Orientador: Márcia Ferreira da Rosa Sobreira / Coorientador: Annelise Carla Camplesi / Banca: Fábio Nelson Gava / Banca: Sabryna Gouveia Calazans / Resumo: Tumores mamários são frequentes em cadelas e apresenta comportamento biológico semelhante aos que ocorrem nas mulheres, tornando a cadela um excelente modelo de estudo comparativo. Os distúrbios hemostáticos são achados comuns em pacientes humanos com câncer, e os mecanismos que conduzem a ativação da coagulação no câncer envolvem o fator tissular, o fator procoagulante do câncer e as citocinas inflamatórias. E já está bem estabelecido que os componentes da hemostasia, como as plaquetas, proteínas da coagulação e da fibrinólise apresentam um papel importante no crescimento e na progressão do tumor. Assim, o objetivo deste estudo foi realizar a caracterização clínica, hematológica e histopatológica de cadelas acometidas por carcinoma mamário, bem como avaliar a integridade do sistema hemostático, através da mensuração do fibrinogênio plasmático, da contagem total de plaquetas, dos tempos de tromboplastina parcial ativada e de protrombina. Para tanto, foram utilizadas 62 cadelas. Sendo 32 acometidas por carcinoma mamário e 30 cadelas clinicamente e laboratorialmente saudáveis como grupo controle. Foram formados quatro subgrupos de acordo com o tipo e o grau histopatológico, estadiamento clínico e tamanho do tumor. Todas as cadelas acometidas por lesões mamárias foram submetidas ao exame físico das glândulas mamárias, exames de hemograma, testes de coagulação e ao exame de histopatológico. E os proprietários submetidos à anamnese por meio de questionário. A apresentação clínica ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Mammary tumors are frequently found in female dogs. These tumors have shown a biological behavior similar to breast cancer in woman. This makes female dogs an excellent comparative study model. Coagulation disorders are common in human patients with cancer. Hemostasis is activated by inflammatory cytokines, tissue and procoagulant factors. It is well established that coagulation components as platelets and coagulation and fibrinolytic proteins have an important function in the growth an progression of tumors. Thus, the aim of this paper was to characterize clinical, hematological and histopathology female dogs with mammary carcinoma and evaluate the integrity of the hemostatic system by measuring the plasma fibrinogen, the total platelet count, and the activated partial thromboplastin and prothrombin time in female dogs. Sixty-two female dogs were used in this study. Thirty-two had mammary carcinoma and thirty were laboratorial and clinically healthy to be used as the control group. Four groups were formed according to histological type and grade, clinical stage and tumor size. The 32 female dogs with carcinoma were submitted to physical mammary gland, blood count, histopathological examinations and coagulation tests and their owners were submitted to a questionnaire. The clinical characteristics of the diseased dogs were older age, pure breed, not spayed with multiple stage one nodules. Grade I and II mixed carcinomas were the most frequent. In this study, significant diffe... (Complete abstract click electronic access below) / Mestre

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Transmembrane protein 59 (tmem59) is a gene that encodes a protein involved in autophagy and apoptosis in human. A previous study in zebrafish showed that tmem59 mRNA was several folds higher in thrombocytes than those found in red blood cells (RBCs). Therefore, we hypothesized that tmem59 has a role in thrombocytes function. We injected a hybrid of control vivo-morpholino (cVMO) and tmem59 specific antisense standard oligonucleotide (tmem59SO) into adult zebrafish to knockdown tmem59.This piggyback knockdown approach resulted in fish that had more bleeding in gill bleeding assay than the control fish. The thrombocytes fromtmem59 knockdown zebrafish aggregated faster with ADP and collagen agonists. Also, the number of blood cells was reduced after the knockdown of tmem59. We also found the effects of MS-222 anesthesia on hemostasis and found that the bleeding was reduced yielding less blood and the blood cell counts increased probably due to vasoconstriction of the blood vessels. In summary, we found tmem59 is a negative regulator of hemostasis and inferred that anesthesia should be avoided in hemostasis studies.

Direct factor Xa inhibitors (FXaI) account for most oral anticoagulant use. FXaI-associated bleeding events are common and are associated with substantial morbidity and mortality. Nonspecific hemostatic therapies such as prothrombin complex concentrates (PCC) are often administered for FXaI-associated bleeding. The mechanism by which these agents improve hemostasis in the setting of direct oral anticoagulation is unclear. Thrombin generation assays may effectively measure the effect of anticoagulation reversal among FXaI-treated patients when bleeding cessation would otherwise be challenging to measure. To build a research program on the utility of thrombin generation assays to measure both the impact of direct oral anticoagulation and anticoagulation reversal, we completed a review of the literature with narrative synthesis and carried out a pilot study to determine the feasibility of a full scale prospective observational study of TGA responses among patients receiving PCC for FXaI-associated major bleeding or needing urgent surgery.

Platelets are crucial components of the hemostatic machinery of the body. When the endothelial continuity is disrupted due to injury or atherosclerotic plaque rupture, one of the earliest responses to arrest the bleeding is the adhesion of circulating platelets to the exposed subendothelial collagen matrix. Subsequent intracellular signaling mediated downstream of various receptor systems leads to alpha IIb beta 3 activation, thromboxane generation, ADP release, etc., culminating in platelet clot or thrombus formation. The protein kinase family of enzymes mediates a significant number of these intracellular signaling events that culminate in platelet activation. These enzymes can be broadly classified into two classes- tyrosine kinases and serine/threonine kinases. Syk (spleen tyrosine kinase) is an important non-receptor tyrosine kinase present in platelets and plays an important role downstream of GPVI-FcR gamma chain receptor complex activation. We studied the effects of curcumin (diferuloylmethane), which is the active ingredient found in the herbal remedy and food spice turmeric, on the GPVI-mediated platelet activation. We have found that it significantly inhibits the kinase activity of Syk without affecting its phosphorylation. Pre-incubating the platelets with curcumin for only a minute resulted in a concentration-dependent inhibition of aggregation and secretion, with approximately 75% inhibition observed at 50 mM curcumin. Additionally, the activation-dependent phosphorylation of tyrosines 753/759 on PLC gamma2 and phosphorylation of tyrosine 191 on the transmembrane scaffold protein LAT, were inhibited (p<0.05). However, the phosphorylation of the activation loop tyrosines 525/526 on Syk and of the tyrosine 145 on intracellular adaptor molecule SLP-76 were not significantly affected. Furthermore, the inhibitory action of curcumin on the catalytic activity of Syk was independent of any of its effects on the thromboxane generation because all our studies were performed using aspirin-treated platelets. PKC zeta is an atypical member of the PKC family of serine/threonine kinases. In this study, we have confirmed that it is expressed in human platelets and is constitutively phosphorylated at the activation loop threonine 410 as well as the turn motif threonine 560, which is an autophosphorylation site. Phosphorylation at these two residues has been shown to be important for its kinase activity. Furthermore, agonist-mediated platelet aggregation under stirring condition results in dephosphorylation of the Thr410 residue, which can be prevented by blocking integrin alpha IIb beta 3 by its antagonist SC-57101 (p<0.01). The dephosphorylation of Thr410 can also be prevented by okadaic acid, a Ser/Thr protein phosphatase inhibitor, at concentrations above 100 nM. However, in PP1c gamma null mice, we did not observe any effect on the dephosphorylation, suggesting that other isoforms of PP1 or other classes of the phosphatases could be responsible for this phenomenon, at least in these knockout mice. The basal phosphorylation of Thr560, however, remained unaffected by agonist stimulation, integrin activation, integrin blockade, okadaic acid treatment and in the PP1c gamma null mice. It can be speculated that PKC zeta may be constitutively active under basal resting conditions and acts as a negative regulator of platelet activation or functional responses. The Thr560 autophosphorylation signal alone may not be sufficient to sustain its full enzymatic activity. / Physiology

Aborto espontâneo recorrente (AER) é definido pela presença de três ou mais abortos espontâneos e consecutivos que ocorreram até a 20ª semana de gestação. O AER possui origem multifatorial. Dentre os diversos fatores associados ao AER, alterações na hemostasia podem comprometer o fluxo sanguíneo na placenta e com isso pode aumentar o risco de complicações obstétricas, como o aborto. O objetivo geral deste estudo foi investigar se existe associação entre polimorfismos genéticos (no gene do fibrinogênio (FGB -455G>A e -148C>T), da trombomodulina (THBD 1418C>T), do fator V (F5 1691G>A), da protrombina (F2 20210 G>A), do PAI-1 (SERPINE1 4G/5G) e do TAFI (CPB2<i/> c.505G>A)) e os abortos espontâneos recorrentes (primários e secundários). Os objetivos específicos desse estudo foram: 1- avaliar se existe associação entre os sete polimorfismos e o período em que ocorreram as perdas fetais (precoce ou tardia) e o número de abortos recorrentes; 2- determinar se os haplótipos dos polimorfismos FGB -455G>A e FGB -148C>T estão ou não associados aos abortos primários e secundários. Foram incluídas 256 mulheres com história de abortos espontâneos recorrentes, provenientes do Ambulatório de Obstetrícia da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da USP e 264 mulheres saudáveis, sem história de aborto espontâneo e que tiveram pelo menos duas gestações normais (grupo controle), pareadas segundo as idades. Amostras de sangue foram obtidas para realização das genotipagens dos polimorfismos por meio de PCR em tempo real (FGB -148C>T, FGB -455G>A, THBD 1418C>T e CBP2 c.505G>A), e PCR-RFLP (SERPINE14G/5G, F5 1691G>A e F2 20210 G>A). As frequências dos genótipos e de alelos para os sete polimorfismos foram semelhantes entre os grupos aborto primário, aborto secundário e grupo controle. Entretanto, quando foi realizada um modelo de regressão logística multivariada saturada, que incluiu as variáveis independentes: F5 1691G>A (referência GG vs GA), F2 20210G>A (referência GG vs GA), CBP2 c.505G>A (referência GG + GA vs AA), THBD 1418C>T (referência CC + CT vs TT), SERPINE1 4G/5G (referência 5G/5G vs 4G/4G + 4G/5G) FGB -455G>A (referência GG vs GA vs AA) e FGB -148C>T (referência CC vs CT vs TT), apenas o polimorfismo FGB -148C>T foi associado ao maior risco de ter aborto primário (OR: 2,91, IC 95% 1,02 - 8,29, p=0,045). Quando os haplótipos para os polimorfismos FGB -455G>A e FGB 148C>T foram considerados, foi observada maior frequência de haplótipo 455G/148T em mulheres com AER primário (3,4%) do que no grupo controle (1,1%), (p=0,030); porém esse efeito não foi observado no AER secundário. Em relação ao número de abortos consecutivos, houve uma tendência (p=0,060) a maior frequência de genótipo TT para o polimorfismo FGB -148C>T no grupo de aborto primário com até três perdas quando comparado com as mulheres do mesmo grupo, porém com número maior de perdas (>3). Em conclusão, os sete polimorfismos quando analisados separadamente, não foram associados ao AER; no entanto, em modelo multivariado de regressão logística, o genótipo TT do polimorfismo FGB 148C>T foi associado com o aumento do risco de ter AER primário. Além disso, foi encontrado maior frequência do haplótipo 455G/148T para os polimorfismos FGB -455G>A e FGB -148C>T em mulheres com aborto primário. / Recurrent pregnancy loss (RPL) is defined by the presence of three or more consecutive losses prior to 20 weeks of gestation. The RPL has multifactorial origin. Among several factors associated with RPL, changes in hemostasis may impair the blood flow in the placenta and thus may increase the risk of obstetric complications, such as pregnancy loss. The general aim of this study was to investigate the association between genetic polymorphisms (in the genes of fibrinogen (FGB -455G>A and -148C>T), thrombomodulin (THBD 1418C>T), factor V (F5 1691G>A), prothrombin (F2 20210 G>A), PAI-1 (SERPINE1 4G/5G) and TAFI (CPB2 c.505G>A)) and recurrent pregnant losses (primary and secondary). The specific aims of this study were: 1 - to evaluate the association between the seven polymorphisms and the period in which the fetal losses occurred (early or late) and the number of recurrent losses; 2 - to determine if the haplotypes of polymorphisms FGB -455G>A and FGB -148C>T present association with primary and secondary pregnant losses. We included 256 women with a RPL history, from the Ambulatory of Obstetrics from Clinical Hospital of the Medical School of USP and 264 healthy women without losses history that have had at least two normal pregnancies (control group), matched according to age. Blood samples were obtained to perform the genotyping of polymorphisms by real-time PCR (FGB -148C>T, FGB -455G>A, THBD 1418C>T and CBP2 c.505G>A), and PCR-RFLP (SERPINE1 4G/5G, F5 1691G>A and F2 20210G>A). The frequencies of genotypes and alleles for the seven genetic polymorphisms were similar in 3 groups. However, when it was performed a model of multivariate logistic regression, which included the independent variables: F5 1691G>A (GG vs GA reference), F2 20210G>A (GG vs GA reference), CBP2 c.505G>A (GG + GA reference vs AA), THBD 1418C>T (reference CC + CT vs TT), SERPINE1 4G/5G (reference 5G/5G + 4G/5G vs 4G/4G), FGB -455G>A (GG reference vs GA vs AA) and FGB - 148C>T (reference CC vs CT vs TT), only the polymorphism FGB 148C>T polymorphism was associated with a higher risk of having primary losses (OR: 2.91, 95% CI 1.02 to 8.29, p = 0.045). When the haplotypes for the polymorphisms FGB -455G>A and FGB -148C>T were considered, had a higher frequency of the haplotype 455G/148T in women with primary RPL (3.4%) than in the control group (1.1%) (p = 0.030); but this effect was not observed in secondary RPL. Regarding the number of successive pregnant losses, there was a trend (p = 0.060) to higher frequency of the TT genotype for FGB -148C>T polymorphism in the group with primary RPL up to three losses when compared with women of the same group, but with loss number higher than three. In conclusion, when the seven genetic polymorphisms were evaluated separately, they do not show association with RPL, however, in multivariate logistic regression analysis, the TT genotype of the FGB -148C>T polymorphism was associated with increased risk for primary RPL. Furthermore, it was found higher frequency of the haplotype 455G/148T for the FGB -455G>A and FGB -148 C>T polymorphisms in women with primary RPL.

Une des propriétés majeures de la thrombine est le caractère pléiotropique de ses effets physiologiques et pathologiques, à la fois dans le compartiment sanguin et tissulaire de la paroi. Notre hypothèse est que les changements phénotypiques des cellules musculaires lisses vasculaires (CMLVs) participent aux modifications des propriétés pro- et anticoagulantes de la paroi. Les objectifs ont été d’étudier : (i) le rôle prothrombotique des CMLVs dans l’hypertension chez le rat SHR et le syndrome métabolique (Smet) chez le rat Zucker, (ii) les mécanismes de régulation de la génération de thrombine par l’intégrine αvβ3 des CMLVs (récepteur de la pro- thrombine), et de développer des glyco-peptides fluorés pour l’imagerie permettant d’évaluer l’activité de cette intégrine dans la paroi, et (iii) d’évaluer l’effet de variants génétiques du locus 9p21 de susceptibilité aux maladies coronariennes sur le phénotype de coagulation. Résultats : Les CMLVs sont responsables du phénotype prothrombotique de la paroi artérielle associée à l’hypertension chez le rat SHR. Les acides gras libres et l’inflammation vasculaire augmentent la génération de thrombine dans les 2 compartiments ce qui se traduit par une fibrinolyse diminuée et une activité métallo-protéinase augmentée chez Le rat Zucker. L’invalidation de l’intégrine αvβ3 des CMLVs diminue la génération de thrombine dans les 2 compartiments et ralentit la survenue de thrombose carotidienne en réponse à une stimulation l’angiotensine. Le traçage de l’intégrine αvβ3 par des glyco-peptides comprenant une séquence RGD a été validé au niveau plaquettaire et des CMLVs. La souris invalidée pour le locus 9p21 exprime un phénotype pro-thrombotique qui est retrouvé chez l’homme pour certains variants (rs10120688 et rs1333040) dans ce locus. En conclusion, la CML est un support cellulaire clé de réactions procoagulants et pourrait être impliqué via les intégrines et/ou ses récepteurs pour la thrombine dans un couplage thrombine tissulaire – rigidité cellulaire dans les pathologies vasculaires / One of the major properties of thrombin is the pleiotropic character of its physiological and pathological effects, both in the blood compartment and the tissue of the arterial wall. We hypothesized that the phenotypic changes of vascular smooth muscle cells (VSMCs) are involved in modifications of pro- and anti-coagulant properties of the arterial wall. The objectives were to examine: (i) the prothrombotic role of VSMCs in hypertension of SHR rats and in the metabolic syndrome (Smet) of Zucker rats, (ii) regulatory mechanisms of thrombin generation by integrin αvβ3 of VSMCs (a pro-thrombin receptor), and to develop fluorinated glyco- peptides for imaging, to assess the activity of this integrin in the wall, and (iii) evaluate the effect of genetic variants of the 9p21 locus that give a susceptibility to coronary heart disease on the coagulation phenotype. Results: The VSMCs are responsible for the prothrombotic phenotype of the arterial wall associated with hypertension in SHR rats. Free fatty acids and vascular inflammation increase thrombin generation in the two compartments resulting in decreased fibrinolysis and an increased metallo-proteinase activity in the Zucker rats. The invalidation of integrin αvβ3 of VSMCs reduced thrombin generation in the two compartments and slowed angiotensin-induced carotid thrombosis. Tracing of the integrin αvβ3 by glyco-peptides including RGD was validated at the platelet level and VSMCs. Mice invalidated for the 9p21 locus express a prothrombotic phenotype that is found in humans for certain variants (rs10120688 and rs1333040) in this locus. In conclusion, the VSMC is a cell supported key to procoagulant reactions and may be involved via integrins and/or its receptors for thrombin in the ”tissular thrombin - cell rigidity” coupling in vascular pathologies

A Coagulação Intravascular Disseminada (CID) é uma síndrome caracterizada pela ativação sistêmica da coagulação sanguínea, levando à trombose microvascular difusa e podendo comprometer a função de múltiplos órgãos. O acelerado consumo de plaquetas e fatores de coagulação pode, no entanto, dar origem a um estado de hipocoagulabilidade, o que confere à CID uma característica paradoxal na qual o excesso de coagulação pode causar uma diátese hemorrágica. Doenças que levam à Síndrome de Resposta Inflamatória Sistêmica (SIRS) estão entre os principais gatilhos da CID. A pancreatite é uma dessas doenças. O maior desafio para o médico veterinário é diagnosticar a CID na fase precoce, silenciosa e de hipercoagulabilidade, visto que os testes laboratoriais de rotina, como contagem de plaquetas, tempo de protrombina (TP) e tempo de tromboplastina parcial ativada (TTPA), detectam apenas o estado de hipocoaguabilidade, que se estabelece na fase mais avançada da síndrome. Nesse contexto ganham importância os analisadores tromboelastográficos, equipamentos que avaliam a coagulação em sangue total e que, ao menos em tese, podem informar a velocidade de formação do coágulo, a força máxima que ele atinge e os padrões de sua dissolução. Este estudo é o primeiro realizado em cães com o aparelho ReoRox G2 (MediRox), uma da marcas disponíveis no mercado. Limites de referência para as variáveis do aparelho foram definidos a partir da análise do sangue de 49 animais clinicamente saudáveis para três tipos de reação: acelerada com fator tecidual (TF), acelerada com TF e um antagonista de agregação plaquetária (abciximab) e apenas com sangue recalcificado. Em seguida, foram comparados a esse intervalo de referência os valores obtidos pela análise tromboelastográfica do sangue de seis pacientes com pancreatite recém-diagnosticada. Nos três tipos de reação pelo menos 50% dos pacientes do Grupo Pancreatite apresentaram alterações sugestivas de hipercoagulabilidade. A variável MAXELAST (força máxima do coágulo) foi a que esteve alterada com mais frequência entre os animais doentes. Não houve alteração nos marcadores de velocidade de fibrinólise. Estudos prospectivos que associem outras variáveis de trombose, protocolos de tratamento e prognóstico de pacientes com doenças subjacentes que predisponham à CID são necessários para que se possa afirmar que o traçado obtido pela tromboelastografia realmente representa um estado de hipercoagulabilidade in vivo em pacientes com pancreatite. / Disseminated Intravascular Coagulation (DIC) is a syndrome characterized by systemic activation of blood clotting, leading to diffuse microvascular thrombosis and may compromise multiple organ function. The accelerated consumption of platelets and coagulation factors may, however, originate a state of hypocoagulability, which gives the DIC a paradoxical characteristic in which excess coagulation can lead to a hemorrhagic diathesis. Diseases which cause Systemic Inflammatory Response Syndrome (SIRS) are among the major triggers of DIC, including pancreatitis. The greatest challenge for veterinarians is to diagnose DIC in the early, silent and hypercoagulable phase, since routine laboratory tests, such as platelet count, prothrombin time (PT) and activated partial thromboplastin time (APTT), detect only the state of hypocoagulability, which occurs in the most advanced stage of the syndrome. In this context, thromboelastography analyzers stand out. They are equipment which evaluate coagulation in whole blood and, at least in theory, inform the speed of clot formation, its maximum force and how it dissolves. This is the first study performed in dogs with the ReoRox G2 (MediRox), one of the brands available in the market. Limits of reference were defined from blood analysis of 49 healthy animals for three reaction types: accelerated with tissue factor (TF), accelerated with TF and a platelet aggregation antagonist (abciximab) and with only recalcified blood. Next, values obtained by blood thromboelastographic analysis of six patients with newly diagnosed pancreatitis were compared to this reference range. In all three types of reactions, at least 50% of patients in the Pancreatitis Group presented alterations suggestive of hypercoagulability. The variable MAXELAST (maximum clot strength) was the one that was most frequently altered among ill animals. There was no change in fibrinolysis rate markers. Prospective studies associating other thrombosis variables, treatment protocols, and prognosis of patients with underlying diseases predisposing to DIC are necessary to confirm that the pathway obtained by thromboelastography actually represents a state of hypercoaguability in vivo in patients with pancreatitis.

O Lopap é um ativador de protrombina da lagarta L. obliqua, pertence à família das lipocalinas e apresenta atividade antiapoptótica. O Lopap foi obtido na forma recombinante (rLopap), na levedura P. pastoris, por metodologia escalonável, e sua atividade foi avaliada in vitro e in vivo. O tratamento com rLopap reduziu o tempo de sangramento em animais anticoagulados com enoxaparina. Por outro lado, um peptídeo derivado do Lopap, designado antiapoptotic peptide (AP), foi capaz de induzir a síntese de colágeno em cultura de fibroblastos e na derme de animais. A região correspondente a AP apresentou propriedades físicas e estruturais semelhantes a seqüências relacionadas em outras lipocalinas com atividade antiapoptótica. Estes resultados abrem perspectivas para aplicações do Lopap, como uma molécula procoagulante, e de AP, através de sua ação na modulação celular, como um componente cosmético, no reparo e remodelamento tecidual e em disfunções que envolvem morte celular e perda de colágeno. / Lopap is a prothrombin activator from the L. obliqua caterpillar, belongs to the lipocalin family, and displays antiapoptotic activity. Lopap was obtained in the recombinant form (rLopap) in the P. pastoris yeast, by a scaled up methodology, and its activity was evaluated in vitro and in vivo. Treatment with rLopap reduced the bleeding time in animals anticoagulated with enoxaparin. On the other hand, a Lopap-derived peptide, designated antiapoptotic peptide (AP), was able to induce collagen synthesis in fibroblast culture and in the animal dermis. The region corresponding to AP had similar physical and structural properties when compared with other antiapoptotic lipocalins. These results open perspectives for the use of Lopap, as a procoagulante molecule, and the use of AP, based on its cell modulation effects, as a cosmetic component, aiding tissue repair and in dysfunctions involving cell death and loss of collagen.