padrão utilizado para algumas doenças hematológicas e também na consolidação do tratamento de outras doenças. O aumento da demanda de pacientes que necessitam deste tratamento fez com que fossem criados alguns modelos de transplante ambulatorial. A alta precoce é uma modalidade de transplante em que o paciente recebe alta hospitalar após o regime de condicionamento e infusão das células-tronco hematopoiéticas (CTH) e a continuidade do seu tratamento ocorre em regime ambulatorial. Na área da Enfermagem, o número limitado de estudos científicos relacionados à Assistência de Enfermagem nos pacientes submetidos ao TCTH com alta hospitalar precoce são ainda deficientes. Diante disso, o objetivo deste estudo foi analisar os resultados da alta hospitalar precoce como alternativa viável ao tratamento dos pacientes submetidos ao TCTHa e sua relação com a assistência de enfermagem. MÉTODO: Estudo retrospectivo, quantitativo, descritivo e transversal. Foram analisados prontuários de 112 pacientes consecutivos submetidos ao TCTHa, no período de janeiro a dezembro de 2009. Destes 12 pacientes não receberam alta hospitalar da unidade de internação até o décimo dia após o TCTH (D+10) e, por isso, foram excluídos, restando 100 pacientes. RESULTADOS: A mediana de idade foi de 48,5 anos (19-69 anos). Houve um pareamento não intencional do sexo. Todos os pacientes mobilizaram e coletaram CTH por fonte periférica. Os regimes de condicionamento mais utilizados foram BU12+Mel100 e BEAM 400. As toxicidades atribuídas ao regime de condicionamento foram bem conduzidas no ambulatório, expressa por 10 pacientes que necessitaram de internação, embora um grande número de pacientes da casuística apresentou algum grau de toxicidade. A neutropenia febril esteve presente em 58% dos pacientes até a enxertia medular. Não houve aumento na mortalidade na fase de aplasia medular; dois pacientes foram a óbito por causas infecciosas durante os 60 primeiros dias após o TCTH, sendo que apenas um não apresentava enxertia medular. A mediana de enxertia de granulócitos após o TCTHa com alta hospitalar precoce foi de 12 dias e de plaquetas 15 dias, com mediana de transfusões até a alta do serviço de três concentrados de hemácias e quatro concentrados de plaquetas. Vinte e três pacientes necessitaram de internação hospitalar em algum momento desde a alta hospitalar após o transplante até o momento de sua alta. CONCLUSÃO: A equipe de enfermagem apresenta papel fundamental no contexto da alta hospitalar precoce na conduta e manejo dos pacientes. O Enfermeiro participou na orientação e condutas durante a fase de mobilização, transplante e acompanhamento ambulatorial. A mediana de tempo para enxertia medular foi de 12 dias e durante a fase de aplasia os pacientes evoluíram com baixa internação e infecção. Houve baixa incidência de complicações e internações, sendo a toxicidade ao regime de condicionamento a maior causa de internação. As toxicidades ao regime de condicionamento apresentadas foram bem manejadas em regime ambulatorial também pela Equipe de Enfermagem / The autologous hematopoietic stem cell transplantation (HSCTa) is a standard treatment used for some hematological malignancies and also in consolidating the treatment of other diseases. The increased number of patients who need this treatment leads to new models of outpatient transplant. The early discharge is a type of transplant in which the patient is discharged after the conditioning regimen and infusion of hematopoietic stem cells (HSC) and the continuity of your treatment will occur in outpatient settings. Although the models of outpatient HSCT are well defined, there is few studies and publications that demonstrate the actual results of this modality. In the field of nursing, the limited number of scientific studies related to nursing care in HSCT patients with early hospital discharge are even more deficient. Thus, the aim of this study was to analyze the results of early discharge as a viable alternative to the treatment of patients undergoing HSCTa and its relationship to nursing care. Methods: A retrospective, quantitative, descriptive and cross study was performed. A total of 112 patients initially enrolled, 12 were excluded due to the discharged occurred after than tenth day after HSCTa (D +10) and, therefore, 100 patients were enrolled in the study. Results: The median age was 48.5 years (range: 19-69 years). There was an unintentional pairing of sex. All patients were mobilized and collected by HSC peripheral source. The conditioning regimens were used more BU12 + Mel100 and BEAM 400. The conditioning regimen-related toxicities was well at the clinic, expressed by 10 patients who required hospitalization, although a large number of patients in the sample had some degree of toxicity. Febrile neutropenia was observed in 58% of patients until the marrow engraftment. There was no increase in mortality in bone marrow aplasia phase, two patients (2%) died of infectious causes during the first 60 days after HSCTa, and only one patient showed no engraftment. The median granulocyte engraftment after HSCTa with early hospital discharge was 12 days and platelets 15 days, with a median transfusion until discharge from the service three and four units of blood transfused platelet concentrates. Twenty-three patients required hospitalization at some time from hospital discharge after transplantation until the time of his discharge. Conclusion: The nursing team has key role in the context of early hospital discharge in the conduct and management of patients. The nurse participated in the orientation and conduct during the mobilization phase, and outpatient transplant. The median time to engraftment was 12 days and during the aplasia phase of the patients improved, with low infection and hospitalization. There was a low incidence of complications and hospitalizations, and the toxicity conditioning regimen the leading cause of hospitalization. The toxicities presented to the conditioning regimen were well managed on an outpatient basis also for the Nursing Team

Die intestinale Mukosa bildet eine biologisch wichtige Barriere zwischen dem Organismus und den schädigenden Faktoren im intestinalen Lumen. Diese komplexe Aufgabe wird durch eine hochdifferenzierte intestinale Mukosa bewältigt, die eine strukturelle sowie funktionelle intestinale Barriere bildet. Das Ziel der vorliegenden Arbeiten war, ausgewählte Aspekte der Regulations- und Reparaturmechanismen der intestinalen mukosalen Barriere weitergehend zu charakterisieren. Unsere Untersuchungen zeigen, dass das Phospholipid Lysophosphatidsäure (LPA) die intestinale epitheliale Zellmigration stimuliert, die dieser Zellen jedoch inhibiert. Die Modulation der intestinalen Wundheilung durch LPA erfolgt durch einen TGF-b-unabhängigen Mechanismus und wird über einen G-Protein-abhängigen Rezeptor vermittelt, wie wir im Rahmen umfangreicher Untersuchungen zur Signaltransduktion unter Verwendung spezifischer Modulatoren der Signaltransduktion wie Bradykinin, Phorbolester, Pertussistoxin, Suramin und neutralisierender TGF-b-Antikörper belegen konnten. In weiteren Experimenten konnten wir zeigen, dass LPA auch in-vivo einen wundheilungsfördernden Effekt besitzt. Die topische Applikation von LPA in diesem experimentellen Kolitismodell bewirkte einen geringeren Gewichtsverlust sowie ein geringeres Ausmaß an intestinaler Entzündung und Nekrose in-vivo. Diese Untersuchungen legen somit nahe, dass LPA die intestinale epitheliale Wundheilung durch eine Modulation der intestinalen epithelialen Migration und Proliferation durch TGF-b-unabhängige Mechanismen stimuliert. Weitere Untersuchungen beschäftigten sich mit der funktionellen Charakterisierung von Lamina propria T-Zellen (LPT) und peripheren Blut T-Zellen (PBT). Wir konnten zeigen, dass der Zellzyklus von LPT distinkt von PBT reguliert wird. Hierbei spielt der Zellzyklusinhibitor p53 eine zentrale Rolle in der Zellzyklusregulation von LPT. Um Autoimmunität zu verhindern, muss es nach einer Eliminierung des Antigens wieder zu einer Depletion des Pools an Effektor-T-Zellen durch die Aktivierung der Apoptose kommen. Wir konnten zeigen, dass beim Antigen-induzierten Zelltod von LPT der intrinsische Apoptoseweg aktiviert wird und Caspase-8 hierbei eine zentrale Rolle spielt. Physiologischerweise sind Zellzyklus und Apoptose eng miteinander verbunden. In weiteren Versuchen konnten wir jedoch zeigen, dass dies nicht bei LPT der Fall ist und somit die von PBT distinkte Regulation von Zellzyklus und Apoptose mukosaler T-Zellen weiter unterstreichen. Zusammengefasst konnten wir durch ausgewählte Untersuchungen zeigen, dass die intestinale Barriere und ihre funktionelle Beeinflussung eine wesentliche Rolle in der Pathogenese und Therapie intestinaler Entzündungen besitzt. Eine Beeinflussung intestinaler Reparaturprozesse und Modulation abnormer T-Zellen könnte neue Möglichkeiten in der Therapie intestinaler Entzündungen, wie z.B. chronisch entzündlichen Darmerkrankungen bewirken. / The intestinal mucosa protect the host from the potential harmful content of the intestinal lumen. To accomplish this difficult goal, the highly complex mucosa forms an anatomical as well as functional barrier to protect the organism.In this work, we aimed to characterize distinct aspect of the intestinal barrier, focussing on distinct regulation and repair mechanism of the intestinal mucosa. First, we demonstrate, that the phospholipid lysophosphatidic acid (LPA) stimulate the migration of intestinal epithelial cells, but, in contrast, inhibit their proliferation. This effect is mediated by G-protein receptors and is TGF-b-independent, as we could demonstrate in further experiments using bradykinine, phorbole ester, pertussis toxin and suramine to modulate distinct signalling pathways.We then demonstrated, using a well-established animal model of colitis, that LPA enhances intestinal wound healing in-vivo. In detail, the topical application of LPA in TNBS-treated rats reduced weight loss, ameliorate intestinal inflammation and prevented necrosis in the animals. This experiments demonstrate for the first time, that LPA modulates migration and proliferation of intestinal epithelial cells by distinct TGF-b independent pathways. Further experiments aimed to explore functional differences between peripheral blood (PBT) and mucosal T-cells (LPT). We demonstrated, that the cell cycle is distinctively regulated in PBT and LPT, identifying p53 as key regulator of LPT cell cycling. To avoid auto-immunity, the pool of effector T-cells must be depleted by apoptosis, once the antigen has been cleared. We demonstrate, that intrinsic pathway of apoptosis is activated during the antigen-induced cell death in LPT and that caspase-8 activity is required to execute LPT apoptosis. Cell cycle and apoptosis are ultimately linked. However, as we show in further experiments, this is not the case in LPT, underlining the distinct regulation of LPT cell cycle and apoptosis.In conclusion, using various distinct experimental tools, we demonstrate that the intestinal barrier itself and the modulation its function plays a fundamental role in the pathogenesis mucosal inflammation. The data presented in this work may therefore open new therapeutic options in the therapy of intestinal inflammatory disorders, such as inflammatory bowel diseases.

Τα τελικά προϊόντα προχωρημένης γλυκοζυλίωσης (AGEs: Advanced Glycation Endproducts) παίζουν σημαντικό ρόλο στην παθογένεια των διαβητικών αγγειακών επιπλοκών. Το καλύτερα χαρακτηριζόμενο είναι η N-καρβοξυμεθυλ-λυσίνη (CML). Τα AGEs προκαλούν σημαντικές επιδράσεις στα αγγεία με την πρόσδεσή τους σε ειδικούς υποδοχείς της κυτταρικής επιφάνειας, όπως τον RAGE (Receptor for Advanced Glycation Endproducts). Διαλυτές μορφές του RAGE (sRAGE) εμφανίζονται στο ανθρώπινο αίμα και δρουν ως παγίδα αιχμαλωτίζοντας τους φλεγμονώδεις προσδέτες του RAGE εξωκυττάρια, προστατεύοντας με αυτό τον τρόπο τα κύτταρα από τη βλάβη που προάγεται από τα AGEs. Σκοπός αυτής της εργασίας ήταν να μελετηθούν τα επίπεδα του sRAGE, η πρωτεϊνική έκφραση του RAGE, καθώς και τα επίπεδα CML σε σχέση με διάφορες κλινικές και βιοχημικές παραμέτρους σε παιδιά, εφήβους και νεαρούς ενήλικες με ΣΔ1. Τα επίπεδα sRAGE και CML προσδιορίστηκαν με ELISA και η πρωτεϊνική έκφραση του RAGE στα μονοπύρηνα του περιφερικού αίματος με ανοσοαποτύπωση κατά Western σε 74 παιδιά, εφήβους και νεαρούς ενήλικες με ΣΔ1 (13± 4 χρονών) και 43 μάρτυρες αντίστοιχης ηλικίας, φύλου και σταδίου Tanner. Σ’ αυτή την εργασία τα αυξημένα επίπεδα sRAGE στα παιδιά με ΣΔ1 και πιο ειδικά, σ’ αυτά ηλικίας κάτω από 13 ετών και με διάρκεια διαβήτη κάτω από 5 έτη, μπορεί να είναι ένα προσωρινό προστατευτικό μέτρο ενάντια στην κυτταρική βλάβη και πιθανόν να είναι επαρκές για να εξουδετερώσει επαρκώς τα κυκλοφορούντα CML, εμποδίζοντας έτσι τις διαβητικές αγγειακές επιπλοκές. Επίσης, μια ήπια αύξηση της LDL θα μπορούσε να είναι ένα ερέθισμα για την αύξηση του sRAGE, οδηγώντας στη δέσμευση του CML και τελικά τη μείωση των επιπέδων CML στην κυκλοφορία. Τα μειωμένα επίπεδα της πρωτεϊνικής έκφρασης του RAGE 55 kd (υποδοχέα πλήρους μήκους) μπορεί να αντανακλούν την αυξημένη έκφραση του sRAGE στους ασθενείς με ΣΔ1 συνολικά λόγω της αποκοπής του RAGE με μεταλλοπρωτεϊνάσες. Με την παρουσία κάποιου παράγοντα κινδύνου, όπως αύξηση ηλικίας, περιμέτρου κοιλίας, BMI, συστολικής ή διαστολικής αρτηριακής πίεσης ή επιδείνωση λιπιδαιμικού προφίλ αυξάνεται η πρωτεϊνική έκφραση της ισομορφής αυτής, ενώ φαίνεται αντίστοιχα να μειώνονται τα επίπεδα του sRAGE. Φαίνεται τελικά ότι συνολικά στα παιδιά, τους εφήβους και τους νεαρούς ενήλικες με ΣΔ1 υπάρχει μια υποκλινική διαταραχή του άξονα sRAGE-RAGE-CML, η οποία δύναται να μετατραπεί σε κλινικά εμφανείς αγγειακές βλάβες, αν προστεθούν περαιτέρω επιβαρυντικοί παράγοντες. / The binding of Advanced Glycation Endproducts (AGEs) to their receptor (RAGE) plays a major role in the development of diabetic vascular complications. This work is based on the relation between circulating soluble RAGE (sRAGE) levels in children, adolescents and young adults with IDDM and RAGE protein expression in association with N-(carboxymethyl)lysine (CML), a major antigenic AGEs component. Circulating sRAGE and CML levels were determined by ELISA and RAGE protein expression was evaluated in peripheral blood mononuclear cells by western immunoblotting in 74 children, adolescents and young adults with IDDM (134 years old) and 43 age, sex and Tanner stage-matched controls. Serum sRAGE levels were significantly higher in IDDM than in controls, inversely correlated to diabetes duration and directly correlated to LDL levels. Furthermore, circulating CML levels were not significantly different between IDDM and controls. Also, the protein expression of the RAGE isoforms 55 kd (full-length), 64 kd and 100 kd, measured by western immunoblotting, was significantly lower in IDDM than in controls, whereas RAGE 37 kd levels were not significantly different between IDDM and controls. Finally, when there was a risk factor, such as increased age, poor lipid profile, increased BMI or waist circumference or increased systolic or diastolic pressure, then it seemed that isoforms RAGE 55, 64 and 100 kd were increased. Isoform RAGE 64 kd could be RAGE-v5, a splice variant which resulted in a change of amino acid sequence in the extracellular ligand-binding domain of RAGE. Isoform RAGE 37 kd seemed to be Δ8-RAGE, a soluble splice variant with probably protective function, which had been found increased in patients with increased HDL. Finally, isoform RAGE 100 kd seemed to be some other splice variant in peripheral mononuclear cells. In conclusion, increased serum levels of sRAGE seen in IDDM children may be a temporary protective measure against cell damage and may be sufficient to efficiently eliminate excessive circulating CML. Moreover, the lower protein expression of the full-length RAGE in IDDM may also reflect the increased sRAGE expression in patients due to RAGE cleavage by metalloproteases. Consequently, in IDDM children, adolescents and young adults there may be a subclinical perturbation of the sRAGE-RAGE-CML axis, which could lead to future clinical vascular damage if additional risk factors are added over time.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / CHAPTER I - Prostate cancer is a common disease in the world and in some countries it is one of the main causes of male population mortality. Some molecular markers have been associated with prostate carcinogenesis. To observe changes in transcript levels of the AR, SRD5A2, KLK2, PSMA and PCA3 genes, the mRNA was analyzed in tissues with prostatic adenocarcinoma (PCa, N= 48) and benign prostatic hyperplasia (BPH, N= 25), performed through a differential multiplex RT-PCR assay. Significant differences were observed in the relative expression of these genes between cancerous and non-cancerous tissues. The optical density ratio of the cDNA amplicons between PCa and BPH for the AR gene was 1.6-fold higher for the prostatic adenocarcinoma. On the other hand, the SRD5A2 mRNA levels were associated with BPH and were 1.4-fold higher than that of PCa. For KLK2, PSMA and PCA3, the transcriptional levels were respectively, 1.9-, 1.9- and 5-fold higher in PCa than those in BPH tissues. Of the diagnostics tests carried through individually, the PCA3 gene was that presented higher sensitivity and accuracy, and the inclusion of the serum PSA improved the sensitivity (of 76 to 92%), positive preditive value (of 85 to 94%), negative preditive value (of 60 to 62%) and accuracy (of 74 to 78%). The results suggest that the higher AR, KLK2, PSMA, and PCA3 and/or reduced SRD5A2 genes expression in prostatic tissues may indicate the occurrence of prostate adenocarcinoma; however the PCA3 and serum PSA analysis together are highly promising as auxiliary method in the diagnosis of this cancer. CHAPTER II - Purpose: Prostate cancer (PCa) is the most commonly diagnosed malignancy in men, and it consists of multifactorial and multifocal events. Due to the complexity of the disease process, which includes genome alterations, local invasion, micrometastatic cell extravasations to circulation, invasion of secondary organ tissues, and resistance to hormonal blockage, many markers must be used to represent the multiple and variable events that lead to cancer development. The low specificity of the unique serum marker for prostate cancer diagnostics, PSA, has leaded us to investigate four potential markers in the peripheral blood of patients by detecting their mRNA levels and associating them to clinical parameters. Methods: The expression levels of the KLK2, KLK3, PCA3 and PSMA transcripts were determined by Nested RT-PCR. Patients with PCa (99) and with benign prostatic hyperplasia (BPH, 36), and healthy volunteers (104) were investigated. Results: Significant differences for the RNA relative levels have been found for the KLK2, PCA3 and PSMA transcripts between PCa and BPH patients or healthy volunteers. The KLK2 and PSMA levels also presented a positive association (P<0.05) with extra-prostatic disease (pT3). The combined positive RT-PCR Nested for the KLK2, PCA3, PSMA genes with serum PSA higher than 4ng/mL presented a 10-fold higher chance of cancer occurrence than healthy controls, with sensitivity, specificity and positive predictive value of 57%, 89% and 93%, respectively. Conclusions: The combined analysis of KLK2, PCA3 and PSMA transcripts may become a useful tool for the discrimination of PCa patients from those with benign disease or healthy individuals. Additionally, the KLK2 and PSMA transcripts may also be used as prognostic markers for the presence of extra-capsular disease and assisting in the prediction of the post-operative outcome. CHAPTER III - Purpose: Transcripts of PCA3/DD3 gene are at the moment the most specific molecule found in prostate cancer specimens. This mRNA can be detected in important sample targets for clinical analyses, such as prostatic tissues, urine after prostatic massage, and the peripheral blood. Methods: The present study evaluated the PCA3 gene expression in prostatic tissues and in peripheral blood of BPH and PCa patients, by RT-PCR assays, and based on its detection together with other clinical parameters, we proposed a model for molecular monitoring in order to improve diagnosis as an auxiliary technology. Results: The concomitant use of PCA3 transcript detection in the peripheral blood and in prostate tissues has improved diagnosis, with sensitivity and an accuracy of 77%. For the molecular staging, patients have been classified as: localized disease (PBL-; negative PCA3) and circulating tumors cells disease (PBL+; positive PCA3). The higher frequencies of PBL- had been observed in T1-T2 stages (75%); on the other hand, the higher PCA3 positivity was observed for the T3-T4 staging (43%), while the T1-T2 stages presented 25% positivity. A correlation was found between the molecular staging and serum PSA < 10ng/mL before surgery, and approximately 60% of patients with T3-T4 stages that presented biochemical failure after radical prostatectomy presented a positive PCA3 result (P= 0.05), with an odds ratio of 16-fold higher for the possibility of disease recurrence in relation to the T1-T2 patients, and an accuracy of 82%. Conclusion: These data demonstrated the importance of the PCA3 gene as an auxiliary method in prostate cancer diagnosis, by distinguishing PCa from BPH patients, and also demonstrated its prognostic value in recurrent disease for post-operative patients. CHAPTER IV - Approximately 98% of all the products transcribed in the human genome correspond to non coding RNAs (ncRNA). Many ncRNA functions are attributed to this structural particularity given mainly for the secondary structures formed from its linear sequence of bases. Among the ncRNA types are tRNA, rRNA, small nuclear RNA, small nucleolar RNA, small interference RNA (siRNA), microRNA (miRNA) and catalytic RNAs (ribozymes). The bioinformatics has supplied useful tools in the prediction of optimal or suboptimal secondary structures allowing the design of interference RNA as miRNAs or siRNAs. In human, miRNAs have been associated with the development of diverse complex diseases as cancer. The PCA3 (DD3) gene was molecularly characterized as cancer and prostate specific, and its transcripts are non-coding, once no peptide products have been found. Due to its structural characteristics, the PCA3 gene belongs thus to the increasing family of ncRNA. In the present work, four new variant molecules of the PCA3 gene have been sequence characterized and their frequencies demonstrated in prostate cancer and in benign prostatic hyperplasia patients, as well as in healthy individuals. We have also investigated and predicted the putative secondary structures formed in order to elucidate its role in prostate cancer biology. No association has been found between the frequency of these molecules and prostate pathologies (PCa or BPH). On the other hand, PCA3 variants were found in 10% (12/115) of cases in the general population. Similar analyses of the possible polypeptides of these molecules demonstrated that it remains as a non-coding RNA, and introns presents in the first, second and fourth variants suggesting a possible role as a miRNA with intracellular activity to these molecules to the PCA3 gene. In prostatic tissues, 100% of the prostate cancer cases presented the RNA molecule with an exon 2 splicing. However, further investigation must be carried out to demonstrate the true role of these splicing variants in prostate tumors and in other pathologies, once these molecules have been preferentially found in the peripheral blood. / CAPÍTULO I - O câncer de próstata é uma doença comum no mundo e já assumiu em alguns países uma das principais causas de mortalidade da população masculina. Vários marcadores moleculares têm sido associados à gênese do câncer de próstata. A fim de demonstrar a expressão diferencial dos níveis transcricionais dos genes AR, SRD5A2, KLK2, PSMA e PCA3 em doenças prostáticas, o RNAm foi analisado em tecidos com adenocarcinoma prostático (CaP, N= 48) e hiperplasia prostática benigna (HPB, N= 25) por meio da técnica RT-PCR multiplex semi-quantitativa. Foram observadas diferenças significativas na expressão relativa desses genes entre os tecidos cancerosos e nãocancerosos. A taxa de densidade ótica entre os amplicons para cDNA provenientes do gene AR foi 1.6 vezes maior no adenocarcinoma prostático. Por outro lado, os níveis de RNAm do gene SRD5A2 foi associado com a HPB e foi 1.4 vezes maior do que no CaP. Para os genes KLK2, PSMA e PCA3, os níveis transcricionais foram respectivamente, 1.9, 1.9 e 5 vezes maior no câncer comparado a tecidos benignos. Dos testes diagnósticos realizados, o gene PCA3 individualmente foi o que apresentou as melhores sensibilidade e acurácia, sendo que a inclusão das medidas de PSA sérico melhorou a sensibilidade (de 76 para 92%), o valor preditivo positivo (de 85 para 94%), o valor preditivo negativo (de 60 para 62%) e a acurácia (de 74 para 78%). Os dados sugerem que a maior expressão dos genes AR, KLK2, PSMA e PCA3 ou expressão reduzida do gene SRD5A2 em tecidos prostáticos podem indicar a ocorrência do adenocarcinoma da próstata, sendo que as análises do gene PCA3 juntamente aos do PSA sérico são altamente promissores como método auxiliar no diagnóstico desse tipo de câncer. CAPÍTULO II - O câncer de próstata (CaP) e o mais comumente diagnosticado na população masculina e consiste de eventos multifatoriais e multifocais. Devido a complexidade da doença, a qual inclui alterações genômicas, invasão local, liberação de células micrometastáticas para a circulação, invasão secundaria de tecidos de outros órgãos, e resistência ao bloqueio hormonal, muitos marcadores podem ser usados para representar os eventos múltiplos e variáveis que levam ao desenvolvimento do câncer. A baixa especificidade do único marcador para diagnostico do câncer de próstata, PSA, tem nos levado a investigar quatro potenciais marcadores no sangue periférico de pacientes pela detecção de seus níveis de RNAm e associá-los a parâmetros clínicos. Os níveis de expressão dos transcritos do KLK2, KLK3, PCA3 e PSMA foram avaliados pela RT-PCR Nested, em pacientes com CaP (99), com hiperplasia prostática benigna (HPB, 36) e voluntários saudáveis (104). Diferenças significativas foram encontradas para a expressão dos genes KLK2, PSMA e PCA3 entre os pacientes com CaP e os pacientes com HPB ou voluntários saudáveis. Os níveis do KLK2 e PSMA também apresentaram associação positiva (P<0.05) com doença extra-prostática (pT3). A RT-PCR Nested positiva combinada para os genes KLK2, PCA3 e PSMA com PSA sérico maior que 4ng/mL apresentou uma chance 10 vezes maior de ocorrência do câncer comparado aos controles saudáveis, com sensibilidade, especificidade e acurácia de 57%, 89% e 93%, respectivamente. A análise combinada dos genes KLK2, PCA3 e PSMA pode ser uma ferramenta útil na distinção de pacientes com CaP daqueles com doença benigna ou de indivíduos saudáveis. Ainda, a analise dos transcritos KLK2 e PSMA podem ser usados como marcadores prognósticos para a presença de doença extra-capsular e auxiliando na predição de recidiva da doença no pós-operatório. CAPÍTULO III - Os transcritos do gene PCA3/DD3 são até o momento as moléculas mais específicas encontradas em espécimes de câncer de próstata. Esses RNAm podem ser detectados em importantes alvos para a análise clínica como tecidos prostáticos, na urina após massagem prostática e em sangue periférico. O presente estudo avaliou a expressão do gene PCA3 em tecidos prostáticos e em sangue periférico de pacientes com HPB e CaP, por técnicas de RT-PCR, e baseado na sua detecção juntamente com os parâmetros clínicos, foi proposto um modelo de estadiamento molecular como técnica assessória para melhor o diagnóstico da doença. O uso concomitante da detecção dos transcritos do gene PCA3 no sangue periférico e no tecido prostático melhorou o diagnóstico, com sensibilidade e acurácia de 77%. Para o estadiamento molecular, os pacientes foram classificados como contendo a doença localizada (PBL-) e em doença com células tumorais circulantes (PBL +). Maiores freqüências de tumor localizado pelo estadiamento molecular foram observadas nos estadios T1-T2 (75%), enquanto que 25 e 43% dos cânceres T1-T2 e T3-T4, respectivamente, apresentaram PCA3 positivo (células circulantes). Uma correlação foi encontrada para o estadiamento molecular para doença localizada e PSA sérico pré-cirúrgico < 10ng/mL, e aproximadamente 60% dos pacientes TNM T3-T4 que apresentaram falha bioquímica após a cirurgia radical apresentaram RTPCR positiva do PCA3 (P= 0.05), com um Odds Ratio 16 vezes maior para a possibilidade de recorrência da doença em relação aos pacientes T1-T2 e uma acurácia de 82%. Esses dados demonstram a importância da detecção do gene PCA3 como método no diagnóstico do câncer de próstata, por distinguir pacientes com CaP daqueles com HPB, e também demonstrando seu valor prognóstico na doença recorrente no pósoperatório dos pacientes. CAPÍTULO IV - Aproximadamente 98% de todos os produtos transcritos do genoma humano correspondem a RNAs não codificantes (RNAnc). Muitas funções dos RNAnc são atribuídas a suas particularidades estruturais dadas principalmente pelas estruturas secundárias formadas a partir da sua sequência linear de bases. Dentre os tipos de RNAnc estão os RNAt, RNAr, small nuclear RNA, small nucleolar RNA, small interference RNA (siRNA), microRNA (miRNA) e RNAs catalíticos (ribozimas). A bioinformática tem fornecido ferramentas úteis na predição de estruturas secundárias ótimas ou subótimas permitindo o design de RNAs de interferência como os miRNAs ou siRNAs. Em humanos, os miRNAs tem sido associados ao desenvolvimento de diversas doenças complexas como o câncer. O gene PCA3 (DD3) foi molecularmente caracterizado como câncer- e próstata- específico e os seus RNAs são os responsáveis por essa característica, isso porque nenhum produto protéico tem sido encontrado para esse gene. Devido às suas características estruturais, o gene PCA3, pertence assim à crescente família de RNAnc. No presente trabalho foi analisado as freqüências de quatro moléculas variantes do gene PCA3, além das anteriormente reportadas, como também foram preditas as suas estruturas secundárias na tentativa de elucidar o seu papel na biologia do câncer de próstata. Nenhuma associação foi encontrada entre a freqüência dessas moléculas e as patologias da próstata como hiperplasia benigna ou câncer, sendo que na população geral analisada essas variantes foram encontradas em apenas 10% (12/115) dos casos. As análises de homologia de possíveis polipeptídeos para essas moléculas demonstram que permanece o papel de RNA não-codificante para o gene PCA3. Ainda, a presença de introns nas variantes 1, 2 e 4 podem sugerir um papel intracelular de miRNA para essas moléculas do gene PCA3. Nos tecidos prostáticos, 100% dos casos de câncer foi representando pela molécula com splicing do exon 2. Contudo, para as variantes de splicing, novas pesquisas deverão ser realizadas incluindo outras patologias além das doenças prostáticas e outros tipos tumorais para verificar o real impacto dessas moléculas, uma vez que foram encontradas preferencialmente no sangue periférico. / Doutor em Genética e Bioquímica

The biological half-life of several pro-inflammatory mediators involved in the pathogenesis of rheumatoid arthritis (RA) is controlled by molecules exhibiting dipeptidyl peptidase-IV (DPP-IV)-like enzymatic activity (Dipeptidyl peptidase-IV activity and/or structure homologues- DASH). The aim of this thesis was to identify the molecular source of the DPP-IV-like enzymatic activity in the peripheral blood and synovial fluid in patients with rheumatoid arthritis as compared to control patients with osteoarthritis (OA), and to evaluate the association of DPP-IV with the disease activity. We found that the main source of the DPP-IV-like enzyme activity in the plasma and in the synovial fluid in patients with RA is the canonical DPP-IV. DPP-IV-like enzymatic activity and canonical DPP-IV were also detected on the cell surface of blood and synovial fluid mononuclear cells. Significantly lower DPP-IV-like enzymatic activity and DPP-IV expression in the synovial fluid mononuclear cells was found in RA as opposed to OA patients. In the synovial fluid of RA patients there was also a negative correlation between the concentration of the pro-inflammatory DPP-IV substrate SDF (stromal cell-derived factor-1 and the proportion of the DPP-IV+ T cells. The blood plasma DPP-IV-like enzymatic activity and...

Dendritische Zellen (DZ) sind essentiell für die Aktivierung von Immunantworten. Drei Flt3-abhängige DZ Populationen aus dem Blut bestehend aus konventionellen (kDZ) BDCA1+ DZs und BDCA3+ DZs und plasmazytoide DZs wurden bereits beschrieben. Hier wurden zum ersten Mal sich aus Monozyten entwickelnde DZ (moDZ), genauer BDCA1+CD14+ pro-inflammatorische DZ (pro-iDZ) aus periphärem Blut unter homöostatischen Bedingungen identifiziert. Isolierte pro-iDZ sekretierten spontan große Mengen an pro-inflammatorischen Zytokinen, die kDZ reifen ließen und T Zell Proliferation unterstützten. Sie waren BDCA1+CD14- DZ und CD14+CD16- Monozyten in der TH17 Zell Induktion überlegen. Pro-iDZ ähnliche BDCA1+CD14+ Zellen konnten durch imaging cycler microscopy in Geweben von Patienten die an Psoriasis, Dermatomyositis oder entzündetem Halonävus erkrankt waren identifiziert werden. Ihr Fehlen in gesunder Haut deutete eine Rekrutierung von pro-iDZs in entzündetes Gewebe an. Eine Verwandtschaftsanalyse von pro-iDZ zwischen Monozyten, kDZ des Blutes und in vitro generierten moDZ auf genomweiter Ebene wies auf einen monozytären Ursprung hin. Anylse mittels funktioneller Annotation auf differentiell exprimierten Genen zwischen pro-iDZ und Monozyten zeigte eine DZ spezifische Gensignatur auf. Diese Gene waren insgesamt in der gleichen Weise wie in kDZ und moDZ reguliert, das eine Entwicklung von Monozyten nach DZ nahelegte. Dieses Entwicklungskonzept wurde insofern unterstützt, indem unter entzündlichen Bedingungen kultivierte CD14+CD16- Monozyten BDCA1 Expression und DZ Funktion erlangten. Da pro-iDZ sehr ähnlich zu BDCA1+CD14+ Zellen aus entzündeter Haut waren und beide große Konvergenz mit zuvor beschriebenen BDCA1+CD14+ inflammatorischen DZ (infDZ) aus entzündeten Geweben aufwiesen, können pro-iDZ als direkte infDZ Vorläufer angesehen werden. Dadurch und wegen ihrer monozytären Herkunft können pro-iDZ als Beweis für die humane Differenzierung von Monozyten nach DZ in vivo betrachtet werden. / Dendritic cells (DCs) are critical for the activation of immune responses. Three Flt3-dependent blood DC populations including conventional BDCA1+ DCs and BDCA3+ DCs (cDCs) and plasmacytoid DCs were described previously. This work identifies for the first time human peripheral blood monocyte derived BDCA1+CD14+ pro-inflammatory DCs (pro-iDCs) during steady state. Isolated pro-iDCs spontaneously secreted high amounts of pro-inflammatory cytokines, which matured cDCs and promoted T cell proliferation. They were superior in priming TH17 cells when compared to BDCA1+CD14- DCs and CD14+CD16- monocytes. BDCA1+CD14+ cells resembling blood pro-iDCs as identified by imaging cycler microscopy were found in samples from patients suffering from psoriasis, dermatomyositosis and inflamed halo nevus. Their absence in healthy donor’s skin indicated a recruitment of pro-iDCs to sites of inflammation. Analysis of the developmental relationship of pro-iDCs between monocytes, blood cDCs and in vitro generated monocyte derived DCs (moDCs) on whole genome level strongly suggested a monocytic origin. Functional annotation analysis of differentially regulated genes between monocytes and pro-iDCs revealed a DC specific gene signature. In addition, these genes were overall regulated in the same way in blood cDCs and moDCs, indicating an ongoing development of pro-iDCs from monocytes towards DCs. This developmental concept was supported as CD14+CD16- monocytes cultured under inflammatory conditions gained BDCA1 expression and DC function. Since pro-iDCs were highly similar to BDCA1+CD14+ cells found in inflamed skin and as both showed a marked convergence with BDCA1+CD14+ inflammatory DCs (infDCs) present in inflamed tissues described previously, pro-iDCs can be regarded as immediate precursors of infDCs. Thus, in respect of a monocytic origin and a presumably inflammatory DC fate, pro-iDCs may constitute a missing link to prove human moDC differentiation in vivo.

This master’s thesis is focused on automating the process of differential leukocyte count in peripherial blood using image processing. It deals with the design of the processing of digital images - from scanning and image preprocessing, segmentation nucleus and cytoplasm, feature selection and classifier, including testing on a set of images that were scanned in the context of this work. This work introduces used segmentation methods and classification procedures which separate nucleus and the cytoplasm of leukocytes. A statistical analysis is performed on the basis of these structures. Following adequate statistical parameters, a set of features has been chosen. This data then go through a classification process realized by three artificial neural networks. Overall were classified 5 types of leukocytes: neutropfiles, lymphocytes, monocytes, eosinophiles and basophiles. The sensitivity and specificity of the classification made for 4 out of 5 leukocyte types (neutropfiles, lymphocytes, monocytes, eosinophiles) is higher than 90 %. Sensitivity of classiffication basophiles was evaluated at 75 % and specificity at 67 %. The total ability of classification has been tested on 111 leukocytes and was approximately 91% successful. All algorithms were created in the MATLAB program.