Pteridine reductase 1 (PTR1) is an NADPH dependent reductase that catalyzes the reduction of several pterins and folates. The gene encoding this enzyme was originally identified in Leishmania based on its ability to provide resistance to the drug methotrexate (MTX). The DNA and amino acid sequences are known, and overproducing strains of Escherichia coli are available. PTR1 has been previously shown to be required for the salvage of oxidized pteridines (folate, biopterin, and others). Since Leishmaniaare folate and pterin auxotrophes, PTR1 is a possible target for novel anti-folate drugs for the treatment of leishmaniasis. PTR1 catalyzes the transfer of hydride from NADPH to the 2-amino-4-oxo-pteridine ring system yielding 7, 8-dihydropteridines, and to the pteridine ring system of 7, 8-dihydropteridines yielding 5,6, 7, 8-tetrahydropteridines. PTR1 shows a pH dependent substrate specificity. At pH 4.6 the specific activity of PTR1 is highest with pterins, while at pH 6.0 the specific activity of PTR1 was highest with folates. The sequence of PTR1 is only 20-30% homologous to the sequences of members of the short chain dehydrogenase/reductase enzyme family. Although this is typical for members of this enzyme family, it does not allow for unambiguous classification in this family. In fact, when the DNA sequence of PTR1was first determined, PTR1 was classified as an aldoketo reductase. To classify PTR1 definitively, further biochemical characterization was required. To provide this information, the work described here was undertaken: (i) the stereochemical and kinetic course of PTR1 was determined; (ii) residues important in catalysis and ligand binding were identified; and (iii) conditions for the crystallization of PTR1 were developed. The stereochemistry of hydride transfer The use of [3H]-folate, showed that the ultimate product of PTR1 was 5, 6, 7, 8-tetrahydrofolate. 4R-[3H]-NADPH and 4S-[3H]-NADPH were synthesized enzymatically and used as the cofactor for the reduction of folate. PTR1 was coupled to thymidylate synthase (TS), and tritium from 4S-[3H]-NADPH was transferred to thymidylate. Therefore, the pro-S hydride of NADPH was transferred to the si face of dihydrofolate (DHF; see figure I-1). The transfer of the pro-Shydride indicates that PTR1 is a B-side dehydrogenase which is consistent with its membership in the short chain dehydrogenase (SDR) family. The kinetic mechanism of PTR1 When NADPH was varied at several fixed concentrations of folate (and vice-versa) V/K (Vmax/KM) showed a dependence upon concentration of the fixed substrate. This is consistent with a ternary complex mechanism, in contrast to a substituted enzyme mechanism that exhibits no dependence of V/K on fixed substrate. Product inhibition patterns using NADP+ and 5-deazatetrahydrofolate (5dTHF, a stable product analog) were consistent with an ordered ternary complex mechanism in which NADPH binds first and NADP+ dissociates last. However, an enzyme-DHF binary complex was detected by fluorescence. Isotope partitioning experiments showed that the enzyme-DHF binary complex was not catalytically competent whereas the enzyme-NADPH complex was. Measurement of the tritium isotope effect on V/K (T(V/K)) at high and low dihydrofolate confirmed that PTR1 proceeds via a steady state ordered mechanism. Rapid quench analysis showed that dihydrofolate was a transient intermediate during the reduction of folate to tetrahydrofolate and that folate reduction is biphasic. Catalytic Residues of PTR1 The amino acid sequences of dihydropteridine reductase and 3-α, 20-β, hydroxy steroid dehydrogenase were aligned to that of PTR1. Based on the results of the alignment, site directed mutagenesis was used to investigate the role of specific residues in the catalytic cycle of PTR1. Variant enzymes were screened based on their ability to rescue a dihydrofolate reductase (DHFR) deficient strain of E. coli. Selected PTR1 variants (some complementing and some non-complementing) were purified and further characterized. Tyrosine 193 of the wild type enzyme was found to be involved in the reduction of pteridines, but not in the reduction of 7, 8-dihydropteridines, and eliminated the substrate inhibition of 7, 8-dihydropteridines observed with the wild type enzyme. Both PTR1(K197Q) and PTR1(Y193F/K197Q) had decreased activity for all substrates and low affinity for NADPH. In contrast to the wild type enzyme, NADPH displayed substrate inhibition towards PTR1(K197Q). All PTR1(D180) variants that were purified were inactive except for PTR1(D180C), which showed 2.5% of wild type activity with DHF. The binary complexes of PTR1(D180A) and PTR1(D180S) with NADPH showed a decrease in affinity for folate. Based on the kinetic properties of the PTR1 variants, roles for Y193, K197, and D180 are proposed. In conjunction with D180, Y193 acts as a proton donor to N8 of folate. K197 forms hydrogen bonds with NADPH in the active site and lowers the pKaof Y193. D180 participates in the protonation of N8 of folate and N5 of DHF. Crystallization of PTR1 and PTR1-ligand complexes The crystallization of PTR1 from L. major and L. tarentolea as unliganded and as binary and ternary complexes was attempted. Several crystal forms were obtained including L. major PTR1-NADPH-MTX crystals that diffracted to ~ 3.2 Å resolution. It was not possible to collect a full data set of any of the crystals. At their current stage, none of the crystal forms is suitable for structural work.

Les infections fongiques peuvent s’exprimer sous différentes formes (leishmaniose cutanée ouviscérale, aspergillose pulmonaire à caractère allergique ou invasive) et connaissent unerecrudescence dans les pays développés en affectant principalement les personnesimmunodéprimées comme les cancéreux, les malades ayant subis des greffes d’organes ou lespatients atteints du VIH. Ces infections sont une cause de mortalité chez 30% des sujetsatteints. L’approche médicamenteuse conventionnelle consiste en l’administration par voieintraveineuse (IV) d’antifongiques. L'Amphotéricine B (AmB), un antibiotiquede la familledes polyènes, reste à ce jour l'un des agents les plus efficaces dans le traitement des infectionsfongiques systémiques mais entraîne aussi des effets indésirables comme une néphrotoxicitéaigüe après injection. Pour améliorer l’index thérapeutique de cette molécule active, nousavons développé différents outils galéniques adaptés à d’autres voies d’administration. Dansun premier temps, nous avons mis au point des liposomes à base de céramides végétales,adaptés pour une administration orale et dans le but de traiter la leishmaniose viscérale. Cesliposomes ont été testés dans un modèle in vitro Estomac/Duodénum pour mimer lesconditions physiologiques et ont montré une bonne stabilité dans un tel milieu avec un tauxd’encapsulation satisfaisant. Des liposomes formulés à partir de Dimyristoylphosphatidylcholine(DMPC)/Dimyristoylphosphatidylglycérol (DMPG) et encapsulantl’AmB ont été étudiés à l’aide de la résonnance magnétique nucléaire (RMN31P et 1H) et parrésonnance paramagnétique électronique (RPE). Ces liposomes, dont la composition pourraitêtre adaptée pour une administration par voie pulmonaire, ont été utiliséscomme modèlemembranaire pour une étude des interactions du principe actif dans la matrice liposomale.Enfin, nous décrivons le développement et la caractérisation physico-chimique d’une nouvellegénération de dispersions solides amorphes sphériques formulées à base de polymères decyclodextrines très hydrophiles et d’amphotéricine B.Les formulations ont été obtenues sousforme de poudre sèche par spray-drying, une méthode de séchage par atomisation. Cessystèmes ont été caractérisés par diverses techniques : spectroscopie infrarouge à transforméede Fourier (FT-IR), spectroscopie Raman, granulométrie laser, microscopie électronique àtransmission et microscopie électronique à balayage. La distribution aérodynamique de cesdispersions solides amorphes a été évaluée à l’aide d’un impacteur à cascades afin de testerleur intérêt pour des applications potentielles par voie pulmonaire. / Résumé en anglais non disponible

Ce travail porte sur la mise au point des nanocochléates intégrant à la fois l’amphotéricine B (AmB) et la miltéfosine (hexadécylphosphocholine, HePC) dotés de propriétés adéquates pour une administration par voie orale pour le traitement de la leishmaniose viscérale. Notre premier axe de recherche a été l’étude des interactions de l’AmB et de l’HePC avec les monocouches de lipides de DOPS (dioleoyl phosphatidylsérine) et de Cho (cholestérol) dans le développement de nanocochléates chargés avec ces deux principes actifs. Les résultats expérimentaux nous ont permis de déterminer le rapport drogue/lipides optimal pour la formulation des nanocochléates : 9DOPS/1Cho/0,5AmB/0,5HePC et de confirmer que dans la formulation de nanocochléates, l’AmB et l’HePC sont incorporés de façon stable et se situent au sein des bicouches lipidiques entre des lipides, plutôt que dans la phase aqueuse entre les bicouches.Notre second axe de recherche a porté sur la formulation et la caractérisation des nanocochléates chargés en AmB et en HePC. Ces nanocochléates ont été formulés à partir des liposomes unilamellaires encapsulant ces deux principes actifs. Les paramètres expérimentaux majeurs (taille de liposomes, proportion DOPS/1Cho) ont été optimisés. Les propriétés physico-chimiques des nanocochléates, telles que la taille, la charge de surface, la morphologie, le rendement d'encapsulation, l’organisation des principes actifs et la stabilité pendant le stockage au cours de temps ont été étudiées. En vue d'une formulation orale, la libération des principes actifs in vitro ainsi que la stabilité des nanocochléates in vitro dans les milieux gastro-intestinaux ont également été étudiés d’après la Pharmacopée des Etats-Unis. Enfin, une étude in vivo préliminaire chez le rat portant sur la pharmacocinétique plasmatique d'AmB après administration orale de nanocochléates chargés en AmB avec ou sans HePC en comparaison avec l’Ambisome® et la Fungizone® a été entamée. Les résultats préliminaires ont démontré une absorption significative par voie orale de l’AmB.Ce travail a permis de développer des nanocochléates avec des propriétés appropriées pour une formulation contenant à la fois l’AmB et l’HePC administrable par voie orale. Néanmoins, des optimisations restent à réaliser avant d’envisager une application clinique. / The aim of this work was to formulate nanocochleates containing both Amphotericin B (AmB) and miltefosine (hexadecylphosphocholine, HePC) with properties suitable for administration by the oral route for the treatment of visceral leishmaniasis. The first part of this work was a fundamental study of the interactions between AmB and HePC and monolayers of dioleylphosphatidylserine (DOPS) with or without cholesterol (Cho), to provide a basis for the formulation of nanocochleates containing the two active molecules. The results allowed us to define the optimal proportions for the formulation of nanocochleates: 9DOPS/1Cho/0.5AmB/0.5HePC and to predict that AmB and HePC would be incorporated stably into the formulation and would be located between the lipids in the bilayers rather than in the aqueous phase between the bilayers. The second part of the work was the formulation and characterization of nanococheates containing both AmB and HePC. These were derived from unilamellar liposomes containing the two active molecules. The crucial experimental parameters (size of the liposomes, ratio of DOPS to Cho) were optimized. The physico-chemical properties of the nanocochleates, such as the size, surface charge, morphology, encapsulation yield, the organization of the active molecules and the stability during long-term storage were studied. Since the formulation was destined for the oral route, in-vitro drug release and the stability of the nanocochleates in simulated gastro-intestinal media were studied according to the recommendations of the US Pharmacopeia. Finally, a preliminary in-vivo study of the plasma pharmacokinetics of AmB after oral gavage to rats of nanocochleates contained AmB with or without HePC, in comparison with AmBisome and Fungizone, was carried out. A significant oral absorption of AmB was observed. This work has led to the formulation of nanocochleates containing AmB and HePC with appropriate properties for oral administration. However, further optimization is necessary before such particles will be suitable for clinical use.

Resumo: A lectina ligante de manose (MBL) é uma lectina sérica membro da família das colectinas, sendo uma importante constituinte da imunidade inata. Também é uma das mais de trinta moléculas do sistema complemento. O Sistema Complemento (SC) é um sofisticado sistema de defesa do hospedeiro que pode ser acionado tanto pelo sistema imune inato quanto pelo mecanismo de imunidade mediada por anticorpos. A via de ativação do SC das Lectinas é ativada por domínios de reconhecimento de carboidratos. O gene que codifica a MBL foi caracterizado em alguns mamíferos, e o mais estudado até agora é o humano. O gene da MBL em cães ainda não foi localizado, contudo, sua versão predita já está disponível, a qual é similar a lectina ligante de manose (A). Em humanos, a região codificadora da proteína é constituída por quatro exons e três introns. A grande maioria da MBL produzida no fígado se origina dos transcritos iniciados no exon 1. Alelos na região promotora do exon 1 contribuem para variações adicionais na concentração sérica da MBL. Em um estudo realizado com pacientes que apresentavam diagnóstico positivo para leishmaniose visceral, cujo agente causador é o protozoário Leishmania chagasi, mostrou que esses pacientes apresentavam um nível maior de MBL sérica do que em indivíduos controle saudáveis. A Leishmaniose é uma doença negligenciada que afeta principalmente as populações de baixa renda. . É uma doença de distribuição mundial, afetando 88 países, dos quais 72 são países em desenvolvimento. Os agentes etiológicos da doença são protozoários que apresentam uma única mitocôndria, sendo que, o DNA mitocondrial aparece condensado e é chamado de cinetoplasto (k). Na área urbana, o cão é o principal reservatório. Os vetores são os flebotomíneos. De uma forma geral, o diagnóstico da LVC vem se apresentando como um problema para os serviços... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Mannose binding lectin (MBL) is a member of the colectins's family, being an important constituent of innate immunity. Also is one of more than thirty molecules of the complement system. The complement system (CS) is a sophisticated defense system of the host that can be triggered by both the innate immune system as the antibody-mediated immunity. The lectin pathway of complement activation is enabled by areas of recognition of carbohydrates. The gene that encodes the MBL was characterized in some mammals, and the most studied so far is the human. The MBL in dogs gene has not yet been located, however, it's predicted version is already available, which is similar to mannose binding lectin (A). In humans, the encoder protein region consists of four exons and three introns. The vast majority of MBL produced in the liver originates from transcripts started in exon 1. Allele in the promoter region of exon 1 contributes to additional variations in serum's levels of MBL. A study conducted with patients that had positive diagnosis for visceral leishmaniasis, whose causal agent is the protozoa Leishmania Chagasi, showed that these patients had a higher level of MBL in serum that in healthy control subjects. Leishmaniasis is a neglected disease that primarily affects low-income populations. The disease has a global distribution, affecting 88 countries, which 72 are developing countries. The etiological agents of the disease are protozoa with has a single mitochondria, and the mitochondrial DNA appears condensed and is called kinetoplast (k). In the urban area, the dog is the main reservoir. The vectors are insects called sandflies. General diagnosis of visceral leishmaniasis in dogs is showing as a problem for public health services, and there is no specific diagnostic test that is 100% sensitive. New diagnostic methods, such as PCR, constitute a new perspective for the diagnosis... (Complete abstract click electronic access below) / Orientador: Paulo Eduardo Martins Ribolla / Coorientador: João Pessoa Araújo Júnior / Banca: Hélio Langoni / Banca: Alessandra Gutierrez de Oliveira / Mestre

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With the advancement of isothermal nucleic acid amplification techniques, detection of the pathogenic DNA in clinical samples at point-of-need is no longer a dream. The newly developed recombinase polymerase amplification (RPA) assay incorporated in a suitcase laboratory has shown promising diagnostic efficacy over real-time PCR in detection of leishmania DNA from clinical samples. For broader application of this point-of-need system, we undertook a current multi-country diagnostic evaluation study towards establishing this technique in different endemic settings which would be beneficial for the ongoing elimination programs for leishmaniasis. For this study purpose, clinical samples from confirmed visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL) patients were subjected to both real-time PCR and RPA assay in Bangladesh, India, and Nepal. Further skin samples from confirmed cutaneous leishmaniasis (CL) patients were also included from Sri Lanka. A total of 450 clinical samples from VL patients, 429 from PKDL patients, 47 from CL patients, and 322 from endemic healthy/healthy controls were under investigation to determine the diagnostic efficacy of RPA assay in comparison to real-time PCR. A comparative sensitivity of both methods was found where real-time PCR and RPA assay showed 96.86% (95% CI: 94.45–98.42) and 88.85% (95% CI: 85.08–91.96) sensitivity respectively in the diagnosis of VL cases. This new isothermal method also exhibited promising diagnostic sensitivity (93.50%) for PKDL cases, when a skin sample was used. Due to variation in the sequence of target amplicons, RPA assay showed comparatively lower sensitivity (55.32%) than that of real-time PCR in Sri Lanka for the diagnosis of CL cases. Except for India, the assay presented absolute specificity in the rest of the sites. Excellent concordance between the two molecular methods towards detection of leishmania DNA in clinical samples substantiates the application of RPA assay incorporated in a suitcase laboratory for point-of-need diagnosis of VL and PKDL in low resource endemic settings. However, further improvisation of the method is necessary for diagnosis of CL.

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