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1.
Bioorg Med Chem Lett ; 27(16): 3666-3668, 2017 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-28709828

RESUMO

Given the need for further improvements in anti-cocaine vaccination strategies, a chimeric hapten (GNET) was developed that combines chemically-stable structural features from steady-state haptens with the hydrolytic functionality present in transition-state mimetic haptens. Additionally, as a further investigation into the generation of an improved bifunctional antibody pool, sequential vaccination with steady-state and transition-state mimetic haptens was undertaken. While GNET induced the formation of catalytically-active antibodies, it did not improve overall behavioral efficacy. In contrast, the resulting pool of antibodies from GNE/GNT co-administration demonstrated intermediate efficacy as compared to antibodies developed from either hapten alone. Overall, improved antibody catalytic efficiency appears necessary to achieve the synergistic benefits of combining cocaine hydrolysis with peripheral sequestration.


Assuntos
Anticorpos Catalíticos/imunologia , Cocaína/imunologia , Haptenos/imunologia , Animais , Anticorpos Catalíticos/sangue , Anticorpos Catalíticos/metabolismo , Catálise , Cocaína/química , Cocaína/farmacologia , Ensaio de Imunoadsorção Enzimática , Haptenos/química , Imunoglobulina G/sangue , Locomoção/efeitos dos fármacos , Radioimunoensaio , Vacinação
2.
Org Biomol Chem ; 15(14): 2979-2992, 2017 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-28294277

RESUMO

Carbohydrate antigens displaying Galα(1,3)Gal epitopes are recognized by naturally occurring antibodies in humans. These anti-Gal antibodies comprise up to 1% of serum IgG and have been viewed as detrimental as they are responsible for hyperacute organ rejections. In order to model this condition, α(1,3)galactosyltransferase-knockout mice are inoculated against the Galα(1,3)Gal epitope. In our study, two α-Gal trisaccharide epitopes composed of either Galα(1,3)Galß(1,4)GlcNAc or Galα(1,3)Galß(1,4)Glc linked to a squaric acid ester moiety were examined for their ability to elicit immune responses in KO mice. Both target epitopes were synthesized using a two-component enzymatic system using modified disaccharide substrates containing a linker moiety for coupling. While both glycoconjugate vaccines induced the required high anti-Gal IgG antibody titers, it was found that this response had exquisite specificity for the Galα(1,3)Galß(1,4)GlcNAc hapten used, with little cross reactivity with the Galα(1,3)Galß(1,4)Glc hapten. Our findings indicate that while homogenous glycoconjugate vaccines provide high IgG titers, the carrier and adjuvanting factors can deviate the specificity to an antigenic determinant outside the purview of interest.


Assuntos
Desenho de Fármacos , Epitopos/química , Epitopos/imunologia , Trissacarídeos/imunologia , Técnicas de Química Sintética , Haptenos/imunologia
3.
J Med Chem ; 59(6): 2523-9, 2016 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-26918428

RESUMO

Despite efforts to produce suitable smoking cessation aids, addiction to nicotine continues to carry a substantive risk of recidivism. An attractive alternative to current therapies is the pharmacokinetic strategy of antinicotine vaccination. A major hurdle in the development of the strategy has been to elicit a sufficiently high antibody concentration to curb nicotine distribution to the brain. Herein, we detail investigations into a new hapten design, which was able to elicit an antibody response of significantly higher specificity for nicotine. We also explore the use of a mutant flagellin carrier protein with adjuvanting properties. These studies underlie the feasibility of improvement in antinicotine vaccine formulations to move toward clinical efficacy.


Assuntos
Nicotina/análogos & derivados , Nicotina/imunologia , Vacinas/síntese química , Vacinas/farmacologia , Animais , Formação de Anticorpos/efeitos dos fármacos , Portadores de Fármacos , Flagelina/química , Haptenos , Hipotermia/induzido quimicamente , Hipotermia/prevenção & controle , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Nicotina/química , Medição da Dor/efeitos dos fármacos , Soroalbumina Bovina/química , Soroalbumina Bovina/imunologia , Abandono do Hábito de Fumar , Relação Estrutura-Atividade
4.
Bioorg Med Chem Lett ; 24(19): 4664-4666, 2014 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-25205191

RESUMO

Cocaine abuse remains prevalent worldwide and continues to be a major health concern; nonetheless, there is no effective therapy. Immunopharmacotherapy has emerged as a promising treatment strategy by which anti-cocaine antibodies bind to the drug blunting its effects. Previous passive immunization studies using our human monoclonal antibody, GNCgzk, resulted in protection against cocaine overdose and acute toxicity. To further realize the clinical potential of this antibody, a recombinant IgG form of the antibody has been produced in mammalian cells. This antibody displayed a high binding affinity for cocaine (low nanomolar) in line with the superior attributes of the GNCgzk antibody and reduced cocaine-induced ataxia in a cocaine overdose model.


Assuntos
Anticorpos Monoclonais/imunologia , Ataxia/tratamento farmacológico , Cocaína/imunologia , Animais , Ataxia/induzido quimicamente , Cocaína/antagonistas & inibidores , Modelos Animais de Doenças , Humanos , Imunoterapia , Camundongos , Conformação Molecular , Proteínas Recombinantes/imunologia
5.
Traffic ; 11(4): 533-47, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20028487

RESUMO

Neutrophils rely on exocytosis to mobilize receptors and adhesion molecules and to release microbicidal factors. This process should be strictly regulated because uncontrolled release of toxic proteins would be injurious to the host. In vivo studies showed that the small GTPase Rab27a regulates azurophilic granule exocytosis. Using mouse neutrophils deficient in Rab27a (Rab27a(ash/ash)), Rab27b [Rab27b knockout (KO)] or both [Rab27a/b double KO (DoKo)], we investigated the role of the Rab27 isoforms in neutrophils. We found that both Rab27a and Rab27b deficiencies impaired azurophilic granule exocytosis. Rab27a(ash/ash) neutrophils showed upregulation of Rab27b expression which did not compensate for the secretory defects observed in Rab27a-deficient cells, suggesting that Rab27 isoforms play independent roles in neutrophil exocytosis. Total internal reflection fluorescence microscopy analysis showed that Rab27a(ash/ash) and Rab27b KO neutrophils have a decreased number of azurophilic granules near the plasma membrane. The effect was exacerbated in Rab27a/b DoKo neutrophils. Rab27-deficient neutrophils showed impaired activation of the reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase at the plasma membrane although intraphagosomal reactive oxygen species (ROS) production was not affected. Exocytosis of secretory vesicles in Rab27-deficient neutrophils was functional, suggesting that Rab27 GTPases selectively control the exocytosis of neutrophil granules.


Assuntos
Exocitose , Neutrófilos/enzimologia , Proteínas rab de Ligação ao GTP/metabolismo , Animais , Camundongos , Camundongos Knockout , NADPH Oxidases/metabolismo , Vesículas Secretórias/metabolismo , Proteínas rab de Ligação ao GTP/genética , Proteínas rab27 de Ligação ao GTP
6.
Immunology ; 127(3): 386-97, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19019092

RESUMO

Lipopolysaccharide (LPS) stimulates exocytosis in neutrophils. The signalling molecules involved in the regulation of this mechanism are currently unknown. Using neutrophils from interleukin-1-receptor-associated kinase (IRAK)-4- and Toll/IL-1 receptor (TIR) domain-containing adaptor inducing IFN-beta (TRIF)-deficient mice, we dissected the signalling pathways that control exocytosis. We analysed exocytosis of peroxidase-negative and azurophilic granules by following the mobilization of the beta2-integrin subunit CD11b and myeloperoxidase (MPO)-containing granules, respectively. IRAK-4-null neutrophils showed marked defects in both peroxidase-negative and azurophilic granule exocytosis in response to LPS. In contrast, the exocytic response to LPS of TRIF-deficient neutrophils was not different from that of wild-type cells. No differences were observed in the exocytosis of secretory organelles between IRAK-4-null and wild-type neutrophils when they were stimulated with the phorbol ester phorbol 12-myristate 13-acetate (PMA). Electron microscopy analysis showed that no morphological abnormalities were present in the granules of IRAK-4-deficient neutrophils, suggesting that the lack of exocytic response to LPS is not attributable to developmental abnormalities. Using pharmacological inhibitors, we found that p38 mitogen-activated protein kinase (p38MAPK) is essential for the exocytosis of all neutrophil secretory organelles in response to LPS. Interestingly, we found that phosphatidylinositol 3-kinase (PI3K) is essential for azurophilic granule exocytosis but not for the mobilization of other neutrophil granules in response to LPS. Azurophilic granule exocytosis in response to Listeria monocytogenes was dependent on PI3K but not IRAK-4 activity, suggesting that alternative signalling pathways are activated in IRAK-4-deficient neutrophils exposed to whole bacteria. Our results identified IRAK-4, p38MAPK and PI3K as important regulatory components with different roles in the signalling pathways that control Toll-like receptor ligand-triggered neutrophil exocytosis.


Assuntos
Exocitose/imunologia , Quinases Associadas a Receptores de Interleucina-1/imunologia , Neutrófilos/imunologia , Fosfatidilinositol 3-Quinases/imunologia , Proteínas Adaptadoras de Transporte Vesicular/imunologia , Animais , Atividade Bactericida do Sangue/imunologia , Grânulos Citoplasmáticos/ultraestrutura , Escherichia coli/crescimento & desenvolvimento , Quinases Associadas a Receptores de Interleucina-1/deficiência , Lipopolissacarídeos/imunologia , Camundongos , Camundongos Knockout , Microscopia Eletrônica , Neutrófilos/ultraestrutura , Organelas/imunologia , Estresse Oxidativo/imunologia , Transdução de Sinais/imunologia , Staphylococcus aureus/crescimento & desenvolvimento , Proteínas Quinases p38 Ativadas por Mitógeno/imunologia
7.
J Innate Immun ; 1(6): 527-42, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20375609

RESUMO

Neutrophils kill bacteria on extracellular complexes of DNA fibers and bactericidal proteins known as neutrophil extracellular traps (NETs). The NET composition and the bactericidal mechanisms they use are not fully understood. Here, we show that treatment with deoxyribonuclease (DNase I) impairs a late oxidative response elicited by Gram-positive and Gram-negative bacteria and also by phorbol ester. Isoluminol-dependent chemiluminescence elicited by opsonized Listeria monocytogenes-stimulated neutrophils was inhibited by DNase I, and the DNase inhibitory effect was also evident when phagocytosis was blocked, suggesting that DNase inhibits an extracellular mechanism of reactive oxygen species (ROS) generation. The DNase inhibitory effect was independent of actin polymerization. Phagocytosis and cell viability were not impaired by DNase I. Immunofluorescence analysis shows that myeloperoxidase is present on NETs. Furthermore, granular proteins were detected in NETs from Rab27a-deficient neutrophils which have deficient exocytosis, suggesting that exocytosis and granular protein distribution on NETs proceed by independent mechanisms. NADPH oxidase subunits were also detected on NETs, and the detection of extracellular trap-associated NADPH oxidase subunits was abolished by treatment with DNase I and dependent on cell stimulation. In vitro analyses demonstrate that MPO and NADPH oxidase activity are not directly inhibited by DNase I, suggesting that its effect on ROS production depends on NET disassembly. Altogether, our data suggest that inhibition of ROS production by microorganism-derived DNase would contribute to their ability to evade killing.


Assuntos
Desoxirribonuclease I/metabolismo , Neutrófilos/imunologia , Espécies Reativas de Oxigênio/metabolismo , Desoxirribonuclease I/imunologia , Escherichia coli/imunologia , Imunofluorescência , Humanos , Listeria monocytogenes/imunologia , Medições Luminescentes , Microscopia Confocal , Microscopia Eletrônica de Transmissão , NADPH Oxidases/imunologia , NADPH Oxidases/metabolismo , Neutrófilos/metabolismo , Neutrófilos/ultraestrutura , Fagocitose/imunologia , Espécies Reativas de Oxigênio/imunologia
8.
Traffic ; 9(12): 2151-64, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18939952

RESUMO

Neutrophil granules contain secretory molecules that contribute to the implementation of all neutrophil functions. The molecular components that regulate the exocytosis of neutrophil granules have not been characterized. In this study, using small interfering RNA gene-targeting approaches and granulocytes from genetically modified mice, we characterized the Rab27a effectors JFC1/Slp1 and Munc13-4 as components of the exocytic machinery of granulocytes. Using total internal reflection fluorescence microscopy analysis, we show that Rab27a and JFC1 colocalize in predocked and docked vesicles in granulocytes. Next, we demonstrate that JFC1-downregulated granulocytes have impaired myeloperoxidase secretion. Using immunological interference, we confirm that JFC1 plays an important role in azurophilic granule exocytosis in human neutrophils. Interference with Rab27a but not with JFC1 impaired gelatinase B secretion in neutrophils, suggesting that a different Rab27a effector modulates this process. In similar studies, we confirmed that Munc13-4 regulates gelatinase secretion. Immunofluorescence analysis indicates that Munc13-4 localizes at secretory organelles in neutrophils. Using neutrophils from a Munc13-4-deficient mouse model (Jinx), we demonstrate that Munc13-4 plays a central role in the regulation of exocytosis of various sets of secretory organelles. However, mobilization of CD11b was not affected in Munc13-4-deficient neutrophils, indicating that secretory defects in these cells are limited to a selective group of exocytosable organelles.


Assuntos
Grânulos Citoplasmáticos/metabolismo , Exocitose , Proteínas de Membrana/metabolismo , Neutrófilos/metabolismo , Proteínas rab de Ligação ao GTP/metabolismo , Sequência de Bases , Células Cultivadas , Humanos , Metaloproteinase 9 da Matriz/metabolismo , Proteínas de Membrana/genética , Microscopia Eletrônica de Transmissão , Neutrófilos/ultraestrutura , Interferência de RNA , Proteínas de Transporte Vesicular , Proteínas rab27 de Ligação ao GTP
9.
Biochem J ; 403(3): 451-61, 2007 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-17217339

RESUMO

Exposure of neutrophils to LPS (lipopolysaccharide) triggers their oxidative response. However, the relationship between the signalling downstream of TLR4 (Toll-like receptor 4) after LPS stimulation and the activation of the oxidase remains elusive. Phosphorylation of the cytosolic factor p47phox is essential for activation of the NADPH oxidase. In the present study, we examined the hypothesis that IRAK-4 (interleukin-1 receptor-associated kinase-4), the main regulatory kinase downstream of TLR4 activation, regulates the NADPH oxidase through phosphorylation of p47phox. We show that p47phox is a substrate for IRAK-4. Unlike PKC (protein kinase C), IRAK-4 phosphorylates p47phox not only at serine residues, but also at threonine residues. Target residues were identified by tandem MS, revealing a novel threonine-rich regulatory domain. We also show that p47phox is phosphorylated in granulocytes in response to LPS stimulation. LPS-dependent phosphorylation of p47phox was enhanced by the inhibition of p38 MAPK (mitogen-activated protein kinase), confirming that the kinase operates upstream of p38 MAPK. IRAK-4-phosphorylated p47phox activated the NADPH oxidase in a cell-free system, and IRAK-4 overexpression increased NADPH oxidase activity in response to LPS. We have shown that endogenous IRAK-4 interacts with p47phox and they co-localize at the plasma membrane after LPS stimulation, using immunoprecipitation assays and immunofluorescence microscopy respectively. IRAK-4 was activated in neutrophils in response to LPS stimulation. We found that Thr133, Ser288 and Thr356, targets for IRAK-4 phosphorylation in vitro, are also phosphorylated in endogenous p47phox after LPS stimulation. We conclude that IRAK-4 phosphorylates p47phox and regulates NADPH oxidase activation after LPS stimulation.


Assuntos
Quinases Associadas a Receptores de Interleucina-1/metabolismo , NADPH Oxidases/metabolismo , Sequência de Aminoácidos , Ativação Enzimática , Humanos , Lipopolissacarídeos/farmacologia , NADPH Oxidases/efeitos dos fármacos , NADPH Oxidases/genética , Neutrófilos/metabolismo , Fosforilação , Regulação para Cima , Proteínas Quinases p38 Ativadas por Mitógeno/antagonistas & inibidores
10.
Biochem J ; 402(2): 229-39, 2007 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-17090228

RESUMO

Neutrophils kill micro-organisms using microbicidal products that they release into the phagosome or into the extracellular space. The secretory machinery utilized by neutrophils is poorly characterized. We show that the small GTPase Rab27a is an essential component of the secretory machinery of azurophilic granules in granulocytes. Rab27a-deficient mice have impaired secretion of MPO (myeloperoxidase) into the plasma in response to lipopolysaccharide. Cell fractionation analysis revealed that Rab27a and the Rab27a effector protein JFC1/Slp1 (synaptotagmin-like protein 1) are distributed principally in the low-density fraction containing a minor population of MPO-containing granules. By immunofluorescence microscopy, we detected Rab27a and JFC1/Slp1 in a minor subpopulation of MPO-containing granules. Interference with the JFC1/Slp1-Rab27a secretory machinery impaired secretion of MPO in permeabilized neutrophils. The expression of Rab27a was dramatically increased when promyelocytic HL-60 cells were differentiated into granulocytes but not when they were differentiated into monocytes. Down-regulation of Rab27a in HL-60 cells by RNA interference did not affect JFC1/Slp1 expression but significantly decreased the secretion of MPO. Neither Rab27a nor JFC1/Slp1 was integrated into the phagolysosome membrane during phagocytosis. Neutrophils from Rab27a-deficient mice efficiently phagocytose zymosan opsonized particles and deliver MPO to the phagosome. We conclude that Rab27a and JFC1/Slp1 permit MPO release into the surrounding milieu and constitute key components of the secretory machinery of azurophilic granules in granulocytes. Our results suggest that the granules implicated in cargo release towards the surrounding milieu are molecularly and mechanistically different from those involved in their release towards the phagolysosome.


Assuntos
Granulócitos/metabolismo , Vesículas Secretórias/metabolismo , Proteínas rab de Ligação ao GTP/metabolismo , Animais , Sequência de Bases , Diferenciação Celular , Linhagem Celular Tumoral , Exocitose , Granulócitos/citologia , Humanos , Proteínas de Membrana/metabolismo , Camundongos , Camundongos Transgênicos , Proteínas do Tecido Nervoso , Peroxidase/metabolismo , Fagossomos/metabolismo , Fenótipo , Ligação Proteica , Regulação para Cima , Proteínas rab de Ligação ao GTP/deficiência , Proteínas rab de Ligação ao GTP/genética , Proteínas rab27 de Ligação ao GTP
11.
BMC Immunol ; 7: 28, 2006 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-17150107

RESUMO

BACKGROUND: Neutrophils are non-dividing cells with poor survival after isolation. Consequently, exogenous gene expression in neutrophils is challenging. We report here the transfection of genes and expression of active proteins in human primary peripheral neutrophils using nucleofection. RESULTS: Exogenous gene expression in human neutrophils was achieved 2 h post-transfection. We show that neutrophils transfected by nucleofection are functional cells, able to respond to soluble and particulate stimuli. They conserved the ability to undergo physiological processes including phagocytosis. Using this technique, we were able to show that the phox homology (PX) domain of p47phox localizes to the plasma membrane in human neutrophils. We also show that RhoB, but not the PX domain of p47phox, is translocated to the membrane of mature phagosomes. CONCLUSION: We demonstrated that cDNA transfer and expression of exogenous protein in human neutrophils is compatible with cell viability and is no longer a limitation for the study of protein function in human neutrophils.


Assuntos
Membrana Celular/metabolismo , Técnicas de Transferência de Genes , NADPH Oxidases/genética , Neutrófilos/metabolismo , Fagossomos/metabolismo , Diferenciação Celular/genética , Membrana Celular/genética , Células Cultivadas , Células HL-60 , Humanos , NADPH Oxidases/biossíntese , Fagossomos/genética , Estrutura Terciária de Proteína/genética , Transporte Proteico/genética
12.
Biochem J ; 391(Pt 3): 699-710, 2005 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-16004602

RESUMO

Two of the major proteins secreted by the prostate epithelium secretory cells are PSA (prostate-specific antigen) and PSAP (prostatic-specific acid phosphatase). The molecules involved in the secretory machinery of PSA and PSAP, and the regulation of this machinery, remain unknown. In the present paper, we provide evidence that JFC1 [synaptotagmin-like protein (slp1)], a Rab27a- and PtdIns(3,4,5)P3-binding protein, regulates the androgen-dependent secretion of PSAP and PSA in human LNCaP prostate carcinoma cells. Androgen-dependent PSAP secretion was significantly inhibited in cells that expressed the C2A domain of JFC1 [PtdIns(3,4,5)P3-binding-domain], but was unaffected by JFC1 overexpression. Conversely, PSA secretion was not inhibited by the C2A domain of JFC1. We show, using immunofluorescence analysis, that JFC1 co-localizes with PSAP, but rarely with PSA, in prostate granules, suggesting that JFC1 is part of the PSAP secretory machinery. However, PSA secretion was significantly increased in LNCaP cells that overexpressed JFC1, indicating that the secretion of PSA is susceptible to variations in the intracellular concentration of JFC1. Both PSAP and PSA secretion was increased by overexpression of wild-type Rab27a or the constitutively active Rab27aQ78L. The secretion of PSA was partially inhibited in the presence of LY294002, while the secretion of PSAP was completely abolished by the PI3K (phosphoinositide 3-kinase) inhibitor. This supports the view that PI3K plays a differential role in the secretion of prostate secretory markers. In conclusion, we present evidence that JFC1 differentially regulates the secretion of PSAP and PSA, and that Rab27a and PI3K play a central role in the exocytosis of prostate-specific markers.


Assuntos
Androgênios/fisiologia , Proteínas de Membrana/metabolismo , Antígeno Prostático Específico/metabolismo , Próstata/enzimologia , Proteínas Tirosina Fosfatases/metabolismo , Proteínas rab de Ligação ao GTP/metabolismo , Fosfatase Ácida , Linhagem Celular Tumoral , Grânulos Citoplasmáticos/metabolismo , Regulação Enzimológica da Expressão Gênica , Humanos , Masculino , Proteínas de Membrana/genética , Fosfatidilinositol 3-Quinases/metabolismo , Antígeno Prostático Específico/genética , Ligação Proteica , Transporte Proteico , Testosterona/farmacologia , Regulação para Cima , Proteínas rab27 de Ligação ao GTP
13.
Clin Gastroenterol Hepatol ; 2(8): 690-5, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15290662

RESUMO

We describe 2 cases of autosomal recessive chronic granulomatous disease (CGD) in 2 sisters presenting with a picture consistent with inflammatory bowel disease. The index case is a 10-year-old girl with a history of refractory Crohn's colitis treated with aggressive immunosuppressive therapy whose course subsequently was complicated by central nervous system aspergillosis. Additional evaluation showed a diagnosis of CGD, an underlying immunodeficiency in which phagocytes fail to produce microbicidal reactive oxygen intermediates because of inherited defects in the reduced form of nicotinamide-adenine phosphate dinucleotide (NADPH) oxidase. The diagnosis of a typically X-linked inherited disease in our female patient suggested that she had 1 of the 3 less common autosomal recessive forms of the disease. This was confirmed by studies showing the absence of the p47(phox) subunit of NADPH oxidase in her neutrophils and the presence of a homozygous dinucleotide deletion in the neutrophil cytosolic factor 1 gene that encodes p47(phox). Additional analyses of members of the patient's immediate family showed the same homozygous mutation in 2 siblings, 1 of whom also developed chronic colitis consistent with a diagnosis of Crohn's disease. These 2 cases emphasize the importance of high clinical suspicion for an alternative diagnosis of immune deficiency in the setting of presumed inflammatory bowel disease and opportunistic infection.


Assuntos
Doença Granulomatosa Crônica/diagnóstico , Fosfoproteínas/metabolismo , Adolescente , Criança , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Feminino , Predisposição Genética para Doença , Doença Granulomatosa Crônica/complicações , Doença Granulomatosa Crônica/genética , Doença Granulomatosa Crônica/metabolismo , Humanos , Enteropatias/etiologia , Mutação , NADPH Oxidases
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