O tratamento da Doença de Hodgkin (DH) tem tido sucesso crescente nos últimos anos. Considerando que a taxa atual de cura situa-se ao redor de 85%, o desafio dos protocolos da DH agora é reduzir a agressividade do tratamento e suas conseqüentes toxicidades agudas e crônicas, sem prejuízo dos resultados oncológicos. O protocolo DH-II-90 foi desenhado com estes propósitos para o tratamento de crianças e adolescentes com DH. O protocolo consiste em três ciclos de ABVD (adriamicina, bleomicina, vinblastina e dacarbazina) e radioterapia em campo envolvido para pacientes de baixo risco, e acrescentando três ciclos de MOP (oncocloramin, vincristina e prednisona) ou COP (substituindo oncocloramin por ciclofosfamida) à quimioterapia e radioterapia em campo estendido para pacientes de alto risco. Objetivos: Este estudo visa: 1) avaliar as taxas de sobrevida global, livre de doença e livre de eventos do protocolo DH-II-90, 2) avaliar as taxas de sobrevida global e livre de eventos de acordo com o estádio, idade, presença de tumor bulky, massa mediastinal, sintomas B, dose e tipo de radioterapia e 3) descrever os efeitos tardios relatados em prontuário. Casuística e Métodos:Trata-se de um estudo retrospectivo por análise de prontuário de pacientes entre 0 e 21 anos portadores de DH, admitidos no serviço de Oncologia do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 1990 e 2005 e que foram tratados de acordo com o protocolo DH-II-90. Foram construídas curvas de sobrevida global, livre de doença e livre de eventos pelo método de Kaplan-Meier e realizada análise com a regressão de Cox. Foi utilizado um nível de significância de 5% (p< 0,05). Foram analisadas as características clínicas e laboratoriais dos pacientes, completando um perfil desta neoplasia em 15 anos de experiência. Resultados: A taxa de remissão completa após a quimioterapia foi de 94,1% para todo o grupo, sendo 97,3% para baixo risco e 90% para alto risco. A sobrevida global em 10 anos foi de 96% para o grupo de baixo risco e 93% para o alto risco. A sobrevida livre de doença foi 90% após 5 anos, sendo o grupo de alto risco pior quando comparado com o baixo risco, 87% e 92% respectivamente, porém não estatisticamente significante (p: 0,468). A sobrevida livre de eventos foi de 90% em 5 anos, sendo as curvas semelhantes para alto e baixo risco (p: 0,969). Foi observada diferença quando comparadas as curvas de sobrevida livre de eventos por presença ou ausência de massa mediastinal (p: 0,020) e dose de radioterapia utilizada (maior ou menor que 2100 cGy) (p: 0,014). Dentre os efeitos tardios, o mais freqüente foi disfunção da glândula tireóide, havendo 2 casos de carcinoma de tireóide como segunda neoplasia. Conclusão: O protocolo DH-II-90 é eficaz, sendo que a presença de massa mediastinal e doses de radioterapia maiores que 2100 cGy apresentam impacto negativo na sobrevida livre de eventos, e anormalidades da tireóide são seqüelas freqüentes neste grupo de pacientes. / The treatment of Hodgkin´s disease (HD) has been increasingly successful lately. Since today cure rates are about 85%, the challenge of new protocols for treatment of HD is to decrease its aggressiveness and consequent acute and late toxicity, without impairing results. The protocol DH-II-90 was designed to treat children and adolescents with HD. It consists of three cycles of ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) and involved-field radiotherapy for low risk patients, and incremented with three cycles of MOP (mechlorethamine, vincristine and prednisone) or COP (replacing mechlorethamine by cyclophosfamide) and extended field radiotherapy for high risk patients. Objectives: the purposes of this study are 1) to assess the overall, disease free and event free survival of the protocol DH-II-90, 2) to assess the overall and event free survival by stage, age, presence of bulky disease, mediastinal mass, B symptoms, dose and type of radiotherapy, and 3) to describe late effects data collected from the patients´charts. Methods: This is a retrospective study to assess archive of patients with HD, with 0 to 21 years old, admitted to the pediatric oncology service of the Instituto da Criança da FMUSP diagnosed between 1990 and 2005 and treated with the protocol DH-II-90. Overall, disease free and event free survival curves were developed by the Kaplan-Meier method and analyzed with the Cox regression. A significant level of 5% (p< 0.05) was employed. The clinical and laboratorial data of these patients are described, completing a profile of 15 year of experience. Results: The complete response rate after chemotherapy was 94.1% for all the group, 97.3% for the low risk patients and 90% for the high risk patients. The overall survival in 10 years was 96% for the low risk group and 93% for the high risk group. The 5- years disease free survival was 90%. Disease free survival for high risk patients was worse than low risk group (87% and 92% respectively), but it was not statistically significant (p: 0.486). The 5-year event free survival was 90%, with similar curves for low and high risk patients (p: 0.969). The presence of mediastinal mass and more than 2100 cGy radiation doses had negative impact on event free survival (p= 0.020 and p= 0.014 respectively). Thyroid gland dysfunction was the most frequent late effect described, with two cases of thyroid carcinoma as a secondary neoplasia. Conclusions: The DH-II-90 protocol is effective , while the presence of mediastinal mass and radiation dose over 2100 cGy have a negative impact on event free survival. Thyroid abnormalities are the most frequent late effects in this group of patients.

O tratamento da Doença de Hodgkin (DH) tem tido sucesso crescente nos últimos anos. Considerando que a taxa atual de cura situa-se ao redor de 85%, o desafio dos protocolos da DH agora é reduzir a agressividade do tratamento e suas conseqüentes toxicidades agudas e crônicas, sem prejuízo dos resultados oncológicos. O protocolo DH-II-90 foi desenhado com estes propósitos para o tratamento de crianças e adolescentes com DH. O protocolo consiste em três ciclos de ABVD (adriamicina, bleomicina, vinblastina e dacarbazina) e radioterapia em campo envolvido para pacientes de baixo risco, e acrescentando três ciclos de MOP (oncocloramin, vincristina e prednisona) ou COP (substituindo oncocloramin por ciclofosfamida) à quimioterapia e radioterapia em campo estendido para pacientes de alto risco. Objetivos: Este estudo visa: 1) avaliar as taxas de sobrevida global, livre de doença e livre de eventos do protocolo DH-II-90, 2) avaliar as taxas de sobrevida global e livre de eventos de acordo com o estádio, idade, presença de tumor bulky, massa mediastinal, sintomas B, dose e tipo de radioterapia e 3) descrever os efeitos tardios relatados em prontuário. Casuística e Métodos:Trata-se de um estudo retrospectivo por análise de prontuário de pacientes entre 0 e 21 anos portadores de DH, admitidos no serviço de Oncologia do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 1990 e 2005 e que foram tratados de acordo com o protocolo DH-II-90. Foram construídas curvas de sobrevida global, livre de doença e livre de eventos pelo método de Kaplan-Meier e realizada análise com a regressão de Cox. Foi utilizado um nível de significância de 5% (p< 0,05). Foram analisadas as características clínicas e laboratoriais dos pacientes, completando um perfil desta neoplasia em 15 anos de experiência. Resultados: A taxa de remissão completa após a quimioterapia foi de 94,1% para todo o grupo, sendo 97,3% para baixo risco e 90% para alto risco. A sobrevida global em 10 anos foi de 96% para o grupo de baixo risco e 93% para o alto risco. A sobrevida livre de doença foi 90% após 5 anos, sendo o grupo de alto risco pior quando comparado com o baixo risco, 87% e 92% respectivamente, porém não estatisticamente significante (p: 0,468). A sobrevida livre de eventos foi de 90% em 5 anos, sendo as curvas semelhantes para alto e baixo risco (p: 0,969). Foi observada diferença quando comparadas as curvas de sobrevida livre de eventos por presença ou ausência de massa mediastinal (p: 0,020) e dose de radioterapia utilizada (maior ou menor que 2100 cGy) (p: 0,014). Dentre os efeitos tardios, o mais freqüente foi disfunção da glândula tireóide, havendo 2 casos de carcinoma de tireóide como segunda neoplasia. Conclusão: O protocolo DH-II-90 é eficaz, sendo que a presença de massa mediastinal e doses de radioterapia maiores que 2100 cGy apresentam impacto negativo na sobrevida livre de eventos, e anormalidades da tireóide são seqüelas freqüentes neste grupo de pacientes. / The treatment of Hodgkin´s disease (HD) has been increasingly successful lately. Since today cure rates are about 85%, the challenge of new protocols for treatment of HD is to decrease its aggressiveness and consequent acute and late toxicity, without impairing results. The protocol DH-II-90 was designed to treat children and adolescents with HD. It consists of three cycles of ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) and involved-field radiotherapy for low risk patients, and incremented with three cycles of MOP (mechlorethamine, vincristine and prednisone) or COP (replacing mechlorethamine by cyclophosfamide) and extended field radiotherapy for high risk patients. Objectives: the purposes of this study are 1) to assess the overall, disease free and event free survival of the protocol DH-II-90, 2) to assess the overall and event free survival by stage, age, presence of bulky disease, mediastinal mass, B symptoms, dose and type of radiotherapy, and 3) to describe late effects data collected from the patients´charts. Methods: This is a retrospective study to assess archive of patients with HD, with 0 to 21 years old, admitted to the pediatric oncology service of the Instituto da Criança da FMUSP diagnosed between 1990 and 2005 and treated with the protocol DH-II-90. Overall, disease free and event free survival curves were developed by the Kaplan-Meier method and analyzed with the Cox regression. A significant level of 5% (p< 0.05) was employed. The clinical and laboratorial data of these patients are described, completing a profile of 15 year of experience. Results: The complete response rate after chemotherapy was 94.1% for all the group, 97.3% for the low risk patients and 90% for the high risk patients. The overall survival in 10 years was 96% for the low risk group and 93% for the high risk group. The 5- years disease free survival was 90%. Disease free survival for high risk patients was worse than low risk group (87% and 92% respectively), but it was not statistically significant (p: 0.486). The 5-year event free survival was 90%, with similar curves for low and high risk patients (p: 0.969). The presence of mediastinal mass and more than 2100 cGy radiation doses had negative impact on event free survival (p= 0.020 and p= 0.014 respectively). Thyroid gland dysfunction was the most frequent late effect described, with two cases of thyroid carcinoma as a secondary neoplasia. Conclusions: The DH-II-90 protocol is effective , while the presence of mediastinal mass and radiation dose over 2100 cGy have a negative impact on event free survival. Thyroid abnormalities are the most frequent late effects in this group of patients.

Made available in DSpace on 2016-04-27T18:12:20Z (GMT). No. of bitstreams: 1 Janayne C Barbosa.pdf: 1776822 bytes, checksum: 9cd09ab8c59e74a7cec3326c857d9bf6 (MD5) Previous issue date: 2007-02-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: Hansen s Disease, an infectious illness of compulsory notification is caused by Hansen s bacillus (Mycobacterium leprae), and may present multiple lesions on any body part, most frequently harming the face, ears, nose and the oral cavity. Aim: The aim of the present study is to evaluate, by means of the patients history and Speech Therapy evaluation, the auditory (auditory thresholds), vocal (vocal characteristics and maximum phonation times), and oral-facial functions (chewing, breathing, swallowing and speech) manifestations in Hansen s Disease patients of a public health center of the city of São Paulo/SP. Methods: The subjects of this study were 20 Hansen s Disease patients, between 18 and 45 years of age. Specific protocols were filled out for each patient. These protocols targeted the subjects auditory, vocal, and oral-facial functions history. Then, these aspects were evaluated through specific Speech Therapy evaluation methods. The results were described numerically and by percentages. Results: Considering the subjects who took part in this study (55% female and 45% mal), 45% had paucibacillary (PB) and 55% multibacillary (MB) Hansen s disease, and all were receiving treatment (MDT/monotherapy). Five subjects complained of auditory changes, three of vocal changes and two of altered oral-facial functions. Discussion:Case description may aid the speech therapist and other members of the multidisciplinary team to better understand the Disease, and its possible speech therapeutic manifestations; as well as to create various hypothesis and to clinically evaluate and design adequate treatment for these patients. Conclusion: The speech therapeutic manifestations observed were few, and it was not possible to establish that the occurrences of the observed alterations were related to Hansen s Disease. This fact may be justified by the patients adequate usage of medication, as well as by the short time-span between diagnosis and the beginning of treatment, and to the age-span considered in this research (18 to 45 years) / Introdução: A Hanseníase, doença crônica infecto-contagiosa e de notificação compulsória, é causada pelo bacilo de Hansen (Mycobacterium leprae), e pode apresentar múltiplas lesões em qualquer local do corpo, com maior freqüência na face, orelhas, nariz e cavidade oral. Objetivo: O objetivo do presente estudo é avaliar, por meio de levantamento do histórico e avaliação fonoaudiológica, as manifestações referentes à audição (limiares auditivos), voz (características vocais e tempos de fonação) e funções orofaciais (mastigação, respiração, deglutição, fala) em doentes de Hanseníase de um centro de atendimento do município de São Paulo/SP. Método: Fizeram parte deste estudo, 20 sujeitos acometidos pela Hanseníase, na faixa etária compreendida entre 18 a 45 anos. Foram aplicados protocolos para levantamento de histórico audiológico, vocal e das funções orais, e em seguida foi realizada uma avaliação fonoaudiológica desses aspectos. Os resultados foram descritos em número e percentual. Resultados: Dos pacientes pesquisados (55% mulheres e 45% homens), 45% eram do tipo paucibacilares (PB) e 55% multibacilares (MB), todos em tratamento (PQT/monoterapia). Dentre as alterações, cinco dos participantes se queixaram de alteração auditiva, três de alteração vocal e dois de alterações orofaciais, todos constatados em avaliação fonoaudiológica. Discussão: A descrição dos casos pode auxiliar o fonoaudiólogo, e os demais integrantes de equipe multidisciplinar, a entender melhor a doença e as possíveis manifestações fonoaudiológicas e, na presença de possíveis doentes, levantar hipóteses e realizar avaliação e tratamento adequados. Conclusão: as manifestações de característica fonoaudiológica foram registradas em número reduzido e não foi possível estabelecer que a ocorrência destas esteja diretamente relacionada à Hanseníase. Tal fato pode ser justificado pelo uso adequado do medicamento, por parte dos participantes, assim como o curto espaço de tempo entre o diagnóstico e o início do tratamento e a faixa etária pesquisada (18 a 45 anos)

ZIEL Als Ursache für die sporadische Creutzfeldt-Jakob Krankheit wird eine spontane Konfigurationsänderung des Prionproteins diskutiert. Die Annahme der Beeinflussung fehlgefaltete Proteinketten, welche bei neurodegenerativen Erkrankungen wie der Alzheimer Demenz oder Parkinson vorliegen, auf die Entwicklung einer zweiten Proteinfehlfaltung stellen eine mögliche Verbindung zwischen dem Auftreten neurodegenerativer Erkrankungen und Prionerkrankungen her. Das Ziel dieser retrospektiven Untersuchung ist es, die klinischen und diagnostischen Eigenschaften von sCJD-Patienten mit Morbus Parkinson oder Demenz in der Familienanamnese zu analysieren um die Diagnostik verbessern zu können. METHODEN Für die vorliegende Arbeit wurde ein Kollektiv aus 133 Patienten mit sicherer oder wahrscheinliche sCJD mit bekannter Ausprägung am Codon-129 rekrutiert. Bei den Geschwistern, den Eltern oder den Großeltern mütterlicher- oder väterlicherseits lag ein Parkinsonsyndrom oder eine dementielle Erkrankung vor. Gegenüber gestellt wurde diesem eine Kontrollgruppe nach Zuordnung nach Geschlecht, Alter (+/- 5 Jahre) sowie PRnP-Codon 129-Genotyp. Der Schwerpunkt der Arbeit liegt auf der klinischen Symptomatik, den Liquorparametern und den Ergebnissen aus bildgebenden Verfahren wie Elektroenzephalographie, zerebraler Computertomographie und Magnetresonanztomographie. ERGEBNISSE Erstes neurologisches Symptom waren zerebelläre Störungen (Ataxie), psychiatrische und visuelle Störungen, während eine dementielle Entwicklung erst im Verlauf hinzutrat. Beim Fortschreiten der Erkrankung wurden Pyramidenbahnzeichen häufiger und extrapyramidale Störungen deutlich seltener diagnostiziert. Insgesamt fiel vom klinischen Erscheinungsbild häufiger die Gruppe FA-Parkinson auf (beispielsweise häufiges Vorkommen von Antriebsstörungen), während FA-Demenz meist der Kontrollgruppe glich. Mit dem Nachweis von PSWC im EEG in 53 % bei FA-Demenz und 61 % bei FA-Parkinson übertrifft die Sensitivität der EEG-Untersuchung nicht die für die sCJD geltende von 64 % (Steinhoff et al. 2004). Mit einem Nachweis der Proteine 14-3-3 im Liquor in 96 % (FA-Demenz) und 100 % (FA-Parkinson) ergibt sich eine ebenso hohe Sensitivität wie für die sCJD bereits postuliert (94 %, Zerr et al. 2000a). Auch die Sensitivität der NSE ist bei den Patienten dieser Arbeit sehr hoch, während der Liquormarker S100b-Protein bei FA-Parkinson-Patienten deutlich seltener den cut-off-Wert erreicht. Ein CJD-typischer MRT-Befund (hyperintense Basalganglien oder kortikale Signalsteigerung) wurde nur in 52 % bei FA-Demenz und bei 49 % bei FA-Parkinson festgestellt. SCHLUSSFOLGERUNG Schließlich lässt sich festhalten, dass bei diesen Patienten nicht vorwiegend eine Demenz wegweisend zur Diagnose ist, sondern auf das Vorliegen zerebellärer oder psychiatrischer Symptome geachtet werden muss. In der Diagnostik kommt dem EEG mit einer hohen Sensitivität eine große Bedeutung zu, während die MRTUntersuchung weniger wegweisend ist. Bei Morbus Parkinson in der Familie unterstützt die Liquoruntersuchung die Diagnostik nicht so stark, während gerade pathologische Werte des Tau-Proteins und des Amyloid-ß 1-42 bei Patienten mit Demenz in der Familie auf eine sCJD hindeuten.

The brain of Alzheimer???s disease (AD) is characterized by accumulations of ??-amyloid peptide aggregates which promote neurodegentartive dysfunction. Comprehensive understanding of the interaction between ??-amyloid aggregates and acetylcholine (ACh) neurocycle is required to uncover the physiological processes related to AD and might result in improving therapeutic approaches for AD. Pharmacokinetics (PK) and pharmacodynamics (PD) techniques were applied to allow predicting the extent of the interaction of certain doses of AD drugs and ??-amyloid inhibitors and levels of ACh as well. Although many researchers focused on the ??-amyloid interactions, the mechanisms by which ??-amyloid affects cholinergic neurons and reduction of ACh are still unclear. The prediction of ACh and drug concentrations in the tissues and body needs an understanding of the physiology and mechanisms of ??-amyloid aggregates processes and their compilation into a mechanistic model In this work, two hypotheses are proposed to investigate the dynamic behavior of the interaction between ??-amyloid peptide aggregates and cholinergic neurocycle and the possible therapeutic approaches through proposing pharmacokinetic/pharmacodynamics (PK/PD) models to represent the impact of ??-amyloid aggregates in AD. The effect of ??-amyloid peptide aggregates is formulated through incorporating ??- amyloid aggregates into non-linear model for the neurocycle of ACh where the presynaptic neuron is considered as compartment 1 and both synaptic cleft and postsynaptic neurons are considered as compartment 2. In the first hypothesis which is choline leakage hypothesis, ??-amyloid peptide aggregates are considered to be located in the membrane of the presynaptic neuron and create pathways inside the membrane to allow for the intracellular choline to leak outside the cholinergic system. It is observed that ??-amyloid aggregates via the choline leakage hypothesis could cause significant reductions of ACh and choline levels in both compartments. Furthermore, the process rates of ACh synthesis and hydrolysis have been affected negatively by a wide range of ??-amyloid aggregate concentrations. It is found that as the input rate of ??-amyloid aggregates to compartment 1 increases, the loss of choline from compartment 1 increases leading to an increase in the intracellular concentration of ??-amyloid. In the second hypothesis, ??-amyloid peptide aggregates are proposed to interact with the enzyme ChAT which is responsible for the synthesis of ACh in compartment 1; three different kinetic mechanisms are suggested to account for the interaction between ??-amyloid aggregates and ChAT activity. In the first and second kinetic mechanisms, ??-amyloid aggregate is supposed to attack different species in the enzyme. It is found that there is a significant decrease in the rate of ACh synthesis in compartment 1 and ACh concentrations in both compartments. However, it is observed that there is no effect on choline levels in both compartments, the rate of ACh hydrolysis in compartment 2, pH, and ACh levels in compartment 2. In the third kinetic mechanism, all species in ChAT are attacked by ??-amyloid aggregates; it is observed that at very high input rates of ??-amyloid aggregates, the oscillatory behavior dominates all components of the neurocycle of ACh. The disturbance observed in ACh levels in both compartments explains the harmful effect of the full attack of ??-amyloid aggregates to all species of ChAT. It is found that to contribute significantly in ACh neurocycle, choline leakage hypothesis needs concentration of ??-amyloid aggregates lower than that needed in ChAT activity hypothesis which is in agreement with experimental observations. The significant decrease in ACh levels observed in both choline leakage and loss of ChAT activity hypotheses leads to cognitive loss and memory impairment which were observed in individuals with AD. A one-compartment drug PK/PD model is proposed to investigate a therapeutic approach for inhibiting ??-amyloid aggregation via choline leakage hypothesis where the maximum feed rate of ??-amyloid (KL2 = 1) is considered. The drug is assumed to interact with the tissues of the presynaptic neurons where ??-amyloid aggregates are located. The PK/PD model is built based on the effect of ??-amyloid aggregates via choline leakage hypothesis where the maximum feed rate of ??-amyloid aggregates is considered. The dynamic behavior of all concentrations of ??-amyloid aggregates, choline, ACh, acetate, and pH in both compartments in addition to the rate of ACh synthesis in compartment 1 and ACh hydrolysis are investigated by monitoring the impacts of the drug on ??-amyloid aggregates and cholinergic neurocycle over a wide range of the input drug dosage. The PK/PD model is able to predict the reduction in levels of ??-amyloid aggregates and the increase in choline and ACh, in both compartments as well as both rates of ACh synthesis and hydrolysis catalyzed. The parameters of the PK/PD model such as maximum concentration (Cmax), maximum time (Tmax), area under the curve (AUC), and maximum effect (Emax) were investigated. It was found that it takes a longer time (Tmax) (3-5 h) to reach Emax as the drug dose increases. Furthermore, AUC was found to increase with increasing drug dosage. The results of the current work show that drugs / therapeutic agents inhibiting ??- amyloid aggregation in the brain represent a likely successful therapeutic approach to give systematic highlights to develop future trials, new diagnostic techniques, and medications for AD. This study is helpful in designing PK and PD and developing experimental animal models to support AD drug development and therapy in the future.

Defects in intracellular transport are implicated in the pathogenesis of Alzheimer’s disease (AD). Hook proteins are a family of cytoplasmic linker proteins that participate in endosomal transport. In this study we show that Hook1 and Hook3 are expressed in neurons while Hook2 is predominantly expressed in astrocytes. Furthermore, Hook proteins are associated with pathological hallmarks in AD; Hook1 and Hook3 are localized to tau aggregates and Hook2 to glial components within amyloid plaques. Additionally, the expression of Hook3 is reduced in AD. Modelling of Hook3 deficiency in cultured cells leads to slowing of endosomal transport and increases β-amyloid production. We propose that Hook3 plays a role in pathogenic events exacerbating AD.

No description available.

The protein alpha-synuclein (α-synuclein) accumulates in the brain in disorders such as Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). It is believed that the monomeric form of α-synuclein can adopt a partially folded structure and start to aggregate and form intermediately sized oligomers or protofibrils. The aggregation process can continue with the formation of insoluble fibrils, which are deposited as Lewy bodies. The oligomers/protofibrils have been shown to be toxic to neurons and are therefore believed to be involved in the pathogenesis of the actual diseases.       The overall aims of this thesis were to investigate the properties of α-synuclein oligomers and to generate and characterize antibodies against these species. In addition, the potential for immunotherapy of the α-synuclein oligomer-selective antibodies were evaluated in a transgenic mouse model with α-synuclein pathology. Stable, β-sheet rich α-synuclein oligomers were induced by incubation with either one of the reactive aldehydes 4-hydroxy-2-nonenal (HNE) and 4-oxo-2-nonenal (ONE). The oligomers exhibited distinct morphological properties, although both types were toxic when added to a neuroblastoma cell line. The seeding effects of ONE-induced oligomers were studied in vitro and in vivo. The oligomers induced seeding of monomeric α-synuclein in a fibrillization assay but not in a cell model or when injected intracerebrally in transgenic mice. It seemed, however, as if the oligomers affected α-synuclein turnover in the cell model. By immunizing mice with HNE-induced oligomers antibody producing hybridomas were generated. Three monoclonal antibodies were found to have strong selectivity for α-synuclein oligomers. These antibodies recognized Lewy body pathology in brains from patients with PD and DLB as well as inclusions in the brain from young α-synuclein transgenic mice, but did not bind to other amyloidogenic proteins. Finally, immunotherapy with one of the oligomer/protofibril selective antibodies resulted in lower levels of such α-synuclein species in the spinal cord of α-synuclein transgenic mice. To conclude, this thesis has focused on characterizing properties of α-synuclein oligomers. In particular, antibodies selectively targeting such neurotoxic forms were generated and evaluated for passive immunization in a transgenic mouse model. Such immunotherapy may represent a future treatment strategy against Lewy body disorders.

No description available.

Alzheimers sjukdom ökar stadigt och beräknas ha stigit till det dubbla år 2050. När en närstående drabbas utav Alzheimers sjukdom förändras även livet för den anhörige. Som sjuksköterska är det av stor vikt att ha kännedom om det för att på bästa sätt ge den anhörige den information och det stöd som behövs. Att involvera den anhörige i den sjukes vård är av stor vikt för att få en så optimal vård som möjligt. Syftet var att belysa anhörigas upplevesle av att leva med en person med Alzheimers sjukdom. Studien genomfördes som en litteraturstudie där tio vetenskapliga artiklar kvalitetsgranskades, analyserades och kodades. Kodningen resulterade i sex olika kategorier. Resultatet visar på att den anhöriges liv vänds upp och ner när en närstående drabbas utav Alzheimers sjukdom. Behovet av information gällande Alzheimers sjukdom och stöd i form av olika vårdinsatser under hela sjukdomsprocessen är stort. Sjuksköterskan efterlyser fler verktyg och mer kunskap om Alzheimers sjukdom för att kunna ge en optimal vård. Det här styrktes av att de anhöriga kände sig dåligt förberedda på att ge vård på grund av kunskapsbristen. / Alzheimer´s disease is growing steadily and is expected to have risen to the double by 2050. When a loved one is affected by Alzheimer´s disease it also changes the lives of the relative. As a nurse, it is very important to be aware of this to be able to give the relative information and the necessary support in the best way. Involving the relative in the care of the loved one´s health is very important to get as optimal care possible. The aim was to highlight the relative`s experience of living with a person with Alzheimers´s disease. The study was conducted as a literature review of ten scientific articles, the articles were reviewed, analyzed and coded. The coding resulted i six different categories. The results show that the relative´s life is turned up side down when a loved one is suffering from Alzheimer´s disease. The need of information about Alzheimer´s diease and support of various health care initiatives throughout the disease process is big. The nurse calls for more tools and more knowledge about Alzheimer´s disease in order to provide optimal care. This was strengthened when the relatives felt ill-prepared to provide care because the lack of knowledge.