Le syndrome périodique lié à NLRP12 (NLRP12-AD) est une maladie rare appartenant au groupe des maladies auto-inflammatoires systémiques héréditaires. Ces maladies sont causées par des anomalies du système immunitaire inné. Les cryopyrinopathies (CAPS) sont une famille de maladie auto-inflammatoire liées à des mutations gain de fonction du gène NLRP3. NLRP3 fait partie d’un composant central de l’inflammation, l’inflammasome. En 2007, Jéru et al. ont décrit un premier patient présentant des symptômes évocateurs d’un CAPS qui n’était pas porteur de mutation de NLRP3 mais présentait une mutation de NLRP12. Depuis, 33 patients pédiatriques atteints de NLRP12-AD ont été décrits dans la littérature. Les signes cliniques de la maladie sont variables et ne permettent pas d’établir de critères cliniques diagnostics fiables. La pathogénicité des mutations observées chez les patients est difficile à établir. Les patients atteints de NLRP12-AD représentent également un défi thérapeutique, un certain nombre d’entre eux ne répondant pas aux anti-IL1, un traitement pourtant efficace dans la plupart des inflammasomopathies. De nombreuses études se sont intéressées au rôle de NLPR12, qui posséderait à la fois des propriétés pro et anti-inflammatoires par sa capacité à inhiber les voies canoniques et non canoniques de NFkb mais aussi à former un inflammasome. Le rôle exact de NLRP12 reste controversé, avec des résultats différents selon les cellules ou les stimuli utilisés lors des expériences. L’objectif de notre étude est de créer un modèle in vitro fiable et reproductible afin de mieux comprendre la physiopathologie de NLRP12. Il permettra ensuite d’étudier les mutations de NLRP12 retrouvées chez des patients présentant des symptômes de maladie auto-inflammatoire pour améliorer les performances et la fiabilité du diagnostic et proposer des traitements personnalisés aux patients concernés. Nous avons créé un modèle de cellules THP1 NLRP12 KO en utilisant la technologie de CRISPR/Cas9 qui a permis d’induire une délétion homozygote à la jonction entre le 2ème intron et le 3ème exon de NLRP12, qui code pour le domaine fonctionnel de la protéine. Nos cellules KO semblent sécréter moins de cytokine pro-inflammatoire (IL-1β et TNFα) que les cellules WT, suggérant un rôle pro-inflammatoire de NLRP12 dans notre modèle. Nous avons par ailleurs décrit une cohorte nord-américaine de 17 patients porteurs de mutations de NLRP12 afin d’étudier leurs mutations et produit des vecteurs lentiviraux contenant ces mutations. Nous prévoyons d’explorer le rôle de NLRP12 sur l’activation de la voie NFkB et la formation d’un inflammasome puis de transduire nos cellules KO avec les différentes mutations de nos patients et d’analyser leurs conséquences sur ces mêmes voies et sur la sécrétion cytokinique. / NLRP12-AD is part of a new group of rheumatics’ diseases: the systemic autoinflammatory diseases. Those diseases are caused by defect or dysfunction in the innate immune system. Cryopyrin-associated periodic syndromes (CAPS) is a family of systemic autoinflammatory disease initially linked to NLRP3 gain-of-function heterozygous mutations. NLRP3 is part of a key component of inflammation, the inflammasome. In 2007, Jeru et al. described the first patient with CAPS phenotype, but without NLRP3 mutations. This patient had NLRP12 mutations. Since then, 33 pediatric patients with NLRP12-AD have been published. There is no specific clinical presentation that allow homogenous diagnosis. Determination of the causality of the mutations remains tricky. Lastly, some patients have shown resistance to anti-IL1 treatment, a medication that is highly effective in other inflammasomopathies such as CAPS, a puzzling observation as to the role of NLRP12. NLRP12 has been described with both anti- and pro- inflammatory roles, by its ability to inhibit the canonical and non-canonical NFkB pathways, but also through its hypothetic capacity to form an inflammasome. Hence, the exact role of NLRP12 remains controversial and its role might be stimuli- or cell-dependant. Our objective is to create a reliable and reproductible in vitro model to better understand the role of NLRP12. This model will then allow us to study NLRP12 mutations found in patients with auto-inflammatory symptoms. This will improve our diagnostic performance and help to offer to patients the most suitable therapy. We created NLRP12 knockout THP-1 cells by using the CRPISP-Cas 9 gene editing technology. We were able to induce a homozygous deletion at the intron 2/exon 3 junction that encodes the protein functional domain. Our KO cells seems to secrete less pro-inflammatory cytokines (IL-1β and TNFα) than WT cells. This suggests a pro-inflammatory role of NLRP12. We described a North American cohort of 17 pediatric patients with NLRP12 mutations to study their mutations in our model and produced lentiviral vectors containing those mutations. We planned to study the effects of NLRP12 on NFkB activation and on inflammasome formation. Then, we will transduce our KO cells with the patient’s mutations and compare their consequences on inflammation pathways and cytokine secretion.

The cardiovascular diseases (CVDs), resulting from complications of atherosclerosis, remain the leading cause of morbidity and death worldwide. Atherosclerosis as a chronic inflammatory disease, involves both innate and adaptive arms of immunity in which macrophages play the orchestral role in modulating lesion initiation, progression, and potentially devastating thrombotic complications. Available evidences support the notion of a central role of oxidative stress, due mainly to the imbalance between antioxidants and reactive oxygen species (ROS) in CVDs. Furthermore, the pathology is frequently associated with dynamic changes in macrophage activation, with classically activated M1 cells implicated in initiating and sustaining inflammation and M2 or M2-like cells associated with resolution or smoldering chronic inflammation. Among endogenous antioxidants, the thiordoxine-1 (Trx1) plays a central role in several diseases including CVD. Thus, the ubiquitous Trx1 has been reported to exert a myriad of beneficial roles. Indeed, it regulates not only cellular redox homeostasis and acts as a principal antioxidant defense system, but it also affects energy metabolism, modulates the immunological and inflammatory responses, and controls cell growth and survival. In contrast, its truncated form (Trx-80), exerts an opposite effects. However, several studies reported the beneficial role of Trx system in CVDs but the detailed molecular mechanism is not addressed yet. Therefore, the present study aims to investigate the role of both Trx1 and Trx80 in the biology of atherosclerosis through the modulation of macrophage polarization and the implicated signaling pathways as well. Our in vitro major findings, using human macrophages and murine peritoneal macrophages, revealed that Trx1 on one hand promoted the polarization of anti-inflammatory M2 macrophages through downregulation of p16INK4a and suppressing nuclear translocation of activator protein-1 (AP-1) and Ref-1 as evidenced by the expression of the CD206 and IL-10 markers. On the other hand Trx1 also reduced the lipopolysaccharide (LPS)-induced differentiation of inflammatory M1 macrophages, as indicated by the decreased expression of the M1 cytokines, tumor necrosis factor-α (TNF-) and monocyte chemoattractant protein-1 (MCP¨-1). By contrast, Trx80 treatment attenuated the polarization of anti-inflammatory M2 macrophages induced by IL-4 or IL-4/IL-13 even it potentiated LPS-induced M1 activation. To validate our obtained in vitro results, hyperlipoproteinemic C57Bl/6.ApoE2.ki mice and human atherosclerotic vessel specimens from patients undergoing vascular surgery were used. Consistently, Trx1 and Trx80 affected macrophage phenotype in thymus, liver and atherosclerotic lesions. As a consequence, Trx1 reduced whereas Trx80 increased the aortic lesion area in mice. Plasma levels of cholesterol and triglycerides did not changed by the treatment. To further explore our results, the implicated signaling pathways has been studied and it was found that both Trx1 and Trx80 activated Akt. Furthermore, Trx80 uses mTOR signaling pathway to exert its effect in polarizing macrophages toward M1 phenotype since it activated mTOR in a dose-dependent manner as demonstrated by the increased phosphorylation of P70S6K. Based on our results, Trx1 antagonizes whereas Trx80 potentiates atherosclerosis through changing M1/M2 phenotypes. Therefore, Trx1 represents a promising target for therapeutic interventions.

Introduction: Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones. Objectives: To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020. Methods: A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19. Results: We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008). Conclusions: We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19. / Introducción: La infección por coronavirus 2019 (SARS-CoV-2) en niños se presentó en Perú desde marzo del 2020. Desde entonces fue necesario internar pacientes pediátricos en el Hospital Nacional Edgardo Rebagliati Martins, en el área de hospitalización adaptada para dicho propósito. Al inicio, la demanda de hospitalización era baja y se fue incrementando progresivamente. Coincidiendo con los reportes internacionales, la mayoría presentó cuadros leves o moderados, pero también hubo casos graves e incluso mortales. Objetivos: Describir las características y el desenlace clínico de los pacientes pediátricos con COVID-19 hospitalizados en un hospital de referencia en Lima, Perú, entre marzo y agosto de 2020. Métodos: Se realizó un estudio transversal descriptivo e inferencial. La población incluyó a todos los pacientes que se hospitalizaron en el Departamento de Pediatría Clínica, con diagnósticos clínicos y quirúrgicos asociados a COVID-19. Resultados: Incluimos 100 pacientes, con edad promedio de 83,4 ± 54 meses, con predominio de varones (55%). Los pacientes hospitalizados fueron agrupados en cinco categorías: insuficiencia respiratoria (17%), síndrome inflamatorio multisistémico (31%), presentación neurológica (19%), abdomen agudo (20%) y pacientes con problemas oncológicos (13%). La mayoría de los pacientes (74%) tenían comorbilidades. Respecto a los síntomas de presentación, el dolor intestinal predominó en el grupo de apendicitis (90%, p < 0,001), la fiebre estuvo presente en la mayoría de los pacientes con falla respiratoria (64,7%), el síndrome inflamatorio multisistémico se registró en 90,3%, la sintomatología neurológica en 15,8%, el abdomen agudo 50% y oncológicos en 61,5% de los pacientes. Los síntomas de Kawasaki estuvieron presentes en 38,7% de los pacientes con síndrome inflamatorio multisistémico. La mortalidad fue de 4%. En 29,4% de problemas respiratorios y en 22,6% de síndrome inflamatorio multisistémico, se requirió de admisión en cuidados intensivos, lo que fue más frecuente que las otras presentaciones (p = 0,008). Conclusiones: Se concluye que la población pediátrica vulnerable es aquella con comorbilidades preexistentes. La división de pacientes en nuestro estudio fue definida por la presentación, diagnóstico y complicaciones predominantemente con problemas respiratorios, y en pacientes oncológicos con COVID-19. / Revisión por pares

Les cellules dendritiques sont des cellules du système immunitaire inné qui jouent un rôle important dans la reconnaissance immunitaire contre les agents pathogènes étrangers. Elles peuvent également prévenir les maladies auto-immunes à l'état basal. En raison de l'importance des cellules dendritiques dans la régulation immunitaire, il est important de comprendre comment le développement, l'état d'homéostasie et de quiescence des ces cellules sont contrôlées dans des conditions physiologiques et pathologiques. Cette étude permettra non seulement de mieux comprendre le contrôle de la régulation immunitaire, mais aussi de contribuer au développement de nouvelles approches pour traiter les maladies infectieuses et auto-immunes, ainsi que les cancers. Notre laboratoire a montré que C-CBL et CBL-B, deux membres de la famille CBL des ubiquitine ligases E3, jouent un rôle redondant dans la régulation négative du développement et de l'activation des cellules T et B. En l'absence de CBL dans les cellules T ou B, les souris développent des maladies auto-immunes sévères, indiquant que C-CBL et CBL-B jouent un rôle dans le système auto-immun. Partant de ces observations, nous proposons que CBL-B et C-CBL peuvent également jouer un rôle similaire dans le développement et la fonction des cellules dendritiques. Pour étudier cette possibilité, nous avons généré une souris knockout de Cbl spécifiques aux cellules dendritiques (dKO). Nous avons trouvé que cette mutation provoque une modification de l'homéostasie d'un sous-ensemble des cellules dendritiques (DC), y compris une augmentation marquée des CD8a+ cDCs et une réduction des pDC dans la rate. Cette modification est causée par la prolifération accrue des CD8a+ cDCs. Dans les CD8a+ cDCs mutantes, les voies de signalisation PKB et ERK sont constitutivement activées. Blocage de la signalisation de MTOR par la rapamycine atténue de manière significative l'hyperprolifération des CD8a+ cDCs in vitro et in vivo, indiquant que l'hyperactivation de MTOR est en partie responsable de l'augmentation CD8a+ cDCs. Les protéines CBL contrôlent l'ubiquitination et la dégradation du récepteur FLT3, suggérant que les protéines CBL contrôlent ainsi l'homéostasie de CD8a+ cDCs. Outre ces effets sur le développement des cellules dendritiques, nous avons trouvé que les souris Cbl dKO développent des inflammations sévères du foie et d'autres organes, caractérisées par une infiltration massive de leucocytes et une activation importante des cellules lymphocytes T périphériques. Les souris mutantes produisent des niveaux élevés de cytokines inflammatoires et de chimiokines, telles que le TNF-α, l'IL-6 et le CCL2. Les souris mutantes développent une maladie inflammatoire du foie. L'ensemble de ces observations montrent que les protéines CBL jouent un rôle essentiel dans le maintien de la quiescence immunitaire chez la souris. Puisque les souris dKO Cbl développent principalement une inflammation sévère du foie, il serait intéressant d'étudier si les voies contrôlées par les protéines CBL contribuent également au développement d'une inflammation du foie chez l'homme. / Dendritic cells (DCs) are innate immune cells that play an important role in immune recognition against foreign pathogens. They may also sense self-cues and prevent autoimmune diseases under the steady-state. Given the importance of DCs in immune regulation, it is conceivable that understanding how DCs development, homeostasis and functional quiescence are regulated under physiological and pathological conditions will not only bring insight into our knowledge how immune regulation is controlled but also some new approaches to treat infectious and autoimmune diseases and even cancers. Dr. Gu’s lab previously has shown that C-CBL and CBL-B, two members of the CBL family of E3 ubiquitin ligases, play a redundant negative regulatory role in both T cells and B cells development and activation. In the absence of CBL family of proteins in either T or B cells, mice develop severe autoimmune diseases, indicating that C-CBL and CBL-B restrain immune system against self. Based on these discoveries, we propose that C-CBL and CBL-B may also have a similar regulatory role in DC development and function. To study this possibility, we have generated DC-specific Cbl dKO mice. We have found that the Cbl dKO mutation results in an altered homeostasis of DC subsets, including a marked increase of CD8a+ cDCs and reduction of pDCs in the spleen (SP). This alteration is due to the enhanced proliferation of CD8a+ cDCs rather than the preferential lineage commitment to CD8a+ cDCs. In the mutant CD8a+ cDCs, both the PKB signaling pathway and ERK signaling pathways are constitutively activated. Blockage of MTOR signaling by Rapamycin significantly attenuates the hyperproliferation of CD8a+ cDCs both in vitro and in vivo, indicating that hyperactivation of MTOR is at least one of the reasons leading to CD8a+ cDC expansion. CBL proteins regulate ubiquitination and degradation of FLT3. Based on these results, we conclude that CBL proteins control CD8a+ cDC homeostasis through promoting FLT3 ubiquitination and degradation. In addition to the altered DC development, we have found that Cbl dKO mice develop severe liver and other organ inflammation characterized by massive leukocytes infiltration and profound peripheral T cell activation. Mutant mice produce high levels of inflammatory cytokines and chemokines including TNF-a, IL-6, CCL2, etc. Most strikingly, the mutant mice develop a similar liver inflammatory disease even in the absence of T and B cells. These findings together indicate that CBL proteins play an essential role in the maintenance of immune quiescence in mice. Since Cbl dKO mice mainly develop severe liver inflammation, it will be interesting to study whether the pathways controlled by CBL proteins also contribute to the development of liver inflammation in humans.

<p align="justify">The production of reactive oxygen species is strictly kept under control in the Human body. However, several conditions are characterized by the over-production or the uncontrolled production of these species, promoting damage to the host tissue. Among oxygen species producer, the myeloperoxidase/hydrogen peroxide/chloride system is a key element. This the consequence of the large quantity of myeloperoxidase found in neutrophils and that can be released rapidly during an inflammatory process. Moreover, hypochlorous acid, synthesized by this system, is a powerful oxidant.</p><p><p align="justify">We have studied the impact of non-steroidal anti-inflammatory drugs (oxicams, nimesulid and flufenamic acid) on three reactive oxygen species, namely, hydroxyl radical, hydrogen peroxide and hypochlorous acid. The first results showed the weak antioxidant properties of these molecules and the necessity to focus on the myeloperoxidase/hydrogen peroxide/chloride system. During the study of the myeloperoxidase inhibition, it appeared that flufenamic acid was an efficient inhibitor that modulated the hypochlorous acid production and was directly oxidized by the enzyme.</p><p><p align="justify">Due to the efficacy of flufenamic acid, this molecule was tested in a model of myeloperoxidase-dependent low-density lipoprotein (LDL) oxidation and compared to thiol-containing molecules like N-AcetylCystein and its lysinate salt, glutathione and captopril. The results showed that flufenamic acid lost part of its inhibiting effect while thiol-containing molecules demonstrated an interesting inhibiting activity in this model. A potential explanation could be the ability of myeloperoxidase to bind lipoproteins, masking the entry of its catalytic pocket. In these conditions, the inhibitor size becomes a key parameter in the inhibition of the MPO-dependent low-density lipoprotein oxidation and N-AcetylCystein appears as a powerful inhibitor in this context. These results render N-AcetylCystein an excellent candidate for studies that focus on the reduction of cardiovascular pathology risk.</p><p><p><br><p><p><p align="justify">Le corps humain est le siège constant de la synthèse d’espèces oxygénées réactives dont la production contrôlée est indispensable au bon fonctionnement de l’organisme. Cependant dans de nombreuses pathologies, il arrive qu’une production exagérée et/ou incontrôlée de ces espèces aboutisse à des dégâts oxydatifs. Parmi les mécanismes de production d’espèces oxydantes, le système myéloperoxydase / peroxyde d’hydrogène / chlorure détient une place importante. Ceci est notamment la conséquence de la grande quantité de MPO présente dans les neutrophiles, pouvant être libérée très rapidement lors de l’inflammation. De plus l’acide l’hypochloreux synthétisé par ce système est un très bon oxydant.</p><p><p align="justify">Nous avons étudié l’impact des anti-inflammatoires non-stéroïdiens (oxicams, nimésulide et acide flufénamique) sur trois espèces oxygénées réactives :le radical hydroxyle, le peroxyde d’hydrogène et l’acide hypochloreux. Les premiers résultats montrent le faible pouvoir anti-oxydant des molécules testées et la nécessité de concentrer notre recherche sur le système myéloperoxydase / peroxyde d’hydrogène / chlorure, responsable de la synthèse de l’acide hypochloreux. Lors de l’étude de l’inhibition de ce système, il est ressorti que l’acide flufénamique est un bon inhibiteur de la myéloperoxydase car il inhibe la synthèse de l’acide hypochloreux en étant directement oxydé par l’enzyme.</p><p><p align="justify">En raison de l’efficacité de l’acide flufénamique, cette molécule a été testée dans un modèle d’oxydation des lipoprotéines de basse densité (LDL) par le système myéloperoxydase / peroxyde d’hydrogène / chlorure en comparaison avec des thiols tels que la N-acétylcystéine et son sel de lysine, le glutathion et le captopril. Les résultats montrent une perte importante du pouvoir d’inhibition de l’acide flufénamique dans ce modèle alors que les thiols et la N-acétylcystéine en particulier, présentent une efficacité non négligeable. Ce phénomène pourrait être attribué à la capacité de la myéloperoxydase de se fixer sur les lipoprotéines, ce qui pourrait masquer l’entrée du site catalytique. Dans ces conditions, la taille de la molécule devient un facteur crucial dans l’inhibition de l’oxydation des lipoprotéines de basse densité et la N-acétylcystéine apparaît dès lors comme un inhibiteur puissant dont les résultats en font un excellent candidat dans des études d’intervention visant la diminution du risque de pathologies cardiovasculaires chez certains patients.</p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

Introdução: Chlamydia trachomatis (CT) é causa da infecção sexualmente transmitida de origem bacteriana mais comum. Na mulher, a infecção genital pela CT pode causar cervicite, uretrite, endometrite, salpingite. Infecções persistentes ou recorrentes provavelmente representam um importante fator de risco para o desenvolvimento de sequelas associadas, como dor pélvica crônica, gravidez ectópica e infertilidade por fator tubário. A lectina ligadora de manose (MBL), componente doo sistema imune inato, tem importante papel na defesa antimicrobiana, reconhecendo vírus, fungos e patógenos bacterianos. O gene que codifica para a MBL é polimórfico, e a substituição de um único nucleotídeo resulta na produção de uma proteína instável, que é rapidamente degradada. Objetivo: Avaliar se mulheres brasileiras portadoras de um polimorfismo do gene da MBL apresentam diferentes susceptibilidades para a ocorrência de obstrução tubária, na presença ou ausência de uma infecção prévia por Chlamydia trachomatis. Métodos: Em estudo caso-controle, foram avaliadas 75 pacientes com obstrução tubária e 75 pacientes com tubas pérvias, atendidas na Divisão de Ginecologia do Hospital das Clínicas da Universidade de São Paulo (HCFMUSP). Anticorpos IgG anti-CT foram mensurados através de um ensaio de imunoabsorção enzimática para investigar uma infecção prévia pela CT. Para o polimorfismo, realizou-se coleta de células bucais e o DNA extraído foi analisado através de reação em cadeia da polimerase (PCR), digestão de endonuclease e gel de eletroforese, utilizando pares de primers específicos para a região polimórfica. Todo material foi mantido a -80°C e enviado em gelo seco para a Division of Immunology and Infectious Diseases da Weill Cornell Medicine em Nova York. Associações entre genótipos de MBL ou alelos e permeabilidade tubária foram analisadas pelo teste de qui-quadrado de Pearson com ou sem correção de Yates. Resultados: Não houve diferença na detecção de anticorpos da CT entre os grupos. Mulheres com tubas obstruídas tiveram uma prevalência maior do genótipo AB (36%) versus (16%), resultado estatisticamente significativo (p < 0,01). De maneira semelhante, a distribuição do alelo A e do alelo variante B também apresentaram diferenças significantes entre os grupos (p < 0,01). Conclusão: Os achados sugerem, que embora a exposição à Chlamydia trachomatis tenha sido semelhante em ambos os grupos, a presença do alelo variante B do gene que codifica para a MBL aumenta o risco de desenvolvimento da obstrução tubária, subsequente à infecção pela CT ou outros agentes infecciosos. Nas mulheres brasileiras avaliadas a presença de tal polimorfismo genético aumentou a probabilidade de obstrução tubária em consequência de uma infecção do trato genital / Introduction: Chlamydia trachomatis (CT) is the cause of the most common bacterial sexually transmitted infection. In women, genital CT infection may cause cervicitis, urethritis, endometritis, salpingitis. Persistent or recurrent infections probably represent an important risk factor for the development of associated sequelae, such as chronic pelvic pain, ectopic pregnancy and tubal factor infertility. Mannose-binding lectin (MBL), a component of the innate immune system, has an important role in antimicrobial defense, recognizing viral, bacterial and fungal pathogens. The gene coding for MBL is polymorphic and a single nucleotide substitution results in production of an unstable protein, that is rapidly degraded. Objective: To evaluate whether Brazilian women with a polymorphism in the MBL gene present different susceptibilities to the occurrence of fallopian tube damage, in the presence or absence of a previous infection by CT. Method: In a case-control study, 75 patients with tubal obstruction and 75 patients with patent tubes were studied, all seen at the Gynecology Division of the Hospital das Clínicas of the University of São Paulo (HCFMUSP). IgG anti-CT antibodies were measured by enzyme-linked immunoassay to investigate a previous CT infection. For the polymorphism analysis, buccal cells were collected and the extracted DNA was analyzed by polymerase chain reaction (PCR), endonuclease digestion and gel electrophoresis using primer pairs specific for the polymorphic region. All material was maintained at -80 ° C and sent on dry ice to the Division of Immunology and Infectious Diseases at Weill Cornell Medicine in New York. Associations between MBL genotypes or alleles and tubal permeability were analyzed by the Pearson chi-square test with or without Yates correction. Results: There was no difference in CT antibody detection between the two groups. Women with obstructed tubes had a higher prevalence of being positive for the heterogenous genotype AB (36%) versus (16%) (p < 0.01). Similarly, the distribution of the normal A allele and variant B allele were also significant different between the two groups (p < 0,01). Conclusion: The findings suggest that while exposure to CT was similar in both groups of women the presence of the variant MBL B allele increases the risk for development of tubal obstruction, subsequent to a CT or other infection. In the Brazilian women evaluated possession of this genetic polymorphism increased the likelihood that blocked fallopian tubes will be a consequence of a genital tract infection

Introdução: Chlamydia trachomatis (CT) é causa da infecção sexualmente transmitida de origem bacteriana mais comum. Na mulher, a infecção genital pela CT pode causar cervicite, uretrite, endometrite, salpingite. Infecções persistentes ou recorrentes provavelmente representam um importante fator de risco para o desenvolvimento de sequelas associadas, como dor pélvica crônica, gravidez ectópica e infertilidade por fator tubário. A lectina ligadora de manose (MBL), componente doo sistema imune inato, tem importante papel na defesa antimicrobiana, reconhecendo vírus, fungos e patógenos bacterianos. O gene que codifica para a MBL é polimórfico, e a substituição de um único nucleotídeo resulta na produção de uma proteína instável, que é rapidamente degradada. Objetivo: Avaliar se mulheres brasileiras portadoras de um polimorfismo do gene da MBL apresentam diferentes susceptibilidades para a ocorrência de obstrução tubária, na presença ou ausência de uma infecção prévia por Chlamydia trachomatis. Métodos: Em estudo caso-controle, foram avaliadas 75 pacientes com obstrução tubária e 75 pacientes com tubas pérvias, atendidas na Divisão de Ginecologia do Hospital das Clínicas da Universidade de São Paulo (HCFMUSP). Anticorpos IgG anti-CT foram mensurados através de um ensaio de imunoabsorção enzimática para investigar uma infecção prévia pela CT. Para o polimorfismo, realizou-se coleta de células bucais e o DNA extraído foi analisado através de reação em cadeia da polimerase (PCR), digestão de endonuclease e gel de eletroforese, utilizando pares de primers específicos para a região polimórfica. Todo material foi mantido a -80°C e enviado em gelo seco para a Division of Immunology and Infectious Diseases da Weill Cornell Medicine em Nova York. Associações entre genótipos de MBL ou alelos e permeabilidade tubária foram analisadas pelo teste de qui-quadrado de Pearson com ou sem correção de Yates. Resultados: Não houve diferença na detecção de anticorpos da CT entre os grupos. Mulheres com tubas obstruídas tiveram uma prevalência maior do genótipo AB (36%) versus (16%), resultado estatisticamente significativo (p < 0,01). De maneira semelhante, a distribuição do alelo A e do alelo variante B também apresentaram diferenças significantes entre os grupos (p < 0,01). Conclusão: Os achados sugerem, que embora a exposição à Chlamydia trachomatis tenha sido semelhante em ambos os grupos, a presença do alelo variante B do gene que codifica para a MBL aumenta o risco de desenvolvimento da obstrução tubária, subsequente à infecção pela CT ou outros agentes infecciosos. Nas mulheres brasileiras avaliadas a presença de tal polimorfismo genético aumentou a probabilidade de obstrução tubária em consequência de uma infecção do trato genital / Introduction: Chlamydia trachomatis (CT) is the cause of the most common bacterial sexually transmitted infection. In women, genital CT infection may cause cervicitis, urethritis, endometritis, salpingitis. Persistent or recurrent infections probably represent an important risk factor for the development of associated sequelae, such as chronic pelvic pain, ectopic pregnancy and tubal factor infertility. Mannose-binding lectin (MBL), a component of the innate immune system, has an important role in antimicrobial defense, recognizing viral, bacterial and fungal pathogens. The gene coding for MBL is polymorphic and a single nucleotide substitution results in production of an unstable protein, that is rapidly degraded. Objective: To evaluate whether Brazilian women with a polymorphism in the MBL gene present different susceptibilities to the occurrence of fallopian tube damage, in the presence or absence of a previous infection by CT. Method: In a case-control study, 75 patients with tubal obstruction and 75 patients with patent tubes were studied, all seen at the Gynecology Division of the Hospital das Clínicas of the University of São Paulo (HCFMUSP). IgG anti-CT antibodies were measured by enzyme-linked immunoassay to investigate a previous CT infection. For the polymorphism analysis, buccal cells were collected and the extracted DNA was analyzed by polymerase chain reaction (PCR), endonuclease digestion and gel electrophoresis using primer pairs specific for the polymorphic region. All material was maintained at -80 ° C and sent on dry ice to the Division of Immunology and Infectious Diseases at Weill Cornell Medicine in New York. Associations between MBL genotypes or alleles and tubal permeability were analyzed by the Pearson chi-square test with or without Yates correction. Results: There was no difference in CT antibody detection between the two groups. Women with obstructed tubes had a higher prevalence of being positive for the heterogenous genotype AB (36%) versus (16%) (p < 0.01). Similarly, the distribution of the normal A allele and variant B allele were also significant different between the two groups (p < 0,01). Conclusion: The findings suggest that while exposure to CT was similar in both groups of women the presence of the variant MBL B allele increases the risk for development of tubal obstruction, subsequent to a CT or other infection. In the Brazilian women evaluated possession of this genetic polymorphism increased the likelihood that blocked fallopian tubes will be a consequence of a genital tract infection

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