Introdução: As mucopolissacaridoses (MPS) constituem um grupo de doenças lisossômicas caracterizadas pela deficiência de uma das enzimas responsáveis pela degradação dos glicosaminoglicanos (GAGs). É difícil determinar a incidência precisa de hidrocefalia em pacientes com MPS, pois não possui uma definição formal por consenso. Além disso, é difícil distinguir a hidrocefalia comunicante da dilatação ventricular secundária à atrofia cerebral, porque ambas apresentam características clínicas e neuroradiológicas comuns. Embora várias técnicas sejam usadas para identificar pacientes com MPS com maior probabilidade de ter hidrocefalia e responder ao tratamento cirúrgico, não existe um método definitivo para provar o diagnóstico. Objetivos: Avaliar a relação entre ventriculomegalia, volume cerebral e liquórico, fluxo de líquor aquedutal e cervical e pressão de abertura liquórica em pacientes com MPS, e detectar potenciais biomarcadores para as alterações da circulação liquórica. Métodos: Quarenta e três pacientes com MPS (12 MPS I, 15 MPS II, 5 MPS III, 9 MPS IV A e 2 MPS VI) realizaram testes clínicos e de desenvolvimento neurológico, ressonância magnética (RM) nas sequências T1, T2, FLAIR e por contraste de fase, seguidas por punção lombar para avaliação da pressão de abertura liquórica. Para a análise das variáveis da RM, foram medidos: volume cerebral e liquórico, carga de lesões na substância branca (LSB), índice de Evans, largura do terceiro ventrículo, ângulo do corpo caloso, espaços perivasculares dilatados (EPVD), estenose da junção craniocervical, volume de stroke aquedutal e cervical, e concentração de GAGs no líquor. Resultados: As formas graves e a macrocefalia estiveram significativamente associadas com a ventriculomegalia, principalmente com o índice de Evans (p = 0.004 e p = 0.008, respectivamente). A carga de LSB apresentou uma forte correlação com as medidas ventriculares e o volume liquórico ventricular (rs = 0.51, p = 0.001). A dilatação ventricular supratentorial e o volume de líquor ventricular apresentaram uma correlação moderada com o volume de stroke aquedutal (VSA) (rs = 0.46, p = 0.002). A pressão de abertura liquórica não se correlacionou nem com as três medidas da ventriculomegalia, nem com a volumetria liquórica, nem com o VSA. O prejuízo cognitivo e os EPVD mostraram uma associação significativa com a ventriculomegalia, especialmente com a largura do terceiro ventrículo (p = 0.019 e p = 0.001, respectivamente). Os EPVD em quantidade aumentada também apresentaram uma significativa associação com o VSA elevado (p = 0.007). Conclusões: Nos pacientes com MPS, a ventriculomegalia está associada a um fenótipo grave da doença, maior declínio cognitivo e maior extensão das LSB e EPVD. Existem associações entre as medidas de fluxo liquórico e as medidas relacionadas à volumetria liquórica. Além disso, as medidas volumétricas estão associadas a quantidade de EPVD. / Background: The mucopolysaccharidoses (MPS) are a group of lysosomal diseases characterized by a deficiency in one of the lysosomal enzymes responsible to degrade glycosaminoglycans (GAGs). The precise incidence of hydrocephalus in patients with MPS is hard to determine, because it lacks a formal, consensus-based definition. In addition, it is difficult to distinguish communicating hydrocephalus from ventricular dilatation secondary to brain atrophy, because both share common clinical and neuroradiological features. Although various techniques are used to identify MPS patients who are most likely to have hydrocephalus and respond to surgical treatment, no definitive method exists to prove diagnosis. Objectives: To assess the relationship between ventriculomegaly, brain and cerebrospinal fluid (CSF) volumes, aqueductal and cervical CSF flows, and CSF opening pressure in MPS patients, and to provide potential biomarkers for abnormal CSF circulation. Methods: Forty-three MPS patients (12 MPS I, 15 MPS II, 5 MPS III, 9 MPS IV A and 2 MPS VI) performed clinical and neurodevelopmental tests, and T1, T2, FLAIR and phase-contrast magnetic resonance imaging (MRI) followed by a lumbar puncture with the CSF opening pressure assessment. For the analysis of MRI variables, the following measures were performed: brain and CSF volumes, white matter (WM) lesion load, Evans’ index, third ventricle width, callosal angle, dilated perivascular spaces (PVS), craniocervical junction stenosis, aqueductal and cervical CSF stroke volumes, and CSF GAGs concentration Results: The severe forms and the macrocephaly were significantly associated with the ventriculomegaly, mainly with the Evans’ index (p = 0.004 and p = 0.008, respectively). The WM lesion load presented a high correlation with the ventricular measurements and the ventricular CSF volume (rs = 0.51, p = 0.001). The supratentorial ventricular dilation and the ventricular CSF volume presented a moderate correlation with the aqueductal CSF stroke volume (ACSV) (rs = 0.46, p = 0.002). The CSF opening pressure did not correlate with either the three measures of ventriculomegaly, either with the CSF volumetry or with the ACSV. The cognitive impairment and the dilated PVS showed a significant association with the ventriculomegaly, especially with the width of the third ventricle (p = 0.019 and p = 0.001, respectively). Increased amount of dilated PVS also had a significant association with the elevated ACSV (p = 0.007). Conclusions: In MPS patients ventriculomegaly is associated with a severe phenotype, increased cognitive decline, WM lesion severity and enlarged PVS. There are associations between CSF flow measurements and measurements related to CSF volumetrics. Also, the volumetric measurements are associated with the degree of dilated PVS.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting motor neurons in the spinal cord, brain stem and motor cortex, leading to paralysis, respiratory failure and death. In about 5% of ALS cases, the disease is associated with mutations in the CuZn-superoxide dismutase (hSOD1) gene. As a rule, ALS caused by hSOD1 mutations is inherited dominantly and the mutant hSOD1s cause ALS by the gain of a noxious property. The present study focused on two hSOD1 mutations with widely differing characters. In Scandinavia, ALS caused by the D90A mutation is inherited in a recessive pattern. Elsewhere, families with dominant inheritance have been found. The properties of D90A mutant hSOD1 are very similar to those of the wild-type protein. The G127insTGGG (G127X) mutation causes a 21 amino acid C-terminal truncation which probably results in an unstable protein. The aim of this thesis was to generate transgenic mice expressing D90A and G127X mutant hSOD1s and to compare these mice with each other and with mice expressing other mutant hSOD1s, in search of a common noxious property. The findings were also compared with the results from studies of human CNS tissue. The cause of the different inheritance patterns associated with D90A mutant hSOD1 was investigated by analyzing erythrocytes from heterozygous individuals from dominant and recessive pedigrees. There was no evidence that a putative protective factor in recessive pedigrees acts by down-regulating the synthesis of D90A mutant hSOD1. In cerebrospinal fluid, there was no difference in hSOD1 content between homozygous D90A patients, ALS patients without hSOD1 mutations and controls. hSOD1 cleaved at the N-terminal end was found in both controls and D90A patients, but the proportion was significantly larger in the latter group. This indicates a difference in degradation routes between mutant and wild-type hSOD1. Both D90A and G127X transgenic mice develop an ALS-like phenotype. Similar to humans, the levels of D90A protein were high. The levels of G127X hSOD1 were very low in the tissues but enriched in the CNS. Similarly, in an ALS patient heterozygous for G127X hSOD1, the levels of the mutant protein were overall very low, but highest in affected CNS areas. Despite the very different levels of mutant hSOD1, both D90A and G127X transgenic mice developed similar levels of detergent-resistant aggregates in the spinal cord when terminally ill. Surprisingly, mice overexpressing wild-type hSOD1 also developed detergent-resistant aggregates, although less and later. Most of the hSOD1 in the CNS of transgenic mice was inactive due to deficient copper charging or because of reduced affinity for the metal. The stabilizing intrasubunit disulfide bond of hSOD1 was partially or completely absent in the different hSOD1s. Both these alterations could increase the propensity of mutant hSOD1s to misfold and form aggregates. The results presented here suggest that the motor neuron degeneration caused by mutant hSOD1s may be attributable to long-term exposure to misfolded, aggregation-prone, disulfide-reduced hSOD1s and that the capacity to degrade such hSOD1s is lower in susceptible CNS areas compared with other tissues. The data also suggest that wild-type hSOD1 has the potential to participate in the pathogenesis of sporadic ALS.

During each cardiac cycle pulsatile arterial blood inflates the vascular bed of the brain, forcing cerebrospinal fluid (CSF) and venous blood out of the cranium. Excessive arterial pulsatility may be part of a harmful mechanism causing cognitive decline among elderly. Additionally, restricted venous flow from the brain is suggested as the cause of multiple sclerosis. Addressing hypotheses derived from these observations requires accurate and reliable investigational methods. This work focused on assessing the pulsatile waveform of cerebral arterial, venous and CSF flows. The overall aim of this dissertation was to explore cerebral blood flow and intracranial pulsatility using MRI, with respect to measurement, physiological and pathophysiological aspects. Two-dimensional phase contrast magnetic resonance imaging (2D PCMRI) was used to assess the pulsatile waveforms of cerebral arterial, venous and CSF flow. The repeatability was assessed in healthy young subjects. The 2D PCMRI measurements of cerebral arterial, venous and CSF pulsatility were generally repeatable but the pulsatility decreased systematically during the investigation. A method combining 2D PCMRI measurements with invasive CSF infusion tests to determine the magnitude and distribution of compliance within the craniospinal system was developed and applied in a group of healthy elderly. The intracranial space contained approximately two thirds of the total craniospinal compliance. The magnitude of craniospinal compliance was less than suggested in previous studies. The vascular hypothesis for multiple sclerosis was tested. Venous drainage in the internal jugular veins was compared between healthy controls and multiple sclerosis patients using 2D PCMRI. For both groups, a great variability in the internal jugular flow was observed but no pattern specific to multiple sclerosis could be found. Relationships between regional brain volumes and potential biomarkers of intracranial cardiac-related pulsatile stress were assessed in healthy elderly. The biomarkers were extracted from invasive CSF pressure measurements as well as 2D PCMRI acquisitions. The volumes of temporal cortex, frontal cortex and hippocampus were negatively related to the magnitude of cardiac-related intracranial pulsatility. Finally, a potentially improved workflow to assess the volume of arterial pulsatility using time resolved, four-dimensional phase contrast MRI measurements (4D PCMRI) was evaluated. The measurements showed good agreement with 2D PCMRI acquisitions. In conclusion, this work showed that 2D PCMRI is a feasible tool to study the pulsatile waveforms of cerebral blood and CSF flow. Conventional views regarding the magnitude and distribution of craniospinal compliance was challenged, with important implications regarding the understanding of how intracranial vascular pulsatility is absorbed. A first counterpoint to previous near-uniform observations of obstructions in the internal jugular veins in multiple sclerosis was provided. It was demonstrated that large cardiac- related intracranial pulsatility were related to smaller volumes of brain regions that are important in neurodegenerative diseases among elderly. This represents a strong rationale to further investigate the role of excessive intracranial pulsatility in cognitive impairment and dementia. For that work, 4D PCMRI will facilitate an effective analysis of cerebral blood flow and pulsatility.

Amyotrophic lateral sclerosis (ALS) is a disease in which the motor neurons die in a progressive manner, leading to paralysis and muscle wasting. ALS is always fatal, usually through respiratory failure when the disease reaches muscles needed for breathing. Most cases are sporadic, but approximately 5–10% are familial. The first gene to be linked to familial ALS encodes the antioxidant enzyme superoxide dismutase-1 (SOD1). Today, more than 160 different mutations in SOD1 have been found in ALS patients.  The mutant SOD1 proteins cause ALS by gain of a toxic property that should be common to all. Aggregates of SOD1 in motor neurons are hallmarks of ALS patients and transgenic models carrying mutant SOD1s, suggesting that misfolding, oligomerization, and aggregation of the protein may be involved in the pathogenesis. SOD1 is normally a very stable enzyme, but the structure has several components that make SOD1 sensitive to misfolding. The aim of the work in this thesis was to study misfolded SOD1 in vivo. Small amounts of soluble misfolded SOD1 were identified as a common denominator in transgenic ALS models expressing widely different forms of mutant SOD1, as well as wild-type SOD1. The highest levels of misfolded SOD1 were found in the vulnerable spinal cord. The amounts of misfolded SOD1 were similar in all the different models and showed a broad correlation with the lifespan of the different mouse strains. The misfolded SOD1 lacked the C57-C146 intrasubunit disulfide bond and the stabilizing zinc and copper ions, and was prinsipally monomeric. Forms with higher apparent molecular weights were also found, some of which might be oligomers. Misfolding-prone monomeric SOD1 appeared to be the principal source of misfolded SOD1 in the CNS. Misfolded SOD1 in the spinal cord was found to interact mainly with chaperones, with Hsc70 being the most important. Only a minor proportion of the Hsc70 was sequestered by SOD1, however, suggesting that chaperone depletion is not involved in ALS.  SOD1 is normally found in the cytoplasm but can be secreted. Extracellular mutant SOD1 has been found to be toxic to motor neurons and glial cells. Misfolded SOD1 in the extracellular space could be involved in the spread of the disease between different areas of the CNS and activate glial cells known to be important in ALS. The best way to study the interstitium of the CNS is through the cerebrospinal fluid (CSF), 30% of which is derived from the interstitial fluid. Antibodies specific for misfolded SOD1 were used to probe CSF from ALS patients and controls for misfolded SOD1. We did find misfolded SOD1 in CSF, but at very low levels, and there was no difference between ALS patients and controls. This argues against there being a direct toxic effect of extracellular SOD1 in ALS pathogenesis. In conclusion, soluble misfolded SOD1 is a common denominator for transgenic ALS model mice expressing widely different mutant SOD1 proteins. The misfolded SOD1 is mainly monomeric, but also bound to chaperones, and possibly exists in oligomeric forms also. Misfolded SOD1 in the interstitium might promote spread of aggregation and activate glial cells, but it is too scarce to directly cause cytotoxicity.

Orientador: Rogerio Martins Amorim / Resumo: As células-tronco mesenquimais (CTM) apresentam propriedades antiinflamatórias, imunomoduladoras, neuroprotetoras e neurorregenerativas. Pela capacidade regenerativa limitada do tecido neural, o potencial terapêutico das células-tronco tem sido estudado em várias enfermidades do sistema nervoso central (SNC). Sendo assim, o objetivo deste trabalho foi avaliar a viabilidade, segurança e a resposta a transplantes intratecais sucessivos, de CTM provenientes de diversas fontes em equinos. Para isso, foram avaliados o potencial de transdiferenciação, terapêutico e o co-cultivo com líquido cefalorraquidiano (LCR) de CTM provenientes da medula óssea, tecido adiposo e cordão umbilical. Posteriormente, as CTM foram utilizadas para o transplante por via intratecal (IT) pela cisterna lombo-sacra (LS), atlanto-occipital (AO) e entre as vértebras C1-C2 em animais sadios (GS), totalizando 3 aplicações com intervalo de 30 dias. Adicionalmente as CTM foram rastreadas por cintigrafia após os transplantes pelas via AO e LS. Finalmente, as CTM foram utilizadas para o transplante IT entre as vértebras C1-C2 em animais com incoordenação motora decorrente de Mieloencefalite Equina por Protozoário (MEP) – grupo doente (GD), sob o mesmo protocolo. Todos os animais (GS e GD) foram avaliados por exame clínico e neurológico, análise hematológica e do LCR antes e após os transplantes. Os resultados demonstraram que as CTM provenientes de diversas fontes apresentaram efeitos positivos na presença de LCR,... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

Pour exercer leur effet princeps, les médicaments doivent atteindre des concentrations nécessaires et suffisantes à leur site d'action tout en évitant la survenue d'effets indésirables. Les antibiotiques sont utilisés pour le traitement d'infection cérébroméningées dont la cible bactériologique se situe dans le liquide céphalorachidien (LCR) ou le liquide extracellulaire cérébral (LEC) un site d'action cérébral qui constitue aussi une cible pour des effets secondaires. La distribution de médicament dans le cerveau et le LCR est limitée par la présence des barrières hémato-encéphalique (BHE) et hématoliquidienne (BHL). De plus, des mécanismes d'efflux diminuent les concentrations tissulaires des médicaments. Pour optimiser l'usage des antibiotiques et diminuer les effets indésirables, il est important d'obtenir des informations pharmacocinétiques tissulaires. Le recueil de LEC par microdialyse cérébrale et le prélèvement de LCR permettent chez des patients de réanimation la comparaison des concentrations libres de médicament. Ce travail constitue une étude de la distribution dans le plasma, le LCR et le LEC de deux antibiotiques : le céfotaxime et le métronidazole. Des patients (après un traumatisme crânien ou un accident vasculaire) ont été traités par céfotaxime et métronidazole pour une pneumopathie. Quatre études pharmacocinétiques ont été réalisées à l'équilibre par microdialyse cérébrale (n=11) pour le recueil du LEC ou par prélèvement de LCR (n=9) par une dérivation ventriculaire externe. Les résultats ont montré que le métronidazole diffusait totalement dans les deux milieux alors que la diffusion du céfotaxime était limitée, probablement en raison de phénomènes d'efflux. / To exert their effect while avoiding adverse events, drugs must reach sufficient concentrations in their site of action. Antibiotics are used for treating infection that bacterial target is in the cerebrospinal fluid (CSF) or brain extracellular fluid (ECF) which is also a target for adverse events. Drug distribution in the brain and CSF may be limited by the presence of the blood-brain barrier (BBB) and blood-CSF barrier (BCSFB). In addition, efflux mechanisms may decrease tissue concentrations of drugs.To optimize the use of antibiotics and reduce adverse events, it is important to obtain tissue pharmacokinetics. Collecting ECF samples via brain microdialysis and CSF samples via external ventricular drain in critically ill patients allow comparison of free drug concentrations. This work is a study of the distribution in plasma, CSF and ECF of two antibiotics, cefotaxime and metronidazole.Patients (after a head injury or stroke) were treated with cefotaxime and metronidazole for pneumonia. Four pharmacokinetic studies were performed at equilibrium by brain microdialysis (n = 11) for collecting ECF or CSF samples (n = 9) by an external ventricular drain. The results showed that metronidazole distributes extensively in both ECF and CSF while the diffusion of cefotaxime was limited, probably due to efflux transporters.

Introdução: As mucopolissacaridoses (MPS) constituem um grupo de doenças lisossômicas caracterizadas pela deficiência de uma das enzimas responsáveis pela degradação dos glicosaminoglicanos (GAGs). É difícil determinar a incidência precisa de hidrocefalia em pacientes com MPS, pois não possui uma definição formal por consenso. Além disso, é difícil distinguir a hidrocefalia comunicante da dilatação ventricular secundária à atrofia cerebral, porque ambas apresentam características clínicas e neuroradiológicas comuns. Embora várias técnicas sejam usadas para identificar pacientes com MPS com maior probabilidade de ter hidrocefalia e responder ao tratamento cirúrgico, não existe um método definitivo para provar o diagnóstico. Objetivos: Avaliar a relação entre ventriculomegalia, volume cerebral e liquórico, fluxo de líquor aquedutal e cervical e pressão de abertura liquórica em pacientes com MPS, e detectar potenciais biomarcadores para as alterações da circulação liquórica. Métodos: Quarenta e três pacientes com MPS (12 MPS I, 15 MPS II, 5 MPS III, 9 MPS IV A e 2 MPS VI) realizaram testes clínicos e de desenvolvimento neurológico, ressonância magnética (RM) nas sequências T1, T2, FLAIR e por contraste de fase, seguidas por punção lombar para avaliação da pressão de abertura liquórica. Para a análise das variáveis da RM, foram medidos: volume cerebral e liquórico, carga de lesões na substância branca (LSB), índice de Evans, largura do terceiro ventrículo, ângulo do corpo caloso, espaços perivasculares dilatados (EPVD), estenose da junção craniocervical, volume de stroke aquedutal e cervical, e concentração de GAGs no líquor. Resultados: As formas graves e a macrocefalia estiveram significativamente associadas com a ventriculomegalia, principalmente com o índice de Evans (p = 0.004 e p = 0.008, respectivamente). A carga de LSB apresentou uma forte correlação com as medidas ventriculares e o volume liquórico ventricular (rs = 0.51, p = 0.001). A dilatação ventricular supratentorial e o volume de líquor ventricular apresentaram uma correlação moderada com o volume de stroke aquedutal (VSA) (rs = 0.46, p = 0.002). A pressão de abertura liquórica não se correlacionou nem com as três medidas da ventriculomegalia, nem com a volumetria liquórica, nem com o VSA. O prejuízo cognitivo e os EPVD mostraram uma associação significativa com a ventriculomegalia, especialmente com a largura do terceiro ventrículo (p = 0.019 e p = 0.001, respectivamente). Os EPVD em quantidade aumentada também apresentaram uma significativa associação com o VSA elevado (p = 0.007). Conclusões: Nos pacientes com MPS, a ventriculomegalia está associada a um fenótipo grave da doença, maior declínio cognitivo e maior extensão das LSB e EPVD. Existem associações entre as medidas de fluxo liquórico e as medidas relacionadas à volumetria liquórica. Além disso, as medidas volumétricas estão associadas a quantidade de EPVD. / Background: The mucopolysaccharidoses (MPS) are a group of lysosomal diseases characterized by a deficiency in one of the lysosomal enzymes responsible to degrade glycosaminoglycans (GAGs). The precise incidence of hydrocephalus in patients with MPS is hard to determine, because it lacks a formal, consensus-based definition. In addition, it is difficult to distinguish communicating hydrocephalus from ventricular dilatation secondary to brain atrophy, because both share common clinical and neuroradiological features. Although various techniques are used to identify MPS patients who are most likely to have hydrocephalus and respond to surgical treatment, no definitive method exists to prove diagnosis. Objectives: To assess the relationship between ventriculomegaly, brain and cerebrospinal fluid (CSF) volumes, aqueductal and cervical CSF flows, and CSF opening pressure in MPS patients, and to provide potential biomarkers for abnormal CSF circulation. Methods: Forty-three MPS patients (12 MPS I, 15 MPS II, 5 MPS III, 9 MPS IV A and 2 MPS VI) performed clinical and neurodevelopmental tests, and T1, T2, FLAIR and phase-contrast magnetic resonance imaging (MRI) followed by a lumbar puncture with the CSF opening pressure assessment. For the analysis of MRI variables, the following measures were performed: brain and CSF volumes, white matter (WM) lesion load, Evans’ index, third ventricle width, callosal angle, dilated perivascular spaces (PVS), craniocervical junction stenosis, aqueductal and cervical CSF stroke volumes, and CSF GAGs concentration Results: The severe forms and the macrocephaly were significantly associated with the ventriculomegaly, mainly with the Evans’ index (p = 0.004 and p = 0.008, respectively). The WM lesion load presented a high correlation with the ventricular measurements and the ventricular CSF volume (rs = 0.51, p = 0.001). The supratentorial ventricular dilation and the ventricular CSF volume presented a moderate correlation with the aqueductal CSF stroke volume (ACSV) (rs = 0.46, p = 0.002). The CSF opening pressure did not correlate with either the three measures of ventriculomegaly, either with the CSF volumetry or with the ACSV. The cognitive impairment and the dilated PVS showed a significant association with the ventriculomegaly, especially with the width of the third ventricle (p = 0.019 and p = 0.001, respectively). Increased amount of dilated PVS also had a significant association with the elevated ACSV (p = 0.007). Conclusions: In MPS patients ventriculomegaly is associated with a severe phenotype, increased cognitive decline, WM lesion severity and enlarged PVS. There are associations between CSF flow measurements and measurements related to CSF volumetrics. Also, the volumetric measurements are associated with the degree of dilated PVS.

Made available in DSpace on 2014-06-11T19:31:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-05Bitstream added on 2014-06-13T18:41:56Z : No. of bitstreams: 1 gama_fgv_dr_jabo.pdf: 362347 bytes, checksum: 50eb2ff84ec762dc6be13df310869856 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A análise do líquido cerebrospinal demonstra ser uma ferramenta complementar viável e eficaz ao exame clínico-patológico do sistema nervoso, especialmente auxiliando no diagnóstico e prognóstico das suas inúmeras enfermidades. Porém, as variáveis apreciadas ao exame de rotina do liquor, nem sempre propiciam a detecção de anormalidades sutis frente a algumas situações neuropatológicas agudas, como por exemplo, nas viroses. Sendo assim, se faz necessário o aprofundamento do estudo do liquor com o escopo de se buscar técnicas mais sensíveis à identificação de alterações estruturais do tecido nervoso, bem como à avaliação do prognóstico do quadro clínico. E, recentemente, tem sido utilizada com sucesso em humanos a avaliação de marcadores bioquímicos, dentre os quais as atividades enzimáticas liquóricas da creatina quinase, lactato desidrogenase e aspartato aminotransferase. Sendo assim, idealizou-se o projeto de pesquisa, em tela, com o objetivo de se avaliar amostras liquóricas de cães acometidos por cinomose, com atenção especial às atividades enzimáticas, e sua correlação com achados histopatológicos do sistema nervoso central. Para tanto, foram colhidas amostras de LCR de 10 cães neurologicamente sadios e de 20 cães na fase neurológica da cinomose, as quais foram analisadas segundo a coloração, o aspecto, o pH, a densidade, a taxa de proteínas liquóricas totais e as atividades enzimáticas da lactato desidrogenase, da aspartato aminotransferase e da creatina quinase total e sua isoenzima CK-BB. Ademais fragmentos do encéfalo e medula espinhal também foram colhidos para posterior avaliação histopatológica. Os resultados obtidos foram capazes de demonstrar, principalmente a origem neurológica do aumento das atividades enzimáticas liquóricas, principalmente da CK e, ainda, a correlação entre o grau... / Evaluation of the cerebrospinal fluid is an important and efficient tool in the clinical-pathologic examination of the central nervous system, helping in the diagnosis and prognosis of several disorders. However, the variables presented in the cerebrospinal fluid not always allow the detection of acute neuropathology, such as viruses. It is necessary more studies with the purpose to obtain more sensitive techniques to identify structural changes in the nervous system, as well as the evaluation and prognosis of clinical signs. Recently, the evaluation of biochemical ma rkers , such as cerebrospinal enzyme activity, lactate dehidrogenase and aspartate aminotransferase, has been used in humans. Thus, the aim of the present study is to evaluate cerebrospinal samples of dogs with canine distemper, with focus on enzymatic activity and its correlation with histopathological finding of the central nervous system. For that purpose, samples of the CSF were collected from 10 dogs clinically healthy and 20 dos presenting neurological signs of canine distemper. The samples were evaluated for color, aspect, pH, density, total protein in CSF and enzyme activities (Iactate dehidrogenase, aspartate aminotransferase and total creatine kinase and its isoenzyme CK-BB). Moreover, fragments of the brain and spinal marrow were collected for histopathological evaluation. The results were capable to demonstrate the neurological origin of the increase in CSF enzyme activities, especially of CK and also the correlation between the degree of enzyme activities and the extent of desmielinizing injury found in the central nervous system.

abstract: The unique anatomical and functional properties of vasculature determine the susceptibility of the spinal cord to ischemia. The spinal cord vascular architecture is designed to withstand major ischemic events by compensating blood supply via important anastomotic channels. One of the important compensatory channels of the arterial basket of the conus medullaris (ABCM). ABCM consists of one or two arteries arising from the anterior spinal artery (ASA) and circumferentially connecting the ASA and the posterior spinal arteries. In addition to compensatory function, the arterial basket can be involved in arteriovenous fistulae and malformations of the conus. The morphometric anatomical analysis of the ABCM was performed with emphasis on vessel diameters and branching patterns. A significant ischemic event that overcomes vascular compensatory capacity causes spinal cord injury (SCI). For example, SCI complicating thoracoabdominal aortic aneurysm repair is associated with ischemic injury. The rate of this devastating complication has been decreased significantly by instituting physiological methods of protection. Traumatic spinal cord injury causes complex changes in spinal cord blood flow (SCBF), which are closely related to a severity of injury. Manipulating physiological parameters such as mean arterial pressure (MAP) and intrathecal pressure (ITP) may be beneficial for patients with a spinal cord injury. It was discovered in a pig model of SCI that the combination of MAP elevation and cerebrospinal fluid drainage (CSFD) significantly and sustainably improved SCBF and spinal cord perfusion pressure. In animal models of SCI, regeneration is usually evaluated histologically, requiring animal sacrifice. Thus, there is a need for a technique to detect changes in SCI noninvasively over time. The study was performed comparing manganese-enhanced magnetic resonance imaging (MEMRI) in hemisection and transection SCI rat models with diffusion tensor imaging (DTI) and histology. MEMERI ratio differed among transection and hemisection groups, correlating to a severity of SCI measured by fraction anisotropy and myelin load. MEMRI is a useful noninvasive tool to assess a degree of neuronal damage after SCI. / Dissertation/Thesis / Doctoral Dissertation Neuroscience 2016

Human neurocysticercosis (NC) is an important but neglected cause of epilepsy in developing countries where the parasite occurs. Expression of single-chain variable fragment (scFv) antibodies on the surface of bacteriophage is widely used to prepare antibodies with pre-defined specificities. A phage antibody library was selected against peptides displayed on phages coupled to beads and total saline extract of Taenia solium metacestodes immobilized on microtiter plate wells. After two rounds of selection 96 phage clones of each panning were selected, tested for scFv expression and specificity to each target. Specific clones were further analyzed by ELISA (Enzyme-linked immunosorbent assay), Dot-blot, sequencing and immunofluorescence. After selection, three clones were used for antigen capture to characterize its targets for future immunodiagnostic assays development. Total saline extract was fractionated on ion exchange resin diethylaminoethyl (DEAE), and fractions were tested by ELISA to detect sera IgG from: NC, other parasites and health controls (40 each). The fractions with best diagnostic parameters (sensitivity, specificity, area under curve and likelihood ratio, calculated by TG-ROC) were selected and subjected to antigen capture using each purified scFv clone. Each captured fraction was tested by ELISA to detect IgG in 30 serum samples from each group. In immunofluorescence tests, no fluorescence was observed in negative controls, and all clones showed a non-uniform staining profile, and their targets were elucidated through mass spectrometry. After ion exchange fractionation and ELISA tests, DEAE S2 fraction showed to be the best one and was used to capture new antigens. DEAE S2 showed 93.3% specificity. Among all clones, A4 and B6 captured antigens from saline extract and DEAE S2 fraction, respectively, with the best diagnostic parameters. In conclusion, antibody phage display technology is a potential approach for the study of antigen-antibody interactions, which can be used to further elucidate the biology of interaction on neurocysticercosis and to capture new antigens with potential applications in NC diagnosis and therapeutics. / A neurocistocercose humana (NC) é uma doença muito importante, porém negligenciada e é a maior causa de epilepsia em países em desenvolvimento onde a parasitose ocorre. A expressão de fragmentos de cadeia única das regiões variáveis de anticorpo (scFv) na superfície de bacteriófagos é amplamente utilizada para obter anticorpos com especificidades pré-definidas. Uma biblioteca de anticorpos foi utilizada para a seleção de clones específicos à peptídeos expostos em fagos acoplados a beads e ao extrato salino total de Taenia solium (S) imobilizado em placas de microtitulação. Após dois ciclos de seleção, 96 clones de anticorpos foram selecionados contra cada alvo, testados para expressão do scFv e especificidade pelo alvo. Aqueles clones que se mostraram específicos foram melhor analisados por ELISA (Enzyme linked immunosorbent assay), Dot blot, sequenciamento e imunofluorescência. Três clones foram selecionados para serem utilizados na captura antigênica e caracterização do antígeno verdadeiro e para captura de novos antígenos com potencial aplicação em testes diagnósticos. O extrato S foi fracionado em resina de troca iônica diethylaminoethyl (DEAE) para obter frações que foram posteriormente testadas por ELISA para detectar IgG em amostras de soro de pacientes: com NC, outras parasitoses e saudáveis, 40 amostras cada grupo. A fração com melhores parâmetros diagnósticos (sensibilidade, especificidade, área sob a curva e likelihood ratio, calculadas por TG-ROC) foi selecionada e sujeita à captura antigênica usando cada clone de scFv purificado. Cada fração capturada foi testada por ELISA para detectar IgG em 30 amostras de soro de cada grupo. Nos testes de imunofluorescência, nenhuma fluorescência foi observada com os controles negativos e todos os clones mostraram um padrão de marcação não uniforme, seus antígenos alvo foram elucidados por espectrometria de massas. Após fracionamento por troca iônica e ELISA, a fração DEAE S2 se mostrou a melhor e foi utilizada para a captura de novos antígenos. A fração DEAE S2 mostrou especificidade de 93,3%. Dentre todos os clones, o A4 e o B6 capturaram antígenos do extrato S e fração DEAE S2, respectivamente, com os melhores parâmetros diagnósticos. Em conclusão a tecnologia de exposição de anticorpos em fagos é uma técnica potencial para o estudo de interações antígeno-anticorpo utilizadas para melhor elucidar a a biologia da interação na NC e para capturar novos antígenos potencialmente aplicáveis para o diagnóstico da NC. / Doutor em Imunologia e Parasitologia Aplicadas