Captação de ferro mediada por sideróforos em Paracoccidioides spp

Tese (doutorado)—Universidade de Brasília, Programa de Pós-Graduação em Patologia Molecular, 2014.O gênero Paracoccidioides inclui espécies fúngicas termodimórficas, causadoras da paracoccidioidomicose, uma micose sistêmica endêmica da América Latina. A infecção ocorre quando propágulos micelianos ou conídios são inalados pelo hospedeiro. Após conversão para levedura nos alvéolos pulmonares o fungo pode disseminar-se para outros órgãos e tecidos. O ferro é um micronutriente essencial para todos os eucariotos, pois participa de vários processos biológicos essenciais. Entretanto, a biodisponibilidade deste metal dentro do hospedeiro é baixa. Como consequência, micro-organismos patogênicos desenvolveram mecanismos de aquisição de alta afinidade como forma de obter ferro durante a infecção. O presente trabalho descreve a aquisição de ferro mediada por sideróforos neste fungo. Análises in silico demonstraram que as espécies do gênero Paracoccidioides possuem todos os genes necessários para síntese e captação de sideróforos, os quais são produzidos em condições de depleção de ferro. Análises de cromatografia líquida de fase reversa e espectrometria de massas revelaram que Paracoccidioides spp. produz sideróforos do tipo hidroxamato. O fungo sintetiza e secreta coprogeno B, o qual gera ácido dimerúmico como produto de degradação, e também produz ferricrocina e ferricromo C como sideróforos intracelulares. Adicionalmente, Paracoccidioides spp. é capaz de crescer na presença de sideróforos como única fonte de ferro, demonstrando que além de produzir, o fungo também utiliza siderofóros para o crescimento, incluindo o xenosideróforo ferrioxamina. A exposição prévia a ferrioxamina aumentou a sobrevivência de Paracoccidioides spp. após fagocitose por macrófagos ativados. Além disso, o fungo provavelmente induz a síntese de sideróforos quando no interior destas células, demonstrando que estas moléculas provavelmente desempenham papel importante durante a interação patógeno-hospedeiro. Ademais, sideróforos produzidos por Paracoccidioides spp. podem ser utilizados como fontes de ferro por Aspergillus nidulans. Em conjunto, estes dados demonstraram que a síntese e a utilização de sideróforos são mecanismos empregados por Paracoccidioides spp. para superar a limitação de ferro. Como a escassez deste micronutriente é encontrada no hospedeiro, a produção de sideróforos está provavelmente relacionada à patogenicidade e virulência do fungo e representa um possível alvo para terapia com antifúngicos levando-se em consideração a ausência de tal via em humanos. _______________________________________________________________________________________ ABSTRACTThe genus Paracoccidioides includes termodimorphic fungal species which causes paracoccidioidomycosis, a systemic mycosis endemic in Latin America. The infection occurs when mycelium propagules or conidia are inhaled by the host. After conversion to yeast in the alveoli the fungus may disseminate to other organs and tissues. Iron is an essential micronutrient for all eukaryotes, since it participates in a variety of essential biological processes. However, the bioavailability of this metal is low inside the host. As a consequence, pathogenic microorganisms evolved high affinity acquisition mechanisms to obtain iron during infection. Here we describe the siderophore mediated iron acquisition in this fungus. In silico analysis demonstrated that species from Paracoccidioides genus possess all the necessary genes for synthesis and uptake of siderophores, which are produced under iron limiting conditions. Reversed phase liquid chromatography and mass spectrometry analysis revealed that Paracoccidioides spp. produce siderophores of hydroxamate type. The fungus synthesizes and secretes coprogen B, which generates dimerumic acid as a breakdown product, and also produces ferricrocin and ferrichrome C as intracellular siderophores. Moreover, Paracoccidioides spp. is able to grow in presence of siderophores as the only iron sources, demonstrating that beyond producing, the fungus also utilizes siderophores for growth, including the xenosiderophore ferrioxamine. Previous exposure to ferrioxamine increased Paracoccidioides spp. survival following phagocytosis by activated macrophages. Moreover, the fungus probably induces siderophore synthesis inside these cells, demonstrating that these iron chelators play an important role during host-pathogen interaction. Additionally, siderophores produced by Paracoccidioides spp. can be utilized as iron sources by Aspergillus nidulans. Altogether, these data demonstrated that synthesis and utilization of siderophores are mechanisms employed by Paracoccidioides spp. to surpass iron limitation. As iron paucity is found within the host, siderophore production may be related to fungus pathogenicity and virulence and represents a possible target for antifungal therapy since these pathway is absent in humans

REVISÃO ABERTA POR PARES: QUANDO, POR QUE E PARA QUEM?

Open peer review, open review or OPR is an asset that benefits authors, evaluators, publishers and the scientific community who use its final product daily basis. This resource is consecrated based on the philosophy coming from the open science, reducing biases of the obscurantism of the conventional molds that perpass the contexto the production and scientificcommunication. This research aims at contributing for adoption on the open peer review, minimizing ideological obstacles over the dynamics that permeate the process, as an answer to the questions that originate and conduct this communication. Aiming to attend the objective, it is searched in the literature and in the metrics of the scientific production recovered in the Web of Science (WoS), with emphasis on the authorship, approaches, date of publication and area of knowledge, used to synthesize and limit distinct aspects of the thematic. There are 130 articles, published from 1993-2020, from different areas of knowledge, in which Information Science and medicine with their specialities present most of the articles. After answers to the question that originated the study, provocations over the destinies that the thematic OPR will follow in the open science and the challenges confronting the subjects who work in the area are made.La revisión abierta por pares, la revisión abierta, u OPR es un activo que beneficia a los autores, revisores, editores y la comunidad científica que utilizan su producto a diario. El recurso existente se consagra a partir de la filosofía derivada de la ciencia abierta, reduce los sesgos del oscurantismo de los moldes convencionales, impregnando la producción científica. La investigación tiene como objetivo contribuir a la adopción de la revisión por pares abierta minimizando los obstáculos ideológicos sobre las dinámicas que permean el proceso, en respuesta a los problemas que originan e impulsan esta comunicación. Para cumplir con el objetivo, se busca la literatura y métricas de producción científica recuperadas de la Web of Science (WoS), enfatizando la autoría, los enfoques, la fecha de publicación y el área de conocimiento utilizada para sustentar distintos aspectos de la asignatura. Son 130 artículos, publicados entre 1993-2020, de diferentes áreas del conocimiento en los que la Ciencia de la Información y la Medicina, con sus especialidades, presentan la mayoría de los artículos. Luego de analizar las preguntas que originan el estudio, se hacen algunas provocaciones sobre los caminos que tomará la temática en la ciencia abierta y sobre los desafíos para quienes trabajan con la revisión abierta por pares. Descriptores: Revisión por pares abierta. Revisión abierta. Comunicación científica. Ciencia abierta.Revisão aberta por pares, revisão aberta, open peer review, open review ou OPR é um ativo que beneficia autores, avaliadores, publishers e comunidade científica que cotidianamente usam seu produto. O recurso existente consagra-se com base na filosofia proveniente do open science, reduz vieses do obscurantismo dos moldes convencionais, perpassando a produção científica. A pesquisa visa contribuir com a adoção do open peer review minimizando obstáculos ideológicos sobre dinâmicas que permeiam o processo, em resposta às questões que originam e conduzem esta comunicação. Para atender o objetivobusca-se na literatura e nas métricas da produção científica recuperadas na Web of Science (WoS) ênfase em autoria, abordagens, data de publicação e área do conhecimento utilizadas para abalizar aspectos distintos da temática. São 130 artigos, publicados de 1993- 2020, oriundos de diversas áreas do conhecimento em que a Ciência da Informação e a Medicina,com suas especialidades, apresentam a maior parte dos artigos. Após análise dos questionamentos que originam o estudo faz-se algumas provocações sobre os rumos que a temática trilhará na ciência aberta e sobre os desafios para quem atua com open peer review

Hydroxamate production as a high affinity iron acquisition mechanism in Paracoccidioides Spp.

Iron is a micronutrient required by almost all living organisms, including fungi. Although this metal is abundant, its bioavailability is low either in aerobic environments or within mammalian hosts. As a consequence, pathogenic microorganisms evolved high affinity iron acquisition mechanisms which include the production and uptake of siderophores. Here we investigated the utilization of these molecules by species of the Paracoccidioides genus, the causative agents of a systemic mycosis. It was demonstrated that iron starvation induces the expression of Paracoccidioides ortholog genes for siderophore biosynthesis and transport. Reversed-phase HPLC analysis revealed that the fungus produces and secretes coprogen B, which generates dimerumic acid as a breakdown product. Ferricrocin and ferrichrome C were detected in Paracoccidioides as the intracellular produced siderophores. Moreover, the fungus is also able to grow in presence of siderophores as the only iron sources, demonstrating that beyond producing, Paracoccidioides is also able to utilize siderophores for growth, including the xenosiderophore ferrioxamine. Exposure to exogenous ferrioxamine and dimerumic acid increased fungus survival during co-cultivation with macrophages indicating that these molecules play a role during host-pathogen interaction. Furthermore, cross-feeding experiments revealed that Paracoccidioides siderophores promotes growth of Aspergillus nidulans strain unable to produce these iron chelators. Together, these data denote that synthesis and utilization of siderophores is a mechanism used by Paracoccidioides to surpass iron limitation. As iron paucity is found within the host, siderophore production may be related to fungus pathogenicity

Hemoglobin Uptake by Paracoccidioides spp. Is Receptor-Mediated

Iron is essential for the proliferation of fungal pathogens during infection. The availability of iron is limited due to its association with host proteins. Fungal pathogens have evolved different mechanisms to acquire iron from host; however, little is known regarding how Paracoccidioides species incorporate and metabolize this ion. In this work, host iron sources that are used by Paracoccidioides spp. were investigated. Robust fungal growth in the presence of the iron-containing molecules hemin and hemoglobin was observed. Paracoccidioides spp. present hemolytic activity and have the ability to internalize a protoporphyrin ring. Using real-time PCR and nanoUPLC-MSE proteomic approaches, fungal growth in the presence of hemoglobin was shown to result in the positive regulation of transcripts that encode putative hemoglobin receptors, in addition to the induction of proteins that are required for amino acid metabolism and vacuolar protein degradation. In fact, one hemoglobin receptor ortholog, Rbt5, was identified as a surface GPI-anchored protein that recognized hemin, protoporphyrin and hemoglobin in vitro. Antisense RNA technology and Agrobacterium tumefaciensmediated transformation were used to generate mitotically stable Pbrbt5 mutants. The knockdown strain had a lower survival inside macrophages and in mouse spleen when compared with the parental strain, which suggested that Rbt5 could act as a virulence factor. In summary, our data indicate that Paracoccidioides spp. can use hemoglobin as an iron source most likely through receptor-mediated pathways that might be relevant for pathogenic mechanisms

The Homeostasis of Iron, Copper, and Zinc in Paracoccidioides Brasiliensis, Cryptococcus Neoformans Var. Grubii, and Cryptococcus Gattii: A Comparative Analysis

Iron, copper, and zinc are essential for all living organisms. Moreover, the homeostasis of these metals is vital to microorganisms during pathogenic interactions with a host. Most pathogens have developed specific mechanisms for the uptake of micronutrients from their hosts in order to counteract the low availability of essential ions in infected tissues. We report here an analysis of genes potentially involved in iron, copper, and zinc uptake and homeostasis in the fungal pathogens Paracoccidioides brasiliensis, Cryptococcus neoformans var. grubii, and Cryptococcus gattii. Although prior studies have identified certain aspects of metal regulation in Cryptococcus species, little is known regarding the regulation of these elements in P. brasiliensis. We also present amino acid sequences analyses of deduced proteins in order to examine possible conserved domains. The genomic data reveals, for the first time, genes associated to iron, copper, and zinc assimilation and homeostasis in P. brasiliensis. Furthermore, analyses of the three fungal species identified homologs to genes associated with high-affinity uptake systems, vacuolar and mitochondrial iron storage, copper uptake and reduction, and zinc assimilation. However, homologs to genes involved in siderophore production were only found in P. brasiliensis. Interestingly, in silico analysis of the genomes of P. brasiliensis Pb01, Pb03, and Pb18 revealed significant differences in the presence and/or number of genes involved in metal homeostasis, such as in genes related to iron reduction and oxidation. The broad analyses of the genomes of P. brasiliensis, C. neoformans var. grubii, and C. gattii for genes involved in metal homeostasis provide important groundwork for numerous interesting future areas of investigation that are required in order to validate and explore the function of the identified genes and gene pathways

Open Science to the perspective of brazilian specialists : taxonomy proposal

Objetivo: Este estudo tem como objetivo contextualizar a Ciência Aberta, propondo uma versão brasileira da taxonomia desenvolvida originalmente pelo grupo Facilitate Open Science Training for European Research (Foster), presente no projeto Open Science do Programa Comunitário de Investigação e Inovação, intitulado Horizon 2020. Método: Adotou-se a pesquisa do tipo bibliográfica, documental, descritiva de abordagem dedutiva, com procedimentos do método Delphi. Utilizou-se a pesquisa bibliográfica com o intuito de recuperar documentos que pudessem dar aporte para conceituação do termo Ciência Aberta, em uma base de documentos adicionados no gerenciador de referências Mendeley. Foram recuperados 158 registros e optou-se por apresentar o conceito mencionado em 13 deles, considerando-se os melhores ranqueados e a quantidade de usuários que os adicionaram em suas bibliotecas Mendeley ou observado o contexto da publicação e deste estudo. A segunda etapa da pesquisa envolveu a tradução e ampliação da taxonomia utilizando o método Delphi, reunindo 13 pesquisadores especialistas na temática sobre Ciência Aberta em geral ou em algumas de suas facetas, os quais cooperaram na proposta de inclusão de novos termos da taxonomia, bem como a validação e sugestões de novos recursos e conceitos na tradução livre realizada inicialmente. Resultado: Para a primeira etapa, o resultado das definições apresenta aspectos do ecossistema da Ciência Aberta envolvendo particularidades filosóficas, científicas, sociais, tecnológicas, políticas e econômicas. O segundo resultado desta pesquisa apresenta a proposta de incorporação de novos termos, compondo uma taxonomia com 11 facetas e 82 rótulos na taxonomia. Conclusões: Vivencia-se um momento transitório de transformação na comunicação científica, envolvendo o surgimento de novos movimentos relacionados à ciência e ao fortalecimento de uma infraestrutura que transpassa a tecnologia utilizada, o que, certamente, pode ser notada na proposta de taxonomia construída em colaboração de pesquisadores e especialista que atuam com a Ciência Aberta ou alguma de suas facetas.Objective: This study aims to contextualize Open Science by proposing a Brazilian version of the taxonomy originally developed by the Facilitate Open Science Training for European Research (Foster) group, present in the Open Science project of the Community Research and Innovation Program, entitled Horizon 2020. Method: Bibliographic, documental, descriptive, and deductive approach research was adopted, with procedures of the Delphi method. Bibliographic research was used to retrieve documents that could contribute to the concept of the term Open Science, in a base of documents added in the Mendeley reference manager. We recovered 158 records and chose to present the concept mentioned in 13 of them, considering the best ranks and the number of users who added them in their Mendeley libraries or observed the context of the publication and this study. The second stage of the research involved the translation and expansion of taxonomy using the Delphi method, bringing together 13 researchers specializing in the subject of Open Science in general or in some of its facets, who cooperated in the proposal to include new terms of taxonomy, as well as the validation and suggestions of new resources and concepts in the free translation initially performed. Result: For the first stage, the result of the definitions presents aspects of the Open Science ecosystem involving philosophical, scientific, social, technological, political, and economic particularities. The second result of this research presents the proposal to incorporate new terms, composing a taxonomy with 11 facets and 82 labels in taxonomy. Conclusions: There is a transitory moment of transformation in scientific communication, involving the emergence of new movements related to science and the strengthening of an infrastructure that goes beyond the technology used, which certainly can be noted in the proposal of taxonomy built in collaboration with researchers and experts who work with Open Science or some of its facets

Aspectos metodológicos e resultados da linha de base do monitoramento da saúde de adultos e idosos infectados pela covid-19 (Sulcovid-19)

AIM: to describe the methodology used in the study, the sample and the prevalence of symptoms in the acute phase of the infection according to socioeconomic variables. METHODS: cross-sectional study carried out in Rio Grande with individuals infected with covid-19 from December 2020 to March 2021. Nineteen symptoms present during the acute phase of the infection were investigated and analyzed, separately and in categories of “0-4”, “5-9” and “10 or more”, according to gender, age and economic class. RESULTS: 2,919 people were part of the sample. The most prevalent symptoms were fatigue (73.7%), headache (67.2%), loss of taste (65.9%), loss of smell (63.9%) and muscle pain (62.3% ). Regarding the occurrence of symptoms stratified by gender, all symptoms, except productive cough, were statistically higher in females. Regarding age, it was found that headache, pain/discomfort to breathe, loss of taste, loss of smell, fatigue, sore throat, nasal congestion, diarrhea, joint pain and muscle pain were statistically higher among adults (18 -59 years). As for economic class, the prevalence of symptoms of shortness of breath, pain/discomfort in breathing, alteration in sensitivity and joint pain showed a linear increase with the reduction in economic class. CONCLUSION: the results of this study made it possible to identify the most frequent symptoms in the acute phase of covid-19 and their distribution in groups, providing data for the implementation of public policies by managers and support for health professionals in assisting this population.OBJETIVO: descrever a metodologia utilizada no estudo, a amostra e a prevalência dos sintomas da fase aguda da infecção de acordo com variáveis socioeconômicas. MÉTODOS: estudo transversal realizado em Rio Grande com indivíduos infectados pela covid-19 no período de dezembro de 2020 a março de 2021. Foram investigados 19 sintomas presentes durante a fase aguda da infecção e analisados, em separado e em categorias de “0-4”, “5-9” e “10 ou mais”, de acordo com sexo, idade e classe econômica. RESULTADOS: 2.919 pessoas fizeram parte da amostra. Os sintomas mais prevalentes foram fadiga (73,7%), dor de cabeça (67,2%), perda de paladar (65,9%), perda de olfato (63,9%) e dores musculares (62,3%). Com relação a ocorrência de sintomas estratificado por sexo, todos os sintomas, exceto tosse produtiva, foram estatisticamente maiores no sexo feminino. Referente à idade, verificou-se que dor de cabeça, dor/desconforto para respirar, perda de paladar, perda de olfato, fadiga, dor de garganta, congestão nasal, diarreia, dores articulares e dores musculares foram estatisticamente maiores entre os adultos (18-59 anos). Quanto a classe econômica, a prevalência dos sintomas falta de ar, dor/desconforto para respirar, alteração de sensibilidade e dores articulares apresentaram aumento linear conforme a redução da classe econômica. CONCLUSÃO: os resultados deste estudo permitiram identificar os sintomas mais frequentes na fase aguda da covid-19 e sua distribuição nos grupos, fornecendo dados para implementação de políticas públicas pelos gestores e respaldo para os profissionais de saúde na assistência a essa população

Testing of Double-Hybrid and Pull-down in the study of molecular interactions of beta-1 ,3-glicanosiltransferse three Paracoccidioides brasiliensis

Made available in DSpace on 2014-07-29T15:16:35Z (GMT). No. of bitstreams: 1 Mirelle Bb.pdf: 2549462 bytes, checksum: 7f8ae645314de6fb536a8445eb69e03e (MD5) Previous issue date: 2010-01-29Paracoccidioides brasiliensis is a thermodimorphic fungus that causes paracoccidioidomycosis (PCM), a systemic mycosis prevalent in South America. In humans, infection starts by inhalation of fungal propagules that reach the pulmonary epithelium. The cell wall presents an essential role in the pathobiology of P. brasiliensis, since it is involved in the morphogenetic changes associated with the life cycle of this pathogen. The biosynthesis and remodeling of the cell wall polysaccharide network is required for fungal growth and glycosylphosphatidylinositol (GPI)-anchored proteins are involved in these processes. The enzymes of the glucan-elongating (GEL) family are GPI-anchored proteins which have beta-1,3-glucanosyltransferase activity and play important role in the cross-linking of cell wall components in fungi. The P. brasiliensis genome possess 3 genes that encode for beta-1,3-glucanosyltransferases (Gel1p, Gel2p e Gel3p). With the aim of searching for other possible functions for beta-1,3-glucanosyltransferase 3 (PbGel3p) in P. brasiliensis, the interactions between this protein and others proteins of the fungus were investigated through the Saccharomyces cerevisiae two-hybrid system and pull-down assay. The two-hybrid system enables the study of interactions in vivo and, through this approach, 8 proteins which interact with PbGel3p were identified. The interaction with phosphatidylinositol- 4-phosphate 5-kinase its3 and protein kinase Dsk1p suggest the participation of PbGel3p in the cell division cycle. The RNA helicase Dbp5p, whose interaction with PbGel3p was in vitro confirmed by coimunoprecipitation, and the 5'-3' exoribonuclease are involved in the mRNA metabolism suggesting a function for PbGel3p in this process. The interaction between PbGel3p and the lipase/serine esterase, which participates on the biosynthesis of the GPI-anchor, was also confirmed by coimunoprecipitation. PbGel3p also interacts with the transcription factor Ctf1Bp and the 3-oxoacyl reductase enzyme, which suggests its involvement in the lipid metabolism. The interaction with the leptomycin B resistance protein Pmd1p suggests a role for PbGel3p in the response to antifungal drugs. The in vitro pull-down assay resulted in the identification of P. brasiliensis 70 kDa heat shock protein. The interaction with this protein suggests that PbGel3p may act in the response to stress conditions, as in the temperature increase. On basis of these data, functional studies may be carried out in order to confirm the Gel3p multifunctionality in P. brasiliensis.Paracoccidioides brasiliensis é um fungo termodimórfico, causador da paracoccidioidomicose, uma micose sistêmica prevalente na América do Sul. A infecção em humanos inicia-se com a inalação de propágulos fúngicos que atingem o epitélio pulmonar. A parede celular desempenha um papel importante na patobiologia do P. brasiliensis, pois está envolvida nas mudanças morfogenéticas associadas com o ciclo de vida deste patógeno. A biossíntese e o remodelamento dos polissacarídeos da parede celular são essenciais para o crescimento do fungo e proteínas glicosilfosfatidilinositol (GPI)-ancoradas estão envolvidas nesses processos. As enzimas da família glicanosiltransferase alongando glicana (GEL) são proteínas GPI-ancoradas que possuem atividade de beta-1,3-glicanosiltransferase e desempenham um importante papel nas ligações cruzadas dos componentes da parede celular em fungos. O genoma de P. brasiliensis possui 3 genes codificantes para beta-1,3-glicanosiltransferases (Gel1p, Gel2p e Gel3p). Com o objetivo de se buscar outras possíveis funções da beta- 1,3-glicanosiltransferase 3 (PbGel3p) em P. brasiliensis, as interações entre essa proteína e outras proteínas do fungo foram investigadas através do sistema de duplohíbrido em Saccharomyces cerevisiae e do ensaio de pull-down. O sistema duplohíbrido permite o estudo das interações in vivo e, através dele, foram identificadas 8 proteínas que interagem com PbGel3p. A interação com a fosfatidilinositol-4-fosfato 5- quinase its3 e com a Dsk1 proteína quinase sugere a participação de PbGel3p no ciclo de divisão celular. A RNA helicase Dbp5p, cuja interação com PbGel3p foi confirmada in vitro através do ensaio de coimunoprecipitação, e a 5'-3' exoribonuclease estão envolvidas no metabolismo de RNAm, sugerindo uma função para PbGel3p nesse processo. A interação entre PbGel3p e a enzima serina esterase/lipase, que participa da via de biossíntese da âncora GPI, também foi confirmada por coimunoprecipitação. PbGel3p interage com o fator de transcrição Ctf1Bp e enzima 3-oxoacil redutase, fato que sugere seu envolvimento no metabolismo de lipídeos de P. brasiliensis. A interação com a proteína de resistência à leptomicina B Pmd1p sugere um papel para PbGel3p na resposta à agentes antifúngicos. O ensaio de pull-down in vitro resultou na identificação da proteína de choque térmico de 70 kDa de P. brasiliensis. A interação com essa proteína sugere que PbGel3p pode atuar na resposta à condições de estresse, como o aumento de temperatura. Com base nesses dados, estudos funcionais devem ser realizados para confirmar a multifuncionalidade de Gel3p em P. brasiliensis

Inequalities in the management of back pain care in Brazil - National Health Survey, 2019

Abstract The aim was to assess the presence of socioeconomic inequalities in the management of back pain among Brazilians. Cross-sectional study with data from the National Health Survey (2019). The management of back pain care was assessed using five outcomes: regular exercise; physiotherapy; use of medications or injections; integrative and complementary practice; regular follow-up with a health professional. The magnitude of inequalities of each outcome in relation to exposures (education and income) was estimated using two indices: slope index of inequality (SII) and concentration index (CIX). Of the 90,846 interviewees, 19,206 individuals (21.1%) reported some chronic back problem. The most prevalent outcomes were use of medications and injections (45.3%), physical exercise (26.3%) and regular follow-up with a health professional (24.7%). The existence of inequalities in the management of back pain in the Brazilian population was evident. The adjusted analysis showed that the richest and most educated performed two to three times more physical exercise, physiotherapy, integrative and complementary practices (ICPS) and regular follow-up with a health professional than the poorest and least educated. Absolute (SII) and relative (CIX) inequalities were significant for all outcomes.</div