Métodos de preparação e atividade biológica do ácido quinolínico e derivados

In 1981 2,3-pyridine dicarboxylic acid (quinolinic acid) was discovery to be a selective agonist for the N-methyl -D-aspartic acid (NMDA) receptor. As a consequence it possesses neurotoxic activity resulting from overstimulation of the receptor. Quinolinic acid is implicated as an etiological factor in a range of neurodegenerative disease including AIDS related dementia, Huntington´s disease and Lyme disease. In the design of novel therapies to treat these diseases, some molecules have been identified as an important target. In this paper we described different methods to prepare quinolinic acid and derivatives.

Role and regulatory mechanisms of heat shock factor 2

Protein homeostasis is essential for cells to prosper and survive. Various forms of stress, such as elevated temperatures, oxidative stress, heavy metals or bacterial infections cause protein damage, which might lead to improper folding and formation of toxic protein aggregates. Protein aggregation is associated with serious pathological conditions such as Alzheimer’s and Huntington’s disease. The heat shock response is a defense mechanism that protects the cell against protein-damaging stress. Its ancient origin and high conservation among eukaryotes suggest that the response is crucial for survival. The main regulator of the heat shock response is the transcription factor heat shock factor 1 (HSF1), which induces transcription of genes encoding protective molecular chaperones. In vertebrates, a family of four HSFs exists (HSF1-4), with versatile functions not only in coping with acute stress, but also in development, longevity and cancer. Thus, knowledge of the HSFs will aid in our understanding on how cells survive suboptimal circumstances, but will also provide insights into normal physiological processes as well as diseaseassociated conditions. In this study, the function and regulation of HSF2 have been investigated. Earlier gene inactivation experiments in mice have revealed roles for HSF2 in development, particularly in corticogenesis and spermatogenesis. Here, we demonstrate that HSF2 holds a role also in the heat shock response and influences stress-induced expression of heat shock proteins. Intriguingly, DNA-binding activity of HSF2 upon stress was dependent on the presence of intact HSF1, suggesting functional interplay between HSF1 and HSF2. The underlying mechanism for this phenomenon could be configuration of heterotrimers between the two factors, a possibility that was experimentally verified. By changing the levels of HSF2, the expression of HSF1-HSF2 heterotrimer target genes was altered, implementing HSF2 as a modulator of HSF-mediated transcription. The results further indicate that HSF2 activity is dependent on its concentration, which led us to ask the question of how accurate HSF2 levels are achieved. Using mouse spermatogenesis as a model system, HSF2 was found to be under direct control of miR-18, a miRNA belonging to the miR-17~92 cluster/Oncomir-1 and whose physiological function had remained unclear. Investigations on spermatogenesis are severely hampered by the lack of cell systems that would mimic the complex differentiation processes that constitute male germ cell development. Therefore, to verify that HSF2 is regulated by miR-18 in spermatogenesis, a novel method named T-GIST (Transfection of Germ cells in Intact Seminiferous Tubules) was developed. Employing this method, the functional consequences of miR-18-mediated regulation in vivo were demonstrated; inhibition of miR- 18 led to increased expression of HSF2 and altered the expression of HSF2 target genes Ssty2 and Speer4a. Consequently, the results link miR-18 to HSF2-mediated processes such as germ cell maturation and quality control and provide miR-18 with a physiological role in gene expression during spermatogenesis.Taken together, this study presents compelling evidence that HSF2 is a transcriptional regulator in the heat shock response and establishes the concept of physical interplay between HSF2 and HSF1 and functional consequences thereof. This is also the first study describing miRNA-mediated regulation of an HSF.

Estudo da utilização no pré-operatório de medicamentos ou drogas fitoterápicas que alteram a coagulação sangüínea

OBJETIVO: Verificar com que freqüência medicamentos e\ou drogas fitoterápicas que interferem na coagulação sangüínea são utilizados por pacientes que serão submetidos à intervenção cirúrgica e cujo uso não é relatado ao cirurgião; ou quando este é informado não se recomenda a sua interrupção antes da operação. MÉTODO: Estudo quantitativo com variáveis qualitativas, transversal, sobre o uso de medicamentos (AAS e Vitamina E) e fitoterápicos (Ginkgo biloba, Alho, Ginseng e Gengibre) por parte de 416 pacientes em programação pré-operatória. Desenvolvido no Hospital Universitário de Taubaté (HUT) no Hospital Regional de Taubaté (HRT) e em um Consultório Particular de Cirurgia Plástica. Estes dados foram obtidos por meio de questionário com perguntas relacionadas ao uso ou não das drogas referidas no último ano e nos 10 dias que antecediam a operação, se o cirurgião foi informado do fato e se houve recomendação médica para a sua suspensão. RESULTADOS: do total pesquisado 58,89% não fizeram uso de alguma das drogas em questão, 39% as usaram no último ano e 13,83% usaram nos últimos 10 dias. O AAS foi o medicamento mais utilizado e dentre os fitoterápicos, o Ginkgo biloba. Do total pesquisado 73,69% dos pacientes não informaram ao cirurgião o uso destas drogas. CONCLUSÕES: Na população estudada é elevada a porcentagem do uso de drogas que interferem na coagulação sanguínea, sendo as mais utilizadas o AAS, a vitamina E e o Ginkgo biloba. A maioria dos pacientes pesquisados não informou ao cirurgião a sua utilização. Deve-se enfatizar a necessidade de pesquisar o uso dessas drogas no pré-operatório, com o objetivo de reduzir possíveis complicações hemorrágicas per e pós-operatórias, pelas suas complicações médicas e eventuais implicações legais.

Contrôle postural et intégration sensorielle chez l’enfant en santé, chez l’adolescent atteint du syndrome Gilles de la Tourette ainsi que chez l’adulte atteint de la maladie de Huntington

Le contrôle postural et la perception des limites de la stabilité sont des processus complexes qui nécessitent le traitement et l’intégration d’informations sensorielles multimodales. Pendant l’enfance, le développement de la stabilité posturale s’effectue de façon non-monotonique. Plusieurs auteurs ont suggéré que ce profil non linéaire serait provoqué par une période de recalibration des systèmes sensoriels. Cette phase, nommée période de transition, est observée vers l’âge de 6-7 ans. Nous disposons toutefois de très peu d’information sur le rôle spécifique des afférences et des mécanismes d’intégration sensorielle au cours du développement postural. Les dysfonctions dans les noyaux gris centraux, telles que ceux observés dans la maladie de Parkinson, ont été associées à divers déficits dans le contrôle de la posture, dans le traitement et l’intégration sensoriel plus particulièrement, au niveau des informations proprioceptives. De plus, les limites fonctionnelles de la stabilité posturale des personnes atteintes de la maladie de Parkinson sont significativement réduites. Cependant, les connaissances concernant comment certaines pathologies des noyaux gris centraux, telles que le syndrome Gilles de la Tourette (SGT) et la maladie de Huntington (MH) affectent la capacité d’utiliser les informations sensorielles pour contrôler la posture demeurent à ce jour, incomplètes. Cette thèse porte sur le rôle des noyaux gris centraux dans les processus de traitements et d’intégration sensorielle, particulièrement les afférences proprioceptives dans le contrôle de la posture au cours du développement de l’enfant en santé, atteint du SGT et chez l’adulte atteint de la MH avec et sans symptôme clinique. Notre protocole expérimental a été testé chez ces trois populations (enfants en santé, SGT et MH). Nous avons utilisé des mesures quantitatives à partir de données issues d’une plateforme de force afin d’évaluer les ajustements posturaux dans les limites de la stabilité posturale. Les participants devaient s’incliner le plus loin possible dans quatre différentes directions (avant, arrière, droite et gauche) et maintenir l’inclinaison posturale maximale pendant 10 secondes. Afin de tester la capacité à traiter et à intégrer les informations sensorielles, la tâche expérimentale a été exécutée dans trois conditions sensorielles : 1) yeux ouverts, 2) yeux fermés et 3) yeux fermés, debout sur une mousse. Ainsi, la contribution relative de la proprioception pour le contrôle postural augmente à travers les conditions sensorielles. Dans la première étude, nous avons évalué la capacité à traiter et à intégrer les informations sensorielles avant (4 ans) et après (8-10 ans) la période de transition comparativement aux adultes. Dans la deuxième et la troisième étude, nous avons également évalué le traitement et l’intégration des informations sensorielles chez les patients atteints de désordres des noyaux gris centraux. La deuxième étude portera spécifiquement sur les adolescents atteints du SGT et la troisième, sur la MH avant et après l’apparition des symptômes cliniques. En somme, les résultats de la première étude ont démontré que la performance des enfants est affectée de façon similaire par les différentes conditions sensorielles avant et après la période de transition. Toutefois, le profil de développement des mécanismes responsables des ajustements posturaux de l’axe antéropostérieur est plus précoce comparativement à ceux de l’axe médiolatéral. Ainsi, nos résultats ne supportent pas l’hypothèse de la période de recalibration des systèmes sensoriels pendant cette période ontogénétique mais suggèrent que la période de transition peut être expliquée par la maturation précoce des mécanismes d’ajustements posturaux dans l’axe antéropostérieur. Dans l’ensemble, les résultats de nos études chez les populations atteintes de désordres des noyaux gris centraux (MH et SGT) démontrent non seulement qu’ils ont des déficits posturaux mais également que les ajustements posturaux dans les deux axes sont affectés par les conditions sensorielles. Pour la première fois, nos études démontrent des déficits globaux de traitements et d’intégration sensorielle accentués pour les signaux proprioceptifs. Ces résultats sont similaires à ceux observés dans la maladie de Parkinson. De plus, les adolescents atteints du SGT éprouvent également des troubles posturaux marqués dans la condition visuelle ce qui suggère des déficits d’intégrations visuelles et/ou multimodaux.

Rôle du métabolisme énergétique dans un contexte de vieillissement chez C. elegans

L’incidence constante des maladies liées à l’âge reflète un réel enjeu dans nos sociétés actuelles, principalement lorsqu’il est question des cas de cancers, d’accidents cérébraux et de maladies neurodégénératives. Ces désordres sont liés à l’augmentation de l’espérance de vie et à un vieillissement de la population. Les coûts, estimés en milliards de dollars, représentent des sommes de plus en plus importantes. Bien que les efforts déployés soient importants, aucun traitement n’a encore été trouvé. Les maladies neurodégénératives, telles que la maladie d’Alzheimer, de Parkinson, d’Huntington ou la sclérose latérale amyotrophique (SLA), caractérisées par la dégénérescence d’un type neuronal spécifique à chaque pathologie, représentent un défi important. Les mécanismes de déclenchement de la pathologie sont encore nébuleux, de plus il est maintenant clair que certains de ces désordres impliquent de nombreux gènes impliqués dans diverses voies de signalisation induisant le dysfonctionnement de processus biologiques importants, tel que le métabolisme. Dans nos sociétés occidentales, une problématique, directement lié à notre style de vie s’ajoute. L’augmentation des quantités de sucre et de gras dans nos diètes a amené à un accroissement des cas de diabètes de type II, d’obésité et de maladies coronariennes. Néanmoins, le métabolisme du glucose, principale source énergétique du cerveau, est primordial à la survie de n’importe quel organisme. Lors de ces travaux, deux études effectuées à l’aide de l’organisme Caenorhabditis elegans ont porté sur un rôle protecteur du glucose dans un contexte de vieillissement pathologique et dans des conditions de stress cellulaire. Le vieillissement semble accéléré dans un environnement enrichi en glucose. Cependant, les sujets traités ont démontré une résistance importante à différents stress et aussi à la présence de protéines toxiques impliquées dans la SLA et la maladie de Huntington. Dans un deuxième temps, nous avons démontré que ces effets peuvent aussi être transmis à la génération suivante. Un environnement enrichi en glucose a pour bénéfice de permettre une meilleure résistance de la progéniture, sans pour autant transmettre les effets néfastes dû au vieillissement accéléré.

Biology and characterisation of polyalanine as an emerging pathological marker

Dix-huit maladies humaines graves ont jusqu'ici été associées avec des expansions de trinucléotides répétés (TNR) codant soit pour des polyalanines (codées par des codons GCN répétés) soit pour des polyglutamines (codées par des codons CAG répétés) dans des protéines spécifiques. Parmi eux, la dystrophie musculaire oculopharyngée (DMOP), l’Ataxie spinocérébelleuse de type 3 (SCA3) et la maladie de Huntington (MH) sont des troubles à transmission autosomale dominante et à apparition tardive, caractérisés par la présence d'inclusions intranucléaires (IIN). Nous avons déjà identifié la mutation responsable de la DMOP comme étant une petite expansion (2 à 7 répétitions supplémentaires) du codon GCG répété du gène PABPN1. En outre, nous-mêmes ainsi que d’autres chercheurs avons identifié la présence d’événements de décalage du cadre de lecture ribosomique de -1 au niveau des codons répétés CAG des gènes ATXN3 (SCA3) et HTT (MH), entraînant ainsi la traduction de codons répétés hybrides CAG/GCA et la production d'un peptide contenant des polyalanines. Or, les données observées dans la DMOP suggèrent que la toxicité induite par les polyalanines est très sensible à leur quantité et leur longueur. Pour valider notre hypothèse de décalage du cadre de lecture dans le gène ATXN3 dans des modèles animaux, nous avons essayé de reproduire nos constatations chez la drosophile et dans des neurones de mammifères. Nos résultats montrent que l'expression transgénique de codons répétés CAG élargis dans l’ADNc de ATXN3 conduit aux événements de décalage du cadre de lecture -1, et que ces événements sont néfastes. À l'inverse, l'expression transgénique de codons répétés CAA (codant pour les polyglutamines) élargis dans l’ADNc de ATXN3 ne conduit pas aux événements de décalage du cadre de lecture -1, et n’est pas toxique. Par ailleurs, l’ARNm des codons répétés CAG élargis dans ATXN3 ne contribue pas à la toxicité observée dans nos modèles. Ces observations indiquent que l’expansion de polyglutamines dans nos modèles drosophile et de neurones de mammifères pour SCA3 ne suffit pas au développement d'un phénotype. Par conséquent, nous proposons que le décalage du cadre de lecture ribosomique -1 contribue à la toxicité associée aux répétitions CAG dans le gène ATXN3. Pour étudier le décalage du cadre de lecture -1 dans les maladies à expansion de trinucléotides CAG en général, nous avons voulu créer un anticorps capable de détecter le produit présentant ce décalage. Nous rapportons ici la caractérisation d’un anticorps polyclonal qui reconnaît sélectivement les expansions pathologiques de polyalanines dans la protéine PABPN1 impliquée dans la DMOP. En outre, notre anticorps détecte également la présence de protéines contenant des alanines dans les inclusions intranucléaires (IIN) des échantillons de patients SCA3 et MD.

Interactions between herbal and conventional medicines

Herb-drug interactions are subject to much interest at present, but for various reasons reports may be unreliable or unsubstantiated. Herbal medicines are variable in composition and quality, which may affect their interaction profile as well as the reliability of reports concerning them. In this review, clinical and experimental reports have been collated, evaluated and summarised, and the theoretical and clinical evidence presented. There is an explanation of the particular issues involved with herbal medicines as compared with conventional drugs, and reasons why comparisons may or may not be valid, which is intended for those without specialist experience in herbal products. It has become apparent that only a few herbal drugs have so far been cited in interaction reports, for example St John's Wort, Ginkgo biloba, Dan Shen, liquorice, Ma huang and garlic, and that the main drugs involved are those which are already susceptible to interactions with many other conventional drugs, such as warfarin, protease inhibitors and anti-cancer drugs. An attempt has been made to put the matter into perspective and recommendations have been given for health professionals to advise or develop strategies to safeguard patients, without resorting to speculation or scaremongering.

Flavonoids as modulators of memory and learning: molecular interactions resulting in behavioural effects

There is considerable interest in the potential of a group of dietary-derived phytochemicals known as flavonoids in modulating neuronal function and thereby influencing memory, learning and cognitive function. The present review begins by detailing the molecular events that underlie the acquisition and consolidation of new memories in the brain in order to provide a critical background to understanding the impact of flavonoid-rich diets or pure flavonoids on memory. Data suggests that despite limited brain bioavailability, dietary supplementation with flavonoid-rich foods, such as blueberry, green tea and Ginkgo biloba lead to significant reversals of age-related deficits on spatial memory and learning. Furthermore, animal and cellular studies suggest that the mechanisms underpinning their ability to induce improvements in memory are linked to the potential of absorbed flavonoids and their metabolites to interact with and modulate critical signalling pathways, transcription factors and gene and/or protein expression which control memory and learning processes in the hippocampus; the brain structure where spatial learning occurs. Overall, current evidence suggests that human translation of these animal investigations are warranted, as are further studies, to better understand the precise cause-and-effect relationship between flavonoid intake and cognitive outputs.

MicroRNA expression is differentially altered by xenobiotic drugs in different human cell lines

Several noncoding microRNAs (miR or miRNA) have been shown to regulate the expression of drug-metabolizing enzymes and transporters. Xenobiotic drug-induced changes in enzyme and transporter expression may be associated with the alteration of miRNA expression. Therefore, this study investigated the impact of 19 xenobiotic drugs (e. g. dexamethasone, vinblastine, bilobalide and cocaine) on the expression of ten miRNAs (miR-18a, -27a, -27b, -124a, -148a, -324-3p, -328, -451, -519c and -1291) in MCF-7, Caco-2, SH-SY5Y and BE(2)-M17 cell systems. The data revealed that miRNAs were differentially expressed in human cell lines and the change in miRNA expression was dependent on the drug, as well as the type of cells investigated. Notably, treatment with bilobalide led to a 10-fold increase of miR-27a and a 2-fold decrease of miR-148a in Caco-2 cells, but no change of miR-27a and a 2-fold increase of miR-148a in MCF-7 cells. Neuronal miR-124a was generally down-regulated by psychoactive drugs (e. g. cocaine, methadone and fluoxetine) in BE(2)-M17 and SH-SY5Y cells. Dexamethasone and vinblastine, inducers of drug-metabolizing enzymes and transporters, suppressed the expression of miR-27b, -148a and -451 that down-regulate the enzymes and transporters. These findings should provide increased understanding of the altered gene expression underlying drug disposition, multidrug resistance, drug-drug interactions and neuroplasticity. Copyright (C) 2011 John Wiley & Sons, Ltd.

Estudo da qualidade da informação constante nas bulas dos principais medicamentos fitoterápicos registrados no Brasil

Os objetivos deste trabalho foram: fazer um levantamento das dez espécies vegetais que compõem o maior número de apresentações farmacêuticas de fitoterápicos simples registradas na ANVISA; realizar o diagnóstico da oferta e da qualidade das informações contidas nas bulas das apresentações contendo as cinco espécies vegetais mais utilizadas; e definir as informações técnicas que devem estar contidas na bula de especialidades farmacêuticas que contenham como ingredientes ativos unicamente extratos preparados a partir destas espécies. O levantamento das dez espécies vegetais abrangeu o período de 01/01/1998 a 30/06/2003 e foi realizado através de consulta ao OPTLINE (www.i-helps.com). Os medicamentos fitoterápicos representam 7,76% (1888) das apresentações de registro de medicamentos no Brasil, sendo 1311 (5,38 %) apresentações de medicamentos fitoterápicos simples. Cinqüenta e oito espécies vegetais constituíam os registros de medicamentos fitoterápicos simples, sendo as dez com maior número de apresentações Ginkgo biloba L.: 302 (23,04%); Hypericum perforatum L.: 126 (9,61%); Piper methysticum F.: 87 (6,64%); Cimicifuga racemosa Nutt: 79 (6,03%); Valeriana officinalis L.: 76 (5,80%); Vitis vinifera L.: 69 (5,26%); Echinacea purpurea L.: 58 (4,42%); Aesculus hippocastanum L.: 53 (4,04%); Panax ginseng C. A Mayer: 48 (3,66%) e Cynara scolymus L.: 31 (2,36%). O diagnóstico da oferta e da qualidade das informações contidas nos textos das bulas foi realizado comparando-se estas informações com aquelas apresentadas na base de dados Medline (PubMed - www.ncbi.nhm.nhi.gov) dos últimos 5 anos e em obras bibliográficas de referência aceitas pela ANVISA, além de outras, clássicas na área de farmacognosia e fitoterapia . Foram avaliadas vinte e oito bulas. As informações de todas as bulas apresentavam incompatibilidades com as informações da literatura consultada. Os problemas mais freqüentemente encontrados foram relativos à sinonímia popular, eficácia, via de administração, contra-indicações, uso em idosos, crianças e grupos de risco, reações adversas e interações medicamentosas. Para cada uma das cinco espécies mais citadas, as informações científicas e técnicas compiladas foram organizadas como uma proposta de bula para o Profissional de Saúde a ser incluída no Compêndio de Bulas de Medicamentos (CBM), conforme previsto na Resolução-RDC nº 140/03, o qual consiste em um conjunto de bulas de medicamentos comercializados, editado pelo órgão regulador e com conteúdo da bula para o paciente e da bula para o profissional de saúde.

Determinação química e biológica de bauhinia forficata link subespécie pruinosa (pata-de-vaca - leguminosae)

Bauhinia forficata, Leguminosae, é conhecida popularmente como pata-devaca e seus principais constituintes químicos são flavonóides. Ë comumente usada como antidiabética, mas existem relatos a respeito de suas atividades antioxidante e antiedematogênica. A fim de avaliar-se o comportamento de seus constituintes químicos frente a variações de temperatura e umidade, realizou-se estudo de estabilidade acelerada (50 ºC ± 2 oC e 90% ± 5% U.R.), onde a substância química majoritária (SQM) serviu como marcador para os devidos cálculos e, portanto, o seu isolamento prévio tornou-se imprescindível. Um método devidamente validado por Cromatografia Líquida de Alta Eficiência (CLAE) foi utilizado para as análises e através das mesmas pode-se predizer uma reação de segunda ordem e, por conseguinte, um tempo de vida útil de 2,63 dias e um tempo de meia-vida de 23,65 dias. Avaliou-se, ainda, as atividades antioxidante (DPPH), antiedematogênica (edema em pata de ratos induzido pela carragenina) e anticolinesterásica (autobiografia). Para a atividade antioxidante, dos extratos testados, o butanólico foi o que demonstrou maior ação (54,73 µl/ml) sendo, no entanto, inferior ao padrão Ginkgo biloba (42,51 µl/ml). Na avaliação da atividade antiedematogênica, o extrato aquoso testado demonstrou um máximo de inibição de 76,5%. Ao testar-se a atividade anticolinesterásica de produtos isolados obtidos a partir de B. forficata, nenhuma ação significativa foi observada exigindo estudos complementares.

Simultaneous Determination of Cadmium and Lead in Medicinal Plants Using Graphite Furnace Atomic Absorption Spectrometry and Direct Slurry Sampling

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efeito da catuama e do bilobalide na regeneração nervosa perifírica de ratos submetidos à secção do nervo isquático

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A Catuama e o bilobalide na regeneração nervosa periférica de ratos submetidos à secção do nervo isquiático

The Catuama((R)) is composed of four Brazilian plants extracts (Paullinia cupana, Trichilia catigua, Ptychopetalum olacoides e Zingiber officinale). The Catuama((R)) is known as having neuroprotector, anti-inflammatory, antioxidant and antidepressant effects. Bilobalide, extracted from leaves of Ginkgo biloba, is known by its neuroprotective effect in the central and peripheral nervous systems. The present study evaluates the effect of Catuama((R)) and bilobalide on peripheral nerve regeneration in rats following a sciatic nerve section. Sciatic nerve of forty adult rats was transected with a 10-mm gap and the proximal and distal nerve stumps were fixed in a silicone tube filled with liquid collagen. The animals were divided into four groups: the control group (A), two groups treated with Catuama((R)) by gavage along 28 days after the surgery in different doses of 100 (B) and 400mg. kg(-1) (C) and the group using 200 mu M bilobalide (D) associated with the liquid collagen in the silicone tube. Evaluations were done by a walk test on the first, fifth and tenth week after the surgery. Electrophysiological stimulation and quantitative and qualitative histological analyses of the sciatic nerve and gastrocnemius muscle were also performed on the tenth week after the surgery. All groups showed good regeneration but no statistical difference was found between treatments and control groups (P > 0.05).

Chorea in primary antiphospholipid syndrome is associated with rheumatic fever

The aim of the study is to evaluate the frequency of chorea in a cohort of primary antiphospholipid syndrome (PAPS) patients and their possible clinical and laboratory associations. The records of 88 PAPS patients, fulfilling Sapporo criteria, followed up at the rheumatology outpatient clinic, were analyzed in order to determine the frequency of chorea. Risk factors for chorea, clinical manifestations, associated comorbidities, serologic features and treatment strategies were analyzed. Eighty-eight PAPS patients were evaluated. Mean age was 40.6 +/- A 11.1 years, and 91% of them were Caucasian and 91% women. Four (4.5%) patients with chorea were identified: 2 of them (50%) had only one chorea episode and 2 (50%) had recurrent chorea. All patients had chorea onset before PAPS diagnosis. Mean age, gender and ethnical distribution were comparable in groups with or without seizures (P > 0.05). Interestingly, the comparison of the 4 PAPS patients with chorea with those without this abnormality (n = 84) demonstrated a lower BMI [21.1 (18-24.2) vs. 27.5 (17.5-40.9) kg/m(2), P = 0.049] and frequency of venous events (0 vs. 63.1%, P = 0.023) in the first group. A higher frequency of rheumatic fever (75% vs. 0, P < 0.001) and thrombocytopenia (75 vs. 21.4%, P = 0.041) was observed in PAPS individuals with chorea. Both groups were alike regarding the other clinical APS manifestations, disease duration, risk factors for cerebrovascular diseases, use of drugs and antiphospholipid antibodies (P > 0.05). This study demonstrated that 4.5% of PAPS patients had chorea, predominately before PAPS diagnosis, and this neurological abnormality was associated with rheumatic fever and thrombocytopenia. These data reinforce the need for RF diagnosis in those PAPS patients with chorea.