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Orientadores: Maria Salete Costa Gurgel, Sílvia de Barros-Mazon / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T03:12:53Z (GMT). No. of bitstreams: 1 Gimenez_RodrigoPinto_D.pdf: 2727620 bytes, checksum: 505f7780aca2f535e4882eb250f83b9d (MD5) Previous issue date: 2013 / Resumo: Introdução: A obesidade tem se mostrado responsável pelo aumento de 30% a 50% dos casos novos de câncer de mama, em particular na pós-menopausa. A mais recente hipótese para explicar tal fato situa os adipócitos e suas funções autócrina, parácrina e endócrina no centro do cenário, através da relação das adipocinas, por ele secretadas, com a obesidade e o câncer de mama. Objetivo: Artigo 1- Comparar o padrão de expressão imunoistoquímica da adiponectina (APN) e dos seus receptores tipos 1 e 2 (adipoR1/R2) no carcinoma invasor (CDI), carcinoma ductal in situ (CDIS) e lesões benignas da mama (BE) e correlacioná-los com parâmetros clínicos e histológicos. Artigo 2- Avaliar a expressão protéica da FABP4 nos tecidos epiteliais e adiposos mamário de portadoras de CDI, CDIS e lesões benignas da mama. Material e Métodos: Foram incluídos os blocos de parafina de 223 mulheres sendo 69 com CDI, 73 com CDIS e 81 com biópsias negativas para câncer de mama, tratadas no CAISM/UNICAMP de janeiro de 2008 a dezembro de 2011, e preparadas lâminas de Tissue Microarray (TMA). A expressão de APN e Adipo R1/R2 foi avaliada no tecido tumoral nos casos CDI e CDIS e no tecido epitelial e nos casos benignos. A expressão de FABP4 foi avaliada no tecido tumoral, na gordura peritumoral (GP) e na gordura mamária distante (GD) nos casos de CDI e CDIS, e no tecido epitelial e gorduras mamários nos casos benignos. Para avaliar uma possível relação entre a expressão dos marcadores entre si e com parâmetros antropométricos, clínicos e histopatológicos, foram utilizados os testes qui-quadrado ou exato de Fisher, Mann-Whitney, Kruskal-Wallis e correlação de Spearman. As determinações foram calculadas considerando o valor de ?=0,05 (p<0,05). Resultados: Artigo 1 - A APN mostrou-se expressa em 65% dos CDI, 48% dos CDIS e 12% das BE e AdipoR1 em 98%, 94% e 71%, respectivamente. Todos os casos de CDI e CDIS expressaram AdipoR2 contra 81% de BE. Nos CDI e CDIS observou-se associação entre maior expressão de APN e tumores RE negativo. No CDIS esta associação foi também observada com RP negativo. Artigo 2 - Observou-se expressão protéica da FABP4 no tecido epitelial em 90% dos CDI, 40% dos CDIS e 28% em BE. Considerando-se a GP e GD esta expressão foi maior nas BE que nos CDI, diferenças consideradas significativas. Nas pacientes com CDI a expressão da FABP4 foi maior quando o diagnóstico ocorreu até 50 anos de idade. A totalidade dos casos expressou moderada a intensamente este marcador no tecido gorduroso periepitelial e distante. Conclusões: As diferenças de expressões protéicas da adiponectina e dos seus receptores AdipoR1/R2 observadas em diferentes diagnósticos mamários sugerem sua participação no complexo mecanismo etiológico destas diferentes condições. Os resultados deste estudo indicam, ainda, que existe uma correlação direta entre expressão protéica da FABP4, câncer de mama e obesidade / Abstract: Introduction: Obesity has been shown to be responsible for a 30 to 50% increase in new breast cancer cases, in particular in the postmenopausal period. The most recent hypothesis that explains this fact places adipocytes and its autocrine, paracrine and endocrine functions at center stage, linking adipokines secreted by adipocytes to obesity and breast cancer. Objective: Article 1- to compare immunohistochemistry expression pattern of adiponectin (APN) and its receptors types 1 and 2 (adipoR1/R2) in invasive carcinoma (IDC), ductal carcinoma in situ (CDIS) and benign breast lesions (BE), correlated with clinical and histological parameters. Article 2- To assess FABP4 protein expression in epithelial and adipose breast tissue in women diagnosed with IDC, DCIS and benign breast lesions. Material and Methods: Paraffin-embedded blocks from 223 women were included. Of the total number of women, 69 had IDC CDI, 73 had CDIS and 81 had biopsies negative for breast cancer. The patients have been treated at CAISM/Unicamp from January 2008 to December 2011 and Tissue Microarray (TMA) slides were constructed. Expression of APN and Adipo R1/R2 was assessed in tumor tissue in cases of IDC and DCIS and in epithelial tissue in benign cases. FABP4 expression was evaluated in tumor tissue, peritumoral fat tissue (PF) and distant fat breast tissue (DF) in cases of IDC and DCIS and in the epithelial tissue and breast fat tissue in benign cases. To assess a possible relationship between marker expression and anthropometric, clinical and histopathological parameters, the chi-square test or Fisher's exact test, Mann-Whitney test, Kruskal-Wallis test and Spearman's correlation were used. Determinations were calculated, considering a value ?=0.05 (p<0.05) as significant. Results: Article 1 - APN was shown to be expressed in 65% of IDC, 48% of DCIS and 12% of BE and AdipoR1 in 98%, 94% and 71%, respectively. All IDC and DCIS cases expressed AdipoR2 versus 81% of BE. In IDC and DCIS, an association between a higher level of APN expression and ER-negative tumors was observed. In DCIS, this association was also observed with PR-negative tumors. Article 2 - FABP4 protein expression was observed in epithelial tissue in 90% of CDI, 40% of DCIS and 28% of BE. Considering PF and DF, FABP4 expression had a higher level in BE than in IDC, a difference that was considered significant. In patients with IDC, FABP4 expression was higher when diagnosis was made in patients aged up to 50 years. In all cases, this marker was moderately to intensely expressed in the peri-epithelial and distant fat tissue. Conclusions: Discrepancies in protein expression of adiponectin and its receptors AdipoR1/R2 observed in different breast diagnoses suggest its participation in the complex etiologic mechanism of these different conditions. Our results indicate that there is a direct correlation between FABP4 protein expression, breast cancer and obesity / Doutorado / Oncologia Ginecológica e Mamária / Doutor em Ciências da Saúde

BACKGROUND: Quantitative evidence of direct links between dietary intake during pregnancy and maternal and infant outcomes in the preterm population is lacking in the literature. However, studies are starting to investigate relationships between them, and data shows that many of the adverse effects of poor maternal diet are linked to inflammatory response and dysbiosis of the microbiome in both the mother and her offspring. OBJECTIVE: Our objective with this study was to analyze the relationships between sociodemographic factors, maternal diet, pH of breast milk, and infant inflammation. We aimed to assess the dietary pattern of our population of mothers who delivered preterm in comparison to other populations, as well as explore the possibility of using pH of mother’s own milk in future research. METHODS: We reviewed the Electronic Medical Records (EMRs) of participants to gather clinical and demographic characteristics (infants n = 53; mothers n = 45). Maternal participants also completed the Dietary Screener Questionnaire (DSQ). Spearman’s rank correlation and raw unadjusted linear regression analyses were used to investigate relationships between maternal diet and characteristics, mother’s own milk pH, and infant urinary intestinal fatty acid binding protein (I-FABP). Kruskal Wallis analysis was used to analyze between group differences of maternal comorbidities. RESULTS: None of our maternal participants met the guidelines for dietary recommendations by the United States Department of Agriculture (USDA) for pregnant women. This follows the trend in national data for women who are pregnant. The greatest number of women met the recommendation for fiber intake (n = 12). Maternal intake of fiber and whole grains was negatively correlated with pH of mother’s own milk (p <0.5). We did not find any significant correlations between maternal characteristics and maternal diet or pH of mother’s own milk. However, meeting the guidelines for added sugars differed by race (p = 0.03). We found no statistically significant correlations between urinary I-FABP and pH of mother’s own milk or maternal dietary intake. Urinary I-FABP values differed by infant sex (p = 0.03) and infant feeding status (> 50% formula or donor milk vs. < 50% formula or donor milk, p = 0.03). Analysis by groups showed statistically significant differences (p = 0.04). Preeclamptic participants had a higher intake of whole grains (0.97 oz) than women without preeclampsia (0.69 oz). Mothers with gestational diabetes had a lower intake of sugar (14.4 tsp) compared to women without diabetes (17.9 tsp) (p = 0.01). We found no other statistically significant results between groups for maternal diet, milk pH, or urinary I-FABP. CONCLUSION: Our findings suggest that additional research on mother’s own milk pH may be warranted, and that continued education on the importance of a healthy diet and its benefits during pregnancy is needed. Areas of planned future research include fat intake calculations and inflammatory measures of the maternal dietary data.

Background: Diagnosis of acute coronary syndromes (ACS) in the Emergency Department (ED) is a topical and contentious issue. Current diagnostic techniques rely on hospital admission for troponin testing. Only a minority of those admitted prove to have ACS while unacceptable proportions of those discharged have unrecognised ACS. Aims: We aimed to evaluate the diagnostic and prognostic value of individual clinical findings and novel biomarkers in ED patients with suspected cardiac chest pain. We then aimed to derive a clinical decision rule (CDR) to potentially enable safe, immediate discharge of a proportion of patients from the ED while risk stratifying others to facilitate triage to an appropriate level of in-patient care. Methods: We recruited patients who presented to the ED with suspected cardiac chest pain. Variables that have previously been shown to predict diagnosis of acute myocardial infarction (AMI) or to predict outcome were prospectively recorded. Blood was drawn at presentation for levels of eight biomarkers. Patients underwent 12-hour troponin testing and were followed up for the composite primary outcome of AMI, death or urgent coronary revascularisation for six months. Variables that were univariate predictors (p<0.05) of outcome were entered into a multivariate analysis using recursive partitioning. Results: While many clinical findings and levels of all eight novel biomarkers were found to be significant predictors of outcome, none could be used individually to confirm or exclude ACS in the ED. We derived a nine-point CDR that combined clinical findings with biomarker levels to effectively stratify patients into four risk groups. 14.2% of patients were identified as being at ‘no risk’ and had a 0.0% outcome rate. The rule performed significantly better than two commonly used risk scores and may improve on triage decisions made in actual clinical practice. Conclusion: ACS remains a difficult diagnosis to confidently confirm or refute in the ED. Our CDR may help to avoid unnecessary hospital admissions while improving on triage decisions made for the remaining in-patients. Prospective validation of our findings is warranted.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Noncovalent interactions are involved in many biological processes in which biomolecules bind specifically and reversibly to a partner. Often, proteins do not have a biological activity without the presence of a partner, a ligand. Biological signals are produced when proteins interact with other proteins, peptides, oligonucleotides, nucleic acids, lipids, metal ions, polysaccharides or small organic molecules. Some key steps in the drug discovery process are based on noncovalent interactions. We have focused our research on the steps involving ligand screening, competitive binding and ‘off-target’ binding. The first paper in this thesis investigated the complicated electrospray ionization process with regards to noncovalent complexes. We have proposed a model that may explain how the equilibrium between a protein and ligand changes during the droplet evaporation/ionization process. The second paper describes an evaluation of an automated chip-based nano-ESI platform for ligand screening. The technique was compared with a previously reported method based on nuclear magnetic resonance (NMR), and excellent correlation was obtained between the results obtained with the two methods. As a general conclusion we believe that the automated nano-ESI/MS should have a great potential to serve as a complementary screening method to conventional HTS. Alternatively, it could be used as a first screening method in an early phase of drug development programs when only small amounts of purified targets are available. In the third article, the advantage of using on-line microdialysis as a tool for enhanced resolution and sensitivity during detection of noncovalent interactions and competitive binding studies by ESI-MS was demonstrated. The microdialysis device was improved and a new approach for competitive binding studies was developed. The last article in the thesis reports studies of noncovalent interactions by means of nanoelectrospray ionization mass spectrometry (nanoESI-MS) for determination of the specific binding of selected drug candidates to HSA. Two drug candidates and two known binders to HSA were analyzed using a competitive approach. The drugs were incubated with the target protein followed by addition of site-specific probes, one at a time. The drug candidates showed predominant affinity to site I (warfarin site). Naproxen and glyburide showed affinity to both sites I and II. / QC 20100705

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A esquistossomose é a mais importante das doenças helmínticas humanas em termos de morbidez e mortalidade. A proteína Sm14 de Schistosoma mansoni, que pertence à família de proteínas ligadoras de ácidos graxos (fatty acid-binding proteins, FABPs) (Moser et al., 1991), mostrou um bom nível de proteção (65%) contra a esquistossomose em animais experimentais (Tendler et al., 1996). No presente trabalho foram desenvolvidos sistemas de expressão que possibilitará a produção da proteína Sm14 em larga escala em E.coli. Com o intuito de conhecer a estrutura do gene da proteína Sm14, foi clonado um fragmento de DNA genômico de S. mansoni que contém a seqüência codificante da proteína Sm14. Como os outros membros da família gênica das FABP, o gene para a proteína Sm14 contém quatro \"exons\" separados por três \"introns\" de 674, 585 e 42 bp. Esta é a primeira descrição da estrutura gênica de um membro das FABP correspondente a um helminto. A Sm14 é uma proteína que pode ser potencialmente usada como vacina. Estudamos a existência de polimorfismo em duas linhagens de S. mansoni endêmicas do Brasil: LE e BH. Para a análise de polimorfismo, a ORF correspondente à proteína Sm14 foi amplificada por RT-PCR do RNA total de vermes adultos de S. mansoni. Os produtos de amplificação independentes foram clonados no vetor pGEM-T e seqüenciados. As análises de seqüências mostraram duas isoformas principais para a proteína Sm14: Sm14-M20, com seqüência idêntica a proteína Sm14 previamente reportada para a linhagem de Puerto Rico de S. mansoni (Moser et AL., 1991), e Sm14-T20, onde o códon da Met20 (ATG) mudou para o códon de Thr (ACG) (polimorfismo M20T). Dois clones mostraram uma deleção de seqüência de aminoácidos correspondente ao \"exon\" 3 inteiro (clones &#916;Exon3), gerada por \"splicing\" alternativo. As outras trocas observadas acontecem em posições onde os aminoácidos são menos conservados e estão representados apenas por um único clone que podem ter sido obtidas por mutagênese na PCR. A metionina correspondente à posição 20 na Sm14 é altamente conservada nas FABP dos mais diversos organismos,e não se tem nenhuma outra proteína com treonina nesta posição. Para o estudo da estrutura e função destas isoformas, os cDNAs correspondentes foram subclonados no vetor pAE (desenvolvido no nosso laboratório), assim como o mutante M20A (Sm14-A20) construído para efeitos de comparação. A estabilidade e estrutura das proteínas recombinantes purificadas foram caracterizadas por dicroísmo circular (CD). A comparação da estrutura e termoestabilidade mostrou que as formas Sm14-T20 e Sm14-A20 são menos termoestáveis do que a Sm14-M20 (um &#916;Tm de aproximadamente 10°C). Porém, todas as formas de Sm14 foram capazes de ligar o DAUDA [ácido 11-(dansylamino) undecanoico] com a mesma afinidade. Para poder diferenciar as propriedades de ligação de ácidos graxos pelas isoformas, experiências de competição do deslocamento do DAUDA por ácidos graxos naturais, foram realizadas. A partir destes dados podemos assumir que a forma Sm14-M20 liga melhor todos os ácidos graxos naturais testados do que a forma Sm14-T20. Porém esta forma mantém a capacidade de ligar ácidos graxos, ao contrario do mutante Sm14-A20. Pode-se deduzir como resultado destas experiências que a proteína Sm14-M20 é mais estável e liga com maior afinidade os ácidos graxos naturais do que a forma Sm14-T20. Pelo visto, a proteína Sm14-T20 tem menos estrutura-&#946;, porém, mantém a capacidade de ligar moléculas hidrofóbicas. Ainda é desconhecido o papel funcional do polimorfismo da proteína Sm14 no metabolismo dos vermes de S. mansoni. Problemas de estabilidade da proteína Sm14 recombinante, durante seu transporte e armazenamento, comprometem sua viabilidade como vacina. Com o intuito de melhorar a estabilidade desta proteína, foi feita uma mutagênese no único resíduo de cisteína presente na Sm14 na posição 62. Este resíduo é responsável pela formação de dímeros, o que é relacionado a estabilização da perda de estrutura-&#946; e precipitação da proteína. Esta cisteína foi trocada por serina (C62S) e por valina (C62V) por mutagênese sítio dirigida, resultando nas proteínas Sm14-M20S62 e Sm14-M20V62. As formas mutantes não apresentaram maior termoestabilidade, mas a renaturação após o aquecimento a 80°C atingiu quase 100%, diferentemente das proteínas com Cys62. As proteínas com o resíduo de cisteina trocado foram as únicas formas que conservaram a estrutura de &#946;-barril após 3 meses de armazenamento a 4°C, como mostram as análises de dicroísmo circular, sendo a forma mais estável a proteína Sm14-M20V62. Após estes estudos, a isoforma Sm14-M20 com a mutação C62V (Sm14-M20V62) mostrou-se como a melhor alternativa ao antígeno Sm14-T20 usado até agora como modelo de vacina experimental para S. mansoni. Esta indicação deve ser confirmada em ensaios de imunização e posterior desafio com cercárias de S. mansoni. / The schistosomiasis is the most important human helmintic disease in terms of morbidity and mortality. The Sm14 protein of Schistosoma mansoni belongs to the family of fatty acid-binding proteins (FABPs) (Moser et aI. , 1991) and showed a good protection level as vaccine antigen against the schistosomiasis in experimental animals (Tendler et al., 1996). In the present work were developed systems for the expression of Sm14 protein that will facilitate its large scale production in E.coli.. In order to know the gene structure of the Sm14 protein, we amplified by PCR a genomic DNA fragment of S. mansoni that contains the coding sequence for the Sm14 protein. As the other members of the FABP family, the Sm14 gene contains four exons separated by three introns of 674,585 and 42 bp, respectively. This is the first detailed description of the genomic structure for a member of FABPs corresponding to a helmint. We also studied the existence of polymorphisms within two Brazilian endemic strains of S.mansoni: LE and BH. For the polymorphism analysis, the ORF corresponding to the Sm14 protein was amplified by RT-PCR from total RNA of S. mansoni adult worms. The independent amplified products were cloned into pGEM-T vector and sequenced. The sequence analyses showed two main isoforms: Sm14-M20, with identical sequence to that previously reported Sm14 protein from the Puerto Rican strain of S. mansoni (Moser et al., 1991), and Sm14-T20, where the codon for Met20 (ATG) was changed for the Thr codon (ACG) (M20T polymorphism). Two clones showed the same amino acid sequence deletion corresponding to the whole third exon (&#916;Exon3 clones), generated by alternative splicing. The other observed changes occurred in positions where the amino acids were less conserved and were just represented by only one clone that could be obtained by PCR mutagenesis. The methionine corresponding to the position 20 in Sm14 is highly conserved among FABPs and no other related protein has threonin in this position. To study the structure and function of these amino acid in the isoforms, the corresponding cDNAs were subcloned in to the pAE vector (developed in our laboratory), as well as the mutant M20A (Sm14-A20). The stability and structure of the purified recombinant proteins were characterized by circular dicroism (CD). The comparison of their structure and thermo stability showed that the forms Sm14-T20 and Sm14-A20 are less thermostable than Sm14-M20 (&#916;Tm around 10ºC). However, all of the Sm14 forms were capable to bind the DAUDA [11- (dansylamine) undecanoic acid] with similar affinities. To differentiate the fatty acid binding properties of Sm14 isoforms, displacement experiments of DAUDA with natural fatty acid were performed. From these data we can assume that the Sm14-M20 form binds better than the Sm14-T20 and Sm14-A20 forms of all natural fatty acid assayed. This suggests that the Sm14-20 protein is most stable and binds better the natural fatty acids than the Sm14-T20 form. Although the Sm14-T20 protein has less structure, it maintains the capacity to bind fatty acids. It is still unknown the functional role of this Sm14 protein polymorphism in the metabolism of S. mansoni worms. Stability problems of the recombinant Sm14 protein during its transport and storage, could hamper its use as vaccine. With the aim to improve the stability of this protein, it was made a mutagenese at the unique cysteine residue present in Sm14 at the position 62. This residue is responsible for the dimer formation and is related the loss of the terciary structure and precipitation of the protein. This cysteine was changed by serine (C62S) and for valine (C62V) by site directed mutagenesis, resulting in the proteins Sm14-M20S62 and Sm14-M20V62. The mutant forms did not present a higher thermal stability but the renaturation after heating at 80°C almost reached 100%, in contrast to Sm14 proteins with Cys62. These mutants conserved the &#946;-barrel structure after 3 months of storage at 4°C, in contrast to proteins with Cys62, as shown by circular dicroism analyses. After these studies, the Sm14-M20 isoform with the C62V mutation (Sm14-M20V62) was considered the best alternative to the antigen Sm14-T20 used up to now as the model for an experimental vaccine for S. mansoni. This indication should be confirmed by immunization and posterior challenge with S. mansoni cercaria.