y e 70,58% para H63D no grupo de talassemia beta e 25% de mutação C282Y e 75% H63D para o grupo de talassemia alfa/beta. Esses resultados evidenciam a necessidade da associação de metodologias para o correto diagnóstico da talassemia beta, bem como caracterização molecular para hemocromatose...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The beta-thalassemia constitutes a heterogeneous group of genetic disorders of hemoglobin synthesis. It has been one of the most common monogenic diseases identified and studied for many decades. Its origins are from Mediterranean region, although nowadays it is spread for the whole world due to gene flow of migration populations. In Brazil, the most prevalent types of thalassemia are the alpha-thalassemia and beta-thalassemia. They present a variable number of individual carriers due to high degree of miscigenation. The serious forms of beta-thalassemia are easily identified, but the milder forms are many times diagnosed and treated as iron deficiency anemia. The objective of the present study was to characterize the thalassemic forms and verify the interferents in the expression of the phenotype as the possible co-inheritance with hereditary hemochromatosis. It was analysed, utilizing hematimetric analysis, classic methodologies and HPLC analysis, 332 blood samples suspect of beta-thalessemia. The total of 70 samples were identified as carriers of normal hemoglobins (AA), 145 carriers of beta-thalassemia heterozigote (BTH) and 117 carriers of alpha/beta-thalassemia (ABT). The statistic analysis by linear regression between classic methodologies and HPLC for quantification of hemoglobin A2 and Fetal hemoglobin were statistically differents and significants. The molecular analysis by PCR-ASO to identify the mutants with hereditary hemochromatosis showed 11,76% of mutation C282Y and 70,58% to H63D in the beta-thalassemia group and 25% of mutation C282Y and 75% of H63D in the alpha/beta- thalassemia group. These results prove the necessity of association of methodologies in order to achieve the correct diagnosis of beta-thalassemia, as well as the molecular characterization of hemochromatosis, due to the fact of its possible co-inheritance with beta-thalassemia in the vast genotypic diversity found in Brazil. / Mestre

Xing Hongtao. / "February 2003." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (p. 149-176). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

INTRODUÇÃO: As Hemoglobinopatias podem ser divididas em Talassemias e Doença Falciforme (DF), mas do ponto de vista clínico, ambas apresentam um quadro de anemia hemolítica crônica, o que acarreta uma série de complicações, entre estas a Hipertensão Pulmonar (HP). Estima-se que cerca de 20-40% da população com DF/talassemia apresente HP, sendo que este diagnóstico está associado a uma elevada morbi-mortalidade. Poucos estudos avaliaram esta prevalência em crianças. O Objetivo deste estudo foi avaliar a prevalência desta complicação na população pediátrica, e associá-la com características clínicas e laboratoriais. MÉTODOS: Estudo de Corte Transversal, com avaliação de 45 pacientes com diagnóstico de DF ou Talassemia maior/ intermédia entre 3-18 anos, atendidos de forma consecutiva no ambulatório de Hemoglobinopatias do HCPA. Os pacientes foram submetidos a um ecocardiograma para estimativa da pressão sistólica da artéria pulmonar, sendo que foi considerado como tendo risco de HP os pacientes com velocidade de regurgitação tricúspide (VRT) ≥ 2,5m/s. Foram obtidos dados clínicos e laboratoriais para avaliação dos parâmetros hemolíticos, função hepática e renal por levantamento de prontuário e comparados os grupos. RESULTADOS: 15% (6/40) dos pacientes apresentaram VRT ≥ 2,5m/s, sugestivo de HP, sendo que destes pacientes todos tinham diagnóstico de Anemia Falciforme (AF). Considerando apenas esta população, a prevalência de HP aumenta para 20% (6/30). A população com VRT ≥ 2,5m/s apresentou média de idade mais elevada, Hb mais baixa, RDW mais alargado, reticulócitos e LDH mais elevado que o grupo com VRT < 2,5m/s. A principal intercorrência clínica nesta população foi a ocorrência de priapismo (p< 0,05). CONCLUSÕES: Os pacientes com Hemoglobinopatias estão em risco aumentado para desenvolvimento de HP desde a infância, principalmente aqueles com AF. Estes pacientes apresentam os parâmetros laboratoriais sugestivos de hemólise alterados, assim como outros sintomas associados ao quadro hemolítico como o priapismo quando comparados com pacientes com VRT normal. Desta forma sugere-se a realização de triagem com ecocardiograma nesta população de forma precoce. / INTRODUCTION: The Hemoglobinopathies can be divided in Thalassemias and Sickle Cell Disease (SCD), but clinically both present with chronic hemolytic anemia, which leads to various complications, one of them being Pulmonary Hypertension (PH). About 20-40% of patients with SCD have PH, and this diagnosis is associated with a high risk of mortality. The objective of this study was to estimate the prevalence of this complication in the pediatric population, and associate clinical and laboratory characteristics. METHODS: A cross sectional descriptive study, with the evaluation of 45 patients with diagnosis of SCD or thalassemia major/intermedia between 3-18 years, which received treatment at the Hemoglobinopathies ambulatory at HCPA. The patients were submitted to an echocardiogram to estimate the pulmonary artery systolic pressure, being considered to have PH patients with a tricuspid regurgitate jet velocity (TRV) ≥ 2.5m/s. Clinical and laboratory data were obtained to evaluate hemolytic parameters, renal and liver function and compared between groups. RESULTS: 15% (6/40) of patients had a TRV ≥ 2.5m/s, suggestive of PH, of which all had Sickle Cell Anemia (SCA). Considering this group of patients alone the prevalence would be of 20% (6/30). Patients with TRV ≥ 2.5m/s had a higher median age, lower hemoglobin count, higher RDW, reticulocyte and DHL then patients with a TRV < 2.5m/s. The major clinical feature was the occurrence of priapism (p<0,05). CONCLUSIONS: Patients with diagnosis of hemoglobinopathies are at higher risk of developing PH since early childhood, especially those with SCA. These patients showed a higher level of hemolytic parameters, as well as symptoms associated with hemolysis, like priapism, when compared with patients with a normal TRV. Therefore, it would be indicated to submit these patients to an echocardiogram routinely in their early years.