Thesis (PhD)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The evaluation of the immune responses in peripheral blood and at the site of disease of people with differential outcomes following M.tb exposure will lead to the discovery of host biomarkers that will increase our understanding of the protective and non-protective immune responses against the bacterium. The main study consisted of a number of pilot studies and the objectives of the studies were: (1) To determine the background and stimulated whole blood cytokine profiles of children and adults of the community; (2) to establish biomarker profiles in whole blood of children with different M.tb infection phenotypes; (3) to investigate the anti-mycobacterial whole blood immune responses in HIV infected and uninfected children; (4) and to investigate the role of the innate immune system during human tuberculosis disease. The study designs were as follow: (1) Adults and children were enrolled in order to determine cytokine profiles in the community. Whole blood was stimulated with BCG and ESAT-6 or left unstimulated. Eighteen cytokines were measured in supernatants of each condition. Progression to active tuberculosis in the years after study participation was assessed by searching for patient entries in the tuberculosis register. (2) Children with known tuberculosis exposure in their households and with M.tb infection as assessed through interferon-ã release assays, children with exposure but no infection and a control group with no exposure and no infection were investigated. Whole blood was stimulated in QuantiFeron tubes overnight and 21 cytokines were measured in antigen stimulated and unstimulated supernatants by multiplex cytokine arrays. (3) HIV infected and uninfected children were enrolled in a hospital based study. Whole blood interferon-ã responses against specific mycobacterial antigens were investigated in a diluted 7 day whole blood assay and compared to QuantiFeron supernatants from the same participants. (4) Tuberculosis diseased adults were enrolled before the onset of treatment and innate and adaptive cell populations were investigated upon start of treatment and at treatment end. In addition, pleural effusion fluid was collected from tuberculosis and cancer patients and innate cell populations further investigated. The studies were performed in Cape Town, South Africa and included Tygerberg Academic Hospital and the surrounding neighbourhoods of Ravensmead, Uitsig and Elsies River. The main findings of the studies included: (1) We showed age related cytokine differences in our study community. Tuberculosis progressors had significantly higher levels of IL-10 in the unstimulated sample several years before the onset of tuberculosis disease. (2) Cytokines that distinguished best between children with tuberculosis infection and no infections were all cytokines that correlated with interferon-ã (interferon-ã was used to make the classification of M.tb infected and uninfected). Higher IL-1â and lower IL-17 levels in children with tuberculosis exposure without subsequent M.tb infection compared to children with no exposure were shown. (3) HIV infected children showed better responses after 7 day whole blood antigen stimulation compared to the overnight stimulation in QuantiFeron tubes. TB10.4 stimulation in HIV infected TST positive children gave higher interferon-ã responses than ESAT-6 and CFP-10. (4) The presence of myeloid derived suppressor cells is shown during tuberculosis disease circulating in peripheral blood. Upon treatment a decrease in the population is observed. No differences were seen in the myeloid derived suppressor cell frequencies between tuberculosis and cancer patients, however significantly lower frequencies were seen in healthy controls. The immune response against M.tb is complex and interactions between the different cell types are essential to control and fight infection and disease. In this thesis we presented new biomarkers that play important roles during different stages of M.tb pathogenesis from exposure to infection and even during disease. These may shed light on mechanisms of protection against M.tb, relevant to development of tuberculosis diagnostics and vaccine strategies. Combinations of multiple biomarkers including cytokines and chemokines and cell subsets are required to characterize biosignatures relevant to the diagnosis of tuberculosis infection and disease. / AFRIKAANSE OPSOMMING: Deur die immuunreaksie te ondersoek, in heelbloed en in die setel van infeksie, in mense met verskillende uitkomste van M.tb blootstelling sal lei tot die ontdekking van biologiese merkers en sal bydra tot ons begrip van die beskermde en nie-beskermde immuunreaksies teen die bakterium. Die hoofstudie het bestaan uit ‘n aantal loodsstudies en die doel van die studies was: (1) Om die sitokienprofiele in gestimuleerde heelbloed, asook agtergrond waardes, van kinders en volwassenes te bepaal, in die gemeenskap; (2) om die profiele van biologiese merkers in heelbloed van kinders met verskillende M.tb infeksie fenotipes te bepaal; (3) om die anti-mykobakteriële immuunreaksies in heelbloed by MIV geïnfekteerde en nie-geïnfekteerde kinders te bepaal; (4) om ondersoek in te stel na die doel van die aangebore immuunsisteem tydens tuberkulose siekte. Die studie ontwerpe was soos volg: (1) Volwassenes en kinders het deelgeneem aan die ondersoek van sitokienprofiele in die gemeenskap. Heelbloed is gestimuleer met BCG en ESAT-6 of is ongestimuleerd gelaat. Agtien sitokiene is gemeet in die bo-stand verkry van elke kondisie. Mense wat aktiewe tuberkulose siekte in die jare na die studie ontwikkel het, is geïdentifiseer deur die pastiëntinligting in die tuberkulose-register. (2) Kinders met gedokumenteerde huishoudelike tuberkulose blootstelling en met M.tb infeksie, soos bepaal deur vrygelate interferon-ã toetse, kinders met blootstelling maar geen infeksie en ‘n kontrole groep met geen blootstelling en geen infeksie, is ondersoek. Heelbloed is gestimuleer in die QuantiFeron buise oornag en 21 sitokiene is gemeet in die antigeen gestimuleerde en ongestimuleerde bostande deur die multiplex sitokienpaneel. (3) MIV geïnfekteerde en nie-geïnfekteerde kinders het deelgeneem aan ‘n hospitaal baseerde studie. Heelbloed interferon-ã reaksies teen spesifieke mykobakteriële antigene is bestudeer in ‘n verdunde 7 dag heelbloed toets en vergelyk met die QuantiFeron bostande van dieselfde deelnemers. (4) Siek tuberkulose volwassenes wat nie op behandeling is nie, het deelgeneem. Die aangebore en verworwe selpopulasies is bepaal aan die begin van behandeling asook voor die einde van behandeling. Verder is pluralevog van tuberkulose en kanker pastiënte bestudeer vir aangebore selpopulasies. Die studies is uitgevoer in Kaapstad, Suid-Afrika en sluit in Tygerberg Akademiese Hospitaal en die gemeenskappe van Ravensmead, Uitsig en Elsiesrivier. Die hoofbevindinge van die studies sluit in: (1) Ons het gewys dat daar ouderdomsverwante sitokien verskille in die studie gemeenskap is. Mense wat tuberkulose siekte ontwikkel het, het beduidende hoër vlakke van IL-10 in die ongestimuleerde monsters getoon ‘n paar jaar voor die begin van die siekte. (2) Sitokiene wat die beste onderskeiding gewys het tussen infeksie en geen infeksie was sitokiene wat ook korrelasie getoon het met interferon-ã (interferon-ã is gebruik om die klassifikasie te maak van M.tb infeksie of geen infeksie). Hoër IL-1â en laer IL-17 vlakke in kinders met tuberkulose blootstelling en sonder M.tb infeksie, is gewys wanneer dit vergelyk is met kinders sonder blootsteling. (3) MIV geïfekteerde kinders het beter reaksies getoon na 7 dag heelbloed antigeen stimulasie as met die oornag stimulasie in QuantiFeron buise. TB10.4 stimulasie in MIV geïnfekteerde TST positiewe kinders het hoër interferon-ã reaksies getoon as na stimulasie met ESAT-6 en CFP-10. (4) Die teenwoordigheid van miloïed afgeleide onderdrukkende selle in heelbloed, is getoon tydens tuberkulose siekte. Na behandeling is ‘n afname in die populasie gesien. Geen verskille is gesien in die aantal miloïed afgeleide onderdrukkende selle tussen tuberkulose en kanker pastiënte nie, alhoewel beduidende laer getalle is waargeneem in gesonde kontrole deelnemers. Die immuunreaksie teen M.tb is kompleks en interaksies tussen die verskillende seltipes is belangrik om infeksie en siekte te kontroleer en te beveg. In die tesis het ons nuwe biologiese merkers geïdentifiseer wat belangrike funksies het, tydens die verskillende stadiums van M.tb patogenesiteit, van blootstelling tot infeksie asook tydens siekte. Dit kan gebruik word as biologiese merkers betrokke by die immuunreaksie teen M.tb en sal bydra tot die diagnose van tuberkulose infeksie en siekte.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Tuberculosis (TB) has become a global health epidemic affecting millions of people worldwide with a high incidence in third-world countries. The emergence of multi-drug and extremely-drug resistant M. tuberculosis strains together with the HIV/AIDS pandemic warrants the need for new drugs or new drug combinations. The folic acid synthesis pathway is one of the key pathways that are essential for the survival of bacteria in general. Sulfonamides are a group of compounds that target folic acid synthesis, particularly dihydropteroate synthetase, the first enzyme in the folate pathway. Some of these sulfonamides were used during the introduction of chemotherapy for the treatment of TB in the 1930s, but had toxic side effects. Newer derivatives became safer, but were not employed again for TB treatment. In a recent case study it was reported that the combination of trimethoprim-sulfamethoxazole (Bactrim), which is used to treat various bacterial infections, such as urinary tract infections, had activity against M. tuberculosis. In light of this and the fact that trimethoprim-sulfamethoxazole is well tolerated by humans, we have investigated their antimycobacterial activity with particular interest in the combinational effect of sulfamethoxazole and trimethoprim with the first-line anti-TB drugs, Isoniazid, Rifampicin and Ethambutol against M. tuberculosis. Since sulfonamides are known to produce oxidative stress, we also investigated the contribution of this factor to the efficacy of sulfamethoxazole using a mycothiol deficient strain of M. tuberculosis, ΔmshA. Though trimethoprim-sulfamethoxazole targets the folic acid pathway, we also investigated the possibility that trimethoprim-sulfamethoxazole may have other cellular targets and applied proteomic analysis. We have found that Trimethoprim-Sulfamethoxazole has activity against M. tuberculosis and that Sulfamethoxazole is the active compound. However, our observation was that not all sulfonamides are active against M. tuberculosis. In addition we observed that sulfamethoxazole enhances the activity of Rifampicin against M. tuberculosis in a synergistic way. We also observed that a mycothiol deletion mutant was more susceptible to Sulfamethoxazole compared to the wild type strain CDC 1551. Through global protein expression profiling (Proteomics) we were also able to show that sulfamethoxazole could also kill M. tuberculosis by oxidative stress production as we identified oxidative stress responsive proteins that were differentially regulated upon exposure to sulfamethoxazole. As trimethoprim-sulfamethoxazole is a registered drug combination, inexpensive and widely available, we propose that this regimen could be used in our fight against M. tuberculosis infection. / AFRIKAANSE OPSOMMING: Tuberkulose (TB) is ‘n globale gesondheidsprobleem wat miljoene mense wêreldwyd affekteer met ‘n besoderse hoë voorkoms in die derdewêreld lande. Die voorkoms van multi-middel weerstandige en uitersweerstandige M. tuberculosis stamme, tesame met die HIV/VIGS pandemie, steun die erns vir die ontwikkeling van nuwe middels teen M.tuberculosis . Die foliensuur sintesepad is essensieël tot die oorlewing van bakterieë in die algemeen. Vir daardie rede is daar vele middels ontwerp om hierdie metaboliese pad te teiken. Die sulfonamiedes is ‘n groep antibiotika wat foliensuursintese, spesifiek dihidropteroaatsintese, die eerste ensiem in die foliensuursintese pad, teiken. Van hierdie sulfonamiedes is voorheen in die 1930’s gebruik vir die behandeling van tuberkulose, maar het toksiese newe-effekte getoon. Nuwe, minder toksiese derivate, is later ontwikkel maar is nooit vir TB behandeling weer aangewend nie. In ‘n onlangse gevallestudie is daar gerapporteer dat die kombinasie trimethoprim-sulfamethoxazole (TMP/SMX. Handelsnaam: Bactrim), wat normaalweg gebruik word vir die behandeling van algemene bakteriële infeksies soos blaasinfeksies, aktiwiteit teen M. tuberculosis getoon het. Na aanleiding hiervan en dat Bactrim veilig in mense gebruik kan word, het ons die aktiwiteit van Bactrim komponente teen M. tuberculosis bepaal en in die besonder die aktiwiteite van SMX en TMP in kombinasie met die eerstelinie anti-tuberkulose middels Isoniasied, Rifampisien en Ethambutol. Aangesien sulfonamiedes ook oksidatiewe stres intrasellulêr genereer, het ons ook die bydrae van hiervan tot die doeltreffendheid van SMX bepaal deur gebruik te maak van ‘n mycothiol-gemuteerde M. tuberculosis stam ( mshA). Omdat TMP/SMX die foliensuur-pad hoofsaaklik teiken het ons ook die moontlikheid ondersoek dat SMX ander sellulêre teikens het en het ons proteomiese (Proteomics) tegnieke hiervoor aangewend. Ons het gevind dat TMP/SMX aktiwiteit teen M. tuberculosis toon en dat SMX die aktiewe komponent van Bactrim is teen M. tuberculosis . Ons wys ook dat sulfonamiedes in die algemeen nie noodwendig ook aktiwiteit teen M. tuberculosis toon nie. Ons het ook waargeneem dat SMX die aktiwiteit van rifampisien bevorder en dat die twee middels saamwerk op ‘n sinergistiese wyse. Ons het ook getoon dat oksidatiewe stres ‘n rol speel deurdat‘n mycothiol delesie-mutant meer vatbaar was vir SMX in vergelyking met die wilde-tipe stam van M. tuberculosis (CDC1551). Met globale proteïenkartering (Proteomics) het ons ook getoon dat SMX M. tuberculosis kan doodmaak deur oksidatiewe stres te genereer omdat ons oksidatiewe stres reaktiewe proteïne geïdentifiseer het wat differensieël gereguleer is gedurende blootstelling aan SMX. Aangesien Bactrim ‘n reeds geregistreerde middel is, goedkoop is en geredelik beskikbaar is, stel ons voor dat Bactrim moontlik geïnkorporeer kan word in die huidige behandeling van Tuberkulose.

Memoria para optar al Título Profesional de Médico Veterinario / La Paratuberculosis es una enfermedad infecto contagiosa crónica con un largo período de incubación causada por Mycobacterium avium subsp. paratuberculosis (MAP), que afecta principalmente a los rumiantes, generando diarrea en algunas especies, caquexia y debilitamiento progresivo y como consecuencia, perdidas económicas en los rebaños. También infecta a animales silvestres que actuarían como posibles reservorios y se le asocia un posible potencial zoonótico, habiendo sido aislada la bacteria en algunos pacientes con la Enfermedad de Crohn, siendo el posible vehículo de infección la leche, ya que esta bacteria resistiría la pasteurización. En este estudio se trata de detectar la presencia de Mycobacterium paratuberculosis desde heces de caprinos de la región Metropolitana. Se realizaron cultivos bacteriológicos para M. paratuberculosis según recomendaciones del Australian Standard Diagnostic Techniques (ASDT) y con las modificaciones que permiten una mejor eficiencia en la recuperación de la bacteria. El medio de cultivo para aislamiento primario es el medio de Herrold con yema de huevo (HEYM) más mycobactina J. Se tuvo acceso a 10 rebaños donde se seleccionaron el número de animales en múltiplos de cinco, tratando de abarcar el 25% de la población de cada rebaño. Se recolectaron muestras directamente desde el recto, tomando 1 a 2 heces de cada caprino, que se depositaron en bolsas de plástico estéril agrupándose en “pools” de cinco animales. Para tener una mayor probabilidad de detectar rebaños caprinos infectados con MAP, se consideraron hembras mayores de un año, y en lo posible animales que hayan presentado signos de diarrea, debilitamiento, pérdida de peso progresiva, disminución de la producción láctea, etc. Se comprobó la presencia de MAP desde heces de caprinos de la Región Metropolitana en 3 rebaños de los 10 muestreados, encontrándose un 18% de los “pools” positivos a MAP. El medio HEYM más la adición de mycobactina J demostró claramente ser muy efectiva para el aislamiento del MAP a partir de muestras de heces de animales que ya estaban diseminando el microorganismo

Mycobacterium abscessus (Mabs) est un pathogène émergent entrainant de graves infections pulmonaires, notamment chez les patients mucoviscidosiques. L'expression différentielle des glycopeptidolipides (GPLs) permet de distinguer le morphotype rugueux (R), présentant un défaut de synthèse des GPLs, du morphotype lisse (S) exprimant les GPLs. Différents modèles ex vivo et in vivo rapportent que le variant R est impliqué dans des manifestations plus sévères associées à une réponse inflammatoire intense. Cependant, ces modèles d'étude restent particulièrement limités pour élucider les caractéristiques de cette infection. L'embryon de zebrafish (ZF) offre de nombreux avantages motivant et validant son utilisation pour une meilleure compréhension des maladies infectieuses. Ce travail de thèse a pour objectif de développer un modèle d'infection de Mabs dans l'embryon de ZF.Pour étudier la physiopathologie de l'infection de Mabs dans ce modèle, l'élaboration d'un protocole de microinjection des bactéries et des méthodes de suivi de la charge bactérienne ont été réalisés. Les techniques d'imagerie ont été employées pour déterminer la chronologie de l'infection au sein des embryons infectés. Les techniques de qRT-PCR, l'utilisation de lignées de ZF transgéniques et la technologie antisens (morpholinos) ont été utilisées pour déterminer le rôle du système immunitaire (Si) inné et de l'inflammation dans la physiopathologie infectieuse. Par ailleurs, le potentiel du ZF en tant qu'organisme modèle en pharmacologie a été mis à profit pour étudier l'activité in vivo d'antibiotiques (ATB) sur Mabs.Le variant R induit une infection létale plus robuste que le S, caractérisée par le développement d'abcès au niveau du système nerveux central (SNC) associés à une réponse inflammatoire intense et au recrutement de neutrophiles. Le suivi des infections a révélé que les bactéries étaient rapidement phagocytées par les macrophages au niveau du site d'injection. Une fois infectés, ces derniers traversent la barrière endothéliale et transportent les mycobactéries dans les tissus du SNC, soulignant leur rôle clé dans la dissémination du pathogène. Des expériences menées dans des embryons dépourvus de macrophages ont validé ces observations en montrant que les bactéries étaient incapables de rejoindre le SNC et restaient confinées dans le système vasculaire. Implanté au sein du tissu nerveux, le macrophage infecté entre en apoptose, libérant ainsi le pathogène dans le milieu extracellulaire. Une fois libéré, à la différence du variant S, la morphotype R forme des cordes augmentant rapidement de taille et capables d'initier le développement d'abcès volumineux. La taille démesurée de ces cordes par rapport à celle des phagocytes professionnels représenterait une stratégie permettant au variant R d'échapper à la phagocytose et donc de promouvoir sa multiplication extracellulaire et d'assurer la progression létale du processus infectieux. Enfin, ce modèle nous a permis de déterminer, en temps réel, l'efficacité thérapeutique de plusieurs ATBs sur les embryons infectés,qui s'accompagne d'une forte réduction de mortalité des embryons et d'une importante diminution des signes physiopathologiques au niveau du SNC. Ces résultats indiquent que l'embryon de ZF représente un modèle d'infection prometteur et pertinent pour 1) l'étude de la virulence de Mabs 2) l'évaluation de la contribution du SI innée au cours de l'infection et 3) le suivi directe de l'effet d'ATBs. Ce nouveau modèle, combiné aux outils déjà disponibles chez le ZF, devrait permettre de mieux caractériser la relation entre Mabs et mucoviscidose, notamment l'implication éventuelle de la protéine CFTR dans la résistance à cette bactérie. Par ailleurs, l'embryon étant particulièrement propice au criblage à haut débit, l'optimisation de ce système biologique pourrait être exploitée dans le cadre d'approches thérapeutiques innovantes pour identifier de nouveaux agents anti-infectieux contre Mabs. / The emerging pathogen Mycobacterium abscessus causes severe lung infections particularly in cystic fibrosis (CF) patients. The Smooth (S) morphotype displays surface expression of glycopeptidolipids (GPL) while the Rough (R) morphotype is characterized by the loss of surface-associated GPL. Previous studies suggested that the R variant is involved in more severe clinical forms, associated with a hyper-proinflammatory response. However, the molecular mechanisms responsible for the virulence and physiopathology associated to the Rvariant remain unknown. The zebrafish embryo offers many advantages that motivated and validated its use for a better understanding of infectious diseases. In this study, a zebrafish model of infection was developed toinvestigate and compare the pathogenesis of R and S variants.A microinjection protocol was first developed and the fate and progression of the infection was monitored at a spatiotemporal level by videomicroscopy. A transcriptomic approach by qRT-PCR, an antisense technology using morpholinos and transgenic zebrafish lines were used to evaluate the contribution of theinnate immune system and the role of inflammation during infection. In addition, the potential of the embryo has been used to study the in vivo pharmacological activity of antibiotics during M. abscessus infection. In contrast to the S variant, the R morphotype induced a more robust and lethal infection in zebrafish embryos, characterized by the rapid development of bacterial foci within the central nervous system (CNS). The use of a mpx:GFP zebrafish transgenic line, exhibiting green fluorescent granulocytes, indicated that neutrophils are actively recruited to CNS infection foci. An intense pro-inflammatory response with production of TNFα was measured by qRT-PCR. Next, the use of a mpeg1:mCherry transgenic zebrafish line, exhibiting red fluorescent macrophages, demonstrated the presence of isolated or small aggregated bacilli within macrophages during early infection. In contrast, later stages were characterized by the presence of large aggregates of extensively replicating extracellularly that enables mycobacteria to induce a strong inflammatoryresponse, leading to rapid tissue damage (abscess) and to larval death. In addition, the high propensity of the R variant to form cords in vivo may, represent a strategy evolved by the R (but not S) M. abscessus, to escape themacrophage or avoid being phagocytosed by macrophages or granulocytes. The role of macrophages in the diffusion of bacteria to the CNS was evaluated in macrophage-depleted embryos. Here, M. abscessus failed to disseminate from vasculature to CNS as shown by infections performed in KDR:GFP transgenic line, exhibiting green vascular endothelium. In addition, we also showed that the activity of antibiotics on infected-embryos is associated with a strong reduction of embryonic mortality, reduction in the bacterial burden and a significant decrease in physiopathological signs in the CNS, which could be imaged in real-time and at high resolution.These results propose the zebrafish embryo as a suitable model, particularly relevant to 1) the study of M. abscessus virulence, 2) the evaluation of role of innate immune system during infection process and to 3)monitor, at spatiotemporal level, the effects of antibiotics in an infected vertebrate. In addition, the antisense technology allowing knocking-down cftr expression can now be optimized to mimic a CF environment. This should greatly help to define the relationship between M. abscessus in CF patients. Moreover, the embryo isparticularly conducive to high-throughput screening, thus allowing this biological system to be exploited in the search for new therapeutic molecules against M. abscessus and other CF-associated patients

O Mycobacterium bovis é o agente causador da tuberculose em bovinos, zoonose que produz prejuízos para a produção de carne e leite em muitos países. Para apoiar estudos epidemiológicos no âmbito dos programas de controle, recentemente surgiram vários métodos de discriminação molecular de isolados de M. bovis. Os mais utilizados são o Spoligotyping, Mycobacterial Interspersed Repetitive Units (MIRU) e Exact Tandem Repeat (ETR), que apresentam diferentes poderes de discriminação. No presente estudo calculou-se a diversidade alélica para cada locus de MIRU e de ETR e o índice discriminatório de Hunter-Gaston (HGI) para o Spoligotyping, 10 MIRU e 3 ETR em 116 amostras de M. bovis isoladas de bovinos. Além disso, verificou-se se a capacidade de detectar agrupamentos espaciais de focos aumenta na medida em que é aumentado o poder discriminatório das análises moleculares. Comparou-se a utilização dessas três técnicas moleculares em análises espaciais para verificação de agrupamentos de focos da doença. A análise da diversidade alélica indicou que os MIRU 16, 26 e 27 e os ETR A, B e C foram os que apresentaram maior diversidade dentre os ensaiados. O HGI para cada uma das técnicas foi de: Spoligotyping = 0,738381; MIRU = 0,829835 e ETR = 0,825337. A associação desses métodos aumentou o poder discriminatório: Spoligotyping + MIRU = 0,930585; Spoligotyping + ETR = 0,931034; MIRU + ETR = 0,953373. O maior poder discriminatório foi alcançado quando as três técnicas foram associadas (HGI = 0,98051). Considerando as análises realizadas no presente estudo, o método inicial deveria ser o Spoligotyping, por diferenciar o M. bovis dos outros integrantes do complexo Mycobacterium tuberculosis. Como as associações do MIRU e do ETR com o Spoligotyping resultaram em HGI praticamente idênticos, depois do Spoligotyping, o método ETR parece ser a melhor escolha, pois é mais rápido e econômico do que o MIRU. Finalmente, o MIRU deve ser o último método a ser realizado. Assim, a escolha do método depende do poder discriminatório necessário para o objetivo em questão. Embora a capacidade de detectar agrupamentos espaciais de focos não tenha sido aumentada na medida em que cresceu o poder discriminatório das análises moleculares, a premissa continua válida. / Mycobacterium bovis is the causative organism of bovine tuberculosis, has zoonotic character and leads economic losses in livestock production in a lot of countries. To support the epidemiological researches on the disease control programs several molecular methods has been used to detect M. bovis strains. Among them, Spoligotyping, Mycobacterial Interspersed Repetitive Units (MIRU) and Exact Tandem Repeat (ETR) are the molecular analyses that present different powers of Mycobacterium bovis discrimination. In this study, allelic diversity of MIRU and ETR locus and Hunter-Gaston discriminatory index (HGI) were calculated for Spoligotyping, 10 MIRU and 3 ETR of 116 isolates of M. bovis from Brazilian bovines. The use of those three molecular techniques was compared in space analyses for verification of groupings of focuses of the disease. Besides, it was verified if the capacity to cluster of focuses increases in the measure in that the discriminatory power of the molecular analyses is increased. The analysis of the allelic diversity indicated that MIRU 16, 26, 27 and ETR A, B, C presented larger diversity among the rehearsed. The HGI for each individual technique was: Spoligotyping = 0.738381; ETR = 0.825337 and MIRU = 0.829835. The associations of these methods increased the discriminatory power: Spoligotyping + MIRU = 0.930585; Spoligotyping + ETR = 0.931034; MIRU + ETR = 0.953373. The greater discriminatory power was verified when the three techniques were associated (HGI = 0,98051). Considering the analyses performed, the initial method for differentiating M. bovis from the other species of the M. tuberculosis complex should be Spoligotyping. The association of MIRU and ETR with Spoligotyping resulted in HGI almost identical, after Spoligotyping, the ETR technique showed to be the best choice, due the shorter time to process and economic benefits when compared to MIRU. Finally, MIRU is the last method to be performed. Thus, the choice among the techniques depends on the discriminatory power necessary for the task. Although the capacity to detect clusters of focuses has not been increased in the measure in that it increased the discriminatory power of the molecular analyses, the premise continues valid.

A Tuberculose é uma das doenças infecciosas mais antiga e bem descrita. Entretanto, ainda permanece como um dos principais problemas de saúde pública a ser enfrentado em âmbito global. A implantação de novas estratégias no controle da Tuberculose requer uma melhor compreensão dos mecanismos que sucedem a fagocitose das micobactérias por macrófagos. Após a fagocitose, as micobactérias dão início a um conjunto de ações para sobreviverem e se replicarem no ambiente intracelular, entre as quais a provável interferência no processo de morte celular. Estudos mostram que M. tuberculosis pode apresentar habilidade de interferir no mecanismo de morte celular. Essa habilidade se tornou um desafio a ser estudado devido às implicações que isso deve ter na patogênese da doença. O nosso estudo teve por objetivo analisar a expressão de genes anti-apoptóticos (bcl-2, bcl-x e mcl-1) e pro-apoptóticos (bak, bax e bid) por PCR em tempo Real em macrófagos humanos derivados de células THP-1 após diferenciação induzida por PMA. Além disso, analisar a porcentagem de fragmentação de DNA nesses macrófagos, utilizando a citometria de fluxo, pois a fragmentação internucleossômica do DNA é uma das características apresentadas por células apoptóticas. Para as infecções foram utilizados isolados clínicos de M. tuberculosis com perfil de suscetibilidade a fármacos diferentes e a cepa padrão H37Rv (ATCC). Os dados de expressão foram analisados pela diferença de entre os isolados clínicos sensíveis, resistentes a três dos fármacos utilizados no tratamento da tuberculose humana e a cepa padrão H37Rv, utilizando-se o método de 2-ΔΔCT. Para comparar os resultados de expressão gênica, bem como a porcentagem de fragmentação de DNA, nos macrófagos infectados com os diferentes isolados clínicos, foram utilizados análise de variância (ANOVA) e o teste de comparação múltipla de Tukey. Os resultados sugerem, que os isolados clínicos resistentes a INH, RIF e EMB utilizados no nosso estudo, bem como a cepa padrão H37Rv (ATCC), não induzem mecanismos anti-apoptóticos para evadir da resposta imune. A ocorrência de fragmentação de DNA nos macrófagos infectados é um indicativo de morte por apoptose ou pyroptose. Além disso, o tempo de infecção éum fator importante e, com certeza, infecções com tempos maiores poderiam induzir ainda mais a morte dos macrófagos infectados. / Tuberculsis, an ancient infection disease, continues to thrive. Although well described, it remains a world health problem to overcome. The development and application of new strategies to control Tuberculosis requires a better understanding of mechanisms involved in mycobacteria-macrophages interaction. Following phagocytosis, mycobacteria initiates a variety of actions to survive and multiply themselves inside macrophages. According to researches, mycobacteria might interfere in the cell death mechanism. This ability became a challenge to be studied due to its implications in the pathogenesis of the disease. The aim of this study was to analyze the gene expression of anti-apoptotic (bcl-2, bcl-x e mcl-1) and pro-apoptotic genes (bak, bax e bid) in PMA-treated THP-1 cells by Real Time qPCR. Moreover, the percentage of macrophage DNA fragmentation was assessed by flow citometry because internucleosomal DNA fragmentation is characteristic of apoptotic and pyroptotic cell death. The infection was carried out using clinical isolates of M. tuberculosis resistent to multiple drugs, drug susceptibility and the M. tuberculosis H37Rv strain. The difference in the expression profile among clinical isolates, susceptible and resistant to three drugs used in the TB treatment, and the M. tuberculosis H37Rv were evaluated with the method 2-ΔΔCT. In order to compare gene expression patterns as well as the percentage of DNA fragmentation in macrophages infected with different clinical isolates, it was used analysis of variance (ANOVA) and Tukey`s multiple comparison test. The results suggest that M. tuberculosis H37Rv and the clinical isolates presenting higher drug resistant profile might induce programmed cell death in macrophages after 24-h infection. This was observed in the gene expression pattern and also in the macrophage DNA fragmentation profile, which indentifies apoptosis or pyroptosis. Therefore, it is suggested these clinical isolates and M. tuberculosis H37Rv do not present anti-apoptotic mechanisms to evade immune response. Moreover, the infection time is an important factor and, definitely, infections for long time could induce increase death of the infectados macrophages.

A Mycobacterium abscessus subspécie abscessus é um pesadelo quando envolvida em infecção pulmonar que são incuráveis, a despeito do uso de antimicrobianos com atividade in vitro, caso o tratamento não inclua a ressecção cirúrgica da área afetada. É a micobactéria patogência de crescimento rápido mais frequentemente isolada de culturas de sítios pulmonares. Há um número reduzido de opções terapêuticas para o tratamento dessas infecções, e é ainda mais reduzido o número de antimicrobianos que atingem concentrações terapêuticas no compartimento intracelular, em particular no fagossomo. O número limitado de antimicrobianos disponíveis para tratamento apontam a necessidade de determinação do perfil de susceptibilidade frente a antimicrobianos isolados e em combinação, nos compartimentos intra e extracelular. Os objetivos deste estudo foram avaliar: a sensibilidade de M. abscessus estruturadas em biofilmes e presentes no interior dos macrófagos; a ocorrência de sinergismo quando da associação entre fármacos, inibidores de betalactamase e o anti-inflamatório. As combinações entre os antimicrobianos foram apenas indiferente quanto ao FIC e a atividade dos fármacos em biofilme e em macrófagos é bacteriostático. / Mycobacterium abscessus subspecies abscessus is a nightmare when involved in lung infection that is incurable, despite the use of antibiotics with in vitro activity, if the treatment does not include surgical resection of the affected area. It is a MCR - rapidly growing mycobacteria pathogenic most frequently isolated from cultures of lung sites. There are a small number of therapeutic options for the treatment of such infections is further reduced and the number of drugs that reach therapeutic concentrations in the intracellular compartment, particularly in the phagosome. The limited number of antimicrobials available for treatment indicate the need for determining the susceptibility profile against antimicrobials alone and in combination, in the intra and extracellular compartments. The objectives of this study were sensitivity of MCR structured biofilms and present in macrophages, the occurrence of synergism when the association between drugs, beta-lactamase inhibitors and anti-inflammatory. Combinations of antimicrobials were just indifferent and the activity of drugs on biofilms and macrophages was bacteriostatic.

A tuberculose continua sendo uma importante doença infecciosa, tanto nos humanos quanto nos animais, com índices de morbidade e mortalidade significativos e perdas econômicas em todo o mundo. A tuberculose bovina é uma doença infecciosa causada pela bactéria Mycobacterium bovis, que gera perdas na produção nos rebanhos infectados, sendo também considerada uma importante zoonose. Os métodos de diagnóstico direto têm fundamental importância para um sistema de vigilância para a tuberculose bovina e a agregação de métodos moleculares, notadamente aqueles que têm aplicação em epidemiologia, traz maior precisão diagnóstica para esses sistemas. Dentre as técnicas moleculares, destacam-se o TB Multiplex PCR, o RD Multiplex PCR e o Multispacer Sequence Typing, para a identificação dos isolados e o Variable Number Tandem Repeat (VNTR) e o Spoligotyping, como técnicas de fingerpint de M. bovis. Assim, o presente estudo teve como objetivo a identificação molecular de amostras oriundas de várias regiões do Brasil utilizando estes padrões de técnicas moleculares. Os espoligotipos identificados em maior abundância foram o SB0121, o qual apresentou-se amplamente distribuído entre as amostras, seguido pelo SB0295, SB1380, SB0140 e SB1050. Além disso, foram detectados quatro perfis nunca antes descritos na literatura, sendo que um deles foi o terceiro mais frequente entra as amostras pesquisadas. Os resultados observados neste trabalho demonstraram ainda que a tipagem pelo MIRU-VNTR revelou-se superior ao Spoligotyping para discriminar os isolados. Nesta perspectiva, acredita-se que as pesquisas moleculares voltadas a identificação de micobactérias, aliadas as técnicas epidemiológicas tradicionais, possam melhorar sensivelmente a performance dos sistemas de vigilância para tuberculose bovina no Brasil. / Tuberculosis remains a major infectious disease in both humans and animals, with morbidity and mortality and significant economic losses. Bovine tuberculosis is an infectious disease caused by Mycobacterium bovis, with yield losses in infected herds and is also considered an important zoonosis. The methods of direct diagnosis are important for a surveillance system for bovine tuberculosis and aggregation of molecular methods brings greater diagnostic accuracy for these systems, especially those that have application in epidemiology. Among them, TB Multiplex PCR, RD Multiplex PCR, and Multispacer Sequence Typing for the identification of strains, and Variable Number Tandem Repeat (VNTR) and Spoligotyping, for fingerprint of M. bovis. Thus, the present study aimed to identify molecular samples from different regions of Brazil using these molecular techniques. The most abundant were the spoligotype SB0121, which has become widely distributed among the samples, followed by SB0295, SB1380, SB0140, and SB1050. In addition, four profiles never before described in the literature were detected, one of which was the third most frequent. The results of this study also showed that the MIRU-VNTR typing has proved superior to Spoligotyping to discriminate the isolates. In this perspective, it is believed that the research focused on molecular identification of mycobacteria, combined traditional epidemiological techniques, can significantly improve the performance of surveillance systems for bovine tuberculosis in Brazil.

Reproduction de : Thèse d'exercice : Médecine. Dermatologie et vénéréologie : Paris 12 : 2008. / Titre provenant de l'écran-titre. Bibliogr. f. 39-49.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniversitet, 2009. / Härtill 5 uppsatser.