Interação entre especialidades: miocardiopatia dilatada e neoplasia de mama HER2 positiva

O progresso no conhecimento dos mecanismos da doença e suas potenciais possibilidades de tratamento, têm com o incremento da pesquisa básica, trazido a algumas situações inusitadas. Como quando algo observado em uma situação específica, definida na prática clínica, pode ser transportado para o laboratório, instigando a investigação de uma provável terapêutica em uma doença não relacionada e fazendo o caminho inverso da "bench-to-bedside". Nos últimos anos, o uso de um anticorpo monoclonal, o trastuzumabe, mostrou-se imprescindível no tratamento das neoplasias de mama com amplificação/superexpressão de HER2, com ganho de sobrevida significativo nos contextos adjuvante e terapêutico. A observação da ocorrência de cardiotoxicidade induzida pelo trastuzumabe, assim como a identificação dos mecanismos relacionados a esse efeito colateral, possibilitaram a pesquisa desses mesmos fatores na miocardiopatia dilatada, de uma forma muito interessante.

Determinação de herbicidas usados no cultivo de arroz irrigado na região sul do estado de Santa Catarina através da SPME-GC-ECD

Evaluation of the pollution by the herbicides alachlor, propanil and atrazine in water samples from four rivers in the cities of Turvo and Meleiro, south of Santa Catarina State, was made using the SPME-GC-ECD method. The proposed method was optimized and validated. The correlation coefficients were higher than 0.997 and linear ranges of the analytical curves were 0.1-4; 0.1-2.5 and 0.1-5 µg L-1 for atrazine, alachlor and propanil, respectively. The herbicides were quantified by GC-ECD and identified by GC-MS. Both of the selected rivers presented contamination by at least one of the studied herbicides.

Loss of PTEN expression and AKT activation in HER2-positive breast carcinomas

PURPOSE: To examine the expression of AKT and PTEN in a series of HER2-positive primary invasive breast tumors using immunohistochemistry, and to associate these expression profiles with classic pathologic features such as tumor grade, hormone receptor expression, lymphatic vascular invasion, and proliferation.METHODS: A total of 104 HER2-positive breast carcinoma specimens were prepared in tissue microarrays blocks for immunohistochemical detection of PTEN and phosphorylated AKT (pAKT). Original histologic sections were reviewed to assess pathological features, including HER2 status and Ki-67 index values. The associations between categorical and numeric variables were identified using Pearson's chi-square test and the Mann-Whitney, respectively.RESULTS: Co-expression of pAKT and PTEN was presented in 59 (56.7%) cases. Reduced levels of PTEN expression were detected in 20 (19.2%) cases, and these 20 tumors had a lower Ki-67 index value. In contrast, tumors positive for pAKT expression [71 (68.3%)] were associated with a higher Ki-67 index value.CONCLUSION: A role for AKT in the proliferation of HER2-positive breast cancers was confirmed. However, immunohistochemical detection of PTEN expression did not correlate with an inhibition of cellular proliferation or control of AKT phosphorylation, suggesting other pathways in these mechanisms of control.

Chromogenic in situ hybridization compared with other approaches to evaluate HER2/neu status in breast carcinomas

Human epidermal growth factor receptor 2 (HER2) has been evaluated in breast cancer patients to identify those most likely to benefit from herceptin-targeted therapy. HER2 amplification, detected in 20-30% of invasive breast tumors, is associated with reduced survival and metastasis. The most frequently used technique for evaluating HER2 protein status as a routine procedure is immunohistochemistry (IHC). HER2 copy number alterations have also been evaluated by fluorescence in situ hybridization (FISH) in moderate immunoexpression (IHC 2+) cases. An alternative procedure to evaluate gene amplification is chromogenic in situhybridization (CISH), which has some advantages over FISH, including the correlation between HER2 status and morphological features. Other methodologies have also been used, such as silver-enhanced in situ hybridization (SISH) and quantitative real-time RT-PCR, to determine the number of HER2 gene copies and expression, respectively. Here we will present a short and comprehensive review of the current advances concerning HER2 evaluation in human breast cancer.

Metronomic chemotherapy in the neoadjuvant setting: results of two parallel feasibility trials (TraQme and TAME) in patients with HER2+ and HER2− locally advanced breast cancer

Neoadjuvant chemotherapy has practical and theoretical advantages over adjuvant chemotherapy strategy in breast cancer (BC) management. Moreover, metronomic delivery has a more favorable toxicity profile. The present study examined the feasibility of neoadjuvant metronomic chemotherapy in two cohorts [HER2+ (TraQme) and HER2− (TAME)] of locally advanced BC. Twenty patients were prospectively enrolled (TraQme, n=9; TAME, n=11). Both cohorts received weekly paclitaxel at 100 mg/m2 during 8 weeks followed by weekly doxorubicin at 24 mg/m2 for 9 weeks in combination with oral cyclophosphamide at 100 mg/day (fixed dose). The HER2+ cohort received weekly trastuzumab. The study was interrupted because of safety issues. Thirty-six percent of patients in the TAME cohort and all patients from the TraQme cohort had stage III BC. Of note, 33% from the TraQme cohort and 66% from the TAME cohort displayed hormone receptor positivity in tumor tissue. The pathological complete response rates were 55% and 18% among patients enrolled in the TraQme and TAME cohorts, respectively. Patients in the TraQme cohort had more advanced BC stages at diagnosis, higher-grade pathological classification, and more tumors lacking hormone receptor expression, compared to the TAME cohort. The toxicity profile was also different. Two patients in the TraQme cohort developed pneumonitis, and in the TAME cohort we observed more hematological toxicity and hand-foot syndrome. The neoadjuvant metronomic chemotherapy regimen evaluated in this trial was highly effective in achieving a tumor response, especially in the HER2+ cohort. Pneumonitis was a serious, unexpected adverse event observed in this group. Further larger and randomized trials are warranted to evaluate the association between metronomic chemotherapy and trastuzumab treatment.

Detecção de cardiotoxicidade subclínica induzida por trastuzumabe em portadoras de câncer de mama

FUNDAMENTO: O trastuzumabe (TZB) é um anticorpo monoclonal humanizado recombinante usado no tratamento do câncer de mama HER2-positivo, com reconhecida cardiotoxicidade associada. Os métodos para sua detecção subclínica precoce não estão bem estabelecidos. OBJETIVO: Avaliar a cardiotoxicidade induzida por TZB em pacientes (pts) portadoras de câncer de mama acompanhadas por um período de 3 meses de tratamento. MÉTODOS: Estudo prospectivo de pts consecutivas em tratamento com TZB para câncer de mama HER2-positivo avançado, admitidas entre maio e setembro de 2010. Foram comparados dados clínicos, laboratoriais e ecocardiográficos antes da introdução de TZB e 3 meses após o início do tratamento com a droga. Foram estudadas a deterioração da função sistólica do ventrículo esquerdo (segundo critérios do Comitê de Avaliação e Revisão Cardíaca) e a função diastólica (classificação da Sociedade Americana de Ecocardiografia). RESULTADOS: Estavam disponíveis dados de 51 pacientes, cuja idade média era de 55,4±14,0 anos. Nenhuma paciente apresentou insuficiência cardíaca sintomática no terceiro mês. Não houve diferenças na fração de ejeção do ventrículo esquerdo (FEVE) aos 3 meses (69,3 ± 7,4 contra 67,1 ± 6,5%, p > 0,05), tendo sido observada redução em 57,9% pts (em apenas uma a FEVE foi < 55%). Houve aumento significativo da relação E/e' (3,9 ± 0,8 contra 8,0 ± 1,9, p < 0,001) devido a uma redução da velocidade e' (0,19 ± 0,02 contra 0,10 ± 0,03, p < 0,001). Os demais parâmetros diastólicos permaneceram inalterados. Tanto o volume atrial esquerdo quanto o ventricular esquerdo permaneceram inalterados. Não houve aumento dos níveis de peptídeo natriurético tipo pró-B N-terminal. Durante o período de seguimento, duas pacientes morreram e duas foram internadas, todas por causas não cardiovasculares. CONCLUSÃO: Durante os três primeiros meses de tratamento com TZB, nenhuma das pacientes apresentou insuficiência cardíaca franca ou deterioração significativa da FEVE. Detectou-se redução significativa da relação e/e', porém sem alterações importantes dos parâmetros de carga e da FEVE.

Avaliação de foco epileptogênico do lobo temporal: correlação entre SPECT ictal, ressonância magnética e ressonância magnética com espectroscopia de prótons

O objetivo deste trabalho foi determinar a existência de concordância entre os métodos radioisotópico e radiológico e, em caso positivo, avaliar a utilidade do SPECT ictal na determinação do foco epileptogênico. Foram realizados SPECT ictal, ressonância magnética (RM) e ressonância magnética com espectroscopia de prótons (RME) em seis pacientes com epilepsia de lobo temporal refratária. O SPECT ictal foi realizado após a retirada das drogas antiepilépticas durante monitoramento por vídeo-EEG, utilizando-se o 99mTc-ECD, administrado aos pacientes no início da crise. As imagens de RM foram obtidas em T1, T2 e FLAIR, com cortes de 3 e 5 mm de espessura, e a RME foi realizada com técnica PRESS, com voxel único posicionado no hipocampo, bilateralmente. A análise estatística incluiu os valores de Kappa (k), erro-padrão (ep) e o nível de significância (p) para a lateralização do foco. Os achados foram analisados com base na localização por EEG da descarga ictal, no tempo de duração da crise (109-280 s; média: 152 s) e no tempo de administração do traçador (30-262 s; média: 96 s). Obtivemos dados correlatos em quatro pacientes (67%), com valores de k = 0,67, ep = 0,38 e p = 0,041. Concluímos que existe concordância entre SPECT ictal, RM e RME, e a utilidade do procedimento radioisotópico está relacionada aos casos em que o EEG não é diagnóstico e quando há discordância ou indefinição diagnóstica na análise comparativa entre EEG, RM e RME.

Aplicação de SPME (Solid Phase Micro-Extraction) na análise de águas potáveis de três localidades do estado de São Paulo

The technique of solid phase microextraction (SPME) was used for the extraction of halogenated contaminants of water samples from three cities of the State of São Paulo and the extracts were submitted to gas chromatographic analysis with electron capture detection (GC-ECD). In the samples of water collected at the city of São Paulo the detected level of trihalomethanes (THM) expressed as the sum of chloroform, dibromochloromethane and dichlorobromomethane, were higher than the permissible limit established by the Brazilian regulation. In the samples collected at the two other cities the level of any of the three THM remained below the sensitivity of the ECD.

Extração em fase sólida (SPE) e micro extração em fase sólida (SPME) de piretróides em água

The pyrethroids bifenthrin, permethrin, cypermethrin and deltamethrin were extracted by solid phase extraction (SPE) and solid phase microextraction (SPME). The analysis were performed on a gas chromatograph with electron capture detection (GC-ECD). Octadecil Silano-C18, Florisil and Silica stationary phases were studied for SPE. Better results were obtained for Florisil which gave recoveries from 80% to 108%. Pyrethroids extraction by SPME showed a linear response and a detection limit of 10 pg ml-1. Although the data showed that the two extraction methods were able to isolate the pesticide residues from water samples, the best results were obtained by using SPME which is more sensitive, faster, cheeper, being a more useful technique for the analysis of pyrethroids in drinking water.

Distribuição de compostos organoclorados nas águas e sedimentos da bacia do rio Piracicaba/SP - Brasil

The great utilization of synthetic and persistent xenobiotic cumulative compounds is the main causes of the deterioration of aquatic ecosystems. The one of objective of this work was the determination of the organochlorine levels in the Piracicaba river basin, situated at the center of São Paulo state. Four PCBs congeners, PCP and HCB were determined by GC-ECD in two different matrices: water and sediments. The pattern of the compound distribution indicated a dominance of PCP, HCB and PCB-200. The results indicated contamination in the sampling points located in Campinas, Piracicaba, Santa Bárbara d'Oeste and Sumaré cities.

Investigation of the occurrence of pesticide residues in rural wells and surface water following application to tobacco

In this work the exposure of wells and surface water to pesticides, commonly used for tobacco cropping, was assessed. Water consumption wells and surface water flows were sampled at different times. After a preconcentration step with solid phase extraction (SPE), the selected pesticides were determined by gas chromatography with electron capture detection (GC-ECD) or high performance liquid chromatography with diode array detection (HPLC-DAD). No pesticides were detected in the well water samples and surface water flow in the winter season. However, in the spring and summer higher concentrations of chlorpyrifos and imidacloprid were found in the water source samples. Atrazine, simazine and clomazone were also found. The occurrence of pesticides in collected water samples was related with the application to tobacco.

Otimização e validação intralaboratorial de método para análise de resíduos de cloranfenicol em leite caprino por cromatografia gasosa com detecção por captura de elétrons (CG/DCE)

The presence of chloramphenicol residues in goat milk can cause toxic effects in the population. The present work consists of the optimization and validation of analytical methodology for determination of chloramphenicol residues in goat milk by GC/ECD. The extraction was made with ethyl acetate and the clean-up with SPE-C18. The identification was made by comparison of retention time and GC/MS, and the quantification by external standard. The method was selective, linearity (0.998), precise (5.8-13.4%), exact (69.87-73.71%) and robust. The LOD and LOQ of method were 0.030 and 0.10 μg/kg, respectively. The method was efficiently for analysis of chloramphenicol in goat milk.

Desenvolvimento de métodos analíticos para determinação de agrotóxicos em sedimentos por cromatografia gasosa monodimensional e bidimensional abrangente com micro detector de captura de elétrons

The development of analytical methods for determination of eight pesticides of different chemical classes (trichlorfon, propanil, fipronil, propiconazole, trifloxystrobin, permethrin, difenoconazole and azoxystrobin) in sediments with gas chromatography-micro-electron capture detector (GC/µECD) and comprehensive two-dimensional gas chromatography with micro-electron capture detector (GCxGC/µECD) is described. These methods were applied to real sediment samples, and the best results were obtained using a 5% diphenyl-methylpolysiloxane column for 1D-GC. For GCxGC the same column was employed in the first dimension and a 50%-phenyl-methylpolysiloxane stationary phase was placed in the second dimension. Due to the superior peak capacity and selectivity of GCxGC, interfering matrix peaks were separated from analytes, showing a better performance of GCxGC.

Influência dos constituintes químicos dos extratos de diferentes matrizes na resposta cromatográfica de agrotóxicos

Multiresidue methods for pesticides monitoring by GC are commonly employed, however, it is well known that the presence of compounds of the matrix introduces errors during the quantiûcation. The main consequence of matrix effect is an increasing or decreasing analyte signal after the GC saturation with extracts of matrix. In this paper, the influence of constituents of nine matrices on the quantification of the four pesticides by GC-ECD was studied. Variation of signal was evaluated by PCA and HCA, and results showed that the constituents of tomato increased the signal (until 300%), while extracts of apple decreased (until -20%). Variation the analyte signal in the presence of the matrix in respect to the same analyte in solvent (standard solution) also was observed, mainly for liver extract (until 270%).

Determinação simultânea de trialometanos e agrotóxicos em água por cromatografia gasosa

A method for simultaneous analysis of trihalomethanes and organochloride and pyrethroid pesticides in water utilizing SPME-HS and GC-ECD was developed. In the optimized method 25 mL of water containing 2% (w/v) Na2HPO4 were heated to 60 °C for 50 min. The fiber (PDMS - 100 μm) was exposed to a headspace for the same period. For all analytes it was found that LOQ < MCL (Maximum Contaminant Level), CV < 20% and r > 0.9. The method was applied to potable and surface water samples. Some trihalomethanes were encountered in potable waters, at levels below the MCL.