Orientador: Maria José Soares Mendes Giannini / Orientador no exterior: Joshua Daniel Nosanchuk / Coorientador: Ana Marisa Fusco Almeida / Banca: Carlos Pelleschi Taborda / Banca: Mauro Cintra Giudice / Banca: Marlus Chorilli / Banca: Maria Aparecida de Resende Stoianoff / Resumo: Dermatófitos são fungos que apresentam a capacidade de invadir os tecidos queratinizados do homem e dos animais, produzindo a dermatofitose. Biofilmes são comunidades estruturadas de microrganismos que se agrupam de maneira organizada a uma superfície ou que se aderem uns aos outros, dentro de uma matriz extracelular que eles mesmos produzem. Pela primeira vez, neste trabalho, foi descrita a formação de biofilmes por isolados clínicos e cepas ATCC de dermatófitos. Também se avaliou a sensibilidade das cepas frente aos antifúngicos convencionais e derivados sintéticos do ácido protocatecuico, determinando sua toxicidade e eficiência, tanto nas formas planctônicas como de biofilme. A identificação molecular dos isolados clínicos mostrou concordância com a identificação convencional. Todas as cepas e isolados foram capazes de formar biofilmes nos quatro meios testados. Trichophyton. rubrum ATCC 28189, ATCC MYA-4438, T. rubrum 143 e Trichophyton. mentagrophytes 66 produziram mais biomassa e matriz extracelular que T. mentagrophytes ATCC 11481 (p<0.05). RPMI 1640, BHI e DMEM estimularam maior produção de biomassa e matriz extracelular que o meio de queratinócitos. Todas as espécies foram capazes de formar biofilmes maduros em 72 h e uma rede de hifas circundadas em vários pontos por uma matriz extracelular foi mostrada por microscopia eletrônica de varredura (MEV). Na microscopia confocal, aparentemente os meios RPMI e DMEM produziram biofilmes mais espessos e o meio BHI, biofilmes mais densos e compactos. As melhores atividades anti-dermatófitos foram expressas pelos protocatecuatos de butila, pentila, hexila, nonila e decila, que exibiram baixa toxicidade para as células HaCat, NHOK e HepG2 nas regiões da concentração inibitória mínima (CIM). Nonila foi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Dermatophytes are fungi that have the ability to invade keratinized tissues of human and animals, producing a condition called dermatophytosis. Biofilms are structured microbial communities that are organized by adhering to a surface, as well as to each other via an extracellular polymeric matrix. For the first time, in this work, the biofilm formation by ATCC strains and clinical isolates of dermatophytes was described. Also, the susceptibilities of the strains to conventional antifungal drugs and to the synthetic derivatives of protocatechuic acid were evaluated, determining its toxicity and efficacy. The molecular identification corroborated with the conventional one. All strains were able to form biofilms in the four media tested. Trichophyton. rubrum ATCC 28189, Trichophyton. mentagrophytes 66, and T. rubrum 143 produced more biomass, polysaccharide structures and extracellular matrix than T. mentagrophytes ATCC 11481 (p <0.05). RPMI 1640, BHI and DMEM stimulated increased production of biomass and extracellular matrix when compared to the medium for keratinocytes. All species were able to form mature biofilms in 72 hours. The SEM results showed a coordinated network of hyphae in all directions, surrounded by an extracellular matrix. In confocal microscopy, apparently RPMI and DMEM media produced thicker biofilms, while the BHI produced denser and compact biofilms. The greatest antidermatophytes activities were expressed by butyl, pentyl, hexyl, nonyl and decyl, protocatechuates, which exhibit low toxicity to HaCat, HepG2 and NHOK cells in the regions of minimal inhibitory concentrations (MIC). Nonyl was the compound with improved selectivity index for HaCat and HepG2 cells; for NHOK cells, the most selective compounds were nonyl and hexyl. Fluconazole, griseofulvin... (Complete abstract click electronic access below) / Doutor

A market survey was conducted to determine the incidence of stem-end rot (SE) on avocado fruit obtained from the Pretoria Fresh Produce Market representing the Tzaneen production area. Dothiorella aromatica isolates collected from this survey were compared in terms of physiological characteristics i.e. growth and temperature, carbon and nitrogen utilization and pH response as well as genetic relatedness using random amplified polymorphic DNA (RAPD's). The incidence of SE was found to be as high as 31% and anthracnose 18%. Symptom development was more apparent when fruit was evaluated at the overripe than eating ripe stage. Of the 12 identified fungi isolated from SE lesions, D. aromatica was by far the most frequently isolated fungus. All D. aromatica isolates tested were found to be pathogenic using the fruit inoculation technique. Based on lesion size, isolates were separated into two groups of virulent and less virulent. Most isolates grouped within the one cluster, with only one isolate falling in the second group being less virulent. Although similar groupings were found between physiological tests, a lack of consistency as to which isolate belonged to which group was found. The optimum temperature for growth was 25°C and an initial pH of 6. The mean colony growth rate was 5 mm day-1. Isolates grew at a minimum of eight to a maximum of 27 mm within 24 hours. Isolates grew best on pectin and poorly on sorbitol when used as a carbon source. Urea supported growth best and poor growth was found on casein-amended sources. At a molecular level, the RAPD technique could be used successfully to seperate isolates into three groups based on cluster analyses. OPC02 was the most discrimatory primer and was therefore used in this study. Isolates produced DNA fragments ranging from 1500 bp to 450 bp. The results obtained from RAPDs could not be correlated with the pathogenicity and physiological tests. Future studies should focus on comparing isolates from different avocado production areas and testing different primers for the ability to distinguish between isolates of D. aromatica. / Dissertation (MInst Agrar (Plant Protection))--University of Pretoria, 2005. / Microbiology and Plant Pathology / unrestricted

Mit klonspezifischer Polymerasekettenreaktion (PCR) ist ein spezifischer Nachweis kleiner DNA-Mengen möglich. Von 47 MF-Patienten wurden aus Hautproben 50 TCR-gamma- und 7 TCR-beta-Sequenzen sequenziert, von 15 bzw. 5 Patienten gelang die Entwicklung eines N-spezifischen Primers. Um einen Zusammenhang zwischen Frequenz der zirkulierenden klonalen Zellen und klinischem Verlauf zu untersuchen, wurden für 4 Patienten im LightCycler die im Blut zirkulierenden klonalen Rearrangements quantifiziert. Ein Vergleich dieser Daten mit dem klinischen Verlauf ergab bei zwei Patienten eine Tendenz zu einem reziproken Verhältnis, bei einem Patienten im Tumorstadium wurde eine gleichsinnige Entwicklung beider Parameter gesehen. Der Nachweis klonaler Rearrangements in Haut- und Blutproben von SPP-Patienten wäre ein Hinweis auf den Lymphomcharakter dieser Erkrankung. Bei 9 von 14 SPP-Patienten wurde in Blutproben mit Hilfe der für VgammaI-Jgamma1/2 spezifischen Konsensusprimer ein monoklonales Rearrangement gefunden. Für 6 Patienten konnte ein klonspezifischer Primer entwickelt werden. Ein Nachweis der klonalen Sequenz aus dem Blut in der Haut war trotz einer geschachtelten PCR nicht möglich. / By clone specific polymerase chain reaction (pcr) small amounts of DNA can be detected. We discovered 50 tcr gamma and 7 tcr beta sequences from skin probes of 47 patients with mycosis fungoides. From 15 respectively 5 patients n-specific primers were designed. In order to examine if there is a relation between frequency of circulating clonal cells and clinical course, for 4 patients circulating clonal cells were quantified by real time pcr in LightCycler. In two patients we saw a reciproce proportion, in one patient with tumourstage disease rising numbers of circulating clonal cells were seen during worsening of clinical course. Detection of clonal rearrangments in skin and blood probes of patients with small plaque parapsoriasis could be a hint for classifying SPP as a lymphoma. In 6/14 patients we designed a clone-specific primer for circulating clonal rearangments. Despite performing a nested pcr circulating clonal rearrangments could not be detected in skin lesions of these patients.

Introdução: A micose fungóide foliculotrópica (MFF) é subtipo de linfoma cutâneo de células T que atinge especialmente o folículo piloso e parece ter prognóstico mais reservado. Informações clínicas sobre a população acometida por linfomas cutâneos no Brasil são escassas. O fenômeno de imunoprivilégio (IP) diz respeito à habilidade de alguns órgãos em permanecer protegidos contra reações inflamatórias. Tem sido sugerido que o folículo piloso normal represente um local de IP. Nesse estudo aventou-se a possibilidade de haver uma quebra no equilíbrio desse fenômeno na MFF, com alteração na expressão de moléculas do complexo maior de histocompatibilidade (MHC) e na expressão de MHC não-clássicos (HLA-G), com algum papel no mecanismo do foliculotropismo. Os objetivos foram: descrever o perfil clínico-epidemiológico de paciente com MFF, descrever a histologia e imunofenótipo dos casos de MFF e investigar os mecanismos envolvidos na predileção dos linfócitos atípicos pelo folículo piloso. Metodologia: Os prontuários de pacientes com diagnóstico de MFF provenientes do ambulatório de Linfomas Cutâneos da Faculdade de Medicina da Universidade de São Paulo (FMUSP) foram revisados (n=33). O material histológico de biópsias de pele dos pacientes com MFF provenientes dos ambulatórios de Linfomas Cutâneos da FMUSP e da Northwestern University foi analisado por meio de escala semi-quantitativa (n=43). Na coloração de hematoxilina-eosina foram avaliados os seguintes parâmetros: infiltrado neoplásico epidérmico, infiltrado neoplásico dérmico, presença de acantose/espongiose, de mucinose folicular, de fibroplasia do tecido conjuntivo, de eosinófilos, de plasmócitos, o tamanho celular e o grau de dano folicular. Analisou-se a positividade do infiltrado neoplásico para os seguintes marcadores celulares: CD1a, CD56, TIA-1 e CD117. As expressões do complexo de histocompatibilidade HLA-G e do MHCII no infiltrado celular e no epitélio folicular foram investigadas no grupo de pacientes com MFF e comparadas com o grupo de pacientes com micose fungóide clássica (MFC) e pele normal. A expressão do complexo de histocompatibilidade MHCII também foi investigada na epiderme. Resultados: A mediana das idades ao diagnóstico foi de 46 anos com 61% dos pacientes classificados como portadores de estágio avançado. A proporção entre homens e mulheres foi de 1,54 e a mediana de duração de doença antes do diagnóstico foi de três anos. Ao final de três anos de acompanhamento, 67% dos casos estavam vivos com a doença. O prurido foi relatado em 82% dos casos. Histologicamente, encontrou-se associação entre a presença de eosinófilos e de plasmócitos com fibroplasia do tecido conjuntivo. Observou-se diminuição da expressão do HLA-G no epitélio folicular nos grupos MFF e MFC em relação à pele normal. Observou-se aumento da expressão do MHCII no epitélio folicular na MFF em comparação à pele normal e na epiderme na MFC quando comparada à MFF. Conclusões: Dados clínicos da população estudada assemelharam-se aos dados da literatura como estágio avançado ao diagnóstico e prognóstico reservado. Cerca de metade dos casos de MFF foi positiva para o marcador citotóxico TIA-1. Demonstrou-se haver um provável colapso do imunoprivilégio folicular nos linfomas cutâneos com expressão diminuída de moléculas HLA-G em comparação à pele normal. O aumento da expressão do MHCII poderia relaciona-se com o foliculotropismo na MFF e com o epidermotropismo na MFC / Introduction: Folliculotropic mycosis fungoides (FMF) is a subtype of cutaneous T cells lymphoma affecting mainly the hair follicle and seems to have a less favorable prognosis. Clinical information on the population affected by cutaneous lymphomas in Brazil is scarce. The immune privilege (IP) phenomenon involves the ability of some body sites remaining protected from inflammatory reactions. It has been suggested that normal hair follicle represents an IP location. We hypothesized that a collapse of this phenomenon would occur in FMF, with changes in the expression of classical major histocompatibility molecules (MHC) and in the expression of nonclassical MHC molecules (HLA-G) with a role in folliculotropism mechanism. The objectives of this study were to describe the clinical and epidemiological profile of patients with MFF, describe the histology and immunophenotype of cases of MFF and investigate the expression of MHC molecules. Methods: The medical records of patients from the outpatient Cutaneous Lymphoma Clinic of the University of Sao Paulo Medical School (FMUSP) diagnosed with MFF were reviewed (n = 33). The histological material from skin biopsies of patients with MFF from the Cutaneous Lymphomas Clinic of FMUSP and Northwestern University was stained and evaluated by semi-quantitative scale. In hematoxylin-eosin staining the following parameters were evaluated: epidermal neoplastic infiltrate, dermal neoplastic infiltrate, acanthosis/spongiosis, follicular mucinosis, connective tissue fibroplasia, presence of eosinophils and plasma cells, cell size and degree of follicular damage. We analyzed the positivity of the neoplastic infiltrate for the following cellular markers: CD1a, CD56, TIA-1, and CD117. Finally, the expression of histocompatibility complex HLA-G and MHC II in the neoplastic infiltrate and the follicular epithelium was investigated in MFF group and compared to patients with classical mycosis fungoides (CMF) and to normal skin. MHCII expression in the epidermis was also investigated. Results: The median age at diagnosis was 46 years, with 61% classified as advanced stage disease. The ratio between men and women was 1.54, the median disease duration before diagnosis was three years. After a median time of follow-up of three years, 67% of the cases were alive with disease. Pruritus was reported in 82% of the cases. Histologically, an association between the presence of eosinophils and plasma cells with fibroplasia of collagen was found. There was a decrease of HLA-G expression in the follicular epithelium in MFF and CMF groups compared to normal skin. There was an increase of MHCII expression in the follicular epithelium in FMF group compared to normal skin. There was an increased MHCII expression in the epidermis in CMF compared to FMF. Conclusions: Clinical data from the studied population were similar to the previous literature in relation to advanced stage at diagnosis and prognosis. There was a relationship between the presence of eosinophils and plasma cells in neoplastic infiltrate and the connective tissue fibrosis. Near half of the cases of FMF was positive for the cytotoxic marker TIA-1. A possible hair follicle immune privilege collapse was suggested by a decreased expression of HLA-G molecules in FMF and CMF compared to normal skin. Increased MHCII expression appears to be involved in the folliculotropism of FMF and epidermotropism of CMF

Psoriasiform diseases are a group of cutaneous disorders that are characterized by impaired keratinocyte maturation leading to epidermal hyperplasia and thickening of skin. This group of disorders includes psoriasis, seborrheic dermatitis (SD) and mycosis fungoides (MF). Psoriasis has been recently shown to be mediated by the pro-inflammatory T helper cell subset, namely Th17 cells, whereas the pathogenesis of SD and MF are still poorly understood. SD is characterized by inflamed skin that primarily manifests on areas populated with sebaceous glands. Interestingly, SD is very common amongst immunosuppressed patients such as those with HIV-AIDS, suggesting the importance of an immune response in the development of SD. Because SD shares common clinical and histopathological features with psoriasis, a disease in which Th17 axis cytokines is known to be involved, and given that Th17 cells and their related cytokines have been implicated in the pathogenesis of a wide range of autoimmune and inflammatory disorders, it is possible that Th17 axis cytokines play a role in the pathogenesis of SD. We explored the involvement of Th17 axis cytokines in a D2C mouse model of psoriasiform disease that shows a high degree homology to the clinicopathological characteristics of human seborrheic dermatitis. IL-6 and IL-23, which are important for the differentiation of Th17 cells, and IL-17 and IL-22, which are the Th17 effector molecules, were measured at both protein and mRNA levels in sera and lesional skin from D2C mice. An immunohistochemical analysis was also performed to detect the presence of IL-17 in D2C lesional skin relative to normal skin from DBA/2 controls. Our data demonstrated significantly elevated levels of IL-6, IL-17 and IL-22 in sera from diseased D2C mice compared to controls and/or convalescent mice. There were no significant differences in IL-23 protein levels in sera from D2C mice compared to those from wild type mice or convalescent D2C mice. RT-PCR revealed a significant increase in IL-23 and IL-17 gene expression in D2C lesional skin relative to normal skin. Gene expression levels of IL-22, but not IL-6, were statistically significant elevated in D2C skin lesions compared to controls, by real time PCR. Our IHC study of IL-17 expression showed an abundance of positively stained mononuclear cells in D2C lesional skin relative to DBA/2 normal skin. Altogether, our data demonstrate that Th17 axis cytokines are elevated locally at mRNA levels for IL-23, IL-17, and IL-22 and systematically at protein levels for IL-6, IL-17, and IL-22. This data lay the foundation for further studies investigating a role for Th17 axis cytokines in the cutaneous inflammatory disease seen in our mouse model of SD and, ultimately, in the development of human SD. Mycosis fungoides (MF) is the most common type of cutaneous T cell lymphoma (CTCL). The etiology of MF is unknown, but there is substantial evidence suggesting a potential role for a yet unidentified infectious agent in the pathogenesis of MF. Many studies have claimed that there is an association between MF and the Human T cell Lymphotorpic Virus Type 1 (HTLV-I); however, the involvement of this virus in the etiology of MF is a controversial topic. In our study, we used nested PCR to explore the association between HTLV-I infection and MF by screening genomic DNA from 114 skin biopsies for the presence of HTLV-I provirus. We also utilized a ViroChip and high-throughput sequencing (HTS), as a case study, to attempt to detect novel virus-specific oligonucleotides that may be associated with CTCL. Our data showed no evidence for HTLV-I proviral integration in the 114 MF samples that were screened using nested-PCR. The ViroChip and HTS results also did not reveal any signature sequence for known or unknown infectious agent in the CTCL case study. Collectively, this data argue against the involvement of HTLV-I provirus in the pathogenesis of MF.

Introdução: A micose fungóide foliculotrópica (MFF) é subtipo de linfoma cutâneo de células T que atinge especialmente o folículo piloso e parece ter prognóstico mais reservado. Informações clínicas sobre a população acometida por linfomas cutâneos no Brasil são escassas. O fenômeno de imunoprivilégio (IP) diz respeito à habilidade de alguns órgãos em permanecer protegidos contra reações inflamatórias. Tem sido sugerido que o folículo piloso normal represente um local de IP. Nesse estudo aventou-se a possibilidade de haver uma quebra no equilíbrio desse fenômeno na MFF, com alteração na expressão de moléculas do complexo maior de histocompatibilidade (MHC) e na expressão de MHC não-clássicos (HLA-G), com algum papel no mecanismo do foliculotropismo. Os objetivos foram: descrever o perfil clínico-epidemiológico de paciente com MFF, descrever a histologia e imunofenótipo dos casos de MFF e investigar os mecanismos envolvidos na predileção dos linfócitos atípicos pelo folículo piloso. Metodologia: Os prontuários de pacientes com diagnóstico de MFF provenientes do ambulatório de Linfomas Cutâneos da Faculdade de Medicina da Universidade de São Paulo (FMUSP) foram revisados (n=33). O material histológico de biópsias de pele dos pacientes com MFF provenientes dos ambulatórios de Linfomas Cutâneos da FMUSP e da Northwestern University foi analisado por meio de escala semi-quantitativa (n=43). Na coloração de hematoxilina-eosina foram avaliados os seguintes parâmetros: infiltrado neoplásico epidérmico, infiltrado neoplásico dérmico, presença de acantose/espongiose, de mucinose folicular, de fibroplasia do tecido conjuntivo, de eosinófilos, de plasmócitos, o tamanho celular e o grau de dano folicular. Analisou-se a positividade do infiltrado neoplásico para os seguintes marcadores celulares: CD1a, CD56, TIA-1 e CD117. As expressões do complexo de histocompatibilidade HLA-G e do MHCII no infiltrado celular e no epitélio folicular foram investigadas no grupo de pacientes com MFF e comparadas com o grupo de pacientes com micose fungóide clássica (MFC) e pele normal. A expressão do complexo de histocompatibilidade MHCII também foi investigada na epiderme. Resultados: A mediana das idades ao diagnóstico foi de 46 anos com 61% dos pacientes classificados como portadores de estágio avançado. A proporção entre homens e mulheres foi de 1,54 e a mediana de duração de doença antes do diagnóstico foi de três anos. Ao final de três anos de acompanhamento, 67% dos casos estavam vivos com a doença. O prurido foi relatado em 82% dos casos. Histologicamente, encontrou-se associação entre a presença de eosinófilos e de plasmócitos com fibroplasia do tecido conjuntivo. Observou-se diminuição da expressão do HLA-G no epitélio folicular nos grupos MFF e MFC em relação à pele normal. Observou-se aumento da expressão do MHCII no epitélio folicular na MFF em comparação à pele normal e na epiderme na MFC quando comparada à MFF. Conclusões: Dados clínicos da população estudada assemelharam-se aos dados da literatura como estágio avançado ao diagnóstico e prognóstico reservado. Cerca de metade dos casos de MFF foi positiva para o marcador citotóxico TIA-1. Demonstrou-se haver um provável colapso do imunoprivilégio folicular nos linfomas cutâneos com expressão diminuída de moléculas HLA-G em comparação à pele normal. O aumento da expressão do MHCII poderia relaciona-se com o foliculotropismo na MFF e com o epidermotropismo na MFC / Introduction: Folliculotropic mycosis fungoides (FMF) is a subtype of cutaneous T cells lymphoma affecting mainly the hair follicle and seems to have a less favorable prognosis. Clinical information on the population affected by cutaneous lymphomas in Brazil is scarce. The immune privilege (IP) phenomenon involves the ability of some body sites remaining protected from inflammatory reactions. It has been suggested that normal hair follicle represents an IP location. We hypothesized that a collapse of this phenomenon would occur in FMF, with changes in the expression of classical major histocompatibility molecules (MHC) and in the expression of nonclassical MHC molecules (HLA-G) with a role in folliculotropism mechanism. The objectives of this study were to describe the clinical and epidemiological profile of patients with MFF, describe the histology and immunophenotype of cases of MFF and investigate the expression of MHC molecules. Methods: The medical records of patients from the outpatient Cutaneous Lymphoma Clinic of the University of Sao Paulo Medical School (FMUSP) diagnosed with MFF were reviewed (n = 33). The histological material from skin biopsies of patients with MFF from the Cutaneous Lymphomas Clinic of FMUSP and Northwestern University was stained and evaluated by semi-quantitative scale. In hematoxylin-eosin staining the following parameters were evaluated: epidermal neoplastic infiltrate, dermal neoplastic infiltrate, acanthosis/spongiosis, follicular mucinosis, connective tissue fibroplasia, presence of eosinophils and plasma cells, cell size and degree of follicular damage. We analyzed the positivity of the neoplastic infiltrate for the following cellular markers: CD1a, CD56, TIA-1, and CD117. Finally, the expression of histocompatibility complex HLA-G and MHC II in the neoplastic infiltrate and the follicular epithelium was investigated in MFF group and compared to patients with classical mycosis fungoides (CMF) and to normal skin. MHCII expression in the epidermis was also investigated. Results: The median age at diagnosis was 46 years, with 61% classified as advanced stage disease. The ratio between men and women was 1.54, the median disease duration before diagnosis was three years. After a median time of follow-up of three years, 67% of the cases were alive with disease. Pruritus was reported in 82% of the cases. Histologically, an association between the presence of eosinophils and plasma cells with fibroplasia of collagen was found. There was a decrease of HLA-G expression in the follicular epithelium in MFF and CMF groups compared to normal skin. There was an increase of MHCII expression in the follicular epithelium in FMF group compared to normal skin. There was an increased MHCII expression in the epidermis in CMF compared to FMF. Conclusions: Clinical data from the studied population were similar to the previous literature in relation to advanced stage at diagnosis and prognosis. There was a relationship between the presence of eosinophils and plasma cells in neoplastic infiltrate and the connective tissue fibrosis. Near half of the cases of FMF was positive for the cytotoxic marker TIA-1. A possible hair follicle immune privilege collapse was suggested by a decreased expression of HLA-G molecules in FMF and CMF compared to normal skin. Increased MHCII expression appears to be involved in the folliculotropism of FMF and epidermotropism of CMF

INTRODUÇÃO: A variante hipocromiante da micose fungoide - MF - (MFh) apresenta características peculiares, como a predileção por indivíduos jovens e melanodérmicos e curso clínico crônico. Estudos especulam a patogênese da hipocromia comparando-a à do vitiligo. No Brasil, faltam dados que permitam conhecer sua importância na saúde pública. O presente trabalho visou avaliar a epidemiologia, a histopatologia e a imunofenotipagem de uma amostra de pacientes com diagnóstico de MFh e propor hipóteses dos mecanismos patogênicos da hipocromia, além de comparar pacientes portadores de lesões hipocrômicas exclusivas com aqueles portadores de outras formas de MF com lesões hipocrômicas concomitantes. MÉTODOS: Foram selecionados pacientes do Ambulatório de Linfomas Cutâneos do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e classificados em três grupos: A (21 portadores apenas de lesões hipocrômicas); B (15 portadores de outras formas de MF com lesões hipocrômicas concomitantes) e C (8 pacientes com diagnóstico de MF clássica, estes apenas para avaliações histológica e imuno-histoquímica). Foram obtidos dados clinicoepidemiológicos e realizadas análises histológica e imuno-histoquímica de biópsias das lesões e de pele normal, como controle. Para o estudo imuno-histoquímico foram utilizados os marcadores para imunofenotipagem da neoplasia, Melan-A, tirosinase, SCF, CD117 e MITF. RESULTADOS: Do total de pacientes acompanhados naquele ambulatório, os pacientes com MF portadores de lesões hipocrômicas corresponderam a 16%. As medianas das idades de início da doença e dos tempos de história foram de, no grupo A 25 anos e 8 anos; no grupo B, 29 anos e 13 anos, respectivamente; houve predomínio de indivíduos melanodérmicos , acometimento do sexo feminino e a maioria dos pacientes encontrava-se em estágios iniciais da doença em ambos os grupos. A avaliação histológica revelou achados semelhantes, como epidermotropismo de linfócitos atípicos e infiltrado dérmico linfomonocitário nas lesões hipocrômicas e não-hipocrômicas. O imunofenótipo CD8+ do infiltrado neoplásico epidérmico foi mais frequente no grupo A, ao passo que os grupos B e C apresentaram mais casos com imunofenótipo CD4+. A avaliação da função melanocítica das lesões hipocrômicas do grupo A revelou diminuição significativa da imunomarcação dos melanócitos por todos marcadores em comparação à pele normal e às lesões do grupo C. Em relação ao grupo B, não houve diferenças para as lesões hipocrômicas, não-hipocrômicas e pele normal, quando avaliadas dentro do próprio grupo (exceto para Melan A). A expressão de SCF pelos queratinócitos foi irregular sobretudo nas lesões hipocrômicas. DISCUSSÃO: Os pacientes com lesões hipocrômicas apresentaram características semelhantes (idade precoce, predomínio do sexo feminino, doença indolente). Mostrou-se que indivíduos melanodérmicos tem maior chance de apresentar lesões hipocrômicas. Além da redução de melanócitos e do receptor melanocítico CD117 em relação à pele normal já demonstradas previamente, mostrou-se, como no vitiligo, a redução da expressão do MITF, fator vital para a função e sobrevida do melanócito. Além disso, também se explicitou desbalanço da produção de citocinas melanogênicas pelos queratinócitos. CONCLUSÃO: A presença de lesões hipocrômicas pode ser considerada um marcador de bom prognóstico na MF. Diferentes mecanismos, como ação celular citotóxica e a alteração do microambiente da unidade epidérmica, colaboram para hipocromia das lesões da MFh / INTRODUCTION: The hypopigmented variant of mycosis fungoides - MF - (MFh) presents specific characteristics, such as a predilection for young and melanodermic individuals, and chronic clinical course. Studies speculate the pathogenesis of the hypopigmentation comparing it to vitiligo\'s. In Brazil, the lack of data prevents the knowledge of its importance in public health. This study aimed to evaluate the epidemiology, the histopathology and the immunophenotyping of a sample of patients diagnosed with MFh and to propose hypotheses of the pathogenic mechanisms of hypopigmentation, in addition to comparing exclusive hypopigmented lesion-bearer patients with those bearing other types of MF with concomitant hypopigmented lesions. METHODS: Patients were selected from the Cutaneous Lymphoma Clinic, from Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo and classified in three groups: A (21 hypopigmented only lesion- bearers); B (15 bearers of other types of MF with concomitant hypopigmented lesion) and C (8 patients diagnosed with classical MF, being those only for histology and immunohistochemistry evaluations). Clinical- epidemiological data were obtained and histology and immunohistochemistry analyses of lesion biopsies and normal skin, as a control, were made. For the immunohistochemistry study, the markers for immunophenotyping the neoplasm, Melan-A, tyrosinase, SCF, CD117 and MITF were used. RESULTS: Of the total number of patients treated at that clinic, the MF patients bearing hypopigmented lesions were 16%. The medians of the age of disease onset and the medical history time were 25 years and 8 years in group A; 29 years and 13 years in group B, respectively; there were a predominance of melanodermic individuals, involvement of the female sex, and the majority of the patients were in early stages of the disease in both groups. The histological evaluation revealed similar findings, such as epidermotropism of atypical lymphocytes and lympho-monocytic dermal infiltrate in hypopigmented and non-hypopigmented lesions. The CD8+ immunophenotype of the epidermal neoplastic infiltrate was more frequent in group A, while groups B and C showed more cases of CD4+ immunophenotype. The evaluation of the melanocytic function of the hypopigmented lesions in group A revealed a significant decrease of immunostaining of the melanocytes by all markers when compared to normal skin and group C lesions. Regarding group B, there were no differences to hypopigmented and non-hypopigmented lesions and normal skin, when evaluated within the group itself (except for Melan A). The SCF expression by the keratinocytes was irregular especially in hypopigmented lesions. DISCUSSION: Patients with hypopigmented lesions showed similar characteristics (early age, female sex predominance, indolent disease). It has been showed that melanodermic subjects are more likely to have hypopigmented lesions. In addition to the previously-showed reduction of melanocytes and CD117 melanocytic receptor related to normal skin, it has been showed, as in vitiligo, the reduction of MITF expression, a vital factor for the function and survival of the melanocyte. Besides that, it has been also made explicit a production imbalance of melanogenic cytokines by the keratinocytes. CONCLUSION: The presence of hypopigmented lesions can be considered a marker of good prognosis in MF. Different mechanisms, such as cytotoxic cellular action and the change of the microenvironment of the epidermal unit, collaborate for the hypopigmentation of the lesions of MFh

INTRODUÇÃO: A variante hipocromiante da micose fungoide - MF - (MFh) apresenta características peculiares, como a predileção por indivíduos jovens e melanodérmicos e curso clínico crônico. Estudos especulam a patogênese da hipocromia comparando-a à do vitiligo. No Brasil, faltam dados que permitam conhecer sua importância na saúde pública. O presente trabalho visou avaliar a epidemiologia, a histopatologia e a imunofenotipagem de uma amostra de pacientes com diagnóstico de MFh e propor hipóteses dos mecanismos patogênicos da hipocromia, além de comparar pacientes portadores de lesões hipocrômicas exclusivas com aqueles portadores de outras formas de MF com lesões hipocrômicas concomitantes. MÉTODOS: Foram selecionados pacientes do Ambulatório de Linfomas Cutâneos do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e classificados em três grupos: A (21 portadores apenas de lesões hipocrômicas); B (15 portadores de outras formas de MF com lesões hipocrômicas concomitantes) e C (8 pacientes com diagnóstico de MF clássica, estes apenas para avaliações histológica e imuno-histoquímica). Foram obtidos dados clinicoepidemiológicos e realizadas análises histológica e imuno-histoquímica de biópsias das lesões e de pele normal, como controle. Para o estudo imuno-histoquímico foram utilizados os marcadores para imunofenotipagem da neoplasia, Melan-A, tirosinase, SCF, CD117 e MITF. RESULTADOS: Do total de pacientes acompanhados naquele ambulatório, os pacientes com MF portadores de lesões hipocrômicas corresponderam a 16%. As medianas das idades de início da doença e dos tempos de história foram de, no grupo A 25 anos e 8 anos; no grupo B, 29 anos e 13 anos, respectivamente; houve predomínio de indivíduos melanodérmicos , acometimento do sexo feminino e a maioria dos pacientes encontrava-se em estágios iniciais da doença em ambos os grupos. A avaliação histológica revelou achados semelhantes, como epidermotropismo de linfócitos atípicos e infiltrado dérmico linfomonocitário nas lesões hipocrômicas e não-hipocrômicas. O imunofenótipo CD8+ do infiltrado neoplásico epidérmico foi mais frequente no grupo A, ao passo que os grupos B e C apresentaram mais casos com imunofenótipo CD4+. A avaliação da função melanocítica das lesões hipocrômicas do grupo A revelou diminuição significativa da imunomarcação dos melanócitos por todos marcadores em comparação à pele normal e às lesões do grupo C. Em relação ao grupo B, não houve diferenças para as lesões hipocrômicas, não-hipocrômicas e pele normal, quando avaliadas dentro do próprio grupo (exceto para Melan A). A expressão de SCF pelos queratinócitos foi irregular sobretudo nas lesões hipocrômicas. DISCUSSÃO: Os pacientes com lesões hipocrômicas apresentaram características semelhantes (idade precoce, predomínio do sexo feminino, doença indolente). Mostrou-se que indivíduos melanodérmicos tem maior chance de apresentar lesões hipocrômicas. Além da redução de melanócitos e do receptor melanocítico CD117 em relação à pele normal já demonstradas previamente, mostrou-se, como no vitiligo, a redução da expressão do MITF, fator vital para a função e sobrevida do melanócito. Além disso, também se explicitou desbalanço da produção de citocinas melanogênicas pelos queratinócitos. CONCLUSÃO: A presença de lesões hipocrômicas pode ser considerada um marcador de bom prognóstico na MF. Diferentes mecanismos, como ação celular citotóxica e a alteração do microambiente da unidade epidérmica, colaboram para hipocromia das lesões da MFh / INTRODUCTION: The hypopigmented variant of mycosis fungoides - MF - (MFh) presents specific characteristics, such as a predilection for young and melanodermic individuals, and chronic clinical course. Studies speculate the pathogenesis of the hypopigmentation comparing it to vitiligo\'s. In Brazil, the lack of data prevents the knowledge of its importance in public health. This study aimed to evaluate the epidemiology, the histopathology and the immunophenotyping of a sample of patients diagnosed with MFh and to propose hypotheses of the pathogenic mechanisms of hypopigmentation, in addition to comparing exclusive hypopigmented lesion-bearer patients with those bearing other types of MF with concomitant hypopigmented lesions. METHODS: Patients were selected from the Cutaneous Lymphoma Clinic, from Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo and classified in three groups: A (21 hypopigmented only lesion- bearers); B (15 bearers of other types of MF with concomitant hypopigmented lesion) and C (8 patients diagnosed with classical MF, being those only for histology and immunohistochemistry evaluations). Clinical- epidemiological data were obtained and histology and immunohistochemistry analyses of lesion biopsies and normal skin, as a control, were made. For the immunohistochemistry study, the markers for immunophenotyping the neoplasm, Melan-A, tyrosinase, SCF, CD117 and MITF were used. RESULTS: Of the total number of patients treated at that clinic, the MF patients bearing hypopigmented lesions were 16%. The medians of the age of disease onset and the medical history time were 25 years and 8 years in group A; 29 years and 13 years in group B, respectively; there were a predominance of melanodermic individuals, involvement of the female sex, and the majority of the patients were in early stages of the disease in both groups. The histological evaluation revealed similar findings, such as epidermotropism of atypical lymphocytes and lympho-monocytic dermal infiltrate in hypopigmented and non-hypopigmented lesions. The CD8+ immunophenotype of the epidermal neoplastic infiltrate was more frequent in group A, while groups B and C showed more cases of CD4+ immunophenotype. The evaluation of the melanocytic function of the hypopigmented lesions in group A revealed a significant decrease of immunostaining of the melanocytes by all markers when compared to normal skin and group C lesions. Regarding group B, there were no differences to hypopigmented and non-hypopigmented lesions and normal skin, when evaluated within the group itself (except for Melan A). The SCF expression by the keratinocytes was irregular especially in hypopigmented lesions. DISCUSSION: Patients with hypopigmented lesions showed similar characteristics (early age, female sex predominance, indolent disease). It has been showed that melanodermic subjects are more likely to have hypopigmented lesions. In addition to the previously-showed reduction of melanocytes and CD117 melanocytic receptor related to normal skin, it has been showed, as in vitiligo, the reduction of MITF expression, a vital factor for the function and survival of the melanocyte. Besides that, it has been also made explicit a production imbalance of melanogenic cytokines by the keratinocytes. CONCLUSION: The presence of hypopigmented lesions can be considered a marker of good prognosis in MF. Different mechanisms, such as cytotoxic cellular action and the change of the microenvironment of the epidermal unit, collaborate for the hypopigmentation of the lesions of MFh

Oncogenic microRNAs (miRNAs) are small RNA molecules that inhibit post-translational regulatory mechanisms at the epigenetic level. miRNAs are often deregulated in malignancies and due to their stability are detectable in non-cellular fractions of peripheral blood. In our laboratory, we have performed several studies that have investigated and utilized miRNAs as biomarkers for various hematological tumors (e.g., chronic lymphocytic leukemia, Hodgkin`s lymphoma) and solid tumors (e.g., breast cancer). The aim of these studies was to find the association of miRNAs with pathophysiological and clinical aspects of each disease. Here, we confirmed the importance of particular miRNA or its complex during disease monitoring. Combining clinical, molecular biological and statistical analyses, we were able to find miRNA sets that fulfilled not only a diagnostic role but also a prognostic role beyond expectations. The main focus of this thesis is on the investigation of microRNAs in the diagnosis of a hematological malignancy - primary cutaneous T-cell lymphoma (CTCL). Tumor specificity of some miRNAs has been demonstrated. Their aberrant expression in tissue samples of CTCL patients obtained from skin biopsies, correctly distinguished malignant disease from control samples of benign skin lesions. Here, we...

Introdução: Micose fungoide poiquilodérmica (MFp) é uma variante clínica de micose fungoide (MF). É mais indolente e caracterizada pela presença da poiquilodermia. As metaloproteinases (MMP) e seus inibidores específicos TIMP (Tissue Inhibitors of Metaloproteinases) estão envolvidos na oncogênese. Especificamente as MMP2 e MMP9 e seus inibidores, TIMP-2 e TIMP-1, respectivamente, foram relacionados ao prognóstico em tumores. Poucos trabalhos estudaram MMP e nenhum estudou a ação dos TIMP na MF. Objetivos: avaliar a relação entre MMP2 e MMP9 e seus inibidores TIMP2 e TIMP1 e a agressividade da MF e descrever a casuística de micose fungoide poiquilodérmica no ambulatório de linfomas cutâneos da Divisão de Clínica Dermatológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Métodos: análise retrospectiva de 54 casos de MFp, sendo 25 de MFp localizada 14 de MFp generalizada e 15 de MFp mista. Para análise das MMP e TIMP, os grupos de MFp foram comparados com 7 amostras de pele normal (PN), 10 casos de MF clássica inicial (MFi), 9 casos de MF tumoral não-transformada (MFT nt) e 10 de MF tumoral transformada (MFT t). Resultados: A proporção de mulheres: homens foi 2,44. MFp apresentou maior tempo entre os primeiros sintomas e o diagnóstico. MFpG apresentou maior prevalência de lesões do tipo pitiríase liquenoide crônica (PLC) (79%). Houve alta prevalência de MF hipocromiante (62%) no grupo MFp mista. A histologia da MFp apresentou características típicas de MF e, adicionalmente, atrofia, telangectasias e derrame pigmentar, específicos da forma poiquilodérmica. Na imuno-histoquímica predominou o fenótipo CD3+, CD4+, CD7-, CD8- em todos os grupos, e MFp apresentou significantemente menor predomínio do fenótipo CD8+ que o grupo MFi. O grupo MFpG apresentou baixa positividade para pesquisa de clonalidade T da pele (12,5%). A MMP2 esteve mais presente na epiderme em MFi e MFp relativamente a MFT. Na derme superficial, os grupos MFi e MFp marcaram mais MMP2 que a pele normal, mas sem diferença estatística entre eles. Não houve diferença estatística em MMP2 na derme profunda entre os grupos. À zimografia, houve maior atividade de MMP2 ativa no grupo MFTt. Não houve expressão de TIMP-2 pela epiderme da pele normal. Os grupos MFi e MFp marcaram TIMP-2 na epiderme de forma semelhante, porém menos que os grupos MFT. Na derme superficial, não houve diferença estatística entre os grupos MFi e MFp. TIMP-2 foi mais expresso na derme profunda dos dois grupos de MFT comparativamente a todos os outros grupos. Na epiderme e na derme superficial, MMP9 foi mais expressa no grupo MFi comparativamente a MFp. Na derme profunda, a expressão de MMP9 foi maior nos grupos MFT, seguido por MFi e, por último, MFp. A atividade de MMP9 foi maior no grupo MFT não transformada comparativamente aos outros grupos. TIMP-1, ne epiderme e na derme superficial e na derme profunda foi mais expresso no grupo MFi, comparativamente aos outros grupos. Discussão: MFpG apresentou mais lesões tipo PLC e a forma mista, lesões hipocrômicas. A histologia da MFp foi semelhante à descrita previamente na literatura, mas a baixa positividade de CD8 difere de relatos prévios. A MMP2 pareceu ser um marcador de atividade para MF, principalmente quando a sua presença por imunohistoquímica foi associada a dados de zimografia. A expressão de MMP9 nas amostras foi compatível com os dados prévios de literatura, tendo sido mais expressa nas formas mais agressivas de MF e, histologicamente, mais localizada nos locais de maior atividade do tumor. TIMP-1 foi expresso de forma análoga à MMP9, conforme descrito previamente na literatura. TIMP-2, por sua vez, seguiu o padrão de distribuição de MMP2. No entanto, não foi expresso pela pele normal e foi mais expresso pelos grupos de MFT, o que não ocorreu com a MMP2 na imuno-histoquímica. Conclusões: A expressão de MMP e TIMP correlacionou-se com o local de maior atividade linfocitária e com a agressividade da MF. A atividade da MMP2 e MMP9 foi maior nos grupos MFT comparativamente aos grupos mais indolentes. Separar os casos de MFp de acordo com suas apresentações localizadas, generalizada e mista foi relevante do ponto de vista clínico, laboratorial e evolutivo / Introduction: poikilodermatous mycosis fungoides (pMF) is a clinical variant of mycosis fungoides (MF). It is more indolent than classic MF and is characterized by the presence of poikiloderma. The matrix metalloproteinases (MMPs) and their specific inhibitors TIMP (Tissue Inhibitors of Metalloproteinases) are involved in oncogenesis. Specifically, MMP2 and MMP9 and their inhibitors, TIMP-2 and TIMP-1, respectively, have been related to prognosis in tumors. There are few studies on MMP and none on the role of TIMPs in MF. Objectives: To evaluate if there is a relationship between the presence and activity of MMP2 and MMP9 and their inhibitors TIMP2 and TIMP1, and the aggressiveness of MF. To describe a casuistic of poikilodermatous mycosis fungoides in an outpatient clinic in the Dermatological Division of Hospital das Clinicas of University of Sao Paulo Medical School. Methods: Retrospective analysis of 54 cases of pMF, this included 25 localized pMF (LpMF), 14 generalized pMF (GpMF) and 15 mixed pMF. For the analysis of MMPs and TIMPs, the pMF groups were compared with 7 normal skin samples (NS), 10 cases of initial classical MF (cMF), 9 cases of non-transformed tumor MF (nt MFT) and 10 transformed tumor MF (t MFT). Results: The proportion of women : men was 2.44. The pMFs groups showed a longer period of time from the first symptoms to the diagnosis than the cMF group. The GpMF group had a higher incidence of pityriasis lichenoides chronica-like lesions (PLC) (79%) than the other groups. There was a high incidence of hypopigmented MF (62%) in the mixed pMF group. Histology showed typical characteristics of MF and, additionally, atrophy, telangiectasia and pigmentary alterations compatible with pMF. At immunohistochemistry the cases were predominantly CD3+, CD4+, CD7-, CD8- phenotype in all groups, and the pMF groups had a significantly lower prevalence of CD8+ phenotype than the cMF group. The GPMF group showed low positivity for clonality of the T-cell receptor at the T skin (12.5%) compared to the other groups. The MMP2 was more present in the epidermis for the cMF and pMF groups compared to MFT. In the superficial dermis, the cMF, LpMF and GpMF groups showed more MMP2 than normal skin, however there was no statistical difference between the three groups. There was no statistical difference in the presence of MMP2 in the deep dermis between the groups. The zymography showed higher MMP2 activity in the MFT group. There was no TIMP-2 expression by the normal epidermis. The epidermis of cMF and pMFs groups marked TIMP-2 in a similar way, but at a lower intensity than the MFT groups. In the superficial dermis, there was no statistical difference between the cMF and pMFs groups. TIMP-2 was more expressed in the deep dermis of the two MFT groups compared to all of the other groups. In the epidermis and superficial dermis, the MMP9 was more expressed in cMF compared to pMF groups. In the deep dermis, MMP9 expression was higher in the MFT groups, followed by cMF and finally pMF. The MMP9 activity was higher in the nt MFT group compared to other groups. TIMP-1, in epidermis, superficial dermis and deep dermis was more expressed in the cMF group compared to other groups. Discussion: The study confirmed that the pMF is an indolent form of MF and the time period between the symptoms and the diagnosis in pMF was longer than in classical MF. There were clinical differences amongst the groups of pMF. The GpMF group had a higher prevalence of PLC-like lesions than the mixed form of pMF, which had more hypochromic lesions. Histology of pMF was similar to descriptions provided in other case studies. However, the low CD8 positivity differs from previous reports. The MMP2 appeared to be a marker of activity for MF in our work, especially when their presence by immunohistochemistry was associated with the enzyme activity. The expression of MMP9 in our samples was consistent with previous data from other case studies, being more expressed in the most aggressive forms of MF and histologically more localized in most active sites of the tumor. TIMP-1 was expressed in an analogous manner to MMP9, as previously described in the literature. TIMP-2, in turn, followed the distribution pattern of MMP2. However, it was not expressed by normal skin and was more expressed by the MFT group, which did not occur with the MMP2 in immunohistochemistry. Conclusions: The expression of MMP and TIMP was correlated with the location of higher lymphocyte activity and with the aggressiveness of MF. The activity of MMP2 and MMP9 was higher in the MFT groups than the more indolent groups. It was important to split the pMF cases according to their presentation (GpMF, LpMF and mix pMF) from a clinical, laboratory and prognostic point of view