A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment

Souto, Jorge - Landoni, Ana Ines - Remedi, Victoria - dos Santos, Gimena - Oliver, Carolina - Irigoin, Victoria - Lema, Virginia - Ranero, Sabrina - Stanganelli, Carmen - Puelma, Jorge Gonzales - Payque, Eugenia - Uria, Rita - Querol, Juliana - Marquez, Maria Elena - de Galvez, Gabriela - Pierri, Silvia - Kollar, Patricia - Stevenazzi, Mariana - Moro, Isabel - Viana, Marcelo - Naya, Hugo - Slavutsky, Irma - Diaz, Lilian - Kescherman, Francis - Muxi, Pablo - Grille, Sofia - Guillermo, Cecilia - Lassus, Mercedes - Dighiero, Guillermo - Gabus, Raúl - Palacios, Florencia - Navarrete, Marcelo - Oppezzo, Pablo

Resumen:

Chronic lymphocytic leukemia (CLL) is characterized by its clinical and molecular heterogeneity. The practical challenge presented by this diverse landscape is the difficulty in predicting leukemia progression. Despite extensive efforts employing various clinical and/or molecular prognostic tools, accurate prediction of disease progression remains elusive for a significant number of patients. Our group and others described that activation-induced cytidine deaminase (AID) is abnormally expressed in the peripheral blood (PB) of patients with poor clinical outcomes, predominantly in unmutated cases (U-CLL). This enzyme is necessary to initiate somatic hypermutation (SHM) and class-switch recombination process in B- lymphocytes. Additionally, deamination of “off-target” genes by AID can result in oncogenic mutations or translocations. Nevertheless, the role of this enzyme in the origins and evolution of CLL as well as why AID is predominantly expressed in U-CLL, remains a topic of ongoing debate. Previous studies from our laboratory demonstrated the loss of superantigenic and polyreactive binding of B-cell receptor (BCR) following SHM, (Oppezzo et al., 2004 EJI). Furthermore, findings from (Hervé et al. 2005, JCI), provide evidence that both U-CLLs and M-CLLs may originate from self-reactive B cell precursors. Collectively, these studies highlight SHM as a pivotal process in the origins/development of B-cell lymphoid neoplasms by altering the original autoreactivity of the BCR. Based on this concept, we hypothesize that the absence of SHM in U-CLL may result in continuous BCR stimulation and constitutive AID expression, contributing to a poorer clinical outcome. In this work, we characterized CLL patients based on AID expression in PB, its association with immunoglobulin heavy chain gene (IgVH) status/use and disease progression, assessed as time to first treatment (TTFT). PB samples were collected from patients meeting the clinical/immunophenotypic criteria for CLL, following the iwCLL guidelines. The cohort included 279 patients from Uruguay and 33 from Argentina. Written informed consent was obtained, and the study was approved by the Institutional Ethics Committees of each institution. Peripheral blood mononuclear cells were isolated using Ficoll-Hypaque, and RNA extraction and cDNA synthesis performed. From 312 studied cases, 56% were Binet's stage A, 23% were stage B, and 21% were stage C. The IgHV gene status was mutated in 52% of cases, cytogenetic aberrations were observed in 70.5% of patients, including 13q14_deletion (36.5%), trisomy_12 (13%), 11q22_deletion (9.7%), and 17p_deletion (8.3%). The median age at diagnosis was 66 years old, and the median follow-up was 5 years. Our results identify a novel CLL subgroup characterized by clonal expression of an unmutated BCR with specific rearrangements (IgHV_1-02, 1-69, 3-30, 4-39), high expression of AID enzyme and earlier treatment. Moreover, our results suggest that AID expression in U-CLL could be linked with antigen restriction and clinical outcome. This subset constitutes approximately 38% of the U-CLL (15% of the total cohort) and can be identified in advance by integrating AID mRNA expression and IgVH profile assessment into routine testing. We propose a new and practical prognostic tool, assessed in PB, which enables the identification of a novel CLL entity requiring early treatment initiation, typically within the first year.

Detalles Bibliográficos
2024
Agencia Nacional de Investigación e Innovación
Leucemia Linfoide Crónica
Citidina deaminasa Inducida por Activación (AID)
Ciencias Médicas y de la Salud
Medicina Básica
Inmunología
Medicina Clínica
Hematología
Inglés
Institut Pasteur de Montevideo
IPMON en REDI
https://hdl.handle.net/20.500.12381/3878
https://lag-cll2024.opc.uy/en/trabajos?area=&numero=&search
Acceso abierto
Reconocimiento 4.0 Internacional. (CC BY)
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author Souto, Jorge
author2 Landoni, Ana Ines
Remedi, Victoria
dos Santos, Gimena
Oliver, Carolina
Irigoin, Victoria
Lema, Virginia
Ranero, Sabrina
Stanganelli, Carmen
Puelma, Jorge Gonzales
Payque, Eugenia
Uria, Rita
Querol, Juliana
Marquez, Maria Elena
de Galvez, Gabriela
Pierri, Silvia
Kollar, Patricia
Stevenazzi, Mariana
Moro, Isabel
Viana, Marcelo
Naya, Hugo
Slavutsky, Irma
Diaz, Lilian
Kescherman, Francis
Muxi, Pablo
Grille, Sofia
Guillermo, Cecilia
Lassus, Mercedes
Dighiero, Guillermo
Gabus, Raúl
Palacios, Florencia
Navarrete, Marcelo
Oppezzo, Pablo
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author_facet Souto, Jorge
Landoni, Ana Ines
Remedi, Victoria
dos Santos, Gimena
Oliver, Carolina
Irigoin, Victoria
Lema, Virginia
Ranero, Sabrina
Stanganelli, Carmen
Puelma, Jorge Gonzales
Payque, Eugenia
Uria, Rita
Querol, Juliana
Marquez, Maria Elena
de Galvez, Gabriela
Pierri, Silvia
Kollar, Patricia
Stevenazzi, Mariana
Moro, Isabel
Viana, Marcelo
Naya, Hugo
Slavutsky, Irma
Diaz, Lilian
Kescherman, Francis
Muxi, Pablo
Grille, Sofia
Guillermo, Cecilia
Lassus, Mercedes
Dighiero, Guillermo
Gabus, Raúl
Palacios, Florencia
Navarrete, Marcelo
Oppezzo, Pablo
author_role author
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bitstream.checksumAlgorithm.fl_str_mv MD5
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bitstream.url.fl_str_mv https://redi.anii.org.uy/jspui/bitstream/20.500.12381/3878/2/license.txt
https://redi.anii.org.uy/jspui/bitstream/20.500.12381/3878/1/5thLAG-CLL.pdf
collection IPMON en REDI
dc.creator.none.fl_str_mv Souto, Jorge
Landoni, Ana Ines
Remedi, Victoria
dos Santos, Gimena
Oliver, Carolina
Irigoin, Victoria
Lema, Virginia
Ranero, Sabrina
Stanganelli, Carmen
Puelma, Jorge Gonzales
Payque, Eugenia
Uria, Rita
Querol, Juliana
Marquez, Maria Elena
de Galvez, Gabriela
Pierri, Silvia
Kollar, Patricia
Stevenazzi, Mariana
Moro, Isabel
Viana, Marcelo
Naya, Hugo
Slavutsky, Irma
Diaz, Lilian
Kescherman, Francis
Muxi, Pablo
Grille, Sofia
Guillermo, Cecilia
Lassus, Mercedes
Dighiero, Guillermo
Gabus, Raúl
Palacios, Florencia
Navarrete, Marcelo
Oppezzo, Pablo
dc.date.accessioned.none.fl_str_mv 2025-02-25T17:06:29Z
dc.date.available.none.fl_str_mv 2025-02-25T17:06:29Z
dc.date.issued.none.fl_str_mv 2024-11
dc.description.abstract.none.fl_txt_mv Chronic lymphocytic leukemia (CLL) is characterized by its clinical and molecular heterogeneity. The practical challenge presented by this diverse landscape is the difficulty in predicting leukemia progression. Despite extensive efforts employing various clinical and/or molecular prognostic tools, accurate prediction of disease progression remains elusive for a significant number of patients. Our group and others described that activation-induced cytidine deaminase (AID) is abnormally expressed in the peripheral blood (PB) of patients with poor clinical outcomes, predominantly in unmutated cases (U-CLL). This enzyme is necessary to initiate somatic hypermutation (SHM) and class-switch recombination process in B- lymphocytes. Additionally, deamination of “off-target” genes by AID can result in oncogenic mutations or translocations. Nevertheless, the role of this enzyme in the origins and evolution of CLL as well as why AID is predominantly expressed in U-CLL, remains a topic of ongoing debate. Previous studies from our laboratory demonstrated the loss of superantigenic and polyreactive binding of B-cell receptor (BCR) following SHM, (Oppezzo et al., 2004 EJI). Furthermore, findings from (Hervé et al. 2005, JCI), provide evidence that both U-CLLs and M-CLLs may originate from self-reactive B cell precursors. Collectively, these studies highlight SHM as a pivotal process in the origins/development of B-cell lymphoid neoplasms by altering the original autoreactivity of the BCR. Based on this concept, we hypothesize that the absence of SHM in U-CLL may result in continuous BCR stimulation and constitutive AID expression, contributing to a poorer clinical outcome. In this work, we characterized CLL patients based on AID expression in PB, its association with immunoglobulin heavy chain gene (IgVH) status/use and disease progression, assessed as time to first treatment (TTFT). PB samples were collected from patients meeting the clinical/immunophenotypic criteria for CLL, following the iwCLL guidelines. The cohort included 279 patients from Uruguay and 33 from Argentina. Written informed consent was obtained, and the study was approved by the Institutional Ethics Committees of each institution. Peripheral blood mononuclear cells were isolated using Ficoll-Hypaque, and RNA extraction and cDNA synthesis performed. From 312 studied cases, 56% were Binet's stage A, 23% were stage B, and 21% were stage C. The IgHV gene status was mutated in 52% of cases, cytogenetic aberrations were observed in 70.5% of patients, including 13q14_deletion (36.5%), trisomy_12 (13%), 11q22_deletion (9.7%), and 17p_deletion (8.3%). The median age at diagnosis was 66 years old, and the median follow-up was 5 years. Our results identify a novel CLL subgroup characterized by clonal expression of an unmutated BCR with specific rearrangements (IgHV_1-02, 1-69, 3-30, 4-39), high expression of AID enzyme and earlier treatment. Moreover, our results suggest that AID expression in U-CLL could be linked with antigen restriction and clinical outcome. This subset constitutes approximately 38% of the U-CLL (15% of the total cohort) and can be identified in advance by integrating AID mRNA expression and IgVH profile assessment into routine testing. We propose a new and practical prognostic tool, assessed in PB, which enables the identification of a novel CLL entity requiring early treatment initiation, typically within the first year.
dc.description.sponsorship.none.fl_txt_mv Agencia Nacional de Investigación e Innovación
dc.identifier.anii.es.fl_str_mv FCE_1_2021_1_166493
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.12381/3878
dc.identifier.url.none.fl_str_mv https://lag-cll2024.opc.uy/en/trabajos?area=&numero=&search
dc.language.iso.none.fl_str_mv eng
dc.rights.*.fl_str_mv Acceso abierto
dc.rights.license.none.fl_str_mv Reconocimiento 4.0 Internacional. (CC BY)
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
dc.source.es.fl_str_mv 5th Latin-American group on CLL_2024 (LAG-CLL)
dc.source.none.fl_str_mv reponame:IPMON en REDI
instname:Institut Pasteur de Montevideo
instacron:Institut Pasteur de Montevideo
dc.subject.anii.none.fl_str_mv Ciencias Médicas y de la Salud
Medicina Básica
Inmunología
Medicina Clínica
Hematología
dc.subject.es.fl_str_mv Leucemia Linfoide Crónica
Citidina deaminasa Inducida por Activación (AID)
dc.title.none.fl_str_mv A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment
dc.type.es.fl_str_mv Documento de conferencia
dc.type.none.fl_str_mv info:eu-repo/semantics/conferenceObject
dc.type.version.es.fl_str_mv Aceptado
dc.type.version.none.fl_str_mv info:eu-repo/semantics/acceptedVersion
description Chronic lymphocytic leukemia (CLL) is characterized by its clinical and molecular heterogeneity. The practical challenge presented by this diverse landscape is the difficulty in predicting leukemia progression. Despite extensive efforts employing various clinical and/or molecular prognostic tools, accurate prediction of disease progression remains elusive for a significant number of patients. Our group and others described that activation-induced cytidine deaminase (AID) is abnormally expressed in the peripheral blood (PB) of patients with poor clinical outcomes, predominantly in unmutated cases (U-CLL). This enzyme is necessary to initiate somatic hypermutation (SHM) and class-switch recombination process in B- lymphocytes. Additionally, deamination of “off-target” genes by AID can result in oncogenic mutations or translocations. Nevertheless, the role of this enzyme in the origins and evolution of CLL as well as why AID is predominantly expressed in U-CLL, remains a topic of ongoing debate. Previous studies from our laboratory demonstrated the loss of superantigenic and polyreactive binding of B-cell receptor (BCR) following SHM, (Oppezzo et al., 2004 EJI). Furthermore, findings from (Hervé et al. 2005, JCI), provide evidence that both U-CLLs and M-CLLs may originate from self-reactive B cell precursors. Collectively, these studies highlight SHM as a pivotal process in the origins/development of B-cell lymphoid neoplasms by altering the original autoreactivity of the BCR. Based on this concept, we hypothesize that the absence of SHM in U-CLL may result in continuous BCR stimulation and constitutive AID expression, contributing to a poorer clinical outcome. In this work, we characterized CLL patients based on AID expression in PB, its association with immunoglobulin heavy chain gene (IgVH) status/use and disease progression, assessed as time to first treatment (TTFT). PB samples were collected from patients meeting the clinical/immunophenotypic criteria for CLL, following the iwCLL guidelines. The cohort included 279 patients from Uruguay and 33 from Argentina. Written informed consent was obtained, and the study was approved by the Institutional Ethics Committees of each institution. Peripheral blood mononuclear cells were isolated using Ficoll-Hypaque, and RNA extraction and cDNA synthesis performed. From 312 studied cases, 56% were Binet's stage A, 23% were stage B, and 21% were stage C. The IgHV gene status was mutated in 52% of cases, cytogenetic aberrations were observed in 70.5% of patients, including 13q14_deletion (36.5%), trisomy_12 (13%), 11q22_deletion (9.7%), and 17p_deletion (8.3%). The median age at diagnosis was 66 years old, and the median follow-up was 5 years. Our results identify a novel CLL subgroup characterized by clonal expression of an unmutated BCR with specific rearrangements (IgHV_1-02, 1-69, 3-30, 4-39), high expression of AID enzyme and earlier treatment. Moreover, our results suggest that AID expression in U-CLL could be linked with antigen restriction and clinical outcome. This subset constitutes approximately 38% of the U-CLL (15% of the total cohort) and can be identified in advance by integrating AID mRNA expression and IgVH profile assessment into routine testing. We propose a new and practical prognostic tool, assessed in PB, which enables the identification of a novel CLL entity requiring early treatment initiation, typically within the first year.
eu_rights_str_mv openAccess
format conferenceObject
id IPMON_e2a432b59dd7bdea00ff81d2697edf3c
identifier_str_mv FCE_1_2021_1_166493
instacron_str Institut Pasteur de Montevideo
institution Institut Pasteur de Montevideo
instname_str Institut Pasteur de Montevideo
language eng
network_acronym_str IPMON
network_name_str IPMON en REDI
oai_identifier_str oai:redi.anii.org.uy:20.500.12381/3878
publishDate 2024
reponame_str IPMON en REDI
repository.mail.fl_str_mv msarroca@pasteur.edu.uy
repository.name.fl_str_mv IPMON en REDI - Institut Pasteur de Montevideo
repository_id_str 9421_2
rights_invalid_str_mv Reconocimiento 4.0 Internacional. (CC BY)
Acceso abierto
spelling Reconocimiento 4.0 Internacional. (CC BY)Acceso abiertoinfo:eu-repo/semantics/openAccess2025-02-25T17:06:29Z2025-02-25T17:06:29Z2024-11https://hdl.handle.net/20.500.12381/3878FCE_1_2021_1_166493https://lag-cll2024.opc.uy/en/trabajos?area=&numero=&searchChronic lymphocytic leukemia (CLL) is characterized by its clinical and molecular heterogeneity. The practical challenge presented by this diverse landscape is the difficulty in predicting leukemia progression. Despite extensive efforts employing various clinical and/or molecular prognostic tools, accurate prediction of disease progression remains elusive for a significant number of patients. Our group and others described that activation-induced cytidine deaminase (AID) is abnormally expressed in the peripheral blood (PB) of patients with poor clinical outcomes, predominantly in unmutated cases (U-CLL). This enzyme is necessary to initiate somatic hypermutation (SHM) and class-switch recombination process in B- lymphocytes. Additionally, deamination of “off-target” genes by AID can result in oncogenic mutations or translocations. Nevertheless, the role of this enzyme in the origins and evolution of CLL as well as why AID is predominantly expressed in U-CLL, remains a topic of ongoing debate. Previous studies from our laboratory demonstrated the loss of superantigenic and polyreactive binding of B-cell receptor (BCR) following SHM, (Oppezzo et al., 2004 EJI). Furthermore, findings from (Hervé et al. 2005, JCI), provide evidence that both U-CLLs and M-CLLs may originate from self-reactive B cell precursors. Collectively, these studies highlight SHM as a pivotal process in the origins/development of B-cell lymphoid neoplasms by altering the original autoreactivity of the BCR. Based on this concept, we hypothesize that the absence of SHM in U-CLL may result in continuous BCR stimulation and constitutive AID expression, contributing to a poorer clinical outcome. In this work, we characterized CLL patients based on AID expression in PB, its association with immunoglobulin heavy chain gene (IgVH) status/use and disease progression, assessed as time to first treatment (TTFT). PB samples were collected from patients meeting the clinical/immunophenotypic criteria for CLL, following the iwCLL guidelines. The cohort included 279 patients from Uruguay and 33 from Argentina. Written informed consent was obtained, and the study was approved by the Institutional Ethics Committees of each institution. Peripheral blood mononuclear cells were isolated using Ficoll-Hypaque, and RNA extraction and cDNA synthesis performed. From 312 studied cases, 56% were Binet's stage A, 23% were stage B, and 21% were stage C. The IgHV gene status was mutated in 52% of cases, cytogenetic aberrations were observed in 70.5% of patients, including 13q14_deletion (36.5%), trisomy_12 (13%), 11q22_deletion (9.7%), and 17p_deletion (8.3%). The median age at diagnosis was 66 years old, and the median follow-up was 5 years. Our results identify a novel CLL subgroup characterized by clonal expression of an unmutated BCR with specific rearrangements (IgHV_1-02, 1-69, 3-30, 4-39), high expression of AID enzyme and earlier treatment. Moreover, our results suggest that AID expression in U-CLL could be linked with antigen restriction and clinical outcome. This subset constitutes approximately 38% of the U-CLL (15% of the total cohort) and can be identified in advance by integrating AID mRNA expression and IgVH profile assessment into routine testing. We propose a new and practical prognostic tool, assessed in PB, which enables the identification of a novel CLL entity requiring early treatment initiation, typically within the first year.Agencia Nacional de Investigación e Innovacióneng5th Latin-American group on CLL_2024 (LAG-CLL)reponame:IPMON en REDIinstname:Institut Pasteur de Montevideoinstacron:Institut Pasteur de MontevideoLeucemia Linfoide CrónicaCitidina deaminasa Inducida por Activación (AID)Ciencias Médicas y de la SaludMedicina BásicaInmunologíaMedicina ClínicaHematologíaA subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatmentDocumento de conferenciaAceptadoinfo:eu-repo/semantics/acceptedVersioninfo:eu-repo/semantics/conferenceObjectInstitut Pasteur de MontevideoAdministración de Servicios de Salud del Estado, Hospital MacielUniversidad de Magallanes. Punta Arenas, Chile.Centro Asistencial del Sindicato Médico del UruguayUniversidad de la República, Facultad de Medicina, Hospital de ClínicasHospital BritánicoCOSEM, Departamento de HematologíaServicio Médico IntegralCONICET, Academia Nacional de Medicina, Argentina.Administración de Servicios de Salud del Estado, Hospital de Rocha, Servicio de Hematología, UE 027Universidad de la República, Facultad de AgronomíaHospital Central de las Fuerzas Armadas (FFAA), Departamento de Hematología//Ciencias Médicas y de la Salud/Medicina Básica/Inmunología//Ciencias Médicas y de la Salud/Medicina Clínica/HematologíaSouto, JorgeLandoni, Ana InesRemedi, Victoriados Santos, GimenaOliver, CarolinaIrigoin, VictoriaLema, VirginiaRanero, SabrinaStanganelli, CarmenPuelma, Jorge GonzalesPayque, EugeniaUria, RitaQuerol, JulianaMarquez, Maria Elenade Galvez, GabrielaPierri, SilviaKollar, PatriciaStevenazzi, MarianaMoro, IsabelViana, MarceloNaya, HugoSlavutsky, IrmaDiaz, LilianKescherman, FrancisMuxi, PabloGrille, SofiaGuillermo, CeciliaLassus, MercedesDighiero, GuillermoGabus, RaúlPalacios, FlorenciaNavarrete, MarceloOppezzo, PabloLICENSElicense.txtlicense.txttext/plain; charset=utf-85124https://redi.anii.org.uy/jspui/bitstream/20.500.12381/3878/2/license.txt710ccfef5cb01d54b75d1d847d6b6b7bMD52ORIGINAL5thLAG-CLL.pdf5thLAG-CLL.pdfPoster aceptado en el 5th LAG-CLL_2024application/pdf422709https://redi.anii.org.uy/jspui/bitstream/20.500.12381/3878/1/5thLAG-CLL.pdf12514d99af289a611f93947fc960dac6MD5120.500.12381/38782025-02-25 14:06:31.217oai:redi.anii.org.uy:20.500.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://hdl.handle.net/20.500.12381/575Organismo científico-tecnológicohttps://pasteur.uy/https://redi.anii.org.uy/oai/requestmsarroca@pasteur.edu.uyUruguayopendoar:9421_22025-02-25T17:06:31IPMON en REDI - Institut Pasteur de Montevideofalse
spellingShingle A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment
Souto, Jorge
Leucemia Linfoide Crónica
Citidina deaminasa Inducida por Activación (AID)
Ciencias Médicas y de la Salud
Medicina Básica
Inmunología
Medicina Clínica
Hematología
status_str acceptedVersion
title A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment
title_full A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment
title_fullStr A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment
title_full_unstemmed A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment
title_short A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment
title_sort A subgroup of patients with unmutated IgHV 1-69; 3-30; 1-02; 4-39 and high expression of AID enzyme require earlier treatment
topic Leucemia Linfoide Crónica
Citidina deaminasa Inducida por Activación (AID)
Ciencias Médicas y de la Salud
Medicina Básica
Inmunología
Medicina Clínica
Hematología
url https://hdl.handle.net/20.500.12381/3878
https://lag-cll2024.opc.uy/en/trabajos?area=&numero=&search