Introdução: A Doença Hepática Gordurosa Não Alcoólica (DHGNA) tem sido considerada atualmente a forma mais comum de doença hepática no mundo ocidental, relacionada principalmente ao aumento da prevalência da obesidade.A DHGNA abrange um largo espectro de doença, desde casos de esteatose simples (EH) até esteato-hepatite não alcoólica (EHNA) e fibrose, podendo evoluir para cirrose e carcinoma hepatocelular (CHC). Embora se conheçam os fatores predisponentes para o desenvolvimento de EHNA, sua patogênese, assim como tratamento eficaz, permanecem pouco conhecidos.Os lípides, principalmente gorduras neutras, fosfolipídios e colesterol, são componentes fundamentais das células, assim como as proteínas e os hidratos de carbono. Embora aumentos marcantes de proteínas e hidratos de carbono não produzam quaisquer alterações macroscópicas no fígado, um acúmulo de gordura é prontamente reconhecido pela coloração amarelada e pelo aumento de volume do órgão. Várias dietas tem sido usadas em animais de laboratórios, principalmente camundongos e ratos no sentido de induzir esteatose, esteatohepatite e fibrose hepática, embora nenhuma delas consiga reproduzir na totalidade os componentes essenciais da doença humana. Não encontramos em nenhum trabalho da literatura a utilização da dieta deficiente em colina e hiperlipídica (DCH), por nós utilizada. Objetivo: O objetivo deste estudo foi avaliar o efeito de uma dieta deficiente em colina e hiperlipídica (DCH) para desenvolver esteatose hepática, esteatohepatite e fibrose hepática no rato. Métodos: A doença hepática foi induzida em ratos Sprague-Dawley machos pesando de 300 a 350 gramas, hospedados em gaiolas padrão e recebendo água à vontade. Foi usado dieta deficiente em colina e hiperlipídica (DCH). Os animais foram distribuídos por meio de tabela sequencial randomizada em dois grupos. No grupo 1 dez ratos receberam a dieta por 4 meses e no grupo 2 dez ratos receberam a dieta durante 8 meses. Após o tempo estipulado das dietas os animais foram anestesiados e sacrificados. Os fígados dos animais foram retirados, pesados e enviados para estudo histopatológico de acordo com os critérios estabelecidos por Kleiner. Os animais foram pesados no início do experimento e por ocasião do sacrifício. Resultados: o peso dos animais do grupo 1 (DCH - 4 meses) no início do experimento variou de 305 a 350 gramas com média de 329,9 gramas e no fim do experimento de 529 a 615 gramas com média de 579,2 gramas. O percentual de ganho de peso dos animais variou de 60 a 86,93% com média de 75,72%. O peso dos animais do grupo 2 (DCH - 8 meses) no início do experimento variou de 320 a 353 gramas com média de 339,4 gramas e no fim do experimento variou de 661,5 a 783 gramas com média de 705,6 gramas. O percentual do ganho de peso dos animais variou de 95,58 a 123,71% com média de 107,78%. O peso do fígado dos animais do grupo 1 no fim do experimento variou de 24,5 a 29,5 gramas. O percentual do peso do fígado em relação ao peso dos animais do grupo 1 variou de 4,16 a 5,54% com média de 4,75%. O peso do fígado dos animais do grupo 2 no fim do experimento variou de 31 gramas a 39 gramas com média de 33,8 gramas. O percentual do peso do fígado em relação ao peso dos animais do grupo 2 variou de 4,63% a 5,07%, com média de 4,78%. A análise histopatológica dos animais do grupo 1 demonstrou intensa balonização e esteatose microgoticular com inflamação lobular; o estadiamento de fibrose foi discreto nestes animais. O estudo histopatológico dos animais do grupo 2 revelou intensa esteatose microgoticular e balonização com inflamação lobular; alguns animais apresentaram esteatose macrogoticular. Os animais deste grupo 2 apresentaram fibrose com grande variação individual. Os animais de ambos os grupos experimentais desenvolveram esteatohepatite, pois apresentaram o índice de atividade da doença hepática gordurosa não alcoólica (NAS)>=5. A análise comparativa demonstrou não haver diferença estatística no valor do NAS entre os dois grupos experimentais. Em relação ao estadiamento da fibrose na esteatohepatite não alcoólica, os animais do grupo 2 apresentaram uma tendência de escores mais elevados do que os animais do grupo 1. No entanto não houve diferença estatística entre os grupos devido a grande variação individual (p=0,2755). Conclusões: A dieta DCH administrada durante 4 e 8 meses induziu nos ratos aumento considerável de peso corpóreo e do peso do fígado. Os animais do grupo 1 apresentaram intensa balonização, esteatose microgoticular e inflamação lobular com discreta fibrose hepática. Os animais do grupo 2 apresentaram intensa balonização, esteatose macro e microgoticular, inflamação lobular e maior grau de fibrose hepática, bem estabelecida com formação de colágeno e expansão fibrosa nos espaços vasculares. A dieta deficiente em colina e hiperlipídica (DCH) induziu no rato esteatose hepática e esteatohepatite com fibrose, servindo de modelo experimental para proporcionar melhor entendimento para procedimentos terapêuticos futuros desta importante patologia do fígado. / Introduction: Nonalcoholic Fatty Liver Disease (NAFLD) has currently been regarded as the most common form of liver disease in the western world, mainly related to the increased prevalence of obesity. NAFLD covers a broad spectrum of diseases, since cases of simple steatosis (HS) to steatohepatitis (EHNA) and fibrosis, and may evolve to cirrhosis and hepatocellular carcinoma (CHC). Although the predisposing factors for the development of EHNA are well established, there is little knowledge on its pathogenesis as well as the effective treatment options. Lipids, especially phospholipids, neutral fats and cholesterol, are fundamental cell components, as well as proteins and carbohydrates. Although striking increases of proteins and carbohydrates do not produce liver macroscopic changes, fat build up can be rapidly recognized by the yellow coloring and increased organ volume. Many diets have been used in laboratory animals, mainly rats although none of them can fully reproduce the fundamental components of the human disease. We could not find in the literature any study on the use of choline-deficient and hiperlipidic diet (CHD), used in the present study. Goal: The objective of this study was to evaluate the effect of a cholinedeficient and hiperlipidic diet (CHD) on the development of steatosis, steatohepatitis and hepatic fibrosis in rats. Methods: The liver disease was induced in male Sprague-Dawley rats, weighing from 300 to 350 grams, hosted in standard cages and receiving water ad libitum and fed with a choline-deficient and hiperlipidic diet (CHD). The experimental animals were distributed by means of a random sequential table in two groups. In Group 1 ten rats received the diet for four months and in Group 2 ten rats received the same diet for eight months. After these predetermined feeding time periods the animals were anesthetized and sacrificed. The animal livers were then removed, weighed and sent to histopathological study according to the criteria established by Kleiner. All the animals were weighed at the beginning of the experiment and by the time of the sacrifice. Results: The weight of Group 1 animals (4 months CHD) at the beginning of the experiment varied from 305 to 350 grams with an average of 329.9 grams and at the end of the experiment from 529 to 615 grams averaging 579.2 grams. The percentage of weight gain in animals of this group ranged from 60% to 86.93% with an average of 75.72%. The weight of Group 2 animals (8 months CHD) at the start of the experiment varied from 320 to 353 grams with an average of 339.4 grams and at the end of the experiment from the 661.5 to 783 g with an average of 705.6 grams. The percentage of weight gain in animals of this group varied from 95.58% to 123.71%, averaging 107.78%. The liver weight of Group 1 animals at the end of the experiment varied from 24.5 to 29.5 grams. The percentage of liver weight in relation to the animals\' weight, in Group 1, ranged from 4.16% to 5.54%, with an average of 4.75%. The liver weight of Group 2 animals at the end of the experiment varied from 31gramas to 39 grams, with an average of 33.8 gram. The percentage of liver weight in relation to the animals\' weight, in Group 2, ranged from 4.63% to 5.07%, with an average of 4.78%. Liver histopathological analysis in Group 1 animals showed marked ballooning degeneration and microgoticular steatosis with lobular inflammation; fibrosis staging was discreet in these animals. Liver histopathological study in animals of Group 2 showed an intense microgoticular steatosis and ballooning with lobular inflammation; some animals of this group presented macrogoticular steatosis. The amount of hepatic fibrosis in animals of this group was extremely variable. Animals of both experimental groups developed steatohepatitis, as they presented the activity index of nonalcoholic fatty liver disease (NAS) >= 5. Statistical analysis did not show a significant difference between the NAS values of the two experimental groups. Fibrosis staging analysis in non-alcoholic steatohepatitis showed a trend toward higher scores in animals of Group 2 as compared to Group 1 animals. However there was no statistical difference between the groups due to a large individual variation (p = 0.2755). Conclusions: CHD diet administered for four and eight months induced considerable increases in the rats\' body weight and liver weight. Animals in Group 1 showed intense liver ballooning, steatosis and lobular inflammation with discrete microgoticular fibrosis. Animals in Group 2 presented intense ballooning, steatosis macro and microgoticular, lobular inflammation and a higher degree of well-established hepatic fibrosis, with collagen formation with fibrotic expansion in vascular spaces. Choline-deficient and hiperlipidic diet (CHD) in the rat induced hepatic steatosis and steatohepatitis with fibrosis, representing an experimental model, which can provide a better knowledge for future therapeutic procedures of this important liver pathology.

O colágeno XVIII é um componente das membranas basais com diversos domínios funcionais, como a endostatina e o domínio frizzled, que têm importante papel em processos celulares como proliferação e diferenciação. COL18A1 possui dois promotores alternativos: o promotor 1, que regula a síntese da variante NC11-303, e o promotor 2 responsável pelas variantes NC11- 728 e NC11-493, expressas por hepatócitos. Existe uma variação interindividual da endostatina circulante e da expressão do colágeno XVIII no fígado. A expressão do colágeno XVIII/endostatina foi correlacionada com a progressão tanto do hepatocarcinoma (HCC), quanto da fibrose/cirrose hepática. Elucidar a regulação da expressão de COL18A1 pode auxiliar na compreensão dessa variação interindividual e da progressão dessas doenças. Neste trabalho demos início a caracterização do promotor 2 do COL18A1. Identificamos na seqüência predita como promotora cinco regiões conservadas entre humanos e camundongos. A análise in silico e funcional dessas regiões revelou que os fatores de transcrição, Sp1, Sp3, YY1, Oct-1, C/EBPα e C/EBPβ, interagem com as mesmas. Demonstramos que C/EBPβaumenta a taxa de transcrição do promotor 2 em hepatócitos, e que existe uma correlação positiva da expressão de NC11-493 com C/EBPαe C/EBPβem tecido hepático cirrótico e tumoral. As expressões de C/EBPαem tecido hepático cirrótico e tumoral estão diretamente correlacionadas, enquanto que os níveis de NC11-493 nos tumores estão inversamente correlacionados com o tamanho dos mesmos. Mostramos a existência de diversos SNPs no promotor 2. O SNP-700T/G, funcional in vitro, afeta a interação de Sp3 e YY1 com essa região regulatória. A deleção da região do SNP indicou que ela possui elementos importantes para a transcrição em hepatócitos, apesar deste SNP não estar relacionado com o nível de expressão do colágeno XVIII em fígado fibrótico ou com susceptibilidade a HCC. O SNP- 700T/G está em desequilíbrio de ligação com o SNPc.1135C/T, no domínio frizzled do colágeno XVIII. Não foi possível elucidar a funcionalidade do SNPs c.1135C/T in vitro, mas os haplótipos formados por esses dois SNPs têm diferentes frequências entre descendentes de europeus e de africanos. Nosso trabalho traz importantes contribuições e abre novas perspectivas para a compreensão da regulação do colágeno XVIII em fígado humano, tanto em situações fisiológicas, quanto em processos fibrogênicos e tumorigênicos¶ / Collagen XVIII is a basal membrane component with several funcional domains, such as endostatin and frizzled domains, which have important roles in cellular processes such as proliferation and differentiation. COL18A1 has two promoter regions: promoter 1, that regulates the synthesis of NC11-303 isoform, and promoter 2, localized in intron 2, responsible for NC11-728 and NC11-493 isoforms expressed by hepatocytes. There is a large interindividual variation in circulating endostatin and in collagen XVIII liver expression. Collagen XVIII/endostatin levels were correlated with hepatocellular carcinoma (HCC) progression, as well as liver fibrosis/cirrhosis, conditions that precede HCC. Elucidating the mechanisms that regulate COL18A1 expression in hepatocytes may help understanding its variation among individuals and liver disease stages, as well as contribute to new treatment strategies. In this work we began to characterize COL18A1 promoter region 2. We identified in the predicted promoter sequence five conserved regions between human and mouse. The in silico and functional analysis of these regions revealed that transcription factors Sp1, Sp3, YY1, Oct-1, C/EBPα and C/EBPβ interact with them. We have demonstrated that C/EBPβ increases promoter 2 transcription rate in hepatocytes, and that there is a positive correlation of NC11-493 expression with that of C/EBPα and C/EBPβ in cirrhotic and tumor liver samples. Non-tumor and tumor C/EBPα expressions positively correlate between themselves, while NC11-493 tumor expression inversely correlates with tumor size. We also showed that there are several SNPs in COL18A1 promoter 2 region. SNP-700T/G, functional in vitro, affects Sp3 and YY1 interaction with the promoter 2 region and deletion of the SNP region indicated that this sequence has important hepatocyte regulatory elements. Our results suggest that this SNP does not significantly affects COL18A1 expression in fibrotic/cirrhotic liver and is not associated with HCC susceptibility. SNP-700T/G is in linkage disequilibrium with SNPc.1135C/T, at collagen XVIII frizzled domain. We could not elucidate SNPc.1135C/T functionality in vitro, but the haplotypes formed by these two SNPs have different frequencies in European and African descendants. In conclusion, our work brings important contributions and opens new perspectives for the comprehension of collagen XVIII regulation in human liver in physiological situations, as well as in fibrotic/cirrhotic and tumorigenic process.

O presente estudo avaliou materiais de 50 pacientes com cirrose hepática pelo vírus da hepatite C (VHC) que foram submetidos ao transplante hepático no Hospital das Clínicas da Faculdade de Medicina de São Paulo no período de 1993 a 2004, sendo divididos em dois grupos: Grupo 1 (33 pacientes com cirrose pelo VHC) e Grupo 2 (17 pacientes com cirrose pelo VHC com carcinoma hepatocelular). Nosso objetivo foi estudar a ocorrência da infecção oculta pelo VHB em pacientes com cirrose pelo VHC com ou sem CHC através do estudo molecular do genoma viral (DNA do VHB) no soro, tecido hepático tumoral e não tumoral pela utilização da técnica de Reação em Cadeia da Polimerase (PCR), pelos métodos in house e em tempo real. Todos os pacientes eram HBsAg negativos, possuíam soroteca e bloco de explante hepático em parafina, não apresentando concomitância com doenças hepáticas colestáticas, metabólicas e autoimunes. Foram avaliados os prontuários por um único pesquisador no sentido de coletar informações tais como: sexo, idade, dados de exames laboratoriais bioquímicos, sorológicos, ?fetoproteína e coagulação; além de dados clínicos tais como ascite e encefalopatia hepática para cálculos de índices prognósticos da cirrose (Child e MELD). Todo o material de explante hepático teve o Escore de Ishak e a Classificação das Sociedades Brasileiras de Patologia e Hepatologia para hepatites crônicas avaliados, assim como a Classificação de Edmondson e Steiner para os que apresentassem CHC. A técnica de PCR in house para detecção do DNA do VHB no soro e em tecido hepático tumoral e não tumoral apresentou negatividade em todas as amostras. Na técnica de PCR em tempo real apenas um caso do grupo 2 foi positivo no soro (sexo masculino, 66 anos, Anti-HBC total isolado e CHC); no tecido hepático tumoral no grupo 2 tivemos dois casos com resultados indeterminados e no tecido hepático não tumoral também do grupo 2, tivemos dois casos indeterminados. O grupo 1 não apresentou positividade para nenhuma das técnicas utilizadas. Concluímos que entre nossos pacientes com ou sem carcinoma hepatocelular associados à cirrose hepática pelo VHC, a infecção oculta pelo VHB foi muito baixa, provavelmente devido à baixa prevalência da infecção pelo VHB na nossa população / This study evaluated serum and liver tissue samples from 50 patients with liver cirrhosis due to hepatitis C virus (HVC) that underwent liver transplant at the Hospital das Clínicas - University of São Paulo School of Medicine during the period of 1993 to 2004, divided into two groups: Group 1 (33 cirrhotic patients due to HCV) and Group 2 (17 cirrhotic patients due to HCV with hepatocellular carcinoma - HCC). Our aim was to study the occurrence of occult HBV0 infection in cirrhotic patients due to HCV with or without HCC through the molecular study of HBV DNA in the serum, tumoral liver tissue and non tumoral liver tissue by the polymerase chain reaction (PCR) techniques using in house and real time PCR. All the patients were HBsAg negative, having previous serum samples frozen at -20ºC and liver tissue explanted in paraffin, without presenting concomitant cholestatic, metabolic and autoimmune liver diseases. The following variables were collected: gender, age, biochemical and coagulation laboratory tests and HBV serology (HBsAg, anti-HBc total, anti-HBs). Among the clinical data, ascites and encephalopathy were collected for the Child and MELD prognostic indexes. In the explanted liver tissue the Ishak\'s Score, The Brazilian Society of Pathology and Hepatology Classification for chronic hepatitis, and Edmondson and Steiner Classification for HCC were applied in the liver tissue. All samples with or without tumoral liver tissue and serum were negative for HBV DNA using in house PCR technique. By the real time PCR technique only one case from Group 2 was HBV DNA positive in serum (male, 66, isolated anti-HBc total positive and HCC). In the tumoral and non-tumoral liver tissues there were two indeterminated HBV DNA cases among Group 2 patients. All samples for Group 1 patients were negative for HBV DNA using both techniques. In conclusion, our study has shown the extremely low occult hepatitis B virus infection among the HCV cirrhotic patients with or without HCC, maybe due to the low HBV past infection among the Southeastern Brazilian population

INTRODUÇÃO: A cirrose hepática é fator de risco para o Carcinoma hepatocelular (CHC) e no Brasil, a etiologia de doença hepática crônica mais frequente associada ao CHC é a infecção crônica pelo vírus da hepatite C (VHC). Angiogênese e deficiência de folato podem estar associados ao risco de CHC. Deste modo, os polimorfismos de genes relacionados com esses processos o VEGF e MTHFR em doentes com hepatite C crônica e CHC podem conduzir a marcadores genéticos para CHC na infecção por HCV.OBJETIVOS: Avaliar os polimorfismos G634C (rs2010963), C460T (rs833061), C936T (rs3025039) do gene do VEGF e polimorfismos C677T (rs1801133) e C1298A (1801131) da MTHFR, em pacientes brasileiros com CHC e infecção crônica pelo VHC . PACIENTES E MÉTODOS: Foram incluídos 119 pacientes com seguimento de CHC e VHC na clínica de hepatologia do HUOC / UPE e do IFP-PE, Brasil. Este estudo teve aprovação do comitê de ética e os pacientes assinaram o formulário de consentimento. Todos os pacientes tiveram diagnóstico de VHC por PCR e CHC por ressonância magnética e / ou tomografia.RESULTADOS: Dentre os indivíduos com CHC, 70,59% foram homens. A média de idade dos participantes foi de 62,3 anos. De acordo com a classificação de Child-Pugh, ficaram assim distribuídos: A 60,9%; B 36,5%; C 2,6%. O tamanho do tumor médio foi de 4,4 cm. Sendo que 52,10% foi multinodular. Foi feita uma análise de associação com os genes MTHFR e VEGF e características do tumor nos pacientes com CHC infectados cronicamente com VHC. Os alelos C da MTHFR (rs1801131) e da VEGF (rs2010963) foram associados com a proteção para o desenvolvimento da forma multinodular, e o alelo T da MTHFR (rs1801133) foi associado a fator de risco para desenvolvimento da forma multinodular p=0,04 OR 1,835 IC (1,0223,297). Foram realizadas análises multivariadas, incluindo-se no modelo o sexo masculino e a idade como potenciais fatores de confusão, o gene VEGF genótipo CC (rs2010963) foi um fator independente associado à proteção ao desenvolvimento de tumores multinodulares. Foi também realizada uma análise de sobrevivência estratificada pelos genótipos MTHFR (rs1801131), MTHFR (rs1801133) e VEGF (rs2010963), mas não foram observados resultados significativos. CONCLUSÕES: Foi observado que os genes MTHFR e VEGF tem influência na forma de apresentação uni ou multinodular do tumor / BACKGROUND: Hepatic cirrhosis is a risk factor for hepatocellular carcinoma (HCC) and in Brazil, the most frequent chronic liver disease associated with HCC is chronic hepatitis C virus (HCV) infection. Angiogenesis and folate deficiency may be associated with the risk of HCC. Thus, gene polymorphisms related to such processes VEGF and MTHFR in patients with chronic hepatitis C and HCC may lead to genetic markers for HCC in HCV infection. OBJECTIVES: To evaluate the polymorphisms G634C (rs2010963), C460T (rs833061), C936T (rs3025039) of the VEGF gene and polymorphisms C677T (rs1801133) and C1298A (1801131) of MTHFR, in Brazilian patients with HCC and chronic HCV infection. PATIENTS AND METHODS: A total of 119 patients with HCC and HCV follow-up were included in the HUOC / UPE and IFP-PE hepatology clinic in Brazil. This study was approved by the ethics committee and the patients signed the consent form. All patients had a diagnosis of HCV by PCR and HCC by magnetic resonance and / or tomography. RESULTS: Among the individuals with HCC, 70.59% were men. The mean age of participants was 62.3 years. According to the Child-Pugh classification, the following were distributed: At 60.9%; B 36.5%; C 2.6%. The mean tumor size was 4.4 cm. Being that 52.10% was multinodular. An association analysis was made with the MTHFR and VEGF genes and tumor characteristics in HCC patients chronically infected with HCV. The C alleles of MTHFR (rs1801131) and VEGF (rs2010963) were associated with developmental protection of the multinodular form, and the MTHFR T allele (rs1801133) was associated with a risk factor for development of the multinodular form p = 0, 04 OR 1,835 IC (1,0223,297). Multivariate analyzes, including male gender and age as potential confounders, were performed in the VEGF gene genotype CC (rs2010963), which was an independent factor associated with the protection of the development of multinodular tumors. A survival analysis stratified by the MTHFR (rs1801131), MTHFR (rs1801133) and VEGF (rs2010963) genotypes was also performed, but no significant results were observed. CONCLUSIONS: It was observed that the MTHFR and VEGF genes have influence on the uni or multinodular presentation of the tumor

Mondialement, le carcinome hépatocellulaire (CHC) et le cancer du poumon (CP) constituent un problème majeur de santé publique. Plusieurs études d'association gène candidat ont montré que les SNPs de gènes candidats à la réparation d'ADN et au métabolisme des monocarbones (MMC) influencent le risque de CHC et CP. Toutefois, aucune étude n'a évalué, de façon exhaustive, l'influence des SNPs de la réparation d'ADN ou du MMC avec le risque de CP ou de CHC. Notre étude vise à identifier - à l'aide de deux SNP array de 384 SNPs - les polymorphismes génétiques de la réparation d'ADN et du MMC qui sont prédictifs du risque de CHC chez des Caucasiens cirrhotiques. Nous avons aussi recherché les déterminants génétiques de la réparation d'ADN associés au risque de CP. Nos résultats ont montré que six SNPs du gène BRIP1 (BRCA1interacting protein C?terminal helicase ; rs4986763, rs4986764, rs1557720, rs4986765, rs2191248, et rs11871785) étaient significativement associés au risque de CHC chez les patients porteurs d'une cirrhose d'étiologie virale selon le modèle génétique additif. Après correction de "False Discovery Rate", BRIP1 rs4986764 et rs1557720 étaient significativement associés au risque de CHC. Deux SNPs du MMC situés sur GGH (rs11545076 et rs11545077) étaient significativement associés au risque de CHC chez les patients porteurs d'une cirrhose d'étiologie non virale. Par ailleurs, seul le polymorphisme POLL rs3730477 était associé à un risque accru de CP dans le modèle génétique récessif. La dernière partie de notre étude était consacrée à l'analyse comparée d'hémogrammes et des dommages d'ADN chez des conducteurs de taxi-moto (CTM) de Cotonou - exposés à l?air pollué par le benzène et les HAPs -, et les témoins non exposés. Nos résultats ont montré une réduction significative du nombre des globules blancs, lymphocytes, neutrophiles et plaquettes, avec une misincorporation accrue d'uracile, de 8 oxodG et la présence d'un adduit majeur d'ADN chez les CTM par rapport aux témoins. En conclusion, nous avons identifié six variants sur BRIP1 et deux variants sur GGH associés au risque de CHC sur une cirrhose d'étiologie virale et non virale, respectivement. De plus, nous avons montré que POLL rs3730477 est un prédicteur significatif du risque de cancer du poumon. Une validation de ces résultats dans des cohortes indépendantes s'avère indispensable / Worldwide, hepatocellular carcinoma (HCC) and lung cancer (LC) represent a major public health problem. Previous studies reported associations between single nucleotide polymorphisms (SNPs) in DNA repair or monocarbon metabolism (MCM) genes and LC or HCC risk. However, influences of these SNPs on LC or HCC risk have not been comprehensively evaluated. Our study aimed to identify potential interesting DNA repair and MCM gene variants associated with HCC risk in cirrhotic Caucasians. To this end, we used the Illumina's GoldenGate® technology and performed a comprehensive investigation of 384 SNPs on 94 DNA repair genes and 384 SNPs on 77 MCM genes. This comprehensive SNP-array fine mapping approach was also used to identify potential interesting DNA repair gene variants associated with susceptibility to LC in Caucasians. Our results showed that six variants on BRIP1 gene (BRCA1 interacting protein C-terminal helicase: rs4986763, rs4986764, rs1557720, rs4986765, rs2191248, and rs11871785) were significantly associated with HCC risk in patients carrying hepatitis virus-associated cirrhosis under an additive genetic model. After false discovery rate (FDR) correction for multiple testing, BRIP1 rs4986764 and rs1557720 displayed statistically significant associations with HCC risk. Two SNPs on GGH gene were associated with HCC risk in patients carrying non viral cirrhosis. In our study, only POLL rs3730477 was associated with an increased LC risk under a recessive genetic model (OR=2.81, 95% CI 1.51?5.24). Lastly, we evaluated hematologic changes and levels of DNA adducts, 8-oxodG, dU, and m5dC in Cotonou's motorbike taxi drivers (MBTD) - exposed to air pollution by benzene and polycyclic aromatic hydrocarbons (PAHs) - compared to unexposed controls. Compared to controls, MBTD displayed a significant decrease in the number of white blood cells, lymphocytes, neutrophils and platelets, with the formation of an unknow DNA adduct, whereas uracil misincorporation and 8-oxodG levels in DNA were significantly increased. In conclusion, we identified six variants on BRIP1 gene and two variants on GGH gene that are associated with susceptibility to HCC. In addition, POLL rs3730477 variant was associated with susceptibility to LC. Replication of these findings in independent cohorts is warranted

O carcinoma hepatocelular (CHC) é a quinta neoplasia maligna mais frequente no mundo, sendo que, em mais de 80% dos casos, seu aparecimento está relacionado à presença de cirrose hepática (CH). A infecção crônica pelo vírus da hepatite C (VHC) é uma das principais causas de cirrose hepática no mundo e, consequentemente, de CHC. Este estudo caso-controle foi baseado na análise de variáveis clínicas, bioquímicas e sorológicas de 31 pacientes cirróticos pelo VHC com CHC de pequeno tamanho (<= 3 cm, tamanho médio = 22 mm) comparando-os com grupo controle de 62 pacientes cirróticos pelo VHC sem CHC, pareados por idade e sexo. Os principais objetivos foram identificar marcadores auxiliares ao diagnóstico de CHC e desenvolver um modelo linear para o diagnóstico presuntivo de CHC de pequeno tamanho. Os dados levantados foram submetidos à análise univariada. Demonstramos diferenças significantes entre os dois grupos com relação à presença de marcadores de infecção pregressa pelo vírus da hepatite B; às dosagens séricas de aspartato aminotransferase, de alanina aminotransferase, de gamaglutamil transpeptidase; à contagem de plaquetas, fibrinogênio plasmático, alfafetoproteína e resposta virológica sustentada ao tratamento com interferon. As variáveis significantes foram submetidas à análise multivariada com procedimento de regressão logística \"stepwise\" para ajustar o modelo linear. Esta análise multivariada selecionou duas variáveis preditoras para o diagnóstico de CHC, a aspartato aminotransferase e a alfa-fetoproteína, com uma probabilidade de 0,26; sensibilidade de 74,2% e especificidade de 66,1%. Entretanto este modelo linear, devido a sua baixa probabilidade, não pode ser empregado para o diagnóstico de CHC, porém potencializa a identificação de um grupo de pacientes com maior risco para o seu desenvolvimento, merecendo assim um programa de rastreamento mais cuidadoso / Hepatocellular carcinoma (HCC) is the fifth most common cause of cancer worldwilde. In 80% of cases HCC develop in cirrhotic livers. Hepatitis C virus infection is considered one of the main causes of liver cirrhosis and HCC. We conducted a case-control study involved 31 small HCC cases (<= 3 cm, mean size = 22 mm) and 62 age and gender matched control HCV liver cirrhosis subjects. All included patients (case and controls) were HCV positive (confirmed by RT-PCR). The present study was based on the comparison of clinical, biochemical and serological data in these patients. Our aims were to identify auxiliar parameters for the diagnosis of HCC and develop a linear model that predict the diagnosis of HCC. Data were submitted to an univariate analysis. Significant differences between the groups were observed in relation to markers of hepatitis B past infection, aspartate aminotransferase, alanine aminotransferase, gammaglutamyltransferase, platelet count, fibrinogen, alpha-fetoprotein and sustained response after Interferon therapy. The significant variables were submitted to a multivariate analysis with stepwise logistic regression procedure to adjust a linear model to estimate the probability of diagnosis of HCC. Two significant variables to HCC prediction were found, the aspartate aminotransferase and alpha-fetoprotein adjusted a linear model that allows HCC diagnosis with 0,26 probability, 74,2% sensibility and 66% specificity. However, because this model has low probability, it cannot make the HCC diagnosis but allows identify the potential group of patients with major risk to rise HCC, so that deserves more accurate surveillance strategy

INTRODUÇÃO: Na maioria dos casos, o carcinoma hepatocelular (CHC) acomete pacientes com cirrose hepática. O algoritmo do Barcelona Clinic Liver Cancer group (BCLC) considera função hepática, características tumorais e, estado geral do paciente para definir o tratamento. Entretanto, a aplicabilidade de um algoritmo terapêutico nem sempre é possível na prática clínica. Este estudo buscou avaliar a aderência às recomendações do BCLC para tratamento dos pacientes com CHC e analisar o impacto sobre a sobrevida nos diferentes estádios. MÉTODOS: Este estudo incluiu todos os pacientes encaminhados para o Instituto do Câncer do Estado de São Paulo para tratamento do CHC entre 2010 e 2012. Os pacientes (n = 364) foram classificados de acordo com as recomendações do BCLC. Se a terapia proposta não foi aplicada, o caso foi considerado como não aderente e as causas foram investigadas. A curva de sobrevida global foi estimada pelo método de sobrevida de Kaplan-Meier e comparada pela regressão de Cox. RESULTADOS: A porcentagem de aderência às recomendações do BCLC foi de 52% e variou entre os estádios: BCLC 0/A, 44%; BCLC B, 78%; BCLC C, 35%; e BCLC D, 67%. A taxa de sobrevida global, em um, dois e três anos, foi de 63, 45 e 33%, respectivamente. Nos pacientes aderentes do estádio BCLC 0/A, a sobrevida global foi significantemente melhor se comparada aos pacientes não aderentes (razão de risco [RR] = 0,19, intervalo de confiança [IC] 95%: 0,09-0,42; p < 0,001). Nos pacientes do estádio BCLC D, a taxa de sobrevida global foi pior em pacientes aderentes comparada aos pacientes não aderentes (RR = 4,0; IC 95%: 1,67-9,88; p < 0,001). Nenhuma diferença foi observada em pacientes do estádio BCLC B ou C classificados como aderentes ou não aderentes. CONCLUSÕES: A porcentagem de aderência às recomendações do BCLC na prática clínica é baixa e varia entre os estádios. A não aderência está associada a pior prognóstico, particularmente em pacientes com estádio precoce / INTRODUCTION: In most cases, hepatocellular carcinoma (HCC) affects patients with liver cirrhosis. Barcelona Clinic Liver Cancer group (BCLC) algorithm takes into consideration liver function, tumor variables and patients general status to guide therapy. However, the application of a therapeutic algorithm is not always feasible in clinical practice. The aim of this study was to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the BCLC treatment guidelines, as well as examine the impact on survival in different stages. METHODS: This study included all patients referred to Instituto do Câncer do Estado de São Paulo for HCC therapy between 2010 and 2012. Patients (n = 364) were classified according to BCLC stage. If the proposed HCC therapy could not be applied, the case was considered to represent deviations from the recommended BCLC guideline. Causes of treatment deviations were investigated. The overall survival (OS) curves were estimated by the Kaplan-Meier survival method and compared by Cox regression. RESULTS: The overall percentage of adherence to BCLC guidelines was 52 % and varied among the disease stages: BCLC 0/A, 44 %; BCLC B, 78 %; BCLC C, 35 %; and BCLC D, 67 %. One-, two-, and three-year OS rates were 63, 45, and 33 %, respectively. In BCLC 0/A, adherent patients presented a significantly better OS compared to non-adherent patients (hazard ratio [HR] = 0.19, 95% confidence interval [CI]: 0.09-0.42; p < 0.001). In BCLC D, the OS rate was worse in adherent patients compared to non-adherent patients (HR = 4.0, 95% CI: 1.67-9.88; p < 0.001), whereas no differences were observed in BCLC stage B or C. CONCLUSIONS: The percentage of adherence to BCLC recommendations in clinical practice is low and varies among the clinical stages. Non-adherence is associated with a worse prognosis, particularly in early stage disease

INTRODUÇÃO O câncer é uma das principais causas de morte no mundo, sendo responsável por cerca de 8 milhões de mortes por ano, segundo dados da OMS. As mortes por câncer são provocadas por tumores que se originam em órgãos como pulmão, fígado, estômago, intestino, mama e esôfago. As células-tronco mesenquimais (CTM) foram identificadas em vários órgãos e estudos da sua interação com células tumorais têm apresentado resultados indicando ação inibitória sobre alguns tipos de tumores. Para explorar essa questão foram analisados os efeitos sobre células tumorais de carcinoma hepatocelular humano (HepG-2) do meio condicionado (MC) obtido do cultivo de CTM isoladas de tecido adiposo (TA), líquido amniótico (LA) e geleia de Wharton (GW). MÉTODOS Os MCs foram coletados após 24 horas de incubação das CTM sub-confluentes com ?-MEM contendo 20% de soro fetal bovino (SFB). Os MCs foram centrifugados e passados através de filtros de 0,22 ?M e armazenadas a -20 °C. O MC da própria célula HepG-2 foi utilizado como controle. Os efeitos dos MCs sobre a proliferação de células HepG-2 foram testados por ensaio MTT, em várias concentrações após 24 h de incubação. O ciclo celular de células HepG-2 tratadas com MC a 25%, 50% ou 75% foi analisado por citometria de fluxo (coloração IP) utilizando o software Modfit LT. A expressão dos genes bcl-2, bcl-6, CCND1 foi analisada por RT-PCR. A proliferação celular foi avaliada pela expressão das proteínas survivina, Bcl-2, PCNA e Ki-67 e pela quantificação de mitocôndrias com corante MitoTracker, assim como pelo potencial de membrana mitocondrial por corante JC-1 Mitoscreen utilizando equipamento de high content analysis. RESULTADOS Os meios condicionados de células-tronco de tecido adiposo (MC-TA) não alteraram a proliferação de células tumorais HepG-2 e os meios condicionados de células-tronco de líquido amniótico (MC-LA) e de geleia de Wharton (MC-GW) provocam aumento da proliferação, confirmada pela contagem de células com núcleos corados com Hoescht 33342. A análise de alterações do ciclo celular demonstrou que a exposição de células HepG-2 aos meios MC-LA diminuem as células na fase G0/G1 e aumentam na fase G2/M do ciclo celular. A expressão dos genes CCND1, Bcl2 e Bcl6 que estão relacionados à proliferação e morte celular não apresentaram alteração. A quantificação das proteínas PCNA e survivina não apresentou alteração sob efeito dos MC, porém a comparação direta entre células tratadas com MC-LA e MC-TA indicou a tendência das células tratadas com MC-LA proliferarem. O percentual de células HepG-2 expressando a proteína Ki-67 foi significativamente menor em relação ao controle quando tratadas com MC-TA, não apresentando diferenças quando tratadas com MC-LA e MC-GW. A contagem de mitocôndrias evidenciou aumento de mitocôndrias nas células HepG-2 tratadas com MC-LA e efeito não significativo dos tratamentos com MC-TA e MC-GW. A diferença do potencial de membrana mitocondrial por JC-1 apresentou aumento da polarização nas células HepG-2 cultivadas com MC-TA. CONCLUSÃO Os resultados confirmam que as células-tronco mesenquimais diferem de acordo com a sua origem tecidual em sua ação na proliferação das células HepG-2. Mais estudos são necessários para estabelecer a causa destas ações, que não parecem ser devido a mediadores mais comuns na proliferação e morte celular / INTRODUCTION Cancer is a leading cause of death worldwide, accounting for about 8 million deaths per year, according to WHO data. Cancer deaths are caused by tumors that originate in organs such as lung, liver, stomach, bowel, breast and esophagus. The mesenchymal stem cells (MSCs) have been identified in many organs and studies of their interaction with tumor cells have shown results indicating an inhibitory effect on some types of tumors. To explore this question the effects of the conditioned medium (CM) obtained from mesenchymal stem cell isolated from adipose tissue (AT), amniotic fluid (AF) and Wharton jelly (WJ) on tumor cells of human hepatocellular carcinoma (HepG-2) were analyzed. METHODS The MSC CM was collected after 24 hours incubation of sub confluent MSC with ?-MEM containing 20% fetal bovine serum (FBS). The MSC CM were centrifuged and passed through 0.22 ?M filter and stored at -20° C. The CM of HepG-2 cell itself was used as control. The effects of contrast media on proliferation of HepG-2 cells were tested by MTT assay at various concentrations after 24 h of incubation. The cell cycle HepG-2 cells treated with CM at 25%, 50% or 75% was analyzed by flow cytometry (PI staining) using Modfit software LT. The expression of the genes Bcl-2, Bcl-6, CCND1 was analyzed by RT-PCR. Cell proliferation was assessed by the expression of survivin, Bcl-2, Ki-67 and PCNA proteins, and the quantization of mitochondrial by MitoTracker dye, as well as the mitochondrial membrane potential by JC-1 Mitoscreen dye using high content analysis equipment. RESULTS The conditioned media of mesenchymal stem cells (MSC) from adipose tissue (AT-CM) did not alter the proliferation of tumor HepG-2 cells and conditioned media of MSC cells from amniotic fluid (AF-CM) and Wharton jelly (WJ-CM) caused increased proliferation, confirmed by counting cells with nuclei stained with Hoechst 33342. The cell cycle analysis showed that exposure of HepG-2 cells to AF-CM means decrease the cells in G0 / G1 cell cycle phase and increase in phase G2 / M. The expression of Bcl2, Bcl6 and CCND1 genes that are related to proliferation and cell death did not change. The quantization of PCNA and survivin protein did not change under the effect of conditioned media, but a direct comparison between cells treated with AF-CM and AT-CM indicated the tendency of cells treated with AF-CM proliferate. The percentage of HepG-2 cells expressing the protein Ki-67 was significantly lower than the control when treated with AT-CM and no differences when treated with AF-CM and WJ-CM. The counting of mitochondria showed increased mitochondria in HepG-2 cells treated with AF-CM and no significant effect of treatment with WJ-CM and AT-CM. The difference in mitochondrial membrane potential by JC-1 showed an increase in polarization in HepG-2 cells cultured with AT-CM. CONCLUSION The results confirm that mesenchymal stem cells differ according to their tissue origin in its action on the proliferation of HepG-2 cells. More studies are needed to establish the cause of these actions, which seem to be not related to the most common mediators in cell proliferation and death

Chan Chun-pong. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 171-176). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / 摘要 --- p.iii / Abbreviation --- p.iv / Table of contents --- p.v / List of figures --- p.xi / List of tables --- p.xvi / Chapter Chapter 1 --- introduction / Chapter 1.1 --- Traditional Chinese medicines (TCMs) --- p.2 / Chapter 1.2 --- Liver disorders in Asia Pacific region --- p.3 / Chapter 1.3 --- Classification of liver disorders --- p.7 / Chapter 1.3.1 --- Hepatitis --- p.8 / Chapter 1.3.1.1 --- Hepatitis A virus infection --- p.8 / Chapter 1.3.1.2 --- Hepatitis B virus infection --- p.9 / Chapter 1.3.1.3 --- Hepatitis C virus infection --- p.11 / Chapter 1.3.1.4 --- Hepatitis D virus infection --- p.12 / Chapter 1.3.1.5 --- Hepatitis E virus infection --- p.12 / Chapter 1.3.2 --- Cancer of the liver --- p.13 / Chapter 1.3.2.1 --- Hepatocellular carcinoma --- p.13 / Chapter 1.3.2.2 --- Cholangiocarcinoma --- p.14 / Chapter 1.3.2.3 --- Metastatic liver cancer --- p.14 / Chapter 1.4 --- Conventional treatment of liver disorders --- p.14 / Chapter 1.5 --- Role of traditional Chinese medicines in hepatoprotective functions --- p.16 / Chapter 1.5.1 --- Abri Herba (Abrus Cantoniensis Hance) --- p.17 / Chapter 1.5.2 --- Rhizoma Coptidis (Coptidis chinensis Franch) --- p.18 / Chapter 1.5.3 --- Fructus Forsythia (Forsythia suspense (Thunb) Vahl) --- p.22 / Chapter 1.6 --- Molecular studies of hepatoprotective effects of TCMs --- p.26 / Chapter 1.6.1 --- Roles of detoxofication enzymes in hepatoprotection --- p.27 / Chapter 1.6.2 --- Studies of growth-related genes in cell cycle control --- p.29 / Chapter 1.7 --- Aims of project --- p.32 / Chapter 1.8 --- Application of the project --- p.33 / Chapter Chapter 2 --- Methods and materials --- p.34 / Chapter 2.1 --- Screening of traditional Chinese medicines --- p.35 / Chapter 2.2 --- Preparation of TCMs --- p.35 / Chapter 2.2.1 --- Preparation of aqueous extracts of TCMs --- p.35 / Chapter 2.2.2 --- Preparation of active components of TCMs --- p.36 / Chapter 2.3 --- In vitro assays --- p.40 / Chapter 2.3.1 --- Cell culture --- p.40 / Chapter 2.3.2 --- Cytotoxicity test --- p.40 / Chapter 2.4 --- Screening of expressed gene induced by TCMs --- p.41 / Chapter 2.4.1 --- RNA preparation --- p.41 / Chapter 2.4.2 --- cDNA array hybridization --- p.42 / Chapter 2.4.3 --- Reverse Transcription --- p.43 / Chapter 2.5 --- Confirmation of expressed genes induced by TCMs --- p.44 / Chapter 2.5.1 --- Semi-quantitative PCR analysis --- p.44 / Chapter 2.5.2 --- Northern blot analysis --- p.46 / Chapter 2.6 --- Studies of effects of TCMs in gene expression --- p.47 / Chapter 2.6.1 --- Dosage-course study --- p.47 / Chapter 2.6.2 --- Time-course study --- p.48 / Chapter Chapter 3 --- Results --- p.50 / Chapter 3.1 --- "Cytotoxicity test of A.H., R.C. and F.F" --- p.51 / Chapter 3.2 --- "Molecular screening of expressed gene induced by A.H., R.C., F.F" --- p.58 / Chapter 3.3 --- Confirmation of expressed gene using semi-quantitative RT- PCR --- p.70 / Chapter 3.3.1 --- Dosage-course and time-course studies of A.H. using RT- PCR --- p.70 / Chapter 3.3.2 --- Dosage-course and time-course studies of R.C. using RT- PCR --- p.94 / Chapter 3.3.3 --- Dosage-course and time-course studies of A.H. using RT- PCR --- p.113 / Chapter 3.4 --- Confirmation of expressed gene using northern blot anaylsis --- p.118 / Chapter 3.4.1 --- Dosage-course and time-course studies of effects of A.H. and L- abrine in Northern blot analysis --- p.118 / Chapter 3.4.2 --- Dosage-course and time-course studies of effects of R.C. and berberine in Northern blot analysis --- p.129 / Chapter 3.4.3 --- Dosage-course and time-course studies of effects of F.Fin Northern blot analysis --- p.147 / Chapter Chapter 4 --- Discussion --- p.152 / Chapter 4.1 --- "Roles of A.H., R.C. and F.F. in treatment and prevention of liver disorders" --- p.153 / Chapter 4.2 --- "Cytotoxicity effect A.H., R.C., and F.F. in liver cells" --- p.153 / Chapter 4.3 --- Effects of herbal medicines on the transcription of mRNA in liver cells --- p.155 / Chapter 4.3.1 --- Effects of treatment of A.H. in liver at transcriptional level … --- p.155 / Chapter 4.3.2 --- Effects of treatment of R.C. in liver at transcriptional level … --- p.156 / Chapter 4.3.3 --- Effects of treatment of R.C. in liver at transcriptional level --- p.157 / Chapter 4.4 --- Comparison of results of RT-PCR and Northern blot analysis --- p.157 / Chapter 4.4.1 --- Comparison of the effects of time and dosage-course studies of DTD expression induced by A.H. and L-abrine --- p.157 / Chapter 4.4.2 --- Comparison of the effects of time and dosage-course studies of p21;cip;waf1 expression induced by A.H. and L-abrine --- p.158 / Chapter 4.4.3 --- Comparison of the effects of time and dosage-course studies of c-myc responsive protein; rcl expression induced by R.C. and berberine --- p.159 / Chapter 4.4.4 --- Comparison of the effects of time and dosage-course studies of GST Ya expression induced by R.C. and berberine --- p.160 / Chapter 4.4.5 --- Comparison of the effects of time and dosage-course studies of GST 7-7 expression induced by F.F --- p.160 / Chapter 4.5 --- Biochemical significance of genes induced by hepatoprotective TCMs --- p.161 / Chapter 4.5.1 --- Roles of significant expression of detoxifying enzymes induced by TCMs in liver cells --- p.161 / Chapter 4.5.2 --- Roles of induction of growth-related c-myc responsive protein; rcl in R.C. treated liver cells --- p.167 / Chapter 4.5.3 --- Roles of increased p21;cip;waf1 expression in A.H. treated liver cells --- p.168 / Chapter 4.6 --- Conclusion --- p.169

Hu, Baoguang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 121-143). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.