Análise molecular de pacientes com holoprosencefalia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A study of multidrug-resistant tuberculosis in risk groups in the city of Santos, Sao Paulo, Brazil

Monitoring the extent of and trends in multidrug-resistant tuberculosis (MDR-TB) is a priority of the Brazilian National Tuberculosis Control Programme. The current study aimed to estimate the incidence of MDR-TB, describe the profile of TB drug resistance in risk groups and examine whether screening for MDR-TB adhered to the recommended guidelines. A descriptive study that examined diagnosed cases of pulmonary TB was conducted in the city of Santos, Brazil, between 2000-2004. Of the 2,176 pulmonary TB cases studied, 671 (30.8%) met the criteria for drug sensitivity testing and, of these cases, 31.7% (213/671) were tested. Among the tested cases, 9.4% were resistant to one anti-TB drug and 15% were MDR. MDR was observed in 11.6% of 86 new TB cases and 17.3% of 127 previously treated cases. The average annual incidence of MDR-TB was 1.9 per 100,000 inhabitants-years. The extent of known MDR-TB in the city of Santos is high, though likely to be underestimated. Our study therefore indicates an inadequate adherence to the guidelines for MDR-TB screening and suggests the necessity of alternative strategies of MDR-TB surveillance.

Antimycobacterial activity of 2-phenoxy-1-phenylethanone, a synthetic analogue of neolignan, entrapped in polymeric microparticles

Conventional treatment of tuberculosis (TB) demands a long course therapy (6 months), known to originate multiple drug resistant strains (MDR-TB), which emphasizes the urgent need for new antituberculous drugs. The purpose of this study was to investigate a novel treatment for TB meant to improve patient compliance by reducing drug dosage frequency. Polymeric microparticles containing the synthetic analogue of neolignan, 1-phenyl-2-phenoxiethanone (LS-2), were obtained by a method of emulsification and solvent evaporation and chemically characterized. Only representative LS-2-loaded microparticles were considered for further studies involving experimental murine TB induced by Mycobacterium tuberculosis H37Rv ATCC 27294. The LS-2-loaded microparticles were spherical in shape, had a smooth wall and showed an encapsulation efficiency of 93% in addition to displaying sustained release. Chemotherapeutic potential of LS-2 entrapped in microparticles was comparable to control groups. These findings are encouraging and indicate that LS-2-loaded microparticles are a potential alternative to conventional chemotherapy of TB.

Análise de mutações nos genes TAC3 e TACR3 em pacientes com distúrbios puberais centrais idiopáticos

OBJETIVO: Investigar a presença de variantes nos genes TAC3 e TACR3, os quais codificam a NKB e seu receptor (NK3R), respectivamente, em uma coorte de pacientes com distúrbios puberais centrais idiopáticos. SUJEITOS E MÉTODOS: Duzentos e trinta e sete pacientes foram estudados: 114 com puberdade precoce central (PPC), 73 com hipogonadismo hipogonadotrófico isolado normósmico (HHI) e 50 com retardo constitucional do crescimento e desenvolvimento (RCCD). O grupo controle consistiu de 150 indivíduos brasileiros que apresentaram desenvolvimento puberal normal. O DNA genômico foi extraído de sangue periférico, e as regiões codificadoras dos genes TAC3 e TACR3 foram amplificadas e sequenciadas automaticamente. RESULTADOS: Uma variante (p.A63P) foi identificada na NKB, e quatro variantes, p.G18D, p.L58L (c.172C>T), p.W275X e p.A449S, foram identificadas no NK3R, as quais foram ausentes no grupo controle. A variante p.A63P foi identificada em uma menina com PPC, e a variante p.A449S, em uma menina com RCCD. As variantes previamente descritas, p.G18D, p.L58L e p.W275X, foram identificadas em três indivíduos com HHI normósmico do sexo masculino não relacionados. CONCLUSÃO: Variantes raras nos genes TAC3 e TACR3 foram identificadas em pacientes com distúrbios puberais centrais idiopáticos. Mutações de perda de função no gene TACR3 foram associadas com o fenótipo de HHI normósmico. Arq Bras Endocrinol Metab. 2012;56(9):646-52

A study of multidrug-resistant tuberculosis in risk groups in the city of Santos, São Paulo, Brazil

Monitoring the extent of and trends in multidrug-resistant tuberculosis (MDR-TB) is a priority of the Brazilian National Tuberculosis Control Programme. The current study aimed to estimate the incidence of MDR-TB, describe the profile of TB drug resistance in risk groups and examine whether screening for MDR-TB adhered to the recommended guidelines. A descriptive study that examined diagnosed cases of pulmonary TB was conducted in the city of Santos, Brazil, between 2000-2004. Of the 2,176 pulmonary TB cases studied, 671 (30.8%) met the criteria for drug sensitivity testing and, of these cases, 31.7% (213/671) were tested. Among the tested cases, 9.4% were resistant to one anti-TB drug and 15% were MDR. MDR was observed in 11.6% of 86 new TB cases and 17.3% of 127 previously treated cases. The average annual incidence of MDR-TB was 1.9 per 100,000 inhabitants-years. The extent of known MDR-TB in the city of Santos is high, though likely to be underestimated. Our study therefore indicates an inadequate adherence to the guidelines for MDR-TB screening and suggests the necessity of alternative strategies of MDR-TB surveillance.

Ablefaro macrostomia - síndrome e audição: relato de dois casos familiares

Introdução: Síndrome de Ablefaro MAcrostomia (AMS) é uma condição rara que compreende pálpebras ausentes ou curto, orelhas anormais, macrostomia, genitália anômalo, pele redundante e cabelos ausente. Brancati et al (2004) relataram uma ocorrência estimada de perda auditiva em 70% desta população. Estudos específicos sobre a audição em AMS não estavam presentes nos jornais que compilados. Relato dos casos: Paciente 1 é o primeiro filho de um ano de idade, a mãe 23 anos e pai de 25 anos de idade, não consangüíneos. Suas características clínicas são pouco cabelo no couro cabeludo, orelhas em forma de taça, raiz nasal larga, narinas antevertidas, macrostomia, os dedos com membranas, pele redundante e hipoplasia mamilos e lábios. Ela não tem atraso no desenvolvimento neuropsicomotor e a fala é normal. A audição foi avaliada aos 15 anos com uma perda auditiva em 6 kHz. Paciente 2 é o terceiro filho do mesmo casal. Ela tem falta grave das pálpebras, uma ponte nasal baixa com narinas hipoplásica e anteversão, macrostomia, orelhas anormalmente modelados, a ausência de mamilos, um de 6 cm onfalocele, ânus anteriormente localizado, hipoplasia dos grandes lábios, unhas hipoplasia, atenuação distal de falanges e pele redundante. Ela está se desenvolvendo com atraso no desenvolvimento neuropsicomotor, fala normal e perda auditiva condutiva leve bilateral. A avaliação audiológica incluiu quatro procedimentos: história clínica audiológica, inspeção otológica, imitanciometria, audiometria tonal e discurso. Conclusões: Os pacientes estudados com AMS apresentaram perda auditiva leve e esta perda de audição pode ser considerado como uma parte do fenótipo AMS sendo compatível os achados com a literatura.

Gene expression and phenotypic traits of Aggregatibacter actinomycetemcomitans in response to environmental changes

Background and Objective: Periodontopathogens experience several challenges in the oral cavity that may influence their transcription profile and resulting phenotype. This study evaluated the effect of environmental changes on phenotype and gene expression in a serotype b Aggregatibacter actinomycetemcomitans isolate. Material and Methods: Cultures in early exponential phase and at the start of stationary growth phase in microaerophilic and anaerobic atmospheres were evaluated. Cell hydrophobic properties were measured by adherence to n-hexadecane; in addition, adhesion to, and the ability to invade, KB cells was evaluated. Relative transcription of 12 virulence-associated genes was determined by real-time reverse transcritption quantitative PCR. Results: The culture conditions tested in this study were found to influence the phenotypic and genotypic traits of A. actinomycetemcomitans. Cells cultured in microaerophilic conditions were the most hydrophobic, reached the highest adhesion efficiency and showed up-regulation of omp100 (which encodes an adhesion) and pga (related to polysaccharide synthesis). Cells grown anaerobically were more invasive to epithelial cells and showed up-regulation of genes involved in host-cell invasion or apoptosis induction (such as apaH, omp29, cagE and cdtB) and in adhesion to extracellular matrix protein (emaA). Conclusion: Environmental conditions of different oral habitats may influence the expression of factors involved in the binding of A. actinomycetemcomitans to host tissues and the damage resulting thereby, and thus should be considered in in-vitro studies assessing its pathogenic potential.

Pre-clinical and clinical development of leukemia stem cell inhibitors in acute leukemias

In Leukemias, recent developments have demonstrated that the Hedgehog pathway plays a key-role in the peculiar ability of self renewal of leukemia stem cells. The aim of this research activity was to investigate, through a first in man, Phase I, open label, clinical trial, the role and the impact, mainly in terms of safety profile, adverse events and pharmacokinetics, of a Sonic Hedgehog inhibitor compound on a population of heavely pretreated patients affected by AML, CML, MF, or MDS, resistant or refractory to standard chemotherapy. Thirty-five patients have been enrolled. The drug was administered orally, in 28 days cycles, without rest periods. The compound showed a good safety profile. The half life was of 17-35 hours, justifying the daily administration. Significant signs of activity, in terms of reduction of bone marrow blast cell amount were seen in most of the patients enrolled. Interestingly, correlative biological studies demonstrated that, comparing the gene expression profyiling signature of separated CD34+ cells before and after one cycle of treatment, the most variably expressed genes were involved in the Hh pathway. Moreover, we observed that many genes involved in MDR (multidrug resistance)were significantly down regulated after treatment. These data might lead to future clinical trials based on combinatory approaches, including, for instance, Hh inhibitors and conventional chemotherapy.

Role of Magnesium and its mitochondrial transporter MRS2 in the modulation of drug-induced apoptosis leading to multidrug resistance phenotype

Magnesium is an essential element for many biological processes crucial for cell life and proliferation. Growing evidences point out a role for this cation in the apoptotic process and in developing multi drug resistance (MDR) phenotype. The first part of this study aimed to highlight the involvement of the mitochondrial magnesium channel MRS2 in modulating drug-induced apoptosis. We generated an appropriate transgenic cellular system to regulate expression of MRS2 protein. The cells were then exposed to two different apoptotic agents commonly used in chemotherapy. The obtained results showed that cells overexpressing MRS2 channel are less responsiveness to pharmacological insults, looking more resistant to the induced apoptosis. Moreover, in normal condition, MRS2 overexpression induces higher magnesium uptake into isolated mitochondria respect to control cells correlating with an increment of total intracellular magnesium concentration. In the second part of this research we investigated whether magnesium intracellular content and compartmentalization could be used as a signature to discriminate MDR tumour cells from their sensitive counterparts. As MDR model we choose colon carcinoma cell line sensitive and resistant to doxorubicin. We exploited a standard-less approach providing a complete characterization of whole single-cells by combining X-Ray Fluorescence Microscopy , Atomic Force Microscopy and Scanning Transmission X-ray Microscopy. This method allows the quantification of the intracellular spatial distribution and total concentration of magnesium in whole dehydrated cells. The measurements, carried out in 27 single cells, revealed a different magnesium pattern for both concentration and distribution of the element in the two cellular strains. These results were then confirmed by quantifying the total amount of intracellular magnesium in a large populations of cells by using DCHQ5 probe and traditional fluorimetric technique.

Biologisch aktive Sekundärmetabolite aus Pflanzen und Pilzen : Phenanthro-Alkaloide ; phytotoxische Dioxolanone

Als Phenanthro-Alkaloide wird eine kleine Gruppe von pentacyclischen, auf dem Phenanthren-Strukturmotiv basierenden Indolizidinen sowie Chinolizidinen bezeichnet. Von Letztgenannten sind bisher fünf, von den homologen Phenanthroindolizidinen mehr als sechzig natürliche Vertreter gefunden worden. Das wohl bekannteste Alkaloid in dieser Gruppe ist das Indolizidin-Alkaloid Tylophorin, das beispielsweise aus Tylophora indica (Apocynaceae, "Hundsgiftgewächse") gewonnen werden kann. Tylophorin und verwandte Derivate besitzen potente biologische und physiologische Wirkungen. So entfalten sie sowohl antiinflammatorische als auch antineoplastische Effekte (wirksam auch bei MDR-Tumorzelllinien, MDR = "multi drug resistant").rnrnDas Ziel der vorliegenden Arbeit war es, neue Methoden zur Herstellung von Phenanthro-Alkaloiden und deren Derivaten zu entwickeln. Ausgehend von (S)-Prolin konnten sowohl (S)-(+)-Tylophorin (>99% ee) als auch ein bisher noch nicht beschriebenes Derivat, das sich durch eine deutlich geringere Lichtempfindlichkeit im Vergleich zu Tylophorin aus¬zeichnet, in 33%-iger Gesamtausbeute über neun lineare Stufen, hergestellt werden. Die Synthese von (R)-(-)-Tylophorin gelang in analoger Weise aus (R)-Prolin in 21%-iger Ausbeute (93% ee). Der Einsatz von Schutzgruppen war nicht notwendig.rnDer Schlüsselschritt ist in beiden Fällen eine Cyclisierung an eine C=N-Doppelbindung über freie Radikale, die bei der Synthese des neuen Derivats hochstereoselektiv zur Bildung des (13aS,14S) Diastereomers führt. Die Synthese von 7-Methoxycryptopleurin gelang durch eine ähnliche Synthesestrategie. rnrnZur Herstellung von Cryptopleurin ist zunächst ein neuer Syntheseweg für 9-(Hydroxymethyl)-2,3,6-trimethoxyphenanthren entwickelt worden. Dieser führt über den Aufbau eines Biphenylsystems durch palladiumkatalysierte Kreuzkupplung, eine anschließende COREY-FUCHS-Transformation und als Schlüsselschritt über eine Gold-NHC-Komplex katalysierte 6-endo-dig-Cyclisierung zum entsprechenden Phenanthren. Diese Ringschlussreaktion verläuft in gewünschter Weise regioselektiv unter Bildung des 2,3,6-trimethoxysubstituierten Phenanthrens. Die Bil¬dung des regioisomeren 2,3,8-Trimethoxyphenanthrens wird nicht beobachtet. Der Alkohol wird dann in fünf linearen Stufen (34%) in das Xanthogenat überführt, aus dem sich durch eine zweistufige Reaktionssequenz, bestehend aus einer Radikal¬cyclisierung nach ZARD und einer Reduktion mit LiAlH4 das extrem lichtempfindliche und hochtoxische Alkaloid (R)-(-)-Cryptopleurin gewinnen ließ (50%).rnNachdem beide Enantiomere und das Racemat von Tylophorin synthetisiert worden waren und zum Vergleich bereit standen, wurde Tylophorin aus Tylophora indica extrahiert. rnDie Motivation rührte unter anderem daher, dass in der bisherigen Literatur Unstimmigkeiten über das in der Natur vorkommende Enantiomer des Tylophorins herrschten. Vor Beginn dieser Arbeit ging man davon aus, dass in T. indica nur (R)-(-)-Tylophorin vorkommt und für die Diskrepanzen zwischen den berichteten Drehwerten von, aus Pflanzenmaterial isolierten und des synthetisierten Naturstoffs, dessen Zersetzung vor oder während der Messung verantwortlich ist. Dieser Effekt kann zwar auch beobachtet werden, jedoch trägt er nur in geringem Maße zur Erniederigung des Drehwertes bei. Schließlich sind Proben von synthetisiertem Tylophorin in gleichem Maße von der schnell eintretenden Oxidation des Alkaloids betroffen. Aus dem Rohextrakt ist Tylophorin durch RP-HPLC isoliert worden. Anschließend wurde die Probe mittels chiraler HPLC/MS analysiert. Durch den Vergleich mit den bereit stehenden synthetischen Proben von (R)- und (S)-Tylophorin konnte in dieser Arbeit erstmals experimentell belegt werden, dass es sich bei (−)-Tylophorin aus T. indica um ein scalemisches Gemisch im Verhältnis von 56:44 (R:S) handelt.rnrnDas Ziel dieses Teilprojektes war die Entwicklung einer Synthese für den bisher noch nicht synthetisch hergestellten phytotoxischen Sekundärmetabolit (+)-Phenguignardiasäure. Isoliert wurde diese Verbindung aus Guignardia bidwellii, dem Erreger der Schwarzfäule der Weinrebe. Die absolute Konfiguration des quartären Stereozentrums war zu Beginn dieser Arbeit nicht bekannt. Ausgehend von (R)-Phenylmilchsäure und 3-Phenylprop-2-in-1-ol gelang die Synthese beider Enantiomere des Dioxolanons in acht linearen Stufen. Sie liefert den experimentellen Beweis (ECD, Polarimetrie) für die (S)-Konfiguration von natürlicher (+)-Phenguignardiasäure.rnrn

Structure-activity relationship and mechanism of action studies of manzamine analogues for the control of neuroinflammation and cerebral infections

Structure-activity relationship studies were carried out by chemical modification of manzamine A (1), 8-hydroxymanzamine A (2), manzamine F (14), and ircinal isolated from the sponge Acanthostrongylophora. The derived analogues were evaluated for antimalarial, antimicrobial, and antineuroinflammatory activities. Several modified products exhibited potent and improved in vitro antineuroinflammatory, antimicrobial, and antimalarial activity. 1 showed improved activity against malaria compared to chloroquine in both multi- and single-dose in vivo experiments. The significant antimalarial potential was revealed by a 100% cure rate of malaria in mice with one administration of 100 mg/kg of 1. The potent antineuroinflammatory activity of the manzamines will provide great benefit for the prevention and treatment of cerebral infections (e.g., Cryptococcus and Plasmodium). In addition, 1 was shown to permeate across the blood-brain barrier (BBB) in an in vitro model using a MDR-MDCK monolayer. Docking studies support that 2 binds to the ATP-noncompetitive pocket of glycogen synthesis kinase-3beta (GSK-3beta), which is a putative target of manzamines. On the basis of the results presented here, it will be possible to initiate rational drug design efforts around this natural product scaffold for the treatment of several different diseases.

Evolution of multidrug-resistant Staphylococcus aureus infections in horses and colonized personnel in an equine clinic between 2005 and 2010

A total of 70 Staphylococcus aureus isolates from postoperative infections in hospitalized horses were isolated between January 2005 and January 2011. Among them, 12 isolates were methicillin-susceptible S. aureus (MSSA), 18 were borderline-oxacillin-resistant S. aureus (BORSA), and 40 were methicillin-resistant S. aureus (MRSA). During the same period, the equine clinic personnel were screened for nasal carriage of BORSA and MRSA. Genotyping revealed that BORSA ST1(MLST)-t2863(spa) isolates were responsible for most equine infections and were the main isolates found in colonized members of the personnel between 2005 and 2007, and that in 2007, MRSA ST398-t011-IVa(SCCmec) emerged in infection sites and personnel, replacing BORSA. Besides decreased susceptibility to oxacillin, all MRSA and BORSA of these two major clonal lineages displayed resistance to gentamicin and kanamycin conferred by the aac(6')-Ie-aph(2')-Ia gene and to trimethoprim conferred by dfr(K) in MRSA and dfr(A) in BORSA. All MRSA had additional resistance to tetracycline conferred by tet(M), whereas BORSA generally also display resistance to streptomycin conferred by str. The number of hospital-acquired MRSA infections in horses could be limited after the introduction of basic hygiene measures and personnel decolonization. Two MRSA carriers could not be decolonized using mupirocin, and a year after decolonization, additional members were recolonized with MRSA. Hygiene measures should, therefore, be maintained to limit the transmission of S. aureus between personnel and horses.

Antimicrobial resistance of Escherichia coli and Enterococcus faecalis in housed laying-hen flocks in Europe

The aim of this study was to determine the potential association between housing type and multiple drug resistance (MDR) in Escherichia coli and Enterococcus faecalis isolates recovered from 283 laying-hen flocks. In each flock, a cloacal swab from four hens was collected and produced 1102 E. coli and 792 E. faecalis isolates. Broth microdilution was used to test susceptibility to antimicrobials. Country and housing type interacted differently with the MDR levels of both species. In the E. coli model, housing in a raised-floor system was associated with an increased risk of MDR compared to the conventional battery system [ odds ratio (OR) 2.12, 95% confidence interval (CI) 1.13-3.97)]. In the E. faecalis model the MDR levels were lower in free-range systems than in conventional battery cages (OR 0.51, 95% CI 0.27-0.94). In Belgium, ceftiofur-resistant E. coli isolates were more numerous than in the other countries.

CD34-related coexpression of MDR1 and BCRP indicates a clinically resistant phenotype in patients with acute myeloid leukemia (AML) of older age

Clinical resistance to chemotherapy in acute myeloid leukemia (AML) is associated with the expression of the multidrug resistance (MDR) proteins P-glycoprotein, encoded by the MDR1/ABCB1 gene, multidrug resistant-related protein (MRP/ABCC1), the lung resistance-related protein (LRP), or major vault protein (MVP), and the breast cancer resistance protein (BCRP/ABCG2). The clinical value of MDR1, MRP1, LRP/MVP, and BCRP messenger RNA (mRNA) expression was prospectively studied in 154 newly diagnosed AML patients >or=60 years who were treated in a multicenter, randomized phase 3 trial. Expression of MDR1 and BCRP showed a negative whereas MRP1 and LRP showed a positive correlation with high white blood cell count (respectively, p < 0.05, p < 0.001, p < 0.001 and p < 0.001). Higher BCRP mRNA was associated with secondary AML (p < 0.05). MDR1 and BCRP mRNA were highly significantly associated (p < 0.001), as were MRP1 and LRP mRNA (p < 0.001) expression. Univariate regression analyses revealed that CD34 expression, increasing MDR1 mRNA as well as MDR1/BCRP coexpression, were associated with a lower complete response (CR) rate and with worse event-free survival and overall survival. When adjusted for other prognostic actors, only CD34-related MDR1/BCRP coexpression remained significantly associated with a lower CR rate (p = 0.03), thereby identifying a clinically resistant subgroup of elderly AML patients.