京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18512号 / 医博第3932号 / 新制||医||1006(附属図書館) / 31398 / 京都大学大学院医学研究科医学専攻 / (主査)教授 髙折 晃史, 教授 前川 平, 教授 小川 誠司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Rapid diagnosis of infectious disease and timely initiation of proper clinical antibiotic treatment is the determinant in obtaining the optimal clinical outcomes and reducing emergences of multidrug-resistant organisms. In particular, acute infections require the detection to be accomplished in limited time with high sensitivity due to the low concentration of organisms causing the infections. Real-time Polymerase Chain Reaction can provide quantitative identification of specific genetic materials and has revolutionized clinical microbiology laboratory diagnosis. It is becoming a standard for infectious disease detection. However, most real-time PCR instruments on the market are bulky, fragile and costly due to their delicate optical components, which restricted their use to point-of-care application. Modern microfluidic and sensing technology provide a transition from benchtop real-time PCR to miniaturizable, robust, and portable real-time PCR devices to achieve rapid, low-cost, and efficient point-of-care diagnosis. In this work, an innovative electrokinetic PCR (EK-PCR) platform that combines AC electrothermal flow (ACEF) and Joule heating induced temperature gradient to implement thermal cycling for DNA amplification is discussed. In addition, in situ electrochemical sensing is incorporated in the EK-PCR chamber for real-time monitoring of the DNA concentration toward quantification of the initial copies of the DNA template. EK-PCR can improve the energy efficiency with minimized total thermal mass and remain high amplification efficiency. More importantly, it represents a highly integrated strategy for portable point-of-care devices.

Entre juin et septembre 2009, nous avons réalisé une étude transversale pour évaluer l'état de la prise en charge du paludisme chez la femme enceinte à Bangui. Les résultats de cette évaluation ont montré que dans les services de consultation prénatale (CPN) de Bangui, 28,8% des femmes enceintes reçoivent à titre curatif au moins une prescription de médicament antipaludique pendant leur grossesse. La quinine et les combinaisons à base d'artémisinine, antipaludiques compatibles avec la grossesse, sont prescrites dans des proportions de 56,7% et 26,8% respectivement. Par contre, la confirmation du paludisme par un examen de laboratoire est réalisée seulement dans 18,9% des cas avant la prescription du traitement. Les deux doses recommandées de traitement préventif intermittent du paludisme par la sulfadoxine-pyrimethamine (TPIsp) sont administrées à 30,5% des femmes pendant leur grossesse. Les moustiquaires imprégnées d'insecticide à longue durée (MIILD) sont utilisées par 42,4% des femmes enceintes. Malgré ce, la prévalence de la parasitémie placentaire à l'accouchement est relativement faible (4%). Ces données nous ont amené à réaliser une étude dont l'objectif était d'évaluer l'intérêt de l'introduction d'un test de diagnostic rapide (TDR) sur la rationalisation du traitement du paludisme chez les femmes enceintes lors des CPN. Entre octobre 2009 et octobre 2011, nous avons réalisé une étude sur une cohorte de 76 femmes enceintes. Le nombre de traitements antipaludiques après confirmation du paludisme par TDR Paracheck-Pf® lors des CPN a été déterminé sur cette cohorte. / From June to September 2009, we designed a cross-sectional study aiming to assess malaria management during pregnancy in antenatal health care in Bangui. Our findings showed that antimalarials are prescribed to 28.8% of pregnant women attending antenatal clinics (ANCs) in Bangui. Quinine and artemisinin combined therapies are widely used (56.7% and 26.8% respectively). However, laboratory diagnosis of malaria infection is performed for solely 18.9% of consultants. The recommended two doses of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTsp) are given to 30.5% of pregnant women, while 42.4% of them use the insecticides treated nets (ITNs). Nonetheless, the prevalence of placental malaria at delivery is relatively low (4%). From those preliminary data of our study we assessed the impact of a systematic rapid diagnosis test (RDT) of malaria during pregnancy on antimalarials prescription, during the period from October 2009 and October 2011. The proportions of antimalarial treatment episodes were compared in two groups of women: a cohort of 76 pregnant women presenting at their ANCs visits, in which a systematic screening of malaria with the RDT Paracheck-Pf® was performed and a control group of women who delivered in the same period. Our findings showed that in the cohort, there was a proportion of 13.8 % of positive RDT, hence requiring antimalarial treatment, while the proportion of antimalarials prescriptions in the control group was 26.3% (P = 0.0001). The avoidable rate of unnecessary antimalarials prescriptions was estimated at 47%.

Sepsis, a life-threatening condition which results from a dysregulation of host response to infection and leads to multiple organ dysfunction, is a cause for great concern. The current gold standard of detection – Blood culturing – is a highly time-consuming process and so, research has proposed the use of biomarkers. Current biomarkers, C-reactive protein and Procalcitonin, though good indicators, individually show certain limitations with respect to the specificity and sensitivity. Hence, as a step forward from singleplex biomarkers, the development of a multi-marker panel was suggested. For this purpose, the use of microRNAs (miRNAs) were employed to serve as potential biomarkers for the detection of sepsis. The aim of this study was to determine whether a higher concentration of miRNA would be obtained from a larger volume of plasma as well as to see if the miRNA present in blood can be used for the diagnosis of sepsis. Extractions were carried out using the QIAGEN exoRNeasy Plasma: Midi & Maxi Kits from plasma and Norgen’s Total RNA Purification Kit from blood. The samples were analysed and quantified using the Qubit® microRNA assay kit & Qubit® 3.0 Fluorometer and the NanoDrop™ 2000 Spectrophotometer. Statistical analysis of the results revealed that there was a significant difference between miRNA concentrations in the two volumes of plasma analysed. Based on the accurate Qubit measurements and readings, it was concluded that a larger volume of plasma, does yield a higher concentration of miRNA. In addition, it was also established that the miRNA detected in blood, could be used as probable biomarkers for the diagnosis of sepsis.

O vírus respiratório sincicial humano (HRSV) é principal agente causador de infecções do trato respiratório inferior em crianças e lactentes. Um diagnóstico rápido e preciso evitaria o uso desnecessário de antibióticos, nos casos em que a infecção é viral. A reação em cadeia da polimerase após transcrição reversa (RT-PCR) e o ensaio de imunofluorescência indireta (IFI) são considerados ferramentas importantes na detecção do HRSV, pela alta sensibilidade e especificidade. Visando simplificar e minimizar os riscos de contaminação freqüentes, em duas etapas, foi padronizada uma reação em tubo único para detecção do HRSV em amostras clínicas. Aspirados de nasofaringe de 226 crianças de 0-5 anos de idade, com doença respiratória, atendidas no Hospital Universitário da Universidade de São Paulo (HU-USP), foram testados por imunofluorescência indireta, RT semi Nested PCR e RT-PCR em tubo único. Cento e duas amostras (45,1%) foram positivas em pelo menos uma das técnicas e 75 (33,2%) em todas. Três (1,3%) amostras foram positivas por IFI e RT semi Nested PCR, 1 (0,4%) foi positiva por IFI e RT-PCR em tubo único, 5 (2,2%) amostras foram positivas somente por IFI, 2 (0,9%) somente por RT semi Nested PCR e 16 (7,1%) amostras foram positivas pela RT semi Nested PCR e RT-PCR em tubo único. A RT-PCR em tubo único mostrou ser uma técnica rápida, sensível e específica, e o uso combinado de dois métodos aumenta a detecção do HRSV. / Respiratory Syncytial Virus is the main cause of acute lower respiratory tract infection (ALTRs) in infants, elderly and immunodepressed patients. Rapid diagnosis of Respiratory Syncytial Virus (RSV) infection is necessary to efficient treatment, avoiding the unnecessary use of antibiotics and determining patient isolation requirements. The reverse trancriptase polymerase chain reaction (RT-PCR) and indirect immunofluorescence assay (IFA) methods have been referred as important tools for virus detection considering the high sensitivity and specificity, respectively of such methods. In order to maximize the simplicity and minimize the risk of sample cross-contamination by two steps RT-PCR, we developed a RT-PCR using a single-tube to detect HRSV in clinical samples. Nasopharyngeal aspirates (Nas) of 226 patients with acute respiratory illness, ranging 0-5 years old, were collected at the University of São Paulo Hospital (HU-USP) in São Paulo city. Samples were tested by indirect immunofluorescence assay, RT semi Nested PCR and single-tube RT-PCR. One hundred two (45,1%) of the 226 samples were positive at least by one of the three methods tested and 75 (33,2%) were positive by all methods. Three (1,3%) samples were positive only by IFI and RT semi Nested PCR, 1 (0,4%) sample were positive only by IFI and RT-PCR single-tube, 5 (2,2%) were positive only by IFI, 2 (0,9%) were positive only by RT semi Nested PCR and 16 (7,1) were positive only RT semi Nested PCR and RT-PCR single-tube. RT-PCR single-tube, showed to be fast, sensitive and specific for diagnosis of RSV and the combined use of both methods enhanced HRSV detection.

Made available in DSpace on 2016-12-08T16:24:17Z (GMT). No. of bitstreams: 1 PGCA14MA131.pdf: 1544474 bytes, checksum: 4f496b43924d95177e7139e1fc3bca48 (MD5) Previous issue date: 2014-02-25 / This study aimed to investigate the use of immunocytochemistry (ICC) as a quick diagnostic method of rabies, and to perform a retrospective study of positive rabies cases of the Animal Pathology Laboratory (LAPA/CAV) archives, by using immunohistochemistry (IHC). The study was divided into two stages: data collection from the LAPA/CAV archives between 1987 and 2011, through the processing of paraffin embedded samples for histopathology and IHC; and clinical follow-up of susceptible animals between the years of 2012 and 2013, in which naturally dead or euthanized animals were necropsied. Central nervous system samples were collected for immunocytochemistry assessment, in addition to direct immunofluorescence (DIF) and histopathology with hematoxylin and eosin staining. The retrospective study showed that the affected animals ages ranged from 4 months to 10 years. Most frequently reported clinical signs were incoordination of the hind limbs, progressing to decumbency and death in 2-7 days. Northeastern (Vale do Itajaí) and eastern Santa Catarina were the regions with most of the cases submitted to the laboratory. During the clinical follow-up stage 13 animals presented the paralytic form of the disease, and one showed the furious form. The histological alterations observed in both stages of the study consisted of mild to severe perivascular lymphocytic and macrophagic meningoencephalitis, sometimes with foci of gliosis and neuronal necrosis; Negri inclusion bodies were observed in 85% of the retrospective study cases and 88% of the clinically assessed animals. IHC was essential to the diagnosis conclusion in the retrospective study, especially those in which no Negri bodies were found. The ICC was positive in 85,7% (12/14) of the cases, including one animal whose direct immunofluorescence was negative, and also proved to be a fast and easy-to-perform test. Rapid diagnostic techniques are extremely important as they allow for prevention and control measures to be taken quickly / Este trabalho teve como objetivos utilizar a imunocitoquímica (ICQ) como método rápido de diagnóstico para raiva, e realizar estudo retrospectivo de casos positivos de raiva nos arquivos do Laboratório de Patologia Animal (LAPA/CAV), através da imunohistoquímica (IHQ). O estudo foi dividido em duas etapas, levantamento de dados entre os anos de 1987 e 2011 no LAPA/CAV, através de processamento das amostras mantidas em parafina, para histopatologia e imunohistoquímica (IHQ), e acompanhamento clínico de animais suspeitos entre os anos de 2012 e 2013, no qual bovinos mortos naturalmente ou eutanasiados foram necropsiados. Amostras de sistema nervoso central foram coletadas para aplicação de ICQ, além de imunofluorecência direta e histopatologia com coloração de Hematoxilina e Eosina. No estudo retrospectivo observou-se que a idade dos animais afetados variou de quatro meses a 10 anos. Os principais sinais clínicos relatados foram incoordenação dos membros posteriores, evoluindo para decúbito e morte em 2 a 7 dias. As regiões do vale e leste de Santa Catarina foram às com maior numero de casos remetidos ao laboratório. Durante o acompanhamento clínico 13 animais apresentaram a forma paralítica da doença e um bovino apresentou forma furiosa. As alterações histológicas observadas, nas duas etapas do trabalho consistiram em meningonecefalite linfocítica e macrofágica perivascular, variando de leve a acentuada, por vezes com focos de gliose e necrose neuronal; Corpúsculos de inclusão de Negri foram observados em 85% dos casos do levantamento e 88% dos animais acompanhados clinicamente. A IHQ foi essencial para a conclusão do diagnóstico nos casos do estudo retrospectivo, especialmente aqueles em que não foram observadas inclusões de Negri. A ICQ foi positiva em 85,7% (12/14) dos bovinos com raiva, inclusive em um animal cuja IFD foi negativa, além de se mostrar um teste rápido e de fácil execução. Técnicas que buscam o diagnóstico rápido são extremamente importantes, pois permitem que medidas de prevenção e controle possam ser tomadas mais rapidamente

O vírus respiratório sincicial humano (HRSV) é principal agente causador de infecções do trato respiratório inferior em crianças e lactentes. Um diagnóstico rápido e preciso evitaria o uso desnecessário de antibióticos, nos casos em que a infecção é viral. A reação em cadeia da polimerase após transcrição reversa (RT-PCR) e o ensaio de imunofluorescência indireta (IFI) são considerados ferramentas importantes na detecção do HRSV, pela alta sensibilidade e especificidade. Visando simplificar e minimizar os riscos de contaminação freqüentes, em duas etapas, foi padronizada uma reação em tubo único para detecção do HRSV em amostras clínicas. Aspirados de nasofaringe de 226 crianças de 0-5 anos de idade, com doença respiratória, atendidas no Hospital Universitário da Universidade de São Paulo (HU-USP), foram testados por imunofluorescência indireta, RT semi Nested PCR e RT-PCR em tubo único. Cento e duas amostras (45,1%) foram positivas em pelo menos uma das técnicas e 75 (33,2%) em todas. Três (1,3%) amostras foram positivas por IFI e RT semi Nested PCR, 1 (0,4%) foi positiva por IFI e RT-PCR em tubo único, 5 (2,2%) amostras foram positivas somente por IFI, 2 (0,9%) somente por RT semi Nested PCR e 16 (7,1%) amostras foram positivas pela RT semi Nested PCR e RT-PCR em tubo único. A RT-PCR em tubo único mostrou ser uma técnica rápida, sensível e específica, e o uso combinado de dois métodos aumenta a detecção do HRSV. / Respiratory Syncytial Virus is the main cause of acute lower respiratory tract infection (ALTRs) in infants, elderly and immunodepressed patients. Rapid diagnosis of Respiratory Syncytial Virus (RSV) infection is necessary to efficient treatment, avoiding the unnecessary use of antibiotics and determining patient isolation requirements. The reverse trancriptase polymerase chain reaction (RT-PCR) and indirect immunofluorescence assay (IFA) methods have been referred as important tools for virus detection considering the high sensitivity and specificity, respectively of such methods. In order to maximize the simplicity and minimize the risk of sample cross-contamination by two steps RT-PCR, we developed a RT-PCR using a single-tube to detect HRSV in clinical samples. Nasopharyngeal aspirates (Nas) of 226 patients with acute respiratory illness, ranging 0-5 years old, were collected at the University of São Paulo Hospital (HU-USP) in São Paulo city. Samples were tested by indirect immunofluorescence assay, RT semi Nested PCR and single-tube RT-PCR. One hundred two (45,1%) of the 226 samples were positive at least by one of the three methods tested and 75 (33,2%) were positive by all methods. Three (1,3%) samples were positive only by IFI and RT semi Nested PCR, 1 (0,4%) sample were positive only by IFI and RT-PCR single-tube, 5 (2,2%) were positive only by IFI, 2 (0,9%) were positive only by RT semi Nested PCR and 16 (7,1) were positive only RT semi Nested PCR and RT-PCR single-tube. RT-PCR single-tube, showed to be fast, sensitive and specific for diagnosis of RSV and the combined use of both methods enhanced HRSV detection.

abstract: Recent studies have shown that human papillomavirus (HPV) plays a role in development of cancers, one of which is head and neck cancer. There is strong and consistent molecular evidence demonstrating that human papillomavirus (HPV) is an etiological cause of these oropharyngeal cancers. Despite the introduction of HPV vaccines, there is still an increase in human papillomavirus associated OPC (HPVOPC) and it is expected that the incidence of head and neck cancer, specifically oropharyngeal cancer (OPC) will increase. The aim of this study is to utilize human papillomavirus (HPV) seropositivity for rapid detection of HPV early specific antigen-antibodies using a lateral flow assay. Human papillomavirus (HPV) 16 proteins of interest, E7, E6 and CE2 were expressed and purified in E. coli for detection of specific antibodies using lateral flow assay because viral and host factors impact the serologic responses to HPV early antigens in HPV-positive oropharyngeal cancer. 17 samples and 5 controls with already known antibody reactivity from ELISA analysis were selected for HPV serologic responses. The lateral flow strip was evaluated for its color band intensity using Image J software. Peak area was used to quantify the color intensity of the lateral flow strip. Out of the 17 samples, 11 (64.7%) showed high antibody levels to E7, 12 (70.6%) showed high Ab levels to E6 and 6 (35.3%) showed high Ab levels to CE2. Correlation coefficient between antibody detection by sight and ELISA for E7, CE2 and E6 were 0.6614, 0.4845 and 0.2372 respectively and correlation coefficient between lateral flow assay and ELISA for E7, CE2 and E6 were 0.3480, 0.1716 and 0.1644 respectively. This further proves patients or samples with HPV 16 oropharyngeal cancer have detectable antibodies to early E7, E6 and E2 proteins, which are potential biomarkers for HPV-associated oropharyngeal cancer. / Dissertation/Thesis / Masters Thesis Molecular and Cellular Biology 2019

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21635号 / 医博第4441号 / 新制||医||1034(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 椛島 健治, 教授 岩田 想, 教授 山田 亮 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

A doença de Chagas é uma zoonose causada pelo protozoário flagelado Trypanosoma cruzi. Estima-se que 8 milhões de pessoas estão infectadas com o T. cruzi em todo o mundo, principalmente na América Latina. Testes tradicionais de diagnóstico estão sendo gradualmente substituídos por métodos inovadores. A utilização de antígenos recombinantes foi proposta nos anos 90, e várias combinações foram testadas com soros de pacientes com diferentes formas clínicas de diferentes regiões da América Latina. Apesar do ganho em especificidade, estes testes apresentaram menor sensibilidade, frustrando expectativas. Este estudo objetivou analisar a variabilidade genética dos genes KMP11 e 1F8 que codificam antígenos comumente utilizados em diagnóstico experimental. Cepas de T. cruzi pertencentes a diferentes sub-grupos taxonômicos e de diferentes regiões foram analisadas para avaliar o impacto da variação antigênica em testes de diagnóstico. Maximizando a sensibilidade, evitar reatividade cruzada com epítopos de outros agentes patogênicos deve permitir a concepção de melhores testes rápidos. Num primeiro passo, DNA genômico foi extraído das seguintes cepas: Dm28c, Colombiana, Y, 3663, 4167, LL014 e CL Brener e foi realizada a amplificação dos genes 1F8 e KMP11 que codificam antígenos a partir destas cepas. Em seguida foram realizadas a clonagem, sequenciamento, expressão e detecção dos antígenos recombinantes. Na etapa final, análises de estruturas secundárias e terciárias, a última apenas para o antígeno 1F8, visualizaram as diferenças nas sequências de aminoácidos obtidas a partir de sequenciamento de DNA. Os resultados apresentados neste estudo mostram que o antígeno KMP11 de T. cruzi possui uma similaridade na sequência de aminoácidos muito elevada com o T. rangeli, mostrando a necessidade de um mapeamento antigênico desta proteína em todos os tripanosomatídeos que apresentaram alta similaridade com o antígeno de T. cruzi, como o T. rangeli, para verificar a presença de epítopos específicos de T. cruzi. O antígeno 1F8 pode ser uma ferramenta útil no diagnóstico da doença de Chagas e que será necessário aprofundar os conhecimentos sobre os determinantes antigênicos para futuramente elaborar poli-epítopos sintéticos adaptados de um maior número possível de antígenos, obtendo a maior especificidade e sensibilidade nos testes de diagnóstico sorológico e de teste rápido da doença de Chagas. Este estudo representa um passo crucial para a otimização de antígenos recombinantes para o diagnóstico da doença de Chagas. / Chagas disease is a zoonosis caused by the flagellate protozoan Trypanosoma cruzi. An estimated 8 million people are infected with T. cruzi worldwide, mostly in Latin America. Traditional diagnostic tests are gradually being replaced by more innovative methods, such as rapid tests and Real Time PCR. The use of recombinant antigens in serology or rapid tests has been proposed in the 90s, and several combinations were tested with sera from patients with different clinical forms in different regions in Latin America. Despite the gain in specificity, these tests showed lower sensitivity, frustrating expectations. This study aims to analyze the genetic variability of KMP11 and 1F8 genes coding for antigens commonly used in such experimental diagnostic. T. cruzi strains belonging to different taxonomic sub-groups and different regions were analyzed in order to assess the impact of antigenic variation in diagnostic tests. Maximizing sensitivity and avoiding cross-reactive epitopes for other pathogens should allow for the design of better rapid tests. In a first step, genomic DNA was extracted from the following strains: DM28c, Colombiana, Y, 3663, 4167, LL014 and CL Brener and we performed amplification of the 1F8 and KMP11 antigen encoding genes from these strains. Gene fragments were cloned, sequenced, and subcloned in expression vectors, followed by detection of the recombinant antigens. Using structural prediction and modeling, secondary and tertiary structures were analyzed the latter only for the 1F8 antigen, to visualize the differences in the amino acid sequences revealed from DNA sequencing. The results presented in this study show that the KMP11 T. cruzi antigen, has a very high similarity in amino acid sequence with T. rangeli, showing the need for antigenic mapping of this protein in all trypanosomatids that showed high similarity with the T. cruzi and T. rangeli, for the presence of specific epitopes of T. cruzi. The 1F8 antigen may be a useful tool in the diagnosis of Chagas disease and will need to know more about the antigenic determinants to further develop poly-epitope synthetic adapted from a larger number of possible antigens, obtaining the highest specificity and sensitivity in tests serological diagnosis and rapid test for Chagas disease.This study represents a crucial step for the optimization of recombinant antigens for the diagnosis of Chagas disease.