Inflammation and an influx of macrophages are common elements in many diseases. Among pro-inflammatory cytokines, tumor necrosis factor (TNF) plays a central role by amplifying the cytokine network. Progranulin (PGRN) is a growth factor that binds to TNF receptors and interferes with TNF-mediated signaling. Extracellular PGRN is processed into granulins by proteases released from immune cells. PGRN exerts anti-inflammatory effects, whereas granulins are pro-inflammatory. The factors coordinating these ambivalent functions remain unclear. In our study, we identify Y-box binding protein-1 (YB-1) as a candidate for this immune-modulating activity. Using a yeast-2-hybrid assay with YB-1 protein as bait, clones encoding for progranulin were selected using stringent criteria for strong interaction. We demonstrate that at physiological concentrations, YB-1 interferes with the binding of TNF to its receptors in a dose-dependent manner using a flow cytometry-based binding assay. We show that YB-1 in combination with progranulin interferes with TNF-mediated signaling, supporting the functionality with an NF-B luciferase reporter assay. Together, we show that YB-1 displays immunomodulating functions by affecting the binding of TNF to its receptors and influencing TNF-mediated signaling via its interaction with progranulin.

<p><strong>Abstract</strong></p> <p>Sandhoff disease (SD) is a monogenic lysosomal storage disorder caused by a lack of a functional β-subunit of the beta-hexosaminidase A and B enzymes. The clinical phenotype of <em>Hexb</em>^-/-mouse model recapitulates the symptoms and signs of Tay-Sachs and Sandhoff diseases in human. To gain insight into the neuropathology of Sandhoff disease, we defined the role of TNFα in the development and progression of Sandhoff disease pathology in mice, by generating a <em>Hexb^-/-Tnf</em><em>a</em><em>^-/-</em> double knock-out mouse. Behavioural testing and immunostaining data revealed the neurodegenerative role of TNFα in disease pathology. Double knock-out mice showed ameliorated clinical course, with prolonged life span. TNFα-deficient Sandhoff mice also demonstrate decreased levels of astrogliosis, and reduced neuronal cell death. Deletion of <em>Tnfα</em> in Sandhoff mice inhibited JAK2/STAT3 pathway, implicating its role in glia cell activation. This result points to TNFa as a potential therapeutic target to attenuate neuro-pathogenesis.</p> <p>To investigate whether blood-derived or CNS-derived TNFα has the major impact on neurological function, we transplanted <em>Hexb^-/-Tnfα^+/+</em> with bone marrow from either <em>Hexb^-/-Tnfα^-/-</em>or <em>Hexb^-/-Tnf</em><em>a</em><em>^+/+</em> mice donors. Neurological tests shows a significant clinical improvement for Hexb<em>^-/-Tnfα^-/-</em> compared to <em>Hexb^-/-Tnf</em><em>a</em><em>^+/+</em> recipient, regardless the genotype of donor cells. These findings highlight the importance of resident-derived TNFα during the robust neurodegenerative consequences in Sandhoff disease. To understand of the role of microRNAs in Sandhoff pathology, we investigated the miRNA profile in Sandhoff brains. A pattern of dys-regulated microRNAs was evident in Sandhoff CNS. Microarray identified miR-210 and miR-96 dys-regulated pattern in the CNS of Sandhoff mice. Strikingly, neuronal pentraxin, a putative target gene for miR-210, was induced in Sandhoff brains.</p> <p>Taken together, this work establishes the proinflammatory role of TNFα in Sandhoff pathology, leading to massive neuro-apoptosis. Importantly, our studies propose that neuronal pentraxin as a novel target gene for microRNA-210 in Sandhoff brain samples, providing a potential modulator of neurodegeneration.</p> / Doctor of Philosophy (PhD)

L'asma és una malaltia d'etiologia complexa, formada per factors genètics i ambientals, on la interrelació de ambdós factors mitjançant interaccions gen-ambient juga un paper clau. L'objectiu d'aquesta tesi ha sigut aprofundir en el coneixement del paper dels polimorfismes genètics, i la seva interacció amb factors ambientals, en la ocurrència d'asma, atòpia i hiperreactivitat bronquial. Aquest objectiu ha estat desenvolupat a través de la replicació de variants genètiques prèviament identificades, l'avaluació d'interaccions gen-ambient i la identificació de nous gens de susceptibilitat mitjançant un disseny basat en el genotipatge de variants genètiques all llarg del genoma en pools d'ADN. La tesi ha estat majoritàriament duta a terme dins l'estudi European Community Respiratory Health Survey (ECRHS) que està comprès per 5.000 individus seguits durant 9 anys, pels quals es disposa d'un qüestionari complet sobre símptomes respiratoris, avaluacions clíniques, informació sobre exposicions ambientals i mostres de ADN. Aquesta tesi a replicat l'associació del polimorfismes dels gens TNFA i NPSR1 amb asma. A més s'han establert les interaccions entre TNFA i obesitat, NQO1 i contaminació atmosfèrica, i NPSR1 i edat d'inici d'asma. L'anàlisi de pools d' ADN ha permès associar la regió on es situa el gen SGK493 amb atòpia. Aquesta tesi contribueix al coneixement de l'etiologia d'asma amb la identificació i replicació d'associacions genètiques i interaccions gen-ambient. / Asthma is a disease with a complex etiology, involving multiple genetic and environmental factors, and with an important role of the interplay of these factors through gene-environment interactions. In this thesis I aimed to advance our knowledge on the importance of genetic polymorphisms and their interaction with environmental data for the occurrence of asthma and related phenotypes (atopy and bronchial hyperreactivity). This objective was developed through the replication of genetic associations previously reported, the assessment of gene-environment interactions and the identification of new susceptibility genes using genome-wide analysis based on a pooling DNA strategy. The thesis was, mostly, performed within the European Community Respiratory Health Survey (ECRHS). This cohort has information and DNA samples from approximately 5,000 adult subjects followed-up for 9 years, with extensive questionnaires on respiratory symptoms, clinical evaluations and information on environmental exposures. This thesis replicates previous effects on asthma of polymorphisms in TNFA and NPSR1 genes. In addition, interactions have been established between TNFA and obesity, NQO1 and air-pollution, and NPSR1 and age at onset of asthma. The approach based on genome-wide analysis of DNA pools identified the SGK493 region being associated with atopy. This thesis contributes to the understanding of the etiology of asthma through the identification and replication of genetic associations and gene-environment interactions.

L’insuffisance hépatique aiguë (IHA) se caractérise par la perte soudaine de la fonction hépatique résultant de la nécrose massive des hépatocytes en l’absence de pathologie hépatique préexistante. L’IHA s’accompagne de perturbations métaboliques et immunologiques qui peuvent entraîner l’apparition de complications périphériques et cérébrales telles qu’un syndrome de réponse inflammatoire systémique (SIRS), une encéphalopathie hépatique (EH), un œdème cérébral, une augmentation de la pression intracrânienne, et la mort par herniation du tronc cérébral. Les infections sont une complication fréquente de l’IHA et elles sont associées à un risque accru de développer un SIRS et une aggravation subséquente de l’EH avec un taux de mortalité augmenté. L’ammoniaque joue un rôle majeur dans les mécanismes physiopathologiques qui mènent au développement de l’EH et de l’œdème cérébral, et des études récentes suggèrent que les cytokines pro-inflammatoires sont également impliquées. Le but de cette thèse est d’étudier le rôle des cytokines pro-inflammatoires circulantes et cérébrales dans le développement de l’EH et de l’œdème cérébral lors d’IHA. Dans l’article 1, nous démontrons que l’inhibition périphérique du facteur de nécrose tumorale-α (TNF-α) par l’etanercept retarde la progression de l’EH en diminuant le dommage hépatocellulaire, réduisant l’inflammation périphérique et centrale ainsi que le stress oxydatif/nitrosatif hépatique et cérébral associé chez la souris avec une IHA induite par l’azoxyméthane (AOM). Ces résultats démontrent un rôle important du TNF-α dans la physiopathologie de l’EH lors d’IHA d’origine toxique et suggèrent que l’etanercept pourrait constituer une approche thérapeutique dans la prise en charge des patients en attente de transplantation hépatique. Dans l’article 2, nous simulons la présence d’une infection chez la souris avec une IHA induite par l’AOM pour mettre en évidence une éventuelle augmentation de la réponse inflammatoire. Nous démontrons que l’endotoxémie induite par le lipopolysaccharide (LPS) précipite la survenue du coma et aggrave la pathologie hépatique. Les cytokines pro-inflammatoires systémiques et cérébrales sont augmentées de façon synergique par le LPS lors d’IHA et résultent en une activation accrue de la métalloprotéinase matricielle-9 cérébrale qui s’accompagne d’une extravasation d’immunoglobulines G (IgG) dans le parenchyme cérébral. Ces résultats démontrent une augmentation majeure de la perméabilité de la barrière hémato-encéphalique (BHE) qui contribue à la pathogenèse de l’EH lors d’IHA en condition infectieuse. Les résultats de l’article 3 démontrent que l’augmentation de la perméabilité de la BHE lors d’IHA induite par l’AOM en condition non infectieuse ne résulte pas de l’altération de l’expression des protéines constitutives de la BHE. Dans l’article 4, nous démontrons que l’exposition d’astrocytes en culture à des concentrations physiopathologiques d’ammoniaque ou d’interleukine-1β résulte en l’altération de gènes astrocytaires impliqués dans la régulation du volume cellulaire et dans le stress oxydatif/nitrosatif. Un effet additif est observé dans le cas d’un traitement combiné au niveau des gènes astrocytaires impliqués dans le stress oxydatif/nitrosatif. L’ensemble des résultats de cette thèse démontre un rôle important de l’inflammation périphérique et cérébrale dans la survenue des complications neurologiques lors d’IHA et une meilleure compréhension des mécanismes physiopathologiques impliqués pourrait contribuer à la mise en place de stratégies thérapeutiques chez les patients atteints d’IHA en attente de transplantation. / Acute liver failure (ALF) is the clinical manifestation of an abrupt loss of hepatic function resuting from a massive hepatocyte necrosis in a patient with no preexisting liver disease. ALF is associated with metabolic and immunological disturbances that may lead to peripheral and cerebral complications such as systemic inflammatory response syndrome (SIRS), hepatic encephalopathy (HE), brain edema, increased intracranial pressure (ICP) and ultimately death by cerebral herniation. ALF is frequently complicated by infections, which are known to increase the risk of developing a SIRS with a subsequent worsening of HE and higher mortality rates. Ammonia plays a pivotal role in the pathophysiological mechanisms leading to HE and brain edema, and recent studies suggest that pro-inflammatory cytokines may also be involved. The aim of this thesis is therefore to investigate the role of circulating and cerebral pro-inflammatory cytokines in the setting of HE and brain edema during ALF. In article No. 1, we demonstrated that peripheral inhibition of tumor necrosis factor-alpha (TNF-α) by etanercept delays the progression of HE by reducing hepatocellular damage, decreasing peripheral and cerebral inflammation as well as associated oxidative/nitrosatif stress in mice with ALF induced by azoxymethane (AOM). These findings demonstrate an important role of TNF-α in the pathophysiology of HE during toxic liver injury and suggest that etanercept may provide a therapeutic approach in the management of patient awaiting liver transplantation. In article No. 2, we mimicked infection in mice with AOM-induced ALF in order to better understand the effects of an increased inflammatory response. We demonstrated that endotoxemia induced by lipopolysaccharide (LPS) precipitates the onset of coma and worsens the liver pathology. Peripheral and brain pro-inflammatory cytokines are synergistically raised by LPS during ALF and result in a large increase in cerebral matrix metalloprotease-9 (MMP-9) activity that was associated with immunoglobulin G (IgG) extravasation in the brain parenchyma. These results demonstrate a major increase of blood-brain barrier (BBB) permeability that contributes to the pathogenesis of HE during ALF with superimposed infection. Results from article No. 3 demonstrate that increase of BBB permeability during AOM-induced ALF without superimposed infection is not due to alteration of BBB constitutive proteins. In article No. 4, we demonstrated that exposure of cultured astrocytes to pathophysiological concentrations of ammonia or interleukin-1β results in an alteration of the expression of astrocytic genes implicated in cell volume regulation and oxidative/nitrosative stress. An additive effect on astrocytic genes implicated in oxidative/nitrosative was made evident in case of co-treatment. Taken together, results of the present thesis demonstrate a major role of peripheral and cerebral inflammation in the onset of neurological complications during ALF and a better understanding of the pathophysiological mechanisms implicated may contribute to new therapeutic strategies for ALF patients awaiting transplantation.

<p>Uvod: Nespecifičnost kliničke slike sepse, velike individualne razlike u odgovoru organizma na infekciju kao i neophodnost adekvatne inicijalne procene težine kliničke slike, toka i ishoda bolesti, čine istraživanja biomarkera koji bi doprineli pravovremenom postavljanju dijagnoze i adekvatnoj prognozi bolesti izuzetno značajnim. Do sada je ispitivano preko 200 biomarkera od kojih ni jedan nije pokazao zadovoljavajuću senzitivnost i specifičnost. Uloga B limfocita u patogenezi sepse pri tome je nedovoljno istražena. Članovi superfamilije tumor-nekrozis faktora alfa: A proliferation inducing ligand (APRIL), Bcell activating factor (BAFF) i solubilni transmembrane activator and calcium modulator cyclophilin ligand interactor (sTACI) su citokini koji imaju ključnu ulogu u homeostazi B limfocita. Cilj istraživanja bio je da se ispita dijagnostički i prognostički značaj citokina članova superfamilije tumor nekrozis faktora alfa (APRIL, BAFF, sTACI) za procenu težine kliničke slike, razvoja multiorganske disfunkcije (MODS) u prvih 48h hospitalizacije i letalnog ishoda sepse. Ispitanici i metode: Istraživanjem je obuhvaćeno 150 obolelih od sepse lečenih na Klinici za infektivne bolesti i Odeljenju anestezije i reanimacije Kliničkog centra Vojvodine i 30 zdravih dobrovljnih davalaca krvi. Kod svih bolesnika evidentirani su demografski i ostali podaci iz istorije bolesti kao i laboratorijske analize u okviru rutinske dijagnostike sepse. Iz dodatnih 5ml venske krvi svim ispitanicima određene su koncentracije APRIL-a, BAFF-a, sTACI-ja ELISA metodom komercijalnim testovima proizvođača R&amp;D Systems. Rezultati pokazuju da su koncentracije sva tri citokina (APRIL, BAFF i sTACI) statistički značajno povi&scaron;ene kod obolelih od sepse u odnosu na zdravu populaciju (p&lt;0.001), pri čemu APRIL pokazuje najveću senzitinvost (99%) i specifičnost (97%). Najveći dijagnostički značaj BAFF-a ogleda se u sposobnosti distinkcije između sepsi uzrokovanih Gram pozitivnim i Gram negativnim bakterijama (p=0,03). U predikciji razvoja MODS-a i letalnog ishoda sepse multivarijantnom regresionom analizom kao nezavisni prediktori pokazali su se jedino antiinflamatorni biomarker sTACI receptor i klinička procena pacijenta iskazana kroz APACHE II i SOFA skor. Senzitivnost i specifilnost sTACI receptora u predikciji razvoja MODS-a i letalnog ishoda daleko nadma&scaron;uje do sada rutinski kori&scaron;ćen prokalcitonin. Zaključak: Dobijeni rezultati ukazuju na to da su citokini koji učestvuju u regulaciji funkcije B limfocita značajni dijagnostički i prognostički parametri u sepsi. Predominacija antiinflamatornog odgovora na koju ukazuju povi&scaron;ene koncentracije sTACI receptora pokazala se pored APACHE II i SOFA skora kao jedini nezavisni prediktor razvoja MODS-a i letalnog ishoda septičnih bolesnika. Neophodna su dalja istraživanja u pravcu određivanja momenta kada u imunskom odgovoru organizam prelazi iz stanja dominacije proniflamatornog u dominaciju antiinflamatornog odgovora radi pravovremenog reagovanja imunomodulatornom terapijom.</p> / <p>Introduction: The nonspecific clinical presentation of sepsis and great individual response variations, as well as huge significance of adequate early prognosis of its clinical course and outcome made sepsis biomarkers research extremely significant. The properties of more than 200 biomarkers have been evaluated for prognostic value, but none have adequate specificity and sensitivity. The role of the B cells in sepsis pathogenesis also remains unclear. Tumor necrosis factor alpha (TNF-&alpha;) superfamily members: A proliferation inducing ligand (APRIL), Bcell activating factor (BAFF) and soluble transmembrane activator and calcium modulator cyclophilin ligand interactor (sTACI) are key factors in B cell biology. The aim of the study was to evaluate the diagnostic and prognostic significance of determining the concentrations of tumor necrosis factor alpha superfamily members for the prediction of MODS development in the first 48h of hospitalization as well as outcome prediction.<br />Subjects and methods: The study included 150 patients suffering from sepsis treated at the Clinic for infectious diseases and Department for anesthesiology and reanimatology of the Clinical center of Vojvodina, and 30 healthy volunteer blood donors. The demographic and other data regarding routine blood analysis performed during sepsis treatment of the patients has been acquired from their hospitalization documentation. Additional 5 ml of venous blood was taken from the patients and the concentrations of APRIL, BAFF and sTACI have been determined using the ELISA method by using R&amp;D Systems commercial kit&rsquo;s. Results: There is a statistically significant difference in concentrations of APRIL, BAFF and sTACI between healthy blood donors and septic patients (p&lt;0.001). APRIL showed the highest sensitivity (99%) and specificity (97%) in distinguishing sepsis from healthy subjects. BAFF showed statistically significant higher concentrations in Gram positive than in Gram negative sepsis (p=0,03). In the multivariate logistic regression analysis, only anti-inflammatory cytokine sTACI and APACHE II or SOFA score remained significant predictors of MODS and lethal outcome. sTACI showed greater sensitivity and specificity for MODS and outcome prediction then the widely used procalcitonin.&nbsp; Conclusions: The concentrations of TNF superfamily members, the main regulators of B cell function, have a significant diagnostic and prognostic value in predicting sepsis course and outcome. The predomination of the anti-inflammatory response, as being pointed out by elevated concentrations of sTACI receptors, has proved to be the only independent predictor, besides APACHE II and SOFA score, in MODS and lethal outcome development in sepsis. Further research is needed in order to accurately determine the exact moment when the immunological response shifts from the predominance of the pro-inflammatory response to the predominance of the anti-inflammatory response, so as to ensure the timely application of therapy that modulates the immunological response.</p>

Alterações metabólicas, inflamatórias e do sistema nervoso autônomo estão presentes em pacientes com insuficiência cardíaca. No entanto, não há até o momento, consenso de que tais alterações são decorrentes da disfunção ventricular ou da síndrome de insuficiência cardíaca. Objetivo: Avaliacão do metabolismo e atividade inflamatória em pacientes com miocardiopatia dilatada chagásica e idiopática e sua correlação com medidas de funcão do sistema nervoso autônomo. Casuística: Foram avaliados 46 pacientes divididos em três grupos: pacientes com miocardiopatia dilatada idiopática, chagásica e controle, pareados entre si de acordo com sexo e idade e índice de massa corpórea. Critérios de inclusão: miocardiopatia chagásica com sorologia positiva em dois métodos diferentes (imunofluorescência indireta e ELISA) e miocardiopatia dilatada idiopática com idade superior a 18 anos; ambos os sexos; Índice de massa corporal (IMC) entre 18,5 e 25 kg/m2 e fração de ejeção < 40% pelo método de Simpson ao ecocardiograma. Metodologia: Todos pacientes foram submetidos a medidas antropométricas: índice de massa corporal e medida da porcentagem de gordura corporal através de bioimpedância. Coletado sangue para dosagens sanguíneas de leptina, adiponectina, interleucina-6, fator de necrose tumoral, glicose, insulina, colesterol total, HDL-Colesterol, LDL-Colesterol e triglicerídeos após jejum de 12 horas e realizados: Holter de 24 horas para avaliação da função autonômica, ecocardiograma transtorácico bidimensional complementado com modo-M, Doppler pulsátil, tecidual e colorido. Resultados: Não houve diferenças entre os grupos com relação a dosagem de glicemia, colesterol total, LDL-colesterol, HDL-colesterol e triglicerídeos. Com relação à leptina e adiponectina e o índice HOMA-IR, não houve diferença entre os grupos. As dosagens de insulina foram menores no grupo chagásico em comparação ao grupo controle e de idiopático (5,4; 8,0; 9,9) respectivamente (p = 0,007). As dosagens de interleucina-6 e fator de necrose tumoral-alfa foram maiores no grupo chagásico em relação aos outros grupos. A insulina correlacionou positivamente no grupo chagásico com leptina (r = 0,579; p = 0,024) e sistema nervoso autônomo ( atividade simpática) BF/AF ( r = 0,562; p = 0,029) e BF (r = 0,562; p = 0,029) e negativamente com adiponectina (r = -0,603; p = 0,017). Na análise multivariada, apenas a adiponectina foi significante. A adição de uma unidade de adiponectina reduziu a média de insulina em 0,332. Conclusões: Os níveis de insulina foram menores nos pacientes com miocardiopatia chagásica em comparação aos pacientes com miocardiopatia dilatada idiopática e controle. Os níveis das citocinas inflamatórias (TNF-alfa e interleucina-6) foram maiores nos pacientes com miocardiopatia chagásica em comparação aos pacientes com miocardiopatia dilatada idiopática e controle. A insulina correlacionou negativamente no grupo chagásico com adiponectina / Metabolic, inflammatory and autonomic nervous system changes are present in patients with heart failure. However, there is so far, consensus that these changes are due to ventricular dysfunction or heart failure syndrome. Objective: Evaluation of metabolism and inflammatory activity in patients with Chagas\' disease and idiopathic dilated cardiomyopathy and its correlation with user function measures the autonomic nervous system. Patients: A total of 46 patients divided into three groups: patients with idiopathic dilated cardiomyopathy, Chagas and control, matched each other according to sex and age and body mass index. Inclusion criteria: serology for Chagas\' disease in two different methods (indirect immunofluorescence and ELISA); idiopathic dilated cardiomyopathy; older than 18 years; both sexes; Body mass index (BMI), ie between 18.5 and 25 kg / m2 and ejection fraction < 40% by Simpson method by echocardiography. Methods: All patients underwent anthropometric measurements: body mass index and measure the percentage of body fat by bioimpedance. Blood was collected for blood leptin dosages, adiponectin, interleukin-6, tumor necrosis factor, glucose, insulin, total cholesterol, HDLcholesterol, LDL-cholesterol and triglyceride levels after fasting for 12 hours and performed: 24 hours for evaluation Holter autonomic function, two-dimensional transthoracic echocardiography complemented by M-mode, pulsed Doppler, tissue and colorful. Results: There were no differences between groups with respect to blood glucose levels, total cholesterol, LDL-cholesterol, HDLcholesterol and triglycerides. With respect to leptin and adiponectin and HOMAIR, there was no difference between groups. Insulin doses were lower in the chagasic group compared to the control group and Idiopathic: 5.4; 8.0; 9.9, respectively (p = 0.007). Dosages of interleukin-6 and tumor necrosis factoralpha were higher in the chagasic group compared to other groups. Insulin positively correlated in the chagasic group with leptin (r = 0.579; p = 0.024) and autonomic nervous system (sympathetic activity) LF / HF (r = 0.562; p = 0.029) and BF (r = 0.562; p = 0.029) and negatively with adiponectin (r = -0.603; p = 0.017). In multivariate analysis, only adiponectin was significant. The addition of an adiponectin unit reduced the average insulin 0.332. Conclusions: Insulin levels were lower in patients with Chagas\' heart disease compared to patients with idiopathic dilated cardiomyopathy and control. The levels of inflammatory cytokines (TNF-alpha and interleukin-6) were higher in patients with Chagas\' heart disease compared to patients with idiopathic dilated cardiomyopathy and control. Insulin negatively correlated with adiponectin in the chagasic group

Introdução: A rinite alérgica (RA) e a rinossinusite crônica (RSC) são doenças inflamatórias nasais com prevalência alta e crescente. Estima-se que 15,5% dos norte-americanos tenham RSC, e estudo recente encontrou prevalência de 5,51% na cidade de São Paulo, enquanto a RA acomete entre 10 e 20% da população mundial. Apesar de terem mecanismos fisiopatológicos distintos, em ambas, há recrutamento de células de defesa, principalmente linfócitos T, e produção de citocinas inflamatórias. Esses mediadores variam não apenas entre as doenças, mas também entre as populações acometidas, e seu conhecimento é importante para o diagnóstico correto e direcionamento da terapia escolhida. Objetivos: Mapear os mediadores inflamatórios presentes no lavado nasal e no condensado do ar exalado na RSC e na RA, avaliando possíveis biomarcadores da doença, e analisar o endotipo inflamatório dos pacientes estudados. Além disso, avaliar a qualidade de vida, o nível de obstrução nasal, a qualidade do sono dos pacientes afetados, o transporte mucociliar e coletar material para análise de pH, contagem de células totais e seu diferencial. Pacientes e métodos: Estudo exploratório prospectivo em corte transversal, sendo os pacientes divididos em quatro grupos: 1) Grupocontrole com pacientes sem queixas; 2) Pacientes com RA com prick test positivo; 3) Pacientes com RSC com polipose; e 4) Pacientes com RSC sem polipose. Todos os pacientes responderam a quatro questionários: 20-Item Sino-Nasal Outcome Test (SNOT-20p), Nasal Obstruction Symptom Evaluation (NOSE), o Índice de Qualidade do Sono de Pittsburgh (Pittsburgh Sleep Quality Index - PSQI-BR) e o questionário para triagem e diagnóstico da asma da European Community Respiratory Health Survey (ECRHS). Foi realizado exame físico, incluindo endoscopia nasal (escore de Lund- Kennedy modificado) e, nos pacientes com RSC, avaliação da tomografia computadorizada (TC) de face (escore de Lund-Mackay). Foi também avaliado o transporte mucociliar por meio do teste da sacarina. Coletou-se o condensado do ar exalado para análise do pH e lavado nasal para avaliação do pH, da presença de citocinas e da celularidade (total e diferencial). Foi avaliada a presença de IL-4, IL-5, IL-8, IL-17A, IL-22, TNF-Alfa e IFN-Gama no lavado nasal e IL-5, IL-17A, IL-22 e IFN-Gama no condensado do ar exalado. Resultados: Os pacientes com RSC apresentaram escores significativamente piores nos questionários de obstrução nasal (NOSE, p < 0,01) e qualidade de vida (SNOT-20p, p < 0,01) quando comparados aos controles, e tanto os pacientes com RSC quanto com RA apresentaram pior qualidade do sono (PSQI-BR, p < 0,01). O escore de extensão de Lund- Mackay foi mais elevado nos pacientes com RSC com polipose (p < 0,02). O teste da sacarina apresentou tempo mais prolongado no grupo RSC com polipose (p < 0,01). O pH do condensado do ar exalado não diferiu entre os grupos. O grupo RSC com polipose apresentou tanto diferença do pH (p < 0,01) quanto da contagem de células totais do lavado nasal (p < 0,01) quando comparado ao grupo-controle, porém sem diferença na contagem diferencial. IFN? do condensado foi mais elevado no grupo RA em comparação ao grupo C (p=0,05), enquanto IL-5 foi mais alto no grupo RSC com polipose quando comparado ao grupo RSC sem polipose (p=0,02). Os pacientes foram, então, divididos em endotipos, segundo os grupos descritos por Tomassen et al., sendo que endotipos são os subtipos da doença definidos funcionalmente e patologicamente por mecanismos moleculares distintos. Conclusão: Pacientes com RSC apresentaram escores piores nos questionários de qualidade de vida (SNOT-20p e NOSE), o que, em parte, poderia ser atribuído à pior qualidade do sono apresentada tanto por estes pacientes quanto pelos portadores de RA. O teste da sacarina evidenciou pior transporte mucociliar nos pacientes com RSC com polipose. Não houve diferença do pH do condensado do ar exalado, sugerindo que, apesar de interessante na avaliação das vias aéreas inferiores, este pode não ser um bom teste para análise das vias aéreas superiores. Foram encontradas alterações significantes tanto do pH quanto da contagem de células totais do lavado nasal do grupo com RSC com polipose, sem, no entanto, haver diferença na contagem diferencial. Dos 17 pacientes com RSC com perfil completo de citocinas, 12 se encaixam em endotipos já descritos, sendo que, dos cinco restantes, dois apresentam o mesmo perfil, podendo indicar um novo subgrupo / Introduction: Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are nasal inflammatory diseases with high and increasing prevalence. It is estimated that 15.5% of Americans have CRS, and a recent study found a prevalence of 5.51% in the city of São Paulo, while AR affects between 10 and 20% of the world population. Although they have distinct pathophysiological mechanisms, in both there is recruitment of defense cells, mainly T lymphocytes, and production of inflammatory cytokines. These mediators vary not only between diseases but also among affected populations, and their knowledge is important for the correct diagnosis and targeting of the therapy chosen. Objectives: To map the inflammatory mediators present in the nasal wash and the exhaled breath condensate in the CRS and AR, evaluating possible biomarkers of this diseases, and to analyze the inflammatory endotype of the patients studied. In addition, assess quality of life, level of nasal obstruction, sleep quality of affected patients, mucociliary transport and collect samples for pH analysis, total cell count and its differential. Patients and Methods: Prospective cross-sectional exploratory study, divided into four groups: 1) Control group with patients without complaints 2) Patients with AR with prick test positive 3) Patients with CRS with polyps 4) Patients with CRS without polyps. All patients responded to four questionnaires: 20-Item Sino-Nasal Outcome Test (SNOT-20p), Nasal Obstruction Symptom Evaluation (NOSE), Pittsburgh Sleep Quality Index (PSQI-BR) and European Community Respiratory Health Survey (ECRHS) questionnaire for screening and diagnosis of asthma. A physical examination was performed, including nasal endoscopy (modified Lund-Kennedy score) and, in patients with CRS, a computerized tomography (Lund-Mackay score) evaluation. The mucociliary transport was also evaluated through the saccharin test. The exhaled breath condensate was collected for pH analysis and the nasal wash for evaluation of pH, cytokines and cellularity (total and differential). The presence of IL-4, IL-5, IL-17, IL-17A, IL-22, TNF-Alfa and IFN-Gama in the nasal wash and IL-5, IL-17A, IL-22 and IFN-Gama in the exhaled breath condensate. Results: Patients with CRS had significantly worse scores in the nasal obstruction questionnaire (NOSE, p < 0.01) and quality of life questionnaire (SNOT-20p, p < 0.01) when compared to controls, and both patients with CRS and AR presented worse sleep quality (PSQI-BR, p < 0.01). The Lund-Mackay extension score was higher in patients with CRS with polyps (p < 0.02). The saccharin test showed longer time in the CSR group with polyps (p < 0.01). The pH of the exhaled breath condensate did not differ between groups. The CRS with polyps group presented both pH difference (p < 0.01) and higher total nasal wash cell count (p < 0.01) when compared to the control group, but with no difference in the differential count (p = 0.05), while IL-5 was higher in the CRS group with polyps when compared to the RSC without polyps group (p = 0.02). Patients were then divided into endotypes according to the groups described by Tomassen et al, Endotypes are the subtypes of the disease defined functionally and pathologically by distinct molecular mechanisms. Conclusions: Patients with CRS presented worse scores on quality of life questionnaires (SNOT-20p and NOSE), which could be attributed in part to the poorer quality of sleep presented by both patients with CRS and AR. The saccharin test evidenced worse mucociliary transport in patients with CRS with polyps when compared with control group. There was no difference in the pH of the exhaled breath condensate, suggesting that, although interesting in the evaluation of the lower airways, this may not be a good test for analyzing the upper airways. Significant alterations were found in both pH and total nasal wash cell count in the CSR group with polyposis, but there was no difference in the differential count. Of the 17 patients with CRS with complete cytokine profile, 12 fit into already described endotypes, and of the remaining five, two have the same profile, which may indicate a new subgroup

A alveolite é uma complicação pós-operatória de carácter inflamatório que acomete alvéolos de dentes recém-extraídos. A incidência dessa complicação varia de 1 a 4% e pode chegar a 30%. O objetivo deste estudo foi analisar os mecanismos biológicos envolvidos no processo de reparo de alvéolos intencionalmente infectados, em ratos; comparar diferentes modalidades de tratamento e correlacionar os resultados encontrados através de duas análises (microscópica e molecular). Foram utilizados 84 ratos, divididos nos grupos: I: alvéolo não infectado; II: alvéolo infectado sem nenhum tratamento; III: alvéolo infectado tratado com irrigação de solução de iodeto de sódio a 2% e peróxido de hidrogênio a 3% na proporção de 1:1; e IV: alvéolo infectado submetido à curetagem, irrigação com soro fisiológico e preenchimento com uma pasta à base de metronidazol. Os animais foram eutanasiados aos 6, 15 e 28 dias pós-operatório. Foi realizada a análise quantitativa da expressão de genes envolvidos no processo de reparo [colágeno tipo I (COL-I), fator de crescimento do endotélio vascular (VEGF), osteocalcina (OCN), fosfatase alcalina (ALP), runt-related transcription factor 2 (RUNX2) e fator de necrose tumoral alfa (TNF-\'alfa\')], através da RealTimePCR, correlacionando sua expressão com as características microscópicas observadas qualitativa e quantitativamente. Com base nos resultados da análise microscópica e molecular, podemos concluir que os marcadores RUNX2, OCN e TNF-\'alfa\' podem ser usados como indicadores para avaliar a neoformação óssea e a quantidade de infiltrado inflamatório em alveolite. Os marcadores ALP e VEGF não representaram adequadamente o que se observou microscopicamente. Embora o tratamento da alveolite com a pasta à base de metronidazol promova maior densidade de neoformação óssea aos 28 dias, não há diferenças entre os tratamentos. / Dry socket is an inflammatory postoperative complication that undertakes sockets of recently extracted teeth. The incidence of such complication varies from 1 to 4% and might reach up to 30%. The objective of this study was to analyze the biological mechanisms involved in the repair process of intentionally infected sockets in mice; compare different treatment conditions and correlate the results of two different analysis (microscopic and molecular). 84 mice were used in this study, divided according the following groups: I: uninfected socket; II: infected socket without any treatment; III: infected socket treated with irrigation of 2% sodium iodide and 3% hydrogen peroxide solution at 1:1 proportion; and IV: infected socket submitted to curettage, physiological saline solution irrigation and fulfillment with metronidazole base paste. The animals were killed at a postoperative period of 6, 15 and 28 days. A quantitative analysis was performed using a RealTimePCR to evaluate the genes expression involved [Collagen Type I (COL-I), vascular endothelial growth factor (VEGF), osteocalcin (OCN), alkaline phosphatase (ALP), runt-related transcription factor 2 (RUNX2) and tumor necrosis factor-alpha (TNF-\'alpha\')], in the repair process, correlating its expression with the microscopic characteristics observed in both qualitative and quantitative manner. Based in the results of the microscopic and molecular analysis, it can be concluded that the RUNX2, OCN and TNF-\'alpha\' markers can be used as indicators to evaluate the dry socket bone neoformation and inflammatory infiltrate quantity. The ALP and VEGF markers did not represented appropriately what was observed microscopically. Although the dry socket treatment with metronidazole base paste promotes an increase in the bone neoformation density at 28 days, no difference was found among the treatments.

Introdução: O fragmento amino-terminal do pró-peptídeo natriurético do tipo B (NT-proBNP) é um forte marcador de doença cardiovascular com evidências recentes de que a inflamação também pode influenciar seus valores. A diferenciação dessa variável de confusão é de particular interesse nas doenças reumáticas. Objetivos: Avaliar o comportamento dos valores de NT-proBNP em pacientes com espondilite anquilosante (EA) pré e pós uso de bloqueadores de TNF para determinar a possível associação entre os valores de NT-proBNP e os parâmetros inflamatórios. Métodos: Quarenta e cinco pacientes consecutivos com EA sem evidência prévia ou atual de doença cardiovascular ou disfunção miocárdica sistólica e que eram elegíveis para terapia anti-TNF foram incluídos prospectivamente. Todos os pacientes receberam bloqueadores de TNF e foram avaliados para concentrações circulantes de NT-proBNP, parâmetros clínicos e laboratoriais de atividade de doença, fatores de risco cardiovasculares tradicionais e ecodopplercardiografia convencional e tecidual no momento da inclusão e após seis meses de tratamento. Resultados: No momento da inclusão, todos os pacientes tinham EA ativa, os valores de NT-proBNP tinham uma mediana de 36 (20-72) pg/mL e 11% dos valores estavam altos mesmo na ausência de alteração miocárdica sistólica. A análise de regressão linear múltipla revelou que esse peptídeo estava independentemente correlacionado com o VHS (p < 0,001), com a idade dos pacientes (p = 0,01) e com a pressão de pulso (p = 0,01) no momento da inclusão. Após seis meses, todos os parâmetros relacionados a doença de base melhoraram e os valores de NT-proBNP se reduziram significativamente [24 (16-47) pg/mL, p = 0,037] quando comparados com os valores do momento da inclusão. As mudanças nos valores de NT-proBNP correlacionaram-se positivamente com as mudanças nos valores do VHS (r = 0,41, p = 0.006). Os fatores de risco cardiovasculares avaliados permaneceram estáveis durante o seguimento. Conclusão: As elevações nos valores de NT-proBNP devem ser interpretadas com cuidado nos pacientes com EA ativa e sem evidência de doença cardiovascular. A redução no curto prazo dos valores de NT-proBNP nesses pacientes recebendo terapia anti-TNF parece refletir uma melhora do estado inflamatório / Introduction: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a strong marker of cardiovascular disease with recent evidence that inflammation may also influence its levels; discrimination of this confounding variable is of particular interest in rheumatic diseases. Objectives: to evaluate NT-proBNP in ankylosing spondylitis (AS) patients pre- and post-TNF blocker to determine the possible association between NT-proBNP levels and inflammatory parameters. Methods: Forty-five consecutive AS patients without previous/current cardiovascular disease or systolic myocardial dysfunction, who were eligible to anti-TNF therapy, were prospectively enrolled. All patients received TNF blockers and they were evaluated for circulating NT-proBNP levels, clinical and laboratory parameters of disease activity, traditional cardiovascular risk factors, and conventional and tissue Doppler imaging echocardiography at baseline (BL) and six months after (6M) treatment. Results: At BL, all patients had active AS, NT-proBNP levels had a median of 36 (20-72) pg/mL and 11% were high in spite of no systolic alteration. Multiple linear regression analysis revealed that this peptide, at BL, was independently correlated with ESR (p < 0.001), age (p = 0.01) and pulse pressure (p = 0.01). After 6M, all disease parameters improved and NT-proBNP levels were significantly reduced [24 (16-47) pg/mL, p = 0.037] compared to BL. Changes in NT-proBNP were positively correlated with ESR changes (r = 0.41, p = 0.006). Cardiovascular risk factors remained stable during follow-up. Conclusion: our data suggests that elevations of NT-proBNP should be interpreted with caution in active AS patients with no other evidence of cardiovascular disease. The short-term reduction of NT-proBNP levels in these patients receiving anti-TNF therapy appears to reflect an improvement in inflammatory status

Fragestellung: Es wird untersucht, ob die isolierte hypertherme Extremitätenperfusion (ILP) mit TNF-alpha und Melphalan eine akute systemische inflammatorische Reaktion (SIRS) auslöst. Weiterhin soll der Einfluß von zwei verschiedenen total intravenösen Narkoseverfahren sowie der Zusammenhang der unabhängig voneinander bestimmten Meßgrößen Herzindex/Sauerstoffverbrauchsindex (HI/VO2I) und Sauerstoffverbrauchsindex/Sauerstoffangebotsindex (VO2I/DO2I) beim Entstehen eines SIRS analysiert werden. Methodik: 73 Patienten, die sich einer ILP mit TNF-alpha und Melphalan in Allgemeinanästhesie unterzogen, wurden in diese klinische, retrospektive Untersuchung eingeschlossen. Ein erweitertes kardiopulmonales Monitoring, bestehend aus kontinuierlicher Thermodilution, kontinuierlicher indirekter Kalorimetrie, invasiver Blutdruckmessung sowie arterieller und gemischtvenöser Blutgasanalysen ermöglichte die Analyse von hämodynamischen, metabolischen und gasanalytischen Parametern an 8 definierten Zeitpunkten im Verlauf der ILP mit TNF-alpha und Melphalan. 21 Patienten erhielten eine Narkose mit Etomidate/Midazolam/Sufentanil/Pancuroniumbromid (N1), und bei 52 Patienten wurde die Narkose mit Propofol/Remifentanil/Cis-Atracurium (N2) durchgeführt. Ergebnisse: Während der ILP mit TNF-alpha und Melphalan kam es bei folgenden Parametern zu signifikanten Veränderungen in der systemischen Reperfusionsphase gegenüber den Ausgangswerten vor der extrakorporalen Zirkulation: Herzfrequenz, Herzindex, Temperatur, Gesamtsauerstoffaufnahme, pulmonale Sauerstoffaufnahme, Sauerstoffangebot, systemischer Gefäßwiderstand, pulmonalarterieller Mitteldruck, kardiale Füllungsdrücke, gemischtvenöser Kohlendioxid- und Sauerstoffpartialdruck, arterieller Kohlendioxid- und Sauerstoffpartialdruck, gemischtvenöse Sauerstoffsättigung, arterieller und gemischtvenöser Sauerstoffgehalt sowie arterieller pH- und Laktatwert. Bezüglich der Narkoseverfahren zeigte die Narkose N2 versus N1 signifikant geringere Herzfrequenzen und Herzindices, sowie signifikant erhöhte pulmonalarterielle Mitteldrücke, pulmonale und systemische Gefäßwiderstände. Die Korrelationen von HI/VO2I und VO2I/DO2I sind in der prä-Bypass-Phase gering, nehmen im Verlauf der ILP zu und erreichen zum Zeitpunkt der systemischen Reperfusion jeweils ihren Maximalwert. Schlußfolgerungen: Die ILP mit TNF-alpha und Melphalan kann als dynamisches in-vivo Modell für das Entstehen einer SIRS-Reaktion aufgefaßt werden. Die inflammatorische Antwort ist in ihrem Ausmaß eher gering und erreicht nach Aufhebung der extrakorporalen Zirkulation mit systemischer Reperfusion der behandelten Extremität ihr Maximum. Die Überwachung der Teilkreisläufe, ein erweitertes hämodynamisches Monitoring sowie forcierte intravenöse Volumentherapie in der Reperfusionsphase lassen dieses Behandlungsverfahren für die Patienten in Allgemeinanästhesie sicher erscheinen. Beide beschriebenen Narkoseverfahren sind für diese operative Therapie geeignet. Der Zusammenhang von HI/VO2I sowie VO2I/DO2I ist im Verlauf der ILP gering, kann sich aber mit Zunahme der inflammatorischen Reaktion verstärken. / objective: To determine whether the isolated hyperthermic limb perfusion (ILP) with tumor necrosis factor alpha (TNF-alpha) and melphalan causes an acute systemic inflammatory response syndrome (SIRS)? Also analysed will be the influence of two total intravenous anaesthesias and the correlation of independent measured values cardiac index/oxygen consumption index (HI/VO2I) and oxygen consumption index/oxygen delivery index (VO2I/DO2I). design: Retrospective review of hemodynamic, metabolic and blood gas values from 73 patients, undervented isolated hyperthermic limb perfusion of leg with TNF-alpha and Melphalan in general anaesthesia. methods: Cardiopulmonary monitoring consisted of continuous thermodilution, continuous calorimetry, arterial pressure and arterial as well as admixed blood-gas analyses. Values were measured on 8 time points in the course of ILP. In 21 patients anaesthesia was carried out with drug-combination of Etomidate/Midazolam/Sufentanil/Pancuroniumbromid (N1), and 52 patients were given anaesthesia with Propofol/Remifentanil/Cis-atracurium (N2). results: The following values changed significantly after limb-reperfusion compared with the baseline: heart rate, cardiac index, temperature, oxygen consumption, pulmonary oxygen consumption, oxygen delivery, systemic vascular resistance, mean pulmonary arterial pressure, precardial pressures, admixed carbon dioxide pressure, admixed oxygen pressure, arterial carbon dioxide pressure, arterial oxygen pressure, admixed oxygen saturation, arterial and admixed oxygen content as well as arterial pH- and lactat. conclusions: The isolated hyperthermic limb perfusion with TNF-alpha and melphalan may be used as a dynamic in-vivo model for the development of an SIRS. The inflammatory response is slight and reached the maximum after reperfusion of treated limb. Monitoring of the two circulations, extended cardiopulmonary monitoring and intravenous volumetherapie in the reperfusion time makes this cancer treatment in general anaesthesia safe. Both anaesthesia are suitable. The correlations of HI/VO2I as well as VO2I/DO2I are low in the beginning and rise with the increase of the inflammatory response.