Concentra????es de neopterina no soro e l??quido cefalorraquidiano em pacientes com paraparesia esp??stica tropical/mielopatia associada ao HTLV-I (TSP/HAM) e indiv??duos HTLV-I assintom??ticos em Manaus, AM-Brasil

• Author(s): Takatani, Massanobu
• Date: 2017
• Origin: Oasisbr
• Subject(s): V??rus HTLV-I; Neopterina; L??quido cefalorraquidiano; CIENCIAS DA SAUDE: MEDICINA: ANATOMIA PATOLOGICA E PATOLOGIA CLINICA
• Document Type: Master thesis
• Language: Portuguese

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FAPEAM - Funda????o de Amparo ?? Pesquisa do Estado do Amazonas

Introduction: The HTLV-I infection may lead to the HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), which is a chronic demyelinating neurological disease that affects the spinal cord and the white brain substance. Less than 5% of HTLV-I asymptomatic individuals will develop this disease. The first appearances of the disease occur in the fourth life decade and the march disorders, the muscle weakness and the hardness of the inferior members constitute the most important signs and symptoms. There is no effective treatment for this myelopath. Numerous researches sustain the idea that the inflammation and immunological process contribute for HAM/TSP pathophysiology. In this research, the neopterin concentrations in cerebrospinal fluid (CSF) serum were evaluated in patients with HAM/TSP and individuals with HTLV-I asymptomatic. Neopterin is a substance released by macrophage after stimulation by interferon-?? during the immune system activation process. Methodology: A neopterin concentrations were being in eleven HAM/TSP patients and twenty-one HTLV-I asymptomatic individuals. From this, eleven (34, 4%) of serum samples and ten (62, 5%) CSF samples from HAM/TSP patients, and twentyone (65, 6%) serum samples and six (37, 5%) CSF samples from HTLV-I asymptomatic individuals. The quantitative determination of neopterin concentration in serum and CSF was carried out by using a commercial diagnosis set, based on the principle of Enzyme immunoassay (ELISA), competitive type. Results: The average age for HAM/TSP patients was 48, 5 +11, 1 years-old and for HTLV-I asymptomatic individuals was 41, 5 + 7,7 years-old (p=0, 0440). The neopterin concentration average (DP) in serum of HAM/TSP patients was 10, 3 + 8, 9 nmol/l and for HTLV-I asymptomatic individuals was 4, 6 +/- 1, 2 nmol/l (Mann- Whitney, p=0, 0069). The average neopterin concentration (DP) in CSF of HAM/TSP patients was 30, 8 + 47, 8 nmol/l and for HTLV-I asymptomatic individuals was 3, 4 + 1, 1 nmol/l (Mann-Whitney, p=0, 0011). The average duration of the disease of HAM/TSP patients was 8,0 + 5 years and the average (DP) for motor disability was 4,6 + 1,8 (variation from 0 to 10). Conclusion: Differences in the average of neopterin concentration in serum and CSF were found between HAM/TSP patients and HTLV-I asymptomatic individuals. In HAM/TSP patients, neopterin concentration in serum and CSF haven???t shown any correlation with the disease period. The neopterin concentrations in CSF have shown correlation with the grade of motor disability, however, the same result was not observed in the serum.

Introdu????o: A infec????o pelo v??rus HTLV-I pode levar a Paraparesia Esp??stica Tropical/Mielopatia Associada ao HTLV-I (TSP/HAM), a qual ?? uma doen??a desmielinizante cr??nica progressiva que afeta a medula espinhal e a subst??ncia branca do c??rebro. Menos de 5% dos portadores cr??nicos do HTLV-I desenvolver??o essa complica????o. As primeiras manifesta????es da doen??a ocorrem na quarta d??cada de vida sendo que os dist??rbios da marcha, a fraqueza e o enrijecimento dos membros inferiores constituem os principais sinais e sintomas de sua apresenta????o. N??o h?? tratamento eficaz para essa mielopatia. Numerosos estudos sustentam a id??ia de que processos inflamat??rios e imunol??gicos contribuem para a etiopatog??nese da TSP/HAM. Nesse estudo avaliaram-se as concentra????es de neopterina no soro e l??quido cefalorraquidiano (LCR), em pacientes com TSP/HAM e indiv??duos HTLV-I assintom??ticos. Neopterina ?? uma subst??ncia liberada pelos macr??fagos ap??s estimula????o pelo interferon gama durante o processo de ativa????o do sistema imune. Metodologia: Concentra????es de neopterina foram avaliadas em 11 pacientes com TSP/HAM e 21 indiv??duos HTLV-I assintom??ticos. Sendo 11 (34,4%) amostras de soro e 10 (62,5%) amostras de LCR de pacientes com TSP/HAM, e 21 (65,6%) amostras de soro e 06 (37,5%) amostras de LCR de indiv??duos HTLV-I assintom??ticos. A determina????o quantitativa das concentra????es de neopterina no soro e LCR foram realizadas empregando-se um conjunto diagn??stico comercial, baseado no princ??pio dos ensaios imunoenzim??tico (ELISA), do tipo competitivo. Resultados: A m??dia de idade para os pacientes com TSP/HAM foi de 48,5 + 11,1 anos e para os indiv??duos HTLV-I assintom??ticos de 41,5 + 7,7 anos (p=0,0440). A concentra????o m??dia (DP) de neopterina no soro de pacientes com TSP/HAM foi 10,3+8,9nmol/l e 4,6+1,2nmol/l em indiv??duos HTLV-I assintom??ticos (Mann- Whitney, p=0,0069). A concentra????o m??dia (DP) de neopterina no LCR em pacientes com TSP/HAM foi 30,8+47,8 nmol/l, e 3,4 +1,1 nmol/l em indiv??duos HTLVI assintom??ticos (Mann-Whitney, p=0,0011). A m??dia (DP) para o tempo de doen??a na TSP/HAM foi de 8,0 + 5,0 anos e a m??dia (DP) para o grau de incapacidade motora foi de 4,6+ 1,8 (varia????o de 0 a 10). Conclus??o: Encontramos diferen??as nas m??dias das concentra????es de neopterina no soro e LCR entre pacientes com TSP/HAM e indiv??duos HTLV-I assintom??ticos. Em pacientes com TSP/HAM, concentra????es de neopterina no soro e LCR n??o apresentaram correla????o com o tempo de doen??a. As concentra????es de neopterina no LCR apresentaram correla????o com o grau de incapacidade motora, por??m, o mesmo n??o foi observado no soro.