Made available in DSpace on 2015-07-22T20:49:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-09-29 / As Leishmanioses são classificadas pela OMS como uma das dez doenças negligenciadas tropicais (DNT), as quais apresentam alta incidência, atingem segmentos empobrecidos da população e não obtêm visibilidade social, portanto o investimento em diagnóstico, terapêutica e imunização é precário. As Leishmanioses fazem parte das doenças tropicais em expansão e não existem mecanismos adequados para sua prevenção e controle. Representam um problema de saúde pública mundial: 88 países apresentam pelo menos uma das trinta espécies de Leishmania e 350 milhões de indivíduos estão expostos à contaminação. Em algumas espécies, a letalidade das Leishmanioses pode alcançar 100% em pacientes sem tratamento. Diante desse quadro, realizou-se uma investigação com o objetivo de identificar o perfil da produção científica brasileira sobre o tema das Leishmanioses, no período 2004-2008, a fim de subsidiar o processo de formulação de políticas e tomada de decisões da gestão governamental, no tocante ao fomento à pesquisa em saúde nessa área do conhecimento. A pesquisa se refere a um estudo descritivo, elaborado com emprego da análise bibliométrica e da pesquisa documental. A Bibliometria consiste em um conjunto de leis e princípios empíricos que compõem os fundamentos teóricos da Ciência da Informação. A análise bibliométrica compreendeu a consulta, coleta e recuperação de informações quantitativas, em bases de dados da ciência da saúde no Brasil, seguida da organização dos dados coletados, sistematização em categorias de indexação, registro da coleta em banco de dados Excel e análise interpretativa das informações científicas e tecnológicas obtidas. A pesquisa documental constou de coleta e análise de dados em acervos institucionais de setores do órgão governamental federal de saúde. Em todas as bases consultadas, foram localizadas 749 publicações, produzidas no período 2004-2008 sobre o tema das Leishmanioses, das quais 521 atenderam aos critérios de inclusão. Foram publicados 415 artigos científicos por pesquisadores brasileiros em revistas indexadas, nacionais e internacionais. No diretório dos grupos de pesquisa da Plataforma Lattes, foi identificado o cadastro de 214 grupos dedicados ao tema. Receberam títulos nessa linha de pesquisa (Leishmanioses) 43 mestres e 44 doutores. A análise bibliométrica e documental permitiu identificar tendências de crescimento da produção científica brasileira sobre as Leishmanioses, no período 2004-2008, de grande relevância para a saúde pública, por tratar-se de doença negligenciada tropical. O Brasil detém o maior número de centros de pesquisa sobre Leishmanioses no mundo e atua em cooperação técnico-científica em âmbito nacional e internacional. Pode-se afirmar, portanto, que existe capacidade de médio porte instalada no país para a pesquisa sobre a doença. Além disso, foram identificados estudos em rede e multicêntricos, que podem favorecer a expansão e fortalecimento dos grupos voltados à pesquisa sobre Leishmaniose em âmbito nacional. Entende-se que seja oportuna a indução de ações e políticas públicas de fomento à pesquisa sobre estudos clínicos de fases I, II e III e sobre desenvolvimento tecnológico, a fim de propiciar o incremento do diagnóstico e tratamento das Leishmanioses no país. / The Leishmaniasis are classified by WHO as one of ten tropical neglected diseases (NTD), which have high incidence, affecting impoverished segments of the population and do not get social visibility, so the investment in diagnostic, therapeutic and immunization are poor. The Leishmaniasis is part of the tropical diseases in expansion process and there aren’t appropriate mechanisms for its prevention and control. They represent a public health problem worldwide: 88 countries have at least one of the thirty species of Leishmania and 350 million individuals are exposed to contamination. In some species, the lethality of Leishmaniasis may reach 100% in untreated patients. Given this situation, we carried out an investigation to identify the profile of Brazilian scientific literature on the subject of Leishmaniasis in the period 2004-2008 in order to support the process of policy formulation and decision making of government administration, with regard to development of health research in this area of knowledge. The survey refers to a descriptive study with use of bibliometric analysis and documentary research. The Bibliometrics consists of a set of empirical laws and principles that form the theoretical foundations of information science. Bibliometric analysis included query, collection and recovery of quantitative information in the databases of health science in Brazil, then organization of the data collected, systematized into categories of indexing, record collection in Excel database and interpretative analysis of scientific and technological information obtained. The collection consisted of desk research and data analysis in institutional sectors of the federal government body health. In all of the following databases were located 749 publications produced in the period 2004-2008 on the theme of Leishmaniasis, of which 521 met the inclusion criteria. 415 scientific articles were published by Brazilian researchers in indexed journals, national and international. In the directory of research groups of the Lattes Platform, were identified from the register 214 groups dedicated to the theme. Received titles in this line of research (Leishmaniasis) 43 masters and 44 doctors. Bibliometric analysis and documentation identified growth trends of the Brazilian scientific production on Leishmaniasis, in the period 2004-2008, of great relevance to public health, because it is neglected tropical disease. Brazil has the largest number of research centers on Leishmaniasis in the world and serves on scientific-technical cooperation in national and international areas, so it can be stated that there is midsize capacity for research on the disease installed in the country. Identified studies in multi-center network can promote the expansion and strengthening of the groups directed to research on Leishmaniasis nationwide. It is understood that is desirable the induction of actions and policies to encourage research on clinical trials of phases I, II and III and on technological development in order to facilitate the increase in diagnosis and treatment of Leishmaniasis in the country. / TEDE / BV UNIFESP: Teses e dissertações

La résistance des moustiques aux insecticides pyréthrinoïdes (PYRs) menace les programmes de lutte anti-vectorielle à l'échelle mondiale. Chez le moustique Aedes aegypti, vecteur de la dengue et du Chikungunya, les principaux mécanismes causant cette résistance ont été identifiés. La résistance métabolique joue alors un rôle important et consiste en une biodégradation accrue de l'insecticide par des enzymes de détoxication. Néanmoins, les bases moléculaires de ce mécanisme restent méconnues. La plupart des gènes impliqués dans la résistance métabolique aux PYRs ont été identifiés par des approches transcriptomiques, mais les modifications génomiques à l'origine de leur sur-expression dans les populations résistantes ainsi que les modifications structurales des enzymes en lien avec la résistance restent méconnues. Cette thèse vise alors à utiliser les nouvelles approches de séquençage à haut débit (NGS) pour caractériser les mécanismes moléculaires de la résistance aux PYRs chez le moustique Ae. Aegypti. La première partie de la thèse présente une étude pilote RNA-seq menée sur des populations de laboratoire sélectionnées avec des insecticides. Cette étude a pour objectif d'évaluer les avantages des NGS pour l'étude des mécanismes de résistance chez les moustiques. Le rôle des enzymes de détoxication dans la résistance a ainsi été clairement confirmé. Plusieurs gènes codant pour ces enzymes apparaissent sur-exprimés dans les populations résistantes et un important regroupement de P450 montre une forte empreinte de sélection en lien avec la résistance aux PYRs. La seconde partie de la thèse présente une étude sur des populations naturelles échantillonnées sur divers continents. Cette étude combine les technologies d'enrichissement génomique et de DNA-seq afin d'étudier les variations génomiques liées à la résistance au PYR Deltaméthrine. La comparaison de la couverture de séquençage entre populations résistantes et sensibles a permis d'identifier des variations de nombre de copies (CNVs) de certains gènes de détoxication associées à la résistance à la Deltaméthrine. Des mutations non-synonymes fortement liées au phénotype de résistance ont également été mises en évidence. La comparaison de ces marqueurs de la résistance entre les différentes populations a révélé que les gènes/mutations associés à la résistance à la Deltaméthrine sont peu conservés entre continents, probablement à cause des différences de fond génétique des populations, de leur histoire démographique et des pressions de sélections. La troisième partie de la thèse décrit une étude par RNA-seq portant sur les mêmes populations naturelles, visant à croiser des données de transcriptomique (expression des gènes et polymorphisme des transcrits) avec les données génomiques générées par l'étude précédente. Plusieurs enzymes de détoxications ont été retrouvées sur-exprimées chez les populations résistantes en lien avec les CNVs précédemment identifiées. Des centaines de variations de polymorphisme ont été identifiées par DNA-seq dans les zones cis-promotrices des différents gènes étudiés. Parmi ces variations, plusieurs apparaissent associées à la sur-régulation d'enzymes de détoxication. Enfin, la comparaison des données de polymorphismes obtenues par DNA-seq et RNA-seq a permis d'étudier les phénomènes d'expression d'allèles spécifiques en lien avec la résistance. Cette étude confirme l'intérêt de croiser des données de transcriptomique et de génomique pour caractériser les bases moléculaires de la résistance aux insecticides. D'un point de vue général, cette thèse permet de mieux appréhender les mécanismes de résistance du moustique Ae. aegypti aux PYRs mais aussi d'identifier de nouveaux marqueurs de la résistance potentiellement utilisables pour développer de nouveaux outils moléculaires diagnostiques de la résistance sur le terrain. Ce travail met également en avant les apports des NGS pour l'étude fine des bases moléculaires de l'adaptation d'organismes modèles. / Mosquito control programs worldwide are increasingly threatened by resistance to pyrethroid insecticides (PYRs). In the dengue and chikungunya vector Aedes aegypti, the key resistance mechanisms include modifications in the protein targeted by insecticides (target-site mutations) and metabolic resistance, consisting in an increased insecticide biodegradation by so called detoxification enzymes. However, as opposed to target-site mutations, the molecular basis of metabolic resistance remains poorly understood. Most metabolic resistance genes have been detected by transcriptomic approaches based on their over-expressed in resistant populations, but genomic changes leading to these expression changes as well as structural changes in enzymes potentially involved in resistance remain unknown. In this context, this thesis aims at using next-generation sequencing approaches for characterizing PYR resistance mechanisms in the mosquito Ae. aegypti.The first chapter of this thesis describes a pilot study on laboratory insecticide-selected populations of Ae. aegypti. This study aims at investigating the benefits of next-generation sequencing for studying resistance mechanisms in mosquitoes. This study confirmed that detoxification enzymes play a key role in resistance, with several of them being over-expressed in resistant populations and a large cluster of cytochrome P450 genes showing a selection imprint associated with resistance to PYRs.The second chapter of this thesis describes a study conducted on natural mosquito populations from various continents. Combining genomic target enrichment (targeting about 800 genes potentially involved in resistance) and DNA-seq allowed unravelling genomic changes associated with resistance to the PYR deltamethrin. Comparing normalized sequencing coverage between resistant and susceptible populations identified significant copy number variations (CNVs) in several detoxification genes strongly associated to deltamethrin resistance. Non-synonymous mutations affecting detoxification enzymes associated to the resistance phenotype were also detected. Comparing resistance markers between populations from various continents revealed that genes/mutations associated with deltamethrin resistance are poorly conserved across continents, probably due to differences in the genetic background of populations but also differences in terms of demographic history and selection pressures.The third chapter describes an RNA-seq study performed on the same natural mosquito populations in order to cross-link transcriptomic data (gene expression and transcript polymorphism) with genomic data obtained from the previous study. Multiple detoxification enzymes were found over-transcribed in resistant populations linked with previously identified CNVs. Hundreds polymorphism variations were identified by targeted DNA-seq in cis-promoter regions of detoxification genes. Among them, several were associated with the upper-regulation of detoxification enzymes in resistant populations. Finally, cross-comparing polymorphism data obtain from DNA-seq and RNA-seq allowed investigating allele specific expression (ASE) events related to PYR resistance. Overall, this study confirmed the benefits of combining transcriptomic and genomic NGS approaches for studying the molecular basis of insecticide resistance.As a whole, this thesis not only contributed to better understand PYR resistance mechanisms in the dengue vector Ae. aegypti but also identified novel genomic markers of resistance opening the way for developing new molecular diagnostic to early detect and monitor resistance mechanisms in the field. This work also highlights the benefits of using NGS technologies for unravelling the molecular bases of adaptation in model organisms.

Neglected tropical diseases are parasitic and bacterial diseases mainly prevalent in developing countries affecting people living in poverty. The World Health Organization’s human rights-based approach emphasizes the “prevention, control, elimination and eradication of neglected tropical diseases” through the use of preventative chemotherapy, such as the mass administration of deworming drugs to improve people’s health.This research paper will take a deeper look at how WHO has been communicating NTDs to make them less ‘neglected’ and how the NTD discourse has been shaping development organizations’ action. In addition, it aims to investigate how successful mass deworming has really been in terms of the recent debate.This study is using a combination of a discourse analysis and qualitative interviews in order to investigate how the NTD discourse and recent initiatives by international organizations have contributed to making NTDs less neglected. It deconstructs representations of the ‘Other’ – the superiority of the ‘West’ over the ‘Rest’ – in relation to the NTD discourse and its inherent power structures. Discourses are analyzed to identify power relations between governments, development organizations, pharmaceutical industries, and recipients of deworming drugs as part of Kenya’s 2013 deworming campaign.The results showed that the NTD discourse has helped raise awareness for NTDs. NTDs and their debilitating effect on populations have been better and more widely communicated, making them less ‘neglected’. WHO and other development organizations’ actions have contributed to making NTDs more visible and have given NTDs higher priority on the global health agenda. Findings from this research study revealed that the ongoing debate has not had a negative impact on international funding. More research and development of a vaccine against NTDs is needed to find more ways to tackle these devastating diseases.

Dengue is a major public health problem that affects tens of millions of people annually in tropical and sub-tropical countries. This acute viral infection happens to be severe and even life threatening but there is still no available drug or vaccine. Previous studies have noted early higher viral burden in patients who develop more severe symptoms suggesting that administration of a potent and safe antiviral may prevent progression to severe dengue. To verify this hypothesis, we have conducted the first RCT directed towards reducing the viral burden in vivo by administrating chloroquine (CQ), a cheap and well-tolerated drug that inhibits DENV in vitro with concentrations achievable in vivo, to 307 Vietnamese adults with suspected dengue (257 of them were laboratory-confirmed cases). Unfortunately, we did not see an effect of CQ on the duration of infection. However in patients treated with CQ, we observed a trend towards a lower incidence of severe forms. We did not find any differences in the immune response that can explain this trend. We also found more adverse events, primarily vomiting, with CQ. In addition, we have explored the relationships between clinical features, antibody responses and virological markers in these patients. We found that the early magnitude of viremia is positively associated with disease severity and there are serotype dependent differences in infection kinetics. We found as well that DENV was cleared faster and earlier in patients with secondary infections. To complete this study, we have also evaluated 2 rapid lateral flow tests for the diagnosis of dengue in a panel of plasma samples from 245 RT-PCR confirmed dengue patients and 47 with other febrile illnesses. Our data suggest that the NS1 test component of these tests are highly specific and have similar levels of sensitivity (~60%). Both NS1 assays were significantly more sensitive for primary than secondary dengue. The IgM parameter in the SD Duo test improved overall test sensitivity without compromising specificity. All these findings are of major importance for further anti-viral drug testing.

Orientador: Prof. Dr. Rodrigo Luiz Oliveira Rodrigues Cunha / Dissertação (mestrado) - Universidade Federal do ABC, Programa de Pós-Graduação em Ciência & Tecnologia - Química, 2014. / Errata: Folha 4, linha 20. Onde se lê "Figura 1. Imagem de microscopia evidanciando o anel trofozoíta (no centro em destaque), leia-se Figura 1. Imagem de microscopia evidanciando o anel trofozoíta (no centro, em destaque). Fonte: https://pt.wikipedia.org/wiki/ficheiro:Plasmodium_ovale_01.png / As doenças tropicais negligenciadas (DTNs), características de regiões menos desenvolvidas do planeta com baixos níveis de escolaridade, habitação e saneamento básico estão sujeitas às opções terapêuticas limitadas e ineficientes. A cada ano, cerca de 250 milhões de casos de malária são diagnosticados e aproximadamente um milhão de pessoas morre desta doença. A baixa eficácia, elevada toxicidade e a emergência de cepas de parasitas resistentes à fármacos, são fatores que determinam a necessidade da síntese de novos fármacos e programas de investimentos e inovação em pesquisa e desenvolvimento (P&D). A proposta de compostos híbridos ou funcionalização de moléculas, como também pode ser chamada, é uma abordagem bem estabelecida para síntese de fármacos. Moléculas híbridas ganham destaque com o uso em várias áreas terapêuticas, tais como inflamação, alergia, depressão, propostas quimioterápicas contra o câncer e parasitemia. Recentemente as atividades biológicas de compostos de Selênio têm recebido crescente atenção, em especial os derivados hipervalentes de Selênio (IV) que têm sido estudados por nosso grupo de pesquisas como inibidores de cisteína peptidases. O merecido destaque dos compostos de Selênio hipervalentes, avaliados como inibidores enzimáticos aumentam as chances de encontrar inibidores mais eficientes e seletivos para enzimas envolvidas em infecções parasitárias. Neste sentido, esse trabalho propôs a junção de duas propriedades químicas que atuam contra o desenvolvimento do Plasmodium falciparum (protozoário responsável pela Malária): a inibição da heme-polimerase através da ação de sistemas hetrocíclicos nitrogenados (como bases fracas), e a inibição de cisteína peptidases com a atuação das selenuranas, as quais reduzem o efluxo da droga em cepas resistentes a outros fármacos. Os compostos sintetizados foram submetidos a testes biológicos para a avaliação de seu potencial como quimioterápicos para a malária. Os compostos foram eficientes na inibição do desenvolvimento dos parasitas in vitro e mostraram interferir na homeostase celular. Além disso, não causaram hemólise e nem diminuição significativa da viabilidade de células endoteliais. Juntos, os resultados obtidos mostram que esses compostos são potenciais candidatos para desenvolvimento de novos fármacos, uma vez que é letal ao parasita e contém os benefícios de composto híbrido. / Neglected tropical diseases (NTDs), typical of less developed regions of the world with low levels of education, habitation and sanitation are subject to limited and ineffective treatment options. Each year, about 250 million cases of Malaria are diagnosed and about 1 million people die of this disease. The low efficacy, high toxicity and the emergence of chloroquine resistant in Plasmodium falciparum strains are factors that determine the necessity for synthesis of new drugs and investments and innovations programs in research and development (R&D). The proposed of hybrid compounds, or they are also called functionalization of molecules, is a well-established approach to synthesis of drugs. Hybrid molecules are highlighted on use in various therapeutic areas such as inflammation, allergy, depression, proposals for cancer and parasitosis chemotherapy. Recently the biological activities of selenium compounds has received great attention, particularly hypervalent derivatives of selenium (IV) that it has been studied by our research group as inhibitors of cysteine peptidases. The worth prominence of hypervalent selenium compounds evaluated as enzyme inhibitors, which increase the chances of finding more efficient and selective for enzymes involved in parasitic infections inhibitors . In this way, this work proposed the addition of two chemical properties that act against the development of Plasmodium falciparum (protozoan responsible for Malaria). Inhibition of heme polymerase by way of the action of amino groups (such as weak bases), and inhibition of cysteine peptidases with the performance of selenuranes reduces the efflux of drug in resistant strains to other drugs. The synthesized compounds were subjected to biological evaluation of their potential as chemotherapeutic agents for Malaria tests. The compounds were effective in inhibiting the development of parasites in vitro and interference on cellular homeostasis. In addition, didn¿t cause hemolysis or a significant decrease in viability of endothelial cells. Together, the results show that these compounds are good candidates for development of new drugs since it is lethal to the parasite, does not harm the host and has the benefits of a hybrid compound.

Comprendre les rétroactions entre les maladies infectieuses, la structure des écosystèmes et le développement économique est nécessaire pour alléger le fardeau des maladies tropicales négligées. Ce groupe d'infections parasitaires, virales, et bactériennes est étroitement associé à des conditions géographiques, environnementales, sanitaires et économiques particulières aux régions tropicales. A travers l'étude de l'ulcère de Buruli, une maladie émergente et négligée associé à une morbidité et handicap très importants dans des régions tropicales, ce travail de thèse s'intéresse aux interactions complexes entre ces différents composants des systèmes épidémiologiques. Combinant un travail de terrain important pour la collecte des données environnementales avec une approche de recherche multidisciplinaire, cette thèse vise à améliorer notre compréhension des différents aspects de l'écologie et de l'épidémiologie de cette maladie infectieuse. Notamment, la dynamique de son agent pathogène, M. ulcerans, est caractérisée pour un large éventail d'écosystèmes et communautés aquatiques au Cameroun, permettant d'identifier les facteurs environnementaux permettant sa propagation. En outre, nous évaluons la transmission de l'agent pathogène de l'environnement à l'homme et l'impact de la maladie sur le développement économique des populations endémiques. Ainsi, ce travail montre comment les dynamiques écologiques, épidémiologiques, environnementales et économiques interagissent de concert, mettant en évidence de façon criante le besoin d'une telle approche interdisciplinaire dans l'étude des maladies tropicales négligées. / Understanding the feedbacks between infectious diseases, ecosystem structure and economic development is necessary to alleviate the burden of Neglected Tropical Diseases. This group of parasitic, viral, and bacterial infections is closely associated with particular geographical and environmental conditions mainly present in the tropics, thriving under conditions of poverty, inefficient sanitation and malnutrition. This PhD thesis works through the case study of Buruli ulcer, an emerging and neglected infectious disease associated with a great morbidity and disability burden in tropical regions. Relying on an extensive environmental field survey and a multidisciplinary research approach, this PhD attempts to gain a better understanding of different aspects of the ecology and epidemiology of Buruli ulcer. Notably, the dynamics of its pathogen, M. ulcerans are characterized for a wide range of freshwater ecosystems and aquatic communities in Cameroon, and the environmental drivers of M. ulcerans presence are investigated. Furthermore, we assess the transmission of the pathogen from the environment to humans and the impact of the disease on the economic development of endemic populations. Thus, this work shows how the interplay between ecological, epidemiological and economic dynamics interact together and calls for an urgent need to apply such inter-disciplinary approach to decrease the burden of neglected tropical diseases.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-03-10T13:11:37Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese Rafael de Freitas e Silva.pdf: 13510018 bytes, checksum: 080b7ee10e7a8be555cb7a7ca29c10fb (MD5) / Made available in DSpace on 2017-03-10T13:11:37Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Tese Rafael de Freitas e Silva.pdf: 13510018 bytes, checksum: 080b7ee10e7a8be555cb7a7ca29c10fb (MD5) Previous issue date: 2016-09-06 / As leishmanioses são doenças causadas por protozoários do gênero Leishmania e estão presentes em 98 países e territórios e possuem incidência anual de 2 milhões de casos. A Leishmania (Viannia) braziliensis (L.V. braziliensis) é uma das principais espécies causadoras da leishmaniose cutânea (LC) no Brasil. Apesar disso, ainda não há uma vacina segura e eficaz para ser utilizada em seres humanos. Nesse sentido, o objetivo deste trabalho foi identificar no proteoma predito de L.V. braziliensis, potenciais epítopos de linfócitos T e avaliá-los por meio de ensaios imunológicos. No primeiro capítulo, o proteoma predito de L. braziliensis foi comparado ao de outras espécies e analisado quanto a presença de epítopos. Nessa etapa foram encontrados epítopos derivados de mais de 8 mil proteínas conservadas entre diferentes espécies de Leishmania. Os epítopos foram clusterizados e então utilizados para etapa de docagem molecular com estruturas de MHC I e MHC II depositadas no Protein Data Bank. A docagem molecular resultou em epítopos peptídicos de 15 aminoácidos com alta afinidade de ligação às moléculas de MHC I e MHC II. Os 10 melhores resultados foram então sintetizados e avaliados, in vitro, quanto à capacidade de estimular a proliferação de células mononucleares do sangue periférico (PBMC) de indivíduos com LC após o tratamento (PT). Os resultados indicaram que 50% das moléculas testadas apresentaram capacidade de estimular, significativamente (p<0,05), a proliferação celular quando comparado às células de indivíduos saudáveis que não vivem em região endêmica para LC. No segundo capítulo, os peptídeos foram avaliados quanto à capacidade de estimular a proliferação de PBMC de indivíduos com LC em sua fase ativa (AD) e indivíduos moradores de área endêmica para LC resistentes à infecção (RT). Em paralelo, quantificou-se a expressão do fator de transcrição T-bet em PBMC de indivíduos PT, e citocinas dos perfis Th1, Th2 e Th17 foram mensuradas no sobrenadante de cultura das células de indivíduos PT e AD. Os resultados demonstraram altos níveis de proliferação nas células do grupo RT para todos os peptídeos testados. Além disso, níveis significativos de Tbet foram observados em linfócitos T CD4+ e CD8+ após estímulo com seis peptídeos. Níveis significativos de IFN-γ, TNF e IL-6 foram observados no sobrenadante das células do grupo PT com quatro dos peptídeos testados. Altos níveis dessas citocinas também foram encontrados no sobrenadante do grupo AD. No terceiro capítulo, avaliou-se o efeito dos peptídeos sobre células dendríticas de medula (BMDC) murinas, produção de citocinas de sobrenadante, e células dendríticas esplênicas murinas após estímulo com os peptídeos. Verificou-se altos níveis de MHC II e CD40 em uma subpopulação de BMDC estimuladas com as moléculas e altos níves de TNF e IL-6 após 48h de estímulo. Para as células esplênicas, foram observados altos níveis de subpopulações celulares expressando CD11b+, IL-12p70+, CD205+ e CD11b+ após estímulo com o peptídeo que teve o melhor resultado in silico. Por fim, os resultados indicam o grande potencial imunogênico que os epítopos identificados apresentam, o que dá suporte ao desenvolvimento futuro de abordagens vacinais. / The leishmaniasis are diseases caused by protozoans from the genus Leishmania which are present in 98 countries and territories, with an annual incidence of 2 million cases. Among the other species, Leishmania (Viannia) braziliensis is the main specie implicated with cutaneous leishmaniasis (CL) in Brazil. Besides that, there is no safe and effective vaccine against leishmaniasis to be applied in humans. In this context, the aim of this work was to identify in the predicted proteome of L. braziliensis potential CD4+ and CD8+ T cell epitopes and evaluate them by immunological assays. In the first chapter, the predicted proteome of L. braziliensis was compared with other species and analyzed for the presence of epitopes. In this step, epitopes from more than 8,000 conserved proteins were found among other species of Leishmania. The epitopes were clustered and then used for the molecular docking with MHC I and MHC II structures deposited in the Protein Data Bank. This approach resulted in 15 aminoacids peptide epitopes with high binding affinity for MHC I and MHC II. The 10 best results were synthesized and evaluated in vitro for their capacity to stimulate the proliferation of peripheral blood mononuclear cells (PBMC) of individuals with CL post treatment (PT). The results have shown that 50% of the tested molecules had the capacity to stimulate, significantly (p<0.05), cell proliferation when compared with cells of healthy individuals living in non-endemic regions. For the second chapter, the peptides were evaluated for their capacity to stimulate the proliferation of PBMC from CL individuals with active disease (AD) and of individuals resistant to infection (RT) living in endemic region. In parallel, the T-bet transcription factor expression was quantified in PBMC of PT individuals, and cytokines from the Th1, Th2 and Th17 profiles were measured in culture supernatant of PT and AD groups. High levels of cell proliferation in the RT group were demonstrated for all peptides tested. Moreover, significant levels of T-bet in CD4+ and CD8+ T cells were verified after stimulation with six peptides. For IFN-γ, TNF and IL-6, significant levels were detected in the supernatant of cultures from the PT group with four peptides tested. High levels of these same cytokines were also present in the supernatant of AD group. In the third chapter, the peptide effects over murine bone marrow dendritic cells (BMDC), the production of cytokines in the supernatant and murine spleen dendritic cell subsets were evaluated after peptide stimuli. High levels of MHC II and CD40 were verified for stimulated BMDC and high levels of TNF and IL-6 after 48h of stimuli. For spleen cells, high levels of cells expressing CD11b+, IL-12p70+, CD205+ e CD11b+ were observed after stimulation with the peptide which showed the best in silico result. In conclusion, the results indicate the great immunogenic potential of the identified peptides and support the further development of vaccine approaches using those molecules.

<p>Policies for the control of dengue fever often construct the mosquito-borne virus as a disease of poverty, and call for disease control through “development” to meet the needs of poor populations and impoverished or unsanitary spaces. However, exceptions to the narrative of a rich/poor dengue divide persist in non-poor urban environments across the world. One example is Malaysia's new administrative capital city of Putrajaya – a wealthy and centrally planned new city with among the highest rates of dengue in the country.</p> <p>This dissertation drew on theories of ecosocial epidemiology and urban political ecology to investigate and contextualize the geography of dengue and development in Putrajaya. Key informant interviews and critical discourse analysis found that infectious disease control fell well below other urban priorities for the city, and that globally dominant dengue control strategies targeted toward poor populations were inappropriately transferred to Putrajaya's non-poor local environment. A systematic review of the research literature found no clear evidence showing an association between dengue and conditions of poverty. These findings challenge conventional thinking by policy makers about epidemiological transition and the social determinants of health.</p> <p>The dissertation addresses the dearth of research into the world's neglected tropical diseases (NTDs); in particular, gaps in our understanding of the biopolitical and socioecological contexts (sites of urban governance, sites of health policy development and implementation, and sites of academic research) in which policies for NTDs like dengue are determined, enacted and justified. The dissertation further identifies non-poor urban environments – in particular those undergoing rapid development, such as Putrajaya – as key spaces for future geographic and political ecological research related to epidemiological transition, economic development and the social and environmental determinants of health.</p> / Doctor of Philosophy (PhD)

「被忽視」的熱帶疾病(NTDs)中的寄生蟲疾病(Parasitic Diseases; PDs)除對非洲人群健康之危害甚鉅外，並進而對非洲地區社經體系造成嚴重衝擊與造成巨大的「失能調整人年」損失。由於不易取得治療PDs傳統基本藥物的問題，許多非洲民眾便以其部落社區的傳統治療師所採用的傳統草藥來進行PDs的治療，雖然這些傳統草藥容易取得，但是成分的內容和藥效品質甚或產生嚴重的致命副作用。雖然TRIPS協定第31條和杜哈宣言的第五和第六段對於製藥能力不足或大部分皆無製藥能力的貧窮國家，可以基於「國家緊急危難或其它緊急狀況」的事由，以強制授權方式取得專利藥或較便宜的學名藥以解決造成國家危難的特定公共健康事件，但是國際大藥廠認為無利可圖，不願意花費資金投注於預防或治療此類疾病藥物的相關研發外，高收入的國家為保護其大藥廠的藥物專利，也往往使用一些經濟制裁手段逼迫上述國家就制定國內專利法以保護其藥物專利。雖然經杜哈宣言修正TRIPS協定第31(f)條有關強制授權對外出口的障礙，但是出口國對於強制授權程序與是否能取得政治上和藥廠業者的支持，仍充滿困難。應用「專利池」可以減少交易成本或法律爭議而可調和「強制授權」與解決「權利耗盡」的爭議，有助於解決非洲開發中國家取得專利藥物的困境。PDs造成非洲開發中國家民眾失能等長期痛苦與健康生活損失，類推適用SARS模式，可依TRIPS協定第31條(b)與杜哈宣言第五段(c)將之視為「造成國家緊急危難或其它緊急狀況」的重大公共健康的事由而可行使強制授權。雖然「生醫專利池BVGH」的「非獨家個別授權與免授權費」的操作模式與傳統電信技術專利池不盡相同，但因藥廠不願投入治療PDs的傳統基本藥物存在的副作用與抗藥性的新藥研發，為鼓勵對治療PDs的藥物進行創新研發， BVGH彈性的授權方式與免繳交授權費，將有利於解決開發中國家未來取得新專利藥的困境。除BVGH外，建議結合全球獎勵基金以「激勵拉拔」的方式獎助願意投入治療PDs新藥研發並將專利自願授權給BVGH的藥廠。鑒於全球暖化與最近中東難民潮大量湧進歐洲，罕見的PDs可預期會大量傳播開來，將嚴重衝擊歐洲等先進國家良好的公共衛生體系，而使得「NTDs尤其是PDs不再只是專屬於貧窮國家的疾病，亦將常現於富有的先進國家」。這些NTDs疾病將提供藥廠進行新藥研發的利基，然而在未來可能產生專利池的反競爭問題，導致支配市場獨占性的隱憂值得關注。 / Parasitic diseases (PDs) not only cause the huge health hazards to African populations, but also they further severely impact on African socio-economic system as resulting in huge economic and health losses as assessed by disability adjusted life-years. Since it is not easy for Africans to access the essential medicine to treat PDs, many of them will seek for the help of local healers in tribal communities to treat PDs. Although these traditional herbs are readily available, the content and quality of drug ingredients may even cause serious fatal side effects. Poor countries with insufficiencies or lacks of the pharmaceutical capacities may still access the patented medicines or cheaper generics to solve the national crisis caused by the specific public health events through compulsory licensing (CL) based on "national emergency or the other emergency situations" according to TRIPS Article 31 and Doha Declaration on the fifth and sixth paragraph due to that the large international pharmaceutical companies consider unprofitable, unwilling to spend money to invest on the research and development (R&D) of new drugs for prevention or treatment purpose. Moreover, the high-income countries also tend to exert some of the economic sanctions to force those poor countries to enact national patent law in order to protect drug patents. Furthermore, the mandatory obstacle of exportation authorized by CL from the amended TRIPS Agreement Article 31 (f) by the Doha Declaration has been improved; nevertheless, it is still fraught with difficulties in utilization of CL for the exporting countries because this should be dependent on whether they may actually get the supports from political and the pharmaceutical industry. Application of patent pools model may benefit to reduce transaction costs or legal dispute thus reconciling and resolving issues related to CL as well as doctrine of patent exhaustion and that it is beneficial to help solve dilemma for African countries to access patented drugs. Because Africans severely suffer from disabled caused by PDs thus leading to long-term pain and health life losses, African countries can grant CL as PDs may be regarded as national crisis like SARS causing "national emergency or the other emergency situations" as authorized from TRIPS Agreement Article 31 (f) and Doha Declaration paragraph 5 (c). Although the practice of individual licensing with royalty-free for BVGH is somewhat different from that of traditional patent pools, this licensing practice mode is beneficial to innovation in new drugs R&D to improve the side effects and drug-resistance of traditional essential medicines and help African countries to access patented new drugs in the future. Finally, it is recommended to cooperate with Award Foundation to encourage incentive for pharmaceutical companies which contribute most to new drugs R&D and voluntary licensing to BVGH. Owing to global warming and recent emergence of huge refugees into Europe rare PDs will be obviously spread out thus causing severe impacts on well-established public health system as leading to emergence of PDs in developed countries like Europe. Altogether, such situations definitely provide a good incentive in new drugs R&D for pharmaceutical companies; however, it guarantees concerns on anti-competitive and monopoly issues derived by biomedical pools in the future.