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Made available in DSpace on 2014-08-20T13:44:38Z (GMT). No. of bitstreams: 1 tese_geri_eduardo_meneghello.pdf: 484002 bytes, checksum: fce3a37f2176aeefed1b425c5ccc0978 (MD5) Previous issue date: 2007-04-04 / The main reserve components in seeds are carbohydrates, lipids and proteins. Aside from their nutritious role, proteins have several important functions in seeds, being essential to the molecular biology of the plant. The detailed knowledge of proteins makes it possible to outline strategies of genetic improvement aimed at increasing production and tolerance to different pathologies, among other traits. Progress in the molecular biology, genomics and proteomics impelled the creation of a great volume of data on proteins of several vegetable species, with information about their functionality in the several tissues and organs they are part of. To use this information, it is necessary to rely on computational tools. This need impelled the appearance and development of bioinformatics, e.g. the use of computational tools for the study of biological data. The objective of this work was to quantify the proteins related to the seeds described already and available in the Swiss- Prot database, and to verify the similarity and hydrophobic pattern of the proteins with same function in different species. A detailed consultation was performed in the Swiss-Prot database, in search of proteins found in seeds, seedlings and their component tissues. The sequences found were grouped and analyzed according to the tissue in which they were expressed, epicotyl, aleurone, coleoptile, cotyledon, endosperm, hypocotyl, mesocotyl, immature seed, seedling and seeds. Alignments were performed among the sequences with similar function in different organs and in different species to verify similarities across tissues and species. The hydrophobic/ hydrophilic character in the proteins found was analyzed to identify patterns. Four hundred and fifty seed-related proteins are in stock at the Swiss Prot database. Oryza sativa, Zea mays, Arabidopsis thaliana, Triticum aestivum, Hordeum vulgare, Glycine max, which are the species that possess the largest number of seed proteins studied so far. There isn t a similarity in the sequences of amino acids of the proteins with same function / Dentre os principais componentes de reserva de uma semente destacam-se os carboidratos, os lipídeos e as proteínas. Além da função nutritiva, as proteínas têm diversas funções importantes nas sementes, sendo integrantes da biologia molecular da planta. O conhecimento detalhado das proteínas possibilita que sejam adotadas estratégias de melhoramento genético visando aumento de produção, resistência a patógenos, etc... Avanços na biologia molecular, genômica e proteômica impulsionaram a criação de um grande volume de dados sobre proteínas de diversas espécies vegetais, com informações sobre a sua funcionalidade nos diversos tecidos e órgãos. Para utilizar essas informações, é imprescindível a utilização de ferramentas computacionais. Essa necessidade impulsionou o surgimento e o desenvolvimento da bioinformática, que é a utilização de ferramentas computacionais para o estudo de dados biológicos. O objetivo deste trabalho foi quantificar as proteínas relacionadas às sementes já descritas e disponíveis no banco Swiss-Prot, e verificar a similaridade e padrão de hidrofobicidade das proteínas de mesma função em espécies diferentes. Para isso, foi feita uma consulta detalhada no banco de dados Swiss-Prot em busca de proteínas encontradas em sementes, plântulas e seus diversos tecidos. As seqüências encontradas foram agrupadas por tecido, sendo selecionadas e analisadas aquelas expressas no epicótilo, camada de aleurona, coleóptilo, cotilédones, endosperma, hipocótilo, mesocótilo, semente imatura, plântula e semente. Realizou-se alinhamentos entre as seqüências com função similar encontradas em diferentes órgãos e em diferentes espécies para verificar a similaridade existente entre as mesmas. Estudou-se a hidrofobicidade/hidrofilicidade nas proteínas encontradas, buscando identificar padrões. Existem 450 proteínas relacionadas a sementes depositadas no banco de dados Swiss-Prot.Oryza sativa, Zea mays, Arabidopsis thaliana, Triticum aestivum, Hordeum vulgare, Glycine max são espécies que possuem um maior número de proteínas de sementes estudadas. Não há um padrão de similaridade nas seqüências de aminoácidos das proteínas de mesma função

L'angiogenèse est un processus physiologique qui correspond à la formation de nouveaux vaisseaux sanguins à partir d'un réseau vasculaire préexistant et est régulée par l'équilibre entre les facteurs endogènes pro- et anti-angiogéniques. La rupture de cet équilibre est associée à de nombreuses pathologies dont l'ischémie, la rétinopathie ou encore la progression tumorale. Etant donné que les cellules endothéliales, principal type cellulaire composant les vaisseaux sanguins expriment les récepteurs à activité tyrosine kinase du facteur anticoagulant, la protéine S, Tyro3, Axl et Mer et produisent de la protéine S, l'objectif de ce travail est d'étudier le rôle, de la protéine S dans l'angiogenèse. Dans la première partie de ce travail, nous avons montré in vivo que la protéine S inhibe l'angiogenèse induite par les facteurs pro-angiogéniques (VEGFA et FGF2). Parallèlement, nous avons observé in vitro une inhibition par la protéine S de la prolifération et de la migration des cellules endothéliales induites par le VEGFA. Cet effet est corrélé à l'inhibition par la protéine S des voies de signalisation des MAP-Kinases et de la phosphatidylinositol 3-kinase (PIK3) induites par le VEGFA. Nous avons ensuite mis en évidence, par l'utilisation d'inhibiteurs pharmacologiques et de petits ARNs interférents, que la protéine S inhibe, via l'activation du récepteur Mer et le recrutement de la protéine phosphatase SHP2, l'activation du VEGFR2, le principal récepteur du VEGFA. Dans la deuxième partie, nous avons montré de manière intéressante que le rôle joué par la protéine S lors de l'angiogenèse est plus complexe, puisqu'elle est capable d'activer directement la voie de signalisatio / Angiogenesis is a physiological process that leads to new blood vessel formation and is regulated by a balance between pro-and anti-angiogenic endogenous factors. Disruption of this balance leads to many pathologies such as ischemia, retinopathies or tumor growth. Because endothelial cells, the main cellular type composing blood vessels, produce the anticoagulant factor, protein S and express its tyrosine kinase receptors Tyro3, Axl and Mer, we investigated the implication of protein S in angiogenesis. In the first part of this work, we demonstrated that protein S inhibits pro-angiogenic factors (VEGFA and FGF2)-induced angiogenesis in vivo. We also observed an inhibition of VEGFA-dependent endothelial cell proliferation and migration induced by protein S. These effects were correlated with protein S induced inhibition of VEGFA-dependent MAP-Kinases (Erk1, Erk2) and phosphatidylinositol 3-kinase (PIK3) activation. Furthermore, we demonstrated, using pharmacological inhibitors and small interfering RNAs, that protein S inhibits VEGFA-induced VEGFR-2 activation through Mer receptor activation and SHP2 protein phosphatase recruitment. In the second part, we demonstrated that, protein S on its own, is able to induce MAP-kinases pathway activation and endothelial cells proliferation. These cellular and molecular effects involved Mer receptor and SHP2 protein activation and required protein kinase SRC recruitment. Our results describe for the first time that protein S is an endogenous regulator for angiogenesis both in vitro and in vivo and may form the framework for the use of protein S as part of an anti-angiogenic treatment.

No description available.

Porcine Epidemic Diarrhea Virus (PEDV) was first detected in Europe in the 1970s, but did not emerge in the United States until 2013. When it arrived, it ran rampant due to the lack of previous exposure, causing the death of 7-8 million neonatal piglets and $900 million to $1.8 billion in losses to the U.S. pork industry in 2013 and 2014. This virus causes diarrhea and vomiting which leads to dehydration and in extreme cases, death. Neonatal piglets rely heavily on passive lactogenic immunity from their mother's milk, thus making them especially vulnerable to this disease. Within 2-3 days of infection during the initial outbreak, there was a 90-95% mortality rate among these weaning piglets. Additionally, this virus is highly contagious, with high rates of fecal shedding during infection. To control the outbreak, the USDA had approved two emergency-relief vaccines, but both have proved to be ineffective at preventing disease or reducing fecal shedding. These vaccines are still available today. As such, it is necessary to develop a vaccine that will be effective at preventing illness and viral shedding. PEDV is a single-stranded RNA virus made of four major subunits: a structural spike (S), membrane (M), envelope (E), and nucleocapsid (N) proteins. The one most studied and of particular interest is the S protein as it facilitates the virus' attachment and entry into the host cell. The S protein is made of two domains, the S1 domain which allows for protein interactions between the virus and the host cell, and the S2 domain which allows for membrane fusion. Because of the S1's role in protein interaction, it is often the target of potential vaccines. Within the S1 domain, it's C-terminal domain encodes for the receptor binding domain (RBD), which is why the S1 CTD is the target of this study. In this study we focused on the expression, purification, and immunogenicity testing of the CTD protein using T7 Express E. coli as the expression host. We used PCR, gel electrophoresis, Sanger Sequencing, western blots, and mass spectrometry to ensure that the protein was being expressed properly. The future goal is to use this protein as the antigen in a future nanoparticle-based PEDV vaccine. / Master of Science / In 2013, Porcine Epidemic Diarrhea Virus (PEDV) emerged in the United States, causing an estimated $900 million to $1.8 billion in damages to the pork industry and the death of 7 to 8 million newborn piglets in just one year. This virus causes diarrhea and vomiting which causes dehydration and death, and newborn piglets are particularly vulnerable. During the initial outbreak, two emergency-relief vaccines were approved but have not been proven effective against the disease. Thus, it is of great importance to develop a vaccine that is both effective and safe. Therefore, our task was to express, purify, and test the immunogenicity of a segment of the PEDV spike protein to be used as the antigen of a future nanoparticle-based vaccine.

De plus en plus d’études montrent un lien entre la teneur en vitamine K (VK) dans l’organisme et la cognition. Certaines études effectuées in vitro on montré l’effet de la VK au niveau moléculaire, mais très peu in vivo. Une étude récente de Tamadon-Nejad a montré qu’un traitement de 14mg/kg/jr de warfarine, un antagoniste de la VK, administré simultanément à des injections sous-cutanées de 85mg/kg/jr de phylloquinone entrainait une diminution significative de la concentration de MK-4 du cerveau, résultant en une diminution significative du statut vitaminique K au cerveau, une altération de la cognition, du comportement exploratoire et de la locomotion [1]. Dans la présente étude, le traitement de Tamadon-Nejad a été modifié et les doses de phylloquinone ont été augmentées à 120mg/kg/jr (WVK) ce qui a maintenu une diminution significative de la concentration de la concentration de MK-4 dans le cerveau, mais a entrainé une surcompensation par la phylloquinone, résultant en une augmentation significative du statut vitaminique K au cerveau. Ce statut a été associé à une mémoire de reconnaissance intacte et corrélé à une amélioration de la mémoire spatiale des rats WVK. Le traitement a aussi été associé à une augmentation significative de l’anxiété et au rétablissement du comportement exploratoire et de la locomotion des rats WVK comparativement à l’étude de Tamadon-Nejad [1]. Dans l’hippocampe des rats WVK, l’amélioration de la cognition et le rehaussement du statut vitaminique K du cerveau n'ont pas induit de variation significative de l’activation des protéines dépendantes de la VK Gas6 et Protéine S, mais ont été associés à une augmentation significative de l’activation de la voie MAPK, à une inhibition de l’apoptose et à une présence accrue de la microglie. En somme, cette étude confirme le rôle modulateur de la VK dans le cerveau sur la cognition et la survie cellulaire. / There is growing evidence that vitamin K (VK) plays a role in cognition. Some in vitro studies have shown how VK affects different molecular pathways in brain cells, but few in vivo studies have been conducted. Recently, a study from Tamadon- Nejad showed that a treatment of 14mg/kg/d of warfarine, a VK antagonist, given simultaneously with subcutaneous injections of 85mg/kg/d lead to a significant decrease in MK-4 concentration in brain, resulting in a significant decrease of VK status in brain, and perturbation in cognition, exploratory behaviour and locomotion [1]. In the present study, we modified the treatment used in Tamadon-Nejad and increased the phylloquinone doses to 120mg/kg/d which maintained the significant decrease in MK-4 concentration in brain, but lead to an overcompensation of phylloquinone that resulted in an increase of VK status in brain. This status was associated with an intact recognition memory and correlated with an improvement in spatial memory of WVK rats. The treatment was also associated with a significant increase in anxiety and recovery of exploratory behavior and locomotion compared to rats in the Tamadon-Nejad study [1]. In WVK rat hippocampi, cognition improvement and increased VK status were not associated with significant variation in VK dependant proteins (VKDP) Gas6 and Protein S activation, but were associated with an increase in the MAPK activation pathway, an inhibition of apoptosis and, an increased presence of microglia. In summary, this study confirms the modulatory role of VK in brain in cognition and cell survival.

L'inhibiteur de la Voie du Facteur Tissulaire (TFPI) est une protéine régulatrice de la coagulation plasmatique intervenant à la phase initiale de la cascade. Il inhibe en présence de la protéine S (PS) le facteur Xa et ce complexe TFPI-Xa inactive ensuite le complexe FT-VIIa. Nous avons recherché une résistance à l'activité anticoagulante du TFPI. La sensibilité du plasma à une quantité fixe de TFPI a été évaluée sur la base d'un temps de thromboplastine diluée (TTD) réalisé avec et sans TFPI : - chez des patients ayant présenté une thrombose veineuse profonde inexpliquée ; cette résistance suspectée sur une 1ère étude n'a pas été confirmée sur la 2ème. - chez des patientes enceintes ; une résistance au TFPI acquise a été montrée et rapportée au déficit acquis en PS ; cependant le degré de résistance au TFPI ne peut pas être utilisé comme marqueur de risque de pathologie vasculaire placentaire. Chez des patients obèses l'effet inhibiteur des taux élevés de Lp(a) sur l'activité TFPI décrit in vitro n'a pas été retrouvé in vivo pas plus que l'effet de l'aspirine sur la normalisation des taux de Lp(a). Le TFPI joue un rôle dans les manifestations hémorragiques des hémophiles. Nous avons montré que les hémophiles B ont comparativement aux A des taux moindres de TFPI ce qui pourrait expliquer leur différence en terme de manifestations hémorragiques. Les taux de TFPI libre sont bien corrélés aux paramètres de la génération de thrombine surtout au temps de latence. En présence d’un anti TFPI humain la génération de thrombine est corrigée chez l'hémophile. Cette correction dépend de la concentration d'anti TFPI, est saturable et doit être étudiée sur du plasma riche en plaquettes / TFPI is a multivalent Kunitz-type proteinase inhibitor that directly inhibits FXa and produces FXa-dependent feedback inhibition of the FVIIa–TF complex. It was recently demonstrated that Protein S (PS) plays the role of TFPI cofactor by enhancing the TFPI inhibition of factor Xa in vivo. Approximately 80% of plasma TFPI circulates as a complex with plasma lipoproteins, about 5–20% circulating as free TFPI. Under quiescent conditions, approximately 50–80% of intravascular TFPI is stored in association with the endothelium. Full-length TFPI α carried in platelets constitutes 8-10% of the total amount of TFPI in the blood, corresponding to a quantity comparable to that of soluble full-length TFPI α in the plasma. We searched for resistance to TFPI activity in patients who presented idiopathic venous thrombosis at a young age. Plasma sensitivity to TFPI was evaluated on the basis of diluted prothrombin time (dPT) measured in patients and in control plasma in the presence (W) and absence (Wo) of exogenous TFPI. At the same time, dPT was measured on a reference plasma to establish a normalized ratio termed TFPI NR and defined as (dPT wTFPI/ dPT Wo TFPI) patient or control / (dPT wTFPI/ dPT Wo TFPI) reference plasma. In an initial study, we found that TFPI resistance could be considered as a new coagulation abnormality that could be related to unexplained thrombosis. In a second study, we failed to demonstrate a role of TFPI resistance in patients with venous thrombosis, abnormal TFPI NR being more likely related to the non-respect of preanalytical conditions rather than to an inherited trait. However, in another study, we showed that inherited or acquired PS deficiency was responsible for a TFPI resistance, providing an ex vivo demonstration that PS is the cofactor of TFPI activity. We showed that this TFPI resistance existed throughout pregnancy and that it disappeared when PS returned to normal values after delivery. We evaluated this TFPI resistance as a possible marker of the risk of a gestational vascular complication (GVC) in 72 patients at risk of developing a GVC. TFPI NR did not differ between GVC+ patients (n =15) and GVC– patients (n = 57). High levels of Lipoprotein(a) (Lp(a) have been shown to be an independent risk factor for cardiovascular disease, lowering of these levels not being achievable by any treatment except possibly aspirin. An in vitro study showed that TFPI activity could be inhibited by Lp(a). We did not confirm this TFPI inhibition in vivo in 20 obese patients with coronary insufficiency who had either normal Lp(a) levels (≤ 0.3 g/L; n = 15) or high Lp(a) levels (≥ 0.3 g/L; n = 5) . Moreover, we found no effect of aspirin treatment on Lp(a) whatever the initial level of Lp(a). Haemophilia B patients bleed less than haemophilia A patients. We showed that this difference in bleeding profile could be explained by lower free TFPI levels in haemophilia B patients compared to haemophilia A patients. In an ongoing study, we showed that in haemophilia A patients there was a strong correlation between the different parameters of thrombin generation (TG) and free TFPI. We also showed, in a TG assay performed in platelet-rich plasma (PRP) with a low TF concentration, that LT was sensitive to free TFPI levels whatever the type of haemophilia and whatever theseverity of the disease. We demonstrated that blocking TFPI by an anti-TFPI Antibody (Ab) allows complete correction of the TG profile in PRP. We showed that it is of major importance to perform a TG assay in PRP in order to evaluate the efficacy of anti-TFPI Ab in correcting TG parameters in haemophilia patients

Objetivo: A trombose da veia porta é uma causa importante de hiper-tensão porta em crianças e adolescentes, porém, em uma proporção importante dos casos, não apresenta fator etiológico definido. O objetivo desse estudo é determinar a freqüência de deficiência das proteínas inibidoras da coagulação – proteínas C, S e antitrombina − e das mutações fator V Leiden, G20210A no gene da protrombina e C677T da metileno-tetraidrofolato redutase em crianças e adolescentes com trom-bose da veia porta, definir o padrão hereditário de uma eventual deficiência das pro-teínas inibidoras da coagulação nesses pacientes e avaliar a freqüência da deficiên-cia dessas proteínas em crianças e adolescentes com cirrose. Casuística e Métodos: Foi realizado um estudo prospectivo com 14 crianças e adolescentes com trombose da veia porta, seus pais (n = 25) e dois gru-pos controles pareados por idade, constituídos por um grupo controle sem hepato-patia (n = 28) e um com cirrose (n = 24). A trombose da veia porta foi diagnosticada por ultra-sonografia abdominal com Doppler e/ou fase venosa do angiograma celíaco seletivo. A dosagem da atividade das proteínas C, S e antitrombina foi determinada em todos os indivíduos e a pesquisa das mutações fator V Leiden, G20210A da pro-trombina e C677T da metileno-tetraidrofolato redutase, nas crianças e adolescentes com trombose da veia porta, nos pais, quando identificada a mutação na criança, e nos controles sem hepatopatia. Resultados: Foram avaliados 14 pacientes caucasóides, com uma média e desvio padrão de idade de 8 anos e 8 meses ± 4 anos e 5 meses e do diagnóstico de 3 anos e 8 meses ± 3 anos e seis meses. Metade dos pacientes pertenciam ao gênero masculino. O motivo da investigação da trombose da veia porta foi hemorra-gia digestiva alta em 9/14 (64,3%) e achado de esplenomegalia ao exame físico em 5/14 (35,7%). Anomalias congênitas extra-hepáticas foram identificadas em 3/14 (21,4%) e fatores de risco adquiridos em 5/14 (35,7%) dos pacientes. Nenhum pa-ciente tinha história familiar de consangüinidade ou trombose venosa. A deficiência das proteínas C, S e antitrombina foi constatada em 6/14 (42,9%) (p < 0,05 vs con-troles sem hepatopatia), 3/14 (21,4%) (p > 0,05) e 1/14 (7,1%) (p > 0,05) pacientes com trombose da veia porta, respectivamente. A deficiência dessas proteínas não foi identificada em nenhum dos pais ou controles sem hepatopatia. A mutação G20210A no gene da protrombina foi identificada em um paciente com trombose da veia porta e em um controle sem hepatopatia (p = 0,999), mas em nenhum desses foi identificado a mutação fator V Leiden. A mutação C677T da metileno-tetraidrofo-lato redutase foi observada na forma homozigota, em 3/14 (21,4%) dos pacientes com trombose da veia porta e em 5/28 (17,9%) controles sem hepatopatia (p = 0,356). A freqüência da deficiência das proteínas C, S e antitrombina nos pacientes com cir-rose foi de 14/24 (58,3%), 7/24 (29,2%) e 11/24 (45,8%), respectivamente (p < 0,05 vs controles sem hepatopatia), sendo mais freqüente nos pacientes do subgrupo Child-Pugh B ou C, que foi de 11/12 (91,7%), 5/12 (41,7%) e 9/12 (75%), respectivamente (p < 0,05 vs controles sem hepatopatia). Conclusões: A deficiência de proteína C foi freqüente nas crianças e adolescentes com trombose da veia porta e não parece ser de origem genética. A deficiência de proteína S, antitrombina e as presenças das mutações G20210A da protrombina e C677T da metileno-tetraidrofolato redutase foram observadas mas não apresentaram diferença estatística significativa em relação ao grupo controle sem hepatopatia. O fator V Leiden não foi identificado. Os resultados deste estudo sugerem que a deficiência da proteína C pode ocorre como conseqüência da hiper-tensão porta. Os distúrbios pró-trombóticos hereditários não parecem apresentar um papel importante em relação à trombose nas crianças e adolescentes estudadas. / Objective: Portal vein thrombosis is a major cause of portal hypertension in children and adolescents; yet, its etiology is not clearly defined in a considerable number of cases. The present study aims at determining the prevalence of blood coagulation disorders – protein C, protein S and antithrombin – and factor V Leiden, G20210A prothrombin, and C677T methylenetetrahydrofolate reductase mutations in children and adolescents with portal vein thrombosis, as well as assessing the hereditary character of these disorders in these patients, and also evaluating the prevalence of blood coagulation disorders in children and adolescents with cirrhosis. Study design: A prospective study was carried out, including children and adolescents with portal vein thrombosis (n = 14), their parents (n = 25), two age-matched control groups, one without liver disease (n = 28), and another with cirrhosis (n = 24). Portal vein thrombosis was diagnosed through abdominal Doppler ultrasonography and/or venous phase of selective coeliac angiograms. The activity of protein C, protein S and antithrombin was evaluated for all individuals; the presence of factor V Leiden, G20210A prothrombin, and C677T methylenetetrahydrofolate reductase gene mutations was investigated in children and adolescents with portal vein thrombosis, in parents when their respective children presented any of these mutations, and in the control group without liver disease. Results: 14 Caucasian patients were assessed. The mean and standard deviation for age were 8 years and 8 months ± 4 years and 5 months while the mean and standard deviation for diagnosis were 3 years and 8 months ± 3 years and six months. Half of the patients were males. Initial clinical manifestations upon diagnosis were digestive hemorrhage in 9/14 (64.3%) and splenomegaly on physical examination in 5/14 individuals (35.7%). Patients presented extrahepatic anomalies in 3/14 (21.4%) and acquired risk factors in 5/14 (35.7%) of the cases. None of the patients had a family history of consanguinity or venous thrombosis. The frequency of protein C, protein S and antithrombin deficiency was observed in 6/14 (42.9%) (p < 0.05 vs. controls without liver disease), 3/14 (21.4%) (p > 0.05) and 1/14 (7.1%) (p > 0.05) of patients, respectively. None of the portal vein thombosis patients or controls presented protein C, S or antithrombin deficiency. One portal vein patient and one control (p = 0.999) presented G20210A prothrombin mutation. None of these patients presented the factor V Leiden. The homozygous form of C677T methylenetetrahydrofolate reductase mutation was observed in 3/14 patients with portal vein thrombosis (21.4%) and in 5/28 controls (17.9%) (p = 0.356). The frequency of coagulation inhibitor deficiency was high in cirrhotic patients (14/24 (58.3%) PC, 7/24 (29.2%) PS and 11/24 (45.8%) AT; p < 0.05 vs. controls), especially in Child-Pugh B and C patients (11/12 (91.7%) PC, 5/12 (41.7%) PS and 9/12 (75%) AT; p < 0.05 vs. controls). Conclusions: Protein C deficiency was frequent in children and adolescents with portal vein thrombosis and does not seem to be an inherited condition. Protein S and antithrombin deficiency, and G20210A prothrombin and C677T methylenetetrahydrofolate reductase mutations were observed but did not present statistically significant differences when compared to the controls without liver disease. Factor V Leiden was not observed. The results suggest the protein C deficiency may originates from portal hypertension. The hereditary prothrombotic disorders do not seem to play a vital role in thrombosis in children and adolescents with portal vein thrombosis.

Objetivo: A trombose da veia porta é uma causa importante de hiper-tensão porta em crianças e adolescentes, porém, em uma proporção importante dos casos, não apresenta fator etiológico definido. O objetivo desse estudo é determinar a freqüência de deficiência das proteínas inibidoras da coagulação – proteínas C, S e antitrombina − e das mutações fator V Leiden, G20210A no gene da protrombina e C677T da metileno-tetraidrofolato redutase em crianças e adolescentes com trom-bose da veia porta, definir o padrão hereditário de uma eventual deficiência das pro-teínas inibidoras da coagulação nesses pacientes e avaliar a freqüência da deficiên-cia dessas proteínas em crianças e adolescentes com cirrose. Casuística e Métodos: Foi realizado um estudo prospectivo com 14 crianças e adolescentes com trombose da veia porta, seus pais (n = 25) e dois gru-pos controles pareados por idade, constituídos por um grupo controle sem hepato-patia (n = 28) e um com cirrose (n = 24). A trombose da veia porta foi diagnosticada por ultra-sonografia abdominal com Doppler e/ou fase venosa do angiograma celíaco seletivo. A dosagem da atividade das proteínas C, S e antitrombina foi determinada em todos os indivíduos e a pesquisa das mutações fator V Leiden, G20210A da pro-trombina e C677T da metileno-tetraidrofolato redutase, nas crianças e adolescentes com trombose da veia porta, nos pais, quando identificada a mutação na criança, e nos controles sem hepatopatia. Resultados: Foram avaliados 14 pacientes caucasóides, com uma média e desvio padrão de idade de 8 anos e 8 meses ± 4 anos e 5 meses e do diagnóstico de 3 anos e 8 meses ± 3 anos e seis meses. Metade dos pacientes pertenciam ao gênero masculino. O motivo da investigação da trombose da veia porta foi hemorra-gia digestiva alta em 9/14 (64,3%) e achado de esplenomegalia ao exame físico em 5/14 (35,7%). Anomalias congênitas extra-hepáticas foram identificadas em 3/14 (21,4%) e fatores de risco adquiridos em 5/14 (35,7%) dos pacientes. Nenhum pa-ciente tinha história familiar de consangüinidade ou trombose venosa. A deficiência das proteínas C, S e antitrombina foi constatada em 6/14 (42,9%) (p < 0,05 vs con-troles sem hepatopatia), 3/14 (21,4%) (p > 0,05) e 1/14 (7,1%) (p > 0,05) pacientes com trombose da veia porta, respectivamente. A deficiência dessas proteínas não foi identificada em nenhum dos pais ou controles sem hepatopatia. A mutação G20210A no gene da protrombina foi identificada em um paciente com trombose da veia porta e em um controle sem hepatopatia (p = 0,999), mas em nenhum desses foi identificado a mutação fator V Leiden. A mutação C677T da metileno-tetraidrofo-lato redutase foi observada na forma homozigota, em 3/14 (21,4%) dos pacientes com trombose da veia porta e em 5/28 (17,9%) controles sem hepatopatia (p = 0,356). A freqüência da deficiência das proteínas C, S e antitrombina nos pacientes com cir-rose foi de 14/24 (58,3%), 7/24 (29,2%) e 11/24 (45,8%), respectivamente (p < 0,05 vs controles sem hepatopatia), sendo mais freqüente nos pacientes do subgrupo Child-Pugh B ou C, que foi de 11/12 (91,7%), 5/12 (41,7%) e 9/12 (75%), respectivamente (p < 0,05 vs controles sem hepatopatia). Conclusões: A deficiência de proteína C foi freqüente nas crianças e adolescentes com trombose da veia porta e não parece ser de origem genética. A deficiência de proteína S, antitrombina e as presenças das mutações G20210A da protrombina e C677T da metileno-tetraidrofolato redutase foram observadas mas não apresentaram diferença estatística significativa em relação ao grupo controle sem hepatopatia. O fator V Leiden não foi identificado. Os resultados deste estudo sugerem que a deficiência da proteína C pode ocorre como conseqüência da hiper-tensão porta. Os distúrbios pró-trombóticos hereditários não parecem apresentar um papel importante em relação à trombose nas crianças e adolescentes estudadas. / Objective: Portal vein thrombosis is a major cause of portal hypertension in children and adolescents; yet, its etiology is not clearly defined in a considerable number of cases. The present study aims at determining the prevalence of blood coagulation disorders – protein C, protein S and antithrombin – and factor V Leiden, G20210A prothrombin, and C677T methylenetetrahydrofolate reductase mutations in children and adolescents with portal vein thrombosis, as well as assessing the hereditary character of these disorders in these patients, and also evaluating the prevalence of blood coagulation disorders in children and adolescents with cirrhosis. Study design: A prospective study was carried out, including children and adolescents with portal vein thrombosis (n = 14), their parents (n = 25), two age-matched control groups, one without liver disease (n = 28), and another with cirrhosis (n = 24). Portal vein thrombosis was diagnosed through abdominal Doppler ultrasonography and/or venous phase of selective coeliac angiograms. The activity of protein C, protein S and antithrombin was evaluated for all individuals; the presence of factor V Leiden, G20210A prothrombin, and C677T methylenetetrahydrofolate reductase gene mutations was investigated in children and adolescents with portal vein thrombosis, in parents when their respective children presented any of these mutations, and in the control group without liver disease. Results: 14 Caucasian patients were assessed. The mean and standard deviation for age were 8 years and 8 months ± 4 years and 5 months while the mean and standard deviation for diagnosis were 3 years and 8 months ± 3 years and six months. Half of the patients were males. Initial clinical manifestations upon diagnosis were digestive hemorrhage in 9/14 (64.3%) and splenomegaly on physical examination in 5/14 individuals (35.7%). Patients presented extrahepatic anomalies in 3/14 (21.4%) and acquired risk factors in 5/14 (35.7%) of the cases. None of the patients had a family history of consanguinity or venous thrombosis. The frequency of protein C, protein S and antithrombin deficiency was observed in 6/14 (42.9%) (p < 0.05 vs. controls without liver disease), 3/14 (21.4%) (p > 0.05) and 1/14 (7.1%) (p > 0.05) of patients, respectively. None of the portal vein thombosis patients or controls presented protein C, S or antithrombin deficiency. One portal vein patient and one control (p = 0.999) presented G20210A prothrombin mutation. None of these patients presented the factor V Leiden. The homozygous form of C677T methylenetetrahydrofolate reductase mutation was observed in 3/14 patients with portal vein thrombosis (21.4%) and in 5/28 controls (17.9%) (p = 0.356). The frequency of coagulation inhibitor deficiency was high in cirrhotic patients (14/24 (58.3%) PC, 7/24 (29.2%) PS and 11/24 (45.8%) AT; p < 0.05 vs. controls), especially in Child-Pugh B and C patients (11/12 (91.7%) PC, 5/12 (41.7%) PS and 9/12 (75%) AT; p < 0.05 vs. controls). Conclusions: Protein C deficiency was frequent in children and adolescents with portal vein thrombosis and does not seem to be an inherited condition. Protein S and antithrombin deficiency, and G20210A prothrombin and C677T methylenetetrahydrofolate reductase mutations were observed but did not present statistically significant differences when compared to the controls without liver disease. Factor V Leiden was not observed. The results suggest the protein C deficiency may originates from portal hypertension. The hereditary prothrombotic disorders do not seem to play a vital role in thrombosis in children and adolescents with portal vein thrombosis.

Objetivo: A trombose da veia porta é uma causa importante de hiper-tensão porta em crianças e adolescentes, porém, em uma proporção importante dos casos, não apresenta fator etiológico definido. O objetivo desse estudo é determinar a freqüência de deficiência das proteínas inibidoras da coagulação – proteínas C, S e antitrombina − e das mutações fator V Leiden, G20210A no gene da protrombina e C677T da metileno-tetraidrofolato redutase em crianças e adolescentes com trom-bose da veia porta, definir o padrão hereditário de uma eventual deficiência das pro-teínas inibidoras da coagulação nesses pacientes e avaliar a freqüência da deficiên-cia dessas proteínas em crianças e adolescentes com cirrose. Casuística e Métodos: Foi realizado um estudo prospectivo com 14 crianças e adolescentes com trombose da veia porta, seus pais (n = 25) e dois gru-pos controles pareados por idade, constituídos por um grupo controle sem hepato-patia (n = 28) e um com cirrose (n = 24). A trombose da veia porta foi diagnosticada por ultra-sonografia abdominal com Doppler e/ou fase venosa do angiograma celíaco seletivo. A dosagem da atividade das proteínas C, S e antitrombina foi determinada em todos os indivíduos e a pesquisa das mutações fator V Leiden, G20210A da pro-trombina e C677T da metileno-tetraidrofolato redutase, nas crianças e adolescentes com trombose da veia porta, nos pais, quando identificada a mutação na criança, e nos controles sem hepatopatia. Resultados: Foram avaliados 14 pacientes caucasóides, com uma média e desvio padrão de idade de 8 anos e 8 meses ± 4 anos e 5 meses e do diagnóstico de 3 anos e 8 meses ± 3 anos e seis meses. Metade dos pacientes pertenciam ao gênero masculino. O motivo da investigação da trombose da veia porta foi hemorra-gia digestiva alta em 9/14 (64,3%) e achado de esplenomegalia ao exame físico em 5/14 (35,7%). Anomalias congênitas extra-hepáticas foram identificadas em 3/14 (21,4%) e fatores de risco adquiridos em 5/14 (35,7%) dos pacientes. Nenhum pa-ciente tinha história familiar de consangüinidade ou trombose venosa. A deficiência das proteínas C, S e antitrombina foi constatada em 6/14 (42,9%) (p < 0,05 vs con-troles sem hepatopatia), 3/14 (21,4%) (p > 0,05) e 1/14 (7,1%) (p > 0,05) pacientes com trombose da veia porta, respectivamente. A deficiência dessas proteínas não foi identificada em nenhum dos pais ou controles sem hepatopatia. A mutação G20210A no gene da protrombina foi identificada em um paciente com trombose da veia porta e em um controle sem hepatopatia (p = 0,999), mas em nenhum desses foi identificado a mutação fator V Leiden. A mutação C677T da metileno-tetraidrofo-lato redutase foi observada na forma homozigota, em 3/14 (21,4%) dos pacientes com trombose da veia porta e em 5/28 (17,9%) controles sem hepatopatia (p = 0,356). A freqüência da deficiência das proteínas C, S e antitrombina nos pacientes com cir-rose foi de 14/24 (58,3%), 7/24 (29,2%) e 11/24 (45,8%), respectivamente (p < 0,05 vs controles sem hepatopatia), sendo mais freqüente nos pacientes do subgrupo Child-Pugh B ou C, que foi de 11/12 (91,7%), 5/12 (41,7%) e 9/12 (75%), respectivamente (p < 0,05 vs controles sem hepatopatia). Conclusões: A deficiência de proteína C foi freqüente nas crianças e adolescentes com trombose da veia porta e não parece ser de origem genética. A deficiência de proteína S, antitrombina e as presenças das mutações G20210A da protrombina e C677T da metileno-tetraidrofolato redutase foram observadas mas não apresentaram diferença estatística significativa em relação ao grupo controle sem hepatopatia. O fator V Leiden não foi identificado. Os resultados deste estudo sugerem que a deficiência da proteína C pode ocorre como conseqüência da hiper-tensão porta. Os distúrbios pró-trombóticos hereditários não parecem apresentar um papel importante em relação à trombose nas crianças e adolescentes estudadas. / Objective: Portal vein thrombosis is a major cause of portal hypertension in children and adolescents; yet, its etiology is not clearly defined in a considerable number of cases. The present study aims at determining the prevalence of blood coagulation disorders – protein C, protein S and antithrombin – and factor V Leiden, G20210A prothrombin, and C677T methylenetetrahydrofolate reductase mutations in children and adolescents with portal vein thrombosis, as well as assessing the hereditary character of these disorders in these patients, and also evaluating the prevalence of blood coagulation disorders in children and adolescents with cirrhosis. Study design: A prospective study was carried out, including children and adolescents with portal vein thrombosis (n = 14), their parents (n = 25), two age-matched control groups, one without liver disease (n = 28), and another with cirrhosis (n = 24). Portal vein thrombosis was diagnosed through abdominal Doppler ultrasonography and/or venous phase of selective coeliac angiograms. The activity of protein C, protein S and antithrombin was evaluated for all individuals; the presence of factor V Leiden, G20210A prothrombin, and C677T methylenetetrahydrofolate reductase gene mutations was investigated in children and adolescents with portal vein thrombosis, in parents when their respective children presented any of these mutations, and in the control group without liver disease. Results: 14 Caucasian patients were assessed. The mean and standard deviation for age were 8 years and 8 months ± 4 years and 5 months while the mean and standard deviation for diagnosis were 3 years and 8 months ± 3 years and six months. Half of the patients were males. Initial clinical manifestations upon diagnosis were digestive hemorrhage in 9/14 (64.3%) and splenomegaly on physical examination in 5/14 individuals (35.7%). Patients presented extrahepatic anomalies in 3/14 (21.4%) and acquired risk factors in 5/14 (35.7%) of the cases. None of the patients had a family history of consanguinity or venous thrombosis. The frequency of protein C, protein S and antithrombin deficiency was observed in 6/14 (42.9%) (p < 0.05 vs. controls without liver disease), 3/14 (21.4%) (p > 0.05) and 1/14 (7.1%) (p > 0.05) of patients, respectively. None of the portal vein thombosis patients or controls presented protein C, S or antithrombin deficiency. One portal vein patient and one control (p = 0.999) presented G20210A prothrombin mutation. None of these patients presented the factor V Leiden. The homozygous form of C677T methylenetetrahydrofolate reductase mutation was observed in 3/14 patients with portal vein thrombosis (21.4%) and in 5/28 controls (17.9%) (p = 0.356). The frequency of coagulation inhibitor deficiency was high in cirrhotic patients (14/24 (58.3%) PC, 7/24 (29.2%) PS and 11/24 (45.8%) AT; p < 0.05 vs. controls), especially in Child-Pugh B and C patients (11/12 (91.7%) PC, 5/12 (41.7%) PS and 9/12 (75%) AT; p < 0.05 vs. controls). Conclusions: Protein C deficiency was frequent in children and adolescents with portal vein thrombosis and does not seem to be an inherited condition. Protein S and antithrombin deficiency, and G20210A prothrombin and C677T methylenetetrahydrofolate reductase mutations were observed but did not present statistically significant differences when compared to the controls without liver disease. Factor V Leiden was not observed. The results suggest the protein C deficiency may originates from portal hypertension. The hereditary prothrombotic disorders do not seem to play a vital role in thrombosis in children and adolescents with portal vein thrombosis.