RESUMEN
Abstract Background: The hair follicle is a unique structure, one of the most dynamic structures in mammalians, which can reproduce in every new cycle all the mechanism involved in its fetal development. Although a lot of research has been made about the human hair follicle much less has been discovered about the importance of the cytokeratins (CKs) in its development. Objective: Study the immunohistochemical pattern of epithelial CKs during human hair follicle development. Methods: We performed an immunohistochemical study using fresh post-mortem skin biopsies of human fetuses between 4 and 25 weeks of gestational age to study the expression of cytokeratins (CKs): CK1, CK10, CK13, CK14, CK16 and CK20 during human hair follicle fetal development. Study limitations: Restrospective study with a good number of makers but with a small population. Results/conclusion: We found that, the CKs were expressed in an intermediate time during follicular development. The epithelial CKs (CK1, CK14, CK10, CK13) and the epithelial CKs with a proliferative character such as CK16 were expressed first, as markers of cellular maturation and follicular keratinization. At a later phase, CK20 was expressed in more developed primitive hair follicles as previously discussed in literature.
Asunto(s)
Folículo Piloso/cirugía , Folículo Piloso/crecimiento & desarrollo , Queratinas Específicas del Pelo/análisis , Inmunohistoquímica , Estudios Retrospectivos , Factores de Edad , Edad Gestacional , Desarrollo Fetal , Anticuerpos Monoclonales/análisisRESUMEN
BACKGROUND: The treatment of multiple myeloma (MM) has been revolutionized by the introduction of therapeutic monoclonal antibodies (tmAbs). Daratumumab, a human IgG1/κ tmAb against CD38 on plasma cells, has improved overall survival in refractory MM and was recently approved as a frontline therapy for MM. Work on tmAb interference with serum protein electrophoresis (SPE) during MM monitoring has failed to provide information for laboratories on incidence of interference and effective methods of managing the interference at a practicable level. We aimed to evaluate daratumumab and elotuzumab interference in a large academic hospital setting and implement immediate solutions. METHODS: We identified and chart reviewed all cases of possible daratumumab interference by electrophoretic pattern (120 of 1317 total cases over 3 months). We retrospectively reviewed SPE cases in our laboratory to assess clinical implications of tmAb interference before the laboratory was aware of tmAb treatment. We supplemented samples with daratumumab and elotuzumab to determine the limits of detection and run free light chain analysis. RESULTS: Approximately 9% (120 of 1317) of tested cases have an SPE and/or immunofixation electrophoresis (IFE) pattern consistent with daratumumab, but only approximately 47% (56) of these cases were associated with daratumumab therapy. Presence of daratumumab led to physician misinterpretation of SPE/IFE results. Limits of daratumumab detection varied with total serum gammaglobulin concentrations, but serum free light chain analysis was unaffected. CONCLUSIONS: Clinical laboratories currently rely on interference identification by electrophoretic pattern, which may be insufficient and is inefficient. Critical tools in preventing misinterpretation efficiently include physician education, pharmacy notifications, separate order codes, and interpretive comments.
Asunto(s)
Anticuerpos Monoclonales Humanizados , Anticuerpos Monoclonales , Errores Diagnósticos/prevención & control , Cadenas Ligeras de Inmunoglobulina/análisis , Mieloma Múltiple , Anticuerpos Monoclonales/análisis , Anticuerpos Monoclonales/inmunología , Anticuerpos Monoclonales/farmacocinética , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados/análisis , Anticuerpos Monoclonales Humanizados/farmacocinética , Anticuerpos Monoclonales Humanizados/uso terapéutico , Electroforesis de las Proteínas Sanguíneas/métodos , Humanos , Inmunoelectroforesis/métodos , Factores Inmunológicos/análisis , Factores Inmunológicos/farmacocinética , Factores Inmunológicos/uso terapéutico , Límite de Detección , Mieloma Múltiple/sangre , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/tratamiento farmacológico , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: The hair follicle is a unique structure, one of the most dynamic structures in mammalians, which can reproduce in every new cycle all the mechanism involved in its fetal development. Although a lot of research has been made about the human hair follicle much less has been discovered about the importance of the cytokeratins (CKs) in its development. OBJECTIVE: Study the immunohistochemical pattern of epithelial CKs during human hair follicle development. METHODS: We performed an immunohistochemical study using fresh post-mortem skin biopsies of human fetuses between 4 and 25 weeks of gestational age to study the expression of cytokeratins (CKs): CK1, CK10, CK13, CK14, CK16 and CK20 during human hair follicle fetal development. STUDY LIMITATIONS: Restrospective study with a good number of makers but with a small population. RESULTS/CONCLUSION: We found that, the CKs were expressed in an intermediate time during follicular development. The epithelial CKs (CK1, CK14, CK10, CK13) and the epithelial CKs with a proliferative character such as CK16 were expressed first, as markers of cellular maturation and follicular keratinization. At a later phase, CK20 was expressed in more developed primitive hair follicles as previously discussed in literature.
Asunto(s)
Folículo Piloso/citología , Folículo Piloso/crecimiento & desarrollo , Queratinas Específicas del Pelo/análisis , Factores de Edad , Anticuerpos Monoclonales/análisis , Desarrollo Fetal , Edad Gestacional , Humanos , Inmunohistoquímica , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the density of anti-galectin-3-immunostained cells, collagen percentage, mast cell density and presence of pathological processes in intestinal muscle biopsies of patients. METHODS: Thirty-five patients who underwent intestinal biopsy were selected from 1997 to 2015. Patients were divided into three groups: chagasic patients with mucosal lesion (n=13), chagasic patients with intact mucosa (n=12) and non-chagasic patients with no mucosal lesion (n=10). Histological processing of the biopsied fragments and immunohistochemistry for galectin-3 were performed. Additional sections were stained with hematoxylin and eosin to evaluate the general pathological processes, picrosirius for evaluation of collagen and toluidine blue to evaluate the mast cell density. RESULTS: Patients of mucosal lesion group had a significantly higher frequency of ganglionitis and myositis when compared to the chagasic patients with intact mucosa and non-chagasic group. The density of anti-galectin-3-immunostained cells was significantly higher in the chagasic patients with intact mucosa group when compared to the non-chagasic group. The group of chagasic patients with intact mucosa presented a higher percentage of collagen in relation to the patients with mucosal lesion and to the non-chagasic group, with a significant difference. There was no significant difference in mast cell density among the three groups. CONCLUSION: The higher density of anti-galectin-3-immunostained cells in patients in the chagasic patients with intact mucosa group suggested the need for greater attention in clinical evaluation of these patients, since this protein is associated with neoplastic transformation and progression.
Asunto(s)
Anticuerpos Monoclonales/análisis , Enfermedad de Chagas/patología , Colonoscopía/métodos , Galectina 3/análisis , Mucosa Intestinal/patología , Megacolon/patología , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Biopsia , Estudios de Casos y Controles , Recuento de Células , Colágeno/análisis , Femenino , Fibrosis , Galectina 3/inmunología , Humanos , Inmunohistoquímica , Masculino , Mastocitos/patología , Persona de Mediana Edad , Miositis/patología , Estudios Retrospectivos , Estadísticas no ParamétricasRESUMEN
ABSTRACT Objective To evaluate the density of anti-galectin-3-immunostained cells, collagen percentage, mast cell density and presence of pathological processes in intestinal muscle biopsies of patients. Methods Thirty-five patients who underwent intestinal biopsy were selected from 1997 to 2015. Patients were divided into three groups: chagasic patients with mucosal lesion (n=13), chagasic patients with intact mucosa (n=12) and non-chagasic patients with no mucosal lesion (n=10). Histological processing of the biopsied fragments and immunohistochemistry for galectin-3 were performed. Additional sections were stained with hematoxylin and eosin to evaluate the general pathological processes, picrosirius for evaluation of collagen and toluidine blue to evaluate the mast cell density. Results Patients of mucosal lesion group had a significantly higher frequency of ganglionitis and myositis when compared to the chagasic patients with intact mucosa and non-chagasic group. The density of anti-galectin-3-immunostained cells was significantly higher in the chagasic patients with intact mucosa group when compared to the non-chagasic group. The group of chagasic patients with intact mucosa presented a higher percentage of collagen in relation to the patients with mucosal lesion and to the non-chagasic group, with a significant difference. There was no significant difference in mast cell density among the three groups. Conclusion The higher density of anti-galectin-3-immunostained cells in patients in the chagasic patients with intact mucosa group suggested the need for greater attention in clinical evaluation of these patients, since this protein is associated with neoplastic transformation and progression.
RESUMO Objetivo Avaliar a densidade de células imunomarcadas por anti-galectina-3, a percentagem de colágeno, a densidade de mastócitos e a presença de processos patológicos na musculatura intestinal de pacientes biopsiados. Métodos Foram selecionados 35 pacientes submetidos à biópsia de intestino entre 1997 a 2015. Os pacientes foram divididos em três grupos: chagásicos com lesão de mucosa (n=13), chagásicos com mucosa íntegra (n=12) e não chagásicos sem lesão de mucosa (n=10). Foram realizados processamento histológico dos fragmentos biopsiados e imunohistoquímica para galectina-3. Cortes adicionais foram corados por hematoxilina e eosina, para avaliar os processos patológicos gerais, pelo picrosírius, para avaliação do colágeno, e pelo azul de toluidina, para avaliar a densidade de mastócitos. Resultados Os pacientes do grupo chagásicos com lesão de mucosa apresentaram frequência significativamente maior de ganglionite e miosite quando comparados aos dos grupos chagásico com mucosa íntegra e não chagásicos. A densidade das células imunomarcadas por anti-galectina-3 foi significativamente maior no grupo chagásicos com mucosa íntegra quando comparada ao grupo não chagásico. O grupo de chagásicos com mucosa íntegra apresentou maior percentagem de colágeno em relação aos grupos chagásicos com mucosa lesada e ao grupo de não chagásicos, com diferença significativa. Não houve diferença significativa com relação à densidade de mastócitos entre os três grupos. Conclusão A maior densidade de células imunomarcadas por anti-galectina-3 nos pacientes do grupo chagásico com mucosa íntegra sugere a necessidade de maior atenção na avaliação clínica desses pacientes, uma vez que essa proteína está associada com transformação e progressão neoplásica.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Anciano de 80 o más Años , Colonoscopía/métodos , Enfermedad de Chagas/patología , Galectina 3/análisis , Mucosa Intestinal/patología , Megacolon/patología , Anticuerpos Monoclonales/análisis , Biopsia , Fibrosis , Inmunohistoquímica , Estudios de Casos y Controles , Recuento de Células , Estudios Retrospectivos , Análisis de Varianza , Colágeno/análisis , Estadísticas no Paramétricas , Galectina 3/inmunología , Mastocitos/patología , Persona de Mediana Edad , Miositis/patologíaRESUMEN
Zika virus (ZIKV), an emerging arthropod-borne virus (arbovirus) of the Flaviviridae family, is a current issue worldwide, particularly because of the congenital and neurological syndromes associated with infection by this virus. As the initial clinical symptoms of all diseases caused by this group are very similar, clinical diagnosis is difficult. Furthermore, laboratory diagnostic efforts have failed to identify specific and accurate tests for each virus of the Flaviviridae family due to the cross-reactivity of these viruses in serum samples. This situation has resulted in underreporting of the diseases caused by flaviviruses. However, many companies developed commercial diagnostic tests after the recent ZIKV outbreak. Moreover, health regulatory agencies have approved different commercial tests to extend the monitoring of ZIKV infections. Considering that a specific and sensitive diagnostic method for estimating risk and evaluating ZIKV propagation is still needed, this review aims to provide an update of the main commercially approved serological diagnostics test by the US Food and Drug Administration (FDA) and Brazilian National Health Surveillance Agency (ANVISA). Additionally, we present the technologies used for monoclonal antibody production as a tool for the development of diagnostic tests and applications of these antibodies in detecting ZIKV infections worldwide.(AU)
Asunto(s)
Infección por el Virus Zika/diagnóstico , Pruebas Serológicas , Comercio , Anticuerpos Monoclonales/análisis , Anticuerpos Monoclonales/química , Virus ZikaRESUMEN
OBJECTIVES: Osteosarcoma of the jaw (OSAJ) is fundamentally different in clinical practice from its peripheral counterparts. Studies are difficult to conduct due to low incidence rates. The primary aim of this study was to provide for the first time a comprehensive retrospective analysis of the treatment concepts and outcome data of OSAJ patients treated at the University Hospital Vienna and to compare these with two recently published studies on OSAJ. The clinical study was accompanied by a biomarker study investigating the prognostic relevance of melanoma-associated antigen-A (MAGE-A) in OSAJ specimens. METHOD: Eighteen patients were included, and their outcomes were compared to published data. Immunohistochemistry was performed with mouse monoclonal antibodies against MAGE-A. Survival rates were estimated by the Kaplan-Meyer method. The log-rank test was used to analyze potential prognostic parameters. Fisher's exact test was performed to define the significant differences between the survival rates of the current study and the DOESAK registry. RESULTS: Disease-specific survival was 93.8% after five and 56.3% after ten years. The development of metastases (p=0.033) or relapse (p=0.037) was associated with worsened outcomes in our group as well as in the comparative group. Despite the different treatment concepts of the study groups, survival rates were comparable. MAGE-A failed to show prognostic relevance for OSAJ patients. CONCLUSIONS: Uncertainties about the optimal treatment strategies of OSAJ patients will currently remain. Thus, prospective studies of OSAJ are needed but are only feasible in a multicenter study setting, conducted over a prolonged time period.
Asunto(s)
Neoplasias Óseas/terapia , Osteosarcoma/terapia , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales/análisis , Antígenos de Neoplasias/análisis , Austria/epidemiología , Biomarcadores/análisis , Neoplasias Óseas/mortalidad , Neoplasias Óseas/patología , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Osteosarcoma/mortalidad , Osteosarcoma/patología , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
INTRODUCTION: Immunocytochemistry is very useful in the differentiation of benign and malignant lesions, through the use of specific antibodies that differentiate the cells according to their origin. This study aims to describe the application of immunohistochemistry to the cytological study of different sample types at the Valle del Lili Foundation. MATERIALS AND METHODS: A descriptive, retrospective, observational study was carried out with cytologies registered in the database of the pathology department of the Fundación Valle del Lili, between December 2015 and October 2017. RESULTS: Fifty-four cytological samples with immunocytochemistry were included. It was possible to perform both the cell block and the liquid-based cytology button to 38.88% (n=21) of the total samples, finding from the results of both types of cytology, a Cohen's Kappa coefficient of 0.80 (95%CI: (0.4-1.0), P<.001. The most commonly used markers were: Calretinin, MOC-31, EMA, TTF1, PAX8, and Calcitonin. Out of the cytological studies positive for malignancy, a definitive diagnosis was made with a biopsy in 58.1% (n=25), with a Cohen's Kappa coefficient of 1.0 (95%CI: 1.0-1.0), P<.001. DISCUSSION: This study provided data that permits the implementation of liquid-based cytology button for immunocytochemical studies, using assessable markers with agreement with cell-block cytology. Furthermore, it provides data useful for future research in this field.
Asunto(s)
Biomarcadores de Tumor/análisis , Inmunohistoquímica , Biopsia Líquida , Neoplasias/química , Neoplasias/patología , Anticuerpos Monoclonales/análisis , Calbindina 2/análisis , Colombia , Proteínas de Unión al ADN/análisis , Hospitales Universitarios , Humanos , Proteínas de la Membrana/análisis , Factor de Transcripción PAX8/análisis , Estudios Retrospectivos , Factores de Transcripción/análisisRESUMEN
OBJECTIVES: Osteosarcoma of the jaw (OSAJ) is fundamentally different in clinical practice from its peripheral counterparts. Studies are difficult to conduct due to low incidence rates. The primary aim of this study was to provide for the first time a comprehensive retrospective analysis of the treatment concepts and outcome data of OSAJ patients treated at the University Hospital Vienna and to compare these with two recently published studies on OSAJ. The clinical study was accompanied by a biomarker study investigating the prognostic relevance of melanoma-associated antigen-A (MAGE-A) in OSAJ specimens. METHOD: Eighteen patients were included, and their outcomes were compared to published data. Immunohistochemistry was performed with mouse monoclonal antibodies against MAGE-A. Survival rates were estimated by the Kaplan-Meyer method. The log-rank test was used to analyze potential prognostic parameters. Fisher's exact test was performed to define the significant differences between the survival rates of the current study and the DOESAK registry. RESULTS: Disease-specific survival was 93.8% after five and 56.3% after ten years. The development of metastases (p=0.033) or relapse (p=0.037) was associated with worsened outcomes in our group as well as in the comparative group. Despite the different treatment concepts of the study groups, survival rates were comparable. MAGE-A failed to show prognostic relevance for OSAJ patients. CONCLUSIONS: Uncertainties about the optimal treatment strategies of OSAJ patients will currently remain. Thus, prospective studies of OSAJ are needed but are only feasible in a multicenter study setting, conducted over a prolonged time period.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/terapia , Osteosarcoma/terapia , Pronóstico , Austria/epidemiología , Neoplasias Óseas/mortalidad , Neoplasias Óseas/patología , Inmunohistoquímica , Biomarcadores/análisis , Osteosarcoma/mortalidad , Osteosarcoma/patología , Tasa de Supervivencia , Estudios Retrospectivos , Anticuerpos Monoclonales/análisis , Antígenos de Neoplasias/análisisRESUMEN
Plant-based platforms are extensively use for the expression of recombinant proteins, including monoclonal antibodies (mAbs). Generally, immunoglobulins (Igs) are sorted to the apoplast, which is often afflicted with intense proteolysis. Here, we describe methods to transiently express mAbs sorted to central vacuole in Nicotiana benthamiana leaves and to characterize the obtained IgG. Central vacuole is an appropriate compartment for the efficient production of Abs, consequently vacuolar sorting should be considered as an alternative strategy to obtain high protein yields.
Asunto(s)
Anticuerpos Monoclonales/análisis , Inmunoglobulina G/análisis , Nicotiana/genética , Vacuolas/genética , Agrobacterium tumefaciens/genética , Agrobacterium tumefaciens/metabolismo , Anticuerpos Monoclonales/genética , Anticuerpos Monoclonales/metabolismo , Western Blotting/métodos , Electroforesis en Gel de Poliacrilamida/métodos , Ensayo de Inmunoadsorción Enzimática/métodos , Expresión Génica , Inmunoglobulina G/genética , Inmunoglobulina G/metabolismo , Espectrometría de Masas/métodos , Hojas de la Planta/genética , Hojas de la Planta/metabolismo , Proteínas Recombinantes/análisis , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Nicotiana/metabolismo , Vacuolas/metabolismoRESUMEN
The use of serum containing polyclonal antibodies from animals immunized with toxins marked the beginning of the application of antibody-based therapy in late nineteenth century. Advances in basic research led to the development of the hybridoma technology in 1975. Eleven years later, the first therapeutic monoclonal antibody (mAb) was approved, and since then, driven by technological advances, the development of mAbs has played a prominent role in the pharmaceutical industry. In this review, we present the developments to circumvent problems of safety and efficacy arising from the murine origin of the first mAbs and generate structures more similar to human antibodies. As of October 2017, there are 61 mAbs and 11 Fc-fusion proteins in clinical use. An overview of all mAbs currently approved is provided, showing the development of sophisticated mAbs formats that were engineered based on the challenges posed by therapeutic indications, including antibody-drug conjugates (ADC) and glycoengineered mAbs. In the field of immunotherapy, the use of immunomodulators, bispecific mAbs and CAR-T cells are highlighted. As an example of promising therapy to treat infectious diseases, we discuss the generation of neutralizing monoclonal-oligoclonal antibodies obtained from human B cells. Scientific and technological advances represent mAbs successful translation to the clinic
Asunto(s)
Animales , Ratones , Desarrollo Tecnológico/clasificación , Anticuerpos , Anticuerpos Monoclonales/análisis , Ratones Transgénicos/clasificación , Inmunoterapia/efectos adversosRESUMEN
Anticorpos são moléculas de grande interesse científico e farmacêutico, principalmente, devido a sua alta especificidade contra antígenos determinados. Atualmente, anticorpos monoclonais estão entre os medicamentos (biofármacos) mais vendidos do mundo. São utilizados para o tratamento das mais diversas doenças, como câncer, retinopatias, doenças inflamatórias e do sistema imune, entre outras. Nos últimos 30 anos, as tecnologias para a obtenção de anticorpos monoclonais evoluíram muito, desde a tecnologia do hibridoma, até os processos de humanização de anticorpos murinos. Entre os métodos mais utilizados para a produção de anticorpos humanos, destaca-se a tecnologia do Phage Display. Nesta técnica, os genes que codificam as regiões variáveis de imunoglobulinas são inseridos no genoma de um bacteriófago, resultando na produção de partículas virais híbridas que contém fragmentos de anticorpos em fusão com uma das proteínas do capsídeo viral. Neste trabalho, desenvolvemos novos vetores para a apresentação de fragmentos ScFv em fusão com duas proteínas das proteínas do capsídeo viral, a pIII e pVIII. Os oligonucleotídeos utilizados para amplificar os genes de imunoglobulinas foram redesenhados e para minimizar a perda do repertório durante a produção da biblioteca, avaliamos em bancos de dados enzimas de restrição que não apresentam sítios de restrição nas sequencias gênicas. Esses sítios de restrição foram utilizados para construir as regiões de clonagem do vetor Phagemid. Outra etapa crítica na produção de bibliotecas de anticorpos é a reação do PCR de overlap, que pode restringir a diversidade de anticorpos e resultar na produção de amplicons codificando anticorpos truncados. Por isso, nossos vetores foram desenhados para permitir a clonagem direta das regiões variáveis das imunoglobulinas humanas ou murinas, sem a necessidade do PCR de overlap. Nossa expectativa, é que estes novos reagentes serão mais efetivos para a produção de novas bibliotecas de anticorpos pelo sistema do Phage Display
Antibodies are molecules of great scientific and pharmaceutical interest, mainly because of their high specificity against certain antigens. Currently, monoclonal antibodies are among the best selling drugs (biopharmaceuticals) in the world. They are used for the treatment of the most diverse disorders, such as cancer, retinopathies, inflammatory and immune system diseases, among others. In the past 30 years, technologies for obtaining monoclonal antibodies has greatly evolved from hybridoma technology to the humanization processes of murine antibodies. Among the methods used for the production of human antibodies, the technology of Phage Display stands out. In this technique, the genes encoding the immunoglobulin variable regions are inserted into the genome of a bacteriophage, resulting in the production of hybrid virus particles which contain fragments of antibodies in fusion with one of the viral capsid proteins. In this work, we developed new vectors for the presentation of ScFv fragments in fusion with two proteins of viral capsid proteins, pIII and pVIII. The oligonucleotides used to amplify the immunoglobulin genes were redesigned and to minimize repertory loss during library production, we evaluated restriction enzymes in databases that lack restriction sites in the gene sequences. These restriction sites were used to construct the cloning regions of the Phagemid vector. Another critical step in the production of antibody libraries is the overlap PCR reaction, which may restrict the diversity of antibodies and result in the production of amplicons encoding truncated antibodies. Therefore, our vectors were designed to allow the direct cloning of human or murine Immunoglobulins variable regions without the need for overlap PCR. Our expectation is that these new reagents will be more effective for the production of new antibody libraries by the Phage Display system
Asunto(s)
Preparaciones Farmacéuticas , Técnicas de Visualización de Superficie Celular/instrumentación , Anticuerpos Monoclonales/análisis , Inmunoglobulinas/clasificación , Anticuerpos de Cadena ÚnicaRESUMEN
The specificity of monoclonal antibodies (mAbs) to desired targets makes these molecules suitable for therapeutic and diagnostic uses against a wide range of pathogens. Phage display antibody libraries offer one method by which mAbs can be selected for, without the use of conventional hybridoma technology. In this work, phage display technology was used to construct, select and characterize a combinatorial single chain fragment variable (scFv) antibody library against bovine herpesvirus type 1 (BoHV-1) from the immune repertoire of chickens immunized with the virus. In silico analysis of the hypervariable domains of the antibody heavy chains revealed a high frequency of scFv fragments with low variability, suggesting that selection had probably been carried out and favored by a few im-munogenic viral antigens. The reactivity of the scFv fragments selected against BoHV-1 was demon-strated by Phage-ELISA. A significant increase in antibody reactivity to the target was observed after six rounds of library selection, showing its potential use as a molecule for BoHV-1 diagnosis. The strategy described here opens up a field for the use of phage display as a tool for selection of mono-clonal antibodies that could be used for theranostic applications against infectious and parasitic dis-eases of veterinary interest.
A especificidade dos anticorpos monoclonais (mAb) aos alvos desejados torna estas moléculas ade-quadas para uso em diagnóstico ou terapia de uma vasta gama de agentes patogênicos. Biblioteca de anticorpos apresentados em fagos filamentosos é uma metodologia para a produção de mAbs, poden-do ser utilizada como alternativa à tecnologia de hibridoma convencional, tradicionalmente empregada para este fim. Neste trabalho, a tecnologia de Phage display foi usada para construir, selecionar e ca-racterizar uma biblioteca combinatorial de fragmentos de anticorpos de cadeia única (scFv) contra o Herpesvírus bovino tipo 1 (BoHV-1) a partir do repertório imune de galinhas imunizadas com o vírus. A análise in silico dos domínios hipervariáveis das cadeias pesadas dos anticorpos revelou uma alta frequência de fragmentos scFv com baixa variabilidade, sugerindo que a seleção foi provavelmente conduzida e favorecida por poucos antígenos virais mais imunogênicos. A reatividade dos fragmentos scFv selecionados contra BoHV-1 foi demonstrada por Fago-ELISA. Observou-se um aumento signi-ficativo da reatividade dos anticorpos após seis ciclos de seleção, evidenciando sua utilização como molécula para o diagnóstico de BoHV-1. A estratégia aqui descrita abre a possibilidade do uso da tec-nologia de Phage display como ferramenta na seleção de anticorpos monoclonais com potencial uso tanto para o diagnóstico quanto para terapia de doenças infecciosas e/ou parasitárias de interesse veterinário.
Asunto(s)
Anticuerpos Monoclonales/análisis , Anticuerpos Monoclonales/clasificación , Herpesvirus Bovino 1/clasificación , Herpesvirus Bovino 1/inmunologíaRESUMEN
The specificity of monoclonal antibodies (mAbs) to desired targets makes these molecules suitable for therapeutic and diagnostic uses against a wide range of pathogens. Phage display antibody libraries offer one method by which mAbs can be selected for, without the use of conventional hybridoma technology. In this work, phage display technology was used to construct, select and characterize a combinatorial single chain fragment variable (scFv) antibody library against bovine herpesvirus type 1 (BoHV-1) from the immune repertoire of chickens immunized with the virus. In silico analysis of the hypervariable domains of the antibody heavy chains revealed a high frequency of scFv fragments with low variability, suggesting that selection had probably been carried out and favored by a few im-munogenic viral antigens. The reactivity of the scFv fragments selected against BoHV-1 was demon-strated by Phage-ELISA. A significant increase in antibody reactivity to the target was observed after six rounds of library selection, showing its potential use as a molecule for BoHV-1 diagnosis. The strategy described here opens up a field for the use of phage display as a tool for selection of mono-clonal antibodies that could be used for theranostic applications against infectious and parasitic dis-eases of veterinary interest.(AU)
A especificidade dos anticorpos monoclonais (mAb) aos alvos desejados torna estas moléculas ade-quadas para uso em diagnóstico ou terapia de uma vasta gama de agentes patogênicos. Biblioteca de anticorpos apresentados em fagos filamentosos é uma metodologia para a produção de mAbs, poden-do ser utilizada como alternativa à tecnologia de hibridoma convencional, tradicionalmente empregada para este fim. Neste trabalho, a tecnologia de Phage display foi usada para construir, selecionar e ca-racterizar uma biblioteca combinatorial de fragmentos de anticorpos de cadeia única (scFv) contra o Herpesvírus bovino tipo 1 (BoHV-1) a partir do repertório imune de galinhas imunizadas com o vírus. A análise in silico dos domínios hipervariáveis das cadeias pesadas dos anticorpos revelou uma alta frequência de fragmentos scFv com baixa variabilidade, sugerindo que a seleção foi provavelmente conduzida e favorecida por poucos antígenos virais mais imunogênicos. A reatividade dos fragmentos scFv selecionados contra BoHV-1 foi demonstrada por Fago-ELISA. Observou-se um aumento signi-ficativo da reatividade dos anticorpos após seis ciclos de seleção, evidenciando sua utilização como molécula para o diagnóstico de BoHV-1. A estratégia aqui descrita abre a possibilidade do uso da tec-nologia de Phage display como ferramenta na seleção de anticorpos monoclonais com potencial uso tanto para o diagnóstico quanto para terapia de doenças infecciosas e/ou parasitárias de interesse veterinário.(AU)
Asunto(s)
Herpesvirus Bovino 1/clasificación , Herpesvirus Bovino 1/inmunología , Anticuerpos Monoclonales/análisis , Anticuerpos Monoclonales/clasificaciónRESUMEN
ABSTRACT Purpose: The cellular origin of retinoblastoma is uncertain as constituent tumor cells heterogeneously express markers of both immature and mature retinal cells. An immunohistochemical analysis of cellular origin may yield valuable insights into disease progression and treatment options. This study aimed to determine the cellular origin of retinoblastoma in a large case series and correlate these findings with histopathological prognostic factors. Methods: Thirty-nine retinoblastoma cases were histopathologically diagnosed and analyzed by immunohistochemistry using monoclonal antibodies against the immature neural cell marker SRY-box containing gene 2 (SOX-2), the mature neuronal cell marker microtubule-associated protein 2 (MAP2), and the mature glial cell marker glial fibrillary acidic protein (GFAP). Histopathological features were also evaluated, including patterns of growth, differentiation, vitreous seeding, and choroidal/scleral, optic nerve, and anterior chamber invasion. Two retinoblastoma cell lines, WERI-1 and Y79, were studied by immunocytochemistry using the same antibodies. Results: Expression of SOX-2 was strong in 97.4% of retinoblastoma cases, while MAP-2 was expressed in 59% of cases. Immunostaining for GFAP was positive only in reactive stromal astrocytes interspersed amongst tumor cells and in peritumoral tissue. There was no correlation between histopathological prognostic factors and immunohistochemical markers. Retinoblastoma cell lines showed strong positivity for SOX2 (90% of WERI-1 cells and 70% of Y79 cells) and MAP2 (90% of cells in both lines). GFAP was completely negative in both cell lines. Conclusion: The majority of retinoblastomas and both RB cell lines expressed an immature neural and/or a mature neuronal cell marker, but not a glial marker. These results indicate a typical neuroblast or neuronal origin and eliminate astrocyte differentiation from neural stem cells as the source of retinoblastoma.
RESUMO Objetivos: Este estudo visa determinar a origem do retinoblastoma em um número de casos e correlacionar essos achados com fatores prognósticos e histopatológicos conhecidos. Métodos: Trinta e nove casos de retinoblastoma foram diagnosticados e analisados com imuno-histoquímica usando marcadores de anticorpos monoclonais contra as células de retina imaturas (SOX-2: SRY-box containing gene 2), contra as células da retina maturas (MAP2: microtubule -associated protein 2) e contra as células gliais maturas (GFAP: glial fibrillar acidic protein). Foram avaliadas características microscópicas dos casos (grau de diferenciação, presença de semeadura vítrea, invasão de coroide/esclera, nervo óptico e câmara anterior). Duas linhas celulares de retinoblastoma (WERI-1 e Y79) também foram testadas, utilizando os três marcadores. Resultados: A expressão de SOX-2 foi positiva em 97,4% dos casos de retinoblastoma, enquanto MAP2 foi positivo em 59% dos casos. GFAP foi apenas positivo no estroma (astrócitos reativos). Não houve correlação entre preditores histopatológicos e marcadores imunohistoquímicos avaliados. As linhagens celulares mostraram positividade para SOX-2 (90% em WERI-1 e 70% das células Y79). Ambas as linhagens celulares se mostraram fortemente positivas con MAP2 (90%), enquanto não houve expressão de GFAP em nenhuma das linhas celulares estudadas. Conclusões: A maioria das células de retinoblastoma desta série de casos expressa marcadores de células retinianas imaturas, além de marcadores de células maduras. As linhas celulares Y79 e WERI-1 apresentaram imunomarcação para ambos os marcadores neurais em percentagens semelhantes a dos casos avaliados. Portanto, estes resultados confirmam a origem neural do tumor em particular. Alem disso, a ausência de células positivas para GFAP no tumor descarta diferenciação de astrócitos em retinoblastoma.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Retinoblastoma/metabolismo , Neuroglía/metabolismo , Neoplasias de la Retina/metabolismo , Células-Madre Neurales/patología , Fenotipo , Pronóstico , Retinoblastoma/patología , Inmunohistoquímica , Biomarcadores/metabolismo , Neuroglía/patología , Astrocitos/metabolismo , Astrocitos/patología , Factores de Transcripción SOXB1/metabolismo , Células-Madre Neurales/metabolismo , Proteína Ácida Fibrilar de la Glía/metabolismo , Proteínas Asociadas a Microtúbulos/metabolismo , Anticuerpos Monoclonales/análisis , Anticuerpos Monoclonales/metabolismoRESUMEN
O objetivo detse artigo é de descrever um protocolo de isolamento das células mononucleares da medula óssea de coelhos, seguido de purificação celular por depleção negativa com o anticorpo monoclonal CD45 e posterior expansão em meio de cultura MesenCult®. Dez coelhos machos adultos, da raça Nova Zelândia, com idade média de 1,0±0,2 anos e peso médio 3,5±0,24kg, foram utilizados para padronização da metodologia. O isolamento das células mononuclares da medula óssea foi realizado pelo gradiente de densidade Ficoll-paque® e a purificação e obtenção das células- pela depleção negativa com o anticorpo monoclonal CD45 em base imunomagnética. A população celular obtida foi expandida posteriormente em meio de cultura MesenCult®. No isolamento pelo gradiente de icoll-Paque® foi obtido um rendimento médio de 7,31x106 células/mL. Após purificação e obtenção das possíveis células-tronco mesenquimais pela base imunomagnética, houve um decréscimo do rendimento para 2,28x106 células/mL, mas o processo de expansão foi incrementado pelo cultivo celular. Os resultados indicaram que as células obtidas da fração mononuclear da medula óssea, cultivadas in vitro foram capazes de gerar células aderentes 24 horas após o cultivo, com predominância de células fibroblastóides sugestivas de células-tronco mesenquimais. Concluiu-se que a obtenção de células-tronco mesenquimais pode ser alcançada após purificação das células mononucleares da medula óssea de coelhos pelo método imunomagético, o meio de cultura MesenCult® proporciona um ambiente adequado para a rápida expansão in vitro e o número de passagens exerce influência negativa sobre as características morfológicas das células.
The objective of this study was to describe guidelines for the isolation of bone marrow mononuclear cells from rabbits, followed by cell purification by negative depletion with CD45 monoclonal antibody, and further expansion in MesenCult® medium. Ten adult male New Zealand White rabbits, age average of 1.0±0.2 years and weighting 3.5±0.24kg, were used to obtain a standardized method. The mononuclear cells of the bone marrow were isolated with Ficoll-paque® density gradient centrifugation, and the cell purification and acquisition was completed by negative depletion with CD45 monoclonal antibody in immunomagnetic base. The cell population obtained was expanded in MesenCult® medium. Through isolation with Ficoll-paque® density gradient was possible to obtain an average yield of 7.31x106 cells/mL. After purification and acquisiton of potential mesenchymal stem cells by the immunomagnetic base, there was a yield decrease to 2.28x106 cells/mL; however the expansion process was increased in cell culture. The results indicated that cells obtained from the mononuclear fraction of bone marrow and cultivated in vitro were capable to generate adherent cells 24 hours after culture, with predominance of fibroblastoid cells suggestive of mesenchymal stem cells. It can be concluded that mesenchymal stem cells can be achieved with purified rabbit bone marrow mononuclear cells through the immunomagnetic method, as the MesenCult® medium provides a suitable environment for a quick in vitro expansion, and the number of passages exerts negative influence on the morphological characteristics.
Asunto(s)
Animales , Masculino , Conejos , Células Madre Adultas , Anticuerpos Monoclonales/análisis , Células de la Médula Ósea , Separación Celular/veterinaria , Lagomorpha , Separación Inmunomagnética/veterinaria , Técnicas In Vitro/veterinariaRESUMEN
RESUMO Objetivo Analisar o percurso dos ensaios clínicos com anticorpos monoclonais e biomedicamentos oncológicos realizados em instituições brasileiras de 2003 a 2012. Método Neste estudo retrospectivo e descritivo, realizou-se um levantamento junto aos repositórios ClinicalTrials.gov e ReBEC. Foram incluídos ensaios de fase II ou III com participação do Brasil e registro em pelo menos um dos repositórios. Após a seleção dos ensaios, foi investigada a trajetória dos anticorpos monoclonais e biomedicamentos desde a pesquisa até o registro sanitário junto a Agência Nacional de Vigilância Sanitária (Anvisa), Food and Drug Administration (FDA) e European Medicines Agency (EMA). Resultado Nove ensaios foram selecionados, todos randomizados controlados. Oito eram de fase III e um de fase II. Dois ensaios utilizaram cegamento duplo e sete eram abertos. Todos apresentaram recrutamento para ambos os sexos, com idade mínima de 18 anos. A média de recrutamento foi de 985,2 pacientes. Sete ensaios estavam finalizados e dois haviam sido encerrados prematuramente. Todos os ensaios foram financiados por indústrias farmacêuticas não brasileiras e enfocaram câncer renal, colorretal, gástrico, de pulmão (não pequenas células), linfoma não-Hodgkin e melanoma, envolvendo a utilização de cetuximabe, figitumumabe, ipilimumabe, rituximabe, bevacizumabe e interferon alfa-2a. A FDA foi a primeira agência a registrar os medicamentos, seguida pela EMA, a não ser no caso do interferon alfa-2a, recusado pela EMA. Não foi possível avaliar o ano de aprovação no Brasil pela Anvisa. Conclusão A participação do Brasil nos ensaios clínicos com anticorpos monoclonais e biomedicamentos oncológicos é insuficiente. A limitação do conteúdo disponível sobre os estudos, histórico de registro e outros elementos relevantes é uma fragilidade importante das fontes consultadas.
ABSTRACT Objective To analyze the pathway of clinical trials of monoclonal antibodies and biological medicines for cancer treatment involving Brazilian institutions from 2003 to 2012. Method This retrospective, descriptive study was based on review of two clinical trial registries, ClinicalTrials.gov and the Brazilian registry ReBEC. Phase II or III studies with participation from Brazilian institutions listed in at least one of the registries were included. Following selection of the trials, the pathway of monoclonal antibodies and biological medicines was investigated from the research stage until licensing by the Brazilian Agency for Sanitary Surveillance (Anvisa), Food and Drug Administration (FDA), and European Medicines Agency (EMA). Results Nine trials (eight phase III and one phase II) were selected. All had a randomized, controlled design. Two trials were double-blind and seven were open-label, and all recruited adults (≥ 18 years of age) of both sexes. The mean number of patients recruited per trial was 985.2. Seven trials had been completed and two had been terminated early. All trials were sponsored by non-Brazilian pharmaceutical companies and focused on renal, colorectal, gastric, and lung (non-small cell) cancer, non-Hodgkin lymphoma, and melanoma, and involved the use of cetuximab, figitumumab, ipilimumab, rituximab, bevacizumab and interferon alfa-2a. The FDA was the first agency to license the drugs, followed by EMA, except in the case of interferon alfa-2a, which was not approved by EMA. We were unable to determine the year of drug licensing by Anvisa in Brazil. Conclusions The participation of Brazil in clinical trials of monoclonal antibodies and biological medications for cancer treatment is insufficient. The quality of the available information on trials, history of licensing, and other relevant elements is a major weakness of the sources reviewed.
Asunto(s)
Investigación Biomédica/métodos , Oncología Médica/tendencias , Anticuerpos Monoclonales/análisis , BrasilRESUMEN
PURPOSE:: The cellular origin of retinoblastoma is uncertain as constituent tumor cells heterogeneously express markers of both immature and mature retinal cells. An immunohistochemical analysis of cellular origin may yield valuable insights into disease progression and treatment options. This study aimed to determine the cellular origin of retinoblastoma in a large case series and correlate these findings with histopathological prognostic factors. METHODS:: Thirty-nine retinoblastoma cases were histopathologically diagnosed and analyzed by immunohistochemistry using monoclonal antibodies against the immature neural cell marker SRY-box containing gene 2 (SOX-2), the mature neuronal cell marker microtubule-associated protein 2 (MAP2), and the mature glial cell marker glial fibrillary acidic protein (GFAP). Histopathological features were also evaluated, including patterns of growth, differentiation, vitreous seeding, and choroidal/scleral, optic nerve, and anterior chamber invasion. Two retinoblastoma cell lines, WERI-1 and Y79, were studied by immunocytochemistry using the same antibodies. RESULTS:: Expression of SOX-2 was strong in 97.4% of retinoblastoma cases, while MAP-2 was expressed in 59% of cases. Immunostaining for GFAP was positive only in reactive stromal astrocytes interspersed amongst tumor cells and in peritumoral tissue. There was no correlation between histopathological prognostic factors and immunohistochemical markers. Retinoblastoma cell lines showed strong positivity for SOX2 (90% of WERI-1 cells and 70% of Y79 cells) and MAP2 (90% of cells in both lines). GFAP was completely negative in both cell lines. CONCLUSION:: The majority of retinoblastomas and both RB cell lines expressed an immature neural and/or a mature neuronal cell marker, but not a glial marker. These results indicate a typical neuroblast or neuronal origin and eliminate astrocyte differentiation from neural stem cells as the source of retinoblastoma.
Asunto(s)
Células-Madre Neurales/patología , Neuroglía/metabolismo , Neoplasias de la Retina/metabolismo , Retinoblastoma/metabolismo , Anticuerpos Monoclonales/análisis , Anticuerpos Monoclonales/metabolismo , Astrocitos/metabolismo , Astrocitos/patología , Biomarcadores/metabolismo , Niño , Preescolar , Femenino , Proteína Ácida Fibrilar de la Glía/metabolismo , Humanos , Inmunohistoquímica , Lactante , Masculino , Proteínas Asociadas a Microtúbulos/metabolismo , Células-Madre Neurales/metabolismo , Neuroglía/patología , Fenotipo , Pronóstico , Neoplasias de la Retina/genética , Neoplasias de la Retina/patología , Retinoblastoma/genética , Retinoblastoma/patología , Factores de Transcripción SOXB1/metabolismoRESUMEN
Since 1996, the Laboratory of Monoclonal Antibodies Antigens and Adjuvants - Immunology Center of Adolfo Lutz Institute (IC-IAL) has been working on N. meningitidis strains antigens characterization by using a predetermined monoclonal antibodies (MoAb) panel; and the new monoclonal production has been performed for characterizing strains with unknown profiles. MoAb were obtained from different fusions performed at IAL using spleen cells and popliteal lymph nodes. Two murine hybridomas secreting MoAb anti-N. meningitidis antigens, produced and characterized in the Laboratory of IC-IAL, are presently being evaluated by immunohistochemical (IHC) technique at Immunohistochemistry Laboratory - Pathology Center, IAL. After standardizing these reactions, a protocol for performing investigation on N.meningitidis antigens by using IHQ was established. An increment in the histopathological diagnosis of meningococcal meningitis was occurred, by using MoAb specific for antigens from N. meningitidis serogroups, serotypes and subtypes, mainly in those cases without microorganisms confirmation by biomolecular techniques as PCR. The results obtained in these first tests proved to be promising, and two MoAb showed excellent results. No cross-reactivity with viral meningitis, S. pneumoniae, Rickettsia or Rubella was detected. For the further studies, it is fundamental to increase the samples size, including samples from patients with meningococcal meningitis and from individuals infected with other pathogens.
Desde 1996, o Laboratório de Anticorpos Monoclonais, Antígenos e Adjuvantes - Centro de Imunologia do Instituto Adolfo Lutz (CI-IAL) tem desenvolvido trabalhos na caracterização antigênica de cepas de Neisseria meningitidis utilizando-se painel de anticorpos monoclonais (AcMo) pré-estabelecido, e produção de novos monoclonais para a análise de cepas com perfis desconhecidos. AcMo foram obtidos das diferentes fusões realizadas no laboratório utilizando-se células esplênicas e linfonodos poplíteos. Dois hibridomas murinos secretores de AcMo anti-N. meningitidis produzidos e caracterizados no CI-IAL têm sido avaliados por meio de estudo imuno-histoquímico (IHQ) no Centro de Patologia-Laboratório de Imunohistoquímica-IAL. Com a padronização da reação, estabeleceu-se um protocolo para efetuar a pesquisa de antígenos de N. meningitidis por IHQ. Houve melhoria no diagnóstico histopatológico da meningite meningocócica, sobretudo em situações em que não há confirmação da presença do microorganismo por técnicas biomoleculares, como PCR, utilizando-se AcMo específicos para antígenos de diferentes sorogrupos, sorotipos e subtipos de N. meningitidis. O resultado obtido nos primeiros testes mostrou-se promissor, e os dois AcMo demonstraram excelentes resultados. Não houve reatividade cruzada com meningite viral, S. pneumoniae, Rickettsia ou rubéola. Nos próximos estudos, é fundamental ampliar número de amostras, incluindo-se aquelas coletadas de pacientes com meningites meningocócicas e de indivíduos infectados com outros agentes patogênicos.
Asunto(s)
Anticuerpos Monoclonales/análisis , Biomarcadores , Meningitis Viral/diagnóstico , Meningitis Bacterianas/diagnóstico , Neisseria meningitidis/inmunología , InmunohistoquímicaRESUMEN
Since 1996, the Laboratory of Monoclonal Antibodies Antigens and Adjuvants - Immunology Center of Adolfo Lutz Institute (IC-IAL) has been working on N. meningitidis strains antigens characterization by using a predetermined monoclonal antibodies (MoAb) panel; and the new monoclonal production has been performed for characterizing strains with unknown profiles. MoAb were obtained from different fusions performed at IAL using spleen cells and popliteal lymph nodes. Two murine hybridomas secreting MoAb anti-N. meningitidis antigens, produced and characterized in the Laboratory of IC-IAL, are presently being evaluated by immunohistochemical (IHC) technique at Immunohistochemistry Laboratory - Pathology Center, IAL. After standardizing these reactions, a protocol for performing investigation on N.meningitidis antigens by using IHQ was established. An increment in the histopathological diagnosis of meningococcal meningitis was occurred, by using MoAb specific for antigens from N. meningitidis serogroups, serotypes and subtypes, mainly in those cases without microorganisms confirmation by biomolecular techniques as PCR. The results obtained in these first tests proved to be promising, and two MoAb showed excellent results. No cross-reactivity with viral meningitis, S. pneumoniae, Rickettsia or Rubella was detected. For the further studies, it is fundamental to increase the samples size, including samples from patients with meningococcal meningitis and from individuals infected with other pathogens.(AU)
Desde 1996, o Laboratório de Anticorpos Monoclonais, Antígenos e Adjuvantes - Centro de Imunologia do Instituto Adolfo Lutz (CI-IAL) tem desenvolvido trabalhos na caracterização antigênica de cepas de Neisseria meningitidis utilizando-se painel de anticorpos monoclonais (AcMo) pré-estabelecido, e produção de novos monoclonais para a análise de cepas com perfis desconhecidos. AcMo foram obtidos das diferentes fusões realizadas no laboratório utilizando-se células esplênicas e linfonodos poplíteos. Dois hibridomas murinos secretores de AcMo anti-N. meningitidis produzidos e caracterizados no CI-IAL têm sido avaliados por meio de estudo imuno-histoquímico (IHQ) no Centro de Patologia-Laboratório de Imunohistoquímica-IAL. Com a padronização da reação, estabeleceu-se um protocolo para efetuar a pesquisa de antígenos de N. meningitidis por IHQ. Houve melhoria no diagnóstico histopatológico da meningite meningocócica, sobretudo em situações em que não há confirmação da presença do microorganismo por técnicas biomoleculares, como PCR, utilizando-se AcMo específicos para antígenos de diferentes sorogrupos, sorotipos e subtipos de N. meningitidis. O resultado obtido nos primeiros testes mostrou-se promissor, e os dois AcMo demonstraram excelentes resultados. Não houve reatividade cruzada com meningite viral, S. pneumoniae, Rickettsia ou rubéola. Nos próximos estudos, é fundamental ampliar número de amostras, incluindo-se aquelas coletadas de pacientes com meningites meningocócicas e de indivíduos infectados com outros agentes patogênicos.(AU)