The overall aim of this research project was to develop surfactant dry powder formulations and devices for efficient delivery of aerosol formulations to infants using the excipient enhanced growth (EEG) approach. Use of novel formulations and inline delivery devices would allow for more efficient treatment of infants suffering from neonatal respiratory distress syndrome and bronchiolitis. A dry powder aerosol formulation has been developed using the commercial product, Survanta ® (beractant) and EEG technology to produce micrometer-sized hygroscopic particles. Spray drying and formulation parameters were initially determined with dipalmitoylphosphatidylcholine (DPPC, the dominant phospholipid in pulmonary surfactant), which produced primary particles 1 um in size with a mass median aerodynamic diameter of 1-2 um. Investigation of dry powder dispersion enhancers and alcohol concentration on the effect of powder aerosol characteristics were performed with the Survanta-EEG formulation. The optimal formulation consisted of Survanta ® , mannitol and sodium chloride as hygroscopic excipients, and leucine as the dry powder dispersion enhancer, prepared in 20% v/v ethanol/water. The powders produced primary particles of 1 um with >50% of the particles less than 1 um. The presence of surfactant proteins and surface activity were demonstrated with the Survanta-EEG formulation following processing. A novel containment unit dry powder inhaler (DPI) was designed for delivery of the surfactant-EEG formulation using a low volume of dispersion air. Studies explored optimization of air entrainment pathway, inlet hole pattern, delivery tube internal diameter and length. With 3- 10 mg fill masses of spray dried surfactant powder, the DPI enabled delivery of >2 mg using one 3-mL actuation of dispersion air. Overall, it was possible to deliver >85% of the loaded fill mass using three actuations. Nebulized aerosol formulations are characterized with low delivered doses. Using a novel mixer-heater delivery system, the highest estimated percent lung dose achieved during realistic in vitro testing of a Survanta-EEG formulation aerosolized with a commercial mesh nebulizer was when nebulization was synchronized with inhalation of the breathing profile. Design changes to the mixer-heater system eliminated the need for synchronization, achieving an estimated percent lung dose of 31% of the nominal, an improvement compared with existing systems that achieve approximately <2% lung dose.

A imunização transcutânea (TCI) é uma via atrativa para o desenvolvimento de vacinação livre de agulhas, atuando nas APCs da pele, podendo substituir algumas das imunizações convencionais, em termos de facilidade, segurança e eficácia. O presente estudo avaliou a resposta imune da TCI com proteína recombinante de leptospira LipL32, uma proteína altamente conservada em cepas patogênicas e potente candidata vacinal. A TCI com a LipL32 na região abdominal de C57BL-6 foi capaz de primar o sistema imune, suscitando resposta sistêmica com altos níveis de anticorpos contra o antígeno, após reforços subimunizantes, ID e Tc. O padrão de citocinas em cultivo de células do sangue total dos grupos imunizados indicou que a imunização Tc foi capaz de primar o sistema imune, tanto inato quanto adaptativo. O tratamento local ou a coadministração com surfactantes ou PEG não evidenciou ação emoliente ou adjuvante. A coadministração Tc da LipL32 com MPL-A levou a efeito moderador da reação pro-inflamatória, redirecionando a resposta adaptativa, tanto humoral quanto celular. / Transcutaneous immunization (TCI) offers an attractive pathway for the development of needle-free vaccination by acting on APCs of the skin, showing potential to replace conventional immunization, in terms of safety and efficacy. In this study we evaluated the immune response by TCI with recombinant protein of leptospira LipL32, a highly conserved protein among pathogenic strains, a potential vaccine candidate. TCI with LipL32 was evaluated in C57BL-6 mice abdominal region and was able to confer systemic response with high levels of antibodies after subimmunizing ID and Tc boosters. The pattern of cytokines in cell cultures from whole blood of immunized groups indicated that the TCI was able to prime the immune system, for both innate and adaptive response. Local treatment of the skin or coadministration with surfactants and PEG did not show an emollient and an adjuvant action. Co-administration of LipL32 with MPL-A influenced the antibody response as well as showed a moderating effect of the pro-inflammatory reaction, redirecting the adaptive response.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22003号 / 医博第4517号 / 新制||医||1038(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 川口 義弥, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

A etiologia da síndrome do desconforto respiratório (SDR) é considerada multifatorial e multigênica. A proteína B do surfactante (SP-B) é essencial para a função pulmonar normal. O gene responsável pela produção da SP-B está localizado no braço curto do cromossomo 2 (2p12->p11.2), estendendo-se por aproximadamente por 9.5 Kilobases e contém 11 exons. A presença de polimorfismos e mutações em genes dos componentes do surfactante, particularmente no gene da SP-B, parece estar associada à SDR. Objetivos: Determinar a freqüência de polimorfismos do gene que codifica a proteína B do surfactante no DNA de recém nascidos pré-termo portadores de SDR e de recémnascidos de termo sadios, comparar as freqüências desses polimorfismos entre os dois grupos e avaliar se existe alguma relação entre sexo, raça e SDR. Casuística e Métodos: Foram incluídos no estudo 150 RN, sendo 50 pré-termo portadores de SDR com idades gestacionais variando entre 28 e 33 semanas e 6 dias, e 100 RN de termo clinicamente sadios com idades gestacionais variando de 37 a 41 semanas e seis dias, no período de junho de 2001 a julho de 2004. Foram analisados quatro polimorfismos: A/C no nucleotídeo - 18; C/T no nucleotídeo 1580; A/G no nucleotídeo 9306 e G/C no nucleotídeo 8714. Os polimorfismos foram determinados através da amplificação dos segmentos de DNA genômico por reação em cadeia da polimerase e posterior genotipagem. Os genótipos foram definidos através da análise dos produtos obtidos a partir de reações com enzimas de S . 22 restrição [PCR-based converted restriction fragment length polymorphism (cRFLP)]. Resultados: O grupo controle foi constituído por 100 RN de termo aparentemente saudáveis; 42(42%) do sexo feminino e 58(58%) do sexo masculino; 39(39%) da raça branca e 61(61%) da raça não branca. O peso variou de 2280g a 4.740g (média de 3.239,9g), e a idade gestacional variou de 37 a 41 semanas e seis dias (média de 39 semanas e 3 dias). O grupo SDR foi composto por 50 RNPT, sendo 21(42%) do sexo feminino e 29(58%) do sexo masculino; 28(56%) eram da raça branca e 22(44%), não brancos. O peso variou de 640g a 2.080g (média de 1273g); a idade gestacional média foi de 31 semanas e dois dias, tendo variado de 28 semanas a 33 semanas e seis dias. Foi encontrada uma diferença estatisticamente significante quando comparados os dois grupos e a variável raça isoladamente no polimorfismo G/C 8714 (p=0,028). Quando a variável sexo foi analisada isoladamente, não houve diferença estatisticamente significante dos polimorfismos entre os dois grupos. As freqüências dos genótipos dos outros três polimorfismos estudados foram muito similares nos dois grupos, não tendo sido encontrada diferença estatisticamente significante quando as variáveis sexo e raça foram avaliadas conjuntamente. Conclusão: A análise do polimorfismo G/C 8714 mostrou que em indivíduos da raça branca, o genótipo GG foi apenas encontrado no grupo SDR, sugerindo que a sua presença possa se constituir em um possível fator de risco para a doença, enquanto que o genótipo GC foi mais prevalente no grupo controle indicando a possibilidade desse genótipo ser um fator protetor / The etiology of respiratory distress syndrome (RDS) is multifactorial and multigenic. Surfactant protein B (SP-B) is essential for normal lung function. The human SP-B gene is located on the short arm of chromosome 2 (2p12->p11.2), encompasses approximately 9.5 kilobases and have 11 exons. Polymorphisms and mutations in the genes that encode the surfactant components, particularly the SP-B gene, have been associated to the pathogenesis of RDS. Aims: To analyze SP-B gene polimorfisms frequencies in preterm babies with RDS and healthy term newborns, to compare the polymorphisms frequencies between both groups and to evaluate if there are differences related to sex, race and RDS. Material and Methods: We included 150 neonates, 50 preterm with RDS and gestational ages ranging from 28 weeks to 33 weeks and 6 days, and 100 healthy term newborns with gestational ages ranging from 37 weeks to 41 weeks and 6 days, during June 2001 to July 2004. Four SP-B gene polymorphisms were analyzed: A/C at - 18, C/T at 1580; A/G at 9306 and G/C at nucleotide 8714. The polymorphisms were detected by PCR amplification of genomic DNA and genotyping. The genotypes were determined using PCR-based converted restriction fragment length polymorphism (cRFLP). Results: The control group comprised 100 apparently healthy term newborns; 42(42%) were female and 58(58%) male; 39(39%) were Whites and 61(61%) non-Whites. Weight ranged from 2280g to 4.740g (mean 3.239,9g); gestational age ranged from 37 weeks to 41 weeks and six days (mean 39 weeks and 3 days). The RDS group comprised 50 preterm neonates, 21(42%) female and 29(58%) male; 28(56%) were Whites and 22(44%) non-Whites. Weight ranged from 640g to 2.080g (mean 1273g); mean gestational age was 31 weeks and two days (range, 28-33 weeks and six days). All genotypes frequencies were similar among both groups when sex and race were analyzed together. When race was analyzed separately, there was a statistically significant difference between both groups in the polymorphism G/C at 8714 (p=0,028). There was no difference between both groups in all polymorphisms when sex was analyzed separately. Conclusions: The analysis of the SP-B polymophism G/C 8714 showed that in white neonates the genotype GG was only found in the RDS group and the genotype GC was more frequently found in controls. This suggests that genotype GG could be a risk factor while GC might be a protective genotype for the development of the disease

Zusammenfassung Viele Untersuchungen deuten darauf hin, dass das Surfaktantprotein A (SP-A) sowohl an der Regulation des Surfaktanthaushalts als auch als unspezifisches Opsonin an der Abwehr von Pathogenen in der Lunge beteiligt ist. Zahlreiche Polymorphismen kennzeichnen die Gene der Proteinuntereinheiten SP-A1 und 2. Die häufigste Aminosäuresubstitution Val50Leu befindet sich in der kollagenartigen Domäne, die an den Kollektinrezeptor der Phagozyten bindet. Weitere existieren in der an der Bindung an Lipopolysaccharide, Surfaktantbestandteile und Rezeptoren auf Pneumozyten beteiligten Kohlehydraterkennungsregion (CRD) der globulären Domäne. Träger des schwach exprimierten Wildtypallels 1a0 des SP-A2-Gens haben ein erhöhtes Risiko, am Atemnotsyndrom des Neugeborenen (RDS) zu erkranken. Bei der Alveolarproteinose akkumulieren die hydrophilen Surfaktantproteine A und D in den Alveolen. In der vorliegenden Arbeit wurde eine nested PCR zur isolierten Amplifikation beider SP-A-Gene etabliert. 31 Patienten mit Verdacht auf einen Surfaktantproteindefekt wurden auf neue Restriktionsfragmentlängenpolymorphismen (RFLP) im SP-A1-Gen untersucht. Der in einer Familie konstante NcoI-Polymorphismus 1162C>T in Codon 39 und der NdeI-Polymorphismus 3138T>C in Codon 184 wurden mit einer Allelfrequenz von etwa 11 % detektiert. Die Sequenzen der entsprechenden Allele wurden kloniert. Bei 14 Patienten mit idiopathischer Alveolarproteinose, therapierefraktärem Surfaktantmangel oder rezidivierender Pneumonie wurden die SP-A-Gene sequenziert. Der bisher nur SP-A1 zugeschriebene Aminosäureaustausch Val50Leu wurde als Substitution 1220G>C bei zwei Patienten im SP-A2-Gen nachgewiesen. Drei Patienten mit Alveolarproteinose waren homozygot für die Substitution Gln223Lys in der CRD des SP-A2. Bei einem Patienten handelte es sich möglicherweise um eine somatische Mutation der Leukozyten-DNA im Rahmen einer Leukämie mit sekundärer Alveolarproteinose. Ein anderer war heterozygoter Träger des seltenen Allels 6a4 mit der Aminosäuresubstitution Arg219Trp in der CRD des SP-A1 und hatte die Alveolarproteinose erst im Erwachsenenalter entwickelt. Der dritte war homozygoter Träger des sehr seltenen Allels 1a3 des SP-A2 und verstarb im Alter von 6 Wochen an konnataler Alveolarproteinose (CAP), ohne dass ein bekannter Defekt des SP-B- oder des GM-CSF-Rezeptorgens vorlag. Die SSCP-Analyse konnte allelische Varianten als Einzelstrangkonformationspolymorphismen unterscheiden, war jedoch als Suchtest in heterozygoten Proben zu unspezifisch. Der hohe Gehalt an Polymorphismusinformation (PIC) macht den SP-A-Genort sftp1 zu einem nützlichen Marker bei der Untersuchung der Surfaktantproteine und anderer auf Chromosom 10 lokalisierter Gene. / Abstract Many studies give evidence of the role of surfactant protein A (SP-A) in the regulation of surfactant homeostasis and the defence from pathogens in the lung by opsonisation. The genes for the two protein subunits SP-A1 and SP-A2 are characterised by numerous polymorphisms. The most frequently substituted amino acid Val50Leu is located within the collagen-like region, which is recognised by the collectin-receptor on phagocytes. Further amino acids are substituted in the globular region, which is involved into the binding to lipopolysaccharides, surfactant particles, and receptors on pneumocytes by its carbohydrate recognition domain (CRD). Individuals carrying the weakly expressed wild-type allele 1a0 of SP-A2 have an increased risk of developing the respiratory distress syndrome (RDS) of the new-born. Alveolar proteinosis is a disease with accumulation of the hydrophilic surfactant proteins SP-A and SP-D in the alveoli. In this study a nested PCR for separate amplification of the two SP-A genes has been established. 31 patients with suspected deficiency of a surfactant protein has been investigated for new restriction fragment length polymorphisms (RFLP) in the SP-A1 gene. The NcoI-polymorphism 1162C>T in codon 39, which was constantly inherited in one family, and the NdeI-polymorphism 3138T>C in codon 184 have been detected with an allele frequency of around 11 %. The DNA sequences of these alleles have been cloned. In 14 patients suffering from idiopathic alveolar proteinosis, therapy-refractory surfactant deficiency, or recurrent pneumonia the SP-A genes have been sequenced. The substituted amino acid Val50Leu, which was previously considered exclusively in SP-A1, has been detected in SP-A2 in two patients. Three patients with alveolar proteinosis proved to be homozygous for the substitution Gln223Lys within the CRD of SP-A2. One of these patients might have a somatic mutation in the DNA of his leucocytes, with alveolar proteinosis developing secondary to his leukaemia. Another one developed alveolar proteinosis as an adult and was heterozygous for the rare allele 6a4 which includes the substituted amino acid Arg219Trp in the CRD of SP-A1. The third one proved to be homozygous for the very rare allele 1a3 of SP-A2 and died at 6 weeks of age from congenital alveolar proteinosis (CAP) without having one of the known mutations responsible for this condition within the genes for surfactant protein B (SP-B) or the GM-CSF receptor protein. The allelic variants could be differentiated by single strand conformation polymorphism but the SSCP-analysis was not enough specific for the screening of heterozygous DNA. Due to its high polymorphism information content (PIC), the SP-A gene locus sftp1 is a useful genetic marker for the analysis of the surfactant proteins and other genes located on chromosome 10.

A etiologia da síndrome do desconforto respiratório (SDR) é considerada multifatorial e multigênica. A proteína B do surfactante (SP-B) é essencial para a função pulmonar normal. O gene responsável pela produção da SP-B está localizado no braço curto do cromossomo 2 (2p12->p11.2), estendendo-se por aproximadamente por 9.5 Kilobases e contém 11 exons. A presença de polimorfismos e mutações em genes dos componentes do surfactante, particularmente no gene da SP-B, parece estar associada à SDR. Objetivos: Determinar a freqüência de polimorfismos do gene que codifica a proteína B do surfactante no DNA de recém nascidos pré-termo portadores de SDR e de recémnascidos de termo sadios, comparar as freqüências desses polimorfismos entre os dois grupos e avaliar se existe alguma relação entre sexo, raça e SDR. Casuística e Métodos: Foram incluídos no estudo 150 RN, sendo 50 pré-termo portadores de SDR com idades gestacionais variando entre 28 e 33 semanas e 6 dias, e 100 RN de termo clinicamente sadios com idades gestacionais variando de 37 a 41 semanas e seis dias, no período de junho de 2001 a julho de 2004. Foram analisados quatro polimorfismos: A/C no nucleotídeo - 18; C/T no nucleotídeo 1580; A/G no nucleotídeo 9306 e G/C no nucleotídeo 8714. Os polimorfismos foram determinados através da amplificação dos segmentos de DNA genômico por reação em cadeia da polimerase e posterior genotipagem. Os genótipos foram definidos através da análise dos produtos obtidos a partir de reações com enzimas de S . 22 restrição [PCR-based converted restriction fragment length polymorphism (cRFLP)]. Resultados: O grupo controle foi constituído por 100 RN de termo aparentemente saudáveis; 42(42%) do sexo feminino e 58(58%) do sexo masculino; 39(39%) da raça branca e 61(61%) da raça não branca. O peso variou de 2280g a 4.740g (média de 3.239,9g), e a idade gestacional variou de 37 a 41 semanas e seis dias (média de 39 semanas e 3 dias). O grupo SDR foi composto por 50 RNPT, sendo 21(42%) do sexo feminino e 29(58%) do sexo masculino; 28(56%) eram da raça branca e 22(44%), não brancos. O peso variou de 640g a 2.080g (média de 1273g); a idade gestacional média foi de 31 semanas e dois dias, tendo variado de 28 semanas a 33 semanas e seis dias. Foi encontrada uma diferença estatisticamente significante quando comparados os dois grupos e a variável raça isoladamente no polimorfismo G/C 8714 (p=0,028). Quando a variável sexo foi analisada isoladamente, não houve diferença estatisticamente significante dos polimorfismos entre os dois grupos. As freqüências dos genótipos dos outros três polimorfismos estudados foram muito similares nos dois grupos, não tendo sido encontrada diferença estatisticamente significante quando as variáveis sexo e raça foram avaliadas conjuntamente. Conclusão: A análise do polimorfismo G/C 8714 mostrou que em indivíduos da raça branca, o genótipo GG foi apenas encontrado no grupo SDR, sugerindo que a sua presença possa se constituir em um possível fator de risco para a doença, enquanto que o genótipo GC foi mais prevalente no grupo controle indicando a possibilidade desse genótipo ser um fator protetor / The etiology of respiratory distress syndrome (RDS) is multifactorial and multigenic. Surfactant protein B (SP-B) is essential for normal lung function. The human SP-B gene is located on the short arm of chromosome 2 (2p12->p11.2), encompasses approximately 9.5 kilobases and have 11 exons. Polymorphisms and mutations in the genes that encode the surfactant components, particularly the SP-B gene, have been associated to the pathogenesis of RDS. Aims: To analyze SP-B gene polimorfisms frequencies in preterm babies with RDS and healthy term newborns, to compare the polymorphisms frequencies between both groups and to evaluate if there are differences related to sex, race and RDS. Material and Methods: We included 150 neonates, 50 preterm with RDS and gestational ages ranging from 28 weeks to 33 weeks and 6 days, and 100 healthy term newborns with gestational ages ranging from 37 weeks to 41 weeks and 6 days, during June 2001 to July 2004. Four SP-B gene polymorphisms were analyzed: A/C at - 18, C/T at 1580; A/G at 9306 and G/C at nucleotide 8714. The polymorphisms were detected by PCR amplification of genomic DNA and genotyping. The genotypes were determined using PCR-based converted restriction fragment length polymorphism (cRFLP). Results: The control group comprised 100 apparently healthy term newborns; 42(42%) were female and 58(58%) male; 39(39%) were Whites and 61(61%) non-Whites. Weight ranged from 2280g to 4.740g (mean 3.239,9g); gestational age ranged from 37 weeks to 41 weeks and six days (mean 39 weeks and 3 days). The RDS group comprised 50 preterm neonates, 21(42%) female and 29(58%) male; 28(56%) were Whites and 22(44%) non-Whites. Weight ranged from 640g to 2.080g (mean 1273g); mean gestational age was 31 weeks and two days (range, 28-33 weeks and six days). All genotypes frequencies were similar among both groups when sex and race were analyzed together. When race was analyzed separately, there was a statistically significant difference between both groups in the polymorphism G/C at 8714 (p=0,028). There was no difference between both groups in all polymorphisms when sex was analyzed separately. Conclusions: The analysis of the SP-B polymophism G/C 8714 showed that in white neonates the genotype GG was only found in the RDS group and the genotype GC was more frequently found in controls. This suggests that genotype GG could be a risk factor while GC might be a protective genotype for the development of the disease

Abstract Respiratory distress syndrome, RDS, is a multifactorial lung disease of premature infants. The main cause of RDS is a deficiency of pulmonary surfactant, a lipoprotein mixture required to reduce surface tension at the air-liquid interface and to prevent generalized atelectasis of the alveolar ducts and alveoli. Prematurity is the most important factor predisposing to RDS. During the past decade the number of multiple pregnancies has increased significantly as a result of diversified infertility treatments and advanced maternal age. Due to the considerably higher rate of preterm births of multiples compared to singletons, RDS is one of the major causes of morbidity among them. The objectives of the present research were to evaluate the incidence and risk factors of RDS in twins compared to singletons, and to assess the role of SP-A and SP-B gene variations and gene-environment interactions in the susceptibility to the disease in a population of preterm twins and higher order multiples. This research showed that during the past fifteen years the gestational age-specific incidence of RDS has declined. Twin infants do not have increased risk of RDS except when born very immaturely at a very early gestational age. The presenting twin is less susceptible to RDS than the non-presenting twin or singleton infant after 28 weeks of gestation until term. Additionally the SP-B Ile131Thr polymorphism was shown to affect the susceptibility specifically in the presenting twin. The role of SP-A polymorphisms in the risk of RDS in twins turned out to be different from that in singletons. The major allele and genotype of SP-A1 were associated with a decreased risk of RDS in near-term twin infants. The threonine allele in SP-B Ile131Thr appeared interactively with SP-A1 to associate with the risk of RDS both in twins and in singletons: associating with a lower risk of RDS in singletons at very early gestation, but surprisingly associating with a protection in twins and multiples from RDS near term. The risk of RDS, defined by the interaction of SP-A and SP-B alleles, was additionally associated with the fetal mass. Thus, the difference in the susceptibility to RDS in premature singletons and multiples may depend on the size of the conceptus. In an evaluation of the genetic risk factors for RDS, the classical twin study method comparing the concordance of a disease between MZ and DZ twins underestimates the extent of heredity. Several predominant intrauterine and perinatal environmental factors contribute to disease susceptibility regardless of zygosity and are suspected to override the hereditary components of RDS. Twin gestation was shown to be an effect modifier in the genetic susceptibility to RDS. / Tiivistelmä Vastasyntyneen hengitysvaikeusoireyhtymä, RDS-tauti, on hyvin monitekijäinen ennenaikaisena syntyneiden lasten sairaus. Taudin tärkein syy on keuhkojen pintajännitystä alentavan aineen, surfaktantin, puute ennenaikaisessa synnytyksessä. Surfaktantti on rasva-proteiiniseos, joka alentaa keuhkorakkuloiden pintajännitystä ja estää rakkuloiden kasaan painumisen hengityksen aikana. Epäkypsyys on tärkein RDS-taudin kehittymiselle altistava tekijä. Viimeisen vuosikymmenen aikana monisikiöiset raskaudet ovat lisääntyneet merkittävästi keinohedelmöitysten ja synnyttäjien kohonneen iän seurauksena. RDS-tauti on monisikiösynnytyksissä tärkeä sairastavuutta aiheuttava tekijä, koska monisikiöraskaudet päättyvät huomattavasti useammin ennenaikaisesti kuin yksösraskaudet. Tämän tutkimuksen tarkoituksena oli selvittää RDS-taudin ilmaantuvuutta ja riskitekijöitä kaksosilla verrattuna yksösiin, tutkia surfaktanttiproteiinien A ja B geenivaihtelua sekä geenien ja ympäristötekijöiden vuorovaikutusta kaksosten ja monisikiöisistä raskauksista syntyneiden lasten RDS-taudissa. Tutkimus osoitti, että viimeisten viidentoista vuoden aikana RDS-taudin raskausikäkohtainen ilmaantuvuus on vähentynyt. Vain hyvin epäkypsillä, ennenaikaisilla kaksosilla on lisääntynyt riski sairastua RDS-tautiin verrattuna yksösiin. 28 raskausviikon jälkeen ensimmäisenä syntyvällä kaksosella on pienempi riski saada RDS-tauti kuin toisena syntyvällä tai yksösellä. Lisäksi surfaktanttiproteiini B:n (SP-B) geenin eksonin 4 monimuotoisuus osoittautui vaikuttavan RDS-taudin alttiuteen erityisesti ensin syntyvällä kaksosella. Surfaktanttiproteiini A:n (SP-A) geenin yhteys RDS-taudin riskiin osoittautui olevan erilainen kaksosilla verrattuna yksösiin. Lähes täysiaikaisilla kaksosilla SP-A1 geenin valta-alleeli ja genotyyppi liittyivät RDS-taudin vähentyneeseen riskiin. SP-B geenin eksonin 4 treoniini alleeli osoittautui liittyvän yhdessä SP-A1 valtagenotyypin kanssa RDS-taudin riskiin sekä yksösillä että kaksosilla: hyvin ennenaikaisilla yksösillä geenien yhteisvaikutus lisäsi riskiä, kun taas lähes täysiaikaisilla kaksosilla sama geenien yhteisvaikutus yllättäen suojeli RDS-taudilta. SP-A ja SP-B geenien vuorovaikutuksen kautta välittyvä RDS-taudin riski oli lisäksi yhteydessä sikiön kokoon. Siten ennenaikaisena syntyneiden yksösten ja monisikiöisten RDS-taudin alttiuden ero voi olla riippuvainen sikiön koosta. Klassinen kaksostutkimusmenetelmä, jossa verrataan identtisten ja ei-identtisten kaksosten sairastuvuutta, aliarvioi perimän määräämien tekijöiden osuutta RDS-taudin synnyssä. Useat hallitsevat kohdunsisäiset ja synnytykseen liittyvät ympäristötekijät vaikuttavat RDS-taudin syntyyn ja kumoavat perimän osuutta. Kaksosuus osoittautui olevan periytymisen vaikutusta muokkaava tekijä RDS-taudissa.

Abstract Pulmonary surfactant is a lipid-protein mixture that lines the inner surface of the lung. The main function of surfactant is to reduce surface tension at the air-liquid interface, thus preventing alveolar collapse at the end of expiration. Lack of surfactant is the main cause of respiratory distress syndrome (RDS) in preterm infants. Very preterm babies are at risk of developing a lung disease called bronchopulmonary dysplasia (BPD). The surfactant proteins SP-A, -B, -C and -D have important functions in surfactant structure, homeostasis and innate immunity of the lung. The genes of these proteins have been studied as candidates for several multifactorial lung diseases both in adults and in children. The aim of the present study was to examine the genetic variation in SP genes and to evaluate the role of SP gene polymorphism in the etiology of severe pulmonary infantile diseases, including RDS, BPD and severe respiratory syncytial virus (RSV) infection among the Finnish population. Conventional allelic association methods in combination with multiparameter analysis and family-based transmission disequilibrium test (TDT) were used. The SP-D Met11 allele was associated with a risk for severe RSV bronchiolitis in a matched case-control setting of 84 infants with severe RSV infection and 93 control infants. The variants of the SP-C gene had no detectable association with BPD. However, a modest association of SP-C Asn138 and Asn186 alleles with RDS was found. A length variation in the SP-B gene was associated with BPD among very preterm infants born before 32 weeks of gestation. The SP-B intron 4 deletion variant allele increased the risk for BPD especially in very low birth weight infants. The association was confounded by birth order, being evident only among presenting infants, who are more prone to ascending infections during a preterm birth process. The present study provides new evidence about the significance of SP gene polymorphisms in the etiology of complex infantile pulmonary diseases, including RDS, BPD and severe RSV bronchiolitis. The results help us to understand the molecular mechanisms underlying these diseases and may, in the long run, enable better treatment of these life-threatening diseases. / Tiivistelmä Keuhkosurfaktantti on keuhkon sisäpintaa peittävä kalvomainen rasva-proteiinikompleksi, jonka tärkein ominaisuus on pintajännityksen vähentäminen keuhkorakkuloissa. Surfaktantin puutos ennenaikaisesti syntyneillä lapsilla aiheuttaa hengitysvaikeusoireyhtymän, RDS-taudin (respiratory distress syndrome). Alle 30 raskausviikon iässä syntyneistä, useimmiten RDS-taudin saaneista keskosista n. 30 % sairastuu vakavaan krooniseen keuhkotautiin, BPD-tautiin (bronchopulmonary dysplasia). Surfaktanttiproteiineilla SP-A, -B, -C ja -D on osoitettu olevan tärkeä tehtävä surfaktantin toiminnassa ja keuhkon synnynnäisessä immuniteetissa. Tämän tutkimuksen tavoitteena oli selvittää surfaktanttiproteiineissa esiintyvän geneettisen muuntelun määrää ja merkitystä keskosten RDS- ja BPD-taudeissa sekä pienten lasten vakavassa respiratory syncytial -viruksen (RSV) aiheuttamassa keuhkotulehduksessa. Tutkimuksen laajin osa keskittyi tutkimaan keskosten BPD-tautia ja surfaktanttiproteiinien geenien osuutta siinä. Geneettisen muuntelun merkitystä tarkasteltiin populaatiogeneettisin keinoin tapaus-verrokkiasetelmissa ja perheaineistojen avulla. Yhteensä analysoitiin noin tuhannen lapsen ja yli kahdensadan vanhemman DNA-näytteet. Tutkimuksessa havaittiin SP-D-geenissä olevan metioniini11-geenimuodon liittyvän pienten lasten vakavaan RSV-infektioon. Lisäksi saatiin uutta tietoa SP-C-geenin populaatiotason yleisestä muuntelusta ja todettiin SP-C:n asparagiini138 ja asparagiini186 -geenimuotojen yhteys keskosten RDS-taudin esiintymiseen. Merkittävin löydös oli SP-B-geenissä olevan deleetiovariantin kytkeytyminen alle 32-viikkoisina syntyneiden keskosten BPD-tautiin. Geneettisen altistuksen lisäksi BPD-tautiin sairastumiseen vaikuttivat lukuisat keskosuudelle ominaiset seikat, kuten alhainen syntymäpaino, RDS-tauti ja syntymähetkellä todettu hapenpuute. Geneettisen tekijän vaikutus oli voimakkain erittäin pienipainoisilla keskosilla. Tutkimuksen tulokset ovat tuoneet arvokasta lisätietoa surfaktanttiproteiinien geenien osuudesta keskosten RDS- ja BPD-taudeissa sekä pienten lasten vakavassa RSV-infektiossa. Ne auttavat ymmärtämään näiden molekyylibiologisia syntymekanismeja ja voivat ajan mittaan olla edistämässä uusien hoitomuotojen kehittämistä.

Les fluorocarbures ont un fort potentiel en médecine. Cependant, et en dépit du fait que certaines formulations employant des fluorocarbures sont utilisées en clinique, il n’existe que relativement peu d’études visant à déterminer les interactions entre un fluorocarbure et une membrane de phospholipides. Notre étude concentre à l’interface fluorocarbure/phospholipide, qui représente d’une part un modèle simplifié du surfactant pulmonaire natif dont le composant majoritaire est la dipalmitoylphosphatiylcholine (DPPC), et d’autre part la paroi de microbulles développées comme nouveaux agents théranostiques.Tout d’abord, nous montrons que les fluorocarbures abaissent considérablement la tension interfaciale d’équilibre d’une série de phospholipides et accélèrent fortement leur adsorption. Nous montrons que des oscillations périodiques appliquées à la bulle induisent une transition du film de DPPC vers un état d’organisation plus dense. L’application d’oscillations périodiques permet aussi à la DPPC d’expulser du film interfacial une protéine, l’albumine, dont la présence est souvent liée aux troubles dus au mauvais fonctionnement du surfactant pulmonaire. L’effet des fluorocarbures, qui accélère considérablement l’expulsion de l’albumine par la DPPC, est également étudié. D’autre part, nous avons obtenu des microbulles exceptionnellement stables grâce à une série homologue de phosphates perfluoroalkylés. Nous avons également réussi à former des microbulles couvertes par des nanoparticules magnétiques, tout en gardant les propriétés échogènes des bulles. De telles microbulles offrent un potentiel comme des agents de contraste bimodaux pour l’IRM et l’échosonographie. / Fluorocarbons have a great potential in medicine. However, and despite the fact that some formulations using fluorocarbons are used clinically, only a few studies are reported that aim to determining the interactions between a fluorocarbon and a membrane of phospholipids. Our work concentrated on the fluorocarbon/phospholipid interface, which represents, on one hand, a simplified model of the lung surfactant, the major component of which is dipalmitoylphosphatiylcholine (DPPC), and on the other hand, the shell of microbubbles developed as new theranostic agents. In a first part, we show that fluorocarbons significantly reduce the equilibrium interfacial tension of a series of phospholipids and greatly accelerate their adsorption rate. We also show that periodical oscillations applied to the bubble induce a transition of DPPC film to state with a denser organization. The application of periodical oscillations also allows DPPC to expel from the interfacial film a protein, albumin, whose presence is often associated with disorders caused by dysfunction of the lung surfactant. The impact of fluorocarbons, which considerably accelerate the expulsion from the interfacial film of albumin, is also studied. In a second part, we have obtained exceptionally stable microbubbles with a homologous series of perfluoroalkylated phosphates. We were also able to form microbubbles covered by magnetic nanoparticles, while preserving the echogenicity of the bubbles. Such microbubbles offer a potential as bimodal contrast agents for MRI and echography.

Made available in DSpace on 2014-07-29T15:16:38Z (GMT). No. of bitstreams: 1 Dissertacao Deyze Alencar Soares.pdf: 632456 bytes, checksum: 33012995df8eabb3f4b7509fe372764d (MD5) Previous issue date: 2010-03-26 / Paracoccidioides brasiliensis, a thermodimorphic fungus, is the causative agent of the most prevalent systemic mycosis in Latin America, paracoccidioidomycosis. The phospholipase B (PLB) enzyme is considered an important virulence factor in this dimorphic fungus, involved in the immune response of the host-pathogen interaction. Our objective was to determine whether a P. brasiliensis (Pb18) PLB is involved in adhesion / internalization of yeast and evasion of host immune responses. The effect of PLB was analysed using specific inhibition of PLB (alexidine dihydrochloride) and pulmonary surfactant in an ex vivo model (Pb18) of alveolar macrophage (MHS cells) infection. PLB enzyme assays and real time RT-PCR (qRTPCR) analysis of genes differentially expressed in the process of evasion: plb1 (phospholipase B1), icl1 (isocitrate lyase) and sod3 (Cu, Zn dismutase) and immune responses: clec2 (C-type lectin domain 2), cd14 (cluster of differentiation 14), tlr2 (toll-like receptor 2), nfkb (nuclear factor kappa B), nkrf (NF-kappaB repressing factor), il1&#946; (inteleukin-1&#946;) and tnf&#945; (tumor necrosis factor alpha) were carried out using selective inhibition of PLB activity and pulmonary surfactant. The levels of cytokines inteleukin 10 (IL-10), IL-12 and TNF-&#945;) were also determined by ELISA. PLB activity under adhesion conditions of P. brasiliensis (Pb18) to alveolar macrophage cells was found at high levels up to 6 hours post-infection. In the conditions of exposure to pulmonary surfactant and alexidine dihydrochloride, PLB activity and the level of transcripts of genes related to phagocytosis and inflammatory response were measured. We found that PLB activity had an influence on the phagocytic activity of alveolar macrophages. Alexidine dihydrochloride (0,25 &#956;M) selectively inhibited PLB activity by 66% and decreased significantly the adhesion and internalization of yeast on MHS cells. Genes involved in phagocytosis (trl2 and cd14) and inflammatory response (nrkf, tnf&#945; and il1&#946;) were down-regulated in the presence of the PLB inhibitor. In contrast, the PLB activity and internalization of fungal yeast cells increased significantly in the presence of pulmonary surfactant (100 &#956;g/mL) and genes such as clec2, important for effective phagocytosis by MHS cells, and the pro-inflammatory inhibitor (nkrf) were up-regulated. Also, the pulmonary surfactant did not alter cytokine production, while alexidine dihydrochloride decreased the levels of IL-10 and increased the levels of IL-12 and TNF-&#945;. In addition, through simultaneous analyses of gene expression for the pathogen, P. brasiliensis, we found upregulation of the genes sod3, icl1 and plb1, required for the evasion of alveolar macrophages. P. brasiliensis PLB is important for the binding and internalization of yeast at macrophage surfaces. The specific effect of inhibiting PLB enzyme activity indicates that adhesion may be facilitated indirectly via fatty acid release from phospholipids of the membrane of host cells. This is the first study to show that PLB activity may modulate immune responses to P. brasiliensis infection. / Paracoccidioides brasiliensis, fungo dimórfico, é o agente etiológico principal micose sistêmica da América Latina, paracoccidioidomicose. A enzima fosfolipase B (PLB) é considerada um importante fator de virulência nesse fungo dimórfico e está envolvida na resposta imune da interação patógeno-hospedeiro. Nosso objetivo foi determinar se a PLB de P. brasiliensis (Pb18) está envolvida na adesão e internalização de leveduras e na evasão da resposta imune hospedeira. O efeito da PLB foi analisado usando o inibidor seletivo de PLB (alexidine dihydrochloride) e o surfactante pulmonar (Survanta) em um modelo ex vivo de infecção de macrófagos alveolares (MHS) com Pb18. Ensaio enzimático de PLB e análise de genes diferencialmente expressos por RT-PCR em tempo real (qRT-PCR) no processo de evasão: plb1 (fosfolipase B1), icl1 (isocitrato liase) e sod3 (Cu, Zn dismutase); e na resposta imune: clec2 (lecitina tipo-C 2), cd14 (cluster de diferenciação 14), tlr2 (receptor toll-like 2), nfkb (fator nuclear kappaB), nkrf (repressor fator nuclear kappaB), il1&#946; (interleucina- 1 beta) e tnf&#945; (fator de necrose tumoral alfa) foram realizados usando o inibidor seletivo da atividade de PLB e surfactante pulmonar. Os níveis de citocinas interleucina 10 (IL-10), IL-12 e TNF- &#945;) foram determinados por ELISA. A atividade de PLB usadas em baixas condições para a adesão de P. brasiliensis (Pb18) obteve altos níveis em 6 horas pós-infecção. Na presença do surfactante pulmonar e alexidine dihydrochloride, a atividade da PLB e os níveis de transcritos dos genes relacionados à fagocitose e à resposta inflamatória foram quantificados. A PLB teve influência na atividade fagocítica dos macrófagos. Alexidine dihydrochloride (0,25 &#956;M) inibiu seletivamente a atividade PLB em 66% e diminuiu significativamente a adesão e internalização de leveduras por macrófagos alveolares (MHS). Genes envolvidos na fagocitose (trl2 e cd14) e resposta inflamatória (nrkf, tnf&#945; e il1&#946;) foram reprimidos na presença do inibidor de PLB. Em contraste, a atividade PLB e internalização de leveduras aumentou significativamente na presença do surfactante pulmonar (100 &#956;g/mL) e genes assim como clec2, importante para uma fagocitose efetiva pelos macrófagos alveolares (MHS), e o inibidor pró-inflamatório (nkrf) foram induzidos. Entretanto, o surfactante pulmonar não alterou a produção de citocinas, enquanto que alexidine dihydrochloride diminuiu os níveis de IL-10 e aumentou os níveis de IL-12 e TNF-&#945;. Em adição, nas análises simultâneas de expressão de genes, P. brasiliensis, houve indução dos genes sod3, icl1 e plb1, requeridos para a evasão dos macrófagos alveolares. A PLB de P. brasiliensis é importante na adesão e internalização de leveduras pelos macrófagos alveolares. O efeito específico da inibição da atividade da PLB indica que a adesão pode ser facilitada indiretamente via liberação de ácidos graxos dos fosfolipídeos de membrana das células hospedeiras. Esse é o primeiro estudo mostrando que a atividade da PLB pode modular a resposta imune à infecção pelo P. brasiliensis.