A importância da avaliação multidimensional na dor oncológica

Introdução: As neoplasias constituem atualmente uma das principais causas de morte relacionadas às doenças crônicas não transmissíveis. A dor acomete 60 a 80% dos pacientes, chegando a 70 a 90% na doença avançada. O quadro crônico, difuso e multifatorial, frequentemente é associado ao tumor primário, à metástase e aos procedimentos diagnósticos e de tratamento. Admite-se que a dor oncológica exerce grande impacto no indivíduo nos níveis físico, psicológico, espiritual e social, podendo acarretar o agravamento do prognóstico, a redução da autonomia e a perda da qualidade de vida. Considerando sua complexidade, o manejo apropriado deve abordar uma avaliação individualizada e multidimensional, visando a caracterização da dor, a determinação dos fatores desencadeantes, dos efeitos nas funções e atividades de vida diária e da influência em outros sintomas, possibilitando uma melhor definição das estratégias de controle disponíveis. Objetivo: Avaliar a abordagem multidimensional na dor oncológica. Material e método: Tratase de uma revisão integrativa de literatura. Foram utilizados os seguintes descritores: “Dor oncológica”, “Oncologia”, “Tratamento para dor oncológica” e “Abordagem em dor oncológica”. Os critérios de inclusão definidos para a seleção dos artigos foram: publicação em português, inglês e espanhol, que abordassem a temática referente à revisão integrativa e artigos publicados e indexados nos referidos bancos de dados nos últimos 10 anos. A busca primária foi realizada nas bases de dados Medline, Google Acadêmico e na biblioteca virtual Scielo, no período de 2 meses. A análise dos estudos selecionados foi realizada de forma descritiva, sendo possível observar, descrever e classificar os dados, com o intuito de agrupar o conhecimento produzido sobre o tema procurado na revisão. Resultados: Como resultados desta pesquisa, destaca-se a importância dos profissionais de saúde na assistência direcionada ao paciente oncológico, onde, o principal sintoma é a dor. Para o seu controle efetivo, é necessária habilidade técnica e científica e uma assistência humanizada. Observouse em diversos estudos, que o câncer por si só causa transtornos, e que a dor, quando não aliviada, os agrava. O tratamento da dor vai além de métodos farmacológicos, envolvendo aspectos psicológicos, físico e social, com auxílio de uma equipe multidisciplinar. Cada profissional contribui com técnicas específicas nos cuidados necessários, promovendo uma assistência completa. Diversos estudos mostraram a importância dos enfermeiros nesse processo, visto que eles possuem um contato direto com o paciente e estão atentos a alterações comportamentais. Em outros artigos, foi apontada a dificuldade enfrentada pelos mesmos durante a avaliação da dor. Por fim, alguns autores também citaram a importância de um psicólogo para trabalhar a autoestima e autonomia do paciente, reforçando a fé e fortalecendo vínculos, proporcionando a superação e alívio da dor. Conclusão: A partir dos trinta artigos analisados, pôde-se concluir que, com a presença de uma equipe multidisciplinar, é possível promover uma maior e mais abrangente assistência dos pacientes com dor oncológica, contemplando os mais diversos aspectos físicos, psicológicos e sociais. Ademais, notou-se a necessidade de uma atenção efetiva do sintoma, por parte desses profissionais, objetivando seu alívio e evitando sua piora

Intermolecular interactions of the malate synthase of Paracoccidioides spp

Background: The fungus Paracoccidioides spp is the agent of paracoccidioidomycosis (PCM), a pulmonary mycosis acquired by the inhalation of fungal propagules. Paracoccidioides malate synthase (PbMLS) is important in the infectious process of Paracoccidioides spp because the transcript is up-regulated during the transition from mycelium to yeast and in yeast cells during phagocytosis by murine macrophages. In addition, PbMLS acts as an adhesin in Paracoccidioides spp. The evidence for the multifunctionality of PbMLS indicates that it could interact with other proteins from the fungus and host. The objective of this study was to identify and analyze proteins that possibly bind to PbMLS (PbMLS-interacting proteins) because protein interactions are intrinsic to cell processes, and it might be possible to infer the function of a protein through the identification of its ligands. Results: The search for interactions was performed using an in vivo assay with a two-hybrid library constructed in S. cerevisiae; the transcripts were sequenced and identified. In addition, an in vitro assay using pull-down GST methodology with different protein extracts (yeast, mycelium, yeast-secreted proteins and macrophage) was performed, and the resulting interactions were identified by mass spectrometry (MS). Some of the protein interactions were confirmed by Far-Western blotting using specific antibodies, and the interaction of PbMLS with macrophages was validated by indirect immunofluorescence and confocal microscopy. In silico analysis using molecular modeling, dynamics and docking identified the amino acids that were involved in the interactions between PbMLS and PbMLS-interacting proteins. Finally, the interactions were visualized graphically using Osprey software. Conclusion: These observations indicate that PbMLS interacts with proteins that are in different functional categories, such as cellular transport, protein biosynthesis, modification and degradation of proteins and signal transduction. These data suggest that PbMLS could play different roles in the fungal cell. © 2013 de Oliveira et al.; licensee BioMed Central Ltd

An Intracellular Arrangement of Histoplasma capsulatum Yeast-Aggregates Generates Nuclear Damage to the Cultured Murine Alveolar Macrophages

Histoplasma capsulatum is responsible for a human systemic mycosis that primarily affects lung tissue. Macrophages are the major effector cells in humans that respond to the fungus, and the development of respiratory disease depends on the ability of Histoplasma yeast cells to survive and replicate within alveolar macrophages. Therefore, the interaction between macrophages and H. capsulatum is a decisive step in the yeast dissemination into host tissues. Although the role played by components of cell-mediated immunity in the host's defense system and the mechanisms used by the pathogen to evade the host immune response are well understood, knowledge regarding the effects induced by H. capsulatum in host cells at the nuclear level is limited. According to the present findings, H. capsulatum yeast cells display a unique architectural arrangement during the intracellular infection of cultured murine alveolar macrophages, characterized as a formation of aggregates that seem to surround the host cell nucleus, resembling a crown. This extranuclear organization of yeast-aggregates generates damage on the nucleus of the host cell, producing DNA fragmentation and inducing apoptosis, even though the yeast cells are not located inside the nucleus and do not trigger changes in nuclear proteins. The current study highlights a singular intracellular arrangement of H. capsulatum yeast near to the nucleus of infected murine alveolar macrophages that may contribute to the yeast’s persistence under intracellular conditions, since this fungal pathogen may display different strategies to prevent elimination by the host's phagocytic mechanisms

Determinação de genes/proteínas endossomais em Paracoccidioides brasiliensis e em macrófagos infectados e não infectados

Os fungos dimórficos, Paracoccidioides brasiliensis (espécies cripticas S1, PS2, PS3) e Paracoccidioides lutzii (Pb01-like espécies), são agentes da paracoccidioidomicose (PCM), doença granulomatosa crônica, endêmica na América Latina, principalmente no Brasil. A doença apresenta grande variedade de manifestações clínicas, desde formas localizadas até disseminadas evoluindo para letalidade. O fungo tem capacidade de aderir, invadir e extravasar barreiras impostas pelos tecidos do hospedeiro. P. brasiliensis (Pb18) já foi observado tanto no interior de macrófagos, como no interior de células epiteliais in vivo e in vitro. A identificação do mecanismo pelo qual este fungo sobrevive no interior da célula hospedeira é campo fértil para a descoberta de sua patogênese, já que este microrganismo possui a capacidade de induzir sua própria endocitose em células epiteliais e muito provavelmente em macrófagos. A absorção de micronutrientes pelo fungo apresenta papel singular, tanto para sua nutrição e processo invasivo, como para sua sobrevivência no interior da célula hospedeira. A via endocítica em microrganismos é de fundamental importância na regulação de todo esse processo. O objetivo deste estudo foi avaliar a via endocítica de Pb18 e também de macrófagos infectados com este fungo. A avaliação da via endocítica de Pb18 foi realizada na condição de depleção de metais, onde foram analisados os genes Clatrina e Ypt7 (Homólogo de Rab7) por RT-PCR semi-quantitativo e PCR em tempo real (RT-PCR quantitativo). Também foi analisada a infecção de macrófagos por Pb18 cultivado na depleção de metais e em diferentes tensões de oxigênio. A via endocítica de macrófagos foi analisada por RT-PCR quantitativo e imunofluorescência. Esta análise foi realizada quando o fungo foi cultivado em...The dimorphic fungus, Paracoccidioides brasiliensis (cryptic species S1, PS2, PS3) and Paracoccidioides lutzii (Pb01-like species), are agents of paracoccidioidomycosis (PCM), chronic granulomatous disease, endemic in Latin America, especially in Brazil. The disease has a wide variety of clinical manifestations, from localized forms to disseminated evolving to lethality. The fungus is able to adhere, invade and spill barriers imposed by host tissues. P. brasiliensis (Pb18) has already been observed both within macrophages, but also inside of epithelial cells in vivo and in vitro. Identification of the mechanism by which this fungus survive within the host cell is a fertile field for the discovery of their pathogenesis, since this microorganism has the ability to induce its own endocytosis in epithelial cells and most probably in macrophages. The micronutrient uptake by the fungus presents unique role, both for its nutritional and invasive procedure, such as for survival within the host cell. The endocytic pathway in microorganisms is of fundamental importance in the regulation of this process. The aim of this study was to evaluate the endocytic pathway of Pb18 and also macrophages infected with this fungus. The evaluation of the endocytic pathway of Pb18 was performed under the condition that depletion of metals, where the genes were analyzed Clathrin and Ypt7 (Rab7 homolog) by RT-PCR semi-quantitative and real-time PCR (RT-PCR quantitative). Was also analyzed by Pb18 infection of macrophages cultured in the depletion of metals at different oxygen tensions. The endocytic pathway of macrophages was analyzed by quantitative RT-PCR and immunofluorescence. This analysis was performed when the fungus was grown at different oxygen tensions and macrophages were infected with this and when the infection was incubated at... (Complete abstract click electronic access below)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Avaliação de moléculas de adesão e da via endocítica na interação Paracoccidioides brasiliensis-células do hospedeiro

Paracoccidioides brasiliensis é um fungo dimórfico, agente de doença granulomatosa crônica denominada de paracoccidioidomicose (PCM), com grande variedade de manifestações clínicas, desde formas localizadas até disseminadas evoluindo para letalidade. O fungo tem capacidade de aderir, extravasar e invadir barreiras impostas pelos tecidos do hospedeiro. Em ensaios in vitro verificou-se que P. brasiliensis pode aderir e invadir células epiteliais, aparecendo algumas vezes internalizado dentro de um vacúolo. A identificação do mecanismo pelo qual este fungo adere, invade e sobrevive no interior da célula hospedeira é campo fértil para a descoberta de sua patogênese. Para tanto, a análise de proteínas presentes no microrganismo e nas células do hospedeiro e também os marcadores da via endocítica para co-localizar os microrganismos no interior das mesmas é o objetivo deste estudo. Assim, foi realizada a infecção de células epiteliais A549 e macrófagos AMJ2-C11com P. brasiliensis (Pb18) nos períodos de 3, 5, 8, 24 e 3, 5, 10 e 24h, respectivamente e feitas análises por técnicas de imunofluorescência para as proteínas de junções compactas, junções aderentes, junções tipo fenda e proteínas de ancoramento intracelular, bem como as proteínas da via endocítica. Entres estas, foram ensaiadas a expressão de clatrina, Rab7 e LAMP-1 por imunofluorescência e EEA1, Rab7 e LAMP-1 por imunoblot. As proteínas de junções foram expressas nas células, bem como na parede do fungo. A clatrina foi evidente na célula e aparentemente mais expressa na parede do fungo. Nas células A549 não houve alteração na expressão de Rab7 e LAMP-1, tanto na imunofluorescência quanto no imunoblot, sendo que para EEA1 e Rab5 não foi evidenciada alteração na expressão pela técnica de imunoblot. Rab7 foi expressa nos macrófagos, localizada na periferia das células e também no...Paracoccidioides brasiliensis is a thermally dimorphic fungus, the etiologic agent of paracoccidioidomycosis (PCM). PCM is a polymorphic disease manifested by an array of diverse clinical manifestations and varying organ involvement. P. brasiliensis may actively penetrate the mucocutaneous surface and parasitize epithelial cells, thus evading the host defenses and reaching deeper tissues. The ability of this fungus to adhere to and invade non-professional phagocyte cells has been observed. In vitro assays verify that P. brasiliensis can adhere and could appear internalized within vacuole. The identification of the mechanism by which this fungus adheres, invades and survivor inside the host cell is a fertile area for discover their pathogenesis. The aim of this study was analyzed the junctions proteins in the fungus and the host cells, as well as the endocytic markers to colocate the microorganisms inside the cells. Thus, the infection was performed in A549 epithelial cells and macrophages AMJ2-C11 with P. brasiliensis (PB18) for periods of 3, 5, 8, 24 and 3, 5, 10 and 24 h, respectively, and the immunofluorescence analysis was developed for the proteins claudin-1, claudin-4, E-cadherin, conexin 43, talin e vinculin, and the endocytic proteins. The macrophages and the cells A549 have been blemish along anti-clatrin, anti-Rab7 and anti-LAMP-1. The junctions’ proteins have been expressed at the cells, as well as on the wall from the fungus. The clathrin was present at the cells and apparently more expressed on the fungus wall. Rab7 and LAMP-1 were not expressed in the cells A549 as demonstrated by the imunofluorescence and the imunoblot. On the contrary Rab7 was expressed in macrophages located at the periphery of the cells and also in the own fungus. The expression of LAMP-1 apparently not presented alteration both at the imunofluorescence and at the imunoblot. The expression of EEA1 was... (Complete abstract click electronic access below)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Early endosome antigen 1 (EEA1) decreases in macrophages infected with Paracoccidioides brasiliensis

Paracoccidioidomycosis (PCM) is a chronic granulomatous disease caused by the dimorphic fungus Paracoccidioides brasiliensis, endemic in Latin America. P. brasiliensis has been observed in epithelial cells in vivo and in vitro, as well as within the macrophages. The identification of the mechanism by which it survives within the host cell is fertile ground for the discovery of its pathogenesis since this organism has the ability to induce its own endocytosis in epithelial cells and most likely in macrophages. The study of the expression of endocytic proteins pathway and co-localization of microorganisms enable detection of the mechanism by which microorganisms survive within the host cell. The aim of this study was to evaluate the expression of the endocytic protein EEA1 (early endosome antigen 1) in macrophages infected with P. brasiliensis. For detection of EEA1, three different techniques were employed: immunofluorescence, real-time polymerase chain reaction (PCR) and immunoblotting. In the present study, decreased expression of EEA1 as well as the rearrangement of the actin was observed when the fungus was internalized, confirming that the input mechanism of the fungus in macrophages occurs through phagocytosis. © 2013 ISHAM

Differential gene expression analysis of Paracoccidioides brasiliensis during keratinocyte infection

Paracoccidioides brasiliensis is the agent of paracoccidioidomycosis, one of the most important systemic fungal diseases in Latin America. This initiates in lung tissue and can subsequently disseminate to other tissues. Clinical manifestations range from localized forms to disseminated disease that can progress to lethality, probably depending on the relationships among the virulence of the fungus, the immune response and the ability to interact with the surface structures and invade epithelial cells and mononuclear cells of the host. It is generally regarded as a multifocal disease, with oral lesions as the prominent feature. The aim of this study was to evaluate P. brasiliensis yeast infection in normal oral keratinocytes (NOKs). The differential expression of mRNAs and proteins was also determined when the fungus was placed in contact with the cell in order to characterize differentially expressed genes and proteins during P. brasiliensis infection. After contact with NOKs, the fungus appeared to induce alterations in the cells, which showed cellular extensions and cavitations, probably resulting from changes in the actin cytoskeleton seen at 5 and 8 h after infection. Levels of protein expression were higher after reisolation of the fungus from infected NOK culture compared with culture of the fungus in medium. The analysis identified transcripts related to 19 proteins involved in different biological processes. Transcripts were found with multiple functions including induction of cytokines, protein metabolism, alternative carbon metabolism, zinc transport and the stress response during contact with NOKs. The proteins found suggested that the yeast was in a stress situation, as indicated by the presence of RDS1. Nevertheless, the yeast seemed to be proliferating and metabolically active, as shown by the presence of a proteasome, short-chain acetylator, glucosamine-6-phosphate isomerase and ADP/ATP carrier transcripts. Additionally, metabolic pathways may have been activated in order to eliminate toxic substances from the cell as a zinc transporter was detected, which is a potential target for the development of future drugs.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Endo-β-1,3-glucanase (GH16 Family) from Trichoderma harzianum Participates in Cell Wall Biogenesis but Is Not Essential for Antagonism Against Plant Pathogens.

Trichoderma species are known for their ability to produce lytic enzymes, such as exoglucanases, endoglucanases, chitinases, and proteases, which play important roles in cell wall degradation of phytopathogens. β-glucanases play crucial roles in the morphogenetic-morphological process during the development and differentiation processes in Trichoderma species, which have β-glucans as the primary components of their cell walls. Despite the importance of glucanases in the mycoparasitism of Trichoderma spp., only a few functional analysis studies have been conducted on glucanases. In the present study, we used a functional genomics approach to investigate the functional role of the gluc31 gene, which encodes an endo-β-1,3-glucanase belonging to the GH16 family in Trichoderma harzianum ALL42. We demonstrated that the absence of the gluc31 gene did not affect the in vivo mycoparasitism ability of mutant T. harzianum ALL42; however, gluc31 evidently influenced cell wall organization. Polymer measurements and fluorescence microscopy analyses indicated that the lack of the gluc31 gene induced a compensatory response by increasing the production of chitin and glucan polymers on the cell walls of the mutant hyphae. The mutant strain became more resistant to the fungicide benomyl compared to the parental strain. Furthermore, qRT-PCR analysis showed that the absence of gluc31 in T. harzianum resulted in the differential expression of other glycosyl hydrolases belonging to the GH16 family, because of functional redundancy among the glucanases