Syssphinx molina (Cramer) é considerada uma espécie de interesse fitossanitário, pois pode ser praga de algumas plantas cultivadas pelo homem, além disso, em lavouras de monoculturas podem ocorrer acidentes com as larvas dessa espécie, causando dermatites nos trabalhadores. O principal objetivo desse estudo é obter e caracterizar as células embrionárias indiferenciadas de Syssphinx molina. Ovos da espécie serão obtidos através de mariposas fêmeas grávidas, coletadas pela equipe da Coleção Zoológica do Maranhão (CZMA), da Universidade Estadual do Maranhão (UEMA), Campus Caxias. Os ovos foram caracterizados e comparados com ovos de outras espécies filogeneticamente próximas à S. molina. Culturas primárias de células embrionárias de S. molina foram cultivadas por 20 dias, ocorreram duas passagens e procedeu-se com o congelamento. Após descongelamento das células ocorreram 10 passagens. Foram analisadas amostras de células de cada passagem para obter dados do ciclo célular e características das células através de uso de marcadores: Anti-Axons, Anti-Caspase 3 ativa, Anti-CD105, Anti-CD117, Anti-CD24, Anti-CD43, Anti-CD73, Anti-CD90/Thy1, Anti-Ciclina D1, Anti GM 130, Anti-HLA DR, Anti-HSP47, Anti-HSP70,. Anti-KI67, Anti-MCP1, Anti- Oct 3/4, Anti-p53, Anti RAB 5, Anti-SSEA4, Anti-Stro-1, Anti-TGF beta 1, Anti-Vimentina e Schneider L2. Pela primeira vez é determinado um protocolo para resfriamento de ovos de S. molina, assim como protocolo para cultura primária e secundária de células embrionárias dessa espécie. São analisadas também as idades gestacionais dos ovos de S. molina e comparadas com ovos de outras espécies de mariposas da mesma subfamília. A análise de ciclo celular e marcadores confirmam a alta taxa de proliferação das células, no entanto, a análise com os anticorpos Anti-Caspase 3 ativa e Anti-P53 mostrou o percentual de morte celular programada (apoptose) é, geralmente, maior que 25% nas populações de células analisadas. Os marcadores Anti GM130 e Anti RAB 5, que participam, respectivamente, do recrutamento de proteínas pela fase cis do aparelho de Golgi e do processo de maturação do endossoma, marcaram mais de 50% das células das amostras analisadas. Anti-HLA-DR, que revela proteínas da membrana do linfócito T, com um percentual geralmente superior a 30% de marcação. Dentre os marcadores de células multi e pluripotentes, aquele que marcou maior taxa de células foi Anti- CD117, que se liga em células estaminais hematopoiéticas. Todos os anticorpos utilizados para marcar células do sistema hematopoiético (Anti-CD24, Anti-CD43, Anti-CD73, Anti-CD90/Thy1, Anti-HLA DR e Anti-MCP1) foram expressos nas células cultivadas de S. molina. Portanto, entende-se que os insetos, a exemplo de S. molina, são um grupo que possuem atividades metabólicas complexas e o entendimento dessas atividades permitirá, no futuro, delinear novas formas de controle biológico. Além disso, os dados inéditos sobre o sistema hematopoiético dos insetos apresentado nesse trabalho, além constitui um subsídio fundamental para estabelecer futuros modelos importantes para estudos de estratégias de controle biológico, como também poderá auxiliar no desenvolvimento de técnicas para combater doenças transmitidas por insetos. / Syssphinx molina (Cramer) is considered a species of phytosanitary interest, it can be curse of some plants cultivated by man, in addition, in monoculture plantations, accidents may occur with the larvae of this species, causing dermatitis in workers. The main objective of this study is to obtain and characterize the undifferentiated embryonic cells of Syssphinx molina. Eggs of the species will be obtained through pregnant female moths, collected by the team of the Coleção Zoológica do Maranhão (CZMA), Universidade Estadual do Maranhão (UEMA), Campus Caxias-MA. The eggs were characterized and compared with eggs of other phylogenetically close species of S. molina. Primary cultures of S. molina embryonic cells were cultured for 20 days, Two passes occurred and proceeded with freezing. After thawing of the cells, there were 10 passes. Cell samples from each passage were analyzed to obtain cell cycle data and cell characteristics through the use of markers: Anti-Axons, Anti-Caspase 3 ativa, Anti-CD105, Anti-CD117, Anti-CD24, Anti-CD43, Anti-CD73, Anti-CD90/Thy1, Anti-Ciclina D1, Anti GM 130, Anti-HLA DR, Anti-HSP47, Anti-HSP70,. Anti-KI67, Anti-MCP1, Anti- Oct 3/4, Anti-p53, Anti RAB 5, Anti-SSEA4, Anti-Stro-1, Anti-TGF beta 1, Anti-Vimentina e Schneider L2. For the first time a protocol for cooling eggs of S. molina is determined, as well as protocol for primary and secondary culture of embryonic cells of this species. The gestational age of S. molina eggs and compared to eggs of other species of moths of the same subfamily. Cell cycle analysis and markers confirm the high rate of cell proliferation, however, analysis with the active Anti-Caspase 3 and Anti-P53 antibodies showed the percentage of programmed cell death (apoptosis) is generally greater than 25 % in the analyzed cell populations. Markers Anti GM130 and anti RAB 5, which participate respectively, recruitment of proteins by cis phase of the Golgi apparatus and endosome maturation process, scored more than 50% of the cells in the samples analyzed. Anti-HLA-DR, which reveals T lymphocyte membrane proteins, with a percentage generally greater than 30% labeling. Among the multi- and pluripotent cell markers, the one that scored the highest cell rate was Anti-CD117, which binds to hematopoietic stem cells. All antibodies used to label cells from the hematopoietic system (Anti-CD24, Anti-CD43, Anti-CD73, Anti-CD90 / Thy1, Anti-HLA DR and Anti-MCP1) were expressed in the cultured cells of S. molina. Therefore, it is understood that insects, like S. molina, are a group that has complex metabolic activities and the understanding of these activities will, in the future, outline new forms of biological control. In addition, the unpublished data on the hamatopoietic system of insects presented in this work, beyond is a key benefit to establish future important models for studies of biological control strategies, but may also assist in the development of techniques to combat diseases transmitted by insects.

Des mises au point de nouvelles stratégies d’expansion ex vivo des cellules souches hématopoïétiques (CSH) sont développées depuis quelques années afin de pallier le problème du faible nombre de ces cellules pour le traitement des hémopathies ou de certaines tumeurs solides. Notre équipe avait établi un modèle d’expansion des CSH via leur exposition aux homéoprotéines HOXB4 ou HOXC4. L’étude comparative des transcriptomes de ces cellules a permis l’identification de cibles précoces des facteurs HOXB4/C4 parmi lesquels les gènes codant les régulateurs post-transcriptionnels Pumilio (de la famille PUF). Les facteurs PUF sont impliqués en particulier dans le maintien des cellules souches germinales dans différents modèles animaux, chez les vertébrés ou les invertébrés. Cependant, le rôle des facteurs PUF humains (hPum1 et hPum2) dans les cellules hématopoïétiques humaines n’avait jamais été étudié.Mon travail de thèse exposé ici a consisté, d’une part, en l’étude du profil d’expression des facteurs hPum1 et hPum2 dans différentes lignées hématopoïétiques et au cours de l’hématopoïèse humaine, démontrant une expression plus importante de ces gènes dans les cellules les plus immatures ainsi que dans les progéniteurs dont la prolifération est activée. D’autre part, l’étude fonctionnelle des facteurs hPum1 et hPum2 a mis en évidence leur implication dans l’expansion et la survie des cellules CD34+. L’inhibition spécifique de hPum1 ou de hPum2 in vitro par des shARN, induit une diminution significative du nombre absolu des cellules ainsi qu’une augmentation de leur apoptose. Cela corrèle avec une accumulation des CSH en phase G0-G1 du cycle cellulaire. Par ailleurs, la répression de l’expression de hPum1 ou de hPum2 diminue la reconstitution de l’hématopoïèse in vivo dans des souris immunodéficientes NOD-SCID-γC-/-. L’analyse des ARNm cibles des facteurs Pum par une étude comparative des transcriptomes des CSH transduites ou non par des vecteurs lentiviraux contenant des shARN hPum1 ou hPum2, a permis l’identification de nombreux gènes impliqués dans le contrôle de la croissance, de la survie ou du cycle cellulaire. L’ensemble de nos résultats montre l’indispensable implication des facteurs Pumilio dans le maintien de l’état souche, la prolifération et la survie des CSH humaines. Nous avons démarré des études fonctionnelles dans les cellules leucémiques myéloïdes primaires afin d’évaluer le rôle éventuel des facteurs Pumilio dans la leucémogenèse. Ultérieurement, la caractérisation de hPum1 et hPum2 comme de nouvelles molécules impliquées dans l’expansion des CSH permettra d’envisager leur étude dans la perspective de nouvelles stratégies thérapeutiques. / Ex vivo expansion of hematopoietic stem cells (HSCs) could improve new therapeutic strategies for the treatment of hematopoietic malignancies and solid tumors. Our team had developed an original method to expand human HSCs, consisting in the transfer into these cells of active HOXB4 or HOXC4 homeoproteins. The comparative transcriptomic analysis of CD34+ cells exposed or not to HOXB4 or HOXC4 proteins induced over-expression of Pumilio (PUF) genes. PUF proteins are post-transcriptional regulators of gene expression. They are involved in different biological functions among which the maintenance of stem cells. However, the function of human PUF factors (hPum1 and hPum2) in hematopoietic stem cells has never been investigated. The work that I developed during my thesis first consisted in analyzing the expression of PUF factors in different hematopoietic cell lines and during human hematopoiesis. The results highlighted a high expression of the hPum1 en hPum2 genes in the most immature cells and in the proliferating active progenitors. The study of human PUF factors by inducing their inhibition using specific shRNAs revealed their involvement in proliferation and survival of CD34+ cells. In vitro, inhibition of hPum1 or hPum2 decreases the expansion of human HSCs and increases cell apoptosis. The hPum1 or hPum2 repression also increases the number of HSCs in G0-G1 phase of the cell cycle. Moreover, the inhibition of hPum1 or hPum2 reduces the capacity of human HSCs to reconstitute in vivo hematopoiesis of immunodeficient NOD-SCID-γC-/- mice. The identification of PUF target mRNAs by a comparative transcriptomic analysis of human HSCs infected or not with lentiviral vectors containing hPum1/2 shRNAs, revealed a large number of genes involved in the regulation of cell growth, survival or cell cycle. On the whole, our results demonstrate the involvement of Pumilio factors in stemness maintenance, expansion and survival of human HSCs. Functional studies in primary myeloid leukemic cells are in progress to assess the potential role of the Pum factors in the leukemogenic process. Later on, identification of Pumilio factors as new regulators of HSCs expansion will allow consider them as new tools for therapeutic perspectives.

Nous avons montré que l'enzyme de conversion de l'angiotensine (ACE) est un nouveau marqueur de la cellule souche hématopoïétique et identifie l’émergence de l'hématopoïèse dans tous les sites hématogènes de l’embryon humain. L'ACE fait partie du système rénine-angiotensine (SRA) dont la fonction principale est d'agir sur l'angiotensine I pour former l'angiotensine II (AngII), un puissant vasoconstricteur.De plus, nous montrons que les principaux composants du SRA (les récepteurs AT1 et AT2, l’angiotensinogène et la rénine) sont exprimés dans la même région de l'embryon qui exprime l'ACE, suggérant ainsi l’existence d’un SRA local dans l'embryon précoce. Des tests fonctionnels, conduits in vitro chez l'embryon de la souris, montrent que l’Ang II stimule dans la culture l'émergence des progéniteurs hématopoïétiques, effet qui peut être bloqué par un antagoniste spécifique de l’AT1. Ces observations suggèrent pour la première fois, le rôle direct du SRA dans l’émergence hématopoïétique au cours de l’ontogenèse. De plus, nous mettons en évidence l'existence d'un SRA local dans la moelle osseuse (MO) adulte et nous montrons que les principaux éléments de ce système sont surexprimés dans la MO de patients atteints de leucémie aiguë myéloïde, aussi bien dans les blastes que dans les cellules stromales. Ces observations suggèrent une contribution du SRA à la dérégulation de la niche observée dans les hémopathies.Ainsi, la présence d’un SRA local dans la niche hématopoïétique intra-embryonnaire et dans la MO chez l’adulte place ce système dans une position stratégique comme acteur important de l’émergence et de la régulation du système sanguin définitif. / We have shown that the angiotensin-converting enzyme (ACE) is a new marker of human hematopoietic stem cells and also identifies emerging hematopoiesis in all hemogenic sites inside the human embryo. ACE is a key component of renin-angiotensin system (RAS) as it catalyses the production of angiotensin II (Ang II) well known for its effect in the control of blood pressure, through AT1 and AT2 receptors.Furthermore, we observe the presence of the main elements of the RAS (AT1, AT2 receptors, angiotensinogen and renin) in the same region of the embryo expressing ACE, meaning that a local RAS exists in the embryo. Functional in vitro analyses, carried out in mouse model, show a stimulatory effect of AngII in the hematopoietic precursors emergence, an effect inhibited by a specific AT1 antagonist. These observations suggest for the first time a direct role of RAS in the emergence of hematopoiesis during ontogeny. In addition, our data indicate the presence of a local RAS inside the adult bone marrow (BM). This system is overexpressed in the BM of acute myeloid leukemia (AML) patients, both in hematopoietic cells and in stromal cells suggesting a RAS contribution to the bone marrow niche deregulation, always observed in these hemopathies.Therefore, the existence of a local RAS in the intraembryonic niche and in the adult bone marrow suggests that this system is an important actor in the emergence and regulation of the definitive blood system.

Class of 2011 Abstract / OBJECTIVES: The purpose of this study was to analyze the impact of patient and hospital characteristics as well as selected comorbidities on inpatient mortality and charges in pediatric HSCT. We have determined the top 25 comorbidities reported during all inpatient stays for HSCT as well as for those stays ending in mortality. METHODS: All data was extracted from the AHRQ KID databases for the years 1997, 2000, 2003, and 2006. Two regression analyses were performed to determine the contribution of various independent variables on mortality and charges. Subjects of this study included all cases of HSCT reported in the Healthcare Cost and Utilization Project (HCUP) KID as ICD-9 41.XX. RESULTS: Factors accounting for larger increases in cost included death during hospital stay, the development of disseminated intravascular coagulation (DIC), pneumonia, and length of stay (LOS). The largest decreases in charges were seen for patients coming from a small or “micropolitan” location, patients cared for in teaching hospitals, and in hospitals with large bedsizes. Variables associated with increased risk of mortality on linear regression included development of DIC, sepsis, or pneumonia. CONCLUSION: Further study relating to HSCT is necessary to determine the contribution of specific comorbidities to mortality and charges. Importantly, DIC is associated with both greater risk of mortality and greater charges. It would be prudent to recommend increased monitoring and early treatment for DIC based on these results.

Dans l’optique de produire de maîtriser les conditions d’expansion ex vivo de greffons hématopoïétiques produits à partir de sang périphérique en homéostasie, l’objectif de ce projet a été de caractériser fonctionnellement, métaboliquement et transcriptomiquement les cellules souches hématopoïétiques (CSH). Compte tenu de l’impossibilité technique de sélectionner spécifiquement les CSH humaines, nous avons utilisé un modèle cellulaire enrichi en CSH, le modèle Side Population(SP). Dans un premier temps, nos travaux ont confirmé que les CSH du sang périphérique étaient majoritairement dans la population SP et qu’elles possédaient des caractéristiques fonctionnelles proches des CSH des autres compartiments hématopoïétiques. Nous avons également démontré l’implication des basses concentrations d’O2 sur le maintien des CSH du sang périphérique. Dans un second temps, nos résultats ont prouvé que les CSH du sang périphérique utilisaient à la fois la glycolyse et la phosphorylation oxydative pour produire l’énergie nécessaire à leur maintien. Enfin, ce projet a permis d’apporter des résultats préliminaires concernant les régulations transcriptomiques des CSH du sang périphérique. Ces données montrent donc que le sang périphérique en homéostasie pourrait constituer une source potentielle de cellules pour la production de greffons hématopoïétiques tout en apportant les premiers éléments de compréhension de la physiologie de ces cellules, afin, dans un plus long terme de maîtriser leur maintien ou leur différenciation ex vivo. / To evaluate the possibility to control ex vivo expansion conditions, a key point to produce hematopoietic graft from steady state peripheral blood (SSPB), the objective of this project to characterize the functional properties, the metabolism and the transcriptomic regulations of hematopoietic stem cell (HSC) from SSPB. Due to the lack of strong HSC’s marker in human, we choose to use the Side Population (SP) model, previously described as enriched in HSC in other hematopoietic compartments. In a first part of our work, we showed that HSC from SSPB are mainly inside the SP population. Indeed, SP cells from SSPB exhibit functional properties very closed from HSC. In addition, we found they strongly affected by low O2 concentrations, as HSC from bone marrow. In a second part, our results showed that HSC from SSPB use as much glycolysis as oxidative phosphorylation to produce energy they need to maintain their properties. All together, these data give some interesting information about HSC regulation and needs. They also suggest that HSC from SSPB could be considering as a potential source of hematopoietic graft for therapy.

The development of effective methods to cryopreserve precious cell types has had tremendous impact on regenerative and transfusion medicine. Hematopoietic stem cell (HSC) transplants from cryopreserved umbilical cord blood (UCB) have been used for regenerative medicine therapies to treat conditions including hematological cancers and immodeficiencies. Red blood cell (RBC) cryopreservation in blood banks extends RBC storage time from 42 days (for hypothermic storage) to 10 years and can overcome shortages in blood supplies from the high demand of RBC transfusions. Currently, the most commonly utilized cryoprotectants are 10% dimethyl sulfoxide (DMSO) for UCB and 40% glycerol for RBCs. DMSO is significantly toxic both to cells and patients upon its infusion. Glycerol must be removed to <1% post-thaw using complicated, time consuming and expensive deglycerolization procedures prior to transfusion to prevent intravascular hemolysis. Thus, there is an urgent need for improvements in cryopreservation processes to reduce/eliminate the use of DMSO and glycerol. Ice recrystallization during cryopreservation is a significant contributor to cellular injury and reduced cell viability. Compounds capable of inhibiting this process are thus highly desirable as novel cryoprotectants to mitigate this damage. The first compounds discovered that were ice recrystallization inhibitors were the biological antifreezes (BAs), consisting of antifreeze proteins and glycoproteins (AFPs and AFGPs). As such, BAs have been explored as potential cryoprotectants, however this has been met with limited success. The thermal hysteresis (TH)activity and ice binding capabilities associated with these compounds can facilitate cellular damage, especially at the temperatures associated with cryopreservation. Consequently, compounds that possess “custom-tailored” antifreeze activity, meaning they exhibit the potent ice recrystallization inhibition (IRI) activity without the ability to bind to ice or exhibit TH activity,are highly desirable for potential use in cryopreservation. This thesis focuses on the rational design of potent ice recrystallization inhibitors and on elucidating important key structural motifs that are essential for potent IRI activity. While particular emphasis in on the development of small molecule IRIs, exploration into structural features that influence the IRI of natural and synthetic BAs and BA analogues is also described as these are some of the most potent inhibitors known to date. Furthermore, this thesis also investigates the use of small molecule IRIs for the cryopreservation of various different cell types to ascertain their potential as novel cryoprotectants to improve upon current cryopreservation protocols, in particular those used for the long-term storage of blood and blood products. Through structure-function studies the influence of (glyco)peptide length, glycosylation and solution structure for the IRI activity of synthetic AFGPs and their analogues is described. This thesis also explores the relationship between IRI, TH and cryopreservation ability of natural AFGPs, AFPs and mutants of AFPs. While these results further demonstrated that BAs are ineffective as cryoprotectants, it revealed the potential influence of ice crystal shape and growth progression on cell survival during cryopreservation. One of the most significant results of this thesis is the discovery of alkyl- and phenolicglycosides as the first small molecule ice recrystallization inhibitors. Prior to this discovery, all reported small molecules exhibited only a weak to moderate ability to inhibit ice recrystallization. To understand how these novel small molecules inhibit this process, structure-function studies were conducted on highly IRI active molecules. These results indicated that key structural features, including the configuration of carbons bearing hydroxyl groups and the configuration of the anomeric center bearing the aglycone, are crucial for potent activity. Furthermore, studies on the phenolic-glycosides determined that the presence of specific substituents and their position on the aryl ring could result in potent activity. Moreover, these studies underscored the sensitivity of IRI activity to structural modifications as simply altering a single atom or functional group on this substituent could be detrimental for activity. Finally, various IRI active small molecules were explored for their cryopreservation potential with different cell types including a human liver cell line (HepG2), HSCs obtained from human UCB, and RBCs obtained from human peripheral blood. A number of phenolic-glycosides were found to be effective cryo-additives for RBC freezing with significantly reduced glycerol concentrations (less than 15%). This is highly significant as it could drastically decrease the deglycerolization processing times that are required when RBCs are cryopreserved with 40% glycerol. Furthermore, it demonstrates the potential for IRI active small molecules as novel cryoprotectants that can improve upon current cryopreservation protocols that are limited in terms of the commonly used cryoprotectants, DMSO and glycerol.

Orientador: Sandra Cecilia Botelho Costa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T10:34:08Z (GMT). No. of bitstreams: 1 Costa_ClaudiaRaquelCantarelli.pdf: 4518268 bytes, checksum: fb54bd9384d947b72d5d29ed906ae70f (MD5) Previous issue date: 2009 / Resumo: O cytomegalovirus humano (HCMV) e o herpesvirus humano 6 (HHV-6) são ß-herpesvirus com homologia superior a 67% e alta soroprevalência na população adulta. A infecção primaria por estes herpesvirus ocorre comumente na infância e é normalmente subclinica, ou pode causar mononucleose (HCMV) ou exantema súbito (HHV-6) sendo resolvidos na maioria dos casos sem complicações. Após a infecção primária os vírus permanecem no hospedeiro por toda vida podendo ser reativado de seu estado de latência em indivíduos adultos imunocomprometidos como os receptores de células tronco hematopoiéticas (TCTH). A reativação ou reinfecção por estes vírus causam serias complicações em pacientes submetidos ao transplante de células tronco hematopoiéticas como pneumonia intersticial, febre, gastroenterite, mielossupressão, encefalite e doença do enxerto contra o hospedeiro (GVHD). A reativação do HHV-6 após o transplante é associada com o desenvolvimento de infecções oportunistas, doença causada pelo citomegalovírus humano e possíveis episódios de rejeição aguda. Com efetivos tratamentos antivirais disponíveis, um monitoramento adequado destes vírus distinguindo entre latência e reativação é critico para estes pacientes. Monitoramos 30 pacientes submetidos à TCTH quanto a infecção ativa por HCMV e HHV-6 pelas técnicas de nested-PCR em soro e células, PCR- em tempo real em soro e células e transcrição reversa acoplada a nestedPCR (RT-nPCR). 29 pacientes (96,66%) apresentaram infecção ativa por HCMV sendo 21 pacientes (70%) pela nested-PCR em células, 17 pacientes(56,66%) pela neste-PCR em soro ,23 pacientes(76,67%) pela PCR em tempo real em células,19 pacientes (63,33%) pela PCR em tempo real em soro e 15 pacientes (53,3%) pela RT-nPCR. 25pacientes (83,33%) apresentaram infecção ativa por HHV-6, sendo 14 pacientes (46,7%) pela nested-PCR em células, 2 pacientes(6,6%) pela PCR em tempo real em células,23 pacientes (76,67%) %) pela PCR em tempo real em soro e 9 pacientes (30%) pela RT-nPCR. Todos os pacientes que apresentaram infecção ativa por HCMV apresentaram também presença do HHV-6, e 25 pacientes (83,33%) apresentaram co-infecção HCMV/HHV-6, sendo a infecção por HHV-6 precoce em relação ao HCMV. O presente estudo encontrou também associação entre infecção ativa por HCMV e doença do enxerto contra o hospedeiro. / Abstract: Human cytomegalovirus (HCMV) and human herpesvirus type 6 (HHV-6) are ß-herpesvirinae extremely closely related with a homology > 67% with a high seroprevalence in the adult population. Primary infection commonly appears in early childhood and is usually subclinical, or may cause mononucleosis (HCMV) or febrile illness, including exanthema subitum (HHV-6), solving, in the majority of cases, without complications. After primary infection, the viruses persist in the infected individual through life and can be reactivated from their state of latency in immunocompromised hosts. Reactivation or reinfection causes severe clinical diseases in patients who underwent hematopoietic stem cell transplantation, like interstitial pneumonia, fever, gastroenteritis, myelossupression, encephalitis and graft-versus-host-disease (GVHD). A potential increase in virulence of HHV-6 in the course of a simultaneous CMV reactivation, leading to a great risk of CMV-associated disease. In this present study, 30 patients who received HSCT were monitoring for active HCMV and HHV-6 infection by Nested PCR in serum and peripheral blood leukocytes (PBL) samples, real time PCR in serum and PBL and RT-nPCR. In 29 patients (96,66%) active HCMV infection was detected: 21 patients (70%) by PBL nested-PCR, 17 patients (56,66%) by serum neste-PCR, 23 patients(76,67%) by PBL real-time-PCR,19 patients (63,33%) by serum real-time-PCR and 15 patients (53,3%) by RT-nPCR. In 25 patients (83,33%) active HHV-6 infection was detected : 14 patients (46,7%) by PBL nested-PCR, 2 patients(6,6%) by PBL real time -PCR,23 patients (76,67%) by serum real time-PCR and 9 patients (30%) by RT-nPCR. In all patients who had active HCMV infection, HHV-6 DNA was detected. 25 patients (83,33) had HCMV/HHV-6 co-infection, and the active HHV-6 infection was detected earlier in the majority of the cases. Our results showed a correlation between GVHD and active HCMV infection and detection of active HCMV infection by serum nested-PCR and PBL and serum real time-PCR. / Universidade Estadual de Campi / Ciencias Basicas / Doutor em Clínica Médica

Orientador: Maria Elvira Pizzigatti Corrêa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-27T08:02:08Z (GMT). No. of bitstreams: 1 Torregrossa_ViniciusRabelo_M.pdf: 2074120 bytes, checksum: 7ac320774930da79cb9aea0a6c37ec73 (MD5) Previous issue date: 2015 / Resumo: INTRODUÇÃO: Alterações salivares quantitativas e qualitativas são complicações comuns ao Transplante de Células-Tronco Hematopoiéticas alogênico (TCTHa). Essas alterações salivares são frequentemente relacionas à fase tardia do TCTHa, principalmente na presença da Doença do Enxerto-Contra-Hospedeiro crônica (DECHc). Poucos estudos abordaram a influência da toxicidade aguda dos regimes de condicionamento sobre as alterações precoces do fluxo salivar. O objetivo deste trabalho foi avaliar a influência do TCTHa nas alterações precoces do fluxo salivar e validar critérios clínicos utilizados para o diagnóstico de hipossalivação nesta população de pacientes. MÉTODOS: O estudo prospectivo das alterações quantitativas da saliva envolveu 69 pacientes adultos submetidos ao primeiro TCTHa. A saliva não estimulada foi coletada e os pacientes foram submetidos à avaliação da saúde oral, do grau de mucosite oral, e de critérios clínicos de hipossalivação previamente ao início do regime de condicionamento, e entre os dias D+8-10 pós-TCTH. A avaliação da condição de saúde oral incluiu a obtenção do índice de Dentes Cariados, Perdidos e Obturados (CPOD), Índice Gengival (IG), e do Índice de Placa (IP). Para a avaliação da hipossalivação foram utilizados quatro critérios clínicos objetivos e quatro critérios subjetivos, considerando-se hipossalivação quando o Fluxo Salivar Não Estimulado (FSNE) ?0,2 mL/min. A avaliação da mucosite oral foi realizada entre os dias D+8-10 pós-TCTH, conforme os critérios da OMS. O estudo de validação dos critérios de hipossalivação envolveu 120 pacientes não consecutivos submetidos ao primeiro TCTH alogênico. As avaliações orais e as coletas de saliva foram realizadas simultaneamente e em diferentes períodos pós-TCTH. Para o estudo das alterações precoces do fluxo salivar, as variáveis categóricas foram analisadas pelo teste de associação Qui-quadrado, ou pelos testes de Fisher ou de Mann-Whitney. O teste t pareado foi utilizado na comparação das variáveis contínuas nos diferentes períodos. No estudo de validação dos critérios de hipossalivação, o teste alfa de Cronbach foi aplicado para medir a consistência interna e confiabilidade dos critérios clínicos utilizados. Foram então selecionados 5/8 critérios clínicos de hipossalivação, e um Sistema de Pontuação para Boca Seca (SPBS) foi elaborado. O teste de Mann-Whitney e a correlação de Pearson foram utilizados na análise da distribuição do FSNE em relação às pontuações obtidas, a partir dos critérios clínicos de hipossalivação selecionados. RESULTADOS: Foi observado um aumento do fluxo salivar (p=0.03) e do grau de inflamação gengival (p=0.03) entre os dias D+8-10 pós-TCTH. O aumento do fluxo salivar neste período foi correlacionado à gravidade da mucosite oral (p=0.02), à presença de vômito (p=0.03), ou ao uso de nutrição parenteral total (p=0.03) nos dias das coletas de saliva. Apesar da hipossalivação não ter sido um achado frequente no período estudado, mulheres e pacientes com doenças de alto risco apresentaram um menor fluxo salivar (p=0.01 e p=0.03, respectivamente). O SPBS incluiu quatro critérios clínicos validados e uma questão subjetiva de hipossalivação: 1.Alta aderência da espátula de madeira na mucosa jugal; 2.Ausência de lago sublingual; 3.Saliva espessa e viscosa; 4.Ausência de secreção salivar após ordenha do ducto parotídeo; 5. Você sente sua boca seca?. O SPBS foi dicotomizado entre as pontuações 0-1 e 2-5, de acordo com os valores obtidos do FSNE. Após a dicotomização, 66 (55%) pacientes apresentaram pontuações de 0-1, com uma média do FSNE de 0.65 mL/min (0.1-9.0 mL/min), e 54 (45%) pacientes apresentaram pontuações de 2-5 com uma média do FSNE de 0.34 mL/min (0.01-6.7 mL/min). Maiores pontuações obtidas no SPBS foram correlacionadas a um FSNE reduzido (p=0.006, r=-25%), confirmado pelo teste de Mann-Whitney (p<0.0001). CONCLUSÕES: O aumento do fluxo salivar nos dias D+8-10 pós-TCTH pode estar relacionado à intensa reação inflamatória e dano tecidual e induzidos pela toxicidade dos regimes de condicionamento, que se traduz pela gravidade da mucosite oral observada clinicamente. O SPBS provou ser uma ferramenta confiável para o diagnóstico de hipossalivação em pacientes submetidos ao TCTH alogênico / Abstract: INTRODUCTION: Qualitative and quantitative salivary changes are common complications of allogeneic hematopoietic stem cell transplantation (allo-HSCT). These salivary changes are related to late effects of HSCT, mostly in the presence of chronic graft-versus-host disease (cGVHD). Little is known about the influence of the conditioning regimens-related toxicity on the very early salivary flow changes. Thus, the aim of the present study was to understand the influence of allo-HSCT on the very early salivary flow changes. A secondary aim was to validate clinical criteria for the diagnosis of hyposalivation in allo-HSCT patients. METHODS: The prospective study of quantitative salivary changes enrolled 69 adult patients undergoing their first allo-HSCT. The unstimulated whole saliva was collected and patients were assessed for their oral health status, the degree of oral mucositis (OM), and for clinical criteria used for the diagnosis of hyposalivation before the start of the pretransplant conditioning regimens and between the days D+8-10 posttransplantation. The oral health exam included the evaluation of Decayed-Missing-Filled teeth (DMFT) index, Gingival Index (GI), and Plaque Index (PI). The clinical assessment of hyposalivation was composed by four objective clinical criteria and by four subjective questions. Hyposalivation was considered when the unstimulated whole saliva flow rate (UWSFR) was ? 0.2 mL/min. OM severity was evaluated at days D+8-10 according to the World Health Organization (WHO) criteria. The validation study of the clinical criteria for the diagnosis of hyposalivation enrolled 120 non-consecutive patients undergoing their first allo-HSCT. The oral health exams and saliva collection were taken simultaneously and in different periods of HSCT. For the study of very early salivary flow changes, chi-square or Fischer¿s test, besides of the Mann-Whitney U Test were applied according to the variable type. Pared T-test was used to compare continuous variables in different periods. For the validation study of the clinical criteria for the diagnosis of hyposalivation, a Cronbach¿s alpha test was applied in order to measure the internal consistency and satisfactory reliability of all criteria used. Five of eight clinical criteria of hyposalivation were selected, and a scoring system called Oral Dryness Score (ODS) was developed. Mann-Whitney U test was applied to analyze the UWSFR distribution among the dichotomized ODS scores, in addition to the Pearson¿s correlation coefficient. RESULTS: An increase of the UWSFR (p=0.03) and the worsening of the gingival index (p=0.03) were observed at days D+8-10 posttransplantation. A positive correlation was found between an increase of the UWSFR and a greater severity of OM (p=0.02), the use of total parenteral nutrition (TPN) (p=0.03), and with vomiting episodes (p=0.03). Although hyposalivation was not a frequent finding among the studied population, a reduced UWSFR was observed in women (p=0.01), and in the group of patients with a high risk underlying disease (p=0.03). The ODS included four validated objective clinical criteria and a subjective question of hyposalivation: 1.Higher adherence of the wood spatula to the jugal mucosa; 2.No saliva pooling in the anterior floor of mouth; 3.Increased viscosity and thickness of saliva; 4.Absence of salivary secretion of the parotid duct under manual pressure; 5.Does your mouth feels dry?. The ODI was dichotomized between 0-1 scores and 2-5 scores, respecting its behavior according to the UWSFR. After dichotomization, 66 (55%) patients presented 0¿1 scores, with a UWSFR median of 0.65 mL/min (0.1¿9.0 mL/min), and 54 (45%) patients presented 2¿5 scores with a UWSFR median of 0.34 mL/min (0.01¿6.7 mL/min). A higher ODS was correlated with a decreased UWSFR (p=0.006, r=-25%), confirmed by a Mann-Whitney U test (p<0.0001). CONCLUSIONS: The clinical impact of the conditioning regimens toxicity showed through the OM severity seemed to have influenced the very early salivary flow changes. If the influence of HSCT on the very early salivary changes could be better characterized, as well as its correlation with short and long-term oral outcomes of HSCT patients, the proper clinical management could be improved. The ODS was correlated with a decreased UWSFR, proving to be a reliable tool for the diagnosis of hyposalivation in this population / Mestrado / Estomatologia / Mestre em Estomatopatologia

Orientadores: Maria Luiza Moretti, Angélica Zaninelli Schreiber / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T08:47:24Z (GMT). No. of bitstreams: 1 Moraes_JoseRenatode_M.pdf: 2487255 bytes, checksum: 4c5a21c13a0b57cf864dbf79cca990fd (MD5) Previous issue date: 2014 / Resumo: Introdução: os fungos do gênero Fusarium são ubíquos no meio ambiente e causam doenças em plantas e aos seres humanos. Objetivos: 1)estabelecer o protocolo para a coleta e o isolamento de Fusarium spp. no ar; 2)isolar fungos do gênero Fusarium do ar da enfermaria de Hematologia e da Unidade de Transplante de Medula Óssea (TMO) no Hospital de Clínicas (HC) da Universidade Estadual de Campinas (UNICAMP) e comparar a relação genética de isolados ambientais de Fusarium spp. com os isolados a partir de hemoculturas de rotina diagnóstica de pacientes hospitalizados durante os anos de 2002 a 2013, 3)identificar os fungos do gênero Fusarium ao nível de complexo de espécies por PCR em tempo real, e ao nível de espécie pelo sequenciamento de fragmento do gene EF1?. Metodologia: foram colhidas amostras de ar nas unidades de TMO (que possui controle de ar através de filtros HEPA e fluxo de ar de pressão positiva) e na Hematologia (unidade sem controle do ar) do HC. De 2006 a 2013 foram identificados 18 isolados de Fusarium spp. em culturas de sangue. A coleta de ar foi realizada através do amostrador de ar BioSamp modelo MBS 1000D (YotsubishiCorp Japão). Um meio de cultura seletivo para Fusarium (Agar Komada com modificações) foi usado na placa de Petri dentro do amostrador de ar. O volume de ar de 1000 mL e 500 mL foram aspirados da Hematologia e enfermarias de TMO, respectivamente. Após o tempo de incubação, as colônias que cresceram nas placas foram avaliadas macroscopicamente e microscopicamente para identificação morfológica. Fusarium spp. foram identificados através de um novo ensaio de PCR em tempo real composto por dois ensaios de PCR em tempo real: um específico para o gênero Fusarium e um ensaio específico para detecção específica do complexo de espécies de Fusarium solani (FSSC). Para confirmar o complexo de espécies de Fusarium, uma região parcial do gene EF-1? foi sequenciado. O alinhamento das sequências foi realizado no programa Clustal W e a análise filogenética utilizou o programa Mega5 com o algorítimo Neighbor-Joininge Bootstrap de 1000 replicatas. Resultado: foram isoladas 108 cepas de Fusarium spp. destes 28% na unidade de TMO e 78% na Hematologia. Os complexos de espécies encontrados foram: 10% FCSC, 21% FIESC, 1% FOSC, 12% FSSC, 51% GFSC e 5% não definido. Na TMO a maior prevalência foi da espécie Fusarium solani (9/30 isolados) e na Hematologia Fusarium verticillioides (25/31 isolados). Não foi possível constatar relevância entre a temperatura e umidade do ar em relação ao aumento ou diminuição de isolados nas coletas. Nove isolados FSSC do ar e 8 de sangue apresentaram BT 99%. Conclusão. Os dados de análise filogenética sugeriram que os isolados de sangue de pacientes e ambientais foram similares sugerindo que o ambiente pôde representar uma fonte potencial de infecção para os pacientes imunodeprimidos / Abstract: Introduction:the fungus Fusarium are ubiquitous in the environment and cause diseases in plants and humans. Objectives: isolate fungi Fusarium in the air of the ward Hematology and Unit of Bone Marrow Transplantation (BMT) at the Hospital de Clinicas (HC), State University of Campinas (UNICAMP), compare the phylogenetic relationship of environmental isolates of Fusarium spp .with isolates from blood cultures of routine diagnosis of hospitalized patients during the years 2002-2013, to establish protocol for the collection and isolation of Fusarium spp. in the air, identify the fungi Fusarium species complex level by real time PCR, and to species level by sequencing the fragment EF1 ? gene. Methodology: air sample was collected in BMT units (which has control of air through HEPA filters and air flow positive pressure) and Hematology (there is not self control air inlet) HC. From 2006 to 2013, 18 samples obtained from blood cultures with the presence of Fusarium spp. were added to study the relationship between degree of molecular clinical isolates isolated from the air. The air sampling was performed using the Bio air sampler Samp MBS model 1000D (Yotsubishi Corp. Japan). A selective medium for Fusarium (Komada Agar changes by Y. Mikami, Chiba University) was used in the petri dish in the air sampler. The air volume of 1000 mL and 500 mL were aspirated Hematology and BMT wards, respectively. After the incubation time, colonies that grew on the plates were evaluated macroscopically and microscopically for morphological identification. Fusarium spp. were identified by PCR of a new system in real time according to Muraosa et al. comprising two PCR assays in real time: the specific assay Fusarium and a specific assay for specific detection of Fusarium solani (FSSC) complex. To confirm the complex of Fusarium species, a partial region of the EF-1? gene was sequenced. The alignment of sequences was performed in Clustal W program and phylogenetic analysis used Mega5 program with the neighbor-joining algorithm and bootstrap 1000 replicates. Results: 108 ceepas Fusarium spp were isolated. 28% of these isolates form the BMT unit and 78% in Hematology. Overall the species complexes ficarm divided as follows: 10% FCSC, 21% FIESC 1% FOSC, FSSC 12%, 51% and 5% GFSC nd not defined). In the BMT was higher prevalence of the species Fusariu solani (9/30 isolates) and the Hematology espéciecom largest presence is Fusarium verticillioides (25/31 isolates). Unable to find relevance between temperature and air humidity in relation to the increase or decrease in collections of isolates. Nine isolates of Fusarium solani air obtained from the same source ancestras 8 Fusarium solani isolates from blood (BT 99%). Conclusion:Fusarium spp were isolated in 108 environmental samples en all evaluated environments. Phylogenetically findings suggest equivalence between environmental isolates and isolates from the blood of patients. The collection protocol set showed satisfactory for the specific isolation of Fusarium result. The findings of Fusarium were grouped into complexes FSSC and FSSC not the technique of real-time PCR and sequencing of the gene EF1? allowed to classify the isolates in the species level / Mestrado / Clinica Medica / Mestre em Ciências

Orientador: Maria Elvira Pizzigatti Corrêa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-28T03:50:50Z (GMT). No. of bitstreams: 1 Vieira_RaizaMeira_M.pdf: 2654950 bytes, checksum: 493dac1ecf0ca2acb92f0ff8829107aa (MD5) Previous issue date: 2015 / Resumo: Complicações orais estão presentes em cerca de 80% dos pacientes durante o Transplante de Células Tronco Hematopoéticas (TCTH), sendo a mucosite oral (MO) e as alterações salivares umas da que possuem maior impacto para a qualidade de vida do paciente. A utilização do perfil proteico salivar (PPS) na abordagem diagnóstica em diversas doenças tem sido frequente. A identificação de um PPS que auxilie o entendimento das manifestações agudas orais do TCTH poderia sobremaneira, influenciar nas decisões terapêuticas visando melhora no manejo do paciente. O objetivo deste trabalho foi identificar alterações do PPS do início do regime do condicionamento pré TCTH até a recuperação medula e correlacioná- las com dados clínicos orais. Para tanto, foi utilizado o banco de dados de proteomica salivar do grupo de Odontologia do Hemocentro, encontrada por Feio et AL (2013). Nesta avaliação foram incluídos 16 pacientes submetidos ao primeiro TCTH alogênico na Unidade de Transplante de Medula Óssea do Hospital de Clínicas da UNICAMP. As amostras de saliva total não estimulada (STNE) foram coletadas em dois momentos: previamente ao condicionamento (coleta A) e a segunda (coleta B), entre os dias D+8 e D+10 pós-TCTH. Dados sobre saúde oral, grau de MO foram coletados, além da avaliação de hiposalivação. O estudo do PPS foi realizado por espectometria de massas no LNBio. Os PPS das duas coletas, A e B foram tabelados no programa Excel® 2007 (Microsoft, WA, EUA), juntamente com os dados clínicos. O teste T pareado foi utilizado para a comparação entre os PPSs com os tempos das coletas. Os critérios clínicos de hiposalivação foram comparados com as divergências proteicas durante as duas coletas por ANOVA. A comparação entre os dados clínicos de cada coleta e seu respectivo PPS, foi feito pelo teste T pareado, sendo considerado significativo p<0,005. Sete proteínas apresentaram intensidades divergentes entre as coletas A e B: Prolactin-inducible protein, Alpha-Amylase 1, Cystatin-SN, Submaxillary gland androgen-regulated protein 3B, Sthaterin, cDNA FLJ60163, highly similar to Carbonic anhydrase 6 apresentaram-se em decréscimo na coleta B comparada a coleta A e a vitamin D-binding protein isoform 1 precursor se apresentou aumentada na coleta B quando comparada a coleta A. A mucosite oral foi correlacionada com as proteinas, Immunoglobulin J chain, Pulative uncharacterized protein DKFZp686N02209 que se demonstraram com intensidade diminuída naqueles pacientes que apresentaram graus III e IV em comparação àqueles com grau 0¿II de MO; a proteína Statherin esteve presente em maior intensidade naqueles pacientes que apresentaram MO com grau III e IV. Esses resultados podem estar relacionados principalmente à toxicidade do regime de condicionamento mieloablativo nas glândulas salivares e sugerem que as proteinas Statherin, Immunoglobulin J chain e Pulative uncharacterized protein DKFZp686N02209 podem ser candidatas a um painel de PPS para a MO no TCTH / Abstract: Hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for various hematological diseases. Oral Complications are present in about 80% of patients who undergo to HSCT. Oral mucositis (OM), oral infections and salivary changes, among others are the most common oral clinical founds in the acute phase of the HSCT. The use of salivary profile as a tool for diagnosis and management of treatment responses has been shown a promising future in different clinical settings. Thus the discovery of a salivary protein profile (SPP) of patients submitted to the allogeneic HSCT during the acute phase of the transplantation may be helpful on the management of the oral effects of the HSCT. The aim of this research was to identify the SPP changes during the acute phase of allogeneic HSCT and correlate them with the oral clinical manifestation of the acute phase of HSCT. This study enrrolled 16 patients with hematological diseases who, underwent to their first allogenic HSCT at the Bone Marrow Transplantation Unit ¿ UNICAMP. Unstimulated salivary samples were collected in two periods: first (collection A), it was performed prior the initiation of the conditioning regimen for the HSCT and collection B; performed between day D+8-10 days after HSCT. Oral health indices were obtained in both moments of the saliva collection. The severity of oral mucositis was collected on the collection B. The PPS analysis was performed by mass spectrometry on a previous study performed by Feio et al (2013). Student T test paired was used in order to between the 39 identified proteins equally between the collections A and B. Clinical correlations were also compared to the different PPS using one-way ANOVA analysis. For both comparisons, considered significant p < 0.05. Among the collections A and B, 7 proteins were presented with differing intensities: Prolactin-inducible protein, Alpha-Amylase 1, Cystatin SN, Submaxillary gland androgen-regulated protein 3B, Sthaterin, cDNA FLJ60163 Similar to highly Carbonic anhydrase 6 showed a decrease intensity in the collection B and the vitamin D-binding protein isoform 1 precursor quantity showed a increased in the collection B. Three proteins were shown altered intensity when correlated with the severity of OM: Immunoglobulin J chain, Pulative uncharacterized protein DKFZp686N02209v. These proteins showed a decreased of intensity in those patients grade III-IV OM when compared to patients with grade 0-II OM. The protein Statherin showed in increased intensity in patients with OM grade III-IV. These results indicate the influence of the toxicity of the conditioning regimens on the salivary protein profiles in the acute phase of the HSCT. The proteins: Immunoglobulin J chain, Pulative uncharacterized protein DKFZp686N02209v and Statherin might be a potential candidates for a panel of salivary biomarkers for OM / Mestrado / Estomatologia / Mestra em Estomatopatologia