A sepse é descrita como uma disfunção orgânica ameaçadora à vida secundária à resposta desregulada do organismo a uma infecção, e é responsável por uma alta e crescente taxa de internação hospitalar no Brasil e no mundo. Apesar da diminuição da mortalidade ao longo do tempo, efeitos da doença a longo prazo como infecções secundárias e mortes tardias têm sido observadas. A sepse caracteriza-se pela liberação de mediadores inflamatórios e posterior imunossupressão compensatória, e o distúrbio na homeostase pode causar danos às células e órgãos levando a um estado mais grave da doença. Os linfócitos T reguladores (Tregs) são células responsáveis pela tolerância periférica e modulação de processos inflamatórios e são essenciais na imunossupressão observada na sepse. Este trabalho teve por objetivo estudar a relação entre a atividade imunológica (quantificação de Tregs, monócitos e citocinas inflamatórias) e a susceptibilidade a novas infecções e mortalidade em pacientes sépticos admitidos na Unidade de Emergência do HC-FMRP-USP. Foram incluídos 33 pacientes sépticos e 34 controles saudáveis, entre outubro de 2014 e novembro de 2015. Os pacientes foram acompanhados durante a internação na admissão (D0), D2, D7, D14, D21 e D28, e 12 pacientes retornaram para avaliação pelo menos três meses após a alta. Os pacientes tiveram porcentagens de Treg em linfócitos CD4+ elevados em relação aos controles nos momentos D2 e retorno (p = 0,0004), sendo que no D2 pacientes que desenvolveram complicação infecciosa tiveram porcentagens significativamente menores que os que não desenvolveram complicação (p = 0,0015). Além disso, porcentagens altas de Treg na admissão (D0) correlacionaram-se inversamente com o tempo de internação dos pacientes sobreviventes (p = 0,0271). Valores absolutos de Treg nos pacientes estiveram significativamente elevados no retorno em relação à admissão (p = 0,0074). Pacientes no retorno tiveram maior porcentagem de monócitos CD163+ em relação aos controles (p = 0,036). Pacientes na admissão tiveram menor porcentagem demonócitos HLA-DR+ em relação aos controles e aos pacientes no retorno (p = 0,0057). Pacientes tiveram valores de IL-6, IL-8, IL-10 e ST2 superiores em relação aos controles em diversos momentos da internação e retorno (p < 0,0001, p < 0,0001, p = 0,0030 e p < 0,0001, respectivamente). Valores de ST2 na admissão correlacionaram-se com o escore SOFA (p = 0,0252), tempo de internação (p = 0,0105), presença de complicação infecciosa (p = 0,0356) e mortalidade (p = 0,0114) dos pacientes. Valores de IL-8 na admissão também se correlacionaram com a presença de complicação infecciosa (p = 0,0387). Podemos inferir, portanto, que apesar de uma inflamação exacerbada já na admissão dos pacientes, evidenciada por altos valores de citocinas inflamatórias, há um aumento posterior de células Treg, imunorreguladoras, no D2, e o mesmo foi benéfico em relação à recuperação mais rápida dos pacientes e instalação de uma nova infecção. Porém, a imunossupressão continua sendo exibida mesmo após a alta dos pacientes, como podemos observar com a alta porcentagem de Tregs e monócitos CD163+ e valores de IL-10 nos pacientes em retorno em relação aos controles. Além disso, muitos dos pacientes sobreviventes à primeira internação foram internados novamente, e alguns deles foram a óbito no ano seguinte. / Sepsis is defined by a life-threatening organ dysfunction caused by a dysregulated host response to infection, and it is responsible for a high and increasing rate of hospital admission in Brazil and worldwide. Despite the decrease in mortality over time, long-term disease effects such as secondary infections and late deaths have been observed. Sepsis is characterized by the release of inflammatory mediators and subsequent compensatory immunosuppression, and the homeostasis disorder can cause damage to cells and organs leading to a more severe disease state. Regulatory T lymphocytes (Tregs) are cells responsible for peripheral toleran ce and modulation of inflammatory processes and are essential in the immunosuppression observed in sepsis. This study aimed to investigate the relationship between immunological activity (quantification of Tregs, monocytes and inflammatory cytokines) and susceptibility to new infections and mortality in septic patients admitted to the HC-FMRP-USP Emergency Unit. Thirty-three septic patients and 34 healthy controls were included between October 2014 and November 2015. Patients were followed up at admission (D0) and during hospitalization at D2, D7, D14, D21 and D28, and 12 patients returned for evaluation at least three months after discharge. Patients had higher Treg percentages on CD4 + lymphocytes than had controls at D2 and on return (p = 0.0004), whereas in D2 patients who developed infectious complications had significantly lower percentages than those who did not develop complications (p = 0.0015). In addition, high percentages of Treg at admission (D0) correlated inversely with the length of hospital stay of surviving patients (p = 0.0271). Absolute values of Treg in patients were significantly elevated in the return relative to admission (p = 0.0074). Patients on return had a higher percentage of CD163 + monocytes than controls (p = 0.036). Patients on admission had a lower percentage of HLA-DR+ monocytes than controls and patients on return (p = 0.0057). Patients had higher IL-6, IL-8, IL-10 and ST2 levels than controls at various times ofhospitalization and return (p < 0.0001, p < 0.0001, p = 0.0030 and p < 0.0001, respectively). ST2 values at admission were correlated with SOFA score (p = 0.0252), length of hospital stay (p = 0.0105), presence of infectious complication (p = 0.0356) and mortality (p = 0.0114). IL-8 values at admission also correlated with the presence of infectious complication (p = 0.0387). We can infer, therefore, that despite exacerbated inflammation as soon as at the admission of the patients, demonstrated by high levels of inflammatory cytokines, there is a posterior increase of immunoregulatory Treg cells at D2, and that was beneficial in relation to the faster recovery of the patients and setting up of new infection. However, immunosuppression continues to appear even after discharge of patients, as can be observed with the high percentage of CD163 + monocytes, Tregs and L-10 levels in patients on return compared to controls. In addition, many of the patients surviving the first hospitalization were hospitalized again, and some of them died the following year.

Orientador: Márcia Guimarães da Silva / Banca: Rodrigo Paupéro de Camargo Soares / Banca: Vera Lúcia Mores Rall / Não disponível / Abstract: Microbial invasion of the amniotic cavity has been described in term deliveries and its role on the immune modulation is of interest to the better understanding of the underlying labor processes. The aim of this study was to determine the prevalence of Mycoplasma hominis and Ureaplasma urealyticum in the amniotic fluid of term pregnancies and to evaluate its influence on cytokines production at the end of pregnancy. A cross sectional study was conducted with fifty five pregnant women out of labor with intact membranes and gestational age between 37 and 41 weeks seen at the Bom Jesus hospital in Ariquemes, Rondônia, between June 2009 and May 2010. Amniotic fluid samples and fragments of chorioamniotic membranes were collected at cesarean section. M. hominis and U. urealyticum detection was performed by PCR and Interleukin (IL)-1β, IL-6, IL-8, IL-10 and Tumor Necrosis Factor (TNF)- levels were determined by ELISA. Chorioamniotic membranes were submitted to histopatological analyses. Presence of M. hominis was detected in 36.4% of amniotic fluid samples and any of them was positive for U. urealyticum. Regarding cytokines levels, 63.6% and 90.9% of samples have not shown detectable concentrations of TNF- and IL-1β. The median concentration of IL-6 and IL-8 were 107.9 pg/mL (0-517.1) and 208.1 pg/mL (0-1897.4), respectively. Interleukin-1, IL-6, IL-8 and TNF- concentrations were not associated with the presence of M. hominis in amniotic fluid, regardless the gestational age. No sample had detectable IL-10 levels. The histopatological analyses have shown no chorioamnionitis in any of the membranes, only a discreet mononuclear infiltration in the decidua could be observed in 40.4% of the samples. Presence of M. hominis was detected in 36.4% of amniotic fluid samples and any of them was positive for U. urealyticum. Regarding cytokines levels, 63.6% and 90.9% of samples have not... (Complete abstact click electronic access below) / Mestre

Antigen-specific CD8 T cells play a critical role in protecting the host from infection by intracellular pathogens including viruses, bacteria and parasites. During the course of an infection, antigen-specific CD8 T cells undergo proliferative expansion to increase in number, which is followed by contraction and generation of a stable pool of long-lived memory cells. Importantly, memory CD8 T cells provide enhanced resistance to re-infection by the same pathogen. Moreover, the number of memory CD8 T cells correlates strongly with the level of protection against re-infection. Therefore, vaccines designed to promote cellular immunity should logically focus on achieving sufficiently high number of these memory cells for protection. Most current vaccines have relied on inducing antibodies to protect the host by neutralizing pathogens or blocking pathogen entry into the cells. However, there is a recognized need to design vaccines that also stimulate a strong CD8 T cell component of the adaptive immune response in addition to antibodies. Importantly, inflammatory cytokines induced by infection or vaccination with adjuvant act directly or indirectly on CD8 T cells to modulate their expansion, contraction and acquisition of memory characteristics. Thus, an understanding of how inflammatory cytokines regulate CD8 T cell memory differentiation may help guide the strategies for rational vaccine design. My studies examine the roles of inflammatory cytokines in regulating CD8 T cell memory differentiation. Specifically, my studies investigate the timing of inflammatory cytokine exposure and the role of type I IFNs and IL-12 in regulating effector/memory CD8 T cell differentiation, and exploiting the cross-presentation pathway to rapidly generate protective CD8 T cell immunity. Specifically, my results indicate that (i) encounter with inflammatory cytokines during the rapid proliferative phase deflects CD8 T cell differentiation away from memory towards a sustained effector program, (ii) that direct signaling by either type I IFN or IL-12 to the responding CD8 T cells promotes maximal expansion, but neither of these cytokines is essential to regulate the effector/memory differentiation program, and (iii) cross-priming with both cell-associated antigen and antigen-coated, biodegradable microspheres, accelerates CD8 T cell memory development that can be exploited to rapidly generate protective CD8 T cell immunity.

Mucositis refers to the widespread damage of mucosal surfaces throughout the length of the alimentary tract (AT) that can occur during cancer treatment. Its development is an important clinical problem that complicates and limits treatment options as well as adversely affecting the quality of life and treatment outcomes for patients. Recent studies directed at determining the pathobiology of mucositis have indicated increasing evidence for the role of transcription factors, such as nuclear factor-κB (NF-κB), and certain pro-inflammatory cytokines, for example tumour necrosis factor (TNF), interleukin-1β (IL-1β) and interleukin- 6 (IL-6), in its development. This thesis developed from an initial clinical investigation in which the expression of NF-κB and COX-2 in oral mucosa was investigated in patients undergoing chemotherapy. Increased levels of NF-κB were demonstrated in the buccal mucosa following chemotherapy. It is well established that mucositis occurs in different sites of the AT. The aims of this research, therefore, were to compare and contrast the changes that do occur at different sites of the AT following chemotherapy in an established animal model (Dark Agouti (DA) rat). Furthermore, the studies were conducted to determine whether changes in tissue and serum levels of NF-κB and pro-inflammatory cytokines occurred following chemotherapy and, with respect to tissue levels, identify whether there were differences in expression at different sites throughout the AT. The final aim was to examine whether the histological changes and changes in pro-inflammatory cytokines were affected by the type of chemotherapy drug used. The effects of three chemotherapy drugs with different mechanisms of action (irinotecan, methotrexate and 5-fluorouracil) were investigated, all of which can cause mucositis in the clinical setting. The thesis is divided into a Literature Review (Chapter 1) followed by 4 research papers: Chapter 2 – “Nuclear factor- κB (NF- κB) and cyclooxygenase-2 (COX-2) expression in the oral mucosa following cancer chemotherapy” Chapter 3 -“Characterisation of mucosal changes in the alimentary tract following administration of irinotecan: Implications for the pathobiology of mucositis” Chapter 4 – “Is the pathobiology of chemotherapy-induced alimentary tract mucositis influenced by the type of mucotoxic drug administered?”, Chapter 5 – “Serum levels of NF-κB and pro-inflammatory cytokines following administration of mucotoxic drugs”. Chapter 6 provides an overall summary and discussion of the results. Previous research has indicated that following administration of chemotherapeutic agents there may be subclinical changes occurring in the mucosa prior to obvious clinical manifestations. The results presented in this thesis also demonstrate this in both humans and animals following administration of chemotherapy. Immunohistochemical analysis of tissue taken from the oral cavity, jejunum and colon from the DA rats following chemotherapy demonstrated that changes in NF-κB and the pro-inflammatory cytokines, TNF, IL-1β and IL- 6, occurred at all sites over a 72 hour time period. This was evident before severe histological evidence of mucositis were observed such as epithelial atrophy in the oral mucosa, atrophy, blunting and fusion of the villi in the jejunum and crypt ablation in the jejunum and colon. Furthermore, each of the three drugs caused different patterns of NF-κB and pro-inflammatory cytokine expression in the tissues; in spite of this, however, histological features of damage were similar. With respect to serum levels of NF-κB and pro-inflammatory cytokines, differences were observed between the serum and tissue levels. Generally, serum changes followed initial histological changes in the tissues, or occurred simultaneously with histological changes. The mechanisms behind this are unclear; however it may be that elevated cytokines in the tissues “overflow” into the serum as tissue damage increases. Furthermore, the use of serum cytokine level measurement to predict mucosal damage is limited because of the differences in timing and short time intervals between changes in the serum and tissues. This thesis has provided additional important information on mucositis pathobiology and highlights its complexity. In particular, it has provided new evidence supporting the notion that mucositis is not restricted to the oral cavity and that other sites of the AT are also affected. Furthermore, these results confirm previous data indicating that subclinical changes occur in the mucosa prior to the development of obvious histological damage or clinical manifestations of mucositis. Contrary to previous reports, these studies have indicated that, although the clinical and histological changes may be similar, the alterations in NF-κB and pro-inflammatory cytokines in the tissues are affected by the type of drug used. This has important implications in the management and prevention of mucositis in the clinical setting particularly when multi-drug or chemotherapy-radiotherapy regimens are used. A common pathway that leads to mucosal damage is yet to be determined. The fact that serum levels appear to reflect the “global” nature of the effects of chemotherapy, highlights the fact that ongoing research needs to be directed, not necessarily at specific side effects, but rather how side effects of chemotherapy are interrelated so that better patient management can be achieved and ultimately provide optimum treatment and better survival for patients with cancer. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1321557 / Thesis (Ph.D.) -- University of Adelaide, School of Dentistry, 2008

Orientador: Suzana Erico Tanni Minamoto / Resumo: Introdução: Estudos recentes mostram que o tecido adiposo também contribui para a inflamação sistêmica em pacientes com DPOC. Entretanto, não há dados na literatura que avaliem a variação das adipocinas e suas associações com marcadores inflamatórios, exacerbações e mortalidade em um ano nos pacientes com DPOC. Objetivo: Avaliar as variações das adipocinas, citocinas inflamatórias e composição corporal em pacientes com DPOC no período de um ano. Pacientes e Métodos: Foram avaliados 57 pacientes com DPOC leve a muito grave, destes 6 pacientes morreram, 6 não foram contatados após a avaliação e 5 não quiseram participar da segunda fase estudo, logo realizamos análise de dois momentos dos 40 pacientes que completaram um ano de acompanhamento. No momento basal e após 1 ano foram realizados espirometria pré e pós-broncodilatador, gasometria arterial, exames laboratoriais, oximetria de pulso, dosagem plasmática sérica de interleucina (IL)-6, fator de necrose tumoral alfa (TNF-α), adiponectina e leptina e avaliação sérica laboratorial. Também foi realizado avaliação da composição do corpo, força muscular do quadríceps (FMQ) (MicroFet 2), sensação de dispneia, por meio do Índice de Dispneia Basal (BDI), Escala de Borg e Medical Research Council Modificado (mMRC), avaliação do estado geral de saúde, por meio do questionário de Qualidade de Vida na Doença Respiratória do Hospital Saint George (SGRQ) e Escala Hospitalar de Ansiedade e Depressão (HAD), calculado índice de BODE e Teste de... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Recent studies show that adipose tissue also contributes to systemic inflammation in chronic obstructive pulmonary disease (COPD). However, there are no data in the literature evaluating the evolution of level of adipokines and their associations with systemic inflammation, exacerbations and mortality in COPD patients. Objective: Evaluate the variations of adipokines and their association with systemic inflammation and and body composition in patients with COPD during one year. Patients and Methods: Fifty-seven patients with mild to very severe COPD were evaluated. During the follow up, six patients died, six lost the follow up and five refused to participate in the second assessment. At baseline and after one year we performed post-bronchodilator spirometry, arterial blood gas analysis, laboratory tests, pulse oximetry, serum plasma levels of interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), adiponectin and leptin. We also assessed body composition, peripheral muscle strength (quadriceps), Basal Dyspnea Index (BDI), Borg Scale, and Modified Medical Research Council (mMRC), general health status was evaluated by Saint George Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HAD), BODE index and 6-minute walk test. Results: From the total of 40 patients, we analyzed the variation during one year and we observed a positive association between leptin and BMI (R:0.43; p=0.006), QMS L (R:0.42; p=0.008) and BODE index (R:0.39; p=0.024) an... (Complete abstract click electronic access below) / Doutor

Made available in DSpace on 2014-06-11T19:27:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-28Bitstream added on 2014-06-13T20:57:18Z : No. of bitstreams: 1 ramos_bra_me_botfm.pdf: 447116 bytes, checksum: 446e118d63a97d1a69658b7e651b69aa (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Microbial invasion of the amniotic cavity has been described in term deliveries and its role on the immune modulation is of interest to the better understanding of the underlying labor processes. The aim of this study was to determine the prevalence of Mycoplasma hominis and Ureaplasma urealyticum in the amniotic fluid of term pregnancies and to evaluate its influence on cytokines production at the end of pregnancy. A cross sectional study was conducted with fifty five pregnant women out of labor with intact membranes and gestational age between 37 and 41 weeks seen at the Bom Jesus hospital in Ariquemes, Rondônia, between June 2009 and May 2010. Amniotic fluid samples and fragments of chorioamniotic membranes were collected at cesarean section. M. hominis and U. urealyticum detection was performed by PCR and Interleukin (IL)-1β, IL-6, IL-8, IL-10 and Tumor Necrosis Factor (TNF)- levels were determined by ELISA. Chorioamniotic membranes were submitted to histopatological analyses. Presence of M. hominis was detected in 36.4% of amniotic fluid samples and any of them was positive for U. urealyticum. Regarding cytokines levels, 63.6% and 90.9% of samples have not shown detectable concentrations of TNF- and IL-1β. The median concentration of IL-6 and IL-8 were 107.9 pg/mL (0-517.1) and 208.1 pg/mL (0-1897.4), respectively. Interleukin-1, IL-6, IL-8 and TNF- concentrations were not associated with the presence of M. hominis in amniotic fluid, regardless the gestational age. No sample had detectable IL-10 levels. The histopatological analyses have shown no chorioamnionitis in any of the membranes, only a discreet mononuclear infiltration in the decidua could be observed in 40.4% of the samples. Presence of M. hominis was detected in 36.4% of amniotic fluid samples and any of them was positive for U. urealyticum. Regarding cytokines levels, 63.6% and 90.9% of samples have not... (Complete abstact click electronic access below)

Submitted by FABIANA DA SILVA FRANÇA (fabiana21franca@gmail.com) on 2017-11-23T16:11:41Z No. of bitstreams: 1 ArquivoTotal.pdf: 1032768 bytes, checksum: 3eb77691ff809d7053b63059c2625856 (MD5) / Made available in DSpace on 2017-11-23T16:11:41Z (GMT). No. of bitstreams: 1 ArquivoTotal.pdf: 1032768 bytes, checksum: 3eb77691ff809d7053b63059c2625856 (MD5) Previous issue date: 2017-06-13 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Atherosclerosis is a multifactorial disease, considered as one of the main risk factors that lead to the development of cardiovascular diseases. It is characterized by endothelial and autonomic dysfunction due to the presence of inflammation and systemic oxidative stress. The objective of this study was to evaluate the presence of ROS (reactive oxygen species) in the subfornical organ (SFO) and rostral ventrolateral medulla (RVLM) of animals knockout apolipoprotein E (apoE-/-) fed with a standard diet and the possible relation of the presence of peripheral inflammatory cytokines with central oxidative stress. So, for this purpose, the serum was collected from C57BL/6 mice, isogenic mice, and apoE-/-, mice, also isogenic, genetically modified for the deletion of the gene coding for apolipoprotein E. The serum was used for cholesterol dosage, lipid peroxidation in the form of malonialdehyde (MDA) and inflammatory cytokines (IL-1β, TNF-α and IL-10). In addition, the aortas of both groups were collected for the evaluation of lipid deposition. For the determination of reactive oxygen species by the dihydroethidine technique (DHE) and quantification of inflammatory cytokines (IL-1β, TNF-α and IL-10) were also collected samples from the SFO and RVLM from the two groups. We observed a significant increase in total cholesterol levels in apoE-/- animals compared to control animals (237.4±17.7 mg/dL n=6 vs 90.7±6.4 mg/dL n=6, p<0.05), both fed a standard diet. We also observed a higher lipid deposition in the apoE-/- animals when compared to controls (27.7±4.8% n=3 vs 5.3±0.6% n=4, p<0.05, respectively). There was an increase in serum levels of malonialdehyde in the apoE-/- mice compared to the control (1.8±0.2 nmol/mL, n=15 vs 1.1±0.2 nmol/mL, n=12, p<0.05). Regarding systemic inflammatory evaluation, we observed an increase in IL-1β levels in apoE-/- animals when compared to controls (17.7±2.9 pg/mL, n=11 vs 5.8±0.5 pg/ML, n=11, p<0.05), as well as TNF-α, which was also elevated in atherosclerotic animals (4.6±0.8 pg/mL, n=8 vs 2.1±0.6 pg/mL, n=8, p<0.05). However, we did not observe a significant difference in IL-10 levels when we compared the groups (apoE-/-: 201.6±16.0 pg/mL, n=6 vs C57BL/6: 190.1±11.1pg/mL, n=6). Regarding the evaluation of the oxidative stress in SFO and RVLM, an increase in O2•- levels was observed in both areas from the apoE-/- animals compared to the control (SFO: 36.4±2.1FR/u.a, n=4 vs 19.4±2 FR/u.a, 1, n=4, p<0.05; RVLM: 31.7±2.7 FR/u.a, n=4 vs 16.0±1.0 FR/u.a, n=5, p<0.05). Finally, we evaluated the levels of inflammatory cytokines in the SFO, and observed a decrease in the levels of both the proinflammatory cytokines (TNF-α and IL-1β) and IL-10 (anti-inflammatory) in apoE-/-: IL-1β (4.4±0.3 pg/mL n = 5, vs. 9.1 ± 0.8 pg/mL n=5, p<0.05), TNF-α (3.0±0.7 pg/mL, n=7 vs 6.4±0.9 pg/mL n=7, p<0.05), IL-10 (214.0±1.9 pg/mL n=3, vs 354.2±19.3 pg/mL n=3, p<0.05). Therefore, we can conclude that apoE-/- animals fed standard diet have high levels of ROS in the SFO and RVLM, which together are important regions responsible for cardiovascular control. We may also suggest that the peripheral inflammatory cytokines participate in the induction of central oxidative stress from its action in the SFO. / A aterosclerose é uma doença multifatorial, considerada como um dos principais fatores de risco que levam ao desenvolvimento de outras doenças cardiovasculares. É caracterizada por disfunção endotelial e autonômica devido à presença de inflamação e estresse oxidativo sistêmico. O objetivo deste trabalho foi avaliar a presença de EROs (espécies reativas de oxigênio) no órgão subfornical (SFO) e no bulbo ventrolateral rostral (RVLM) de animais knockout para apolipoproteína E (apoE-/-), alimentados com dieta padrão e a possível relação da presença de citocinas inflamatórias periféricas com a geração de estresse oxidativo central. Para isso foi realizada a coleta do soro de camundongos C57BL/6, camundongos isogênicos, e apoE-/-, camundongos, também isogênicos, geneticamente modificados para a deleção do gene que codifica a apolipoproteína E. O soro foi utilizado para a dosagem do colesterol, da peroxidação lipídica na forma de malonialdeído (MDA) e das citocinas inflamatórias (IL-1β, TNF-α e IL-10). Além disso, foram coletadas as aortas de ambos os grupos para a avaliação “en face” da deposição lipídica. Ainda foi realizada a coleta de amostras do SFO e do RVLM dos dois grupos para a realização da dosagem de espécies reativas de oxigênio pela técnica do di-hidroetídio (DHE) e para a quantificação de citocinas inflamatórias (IL-1β, TNF-α e IL-10) no SFO. Observamos um aumento significativo dos níveis de colesterol total nos animais apoE-/- em relação aos animais controle (237,4±17,7 mg/dL n=6 vs 90,7±6,4 mg/dL n=6, p<0,05), ambos alimentados com dieta padrão e com idade de 13 meses. Observamos também uma maior deposição lipídica nos animais apoE-/- quando comparados com os controles (27,7±4,8% n=3 vs 5,3± 0,6% n=4, p<0,05, respectivamente). Houve aumento nos níveis séricos de malondialdeído nos camundongos apoE-/- quando comparados com o controle (1,8±0,2 nmol/mL, n=15 vs 1,1±0,2 nmol/mL, n=12, p<0,05). Com relação a avaliação inflamatória sistêmica, observamos aumento nos níveis de IL-1β nos animais apoE-/- quando comparados aos controles (17,7±2,9 pg/mL, n=11 vs 5,8±0,5 pg/mL, n=11, p<0,05), bem como o TNF-α que também se apresentou elevado nos animais ateroscleróticos (4,6±0,8 pg/mL, n=8 vs 2,1±0,6 pg/mL, n=8, p<0,05). No entanto, não constatamos diferença significativa nos níveis de IL-10 quando comparamos ambos os grupos (apoE-/-:201,6±16,0 pg/mL, n=6 vs C57BL/6:190,1±11,1 pg/mL, n=6). Quanto à avaliação do estresse oxidativo no SFO e no RVLM foi observado aumento nos níveis de O2•- em ambas as áreas dos camundongos apoE-/- quando comparados com o controle (SFO: 36,4±2,1 FR/u.a, n=4 vs 19,4±2,1 FR/u.a, n=4, p<0,05; RVLM: 31,7±2,7 FR/u.a, n=4 vs 16,0±1,0 FR/u.a, n=5, p<0,05). Por fim avaliamos os níveis de citocinas inflamatórias no SFO e observamos uma diminuição nos níveis tanto das citocinas pró-inflamatórias (TNF-α como da IL-1β), como da IL-10 (anti-inflamatória) nos camundongos apoE-/- quando comparados com o controle: IL-1β (4,4±0,3 pg/mL n=5, vs 9,1±0,8 pg/mL n=5, p<0,05), TNF-α (3,0±0,7pg/mL, n=7 vs 6,4±0,9 pg/mL n=7, p<0,05), IL-10 (214,0±1,9 pg/mL n=3, vs 354,2±19,3 pg/mL n=3, p<0,05). Portanto, concluímos que os animas apoE-/- alimentados com dieta padrão apresentam níveis elevados de EROs no SFO e RVLM, que em conjunto, são importantes regiões responsáveis pelo controle cardiovascular. Podemos ainda sugerir que, possivelmente, as citocinas inflamatórias periféricas participam da indução do estresse oxidativo central a partir da sua ação no SFO.

Submitted by CAROLINA BONFANTI MESQUITA null (carollmesquita@hotmail.com) on 2018-04-08T02:56:34Z No. of bitstreams: 1 Tese de Doutorado.pdf: 1515003 bytes, checksum: 930fae76eb93a6d1751c77b8ed8deca4 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-04-10T12:59:14Z (GMT) No. of bitstreams: 1 mesquita_cb_dr_bot.pdf: 1515003 bytes, checksum: 930fae76eb93a6d1751c77b8ed8deca4 (MD5) / Made available in DSpace on 2018-04-10T12:59:14Z (GMT). No. of bitstreams: 1 mesquita_cb_dr_bot.pdf: 1515003 bytes, checksum: 930fae76eb93a6d1751c77b8ed8deca4 (MD5) Previous issue date: 2018-02-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: Estudos recentes mostram que o tecido adiposo também contribui para a inflamação sistêmica em pacientes com DPOC. Entretanto, não há dados na literatura que avaliem a variação das adipocinas e suas associações com marcadores inflamatórios, exacerbações e mortalidade em um ano nos pacientes com DPOC. Objetivo: Avaliar as variações das adipocinas, citocinas inflamatórias e composição corporal em pacientes com DPOC no período de um ano. Pacientes e Métodos: Foram avaliados 57 pacientes com DPOC leve a muito grave, destes 6 pacientes morreram, 6 não foram contatados após a avaliação e 5 não quiseram participar da segunda fase estudo, logo realizamos análise de dois momentos dos 40 pacientes que completaram um ano de acompanhamento. No momento basal e após 1 ano foram realizados espirometria pré e pós-broncodilatador, gasometria arterial, exames laboratoriais, oximetria de pulso, dosagem plasmática sérica de interleucina (IL)-6, fator de necrose tumoral alfa (TNF-α), adiponectina e leptina e avaliação sérica laboratorial. Também foi realizado avaliação da composição do corpo, força muscular do quadríceps (FMQ) (MicroFet 2), sensação de dispneia, por meio do Índice de Dispneia Basal (BDI), Escala de Borg e Medical Research Council Modificado (mMRC), avaliação do estado geral de saúde, por meio do questionário de Qualidade de Vida na Doença Respiratória do Hospital Saint George (SGRQ) e Escala Hospitalar de Ansiedade e Depressão (HAD), calculado índice de BODE e Teste de caminhada de 6 minutos. Resultados: Na análise da variação dos 40 pacientes nos dois momentos observamos associação da variação da leptina com a variação de IMC (R:0,43; p=0,006), variação de FMQ E (R:0,42; p=0,008), variação do índice BODE (R:0,39; p=0,024) e variação da IL-6 (R:-0,33; p=0,003). Na análise de regressão linear múltipla apenas observamos associação negativa da variação da IMMC com a variação da adiponectina (coef: -0,35; p=0,03). Não observamos associação das adipocinas na frequência de exacerbação ou mortalidade em um ano. Conclusão: O presente estudo mostrou que a leptina está associada positivamente com a IMC, força muscular periférica e índice BODE e associada negativamente com a IL-6. Novos estudos sobre a variação das adipocinas e suas associações com as variações dos marcadores inflamatórios e do estado nutricional devem ser realizados para melhor esclarecimento. / Introduction: Recent studies show that adipose tissue also contributes to systemic inflammation in chronic obstructive pulmonary disease (COPD). However, there are no data in the literature evaluating the evolution of level of adipokines and their associations with systemic inflammation, exacerbations and mortality in COPD patients. Objective: Evaluate the variations of adipokines and their association with systemic inflammation and and body composition in patients with COPD during one year. Patients and Methods: Fifty-seven patients with mild to very severe COPD were evaluated. During the follow up, six patients died, six lost the follow up and five refused to participate in the second assessment. At baseline and after one year we performed post-bronchodilator spirometry, arterial blood gas analysis, laboratory tests, pulse oximetry, serum plasma levels of interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), adiponectin and leptin. We also assessed body composition, peripheral muscle strength (quadriceps), Basal Dyspnea Index (BDI), Borg Scale, and Modified Medical Research Council (mMRC), general health status was evaluated by Saint George Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HAD), BODE index and 6-minute walk test. Results: From the total of 40 patients, we analyzed the variation during one year and we observed a positive association between leptin and BMI (R:0.43; p=0.006), QMS L (R:0.42; p=0.008) and BODE index (R:0.39; p=0.024) and a negative association between IL-6 (R:-0.33; p=0.003). Multiple linear regression showed a negative association between the variation of IMMC and variation of adiponectin levels (coef:-0.35, p=0.03). We did not find association between the frequency of exacerbation and mortality with adipokines. Conclusion: The present study showed that leptin is positively associated with BMI, peripheral muscle strength and BODE index and negatively associated with the IL-6. Further studies on the variation of adipokines and their associations with variations in inflammatory markers and nutritional status should be performed for better clarification.

A sepse é descrita como uma disfunção orgânica ameaçadora à vida secundária à resposta desregulada do organismo a uma infecção, e é responsável por uma alta e crescente taxa de internação hospitalar no Brasil e no mundo. Apesar da diminuição da mortalidade ao longo do tempo, efeitos da doença a longo prazo como infecções secundárias e mortes tardias têm sido observadas. A sepse caracteriza-se pela liberação de mediadores inflamatórios e posterior imunossupressão compensatória, e o distúrbio na homeostase pode causar danos às células e órgãos levando a um estado mais grave da doença. Os linfócitos T reguladores (Tregs) são células responsáveis pela tolerância periférica e modulação de processos inflamatórios e são essenciais na imunossupressão observada na sepse. Este trabalho teve por objetivo estudar a relação entre a atividade imunológica (quantificação de Tregs, monócitos e citocinas inflamatórias) e a susceptibilidade a novas infecções e mortalidade em pacientes sépticos admitidos na Unidade de Emergência do HC-FMRP-USP. Foram incluídos 33 pacientes sépticos e 34 controles saudáveis, entre outubro de 2014 e novembro de 2015. Os pacientes foram acompanhados durante a internação na admissão (D0), D2, D7, D14, D21 e D28, e 12 pacientes retornaram para avaliação pelo menos três meses após a alta. Os pacientes tiveram porcentagens de Treg em linfócitos CD4+ elevados em relação aos controles nos momentos D2 e retorno (p = 0,0004), sendo que no D2 pacientes que desenvolveram complicação infecciosa tiveram porcentagens significativamente menores que os que não desenvolveram complicação (p = 0,0015). Além disso, porcentagens altas de Treg na admissão (D0) correlacionaram-se inversamente com o tempo de internação dos pacientes sobreviventes (p = 0,0271). Valores absolutos de Treg nos pacientes estiveram significativamente elevados no retorno em relação à admissão (p = 0,0074). Pacientes no retorno tiveram maior porcentagem de monócitos CD163+ em relação aos controles (p = 0,036). Pacientes na admissão tiveram menor porcentagem demonócitos HLA-DR+ em relação aos controles e aos pacientes no retorno (p = 0,0057). Pacientes tiveram valores de IL-6, IL-8, IL-10 e ST2 superiores em relação aos controles em diversos momentos da internação e retorno (p < 0,0001, p < 0,0001, p = 0,0030 e p < 0,0001, respectivamente). Valores de ST2 na admissão correlacionaram-se com o escore SOFA (p = 0,0252), tempo de internação (p = 0,0105), presença de complicação infecciosa (p = 0,0356) e mortalidade (p = 0,0114) dos pacientes. Valores de IL-8 na admissão também se correlacionaram com a presença de complicação infecciosa (p = 0,0387). Podemos inferir, portanto, que apesar de uma inflamação exacerbada já na admissão dos pacientes, evidenciada por altos valores de citocinas inflamatórias, há um aumento posterior de células Treg, imunorreguladoras, no D2, e o mesmo foi benéfico em relação à recuperação mais rápida dos pacientes e instalação de uma nova infecção. Porém, a imunossupressão continua sendo exibida mesmo após a alta dos pacientes, como podemos observar com a alta porcentagem de Tregs e monócitos CD163+ e valores de IL-10 nos pacientes em retorno em relação aos controles. Além disso, muitos dos pacientes sobreviventes à primeira internação foram internados novamente, e alguns deles foram a óbito no ano seguinte. / Sepsis is defined by a life-threatening organ dysfunction caused by a dysregulated host response to infection, and it is responsible for a high and increasing rate of hospital admission in Brazil and worldwide. Despite the decrease in mortality over time, long-term disease effects such as secondary infections and late deaths have been observed. Sepsis is characterized by the release of inflammatory mediators and subsequent compensatory immunosuppression, and the homeostasis disorder can cause damage to cells and organs leading to a more severe disease state. Regulatory T lymphocytes (Tregs) are cells responsible for peripheral toleran ce and modulation of inflammatory processes and are essential in the immunosuppression observed in sepsis. This study aimed to investigate the relationship between immunological activity (quantification of Tregs, monocytes and inflammatory cytokines) and susceptibility to new infections and mortality in septic patients admitted to the HC-FMRP-USP Emergency Unit. Thirty-three septic patients and 34 healthy controls were included between October 2014 and November 2015. Patients were followed up at admission (D0) and during hospitalization at D2, D7, D14, D21 and D28, and 12 patients returned for evaluation at least three months after discharge. Patients had higher Treg percentages on CD4 + lymphocytes than had controls at D2 and on return (p = 0.0004), whereas in D2 patients who developed infectious complications had significantly lower percentages than those who did not develop complications (p = 0.0015). In addition, high percentages of Treg at admission (D0) correlated inversely with the length of hospital stay of surviving patients (p = 0.0271). Absolute values of Treg in patients were significantly elevated in the return relative to admission (p = 0.0074). Patients on return had a higher percentage of CD163 + monocytes than controls (p = 0.036). Patients on admission had a lower percentage of HLA-DR+ monocytes than controls and patients on return (p = 0.0057). Patients had higher IL-6, IL-8, IL-10 and ST2 levels than controls at various times ofhospitalization and return (p < 0.0001, p < 0.0001, p = 0.0030 and p < 0.0001, respectively). ST2 values at admission were correlated with SOFA score (p = 0.0252), length of hospital stay (p = 0.0105), presence of infectious complication (p = 0.0356) and mortality (p = 0.0114). IL-8 values at admission also correlated with the presence of infectious complication (p = 0.0387). We can infer, therefore, that despite exacerbated inflammation as soon as at the admission of the patients, demonstrated by high levels of inflammatory cytokines, there is a posterior increase of immunoregulatory Treg cells at D2, and that was beneficial in relation to the faster recovery of the patients and setting up of new infection. However, immunosuppression continues to appear even after discharge of patients, as can be observed with the high percentage of CD163 + monocytes, Tregs and L-10 levels in patients on return compared to controls. In addition, many of the patients surviving the first hospitalization were hospitalized again, and some of them died the following year.

O Diabete tipo 2 é uma síndrome heterogênea caracterizada por resistência à insulina e /ou diminuição relativa da função secretora das células &#946; pancreáticas. Os Diabéticos têm risco maior de desenvolver aterosclerose, que é uma doença inflamatória crônica que envolve a resposta imune. Os TLRs sinalizadores da resposta imune inata que ativam vias que participam na regulação da inflamação podem estar associados com a patogênese da aterosclerose. Além disso, são capazes de induzir a resistência à insulina. Estudos sugerem que a inflamação é um fator chave na aterogênese em diabéticos tipo 2. Citocinas pró-inflamatórias, como a IL-6 e o TNF-&#945;, são produzidas pelo tecido adiposo em grande quantidade em indivíduos obesos, especialmente em pacientes com DM2. Este estudo tem por objetivo avaliar a associação dos genes do TLR2, TLR4, TNF-&#945; e IL-6 com o diabetes tipo 2 e com a aterosclerose. Foram selecionados sessenta e um indivíduos DM2 e trinta e nove indivíduos normoglicêrmicos (grupo controle) na seção de Coronárias do Instituto Dante Pazzanese de Cardiologia (São Paulo, Brasil). O ultra-som de carótida foi utilizado para avaliar a presença de aterosclerose. Os polimorfismos dos genes TLR4 (Thr399lle), TLR2 (Arg753Gln), and IL6 (-174G>C) foram identificados pela PCR-RFLP. O polimorfismo dos genes TLR4 (Asp299Gly) and TNF-&#945; (-308G>A) foram detectados por HRM. A expressão do mRNA nos leucócitos do sangue periférico foi mensurado pela PCR em tempo real utilizando o gene GAPD como gene referência. No grupo diabéticos, indivíduos portadores do alelo IL-6 -174C apresentaram colesterol total, VLDL-C e triglicérides que os portadores do genótipo GG (respectivamente, p=0,007, p=0,006 e p= 0,030). A expressão de TLR4 foi maior em indivíduos do grupo diabéticos que no grupo controle (p=0,029). Em DM2, o genótipo TNF-&#945; -308GG foi associado com o aumento da expressão do mRNA do gene TNF-&#945; (p=0,031) e maiores concentrações de fibrinogênio que os portadores do alelo -308A (genótipo GA+AA) (p=0,020). Em indivíduos com aterosclerose o alelo TLR4 299Gly foi associado com altas concentrações de glicemia pós 75g de glicose (p=0,012). E portadores do alelo IL6 -174C apresentaram maiores concentrações de colesterol total e LDL-C que nos portadores do genótipo GG (ambos p<0,001). O polimorfismo -174G>C (alelo C) e o DM2 mostraram serem fatores de risco para a aterosclerose (odds ratio respectivamente: 3,0 and 16,962). E, o sexo masculino e a menopausa mostraram serem fatores de risco para o DM2. / Type 2 diabetes is an heterogeneous syndrome characterized by the resistance to insulin and/or relative decrease of the secretion of insulin of the pancreatic &#946; cells. T2DM are in high risk of develop atherosclerosis, that is a chronic inflammatory disease involving immune response. Many existing in the atherosclerotics plaques the TLRs are signaling for immune innate response, that activate inflammatory cells involved in progression of atherosclerotic disease. TLRs can be also associated with induction of the resistance to insulin. Many studies have been suggesting that inflammation is a key factor of the progression of atherosclerotic disease in type 2 diabetes. Proinflammatory cytokines, such as IL-6 and TNF-&#945;, are produced by the adipose tissue in high concentration in obese individuals, mainly among patients with T2DM. This study aims to investigate the relationship between TLR2, TLR4, TNF-&#945; and IL-6 gene expression and polymorphisms with T2DM and atherosclerosis. Sixty-one T2DM and thirty nine normoglycemic (control group) individuals were selected at the Coronary Session of the Instituto Dante Pazzanese de Cardiologia (Sao Paulo, Brazil). Carotid artery ultrassonography was used to evaluate the atherosclerotic status. Polymorphisms of TLR4 (Thr399lle), TLR2 (Arg753Gln), and IL6 (-174G>C) genes were detected by PCR-RFLP. TLR4 (Asp299Gly) and TNFA (-308G>A) gene polymorphisms were detected by HRM. Blood leukocytes mRNA expression was measured by real time PCR using GAPD as a reference gene. In T2DM, individuals carrying IL6 -174C allele had higher total cholesterol, VLDL-c and triglycerides than the genotype GG carriers (respectively, p=0,007, p=0,006 and p= 0,030). TLR4 mRNA expression was higher in T2DM than in control individuals (p=0,029). In T2DM group, TNF-&#945; -308GG genotype was associated with increased TNF-&#945; mRNA expression levels (p=0,031) and higher fibrinogen levels than those carrying -308A allele (GA+AA genotypes) (p=0,020). In individuals with atherosclerosis TLR4 299Gly allele was associated with high post-test glucose levels (p=0,012). And carrying IL6 -174C allele had higher total cholesterol and LDL-C than the genotype GG carriers (both p<0,001). The polymorphism -174G>C and the T2DM was related with risk for atherosclerosis (odds ratio respectively: 3,0 and 16,962) and, the male sex and menopause was related with risk for T2DM (odds ratio respectively: 3,401 and 3,025).