O objetivo deste estudo foi avaliar o impacto clínico, funcional e bacteriológico das infecções respiratórias virais nos pacientes com fibrose cística durante um ano. A identificação viral foi feita por métodos de biologia molecular para os seguintes virus: Vírus sincicial respiratório, Influenza A e B, Parainfluenza 1, 2 e 3, Adenovírus, Rinovírus, Metapneumovírus humano, Coronavírus, Enterovírus e Bocavírus. Foram 408 amostras com identificação viral em 199 amostras (48,7%). O Rinovírus foi o mais prevalente sendo identificado em 140 amostras (34,31%), mas contrastando com outros estudos em fibrose cística e em outras doenças pulmonares crônicas, o Rinovírus não mostrou ter impacto clínico, funcional ou bacteriológico significativo nos pacientes com fibrose cística / The objective of this study was to evaluate the clinical, functional and bacteriological impact of the viral respiratory tract infections in cystic fibrosis patients over one year. Viral identification was done through molecular biology methods for the following virus: Respiratory syncytial virus, Influenza A and B, Parainfluenza viruses type 1 to 3, Adenovirus, Rhinovirus, Human metapneumovirus, Coronavirus, Enterovirus and Human bocavirus. 199 (48,7%) samplings among 408 were positive for at least one virus. Rhinovirus was the virus with a higher prevalence, which was identified in 140 samplings (34,31%), but without clinical, functional or bacteriological impact contrasting with other studies in patients with cystic fibrosis and other chronic lung diseases

Die Assemblierung von Influenzaviren erfolgt an Rafts der apikalen Wirtszellplasmamembran mit denen das Hämagglutinin (HA) über Acylierungen im C-Terminus und hydrophobe Aminosäuren seiner Transmembrandomäne (TMD) interagiert. M2 besitzt eine cytoplasmatische amphiphile Helix (AH), die ebenso potenzielle Raft-Motive aufweist: Eine Acylierung und Cholesterol-Bindemotive. In dieser Arbeit wurde per Konfokalmikroskopie an polarisierten Zellen, die fluoreszenzmarkierte M2-Varianten exprimierten, gezeigt, dass diese M2-Motive nicht für den apikalen Transport, der vermutlich durch Raft-ähnliche Vesikel erfolgt, benötigt werden. Messungen des Förster-Resonanzenergietransfers über Fluoreszenz-Lebenszeit-Mikroskopie (FLIM-FRET) in der Plasmamembran lebender Zellen, die fluoreszenzmarkiertes HA und M2 koexprimierten, ergaben, dass diese Motive auch nicht für die Interaktion mit den durch HA, in Abhängigkeit von dessen Raft-Motiven, stabilisierten Raft-Domänen notwendig sind. Mittels reverser Genetik konnten infektiöse WSN-Viren mit fehlender Acylierung am Ende der HA-TMD, nicht jedoch Viren ohne die zwei cytoplasmatischen Acylierungen hergestellt werden. Weiterhin ergaben Wachstumsanalysen, dass die Acylierung von HA und M2 für den gleichen Schritt des viralen Replikationszyklus von Bedeutung sind. Für die M2-AH wurde postuliert, dass sie die Membrankrümmung detektiert und durch Insertion in die Wirtszellmembran die Virusabschnürung bewirkt. Infektiöse Viren ohne M2 oder ohne die AH konnten ebenso wie Viren mit M2 mit einer Helix mit reduzierter Amphiphilität in dieser Arbeit nicht hergestellt werden. Allerdings führte die Substitution der AH durch typische krümmungsdetektierende oder modulierende Helices zu Viren, deren Wachstum um zwei bis vier Titerstufen im Vergleich zum Wildtyp reduziert war. Die Helix-Amphiphilität scheint wichtig zu sein, aber auch die Sequenz oder bestimmte Aminosäuren sind offenbar für eine effiziente Virusreplikation notwendig. / The assembly of influenza virus particles occurs at the apical plasma membrane of the host cell at membrane rafts which the hemagglutinin (HA) interacts with via acylations in its C-terminal region and via hydrophobic amino acids in the transmembrane domain (TMD). M2 possesses a cytoplasmic amphiphilic helix (AH) that also contains potential raft motifs: an acylation and cholesterol-binding motifs. In this work, confocal microscopy of polarised cells, which were expressing fluorescently labelled M2-variants, demonstrated that these motifs of M2 are not required for apical transport, which is assumed to be mediated by raft-like vesicles. Furthermore, FLIM-FRET (Förster resonance energy transfer measured via fluorescence lifetime imaging microscopy) analyses, performed in the plasma membrane of living cells coexpressing fluorescently labelled HA and M2, revealed that these M2-motifs are not required for association with the large coalesced raft phase organised by HA. In contrast, deleting HA’s raft-targeting features clearly reduced clustering with M2. While the removal of the two cytoplasmic acylations prevented the rescue of infectious virus by reverse genetics, a mutant virus without acylation in the HA-TMD could be rescued. Moreover, growth analyses revealed that the acylations of HA and M2 are important for the same step in the viral replication cycle. It has been postulated that the M2-AH detects membrane curvature and accomplishes membrane scission by inserting into the host cell membrane. Viruses without M2, without the M2-AH or with M2 containing a helix with reduced amphiphilicity could not be produced in this work. However, substituting the AH by typical curvature-sensing or -generating helices led to viruses with two to four orders of magnitude reduced growth as compared to wildtype virus. The amphiphilicity of the helix seems to be important, but also the sequence or specific amino acids appear to be necessary for an efficient virus replication.

Le projet de ma thèse a consisté en la mise au point de biomatériaux capables d'agir en tant que capteurs moléculaires pour la construction de biocapteurs d'affinité tels que des immunocapteurs, aptacapteurs et capteurs d'ADN, basés sur la lecture électrochimique. Les biocapteurs électrochimiques deviennent une technique intéressante pour l'identification des biomolécules en raison de possibilités de miniaturisation, de faible coût et de la lecture directe des signaux électriques. Toutefois, le choix d'un transducteur, qui permet d'obtenir un signal électrochimique, est crucial dans la construction du biocapteur. Au cours de ma thèse, j'ai eu l'occasion de comparer l'efficacité de différents matériaux conductrices tels que les conducteurs polymères (polypyrrole), les nanotubes de carbone et des nanoparticules d'or. Pour obtenir une réponse électrochimique intense, j'ai associé ces plateformes avec un marqueur redox-ferrocène. Les biocapteurs ont été basés sur la détection directe, généralement avec un «signal off» (diminution de la réponse électrochimique lors de la détection). J'ai travaillé sur différents types de reconnaissance biologique comme anticorps/antigène, aptamer/protéine, sonde ADN/ADN cible. Ces biocapteurs sont particulièrement intéressants dans le domaine de la biologie et de la santé publique. Au début je me suis intéressée à la nouvelle protéine impliquée dans le virus de la grippe et démontrée son évolution dans le cycle viral avec l'objectif de développer de nouveaux médicaments pour cette maladie ainsi que de nouveaux outils de détection. J'ai construit ces biocapteurs basés sur polymère conductrice-polypyrrole associé avec le marqueur redox, ferrocène pour l'immobilisation des anticorps spécifique pour les protéines impliquées dans le virus de la grippe. De nouveaux biorécepteurs - aptamères et des techniques électrochimiques ont été ensuite développés pour concevoir un système sensible capable de détecter la protéine prion cellulaire au niveau pM dans les échantillons de plasma humaine. Les aptamères sont associés sur la plateforme composée de nanotubes de carbone, conjuguées avec des dendrimères poly(amidoamine) PAMAM. Les composites combinent les performances électriques de nanotubes mais permet simultanément l'attachement de nombreux biomolécules, en raison des nombreux groupes amines portant par des dendrimères. Puis j'étais aussi intéressé par la détection de l'ADN par le développement de biocapteurs à base de nanotubes de carbone pour deux maladies infectieuses telles que l'hépatite C avec des cibles d'ADN synthétiques et l'ADN de M. tuberculosis provenant d'échantillons PCR. Ces exemples ont été utilisés pour démontrer que le capteur d'ADN pourrait être généralisé à toutes les maladies infectieuses et utilisé dans le système «point of care». Des études précédentes ont consisté dans le dépôt de nanotubes de carbone sur la surface par adsorption et j'ai trouvé que c'était problématique en termes de reproductibilité. Alors, j'ai utilisé polypyrrole comme une matrice pour l'association des nanotubes de carbone. Cette méthode semble être la plus efficace et a permis de combiner les propriétés des nanotubes avec celles de polypyrrole conducteurs. Au cours de ma thèse, j'ai démontré que les capteurs électrochimiques d'affinité à base de polymères conducteurs et les nanomatériaux peuvent être appliqués dans différents domaines concernant les problèmes de santé. Ces biocapteurs sont prêts pour être intégrés dans les microsystèmes ainsi que dans les systèmes «point of care». / The project of my thesis consisted on the development of biomaterials that are able to act as molecular transducers for the construction of affinity biosensors such as immunosensors, aptasensors and DNA sensors, based on electrochemical reading. Electrochemical biosensors become an attractive technique for the identification of biomolecules due to miniaturization possibilities, low cost and direct lecture of electric signals. However the choice of a transducer, which allows obtaining electrochemical signal, is crucial in biosensor construction. During my thesis I had the opportunity to compare the efficacy of different conducting materials such as conducting polymers (polypyrrole), carbon nanotubes. To obtain an intense electrochemical response, I associated these platforms with a redox marker – ferrocene. The biosensors which I constructed were based on direct detection, usually with “signal off” (decrease in electrochemical response during detection). I worked on different types of biological recognition such as antibody/antigen, aptamer/protein, DNA probe/DNA target. These biosensors are especially attractive in the biological field and public health. First, I was interested in the new protein involved in Influenza virus and demonstrated its evolution in viral cycle with the objective to develop new drugs for this disease as well as new tools for detection. I constructed biosensors based on conducting polypyrrole which was studied extensively in our group. I used this polypyrrole matrix associated with redox marker, ferrocene for immobilization of antibody specific for protein involved in Influenza virus. By this approach I demonstrate that electrochemical biosensors can become effective tools in the daily laboratory work, especially useful for biologists who are often limited by commercially available methods. Then new bioreceptors - aptamers and electrochemical techniques have been developed to design a sensitive system able to detect cellular prion protein at pM level in plasma samples. Aptamers were associated on the platform composed of polypyrrole or carbon nanotubes conjugated with dendrimers poly(amidoamine) PAMAM. Composite combines the high electrical performance of transducers but simultaneously allows attachment of high number of biomolecules, due to numerous amine groups bearing by dendrimers. I was also interested in DNA detection and in the development of biosensors based on carbon nanotubes for two infectious diseases like hepatitis C with synthetic DNA targets and M. tuberculosis DNA from PCR samples. Such examples were used to demonstrate that DNA sensor could be generalised to all infectious diseases and used in point-of-care system. My previous studies consisted on the deposition of carbon nanotubes on the surface by adsorption and I found that it was problematic in terms of reproducibility, so important in biosensor construction. I used polypyrrole as a matrix for carbon nanotubes association. This method seems to be effective and allowed combination of nanotubes properties with those of conducting polypyrrole. During my thesis I demonstrated that electrochemical affinity sensors based on conducting polymers and nanomaterials can be applied in different fields concerning health problems. These biosensors are ready for integration in microsystems for application as analytical tools as well as in point-of-care systems.

O objetivo deste estudo foi avaliar o impacto clínico, funcional e bacteriológico das infecções respiratórias virais nos pacientes com fibrose cística durante um ano. A identificação viral foi feita por métodos de biologia molecular para os seguintes virus: Vírus sincicial respiratório, Influenza A e B, Parainfluenza 1, 2 e 3, Adenovírus, Rinovírus, Metapneumovírus humano, Coronavírus, Enterovírus e Bocavírus. Foram 408 amostras com identificação viral em 199 amostras (48,7%). O Rinovírus foi o mais prevalente sendo identificado em 140 amostras (34,31%), mas contrastando com outros estudos em fibrose cística e em outras doenças pulmonares crônicas, o Rinovírus não mostrou ter impacto clínico, funcional ou bacteriológico significativo nos pacientes com fibrose cística / The objective of this study was to evaluate the clinical, functional and bacteriological impact of the viral respiratory tract infections in cystic fibrosis patients over one year. Viral identification was done through molecular biology methods for the following virus: Respiratory syncytial virus, Influenza A and B, Parainfluenza viruses type 1 to 3, Adenovirus, Rhinovirus, Human metapneumovirus, Coronavirus, Enterovirus and Human bocavirus. 199 (48,7%) samplings among 408 were positive for at least one virus. Rhinovirus was the virus with a higher prevalence, which was identified in 140 samplings (34,31%), but without clinical, functional or bacteriological impact contrasting with other studies in patients with cystic fibrosis and other chronic lung diseases

Afin de se répliquer et de se propager efficacement, les virus ont développé de multiples stratégies leur permettant d’échapper au système de défense innée : le système IFN de type I. Ce travail de thèse a alors consisté à étudier les interactions entre protéines virales et protéines de ce système de défense afin de mieux comprendre les mécanismes de subversion virale et d’identifier d’éventuelles cibles cellulaires thérapeutiques. La reconstruction d’un réseau d’interactions entre ces protéines nous a permis d’identifier des stratégies différentielles de subversion pour 4 familles virales et de montrer un ciblage massif et significatif des protéines du système IFN de type I par les virus. Les protéines en interaction directe avec ces protéines sont également fortement touchées par les virus et sont de potentiels modulateurs du système IFN de type I. Parmi ces modulateurs, le processus biologique sur-représenté est le transport nucléocytoplasmique et la protéine KPNA1 impliquée dans ce processus a retenu notre attention. L’étude fonctionnelle de l’interaction entre la protéine KPNA1 et la protéine NS3 du VHC a montré que la protéine NS3 associée à son cofacteur NS4A inhibe partiellement la réponse IFN de type I en empêchant l’import nucléaire de STAT1. Ce phénotype pourrait résulter de la dégradation de KPNA1 par NS3/4A. Par ailleurs, l’identification de nouveaux inter-acteurs de la protéine NS1 du virus influenza par criblage double-hybride levure a révélé la protéine induite par les IFN de type I, ADAR1, comme partenaire de la protéine NS1 de multiples souches virales et nous avons montré qu'ADAR1 est un facteur pro-viral dont la fonction editing est activée par NS1 / To replicate and propagate efficiently, viruses have developed multiple strategies allowing them to escape the innatedefense system: the type I IFN system, This work of thesis then consisted in studying the interactions between viralproteins and proteins of this defence system in order to understand better the mechanisms of viral subversion andidentifY possible therapeutic cellular tatgets. The reconstruction of a network of interacting proteins involved in the typeI IFN system allowed us to identifY differentiai subversion strategies for 4 viral families and to show a massive andsignificant targeting of proteins of the type I IFN system by viruses. Proteins directly interacting with the type Iinterferon system network are also strongly targeted by viruses and are potential modulators of the type I IFN system.Among these modulators, the most tatgeted function conesponds to the transport of NLS-bearing substrates to thenucleus and the KPNAI protein involved in this process held our attention. The functional study of the interactionbetween KPNA1 and NS3 protein of the HCV showed that NS3 protein associated with its cofactor NS4A inhibitsprutially the type I IFN response by preventing the nuclear translocation of ST A Tl. This phenotype could result fromthe degradation of KPNAI by NS3/4A. Besides, the identification of new cellular prutners ofNS 1 prote in of influenzavirus by yeast two-hybrid screens revealed ADARI, an interferon-stimulated prote in, as partner of NS 1 of ali testedvirus strains and we showed that ADARI is an essential host factor for viral replication and its editing function isactivated by NS 1 protein

Introdução: As infecções respiratórias causam elevadas morbidade e mortalidade, sendo os vírus os principais agentes destas doenças. O monitoramento e vigilância de vírus respiratórios, desde os mais conhecidos até os emergentes, são importantes para a gestão em saúde, orientando tempo de profilaxia e minimizando o impacto de epidemias nas comunidades. Objetivos: Estudar a epidemiologia molecular do vírus sincicial respiratório (VSR) e descrever a epidemiologia dos seguintes vírus: influenza (IF), influenza A (H1N1), adenovírus (AdV) e parainfluenza (PIV) no Hospital de Clínicas de Porto Alegre. Para isso foram conduzidos três estudos: (1) caracterização das infecções respiratórias causadas por VSR, IF, AdV e PIV em crianças; (2) validação de uma técnica de reação em cadeia da polimerase em tempo real (RT-PCR) para detecção de VSR A/B e IF A/B e (3) caracterização de genótipos do VRS em crianças com infecções comunitárias e hospitalares. Métodos: No primeiro estudo foram levantadas as seguintes variáveis: casos de infecções respiratórias por VSR, AdV, PIV ou IF e H1N1; internações em enfermarias hospitalares e internações em unidades de terapia intensiva (UTI); infecções hospitalares e taxas de letalidade. As variáveis foram coletadas durante o atendimento de crianças (idade 0-12 anos) no HCPA entre 2007 e 2010. No segundo estudo, os alvos do ensaio de RT-PCR foram: o gene da proteína da matriz de IFA, o gene da hemaglutinina do IFB e o gene da nucleoproteína de RSVA/B. A especificidade do ensaio e seu limite de detecção foram determinados. Uma comparação entre RT-PCR e imunofluorescência indireta foi realizada. No terceiro estudo, 63 isolados de VSR (21 de origem nosocomial e 42 adquiridos na comunidade) foram sequenciados para estabelecer uma análise filogenética deste vírus. Resultados: Cada um dos vírus estudados apresentou um comportamento diferente. O VSR demonstrou ser o principal agente envolvido em infecções nosocomiais. Já os pacientes com AdV, bem como o VSR, apresentaram altas taxas de admissão em UTI em 2007 e 2010. O AdV e o H1N1 tiveram as maiores taxas de letalidade. O ensaio de RT-PCR mostrou-se específico e foi mais sensível do que a imunofluorescência, sendo capaz de detectar co-infecções. Os seguintes limites de detecção foram obtidos: 1 cópia/mL para a IFA, 10 cópias/mL para IFB, 5 cópias/mL para RSVA e 250 cópias/mL para RSVB. A investigação dos genótipos de VSR revelou que todos os isolados VSRA circulantes eram do mesmo grupo filogenético, o genótipo NA1 de origem japonesa. Por outro lado, os isolados VSRB foram distribuídos em grupos diferentes: BA4, POA1, POA2, POA3 e POA4. Este estudo foi o primeiro que descreveu a circulação do genótipo NA1 no Brasil, bem como quatro novos genótipos (POA1, POA2, POA3 e POA4). Conclusão: Os resultados obtidos no primeiro estudo demonstram o impacto das epidemias sazonais de vírus respiratórios. O segundo estudo corroborou relatos da literatura que técnicas moleculares, como RT-PCR, são adequadas para a detecção de vírus respiratórios. O terceiro estudo relatou genótipos emergentes de VSR. Estudos de vigilância como os descritos acima deveriam ser conduzidos periodicamente para acompanhar o padrão de comportamento dos vírus na população alvo. / Background: Respiratory tract infections of viral origin are a major cause of morbidity and mortality worldwide. Surveillance of well-known viruses and emerging threats is important for management, prophylaxis and to minimize impact on the community. Objective: To study the molecular epidemiology of respiratory syncytial virus (RSV) and describe the epidemiology of viruses: influenza (IF), influenza A (H1N1), adenovirus (AdV) and parainfluenza (PIV) at Hospital de Clinicas de Porto Alegre. Three studies were performed: (1) characterization of respiratory infections caused by RSV, IF, AdV and PIV in children, (2) validation of a technique of polymerase chain reaction in real-time (RT-PCR) to detect RSVA/B and IFA/B and (3) detection of genotypes of RSV in children with communityand hospital-acquired infection. Methods: In the first study, variables such as number of cases of viral (RSV, AdV, PIV or IF and H1N1) infection, hospitalizations in general wards and intensive care units (ICUs), nosocomial infections and lethality rates were collected. These variables obtained from each children (age 0-12 years) between 2007 and 2010. In the second study the assay RT-PCR was used to target the matrix gene of IFA, the hemagglutinin gene of IFB and the nucleoprotein gene of RSVA/B. The specificity of the assay and its limit of detection were determined. A comparison of RT-PCR and indirect immunofluorescence was performed. In the third study, 63 RSV isolates (21 nosocomial and 42 community-acquired) were submitted to sequencing to establish a phylogenetic analysis of this virus. Results: The different viruses presented a diversity of behaviors according to hospitalization, nosocomial outbreaks or lethality in children. RSV accounted for most nosocomial infections. Rates of ICU admission for AdV and RSV infection were highest in 2007 and 2010. During 2008–2009, H1N1 and AdV had the highest ICU admission rates. AdV and H1N1 had the highest lethality rates. The RT-PCR assay was more sensitive than immunofluorescence and it was able to detect viral co-infections. Futhermore, the limits of detection were 1 copy/μL for IFA, 10 copies/μL for IFB, 5 copies/μL for RSVA, and 250 copies/μL for RSVB. The genotyping study showed that hospital- and community-acquired RSVA isolates were from the same phylogenetic group (the same group of the NA1 Japanese isolates). Conversely, RSVB isolates were distributed across different groups: BA4, POA1, POA2, POA3 and POA4. This was the first study to describe circulation of the NA1 genotype in Brazil, as well as four RSVB genotypes: POA1, POA2, POA3 and POA4. Conclusion: The results obtained in the first study demonstrate the impact of seasonal epidemics of respiratory viruses. The second study confirmed that molecular techniques such as RT-PCR, are suitable for the detection of respiratory viruses. The third study reported emerging genotypes of RSV. Surveillance studies such as this should be performed periodically to monitor the behavior pattern of the virus in the target population.

Introdução: As infecções respiratórias causam elevadas morbidade e mortalidade, sendo os vírus os principais agentes destas doenças. O monitoramento e vigilância de vírus respiratórios, desde os mais conhecidos até os emergentes, são importantes para a gestão em saúde, orientando tempo de profilaxia e minimizando o impacto de epidemias nas comunidades. Objetivos: Estudar a epidemiologia molecular do vírus sincicial respiratório (VSR) e descrever a epidemiologia dos seguintes vírus: influenza (IF), influenza A (H1N1), adenovírus (AdV) e parainfluenza (PIV) no Hospital de Clínicas de Porto Alegre. Para isso foram conduzidos três estudos: (1) caracterização das infecções respiratórias causadas por VSR, IF, AdV e PIV em crianças; (2) validação de uma técnica de reação em cadeia da polimerase em tempo real (RT-PCR) para detecção de VSR A/B e IF A/B e (3) caracterização de genótipos do VRS em crianças com infecções comunitárias e hospitalares. Métodos: No primeiro estudo foram levantadas as seguintes variáveis: casos de infecções respiratórias por VSR, AdV, PIV ou IF e H1N1; internações em enfermarias hospitalares e internações em unidades de terapia intensiva (UTI); infecções hospitalares e taxas de letalidade. As variáveis foram coletadas durante o atendimento de crianças (idade 0-12 anos) no HCPA entre 2007 e 2010. No segundo estudo, os alvos do ensaio de RT-PCR foram: o gene da proteína da matriz de IFA, o gene da hemaglutinina do IFB e o gene da nucleoproteína de RSVA/B. A especificidade do ensaio e seu limite de detecção foram determinados. Uma comparação entre RT-PCR e imunofluorescência indireta foi realizada. No terceiro estudo, 63 isolados de VSR (21 de origem nosocomial e 42 adquiridos na comunidade) foram sequenciados para estabelecer uma análise filogenética deste vírus. Resultados: Cada um dos vírus estudados apresentou um comportamento diferente. O VSR demonstrou ser o principal agente envolvido em infecções nosocomiais. Já os pacientes com AdV, bem como o VSR, apresentaram altas taxas de admissão em UTI em 2007 e 2010. O AdV e o H1N1 tiveram as maiores taxas de letalidade. O ensaio de RT-PCR mostrou-se específico e foi mais sensível do que a imunofluorescência, sendo capaz de detectar co-infecções. Os seguintes limites de detecção foram obtidos: 1 cópia/mL para a IFA, 10 cópias/mL para IFB, 5 cópias/mL para RSVA e 250 cópias/mL para RSVB. A investigação dos genótipos de VSR revelou que todos os isolados VSRA circulantes eram do mesmo grupo filogenético, o genótipo NA1 de origem japonesa. Por outro lado, os isolados VSRB foram distribuídos em grupos diferentes: BA4, POA1, POA2, POA3 e POA4. Este estudo foi o primeiro que descreveu a circulação do genótipo NA1 no Brasil, bem como quatro novos genótipos (POA1, POA2, POA3 e POA4). Conclusão: Os resultados obtidos no primeiro estudo demonstram o impacto das epidemias sazonais de vírus respiratórios. O segundo estudo corroborou relatos da literatura que técnicas moleculares, como RT-PCR, são adequadas para a detecção de vírus respiratórios. O terceiro estudo relatou genótipos emergentes de VSR. Estudos de vigilância como os descritos acima deveriam ser conduzidos periodicamente para acompanhar o padrão de comportamento dos vírus na população alvo. / Background: Respiratory tract infections of viral origin are a major cause of morbidity and mortality worldwide. Surveillance of well-known viruses and emerging threats is important for management, prophylaxis and to minimize impact on the community. Objective: To study the molecular epidemiology of respiratory syncytial virus (RSV) and describe the epidemiology of viruses: influenza (IF), influenza A (H1N1), adenovirus (AdV) and parainfluenza (PIV) at Hospital de Clinicas de Porto Alegre. Three studies were performed: (1) characterization of respiratory infections caused by RSV, IF, AdV and PIV in children, (2) validation of a technique of polymerase chain reaction in real-time (RT-PCR) to detect RSVA/B and IFA/B and (3) detection of genotypes of RSV in children with communityand hospital-acquired infection. Methods: In the first study, variables such as number of cases of viral (RSV, AdV, PIV or IF and H1N1) infection, hospitalizations in general wards and intensive care units (ICUs), nosocomial infections and lethality rates were collected. These variables obtained from each children (age 0-12 years) between 2007 and 2010. In the second study the assay RT-PCR was used to target the matrix gene of IFA, the hemagglutinin gene of IFB and the nucleoprotein gene of RSVA/B. The specificity of the assay and its limit of detection were determined. A comparison of RT-PCR and indirect immunofluorescence was performed. In the third study, 63 RSV isolates (21 nosocomial and 42 community-acquired) were submitted to sequencing to establish a phylogenetic analysis of this virus. Results: The different viruses presented a diversity of behaviors according to hospitalization, nosocomial outbreaks or lethality in children. RSV accounted for most nosocomial infections. Rates of ICU admission for AdV and RSV infection were highest in 2007 and 2010. During 2008–2009, H1N1 and AdV had the highest ICU admission rates. AdV and H1N1 had the highest lethality rates. The RT-PCR assay was more sensitive than immunofluorescence and it was able to detect viral co-infections. Futhermore, the limits of detection were 1 copy/μL for IFA, 10 copies/μL for IFB, 5 copies/μL for RSVA, and 250 copies/μL for RSVB. The genotyping study showed that hospital- and community-acquired RSVA isolates were from the same phylogenetic group (the same group of the NA1 Japanese isolates). Conversely, RSVB isolates were distributed across different groups: BA4, POA1, POA2, POA3 and POA4. This was the first study to describe circulation of the NA1 genotype in Brazil, as well as four RSVB genotypes: POA1, POA2, POA3 and POA4. Conclusion: The results obtained in the first study demonstrate the impact of seasonal epidemics of respiratory viruses. The second study confirmed that molecular techniques such as RT-PCR, are suitable for the detection of respiratory viruses. The third study reported emerging genotypes of RSV. Surveillance studies such as this should be performed periodically to monitor the behavior pattern of the virus in the target population.

Introdução: As infecções respiratórias causam elevadas morbidade e mortalidade, sendo os vírus os principais agentes destas doenças. O monitoramento e vigilância de vírus respiratórios, desde os mais conhecidos até os emergentes, são importantes para a gestão em saúde, orientando tempo de profilaxia e minimizando o impacto de epidemias nas comunidades. Objetivos: Estudar a epidemiologia molecular do vírus sincicial respiratório (VSR) e descrever a epidemiologia dos seguintes vírus: influenza (IF), influenza A (H1N1), adenovírus (AdV) e parainfluenza (PIV) no Hospital de Clínicas de Porto Alegre. Para isso foram conduzidos três estudos: (1) caracterização das infecções respiratórias causadas por VSR, IF, AdV e PIV em crianças; (2) validação de uma técnica de reação em cadeia da polimerase em tempo real (RT-PCR) para detecção de VSR A/B e IF A/B e (3) caracterização de genótipos do VRS em crianças com infecções comunitárias e hospitalares. Métodos: No primeiro estudo foram levantadas as seguintes variáveis: casos de infecções respiratórias por VSR, AdV, PIV ou IF e H1N1; internações em enfermarias hospitalares e internações em unidades de terapia intensiva (UTI); infecções hospitalares e taxas de letalidade. As variáveis foram coletadas durante o atendimento de crianças (idade 0-12 anos) no HCPA entre 2007 e 2010. No segundo estudo, os alvos do ensaio de RT-PCR foram: o gene da proteína da matriz de IFA, o gene da hemaglutinina do IFB e o gene da nucleoproteína de RSVA/B. A especificidade do ensaio e seu limite de detecção foram determinados. Uma comparação entre RT-PCR e imunofluorescência indireta foi realizada. No terceiro estudo, 63 isolados de VSR (21 de origem nosocomial e 42 adquiridos na comunidade) foram sequenciados para estabelecer uma análise filogenética deste vírus. Resultados: Cada um dos vírus estudados apresentou um comportamento diferente. O VSR demonstrou ser o principal agente envolvido em infecções nosocomiais. Já os pacientes com AdV, bem como o VSR, apresentaram altas taxas de admissão em UTI em 2007 e 2010. O AdV e o H1N1 tiveram as maiores taxas de letalidade. O ensaio de RT-PCR mostrou-se específico e foi mais sensível do que a imunofluorescência, sendo capaz de detectar co-infecções. Os seguintes limites de detecção foram obtidos: 1 cópia/mL para a IFA, 10 cópias/mL para IFB, 5 cópias/mL para RSVA e 250 cópias/mL para RSVB. A investigação dos genótipos de VSR revelou que todos os isolados VSRA circulantes eram do mesmo grupo filogenético, o genótipo NA1 de origem japonesa. Por outro lado, os isolados VSRB foram distribuídos em grupos diferentes: BA4, POA1, POA2, POA3 e POA4. Este estudo foi o primeiro que descreveu a circulação do genótipo NA1 no Brasil, bem como quatro novos genótipos (POA1, POA2, POA3 e POA4). Conclusão: Os resultados obtidos no primeiro estudo demonstram o impacto das epidemias sazonais de vírus respiratórios. O segundo estudo corroborou relatos da literatura que técnicas moleculares, como RT-PCR, são adequadas para a detecção de vírus respiratórios. O terceiro estudo relatou genótipos emergentes de VSR. Estudos de vigilância como os descritos acima deveriam ser conduzidos periodicamente para acompanhar o padrão de comportamento dos vírus na população alvo. / Background: Respiratory tract infections of viral origin are a major cause of morbidity and mortality worldwide. Surveillance of well-known viruses and emerging threats is important for management, prophylaxis and to minimize impact on the community. Objective: To study the molecular epidemiology of respiratory syncytial virus (RSV) and describe the epidemiology of viruses: influenza (IF), influenza A (H1N1), adenovirus (AdV) and parainfluenza (PIV) at Hospital de Clinicas de Porto Alegre. Three studies were performed: (1) characterization of respiratory infections caused by RSV, IF, AdV and PIV in children, (2) validation of a technique of polymerase chain reaction in real-time (RT-PCR) to detect RSVA/B and IFA/B and (3) detection of genotypes of RSV in children with communityand hospital-acquired infection. Methods: In the first study, variables such as number of cases of viral (RSV, AdV, PIV or IF and H1N1) infection, hospitalizations in general wards and intensive care units (ICUs), nosocomial infections and lethality rates were collected. These variables obtained from each children (age 0-12 years) between 2007 and 2010. In the second study the assay RT-PCR was used to target the matrix gene of IFA, the hemagglutinin gene of IFB and the nucleoprotein gene of RSVA/B. The specificity of the assay and its limit of detection were determined. A comparison of RT-PCR and indirect immunofluorescence was performed. In the third study, 63 RSV isolates (21 nosocomial and 42 community-acquired) were submitted to sequencing to establish a phylogenetic analysis of this virus. Results: The different viruses presented a diversity of behaviors according to hospitalization, nosocomial outbreaks or lethality in children. RSV accounted for most nosocomial infections. Rates of ICU admission for AdV and RSV infection were highest in 2007 and 2010. During 2008–2009, H1N1 and AdV had the highest ICU admission rates. AdV and H1N1 had the highest lethality rates. The RT-PCR assay was more sensitive than immunofluorescence and it was able to detect viral co-infections. Futhermore, the limits of detection were 1 copy/μL for IFA, 10 copies/μL for IFB, 5 copies/μL for RSVA, and 250 copies/μL for RSVB. The genotyping study showed that hospital- and community-acquired RSVA isolates were from the same phylogenetic group (the same group of the NA1 Japanese isolates). Conversely, RSVB isolates were distributed across different groups: BA4, POA1, POA2, POA3 and POA4. This was the first study to describe circulation of the NA1 genotype in Brazil, as well as four RSVB genotypes: POA1, POA2, POA3 and POA4. Conclusion: The results obtained in the first study demonstrate the impact of seasonal epidemics of respiratory viruses. The second study confirmed that molecular techniques such as RT-PCR, are suitable for the detection of respiratory viruses. The third study reported emerging genotypes of RSV. Surveillance studies such as this should be performed periodically to monitor the behavior pattern of the virus in the target population.

Influenza virus is a pleiomorphic human pathogen which causes self-limiting respiratory illness lasting one-two weeks in most individuals. However, in immunologically compromised individuals, influenza infection may lead to severe morbidity and fatality. Annual epidemics cause 250,000-500,000 deaths worldwide and remain a major public health threat. The virus has evolved mechanisms of antigenic ‘drift’ and ‘shift’ to evade the host immune response. Hence, current influenza vaccines need to be updated every few years. Moreover, the currently available inactivated/live attenuated vaccines entail virus culture in embryonated chicken eggs hindering rapid scale-up. The aforementioned limitations of the current vaccines has had debilitating effect when strain mismatch between vaccine formulation and influenza viruses circulating within the population has occurred in the past, despite intensive monitoring. Public health is further compromised when an unpredictable mixing event among influenza virus genomes leads to antigenic shift, facilitating a potential pandemic outbreak. These concerns have expedited efforts towards developing a ‘universal’ flu vaccine. Influenza hemagglutinin (HA) is the primary target of the humoral response during infection/vaccination. The precursor polypeptide, HA0, is assembled into a trimer along the secretory pathway and transported to the cell surface. Cleavage of HA0 generates the mature, disulfide linked HA1 and HA2 subunits. Mature HA has a globular head domain which mediates receptor binding and is primarily composed of the HA1 subunit while the stem domain predominantly comprises of the HA2 subunit. The HA stem is trapped in a metastable state and undergoes an extensive low-pH induced conformational rearrangement in the host-cell endosomes to adopt the virus-host membrane fusion competent state. The ‘antigenic sites’ on the immunodominant globular head of HA are subjected to heightened immune pressure resulting in escape variants, thereby limiting the breadth of head-directed neutralizing antibodies (nAbs). As opposed to the highly-variable head domain, the HA stem is conserved and targeted by several broadly neutralizing antibodies (bnAbs) with neutralizing activity against diverse influenza A virus subtypes. Although several bnAbs bind to the conserved HA stem, focusing the immune response to this conserved, subdominant stem domain in presence of the variable head domain of HA has been challenging. Alternatively, mimicking the epitope of these stem-directed bnAbs in the native, pre-fusion conformation in a ‘headless’ stem immunogen capable of eliciting a broadly protective immune response has been difficult because of the metastable conformation of HA. Addressing the aforementioned challenges, we describe the design and characterization of novel influenza immunogens by HA protein minimization. Chapter 1 gives an overview of the influenza virus life cycle, and outlines the structural organization and function of viral proteins. The conventional vaccines that are currently used and their limitations are described in this chapter. Recent improvements in influenza vaccine production focusing on recombinant HA as an alternate solution are discussed. Painstaking efforts of several groups in the recent past has led to the isolation of bnAbs that recognize novel ‘antigenic signatures’ within the globular head and the HA stem domains. Attempts to focus the immune response to these ‘cross-protective’ epitopes are described. The design and characterization of trimeric HA stem-fragment immunogens from influenza A Group-1 viruses which mimic the native, pre-fusion conformation of HA are described in Chapter 2. We engineered ‘headless’ HA stem immunogens based on influenza A/Puerto Rico/8/34 (H1N1) subtype. H1HA10-Foldon, a trimeric derivative of our parent construct (H1HA10), bound conformation sensitive stem-directed bnAbs such as CR6261, F10 and FI6v3 with high affinity (equilibrium dissociation constant [KD] of 10-50nM). The designed immunogens elicited broadly cross-reactive antiviral antibodies which neutralized highly drifted influenza virus strains belonging to both Group-1 (H1, H5 subtypes) and 2 (H3 subtype) in vitro. Significantly, stem immunogens designed from unmatched, highly drifted influenza strains conferred protection against a lethal (2LD90) heterologous A/Puerto Rico/8/34 virus challenge in mice. Our immunogens conferred robust subtype-specific and modest heterosubtypic protection in vivo. In contrast to previous HA stem domain immunogens, the designed immunogens described here were purified from the soluble fraction in E.coli. These HA stem-fragment immunogens do not aggregate even at high concentrations and are cysteine-free which eliminates the complications arising from incorrect disulfide-linked, misfolded conformations. The aforementioned properties of the HA stem-fragment immunogens make it amenable for scalability at short notice which is vital during pandemic outbreaks. The detailed mechanism(s) by which our ‘headless’ stem immunogens provide protection need further investigation. The long central α-helices (LAH) located in the HA stem assemble together into a parallel, trimeric coiled-coil. Immunization with the wt-LAH (76-130 of HA2) derived synthetic peptide designed from an H3 subtype (H3N2 A/Hong Kong/1/68) and conjugated to keyhole limpet hemocyanin (KLH) was shown previously to elicit antibodies reactive in ELISA with multiple hemagglutinin subtypes and to confer protection against challenge with H3N2, H1N1 and H5N1 virus strains. The LAH peptide sequence was chosen based on maximal binding to the monoclonal antibody (MAb), 12D1, which has broad neutralizing activity against influenza viruses of the H3 subtype. These results motivated us to rationally design stabilized derivatives of wt-LAH and test their protective capacity in a mouse challenge model of influenza. This work is described in Chapter 3. Additionally, to understand the contribution towards protection conferred by the two distinct surface exposed patches on LAH, we designed constructs spanning different stretches of LAH. The biophysical characterization of the LAH-derived constructs indicates that most of them were well-folded. All these constructs were moderately immunogenic in mice but at best, conferred limited protection from lethal viral challenge. In contrast to previously reported results, our data suggests that the LAH in the absence of other regions of HA may require not only strong, but also specific adjuvantation to induce a robust and functional immune response in vivo. Chapter 4 describes an immunogen design (H1pHA9) based on the globular head domain of pandemic H1N1 HA which can be produced using a prokaryotic expression system. The HA-fragment, H1pHA9, stably refolds to mimic the conformation sensitive neutralizing epitopes in the globular head domain of HA. We have also successfully engineered the HA head domain to delineate the epitope of antibodies neutralizing the pandemic H1N1 virus using a yeast cell-surface display platform. In this direction, we report the isolation of a novel, neutralizing murine MAb, MA2077, against the pandemic H1N1 virus. The epitope of this MAb has been mapped onto the ‘Sa’ antigenic site. The ability of the head domain fragment, H1pHA9, which binds MA2077 with high affinity to elicit such neutralizing antibodies in vivo needs to be further explored. Structural analysis has shown that elements of the HA stem diverge between the two phylogenetic groups. Therefore, to mitigate the threat of circulating influenza A viruses from these distinct structural classes (H1 and H3 belonging to Groups 1 and 2 respectively), in lieu of a ‘universal’ vaccine, a combination of immunogens derived from both the groups is a practical alternative. In Chapter 5 we describe the design of stem-fragment immunogens from an influenza A Group-2 virus strain. We report the characterization of engineered ‘headless’ HA stem immunogens based on influenza A/Hong Kong/1/68 (H3N2) subtype. The designed immunogens were expressed in E.coli and purified from the soluble fraction with abundant yields (~15mg/lt). The HA stem-fragment immunogens could be concentrated to high concentrations without aggregation. While, H3HA10-IZ and H3HA10-Foldon, the trimeric derivatives of our parent construct (H3HA10) which were folded, conferred modest protection against a lethal homologous virus challenge in mice, there is considerable scope to improve our immunogen design. Analyzing the results from our previous work (Chapter 2), we speculate that structural elements at the N-terminus of A-helix are critical for helix initiation. We therefore extended the design to include residues from the start of the A-helix. We designed the extended stem immunogens from both H3 and H7 subtypes. The proteins were purified from the soluble fraction of the E.coli cell culture lysate. Preliminary studies suggest that extension of the A-helix has aided proper folding. These proteins need to be further characterized and evaluated in an animal model.

Le développement de médicaments efficaces contre le virus de l'immunodéficience humaine (VIH) est l'une des plus grandes réussites dans l'histoire médicale récente: lorsque la thérapie combinée est devenu la norme des soins en 1996, une maladie mortelle a été progressivement transformée en une maladie chronique gérable. Les décennies suivantes ont été consacrées à l'élaboration des schémas thérapeutiques consolidés pour les adultes et les enfants, à la prévention de la transmission mère-enfant et à élargir l'accès à la thérapie antirétrovirale dans les pays en développement. La réussite d'un traitement antiviral de l'infection par le VIH est devenue un modèle pour l'élaboration de stratégies de traitement efficaces pour d'autres maladies virales, telles que les hépatites, les infections à herpesviridae, enteroviridae, et la grippe A et B. Cette thèse vise à tracer une ligne continue depuis : (1) de nouveaux modèles in vitro pour simuler un traitement combiné contre un VIH-1 multirésistant afin de promouvoir la sélection du régime le plus/ durable chez les patients en sauvetage thérapeutique, à (2) la meilleure approche e11 termes de coût-bénéfice pour la surveillance de la pharmacorésistance dans les cohortes de patients traités dans des milieux à faibles ressources, et enfin jusqu'à (3) une approche translationnelle vers la gestion du traitement de la grippe et la prédiction du développement- de virus résistants aux médicaments chez les enfants. Elle vise à fournir une synthèse des leçons apprises dans l'optimisation de stratégies de traitements antiviraux et de la prévention des résistances contre le VIH et le virus de fa grippe chez les adultes et les enfants. / The development or efficacious drugs against the human immunodeficiency virus is one of the greatest success stories in the recent medical history: when combination therapy became standard of care after the Vancouver Conference in 1996, a deadly disease was gradually turned into a manageable chronic condition. The following decades have been dedicated to developing consolidated treatment regimens for both adults and children, to the prevention of mother-to-child transmission and to expanding access to antiretroviral therapy (AR1) in developing countries. Subsequently, the success story of antiviral treatment of Hl V infection has become a model for tl1e development of successful treatment strategies for other viral diseases, such as hepatitis and infections with herpesviridae, enteroviridae and influenza A and B. This thesis aims to draw a continuous line from: (1) new in vitro models to simulate comhination therapy against multidrug-resistant HIV-1 promoting the selection of the most sustainable regimen in salvage patients, to (2) a cost-effective approach to monitoring drug resistance in treatment cohorts in low-resource settings, and finally to (3) a translational approach to managing influenza therapy and predicting the development of drug resistant influenza in children. The work presented herein aims to provide a comprehensive view of the lessons learned in optimizing antiviral treatment strategies against HIV and influenza virus in adults and children