Caracterização da paracoccidioidomicose-infecção como a forma de resistencia da paracoccidioidomicose humana : comparação com as formas juvenil e adulta da doença

Orientador: Maria Heloisa Souza Lima BlottaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: A paracoccidioidomicose (PCM) pode ser classificada em três grupos principais: PCM-infecção (PI); forma adulta (FA) e forma juvenil (FJ). O presente trabalho teve como objetivo comparar a resposta imunológica nesses diferentes grupos, por meio da análise da cinética da expressão do RNA mensageiro (RNAm) de citocinas e quimiocinas (IL-2, IL-4, IL-5, IL-6, IL-10, IFN-g, TGF-b, TNF-a, CXCL8, CXCL9, CXCL10) por RT-PCR, e caracterizar fenotipicamente as células produtoras dessas citocinas por citometria de fluxo. Como resultado obtivemos que indivíduos do grupo PI expressam precocemente maior quantidade de RNAm para IFN-g, TNF-a, CXCL9 e CXCL10, quando comparados aos pacientes com a FJ da PCM, e níveis similares de CXCL10 e IFN-g e aumentados de CXCL9 e TNF-a quando comparados aos pacientes com a FA. A expressão do RNAm para citocinas Th2 (IL-4, IL-10, IL-5 e TGF-b), de maneira geral, foi maior e mais precoce em indivíduos com a FA ou FJ, quando comparados aos indivíduos do grupo PI. Em relação a expressão proteica, observamos que indivíduos do grupo PI apresentam um número maior de células produtoras de IFN-g, TNF-a, IL-2, CXCL9 e CXCL10 quando comparados aos dois grupos de pacientes. A produção de IFN-g foi observada principalmente em células CD3+CD8+, enquanto que IL-2 e TNF-a foram detectados principalmente em células CD3+CD4+. Em relação à expressão de moléculas de superfície, observamos que monócitos de indivíduos do grupo PI apresentam maior expressão de CD80 e menor expressão de CD86 e CD54, quando comparados aos indivíduos com a FA ou FJ, e maior expressão de HLA-DR e CD11a quando comparados aos indivíduos com a FJ da PCM. Nossos resultados indicam que a cinética diferencial de produção de RNAm para citocinas do tipo Th1 ou Th2 pelos grupos estudados pode direcionar a resposta imunológica após a infecção, originando as diferenças clínicas observadasAbstract: Paracoccidioidomycosis (PCM) presents three major forms: PCM-infection (PI); adult form (AF) and juvenile form (JF). The aim of this study was to compare the immunological response in these groups through the analysis of the kinectics of mRNA expression of some cytokines and chemokines (IL-2, IL-4, IL-5, IL-6, IL-lO, IFN-y, TGF p, TNF-a, CXCLS, CXCL9 and CXCLlO) by RT-PCR, as well as, to characterize the phenotype of the cytokines producing cells by flow cytometry. The results showed that PI individuaIs express earlier and higher levels of mRNA for IFN-y, TNF-a, CXCL9 and CXCLIO when compared to JF patients and similar levels of CXCLlO and IFN-y and higher levels of CXCL9 and TNF -a when compared to AF ones. On the other hand, the mRNA expression ofTh2 cytokines (IL-4, IL-IO, IL-5 and TGF-P) was higher and earlier in JF and AF groups when compared to PI individuaIs. In relation to protein expression, we observed that PI group presents a higher percentage of cells producing IFN-y, TNF-a, IL-2, CXCL9 and CXCLIO when compared to both groups ofpatients. The production ofIFN-y was predominantIy done by CD3+CDS+ T cells, whereas IL-2 and TNF-a production was higher in CD3+CD4+ cells. Monocytes ofPI individuaIs also presented higher expression of CDSO and lower expression of CDS6 and CD54 when compared to JF and AF patients, and higher expression of HLA-DR and CDIIa only when compared to JF patients. These results indicate that the differential kinetic of mRNA expression of ThI or Th2 cytokines observed in the different forms of PCM may modulate the immunological response resulting in the different outcomes observed in this diseaseDoutoradoCiencias BiomedicasDoutor em Ciências Médica

Design and protocol of the multimorbidity and mental health cohort study in frailty and aging (MiMiCS-FRAIL):unraveling the clinical and molecular associations between frailty, somatic disease burden and late life depression

BACKGROUND: To explore the mutual relationship between multimorbidity, mental illness and frailty, we have set-up the Multimorbidity and Mental health Cohort Study in FRAILty and Aging (MiMiCS-FRAIL) cohort. At the population level, multimorbidity, frailty and late-life depression are associated with similar adverse outcomes (i.e. falls, disability, hospitalization, death), share the same risk factors, and partly overlap in their clinical presentation. Moreover, these three variables may share a common underlying pathophysiological mechanism like immune-metabolic dysregulation. The overall objectives of MiMiCS-FRAIL are 1) to explore (determinants of) the cross-sectional and longitudinal relationship between multimorbidity, depression, and frailty among non-demented geriatric outpatients; 2) to evaluate molecular levels of senoinflammation as a broad pathophysiological process underlying these conditions; and 3) to examine adverse outcomes of multimorbidity, frailty and depression and their interconnectedness. METHODS: MiMiCS-FRAIL is an ongoing observational cohort study of geriatric outpatients in Brazil, with an extensive baseline assessment and yearly follow-up assessments. Each assessment includes a comprehensive geriatric assessment to identify multimorbidity and geriatric syndromes, a structured psychiatric diagnostic interview and administration of the PHQ-9 to measure depression, and several frailty measures (FRAIL, Physical Phenotype criteria, 36-item Frailty Index). Fasten blood samples are collected at baseline to assess circulating inflammatory and anti-inflammatory cytokines, leukocytes' subpopulations, and to perform immune-metabolic-paired miRome analyses. The primary outcome is death and secondary outcomes are the number of falls, hospital admissions, functional ability, well-being, and dementia. Assuming a 5-year mortality rate between 25 and 40% and a hazard rate varying between 1.6 and 2.3 for the primary determinants require a sample size between 136 and 711 patients to detect a statistically significant effect with a power of 80% (beta = 0.2), an alpha of 5% (0.05), and an R2 between the predictor (death) and all covariates of 0.20. Local ethical board approved this study. DISCUSSION: Frailty might be hypothesized as a final common pathway by which many clinical conditions like depression and chronic diseases (multimorbidity) culminate in many adverse effects. The MiMiCS-FRAIL cohort will help us to understand the interrelationship between these variables, from a clinical perspective as well as their underlying molecular signature

Kinetics Of Cytokines And Chemokines Gene Expression Distinguishes Paracoccidioides Brasiliensis Infection From Disease.

The human infection with Paracoccidioides brasiliensis may result in three major outcomes: the paracoccidioidomycosis-infection (PI), the adult form (AF) and the juvenile form (JF) of the disease. The aim of this study was to compare the immunological response among these groups. The gene expression of multiple cytokines, including IL-4, IL-5, IL-6, IL-10, IFN-gamma, TNF-alpha and TGF-beta1, and chemokines, CXCL8, CXCL9 and CXCL10 was evaluated by RT-PCR in peripheral blood mononuclear cells unstimulated or following phytohemagglutinin stimulation for 3, 6, 12, 24 and 48 h. PI individuals expressed earlier and higher levels of mRNA of IFN-gamma, TNF-alpha, CXCL9 and CXCL10 when compared to JF patients. In relation to AF patients, the PI group presented similar levels of CXCL10 and IFN-gamma and higher levels of CXCL9. On the other hand, mRNA expression of Th2 cytokines (IL-4, IL-10, IL-5 and TGF-beta1) was higher and earlier in JF and AF groups, when compared to PI individuals. At some time intervals it was possible to differentiate JF from AF, mainly in relation to IL-4 and TGF-beta1 mRNA, expressed in higher levels in the JF patients. The distinct patterns of cytokines and chemokines expression support their important role in determining the different outcomes observed in this disease.3220-

Flow-cytometric Analysis Of Cytokine Production In Human Paracoccidioidomycosis.

Human infection with Paracoccidioides brasiliensis may result in three major outcomes: paracoccidioidomycosis-infection (PI), which is observed in healthy carriers living in endemic areas and the adult form (AF) and juvenile form (JF) of the disease. In this study we proposed to examine the intracellular expression of IFN-gamma, TNF-alpha, IL-2, IL-10, IL-12, CXCL8, CXCL9 and CXCL10 by peripheral blood mononuclear cells (PBMC) of patients with the JF and AF of the disease, as well as of PI individuals stimulated with PMA plus ionomycin, LPS or anti-CD3 plus anti-CD28, by flow cytometry. The results showed that PI individuals present a higher percentage of cells producing IFN-gamma, TNF-alpha, IL-2, CXCL9 and CXCL10 when compared to AF and JF patients. IFN-gamma was predominantly detected in CD3(+)CD8(+) T cells, whereas IL-2 and TNF-alpha were mainly expressed in CD3(+)CD4(+) cells. Monocytes of PI individuals also presented higher expression of CD80 and lower expression of CD86 when compared to JF and AF patients, and higher expression of HLA-DR, only when compared to JF patients. These results indicate that the differential production of cytokines and chemokines, as well as the expression of co-stimulatory molecules involved in antigen presentation, may influence the outcome of PCM infection.35207-1

Tlr-2, Tlr-4 And Dectin-1 Expression In Human Monocytes And Neutrophils Stimulated By Paracoccidioides Brasiliensis.

Paracoccidioidomycosis (PCM) is an endemic mycosis in Latin America caused by the dimorphic fungus Paracoccidioides brasiliensis. The pattern of the immune responses to P. brasiliensis determines the disease progression and clinical outcome. Innate immune response is mediated by phagocytic cells, such as macrophage and neutrophils, which ingest and kill invading pathogens and then trigger the adaptive immune system through the secretion of cytokines and chemokines. The C-type like lectin receptors (CLR) and Toll-like receptors (TLRs) are the two main pattern recognition receptors in phagocytic cells that recognize fungal components. Therefore, the purpose of the present study was to evaluate the expression of TLR-1, TLR-2, TLR-4 and dectin-1 (CLR) in monocytes and neutrophils from healthy individuals after stimulation with Pb18 (high virulence) and Pb265 (low virulence) yeasts of P. brasiliensis. As positive controls we used specific ligands to TLR-4 (LPS), TLR-2 and dectin-1 (zymosan). Our results demonstrated a decreased of TLRs and dectin-1 expression mainly on monocytes as opposes on neutrophils, as soon as 30 minutes after yeast cells stimulation. This decrease was similar to the one caused by zymosan stimulation and indicates that up binding the complexes are rapidly internalized. There was a tendency towards an increased TLR2 and dectin-1 mRNA expression in response to fungal cells, mainly to Pb265. P. brasiliensis yeast cells induced the production of pro-inflammatory and anti-inflammatory cytokines, but the low ratio between TNF-alpha and IL-10 in response to zymosan and Pb265 indicates a balanced production of IL-10 and TNF-alpha, while Pb18 predominantly induced TNF-alpha secretion. Fungal cells also induced an elevated production of PGE(2) by monocytes and neutrophils showing their potential to provoke an intense inflammatory response. Altogether our results suggest the participation of TLR2, TLR-4 and dectin-1 in P. brasiliensis recognition, internalization and consequent activation of the immune response against the fungus. Moreover, the preferential recognition of zymosan and Pb265 by TLR-2 and dectin-1 would result in the production of adequate concentration of IL-10, which would be able to counterbalance the excessive inflammatory response mediated by TNF-alpha and PGE2. With these attributes the low virulence strain of P. brasiliensis would induce a controlled immune response beneficial to the host.47722-3

Involvement of Regulatory T Cells in the Immunosuppression Characteristic of Patients with Paracoccidioidomycosis▿

Patients with paracoccidioidomycosis (PCM) exhibit a suppression of the cellular immune response characterized by negative delayed-type hypersensitivity (DTH) to Paracoccidioides brasiliensis antigens, the apoptosis of lymphocytes, and high levels of expression of cytotoxic-T-lymphocyte-associated antigen 4 (CTLA-4), interleukin-10 (IL-10), and transforming growth factor β (TGF-β). The aim of this study was to investigate whether and how regulatory T cells (Treg cells) are involved in this immunosuppression by analyzing the number, phenotype, and activity of these cells in patients with active disease (AD group) and patients who had received treatment (TD group). Our results showed that the AD patients had more Treg cells than the TD patients or controls (C group) and also had elevated levels of expression of regulatory markers (glucocorticoid-induced tumor necrosis factor [TNF] receptor-related protein [GITR], CTLA-4, CD95L, LAP-1, and CD38). An analysis of regulatory activity showed that Treg cells from the AD group had greater activity than did cells from the other groups and that cell-cell contact is mandatory for this activity in the C group but was only partially involved in the regulatory activity of cells from AD patients. The addition of anti-IL-10 and anti-TGF-β neutralizing antibodies to the cultures showed that the production of cytokines may be another mechanism used by Treg cells. In conclusion, the elevated numbers of these cells with an increased regulatory phenotype and strong suppressive activity suggest a potential role for them in the immunosuppression characteristic of paracoccidioidomycosis. In addition, our results indicate that while Treg cells act by cell-cell contact, cytokine production also plays an important role

Circulating Levels Of Chemokines In Psoriasis.

Chemokines may contribute to local and systemic inflammation in patients with psoriasis. Previous studies have demonstrated the importance of chemokine ligands and receptors in the recruitment of T cells into psoriatic lesional skin and synovial fluid. The aim of this study was to evaluate the levels of Th1-related chemokines in psoriasis and to investigate any association with disease severity. We quantified serum levels of CXCL9, CXCL10 and CXCL16 and the frequencies of CD4+CXCR3+ T lymphocytes through ELISA and flow cytometry, respectively. A total of 38 patients with psoriasis and 33 controls were included. There were no significant differences in chemokine levels between psoriasis and control groups. Patients with psoriatic arthritis had lower median level of CXCL10 when compared with controls (p=0.03). There were no significant correlations between serum chemokines analyzed and disease severity. Frequencies of CD4+CXCR3+ T cells were lower in patients with psoriasis than in controls (p<0.01). A sensitivity analysis excluding patients on systemic therapy yielded similar results. Serum concentrations of CXCL9, CXCL10 and CXCL16 were not increased in the psoriasis group or correlated with disease severity. Systemic levels of chemokine ligands do not seem to be sensitive biomarkers of disease activity or accurate parameters to predict response to therapy. Frequencies of CD4+CXCR3+ T cells were decreased in the peripheral blood of psoriasis patients, possibly due to recruitment to inflammatory lesions.4857-6

Characterization of CD4+ T Cell Subsets in Patients with Abdominal Aortic Aneurysms

Background. The mediators produced by CD4+ T lymphocytes are involved in the pathogenesis of aneurysmal lesions in abdominal aortic aneurysm (AAA) patients. The aim of this study was to identify and characterize the CD4+ T cell subsets involved in human AAA. Methods. The CD4+ T cell subsets in 30 human aneurysmal lesions were determined using flow cytometry (FC) and immunohistochemistry (IHC). The peripheral blood mononuclear cells (PBMCs) from patients with AAA were also analyzed by FC and compared with control subjects. Results. Human aneurysmal lesions contained IFN-γ, IL-12p35, IL-4, IL-23p19, IL-17R, and IL-22 positive cells. PBMCs from AAA patients had higher expression levels of IFN-γ, TNF-α, IL-4, and IL-22 when compared to controls. Conclusions. Our results show the presence of TH1, TH2, TH17, and TH22 subsets in aneurysmal lesions of AAA patients and suggest that these cells may be mainly activated in situ, where they can induce tissue degradation and contribute to the pathogenesis of AAA