A tuberculose permanece como um dos maiores problemas de saúde pública mundial. O diagnóstico precoce e o tratamento rápido e eficiente dos indivíduos com tuberculose pulmonar ativa são medidas essenciais para a redução da morbidade, mortalidade e da incidência da tuberculose no mundo. As limitações encontradas nos métodos microbiológicos tradicionais, fizeram com que metodologias alternativas fossem desenvolvidas para melhorar o diagnóstico e o prognóstico da tuberculose humana. Neste trabalho verificamos o desempenho diagnóstico do Western blotting para pesquisa de anticorpos IgG anti - Mycobacterium tuberculosis, a utilização do teste QuantiFERON® - TB Gold e a detecção de moléculas de adesão celular (ICAM-1 e selectinas) como marcadores de prognóstico. Foram acompanhados até o final do tratamento 31 pacientes com tuberculose pulmonar diagnosticados por critérios clínicos e laboratoriais. Como controles, selecionamos população de indivíduos sadios, doadores de banco de sangue e indivíduos com outras pneumopatias. Os resultados mostraram que o Western blotting apresentou sensibilidade de 94% e especificidade de 96% no diagnóstico da tuberculose pulmonar, atendendo os requisitos da OMS para testes sorológicos. O QuantiFERON® - TB Gold apresentou sensibilidade de 83% e especificidade de 100%, após ajuste do limiar de reatividade. Os resultados das moléculas de adesão celular sugerem potencial para serem utilizadas como marcadores de prognóstico da doença. Ao associarmos os resultados do Western blotting ou do QuantiFERON® - TB Gold com a baciloscopia obtivemos sensibilidade superior a 95%; e quando associados à cultura a sensibilidade encontrada foi de 100%. O Western blotting mostrou ser uma ferramenta útil como auxiliar no diagnóstico da tuberculose pulmonar mesmo em pacientes com baciloscopia negativa. / Tuberculosis remains a major public-health problem. Rapid diagnosis and prompt treatment is the cornerstone to reduce morbidity, mortality and incidence of tuberculosis in the world. Alternative methods have been developed to overcome the limitations presented by conventional microbiological methods and to improve the diagnosis and prognosis of tuberculosis. In this study we verified the diagnostic performance of Western blotting for IgG anti-M.tuberculosis antibodies detection, QuantiFERON® - TB Gold and circulating adhesion molecules (ICAM-1 and Selectins) as prognosis markers. Thirty-one patients were followed-up during the treatment. Active pulmonary tuberculosis was diagnosed by clinical and laboratorial criteria. As group control healthy individuals, blood donors and patients with other lung diseases were included. Western blotting results showed a high performance with sensitivity of 94% and specificity of 96% for the diagnosis of pulmonary tuberculosis, attending WHO requirements for serological tests. After adjusting the threshold, QuantiFERON® - TB Gold showed sensitivity of 83% and specificity of 100%. The results of adhesion molecules suggested potential to use the test as prognosis markers. Combining Western blotting or QuantiFERON® - TB Gold with acid-fast bacilli (AFB) smear results, the overall sensitivity increase to more than 95%, and when combined with culture the overall sensitivity was 100%. Together, these findings, suggest that Western blotting could be a very useful supplementary tool for pulmonary tuberculosis, especially in patients with AFB smear negative.

O melanoma é um dos tipos de câncer de pele cuja frequência tem crescido nos últimos anos e apresentado elevada taxa de mortalidade, apesar de ter reduzida prevalência. Mesmo havendo um considerável avanço nas propostas terapêuticas nos últimos anos, ainda se vê necessário o desenvolvimento de novas abordagens, sendo a terapia gênica uma promissora possibilidade para tal. Utilizando vetores adenovirais com promotor responsivo à p53 (PGTx beta) para a transferência gênica de p19Arf (proteína supressora de tumor) e interferon-beta (citocina imunomodulatória) em células de melanoma murino com o gene Trp53 selvagem, o nosso grupo demonstrou previamente que a combinação dos dois genes, mas não o tratamento individual, promove efeito citotóxico sinérgico com a liberação de marcadores de morte imunogênica, in vitro; e significativa redução da progressão tumoral acompanhada de uma forte resposta imunológica de linfócitos T CD4+ e CD8+, células NK e neutrófilos contra desafios tumorais, in vivo. Porém, como a translação para modelos de melanomas humanos ainda estava em estágio inicial, ainda não haviam sido confirmamos se esses benefícios também seriam recapitulados. Observações inicias sugeriam que apenas a transferência gênica de interferon-beta seja suficiente para induzir morte celular em linhagens humanas portadoras de TP53 selvagem, sem ainda terem sido identificado o efeito da transferência de p14ARF e nem a necessidade de p53 endógeno para a resposta. Dessa forma, o presente projeto buscou avaliar os efeitos antitumorais provocados pela terapia gênica combinada de p14ARF e interferon-beta em modelos de melanoma humano utilizando linhagens com e sem a via da p53 integra. Para isso, foram utilizadas diferentes linhagens celulares com TP53 selvagem ou com distintas mutações e também foram construídos vetores adenovirais com o promotor constitutivo CMV, tornando assim possível a expressão dos transgenes de maneira independente do status do TP53 endógeno. O presente trabalho revelou que a transferência combinada do interferon-beta e p14ARF revelou vantagem quanto ao estímulo citotóxico e regulação negativa na dinâmica da população em ambas as linhagens UACC-62 e SK-Mel-29, independentemente do estado da via da p53. Na avaliação dos mecanismos de morte foi observado que ambas a linhagens apresentaram marcação positiva para marcadores da via da apoptose, porém com possível participação de outras modalidades de morte-celular, como a necrose, para a linhagem com o TP53 mutado (SK-Mel-29). Além disso, mostramos que os tratamentos potencialmente induzem vias de morte com caráter imunogênico pela secreção de ATP e exposição da calreticulina, sendo este último marcador mais significantemente observado mediante o tratamento combinado. Assim, recapitulamos o benefício observado em modelo murino para a transferência gênica do interferon-beta e p14ARF em modelo de melanoma humano, e investigamos marcadores importantes à translação da proposta terapêutica para o melanoma / Melanoma is one of the types of skin cancer whose frequency has grown in the last years and presents a high mortality rate, despite its low prevalence. Although there has been considerable progress in therapeutic proposals in recent years, it is still necessary to develop new approaches, being gene therapy a promising possibility for this. With the use of adenoviral vectors with a p53 responsive promoter (PGTx beta) for the gene transfer of p19Arf (tumor suppressor protein) and interferon-beta (immunomodulatory cytokine) in murine melanoma cells bearing wild-type Trp53 gene, our group previously demonstrated that the combination of the two genes, but not individual treatment, promotes a synergistic cytotoxic effect with the release of immunogenic death markers in vitro; and significant reduction of tumor progression with a strong immune response mediated by CD4+ and CD8+ T lymphocytes, NK cells and neutrophils in tumor challenges in vivo. However, as the translation for human melanoma models was still at an early stage, it still was not possible to confirm whether these benefits would also be recapitulated in a human model. Initial observations suggested that interferon-beta gene transfer is sufficient to induce cell death in wild-type TP53-bearing human melanoma cell lines, with the effect of p14ARF gene transfer and the role for endogenous p53 in this response yet to be investigated. Thus, the present work aimed to evaluate the antitumor effects induced upon the combined gene transfer of p14ARF and interferon-beta in human melanoma cell lines with and without a functional p53 pathway. For this, different cell lines bearing wild-type TP53 or with different mutations were used and adenoviral vectors with the constitutive CMV promoter were also constructed, making possible the expression of the transgenes independently of the endogenous TP53 status. The present work showed that the combined transfer of interferon-beta and p14ARF was advantageous in cytotoxic stimulation and negative regulation in population dynamics for both cell lines UACC-62 and SK-Mel-29, regardless of p53 pathway status. In the evaluation of the triggered cell death mechanisms it was observed that both cell lines presented positive markers of the apoptosis pathway, but with possible participation of other cell death mechanism, such as necrosis, for the mutated TP53 cell line SK-Mel-29. In addition, we showed that the treatments potentially induced cell death pathways with immunogenic features including the secretion of ATP and calreticulin exposure, being the latter marker more significantly presented after the combined treatment. Thus, we recapitulated the benefit observed in murine model for the gene transfer of interferon-beta and p14ARF in the model of human melanoma, and investigated important markers for the translation of the melanoma therapeutic proposal

alpha-Interferon (alpha IFN) ist derzeit die Grundlage jeder Behandlung der chronischen Hepatitis C. Zu den unerwünschten Effekten von alpha-IFN gehört die Entwicklung psychiatrischer Nebenwirkungen, die sich häufig als Depressivität äussern. Deren Häufigkeit, Schweregrad und Behandlungsbedarf wurden jedoch bisher nur unzureichend erforscht. 66 Patienten mit chronischer Hepatitis C wurden in einer Pilotstudie mit alpha-IFN als Monotherapie (3x3 MU/ Woche) oder in Kombination mit Ribavirin (1000-1200 mg/ Woche) behandelt. Sämtliche Patienten wurden vor, während und nach der Therapie hinsichtlich ihrer Depressivität beurteilt. Dies geschah sowohl im persönlichen Gespräch als auch mit Hilfe der Selbstbeurteilungsinstrumente ADS (Allgemeine Depressions Skala) und BDI (Beck Depressions Inventar). Die Ausgangsdepressivität der Hepatitispatienten entsprach dem gesunden Eichkollektiv. Im Gesamtdurchschnitt stieg die Depressivität innerhalb der ersten drei Behandlungsmonate um 5,15 (+/-8,94) Punkte auf der ADS und um 3,85 (+/-6,94) Punkte im BDI an. Weniger als ein Drittel der Patienten erlebte keine Zunahme der Depressivität. Patienten, die vor Therapiebeginn eine geringe Depressivität aufwiesen, beschrieben eine stärkere Zunahme depressiver Symptome als Patienten, die initial als depressiv beurteilt wurden. Letztere blieben während des Therapieverlaufs jedoch weiterhin depressiver als die anfangs nicht-depressiven Patienten. Vier Patienten wurden wegen schwerster depressiver Nebenwirkungen stationär psychiatrisch behandelt. Es wurde kein signifikanter Zusammenhang zwischen Ausgangsdepressivität und Behandlungserfolg festgestellt. Um stark gefährdete Patienten frühzeitig zu erkennen, wird vorgeschlagen, sowohl ADS als auch BDI vor und während der Therapie zu verwenden. Anhand eines ADS-Grenzwertes von > 17 vor und >= 30 während der Behandlung konnten 75% derjenigen Patienten, die im Verlauf der Therapie mit alpha-IFN schwerste depressive Symptome entwickelten, identifiziert werden. / Interferon-alpha (alpha-IFN) is presently the mainstay of the treatment of chronic hepatitis C. Side effects include a range of psychiatric symptoms, most frequently the development of depressive symptoms. Their incidence, severity and necessity for therapeutic intervention has not yet been sufficiently studied. 66 patients with chronic hepatitis C were enrolled in a pilot study and treated with either alpha-IFN alone (3x3 MU/ week) or in combination with Ribavirin (1000-1200 mg/ week). All patients went through repeated evaluations concerning their depressive symptoms before, during, and after treatment. Apart from individual interviews with the psychosomatic staff, the psychometric instruments used were the ADS (Allgemeine Depressions Skala, the German version of the Center for Epidemiological Studies Depression Scale, CES-D) and the BDI (Beck Depression Inventory). The initial depression score of the hepatitis C patients was comparable to that of a healthy population. On average, depression scores increased by 5,15 points (+/-8,94) on the ADS and 3,85 points (+/-6,94) on the BDI during the first 3 months of treatment. Less than a third of all patients did not show an increase of depressive symptoms. Patients with an initially low depression score experienced a greater increase of depressive symptoms than patients initially diagnosed as depressive. Nevertheless, the latter patients remained more depressive throughout the study period. Four patients developed severe depressions that necessitated admission to a psychiatric clinic. There was no significant correlation between the initial depression score and the treatment response. In order to recognize those patients at high risk for the development of severe depressions at an early stage, the author proposes the use of ADS and BDI both before and during treatment with alpha-IFN. Using a cut-off score of more than 17 points on the ADS before, and >=30 points during treatment, 75% of all patients developing severe depressions during treatment with alpha-IFN could be identified.

<p>Patients with systemic lupus erythematosus (SLE) have elevated levels of interferon (IFN)-α in blood and IFN-α-producing cells in tissues. In the present thesis, we investigate the mechanisms behind the upregulated IFN-α-production in SLE and also show that the IFN-α system is activated in primary Sjögren’s syndrome (pSS), with IFN-α-producing cells in the major affected organ, the salivary glands. The IFN-α is a type I IFN, a family of cytokines counteracting especially viral infections, by acting directly on infected cells, and via many immunomodulatory effects. The latter may also contribute to autoimmune processes.</p><p>The type I IFNs are usually produced upon recognition of microbial structures. In SLE, however, DNA-containing immune complexes (ICs) that induce IFN-α production are found. Many autoantibodies in SLE and pSS are directed to nucleic acids or to DNA/RNA-binding proteins. We show that also RNA in complex with autoantibodies from SLE or pSS patients (RNA-IC) induces IFN-α-production. The RNA could be either in the form of RNA-containing material released from apoptotic or necrotic cells or as a pure RNA-containing autoantigen, the U1 small nuclear ribonucleoprotein particle. </p><p>The IFN-α-production induced by RNA-IC occurred in plasmacytoid dendritic cells (PDCs), also termed natural IFN-producing cells (NIPCs), via binding to Fcγ-receptor IIa, endocytosis and triggering of Toll-like receptors (TLRs), probably TLR7 and TLR9. The RNA-IC may also have other effects, and we found that they induce prostaglandin E2 (PGE2) production in monocytes and tumor necrosis factor (TNF)-α in both monocytes and NIPC/PDC. The PGE2 downregulated the IFN-α induction in NIPC/PDC, and the IFN-α induction was increased in monocyte-depleted cell cultures. </p><p>The findings presented in this thesis aids in the understanding of the mechanisms behind the activated IFN-α system in SLE and other autoimmune diseases, and shows that also pSS is one of these diseases.</p>

Patients with systemic lupus erythematosus (SLE) have elevated levels of interferon (IFN)-α in blood and IFN-α-producing cells in tissues. In the present thesis, we investigate the mechanisms behind the upregulated IFN-α-production in SLE and also show that the IFN-α system is activated in primary Sjögren’s syndrome (pSS), with IFN-α-producing cells in the major affected organ, the salivary glands. The IFN-α is a type I IFN, a family of cytokines counteracting especially viral infections, by acting directly on infected cells, and via many immunomodulatory effects. The latter may also contribute to autoimmune processes. The type I IFNs are usually produced upon recognition of microbial structures. In SLE, however, DNA-containing immune complexes (ICs) that induce IFN-α production are found. Many autoantibodies in SLE and pSS are directed to nucleic acids or to DNA/RNA-binding proteins. We show that also RNA in complex with autoantibodies from SLE or pSS patients (RNA-IC) induces IFN-α-production. The RNA could be either in the form of RNA-containing material released from apoptotic or necrotic cells or as a pure RNA-containing autoantigen, the U1 small nuclear ribonucleoprotein particle. The IFN-α-production induced by RNA-IC occurred in plasmacytoid dendritic cells (PDCs), also termed natural IFN-producing cells (NIPCs), via binding to Fcγ-receptor IIa, endocytosis and triggering of Toll-like receptors (TLRs), probably TLR7 and TLR9. The RNA-IC may also have other effects, and we found that they induce prostaglandin E2 (PGE2) production in monocytes and tumor necrosis factor (TNF)-α in both monocytes and NIPC/PDC. The PGE2 downregulated the IFN-α induction in NIPC/PDC, and the IFN-α induction was increased in monocyte-depleted cell cultures. The findings presented in this thesis aids in the understanding of the mechanisms behind the activated IFN-α system in SLE and other autoimmune diseases, and shows that also pSS is one of these diseases.

No description available.

Toxoplasma gondii ist ein obligat intrazellulär lebender einzelliger Parasit, der sich durch ein breites Wirtsspektrum sowie lebenslang persistierende Infektionen bei Menschen und Tieren auszeichnet. T. gondii hat für ein langfristiges Überleben unterschiedliche Mechanismen entwickelt, die ein Gleichgewicht zwischen der Pathogenität des Erregers und der intakten Immunabwehr des Wirtes gewährleisten. In diesem Kontext stellt die Modulation von Signalwegen der Wirtszelle eine wichtige Überlebensstrategie von Toxoplasmen dar. Frühere Arbeiten mit murinen Monozyten haben gezeigt, dass T. gondii die Expression von MHC-Klasse-II-Molekülen auf der Oberfläche infizierter Wirtszellen hemmt und dadurch eine effektive Antigenpräsentation an T-Helfer-Lymphozyten verhindert. Das Ziel der vorliegenden Dissertation war es herauszufinden, inwieweit Toxoplasma gondii auch die Interferon-γ-induzierte MHC-Expression von Monozyten des Menschen vermindert. Analysen mittels Immunfluoreszenzfärbung und Durchflusszytometrie zeigten, dass sowohl primäre, aus PBMC des Menschen isolierte Monozyten als auch permanente humane Monozyten (THP-1) durch eine Infektion mit T. gondii in der Expression von HLA-A, -B, -C und HLA-DR, -DP, -DQ signifikant gehemmt werden. Das Ausmaß der Inhibition ist dabei von der Infektionsdosis des Parasiten abhängig und betrifft sowohl die HLA-Expression auf der Zelloberfläche als auch den intrazellulären HLA-Pool. Interessanterweise kann dieser Effekt auch durch hohe Konzentrationen des stimulierenden Zytokins Interferon-γ nicht aufgehoben werden. Es zeigt sich außerdem eine signifikant reduzierte Expression von HLA-DR, -DP, -DQ bei Parasit-negativen Zellen einer T. gondii-infizierten Kultur, was möglicherweise durch sezernierte Proteine des Parasiten oder durch die Produktion hemmender Zytokine durch infizierte Wirtszellen begründet sein kann. Die HLA-Expression in in vitro-infizierten und nicht-infizierten primären Monozyten wurde darüberhinaus zwischen T. gondii-negativen Individuen und Spendern mit chronischer Toxoplasmose verglichen. Chronisch mit T. gondii infizierte Blutspender wurden serologisch anhand von spezifischen IgG-Antikörpern identifiziert. Durchflusszytometrische Analysen zeigten, dass Monozyten aus chronisch mit T. gondii infizierten Blut-Spendern signifikant mehr HLA-A, -B, -C und HLA-DR, -DP, -DQ exprimieren als Monozyten aus Toxoplasma-negativen Spendern. Eine Erklärung für diese gesteigerte MHC-Expression könnte eine Dominanz bestimmter Monozyten-Subpopulationen in Abhängigkeit vom Infektionsstatus ihres Spenders sein. Die Expression von HLA-A, -B, -C und HLA-DR, -DP, -DQ wird jedoch sowohl bei Monozyten von T. gondii-positiven als auch nicht-infizierten Individuen durch eine Infektion mit Toxoplasmen in vitro signifikant inhibiert. Analysen mit Hilfe von RT-qPCR zeigten deutlich, dass T. gondii mit der HLA-DR-, -DP-, -DQ-Expressions-Kaskade interferiert und die Synthese der Transkripte von IRF-1 und CIITA dosisabhängig inhibiert. Außerdem sind die Transskripte für HLA-A und HLA-DRα in infizierten Monozyten deutlich reduziert. Dies legt die Annahme nahe, dass T. gondii die Aktivierung von STAT1-abhängigen Promotoren effektiv inhibiert und so die Synthese der sich anschließenden HLA-Expressionskaskade supprimiert. Die Ergebnisse dieser Arbeit eröffnen interessante Ansätze für weitere Untersuchungen, insbesondere eine genauere Charakterisierung von Monozyten-Subpopulationen bei T. gondii-positiven Individuen sowie die Erforschung einer möglicherweise gesteigerten Immunreaktivität gegen andere Infektionserreger im Rahmen einer chronischen Toxoplasmose.

Das Oberflächenepithel (OSE) des Ovars besteht aus einer Schicht flacher oder kubischen Zellen, die am Hilus in das flache Peritonealepithel übergehen. Das OSE zeigt zyklusabhängige Veränderungen. OSE-Zellen sollen am Prozess der Ovulation aktiv teilnehmen und die Läsion nach der Follikelruptur reparieren. Die mitotische Aktivität der OSE-Zellen um den Reparatur-Prozess könnte das Überleben von mutierten Zellen begünstigen und zum Ovarialkarzinom führen. Hierbei spielen Zell-Zell-Kontakte eine Schlüsselrolle bei der Integrität von Gewebe und der Metastasierung von Tumoren. Um das Verständnis über die Pathogenese des Ovarialkarzinoms zu verbessern, untersuchte die vorliegende Arbeit die Zell-Zell-Kontakte des OSE sowie dessen Abhängigkeit von Interferon-γ (IFN-γ), welches u.a. bei der adjuvanten Therapie des Ovarialkarzinoms verwendet wird. Abstriche von humanen und bovinen Ovarien dienten als Quelle zur Kultivierung von OSE-Zellen. Konfluente Kulturen wurden mit 200 U/ml rekombinantem, speziesspezifischem IFN-γ für 72 h behandelt oder als Kontrolle unbehandelt gelassen. Die Morphologie der OSE-Zellen vor und nach der Behandlung wurde dargestellt. Weiterhin wurden mittels immunzytologischer Färbungen sowie Western Blot Analyse E- und N-Cadherin, β-Catenin, Cytokeratin sowie Vimentin nachgewiesen. Permeabilitätsmessungen von Meerrettichperoxidase (HRP) in einem Ko-Kultursystem wurden mit und ohne IFN-γ durchgeführt. Die Arbeit zeigt eine neue Wirkung von IFN-γ. Es hat die besondere Eigenschaft, das OSE komplett über Cadherin-vermittelte „tight juctions“ abzudichten. Dies könnte die Wirksamkeit des Zytokins bei der adjuvanten Therapie des Ovarialkarzinoms erklären. Möglicherweise werden Interzellularkontakte verstärkt und die Frühinvasion maligner Zellen eingeschränkt. Das erstmals beschriebene Cadherinmuster an den Zell-zu-Zell-Ecken verweist auf die Interaktion der „tight junctions“ mit E-Cadherin.

The results of experiments aimed at determining whether cytotoxic T lymphocytes (CTLs) can kill keratinocytes (KCs) expressing endogenously loaded antigen indicated that antigen specific cytotoxic T lymphocytes could recognize and kill keratinocytes expressing ovalbumin (OVA) or SIINFEKL peptide. Exposure of the KCs to interferon-gamma (IFN-γ) enhanced this CTL-mediated KC lysis and increased CTL epitope presentation on the surface of target cells. Expression of HPV 16 E7 protein in KCs affected CTL-mediated lysis. Expression of HPV 16 E7 inhibited IFN-γ-mediated up-regulation of SIINFEKL/H-2Kb complexes on keratinocytes, and also inhibited IFN-γ-mediated up-regulation of IRF-1 expression, and consequent up-regulation of TAP1 transcription. Further, overexpression of IRF-1 partially corrected the HPV 16 E7-mediated inhibition of enhanced susceptibility of KC lysis induced by IFN-γ. Thus, the effects of HPV 16 E7 on CTL-mediated lysis of IFN-γ exposed KCs are likely mediated by inhibition of MHC class I antigen presentation by IFN-γ. These findings may help explain why HPV-infected epithelial cells can escape from immune surveillance mediated by CTLs in vivo and in vitro.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed June 6, 2008). Includes bibliographical references.