Efeito imunomodulador de baixas concentrações de antineoplásicos

Pós-graduação em Patologia - FMB

Efeito protetor in vivo de vacinas de células dendríticas sensibilizadas com RNA de células MC-38 pré-tratadas com agentes antineoplásticos em concentrações efetivas minímas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos anti-inflamatório e antitumoral dos constituintes de Qualea grandiflora no tumor de Ehrlich

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Relationship between head and neck cancer therapy and some genetic endpoints

Head and neck cancer (HNC) is the sixth most common human malignancy worldwide. The main forms of treatment for HNC are surgery, radiotherapy (RT) and chemotherapy (CT). However, the choice of therapy depends on the tumor staging and approaches, which are aimed at organ preservation. Because of systemic RT and CT genotoxicity, one of the important side effects is a secondary cancer that can result from the activity of radiation and antineoplastic drugs on healthy cells. Ionizing radiation can affect the DNA, causing single and double-strand breaks, DNA-protein crosslinks and oxidative damage. The severity of radiotoxicity can be directly associated with the radiation dosimetry and the dose-volume differences. Regarding CT, cisplatin is still the standard protocol for the treatment of squamous cell carcinoma, the most common cancer located in the oral cavity. However, simultaneous treatment with cisplatin, bleomycin and 5-fluorouracil or treatment with paclitaxel and cisplatin are also used. These drugs can interact with the DNA, causing DNA crosslinks, double and single-strand breaks and changes in gene expression. Currently, the late effects of therapy have become a recurring problem, mainly due to the increased survival of HNC patients. Herein, we present an update of the systemic activity of RT and CT for HNC, with a focus on their toxicogenetic and toxicogenomic effects.

Notificações espontâneas de eventos adversos a medicamentos hospitalares: estudo piloto

Introduction: Post-marketing surveillance of drugs aims to detect problems related to safety, effectiveness and quality. The identification of adverse drug events (ADE) is made, mainly, by health professionals´ spontaneous reporting. This method allows risk communication in pharmacovigilance and contributes for market regulation. Objective: To estimate the prevalence of adverse drug reaction (ADR) and the suspicions of therapeutic failure (TF) reported by health professionals; to verify the active principle and type of drugs related to ADE, seriousness, causality, production mechanism and clinical manifestation of the events identified. METHODS: A cross-sectional study was performed in a teaching and public hospital which integrates the Sentinel Hospital Network, in 2008. ADR seriousness was classified according to intensity (mild, moderate, serious and lethal); drugs associated with ADE were categorized according to type (brand name drugs and non-brand name drugs); causality was imputed with Naranjo algorithm and the mechanism of occurrence was analyzed according to Rawlins e Thompson definitions (A or B). Results: There were 103 ADE reports in the period, of which 39 comprised TF and 64 ADR. Nurses reported the most ADE (53.4%). The majority of ADR were classified as type A (82.8%), mild (81.3%), possible (57.8%), according to causality assessment, and related to brand name drugs (20/35). Human immunoglobulin, docetaxel and paclitaxel were the drugs frequently associated with ADR. TF arising from no-brand name drugs (26/29), regarding, mainly, midazolam and ganciclovir. Conclusion: The results of the ADE report contribute for proposition of trigger tools for intensive monitoring of drug safety, as well as for the supplier qualification and for the improvement of quality products.

Stroke as the First Clinical Manifestation of Takayasu's Arteritis

Takayasu's arteritis is a chronic inflammatory disease, and neurological symptoms occur in 50% of cases, most commonly including headache, dizziness, visual disturbances, convulsive crisis, transient ischemic attack, stroke and posterior reversible encephalopathy syndrome. The aim of this study was to report the case of a young Brazilian female with a focal neurological deficit. She presented with asymmetry of brachial and radial pulses, aphasia, dysarthria and right hemiplegia. Stroke was investigated extensively in this young patient. Only nonspecific inflammatory markers such as velocity of hemosedimentation and C-reactive protein were elevated. During hospitalization, clinical treatment was performed with pulse therapy showing improvement in neurological recuperation on subsequent days. In the chronic phase, the patient was submitted to medicated angioplasty of the brachiocephalic trunk with paclitaxel, with significant improvement of the stenosis. At the 6-month follow-up, the neurological exam presented mild dysarthria, faciobrachial predominant disproportionate hemiparesis, an NIHSS score of 4 and a modified Rankin Scale score of 3 (moderate incapacity). In conclusion, Takayasu's arteritis must be recognized as a potential cause of ischemic stroke in young females.

Late clinical outcomes after implantation of drug-eluting stents coated with biodegradable polymers: 3-year follow-up of the PAINT randomised trial

Aims: The long-term clinical performance of drug-eluting stents (DES) coated with biodegradable polymers is poorly known. Methods and results: A total of 274 coronary patients were randomly allocated to paclitaxel-eluting stents, sirolimus-eluting stents, or bare metal stems (2:2:1 ratio). The two DES used the same biodegradable polymers and were identical except for the drug. At three years, the pooled DES population had similar rates of cardiac death or myocardial infarction (9.0% vs. 7.1; p=0.6), but lower risk of repeat interventions (10.0% vs. 29.9%; p<0.01) than controls with bare stents. The cumulative 3-year incidence of definite or probable stent thrombosis in the pooled DES group was 2.3% (first year: 1.8%; second year: 0.4%; third year: zero). There were no significant differences in outcomes between paclitaxel- and sirolimus-eluting stents. Conclusions: The biodegradable-polymer coated DES releasing either paclitaxel or sirolimus were effective in reducing the 3-year rate of re-interventions.

Abbaubare Polymere und Kupfer-katalysierte Reaktionen in Miniemulsion zum Aufbau funktioneller Nanopartikel und –kapseln

Die vorliegende Dissertation zeigte die Anwendung von funktionellen Monomeren um Nanokapseln und Nanopartikeln, die mit der Miniemulsionstechnik hergestellt wurden, eine Vielzahl von Eigenschaften zu verleihen. Hierbei wurden zum einen die Vorteile der Miniemulsionstechnik genutzt, die vor allem eine sehr große Bandbreite von Methoden und Monomeren erlaubt. Zum anderen wurden durch das Design der Monomere neue Polymere mit speziellen Eigenschaften synthetisiert.rnEs wurden abbaubare Polymere synthetisiert, die für Freisetzungs- und Sensorapplikationen verwendet werden konnten. Hierzu wurde durch die Verwendung von Dioxepanen die einfache Synthese von abbaubaren Polyester- und Copolyester-Nanopartikeln ermöglicht. Es konnte weiterhin gezeigt werden, das diese Partikel einen hydrophoben Wirkstoff, Paclitaxel, in eine Zelle schleusen können und ihn dort freisetzen.rnDurch die Verwendung tertiärer Diole konnten funktionale Polyurethane hergestellt werden, die eine einzigartige Abbaubarkeit durch die Zugabe von Säuren oder durch thermische Behandlung aufwiesen. Diese bisher in der Literatur unbekannte Klasse von Polyurethanen kann als Sensormaterial und für Opferschichten verwendet werden. rnWeiterhin wurde die Strukturbildung von Hybridblockcopolymeren in Nanopartikeln und Nanokapseln untersucht. Es wurden hierzu neuartige, aminfunktionalisierte Azoinitiatoren hergestellt, die zu Polyurethan-Makroazoinitiatoren weiterreagiert wurden. rnim Folgenden wurden mittels kontrollierten radikalische Polymerisationstechniken Basis der tertiären Carbamate Polyurethan-ATRP-Makroinitiatoren hergestellt. Diese wurden sowohl in Lösung wie auch in inverser Miniemulsion dazu verwendet, Blockterpolymere herzustellen. Es wurden durch unterschiedliche Miniemulsionstechniken Nanopartikel und Nanokapseln hergestellt, die allesamt eine Mikrophasenseparation zeigten, wodurch Kern-Schale-Strukturen erhalten wurden. rnDie Huisgen-Zykloaddition von Aziden und terminalen Alkinen wurde dazu ausgenutzt, um durch die Verwendung von Dialkinen und Diaziden an der Grenzfläche von Topfen in inverser Miniemulsion eine Polymerisation durchzuführen. Es wurden sehr hohe Polymerisationsgrade bei sehr milden Temperaturen durch den Einsatz eines grenzflächenaktiven Kupferkatalysators erreicht. Die hergestellten Nanokapseln wurden Des Weiteren konnte durch die Herstellung eines neuartigen Dipropiolatesters ein System beschrieben werden, das eine Polymerisation mit Diaziden an der Grenzfläche bei Raumtemperatur eingeht. rnWeiterhin wurde die kupferkatalysierte 1,3-Dipolare Zykloaddition von terminalen Alkinen und Aziden (Clickreaktion) dazu ausgenutzt, um Nanokapseln an der Oberfläche zu funktionalisieren. Hierzu wurden Azid- und Alkin funktionalisierte Monomere verwendet, die in inverser Miniemulsion an der Grenzfläche polymerisiert wurden. Die kovalente Anbindung und der Umsatz der von Alkinfunktionen an der Oberfläche wurde mittels eines fluorogenen Click-Farbstoffes (9-Azidomethylen-Anthracen) untersucht und durch Messung der Fluoreszenzverstärkung konnte eine Aussage über die umgesetzten Alkinfunktionen getroffen werden. rnAzidfunktionen konnten mit einem neuartigen kupferfreien System adressiert werden. Hierbei wurde durch den Umsatz mit Acetylensäure eine sehr einfache Funktionalisierung der Polyurethan-Nanokapseloberfläche mit Carboxylgruppen bei Raumtemperatur ohne den Einsatz von Katalysatoren oder einer inerten Atmosphäre erreicht. Die erfolgreiche Anbindung konnte mit Partikelladungsmessungen sowie Bestimmung des Zetapotentials verifiziert werden.rn

Nanopartikel und Nanokapseln als potentielle Wirkstofftransportsysteme : zelluläre Aufnahme in Leukozyten in peripherem Vollblut und in Zellkultur

Nanopartikuläre Wirkstofftransportsysteme besitzen ein großes Potential für therapeutische Anwendungen. In der vorliegenden Arbeit wurden verschiedene grundlegende Aspekte, die für das erweiterte biologische Verständnis und die Entwicklung weiterer zielgerichteter Strategien zur Pharmakotherapie mit Nanopartikeln und –kapseln notwendig sind, näher untersucht. Experimente zur zellulären Aufnahmefähigkeit (in vitro und ex vivo) wurden mit verschiedenen Nanopartikeln und –kapseln aus diversen Monomeren und biokompatiblen Makromolekülen in immortalisierten Zellkulturlinien, humanen mesenchymalen Stammzellen und Leukozyten durchgeführt und durchflusszytometrisch sowie mittels konfokaler Laser-Raster-Mikroskopie analysiert. Die Einflüsse der Oberflächenfunktionalisierungen der nanopartikulären Systeme, deren toxikologische Effekte sowie der Einfluss von adsorbiertem bovinem Serumalbumin auf funktionalisierten Polystyrol-Nanopartikeln wurden in Bezug auf die zelluläre Aufnahme untersucht.Um die multiplen Wechselwirkungen der Nanopartikel mit Bestandteilen des humanen peripheren Vollblutes zu untersuchen, wurde erfolgreich ein durchflusszytometrisches Analyseverfahren in antikoaguliertem peripherem Vollblut (ex vivo) entwickelt. Es konnte nachgewiesen werden, dass der Einfluss von Calcium-komplexierenden Antikoagulanzien zu einer Verringerung und nicht Li-Heparin zu einer Verstärkung der zellulären Aufnahme von funktionalisierten Polystyrol-Nanopartikeln in diversen Leukozyten führt.Für Folsäure-gekoppelte Hydroxyethylstärke-Nanokapseln (Synthese Frau Dr. Grit Baier) konnte ein größenabhängiger selektiver, Folatrezeptor α vermittelter, zellulärer Aufnahmeweg in HeLa-Zellen nachgewiesen werden.Hydrolysierbare, nicht zytotoxische Polyester-Nanopartikel aus Poly(5,6-Benzo-2-methylen-1,3-dioxepan) (Synthese Herr Dr. Jörg Max Siebert) mit eingebettetem Paclitaxel zeigten in HeLa-Zellen eine vergleichbare pharmakologische Wirkung wie kommerziell erhältliche Paclitaxel-Formulierungen.Die in dieser Arbeit eingesetzten Nanopartikel und Nanokapseln besitzen ein vielfältiges Potential als Wirkstofftransportsysteme. Es zeigte sich, dass Unterschiede bei der Größe, der Größenverteilung, des Polymers sowie der Oberflächenfunktionalisierung der Nanopartikel bedeutende Unterschiede der Zellaufnahme in diversen Zellkulturlinien (in vitro) und Leukozyten in peripherem Vollblut (ex vivo) zur Folge haben.

Drug eluting balloons

Ever since the first percutaneous transluminal angioplasty (PTA) was carried out in Switzerland in 1977, restenosis remains a major drawback of this minimally invasive treatment intervention. Numerous attempts to increase vessel patency after PTA have included systemic medications and endovascular brachytherapy, but these techniques have not met our expectations in preventing restenosis. Nitinol stents have been shown to reduce rates of restenosis and target lesion revascularization in patients undergoing endovascular treatment of long femoropopliteal obstructions. Despite further technical refinements in nitinol stent technology, restenosis occurs in approximately every third patient undergoing femoropopliteal stenting. Similarly, initial clinical trials with drug-eluting stents have failed to indicate restenosis inhibition in femoropopliteal segment. Unfortunately, restenosis rates after below-the-knee PTA and stenting have been reported to be even higher than those following femoropopliteal revascularization. Current concepts for the prevention and treatment of restenosis after PTA or stenting include the sustained release of antiproliferative paclitaxel into the vessel wall. Drug eluting balloons are a promising, novel technology aimed at inhibiting restenosis after PTA. Its clinical efficacy in reducing restenosis has already been proven for coronary arteries as well as for the femoropopliteal segment. The purpose of this article is to review the clinical utility of drug-eluting balloons for lower limb endovascular interventions.

Impact of stent overlap on angiographic and long-term clinical outcome in patients undergoing drug-eluting stent implantation

Objectives We compared the angiographic and long-term clinical outcomes of patients with and without overlap of drug-eluting stents (DES). Background DES overlap has been associated with delayed healing and increased inflammation in experimental studies, but its impact on clinical outcome is not well established. Methods We analyzed the angiographic and clinical outcomes of 1,012 patients treated with DES in the SIRTAX (Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization) trial according to the presence or absence of stent overlap and the number of stents per vessel: 134 (13.2%) patients with multiple DES in a vessel with overlap, 199 (19.7%) patients with multiple DES in a vessel without overlap, and 679 (67.1%) patients with 1 DES per vessel. Results Angiographic follow-up at 8 months showed an increased late loss in DES overlap patients (0.33 ± 0.61 mm) compared with the other groups (0.18 ± 0.43 mm and 0.15 ± 0.38 mm, p < 0.01). The smallest minimal lumen diameter was located at the zone of stent overlap in 17 (68%) of 25 patients with stent overlap who underwent target lesion revascularization. Major adverse cardiac events were more common in patients with DES overlap (34 events, 25.4%) than in the other groups (42 events, 21.1% and 95 events, 14.0%) at 3 years (p < 0.01). Both the risk of target lesion revascularization (20.2% vs. 16.1% vs. 9.7%, p < 0.01) and the composite of death or myocardial infarction (17.2% vs. 14.1% vs. 9.1%, p = 0.01) were increased in patients with DES overlap compared with the other groups. Conclusions DES overlap occurs in >10% of patients undergoing percutaneous coronary intervention in routine clinical practice and is associated with impaired angiographic and long-term clinical outcome, including death or myocardial infarction. (Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization; NCT00297661).

Impact of arterial injury on neointimal hyperplasia after implantation of drug-eluting stents in coronary arteries: an intravascular ultrasound study

Aims: We investigated the impact of arterial injury on neointimal hyperplasia following implantation of drug-eluting stents (DES). Methods and results: A total of 196 patients with 223 segments (sirolimus-eluting stents [SES]: 104, paclitaxel-eluting stents [PES]: 119) underwent intravascular ultrasound eight months after DES implantation. Arterial injury was defined as the balloon-to-artery ratio (BAR). Segments were categorised into two groups: high BAR defined as BAR>1.1 (120 segments), and low BAR defined as BAR ≤1.1 (103 segments). Baseline clinical characteristics were similar for both groups. Although reference vessel diameter was smaller, stent diameter, maximal balloon pressure and balloon diameter were higher in the high BAR compared with the low BAR group. Lumen (7.10±1.91 vs. 6.25±1.69, p=0.001), stent (7.31±1.95 vs. 6.41±1.80, p=0.001), and external elastic membrane (17.1±4.9 vs. 14.8±4.0, p<0.0001) areas (mm2) were higher, but neointimal hyperplasia (0.21±0.36 vs. 0.16±0.48, p=0.42) area (mm2) was similar in the high BAR compared with the low BAR group. Arterial injury as assessed by BAR was not associated with the amount of neointimal hyperplasia (R2=0.003, p=0.40). Conclusions: Arterial injury does not correlate with the amount of neointimal hyperplasia following DES implantation. Conventionally aggressive DES implantation techniques do not adversely affect long-term outcome with respect to restenosis. - See more at: http://www.pcronline.com/eurointervention/30th_issue/79/#sthash.1do4X31G.dpuf

Current status of drug-eluting stents

First-generation drug-eluting stents (DES) with controlled release of sirolimus or paclitaxel from durable polymers compared with bare-metal stents have been consistently shown to reduce the risk of repeat revascularization procedures due to restenosis. The superior efficacy was found across a wide range of patients and lesion subsets and persisted up to 5 years whereas similar outcomes have been observed in terms of death and myocardial infarction. Newer generation DES have been developed with the goal to further improve upon the safety profile of first-generation DES while maintaining efficacy. These platforms include DES with improved and more biocompatible durable polymers, DES using bioabsorbable polymers for drug release, DES with polymer-free drug release, and fully bioabsorbable DES. Newer generation DES with durable polymers such as zotarolimus-eluting or everolimus-eluting XIENCE V stents have been directly compared with first-generation DES. Most recent results of large scale clinical trials are encouraging in terms of similar or increased efficacy while improving safety by reducing the rates of myocardial infarctions and stent thrombosis. DES using biodegradable polymers for drug release represent the next technological modification and preliminary results are favorable and demonstrate similar angiographic and clinical efficacy as first-generation DES, but only longer term follow-up and investigation in larger patient cohorts will determine whether their use is associated with improved long-term safety. Fully bioabsorbable stents represent another innovative approach. Whether this innovative concept will enter into clinical routine remains yet to be determined.

Atypical presentation of a hormonally active adrenocortical tumor in an adolescent leading to delayed diagnosis

Adrenocortical tumors are rare in children and present with variable signs depending on the type of hormone excess. We herein describe the unusual presentation of a child with adrenocortical tumor and introduce the concept of in vitro chemosensitivity testing. CASE REPORT: A 10.5-year-old girl presented with hypertrichosis/hirsutism and weight loss. The weight loss and behavioral problems, associated with halted puberty and growth, led to the initial diagnosis of anorexia nervosa. However, subsequent weight gain but persisting arrest in growth and puberty and the appearance of central fat distribution prompted further evaluation. RESULTS AND FOLLOW-UP: 24h-urine free cortisol was elevated. Morning plasma ACTH was undetectable, while cortisol was elevated and circadian rhythmicity was absent. Thus a hormonally active adrenal cortical tumor (ACT) was suspected. On magnetic resonance imaging (MRI) a unilateral, encapsulated tumor was found which was subsequently removed surgically. Tissue was investigated histologically and for chemosensitivity in primary cell cultures. Although there were some risk factors for malignancy, the tumor was found to be a typical adenoma. Despite this histology, tumor cells survived in culture and were sensitive to cisplatin in combination with gemcitabine or paclitaxel. At surgery, the patient was started on hydrocortisone replacement which was unsuccessfully tapered over 3 months. Full recovery of the hypothalamus-pituitary-adrenal axis occurred only after 3 years. CONCLUSIONS: The diagnosis of a hormonally active adrenocortical tumor is often delayed because of atypical presentation. Cortisol replacement following unilateral tumor excision is mandatory and may be required for months or years. Individualized chemosensitivity studies carried out on primary cultures established from the tumor tissue itself may provide a tool in evaluating the effectiveness of chemotherapeutic drugs in the event that the adrenocortical tumor may prove to be carcinoma.

Very late coronary stent thrombosis of a newer-generation everolimus-eluting stent compared with early-generation drug-eluting stents: a prospective cohort study

Early-generation drug-eluting stents releasing sirolimus (SES) or paclitaxel (PES) are associated with increased risk of very late stent thrombosis occurring >1 year after stent implantation. It is unknown whether the risk of very late stent thrombosis persists with newer-generation everolimus-eluting stents (EES).