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Blood-brain barrier (BBB) is a unique membranous barrier, which segregates brain from the circulating blood. It works as a physical and metabolic barrier between the central nervous system (CNS) and periphery. In mammals, endothelial cells were shown to be of BBB and are characterized by the tight junctions along with efflux system which are responsible for the restriction of movement of molecules within the cells. Efflux system consists of multidrug resistance proteins such as P-glycoprotein (P-gp). P-gp removes substances out back from the brain to the blood before they reach to the brain. So the barrier is impermeable to many compounds such as amino acids, ions, small peptides and proteins, making it the most challenging factor for the development of new drugs for targeting CNS. Curcumin is a bioactive compound that has a number of health promoting benefits such as anti-inflammatory, anticancer, anti-oxidant agent; as well as a role in neurodegenerative diseases, but low oral bioavailability is the major limiting factor. Low water solubility and rapid metabolism are the two important factors responsible for poor bioavailability of curcumin. Galaxolide is a musk compound and previously known for the bioaccumulation of toxic components in the aquatic animals by interference with the activity of multidrug/multixenobiotic resistance efflux transporters (MDR/MXR). The bioavailability of curcumin can be enhanced when administered with galaxolide. This study was carried out to investigate the effect of galaxolide on the permeation of curcumin through the epithelial cell monolayers. MDCKII-MDR1 cell monolayer is used an in vitro blood-brain barrier model while Caco-2 monolayer is used as an in vitro intestinal model, which also expresses the P-glycoprotein. The curcumin and galaxolide were separately solubilised in the DMSO and used in combination to perform permeation study, to determine the effect of galaxolide on curcumin permeation through epithelial cell monolayers. The galaxolide shows an efflux protein inhibition activity and this activity was used to enhance permeation of curcumin through the Caco-2 monolayer. In summary, galaxolide is a novel permeation enhancer molecule, which can be used for the improvement of drug delivery of other bioactive compounds in future. / Department of Social Welfare, Govt. of Maharashtra (India)

BACKGROUND:Active HIV infection within the central nervous system (CNS) is confined primarily to microglia. The glial cell compartment acts as a viral reservoir behind the blood-brain barrier. It provides an additional roadblock to effective pharmacological treatment via expression of multiple drug efflux transporters, including P-glycoprotein. HIV/AIDS patients frequently suffer bacterial and viral co-infections, leading to deregulation of glial cell function and release of pro-inflammatory mediators including cytokines, chemokines, and nitric oxide.METHODS:To better define the role of inflammation in decreased HIV drug accumulation into CNS targets, accumulation of the antiretroviral saquinavir was examined in purified cultures of rodent microglia exposed to the prototypical inflammatory mediator lipopolysaccharide (LPS).RESULTS:3H]-Saquinavir accumulation by microglia was rapid, and was increased up to two-fold in the presence of the specific P-glycoprotein inhibitor, PSC833. After six or 24 hours of exposure to 10 ng/ml LPS, saquinavir accumulation was decreased by up to 45%. LPS did not directly inhibit saquinavir transport, and did not affect P-glycoprotein protein expression. LPS exposure did not alter RNA and/or protein expression of other transporters including multidrug resistance-associated protein 1 and several solute carrier uptake transporters.CONCLUSIONS:The decrease in saquinavir accumulation in microglia following treatment with LPS is likely multi-factorial, since drug accumulation was attenuated by inhibitors of NF-kappabeta and the MEK1/2 pathway in the microglia cell line HAPI, and in primary microglia cultures from toll-like receptor 4 deficient mice. These data provide new pharmacological insights into why microglia act as a difficult-to-treat viral sanctuary site.

Multidrug resistance protein 2 (MRP2) is the second member the C subfamily in the superfamily of adenosine triphosphate (ATP)-binding cassette (ABC) efflux transporters. MRP2 is a critical player for generation of bile acidindependent bile flow and biliary excretion of glutathione, glucuronate and sulfate conjugates of endo- and xenobiotics. Dysfunctional expression of MRP2 is associated with Dubin-Johnson Syndrome. Pathological and physiological states or xenobiotics change the MRP2 expression level. Under some conditions, expression of the human MRP2 and rat Mrp2 proteins are regulated at the translation level. There are several transcription initiation sites in MRP2/Mrp2 gene. The 5’ untranslated regions (5’UTRs) of MRP2/Mrp2 contains multiple translation start codons. The focus of this study, therefore, was investigation of the translational regulatory mechanisms mediated by the upstream open reading frames (uORF) of MRP2/Mrp2. Using in vitro translation assays and transient cotransfection assays in HepG2 cells, we showed that the rat uORF1 starting at position -109 (relative to the ATG of Mrp2) and the human uORF2 starting at position -105 (relative to the ATG of MRP2) are two major cis-acting inhibitors of translation among the rat and human multiple uORFs, respectively. Translational regulation mediated by the uORFs in the rat Mrp2 mRNA is a combined effect of the leaky scanning model and the reinitiation model, and also results from interaction of the multiple uORFs. In addition, by Ribonuclease Protection Assays (RPA), we detected multiple transcription initiation sites of MRP2/Mrp2 gene in tissues. We also found that the relative abundance of the rat Mrp2 mRNA isoforms with different 5’UTRs differed in the rat liver, kidney, jejunum, ileum, placenta, and lung. This is the first study on the translational regulatory mechanisms of the MRP2/Mrp2 gene.

Les salmonelles sont l’une des premières causes d’infections bactériennes d’origine alimentaire. Depuis le début des années 1990, l’isolement de salmonelles multirésistantes aux antibiotiques a considérablement accru avec l’émergence des souches épidémiques Salmonella Typhimurium DT104 qui sont, pour la majorité, résistantes à l’ampicilline, le chloramphénicol, la streptomycine, les sulfamides et les tétracyclines. Les gènes codant ces résistances sont regroupés sur un intégron complexe de classe 1 nommé In104, localisé lui-même sur un îlot génomique de 43 kb désigné Salmonella Genomic Island 1 (SGI1). Depuis sa première identification chez S. Typhimurium DT104, SGI1 a été identifié à travers le monde chez plusieurs sérovars de Salmonella, et plus récemment chez Proteus mirabilis. Chez ces souches, la multirésistance aux antibiotiques est liée, soit à l’îlot SGI1 dans sa forme initialement décrite, soit à des variants de SGI1 correspondant à la structure initiale de SGI1 comportant des modifications au niveau de l’intégron complexe In104. L’îlot génomique Salmonella Genomic Island 1 (SGI1) représente une préoccupation importante car le phénotype de multirésistance qu’il confère aux souches bactériennes est souvent responsable d’échecs thérapeutiques pouvant entrainer des complications importantes, voire la mort. Dans ce contexte, le travail de thèse a été centré sur l’enjeu sanitaire majeur représenté par cette diffusion épidémique du clone S. Typhimurium au cours des années 1990 chez l’homme et les bovins. Les travaux entrepris dans le cadre de la thèse ont eu, en premier lieu, l’objectif d’apprécier l’évolution moléculaire de SGI1 dix années après l’émergence de ces souches en élevage bovin, puis d’évaluer la diffusion de SGI1 chez des souches naturelles appartenant à d’autres genres bactériens que Salmonella. Il a ainsi été dressé un bilan de la multirésistance aux antibiotiques chez les souches de S. Typhimurium isolées de bovins malades en France de 2002 à 2007 et une recherche de la présence de SGI1, chez d’autres espèces bactériennes que Salmonella, et par sondage à partir de leurs phénotypes de résistance, a été mise en œuvre. Les résultats obtenus ont indiqué un faible pouvoir évolutif de SGI1 qui semble en contradiction avec les capacités moléculaires majeures de recombinaison et de transfert démontrées tant in vitro qu’in vivo. Les études menées ont toutefois permis la première description d’un nouveau variant, nommé SGI1-T, qui résulte d’une recombinaison intramoléculaire. Le deuxième grand objectif de la thèse a été de contribuer à une meilleure connaissance du rôle que pourrait avoir SGI1 dans la virulence bactérienne. Une première stratégie de modélisation expérimentale (salmonellose systémique murine) a ainsi été conduite, qui visait à comparer le pouvoir virulent in vivo de souches isogéniques ne se distinguant que par la présence ou l’absence de SGI1. Une seconde approche a été également menée, qui a consisté en une évaluation du rôle de SGI1 dans la formation de biofilms, l’organisation en biofilms favorisant une meilleure colonisation bactérienne, qui peut constituer à son tour un élément d’efficacité du pouvoir virulent final. Les résultats obtenus ont confirmé le rôle positif de SGI1 dans la formation de biofilms, et plus généralement son implication dans la signalisation cellulaire du Quorum Sensing. / Salmonella is a major cause of food-borne outbreaks. Since the early 1990s, isolation of multidrug-resistant Salmonella has increased with the emergence of epidemic Salmonella Typhimurium DT104 strains which are mostly resistant to ampicilin, chloramphenicol, streptomycin, sulfonamides and tetracyclines. The genes coding these resistances are clustered on a complex class 1 integron (MDR region) located on a genomic island of 43 kb designated SGI1. Since its first identification in S. Typhimurium DT104, SGI1 has been identified worldwide in other Salmonella serotypes, and more recently in Proteus mirabilis. For these strains, multidrug resistance is conferred, either to the classical structure of SGI1, or to related variants of SGI1 corresponding to the initial structure of SGI1 with modification of the complexe integron In104. The Salmonella Genomic Island 1 (SGI1) constitutes a great concern since it confers a multidrug resistance phenotype often responsible of therapeutic failures which may cause important complications, or even death. In this context, the work has been focused on the major health issue represented by the epidemic diffusion of the Salmonella Typhimurium clone in the course of 1990s in human and cattle. As a first objective, the work allowed to appreciate the molecular evolution of SGI1 in the course of time and to assess the diffusion of SGI1 to other bacterial strains than Salmonella in natural conditions. Therefore, an overview of the multidrug resistance in Salmonella Typhimurium strains isolated from diseased cattle in France from 2002 to 2007 was carried out and a screening of natural strains from other bacterial species than Salmonella that may harbor SGI1 was undertaken. The results indicated weak molecular evolutions of SGI1, which seems in contradiction with the great capability of SGI1 to recombine and transfer, as attested in vitro as in vivo. Nevertheless, this study allowed the first description of a new SGI1 variant, named SGI1-T, which is the result of intra-molecular recombination events. Another second objective of the thesis was to contribute to a better knowledge of the role of SGI1 in bacterial virulence. A strategy of experimental modeling (murine systemic salmonellosis) was first set up to compare the levels of virulence conferred by isogenic strains differing only by the presence or the absence of SGI1. A second approach was also carried out to evaluate the role of SGI1 in biofilm formation. Indeed, the organization in biofilm facilitates bacterial colonization, which constitutes in turn an element of effectiveness of the final virulence. A positive role of SGI1 in biofilm formation was demonstrated in the framework of this study, and more generally, questions the role of SGI1 in the Quorum Sensing regulation system.

Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Martina Sýkorová Supervisor: RNDr. Jakub Hofman, Ph.D. Title of diploma thesis: Study on impact of selected tyrosine kinase inhibitors on multidrug resistance mediated by ABC drug efflux transporters Tyrosine kinases are an important class of enzymes controlling cell proliferation, carcinogenesis, apoptosis and cell differentiation. Deregulation of these enzymes can transform normal cell into a cancerous one. Blocking their function by tyrosine kinase inhibitors (TKi) is considered a promising treatment for various types of cancer. ATP-binding cassette (ABC) transporters form a family of transmembrane proteins that can transport a wide variety of substrates across biological membranes via ATP-dependent drug efflux pumps. They modulate drug pharmacokinetics, but on the other hand, lead to therapy failure due to overexpression in cancer cells. In our previous study, we evaluated inhibition properties of two selected TKi (alectinib, brivanib) in MDCKII cell lines (parent one and those transduced with human ABCB1, ABCC1 and ABCG2). Alectinib significantly inhibited ABCB1, ABCG2 but not ABCC1 transporter. Brivanib showed triple inhibition of all studied transporters. In the present work, we...

Fosfoetanolamina sintética (Pho-s) é um monoéster análogo à fosfoetanolamina da membrana celular fosforilada artificialmente, com propriedades antiinflamatórias e apoptóticas para vários tipos de células tumorais humanas e murinas. Neste projeto foram avaliados os efeitos antitumorais in vitro da Pho-s e da formulação lipossomal DODAC/Pho-s na linhagem tumoral de leucemia mielóide crônica humana (K-562), em comparação ao modelo resistente a múltiplas drogas K-562 Lucena (MDR+). Os efeitos de citotoxicidade da Pho-s na linhagem tumoral K-562 e K-562 Lucena (MDR+) foram avaliados pela viabilidade celular utilizando o teste da Sulforodamina B, e os valores da IC50% obtidos foram de 43.1 mM e 145.9 mM, respectivamente após 24 horas de tratamento. O tratamento com o carreador DODAC vazio nas células K-562 e K-562 Lucena (MDR+) a IC50% foi de 0,0003mM e 0,008mM respectivamente, e com o tratamento com a formulação lipossomal DODAC/Pho-s a IC50% obtida respectivamente de, 0,56 mM e 0,31 mM. A viabilidade celular foi determinada a exclusão pelo azul de tripan 0,2%, em sistema automatizado Vi-Cell e foram significativas as diminuições da viabilidade celular em comparação ao grupo controle não tratado nas diversas concentrações e em diferentes períodos de tempo de tratamento. As alterações nas distribuições nas populações celulares nas fases do ciclo celular determinadas por citometria de fluxo mostraram aumento do DNA fragmentado (Sub/G1) em 12 e 24 horas de tratamento. Atividade apoptótica das células tumorais pela expressão da Anexina V/PI, no estágio de apoptose inicial, apoptose tardia e necrose foram quantificadas em citometria de fluxo, o tratamento com Pho-s, quando comparado ao grupo controle K-562 (40 e 80 mM) e K-562 Lucena (MDR+) (146 e 292 mM) ocorreu aumento significativo do número de células apoptóticas e em menor percentual o número de células necróticas. O tratamento com a Pho-s em célula leucêmica K-562 e K-562 Lucena (MDR+) tratadas, respectivamente com 40 e 80 mM e 146 e 292 mM mostraram que independente da expressão do fenótipo de resistência há uma redução significativa no potencial elétrico mitocondrial, analisado pelo o ensaio da rodamina-123. Os marcadores de controle e progressão do ciclo celular e da apoptose, mostraram efeitos moduladores da Pho-s dependentes da p53 na expressão da moléculas pró-apoptóticas. Esse conjunto de informações demonstrou os efeitos apoptóticos da Pho-s e da formulação lipossomal nas células tumorais independentemente do perfil molecular de resistência (MDR+), o que possibilita dizer que esse composto possui significativo potencial terapêutico nesse grupo de leucemias / Synthetic phosphoethanolamine (Pho-s) is a monoester analogous to the phosphoethanolamine which composes the membrane of an artificially phosphorylated cell, with anti-inflammatory and apoptotic properties for various types of human and murine tumor cells. In this project, we evaluated in vitro antitumor effects of Pho-s and the DODAC/Pho-s liposomal formulation in the human chronic myeloid leukemia (K-562) tumor line in comparison with the K-562 Lucena (MDR+). The effects of cytotoxicity of Pho-s on K-562 and K-562 Lucena (MDR +) tumor cells lines were evaluated by cell viability using the Sulforhodamine B test, and the IC50% values obtained were 43.1 mM and 145.9 mM after 24 hours of treatment, respectively. Treatment with the empty DODAC carrier on the K-562 and K-562 Lucena (MDR+) at IC50% cells was 0.0003 mM and 0.008 mM, and the treatment with the DODAC/Pho-s liposomal formulation obtained results of 0.56 mM and 0.31 mM, respectively. Cell viability was determined by 0.2% trypan blue exclusion in automated Vi-Cell system and the decreases in cell viability were significant in comparison to the untreated control group at various concentrations and different treatment time periods. Alterations in the distributions of cell populations in the cell cycle phases determined by flow cytometry showed increment of fragmented DNA (Sub/G1) in 12 and 24 hours of treatment. Apoptotic activity of tumor cells by the expression of Annexin V/PI, in the early apoptosis, late apoptosis phase and necrosis stage were quantified in flow cytometry, the treatment with Pho-s, when compared to the control group K-562 (40 and 80 mM) and K-562 Lucena (MDR +) (146 and 292 mM) demonstrated that there was a significant increase in the number of apoptotic cells and, in a lower percentage, the number of necrotic cells. Treatments with Pho-s in leukemic cell K-56 with 40 and 80 mM and in K-562 Lucena (MDR+) with 146 and 292 mM showed that independent of the expression of the resistance phenotype there is a significant reduction in the electrical potential of the mitochondrial membrane, analyzed with the rhodamine-123 assay. Control and progression markers of cell cycle and apoptosis showed p53-dependent modulating effects on the expression of pro-apoptotic molecules. This set of information demonstrated the apoptotic effects of Pho-s and liposomal formulation on tumor cells independently of the molecular resistance profile (MDR+), which makes it possible to say that this compound has significant therapeutic potential in this group of leukemias

INTRODUÇÃO: O aumento da incidência de infecções causadas por bactérias resistentes a múltiplos antimicrobianos limita cada vez mais as opções terapêuticas, dificultando o tratamento e aumentando os índices de morbidade e mortalidade, além dos gastos em saúde. Ao longo dos últimos cinco anos, essa limitação tem levado ao reestabelecimento do uso de antimicrobianos consideradas ultrapassados, como as polimixinas. Este grupo passou a ser utilizado com cada vez mais frequência no tratamento de infecções causadas por microrganismos gram-negativos resistentes aos carbapenêmicos. As enterobactérias, em particular a espécie Klebsiella pneumoniae, tem apresentado frequentemente esse perfil, porém, a resistência à polimixinas têm sido relatada, eliminando essa importante alternativa terapêutica. Apesar da importância do tema, são escassas as publicações sobre frequência de resistência às polimixinas em K. pneumoniae e a relação clonal entre isolados resistentes à polimixina B no Brasil. OBJETIVOS: Avaliar a relação genética, perfil de sensibilidade antimicrobiana e mecanismos de resistência às polimixinas em K. pneumoniae. MATERIAIS E MÉTODOS: A execução deste trabalho dividiu-se em duas partes principais: (i) levantamento de dados de culturas positivas para K. pneumoniae da rotina de pacientes hospitalizados em instituições atendidas pelo serviço de análises clínicas do Fleury Medicina e Saúde; (ii) confirmação das concentrações inibitórias mínimas (CIM) para polimixina B, avaliação da relação clonal por eletroforese em campos pulsados (PFGE),e sequenciamento de múltiplos loci (MLST), avaliação da integridade do gene mgrB e da presença do gene mcr-1 por PCR entre isolados resistentes à polimixina B e aos carbapenêmicos (CPRKp). RESULTADOS e CONCLUSÕES: Na análise de 3.085 isolados de K. pneumoniae obtidos de pacientes internados em 11 hospitais da Grande São Paulo entre os anos de 2011 e 2015, foi evidenciado um aumento estatisticamente significativo na resistência aos carbapenêmicos de 6,8% em 2011 para 35,5% em 2015. Em 2015, KPC foi detectada em 96,2% dos isolados resistentes aos carbapenêmicos. A distribuição das concentrações inibitórias mínimas de polimixina B entre todos os isolados de K. pneumoniae evidenciou uma distribuição bimodal com a CIM de 2 mg/L como o valor de ponto de corte para a susceptibilidade à polimixina B; assim, 3,6% do número total de isolados sensíveis aos carbapenêmicos foram interpretados como resistentes enquanto essa proporção foi de 22,5% entre as resistentes aos carbapenêmicos (CRKp). Entre esses últimos isolados também houve um aumento estatisticamente significativo na tendência anual de resistência à polimixina B, de 0% em 2011 para 27,1% em 2015. Estas taxas variaram de 0,7% em 2011 para 3,9% até junho de 2014 entre os sensíveis aos carbapenêmicos. Entre os antimicrobianos alternativos, a amicacina e a tigeciclina foram os compostos mais ativos. A análise por PFGE de 60 isolados de CPRKp obtidos de pacientes distintos nos anos de 2014 e 2015 evidenciou dois grandes grupos clonais: CPRKp1 e CPRKp2, os quais segundo a análise por MLST pertencem, respectivamente, aos grupos ST11 e ST437, ambos do complexo clonal 258. Foi observado o mesmo grupo ST entre isolados obtidos dentro de um mesmo hospital e também entre diferentes hospitais, públicos e privados. O mecanismo de resistência mais comum entre os isolados de CPRKp foi a presença de sequências de inserção interrompendo o gene mgrB. O gene mcr-1 não foi detectado em nenhum dos isolados. / INTRODUCTION: The increasing incidence of infections caused by bacteria resistant to multiple antimicrobials increasingly limits therapeutic options, making treatment difficult and increasing the morbidity and mortality and health spending. Over the past five years, this limitation has led to the reestablishment of the use of antimicrobials deemed outdated, such as polymyxins. This group is now used with increasing frequency to treat infections caused by carbapenem-resistant gram-negative microorganisms. Enterobacteria, especially Klebsiella pneumoniae, have often presented this profile, however, resistance to polymyxins have been also reported, eliminating this important therapeutic alternative. Despite the importance of this issue, the publications are scarce on the polymyxins resistance frequency in K. pneumoniae and clonal relationship among isolates resistant to polymyxin B in Brazil. OBJECTIVES: To evaluate the genetic relationship, antimicrobial susceptibility profile and polymyxin B resistance mechanisms in K. pneumoniae. MATERIALS AND METHODS: The execution of this work was divided into two main parts: (i) survey data on routine cultures positive for K. pneumoniae from patients hospitalized in institutions attended by the clinical analysis service of Fleury Health and Medicine; (ii) confirmation of to polymyxin B minimum inhibitory concentrations (MIC), evaluation of clonal relationship by electrophoresis pulsed field gel electrophoresis (PFGE), multilocus sequence typing (MLST), evaluation of the integrity of the mgrB gene and the presence of mcr-1 gene by PCR among isolates resistant to polymyxin B and carbapenems (CPRKp). RESULTS AND CONCLUSIONS: The analysis of 3,085 K. pneumoniae isolates obtained from inpatients from 11 hospitals in the São Paulo urban area between 2011 and 2015, has shown a statistically significant increase in carbapenem resistance from 6.8% in 2011 to 35.5% in 2015. In 2015, KPC was detected in 96.2% of isolates resistant to carbapenems. The polymyxin B MIC distribution of all Klebsiella pneumoniae showed a bimodal distribution with the MIC of 2 mg/L as the cutoff value for polymyxin B susceptibility; thus, 3.6% of the total number of isolates susceptible to carbapenems were interpreted as resistant while this proportion was 22.5% among carbapenem-resistant isolates (CRKp). Among these isolates there was also a statistically significant increase in the annual trend of polymyxin B resistance, from 0% in 2011 to 27.1% in 2015. These rates ranged from 0.7% in 2011 to 3.9% by June 2014 between carbapenem-susceptible isolates. Among alternative antimicrobials, amikacin and tigecycline were the most active compounds. The analysis by PFGE of 60 CPRKp isolates obtained from different patients in the years 2014 and 2015 showed two major clonal groups: CPRKp1 and CPRKp2, which according to the analysis by MLST belong respectively to ST11 and ST437 groups, both from clonal complex 258. We observed the same ST group of isolates obtained within a hospital and between different public and private hospitals. The most common mechanism of polymyxin B resistance among CPRKp isolates was the presence of insertion sequences interrupting the mgrB gene. The mcr-1 gene was not detected in any of the isolates.

INTRODUÇÃO: A incidência de tuberculose (TB) em Santos (SP) situa-se em 73/100.000 habitantes-ano. A prevalência média de coinfecção TB/HIV é de 16%, taxas de cura e abandono de tratamento, entre casos novos são, respectivamente, 71% e 12%. Tais indicadores sugerem elevado risco para TB multidroga resistente (TBMR) no município, com incidência estimada em 1,9/100.000 habitantes-ano. OBJETIVO: Descrever e analisar o perfil de sensibilidade às drogas (TS) de primeira e segunda linha de tratamento entre pacientes com TB pulmonar (TBP), estimar a incidência de TBMR e a proporção de TB extensivamente resistente (TBXR); analisar aspectos moleculares, epidemiológicos e institucionais dos casos de TBP resistentes em Santos (SP). MÉTODOS: Estudo descritivo de uma coorte de pacientes de TBP, com início de tratamento ou retratamento entre 01 de janeiro de 2011 a 31 de dezembro de 2012. Definiu-se como caso de TBP, indivíduos com 15 anos ou mais, de ambos os sexos, residentes no município de Santos, com manifestações clínicas compatíveis com TBP e confirmação por cultura com isolamento de Mycobacterium tuberculosis. As variáveis de interesse para o estudo foram as características sociodemográficas, história atual e pregressa de TB, aspectos relativos ao tratamento, co-morbidades, ao diagnóstico e resistência a drogas. Para as análises comparativas entre proporções foram usados os testes qui-quadrado de Pearson e o Exato de Fisher e para variáveis contínuas o teste T de Student ou o de Kruskal - Wallis. Os perfis genéticos dos isoladas resistentes a ao menos uma droga foram obtidos pela técnica RLFP e analisados pelo programa Bionumerics versão 5.0 (Applied Maths - Bélgica). A descrição da distribuição espacial da TB resistentes e clusters foram feitas mediante a inserção dos casos no mapa de Santos, por endereço de residência, segundo o índice de vulnerabilidade social. RESULTADOS: Dos 263 casos de TBP selecionados, 68,4% (180/263) eram do sexo masculino, a mediana da idade foi de 38 anos, 8,7% (23/263) eram diabéticos; 20,4% (42/206) dos casos novos apresentavam ao menos um fator de risco para TBMR; destacando-se entre estes casos 10,7% (22/206) de confecção HIV/TB; 47,3% (123/260) tiveram tratamento supervisionado, 14,7% (91/617) dos contatos foram examinados, 18,6% (49/263) foram hospitalizados durante o tratamento, perfazendo uma média de 145,4 dias por paciente. Entre os casos resistentes a ao menos uma droga, a resistência à isoniazida foi 8,4% (22/263) e à rifampicina 3,8% (10/263) dos casos. A TBMR primária foi encontrada em 1,9% (4/206) dos casos e destes 25,0% (1/4) eram TBXR. A incidência média anual de TBMR foi de 0,57/100,000 habitantes. Dos 25 isolados resistentes ao menos uma droga, submetidos à RFLP, 12 (48,0%) foram agrupados em seis grupos genéticos, com dois pacientes em cada grupo. CONCLUSÕES: A elevada proporção TBMR primária, com um caso de TBXR enfatizam a necessidade de universalizar a cultura e TS, ampliar a cobertura do tratamento supervisionado, a investigação rotineira dos contatos e o monitoramento da resistência a drogas. O fortalecimento da vigilância da resistência às drogas é indispensável para o contínuo aperfeiçoamento do Programa de Controle da TB, especialmente em regiões de elevada carga da doença / INTRODUCTION: The incidence of tuberculosis (TB) in Santos (SP) is located around 73 / 100,000-year, approximately double that found on average in the country. The average prevalence of TB / HIV is 16% cure rates and treatment dropout among new cases are, respectively, 71% and 12%. Such indicators suggest high risk for multidrug-resistant TB (MR-TB) in the city, with the incidence estimated at 1.9 / 100,000-year. OBJECTIVE: To describe and analyze the sensitivity to drugs of first and second line treatment of patients with pulmonary TB (PTB) to estimate the incidence of MR-TB and extensively drugresistant TB (TBXR), describe molecular and institutional aspects, spatial distribution, epidemiological PTB resistant cases in the city of Santos (SP). METHODS: A descriptive study of a cohort of patients with PTB residing in the city who started treatment or retreatment in the period January 2011 to December 31, 2012. The case definition PTB individuals 15 years or more, both sexes, living in the city of Santos (SP), who present clinical manifestations compatible with PTB and whose confirmation was made by culture with isolation of M. tuberculosis. The variables of interest for the study were: bacteriological / laboratory socio-demographic characteristics, current and previous history of TB, aspects related to treatment, and comorbidities. For comparative analyzes of proportions the chi-squared tests and Fisher\'s exact were used for continuous variables and the Student t test or the Kruskal - Wallis. The genetic profiles of isolates resistant to at least one drug were obtained by RFLP (length polymorphism restriction fragment) and analyzed using version BioNumerics 5.0 (Applied Maths - Belgium) software. The description of the spatial distribution of resistant TB and the clusters was made by inserting the cases in Santos map, by address of residence, which was according to the index of social vulnerability. RESULTS: Of the 263 cases of PTB selected, 68.4% (180/263) were male, th median age was 38 years, 8.7% (23/263) were diabetes; 20.4% (42/206) of new cases had at least one risk factor for MR-TB, especially 10.7% (22/206) of making HIV / TB; 47.3% (123/260) underwent supervised treatment, 14.7% (91/617) of the contacts were examined, 18.6% (49/263) were hospitalized during treatment, totaling 7127 days of hospitalization with a mean 145.4 days per patient. Among the cases resistant to at least one drug resistance to isoniazid 8.4% (22/263) and rifampin 3.8% (10/263) of the cases was found. The primary MR-TB was found in 1.9% (4/206) of MR-TB cases and of these 25.0% (1/4) were TBXR. The average annual incidence of MDR-TB was 0.57/100,000 inhabitants. Of the 25 isolates resistant least one drug, subjected to molecular characterization of IS6110, 12 (48.0%) were grouped in six clusters, with each group including two isolates. CONCLUSIONS: A high proportion of primary MR-TB, including a case of TBXR emphasizes the need to universalize culture and TS, expand the coverage of supervised treatment, routine investigation of contacts and monitoring of drug resistance. The strengthening of the surveillance of drug resistance is essential for continuous improvement of the TB Control Program, especially in regions of high disease burden

La résistance aux agents anticancéreux souvent observée en chimiothérapie s'accompagne d'une augmentation de l'expression des gènes tels que MDR-1, gérée par des réactions de méthylation cellulaire. La physiologie des réactions de méthylation régulant l'expression de MDR-1 est insuffisamment connue. La méthionine synthase est l'enzyme clé du cycle métabolique de la méthionine et possède comme cofacteur la cobalamine (vitamine B12), suggérant un rôle crucial du couple cobalamine / méthionine synthase dans la survenue de la chimio-résistance par l'intermédiaire de la méthylation. Nous avions trouvé que l'ajout de cobalamine à des cellules d'adénocarcinome hépatique conduisait à une répression du gène MDR-1 qui ne passe pas par la méthylation du promoteur. Notre objectif est d'explorer et d'étudier les voies métaboliques situées entre le cycle de la méthionine et l'expression du gène MDR-1. Des techniques chromatographiques, électrophorétiques, de culture cellulaire, de pharmacotoxicologie et d'expression génique sont utilisées sur la lignée HepG2. La répression cobalamine-dépendante du gène MDR-1 est associée à une activation de la PLD, une diminution du facteur de signalisation Akt ainsi qu'à une inhibition de Cox2. Le ciblage pharmacologique de ces voies semble potentialiser l'effet d'agents utilisés en chimiothérapie. Cette étude devrait permettre de mieux comprendre des mécanismes de chimiorésistance, de déterminer des paramètres d'optimisation de l'utilisation de ces anticancéreux en relation avec l'expression de MDR-1 elle même en relation avec le statut vitaminique B et peut être d'orienter la recherche en chimiothérapie vers de nouvelles voies thérapeutiques / A key factor of chemioresistance is an increased expression of MDR-1 gene, partly controlled by cellular methylation reactions. Until now, the physiology of these reactions is not clearly known. The main intracellular metabolic pathway, generating methyl donors, is the methionine cycle, the activity of which is strongly depending on B-group vitamins (B12, B9). Thus, MDR-1 gene expression may be controlled by the activity of the methionine cycle and consequently presence of these vitamins. The aim of this study is to determine if, and to elucidate how, the methionine cycle influences the MDR-1 gene expression. Chromatography, pharmacotoxicology, cell culture techniques, gene and protein expression studies have been used on the human hepatocarcinoma cell line HepG2. We showed that cobalamin-induced MDR-1 gene repression was associated with phospholipase D activation, Akt phosphorylation, and Cox-2 co-repression in a complex and intricated manner. We may suggest that targeting these pathways could potentiate chimotherapy. This work shoiuld allow 1) a better understanding of mechanisms explaining why some anticancer agents may become inactive, 2) to optimize utilisation of these agents in relationship with MDR-1 gene expression and the B vitamin status, 3) to evaluate impacts of nutritionnal factors (cobalamine) in MDR-1 gene expression and 4) probably developp possible ways to improve chemotherapy