INTRODUÇÃO: O câncer de ovário é o mais letal de todos os cânceres ginecológicos e requer ser tratado por ginecologistas especializados em centros terciários para se obter melhor prognóstico. Este trabalho tem como objetivo analisar e comparar quatro estratégias diferentes para predizer a benignidade ou malignidade de tumores pélvicos supostamente de origem ovariana utilizando para este fim, marcadores tumorais CA 125 e HE4, índice de risco de malignidade (IRM) e algoritmo ROMA. MÉTODOS: Neste estudo prospectivo foram avaliadas 128 pacientes com diagnóstico de tumores pélvicos supostamente de origem ovariana atendidas na Divisão de Clínica Ginecológica do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo e Instituto do Câncer do Estado de São Paulo entre julho de 2008 e janeiro 2011. Foram calculadas a sensibilidade e a especificidade e construídas curvas ROC para comparar os quatro parâmetros (CA 125, HE4, ROMA e IRM) na eficácia de diferenciar tumores ovarianos. RESULTADOS: A sensibilidade obtida para CA 125, HE4, ROMA e IRM foi de, respectivamente, 70,4%, 79,7%, 74,1% e 63,0%. A especificidade para CA 125, HE4, ROMA e IRM foi de, respectivamente, 74,2%, 66,7%, 75,8% e 92,4%. Não houve diferença na comparação das áreas abaixo da curva ROC entre os quatro parâmetros. CONCLUSÕES: Nenhum dos quatro métodos estudados é o ideal na diferenciação de tumores ovarianos. Entre os quatro parâmetros analisados o HE4 foi o parâmetro com melhor sensibilidade na diferenciação de tumores ovarianos. A acurácia dos quatro métodos é equivalente e podem ser utilizados indistintamente para referenciar pacientes para serviços especializados no tratamento de câncer de ovário / BACKGROUND: Ovarian cancer is the most lethal of all gynecological cancers and requires to be treated by gynecologic oncologists in tertiary centers accustomed to treating this disease to achieve the best prognosis. This study aims to compare four different strategies to predict the benignity or malignancy of pelvic tumors presumably of ovarian origin using, for this purpose, tumor markers CA 125 and HE4, risk malignancy index (RMI) and algorithm ROMA. METHODS: This prospective study evaluated 128 patients supposedly with ovarian tumors treated at the Divisão de Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and at Instituto do Câncer do Estado de São Paulo between July 2008 and January 2011. We calculated sensitivity, specificity and ROC curves to compare the four parameters (CA 125, HE4, ROMA and RMI) ability to differentiate the ovarian tumors. RESULTS: The sensitivity obtained for CA 125, HE4, ROMA and RMI was, respectively, 70.4%, 79.7%, 74.1% and 63.0%. The specificity obtained for CA 125, HE4, ROMA and RMI was, respectively, 74.2%, 66.7%, 75.8% and 92.4%. There was no difference the areas under the ROC curve among the four parameters. CONCLUSIONS: None of the four studied methods is best in the differentiation of ovarian tumors. Among the four parameters analyzed, HE4 was the parameter with highest sensitivity in the differentiation of ovarian tumors. The accuracy of the four methods is equivalent and can be used interchangeably to refer patients for specialized services in the treatment of ovarian cancer

A exocitose de grânulos secretórios é o principal mecanismo efetor de células TCD8+. No entanto, pouco se sabe sobre a composição dos grânulos líticos dessas células. Resultados prévios do nosso grupo identificaram algumas dezenas de novas proteínas desses grânulos. Dentre elas foi identificada Gal-1. A literatura relata que Gal-1 age por via exógena através de sua secreção por via não convencional. Dados iniciais do nosso grupo apontam um novo cenário para esta proteína no qual ela está presente em grânulos citotóxicos. Através das técnicas de microscopia eletrônica e confocal e de ensaios de citotoxicidade, nossos resultados sugerem que Gal-1 participa do papel citotóxico das CTLs modulando a via dos receptores de morte FAS-FASL. Nós também mostramos que Gal-1 interfere com o tempo de contato entre APCs e linfócitos TCD8+, com a ativação dessas células e com o controle da proliferação dos linfócitos. Nossos resultados apontam um novo cenário para Gal-1, no qual ela está presente em grânulos líticos das CTLs e está relacionada a resposta efetora dessas células. / Exocytosis of secretory granules is the main effector mechanism of CD8+ T cells. In particular, little is known about CTLs lytic granules composition. Previous results from our group identified a few dozens of new proteins associated with these granules. Among them, we identified galectin-1. Literature reports the extracellular action of Gal-1. Initial data from our group suggested a new scenario for this protein, since Gal-1 was found inside cytotoxic granules. Here, we show by transmission electron and confocal laser scanning microscopy and cytotoxicity assays that Gal-1 has a role on CTL killing probably mediating the FAS-FASL pathway. We also show that Gal-1 is regulates the time of contact between APCs and TCD8+ lymphocytes, the activation of APCs and the proliferation of CD8 T cells. Taken together, our findings suggest a new scenario, in which Gal-1 is present in CTL granules and participates in cytotoxic effector response.

INTRODUÇÃO: O câncer de ovário é o mais letal de todos os cânceres ginecológicos e requer ser tratado por ginecologistas especializados em centros terciários para se obter melhor prognóstico. Este trabalho tem como objetivo analisar e comparar quatro estratégias diferentes para predizer a benignidade ou malignidade de tumores pélvicos supostamente de origem ovariana utilizando para este fim, marcadores tumorais CA 125 e HE4, índice de risco de malignidade (IRM) e algoritmo ROMA. MÉTODOS: Neste estudo prospectivo foram avaliadas 128 pacientes com diagnóstico de tumores pélvicos supostamente de origem ovariana atendidas na Divisão de Clínica Ginecológica do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo e Instituto do Câncer do Estado de São Paulo entre julho de 2008 e janeiro 2011. Foram calculadas a sensibilidade e a especificidade e construídas curvas ROC para comparar os quatro parâmetros (CA 125, HE4, ROMA e IRM) na eficácia de diferenciar tumores ovarianos. RESULTADOS: A sensibilidade obtida para CA 125, HE4, ROMA e IRM foi de, respectivamente, 70,4%, 79,7%, 74,1% e 63,0%. A especificidade para CA 125, HE4, ROMA e IRM foi de, respectivamente, 74,2%, 66,7%, 75,8% e 92,4%. Não houve diferença na comparação das áreas abaixo da curva ROC entre os quatro parâmetros. CONCLUSÕES: Nenhum dos quatro métodos estudados é o ideal na diferenciação de tumores ovarianos. Entre os quatro parâmetros analisados o HE4 foi o parâmetro com melhor sensibilidade na diferenciação de tumores ovarianos. A acurácia dos quatro métodos é equivalente e podem ser utilizados indistintamente para referenciar pacientes para serviços especializados no tratamento de câncer de ovário / BACKGROUND: Ovarian cancer is the most lethal of all gynecological cancers and requires to be treated by gynecologic oncologists in tertiary centers accustomed to treating this disease to achieve the best prognosis. This study aims to compare four different strategies to predict the benignity or malignancy of pelvic tumors presumably of ovarian origin using, for this purpose, tumor markers CA 125 and HE4, risk malignancy index (RMI) and algorithm ROMA. METHODS: This prospective study evaluated 128 patients supposedly with ovarian tumors treated at the Divisão de Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and at Instituto do Câncer do Estado de São Paulo between July 2008 and January 2011. We calculated sensitivity, specificity and ROC curves to compare the four parameters (CA 125, HE4, ROMA and RMI) ability to differentiate the ovarian tumors. RESULTS: The sensitivity obtained for CA 125, HE4, ROMA and RMI was, respectively, 70.4%, 79.7%, 74.1% and 63.0%. The specificity obtained for CA 125, HE4, ROMA and RMI was, respectively, 74.2%, 66.7%, 75.8% and 92.4%. There was no difference the areas under the ROC curve among the four parameters. CONCLUSIONS: None of the four studied methods is best in the differentiation of ovarian tumors. Among the four parameters analyzed, HE4 was the parameter with highest sensitivity in the differentiation of ovarian tumors. The accuracy of the four methods is equivalent and can be used interchangeably to refer patients for specialized services in the treatment of ovarian cancer

Introdução: Gestações múltiplas apresentam alta morbidade relacionada a fatores como prematuridade, baixo peso ao nascer e sepse. Em gemelares, a aquisição de imunidade passiva por meio do cordão umbilical e do colostro ainda não é bem conhecida. O objetivo geral do estudo foi descrever a concentração de IgG total e específico anti-Streptococcus B, antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa no cordão umbilical de recém-nascidos gemelares e a concentração de IgA secretora total e específica destes anticorpos no colostro. O objetivo específico foi analisar a associação entre infecção neonatal e concentração dos anticorpos no sangue de cordão umbilical e no colostro. Métodos: estudo prospectivo transversal de uma coorte de recémnascidos gemelares internados no Centro Neonatal do Instituto da Criança do Hospital das Clínicas da FMUSP no período de 20 meses. Foram excluídos: recém-nascidos com malformação; mães com infecção ou imunodeficiência. Variáveis analisadas: idade gestacional; peso de nascimento; classificação gestacional; concentrações de IgG total e específicos e IgA total e específicas anti-Streptococcus B, antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa no sangue de cordão umbilical e no colostro; nutrição enteral; episódios de infecção; desfecho. As dosagens de IgG total foram realizadas por nefelometria e dos demais anticorpos através de ensaio imunoenzimático. Os testes t-Student pareado ou teste de Wilcoxon pareado, teste de Mann-Whitney e teste de Kruskal-Wallis, foram utilizados, considerando-se significante p< 0,005. Resultados: Foram incluídos 57 pares de gêmeos, compondo a casuística de 114 recém-nascidos. A idade gestacional foi 36±1,65 semanas (média±DP) e o peso de nascimento foi 2.304,8 ± 460g (média±DP). As concentrações de anticorpos encontradas foram (média±DP): IgG total 835,71 ± 190,73 mg/dL, IgG anti-Streptococcus B 295,1 ± 250,66 UA/mL, IgG antilipopolissacarídeos de Pseudomonas aeruginosa 280,04 ± 498,66 UA/mL e IgG antilipopolissacarídeos de Klebsiella pneumoniae 504,75 ± 933,93 UA/mL; IgA total 210,2 ± 285,3 g/L, IgA anti-Streptococcus B 6640 ± 9526,8 UA/mL, IgA antilipopolissacarídeos de Pseudomonas aeruginosa 3231,0 ± 2935,2 UA/mL, IgA antilipopolissacarídeos de Klebsiella pneumoniae 3070,1±2886,6 UA/mL. A concentração de IgG total foi menor nos recém-nascidos prematuros (p < 0,001). Em gemelares com idade gestacional < 34 semanas a concentração de IgG total (p=0,013) e IgG antilipopolissacarídeos de Pseudomonas aeruginosa (p=0,032) foi menor. A concentração de anticorpos IgG antilipopolissacarídeos de Klebsiella pneumoniae foi menor nos recém-nascidos pequenos para a idade gestacional (p=0,013). No colostro, houve detecção de IgA total, IgA anti-Streptococcus B, IgA antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa em 98,1% das mães. A concentração de IgA antilipopolissacarídeos de Pseudomonas aeruginosa foi menor no colostro das mães de recém-nascidos prematuros (p=0,013). A concentração de IgA antilipopolissacarídeos de Klebsiella pneumoniae foi menor no colostro das mães com parto antes de 34 semanas (p=0,001). Houve infecção em cinco recém-nascidos, cuja concentração de IgG total foi menor (p<0,05). Os neonatos que receberam colostro apresentaram menor incidência de infecção (p < 0,001). Conclusões: Os anticorpos IgG total e específicos foram detectados no sangue do cordão umbilical em todos os gemelares, comprovando sua passagem transplacentária. Houve diminuição significativa na concentração de anticorpos IgG total nos gemelares prematuros e de IgG total e IgG antilipopolissacarídeos de Pseudomonas aeruginosa nos gemelares com idade gestacional inferior a 34 semanas. No colostro houve detecção de IgA total e específica em 98,1% das mães. A concentração de IgA anti-lipopolissacarídeos de Pseudomonas aeruginosa foi menor no colostro das mães de gemelares prematuros. Nas mães com parto antes de 34 semanas houve diminuição da concentração de IgA antilipopolissacarídeos de Klebsiella pneumoniae, sugerindo que a prematuridade possa ter influenciado a transferência de anticorpos maternos pelo colostro. A maior incidência de infecção no grupo de recém-nascidos, que não receberam colostro e naqueles que apresentavam concentração sérica de IgG total significativamente menor, reforça a importância da proteção anti-infecciosa conferida pela imunidade passiva transferida da mãe / Introduction: Multiple pregnancies have high morbidity related to factors such as prematurity, low birth weight and sepsis. In twins, acquisition of passive immunity through the umbilical cord and colostrum is not yet known. The overall aim of the study was to describe the concentration of total and specific IgG antibodies anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella pneumoniae and anti-lipopolysaccharide of Pseudomonas aeruginosa in the umbilical cord of newborn twins and the concentration of total and specific secretory IgA antibodies in the colostrum. The specific aim was to analyze the association between neonatal infection and antibody concentration in the umbilical cord blood and colostrum. Methods: A prospective cross-sectional study of a cohort of newborn twins admitted to the Neonatal Center of Children\'s Institute, University of São Paulo during the period of 20 months. Patients with malformations and mothers with infection or immunodeficiency were excluded from our analysis. Variables analyzed: gestational age; birth weight; sex; gestational classification; antibody concentrations of total and specific IgG and IgA anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella pneumoniae and antilipopolysaccharide of Pseudomonas aeruginosa in umbilical cord blood and colostrum; enteral nutrition; infection episodes; outcome. Total IgG measurements were performed using nephelometry and the specific antibodies were evaluated by enzyme immunoassay. We used paired Student t test or Wilcoxon test, Mann-Whitney test and Kruskal-Wallis test considering significant p < 0.005. Results: During the study period a total of 57 pairs of twins were included, making the sample of 114 newborns. Gestational age was 36 ± 1.65 weeks (mean±SD) and birth weight was 2304.8 ± 460g (mean±SD). We found the following antibody concentrations (mean±SD): total IgG 835.71 ± 190.73 mg/dL, anti-Streptococcus B IgG 250.66 ± 295.1 AU/mL, anti-lipopolysaccharide of Pseudomonas aeruginosa IgG 280.04 ± 498.66 AU/mL and anti-lipopolysaccharide of Klebsiella pneumoniae IgG 504.75±933.93 AU/mL; total IgA 210.2 ± 285.3 g/L, anti- Streptococcus B IgA 6640±9526.8 AU/mL, anti-lipopolysaccharide of Pseudomonas aeruginosa IgA 3231.0±2935.2 AU/mL, antilipopolysaccharide Klebsiella pneumoniae IgA 3070.1±2886.6 AU/mL. The concentration of total IgG was lower in preterm infants (p < 0.001). In twins with gestational age < 34 weeks both total IgG concentration (p = 0.013) and anti-lipopolysaccharide of Pseudomonas aeruginosa IgG concentration (p = 0.032) were lower. The concentration of anti-lipopolysaccharide of Klebsiella pneumoniae IgG was lower in small for gestational age newborns (p=0,013). There was detection of total IgA and specific antibodies in the colostrum of 98.1% mothers. The concentration of anti-lipopolysaccharide of Pseudomonas aeruginosa IgA was lower in the colostrum of premature\'s mothers (p = 0.013). The concentration of anti-lipopolysaccharide of Klebsiella pneumoniae IgA was lower in the colostrum of mothers with delivery before 34 weeks (p = 0.001). Five newborns were diagnosed with sepsis and in this group the concentration of total IgG was lower (p < 0.05). Neonates receiving colostrum had a lower incidence of infection (p < 0.001). Conclusion: This study showed detection of total and specific IgG antibodies in umbilical cord blood for all twin newborn, proving its transplacental passage. There was a significant decrease in the concentration of total IgG antibodies in premature twins and antilipopolysaccharide of Pseudomonas aeruginosa IgG in twins with gestational age less than 34 weeks. There was detection of total and specific IgA in the colostrum of 98.1% mothers. The concentration of anti-lipopolysaccharide of Pseudomonas aeruginosa IgA was lower in mothers of premature twins. Among the newborns with gestational age less than 34 weeks there was a decrease in the concentration of anti-lipopolysaccharide Klebsiella pneumoniae IgA, suggesting that prematurity may have influenced the transfer of maternal antibodies through colostrum. The highest incidence of infection in the newborn group who did not receive colostrum and in those who had significantly lower total IgG serum antibodies reinforces the importance of anti-infectious protection afforded by passive immunity transferred from the mother

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2016-10-03T19:51:39Z No. of bitstreams: 1 cassiarubiabernardo_dissert.pdf: 1967854 bytes, checksum: 8824de8e39f94d01de50b4ffdbee4e9c (MD5) / Made available in DSpace on 2016-10-03T19:51:39Z (GMT). No. of bitstreams: 1 cassiarubiabernardo_dissert.pdf: 1967854 bytes, checksum: 8824de8e39f94d01de50b4ffdbee4e9c (MD5) Previous issue date: 2014-02-27 / Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP / Introduction: Chagas disease is caused by the protozoan Trypanosoma cruzi, which is transmitted to humans commonly in the feces of a hemipterous popularly known as barber. The natural infection occurs mainly in childhood. After a period of approximately two decades infected individuals develop clinical manifestations such as Chagas heart disease and Chagas gastrointestinal disease (Megaesophagus and/or Megacolon). The expression of the antigens belonging to histo-blood systems ABO, Secretor and Lewis, controlled by the genes ABO (9q34.1), FUT2 (19q13.3) and FUT3 (19p13.3) differs between the organs affected by Chagas disease. It is possible that the differential tissue expression of ABO, Secretor and Lewis histo-blood groups influences the clinical manifestations of Chagas disease. Aim: The aim if this study was to verify if the antigens of the histo-blood systems ABO, Secretor and Lewis are associated with different clinical forms of Chagas disease. Materials and methods: After obtaining the informed consent peripheral blood and serum samples from 827 individuals were collected. Patients were divided into three subgroups according to their clinical state (megacólon [n=66], megaesophagus [n=119] and cardiomyopathy [n=154]). The control group consisted of 488 blood donors properly fit for the donation. The Lewis and ABO phenotyping were performed by hemagglutination test tube and gel columns agglutination, respectively. The IgG anti-T. cruzi antibodies were identified by ELISA. FUT2 and FUT3 genotyping were carried out by PCR-RFLP. Results: The mean age of patients with Chagas disease was 64.8±11.2 and blood donors 34.3±11.0 (p<0.0001). The differences between the percentages of the sex of the patients and donors were statistically significant (p <0.0001). The frequencies of ABO, Secretor and Lewis distributed in the three forms of the disease compared with each other and with donors, did not give differences statistically significant. The comparison between the ABO and Secretor combined, according to the three forms of Chagas disease, showed statistically significant differences for megaesophagus form (p=0.015). The frequencies of ABO, Secretor and Lewis antigen profiles between patients and donors showed differences statistically significant in favor of BLeb antigen (p=0.032). Conclusion: The results suggest that the high expression of antigen B, which characterizes the B and AB blood groups under the control of functional FUT2 (Secretor) gene acts as a risk factor for megaesophagus form of the Chagas disease. / Introdução: A doença de Chagas é causada pelo protozoário Trypanosoma cruzi, o qual é transmitido ao homem, comumente, pelas fezes de um hemíptero conhecido popularmente como barbeiro. A infecção natural ocorre principalmente na infância e após um período aproximado de duas décadas, parte dos indivíduos infectados desenvolvem manifestações clínicas como a Cardiopatia Chagásica Crônica e a doença do trato gastrointestinal (Megaesôfago e/ou Megacólon). A expressão dos antígenos dos sistemas histo-sanguíneos ABO, Secretor e Lewis, controlada pelos genes ABO (9q34.1), FUT2 (19q13.3) e FUT3 (19p13.3), difere entre os órgãos acometidos por esta doença e pode influenciar suas manifestações clínicas. Objetivo: Avaliar se os antígenos dos sistemas histo-sanguíneos ABO, Secretor e Lewis estão associados às diferentes formas clínicas da Doença de Chagas. Materiais e Métodos: Após a entrevista e obtenção do termo de consentimento livre e esclarecido, amostras de sangue periférico e soro de 827 indivíduos foram analisadas. Os pacientes com a forma crônica da Doença de Chagas foram divididos em três subgrupos de acordo com a forma clínica, (megacólon=66, megaesôfago=119 e cardiomiopatia=154). O grupo controle constitui-se de 488 doadores de sangue devidamente aptos à doação. As fenotipagens ABO e Lewis foram realizadas por métodos de hemaglutinação em tubos e colunas de gel, respectivamente. A pesquisa de anticorpos da classe IgG anti-T. cruzi foi realizada pelo teste de ELISA. Os genótipos FUT2 e FUT3 foram identificados por PCR-RFLP. Resultados: A média de idade dos pacientes chagásicos foi de 64,8±11,2 e dos doadores de sangue 34,3±11,0 (p<0.0001). As diferenças entre as porcentagens do sexo dos pacientes e doadores foram estatisticamente significantes (p< 0.0001). As frequências dos fenótipos ABO, Secretor e Lewis distribuídos nas três formas da doença comparados entre si e com os doadores, não revelaram diferenças estatisticamente significantes. A comparação entre os fenótipos ABO e Secretor combinados, de acordo com as três formas da Doença de Chagas, mostrou diferenças estatisticamente significantes para a forma megaesôfago (p=0,015). A comparação entre as frequências dos perfis antigênicos de pacientes e doadores, revelaram diferença estatisticamente significante para o perfil de antígenos BLeb (p=0,032). Conclusões: Os resultados sugerem que a expressão do antígeno carboidrato B, o qual caracteriza os grupos sanguíneos B e AB, cuja síntese está sob o controle dos genes funcionais FUT2 (Secretor), atua como um fator de risco para a forma megaesôfago da Doença de Chagas.

Introdução: Gestações múltiplas apresentam alta morbidade relacionada a fatores como prematuridade, baixo peso ao nascer e sepse. Em gemelares, a aquisição de imunidade passiva por meio do cordão umbilical e do colostro ainda não é bem conhecida. O objetivo geral do estudo foi descrever a concentração de IgG total e específico anti-Streptococcus B, antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa no cordão umbilical de recém-nascidos gemelares e a concentração de IgA secretora total e específica destes anticorpos no colostro. O objetivo específico foi analisar a associação entre infecção neonatal e concentração dos anticorpos no sangue de cordão umbilical e no colostro. Métodos: estudo prospectivo transversal de uma coorte de recémnascidos gemelares internados no Centro Neonatal do Instituto da Criança do Hospital das Clínicas da FMUSP no período de 20 meses. Foram excluídos: recém-nascidos com malformação; mães com infecção ou imunodeficiência. Variáveis analisadas: idade gestacional; peso de nascimento; classificação gestacional; concentrações de IgG total e específicos e IgA total e específicas anti-Streptococcus B, antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa no sangue de cordão umbilical e no colostro; nutrição enteral; episódios de infecção; desfecho. As dosagens de IgG total foram realizadas por nefelometria e dos demais anticorpos através de ensaio imunoenzimático. Os testes t-Student pareado ou teste de Wilcoxon pareado, teste de Mann-Whitney e teste de Kruskal-Wallis, foram utilizados, considerando-se significante p< 0,005. Resultados: Foram incluídos 57 pares de gêmeos, compondo a casuística de 114 recém-nascidos. A idade gestacional foi 36±1,65 semanas (média±DP) e o peso de nascimento foi 2.304,8 ± 460g (média±DP). As concentrações de anticorpos encontradas foram (média±DP): IgG total 835,71 ± 190,73 mg/dL, IgG anti-Streptococcus B 295,1 ± 250,66 UA/mL, IgG antilipopolissacarídeos de Pseudomonas aeruginosa 280,04 ± 498,66 UA/mL e IgG antilipopolissacarídeos de Klebsiella pneumoniae 504,75 ± 933,93 UA/mL; IgA total 210,2 ± 285,3 g/L, IgA anti-Streptococcus B 6640 ± 9526,8 UA/mL, IgA antilipopolissacarídeos de Pseudomonas aeruginosa 3231,0 ± 2935,2 UA/mL, IgA antilipopolissacarídeos de Klebsiella pneumoniae 3070,1±2886,6 UA/mL. A concentração de IgG total foi menor nos recém-nascidos prematuros (p < 0,001). Em gemelares com idade gestacional < 34 semanas a concentração de IgG total (p=0,013) e IgG antilipopolissacarídeos de Pseudomonas aeruginosa (p=0,032) foi menor. A concentração de anticorpos IgG antilipopolissacarídeos de Klebsiella pneumoniae foi menor nos recém-nascidos pequenos para a idade gestacional (p=0,013). No colostro, houve detecção de IgA total, IgA anti-Streptococcus B, IgA antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa em 98,1% das mães. A concentração de IgA antilipopolissacarídeos de Pseudomonas aeruginosa foi menor no colostro das mães de recém-nascidos prematuros (p=0,013). A concentração de IgA antilipopolissacarídeos de Klebsiella pneumoniae foi menor no colostro das mães com parto antes de 34 semanas (p=0,001). Houve infecção em cinco recém-nascidos, cuja concentração de IgG total foi menor (p<0,05). Os neonatos que receberam colostro apresentaram menor incidência de infecção (p < 0,001). Conclusões: Os anticorpos IgG total e específicos foram detectados no sangue do cordão umbilical em todos os gemelares, comprovando sua passagem transplacentária. Houve diminuição significativa na concentração de anticorpos IgG total nos gemelares prematuros e de IgG total e IgG antilipopolissacarídeos de Pseudomonas aeruginosa nos gemelares com idade gestacional inferior a 34 semanas. No colostro houve detecção de IgA total e específica em 98,1% das mães. A concentração de IgA anti-lipopolissacarídeos de Pseudomonas aeruginosa foi menor no colostro das mães de gemelares prematuros. Nas mães com parto antes de 34 semanas houve diminuição da concentração de IgA antilipopolissacarídeos de Klebsiella pneumoniae, sugerindo que a prematuridade possa ter influenciado a transferência de anticorpos maternos pelo colostro. A maior incidência de infecção no grupo de recém-nascidos, que não receberam colostro e naqueles que apresentavam concentração sérica de IgG total significativamente menor, reforça a importância da proteção anti-infecciosa conferida pela imunidade passiva transferida da mãe / Introduction: Multiple pregnancies have high morbidity related to factors such as prematurity, low birth weight and sepsis. In twins, acquisition of passive immunity through the umbilical cord and colostrum is not yet known. The overall aim of the study was to describe the concentration of total and specific IgG antibodies anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella pneumoniae and anti-lipopolysaccharide of Pseudomonas aeruginosa in the umbilical cord of newborn twins and the concentration of total and specific secretory IgA antibodies in the colostrum. The specific aim was to analyze the association between neonatal infection and antibody concentration in the umbilical cord blood and colostrum. Methods: A prospective cross-sectional study of a cohort of newborn twins admitted to the Neonatal Center of Children\'s Institute, University of São Paulo during the period of 20 months. Patients with malformations and mothers with infection or immunodeficiency were excluded from our analysis. Variables analyzed: gestational age; birth weight; sex; gestational classification; antibody concentrations of total and specific IgG and IgA anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella pneumoniae and antilipopolysaccharide of Pseudomonas aeruginosa in umbilical cord blood and colostrum; enteral nutrition; infection episodes; outcome. Total IgG measurements were performed using nephelometry and the specific antibodies were evaluated by enzyme immunoassay. We used paired Student t test or Wilcoxon test, Mann-Whitney test and Kruskal-Wallis test considering significant p < 0.005. Results: During the study period a total of 57 pairs of twins were included, making the sample of 114 newborns. Gestational age was 36 ± 1.65 weeks (mean±SD) and birth weight was 2304.8 ± 460g (mean±SD). We found the following antibody concentrations (mean±SD): total IgG 835.71 ± 190.73 mg/dL, anti-Streptococcus B IgG 250.66 ± 295.1 AU/mL, anti-lipopolysaccharide of Pseudomonas aeruginosa IgG 280.04 ± 498.66 AU/mL and anti-lipopolysaccharide of Klebsiella pneumoniae IgG 504.75±933.93 AU/mL; total IgA 210.2 ± 285.3 g/L, anti- Streptococcus B IgA 6640±9526.8 AU/mL, anti-lipopolysaccharide of Pseudomonas aeruginosa IgA 3231.0±2935.2 AU/mL, antilipopolysaccharide Klebsiella pneumoniae IgA 3070.1±2886.6 AU/mL. The concentration of total IgG was lower in preterm infants (p < 0.001). In twins with gestational age < 34 weeks both total IgG concentration (p = 0.013) and anti-lipopolysaccharide of Pseudomonas aeruginosa IgG concentration (p = 0.032) were lower. The concentration of anti-lipopolysaccharide of Klebsiella pneumoniae IgG was lower in small for gestational age newborns (p=0,013). There was detection of total IgA and specific antibodies in the colostrum of 98.1% mothers. The concentration of anti-lipopolysaccharide of Pseudomonas aeruginosa IgA was lower in the colostrum of premature\'s mothers (p = 0.013). The concentration of anti-lipopolysaccharide of Klebsiella pneumoniae IgA was lower in the colostrum of mothers with delivery before 34 weeks (p = 0.001). Five newborns were diagnosed with sepsis and in this group the concentration of total IgG was lower (p < 0.05). Neonates receiving colostrum had a lower incidence of infection (p < 0.001). Conclusion: This study showed detection of total and specific IgG antibodies in umbilical cord blood for all twin newborn, proving its transplacental passage. There was a significant decrease in the concentration of total IgG antibodies in premature twins and antilipopolysaccharide of Pseudomonas aeruginosa IgG in twins with gestational age less than 34 weeks. There was detection of total and specific IgA in the colostrum of 98.1% mothers. The concentration of anti-lipopolysaccharide of Pseudomonas aeruginosa IgA was lower in mothers of premature twins. Among the newborns with gestational age less than 34 weeks there was a decrease in the concentration of anti-lipopolysaccharide Klebsiella pneumoniae IgA, suggesting that prematurity may have influenced the transfer of maternal antibodies through colostrum. The highest incidence of infection in the newborn group who did not receive colostrum and in those who had significantly lower total IgG serum antibodies reinforces the importance of anti-infectious protection afforded by passive immunity transferred from the mother

EBAG9 (estrogen receptor-binding fragment-associated gene 9) hat als unabhängiger prognostischer Marker viel Aufmerksamkeit erregt, da in einigen Tumoren hohe Expressionsraten und Tumorentwicklung korrelieren. In diesen Fällen ist eine hohe EBAG9 Expression häufig mit einer schlechten klinischen Prognose verbunden. EBAG9 ist ein ubiquitär exprimiertes Golgi Protein. Aktuelle Daten demonstrieren, dass es in sekretorischen Zellen an der regulierten Exozytose und an der zytotoxischen Funktion von Lymphozyten beteiligt ist. In epithelialen Zellen führt es zur Generierung von Tumor-assoziierten O-Glykanen, welche ein Erkennungsmerkmal vieler Krebsarten sind. In dieser Arbeit wurde der pathogenetische Zusammenhang zwischen EBAG9 Expression und der Veränderung des zellulären Glykoms untersucht. Um einen tieferen Einblick in die zelluläre Funktion von EBAG9 in epithelialen Zellen zu gewinnen, wurden Zellen mit tumorähnlicher EBAG9 Expression verwendet. Innerhalb dieser Arbeit wurde demonstriert, dass EBAG9 mit anterograden COPI Vesikeln assoziiert und zwischen dem ER-Golgi intermediären Kompartiment und cis-Golgi pendelt. EBAG9 verursacht eine Verzögerung des anterograden Transportes vom ER zum Golgi und verändert die Lokalisation von Komponenten der ER Qualitätskontrolle und des Glycosylierungsapparates. Auf der anderen Seite beschleunigt die verminderte Expression von EBAG9 den Proteintransport durch den Golgi und verstärkt die Aktivität von Mannosidase II. Mechanistisch betrachtet verhindert EBAG9 die Rekrutierung von ArfGAP1 an die Membran. Dies beeinträchtigt das Auflösen der COPI Vesikelhülle und somit die Fusion von Vesikeln am cis-Golgi. Damit agiert EBAG9 in epithelialen Zellen als negativer Regulator des COPI-abhängigen ERGolgi Transportes und stellt damit ein neues phatogenetisches Prinzip dar, bei dem die Beeinflussung des intrazellulären Transportes zu der Entstehung von Tumor-assoziierten Glykanen führt. / The estrogen receptor-binding fragment-associated gene 9 (EBAG9) has received increased attention as an independent prognostic marker for disease-specific survival since in some human tumor entities high expression levels correlate with tumor progression and poor clinical prognosis. Interestingly, EBAG9 was identified as an ubiquitously expressed Golgi protein. Recent data demonstrate an involvement in regulated exocytosis in secretory cells and the cytotoxic functions of lymphocytes. However, EBAG9 is expressed in essentially all mammalian tissues, and in epithelial cells it has been identified as a modulator of tumorassociated O-linked glycan expression, a hallmark of many carcinomas. This thesis addresses the pathogenetic link between EBAG9 expression and the alteration of the cellular glycome. To gain further insights into the cellular functions of EBAG9 in epithelial cells, tumor-associated EBAG9 overexpression was mimicked in living cells. It was demonstrated that EBAG9 associates with anterograde COPI-coated carriers and shuttles between the ER-Golgi intermediate compartment and cis-Golgi stacks. EBAG9 overexpression imposes a delay in anterograde ER-to-Golgi transport and mislocalizes components of the ER quality-control and glycosylation machinery. Conversely, EBAG9 downregulation accelerates glycoprotein transport through the Golgi and enhances mannosidase activity. Functionally, EBAG9 impairs ArfGAP1 recruitment to membranes and consequently, interferes with the disassembly of the coat lattice at the cis-Golgi prior to fusion. Thus, EBAG9 acts as a negative regulator of a COPI-dependent ER-to-Golgi transport pathway in epithelial cells and represents a novel pathogenetic principle in which interference with intracellular membrane trafficking results in the emergence of a tumor-associated glycome.

A exocitose de grânulos secretórios é o principal mecanismo efetor de células TCD8+. No entanto, pouco se sabe sobre a composição dos grânulos líticos dessas células. Resultados prévios do nosso grupo identificaram algumas dezenas de novas proteínas desses grânulos. Dentre elas foi identificada Gal-1. A literatura relata que Gal-1 age por via exógena através de sua secreção por via não convencional. Dados iniciais do nosso grupo apontam um novo cenário para esta proteína no qual ela está presente em grânulos citotóxicos. Através das técnicas de microscopia eletrônica e confocal e de ensaios de citotoxicidade, nossos resultados sugerem que Gal-1 participa do papel citotóxico das CTLs modulando a via dos receptores de morte FAS-FASL. Nós também mostramos que Gal-1 interfere com o tempo de contato entre APCs e linfócitos TCD8+, com a ativação dessas células e com o controle da proliferação dos linfócitos. Nossos resultados apontam um novo cenário para Gal-1, no qual ela está presente em grânulos líticos das CTLs e está relacionada a resposta efetora dessas células. / Exocytosis of secretory granules is the main effector mechanism of CD8+ T cells. In particular, little is known about CTLs lytic granules composition. Previous results from our group identified a few dozens of new proteins associated with these granules. Among them, we identified galectin-1. Literature reports the extracellular action of Gal-1. Initial data from our group suggested a new scenario for this protein, since Gal-1 was found inside cytotoxic granules. Here, we show by transmission electron and confocal laser scanning microscopy and cytotoxicity assays that Gal-1 has a role on CTL killing probably mediating the FAS-FASL pathway. We also show that Gal-1 is regulates the time of contact between APCs and TCD8+ lymphocytes, the activation of APCs and the proliferation of CD8 T cells. Taken together, our findings suggest a new scenario, in which Gal-1 is present in CTL granules and participates in cytotoxic effector response.

Les maladies neurodégénératives regroupent un ensemble de neuropathologies qui se caractérisent par le dysfonctionnement progressif des neurones et leur perte irréversible au niveau du système nerveux central. Parmi ces maladies figure la maladie d’Alzheimer (MA) qui est une des conditions neurodégénératives la plus fréquente. Bien qu’aucune étiologie n’ait encore été identifiée, le vieillissement est par conséquent le principal facteur de risque de la MA. Grâce aux recherches réalisées sur le vieillissement, des caractéristiques de changements cellulaires et biochimiques, comme la sénescence cellulaire et l’inflammaging, ont été associées à ce phénomène. La sénescence cellulaire qui se définit par un état d’arrêt du cycle cellulaire pourrait aggraver une maladie neurodégénérative, entre autres par le biais de phénotypes sécrétoires associés à la sénescence. L’implication du proto-oncogène BMI1 dans la régulation du cycle cellulaire et la sénescence a été démontrée à travers son inhibition du locus INK4/ARF. De plus, une déficience en BMI1 a été rapportée dans des neurones de certains patients avec la MA, et elle est également associée à une neurodégénérescence précoce. Le complexe NF-κB participe à l’expression d’un large éventail de gènes de cytokines pro-inflammatoires impliquées dans les processus de l’inflammaging et de la sénescence cellulaire. Cependant, l’implication conjointe de BMI1 et de NF-κB dans les processus de neurodégénérescence demeure peu connue. Compte tenu de ce contexte, dans le cadre de ce projet de maitrise, nous avons voulu explorer l’implication conjointe des molécules BMI1 et de la voie canonique du facteur NF-κB dans la production de cytokines pro-inflammatoires en utilisant des modèles in vivo et in vitro reproduisant un phénotype de neurodégénérescence similaire à la maladie d’Alzheimer. Nos résultats indiquent qu’une déficience en BMI1 est corrélée à une inactivation du facteur NF-κB aussi bien dans des neurones in vitro qu’in vivo ainsi qu’a une baisse de l’expression des cytokines IL6 et IL8. Bien que nous présentions des résultats générés à partir d’expériences non dupliquées, ils convergent tout de même vers des conclusions similaires à celles obtenues au niveau de pathologies cancéreuses. Ainsi notre projet apporte une information additionnelle qui pourrait servir à la compréhension des mécanismes sous-jacents au phénomène de l’inflammaging dans la neurodégénérescence. / Neurodegenerative diseases are a group of neuropathologies characterized by the progressive dysfunction of neurons and their death in the central nervous system. Among these diseases, Alzheimer's disease (AD) is the most common one. Although no aetiology has yet been identified, aging is therefore the main risk factor for AD. Thanks to several research work on aging, cellular characteristics and biochemical changes, such as senescence and inflammaging, have been associated with this phenomenon. Senescence, which is defined as a state of cell cycle arrest, could worsen neurodegenerative diseases throughout senescence associated secretory phenotypes. The involvement of the proto-oncogene BMI1 in cell cycle regulation and senescence has been demonstrated through its inhibition of the INK4/ARF locus. Additionally, BMI1 deficiency has been reported in neurons of AD patients, and it is also associated with early neurodegeneration. The NF-κB complex participates in the expression of a wide range of pro-inflammatory cytokine involved in the processes of inflammaging and cellular senescence. However, little is known about the joint involvement of BMI1 and NF-κB molecules in neurodegeneration processes. Given this context, within the framework of this master's project, we wanted to explore the combined implication of BMI1 and the canonical pathway of the NF-κB factor in the production of pro-inflammatory cytokines using in vivo and in vitro models reproducing a neurodegenerative phenotype similar to Alzheimer's disease. Our results indicate that a deficiency in BMI1 is correlated to an inactivation of the NF-κB expression both in vitro and in vivo neurones, as well as with a decrease in the expression of cytokines IL6 and IL8. Although we present results generated from unduplicated experiments, they nonetheless converge towards similar conclusions obtained in studies carried out on cancerous pathologies. Thus, our project provides additional information that could help to understand the mechanisms underlying the inflammaging phenomena in neurodegeneration.

Durch die höhere Verfügbarkeit von Schnittbildverfahren in der Kleintiermedizin treten Flüssigkeitsansammlungen in der Bulla tympanica immer häufiger als Zufallsbefund bei Hunden, insbesondere bei brachyzephalen Rassen, auf. Aufgrund der fehlenden klinischen Symptome der Patienten ist eine akute Entzündung unwahrscheinlich. Daher bezeichnen neuere Studien diese Flüssigkeitsansammlung als primär sekretorische Otitis media (PSOM). In der vorliegenden Studie wurde untersucht, ob Hunde der Rassen Mops und Französische Bulldogge mit einer primär sekretorischen Otitis media einen konduktiven Hörverlust für das betroffene Ohr im Vergleich zu „Ohr gesunden“ Hunden ihrer Rasse zeigen. Des Weiteren wurde untersucht, ob Französische Bulldoggen signifikant häufiger eine primär sekretorische Otitis media als Hunde der Rasse Mops zeigen. Es wurden bei jeweils 41 Hunde der Rasse Mops und Französische Bulldogge, die zur chirurgischen Versorgung des Brachyzephalen Syndroms vorgestellt wurden, die frühen akustisch evozierten Potentiale (FAEP) abgeleitet. Des Weiteren erfolgte bei allen Patienten eine Computertomographie des Kopfes, eine Otoskopie und ggf. eine Punktion der Bulla tympanica inklusive einer Zytologie und bakteriologischen Untersuchung des Sekrets. In der vorliegenden Studie konnte kein konduktiver Hörverlust für die Hunde mit einer PSOM nachgewiesen werden. Es zeigte sich nur eine Verlängerung der Latenz der Welle I bei Vorliegen einer PSOM, jedoch ohne dass eine signifikant erhöhte Hörschwelle für diese Patienten festgestellt werden konnte. Als Ursache für die Verlängerung der Latenz der Welle I kommt sowohl die beschriebene Füllung der Bulla als auch ein stenotischer Gehörgang in Frage. Die Hörschwelle ist zwar bei den Hunden mit einer PSOM tendenziell höher als bei den Patienten ohne Füllung der Bullae, allerdings konnte hierfür kein signifikanter Unterschied nachgewiesen werden. Bei 40 % der untersuchten Patienten mit einseitiger PSOM konnte für beide Ohren dieselbe Hörschwelle bestimmt werden, so dass eine Füllung der Bulla tympanica nicht immer zu einer vorhersagbaren Veränderung der Hörschwelle führen muss. Eine mögliche Erklärung für diesen Umstand ist ein sensorineuraler Hörverlust, der durch eine chronische Entzündung des Mittelohres zustande kommt. Dies ist bisher nur in der Humanmedizin beschrieben und die Pathogenese ist noch unklar. Die Ergebnisse zeigen zusätzlich, dass Französische Bulldoggen signifikant häufiger von einer PSOM betroffen sind. Die Ursache für diese Häufung könnte ein dickerer weicher Gaumen der Französischen Bulldoggen im Vergleich zu Hunden der Rasse Mops sein, durch den es zu einer Funktionsstörung der Tuba auditiva kommen könnte. Beim Vergleich der Hunde ohne Vorliegen einer Füllung konnte festgestellt werden, dass Französische Bulldoggen eine höhere Hörschwelle und eine längere Latenz der Welle I als Hunde der Rasse Mops aufweisen. Bei beiden Rassen ist zusätzlich auffällig, dass die Hörschwelle um 30 dB höher liegt als bei Hunden anderer Rassen (SHIU et al. 1997). Alle brachyzephalen Hunde dieser Studie zeigen somit ein im Vergleich zu anderen Rassen vermindertes Hörvermögen, das aber durch eine PSOM nicht weiter verschlechtert wird. Der Symptomenkomplex Brachyzephalen Syndrom muss nach der vorliegenden Studie durch die Symptome vermindertes Hörvermögen und das Vorliegen einer PSOM ergänzt werden. Die klinischen Auswirkungen des Hörverlusts, wie etwa eine starke Anhänglichkeit, könnten bei Hunden dieser Rassen übersehen werden, da dies als gewünschter Charakterzug der Rassen interpretiert wird und nicht als mögliches Symptom einer Erkrankung wahrgenommen wird. / Because of the increased availability of cross-sectional imaging modalities in small animal medicine the incidental finding of material in the middle ear is more common, especially in brachycephalic dogs. Because the animals show no clinical signs, an acute inflammation is unlikely. Therefore recent studies term it as primary secretory otitis media (PSOM). The aim of the current study was to determine whether brachycephalic dogs with PSOM show a conductive hearing loss compared to brachycephalic dogs without changes in the middle ear. Additionally it was evaluated whether French bulldogs suffer from PSOM more frequent than pugs. BAER was recorded in 41 pugs and 41 French bulldogs, which were under general anesthesia because of the surgical correction of the brachycephalic syndrome. In all patients a computed tomography of the head, an otoscopy and if possible a myringotomy with aspiration of the fluid in the middle ear was performed. If fluid was available a cytological examination and a bacterial culture of the fluid was initiated. In the current study no conductive hearing loss was detected in brachycephalic dogs with PSOM. The latencies of wave I were increased in patients with PSOM, although the thresholds of hearing were not increased. The increased latencies of wave I can be explained by the fluid in the middle ear as well as the stenotic external ear canal. The thresholds of hearing in dogs with PSOM were tendentially higher than in dogs without fluid in the middle ear, but the correlation was not significant. In 40 % of the patients with PSOM in one ear the threshold of hearing in both ears is at the same level. Therefore there is no strict correlation between fluid in the middle ear and an increased threshold of hearing on the affected side. This could be explained by a sensorineural hearing loss caused by chronic inflammation of the middle ear. Until now a chronic inflammation as a cause of sensorineural hearing loss has only been described in human medicine, not in veterinary medicine. The pathogenesis is still unknown. The results show that French bulldogs suffer more frequently from the PSOM than pugs. French bulldogs usually show a bigger soft palate than pugs which could result in a dysfunction of the tuba auditiva. Hence the bigger soft palate could be causing the increased prevalence of PSOM in French bulldogs. Compared to pugs without PSOM, French bulldogs without PSOM show an increased latency of wave I as well as an increased threshold of hearing. Additionally for both breeds an increase in the threshold of hearing by 30 dB compared to normocephalic breeds could be detected (SHIU et al. 1997). It is remarkable that French bulldogs as well as pugs show a hearing loss without correlation to the PSOM. In conclusion hearing loss has to be added to the characteristic triad of symptoms of the brachycephalic syndrome. Clinical signs of hearing loss like loyalty to the owner could be misinterpreted especially in these breeds, since this is a favored behavior of these dogs.