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Das Monozyten chemotaktische Protein-1 (MCP-1) ist ein CC-Chemokin, das in seiner Rolle als Chemoattraktor auf Monozyten in der Genese von Malignomen eine wesentliche Rolle spielt. Dabei kann es sowohl zur lokalen Tumorabwehr als auch zur Tumorgenese, Tumor-angiogenese und Metastasierung beitragen. Die vorliegende Arbeit untersucht die MCP-1-Inhibition und die Stimulation durch MCP-1 auf die Koloniebildung und die Zytokinexpression von Plattenepithelkarzinomen der Kopf-Hals-Region (HNSCC) im FLAVINO-Assay. Dieser ist ein klonogener, qualitätskontrollierter Ex-vivo-Koloniebildungsassay, der an der Klinik für Hals-Nasen-Ohrenheilkunde der Universität Leipzig etabliert und patentiert wurde und unter flavinschützenden Bedingungen durchgeführt wird. Weiterhin wird die Eignung von MCP-1, Interleukin-6 (IL-6), Interleukin-8 (IL-8) und des Vascular endothelial growth factor (VEGF) als Biomarker in HNSCC, die mithilfe von ELISA in Seren und Kulturüberständen quantifiziert wurden, untersucht. Durch die Stimulation durch MCP-1 und dessen Blockade sowie durch in vivo tolerierbare Konzentrationen von Cisplatin, Docetaxel, Cilengitide und Temsirolimus wurde die Expression der untersuchten Zytokine in den Kulturüberständen der HNSCC unterschiedlich moduliert. Cisplatin und MCP-1 supprimierten die Koloniebildung signifikant, während unter Docetaxel und Temsirolimus eine insignifikante Reduktion und durch Cilengitide eine insignifikante Stimulation der Koloniebildung beobachtet wurde. Die MCP-1-Blockade durch einen Anti-MCP-1-Antikörper führte zu keiner signifikanten Modulation der Koloniebildung. MCP-1 und der Anti-MCP-1-Antikörper senkten die Zytokinexpression, während bis auf Cisplatin alle Zytostatika die Zytokinexpressionen steigerten. Bezüglich der kombinierten Testung der Zytostatika und der MCP-1-Blockade bzw. Stimulation unterschieden sich die Proben, sodass additive, synergistische und antagonistische Effekte resultierten. Da durch MCP-1 gesteuerte tumorassoziierte Makrophagen das Mikromilieu eines Tumors wesentlich beeinflussen, gebührt diesen ebenfalls eine besondere Aufmerksamkeit. In dieser Arbeit wurden unter MCP-1 antitumoröse Effekte beobachtet, sodass weitere klinische Testungen der antitumorösen Wirkung des MCP-1 auf HNSCC lohnenswert erscheinen. Die individuelle Chemoresponse-Testung kann dabei helfen, das biologisch heterogene Verhalten der HNSCC besser zu verstehen. In diesem Sinne wäre die klinische Validierung solcher Testsysteme wertvoll.

Made available in DSpace on 2014-08-20T14:30:10Z (GMT). No. of bitstreams: 1 Dissertacao_alessandro_menna_alves.pdf: 813449 bytes, checksum: 43f43131b0d8e54633d172ea87ffa722 (MD5) Previous issue date: 2013-03-18 / This dissertation was divided into two distinct works, which can be summarized as follows: Article 1: The oral squamous cell carcinoma (OSCC) is the most prevalent malignance in mouth, being an important public health problem. The aim of this study was to evaluate the clinical and epidemiological profile of the OSCC cases registered in a center of clinical and histopathological diagnosis, located in Southern Brazil. Eight hundred and six individuals with OSCC and its variants were included in this study, over 1959-2012 period. The variables recorded from the files were: age, gender, skin color, tumor location, size and evolution time of the lesions (referred by the patients), as well as, the presence of pain lymph nodes, habits of tobacco and alcohol, and also the profession. OSSC was more frequent in males (76.6%), with the majority of cases distributed between 51 and 70 years old (53.9%). The most prevalent sites were lower lip vermilion [23.3% (20.4; 26.4)], followed by lateral border/ventral surface of the tongue [20.2% (17.5; 23.2)], gingiva/alveolar ridge [18.1% (15.5; 21.0)], and floor of the mouth [14.9% (12.5; 17.5)]. A strong association between outdoor occupation and OSCC in lower lip vermilion was found. The OSCC lesions located in tongue, gingiva/alveolar ridge and floor of the mouth were commonly more painful, bigger than 2 cm, and frequently presenting lymph nodes involvement. Most of the results confirm the data from literature. Mouth self-examination should be recommended and campaigns of prevention and early detection of OSCC should be periodically performed in order to increase people s feelings of personal risk. Article 2: Inside the tumor microenvironment (TM) the neoplastic cells are in dynamic crosstalk with the vascular and lymphatic endothelial cells in order to allow the tumor to growth and metastasize. Hypothesizing that there is a crosstalk between lymphatic endothelial cells and tumor cells from squamous cell carcinoma (SCC) that plays an important role in metastasis, we aimed to identify potential interactions between lymphatic endothelial cells and tumor cells lines from SCCs, through some in vitro assays. Primary adult human dermal lymphatic microvascular endothelial cells (HMVECs) and the human head and neck SCC cell lines like A431, UM-SCC-1, UM-SCC-22A and UM-SCC-22B were cultured in their specific media. UM-SCC cells lines were treated with rhIL-6, being VEGF-C expression checked by Elisa. Baseline IL-6 was evaluated in HMEVCs using the same assay. Also the IL-6 receptor (IL-6R) was analyzed by Western blot in UM-SCC cells. Conditioned media from HMVECs were prepared with different treatments and incubated with SCC A431 cells, in order to verify the MMPs enzymatic activities by gelatin zymography. Our results demonstrated that there are interactions between tumor cells and LECs, since the LECs-CM were able to enhance MMP-2 gelatinolytic activity. Moreover, we showed that LECs secrete IL-6, and different SCC lines have receptors for this cytokine. Therefore, our results indicate some potential interactions between LECs and TCs, being necessary other studies to elucidate the involved signaling pathways / Esta dissertação foi dividida em dois trabalhos distintos, os quais podem ser resumidos da seguinte maneira: Artigo 1: O carcinoma espinocelular oral (CEO) é o tumor maligno mais prevalente na cavidade oral, sendo um importante problema de saúde pública. O objetivo deste estudo foi avaliar o perfil clínico e epidemiológico dos casos registrados de CEO em um centro de diagnóstico clínico e histopatológico, localizado no Sul do Brasil. Oitocentos e seis indivíduos com CEO e suas variantes histológicas foram incluídos neste estudo, num período entre 1959 e 2012. As variáveis anotadas dos arquivos foram: idade, sexo, cor da pele, sítio, tamanho, tempo de evolução (relatado pelo paciente), assim como a presença de dor, linfonodos palpáveis, hábitos de tabagismo e etilismo, e a profissão. CEO foi mais prevalente em homens (76,6%), com a maioria dos casos distribuídos entre os 51 e 70 anos de idade (53,9%). Os sítios mais prevalentes foram vermelhão do lábio inferior [23,3% (20,4; 26,4)], seguido por borda lateral/ventre de língua [20,2% (17,5; 23,2)], gengiva/rebordo alveolar [18,1% (15,5; 21,0)], e assoalho bucal [14,9% (12,5; 17,5)]. Foi encontrada uma forte associação entre ocupações ao ar livre e CEO de vermelhão de lábio inferior. As lesões localizadas na língua, gengiva/rebordo alveolar e assoalho bucal foram comumente mais dolorosas, maiores que 2 cm, a frequentemente apresentavam envolvimento de linfonodos. A maioria dos nossos resultados confirmam os dados da literatura. O autoexame bucal deveria ser recomendado e campanhas de prevenção e detecção precoce do CEO deveriam ser realizadas periodicamente na tentativa de aumentar o sentimento pessoal em relação ao CEO. Artigo 2: Dentro do microambiente tumoral (MT), as células neoplásicas estão numa constante crosstalk com células endoteliais linfáticas (CELs) e sanguíneas a fim de permitir o crescimento tumoral e metástase. Supondo que haja um crosstalk entre as CELs e as células do carcinoma espinocelular (CE) que exerce um importante papel na metástase, nosso objetivo foi identificar potenciais interações entre as CELs e linhagens celulares de CE, através de alguns ensaios in vitro. Células endoteliais linfáticas primárias adultas humanas da microvasculatura dérmica (HMVECs) e as linhagens de CE A431, UM-SCC-1, UM-SCC-22A e UM-SCC-22B foram cultivadas nos seus meios específicos. UM-SCC foram tratadas com rhIL-6, sendo a expressão de VEGF-C verificada por Elisa. Produção natural de IL-6 pelas HMVECs foi avaliada da mesma maneira. A presença de receptor de IL-6 (IL-6R) foi analisada por Western Blot nas linhagens UM-SCC. Meios condicionados(MC) das HMVECs foram preparados com diferentes tratamentos e incubados com a linhagem A431, a fim de verificar a atividade genatinolítica das MMPs por zimografia. Nossos resultados demonstraram que há interações entre as células tumorais e as CELs, uma vez que MC-CELS foram capazes de aumentar a atividade genatinolítica da MMP-2. Além disso, nós mostramos que as CELs secretam IL-6, e diferentes linhagens de CE possuem receptores para esta citocina. Sendo assim, nossos resultados indicam potenciais interações entre as LECs e as células tumorais, sendo necessário outros estudos para elucidar as vias de sinalização envolvidas

Das Monozyten chemotaktische Protein-1 (MCP-1) ist ein CC-Chemokin, das in seiner Rolle als Chemoattraktor auf Monozyten in der Genese von Malignomen eine wesentliche Rolle spielt. Dabei kann es sowohl zur lokalen Tumorabwehr als auch zur Tumorgenese, Tumor-angiogenese und Metastasierung beitragen. Die vorliegende Arbeit untersucht die MCP-1-Inhibition und die Stimulation durch MCP-1 auf die Koloniebildung und die Zytokinexpression von Plattenepithelkarzinomen der Kopf-Hals-Region (HNSCC) im FLAVINO-Assay. Dieser ist ein klonogener, qualitätskontrollierter Ex-vivo-Koloniebildungsassay, der an der Klinik für Hals-Nasen-Ohrenheilkunde der Universität Leipzig etabliert und patentiert wurde und unter flavinschützenden Bedingungen durchgeführt wird. Weiterhin wird die Eignung von MCP-1, Interleukin-6 (IL-6), Interleukin-8 (IL-8) und des Vascular endothelial growth factor (VEGF) als Biomarker in HNSCC, die mithilfe von ELISA in Seren und Kulturüberständen quantifiziert wurden, untersucht. Durch die Stimulation durch MCP-1 und dessen Blockade sowie durch in vivo tolerierbare Konzentrationen von Cisplatin, Docetaxel, Cilengitide und Temsirolimus wurde die Expression der untersuchten Zytokine in den Kulturüberständen der HNSCC unterschiedlich moduliert. Cisplatin und MCP-1 supprimierten die Koloniebildung signifikant, während unter Docetaxel und Temsirolimus eine insignifikante Reduktion und durch Cilengitide eine insignifikante Stimulation der Koloniebildung beobachtet wurde. Die MCP-1-Blockade durch einen Anti-MCP-1-Antikörper führte zu keiner signifikanten Modulation der Koloniebildung. MCP-1 und der Anti-MCP-1-Antikörper senkten die Zytokinexpression, während bis auf Cisplatin alle Zytostatika die Zytokinexpressionen steigerten. Bezüglich der kombinierten Testung der Zytostatika und der MCP-1-Blockade bzw. Stimulation unterschieden sich die Proben, sodass additive, synergistische und antagonistische Effekte resultierten. Da durch MCP-1 gesteuerte tumorassoziierte Makrophagen das Mikromilieu eines Tumors wesentlich beeinflussen, gebührt diesen ebenfalls eine besondere Aufmerksamkeit. In dieser Arbeit wurden unter MCP-1 antitumoröse Effekte beobachtet, sodass weitere klinische Testungen der antitumorösen Wirkung des MCP-1 auf HNSCC lohnenswert erscheinen. Die individuelle Chemoresponse-Testung kann dabei helfen, das biologisch heterogene Verhalten der HNSCC besser zu verstehen. In diesem Sinne wäre die klinische Validierung solcher Testsysteme wertvoll.

Beeinträchtigungen der humanen Immunantwort durch primäre Immundefekte (PID) oder Immundysfunktionen können zu einer lebensbedrohlichen Anfälligkeit für Infektionen führen. Der erste Abschnitt dieser Arbeit umfasst die Charakterisierung einer unbekannten IKBKG-Mutation, die zu einer bisher unbeschriebenen NEMO-Defekt-Variante führt. NEMO-Defekte wurden bislang den Defekten der angeborenen Immunität zugeordnet. Die Mutation verursachte jedoch einen zusätzlichen schweren T-Zelldefekt, infolgedessen der Patient in seinem ersten Lebensjahr vermehrt an schweren bakteriellen Infektionen litt. Die Analyse der NEMO-kodierenden Sequenz ergab, dass die Mutation zu einem Exon-Verlust und somit zu einem verkürzten, funktionell-eingeschränkten Protein führte. Im Vergleich mit vorbeschriebenen NEMO-Defekten wurde deutlich, dass das Spektrum der Erkrankungen durch IKBKG-Mutationen breiter als bisher angenommen und die frühzeitige Charakterisierung der Immunantwort zur Abschätzung der individuellen Prognose essentiell ist. Der zweite Abschnitt umfasst die Charakterisierung von anti-Interleukin (IL)-6-Autoantikörpern (AAk) in Patienten, die an mindestens einer schweren bakteriellen Infektion erkrankt waren. 0,6 % dieser Patienten wiesen neutralisierende AAk gegen IL-6 auf, während 0,4 % einer Patientenkohorte mit Autoimmunerkrankungen, 0 % einer Patientenkohorte mit mykobakteriellen Infektionen und 0,1 % von Individuen ohne schwere bakterielle Infektionen anti-IL-6-AAk präsentierten. Des Weiteren wurden drei bislang gesunde Frauen mit neutralisierenden AAk identifiziert. Das Epitop-Mapping zeigte Bindungsstellen, die für die Bildung des IL-6-Rezeptorkomplexes notwendig sind. Die Verlaufsanalyse der Titer ergab, dass trotz persistentem bzw. abfallendem Titer keine weiteren Infektionen eintraten. Zusammenfassend führen anti-IL-6-AAk einerseits zu einer erhöhten Anfälligkeit für bakterielle Infektionen, andererseits ist diese Anfälligkeit nicht in dem Maße ausgeprägt wie bei einem PID. / Disturbances of the human immune response in the form of primary immunodeficiencies (PID) or immune dysfunctions can lead to life-threatening infections. The first chapter of this work refers to the analysis of an unknown IKBKG mutation resulting in an undescribed variant of NEMO-deficiency. These defects have been previously assigned to immunodeficiencies of the innate immunity. However, the mutation additionally leads to a severe T-cell defect, whereupon the patient suffered from several severe bacterial infections in his first year of life. Analysis of the NEMO-coding sequence indicated that the mutation leads to an exon skipping and a shortened, functionally restricted protein. The range of diseases caused by IKBKG mutations is broader than previously presumed when compared to other NEMO-deficiencies. Therefore, the early characterization of the immune response is essential for the assessment of the individual prognosis. The second chapter comprises the characterization of anti-IL-6-autoantibodies in a cohort of patients who suffered from at least one severe bacterial infection. 0.6 % of these patients presented neutralizing autoantibodies against IL-6 whereas 0.4 % of patients with autoimmune diseases, 0 % of patients with mycobacterial infections and 0.1 % of individuals without severe infections demonstrated neutralizing autoantibodies against IL-6. In addition, three so far healthy women with neutralizing anti-IL-6-autoantibodies were identified. Analysis of the binding characteristics identified IL-6-binding sites that are essential for the formation of the IL-6 signaling complex. The examination over several years revealed that, despite persistent or decreasing antibody titers, no further or new infections occurred. In summary, anti-IL-6-autoantibodies seem to have an extenuated predisposition to severe infections, but this susceptibility is not as severe as in PID.

BACKGROUND:Lysophosphatidic acid (LPA) is a bioactive phospholipid with a potentially causative role in neurotrauma. Blocking LPA signaling with the LPA-directed monoclonal antibody B3/Lpathomab is neuroprotective in the mouse spinal cord following injury.FINDINGS:Here we investigated the use of this agent in treatment of secondary brain damage consequent to traumatic brain injury (TBI). LPA was elevated in cerebrospinal fluid (CSF) of patients with TBI compared to controls. LPA levels were also elevated in a mouse controlled cortical impact (CCI) model of TBI and B3 significantly reduced lesion volume by both histological and MRI assessments. Diminished tissue damage coincided with lower brain IL-6 levels and improvement in functional outcomes.CONCLUSIONS:This study presents a novel therapeutic approach for the treatment of TBI by blocking extracellular LPA signaling to minimize secondary brain damage and neurological dysfunction.

L’interleukine 6 (IL-6) est une cytokine qui joue un rôle essentiel dans l’inflammation. Son récepteur (IL-6R) est composé de la chaîne non signalétique IL-6Rα et de la chaîne transductrice du signal gp130, commune aux cytokines de la famille IL-6. La liaison de l’IL-6 à son récepteur permet l’activation de plusieurs voies de signalisation, notamment des voies Jak/STAT1 et préférentiellement Jak/STAT3. De façon complémentaire, nous avons démontré que l’IL-6 est capable d’activer la voie Jak/STAT5 dans les lymphocytes T CD4. L’activation de cette voie de signalisation pourrait être impliquée dans le rétrocontrôle des effets pro-inflammatoires de l’IL-6 sur les cellules T CD4. Le facteur neurotrophique ciliaire (CNTF) et la « cardiotrophin-like cytokine/cytokine-like factor 1 » (CLC/CLF) sont deux cytokines de la famille de l’IL-6 qui signalent à travers un récepteur commun, le récepteur au CNTF (CNTFR), composé du CNTFRα, « leukaemia inhibitory factor receptor β » (LIFRβ) et gp130. Toutes deux exercent des actions au niveau du système immunitaire, or la chaîne CNTFRα de leur récepteur n’y est pas exprimée. Il a été montré que le CNTFR humain peut également activer un récepteur formé des sous-unités IL-6Rα, LIFRβ et gp130. Nous avons comparé les effets du CNTF et du CLC/CLF de souris sur des transfectants exprimant LIFRβ et gp130 et les chaines α connues de la famille IL-6 (IL-6Rα, IL-11Rβ et CNTFRα). Nos résultats indiquent que le CNTF de souris, comme le CNTF humain est capable d’activer un récepteur formé de l’IL-6Rα, LIFRβ et gp130. Toutefois cette propriété n’est pas partagée par CLC/CLF et le récepteur impliqué dans les effets de cette cytokine sur le système immunitaire reste donc à identifier. L’IL-27 appartient à la famille de l’IL-6 composée d’une sous-unité cytokinique, p28, associée à un récepteur soluble « l’Epstein-Barr virus-induced gene 3» (EBI3). La sous-unité p28 peut s’associer avec le récepteur soluble CLF pour former une cytokine capable d’activer les lymphocytes T. Dans le but de caractériser cette cytokine, nous avons montré que p28/CLF agit aussi sur les lymphocytes B et permet leur différenciation en plasmocytes. Le partage de l’IL-6R par l’IL-6 et p28/CLF semble être à l’origine de la similarité des effets de ces deux cytokines. De plus, nous avons observé des effets semblables à ceux de l’IL-6 suite à l’association de la sous-unité p28 seule avec la chaîne IL-6Rα. En effet, afin de mieux caractériser la cytokine p28/CLF, nous avons étudié les effets dus au recrutement de la chaîne IL-6Rα par la sous-unité p28. Les cytokines de la famille de l’IL-6 sont composées de quatre hélices α disposées de façon anti-parallèle deux à deux. La sous-unité p28 possède, au niveau d’une boucle reliant deux hélices α, un motif de plusieurs acides glutamiques consécutifs (motif polyE) qui n’est retrouvé dans aucune autre cytokine de cette famille. Nous avons démontré que ce motif est impliqué dans la liaison de cette sous-unité avec l’hydroxyapatite et l’os. Cette caractéristique de p28 pourrait permettre un ciblage de l’IL-27 (p28/EBI3) et de p28/CLF préférentiellement vers la niche endostéale des cellules souches et des cellules immunitaires. / Interleukin 6 (IL-6) is a well known cytokine, characterized for its essential function in inflammation. IL-6 receptor (IL-6R) is composed of IL-6Rα, an unsignalling chain, associated with the signaling transducing chain gp130. This glycoprotein is shared by all IL-6 family cytokines. After binding with its receptor, IL-6 preferentially induces the activation of the Jak/STAT3 pathway but can also activate the Jak/STAT1 pathway. Unexpectedly we demonstrated that IL-6 can activate the Jak/STAT5 pathway in CD4 T cells. This STAT5 could act as negative feedback mechanism in response to the pro-inflammatory effects induced by an excess of IL-6. Ciliary neurotrophic factor (CNTF) and cardiotrophin-like cytokine (CLC/CLF) both belong to the IL-6 cytokine family and share the same receptor, the CNTF receptor (CNTFR). CNTFR is composed of CNTFRα, leukaemia inhibitory factor receptor β (LIFRβ) and the glycoprotein gp130. Interestingly, the CNTFRα chain is not expressed by immune cells even though CNTF and CLC/CLF are active on these cells. These effects can be due to the formation of a complex between cytokine and CNTFRα, which can be shedded. This complex can then activate cells expressing only gp130 and LIFRβ. In human, it has been demonstrated that the CNTFRα chain can be substitute with IL-6Rα. Here, we compare mouse CNTF- and CLC/CLF-induced effects in transfected cells expressing LIFRβ, gp130 and different α chains belonging to the IL-6 family (IL-6Rα, IL-11Rα or CNTFRα). Our data demonstrate that like human CNTF, mouse CNTF is able to activate a receptor comprising of IL-6Rα, gp130 and LIFRβ. However, this property is not shared with CLC/CLF. Therefore, second receptor for this cytokine within the immune system still remains to be identify. Interleukin 27 (IL-27) belongs to the IL-6 cytokine family and is composed of the cytokine subunit p28 associated with a soluble receptor chain Epstein-Barr virus-induced gene 3 (EBI3). We demonstrate that the p28 subunit can bind the soluble receptor CLF to form a new dimeric cytokine named p28/CLF. This cytokine is active on T cells and our study demonstrates its activity on B cells. Our results show that p28/CLF sustains plasma cell differentiation. Those IL-6-like properties can be explained by the use of a common receptor, IL-6R. Moreover, our findings demonstrate that p28 has IL-6-like properties when associated with IL-6Rα. In order to better characterize p28/CLF, we next studied effects of to the recruitment of the IL-6Rα chain by p28 subunit. Cytokines belonging to the IL-6 family share a structural particularity by forming a four helix bundle cytokines family. The p28 subunit uniquely expresses a motif composed of a dozen of glutamic acids (polyE motif). We demonstrate that this motif permits p28 binding to hydroxyapatite and bone matrix. This observation could allow a preferential targeting to bone of IL-27 (p28/EBI3) and p28/CLF, and specifically a targeting of stem or immune cells to endosteal niches.

Objetivo: Avaliar o perfil de citocinas pró-inflamatórias e de melatonina no cordão umbilical e no sangue materno de gestantes hígidas de acordo com a via de parto. Métodos: Entre março e setembro de 2010, foi realizado estudo observacional prospectivo no Hospital Universitário da Universidade de São Paulo. Foram dosadas citocinas (IL-1, IL-6, TNF) e melatonina em pacientes sem doenças clínicas ou complicações obstétricas que entraram em trabalho de parto espontâneo. As concentrações de citocinas e de melatonina foram comparadas de acordo com a via de parto, além do período do dia e do local de coleta. O sangue retirado da veia do cordão umbilical (VCU) era obtido imediatamente após o parto, sendo que após uma hora era colhido o sangue da veia braquial materna (VB). Foram excluídas pacientes com infecção, parto prematuro e sofrimento fetal. Resultados: Foram estudadas 50 parturientes, das quais 25 evoluíram para parto vaginal e 25 para cesárea. A idade materna foi em média 26,0 ± 6,7 anos. A idade gestacional no parto foi em média 39,5 ± 1,7 semanas. O peso médio dos recém-nascidos foi 3366,5 ± 340,2 gramas. Todos os casos receberam analgesia durante o parto (analgesia combinada: peridural e raquianestesia). A maioria das pacientes era de nulíparas (31/50 - 62,0%). A duração do trabalho de parto foi semelhante nas pacientes que evoluíram para o parto vaginal (7,6 ± 4,4 horas) e nas que foram submetidas à operação cesariana (8,2 ± 4,4 horas; p=0,87). Houve tendência de níveis mais elevados de melatonina no VCU e na VB em pacientes após parto vaginal, porém sem diferença estatística (p=0,41 e p=0,16). Pacientes que evoluíram para cesariana apresentaram dosagens significativamente maiores de TNF na VB, de IL-1 na VCU e na VB e de IL-6 na VCU que em pacientes que evoluíram para parto vaginal (p= 0,02; p<0,01; p<0,01 e p<0,01; respectivamente). Observou-se variação no ritmo circadiano das dosagens dessas citocinas após cesariana, com correlação significativa entre dosagem de melatonina e de citocinas nessa via de parto. Conclusão: Pacientes submetidas à operação cesariana apresentaram tendência a redução da secreção de melatonina, com aumento significativo da secreção de citocinas pró-inflamatórias, o que pode ser conseqüência do processo inflamatório relacionado ao estresse cirúrgico / Objetive: To evaluate the profile of pro-inflammatory cytokines and the melatonin level in maternal and umbilical cord blood samples in accordance with the mode of delivery. Methods: Between March 2010 and September 2010, a prospective observational study was conducted at University Hospital of University of São Paulo. Cytokines (IL-1, IL-6, TNF) and melatonin levels were analyzed from maternal brachial vein (BV) and umbilical cord vein (UCV) obtained from healthy patients that started spontaneous labor. The levels of cytokines and melatonin were evaluated in accordance to the mode of delivery as well as the day period and the local of blood sample (UCV - immediately after delivery and BV - one hour after delivery). Patients with infection, preterm labor and fetal distress were excluded. Results: A total of 50 patients were evaluated in the present study: 25 underwent vaginal delivery and 25 c-section. Mean maternal age was 26.0 ± 6.7 years. Mean gestational age at delivery was 39.5 ± 1.7 weeks. The average of newborn weight was 3366.5 ± 340.2 grams. All patients had combined epidural and raquianesthesia. The majority of the patients was nullipara (31/50 62.0%). The labor duration was similar in patients that underwent vaginal delivery (7.6 ± 4.4 hours) or c-section (8.2 ± 4.4 hours, p=0.87). There was a tendency of increased levels of melatonin in the UCV and BV samples after vaginal deliveries, but with statistical significance (p=0.41 and p=0.16). Patients that underwent c-section had increased levels of TNF at the BV, IL-1 at the UCV and BV and IL-6 at the UCV than in patients that underwent vaginal delivery (p= 0.02; p<0.01; p<0.01 and p<0.01; respectively). Circadian variations of the cytokines and the melatonin levels were observed in patients that underwent c-section, with significant correlation between the levels of cytokines and melatonin. Conclusion: Patients that underwent c-section had a tendency of reduced melatonin level, with significant increase in the cytokine levels, which may be consequent of the inflammatory process related to the surgical stress.

Objetivo: Avaliar o perfil de citocinas pró-inflamatórias e de melatonina no cordão umbilical e no sangue materno de gestantes hígidas de acordo com a via de parto. Métodos: Entre março e setembro de 2010, foi realizado estudo observacional prospectivo no Hospital Universitário da Universidade de São Paulo. Foram dosadas citocinas (IL-1, IL-6, TNF) e melatonina em pacientes sem doenças clínicas ou complicações obstétricas que entraram em trabalho de parto espontâneo. As concentrações de citocinas e de melatonina foram comparadas de acordo com a via de parto, além do período do dia e do local de coleta. O sangue retirado da veia do cordão umbilical (VCU) era obtido imediatamente após o parto, sendo que após uma hora era colhido o sangue da veia braquial materna (VB). Foram excluídas pacientes com infecção, parto prematuro e sofrimento fetal. Resultados: Foram estudadas 50 parturientes, das quais 25 evoluíram para parto vaginal e 25 para cesárea. A idade materna foi em média 26,0 ± 6,7 anos. A idade gestacional no parto foi em média 39,5 ± 1,7 semanas. O peso médio dos recém-nascidos foi 3366,5 ± 340,2 gramas. Todos os casos receberam analgesia durante o parto (analgesia combinada: peridural e raquianestesia). A maioria das pacientes era de nulíparas (31/50 - 62,0%). A duração do trabalho de parto foi semelhante nas pacientes que evoluíram para o parto vaginal (7,6 ± 4,4 horas) e nas que foram submetidas à operação cesariana (8,2 ± 4,4 horas; p=0,87). Houve tendência de níveis mais elevados de melatonina no VCU e na VB em pacientes após parto vaginal, porém sem diferença estatística (p=0,41 e p=0,16). Pacientes que evoluíram para cesariana apresentaram dosagens significativamente maiores de TNF na VB, de IL-1 na VCU e na VB e de IL-6 na VCU que em pacientes que evoluíram para parto vaginal (p= 0,02; p<0,01; p<0,01 e p<0,01; respectivamente). Observou-se variação no ritmo circadiano das dosagens dessas citocinas após cesariana, com correlação significativa entre dosagem de melatonina e de citocinas nessa via de parto. Conclusão: Pacientes submetidas à operação cesariana apresentaram tendência a redução da secreção de melatonina, com aumento significativo da secreção de citocinas pró-inflamatórias, o que pode ser conseqüência do processo inflamatório relacionado ao estresse cirúrgico / Objetive: To evaluate the profile of pro-inflammatory cytokines and the melatonin level in maternal and umbilical cord blood samples in accordance with the mode of delivery. Methods: Between March 2010 and September 2010, a prospective observational study was conducted at University Hospital of University of São Paulo. Cytokines (IL-1, IL-6, TNF) and melatonin levels were analyzed from maternal brachial vein (BV) and umbilical cord vein (UCV) obtained from healthy patients that started spontaneous labor. The levels of cytokines and melatonin were evaluated in accordance to the mode of delivery as well as the day period and the local of blood sample (UCV - immediately after delivery and BV - one hour after delivery). Patients with infection, preterm labor and fetal distress were excluded. Results: A total of 50 patients were evaluated in the present study: 25 underwent vaginal delivery and 25 c-section. Mean maternal age was 26.0 ± 6.7 years. Mean gestational age at delivery was 39.5 ± 1.7 weeks. The average of newborn weight was 3366.5 ± 340.2 grams. All patients had combined epidural and raquianesthesia. The majority of the patients was nullipara (31/50 62.0%). The labor duration was similar in patients that underwent vaginal delivery (7.6 ± 4.4 hours) or c-section (8.2 ± 4.4 hours, p=0.87). There was a tendency of increased levels of melatonin in the UCV and BV samples after vaginal deliveries, but with statistical significance (p=0.41 and p=0.16). Patients that underwent c-section had increased levels of TNF at the BV, IL-1 at the UCV and BV and IL-6 at the UCV than in patients that underwent vaginal delivery (p= 0.02; p<0.01; p<0.01 and p<0.01; respectively). Circadian variations of the cytokines and the melatonin levels were observed in patients that underwent c-section, with significant correlation between the levels of cytokines and melatonin. Conclusion: Patients that underwent c-section had a tendency of reduced melatonin level, with significant increase in the cytokine levels, which may be consequent of the inflammatory process related to the surgical stress.

A morfina é um analgésico eficaz e muitas vezes opioide usado para aliviar a dor moderada a grave durante o período neonatal precoce. A exposição repetida de morfina no início da vida tem implicações duradouras para o desenvolvimento do sistema nervoso, tais como alterações neuroquímicas e comportamentais a longo prazo em ratos. O exercício físico vem sendo utilizado como uma alternativa não farmacológica para tratamento de quadros dolorosos. Deste modo nosso objetivo foi avaliar o efeito da exposição a morfina no período neonatal nas respostas nociceptiva (térmica e mecânica) e bioquímicas (citocinas e neurotrofinas) em ratos de P30 e P60 antes e após a exposição ao exercício físico. Ratos Wistar com 7 dias foram divididos em dois grupos: salina (SA) e morfina (MO) e submetidos a 5 mg / dia / 7 dias P8 para P14 a soro fisiológico ou MO respectivamente. Nas idades de P16, P30 e P60 a resposta nociceptiva térmica foi avaliada através do teste da placa quente (PQ), a resposta mecânica por Von Frey (VF) e Randal e Selitto (RS). Ainda foram medidos os níveis basais de BDNF, NGF, IL-6 e IL-10 em córtex cerebral e tronco encefálico. Após a sessão de exercício foram realizados em P30 e P60 o teste de PQ, 1h e 24h após o exercício, o teste de VF foi realizado 24h após e os níveis de BDNF, NGF, IL-6 e IL-10 também foram medidos em córtex cerebral e tronco encefálico após a exposição ao exercício. Nossos resultados demonstram que os animais que receberam morfina no período neonatal apresentam diminuição do limiar nociceptivo térmico e mecânico em P30 e P60. Os níveis de BDNF, NGF, IL-6 e IL-10 apresentaram relação direta com a idade em tronco encefálico, aumento ao longo do tempo. Em córtex cerebral os níveis de BDNF e NGF demonstraram uma interação entre os fatores grupo e idade, onde os animais do grupo MO têm diminuição desses com a idade. A IL-10 teve efeito somente da idade, enquando a IL-6 não se mostrou alterada por nenhum fator. Após a exposição ao exercício no teste da PQ no P30 e P60 os animais SAE tiveram uma diminuição do limiar nociceptivo se igualando aos grupos que receberam morfina. No teste de VF em P30 os grupos que receberam morfina são diferentes do grupos salina. Em P60 o grupo SAE mostra mais uma vez diminuiçao do limiar nociceptivo se igualando as grupos morfina. Nos níveis de BDNF e NGF em tronco encefálico ocorreu interação entre idade e grupo, onde o grupo MOE demonstra diminuição. Em tronco encefalico a IL-6 e Il-10 só tiveram efeito da idade. Em córtex cerebral os níveis de BDNF tiveram interação entre idade e grupo, o grupo MOE teve diminuição destes níveis em comparação aos demais grupos. Nos níveis de NGF se observou efeito do tempo e do grupo onde os grupos que recebem morfina têm níveis menores do que os que recebem salina em P60. O grupo MOS teve níveis menores de IL-6 em cortex cerebral do que os demais grupos, enquanto que os níveis de IL-10 só tiveram efeito da idade. Portanto a morfina no período neonatal leva a diminuição no limiar nociceptivo térmico e mecânico em ratos e que o exercício físico melhora os níveis BDNF, NGF e IL-6 em animais expostos a morfina no período neonatal. Porém o exercício físico não foi capaz de reverter a hiperalgesia e alodínia induzida pela morfina nos animais de P30 e P60. Sendo assim nossos dados mostram a necessidade de mais estudos sobre a dor em recém-nascidos e o sobre o uso de opioides neste período. Também se mostra necessário mais estudos sobre tratamentos não farmacológicos como o exercício físico. / Morphine is an effective analgesic often used to relieve moderate to severe pain during the early neonatal period. In our previous study, repeated morphine exposure in early life triggered persistent implications for the development of the nervous system, such as neurochemical and behavioral alterations in rats at long-term. The exercise has been used as a non-pharmacological alternative for treating painful conditions. Thus our aim was to evaluate the effect of repeated morphine exposure during the neonatal period upon nociceptive responses (thermal and mechanical) and biochemical markers (cytokines and neurotrophins) before and after unique physical exercise session in rats at P30 and P60. Seven-day-old male Wistar rats were divided into two groups: saline and morphine and subjected to saline and morphine (5 μg/day/7 days) from P8 to P14, respectively. At P16, P30 and P60, the thermal nociceptive response was assessed using the hot plate test (HP), while the mechanical response by Von Frey (VF) and Randal and Selitto (RS) tests. The basal levels of BDNF, NGF, IL-6 and IL-10 were measured in brainstem and cerebral cortex. One hour and 24h after exercise, the HP was conducted in P30 and P60, the VF test was only performed 24 ho after exercise, as well as the levels of BDNF, NGF, IL-6 and IL-10 were also measured in cerebral cortex and brainstem. Our results show that rats that received morphine in the neonatal period presented decreased thermal and mechanical nociceptive threshold in P30 and P60. And, BDNF, NGF, IL-6 and IL-10 levels presented a direct relationship with age in brainstem, increase their levels when the age increased. In cerebral cortex, BDNF and NGF levels showed an interaction between age and treatment group, where the morphine group showed decreased levels when the age increased. There was age effect upon IL-10 levels and no effects upon IL-6 levels in cerebral cortex. After 24h of exercise, saline group subjected to exercise presented decreased nociceptive threshold in using HP at P30 and P60, with similar threshold presented by morphine group. In VF test, both morphine groups presented decreased threshold in relation to both saline groups at P30. However, at P60, saline group subjected to exercise presented decreased nociceptive threshold, matching the morphine groups. In brainstem, we found interaction between age and group in BDNF and NGF levels, where morphine-exercise group showed decreased levels; and we observed only age effect upon IL-6 and IL-10 levels. In cerebral cortex, we observed interaction between age and group upon BDNF levels, where morphine-exercise group showed decreased levels compared to other groups. In relation to NGF levels, we observed effect of age and group, where morphine groups presented lower levels than saline groups in P60. The morphine-sedentary group presented lower IL-6 levels in the cerebral cortex than the other groups, while only age effect was observed on IL-10 levels. Our data lead us to conclude that morphine exposure in the neonatal period triggers a decrease in thermal nociceptive and mechanical thresholds in rats. And, the physical exercise improves BDNF, NGF and IL-6 levels in rats exposed to morphine in the neonatal period. However, on session of exercise was not able to revert the hyperalgesia and allodynia induced by morphine in rats at P30 and P60. Therefore, our data highlight the need of more studies about pain in newborns and neonates and the effect of the opioid use in this period. And, it is necessary more studies about non-pharmacological treatments, for example exercise.