Recomendações para rastreamento de Tuberculoses Latente (TBL) em pacientes que receberão tratamento com antagonistas do TNF-alfa (anti- TNF) permanecem controversas para regiões endêmicas Objetivo: Esse estudo buscou demonstrar a eficácia em longo prazo do rastreamento e tratamento da TBL em pacientes portadores de Artrite Reumatoide (AR) recebendo anti-TNF. Métodos: 202 pacientes com AR, antes do início do anti-TNF, foram rastreados para TBL por meio do teste tuberculínico (TT), Radiografia de tórax (RX) e história de prévia de exposição à tuberculose (EXP). Todos os pacientes foram seguidos com intervalos de um a três meses. Resultados: 85 pacientes (42%) foram tratados com um único agente anti-TNF e 117 pacientes (58%) mudaram de anti-TNF uma ou duas vezes. O rastreamento para TBL foi positivo em 66 pacientes, 44 apresentaram TT positivo, 23 apresentavam história de exposição (EXP), e 14, alterações radiográficas (RX). EXP isoladamente foi responsável por 14 diagnósticos em pacientes TT negativos. Pacientes portadores de TBL receberam tratamento com Isoniazida (300 mg/dia por seis meses) e nenhum deles desenvolveu TB. Durante os seguimentos, o TT foi repetido em 51 pacientes. A conversão foi observada em cinco: três foram diagnosticados com TBL e dois com TB ativa (14 e 36 meses após receber terapia anti-TNF), sugerindo nova exposição a TB. Conclusão: O rastreamento e tratamento da TBL antes do início da terapia com anti-TNF é efetiva em regiões endêmicas, e reforça a relevância da história de contato com TB para o diagnóstico da TBL em pacientes com AR / Recommendations for screening of latent tuberculosis infection (LTBI) in patients eligible for anti-TNF agents remain unclear in endemic regions. Objective: This study aimed to evaluate the long-term efficacy of LTBI screening/treatment in patients with rheumatoid arthritis (RA) receiving TNF blockers. Design: 202 RA patients were screened for LTBI prior to receiving anti-TNF treatment, by means of tuberculin skin test (TST), chest radiography (X-Ray), and history of tuberculosis exposure (EXP). All subjects were regularly followed at 1- to 3-month intervals. Results: Eighty-five patients (42%) were treated with a single anti-TNF agent, and 117 patients (58%) switched anti-TNF agents once or twice. LTBI screening was positive in 66 patients, 44 presented positive TST, 23 had a history of EXP, and 14, abnormal X-Ray. Exposure alone accounted for LTBI diagnosis in 14 patients with negative TSTs. LTBI patients were treated with Isoniazid (300 mg/day during six months) and none developed TB. During follow up, TST was repeated in 51 patients. Conversion was observed in five: three were diagnosed with LTBI and two with active TB (14 and 36 months after receiving anti-TNF therapy, suggesting new TB exposure). Conclusion: LTBI screening and treatment prior to anti-TNF treatment is effective in endemic areas and reinforces the relevance of contact history for diagnosing LTBI in RA patients

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-06-02T20:34:02Z No. of bitstreams: 1 KayniLima.pdf: 2329691 bytes, checksum: f4483166f9b35c9a8cce0606f988ddb5 (MD5) / Made available in DSpace on 2017-06-02T20:34:02Z (GMT). No. of bitstreams: 1 KayniLima.pdf: 2329691 bytes, checksum: f4483166f9b35c9a8cce0606f988ddb5 (MD5) Previous issue date: 2016-07-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The present work describes the development of a novel platform for the electrocatalysis of isoniazid (INH) employing a glassy carbon electrode (GCE) modified with 2,3-dichloro-5,6-dicyano-p-benzoquinone (DDQ) adsorbed on reduced graphene oxide (rGO). The modified electrode (GCE/OGr/DDQ) was covered with a Náfion® film to avoid the leaching out of the composite from electrodic surface. The materials rGO, DDQ and rGO/DDQ were characterized by Fourier transform infrared spectroscopy (FTIR) and the analytical response of the sensor for the analyte was studied by cyclic voltammetry (CV) and amperometry techniques. The sensor showed excellent electrocatalytic activity for INH oxidation with a decrease in the overpotential about 660 mV vs Ag/AgCl and anodic peak current about 4 times higher than the observed response at an electrode unmodified. The increase of the reaction rate for INH was attributed to the efficient electron transfer between the studied specie and immobilized material on the surface of the GCE surface. The number of electrons determined in the INH oxidation process on the modified electrode was equal to 2. Under the optimized operational and experimental conditions, the sensor showed a wide linear range for INH from 0.5 to 380 µmol L-1 for n = 16 (r2 = 0.999); good sensibility and limit of detection equal to 0.42 µA µmol-1 L, and 0.15 µmol L-1, respectively. The proposed sensor was successfully applied for INH determination in drug samples used in the tuberculosis treatment and results obtained in studies of addition and recovery showed that the proposed method has good accuracy with recovery values between 98.46 and 101 % to INH. / O presente trabalho descreve o desenvolvimento de uma nova plataforma para a eletrocatálise de isoniazida (INH) empregando um eletrodo de carbono vítreo (ECV) modificado com 2,3-dicloro-5,6-diciano-p-benzoquinona (DDQ) adsorvido em óxido de grafeno reduzido (OGr). O eletrodo modificado (ECV/OGr/DDQ) foi coberto com um filme de náfion® para evitar o lixiviamento do compósito da superfície eletródica. Os materiais OGr, DDQ e OGr/DDQ foram caracterizados por Espectroscopia no infravermelho com transformada de Fourier (FTIR) e a resposta analítica do sensor para o analito foi estudada através das técnicas voltametria cíclica (CV) e amperometria. O sensor apresentou uma excelente atividade eletrocatalítica para a oxidação de INH com uma diminuição do sobrepotencial cerca de 660 mV vs Ag/AgCl e corrente de pico anódica quatro vezes maior que a resposta observada em um eletrodo não modificado. O aumento na velocidade de reação para a INH foi atribuído à eficiente transferência eletrônica entre a espécie estudada e os materiais imobilizados na superfìcie do ECV. O número de elétrons determinado no processo de oxidação de INH sobre o eletrodo modificado foi igual a 2. Sob as condições experimentais e operacionais otimizadas, o sensor apresentou uma relação linear para a INH de 0,5 à 380 µmol L-1 para n=16 (r2 = 0,999); boa sensibilidade e limite de detecção igual a 0,42 µA µmol-1 L e 0,15 µmol L-1, respectivamente. O sensor proposto foi utilizado com sucesso para a determinação INH em amostras de medicamentos utilizadas no respectivo tratamento da tuberculose e os resultados obtidos nos estudos de adição e recuperação mostraram que o método proposto apresenta boa exatidão com valores de recuperação entre 98,46 e 101% para a INH.

This study firstly reports the development and characterization of PVP-AgNPs, PANSA and PVPAgNPs/ PANSA nanocomposite on gold. AFM and TEM analyses revealed highly electroactive nanocomposites whose morphogy and properties were essential for the immobilization of CYP2E1. Secondly, the development and characterization of Au/PVPAgNPs/ PANSA/CYP2E1, Au/PVP-AgNPs/PANSA/SA-CYP2E1 and Au/PVPAgNPs/ PANSA/EG-CYP2E1 nanobiosensors are reported. AFM studies displayed globular morphologies with large roughness for the enzyme modified electrodes as opposed to those electrodes without enzymes. Finally, the biotransformation of standard solutions of TB drugs (isoniazid, ethambutol, pyrazinamide and rifampicin) in pH 7.4, 0.1 M phosphate buffer solution is reported. The biotransformations of the TB drugs were successfully studied using cyclic voltammetry (CV), square wave voltammetry (SWV), differential voltammetry (DPV) and steady state amperometry under aerobic conditions. Very good detection limits were obtained for the standard solutions of TB drugs and were found to be in the micromolar range. The detection limit values for the individual TB drugs were 0.55 μM (isoniazid), 0.7 μM (ethambutol), 0.054 μM (pyrazinamide) and 0.05 μM (rifampicin). The detection limit results showed that the nanobiosensors were more sensitive and suitable for the determination of the respective drugs in plasma and serum.

This study firstly reports the development and characterization of PVP-AgNPs, PANSA and PVPAgNPs/ PANSA nanocomposite on gold. AFM and TEM analyses revealed highly electroactive nanocomposites whose morphogy and properties were essential for the immobilization of CYP2E1. Secondly, the development and characterization of Au/PVPAgNPs/ PANSA/CYP2E1, Au/PVP-AgNPs/PANSA/SA-CYP2E1 and Au/PVPAgNPs/ PANSA/EG-CYP2E1 nanobiosensors are reported. AFM studies displayed globular morphologies with large roughness for the enzyme modified electrodes as opposed to those electrodes without enzymes. Finally, the biotransformation of standard solutions of TB drugs (isoniazid, ethambutol, pyrazinamide and rifampicin) in pH 7.4, 0.1 M phosphate buffer solution is reported. The biotransformations of the TB drugs were successfully studied using cyclic voltammetry (CV), square wave voltammetry (SWV), differential voltammetry (DPV) and steady state amperometry under aerobic conditions. Very good detection limits were obtained for the standard solutions of TB drugs and were found to be in the micromolar range. The detection limit values for the individual TB drugs were 0.55 μM (isoniazid), 0.7 μM (ethambutol), 0.054 μM (pyrazinamide) and 0.05 μM (rifampicin). The detection limit results showed that the nanobiosensors were more sensitive and suitable for the determination of the respective drugs in plasma and serum.

Catalase-peroxidases (KatGs), responsible for the activation of the anti-tubercular prodrug isoniazid (INH), are unusual members of the class I plant peroxidase family that possess strong catalase activity as well as peroxidase activity. Due to their strong catalase activity and their ability to activate INH, KatGs have been the subject of intense study for many years, and thus the goal of this work is to further characterize this enzyme in the hope of gaining a better understanding into these unusual reactions. Recent successful crystallization of a few representative KatGs revealed a unique covalent Met-Tyr-Trp cross-link joined to the conserved tryptophan in the heme active site, along with a nearby arginine that is in ionic association with the cross-linked tyrosine. Using the KatG from Burkholderia pseudomallei (BpKatG) as a model, site-directed mutagenesis to these residues revealed that they were essential for catalase, but not peroxidase activity. Structural and kinetic analysis revealed that Arg426 acts as a molecular switch, moving between 2 conformations, favoring heme oxidation when not in association with Tyr238 and favoring heme reduction when in association with Tyr238 by imparting its influence on the heme through the cross-link. Analysis of the reaction with peroxyacetic acid using stopped-flow spectrophotometry revealed an initial, rapidly formed enzyme-substrate complex before the formation of the oxoferryl compound I. Kinetic characterization revealed that formation of both the enzyme-substrate complex and the oxoferryl species were dependent on peroxyacetic acid concentration implying that 2 molecules of peroxyacetic acid are required to form the oxoferryl compound I intermediate. Successful co-crystallization with INH and its co-substrate, NAD+ has revealed their binding sites for the first time in a KatG. The NAD+ binding site is 20 Å from the entrance to the heme cavity, involving interactions primarily with the ADP portion of the molecule. The best defined INH binding site is located in a funnel shaped channel on the opposite side of the protein from the entrance channel that requires the movement of a glutamate residue for binding. The structures suggest that once INH is cleaved to the isonicotinoyl radical it diffuses to the NAD+ binding site to form the final active antimicrobial compound, IN-NAD, in a non-enzymatic reaction enhanced by the enzyme’s ability to bind NAD+.

Catalase-peroxidases (KatGs), responsible for the activation of the anti-tubercular prodrug isoniazid (INH), are unusual members of the class I plant peroxidase family that possess strong catalase activity as well as peroxidase activity. Due to their strong catalase activity and their ability to activate INH, KatGs have been the subject of intense study for many years, and thus the goal of this work is to further characterize this enzyme in the hope of gaining a better understanding into these unusual reactions. Recent successful crystallization of a few representative KatGs revealed a unique covalent Met-Tyr-Trp cross-link joined to the conserved tryptophan in the heme active site, along with a nearby arginine that is in ionic association with the cross-linked tyrosine. Using the KatG from Burkholderia pseudomallei (BpKatG) as a model, site-directed mutagenesis to these residues revealed that they were essential for catalase, but not peroxidase activity. Structural and kinetic analysis revealed that Arg426 acts as a molecular switch, moving between 2 conformations, favoring heme oxidation when not in association with Tyr238 and favoring heme reduction when in association with Tyr238 by imparting its influence on the heme through the cross-link. Analysis of the reaction with peroxyacetic acid using stopped-flow spectrophotometry revealed an initial, rapidly formed enzyme-substrate complex before the formation of the oxoferryl compound I. Kinetic characterization revealed that formation of both the enzyme-substrate complex and the oxoferryl species were dependent on peroxyacetic acid concentration implying that 2 molecules of peroxyacetic acid are required to form the oxoferryl compound I intermediate. Successful co-crystallization with INH and its co-substrate, NAD+ has revealed their binding sites for the first time in a KatG. The NAD+ binding site is 20 Å from the entrance to the heme cavity, involving interactions primarily with the ADP portion of the molecule. The best defined INH binding site is located in a funnel shaped channel on the opposite side of the protein from the entrance channel that requires the movement of a glutamate residue for binding. The structures suggest that once INH is cleaved to the isonicotinoyl radical it diffuses to the NAD+ binding site to form the final active antimicrobial compound, IN-NAD, in a non-enzymatic reaction enhanced by the enzyme’s ability to bind NAD+.

Os métodos termo-analíticos são ferramentas úteis na avaliação da compatibilidade entre fármacos e adjuvantes, com destaque à calorimetria exploratória diferencial. Neste trabalho foram avaliados a compatibilidade e o comportamento térmico entre a isoniazida e adjuvantes tecnológicos primários usualmente empregados em formas farmacêuticas sólidas. A compatibilidade foi examinada por meio da preparação de misturas físicas binárias do tipo fármaco/adjuvante. Foi investigada também a influência da granulação por via úmida e do processo de compactação para as misturas de isoniazida e adjuvantes com função de material de enchimento e carga e deslizante. A isoniazida apresentou um comportamento térmico não encontrado na literatura. Os adjuvantes avaliados foram: ácido esteárico, amido, celulose microcristalina, crospovidona, croscarmelose sódica, dióxido de silício coloidal estearato de magnésio, glicolato de amido sódico, hipromelose, lactose, manitol, polidona e talco. Para as misturas físicas, a maioria dos adjuvantes mostrou-se compatível com o fármaco em questão. Foram verificadas interações com o ácido esteárico, o glicolato de amido sódico, a lactose, o manitol e a povidona. A isoniazida mostrou a formação de uma mistura eutética com o manitol e de interação química com a lactose. A agregação por via úmida e o processo de compactação não mostraram influências adicionais na compatibilidade das misturas avaliadas. Os resultados observados foram confirmados por métodos não-térmicos como difratometria de raios X, espectroscopia de infravermelho e ressonância nuclear magnética. / Thermo-analytical methods, and specially Differential Scanning Calorimetry, are useful support for the evaluation of compatibility between drug substances and pharmaceutical excipients. In this work were studied the compatibility and the thermal behavior of isoniazid and pharmaceutical excipients, commonly used for the formulation of solid dosage forms. Colloidal silicon dioxide, corn starch, crospovidone, hypromellose, lactose, magnesium stearate, mannitol, microcrystalline cellulose, povidone, sodium croscarmellose, sodium starch glycolate, stearic acid and talc were the excipients employed in these experiments. The compatibility was analyzed testing binary physical drug/excipient admixtures. The effect of wet granulation and compression was also investigated, in this case especially between isoniazid, fillers and lubricant. For almost all excipients no incompatibilities with isoniazid were observed. Interactions were detected when the drug substance was added to stearic acid, sodium starch glycolate, lactose, mannitol and povidone. Isoniazid formed a euthetic mixture with mannitol, whereas a possible chemical reaction occurred between isoniazid and lactose. Wet granulation and compaction of the tested admixtures did not affect the results observed above. These observations were confirmed by non-thermal techniques, such as X-Ray diffractometry, infrared spectroscopy and nuclear magnetic resonance.

Philosophiae Doctor - PhD / This study firstly reports the development and characterization of PVP-AgNPs, PANSA and PVPAgNPs/ PANSA nanocomposite on gold. AFM and TEM analyses revealed highly electroactive nanocomposites whose morphogy and properties were essential for the immobilization of CYP2E1. Secondly, the development and characterization of Au/PVPAgNPs/ PANSA/CYP2E1, Au/PVP-AgNPs/PANSA/SA-CYP2E1 and Au/PVPAgNPs/ PANSA/EG-CYP2E1 nanobiosensors are reported. AFM studies displayed globular morphologies with large roughness for the enzyme modified electrodes as opposed to those electrodes without enzymes. Finally, the biotransformation of standard solutions of TB drugs (isoniazid, ethambutol, pyrazinamide and rifampicin) in pH 7.4, 0.1 M phosphate buffer solution is reported. The biotransformations of the TB drugs were successfully studied using cyclic voltammetry (CV), square wave voltammetry (SWV), differential voltammetry (DPV) and steady state amperometry under aerobic conditions. Very good detection limits were obtained for the standard solutions of TB drugs and were found to be in the micromolar range. The detection limit values for the individual TB drugs were 0.55 μM (isoniazid), 0.7 μM (ethambutol), 0.054 μM (pyrazinamide) and 0.05 μM (rifampicin). The detection limit results showed that the nanobiosensors were more sensitive and suitable for the determination of the respective drugs in plasma and serum. / South Africa

Made available in DSpace on 2016-04-04T12:26:00Z (GMT). No. of bitstreams: 2 2.pdf: 3729000 bytes, checksum: 78661b59dc7c742033ca6ce5a153cc47 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2013 / Fundação Oswaldo Cruz. Instituto de Tecnologia em Fármacos/Farmanguinhos. Rio de Janeiro, RJ, Brasil. / O crescimento do número de casos de tuberculose no Brasil fez com que o Governo Federal desenvolvesse uma política nacional de controle da tuberculose que possibilitasse melhorar e prolongar a qualidade de vida dos indivíduos infectados. Esta política inclui, entre várias outras iniciativas, o aumento na adesão de pacientes com um tratamento terapêutico adequado utilizando Formulações de Doses Fixas Combinadas (FDC), contendo os fármacos aos quais o bacilo de Koch é mais sensível. Um dos pontos críticos para o desenvolvimento de tuberculostáticos é o desenvolvimento de metodologias analíticas para seu controle que sejam viáveis, eficazes e robustas, uma vez que a rifampicina um dos insumos farmacêuticos ativos (IFAs) da associação apresenta características peculiares como a sua baixa estabilidade em solução, o que pode levar à formação de muitos produtos de degradação. O presente estudo tem por objetivo otimizar e validar uma metodologia analítica que seja adequada à rotina de um laboratório de controle de qualidade para a determinação dos fármacos isoniazida e rifampicina (ambos IFAs da formulação) e suas substâncias relacionadas, associados em comprimidos de dose fixa combinada para serem utilizados no tratamento dos casos da tuberculose e serem distribuídos pelo Sistema Único de Saúde. Para tanto, foi otimizada e validada uma metodologia analítica utilizando a técnica de cromatografia líquida de alta eficiência (CLAE) capaz de determinar não só o teor dos insumos farmacêuticos ativos (IFAs) presentes na formulação, mas também de quantificar as suas substâncias relacionadas. Um estudo de estabilidade de longa e acelerada durações também foi conduzido e a metodologia analítica otimizada e validada foi usada para avaliação dos comprimidos, mostrando sua capacidade de detectar o esperado decaimento do teor dos IFAs e o aumento no teor de suas substâncias relacionadas. Posteriormente, houve a transferência do método para a técnica de cromatografia líquida de ultraeficiência (CLUE), visando uma análise cromatográfica em tempo mais curto e uma maior sensibilidade do método. Essa metodologia utilizando a técnica de CLUE também foi validada. / As the number of tuberculosis (TB) cases in Brazil is rising, the brazilian Government implemented a national policy for TB control that would enable to improve and endure the quality of life in infected individuals. This policy includes, among many actions, the increase of the patient’s adhesion by a therapeutic treatment using suitable formulations of Fixed Dose Combination (FDC) including drugs to which M. tuberculosis is more sensitive. One critical point for FDC formulation development is the establishment of viable, effective and robust analytical methods for its quality control, since rifampicin – one of the formulation’s active pharmaceutical ingredient (API) – has particular characteristics such as its low stability in aqueous solution, which can lead to formation of many degradation products. This study aims to optimize and validate an analytical methodology for the determination of isoniazid and rifampicin (both APIs in the formulation) and their related substances en tablets with fixed dose. This medicines will be distributed by the national health system for the treatment of tuberculosis patients. Therefore, an analytical method was optimized and validated using the technique of high performance liquid chromatography (HPLC) that can evaluate not only the dosage of APIs in the formulation, but also to determine their related substances. A stability study of accelerated and long durations was also conducted and the optimized analytical method was used to evaluate the tablet, showing its ability to detect the expected reduction of API dosage and the increase in the amount of its related products. Later, an upgrade of the optimized and validated method to ultra-high performance liquid chromatography (UPLC) was succefully performed, with the reduced chromatographic analysis time and increased sensitivity. This UPLC methodology has also been validated.

Os métodos termo-analíticos são ferramentas úteis na avaliação da compatibilidade entre fármacos e adjuvantes, com destaque à calorimetria exploratória diferencial. Neste trabalho foram avaliados a compatibilidade e o comportamento térmico entre a isoniazida e adjuvantes tecnológicos primários usualmente empregados em formas farmacêuticas sólidas. A compatibilidade foi examinada por meio da preparação de misturas físicas binárias do tipo fármaco/adjuvante. Foi investigada também a influência da granulação por via úmida e do processo de compactação para as misturas de isoniazida e adjuvantes com função de material de enchimento e carga e deslizante. A isoniazida apresentou um comportamento térmico não encontrado na literatura. Os adjuvantes avaliados foram: ácido esteárico, amido, celulose microcristalina, crospovidona, croscarmelose sódica, dióxido de silício coloidal estearato de magnésio, glicolato de amido sódico, hipromelose, lactose, manitol, polidona e talco. Para as misturas físicas, a maioria dos adjuvantes mostrou-se compatível com o fármaco em questão. Foram verificadas interações com o ácido esteárico, o glicolato de amido sódico, a lactose, o manitol e a povidona. A isoniazida mostrou a formação de uma mistura eutética com o manitol e de interação química com a lactose. A agregação por via úmida e o processo de compactação não mostraram influências adicionais na compatibilidade das misturas avaliadas. Os resultados observados foram confirmados por métodos não-térmicos como difratometria de raios X, espectroscopia de infravermelho e ressonância nuclear magnética. / Thermo-analytical methods, and specially Differential Scanning Calorimetry, are useful support for the evaluation of compatibility between drug substances and pharmaceutical excipients. In this work were studied the compatibility and the thermal behavior of isoniazid and pharmaceutical excipients, commonly used for the formulation of solid dosage forms. Colloidal silicon dioxide, corn starch, crospovidone, hypromellose, lactose, magnesium stearate, mannitol, microcrystalline cellulose, povidone, sodium croscarmellose, sodium starch glycolate, stearic acid and talc were the excipients employed in these experiments. The compatibility was analyzed testing binary physical drug/excipient admixtures. The effect of wet granulation and compression was also investigated, in this case especially between isoniazid, fillers and lubricant. For almost all excipients no incompatibilities with isoniazid were observed. Interactions were detected when the drug substance was added to stearic acid, sodium starch glycolate, lactose, mannitol and povidone. Isoniazid formed a euthetic mixture with mannitol, whereas a possible chemical reaction occurred between isoniazid and lactose. Wet granulation and compaction of the tested admixtures did not affect the results observed above. These observations were confirmed by non-thermal techniques, such as X-Ray diffractometry, infrared spectroscopy and nuclear magnetic resonance.