Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2006. / Submitted by Thaíza da Silva Santos (thaiza28@hotmail.com) on 2009-10-24T13:16:24Z No. of bitstreams: 1 2006_Paulo Cesar Rodrigues Tabanez.pdf: 2997772 bytes, checksum: c45f51b562196594cb16abea9281c014 (MD5) / Approved for entry into archive by Tania Milca Carvalho Malheiros(tania@bce.unb.br) on 2009-10-27T13:18:02Z (GMT) No. of bitstreams: 1 2006_Paulo Cesar Rodrigues Tabanez.pdf: 2997772 bytes, checksum: c45f51b562196594cb16abea9281c014 (MD5) / Made available in DSpace on 2009-10-27T13:18:02Z (GMT). No. of bitstreams: 1 2006_Paulo Cesar Rodrigues Tabanez.pdf: 2997772 bytes, checksum: c45f51b562196594cb16abea9281c014 (MD5) Previous issue date: 2006-07-31 / A talidomida é uma droga imunomoduladora que tem sido utilizada experimentalmente em muitas condições clínicas, porém seu uso na malária ainda é insipiente. A malária é uma doença com alta morbi-mortalidade presente em todas as regiões tropicais do mundo. As manifestações severas da doença, possivelmente, estão ligadas à excessiva resposta imunitária, principalmente à produção de fator de necrose tumoral e radicais de oxigênio e nitrogênio. A talidomida diminui a produção de FNT por aumentar a degradação do seu ARNm e diminuir a ativação do NFκB. O presente trabalho avaliou a influência da talidomida sobre a evolução da malária e sobre as funções dos macrófagos em camundongos susceptíveis ou não à malária cerebral. Camundongos Balb/C e CBA foram infectados com 106 eritrócitos parasitados por Plasmodium berghei ANKA, tratados a partir do terceiro dia de infecção com 150 mg/Kg de talidomida diluída em solução a 0,8M de sacarose, por via oral, uma vez ao dia, em um volume de 100 μL. Outros dois grupos não foram infectados, mas foram tratados da mesma forma. No oitavo dia de infecção, o sangue foi obtido para a determinação do FNT e os macrófagos foram recuperados da cavidade abdominal para avaliação, in vitro, da capacidade fagocitária, produção de peróxido de hidrogênio, óxido nítrico e FNT. A capacidade fagocitária foi avaliada pelo teste de fagocitose, com ou sem opsoninas, em placa sendo determinado o índice fagocitário. A produção de peróxido de hidrogênio foi determinada pelo teste de oxidação do vermelho de fenol na presença de peroxidase. O óxido nítrico foi determinado pela reação de Griess. O FNT foi quantificado no soro e no sobrenadante das culturas dos macrófagos pelo teste imunoenzimático. A influência da talidomida, mas também da sacarose e da associação da talidomida com sacarose foi avaliada na evolução da malária por meio da curva de sobrevida, da parasitemia, anemia e peso dos camundongos Balb/C. Nos camundongos Balb/C, o tratamento com talidomida não modificou a sobrevida, diminuiu a perda de peso, retardou a elevação da parasitemia em nove dias, porém agravou a anemia a partir do vigésimo primeiro dia de infecção. O tratamento com solução a 0,8M de sacarose antecipou em um dia o início da morte e diminuiu em nove dias o tempo de vida, aumentou a perda de peso no início da infecção e posteriormente, a partir do décimo quarto dia, reduziu a perda de peso, agravou a parasitemia e a anemia. Porém, a associação da talidomida com a sacarose não modificou a curva de sobrevida e retardou a evolução da parasitemia a partir do vigésimo primeiro dia de infecção, por outro lado, agravou a evolução da anemia e aumentou a perda de peso a partir do vigésimo primeiro dia de infecção. Nos camundongos CBA, a associação da talidomida com sacarose não modificou a curva de sobrevida dos animais, a perda de peso, a parasitemia e a anemia. Em relação à função dos macrófagos, o tratamento dos camundongos Balb/C e CBA com talidomida diluída em solução 0,8M de sacarose não alterou a capacidade fagocitária e a produção de peróxido de hidrogênio, modulou negativamente a produção de óxido nítrico e diminuiu a produção de FNT tanto na cultura de macrófagos quanto no soro. Nossos dados sugerem que a talidomida, nos camundongos Balb/C, modulou a hiperativação do sistema imunitário de forma benéfica, uma vez que os aspectos gerais da evolução da malária não foram alterados, ao contrário, houve diminuição da perda de peso e retardo na evolução da parasitemia, porém, a administração isolada de sacarose deve ser avaliada pelos seus possíveis efeitos deletérios durante a infecção. Os dois modelos estudados não respondem da mesma forma à infecção provavelmente determinados por fatores genéticos. Sugerem, portanto, que a utilização da talidomida como terapia adjuvante aos anti-plasmodiais, antes das manifestações clínicas de gravidade, deve ser avaliada em seres humanos, exceto mulheres, com o objetivo de diminuir a grande morbidade e mortalidade da malária. ______________________________________________________________________ ABSTRACT / Thalidomide is an immunomodulatory drug that has been successfully evaluated in several clinical conditions, however it needs better evaluation in severe malaria. Malaria has high morbimortality in vast areas of the world. The excessive activation of the immune system, with increased production of tumor necrosis factor, oxygen and nitrogen reactive species, plays an important role in the pathogenesis of the disease. Thalidomide inhibits the production of TNF increasing the rate of mRNA degradation and depressing NFκB pathway. This work aimed to evaluate the influence of thalidomide on malaria outcome and on macrophage functions of susceptible (CBA) and not susceptible (Balb/C) mice to cerebral malaria. Balb/C and CBA mice were injected with 106 Plasmodium berghei ANKA infected-erythrocytes, and after three days mice were treated per os with 150 mg/Kg/day of thalidomide in 100 μL of 0,8M sucrose solution. The same treatment was administered to two other not infected groups. Another group was treated with only 0,8M sucrose solution. On the eightieth day after infection, blood was collected and macrophages were obtained from peritoneal cavity to assess, in vitro, immunological functions. Phagocytosis was evaluated by phagocytic index. Hydrogen peroxide was assessed by phenol red oxidation and nitric oxide production was assessed by Griess reaction. TNF production was evaluated in serum and supernatant of peritoneal macrophage cultures by immunoassay test. The influence of thalidomide on mortality, parasitemia, hematocrit and body weight was assessed in Balb/C and CBA-infected mice. Another Balb/c group treated with sucrose was added. Thalidomide did not influence the survival time, diminished body weight loss, delayed parasitemia in fortieth day, but worsened anemia twenty one days onward of infection in Balb/C mice compared to non-treated animals. The treatment with sucrose prompts one day the beginning of death and nine days the survival time. Firstly sucrose increased and after fortieth day of infection decreased body weight loss. It worsened parasitemia and anemia compared to that non-treated animals. However, association of thalidomide and sucrose did not alter survival time and body weight loss but increased parasitemia on fourth day onward of infection and worsened anemia after twenty one days of infection compared to that non-treated animals. The association of thalidomide and sucrose to treat CBA infected mice did not alter the survival time, body weight loss, parasitemia or anemia. The treatment with thalidomide of Balb/C and CBA infected mice did not influence the phagocytosis and hydrogen peroxide production, but it downregulated nitric oxide production, and decreased TNF production in serum (Balb/C) and supernatant of peritoneal macrophage cultures (Balb/C and CBA). Our findings suggest that thalidomide improved the outcome of disease, by decreasing body weight loss and delaying the parasitemia. Treatment with sucrose should be better evaluated because its possible deleterious effects. Our findings suggest that both experimental models show different immunopathological mechanisms, probably due to genetic factors. Moreover, thalidomide as adjuvant therapy in human malaria should be evaluated, except in women, to reduce morbidity and mortality of severe malaria.

Severe manifestations of malaria, including cerebral malaria (CM) and respiratory distress, result in approximately three million deaths annually worldwide. Currently, relatively little is known about severe disease pathogenesis. The development and outcome of severe malaria is determined by host-pathogen interactions, a complex interface of genetics and immune responses. Hypothetically, a spectrum of genetic susceptibility and resistance to severe disease exists within the host population, and malaria infection results in diverse host and parasite responses that impact disease outcome. The aim of this study was to identify differential host and parasite responses in a murine model of severe malaria, Plasmodium berghei ANKA (PbA), in CM-susceptible and CM-resistant mice; and to analyze host genetics in patients with severe disease due to Plasmodium falciparum. In vivo, expression microarray analysis showed that, in malaria target organs, differential responses were related to immune response – primarily interferon and complement pathways – and apoptosis. Histopathological examination of the brain confirmed an increased prevalence of apoptosis in CM-susceptible mice. Further examination of the role of complement in CM-susceptibility determined that early complement 5 (C5) activation conferred susceptibility to CM, and that C5 deficiency conferred resistance, which could be recapitulated by antibody blockade of activated C5 or its receptor in susceptible mice. Additionally, single nucleotide polymorphism (SNP) studies identified that complement receptor 1 SNPs were associated with disease severity in patients with P. falciparum malaria. PbA parasites displayed a unique transcriptional signature in each tissue examined (brain, liver, spleen and lung), showed differential gene expression between CM-resistant and susceptible hosts, and were most prominent in lung tissue. Closer examination of lung involvement in PbA infection revealed that PbA-infected C57BL/6 mice develop acute lung injury (ALI), defined by disruption of the alveolar-capillary membrane barrier. ALI susceptibility did not correlate with CM susceptibility, but was influenced by peripheral parasite burden and CD36-mediated parasite sequestration in the lung. PbA provides a clinically relevant experimental model for CM and ALI, through which important disease mechanisms can be identified and modulated. Ideally, the use of such models aids in the discovery of disease biomarkers and novel therapeutic strategies, which may be applied to human severe and cerebral malaria.

Severe manifestations of malaria, including cerebral malaria (CM) and respiratory distress, result in approximately three million deaths annually worldwide. Currently, relatively little is known about severe disease pathogenesis. The development and outcome of severe malaria is determined by host-pathogen interactions, a complex interface of genetics and immune responses. Hypothetically, a spectrum of genetic susceptibility and resistance to severe disease exists within the host population, and malaria infection results in diverse host and parasite responses that impact disease outcome. The aim of this study was to identify differential host and parasite responses in a murine model of severe malaria, Plasmodium berghei ANKA (PbA), in CM-susceptible and CM-resistant mice; and to analyze host genetics in patients with severe disease due to Plasmodium falciparum. In vivo, expression microarray analysis showed that, in malaria target organs, differential responses were related to immune response – primarily interferon and complement pathways – and apoptosis. Histopathological examination of the brain confirmed an increased prevalence of apoptosis in CM-susceptible mice. Further examination of the role of complement in CM-susceptibility determined that early complement 5 (C5) activation conferred susceptibility to CM, and that C5 deficiency conferred resistance, which could be recapitulated by antibody blockade of activated C5 or its receptor in susceptible mice. Additionally, single nucleotide polymorphism (SNP) studies identified that complement receptor 1 SNPs were associated with disease severity in patients with P. falciparum malaria. PbA parasites displayed a unique transcriptional signature in each tissue examined (brain, liver, spleen and lung), showed differential gene expression between CM-resistant and susceptible hosts, and were most prominent in lung tissue. Closer examination of lung involvement in PbA infection revealed that PbA-infected C57BL/6 mice develop acute lung injury (ALI), defined by disruption of the alveolar-capillary membrane barrier. ALI susceptibility did not correlate with CM susceptibility, but was influenced by peripheral parasite burden and CD36-mediated parasite sequestration in the lung. PbA provides a clinically relevant experimental model for CM and ALI, through which important disease mechanisms can be identified and modulated. Ideally, the use of such models aids in the discovery of disease biomarkers and novel therapeutic strategies, which may be applied to human severe and cerebral malaria.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico / FAPEMIG - Fundação de Amparo a Pesquisa do Estado de Minas Gerais / A malária é um grave problema de saúde pública. Os medicamentos de escolha para tratar a doença são as terapias baseadas em combinações de artemisininas. Porém, uma crescente resistência à estas drogas tem sido reportada. A presente investigação teve como objetivo avaliar o papel do extrato etanólico bruto de Trichoderma stromaticum (Ext-Ts) em camundongos C57BL/6 infectados com Plasmodium berghei ANKA, um conhecido modelo experimental de malária cerebral experimental. Foram monitoradas as manifestações clinicas, histológicas, imunológicas e bioquímicas características da infecção. Observou-se que o tratamento com Ext-Ts foi capaz de prevenir as alterações neurológicas associadas à malária cerebral experimental, diminuir os níveis de parasitemia e aumentar significativamente a sobrevivência de animais infectados. Além disso, foi observado que em camundongos tratados com Ext-Ts houve diminuição dos níveis de colesterol total, triglicerídeos e TGP no soro, menor deposição de hemozoína no fígado, atenuação da intensidade do edema pulmonar, proteção da integridade da barreira hematoencefálica, assim como menor citoaderência e achados histopatológicos nos tecidos avaliados, quando comparado com camundongos infectados não tratados. Esta proteção foi associada com uma diminuição na expressão de IFN-γ e ICAM-1 no cérebro dos animais tratados em relação a animais não tratados. Estes resultados sugerem que o Ext-Ts é uma potencial fonte de compostos antimaláricos e/ou imunomoduladores que poderiam melhorar o tratamento atual no contexto do aumento da resistência aos derivados da artemisinina. / Malaria is a severe health problem. The first-line treatment against the disease are the artemisinin-based combination therapies. However, increased resistance to these drugs has been reported. The aim of this study was to evaluate the role of crude etanolic extracts of Trichoderma stromaticum (Ext-Ts) in C57BL/6 mice infected with Plasmodium berghei ANKA, a well-known model of experimental cerebral malaria. Clinical, histological, immunological and biochemical features of the infection were monitored. It was found that Ext-Ts treatment was able to prevent neurological alterations associated with experimental cerebral malaria, decreased parasitemia levels and significantly improved survival of infected animals. Furthermore, it was observed that in Ext-Ts-treated mice a reduction of total serum cholesterol, triglycerides and TGP, lower hemozoin deposition into the liver, attenuation of pulmonary edema intensity, integrity of the blood-brain barrier as well as fewer cytoadherence and histopathological findings in assessed tissues in comparison with untreated infected mice. This protection was associated with decreased IFN-γ and ICAM-1 mRNA expression in brain of treated animals compared with untreated animals. These results suggest that Ext-Ts is a potential source of antimalarial and immunomodulatory compounds that could improve the current treatment in the context of resistance to artemisinin derivatives. / Dissertação (Mestrado)