A alergia ao látex representa um importante problema de saúde em pacientes denominados de risco e está relacionada com a ocorrência de diversas manifestações clínicas, inclusive reações potencialmente fatais. O estudo de fatores associados à sensibilização e alergia ao látex é fundamental para o estabelecimento de medidas eficazes quanto à prevenção, tratamento e conhecimento do prognóstico. O principal grupo de risco para a alergia ao látex são os pacientes com defeito de fechamento do tubo neural. O estudo atual teve como objetivo principal identificar fatores clínicos e sorológicos associados à sensibilização e alergia ao látex em pacientes com defeito de fechamento do tubo neural. A pesquisa também analisou concentrações de corte de IgE específica sérica para látex e alérgenos do látex que pudessem identificar pacientes sensibilizados e alérgicos ao látex e avaliou o comportamento da IgG4 específica para látex como fator de proteção associado à ausência de sintomas. Com o intuito de responder estas perguntas, foi realizado um estudo transversal tipo coorte retrospectiva com 400 pacientes com defeito de fechamento do tubo neural, entre 0 e 18 anos, que estavam em seguimento na Associação de Assistência à Criança Deficiente - AACD. Após responderem a questionário específico, os pacientes foram submetidos à coleta de sangue periférico para a detecção dos níveis séricos de IgE total, IgE e IgG4 séricas específicas para látex, IgE sérica específica para rHevb1, 3, 5, 6.01, 6.02, 8, 9 e 11, Dermatophagoides pteronyssinus, Blomia tropicalis, abacate, banana, castanha, mamão, batata, através da metodologia ImmunoCap®. De acordo com a história clínica e o valor da IgE sérica específica para látex, os pacientes foram classificados em quatro grupos: sensibilizados asintomáticos ao látex, alérgicos ao látex, sintomáticos sem sensibilização e controle negativo. A prevalência total de sensibilização ao látex nesta amostra de pacientes foi de 33,2%, sendo 12,2% alérgicos e 21,0% sensibilizados assintomáticos ao látex. Os sintomas cutâneos foram a manifestação clínica mais comum de alergia ao látex (79,6%), sendo a urticária de contato a mais prevalente (67,3%). Houve episódios de anafilaxia associados à exposição ao látex em 21 pacientes (5,2%). Níveis de IgE sérica específica para látex de 0,77 kUA/L foram capazes de diferenciar com boa acurácia os pacientes alérgicos dos demais. Na comparação entre os grupos controle negativo e alérgico, sensibilizado e alérgico, houve diferença entre as variáveis clínicas, cirúrgicas e laboratoriais que estiveram associadas à alergia ao latex. A razão entre IgG4/IgE séricas específicas para látex foi estatisticamente maior no grupo controle negativo. A análise multivariada mostrou na comparação entre o grupo controle negativo e alérgico que a presença de IgE sérica específica para rHevb1 e IgE rHevb5 estão associadas com alergia. Na comparação entre o grupo sensibilizado e alérgico, houve associação de alergia com a presença de IgE sérica específica para rHevb5 e com escore clínico >= 40%. Por outro lado, a IgG4 sérica específica para látex esteve associada à ausência de sintomas no grupo sensibilizado / Latex allergy is an important health problem in patients at risk groups and it is associated with the occurrence of many clinical manifestations, including potentially fatal reactions. The study of factors associated with latex sensitization and allergy is crucial to establish effective measures of prevention, treatment and prognostic. The main risk group for latex allergy is patients with neural tube defects. The objective of this study was to identify the clinical and serologic factors associated with sensitization and allergy to latex. Levels of specific IgE to latex and latex allergens associated with allergy, as well as levels of specific IgG4 associated with clinical tolerance, were established, and its accuracy and cutoff values were calculated. The profile of clinical manifestations, including anaphylaxis, was also characterized. This study was a retrospective cross-sectional cohort of 400 patients with neural tube defects, between 0 and 18 years, who were being followed at the Association for Assistance of Disabled Children - AACD. After answering a specific questionnaire, patients were submitted to blood draw for the detection of total IgE, specific IgG4 to latex, and specific IgE to latex, rHevb (1, 3, 5, 6.01, 6.02, 8, 9, 11), Dermatophagoides pteronyssinus, Blomia tropicalis, avocado, banana, cashew, papaya, and potato, by ImmunoCAP ® methodology. According to the history and value of specific IgE to latex, patients were classified into four groups: sensitized asymptomatic patients, allergic patients, symptomatic patients and negative control. The overall prevalence of latex sensitization in this sample of patients was 33.2%, with 12.2% of allergic and 21.0% of sensitized patients. The skin symptoms were the most common clinical manifestation of latex allergy (79.6%), and contact urticaria was the most prevalent (67.3%). Anaphylaxis after latex exposure was observed in 21 patients (5.2%). Levels of specific IgE to latex of 0.77 kUA/L were able to differentiate allergic patients, with good accuracy. Comparing the negative control and allergic groups, the sensitized and allergic groups they had differents clinical, surgical and laboratory factors associated with allergy to latex. The ratio serum specific IgG4/IgE to latex was statistically higher in the negative control group. Multivariate analysis showed, in the comparison between the negative control and allergic groups, that the presence of serum specific IgE to rHevb1 and rHevb5 were associated with allergy. Comparing the sensitized and allergy groups, allergy was associated with the presence of serum specific IgE to rHevb5 and clinical score >= 40%. Moreover, serum specific IgG4 to latex was associated with lack of symptoms in the sensitized group.

Este estudo tratou de avaliar possíveis efeitos a saúde de recémnascidos cujas mães foram expostas ao trihalometanos (THM) contidos nas água de abastecimento público da cidade de São Paulo. O processo de tratamento da água de abastecimento utilizado no Brasil envolve uma etapa de desinfecção cujo objetivo é eliminar microorganismos patogênicos presentes na água. O cloro é um dos principais agentes desinfetantes. Apesar de pesquisas apontarem benefícios para a saúde humana no uso do cloro durante o processo de desinfecção, quando na água de abastecimento há a presença de matéria orgânica ocorrem reações entre essas substâncias que geram como subproduto, os THM. Estudos têm sido conduzidos para avaliar os efeitos da exposição ao THM e a ocorrência de eventos adversos na gravidez. Alguns destes trabalhos têm encontrado excesso de risco; outros não têm encontrado tal associação. Os artigos de revisão publicados sobre o assunto relatam que os resultados destas avaliações ainda são inconclusivos. O presente estudo objetivou avaliar se existe associação entre a exposição ao THM presente na água de abastecimento, utilizando para isso mensurações realizadas nas redes de distribuição da cidade de São Paulo, e a ocorrência de malformações congênitas. Foram considerados os seguintes desfechos: defeitos cardíacos, fenda labial e fenda palatina; anomalias cromossômicas, defeito no sistema nervoso central. Nesta classe, avaliou-se também o defeito do tubo neural. A população estudada foi composta de recém-nascidos de mães residentes na cidade de São Paulo cuja gestação foi única e a termo, no período de janeiro de 2002 a dezembro de 2006. As informações sobre os recém-nascidos foram obtidas do Sistema de Informação sobre Nascidos Vivos (SINASC). As concentrações de THM foram obtidas por meio de mensurações realizadas rotineiramente pela Companhia de Saneamento Básico de São Paulo (SABESP), nas redes de distribuição de água da cidade de São Paulo. A exposição ao THM atribuída a casos e controles foi determinada a partir da associação da medida realizada na rede de distribuição com o endereço residencial da gestante, no período da concepção. Os resultados encontrados apontaram que a exposição ao THM está inversamente associada às ocorrências de malformações avaliadas no estudo. A falta de informação quanto à mobilidade, origem e quantidade de água clorada à qual a gestante foi exposta, bem como a não avaliação de outras vias de exposição, além da ingestão, podem ter conduzido a vieses que subestimaram os riscos do efeito da exposição aos compostos. Este fato fortalece a necessidade de trabalhos mais aprofundados, avaliando mais criteriosamente a exposição materna ao THM e considerando também um melhor aprofundamento da investigação sobre a possibilidade de efeitos interativos de outros compostos clorados contidos na água de abastecimento. / This present application is going to deal about the potential effects related to the newborn babies health whose mothers had been exposed to the trihalomethanes (THM) that the water supply of the city of São Paulo contain. The water treatment process of supply used in Brazil has one stage of disinfection which purpose is eliminate the pathogenic microorganism presents in the water. Chlorine is one of the main disinfectant agents. Although researches indicates the chlorine benefits to human health when used in the disinfection process, when in the water supply has some organic material, some reactions can occur between these substances generating as a sub-product the trihalomethanes. Many studies is being conducted to consider the effects of the trihalomethanes (THM) exposition and the adverse events that can occur during pregnancy. Some of these studies have found excess of risks; others havent. The review articles published about this topic report that the results are still inconclusive. The present study wants to assess whether there is an association between exposures to THM in the water supply by means of measurements taken in the distribution networks of the city of São Paulo and the occurrence of congenital malformations, considering the following outcomes: cardiac defects, cleft lip and cleft palate, chromosomal abnormalities, defects in the central nervous system. It will also assess the neural tubes defect. The studied population was composed by mothers of newborn babies living in São Paulo, between January, 2002 and December, 2006, whose had a normal and single pregnancy. The information about the newborn was obtained from the SINASC (Information System about Live Births). The concentrations of trihalomethanes were obtained by measurements carried out routinely by SABESP (Basic Sanitation Company of the State of São Paulo) in water distribution networks of the city of São Paulo. The exposition to THM related to the cases and controls, was determined to the realized association in the distributed network with the pregnants address, in the period of conception. The results indicate that the exposition to THM is inversely associated with the malformations occurrence evaluated in the study. The lack of information about the mobility, origin and amount of chlorinated water to which the pregnant woman was exposed, as well as the non evaluation of others ways of exposure, instead of ingestion, may have led to bias which under-estimated the risks of the effect of exposure to the compounds. This fact shows that more specific researches must be done, evaluating more carefully the maternal exposure to the THM, and it also has to consider greater depth of research about the possibility of interactive effects of other chlorinated compounds in the water supply.

La transition épithélio-mésenchymateuse (EMT) est un processus incontournable dans de nombreux contextes normaux et pathologiques, tels que gastrulation, organogenèse, fibroses et cancers. Cette transformation de cellule épithéliale en cellule mésenchymateuse est indissociable de l'acquisition de propriétés migratoires et est généralement associée à un changement de destin cellulaire. Différentes voies moléculaires sont impliquées selon le contexte de l'EMT concernée. Récemment, notre laboratoire a mis en évidence que la voie Notch cytoplasmique contrôle l'EMT des cellules de la lèvre dorso-médiale du somite (DML). Les crêtes neurales exprimant DLL1 activent « en passant » le récepteur NOTCH, liberant ainsi le domaine intra-cytoplasmique de NOTCH (NICD). Dans le cytoplasme, NICD inhibe la kinase GSK3ß, conduisant à la stabilisation de SNAIL, un gène maître de la transition épithélio-mésenchymateuse. Il en résulte une libération de la βcaténine des jonctions adhérentes qui, après translocation dans le noyau, active la transcription des gènes de la myogénèse (Myf5). Ainsi, l'activation de la voie Notch cytoplasmique permet une induction concomitante de l'EMT et de la myogénèse. La fonction cytoplasmique de Notch reste controversée et le mécanisme par lequel NICD inhibe GSK3ß reste obscur. Au cours de ma thèse j'ai cherché à élucider le mécanisme par lequel NICD inhibe l'activité kinase de GSK3ß. J'ai confirmé l'interaction de GSK3ß et de NICD en démontrant leur interaction via CoIP. Après avoir démontré l'implication de la sérine-thréonie kinase AKT dans la myogenèse des cellules de la DML, j'ai mis en évidence, via CoIP et électroporation, que l'inhibition GSK3ß par NICD est très certainement médiée par AKT, connue pour être impliquée dans l'EMT et inhiber GSK3ß par phosphorylation. En comparant le NICD1 de poulet et les 4 NICD de souris, j'ai montré que l'expression exogène de ces 5 molécules induit l'EMT et la différenciation myogénique de manière similaire. J'ai aussi montré que parmi des différents domaines de NICD, le domaine RAM, connu pour se lier à l'ADN (via RBPJ), est nécessaire et suffisant à l'inhibition de GSK3ß. Un second axe de ma thèse a été de tester l'implication de la voie Notch cytoplasmique dans d'autres contextes d'EMT. Pour ce faire, j'ai mis en évidence que cette voie est impliquée dans les autres lèvres du dermomyotome mais aussi dans les crêtes neurales qui délaminent du toit du tube neural. J'ai en particulier mis en évidence une co-activation des voies Wnt et Notch, une inhibition de la kinase GSK3ß par NICD cytoplasmique ainsi qu'une inhibition de la différenciation en présence d'une ß-caténine mutée, retenue à la membrane, ou en présence d'une molécule SNAIL2 dominant-négative. Le dernier axe de ma thèse a consisté à élucider le mécanisme de régulation de l'induction de l'EMT et de la myogenèse via l'activation de NICD. Il a été mis en évidence que toutes les cellules de la DML peuvent être activées via DLL1 et que la surexpression massive de NICD dans la DML provoque une différenciation massive et une déplétion du groupe de cellules progénitrices. Afin de déterminer si la régulation de cette initiation se fait avant ou après induction de NICD, j'ai créé un plasmide permettant de répondre à cette question et afin de visualiser son expression in vivo, j'ai initié une collaboration avec une équipe de l'ILM afin de créer un microscope vertical SPIM biphoton permettant l'observation d'embryon de poulets vivants [etc...] / The epithelio-mesenchymal transition (EMT) is a well-known mechanism by which epithelial cells lose their adherent connections and gain migratory properties, associated with a gain of a mesenchymal phenotype. This EMT is required in numerous processes as gastrulation, organogenesis, fibrosis and cancers. Various molecular pathways orchestrate the EMT depending on the EMT biological context. Recently, our laboratory highlighted the implication of the cytoplasmic Notch pathway in the dorso-medial lip (DML) EMT. In the DML tissue, theEMT is synchronized with differentiation pathways, to generate cells forming the primary myotome. Our laboratory showed that neural crests cells expressing DLL1 activate NOTCH receptor of the DML cells, via a “kiss and run” model. This leads to NOTCH cleavage, releasing an activated intra-cytoplasmic NOTCH domain (NICD). In the cytoplasm, NICD inhibits the GSK3ß kinase, leading to the stabilization of SNAIL and the free cytoplasmic ßcatenin. These molecules translocate into the nucleus and lead to the activation of MRF as Myf5 (ß-catenin) and to the repression of adherent genes (SNAIL). Therefore, Notch cytoplasmic pathway allows a synergized induction of both, the EMT and myogenic programs. This pathway remains controversial and the precise mechanism how NICD inhibits GSK3ß needs to be elucidated. Therefore, the aim of my thesis project was to clarify how NICD inhibits GSK3ß activity. First, I confirmed that NICD and GSK3ß physically interact by CoIP. Moreover, I demonstrated that the serin-threonin kinase AKT, known to inhibit GSK3ß by phosphorylation and also to mediate EMT in cancer, can physically interact with NICD in the cytoplasm. I have also shown that AKT mediates the induction of the myogenic program through the inhibitory phosphorylation of GSK3ß and that SNAIL is downstream of AKT. Together, these experiments indicate that AKT mediates, through phosphorylation, the cytoplasmic NICD inhibition of GSK3ß leading to myogenesis. A comparison of the chicken NICD1 and the 4 isoforms of mouse NICD highlighted that these 5 proteins induce EMT and myogenesis similarly. The dissection of the different conserved domains in the 5 different NICD proteins demonstrated that the RAM domain, known to activate transcription by binding to RBPJ, is necessary and sufficient for GSK3ß inhibition. A second axis of the thesis has been to test the involvment of the cytoplasmic Notch pathway in other EMT contexts. First, I highlighted that this pathway induces myogenesis, showing that NICD inhibits GSK3ß activity in the ventro-lateral lip. I further demonstrated that the cytoplasmic Notch pathway is implicated in the EMT and differentiation of the neural crests cells delaminating from the dorsal neural tube. Particularly, I have shown a co-activation of the Wnt and Notch pathway in premigratory and migratory neural crests. Moreover, I demonstrated a cytoplasmic inhibition of the kinase activity of GSK3ß by NICD, as well as the induction of the differentiation by cytoplasmic ß-catenin or SNAIL2. In a third axis of my thesis, I tried to clarify the regulatory mechanism involved in Notch activation. Previously it has been demonstrated that in all the DML cells Notch can be activated by an overexpression of DLL1 and that an ectopic expression of NICD in the DML cells induce a massive differentiation and depletion of the progenitor pool. To determine if the regulation of this initiation of the myogenic program occurs before or after Notch activation, I designed a plasmid to visualize Notch activation in vivo. In order to be able to follow the DLM cells and Notch activation in vivo, I initiated a collaboration with an ILM team to create a vertical SPIM biphoton microscope. In the future, this microscope will allow us to follow cells in living chicken embryos [etc...]

A alergia ao látex representa um importante problema de saúde em pacientes denominados de risco e está relacionada com a ocorrência de diversas manifestações clínicas, inclusive reações potencialmente fatais. O estudo de fatores associados à sensibilização e alergia ao látex é fundamental para o estabelecimento de medidas eficazes quanto à prevenção, tratamento e conhecimento do prognóstico. O principal grupo de risco para a alergia ao látex são os pacientes com defeito de fechamento do tubo neural. O estudo atual teve como objetivo principal identificar fatores clínicos e sorológicos associados à sensibilização e alergia ao látex em pacientes com defeito de fechamento do tubo neural. A pesquisa também analisou concentrações de corte de IgE específica sérica para látex e alérgenos do látex que pudessem identificar pacientes sensibilizados e alérgicos ao látex e avaliou o comportamento da IgG4 específica para látex como fator de proteção associado à ausência de sintomas. Com o intuito de responder estas perguntas, foi realizado um estudo transversal tipo coorte retrospectiva com 400 pacientes com defeito de fechamento do tubo neural, entre 0 e 18 anos, que estavam em seguimento na Associação de Assistência à Criança Deficiente - AACD. Após responderem a questionário específico, os pacientes foram submetidos à coleta de sangue periférico para a detecção dos níveis séricos de IgE total, IgE e IgG4 séricas específicas para látex, IgE sérica específica para rHevb1, 3, 5, 6.01, 6.02, 8, 9 e 11, Dermatophagoides pteronyssinus, Blomia tropicalis, abacate, banana, castanha, mamão, batata, através da metodologia ImmunoCap®. De acordo com a história clínica e o valor da IgE sérica específica para látex, os pacientes foram classificados em quatro grupos: sensibilizados asintomáticos ao látex, alérgicos ao látex, sintomáticos sem sensibilização e controle negativo. A prevalência total de sensibilização ao látex nesta amostra de pacientes foi de 33,2%, sendo 12,2% alérgicos e 21,0% sensibilizados assintomáticos ao látex. Os sintomas cutâneos foram a manifestação clínica mais comum de alergia ao látex (79,6%), sendo a urticária de contato a mais prevalente (67,3%). Houve episódios de anafilaxia associados à exposição ao látex em 21 pacientes (5,2%). Níveis de IgE sérica específica para látex de 0,77 kUA/L foram capazes de diferenciar com boa acurácia os pacientes alérgicos dos demais. Na comparação entre os grupos controle negativo e alérgico, sensibilizado e alérgico, houve diferença entre as variáveis clínicas, cirúrgicas e laboratoriais que estiveram associadas à alergia ao latex. A razão entre IgG4/IgE séricas específicas para látex foi estatisticamente maior no grupo controle negativo. A análise multivariada mostrou na comparação entre o grupo controle negativo e alérgico que a presença de IgE sérica específica para rHevb1 e IgE rHevb5 estão associadas com alergia. Na comparação entre o grupo sensibilizado e alérgico, houve associação de alergia com a presença de IgE sérica específica para rHevb5 e com escore clínico >= 40%. Por outro lado, a IgG4 sérica específica para látex esteve associada à ausência de sintomas no grupo sensibilizado / Latex allergy is an important health problem in patients at risk groups and it is associated with the occurrence of many clinical manifestations, including potentially fatal reactions. The study of factors associated with latex sensitization and allergy is crucial to establish effective measures of prevention, treatment and prognostic. The main risk group for latex allergy is patients with neural tube defects. The objective of this study was to identify the clinical and serologic factors associated with sensitization and allergy to latex. Levels of specific IgE to latex and latex allergens associated with allergy, as well as levels of specific IgG4 associated with clinical tolerance, were established, and its accuracy and cutoff values were calculated. The profile of clinical manifestations, including anaphylaxis, was also characterized. This study was a retrospective cross-sectional cohort of 400 patients with neural tube defects, between 0 and 18 years, who were being followed at the Association for Assistance of Disabled Children - AACD. After answering a specific questionnaire, patients were submitted to blood draw for the detection of total IgE, specific IgG4 to latex, and specific IgE to latex, rHevb (1, 3, 5, 6.01, 6.02, 8, 9, 11), Dermatophagoides pteronyssinus, Blomia tropicalis, avocado, banana, cashew, papaya, and potato, by ImmunoCAP ® methodology. According to the history and value of specific IgE to latex, patients were classified into four groups: sensitized asymptomatic patients, allergic patients, symptomatic patients and negative control. The overall prevalence of latex sensitization in this sample of patients was 33.2%, with 12.2% of allergic and 21.0% of sensitized patients. The skin symptoms were the most common clinical manifestation of latex allergy (79.6%), and contact urticaria was the most prevalent (67.3%). Anaphylaxis after latex exposure was observed in 21 patients (5.2%). Levels of specific IgE to latex of 0.77 kUA/L were able to differentiate allergic patients, with good accuracy. Comparing the negative control and allergic groups, the sensitized and allergic groups they had differents clinical, surgical and laboratory factors associated with allergy to latex. The ratio serum specific IgG4/IgE to latex was statistically higher in the negative control group. Multivariate analysis showed, in the comparison between the negative control and allergic groups, that the presence of serum specific IgE to rHevb1 and rHevb5 were associated with allergy. Comparing the sensitized and allergy groups, allergy was associated with the presence of serum specific IgE to rHevb5 and clinical score >= 40%. Moreover, serum specific IgG4 to latex was associated with lack of symptoms in the sensitized group.

Este estudo tratou de avaliar possíveis efeitos a saúde de recémnascidos cujas mães foram expostas ao trihalometanos (THM) contidos nas água de abastecimento público da cidade de São Paulo. O processo de tratamento da água de abastecimento utilizado no Brasil envolve uma etapa de desinfecção cujo objetivo é eliminar microorganismos patogênicos presentes na água. O cloro é um dos principais agentes desinfetantes. Apesar de pesquisas apontarem benefícios para a saúde humana no uso do cloro durante o processo de desinfecção, quando na água de abastecimento há a presença de matéria orgânica ocorrem reações entre essas substâncias que geram como subproduto, os THM. Estudos têm sido conduzidos para avaliar os efeitos da exposição ao THM e a ocorrência de eventos adversos na gravidez. Alguns destes trabalhos têm encontrado excesso de risco; outros não têm encontrado tal associação. Os artigos de revisão publicados sobre o assunto relatam que os resultados destas avaliações ainda são inconclusivos. O presente estudo objetivou avaliar se existe associação entre a exposição ao THM presente na água de abastecimento, utilizando para isso mensurações realizadas nas redes de distribuição da cidade de São Paulo, e a ocorrência de malformações congênitas. Foram considerados os seguintes desfechos: defeitos cardíacos, fenda labial e fenda palatina; anomalias cromossômicas, defeito no sistema nervoso central. Nesta classe, avaliou-se também o defeito do tubo neural. A população estudada foi composta de recém-nascidos de mães residentes na cidade de São Paulo cuja gestação foi única e a termo, no período de janeiro de 2002 a dezembro de 2006. As informações sobre os recém-nascidos foram obtidas do Sistema de Informação sobre Nascidos Vivos (SINASC). As concentrações de THM foram obtidas por meio de mensurações realizadas rotineiramente pela Companhia de Saneamento Básico de São Paulo (SABESP), nas redes de distribuição de água da cidade de São Paulo. A exposição ao THM atribuída a casos e controles foi determinada a partir da associação da medida realizada na rede de distribuição com o endereço residencial da gestante, no período da concepção. Os resultados encontrados apontaram que a exposição ao THM está inversamente associada às ocorrências de malformações avaliadas no estudo. A falta de informação quanto à mobilidade, origem e quantidade de água clorada à qual a gestante foi exposta, bem como a não avaliação de outras vias de exposição, além da ingestão, podem ter conduzido a vieses que subestimaram os riscos do efeito da exposição aos compostos. Este fato fortalece a necessidade de trabalhos mais aprofundados, avaliando mais criteriosamente a exposição materna ao THM e considerando também um melhor aprofundamento da investigação sobre a possibilidade de efeitos interativos de outros compostos clorados contidos na água de abastecimento. / This present application is going to deal about the potential effects related to the newborn babies health whose mothers had been exposed to the trihalomethanes (THM) that the water supply of the city of São Paulo contain. The water treatment process of supply used in Brazil has one stage of disinfection which purpose is eliminate the pathogenic microorganism presents in the water. Chlorine is one of the main disinfectant agents. Although researches indicates the chlorine benefits to human health when used in the disinfection process, when in the water supply has some organic material, some reactions can occur between these substances generating as a sub-product the trihalomethanes. Many studies is being conducted to consider the effects of the trihalomethanes (THM) exposition and the adverse events that can occur during pregnancy. Some of these studies have found excess of risks; others havent. The review articles published about this topic report that the results are still inconclusive. The present study wants to assess whether there is an association between exposures to THM in the water supply by means of measurements taken in the distribution networks of the city of São Paulo and the occurrence of congenital malformations, considering the following outcomes: cardiac defects, cleft lip and cleft palate, chromosomal abnormalities, defects in the central nervous system. It will also assess the neural tubes defect. The studied population was composed by mothers of newborn babies living in São Paulo, between January, 2002 and December, 2006, whose had a normal and single pregnancy. The information about the newborn was obtained from the SINASC (Information System about Live Births). The concentrations of trihalomethanes were obtained by measurements carried out routinely by SABESP (Basic Sanitation Company of the State of São Paulo) in water distribution networks of the city of São Paulo. The exposition to THM related to the cases and controls, was determined to the realized association in the distributed network with the pregnants address, in the period of conception. The results indicate that the exposition to THM is inversely associated with the malformations occurrence evaluated in the study. The lack of information about the mobility, origin and amount of chlorinated water to which the pregnant woman was exposed, as well as the non evaluation of others ways of exposure, instead of ingestion, may have led to bias which under-estimated the risks of the effect of exposure to the compounds. This fact shows that more specific researches must be done, evaluating more carefully the maternal exposure to the THM, and it also has to consider greater depth of research about the possibility of interactive effects of other chlorinated compounds in the water supply.

Un nouveau facteur de transcription, appartenant à la famille des protéines à domaine bHLH, a récemment été isolé dans notre laboratoire. Initialement appelé « clone bc8 » puis HRT1, ce facteur présentait des similitudes avec les protéines Hairy and Enhancer of split qui interviennent notamment dans le phénomène d’inhibition latérale lors de la formation du tissu neural. Des études d’hybridation in situ réalisées chez l'embryon de xénope ont suggéré un rôle important de XHRT1, la protéine HRT1 de xénope, dans le développement neural. Nous avons recherché les partenaires protéiques de XHRT1 par la technique du double-hybride afin de mieux comprendre son mécanisme d’action moléculaire dans la neurogenèse.<p>Tout d’abord nous avons construit les outils appropriés pour l’élaboration du travail, à savoir, les clones de levures exprimant les appâts spécifiques des domaines de la protéine étudiée et la création d’une banque d’ADNc du xénope au stade de la neurulation. Ensuite, trois criblages ont été réalisés. Dans le premier cas, nous avons recherché les partenaires des domaines bHLH et Orange (bHLH-O). Le domaine bHLH est en effet responsable de la dimérisation de ce type de protéine. Le domaine Orange qui suit le domaine bHLH, pourrait participer dans le choix du partenaire d’hétérodimérisation. Nous avons isolé deux facteurs de type bHLH-Orange apparentés à HRT1, XHairy1 et XHairy2b et confirmé leur interaction avec XHRT1. Les domaines impliqués dans ces interactions sont les bHLH-O pour les trois facteurs. Ce même criblage nous a permis d’isoler un nouvel ADNc qui code une protéine sans domaine apparent connu actuellement. Nous avons montré que cette protéine reconnaissait spécifiquement le domaine Orange de HRT1 mais pas celui des autres facteurs de type bHLH-O. Elle a été baptisée BOIP pour Bc8 Orange Interacting Protein. Le rôle physiologique de cette interaction n’a pu être démontré. Nous avons établi que la protéine BOIP pouvait aussi s’homodimériser. Nous avons aussi déterminé son profil d’expression chez le xénope et la souris. Son transcrit est hautement présent dans les testicules adultes. La protéine pourrait donc jouer un rôle important dans la spermatogenèse. Les deux autres criblages, utilisant les domaines situés dans la partie C-terminale de XHRT1, ont apporté des nouveaux partenaires potentiels, mais ces interactions n’ont pu être confirmées dans un système indépendant. <p>Enfin, en étudiant plus en détail les interactions entre XHRT1 et XHairy1 ou XHairy2b, nous avons mis à jour une possible fonction de spécificité dans le choix du partenaire dans la région C-terminale de HRT1. La formation de ces dimères pourrait jouer un rôle dans la formation du tube neural mais également dans d’autres différenciations tissulaires.<p> / Doctorat en sciences, Spécialisation biologie moléculaire / info:eu-repo/semantics/nonPublished

ARMC5 est une protéine qui contient sept motifs Armadillo répétitifs organisés en tandem et un domaine BTB. Nous avons observé que cette protéine était fortement exprimée dans les organes lymphoïdes, les glandes surrénales et le cerveau. Les souris avec une délétion d’Armc5 (souris KO) étaient de petite taille, et présentaient une diminution de la prolifération et la différenciation des lymphocytes T. L’absence d’ARMC5 entraînait une déficience de la réponse immunitaire médiée par les lymphocytes CD4+ et CD8+ dans les modèles expérimentaux d’encéphalomyélite auto-immune et d’infection au virus de la chorioméningite lymphocytaire, respectivement. Par la suite, plusieurs études ont révélé que la mutation ARMC5 était associée à l’hyperplasie macronodulaire bilatérale primitive des surrénales (HMBPS), qui représente une cause rare du syndrome de Cushing. Nous avons ensuite confirmé que l’hyperplasie des glandes surrénales s’était développée chez les souris KO âgées, et qu’elle s’accompagnait d’une légère augmentation des taux sériques de glucocorticoïdes. Comme ARMC5 ne présentait pas d’activité enzymatique, il était probable qu’elle faisait appel à d’autres protéines pour exercer sa fonction. Nous avons identifié plusieurs protéines qui se liaient à ARMC5, et plus particulièrement le complexe ARMC5/Cullin3 qui formait une ubiquitine ligase (E3) spécifique de la sous-unité RPB1 de l’ARN polymérase II. ARMC5 contrôlait le processus d’ubiquitination de RPB1 qui, par conséquent, s’accumulait dans plusieurs organes majeurs : les glandes surrénales, les ganglions lymphatiques, le cerveau, les poumons, le foie, etc. chez la souris KO. Ces résultats démontrent un rôle clé de l’ubiquitine ligase dans la dégradation de la protéine RPB1. Une accumulation similaire a également été observée dans les tissus hyperplasiques des surrénales provenant de patients atteints d’HMBPS et porteurs de la mutation ARMC5, ce qui souligne la pertinence clinique de nos résultats de recherche fondamentale dans les maladies humaines. Un défaut de dégradation de RPB1 augmentait le pool d’ARN polymérase II. Par ailleurs, nous avons identifié un groupe de gènes fortement surexprimés dans les glandes surrénales déficientes en ARMC5, parmi lesquels figurent les gènes effecteurs qui seraient impliqués dans l’hyperplasie des surrénales chez les souris KO et l’HMBPS chez les patients porteurs de la mutation ARMC5. Finalement, nous avons montré que la délétion ou la mutation d’Armc5 augmentait considérablement le risque des anomalies du tube neural chez les souris et les humains. Chez les patients souffrant de myéloméningocèle, nous avons constaté neuf différentes mutations faux-sens délétères, dont une diminuait l’interaction entre ARMC5 et RPB1. L’augmentation du pool d’ARN polymérase II dans les cellules précurseurs neurales (CPN), causée par la délétion ARMC5, influençait un groupe particulier de gènes, dont certains (p. ex. Folh1) seraient susceptibles de participer au développement du tube neural. En résumé, l’association ARMC5 et Cullin3 forme un complexe E3 qui cible RPB1 provoquant son ubiquitination et sa dégradation. En absence d’un tel mécanisme, on observe une perturbation de l’homéostasie de l’ARN polymérase II, qui mène à une diminution de la réponse immunitaire médiée par lymphocytes T, le développement d’HMBPS et un risque accru d’anomalies du tube neural. / ARMC5 protein contains seven tandem Armadillo repeats and one BTB domain. We observed that Armc5 was highly expressed in the lymphatic organs, adrenal glands, and brain. Armc5 knockout (KO) mice were small in size and exhibited compromised T cell proliferation and differentiation. The absence of ARMC5 resulted in an impairment of the CD4 + cell- and CD8 + cell-mediated immune response in the experimental autoimmune encephalomyelitis model and lymphocytic choriomeningitis virus infection model, respectively. Subsequently, several studies revealed that ARMC5 mutations were related to primary bilateral macronodular adrenal hyperplasia (PBMAH), which is a rare cause of Cushing’s syndrome. We then confirmed that adrenal gland hyperplasia was indeed developed in aged Armc5 KO mice with mildly increased serum glucocorticoid levels. Since ARMC5 did not exhibit enzymatic activity, its function likely depends on the interaction with other proteins. We identified several proteins that binds to ARMC5, most notably ARMC5 binding to Cullin3, forming a ubiquitin ligase (E3) specific for RNA polymerase II subunit I (RPB1). ARMC5 regulated the ubiquitination of RPB1, and its deletion resulted in RPB1 accumulation in major organs (e.g., adrenal glands, lymph nodes, brain, lung, and liver), indicating the critical role of this E3 in RPB1 degradation. A similar accumulation was also found in hyperplasia tissues from adrenal glands of PBMAH patients carrying ARMC5 mutations, underscoring the clinical relevance of our basic research findings in human disease. Defective degradation of RPB1 led to an enlarged RNA polymerase II (Pol II) pool. In addition, we have identified a group of genes strongly upregulated in KO adrenal glands, including the effector genes which would be involved in adrenal gland hyperplasia in Armc5 KO mice and PBMAH patients carrying ARMC5 mutation. Finally, we have shown that deleting or mutating Armc5 significantly augments the risk of neural tube defects in mice and humans. In patients with myelomeningocele, we found nine deleterious missense mutations in ARMC5, one of which weakened the interaction between ARMC5 and RPB1. The enlarged Pol II pool in Armc5 KO neural precursor cells (NPCs) influenced a particular group of genes, some of which (e.g., Folh1) are thought to be involved in the development of the neural tube. In summary, ARMC5 and CUL3 form an E3 complex, which targets RPB1 causing its ubiquitination and degradation. In the absence of such a mechanism, there is a disturbance of RNA polymerase II homeostasis, which leads to a decrease in the T cell-mediated immune response, the development of PBMAH and an increased risk of neural tube defects.