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A malária é uma das doenças infecciosas mais graves que afligem a espécie humana, sendo endêmica na maioria das regiões tropicais e subtropicais do mundo. Em humanos, essa doença é causada pelos protozoários Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale, Plasmodium vivax e Plasmodium knowlesi, que são transmitidos ao hospedeiro pela picada dos mosquitos do gênero Anopheles. No Brasil, 87% dos casos de malária ocorrem pela infecção por P. vivax e as infecções por P. falciparum e infecções mistas representam o restante. As infecções por P. vivax foram tradicionalmente relacionadas com casos mais brandos de malária e pesquisas sobre essas infecções foram por muito tempo negligenciadas pela comunidade científica e indústrias farmacêuticas. Atualmente, casos severos e mortes por essas infecções são cada vez mais frequentes, tornando essa espécie de Plasmodium um importante alvo para os programas de controle e erradicação da malária. Apesar das evidências mostrarem que há variabilidade entre os indivíduos na suscetibilidade e resposta ao tratamento da malária, estudos relacionados com a influência genética da resposta imunológica na suscetibilidade ou resistência nas infecções por P. vivax são escassos, e pesquisas sobre a variabilidade genética da resposta ao tratamento com os fármacos utilizados no tratamento dessas infecções são inexistentes. No presente trabalho, foram investigados a influência de 33 polimorfismos nos genes IL1B, IL2, IL4, IL4R, IL6, IL8, IL10, IL12A, IL12B, IL12RB1, SP110, TNF, TNFRSF1A, IFNG, IFNGR1, VDR, PTPN22 e P2X7 na suscetibilidade à malária e na evolução clínica dessa doença. Também foram investigados 30 polimorfismos nos genes CYP1A2, CYP2C8, CYP2C9, CYP3A4, CYP3A5, SLCO1A2, SLCO1B1, SLCO1B3 e SLCO2B1 na resposta ao tratamento da malária. Entre os anos de 2002 e 2009, 216 pacientes naturais do estado do Pará diagnosticados com malária causada por P. vivax aceitaram participar do estudo. Todos os pacientes fizeram o tratamento padrão com cloroquina associada à primaquina. Desse grupo de pacientes, 167 foram avaliados clinicamente durante o período do tratamento e os níveis de parasitemia e gametocitemia foram estimados diariamente. Além dos genes em estudos, os pacientes também foram genotipados para a enzima G6PD. A ancestralidade genética desses pacientes foi estimada por um conjunto de 48 marcadores de ancestralidade. 10 O presente trabalho descreve a associação de polimorfismos nos genes IL1B, IL4R, IL12RB1 e TNF com a suscetibilidade à malária, e dos polimorfismos nos genes IL6, IL12B e VDR aos níveis de parasitemia e gametocitemia. Já as variantes nos genes IL6 e IL10 foram associadas à severidade dos sintomas nas infecções por P. vivax. Esse trabalho, também demonstra que alelos dos genes CYP2C8, ABCB1, SLCO1B1 e SLCO2B1 influenciam a resposta ao tratamento da malária. Variantes nesses genes estão associadas a uma resposta mais rápida à medicação fazendo com que seus portadores eliminem os parasitos e gametócitos em menor tempo. Esses resultados contribuem para a compreensão da malária e podem ajudar na obtenção de métodos de controle e esquemas terapêuticos mais eficientes para o controle dessa doença. / Malaria is a major infection disease that affects human species, and is spread in tropical and sub-tropical regions in different continents. This disease is caused by Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale, Plasmodium vivax and Plasmodium knowlesi protozoan which are transmitted to humans by Anopheles mosquito bites. In Brazil, 87% of malaria infections result from P. vivax infections, P. falciparum and mixed infections represent all other cases. P. vivax infections were traditionally related to malaria milder symptoms therefore research in such infections was neglected by the scientific community and pharmaceutical industries. At present severe cases and deaths by these infections are more frequent and P. vivax become an important target for malaria control and elimination program. Despite evidences showing malaria susceptibility and treatment response variability, studies in immune system response related to P. vivax malaria susceptibility are scarce. In the present study 33 polymorphisms in IL1B, IL2, IL4, IL4R, IL6, IL8, IL10, IL12A, IL12B, IL12RB1, SP110, TNF, TNFRSF1A, IFNG, IFNGR1, VDR, PTPN22 and P2X7 genes were investigated for association with malaria susceptibility, and its clinical aspects. Thirty polymorphisms in CYP1A2, CYP2C8, CYP2C9, CYP3A4, CYP3A5, SLCO1A2, SLCO1B1, SLCO1B3 and SLCO2B1 genes were investigated in relation to malaria treatment outcomes. Two hundred and sixteen (216) patients diagnosed with P. vivax malaria recruited during the period 2002-2009, who were born in Pará state, Brazil were enrolled in the study. All patients received chloroquine and primaquine standard treatment regimens. From these group of patients, 167 were clinically evaluated during treatment and have parasitemia and gametocytemia levels estimated daily. Besides the investigated genes, the patients were genotyped for G6PD. Genetic ancestry was estimated by a set of 48 ancestry markers. The present work reports that IL1B, IL4R, IL12RB1 and TNF gene polymorphisms were associated with malaria susceptibility, whereas IL6, IL12B and VDR gene polymorphisms were associated with parasitemia and gametocytemia levels. IL6 and IL10 genetic variants were associated with malaria symptoms intensity in P. vivax infections. The present work also reports the influence of CYP2C8, ABCB1, SLCO1B1 and SLCO2B1 alleles on malaria treatment response. Genetic variants in these genes were associated with a faster drug response and patients with these variants present parasites and gametocytes clearance in a shorter time. These results have a great value for malaria understanding and could help to improve disease control and therapeutic regimen to more efficient methods to control this disease.

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Resumo: Clicar acesso eletrônico abaixo. / Abstract: Click electronic access below. / Orientador: Ricardo Luiz Dantas Machado / Coorientador: Andréa Regina Baptista Rossit / Banca: Sandra do Lago Moraes de Ávila / Banca: Luiz Carlos de Mattos / Mestre

<p>Malaria remains the most important parasitic disease worldwide. It is estimated that over 500 million infections and more that 2.7 million deaths arising from malaria occur each year. Most (90%) of the infections occur in Africa with the most affected groups being children of less than five years of age and women. this dire situation is exacerbated by the emrggence of drug resistant strains of Plasmodium falciparum. The work reported in this thesis focuses on improving the purification of PfHPRT by investigating the characteristics of anion exchange DE-52 chromatography (the first stage of purification), developing an HPLC gel filtration method for examining the quaternary structure of the protein and possible end stage purification, and initialcrystalization trials. a homology model of the open, unligaded PfHPRT is constructed using the atoomic structures of human, T.ccruz and STryphimurium HPRT as templates.</p>

<p>Malaria remains the most important parasitic disease worldwide. It is estimated that over 500 million infections and more that 2.7 million deaths arising from malaria occur each year. Most (90%) of the infections occur in Africa with the most affected groups being children of less than five years of age and women. this dire situation is exacerbated by the emrggence of drug resistant strains of Plasmodium falciparum. The work reported in this thesis focuses on improving the purification of PfHPRT by investigating the characteristics of anion exchange DE-52 chromatography (the first stage of purification), developing an HPLC gel filtration method for examining the quaternary structure of the protein and possible end stage purification, and initialcrystalization trials. a homology model of the open, unligaded PfHPRT is constructed using the atoomic structures of human, T.ccruz and STryphimurium HPRT as templates.</p>

Thesis (Ph. D.)--Case Western Reserve University, 2009. / [School of Medicine] Department of Genetics. Includes bibliographical references.

Thèse d'exercice : Pharmacie : Université de Nantes : 2004. / Bibliogr. f. 119-121 [36 réf.].

Thèse de doctorat : Parasitologie : Paris 12 : 2003. / Titre provenant de l'écran-titre.

Thesis (Ph.D.) -- University of Glasgow, 2008. / Ph.D. thesis submitted to the Division of Infection and Immunity, Institute of Biomedical and Life Sciences, University of Glasgow, 2008. Includes bibliographical references. Print version also available.