ABCB1, a member of the ATP binding cassette (ABC) transporter family, hydrolyses ATP as energy source for the translocation of substrate chemicals across the cell membrane. ABCB1-like transporters are found in all studied species. Typically, these transporters are abundant in tissues that separate compartments of the body such as the blood-brain barrier. Among the ABC transporters the ABCB1-like transporter proteins are of particular interest because they accept a broad variety of substrates and are therefore able to confer multidrug resistance (MDR) and multixenobiotic resistance (MXR) in wildlife, respectively. Inhibitors of the ABCB1-like transporter function can cause chemosensitisation, i.e. accumulation and increased sensitivity of organisms towards potentially harmful (natural/man-made) ABCB1-like substrate chemicals. In zebrafish (Danio rerio) Abcb4 was identified as functionally homologous to ABCB1. The aim of this study was to further characterise Danio rerio Abcb4 and to provide a database to approach the question to what extent ABCB1-like transporter related functions/effects are of ecotoxicological relevance. Main objectives are whether and how known ABCB1 ATPase stimulators and inhibitors interact with Abcb4 ATPase activity; to what extent ABCB1 ATPase assay data are transferable to Abcb4 ATPase assay data; and whether and how environmental chemicals interact with Danio rerio Abcb4 ATPase activity. In this study we established a test system – the ATPase assay with recombinant Danio rerio Abcb4 – to study the interaction of chemicals with the ATPase activity of the transporter protein. To relate obtained data to data for the well-known Homo sapiens ABCB1 and because available data for Homo sapiens ABCB1 were not in all cases suitable for a comparison, the ATPase assay with recombinant ABCB1 was adapted accordingly. Chemicals were tested up to concentrations in the range of their water solubilities to modulate basal and stimulator co-treated Abcb4 and/or ABCB1 ATPase activities. ATPase stimulators are often transported substrates. However, lipophilic compounds stimulating the transporter ATPase activity are not or little transported by transporter action. Therefore, experiments revealing whether compounds are translocated by transporters chemical interference with the transporter protein will not be indicated. Chemicals inhibiting the stimulator (here verapamil) co-treated ATPase activity compete with the verapamil to stimulate ATPase activity or are non-competitive inhibitors. When tested individually, these chemicals can be stimulators or inhibitors of basal ATPase activity, or do not interact with basal ATPase activity. ATPase inhibitors mitigate ATPase activity and ABCB1-like transporter mediated translocation of substrate chemicals. Obtained ATPase assay data were analysed with regard to concentrations at half-maximal effects (EC50s) and effect strengths (percent modulation). ATPase assays with recombinant Abcb4 (at 27 °C) are comparable to ABCB1 ATPase assay data obtained at 37 °C. Danio rerio Abcb4 seems less temperature-sensitive than ABCB1. Calculated activation energies for Abcb4 ATPase activities (40.75 kJ/mol for basal ATPase activity) were up to half as high as those for ABCB1 ATPase activities (81.61 kJ/mol for basal ATPase activity). Larger activation energies were previously proposed to be indicative for larger conformational rearrangements and hence possibly smaller rearrangements take place in Abcb4 compared to ABCB1. Known standard modulators of Homo sapiens ABCB1 ATPase activity interacted specifically with Danio rerio Abcb4 ATPase actitiy. The EC50s of the tested chemicals – 16 of 17 tested chemiacals interacted with the ABCB1 and the Abcb4 ATPase activity – ranged from 0.09 to 296 µM for ABCB1 and from 0.14 to 171 µM for Abcb4. Qualitative ATPase assay data for ABCB1, as interaction or not, seems transferable to Danio rerio Abcb4. Furthermore, when aligning amino acid sequences of mammalian ABCB1 transporter proteins and Danio rerio Abcb4 and comparing ABCB1 residues known to bind to (lipophilic) chemicals no obvious hints were found that chemical binding to Abcb4 is certainly different from ABCB1. Twenty-five of 33 studied environmental chemicals modulated the Abcb4 ATPase activity as stimulators and/or inhibitors. Stimulation of basal Abcb4 ATPase activity was lower for environmental chemicals than for known standard modulators. EC50s of environmental chemicals ranged from below 10 to 357 µM. Effects by environmental chemicals on Abcb4 ATPase activity with EC50s close to their water solubilities may be rather unspecific. The results of this work underline that Abcb4 function is of ecotoxicological importance as on the one hand several environmental chemicals were identified to inhibit Abcb4 ATPase activity – likely acting as chemosensitisers, while on the other hand chemicals stimulating basal ATPase activity suggest that these chemicals are possibly transported. A number of environmental chemicals also inhibited the basal Abcb4 ATPase activity. Especially non-transported inhibitors of the basal Abcb4 ATPase activity would be of ecotoxicological relevance as organisms (here Danio rerio) exposed to these chemicals would not be protected by Abcb4 mediated multixenobiotic resistance and were moreover threatened by chemosensitisation. Future studies should systematically elucidate under which circumstances chemicals are apparently net transported by ABCB1-like transporters and relate these findings to concentrations of environmental chemicals and ABCB1-like transporter protein abundance in wildlife.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Ovarian cancer is one of the most common female cancer diseases in the world today and in Sweden more than 800 new cases are diagnosed every year. The standard treatment consists of chemotherapy with paclitaxel in combination with carboplatin after initial cytoreductive surgery. The response to treatment and the severity of adverse drug reactions after chemotherapy varies greatly among individuals, and one of the most important factors responsible for these differences is now recognized to be the genetic variability. One of the major obstacles to successful treatment is drug resistance. Several potential mechanisms have been suggested for the resistance to paclitaxel, such as mutations in the target protein β-tubulin, single nucleotide polymorphisms (SNPs) in the gene ABCB1, which encodes the transport protein P-glycoprotein. P-glycoprotein can mediate efflux of various drugs from cancer cells as well as from the circulation into the intestinal lumen, and overexpression and/or high activity leads to drug resistance and/or increased elimination. Another reason might be the high interindividual variability of paclitaxel plasma concentrations, which has been suggested to be influenced by variability in metabolic enzymes, such as CYP2C8 and CYP3A4, and transport proteins e.g. P-glycoprotein. In the studies constituting this thesis we have investigated the possibilities of predicting the pharmacokinetics of paclitaxel as well as the tumor response and adverse drug reactions after chemotherapy in the preparation of personalized chemotherapy. We studied the correlation between the response and the presence of mutations in the dominant β-tubulin gene and SNPs in ABCB1. DNA from 40 ovarian tumors was screened for sequence variations in the β-tubulin gene without finding any, showing that β-tubulin mutations are rare and unlikely to be a clinically relevant resistance mechanism for paclitaxel. The SNPs G2677T/A and C3435T in the ABCB1 gene were determined in 53 ovarian cancer tumors from patients with poor (progressive disease or relapse within one year) or good (disease-free survival of more than one year) response to paclitaxel-carboplatin chemotherapy. Patients homozygously mutated for G2677T/A had a higher probability of responding to chemotherapy. There was also a dose-dependent influence of the number of mutated alleles on the response to paclitaxel treatment. No correlation was found for the C3435T variant. By using a newly developed quantitative LC/MS method for the simultaneous determination of paclitaxel and its hydroxymetabolites in human plasma we assessed the individual elimination of paclitaxel in 33 ovarian cancer patients. The patients were genotyped for SNPs in the ABCB1, CYP2C8 and CYP3A4 genes and their in vivo CYP3A4 enzyme activity, tumor response and toxicity, especially the neurotoxicity, were determined. Patients heterozygous for G/A in position 2677 in ABCB1 had a significantly higher clearance of paclitaxel than patients with the wild type or homozygously mutated, but not compared to patients carrying the G/T alleles. A lower clearance of paclitaxel was also found for patients heterozygous for CYP2C8*3 when stratified according to the ABCB1 G2677T/A genotype. The CYP3A4 enzyme activity in vivo affected the relative influence of CYP2C8 and CYP3A4 on the metabolism, but not the total clearance of paclitaxel. The exposure to paclitaxel was correlated to the neurotoxicity, but not to the treatment response. In conclusion, our findings suggest that the SNP G2677T/A in the ABCB1 gene, but not β-tubulin mutations, might be a predictor for paclitaxel response and that the interindividual variability in paclitaxel pharmacokinetics might be predicted by ABCB1 and CYP2C8 genotypes and provide useful information for individualized chemotherapy. / Ovarialcancer (äggstockscancer) är en av de vanligaste cancerformerna hos kvinnor i Sverige idag. Behandlingen består vanligen av tumörreducerande kirurgi följd av kemoterapi med paklitaxel och karboplatin. Målsättningen med detta avhandlingsarbete har varit att förbättra cytostatikabehandlingen (cellgiftsbehandlingen) med framförallt paklitaxel vid ovarialcancer genom att lägga grunden för individualisering av doser och förutsäga tumörsvaret vid behandlingen. Ett problem med dagens cancerbehandling är att många cancerceller så småningom blir resistenta mot olika cytostatika. För att angripa den mest resistenta cellen innan den induceras att öka uttrycket av, eller utveckla, fler resistensmekanismer vore det en fördel om vi före behandlingen kunde prediktera vilken dos av cytostatika som är bäst lämpad för individen samt om tumören kommer att reagera på behandlingen eller ej. En av de viktigaste faktorerna för skillnader i behandlingseffekt tros vara genetiska variationer mellan olika individer. I våra studier har vi använt genetiska metoder för att studera om vi kan prediktera tumörsvaret vid behandlingen genom att bestämma mutationer i genen för paklitaxels målprotein, β-tubulin, samt bestämma genetiska variationer i ABCB1-genen, kodande för transportproteinet P-glykoprotein. Tanken är att ett förändrat målprotein eller en förändrad förmåga hos cancercellerna eller kroppen att transportera ut paklitaxel skulle leda till en skillnad i påverkan på tumören. DNA från 40 ovarialtumörer analyserades utan att en enda sekvensvariation hittades i genen för β-tubulin, vilket tyder på att genetiska förändringar i genen för β-tubulin sannolikt inte är en klinisk relevant resistensmekanism. De normalt förekommande genetiska variationerna G2677T/A och C3435T i ABCB1-genen bestämdes i DNA från 53 ovarialtumörer där behandlingen endera givit en bra (tumörfri minst ett år) eller dålig (progression av tumören eller tumörfri mindre än ett år) anti-tumöreffekt. Patienter som var dubbelmuterade i position 2677 dvs hade endera T/T eller T/A (A/A hittades inte i materialet) i denna position hade en högre sannolikhet att få ett bra anti-tumörsvar vid behandlingen. Även antalet muterade baser påverkade utfallet, ju fler muterade baser i position 2677, desto högre sannolikhet att få ett bra svar på behandlingen. Andelen T eller A var också högre i den grupp av patienter som fått en lyckad behandling. För att kunna prediktera patientens individuella förmåga att bryta ner paklitaxel studerade vi inverkan av sekvensvariationer i generna för de nedbrytande enzymerna, CYP2C8 och CYP3A4, och transportproteinet P-glykoprotein (genen ABCB1) på eliminationen av läkemedlet i kroppen. Vi utvecklade en metod för att mäta paklitaxelkoncentrationerna i blodet och använde den för att studera hur snabbt 33 ovarialcancer patienter eliminerade cytostatikat från blodbanan. Hos dessa patienter bestämde vi förekomsten av kända genetiska variationer i generna ABCB1, CYP2C8 och CYP3A4 samt deras CYP3A4 enzymaktivitet i kroppen. Biverkningarna och tumörsvaret vid behandlingen utvärderades också. Eliminationen av paklitaxel hos dessa patienter var beroende av vilken bas som fanns i position 2677 i ABCB1-genen och förekomsten av den genetiska varianten CYP2C8*3. Enzymaktiviteten hos CYP3A4 kunde inte påvisas påverka eliminationen av paklitaxel utan snarare vilket enzym, CYP2C8 eller CYP3A4, som var relativt dominant i respektive patient. Exponeringen av paklitaxel korrelerade till den neurologiska påverkan som patienten orsakades av cytostatikat, men kunde inte korreleras till tumörsvaret vid slutet av cytostatikabehandlingen. Sammanfattningsvis ger patientens genetiska variationer i ABCB1, men inte β-tubulin, information om behandlingsutfallet. Genetiska variationer i CYP2C8 och ABCB1 påverkar patientens förmåga att eliminera paklitaxel och kan förhoppningsvis användas för att individualisera doserna. Vår förhoppning är att resultaten i denna avhandling skall kunna användas för att individualisera och ytterligare förbättra cytostatikabehandlingen vid ovarialcancer.

Background: Negative outcomes from fetal exposure to maternal dug use include Neonatal Abstinence Syndrome (NAS) and altered development, the unpredictability of which suggests a biological element as yet not accounted for. The manner in which the human placenta protects the fetus from xenobiotics such as drugs of misuse is not completely characterised. However, Adenosine Triphosphate Binding Cassette (ABC) transporters in placentae have demonstrated their ability to efflux xenobiotics away from the fetal vascular compartment leading to lower concentrations than in the maternal compartment and some commonly used drugs have been shown to be substrates for these proteins, e.g. methadone. It is suggested that polymorphisms in the genes that encode these transporter proteins may alter their expression and/or function. Hypothesis- Polymorphisms (SNPs) in the ABC transporters ABCB1, ABCG2, ABCC1 and ABCC2 change protein expression and/or function leading to increased fetal exposure demonstrated by increased signs of NAS and/or altered development. Objectives: To determine if genotype alters protein expression and whether there is a relationship between the level of placental multidrug resistance protein P-glycoprotein (P-gp), Breast Cancer Resistance Protein (BCRP), Multidrug Resistance Associated Proteins (MRP1 and MRP2) expression and neonatal and/or developmental outcomes. Methods: Drug using women were recruited. In the immediate postnatal period placental tissue, cord blood and maternal hair samples were taken. Hair was analysed to determine drug use in the preceding 3 months, immunoblotting determined the level of P-gp, BCRP, MRP1 and MRP2 protein expression. Sequenom MassExtend Array produced genotypes from DNA obtained from cord blood. Infants were assessed for NAS at birth, 3 days and 3 weeks. At 8 months and 1 year development was assessed using the Griffiths Mental Development Scales. Plink was used to determine statistically significant associations between genotype and outcome phenotypes. Results- The level of fetal drug exposure did not predict the need for pharmacological treatment for NAS. 32 polymorphisms with significant associations to outcome measures were identified: 4 SNPs significantly altered protein expression, (3 for P-gp and 1 for MRP1). 41 SNPs were associated with changes across 4 of the 5 GMDS subscales. Discussion: No clear relationship between MDRP protein expression and neonatal outcome was noted. However, fetal genotype did influence the expression of P-gp and MRP1 and genotype across all four proteins was associated with significant changes in the measures of infant development. This was a small study and as such generation of susceptible haplotypes was not possible. However the data generated do support the concept. Further larger and longer term prospective studies, building on the experience reported in this thesis, are necessary to generate more data in order to identify haplotypes leading to increased fetal susceptibility to drug exposure.

No description available.

Contexte - La variation interindividuelle de la réponse aux corticostéroïdes (CS) est un problème important chez les patients atteints de maladies inflammatoires d’intestin. Ce problème est bien plus accentué chez les enfants avec la prévalence de la corticodépendance extrêmement (~40 %) élevée. La maladie réfractaire au CS a des répercussions sur le développement et le bien-être physique et psychologique des patients et impose des coûts médicaux élevés, particulièrement avec la maladie active comparativement à la maladie en rémission, le coût étant 2-3 fois plus élevé en ambulatoire et 20 fois plus élevé en hôpital. Il est ainsi primordial de déterminer les marqueurs prédictifs de la réponse aux CS. Les efforts précédents de découvrir les marqueurs cliniques et démographiques ont été équivoques, ce qui souligne davantage le besoin de marqueurs moléculaires. L'action des CS se base sur des processus complexes déterminés génétiquement. Deux gènes, le ABCB1, appartenant à la famille des transporteurs transmembraneaux, et le NR3C1, encodant le récepteur glucocorticoïde, sont des éléments importants des voies métaboliques. Nous avons postulé que les variations dans ces gènes ont un rôle dans la variabilité observée de la réponse aux CS et pourraient servir en tant que les marqueurs prédictifs. Objectifs - Nous avons visé à: (1) examiner le fardeau de la maladie réfractaire aux CS chez les enfants avec la maladie de Crohn (MC) et le rôle des caractéristiques cliniques et démographiques potentiellement liés à la réponse; (2) étudier l'association entre les variantes d'ADN de gène ABCB1 et la réponse aux CS; (3) étudier les associations entre les variantes d'ADN de gène NR3C1 et la réponse aux CS. Méthodes - Afin d’atteindre ces objectifs, nous avons mené une étude de cohorte des patients recrutés dans deux cliniques pédiatriques tertiaires de gastroentérologie à l’Ottawa (CHEO) et à Montréal (HSJ). Les patients avec la MC ont été diagnostiqués avant l'âge de 18 ans selon les critères standard radiologiques, endoscopiques et histopathologiques. La corticorésistance et la corticodépendance ont été définies en adaptant les critères reconnus. L’ADN, acquise soit du sang ou de la salive, était génotypée pour des variations à travers de gènes ABCB1 et NR3C1 sélectionnées à l’aide de la méthodologie de tag-SNP. La fréquence de la corticorésistance et la corticodépendance a été estimée assumant une distribution binomiale. Les associations entre les variables cliniques/démographiques et la réponse aux CS ont été examinées en utilisant la régression logistique en ajustant pour des variables potentielles de confusion. Les associations entre variantes génétiques de ABCB1 et NR3C1 et la réponse aux CS ont été examinées en utilisant la régression logistique assumant différents modèles de la transmission. Les associations multimarqueurs ont été examinées en utilisant l'analyse de haplotypes. Les variantes nongénotypées ont été imputées en utilisant les données de HAPMAP et les associations avec SNPs imputés ont été examinées en utilisant des méthodes standard. Résultats - Parmi 645 patients avec la MC, 364 (56.2%) ont reçu CS. La majorité de patients étaient des hommes (54.9 %); présentaient la maladie de l’iléocôlon (51.7%) ou la maladie inflammatoire (84.6%) au diagnostic et étaient les Caucasiens (95.6 %). Huit pourcents de patients étaient corticorésistants et 40.9% - corticodépendants. Le plus bas âge au diagnostic (OR=1.34, 95% CI: 1.03-3.01, p=0.040), la maladie cœxistante de la région digestive supérieure (OR=1.35, 95% CI: 95% CI: 1.06-3.07, p=0.031) et l’usage simultané des immunomodulateurs (OR=0.35, 95% CI: 0.16-0.75, p=0.007) ont été associés avec la corticodépendance. Un total de 27 marqueurs génotypés à travers de ABCB1 (n=14) et NR3C1 (n=13) ont été en l'Équilibre de Hardy-Weinberg, à l’exception d’un dans le gène NR3C1 (rs258751, exclu). Dans ABCB1, l'allèle rare de rs2032583 (OR=0.56, 95% CI: 0.34-0.95, p=0.029) et génotype hétérozygote (OR=0.52, 95% CI: 0.28-0.95 p=0.035) ont été négativement associes avec la dépendance de CS. Un haplotype à 3 marqueurs, comprenant le SNP fonctionnel rs1045642 a été associé avec la dépendance de CS (p empirique=0.004). 24 SNPs imputés introniques et six haplotypes ont été significativement associés avec la dépendance de CS. Aucune de ces associations n'a cependant maintenu la signification après des corrections pour des comparaisons multiples. Dans NR3C1, trois SNPs: rs10482682 (OR=1.43, 95% CI: 0.99-2.08, p=0.047), rs6196 (OR=0.55, 95% CI: 0.31-0.95, p=0.024), et rs2963155 (OR=0.64, 95% CI: 0.42-0.98, p=0.039), ont été associés sous un modèle additif, tandis que rs4912911 (OR=0.37, 95% CI: 0.13-1.00, p=0.03) et rs2963156 (OR=0.32, 95% CI: 0.07-1.12, p=0.047) - sous un modèle récessif. Deux haplotypes incluant ces 5 SNPs (AAACA et GGGCG) ont été significativement (p=0.006 et 0.01 empiriques) associés avec la corticodépendance. 19 SNPs imputés ont été associés avec la dépendance de CS. Deux haplotypes multimarqueurs (p=0.001), incluant les SNPs génotypés et imputés, ont été associés avec la dépendance de CS. Conclusion - Nos études suggèrent que le fardeau de la corticodépendance est élevé parmi les enfants avec le CD. Les enfants plus jeunes au diagnostic et ceux avec la maladie coexistante de la région supérieure ainsi que ceux avec des variations dans les gènes ABCB1 et NR3C1 étaient plus susceptibles de devenir corticodépendants. / Background - Inter-individual variation in response to treatment by corticosteroids (CS) is an important problem in the management of inflammatory bowel disease (IBD) patient’s. This problem is even more prominent in children, the prevalence of steroid dependence (~40%) in whom is extremely high. Steroid refractoriness has a considerable impact on the physical and psychological development of these children, also imposing high medical costs related to treatment. Active disease, as opposed to quiescent, increases medical costs 2-3 times in ambulatory patients and 20 times in hospitalized cases. Identifying markers that could predict steroid response is therefore a high clinical priority. Previous attempts to investigate potential clinical and demographic markers have been equivocal, highlighting the need for further investigations of other predictive markers. It is well known that the action of CS entails complex processes controlled by genetic factors. Two genes, the ABCB1 gene, which belongs to the family of trans-membrane transporters, and the NR3C1 gene, coding for the glucocorticoid receptor, are major elements of the pathway. We postulated that inter-individual variations in these genes may play a role in the observed variability of the response to CS and could serve as potential predictors. Objectives - We aimed to: (1) examine the burden of steroid refractoriness in children diagnosed with CD and explore the potential clinical/demographic factors related to CS response; (2) study the association between DNA variants in the ABCB1 gene and CS response; (3) investigate the associations between DNA variants in the NR3C1 gene and CS response. Methods - We investigated these objectives in a cohort of CD patients recruited from two tertiary paediatric gastroenterology clinics from Ottawa (CHEO) and Montreal (HSJ). CD patients diagnosed prior to age 18 using standard clinical, radiological, endoscopic and histopathological criteria were included. Published criteria were adapted to define CS-resistance and dependence. DNA acquired from blood and/or saliva was genotyped for variations across the ABCB1 and NR3C1 genes selected using the tag-SNP methodology. The frequencies of steroid resistance and dependence were estimated assuming a binomial distribution. Associations between clinical/demographic variables and steroid responses were examined using logistic regression modeling after accounting for potential confounding variables. Associations between ABCB1 and NR3C1 genes’ variants and steroid responses were examined using logistic regression assuming different models of inheritance. Multi-marker associations were examined via haplotype analysis. Un-genotyped variants in the genes were imputed using HAPMAP data as the reference panel and associations with imputed SNPs examined using standard methods. Results - Among 645 CD patients diagnosed at the study centers, 364 (56.2%) received corticosteroids during the first year since diagnosis. The majority of patients were male (54.9%), had inflammatory (84.6%), ileo-colonic (51.7%) disease phenotypes at diagnosis and were Caucasians (95.6%). Eight percent of patients developed CS-resistance and 40.9% became CS-dependent. Younger age at diagnosis (OR=1.34, 95% CI: 1.03-3.01, p=0.040), coexisting upper digestive tract involvement (OR=1.35, 95% CI: 1.06-3.07, p=0.031) and concomitant immunomodulators use (OR=0.35, 95% CI: 0.16-0.75, p=0.007) were significantly associated with CS-dependency in multivariate analysis. From among the 27 markers genotyped across the ABCB1 (n=14) and NR3C1 genes (n=13), all except one in NR3C1 gene (rs258751, excluded) were in Hardy-Weinberg Equilibrium. For ABCB1, the rare allele of rs2032583 (OR=0.56, 95% CI: 0.34-0.95, p=0.029) and heterozygous genotype (OR=0.52, 95% CI: 0.28-0.95, p=0.035) conferred protection from CS dependency. A 3-marker haplotype including the functional SNP rs1045642 was associated with CS-dependence (empiric p-value=0.004). On imputation 24 intronic SNPs and six haplotypes were statistically significantly associated with CS dependence. None of these associations however maintained significance after corrections for multiple comparisons. For the NR3C1 gene 3 SNPs, rs10482682 (OR=1.43, 95% CI: 0.99-2.08, p=0.047), rs6196 (OR=0.55, 95% CI: 0.31-0.95, p=0.024), and rs2963155 (OR=0.64, 95% CI: 0.42-0.98, p=0.039), showed associations under an additive model whereas rs4912911 (OR=0.37, 95% CI: 0.13-1.00, p=0.03) and rs2963156 (OR=0.32, 95% CI: 0.07-1.12, p=0.047) showed associations under a recessive model. Two haplotypes encompassing these 5 SNPs (AAACA and GGGCG) were significantly (empirical p=0.006 and 0.01 respectively) were associated with CS-dependence. On imputation 19 SNPs were associated with CS-dependence. Two multi-marker haplotypes (p-values=0.001 each) including genotyped and imputed SNPs conferred susceptibility for CS-dependency. Conclusions - Our studies suggest that the burden of steroid dependence is high among children with CD. Children diagnosed at a younger age, those with co-existent upper tract disease and with variations in the ABCB1 and NR3C1 genes were more likely to become CS dependent.

Récemment, des études menées chez des patients atteints de la maladie d’Alzheimer (MA) suggèrent un rôle important de la clairance cérébrale des peptides bêta-amyloïde (Abeta) dans la physiopathologie de la MA. Les échanges de peptide Abeta entre le cerveau et le sang peuvent se faire à travers la barrière hémato-encéphalique (BHE). De nombreux transporteurs sont exprimés au niveau de la BHE, telles les protéines ABC (ATP-Binding Casette) et SLC (Solute Carriers). Il a été montré que l’influx du peptide Abeta à travers la BHE était partiellement médié par le récepteur RAGE (Receptor for Advanced Glycation End products) et son efflux par le récepteur LRP-1 (Low density lipoprotein receptor-related protein 1). De plus, l’implication de transporteurs ABC/SLC dans le passage cérébral du peptide Abeta a été suggérée. Il paraît donc important de caractériser les transporteurs ABC et/ou SLC impliqués dans le transport du peptide Abeta à travers la BHE. D’autre part, l’on peut se demander si, dans le cadre de la MA, la BHE subit des modifications, en termes d’étanchéité, d’expression de transporteurs, de mécanismes de transport, et si, dans ce cas, il y a une modification du transport du peptide Abeta à travers la BHE altérée. Nous avons d’abord montré que des transporteurs ABC et SLC étaient respectivement impliqués dans l’efflux et l’influx des peptides Abeta à travers la BHE. Concernant l’efflux, outre l’Abcb1, nous avons montré qu’Abcg2 et Abcg4 étaient impliquées dans la clairance cérébrale des peptides Abeta. Concernant l’influx, nous avons montré qu’Oatp1a4 pourrait jouer un rôle important dans la pénétration cérébrale des peptides Abeta. De plus, Abca1, principal transporteur ABC impliqué dans le transport du cholestérol, régule indirectement les taux cérébraux d’Abeta. En particulier, nous avons identifié la L-thyroxine et la rosuvastatine comme de puissants inhibiteurs respectifs de l’efflux et de l’influx cérébral d’Abeta. L’ensemble de ces transporteurs d’influx et d’efflux fixe ainsi la clairance cérébrale des peptides Abeta à travers la BHE. Or ces transporteurs sont régulés chez les souris 3xTg-AD (modèle de souris triple transgénique pour la MA exprimant à la fois les pathologies amyloïde et tau), dans des phases précoces et/ou tardives de la MA. Précocement, l’expression de Rage et d’Abca1 sont fortement augmentées au niveau de la BHE chez les souris 3xTg-AD. L’augmentation de Rage dès l’âge de 3 mois laisse supposer une augmentation très précoce de l’influx du peptide Abeta à travers la BHE. Mais cet influx semble être contre-balancé par l’augmentation concomitante d’Abcg4. Quant à Abca1, ne transportant pas directement le peptide Abeta, le rôle de son augmentation graduelle au cours du développement de la MA reste à déterminer. L’ensemble de ces régulations n’étant pas suffisantes pour empêcher l’accumulation cérébrale d’Abeta, des régulations plus tardives semblent se mettre en place, avec notamment l’augmentation de l’expression d’Abcb1 et d’Abcg2, et la diminution d’Oatp1a4. Ces mécanismes semblent donc correspondre à des phénomènes compensatoires ayant pour objectif d’augmenter la clairance cérébrale d’Abeta. Enfin, nous avons montré que l’intégrité physique de la BHE n’était pas altérée chez ces souris 3xTg-AD âgées de 3 à 18 mois. De plus, nos résultats ont montré que le volume vasculaire était diminué de manière précoce, notamment au niveau de l’hippocampe, chez les souris 3xTg-AD par rapport à leurs contrôles. Ce phénomène n’a pas été retrouvé chez les souris APP/PS1 n’exprimant que la pathologie amyloïde. Ces résultats suggèrent un rôle causal et précoce de la protéine tau hyperphosphorylée dans la pathologie de la MA. En conclusion, nos résultats soulignent l’importance de la BHE dans la physiopathologie de la MA. Ce travail de thèse ouvre des perspectives thérapeutiques, mais aussi des pistes pour la compréhension des mécanismes conduisant à une régulation de ces systèmes de transport dans la MA. / Recent studies in Alzheimer's disease (AD) patients have suggested an important role of cerebral clearance of Abeta peptide in the pathogenesis of AD. The blood-brain barrier (BBB) represents a major pathway for exchanges of Abeta between the brain and the peripheral circulation. Many transporters are expressed at the BBB, such as the ABC (ATP-Binding Casette) and SLC (Solute Carriers) proteins. It has been shown that the influx of Abeta peptide across the BBB was partially mediated by the receptor RAGE (Receptor for Advanced Glycation End products) and its efflux by the LRP-1 receptor (low density lipoprotein receptor-related protein 1). On the other hand, the involvement of ABC/SLC transporters in the brain efflux/influx of Abeta peptide has been suggested. It was therefore important to characterize the ABC/SLC transporters involved in the transport of Abeta peptide across the BBB. In addition, the disorders of the BBB have always been suggested in neurodegenerative diseases. The question is whether, in the context of AD, the BBB undergoes changes in terms of integrity, expression of transporters, transport mechanisms, and if, in this case, there is a change in the transport of Abeta peptide across the impaired BBB. We first showed that the BBB regulated the exchange of blood-brain Abeta peptides. Thus, the involvement of efflux (ABCG2 and ABCG4) and influx (Oatp1a4) transporters allows this equilibrium of Abeta peptides between the blood and the brain parenchyma. In addition, ABCA1, the main ABC transporter involved in cholesterol transport, regulates indirectly the brain levels of Abeta. We also identified the L-thyroxine and rosuvastatin as potent inhibitors of the efflux and influx transport of brain Abeta, respectively. All these influx and efflux transporters could control the transport of Abeta peptide across the BBB. However, these transporters are regulated in 3xTg-AD mice (triple transgenic mouse model for AD expressing both amyloid and tau pathologies) in the early and/or late stages of AD. Early, the expression of Abca1 and Rage are strongly increased at the BBB in 3xTg-AD mice. The high expression levels of Rage at the age of 3 months suggest an early increase in the influx transport of Abeta peptide across the BBB. But this increase seems to be compensated by the concomitant increase of Abcg4. As Abca1 does not directly mediate the transport of Abeta peptide, the role of its gradual increase in the development of AD remains to be determined. As all these regulations are not sufficient to prevent the accumulation of cerebral Abeta, the late regulations seem to develop, including increased expression of Abcb1 and Abcg2, and decreased expression of Oatp1a4. These mechanisms seem to correspond to compensatory phenomena with the objective to increase the cerebral clearance of Abeta. Finally, we have shown that the physical integrity of the BBB was not altered in 3xTg-AD mice aging from 3 to18 months. In addition, our results showed that the cerebral vascular volume was reduced early, especially in the hippocampus of 3xTg-AD mice compared to their age-matched controls. This phenomenon was not found in APP/PS1 mice expressing only the amyloid pathology. These results suggest a causal and early role of hyperphosphorylated tau in AD pathology.In conclusion, our results show the importance of the BBB and particularly of Abcg2, Abcg4 and Oatp1a4 transporters in the pathophysiology of AD. Knowledge of these transporters not only opens up therapeutic or prophylactic purposes, but also leads to the further understanding of the regulation mechanisms of these transport systems in AD.

Contexte - La variation interindividuelle de la réponse aux corticostéroïdes (CS) est un problème important chez les patients atteints de maladies inflammatoires d’intestin. Ce problème est bien plus accentué chez les enfants avec la prévalence de la corticodépendance extrêmement (~40 %) élevée. La maladie réfractaire au CS a des répercussions sur le développement et le bien-être physique et psychologique des patients et impose des coûts médicaux élevés, particulièrement avec la maladie active comparativement à la maladie en rémission, le coût étant 2-3 fois plus élevé en ambulatoire et 20 fois plus élevé en hôpital. Il est ainsi primordial de déterminer les marqueurs prédictifs de la réponse aux CS. Les efforts précédents de découvrir les marqueurs cliniques et démographiques ont été équivoques, ce qui souligne davantage le besoin de marqueurs moléculaires. L'action des CS se base sur des processus complexes déterminés génétiquement. Deux gènes, le ABCB1, appartenant à la famille des transporteurs transmembraneaux, et le NR3C1, encodant le récepteur glucocorticoïde, sont des éléments importants des voies métaboliques. Nous avons postulé que les variations dans ces gènes ont un rôle dans la variabilité observée de la réponse aux CS et pourraient servir en tant que les marqueurs prédictifs. Objectifs - Nous avons visé à: (1) examiner le fardeau de la maladie réfractaire aux CS chez les enfants avec la maladie de Crohn (MC) et le rôle des caractéristiques cliniques et démographiques potentiellement liés à la réponse; (2) étudier l'association entre les variantes d'ADN de gène ABCB1 et la réponse aux CS; (3) étudier les associations entre les variantes d'ADN de gène NR3C1 et la réponse aux CS. Méthodes - Afin d’atteindre ces objectifs, nous avons mené une étude de cohorte des patients recrutés dans deux cliniques pédiatriques tertiaires de gastroentérologie à l’Ottawa (CHEO) et à Montréal (HSJ). Les patients avec la MC ont été diagnostiqués avant l'âge de 18 ans selon les critères standard radiologiques, endoscopiques et histopathologiques. La corticorésistance et la corticodépendance ont été définies en adaptant les critères reconnus. L’ADN, acquise soit du sang ou de la salive, était génotypée pour des variations à travers de gènes ABCB1 et NR3C1 sélectionnées à l’aide de la méthodologie de tag-SNP. La fréquence de la corticorésistance et la corticodépendance a été estimée assumant une distribution binomiale. Les associations entre les variables cliniques/démographiques et la réponse aux CS ont été examinées en utilisant la régression logistique en ajustant pour des variables potentielles de confusion. Les associations entre variantes génétiques de ABCB1 et NR3C1 et la réponse aux CS ont été examinées en utilisant la régression logistique assumant différents modèles de la transmission. Les associations multimarqueurs ont été examinées en utilisant l'analyse de haplotypes. Les variantes nongénotypées ont été imputées en utilisant les données de HAPMAP et les associations avec SNPs imputés ont été examinées en utilisant des méthodes standard. Résultats - Parmi 645 patients avec la MC, 364 (56.2%) ont reçu CS. La majorité de patients étaient des hommes (54.9 %); présentaient la maladie de l’iléocôlon (51.7%) ou la maladie inflammatoire (84.6%) au diagnostic et étaient les Caucasiens (95.6 %). Huit pourcents de patients étaient corticorésistants et 40.9% - corticodépendants. Le plus bas âge au diagnostic (OR=1.34, 95% CI: 1.03-3.01, p=0.040), la maladie cœxistante de la région digestive supérieure (OR=1.35, 95% CI: 95% CI: 1.06-3.07, p=0.031) et l’usage simultané des immunomodulateurs (OR=0.35, 95% CI: 0.16-0.75, p=0.007) ont été associés avec la corticodépendance. Un total de 27 marqueurs génotypés à travers de ABCB1 (n=14) et NR3C1 (n=13) ont été en l'Équilibre de Hardy-Weinberg, à l’exception d’un dans le gène NR3C1 (rs258751, exclu). Dans ABCB1, l'allèle rare de rs2032583 (OR=0.56, 95% CI: 0.34-0.95, p=0.029) et génotype hétérozygote (OR=0.52, 95% CI: 0.28-0.95 p=0.035) ont été négativement associes avec la dépendance de CS. Un haplotype à 3 marqueurs, comprenant le SNP fonctionnel rs1045642 a été associé avec la dépendance de CS (p empirique=0.004). 24 SNPs imputés introniques et six haplotypes ont été significativement associés avec la dépendance de CS. Aucune de ces associations n'a cependant maintenu la signification après des corrections pour des comparaisons multiples. Dans NR3C1, trois SNPs: rs10482682 (OR=1.43, 95% CI: 0.99-2.08, p=0.047), rs6196 (OR=0.55, 95% CI: 0.31-0.95, p=0.024), et rs2963155 (OR=0.64, 95% CI: 0.42-0.98, p=0.039), ont été associés sous un modèle additif, tandis que rs4912911 (OR=0.37, 95% CI: 0.13-1.00, p=0.03) et rs2963156 (OR=0.32, 95% CI: 0.07-1.12, p=0.047) - sous un modèle récessif. Deux haplotypes incluant ces 5 SNPs (AAACA et GGGCG) ont été significativement (p=0.006 et 0.01 empiriques) associés avec la corticodépendance. 19 SNPs imputés ont été associés avec la dépendance de CS. Deux haplotypes multimarqueurs (p=0.001), incluant les SNPs génotypés et imputés, ont été associés avec la dépendance de CS. Conclusion - Nos études suggèrent que le fardeau de la corticodépendance est élevé parmi les enfants avec le CD. Les enfants plus jeunes au diagnostic et ceux avec la maladie coexistante de la région supérieure ainsi que ceux avec des variations dans les gènes ABCB1 et NR3C1 étaient plus susceptibles de devenir corticodépendants. / Background - Inter-individual variation in response to treatment by corticosteroids (CS) is an important problem in the management of inflammatory bowel disease (IBD) patient’s. This problem is even more prominent in children, the prevalence of steroid dependence (~40%) in whom is extremely high. Steroid refractoriness has a considerable impact on the physical and psychological development of these children, also imposing high medical costs related to treatment. Active disease, as opposed to quiescent, increases medical costs 2-3 times in ambulatory patients and 20 times in hospitalized cases. Identifying markers that could predict steroid response is therefore a high clinical priority. Previous attempts to investigate potential clinical and demographic markers have been equivocal, highlighting the need for further investigations of other predictive markers. It is well known that the action of CS entails complex processes controlled by genetic factors. Two genes, the ABCB1 gene, which belongs to the family of trans-membrane transporters, and the NR3C1 gene, coding for the glucocorticoid receptor, are major elements of the pathway. We postulated that inter-individual variations in these genes may play a role in the observed variability of the response to CS and could serve as potential predictors. Objectives - We aimed to: (1) examine the burden of steroid refractoriness in children diagnosed with CD and explore the potential clinical/demographic factors related to CS response; (2) study the association between DNA variants in the ABCB1 gene and CS response; (3) investigate the associations between DNA variants in the NR3C1 gene and CS response. Methods - We investigated these objectives in a cohort of CD patients recruited from two tertiary paediatric gastroenterology clinics from Ottawa (CHEO) and Montreal (HSJ). CD patients diagnosed prior to age 18 using standard clinical, radiological, endoscopic and histopathological criteria were included. Published criteria were adapted to define CS-resistance and dependence. DNA acquired from blood and/or saliva was genotyped for variations across the ABCB1 and NR3C1 genes selected using the tag-SNP methodology. The frequencies of steroid resistance and dependence were estimated assuming a binomial distribution. Associations between clinical/demographic variables and steroid responses were examined using logistic regression modeling after accounting for potential confounding variables. Associations between ABCB1 and NR3C1 genes’ variants and steroid responses were examined using logistic regression assuming different models of inheritance. Multi-marker associations were examined via haplotype analysis. Un-genotyped variants in the genes were imputed using HAPMAP data as the reference panel and associations with imputed SNPs examined using standard methods. Results - Among 645 CD patients diagnosed at the study centers, 364 (56.2%) received corticosteroids during the first year since diagnosis. The majority of patients were male (54.9%), had inflammatory (84.6%), ileo-colonic (51.7%) disease phenotypes at diagnosis and were Caucasians (95.6%). Eight percent of patients developed CS-resistance and 40.9% became CS-dependent. Younger age at diagnosis (OR=1.34, 95% CI: 1.03-3.01, p=0.040), coexisting upper digestive tract involvement (OR=1.35, 95% CI: 1.06-3.07, p=0.031) and concomitant immunomodulators use (OR=0.35, 95% CI: 0.16-0.75, p=0.007) were significantly associated with CS-dependency in multivariate analysis. From among the 27 markers genotyped across the ABCB1 (n=14) and NR3C1 genes (n=13), all except one in NR3C1 gene (rs258751, excluded) were in Hardy-Weinberg Equilibrium. For ABCB1, the rare allele of rs2032583 (OR=0.56, 95% CI: 0.34-0.95, p=0.029) and heterozygous genotype (OR=0.52, 95% CI: 0.28-0.95, p=0.035) conferred protection from CS dependency. A 3-marker haplotype including the functional SNP rs1045642 was associated with CS-dependence (empiric p-value=0.004). On imputation 24 intronic SNPs and six haplotypes were statistically significantly associated with CS dependence. None of these associations however maintained significance after corrections for multiple comparisons. For the NR3C1 gene 3 SNPs, rs10482682 (OR=1.43, 95% CI: 0.99-2.08, p=0.047), rs6196 (OR=0.55, 95% CI: 0.31-0.95, p=0.024), and rs2963155 (OR=0.64, 95% CI: 0.42-0.98, p=0.039), showed associations under an additive model whereas rs4912911 (OR=0.37, 95% CI: 0.13-1.00, p=0.03) and rs2963156 (OR=0.32, 95% CI: 0.07-1.12, p=0.047) showed associations under a recessive model. Two haplotypes encompassing these 5 SNPs (AAACA and GGGCG) were significantly (empirical p=0.006 and 0.01 respectively) were associated with CS-dependence. On imputation 19 SNPs were associated with CS-dependence. Two multi-marker haplotypes (p-values=0.001 each) including genotyped and imputed SNPs conferred susceptibility for CS-dependency. Conclusions - Our studies suggest that the burden of steroid dependence is high among children with CD. Children diagnosed at a younger age, those with co-existent upper tract disease and with variations in the ABCB1 and NR3C1 genes were more likely to become CS dependent.

<p>Transport into and across the cells of the human body is a prerequisite for the pharmacological action of drugs. Passive membrane permeability and active transport mechanisms are major determinants of the intestinal absorption of drugs, as well as of the distribution to target tissues and the subsequent metabolism and excretion from the body. In this thesis, the role of ATP-binding cassette (ABC) transporters and passive permeability on drug absorption and disposition was investigated. Particular emphasis was placed on defining the molecular properties important for these transport mechanisms. </p><p>The influence of different transport pathways on predictions of intestinal drug absorption was investigated using experimental models of different complexity. Experimental models that include the paracellular pathway gave improved predictions of intestinal drug absorption, especially for incompletely absorbed drugs. Further, the inhibition of the ABC transporters breast cancer resistance protein (BCRP/ABCG2) and multidrug-resistance associated protein 2 (MRP2/ABCC2) was experimentally investigated using structurally diverse datasets that were representative of orally administered drugs. A large number of previously unknown inhibitors were identified among registered drugs, but their clinical relevance for drug-drug interactions and drug-induced toxicity remains to be determined. The majority of the inhibitors affected all three major ABC transporters BCRP, MRP2 and P-glycoprotein (P gp/ABCB1), and these multi-specific inhibitors were found to be enriched in highly lipophilic weak bases. </p><p>To summarize, the present work has led to an increased knowledge of the molecular features of importance for ABC transporter inhibition and passive membrane permeability. Previously unknown ABC transporter inhibitors were identified and predictive computational models were developed for the different drug transport mechanisms. These could be valuable tools to assist in the prioritization of experimental efforts in early drug discovery.</p>

Transport into and across the cells of the human body is a prerequisite for the pharmacological action of drugs. Passive membrane permeability and active transport mechanisms are major determinants of the intestinal absorption of drugs, as well as of the distribution to target tissues and the subsequent metabolism and excretion from the body. In this thesis, the role of ATP-binding cassette (ABC) transporters and passive permeability on drug absorption and disposition was investigated. Particular emphasis was placed on defining the molecular properties important for these transport mechanisms. The influence of different transport pathways on predictions of intestinal drug absorption was investigated using experimental models of different complexity. Experimental models that include the paracellular pathway gave improved predictions of intestinal drug absorption, especially for incompletely absorbed drugs. Further, the inhibition of the ABC transporters breast cancer resistance protein (BCRP/ABCG2) and multidrug-resistance associated protein 2 (MRP2/ABCC2) was experimentally investigated using structurally diverse datasets that were representative of orally administered drugs. A large number of previously unknown inhibitors were identified among registered drugs, but their clinical relevance for drug-drug interactions and drug-induced toxicity remains to be determined. The majority of the inhibitors affected all three major ABC transporters BCRP, MRP2 and P-glycoprotein (P gp/ABCB1), and these multi-specific inhibitors were found to be enriched in highly lipophilic weak bases. To summarize, the present work has led to an increased knowledge of the molecular features of importance for ABC transporter inhibition and passive membrane permeability. Previously unknown ABC transporter inhibitors were identified and predictive computational models were developed for the different drug transport mechanisms. These could be valuable tools to assist in the prioritization of experimental efforts in early drug discovery.