El presente tema de tesis pretende realizar un análisis costo efectividad entre la Técnica Reacción en Cadena de la Polimerasa y la Prueba de Sensibilidad y Resistencia para el diagnóstico de tuberculosis multidrogorresistente , este análisis busca la mejor relación entre beneficios y costos para alcanzar la forma más eficaz de realizar la vigilancia epidemiológica de la tuberculosis multidrogorresistente, tomando en cuenta que los consecuentes diagnósticos tardíos generan multidrogorresistencia y que el costo individual por paciente multidrogorresistente asciende aproximadamente a 7000 Bs. 1 Las pruebas de sensibilidad a los fármacos antituberculosos son imprescindibles y recomendadas para la vigilancia epidemiológica de la resistencia, debida generalmente a malos tratamientos o mala supervisión de los mismos en grupos de alto riesgo difíciles de manejar y controlar (reclusos, enfermos con VIH). La sensibilidad a los fármacos esenciales se investiga en todo enfermo nuevo, en fracasos de tratamiento y en recaídas. La prueba de sensibilidad y resistencia es una técnica que tiene buena sensibilidad (70-90%) pero el aislamiento de las micobacterias por cultivo es entorpecido por su lento crecimiento, la demora hace poco útil este tipo de estudios con carácter asistencial ya que los resultados se obtienen en 6 semanas, se pueden obtener excelentes resultados si se mantienen estrictamente las normas de control de calidad. pero el neumólogo siempre recibe una imagen vieja de la situación, de tal manera que en casos en los que se requiera una toma de decisiones rápidas para instaurar una terapéutica efectiva su valor es muy limitado.

The recent increase in the incidence of tuberculosis (TB) with the emergence of multidrug-resistant (MDR) cases has lead to the search for new TB-drugs. Mycobacterium tuberculosis is a complex, resilient organism, and it is important to note that new drugs are required which can reduce TB’s six month treatment time and can be effective against drug-resistant strains of mycobacteria. Plants contain numerous biological active compounds, many of which have been shown to have antimicrobial activity. The search for biologically active extracts based on traditional use of plants is relevant due to the appearance of microbial resistance to many antibiotics and the occurrence of fatal opportunistic infections. Ethanol extracts of seven selected ethnobotanically South African medicinal plants (Artemisia afra, Dodonaea angustifolia, Drosera capensis, Galenia africana, Prunus africana, Syzygium cordatum and Ziziphus mucronata) were investigated for their antimycobacterial activity against two Mycobacterium species. The minimum inhibitory concentration (MIC) of ethanol extracts of A. afra, Dodonaea angustifolia, Drosera capensis and G. africana ranged from 0.781 to 6.25 mg/mL against a non-pathogenic strain of mycobacteria, ‘M. smegmatis’. G. africana showed the best activity, exhibiting an MIC of 0.781 mg/mL and a minimum bactericidal concentration (MBC) of 1.563 mg/mL against M. smegmatis. A drug sensitive strain of M. tuberculosis was found to be susceptible to the ethanol extracts of Dodonaea angustifolia and G. africana. (MICs 5.0 and 1.2 mg/mL respectively) when using the rapid radiometric-BACTEC method. The phytochemical analysis of G. africana led to the isolation and identification of three known compounds namely; (2S)-5,7,2'-trihydroxyflavanone, (E)-3,2',4'-trihydroxychalcone (not reported from natural sources) and (E)-2',4'-dihydroxychalcone. A novel chalcone ‘(E)-3,2',4'-trihydroxy-3'-methoxychalcone’ was also isolated from the ethanol extract of G. africana. Isolation of (2S)-5,7,2'-trihydroxyflavanone, (E)-3,2',4'-trihydroxychalcone and E)-3,2',4'-trihydroxy-3'-methoxychalcone was reported for the first time from this plant. The MIC of novel compound against M. tuberculosis was found to be 50.0 µg/mL whereas (2S)-5,7,2'-trihydroxyflavanone and (E)-3,2',4'-trihydroxychalcone exhibited an MIC of 100.0 µg/mL. During synergistic studies using (2S)-5,7,2'-trihydroxyflavanone and (E)-2',4'-dihydroxychalcone with the antituberculosis drug INH, it was found that the MICs of INH and the compounds were reduced sixteen and eight-fold respectively, resulting in a Fractional Inhibitory Concentration (FIC) of 0.1250 and 0.1875 respectively. The synergistic effect of two isolated compounds (2S)-5,7,2'-trihydroxyflavanone and (E)-2',4'-dihydroxychalcone) in in vitro studies also showed synergistic action, reducing their original MICs four-fold resulting in a FIC of 0.5. Since (2S)-5,7,2'-trihydroxyflavanone and (E)-2',4'-dihydroxychalcone from G. africana showed synergistic activity with INH, it is speculated that the compounds might have similar mechanism as that of INH. However, mechanistic studies on these compounds should be done in order to get an indication of the ‘flavonoids and chalcones’ interferences on mycolic acid synthesis, membrane synthesis and enzyme inhibition. Our investigation on the NADPH oxidase activity of (2S)-5,7,2'-trihydroxyflavanone with Mtr, found that this compound failed to exhibit any NADPH oxidase activity at 800 µM concentrations. Mtr is evidently not the target for the antimycobacterial activity of (2S)-5,7,2'-trihydroxyflavanone. Fifty percent inhibitory concentration of the ethanol extract of G. africana, and the two purified compounds, (2S)-5,7,2'-trihydroxyflavanone and (E)-2',4'-dihydroxychalcone were found to be 120.0; 110.3 and 80.2 µg/mL respectively against the U937 cells. The MIC of the ethanol extract of G. africana in U937 macrophages infected with M. tuberculosis was found to be 50.0 µg/mL indicating the extract’s intracellular antimycobacterial activity in real physiological conditions. The two purified compounds also showed good intracellular antimycobacterial activity. The MICs of (2S)-5,7,2'-trihydroxyflavanone and (E)-2',4'-dihydroxychalcone were found to be 100 and 50 µg/mL respectively. This study indicated that the intracellular activity of the ethanol extract is significant in macrophages. The activity might be due to M. tuberculosis being unable to avoid macrophage killing and its survival during phagocytosis, (including inhibition of phagosome-lysosome fusion, inhibition of the acidification of phagosomes, resistance to killing by reactive oxygen intermediates and modification of the lipid composition of the mycobacterial cell membrane, thereby altering its capacity to interact with immune or inflammatory cells). It can be concluded that the traditional use of G. africana for TB has been scientifically validated to some extent. Isolated compounds and the ethanol extract of the plant warrant further investigation for their potential as antimycobacterial agents. Since synergistic activity of purified compounds with existing antituberculosis drug INH, was significant, it will be worthwhile evaluating the efficacy of purified compounds in combination with TB-drugs in pre-clinical studies. / Thesis (PhD)--University of Pretoria, 2009. / Plant Science / unrestricted

nÃo hà / A introduÃÃo na prÃtica clÃnica dos agentes bloqueadores do TNF-α representou uma revoluÃÃo no tratamento das doenÃas inflamatÃrias crÃnicas: artrite reumatÃide (AR), espondilite anquilosante (EA), doenÃa de Crohn (DC) e psorÃase. Desde entÃo, seu uso tem sido ampliado, contudo essa terapia de alto custo econÃmico elevou o risco de desenvolvimento das doenÃas infecciosas entre elas, à tuberculose (TB). Por este motivo recomenda-se a investigaÃÃo da Tuberculose latente (TBL) antes do inÃcio da terapÃutica com os bloqueadores do TNF-α. O objetivo do nosso estudo foi traÃar o perfil clÃnico-epidemiolÃgico dos pacientes nessa condiÃÃo clÃnica e avaliar os desfechos de tratamento de pacientes submetidos ao tratamento da TBL por indicaÃÃo do uso de bloqueadores do TNF-α no AmbulatÃrio de Tisiologia do Hospital UniversitÃrio Walter CantÃdeo (HUWC/UFC). MÃtodo: Foi realizada no perÃodo de 2008-2009 uma anÃlise descritiva prospectiva desse grupo de pacientes seguido de um estudo analÃtico observacional do tipo transversal do desfecho. Resultados: Foram estudados 45 pacientes classificados como portadores de TBL por apresentarem teste tuberculÃnico (TT) ≥ 5 mm e radiografia de tÃrax normal ou com lesÃes residuais mÃnimas. A maioria era do sexo feminino (56%), cerca da metade estava na faixa etÃria de 40 a 49 anos (45%). Em relaÃÃo à doenÃa de base tivemos diagnÃsticos reumatolÃgicos â artrite reumatÃide e espondilite (49,0%), dermatolÃgicos â psorÃase (37,7%) e doenÃa de Chron (13,3%). A presenÃa de 01 comorbidades foi observada em15/45 (33,3%) e em 6/45 (13,3%) pacientes apresentavam mais de uma doenÃa associada. Contato com paciente de TB foi relatado em 9/45 (20%) dos indivÃduos estudados. Dois pacientes referiram TB pulmonar tratada anteriormente. A maioria (88,9%) era de assintomÃticos respiratÃrios. O resultado mÃdio do TT foi 14,6mm, variando de 5 a 30 mm, sendo que 30/45 (66,7%) apresentou TT >10 mm. O uso de medicaÃÃo antiinflamatÃria nÃo influiu no resultado do TT. A anÃlise radiolÃgica do tÃrax foi normal em 64,4% e em 35,6 % foram observadas alteraÃÃes radiolÃgicas mÃnimas. Dos 45 pacientes estudados 37 utilizaram fÃrmacos para tratamento da doenÃa de base, 20 (54,0%) usaram corticosterÃides (prednisona) e 36 (97,3%) relataram o uso de imunossupressores, principalmente o Metrotexato. A isoniazida 300mg/dia foi utilizada no tratamento da TBL e os efeitos colaterais ocorreram em 15,6 % dos pacientes. Em relaÃÃo ao desfecho foi observado que 41 completaram o tratamento. Houve 01 abandono, 01 transferÃncia e 02 suspensÃes de tratamento por hepatite medicamentosa. ConclusÃo: A determinaÃÃo do perfil do paciente candidato ao tratamento da TBL pode contribuir para a uniformizaÃÃo dos procedimentos de rastreio e prevenÃÃo da TB, bem como para estabelecer os protocolos clÃnicos de uso e acompanhamento dos fÃrmacos anti-TNF. Todos os pacientes continuam em acompanhamento no ambulatÃrio de tisiologia do HUWC/UFC por um perÃodo mÃnimo de 5 anos.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / NÃveis subterapÃuticos de drogas antimicobacterianas tÃm sido observados no curso do tratamento de pacientes com tuberculose e nos co-infectados TB/HIV e podem facilitar o surgimento de cepas de M. tuberculosis resistentes Ãs drogas. A mal-absorÃÃo intestinal inclue-se entre as provÃveis causas e tem sido descrita em tuberculosos desnutridos, alcoÃlatras, diabÃticos, aidÃticos ou com patologias gastrointestinais associadas. Estudos da permeabilidade intestinal permitem a avaliaÃÃo da funÃÃo intestinal em vÃrias doenÃas, mas tÃm sido escassos na tuberculose. O teste da lactulose / manitol tem sido utilizado como critÃrio de lesÃo com dÃficit absortivo da mucosa intestinal e pode ser de utilidade no prognÃstico da absorÃÃo intestinal de drogas em pacientes com tuberculose. Foram estudados 41 pacientes (30H e 11M). A coleta dos dados foi realizada no Hospital de MaracanaÃ, Fortaleza-CE, em 2001. Procedeu-se descriÃÃo clÃnica, social e laboratorial do grupo de pacientes e estudo piloto de observaÃÃo utilizando o teste da lactulose / manitol em 40 pacientes com tuberculose pulmonar ativa, comparando com grupo controle de 28 voluntÃrios sadios objetivando estudar a permeabilidade intestinal. Testes de sensibilidade Ãs drogas antituberculose, pelo mÃtodo das proporÃÃes indireto, foram realizados em 20 pacientes com cultura de escarro positivas. O grau de nutriÃÃo avaliado atravÃs do Ãndice de Massa CorpÃrea (IMC) e o nÃvel sÃrico das drogas foram correlacionados com os valores da permeabilidade intestinal. CinqÃenta e nove por cento (24 pacientes) foram considerados desnutridos pelo IMC<18,5 kg/m2, sendo vinte e dois por cento (9 pacientes) considerados severamente desnutridos (IMC<16 kg/m2). Em 18 pacientes, apÃs 2 h da tomada de 600mg de rifampicina (R) e 400 mg de isoniazida (H) os nÃveis sÃricos de R (CRM 2h) e H (CINH 2h) foram analisados por HPLC. A taxa de excreÃÃo urinÃria de manitol (mÃdia  desvio padrÃo) foi significativamente menor p<0,001 (9,52  5,70) nos pacientes que dos controles (20,14  10,84). A taxa de excreÃÃo de lactulose foi significativamente maior p<0,05 nos pacientes (0,59  1,79) que nos controles (0,52  0,47) e a razÃo L/M foi aumentada de forma consistente, embora nÃo significativa p>0,05 (0,05  0,10 pacientes contra 0,02  0,02 controles). Considerando a faixa terapÃutica da R (8-24 mcg/mL ) e da H (3-6 mcg/mL) observamos que as CRM2h e CINH2h em 16/18 (88,8%) pacientes nÃo atingiram nÃveis sÃricos adequados para as duas drogas. 8/18 (44,4%) pacientes nÃo alcanÃaram nÃveis sÃricos para ambas as drogas simultaneamente. Na anÃlise das drogas isoladas verificamos que em 12/18 (66,7%) pacientes a CRM2h o nÃvel sÃrico mÃnimo nÃo foi alcanÃado (mÃdia R =6,47 mcg/mL) e 13/18 (72,2%) a CINH2h tambÃm foi reduzida (mÃdia H =2,17 mcg/mL). Quanto ao perfil de resistÃncia do M. tuberculosis em cultura de escarro, observamos 4/20 (20%) multirresistentes (3 à R+H e 1 à todas as drogas) e 2/20 (10%) monorresistentes à H sendo 14/20 (70%) amostras consideradas sensÃveis Ãs drogas testadas. Os resultados observados sugerem uma intensa reduÃÃo na Ãrea de absorÃÃo e lesÃo da mucosa intestinal nos indivÃduos estudados. Os dados sÃo consistentes com a reduÃÃo na biodisponibilidade de rifampicina e isoniazida e com o estado nutricional destes pacientes. Os dados preliminares recomendam estudos adicionais na avaliaÃÃo completa da biodisponibilidade das drogas antimicobacterianas em pacientes com tuberculose / Subtherapeutic antimycobacterial drugs levels have been observed during treatment of patients with tuberculosis and in HIV coinfected. It may facilitate the development of M. tuberculosis resistant strains. Malabsorption may be one of the underlyne cause. It has been documented in tuberculosis patients associated to malnutrition, alchoolics, diabetes, AIDS and gastrointestinal symptoms. Intestinal permeability studies have been conducted in order to evaluate the intestinal function in some diseases but are scant in tuberculosis. Lactulose / manitol ratio in urine a widely used measure of malabsorption and intestinal permeability may be useful to assesss the drug absorption area in tuberculosis. In order to study the intestinal permeability in tuberculosis, we conducted in a pilot study 40 patients and 28 healthy volunteers, using the urinary excretion of ingested lactulose and manitol as respective markers of barrier disruption and overall villous surface area. The Maracanaà Hospital in Fortaleza-CE, was choosen and the data were collected in 2001. Eigthteen patients receiving 600 mg rifampicin (R) and 400 mg isoniazid (H) were evaluated through venous blood analysis obtained at 2 hours after directly observed ingestion. The serum samples were analysed by HPLC at the Infectious Disease Pharmacokinetics Laboratory / National Jewish Center / Denver, USA. Nutritional status by body mass index (BMI) and serum drug levels were correlated with intestinal permeability data. M. tuberculosis isolates from 20 clinical specimens were tested to drug susceptibility by standard proportion method (APM ) using Lowestein-Jensen medium. Forty-one patients (30 M, 11 F) were studied. Fifty nine per cent (24) patients were malnourish (BMI<18,5 kg/m2); 22% (9) were severely malnourish (BMI<16 kg/m2). The urinary excretion of mannitol (mean  standard deviation) showed a significant decrease p < 0,001 in patients (9,52  5,70) compared to controls (20,14  10,84). The excretion of lactulose was significant increased p < 0,05 in patients (0,59  1,79), than controls (0,52  0,47) and the L/M ratio shown consistent increased (0,05  0,10) in patients compared to controls (0,029  0,0,02) p > 0,05. Considering the reported target range for R (8-24 mcg/mL ) and H (3-6 mcg/mL) we observed that 2-h serum levels were below the lower limit for R and H in 88,8% (16/18) patients. Forty four per cent ( 8/18) of patients had reduced levels for the two drugs. Analysing single drugs we documented that 66,7% (12/18) patients had levels below the target limit for R (mean R =6,47 mcg/mL) and 72,2% (13/18) for H (mean H =2,17mcg/mL). Concerning to M. tuberculosis susceptibility profile in sputum culture, we observed 20% (4/20) multidrug resistants strains (3 for R + H and 1 for all drugs). Ten per cent (2/20) were resistant only for H and 70% (14/20) strains were sensitive. These results suggests an important decrease in the funcional absorptive surface of the intestine and damage of the intestine in patients studied. The data are consistent with reduced antituberculosis drugs bioavailability and compromissed nutritional status of these patients. The preliminary results indicate the necessity of new approaches to accurate portrait of drugs bioavailability in tuberculosis patients

Apesar de ser uma das doenças infecciosas mais antigas e bem conhecidas, a tuberculose (TB) permanece como a segunda maior causa de morte após a síndrome da imunodeficiência adquirida. A TB é uma doença infecciosa e transmissível, causada pela bactéria Mycobacterium tuberculosis (Mtb), que afeta prioritariamente os pulmões, embora possa acometer outros órgãos e sistemas. O presente trabalho teve como objetivo desenvolver nanofibras e nanoesferas de poli (D,L-láctico co-glicólico) (PLGA) contendo os Insumos Farmacêuticos Ativos (IFAs), rifampicina e isoniazida; caracterizá-las físico quimicamente e determinar a eficiência de encapsulação destes IFAs pelos métodos de eletroforese capilar (CE) e cromatografia líquida de alta eficiência (HPLC). O método de CE para a determinação simultânea dos IFAs antituberculose (isoniazida, rifampicina, pirazinamida e etambutol) foi otimizado por meio de um delineamento de experimentos de mistura com uma abordagem de vértices extremos usando o Software estatístico Minitab 17. Para o desenvolvimento das nanofibras se utilizou a técnica de electrospinning e para as nanoesferas se utilizou a técnica de emulsão/evaporação de solvente. As nanofibras foram caraterizadas por microscopia eletrônica de varredura (SEM), microscopia eletrônica de transmissão (TEM), espectrofotometria de absorção na região do infravermelho (FTIR), calorimetria exploratória diferencial (DSC) e termogravimetria/termogravimetria derivada (TGA) e as nanoesferas foram caracterizadas pelas técnicas de espalhamento dinâmico de luz (DLS), potencial zeta, índice de polidispersão, pH, SEM, TEM, FTIR e DSC. A eficiência de encapsulação dos IFAs nas nanofibras e nas nanoesferas foram realizadas através de duas técnicas analíticas, HPLC e CE, previamente validadas. A eficiência de encapsulação de isoniazida e rifampicina nas nanofibras foi 12,16 % e 5,90 %, respectivamente usando a técnica de HPLC e através da técnica de CE a eficiência de encapsulação foi de 12,30 % e 6,36 %, para isoniazida e rifampicina, respectivamente. A eficiência de encapsulação para a melhor formulação das nanoesferas foi de 2,33 % e 14,75 % para a isoniazida e rifampicina, respectivamente através da técnica de HPLC e uma eficiência de encapsulação de 2,26 % para a isoniazida e 14,22 % para a rifampicina através da técnica de CE. O método por CE teve a vantagem de apresentar um menor tempo de analise, menos de 6 min, com uma adequada resolução entre os picos dos IFAs. O tempo de analise por HPLC foi de 10 min. O método de CE foi menos lesivo ao meio ambiente, devido à pouca quantidade de solventes orgânicos, tornando assim a CE em um método alternativo à HPLC. / Despite being one of the oldest and most well-known infectious diseases, tuberculosis (TB) remains the second leading cause of death after acquired immunodeficiency syndrome. TB is an infectious and transmissible disease caused by Mycobacterium tuberculosis (Mtb) bacteria, which primarily affects the lungs, although it can affect other organs and systems. The present work aimed to develop nanofibers and nanospheres of poly (D, L-lactic co-glycolic) (PLGA) containing Active Pharmaceutical Ingredients (IPAs), rifampicin and isoniazid; characterize them physical-chemically and determine the encapsulation efficiency of these drugs by capillary electrophoresis (CE) and high-performance liquid chromatography (HPLC) methods. A CE method for determination of IPAs (isoniazid, rifampicin, pyrazinamide and ethambutol) was optimized through a design of mixing experiments with an extreme vertex approach using the Minitab 17 statistical Software. For the development of nanofibers and nanospheres the electrospinning and the emulsion/solvent evaporation techniques, respectively were used. Nanofibers were characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC) and thermogravimetry (TGA). Nanospheres were characterized by dynamic light scattering (DLS), zeta potential, polydispersity index, pH, SEM, TEM, FTIR and DSC. The encapsulation efficiency of the IPAs in nanofibres and nanospheres was performed using two analytical techniques, HPLC and EC, previously validated. For nanofibers, the encapsulation efficiency were 12.16 % and 5.90 % for isoniazid and rifampicin, respectivey by using HPLC method and 12,30 % for isoniazid and 6,36 % for rifampicin by CE method. The encapsulation efficiency for the best formulation of nanospheres was 2,33 % and 14,75 % for rifampicin and isoniazid, respectively by using HPLC method and 2,26 % for isoniazid and 14,22 % for rifampicin by EC method. It was shown that CE method presented a shorter analysis time (< 6min) and also and adequate resolution between the IPAs peaks. The time of analysis for the HPLC method was 10 min.CE method was less aggressive to the environment because it uses smaller amount of organic solvents. Therefore the CE is an alternative method to HPLC.

Apesar de ser uma das doenças infecciosas mais antigas e bem conhecidas, a tuberculose (TB) permanece como a segunda maior causa de morte após a síndrome da imunodeficiência adquirida. A TB é uma doença infecciosa e transmissível, causada pela bactéria Mycobacterium tuberculosis (Mtb), que afeta prioritariamente os pulmões, embora possa acometer outros órgãos e sistemas. O presente trabalho teve como objetivo desenvolver nanofibras e nanoesferas de poli (D,L-láctico co-glicólico) (PLGA) contendo os Insumos Farmacêuticos Ativos (IFAs), rifampicina e isoniazida; caracterizá-las físico quimicamente e determinar a eficiência de encapsulação destes IFAs pelos métodos de eletroforese capilar (CE) e cromatografia líquida de alta eficiência (HPLC). O método de CE para a determinação simultânea dos IFAs antituberculose (isoniazida, rifampicina, pirazinamida e etambutol) foi otimizado por meio de um delineamento de experimentos de mistura com uma abordagem de vértices extremos usando o Software estatístico Minitab 17. Para o desenvolvimento das nanofibras se utilizou a técnica de electrospinning e para as nanoesferas se utilizou a técnica de emulsão/evaporação de solvente. As nanofibras foram caraterizadas por microscopia eletrônica de varredura (SEM), microscopia eletrônica de transmissão (TEM), espectrofotometria de absorção na região do infravermelho (FTIR), calorimetria exploratória diferencial (DSC) e termogravimetria/termogravimetria derivada (TGA) e as nanoesferas foram caracterizadas pelas técnicas de espalhamento dinâmico de luz (DLS), potencial zeta, índice de polidispersão, pH, SEM, TEM, FTIR e DSC. A eficiência de encapsulação dos IFAs nas nanofibras e nas nanoesferas foram realizadas através de duas técnicas analíticas, HPLC e CE, previamente validadas. A eficiência de encapsulação de isoniazida e rifampicina nas nanofibras foi 12,16 % e 5,90 %, respectivamente usando a técnica de HPLC e através da técnica de CE a eficiência de encapsulação foi de 12,30 % e 6,36 %, para isoniazida e rifampicina, respectivamente. A eficiência de encapsulação para a melhor formulação das nanoesferas foi de 2,33 % e 14,75 % para a isoniazida e rifampicina, respectivamente através da técnica de HPLC e uma eficiência de encapsulação de 2,26 % para a isoniazida e 14,22 % para a rifampicina através da técnica de CE. O método por CE teve a vantagem de apresentar um menor tempo de analise, menos de 6 min, com uma adequada resolução entre os picos dos IFAs. O tempo de analise por HPLC foi de 10 min. O método de CE foi menos lesivo ao meio ambiente, devido à pouca quantidade de solventes orgânicos, tornando assim a CE em um método alternativo à HPLC. / Despite being one of the oldest and most well-known infectious diseases, tuberculosis (TB) remains the second leading cause of death after acquired immunodeficiency syndrome. TB is an infectious and transmissible disease caused by Mycobacterium tuberculosis (Mtb) bacteria, which primarily affects the lungs, although it can affect other organs and systems. The present work aimed to develop nanofibers and nanospheres of poly (D, L-lactic co-glycolic) (PLGA) containing Active Pharmaceutical Ingredients (IPAs), rifampicin and isoniazid; characterize them physical-chemically and determine the encapsulation efficiency of these drugs by capillary electrophoresis (CE) and high-performance liquid chromatography (HPLC) methods. A CE method for determination of IPAs (isoniazid, rifampicin, pyrazinamide and ethambutol) was optimized through a design of mixing experiments with an extreme vertex approach using the Minitab 17 statistical Software. For the development of nanofibers and nanospheres the electrospinning and the emulsion/solvent evaporation techniques, respectively were used. Nanofibers were characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC) and thermogravimetry (TGA). Nanospheres were characterized by dynamic light scattering (DLS), zeta potential, polydispersity index, pH, SEM, TEM, FTIR and DSC. The encapsulation efficiency of the IPAs in nanofibres and nanospheres was performed using two analytical techniques, HPLC and EC, previously validated. For nanofibers, the encapsulation efficiency were 12.16 % and 5.90 % for isoniazid and rifampicin, respectivey by using HPLC method and 12,30 % for isoniazid and 6,36 % for rifampicin by CE method. The encapsulation efficiency for the best formulation of nanospheres was 2,33 % and 14,75 % for rifampicin and isoniazid, respectively by using HPLC method and 2,26 % for isoniazid and 14,22 % for rifampicin by EC method. It was shown that CE method presented a shorter analysis time (< 6min) and also and adequate resolution between the IPAs peaks. The time of analysis for the HPLC method was 10 min.CE method was less aggressive to the environment because it uses smaller amount of organic solvents. Therefore the CE is an alternative method to HPLC.

Tee PhD thesis presents the study of the response of Mycobacterium tuberculosis, the causative agent of tuberculosis, upon prolonged exposure to lethal concentrations of the first line anti-tuberculosis drug, rifampicin. The study shows that prolonged exposure to lethal concentration of rifampicin causes cell death initially by several log orders of cells, followed by a persistence phase, from where rifampicin resisters emerge carrying mutation in the RRDR locus of the rpoB gene. This phenomenon was found to occur even when the drug concentration is well above MBC levels. Luria-Delbruck experiment, in a modified format, showed that the resisters emerged as fresh mutants, and not due to the growth of pre-existing natural resisters to rifampicin. The per sister cells, which showed high levels of hydroxyl radical generation, were found to have thickened outer layer, unlike the mid-log phase cells, which restricts the permeability of a fluorescent-conjugate of rifampicin, 5-FAM-rifampicin, 10-fold less in per sister cells, as compared to mid-log phase cells. The thickened outer layer has high negative surface charge and is hydrophilic in nature. It is proposed that the hydrophilic-natured thickened outer layer might have restricted the permeability of lethal concentrations of hydrophobic-natured rifampicin. This, in turn, might have ensured the presence of sub-lethal concentration rifampicin inside the per sisters, which in turn might have generated the hydroxyl radical that caused mutagenesis to generate rifampicin resisters. The Chapter 1 is the Introduction to the thesis presented in 4 parts – Part 1.1, 1.2, 1.3 and 1.4, introducing briefly the history of antibiotics, antibiotic resistance, antibiotic persistence and a brief history of tuberculosis respectively. It is concluded with a rationale behind the present study. The Chapter 2 presents the entire Materials and Methods used in the experiments described in the thesis. The Chapter 3 presents the data on the response of M. tuberculosis to rifampicin upon extended exposure. Rifampicin exposure of susceptible M. tuberculosis H37Ra cells showed a decrease in their CFU/ml followed by a persistence phase wherein the CFU/ml remained constant. However, prolonged exposure of rifampicin even at higher concentrations showed regrowth in the culture, which was found to be due to the emergence of rifampicin-resistant bacteria. Screening of rifampicin-resistant mutants showed point mutations in the rifampicin resistance determining region (RRDR) of the rpoB gene in all the mutants. In parallel, using trans formants of M. tuberculosis expressing unstable GFP under the respective native ribosomal RNA promoter, the metabolic status of the per sister cells was determined. When actively growing highly fluorescing cells were exposed to lethal concentration of rifampicin, their metabolism diminished, as illustrated by the decrease in their fluorescence during persistence phase, followed by the emergence of a sub-population of bacteria which were again metabolically active. In order to verify whether the rifampicin resisters are freshly formed mutants or have come from the naturally existing resisters, Luria-Delbruck fluctuation test was performed in a modified manner. The number of rifampicin resisters that emerged from the persistent phase was found to vary amongst different cultures from different days and different times of exposure, showing fluctuation. However, the addition of theorem before persistence phase almost abolished the generation of the rifampicin-resistant bacilli, indicating the role of hydroxyl radical in the emergence of rifampicin resisters. The generation of hydroxyl radical in mycobacteria exposed to rifampicin was confirmed using electron para-magnetic resonance spectrometry (EPR), with the spin trap agent, 5,5- Dimethyl-1-pyrroline N-oxide (DMPO) specific for hydroxyl radical. An increase in the formation DMPO-OH adduct in the persistence phase cells was observed, in comparison to mid-log phase cells. Exposure to theorem significantly diminished the adduct formation. The persistence phase cells also showed significantly high levels of signal specific to the hydroxyl-specific fluorescent dye, hydroxyphenyl fluorescein (HPF), as compared to the mid-log phase cells. In addition we have determined the oxidative stress in the bacilli upon rifampicin exposure using a redox biosensor (Mrx1-roGFP) which also showed high oxidative stress in the persistent phase. These observations confirmed the presence of high levels of oxidative stress and hydroxyl radical in the rifampicin persistent cells, in comparison with mid-log phase cells. Whole genome sequencing of the four independently isolated rifampicin resistant M. tuberculosis showed genome wide mutations having less common mutations with respect to the wild type genome, indicative of the occurrence of random mutagenesis. In addition mutation frequencies were comparable between the samples with respect to the wild type sample. About 69% of the mutations were A-C or T-G, followed by A-T or T-A, which is known to be due to oxidative stress in the cells. Variations in the colony morphology were also observed on the persistent phase cells, indicating the occurrence of mutagenesis in the bacterial genome during rifampicin treatment. The Chapter 4 is on the morphological and ultrastructural studies on rifampicin-exposed M. tuberculosis cells. Transmission electron micrographs of rifampicin per sisters showed significant thickening of the outermost capsular layer (OL), as compared to the mid-log phase cells. This observation was verified by staining the cells with ruthenium red, which specifically stains anionic polysaccharide of the OL. Zeta potential (ZP) measurement of the surface charge of the persistent cells showed high negative ZP, as compared to the mid-log phase cells. The negative ZP value was found to gradually increase during the course of rifampicin treatment and to decrease during the regrowth phase. Hexadecane assay showed larger proportion of per sister cells being retained in the aqueous phase, as compared to the mid-log phase cells. This indicated the higher hydrophilicity of the per sister cells, which was in agreement with the higher surface negative charge of the cells. The permeability of rifampicin per sister cells to 5-FAM-rifampicin (rifampicin conjugated to 5-carboxy fluorescein, which is as hydrophobic as rifampicin) was found to be 10-fold less than that of the mid-log phase cells. However, removal of the thick OL by bead beating (BB) with 4 mm glass beads significantly improved the permeability of per sister cells to 5-FAM-rifampicin. On the contrary, no difference in the 5-FAM-rifampicin uptake was observed in mid-log phase cells, with or without BB. These observations implied that the thick hydrophilic-natured OL with high negative surface charge may be playing a significant role in limiting the permeability of hydrophobic-natured rifampicin entry into the persisted cells. This in turn may ensure the presence of sub-lethal concentration of rifampicin inside the persisted cells that are exposed to lethal concentration of the antibiotic. Exposure of bacteria to sub-lethal concentration of antibiotics has been reported to generate oxidative stress in the bacteria, leading to mutagenesis. A model has been proposed based on these observations in which the persistent mycobacteria are protected from lethal concentrations of the rifampicin by the thick OL which in turn ensures sub-lethal intracellular antibiotic concentration, leading to the generation of hydroxyl radical mediated mutagenesis and thereby emergence of rifampicin resisters. This thesis is concluded with the list of salient findings, publications and references.