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Cardiac arrhythmias are caused by a disruption of the normal initiation or propagation of electrical impulses in the heart. Hundreds of mutations in genes encoding ion channels or ion channel regulatory proteins are linked to congenital arrhythmia syndromes that increase the risk for sudden cardiac death. This dissertation focuses on how mutations in a gene (KCNQ1) that encodes a voltage-gated K+ ion channel (Kv7.1) can disrupt proper channel function and lead to abnormal repolarization of atrial and ventricular cardiomyocytes. In the heart, Kv7.1 coassembles with a regulatory protein to conduct the slowly activating delayed rectifier K+ current (IKs). Loss-of-function KCNQ1 mutations are linked to type 1 long QT syndrome (LQT1), and typically decrease IKs, which can lead to ventricular action potential (AP) prolongation. In patients, LQT1 is often characterized by an abnormally long corrected QT (QTc) interval on an electrocardiogram (ECG), and increases the risk for polymorphic ventricular tachycardias. KCNQ1 mutations are also linked to atrial fibrillation (AF), but cause a gain-of-function phenotype that increases IKs. Surprisingly, patients diagnosed with both LQT1 and AF are increasingly identified as genotype positive for a KCNQ1 mutation. The first aim of this dissertation was to determine a unique functional phenotype of KCNQ1 mutations linked to both arrhythmia syndromes by functional analyses via the whole-cell patch clamp technique in HEK293 cells. A proportion of patients with LQT1-linked KCNQ1 mutations do not have abnormal QTc prolongation known as latent LQT1. Interestingly, exercise can reveal abnormal QTc prolongation in these patients. During exercise, beta-adrenergic activation stimulates PKA to phosphorylate Kv7.1, causing an increase in IKs to prevent ventricular AP prolongation. Therefore, the second aim of this dissertation was to determine a molecular mechanism of latent LQT1 through functional analyses in HEK293 cells while incorporating pharmacological and phosphomimetic approaches to study PKA regulation of mutant Kv7.1 channels. The findings in this dissertation provide new insight into how KCNQ1 mutations disrupt the function of Kv7.1 in a basal condition or during beta-adrenergic activation. Also, this dissertation suggests these approaches will improve patient management by identifying mutation specific risk factors for patients with KCNQ1 mutations.

En France, le cancer de sein héréditaire représente environ 2500 nouveaux cas par an, dont prés de la moitié est attribuée à la mutation du gène BRCA1.La recherche de la mutation par biologie moléculaire est un travail fastidieux, coûteux et long (8 mois d’attente environ actuellement).Pour trouver une solution à ce délai, nous avons étudié en immunohistochimie une série initiale de 21 anticorps répartis en 5 groupes : anticorps antiBrca1 du commerce, liés à la perte de l’inactivation de l’X, liés à la signature basale ou myoépithéliale, anticorps dits classiques du cancer de sein et finalement dérivés de signatures établies par cDNAarray.Nous avons utilisé la technique de’ tissue microarrays’ en utilisant de manière comparative une population de 27 cas de cancer de sein présentant une mutation germinale de BRCA1, et 81 cas témoins de cancer de sein sporadiques appariés à l’âge, ainsi qu’à des lignées cellulaires d’origine mammaires. Dans une deuxième série indépendante de validation nous avons appliqué les résultats obtenus de la première série sur 28 cas de cancer mammaire muté, et 28 cas du cancer mammaire sporadique dans les mêmes conditions initiales.Nos résultats montrent pour la première fois sur des tissus tumoraux une probabilité forte d’une association entre la mutation Brca1 et la perte de l’inactivation de l’X ; confirment la valeur de MS110 comme un bon anticorps prédictif d’une mutation de Brca1 ; apportent un argument pour une participation myoépithéliale dans l’oncogenèse de cancer mammaire Brca1 muté; appuient la relation entre ce dernier et les récepteurs RE,RP ainsi que P53 , Bcl2,Ki67 et valident en protéomique la valeur discriminant de CDC47 correspondant à un des gènes de la signature génomique.Après confirmation des mêmes résultats dans la série de validation, nous soutenons en analyses multivariés un modèle qui comprend seulement Grade 3, MS110, Lys27H3 négative, Vimentine et KI67 positive. Cette équation correspond à une sensibilité de 82% et spécificité de 81% et propose une approche rapide économique de pré- ciblage de la mutation Brca1 ; ce qui améliorait la prise en charge préventive, thérapeutique et globale des patients et leurs familles. / Family structure, lack of reliable information, cost and delay are usual concerns faced with when deciding to perform BRCA analyses. Testing the breast cancer tissues with four antibodies (MS110, lys27H3, Vimentin, KI67) in addition to grade evaluation enabled to rapidly select patients to carry out genetic testing identification. We constituted an initial breast cancer tissue micro-array, considered as a learning set comprising 27 BRCA1 and 81 sporadic tumours. A second independent validation set of 28 BRCA1 tumours was matched to 28 sporadic tumours using the same original conditions.We have investigated morphological parameters and 21 markers by immunohistochemistry.A logistic regression model was used to select the minimal number of markers providing the best model to predict BRCA1 status. The model was applied to the validation set to estimate specificity and sensibility.In the initial set, the univariate analysis identified 11 markers significantly associated with BRCA1 status. Then the best multivariate model comprised only Grade 3, MS110, Lys27H3, Vimentin and KI67. When applied to the validation set, BRCA1 tumours were correctly classified with a sensitivity of 83% and a specificity of 81%. The performance of this model was superior when compared to other profiles.This work offers a new rapid and economic method for the pre-screening of patients at high risk of being BRCA1mutation carriers, then to guide genetic testing, and finally to provide appropriate preventive measure, advices and treatments including targeted therapy to patients and their families.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

La présentation antigénique par le complexe majeur d’histocompatibilité (MHC) I est un processus ubiquitaire permettant la présentation de protéines endogènes qui reflètent l'état de la cellule à la surface cellulaire aux lymphocytes T CD8+ dans le contexte de la surveillance et la réponse immunitaires. Ainsi, l'expression des molécules du MHC I classiques est induite en réponse aux stimuli inflammatoires afin de favoriser la reconnaissance immunitaire et l'élimination des pathogènes. HFE est une molécule du MHC Ib non-classique qui sert de régulateur négatif de l'absorption du fer. HFE est associé au développement de l'hémochromatose héréditaire (HH), maladie associée au métabolisme du fer mais souvent accompagnée de défauts immunitaires. Ainsi, nous avons en premier lieu étudié l'impact de HFE sur la présentation antigénique par MHC I, afin d'expliquer en partie les défauts immunitaires liés à l'HH associée à HFEC282Y. Puis, compte tenu de l'impact de l'inflammation sur l'expression des molécules du MHC I classiques, nous avons étudié la régulation de l'expression de HFE en réponse aux stimuli inflammatoires induits par les cellules du sang périphérique mononucléées (PBMC). Nous avons mis au point un système d’expression antigénique dans lequel nous contrôlons l’expression de MHC I, de HFE et d’un antigène pour lequel nous avons généré des lymphocytes T CD8+ spécifiques. Nos résultats démontrent que la forme sauvage de HFE (HFEWT), contrairement à sa forme mutée (HFEC282Y), inhibe la reconnaissance de complexes MHC I/peptide (pMHC). Nous avons également démontré que l'inhibition de la reconnaissance est maintenue, indépendamment des niveaux d'expression de MHC I à la surface, d'une compétition pour la β2-microglobuline, de la capacité de HFE d'interagir avec le récepteur de la transferrine, de l'origine de l'antigène ou de l'affinité de celui-ci. Par ailleurs, nous avons identifié les domaines α1-2 de HFEWT comme étant responsables de l'inhibition de la reconnaissance antigénique. Par contre, la reconnaissance de peptides chargés de manière externe sur les molécules du MHC I présentes à la surface n'a démontré aucune inhibition en présence de HFEWT, suggérant que HFEWT pourrait affecter la reconnaissance en interférant avec le processus d'apprêtement antigénique intracellulaire. À l’inverse, nous avons souhaité déterminer si les lymphocytes T activés pouvaient influencer les niveaux d'expression de HFE. En termes de régulation de l'expression de HFE, nous avons établi que HFE est exprimé dans les tissus sains chez l'humain et induit chez les lignées de cancers du colon, du sein, du poumon, du rein et du mélanome. Par ailleurs, en co-cultivant des lymphocytes T activés avec ces lignées tumorales, nous avons démontré que l'expression de HFE est fortement inhibée dans toutes ces lignées tumorales lorsqu'exposées à des lymphocytes T activés. Finalement, la modulation de l'expression de HFE est indépendante du contact cellulaire et semble médiée en partie par le GM-CSF, l'IFN-γ et le TNF. En somme, ces résultats suggèrent que les lymphocytes T de l'hôte modulent l'expression de HFE dans le microenvironnement inflammatoire, ce qui pourrait promouvoir la reconnaissance des antigènes présentés sur les molécules du MHC I présentées aux lymphocytes T CD8+ antigène-spécifiques. De plus, ces études soulèvent la possibilité d'un nouveau rôle physiologique de HFEWT dans la voie de présentation antigénique par MHC I, qui pourrait moduler l'immunogénicité des antigènes et la réponse immunitaire cellulaire chez l'hôte. / MHC class I antigen presentation is an ubiquitous process by which cells present endogenous proteins to CD8+ T lymphocytes during immune surveillance and response. Accordingly, classical MHC I molecules are up-regulated in response to inflammatory stimuli to favor immune recognition and pathogen clearance. HFE is a non-classical, MHC Ib molecule which acts as a negative regulator of iron absorption. HFE has been linked to the development of hereditary hemochromatosis (HH), an iron overload disease often associated to immune defects. Firstly, we studied the impact of HFE expression on MHC I antigen presentation, as a hypothesis for HH-associated immunological defects observed in HFEC282Y-mutated HH patients. Secondly, we evaluated whether, like its classical MHC I counterparts, HFE expression could be modulated in response to peripheral blood mononuclear cell (PBMC) inflammation. We developed an antigen presentation system in which we control MHC I expression, HFE expression, and expression of a model antigen for which we have generated antigen-specific CD8+ T lymphocytes. Our results demonstrate that wild-type HFE (HFEWT), but not C282Y-mutated HFE (HFEC282Y), inhibits recognition of MHC I antigens. We further demonstrate that inhibition of antigen recognition is maintained regardless of MHC I surface levels, β2-microglobulin competition, HFE ability to interact with transferrin receptor, antigen origin, or epitope affinity. We identified the α1-2 domains of HFEWT as being responsible for inhibiting antigen recognition. However, recognition of externally peptide-pulsed 293-A2 remained uninhibited in presence of HFEWT, indicating that HFE may affect T cell recognition by interfering with intracellular antigen processing. We also questioned whether activated T lymphocytes may influence HFE expression. We established that HFE is widely expressed in healthy human tissues and induced in colon cancer, breast cancer, lung cancer, kidney cancer and melanoma cell lines. Furthermore, HFE mRNA expression was drastically inhibited in all tumor cell lines when exposed to activated T lymphocytes. Down-regulation of HFE mRNA expression was independent of cell contact and appears to be partially mediated by GM-CSF, IFN-γ, and TNF. Overall, these data suggest that host T lymphocytes may alter HFE expression levels in the inflammatory microenvironment, which could, in turn, promote recognition of MHC I antigens presented to antigen-specific CD8+ T lymphocytes. Accordingly, this could suggest a new physiological role for HFEWT in the MHC I antigen presentation pathway, which could modulate antigen immunogenicity and the cellular immune response.

Smith-Magenis Syndrome (SMS; OMIM #182290) is a multiple congenital abnormality and intellectual disability (ID) disorder caused by either an interstitial deletion of the 17p11.2 region containing the retinoic acid induced-1 (RAI1) gene or a mutation of the RAI1 gene. Individuals diagnosed with SMS typically present characteristics such as ID, self-injurious behavior, sleep disturbance, ocular and otolaryngological abnormalities, craniofacial and skeletal abnormalities, neurological and behavioral abnormalities, as well as other systemic defects and manifestations. Previous work by Vyas in 2009 showed temporal expression of rai1 in zebrafish embryos as early as 9 hpf. We hypothesize that there is maternal rai1 expression as early as zero hours post fertilization in wild type embryos. Using end-point PCR, we found that in fact there is maternal rai1 expression is detectable as early as 2 hours post fertilization (hpf) in wild type zebrafish embryos. Furthermore, we quantified rai1 expression using qPCR and found that rai1 expression declines significantly after 6 hpf. We hypothesize that a down regulation of rai1 or loss of rai1 will lead to morphological phenotypes, especially if that loss of rai1 function occurs during the earliest stages of zebrafish embryogenesis. Using a rai1morpholino oligonucleotide (MO), we found a loss of rai1 expression did not induce a morphological phenotype in in wild type embryos; furthermore, we also found that a loss of maternal rai1 expression did not induce a morphological phenotype as well. Utilizing a mutant rai1 zebrafish line, we found that both rai1 +/fh370 progeny nor rai1 fh370/fh370 progeny exhibited a morphological phenotype and that downstream targets such as bdnf were not affected by a reduction or complete loss of rai1. Prior research has shown that retinoic acid (RA) can induce rai1 expression. We hypothesize that RA can induce expression of rai1 during zebrafish embryogenesis. Using wild type fish and a rai1 in situ hybridization probe, we found that RA treatment at 25 hpf induced expression of rai1. The construction of a rai1 overexpression vector used for overexpression studies was started. Further development of GFP expression vector and zebrafish rai1 antibody are needed to determine if the morpholino is reducing rai1 protein expression.

A neuropatia hansênica e a neuropatia hereditária com suscetibilidade à pressão (Hereditary Neuropathy with liability to Pressure Palsies - HNPP) são mononeuropatias múltiplas em que os estudos da condução nervosa (ECN) mostram geralmente alentecimento focal em topografias muito semelhantes. Na ausência de uma história familiar de HNPP e das manifestações na pele típicas da hanseníase, o diagnóstico diferencial entre elas pode ser muito difícil. Procurando identificar características que ajudassem a distinguir essas doenças, revisamos e catalogamos os dados da história clínica e dos ECN de 39 pacientes com HNPP e 78 pacientes com neuropatia hansênica. A manifestação inicial mais frequente na hanseníase foi o déficit sensitivo (43 pacientes-55.1%) e na HNPP foi a fraqueza muscular localizada indolor (24 pacientes-61%). Fraqueza muscular foi significativamente superior na HNPP e déficit sensitivo foi significativamente superior na hanseníase (p<0.001). A evolução clínica foi estável ou progressiva até o tratamento em todos os pacientes com hanseníase e na HNPP dez pacientes (25.6%) tiveram um curso progressivo e 29 (74.4%) uma evolução com flutuações. O padrão predominante ao exame neurológico foi a mononeuropatia múltipla: 66 pacientes (84.6%) na hanseníase e 26 pacientes (66.7%) na HNPP. Espessamento neural foi mais frequente na hanseníase (p=0,001) e déficit sensitivo intradérmico foi observado somente na hanseníase (p<0,001). Episódio prévio ou atual de paralisia aguda de nervo foi referido somente na HNPP (p<0,001). O padrão dos ECN prevalente foi a neuropatia sensitivo-motora assimétrica com alentecimento focal da condução (NSMAAF): 44 pacientes (56.4%) na hanseníase e 31 pacientes (94.0%) na HNPP. Os parâmetros clínicos mais úteis em distinguir as duas doenças foram: a perda sensitiva intradérmica com comprometimento precoce das fibras finas e ocorrência de reação hansênica na hanseníase; o envolvimento motor inicial predominante, episódios de paralisia aguda de nervo e a evolução com flutuações na HNPP. Se o paciente a ser avaliado apresentar mononeuropatia múltipla com alentecimentos focais da velocidade de condução, os seguintes achados neurofisiológicos sugerem hanseníase: a não detecção de potenciais sensitivos ou motores, a redução da amplitude dos potenciais de ação sensitivos dos nervos sural, fibular superficial e radial superficial (< 8,8 ?V), a redução da amplitude do potencial de ação muscular composto dos nervos ulnar e tibial posterior, a redução da velocidade de condução do potencial de ação muscular composto do nervo ulnar motor no segmento do antebraço (< 43 m/s) e a presença de dispersão temporal frequente; enquanto os seguintes achados sugerem HNPP: aumento desproporcional da latência distal do nervo mediano motor e a presença de bloqueio de condução. / The Hansen\'s disease neuropathy (HDN) and the Hereditary Neuropathy with liability to Pressure Palsies (HNPP) are multiple mononeuropathies whose nerve conduction studies (NCS) usually show focal slowing at very similar topographies. In the absence of a family history of HNPP and the typical skin manifestations of HD, the differential diagnosis between them may be very difficult. In order to identify characteristics that may distinguish these diseases, we reviewed the data of 39 patients with HNPP and of 78 patients with HDN. The most frequent presenting sign was a sensory deficit in 43 patients (55.1%) in the HDN and a localized painless muscular weakness in 24 patients (61%) in the HNPP. Muscle weakness was significantly higher in HNPP and sensory deficit was significantly higher in leprosy (p<0.001). The disease was stable or progressive until treatment in all patients with HDN and among HNPP ten patients (25.6%) had a progressive course and 29 (74.4%) an intermittent evolution. Neural thickening was more frequent in leprosy (p=0.001) and intradermal sensory deficit was observed only in leprosy (p<0.001). Previous or current episode of acute nerve palsy was reported only in HNPP (p<0.001). The predominant pattern on neurological examination was the multiple mononeuropathy: 66 patients (84.6%) in the HDN and 26 patients (66.7%) in the HNPP. The most prevalent pattern of NCS was an asymmetric sensorimotor neuropathy with focal slowing (ASMNFS): 44 patients (56.4%) in HDN and 31 patients (94.0%) in HNPP. The most helpful clinical parameters in distinguishing these diseases were the presence of leprosy reaction and the intradermal sensory loss with predominant early involvement of small nerve fibers in HDN; the initial predominant motor involvement, episodes of acute nerve palsies and the intermittent evolution in HNPP. If the patient evaluation show a pattern of multiple mononeuropathy with focal slowing, the following neurophysiological findings suggest HDN: no detection of sensory or motor potentials, amplitude reduction of the sural, superficial fibular and superficial radial (<8.8 ?V) nerves, amplitude reduction of the motor ulnar and posterior tibial nerves, reduction of the conduction velocity of the motor ulnar nerve at the forearm segment (<43 m/s) and the presence of frequent temporal dispersion; while the following findings suggest HNPP: a disproportionate increase in the motor distal latency of the median nerve and the presence of conduction block.

Mutações no gene HFE têm sido apontadas como um dos principais fatores para o desenvolvimento de sobrecarga de ferro, especialmente os SNPs (single nucleotide polymorphism) clássicos C282Y e H63D. A sobrecarga de ferro pode ser primária, atribuída diretamente a mutações do gene HFE (hemocromatose hereditária - HH) ou adquirida em decorrência de fatores genéticos e de comorbidades, particularmente, infecção pelo vírus da hepatite C (HCV) e carcinoma hepatocelular (CHC). Desequilíbrio de ligação entre os SNPs principais do gene HFE com alelos dos genes HLA-A e HLA-B podem contribuir com alterações da função das células do sistema imunológico. Neste trabalho, sequenciamos a região codificadora do gene HFE (éxon 2, 3, 4 e 5) de pacientes que apresentam ou não sobrecarga de ferro primária ou adquirida. Assim, estudamos 130 pacientes com hepatite C, 60 pacientes com CHC, 14 pacientes com HH e 100 indivíduos saudáveis. Foram encontrados sete SNPs no gene HFE no sentido 5\' para 3\': i) H63D C>G no éxon 2 (rs1799945); ii) IVS2(+4)T>C no íntron 2 (rs2071303); iii) íntron 3 C>G (rs807209); iv) C282Y G>A no éxon 4 (rs1800562); v) íntron 4 G>A (rs2794717); vi) IVS4(-44) T>C (rs1800708); vii) no íntron 5 a deleção G>del, ainda não foi descrita na literatura. Foram realizadas as reconstruções de haplótipos da região codificadora e os haplótipos estendidos englobando o gene HFE e dez outros loci (HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQB1, TNFa, TNFb, TNFc, TNFd e HLA-G-14pb). Também, normatizamos a nomenclatura do gene de acordo com as regras do The International ImMunoGeneTics Information System - IMGT (http://www.imgt.org/). Diversas ferramentas foram utilizadas para avaliar a associação entre os sítios polimórficos do gene HFE com a sobrecarga de ferro, incluindo testes de associações avaliando alelos, genótipos, desequilíbrio de ligação, haplótipos e diplótipos, testes de diversidades e neutralidade. Finalmente, comparamos os SNPs do gene HFE encontrados na população saudável do presente trabalho com as diversas populações mundiais, disponíveis no sítio 1000genomes (http://www.1000genomes.org/). Os resultados demonstraram que a nossa a população estava mais próxima das populações europeias e americanas, sendo parcialmente próxima das populações africanas e distante das populações asiáticas. O alelo C282Y G, contido no haplótipo da região codificadora HFE*01:03, conferiu susceptibilidade a HH na população brasileira testada, concordando com os achados observados em outras populações mundiais. O diplótipo HFE*01:02:01:01/HFE*01:01:01:05 conferiu susceptibilidade para o desenvolvimento de sobrecarga de ferro em pacientes com CHC causado pelo HCV. Detectamos forte desequilíbrio entre os alelos H63D G e IVS2(+4) C no éxon 2 do gene HFE, e concomitantemente, desequilíbrio desses alelos com alelo HLA-B*44, aparentemente, sem associação com sobrecarga de ferro, mas com aparente origem histórica. Finalmente, o teste de diversidade encontrou diferenças apenas na amostra de HH e o teste de neutralidade não encontrou pressões seletivas na população controle do presente trabalho. Concluindo, este é o primeiro trabalho, avaliando grande segmento da região codificadora do gene HFE em diversas amostras de pacientes apresentando ou não sobrecarga de ferro e em indivíduos controle. / Mutations at the HFE gene have been identified as a major factor for the development of iron overload, especially the classical single nucleotide polymorphism (SNP) C282Y and H63D. Primary iron overload can be directly attributed to mutations in the HFE gene (hereditary hemochromatosis - HH), whereas secondary overload may be acquired due to genetic factors and comorbidities, particularly infection with hepatitis C virus (HCV) and hepatocellular carcinoma (HCC). Linkage disequilibrium between major SNPs at the HFE gene with HLA-A and HLA-B alleles may contribute to alterations in the function of immune cells. We sequenced the coding region of the HFE gene (exon 2, 3, 4 and 5) of patients exhibiting primary or secondary iron overload. Thus, we studied 130 patients with hepatitis C, 60 patients with HCC, 14 patients with HH and 100 healthy individuals. We observed seven SNPs in the HFE gene in 5 \'to 3\' sequence: i) H63D C>G at exon 2 (rs1799945); ii) IVS2(+4)T>C at intron 2 (rs2071303); iii) intron 3 C>G (rs807209); iv) C282Y G>A at exon 4 (rs1800562); v) intron 4 G>A (rs2794717); vi) IVS4(-44) T>C (rs1800708); vii) at intron 5 we detected a yet undescribed G>deletion. We performed haplotype reconstruction of the coding region and extended haplotypes comprising the HFE gene and ten other loci (HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQB1, TNFa, TNFb, TNFc, TNFd and HLA-G14bp). In addition, we normatized the nomenclature of the HFE gene, according to the rules of the International ImMunoGeneTics Information System - IMGT (http://www.imgt.org/). Several tools were used to evaluate the association between HFE polymorphic sites with iron overload, including tests assessing associations of alleles, genotypes, linkage disequilibrium, haplotype and diplotypes, diversity and neutrality tests. Finally, we compare the SNPs at the HFE gene observed in the healthy population with those observed in diverse worldwide populations available at the 1000genomes site (http://www.1000genomes.org/) the results showed that our population was closer to American and European populations, partially close the populations of African and distant of Asian populations. The C282Y allele G, contained in the coding region HFE * 01:03 haplotype, conferred susceptibility to HH in the Brazilian population tested, agreeing with the findings observed in other worldwide populations. The HFE*01:02:01:01/HFE* 01:01:01:05 dyplotype conferred susceptibility to the development of iron overload in patients with HCC caused by HCV. A strong linkage disequilibrium was detected between the H63D G and IVS2 (+4) C alleles in exon 2 of the HFE gene, and concomitantly, a linkage between these alleles with HLA-B*44, apparently not associated with iron overload, but with apparent historical origin. Finally, the test of diversity revealed differences only in the HH sample and the neutrality test detected no selective pressures on the control population of this study. In conclusion, this is the first study evaluating a large segment of the coding region of the HFE gene in several samples of patients exhibiting or not iron overload and in control subjects.

INTRODUÇÃO: Considerando que a dor é multifacetada e levando em conta a importância em realizar uma aproximação às vivências de pessoas acometidas por enfermidades relacionadas à cronicidade deste adoecimento, este trabalho buscou contribuir para o conhecimento a respeito do fenômeno da dor enfatizando o discurso tanto de doentes submetidos à redução aguda da nocicepção por cirurgia, como também de pessoas com neuropatia periférica congênita. MÉTODOS: O acompanhamento dos 15 participantes com dor crônica (pacientes com cordotomia cervical por dor oncológica refratária e rizotomia trigeminal percutânea por neuralgia do trigêmeo) se deu no ambulatório de Neurologia do Hospital das Clínicas ao longo de 12 meses, em três momentos distintos: pré-operatório (V1), pós-operatório imediato (V2) e pós-operatório posterior (V3) (após 4 meses da intervenção). Para a avaliação quantitativa do fenômeno da dor, foram aplicados instrumentos utilizados habitualmente no Departamento: o Questionário Sociodemográfico e o Protocolo de Modulação Condicionada da Dor (MCD) somente no primeiro momento; e o Questionário para Diagnóstico de Dor Neuropática 4 (DN4), o Inventário de Sintomas de Dor Neuropática (NPSI), o Inventário Breve de Dor (BPI), o McGill Breve, a Escala de Catastrofismo Associado à Dor (PCS) e a Escala Hospitalar de Ansiedade e de Depressão (HADS). As entrevistas abertas foram realizadas em três momentos, embasando-se no método fenomenológico hermenêutico. Para enriquecer a compreensão de que a nocicepção é um dos fatores, mas não o único que influência a ocorrência do fenômeno da dor e se aproximar do aspecto do sofrimento, também foram entrevistadas duas pessoas acometidas por Neuropatias Hereditárias Sensoriais Autonômicas (HSAN), que não apresentam sensibilidade à dor. Estes participantes foram acompanhados em momento único, no qual, além da realização da entrevista, foram aplicados o Questionário Sociodemográfico e a Escala Hospitalar de Ansiedade e de Depressão (HADS). RESULTADOS: Percebeu-se através da análise quantitativa das escalas aplicadas que, no geral, houve uma tendência de diminuição da dor e dos índices de ansiedade após a realização do procedimento cirúrgico. Esta redução se apresentou de maneira mais significativa entre os pacientes com câncer. Os escores do DN4 (6,9±2,3; 2,7±2,2; 5,5±2,5) foram significantes nos diferentes momentos e diminuíram entre as visitas V1 e V2. Para o NPSI os valores foram significantes apenas entre as visitas V1 e V2, apresentando os respectivos valores (65,6±12; 26,4±13,7). O valor da média de interferência do BPI mostrou-se diferente entre os momentos V1 e V2 com valores médios de (60,3±14,1; 15,7±13,3). Os valores do questionário McGill Breve para dor foram (6,1±1,5 e 2,0±1,0) respectivamente para V1 e V2 no componente sensitivo, para o componente afetivo os valores foram (2,8±1,8; 0,3±0,6) respectivamente. Para escala de humor os padrões mantiveram-se semelhantes aos das escalas de dor, houve uma queda dos valores entre a visita 1 e 2 para a escala PCS que se manteve na visita 3. Não houve significância entre os momentos para a escala HADS depressão. Já para a HADS ansiedade houve uma queda nos valores entre V1 e V2, assim como entre as visitas V1 e V3. Ou seja, não houve significância entre V2 e V3. As entrevistas foram analisadas a partir de Unidades de Sentido que emergiram a partir do discurso dos participantes. Para o momento V1, foram consideradas as unidades: Tempo de Procura por um Diagnóstico, Relação com o Cônjuge e Família, Trabalho, Relação com a Morte e Expectativa de Melhora. Nos momentos V2 e V3, as mesmas unidades foram mantidas, com exceção de \"Tempo de Procura por Diagnóstico\". Na análise dos doentes com insensibilidade à dor, foram mantidas as mesmas Unidades de Sentido do outro grupo de participantes, com exceção de \"Relação com a morte\" e \"Expectativas de melhora\". O aspecto da escuta apresentou-se como de extrema importância para a compreensão dos doentes com dor crônica entendendo-os antes da realização de procedimento neurocirúrgico, imediatamente após a neurocirurgia e em momento posterior. Também se tornou possível a escuta do relato das pessoas que, por possuírem uma condição de insensibilidade à dor, apresentam uma experiência diferenciada de sofrimento frente ao aspecto da dor / INTRODUCTION: Considering that pain is multifaceted and acknowledging the importance to approach the experiences of people affected by illness related to its chronicity, this work sought to contribute to the knowledge about the phenomenon of pain emphasizing the discourse of both patients submitted to acute reduction of nociception by surgery, and also of people with congenital peripheral neuropathy. METHODS: The follow-up of the 15 participants with chronic pain (patients with cervical cordotomy for refractory oncologic pain and percutaneous trigeminal rhizotomy for trigeminal neuralgia) occurred at the Neurology outpatient clinic of the Hospital das Clínicas during 12 months at three different moments: preoperative (V1), immediate postoperative (V2) and late postoperative (V3) (after 4 months of intervention). For the quantitative evaluation of pain phenomenon, instruments commonly used in the Department were applied: the Sociodemographic Questionnaire and the Conditioned Pain Modulation (CPM) protocol only at the first moment; and the Questionnaire for Diagnosis of Neuropathic Pain (DN4), the Neuropathic Pain Symptom Inventory (NPSI), the Brief Pain Inventory (BPI), the McGill Pain Questionnaire, the Pain Catastrophizing Scale (PCS) and Hospital Anxiety and Depression Scale (HADS). The open interviews were carried out in three moments, based on the hermeneutic phenomenological method. To enrich the understanding that nociception is one of the factors, but not the only one that influences the occurrence of pain phenomenon and to approach the aspect of suffering, two people affected by Autonomic Sensorial Hereditary Neuropathies (HSAN) were also interviewed. These participants were followed in a single moment, in which, in addition to the interview, the Sociodemographic Questionnaire and the Hospital Anxiety and Depression Scale (HADS) were applied. RESULTS: It was noticed through the quantitative analysis of the scales that, in general, there was a tendency to decrease pain and anxiety indexes after performing the surgical procedure. This reduction was more significant among cancer patients. The DN4 scores (6,9±2,3; 2,7±2,2; 5,5±2,5) were significant at different moments and decreased between visits V1 and V2. For NPSI values were significant only between visits V1 and V2, presenting the respective values (65,6±12; 26,4±13,7). The mean value of BPI interference was different between moments V1 and V2 with mean values of (60,3±14,1; 15,7±13,3). The values of McGill questionnaire for pain were (6,1±1,5 e 2,0±1,0) respectively for V1 and V2 in the sensory component, and for the affective component the values were (2,8±1,8; 0,3±0,6) respectively. For mood scales the patterns remained similar to those of the pain scales, there was a decrease in the values between visit 1 and 2 for the scale PCS that remained at visit 3. For HADS Depression scale there was no significance between the different moments. Considering the HADS Anxiety scale there was a decrease in the values between V1 and V2, as well as between visits V1 and V3, but there was no significance between V2 and V3 moments. The interviews were analyzed from Units of Meaning that emerged from the discourse of the participants. For the V1 moment, the following units were considered: Search Time for a Diagnosis, Relationship with Spouse and Family, Work, Relationship with Death and Expectation of Improvement. At moments V2 and V3, the same units were maintained, except for \"Search Time for a Diagnosis\". In the analysis of patients with HSAN condition the same Units of Meaning were kept, except for \"Relationship with Death\" and \"Expectation of Improvement\". The listening aspect was extremely important for the understanding of patients with chronic pain in the three different moments, before performing a neurosurgical procedure, immediately after neurosurgery and at a later time. It also brought the opportunity to listen to the ones with HSAN condition who present a differentiated experience of suffering towards pain

Introdução: A Retinose Pigmentar (RP) é uma doença hereditária da retina, caracterizada por perda da função visual, principalmente devido à degeneração dos fotorreceptores (bastonetes e cones). Objetivo: Avaliar os efeitos de uma única injeção intravítrea de fração mononuclear de células da medula óssea (FMMO) CD34+ em pacientes portadores de RP. Métodos: Ensaio clínico aberto, não randomizado, prospectivo, observador mascarado, no qual 20 pacientes, portadores de RP, com boa fixação ao exame de campo visual, foram incluídos. Única injeção intravítrea (IIV) de FMMO foi aplicada em apenas um dos olhos de cada paciente, enquanto que os olhos contralaterais serviram como controle e foram submetidos à injeção simulada. As avaliações incluíram: melhor acuidade visual corrigida (MAVC); campo visual estático - estratégia 30-2 (Octopus 900); microperimetria (MAIA - Center Vue) para avaliar estabilidade de fixação e sensibilidade macular; eletrorretinografia de campo total (ERG) e multifocal (mfERG) - padrão da ISCEV usando aparelho Espion E2 (Diagnosys LLC) e tomografia de coerência óptica (OCT). Os exames foram realizados antes da injeção e 4, 16, 32 e 48 semanas após. Resultados: Não houve diferença significativa na MAVC durante o seguimento. A diferença entre MAVC medida após 48 semanas e a basal foi de -0,04 ? 0,02 logMAR nos olhos tratados frente a -0,03 ? 0,01 logMAR nos controles (p=0,3898). A melhora da sensibilidade macular foi discretamente maior nos olhos com FMMO: 1,0 ? 0,5 dB do que nos olhos contralaterais: 0,2 ? 0,5 dB, mas sem significância estatística (p=0,0569). Não se observou mudança na estabilidade de fixação. A perda de desvio médio (MD) do campo visual dos olhos tratados (0,33 ? 0,70 dB) foi discretamente menor do que nos olhos controle (1,12 ? 0,58 dB) (p=0,0761). Nenhuma diferença significativa foi observada nas amplitudes e latências das respostas eletrorretinográficas durante o período avaliado. Não se verificou nenhuma complicação e nem efeito colateral após a injeção. Conclusão: A aplicação intravítrea de FMMO contendo células CD34+ mostrou-se segura em pacientes com RP. Observou-se, ainda, discreta melhora na sensibilidade macular, mas esta não foi significativa estatisticamente. Estudos futuros são necessários para esclarecer o potencial uso dessas células em distrofias retinianas. / Introduction: Retinitis pigmentosa (RP) is a hereditary disease of the retina, characterized by loss of visual function, mainly due to degeneration of the photoreceptors (rods and cones). Objective: To evaluate the effects of a single intravitreal injection of bone marrow mononuclear fraction (BMMF) containing CD34+ cells in patients with RP. Methods: Open trial, non-randomized, prospective, masked observer, in which 20 patients with RP with good fixation in visual field examination were included. Single intravitreal injection of BMMF was performed in only one eye of each patient, while the contralateral eyes served as control and underwent shaw injection. Evaluations included: best corrected visual acuity (BCVA); static visual field - strategy 30-2 (Octopus 900); microperimetry (MAIA - Center Vue) to evaluate fixation stability and macular sensitivity; full-field (ERG) and multifocal (mfERG) electroretinograms according to the ISCEV using Espion E2 (Diagnosys LLC) and optical coherence tomography (OCT). The exams were performed before the injection and 4, 16, 32 and 48 weeks after. Results: There was no significant difference in BCVA during follow-up. The difference measured in BCVA between 48 weeks and baseline was 0.04 ? 0.02 logMAR in treated eyes versus -0.03 ? 0.01 logMAR in controls (p=0.3898). The improvement in macular sensitivity was slightly higher in BMMF eyes: 1.0 ? 0.5 dB than in contralateral eyes: 0.2 ? 0.5 dB, but without statistical significance (p=0.0569). No change in fixation stability was observed. The mean deviation loss (MD) of the visual field in treated eyes (0.33 ? 0.70 dB) was slightly lower than in the control eyes (1.12 ? 0.58 dB) (p=0.0761). No significant difference was observed evaluating amplitudes and latencies of ERG and mfERG responses during the follow-up. No complications or side effects were observed after the injection. Conclusion: The intravitreal injection of BMMF containing CD34 + cells was shown to be safe in patients with RP. There was still a slight improvement in macular sensitivity, but this was not statistically significant. Future studies are needed to clarify the potential use of these cells in retinal dystrophies.