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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
141

Alelos HLA-DR em pacientes com poliarterite nodosa e poliangite microscopica / Alleles HLA-DR in patients with polyarteritis nodosa and microscopic polyangiitis

Freire, Alzirton de Lira 14 August 2018 (has links)
Orientadores: Sandra Regina M. Fernandes, Manoel Barros Bertolo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T08:19:53Z (GMT). No. of bitstreams: 1 Freire_AlzirtondeLira_D.pdf: 2046365 bytes, checksum: 7caf510992e59ec21c00856d2d31ff02 (MD5) Previous issue date: 2009 / Resumo: O presente estudo avaliou a freqüência dos alelos HLA-DR em um grupo de 29 pacientes brasileiros caucasóides com PAN ou poliangiíte microscópica e investigou uma possível relação entre os alelos HLA-DR, os índices de atividade e gravidade e as manifestações clínicas de doença. O diagnóstico de cada paciente baseou-se nos critérios do Colégio Americano de Reumatologia (ACR) para a PAN e da Conferência Internacional de Consenso de Chapel Hill (CHCC) para poliangiíte microscópica. A atividade e a gravidade da doença foram mensuradas retrospectivamente, por ocasião do diagnóstico, utilizando-se, respectivamente, o Birmingham Vasculitis Activity Score (BVAS) e o Five-Factors Score (FFS). De acordo com o BVAS, os pacientes foram divididos em dois grupos: aqueles com BVAS < 22 e outro com BVAS ³ 22. De acordo com o FFS, dois grupos foram definidos: 0, quando nenhum fator de pior prognóstico foi notado e ³ 1 quando 1 ou mais fatores estavam presentes. As manifestações clínicas presentes por ocasião do diagnóstico foram avaliadas de acordo com o sistema orgânico acometido. Cinquenta e nove indivíduos caucasóides, saudáveis, da mesma população, formaram o grupo controle. A tipagem dos alelos HLA-DR foi realizada através da técnica de amplificação pela reação em cadeia da polimerase (PCR), utilizando-se sequências específicas de primers DR de baixa resolução. No grupo total de casos, encontrou-se uma maior frequência estatisticamente significativa de HLADRB1* 16 (p=0.023) e DRB4*01 (p=0.048) nos pacientes com BVAS ³ 22. Os pacientes com FFS=0 apresentaram uma maior frequência estatisticamente significativa de HLA-DRB1*03. A frequência de HLA-DRB1*11 e/ou B1*12 (p=0.046), B1*13 (p=0.021) e B3 (p=0.008) foi significativamente maior nos pacientes com envolvimento do trato gastrintestinal e a de DRB1*15 e/ou DRB1*16 (p=0.035) e B5 (p=0.035) nos pacientes com acometimento renal. Nossos resultados sugerem que os alelos HLA-DRB1*15/B1*16, B4*01, B1*03, B1*11/B1*12, B1*13, B3 e B5 podem influenciar a expressão clínica da PAN e da poliangiíte microscópica na nossa população. / Abstract: The aim of this study was to evaluate the frequency and clinical associations of HLA-DR alleles in Brazilian Caucasian patients with polyarteritis nodosa (PAN) or microscopic polyangiitis (MPA). We evaluated 29 Caucasian patients with vasculitis classified as PAN or MPA according to the American College of Rheumatology (ACR) 1990 Criteria and Chapel Hill Consensus Conference (CHCC) nomenclature for vasculitis. HLA-DR alleles were typed using polymerase chain reaction-amplified DNA, hybridized with sequence specific low resolution primers. DNA obtained from 59 Caucasian healthy blood donors were used as control. In order to evaluate if a specific HLA may have influence on the clinical profile of those diseases, we also divided the patients according to Birmingham vasculitis score (BVAS) and Five-Factors Score (FFS) at the time of diagnosis. Increased frequency of HLA-DRB1*16 (p=0.023) and DRB4*01 (p=0.048) was found in patients with higher disease activity at the time of diagnosis (BVAS ³ 22). Patients with less severe disease (FFS=0) had a higher frequency of HLA-DRB1*03 (p=0.011). Patients with gastrointestinal tract involvement had significantly increased frequency of HLA-DRB1*11 or B1*12 (p=0.046), B1*13 (p=0.021) and B3 (p=0.008). In contrast, patients with renal disease, had higher frequency of DRB1*15 or DRB1*16 (p=0.035) and B5 (p=0.035). Our results suggest that HLA-DR alleles may influence PAN and MPA clinical expression and outcome. / Doutorado / Clinica Medica / Mestre em Clinica Medica
142

Papel do HLA-G na endometriose / Role of HLA-G in endometriosis

Marici Rached Rached 27 June 2017 (has links)
A endometriose é uma doença inflamatória crônica, estrógeno-dependente e de etiologia multifatorial, caracterizada pela implantação e crescimento de tecido endometrial fora da cavidade uterina e associada à dor pélvica e infertilidade. A doença é classificada de acordo com os estádios e sítios de acometimento nos órgãos pélvicos. Variantes genéticas, endócrinas e ambientais podem contribuir para a geração de uma deficiência na resposta imune local permitindo a implantação das células ectópicas na cavidade pélvica. Alterações constatadas no padrão de citocinas presentes no microambiente pélvico poderiam promover um ambiente imunossupressor, justificando a diminuição da resposta imune efetora verificada na endometriose. Dentre os possíveis fatores imunomoduladores, está o antígeno leucocitário humano-G (HLA-G), cuja expressão se dá intensamente nas células trofoblásticas, sendo reconhecido por induzir a tolerância materno-fetal. A proteína HLA-G pode ser expressa na membrana celular ou ser secretada na forma solúvel. HLA-G encontra receptores inibitórios nas células do sistema imune inato e adaptativo e tem sua expressão induzida sob condições não fisiológicas, como em transplantes alogênicos, doenças inflamatórias ou neoplasias malignas. Assim, a hipótese deste estudo é a de que a proteína HLA-G seria produzida em níveis superiores nas mulheres com endometriose, o que poderia contribuir para a imunossupressão no microambiente da doença. Para testar esta hipótese, a proteína solúvel foi mensurada no soro e no fluido peritoneal de mulheres com e sem endometriose, por ensaio de imunoabsorção enzimática (ELISA). Além disto, a expressão gênica de HLA-G foi avaliada nos tecidos de endométrio, por qRT-PCR, bem como a expressão da proteína, avaliada por imunohistoquímica, nos tecidos de endométrio e de lesão de endometriose, em mulheres com e sem a doença. Como resultados, verificaram-se maiores níveis da proteína solúvel no soro de mulheres que apresentavam endometriose em estádios avançados, especialmente naquelas com endometriose ovariana. Entretanto, na comparação entre os fluidos peritoneais, não houve diferença significativa entre os grupos com e sem endometriose. A expressão do transcrito gênico (mRNA) se mostrou maior no endométrio de mulheres sem a doença, mas a presença da proteína foi semelhante entre os endométrios de mulheres com e sem endometriose. Por outro lado, a expressão da proteína HLA-G nos tecidos de lesão de endometriose avançada se mostrou superior à do endométrio de mulheres sem a doença, indicando que a expressão de HLA-G seria induzida ectopicamente, no microambiente pélvico da doença. Portanto, os resultados apontam para um aumento da expressão de HLA-G em endometriose avançada / Endometriosis is a chronic inflammatory, estrogen-dependent disease of multifactorial etiology characterized by implantation and growth of endometrial tissue outside the uterine cavity, and associated with pelvic pain and infertility. Endometriosis is classified according to the stages and sites of the disease. Genetic, endocrine and environmental factors may contribute to the deficit on local immune response, allowing ectopic implantation of endometrial cells into the pelvic cavity. Changes in cytokines pattern in the pelvic microenvironment might promote an immune suppressor environment and explain the decreased immune effector cells response verified in endometriosis. Among possible immunomodulatory factors is the human leucocytary antigen-G (HLA-G) which is intensively expressed in trophoblasts and recognized by inducing maternal-fetal tolerance. HLA-G protein is expressed in both membrane-bound and soluble forms. HLA-G binds inhibitory receptors on innate and adaptive immune cells surface and its expression is induced in non-physiological conditions, such as allogeneic transplants, inflammatory diseases or neoplastic malignancies. Thus, this study hypothesizes that the HLA-G protein would be overexpressed in women with endometriosis, and could contribute to the immunosuppression in the disease microenvironment. To test this hypothesis soluble HLA-G protein was measured in serum and peritoneal fluid of women with and without endometriosis. Moreover, HLA-G gene expression were evaluated on endometrial tissue using RT-qPCR, and HLA-G protein expression were evaluated in matched ectopic and eutopic endometrium of women with and without endometriosis. As results, higher levels of soluble HLA-G were found in serum of women with advanced endometriosis, especially in those with ovarian endometriosis. However, soluble HLA-G levels in peritoneal fluid did not show significant differences between women with and without endometriosis. HLA-G mRNA expression were higher in eutopic endometrium of women without endometriosis, but the HLA-G protein expression were similar in eutopic endometrium of women with and without endometriosis. On the other hand, HLA-G protein expression in ectopic endometrium of women with advanced endometriosis was higher than in eutopic endometrium of women without endometriosis, suggesting that HLA-G expression was induced ectopically, in the pelvic microenvironment of the disease. In conclusion, the results point to an upregulation of HLA-G expression in advanced endometriosis
143

Associações dos anticorpos anti-HLA pré-formados e da compatibilidade HLA à rejeição celular aguda precoce no transplante hepático / Associations of preformed anti-HLA antibodies and HLA compatibility with early acute cellular rejection in liver transplantation

Rafael Antonio Arruda Pecora 18 May 2016 (has links)
INTRODUÇÃO: As moléculas HLA são os principais alvos da rejeição nos transplantes de órgãos sólidos. A influência dos anticorpos anti-HLA pré-formados e da compatibilidade HLA no transplante de fígado ainda não está bem definida. A maioria dos transplantes é realizada sem a pesquisa de anticorpos anti-HLA pré-formados e sem pareamento HLA. OBJETIVOS: Avaliar as associações dos anticorpos anti-HLA pré-formados e da compatibilidade HLA à rejeição celular aguda (RCA) em até 90 dias após o transplante. MÉTODOS: Coorte prospectiva de transplantes de fígado ABO compatíveis/idênticos realizados entre janeiro de 2012 e dezembro de 2013. Enxertos que sobreviveram além de 4 dias foram incluídos. A pesquisa de anticorpos anti-HLA classes I e II foram realizadas por meio de ensaios de fase sólida (LABScreen® Mixed e LABScreen® Single Antigen). MFI (Mean Fluorescence Intensity) >= 1.000 foi onsiderado omo positi o para anticorpos anti-HLA. Tipificação HLA-A, B e DR, de receptores e doadores foi feita por meio de PCR (Polymerase Chain Reaction). Conforme o número de alelos HLA incompatíveis, os transplantes foram classificados em compatíveis (0-3 incompatibilidades) e incompatíveis (4-6 incompatibilidades). Apenas episódios de RCA comprovados por biópsia, associados a alterações das provas hepáticas, foram considerados. O critério Banff foi utilizado para diagnóstico e os episódios foram estratificados em leves, moderados e graves. Modelos de regressão de Cox foram realizados e as razões de risco (RR) associadas foram determinadas. Sobrevidas livres de RCA foram obtidas por meio do estimador de Kaplan Meier e comparadas entre os grupos pelo teste log-rank. RESULTADOS: Cento e vinte e nove transplantes foram analisados. Incidência global de RCA em 90 dias foi de 14,7%. A pesquisa de anticorpos anti-HLA pré-formados foi considerada positiva em 35,6% dos transplantes. Em relação à compatibilidade HLA, 91,5% dos transplantes foram classificados como incompatíveis. A sensibilização para anticorpos anti-HLA foi associada a um risco aumentado de RCA (RR=4,3; IC 95%=1,3 - 13,5; p=0,012). De acordo com a classe do anticorpo, observamos que a classe II foi associada a um risco aumentado de RCA (RR=56,4; IC 95%= 4,5 - 709,6; p=0,002). Para anticorpos classe I, foi observada associação marginalmente significante (RR=2,77; IC 95%=0,8 - 8,8; p= 0,08). Uma melhor compatibilidade HLA não foi associada a um risco reduzido de RCA (RR= 0,9; IC 95%=0,2-4; p=0,89). CONCLUSÕES: O presente estudo mostrou que a sensibilização para anticorpos anti-HLA pré-formados om I >= 1.000 está asso iada a um risco aumentado de rejeição celular aguda precoce no transplante de fígado. Anticorpos classe II foram também associados a um risco aumentado de RCA e anticorpos classe I foram tendência. A melhor compatibilidade HLA não foi associada a um risco reduzido de RCA neste estudo. A presença de sensibilização para anticorpos anti-HLA pré-formados poderia servir como marcador de imunorreatividade aumentada contra os enxertos. Isso permitiria ajustes individualizados de imunossupressão / INTRODUCTION: Human leucocyte antigens (HLA) molecules are the main targets of rejection in solid organ transplantation. Significance of anti-HLA preformed antibodies and HLA compatibility remains unclear in liver transplantation. Majority of liver transplants are performed without assessment of preformed anti-HLA antibodies and HLA-matching. OBJECTIVES: Evaluate associations of preformed anti-HLA antibodies and HLA compatibility with acute cellular rejection (ACR) in the first 90 days after transplantation. METHODS: Prospective cohort of ABO-identical/compatible liver transplants between January 2012 and December 2013. Grafts that survived more than 4 days were included. Anti-HLA class I and II antibodies were determined by solid phase assays (LABScreen® Mixed and LABScreen® ingle Antigen). A mean fluores en e intensity ( I) >= 1.000 was considered as positive for anti-HLA antibodies. Recipients and donors HLA typing for HLA-A, B and DR were performed using polymerase chain reaction (PCR) assays. According to HLA mismatches (MM), transplants were divided in compatible (0-3 MM) and incompatible (4-6 MM). Only biopsy proven ACR episodes, associated with abnormal liver tests, were considered. Banff criteria was used for diagnosis of ACR and episodes were graded as mild, moderate and severe. Cox proportional hazards models were performed and associated hazard ratios (HR) were determined. Free ACR rates were estimated with Kaplan-Meier analysis and were compared between groups with the log-tank test. RESULTS: One hundred twenty nine transplants were analyzed. Overall incidence of ACR was 14.7% in 90 days. Assessment of anti-HLA pre-formed antibodies was considered positive in 35.6% of transplants. Regarding HLA compatibility, 91.5% were considered incompatible. Anti-HLA antibodies sensitization was associated with an increased risk of ACR (HR= 4.3; CI 95%=1,3 - 13,5; p=0.012). According to class of antibody, we could observe that class II was associated with an increased risk of ACR (HR=56.4; CI 95%= 4.5 - 709.6; p=0.002). Class I antibodies were considered tendency to increased risk of ACR (HR=2.7; CI 95%= 0.8 - 8.8; p=0,08). A better HLA compatibility was not associated with a lower risk of ACR (HR=0.9; CI 95%=0.2-3.8 p=0.89). CONCLUSIONS: The present study indicates that preformed anti-HLA antibodies with I >= 1.000 are associated with an increased risk of early ACR rejection in liver transplantation. Class II antibodies were also associated with an increased risk of ACR. Class I antibodies were considered tendency. HLA matching had no influence on early acute cellular rejection on this study. Anti-HLA antibodies sensitization could serve as a marker of increased immunoreactivity to the graft. It would serve for tailored immunosuppression
144

Expressão das moléculas HLA-E nas lesões intraepiteliais cervicais em mulheres portadoras do HPV com ou sem a infecção pelo HIV-1 / HLA-E molecules expression in cervical intraepithelial lesions of HIV-1 infected and non-infected women

Marjory Lucia Firmino da Costa 19 December 2016 (has links)
Entre mulheres com HIV/AIDS há um maior número de casos de infecções persistentes pelo HPV contribuindo para um risco aumentado do desenvolvimento de lesões intraepiteliais escamosas cervicais. Ademais, a expressão anormal de moléculas HLA-E pode modular o sistema imunológico através da ligação com o receptor inibitório (CD94/NKG2A) ou estimulatório (CD94/NKG2C) de células NK e linfóticos T CD8+, diminuindo imunovigilância favorecendo a evasão de céulas infectadas por vírus. Diante da escassez de estudos avaliando a molécula HLA-E na interação com o HPV, mais especificamente na infecção pelo HIV-1, este estudo teve como objetivo avaliar a expressão de HLA-E em lesões intraepiteliais cervicais em mulheres portadoras do HPV, apresentando ou não a infecção pelo HIV-1. Trata-se de um estudo transversal, ao qual foram submetidos ao processo imunohistoquímico tecido do colo do útero parafinado de 67 mulheres infectadas pelo HIV-1 e 62 mulheres não infectadas, todas com lesão intraepitelial cervical com HPV, o qual foi tipificado. A expressão da molécula HLA-E foi analisada quantitativamente como sem expressão, de 1% a 30%, de 31% a 70% e de 71% a 100%. Os resultados mostraram que a infecção por herpes vírus foi maior entre as participantes HIV+ (P=0,005). Na análise imunohistoquímica, ficou evidente que as lesões intraepiteliais cervicais de mulheres infectadas pelo HIV-1 apresentaram redução na expressão da molécula HLA-E de 31% a 100% em comparação com mulheres sem a infecção pelo HIV- 1 (P=0,001), sugerindo que essa redução possa ser um mecanismo de escape viral, que acarreta a redução da apresentação de peptídeos virais para os linfócitos T CD8+. A expressão do HLA-E não foi associada aos graus de lesões intraepiteliais cervicais. Outros estudos são necessários para melhor compreensão do padrão e da função da expressão das moléculas HLA-E em lesões intraepiteliais cervicais de mulheres infectadas pelo HIV- 1 / Among women with HIV / AIDS there is a greater number of cases of persistent HPV infections contributing to an increased risk of developing squamous intraepithelial lesions of the cervix. In addition, abnormal expression of HLA-E molecules can modulate the immune system by binding to the inhibitory (CD94 / NKG2A) or stimulatory (CD94 / NKG2C) receptor NK cells and CD8+ T lymphocytes, decreasing immunovigilance and favoring the evasion of infected cells infected with virus. Due to the lack of studies evaluating the HLA-E molecule in the interaction with HPV, more specifically in HIV-1 infection, this project aimed to evaluate the expression of HLA-E in cervical intraepithelial lesions of infected women or not by HIV- 1, with the infection by HPV. It is a cross-sectional study, which was submitted to immunohistochemical processing the paraffin-embedded cervix tissue of 67 HIV-1 women infected with HIV-1 and 62 uninfected women, all of them with cervical intraepithelial lesion with HPV, which was typified. The expression of HLA-E was quantitatively analyzed as non- expressed, 1% to 30%, 31% to 70% and 71% to 100%. The results showed that the herpes virus infection was higher among HIV + participants (P = 0.005). In immunohistochemical analysis, it became evident that cervical intraepithelial lesions in HIV-1 infected women showed a reduction the expression of HLA-E molecule from 31% to 100% compared to women without HIV-1 infection (P = 0.001) Suggesting that this reduction may be a viral escape mechanism, which leads to a reduction in the presentation of viral peptides to CD8+ T lymphocytes. The expression of HLA-E was not associated with cervical intraepithelial lesions. More studies are need to better understand the pattern and function of HLA-E molecule expression in cervical intraepithelial lesions of infected women by HIV-1
145

Relevância da monitorização dos anticorpos anti-HLA após o transplante renal: estudo clínico e anatomopatológico / Relevance of anti-HLA monitoring after kidney transplantation: Clinical and anatomopathological study

Patrícia Soares de Souza 29 January 2009 (has links)
INTRODUÇÃO: O objetivo deste estudo foi avaliar prospectivamente os anticorpos anti-HLA após o transplante renal e associar estes achados com episódios de rejeição aguda, marcação por C4d e sobrevida do enxerto. MÉTODOS: Foram avaliados 926 soros de 111 pacientes no primeiro ano pós-transplante ou até a perda do enxerto. Os anticorpos foram analisados por PRA-ELISA (Panel Reactive Antibodies by Enzyme Linked Immuno Sorbent Assay). Anticorpos anti-HLA doador-específicos foram detectados por provas-cruzadas e caracterizados pelo método de microesferas marcadas com antígenos HLA. Episódios de rejeição aguda foram classificados conforme os Critérios de Banff 97, atualizados em 2003. RESULTADOS: Conforme o PRA-ELISA pós-transplante os pacientes foram classificados em 5 Grupos: Grupo A (n=80): sem evidência de anticorpos pré e pós-transplante; Grupo B (n=8): pacientes com anticorpos de novo; Grupo C (n=5): pacientes sensibilizados que permaneceram com mesmo nível de PRA-ELISA; Grupo D (n=4): pacientes sensibilizados que elevaram o nível de PRA-ELISA e Grupo E (n=14): pacientes sensibilizados que diminuíram o nível de PRA-ELISA durante o primeiro ano pós-transplante. A incidência de rejeição aguda foi de 23,4%. Pacientes dos Grupos B, C e D apresentaram mais episódios de rejeição aguda (respectivamente, 57%; 60% e 100%) que os dos Grupos A (18%) e E (7%), (p<0,001). Rejeições ocorridas no Grupo A foram histologicamente menos severas do que as dos outros Grupos (p=0,03) e com menor incidência de C4d+ (p<0,001). Entre os pacientes com rejeição aguda, 44% deles apresentaram anticorpos no momento da rejeição, sendo que em 90% dos casos esses anticorpos foram doadorespecíficos. Rejeição mediada por células, ou seja, sem anticorpos e com C4d-, ocorreu em 56% dos casos. A incidência global de rejeição mediada por anticorpos (RMA) foi de 11%. A sobrevida do enxerto censurada para óbito foi menor em pacientes com rejeição aguda (p<0,001), especialmente naqueles com anticorpos anti-HLA doador-específicos (p<0,001), com C4d+ (p=0,003) e nos casos de RMA (p<0,003). CONCLUSÃO: Nossos dados sugerem que a monitorização dos anticorpos anti-HLA após o transplante renal pode ser útil no diagnóstico das respostas mediadas por anticorpos e tem implicações em termos de sobrevida do enxerto. / INTRODUCTION: The aim was to follow prospectively anti-HLA antibodies (Abs) after kidney transplantation and to evaluate their association with acute rejection episodes, C4d staining and graft survival. METHODS: We analyzed 926 sera from 111 transplanted patients until graft lost or during 1 year posttransplant. The antibodies were analyzed using Panel Reactive Antibodies by Enzyme Linked Immuno Sorbent Assay (PRA-ELISA). Donor-specific antibodies (DSA) were detected by crossmatch tests and characterized by single antigen beads. Acute rejections (AR) were classified by Banff 97 criteria, updated in 2003. RESULTS: According to post-transplant PRAELISA the patients were classified in 5 groups: Group A (n=80): no evidence of Abs pre and post-transplant; Group B (n=8): patients with Abs de novo; Group C (n=5): sensitized patients who sustained the same PRA-ELISA levels; Group D (n=4): sensitized patients who increased PRA-ELISA levels and Group E (n=14): sensitized patients who decreased PRA-ELISA levels during the first year. The overall incidence of acute rejection was 23,4%. Patients from Groups B, C and D had more AR (respectively, 57%; 60% and 100%) than patients from Groups A (18%) and E (7%), (p<0.001). Patients from Group A had lower Banff scores than other groups (p=0.03) and lower rates of C4d positivity on AR biopsies (p<0.001). Among patients with AR, 44% of them had antibodies which appeared/increased during the AR episodes, and 90% were DSA. AR were pure cell-mediated (C4d-/Abs-) in 56% of the cases. The overall incidence of antibody-mediated rejection (AMR) was 11%. One-year censored graft survival was lower in patients with AR (p<0.001), specially in those with DSA (p<0.001), C4d+ (p=0.003), and AMR (p<0.003). CONCLUSION: Our data suggest that monitoring of anti- HLA antibodies post-transplantation is an useful tool for the diagnosis of antibody-mediated responses, and has prognostic implications in terms of graft survival.
146

Frequência dos antígenos HLA-DR em 97 pacientes piauienses com artrite reumatoide e envovimento pulmonar / Frequency of HLA-DR antigens in 97 patients from Piauí with rheumatoid arthritis and pulmonary involvement

Almeida, Maria do Socorro Teixeira Moreira, 1951- 06 April 2014 (has links)
Orientador: Manoel Barros Bertolo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T16:46:42Z (GMT). No. of bitstreams: 1 Almeida_MariadoSocorroTeixeiraMoreira_D.pdf: 2149275 bytes, checksum: 99ea931f214943626d6352a600cd07e9 (MD5) Previous issue date: 2014 / Resumo: Objetivo: Determinar a frequência dos antígenos HLA-DR em pacientes piauienses com artrite reumatoide (AR) e envolvimento pulmonar. Pacientes e métodos: Foram avaliados 97 pacientes piauienses com AR. A genotipagem do HLA-DR foi realizada através da técnica de amplificação pela reação em cadeia da polimerase. Resultados: Oitenta e cinco pacientes (88,0%) eram do sexo feminino, 77,0% não caucasoides e tinham idade média de 47,3 anos. Cinquenta e quatro pacientes (56,0%) apresentavam manifestações extra-articulares, sendo nódulos subcutâneos a mais frequente (19,0%). Após a realização de avaliação pulmonar, constatou-se comprometimento pulmonar em 54 (56,0%) pacientes. HLA mais frequente foi o HLA DRB4*01, seguido por DRB1*04, DRB3 e DRB1*01 e nos pacientes com comprometimento pulmonar foram HLA-DRB4*01, HLA-DRB1*04 e HLA-DRB1*13. Conclusão: O HLA mais frequente foi o HLA-DRB4*01 em todos os pacientes do estudos e nos pacientes com envolvimento pulmonar também foi o HLA-DRB4*01, não havendo, no entanto, associação estatisticamente significativa / Abstract: Aims: To establish the frequency of HLA-DR antigens in individuals with rheumatoid arthritis (RA) from Piaui with and without lung affection. Participants and methods: The sample comprised 97 individuals. HLA-DR was genotyped by means of polymerase chain reaction amplification. Results: A total of 85 participants (88.0%) were female; 77.0% were non-white; and the average age of the sample was 47.3 years old. A total of 54 participants (56.0%) exhibited extra-articular manifestations, most frequently subcutaneous nodules (19.0%). Lung assessment detected affection in 54 (56.0%) participants. HLA-DRB4*01 was the most frequently found allele, followed by HLA-DRB1*04, HLA-DRB3 and HLA-DRB1*01, whereas the most frequent alleles were HLA-DRB4*01, HLA-DRB1*04 and HLA-DRB1*01 in the participants with lung affection. Conclusion: HLA-DRB4*01 was the allele most frequently found overall, and HLA-DRB4*01 was the most frequent allele among the participants with lung affection; however, the association was not statistically significant / Doutorado / Medicina Interna / Doutora em Ciências Médicas
147

Estudo do HLA-DR e HLA-DQ em pacientes piauienses com artrite idiópática juvenil / Study of HLA-DR and HLA-DQ in patients from Piauí with juvenile idiopathic arthritis

Pires, Catarina Fernandes, 1956- 06 May 2014 (has links)
Orientador: Manoel Barros Bertolo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T03:37:39Z (GMT). No. of bitstreams: 1 Pires_CatarinaFernandes_D.pdf: 2601322 bytes, checksum: 1acb7f604b763cb1fd45c71455e387bf (MD5) Previous issue date: 2014 / Resumo: O presente estudo de caso-controle avaliou 74 crianças piauienses com Artrite Idiopática Juvenil (AIJ) em suas diversas formas: Oligoarticular, Sistêmica, Poliarticular Fator Reumatoide Positivo (FR+), Poliarticular Fator Reumatoide Negativo (FR-), Artrite relacionada a Entesite (ERA), Artrite Psoriásica e Artrite indeterminada, classificadas de acordo com os Critérios da Liga Internacional de Associações de Reumatologia (ILAR) e cento e um controles saudáveis pareados de acordo com idade, sexo, procedência e etnia. Os objetivos foram identificar e determinar os alelos HLA-DR e HLA-DQ em uma amostra da população infanto-juvenil piauiense com AIJ nas formas oligoarticular, sistêmica, poliarticular FR+, poliarticular FR-, artrite psoriásica, artrite relacionada a entesite e artrite indeterminada e compará-las com as frequências observadas no grupo de controle saudáveis; conhecer os alelos HLA-DR e HLA-DQ que estão associados a maior susceptibilidade e os que conferem maior proteção na população de crianças com AIJ em suas diversas formas. As tipagens dos alelos HLA-DR e HLA-DQ foram realizadas por meio da técnica de amplificação pela Reação de Cadeia da Polimerase (PCR), utilizando cadeias específicas de primers DR e DQ. O resultado da análise demostrou que, entre todas as formas de apresentação da AIJ, houve associação estatística significativa para a susceptibilidade da doença com o HLA-DRB1*10 OR 8,8 (IC 1,1 a 74,9) e HLA-DRB1*16 OR 2,8 (IC 1,1 a 7.5). Na forma oligoarticular a associação estatística significativa para a susceptibilidade ocorreu com o alelo HLA-DRB1*08 OR 4,6 (IC 1,4 a 14,6). Na forma sistêmica, essa associação aconteceu com o alelo HLA-DRB1*10 OR 22,2 (IC 1,8 a 269,5).Na forma Poliarticular FR+ a associação estatística significativa para a susceptibilidade ocorreu com os alelos DRB1*09 OR 12,1 (IC 2,2 a 66,9) e DRB1*10 OR 28,5 (IC 2,3 a 355,0). Na forma Poliarticular FR-, a associação estatística significativa para a susceptibilidade foi com o alelo DRB1*16 OR 13,4 (IC 1,6 a 111,2). A Artrite Psoriásica não apresentou nenhuma associação estatística significativa com os HLA pesquisados. O resultado da análise demostrou que, entre todas as formas de apresentação da AIJ, houve associação estatística significativa para a proteção da doença com o HLA-DRB1*03 OR 0,7 (IC 0,5 a 0,9) e, na forma sistêmica, essa associação aconteceu igualmente com DRB1*03 OR 0,7 (IC 0,6 a 0,8). As outras formas de apresentação da doença não demonstraram associação estatística significativa para a proteção com nenhum tipo da HLA pesquisado. A população estudada não apresentou nenhum caso de ERA e de Artrite indeterminada. O estudo encontrou ainda, associação para o risco entre o HLA-DQB1*03 OR = 6,06 (IC 1,3 a 27,2) e uveíte em pacientes com a forma oligoarticular da AIJ. Desta forma, concluímos que os nossos resultados apresentam tanto semelhanças em relação a susceptibilidade, quanto diferenças, principalmente quanto a proteção, nas associações tipicamente encontradas na literatura / Abstract: This case-controle valuated 74 children from Piauí with Juvenile Idiopathic Arthritis (AIJ) in its various forms: Oligoarticular, Systemic, Polyarticular Rheumatoid Factor Positive (FR +), Polyarticular Rheumatoid Factor Negative (FR-), Enthesitis-related Arthritis (ERA), Arthritis Psoriatic and Arthritis indeterminate, classified according to the Criteria of the International League of Associations for Rheumatology(ILAR), and one hundred and one healthy control smatched according to age ,sex, origin and ethnicity. The objectives were to identify and determine the HLA-DR and HLA-DQ in a sample of Piauí juvenile population subtypes JIA in oligoarticular, systemic, polyarticular RF + polyarticular RF -, psoriatic arthritis, enthesitis-related arthritis and arthritis indeterminate and compares them with the observed frequencies in the group of healthy control; know the HLA-DR and HLA-DQ alleles are associated with increased susceptibility and conferring greater protection in the population with JIA in its various forms and identify a possible relationship between the alleles HLA-DR and HLA-DQ and the most frequent and most aggressive form of the disease in the population studied. Polymerase Chain Reaction (PCR) using primers specific chains of DR and DQ performed the typing of HLA-DR and HLA-DQ using the technique of amplification. The result of the analysis demonstrate damong all cases of JIA was statistically significant association for disease susceptibility with HLA-DRB1*10 OR 8.8 (CI 1.1 to 74.9) and HLA-DRB1*16 OR 2.8 (CI 1.1 to 7.5). In oligoarticular JIA significant statistical association to susceptibility occurred with HLA-DRB1*08 allele OR 4.6 (CI 1.4 to 14.6), association systemic form happened to HLA-DRB1*10 OR 22.2 (CI 1.8 to 269.5) allele in polyarticular RF + the statistically significant association to susceptibility occurred with the DRB1*09 alleles OR 12.1(CI 2.2 to 66.9) and DRB1*10 OR 28.5(CI 2.3 to 355.0) in polyarticular RF- significant statistical association to susceptibility was with DRB1*16 allele OR 13.4 (CI 1.6 to 111.2). The Psoriatic Arthritis showed no statistically significant association with HLA surveyed. The result of the analysis demonstrate damong all cases of JIA was statistically significant association for disease protection with HLA-DRB1*03 OR 0.7(CI 0.5 to 0.9) and the systemic form this association also happened DRB1*03 OR with 0.7 (CI 0.6 to 0.8). The other forms of the disease showed no statistically significant association for protection on any type of HLA searched. The study population did not show any cases of ERA and indeterminate Arthritis. The study also found, statistically significant difference between the HLA-DQB1*03 OR 6.0 (CI 1.3 to 27.2), and uveitis in patients with oligoarticular form of JIA. Thus, we conclude that our results show both similarities in terms of susceptibility, and differences, especially regarding the protection, associations typically found in the literature / Doutorado / Medicina Interna / Doutora em Ciências Médicas
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Particularités immunobiochimiques et trafic intracellulaire de la protéine HLA-B27, molécule du complexe majeur d'histocompatibilité de classe I impliquée dans les spondylarthrites / Immunobiochimiques features and intracellular trafficking of HLA-B27 molecule major histocompatibility complex class I involved in spondylitis

Gaspard, Cindy Jeanty 30 January 2012 (has links)
La spondylarthrite ankylosante (SA), la forme la plus commune des spondylarthrites (SpA), est fortement associée à la molécule du CMH de classe I HLA-B27 mais le rôle de cet antigène d'histocompatibilité dans le développement de ces pathologies reste encore inexpliqué. L’étude des rats transgéniques HLA-B27, développant une pathologie inflammatoire spontanée ressemblant aux SpA, a permis de confirmer l’implication directe du HLA-B27 et de corréler l’apparition des symptômes avec une forte expression de cette molécule. De plus, il a été montré que l’HLA-B27 présentait une propension particulière au mauvais repliement et à la formation d’oligomères de chaînes lourdes. L’objectif de mon travail de thèse était de déterminer si le trafic et/ou la formation d’oligomères du HLA-B27 étaient corrélés à sa surexpression. Pour cela, notre équipe a développé des protéines de fusion (HLA-BYFP et HLA-BRLuc) ainsi que la technique BRET afin d’étudier les interactions HLA-B/HLA-B. Au moyen de ce système expérimental, nous avons montré la formation de vésicules intracellulaires riches en protéines HLA-B mal repliées lorsqu’elles étaient fortement exprimées, qu'il s'agisse d'allèles associés à la SA (HLA-B*2702, -05, et -07) ou non (HLA-B*2706, et -09, HLA-B*0702). Cependant, ce phénomène était significativement plus prononcé pour les sous-types associés à la SA. Dans les conditions de forte expression, nous avons également observé que les sous-types associés à la SA formaient des oligomères qui se comportent différemment de ceux formés par la protéine HLA-B7. Ce phénomène ne semble pas être dû au déclenchement de la réponse cellulaire « Unfolded Protein Response » (UPR) et n’est pas abrogé par l’inhibition du protéasome. / Ankylosing spondylitis (AS), the most common form of spondyloarthritis (SpA), is strongly associated with the MHC class I HLA-B27 molecule. Although this association has been largely studied, mechanisms of pathology remain unclear. Development of a spontaneous inflammatory disease resembling human SpA in HLA-B27 transgenic rats confirmed the direct involvement of HLA-B27 and allowed to associate disease development with high expression levels of this molecule. Moreover, the HLA-B27 protein has an enhanced propensity to misfold and form aberrant disulfide linked heavy chain oligomers in the endoplasmic reticulum and at the cell surface. The goal of my thesis work was to determine if the HLA-B27 traffic and/or its ability to form oligomers are involved in this requirement of overexpression. For that, our team has developed fusion proteins ((HLA-BYFP and HLA-BRLuc) and the BRET technique to study, in vitro, the HLA-B/HLA-B interactions. Using this experimental system, we have shown the formation of intracellular vesicles, in which misfolded/unfolded HLA-B proteins accumulated when they were highly expressed, for both AS-associated alleles (HLA-B*2702, -05, et -07) or not (HLA-B*2706, et -09, HLA-B*0702). This phenomenon is strongly pronounced for AS-associated subtypes. For high-level expression, we also observed that the AS-associated subtypes form oligomers that behave differently from those formed by the HLA-B7 control protein. This phenomenon doesn’t appear to be due to unfolded protein response (UPR) triggering and is not abrogated by proteasome inhibition.
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Étude de l'antigène du complexe majeur d'histocompatibilité HLA-G : rôle dans le phénomène de tolérance immunitaire au cours de l'infection palustre / Antigen of major histocompatibility complex HLA-G : role in immune tolerance during malaria infection

D'Almeida, Tania Carenne Djidemi Ayemouwa 24 January 2017 (has links)
Les femmes enceintes et les enfants sont les populations à haut risque pour le paludisme. Chez les premières, l'infection peut entraîner une infection placentaire (IP). Les enfants nés d'une mère ayant une IP seraient plus à risque de développer une infection palustre rapidement après la naissance. Un phénomène de tolérance immunitaire est évoqué mais aucune explication n'est émise. Nous proposons une explication basée sur l'implication de HLA-G, protéine de la tolérance immunitaire. Nous avons pu montrer que les niveaux élevés de HLA-G chez les enfants étaient associés à un risque élevé de paludisme et au faible poids de naissance. Il existe une très forte ressemblance mère-enfant au cours de la grossesse et durant les 2 premières années de vie de l’enfant avec une probabilité très élevé chez les enfants d’avoir le même profil que leur mère. Les femmes ayant une IP présentent un risque plus élevé d’avoir des enfants ayant des niveaux de HLA-G soluble élevé, et le délai de 1ère infection palustre est plus court pour les enfants nés de mères ayant un niveau de HLA-G élevé en début de grossesse. Ces résultats confirment que HLA-G est associée à l’infection palustre. Ils montrent que le rôle de HLA-G dans l’IP est très complexe. Face à la ressemblance mère-enfant et le délai de 1ère infection, il serait intéressant d’envisager le dosage de HLA-G maternel en début de grossesse afin de confirmer son rôle prédictif. HLA-G pourrait alors être un outil de santé publique intéressant pour identifier de potentiels futurs enfants à risque. / Pregnant women and children are populations at high risk for malaria. Malaria infection in pregnancy can lead to placental malaria (PM). Children born to a mother with PM have an increased risk of malaria infection during the first years of life. To explain this phenomenon related to an immune tolerance, we suggest an explanation based on the implication of HLA-G, an immune tolerance protein. We show that high levels of soluble HLA-G in children were associated with malaria risk and low birth weight. There is a very strong mother/child resemblance during pregnancy and the first 2 years of life of the child with a very high probability in children of having the same profile as their mother. Women with PM have a higher risk to give birth to a child with high levels of soluble HLA-G, and children born to mothers with high HLA-G levels have an increased risk of malaria in early pregnancy. These results confirm that HLA-G is associated with malaria infection. They show that the role of HLA-G in PM is very complex. According to the maternal-child resemblance and the delay onset the first infection, it would be interesting to consider the dosage of maternal HLA-G in early pregnancy in order to confirm its predictive role. HLA-G could then be an interesting public health tool to identify potential children at risk.
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Caractéristiques immunogénétiques et immuno-inflammatoires des troubles du spectre autistique (TSA) / Immunogenetic and immuno-inflammatory characteristics of autism spectrum disorders (ASD)

Bennabi, Meriem 31 January 2017 (has links)
Les troubles du spectre autistique (TSA) sont un ensemble de pathologies neurodéveloppementales dont la prévalence est en constante augmentation. Ils sont caractérisés par des déficits de la communication et des interactions sociales, et par des comportements répétitifs et stéréotypés. A l’origine d’un handicap sévère, ces troubles se manifestent dès la petite enfance et persistent chez l’adulte. Cette entité recouvre des profils cliniques très hétérogènes, tant par le spectre de sévérité des symptômes que par la variété des comorbidités psychiatriques et somatiques associées sous tendues, en partie, par des dysfonctionnements immunitaires. Dans ce contexte, nous nous sommes de ce fait intéressés à l’identification et à la caractérisation de biomarqueurs à valence immunogénétique et immunologique afin d’en étudier l’implication physiopathologique et d’en déterminer les corrélats cliniques.De manière plus précise, nous avons évalué l’implication de la diversité génétique de molécules intervenant dans l’immunité innée (PRR, CLR, Dectin-1) et l’immunité adaptative (système HLA) dans le but d’apprécier le poids du terrain immunogénétique sur le développement de ces troubles. Puis, nous avons analysé les caractéristiques phénotypiques et fonctionnelles des cellules Natural Killer de patients atteints de TSA afin d’en déterminer l’influence potentielle sur l’état inflammatoire permanent rapporté chez certains patients TSA.Sur le plan immunogénétique, nous avons montré que la diversité génétique de Dectin-1 (CLEC7A), candidat sélectionné en raison de son implication dans la modulation de pathologies microbiennes intestinales, était associé à une forme particulière de TSA, le syndrome d’Asperger. Nous avons observé que le génotype CLEC7A rs2078178 GG ainsi que l’haplotype rs2078178/rs16910631 GG/GG étaient non seulement plus fréquents chez les Asperger mais aussi associées aux scores de quotient intellectuel (QI). Dans le cadre de l’analyse de la diversité génétique du système HLA, nous avons identifié un haplotype à risque (HLA-DRB1 *11-DQB1*07) et un haplotype de protection (HLA-DRB1 *17-DQB1*02). L’haplotype à risque étant également associé avec la sévérité de la maladie, reflétée par des scores défavorables dans les échelles cliniques psychiatriques testées.Dans la seconde partie de cette thèse nous avons exploré les modifications phénotypiques et fonctionnelles des cellules NK CD3- CD56+ chez les patients atteints d’autisme de haut niveau. Nous avons observé un état d’activation cellulaire permanent concomitant avec une capacité de dégranulation spontanée, une production soutenue d’IFN-?, et un état hypofonctionnel/épuisement cellulaire après stimulation in vitro. De plus, nous avons identifié un cluster spécifique de cellules NK, basé sur les paramètres HLA-DR, NKG2C, et KIR2DL1, et nous avons observé une augmentation inattendue des cellules NK NKG2C+ chez les sujets TSA en dehors de toute piste infectieuse connue. Enfin, nous avons observé que l’expression de KIR2DL1 et de HLA-DR était respectivement corrélée aux scores de QI et à ceux évaluant les CCA-LS et SAWR.Pris dans leur ensemble, ces données pourraient permettre de contribuer à une meilleure connaissance des mécanismes physiopathologiques associés au système immunitaire dans les TSA et par conséquent à une meilleure catégorisation des groupes de patients susceptibles de bénéficier de stratégies thérapeutiques immunologiques ciblées. / Autism spectrum disorders (ASD) are severe neurodevelopmental conditions characterized by deficits in communication and social interactions, and by repetitive and stereotyped behaviors and exhibiting a constant increase in terms of prevalence. Affecting ages ranging from the early post-natal period to adulthood, ASD are clinically heterogeneous and often associated with psychiatric and somatic comorbidities underlying, in part, by immune dysfunctions. In this context, we thus focused our attention on the analysis of immunogenetic and immunological characteristics potentially implicated in the disease risk and/or in the modulation their clinical phenotype. More precisely, we evaluated the potential implication of the genetic diversity of molecules involved in innate (PRR, CLR, Dectin-1) and adaptive (HLA) immune responses in disease risk. We then analyzed the phenotypic and functional characteristics of Natural Killer cells in patients with ASD, investigating their influence on the permanent inflammatory state often reported in ASD settings.On the immunogenetic point of view, we found that the genetic diversity of Dectin-1 (CLEC7A), a candidate selected because of its involvement in the modulation of intestinal microbial disorders, was associated with Asperger syndrome, a clinical form of ASD. We observed that the CLEC7A genotype rs2078178 GG and the rs2078178 / rs16910631 GG /GG haplotype were not only more frequent in Asperger but also associated with IQ scores.In terms of HLA diversity, we identified a risk haplotype (HLA-DRB1 * 11-DQB1 * 07) and a protective haplotype (HLA-DRB1 * 17-DQB1 * 02). The risk haplotype was also found to be associated with disease’s severity as reflected by unfavorable scores in the psychiatric clinical scales tested.In the second part of this thesis, we explored the phenotypic and functional modifications of CD3-CD56 + NK cells in patients with high-functioning autism. We observed a permanent cell activation state concomitant with spontaneous degranulation capacity, sustained IFN-? production and cellular hypofunction /exhaustion after in vitro stimulation. In addition, we identified a specific cluster of NK cells, based on the HLA-DR, NKG2C, and KIR2DL1 parameters, and we observed an unexpected increase of NK NKG2C + cells in ASD subjects independent of CMV infection. Finally, we observed that the expression of KIR2DL1 and HLA-DR were respectively correlated with the scores of IQ and those evaluating the CCA-LS and SAWR scales.Taken together, these data could contribute to a better knowledge of the pathophysiological mechanisms associated with the immune system in ASD and consequently to a better categorization of the groups of patients likely to benefit from targeted immunological therapeutic strategies.

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