Orientador: Maria Heloísa Souza Lima Blotta / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T06:53:06Z (GMT). No. of bitstreams: 1 Oliveira_SaradeJesus_D.pdf: 1409092 bytes, checksum: 77c1f0b5742ae7b24491a77030821e3f (MD5) Previous issue date: 2003 / Resumo: A paracoccidioidomicose, causada pelo fungo dimórfico Paracoccidioides brasiliensis, é a micose sistêmica de maior prevalência na América Latina, acometendo hoje mais de 10 milhões de pessoas e apresentando as maiores taxas de mortalidade nas regiões Sul e Sudeste do Brasil. A infecção se dá pela via respiratória sendo que a grande maioria de indivíduos que entram em contato com o fungo, não desenvolve a doença. Esta condição chamada PCM-infecção ocorre em indivíduos que moram em áreas endêmicas e apresentam teste cutâneo de HTT positivo aos antígenos do fungo. A progressão de infecção para doença origina duas formas clínicas principais: a forma aguda ou juvenil (FJ), de maior gravidade e a forma adulta ou crônica (FA), mais localizada e menos agressiva. Com o objetivo de estudar a epidemiologia e o perfil imunológico da PCM humana na cidade de Campinas, analisamos as características gerais (sexo, idade profissão) de pacientes atendidos no HC da UNICAMP e a incidência da doença na região, juntamente com seus fatores de risco e suas formas clínicas. Avaliamos também a resposta imune celular (proliferação de linfócitos a antígenos do fungo e produção de citocinas do tipo Th1 e Th2), em pacientes com as formas adulta e juvenil da doença, indivíduos portadores da infecção e controles saudáveis (teste cutâneo de HTT negativo). Nossos resultados mostraram que a PCM é endêmica em Campinas e região, acometendo em sua maioria, indivíduos adultos do sexo masculino, trabalhadores rurais e da construção civil. No entanto, encontramos elevado número de pacientes do sexo feminino e crianças com a forma juvenil da doença, mais grave e disseminada. Esses pacientes apresentam resposta imune celular suprimida, caracterizada por teste cutâneo negativo e proliferação de linfócitos reduzida a antígenos do fungo, enquanto produzem citocinas do tipo Th2, com aumento de IL-4 e IL-5, juntamente com baixos níveis de IFN-?, TNF-? e IL-12. Apresentam também, no período inicial da infecção, número elevado de eosinófilos no sangue periférico e em biópsias de linfonodos. Ao contrário, indivíduos portadores da PCM-infecção apresentam proliferação de linfócitos bastante acentuada a antígenos do fungo, teste cutâneo positivo, ausência de anticorpos e padrão de resposta Th1 com produção de IFN-?, IL-2, TNF-? e IL-12, e níveis basais de IL-4, IL-5 e IL-10. Já os pacientes com a forma adulta apresentam resposta imune celular preservada, com teste cutâneo que variam de acordo com a forma unifocal ou multifocal da doença. De modo geral, produzem menores níveis de IL-4 e IL-5 e níveis aumentados de TNF-? e IL-12. Esses resultados nos permitiram situar a forma adulta da paracoccidioidomicose como intermediária entre o padrão Th2 de resposta imune apresentado pela forma juvenil e o padrão Th1 desenvolvido pelos indivíduos portadores da PCM-infecção / Abstract: We studied the clinical-seroepidemiological characteristics of patients with paracoccidioidomycosis (PCM) attended at the University Hospital at UNICAMP (Campinas, São Paulo, Brazil). The study group consisted of 584 individuals (492 M, 92 F) with ages ranging from 5 to 87 years. The highest incidence of the disease occurred between the ages of 41 and 50 years for men and 11 and 40 for women. Rural activities were the principal occupation of 46% of the patients. The diagnosis was confirmed by histopathological examination and by demonstration of fungus in scrapings, secretions or in the sputum. Serological tests for PCM were positive in 80% of the 584 patients studied. The significant number of patients, including 33 children under 14 years old, is an indication of the fungus? presence in the area and indicates that this region is an important endemic area for paracoccidioidomycosis. Cellular immune response to Paracoccidiodes brasiliensis antigens (PbAg) was evaluated in patients with the juvenile (JF) and adult (AF) forms of paracoccidioidomycosis (PCM) as well as in a group of infected individuals living in the endemic area but without any clinical manifestation of the disease. The immune profile of this group of PCM-infected (PI) individuals was characterized by: 1) a positive skin test to P. brasiliensis antigen, 2) absence of specific antibodies, 3) a vigorous lymphoproliferative response to PbAg, and 4) a typical Th1 pattern of cytokines, with production of IFN-?, IL-2, IL-12 and TNF-? and basal levels of IL-4, IL-5 and IL-10. At the opposite end of the spectrum were the JF patients whose proliferative response to PbAg was significantly impaired and whose cytokine pattern was characteristically Th2, i.e., lower IFN-? TNF-? and IL-12 secretion and significantly higher levels of IL-4 and IL-5. These profiles are compatible with forms of higher and lower resistance, respectively. Intermediate immune responses were observed in AF patients, whose specific lymphoproliferative response was lower than in the PI group but higher than in the JF patients. The secretion of IFN-? and IL-10 did not differ from the JF group, although IL-4 and IL-5 levels were significantly lower, and TNF-? and IL-12 higher. Since AF patients are able to control fungal dissemination for decades, they can be considered more resistant than JF patients, who manifest the disease soon after infection / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas

Protein therapeutics are available as cytokines, clotting factors, enzymes, hormones, growth factors, antibodies et al. They have been shown to be effective in treating a variety of important human diseases. Since human insulin was approved as the first recombinant protein therapeutic, this field has experienced rapid growth. One of the biggest challenges for protein therapeutics in clinical application is their short half-life. Except for monoclonal antibodies, which have serum half-life for weeks, most of the protein therapeutics have half-lives ranging from minutes to hours. Kidney filtration, proteasome degradation and liver metabolism are the main factors that attribute to their short half-lives. The short half-life of protein therapeutics requires a higher dose or frequent application to maintain therapeutic concentration over a certain period. However, higher dose is easy to cause large plasma concentration fluctuation, which is easy to cause side effects. Most of protein therapeutics are not orally bioavailable. Frequent application will increase the burden of patients, affect their life quality, and reduce patient compliance. Thus, it is important to generate long-lasting therapeutics with improved pharmacokinetic properties. The current half-life extension approaches for protein therapeutics include PEGylation, albumin fusion or binding and fusion to an immunoglobulin Fc region. Their primary aim is to increase the size of biotherapeutics or to implement recycling by the neonatal Fc receptor (FcRn). However, the half-life extension by PEGylation, albumin fusion or Fc fusion is at the cost of binding affinity reduction. And the increase of size has limited their application in the field of anticancer agents where tumor penetration is required. Noncovalent albumin binding using albumin binding ligands such as fatty acids could maintain the small size and binding affinity. However, it would increase hydrophobicity, therefore is not suitable for protein therapeutics with low solubility. Here, we present a new approach for half-life extension for biotherapeutics. Human interleukin 2 (IL-2), a low solubility cytokine, was used as a model protein. By conjugating IL-2 with a hydrophilic small molecule that binds reversibly to the serum protein transthyretin, we enhanced its circulation half-life in rodents while maintained its in vitro bioactivity. To the best of our knowledge, this is the first demonstration of a successful approach that harnesses a small molecule in extending the circulation half-life of a protein while at the same time maintains the small size and hydrophilicity.

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Interleukin-2-Rezeptor-Antikorper (IL-2RA) sind monoklonale Anti-IgG-Antikörper, die den Interleukin-2-Rezeptor aktivierter T-Zellen blockieren und so zu einer signifikanten Reduktion von akuten Abstoßungsreaktionen (AR) nach Nierentransplantation führen. Ziel dieser Arbeit ist die Durchführung einer Meta-Analyse aller verfügbaren kontrollierten Studien, die Erwachsene und Kinder nach primarer Lebertransplantation mit einer Induktionstherapie mit IL-2RA behandelten und diese mit Placebo oder keiner Heilbehandlung verglichen. Die Meta-Analyse soll zeigen, dass durch IL-2RA-Gabe die AR, SRAR (steroidresistente AR), Tod des Patienten (D), Transplantatverlust (GL) sowie CNI- und Steroid-bedingte Nebenwirkungen durch Dosisreduktion signifikant reduziert werden. Sechs Studien mit pädiatrischen und 20 Studien mit adulten Transplantatempfängern erfüllten die Einschlusskriterien. Die Analyse der Endpunkte wurde mit dem Modell mit zufälligen Effekten durchgeführt. Die IL-2RA-Induktionstherapie kann als sicher und ohne signifikante Nebenwirkungen für mindestens zwölf Monate bei Patienten nach Lebertransplantation beurteilt werden. IL-2RA reduziert signifikant die AR bei pädiatrischen (RR 0,38 CI [0,22-0,66]; p=0,0126; NNT=4) und adulten Patienten (RR 0,83 CI [0,74-0,93]; p=0,0007; NNT=18) nach Lebertransplantation und SRAR bei adulten Patienten (RR 0,66 CI [0,48-0,91]; p=0,011; NNT=29). D und GL werden reduziert. In adulten Studien der Vergleichsgruppe delayed/reduced CNI wurden eine signifikante Reduktion der gepoolten renalen Dysfunktionen (RR 0,46; CI [0,27-0,78]; p=0,004; 5 Kohorten), des Serum-Kreatinin (MD -0,05; [0,11-0,01]; p=0,03; 3 Kohorten) sowie eine signifikante Steigerung der eGFR beobachtet. Bei adulten Patienten der Vergleichsgruppe no/low steroids zeigte sich eine signifikante Reduktion des PTDM (RR 0,42; CI [0,31-0,55]; p<0,0001; NNT=12) und des HTN (RR 0,49; CI [0,25-0,96]; p=0,04; NNT=11).

The fatty acid amides, a structurally diverse endogenous congener of molecules active in cell signaling, may prove to have diverse activity due to their interface with a number of receptor systems, including, but not limited to cannabinoid receptor 2 (CB2) and PPARγ. Select extracts of Echinacea spp. contain the fatty acid amides known as alkylamides. These extracts were a previously popular remedy relied on by U.S. physicians, one of the top sellers in the natural products industry and are currently a frequently physician prescribed remedy in Germany. In the series of experiments contained within, Galenic ethanolic extracts of Echinacea spp. root were used for the quantification, identification, degradation and bioactivity studies. On extraction, depending on the ratio of plant to solvent and fresh or dry, the data indicate that there is variability in the alkylamide classes extracted. For example the acetylene alkylamides appear to extract under different concentrations, as well as degrade faster than the olefinic alkylamides. In addition, the alkylamides are found to degrade significantly in both cut/sift and powdered forms of echinacea root. Human liver microsome oxidation of the major alkylamide dodeca-2E,4E,8Z,10Z-tetraenoic acid isobutylamide generate hydroxylated, caboxylated and epoxidized metabolites. The carboxylated metabolite has, thus far, shown different immune activity than the native tetraene isobutylamide. Bioactivity studies, based on cytokine modulation of the alkylamides have been assumed to be due to a classic CB2 response. However, the results of experiments contained herein suggest that IL-2 inhibition by the alkylamide undeca-2E-ene-8,10-diynoic acid isobutylamide, which does not bind to CB2, is due to PPARγ activation. These data, combined with data generated by other groups, suggest that the alkylamides of Echinacea spp. are polyvalent in effect, in that they modulate multiple biochemical pathways.

Zytotoxische CD8+ T-Zellen spielen eine bedeutende Rolle in der Immunantwort gegen HIV-1. Trotz allem kommt es jedoch im Verlauf der Infektion bei den meisten Betroffenen zum Anstieg der Viruslast und Abfall der CD4 Zellzahl, obwohl auch in diesem fortgeschrittenen Stadium der Infektion virusspezifische CD8+ T-Zellantworten mittels INF-&#947;-Produktion nachgewiesen werden können. Ziel der vorliegenden Arbeit war es daher, weitere funktionelle und phänotypische Merkmale von CD8+ T-Zellen zu untersuchen, um eine mögliche Ursache für die im Verlauf der Infektion ineffizient werdende Immunantwort zu finden. Einen statistisch signifikanten Unterschied der INF-&#947; Produktion CD8+ T-Zellen zwischen Progressors und Controllers ließ sich mittels INF-&#947; Elispot bei den von uns untersuchten Patienten nicht nachweisen. Es ist also davon auszugehen, dass CD8+-T-Zellen im fortgeschrittenen, chronischen Stadium der Infektion funktionelle Lücken aufweisen, die sich nicht durch INF&#61543;-basierte Untersuchungsmethoden nachweisen lassen. Anhand intrazellulärer Zytokinfärbung ließ sich unabhängig vom Schweregrad der Infektion eine erhaltene Produktion der Zytokine INF&#947; und TNF&#945;, nicht hingegen eine Produktion von IL-2 nachweisen. Bei der Untersuchung HIV spezifischer CD8+ T-Zellen mit Hilfe von Tetramerfärbungen zeigte sich in Bezug auf den Aktivierungsgrad, gemessen an der CD38-Expression, ein deutlicher Unterschied zwischen Progressors und Controllers, der innerhalb der HIV-spezifischen CD8+ T-Zellen im Vergleich zur gesamten CD8+ T-Zellpopulation noch ausgeprägter zu erkennen war. Hier gab es eine signifikante positive Korrelation zur Viruslast und eine signifikante negative Korrelation zur CD4-Zellzahl der HIV-Infizierten. Anhand des Aktivierungsmarkers HLA-DR ließ sich dieser Unterschied nicht nachweisen. Im Bezug auf die Proliferationsfähigkeit, Apoptoseempfindlichkeit und lytische Funktion HIV-spezifischer Zellen konnte kein statistisch signifikanter Unterschied zwischen Progressors und Controllers ausgemacht werden. Schlüsse für die Gesamtheit der HIV-spezifischen Zellen eines HIV-Infizierten kann man natürlich nicht ziehen. Man darf nicht außer Acht lassen, dass uns lediglich eine begrenzte Anzahl von Epitopen bei den durchgeführten Untersuchungen zur Verfügung stand. Es wurde jedoch deutlich, dass es feine Unterschiede und Trends zu geben scheint, die eine gezielte weiterführende Untersuchung erfordern. Weiterhin ist auch zu bedenken, dass möglicherweise andere Faktoren, als die von uns untersuchten, für den unterschiedlichen Krankheitsverlauf verantwortlich sein können. Welche Faktoren nun tatsächlich die Ursache sind dafür, dass das menschliche Immunsystem gegen das HI-Virus in der Regel früher oder später verliert, bleibt weiterhin offen. Sehr wahrscheinlich handelt es sich hierbei um das Zusammenspiel mehrerer Mechanismen. Die gezielte Untersuchung HIV-spezifischer Zellen ist bei der weiteren Erforschung der genauen Zusammenhänge unerlässlich.

Neste estudo investigamos os efeitos dos ácidos graxos sobre a função e sinalização intracelular de linfócitos humanos. Os ácidos oléico (OA) e linoléico (LA), em baixas concentrações, estimularam a proliferação celular induzida pela IL-2 através do aumento da fosforilação da proteína PKC-<font face=\"symbol\">Z que levou a um aumento da fosforilação de ERK 1/2. Já os ácidos palmítico (PA), esteárico (SA), DHA e EPA diminuíram a proliferação destas células e inibiram a fosforilação de JAK1 e 3, STAT5, ERK e Akt. Os resultados obtidos são sugestivos de que o efeito inibitório promovido por PA, SA, DHA e EPA sobre a proliferação de linfócitos ocorreu devido à diminuição da fosforilação de proteínas fundamentais para a proliferação celular. Por outro lado, OA e LA estimularam a proliferação de linfócitos aumentando a fosforilação de ERK 1/2 através da ativação de PKC-<font face=\"symbol\">Z, efeito dependente da PI3K. O efeito inibitório promovido pelo DHA está associado a uma alteração na quantidade de lipid rafts na membrana plasmática nos quais o receptor de IL-2 está localizado. / The effect of fatty acids (FA) on interleukin -2 (IL-2) signaling pathway in human lymphocytes was investigated. Docosahexaenoic (DHA), eicosapentaenoic (EPA), palmitic (PA) and stearic (SA) acids decreased lymphocyte proliferation in concentrations above 50 <font face=\"symbol\">mM. However, oleic (OA) and linoleic (LA) acids increase lymphocyte proliferation at 25 <font face=\"symbol\">mM. PA, SA, DHA and EPA decreased JAK 1, JAK 3, STAT 5 and AKT phosphorylation induced by IL-2 but OA and LA did not cause any effect. OA and LA increased ERK1/2 phosphorylation whereas the other FA caused a marked decrease. PKC-<font face=\"symbol\">Z phosphorylation was decreased by OA and LA only. In conclusion, the inhibitory effect of PA, SA, DHA and EPA on lymphocyte proliferation observed in our previous study was due to a decrease in protein phosphorylation activated by IL-2. Probably, OA and LA stimulated lymphocyte proliferation by increasing ERK 1/2 phosphorylation throught PKC-<font face=\"symbol\">Z activation. The inhibition of JAK 1, JAK3, STAT 5, ERK1/2 and Akt phosphorylation caused by DHA is associated to a decrease in membrane lipid rafts contend.

Nos travaux décrivent l’identification et la caractérisation d’une cellule immunitaire : l’IKDC pour Interferon Producing killer dendritic cell. Cette population cellulaire, découverte à la faveur de la combinaison Imatinib mesilate et Interleukine 2 dans le traitement des métastases pulmonaires de mélanome B16F10 chez la souris, combine des caractéristiques de cellule dendritique (présentation antigénique) et de cellule natural killer (lyse sans apprentissage). Le phénotype des IKDC est le suivant :CD3-, CD19-, CD11c+,B220+, NK1.1+. Nous avons établi une stratégie de culture des IKDC ex vivo grâce à la trans-présentation de l’IL-15 et montré que ces cellules sont capables de présenter des antigènes aux lymphocytes T et de vacciner une souris contre une tumeur. Ce projet se poursuit par la mise en place d’un essai clinique de phase I utilisant Imatinib mesilate et l’Interleukine 2. / In this manuscript, we describe the isolation and the characterisation of a novel immune cell: the IKDC for Interferon Producing killer dendritic cell. This cell population, discovered thanks to the combination Imatinib mesilate and Interleukine 2 for the treatment of lung metastases of B16F10 murine melanoma, shares dendritic cell (antigen presentation) and natural killer cell (non specific lysis) properties. IKDC phenotype is the following: CD3-, CD19-, CD11c+, B220+, NK1.1+. We established a culture strategy for the IKDC ex vivo thanks to the trans-presentation of IL-15 and demonstrated that these cells once cultivated are able to prime lymphocytes and to protect mice from tumor development. This project has led to a phase I clinical trial testing the antitumor effect of the combination Imatinib mesilate and Interleukin 2.