A permeabilidade através do epitélio intestinal tem se tornado um importante aspecto a ser determinado nas avaliações biofarmacotécnicas envolvendo fármacos e medicamentos. A técnica mais empregada para essa determinação in vitro é aquela que utiliza a cultura de células Caco-2. Entretanto, ainda são discutíveis as condições para a realização desses experimentos, uma vez que a padronização das mesmas é fator fundamental para a confiabilidade dos resultados. Nesta tese, foram avaliadas as condições para realização dos estudos de permeabilidade através de membranas de células Caco-2 para a rifampicina, principal fármaco utilizado no tratamento da tuberculose. Para tanto, foram investigados fatores tais como a citotoxicidade da rifampicina em diferentes concentrações, a influência da concentração do fármaco sobre a permeabilidade, do pH de realização dos experimentos e da presença de proteínas do muco intestinal, além da influência de proteínas plasmáticas. Foi também investigado o potencial indutor da rifampicina sobre a expressão da glicoproteína-P (Pgp) e seu impacto na permeabilidade da própria rifampicina. Os estudos foram desenvolvidos utilizando membranas de células Caco-2 provenientes da American Type Culture Collection (ATCC) cultivadas em placas Transwel®, a quantificação da fração permeada foi por cromatografia líquida de alta eficiência com métodos validados. A análise da indução da expressão da Pgp foi realizada por PCR-RT. Demonstrou-se que as concentrações da rifampicina (10,0; 25,0 e 50,0 µg/mL) não ocasionaram danos às células Caco-2 no estudo de citotoxicidade pela técnica que emprega o sal do brometo de 3-(4,5-dimetil-2-tiazoli)-2,5-difenil-2H-tetrazólio (MTT). As concentrações de rifampicina (5,0; 10,0 e 25,0 µg/mL) não resultaram em valores estatisticamente diferentes de permeabilidade aparente (Papp) em células Caco-2 nas condições do estudo. A rifampicina apresentou valor de Papp significativamente maior em pH 6,8 dentre os valores de pH avaliados (5,8 ; 6,8; 7,4). A presença de muco simulado e de soro fetal bovino não resultou em valores de permeabilidade significativamente distintos do resultado obtido sem a sua adição ao experimento. A expressão da Pgp em células Caco-2 é induzida pela adição da rifampicina (10µg/mL), ocasionando diminuição da sua permeabilidade por mecanismo de efluxo. Pelos resultados de permeabilidade obtidos em todas as condições avaliadas, a rifampicina pode ser considerada um fármaco de alta permeabilidade de acordo com o Sistema de Classificação Biofarmacêutica. / The permeability through the intestinal epithelium has become an important aspect to be determined in evaluations involving drugs and pharmaceutical products. The most common technique for this determination in vitro is one that uses the culture of Caco-2 cells. Nevertheless, the conditions for carrying out such experiments are still questionable, since the standardization of them is essential to the reliability of the results. In this thesis, we evaluate the conditions for the studies of permeability of rifampicin through membranes of Caco-2 cells, the main drug used in the treatment of tuberculosis. To this end, we examined factors such as cytotoxicity of rifampicin at different concentrations, the influence of drug concentration on the permeability, as well as the pH of the experiments, the presence of proteins of intestinal mucus, and the influence of plasma proteins. It was also investigated the potential of rifampicin on the expression of P-glycoprotein (Pgp) and its impact on the permeability of rifampicin itself. The studies were developed using membranes of Caco-2 cells from American Type Culture Collection (ATCC) grown on plates Transwel®, and the quantification of the fraction of drug permeated was obtained by high performance liquid chromatography with validated methods. The analysis of induction of expression of Pgp was performed by RT-PCR. It was demonstrated that the concentrations of rifampicin (10,0; 25,0 and 50,0 µg/mL) did not cause damage to Caco-2 cells in the study of the cytotoxicity technique that uses a bromide salt of 3 - (4,5-dimethyl-2 - thiazol) -2,5-diphenyl-2H-tetrazolium (MTT). The concentrations of rifampicin (5,0; 10,0 and 25,0 &#181g/mL) did not result in statistically different values of apparent permeability (Papp) in Caco-2 cells under the conditions of the study. Rifampicin showed a value of Papp significantly higher at pH 6.8 in comparison with other measured pH values (5,8 and 7,4). The presence of mucus simulated and fetal calf serum did not result in permeability values significantly different from the result obtained without its addition to the experiment. The expression of P-gp in Caco-2 cells is induced by the addition of rifampicin (10 µg/ml), decreasing its permeability by efflux mechanism. Taking into account the results of permeability obtained in all conditions, the rifampicin can be considered a high permeability drug according to the biopharmaceutical classification system.

Malgré la disponibilité d’un traitement curatif et un vaccin largement utilisé, l’OMS estime qu’approximativement un tiers de la population mondiale est infectée par Mycobacterium tuberculosis, l’agent étiologique de la tuberculose, et qu’environ 2 millions de personnes en meurent chaque année. La compréhension de l’épidémiologie de la tuberculose et les actions de contrôle de la maladie ont été, récemment, compliquées par l’émergence de bacilles tuberculeux résistants aux antibiotiques et par la synergie fournie par la co-infection avec le VIH. Une tendance alarmante pour la santé publique est l’émergence de souches résistantes à plusieurs antibiotiques (multi-résistantes, MDR), définies comme des isolats résistants au moins à l’isoniazide (INH) et la rifampicine (RIF), les deux agents anti-tuberculeux les plus puissants.<p><p>La sélection de mutants résistants se produit chez le patient lorsque les taux d’antibiotiques présents dans le corps sont sub-thérapeutiques ou lorsque la thérapie est inappropriée. Un des facteurs favorisant est l’exceptionnelle durée de la chémothérapie. Le besoin de maintenir des taux élevés d’antibiotiques pendant des mois, combiné avec la toxicité inhérente des agents, résultent en une observance incomplète du traitement par le patient et le risque d’acquérir des résistances. La résistance aux antibiotiques chez M. tuberculosis résulte d’altérations dans des gènes chromosomiques spécifiques. Les causes génétiques de la résistance ont été définies pour certains antibiotiques bien que plusieurs inconnues persistent. <p><p>Le présent travail a consisté en l’étude du problème de la résistance aux antibiotiques anti-tuberculeux par différentes approches :l’analyse génétique des mécanismes de résistance, l’évaluation de l’activité thérapeutique de nouvelles molécules et la caractérisation du profil de résistance de souches cliniques. <p><p>L’acide p-aminosalicylique (PAS) est un antibiotique bactériostatique de deuxième ligne dont le mécanisme d'action sur le bacille tuberculeux est incompris. Récemment, en utilisant la mutagenèse par transposon, la résistance au PAS fut associée à des mutations de la thymidylate synthase encodée par le gène thyA. Suite à cette découverte, nous avons entrepris une étude moléculaire de souches cliniques et de mutants spontanés résistants au PAS. Des mutations du gène thyA furent identifiées chez seulement 37% des souches. En tout, vingt-quatre mutations différentes furent identifiées dans le gène thyA. Les séquences nucléotidiques de cinq autres gènes de la voie de synthèse du folate et de la thymine (dfrA, folC, folP1, folP2, et thyX) ainsi que de 3 gènes encodant des N-acétyltransférases (nhoA, aac1 et aac2) furent également analysées mais aucune mutation associée à la résistance au PAS n’a pu être mise en évidence. L’utilisation de techniques bioinformatiques de prédiction structurelle révèle que les mutations identifiées affectent soit la structure soit le site fonctionnel de ThyA. L’étude des profils de croissance des organismes résistants au PAS nous permit de constater que les organismes porteurs d’une mutation de la protéine ThyA présentent un profil de croissance constant en présence de concentrations croissantes de PAS. Les organismes résistants au PAS possédant une protéine ThyA sauvage répondent, quant à eux, aux concentrations croissantes de PAS de façon dose-dépendante, indiquant que le(s) mécanisme(s) alternatif(s) de résistance au PAS est (sont) dose-dépendant(s).<p><p>La thymidylate synthase est également une des cibles du 5-fluorouracil (5-FU), l’agent chimiothérapeutique le plus largement utilisé pour le traitement du cancer colorectal avancé. Etant donné l’augmentation du nombre de souches résistantes de M. tuberculosis, de nouveaux composés anti-tuberculeux sont nécessaires de façon urgente. Ici, nous avons évalué l’efficacité in vitro et in vivo du 5-FU sur M. tuberculosis. La concentration minimale inhibitrice du 5-FU fut déterminée sur une collection de souches cliniques sensibles et multi-résistantes ainsi que sur des mutants spontanés résistants au PAS. Tous les isolats montrèrent une sensibilité au 5-FU à des concentrations allant de 0.4 à 1.8 µg/ml, et ce indépendamment de leur profil de sensibilité/résistance aux agents anti-tuberculeux actuels. Les études in vivo du 5-FU (sur un modèle murin de tuberculose active) montrèrent une efficacité de celui-ci durant les deux premières semaines de traitement puis une perte d’activité à la troisième semaine, vraisemblablement engendrée par les effets secondaires du 5-FU.<p><p>L’éthionamide (ETH) est un autre antibiotique de deuxième ligne dont l’utilisation est limitée aux tuberculoses multi-résistantes étant donné les effets secondaires qu’il engendre. Ces dernières années, les études ont montré que l’ETH est un pro-médicament, transformé en forme active par l’enzyme monooxygénase EthA dont l’expression est contrôlée par le répresseur transcriptionnel EthR. Notre étude décrit l’élaboration d’inhibiteur d’EthR capable d’augmenter la sensibilité de M. tuberculosis à l’ETH suite à l’amélioration de son activation. Les composés synthétisés et sélectionnés pour leur capacité à inhiber l’interaction EthR-ADN furent co-cristallisés avec EthR. Les structures tridimensionnelles des complexes furent utilisées pour la synthèse d’analogues capables d’améliorer la puissance de l’ETH en culture. Les molécules les plus prometteuses furent testées sur un modèle murin de tuberculose. Pour un des inhibiteurs d’EthR testés, nous avons montré que sa co-administration avec l’ETH permet une réduction de la dose d’ETH utilisée de 3 fois, pour l’obtention d’une même réduction de charge mycobactérienne pulmonaire. Ce travail démontre la possibilité d’augmenter l’index thérapeutique de l’éthionamide en agissant pharmacologiquement sur le mécanisme régulateur de son activation.<p><p>Dans certaines régions du monde, le problème de la multi-résistance devient très présent. Nous avons étudié l’état de la situation à Mourmansk (Fédération russe), une région à haute incidence de tuberculose. La résistance aux antibiotiques et l’épidémiologie moléculaire de la tuberculose furent étudiées sur des isolats collectés en 2003 et 2004 dans cette région. Une extrêmement haute prévalence de tuberculose multi-résistante (MDR-TB) fut constatée à la fois pour les nouveaux cas (primaires) (26%) et les cas précédemment traités (72.9%). Le typage des souches MDR primaires révèle une appartenance au génotype Beijing pour la plupart des isolats (79.8%) et l’homogénéité génétique des souches suggère une transmission active au sein de la population. L’analyse moléculaire des gènes impliqués dans la résistance à l’INH et à la RIF montre la présence des mutations katG codon 315 et rpoB codon 531 chez, respectivement, 98,2% et 76,3% des isolats MDR-TB primaires. La haute fréquence de ces mutations « communes » suggère la possible utilisation de tests moléculaires ciblant spécifiquement ces mutations pour détecter rapidement la plupart des cas de MDR-TB.<p><p>Nos travaux illustrent les différentes voies à suivre pour maitriser le problème de la résistance aux antibiotiques :l’élucidation des mécanismes de résistance, le développement de nouveaux médicaments et la détection rapide des cas de résistance.<p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

This study has been concerned with the design and synthesis of A TP analogues with the potential to act as inhibitors of glutamine synthetase - a novel target for therapeutic intervention in the treatment of tuberculosis. Using a structural -analogy approach, various 3-indolylalkanoic acid, benzimidazole and pyrazolo[3,4-dJpyrimidine derivatives have been prepared and characterized. Alkylation of the heterocyclic bases using 4-(bromomethyl)-2,2-dimethyl-1 ,3-d ioxolane, 2-(bromomethoxy)ethyl acetate and 2-(chloroethoxy)ethanol in the presence of either NaH or BulOK afforded the corresponding N-alkylated derivatives of benzimidazole and 4-aminopyrazolo[3,4-dJpyrimidine (4-APP). Similar reactions with 3-indo lylalkanoic esters resulted in O-alkyl cleavage with the formation of new esters. Alkylation of benzimidazole with allyl bromide, 4-bromobutene and 2-methylbut-2-ene has also been shown to afford the corresponding l-alkenylbenzimidazoles in moderate to excellent yield (43-96%). Subsequent oxidation of these products using CTAP, gave the dihydroxy derivatives in poor to good yields (26-77%). Phosphorylation of various hydroxy derivatives of benzimidazole and 4-APP has been achieved using diethyl chlorophosphate to afford the corresponding monophosphate and 1,2-diphosphate esters. Glycosylation of each of the heterocyclic bases has been successfully achieved using 1,2,3,4,6-penta-O-acetyl-D-glucopyranose and SnCl4 in acetonitri le, while methanolysis of the resulting tetraacetates, using methanolic NaOMe, afforded the hydroxy derivatives in good yield (50-70%). Various 1- and 2-dimensional NMR spectroscopic methods (e.g., IH, 13C, lip, COSY, HSQC and HMBC) have been used to confirm the structures of the synthesized A IP analogues. The application of NMR prediction programmes has been explored, permitting assessment of their agreement with the experimental data and confirmation of assigned structures. High-resolution electron impact (EI) mass spectrometric data have been used to explore the mass fragmentation pathways exhibited by selected derivatives, and certain common fragmentations have been identified. Molecular modelling of selected products as potential glutamine synthetase ligands has been performed on the Accelrys Cerius2 platform, and interactive receptor-ligand docking studies have been conducted using the Ligand-Fit module. These studies have revealed possible hydrogen-boding interactions between the selected analogues and various amino acid residues in the glutamine synthetase active site.

O objetivo desse trabalho foi construir o fago recombinante D29::gfp e testar a sua utilização como um agente revelador da viabilidade bacilar na determinação da concentração inibitória mínima (GIM) aos principais fármacos administrados no tratamento da tuberculose. O fago recombinante contém o promotor hsp70 e o gene da proteína verde fluorescente (gfp) e foi construído através da restrição pela Spe I em uma região intergênica próxima a extremidade coesiva direita no genoma do fago D29. O promotor hsp70 e gfp clonados no pYL GFP foram amplificados pela PCR utilizando iniciadores com sítios para Spe I. O DNA do fago D29 digerido pela Spe I foi ligado com o fragmento hsp 70- gfp empregando a T 4 DNA ligase e os produtos da reação de ligação foram transformados de acordo com o protocolo de encapsulamento. A infecção do M.smegmatis com esse fago recombinante induziu a expressão da proteína verde fluorescente (GFP). Para avaliar o uso do fago recombinante em teste de sensibilidade aos fármacos anti-tuberculose, 100 isolados clínicos foram testados quanto ao perfil de sensibilidade a isoniazida (H), rifampicina (R), estreptomicina (S) e etambutol (E), utilizando o método das proporções em Lowenstein-Jensen (L-J), técnica em microplaca com a resazurina (REMA) e técnica em microplaca com D29::gfp. Os resultados do REMA demonstraram que 30 isolados clínicos foram sensíveis à H e 58 (66 %) isolados clínicos foram resistentes, dentre os quais a CIM foi 1 &#181;g/mL ou maior para 41 (71 %). A CIM da R para 49 (56%) dos isolados clínicos resistentes foi de 0,5 &#181;g/mL para 17 (35%). A CIM da S para 33 (37%) dos isolados clínicos resistentes foi de 2 &#181;g/mL para 13 (40%) e CIM do E para 34 (39%) dos isolados clínicos resistentes foi de 16 &#181;g/mL ou maior para 19 (56%). A caracterização molecular pela PCR IS6110 identificou 88 isolados clínicos como M.tuberculosis e pelo PRA hsp65, sete isolados clínicos foram M.kansasii, quatro foram M.abscessus e um M.szulgai. Após empregar o fago recombinante como um agente indicador da viabilidade bacilar para testar a atividade dos fármacos anti-tuberculose conclui-se que a expressão da proteína verde fluorescente foi inespecífica e não reprodutiva, não justificando o seu uso para determinar a CIM para os principais fármacos administrados no tratamento da tuberculose. / The objective of this work was to construct the recombinant phage D29::gfp and to use this phage as an indicator agent of cell viability in a minimal inhibitory concentration (MIC) assay for the mains drugs used for tuberculosis treatment. The recombinant phage contains the mycobacteria-specific hsp70 promoter controlling the green fluorescent protein gene (gfp) and was constructed by Spe I restriction in the intergenic region next to the right cohesive termini of the D29 phage genome. An hsp 70 promoter and gfp previously cloned in p YL GFP was amplified by PCR using primers with Spe I sites. The Spe I-restricted D29 phage DNA was ligated with the hsp 70-gfp fragment using T4 DNA ligase and ligated product was transformed using the packing protocol. Infection of M.smegmatis with this recombinant phage indicated the expression of green f1uorescent protein (GFP). To use the recombinant phage for assaying the activity of anti-TB drugs, 100 clinical isolates was tested for susceptibility to isoniazid (H), rifampicin (R), streptomycin (S), and ethambutol (E) using both the proportion method on Lowenstein-Jensen (L-J) medium, resazurin microtiter assay plate (REMA), as well as a microplate assay using D29::gfp. The REMA plate method showed that 30 clinical isolates were susceptible to H and 58 (66%) clinical isolates were resistant, where the MICs were 1 &#181;g/mL or higher for 41 (71%). The R MICs for 49 (56%) resistant clinical isolates were 0,5 &#181;g/mL for 17 (35%). The S MICs for 33 (37%) resistant clinical isolates were 2 &#181;g/mL for 13 (40%) and E MICs for 34 (39%) resistant clinical isolates were 16 &#181;g/mL or higher for 19 (56%). Molecular characterization by PCR IS6110 showed that 88 clinical isolates were M.tuberculosis and by PRA hsp65 were seven clinical isolates were M.kansasii and four was M.abscessus, and one M.zulgai. After using the recombinant phage as an indicator agent of cell viability for assaying the activitity of anti-TB drugs we can conclude that the expression of green fluorescent protein was non-specific and not reproducible, rendering it not useful for the determination of the MIC of the principal drugs used for the treatment of tb.

O objetivo desse trabalho foi construir o fago recombinante D29::gfp e testar a sua utilização como um agente revelador da viabilidade bacilar na determinação da concentração inibitória mínima (GIM) aos principais fármacos administrados no tratamento da tuberculose. O fago recombinante contém o promotor hsp70 e o gene da proteína verde fluorescente (gfp) e foi construído através da restrição pela Spe I em uma região intergênica próxima a extremidade coesiva direita no genoma do fago D29. O promotor hsp70 e gfp clonados no pYL GFP foram amplificados pela PCR utilizando iniciadores com sítios para Spe I. O DNA do fago D29 digerido pela Spe I foi ligado com o fragmento hsp 70- gfp empregando a T 4 DNA ligase e os produtos da reação de ligação foram transformados de acordo com o protocolo de encapsulamento. A infecção do M.smegmatis com esse fago recombinante induziu a expressão da proteína verde fluorescente (GFP). Para avaliar o uso do fago recombinante em teste de sensibilidade aos fármacos anti-tuberculose, 100 isolados clínicos foram testados quanto ao perfil de sensibilidade a isoniazida (H), rifampicina (R), estreptomicina (S) e etambutol (E), utilizando o método das proporções em Lowenstein-Jensen (L-J), técnica em microplaca com a resazurina (REMA) e técnica em microplaca com D29::gfp. Os resultados do REMA demonstraram que 30 isolados clínicos foram sensíveis à H e 58 (66 %) isolados clínicos foram resistentes, dentre os quais a CIM foi 1 &#181;g/mL ou maior para 41 (71 %). A CIM da R para 49 (56%) dos isolados clínicos resistentes foi de 0,5 &#181;g/mL para 17 (35%). A CIM da S para 33 (37%) dos isolados clínicos resistentes foi de 2 &#181;g/mL para 13 (40%) e CIM do E para 34 (39%) dos isolados clínicos resistentes foi de 16 &#181;g/mL ou maior para 19 (56%). A caracterização molecular pela PCR IS6110 identificou 88 isolados clínicos como M.tuberculosis e pelo PRA hsp65, sete isolados clínicos foram M.kansasii, quatro foram M.abscessus e um M.szulgai. Após empregar o fago recombinante como um agente indicador da viabilidade bacilar para testar a atividade dos fármacos anti-tuberculose conclui-se que a expressão da proteína verde fluorescente foi inespecífica e não reprodutiva, não justificando o seu uso para determinar a CIM para os principais fármacos administrados no tratamento da tuberculose. / The objective of this work was to construct the recombinant phage D29::gfp and to use this phage as an indicator agent of cell viability in a minimal inhibitory concentration (MIC) assay for the mains drugs used for tuberculosis treatment. The recombinant phage contains the mycobacteria-specific hsp70 promoter controlling the green fluorescent protein gene (gfp) and was constructed by Spe I restriction in the intergenic region next to the right cohesive termini of the D29 phage genome. An hsp 70 promoter and gfp previously cloned in p YL GFP was amplified by PCR using primers with Spe I sites. The Spe I-restricted D29 phage DNA was ligated with the hsp 70-gfp fragment using T4 DNA ligase and ligated product was transformed using the packing protocol. Infection of M.smegmatis with this recombinant phage indicated the expression of green f1uorescent protein (GFP). To use the recombinant phage for assaying the activity of anti-TB drugs, 100 clinical isolates was tested for susceptibility to isoniazid (H), rifampicin (R), streptomycin (S), and ethambutol (E) using both the proportion method on Lowenstein-Jensen (L-J) medium, resazurin microtiter assay plate (REMA), as well as a microplate assay using D29::gfp. The REMA plate method showed that 30 clinical isolates were susceptible to H and 58 (66%) clinical isolates were resistant, where the MICs were 1 &#181;g/mL or higher for 41 (71%). The R MICs for 49 (56%) resistant clinical isolates were 0,5 &#181;g/mL for 17 (35%). The S MICs for 33 (37%) resistant clinical isolates were 2 &#181;g/mL for 13 (40%) and E MICs for 34 (39%) resistant clinical isolates were 16 &#181;g/mL or higher for 19 (56%). Molecular characterization by PCR IS6110 showed that 88 clinical isolates were M.tuberculosis and by PRA hsp65 were seven clinical isolates were M.kansasii and four was M.abscessus, and one M.zulgai. After using the recombinant phage as an indicator agent of cell viability for assaying the activitity of anti-TB drugs we can conclude that the expression of green fluorescent protein was non-specific and not reproducible, rendering it not useful for the determination of the MIC of the principal drugs used for the treatment of tb.