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1.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.377-382, tab, ilus.
Monografia em Português | LILACS | ID: biblio-1352599
2.
J Virol ; 93(18)2019 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-31243130

RESUMO

Previously, the cyclophilin inhibitors cyclosporine (CsA) and alisporivir (ALV) were shown to inhibit the replication of diverse RNA viruses, including arteriviruses and coronaviruses, which both belong to the order Nidovirales In this study, we aimed to identify arterivirus proteins involved in the mode of action of cyclophilin inhibitors and to investigate how these compounds inhibit arterivirus RNA synthesis in the infected cell. Repeated passaging of the arterivirus prototype equine arteritis virus (EAV) in the presence of CsA revealed that reduced drug sensitivity is associated with the emergence of adaptive mutations in nonstructural protein 5 (nsp5), one of the transmembrane subunits of the arterivirus replicase polyprotein. Introduction of singular nsp5 mutations (nsp5 Q21R, Y113H, or A134V) led to an ∼2-fold decrease in sensitivity to CsA treatment, whereas combinations of mutations further increased EAV's CsA resistance. The detailed experimental characterization of engineered EAV mutants harboring CsA resistance mutations implicated nsp5 in arterivirus RNA synthesis. Particularly, in an in vitro assay, EAV RNA synthesis was far less sensitive to CsA treatment when nsp5 contained the adaptive mutations mentioned above. Interestingly, for increased sensitivity to the closely related drug ALV, CsA-resistant nsp5 mutants required the incorporation of an additional adaptive mutation, which resided in nsp2 (H114R), another transmembrane subunit of the arterivirus replicase. Our study provides the first evidence for the involvement of nsp2 and nsp5 in the mechanism underlying the inhibition of arterivirus replication by cyclophilin inhibitors.IMPORTANCE Currently, no approved treatments are available to combat infections with nidoviruses, a group of positive-stranded RNA viruses, including important zoonotic and veterinary pathogens. Previously, the cyclophilin inhibitors cyclosporine (CsA) and alisporivir (ALV) were shown to inhibit the replication of diverse nidoviruses (both arteriviruses and coronaviruses), and they may thus represent a class of pan-nidovirus inhibitors. In this study, using the arterivirus prototype equine arteritis virus, we have established that resistance to CsA and ALV treatment is associated with adaptive mutations in two transmembrane subunits of the viral replication machinery, nonstructural proteins 2 and 5. This is the first evidence for the involvement of specific replicase subunits of arteriviruses in the mechanism underlying the inhibition of their replication by cyclophilin inhibitors. Understanding this mechanism of action is of major importance to guide future drug design, both for nidoviruses and for other RNA viruses inhibited by these compounds.


Assuntos
Equartevirus/genética , RNA Polimerase Dependente de RNA/genética , Proteínas não Estruturais Virais/metabolismo , Arterivirus/genética , Linhagem Celular , Ciclofilinas/metabolismo , Ciclosporina/antagonistas & inibidores , Equartevirus/metabolismo , Células HEK293 , Humanos , Mutação , Nidovirales/genética , Nidovirales/metabolismo , Inibidores da Síntese de Ácido Nucleico/metabolismo , RNA Viral/genética , RNA Polimerase Dependente de RNA/metabolismo , Proteínas não Estruturais Virais/genética , Replicação Viral
3.
J Cell Biochem ; 119(10): 8220-8232, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29932236

RESUMO

An increasing number of experiments and clinical trials have demonstrated the safety, feasibility, and efficacy of mesenchymal stem cells (MSCs)-based therapies for the treatment of various diseases. The main drawbacks of MSC therapy are the lack of specific homing after systemic infusion and early death of injected cells because of the injury micro-environment. We pretreated bone mesenchymal stem cells (BMSCs) with erythropoietin (EPO) to investigate their positive effect on cyclosporine A (CsA)-induced nephrotoxicity. BMSCs were incubated with different concentrations of EPO (10, 100, 500, and 1000 IU/mL) for 24 and 48 h, and their proliferation rate, cytoskeletal morphology, migration ability, and the expression of CXCR4 were evaluated to determine the optimal pretreatment conditions. To investigate the therapeutic effects of BMSCs pretreated with EPO in CsA-induced nephrotoxicity, we established CsA-induced in vitro and in vivo toxicity models. In our in vitro study, preconditioning of BMSCs with 500 IU/mL EPO for 48 h induced a marked increase in their proliferation rate, cytoskeletal rearrangement, migration in the scrape-healing assay, and migration toward injured HK2 cells. In vivo, EPO-BMSCs showed higher ability to improve renal function than BMSCs, and in CsA-induced rats treated with EPO-BMSCs, interstitial lymphocyte infiltration, tubular swelling, necrosis, and interstitial fibrosis decreased. We demonstrated that pretreatment with 500 IU/mL EPO before infusion markedly increased the homing ability of BMSCs, and obviously ameliorate CsA-induced nephrotoxicity in rats.


Assuntos
Ciclosporina/antagonistas & inibidores , Eritropoetina/farmacologia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/efeitos dos fármacos , Nefrite/terapia , Animais , Células da Medula Óssea/citologia , Células da Medula Óssea/efeitos dos fármacos , Células da Medula Óssea/metabolismo , Diferenciação Celular/efeitos dos fármacos , Linhagem Celular , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Técnicas de Cocultura , Ciclosporina/toxicidade , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Feminino , Expressão Gênica/efeitos dos fármacos , Sobrevivência de Enxerto , Rim/efeitos dos fármacos , Rim/metabolismo , Rim/patologia , Testes de Função Renal , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Nefrite/induzido quimicamente , Nefrite/metabolismo , Nefrite/patologia , Cultura Primária de Células , Ratos , Ratos Sprague-Dawley , Receptores CXCR4/genética , Receptores CXCR4/metabolismo
4.
Eur Rev Med Pharmacol Sci ; 22(10): 3207-3213, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29863267

RESUMO

OBJECTIVE: To investigate the role of cortistatin (CST) on cyclosporine A (CsA)-induced myocardial apoptosis in rats and determine its effect on the expressions of myocardial apoptosis genes. MATERIALS AND METHODS: H9C2 cells were treated with different concentrations of CsA solution (0.04, 0.2, 1 and 5 µM) for 24, 48 and 72 h, respectively. The cell viability was detected via methyl thiazolyl tetrazolium (MTT) assay, and the appropriate dose and time were compared and determined. At the same time, CST in different concentrations (0.08, 0.04, 0.2, 1, 5 and 25 µM) was added into cell culture, and the appropriate dose was identified using MTT assay. The cellular morphology in each group was observed, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was performed for the detection of cell apoptosis. Moreover, in molecular mechanism research, the apoptosis-associated factors, factor associated suicide (Fas), Fas ligand (FasL) and B-cell lymphoma-2-associated X protein (Bax), were detected via quantitive Real-time polymerase chain reaction (qPCR). Finally, the levels of a protein related to myocardial apoptosis in rats were investigated via Western blotting. RESULTS: The treatment with 1 µM CsA for 48 h caused significant apoptosis. The results of TUNEL staining showed the inhibitory role of CST on the myocardial apoptosis in rats induced by CsA. The detection of apoptosis factors via Real-time PCR revealed that after the induction of CsA, the expressions of Fas, FasL and Bax mRNA in cells were significantly higher than those in control group, but were significantly decreased after administration of CST. Western blotting showed that the protein expressions of Caspase 3 and Caspase 9 were remarkably elevated in cells after the use of CsA, but were significantly reduced after administration of CST (p < 0.01). CONCLUSIONS: CST contributes to antagonistic function against the CsA-induced apoptosis of rat myocardial cells, and its effect is related to the down-regulation of expressions of apoptotic factors, Fas, FasL, Bax, Caspase 3, and Caspase 9.


Assuntos
Apoptose/efeitos dos fármacos , Apoptose/genética , Ciclosporina/farmacologia , Miocárdio/citologia , Neuropeptídeos/farmacologia , Animais , Proteínas Reguladoras de Apoptose/metabolismo , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Ciclosporina/antagonistas & inibidores , Relação Dose-Resposta a Droga , Regulação para Baixo , Expressão Gênica/efeitos dos fármacos , Marcação In Situ das Extremidades Cortadas , Masculino , Miocárdio/metabolismo , Ratos
5.
Clin Transplant ; 28(2): 177-83, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24372696

RESUMO

BACKGROUND: Previously, we have reported that flow cytometry analysis of fine-needle aspirates can accurately predict rejection in kidney transplants treated with cyclosporine-azathioprine-prednisolone. In this study, we examined this technique's accuracy using current immunosuppression. METHODS: Kidney transplant recipients were treated with calcineurin inhibitors, mycophenolate mofetil, and prednisolone: 92 remained rejection-free - Group I - and 37 developed acute rejection - Group II. An allograft aspiration specimen and peripheral blood were collected from Group I on post-transplant day 7 and from Group II on the day of clinical rejection. RESULTS: Significant changes were seen in both aspiration and peripheral blood samples in several T cell subsets when comparing Groups I and II. A sensitivity of 94.6%, specificity of 85%, and AUC = 0.966 were observed through combining CD8DR with CD3CD69 values from aspiration specimen; the corresponding AUC in peripheral blood was 0.847. Irreversible rejections displayed a significantly higher activation score (p = 0.024). CONCLUSIONS: Flow cytometry analysis of aspiration specimen achieved high diagnostic performance in renal transplants through studying CD8DR and CD3CD69 under current immunosuppressive therapy. Peripheral blood analysis, although not significant, showed the same trend. The activation score anticipated the irreversibility of rejection. The data suggest this test, through an easily tolerated technique, merits further diagnostic use.


Assuntos
Citometria de Fluxo/métodos , Rejeição de Enxerto/diagnóstico , Imunossupressores/farmacologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Linfócitos/patologia , Adulto , Idoso , Biópsia por Agulha , Ciclosporina/antagonistas & inibidores , Feminino , Seguimentos , Taxa de Filtração Glomerular , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/etiologia , Humanos , Imunossupressores/uso terapêutico , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Subpopulações de Linfócitos T/imunologia , Adulto Jovem
6.
Cancer Lett ; 338(2): 292-9, 2013 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-23752066

RESUMO

Although calcineurin inhibitors (CNIs) are very useful in preventing allograft rejection, they can mediate a rapid progression of post-transplantation malignancies. The CNI cyclosporine A (CsA) can promote renal tumor growth through activation of the proto-oncogene ras and over-expression of the angiogenic cytokine VEGF; the ras activation also induces over-expression of the cytoprotective enzyme HO-1, which promotes survival of renal cancer cells. Here, we show that the natural product honokiol significantly inhibited CsA-induced and Ras-mediated survival of renal cancer cells through the down-regulations of VEGF and HO-1. Thus, honokiol treatment may help to prevent tumor-promoting effects of CsA in transplant patients.


Assuntos
Compostos de Bifenilo/farmacologia , Inibidores de Calcineurina , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Lignanas/farmacologia , Proteínas ras/metabolismo , Apoptose/efeitos dos fármacos , Calcineurina/genética , Calcineurina/metabolismo , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Ciclosporina/antagonistas & inibidores , Ciclosporina/farmacologia , Regulação para Baixo/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Genes ras , Heme Oxigenase-1/biossíntese , Humanos , Neoplasias Renais/genética , Neoplasias Renais/metabolismo , Fosforilação/efeitos dos fármacos , Proto-Oncogene Mas , Transdução de Sinais/efeitos dos fármacos , Ativação Transcricional/efeitos dos fármacos , Transfecção , Fator A de Crescimento do Endotélio Vascular/biossíntese , Fator A de Crescimento do Endotélio Vascular/genética , Fator A de Crescimento do Endotélio Vascular/metabolismo , Quinases raf/genética , Quinases raf/metabolismo , Proteínas ras/genética
7.
Am J Physiol Renal Physiol ; 305(3): F304-13, 2013 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-23720343

RESUMO

We used mouse cortical collecting duct principal cells (mpkCCDc14 cell line) as a model to determine whether statins reduce the harmful effects of cyclosporine A (CsA) on the distal nephron. The data showed that treatment of cells with CsA increased transepithelial resistance and that the effect of CsA was abolished by lovastatin. Scanning ion conductance microscopy showed that CsA significantly increased the height of cellular protrusions near tight junctions. In contrast, lovastatin eliminated the protrusions and even caused a modest depression between cells. Western blot analysis and confocal microscopy showed that lovastatin also abolished CsA-induced elevation of both zonula occludens-1 and cholesterol in tight junctions. In contrast, a high concentration of CsA induced apoptosis, which was also attenuated by lovastatin, elevated intracellular ROS via activation of NADPH oxidase, and increased the expression of p47phox. Sustained treatment of cells with lovastatin also induced significant apoptosis, which was attenuated by CsA, but did not elevate intracellular ROS. These results indicate that both CsA and lovastatin are harmful to principal cells of the distal tubule, but via ROS-dependent and ROS-independent apoptotic pathways, respectively, and that they counteract probably via mobilization of cellular cholesterol levels.


Assuntos
Apoptose/efeitos dos fármacos , Ciclosporina/antagonistas & inibidores , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Imunossupressores/antagonistas & inibidores , Túbulos Renais Coletores/citologia , Túbulos Renais Coletores/efeitos dos fármacos , Lovastatina/farmacologia , Junções Íntimas/efeitos dos fármacos , Análise de Variância , Animais , Western Blotting , Células Cultivadas , Colesterol/biossíntese , Corantes , Ciclosporina/farmacologia , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/ultraestrutura , Imunossupressores/farmacologia , Túbulos Renais Coletores/ultraestrutura , Camundongos , Microscopia Confocal , Microscopia Eletrônica de Varredura , NADPH Oxidases/metabolismo , Permeabilidade , Espécies Reativas de Oxigênio/metabolismo , Junções Íntimas/metabolismo , Junções Íntimas/ultraestrutura , Proteína da Zônula de Oclusão-1/biossíntese
8.
Toxicol Lett ; 218(1): 30-8, 2013 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-23347876

RESUMO

Cyclosporine A (CsA) nephrotoxicity has been linked to reactive oxygen species (ROS) production in renal cells. We have demonstrated that the antioxidant Vitamin E (Vit E) abolished renal toxicity in vivo and in vitro models. As one of the main sources of intracellular ROS are mitochondria, we studied the effects of CsA on several mitochondrial functions in LLC-PK1 cells. CsA induced ROS synthesis and decreased reduced glutathione (GSH). The drug decreased mitochondrial membrane potential (ΔΨm) and induced physiological modifications in both the inner (IMM) and the outer mitochondrial membranes (OMM). In the IMM, CsA provoked mitochondrial permeability transition pores (MPTP) and cytochrome c was liberated into the intermembrane space. CsA also induced pore formation in the OMM, allowing that intermembrane space contents can reach cytosol. Furthermore, CsA altered the mitochondrial dynamics, inducing an increase in mitochondrial fission; CsA increased the expression of dynamin related protein 1 (Drp1) that contributes to mitochondrial fission, and decreased the expression of mitofusin 2 (Mfn2) and optic atrophy protein 1 (Opa1), proteins involved in the fusion process. All these phenomena were related to apoptosis. These effects were inhibited when cells were treated with the antioxidant Vit E suggesting that they were mediated by the synthesis of ROS.


Assuntos
Apoptose/efeitos dos fármacos , Ciclosporina/toxicidade , Túbulos Renais/efeitos dos fármacos , Mitocôndrias/efeitos dos fármacos , Dinâmica Mitocondrial/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Animais , Antioxidantes/farmacologia , Ciclosporina/antagonistas & inibidores , Antagonismo de Drogas , Transferência Ressonante de Energia de Fluorescência , Glutationa/metabolismo , Túbulos Renais/metabolismo , Túbulos Renais/patologia , Células LLC-PK1 , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Proteínas de Membrana/antagonistas & inibidores , Proteínas de Membrana/metabolismo , Mitocôndrias/metabolismo , Dinâmica Mitocondrial/fisiologia , Proteínas de Transporte da Membrana Mitocondrial/efeitos dos fármacos , Membranas Mitocondriais/efeitos dos fármacos , Membranas Mitocondriais/metabolismo , Poro de Transição de Permeabilidade Mitocondrial , Proteínas Mitocondriais/antagonistas & inibidores , Proteínas Mitocondriais/metabolismo , Permeabilidade/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Suínos , Vitamina E/farmacologia
9.
J Pineal Res ; 48(3): 204-211, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20136702

RESUMO

Cyclosporine A (CsA) is a powerful immunosuppressive drug with side effects including the induction of chronic nephrotoxicity including endoplasmic reticulum (ER) stress in tubular cells. Recently, it was reported that autophagy is induced by ER stress and serves to alleviate the associated deleterious effects. In the current study, CsA treatment (0-100 microm) decreased cell survival of rat pituitary GH3 cells in a dose-dependent manner. At concentrations ranging from 1.0 to 10 microm, CsA induced a dose-dependent increase in the expression of microtubule-associated protein 1 light chain 3 (LC3)-I and LC3-II. Cells treated with 2.5 microm CsA exhibited cytoplasmic vacuolation, indicating that CsA induces autophagy in rat pituitary GH3 cells. In the presence of 1.0-10 microm CsA, the expression of catalase decreased while that of the ER stress markers, ER luminal binding protein (BiP) and inositol-requiring enzyme 1 alpha (IRE1alpha), increased as compared those levels in untreated cells. These results suggested that CsA-induced autophagy is dependent on ER stress. To determine whether melatonin would protect cells against CsA-induced autophagy, we treated rat pituitary GH3 cells with melatonin in the presence of CsA. Melatonin treatment (100 and 200 microm) suppressed autophagy induced by 2.5 and 5 microm CsA. Furthermore, co-treatment with 100 microm melatonin inhibited LC3-II expression, and increased catalase and phosphorylated p-ERK levels in the presence of 2.5 and 5 microm CsA. BiP and IRE1alpha expression in melatonin-co-treated cells was superior to that in cells treated with 2.5 and 5 microm CsA alone. Thus, melatonin suppresses CsA-mediated autophagy in rat pituitary GH3 cells.


Assuntos
Autofagia/efeitos dos fármacos , Ciclosporina/antagonistas & inibidores , Melatonina/farmacologia , Hipófise/efeitos dos fármacos , Análise de Variância , Animais , Western Blotting , Catalase/metabolismo , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Ciclosporina/farmacologia , Interações Medicamentosas , Retículo Endoplasmático/metabolismo , Chaperona BiP do Retículo Endoplasmático , Endorribonucleases/metabolismo , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Proteínas de Choque Térmico/metabolismo , Proteínas Associadas aos Microtúbulos/metabolismo , Hipófise/citologia , Hipófise/metabolismo , Proteínas Serina-Treonina Quinases/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos , Estresse Fisiológico , Proteína X Associada a bcl-2/metabolismo
10.
Int Immunopharmacol ; 10(2): 177-82, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19883798

RESUMO

This study was conducted to investigate the possible protective effect of ellagic acid (EA) on cyclosporine A (CsA)-induced testicular and spermatozoal damages associated with oxidative stress in male rats. Forty adult male Sprague-Dawley rats were divided into 4 groups of 10 animals each. Control group was used as placebo. Cyclosporine group received CsA at the dose of 15 mg/kg/day. Ellagic acid group was treated with EA (10 mg/kg/day). Cyclosporine plus ellagic acid group received CsA+EA. Reproductive organs were weighed and epididymal sperm characteristics and histopathological structure of testes were examined along with malondialdehyde (MDA) and glutathione (GSH) levels, glutathione-peroxidase (GSH-Px) and catalase (CAT) activities in testicular tissue. CsA significantly decreased the weights of testes and ventral prostate, epididymal sperm concentration, motility, testicular tissue glutathione (GSH), glutathione-peroxidase (GSH-Px) and catalase (CAT), diameters of seminiferous tubules and germinal cell layer thickness, and it significantly increased malondialdehyde (MDA) level and abnormal sperm rates along with degeneration, necrosis, immature germ cells, congestion and atrophy in testicular tissue. However, the CsA plus EA treatment attenuated all the CsA-induced negative changes observed in the testicular tissue, sperm and oxidant/antioxidant parameters. In conclusion, CsA-induced oxidative stress leads to the structural and functional damages in the testicular tissue and sperm quality of rats, and also EA has a protective effect on these damages.


Assuntos
Ciclosporina/antagonistas & inibidores , Ácido Elágico/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Espermatozoides/efeitos dos fármacos , Testículo/efeitos dos fármacos , Animais , Catalase/efeitos dos fármacos , Ciclosporina/efeitos adversos , Epididimo/efeitos dos fármacos , Glutationa/efeitos dos fármacos , Glutationa Peroxidase/efeitos dos fármacos , Masculino , Malondialdeído/química , Próstata/efeitos dos fármacos , Próstata/enzimologia , Ratos , Ratos Sprague-Dawley , Túbulos Seminíferos/efeitos dos fármacos , Túbulos Seminíferos/enzimologia , Testículo/enzimologia
11.
Transpl Int ; 23(4): 407-16, 2010 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-19912591

RESUMO

Calcineurin inhibitors (cyclosporine and tacrolimus; CNIs) continue to be used as constituents of post-transplant immunosuppression in most centers. However, renal toxicity associated with the use of these drugs remains a problem adversely affecting the long-term graft survival. Fifteen adequate protocol renal allograft biopsies, with histological features of CNI toxicity among 140 protocol biopsies performed at 1-, 6-, and 12-month post-transplant, were included. Mitochondrial alterations in the tubular epithelial cells and endothelia of glomerular, peritubular capillaries and arterioles were graded semiquantitatively and further ultrastructural morphometric evaluation of numerical density and area of the mitochondria was performed. Immunohistochemical staining for nitrotyrosine (marker of peroxynitrite formation) and vascular endothelial growth factor (VEGF) was performed and expression graded semiquantitatively. Higher grades of alterations were seen in endothelial mitochondria as compared with tubular mitochondria in biopsies with calcineurin inhibitor toxicity (CNIT). Endothelial mitochondrial numerical density showed progressive decline over 1-, 6- and 12-month biopsies while area showed progressive increase in biopsies with CNIT as compared with controls. Upregulation of nitrotyrosine was seen even at 1-month post-transplant, persisted at 6 and 12 months, and was significantly greater than that in control biopsies. Intense VEGF expression was noted in early CNIT while progressive reduction was seen in 6- and 12-month protocol biopsies. This study shows a relatively high incidence of CNIT in protocol renal allograft biopsies, indicating that this might be an important mechanism of background damage to the allograft. Structural alterations in endothelial mitochondria are consistent findings in protocol biopsies with CNIT and this relatively specific mitochondrial damage may stem from the peroxynitrite-mediated damage associated with progressive loss of protective function of VEGF.


Assuntos
Inibidores de Calcineurina , Ciclosporina/antagonistas & inibidores , Endotélio Vascular/metabolismo , Transplante de Rim/métodos , Mitocôndrias/metabolismo , Mitocôndrias/ultraestrutura , Tacrolimo/antagonistas & inibidores , Tirosina/análogos & derivados , Fator A de Crescimento do Endotélio Vascular/metabolismo , Adulto , Biópsia , Ciclosporina/toxicidade , Feminino , Humanos , Imuno-Histoquímica/métodos , Masculino , Tacrolimo/toxicidade , Transplante Homólogo , Tirosina/química , Fator A de Crescimento do Endotélio Vascular/biossíntese
12.
Food Chem Toxicol ; 46(12): 3612-5, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18834914

RESUMO

Tomato products containing lycopene are believed to be associated with decreased risk of chronic diseases including cancer, and its effects are suggested to be due to antioxidant effect of lycopene. The aim of this research was to study the effects of tomato extract on acetaminophen (APAP), amiodarone (ADN) and cyclosporine A (CsA)-induced liver, lung and kidney toxicity, respectively. Previous studies have shown that free radical reactions may play important roles in toxicity of these drugs. Rats received a single dose of APAP (750mg/kg, i.p.) before treatment with tomato extract (5mg/kg, oral) for seven consecutive days, ADN (100mg/kg, i.p.) plus tomato extract (5mg/kg, oral) for 10 consecutive days, or CsA (250mg/kg, i.p.) plus tomato extract (5mg/kg, oral) for 14 consecutive days. At the end of each treatment, the animals were sacrificed and the related organ tissues were collected for biochemical and histopathological examinations. Simultaneous treatment of tomato extract ameliorated tissue damage, biochemical indices, and oxidative stress parameters against APAP-induced acute hepatotoxicity, but had less beneficial effects on ADN-induced lung toxicity and little effect against CsA-induced nephrotoxicity. Therefore, tomato products may be beneficial for the prevention and therapy of toxicity induced by ADN and APAP.


Assuntos
Analgésicos não Narcóticos/toxicidade , Estresse Oxidativo/efeitos dos fármacos , Solanum lycopersicum/química , Acetaminofen/antagonistas & inibidores , Acetaminofen/toxicidade , Amiodarona/antagonistas & inibidores , Amiodarona/toxicidade , Analgésicos não Narcóticos/antagonistas & inibidores , Animais , Antiarrítmicos/antagonistas & inibidores , Antiarrítmicos/toxicidade , Doença Hepática Induzida por Substâncias e Drogas/patologia , Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Ciclosporina/antagonistas & inibidores , Ciclosporina/toxicidade , Glutationa/metabolismo , Imunossupressores/antagonistas & inibidores , Imunossupressores/toxicidade , Nefropatias/induzido quimicamente , Nefropatias/patologia , Nefropatias/prevenção & controle , Peroxidação de Lipídeos/efeitos dos fármacos , Pneumopatias/induzido quimicamente , Pneumopatias/patologia , Pneumopatias/prevenção & controle , Masculino , Extratos Vegetais/farmacologia , Ratos , Ratos Sprague-Dawley
13.
Food Chem Toxicol ; 46(5): 1844-50, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18308444

RESUMO

The clinical use of an immunosuppressive cyclosporine A (CsA) is limited by its serious nephrotoxic effect. Evidences have suggested the role of oxidative stress in its pathogenesis. Shallot (Allium ascalonicum L.) has recently been shown to possess antioxidative and free radical scavenging abilities. The present study was undertaken to investigate the possible beneficial effect of shallot extract on renal injury caused by CsA. Male Wistar rats were treated orally with vehicle, CsA (25 mg/kg), shallot extract (1 g/kg), and CsA plus shallot extract for 21 days. Renal function, histopathology, tissue malondialdehyde (MDA) and glutathione (GSH) levels were evaluated 24 h after the last treatment. CsA-induced nephrotoxicity was evidenced by increased blood urea nitrogen and serum creatinine, but decreased urea and creatinine clearance. The kidney of CsA treated rats exhibited severe vacuolations and tubular necrosis. CsA also induced oxidative stress, as indicated by increased renal MDA and reduced GSH concentrations. Administration of shallot extract along with CsA counteracted the deleterious effects of CsA on renal dysfunction, oxidative stress markers, and morphological changes. These data indicate the protective potential of shallot extract against CsA nephrotoxicity and suggest a significant contribution of its antioxidant property to this beneficial effect.


Assuntos
Ciclosporina/antagonistas & inibidores , Ciclosporina/toxicidade , Imunossupressores/antagonistas & inibidores , Imunossupressores/toxicidade , Nefropatias/induzido quimicamente , Nefropatias/prevenção & controle , Cebolinha Branca/química , Animais , Peso Corporal/efeitos dos fármacos , Creatinina/sangue , Ingestão de Alimentos/efeitos dos fármacos , Glutationa/metabolismo , Rim/patologia , Nefropatias/patologia , Testes de Função Renal , Masculino , Malondialdeído/metabolismo , Extratos Vegetais/farmacologia , Ratos , Ratos Wistar , Sódio/urina , Urodinâmica/efeitos dos fármacos
14.
Kidney Int ; 73(1): 77-85, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17960138

RESUMO

The use of cyclosporine has been restricted by its nephrotoxic effects mediated, in part, by reactive oxygen species (ROS). Phosphoinositide 3-kinase, protein kinase B, and extracellular regulated kinase (ERK) pathways are related to survival and cell death and are activated after ROS generation. In this study, we evaluated the effects of cyclosporine on these pathways and their contribution to cyclosporine-induced toxicity. Viability of cells derived from the proximal tubule of transgenic mice was measured with Trypan Blue, ROS generation by a fluorescent probe, while ERK and phosphoinositide 3-kinase/protein kinase B activation were monitored with phospho-specific antibodies. Cyclosporine decreased cell viability and induced ROS generation and ERK and phosphoinositide 3-kinase activation. Both pathways were activated by the epidermal growth factor receptor (EGFR). Antioxidants blocked ERK activation but failed to inhibit protein kinase B phosphorylation or prevent cyclosporine toxicity. ERK inhibition did not protect from cyclosporine-induced cell death. EGFR or phosphoinositide 3-kinase inhibitors protected from cyclosporine-triggered cell death without decreasing ROS. Small interfering RNA against the catalytic subunit of phosphoinositide 3-kinase decreased protein kinase B phosphorylation but did not prevent cyclosporine-mediated cell death. Our results show that EGFR mediates the cytotoxic effects of cyclosporine through an ROS-independent mechanism. Cyclosporine-induced cell death is triggered by a non-classical phosphoinositide 3-kinase and does not require ERK activation.


Assuntos
Ciclosporina/antagonistas & inibidores , Citoproteção , Inibidores Enzimáticos/farmacologia , Túbulos Renais Proximais/efeitos dos fármacos , Inibidores de Fosfoinositídeo-3 Quinase , Animais , Antioxidantes/farmacologia , Apigenina/farmacologia , Apoptose , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Cromonas/farmacologia , Ciclosporina/toxicidade , Receptores ErbB/metabolismo , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Túbulos Renais Proximais/enzimologia , Camundongos , Camundongos Transgênicos , Morfolinas/farmacologia , Fosfatidilinositol 3-Quinases/genética , Fosfatidilinositol 3-Quinases/metabolismo , RNA Interferente Pequeno/farmacologia , Espécies Reativas de Oxigênio/metabolismo
15.
Calcif Tissue Int ; 81(2): 114-23, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17612778

RESUMO

Tacrolimus is used for transplant patients with refractory graft rejection and those with intolerance to cyclosporin (CsA), without the disfiguring adverse effects frequently attributed to CsA therapy. Since we have shown that CsA-associated bone loss can also affect alveolar bone, the purpose of this study was to evaluate the effects of conversion of monotherapy from CsA to tacrolimus on alveolar bone loss in rats. Groups of rats were treated with either CsA (10 mg/kg/day, s.c.), tacrolimus (1 mg/kg/day, s.c.), or drug vehicle for 60 and 120 days, and an additional group received CsA for 60 days followed by conversion to tacrolimus for a further 60-day period. Bone-specific alkaline phosphatase (BALP), tartrate-resistent acid phosphatase (TRAP-5b), calcium (Ca(2+)), interleukin (IL)-1beta, IL-6, and tumor necrosis factor alpha (TNF-alpha) concentrations were evaluated in the serum. Analyses of bone volume, bone surface, number of osteblasts, and osteoclasts were performed. Treatment with CsA for either 60 or 120 days was associated with bone resorption, represented by lower bone volume and increased number of osteoclasts; serum BALP, TRAP-5b, IL-1beta, IL-6, and TNF-alpha were also higher in these animals. After conversion from CsA to tacrolimus, all the altered serum markers returned to control values in addition to a significant increase of bone volume and a lower number of osteoclasts. This study shows that conversion from CsA to tacrolimus therapy leads to a reversal of the CsA-induced bone loss, which can probably be mediated by downregulation of IL-1beta, IL-6, and TNF-alpha production.


Assuntos
Perda do Osso Alveolar/induzido quimicamente , Perda do Osso Alveolar/tratamento farmacológico , Conservadores da Densidade Óssea/uso terapêutico , Osso e Ossos/efeitos dos fármacos , Ciclosporina/efeitos adversos , Tacrolimo/uso terapêutico , Fosfatase Ácida/sangue , Fosfatase Ácida/efeitos dos fármacos , Fosfatase Alcalina/sangue , Fosfatase Alcalina/efeitos dos fármacos , Perda do Osso Alveolar/prevenção & controle , Animais , Densidade Óssea/efeitos dos fármacos , Densidade Óssea/fisiologia , Matriz Óssea/efeitos dos fármacos , Matriz Óssea/metabolismo , Osso e Ossos/patologia , Osso e Ossos/fisiopatologia , Cálcio/sangue , Contagem de Células , Proliferação de Células/efeitos dos fármacos , Ciclosporina/antagonistas & inibidores , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/efeitos adversos , Interleucinas/sangue , Isoenzimas/sangue , Isoenzimas/efeitos dos fármacos , Masculino , Osteoclastos/efeitos dos fármacos , Osteoclastos/metabolismo , Ratos , Ratos Wistar , Fosfatase Ácida Resistente a Tartarato
16.
Clin Exp Pharmacol Physiol ; 33(3): 189-96, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16487261

RESUMO

Cyclosporine A (CsA) is the first-line immunosuppressant used for the management of solid organ transplantation and autoimmune diseases. Nephrotoxicity is the major limitation of CsA use. Recent evidence suggests that reactive oxygen species (ROS) play an important role in mediating CsA-induced hypertension and nephrotoxicity. Taurine, the major intracellular free beta-amino acid, is known to be an endogenous anti-oxidant and membrane-stabilizing agent. The present study was designed to investigate the effects of taurine on CsA-induced oxidative stress, hypertension and renal dysfunction. 2. Animals were assigned into four groups of seven rats each as follows: (i) control group, receiving vehicle (olive oil; 1 mL/kg, s.c.); (ii) CsA group, given CsA (25 mg/kg per day, s.c.) for 21 days; (iii) taurine group, supplemented with taurine (1% in the drinking water); and (iv) taurine + CsA group, treated with taurine 3 days before and concurrently during CsA injections for 21 days. 3. Cyclosporine A administration elevated blood pressure, reduced serum nitric oxide (NO) levels and deteriorated renal function, as assessed by increased serum creatinine levels and proteinuria and reduced urine flow rate and creatinine clearance compared with vehicle-treated rats. Cyclosporine A induced oxidative stress, as indicated by increased renal tissue concentrations of thiobarbituric acid-reactive substances and reduced concentrations of renal glutathione, glutathione peroxidase and superoxide dismutase. Conversely, no change was noted in renal catalase activity. Moreover, the kidneys of CsA-treated rats showed interstitial inflammation and renal tubular atrophy. 4. Taurine markedly reduced elevated blood pressure, attenuated renal dysfunction and the reduction in serum NO levels and counteracted the deleterious effects of CsA on oxidative stress markers. Furthermore, taurine ameliorated CsA-induced morphological changes. 5. These data clearly indicate the protective potential of taurine against CsA-induced hypertension and nephrotoxicity and suggest a significant contribution of its anti-oxidant property to this beneficial effect.


Assuntos
Ciclosporina/antagonistas & inibidores , Ciclosporina/toxicidade , Hipertensão/tratamento farmacológico , Imunossupressores/antagonistas & inibidores , Imunossupressores/toxicidade , Nefropatias/induzido quimicamente , Nefropatias/tratamento farmacológico , Taurina/uso terapêutico , Animais , Pressão Sanguínea/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Catalase/metabolismo , Glutationa/metabolismo , Glutationa Peroxidase/metabolismo , Frequência Cardíaca/efeitos dos fármacos , Rim/patologia , Nefropatias/patologia , Testes de Função Renal , Masculino , Óxido Nítrico/sangue , Ratos , Ratos Wistar , Superóxido Dismutase/metabolismo , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo
17.
Am J Transplant ; 6(1): 41-9, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16433755

RESUMO

The aim of this study was to determine the effects of dietary antioxidant supplementation with alpha-tocopherol and alpha-lipoic acid on cyclosporine-induced alterations to erythrocyte and plasma redox balance, and cyclosporine-induced endothelial and smooth muscle dysfunction. Rats were randomly assigned to either control, antioxidant, cyclosporine or cyclosporine + antioxidant treatments. Cyclosporine A was administered for 10 days after an 8-week feeding period. Plasma was analyzed for alpha-tocopherol, total antioxidant capacity, malondialdehyde and creatinine. Erythrocytes were analyzed for glutathione, methemoglobin, superoxide dismutase, catalase, glutathione peroxidase, glucose-6-phosphate dehydrogenase, alpha-tocopherol and malondialdehye. Vascular endothelial and smooth muscle function was determined in vitro. Antioxidant supplementation resulted in significant increases in erythrocyte alpha-tocopherol concentration and glutathione peroxidase activity in both of the antioxidant-supplemented groups. Cyclosporine administration caused significant decreases in glutathione concentration, methemoglobin concentration and superoxide dismutase activity. Antioxidant supplementation attenuated the cyclosporine-induced decrease in superoxide dismutase activity. Cyclosporine therapy impaired both endothelium-independent and -dependent relaxation of the thoracic aorta, and this was attenuated by antioxidant supplementation. In summary, dietary supplementation with alpha-tocopherol and alpha-lipoic acid attenuated the cyclosporine-induced decrease in erythrocyte superoxide dismutase activity and attenuated cyclosporine-induced vascular dysfunction.


Assuntos
Antioxidantes/administração & dosagem , Ciclosporina/toxicidade , Eritrócitos/efeitos dos fármacos , Imunossupressores/toxicidade , Ácido Tióctico/administração & dosagem , Doenças Vasculares/induzido quimicamente , alfa-Tocoferol/administração & dosagem , Animais , Aorta Torácica/efeitos dos fármacos , Aorta Torácica/patologia , Creatinina/sangue , Ciclosporina/antagonistas & inibidores , Suplementos Nutricionais , Eritrócitos/química , Glutationa/sangue , Imunossupressores/antagonistas & inibidores , Masculino , Malondialdeído/sangue , Metemoglobina/análise , Ratos , Ratos Sprague-Dawley , Superóxidos/sangue , Ácido Tióctico/sangue , Doenças Vasculares/prevenção & controle , alfa-Tocoferol/sangue
18.
Toxicol Appl Pharmacol ; 205(1): 65-70, 2005 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-15885265

RESUMO

Morin is a flavonoid present in mulberry and herbs. We have reported that morin exerted anti-inflammatory activity on the activated macrophages. Cyclosporin (CsA) is a potent immunosuppressive agent with narrow therapeutic range, which is widely used for the treatments of autoimmune diseases and transplantation rejection. This study aimed to measure the effects of morin on the disposition of CsA in lymphoid and non-lymphoid tissues, and on the functions of immune cells in mice. CsA (Neoral, 10 mg/kg) was orally administered with and without a concomitant dose of morin (0, 50, 100, 200 mg/kg) to mice once daily for 2 weeks. CsA concentrations in blood, liver, kidney, and spleen were determined by a specific monoclonal fluorescence polarization immunoassay. The decreased levels of CsA in tissues were found well correlated to increased doses of morin. The coadministration of 200 mg/kg morin significantly decreased CsA in blood, liver, kidney, and spleen by 33%, 17%, 38%, and 45%, respectively. On the other hand, coadministration of morin decreased dramatically the nitric oxide production by the activated macrophages when compared to CsA treatment alone. Moreover, morin maintained the level of CsA-suppressed T helper 1 (Th1) type cytokine, although the CsA concentration in spleen was markedly reduced. In conclusion, morin coadministration profoundly reduced CsA concentration but did not significantly alter the CsA-suppressed Th1 immune response in mice.


Assuntos
Ciclosporina/antagonistas & inibidores , Ciclosporina/farmacologia , Flavonoides/farmacologia , Animais , Subpopulações de Linfócitos B/efeitos dos fármacos , Subpopulações de Linfócitos B/imunologia , Subpopulações de Linfócitos B/metabolismo , Linfócitos T CD8-Positivos/efeitos dos fármacos , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Células Cultivadas , Ciclosporina/sangue , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Interações Medicamentosas , Flavonoides/sangue , Interferon gama/antagonistas & inibidores , Interferon gama/metabolismo , Interferon gama/farmacologia , Interleucina-2/antagonistas & inibidores , Interleucina-2/biossíntese , Interleucina-2/imunologia , Interleucina-2/metabolismo , Intubação Gastrointestinal , Rim/química , Rim/efeitos dos fármacos , Rim/metabolismo , Lipopolissacarídeos/farmacologia , Fígado/química , Fígado/efeitos dos fármacos , Fígado/metabolismo , Macrófagos Peritoneais/química , Macrófagos Peritoneais/efeitos dos fármacos , Macrófagos Peritoneais/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Óxido Nítrico/antagonistas & inibidores , Óxido Nítrico/biossíntese , Baço/química , Baço/efeitos dos fármacos , Baço/patologia , Subpopulações de Linfócitos T/efeitos dos fármacos , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo , Células Th1/efeitos dos fármacos , Células Th1/imunologia , Células Th1/metabolismo , Células Th2/efeitos dos fármacos , Células Th2/imunologia , Células Th2/metabolismo
19.
J Biol Chem ; 279(53): 55531-9, 2004 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-15502157

RESUMO

Eph kinases are the largest family of receptor tyrosine kinases, and their ligands are ephrins (EFNs), which are also cell surface molecules. We have very limited knowledge about the expression and function of these kinases and their ligands in the immune system. In this study we investigated the effect of EFNB1 on mouse T-cells. EFNB1 and the Eph kinases it interacts with (collectively called EFNB1 receptors (EFNB1R)) were expressed on T-cells, B cells, and monocytes/macrophages. Some T-cells were double positive for EFNB1 and EFBB1R. Solid phase EFNB1 in the presence of suboptimal TCR ligation augmented T-cell responses in terms interferon-gamma secretion, proliferation, and cytotoxic T lymphocyte activity but not interleukin-2 production. After T-cell receptor (TCR) ligation, EFNB1R congregated to TCR caps, and then both of them translocated to raft caps. This provides a morphological basis for EFNB1R to enhance TCR signaling. Further downstream of the signaling pathway, EFNB1R stimulation led to increased LAT (linker for activation of T-cells) phosphorylation and p44/42 and p38 MAPK activation. Similar to CD28 costimulation, EFNB1R costimulation was insensitive to cyclosporin A inhibition. On the other hand, unlike the former, EFNB1R costimulation failed to activate Akt, which is essential in triggering interleukin-2 production. Our study suggests that EFNB1 is pivotal in T-cell-T-cell costimulation and in reducing T-cell response threshold to antigen stimulation.


Assuntos
Efrina-B1/fisiologia , Ativação Linfocitária , Linfócitos T/metabolismo , Animais , Antígenos/química , Antígenos CD28/biossíntese , Complexo CD3/biossíntese , Linfócitos T CD4-Positivos/metabolismo , Comunicação Celular , Proliferação de Células , Reagentes de Ligações Cruzadas/farmacologia , Ciclosporina/antagonistas & inibidores , Ciclosporina/metabolismo , Citocinas/metabolismo , DNA Complementar/metabolismo , Relação Dose-Resposta a Droga , Efrina-B1/metabolismo , Citometria de Fluxo , Immunoblotting , Hibridização In Situ , Interferon gama/metabolismo , Interleucina-2/metabolismo , Leucócitos/metabolismo , Linfocinas/metabolismo , Macrófagos/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Microscopia Confocal , Microscopia de Fluorescência , Monócitos/metabolismo , Fosforilação , Ligação Proteica , Estrutura Terciária de Proteína , Transporte Proteico , Receptores de Antígenos de Linfócitos T/metabolismo , Transdução de Sinais , Timidina/química , Fatores de Tempo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
20.
Toxicology ; 201(1-3): 239-45, 2004 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-15297037

RESUMO

We investigate the ability of S-adenosylmethionine (SAMe) to antagonize the cyclosporine A (CyA)-induced inhibition of biliary glutathione efflux induced by long-term administration of CyA (10 mg/kg per day-CyA10 or 20 mg/kg per day-CyA20 for 4 weeks) in rats. CyA treatment reduced the liver content of total glutathione and caused a significant increase in the oxidized-to-reduced glutathione ratio and the thiobarbituric acid-reactive substances (TBARS) concentration. When the rats were concurrently treated with SAMe (10 mg/kg twice daily) and CyA, all these parameters did not significantly differ from control values. Treatment with CyA induced a significant increase in liver GGT activity that was attenuated by coadministration of SAMe. Biliary efflux of total glutathione was significantly reduced in animals treated with CyA. These changes were abolished by SAMe administration. Following inhibition of the intrabiliary catabolism of the tripeptide by acivicin, glutathione efflux rates increased to a lesser extent in animals cotreated with SAMe when compared to those receiving only CyA. The significant decrease in biliary efflux of oxidized glutathione induced by CyA was totally (S + CyA10) or partially (S + CyA20) prevented by coadministration of SAMe. Our observations confirm that SAMe cotreatment in rats antagonizes CyA-induced inhibition in the biliary efflux of glutathione and suggest that protection against intrabiliary glutathione degradation plays a major role in this protective effect.


Assuntos
Ciclosporina/antagonistas & inibidores , Glutationa/metabolismo , Imunossupressores/antagonistas & inibidores , Fígado/efeitos dos fármacos , S-Adenosilmetionina/uso terapêutico , Animais , Ciclosporina/efeitos adversos , Imunossupressores/efeitos adversos , Fígado/enzimologia , Fígado/metabolismo , Masculino , Ratos , Ratos Wistar , gama-Glutamiltransferase/metabolismo
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