[Truncated abstract] The assumption that facial attractiveness signals mate quality is central to current evolutionary theories of human sexual selection. Evidence for direct links between attractiveness and mate quality is, however, scarce, and the exact nature of mate quality remains the subject of debate. Mate quality may include genetic diversity, because genome-wide diversity has been linked to individual fitness, and diversity within the Major Histocompatibility Complex (MHC) has been associated with immunocompetence and health in many species. This thesis investigates whether individual genetic diversity plays a role in human sexual selection. The main aim is to examine whether MHC diversity, compared to genetic diversity in general, is especially important for mate preferences, health and mating success. The four studies herein are based on data collected from a large sample of heterosexual, Caucasian males and females. Participants were photographed, provided a DNA sample, and completed questionnaires regarding sexual history and health. Genetic diversity was calculated as both mean heterozygosity (H) and standardised mean-d2 (d2), separately for 12 MHC microsatellite loci and 11 nonMHC loci. The photographs were rated for various attractive features by opposite-sex raters. The first study investigated whether MHC diversity influences preferences for facial appearance in a potential mate, and if so, are they specific to the MHC and are they mediated by specific facial characteristics? I found that MHC-H, but not nonMHCH, positively predicted male facial attractiveness, and that this relationship was mediated by facial averageness. For females, nonMHC-d2 predicted facial symmetry, and potentially attractiveness. These findings indicate that faces contain visual cues to mate quality in both males and females, providing support for evolutionary theories that our preferences are adaptations for identifying mates of high quality. ... Measuring them both allowed me to tease apart their effects on mate preferences, and on health and mating success. Indeed, the MHC appears to be especially important in sexual selection as MHC diversity predicted female mate preferences after controlling for nonMHC diversity, and MHC dissimilarity predicted male mate preferences after controlling for nonMHC dissimilarity. Moreover, although MHC diversity did not appear to influence males’ preference for females, it did predict female mating success, suggesting that males also attend to MHC-related cues, although perhaps non-facial cues, when seeking mates. Additionally, nonMHC diversity predicted both male preferences for female faces and health, suggesting that such preferences are adaptive. Importantly, by providing direct links between facial attractiveness and biological markers of individual quality, genetic diversity, these results support the commonly held assumption that facial attractiveness signals mate quality.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

O CD30 solúvel (CD30s) é uma glicoproteína transmembrana da família do fator de necrose tumoral expressa na superfície das células T. Quando este marcador é clivado ele torna-se solúvel, sendo detectado na circulação. Atualmente, o valor de CD30s pré-transplante vem sido demonstrado como um bom preditor de rejeição aguda (RA) e perda do enxerto. Poucos estudos foram realizados para sua avaliação no pós-transplante e sua correlação com sobrevida e TFG. Avaliar a eficácia da determinação dos marcadores laboratoriais CD30 solúvel (CD30s) e anticorpos reativos contra painel HLA (PRA) em seis meses, um ano e seis anos pós-transplante renal em receptores de doadores vivos, correlacionando estes marcadores com episódios de rejeição aguda, eventos infecciosos no pós-transplante, perda do enxerto e óbito do paciente transplantado. E, avaliar a correlação destes marcadores com a sobrevida do enxerto renal nestes períodos. Os pacientes estudados foram transplantados renais com doadores vivos no Hospital Federal de Bonsucesso (HFB) do Rio de Janeiro no ano de 2006 e do período de agosto de 2010 a maio de 2011, sendo uma extensão de um trabalho realizado previamente. CD30s e PRA foram analisados nas amostras coletadas no pré-transplante e com 7, 14, 21 dias, 1, 3, 6, 12 meses após o transplante e nos pacientes transplantados em 2006 amostras após 6 anos de transplante. A taxa de filtração glomerular (TFG) foi estimada utilizando MDRD e CKD-epi e 6 meses, 1 ano e 6 anos após o transplante. Os pacientes foram agrupados em 5 grupos: sem eventos, com perda do enxerto, óbito, rejeição aguda e pacientes com quadros infecciosos. Estes grupos foram avaliados com relação ao CD30s, PRA I e II e comparados dois a dois. O teste qui quadrado foi utilizado. Quando necessário aplicou-se a correção de Yates, o teste de Fisher, o teste de Kruskal-wallis. Foi considerado estatisticamente significante p<0,05. As análises foram feitas pelo programa EPI-Info (versão 3.5.3). Setenta e seis pacientes com doadores vivos foram incluídos no estudo 47 pacientes não tiveram nenhum evento (grupo 1), 7 pacientes perderam o enxerto (grupo 2), 3 pacientes faleceram (grupo 3), 11 pacientes ficaram no grupo de rejeição aguda (grupo 4) e oito pacientes tiveram infecção por CMV e herpes (grupo 5). Os pacientes do grupo de RA tiveram correlação positiva com os valores tanto de CD30s Pré-transplante (p=0,01), quanto do CD30s pós-transplante (p=0,002) e PRA I e II (p<0,001), respectivamente, quando comparados com pacientes sem eventos. A TFG tanto com MDRD e CKD-Epi não mostrou correlação com CD30s pré e pós-transplante e nem PRA I e II. A TFG com as duas fórmulas foi menor no grupo com RA comparado com o grupo sem evento após 6 anos de transplante (p=0,006). CD30s é um bom preditor de RA, assim como PRAI e II. E, também mais uma ferramenta que pode ser utilizada no acompanhamento pós-transplante Renal. A RA é um preditor isolado para diminuição de TFG no transplante.

O CD30 solúvel (CD30s) é uma glicoproteína transmembrana da família do fator de necrose tumoral expressa na superfície das células T. Quando este marcador é clivado ele torna-se solúvel, sendo detectado na circulação. Atualmente, o valor de CD30s pré-transplante vem sido demonstrado como um bom preditor de rejeição aguda (RA) e perda do enxerto. Poucos estudos foram realizados para sua avaliação no pós-transplante e sua correlação com sobrevida e TFG. Avaliar a eficácia da determinação dos marcadores laboratoriais CD30 solúvel (CD30s) e anticorpos reativos contra painel HLA (PRA) em seis meses, um ano e seis anos pós-transplante renal em receptores de doadores vivos, correlacionando estes marcadores com episódios de rejeição aguda, eventos infecciosos no pós-transplante, perda do enxerto e óbito do paciente transplantado. E, avaliar a correlação destes marcadores com a sobrevida do enxerto renal nestes períodos. Os pacientes estudados foram transplantados renais com doadores vivos no Hospital Federal de Bonsucesso (HFB) do Rio de Janeiro no ano de 2006 e do período de agosto de 2010 a maio de 2011, sendo uma extensão de um trabalho realizado previamente. CD30s e PRA foram analisados nas amostras coletadas no pré-transplante e com 7, 14, 21 dias, 1, 3, 6, 12 meses após o transplante e nos pacientes transplantados em 2006 amostras após 6 anos de transplante. A taxa de filtração glomerular (TFG) foi estimada utilizando MDRD e CKD-epi e 6 meses, 1 ano e 6 anos após o transplante. Os pacientes foram agrupados em 5 grupos: sem eventos, com perda do enxerto, óbito, rejeição aguda e pacientes com quadros infecciosos. Estes grupos foram avaliados com relação ao CD30s, PRA I e II e comparados dois a dois. O teste qui quadrado foi utilizado. Quando necessário aplicou-se a correção de Yates, o teste de Fisher, o teste de Kruskal-wallis. Foi considerado estatisticamente significante p<0,05. As análises foram feitas pelo programa EPI-Info (versão 3.5.3). Setenta e seis pacientes com doadores vivos foram incluídos no estudo 47 pacientes não tiveram nenhum evento (grupo 1), 7 pacientes perderam o enxerto (grupo 2), 3 pacientes faleceram (grupo 3), 11 pacientes ficaram no grupo de rejeição aguda (grupo 4) e oito pacientes tiveram infecção por CMV e herpes (grupo 5). Os pacientes do grupo de RA tiveram correlação positiva com os valores tanto de CD30s Pré-transplante (p=0,01), quanto do CD30s pós-transplante (p=0,002) e PRA I e II (p<0,001), respectivamente, quando comparados com pacientes sem eventos. A TFG tanto com MDRD e CKD-Epi não mostrou correlação com CD30s pré e pós-transplante e nem PRA I e II. A TFG com as duas fórmulas foi menor no grupo com RA comparado com o grupo sem evento após 6 anos de transplante (p=0,006). CD30s é um bom preditor de RA, assim como PRAI e II. E, também mais uma ferramenta que pode ser utilizada no acompanhamento pós-transplante Renal. A RA é um preditor isolado para diminuição de TFG no transplante.

Le polymorphisme et le polygénisme des complexes majeurs d’histocompatibilité (CMH) limitent les succès de la transplantation. En effet, les disparités, tant d’antigènes mineurs que majeurs, exposent le patient transplanté au risque de rejet et imposent l’administration d’un traitement immunosuppresseur. Ce dernier affecte de façon non spécifique l’ensemble des réponses immunitaires et augmente le risque d’infections mortelles et de cancers. En outre, ce traitement ne semble pas prévenir le rejet chronique. <p>Des découvertes récentes ont confirmé l’existence de lymphocytes appelés régulateurs (Tregs) dont le rôle est de garantir l’homéostasie des réponses immunes afin qu’elles ne deviennent incontrôlées et pathologiques. Les Tregs classiquement décrits expriment de manière constitutive l’antigène CD4+, la chaîne alpha du récepteur de l’interleukine (IL)-2 (CD25) et le facteur de transcription Foxp3. Ils représentent 5 à 10% des lymphocytes CD4+ totaux. Les Tregs sont capables de réguler des lymphocytes alloréactifs et ont été décrits comme responsables du maintien de la tolérance d’allogreffe chez la souris. Mais jusqu'alors, les modèles employés pour démontrer l'importance des Tregs en transplantation utilisaient soit un traitement immunosuppresseur transitoire, soit des transferts de cellules T dans des souris lymphopéniques. <p>Toutefois, ces derniers ne permettent pas de distinguer l'effet des Tregs sur la prolifération homéostatique des lymphocytes effecteurs de leur effet sur la réponse allogénique.<p>Dans notre travail, nous montrons que les Tregs jouent un rôle prépondérant dans l’acceptation spontanée d’allogreffes en l’absence d’immunosuppresseur et en dehors d’un contexte lymphopénique chez la souris. En effet, la déplétion des Tregs du receveur par l’administration d’anticorps anti CD25 amplifie les réponses allogéniques de type Th1 et Th2 et, par conséquent, déclenche le rejet d’allogreffe. Les propriétés régulatrices des Tregs ne sont cependant pas illimitées. En effet, dans un second travail, nous décrivons, d’une part, leur incapacité à contrôler la production d’IL-17 par des lymphocytes CD4+CD25pos mémoires et, d’autre, part leur implication directe dans la différenciation de cellules Th17 au départ de lymphocytes CD4+CD25neg alloréactifs.<p>Nous concluons donc que si les Tregs naturellement présents chez le receveur jouent un rôle primordial dans la protection du greffon contre des réponses de type Th1 ou Th2, ils pourraient néanmoins favoriser une voie alterne du rejet d’allogreffe dépendante de l’IL 17.<p>/<p>Major histocompatibility complex (MHC) polymorphism is a major hindrance to transplantation success. Both minor and major antigen disparities between donor and recipient increase the risk of transplant rejection. This is thwarted by the administration of an immunosuppressive therapy that unspecifically affects all immune responses therefore increasing the risk of infections and cancers. Besides, this treatment does not seem to prevent chronic rejection.<p>Recent studies have confirmed the existence of lymphocytes called regulatory T cells (Tregs), whose role is to maintain the general immune homeostasis and to protect the individual from autoimmune diseases.<p>The classically described Tregs express constitutively the CD4 antigen, the alpha chain of the interleukin (IL)-2 receptor (CD25) and the transcription factor Foxp3. They represent 5 to 10% of total CD4+ T cells. Tregs are able to control alloreactive responses and were described to be responsible for the maintenance of allograft tolerance in mice. So far, the tolerogenic capacities of Tregs have been demonstrated either in mice treated with immunomodulatory antibodies (induced Tregs) or by adoptive co-transfer of Tregs and effector cells into lymphopenic mice. However, the latter has the disadvantage of not being able to distinguish the effect of Treg on lymphopenia-induced homeostatic proliferation from their effect on alloreactive responses. <p>Herein, we show that Tregs play a crucial role in spontaneously accepted allografts in the absence of immunosuppressive therapy and in non-lymphopenic condition. Indeed, the depletion of the recipient’s Tregs through the administration of an anti-CD25 antibody enhances type Th1 and type-Th2 allogeneic responses, consequently triggering allograft rejection. However, the regulatory properties of Tregs are not unlimited. Indeed, we found that Tregs are unable to control allogeneic IL-17 production by memory CD4+ T cells and are even necessary for de novo Th17 differentiation. <p>We conclude, therefore, that Tregs naturally present in the recipient play a critical role in protecting the allograft. Nevertheless, despite this context of regulation, IL-17-producing alloreactive T cells, beyond the control of Tregs, could mediate an alternative pathway of allograft rejection. / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

Les molécules classiques du complexe majeur d’histocompatibilité de classe II (CMHII) sont des glycoprotéines de surface spécialisées dans la présentation de peptides, principalement dérivés de pathogènes extracellulaires, aux récepteurs des lymphocytes T CD4+ afin d’initier la réponse immunitaire adaptative. Elles sont encodées, avec celles du CMH de classe I, par les gènes les plus polymorphiques identifiés jusqu’à maintenant, avec plusieurs loci et une grande diversité allélique à chacun d’eux. De plus, le polymorphisme des gènes du CMHII n’est pas limité qu’aux séquences codantes. Il est également observé dans les promoteurs où on a démontré ses effets sur le niveau d’expression des gènes. La variation de la régulation d’un gène est considérée comme un facteur important et pour laquelle des modifications morphologiques, physiologiques et comportementales sont observées chez tous les organismes. Des séquences d’ADN répétées impliquées dans cette régulation ont été identifiées dans les régions non-codantes des génomes. D’un autre côté, la sélection par les pathogènes permettrait l’évolution et le maintien du polymorphisme des gènes du CMH chez les vertébrés. À ce sujet, plusieurs études ont montré l’implication de différents allèles du CMH dans la résistance ou la susceptibilité aux maladies. Cette étude avait pour objectifs de caractériser le polymorphisme du gène MHIIb chez l’omble de fontaine (Salvelinus fontinalis) et de documenter ses effets au niveau de la survie conférée par des allèles et/ou génotypes particuliers lors d’une infection, ainsi que sur la variation du niveau d’expression du gène dans différentes conditions. Dans une première partie, nous avons identifié un total de 6 allèles du gène MHIIb, désignés Safo-DAB*0101 à Safo-DAB*0601, qui montrent une grande similarité avec les séquences codantes provenant de poissons téléostéens et de l’humain. L’analyse des séquences du domaine b1 a permis de détecter l’effet d’une pression sélective positive pour maintenir le polymorphisme dans cette région de la molécule. Quatre de ces allèles ont été testés lors d’une expérience d’infection avec le pathogène Aeromonas salmonicida afin d’évaluer l’effet qu’ils pouvaient avoir sur la survie des poissons. Nous avons trouvé que l’allèle DAB*0101 était significativement associé à la résistance à la furonculose. En plus d’avoir été identifié chez les individus homozygotes pour cet allèle, l’effet a également été remarqué au niveau de la survie les poissons de génotype DAB*0101/*0201. À l’opposé, les facteurs de risque élevé obtenus pour les génotypes DAB*0201/*0301 et DAB*0301/*0401 suggèrent plutôt une association à la susceptibilité. Étant donné la faible fréquence à laquelle l’allèle DAB*0101 a été retrouvé dans la population, le modèle de la sélection dépendante de la fréquence pourrait expliquer l’avantage conféré par ce dernier et souligne l’importance de ce mécanisme pour le maintien du polymorphisme du gène MHIIb chez l’omble de fontaine. Dans une seconde partie, nous avons rapporté la présence d’un minisatellite polymorphique formé d’un motif de 32 nucléotides dans le second intron du gène MHIIb, et pour lequel un nombre exclusif de répétitions du motif a été associé à chaque allèle (69, 27, 20, 40, 19 et 25 répétitions pour les allèles DAB*0101 à DAB*0601 respectivement). L’expression relative de quatre allèles a été évaluée dans des poissons hétérozygotes aux températures de 6 ºC et 18 ºC. Les résultats indiquent que les allèles possédant un long minisatellite montrent une réduction de l’expression du gène d’un facteur 1,67 à 2,56 par rapport aux allèles qui en contiennent un court. De même, des allèles qui incluent des minisatellites de tailles similaires n’affichent pas de différence significative au niveau de l’abondance du transcrit aux deux températures. De plus, l’effet répressif associé aux longs minisatellites est amplifié à la température de 18 ºC dans des poissons de trois génotypes différents. Nous avons finalement observé une augmentation significative par un facteur 2,08 de l’expression totale du gène MHIIb à la température de 6 ºC. Ces résultats appuient l’implication des séquences d’ADN répétées dans la régulation de l’activité transcriptionnelle d’un gène et suggèrent qu’un minisatellite sensible aux différences de températures pourrait être soumis aux forces sélectives et jouer un rôle important dans l’expression de gènes et l’évolution des organismes poïkilothermes. / Classical major histocompatibility complex class II (MHCII) molecules are cell-surface glycoproteins specialized in the presentation of peptides, mainly derived from extracellular pathogens, to the antigen receptors of CD4+ T cells in the adaptive immune system. They are encoded, with those of the MHC class I, by the most polymorphic genes known to date, with multiple loci and high allelic diversity at each one. Moreover, the polymorphism within MHCII genes is not restricted to coding sequences. It has also been observed in promoters where it was shown to affect the expression level of the genes. Variation in gene regulation is believed to be an important factor from which modification in morphology, physiology or behaviour can be observed in all organisms. Repeated DNA sequences with functional roles in this regulation have been identified within the non-coding parts of the genomes. On the other hand, pathogen-driven selection is also believed to be important in the evolution and maintenance of the polymorphism of the MHC genes in vertebrates. Studies have shown the implication of different MHC alleles in disease resistance or susceptibility. In this study, our aims were to characterize the polymorphism of the MHIIb gene in brook charr (Salvelinus fontinalis), to document its effects on the survival conferred by specific alleles and/or genotypes following an infection and on the variation of the expression level of the gene in different environmental conditions. In a first part, we identified a total of 6 MHIIb alleles, designated Safo-DAB*0101 to Safo-DAB*0601, showing a high similarity to coding sequences from teleost fish and human. Analysis of the b1 domain sequences indicates the effect of a positive selection pressure to select polymorphic mutations in that region of the molecule. Four of these alleles were tested in a challenge experiment against the pathogen Aeromonas salmonicida to evaluate their effect on fish survival. We found that one allele, DAB*0101, was significantly associated with resistance to furonculosis. In addition to homozygotes for this allele, its resistance effect was also detected in the heterozygote individuals of the DAB*0101/*0201 genotype. In contrast, other allelic combinations, namely heterozygous genotypes DAB*0201/*0301 and DAB*0301/*0401 were significantly associated with increased susceptibility. Given that its frequency was relatively low in the population, the negative frequency dependant selection hypothesis could explain the advantage associated with the allele DAB*0101 over the other alleles and highlight the importance of this mechanism to sustain variation at the MHC in brook charr. In a second part, we reported the identification of a polymorphic minisatellite formed of a 32 nucleotides motif in the second intron of MHIIb gene, and for which distinctive repeat numbers of the motif were associated to each alleles (69, 27, 20, 40, 19 and 25 repeats for the DAB*0101 to DAB*0601 alleles respectively). Relative expression levels of four alleles were determined in heterozygous fish at temperature of 18 ºC and 6 ºC. Results indicate that alleles carrying the longest minisatellite showed a 1.67 to 2.56-fold reduction in the transcript expression relatively to the shortest one. In contrast, no significant differences were seen in the expression levels between alleles with comparable minisatellite length at both temperatures. Furthermore, the repressive activity associated to the longest minisatellite was more effective at temperature of 18 ºC in fish from three different genotypes. We finally observed a significant 2.08-fold up-regulation of the total MHII transcript amount at 6 ºC. The results support the implication of repeated DNA sequences in the regulation of the gene transcriptional activity and suggest that a temperature-sensitive minisatellite could potentially be submitted to selective forces and therefore play an important role in gene expression and evolution in ectothermic organisms.

Le système de différenciation entre le « soi » et le « non-soi » des vertébrés permet la détection et le rejet de pathogènes et de cellules allogéniques. Il requiert la surveillance de petits peptides présentés à la surface cellulaire par les molécules du complexe majeur d’histocompatibilité de classe I (CMH I). Les molécules du CMH I sont des hétérodimères composés par une chaîne lourde encodée par des gènes du CMH et une chaîne légère encodée par le gène β2-microglobuline. L’ensemble des peptides est appelé l’immunopeptidome du CMH I. Nous avons utilisé des approches en biologie de systèmes pour définir la composition et l’origine cellulaire de l’immunopeptidome du CMH I présenté par des cellules B lymphoblastoïdes dérivés de deux pairs de fratries avec un CMH I identique. Nous avons découvert que l’immunopeptidome du CMH I est spécifique à l’individu et au type cellulaire, qu’il dérive préférentiellement de transcrits abondants, est enrichi en transcrits possédant d’éléments de reconnaissance par les petits ARNs, mais qu’il ne montre aucun biais ni vers les régions génétiques invariables ni vers les régions polymorphiques. Nous avons également développé une nouvelle méthode qui combine la spectrométrie de masse, le séquençage de nouvelle génération et la bioinformatique pour l’identification à grand échelle de peptides du CMH I, dont ceux résultants de polymorphismes nucléotidiques simples non-synonymes (PNS-ns), appelés antigènes mineurs d’histocompatibilité (AMHs), qui sont les cibles de réponses allo-immunitaires. La comparaison de l’origine génomique de l’immunopeptidome de soeurs avec un CMH I identique a révélé que 0,5% des PNS-ns étaient représentés dans l’immunopeptidome et que 0,3% des peptides du CMH I seraient immunogéniques envers une des deux soeurs. En résumé, nous avons découvert des nouveaux facteurs qui modèlent l’immunopeptidome du CMH I et nous présentons une nouvelle stratégie pour l’indentification de ces peptides, laquelle pourrait accélérer énormément le développement d’immunothérapies ciblant les AMHs. / The self/nonself discrimination system of vertebrates allows detection and rejection of pathogens and allogeneic cells. It requires the surveillance of short peptides presented by major histocompatibility class I (MHC I) molecules on the cell surface. MHC I molecules are heterodimers that consist of a heavy chain produced by MHC genes and a light chain encoded by the β2-microglobulin gene. The peptides presented by MHC I molecules are collectively referred to as the MHC I immunopeptidome. We employed systems biology approaches to define the composition and cellular origin of the self MHC I immunopeptidome presented by B lymphoblastoid cells derived from two pairs of MHC-identical siblings. We found that the MHC I immunopeptidome is subject- and cell-specific, derives preferentially from abundant transcripts, is enriched in transcripts bearing microRNA response elements and shows no bias toward invariant vs. polymorphic genomic sequences. We also developed a novel personalized approach combining mass-spectrometry, next-generation sequencing and bioinformatics for high-throughput identification of MHC I peptides including those caused by nonsynonymous single nucleotide polymorphisms (ns-SNPs), termed minor histocompatibility antigens (MiHAs), which are the targets of allo-immune responses. Comparison of the genomic landscape of the immunopeptidome of MHC-identical siblings revealed that 0.5% of ns-SNPs were represented in the immunopeptidome and that 0.3% of the MHC I-peptide repertoire would be immunogenic for one of the siblings. We discovered new factors that shape the self MHC I immunopeptidome and present a novel strategy for the identification of MHC I-associated peptides that could greatly accelerate the development of MiHA-targeted immunotherapy.

Intrdodução: As terapias com anticonvulsivantes de anel aromático (ACA) são freqüentemente associadas a reações adversas. No entanto, reações de hipersensibilidade (RH) não-imediatas (tardias) a estes fármacos são raras, imprevisíveis e geralmente relacionadas à alta morbidade e mortalidade. Foi demonstrado que estas RH aos ACA estão fortemente associadas ao Antígenio de Leucócitos Humanos (HLA)-B*1502 em pacientes chineses e ao HLA-A*3101 em caucasianos. Polimorfismos de genes do metabolismo do Citocromo P450 (CYP)2C9 foram mais associados a estas reações em pacientes orientais. Objetivo: Nosso objetivo é analisar a associação das reações de hipersensibilidade a anticonvulsivantes de anel aromático com os polimorfismos descritos e de interesse, bem como realizar a tipificação de HLA em uma população de São Paulo, Brasil. Métodos: Estudo tipo caso-controle com genotipagem dos polimorfismos de interesse por reação em cadeia da polimerase (PCR) em tempo real e tificação de HLA A, B, C, DRB, DQA, DQB por PCR seguido de deteção utilizando método LuminexR. A avaliação fenotípica se baseou em sistemas de escores padronizados, utilizando um questionário adaptado da ENDA (Rede Européia de Alergia a Medicamentos), em registros médicos e no acompanhamento clínico. O teste de contato com o medicamento suspeito foi realizado de acordo com as recomendações da ENDA, nos pacientes que apresentaram reação. Resultados: Foram estudados 506 pacientes, 65% do gênero feminino e a idade média foi de 43,6 anos. Oitenta por cento era de etnia mista. Polimorfismos de HLA-A*3101, HLA-B*1502, CYP2C9, CYP2C19 e CYP3A5 foram analisados de 55 indivíduos com reações de hipersensibilidade (RH) a antiepilépticos, de 85 tolerantes e de 366 controles sadios. Dos 55 casos foram validados como RH, 32 apresentaram Reação a Drogas com eosinofilia e sintomas sistêmicos (DRESS), 12 Síndrome de Stevens-Johnson (SSJ) e 11 exantema maculo-papular. De todos os 46 testes de contato com medicamento, 29 (63%) foram positivos, tanto em SSJ como em DRESS. Houve associação significativa entre polimorfismo de HLA-A*1502 e casos. Nenhum de nossos grupos de estudo apresentou associação positiva com polimorfismos de HLAA* 3101. Verificamos uma forte associação entre a atividade normal do CYP3A5 e indivíduos tolerantes quando comparado com casos (p = 0,0002, OR = 4,8). A tipificação de HLA demonstrou associação significante de HLA-A*31, HLA-A*74, HLA-B*35 e HLA-B*53 com reações graves aos ACA e de HLA-B*44 e HLA-C*03 com indivíduos tolerantes. Conclusão: Estes resultados sugere fortemente a existência de fatores genéticos de risco e/ou de proteção a RH a ACA em indivíduos brasileiros, mas não devem ser considerados de forma isolada. Assim, a relevância deste estudo extrapola o objetivo de estudo caso-controle e sugere um modelo como forma de prevenção primária às RH aos ACA. / Background: Antiepileptics with aromatic ring (AAR) therapies are frequently associated with adverse reactions. Nevertheless non-immediate (late) hypersensitivity reactions (HR) to these drugs are rare, unpredictable and usually related with high morbidity and mortality. A strong pharmacogenetic association has been reported in Chinese patients with these HR and Human Leukocyte Antigen (HLA)-B*1502 and with HLA- A*3101 in caucasians. Polymorphism of genes of P450 Cytocrome (CYP)2C9 has been related to these reactions in patients of oriental origin. Objective: Our aim is to analyze the association between hypersensitivity reactions due to AAR and the described polymorphisms, as well as perform the typification of HLA in a population of São Paulo, Brazil. Methods: Case-control study genotyping the polymorphisms of interest by polymerase chain reaction (PCR) real time and typifying HLA A, B, C, DRB, DQA, DQB by PCR followed by LuminexR .The phenotype evaluation was based on standardized scoring systems using an adapted ENDA (European Network of Drug Allergy) questionnaire, medical records and on the clinical follow-up in our Allergy Clinic. The patch test with the culprit drug was performed in patients who experienced HR according to the ENDA recommendations. Results: We studied 506 subjects, 65% female and mean age was 43,6 years. Eighty percent had mixed ethnicity. Polymorphisms of HLA-B*1502, HLA- A*3101, CYP2C9, CYP2C19 e CYP3A5 were studied in 55 subjects with antiepileptics HR, 85 tolerants, and 366 control subjects. Of 55 cases were validated as AHR, 32 presented Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), 12 Stevens-Johnson Syndrome (SJS) and 11 maculopapular exanthema. Of all 46 drug patch tests, 29 (63%) were positive, in both SJS and DRESS. A significant association between polymorphism of HLA-A*1502 and cases was found. None of our study groups presented positive association with HLA-A*3101 polymorphisms. We found a strong association between the normal activity of CYP3A5 and tolerants subjects when compared to HR (p=0.0002, OR=4.8). The HLA typification showed a significant association between HLA-A*31, HLA-A*74, HLAB* 35 e HLA-B*53 and severe AAR reactions and HLA-B*44 and HLA-C*03 in tolerants subjects. Conclusion: These results strongly suggests the existence of genetic risk and/or protective factors to the development of HR to AAR AAR in Brazilian subjects, but it should not be considered in a isolated manner. So, the relevance of this study extrapolates the aim of a case-control study and suggests a system of primary prevention to HR due to AAR

INTRODUÇÃO. A proteína Fator Inibitório da Migração de Macrófagos (MIF) é frequentemente observada com expressão elevada em tecidos tumorais quando comparados aos tecidos equivalentes normais e estudos têm sugerido seu papel como marcador prognóstico de neoplasias malignas, incluindo carcinomas hepatocelular, de ovário, de esôfago e também de cabeça e pescoço. Adicionalmente, alguns de seus mecanismos de ação já demonstrados, como a indução da proliferação e migração celular permitem implicar essa expressão diferencial no desenvolvimento tumoral e, consequentemente, no prognóstico das neoplasias malignas. OBJETIVO. Esse estudo objetivou avaliar o papel diagnóstico e prognóstico da proteína MIF em carcinoma epidermóide da cavidade bucal. METODOLOGIA. O estudo foi composto por 50 pacientes com carcinoma epidermoide da cavidade bucal coletados prospectivamente e 57 casos retrospectivos admitidos nos Serviços de Cirurgia de Cabeça e Pescoço do Hospital Heliópolis e da Faculdade de Medicina da Fundação ABC. As análises foram feitas por meio de imunoistoquímica dos tecidos tumorais e margens epiteliais normais e de ELISA das amostras de soro e saliva, coletadas pré e pós-tratamento cirúrgico, dos pacientes participantes. Os resultados foram correlacionados aos achados clínicos e histopatológicos. RESULTADOS. A expressão da proteína MIF e seu receptor CD74 mostrou-se elevada em tecido tumoral quando comparado ao tecido epitelial livre de neoplasia (p < 0,0001). Associação entre a alta expressão da MIF no tumor e infiltração vascular linfática foi observada (p=0,005) e alta expressão da MIF no epitélio livre de tumor apresentou correlação marginalmente significativa com ocorrência de segundo tumor primário (p=0,072). A expressão positiva do receptor CD74 não apresentou associação com variáveis clínicas ou histopatológicas. A concentração sorológica da proteína MIF apresentou associação inversa com metástase linfonodal (p=0,018) e estádios patológicos avançados (p=0,040) e foi significativamente reduzida após a ressecção do tumor (p=0,001). A concentração da MIF na saliva não apresentou redução significativa após o tratamento cirúrgico, mas foi associada aos estágios pT3 e pT4 (p=0,001) e a estádios patológicos avançados (p=0,032). CONCLUSÕES. A redução significante da concentração da MIF observada no soro dos pacientes após a ressecção cirúrgica do tumor permite sugerir papel potencial dessa proteína como biomarcador para a detecção precoce de recorrência do carcinoma epidermoide da cavidade bucal. A expressão tecidual da proteína MIF e seu receptor CD74 apresentou papel controverso, mas a concentração salivar da proteína MIF parece relacionar-se a um possível papel pró-tumoral em carcinoma epidermoide da cavidade bucal / INTRODUCTION. The Macrophage Migration Inhibitory Factor (MIF) overexpression is frequently observed in tumor tissues compared to normal tissues and some previous studies have suggested its role as a prognostic marker of malignancies, including hepatocellular, ovarian, esophageal and also head and neck carcinoma. Additionally, some of its mechanisms of action, as migration and cell proliferation induction, have been demonstrated, which allow imply a differential expression in tumor progression and therefore in the prognosis of malignant neoplasms. OBJECTIVES. This study aimed to evaluate the role of MIF protein and its receptor CD74 in prognosis and diagnostic of oral squamous cell carcinoma. METHODS. The study consisted of 50 patients with oral squamous cell carcinoma prospectively collected and 57 patients retrospectively collected admitted at the Head and Neck Surgery Service from Heliópolis Hospital and ABC Medical School. The analysis were performed by Imunohistochemistry of tumor and normal tissues and by ELISA of serum and saliva samples collected pre and post-surgical treatment. Results were correlated to clinical and histopathological data. RESULTS. The expression of MIF protein and of its receptor CD74 was higher in OSCC than in normal epithelium (p < 0,0001). Association between overexpression of MIF in tumor tissue and lymphatic vessel invasion was observed (p=0,005) and higher concentration of MIF in normal epithelium showed correlation of marginal significance with second primary tumor occurrence (p=0,072). The positive expression of the receptor CD74 did not presented association with clinical or histopathological variables. Serum MIF concentration presented inverse association with lymph node metastasis (p=0,018) and advanced pathological stage (p=0,040) and it was significantly reduced after the surgery (p=0,001). The salivary MIF concentration was not significantly reduced after the surgery, but it was associated with pT3 and pT4 stages (p=0,001) and advanced pathological findings (p=0,032). CONCLUSIONS. The results showing significant reduction of MIF concentration in post-surgical serum of patients suggest its potential role as a biomarker to early detection of oral squamous cell carcinoma recurrence. The MIF and CD74 expression presented controversial role, but the salivary concentration of MIF seems to develop a possible pro-tumoral role

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