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La cellule est l’unité à la base de la vie. Elle est généralement délimitée par sa membrane et contient un noyau et du cytoplasme en plus d’autres composantes. Les cellules se divisent afin de maintenir et de perpétuer la vie par duplication de leur matériel génétique et par leur séparation en deux cellules physiquement distinctes durant la cytocinèse. Cependant, la division cellulaire est parfois modifiée et aboutit à la formation d’un tissu contenant plusieurs noyaux bordés d’une membrane unique appelé syncytium. Les syncytia sont fréquemment retrouvés chez les organismes vivants, bien que leurs fonctions et mode de formation restent peu compris. L’organisation en syncytium est conservée chez tous les animaux étudiés à ce jour au niveau de la lignée germinale dans laquelle les cellules partagent un cytoplasme commun par l’intermédiaire d’un pont intercellulaire stable. Dans la majorité des lignées germinales étudiées, les cellules sont directement connectées l’une à l’autre par un pont intercellulaire stable qui émerge de cytocinèses incomplètes. Cependant, certaines lignées germinales sont organisées autour d’une cavité commune à laquelle chaque cellule germinale est connectée. Dans ces lignées germinales, les mécanismes qui mènent à l’expansion du syncytium sont peu compris. Ma thèse décrit l’utilisation de la lignée germinale primordiale de C. elegans à son premier stade larvaire pour mieux comprendre l’organisation, l’expansion et la fonction des lignées germinales syncytiales. En utilisant la microscopie électronique et confocale, j’ai découvert que l’organisation du syncytium est fixée au premier stade larvaire. En effet, les deux cellules germinales primordiales (CGP) sont chacune individuellement connectée à une cavité cytoplasmique centrale par le biais de ponts intercellulaires stables. Nous avons nommé cette cavité le proto-rachis car l’organisation des CGP est identique à l’organisation de la gonade adulte. Chez l’adulte, les ponts intercellulaires qui connectent les cellules germinales au rachis sont stabilisés par des régulateurs d’actomyosine. Nous avons vérifié si cela était également le cas dans la gonade au premier stade larvaire. Tous les régulateurs présents dans la gonade adulte, sont aussi présent dans les ponts intercellulaires des CGP, mais la lignée germinale primordiale est réfractaire à la perturbation de la fonction de ces régulateurs. Ce résultat suggère que les régulateurs d’actomyosine sont organisés de manière très stable au premier stade larvaire. Afin de mieux comprendre comment le syncytium se développe dans la lignée germinale de C. elegans, j’ai ensuite suivi la première division des CGP par microscopie à temps réel. J’ai mis en évidence que l’anneau de cytocinèse se stabilise, puis se déplace vers le proto-rachis jusqu’à qu’il s’y intègre. Ces résultats indiquent que le syncytium se développe par cytocynèse incomplète. De plus, mes résultats montrent que la connexion au proto-rachis est maintenue durant la division des CGP. C’est pourquoi nous proposons un modèle pour l’expansion du syncytium dans lequel l’anneau de cytocinèse stabilise pour connecter une des cellules filles au proto-rachis, tandis que l’autre cellule fille est connecté par l’anneau stable qu’elle aura hérité de la cellule mère. Enfin, pour s’assurer que les mécanismes d’expansion du syncytium observés durant la division des CGP sont conservés au cours du développement de la gonade, j’ai conceptualisé et créé un dispositif de micro-fluidique qui en théorie permettrait de suivre plusieurs séries de division des CGP. En somme, mon travail de doctorat a fourni une caractérisation détaillée de la structure du syncytium dans la lignée germinale de C. elegans au premier stade larvaire, ainsi qu’un modèle pour l’expansion du syncytium. Mes découvertes indiquent que malgré des différences dans l’organisation des syncytia, la cytocinèse incomplète est un mécanisme conservé dans toutes les lignées germinales animales. Des travaux futurs seront nécessaires pour découvrir quelles voies de signalisation moléculaires sont sous-jacentes aux mécanismes de formation des syncytia, et ainsi de mieux comprendre quelle est la fonction de ces structures fascinantes. / The cell constitutes the basic unit of life. It is generally delimited by its membrane and contains a nucleus and cytoplasm amongst other components. To maintain and perpetuate life, cells divide by duplicating their genetic material, and by physically separating into two distinct cells during the process called cytokinesis. However, cell division is sometimes modified and leads to the formation of a tissue in which several nuclei are delimited by a single membrane, called a syncytium. Syncytial tissues are common amongst living organisms, but why and how they form remains unclear. The syncytial architecture is conserved in all studied animal germlines where germ cells share a common cytoplasm through stable intercellular bridges. In most animal germlines, the germ cells are directly connected with one another, and the stable intercellular bridges that connect the cells are known to arise from regulated incomplete cytokinesis. However, some germlines are organized around a central common cavity to which each germ cell is connected. In such germlines, the mechanisms of syncytium expansions remain unknown. My thesis describes the use of the C. elegans germline primordium at the first larval stage to better understand the organization, the expansion, and the function of germline syncytia. Using electron and confocal microscopy I found that the organization of the syncytium is established at the first larval stage. The two germ cells called the primordial germ cells (PGCs) each connect to a central cytoplasmic cavity through stable intercellular bridges. Because this organization is identical to the adult germline where each germ cell is connected to the central rachis, we termed the cavity between the PGCs proto-rachis. In the adult gonad, the intercellular bridges that connect the germ cells to the rachis are stabilized by actomyosin regulators, so I verified if this was also the case in the first larval stage gonad. All the regulators that localize to adult intercellular bridges were also present between the PGCs, but the primordial germ line is refractory to perturbation of these regulators. This suggests that the actomyosin regulators are organized in a very stable manner in the first larval stage germline. I next tracked the first division of the PGCs with live imaging to better understand how the syncytium expands in the C. elegans germline. I found that the cytokinetic ring stabilizes, then displaces towards the proto-rachis until it integrates into the syncytial structures. This finding suggests the syncytium expands by incomplete cytokinesis. In addition, my results indicate that the connection to the proto-rachis was maintained during PGCs division. We therefore propose a model in which the cytokinetic ring stabilizes and connects one of the daughter cells to the proto- rachis while the other cell is connected through the inherited stable ring from the mother cell. Finally, I designed and a created a microfluidic device that in theory would allow us to live image several rounds of PGCs division. This would confirm if the mechanisms of syncytium expansion that we observed during the first division of the PGCs are conserved in further development. My work has provided a detailed characterization of the syncytial structure in the C. elegans germline primordium as well as a model for syncytium expansion. My findings indicate that despite differences in the organization of the syncytium, incomplete cytokinesis is conserved as the mechanism for syncytium expansion in all animal germlines. Further research will be necessary to bring to light the molecular pathways underlying syncytium formation to have a better understanding of the function of these fascinating structures.

Thesis with manuscript / La communication intercellulaire joue un rôle important dans tous les organismes, car elle permet l'échange de molécules bioactives entre les cellules. La plupart des cellules peuvent sécréter des vésicules extracellulaires (VE) délimitées par une membrane, qui peuvent servir de médiateur pour le transfert sélectif de matériel génétique, en particulier de molécules d'ARN, vers des cellules réceptrices et modifier leur phénotype. Pour faciliter le ciblage de l'ARN vers les VE, les protéines de liaison de l'ARN (RBP) interagissent avec les ARN, formant des complexes ribonucléoprotéiques (RNP) et guidant leur localisation vers les sites de production des VE. Alors que la facilitation du transport de l'ARN par les RBP est bien étudiée dans les cellules, leur mécanisme dans les VE reste mal compris. Pour mieux comprendre le chargement sélectif des ARN dans les VE, nous avons effectué un profilage RBP complet du sécrétome libéré par les cellules épithéliales mammaires humaines (HMLE), en comparaison avec le matériel des cellules entières. Nous avons d'abord utilisé la réticulation UV pour lier de manière covalente les RBP et leurs ARN associés, puis nous avons isolé le sécrétome par ultracentrifugation et purifié les RBP par extraction d'ARN lié à des protéines (XRNAX) et par spectrométrie de masse (MS). Grâce à une analyse comparative des RBP dans les environnements cellulaire et extracellulaire, nous avons identifié des collections de protéines associées à l'ARN qui étaient communes aux deux compartiments (n=189), ou qui présentaient une association plus spécifique avec l'ARN dans les échantillons cellulaires (n= 866) ou EV (n=502). Nous avons constaté que les RBP du compartiment extracellulaire (ExRBP) avaient des signatures fonctionnelles distinctes (par exemple, le métabolisme cellulaire, la structure et la modification des cellules, le repliement des protéines) par rapport aux facteurs enrichis en cellules (par exemple, le processus métabolique de l'ARN non codant). Notamment, des RBP EV bien connus, tels que ALIX, ANXA1, hnRNPR, hnRNPQ (SYNCRIP), YBX1, ainsi que des marqueurs EV de tétraspanine (CD9, CD81, TSG101), étaient enrichis dans l'ExRBP, ce qui indique le succès de XRNAX dans la purification des RBP EV. En comparant notre collection d'ExRBP aux signatures MS des VE plus pures dérivées des cellules HMLE, nous avons également pu délimiter les ExRBP qui vi sont susceptibles d'être enrichies en VE (PureEVRBP) par rapport à celles trouvées dans le sécrétome non VE (SecRBP). Il est frappant de constater que le PureEVRBP étaient enrichies en protéines de jonction cellulaire, tandis que le secRBP étaient enrichies en facteurs spliceosomaux, ce qui implique un chargement sélectif des RBP dans les VE ou leur sécrétion dans l'espace extracellulaire. Cette recherche fournit des informations précieuses sur la composition des RBP dans les EV, servant d'ensembles de données protéomiques clés pour élucider davantage les mécanismes modulant le recrutement sélectif des ARN dans les EV et améliorant notre connaissance des rôles des RBP dans la biologie des VE. / Intercellular communication plays an important role in all organisms, as it enables the exchange of bioactive molecules between cells. Most cells can secrete membrane-delimited extracellular vesicles (EVs), which can mediate the selective transfer of genetic material, in particular RNA molecules, to recipient cells and modify their phenotypes. To facilitate the targeting of RNA to EVs, RNA binding proteins (RBPs) are thought to interact with RNAs, forming ribonucleoprotein complexes (RNPs) and guiding their localization to sites of EV production. While the facilitation of RNA transportation by RBPs is well-studied in cells, their mechanism in EVs remain poorly understood. To gain insights into the selective loading of RNAs into EVs, we conducted comprehensive RBP profiling on the secretome released by Human Mammary Epithelial (HMLE) cells, in comparison to whole cell material. We first employed UV cross-linking to covalently link RBPs and their associated RNAs, followed by secretome isolation through ultracentrifugation and purification of RBPs using Protein-Xlinked RNA Extraction (XRNAX) and mass spectrometry (MS). Through a comparative analysis of RBPs in cellular and extracellular environment, we identified collections of RNA-associated proteins that were common to both compartments (n=189), or which exhibited more specific RNA association in cellular (n= 866) or EV (n=502) specimens. We found that extracellular compartment RBPs (ExRBPs) had distinctive functional signatures (e.g. cellular metabolism, cell structure and modification, protein folding) compared to cellular-enriched factors (e.g. non-coding RNA metabolic process). Notably, well-known EV RBPs, such as ALIX, ANXA1, hnRNPR, hnRNPQ (SYNCRIP), YBX1, as well as tetraspanin EV markers (CD9, CD81, TSG101), were enriched in ExRBP, indicating the success of XRNAX in EV RBP purification. By comparing our ExRBP collection to the MS signatures of more pure HMLE cell derived EVs, we were also able to delineate ExRBPs that are likely to be EV-enriched enriched versus those found in the non-EV secretome. Strikingly, pure EV-RBPs were enriched for cell-junction proteins, while general secretome RBPs were enriched for spliceosomal factors, implying selective loading of RBPs into EVs or their secretion into the extracellular space. This research provides valuable insights into the composition of RBPs in EVs, serving as key proteomic datasets to further elucidate iv the mechanisms modulating the selective recruitment of RNAs into EVs and enhancing our knowledge of the roles of RBPs in EV biology.

Porcine circovirus type 2 (PCV2) is the causative agent of porcine circovirus-associated disease (PCVAD). Porcine reproductive and respiratory syndrome (PRRS) is caused by PRRS virus (PRRSV). Both PCV2 and PRRSV have caused devastating diseases in the swine industry worldwide, resulting in immense economic losses. One of the most common co-infections in the swine industry is PCV2 and PRRSV. The aim of this dissertation research is to explore different experimental approaches to develop novel vaccines against the two major pathogens affecting swine production and study the basic mechanisms that may be involved in viral pathogenesis. Two types of porcine circovirus (PCV), PCV1 and PCV2, have been identified thus far. PCV1, first identified as a contaminant of the PK-15 cell line, is non-pathogenic and has a low prevalence in swine herds. PCV2 is highly prevalent in most swine-producing countries and is associated with clinical PCVAD. The non-pathogenic PCV1 shares similar genomic organization with PCV2. Previously, it has been demonstrated that a genetically modified infectious chimeric PCV1-2a virus can tolerate up to a 27 aa insertion in the C-terminus of the ORF2 without affecting infectivity and produce a dual immune response against PCV2cap and the inserted epitope tag. Therefore, we evaluated the use of the non-pathogenic PCV1 wild-type (wt) virus and chimeric PCV1-2a vaccine virus (vs) to express four known B-cell epitopes of PRRSV. Peptide epitopes of PRRSV-VR2385, including GP2II (aa 40–51, ASPSHVGWWSFA), GP3I (aa 61–72, QAAAEAYEPGRS), GP5I (aa 35–46, SSSNLQLIYNLT), and GP5IV (aa 187–200, TPVTRVSAEQWGRP) were inserted in frame into the C-terminus of the ORF2 of PCV1wt as well as the PCV1-2avs. Four PCV1-PRRSVEPI chimeric viruses and four PCV1-2a-PRRSVEPI chimeric viruses were successfully rescued and shown to be infectious in vitro and co-expressed PCV1cap or PCV2cap with each specific PRRSV epitope. Two independent animal studies were conducted to evaluate whether the non-pathogenic PCV1 can serve as a vaccine delivery vector and whether the PCV1-2a vaccine virus can be used to develop a bivalent vaccine against both PCV2 and PRRSV. We demonstrated that three PCV1-PRRSVEPI chimeric viruses and two PCV1-2a-PRRSVEPI chimeric viruses were infectious in pigs. Importantly, we demonstrated that the PCV1-PRRSVEPI and PCV1-2a-PRRSVEPI chimeric viruses not only induced specific PCV1 or PCV2 IgG antibody but also specific anti-PRRSV epitope antibody responses as well. Regardless of the PCV backbone used, we showed that the PCV-PRRSV chimeric viruses elicited neutralizing antibodies against PRRSV-VR2385. These results provided a proof of concept for the potential use of the non-pathogenic PCV1 as a vaccine delivery system for PRRSV or other swine pathogens and the use of PCV1-2a vaccine virus to generate a bivalent vaccine against both PCV2 and PRRSV. PRRSV causes a persistent infection and immunosuppression. Immunomodulation of the host immune system is caused by modulation of numerous interleukins, such as type I interferons, tumor necrosis factor alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), and interleukin-12 (IL-12) in infected pigs. Antigen-presenting cells (APCs) are the first line of defense, and their infection plays an important role in innate-mediated immune regulation during early immune responses. Among the APCs, pulmonary alveolar macrophages (PAMs), pulmonary interstitial macrophages (PIMs), and dendritic cells (DCs) are the main targets for PRRSV replication. The role of PRRSV-DCs interaction is not fully understood, and current research focuses on the production and regulation of interferons through DC-SIGN receptors. In this study, we evaluated the immunomodulation of MoDCs by PRRSV through interactions with the pDC-SIGN receptor, by blocking pDC-SIGN with recombinant hICAM-3-Fc or anti-pDC-SIGN mAb. Our results indicate that recombinant hICAM-3-Fc enhances mRNA expression of proinflammatory cytokines and that anti-pDC-SIGN mAb inhibits mRNA expression of TNF-α and IL-1α and enhances the expression of IL-12 induced by PRRSV in MoDCs. The results will help understand the molecular mechanisms of PRRSV pathogenesis. / Ph. D.

No / Gestational diabetes mellitus (GDM) is known to be associated with fetal endothelial dysfunction, however, the mechanisms are not fully understood. This study examines the effect of maternal diabetes on fetal endothelial function and gene expression under physiological glucose conditions (5 mM). Human umbilical vein endothelial cell (HUVEC) isolated from diabetic mothers (d.HUVEC) grew more slowly than HUVEC isolated from healthy mothers (c.HUVEC) and had delayed doubling time despite increased levels of total vascular endothelial growth factor (VEGF) expression and protein production as determined by real-time PCR and ELISA respectively. Using western blot, the levels of antiproliferative VEGF165b isoform were increased in d.HUVEC relative to c.HUVEC. Successful VEGF165b knockdown by small interfering RNA (siRNA) resulted in increased proliferation of d.HUVEC measured by MTT, compared with negative siRNA control, to similar levels measured in c.HUVEC. In addition, d.HUVEC generated excess levels of ROS as revealed by 2',7' Dichlorodihydrofluorescein Diacetate (DCFH-DA) and Nitrotetrazolium blue (NBT). Using microarray, 102 genes were differentially overexpressed between d.HUVEC versus c.HUVEC (>1.5-fold change; P < 0.05). Functional clustering analysis of these differentially expressed genes revealed participation in inflammatory responses (including adhesion) which may be related to pathological outcomes. Of these genes, ICAM-1 was validated as upregulated, confirming microarray results. Additional confirmatory immunofluorescence staining revealed increased protein expression of ICAM-1 compared with c.HUVEC which was reduced by vitamin C treatment (100 muM). Thus, maternal diabetes induces persistent alterations in fetal endothelial function and gene expression following glucose normalization and antioxidant treatment could help reverse endothelium dysfunction.

INTRODUÇÃO: Os distúrbios minerais e ósseos da doença renal crônica (DMO-DRC) são influenciados por vários fatores, como idade, etiologia da DRC, toxinas urêmicas e modalidade dialítica. Os DMO-DRC são bem descritos em pacientes tratados com hemodiálise (HD). No entanto, na diálise peritoneal (DP) os estudos são escassos e, na maioria deles, não há dados de histologia óssea. OBJETIVOS: caracterizar os DMO-DRC em uma coorte de pacientes em DP; comparar os resultados com aqueles obtidos da HD; e analisar o desempenho de marcadores séricos para o diagnóstico das doenças de alto e baixo remodelamento ósseo. MÉTODOS: quarenta e um pacientes tratados com DP submeteram-se a avaliação clínica, bioquímica e biópsia óssea. RESULTADOS: a doença óssea adinâmica (DOA) foi o tipo de osteodistrofia renal (OR) predominante, correspondendo a 49% da amostra. Ao se analisar separadamente diabéticos e não diabéticos, a prevalência de DOA foi de 77,7% no primeiro grupo e 26% no segundo (p=0,001). Na comparação entre DP e HD, observou-se que os pacientes do primeiro grupo apresentavam 25(OH) vitamina D mais baixa, mineralização óssea mais comprometida e melhor volume ósseo. A fosfatase alcalina óssea (FAO) apresentou a melhor sensibilidade e especificidade tanto para o diagnóstico de alto, quanto de baixo remodelamento ósseo. CONCLUSÕES: a DOA é o tipo de OR mais prevalente na DP. No entanto, a influência do diabetes como fator de risco parece ser maior do que a própria modalidade dialítica / INTRODUCTION: Chronic kidney disease - mineral bone disorder (CKD-MBD) is a complex syndrome influenced by various factors, such as age, CKD etiology, uremic toxins and dialysis modality. CKD-MBD has been extensively studied in hemodialysis (HD) patients. However, for peritoneal dialysis (PD), only a few, older studies exist, most of which contain no bone biopsy data. The present study sought to: characterize CKD-MBD in a cohort of prevalent PD patients; compare the results with that obtained from HD patients; and analyse performance of bone turnover serum markers to make the diagnosis of high or low bone turnover disease in PD patients. METHODS: Forty-one PD patients underwent to a clinical evaluation, biochemical analysis and bone biopsy. RESULTS: The most prevalent pattern of renal osteodystrophy (ROD) was adynamic bone disease (ABD), comprising 49% of the sample population. When we separately analyzed diabetic and non-diabetic patients, the ABD prevalence was 77.7% in the former group and 26% in the latter group (p=0.001). The comparison between DP and HD patients revealed low 25(OH) vitamin D level, worst bone mineralization and better bone volume parameters in the former group. Bone alkaline phosphatase (BAP) demonstrated the best sensitivity and specificity values to detect both high and low turnover disease. CONCLUSION: ABD is the most frequent type of ROD. However, the effect of diabetes on the development of ABD is more important than the dialysis modality itself

INTRODUÇÃO: A elevada frequência e morbimortalidade das infecções do trato respiratório inferior (ITRI) pelo vírus sincicial respiratório (VSR) na infância, além da ausência de estudos no Brasil que correlacionam evolutivamente a resposta inflamatória no epitélio respiratório e no sangue periférico à gravidade da doença respiratória pelo VSR, estimularam a realização desta pesquisa. OBJETIVOS: Avaliar se as concentrações dos mediadores inflamatórios (MI) (RANTES, sICAM-1, TNF-,IL -6 e IL-10) e suas razões na secreção nasofaríngea e no sangue de crianças com idade inferior a 3 meses e ITRI pelo VSR correlacionam-se à gravidade da doença; determinar a frequência dos grupos A e B do VSR nas crianças internadas na Unidade de Cuidados Intensivos Neonatal (UCINE) do Instituto da Criança do HCFMUSP; avaliar se há diferença na gravidade da doença respiratória pelo VSR entre as crianças internadas na UCINE e infectadas pelos grupos A e B do vírus; comparar as concentrações dos MI na secreção nasofaríngea e no sangue à admissão hospitalar ou por ocasião do diagnóstico de ITRI pelo VSR adquirida durante a internação, no terceiro e sétimo dias de evolução ou à alta (se antes do sétimo dia); comparar as concentrações dos MI na secreção nasofaríngea e no sangue dos pacientes à admissão, de acordo com grupos A e B do VSR; e descrever a evolução das concentrações de RANTES, sICAM-1, TNF-, IL-6 e IL-10 na secreção nasofaríngea e no sangue durante a doença pelo VSR. MÉTODOS: Foram incluídas no estudo prospectivo, de coorte, observacional, de julho de 2004 a dezembro de 2005, 30 crianças com idade inferior a três meses portadoras de ITRI pelo VSR internadas na UCINE. Foram medidas as concentrações dos MI na secreção nasofaríngea e no soro de todas as crianças à admissão no estudo, no terceiro e sétimo dias de evolução ou à alta hospitalar (se antes do sétimo dia) através da técnica ELISA sanduíche. Utilizamos para avaliar a gravidade da doença respiratória os seguintes marcadores clínicos: sistema de escore clínico modificado de De Boeck et al. (1997), tempos de oxigenoterapia e de ventilação mecânica e duração da internação. RESULTADOS: Houve correlação positiva significante entre a gravidade da doença pelo sistema de escore clínico modificado à admissão hospitalar e as concentrações na secreção nasofaríngea de sICAM-1 (r=0,401, p=0,028) e IL-10 (r=0,412, p=0,024) e de IL-6 no soro (r=0,469, p=0,009). Houve também correlação positiva significante entre as concentrações de IL-6 no soro e o tempo de oxigenoterapia (r=0,445, p=0,023) e a duração da internação (r=0,572, p=0,001). Das razões dos MI estudadas, a IL-10/IL-6 (primeiras amostras de soro), a IL-6/TNF- e a IL -6/IL-10 (segundas amostras de soro) foram associadas de forma mais consistente (p<0,001) à gravidade da ITRI pelo VSR. Não ocorreram óbitos entre as crianças envolvidas neste estudo. Os dois grupos de VSR causaram ITRI nas crianças internadas na UCINE, sendo que o grupo A foi o mais frequente (57%). No entanto, foram as crianças infectadas pelo grupo B do VSR as que evoluíram com maior morbidade (p<0,001). As medianas das concentrações de RANTES, sICAM-1 e IL-10 foram maiores nas três amostras de soro (p<0,001); enquanto as medianas das concentrações de IL-6 predominaram nas três amostras de secreção nasofaríngea (p<0,001). A mediana das concentrações de TNF- foi maior apenas nas primeiras amostras de secreção nasofaríngea (p<0,001). Houve diferença estatisticamente significante entre os dois grupos do VSR apenas em relação à mediana das concentrações de IL-10 na secreção nasofaríngea à admissão hospitalar, que foi mais elevada nas crianças com infecção pelo grupo B (p=0,039). As concentrações de RANTES, sICAM-1, IL-6 e IL-10 na secreção nasofaríngea e de TNF-,IL -6 e IL-10 no soro variaram, de forma significante, durante a evolução da ITRI pelo VSR. Os demais níveis de MI na secreção nasofaríngea e no soro mantiveram-se estáveis durante o período de estudo. CONCLUSÕES: Níveis de RANTES, sICAM-1, TNF-,IL -6 e IL-10 foram detectados em todas as amostras de secreção nasofaríngea e de soro das crianças com ITRI pelo VSR internadas na UCINE, confirmando o papel destes MI na patogênese da doença. Nossos resultados sugerem que as concentrações de sICAM-1 e IL-10 na secreção nasofaríngea e IL-6 no soro à admissão, bem como as razões IL-10/IL-6 (primeiras amostras de soro), IL-6/TNF- e IL -6/IL-10 (segundas amostras de soro), poderiam ser usadas como marcadores de gravidade da doença respiratória pelo VSR. Os níveis de IL-6 determinados no soro admissão também poderiam ser usados para predizer tempo de oxigenoterapia e duração da internação mais prolongados. Os grupos A e B do VSR cocircularam durante o período do estudo, com o grupo A sendo dominante nestes pacientes. Entretanto, foram as crianças infectadas com o grupo B do vírus que evoluíram com maior morbidade. As concentrações de IL-10 na secreção nasofaríngea à admissão hospitalar foram significantemente maiores nos pacientes com ITRI pelo grupo B do VSR. O tempo de evolução da doença pelo VSR foi significante para os níveis de RANTES, sICAM-1, IL-6 e IL-10 na secreção nasofaríngea e de TNF-,IL -6 e IL-10 no soro destas crianças. / INTRODUCTION: The high frequency and morbimortality of respiratory syncytial virus (RSV) lower respiratory tract infections (LRTI) in children, besides the lack of studies in Brazil that evolutionally correlate the inflammatory response in respiratory epithelium and in peripheral blood with RSV respiratory disease severity, have stimulated this research. OBJECTIVES: To assess whether the concentrations of inflammatory mediators (IM) (RANTES, sICAM-1, TNF- , IL-6 and IL-10) and their ratios in nasopharyngeal secretion and in blood of children less than 3 months of age and RSV LRTI correlate with disease severity; to determine the frequency of RSV groups A and B in children admitted to Unidade de Cuidados Intensivos Neonatal (UCINE) do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; to assess whether there is difference in RSV respiratory disease severity, according to RSV groups A and B; to compare the concentrations of IM in nasopharyngeal secretion and in blood at the time of hospital admission or by occasion of a diagnosis of RSV LRTI acquired during the stay, on third and seventh days of evolution or at the hospital discharge (should it had happened before the seventh day); to compare the concentrations of IM in nasopharyngeal secretion and in blood of patients at the hospital admission, according to RSV groups A and B; to describe the evolution of RANTES, sICAM-1, TNF-, IL-6 and IL-10 concentrations in nasopharyngeal secretion and in blood. METHODS: Thirty children less than 3 months of age with RSV LRTI admitted to UCINE were included in the prospective cohort observational study, from July 2004 to December 2005. The concentrations of IM were measured through the sandwich ELISA technique in nasopharyngeal secretion and in serum of all children at the hospital admission, and on the third and seventh days of evolution or at the hospital discharge (if before the seventh day). We used the following markers to assess the severity of respiratory illness: the modified clinical scoring system by De Boeck et al. (1997), the days of oxygen supplementation and of mechanical ventilation and duration of hospitalization. RESULTS: There was a significant positive correlation between severity of disease by modified clinical scoring system at the time of hospital admission and nasopharyngeal secretion sICAM-1 (r=0.401, p=0.028) and IL-10 concentrations (r=0.412, p=0.024) and serum IL-6 concentrations (r=0.469, p=0.009). There was also a significant positive correlation between serum IL-6 concentrations and the days of oxygen supplementation (r=0.572, p=0.001), as well as the days of hospital stay (r=0.572, p=0.001). Of IM ratios studied, IL-10/ IL-6 (first samples of serum), IL-6/TNF- and IL-6/IL-10 (second samples of serum) were associated to severity of RSV LRTI with greatest consistency (p<0.001). No fatal cases occurred among the children enrolled in this study. The two groups of RSV caused LRTI in 30 children less than 3 months of age hospitalized in UCINE, being group A the most frequent (57%). However, the children infected by RSV group B were the ones that evolved with a greater need of mechanical ventilation (p<0.001). Medians RANTES, sICAM-1 and IL-10 concentrations were greater in all the three serum samples (p<0.001); whereas medians IL-6 concentrations were predominant in the three nasopharyngeal secretion samples (p<0.001). Median TNF- concentration was greater only in the first nasopharyngeal secretion samples (p<0.001). There was a statistically significant difference between the two groups of RSV only relative to the median IL-10 concentrations on first nasopharyngeal secretion samples, which was more elevated in children infected by RSV group B (p=0.039). The nasopharyngeal secretion RANTES, sICAM-1, IL-6 and IL-10 and serum TNF- , IL-6 and IL-10 concentrations varied significantly during the evolution of RSV LRTI. The other nasopharyngeal secretion and serum IM levels remained stable during the period of study. CONCLUSIONS: Levels of RANTES, sICAM-1, TNF- , IL-6 and IL-10 were detected in all nasopharyngeal secretion and serum samples of children with RSV LRTI admitted to UCINE, therefore confirming the role of these IM in pathogenesis of illness. Our results suggest that nasopharyngeal secretion sICAM-1 and IL-10 and serum IL-6 concentrations determined at hospital admission, as well as the ratios IL-10/IL-6 (first samples of serum), IL-6/TNF- and IL-6/IL-10 (second samples of serum), could be used as markers of RSV respiratory disease severity. The levels of IL-6 found in serum at the time of hospital admission could also be used to predict prolonged oxygen supplementation and hospital stay. RSV groups A and B co-circulated during the period of the study, with group A being dominant in these patients. However, the children infected by RSV group B were the ones that evolved with a greater morbidity. Nasopharyngeal secretion IL-10 concentrations at admission were significantly greater in patients with RSV group B LRTI. The duration of RSV disease evolution was significant to nasopharyngeal secretion RANTES, sICAM-1, IL-6, IL-10 levels and to serum TNF- , IL-6 and IL-10 concentrations of these children.

INTRODUÇÃO: Eventos vasculares e imunológicos são centrais na patogênese da granulomatose com poliangeíte (GPA). Moléculas de adesão celular tem papel fundamental no recrutamento de células inflamatórias do sangue para os tecidos. Diferentes leitos vasculares apresentam particularidades na expressão de moléculas de adesão celular explicando talvez parte da especificidade da GPA por determinados órgãos. A elevação no nível sérico de moléculas de adesão celular e aumento da expressão destas em amostras de biópsia renal já foram demonstrados em pacientes com vasculite ANCA associada. No entanto, o fenômeno ainda não foi estudado in situ no pulmão. OBJETIVO: O objetivo deste estudo foi analisar o padrão de expressão endotelial pulmonar de três moléculas de adesão celular na GPA, in situ: molécula de adesão intercelular 1 (ICAM-1), molécula e adesão vascular 1 (VCAM-1) e E-selectina. MÉTODOS: Examinou-se a expressão endotelial de ICAM-1, VCAM-1, E-selectina usando marcação imuno-histoquímica em secções de pulmão fixadas e parafinadas de lesões de GPA (n = 8 casos, 90 secções transversais de vasos analisados). Foram também analisados controles positivos: amostras de pulmão de doença intersticial associada à esclerodermia (SScl) (n = 8 casos, 96 secções transversais de vasos analisados) e controles negativos (n = 9 casos, 90 secções transversais de vasos analisados). A quantificação imuno-histoquímica foi realizada no aumento de 400x usando a técnica de point-counting. RESULTADOS: ICAM-1: A expressão endotelial mediana de ICAM-1 esteve aumentada de forma semelhante na GPA e na SScl (81% and 73%, respectivamente; p = 0.97). A comparação com o grupo controle (26.3%) revelou diferença estatisticamente significativa entre controle e GPA (p <0.001) quanto entre controle e SScl (p = 0.017). VCAM-1: A expressão mediana de VCAM-1 esteve significativamente aumentada na GPA se comparada a SScl (79.5% vs 41.4%; p = 0.012), no entanto, a expressão endotelial de VCAM-1 nos controles também esteve moderadamente aumentada (49.8%) e não houve diferença estatística entre SScl e controles ( p = 0.549) ou entre GPA e controles (p = 0.242). E-selectina: A expressão endotelial mediana de E-selectina esteve aumentada de forma semelhante na GPA e SScl (100% e 88.2%, respectivamente; p = 0.272). A comparação com o grupo controle (13.8%) revelou diferença estatisticamente significativa entre controle e GPA (p < 0.001) e controle e SScl (p = 0.045). CONCLUSÃO: Esses achados evidenciam o fenômeno de ativação endotelial pulmonar in situ em lesões de GPA. O perfil de expressão de moléculas de adesão parece ter particularidades em diferentes doenças a exemplo da maior expressão de VCAM-1 na GPA em relação à SScl. Essas observações contribuem para o conhecimento fisiopatogênico na GPA. / INTRODUCTION: Vascular and immunologic processes are central to the pathogenesis of granulomatosis with polyangiitis (GPA). Endothelial cellular adhesion molecules have a central role in recruiting leukocytes to sites of inflammation. Moreover, different vascular beds are phenotypically and functionally distinct with regard to expression of cellular adhesion molecules. They have been shown to be elevated in sera and in renal biopsies of patients with active ANCA-associated vasculitis. Despite of that, the expression of cellular adhesion molecules has not been studied in situ in the lungs. OBJECTIVE: Within this context, the aim of this study was to analyze the in situ pulmonary endothelial immunohistochemical pattern of expression of three cellular adhesion molecules in GPA: intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and E-selectin . METHODS: For such, we examined formalin-fixed, paraffin-embedded sections of lung lesions of GPA (n = 8 cases, 90 transverse sections of pulmonary vessels), negative controls which were obtained from autopsies ( n = 9 cases, 90 transverse sections of pulmonary vessels analyzed) and positive controls which were cases of interstitial lung disease associated with systemic sclerosis (SScl) (n = 8 cases, 96 transverse sections of pulmonary vessels). The quantification of the immunohistochemical staining was performed at x400 magnification using the technique of point-counting, previously described. RESULTS: ICAM-1: Median endothelial expression of ICAM-1 was similarly enhanced in GPA and SScl (81% and 73%, respectively; p = 0.97). When compared to controls (26.3%), both GPA (p <0.001) and SScl (p = 0.017) had significantly higher endothelial expression of ICAM-1. VCAM-1: Median endothelial expression of VCAM-1 was significantly enhanced in GPA when compared to SScl (79.5% vs 41.4%; p = 0.012), however the endothelial expression of VCAM-1 in the controls was also moderately enhanced (49.8%) and no statistically significant difference was found between SScl and controls ( p = 0.549) or between GPA and controls (p = 0.242). E-selectin: Median endothelial expression of E-selectin was similarly enhanced in GPA and SScl (100% and 88.2%), respectively; p = 0.272. When compared to controls (13.8%), both GPA (p < 0.001) and SScl (p = 0.045) had significantly higher endothelial expression of E-selectin. CONCLUSION: These observations are evidence of in situ pulmonary endothelial activation in lesions of GPA. The profile of expression of cellular adhesion molecules seems to be particular for each disease state and timing as evidenced by the enhanced expression of VCAM-1 in GPA when compared to SScl. These observations add information to the pathogenetic knowledge of GPA

INTRODUÇÃO: A elevada frequência e morbimortalidade das infecções do trato respiratório inferior (ITRI) pelo vírus sincicial respiratório (VSR) na infância, além da ausência de estudos no Brasil que correlacionam evolutivamente a resposta inflamatória no epitélio respiratório e no sangue periférico à gravidade da doença respiratória pelo VSR, estimularam a realização desta pesquisa. OBJETIVOS: Avaliar se as concentrações dos mediadores inflamatórios (MI) (RANTES, sICAM-1, TNF-,IL -6 e IL-10) e suas razões na secreção nasofaríngea e no sangue de crianças com idade inferior a 3 meses e ITRI pelo VSR correlacionam-se à gravidade da doença; determinar a frequência dos grupos A e B do VSR nas crianças internadas na Unidade de Cuidados Intensivos Neonatal (UCINE) do Instituto da Criança do HCFMUSP; avaliar se há diferença na gravidade da doença respiratória pelo VSR entre as crianças internadas na UCINE e infectadas pelos grupos A e B do vírus; comparar as concentrações dos MI na secreção nasofaríngea e no sangue à admissão hospitalar ou por ocasião do diagnóstico de ITRI pelo VSR adquirida durante a internação, no terceiro e sétimo dias de evolução ou à alta (se antes do sétimo dia); comparar as concentrações dos MI na secreção nasofaríngea e no sangue dos pacientes à admissão, de acordo com grupos A e B do VSR; e descrever a evolução das concentrações de RANTES, sICAM-1, TNF-, IL-6 e IL-10 na secreção nasofaríngea e no sangue durante a doença pelo VSR. MÉTODOS: Foram incluídas no estudo prospectivo, de coorte, observacional, de julho de 2004 a dezembro de 2005, 30 crianças com idade inferior a três meses portadoras de ITRI pelo VSR internadas na UCINE. Foram medidas as concentrações dos MI na secreção nasofaríngea e no soro de todas as crianças à admissão no estudo, no terceiro e sétimo dias de evolução ou à alta hospitalar (se antes do sétimo dia) através da técnica ELISA sanduíche. Utilizamos para avaliar a gravidade da doença respiratória os seguintes marcadores clínicos: sistema de escore clínico modificado de De Boeck et al. (1997), tempos de oxigenoterapia e de ventilação mecânica e duração da internação. RESULTADOS: Houve correlação positiva significante entre a gravidade da doença pelo sistema de escore clínico modificado à admissão hospitalar e as concentrações na secreção nasofaríngea de sICAM-1 (r=0,401, p=0,028) e IL-10 (r=0,412, p=0,024) e de IL-6 no soro (r=0,469, p=0,009). Houve também correlação positiva significante entre as concentrações de IL-6 no soro e o tempo de oxigenoterapia (r=0,445, p=0,023) e a duração da internação (r=0,572, p=0,001). Das razões dos MI estudadas, a IL-10/IL-6 (primeiras amostras de soro), a IL-6/TNF- e a IL -6/IL-10 (segundas amostras de soro) foram associadas de forma mais consistente (p<0,001) à gravidade da ITRI pelo VSR. Não ocorreram óbitos entre as crianças envolvidas neste estudo. Os dois grupos de VSR causaram ITRI nas crianças internadas na UCINE, sendo que o grupo A foi o mais frequente (57%). No entanto, foram as crianças infectadas pelo grupo B do VSR as que evoluíram com maior morbidade (p<0,001). As medianas das concentrações de RANTES, sICAM-1 e IL-10 foram maiores nas três amostras de soro (p<0,001); enquanto as medianas das concentrações de IL-6 predominaram nas três amostras de secreção nasofaríngea (p<0,001). A mediana das concentrações de TNF- foi maior apenas nas primeiras amostras de secreção nasofaríngea (p<0,001). Houve diferença estatisticamente significante entre os dois grupos do VSR apenas em relação à mediana das concentrações de IL-10 na secreção nasofaríngea à admissão hospitalar, que foi mais elevada nas crianças com infecção pelo grupo B (p=0,039). As concentrações de RANTES, sICAM-1, IL-6 e IL-10 na secreção nasofaríngea e de TNF-,IL -6 e IL-10 no soro variaram, de forma significante, durante a evolução da ITRI pelo VSR. Os demais níveis de MI na secreção nasofaríngea e no soro mantiveram-se estáveis durante o período de estudo. CONCLUSÕES: Níveis de RANTES, sICAM-1, TNF-,IL -6 e IL-10 foram detectados em todas as amostras de secreção nasofaríngea e de soro das crianças com ITRI pelo VSR internadas na UCINE, confirmando o papel destes MI na patogênese da doença. Nossos resultados sugerem que as concentrações de sICAM-1 e IL-10 na secreção nasofaríngea e IL-6 no soro à admissão, bem como as razões IL-10/IL-6 (primeiras amostras de soro), IL-6/TNF- e IL -6/IL-10 (segundas amostras de soro), poderiam ser usadas como marcadores de gravidade da doença respiratória pelo VSR. Os níveis de IL-6 determinados no soro admissão também poderiam ser usados para predizer tempo de oxigenoterapia e duração da internação mais prolongados. Os grupos A e B do VSR cocircularam durante o período do estudo, com o grupo A sendo dominante nestes pacientes. Entretanto, foram as crianças infectadas com o grupo B do vírus que evoluíram com maior morbidade. As concentrações de IL-10 na secreção nasofaríngea à admissão hospitalar foram significantemente maiores nos pacientes com ITRI pelo grupo B do VSR. O tempo de evolução da doença pelo VSR foi significante para os níveis de RANTES, sICAM-1, IL-6 e IL-10 na secreção nasofaríngea e de TNF-,IL -6 e IL-10 no soro destas crianças. / INTRODUCTION: The high frequency and morbimortality of respiratory syncytial virus (RSV) lower respiratory tract infections (LRTI) in children, besides the lack of studies in Brazil that evolutionally correlate the inflammatory response in respiratory epithelium and in peripheral blood with RSV respiratory disease severity, have stimulated this research. OBJECTIVES: To assess whether the concentrations of inflammatory mediators (IM) (RANTES, sICAM-1, TNF- , IL-6 and IL-10) and their ratios in nasopharyngeal secretion and in blood of children less than 3 months of age and RSV LRTI correlate with disease severity; to determine the frequency of RSV groups A and B in children admitted to Unidade de Cuidados Intensivos Neonatal (UCINE) do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; to assess whether there is difference in RSV respiratory disease severity, according to RSV groups A and B; to compare the concentrations of IM in nasopharyngeal secretion and in blood at the time of hospital admission or by occasion of a diagnosis of RSV LRTI acquired during the stay, on third and seventh days of evolution or at the hospital discharge (should it had happened before the seventh day); to compare the concentrations of IM in nasopharyngeal secretion and in blood of patients at the hospital admission, according to RSV groups A and B; to describe the evolution of RANTES, sICAM-1, TNF-, IL-6 and IL-10 concentrations in nasopharyngeal secretion and in blood. METHODS: Thirty children less than 3 months of age with RSV LRTI admitted to UCINE were included in the prospective cohort observational study, from July 2004 to December 2005. The concentrations of IM were measured through the sandwich ELISA technique in nasopharyngeal secretion and in serum of all children at the hospital admission, and on the third and seventh days of evolution or at the hospital discharge (if before the seventh day). We used the following markers to assess the severity of respiratory illness: the modified clinical scoring system by De Boeck et al. (1997), the days of oxygen supplementation and of mechanical ventilation and duration of hospitalization. RESULTS: There was a significant positive correlation between severity of disease by modified clinical scoring system at the time of hospital admission and nasopharyngeal secretion sICAM-1 (r=0.401, p=0.028) and IL-10 concentrations (r=0.412, p=0.024) and serum IL-6 concentrations (r=0.469, p=0.009). There was also a significant positive correlation between serum IL-6 concentrations and the days of oxygen supplementation (r=0.572, p=0.001), as well as the days of hospital stay (r=0.572, p=0.001). Of IM ratios studied, IL-10/ IL-6 (first samples of serum), IL-6/TNF- and IL-6/IL-10 (second samples of serum) were associated to severity of RSV LRTI with greatest consistency (p<0.001). No fatal cases occurred among the children enrolled in this study. The two groups of RSV caused LRTI in 30 children less than 3 months of age hospitalized in UCINE, being group A the most frequent (57%). However, the children infected by RSV group B were the ones that evolved with a greater need of mechanical ventilation (p<0.001). Medians RANTES, sICAM-1 and IL-10 concentrations were greater in all the three serum samples (p<0.001); whereas medians IL-6 concentrations were predominant in the three nasopharyngeal secretion samples (p<0.001). Median TNF- concentration was greater only in the first nasopharyngeal secretion samples (p<0.001). There was a statistically significant difference between the two groups of RSV only relative to the median IL-10 concentrations on first nasopharyngeal secretion samples, which was more elevated in children infected by RSV group B (p=0.039). The nasopharyngeal secretion RANTES, sICAM-1, IL-6 and IL-10 and serum TNF- , IL-6 and IL-10 concentrations varied significantly during the evolution of RSV LRTI. The other nasopharyngeal secretion and serum IM levels remained stable during the period of study. CONCLUSIONS: Levels of RANTES, sICAM-1, TNF- , IL-6 and IL-10 were detected in all nasopharyngeal secretion and serum samples of children with RSV LRTI admitted to UCINE, therefore confirming the role of these IM in pathogenesis of illness. Our results suggest that nasopharyngeal secretion sICAM-1 and IL-10 and serum IL-6 concentrations determined at hospital admission, as well as the ratios IL-10/IL-6 (first samples of serum), IL-6/TNF- and IL-6/IL-10 (second samples of serum), could be used as markers of RSV respiratory disease severity. The levels of IL-6 found in serum at the time of hospital admission could also be used to predict prolonged oxygen supplementation and hospital stay. RSV groups A and B co-circulated during the period of the study, with group A being dominant in these patients. However, the children infected by RSV group B were the ones that evolved with a greater morbidity. Nasopharyngeal secretion IL-10 concentrations at admission were significantly greater in patients with RSV group B LRTI. The duration of RSV disease evolution was significant to nasopharyngeal secretion RANTES, sICAM-1, IL-6, IL-10 levels and to serum TNF- , IL-6 and IL-10 concentrations of these children.

INTRODUÇÃO: Eventos vasculares e imunológicos são centrais na patogênese da granulomatose com poliangeíte (GPA). Moléculas de adesão celular tem papel fundamental no recrutamento de células inflamatórias do sangue para os tecidos. Diferentes leitos vasculares apresentam particularidades na expressão de moléculas de adesão celular explicando talvez parte da especificidade da GPA por determinados órgãos. A elevação no nível sérico de moléculas de adesão celular e aumento da expressão destas em amostras de biópsia renal já foram demonstrados em pacientes com vasculite ANCA associada. No entanto, o fenômeno ainda não foi estudado in situ no pulmão. OBJETIVO: O objetivo deste estudo foi analisar o padrão de expressão endotelial pulmonar de três moléculas de adesão celular na GPA, in situ: molécula de adesão intercelular 1 (ICAM-1), molécula e adesão vascular 1 (VCAM-1) e E-selectina. MÉTODOS: Examinou-se a expressão endotelial de ICAM-1, VCAM-1, E-selectina usando marcação imuno-histoquímica em secções de pulmão fixadas e parafinadas de lesões de GPA (n = 8 casos, 90 secções transversais de vasos analisados). Foram também analisados controles positivos: amostras de pulmão de doença intersticial associada à esclerodermia (SScl) (n = 8 casos, 96 secções transversais de vasos analisados) e controles negativos (n = 9 casos, 90 secções transversais de vasos analisados). A quantificação imuno-histoquímica foi realizada no aumento de 400x usando a técnica de point-counting. RESULTADOS: ICAM-1: A expressão endotelial mediana de ICAM-1 esteve aumentada de forma semelhante na GPA e na SScl (81% and 73%, respectivamente; p = 0.97). A comparação com o grupo controle (26.3%) revelou diferença estatisticamente significativa entre controle e GPA (p <0.001) quanto entre controle e SScl (p = 0.017). VCAM-1: A expressão mediana de VCAM-1 esteve significativamente aumentada na GPA se comparada a SScl (79.5% vs 41.4%; p = 0.012), no entanto, a expressão endotelial de VCAM-1 nos controles também esteve moderadamente aumentada (49.8%) e não houve diferença estatística entre SScl e controles ( p = 0.549) ou entre GPA e controles (p = 0.242). E-selectina: A expressão endotelial mediana de E-selectina esteve aumentada de forma semelhante na GPA e SScl (100% e 88.2%, respectivamente; p = 0.272). A comparação com o grupo controle (13.8%) revelou diferença estatisticamente significativa entre controle e GPA (p < 0.001) e controle e SScl (p = 0.045). CONCLUSÃO: Esses achados evidenciam o fenômeno de ativação endotelial pulmonar in situ em lesões de GPA. O perfil de expressão de moléculas de adesão parece ter particularidades em diferentes doenças a exemplo da maior expressão de VCAM-1 na GPA em relação à SScl. Essas observações contribuem para o conhecimento fisiopatogênico na GPA. / INTRODUCTION: Vascular and immunologic processes are central to the pathogenesis of granulomatosis with polyangiitis (GPA). Endothelial cellular adhesion molecules have a central role in recruiting leukocytes to sites of inflammation. Moreover, different vascular beds are phenotypically and functionally distinct with regard to expression of cellular adhesion molecules. They have been shown to be elevated in sera and in renal biopsies of patients with active ANCA-associated vasculitis. Despite of that, the expression of cellular adhesion molecules has not been studied in situ in the lungs. OBJECTIVE: Within this context, the aim of this study was to analyze the in situ pulmonary endothelial immunohistochemical pattern of expression of three cellular adhesion molecules in GPA: intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and E-selectin . METHODS: For such, we examined formalin-fixed, paraffin-embedded sections of lung lesions of GPA (n = 8 cases, 90 transverse sections of pulmonary vessels), negative controls which were obtained from autopsies ( n = 9 cases, 90 transverse sections of pulmonary vessels analyzed) and positive controls which were cases of interstitial lung disease associated with systemic sclerosis (SScl) (n = 8 cases, 96 transverse sections of pulmonary vessels). The quantification of the immunohistochemical staining was performed at x400 magnification using the technique of point-counting, previously described. RESULTS: ICAM-1: Median endothelial expression of ICAM-1 was similarly enhanced in GPA and SScl (81% and 73%, respectively; p = 0.97). When compared to controls (26.3%), both GPA (p <0.001) and SScl (p = 0.017) had significantly higher endothelial expression of ICAM-1. VCAM-1: Median endothelial expression of VCAM-1 was significantly enhanced in GPA when compared to SScl (79.5% vs 41.4%; p = 0.012), however the endothelial expression of VCAM-1 in the controls was also moderately enhanced (49.8%) and no statistically significant difference was found between SScl and controls ( p = 0.549) or between GPA and controls (p = 0.242). E-selectin: Median endothelial expression of E-selectin was similarly enhanced in GPA and SScl (100% and 88.2%), respectively; p = 0.272. When compared to controls (13.8%), both GPA (p < 0.001) and SScl (p = 0.045) had significantly higher endothelial expression of E-selectin. CONCLUSION: These observations are evidence of in situ pulmonary endothelial activation in lesions of GPA. The profile of expression of cellular adhesion molecules seems to be particular for each disease state and timing as evidenced by the enhanced expression of VCAM-1 in GPA when compared to SScl. These observations add information to the pathogenetic knowledge of GPA