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Doctoral Thesis
DOI
10.11606/T.5.2010.tde-01022011-160118
Document
Author
Full name
Roberta Pereira de Almeida Manzano
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2010
Supervisor
Committee
Takahashi, Walter Yukihiko (President)
Aihara, Teruo
Betinjane, Alberto Jorge
Sibinelli, Maria Auxiliadora Monteiro Frazão
Ventura, Dora Selma Fix
Title in Portuguese
Estudo da toxicidade do adalimumabe (Humira®) intravítreo para a retina de coelhos
Keywords in Portuguese
Adalimumabe
Coelhos
Fator de necrose tumoral alfa
Injeções intraoculares
Retina
Toxicidade
Abstract in Portuguese
O adalimumabe (Humira®, Abbott) é um antagonista do Fator de Necrose Tumoral- alpha (TNF-alfa ). É aprovado para o tratamento de artrite reumatoide, espondilite anquilosante, doença de Crohn, psoríase crônica e artrite reumatoide juvenil. É um anticorpo monoclonal que contém apenas sequências humanas de peptídeos contra a molécula do Fator de Necrose Tumoral-alfa. Na literatura, relatos e série de casos sugerem que os antagonistas do Fator de Necrose Tumoral-alfa são úteis no tratamento da inflamação ocular, edema macular cistoide e secundário à uveíte e degeneração macular relacionada à idade. Entretanto, a administração sistêmica do adalimumabe pode gerar efeitos adversos graves. A fim de diminuir esses efeitos adversos e aumentar a concentração da medicação no segmento posterior do olho, uma possível opção é a injeção intravítrea. O objetivo do presente estudo foi avaliar a toxicidade do adalimumabe intravítreo nas diferentes doses para a retina de coelhos por meio de avaliação clínica (biomicroscopia e oftalmoscopia indireta), funcional (eletrorretinograma) e histopatológica (microscopia óptica e eletrônica). Foram utilizados 30 coelhos albinos da raça Nova Zelândia divididos em cinco grupos de seis coelhos. Injeções intravítreas foram realizadas nas seguintes concentrações de adalimumabe: 0,5mg/0,1ml, 1mg/0,1ml, 2,5mg/0,1ml, 5,0mg/0,1ml e 10mg/0,2ml e 0,1ml de solução salina balanceada (BSS) foi injetada nos olhos esquerdos dos grupos 1 e 2 para constituir o grupo controle. Foram realizadas biomicroscopia e fundoscopia e sinais de inflamação, infecção ou toxicidade foram observados durante duas semanas. O eletrorretinograma foi realizado antes do tratamento e após 14 dias da injeção intravítrea. Os animais foram sacrificados, foi feita a enucleação dos olhos, e o tecido para a avaliação histopatológica foi preparado. A injeção intravítrea de adalimumabe (Humira®) nas doses estudadas até 5mg (0,5mg, 1,0mg, 2,5mg, 5mg) não apresentou sinais clínicos, eletrorretinográficos e histopatológicos de toxicidade para a retina de coelhos a curto prazo. No grupo de 10mg, foram observados sinais inflamatórios leves em três dos seis olhos e houve diminuição da amplitude da onda a na resposta fotópica do ERG, não foram observadas alterações na microscopia óptica
Title in English
Testing intravitreal toxicity of adalimumab (Humira®) in the rabbit
Keywords in English
Adalimumab
Intraocular injection
Rabbits
Retina
Toxicity
Tumor necrosis factor-alpha
Abstract in English
Adalimumab is a fully human anti-TNF alpha monoclonal antibody consisting of 100% human sequences developed using phage display technology. It is currently FDA approved for the treatment of rheumatoid arthritis, ankylosing spondylitis, Crohns disease, moderate to severe chronic psoriasis, and juvenile idiopathic arthritis. Anti-TNF alpha drugs may be an effective therapy for cystoid macular edema associated with uveitis. Significant improvements in chronic diabetic macular edema and regression of CNV from AMD have also been documented in small published series after systemic treatment with TNF-alpha antagonists. However the systemic administration of these drugs can have serious side effects. Intravitreous injection would assure delivery of high concentrations of medication at the posterior segment with minimum side effects.The aim of this study was to evaluate the ocular toxicity of escalating doses of intravitreous adalimumab (Humira®) in the rabbit eye. Thirty New Zealand albino rabbits received intravitreous injections of 0.1ml of adalimumab 0.5 mg (6 eyes), 1mg (6 eyes), 2.5mg (6 eyes), 5mg (6 eyes) and 0.2ml was injected in the10mg (6 eyes) group. BSS (0,1ml) was injected in the left eye of the rabbits from the groups 1 and 2 to serve as control group. Slit lamp biomicroscopy, fundoscopy were carried out at baseline, day 7 and 14 following intravitreous injection while electroretinography (ERG) was carried out at baseline and day 14. Animals were euthanized on day 14 and histopathological examination of the eyes was performed. The tested doses of intravitreous adalimumab up to 5mg (0.5mg, 1.0mg, 2.5mg, 5mg) had no associated ocular short-term toxicity in rabbit eyes. The 10mg group showed mild inflammatory reaction in 3 out of 6 eyes and showed decrease in the a wave amplitude in the photopic response, light microscopy was normal
 
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Publishing Date
2011-02-02
 
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