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- Ensaio Clínico NCT04089579
hCT-MSC em crianças com transtorno do espectro autista (IMPACT)
Um estudo de fase II de hCT-MSC, um produto de células estromais mesenquimais derivadas do cordão umbilical, em crianças com transtorno do espectro autista
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
O objetivo deste estudo duplo-cego de Fase II é determinar a eficácia das células estromais mesenquimais derivadas do tecido do cordão umbilical humano (hCT-MSC), administradas em duas estratégias de dosagem diferentes, em crianças com transtorno do espectro autista (TEA).
Este estudo incluirá crianças com TEA, de 4 a 11 anos de idade. Os indivíduos qualificados passarão por avaliação neuropsicológica, teste de EEG, rastreamento ocular, avaliações de AVC e infusão do produto do estudo. Os indivíduos serão randomizados para um dos dois braços do estudo; 1) uma única infusão de 6,0x106 células/kg no início do estudo, seguida de uma infusão cega de placebo aos seis meses ou, 2) infusão de placebo no início do estudo, seguida de uma dose intravenosa de 6x106 células/kg aos seis meses.
O endpoint primário deste estudo é a mudança na habilidade de comunicação social desde a linha de base até seis meses. Os riscos potenciais associados à infusão de MSCs incluem uma reação ao produto (erupção cutânea, falta de ar, chiado, dificuldade respiratória, hipotensão, inchaço ao redor da boca, garganta ou olhos, taquicardia, diaforese), transmissão de infecção e sensibilização HLA.
Tipo de estudo
Inscrição (Real)
Estágio
- Fase 2
Contactos e Locais
Locais de estudo
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North Carolina
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Durham, North Carolina, Estados Unidos, 27705
- Duke University Medical Center
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Descrição
Critério de inclusão
- Idade ≥ 4 anos a < 12 anos (11 anos, 364 dias) no momento do consentimento
- Diagnóstico clínico confirmado do DSM-5 de Transtorno do Espectro do Autismo usando a Lista de Verificação do DSM-5, conforme informado pela Breve Observação dos Sintomas do Autismo (BOSA) e pela Entrevista de Diagnóstico de Autismo Revisada (ADI-R)
- Teste de X Frágil realizado e negativo; CMA e/ou sequenciamento completo do exoma realizado e resultados não relacionados ao diagnóstico de autismo
- Estável no atual regime de medicação psiquiátrica (dose e esquema de dosagem) por pelo menos 2 meses antes da infusão do produto do estudo
- Contagem absoluta normal de linfócitos (≥1200/uL para participantes afro-americanos e ≥1500/uL para todos os outros participantes)
- GAI ≥ 65 por meio de testes cognitivos pelo pessoal do estudo
- O participante e os pais/responsáveis falam inglês
- Capaz de viajar para a Duke University duas vezes (linha de base, seis meses), e o pai/responsável pode participar de pesquisas e entrevistas provisórias
- Consentimento dos pais/responsável de pelo menos um dos pais/responsável
Critério de exclusão
Em geral:
- Revisão de registros médicos e/ou avaliações de triagem indicam diagnóstico de TEA e/ou GAI > 65 não confiante
- Diagnóstico conhecido de qualquer uma das seguintes condições psiquiátricas coexistentes: depressão, transtorno bipolar, esquizofrenia, transtorno obsessivo-compulsivo associado ao transtorno bipolar, síndrome de Tourette
- Os dados de triagem sugerem que o participante não seria capaz de cumprir os requisitos dos procedimentos do estudo, conforme avaliado pela equipe do estudo
- A família não quer ou não pode se comprometer a participar de todas as avaliações relacionadas ao estudo, incluindo o acompanhamento do protocolo
- O irmão está inscrito neste estudo (Duke IMPACT)
Genético:
- Registros indicam que a criança tem uma síndrome genética conhecida, como (mas não limitada a) síndrome do X frágil, neurofibromatose, síndrome de Rett, esclerose tuberosa, mutação PTEN, fibrose cística, distrofia muscular ou um defeito genético definitivamente conhecido por estar associado ao TEA
- Mutação patogênica conhecida ou variação do número de cópias (CNV) associada ao TEA (por exemplo, 16p11.2, 15q13.2, 2q13.3)
Infeccioso:
- Infecção ativa conhecida do SNC
- Evidência de infecção não controlada com base em registros ou avaliação clínica
- HIV positivo conhecido
- Exposição ao COVID-19 nos 14 dias anteriores ou teste positivo para COVID-19 nos 28 dias anteriores. Indivíduos com histórico de infecção por COVID-19 devem estar assintomáticos por 14 dias antes da visita inicial.
Médico:
- Distúrbio metabólico conhecido
- Disfunção mitocondrial conhecida
- História de epilepsia instável ou distúrbio convulsivo descontrolado, espasmos infantis, síndrome de Lennox Gastaut, síndrome de Dravet ou outro distúrbio convulsivo crônico semelhante
- Malignidade ativa ou malignidade prévia tratada com quimioterapia
- História de um distúrbio primário de imunodeficiência
- História de citopenias autoimunes (ou seja, ITP, AIHA)
- Condição médica coexistente que colocaria a criança em risco aumentado de complicações dos procedimentos do estudo
- Doença genética ou adquirida concomitante ou comorbidade(s) que podem exigir um futuro transplante de células-tronco
- Comprometimento sensorial significativo (por exemplo, cegueira, surdez, deficiência auditiva não corrigida) ou motor (por exemplo, paralisia cerebral)
- Função renal ou hepática prejudicada conforme determinado pela creatinina sérica >1,5mg/dL ou bilirrubina total >1,3mg/dL, exceto em pacientes com doença de Gilbert conhecida
- Anormalidades hematológicas significativas definidas como: Hemoglobina <10,0 g/dL, Plaquetas <150 x 10e9/uL, WBC <3.000 células/mL, ALC <1200/uL para afro-americanos ou <1500/uL para todos os outros participantes.
- Evidência de dismorfologia física clinicamente relevante indicativa de uma síndrome genética conforme avaliado pelos IPs ou outros investigadores, incluindo um geneticista médico e psiquiatras treinados na identificação de características dismórficas associadas a condições de neurodesenvolvimento.
Terapia atual/anterior:
a. Disponibilidade de uma unidade de sangue do cordão umbilical autóloga qualificada, ou os pais adiaram o uso de uma unidade de sangue do cordão umbilical autóloga qualificada b. História de terapia celular prévia c. Uso atual ou anterior de IVIG ou outros medicamentos anti-inflamatórios, exceto AINEs d. Terapia imunossupressora atual ou anterior i. Nenhuma terapia com esteróides sistêmicos que durou > 2 semanas e sem esteróides sistêmicos dentro de 3 meses antes da inscrição. Esteróides tópicos e inalatórios são permitidos.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Quadruplicar
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Experimental: MSC
Uma dose de 6x10e6 células/kg administrada por via intravenosa.
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Células estromais mesenquimais derivadas de tecido de cordão umbilical humano (hCT-MSC), isoladas e expandidas de tecido de cordão umbilical de doadores não aparentados alogênicos.
Uma dose de 6x10e6 células/kg administrada por via intravenosa.
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Comparador de Placebo: Infusão de Placebo
Infusão de placebo
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Infusão comparativa de placebo
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Change on the Average Socialization and Communication Subscale Standard Scores on the Vineland Behavior Scales (VABS-3)
Prazo: Baseline, 6 months
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The primary outcome measure is the mean of the Socialization and Communication Subscale Standard Scores on the Vineland Adaptive Behavior Scales (VABS-3) from the Comprehensive Interview form.
The primary endpoint is the change in this outcome measure from baseline to six months before the second infusion.
A positive change in the scores indicates an improvement in socialization and communication.
A standard score of 100 is the mean with a standard deviation of 15 points.
A score of 100 should be understood as being similar to the typical population of the same age.
Scores greater than or equal to 86 are considered adequate or above adequate.
Domain scores less than or equal to 85 are considered moderately low to low and indicate the patient has a significant skill deficit when compared with similarly aged peers.
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Baseline, 6 months
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Change in VABS-3 (Vineland Adaptive Behavior Scales) Socialization Standard Score
Prazo: Baseline, 6 months
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The change in the Socialization Subscale Standard Scores on the Vineland Adaptive Behavior Scales (VABS-3) from baseline to six months.
Higher Socialization Standard scores indicate greater socialization.
A positive change in the scores indicates an improvement in socialization.
A standard score of 100 is the mean with a standard deviation of 15 points.
A score of 100 should be understood as being similar to the typical population of the same age.
Scores greater than or equal to 86 are considered adequate or above adequate.
Domain scores less than or equal to 85 are considered moderately low to low and indicate the patient has a significant skill deficit when compared with similarly aged peers.
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Baseline, 6 months
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Change in VABS-3 Communication Standard Score
Prazo: Baseline, 6 months
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The change in the Communication Standard Scores on the Vineland Adaptive Behavior Scales (VABS-3) from the Comprehensive Interview form from baseline to six months before the second infusion.
Higher scores indicate greater communication.
A positive change in the scores indicates an improvement in communication.
A standard score of 100 is the mean with a standard deviation of 15 points.
A score of 100 should be understood as being similar to the typical population of the same age.
Scores greater than or equal to 86 are considered adequate or above adequate.
Domain scores less than or equal to 85 are considered moderately low to low and indicate the patient has a significant skill deficit when compared with similarly aged peers.
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Baseline, 6 months
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CGI-S (Clinical Global Impression - Severity of Illness) Overall Score
Prazo: 6 months
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The CGI-S Overall Score is a 7-point scale that requires the clinician to rate the severity of the participant's overall functioning and symptoms of autism at the time of assessment, relative to the clinician's experience with participants who have the same diagnosis.
The clinician rates the severity of autism symptoms - 1, normal, no symptoms; 2, borderline level of symptoms; 3, mild symptoms; 4, moderate symptoms; 5, marked symptoms; 6, severe symptoms; or 7, extremely severe symptoms.
The higher ratings indicate greater severity of overall functioning impairment.
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6 months
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CGI-I (Clinical Global Impression - Improvement) Overall Score
Prazo: 6 months
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The CGI-I Overall Score is a 7-point scale that requires the clinician to assess how much the participant's autism overall functioning and symptoms have improved or worsened relative to a baseline assessment.
The symptoms are rated as: 1, very much improved; 2, much improved; 3, minimally improved; 4, no change; 5, minimally worse; 6, much worse; or 7, very much worse.
The lower scores indicate greater improvement.
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6 months
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Change in the Pediatric Quality of Life (PedsQL) Total Scale Score
Prazo: Baseline, 6 months
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The PedsQL 4.0 Generic Core Scales is a 5-minute parent questionnaire that measures the child's functioning in the dimensions of physical, emotional, social, and school.
The items use a Likert rating scale from 0 (Never) to 4 (Almost Always).
This 0-4 scale is then transformed to 0=100, 1=75, 2=50, 3=25, and 4=0 for a reverse score.
The Total Scale Score is then computed as the sum of all the items over the number of items answered on all the Scales for a total score range of 0 to 100.
Higher scores indicate a better quality of life.
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Baseline, 6 months
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Outras medidas de resultado
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Number of Participants Experiencing an Infusion Reaction
Prazo: up to 12 months
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To assess safety, participants were considered according to the treatment received at each time point, not what they were randomized.
Patients received the infusion to which they were randomized at baseline and the alternate treatment at 6 months.
Therefore, adverse events are reported by randomized treatment arm broken into periods: 0-6 months (post-baseline infusion, pre-six month infusion) and 6-12 months (post-six month infusion).
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up to 12 months
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Number of Participants Experiencing Product-related Infections
Prazo: up to 12 months
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To assess safety, participants were considered according to the treatment received at each time point, not to what they were randomized.
Patients received the infusion to which they are randomized at baseline, and the alternate treatment at 6 months.
AEs are reported by randomized treatment arm broken into periods: 0-6 months (post-baseline infusion, pre-six month infusion) and 6-12 months (post-six month infusion).
6-12 month evaluation time points are further broken into whether or not the participant received a second infusion, since three MSC patients and one Placebo patient did not receive the 6-month incentive infusion but were still evaluated.
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up to 12 months
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Evidence of Formation of Anti-HLA Antibodies
Prazo: Baseline, 6 months, 12 months
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Assess for anti-HLA antibodies
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Baseline, 6 months, 12 months
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Number of Participants Experiencing Graft Versus Host Disease (GVHD)
Prazo: up to 12 months
|
To assess safety, participants were considered according to the treatment received at each time point, not to what they were randomized.
Patients received the infusion to which they are randomized at baseline, and the alternate treatment at 6 months.
AEs are reported by randomized treatment arm broken into periods: 0-6 months (post-baseline infusion, pre-six month infusion) and 6-12 months (post-six month infusion).
6-12 month evaluation time points are further broken into whether or not the participant received a second infusion, since three MSC patients and one Placebo patient did not receive the 6-month incentive infusion but were still evaluated.
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up to 12 months
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Number of Participants Experiencing Unexpected Adverse Events Related to the Study Product
Prazo: up to 12 months
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To assess safety, participants were considered according to the treatment received at each time point, not to what they were randomized.
Patients received the infusion to which they are randomized at baseline, and the alternate treatment at 6 months.
AEs are reported by randomized treatment arm broken into periods: 0-6 months (post-baseline infusion, pre-six month infusion) and 6-12 months (post-six month infusion).
6-12 month evaluation time points are further broken into whether or not the participant received a second infusion, since three MSC patients and one Placebo patient did not receive the 6-month incentive infusion but were still evaluated.
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up to 12 months
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Change on the Adaptive Behavior Composite Subscale Standard Score on the Vineland Behavior Scales (VABS-3)
Prazo: Baseline, 6 months
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The change in the Vineland Adaptive Behavior Scales (VABS-3) Adaptive Behavior Composite Subscale from baseline to 6 months before the second infusion.
Higher Adaptive Behavior Composite Standard scores indicate greater adaptive behavior.
A positive change in the scores indicates an improvement in adaptive behavior.
A standard score of 100 is the mean with a standard deviation of 15 points.
A score of 100 should be understood as being similar to the typical population of the same age.
Scores greater than or equal to 86 are considered adequate or above adequate.
Domain scores less than or equal to 85 are considered moderately low to low and indicate the patient has a significant skill deficit when compared with similarly aged peers.
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Baseline, 6 months
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Change in VABS-3 (Vineland Adaptive Behavior Scales) Daily Living Skills Standard Score
Prazo: Baseline, 6 months
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The change in the Daily Living Skills Subscale Standard Scores on the Vineland Adaptive Behavior Scales (VABS-3) from baseline to six months before the second infusion.
Higher Daily Living Skills Standard scores indicate greater daily living skills.
A positive change in the scores indicates an improvement in daily living skills.
A standard score of 100 is the mean with a standard deviation of 15 points.
A score of 100 should be understood as being similar to the typical population of the same age.
Scores greater than or equal to 86 are considered adequate or above adequate.
Domain scores less than or equal to 85 are considered moderately low to low and indicate the patient has a significant skill deficit when compared with similarly aged peers.
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Baseline, 6 months
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Change in VABS-3 Motor Skills Standard Score
Prazo: Baseline, 6 months
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The change in the Motor Skills Standard Scores on the Vineland Adaptive Behavior Scales (VABS-3) from the Comprehensive Interview form from baseline to six months before the second infusion.
Higher scores indicate greater motor skills.
A positive change in the scores indicates an improvement in motor skills.
A standard score of 100 is the mean with a standard deviation of 15 points.
A score of 100 should be understood as being similar to the typical population of the same age.
Scores greater than or equal to 86 are considered adequate or above adequate.
Domain scores less than or equal to 85 are considered moderately low to low and indicate the patient has a significant skill deficit when compared with similarly aged peers.
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Baseline, 6 months
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Change in Aberrant Behavior Checklist-Community (ABC-C) Social Withdrawal
Prazo: Baseline, 6 months
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The change in the Aberrant Behavior Checklist-Community (ABC-C) Social Withdrawal scale from baseline to six months before the second infusion.
Higher scores indicate greater problems with social withdrawal.
A positive change in the scores indicates a worsening in social withdrawal.
This scale has 16 items that are scored on a 4-point Likert scale: 0 = not a problem, 1 = slight problem, 2 = moderately serious problem, 3 = severe problem.
The individual items are added together to calculate the Social Withdrawal scale score.
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Baseline, 6 months
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Change in Pervasive Developmental Disorder Behavior Inventory (PDDBI) Total Score
Prazo: Baseline, 6 months
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The change in the Pervasive Developmental Disorder Behavior Inventory (PDDBI) from baseline to 6 months before the second infusion.
The PDDBI is a measure of problem behaviors and social, language, and learning or memory skills of children who have been diagnosed with autism spectrum disorder.
Raw scores are converted to T-scores.
The T-score has a mean of 50 with a standard deviation of 10 points with a range of 10-100.
Higher scores indicate greater behavioral issues and a positive change in score indicates worsening.
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Baseline, 6 months
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Change in the Autism Impact Measure (AIM)
Prazo: Baseline, 6 months
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The change in the Autism Impact Measure (AIM) from baseline to 6 months before second infusion.
AIM is a measure of core Autism Spectrum Disorder Symptoms.
It is a parent-report questionnaire that includes 41 core-symptom items rated on two corresponding 5-point scales: frequency (ranging from "never" to "always") and impact (ranging from "not at all" to "severely") over the previous two weeks.
Frequency and impact ratings are combined, yielding a total score range of 82 to 410.
Higher scores indicate greater symptom severity; a positive change in score indicates worsening of symptoms.
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Baseline, 6 months
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Change in the Behavior Rating Inventory of Executive Function (BRIEF) Emotional Control Subscale
Prazo: Baseline, 6 months
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The change in the Behavior Rating Inventory of Executive Function (BRIEF) Emotional Control subscale from baseline to month 6 before the second infusion.
BRIEF is a survey that assesses executive function and self-regulation with the following subscales: Inhibit, Shift, Emotional Control, Working Memory, and Planning and Organization.
Higher scores indicate greater levels of dysfunction each respective domain.
A positive change in score indicates worsening the respective domain.
Raw scores for each domain are converted to t-scores (Mean = 50, SD = 10) and percentiles.
T scores 60-64 are considered to be mildly elevated, 65-69 are considered to be potentially clinically elevated, and >= 70 are considered to be clinically elevated.
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Baseline, 6 months
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Change in the Behavior Rating Inventory of Executive Function (BRIEF) Working Memory Subscale
Prazo: Baseline, 6 months
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The change in the Behavior Rating Inventory of Executive Function (BRIEF) Working Memory subscale from baseline to month 6 before the second infusion.
The BREIF is a survey that assesses executive function and self-regulation with the following subscales: Inhibit, Shift, Emotional Control, Working Memory, and Planning and Organization.
Higher scores indicate greater levels of dysfunction each respective domain.
A positive change in score indicates worsening the respective domain.
Raw scores for each domain are converted to t-scores (Mean = 50, SD = 10) and percentiles.
T scores 60-64 are considered to be mildly elevated, 65-69 are considered to be potentially clinically elevated, and >= 70 are considered to be clinically elevated.
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Baseline, 6 months
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Change in the Behavior Rating Inventory of Executive Function (BRIEF) Inhibit Subscale
Prazo: Baseline, 6 months
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The change in the Behavior Rating Inventory of Executive Function (BRIEF) Inhibit subscale from baseline to month 6 before the second infusion.
The BRIEF is a survey that assesses executive function and self-regulation with the following subscales: Inhibit, Shift, Emotional Control, Working Memory, and Planning and Organization.
Higher scores indicate greater levels of dysfunction each respective domain.
A positive change in score indicates worsening the respective domain.
Raw scores for each domain are converted to t-scores (Mean = 50, SD = 10) and percentiles.
T scores 60-64 are considered to be mildly elevated, 65-69 are considered to be potentially clinically elevated, and >= 70 are considered to be clinically elevated.
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Baseline, 6 months
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Change in the Behavior Rating Inventory of Executive Function (BRIEF) Plan/Organization Subscale
Prazo: Baseline, 6 months
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The change in the Behavior Rating Inventory of Executive Function (BRIEF) Plan/Organization subscale from baseline to month 6 before the second infusion.
The BRIEF is a survey that assesses executive function and self-regulation with the following subscales: Inhibit, Shift, Emotional Control, Working Memory, and Planning and Organization.
Higher scores indicate greater levels of dysfunction each respective domain.
A positive change in score indicates worsening the respective domain.
Raw scores for each domain are converted to t-scores (Mean = 50, SD = 10) and percentiles.
T scores 60-64 are considered to be mildly elevated, 65-69 are considered to be potentially clinically elevated, and >= 70 are considered to be clinically elevated.
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Baseline, 6 months
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Change in the Behavior Rating Inventory of Executive Function (BRIEF) Shift Subscale
Prazo: Baseline, 6 months
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The change in the Behavior Rating Inventory of Executive Function (BRIEF) Shift subscale from baseline to month 6 before the second infusion.
The BRIEF is a survey that assesses executive function and self-regulation with the following subscales: Inhibit, Shift, Emotional Control, Working Memory, and Planning and Organization.
Higher scores indicate greater levels of dysfunction each respective domain.
A positive change in score indicates worsening the respective domain.
Raw scores for each domain are converted to t-scores (Mean = 50, SD = 10) and percentiles.
T scores 60-64 are considered to be mildly elevated, 65-69 are considered to be potentially clinically elevated, and >= 70 are considered to be clinically elevated.
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Baseline, 6 months
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Change in the Expressive Vocabulary Test (Third Edition, EVT-3)
Prazo: Baseline, 6 months
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The change in the Expressive Vocabulary Test (Third Edition, EVT-3) from baseline to 6 months before the second infusion.
The EVT-3 is a measure of a participant's ability to match a spoken word with an image of an object, action, or concept.
The number of words that are retrieved is converted to a Standard Score, where 100 is the mean with a standard deviation of 15 points.
A score of 100 should be understood as being similar to the typical population of the same age.
Scores greater than or equal to 86 are considered adequate or above adequate.
Scores less than or equal to 85 are considered moderately low to low and indicate the patient has a significant skill deficit when compared with similarly aged peers.
A positive change in EVT-3 score indicates improvement.
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Baseline, 6 months
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Lauren Franz, MBChB, Duke University
- Investigador principal: Beth Shaz, MD, Duke University
Publicações e links úteis
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Real)
Conclusão do estudo (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- Pro00113011
- Pro00102894 (Outro identificador: Duke IRB)
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Informações sobre medicamentos e dispositivos, documentos de estudo
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