Várias zoonoses virais acometem equídeos causando quadros neurológicos, entre as quais a raiva e as encefalites equinas do Leste (EEE) e Oeste (WEE). O diagnóstico clínico geralmente não é conclusivo, o que torna imprescindível o diagnóstico laboratorial. Dados do Laboratório de Diagnóstico de Raiva do Instituto Pasteur de São Paulo, entre os anos 2000 e 2010, mostram que aproximadamente 75% das amostras enviadas foram negativas para raiva, ressaltando a relevância da realização de um diagnóstico diferencial para as encefalites equinas causadas por alfavírus. Os objetivos do estudo foram testar a adequação do uso de multiplex hemi-nested RT-PCR para o diagnóstico de raiva, EEE e WEE em amostras de sistema nervoso central de equídeos e realizar uma análise de custo das reações de cada técnica. Foram utilizados os primers 21G, 304 e 504 dirigidos ao gene N do vírus da raiva, e os primers cM3W, M2W, nEEE e nWEE dirigidos ao gene NSP1 dos vírus da EEE e WEE. Procedeu-se a um estudo preliminar dos primers e de seu uso em uma hemi-nested RT-PCR, avaliando a temperatura ótima de anelamento, a sensibilidade e especificidade analíticas e a reprodutibilidade da técnica em amostras de campo positivas para raiva e para EEE. A partir do protocolo estabelecido na reação de hemi-nested RT-PCR, realizaram-se variações de concentração de reagentes no protocolo para a reação de multiplex hemi-nested RT-PCR. Após o estabelecimento do protocolo para esta reação, os mesmos testes para verificação da sensibilidade e especificidade analíticas e da reprodutibilidade foram realizados, comparando-se os resultados com os obtidos pela hemi-nested RT-PCR. No teste de limiar de detecção, a sensibilidade analítica foi semelhante para as duas técnicas, obtendo-se 10&#45;1,7 para os três vírus padrão CVS, EEEV e WEEV. No teste de limiar de detecção utilizando uma amostra com os três vírus verificou-se uma alta especificidade dos primers, sendo que na reação de multiplex hemi-nested RT-PCR foi possível detectar simultaneamente os três vírus padrão. Não houve diferença nas proporções de amostras detectadas como positivas para raiva obtidas pelas duas técnicas, analisando-se pelo teste exato de Fisher (P=1,0000). No entando, para amostras de campo positivas para EEE, a proporção de amostras detectadas como positivas pela hemi-nested RT-PCR foi maior do que a proporção obtida pela multiplex hemi-nested RT-PCR (P<0,0001). Apesar de não ter sido possível o uso de amostras de campo positivas para WEE nesse estudo, os resultados sugerem que seria possível a detecção pela multiplex hemi-nested RT-PCR. Estes dados sugerem que a técnica de multiplex hemi-nested RT-PCR poderia ser aplicada para detecção de raiva e WEE, mas com limitações para a detecção de EEE. Pela análise de custo dos reagentes, o valor de uma reação de multiplex hemi-nested RT-PCR é semelhante ao de uma hemi-nested RT-PCR, podendo representar uma economia de pelo menos 49,17%. / Several viral zoonoses affect the equids causing neurological diseases, including rabies and Eastern and Western equine encephalitides (EEE and WEE). Clinical diagnosis is often not conclusive, in a way that laboratory diagnosis is essential. Data from the Laboratory of Rabies Diagnosis at the Pasteur Institute of São Paulo, between 2000 and 2010, demonstrate that approximately 75% of submitted equid samples were negative for rabies, emphasizing the importance of achieving a differential diagnosis for equine encephalitis caused by alphaviruses. The aims of this study were to test the suitability of using multiplex hemi-nested RT-PCR for the diagnosis of rabies, EEE and WEE in equids central nervous system samples and to perform a cost analysis of the reactions of each technique. We used the primers 21G, 304 and 504 directed to the N gene of rabies virus, and the primers cM3W, M2W, nEEE and nWEE directed the NSP1 gene of WEE and EEE viruses. A preliminary study of the primers was carried out, as well as their use in a hemi-nested RT-PCR, evaluating the optimal annealing temperature, the analytical sensitivity and specificity and the reproducibility of the technique in positive field samples for rabies and EEE. From the protocol established for the hemi-nested RT-PCR, variations in reagents concentrations for the multiplex hemi-nested RT-PCR protocol were perfomed. After establishing the protocol for this reaction, the same tests to verify the analytical sensitivity and specificity and reproducibility were performed and the results compared to those obtained by hemi-nested RT-PCR. In the detection threshold test, the analytical sensitivity was similar for both techniques, resulting in 10&#45;1.7 for the three virus standard CVS, and EEEV WEEV. In the detection threshold test using a sample with the three viruses, a high specificity of the primers was verified and the multiplex hemi-nested RT-PCR was able to detect the three viruses simultaneously. There was no difference in the proportions of samples detected as positive for rabies obtained by both techniques, according to the Fisher exact test (P = 1.0000). However, for EEE positive field samples, the proportion of samples detected as positive by the hemi-nested RT-PCR was higher than the proportion obtained by multiplex hemi-nested RT-PCR (P <0.0001). Although it was not possible to use WEE positive field samples in this study, the results suggest that its detection would be possible by multiplex hemi-nested RT-PCR. Thus, data suggest that the multiplex hemi-nested RT-PCR technique could be applied to detect rabies and WEE, but with limitations for the EEE detection. For the analysis of reagent costs, the cost of one multiplex hemi-nested RT-PCR is similar to one hemi-nested RT-PCR, and may represent a saving of 49,17% at least.

No description available.

Várias zoonoses virais acometem equídeos causando quadros neurológicos, entre as quais a raiva e as encefalites equinas do Leste (EEE) e Oeste (WEE). O diagnóstico clínico geralmente não é conclusivo, o que torna imprescindível o diagnóstico laboratorial. Dados do Laboratório de Diagnóstico de Raiva do Instituto Pasteur de São Paulo, entre os anos 2000 e 2010, mostram que aproximadamente 75% das amostras enviadas foram negativas para raiva, ressaltando a relevância da realização de um diagnóstico diferencial para as encefalites equinas causadas por alfavírus. Os objetivos do estudo foram testar a adequação do uso de multiplex hemi-nested RT-PCR para o diagnóstico de raiva, EEE e WEE em amostras de sistema nervoso central de equídeos e realizar uma análise de custo das reações de cada técnica. Foram utilizados os primers 21G, 304 e 504 dirigidos ao gene N do vírus da raiva, e os primers cM3W, M2W, nEEE e nWEE dirigidos ao gene NSP1 dos vírus da EEE e WEE. Procedeu-se a um estudo preliminar dos primers e de seu uso em uma hemi-nested RT-PCR, avaliando a temperatura ótima de anelamento, a sensibilidade e especificidade analíticas e a reprodutibilidade da técnica em amostras de campo positivas para raiva e para EEE. A partir do protocolo estabelecido na reação de hemi-nested RT-PCR, realizaram-se variações de concentração de reagentes no protocolo para a reação de multiplex hemi-nested RT-PCR. Após o estabelecimento do protocolo para esta reação, os mesmos testes para verificação da sensibilidade e especificidade analíticas e da reprodutibilidade foram realizados, comparando-se os resultados com os obtidos pela hemi-nested RT-PCR. No teste de limiar de detecção, a sensibilidade analítica foi semelhante para as duas técnicas, obtendo-se 10&#45;1,7 para os três vírus padrão CVS, EEEV e WEEV. No teste de limiar de detecção utilizando uma amostra com os três vírus verificou-se uma alta especificidade dos primers, sendo que na reação de multiplex hemi-nested RT-PCR foi possível detectar simultaneamente os três vírus padrão. Não houve diferença nas proporções de amostras detectadas como positivas para raiva obtidas pelas duas técnicas, analisando-se pelo teste exato de Fisher (P=1,0000). No entando, para amostras de campo positivas para EEE, a proporção de amostras detectadas como positivas pela hemi-nested RT-PCR foi maior do que a proporção obtida pela multiplex hemi-nested RT-PCR (P<0,0001). Apesar de não ter sido possível o uso de amostras de campo positivas para WEE nesse estudo, os resultados sugerem que seria possível a detecção pela multiplex hemi-nested RT-PCR. Estes dados sugerem que a técnica de multiplex hemi-nested RT-PCR poderia ser aplicada para detecção de raiva e WEE, mas com limitações para a detecção de EEE. Pela análise de custo dos reagentes, o valor de uma reação de multiplex hemi-nested RT-PCR é semelhante ao de uma hemi-nested RT-PCR, podendo representar uma economia de pelo menos 49,17%. / Several viral zoonoses affect the equids causing neurological diseases, including rabies and Eastern and Western equine encephalitides (EEE and WEE). Clinical diagnosis is often not conclusive, in a way that laboratory diagnosis is essential. Data from the Laboratory of Rabies Diagnosis at the Pasteur Institute of São Paulo, between 2000 and 2010, demonstrate that approximately 75% of submitted equid samples were negative for rabies, emphasizing the importance of achieving a differential diagnosis for equine encephalitis caused by alphaviruses. The aims of this study were to test the suitability of using multiplex hemi-nested RT-PCR for the diagnosis of rabies, EEE and WEE in equids central nervous system samples and to perform a cost analysis of the reactions of each technique. We used the primers 21G, 304 and 504 directed to the N gene of rabies virus, and the primers cM3W, M2W, nEEE and nWEE directed the NSP1 gene of WEE and EEE viruses. A preliminary study of the primers was carried out, as well as their use in a hemi-nested RT-PCR, evaluating the optimal annealing temperature, the analytical sensitivity and specificity and the reproducibility of the technique in positive field samples for rabies and EEE. From the protocol established for the hemi-nested RT-PCR, variations in reagents concentrations for the multiplex hemi-nested RT-PCR protocol were perfomed. After establishing the protocol for this reaction, the same tests to verify the analytical sensitivity and specificity and reproducibility were performed and the results compared to those obtained by hemi-nested RT-PCR. In the detection threshold test, the analytical sensitivity was similar for both techniques, resulting in 10&#45;1.7 for the three virus standard CVS, and EEEV WEEV. In the detection threshold test using a sample with the three viruses, a high specificity of the primers was verified and the multiplex hemi-nested RT-PCR was able to detect the three viruses simultaneously. There was no difference in the proportions of samples detected as positive for rabies obtained by both techniques, according to the Fisher exact test (P = 1.0000). However, for EEE positive field samples, the proportion of samples detected as positive by the hemi-nested RT-PCR was higher than the proportion obtained by multiplex hemi-nested RT-PCR (P <0.0001). Although it was not possible to use WEE positive field samples in this study, the results suggest that its detection would be possible by multiplex hemi-nested RT-PCR. Thus, data suggest that the multiplex hemi-nested RT-PCR technique could be applied to detect rabies and WEE, but with limitations for the EEE detection. For the analysis of reagent costs, the cost of one multiplex hemi-nested RT-PCR is similar to one hemi-nested RT-PCR, and may represent a saving of 49,17% at least.

Tick-borne encephalitis is a serious disease of the central nervous system. It is caused by tick-borne encephalitis virus, which is transmitted by ticks. The Czech Republic is one of the countries with the highest prevalence of this disease. Tick-borne encephalitis virus is able to replicate in several cell types. In this work we focused on macrophage line IC-21 and dendritic cells, because these cells are the first, which encounter the virus and support its spreading in the host at early stage of infection. So far there is not known any specific receptor for virus entry into cells or which signaling pathways activates. Therefore, we decided to investigate the activation of selected signaling pathways after infection with tick-borne encephalitis virus and influence of tick saliva on this activation. We employed methods of dual luciferase reporter assay, immunosandwich assay and western blot. The obtained results showed that in virus infected IC-21 cells are activated phosphatidyl-inositol pathway, NF-κB pathway, signaling molecule Erk1/2 and others. Testing of tick saliva effect revealed significantly decreased activity of NF-κB, AP-1 and CREB.

Die Autoimmunenzephalitis ist eine kürzlich beschriebene entzündliche Erkrankung des zentralen Nervensystems, die Gedächtnisdefizite, Psychosen, oder epileptische Anfälle hervorrufen kann. Derzeit ist hingegen noch nicht ausreichend verstanden, welche pathologischen Veränderungen zu den kognitiven Defiziten führen und welche neuropsychologischen und bildgebenden Langzeitoutcomes zu erwarten sind. Anhand von strukturellen und funktionellen Bildgebungsanalysen zeigt diese Dissertation, dass kognitive Defizite auch nach der akuten Phase der Autoimmunenzephalitis fortbestehen können. Bei der LGI1-Enzephalitis gehen Gedächtnisdefizite mit fokalen strukturellen Läsionen im Hippocampus einher. Durch eine funktionelle Störung der Resting-State-Konnektivität des Default-Mode- und Salienznetzwerkes beeinträchtigen diese Hippocampusläsionen auch Hirnregionen außerhalb des limbischen Systems. Bei Patient:innen mit NMDA-Rezeptor-Enzephalitis finden sich in der longitudinalen neuropsychologischen Untersuchung trotz guter allgemeiner Genesung auch noch mehrere Jahre nach der Akutphase persistierende Defizite des Gedächtnisses und exekutiver Funktionen. Zuletzt zeigt eine transdiagnostische Analyse, dass der anteriore Hippocampus eine erhöhte Vulnerabilität gegenüber immunvermittelten pathologischen Prozessen aufweist. Diese Ergebnisse legen nahe, dass kognitive Symptome auch noch nach der Entlassung aus der stationären Behandlung fortbestehen können. Sowohl umschriebene strukturelle Hippocampusläsionen als auch Veränderungen in makroskopischen funktionellen Hirnnetzwerken tragen zur pathophysiologischen Erklärung dieser Symptome bei. Zudem erlauben diese Ergebnisse einen Einblick in neuroplastische Veränderungen des Gehirns und haben weitreichende Implikationen für die Langzeitversorgung und das Design zukünftiger klinischer Studien. / Autoimmune encephalitis is a recently described inflammatory disease of the central nervous system that can cause memory deficits, psychosis, or seizures. The trajectory of cognitive dysfunction and the underlying long-term imaging correlates are, however, not yet fully understood. By using advanced structural and functional neuroimaging, this thesis shows that cognitive deficits persist beyond the acute phase. In LGI1 encephalitis, MRI postprocessing revealed that memory deficits are related to focal structural hippocampal lesions. These hippocampal lesions propagate to brain areas outside the limbic system through aberrant resting-state connectivity of the default mode network (DMN) and the salience network. In NMDA receptor encephalitis, a longitudinal analysis of neuropsychological data describes persistent cognitive deficits, especially in the memory and executive domains, despite good physical recovery several years after the acute disease. Lastly, a transdiagnostic analysis reveals that the anterior hippocampus is particularly vulnerable to immune-mediated damage. In conclusion, these results demonstrate that cognitive symptoms in autoimmune encephalitis can persist beyond discharge from neurological care. Both discrete structural hippocampal damage and changes in macroscopic functional networks shed light on the pathophysiological basis of these symptoms. These findings help to explain how the brain responds to pathological damage and have substantial implications for long-term patient care and the design of future clinical studies.

No description available.

Klinische, epidemiologische und experimentelle Daten deuten darauf hin, dass Autoimmunkrankheiten wie z.B. rheumatoide Arthritis, multiple Sklerose oder Typ I Diabetes durch Infektionen ausgelöst oder verschlimmert werden können. Bis heute ist jedoch nicht bekannt, welche molekularen und zellulären Mechanismen den Zusammenhang zwischen Infektion und Autoimmunität vermitteln. Eine Hypothese, die diesen Zusammenhang zu erklären versucht, ist die Hypothese der molekularen Mimikry. Dieser Hypothese zufolge sind kreuzreaktive Lymphozyten, die sowohl Selbst- als auch Fremdantigene erkennen, für die Induktion von Autoimmunität verantwortlich. Die Hypothese der molekularen Mimikry erklärt die Kreuzreaktivität von Lymphozyten durch Sequenzhomologie oder Identität von Selbst- und Fremdantigenen. Wir haben diese Hypothese an zwei Modellen, der chronischen Lyme Arthritis und einem Maus Modell der multiplen Sklerose, getestet und dabei festgestellt, dass Kreuzreaktivität von Lymphozyten weitaus häufiger ist als bis vor kurzem noch vermutet wurde. Wir konnten weiterhin zeigen, dass nicht die Primärstruktur sondern definierbare strukturelle Motive die Ursache für die Kreuzerkennung von Selbst- und Fremdpeptiden sind, und das Kreuzreaktivität in den seltensten Fällen von pathogenetischer Relevanz ist. Die Vorstellung, immunologische Kreuzreaktivität zwischen einem definierten mikrobiellen Antigen und einem definierten Selbstantigen sei für die Pathogenese von Autoimmunkrankheiten verantwortlich, ist also zu einfach. Der zweite Schwerpunkt dieser Arbeit ist die immunologische Analyse eines von uns charakterisierten Th2-spezifisch exprimierten Moleküls, T1/ST2. Wir konnten zeigen, dass T1/ST2 auf Th2, nicht jedoch Th1-Zellen exprimiert wird; dass die Expression von T1/ST2 ex vivo die Lokalisation aktueller Th2-Antworten widerspiegelt; und dass T1/ST2 von funktioneller Bedeutung für die Th2 Zellen ist: Kreuzvernetzung des T1/ST2 Moleküls durch einen T1/ST2-spezifischen monoklonalen Antikörper induziert Proliferation und die Produktion von Typ 2 Zytokinen. In vivo läßt sich durch Applikation des löslichen Antikörpers gegen T1/ST2 die pathogene Th2-Immunantwort im Mausmodell von Asthma modulieren. T1/ST2 ist also ein Kandidat für die gezielte immunmodulatorische Therapie Th2-dominierter Erkrankungen wie Asthma und Allergie. / Clinical, epidemiological, and experimental data suggest that infections can sometimes trigger or exacerbate autoimmune diseases such as multiple sclerosis, type I diabetes, or rheumatoid arthritis. To date, the molecular and cellular mechanisms leading from infection to autoimmunity have not been defined. The molecular mimicry hypothesis proposes that crossreactive lymphocytes that recognize both self- and microbial antigens are key factors in the pathogenesis of autoimmunity. According to the molecular mimicry hypothesis, sequence identity or marked sequence similarity between self- and microbial antigens is the cause of such crossreactivity. We have examined the molecular mimicry hypothesis systematically in two different models: treatment-resistant Lyme arthritis and experimental autoimmune encephalitis (EAE). The major findings were: i) crossreactivity at the level of peptide recognition by T cells is far more frequent than previously expected; ii) structural criteria rather than sequence similarity determine cross-recognition; iii) immunoregulatory mechanisms normally prevent pathogenic effects mediated by crossreactive lymphocytes. Thus, the idea that crossrecognition of a defined microbial peptide and a particular self-peptide would explain autoimmunity is most likely too simple. The other major topic of this work was the immunological analysis of T1/ST2, a Th2-specific molecule that we characterized. Here, we could show that T1/ST2 is expressed on Th2 but not Th1 cells. Furthermore, T1/ST2 expression can be used to identify sites of ongoing Th2 reactions directly ex vivo. Most importantly, T1/ST2 is important for Th2 effector functions: crosslinking of T1/ST2 via a T1/ST2-specific monoclonal antibody induces proliferation and type 2-cytokine production. In vivo, administration of the soluble antibody against T1/ST2 ameliorates the immunological parameters of bronchial hyperreactivity in a murine model of asthma. Thus, T1/ST2 is a candidate target for therapeutic immunomodulation of diseases such as allergy and asthma.

Das Frühsommer-Meningoezephalitis-Virus (FSMEV) ist eines der wichtigsten vektorübertragenen Viren in Europa und Asien. Die häufigste Übertragung erfolgt durch den Stich einer infizierten Zecke, gelegentlich werden FSME Infektionen auch durch den Genuss von Rohmilchprodukten infizierter Tiere verursacht. Die Pathogenese von Caco-2 Monolayer Epithelzellen zeigten nach Infektion mit FSMEV morphologische Änderungen mit signifikanter Vakuolisierung. Ultrastrukturanalysen zeigten eine Ausdehnung des rauen ER und das Auftreten FSMEV haltiger Kavernen. Monolayer von Caco-2 Zellen bildeten eine Barriere mit stabilem transepithelialem elektrischem Widerstand (TEER). Auch traten Viren im basolateralen Medium auf, die über einen Tanscystose pathway (PW) aufgenommen wurden. Der Zelleintritt von FSMEV konnte durch verschiedene Inhibitoren wirksam blockiert werden, was darauf hinweist, dass Aktinfilamente und Mikrotubuli wichtig für die PI3K-abhängige Endozytose sind. Die experimentelle Flüssigkeitsaufnahme zeigte erhöhte intrazelluläre Ansammlungen von FITC-Dextran haltigen Vesikeln und die Co-Lokalisation von FSME-Viren mit frühem Endosom Antigen-1 und mit sorting nexin-5. Was auf die Makropinozytose als Transportmechanismus hinweist. Während der Infektion wurden weitere Hinweise für die Virustranslokation über den parazellulären Weg gefunden. Das konnte den FSMEV Pathomechanismus in humanen Intestinalepithelzellen über Nahrungsmittel näher aufklären. Die Untersuchung der zwei UPR „signaling PWs“ während der FSMEV Infektion in VeroE6 Zellen zeigte, dass die Menge von „heat shock protein“ 72 im Verlauf der FSMEV Infektion ansteigt, und eine FSMEV Infektion den „IRE1- und den ATF6 PW“ aktiviert. Auch die Hemmung des „IRE1 PW“ wirkt auf die FSMEV Infektion, was darauf hinweist, dass eine FSMEV Infektion die beiden „UPR signaling PWs“ aktiviert. Diese Hemmung der FSMEV Replikation durch UPR Inhibitoren könnte ein neuer Ansatz für spezifische Therapien gegen FSME sein. / Tick-borne encephalitis virus (TBEV) is one of the most important vector-borne viruses in Europe and Asia. The transmission mainly occurs by the bite of an infected tick. Consuming of rough milk products from infected livestock animals also occasionally cause TBE cases. Human intestinal Caco-2 cells were used to investigate the pathogenesis caused by TBEV. During TBEV infection Caco-2 monolayers showed morphological changes with significant vacuolization. Ultrastructural analysis revealed dilatation of the rough endoplasmic reticulum and further enlargement to TBEV containing caverns. Caco-2 monolayers showed an intact epithelial barrier with stable transepithelial electrical resistance (TER). Concomitantly, viruses were detected in the basolateral medium, taken up via a transcytosis pathway. TBEV cell entry was efficiently blocked with different inhibitors, suggesting that actin filaments and microtubules are important for PI3K-dependent endocytosis. Moreover, experimental fluid uptake assay showed increased intracellular accumulation of FITC-dextran containing vesicles and co-localization of TBEV with early endosome antigen-1 and with sorting nexin-5 could confirm macropinocytosis as trafficking mechanism. In the late phase of infection, further evidence was found for translocation of virus via the paracellular pathway. Thus, TBEV pathomechanisms in human intestinal epithelial cells and its transmission via the alimentary route were enlightened. In addition, I investigated the effects of the two unfolded protein response (UPR) signaling pathways upon TBEV infection in Vero E6 cells. I showed that the amount of heat shock protein 72 increased in the course of TBEV infection. I then confirmed that TBEV infection activates the IRE1 pathway and ATF6 pathway. These findings provide the first evidence that TBEV infection activates the two UPR signaling pathways. Moreover, inhibition of UPR may provide a novel therapeutic strategy against TBE.

Introdução: A doença associada ao anticorpo MOG-IgG tem sido reconhecida como uma entidade clínica distinta de neuromielite óptica (NMO) e esclerose múltipla (EM). As principais apresentações clínicas associadas ao MOG-IgG são neurite óptica (NO), mielite e encefalite. Apesar das crescentes evidências na literatura, o papel da análise longitudinal de MOG-IgG ainda não é conhecido. Os objetivos deste estudo foram 1) descrever os aspectos clínicos, laboratoriais e imagenológicos dos pacientes MOG-IgG positivo; 2) estudar as diferenças clínicas e laboratoriais entre os pacientes MOG-IgG com curso monofásico e recorrente; 3) analisar a existência de fatores preditores de recorrência de surtos; 4) investigar se a persistência de MOG-IgG determina doença recorrente; 5) comparar as características clínicas e laboratoriais de pacientes MOG-IgG com pacientes NMOSD AQP4-IgG positivo e negativo. Casuística e métodos: após avaliação de elegibilidade de 574 sujeitos, foram incluídos 31 pacientes MOG-IgG positivos. Estes pacientes foram divididos em dois grupos segundo o padrão de surto, monofásico ou recorrente. Os pacientes foram acompanhados por dois anos em consulta clínica semestral e coleta anual de amostra de sangue para avaliação de MOG-IgG e AQP4-IgG. Resultados: neurite óptica (NO) foi frequente em ambos os grupos sem diferença significativa. Mielite foi encontrada em maior proporção nos pacientes recorrentes, porém sem significância estatística. NO acarretou maior risco para novos surtos, RC= 3,66 (IC 95 % 1,03- 29,91) (p 0,048). Após um primeiro surto de NO, existe uma probabilidade de 75% de que o segundo surto seja também NO. A mesma análise foi realizada para pacientes com mielite no primeiro surto, com uma probabilidade de 80% de mielite no segundo surto. A mediana de EDSS foi maior no grupo de pacientes recorrentes, sendo a diferença significativa entre o grupo recorrente e monofásico (p 0,013). A doença associada ao MOG-IgG possui bom prognóstico com melhora significante de EDSS e acuidade visual (AV) no desfecho quando comparados aos do evento inicial. O desfecho de AV não se correlacionou diretamente com número de episódios de NO. O tratamento imunossupressor profilático reduziu de forma significativa a ocorrência de surtos (p < 0,001). Na análise longitudinal de sorologias de MOG-IgG, a permanência de MOG-IgG esteve associada à atividade clínica de doença e o tratamento imunossupressor reduziu de forma significativa a taxa de amostras positivas. Altos títulos de MOG-IgG tiveram correlação com maior número de surtos de neurite óptica. As sorologias de pacientes com curso monofásico se tornaram negativas ao longo do seguimento clínico, e pacientes recorrentes em remissão clínica também apresentaram menor proporção de amostras positivas / Introduction: The MOG-IgG-associated disease has been recently recognized as different from multiple sclerosis and neuromyelitis optica spectrum disorders. The main phenotypes associated with MOG-IgG are optic neuritis, myelitis and encephalitis. Although there is a growing body of evidence in the literature, the role of longitudinal MOG-IgG analysis is still unknown. The objectives of this study were: 1) to describe clinical and laboratorial aspects of MOG-IgG positive patients; 2) to study the differences between monophasic and relapsing group in clinical and laboratorial aspects; 3) to analyze predictors factors associated with risk of recurrence; 4) to investigate if the persistence of MOG-IgG is associated with risk of relapses; 5) to compare clinical and laboratorial aspects of MOG-IgG patients with NMOSD AQP4-IgG positive and negative patients. Methods: After assessment of eligibility in 574 subjects, 31 patients have been included. These patients have been divided in two groups, according to the course of the disease, if monophasic or relapsing. They have been followed for two years. During this period, annual blood samples have been collected to detect MOG-IgG and AQP4-IgG. Results: optic neuritis (ON) phenotype was frequent in both, monophasic and relapsing group; there were no statistically significant differences between them. Myelitis predominates in the relapsing group, with no significance though. The risk of recurrence is increased by having ON OR 3,66 (CI 95 % 1,03- 29,91) (p 0,048). In a logistic regression analysis, when the patient had ON in the first attack, we found a 75 % probability of having ON in the second attack. When analyzing myelitis, the risk of having a second myelitis as a phenotype was 80%. There were significant differences in EDSS scores between monophasic and relapsing patients (p 0,013). Good outcomes have been found when evaluating EDSS scores and visual acuity at the last visit. Immunossupressor treatment has significantly reduced the number of relapses (p < 0,001). When analyzing longitudinal MOG-IgG samples, relapses have been associated with positive serostatus and the immunosuppressor treatment has significantly reduced the proportion of MOG-IgG positivity. High MOG-IgG titers have been associated with higher proportion of optic neuritis relapses. Monophasic patients became MOG-IgG negative during follow-up, as well as relapsing patients on clinical remission

Made available in DSpace on 2016-01-26T12:51:28Z (GMT). No. of bitstreams: 1 adrianomondini_tese.pdf: 12162182 bytes, checksum: fe0a4d238020f614624084ebb47e1011 (MD5) Previous issue date: 2010-03-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Dengue belongs to the Flavivirus genus and is the most common arboviral infection worldwide. It can be caused by four antigenically different serotypes (DENV 1-4). These serotypes are transmitted mainly by the bite of Aedes aegypti mosquitoes. The vector is widely associated with human activity and the influence of organized social space favors the interaction among vector, virus and man, making populated areas sources of dengue dispersion. In this study, we performed a molecular, spatial and temporal study of DENV transmission through positive samples of blood and infected mosquitoes captured in São José do Rio Preto/SP in a period of four years. Material and Methods: Serum samples of patients presenting dengue like symptoms and pools of mosquitoes had their viral RNA extracted and were tested by Multiplex- RT-PCR with Flavivirus generic primers based on non-structural protein (NS5) in the first round, followed by Nested assays with species-specific primers for the identification of DENV 1-3, yellow fever virus, Saint Louis encephalitis virus (SLEV) among others. Positive samples were analyzed spatially and phylogenetically. Results and Discussion: We analyzed 613 blood samples for four years: 199 in 2006, 94 in 2007, 313 in 2008 and 10 in 2009. The positivity was high in 2006 and 2007, with 106 and 51 infected patients, respectively. The major dengue serotype circulating during the 2006 and 2007 epidemics was DENV-3 and few cases of DENV-2, which is an indication of its recent introduction in the municipality. We also reported the first outbreak of SLEV in Brazil in 2006. Among DENV patients in 2008, only seven were infected by DENV-3 and 90 were infected by DENV-2, suggesting the reemergence of this serotype. We detected the circulation of DENV-1 in two Abstract xxv patients in 2008 and in four patients in 2009. Nearly 1200 mosquitoes were captured from December 2007 to March 2008. We have captured 814 Aedes aegypti mosquitoes, which were divided in 463 pools. Only 3.67% of them were positive for DENV-3 and DENV-2. Pools containing only male mosquitoes were positive for DENV, indicating the presence of transovarial transmission. We obtained sequences from 82 patients among 174 blood samples. We were able to geo-code 46 sequences. The alignment generated a 399-nucleotide long dataset with 134 taxa. The phylogenetic analysis indicated that all samples were of DENV-3 and related to strains circulating on the isle of Martinique in 2000 2001. Sixty DENV-3 from São José do Rio Preto formed a monophyletic group (lineage 1), closely related to the remaining 22 isolates (lineage 2). We assumed that these lineages appeared before 2006 in different occasions. The possibility of inferring the spatio-temporal dynamics from genetic data has been generally little explored, and it may shed light on DENV circulation. The use of both geographic and temporally structured phylogenetic data provided a detailed view on the spread of at least two dengue viral strains in a populated urban area. / Dengue pertence ao gênero Flavivirus e é a infecção por arbovírus mais comum no mundo todo. Pode ser causada por quatro sorotipos antigenicamente distintos (DENV 1-4). Estes sorotipos são transmitidos pela picada do mosquito Aedes aegypti. O vetor está amplamente associado a atividade humana e a influencia do espaço urbano favorece a interação entre o vetor, o vírus e o homem, tornando áreas populosas, grandes centros de dispersão do dengue. Neste estudo, foi realizada um estudo molecular, espacial e temporal da transmissão de DENV através de amostras positivas de sangue e de mosquitos infectados capturados em São José do Rio Preto/SP, num período de quatro anos. Materiais e métodos: Soro de pacientes apresentando sintomas de dengue e pools de mosquitos tiveram seu RNA viral extraído e foram testados por Multiplex-RT-PCR, com primers genéricos de Flavivirus baseados na proteína não estrutural 5 (NS5) numa primeiro ciclo,seguida por ensaios Nested com primers específicos para DENV, para o vírus da febre amarela, para o vírus da encefalite de Saint Louis, entre outros. As amostras positivas foram analisadas espacial e filogeneticamente. Resultados e discussão: Analisamos 613 amostras de soro durante 4 anos: 199 em 2006; 94 em 2007; 313 em 2008 e 10 em 2009. A positividade foi alta em 2006 e 2007, com 106 e 51 pacientes infectados, respectivamente. O principal sorotipo circulante durante as epidemias de 2006-2007 foi DENV-3 e poucos casos de DENV-2, o que pode ser a indicação de sua recente introdução no município. Nós também descrevemos a primeira epidemia de SLEV no Brasil em 2006. Dentre os pacientes com DENV em 2008, apenas sete estavam infectados com DENV-3 e 90 com DENV-2, sugerindo a reemergência do sorotipo. Nós Resumo xxiii detectamos a circulação de DENV-1 em dois pacientes em 2009 e em quatro pacientes em 2009. Aproximadamente 1200 mosquitos foram capturados entre Dezembro 2007 e Março de 2008. Capturamos 814 mosquitos Aedes aegypti, que foram divididos em 463 pools. Apenas 3,67% deles foram positivos para DENV-2 e DENV-3. Pools contendo apenas machos foram positivos para DENV, indicando a presença de transmissão transovariana. Nós obtivemos sequências de 82 pacientes dentre 174 amostras de sangue. Nós fomos capazes de geocodificar 46 sequências. O alinhamento gerou gerou nucleotídeos com 399 bp com 134 taxa. A análise filogenética indicou que todas as amostras foram de DENV-3 e estavam relacionadas às cepas circulantes na ilha da Martinica em 2000-2001. Sessenta pacientes com DENV- 3 de São José do Rio Preto formaram um grupo monofilético (linhagem 1), intimamente relacionado com os outros 22 isolados (linhagem 2). Nós assumimos que estas linhagens apareceram antes de 2006 em ocasiões diferentes. A possibilidade de inferir a dinâmica espaço-temporal através de dados genéticos é relativamente pouco explorada e pode esclarecer acirculação de DENV. O uso de dados filogenéticos estruturadosgeograficamente e temporalmente forneceu uma visão detalhada na dispersão de, pelo menos, duas cepas virais distintas numa área urbana.