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1.
Int J Cancer ; 66(2): 209-13, 1996 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-8603813

RESUMO

Purification of cytokines was carried out while monitoring their in vivo anti-tumor activity and in vitro cytotoxic activities. As a result, purified new cytokines were obtained from culture supernatant of a histiocytic cell line from rabbit serum. Briefly, a new cytokine (HSF, histiocyte-secreted-factor) was purified from the culture of supernatant of the histiocytic cell line (TYH) which we established from the peripheral blood of a malignant-lymphoma patient. The purified samples exhibited suppressive effects on tumor growth but no necrotizing activity towards transplanted murine tumors. The substance displayed no cytotoxic activity against L cells (mouse fibroblast cells). The molecular weight of human HSF was about 42 kDa as estimated by SDS-PAGE. Amino-acid sequencing of the purified HSFD from the culture supernatant was performed, but the N-terminal was blocked. Next, a new cytokine was purified from rabbit serum stimulated with Propionibacterium acnes and elicited with lipopolysaccharide. The rabbit HSF was isolated by the same procedures as those used for the human HSF purification steps. Amino-acid sequencing was carried out after enzyme digestion. Three parts of the amino-acid sequence of the rabbit HSF were determined as LPPGLLAPMRQLRS-, NLEXFTNGMEQHYAQL-, NPAENQAHELPNQLN-. A computer-based homology search demonstrated that these sequences were novel. The molecular weight of HSF as determined using anti-peptide antibodies revealed the following values: human HSF, 41 and 46 kDa; rabbit HSF, 35, 42 and 55 kDa.


Assuntos
Antineoplásicos/isolamento & purificação , Citocinas/isolamento & purificação , Sequência de Aminoácidos , Animais , Antineoplásicos/química , Antineoplásicos/farmacologia , Citocinas/química , Citocinas/farmacologia , Humanos , Immunoblotting , Camundongos , Camundongos Endogâmicos BALB C , Dados de Sequência Molecular , Coelhos , Células Tumorais Cultivadas
2.
Cancer Biother ; 10(2): 131-8, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-7663572

RESUMO

The antitumor activity of combination therapy with traditional Chinese medicines and OK432 (Streptococcus pyogenes) for cancer patients was investigated. Excellent antitumor activity of this treatment was achieved in one patient with hepatocellular carcinoma. The present report describes the clinical course of this patient and examines the contribution of production of tumor necrosis factor (TNF) and interferon-gamma (IFN). Endogenous production of TNF could be observed after drip intravenous injection of OK 432 in the serum of patients treated by previous oral administration of traditional Chinese medicines. The serum levels of IFN were very low and remained at almost undetectable levels under these conditions. The selective use of immunostimulants such as traditional Chinese medicines may be of value in combination with other therapies such as drip infusion of OK 432, in the treatment of advanced cancer or of aged patients because of the low toxicity. One patient out of 12 revealed a partial response as assessed by the antitumor activity. However, with this treatment, patients did become free from pain and a good performance status was supported.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/imunologia , Medicamentos de Ervas Chinesas/administração & dosagem , Feminino , Humanos , Interferon gama/sangue , Interleucina-1/sangue , Neoplasias Hepáticas/imunologia , Contagem de Linfócitos , Masculino , Picibanil/administração & dosagem , Subpopulações de Linfócitos T , Fator de Necrose Tumoral alfa/metabolismo
3.
Mol Biother ; 4(1): 34-9, 1992 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-1627271

RESUMO

The antitumor activity of recombinant human tumor necrosis factor (rhTNF) against heterotransplanted human prostatic carcinoma (PC-3) and spontaneous lymphatic tumor metastasis was studied in vivo. The spontaneous lymphatic metastasis of PC-3 tumor was found in approximately 50% of cases. Significant antitumor activity was observed with repeated intratumoral administration of a large dose of rhTNF, not only on the subcutaneous tumor xenografts but also on the lymph node metastases. Strong antitumor activity could be achieved even with the intratumoral administration of a small dose of rhTNF in combination with mild hyperthermia on either the transplanted tumors or on the metastatic tumors.


Assuntos
Hipertermia Induzida , Neoplasias da Próstata/terapia , Fator de Necrose Tumoral alfa/uso terapêutico , Fosfatase Ácida/metabolismo , Animais , Terapia Combinada , Humanos , Metástase Linfática , Masculino , Camundongos , Camundongos Nus , Transplante de Neoplasias , Próstata/enzimologia , Neoplasias da Próstata/enzimologia , Neoplasias da Próstata/secundário , Proteínas Recombinantes/uso terapêutico , Transplante Heterólogo
5.
Biotherapy ; 2(3): 227-34, 1990.
Artigo em Inglês | MEDLINE | ID: mdl-2169830

RESUMO

The participation of tumor necrosis factor (TNF) and lipopolysaccharide (LPS) in Pseudomonas aeruginosa (Pa) infection was examined. The lethal challenge of Pa or TNF and LPS injection could be prevented by pretreatment with anti-TNF antibody, polymyxin B, ONO 1078, or Shosaiko-to. The combined effects of TNF and LPS may be deeply related to the lethality of Pa infection. The activities of leukotriene(LT) C4/D4/E4 or platelet activating factor (PAF) were also related to the lethality of Pa infection, probably due to the subsequently produced TNF which acts in combination with LPS. Activating the host defence mechanism with biological response modifiers like Chinese medicines was effective against Pa infection. One mechanism could involve an activity as an LT inhibitor or PAF antagonist. Following the administration of TNF and/or LPS, the serum levels of arachidonic cascade products underwent various changes. With a combination of TNF and LPS, there was a synergistic increment of prostaglandins, thromboxane, and LT. Following pretreatment with Shosaiko-to, suppression of LTs was dominant even with the combination of TNF and LPS, which might be related to the lethality of the infection or combined TNF with LPS.


Assuntos
Aminoglicosídeos , Protocolos de Quimioterapia Combinada Antineoplásica/toxicidade , Antagonistas de Leucotrienos , Fator de Ativação de Plaquetas/antagonistas & inibidores , Infecções por Pseudomonas/prevenção & controle , Animais , Antibacterianos/uso terapêutico , Anticorpos/uso terapêutico , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Ácido Araquidônico , Ácidos Araquidônicos/sangue , Cefamicinas/uso terapêutico , Cromonas/uso terapêutico , Sinergismo Farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Leucotrieno E4 , Lipopolissacarídeos/administração & dosagem , Lipopolissacarídeos/toxicidade , Camundongos , Camundongos Endogâmicos , Polimixina B/uso terapêutico , Infecções por Pseudomonas/sangue , Proteínas Recombinantes/toxicidade , SRS-A/análogos & derivados , SRS-A/antagonistas & inibidores , SRS-A/sangue , SRS-A/metabolismo , Fator de Necrose Tumoral alfa/administração & dosagem , Fator de Necrose Tumoral alfa/imunologia , Fator de Necrose Tumoral alfa/toxicidade
6.
J Biol Response Mod ; 8(5): 528-38, 1989 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-2677250

RESUMO

We have investigated the antitumor activity of tumor necrosis factor (TNF) against numerous. It appears that the efficacy of TNF against highly immunogenic tumor cell lines is greater than that against low immunogenic cell lines. Tumor cells express immunogenic tumor-associated antigen and sometimes shed antigens. Antibody against shedding antigens from Meth A sarcoma cells was prepared by immunizing rabbits seven times. This antibody by itself was not curative. However, in combination with TNF, the antibody was effective even against large and well-established tumors. When the antibody was injected 1 day after administration of TNF, the antitumor activity was stronger than in the case of simultaneous administration of TNF and antibody. We further examined the effect of this antibody against Ehrlich tumors in combination with TNF. The results were similar to those for Meth A sarcoma, although effects were weaker.


Assuntos
Anticorpos Antineoplásicos/uso terapêutico , Antígenos de Neoplasias/imunologia , Sarcoma Experimental/terapia , Fator de Necrose Tumoral alfa/uso terapêutico , Animais , Anticorpos Antineoplásicos/biossíntese , Antígenos de Neoplasias/administração & dosagem , Carcinoma de Ehrlich/terapia , Terapia Combinada , Imunização , Técnicas Imunoenzimáticas , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos , Proteínas Recombinantes/uso terapêutico
7.
Mol Biother ; 1(3): 155-62, 1989.
Artigo em Inglês | MEDLINE | ID: mdl-2604914

RESUMO

It was found that the capacity for tumor necrosis factor (TNF) production by Japanese modified traditional Chinese medicines and crude drugs broadly paralleled their antitumor activity. Pretreatment with these drugs prevented the lethal and marked side effects of recombinant human TNF (rhTNF) and lipopolysaccharide (LPS) without impairing their antitumor activity. These drugs are thought to decrease the oxygen radicals and stabilize the cell membranes, with a deep relation to the arachidonic cascade. The release of prostaglandins and leukotriene B4 was suppressed by pretreatment with Shosaiko-to. Thromboxane B2 was transiently increased, followed by suppression. After pretreatment with Hochu-ekki-to or Juzen-taiho-to, suppression of leukotriene B4 could not be observed. The release of prostaglandin D2 was suppressed in mice pretreated with Shosaiko-to, Juzentaiho-to or Ogon (Scutellariae Radix) but it increased following pretreatment with Hochu-ekki-to. Chemicals that could prevent the lethality of rhTNF and LPS also revealed suppression of prostaglandins, leukotriene B4 and thromboxane B2. In general, drugs that prevented the lethality of rhTNF and LPS without impairing the antitumor activity could inhibit the release of leukotriene B4 and/or prostaglandin D2. rhTNF could activate the arachidonic cascade in combination with LPS. The lethality of rhTNF and LPS could be prevented by pretreatment with Japanese modified traditional Chinese medicines and the crude drug, Ogon.


Assuntos
Antineoplásicos/uso terapêutico , Ácidos Araquidônicos/sangue , Medicamentos de Ervas Chinesas , Lipopolissacarídeos/uso terapêutico , Medicina Tradicional Chinesa , Fator de Necrose Tumoral alfa/uso terapêutico , Animais , Quimioterapia Combinada , Japão , Camundongos , Sarcoma/tratamento farmacológico , Sarcoma/prevenção & controle , Células Tumorais Cultivadas
11.
J Biol Response Mod ; 7(1): 77-90, 1988 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3131489

RESUMO

To examine the effects of combination therapy with traditional Chinese preparations (Syô-saiko-tô, Zyûzen-taiho-tô or Cinnamomum cortex) and OK432 or mitomycin C on the antitumor activities and TNF producibility, an investigation was carried out using mice transplanted with Ehrlich or Meth A tumor cells. Development of the transplanted tumors was strongly inhibited by the combination therapy, and the tumor necrosis factor (TNF) producibility was increased with the combination of a traditional Chinese preparation and OK432. A significant negative correlation was observed between the TNF activities and tumor weight, and there was a positive correlation between the TNF activities and spleen weight in the Ehrlich-bearing DDY mice receiving traditional Chinese preparations or OK432. Marked lymphocytosis, hyperplasia, and hypertrophy of Kupffer's cells in the liver were noted in the tumor-bearing DDY mice receiving traditional Chinese preparations or OK432. In two-step carcinogenesis experiments involving treatment with DMBA and TPA to induce skin papillomas, Zyûzen-taiho-tô appeared to be effective in inhibiting carcinogenesis. These results suggest that the antitumor activities and capacity for TNF production of the preparations are probably due in part to stimulation of the reticuloendothelial system, including macrophages, and induction of a host-mediated antitumor substance like TNF as one of the immunopotentiators.


Assuntos
Carcinoma de Ehrlich/terapia , Imunoterapia , Medicina Tradicional Chinesa , Plantas Medicinais/imunologia , Animais , Terapia Combinada , Fígado/anatomia & histologia , Camundongos , Camundongos Endogâmicos BALB C , Mitomicina , Mitomicinas/uso terapêutico , Tamanho do Órgão , Picibanil/uso terapêutico , Baço/anatomia & histologia , Fator de Necrose Tumoral alfa/sangue
12.
J Biol Response Mod ; 7(1): 54-64, 1988 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3373234

RESUMO

Toxicity has been observed in mice receiving recombinant human tumor necrosis factor (rhTNF). In the present experiments, several chemicals were used to determine whether they could prevent the lethality of rhTNF without impairing its antitumor activity. Injection of phospholipase A2, cyclooxygenase, and lipoxygenase inhibitors at the same time as rhTNF administration could prevent the lethality of rhTNF, but the antitumor activity was also reduced. Urinastatin and reduced glutathione could prevent the lethality while reducing the activity. In contrast, by pretreatment with O2 scavengers, the lethality of rhTNF was markedly reduced without impairment of the antitumor activity of rhTNF. Antihistamines exerted no influence on the lethality of rhTNF. Histopathologic examinations have demonstrated that the capillaries of the tumor tissue show aggregation of platelets and formation of fibrin adherent to the vascular surface after TNF administration. Heparin or protamine revealed no effects against the lethality of rhTNF. These results strongly suggest that the arachidonic cascade is deeply related to the antitumor activity of TNF and its side effects. Pretreatment with O2 scavengers, especially bismuth subnitrate, could prevent the lethality of rhTNF without impairing its antitumor activity.


Assuntos
Carcinoma de Ehrlich/tratamento farmacológico , Fator de Necrose Tumoral alfa/efeitos adversos , Animais , Sangue , Clorpromazina/farmacologia , Cortisona/farmacologia , Quimioterapia Combinada , Feminino , Glutationa/farmacologia , Camundongos , Camundongos Endogâmicos BALB C , Mortalidade , Recidiva Local de Neoplasia , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Fator de Necrose Tumoral alfa/uso terapêutico , Vitamina E/farmacologia
13.
J Biol Response Mod ; 6(4): 379-91, 1987 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-3625230

RESUMO

The antitumor activity of recombinant human tumor necrosis factor (rhTNF) against methylcholanthrene A-induced sarcoma (Meth A sarcoma) and human tumors in vivo was studied. On systemic administration of rhTNF to Meth A sarcoma-bearing mice, tumor regression was achieved with a large dose or with repeated administration of a small dose. Strong antitumor activity could be achieved in the Meth A sarcoma model by administration of a small dose of rhTNF in combination with moderate temperature hyperthermia (p less than 0.005). rhTNF (1,000 U/mouse) combined with moderate hyperthermia (40 degrees C for 40 min) within 2 h after the TNF administration effected 100% complete regression. In contrast, the rhTNF or moderate hyperthermia alone revealed 0% complete regression. The antitumor activity of rhTNF was decreased in combination with cyclophosphamide (0.6 or 1.2 mg/mouse) (p less than 0.005). However, in combination with mitomycin C (30 or 120 micrograms/mouse), the antitumor activity of rhTNF was enhanced (p less than 0.005). In combination with immunotherapy (lentinan or OK 432), the antitumor activity was mostly enhanced. Repeated rhTNF administration also displayed antitumor activity in heterotransplanted human tumors (p less than 0.005). The antitumor activity of TNF was enhanced by repeated administration of even small dosages, in combination with hyperthermia, or in combination with immunotherapy.


Assuntos
Glicoproteínas/uso terapêutico , Neoplasias Experimentais/terapia , Sarcoma Experimental/terapia , Animais , Antineoplásicos/administração & dosagem , Terapia Combinada , Temperatura Alta , Humanos , Imunoterapia , Transplante de Neoplasias , Proteínas Recombinantes/uso terapêutico , Fator de Necrose Tumoral alfa
14.
Ciba Found Symp ; 131: 140-53, 1987.
Artigo em Inglês | MEDLINE | ID: mdl-3450479

RESUMO

The antitumor activity of murine, rabbit and recombinant human tumour necrosis factor (TNF) was examined in an experimental animal model. TNF showed an excellent curative effect against the murine and human tumours tested. Strong antitumour activity was obtained by combining a small dose of TNF with moderate hyperthermia (40 degrees C for 40 min). TNF was also active against metastatic tumours, especially after repeated administration. The necrotizing action of TNF in vivo mainly relates to capillary injury. TNF causes necrosis not only in tumour tissue but also in granulation tissue. It causes morphological changes in, growth inhibition of, and cytotoxicity against cultured vascular endothelial cells. TNF inhibits endothelial motility evoked by the tumour. The mechanism of the cytotoxic action of TNF was examined using a microspectrophotometric assay for the lysosomotropic probe, acridine orange. The results suggest that TNF exerts its effect by enhancing endogenous tumour lysosomal activity. The increment in cellular respiration paralleled the susceptibility to TNF.


Assuntos
Citotoxicidade Imunológica , Necrose/etiologia , Neoplasias Experimentais/tratamento farmacológico , Fator de Necrose Tumoral alfa/farmacologia , Animais , Humanos , Hipertermia Induzida , Técnicas In Vitro , Camundongos , Camundongos Endogâmicos BALB C , Transplante de Neoplasias , Neoplasias Experimentais/patologia , Coelhos , Proteínas Recombinantes/farmacologia , Células Tumorais Cultivadas
15.
Artigo em Inglês | MEDLINE | ID: mdl-2884771

RESUMO

The effects of a highly purified tumor necrosis factor (TNF) on transplanted methylcholanthrene (Meth A)-induced murine tumors were compared with those of lipopolysaccharide (LPS). TNF caused immediate subepidermal edema and hyperemia followed 2 h later by fibrin thrombi in tumor blood vessels. Finally hemorrhagic necrosis with dispersal of tumor cells occurred. LPS produced similar hemorrhagic necrotizing changes. However, the necrotic action of LPS was delayed and complete tumor regression was not achieved with LPS. These findings suggest that tumor necrosis induced by TNF is due to circulatory disturbance associated with a microvascular injury in the tumor manifested by hyperemia and multiple fibrin thrombi.


Assuntos
Fibrossarcoma/tratamento farmacológico , Glicoproteínas/uso terapêutico , Animais , Fibrossarcoma/irrigação sanguínea , Fibrossarcoma/induzido quimicamente , Fibrossarcoma/patologia , Lipopolissacarídeos/uso terapêutico , Metilcolantreno , Camundongos , Camundongos Endogâmicos BALB C , Microcirculação , Microscopia Eletrônica , Necrose , Transplante de Neoplasias , Trombose/induzido quimicamente , Fator de Necrose Tumoral alfa
16.
J Natl Cancer Inst ; 78(1): 115-20, 1987 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-2432305

RESUMO

The effect of tumor necrosis factor (TNF) on the tumor-induced endothelial migration was evaluated with the use of a phagokinetic track assay. TNF from both ddy mice and Japanese albino rabbits (sp act, 3-5 X 10(5) U/mg, respectively) was found to inhibit the migration of bovine capillary endothelial (BCE) cells stimulated by factors from tumor cells, such as the medium conditioned with mouse sarcoma 180 cells or human meningioma extract. These TNF preparations, however, did not affect the spontaneous migration of the BCE cells. When mouse TNF was further fractionated by polyacrylamide gel electrophoresis, only TNF-positive fractions showed an inhibitory activity on the tumor-induced endothelial motility. Moreover, monoclonal antibody against rabbit TNF completely neutralized its migration-inhibitory activity. These findings indicate that the observed inhibitory effect of TNF preparations on the endothelial motility evoked by tumor is exclusively ascribed to the function of TNF. This activity presumably is involved in the suppression of tumor angiogenesis in vivo.


Assuntos
Quimiotaxia/efeitos dos fármacos , Endotélio/efeitos dos fármacos , Glicoproteínas/farmacologia , Meningioma/análise , Sarcoma 180/análise , Animais , Capilares/citologia , Bovinos , Células Cultivadas , Meios de Cultura/farmacologia , Depressão Química , Endotélio/fisiologia , Glicoproteínas/isolamento & purificação , Humanos , Camundongos , Camundongos Mutantes , Neovascularização Patológica , Coelhos , Fator de Necrose Tumoral alfa
17.
Artigo em Inglês | MEDLINE | ID: mdl-2891219

RESUMO

The action of tumor necrosis factor (TNF) was investigated histopathologically in mice using methylcholanthrene A (Meth A)-induced sarcomas and granulation tissue induced by autotransplantation of fragments of liver and spleen. Highly purified murine TNF caused hemorrhagic necrosis of both the tumors and the granulation tissue. Proliferation of tumor capillaries, demonstrated microangiographically, occurred 2 h after TNF administration and hyperemia of tumor vessels was obvious after 3-6 h. Hyperemia and capillary leakage were also observed in the granulation tissue 6 h after TNF injection and hemorrhage was noted in the epidermis after 12 h. These results strongly suggest that the in vivo necrotizing action of TNF is mainly related to capillary injury.


Assuntos
Tecido de Granulação/efeitos dos fármacos , Necrose/induzido quimicamente , Sarcoma Experimental/patologia , Fator de Necrose Tumoral alfa/farmacologia , Animais , Capilares/diagnóstico por imagem , Capilares/efeitos dos fármacos , Capilares/patologia , Tecido de Granulação/patologia , Lipopolissacarídeos/farmacologia , Metilcolantreno , Camundongos , Polimixina B/farmacologia , Radiografia , Sarcoma Experimental/induzido quimicamente
19.
Jpn J Exp Med ; 56(5): 195-9, 1986 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-3807015

RESUMO

Cytotoxic factor was produced from murine macrophage-like cell line, J774, after stimulation with 12-o-tetradecanoyl phorbol-13-acetate (TPA) and lipopolysaccharide (LPS). J774-derived cytotoxic factor is a glycoprotein with a molecular weight of 39,000 by gel filtration and 18,000 by SDS-PAGE, and with an isoelectric point of below 4.3. J774-derived cytotoxic factor exhibited cytotoxicity to L(S) cells, not cytotoxic to L(R) cells, and a necrotizing action against transplanted Meth A sarcoma. J774-derived cytotoxic factor and murine serum tumor necrosis factor (TNF) were identical as regards properties.


Assuntos
Glicoproteínas/biossíntese , Macrófagos/metabolismo , Animais , Linhagem Celular , Citotoxinas/biossíntese , Citotoxinas/isolamento & purificação , Glicoproteínas/isolamento & purificação , Lipopolissacarídeos/farmacologia , Macrófagos/efeitos dos fármacos , Camundongos , Peso Molecular , Acetato de Tetradecanoilforbol/farmacologia , Fator de Necrose Tumoral alfa
20.
Proc Natl Acad Sci U S A ; 83(11): 3949-53, 1986 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-3520561

RESUMO

Mouse tumor necrosis factor (TNF) was purified from serum through a series of steps, and each step was monitored for L-cell cytotoxicity in vitro and tumor-necrotizing activity in vivo. The two activities copurified and could not be dissociated. Purified mouse TNF has a specific activity of 2.2 X 10(7) (L-cell assay in the absence of actinomycin D) and 1 microgram causes necrosis of the standard TNF-sensitive sarcoma Meth A. TNF has a Mr of 39,000 +/- 2000 by gel filtration and a Mr of 16,000-18,000 by NaDodSO4/PAGE. Both molecular weight forms display cytotoxic and necrotizing activities. TNF has a pI of 3.9 and is destroyed by trypsin, protease, elastase, and alpha-chymotrypsin but not by neuraminidase or papain. These characteristics of nonrecombinant mouse TNF clearly resemble those of recombinant human and mouse TNF.


Assuntos
Glicoproteínas/isolamento & purificação , Animais , Cromatografia/métodos , Concanavalina A/metabolismo , Glicoproteínas/uso terapêutico , Temperatura Alta , Concentração de Íons de Hidrogênio , Ponto Isoelétrico , Camundongos , Camundongos Endogâmicos , Peso Molecular , Peptídeo Hidrolases/metabolismo , Sarcoma Experimental/tratamento farmacológico , Fator de Necrose Tumoral alfa
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