Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da Uninove |
Texto Completo: | http://bibliotecatede.uninove.br/handle/tede/3307 |
Resumo: | Bothrops snakes are responsible for most snakebites in Latin America. Bothropic envenoming causes both systemic and severe local effects. Furthermore, it is described that venoms from young and adult snakes have differences in their composition, which can lead to differences in the evolution of the local picture. Bothropic antivenom is the treatment of first choice, however, its effectiveness is limited, being able to neutralize only the systemic effects. It has been shown in previous studies that photobiomodulation (PBM) is promising in reducing local effects induced by bothropic snakes. The aim of this study was to expand the knowledge of the actions of low-level laser (LLL) on the local effect, after the action of the snake venom Bothrops alternatus (VBa), in its juvenile (VBaJ) and adult (VBaA) stages. For this, in vivo experiments were carried out with Balb-C mice and, in vitro with C2C12 muscle cells. For the treatment, LLL, 660 nm, 100 mW and 40 seconds of irradiation were used. In vivo, the animals were injected with VBaJ or VBaA, or only with saline, and the groups that received PBM, the treatment was conducted 30 minutes after the injection of the venoms. After 6 hours, edema, inflammatory infiltrate, myotoxicity and histology of the gastrocnemius muscle were analyzed, and after 1, 3, 6 and 24 hours, hyperalgesia was analyzed. In vitro, C2C12 cells received either VBaJ or VBaA, or culture medium alone, and were immediately irradiated with LLL. After 3 hours of the action of the venoms, cell viability, cytotoxicity, differentiation, membrane potential, proliferation, and cellular apoptosis/necrosis were evaluated. It was observed that, in vivo, VBaJ and VBaA, at the applied doses, were able to induce edema, inflammatory infiltrate, hemorrhage, to increase hyperalgesia and to cause myotoxicity and myonecrosis, at different intensities. In vitro, the two venoms also caused cytotoxicity, decreased cell differentiation, increased cell proliferation, and also induced apoptosis. Treatment with PBM, in vivo, was effective in reducing myotoxicity, leukocyte migration and hyperalgesia caused by the two venoms tested. Furthermore, it reduced the edema caused by VBaJ. In vitro, PBM induced cell differentiation and proliferation and also reduced apoptotic and necrotic cells. It can be concluded that, although both venoms (juvenile and adult) are capable to induce local reactions, there is a difference in the magnitude of these effects, both in vivo and in vitro, and treatment with PBM was shown to be beneficial in reducing these local reactions induced by the venoms of this snake. |
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Zamuner, Stella Reginahttp://lattes.cnpq.br/1935805744318404Zuliani, Juliana Pavanhttp://lattes.cnpq.br/9093880214338747Zamuner, Stella Reginahttp://lattes.cnpq.br/1935805744318404Dellê, Humbertohttp://lattes.cnpq.br/7435662740477057Leiva, Laura C.http://lattes.cnpq.br/9589613288491092David, Amanda Cabral2024-04-08T19:14:01Z2021-12-16David, Amanda Cabral. Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto. 2021. 99 f. Dissertação( Programa de Mestrado em Medicina) - Universidade Nove de Julho, São Paulo.http://bibliotecatede.uninove.br/handle/tede/3307Bothrops snakes are responsible for most snakebites in Latin America. Bothropic envenoming causes both systemic and severe local effects. Furthermore, it is described that venoms from young and adult snakes have differences in their composition, which can lead to differences in the evolution of the local picture. Bothropic antivenom is the treatment of first choice, however, its effectiveness is limited, being able to neutralize only the systemic effects. It has been shown in previous studies that photobiomodulation (PBM) is promising in reducing local effects induced by bothropic snakes. The aim of this study was to expand the knowledge of the actions of low-level laser (LLL) on the local effect, after the action of the snake venom Bothrops alternatus (VBa), in its juvenile (VBaJ) and adult (VBaA) stages. For this, in vivo experiments were carried out with Balb-C mice and, in vitro with C2C12 muscle cells. For the treatment, LLL, 660 nm, 100 mW and 40 seconds of irradiation were used. In vivo, the animals were injected with VBaJ or VBaA, or only with saline, and the groups that received PBM, the treatment was conducted 30 minutes after the injection of the venoms. After 6 hours, edema, inflammatory infiltrate, myotoxicity and histology of the gastrocnemius muscle were analyzed, and after 1, 3, 6 and 24 hours, hyperalgesia was analyzed. In vitro, C2C12 cells received either VBaJ or VBaA, or culture medium alone, and were immediately irradiated with LLL. After 3 hours of the action of the venoms, cell viability, cytotoxicity, differentiation, membrane potential, proliferation, and cellular apoptosis/necrosis were evaluated. It was observed that, in vivo, VBaJ and VBaA, at the applied doses, were able to induce edema, inflammatory infiltrate, hemorrhage, to increase hyperalgesia and to cause myotoxicity and myonecrosis, at different intensities. In vitro, the two venoms also caused cytotoxicity, decreased cell differentiation, increased cell proliferation, and also induced apoptosis. Treatment with PBM, in vivo, was effective in reducing myotoxicity, leukocyte migration and hyperalgesia caused by the two venoms tested. Furthermore, it reduced the edema caused by VBaJ. In vitro, PBM induced cell differentiation and proliferation and also reduced apoptotic and necrotic cells. It can be concluded that, although both venoms (juvenile and adult) are capable to induce local reactions, there is a difference in the magnitude of these effects, both in vivo and in vitro, and treatment with PBM was shown to be beneficial in reducing these local reactions induced by the venoms of this snake.As serpentes do gênero Bothrops são responsáveis pela maioria dos acidentes ofídicos na América Latina. O envenenamento botrópico provoca tanto efeitos sistêmicos, como efeitos locais graves. Além disso, é descrito que venenos de serpentes jovens e adultas possuem diferenças em sua composição, o que pode levar a diferenças na evolução do quadro local. O antiveneno botrópico é o tratamento de primeira escolha, entretanto, sua eficácia é limitada, sendo capaz de neutralizar somente os efeitos sistêmicos. Já foi demonstrado em estudos anteriores, que a fotobiomodulação (FBM) é promissora na redução dos efeitos locais induzidos por serpentes botrópicas. O objetivo deste estudo foi ampliar o conhecimento das ações do laser de baixa intensidade (LBI) sobre o efeito local, após ação do veneno da serpente Bothrops alternatus (VBa), em seus estágios juvenil (VBaJ) e adulto (VBaA). Para isto, foram realizados experimentos in vivo com camundongos Balb-C e, in vitro, com células musculares C2C12. Para o tratamento, foi utilizado o LBI, 660 nm, 100 mW e 40 segundos de irradiação. In vivo, os animais foram injetados com o VBaJ ou VBaA, ou somente com salina e os grupos que receberam a FBM, o tratamento foi feito após 30 minutos da injeção dos venenos. Após 6 horas, foram analisados o edema, infiltrado inflamatório, a miotoxicidade e a histologia do músculo gastrocnêmio e, após 1, 3, 6 e 24 horas, foi analisada a hiperalgesia. In vitro, as células C2C12 receberam o VBaJ ou VBaA, ou somente meio de cultura, e foram imediatamente irradiadas com o LBI. Após 3 horas da ação dos venenos, foram avaliados a viabilidade celular, a citotoxicidade, a diferenciação, o potencial de membrana, a proliferação e a apoptose/necrose celular. Foi observado que, in vivo, o VBaJ e VBaA, nas doses aplicadas, foram capazes de induzir edema, infiltrado inflamatório, hemorragia, de aumentar a hiperalgesia e de causar miotoxicidade e mionecrose, em diferentes intensidades. In vitro, os dois venenos também causaram citotoxicidade, diminuíram a diferenciação celular, aumentaram a proliferação celular e também induziram apoptose. O tratamento com a FBM, in vivo, foi eficaz em reduzir a miotoxicidade, a migração leucocitária e a hiperalgesia causadas pelos dois venenos testados. Ainda, reduziu o edema causado pelo VBaJ. Já in vitro, a FBM induziu a diferenciação e proliferação celular e também reduziu as células apoptóticas e necróticas. Pode-se concluir que, embora ambos os venenos (juvenil e adulto) sejam capazes de causar reações locais, existe diferença na magnitude desses efeitos, tanto in vivo como in vitro, e o tratamento com a FBM se mostrou benéfico em reduzir essas reações locais induzidas pelos venenos desta serpente.Submitted by Nadir Basilio (nadirsb@uninove.br) on 2024-04-08T19:14:01Z No. of bitstreams: 1 Amanda Cabral David.pdf: 2094031 bytes, checksum: d51d3a020366e92f2db0caf0542bb316 (MD5)Made available in DSpace on 2024-04-08T19:14:01Z (GMT). No. of bitstreams: 1 Amanda Cabral David.pdf: 2094031 bytes, checksum: d51d3a020366e92f2db0caf0542bb316 (MD5) Previous issue date: 2021-12-16application/pdfporUniversidade Nove de JulhoPrograma de Mestrado em MedicinaUNINOVEBrasilSaúdeBothrops alternatusjuvenil e adultofotobiomodulaçãomiotoxicidadecitotoxicidadeveneno botrópicoBothrops alternatusjuvenile and adultphotobiomodulationmyotoxicitycytotoxicitybothropic venomCIENCIAS DA SAUDEEfeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adultoEffect of photobiomodulation on local reaction induced by the venon of Bothrops alternatus on its juvenile and adult stagesinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesis8765449414823306929600info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da Uninoveinstname:Universidade Nove de Julho (UNINOVE)instacron:UNINOVEORIGINALAmanda Cabral David.pdfAmanda Cabral David.pdfapplication/pdf2094031http://localhost:8080/tede/bitstream/tede/3307/2/Amanda+Cabral+David.pdfd51d3a020366e92f2db0caf0542bb316MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82165http://localhost:8080/tede/bitstream/tede/3307/1/license.txtbd3efa91386c1718a7f26a329fdcb468MD51tede/33072024-04-08 16:14:01.156oai:localhost: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Biblioteca Digital de Teses e Dissertaçõeshttp://bibliotecatede.uninove.br/PRIhttp://bibliotecatede.uninove.br/oai/requestbibliotecatede@uninove.br||bibliotecatede@uninove.bropendoar:2024-04-08T19:14:01Biblioteca Digital de Teses e Dissertações da Uninove - Universidade Nove de Julho (UNINOVE)false |
dc.title.por.fl_str_mv |
Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto |
dc.title.alternative.eng.fl_str_mv |
Effect of photobiomodulation on local reaction induced by the venon of Bothrops alternatus on its juvenile and adult stages |
title |
Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto |
spellingShingle |
Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto David, Amanda Cabral Bothrops alternatus juvenil e adulto fotobiomodulação miotoxicidade citotoxicidade veneno botrópico Bothrops alternatus juvenile and adult photobiomodulation myotoxicity cytotoxicity bothropic venom CIENCIAS DA SAUDE |
title_short |
Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto |
title_full |
Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto |
title_fullStr |
Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto |
title_full_unstemmed |
Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto |
title_sort |
Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto |
author |
David, Amanda Cabral |
author_facet |
David, Amanda Cabral |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Zamuner, Stella Regina |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/1935805744318404 |
dc.contributor.advisor-co1.fl_str_mv |
Zuliani, Juliana Pavan |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/9093880214338747 |
dc.contributor.referee1.fl_str_mv |
Zamuner, Stella Regina |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/1935805744318404 |
dc.contributor.referee2.fl_str_mv |
Dellê, Humberto |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/7435662740477057 |
dc.contributor.referee3.fl_str_mv |
Leiva, Laura C. |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/9589613288491092 |
dc.contributor.author.fl_str_mv |
David, Amanda Cabral |
contributor_str_mv |
Zamuner, Stella Regina Zuliani, Juliana Pavan Zamuner, Stella Regina Dellê, Humberto Leiva, Laura C. |
dc.subject.por.fl_str_mv |
Bothrops alternatus juvenil e adulto fotobiomodulação miotoxicidade citotoxicidade veneno botrópico |
topic |
Bothrops alternatus juvenil e adulto fotobiomodulação miotoxicidade citotoxicidade veneno botrópico Bothrops alternatus juvenile and adult photobiomodulation myotoxicity cytotoxicity bothropic venom CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
Bothrops alternatus juvenile and adult photobiomodulation myotoxicity cytotoxicity bothropic venom |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE |
description |
Bothrops snakes are responsible for most snakebites in Latin America. Bothropic envenoming causes both systemic and severe local effects. Furthermore, it is described that venoms from young and adult snakes have differences in their composition, which can lead to differences in the evolution of the local picture. Bothropic antivenom is the treatment of first choice, however, its effectiveness is limited, being able to neutralize only the systemic effects. It has been shown in previous studies that photobiomodulation (PBM) is promising in reducing local effects induced by bothropic snakes. The aim of this study was to expand the knowledge of the actions of low-level laser (LLL) on the local effect, after the action of the snake venom Bothrops alternatus (VBa), in its juvenile (VBaJ) and adult (VBaA) stages. For this, in vivo experiments were carried out with Balb-C mice and, in vitro with C2C12 muscle cells. For the treatment, LLL, 660 nm, 100 mW and 40 seconds of irradiation were used. In vivo, the animals were injected with VBaJ or VBaA, or only with saline, and the groups that received PBM, the treatment was conducted 30 minutes after the injection of the venoms. After 6 hours, edema, inflammatory infiltrate, myotoxicity and histology of the gastrocnemius muscle were analyzed, and after 1, 3, 6 and 24 hours, hyperalgesia was analyzed. In vitro, C2C12 cells received either VBaJ or VBaA, or culture medium alone, and were immediately irradiated with LLL. After 3 hours of the action of the venoms, cell viability, cytotoxicity, differentiation, membrane potential, proliferation, and cellular apoptosis/necrosis were evaluated. It was observed that, in vivo, VBaJ and VBaA, at the applied doses, were able to induce edema, inflammatory infiltrate, hemorrhage, to increase hyperalgesia and to cause myotoxicity and myonecrosis, at different intensities. In vitro, the two venoms also caused cytotoxicity, decreased cell differentiation, increased cell proliferation, and also induced apoptosis. Treatment with PBM, in vivo, was effective in reducing myotoxicity, leukocyte migration and hyperalgesia caused by the two venoms tested. Furthermore, it reduced the edema caused by VBaJ. In vitro, PBM induced cell differentiation and proliferation and also reduced apoptotic and necrotic cells. It can be concluded that, although both venoms (juvenile and adult) are capable to induce local reactions, there is a difference in the magnitude of these effects, both in vivo and in vitro, and treatment with PBM was shown to be beneficial in reducing these local reactions induced by the venoms of this snake. |
publishDate |
2021 |
dc.date.issued.fl_str_mv |
2021-12-16 |
dc.date.accessioned.fl_str_mv |
2024-04-08T19:14:01Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/masterThesis |
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masterThesis |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
David, Amanda Cabral. Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto. 2021. 99 f. Dissertação( Programa de Mestrado em Medicina) - Universidade Nove de Julho, São Paulo. |
dc.identifier.uri.fl_str_mv |
http://bibliotecatede.uninove.br/handle/tede/3307 |
identifier_str_mv |
David, Amanda Cabral. Efeito da fotobiomodulação na reação local induzida pelo veneno da serpente Bothrops alternatus em seus estágios juvenil e adulto. 2021. 99 f. Dissertação( Programa de Mestrado em Medicina) - Universidade Nove de Julho, São Paulo. |
url |
http://bibliotecatede.uninove.br/handle/tede/3307 |
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dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Saúde |
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Universidade Nove de Julho |
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