A doença renal crônica (DRC) está associada com inibição de sistemas enzimáticos e de transportadores de fármacos. O nebivolol, um bloqueador de terceira geração, seletivo para receptores 1 adrenérgicos e com atividade vasodiladora, é metabolizado principalmente por hidroxilação aromática dependente do CYP2D6, hidroxilação alicíclica e por glicuronidação. O estudo avalia a influência da DRC estágios 3 e 4 e da hemodiálise na farmacodinâmica e na farmacocinética dos isômeros do nebivolol. Os pacientes investigados divididos nos Grupos controle (n=12), DRC estágios 3 e 4 (n=12) e Hemodiálise (n=11) receberam dose única p.o. de 10 mg de nebivolol racêmico. As amostras seriadas de sangue foram coletadas até 48h após a administração do fármaco. Em cada tempo de colheita de sangue, a frequência cardíaca foi avaliada na situação de exercício isométrico durante 2 min com o handgrip, a 30% da contratilidade voluntária máxima. Todos os pacientes foram fenotipados como metabolizadores rápidos do metoprolol, exceto um paciente do Grupo controle fenotipado como metabolizador lento. Os isômeros do nebivolol foram analisados em plasma como concentração total empregando LC-MS/MS e coluna de fase quiral. O método foi linear no intervalo de concentrações de 25-2500 pg de cada isômero do nebivolol/mL de plasma. Os parâmetros farmacocinéticos foram calculados empregando o programa WinNonlin. O teste de Wilcoxon foi empregado para avaliar as razões isoméricas diferentes da unidade (p<0,05) e o teste de Kruskal-Wallis foi empregado para comparar os parâmetros farmacocinéticos entre os três Grupos investigados. A disposição cinética do nebivolol nos pacientes do Grupo controle é enantiosseletiva com acúmulo plasmático (Cmax 1,32 vs 0,88 ng/mL e AUC0-¥ 8,02 vs 4,25 ng.h/mL), menores valores de clearance oral aparente (623,58 vs 1176,40 L/h) e menores valores de volume aparente de distribuição (5383,30 e 6397,70 L) para o isômero lnebivolol. Os parâmetros farmacocinéticos do l-nebivolol e d-nebivolol para os pacientes do Grupo DRC (n=12) permitem inferir, à semelhança do Grupo controle, maiores valores de Cmax e AUC (Cmax 2,40 vs 1,67 ng/mL e AUC0- 10,20 vs 8,37 ng.h/mL) e menores valores de clearance oral aparente (491,51 vs 604,58 L/h) e de volume aparente de distribuição (3527,00 e 5232,50 L) para o isômero l-nebivolol. Semelhante aos Grupos controle e DRC, o Grupo Hemodiálise também apresenta enantiosseletividade com acúmulo acúmulo plasmático (Cmax 1,35 vs 0,78 ng/mL e AUC0- 6,74 vs 4,50 ng.h/mL), menores valores de clearance oral aparente (742,26 vs 1112,10 L/h) e menores valores de volume aparente de distribuição (5704,70 vs 9477,10 L) para o isômero l-nebivolol. A farmacocinética dos isômeros do nebivolol no paciente investigado do Grupo controle, fenotipado como metabolizador lento, difere dos dados apresentados para os pacientes do Grupo controle (n=11), Grupo DRC (n=12) e Grupo Hemodiálise (n=11), fenotipados como metabolizadores rápidos, com observação de razão isomérica de AUC l/d de 4,77 e redução nos valores de clearance oral aparente de ambos os isômeros do nebivolol (67,24 vs 122,07 L/h, respectivamente para os isômeros l-nebivolol e d-nebivolol). Concluindo, a DRC estágios 3 e 4 e a Hemodiálise não alteram a farmacocinética de ambos os isômeros do nebivolol, o volume aparente de distribuição de ambos os isômeros do nebivolol não mostra correlação com o peso dos pacientes, assim como os valores de clearance aparente de ambos os isômeros não mostram correlação com o peso ou com os valores de clearance da creatinina dos pacientes investigados. No entanto, os valores de clearance aparente de ambos os isômeros do nebivolol mostram correlação significativa com a atividade do CYP2D6 avaliada através da RMplasma ix metoprolol/-hidroximetoprolol. A análise PK-PD foi realizada incluindo os 34 pacientes fenotipados como metabolizadores extensivos. O modelo Emax inibitório descreveu a análise PK-PD empregando a variação da frequência cardíaca como parâmetro farmacodinâmico em função das concentrações plasmáticas do d-nebivolol, resultando em valores de Emax de 15,42 bpm e de EC50 de 2,26 ng/mL, seguindo a administração de dose única oral de 10 mg de nebivolol racêmico. / Chronic kidney disease (CKD) is related to inhibition of enzyme systems and drug transporters. Nebivolol, a third generation -blocker, is a selective 1-adrenoceptor antagonist and has vasodilatory properties. It undergoes aromatic hydroxylation through the CYP2D6, alicyclic hydroxylation and glucuronidation. The study evaluates the influence of CKD stages 3 and 4 and hemodialysis on the pharmacodynamics and pharmacokinetics of nebivolol isomers. The investigated patients were divided into 3 groups: control group (n = 12), CKD stages 3 and 4 (n = 12) and hemodialysis (n = 11). They received a single oral dose of 10 mg of racemic nebivolol and serial blood samples were collected up to 48h. At each time of blood sampling, heart rate was assessed in the situation of isometric exercise during 2 min with handgrip at 30% of maximal voluntary contractility. All patients were phenotyped as extensive metabolizers (EM) of metoprolol, except one patient in the control group phenotyped as poor metabolizer (PM). The isomers of nebivolol were analyzed in plasma samples by LC-MS/MS using a chiral phase column. The method was linear over the concentration range of 25-2500 pg of each isomer of nebivolol/mL of plasma. Pharmacokinetic parameters were calculated using the WinNonlin program. The Wilcoxon test was used to assess isomeric ratios different from unit (p <0.05) and the Kruskal-Wallis test was used to compare the pharmacokinetic parameters among the 3 groups investigated. The kinetic disposition of nebivolol was stereoselective in control group with plasma accumulation (Cmax 1.32 vs 0.88 ng/mL and AUC0 0- 8.02 vs 4.25 ng.h/mL), lower values of apparent clearance (623.58 vs 1176.40 L/h) and apparent volume of distribution (5383.30 and 6397.70 L) for the l-nebivolol isomer. The kinetic disposition of nebivolol was also stereoselective in CKD group (n=12) showing higher Cmax and AUC (Cmax 2.40 vs 1.67 ng/mL and AUC0- 10.20 vs 8.37 ng.h/mL) and lower values of apparent clearance (491.51 vs 604.08 L/h) and apparent volume of distribution (3527.00 vs 5232.50 L) for the l-nebivolol isomer. Similarly to CKD and control groups, the Hemodialysis Group showed stereoselectivity with plasma accumulation (Cmax 1.35 vs 0.78 ng/mL and AUC0- 6.74 vs 4.50 ng.h/mL), lower values of apparent clearance (742.26 vs 1112.10 L/h) and apparent volume of distribution (5704.70 vs 9477.10 L) for the l-nebivolol isomer. The pharmacokinetics of nebivolol isomers in the patient phenotyped as PM differed from the data presented to the patients phenotyped as EM, with observation of isomeric ratios AUC l/d of 4.77 and reduced values of apparent clearance of both nebivolol isomers (67.24 vs 122.07 L/h, respectively for l- and d-nebivolol). Concluding, CKD stages 3 and 4 and Hemodialysis did not alter the pharmacokinetics of both nebivolol isomers (Kruskal-Wallis test, p> 0.05), the apparent volume of distribution of both nebivolol isomers showed no correlation with the weight of the patients, the apparent clearance of both isomers also showed no correlation with the weight or with the creatinine clearance of the investigated patients. However, the values for apparent clearance for both nebivolol isomers showed a significant correlation with the CYP2D6 activity evaluated by the metabolic ratios plasma metoprolol/-hidroximetoprolol. PK-PD analysis was evaluated including all the investigated patients phenotyped as EM (n=34). The inhibitory Emax model described the PK-PD analysis using heart rate variation as a pharmacodynamic parameter plotted against the plasma concentrations of the isomer dxi nebivolol, showing Emax values of 15.42 bpm and EC50 of 2.26 ng/mL, following administration of a single oral dose of 10 mg of racemic nebivolol.

Made available in DSpace on 2016-03-15T19:40:00Z (GMT). No. of bitstreams: 1 Ana Cristina Silva Araujo.pdf: 523045 bytes, checksum: 16d7e21650b3e9b5165a5dc2c0d09f29 (MD5) Previous issue date: 2007-03-01 / Fundo Mackenzie de Pesquisa / The frequency of the manifestation of autistic phenotype in children and young with congenital blindness has been subject of great interest in the last decades. In this study 29 children and young between four and 15 years old with congenital blindness had been investigated regarding the frequency of manifestation of the signals and symptoms of autistic phenotype, from the application of a suitable version of Autism Screening Questionnaire (ASQ) in interview with the parents. The results had identified that of the 29 children and young, 13 scored above of the cut off for the Pervasive Development Disorders (PDD). Considering the three areas that the instrument encloses, the communication area was the biggest concentration of points for each subject. These findings are in accordance with international literature, however a better inquiry of this sample becomes necessary to verify if the identified characteristics are part of the consequences of the blindness or if they demonstrate the comorbidity with the PDD. / A freqüência da manifestação do fenótipo autista em crianças e jovens com cegueira congênita têm sido assunto de grande interesse nas ultimas décadas. Neste estudo 29 crianças e jovens entre quatro e 15 anos com cegueira congênita foram investigados a respeito da freqüência de manifestação dos sinais e sintomas do fenótipo autista, a partir da aplicação de uma versão adaptada do Autism Screening Questionnaire (ASQ) em entrevista com os pais. Os resultados identificaram que das 29 crianças e jovens, 13 pontuaram acima da nota de corte para os Transtornos Invasivos do Desenvolvimento (TID). Sendo que das três áreas que o instrumento abrange, a área de comunicação foi onde existiu a maior concentração de pontos por sujeito. Estes achados estão de acordo com a literatura internacional, entretanto se faz necessário uma melhor investigação desta amostra para verificar se as características identificadas fazem parte das conseqüências da cegueira ou se demonstram a comorbidade com os TID.

Rearranjos cromossômicos envolvendo a presença de cromossomos marcadores extranumerário são achados citogenéticos freqüentes em pacientes que apresentam deficiência mental, alterações de crescimento, dismorfias e/ou malformações. A presença desse material é responsável por trissomia ou tetrassomia parcial de determinadas regiões cromossômicas, causando quadros clínicos distintos e inespecíficos. A variabilidade fenotípica está relacionada principalmente com os diferentes graus de mosaicismo, os genes presentes na região adicional, o cromossomo de origem, entre outros fatores. Sendo assim, a caracterização desse material cromossômico é de importância fundamental para a determinação do prognóstico e do aconselhamento genético dos pacientes e suas famílias. O presente estudo teve como objetivo a análise de cromossomos marcadores extranumerários por meio de técnicas de citogenética convencional e molecular. Foram selecionados onze pacientes que são acompanhados pelo o Serviço de Genética Médica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto USP, todos com diagnóstico citogenético convencional por bandeamentos GTG de cromossomo marcador extranumerário. Para determinação da origem e caracterização dos cromossomos marcadores foram aplicadas as técnicas de Cariótipo Espectral (SKY) e de Hibridação in situ Fluorescente (FISH). Em dez pacientes foi possível determinar a origem e composição dos marcadores. Dois pacientes apresentam cromossomos marcadores identificados como duplicações invertidas do cromossomo 15, com cariótipos definidos, respectivamente, como 47,XY,+idic(15)(pterq15::q15pter) e 47,XX,+idic(15)(pterq21::q21p11.2), um paciente possui cromossomo marcador derivativo do cromossomo 15, com cariótipo 47,XX,+der(15)(pterq21) e dois pacientes, sendo uma menina e seu pai, possuem cromossomos marcadores derivativos do cromossomo 15 com cariótipos, respectivamente, 48,XX,+2der(15)(pterq12) e 48,XY,+2der(15)(pterq12). Dois pacientes possuem cromossomos marcadores derivativos do cromossomo 9, com cariótipos definidos, respectivamente, como 47,XX,+der(9)(pterq21) e 47,XX,+der(9)(pterq32) e um paciente apresenta cromossomo derivativo do cromossomo 4 [47,XX,+der(4)(p16q21)[9]/48,XX,+der(4)(p16q21),+mar[91]]. Um paciente possui um cromossomo marcador translocado derivativo do cromossomo 22 [47,XY,+der(22)t(11;22)(q25:q11.2)] e outro paciente, um cromossomo translocado derivativo do cromossomo 15 [47,XY,+der(15)t(15;16)(q13;q13)], ambos herdados de mães portadoras de translocações aparente balanceadas. Em um caso, não foi possível a caracterização dos cromossomos marcadores por meio das técnicas aplicadas. Há uma grande variação fenotípica associada à presença de cromossomos marcadores e muitas vezes o prognóstico e o aconselhamento genético são difíceis de determinar. As técnicas de citogenética molecular são ferramentas importantes para a caracterização dos cromossomos marcadores, tanto durante o pré-natal, como para uma família que já possui um membro afetado, auxiliando no mapeamento gênico de cada região envolvida para futura correlação cariótipo-genótipo-fenótipo. / Chromosomal rearrangements involving supernumerary marker chromosomes are frequently found in patients with mental retardation, growth defects and malformations. The genetic materials presented in trisomy/tetrasomy are responsible by distinct and unspecific clinical symptoms. The phenotypic variation is related mainly to different mosaicismo degrees, genetic content and chromosomal origin. Thus, the characterization of marker chromosomes is important to determine the prognosis and genetic counseling to the patients and their families. The aim of this study was to analyze supernumerary marker chromosomes using conventional and molecular cytogenetic techniques. Eleven patients were included in this study, all assisted in Medical Genetic Division of Clinical Hospital of School of Medicine of Ribeirao Preto USP. They all presented supernumerary marker chromosomes detected by GTG band. The origin and composition were determined using Spectral Karyotype (SKY) and Fluorescence in situ Hybridization (FISH) techniques. To ten patients, the origin and composition were determined. Two patients presented inverted duplications of chromosome 15, and their karyotype were defined as 47,XY,+idic(15)(pterq15::q15pter) and 47,XX,+idic(15)(pterq21::q21p11.2), one patient had a derivative chromosome 15, with karyotype 47,XX,+der(15)(pterq21), and two patients, a girl and her father, had two derivatives chromosomes 15, with karyotypes 48,XX,+2der(15)(pterq12) e 48,XY,+2der(15)(pterq12), respectively. Two patients presented derivative chromosomes 9 and their karyotype were defined as 47,XX,+der(9)(pterq21) and 47,XX,+der(9)(pterq32), and one patient had a derivative chromosome 4, with karyotype 47,XX,+der(4)(p16q21)[9]/48,XX,+der(4)(p16q21),+mar[91]. One patient had a translocated marker chromosome, derivative 22, [47,XY,+der(22)t(11;22)(q25:q11.2)] and another patient had a translocated marker chromosome, derivative 15 [47,XY,+der(15)t(15;16)(q13;q13)]. In one case, was not possible to define the origin and composition of the marker chromosome using SKY and FISH techniques. A large phenotypic variation is associated with supernumerary marker chromosomes and many times, the prognosis and genetic counseling is difficult to determine. The molecular cytogenetic techniques are important tools to its characterization, during prenatal diagnosis or to a family with an affected person, helping the genetic mapping of each region to a future correlation karyotype-genotype-phenotype.

Existe um relevante interesse em pesquisar a ocorrência de polimorfismos no genoma bovino por diferentes motivos, e mais recentemente, com a finalidade de agregar mais informações ao estudo de características quantitativas visando selecionar animais geneticamente superiores com considerável valor comercial. Os polimorfismos de base única (SNPs) neste estudo foram identificados como RFLP/MboII e RFLP/HpaII sendo que o polimorfismo RFLP/MboII está situado no exon 6 do gene IGF2 (insulin-like growth factor 2), localizado no cromossomo 29 em bovinos, e desempenha um papel importante na proliferação e diferenciação celular para o crescimento e desenvolvimento dos mamíferos. O polimorfismo RFLP/HpaII encontra-se no elemento Bov-A2 (considerado um elemento SINE - Short Interspersed Nucleotide Element) presente na região promotora do gene CYP21 (Steroid 21-hydroxylase gene) no cromossomo 23 em bovinos. Para avaliar a ocorrência dos SNPs utilizou-se a técnica de PCR-RFLP em amostras de DNA a partir de sangue/sêmen de cerca de 300 animais bovinos das raças zebuínas Gir, Guzerá e Nelore. As frequências alélicas mostraram maior incidência do alelo T quando comparado ao C enquanto que as frequências genotípicas apresentaram alta ocorrência do heterozigoto TC em comparação aos homozigotos CC e TT para o polimorfismo IGF2 - RFLP/MboII. Com relação ao polimorfismo CYP21 RFLP/HpaII, a frequência alélica revelou alto valor do alelo T. A população encontrou-se em equilíbrio de Hardy-Weinberg para os SNPs estudados. Ferramentas de bioinformática foram utilizadas para investigações in silico revelando que os sítios polimórficos estão em regiões com potencial regulatório. A associação desses polimorfismos com DEPs das características reprodutivas e produtivas foram investigadas, entretanto mostrou-se significativas apenas para DP550 (IGF2 - RFLP/MboII) e DP450 (CYP21 - RFLP/HpaII). Os resultados obtidos sugerem que protocolos de Biologia Molecular in vitro podem ser usados para identificar novos marcadores moleculares, como SNPs funcionais adicionando informações que certamente contribuirão para estratégias de melhoramento dessas raças bovinas de grande importância para a produção de carne e leite em nosso país. Este foi o primeiro estudo sobre a ocorrência desses polimorfismos em raças zebuínas criadas no Brasil. / There is a considerable interest in researching the occurrence of polymorphisms in the bovine genome for different reasons, and more recently, in order to add more information to the study of quantitative traits to select genetically superior animals with considerable commercial value. The single nucleotide polymorphisms (SNPs) in this study were identified as RFLP/MboII and RFLP/HpaII polymorphisms being the RFLP/MboII is situated in exon 6 of the IGF2 gene (insulin-like growth factor 2), located on chromosome 29 in cattle, perform an important role in cell proliferation, differentiation for growth and in the development of mammals. Polymorphism RFLP/HpaII is the element Bov-A2 (considered an element SINE - Short Interspersed Nucleotide Element) present in the promoter region of CYP21 gene (Steroid 21-hydroxylase gene) on chromosome 23 in cattle. To evaluate the occurrence of SNPs, we used the PCR-RFLP method on DNA samples from blood/semen of about 300 cattle breeds from Zebu Gyr, Guzerat and Nellore. The allele frequencies showed a higher incidence of T allele compared to C while the genotype frequencies showed high incidence of heterozygous CT compared to CC and TT homozygous for the IGF2 polymorphism - RFLP/MboII. On the subject of the CYP21 polymorphism - RFLP/HpaII, the allele frequency showed high value T. The population was found in Hardy-Weinberg equilibrium for the SNPs studied. Bioinformatics tools, used for in silico investigations, revealed that the polymorphic sites are in regions with regulatory potential. The association of these polymorphisms with EPDs of reproductive and productive traits were investigated, but proved to be significant only for DP550 (IGF2 - RFLP/MboII) and DP450 (CYP21 - RFLP/HpaII). The results suggest that protocols of molecular biology in vitro can be used to identify new molecular markers, such as functional SNPs adding information that certainly will contribute to the improvement strategies of these breeds of great importance for the production of meat and milk in our country. It has been the first study on the occurrence of these polymorphisms in Zebu breeds raised in Brazil.

Orientador: Antonio Fernando Ribeiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T10:15:56Z (GMT). No. of bitstreams: 1 Marsom_FernandoAugustodeLima_M.pdf: 12182231 bytes, checksum: e98655cb1347b5ba1ffbceac13daebb0 (MD5) Previous issue date: 2011 / Resumo: Introdução: A fibrose cística (FC) se manifesta clinicamente com várias formas de gravidade, moduladas por diferentes genótipos e o meio ambiente. Enquanto as classes das mutações no gene CFTR ("Cystic Fibrosis Transmembrane Conductance Regulator") estão bem definidas, como moduladores de gravidade da FC, os polimorfismos continuam controversos. Objetivo: Verificar se polimorfismos em genes modificadores estão associados com a gravidade da FC. Método: Estudo de corte transversal, entre 2009 a 2010. Todos pacientes foram submetidos à análise das principais mutações no gene CFTR, presença dos polimorfismos (por meio de diferentes técnicas moleculares - "nested" PCR, digestão enzimática, PCR "multiplex", genotipagem em sequenciador automático e PCR ARMS) e características clínicas de gravidade da FC. Resultado: As mutações identificadas no gene CFTR foram associadas com variáveis que descrevem o início da doença, atuando como fator de proteção a clínica de maior gravidade [idade (p?0,0001), 1ª manifestação clínica (1MC) (p?0,0001), diagnóstico (p?0,0001), início dos sintomas pulmonares (ISP) (p?0,0001) e digestivos (ISD) (p?0,0001), 1ª bactéria Pseudomonas aeruginosa isolada (1PA) (p?0,0001), insuficiência pancreática (IP) (p?0,0001), P. aeruginosa mucóide (PAM) (p?0,0001), P. aeruginosa não mucóide (PANM) (p?0,0001)]. O gene ACE foi associado a 1MC (p:0,038), ao escore de Bhalla (EB) (p:0,049) e a presença de Bulkolderia cepacia (BC) (p:0,038). O polimorfismo GCLC129C>T foi associado à PAM (p:0,037). O polimorfismo GCLC350 foi associado a 1PA (p:0,049), Achromobacter xylosoxidans (p:0,044) e Staphylococcus aureus (SA) (p:0,037). O gene GSTM1 foi associado ao diagnóstico (p:0,014), índice de massa corpórea (IMC) (0,045), escore de Kanga (EK) (p:0,046), capacidade vital forçada [CVF(%)] (p:0,004) e volume expiratório forçado no primeiro segundo [VEF1(%)] (p:0,004). O gene GSTT1 foi associado ao ISD (p:0.033), osteoporose (p:0.021), EB (p:0,026), escore de Shwachman Kulczycki (SC) (p:0,009), CVF(%) (p:0,015), VEF1(%) (p:0,005), razão entre o VEF1 e a CVF [TIF(%)] (p:0,033), fluxo expiratório forçado entre 25 e 75% da CVF [FEF25- 75%(%)] (p:0,005) e PAM (p:0,038). O agrupamento genotípico dos genes GSTM1 e GSTT1 foi associado com o diagnóstico (p:0,014), BC (p:0,042) e SA (p:0,032). O gene GSTP1 foi associado com o ISP (p:0,026), IP (p:0,011), EB (p:0,015), EK (p:0,028), SC (p:0,039), CVF(%) (p:0,021), VEF1(%) (p:0,021), FEF25-75% (p:0,02) e 1PA (p:0,022). O alelo 1 para o polimorfismo de repetição AAT no gene NOS-1 foi associado com a idade (p:0,009) e com o ISD (p:0,001). O alelo 2 com ISP (p:0,031), ISD (p:0,001) e EB (p:0,046). O alelo 1 para o polimorfismo GT-1 no gene NOS-1 não apresentou associação com as variáveis clínicas. O alelo 2 apresentou associação com a saturação de oxigênio transcutânea (p:0,012), EB (p:0,013), CVF(%) (p:0,038), VEF1(%) (p:0,007), TIF(%) (p:0,036) e FEF25-75(%) (p:0,007). O alelo 1 para o polimorfismo de repetição GT-2 no gene NOS1 apresentou associação com a CVF(%) (p:0,032). O alelo 2 apresentou associação com o TIF(%) (p:0,009). O polimorfismo Arg>Gly no gene ADRB2R apresentou associação com a IP (p:0,009), EB (p:0,039), VEF1(%) (p:0,003), FEF25-75(%) (p:0,008), 1PA (p:0,012), PAM (p:0,023) e PANM (p:0,024). O polimorfismo Gln>Glu no gene ADRB2R apresentou associação com o EB (p:0,019) e TIF(%) (p:0,047). A resposta ao broncodilatador inalatório na prova de espirometria apresentou associação com os marcadores de gravidade clínica VEF1(%) (p:0,011) e FEF25-75(%) (p:0,019) apenas para o polimorfismo Arg>Gly no gene ADRB2R. Conclusão: Houve associação entre os polimorfismos analisados e as mutações no gene CFTR com a gravidade clínica da FC / Abstract: Introduction: Cystic fibrosis (CF) is clinically manifested in various forms of gravity, modulated by different genotypes and environment. While the classes of mutations in the CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) gene are well defined as modulators of severity in CF, polymorphisms remain controversial. Objective: To determine whether polymorphisms in modifier genes are associated with the severity in the CF. Method: Cross-sectional study, between 2009 to 2010. All patients were subjected to analysis of major mutations in CFTR gene, presence of polymorphisms (using different molecular techniques - Nested PCR, enzyme digestion, multiplex PCR, genotyping in automatic sequencer and ARMS PCR) and clinical severity in CF. Results: Mutations were identified in CFTR gene associated with variables that describe the onset of the disease, acting as a protective factor for the clinical severity [age (p?0.0001), first clinical manifestation (1CM) (p?0.0001), diagnosis (p?0.0001) , onset of pulmonary symptoms (OPS) (p?0.0001) and digestive (ODS) (p?0.0001), 1st isolated bacterium Pseudomonas aeruginosa (1PA) (p?0.0001), pancreatic insufficiency (PI) ( p?0.0001), P. aeruginosa mucoid (PAM) (p?0.0001) and P. aeruginosa no mucoid (PANM) (p?0.0001)]. ACE gene was associated with 1CM (p:0.038), Bhalla score (BS) (p:0.049) and presence of Bulkolderia cepacia (BC) (p:0.038). Polymorphism GCLC129C>T was associated with PAM (p:0.037). Polymorphism GCLC350 was associated with 1PA (p:0.049), Achromobacter xylosoxidans (p:0.044) and Staphylococcus aureus (SA) (p:0.037). GSTM1 gene was associated with diagnosis (p:0.014), body mass index (BMI) (0.045), Kanga score (KS) (p:0.046), forced vital capacity [FVC(%)] (p:0.004) and forced expiratory volume in one second [FEV1(%)] (p:0.004). GSTT1 gene was associated with ODS (p:0033), osteoporosis (p:0.021), BS (p:0.026), Shwachman-Kulczycki score (SS) (p:0.009), FVC(%) (p:0.015) , FEV1(%) (p:0.005), ratio between FEV1 and FVC [TIF(%)] (p:0.033), forced expiratory flow between 25 and 75% of FVC [FEF25-75%(%)] (p:0.005) and PAM (p:0.038). The genotypic groupings of genes GSTM1 and GSTT1 was associated with diagnosis (p:0.014), BC (p:0.042) and SA (p:0.032). GSTP1 gene was associated with the OPS (p:0.026), PI (p:0.011), BS (p:0.015), KS (p:0.028), SS (p:0.039), FVC(%) (p:0.021 ), FEV1(%) (p:0.021), FEF25-75% (p:0.02) and 1PA (p:0.022). Allele 1 for AAT repeat polymorphism in NOS-1 gene was associated with age (p:0.009) and ODS (p:0.001). Allele 2 with OPS (p:0.031), ODS (p:0.001) and BS (p:0.046). Allele 1 for repeat polymorphism GT-1 in NOS-1 gene was not associated with clinical variables. Allele 2 was associated with transcutaneous oxygen saturation (p:0.012), BS (p:0.013), FVC(%) (p:0.038), FEV1(%) (p:0.007), TIF(%) (p:0.036) and FEF25-75(%) (p:0.007). The allele 1 for repeat polymorphism GT-2 in NOS1 gene was associated with FVC(%) (p:0.032). The allele 2 was associated with the TIF(%) (p:0.009). Polymorphism Arg>Gly in ADRB2R gene was associated with PI (p:0.009), BS (p:0.039), FEV1(%) (p:0.003), FEF25-75(%) (p:0.008), 1PA ( p:0.012), PAM (p:0.023) and PANM (p:0.024). Polymorphism Gln>Glu in ADRB2R gene was associated with BS (p:0.019) and TIF(%) (p:0.047). The response to inhaled bronchodilator in the spirometry test presented association for the markers of clinical severity FEV1(%) (p:0.011) and FEF25-75(%) (p:0.019) only for the polymorphism Arg>Gly in ADRB2R gene. Conclusion: There was association between the polymorphisms studied and CFTR mutations with the clinical severity in CF / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

CYP2D6, a member of the cytochrome P450 enzyme system, has a central role in drug metabolism, it metabolizes 25 % of clinically used drugs. The gene that codes for the enzyme displays a high degree of polymorphism, which effects enzyme functions to various degrees. Aside from smaller mutations like SNPs, alleles may also feature duplications or deletion of the whole gene. Due to the clinical relevance of these mutations, a simple and precise method for genotyping is needed. In this study, a method based on pyrosequencing for copy number analysis was evaluated, wherein the copy number was determined by relative quantification to a reference gene CYP2D8P. During evaluation of the method, several adjustments were tried for optimization, including adjustments of annealing temperature and primer concentration. The results showed a difficulty in distinguishing between copy numbers using the method, as well as a high coefficient of variation. Therefore, further optimization is required before the method could be implemented into clinical practice.

Abstract Neurological features are common in mitochondrial diseases because tissues depending upon oxidative phosphorylation bear the brunt of the pathogenesis. The 3243A>G mutation in the MTTL1 gene in mitochondrial DNA is regarded as the most frequent mitchondrial point mutation and classically presents with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS). Myopathy and peripheral neuropathy have been documented in patients with mitochondrial diseases, but not properly characterised in patients with the 3243A>G mutation. We have previously determined the prevalence of patients with this mutation in a defined population in northern Finland. The clinical spectrum and molecular aspects of myopathy and peripheral neuropathy are analysed here in a population-based cohort of patients with 3243A>G. Fifty patients were examined neurologically in order to define the frequency of myopathy and its histological, ultrastructural and clinical features. The frequency and phenotypic variability of peripheral neuropathy were determined in 32 patients and muscle computed tomography findings recorded in 24 patients. Finally, variations in mutation heteroplasmy were analysed in 10 patients using single muscle fibre PCR analysis. The frequency of peripheral neuropathy was 22% (95% confidence interval (CI), 9–40%) and that of clinical myopathy 50% (95% CI, 36–64%). Moderate limb weakness was the most common myopathic feature, but mild weakness and external ophthalmoplegia were also present. CT scans revealed myopathic changes in 54% of the patients (95% CI, 33–76%), most frequently in the pelvic muscles. The incidence of myopathy was highest in the fifth decade of life, and higher age and male gender increased the risk of neuropathy. Muscle histology was abnormal in 72% of the cases examined (95% CI, 55–86%). The presence of intramitochondrial crystals and COX-negative fibres and variations in the size and shape of mitochondria were more common in the muscle of myopathic patients. Single muscle fibre analysis pointed to a correlation between the mutation load in ragged red fibres and in adjacent histologically normal fibres, and the proportion of 3243A>G in histologically normal muscle fibres showed a pattern compatible with random genetic drift. The results indicate that myopathy and peripheral neuropathy are common in patients with the 3243A>G and that myopathy is highly variable in presentation. Segregation of 3243A>G in individual muscle fibres showed a complex process with random and non-random elements.

Abstract The 3243A>G mutation in mitochondrial DNA (mtDNA), the most common cause of the syndrome of mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes, is also associated with many other phenotypes such as hearing loss, diabetes mellitus, epilepsy, cognitive decline, myopathy and cardiomyopathy. The prevalence of the mutation has been shown to be 16.3/100 000 adults in Northern Finland. The present study was performed to estimate the frequency and progression of cardiac abnormalities and to examine causes of death in patients with 3243A>G. Left ventricular hypertrophy (LVH) was found in echocardiography in 56% of patients with 3243A>G and in 15% of age and sex-matched controls. The median thickness of the diastolic interventricular septum or posterior wall was 14 mm in the patients with LVH. The prevalence of LVH determined by echocardiography increased from 40% to 56% in 25 patients with 3243A>G during three years of follow-up, this trend being especially marked among the diabetic patients. The ultra-low-frequency (ULF) and very-low-frequency (VLF) components of the spectral analysis of heart rate variability (HRV) were lower among the patients with 3243A>G than in matched controls (p = 0.02 in ULF and p = 0.04 in VLF), and the short-term fractal scaling exponent in detrended fluctuation analysis of HRV was lower in the patients with 3243A>G (1.16 ± 0.18 vs. 1.28 ± 0.13) (p &lt; 0.01). Survival analysis of a birth cohort from pedigrees with 3243A>G revealed excess mortality before the age of 50 years. Neurological and cardiovascular diseases accounted for 32% of all the underlying causes of death in families with 3243A>G. Death was sudden and unexpected in 31% of cases in which 3243A>G was considered to be involved in the cause of death. The results show that cardiac abnormalities are frequent and progressive in patients with the 3243A>G mtDNA mutation and that cardiac autonomic regulation is disturbed. Patients with the 3243A>G mutation and their first degree maternal relatives died younger than was presupposed by their life expectancy at birth or at 15 years. The most common causes of death were neuropsychiatric and cardiovascular diseases.

Abstract The nature of symptoms and signs of sciatica, genetic factors, and efficacy of periradicular infiltration were studied in 160 nonoperated patients with unilateral sciatica of 3 to 28 weeks duration. Back and leg pain (100-mm VAS), disability (Oswestry), and quality-of-life (NHP) were evaluated. ENMG and 1.5-T MRI were performed on every patient. Presence of the Trp2 and Trp3 alleles of collagen IX was determined from blood samples. After informed consent, patients were randomized for periradicular infiltration with either methylprednisolone-bupivacaine, or saline. The final follow-up assessment was 1 year after the intervention. Economic analysis was based on data gathered from the patients, medical records and the National Insurance Register. At baseline, symptoms of sciatica did not correlate with the type of displacement of the symptomatic disc in MRI, or the presence of the Trp2 or Trp3 alleles. In the case of the Trp2 allele, there was a non-significant tendency for the presence of a radial tear at the L4–5 level. A significant genotype-phenotype association was found for the Trp3 allele: 15 of 34 (44%) patients with the Trp3 allele were positive for thoracolumbar Scheuermann's disease in MRI compared to 19% for sciatic patients without the allele (p = 0.003). Periradicular infiltration with methylprednisolone-bupivacaine produced a significant treatment effect compared to saline at 2 weeks for leg pain, straight leg raising, lumbar flexion and patient satisfaction. At 6 months, saline was superior to steroid in back and leg pain. By 1 year, 18 patients in the methylprednisolone group and 15 in the saline group had received surgical treatment. Subgroup analysis revealed that the short-term effect of the steroid treatment was most pronounced for contained herniations and symptomatic lesions situated at the L4–5 (or L3–4) disc level. Patients with a contained herniation were less likely to undergo back surgery when receiving the steroid treatment and they also had significantly fewer days on sick leave from 3 to 6 months. Counter-effectiveness was most pronounced for extrusions. The results indicate that disability among sciatic patients may be present even when MRI findings are minor; and vice versa, prominent MRI findings may not associate with any symptoms. However, MRI seems to be useful for identifying patients with the Trp3 allele. On the basis of the treatment intervention results, periradicular infiltration with a combination of steroid and anaesthetic may be recommended for sciatica as it offers at least short-term pain relief. Furthermore, in the case of contained herniations the steroid injection is cost-effective and may also prevent surgery. However, this subgroup analysis calls for a verification study.

Mesenchymal stem cells (MSCs) derived from human adipose tissue and umbilical cord (Wharton’s jelly, UCB) represent a useful source of adult stem cells for cellular therapy and tissue engineering. The biggest concern with the use of MSCs therapeutically relates to their isolation and growth/manipulation ex vivo. This study aimed to establish methods for the routine isolation and characterization of MSCs from human tissues. The objectives were (1) to show that MSCs could be isolated from different human tissues, namely adipose tissue, Wharton’s jelly, and UCB; (2) to confirm the MSC phenotypic profile over at least 10 passages; and (3) to show the multilineage differentiation capacity of the isolated cells. The minimal criteria as defined by the International Society for Cellular Therapy (ISCT) were used to determine whether MSCs were successfully isolated from various human tissues. Two different techniques involving enzymatic digestion or explant cultures were utilized, and compared for isolating MSCs from Wharton’s jelly. Umbilical cord blood has been suggested as another source of MSCs. However, we were unable to grow MSCs from UCB. Proliferation kinetics of isolated MSCs revealed that cords, either from digested cords or cord pieces had a mean PDT from passage 1 to 4 that was approximately 3 fold lower than for the ASCs. Mesenchymal stem cells from adipose tissue and Wharton’s jelly expressed the classical MSC phenotype (CD73+, CD90+, CD105+, CD34-, and CD45-). The cells from Wharton’s jelly showed a more uniform MSC profile over passages, with higher levels of marker expression when compared to ASCs. Variability in phenotype was observed in early ASC passages, whereas WJ-MSCs seemed to attain the MSC phenotype as early as passage 0 for both isolation techniques. Low levels of CD34 positive cells remained in the ASCs. Oil red O staining was used for identifying the lipid droplets in adipogenic differentiation cultures. A colorimetric assay as well as image analysis was used to quantify the differentiation. For the cord samples, both assays produced positive results. Histological examination, however, revealed that the cords did not form lipid droplets. The ASCs showed a statistically significantly greater differentiation capacity into adipocytes compared with the cords (pooled digested and pieces data). Alizarin red S staining was used for identifying calcium deposition during matrix mineralization in osteogenic differentiation cultures. No significant differences in osteogenic differentiation were observed between ASCs and WJ-MSCs. Chondrogenic differentiation was observed for both MSC sources by positive staining of glycosaminoglycans using toluidine blue O. The main findings of the study showed that MSCs, according to the ISCT guidelines, were successfully harvested from adipose tissue. However, due to the lack of adipogenic differentiation of WJ-derived cells, they did not meet the ISCT guidelines to be classified as MSCs, and were referred to as MSC-like cells. Regardless of the isolation technique used, Wharton’s jelly yielded cells with similar proliferation capacity, phenotype, and differentiation capacity. This study did, however, reveal that biological differences do exist between stem cells from different sources. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Immunology / unrestricted