Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-08-03T15:27:59Z No. of bitstreams: 0 / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-08-28T13:54:44Z (GMT) No. of bitstreams: 0 / Made available in DSpace on 2018-08-28T13:54:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-04-08 / Introdução: O uso de células progenitoras hematopoéticas mobilizadas no sangue periférico tornaram-se a fonte preferencial para transplante autólogo. Alguns fatores podem afetar a mobilização de células CD34+ no transplante autólogo de células progenitoras hematopoéticas (TACPH). Este estudo teve como objetivo avaliar a influência desses fatores e correlacionar com a contagem de células CD34+ pré-aférese. Método: Estudo prospectivo que envolveu a avaliação de pacientes submetidos a mobilização de células progenitoras hematopoéticas com fator de crescimento de granulócitos (G-CSF) para realizar o transplante autólogo. Foi realizada quantificação de células CD34+ no sangue periférico pré-aférese e no produto final. Foi determinado a quantidade de células CD34+ relacionada com menor número de coletas para se obter o valor necessário para a realização do transplante, além da associação com os dados clínicos e laboratoriais. Resultados: Do total de 34 pacientes, 85% tinham mais que 20.000 leucócitos/μl. Dos pacientes que apresentaram falha na mobilização, 100% apresentaram leucometria inferior a 20.000 leucócitos/μl. Houve diferença estatisticamente significativa na associação entre o CD34+ pré-aférese e as variáveis idade (p=0,025), leucometria (p<0,001) e células mononucleares (p=0,001) do sangue periférico. O CD34+ ≥ 14 células/μl pré-aférese teve relação com um melhor rendimento dessas células no produto final e com a necessidade de apenas uma coleta para se obter a quantidade necessária para realizar o TACPH. Conclusão: Esse estudo demonstra que a contagem de células CD34+ relacionada com a idade e a leucometria pré-aférese do paciente, foi o único fator associado estatisticamente com o número de coletas e com rendimento do produto final. / Introduction: The use of hematopoietic progenitor cells mobilized in the peripheral blood became the preferred source for autologous transplantation Some factors may affect the mobilization of CD34+ cells in autologous transplantation of hematopoietic progenitor cell (ATHPC). This study aimed to evaluate the influence of these factors and to correlate with the pre-apheresis CD34+ cell count. Method: This is a prospective study evaluating 34 patients submitted to the mobilization of hematopoietic progenitor cells with granulocyte growth factor (G-CSF). Quantification of CD34+ cells in the peripheral blood pre-apheresis and in the final product of the apheresis was performed. The amount of CD34+ cells related to fewer collections was determined to obtain the value needed for the transplantation, in addition to the association with clinical and laboratory data. Results: Out of the 34 patients, 85% had more than 20,000 leukocytes / μl. Of the patients who presented failure during mobilization, all presented < 20,000 leukocytes / μl. There was a statistically significant difference in the association between pre-apheresis CD34+ and the variables age (p = 0.025), leukocyte count (p <0.001) and mononuclear cells (p = 0.001) in peripheral blood. Pre-apheresis CD34+ ≥14 cells/μl was related to better yield of these cells in the final product and with the need for only one collection to obtain the minimum cumulative yield of 2 x 106 CD34+/Kg. Conclusion: This study demonstrates that the age-related CD34+ cell count and patient pre-apheresis leukocyte count was the only factor statistically associated with the number of collections and yield of the final product.

Orientadores: Ester Maria Danielli Nicola, Eulália Sakano / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T13:39:38Z (GMT). No. of bitstreams: 1 Ortiz_Erica_D.pdf: 2854168 bytes, checksum: c4f7e3d14049e592b11a3b339481fa12 (MD5) Previous issue date: 2014 / Resumo: Introdução: Acredita-se que a imunossupressão seja única causa para maior prevalência de rinossinusites (RS) no transplantado de células tronco hematopoiéticas (TCTH) principalmente naqueles com Doença do Enxerto contra o Hospedeiro (DECH) crônica. Pacientes submetidos ao TCTH podem apresentar alterações nasossinusais, que podem se relacionar ao próprio transplante, assim como pelo regime de condicionamento ou pela DECH. Entretanto, estas alterações nasossinusais não estão bem descritas na literatura assim como a associação entre estas e a rinossinusite. Objetivo: verificar a histologia e ultraestrutura da mucosa nasossinusal com RS no TCTH com e sem DECH; e verificar a influencia da RS nas possíveis alterações histológicas nestes pacientes. Método: estudo prospectivo exploratório de coorte transversal com análise estatística de dados obtidos da avaliação de mucosa de processo unciforme de pacientes transplantados com (16) e sem DECH (8) com RS; através da microscopia eletrônica de transmissão e óptica. Comparação da recorrência das RS e alterações histológicas. Resultados: 47% (14) tiveram apenas 1 ou 2 episódios e 33%, mais de 3 episódios de rinossinusite. Apenas a presença de microvilosidades foi significativamente maior nos pacientes sem GVHD (p=0,05). Não houve diferença significativa na quantidade de cílios, ultraestrutura ciliar, metaplasia escamosa, células caliciformes, vacuolização citoplasmática, densidade do infiltrado inflamatório, linfócitos, eosinófilos e corpúsculos apoptóticos intraepiteliais, glândulas mucosas, espessura da membrana basal, edema e fibrose subepiteliais entre os grupos com e sem DECH. Houve diminuição significante de cílios conforme maior recorrência de rinossinusite (p=0,008). Conclusão: pacientes com RS e TCTH não apresentaram diferenças nas alterações histológicas nasossinusais, exceto aumento de microvilosidades naqueles sem a DECH. Os transplantados com e sem DECH apresentaram somente diminuição dos cílios conforme o aumento da recorrência de RS / Abstract: INTRODUCTION: It is believed that immunosuppression is the sole cause for the occurrence of rhinosinusitis in hematopoietic stem cell transplant (HSCT). There is a high incidence of sinusitis in recipient patients, especially in those with Chronic Graft-Versus-Host disease (GVHD). Histopathological abnormalities were described in recipients¿ sinus mucosa compared to immunocompetent patients. There were also mucosal abnormalities related to cytotoxicity in the transplanted patients with chronic GVHD but no difference in ultrastructure between HSCT patients with and without GVHD, except for increased goblet cells in patients without GVHD. The relation between the sinonasal mucosa abnormalities of patients with and without GVHD and rhinosinusitis is not well established yet. OBJECTIVE: To verify the ultrastructure of the sinonasal mucosa of HSCT with and without GVHD with rhinosinusitis to understand the cause of high sinusitis incidence in recipients with and without GVHD. METHOD: A prospective study with preliminary exploratory statistical analysis of data obtained from the evaluation of the uncinate process mucosa of patients transplanted with (16) and without GVHD (8) with rhinosinusitis by transmission electron and optical microscopy. RESULTS: Of the patients, 47% (14) had only 1 or 2 episodes, and 33% had more than 3 episodes of rhinosinusitis. Only the presence of microvilli was significantly higher in patients without GVHD. There was no significant difference in the amount of cilia, ciliary ultrastructure, squamous metaplasia, goblet cells, vacuolization, density of the inflammatory infiltrate, intraepithelial lymphocytes, eosinophils, mucous glands, apoptotic corpuscles intraepithelial basement membrane thickness, edema and subepithelial fibrosis between groups. There was a significant decrease of cilia with higher recurrence of rhinosinusitis. CONCLUSION: There was an increase in microvilli HSCT without GVHD with rhinosinusitis, and the ultrastructure and histological changes of HSCT with and without GVHD did not change with the recurrence of rhinosinusitis. However, there was a decrease of cilia in the epithelium of the sinonasal HSCT with higher recurrence of rhinosinusitis / Doutorado / Otorrinolaringologia / Doutora em Ciências Médicas

Orientador: Sandra Cecília Botelho Costa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T18:24:50Z (GMT). No. of bitstreams: 1 Peres_RenataMariaBorges_D.pdf: 6331424 bytes, checksum: 507ca7bba502f408e486703c76d9ef20 (MD5) Previous issue date: 2014 / Resumo: Introdução: Considerando-se que o transplante de células-tronco hematopoiéticas (TCTH) está associado à significativa morbidade e mortalidade devido à toxicidade do regime de condicionamento, sepse, doença do enxerto-contra-hospedeiro (DECH), entre outras complicações, sua indicação requer uma avaliação cuidadosa do risco. As infecções estão associadas a elevados índices de óbitos no pós-transplante, e seu aparecimento pode estar associado a fatores como o regime de condicionamento, imunodepressão para a prevenção da DECH, a própria DECH e a terapia adicional para a doença de base após o transplante. Dentre as infecções virais, o citomegalovírus humano (HCMV) é o patógeno mais importante no pós-TCTH pela morbidade e mortalidade associadas a ele. Por este motivo os pacientes submetidos ao TCTH são monitorados por testes laboratoriais sensíveis e específicos para o diagnóstico precoce da infecção ativa causada pelo HCMV, permitindo assim, a administração imediata da terapia antiviral. A antigenemia tem sido indicada como "padrão ouro" para guiar o tratamento precoce desta infecção. Embora a PCR em tempo real seja outra técnica muito utilizada para este fim, esta pode ser demasiadamente sensível para uso clínico, podendo haver diagnósticos positivos em pacientes que não apresentam risco de desenvolvimento da doença causada pelo HCMV. Objetivos: Determinar um valor de cutoff para diferenciar infecção latente de infecção ativa, além do risco do desenvolvimento da doença causada pelo HCMV. Métodos: Neste trabalho, 49 pacientes submetidos ao TCTH do tipo alogênico foram monitorados desde o dia do transplante até o dia +150 pelas técnicas de antigenemia e pela PCR em tempo real. Resultados: Após a construção da curva ROC o cutoff encontrado para indicar a reativação do HCMV foi 116 cópias. Baseado nesta determinação, os resultados positivos da PCR em tempo real (?116 cópias) foram comparados com resultados positivos da antigenemia (? 3 células pp65 positivas), observando associação estatisticamente significante entre eles. Sendo assim, a PCR em tempo real com 116 cópias como cutoff foi adotada como o único critério para definir a infecção ativa causada pelo HCMV nos pacientes incluídos no estudo. Vinte (40,8%) dos 49 pacientes tiveram infecção ativa causada pelo HCMV durante o monitoramento, ocorrendo com maior frequência entre os dias +41 e +50 pós-TCTH. Dezoito (90%) desses 20 pacientes foram tratados com ganciclovir e 16 deles atingiram a negativação da PCR em tempo real numa mediana de 6 dias após o início do tratamento. Quatro (8,2%) pacientes tiveram doença causada pelo HCMV comprovada por biópsia do trato gastrointestinal, 1 deles sem diagnóstico da viremia. Dois (50%) dos 4 pacientes que tiveram doença causada pelo HCMV não responderam bem ao tratamento antiviral, evoluindo para o óbito por esta causa numa mediana de 6,5 dias após o início do tratamento com ganciclovir. Outros 15 pacientes morreram por infecções fúngicas e bacterianas, DECH, recidiva da doença de base ou doença veno-oclusiva hepática. Conclusões: Pacientes submetidos ao TCTH não aparentado apresentam maior risco de infecção ativa causada pelo HCMV, o aumento repentino da carga viral parece ter relação com o aparecimento da doença causada pelo HCMV, a gravidade desta doença pode estar associada com o tempo de resposta ao tratamento antiviral e a manifestação de doença causada pelo HCMV e provável doença causada pelo HCMV aumentam o risco de óbito no pós-TCTH / Abstract: Considering that allogeneic hematopoietic stem cell transplantation (HSCT) is associated with significant morbidity and mortality due to toxicity of the conditioning regimen, sepsis onset, graft versus host disease (GVHD) manifestation, among other complications, its indication requires careful risk assessment. Infections are associated with high rates of deaths after transplantation, and their appearance can be associated with factors such as conditioning regimen, immunosuppression to prevent GVHD, GVHD itself and additional therapy for the underlying disease after transplantation. Among the viral infections, human cytomegalovirus (HCMV) is the most significant pathogen after HSCT, considering morbidity and mortality associated with it. For this reason, patients submitted to HSCT are monitored by sensitive and specific laboratory tests for early diagnosis of HCMV reactivation, thus allowing immediate administration of antiviral therapy. The antigenemia method has been indicated as the gold standard for guiding the early treatment of this infection. Although real-time PCR is another technique widely used for this purpose, this may be too sensitive for clinical use, there may be positive diagnoses in patients without risk of developing HCMV disease. Objectives: Determining a cutoff value to distinguish latent infection from active infection and the risk of developing HCMV disease. Methods: In this study, 49 patients undergoing allogeneic HSCT were monitored from the day of transplantation until day +150 by antigenemia and real-time PCR. Results: After constructing the ROC curve, the cutoff found for HCMV reactivation was 116 copies. Based on this determination, the positive results of real-time PCR (? 116 copies) were compared with results of positive antigenemia (pp65 positive cells ? 3), observing statistically significant association between them. Thus, the real-time PCR with 116 copies as cutoff was adopted as the sole criterion to define the active infection in the patients included in the study. Twenty (40.8%) of the 49 patients had HCMV reactivation during monitoring, occurring most frequently between days +41 and +50 after HSCT. Eighteen (90%) of these 20 patients were treated with ganciclovir and 16 have reached their negative real-time PCR in a median of six days after the beginning of treatment. Four (8.2%) patients had positive gastrointestinal tract biopsy for HCMV disease, one of them with no diagnosis of viremia. Two (50%) of four patients who had HCMV disease have not responded well to antiviral therapy, progressing to death by HCMV disease at a median of 6.5 days after starting treatment with ganciclovir. Another 15 patients died from fungal bacterial infection, GVHD, underlying disease relapse or veno-occlusive hepatic disease. Conclusions: Patients undergoing unrelated HSCT had higher risk of HCMV reactivation; the sudden increase in viral load seems to be related to the onset of HCMV disease; the severity of HCMV disease may be associated with the response time to antiviral therapy; and HCMV disease manifestation and probable HCMV disease increase the risk of death after HSCT / Doutorado / Clinica Medica / Doutora em Clínica Médica

IL-1 is a pro-inflammatory cytokine which play an important role in the activation and regulation of host defence and immune responses to inflammation or injury. IL-1 is able to bind and activate IL1-RI and IL1-RII, which are found on many cells types. The role of the IL-1 signalling in the deployment of Th cell subsets, especially Th17 cells is well known. However, the specific cells which are responsible for the expression of IL-1 signalling in the immune defense and in the development of the Th cell lineage in response to infection, is still largely unclear. Therefore in this thesis, IL1-RI conditional knockout mice specifically in hematopoietic cells (IL1-RI vaviCre+) were generated. Using IL1-RI vaviCre+ mice in comparison with IL1-RI global knockout mice (IL1-RI-/-) would determine whether the expression IL-1 signalling from hematopoietic cells is responsible for the immune defense and in the development of the Th1, Th2 and Th17 cells against gastrointestinal helminth Trichuris muris (T.muris) infections. The generation of IL1-RI vaviCre+ mice have been investigated at the genomic and proteomic level in order to confirm that the Il1-rI gene is inactivated in hematopoietic cells. The characterisation of IL1-RI vaviCre + mice at the genomic level confirmed that the Il1-rI gene was obliterated successfully. At protein level the characterisation of IL1- RI vaviCre + mice confirmed that IL1-RI was dysfunctional in hematopoietic cells. Additionally, the development of the immune cells was investigated in IL1-RI vaviCre + and IL1-RI-/- mice. Our findings demonstrated that the lymphocyte development was not affected by the deletion of the IL1- RI gene. This data indicated that IL1- RI vaviCre + and IL1-RI-/- mice are vital in vivo models. In high dose infection, both IL1-RI vaviCre + and IL1-RI -/- mice were able to clear the infections due to their ability to generate a Th2 response. Both IL1-RI vaviCre + and IL1-RI -/- mice infected with low dose of T.muris were susceptible to infections and showed high levels of Th1 cytokines. Thus, we hypothesised that IL1-RI signalling in hematopoietic cells was not required for worm expulsion and the generation of Th2 and Th1 response. Interestingly, low dose T.muris infection showed a clear reduction in the Th17 cytokines IL22 and IL17 in both IL1-RI vaviCre + and IL1-RI -/- mice, suggesting that IL-1 signalling expressed from hematopoietic cells is responsible for the development of Th17 cells and secretion of IL17 and IL22. IL1- RI vaviCre + and IL1-RI -/- mice infected with low dose of T.muris also showed an increase in inflammation in the colon and decreased of goblet cell hyperplasia. It is well known that IL22 plays an important role in preventing tissue damage and repair. Thus, in this study IL22 global knockout mice (IL22 -/-) were used to determine if the change in crypt lengths and goblet cell hyperplasia in IL1-RI vaviCre + and IL1-RI -/- was due to an absence of IL22. Our finding showed that IL22 -/- mice infected with low dose of T.muris had increased crypt length and a reduction in goblet cells. The similar phenotype in crypt length and goblet cell hyperplasia between IL22 -/-, IL1-RI vaviCre + and IL1-RI -/- mice suggested that a lack of IL22 in IL1-RI vaviCre + and IL1-RI -/- mice is responsible for the change in mice phenotype. It also provides more evidence for the role of IL-1 signaling in hematopoietic cells in the generation of Th17 cells and in the production of its cytokine IL22.IL1-RII is an inhibitor of IL1-RI, thus, in this study IL1-RII global knockout mice (IL1-RII -/-) mice was used in comparison with IL1-RI -/- mice to verify the role of IL-1 signaling in the development of Th17 cells. Our finding showed an overexpression of IL17 and IL22 in IL1-RII -/- compared with IL1-RI -/- mice and a higher level of IL17 in IL1-RII -/- mice compared with IL1-RII flox/flox mice. This data confirmed that IL-1 signaling is important for the development of Th17 cells and the production of its cytokine IL17 and IL22.

Chez les cellules eucaryotes, la transcription est réalisée par les ARN polymérases I, II et III. L’ARN polymérase III (Pol III) transcrit des petits ARNs non codants tels que les ARNt, l’ARN U6, l’ARNr 5S et certains microARN. Il a été montré précédemment que l’augmentation de l’activité transcriptionnelle de la Pol III était associée à la transformation tumorale. Au sein du laboratoire, nous avons décrit une nouvelle sous–unité de la Pol III, RPC32α, qui met en évidence l’existence de deux isoformes de la Pol III humaine : la Pol IIIα et la Pol IIIβ. La sous-unité RPC32β, présente dans la Pol III, est exprimée de façon ubiquitaire et parait comme essentielle pour la croissance cellulaire. La sous-unité RPC32α n’est pas essentielle pour la survie cellulaire et son expression est limitée aux cellules souches non différenciées et aux cellules tumorales. De plus, l’expression ectopique de RPC32α induit la transformation tumorale des cellules fibroblastes IMR90 et change totalement l’expression de nombreux transcrits Pol III mais aussi d’autres ARNm impliqués dans la tumorogenèse (Haurie et al., 2010). Les travaux décrits dans ce manuscrit ont eu pour but de mieux caractériser et comprendre les deux isoformes de la Pol III humaine. Nous avons purifié les Pol IIIα et Pol IIIβ afin d’identifier tous les composants protéiques des deux isoformes du complexe. Au cours de cette étude nous avons observé que des modifications post-traductionnelles de RPC32α semblaient jouer un rôle déterminant dans la capacité oncogénique de la Pol IIIα. Pour comprendre par quel mécanisme moléculaire les Pol IIIα et Pol III pouvaient influencer l’expression de transcrits Pol II, notamment lors de la transformation cellulaire induite par l’expression de RPC32α, nous avons étudié cette régulation lors de la surexpression des deux sous unités paralogues. Ainsi, nous avons mené des analyses ciblées révélant la régulation de certains gènes impliqués dans le développement, la différenciation et la tumorogenèse. Nous avons également essayé de décrire les changements d'expression des gènes au niveau globale en utilisant la technologie des puces à ADN. Cette approche innovante et puissante nous a permis d’obtenir une vision d’ensemble des transcrits Pol II différentiellement régulés lors de la surexpression de RPC32α et RPC32β Nous avons pu apprécier l’impact de la Pol III pour le développement embryonnaire, la différenciation cellulaire, la survie de la cellule, la prolifération tumorale ou encore à la réponse immunitaire innée. Les résultats de cette étude qui demandent à être confirmés ouvrent des voies de recherches particulièrement intéressantes qui mériteront d’être approfondies dans le futur / Transcription in eukaryotic nuclei is carried out by DNA-dependent RNA polymerases I, II, and III. Human RNA polymerase III (Pol III) transcribes small untranslated RNAs that include tRNAs, 5S RNA, U6 RNA, and some microRNAs. Increased Pol III transcription has been reported to accompany or cause cell transformation. In the laboratory, we described a Pol III subunit (RPC32β) that led to the demonstration of two human Pol III isoforms (Pol IIIα and Pol IIIβ). RPC32β-containing Pol IIIβ is ubiquitously expressed and essential for growth of human cells. RPC32α-containing Pol IIIα is dispensable for cell survival, with expression being restricted to undifferentiated ES cells and to tumor cells. In this regard, and most importantly, ectopic expression of RPC32α in fibroblast IMR90 enhances cell transformation and dramatically changes the expression of several tumor-related mRNAs and that of a subset of Pol III RNAs. These results identify a human Pol III isoform and isoform-specific functions in the regulation of cell growth, the differentiation and transformation. (Haurie et al., 2010).The work described in this manuscript enables identification and understanding the function of the two human Pol III isoforms. Pol IIIα and Pol IIIβ are purified in order to describe all the protein components of the two Pol III complex. During this study, we observed that post-translated modifications of RPC32α seem to have a crucial function in oncogenic capacity of Pol IIIα. To understand how Pol IIIα and Pol IIIβ can affect Pol II RNA expression, in particular during cell transformation induced by RPC32α, we studied this regulation during the overexpression of the two paralogue subunits. We performed focused analysis, this study revealed the regulation of certain genes involved in the development, the differentiation and the tumorigenesis. We also tried to describe global gene expression modification using microarray technology. This new and powerful approach enables to obtain a global view on mRNA regulation by overexpression of RPC32α and RPC32β. We observed the effect of Pol III on embryo development, cell differentiation, cell survival, tumor proliferation and on innate immune response. The results of this study need further confirmation pave the way for interesting projects which are worth going into detail for the future.

L'objectif de notre projet de recherche est l'exploration de la faisabilité de l'allogreffe des tissus composites (ATC) chez les nouveau-nés ayant des anomalies congénitales sévères de la main ou du visage. Dans la partie bibliographique, nous avons étudié les mécanismes de tolérance néonatale chez la souris, ainsi que la transplantation in utero des cellules souches hématopoïétiques avec des modèles animaux et humains. Ensuite, les propriétés du système immunitaire du nouveau-né humain ont été décrites avec étude des différents protocoles de conditionnement non-myéloablatifs utilisés pour induire une tolérance aux greffes d'organes solides, afin de trouver le type de conditionnement utilisable chez les nouveaux nés pour l'induction de tolérance. La greffe du thymus et de la moelle osseuse vascularisée avec l'ATC ont été également étudiés. Enfin, une revue exhaustive des différentes études d'ATC concernant l'induction de tolérance chez les humains et les larges animaux a été faite. Un premier modèle préclinique expérimental d'ATC a été élaboré chez le porcelet nouveau-né. Des études ultérieures ont par suite étudié les agents immunosuppresseurs ainsi que le régime de conditionnement avec l'administration de cyclosporine A., des thymo-globulines de lapin anti-porc et du mycophénolate mofétil. Un protocole d'induction de tolérance pour l'ATC chez les porcelets nouveau-nés a été rédigé et l'expérimentation sera réalisée courant 2014-2015. Si la tolérance d'ATC spécifique du donneur pourra être induite avec notre protocole, nous allons par la suite élaborer un protocole d'induction de tolérance et un programme d'allogreffe de main applicable chez les nouveau-nés humains / This present research is devoted to the exploration of performing vascularized composite allografts as a treatment for severe congenital hand or face anomalies in neonates or very young infants. The bibliographic studies at first revised the discovery and mechanisms of neonatal tolerance in mice, as well as in utero hematopoietic stem cells transplantation in large-animal models and human fetuses. Then the properties of human neonatal immune system were described; and the non-myeloablative or non-toxic conditioning regimens for solid organ transplant tolerance induction were also studied, in order to give the clue to a applicable conditioning regimen for tolerance induction in neonates. The potent thymus and vascularized bone marrow transplantation in neonatal VCA were considered as advantages. Finally, the researches concerning tolerance induction for VCA in large animal models and in human patients were reviewed. ln experimental studies, the preclinical VCA was firstly established in neonatal swines. Subsequent experiments thus studied the immunosuppressive agents, as well as conditioning regimen, including the administration of cyclosporine A, rabbit anti-pig thymocyte globulin and mycophenolate mofetil for VCA in pig neonates. The findings in these experiments were then concluded. Based on these finding, a general tolerance induction protocol for VCA in neonatal swines was designed and experiment will be performed in year 2014-2015. lf donor-specific tolerance for VCA could be induced with present protocol, we will subsequently elaborate an applicable tolerance induction protocol and hand allotransplantation program in human newborn infants

Orientador: Carmino Antonio De Souza / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T04:16:36Z (GMT). No. of bitstreams: 1 Miranda_ElianaCristinaMartins_D.pdf: 1801629 bytes, checksum: b4c847d7141a9b207af7438bdef8c791 (MD5) Previous issue date: 2013 / Resumo: O estudo analisa duas metodologias que estão sendo usadas para estimar a probabilidade de eventos. Um método é a inversão do Kaplan-Meier (1-KM), o qual não considera eventos competitivos, e o outro método é a função da incidência cumulativa (FIC). O estudo contemplou a definição do conceito de risco competitivo e a aplicação dos métodos citados em um conjunto de dados de pacientes submetidos ao transplante de células-tronco hematopoiéticas (TCTH). Os critérios de inclusão foram pacientes consecutivos transplantados no período de Janeiro de 1994 a Dezembro de 2010, com diagnóstico de leucemia aguda (LA) ou leucemia mieloide crônica (LMC). O evento de interesse foi a doença do enxerto contra o hospedeiro (DeCH) crônica, enquanto os eventos competitivos foram: recaída e morte prévia a DeCH crônica. O resultado após a aplicação do método 1-KM para o grupo de pacientes com LA foi de 52% e estratificado pelo tipo de enxerto foi 44% para medula óssea (MO) e 77% para sangue periférico (SP) p= 0.003. Quando aplicado o método FIC a probabilidade geral foi de 45% e por tipo de enxerto foi 17% para MO e 33% para SP, p= 0.00002. No grupo de pacientes diagnosticados com LMC, usando a mesma racional os resultados foram similares. Não há comparações entre os métodos estatísticos, principalmente porque o pressuposto de se considerar o evento competitivo é aplicado somente na metodologia FIC. A fonte de células SP cotejada com fonte de células MO conduzem a uma incidência cumulativa maior de DeCH, independente da doença de base. Os resultados apresentaram, na grande maioria, diferenças grandes entre os testes, indicando a importância de se averiguar os detalhes no momento da aplicação / Abstract: This study presents two methodologies that have been used to estimate the probability of events. One method is the Kaplan-Meier inversion (1-KM), which no consider the competitive events, and another one is the cumulative incidence function (CIF). The study showed the definition of competitive risk concepts and its application in the database of patients submitted to the hematopoietic stem cell transplantation (HSCT). Inclusion criteria were consecutive transplanted patients in the period between January 1994 to December 2010, with acute leukemia (AL) or chronic myeloid leukemia (CML). The interest event was chronic graft versus host disease (GVHD), insofar, competitive events were relapse or early death previous to chronic GVHD. The results after 1-KM application in the AL group was 52% and stratified by source of graft was 44% in bone marrow (BM) and 77% in peripheral blood (PB) with p=0.003. When CIF test applied the results was 45% and by source of graft was 17% in BM and 33% in PB, p= 0.00002. In the CML group the results were similar. There is no comparison between the statistical tests, mainly because their assumptions are not the same. PB as source of graft induces a higher incidence of chronic GVHD, independent of disease. All results presented, in the mayor, huge differences among the tests, indicating the importance to check the details at time of application / Doutorado / Clinica Medica / Doutora em Clínica Médica

Orientador: Simone dos Santos Aguiar / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T08:24:49Z (GMT). No. of bitstreams: 1 Eid_KatiaAparecidadeBrito_D.pdf: 1187431 bytes, checksum: e62e4911ad1d92b3213551ba2a1b41a7 (MD5) Previous issue date: 2015 / Resumo: Introdução: As células progenitoras periféricas hematopoiéticas (CPHP) é uma das alternativas de enxerto para a realização de transplante autólogo em crianças, adolescente e adulto jovem portadores de tumores sólidos e linfomas. Na mobilização, a dose clássica de G-CSF é 10µg/kg/peso do paciente SC em dose única. Acredita-se que doses maiores de G-CSF aplicadas duas vezes ao dia aumentariam o número de CD34+ coletadas com o menor número de leucaféreses. A tecnologia atual permite que seja realizado leucaférese em crianças com baixo peso (<10 kg). Objetivo: o mote do estudo foi avaliar se o G-CSF na dose de 15µg/kg peso do paciente ao dia e fracionado em duas doses, 10µg/kg e 5µg/kg, diminuiria o número de leucaférese realizada para atingir o mínimo de 3x106/kg/peso do paciente de CD34+ quando comparada com G-CSF na dose convencional, 10µg/kg/peso do paciente em dose única. Métodos: Os pacientes foram divididos em dois grupos. Grupo 10 formado por pacientes que receberam G-CSF 10µg/kg/peso SC ao dia em dose única às 6h e grupo 15 formado por pacientes que receberam G-CSF 15µg/kg/peso SC ao dia dividido em duas vezes, 10µg/kg SC às 6h e 5µg/kg SC às 18h. As leucaféreses foram realizadas em um separador celular automático de fluxo contínuo com anticoagulante ACD-A, foram processados 4 volemias em cada leucaférese. Pacientes com < 20 kg receberam priming de concentrado de hemácias filtradas e irradiadas (CHFI) durante as leucaféreses. A realização do transplante autólogo ocorreu com o número mínimo de 3x106/kg/peso de CD34+. Resultados: Sessenta e cincos pacientes portadores de tumores sólidos e linfomas foram avaliados, 39 pacientes receberam 10µg/kg/peso SC ao dia em dose única às 6h de G-CSF e 26 pacientes receberam 10µg/kg SC às 6h e 5µg/kg SC às 18h de G-CSF. Foram realizadas 146 leucaféreses, 110 (75,3%) no grupo 10 e 36 (24,7%) leucaféreses no grupo 15. No grupo 10 foi obtido uma mediana de 3 (1-7) leucaféreses e coletado uma média de 8,89x106/kg (± 9,59) de CD34+, o grupo 15 realizou uma mediana de 1 (1-3) leucaféreses e coletado uma média de 5,29x106/kg (± 4,95) de CD34+. Uma diferença estatística importante foi o número de leucaféreses (p<0,0001). Nenhum paciente apresentou intercorrências durante as leucaféreses. Os pacientes que receberam CHFI (<20 kg) não apresentaram hipovolemia nas leucaféreses realizadas. Conclusão: Para coletar o mínimo de 3x106/kg/peso de CD34+, a aplicação de G-CSF 15µg/kg/peso fracionada diminuiu significativamente o número de leucaférese realizada / Abstract: Introduction: The peripheral hematopoietic progenitor cells are a graft choice for performing autologous transplantation. In the mobilization, the classical dose of G-CSF is 10?g/kg of the patient in a single dose. There is a theory that higher doses of G-CSF applied twice daily could increase the number of collected CD34+ cells with a smallest number of leukapheresis. Objective: The aim of this study is to evaluate if a fractionated-dose of G-CSF at 15?g/kg of patient may reduce the number of leukapheresis for achieving the minimum target of 3 x 106/kg of CD34+ cells as compared to conventional dose of G-CSF. Methods: Patients were divided into two groups. Group 10: patients who received a single dose daily of G-CSF 10?g/kg and Group 15: patients who received twice dose daily of G-CSF 15?g/kg. The leukapheresis were processed in an automated cell separator. The autologous transplantation happened when the minimum number of 3x106/kg CD34+ was reached. Results: Group 10 enrolled 39 patients who received 10?g/kg of G-CSF and group 15 had 26 patients who received 15?g/kg fractionated of G-CSF. There were a total of 146 aphaeresis; 110 (75.3%) in group 10 and 36 (24.7%) group 15. Group 10 collected a median of 3 (1-7) leukapheresis and a mean of 8.89 x106/kg (± 9.59) CD34+, whereas group 15 had a median of 1 (1-3) leukapheresis and collected a mean of 5.29 x106/kg (± 4.95). The relevant difference statistic was the number of aphaeresis (p<0.0001). Conclusion: To collect a minimum target of 3x106/kg of CD34 +, the application of fractionated-dose of 15?g/kg G-CSF decreased significantly the number of leukapheresis performed / Doutorado / Saude da Criança e do Adolescente / Doutora em Ciências

A esclerose múltipla (EM) é uma doença autoimune desmielinizante progressiva imunomediada por linfócitos T auto-reativos, que provocam uma cascata imunológica, amplificando a inflamação local. No Diabetes mellitus tipo 1 (DM1), existem linfócitos T auto reativos destroem as células beta do pâncreas, causando deficiência na produção de insulina. O desenvolvimento de terapêuticas específicas fica limitado pela etiologia indefinida destas doenças, apesar de avanços na terapêutica antiinflamatória e imunossupressora. Uma alternativa de tratamento atual para tais doenças é o transplante autólogo de células tronco hematopoéticas (TACTH). O presente estudo, observacional do tipo transversal, com a coleta de dados de caráter retrospectivo, tem como objetivo identificar as reações adversas manifestadas pelos pacientes diabéticos ou de esclerose múltipla, submetidos ao TACTH no período de 2004 a dezembro de 2010. Para a coleta de dados elaborou-se dois instrumentos que foram submetidos à validação aparente e de conteúdo por três juízes. A amostra final do estudo foi constituída pela obtenção dos dados de 72 prontuários, sendo 23 de pacientes diabéticos e 49 de pacientes com EM. Em relação aos pacientes diabéticos 16 pertenciam ao sexo masculino e a idade média foi 18,26 anos. Todos possuíam positividade para o anticorpo anti-carboxilase do ácido glutâmico (antiGAD65). Quanto aos pacientes com EM, trinta e três pertenciam ao sexo feminino e idade média foi de 37,2 anos. O subtipo da doença mais frequente foi o surto-remissivo em 21 (42,9%) pacientes. A escala expandida do estado de incapacidade (EDSS) variou entre 3,0 e 6,5. Em relação às reações adversas manifestadas pelos pacientes diabéticos foram mais frequentes os calafrios, febre, cefaléia, náusea e vômito e nos pacientes com esclerose múltipla foram retenção hídrica e cefaléia. As principais intervenções de enfermagem identificadas para os pacientes diabéticos e com EM foram monitorização dos sinais vitais, coleta de hemocultura, otimização da administração de medicamentos antieméticos, controle da infusão da globulina antitimocitária, orientações sobre alimentação e para reduzir o risco de queda. Os pacientes com DM1 apresentam reações mais agudas e necessitam de monitorização contínua. Já os pacientes com EM são mais dependentes dos cuidados de enfermagem, exigindo maior tempo de cuidados prestados pelo profissional. Embora o DM1 e a EM sejam doenças distintas, percebe-se que na prática clínica, exigem do enfermeiro uma excelência no cuidado, quer pelas particularidades do tratamento realizado ou pelas singularidades de cada uma delas. / Multiple sclerosis (MS) is a progressive demyelinating autoimmune disease, immune- mediated by auto-reactive T lymphocytes, which provoke an immunological cascade, enhancing the local inflammation. In type 1 diabetes mellitus (DM1), self-reactive T lymphocytes exist that destroy ? cells in the pancreas, causing insulin production deficiency. The development of specific therapeutics is limited by these diseases\' undefined etiology, despite advances in anti-inflammatory and immunosuppressive therapy. A current treatment alternative for these diseases is autologous hematopoietic stem cell transplantations (AHSCT). The aim of this observational and cross-sectional study with retrospective data collection is to identify the adverse reactions manifested by diabetic or MS patients who were submitted to AHSCT between 2004 and December 2010. For data collection, two instruments were elaborated, submitted to face and content validation with the help of three experts. The final study sample comprised data from 72 patient files, 23 from diabetic and 49 from MS patients. As for the diabetic patients, 16 were male and the mean age was 18.26 years. All were positive for the anti-glutamic acid decarboxylase (antiGAD65) antibody. Concerning MS patients, 33 were female and the mean age was 37.2 years. The most frequent disease subtype was relapsing-remitting in 21 (42.9%) patients. The expanded disability status scale (EDSS) score ranged between 3.0 and 6.5. As for the adverse reactions the diabetic patients manifested, shivers, fever, migraine, nausea and vomiting were the most frequent, while fluid retention and migraine were the most frequent among multiple sclerosis patients. The main nursing interventions identified for the diabetic and MS patients were vital sign monitoring, blood culture collection, optimization of anti-emetic drug administration, control of anti- thymocyte globulin infusion, dietary orientations and advice to reduce the risk of falls. DM1 patients present more acute reactions and need continuous monitoring. MS patients are more dependent on nursing care, demanding lower professional care time. Although DM1 and MS are distinct conditions, in clinical practice, they demand excellent care from nurses, whether due to the particularities of the treatment or the singularities of each disease.

Bien que largement étudiés, les mécanismes fondamentaux de prise de décision dans les processus de différenciation cellulaire restent mal compris. Les théories déterministes, souvent basées sur des études populationnelles, atteignent rapidement leur limite lorsqu’il s’agit d’expliquer les différences de choix individuels de cellules, pourtant exposées au même environnement. L’objectif de ma thèse est donc d’étudier les premières étapes de la différenciation des cellules hématopoïétiques à l’échelle de la cellule unique, par des analyses transcriptomiques, protéomiques et morphologiques. Ce travail a été effectué sur deux modèles de différenciation : les lymphocytes T régulateurs et les cellules CD34+ humaines issues de sang de cordon. Nous avons observé le comportement de ces cellules uniques après stimulation. Grâce à la combinaison de la microscopie en time lapse et des analyses moléculaires réalisées à l’échelle de la cellule individuelle, nous avons pu démontrer que le choix du devenir cellulaire n’était pas unique, programmé. La cellule passe d’abord par un état dit « multi-primed », métastable où elle exprime des gènes de plusieurs lignées différentes, puis elle passe par une phase dite « incertaine », instable où elle hésite entre deux phénotypes avant de se stabiliser dans un état fixe. Nos observations sont cohérentes avec une explication stochastique de la prise de décision. La différenciation serait donc un processus spontané, dynamique, fluctuant et non un processus prédéterminé. Les décisions du destin cellulaire sont prises séparément par les cellules individuelles. / Despite intensively studies, the fundamental mechanisms of cell fate decision during cellular differentiation still remain unclear. The deterministic mechanisms, often based on studies of large cell populations, cannot explain the difference between individual cell fates choices placed in the same environment. The aim of my thesis work is to study the first steps of hematopoietic cell differentiation at the single cell level thanks to transcriptomic, proteomic and morphological analyses. Two differentiation models have been used: T regulatory lymphocytes and human cord blood-derived CD34+ cells. The behavior of individual cells following stimulation has been analyzed. Using time-lapse microscopy coupled to single cell molecular analyses, we could demonstrate that the cell fate choice is not a unique, programmed event. First, the cell reaches a metastable “multi-primed” state, which is characterized by a mixed lineage gene expression pattern. After transition through an “uncertain”, unstable state, characterized by fluctuations between two phenotypes, the cell reaches a stable state. Our observations are coherent with a stochastic model of cell fate decision. The differentiation is likely to be a spontaneous, dynamic, fluctuating and not a deterministic process. The cell fate decisions are taken by individual cells.