La gale humaine, récemment reconnue comme maladie tropicale négligée par l’OMS est due à l'acarien Sarcoptes scabiei variété hominis. La gale est un problème majeur de santé publique avec une prévalence mondiale estimée à 200 millions de cas/an. La morbidité est surtout liée aux surinfections bactériennes par Streptococcus pyogenes et Staphylococcus aureus. L’arsenal thérapeutique demeure limité. Plusieurs molécules sont disponibles, surtout des traitements topiques (dont la perméthrine). L’ivermectine de la famille des lactones macrocycliques est la seule molécule orale disponible. Elle a une efficacité prouvée mais pas absolue. La plupart des molécules ne sont pas ovicides et leurs demi-vies, plus courtes que le cycle du parasite, impliquent de proposer systématiquement une deuxième application/prise à une semaine d’intervalle. Des inquiétudes concernant l'apparition de sarcoptes résistants à la perméthrine et à l’ivermectine apparaissent. Des alternatives sont donc nécessaires à courte échéance. Le traitement de la gale comprend toujours un traitement médical pour le patient et ses contacts mais également une désinfection de son environnement mais aucune mesure de décontamination n’a pu réellement faire la preuve de son efficacité.L’objectif de cette thèse a été de proposer et d’évaluer des alternatives thérapeutiques pour la prise en charge de la gale en utilisant de nouveaux modèles expérimentaux, in vitro et in vivo, notamment dans un modèle animal porcin. Dans la première partie de la thèse, deux spécialités vétérinaires de la famille des lactones macrocycliques (moxidectine) ou des isoxazolines (afoxolaner) ont été évaluées dans deux essais thérapeutiques. L’efficacité d’une administration orale unique de moxidectine et d’afoxolaner a été évaluée sur des porcs expérimentalement infestés. Une évaluation pharmacologique plasmatique et cutanée a aussi pu être réalisée. La deuxième partie de la thèse a porté sur une meilleure connaissance des molécules déjà disponibles et sur leur amélioration. L’activité ovicide de différentes molécules a été évaluée. La possibilité d’utiliser une dose plus importante d’ivermectine a pu elle aussi être étudiée. Dans la troisième partie de la thèse, nous avons travaillé sur la prise en charge de l’environnement. Nous avons évalué in vitro l’efficacité́ de différentes procédures de lavage en machine pour l’éradication d’une population de Sarcoptes scabiei ainsi que l’effet de la congélation, du séchage en lave-linge et de l’utilité de sacs en plastique occlus. Nous avons aussi étudier l’activité de molécules répulsives ou de produits acaricides pour la prise en charge des sarcoptes dans l’environnement.L’ensemble des résultats de ces différentes études va nous permettre de proposer de nouvelles alternatives pour la prise en charge thérapeutique de la gale. Certaines nouvelles alternatives vont pourvoir être évaluées chez l’homme prochainement. Pour l’environnement, des recommandations précises et universelles à l’échelle individuelle mais aussi collective pourront être proposées dans les pays développés mais aussi dans les pays en voie de développement. / Human scabies is caused by the mite Sarcoptes scabiei variety hominis. Scabies was recently recognized as a neglected tropical disease, due to its high global prevalence estimated to be around 200 million cases/year and its high morbidity mainly related to bacterial superinfection by Streptococcus pyogenes and Staphylococcus aureus. The therapeutic arsenal remains limited. Several molecules are available, including topical treatments. Ivermectin, a member of the macrocyclic lactone family is the only oral drug available. It has proven efficacy but not absolute. Most molecules are not ovicidal and their half-lives are too short to cover the entire parasite cycle. Indeed, a second application/intake at one week interval is mandatory. Furthermore, resistance to the main acaricides has been reported. Thus, alternatives need to be found in the short term. Treatment of scabies always includes medical treatment for the patient and his contacts, but also a disinfection of his environment. However, the efficacy of decontamination procedures, especially those possible in resource poor settings, has not been determined with a good level of evidence.The aim of this thesis was to propose and evaluate therapeutic alternatives for the management of scabies by using new experimental models, in vitro and, in vivo in an experimental porcine animal model.In the first part of the thesis, two veterinary molecules from the macrocyclic lactones family (moxidectin) or the isoxazolines (afoxolaner) were evaluated in two therapeutic trials. Efficacy of a single oral administration of moxidectin and afoxolaner was evaluated in experimentally infested pigs. A plasma and cutaneous pharmacological evaluation was also possible.The second part of the thesis focused on increasing our knowledge on molecules already available and on their improvement. We studied the ovicidal activities of currently available molecules for human scabies treatment and molecules use in the veterinary clinic. Furthermore, we studied the potential of a higher dose of ivermectin for scabies treatment.In the third part of the thesis, we worked on the management of the environment. We evaluated in vitro the effectiveness of different machine washing procedures for the eradication of a population of Sarcoptes scabiei as well as the effect of freezing, drying and the usefulness of closed plastic bags. We also studied the activity of repellent molecules or acaricide products for the management of Sarcoptes mites in the environment.Using the results of these different studies it will be possible to propose new alternatives for the therapeutic management of human scabies. New alternatives will be evaluated in humans in the next future. For the environment, specific and universal recommendations at individual and collective level will be proposed.

The primary aim of this research is to test the therapeutic potential of certain new generation corticosteroid drugs in order to develop safe and effective treatment for eye diseases that result in oedema, or swelling. The rising incidence of diabetes and the ageing population of developed countries mean that the prevalence of uveitis, diabetic retinopathy and age related macular degeneration will rise. Often, oedema is one of the reasons for vision loss. Corticosteroids are often used to reduce inflammation. Inflammation is one of several sources of oedema. Glucocorticoids, a class of corticosteroids that have anti-inflammatory properties, are thus used to treat ocular oedema. There is an unmet need to support clinical experience of the efficacy of steroids for ocular inflammation and oedema with more substantial scientific evidence. None of the drugs under investigation, with the exceptions of dexamethasone and triamcinolone, have been used for any ocular therapeutic purpose before. This thesis investigates “repurposing” fludrocortisone to the ophthalmic area. 11-Desoxycorticosterone (11D) and Deoxycorticosterone (DCS), other potentially valuable mineralocorticoids, remain completely untested. Lastly, Kenacort ®, or triamcinolone acetonide (TCA), is only used off-label by ophthalmologists. Methods: In the first study, corticosteroids, and especially mineralocorticoids, were investigated for their treatment efficacy in experimental uveitis, or intraocular inflammation (using a model known as endotoxin induced uveitis). In the second study, endothelial cells from choroidal blood vessels in the back of the eye were used in vitro to study whether corticosteroids reduce paracellular (between cells) permeability. Lastly, since endophthalmitis due to frequent injections is a side effect of corticosteroid use, the pharmacokinetics of different size formulations of corticosteroids were studied in an effort to find a formula that would have a prolonged dwell time within the eye.

<p>Septic shock is frequently seen in intensive care units and is associated with significant mortality. Endotoxin – a major mediator of the pathophysiologic responses – is released during lysis of Gram-negative bacteria. These responses can be mimicked in the endotoxaemic pig.</p><p>This thesis focuses on the following topics: the inflammatory and pathophysiological responses to various endotoxin doses and infusion patterns; covariations between endotoxin induced inflammatory and pathophysiological responses; whether the biological effects of endotoxin can be modulated by clopidogrel and whether tobramycin or ceftazidime reduce plasma cytokine levels.</p><p>Endotoxin induced linear log-log cytokine and F2-isoprostane responses. Leukocyte and platelet responses, pulmonary compliance, circulatory variables as well as indicators of plasma leakage and hypoperfusion exhibited log-linear responses to the endotoxin dose. Biological responses to endotoxaemia such as inflammation, hypotension, hypoperfusion and organ dysfunction were more expressed when the organism was exposed to endotoxin at a higher rate. These results may facilitate the possibility to choose relevant endotoxin administration, when experiments are set up in order to evaluate certain responses to endotoxaemia.</p><p>Correlation studies between cytokines, leukocytes, platelets and the endotoxin dose were in agreement with the well-known ability of endotoxin to induce cytokine expression and to activate both primary haemostasis and leukocytes. Free radical mediated lipid peroxidation and COX-mediated inflammation correlated to cytokine expression and organ dysfunction in endotoxaemic shock. </p><p>Endotoxaemic pigs pretreated with clopidogrel, exhibited a trend towards less expressed deterioration of renal function, although blocking of ADP-induced primary haemostasis is not a key mediator of endotoxin induced deterioration of renal function.</p><p>Tobramycin did not neutralise the biological effects of endotoxin or the plasma levels of endotoxin, suggesting that these antibiotics do not bind to endotoxin.</p><p>Reduction in IL-6 was greater in pigs treated with ceftazidime and tobramycin as compared with those given saline, indicating a possible anti-inflammatory effect of both antibiotics.</p>

Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2008.

Les hémorragies endométriales sont une cause fréquente de consultation gynécologique. Lapparition de ces saignements est probablement facilitée par des perturbations du développement et de la structure des vaisseaux, ce qui est également observé lors dun traitement avec un progestatif à long terme. Toutefois, la raison du déclenchement des hémorragies reste encore obscure. Le but de notre étude a été de développer un modèle de transplantation dendomètre humain chez des souris immunodéficientes afin de déterminer les mécanismes impliqués dans lapparition de saignements utérins lors des menstruations ou liés au traitement local continu par progestatif (lévonorgestrel). Dans ce travail, nous avons étudié les vaisseaux sanguins endométriaux (nombre, taille, maturation), lexpression des enzymes protéolytiques (métalloprotéinases matricielles ou MMPs) et des récepteurs hormonaux aux strogènes et à la progestérone en présence ou non dun progestatif (lévonorgestrel). Nous avons également étudié laction combinée du progestatif et dun inhibiteur de MMPs dans le but de prévenir les saignements utérins. La meilleure compréhension des mécanismes sous-tendant ces pathologies devrait ouvrir des nouvelles perspectives thérapeutiques que le modèle que nous avons mis au point permettra de tester.

Sepsis is a common diagnose in the intensive care population, burdened with a high mortality. The systemic inflammatory reaction underlying the development of septic organ dysfunction can be modeled using Gram-negative bacterial lipopolysaccharide, endotoxin. This thesis used a porcine endotoxemic experimental sepsis model to address clinical questions difficult to answer in clinical trials; furthermore a model of secondary sepsis was developed. No additional effect on the development of renal dysfunction by tobramycin was found, indicating that a single dose of tobramycin does not further compromise renal function in inflammatory-induced acute kidney injury. Antiendotoxin treatment had no measurable effect on TNF-α-mediated toxicity once the inflammatory cascade was activated. There was an effect on the leukocyte response that was associated with improvements in respiratory function and microcirculation, making it impossible to rule out fully the beneficial effect of this strategy. However, the effects were limited in relation to the magnitude of the endotoxin concentration reduction and the very early application of the antiendotoxin measure. The lungs stood out compared to the other organ systems as having a threshold endotoxin dose for the protective effect of endotoxin tolerance. As to the development of circulatory and renal dysfunction, tolerance to endotoxin was evident regardless of the endotoxin pre-exposure and challenge dose. There was a temporal variation of endotoxin tolerance that did not follow changes in plasma TNF-α concentrations and maximal tolerance was seen very early in the course. More pronounced endotoxin tolerance at the time of maximum tolerance was associated with a more marked hyperdynamic circulation, reduced oxygen consumption and thrombocytopenia eighteen hours later. It might be of interest to use the experimental model of long-term endotoxemia followed by a second hit, which has been designed to resemble an intensive care setting, for the study of treatment effects of immunomodulating therapies in secondary sepsis. / Paper 3, previous title as submitted: "Compartmentalization of organ endotoxin tolerance in a porcine model of secondary sepsis"

Bone morphogenetic protein-2 (BMP-2) is considered a promising adjuvant for the treatment of bone regeneration. However, BMP-2 delivery in a conventional collagen scaffold needs a high dose to achieve an effective outcome. Moreover, such dosage may lead to serious side effects. The aim of the following thesis was to find clinically acceptable strategies reducing the required dose of BMP-2 by improving the delivery and optimizing the preclinical testing of the new approaches. In all the studies hyaluronic acid (HA) hydrogels was used as a carrier for BMP-2. The HA hydrogel/BMP-2 construct was modified with bioactive matrix components in order to obtain an effective release of BMP-2 and an enhanced bone formation. The most promising were two strategies. In the first one, BMP-2, precomplexed with the glycosaminoglycans dermatan sulfate or heparin prior to loading it into HA hydrogel, protected and prolonged the delivery of the protein, resulting in twofold larger bone formation in comparison to non-complexed BMP-2. In the second strategy, the fibronectin fragment integrin-binding domain (FN) was covalently incorporated into HA hydrogel. The FN remarkably improved the capacity of the material to support the cells attachment and spreading, providing the formation of twice as much bone in comparison to non-functionalized HA hydrogel/BMP-2. Furthermore, the importance of a proper design of the preclinical study for BMP-2 delivery systems was highlighted. Firstly, proper physicochemical handling of BMP-2 showed the improvement in further in vivo activity.  The use of glass storage vials and an acidic formulation buffer was superior to plastic surfaces and physiological pH. Secondly, while regenerative medicine strategy testing required the use of animal models that matched the research questions related to clinical translation, two new animal models were developed. The subperiosteal mandibular and calvarial models in rats were found to be minimally invasive, convenient and rapid solution for the evaluation of a broad range of approaches including bone augmentation, replacement and regeneration. Both models are primarily relevant for the initial testing of the injectable bone engineering constructs.  Those clinically translatable approaches presented here could prove to be a powerful platform for a wider use of BMP-2 in orthopedic, plastic surgery and regenerative medicine research.

The goal of this thesis was to produce an animal model that develops atherosclerotic plaque featuring plaque neovascularization leading to intraplaque hemorrhage and is suitable for noninvasive imaging studies. Several strategies were tested for their effectiveness in producing such plaques in the rabbit aorta, including: a high cholesterol diet, vascular endothelial growth factor injections, therapeutic contrast ultrasound, and balloon catheter injury. It was found that a combination of the high cholesterol diet and balloon injury was able to achieve plaque neovascularization in a manner dependent on circulating plasma cholesterol levels. In addition, a contrast-enhanced magnetic resonance imaging technique implemented in the animal model was able to detect plaque neovascularization and monitor its change over time in a single group of animals. In conclusion, an animal model was created where plaque neovascularization occurs in a predictable fashion and can be studied with non-invasive magnetic resonance imaging.

The goal of this thesis was to produce an animal model that develops atherosclerotic plaque featuring plaque neovascularization leading to intraplaque hemorrhage and is suitable for noninvasive imaging studies. Several strategies were tested for their effectiveness in producing such plaques in the rabbit aorta, including: a high cholesterol diet, vascular endothelial growth factor injections, therapeutic contrast ultrasound, and balloon catheter injury. It was found that a combination of the high cholesterol diet and balloon injury was able to achieve plaque neovascularization in a manner dependent on circulating plasma cholesterol levels. In addition, a contrast-enhanced magnetic resonance imaging technique implemented in the animal model was able to detect plaque neovascularization and monitor its change over time in a single group of animals. In conclusion, an animal model was created where plaque neovascularization occurs in a predictable fashion and can be studied with non-invasive magnetic resonance imaging.

El uso de modelos animales constituye una herramienta esencial para investigar la etiología y patogenia de la diabetes, así como para desarrollar tratamientos efectivos: el transplante de islotes pancreáticos o ingeniería genética. El éxito de estas terapias depende en gran medida de la correcta elección de la vía de administración. Objetivos: 1.- Estudiar la anatomía e histología del páncreas porcino; 2.- Describir la anatomía seccional de la región pancreática mediante RM y secciones anatómicas plastinadas; 3.- Confirmar que las arterias pancreáticas terminales en el cerdo constituyen una ruta potencial para la administración selectiva mediante técnicas endovasculares mínimamente invasivas.Diseño de la investigación y métodos: Cerdos Large White jóvenes fueron examinados con RM y posteriormente sacrificados de forma humanitaria. Criosecciones transversales finas (2-3 mm) en las que se interesaba el páncreas fueron plastinadas mediante el método E-12 (Biodur®). 19 páncreas se procesaron para el estudio histológico. El análisis vascular de las ramas terminales del páncreas se realizó mediante la inyección de ocho cadáveres de cerdo con resina epoxy. En 20 cerdos vivos se llevaron a cabo angiografías superselectivas en ramas terminales.Resultados: El porcentaje y tamaño de los islotes de parénquima endocrino fueron mayores en el lóbulo derecho que en el resto del páncreas. Las secciones a nivel de la vértebra T15 interesaron las mayores áreas del páncreas, en concreto el lóbulo izquierdo. Una rama pancreática terminal de la arteria esplénica se presentó en todos los animales. Conclusión: se ha desarrollado un valioso abordaje mínimamente invasivo al páncreas porcino. Ello puede contribuir al ensayo de nuevas terapias para diabetes en este modelo animal. No obstante, nuevos estudios se hacen necesarios para poder evaluar la eficacia del abordaje referido en terapia para diabetes. / Animal models are essential tools for investigating the etiology and pathogenesis of diabetes and for the development of effective treatments: islet transplantation or genetic engineering. Successful of these new therapies will depend on the appropriate choice of the route of administration. Objectives: 1. Study the anatomy and histology of the porcine pancreas; 2. Describe the normal sectional anatomy of the pig pancreatic region by MRI and plastinated anatomic sections; 3. Confirm that the pancreatic terminal arteries in pigs are a potential route for the selective delivery of islet cells or gene products to the pancreas by minimally invasive endovascular techniques. Research design and methods: Large White juvenile pigs were examined by MRI and then euthanized according to human procedure. Thin transversal cryosections (2-3mm) containing the pancreas were plastinated by the E12 method (Biodur®). 19 pancreases were process for histology study. Anatomic vascular study of pancreatic terminal arteries was obtained by epoxy resin injection of eight pig cadavers. Super selective angiography in the pancreatic terminal branch was conducted in vivo in 20 pigs. Results: Frequency and size of endocrine parenchyma islets was higher in right lobe of the pancreas than in the rest of the pancreas. Sections at the level of vertebra T15 showed the highest areas of pancreas and were related with left lobe. A constant pancreatic terminal branch from the splenic artery was present in all animals. Conclusion: a valuable minimally invasive approach to the porcine pancreas has been developed. It may contribute to assay new diabetes therapies in swine models. Further studies are needed to examine the specific efficiency of this approach in diabetes therapies.