In recent years there have been two cycloterpenals, molecules consisting of a cyclohexadienal core, isolated from nature. Cyclocitral, the condensation product of citral, has been isolated from the North Sea bryozoans Flustra foliacea. In the human eyes, cycloretinal has been isolated and is a toxic by product of the vision cycle. This retinal dimer is believed to contribute to age related macular degeneration, the leading cause of blindness in the elderly. In 1992, it was discovered that if [beta]-ionylideneacetaldehyde was incubated with beta-lactoglobulin ([beta]-LG), the principal whey protein in dairy milk, that it would mediate the formation of cyclo-[beta]-ional. No follow up studies were performed on this protein mediated reaction or what biological activities these cycloterpenals may possess. This dissertation investigates the biological roles of substituted cyclohexadienes including cycloterpenals and cyclohexadiene enaminonitriles. To mimic the protein mediated reaction, we developed a synthetic procedure to produce a wide array of cycloterpenal by utilizing L-proline. Over 100 cycloterpenals were synthesized and screened for their biological activities against an array of cell based screens. The phenotypic effects of these cycloterpenals were screened against a PC12 assay where dramatic effects were observed on neurite outgrowth. During the synthesis of starting materials for the production of our cycloterpenal library, it was discovered that if excess base was added to the Horner-Wadsworth-Emmons reaction between a methyl-ketone and diethyl-(cyanomethyl)-phosphonate, conversion of the [alpha]-[beta]-unsaturated nitrile into an enaminonitrile was observed. This new synthetic procedure was optimized to generate a library of enaminonitriles as well as their quinazoline derivatives. The work within also includes the investigation of the [beta]-LG mediated reaction formation of cycloterpenals with natural and unnatural [beta]-methyl aldehydes. We were able to demonstrate that [beta]-LG could mediate the conversion of [alpha],[beta]-unsaturated aldehydes into their corresponding cycloterpenal. In vitro analysis was also performed with store bought milks and the [beta]-LG present was able to mediate the formation of cyclocitral. An in vivo experiment was also performed by utilizing New Zealand White rabbits to demonstrate the formation of cycloretinal within the blood stream by feeding a source of [beta]-LG with retinal. Interestingly, in human blood, [beta]-LG is present at concentrations of 0.7-1.2 g/dL. The protein has been identified within drusen pigments and lipofuscin granules that accumulate in the retina of macular degeneration patients. As humans do not produce beta-lactoglobulin, the source of this protein is from milk and milk products. With these experiments, we clearly demonstrate that under the appropriate conditions, cycloretinal can be produced with [beta]-LG. We have clearly established a direct link between [beta]-LG chemistry and age-related macular degeneration.

published_or_final_version / Biological Sciences / Doctoral / Doctor of Philosophy

Major depression and Alzheimer’s disease (AD) are highly prevalent psychiatric disorders. Further investigation demonstrated that depression itself is a risk factor for AD, and several associated genetic mutations have been found Moreover, significant proportion of AD patients suffer also suffer from depression. These findings generated interests in finding the neurobiological linkages between depression and AD. The elucidation of pathophysiological mechanisms common in both disorders would be important, as the knowledge could provide additional insights regarding the pathogeneses of the disorders and possible interventions. The present study proposes that synaptic degeneration plays a central role in the pathogenesis of depression and AD. Using in vitro disease models, this study demonstrated abnormalities in pre-synaptic and cytoskeletal proteins, which leads to impaired synaptic function. Further investigation into the upstream events demonstrated the involvement of ubiquitin-mediated protein degradation mechanism and the preferential activation of the autophagic-lysosomal pathway. This study also investigated the neuroprotective properties of the antidepressants imipramine and escitalopram. Antidepressants have originally been thought to exert their therapeutic effects through monoaminergic system modulation. Interestingly, results in this study showed that these two agents were able to ameliorate the observed synaptic protein changes, thereby implicating other possible mechanism of action for antidepressants. In conclusion, this study provides evidence that similar synaptic pathologies exist between depression and AD, which could be responsible for the development of these two disorders. Furthermore, antidepressants may be exerting its effects through alleviating synaptic degeneration. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

Choroidal neovascularization (CNV) is a leading threat to severe vision loss, particularly in patients with age-related macular degeneration (AMD). In CNV, newly formed blood vessels sprout from the choroid to the sub-retinal space, where leakage and bleeding of the abnormal vessels lead to photoreceptor death and subsequent vision loss. It is believed that CNV is mediated by growth factors (e.g. vascular endothelial growth factor {VEGF}) produced by the retinal pigment epithelium (RPE) under pathological states (e.g. hypoxia). Current treatments for CNV aiming at countering VEGF only help decrease leakage and inhibit formation of CNV, but none of them is curative and the recurrence rate remains high. In order to find other more powerful potential therapeutic targets, the regulations of VEGF signaling in the pathophysiology of CNV is the focus of numerous translational investigations. Previously, Hypoxia-inducible factor-1 (HIF-1), a crucial transcriptional factor in response to hypoxia, is identified as the master transcriptional factor controlling VEGF expression in the RPE promoting CNV. Alpha-enolase (ENO1), a key glycolytic enzyme, is known to be over expressed in several types of carcinomas also under the regulation of HIF-1. ENO1 has been reported to be closely associated with cancer progression, angiogenesis, and venous invasion. The molecular events of ENO1 in the pathogenesis of promoting angiogenesis are of interest but still barely understood. Recently, the association of ENO1 antibodies with retina has been seen in patients with AMD. We hypothesize that ENO1 expression in the RPE may play a role in the development of CNV, participating in the regulation of VEGF. Hypoxia is an important pathological condition in the formation of CNV. Here, we first determined ENO1 expression and cell death in a human RPE cell line, ARPE-19, under cobalt (II) chloride (CoCl2)-induced hypoxia or anoxia (95% N2, 5% CO2). To further investigate the regulation of ENO1 in CNV, HIF-1α-diminished RPE cells were generated using small interfering RNA (siRNA) and the change of ENO1 expression in response to hypoxic injury was determined. Upon 24 hr of treatment with CoCl2-induced hypoxia or anoxia, the expression of ENO1 and VEGF increased significantly along with HIF-1α in ARPE-19 cells, both of which could in turn be significantly down-regulated by HIF-1α siRNA. Interestingly, cell death remained low in ARPE-19 cells, even after 24 hr of CoCl2-induced hypoxia or anoxia. To further study the role of ENO1 in CNV, we started by investigating the relationship between ENO1 and VEGF. SiRNA was used to knock down the expression of ENO1 in ARPE-19 cells. Upon transfection with the siRNA, ENO1 expression was successfully down-regulated when treated with CoCl2-induced hypoxia. However, VEGF secretions from the ENO1-diminished ARPE-19 cells under CoCl2-induced hypoxia remained unchanged. Double knockdown of ENO1 together with HIF-1α by siRNA also did not help to further suppress VEGF secretion in the hypoxic ARPE-19 cells. Hence, ENO1 was demonstrated to be activated and up-regulated by HIF-1 in RPE cells responding to hypoxia, suggesting a potential role of ENO1 in favoring the formation of CNV, but not through influencing VEGF secretion. / published_or_final_version / Ophthalmology / Master / Master of Philosophy

Although bevacizumab is one of the most commonly used treatments for DME and AMD, there are concerns regarding safety and effectiveness due to its off-label use. The study objectives were to determine if: 1) the risk of cardiovascular/ hemorrhagic events (safety) and visual impairment (effectiveness) differed by bevacizumab use (i.e., use vs. non-use and number of treatments) among DME and AMD patients; and 2) direct medical costs differed between DME and DME control patients. A retrospective cohort analysis was conducted with Texas Medicaid medical and prescription data (9/1/07-12/31/12) for patients: 18- 63 years, continuously enrolled 1-year pre- and post-index, and diagnosed with DME or AMD. The index date was the first date of diagnosis. The dependent variables were: 1) cardiovascular/hemorrhagic risk; 2) visual impairment; 3) direct medical costs. The independent variables were bevacizumab use and number of bevacizumab treatments. Covariates were disease state, Charlson Comorbidity Index (CCI) score, total medication use, number of laser treatments, and demographics. Propensity scoring technique was used to match: 1) bevacizumab users and non-users; and 2) DME and DME control cohorts. Descriptive analyses, logistic regression, Cox-regression, and generalized linear models were employed. A final cohort of 3,647 DME, 297 AMD, and 57,897 DME control patients were included. The majority (DME and AMD) was between 45-63 years of age (86.6%), Hispanic (54.0%), and female (65.1%). The mean total number of unique medications and mean CCI were 2.7 ± 3.4 and 6.0 ± 3.3, respectively. Total direct medical costs/person (Mean (±SD)) incurred by DME, DME control, and AMD subjects in the post-index period were $6,704(±9,338), $5,495(±10,153), and $4,935(±12,702), respectively. No differences in cardiovascular/ hemorrhagic risk were found between bevacizumab users and non-users. The claims data lacks the detail to determine the effectiveness of bevacizumab. DME control patients had lower overall direct medical costs than DME patients (p<0.0001). In conclusion, although bevacizumab is a less expensive off-label alternative of ranibizumab, the choice between bevacizumab and ranibizumab should be made through careful consideration. However, as the use of anti-VEGF agent increases, further research should be conducted to determine if any changes in cardiovascular adverse events occur. / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Σκοπός: Ο νεοεννευρωμένος μεσοσπονδύλιος δίσκος (ΜΔ), κλινικά θεωρείται μια σημαντική πηγή πόνου στους ασθενείς με οσφυαλγία. Η ταυτοποίηση των νεοσχηματιζόμενων νεύρων, που εκφράζουν τους υποδοχείς των νευροτροφινών, στην εκφύλιση του ΜΔ, σπονδυλικών επιπέδων που αναφέρονται ως πηγή δισκογενή πόνου και η συσχέτισή τους με το ενδοκανναβινοειδές σύστημα αναλγησίας, αποτελεί το αντικείμενο αυτής της μελέτης. Υλικό και μέθοδος: Συλλέχθηκαν 50 ανθρώπινοι ΜΔ ή τμήματα αυτών, μετά από δισκεκτομή σε χειρουργεία κήλης και εκφυλιστικών παθήσεων της Οσφυϊκής Μοίρας της Σπονδυλικής Στήλης (ΟΜΣΣ). Εφαρμόσθηκε ανοσοϊστοχημεία για την ανίχνευση νευρικών ινών, στους ΜΔ, αφού διαπιστώθηκε η εκφύλισή τους. Συσχετίσθηκε η ανάπτυξη νευρικών ινών των εκφυλισμένων ΜΔ με την έκφραση των υψηλής και χαμηλής συγγένειας υποδοχέων των νευροτροφινών, TrkA, TrkB, TrkC και p75, αντίστοιχα. Στα περιστατικά με ανάπτυξη νευρικών ινών ανιχνεύθηκε ανοσοϊστοχημικά η έκφραση του υποδοχέα CB1 των ενδοκανναβινοειδών. Αποτελέσματα: Η εκτεταμένη νεύρωση στον ΜΔ που φέρεται στον έσω ινώδη δακτύλιο (ΙΔ) και μπορεί να φτάνει μέχρι τον πηκτοειδή πυρήνα (ΠΠ), φαίνεται να είναι εξαρτώμενη από τους υποδοχείς των νευροτροφινών TrkA, TrkB, TrkC και p75. Μικρά αιμοφόρα αγγεία συνοδεύουν τις νευρικές ίνες στα σπονδυλικά επίπεδα του ΜΔ που δίνουν δισκογενή πόνο και εκφράζουν επίσης τους υποδοχείς των νευροτροφινών. Ο CB1 υποδοχέας των ενδοκανναβινοειδών ταυτοποιήθηκε σε όλα τα περιστατικά που εμφάνιζαν ανάπτυξη νευρικών ινών. Βρέθηκε να εκφράζεται στα αγγεία που συνοδεύουν τις νευρικές ίνες και σε μερικά νεύρα. Δεν ταυτοποιήθηκε ανάπτυξη νευρικών ινών σε εκφυλισμένους ΜΔ σπονδυλικών επιπέδων που δεν αποτελούσαν αιτία δισκογενούς οσφυαλγίας. Συμπέρασμα: Η αλγοϊδιοδεκτική ανάπτυξη νευρικών ινών στον ΜΔ συνδέεται με την έκφραση των υποδοχέων των νευροτροφινών στις νεοσχηματιζόμενες νευρικές ίνες, δείχνοντας ότι όχι μόνο ο NGF, αλλά και άλλες νευροτροφίνες εμπλέκονται στην ανάπτυξη νευρικών ινών. Η έκφραση του CB1 υποδοχέα των ενδοκανναβινοειδών αποτελεί πεδίο έρευνας για τη θεραπεία του δισκογενή πόνου. / The current study was designed in order to detect immunohistochemically the expression of cannabinoid CB1 receptor and high and low affinity neurotrophin receptors TrkA, TrkB, TrkC and p75 respectively in human painful intervertebral disc (IVD). Previous data have shown an association between nerve ingrowth in human degenerated IVD and patient’s experience of pain. The nociceptive nerve ingrowth into painful IVD is causally linked with Nerve Growth Factor (NGF) production by blood vessels growing into the IVD. NGF causes further innervation and is involved in processes that result in an inflammatory hyperalgesia. There is evidence that cannabinoids show a neuronal CB1 receptor-mediated antihyperalgesic action and a separate inhibition of proinflammatory neuroimmune processes. A total of 50 IVD specimens after lumbar discectomy were included in the present study. The degeneration of IVD was identified and connected with clinical background of patients. An immunoperoxidase method on formalin-fixed, paraffin-embedded tissue sections and specific antibodies against CB1 and neurotrophin receptors (TrkA, TrkB, TrkC and p75) were used. Immunohistochemistry was also performed to detect neural and vascular markers: tubulin (βIII) and CD31. Neurotrophin receptors (TrkA, TrkB, TrkC and p75) expression was detected only in innervated degenerated IVD. Blood microvessels accompanied nerve fibers growing into IVD expressed also neurotrophin receptors. Furthermore, in some nerve fibers CB1 cannabinoid receptor expression was identified. Interestingly, CB1 receptor expression was detected in the majority of vessels accompanying nerve fibers. Nociceptive nerve ingrowth into degenerated IVD was strongly associated with all neurotrophin receptors expression indicating that not only NGF but also and others neurotrophins are involved in nerve ingrowth. Expression of CB1 cannabinoid receptor in innervated IVD suggests a possible therapeutic site of analgesic action. Additional studies would be necessary to clarify the functional role of CB1 cannabinoid receptor in degenerated intervertebral disc.

Age related macular degeneration (AMD) is the most common cause of irreversible vision loss in the elderly. At present, there are an estimated one million people in Canada with some form of AMD and this number is expected to double to two million by 2031. These estimates are sobering, and it is predicted that costs for treatment and care of individuals who suffer vision loss from AMD will have significant impact on the social and public health systems in Canada in the next two decades. There are treatments to slow the progression of vision loss, but unfortunately, there are currently no cures available for AMD. In order to develop effective second generation therapies and cures, further insights into how and why AMD develops are greatly needed. Recent studies have provided novel insights into the role of inflammation in the pathogenesis of AMD. Inflammation, or swelling of the retinal tissues, causes harmful processes that promote macular degeneration. The proposed studies will focus on the triggers of inflammation in the retina. It is hypothesized that macular degeneration may be slowed or stopped by eliminating the molecules that cause inflammation in the retina. This study will focus on amyloid beta (Aβ), a toxic molecule that has been implicated in retinal inflammation, and the role that it may play in gene expression of the retinal pigment epithelial cell. Amyloid beta is a well studied peptide in another age related disorder, Alzheimer’s disease. It is the major extracellular deposit in Alzheimer’s disease plaques, and has recently been discovered as a component of drusen, the hallmark extracellular deposits in the retina of patients with the ‘dry’ form of AMD. These studies will allow the development of new treatment regimens that target retinal inflammation and thus minimize the processes that ‘trigger’ the onset of macular degeneration.

Axon degeneration is a selective elimination of axons, which plays a crucial role during development, injury, and maintenance of neuronal connections. The p75 neurotrophin receptor (NTR) is responsible for maintaining the specificity of neuronal connectivity in parts of the adult brain by inducing the degeneration of aberrantly growing axons into myelinated tracts. The objective of this study is to identify and characterize the signaling pathways used by p75NTR to mediate axon degeneration on myelin. Since p75NTR signals via JNK/Bax/caspase pathway to cause apoptosis, I asked whether this pathway might also be involved in axon degeneration. I observed that inhibition of JNK or Bax significantly decreased myelin-induced axonal degeneration, while depolarization of axons with potassium chloride prevented axonal degeneration on myelin. Together, these results suggest that p75NTR-dependent, myelin-mediated axon degeneration occurs via JNK/BAX signaling, and that neural activity is important for the prevention of myelin-induced axonal degeneration.

No description available.