No presente trabalho avaliamos fenotípica e molecularmente isolados de P. vivax da Amazônia Ocidental Brasileira. A avaliação fenotípica de sensibilidade à cloroquina (CQ) foi realizada por meio do ensaio de maturação de esquizonte. A avaliação molecular efetuou-se por tipagem de cinco polimorfismos de nucleotídeo único (SNPs) não-sinônimos do gene pvmdr-1 (A266G, A1498G, A2722C, A2927T e T3226C) e variações no número de cópias deste gene. Em decorrência, o fenótipo de susceptibilidade à CQ nos 36 isolados analisados não foi estabelecido devido ao escasso desenvolvimento ex-vivo dos parasitos. Mutações na posição Y976F, potencialmente associada à resistência à CQ, não foram observadas nos 80 isolados testados. Além disso, 10% das amostras apresentaram a mutação F1076L, que frequentemente acompanha a mutação Y976F. Finalmente, apenas dois isolados (0,9%) dos 215 analisados apresentaram duas cópias do gene pvmdr-1, sugerindo que a duplicação gênica, potencial mecanismo de resistência à mefloquina, ainda não está disseminada nas populações de parasitos desta região. / In this study, we performed a molecular and phenotypic evaluation of isolates of P. vivax from Brazilian Western Amazon. The phenotypic evaluation of chloroquine (CQ) sensitivity was performed using the schizont maturation assay. The molecular evaluation was made by typing of five non-synonymous single nucleotide polymorphisms (SNPs) of the pvmdr-1 gene (A266G, A1498G, A2722C, T3226C and A2927T) and variations of the copy number of this gene. As a result, the CQ susceptibility phenotype in 36 isolates of P. vivax analyzed was not established, due to the scarce ex-vivo development of the parasites. Mutations at position Y976F, potentially associated with CQ resistance, were not observed in 80 isolates tested. In addition, 10% of the isolates had the mutation F1076L, which often accompanies the mutation Y976F. Finally, two isolates (0,9%), from a total of 215 had two copies of the pvmdr-1 gene, suggesting that the gene duplication, a potential mechanism of mefloquine resistance, is not spread in the parasites populations of this region.

No presente trabalho avaliamos fenotípica e molecularmente isolados de P. vivax da Amazônia Ocidental Brasileira. A avaliação fenotípica de sensibilidade à cloroquina (CQ) foi realizada por meio do ensaio de maturação de esquizonte. A avaliação molecular efetuou-se por tipagem de cinco polimorfismos de nucleotídeo único (SNPs) não-sinônimos do gene pvmdr-1 (A266G, A1498G, A2722C, A2927T e T3226C) e variações no número de cópias deste gene. Em decorrência, o fenótipo de susceptibilidade à CQ nos 36 isolados analisados não foi estabelecido devido ao escasso desenvolvimento ex-vivo dos parasitos. Mutações na posição Y976F, potencialmente associada à resistência à CQ, não foram observadas nos 80 isolados testados. Além disso, 10% das amostras apresentaram a mutação F1076L, que frequentemente acompanha a mutação Y976F. Finalmente, apenas dois isolados (0,9%) dos 215 analisados apresentaram duas cópias do gene pvmdr-1, sugerindo que a duplicação gênica, potencial mecanismo de resistência à mefloquina, ainda não está disseminada nas populações de parasitos desta região. / In this study, we performed a molecular and phenotypic evaluation of isolates of P. vivax from Brazilian Western Amazon. The phenotypic evaluation of chloroquine (CQ) sensitivity was performed using the schizont maturation assay. The molecular evaluation was made by typing of five non-synonymous single nucleotide polymorphisms (SNPs) of the pvmdr-1 gene (A266G, A1498G, A2722C, T3226C and A2927T) and variations of the copy number of this gene. As a result, the CQ susceptibility phenotype in 36 isolates of P. vivax analyzed was not established, due to the scarce ex-vivo development of the parasites. Mutations at position Y976F, potentially associated with CQ resistance, were not observed in 80 isolates tested. In addition, 10% of the isolates had the mutation F1076L, which often accompanies the mutation Y976F. Finally, two isolates (0,9%), from a total of 215 had two copies of the pvmdr-1 gene, suggesting that the gene duplication, a potential mechanism of mefloquine resistance, is not spread in the parasites populations of this region.

Leung Kam Tong. / Thesis submitted in: September 2006. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 79-95). / Abstracts in English and Chinese. / Abstract --- p.i / Abstract (Chinese) --- p.iii / Acknowledgements --- p.v / Table of contents --- p.vi / List of figures --- p.ix / List of abbreviations --- p.xii / Chapter Chapter 1 --- General Introduction --- p.1 / Chapter 1.1 --- Acute lymphoblastic leukemia --- p.1 / Chapter 1.2 --- T-cell acute lymphoblastic leukemia --- p.2 / Chapter 1.2.1 --- Chemotherapy --- p.2 / Chapter 1.2.1.1 --- Induction therapy --- p.2 / Chapter 1.2.1.2 --- Intensification therapy --- p.3 / Chapter 1.2.1.3 --- Maintenance therapy --- p.3 / Chapter 1.2.2 --- Chemoresistance in T-ALL --- p.3 / Chapter 1.3 --- Apoptosis and chemoresistance --- p.5 / Chapter 1.3.1 --- "Initiation, execution and regulation of apoptosis" --- p.5 / Chapter 1.3.1.1 --- Initiation of apoptosis --- p.5 / Chapter 1.3.1.2 --- Execution of apoptosis --- p.7 / Chapter 1.3.1.3 --- Regulation of apoptosis --- p.7 / Chapter 1.3.2 --- Mechanisms of resistance to apoptosis --- p.9 / Chapter 1.3.2.1 --- Overexpression of pro-survival proteins --- p.9 / Chapter 1.3.2.2 --- Downregulation and mutation of pro-apoptotic proteins --- p.11 / Chapter 1.3.2.3 --- Other mechanisms --- p.13 / Chapter 1.4 --- Bcl-2 interating mediator of cell death --- p.14 / Chapter 1.4.1 --- Role of Bim in apoptosis --- p.16 / Chapter 1.4.2 --- Regulation of Bim --- p.17 / Chapter 1.4.2.1 --- Transcriptional regulation of Bim --- p.18 / Chapter 1.4.2.2 --- Post-transcriptional regulation of Bim --- p.18 / Chapter 1.5 --- c-Jun N-terminal kinase --- p.20 / Chapter 1.5.1 --- Pro-apoptotic role of JNK --- p.21 / Chapter 1.5.2 --- Anti-apoptotic role of JNK --- p.21 / Chapter 1.6 --- Hypotheses --- p.22 / Chapter Chapter 2 --- Materials and Methods --- p.23 / Chapter 2.1 --- Cell culture --- p.23 / Chapter 2.2 --- Induction of quantification of apoptosis --- p.24 / Chapter 2.3 --- Determination of caspase activities --- p.24 / Chapter 2.4 --- Western blotting --- p.25 / Chapter 2.4.1 --- Protein extraction and determination of protein concentration --- p.25 / Chapter 2.4.2 --- SDS-PAGE and immunodetection --- p.26 / Chapter 2.5 --- Cell-free apoptosis reactions --- p.27 / Chapter 2.6 --- Analysis of mitochondrial membrane potential --- p.27 / Chapter 2.7 --- Transient transfection of Sup-Tl cells --- p.28 / Chapter 2.8 --- Reverse transcription-polymerase chain reaction (RT-PCR) --- p.28 / Chapter 2.8.1 --- RNA isolation --- p.28 / Chapter 2.8.2 --- Synthesis of first-strand cDNA --- p.29 / Chapter 2.8.3 --- Polymerase chain reaction --- p.29 / Chapter 2.9 --- Alkaline phosphatase digestion of Bim --- p.30 / Chapter Chapter 3 --- Results --- p.31 / Chapter 3.1 --- The T-ALL cell line Sup-Tl is resistant to etoposide-induced apoptosis --- p.31 / Chapter 3.2 --- Sup-Tl cells are resistant to etoposide-induced caspase activation --- p.40 / Chapter 3.3 --- Sup-Tl cells are insusceptible to etoposide-induced mitochondrial alterations --- p.46 / Chapter 3.4 --- BimEL is required for etoposide-induced apoptosis in Sup-Tl cells --- p.51 / Chapter 3.5 --- The reduced level of BimEL in Sup-Tl cells is owing to the presence of constitutively active JNK --- p.58 / Chapter Chapter 4 --- Discussion --- p.67 / References --- p.79

Ko Mui Lam. / Thesis submitted in: December 2003. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 84-100). / Abstracts in English and Chinese. / Chapter Chapter 1 --- Introduction --- p.1 / Chapter A. --- Antibiotic use and resistance --- p.1 / Chapter B. --- Selection of resistant strains by antibiotics --- p.2 / Chapter C. --- Fluoroquinolones --- p.5 / Chapter D. --- β-Lactams --- p.8 / Chapter E. --- Aminoglycosides --- p.9 / Chapter F. --- Salmonella sp --- p.9 / Chapter a. --- Microbiology and clinical significance --- p.9 / Chapter b. --- Antimicrobial susceptibilities --- p.10 / Chapter G. --- Escherichia coli --- p.14 / Chapter a. --- Microbiology and clinical significance --- p.14 / Chapter b. --- Antimicrobial susceptibilities --- p.15 / Chapter H. --- Pseudomonas aeruginosa --- p.18 / Chapter a. --- Microbiology and clinical significance --- p.18 / Chapter b. --- Antimicrobial susceptibilities --- p.18 / Chapter I. --- Objectives --- p.22 / Chapter Chapter 2 --- Materials and Methods --- p.23 / Chapter A. --- Bacterial strains --- p.23 / Chapter B. --- Methods --- p.23 / Chapter a. --- Identification --- p.23 / Chapter i) --- Salmonella --- p.23 / Chapter ii) --- Escherichia coli --- p.24 / Chapter iii) --- Pseudomonas aeruginosa --- p.24 / Chapter b. --- Antimicrobial susceptibility testing --- p.24 / Chapter i) --- Determination of minimal inhibitory concentrations (MICs) of antibiotics --- p.24 / Chapter ii) --- "Determination of the antimicrobial susceptibility of Salmonella sp, Escherichia coli and Pseudomonas aeruginosa by the breakpoint method" --- p.28 / Chapter c. --- Effects of antimicrobial agents on the development of resistant mutants --- p.28 / Chapter Chapter 3 --- Results --- p.32 / Chapter A. --- Antimicrobial susceptibilities --- p.32 / Chapter B. --- Effects of fluoroquinolones on the development of resistance --- p.36 / Chapter a. --- Salmonella sp --- p.38 / Chapter b. --- Escherichia coli --- p.40 / Chapter c. --- Pseudomonas aeruginosa --- p.46 / Chapter C. --- Effects of β-lactams on the development of resistance --- p.49 / Chapter a. --- Salmonella sp --- p.49 / Chapter b. --- Escherichia coli --- p.53 / Chapter c. --- Pseudomonas aeruginosa --- p.56 / Chapter D. --- Effects of aminoglycosides on the development of resistance --- p.60 / Chapter a. --- Salmonella sp --- p.60 / Chapter b. --- Escherichia coli --- p.68 / Chapter c. --- Pseudomonas aeruginosa --- p.68 / Chapter Chapter 4 --- Discussion --- p.76 / References --- p.84 / List of Tables / Chapter I-1 --- Antimicrobial susceptibilities of salmonellae reported in the literature --- p.12 / Chapter I-2 --- Antimicrobial susceptibilities of Escherichia coli reported in the literature --- p.16 / Chapter I-3 --- Antimicrobial susceptibilities of Pseudomonas aeruginosa reported in the literature --- p.20 / Chapter II-1 --- Antibiotics and their solvents --- p.26 / Chapter II-2 --- Antibiotics and their concentrations tested --- p.27 / Chapter II-3 --- Antibiotics and their breakpoint concentration tested --- p.29 / Chapter III-1 --- Susceptibilities of 40 isolates of Salmonella sp to 12 antimicrobial agents --- p.33 / Chapter III-2 --- Susceptibilities of 40 isolates of Escherichia coli to 12 antimicrobial agents --- p.34

引發獲得性免疫缺陷綜合癥（AIDS）的人類免疫缺陷病毒（HIV）是一種逆轉錄病毒。過去的十餘年間，高效抗逆轉錄病毒治療療法（HARRT），在抗病毒感染方面取得了很大的成功。高效抗逆轉錄病毒治療療法是一種將多種抗逆轉錄病毒藥物複合的藥物聯用療法。然而，因為病毒的逆轉錄過程極易突變，導致HIV已經可以對大多數使用的抑製藥物產生抗藥性。因此，有越來越多的需要去尋找新型的抗病毒複製機理，例如將人體細胞蛋白作為載體，來達到克服病毒抗藥性的目的。 / HIV-1的複製離不開宿主細胞的剪接因子，例如SR蛋白。選擇性剪接因子ASF/SF2，一個典型的調控pre-RNA剪接的SR蛋白，在HIV-1的pre-mRNA剪接和複製中起到了很重要的調控作用。ASF/SF2和其他SR蛋白一樣，都被丝氨酸/苏氨酸蛋白激酶（SRPK）磷酸化，磷酸化位點位於C端的丝氨酸/苏氨酸結構域（RS domain）。SRPK通過磷酸化來調節ASF/SF2在細胞中的分佈。對於SRPK 和ASF/SF2複合物的結構學和功能學研究指出，ASF/SF2的docking motif和SRPK1的遠離活性位點的docking groove存在很強的相互作用。而這種相互作用是調節磷酸化過程關鍵。所以，在我們的研究過程中，我們希望通過阻斷2個蛋白的相互作用來干擾ASF/SF2的磷酸化，進而抑制其在HIV-1 pre-mRNA剪接過程中的活性。 / 我們採用以結構為基礎的藥物模擬篩選，來選擇潛在的抑制物，達到通過抑制物與docking groove的相互作用來阻斷ASF/SF2和SRPK1的相互作用，以達到抑制磷酸化的目的。我們使用的數據庫來自于ZINC數據庫（UCSF），包括天然產物數據庫和SPECS。我們採用AutoDock Vina 和AutoDock 4.2 二個模擬軟件來栓選數據庫中351473个化合物。并從中選出50個潛在的化合物用作之後的化學生物學測試。體外的激酶活性試驗顯示，6個化合物對ASF/SF2的磷酸化有抑製作用。 / 體外的HIV-1 pre-mRNA剪接實驗顯示，5個化合物在逆轉錄PCR（RT-PCR）中有一定得抑制效果。和DMSO對照組相比，在抑製劑作用下剪接產物的生成被抑制。HIV-1病毒合胞體感染實驗顯示，有一個化合物對病毒的感染起到了一定的抑制作用。 / 其他的測試實驗還在進行中，包括對SRPK1和抑制物複合物的結構研究，從而更好的研究抑制物的作用機理。以及，採用表面等離子共振波譜來進行動力學研究和其他關於化合物在病毒複製過程中的實驗測試。 / Human immunodeficient virus (HIV) is a retrovirus that cause acquired immunodeficiency syndrome (AIDS). Highly active antiretroviral therapy (HAART) is a treatment of HIV infection that uses combinations of antiretroviral drugs and has achieved great success in the past two decades. However, since the reverse transcription process of viral RNA is notoriously prone to error, HIV-1 can acquire resistance to nearly all known inhibitors and has started to develop resistance to HAART. Therefore, there is an ongoing search for new drugs with novel inhibitory mechanism such as targeting cellular proteins essential for HIV-1 replication to overcome drug resistance of the virus. / HIV-1 mRNA undergoes complex splicing and the expression of the integrated HIV-1 provirus is largely dependent on the host’s splicing machinery which assembly requires splicing factors such as serine-arginine rich proteins (SR proteins). Alternative splicing factor/splicing factor 2 (ASF/SF2), a prototypic SR protein that is essential for pre-mRNA splicing, has been shown to play critical roles during HIV-1 pre-mRNA splicing and replication. ASF/SF2, like other SR proteins, is phosphorylated by SR protein-specific kinases (SRPKs) at its C-terminal arginine/serine (RS) domain, which governs its localization and metabolism. Structural and functional studies of SRPK1 in complex with ASF/SF2 has revealed that a docking groove on SRPK1 that is distal to the active site interacts strongly with a docking motif and the RS domain of ASF/SF2, leading to high affinity binding as well as regulating the mechanism of phosphorylation. In this study, we propose that by blocking this interaction, we might interfere the phosphorylation of ASF/SF2 and inhibit its activity during splicing of HIV-1 pre-mRNA. / Structure-based in silico screening method is adopted to identify potential inhibitors that bind to the docking groove of SRPK1 to block the binding and phosphorylation of ASF/SF2. The compound libraries being used include the Natual Products Database and SPECS database from ZINC (UCSF). 351,473 compounds have been screened using the program Autodock Vina as well as Autodock 4.0. Until now 50 potential candidates of inhibitor have been selected for biochemical analyses. In vitro kinase assays showed that six compounds exhibit inhibitory activity against the phosphorylation of ASF/SF2. / To test the effect of the selected inhibitors on the splicing of HIV-1 mRNA, ex vivo splicing assay has been performed. Current results showed that the synthesis of splicing products extracted from drug-treated cells was less efficient when compared to untreated cells. Biological assays testing the inhibitory effects of the compounds on viral infection are currently underway. Our preliminary result suggested that one of the compounds could indeed inhibit HIV-1 viral infection. / Other biochemical and biological analyses including structural study of kinase-inhibitor complexes to understand the mode of inhibition; measurement of binding kinetics using surface plasmon resonance spectroscopy (SPR); and biological assays testing the inhibitory effects of the compounds on replication are underway. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Yu, Xiyao. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 95-107). / Abstracts also in Chinese. / Abstract --- p.I / 摘要 --- p.III / Acknowledgements --- p.V / TABLE OF CONTENTS --- p.VI / LIST OF FIGURES --- p.IX / LIST OF TABLES --- p.XI / Chapter Chapter I --- : Introduction --- p.1 / Chapter 1.1 --- HIV, HAART and HIV Drug Resistance --- p.2 / Chapter 1.2 --- HIV-1 alternative splicing mechanism --- p.9 / Chapter 1.3 --- SR Protein Family --- p.13 / Chapter 1.4 --- Functional roles of SR protein in HIV pre-mRNA splicing --- p.16 / Chapter 1.5 --- Phosphorylation States of SR Proteins --- p.18 / Chapter 1.6 --- SR protein Kinase --- p.20 / Chapter 1.7 --- Interaction between SRPK1 and ASF/SF2 --- p.23 / Chapter 1.8 --- IDC16 and SPRIN340 --- p.26 / Chapter 1.9 --- Structure-based drug screening --- p.27 / Chapter 1.10 --- AutoDock Suite --- p.29 / Chapter 1.11 --- Kinase-substrate interaction inhibitors --- p.30 / Chapter 1.12 --- Focus of study --- p.34 / Chapter Chapter II --- : Materials and Methods --- p.35 / Chapter 2.1 --- Materials --- p.36 / Chapter 2.1.1 --- Bacterial strain --- p.36 / Chapter 2.1.2 --- Antibodies --- p.36 / Chapter 2.1.3 --- Cell line --- p.36 / Chapter 2.1.4 --- Plasmid --- p.36 / Chapter 2.1.5 --- Reagents --- p.38 / Chapter 2.2 --- Expression and purification of Recombinant protein --- p.38 / Chapter 2.3 --- In silico screening of inhibitors --- p.44 / Chapter 2.4 --- Kinase Glo Assay --- p.45 / Chapter 2.5 --- In vitro kinase assay --- p.45 / Chapter 2.6 --- Cell Culture --- p.46 / Chapter 2.7 --- MTT Assay --- p.46 / Chapter 2.8 --- Immunocytochemistry --- p.47 / Chapter 2.9 --- Ex vivo splicing assay --- p.47 / Chapter 2.10 --- Surface plasmon resonance spectroscope --- p.48 / Chapter Chapter III --- : Results --- p.50 / Chapter 3.1 --- In silico screening of inhibitors --- p.51 / Chapter 3.2 --- Selected Compounds Inhibits SRPK1 in Vitro --- p.60 / Chapter 3.2.1 --- Protein purification --- p.60 / Chapter 3.2.2 --- Inhibits ASF/SF2 Phosphorylation by SRPK --- p.66 / Chapter 3.3 --- Surface Plasmon Resonance Binding Competition Assay --- p.76 / Chapter 3.4 --- Inhibitors Alters HIV-1 Alternative Splicing ex Vivo --- p.79 / Chapter 3.5 --- Cytotoxic effect of candidate compound on HeLa cells --- p.84 / Chapter 3.6 --- Nature compound alters ASF/SF2 localization --- p.86 / Chapter Chapter IV --- : Discussion and Conclusion --- p.89 / References --- p.95

背景和目的：胰腺導管腺癌（簡稱胰腺癌）是世界範圍內惡性程度最高的癌癥之一，目前它的5 年生存率不到5%。大部分的病人在診斷初期就已經發展到了局部浸潤或遠處轉移的階段，因此失去了根治性手術切除的机会。輔助性化療對於胰腺癌病人來說是一個首選的治療方案，但是目前只有一小部分病人對化療藥物有良好的反應，而臨床化療失敗常與腫瘤細胞對化療藥物產生耐藥有關。吉西他濱是目前臨床上常用的一線抗癌藥物，但是它的耐藥現象在胰腺癌病人中廣泛存在，也是阻礙其臨床應用的主要原因之一。盡管已經有很多研究致力於揭示吉西他濱在胰腺癌細胞中的耐藥機理，目前臨床上仍然沒有有效的方法應對吉西他濱耐藥。我們的研究主要是為了探討一些以前沒有报道過的參與吉西他濱耐藥機理的基因，借此揭示胰腺癌細胞的吉西他濱耐藥的深層機制，為臨床上的治療提供理論依據。 / 實驗方法：我們實驗室之前在胰腺癌細胞株Capan2 中用全基因組RNAi篩選的方法確定LLGL1 作為抑癌基因能增強吉西他濱在胰腺癌細胞中的細胞毒性。我們隨後用體外細胞毒性分析實驗和皮下腫瘤動物模型來驗證LLGL1 是否能增強吉西他濱的細胞毒性，用蘇木素-伊紅染色和原味末端轉移酶標記技術分析抑制LLGL1 的表達是否會影響吉西他濱誘導的細胞雕亡反應。我們還應用微陣列分析技術進一步探尋LLGL1 的下遊靶蛋白，用實時定量PCR(qRT-PCR) 、蛋白印跡法（western blotting）、熒光素酶檢測等技術來進一步證實LLGL1 與下遊靶蛋白的關系，用免疫組織化學方法探究LLGL1 下遊靶蛋白在胰腺癌組織中的表達情況，以及該蛋白與LLGL1 的表達相關性，還應用染色體免疫共沈澱的方法探討轉錄因子Sp1(pThr453) 和RNA 聚合酶 II 在LLGL1 下遊靶蛋白的啟動子上的富集情況。 / 實驗結果：LLGL1 能增強吉西他濱在胰腺癌中的細胞毒性，抑制該基因的表達能誘導胰腺癌細胞對吉西他濱的耐藥，而上調該基因的表達則會增強胰腺癌細胞對吉西他濱的細胞毒性反應。OSMR 是LLGL1 的下遊靶蛋白, 其在胰腺癌組織中的表達與LLGL1 呈負性相關，抑制OSMR 的表達可以逆轉由LLGL1表達下調引起的吉西他濱耐藥現象。OSMR 表達上調可以增強腫瘤幹細胞標記物CD44 和CD24 的表達。另外，在胰腺癌細胞中，抑制LLGL1 的表達能激活ERK2/Sp1 信號通路，導致磷酸化Sp1(pThr453)的表達升高。OSMR 啟動子既沒有TATA 元件也沒有INR 元件，但是有Sp1 结合元件可供Sp1 結合。磷酸化Sp1(pThr453)可以結合到OSMR 啟動子的Sp1 结合元件上，從而促使RNA 轉錄酶II 結合到該啟動子上，啟動OSMR 基因的轉錄。 / 結論：我們的研究發現：1，LLGL1 能增強吉西他濱在胰腺癌中的細胞毒性，抑制該基因在胰腺癌細胞中的表達能上調OSMR 的表達，並誘導吉西他濱耐藥；2，OSMR 的表達在胰腺癌組織中與LLGL1 呈負性相關；3，下調LLGL1的表達能激活ERK2/Sp1 信號通路，進一步導致磷酸化Sp1(pThr453)和RNA 轉錄酶II 在OSMR 啟動子上的聚集，最終促使OSMR 的高表達，而下調LLGL1的表達能抑制該調節通路，從而抑制OSMR 的轉錄。 / Background & Aims: Pancreatic ductal adenocarcinoma (PDAC) is one of the most malignant cancers worldwide. Its 5-year survival rate is less than 5%, because most patients have already developed to the advanced stage of local invasion or distant metastasis once diagnosed, and missed the chances of curable surgical resection. Adjuvant chemotherapy is an alternative therapeutic strategy against PDAC. Yet, only very small proportion of patients could benefit from chemotherapy due to the innate and easily-acquired chemo-resistance in PDAC cells, especially to the first-line chemotherapeutic drug, gemcitabine. Many studies have been conducted to exploring the mechanisms underlying gemcitabine resistance in PDAC cells, but gemcitabine resistance is still the major obstacle impeding PDAC patients benefits from chemotherapy. Our studies aimed to investigate novel genes involved in gemcitabine response and to explore the undefined mechanisms generating gemcitabine resistance in PDAC cells. / Methods: Our colleagues previously performed genome-wide RNAi screening in gemcitabine-sensitive Capan2 cells. Lethal giant larvae homolog 1 (LLGL1) was identified as a potential gemcitabine-sensitizing gene which was then validated by our subsequent in-vitro drug cytotoxicity assay in LLGL1-inhibited Capan2 and SW1990 cells and in vivo subcutaneous xenograft mouse model. Hematoxylin & Eosin staining and terminal Deoxynucleotidyl Transferase dUTP Nick End Labeling were applied for the assessment of apoptotic effects induced by gemcitabine in subcutaneous xenografts. We did gene expression microarray analysis to explore the potential downstream targets of LLGL1. Western blotting, qRT-PCR, and luciferase assay were applied to validate the downstream target of LLGL1 that were figured out by microarray analysis. We also did immunohistochemical staining to investigate the expression levels and correlationship of LLGL1 and its downstream target in PDAC specimens. Chromatin immunoprecipitation was performed to explore the enrichment of the transcriptional factor Sp1(pThr453) and RNA polymerase II (Pol II) at the promoter of the downstream targets of LLGL1. / Results: LLGL1 was identified as a gemcitabine-sensitizing gene, whose inhibition remarkably reduced gemcitabine response in gemcitabine-sensitive Capan2 and SW1990 cells, and ectopic expression induced gemcitabine response in gemcitabine-resistant PANC1 cells. Oncostatin M receptor (OSMR) was identified as a downstream target of LLGL1, whose expression was negatively correlated with LLGL1, and knockdown of OSMR significantly reversed gemcitabine resistance induced by LLGL1 inhibition in Capan2 and SW1990 cells. Additionally, activation of OSMR signaling was associated with the elevated expression of cancer stem cell markers, CD44 and CD24, both of which had already been identified to contribute to gemcitabine resistance in PDAC cells. Moreover, OSMR up-regulation induced by LLGL1 inhibition in SW1990 cells depended on the activation of ERK2/Sp1 signaling and subsequent accumulation of Sp1(pThr453) and Pol II at the TATA-less, INR-less but Sp1-binding-site-rich promoter of OSMR, while ectopic expression of LLGL1 in PANC1 cells inactivated ERK2/Sp1 signaling and subsequently reduced the enrichment of Sp1(pThr453) and Pol II at OSMR promoter. / CONCLUSIONS: Our studies revealed the novel tumor suppressive role of LLGL1 as a gemcitabine-sensitizing gene in PDAC cells. Loss of LLGL1 resulted in the activation of ERK2/Sp1 signaling and up-regulation of OSMR expression, and ultimately desensitized gemcitabine response in PDAC cells. More importantly, ectopic expression of LLGL1 disrupted such regulatory axis and improved gemcitabine response. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Zhu, Yinxin. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 154-183). / Abstracts also in Chinese.

Wong, Kai Yi. / Thesis (M.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 101-110). / Abstracts in English and Chinese. / Abstract --- p.4 / 摘要 --- p.7 / Acknowledgements --- p.9 / List of Tables --- p.10 / List of Figures --- p.11 / List of Abbreviations and Symbols --- p.12 / Chapter Chapter 1 --- Introduction --- p.14 / Chapter 1.1 --- Staphylococcus aureus --- p.14 / Chapter 1.2 --- Methicillin-resistant Staphylococcus aureus (MRSA) --- p.14 / Chapter 1.2.1 --- Methicillin resistance of MRSA --- p.15 / Chapter 1.2.2 --- Staphylococcal Chromosomal Cassette mec (SCCmec) --- p.16 / Chapter 1.2.3 --- Hospital-associated MRSA (HA-MRSA) and Community-associated MRSA (CA-MRSA) --- p.22 / Chapter 1.2.3.1 --- Hospital-associated MRSA (HA-MRSA) --- p.23 / Chapter 1.2.3.2 --- Community-associated MRSA (CA-MRSA) --- p.23 / Chapter 1.2.4 --- Pathogenesis of MRSA infection --- p.27 / Chapter 1.2.4.1 --- Possible virulence genes contributing to necrotizing pneumonia --- p.29 / Chapter 1.2.4.1.1 --- Panton-Valentine Leukocidin (PVL) --- p.29 / Chapter 1.2.4.1.2 --- Phenol-soluble modulins (PSMs) --- p.36 / Chapter 1.3 --- Evolution of MRSA --- p.36 / Chapter 1.4 --- Epidemiology of MRSA --- p.38 / Chapter 1.4.1 --- Epidemiology of MRSA worldwide --- p.38 / Chapter 1.4.1.1 --- Epidemiology of HA-MRSA worldwide --- p.38 / Chapter 1.4.1.2 --- Epidemiology of CA-MRSA worldwide --- p.39 / Chapter 1.4.2 --- Epidemiology of MRSA in Hong Kong --- p.40 / Chapter 1.5 --- Clinical significance of MRSA --- p.41 / Chapter 1.6 --- Antibiotics --- p.43 / Chapter 1.6.1 --- Beta-lactams --- p.43 / Chapter 1.6.2 --- Fluoroquinolone --- p.44 / Chapter 1.6.3 --- Linezolid --- p.45 / Chapter 1.6.4 --- Glycopeptides --- p.45 / Chapter 1.6.5 --- Aminoglycosides --- p.46 / Chapter 1.6.6 --- Fusidic acid --- p.46 / Chapter 1.6.7 --- Clindamycin --- p.47 / Chapter 1.7 --- Hypothesis --- p.47 / Chapter Chapter 2 --- Methods and Materials --- p.50 / Chapter 2.1 --- Bacterial isolate --- p.50 / Chapter 2.2 --- Effect of subinhibitory antibiotics on the expression of mRNA in MRSA in vitro --- p.53 / Chapter 2.2.1 --- Collection of bacterial fraction --- p.53 / Chapter 2.2.2 --- RNA extraction and DNA digestion --- p.53 / Chapter 2.2.3 --- Reverse transcription for cDNA synthesis --- p.54 / Chapter 2.2.4 --- Quantitative real-time PCR (qPCR) analysis (pvl and psma\-A expression) --- p.55 / Chapter 2.2.5 --- Preparation of standard controls for quantification of DNA copy number in qPCR reactions... --- p.58 / Chapter 2.3 --- Effect of subinhibitory concentration of antibiotics on MRSA pneumonia in a murine model --- p.60 / Chapter 2.4 --- Statistical Analysis --- p.62 / Chapter Chapter 3 --- Results --- p.63 / Chapter 3.1 --- Effect of subinhibitory antibiotics on the expression ofmRNA in MRSA in vitro --- p.63 / Chapter 3.2 --- Effect of subinhibitory concentration of antibiotics on MRSA pneumonia in a murine model --- p.74 / Chapter Chapter 4 --- Discussion --- p.80 / Chapter 4.1 --- Effect of subinhibitory antibiotics on the expression of mRNA in MRSA in vitro --- p.81 / Chapter 4.2 --- Effect of subinhibitory concentration of antibiotics on MRSA pneumonia in a murine model --- p.87 / Chapter 4.3 --- Correlation of effects of subinhibitory antibiotics on the expression ofmRNA in MRSA in vitro and on MRSA pneumonia in a murine model --- p.91 / Chapter 4.4 --- Limitations of Study --- p.95 / Chapter 4.5 --- Future Work --- p.95 / Chapter Chapter 5 --- Conclusions --- p.97 / References --- p.99 / Chapter Appendix I- --- Materials and Reagents --- p.109 / Chapter Appendix II- --- Average and standard deviation of the copy number ratio (pvl or psmal-4 copy number/JdiS1 copy number) --- p.111 / Chapter Appendix III- --- In-vivo experimental data for infected control group and seven antibiotic groups --- p.116

Ma, Hok Lun. / Thesis submitted in: December 2008. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 233-273). / Abstracts in English and Chinese. / Abstract --- p.i / Abstract (Chinese version) --- p.v / Tables of contents --- p.vi / Acknowledgement --- p.xvi / List of figures --- p.xvii / List of tables --- p.xxi / List of abbreviations and symbols --- p.xxviii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Respiratory illnesses in children --- p.1 / Chapter 1.1.1 --- Worldwide burden of childhood pneumonia --- p.1 / Chapter 1.1.2 --- Further mortality related to childhood pneumonia --- p.4 / Chapter 1.2 --- Etiology agent of childhood respiratory illnesses --- p.5 / Chapter 1.2.1 --- Difficulties in determining etiological agent --- p.5 / Chapter 1.2.2 --- Overall situation of etiological agents in childhood pneumonia --- p.6 / Chapter 1.2.3 --- Relationship between age and pathogens --- p.9 / Chapter 1.2.4 --- "Relationship between serotypes, carriage and invasiveness" --- p.11 / Chapter 1.2.4.1 --- Carriage and Invasiveness --- p.12 / Chapter 1.2.4.2.1 --- Carriage of S. pneumoniae and H. influenzae in children in Hong Kong --- p.12 / Chapter 1.2.4.2.2 --- "Serotypes, carriage and invasiveness in S. pneumoniae" --- p.14 / Chapter 1.2.4.2.3 --- "Serotypes, carriage and invasiveness in H. influenzae" --- p.17 / Chapter 1.3 --- Epidemiology of antibiotic-resistant pathogens --- p.18 / Chapter 1.3.1 --- Molecular typing methods --- p.18 / Chapter 1.3.2 --- Spread of antibiotic-resistant pathogens --- p.20 / Chapter 1.3.2.1 --- Spread of antibiotic-resistant S. pneumoniae --- p.26 / Chapter 1.3.2.1.1 --- Spread of penicillin-resistant S. pneumoniae --- p.26 / Chapter 1.3.2.1.1.1 --- Spread of Spanish-23F-1 --- p.27 / Chapter 1.3.2.1.1.2 --- Spread of Spanish-6B-2 --- p.28 / Chapter 1.3.2.1.1.3 --- Spread of antibiotic-resistant S. pneumoniae clones in Hong Kong --- p.28 / Chapter 1.3.2.1.2 --- Spread of cephalosporin-resistant S. pneumoniae --- p.29 / Chapter 1.3.2.1.3 --- Spread of macrolide-resistant S. pneumoniae --- p.30 / Chapter 1.3.2.1.4 --- Spread of fluoroquinolone-resistant S. pneumoniae --- p.31 / Chapter 1.3.2.2 --- Spread of antibiotic-resistant H. influenzae --- p.32 / Chapter 1.3.2.2.1 --- Spread of β-lactam-resistant H. influenzae --- p.32 / Chapter 1.3.2.2.2 --- Spread of macrolide-resistant H. influenzae --- p.33 / Chapter 1.3.2.2.3 --- Spread of fluoroquinolone-resistant H. influenzae --- p.34 / Chapter 1.4 --- Mechanism of antibiotic-resistance in respiratory pathogens --- p.36 / Chapter 1.4.1 --- Mechanism of antibiotic-resistance in S. pneumoniae --- p.37 / Chapter 1.4.1.1 --- Mechanism of penicillin- and cephalosporin-resistance in S. pneumoniae --- p.37 / Chapter 1.4.1.1.1 --- Penicillin-binding protein (PBP)-mediated mechanism --- p.37 / Chapter 1.4.1.1.2 --- PBP-independent mechanisms --- p.49 / Chapter 1.4.1.1.2.1 --- "Murine peptide branching genes, murMN operon" --- p.49 / Chapter 1.4.1.1.2.2 --- "Two-component system, CiaRH" --- p.50 / Chapter 1.4.1.1.2.3 --- "Putative glycosyltransferase, CpoA" --- p.52 / Chapter 1.4.1.1.3 --- RNA and protein expression studies on S. pneumoniae for β-lactam-resistance --- p.52 / Chapter 1.4.1.1.3.1 --- RNA expression in penicillin-sensitive S. pneumoniae --- p.53 / Chapter 1.4.1.1.3.2 --- Protein expression in penicillin-resistant S. pneumoniae --- p.53 / Chapter 1.4.1.2 --- Mechanism of macrolide- and lincosamide- resistance in S. pneumoniae --- p.54 / Chapter 1.4.1.3 --- Mechanism of tetracycline-resistance in S. pneumoniae --- p.55 / Chapter 1.4.1.4 --- Mechanism of fluoroquinolone-resistance in S. pneumoniae --- p.55 / Chapter 1.4.2 --- Mechanism of antibiotic-resistant in H. influenzae --- p.56 / Chapter 1.4.2.1 --- Mechanism of β-lactam-resistance in H. influenzae --- p.56 / Chapter 1.4.2.1.1 --- β-lactamase-producing H. influenzae --- p.56 / Chapter 1.4.2.1.2 --- β-lactamase-negative ampicillin-resistant (BLNAR) H. influenzae --- p.58 / Chapter 1.4.2.1.2.1 --- Relationship between amino acid substitutions in PBP3 and β-lactam- resistance --- p.58 / Chapter 1.4.2.1.2.2 --- Relationship between amino acid substitutions in AcrR and β-lactam-resistance --- p.60 / Chapter 1.4.2.2 --- Mechanism of macrolide-resistance in H. influenzae --- p.61 / Chapter 1.4.2.3 --- Mechanism of fluoroquinolone-resistance in H. influenzae --- p.64 / Chapter 1.5 --- Impact of vaccination --- p.65 / Chapter 1.5.1 --- H. influenzae type b vaccination --- p.65 / Chapter 1.5.1.1 --- Efficacy of Hib conjugate vaccine --- p.66 / Chapter 1.5.1.2 --- Herd immunity related to Hib conjugate vaccine --- p.66 / Chapter 1.5.2 --- Pneumococcal vaccination --- p.66 / Chapter 1.5.2.1 --- Vaccine efficacy and herd immunity of pneumococcal vaccines --- p.67 / Chapter 1.5.2.2 --- Development of conjugate vaccines with higher valency --- p.67 / Chapter 1.5.2.3 --- Serotype replacement --- p.67 / Chapter 1.5.2.4 --- Development of pneumococcal vaccines with new targets --- p.69 / Chapter 1.6 --- Objectives of this study --- p.70 / Chapter Chapter 2 --- Materials and methods --- p.72 / Chapter 2.1 --- Collection and Identification of microorganisms --- p.72 / Chapter 2.1.1 --- Collection of S. pneumoniae and H. influenzae --- p.72 / Chapter 2.1.2 --- Identification of S. pneumoniae and H. influenzae --- p.73 / Chapter 2.2 --- Serotyping of S. pneumoniae and H. influenzae --- p.74 / Chapter 2.2.1 --- Serotyping by polymerase chain reaction (PCR) --- p.74 / Chapter 2.2.1.1 --- Preparation of crude DNA extract --- p.74 / Chapter 2.2.1.2 --- Screening for common serotypes by multiplex PCR --- p.74 / Chapter 2.2.1.3 --- Composition of PCR Mix --- p.77 / Chapter 2.2.1.4 --- Serotyping PCR conditions --- p.81 / Chapter 2.2.1.5 --- Gel Electrophoresis --- p.81 / Chapter 2.2.2 --- Serotyping by serum agglutination --- p.82 / Chapter 2.3 --- Antimicrobial susceptibility testing --- p.83 / Chapter 2.4 --- Clonal analysis of penicillin- and cephalosporin-resistant S. pneumoniae --- p.87 / Chapter 2.4.1 --- Pulsed-field Gel Electrophoresis (PFGE) --- p.87 / Chapter 2.4.1.1 --- Preparation of agarose plugs for PFGE --- p.87 / Chapter 2.4.1.2 --- Lysis of bacteria in agarose plugs --- p.89 / Chapter 2.4.1.3 --- Digestion of chromosomal DNA by restriction enzyme --- p.89 / Chapter 2.4.2 --- Multi-locus sequence typing (MLST) --- p.90 / Chapter 2.4.2.1 --- PCR amplification of house-keeping genes in MLST --- p.90 / Chapter 2.4.2.1.1 --- Preparation of DNA from agarose plugs --- p.92 / Chapter 2.4.2.1.2 --- Composition of PCR Mix --- p.92 / Chapter 2.4.2.1.3 --- MLST PCR conditions --- p.92 / Chapter 2.4.2.1.4 --- Gel Electrophoresis of MLST PCR products --- p.92 / Chapter 2.4.2.1.5 --- MLST PCR products purification --- p.93 / Chapter 2.4.2.2 --- Sequencing of housekeeping genes in MLST --- p.93 / Chapter 2.4.2.3 --- Sequencing analysis and sequence type (ST) determination in MLST --- p.94 / Chapter 2.4.3 --- Extended panel of antibiotic susceptibility testing on S. pneumoniae with known STs --- p.94 / Chapter 2.5 --- Analysis on potential penicillin- and cephalosporin-resistance mechanisms in S. pneumoniae --- p.96 / Chapter 2.5.1 --- Sequencing of potnetial penicillin- and cephalosporin- resistance determinants in S. pneumoniae --- p.96 / Chapter 2.5.1.1 --- Primer design of penicillin-binding protein (PBP) genes --- p.96 / Chapter 2.5.1.2 --- Primer design of non-PBP resistance determinants --- p.100 / Chapter 2.5.1.3 --- PCR amplification and sequencing of resistant determinants --- p.100 / Chapter 2.5.1.4 --- Sequence analysis --- p.100 / Chapter 2.5.2 --- Study on efflux mechanism of S. pneumoniae --- p.103 / Chapter 2.5.2.1 --- Modification of macrodilution for efflux assay --- p.103 / Chapter 2.5.2.2 --- Cefotaxime MIC determination with efflux inhibitors --- p.104 / Chapter 2.5.2.3 --- Determination of appropriate CCCP concentration --- p.105 / Chapter 2.5.2.4 --- Growth curve with efflux inhibitor --- p.105 / Chapter 2.5.3 --- Heteroresistance assay of S. pneumoniae --- p.106 / Chapter 2.5.4 --- "RNA expression study on penicillin- and cefotaxime-resistance determinants (pbp2x, pbpla and pbp2a) of S. pneumoniae" --- p.107 / Chapter 2.5.4.1 --- Growth of S. pneumoniae for RNA extraction --- p.107 / Chapter 2.5.4.2 --- RNA extraction and DNase digestion --- p.107 / Chapter 2.5.4.3 --- cDNA synthesis and real-time PCR --- p.108 / Chapter 2.6 --- Analysis on cephalosporin- and macrolide-resistance mechanisms in H. influenzae --- p.111 / Chapter 2.6.1 --- β-lactamase production of H. influenzae --- p.111 / Chapter 2.6.1.1 --- Nitrocefin Hydrolysis --- p.111 / Chapter 2.6.1.2 --- Screening for the presence of p-lactamase gene (blaTEM-1 and blaROB-1) by multiplex PCR --- p.111 / Chapter 2.6.2 --- PCR detection and sequencing of β-lactam- and macrolide- resistance determinants in H. influenzae --- p.113 / Chapter Chapter 3 --- Results of S. pneumoniae and H. influenzae children study --- p.116 / Chapter 3.1 --- Patient demographics of children study --- p.116 / Chapter 3.2 --- Serotype distributions --- p.117 / Chapter 3.2.1 --- Serotypes / serogroup distribution in S. pneumoniae --- p.117 / Chapter 3.2.2 --- Serotype distribution in H. influenzae children study --- p.120 / Chapter 3.3 --- Antibiotic susceptibilities and resistance antibiograms --- p.122 / Chapter 3.3.1 --- Antibiotic susceptibilities of S. pneumoniae --- p.122 / Chapter 3.3.2 --- Relationship between antibiotic resistance profiles and serotypes in S.pneumoniae --- p.126 / Chapter 3.3.3 --- Antibiotic susceptibilities of H. influenzae --- p.135 / Chapter 3.3.4 --- Antibiotic resistance profiles of H. influenzae --- p.138 / Chapter 3.4 --- Clonal analysis of penicillin- and cephalosporin-resistant S.pneumoniae --- p.139 / Chapter 3.4.1 --- Pulsed-field gel electrophoresis (PFGE) of S. pneumoniae --- p.139 / Chapter 3.4.2 --- Multi-locus sequence typing of S. pneumoniae --- p.141 / Chapter 3.5 --- Analysis of the penicillin- and cephalosporin-resistance determinants in S. pneumoniae --- p.143 / Chapter 3.5.1 --- "Sequence analysis of major pbp genes (pbp2x, pbpla and pbp2a)" --- p.143 / Chapter 3.5.2 --- "Sequence analysis of other potential penicillin- and cephalosporin- resistance determinants (pbp 1 b, pbp2b, pbp3, cpoA, ciaRH and murMN)" --- p.152 / Chapter 3.5.3 --- Sequence analysis of putative promoter sequences of pbp genes --- p.167 / Chapter 3.5.4 --- Efflux Inhibition Assay --- p.171 / Chapter 3.5.5 --- Heteroresistance Assay --- p.177 / Chapter 3.5.6 --- "RNA expression study on penicillin- and cephalosporin resistance determinants (pbp2x, pbpla and pbp2a)" --- p.179 / Chapter 3.6 --- Analysis of β-lactam-resistance determinants in H. influenzae --- p.185 / Chapter 3.6.1 --- β-lactamase production and blaTEM-1 promoter study --- p.185 / Chapter 3.6.2 --- "Sequence analysis of β-lactam-resistance determinants (ftsl, acrR genes, AcrAB-TolC efflux pump)" --- p.188 / Chapter 3.6.2.1 --- Sequence analysis offtsl --- p.188 / Chapter 3.6.2.2 --- Analysis of acrR and AcrAB-TolC efflux pump --- p.189 / Chapter 3.7 --- "Analysis of macrolide-resistance determinants in H, influenzae (AcrAB-TolC efflux pump, 23SrRNA, Ribosomal proteins L4 and L22)" --- p.199 / Chapter Chapter 4 --- Discussion on S. pneumoniae and H. influenzae children study --- p.204 / Chapter 4.1 --- Carriage rate of S. pneumoniae children collection --- p.204 / Chapter 4.2 --- Serotype distribution --- p.205 / Chapter 4.2.1 --- Serotype distribution and potential vaccine coverage in S. pneumoniae --- p.205 / Chapter 4.2.2 --- Serotype distribution in H. influenzae --- p.209 / Chapter 4.3 --- Antimicrobial resistance --- p.210 / Chapter 4.3.1 --- Antimicrobial resistance in S. pneumoniae --- p.210 / Chapter 4.3.2 --- Antimicrobial resistance in H. influenzae --- p.214 / Chapter 4.4 --- "Clonal analysis of high-level β-lactam-resistant S, pneumoniae" --- p.217 / Chapter 4.5 --- "β-lactam-resistance mechanisms in S, pneunomiae" --- p.220 / Chapter 4.6 --- Antimicrobial resistance mechanisms in H. influenzae --- p.224 / Chapter 4.6.1 --- β-lactam-resistance mechanism in β-lactamase-producing H. influenzae --- p.224 / Chapter 4.6.1.1 --- Variations in blaTEM-1 promoters in β-lactamase-producing H.influenzae --- p.224 / Chapter 4.6.1.2 --- β-lactam-resistance in β-lactamase-nonproducing H. influenzae --- p.225 / Chapter 4.6.2 --- Macrolide-resistance mechanisms in H. influenzae --- p.228 / Chapter Chapter 5 --- Conclusion and future studies --- p.230 / Chapter 5.1 --- "S, pneumoniae children study" --- p.230 / Chapter 5.2 --- H. influenzae children study --- p.231 / Chapter 5.3 --- Future studies --- p.232 / Bibliography --- p.233 / Appendix I 一 Sequence alignments and Tables --- p.274 / Appendix II 一 Materials and Methods --- p.313

A current initiative to eliminate lymphatic filariasis (LF), headed by the World Health Organization, aims to interrupt transmission of the disease through yearly community-wide treatment with the broad spectrum anthelmintic albendazole (ABZ), in combination with ivermectin (IVM) or diethylcarbamazine (DEC). Over the years, the use of both ABZ and IVM in the treatment of veterinary parasites has led to widespread anthelmintic resistance against these drugs. In this study, we genotyped microfilaria of Wuchereria bancrofti, a causative agent of LF, in order to detect the presence of mutations which confer ABZ resistance in other parasites, and we identified such mutations in worms obtained from untreated patients in Ghana and Burkina Faso, West Africa. Microfilaria from patients who had been treated with ABZ + IVM, had a significantly higher frequency of the resistant genotype, and this frequency was even higher in worms from patients that had received two rounds of treatment. In addition, the untreated population of microfilaria had an excess of homozygotes in the population. This excess homozygosity was equivalent to a Wright's Inbreeding Statistic of FIT= 0.44, and we found that the population was significantly subdivided between patients. In order to better understand the mechanisms and factors involved in the potential spread of ABZ resistance, caused by such mutations, through a population of Culex-transmitted W. bancrofti, we developed a deterministic model that incorporates genotype structure into the epidemiological model EPIFIL. This model predicts that the combination of ABZ + DEC leads to stronger selection for the resistant genotype than ABZ + IVM, and that drug efficacy assumptions are an important factor affecting the spread of drug resistance. Treatment coverage, non-random mating, initial allele frequency and number of treatments also had substantial impact on the speed and magnitude of the spread of ABZ resistance. When we expanded this model to include potential IVM-resistance alleles we found that, under ABZ + IVM treatment, selection for resistance to either drug is enhanced by the presence of resistance against the second drug. Similarly, excess homozygosity caused by parasite non-random mating may increase selection for a dominant IVM resistance allele through enhancing the spread of a recessive ABZ resistance allele. Resistence developed more slowly when it was inherited as a polygenic trait. Results from this study suggest that resistance monitoring is crucial, as resistance may not be apparent until treatment is stopped, recrudescence occurs and treatment is reapplied.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 4 uppsatser.