Spontaneous healing of Mycobacterium ulcerans lesions in the guinea pig model

Buruli Ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans infection. BU is characterized by a wide range of clinical forms, including non-ulcerative cutaneous lesions that can evolve into severe ulcers if left untreated. Nevertheless, spontaneous healing has been reported to occur, although knowledge on this process is scarce both in naturally infected humans and experimental models of infection. Animal models are useful since they mimic different spectrums of human BU disease and have the potential to elucidate the pathogenic/protective pathway(s) involved in disease/healing. In this time-lapsed study, we characterized the guinea pig, an animal model of resistance to M. ulcerans, focusing on the macroscopic, microbiological and histological evolution throughout the entire experimental infectious process. Subcutaneous infection of guinea pigs with a virulent strain of M. ulcerans led to early localized swelling, which evolved into small well defined ulcers. These macroscopic observations correlated with the presence of necrosis, acute inflammatory infiltrate and an abundant bacterial load. By the end of the infectious process when ulcerative lesions healed, M. ulcerans viability decreased and the subcutaneous tissue organization returned to its normal state after a process of continuous healing characterized by tissue granulation and reepethelialization. In conclusion, we show that the experimental M. ulcerans infection of the guinea pig mimics the process of spontaneous healing described in BU patients, displaying the potential to uncover correlates of protection against BU, which can ultimately contribute to the development of new prophylactic and therapeutic strategies.

Segmentação do tecido tumoral cerebral em imagens de ressonância magnética

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Eletrónica Médica)

Imunologia do transtorno bipolar

OBJETIVO: Pesquisas recentes têm implicado fatores imunes na patogênese de diversos transtornos neuropsiquiátricos. O objetivo do presente trabalho é revisar os trabalhos que investigaram a associação entre transtorno bipolar e alterações em parâmetros imunes. MÉTODOS: Artigos que incluíam as palavras-chave: "bipolar disorder", "mania", "immunology", "cytokines", "chemokines", "interleukins", "interferon" e "tumor necrosis factor" foram selecionados em uma revisão sistemática da literatura. As bases de dados avaliadas foram MedLine e Scopus, entre os anos de 1980 e 2008. RESULTADOS: Foram identificados 28 trabalhos que estudaram alterações imunes em pacientes com transtorno bipolar. Seis artigos investigaram genes relacionados à resposta imune; cinco, autoanticorpos; quatro, populações leucocitárias; 13, citocinas e/ou moléculas relacionadas à resposta imune e seis, leucócitos de pacientes in vitro. CONCLUSÕES: Embora haja evidências na literatura correlacionando o transtorno bipolar a alterações imunes, os dados não são conclusivos. O transtorno bipolar parece estar associado a níveis mais elevados de autoanticorpos circulantes, assim como à tendência à ativação imune com produção de citocinas pró-inflamatórias e redução de parâmetros anti-inflamatórios.

Extensive subcutaneous emphysema as a presentation of ischemic colitis

Introduction . Subcutaneous emphysema is usually benign and self-limited; however, it may be associated with a life-threating situation. Case Report . An elderly woman with progressive malaise with extensive subcutaneous emphysema (cervical to abdominal wall) was observed at the emergency department. Colonic perforation was diagnosed and the patient underwent surgery. Intraoperatively, necrosis and perforation of the sigmoid colon into the retroperitoneum were found and a Hartmann procedure was performed. Conclusion . Cervical and thoracic subcutaneous emphysema may be the first sign of intra-abdominal lesion.

MET is required for the recruitment of anti-tumoural neutrophils

Mutations or amplification of the MET proto-oncogene are involved in the pathogenesis of several tumours, which rely on the constitutive engagement of this pathway for their growth and survival. However, MET is expressed not only by cancer cells but also by tumour-associated stromal cells, although its precise role in this compartment is not well characterized. Here we show that MET is required for neutrophil chemoattraction and cytotoxicity in response to its ligand hepatocyte growth factor (HGF). Met deletion in mouse neutrophils enhances tumour growth and metastasis. This phenotype correlates with reduced neutrophil infiltration to both the primary tumour and metastatic sites. Similarly, Met is necessary for neutrophil transudation during colitis, skin rash or peritonitis. Mechanistically, Met is induced by tumour-derived tumour necrosis factor (TNF)-a or other inflammatory stimuli in both mouse and human neutrophils. This induction is instrumental for neutrophil transmigration across an activated endothelium and for inducible nitric oxide synthase production upon HGF stimulation. Consequently, HGF/MET-dependent nitric oxide release by neutrophils promotes cancer cell killing, which abates tumour growth and metastasis. After systemic administration of a MET kinase inhibitor, we prove that the therapeutic benefit of MET targeting in cancer cells is partly countered by the pro-tumoural effect arising from MET blockade in neutrophils. Our work identifies an unprecedented role of MET in neutrophils, suggests a potential 'Achilles' heel' of MET-targeted therapies in cancer, and supports the rationale for evaluating anti-MET drugs in certain inflammatory diseases.

Protective effect of left ventricular hypertrophy in right coronary artery occlusions

OBJECTIVE: To test the hypothesis that left ventricular hypertrophy (LVH) reduces the electrocardiographic and functional effects of right coronary artery occlusion. METHODS: We analysed 215 patients (166 males and 49 women,age of 58.9±10.6 years), with occlusion of the right coronary artery without other associated lesions. There was no significant difference (p>0.05) in age and gender distribution between the 78 patients with LVH (left ventricular mass >100g/m²) (Group A) when compared with the 137 patients without LVH (left ventricular mass <100g/m²) (Group B). RESULTS: The electrocardiographic finding of transmural necrosis was more often found in group B patients than in group A patients (56.9% and 30.8%, respectively; p<0.05). The left ventricular function parameters of group A were better than those of group B: the ratio end-diastolic pressure/systolic pressure (EDP/SP) (A: 0.108±0.036; B: 0.121±0.050; p<0.05); the end-diastolic volume index (A: 75.9±31.3ml/m²; B: 88.0±31.0ml/m²; p<0.01); the end-systolic volume index (A: 16.0±10.0ml/m²; B: 27.0 ±20.0ml/m²; p<0.001); the ejection fraction (A 78.6±10.8%; B 67.7±17.9%; p<0.001); the anteroinferior shortening (A: 43.9±10.3%; B: 35.1±12.8%; p<0.001). A higher degree of coronary tortuosity was observed in group A than in group B (78.2% and 24.1%; p<0.001) and also a more frequent absent or minimal diaphragmatic hypokinetic area (A: 80.8%; B: 54.0%; p<0.05). CONCLUSION: LVH reduces the effects of myocardial sequela and protects LV function when right coronary occlusion develops.

Plasma levels of immunoinflammatory markers in De Novo coronary atherosclerosis and coronary restenosis postangioplasty

OBJECTIVE: To compare circulating plasma levels of immunoinflammatory markers in patients with known de novo coronary artery disease and patients with postangioplasty restenosis. METHODS: Using enzymatic immunoabsorbent assay, we measured plasma levels of soluble interleukin-2 receptosr, tumor necrosis factor alpha, and soluble tumor necrosis alpha receptors I and II in 11 patients with restenosis postcoronary angioplasty (restenosis group), in 10 patients with primary atherosclerosis (de novo group) who were referred for coronary angiography because of stable or unstable angina, and in 9 healthy volunteers (control group). Levels of soluble interleukin-2 receptors were significantly higher in the de novo group compared with that in the restenosis and control groups. Levels were also higher in the restenosis group compared with that in the control group. Plasma levels of tumor necrosis alpha and receptor levels were significantly higher in the de novo group compared to with that in the restenosis and control groups, but levels in the restenosis group were not different from that in the controls. CONCLUSION: Coronary artery disease, either primary or secondary to restenosis, is associated with significant immunoinflammatory activity, which can be assessed by examining the extent of circulating plasma levels of inflammatory markers. Moreover, patients with de novo lesions appear to have increased inflammatory activity compared with patients with restenosis.

Evaluation of inflammatory response induced by different types of daily contact lenses

Dissertação de mestrado em Genética Molecular

Cytokines and troponin-I in cardiac dysfunction after coronary artery grafting with cardiopulmonary bypass

OBJECTIVE: The association between cytokines and troponin-I with cardiac function after cardiac surgery with cardiopulmonary bypass remains a topic of continued investigation. METHODS: Serial measurements, within 24h following surgery, of tumor necrosis factor-alpha, its soluble receptors, and troponin-I were performed in patients with normal ejection fraction undergoing coronary artery bypass grafting. Ejection fraction was measured by radioisotopic ventriculography preoperatively, at 24h and at day 7 postoperatively. RESULTS: Of 19 patients studied (59±8.5 years), 10 (group 1) showed no changes in ejection fraction, 53±8% to 55±7%, and 9 (group 2) had a decrease in ejection fraction, 60±11% to 47±11% (p=0.015) before and 24h after coronary artery bypass grafting, respectively. All immunological variables, except tumor necrosis factor-alpha soluble receptor I at 3h postoperation (5.5± 0.5 in group 1 versus 5.9±0.2 pg/ml in group 2; p=0.048), were similar between groups. Postoperative troponin-I had an inverse correlation with ejection fraction at 24h (r= -0.44). CONCLUSIONS: Inflammatory activity, assessed based on tumor necrosis factor-alpha and its receptors, appears to play a minor role in cardiac dysfunction after cardiac surgery. Troponin I levels are inversely associated with early postoperative ejection fraction.

Behavior of inflammatory markers of myocardial injury in cardiac surgery: laboratory correlation with the clinical picture of postpericardiotomy syndrome

OBJECTIVE: To verify the association of serum markers of myocardial injury, such as troponin I, creatinine kinase, and creatinine kinase isoenzyme MB, and inflammatory markers, such as tumor necrosis factor alpha (TNF-alpha), C-reactive protein, and the erythrocyte sedimentation rate in the perioperative period of cardiac surgery, with the occurrence of possible postpericardiotomy syndrome. METHODS: This was a cohort study with 96 patients undergoing cardiac surgery assessed at the following 4 different time periods: the day before surgery (D0); the 3rd postoperative day (D3); between the 7th and 10th postoperative days (D7-10); and the 30th postoperative day (D30). During each period, we evaluated demographic variables (sex and age), surgical variables (type and duration , extracorporeal circulation), and serum dosages of the markers of myocardial injury and inflammatory response. RESULTS: Of all patients, 12 (12.5%) met the clinical criteria for a diagnosis of postpericardiotomy syndrome, and their mean age was 10.3 years lower than the age of the others (P=0.02). The results of the serum markers for tissue injury and inflammatory response were not significantly different between the 2 assessed groups. No significant difference existed regarding either surgery duration or extracorporeal circulation. CONCLUSION: The patients who met the clinical criteria for postpericardiotomy syndrome were significantly younger than the others were. Serum markers for tissue injury and inflammatory response were not different in the clinically affected group, and did not correlate with the different types and duration of surgery or with extracorporeal circulation.

Female alcoholics: electrocardiographic changes and associated metabolic and electrolytic disorders

OBJECTIVE: To identify the electrocardiographic changes and their associations with metabolic and electrolytic changes in female alcoholics. METHODS: The study comprised 44 female alcoholics with no apparent physical disorder. They underwent the following examinations: conventional electrocardiography; serologic tests for syphilis, Chagas' disease, and hepatitis B and C viruses; urinary pregnancy testing; hematimetric analysis; biochemical measurements of albumin, fibrinogen, fasting and postprandial glycemias, lipids, hepatic enzymes, and markers for tissue necrosis and inflammation. RESULTS: Some type of electrocardiographic change was identified in 33 (75%) patients. In 17 (38.6%) patients, more than one of the following changes were present: prolonged QTc interval in 24 (54.5%), change in ventricular repolarization in 11(25%), left ventricular hypertrophy in 6 (13.6%), sinus bradycardia in 4 (9.1%), sinus tachycardia in 3 (6.8%), and conduction disorder in 3 (6.8%). The patients had elevated mean serum levels of creatine phosphokinase, aspartate aminotransferases, and gamma glutamyl transferase, as well as hypocalcemia and low levels of total cholesterol and LDL-cholesterol. The patients with altered electrocardiograms had a more elevated age, a lower alcohol consumption, hypopotassemia, and significantly elevated levels of triglycerides, postprandial glucose, sodium and gamma glutamyl transferase than those with normal electrocardiograms. The opposite occurred with fasting glycemia, magnesium, and alanine aminotransferase. CONCLUSION: The electrocardiographic changes found were prolonged QTc interval, change in ventricular repolarization, and left ventricular hypertrophy. Patients with normal and abnormal electrocardiograms had different metabolic and electrolytic changes.

Avaliação da expressão de mediadores imunitários em amostras de cetáceos capturados acidentalmente em Portugal Continental

Dissertação de Mestrado Integrado em Medicina Veterinária

Influencia de aines sobre marcadores de osteoartrosis. Antiinflammatory drugs influence on osteoarthritis markers.

La osteoartritis es una enfermedad crónica y degenerativa del cartílago articular con elevada prevalencia en pacientes mayores de 60. En su etiología confluyen alteraciones mecánicas y bioquímicas del sistema músculo-esquelético que provocan disbalance entre síntesis y degradación condral., con deterioro y pérdida tisular. El cartílago articular es un tejido paucicelular. Sus escasos condrocitos se dispersan en una matriz moduladora bioquímica y morfológica. La homeostasis osteocondral resume acciones estimulantes, inhibidoras y reguladoras de citokinas e interleukinas Son péptídos liberados por las membranas celulares al líquido sinovial, que difunden hacia el cartílago en tanto órgano blanco. Importante avance en la fisiopatología de la inflamación fue el descubrimiento del rol del óxido nítrico (ON) derivado metabólico de la arginina por acción de las ON-Sintasas (ONS). Estimula la producción de colagenasas (MMP-1), que intensifican la resorción de proteoglicanos En OA también aumenta el factor de necrosis tumoral TNFa, rápidamente activado por su enzima convertidora TACE. Objetivo Evaluar efectos de antiinflamatorios sobre cultivo de cartílago articular de pacientes con osteoartritis y cuantificar in vitro producción de MMPs, relación NO2/NO3. IL6 y TNFa. Material y métodos: En sobrenadante de los cultivos se determinarán por espectrofotometría niveles de NO-2 y NO-3 (Griess et al, 1992) y usando ELISA doble sándwich la actividad de colagenasa (MMP-1), IL-6 y TNF-a, contrastadas con anticuerpos monoclonales .Los parámetros obtenidos con y sin agregado de fármacos, se correlacionarán con la microscopía óptica.

Infección de macrófagos con el Virus Encefalitis Saint Louis: efecto sobre el fenotipo celular y la apoptosis.

El virus Encefalitis Saint Louis (VESL) (género Flavivirus) experimenta una re-emergencia en la región central del país, con la ocurrencia de un brote en Córdoba y el aislamiento de cepas de distintos genotipos. Está demostrado que los Flavivirus neurotrópicos, como VESL, replican en macrófagos y células dendríticas, tanto en el tejido local como en nódulos linfáticos satélites, para luego llegar a torrente sanguíneo y ser transportados a sistema nervioso central. Es así que el nivel de viremia inicial es regulado por la depuración del virus que realizan los macrófagos. Estas células reconocen a los virus por medio de receptores de reconocimiento de patrones moleculares asociados a patógenos, que incluyen a los receptores Toll-like (TLR). La relación entre los TLR y los virus, se fundamenta en tres aspectos: 1) los TLR al ser estimulados por moléculas derivadas de virus activan vías de señalización que inducen la producción de citoquinas pro-inflamatorias, como TNF- , IL-1, 6, 8 y 18, INF-  y , que median la respuesta inmune antiviral; 2) las señales que dependen de los TLR median efectos inmunopatogénicos, como la apoptosis y la patogénesis del virus; 3) algunas estrategias terapéuticas o profilácticas antivirales se basan en la estimulación de los TLR mediante los respectivos agonistas. Como parte de la respuesta del macrófago a la infección viral, hay proliferación, diferenciación y muerte celular. A la hora de morir, estas células pueden seguir el camino que lleva a la necrosis o el de la apoptosis. Durante la activación de la respuesta inmune frente a antígenos extraños, la apoptosis es requerida para eliminar las células efectoras, una vez que han ejecutado su función y así evitar el desarrollo de procesos deletéreos para el huésped. Estudios realizados con distintos Flavivirus documentan el incremento de apoptosis de macrófagos durante la progresión de la infección y también su relación con la severidad de la patología. De acuerdo a los antecedentes expuestos, se formulan las siguientes hipótesis de estudio: 1-El fenotipo de activación del macrófago infectado con VESL está relacionado con el genotipo viral. 2-La clase de inmunomoduladores liberados y el grado de apoptosis de los macrófagos infectados con el VESL dependen del receptor de reconocimiento utilizado por el virus.El objetivo principal es caracterizar la respuesta inmune inducida en macrófagos infectados in vitro con diferentes genotipos de VESL. Para ello se plantean los siguientes objetivos específicos: 1-Determinar la capacidad de replicación de VESL en macrófagos.2-Evaluar la expresión de molécula de superficie, receptores y la producción de inmunomoduladores en macrófagos infectados con VESL.3-Analizar el impacto de la infección con VESL sobre la apoptosis de macrófagos.4-Correlacionar la expresión de antígenos de superficie, receptores, producción de inmunomoduladores, apoptosis y carga viral con el genotipo viral que infecta al macrófago.Se utilizará una línea línea celular mieloide U937 y cepas del VESL genotipo III, V y VII. Se estudiará la infección de las mismas y determinará la expresión de: CD14, CD16, CD54/ICAM-1, HLA-DR, Fas, R-TNF, CD86, IL4R, TLR2, TLR3, TLR4 y TLR7 por Citometría de Flujo. En el sobrenadante de los cultivos infectados se cuantificarán las concentraciones de IFN-, IFN-, TNF-, IL-1, IL-6, IL-8, IL-10, IL-12, IL-18 y TGF- por técnica de ELISA.Se determinará la apoptosis en los macrófagos infectados mediante marcación con Anexina V-Ficoeritrina y análisis de fragmentación del ADN.La emergencia de esta virosis en nuestro medio amerita abordar distintos aspectos de la respuesta inmune en esta infección. El conocimiento de las características de la activación del macrófago cuando se infecta con VESL, los inmunomoduladores liberados y el impacto de la infección sobre la apoptosis de ésta célula, aportaría posibles blancos para el diseño futuro de estrategias terapéuticas o profilácticas contra esta infección.

Producción de factores de virulencia por fitopatógenos bacterianos de soja. Utilización de productos naturales como biocontrol. Production of virulence factors by soybean bacterial phytopathogens. The use of natural products as biocontrolers.

En Argentina el cultivo de soja ocupa el primer lugar en superficie sembrada. El 90% de la producción se obtiene en la zona central del pais. La siembra directa favorece la multiplicación y supervivencia de fitopatógenos causantes de tizón y pústula bacterianos. El tizón es producido por Pseudomonas syringae pv. glycinea observándose manchas marrones en las hojas. Produce gran variedad de toxinas: coronatina, faseolotoxina, siringomicina, tabtoxina, proteínas “nucleation ice”, entre otras, las cuales contribuyen a la clorosis y necrosis. En la infección, además, están involucrados exopolisacáridos (levano y alginato). La celulosa ha sido relacionada en la adhesión bacteriana y en la formación de biofilm. La pústula es causada por Xanthomonas axonopodis pv. glycines. Produce manchas pequeñas con una pequeña pústula de color claro. Libera enzimas como α-amilasa, proteasa, endo β-mannanasa, actividad peptolítica, que degradan componentes vegetales. Xantan, producido por X. axonopodis es uno de los componentes necesarios para la formación de biofilm. Este último es considerado un importante factor de virulencia porque proporciona una estrategia de colonización que otorga mayor resistencia a ambientes desfavorables, tolerancia a antimicrobianos, producción de metabolitos y exoenzimas, etc. Actualmente el control de bacterias fitopatógenas se realiza mediante pesticidas con alta toxicidad para los consumidores y el ambiente. Para evitar las bacteriosis en la práctica se sugiere la rotación de cultivos y utilizar semillas certificadas. Se están probando compuestos naturales derivados de plantas medicinales como pesticidas; estos se pueden dividir en varias categorías fitoquímicas. Varios estudios confirman la actividad antibacteriana, antifúngica y antiviral de estos productos. Extractos vegetales con alto contenido de flavonoides y aceite esenciales poseen una importante actividad antibacteriana. Además, algunos aceites esenciales podrían estar incidiendo en la liberación y/o producción de biofilm, exopolisacáridos y exoproteínas. La gran incidencia de las infecciones por fitopatógenos y las pérdidas económicas que estas acarrean hacen que su control presente grandes dificultades para la agricultura sustentable en soja de nuestro país. En este trabajo se propone estudiar los diferentes factores de virulencia de cepas bacterianas fitopatógenas y evaluar el rol que cumplen en el proceso de la enfermedad en cultivos de soja y desarrollar estrategias para el control de bacteriosis vegetales aplicando productos naturales aislados de plantas aromáticas. La correcta utilización de productos antimicrobianos de origen natural aplicados sobre el cultivo y/o sobre las semillas evitaría la dispersión de la enfermedad y la eliminación al medio ambiente de productos contaminantes no deseados. In Argentina, soybean cultivation occupies the first place; 90% of this cereal is produced in the central region of the country. Intensive tillage practices favour multiplication and survival of bacterial phytopathogens causing blight and pustule diseases. Pseudomonas syringae pv. glycinea produce several toxins like coronatine, faseolotoxine, siringomicine, tabtoxine and proteins of nucleation ice that contribute to the develop of chlorosis and necrosis, characteristic of bacterial blight. It also produces levan and alginate, cellulose and biofilm. Pustule disease is caused by Xanthomonas axonopodis pv glycines, which produce enzymes like α-amilase, protease, endo β-mannanase, peptolitic activity, xanthan and biofilm. Nowadays the control of phytopathogenic bacteria consists in the application of pesticides that are toxic for the environment and man. Natural products from medicinal plants are a new alternative for the treatment of phytopathogens. Researches made with phytochemical compounds (flavonoids, phenols, quinones, cummarines, essential oils, terpenes) support the antimicrobial activity of these natural products. What is more, these substances could suppress the biofilm, exoproteins and exopolisaccharides formation and release of them. The infections caused by phytopathogens provoke economical loses and its control presents big difficulties in our country. The proposal of this work is the characterization of phytopatoghenic strains, its virulence factors and the role they play in the disease process. The development of a new alternative for the control of vegetable bacteriosis using natural products obtained from aromatic plants and the correct application of them on sown fields or on seeds is also an objective in this work.