Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2665. Adviser: Tommy C. Douglas. Includes bibliographical references.

La tuberculose continue d’être une cause majeure de morbidité et de mortalité dans le monde, principalement dans les pays en voie de développement, bien qu’elle soit une maladie curable. Le diagnostic rapide et précis de la TB active est essentiel pour l’initiation rapide du traitement et le contrôle de la maladie. Le développement de nouveaux tests rapides de diagnostic de TB active représente un véritable challenge pour l’optimisation du diagnostic.L’objectif principal de nos travaux de thèse était de développer et d’évaluer des approches de PCR en temps réel ciblant la séquence d’insertion IS6110 pour la détection de l’ADN de MTB dans les expectorations.Nous avons tout d’abord développé une PCR en temps réel ciblant la séquence répétée IS6110 pour la quantification de l’ADN de MTB. L’évaluation des étapes d’optimisation de la sensibilité de la PCR IS6110 a permis de préciser les performances analytiques et le gain de sensibilité comparativement à une PCR ciblant le gène unique senX3. Au terme d’une comparaison de six protocoles de lyse/ extraction la méthode Chelex® s’est avérée être la plus efficace dans la récupération de l’ADN. La performance diagnostique de la PCR optimisée a été évaluée et comparée avec la PCR automatisée Xpert MTB/RIF sur un panel de 62 échantillons respiratoires.Dans un deuxième temps, nous avons comparé la performance diagnostique de la PCR IS6110 optimisée, le test Xpert MTB/RIF et la version ultrasensible récemment commercialisée du test PCR leader Xpert MTB/RIF Ultra pour la détection de l’ADN de MTB dans des expectorations ayant une faible charge bacillaire.Enfin, à partir de 203 LCR collectés dans le cadre du diagnostic de méningites aseptiques au Burkina Faso, nous avons évalué la performance de la PCR en temps réel multiplexe (IS6110, HSV1, HSV2) combinée à l’extraction par la méthode Chelex® pour la détection de l’ADN de MTB et d’Herpès. / TTuberculosis continues to be a major cause of morbidity and mortality worldwide, mainly in developing countries, despite being a curable disease. The rapid and accurate diagnosis of active TB is essential for rapid initiation of treatment and disease control. The development of new rapid diagnostic tests for active TB represents a real challenge for the optimization of the diagnosis.The main objective of our thesis work was to develop and evaluate real-time PCR approaches targeting the IS6110 insertion sequence for the detection of sputum MTB DNA. We first developed a real-time PCR targeting the IS6110 repeat sequence for the quantification of MTB DNA. The evaluation of the sensitivity optimization steps of the IS6110 PCR made it possible to specify the analytical performances and the sensitivity gain compared to a PCR targeting the single gene senX3. After a comparison of six lysis / extraction protocols, the Chelex® method proved to be the most efficient in the recovery of DNA. The diagnostic performance of optimized PCR was evaluated and compared with automated Xpert MTB / RIF PCR on a panel of 62 respiratory specimens.In a second step, we compared the diagnostic performance of the optimized IS6110 PCR, the Xpert MTB / RIF test and the highly marketed ultra-sensitive version of the Xpert MTB / RIF Ultra leader PCR assay for the detection of sputum MTB DNA. having a low bacillary load.Finally, from 203 LCR collected in the context of the diagnosis of aseptic meningitis in Burkina Faso, we evaluated the performance of the multiplexed real-time PCR (IS6110, HSV1, HSV2) combined with extraction by the Chelex® method for the detection of MTB and Herpes DNA.

Apesar da incidência per capita da tuberculose (TB) ter se mantido estável em 2005, o número de novos casos que surgem a cada ano continua a aumentar no mundo todo. De acordo com a Organização Mundial de Saúde, foram estimados 9,4 milhões de novos casos de TB em 2008, dos quais 1,4 milhões eram HIV - positivos, e com 1,8 milhões de mortes - o equivalente a 4.500 mortes por dia. Fatores como migração, privação sócio-econômica, co-infecção TB-HIV e o aparecimento de cepas resistentes contribuíram para o aumento do número de casos de TB no mundo, principalmente nos países onde a TB já foi considerada erradicada, e criaram a necessidade do desenvolvimento de novas terapêuticas. Alvos moleculares específicos, que são essenciais para o patógeno, e ausentes no hospedeiro, como as enzimas da via do ácido chiquímico são alvos atraentes para o desenvolvimento de novas drogas antituberculose. Essa via leva à síntese de compostos aromáticos, como aminoácidos aromáticos, e é encontrada em plantas, fungos, bactérias e parasitas do phylum Apicomplexa, mas está ausente em humanos. No ano de 2000, foi comprovada a essencialidade dessa via para a viabilidade do bacilo, tornando todas essas enzimas alvos validados para estudo. A segunda enzima da via, deidroquinato sintase (DHQS), catalisa a conversão de 3-deoxi-D-arabino heptulosonato-7-fosfato em 3-deidroquinato, o primeiro composto cíclico. Neste trabalho, são descritos o requerimento de metais divalentes na reação e a determinação do mecanismo cinético da DHQS. Os parâmetros cinéticos verdadeiros foram determinados e, juntamente com os experimentos de ligação, o mecanismo rápido-equilíbrio aleatório foi proposto. O tratamento com EDTA aboliu completamente a atividade de DHQS, sendo que a adição de Co+2 e Zn+2 levam a recuperação total e parcial da atividade enzimática, respectivamente. O excesso de Zn+2 inibe a atividade DHQS, e os dados de ITC indicaram a presença de dois sítios seqüenciais de ligação, o que é consistente com a existência de um sítio secundário inibitório. O protocolo de cristalização foi estabelecido e experimentos em andamento proporcionarão a elucidação da estrutura tridimensional da DHQS, que irá beneficiar tanto o desenho de novos inibidores como uma análise detalhada dos rearranjos do domínio da proteína. Em conjunto, estes resultados representam um passo essencial para o desenho racional de inibidores específicos que podem fornecer uma alternativa promissora para um novo, eficaz, e mais curto de tratamento para TB. / Although the estimated per capita tuberculosis (TB) incidence was stable in 2005, the number of new cases arising each year is still increasing globally. According with World Health Organization, there were estimated 9.4 million new TB cases in 2008, from which 1.4 million were HIV-positive, with 1.8 million deaths total – equal to 4500 deaths a day. Migration, socio-economic deprivation, HIV co-infection and the emergence of extensively-resistance strains, have all contributed to the increasing number of TB cases worldwide, mainly in countries where it was once considered eradicated, and have created an urgent need for the development of new therapeutics against TB. Specific molecular targets, that are essential to the pathogen, and absent in the host, like the enzymes of the shikimate pathway, are attractive targets to development of new antitubercular drugs. This pathway leads to the biosynthesis of aromatic compounds, including aromatic amino acids and it is found in plant, fungi, bacteria and Apicomplexa parasites, but is absent in humans. In 2000, this pathway was proved to be essential to the viability of the pathogen, which validates all its enzymes as potential targets. The second enzyme of this pathway, dehydroquinate synthase (DHQS), catalyzes the conversion of 3-deoxy-D-arabinoheptulosonate 7-phosphate in 3-dehydroquinate, the first cyclic compound. In this work, we described the metal requirement and kinetic mechanism determination of the dehydroquinate synthase. The determination of the true kinetic parameters was performed, and, in addition to ligand binding experiments, the rapid-equilibrium random mechanism was determined. The treatment with EDTA abolished completely the activity of DHQS, and the addition of Co+2 and Zn+2 leads to full and partial recovery of enzyme activity, respectively. Excess of Zn+2 inhibits the DHQS activity, and the ITC data revealed two sequential binding sites, which is consistent with the existence of a secondary inhibitory site. The crystallization protocol was established and ongoing experiments will provide the three-dimensional structure of mtDHQS, which will benefit both the design of novel inhibitors as well as detailed analysis of domain rearrangements of protein. Taken together, these results represent an essential step for the rational design of specific inhibitors that can provide a promising alternative to a new, effective, and shorter treatment for TB.

Apesar da incidência per capita da tuberculose (TB) ter se mantido estável em 2005, o número de novos casos que surgem a cada ano continua a aumentar no mundo todo. De acordo com a Organização Mundial de Saúde, foram estimados 9,4 milhões de novos casos de TB em 2008, dos quais 1,4 milhões eram HIV - positivos, e com 1,8 milhões de mortes - o equivalente a 4.500 mortes por dia. Fatores como migração, privação sócio-econômica, co-infecção TB-HIV e o aparecimento de cepas resistentes contribuíram para o aumento do número de casos de TB no mundo, principalmente nos países onde a TB já foi considerada erradicada, e criaram a necessidade do desenvolvimento de novas terapêuticas. Alvos moleculares específicos, que são essenciais para o patógeno, e ausentes no hospedeiro, como as enzimas da via do ácido chiquímico são alvos atraentes para o desenvolvimento de novas drogas antituberculose. Essa via leva à síntese de compostos aromáticos, como aminoácidos aromáticos, e é encontrada em plantas, fungos, bactérias e parasitas do phylum Apicomplexa, mas está ausente em humanos. No ano de 2000, foi comprovada a essencialidade dessa via para a viabilidade do bacilo, tornando todas essas enzimas alvos validados para estudo. A segunda enzima da via, deidroquinato sintase (DHQS), catalisa a conversão de 3-deoxi-D-arabino heptulosonato-7-fosfato em 3-deidroquinato, o primeiro composto cíclico. Neste trabalho, são descritos o requerimento de metais divalentes na reação e a determinação do mecanismo cinético da DHQS. Os parâmetros cinéticos verdadeiros foram determinados e, juntamente com os experimentos de ligação, o mecanismo rápido-equilíbrio aleatório foi proposto. O tratamento com EDTA aboliu completamente a atividade de DHQS, sendo que a adição de Co+2 e Zn+2 levam a recuperação total e parcial da atividade enzimática, respectivamente. O excesso de Zn+2 inibe a atividade DHQS, e os dados de ITC indicaram a presença de dois sítios seqüenciais de ligação, o que é consistente com a existência de um sítio secundário inibitório. O protocolo de cristalização foi estabelecido e experimentos em andamento proporcionarão a elucidação da estrutura tridimensional da DHQS, que irá beneficiar tanto o desenho de novos inibidores como uma análise detalhada dos rearranjos do domínio da proteína. Em conjunto, estes resultados representam um passo essencial para o desenho racional de inibidores específicos que podem fornecer uma alternativa promissora para um novo, eficaz, e mais curto de tratamento para TB. / Although the estimated per capita tuberculosis (TB) incidence was stable in 2005, the number of new cases arising each year is still increasing globally. According with World Health Organization, there were estimated 9.4 million new TB cases in 2008, from which 1.4 million were HIV-positive, with 1.8 million deaths total – equal to 4500 deaths a day. Migration, socio-economic deprivation, HIV co-infection and the emergence of extensively-resistance strains, have all contributed to the increasing number of TB cases worldwide, mainly in countries where it was once considered eradicated, and have created an urgent need for the development of new therapeutics against TB. Specific molecular targets, that are essential to the pathogen, and absent in the host, like the enzymes of the shikimate pathway, are attractive targets to development of new antitubercular drugs. This pathway leads to the biosynthesis of aromatic compounds, including aromatic amino acids and it is found in plant, fungi, bacteria and Apicomplexa parasites, but is absent in humans. In 2000, this pathway was proved to be essential to the viability of the pathogen, which validates all its enzymes as potential targets. The second enzyme of this pathway, dehydroquinate synthase (DHQS), catalyzes the conversion of 3-deoxy-D-arabinoheptulosonate 7-phosphate in 3-dehydroquinate, the first cyclic compound. In this work, we described the metal requirement and kinetic mechanism determination of the dehydroquinate synthase. The determination of the true kinetic parameters was performed, and, in addition to ligand binding experiments, the rapid-equilibrium random mechanism was determined. The treatment with EDTA abolished completely the activity of DHQS, and the addition of Co+2 and Zn+2 leads to full and partial recovery of enzyme activity, respectively. Excess of Zn+2 inhibits the DHQS activity, and the ITC data revealed two sequential binding sites, which is consistent with the existence of a secondary inhibitory site. The crystallization protocol was established and ongoing experiments will provide the three-dimensional structure of mtDHQS, which will benefit both the design of novel inhibitors as well as detailed analysis of domain rearrangements of protein. Taken together, these results represent an essential step for the rational design of specific inhibitors that can provide a promising alternative to a new, effective, and shorter treatment for TB.

A biodiversidade de microrganismos encontrados nos ecossistemas constitui excelentes fontes para a descoberta de moléculas farmacologicamente ativas. Neste estudo, 32 isolados de actinobactérias coletadas do solo e 51 isolados de fungos de manguezais da costa brasileira foram avaliados quanto à ação antifúngica, antimicobacteriana, leishmanicida e tripanossomicida. Extratos orgânicos obtidos a partir do sobrenadante da cultura dos isolados foram testados e cinco apresentaram concentrações inibitórias mínimas iguais ou inferiores a 400 mg/mL sobre fungos patogênicos e dois demonstraram expressiva ação contra a forma tripomastigota de Trypanosoma cruzi. Para a forma promastigota de Leishmania amazonensis e Mycobacterium tuberculosis H37Rv, os extratos não foram efetivos. Os resultados indicam que fungos isolados de manguezais representam boas perspectivas na investigação de novos agentes antimicrobianos. / The biodiversity of microorganisms found in the ecosystems provide excellent perspectives for the discovery of pharmacologically active molecules. In this study, 32 actinobacteria from the soil and 51 fungi from the mangrove swamps of the Brazilian coast were analyzed with respect to their antifungal, antimycobacterial, leishmanicidal and trypanocidal actions. Organic extracts from the supernatant of the culture of the microorganisms were analyzed and five extracts presented MICs equal or less than 400 mg/mL over the pathogenic fungi and two presented significant action against the trypomastigote of Trypanosoma cruzi. The results indicate that fungi from mangrove swamps present promising perspectives for the research of new antimicrobial agents.

Made available in DSpace on 2014-07-29T15:30:39Z (GMT). No. of bitstreams: 1 Dissetacao Arioldo Vasconcelos Junior.pdf: 3999475 bytes, checksum: fcfb183b016528e836128fc94bae53f7 (MD5) Previous issue date: 2008-02-21 / This work characterized the specific cellular immune response of TCD4 and TCD8 lymphocytes against recombinant Mycobacterium tuberculosis at the Hospital Anuar Auad, Goiania Brazil, and constituted of two experimental groups: 1) 22 active TB patients with positive acid fast aputum, X-ray indicative of tuberculosis, smear culture positive for M. tuberculosis and HIV negative. 2) 15 sex and age matched healthy controls, tuberculin skin test and HIV negative. Venous blood was drawn and processed to obtain PBMC that were cultivated for 96 hours with the specific antigens (1mg/106 cells). TCD8 and TCD4 cells were analyzed by flow citometry for IL-10 and IFN-g production. In general, the percentage of positive TCD4 and TCD8 cells for IFN-g and IL-10 were superior among the TB patients. Additionally, TCD4+IFNg+ (5,63±2,43) and IL-10+ (5,83± 2,19) cells were significantly higher in TB patients than in healthy controls (TCD4+IFNg+ =1,75±0,71 and IL-10+ =1,47±0,90), (p<0,01). Regarding the percentage of TCD8 cells, a higher percentage of IFNg+ (4,33±1,45) and IL-10+ (4,01±1,14) among TB patients than controls (TCD8+IFNg+ = 1,49±0,42 and IL- 10+ 1,62±0,59) was observed (p<0,01). TB treatment did not alter the response to the tested antigens immediately after the treatment initiation. In conclusion, the recombinant antigens MPT-51, ESAT-6, GLcB, Ag85A were recognized by the specific immune response of active TB patients. Key words: Tuberculosis, Mycobacterium tuberculosis, Recombinant antigens, Cellular immune response. to the tested antigens immediately after the treatment initiation. In conclusion, the recombinant antigens MPT-51, ESAT-6, GLcB, Ag85A were recognized by the specific immune response of active TB patients. / Este trabalho avaliou a resposta imune celular dos linfócitos TCD4 e TCD8 de pacientes com tuberculose pulmonar ativa antes e após o tratamento, contra os antígenos recombinantes MPT-51, ESAT-6, GLcB, Ag85A e o Filtrado Protéico de Cultura (CFP) de Mycobacterium tuberculosis atendidos no Hospital de Doenças Tropicais Anuar Auad. A população de estudo, composta de 37 indivíduos, foi dividida em dois grupos experimentais. 1) 22 pacientes com tuberculose pulmonar, selecionados de acordo com idade, diagnóstico confirmado por baciloscopia (BAAR), radiografia evidente de tuberculose, HIV1/2 negativos. 2) 15 controles saudáveis negativos para prova tuberculinica (PT) e HIV1/2, pareados por faixa etária e sexo aos pacientes selecionados. Coletou-se aproximadamente 20 ml de sangue com heparina. O sangue total foi processado e cultivado por 96 horas na presença dos antígenos recombinantes e os linfócitos TCD4 e TCD8 foram analisados quanto à positividade para as citocinas IL-10 e IFN-g por citometria de fluxo. As porcentagens de linfócitos responsivos aos diversos antígenos de M. tuberculosis apresentaram-se em geral superiores aos controles. A porcentagem dos linfócitos TCD4+IFNg+ (5,63±2,43) e IL-10+ (5,83±2,19) foram maiores em pacientes com tuberculose pulmonar ativa em comparação com os linfócitos TCD4+IFNg+ (1,75±0,71) e IL-10+ (1,47±0,90) dos controles (p<0,01). Também, as porcentagens dos linfócitos TCD8+IFNg+ (4,33±1,45) e IL-10+ (4,01 ±1,14) dos pacientes foram maiores que os linfócitos TCD8+IFNg+ (1,49±0,42) e IL-10+ (1,62±0,59) dos controles (p<0,01). Não houve diferença significativa antes (5,63±2,43) e após (5,0±2,0) o tratamento nas populações celulares TCD4+ e TCD8+ positivas para IFN-g e IL-10 quando estimuladas com o painel de antígenos (p>0,05). Com estes resultados podemos considerar que todos os antígenos testados (MPT-51, ESAT-6, GLcB, Ag85A) são reconhecidos pelos linfócitos TCD4+ e TCD8+ de pacientes com tuberculose pulmonar ativa.

A tuberculose é considerada um problema emergente de saúde pública. Este estudo tem como objetivo avaliar a associação da patogenicidade/virulência e propriedades imunomoduladoras de isolados clínicos de Mbv (cepas B2 e MP287/03) e Mtb (cepa Beijing 1471), e da cepa de Mtb H37Rv, como referência de virulência. Os isolados, MP287/03 e Beijing 1471, apresentaram maior virulência em relação às demais cepas, levando os camundongos à morte ainda na fase aguda de infecção. Foi verificada baixa produção de mediadores pró-inflamatórios nos animais infectados com o isolado MP287/03, enquanto nos infectados com o isolado Beijing 1471 os níveis destes mediadores foram exacerbados. O desbalanço na produção destes mediadores pode ter contribuído para morte precoce dos animais. Baseado nesse estudo, nós podemos concluir que as propriedades que conferem hipervirulência aos isolados clínicos de Mbv e Mtb estão principalmente relacionadas à alta capacidade de crescimento intracelular das bactérias, que parece ser pouco alterada pela presença de citocinas pró-inflamatórias. Sendo assim, as infecções por isolados hipervirulentos podem acarretar consequências semelhantes, mesmo quando associadas a diferentes padrões de modulação da resposta imune. / Tuberculosis is an emergent problem of public health. This study aimed to evaluate the association between pathogenicity/virulence and immunemodulatory ability of Mbv (B2 and MP287/03) and Mtb (Beijing 1471) clinical isolates, using H37Rv strain as reference of virulence. The virulence was assessed in C57BL/6 mice infected with a low dose of bacilli (~100 bacteria) via intratracheal route. MP287/03 and Beijing 1471 isolates showed higher virulence than all others strains, leading to mice death during the acute phase. It was verified low production of pro-inflammatory mediators in mice infected by MP287/03 bacteria, whereas in mice infected by Beijing 1471 bacteria were observed exacerbated levels of pro-inflammatory mediators. The disbalance of these mediators may have contributed to the early mouse death. Based on this study, we concluded that the properties that confer hypervirulence to Mbv and Mtb clinical isolates are primarily related to the high intracellular growth capacity of the bacteria, which seems to be marginally affected by the presence of pro-inflammatory cytokines. Therefore, the infection by hypervirulent isolates can lead to similar outcomes, even when associated to different patterns of modulation of the immune response.

Comparou-se a eficácia da baciloscopia in natura e pós concentração (Coloração Ziehl Neelsen) e cultura tradicional e automatizada MA de amostras de escarro ou saliva/muco para a detecção do Complexo M. tuberculosis (MTB) em Centro de Referencia Ambulatorial para Tuberculose na Cidade de São Paulo. A identificação do grupo MTB baseou-se no crescimento em meio com Ácido para nitrobenzóico, e visualização do fator corda. Do total de 374 amostras, 228 eram de pacientes sob diagnóstico inicial e 146 em tratamento. 83 amostras eram saliva/muco. Destas, sete foram positivas à baciloscopia, 03 (3,6%) no material concentrado e uma (1,2%) in natura (p=0.5 McNemar Test). Cinco amostras (6%) positivas na cultura pelo método tradicional e 07 (8,4%) p=0.5 pelo MA. As amostras de escarro eram 74 foram positivas na baciloscopia, sendo 34 (11,7%) in natura e 45 (15,5%) no material concentrado, p=0.001. No método tradicional 56 (19,2%) e 67 (23%) pelo MA p=0.001. Independente da característica da amostra a baciloscopia pós concentração e a cultura pelo MA foram mais sensíveis. / Effectiveness of bacilloscopy were compared in natura and pos-concentrated (Ziehl Neelsen staining), and tradicional and automated culture-AM of sputum or saliva/mucus samples for detection of M. tuberculosis complex (MTB) in Ambulatory Reference Center in the city of São Paulo. Identification of MTB group was based on growth in medium with para nitrobenzoic acid, and cord factor visualization. From the total 374 samples, 228 were from patients under initial diagnostic and 146 in treatment. 83 samples were saliva/mucus. Seven of these were bacilloscopy positive, 03 (3.6%) in concentrated material and one (1.2%) in natura (p=.500ª McNemar Test). Five samples (6%) positive for culture by traditional method and 07 (8.4%) p=0.5 for AM. For sputum 74 were bacilloscopy positive, being 34 (11.7%) in in natura and 45 in concentrated material, p=0.001. In traditional method, 56 (19.2%) and 67 (23%) for AM, p=0.001. Independently of sample characteristics, pos-concentrated bacilloscopy and culture by AM were more effectiveness.

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No. of bitstreams: 1 paulovictorpintodossantos.pdf: 2264483 bytes, checksum: d32e0acf15af39bf9bd4b8f4027d8daf (MD5) Previous issue date: 2017-02-23 / No presente trabalho são descritas as sínteses e as caracterizações dos ligantes salizid, o-vanizid, m-vanizid e p-vanizid e de seus respectivos complexos de prata(I), na proporção 1:2 (M:L). Todos os compostos foram analisados por métodos analíticos, técnicas espectroscópicas, como RMN de 1H e de 13C e por difração de raios X, porém somente para o complexo [Ag(o­vanizid)2(NO3)].H2O foi obtida a estrutura cristalina pura, através dos métodos por monocristal e por policristais. Pôde­se concluir que para todos os complexos sintetizados a coordenação ocorre através do átomo de nitrogênio do anel piridínico, e mesmo que os complexos Ag(m-vanizid) e Ag(p-vanizid) não tiveram suas estruturas cristalinas determinadas, os resultados das análises espectroscópicas no IV e RMN de 1H e 13C realizadas para esses compostos corroboram para uma afirmação nesse sentido. Ao comparar­se a estrutura obtida pela difração por policristais com a difração por monocristal do composto Ag(o­vanizid)2(NO3)].H2O, verificou­se que ocorreu empacotamento em sistemas e grupo espaciais diferentes, uma vez que na primeira técnica citada o complexo apresenta­se em um grupo espacial P­1, enquanto que na segunda, o complexo apresenta­se em grupo espacial Pbcn. Isso se deve, possivelmente, pela diferença dos solventes utilizados em cada síntese. Notou­se também que as estruturas obtidas por esses dois métodos de difração se diferenciam pelo tipo de coordenação, uma vez que na forma policristalina há um íon nitrato coordenado à prata. Porém na forma de monocristal, o íon nitrato não se coordena à prata. Assim, pode­se dizer que se trata de um caso de isomeria de coordenação. Foram realizados testes biológicos in vitro para todos os compostos sintetizados, nos quais determinou­se a concentração inibitória mínima (CIM90) dos compostos frente ao Mycobacterium tuberculosis H37Rv (ATCC 27294). Através dos dados obtidos nesse teste biológico pode­se afirmar que todos os compostos apresentaram atividade antimicobacteriana sobre esta bactéria, sendo que para os compostos com substituições nas posições 1,3 (meta) e 1,4 (para) no anel aromático notou­se CIM90 abaixo de 0,09 mg/L indicando um maior impacto na atividade antimicobacteriana que os compostos com substituintes na posição 1,2 (orto). / In the present work, syntheses and characterizations of the salizid, o­vanizid, m­vanizid and p­vanizid ligands and their respective silver complexes in the ratio 1:2 (M:L) have been described. All compounds were analyzed by analytical methods, spectroscopic techniques, such as 1H and 13C NMR and by X­ray diffraction, All compounds were analyzed by analytical methods, spectroscopic techniques such as 1H and 13C NMR and by X­ray diffraction, but only for the complex [Ag(o­vanizid)2(NO3)].H2O was obtained the pure crystalline structure, through single crystal and polycrystalline methods. The Ag(I) coordination of all the synthesized complexes occurs by the nitrogen atom of the pyridine ring, and even considering the absence of crystallography model for Ag(m­vanizid) and Ag(p­vanizid) complexes the obtained results of IR and 1H and 13C NMR spectroscopic analyzes corroborate the coordination about silver(I) ions through N of the pyridine moiety. The [Ag(o­vanizid)2(NO3)].H2O crystalline structure has been solved by X Ray diffraction in both monocrystal and polycrystalline methods. The structure obtained by powder diffraction belongs to triclinic system and P­1 space group while the single­crystal method provide us a structure in orthorhombic system and Pbcn as space group. However, the basic structure is the same in both models. It was also observed that the structures obtained by these two methods of diffraction are differentiated by the type of coordination, since in the polycrystalline form there is a nitrate ion coordinated to silver. However in monocrystal form, the nitrate ion does not coordinate with silver. Thus, it can be said that this is a coordination isomerism case. Biological assays, in vitro, were performed for all the compounds synthesized, in which the minimum inhibitory concentration (MIC90) of compounds against Mycobacterium tuberculosis H37Rv (ATCC 27294) was determined. Higher antibacterial activities against M. tuberculosis were found when the compounds have substitutions in the 1,3 (meta) and 1,4 (para) positions in comparing with ortho (1,2) position in the aromatic ring, showing MIC90 below than 0.09 mg/L.

Tuberculosis (TB) is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. It is caused by micro-organisms of the Mycobacterium tuberculosis complex. It is the second greatest killer worldwide due to a single infectious agent, after the Human Immunodeficiency Virus (HIV). Without treatment, fatality is 50% in immune competent persons. TB remains the leading cause of death among HIV positive persons, causing one fifth of the deaths. The World Health Organization estimates that one third of the world population is infected by this micro-organism but only 5 to 10% develop TB disease. Nevertheless, this enormous reservoir leads to around 1.4 millions deaths annually. Standard curative treatment lasts at least 6 months and includes 4 different drugs. Toxicity of the drugs leading to (severe) adverse events and the long duration of the daily administration challenges patient’s compliance. Subinhibitory concentration of the drugs (due to poor adherence) can induce resistance of the mycobacteria to the provided drugs. Unlike most bacteria where resistance is acquired by plasmids, drug resistance of mycobacteria is obtained by genomic mutations. “Multi drug-resistant tuberculosis (MDR-TB)” is strictly defined as TB resistant to specifically isoniazid and rifampicin, the two main first line drugs. “Extensively drug resistance (XDR)” is defined as MDR-TB with additional resistance to any of the fluoroquinolones (such as ofloxacin or moxifloxacin) and to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin). The increase of MDR-TB represents an enormous challenge to Public Health globally. This research examined different aspects of tuberculosis resistance performed in the Belgian National Reference Center, a clinical laboratory setting. <p><p>First of all, a profound analysis of the MDR-TB situation in Belgium was conducted. It is the first retrospective population-based survey of MDR-TB in Belgium, covering a 15-year period (1994-2008). It comprises 174 patients representing more than 80% of the culture positive MDR-TB patients reported to the Belgian register, thus this study is considered of national relevance. It includes bacteriological and molecular data on the isolates as well as clinical aspects of the patients and treatment results. Considering only the patient’s first MDR-TB isolate, an increase over time was observed in the number of isolates resistant to a second-line drug as well as the total number of drugs each isolate was resistant to. XDR-TB was detected since 2002 and panresistant TB (resistant to every available antituberculosis drug) since 2009. Overall, a successful treatment outcome was obtained for 67.8% of the MDR-TB cases. Drug susceptibility testing (DST) of Mycobacterium tuberculosis to first line drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) in liquid culture medium has a turn around time of at least two weeks, after identification of the positive culture (obtained after 2 to 4 weeks) from the patient’s clinical isolate. In order to provide the clinician with valuable information about the isolated mycobacteria leading to patient adapted therapy before bacteriological DST results are available, resistance is predicted by detection of mutations in certain genes of the mycobacteria. It is common practice for rifampicin (rpoB gene) and isoniazid (katG gene and/or inhA promoter region). In this MDR-TB collection, rifampicin resistant related mutations were found in 97.1% (168/173) of the clinical isolates and isoniazid resistant related mutations in 94.1% (160/170). The pncA, embB and gyrA genes have been sequenced to identify possible mutations because of their possible involvement with resistance to pyrazinamide, ethambutol and the fluoroquinolones respectively. However, little is known about the resistance prediction value of the mutations in these genes.<p>The study is also the first study on the molecular epidemiology of MDR-TB in the country. DNA fingerprinting showed a large diversity of strains (67% of the patients were infected by a strain with a unique pattern) and further epidemiological examination revealed limited local transmission of MDR-TB in Belgium.<p><p>The second part investigated the pncA gene and its association with pyrazinamide resistance in MDR-TB isolates from Belgium and in vitro cultured spontaneous mutants. The genetic analysis showed that 98.3% (59/60) of the Belgian clinical MDR pyrazinamide resistant (PZAR) isolates present a mutation in the pncA gene. We found 1.7% (1/60) of the PZAR MDR-isolates encoding wild type pncA and flank. A total (PZAR and PZAS) of 41 different amino acid changes, 3 protein truncations and 5 frameshifts were observed including eight novel mutations: 8Asp>Ala, 13Phe>Leu, 64Tyr>Ser, 107Glu>stop, 143Ala>Pro, 172Leu>Arg and frameshifts starting in codon 55 and 82. Analysis of all observed mutations (i.e. in clinical isolates as well as spontaneous mutants) revealed that they are not always associated with drug resistance and that they are not scattered randomly throughout the gene, but occur rather at preferential sites such as in codons with amino acids associated with either iron or substrate binding and catalytic active sites. The frequency of in vitro mutagenesis to pyrazinamide at pH 6.0 was determined and found to be relatively high at 10-5 CFU/ml.<p><p>Finally, the in vitro activity of tobramycin and clarithromycin (with unclear efficacy against M. tuberculosis) was evaluated on 25 M. tuberculosis clinical isolates with various resistance profiles. The effect of the drugs administered together was examined for possible synergistic effect. The median minimum inhibitory concentration (MIC) of 8 µg/ml obtained for both drugs in this study is rather high but are beyond the concentrations obtained in lung tissues. This suggests that both drugs should be investigated further as potential adjuncts to the treatment of resistant TB when other alternatives have failed; in particularly through new drug delivery systems such as the Dry Power Inhaler which allows local drug deposition with high drug concentrations in the lungs but low toxicity due to limited systemic absorption. In addition, for 36% of the tested isolates a decrease of the MIC of clarithromycin by a single or twofold dilution was observed in the presence of a subinhibitory concentration of tobramycin and no antagonistic effect was seen for the remaining isolates.<p><p>This research illustrates different (laboratory) aspects in the fight against drug resistant TB, all using the Belgian TB collection: characterisation of the Belgian MDR-TB situation on bacteriological, molecular and epidemiological level; profound analysis of genomic mutations and their possible association with drug resistance; and investigation of synergistic activity of drugs with low efficacy against M. tuberculosis.<p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished