Macrófagos recuperados de peritôneo de camundongos 48 horas após administração de concanavalina A (Con A) são ativados e possuem um conteúdo maior de mieloperoxidase (MPO) do que macrófagos residentes. Este aumento pode ser observado por immunobloting e pelo aumento da atividade peroxidásica. Esta atividade foi avaliada pela quimiluminescência desencadeada por homogenato de macrófagos e peróxido de hidrogênio, durante a oxidação de luminol e melatonina. Os macrófagos contendo MPO são capazes de gerar ácido hipocloroso quando estimulados com acetato de forbol miristato (PMA). O aumento do conteúdo de MPO em macrófagos é um processo que independe de interferon-γ (IFN-γ), uma vez que camundongos IFN-γ-\"knockout\" têm uma atividade ainda maior que camundongos \"wild type\". O contato entre macrófagos e neutrófilos in vivo, não é necessário para o incremento observado, visto que macrófagos de camundongos tratados com anticorpo anti-granulócitos preservam a atividade peroxidásica. Este achado é uma evidência de que em algumas condições a ativação de macrófagos é acompanhada por um aumento da atividade peroxidásica. Dentre o amplo espectro de ação da MPO, este processo pode ter um papel especial na inflamação. Também é de especial interesse o fato de macrófagos serem capazes de oxidar melatonina, um hormônio com vários efeitos imunomodulatórios. / Macrophages recovered from mice peritoneum 48 after concanavalin-A (Con A) administration are primed and have a higher content of myeloperoxidase (MPO) than resident cells. The increase of MPO is accompanied by an increment in peroxidase activity, evaluated by the chemiluminescence during the oxidation of luminol and melatonin triggered by macrophages homogenates plus hydrogen peroxide. MPO present in macrophages are able to generate hypochlorous acid when macrophages are stimulated with phorbol myristate acetate. Interferon-γ (IFN-γ) does not participate in the process that lead macrophages to become enriched in MPO, since IFN-γ knockout mice have an even higher peroxidase activity compared to the wild type. The contact of macrophages with neutrophil in vivo seems to be not necessary for the observed increment in peroxidase since macrophages recovered from mice treated with antigranulocyte antibody preserves the peroxidase activity. These finding provides evidences that, at least in some conditions, macrophage activation is accompanied by an increment in peroxidase activity. Given the broad spectrum of action of MPO, this process might play a special role in inflammation. Also of special interest is the finding that macrophages are able to oxidize melatonin, a hormone with several immunomodulatory effects.

A Indoleamina 2,3-dioxigenase (IDO) é uma enzima que apresenta um importante papel na prevenção da rejeição fetal. A IDO demonstra efeitos na supressão da ativação de células T por catabolizar o aminoácido essencial Triptofano. Nós estudamos a expressão da IDO em cultura celulares de placenta com a adição individual de Estradiol, Progesterona, Interferon , Triptofano e 1-Metil-Triptofano com o uso de citometria de fluxo, imunocitoquímica e quantificação celular, imunofluorescência, peroxidação lipídica, análise das fases do ciclo celular, imunoblotting e PCR em placentas bovinas nos três trimestres gestacionais. A quantificação celular revelou que em bovinos a atividade da IDO aumenta com o avanço do período gestacional e, sua expressão varia de acordo com os fatores, sendo o mesmo padrão observado pela imunofluorescência. O Imunoblotting mostrou a presença de possíveis isoformas desta proteína na espécie bovina que ainda não foram identificadas. A investigação pela lipoperoxidação revelou que os hormônios modularam diferencialmente a produção de radicais peroxidados nos três terços de gestação e, possivelmente atuam como fatores indutores de proliferação. As células placentárias apresentaram padrões diferenciados de proliferação e apoptose ao longo da gestação, principalmente nos tratamentos com Estradiol e Progesterona, sendo também variantes com outros fatores em todos os grupos. Observou-se que a Progesterona atua na maturação das células placentárias independente da concentração utilizada. Em todos os grupos uma grande proporção de células apresentava-se em estado de quiescência (G1). No terceiro trimestre foi detectado um aumento no número de células em G2/M, indicando a parada da capacidade proliferativa ou de progressão no ciclo celular (\"arrest\"). Maior taxa de apoptose foi observada nos animais de segundo trimestre gestacional. Baseados nisso, podemos concluir que a IDO é suscetível ao controle pelos mecanismos testados, o que nos leva a formular hipóteses de implantação de possíveis mecanismos terapêuticos para a reprodução com a participação da IDO. / Indoleamina 2,3-dioxigenase (IDO) is an enzyme that plays an important role in preventing fetal rejection. IDO is related to the suppression of the T-cells activation due to the catabolism of essential amino acid Triptophan. We studied the expression of IDO in bovine placenta cell culture with individual supplementation of factors as Estrogen, Progesterone, Interferon , Triptophan and 1-Methyl-Triptophan. Evaluations were made by flow cytometry, immunocitochemistry and cellular quantification, lipidic peroxidation, cell cycle phases, imunoblotting, PCR and immunofluorescency in the three trimesters of pregnancy. Cellular quantification demonstrated that in bovines the activity of the IDO increases during pregnancy, and its expression is factor-dependent, which was also observed in immunofluorescency. Imunoblotting demonstrated the presence of possible unknown protein isoforms in bovine. Lipoperoxidation evaluation demonstrated that hormones distinguishingly modulated the production of peroxide radicals in the three trimesters of pregnancy and, possibly acting as inductive factors of proliferation. Placental cells demonstrated differentiated patterns of proliferation and apoptosis during the gestation, mainly in the presence of Estrogen and Progesterone, besides variant rates were also observed under other factors. Independent of the concentration, Progesterone influenced placental cells maturation. All groups presented great ratio of cells in quiescence state (G1). In third trimester, G2/M high rates indicated a pause in proliferative capacity or in cell cycle progression (arrest). High apoptosis rates were observed in animals at second pregnancy trimester. Based on the presented, we concluded that IDO is susceptible to be controlled by the applied-factors, what lead us to think about hypothetical therapeuthic mechnism for reproduction with the participation of IDO.

O tubarão-azul (Prionace glauca) é uma espécie que apresenta desenvolvimento vivíparo placentário em que o saco vitelino se desenvolve ao longo da gestação tornando-se uma placenta que executa função matrotrófica. A Indoleamina 2,3-dioxigenase (IDO) é uma proteína encontrada em mamíferos nos quais participa, além de outras funções, da tolerância materno-fetal, sendo também encontrada em peixes ósseos. Assim, a proposta deste trabalho foi verificar a expressão da IDO na interface materno-fetal de Prionace glauca e descrever sua localização. Para tanto, material placentário/uterino e embriológico de três fases distintas da gestação (pré-placenta, meia gestação e fim da gestação) de fêmeas de P. glauca foram coletados e processados para a imuno-histoquímica. Os resultados mostraram a presença da IDO ao longo do desenvolvimento do saco vitelino/placenta, na ectoderme nas três fases e na endoderme apenas nas duas primeiras fases. No epitélio uterino observou-se a marcação da IDO nas duas últimas fases. Esses tecidos de interface seriam locais de maior contato entre a mãe e o concepto, fato que poderia levar à indução de uma resposta imunológica contra o concepto semi-alogenêico. A soma destes fatores poderia contribuir como um indício de uma possível atuação da IDO como mecanismo da tolerância materno-fetal na interface placentária de Chondrichtyes, como relatado em mamíferos eutérios / The blue shark (Prionace glauca) is a viviparous placentary species in which the yolk sac develops along pregnancy turning into a placenta with a matrotrofic role. The indoleamine 2 3-dioxygenase (IDO) is a protein usually described in mammals, which, among other functions, participates on the maternal-fetal tolerance process. Although it has also been reported in bony fish, no information is available regarding its function. Therefore, the purpose of this study was to investigate the expression of IDO in blue shark maternal-fetal interface and describe its distribution. Thus, placental / uterine and embryonic materials from three different stages (pre-placenta, middle and late gestation) of pregnant P. glauca females were processed for immunohistochemistry. The results showed IDO labelling during the yolk sac / placenta development in ectoderm along the three development phases and at endoderm only at phases I and II. In uterine epithelium, IDO was observed in the last two phases. These interface tissues are major contact areas between the mother ant the conceptus, that would induce an immunological response against the semialogeneic conceptus.The sum of these factors may contribute as an indication to the possible IDO role as a mechanism of maternal-fetal tolerance in Chondrichtyes placentary interface, as described in eutherian mammals

Le système immunitaire se doit d’être étroitement régulé afin d’éviter que des réponses immunologiques inappropriées ou de trop forte intensité ne surviennent. Ainsi, différents mécanismes permettent de maintenir une tolérance périphérique, mais aussi d’atténuer la réponse lorsque celle-ci n’est plus nécessaire. De tels mécanismes sont cependant aussi exploités par les tumeurs, qui peuvent ainsi échapper à une attaque par le système immunitaire et donc poursuivre leur progression. Ces mécanismes immunosuppresseurs nuisent non seulement à la réponse naturelle contre les cellules tumorales, mais font aussi obstacle aux tentatives de manipulation clinique de l’immunité visant à générer une réponse anti-tumorale par l’immunothérapie. L’un des mécanismes par lesquels les tumeurs s’évadent du système immunitaire est l’expression d’enzymes responsables du métabolisme des acides aminés dont l’une des principales est l’indoleamine 2,3-dioxygénase (IDO). Cette dernière dégrade le tryptophane et diminue ainsi sa disponibilité dans le microenvironnement tumoral, ce qui engendre des effets négatifs sur la prolifération, les fonctions et la survie des lymphocytes T qui y sont présents. Bien que la régulation de l’expression de cette enzyme ait été largement étudiée chez certaines cellules présentatrices d’antigènes, dont les macrophages et les cellules dendritiques, peu est encore connu sur sa régulation dans les cellules tumorales humaines. Nous avons posé l’hypothèse que différents facteurs produits par les cellules immunitaires infiltrant les tumeurs (TIIC) régulent l’expression de l’IDO dans les cellules tumorales. Nous avons effectivement démontré qu’une expression de l’IDO est induite chez les cellules tumorales humaines, suite à une interaction avec des TIIC. Cette induction indépendante du contact cellulaire résulte principalement de l’interféron-gamma (IFN-g) produit par les lymphocytes T activés, mais est régulée à la baisse par l’interleukine (IL)-13. De plus, la fludarabine utilisée comme agent chimiothérapeutique inhibe l’induction de l’IDO chez les cellules tumorales en réponse aux lymphocytes T activés. Cette observation pourrait avoir des conséquences importantes en clinique sachant qu’une forte proportion d’échantillons cliniques provenant de tumeurs humaines exprime l’IDO. Enfin, les lymphocytes B, qui sont retrouvés également dans certaines tumeurs et qui interagissent étroitement avec les lymphocytes T, sont aussi susceptibles à une induction transcriptionnelle et traductionnelle de l’IDO. Cette enzyme est cependant produite sous une forme inactive dans les lymphocytes B, ce qui rend peu probable l’utilisation de l’IDO par les lymphocytes B comme mécanisme pour freiner la réponse immunitaire. Nos travaux apportent des informations importantes quant à la régulation de l’expression de la molécule immunosuppressive IDO dans les cellules cancéreuses. Ils démontrent que l’expression de l’IDO est influencée par la nature des cytokines présentes dans le microenvironnement tumoral. De plus son expression est inhibée par la fludarabine, un agent utilisé pour le traitement de certains cancers. Ces données devraient être prises en considération dans la planification de futurs essais immunothérapeutiques, et pourraient avoir un impact sur les réponses cliniques anti-tumorales. / The immune system is under tight control to avoid inappropriate and excessive immunological responses. Many mechanisms allow the maintenance of peripheral tolerance and mediate attenuation of the immune response after pathogen clearance. Such mechanisms are also exploited by tumors, thereby favoring their escape from assault by the immune system. These immunosuppressive mechanisms hamper host natural immune responses against tumor cells, but also represent an obstacle to the successful clinical manipulation of the immune system in attempts to generate an anti-tumor response through immunotherapy. One immune escape mechanism used by tumors is the production of enzymes responsible for amino acid metabolism, amongst which indoleamine 2,3-dioxygenase (IDO) is of major importance. IDO degrades tryptophan, thus leading to its depletion from intracellular pools and local microenvironments. This culminates in multi-pronged negative effects on T lymphocytes neighboring IDO-expressing cells, notably on proliferation, function and survival. The regulation of IDO expression has been largely studied in antigen-presenting cells such as macrophages and dendritic cells, but its regulation in human tumor cells must still be characterized. We hypothesized that different factors produced by tumor-infiltrating immune cells (TIIC) regulate IDO expression in tumor cells. Accordingly, we have demonstrated that IDO expression is induced in human tumor cells upon interaction with TIIC. This induction is cell contact-independent, and results mainly from interferon-gamma (IFN-g) produced by activated T lymphocytes, while being antagonised by interleukin (IL)-13. Moreover, the chemotherapeutic agent fludarabine inhibits activated T lymphocyte-dependent IDO induction in tumor cells. This observation could have major clinical consequences, considering the large proportion of human cancer clinical samples expressing IDO. Finally, B lymphocytes, which interact closely with T lymphocytes and are found infiltrating human tumors, are also susceptible to transcriptional and translational IDO induction. This enzyme is however produced in an inactive form, suggesting that B lymphocytes do not exploit this mechanism to impede the immune response. In conclusion, our work brings crucial information on the regulation of the immunosuppressive molecule IDO in human tumor cells. We demonstrate that IDO expression is dependent on the nature of cytokines present in the tumor microenvironment. Furthermore, its expression is inhibited by fludarabine, a compound used to treat some types of cancer. These data should be taken into consideration in planning future immunotherapy trials and could impact anti-tumor clinical responses.

Le système immunitaire se doit d’être étroitement régulé afin d’éviter que des réponses immunologiques inappropriées ou de trop forte intensité ne surviennent. Ainsi, différents mécanismes permettent de maintenir une tolérance périphérique, mais aussi d’atténuer la réponse lorsque celle-ci n’est plus nécessaire. De tels mécanismes sont cependant aussi exploités par les tumeurs, qui peuvent ainsi échapper à une attaque par le système immunitaire et donc poursuivre leur progression. Ces mécanismes immunosuppresseurs nuisent non seulement à la réponse naturelle contre les cellules tumorales, mais font aussi obstacle aux tentatives de manipulation clinique de l’immunité visant à générer une réponse anti-tumorale par l’immunothérapie. L’un des mécanismes par lesquels les tumeurs s’évadent du système immunitaire est l’expression d’enzymes responsables du métabolisme des acides aminés dont l’une des principales est l’indoleamine 2,3-dioxygénase (IDO). Cette dernière dégrade le tryptophane et diminue ainsi sa disponibilité dans le microenvironnement tumoral, ce qui engendre des effets négatifs sur la prolifération, les fonctions et la survie des lymphocytes T qui y sont présents. Bien que la régulation de l’expression de cette enzyme ait été largement étudiée chez certaines cellules présentatrices d’antigènes, dont les macrophages et les cellules dendritiques, peu est encore connu sur sa régulation dans les cellules tumorales humaines. Nous avons posé l’hypothèse que différents facteurs produits par les cellules immunitaires infiltrant les tumeurs (TIIC) régulent l’expression de l’IDO dans les cellules tumorales. Nous avons effectivement démontré qu’une expression de l’IDO est induite chez les cellules tumorales humaines, suite à une interaction avec des TIIC. Cette induction indépendante du contact cellulaire résulte principalement de l’interféron-gamma (IFN-g) produit par les lymphocytes T activés, mais est régulée à la baisse par l’interleukine (IL)-13. De plus, la fludarabine utilisée comme agent chimiothérapeutique inhibe l’induction de l’IDO chez les cellules tumorales en réponse aux lymphocytes T activés. Cette observation pourrait avoir des conséquences importantes en clinique sachant qu’une forte proportion d’échantillons cliniques provenant de tumeurs humaines exprime l’IDO. Enfin, les lymphocytes B, qui sont retrouvés également dans certaines tumeurs et qui interagissent étroitement avec les lymphocytes T, sont aussi susceptibles à une induction transcriptionnelle et traductionnelle de l’IDO. Cette enzyme est cependant produite sous une forme inactive dans les lymphocytes B, ce qui rend peu probable l’utilisation de l’IDO par les lymphocytes B comme mécanisme pour freiner la réponse immunitaire. Nos travaux apportent des informations importantes quant à la régulation de l’expression de la molécule immunosuppressive IDO dans les cellules cancéreuses. Ils démontrent que l’expression de l’IDO est influencée par la nature des cytokines présentes dans le microenvironnement tumoral. De plus son expression est inhibée par la fludarabine, un agent utilisé pour le traitement de certains cancers. Ces données devraient être prises en considération dans la planification de futurs essais immunothérapeutiques, et pourraient avoir un impact sur les réponses cliniques anti-tumorales. / The immune system is under tight control to avoid inappropriate and excessive immunological responses. Many mechanisms allow the maintenance of peripheral tolerance and mediate attenuation of the immune response after pathogen clearance. Such mechanisms are also exploited by tumors, thereby favoring their escape from assault by the immune system. These immunosuppressive mechanisms hamper host natural immune responses against tumor cells, but also represent an obstacle to the successful clinical manipulation of the immune system in attempts to generate an anti-tumor response through immunotherapy. One immune escape mechanism used by tumors is the production of enzymes responsible for amino acid metabolism, amongst which indoleamine 2,3-dioxygenase (IDO) is of major importance. IDO degrades tryptophan, thus leading to its depletion from intracellular pools and local microenvironments. This culminates in multi-pronged negative effects on T lymphocytes neighboring IDO-expressing cells, notably on proliferation, function and survival. The regulation of IDO expression has been largely studied in antigen-presenting cells such as macrophages and dendritic cells, but its regulation in human tumor cells must still be characterized. We hypothesized that different factors produced by tumor-infiltrating immune cells (TIIC) regulate IDO expression in tumor cells. Accordingly, we have demonstrated that IDO expression is induced in human tumor cells upon interaction with TIIC. This induction is cell contact-independent, and results mainly from interferon-gamma (IFN-g) produced by activated T lymphocytes, while being antagonised by interleukin (IL)-13. Moreover, the chemotherapeutic agent fludarabine inhibits activated T lymphocyte-dependent IDO induction in tumor cells. This observation could have major clinical consequences, considering the large proportion of human cancer clinical samples expressing IDO. Finally, B lymphocytes, which interact closely with T lymphocytes and are found infiltrating human tumors, are also susceptible to transcriptional and translational IDO induction. This enzyme is however produced in an inactive form, suggesting that B lymphocytes do not exploit this mechanism to impede the immune response. In conclusion, our work brings crucial information on the regulation of the immunosuppressive molecule IDO in human tumor cells. We demonstrate that IDO expression is dependent on the nature of cytokines present in the tumor microenvironment. Furthermore, its expression is inhibited by fludarabine, a compound used to treat some types of cancer. These data should be taken into consideration in planning future immunotherapy trials and could impact anti-tumor clinical responses.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-05-17T21:35:19Z No. of bitstreams: 1 Mario Cezar Saffi Junior.pdf: 600477 bytes, checksum: 389162272a6d7d9eb1d1a097d21a6d9a (MD5) / Made available in DSpace on 2016-05-17T21:35:19Z (GMT). No. of bitstreams: 1 Mario Cezar Saffi Junior.pdf: 600477 bytes, checksum: 389162272a6d7d9eb1d1a097d21a6d9a (MD5) Previous issue date: 2015-01-22 / The cervical cancer is the first cancer of the female genital tract in Brazil and HPV is essential factor for carcinogenesis. The Brazilian program tracking proposes conventional cervical cytology as the primary method to detect cervical cancer, despite its low sensitivity. Risk factors associated with the spread of HPV are despised and not rely on a biomolecular tool that can increase the program offered by the Ministry of Health. The aim of this study was to determine whether the risk factors for cervical cancer may contribute to the conventional cervical cytology to increase diagnostic sensitivity and assess whether the mRNA indoleamine 2,3 dioxygenase (IDO) and mRNA CDKN2A / p16 may increase the diagnostic yield of this neoplasm. The logistic regression analysis was based on clinical variables (risk factors), cytological and biomolecular to seek an association with pathological results. The proportion of explained variance (PVE) for each variable studied was calculated by the formula omega, whereas the sensitivity, specificity, positive predictive value and negative predictive value were calculated by the formulas of Galen and Gambino. We conclude that oral contraceptive showed greater predictive power of high-grade lesions compared to other risk factors, and that both the IDO mRNA as CDKN2A mRNA / p16 may help screening of cervical cancer, either when used alone, or in conjunction with conventional cervical cytology, increasing their sensitivity and maintaining a considerable specificity. / O câncer de colo uterino apresenta-se como a principal neoplasia do trato genital feminino no Brasil, sendo o HPV fator essencial para a carcinogênese. O programa brasileiro de rastreamento propõe a citologia oncológica cervical convencional como principal método para detectar o câncer do colo uterino, apesar da sua baixa sensibilidade. Os fatores de risco associados ao contágio do HPV são desprezados e não contamos com uma ferramenta biomolecular que possa incrementar o programa oferecido pelo Ministério da Saúde. O objetivo desse trabalho foi verificar se os fatores de risco para o câncer de colo uterino podem contribuir com a citologia oncológica cervical convencional para aumentar a sensibilidade diagnóstica e avaliar se o RNAm Indoleamine 2,3 dioxigenase (IDO) e o RNAm CDKN2A/p16 podem incrementar a capacidade diagnóstica dessa neoplasia. A análise de regressão logística foi baseada nas variáveis clínicas (fatores de risco), citológicas e biomoleculares a fim de buscar uma associação com o resultado anatomopatológico. A proporção de variação explicada (PVE) por cada uma das variáveis estudada foi calculada pela fórmula ômega, enquanto que a sensibilidade, especificidade, valor preditivo positivo e o valor preditivo negativo foram calculados pelas fórmulas de Galen e Gambino. Concluímos que o uso do contraceptivo oral mostrou um maior poder de predição de lesões de alto grau em relação aos demais fatores de risco, e que tanto a RNAm IDO quanto o RNAm CDKN2A/p16 poderem auxiliar no rastreamento do câncer de colo uterino, seja quando usados de forma isolada, seja conjuntamente com a citologia cervical convencional, elevando sua sensibilidade e mantendo uma considerável especificidade.

Os tumores carcinoides típicos broncopulmonares (TCTB) são considerados neoplasias bem diferenciadas e as menos agressivas dentro do espectro dos tumores neuroendócrinos. Entretanto, metástases linfonodais e hematogênicas tem sido encontradas em número considerável de casos e não existem, até o momento, estudos relacionados aos mecanismos de escape imune tumoral em TCTB. Alguns trabalhos tem relacionado a expressão da enzima indoleamine 2,3-dioxigenase (IDO) em células neoplásicas como fator responsável pela aquisição de tolerância tumoral. Além disso, os níveis de infiltração linfocitária intratumoral parecem estar associados com prognóstico e sobrevida nesses tumores. O principal objetivo deste estudo foi determinar os níveis de expressão intratumorais da IDO e sua possível aplicação como marcador biológico de metástases em TCTB. Além disso, também foi estabelecido o padrão de infiltração linfocitária intratumoral e analisada sua provável correlação com os níveis de expressão da IDO. Portanto, realizou-se uma coorte retrospectiva multicêntrica no qual 64 pacientes submetidos à cirurgia de ressecção de TCTB entre 1981 e 2003 foram selecionados. O período de seguimento pós-operatório foi de 5 anos e a ocorrência de metástases linfonodais (hilar ou mediastinal) e hematogênicas foi avaliada através de tomografia computadorizada. Os níveis da expressão da IDO e de infiltração linfocitária intratumoral foram avaliados através de estudo imunohistoquímico. Os resultados obtidos mostraram que dos 64 pacientes selecionados, 17 (26.5%) apresentaram qualquer tipo de metátases durante o estudo: linfonodal, hematogênica ou ambas. A expressão da IDO foi encontrada em níveis diferentes de intensidade em mais de 80% das células dos TBCT. Entretanto, a análise univariada não mostrou nenhuma diferença significante na expressão da IDO entre grupos com e sem metástase (p=0,9 e p=0,3 pela análise semi-quantitativa e quantitativa, respectivamente). A quantificação dos linfócitos em todos os grupos estudados demonstrou predominância de linfócitos T CD8+, quando comparado aos linfócitos T CD4+(p< 0.01). Nenhuma diferença na infiltração intratumoral de linfócitos T CD8+ foi encontrada entre grupos com e sem metástase (p=0,98). Entretanto, a quantificação de linfócitos T CD4+ foi nula nos grupos com qualquer tipo de metástase (p=0,01), e nos casos com metástase linfonodal (p=0,02). Nenhuma correlação entre os níveis da expressão da IDO e da infiltração linfocitária intratumoral foi identificada nos grupos analisados (r= -0.2 e p=0,1 para ambos os grupos). Conclui-se que, a expressão intratumoral da IDO não apresenta correlação com a ocorrência de metástase nos TBCT. Apesar de nenhuma diferença ter sido identificada na infiltração intratumoral de linfócitos T CD8+ nos grupos com e sem metástase, a ausência de infiltração de linfócitos T CD4+ está associado à ocorrência do evento estudado. Estes linfócitos parecem conferir um efeito protetor evitando o escape tumoral / Typical bronchopulmonary carcinoid tumors (TBCT) are considered the less aggressive neoplasm within the spectrum of neuroendocrine tumors. However, regional nodes and haematogenic metastasis occur in a considerable rate and no data regarding immune escape mechanisms in these tumors are available. Some studies have implicated indoleamine 2,3 dioxygenase (IDO) expression in malignant cells as the responsible for tumor tolerance. Also, levels of tumor infiltrating lymphocytes (TILs) seem to be related with prognosis and survival. Our aim in this study was to determine intratumoral IDO expression levels and the value of this variable as a predictive marker of TBCT metastasis. Thus, TILs pattern was determined and correlation with intratumoral IDO expression analyzed. For this purpose, a multicenter retrospective cohort study was performed and 64 patients operated on for TBCT between 1981 and 2003 were enrolled. Follow-up period was 5 years and regional or haematogenic metastasis was assessed by computerized tomography (CT) scan. Levels of IDO expression and TILs were assessed by immunohistochemical study. The results obtained showed that of all 64 patients, 17 (26,5%) presented with any metastasis during the study: regional nodes, haematogenic or both. IDO expression was found in different intensity levels in over 80% of TBCT cells. However, univariate analysis showed no significant difference in IDO expression between groups with and without metastasis (p=0,9 and p=0,3 for semi-quantitative and quantitative analysis respectively). TILs quantification in all studied groups demonstrated predominance of CD8+ TILs when compared to CD4+ TILs (p<0,01). No difference in CD8+ TILs was found between groups with and without metastasis (p=0,98). However CD4+ TILs quantification was null in the groups with any metastasis (p=0,01), and regional nodes metastasis (p=0,02). No correlation between IDO expression levels and TILs was identified in all analyzed groups(r= -0,2 and p=0,1 for both groups). In conclusion, these data shows that intratumoral IDO expression do not correlate with TBCT metastasis. Even though no difference in CD8+ TILs between groups with and without metastasis was found, absence of CD4+ TILs is associated with the studied event. These cells seem to confer a protective effect against tumoral immune escape

Neste estudo avaliamos o papel do metabolismo do triptofano (Trp) na homeostasia, na vaginose bacteriana e nas lesões cervicais associadas ao HPV. A importância do metabolismo do Trp se deve a sua ação na proliferação de microrganismos e de células do sistema imune. O consumo de triptofano tem sido identificado como uma forma de controlar o crescimento bacteriano limitando a infecção. Por outro lado, a oxidação de Trp produz quinurenina (QUIN), que tem papel chave na tolerância imunológica. A formação de QUIN se dá através das enzimas indoleamina 2,3-dioxigenase (IDO) e triptofano 2,3- dioxigenase (TDO). A mais estudada delas no âmbito das infecções/ imuno escape é a enzima IDO. Mais recentemente, tem-se dado ênfase ao papel da TDO no câncer. Nesta dissertação, o interesse foi avaliar a expressão da IDO no epitélio cervicovaginal de mulheres com vaginose bacteriana e de IDO e TDO em amostras cervicais de mulheres com diferentes graus de lesão cervical associada ao HPV. Foram incluídas 165 mulheres atendidas no CAISM/UNICAMP, as quais foram divididas em dois grupos: grupo caso composto por mulheres com lesão de baixo ou alto grau e carcinoma invasor (n=42) e grupo controle composto por mulheres com citologia oncológica normal, independente de apresentar infecção genital (n=123). IDO foi avaliada por imunocitoquímica em citologia em base líquida e IDO e TDO em biópsias cervicais. Mulheres com vaginose bacteriana apresentaram expressão aumentada de IDO em células escamosas em comparação às mulheres sem vaginose bacteriana (OR=7.41; IC 95%= 2.50 a 21.4; p <0.0001). No epitélio vaginal normal com ou sem infecção por HPV houve uma expressão leve de IDO em células escamosas. Na presença de lesões ou carcinoma, houve um aumento no número de células escamosas displásicas e de leucócitos IDO-positivos; aumento de IDO também pôde ser observada em culturas de pele organotípicas transduzidas com as oncoproteínas E6/ E7 do HPV16. Nas lesões cervicais, assim como visto para a IDO, a TDO esteve expressa em leucócitos, especialmente os infiltrados na região estromal e na parede dos vasos sanguíneos. A expressão basal de IDO no epitélio cervical normal e sua regulação positiva na infecção por HPV e lesões associadas sugerem a participação do metabolismo do Trp nos mecanismos imunossupressores envolvidos na doença. Embora o papel do IDO já tenha sido abordada anteriormente, até onde sabemos esta é a primeira evidência da expressão de TDO no epitélio vaginal, na neoplasia intraepitelial cervical e carcinoma de células escamosas. Ainda, em leucócitos, especialmente aqueles com morfologia típica de polimorfonucleares, parecem ser importantes fontes de IDO na cérvix uterina. / In this study we evaluated the role of tryptophan (Trp) metabolism in cervix homeostasis, bacterial vaginosis and HPV-associated lesions. The importance of Trp metabolism is due to its action on microorganisms and immune cells. Tryptophan consumption has been identified as a way to controlling bacterial growth limiting infection. On the other hand, the oxidation of Trp produces kynurenine (Kyn) which plays a key role in immunological tolerance. The formation of Kyn occurs through the enzymes indoleamine 2,3-dioxygenase (IDO) and tryptophan 2,3-dioxygenase (TDO). IDO is the most studied of them within the context of infections / immune escape. More recently, TDO has also been considered in studies of cancer progression. In this thesis, we were interested in cervicovaginal epithelium IDO expression in women with bacterial vaginosis and of IDO and TDO in cervical samples of women with different degrees of cervical lesion associated with HPV. A total of 165 women attended at CAISM/UNICAMP were divided into two groups: a case group composed of women with low or high grade lesions and invasive carcinoma (n = 42) and a control group composed of women with normal cytology, independent to present genital infection (n =123). IDO was evaluated by immunocytochemistry in liquid-based cytology and IDO and TDO in cervical biopsies. Women with bacterial vaginosis had increased IDO expression in squamous cells compared to women without bacterial vaginosis (OR = 7.41, 95% CI = 2.50- 21.74; p<0.0001). In normal vaginal epithelium with or without HPV infection there was a mild IDO expression in squamous cells. In the presence of cervical intraepithelial lesions or squamous cell carcinoma, there was an increase in the number of IDO-positive dysplastic squamous cells and leukocytes; increase in IDO can also be observed in organotypic skin cultures transduced with HPV-16 E6/E7 oncoproteins. In cervical lesions, as observed for IDO, TDO was expressed in leukocytes, especially infiltrates in the stromal region and in the wall of blood vessels. The basal expression of IDO in the normal cervical epithelium and its positive regulation in HPV infection and associated lesions suggests the participation of Trp metabolism in the immunosuppressive mechanisms involved in the disease. Although some previous data have already considered the role of IDO, as far as we know this is the first evidence of the participation of TDO in the vaginal epithelium, cervical intraepithelial neoplasia and squamous cell carcinoma. In addition, in leukocytes, especially those with a typical polymorphonuclear morphology, appear to be important sources of IDO in the uterine cervix.

Os tumores carcinoides típicos broncopulmonares (TCTB) são considerados neoplasias bem diferenciadas e as menos agressivas dentro do espectro dos tumores neuroendócrinos. Entretanto, metástases linfonodais e hematogênicas tem sido encontradas em número considerável de casos e não existem, até o momento, estudos relacionados aos mecanismos de escape imune tumoral em TCTB. Alguns trabalhos tem relacionado a expressão da enzima indoleamine 2,3-dioxigenase (IDO) em células neoplásicas como fator responsável pela aquisição de tolerância tumoral. Além disso, os níveis de infiltração linfocitária intratumoral parecem estar associados com prognóstico e sobrevida nesses tumores. O principal objetivo deste estudo foi determinar os níveis de expressão intratumorais da IDO e sua possível aplicação como marcador biológico de metástases em TCTB. Além disso, também foi estabelecido o padrão de infiltração linfocitária intratumoral e analisada sua provável correlação com os níveis de expressão da IDO. Portanto, realizou-se uma coorte retrospectiva multicêntrica no qual 64 pacientes submetidos à cirurgia de ressecção de TCTB entre 1981 e 2003 foram selecionados. O período de seguimento pós-operatório foi de 5 anos e a ocorrência de metástases linfonodais (hilar ou mediastinal) e hematogênicas foi avaliada através de tomografia computadorizada. Os níveis da expressão da IDO e de infiltração linfocitária intratumoral foram avaliados através de estudo imunohistoquímico. Os resultados obtidos mostraram que dos 64 pacientes selecionados, 17 (26.5%) apresentaram qualquer tipo de metátases durante o estudo: linfonodal, hematogênica ou ambas. A expressão da IDO foi encontrada em níveis diferentes de intensidade em mais de 80% das células dos TBCT. Entretanto, a análise univariada não mostrou nenhuma diferença significante na expressão da IDO entre grupos com e sem metástase (p=0,9 e p=0,3 pela análise semi-quantitativa e quantitativa, respectivamente). A quantificação dos linfócitos em todos os grupos estudados demonstrou predominância de linfócitos T CD8+, quando comparado aos linfócitos T CD4+(p< 0.01). Nenhuma diferença na infiltração intratumoral de linfócitos T CD8+ foi encontrada entre grupos com e sem metástase (p=0,98). Entretanto, a quantificação de linfócitos T CD4+ foi nula nos grupos com qualquer tipo de metástase (p=0,01), e nos casos com metástase linfonodal (p=0,02). Nenhuma correlação entre os níveis da expressão da IDO e da infiltração linfocitária intratumoral foi identificada nos grupos analisados (r= -0.2 e p=0,1 para ambos os grupos). Conclui-se que, a expressão intratumoral da IDO não apresenta correlação com a ocorrência de metástase nos TBCT. Apesar de nenhuma diferença ter sido identificada na infiltração intratumoral de linfócitos T CD8+ nos grupos com e sem metástase, a ausência de infiltração de linfócitos T CD4+ está associado à ocorrência do evento estudado. Estes linfócitos parecem conferir um efeito protetor evitando o escape tumoral / Typical bronchopulmonary carcinoid tumors (TBCT) are considered the less aggressive neoplasm within the spectrum of neuroendocrine tumors. However, regional nodes and haematogenic metastasis occur in a considerable rate and no data regarding immune escape mechanisms in these tumors are available. Some studies have implicated indoleamine 2,3 dioxygenase (IDO) expression in malignant cells as the responsible for tumor tolerance. Also, levels of tumor infiltrating lymphocytes (TILs) seem to be related with prognosis and survival. Our aim in this study was to determine intratumoral IDO expression levels and the value of this variable as a predictive marker of TBCT metastasis. Thus, TILs pattern was determined and correlation with intratumoral IDO expression analyzed. For this purpose, a multicenter retrospective cohort study was performed and 64 patients operated on for TBCT between 1981 and 2003 were enrolled. Follow-up period was 5 years and regional or haematogenic metastasis was assessed by computerized tomography (CT) scan. Levels of IDO expression and TILs were assessed by immunohistochemical study. The results obtained showed that of all 64 patients, 17 (26,5%) presented with any metastasis during the study: regional nodes, haematogenic or both. IDO expression was found in different intensity levels in over 80% of TBCT cells. However, univariate analysis showed no significant difference in IDO expression between groups with and without metastasis (p=0,9 and p=0,3 for semi-quantitative and quantitative analysis respectively). TILs quantification in all studied groups demonstrated predominance of CD8+ TILs when compared to CD4+ TILs (p<0,01). No difference in CD8+ TILs was found between groups with and without metastasis (p=0,98). However CD4+ TILs quantification was null in the groups with any metastasis (p=0,01), and regional nodes metastasis (p=0,02). No correlation between IDO expression levels and TILs was identified in all analyzed groups(r= -0,2 and p=0,1 for both groups). In conclusion, these data shows that intratumoral IDO expression do not correlate with TBCT metastasis. Even though no difference in CD8+ TILs between groups with and without metastasis was found, absence of CD4+ TILs is associated with the studied event. These cells seem to confer a protective effect against tumoral immune escape

Introduction: Coronary artery disease (CAD) has been associated with depressive symptoms and deficits in cognitive performance, both of which have been associated with poorer medical prognoses and poorer psychosocial outcomes. Physical activity can improve cognitive and depressive symptoms, and, for those with CAD, improve medical prognoses. It was hypothesized that depressive symptoms and poorer cognitive performance would be associated with poorer cardiopulmonary fitness in patients with CAD, and that these sequelae would be associated prospectively with noncompletion of cardiac rehabilitation (CR). The benefits of physical activity are thought to result, in part, from decreased inflammatory activity and increased adaptive neural plasticity, to which the ratio of kynurenine to tryptophan (K/T) and brain derived neurotrophic factor (BDNF), respectively, in peripheral blood may pertain. Methods and Results: In a cohort study of patients entering CR, depressive symptoms (Center for Epidemiological Studies Depression scale; CES-D scores) were associated with cardiopulmonary fitness (peak volume of oxygen uptake; VO2Peak) during an exercise stress test (B=-.404, p=.001, n=366). The VO2Peak was also associated with performance across multiple cognitive domains, but most strongly with performance on tests involving executive function, attention and psychomotor processing speed (β=.322, p=.002 for composite score, n=81) in a cohort of patients entering CR. In prospective cohort studies, Major Depressive Disorder (adjusted hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.3–4.7, n=195) and poorer performance on a verbal memory test (HR 0.86, 95% CI 0.77-0.96, p=.009, n=131) predicted non-completion of CR. In patients undertaking CR, higher serum K/T ratios were associated with CES-D scores (β=.322, p=.002, n=95) and with VO2Peak (β=-.391, p<.001, n=95), and in a cohort of patients entering CR (n=88), serum concentrations of BDNF were associated with psychomotor processing speed (F1,87=9.620, p=.003), overall cognitive status (Mini Mental Status Exam) scores (F1,87=15.406, p<.0005) and VO2Peak (β=.305, p=.013). Conclusions: Depressive symptoms and poorer cognitive performance are clinically important in patients with CAD entering CR and they are both associated with poorer cardiopulmonary fitness. Poorer cardiopulmonary fitness was also associated with higher K/T ratios and with lower BDNF concentrations in serum, which predicted depressive symptoms and poorer cognitive performance, respectively.