Diagnóstico da Leishmaniose Tegumentar Americana utilizando a saliva coletada com swab

As leishmanioses caracterizam-se por um espectro de doenças distribuídas endemicamente em regiões tropicais e subtropicais do mundo. A obtenção de material biológico para análise diagnóstica apresenta cuidados cruciais ao paciente, por se tratar de um processo invasivo, passível de inflamação, e podendo haver reativação da doença, em alguns casos. Diante do avanço das técnicas moleculares e da utilização de alguns fluidos biológicos para o diagnóstico da Leishmaniose Tegumentar Americana (LTA), cogitou-se a possibilidade da identificação de DNA de Leishmania spp. em saliva através do método de coleta de swab, sendo contribuinte para o avanço no diagnóstico laboratorial. Assim, o propósito do estudo foi a identificação de DNA de Leishmania spp. a partir do diagnóstico molecular. Foram incluídos no estudo os pacientes que apresentaram lesões ativas, diagnósticos clínicos para LTA, antecedentes epidemiológicos compatíveis e não possuíam lesões cutâneo mucosas. O diagnóstico laboratorial envolveu a abordagem parasitológica através da pesquisa direta do parasito em amostras escarificadas de lesões, enquanto que o molecular compreendeu a extração do DNA das amostras de biópsia e swab salivar, seguidas da reação de PCR convencional (cPCR) e PCR em tempo real (qPCR). Foram investigados 40 pacientes com LTA havendo ocorrência de DNA do parasito em 10 amostras de saliva com cPCR, e 36 amostras utilizando qPCR. Em 28 amostras de biópsias também foi possível a detecção do DNA de Leishmania spp. e em 35 amostras de escarificado de lesão foram encontradas formas amastigotas do parasito, através de pesquisa direta. Na comparação entre os métodos propostos, a biópsia apresentou uma média de 50 por cento de compatibilidade em relação a cPCR e 67,5 por cento para a qPCR. A análise comparativa observou entre o diagnóstico parasitológico e os diagnósticos moleculares uma concordância de 32,5 por cento (14/40) em relação a cPCR, enquanto que a qPCR obteve 75,5 por cento (31/40) de concordância. Considerando a sensibilidade das técnicas de PCR utilizadas e o procedimento de coleta, através de swab advindo de fluidos salivares, os resultados demonstram a viabilidade do método de coleta de Leishmania spp. como uma nova abordagem diagnóstica auxiliar para a LTA, com benefícios à saúde do paciente

Estratégias para o aprimoramento do diagnóstico molecular na leishmaniose visceral

A leishmaniose visceral (LV) é uma doença infecto-parasitária causada por protozoários do gênero Leishmania. O trabalho teve como objetivo avaliar estratégias para o aprimoramento do diagnóstico molecular na LV, que compreenderam a avaliação da eficiência de diferentes métodos de extração de DNA em amostras de urina; a análise do uso da Reação em Cadeia da Polimerase quantitativa em tempo real (qPCR) como ferramenta para a detecção do DNA de Leishmania infantum na referida amostra; e a padronização de uma reação duplex qPCR para a detecção simultânea do DNA de L. infantum e do gene G3PD (controle endógeno). Depois da escolha do protocolo de extração de DNA mais apropriado, e após a otimização e a análise de reprodutibilidade, uma qPCR em urina foi padronizada. Em paralelo, após o desenho e a síntese de sondas TaqMan® compatíveis com os sistemas LINF 1B e G3PD1, após otimização e análise de reprodutibilidade, uma duplex qPCR em sangue também foi padronizada. Para avaliação dos protocolos desenvolvidos foram utilizadas técnicas de estatística descritiva. Para análise comparativa com técnicas clássicas de diagnóstico da LV utilizou-se Teste Qui Quadrado de independência ou Teste Exato de Fisher (p<0,05 e p<0,01, respectivamente). Como resultados, após otimização, o limite de detecção alcançado pela qPCR em urina utilizando o protocolo de extração selecionado (kit comercial) foi de 5 fg/microlitros de amostra 0,034 parasitos) A duplex qPCR em sangue alcançou um limite de detecção de 2x102 fg/microlitros de amostra 1,4 (ou ~ 1,4 parasito), após a otimização. A partir dos dados estatísticos obtidos, pôde-se analisar alta concordância percentual entre a qPCR e urina e o conjunto de critérios diagnósticos (sorologia rK39 + qPCR em sangue), bem como entre a duplex qPCR em sangue e a qPCR em sangue, para os Grupos 01 (pacientes com suspeita de LV) e 02 (pacientes HIV positivos co-infectados ou não). Como um conjunto de critérios, os dois novos ensaios obtiveram excelentes concordâncias com o conjunto de técnicas clássicas: 88,89 por cento e 94,74 por cento para os Grupos 01 e 02, respectivamente. Não houve diferenças estatísticas significativas entre os testes. Pôde-se concluir que ambos os ensaios mostraram bom potencial para a incorporação, após validação, ao diagnóstico da LV; em conjunto ou individualmente (quando necessário), trazendo mais conforto, praticidade, confiabilidade e rapidez ao diagnóstico definitivo da patologia

Implementação da tecnologia de IgY para o diagnóstico da leishmaniose visceral canina

Os métodos de diagnóstico sorológico são ainda as ferramentas mais realistas e aplicáveis para identificação de cães com leishmaniose visceral. A pesquisa por métodos sorológicos mais eficientes e de produção simplificada é importante para a identificação do reservatório canino, ação primordial para o controle da doença. Este estudo teve por objetivo o desenvolvimento e a avaliação do desempenho de um ELISA para leishmaniose visceral canina, utilizando como conjugado enzimático uma IgY anti-IgG canina. Para isto, galinhas poedeiras foram imunizadas com IgG canina purificada e a IgY anti-IgG foi isolada das gemas dos ovos por precipitação com polietilenoglicol e purificada por meio de adsorção tiofílica. A especificidade frente ao antígeno imunizante foi verificada por imunodifusão radial dupla, ELISA e western-blot. O ELISA foi desenvolvido utilizando IgY conjugada a enzima peroxidase, tendo seus parâmetros de acurácia avaliados e comparados com o ELISA utilizando IgG de mamíferos conjugada a peroxidase. A concentração total de IgY isolada nas gemas foi constante, sem diferença significativa nos meses analisados (...), com média de 97,55 mg de IgY/ gema. A IgY produzida reconheceu a IgG canina, demonstrando uma forte sensibilidade e especificidade no ELISA, porém na imunodifusão não foi detectada ligação da IgY produzida a IgG canina. Após a imunização, houve um aumento significante da produção de IgY específica do primeiro para o segundo mês (...) onde ocorreu um pico estável sem queda de produção até o final do período analisado (...). A IgY demonstrou ainda, forte reatividade no western-Blot frente a IgG canina purificada e a presente no soro de cão clinicamente saudável, não sendo capaz de reconhecer IgG de outras espécies animais.

Tratamento intralesional da leishmaniose cutânea com antimoniato de meglumina no Instituto de Pesquisa Clínica Evandro Chagas, Fiocruz, Rio de Janeiro (2002 a julho 2011)

A leishmaniose tegumentar americana é uma doença que acomete a pele e as mucosas das vias aerodigestivas superiores. Os antimoniais pentavalentes vêm sendo empregados há muitas décadas como fármacos de primeira linha para o seu tratamento. Pacientes com poucas lesões cutâneas, com impossibilidade de receber medicação parenteral regular ou com sinais de toxicidade importante ao antimonial por via sistêmica, podem ser submetidos ao tratamento intralesional com antimoniato de meglumina. Objetivos: descrever a eficácia e a segurança do antimoniato de meglumina administrado por via intralesional, para o tratamento da leishmaniose cutânea. Método: Foi realizado um estudo descritivo, retrospectivo, tipo série de casos, de pacientes atendidos no Laboratório de Vigilância em Leishmanioses do Instituto de Pesquisa Clínica Evandro Chagas \2013 FIOCRUZ, de 2002 até julho de 2011, que tivessem sido tratados para leishmaniose cutânea com aplicação intralesional de antimoniato de meglumina, após tratamento sistêmico com o mesmo fármaco Além disso, relatamos dois casos especiais de pacientes tratados com antimoniato de meglumina intralesional: o primeiro, de um paciente que apresentou resistência ao antimoniato de meglumina sistêmico e intralesional, não tolerou anfotericina B e respondeu apenas à pentamidina. O outro, de paciente com eczema generalizado após antimoniato de meglumina sistêmico e que desenvolveu eczema bolhoso em local de aplicação intralesional do mesmo fármaco. Resultados: Pacientes com leishmaniose cutânea apresentaram boa resposta terapêutica ao antimoniato de meglumina administrado por via intralesional com um mínimo de efeitos adversos, geralmente sem necessidade de mudar o fármaco para outros de mais difícil administração e alto custo, e sem desenvolvimento de lesões mucosas. Medicamentos de segunda ou terceira escolha são eficazes, na ausência de resposta prévia ao antimoniato de meglumina sistêmico e intralesional. A via intralesional deve ser evitada em caso de farmacodermia ao antimoniato de meglumina sistêmico

Developing synthetic mucosa-mimetic hydrogels to replace animal experimentation in characterisation of mucoadhesive drug delivery systems

Mucosa-mimetic polymeric hydrogels have been developed to replace the use of animal tissues as substrates for characterising mucoadhesive properties of drug delivery systems.

Intermittent Escherichia coli O157:H7 colonisation at the terminal rectum mucosa of conventionally-reared lambs

In cattle, the lymphoid rich regions of the rectal-anal mucosa at the terminal rectum are the preferred site for Escherichia coli O157:H7 colonisation. All cattle infected by rectal swab administration demonstrate long-term E. coli O157:H7 colonisation, whereas orally challenged cattle do not demonstrate long-term E. coli O157:H7 colonisation in all animals. Oral, but not rectal challenge of sheep with E. coli O157:H7 has been reported, but an exact site for colonisation in sheep is unknown. To determine if E. coli O157:H7 can effectively colonise the ovine terminal rectum, in vitro organ culture (IVOC) was initiated. Albeit sparsely, large, densely packed E. coli O157:H7 micro-colonies were observed on the mucosa of ovine and control bovine terminal rectum explants. After necropsy of orally inoculated lambs, bacterial enumeration of the proximal and distal gastrointestinal tract did suggest a preference for E. coli O157:H7 colonisation at the ovine terminal rectum, albeit for both lymphoid rich and non-lymphoid sites. As reported for cattle, rectal inoculation studies were then conducted to determine if all lambs would demonstrate persistent colonisation at the terminal rectum. After necropsy of E. coli O157:H7 rectally inoculated lambs, most animals were not colonised at gastrointestinal sites proximal to the rectum, however, large densely packed micro-colonies of E. coli O157:H7 were observed on the ovine terminal rectum mucosa. Nevertheless, at the end point of the study (day 14), only one lamb had E. coli O157:H7 micro-colonies associated with the terminal rectum mucosa. A comparison of E. coli O157:H7 shedding yielded a similar pattern of persistence between rectally and orally inoculated lambs. The inability of E. coli O157:H7 to effectively colonise the terminal rectum mucosa of all rectally inoculated sheep in the long term, suggests that E. coli O157:H7 may colonise this site, but less effectively than reported previously for cattle.

Interaction of enterohemorrhagic Escherichia coli O157 : H7 with mouse intestinal mucosa

In this study, we used mouse ileal loops to investigate the interaction of enterohemorrhagic Escherichia coli (EHEC) O157:H7 with the mouse intestinal mucosa. With a dose of 10(9) and 3 h incubation, EHEC O157 was detected in the lumen and to a lesser extent associated with the epithelium. Typical attaching and effacing (A/E) lesions were seen, albeit infrequently. While the effector protein Tir was essential for A/E lesion formation, the bacterial type III secretion system adaptor protein TccP was dispensable. These results suggest that A/E lesions on mouse intestinal mucosa can be formed independently of robust actin polymerization.

MYOD-1 in normal colonic mucosa - role as a putative biomarker?

Background DNA methylation of promoter-associated CpG islands of certain genes may play a role in the development of colorectal cancer. The MYOD-1 gene which is a muscle differentiation gene has been showed to be significantly methylated in colorectal cancer which, is an age related event. However the role of this gene in the colonic mucosa is not understood and whether methylation occurs in subjects without colon cancer. In this study, we have determined the frequency of methylation of the MYOD-1 gene in normal colonic mucosa and investigated to see if this is associated with established colorectal cancer risk factors primarily ageing. Results We analysed colonic mucosal biopsies in 218 normal individuals and demonstrated that in most individuals promoter hypermethylation was not quantified for MYOD-1. However, promoter hypermethylation increased significantly with age (p < 0.001 using regression analysis) and this was gender independent. We also showed that gene promoter methylation increased positively with an increase in waist to hip (WHR) ratio - the latter is also a known risk factor for colon cancer development. Conclusions Our study suggests that promoter gene hypermethylation of the MYOD-1 gene increases significantly with age in normal individuals and thus may offer potential as a putative biomarker for colorectal cancer.

The gut microbiota elicits a profound metabolic reorientation in the mouse jejunal mucosa during conventionalisation

Objective: Proper interactions between the intestinal mucosa, gut microbiota and nutrient flow are required to establish homoeostasis of the host. Since the proximal part of the small intestine is the first region where these interactions occur, and since most of the nutrient absorption occurs in the jejunum, it is important to understand the dynamics of metabolic responses of the mucosa in this intestinal region.Design: Germ-free mice aged 8-10 weeks were conventionalised with faecal microbiota, and responses of the jejunal mucosa to bacterial colonisation were followed over a 30-day time course. Combined transcriptome, histology, (1)H NMR metabonomics and microbiota phylogenetic profiling analyses were used.Results: The jejunal mucosa showed a two-phase response to the colonising microbiota. The acute-phase response, which had already started 1 day after conventionalisation, involved repression of the cell cycle and parts of the basal metabolism. The secondary-phase response, which was consolidated during conventionalisation (days 4-30), was characterised by a metabolic shift from an oxidative energy supply to anabolic metabolism, as inferred from the tissue transcriptome and metabonome changes. Detailed transcriptome analysis identified tissue transcriptional signatures for the dynamic control of the metabolic reorientation in the jejunum. The molecular components identified in the response signatures have known roles in human metabolic disorders, including insulin sensitivity and type 2 diabetes mellitus.Conclusion: This study elucidates the dynamic jejunal response to the microbiota and supports a prominent role for the jejunum in metabolic control, including glucose and energy homoeostasis. The molecular signatures of this process may help to find risk markers in the declining insulin sensitivity seen in human type 2 diabetes mellitus, for instance.

Nutritional factors and gender influence age-related DNA methylation in the human rectal mucosa

Aberrant methylation of CpG islands (CGI) occurs in many genes expressed in colonic epithelial cells, and may contribute to the dysregulation of signalling pathways associated with carcinogenesis. This cross-sectional study assessed the relative importance of age, nutritional exposures and other environmental factors in the development of CGI methylation. Rectal biopsies were obtained from 185 individuals (84 male, 101 female) shown to be free of colorectal disease, and for whom measurements of age, body size, nutritional status and blood cell counts were available. We used quantitative DNA methylation analysis combined with multivariate modelling to investigate the relationships between nutritional, anthropometric and metabolic factors and the CGI methylation of 11 genes, together with LINE-1 as an index of global DNA methylation. Age was a consistent predictor of CGI methylation for 9/11 genes but significant positive associations with folate status and negative associations with vitamin D and selenium status were also identified for several genes. There was evidence for positive associations with blood monocyte levels and anthropometric factors for some genes. In general, CGI methylation was higher in males than in females and differential effects of age and other factors on methylation in males and females were identified. In conclusion, levels of age-related CGI methylation in the healthy human rectal mucosa are influenced by gender, the availability of folate, vitamin D and selenium, and perhaps by factors related to systemic inflammation

Dendritic cells interact with CD4 T cells in intestinal mucosa

Absence of lymph nodes in nonmammalian species, expression of MHCII by APCs in the periphery, and the recent findings that T cells can change their polarization status after presentation in the lymph nodes imply a role for MHCII-mediated presentation outside the organized lymphoid tissue. This study shows that MHCII+ ECs and DCs from the intestinal mucosa of the pig can present antigen to T cells in vitro. In vivo, APCs colocalize with T cells in pig and mouse intestinal mucosa. In the pig, endothelium is involved in these interactions in neonates but not in adults, indicating different roles for stromal and professional APCs in the neonate compared with the adult. The ratio of expression of DQ and DR MHCII locus products was lower on ECs than on other mucosal APCs, indicating that the two types of cells present different peptide sets. Adult nonendothelial APCs expressed a higher ratio of DQ/DR than in neonates. These results suggest that mucosal DCs can present antigen locally to primed T cells and that stromal APCs are recruited to these interactions in some cases. This raises the possibility that local presentation may influence T cell responses at the effector stage after initial presentation in the lymph node.

Investigation of milk proteins binding to the oral mucosa

High protein dairy beverages are considered to be mouth drying. The drying sensation may be due to the product protein content; however the mechanism of this mouth drying is uncertain. This study investigated the potential adhesion of milk proteins to porcine oral mucosal tissues and their resistance to wash out with simulated saliva was monitored using fluorescence microscopy. Cadein was found to be more adhesive to porcine mucosa then lactogloubulin. Some investigation into the reason for this difference in mucoadhesion was conducted by thiol-content analysis, rheology and zeta-potential measurements. The higher viscosity of casein solution and smaller zeta-potential is believed to be responsible for its better retention on mucosal surfaces. These findings suggest that casein and whey protein are both capable of binding and eliciting mouth drying in high protein dairy beverages.

Novel glycopolymer hydrogels as mucosa-mimetic materials to reduce animal testing

Glycopolymer hydrogels capable of mimicking mucosal tissue in mucoadhesion testing have been designed. Liquid formulations containing mucoadhesive polymers were found to be retained on these tissues to the same extent as ex vivo gastric mucosa, when using a dynamic method of assessing mucoadhesion.

Opposite effects of fasting on TGF-beta 3 and T beta RI distribution in the gastric mucosa of suckling and early weanling rats

Objective: Our aim was to evaluate the effects of a dietary regimen (suckling or early weaning) and feeding status (fed or fasted) on the distribution of transforming growth factor-beta 3 (TGF-beta 3) and TGF receptor-I (T beta RI) in the gastric epithelium of pups Methods: Wistar rats were used At 15 d, half of the pups were separated from dams and fed with hydrated powered chow On day 17, suckling and early weanling rats were subjected to fasting (17 h). Four different conditions were established. suckling fed and fasted and early weanling fed and fasted At 18 d stomachs were collected under anesthesia and were fixed in 4% formaldehyde for immunohistochemistry The number of immunostained epithelial cells per microscopic field was determined for TGF-beta 3 and T beta RI in longitudinal sections from the gastric mucosa Results: We found that during suckling, fasting reduced the number of immunolabeled cells per field of both molecules when compared with the fed group (P < 0.05), whereas in early weaning, food restriction increased TGF-beta 3 and T beta RI distributions (P < 0.05) We also observed that TGF-beta 3 and T beta RI were more concentrated in parietal cells in the upper gland in suckling pups, whereas after early weaning these were displaced to parietal and chief cells at the bottom of the gland Conclusion: Suckling and early weaning directly influence TGF-beta 3 and T beta RI distributions in the gastric epithelium in response to fasting, such that early weaning anticipates the effects observed in adult rats. Furthermore, the differential concentrations of TGF-beta 3 and T beta RI indicate that they might be important for cell proliferation events in growth control (C) 2010 Elsevier Inc. All rights reserved

Early weaning accelerates the differentiation of mucous neck cells in rat gastric mucosa: Possible role of TGF alpha/EGFR

The development of the gastric mucosa is controlled by hormones, growth factors and feeding behavior. Early weaning (EW), which means the abrupt interruption of suckling, increases proliferation and differentiation in the rat gastric epithelium. Transforming growth factor alpha(TGF alpha) is secreted in the stomach, binds to the epidermal growth factor receptor( EGFR) and may control cell proliferation, differentiation and migration. Here, we investigated the influence of suckling-weaning transition on the differentiation of mucous neck cells in the stomach and its association to the expression of TGF alpha and EGFR. Fifteen-day-old Wistar rats were divided into two groups: suckling( control), in which pups were kept with the dam, and early weaning( EW), in which rats were separated from their mother and fed with hydrated powdered chow. TGF alpha and EGFR levels were increased at 18 days in EW animals compared to control ones (p<0.05). Histochemical reactions with Periodic Acid-Schiff reagent+Alcian Blue or Bandeiraea simplicifolia II lectin were used to stain the mucous neck cells and showed an increase in this cell population throughout EW, which was more pronounced at 17 days when compared to suckling pups (p<0.05). These morphological results were confirmed by RT-PCR for mucin 6. The levels of mucin 6 mRNA were higher in EW animals from the 16th to the 18th day(1-3 days post-weaning) when compared to the respective control group. Inhibition of EGFR through AG1478 administration to EW animals prevented the expansion of mucous neck cell population induced by EW (p<0.05). Therefore, early weaning up regulated TGF alpha/EGFR expression and induced differentiation of mucous neck cells. Moreover, we showed that EGFR takes part in the maturation of this cell population. We conclude that regular suckling-weaning transition is crucial to guarantee the development of the gastric mucosa. (C) 2009 International Society of Differentiation. Published by Elsevier Ltd. All rights reserved.