Introduction: Endoscopic sinus surgery (ESS) is at present the gold standard therapeutic modality for chronic rhinosinusitis (CRS) resistant to medical therapy. Whilst results from ESS for CRS are generally good, postoperative bleeding and impaired wound healing with adhesion formation remains a concern. Due to patient discomfort and the detrimental effects on wound healing caused by most packing materials, many surgeons no longer routinely use nasal packing. Surgeons have in the past sought agents which would provide post-operative haemostasis without detrimentally affecting wound healing. Antifibrinolytics have been available for many years, however, their topical application has only been explored in the last few years. Recently different forms of chitosan have separately shown significant promise as powerful haemostatic and anti-adhesion agents. The aim of this thesis was to explore the progressive understanding of the interaction between haemostasis and wound healing with possible development of a novel agent. Methods: The first step to scientifically assess bleeding after sinus surgery was to develop a standardised method of video endoscopy and grading the surgical field during ESS. This was done as a multinational collaborative trial. Once this assessment tool was validated a randomised controlled trial evaluating the effect of two antifibrinolytics (epsilon aminocaproic acid and tranexamic acid) was conducted. Further evaluation was then conducted on other possible hemostatic and antiadhesion substances. This included various combinations of a novel chitosan gel. These gels were trialled in vitro to determine their effect on human nasal fibroblasts derived from CRS patients. Fibroblast adhesion and proliferation as well as closure of standardised wounds were studied. The most promising of these gels was then used in an in vivo sheep model. Once effectiveness of the chitosan-dextran gel was shown in the laboratory, this was evaluated against a number of currently available hemostatic and anti-adhesion substances in a standardised model of wound healing in sheep with CRS. This model had been previously extensively validated in our department. Full thickness mucosal injuries were created on the lateral nasal wall and ethmoids of twenty sheep and recombinant tissue factor (rTF), SprayGel or Chitosan-Dextran derivative gel applied topically in a randomized fashion. Adhesion formation and severity as well as microscopic wound healing and ciliary function were analysed at day 28, 56, 84 and 112 post initial surgery. A further sheep study was conducted applying chitosan dextran gel to standardised mucosal injuries and comparing its effect on the control of bleeding to control. Bleeding time and grade were recorded and wound healing monitored via serial videoendoscopy over two weeks and objectively measured. Results: a) Assessment of the bleeding scales showed that inter and intra observer reliability for both scales tested were significantly improved by employing a standardized video-endoscopy technique. The Wormald scale proved to be more reliable and sensitive to changes in the most common surgical fields encountered in ESS. b) Tranexamic acid showed a modest but clinically significant improvement in the surgical field at 2, 4 and 6 minutes after application. Epsilon aminocaproic acid did not effectively improve the surgical field. c) Nasal fibroblast adhesion and proliferation were significantly impaired with dextran and chitosan. The most effective ratio that delayed but did not prevent wound closure were 5 % chitosan: 5 % dextran gel. d) In a standardised sheep model of mucosal wound healing the chitosan gel significantly decreased lateral nasal wall and ethmoidal adhesions at all time points. The chitosan group had a significantly greater percentage of re-epithelialisation and reciliation than control and rTF. In addition the mean cilial grade in the chitosan group was significantly better than control. e) The chitosan dextran gel was significantly more haemostatic at 2,4, and 6 minutes after injury with no significant difference noted in wound healing. Conclusions: Standardised methods of videoendoscopy and grading the surgical field in ESS are valuable tools for further research. Tranexamic acid significantly improved the surgical field to a moderate degree in ESS compared to control. Chitosan gel is a promising new powerful haemostatic bio-polymer which has a mild inhibitory effect on fibroblast attachment and proliferation. This may partially explain the significant improvement in microscopic wound healing and reduction in adhesion formation seen in a sheep model of chronic sinusitis. Future work evaluating this gel in the setting of a human trial is currently underway. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1375402 / Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2009

Objetivos: Avaliar o papel da turbinectomia inferior parcial endoscópica (TIPE) na rinosseptoplastia primária sobre os desfechos de qualidade de vida, complicações e tempo cirúrgico. Delineamento: Ensaio clínico pragmático, randomizado, duplo-cego em um centro único e de grupos paralelos. Métodos: Indivíduos maiores de 16 anos, com queixas estéticas e obstrução nasal, candidatos à rinosseptoplastia primária, avaliados entre março de 2014 e maio de 2015, em um Hospital Terciário Universitário no Brasil. Pacientes elegíveis foram randomizados para receberem ou não TIPE concomitantemente à cirurgia. Desfechos: Diferença absoluta dos escores pré e pós-operatórios em qualidade de vida específica, pela aplicação dos questionários Nasal Obstruction Symptom Evaluation Portuguese (NOSE-p) e Rhinoplasty Outcome Evaluation (ROE), e geral, através de aplicação do World Health Organization Quality of Life (WHOQOL)-breve. Os desfechos eram cegados e acessados somente três meses após a cirurgia. O protocolo foi registrado no ClinicalTrials.gov (NCT02231216). Resultados: 50 pacientes foram incluídos, maioria caucasiana com rinite alérgica com sintomas moderados a severos. A média de idade foi 36 (±14,5) anos. Os escores de qualidade de vida específicos e gerais melhoraram independentemente da intervenção TIPE (p < 0,001). ANCOVA foi aplicada para controlar potenciais fatores confundidores. Não houve divergência entre a diferença absoluta nos pacientes submetidos ou não a TIPE nos escores NOSE-p (-50,5 vs. -47,6; p=0,723); ROE (47 vs. 44,8; p= 0,742) e todos os domínios do WHOQOL-breve (p > 0,05). Não houve diferença entre os grupos sobre a presença de complicações. O tempo cirúrgico foi maior no grupo TIPE (212 minutos ± 7,8 vs. 159,1 ± 5,6; p ˂ 0,001). Conclusão: A redução das conchas inferiores através da TIPE durante a rinosseptoplastia primária não melhorou, em curto prazo, a qualidade de vida geral nem específica. O uso de TIPE aumenta o tempo cirúrgico consideravelmente, sem adicionar benefício aos escores avaliados. Não houve diferença na incidência de complicações no pós-operatório, sugerindo a segurança da técnica. / Objectives/Hypothesis: To evaluate the impact of endoscopic partial inferior turbinectomy (EPIT) associated with primary Rhinoseptoplasty on quality of life outcomes (QOL), complications, and surgical duration. Study Design: Randomized clinical trial. Methods: Individuals with nasal obstruction aged ≥ 16 years who were candidates for functional and aesthetics primary Rhinoseptoplasty were evaluated from March 2014 through May 2015 at a tertiary university hospital in Brazil. Eligible participants were randomly allocated to rhinoseptoplasty with or without EPIT. Outcomes: Absolute change (postoperative –preoperative) in the following QOL scores: Nasal Obstruction Symptom Evaluation-Portuguese (NOSE-p), Rhinoplasty Outcome Evaluation (ROE) and World Health Organization Quality of Life (WHOQOL)-bref (to measure general QOL). Outcomes were blindly assessed 3 months postoperatively. The protocol was registered at ClinicalTrials.gov (NCT02231216). Results: Fifty patients were studied. Most were Caucasian and had moderate/severe allergic rhinitis symptoms. Mean age was 36 (±14.5) years. Rhinoseptoplasty was associated with improvement in all QOL scores irrespective of turbinate intervention (P <0.001). ANCOVA was conducted to control for potential confounders. There was no difference between the groups in absolute score changes for NOSE-p (-50.5 vs. -47.6; P=0.723); ROE (47 vs. 44.8; P = 0,742), and all WHOQOL-bref score domains (P >0.05). There were no differences between the groups regarding presence of the complications. Surgical duration was higher in the EPIT group (212 minutes ± 7.8 vs. 159.1 ± 5.6; p ˂ 0.001). Conclusions: Turbinate reduction through EPIT during primary rhinoseptoplasty did not improve short-term general and specific QOL outcomes. The use of EPIT increases surgical time considerably without improving QOL scores. There was no difference in postoperative incidence of complications, suggesting that EPIT is a safe technique.

Introdução: A polipose nasal (PN) é considerada uma condição inflamatória crônica da mucosa da cavidade nasal e seios paranasais de etiologia não muito clara. Há poucos dados sobre alterações epiteliais em PN e sua relação com a ação dos radicais livres. Muitas doenças estão ligadas a danos causados por espécies reativas de oxigênio (ROS) e de nitrogênio (RNSS) e ocorrem de um desequilíbrio entre eles e antioxidantes, o que for maior atividade de espécies reativas, o que chamamos de estresse oxidativo. Objetivo: O objetivo principal deste estudo é avaliar o estresse oxidativo em pólipos removidos cirurgicamente em 3 grupos de pacientes com polipose nasal (com PN unicamente, PN associado à asma e PN associado à asma e intolerância ao ácido acetilsalicílico) a fim de elucidar possíveis diferenças no perfil redox nestes grupos. Material e Métodos: Cinquenta e nove pacientes com diagnóstico de polipose nasal foram divididos em três grupos clínicos: um grupo controle PN unicamente, um grupo asma (PN associado à asma) e um grupo Widal (PN associado à asma e intolerância ao ácido acetilsalicílico). Medição e Resultados Principais: Neste trabalho defesas enzimáticas (superóxido dismutase, consumo de peróxido de hidrogênio, glutationa peroxidase e glutationa S-transferase) e defesas não enzimáticas (glutationa total, nitritos e nitratos, vitamina C e E) foram analisados. Também foi realizada a medição de danos em lipídios (malondialdeído) e proteínas (carbonila). No grupo asma, o consumo de peróxido de hidrogênio, atividade da glutationa peroxidase, níveis de malondialdeído e vitamina E foram significativamente menores do que no grupo de controle. Também foi realizada a medição de danos em lipídios (malondialdeído) e proteínas (carbonila). No grupo Widal foram encontrados níveis significativamente maiores de glutationa e nitritos e nitratos em relação ao grupo controle. Não foram encontradas diferenças entre os grupos em relação ao nível de carbonila e glutationa, tamanho dos pólipos, atividades da superóxido dismutase e S-transferase. Conclusões: A classificação redox dos grupos de PN foi parcialmente alcançada. Os pólipos do grupo asma possuem alterações nas defesas enzimáticas relacionadas com o peróxido de hidrogênio e a peroxidação lipídica, enquanto pólipos do grupo Widal apresentaram alterações nos níveis de óxido nítrico e glutationa. / Introduction: Nasal polyposis (NP) is considered a chronic inflammatory condition of the mucosa of the nasal cavity and paranasal sinuses of etiology is not very clear. There are few data on epithelial changes in nasal polyposis and its relation to the action of free radicals. Many diseases are linked to damage caused by reactive oxygen species (ROS) and nitrogen (RNSs) and occur from an imbalance between them and antioxidants, whichever is greater activity of reactive species, what we call oxidative stress. Objective: The primary objective of this study is to evaluate oxidative stress in polyps surgically removed in 3 groups of patients with nasal polyposis, in order to elucidate possible differences in redox profile in these groups. Methods: Fifty nine patients diagnosed with nasal polyposis were divided into three groups: a control group, an asthma group (NP with asthma) and a Widal group (NP with asthma and aspirin intolerance) in which patients had an association of NP, asthma and aspirin intolerance. Measurement and main results: In this work enzymatic defenses (superoxide dismutase, hydrogen peroxide consumption, glutathione peroxidase and glutathione S-transferase) and non-enzymatic defenses (total glutathione, measurement of nitrites and nitrates, vitamin C and E) were analyzed. Also the measurement of damage in lipids (malondialdehyde) and proteins (carbonyl) was conducted. In the asthma group, hydrogen peroxide consumption, glutathione peroxidase activity, malondialdehyde, and vitamin E levels were significantly lower than in the control group. The Widal group showed significant higher glutathione levels, nitrite and nitrate levels than found in the control group. No differences were found among the groups regarding carbonyl level, polyp size, superoxide dismutase, and glutathione S-transferase activities. Conclusions: The redox classification of the groups of NP was partly achieved. Polyps of patients with asthma have changes in enzymatic defense pathways related to hydrogen peroxide and lipid peroxidation while polyps of patients with Widal triad present changes in nitric oxide and glutathione.

Objetivos: Avaliar o papel da turbinectomia inferior parcial endoscópica (TIPE) na rinosseptoplastia primária sobre os desfechos de qualidade de vida, complicações e tempo cirúrgico. Delineamento: Ensaio clínico pragmático, randomizado, duplo-cego em um centro único e de grupos paralelos. Métodos: Indivíduos maiores de 16 anos, com queixas estéticas e obstrução nasal, candidatos à rinosseptoplastia primária, avaliados entre março de 2014 e maio de 2015, em um Hospital Terciário Universitário no Brasil. Pacientes elegíveis foram randomizados para receberem ou não TIPE concomitantemente à cirurgia. Desfechos: Diferença absoluta dos escores pré e pós-operatórios em qualidade de vida específica, pela aplicação dos questionários Nasal Obstruction Symptom Evaluation Portuguese (NOSE-p) e Rhinoplasty Outcome Evaluation (ROE), e geral, através de aplicação do World Health Organization Quality of Life (WHOQOL)-breve. Os desfechos eram cegados e acessados somente três meses após a cirurgia. O protocolo foi registrado no ClinicalTrials.gov (NCT02231216). Resultados: 50 pacientes foram incluídos, maioria caucasiana com rinite alérgica com sintomas moderados a severos. A média de idade foi 36 (±14,5) anos. Os escores de qualidade de vida específicos e gerais melhoraram independentemente da intervenção TIPE (p < 0,001). ANCOVA foi aplicada para controlar potenciais fatores confundidores. Não houve divergência entre a diferença absoluta nos pacientes submetidos ou não a TIPE nos escores NOSE-p (-50,5 vs. -47,6; p=0,723); ROE (47 vs. 44,8; p= 0,742) e todos os domínios do WHOQOL-breve (p > 0,05). Não houve diferença entre os grupos sobre a presença de complicações. O tempo cirúrgico foi maior no grupo TIPE (212 minutos ± 7,8 vs. 159,1 ± 5,6; p ˂ 0,001). Conclusão: A redução das conchas inferiores através da TIPE durante a rinosseptoplastia primária não melhorou, em curto prazo, a qualidade de vida geral nem específica. O uso de TIPE aumenta o tempo cirúrgico consideravelmente, sem adicionar benefício aos escores avaliados. Não houve diferença na incidência de complicações no pós-operatório, sugerindo a segurança da técnica. / Objectives/Hypothesis: To evaluate the impact of endoscopic partial inferior turbinectomy (EPIT) associated with primary Rhinoseptoplasty on quality of life outcomes (QOL), complications, and surgical duration. Study Design: Randomized clinical trial. Methods: Individuals with nasal obstruction aged ≥ 16 years who were candidates for functional and aesthetics primary Rhinoseptoplasty were evaluated from March 2014 through May 2015 at a tertiary university hospital in Brazil. Eligible participants were randomly allocated to rhinoseptoplasty with or without EPIT. Outcomes: Absolute change (postoperative –preoperative) in the following QOL scores: Nasal Obstruction Symptom Evaluation-Portuguese (NOSE-p), Rhinoplasty Outcome Evaluation (ROE) and World Health Organization Quality of Life (WHOQOL)-bref (to measure general QOL). Outcomes were blindly assessed 3 months postoperatively. The protocol was registered at ClinicalTrials.gov (NCT02231216). Results: Fifty patients were studied. Most were Caucasian and had moderate/severe allergic rhinitis symptoms. Mean age was 36 (±14.5) years. Rhinoseptoplasty was associated with improvement in all QOL scores irrespective of turbinate intervention (P <0.001). ANCOVA was conducted to control for potential confounders. There was no difference between the groups in absolute score changes for NOSE-p (-50.5 vs. -47.6; P=0.723); ROE (47 vs. 44.8; P = 0,742), and all WHOQOL-bref score domains (P >0.05). There were no differences between the groups regarding presence of the complications. Surgical duration was higher in the EPIT group (212 minutes ± 7.8 vs. 159.1 ± 5.6; p ˂ 0.001). Conclusions: Turbinate reduction through EPIT during primary rhinoseptoplasty did not improve short-term general and specific QOL outcomes. The use of EPIT increases surgical time considerably without improving QOL scores. There was no difference in postoperative incidence of complications, suggesting that EPIT is a safe technique.

Made available in DSpace on 2014-06-11T19:23:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-19Bitstream added on 2014-06-13T19:50:57Z : No. of bitstreams: 1 oliveira_lg_me_jabo.pdf: 385808 bytes, checksum: 724ed5f57dfbaab664f6c58ba810c163 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A transmissão pela via fecal-oral é considerada o mais importante meio de disseminação de Salmonella sp. entre os suínos. Foi comprovada que a transmissão de Salmonella sp. através do contato naso-nasal entre suínos pode ser viável. Porém, alguns experimentos não conseguiram demonstrar tal transmissão em determinados sorotipos de Salmonella enterica. Este ensaio teve como objetivo produzir infecção experimental de Salmonella enterica subsp. enterica sorotipo Panama e verificar a importância da via nasonasal na transmissão entre leitões desmamados. Seis leitões recém-desmamados foram adquiridos de granja previamente selecionada, livre de Salmonella sp. Análises bacteriológicas confirmaram que todos os animais estavam livres de contaminação por Salmonella sp. Utilizaram-se baias isoladoras que proporcionavam o contato naso-nasal e eliminavam a possibilidade de outras vias de transmissão e de contaminação externa. Três grupos foram formados: controle, sentinela e infectados. Os leitões do grupo controle e do grupo sentinela receberam, individualmente, por via oral, solução estéril, enquanto que leitões do grupo infectado receberam inóculo contendo 2,16 X 1010 UFC de Salmonella Panama. Foram alojados nos isoladores respectivos e retirados depois de 14 dias, período no qual amostras de fezes eram colhidas e avaliadas diariamente. Os animais foram necropsiados e amostras de tecidos colhidas. Realizaram-se testes bacteriológicos, ELISA e sorotipificação. Houve infecção sistêmica por Salmonella Panama nos animais do grupo infectado, porém os resultados revelaram não haver a transmissão pela via naso-nasal entre leitões desmamados, pois em nenhum momento o agente foi isolado dos animais sentinelas. / The faecal-oral transmission is considering the most important route for transmission of Salmonella sp. between pigs. It has been proven that the Salmonella sp. transmission through the nose-to-nose contact among pigs can be viable. However, current data could not demonstrate such transmission in certain serovars of Salmonella enterica. This study aimed to produce experimental infection of Salmonella enterica serovars Panama and verifies the importance of the nose-to-nose contact in the transmission among weaned pigs. Six recently-weaned pigs were acquired from farm previously selected; free from Salmonella sp. Bacteriological analysis ruled out previous Salmonella sp contamination in all selected subjects. Isolations cabinets were used that provided the nose-to-nose contact and to eliminated the presence of other transmission routes and of outside contamination. Three groups were formed: control, sentinel and infected. The pigs of the control group and of the sentinel group, received, individually, orally sterile solution, while pigs of the infected group received solution containing 2,16 X 1010 CFU of Salmonella Panama. They were housed in the respective isolations cabinets and removed from it after 14 days, period in which samples of faeces were collected and submitted to daily analysis. The animals were necropsied and samples of tissues were collected. They were tested by bacteriological analysis, ELISA and serovars typification. There was systemic infection for Salmonella Panama in the animals of the infected group; however there was non transmission by nose-to-nose contact among weaned pigs, justifying the non isolation of the agent in the sentinel group at any moment.

Submitted by SHEILA MINATTI HANNUCH null (sheilaminatti@gmail.com) on 2017-08-02T14:04:04Z No. of bitstreams: 1 Sheila Minatti Tese - Versão Final c: ficha catalografica.pdf: 3249036 bytes, checksum: 6981c676b1072a7aef1c801ad95ef597 (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-08-03T17:38:22Z (GMT) No. of bitstreams: 1 hannuch_sm_dr_ia.pdf: 3249036 bytes, checksum: 6981c676b1072a7aef1c801ad95ef597 (MD5) / Made available in DSpace on 2017-08-03T17:38:22Z (GMT). No. of bitstreams: 1 hannuch_sm_dr_ia.pdf: 3249036 bytes, checksum: 6981c676b1072a7aef1c801ad95ef597 (MD5) Previous issue date: 2017-07-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A nasalidade do português brasileiro cantado e falado se caracteriza por uma grande variação articulatória. Com o objetivo de organizar e esclarecer essas múltiplas possibilidades de tratamento articulatório no canto, o presente trabalho investiga o comportamento e a articulação dos processos nasais na fala em português brasileiro, apresenta uma proposta de transcrição fonética para esses sons no canto e evidencia distintas possibilidades de variação articulatória pertinentes à pratica musical. Dessa maneira, estabelece um trajeto que fundamenta o processo de escolha dos símbolos a serem utilizados na representação fonética dos nasais no canto, baseado em estudos fonético-fonológicos da fala e na abordagem articulatória, até a sua aplicação prática, por meio do uso da sílaba melódica em uma proposta alternativa de representação. / The nasality of the Brazilian Portuguese language sung and spoken is characterized by a great articulatory variation. In order to organize and clarify these multiple possibilities of articulatory treatment in singing, the present work investigates the behavior and articulation of nasal processes in Brazilian Portuguese, presents a proposal of phonetic transcription for these sounds in the singing and shows different possibilities of articulatory variation pertinent to musical practice. In this way, it establishes a path that bases the process of choosing the symbols to be used in the phonetic representation of the nasals in the song, based on phonetic-phonological studies of speech and in the articulatory approach until its practical application, through the use of the melodic syllable in an alternative proposal for representation.

Made available in DSpace on 2015-05-14T13:00:00Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 5040357 bytes, checksum: d112d16462e653eb7f528351d768dc3f (MD5) Previous issue date: 2014-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Cissampelos sympodialis Eichl (Menispermaceae) is a plant commonly found in semi-arid regions of Brazil. Its roots and leaves are used in folk medicine to treat arthritis, rheumatism and respiratory disorders. Studies have shown its anti-inflammatory, immunomodulatory and anti-asthmatic effects. The aim of this study was: 1) to evaluate the effect of administration, intranasally (i.n.) of the leave extract (AFL) and its alkaloids warifteine (WAR), methylwarifteine (MWA) and milonine (MIL) in the lungs of BALB/c mice sensitized and challenged with ovalbumin (OVA) and 2) to analyze the effects of alkaloids on inflammatory cells and their molecules related to inflammation. The parameters evaluated in vivo were: the cell migration into bronchoalveolar lavage (BAL), histopathological changes in the lung tissue and analysis of IgE levels on the serum. In vitro assays, were evaluated the phosphorylation of JNK kinase enzyme and expression of COX-2 on cultured macrophage and mast cells. The results showed that the AFL and the alkaloids were able to inhibit the migration of inflammatory cells, mainly eosinophils to the lung. However the AFL and milonine induced neutrophil migration to the lung. Treatment with the extract and the alkaloids inhibited the production of mucus by goblet cells present in the bronchial epithelium and the migration of TCD4+ and TCD8+ into the lung tissue, except warfteine that increased the TCD8+ subpopulation,. Only the AFL treatment was able to decrease serum IgE concentration and, among the alkaloids, MWA was able to inhibit the production of interleukin-13 (IL-13) by cells from the BAL. In vitro tests showed that the alkaloids presented no toxicity for macrophage and mast cells at all concentrations tested 0.1, 1.0 and 10 μM. However, only milonine was able to inhibit degranulation of mast cells via inhibition of histamine release. The inhibition of JNK phosphorylation was observed with MWA and MIL independent of COX-2 activation. These results indicate that the extract, when administered intranasally, has antiasthmatic effect by decreasing the eosinophil migration into the lung and the mucus production and, MWA is one of the important compounds present into the extract due to decreasing the JNK phosphorylation. In addition, these data provide additional information to produce an herbal plant for the treatment of intranasal airway inflammatory disorders and the MWA may be the molecular marker for the quality and effect of the herbal medicine. / Cissampelos sympodialis Eichl. (Menispermaceae) é uma planta comumente encontrada em regiões semiáridas do Brasil. Suas raízes e folhas são usadas na medicina popular no tratamento de artrite, reumatismo e doenças respiratórias. Estudos têm demonstrado seu efeito anti-inflamatório, antiasmático e imunomodulador. Os objetivos do presente trabalho foram: 1) avaliar o efeito da administração, por instilação nasal (i.n.), do extrato das folhas de Cissampelos sympodialis (AFL) e de seus alcaloides warifteina (WAR), metilwarifteina (MWA) e milonina (MIL) em pulmões de camundongos BALB/c sensibilizados e desafiados com ovalbumina (OVA) e 2) analisar o efeito destes alcaloides sobre células inflamatórias e suas moléculas relacionadas com a inflamação. Os parâmetros avaliados in vivo foram: padrão de migração de células no lavado bronco alveolar (BAL), alterações histopatológicas no tecido pulmonar e análise dos níveis de IgE no soro. Nas análises in vitro, em cultura de macrófagos e mastócitos, foram avaliados a fosforilação das enzimas JNK quinase e a expressão da COX-2. Os resultados demonstraram que o AFL e os alcaloides foram capazes de inibir a migração das células da inflamação, em especial, os eosinófilos no pulmão. Entretanto, o AFL e a milonina induziram aumento no número de neutrófilos no pulmão. Os tratamentos com o extrato e os alcaloides inibiram a produção de muco pelas células caliciformes presentes no epitélio brônquico e a migração de linfócitos T CD4+ e TCD8+ da cavidade pulmonar, com exceção da warifteina que aumentou a subpopulação T CD8+. Apenas o tratamento com AFL foi capaz de diminuir a concentração de IgE sérica e, entre os alcaloides, somente a MWA foi capaz de inibir a produção da interleucina-13 (IL-13) pelas células do BAL. Nos ensaios in vitro, observou-se que os alcaloides não apresentaram toxicidade para mastócitos e macrófagos em todas as concentrações testadas 0.1, 1.0 e 10 μM. Entretanto, apenas a milonina foi capaz de inibir degranulação de mastócitos via inibição da liberação da histamina. A inibição da fosforilação da JNK foi observada com a MWA e a MIL independentes da expressão da enzima COX-2. Estes resultados indicam que o extrato, quando administrado por instilação nasal, apresenta efeito antiasmático principalmente pela diminuição da migração de eosinófilos para o pulmão e pela produção de muco e que a MWA é um dos compostos presentes no extrato importante para o efeito antiasmático da planta devido á diminuição da fosforilação da JNK. Em adição, estes dados fornecem informações para a produção de um fitoterápico da planta para o tratamento intranasal de doenças inflamatórias das vias aéreas e a MWA pode ser o marcador molecular de qualidade e efeito do fitoterápico.

Mucosal immune system comprises not only the major compartment of the immune system but also important interface with the outer environment. It is responsible in maintaining an intricate balance with the danger and non-danger stimuli of the outer world by employing specific anatomical features and unique functional mechanisms. Mucosal immune system has been long understudied, perhaps due to the limited accessibility, and its biological importance is thus still underevaluated. However, it has become evident that it is important to study mucosal immune system not only in local mucosal affections but also when uncovering pathogenic mechanisms and novel prevention strategies of organ specific autoimmune diseases such as type 1 diabetes. Thus, the first, more clinically oriented part of this thesis is focused on mucosal immune system of the upper respiratory tract in disease conditions - in nasal polyposis (NP). Because there is a substantial accumulation of eosinophils and neutrophils in the most frequent type of NP, we investigated and described increased expression of chemokine receptors CCR1 and CCR3 in NP versus nasal mucosa. Both innate immune mechanisms as well as homeostasis of epithelial cells may participate in NP. We have documented increased numbers of iNOS-positive and insulin-like growth...

Introdução: A polipose nasal (PN) é considerada uma condição inflamatória crônica da mucosa da cavidade nasal e seios paranasais de etiologia não muito clara. Há poucos dados sobre alterações epiteliais em PN e sua relação com a ação dos radicais livres. Muitas doenças estão ligadas a danos causados por espécies reativas de oxigênio (ROS) e de nitrogênio (RNSS) e ocorrem de um desequilíbrio entre eles e antioxidantes, o que for maior atividade de espécies reativas, o que chamamos de estresse oxidativo. Objetivo: O objetivo principal deste estudo é avaliar o estresse oxidativo em pólipos removidos cirurgicamente em 3 grupos de pacientes com polipose nasal (com PN unicamente, PN associado à asma e PN associado à asma e intolerância ao ácido acetilsalicílico) a fim de elucidar possíveis diferenças no perfil redox nestes grupos. Material e Métodos: Cinquenta e nove pacientes com diagnóstico de polipose nasal foram divididos em três grupos clínicos: um grupo controle PN unicamente, um grupo asma (PN associado à asma) e um grupo Widal (PN associado à asma e intolerância ao ácido acetilsalicílico). Medição e Resultados Principais: Neste trabalho defesas enzimáticas (superóxido dismutase, consumo de peróxido de hidrogênio, glutationa peroxidase e glutationa S-transferase) e defesas não enzimáticas (glutationa total, nitritos e nitratos, vitamina C e E) foram analisados. Também foi realizada a medição de danos em lipídios (malondialdeído) e proteínas (carbonila). No grupo asma, o consumo de peróxido de hidrogênio, atividade da glutationa peroxidase, níveis de malondialdeído e vitamina E foram significativamente menores do que no grupo de controle. Também foi realizada a medição de danos em lipídios (malondialdeído) e proteínas (carbonila). No grupo Widal foram encontrados níveis significativamente maiores de glutationa e nitritos e nitratos em relação ao grupo controle. Não foram encontradas diferenças entre os grupos em relação ao nível de carbonila e glutationa, tamanho dos pólipos, atividades da superóxido dismutase e S-transferase. Conclusões: A classificação redox dos grupos de PN foi parcialmente alcançada. Os pólipos do grupo asma possuem alterações nas defesas enzimáticas relacionadas com o peróxido de hidrogênio e a peroxidação lipídica, enquanto pólipos do grupo Widal apresentaram alterações nos níveis de óxido nítrico e glutationa. / Introduction: Nasal polyposis (NP) is considered a chronic inflammatory condition of the mucosa of the nasal cavity and paranasal sinuses of etiology is not very clear. There are few data on epithelial changes in nasal polyposis and its relation to the action of free radicals. Many diseases are linked to damage caused by reactive oxygen species (ROS) and nitrogen (RNSs) and occur from an imbalance between them and antioxidants, whichever is greater activity of reactive species, what we call oxidative stress. Objective: The primary objective of this study is to evaluate oxidative stress in polyps surgically removed in 3 groups of patients with nasal polyposis, in order to elucidate possible differences in redox profile in these groups. Methods: Fifty nine patients diagnosed with nasal polyposis were divided into three groups: a control group, an asthma group (NP with asthma) and a Widal group (NP with asthma and aspirin intolerance) in which patients had an association of NP, asthma and aspirin intolerance. Measurement and main results: In this work enzymatic defenses (superoxide dismutase, hydrogen peroxide consumption, glutathione peroxidase and glutathione S-transferase) and non-enzymatic defenses (total glutathione, measurement of nitrites and nitrates, vitamin C and E) were analyzed. Also the measurement of damage in lipids (malondialdehyde) and proteins (carbonyl) was conducted. In the asthma group, hydrogen peroxide consumption, glutathione peroxidase activity, malondialdehyde, and vitamin E levels were significantly lower than in the control group. The Widal group showed significant higher glutathione levels, nitrite and nitrate levels than found in the control group. No differences were found among the groups regarding carbonyl level, polyp size, superoxide dismutase, and glutathione S-transferase activities. Conclusions: The redox classification of the groups of NP was partly achieved. Polyps of patients with asthma have changes in enzymatic defense pathways related to hydrogen peroxide and lipid peroxidation while polyps of patients with Widal triad present changes in nitric oxide and glutathione.

Cytosolic protein degradation is crucial for cellular homeostasis as it orchestrates protein turnover by destruction of misfolded, unstable and abnormal proteins. This process has two main stages: (i) an ATP-dependent stage mediated by unfoldases and proteases, and (ii) an ATP-independent stage mediated by various peptidases. The ATP dependent proteases recognise target proteins and cleave them into smaller peptides. These enzymes comprise the ATPase-family-associated-with-various-cellular-activities domain that is important for unfolding target proteins. Subsequently, unfolded proteins enter a barrel-shaped proteolytic chamber, an architecture conserved throughout prokaryotes, archea and eukaryotes, where the peptide bond is hydrolysed in an ATP-independent manner. The smaller peptides released are broken down by ATP-independent peptidases into free amino acids recycled into the cellular pool. In prokaryotes, major cellular protein degradation functions are performed by Clp and Lon proteases. Earlier studies in our laboratory have shown the role of an ATP-independent peptidase, AminopeptidaseN, in sodium salicylate (NaSal) induced growth inhibition. NaSal belongs to the family of Non-Steroidal Anti-Inflammatory Drugs and its acetyl ester, Aspirin, is a very widely used analgesic. It is produced by plants as a defence response and is known to cause different effects, including xenobiotic stress i. e. stress mediated by compounds which are not naturally produced or expected to be present in the organism in bacteria. In bacteria, salicylate modulates outer membrane proteins, virulence factors, and reduces motility. In addition, NaSal is able induce “phenotypic antibiotic resistance” by binding to MarR and de-repressing the mar operon. NaSal promotes the dissociation of MarR from the promoter site leading to transcription of MarA, a transcription factor that induces several genes that encode the AcrAB-TolC pump which effluxes multiple antibiotics from the cell. The present study investigates the possible roles of ATP-dependent proteases, Lon and Clp, during growth reduction of E. coli induced with high (2-3 mM) amounts of NaSal. The growth of the Lon mutant (lon), but not clpP, was found to be greatly reduced with high doses of NaSal in the media. Our hypothesis was that the lack of Lon led to the accumulation of high amounts of substrate proteins, which led to its greater sensitivity with high doses of NaSal. To identify the substrate protein/s and to better understand the mechanism of action, single and double mutants (with lon) of E. coli lacking several prominent Lon substrates, i.e. MarA, RcsA, StpA, SulA and UmuD, were generated and screened for rescue of growth with 2-3 mM NaSal. MarA, a transcription factor, was identified to be important during NaSal-induced growth reduction. It modulates outer membrane proteins and induces the AcrAB-TolC pump that increases the efflux of antibiotics from the cell. Also, RT-PCR analysis revealed that the levels of marA and its targets, acrA and acrB, were higher in the lon strain suggesting that the MarA protein levels were stabilised the cell in the absence of Lon. Further studies using approriate strains demonstrated that one of the effectors of MarA, i.e. the AcrAB-TolC efflux pump, was not involved in the NaSal-induced growth inhibition of lon. Therefore, in presence of higher doses of NaSal, MarA is upregulated due to de-repression of the operon. The levels of MarA are regulated by Lon via degradation but in the absence of Lon, MarA levels are stabilised and lead to upregulation of MarA and its target genes like AcrAB-TolC. This study identifies higher amounts of MarA to be responsible for NaSal-induced growth inhibition of lon. Subsequently, experiments were conducted to demonstrate the role of MarA and its targets in antibiotic resistance with low dose (0.5 mM) NaSal that does not affect growth. This low dose of NaSal was able to upregulate marA and its target genes, acrA, acrB and tolC. Quantification of antibiotic resistance further revealed an induction in resistance by 0.5 mM NaSal in a MarA- and AcrB-dependent fashion. Studies using atomic force microscopy demonstrated that ciprofloxacin-induced cell elongation was lower in lon due to higher levels of MarA. Therefore, low dose of NaSal is capable of upregulating MarA and inducing antibiotic resistance but does not affect cell growth. This part of the study addresses the roles of Lon protease, its substrate MarA and MarA-induced targets, e.g. AcrB, during NaSal-mediated growth reduction and antibiotic resistance. The factors contributing to antibiotic resistance in bacteria are an important area of study for the global public health care system. Antibiotic resistance can be acquired by transmittance of genetic material, accumulation of antibiotic resistant mutations in the target molecule or can be induced by certain compounds present in the environment like NaSal. For rapid identification of compounds that may behave in a similar fashion as NaSal, a 96-well plate based screen was developed utilising the growth inhibition feature of the lon strain. The compounds were selected on the basis of their structural (phenolic compounds) and functional (Non-Steroidal Anti Inflammatory Drugs or NSAIDs) similarity to NaSal. Through this screen, four compounds were identified that lowered the growth of lon more than that of wild type strain and may be important in inducing phenotypic antibiotic resistance: Acetaminophen (anti-pyretic), Ibuprofen (NSAID), and two phenolic uncouplers, Carbonyl cyanide m-chlorophenyl hydrazone (CCCP) and 2,4-dinitrophenol (2,4-DNP). Notably, another compound Phenylbutazone (NSAID), which is used to lower inflammation in animals, did not reduce the growth of E. coli. RNA expression analysis revealed that these four compounds, but not phenylbutazone, induced the expression of marA and its target gene involved in antibiotic efflux, acrB. Furthermore, dose dependent and comparative studies with Nasal demonstrated differential effects of these four compounds in inducing antibiotic resistance with respect to ciprofloxacin, tetracycline and nalidixic acid. The two uncouplers were much more effective in inducing antibiotic resistance at lower doses than the NSAIDs. As NSAIDs are clinically important compounds, the study suggests that it would be desirable to screen them for induction of antibiotic resistance. The approach elucidated in this study has the potential to identify additional compounds present in the environment that may contribute to antibiotic resistance in bacteria. Overall, this study delineates the roles of Lon protease and its substrate, MarA, during NaSal-mediated responses, involving antibiotic resistance and/or growth reduction in E. coli. In addition, four other compounds were identified that could induce phenotypic antibiotic resistance in E. coli in a MarA-dependent manner. These observations may have implications in the adaptation of bacteria under different environmental conditions.