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1.
BMC Genomics ; 19(1): 525, 2018 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-29986648

RESUMO

BACKGROUND: Mycoplasma hominis is a human urogenital pathogen involved in gynaecological, neonatal and extra-genital infections. However, no versatile genetic tools are currently available to study the pathogenicity of this bacterium. Targeting-Induced Local Lesions IN Genomes (TILLING) is a reverse-genetic method that combines point mutations induced by chemical mutagenesis with a DNA screening technique. We used ethyl methanesulfonate (EMS) that introduces C-G to T-A transition mutations to generate a library of M. hominis mutants. As a proof of concept, mutagenized organisms were screened for mutations in two target genes previously associated with the mycoplasma pathogenicity, the vaa gene encoding an adhesin lipoprotein and the oppA gene encoding the main ectoATPase of the bacterium. The resulting mutants were evaluated using functional assays, an adhesion to HeLa cell assay for vaa-mutants and an ATPase activity test for oppA-mutants. RESULTS: A 1200-clone library was generated by exposing M. hominis PG21 to 9 mg/mL EMS for 3 h. To identify mutants of interest, targeted gene fragments were amplified, heat-denatured, slowly reannealed and digested with the mismatch-specific endonuclease ENDO1. If multiple alleles were present in the PCR amplicons, these alleles formed heteroduplexes during reannealing that were specifically cleaved by ENDO1 at mismatching positions. A total of four vaa-mutants and two oppA-mutants harbouring missense mutations were obtained and fully sequenced. Zero to eight additional mutations were identified in the genomes of each mutant. The vaa-mutants were tested for adhesion to immobilized HeLa cells but their adhesion was not significantly different from the adhesion of M. hominis PG21. One of the two oppA-mutants that were tested for ATPase activity presented a higher affinity for its ATP substrate than the parental strain. CONCLUSION: For the first time, we demonstrated that M. hominis gene-targeted mutants could be successfully obtained using this TILLING strategy. In the absence of robust genetic tools for studying M. hominis, the TILLING strategy that can target any gene of the genome could help to elucidate gene functions and to better understand the pathogenesis of this human pathogenic species.


Assuntos
Proteínas de Bactérias/genética , Proteínas de Transporte/genética , Marcação de Genes/métodos , Lipoproteínas/genética , Mycoplasma hominis/genética , Adenosina Trifosfatases/metabolismo , Adesinas Bacterianas/genética , Pareamento Incorreto de Bases , Metanossulfonato de Etila/farmacologia , Biblioteca Gênica , Células HeLa , Humanos , Mycoplasma hominis/fisiologia , Mutação Puntual/efeitos dos fármacos
2.
Molecules ; 23(5)2018 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-29695086

RESUMO

Cancer was initially considered a genetic disease. However, recent studies have revealed the connection between bacterial infections and growth of different types of cancer. The enteroinvasive strain of Mycoplasma hominis alters the normal behavior of host cells that may result in the growth of prostate cancer. The role of M. hominis in the growth and development of prostate cancer still remains unclear. The infection may regulate several factors that influence prostate cancer growth in susceptible individuals. The aim of this study was to predict M. hominis proteins targeted into the endoplasmic reticulum (ER) of the host cell, and their potential role in the induction of prostate cancer. From the whole proteome of M. hominis, 19 proteins were predicted to be targeted into the ER of host cells. The results of our study predict that several proteins of M. hominis may be targeted to the host cell ER, and possibly alter the normal pattern of protein folding. These predicted proteins can modify the normal function of the host cell. Thus, the intercellular infection of M. hominis in host cells may serve as a potential factor in prostate cancer etiology.


Assuntos
Retículo Endoplasmático/metabolismo , Interações Hospedeiro-Patógeno , Infecções por Mycoplasma/complicações , Mycoplasma hominis/fisiologia , Neoplasias da Próstata/etiologia , Neoplasias da Próstata/metabolismo , Proteínas de Bactérias/metabolismo , Transformação Celular Neoplásica , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Infecções por Mycoplasma/microbiologia , Neoplasias da Próstata/patologia , Ligação Proteica , Transporte Proteico , Proteoma , Proteômica/métodos , Biologia de Sistemas
3.
Transpl Infect Dis ; 19(3)2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28294481

RESUMO

We report the first case of Mycoplasma hominis periaortic abscess after heart-lung transplantation. The absence of sternal wound infection delayed the diagnosis, but the patient successfully recovered with debridement surgeries and long-term antibiotic therapy. Owing to the difficulty in detection and the intrinsic resistance to beta-lactams, M. hominis infections are prone to being misdiagnosed and undertreated. M. hominis should be suspected in cases where conventional microbiological identification and treatment approaches fail.


Assuntos
Abscesso/terapia , Antibacterianos/uso terapêutico , Cardiomiopatia Restritiva/cirurgia , Transplante de Coração-Pulmão/efeitos adversos , Hipertensão Pulmonar/cirurgia , Mycoplasma hominis/patogenicidade , Abscesso/diagnóstico por imagem , Abscesso/microbiologia , Adulto , Broncoscopia , Desbridamento/métodos , Dispneia/tratamento farmacológico , Dispneia/microbiologia , Glucocorticoides/uso terapêutico , Rejeição de Enxerto/diagnóstico por imagem , Rejeição de Enxerto/terapia , Humanos , Levofloxacino/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Minociclina/uso terapêutico , Mycoplasma hominis/isolamento & purificação , Mycoplasma hominis/fisiologia , Náusea/induzido quimicamente , Plasmaferese , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Esterno/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico , Tomografia Computadorizada por Raios X , Adulto Jovem , Resistência beta-Lactâmica , beta-Lactamases/farmacologia , beta-Lactamases/uso terapêutico
4.
Oncotarget ; 8(19): 30830-30843, 2017 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-27027344

RESUMO

Although the idea of bacteria causing different types of cancer has exploded about century ago, the potential mechanisms of carcinogenesis is still not well established. Many reports showed the involvement of M. hominis in the development of prostate cancer, however, mechanistic approach for growth and development of prostate cancer has been poorly understood. In the current study, we predicted M. hominis proteins targeting in the mitochondria and cytoplasm of host cells and their implication in prostate cancer. A total of 77 and 320 proteins from M. hominis proteome were predicted to target in the mitochondria and cytoplasm of host cells respectively. In particular, various targeted proteins may interfere with normal growth behaviour of host cells, thereby altering the decision of programmed cell death. Furthermore, we investigated possible mechanisms of the mitochondrial and cytoplasmic targeted proteins of M. hominis in etiology of prostate cancer by screening the whole proteome.


Assuntos
Proteínas de Bactérias/metabolismo , Interações Hospedeiro-Patógeno , Mitocôndrias/metabolismo , Infecções por Mycoplasma/complicações , Infecções por Mycoplasma/metabolismo , Mycoplasma hominis/fisiologia , Neoplasias da Próstata/etiologia , Neoplasias da Próstata/metabolismo , Transformação Celular Neoplásica , Biologia Computacional/métodos , Simulação por Computador , Citoplasma/metabolismo , Humanos , Masculino , Infecções por Mycoplasma/microbiologia , Neoplasias da Próstata/patologia , Ligação Proteica , Transporte Proteico
5.
PLoS Negl Trop Dis ; 10(8): e0004913, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27529696

RESUMO

Trichomonas vaginalis (Tv) is an extracellular protozoan parasite that causes the most common non-viral sexually transmitted infection: trichomoniasis. While acute symptoms in women may include vaginitis, infections are often asymptomatic, but can persist and are associated with medical complications including increased HIV susceptibility, infertility, pre-term labor, and higher incidence of cervical cancer. Heightened inflammation resulting from Tv infection could account for these complications. Effective cellular immune responses to Tv have not been characterized, and re-infection is common, suggesting a dysfunctional adaptive immune response. Using primary human leukocyte components, we have established an in vitro co-culture system to assess the interaction between Tv and the cells of the human immune system. We determined that in vitro, Tv is able to lyse T-cells and B-cells, showing a preference for B-cells. We also found that Tv lysis of lymphocytes was mediated by contact-dependent and soluble factors. Tv lysis of monocytes is far less efficient, and almost entirely contact-dependent. Interestingly, a common symbiont of Tv, Mycoplasma hominis, did not affect cytolytic activity of the parasite, but had a major impact on cytokine responses. M. hominis enabled more diverse inflammatory cytokine secretion in response to Tv and, of the cytokines tested, Tv strains cleared of M. hominis induced only IL-8 secretion from monocytes. The quality of the adaptive immune response to Tv is therefore likely influenced by Tv symbionts, commensals, and concomitant infections, and may be further complicated by direct parasite lysis of effector immune cells.


Assuntos
Membrana Celular/metabolismo , Citocinas/biossíntese , Leucócitos/imunologia , Leucócitos/patologia , Tricomoníase/parasitologia , Trichomonas vaginalis/imunologia , Trichomonas vaginalis/fisiologia , Linfócitos B/patologia , Técnicas de Cocultura , Citocinas/imunologia , Feminino , Humanos , Inflamação , Interleucina-8/metabolismo , Monócitos/imunologia , Monócitos/patologia , Mycoplasma hominis/fisiologia , Simbiose , Linfócitos T/patologia , Tricomoníase/transmissão , Trichomonas vaginalis/microbiologia
6.
Sex Transm Infect ; 89(6): 449-54, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23633668

RESUMO

OBJECTIVES: Trichomonas vaginalis is the causative agent of trichomoniasis, one of the most common sexually transmitted diseases worldwide. In recent years we have described the symbiotic relationship between T vaginalis and Mycoplasma hominis. How this biological association might affect the pathogenicity of one or both the microorganisms is still unknown. Since local inflammation is thought to play a central role in T vaginalis infection, we investigated the in vitro response of human macrophages to naturally mycoplasma-free T vaginalis, as compared to a mycoplasma-infected trichomonad isolate. METHODS: THP-1 cells were stimulated with two isogenic T vaginalis isolates, one naturally mycoplasma-free and one stably associated with M hominis, and secreted cytokines measured by ELISA. Nuclear factor κB (NFκB) involvement in THP-1 response to T vaginalis and M hominis was evaluated by means of a reporter system based on detection of alkaline phosphatase activity. RESULTS: We found that the presence of M hominis upregulates the expression of a panel of proinflammatory cytokines in a synergistic fashion. We also found that the upregulation of the proinflammatory response by THP-1 cells involves the transcription factor NFκB. CONCLUSIONS: These findings suggest that the presence of M hominis in T vaginalis isolates might play a key role in inflammation during trichomoniasis, thus affecting the severity of the disease. The synergistic upregulation of the macrophage proinflammatory response might also affect some important clinical conditions associated with T vaginalis infection, such as the increased risk of acquiring cervical cancer or HIV, which are thought to be affected by the inflammatory milieu during trichomoniasis.


Assuntos
Citocinas/metabolismo , Inflamação/imunologia , Inflamação/patologia , Monócitos/imunologia , Mycoplasma hominis/imunologia , Trichomonas vaginalis/imunologia , Trichomonas vaginalis/microbiologia , Fosfatase Alcalina/análise , Linhagem Celular , Técnicas de Cocultura , Meios de Cultura/química , Ensaio de Imunoadsorção Enzimática , Genes Reporter , Humanos , Monócitos/microbiologia , Monócitos/parasitologia , Mycoplasma hominis/patogenicidade , Mycoplasma hominis/fisiologia , NF-kappa B/metabolismo , Simbiose , Trichomonas vaginalis/patogenicidade , Trichomonas vaginalis/fisiologia
7.
BMC Microbiol ; 11: 185, 2011 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-21854595

RESUMO

BACKGROUND: In Mycoplasma hominis, a facultative human pathogen of the human genital tract, OppA, the substrate-binding domain of the oligopeptide permease, is a multifunctional protein involved in nutrition uptake, cytoadhesion and hydrolysis of extracellular ATP. RESULTS: To map the function-related protein regions the ATPase activity and adhesive behavior of OppA mutants were analyzed. Mutations of the Walker BA motifs resulted in an inhibition of up to 8% of the OppA ATPase activity, whereas deletion of the N-terminal CS1 or the CS2 region, structural motifs that are conserved in bacterial OppA proteins, reduced ATPase activity to 60% and deletion of CS3, the third conserved region adjacent to the Walker B motif led to a reduction to 42% ATPase activity. Interestingly, adhesion of the OppA mutants to immobilized HeLa cells demonstrated that two distal regions are mainly involved in adherence of OppA: the CS1 region, deletion of which led to 35% of the cytoadhesion, and the Walker BA with the adjacent upstream region CS3, deletion of which led to 25% of the cytoadhesion. The influence of the ATPase activity on the adherence of M. hominis to HeLa cells was confirmed by the use of ATPase inhibitors which reduced mycoplasmal cytoadhesion to 50%. CONCLUSIONS: These findings suggest that the OppA-mediated cytoadherence of Mycoplasma hominis depends on both, the topology of the neighbouring CS1 and ATPase domain regions and the functionality of the ecto-ATPase activity in addition.


Assuntos
Adenosina Trifosfatases/metabolismo , Aderência Bacteriana , Proteínas de Bactérias/metabolismo , Proteínas de Transporte/metabolismo , Lipoproteínas/metabolismo , Infecções por Mycoplasma/microbiologia , Mycoplasma hominis/fisiologia , Adenosina Trifosfatases/química , Adenosina Trifosfatases/genética , Proteínas de Bactérias/química , Proteínas de Bactérias/genética , Proteínas de Transporte/química , Proteínas de Transporte/genética , Células HeLa , Humanos , Lipoproteínas/química , Lipoproteínas/genética , Mycoplasma hominis/química , Mycoplasma hominis/enzimologia , Mycoplasma hominis/genética , Estrutura Terciária de Proteína
9.
Oncotarget ; 2(4): 289-97, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21471611

RESUMO

The origin of chronic inflammation preceding the development of prostate cancer (PCa) remains unknown. We investigated possible involvement of mycoplasma infection in PCa by screening prostate biopsies from two groups of Russian men undergoing PCa diagnosis. M. hominis was detected by standard PCR in 15% of the 125 patients in the first group and by quantitative real-time PCR in 37.4% of the 123 men in the second group. In both groups, stratification of patients according to diagnosis showed that M. hominis was present at three times higher frequency in patients with PCa than in those with benign prostatic hyperplasia. No M. hominis was detected in the prostates of 27 men without detectable prostate disease. In addition, PCa-positive men had higher titers of antibodies against M. hominis and average PSA levels were higher in M. hominis-positive men. These data, together with previous observations linking mycoplasma infection with cell transformation, genomic instability and resistance to apoptosis, suggest that M. hominis infection may be involved in PCa development and may, therefore, be a potential PCa marker and/or target for improved prevention and treatment of this disease.


Assuntos
Carcinoma/etiologia , Infecções por Mycoplasma/complicações , Mycoplasma hominis/fisiologia , Neoplasias da Próstata/etiologia , Idoso , Idoso de 80 Anos ou mais , Anticorpos/sangue , Anticorpos/isolamento & purificação , Biópsia , Carcinoma/epidemiologia , Carcinoma/microbiologia , Carcinoma/patologia , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycoplasma/epidemiologia , Infecções por Mycoplasma/microbiologia , Infecções por Mycoplasma/patologia , Mycoplasma hominis/imunologia , Mycoplasma hominis/isolamento & purificação , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/patologia , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/microbiologia , Neoplasias da Próstata/patologia , Federação Russa/epidemiologia
11.
Am J Reprod Immunol ; 65(6): 549-56, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21214658

RESUMO

PROBLEM: We compared the frequency of intra-amniotic infection in preterm labor (PL) with women not in labor, and correlated infection with amniotic fluid (AF) cytokines. Detailed identification of species, especially mycoplasmata, was tried to improve our understanding of the pathogenesis of PL. METHOD OF STUDY: AF from 20 women with PL and 20 controls were evaluated. Infection was detected by PCR for Mycoplasma hominis, Ureaplasma urealyticum and 16S rRNA bacterial gene, which was cloned and sequenced for bacterial identification. Interleukin (IL)-1ß, IL-6, IL-8 and tumor necrosis factor (TNF)-α levels were measured by ELISA. RESULTS: Frequency of intra-amniotic infection is higher in PL (40.0%). Sequencing-based method identified Bacteroides fragilis, Prevotella bivia and Leptotrichia amnionii, in addition to Mycoplasma species detected by PCR. AF infection correlated with increased IL-1ß and IL-6 levels. CONCLUSION: The frequency of intra-amniotic infection, especially M. hominis, in PL women who delivered with 7 days, is high and correlates with high IL-1ß and IL-6 levels, but not IL-8.


Assuntos
Líquido Amniótico/metabolismo , Bactérias Anaeróbias Gram-Negativas/fisiologia , Infecções por Bactérias Gram-Negativas/imunologia , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Infecções por Mycoplasma/imunologia , Mycoplasma hominis/fisiologia , Trabalho de Parto Prematuro/imunologia , Infecções por Ureaplasma/imunologia , Ureaplasma urealyticum/fisiologia , Líquido Amniótico/imunologia , Líquido Amniótico/microbiologia , Feminino , Bactérias Anaeróbias Gram-Negativas/patogenicidade , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Interleucina-1beta/genética , Interleucina-1beta/imunologia , Interleucina-6/genética , Interleucina-6/imunologia , Interleucina-8/genética , Interleucina-8/imunologia , Interleucina-8/metabolismo , Infecções por Mycoplasma/epidemiologia , Mycoplasma hominis/patogenicidade , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/microbiologia , Gravidez , Prevalência , RNA Ribossômico 16S/análise , Análise de Sequência de RNA , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/imunologia , Fator de Necrose Tumoral alfa/metabolismo , Infecções por Ureaplasma/epidemiologia , Ureaplasma urealyticum/patogenicidade
12.
J Investig Med ; 48(6): 457-64, 2000 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11094869

RESUMO

BACKGROUND: Very small preterm infants who have genital mycoplasmas isolated from the trachea are at increased risk to develop bronchopulmonary dysplasia (BPD). The early stages of BPD are characterized by inflammation. Recruitment and activation of mononuclear cells in response to mycoplasmas may be important in the early stage of the disease. Lung epithelial cell production of monocyte chemoattractant protein-1 (MCP-1), a protein that attracts and activates mononuclear cells, could be critical in the regulation of mononuclear cell migration to the lung. METHODS: We examined the potential of Mycoplasma hominis (Mh) to induce MCP-1 gene expression and protein production in A549 cells, a pulmonary epithelial cell line with characteristics of type II cells. RESULTS: Live or heat-inactivated Mh induces MCP-1 mRNA and protein in a dose- and time-dependent manner. Stimulation of MCP-1 by Mh was not inhibited by 50 micrograms/mL of polymyxin B, interleukin (IL)-1ra, or neutralizing antibodies to IL-1 alpha, IL-1 beta, or tumor necrosis factor alpha (TNF-alpha). IL-1 alpha, IL-1 beta, and TNF-alpha were not detected in conditioned media of Mh-stimulated A549 cells. CONCLUSIONS: These data suggest that Mh may participate in the inflammatory component of BPD by directly inducing epithelial cell production of cytokines that recruit and activate mononuclear cells.


Assuntos
Quimiocina CCL2/genética , Pulmão/metabolismo , Mycoplasma hominis/fisiologia , Displasia Broncopulmonar/etiologia , Células Cultivadas , Células Epiteliais/metabolismo , Humanos , Recém-Nascido , RNA Mensageiro/análise
13.
FEMS Immunol Med Microbiol ; 27(1): 43-50, 2000 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10617789

RESUMO

To better understand how infections by mycoplasmas affect gene expression in human cells, we quantitatively measured the transcripts of 38 cytokine genes in HPV E6- and E7-immortalized cervical and prostatic epithelial cells before and after infection by four human urogenital mycoplasmas, M. fermentans, M. genitalium, M. hominis and M. penetrans. Using the multi-probe RNase protection assay (RPA), 22 and 23 cytokine gene transcripts were detected in the non-infected control prostatic and cervical epithelial cells, respectively. Although there were no discernible changes in cell morphology and growth kinetics following 72 h of mycoplasmal infection, 55-74% of the cytokine genes expressed in the two human epithelial cell lines were altered. Most changes reflected an increased expression of these cytokine genes, while expression of some cytokine genes significantly decreased. The effects varied with host cell type and species of infecting mycoplasmas. These alterations in gene expression were more profound in the cervical epithelial cells than in the prostatic cells. M. fermentans produced the most significant effects, followed by M. penetrans, M. genitalium and M. hominis. Some alterations in the gene expression were transient, but most persisted over the course of chronic (9 months) mycoplasmal infection. Prolonged gene expression changes induced by chronic mycoplasmal infection may gradually alter important biological properties in the infected mammalian cells and produce a unique form of disease process.


Assuntos
Colo do Útero/microbiologia , Citocinas/genética , Expressão Gênica , Mycoplasma/fisiologia , Próstata/microbiologia , Linhagem Celular Transformada , Transformação Celular Viral , Colo do Útero/citologia , Citocinas/metabolismo , Células Epiteliais/microbiologia , Feminino , Humanos , Cinética , Masculino , Mycoplasma fermentans/fisiologia , Mycoplasma hominis/fisiologia , Mycoplasma penetrans/fisiologia , Próstata/citologia
15.
Am J Obstet Gynecol ; 178(1 Pt 1): 50-3, 1998 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9465802

RESUMO

OBJECTIVE: Our goal was to evaluate the effect of Escherichia coli, Bacteroides fragilis, Mycoplasma hominis, and Staphylococcus aureus on cytokine and prostaglandin production by amnion cells in vitro. STUDY DESIGN: Amnion cells were obtained from women undergoing elective cesarean section before the onset of labor and cultured in a primary cell culture. Confluent amnion cells were incubated with heat-inactivated bacteria in different concentrations (10(1) to 10(6) colony-forming units/ml) for 48 hours. Samples for quantification of interleukin-1 beta, interleukin-6, interleukin-8, tumor necrosis factor-alpha, and prostaglandin E2 were collected at 6, 12, 24, and 48 hours. RESULTS: Under basal conditions, minor amounts of interleukin-6 and interleukin-8 were detectable. Incubation of amnion cells with E. coli enhanced the secretion of interleukin-8 and also induced an transient increase of prostaglandin E2 in a dose-dependent manner. B. fragilis produced an increase in the secretion of interleukin-6 and interleukin-8. M. hominis and S. aureus did not cause an increase in either interleukin-6, interleukin-8, or prostaglandin E2. CONCLUSION: The gram-negative bacteria E. coli and B. fragilis stimulated interleukin-6 and interleukin-8 to a greater degree than the other bacteria investigated in this study. This finding may be of clinical interest in the onset of preterm birth.


Assuntos
Âmnio/metabolismo , Bacteroides fragilis/fisiologia , Citocinas/biossíntese , Escherichia coli/fisiologia , Mycoplasma hominis/fisiologia , Prostaglandinas/biossíntese , Staphylococcus aureus/fisiologia , Âmnio/citologia , Âmnio/microbiologia , Contagem de Colônia Microbiana , Dinoprostona/metabolismo , Feminino , Humanos , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Gravidez , Fatores de Tempo
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