Submitted by Jeane Batista de Carvalho null (carvalhojeanetiagina@yahoo.com.br) on 2017-05-23T15:08:27Z No. of bitstreams: 1 Dissertação_CarvalhoJeane.pdf: 8189158 bytes, checksum: ebb9bc23a7d48fbc4154db51680f263e (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-05-23T18:27:50Z (GMT) No. of bitstreams: 1 carvalho_jb_me_ilha.pdf: 8189158 bytes, checksum: ebb9bc23a7d48fbc4154db51680f263e (MD5) / Made available in DSpace on 2017-05-23T18:27:50Z (GMT). No. of bitstreams: 1 carvalho_jb_me_ilha.pdf: 8189158 bytes, checksum: ebb9bc23a7d48fbc4154db51680f263e (MD5) Previous issue date: 2017-03-24 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Nas últimas décadas, há uma crescente preocupação em mensurar os parâmetros dinâmicos do sangue, dadas as imensas perdas de vidas por doenças cardiovasculares sendo, muitas delas, por aneurismas. A formação e desenvolvimento de um aneurisma é, predominantemente, degenerativo e provém de uma complexa interação entre os efeitos biológicos da parede arterial, os estímulos de escoamento e tensões provenientes da hemodinâmica. A tensão cisalhante na parede e o cíclico campo de pressão são um dos principais fatores responsáveis pela formação e crescimento de um aneurisma. Logo, há a necessidade de se conhecer os campos de velocidades e pressão além das tensões cisalhantes e efetivas na parede. Uma análise numérica é mais promissora que uma experimental. Uma análise experimental in-vivo possui impasses éticos e morais, sem contar a necessidade de um grande investimento. Outra vantagem de um estudo numérico é a disponibilidade de softwares livres de extração de tomografias que permite a extração da geometria sem a necessidade de um método invasivo que ocorreria em estudo experimental in vivo. Portanto com o auxílio de simulações numéricas (Ansys®), considerando o efeito multi-física de interação fluido estrutura (FSI) pela metodologia de elementos e volumes finitos foi possível verificar o efeito dos fatores que levam a formação e crescimento de aneurisma na aorta abdominal. Os aneurismas estudados foram modelos geométricos e reais sendo um dos reais obtidos através de imagens DICOM. / In recent decades, there is growing concern in measuring the dynamic parameters of the blood, given the immense loss of life from cardiovascular disease in human history, including, aneurysms. The formation and development of an aneurysm is predominantly degenerative and results from a complex interaction between the biological effects of the arterial wall and the flow and stress effects from hemodynamics. The stress in the wall and in the cyclic field of pressure is one of the main factors for the formation and growth of an aneurysm that degenerates until its rupture. Therefore, it is necessary to know the velocity and pressure fields as well as the shear stress and effective stress on the wall. A numerical analysis is more promising than an experimental one since an in-vivo experimental analysis has ethical and moral impasses, not counting the need for a large investment. Another advantage of a numerical study is the availability of free softwares for tomography analysis that allows the extraction of the geometry without the need for an invasive method that would occur in an in vivo experimental study. Therefore, with the aid of numerical simulations (Ansys®), considering the multi-physical effect of fluid structure interaction (FSI) by the methodology of finite elements and finite volumes it was possible to verify the effect of factors that lead to the formation and growth of abdominal aortic aneurysm. The studied aneurysms came from geometric models and from real examples, being one of the real ones obtained through DICOM images. / CNPq: 131153/2015-3

INTRODUÇÃO: A isquemia da medula espinhal continua sendo uma importante complicação nas cirurgias das doenças da aorta descendente torácica e toracoabdominal. OBJETIVOS: Células-tronco são capazes de promover a regeneração do tecido nervoso. Células-tronco derivadas do cordão umbilical humano (CTCUH) são fortes candidatas para uso nas lesões da medula espinhal devido à sua baixa imunogenicidade e pronta disponibilidade. O estudo avaliou os efeitos da administração de CTCUH na lesão isquêmica da medula espinhal em ratos. MÉTODOS: Quarenta ratos Wistar receberam injeção intratecal de 10 uL de solução de HemoHes (6 %) e albumina humana (20 %) contendo 1x104 CTCUH, 30 minutos antes (grupo Tcpré; n=10) e 30 minutos após (grupo Tcpós n=10) oclusão da aorta torácica descendente através de um balão intraluminal por 12 minutos. Os grupos controle receberam apenas a solução de Hemohes (6 %) e albumina humana (20 %) (grupo Cpré; n=10 e grupo Cpós; n=10). O período observacional, para avaliação da função motora dos animais, foi de 28 dias. Cortes de três segmentos tóraco-lombares da medula espinhal foram submetidos à análise histológica e imunohistoquímica para detecção de apoptose (TUNEL) e quantificação de células-tronco humanas hematopoiéticas CD45 +. RESULTADOS: Todos os grupos mostraram incidência semelhante de paraplegia e mortalidade. A média de pontuação da função motora não mostrou diferença durante o período observacional nos grupos, com exceção do grupo Tcpós o qual melhorou de 8,14 ± 8,6 para 14,28 ± 9,8 (p < 0,01). Número de neurônios viáveis foi maior no grupo Tcpós (p=0,14) e a média de apoptose foi mais baixa nesse mesmo grupo (p=0,048), porém sem diferença estatística significativa em relação ao controle. Foi confirmada a presença de células CD45 + quatro semanas após a injeção intratecal em ambos os grupos terapêuticos, principalmente, no grupo Tcpós. CONCLUSÕES: A injeção intratecal de CTCUH é factível e melhora a função motora da medula espinhal em um modelo de oclusão endovascular da aorta torácica descendente / BACKGROUND: Spinal cord ischemia remains a complication after surgical repair of descending and thoracoabdominal aortic diseases. OBJECTIVES: Stem cells have the potential to induce nervous tissue regeneration processes. Human stem cells derived from the umbilical cord are one of strong candidates used in cell therapy for spinal cord injury due to weak immunogenicity and ready availability. We sought to evaluate the use of Human Umbilical Cord Blood Stem Cells (HUCBSC) attenuates the neurologic effects of spinal cord ischemia. METHODS: Fourty Wistar rats received intrathecally injection of 10 uL Hemohes (6 %) and human albumin (20 %) solution contained 1x104HUCBSC, 30 minutes before (Tcpré group; n=10) and 30 minutes after (Tcpós group; n=10) descending thoracic aortic occlusion by intraluminal balloon during 12 minutes. Control groups received only PBS solution (Cpré group; n=10 and Cpós group; n=10). During a 28-day observational period, animals motor function was assessed. Three segments of thoraco-lombar spinal cord specimens were analyzed for histologic and immunohistochemical assessment for detection and quantification of human hematopoietic cells CD45+ and apoptosis (TUNEL). RESULTS: All groups showed similar incidence of paraplegia and mortality. The mean motor function scores showed no difference during time, excepting for Tpos group which improved from 8.14(8.6) to 14.28(9.8)(p < 0,01). Number of viable neurons was higher in Tcpós group (p = 0.14) and apoptosis average was lower in the same animals (p = 0.048), but showed no difference with its respective control. We confirmed the presence of CD45+ cells four weeks after intrathecal injection in both therapeutic groups but mainly in Tpos group. CONCLUSIONS: Intrathecal transplantation of HUCBSC is feasible and improved spinal cord function in a model of endovascular descending aortic occlusion

Vasorrelaxant effects of R(+)-pulegone were tested in normotensive rats using two different methodological approaches. In vivo, increasing doses (1, 3, 10, 20 and 30 mg / kg) were administered in the animals, i.v. bolus and selected randomly, then the parameters for mean arterial pressure (MAP) and heart rate (HR) were evaluated. In this situation the substance triggered a hypotensive effect and bradycardia. In the ex vivo approach, we used the thoracic aorta of these animals and isometric tension experiments, evaluated the vasorelaxant activity of the substance. The administration of R (+)-pulegone triggered vasorelaxant effect concentration-dependent in both rings with intact endothelium and with this removed, but the substance had the lowest pD2 value in the presence of the endothelium (-3.64 ± 0.06, n = -3.17 vs 5 ± 0.034, n = 6, respectively), no change in peak effect (98.2 ± 1.2%, n = 5 vs. 106.0 ± 8.1%, n = 6) indicating that the substance acts triggering vasodilation in aortic dependent manner and independent of the vascular endothelium. In rings with intact endothelium, the vasorelaxant activity of R(+)-pulegone was not altered in the presence of diclofenac and atropine, but was modified by L-NAME (-3.00 ± 0.016; n=5), HDX (-3.07 ± 0.021; n=5), ODQ (-3.17 ± 0.03; n = 5) and the red ruthenium (-3.14 ± 0.04; n=5) vs control: -3.64 ± 0.06; n = 5. These results suggest that the substance is probably stimulating NO production via the activation of TRP channels. In smooth muscle vascular, R(+)-pulegone inhibited curve calcium concentration-dependent manner (Emax: 10-4 M: 68 9 ± 3.81%; 3x10-4 M: 40.97 ± 8.05%; 10-3 M: 24.79 ± 5.04% and 3x10-3 M: 0.29 ± 0.33%) via calcium channels type L, as in the presence of nifedipine, there was a reduction of the maximum effect (Emax: 93.3 ± 1.7% ; n = 6 vs Emax control: 106.8 ± 8.1%; n = 6 ). Additionally, it was surveyed the participation of for potassium channels, using 4-aminiopiridine, it was seen that the substance has inhibited response by blocking the potassium channels sensitive to voltage (-2.93 ± 0.012 - n = 5 vs control - 3.17 ± 0.034 - n = 6) as well as sensitive to ATP, since, in the presence of glybenclamide, the relaxant response to R(+)-pulegone was also inhibited (-2.94 vs. -3.17 ± 0.012 ± 0.03). Thus, to cause vasorelaxation in normotensive rat thoracic aorta, R(+)-pulegone, stimulates the production of NO in endothelial cells, probably by activating calcium influx via TRP channels. The effect independent of the endothelium is mediated by inhibition of calcium influx, likely through the CaV and for opening potassium channels (KATP and Kv). / O efeito vasorrelaxante de R(+)-pulegona foi estudado em ratos normotensos, utilizando duas abordagens metodológicas. Na avaliação in vivo, doses crescentes (1, 3, 10, 20 e 30 mg/Kg), foram administradas nos animais, via i.v. em bolus de maneira aleatória, posteriormente os parâmetros de pressão arterial média (PAM) e frequência cardíaca (FC) foram avaliados. Nesta situação a substância desencadeou um efeito hipotensor e bradicárdico dependente de dose. Na abordagem ex vivo, utilizou-se a aorta torácica destes animais e avaliou-se a atividade vasorrelaxante da substância. A administração de R(+)-pulegona desencadeou efeito vasorrelaxante, concentração dependente tanto em anéis com endotélio intacto quanto com este removido, porém a substância apresentou o valor do pD2 menor na presença do endotélio (-3,64 ± 0,06, n=5 vs -3,17 ± 0,034, n=6, respectivamente), sem nenhuma alteração no efeito máximo (98,2 ± 1,2%, n=5 vs 106,0 ± 8,1%, n=6), indicando que a substância atua desencadeando vasodilatação na aorta de maneira dependente e independente do endotélio vascular. Em anéis com endotélio intacto, a atividade vasorrelaxante de R(+)-pulegona não foi alterada na presença de diclofenaco e atropina, porém foi modificada por L-NAME (-3,00 ± 0,016, n=5), HDX (-3,07 ± 0,021, n=5), ODQ (-3,17 ± 0,03, n=5) e o vermelho de rutênio (-3,14 ± 0,04, n=5) todos vs controle: -3,64 ± 0,06, n=5. Estes resultados sugerem que a substância provavelmente está estimulando a produção de óxido nítrico (NO), via ativação dos canais TRP na célula endotelial. O efeito dependente do músculo liso vascular de R(+)-pulegona dá-se através da inibição da curva de cálcio de maneira dependente de concentração (Emáx: 10-4 M: 68,9 ± 3,81%; 3x10-4 M: 40,97 ± 8,05%; 10-3 M: 24,79 ± 5,04% e 3x10-3 M: 0,29 ± 0,33%), via canais para cálcio tipo L, pois na presença de NIF, ocorreu redução do efeito máximo (Emáx: 93,3 ± 1,7%, n= 6 vs controle Emáx: 106,8 ± 8,1%, n=6). Adicionalmente, pesquisou-se a participação dos canais para potássio e na presença de 4-AP ocorreu redução da resposta relaxante da substância indicando a participação dos canais para potássio sensíveis a voltagem (-2,93 ± 0,012, n=5 vs controle -3,17 ±0,034, n=6) e também sensíveis ao ATP, uma vez que, na presença de glibenclamida, a resposta relaxante para R(+)-pulegona também foi reduzida (-2,94 ± 0,012, n=5 vs -3,17 ± 0,03, n=6). Assim, para causar vasorrelaxamento em aorta torácica de ratos normotensos, R(+)-pulegona, estimula a produção de NO na célula endotelial, provavelmente por ativar o influxo de cálcio via canais TRP e o efeito independente do endotélio, é mediado pela inibição do influxo de cálcio, provavelmente através dos CaV e abertura dos canais para potássio (Kv e KATP).

Toxinas que atuam em canais para Na+ operados por voltagem são as principais responsáveis pelos efeitos tóxicos do envenenamento escorpiônico e podem ser divididas em duas classes: a- e b-neurotoxinas. TsTX-V e TsTX-I da peçonha de Tityus serrulatus (TsV) são, respectivamente, exemplos destas toxinas. Neste trabalho, foram avaliados os efeitos da TsV e destas toxinas sobre a pressão arterial média (PAM) e liberação de catecolaminas em ratos conscientes e não imobilizados, previamente cateterizados, bem como a captação de GABA, dopamina (DA) e glutamato (Glu) em sinaptosomas isolados de cérebro de ratos e a concentração citoplasmática de Ca+2 ([Ca+2 ]C) em células de músculo liso vascular de aorta de ratos. As toxinas foram isoladas por cromatografia de troca iônica (TsTX-I) seguida por CLAE de fase reversa (TsTX-V). As toxinas (15 e 30 g/kg) e TsV (50 e 100 g/kg) foram injetadas intravenosamente. A PAM foi monitorada continuamente através do cateter femoral. Os níveis plasmáticos de adrenalina (ADR) e noradrenalina (NA) foram determinados por CLAE de fase reversa com detector eletroquímico, em 10 min antes e 2,5, 30 e 90 min após os tratamentos. Efeitos pressores máximos foram observados em 2,5?3,5 min. TsV induziu um intenso aumento de longa duração na PAM, bem como a TsTX-I. A TsTX-V mostrou efeitos pressores menores. TsV mostrou os maiores efeitos sobre a liberação de catecolaminas, seguido pela TsTX-I e TsTX-V com um efeito máximo em 2,5 min, seguido por uma gradual redução, permanecendo, todavia, maior que os controles. Embora ambas as classes de toxinas atuem em canais para Na+, TsTX-I mostrou efeitos mais significantes e intensos sobre a liberação de catecolaminas e pressão arterial que a TsTX-V. Parece que a toxicidade da TsTX-V não está somente relacionada à sua capacidade de liberar catecolaminas, indicando que outros neutrotransmissores podem estar envolvidos em sua toxicidade. Nem a TsV ou suas toxinas foram capazes de afetar a captação de 3H-Glu. TsTXI inibiu somente a captação de 3H-DA (IC50 = 28,41 nM). Por outro lado, TsV (0,43ng/mL) inibiu a captação de 3H-GABA e 3H-DA (~50%). TsTX-V mostrou IC50 = 9,37 nM e 22,2 nM para a captação de 3H-GABA e 3HDA, respectivamente. Esses efeitos foram abolidos pelo pré-tratamento com TTX, indicando o envolvimento de canais para Na+ neste processo. Na ausência de Ca+2 e em baixas concentrações de toxinas, a redução não é tão singnificante como na presença de Ca+2. TsTX-V não reduziu a captação de 3H-GABA em células COS-7 expressando os transportadores de GABA, GAT-1 e GAT-3, sugerindo que esta toxina reduz indiretamente o transporte. A redução da captação de 3H-GABA pelos sinaptosomas pode ser devido a rápida e intensa despolarização celular, como revelado por microscopia confocal em células de glioma C6. Assim, TsTX-V causou redução da captação de 3H-GABA e 3H-DA de uma maneira independente de Ca+2, não afetando diretamente os transportadores de GABA, mas em consequencia da despolarização, envolvendo canais para Na+ operados por voltagem. TsV e suas toxinas foram capazes de aumentar a ([Ca2+ ]C , provavelmente por interargir com canais para Na+. Quando comparado aos efeitos despolarizantes do KCl 60 mM (100 %), TsV (100 e 500 g/mL) exibiu um aumento de 49,60 ± 2,58 % e 103,66 ± 5,17 %, respectivamente, enquanto que a TsTX-I e TsTX-V (50 e 100 g/mL de cada) exibiu 43,92 ± 3,06 % e 121,8 ± 8,9 %; 52,56 ± 8,33 % e 79,5 ± 6,1 % de aumento, respectivamente. TsTX-I (100 g/mL) mostrou-se mais potente nesta preparação, visto que uma dose de 100 g/mL causou efeito muito mais intenso do que a TsTX-V na mesma concentração. É possível que as diferenças observadas sobre os efeitos induzidos pela TsTX-I e TsTX-V sejam conseqüência de alterações estruturais entre canais para Na+ presentes em vários tipos de tecidos e inervações. / Voltage-gated Na+ channel toxins are mainly responsible for the toxic effects of scorpion envenoming and can be classified into two classes: a- and b-neurotoxins. TsTX-V and TsTX-I from Tityus serrulatus venom (TsV) are, respectively, examples of these toxins. In this work, were evaluate the effects of TsV and its toxins on mean arterial pressure (MAP) and catecholamines release in conscious unrestrained rats previously catheterized, as well as GABA, dopamine (DA) and glutamate (Glu) uptake in isolated rat brain synaptosomes and cytosolic Ca2+ concentration ([Ca2+ ]C) in vascular smooth muscle cells from rat aorta. Toxins were isolated by ion exchange chromatography (TsTX-I) followed by RP-HPLC (TsTX-V). The toxins (15 and 30 g/kg) and TsV (50 and 100 g/kg) were injected intravenously. MAP was continuously monitored through femoral catheter. Epinephrine (E) and norepinephrine (NE) plasma levels were determined by RP-HPLC with electrochemical detection, at 10 min before and 2.5, 30 and 90 min after treatments. Maximal pressor effects were observed at 2.5 3.5 min. TsV induced intense long lasting increase in MAP, as did TsTX-I. TsTX-V showed the lowest pressor effects. TsV showed the highest effects on catecholamines release, followed by TsTX-I and TsTX-V with maximal effect at 2.5 min, followed by a gradual reduction, however remaining higher than controls. Although both toxins act on Na+ channels, TsTX-I displayed significant and more intense effects on catecholamines release and blood pressure than TsTX-V. It seems that the toxicity of TsTX-V is not related only with its ability to release catecholamines, indicating that other neurotransmitters, may be involved in its toxicity. Neither the TsV or its toxins was capable to affect the 3H-Glu uptake. TsTX-I inhibited only 3H-DA uptake (IC50 = 28.41 nM). On the other hand, TsV (0.43ng/mL) inhibited both 3H-GABA and 3H-DA uptake (~50%). TsTX-V showed IC50 = 9.37 nM and 22.2 nM for 3H-GABA and 3H-DA uptake, respectively. These effects were abolished by pre-treatment with TTX, indicating the involvement of Na+ channels in this process. In the absence of Ca2+ and at low concentrations of toxin, the reduction is not as significant as in the presence of Ca2+. TsTX-V did not reduce 3H-GABA uptake in COS-7 cells expressing GABA transporters GAT-1 and GAT-3, suggesting that this toxin indirectly reduces the transport. The reduced 3H-GABA uptake by synaptosomes could be due to fast and intense cell depolarization as revealed by confocal microscopy of C6 glioma cells. Thus, TsTX-V causes reduction on 3H-GABA and 3H-DA uptake in a Ca2+-independent manner, not affecting directly GABA transporters, but, in consequence of depolarization, involving voltage-gated Na+ channels. TsV and its toxins were able to increase the ([Ca2+ ]C , probably by interact with Na+ channels. When compared to KCl 60 mM depolarizing effect (100 %), TsV (100 and 500 ?g/mL), showed an increase of 49.60 ± 2.58 % and 103.66 ± 5.17 %, respectively, whereas TsTX-I and TsTX-V (50 and 100?g/mL of each) showed 43.92 ± 3.06 % and 121.8 ± 8.9 %; 52.56 ± 8.33 % and 79.5 ± 6.1 %, respectively. TsTX-I (100 ?g/mL) showed most potent effects in this type of preparation, since induced most intense effect that TsTX-V in the same concentration. Thus, it is possible that the differences observed on the effects induced by both toxins are consequence of structural changes among Na+ channels present in several types of tissues and innervations .

O aneurisma de aorta abdominal (AAA) é uma doença assintomática na maioria dos casos, podendo acometer 5% das pessoas do gênero masculino com idade superior a 65 anos, predispondo ao risco de ruptura com mortalidade em torno de 80%. O presente estudo teve como objetivo avaliar os perfis de expressão gênica e de metilação do DNA no tecido, como também os microRNAs no plasma e no tecido de indivíduos com e sem AAA na tentativa de identificar marcadores biológicos e alvos terapêuticos para o diagnóstico, monitoramento e tratamento precoce do AAA. Os perfis de expressão gênica, miRNA e metilação de DNA dos tecidos da aorta abdominal (n=6) obtidos durante a cirurgia aberta para correção de AAA foram comparados com tecidos da aorta abdominal de doadores de órgãos sem AAA (n=6). Também foram comparados os perfis de miRNAs circulantes no plasma do grupo AAA (n=6) com o grupo-controle de voluntários com as características semelhantes, porém sem AAA (n=6). Para a análise da expressão gênica, utilizou-se a qPCR Array, analisando-se genes relacionados ao endotélio vascular humano (PAHS-015Z, QIAGEN®). A análise do perfil de miRNA foi realizada utilizando-se Human miFinder 384HC miScript miRNA PCR Array (MIHS-3001Z, QIAGEN®) e, para análise de metilação do DNA, utilizou-se a qPCR array com 22 genes das vias de estresse e toxicidade EpiTect Methyl II (EAHS-581Z, QIAGEN®). O software Ingenuity Pathway analysis (IPA®) foi utilizado para identificação das prováveis relações entre os microRNAs e a expressão gênica realizada nesta pesquisa. No estudo da expressão gênica, quatro genes (SPHK-1, TYMP, ALOX5 e HIF1A) foram identificados como mais expressos e outros 6 genes (PTGIS, CX3CL1, ITGB1, COL18A-1, FN1 e AGTR1) apresentaram expressão reduzida nos tecidos de AAA. Na análise do perfil de miRNAs, 24 miRNAs foram significantemente mais expressos e 35 miRNAs menos expressos no tecido. No plasma de indivíduos com AAA, 8 miRNAs apresentaram-se mais expressos e 9 miRNAs menos expressos. Dois miRNAs, miR-328-3p e let-7c-5p demonstraram expressões comuns entre tecido e plasma. Quanto ao padrão de metilação de DNA, somente o gene GDF15 teve grau de metilação maior nos tecidos de AAA quando comparado ao grupo-controle. A análise funcional revelou que o gene PTGIS (prostaciclina sintetase), um potente vasodilatador e inibidor da atividade plaquetária, foi reprimido pelo miR-150-5p, que se mostrou 7,5 vezes mais expresso no tecido de AAA, e teve uma possível interação com o miR-328-3p, cuja expressão foi 3,7 vezes mais baixa no tecido. Os genes com expressão reduzida nos tecidos do AAA foram alvos de miRNAs com expressão aumentada, evidenciando a importância e influência dos fatores epigenéticos tanto para o desenvolvimento quanto para a gravidade do AAA. / Abdominal aortic aneurism (AAA) is an asymptomatic disease in the majority of cases that may occur in 5% of males over age 65, predisposing to the risk of rupture leading to a mortality rate of 80%. The aim of this study was to evaluate the DNA metilation and gene expression profile in tissue, and microRNA expression pattern in both plasma and tissue samples from individuals with and without AAA to identify biological markers and therapeutic targets for an early diagnosis and treatment of AAA, respectively. Genes and miRNA expression and DNA metilation profiles in AAA tissues (n= 6) were compared to abdominal aortic tissues obtained from organ donators without AAA (n = 6). We also compared circulating miRNAs profiles in plasma samples, between AAA (n = 6) and the control group without AAA (n = 6). For the gene expression analysis we used a qPCR Array (PAHS-015Z, QIAGEN®) to analyze genes related to human vascular endothelium. For the miRNA expression pattern and for DNA methylation analysis we used the Human miFinder 384HC miScript miRNA PCR Array (MIHS-3001Z, QIAGEN®) and EpiTect Methyl II (EAHS-581Z, QIAGEN®), respectively. The Ingenuity software was used to identify the interactions between the miRNAs and genes evaluated in this study. Four genes (SPHK-1, TYMP, ALOX5 and HIF1A) were upregulated and six other genes (PTGIS, CX3CL1, ITGB1, COL18A-1, FN1 e AGTR1) were downregulated in AAA tissues. In addition, the miRNAs analysis showed 24 miRNAs more expressed and 35 miRNAs less expressed in AAA tissue than controls. Although in plasma samples, AAA group presented 8 miRNAs more expressed and 8 miRNAs less expressed than controls. Only, miR-328-3p and let-7c-5p were differently expressed between AAA and controls in both tissue and plasma samples. DNA methylation analysis showed that the gene GDF15 was hypermethylated in AAA tissues when compared to the control group. Functional analysis revealed that PTGIS, a potent vasodilator and platelet activity inhibitor was supressed by miR-150-5p, which had a seven-fold increase in AAA tissues. Moreover, a possible interaction between PTGIS and miR-328-3p, about 4-fold decreased in AAA tissues, was showed. Thus, the downregulated genes in AAA tissues are targets of miRNAs with increased expression in the same biological sample. These results highlight the importance and influence of epigenetic factors for both development and severity of AAA.

INTRODUÇÃO: Os enxertos vasculares sintéticos disponíveis atualmente apresentam baixos índices de patência, quando utilizados na revascularização de vasos de pequeno calibre, e possuem resultados inferiores quando comparados ao uso de veias autólogas em derivações infrageniculares. Nova prótese de pequeno calibre confeccionada em silicone (polidimetilsiloxano, PDMS) com reforço de tecido de poliéster foi desenvolvida e comparada à prótese de PTFE. OBJETIVOS: Analisar, em modelo experimental em coelhos, o tubo de PDMS como material para prótese vascular e compará-lo a prótese de PTFE. MÉTODOS: Quarenta coelhos foram submetidos a interposição na aorta infrarrenal de próteses de 4mm de diâmetro, sendo 20 animais com PDMS e 20 com PTFE (grupo controle). Foi medido o tempo de clampeamento e realizada arteriografia retrógrada da aorta para avaliar a patência das próteses. Para avaliar a endotelização das próteses foi realizada microscopia eletrônica de maneira amostral pareada. RESULTADOS: Vinte e cinco animais (62,5%) não apresentaram intercorrências pós-operatórias; oito (20%) morreram precocemente e sete (17,5%) ficaram paraplégicos no pós-operatório imediato (e foram sacrificados), sendo que esses animais não foram incluídos nas análises de patência. Não foi observada diferença entre os grupos quanto à evolução com complicações pós-operatórias (p=0,526) e quanto ao tempo de clampeamento da aorta (p=0,299). A patência em 30 dias foi de 100% para as duas próteses. Aos 60 dias, a taxa de patência do PDMS foi de 92,3% (± 7,4), e de 73,8% (±13,1) em 90 dias; as próteses de PTFE tiveram taxas de patência de 87,5% (± 11,7) aos 60 e 90 dias. Não foi observada diferença significativa entre as taxas de patência dos grupos (p=0,62). Não houve diferença siginificativa entre os grupos quanto ao grau de estenose das próteses patentes (p=0,650) à avaliação angiográfica. A microscopia eletrônica mostrou crescimento endotelial limitado às regiões próximas às anastomoses nos dois tipos de próteses. CONCLUSÃO: O PDMS mostrou-se passível de utilização como prótese vascular, com resultados comparáveis aos do PTFE no modelo utilizado / INTRODUCTION: Synthetic vascular grafts currently available have suboptimal patency rates in small-diameter vessels and inferior outcomes in below-the-knee arterial bypass procedures when compared to the use of autologous vein. A new small vessel prosthesis made of silicone (polydimethylsiloxane, PDMS) and reinforced with polyester fabric was developed and compared to the standard PTFE prosthesis. OBJECTIVES: On a rabbit experimental model, we compared the outcomes of new PDMS vascular prostheses with PTFE vascular prostheses. METHODS: Forty rabbits underwent infra-renal aorta replacement with 4 mm diameter prostheses, twenty animals with PDMS and twenty animals with PTFE (control group). Aortic clamping time was measured and retrograde aortic angiography was performed to assess patency. Histological graft samples were examined by electron microscopy to evaluate prostheses endothelialization. RESULTS: Twenty-five (62,5%) animals had good surgical outcome; eight animals (20%) expired and seven animals (17.5%) became paraplegic (and subsequently sacrificed) during early follow up and were not included in anastomosis patency analysis. Postoperative complications (death, paraplegia) rates (p=0,526) and aortic clamping times (p=0,299) were comparable in both groups. Patency rates in 30 days were 100% for both grafts. At 60 days, patency rate for PDMS was 92,3% (±7,4), and 73,8% (±13,1) at 90 days. PTFE grafts had patency rates of 87,5% (±11,7) at 60 and 90 days. No statistically significant difference was found in between groups for patency rates (p=0,62). No statistically significant difference for stenosis was found on angiographical analysis in between groups (p=0,650). Electron microscopy revealed limited anastomotic endothelial ingrowth in both prostheses used. CONCLUSION: In this experimental model, PDMS and PTFE vascular prostheses had comparable outcomes and PDMS prosthesis could be used as a vacular graft

[pt] As patologias na valva aórtica representam umas das principais causas de óbito no mundo. Nos casos de estenose aórtica grave, a substituição da valva nativa é necessária. Existem dois mecanismos de substituição de valva aórtica: cirurgia convencional, através da toracotomia, ou o implante valvar aórtico percutâneo (TAVI, Transcatheter Aortic Valve Implantation). O posicionamento coaxial da prótese valvar em relação ao ânulo aórtico influência o fluxo sanguíneo transvalvar, podendo contribuir para o remodelamento aórtico, culminando em dilatações aneurismáticas, dissecção aórtica e processo aterosclerótico. O presente estudo avalia numericamente a influência do posicionamento coaxial da prótese valvar nas estruturas hemodinâmicas na região de aorta ascendente e início do arco aórtico, durante um ciclo cardíaco. A geometria anatômica avaliada corresponde a um modelo aórtico de um paciente que foi submetido ao implante valvar percutâneo. O escoamento foi obtido com o modelo de turbulência (K - W), utilizando o software ANSYS-Fluent. A interação entre a complacência aórtica e o fluxo sanguíneo durante o ciclo cardíaco foi obtida empregando simulações do tipo FSI (Fluid Structure Interaction). A metodologia numérica foi validada através de comparações com dados experimentais nobres do tipo PIV estereoscópico, com excelente concordância do campo de velocidade e tensões de Reynolds. Observou-se a importância do posicionamento coaxial da prótese valvar aórtica com relação ao direcionamento do jato e área de impacto na parede da aorta; influenciando na formação de regiões de recirculação na raiz da aorta e aorta ascendente; com diferentes estruturas coerentes (vórtices). Identificou-se as regiões de alta pressão e tensão de cisalhamento na parede da aorta, assim como de alta intensidade das grandezas turbulentas no volume interno da aorta. A partir da análise dos resultados foi possível sugerir que a posição coaxial ideal da prótese pode ser obtida quando é direcionada à parede esquerda da aorta com uma inclinação de 4 graus. / [en] Aortic valve pathologies are one of the leading causes of death in the world. In cases of severe aortic stenosis, replacement of the native valve is necessary. There are two mechanisms of aortic valve replacement: conventional surgery through thoracotomy or Transcatheter Aortic Valve Implantation (TAVI). Coaxial positioning of the valve prosthesis in relation to the aortic annulus influences on the transvalvar blood flow, which may contribute to aortic remodeling, culminating in aneurysmal dilations, aortic dissection and atherosclerotic process. The present thesis evaluates the influence of the coaxial positioning of the valve prosthesis on hemodynamic structures in the ascending aorta and the beginning of the aortic arch, during a cardiac cycle. The anatomical geometry evaluated was the aortic model of a specific patient after being submitted to percutaneous valve implantation procedure. The flow was obtained with the (K - W) turbulence model, using ANSYS-Fluent software. Interaction between aortic compliance and blood flow during the cardiac cycle was obtained using simulations FSI (Fluid Structure Interaction). The numerical methodology was validated through comparisons with noble experimental data obtained from stereoscopic PIV method, with excellent agreement of the velocity field and Reynolds stress. It was observed the importance of the coaxial positioning of the aortic valve prosthesis in relation to the jet direction and the impact area in the aortic wall, influencing the formation of recirculation regions in the aortic root and ascending aorta; with different coherent structures (vortices). The regions of high pressure and shear stress were identified in the aortic wall, as well as high intensity turbulent quantities in the internal aortic volume. From the results analysis it was possible to suggest that the ideal coaxial position of the prosthesis can be obtained when it is directed to the left wall of the aorta with an inclination of 4 degrees.

Aortic stiffness is an independent risk factor that has prognostic value regarding future cardiovascular disease (CVD) events such as myocardial infarction, strokes, and heart failure. Although death rates due to coronary heart disease have declined in recent years, the leading global killer remains CVD and prevalence is still high. Understanding lifestyle contributors associated with aortic stiffness would provide the public with insight into targeting key health-related behaviors. The purpose of this observational study was to examine the association of physical activity, physical function, and dietary quality as independent factors contributing to aortic stiffness in apparently healthy middle aged men. Fifty-two men between the ages of 30 and 59 years were recruited to participate in this study, which required two visits to the Exercise Physiology Laboratory. Aortic stiffness was measured by aortic pulse wave velocity (aPWV) and was not associated with total daily step counts (r=-0.06; P=0.70). However, aortic stiffness was inversely associated with physical function, determined with the sitting-rising test score (r=-0.44; P<0.01) and inversely associated with relative muscular strength, determined with peak handgrip strength in both hands normalized to body mass (r=-0.41; P<0.01). Additionally, aortic stiffness was inversely associated with dietary quality, determined with the Healthy Eating Index score (r=0.51; P<0.01). In conclusion, key health-related behaviors in this study that explained a large percentage of the variation in aortic stiffness were physical function and dietary quality (Adj r²=0.47; SEE=0.634). Hence, optimizing overall musculoskeletal fitness by focusing on strength, balance, coordination, and flexibility in addition to greater adherence to the U.S. Dietary Guidelines are key lifestyle contributors associated with reduced CVD risk in otherwise healthy middle aged men.

Background: Thoracic aortic aneurysms and dissections (TAAD) have a genetic component with an estimated 20-25% of the patients having a positive family history. An aneurysm often precedes a dissection. Acute aortic dissections are associated with high mortality and morbidity, even when operated on. Complications due to prophylactic surgery are considerably fewer. Therefore, patients at risk for dissection should be identified, followed-up and evaluated for prophylactic intervention. Aims: 1. To establish reference values for ascending (AoA) and descending aortic (AoD) diameters measured by computed tomography. 2. To study the effectiveness of phenotypic cascade screening in families with an inherited form of thoracic aortic aneurysms and dissections (FTAAD) and to address questions that arise when screening for a genetic disorder is applied. 3. To study the agreement of aortic diameters obtained by TTE and MRI and to study aortic stiffness in individuals from families with FTAAD. 4. To perform exome sequencing in order to identify pathogenic sequence variants causing FTAAD, to characterize the phenotype, and to compare thoracic aortic diameter and stiffness in mutation carriers and non-carriers. Results: Paper I: The diameter of the thoracic aorta increased by 0.17 mm (0.12 – 0.20 mm) per year. The mean sex-related difference in diameter was 1.99 mm (1.28 – 2.60 mm) with men having larger aortas than women. The mean difference in aortic diameter per unit BMI was 0.27 mm (0.14 – 0.44 mm). Upper normal limits for the AoA can be calculated by the formula D (mm)=31+0.16*age and for the AoD by D (mm)=21+0.16*age. Paper II: Of 106 individuals from families with FTAAD but without known thoracic aortic disease, 19 individuals (18%) were identified to have a dilated AoA. The expected number of individuals in this group with an autosomal dominant disease would have been 40 (p&lt;0.0001). In first-degree relatives younger than 40, we found only one individual with a dilated aorta although the expected number of individuals with disease causing mutation would have been 10. Paper III: Of 116 individuals investigated, 21 were identified with thoracic aortic dilatation and 95 individuals with normal thoracic aortic diameter. Aortic stiffness increased with age and diameter. The individuals with aortic dilatation were older than those without (49 vs. 37 years, p=0.001) and showed lower aortic elastic properties. The diameters measured by TTE and MRI correlated strongly (r2=0.93). The mean difference in diameters between the two methods was 0.72 mm (95% CI 0.41-1.02) with TTE giving larger diameters than MRI. Paper IV: From exome sequencing and segregation analysis, a 2-bp deletion in the MYLK gene (c.3272_3273del) was identified to cause FTAAD. The age and the aortic diameter at dissection or rupture varied in the family members. We did not find any differences in aortic diameter, aortic stiffness, or pulse wave velocity between carriers and non-carriers. Conclusions: Thoracic aortic diameter increases with age, and sex and body size are also associated with the diameter. In FTAAD, screening identifies family members with a previously unknown aortic dilatation. However, a normal aortic diameter does not exclude an individual from being a carrier of FTAAD. TTE can be used in follow-up for the ascending aorta. Individuals identified to have a dilated thoracic aorta have increased aortic stiffness compared to individuals with normal thoracic aortic diameter. The MYLK mutation (c.3272_3273del) causes thoracic aortic dissections with variable clinical expression. No differences in aortic stiffness were identified between MYLK mutation carriers and non-carriers.

Background: Coarctation of the aorta (CoA) is a congenital heart disease which represents a narrowing of the proximal descending aorta, hence increasing pressure afterload to the left ventricle (LV). Conventional treatment of native CoA is surgical repair, however potential recurrence or other related complications e.g. aortic rupture, heart failure and cerebrovascular events are common. Thus, lifelong follow-up of these patients is required. Echocardiography is the most patient’s friendly method to evaluate CoA and in particular its effect on LV function. Moreover, the novel speckle tracking echocardiography (STE) is an important method to assess subclinical LV dysfunction, a technique that promises better evaluation of LV function in these patients. The aims of this thesis were to review the literature on LV function in children with CoA using myocardial deformation imaging technologies, hence, to better understand the current knowledge and vagueness of the scientific evidence. We also aimed to study the effect of early CoA repair on the structure and function of LV and ascending aorta. In addition, we wished to establish in a meta-analysis format normal values of speckle tracking derived strain and strain rate values. Methods: Study 1. We have systematically searched the PubMed, and studies that fulfilled the inclusion criteria were critically analyzed and presented on a narrative form. Study 2 and 3. In addition to conventional echocardiographic measures of LV and ascending aorta, we measured longitudinal strain and strain rate of the LV using a vendor independent software, TomTec. We have also measured the aorto-septal angle (AoSA). Data was compared with normal healthy controls. Study 4. Electronic databases were systematically searched and suitable studies were meta analyzed using Comprehensive meta-analysis version 3 software. Results: Study 1. In 7/4945 included articles, 123 and 76 patients with congenital aortic stenosis (CAS) and CoA were reported, respectively. Normal conventional LV function, with subclinical myocardial dysfunction were reported in all studies before intervention. After intervention, a consistent improvement of myocardial deformation parameters was documented, even though not reaching normal values. Study 2. In 21 patients with CoA, LV function significantly improved after intervention (p &lt;0.001), however normal values were not reached even at medium-term follow-up (p = 0.002). Medium-term longitudinal strain correlated with pre intervention LV ejection faction (EF) (r = 0.58, p = 0.006). Medium-term subnormal values were more frequently associated with Bicuspid aortic valve (BAV) (33.3% vs. 66.6%; p &lt;0.05). Study 3. AoSA was abnormally wide before intervention, in particular at peak ejection in the descending aorta (p &lt;0.0001), and correlated with CoA pressure gradient. After intervention, AoSA normalized and significantly correlated with the increase of LV cavity function and overall LV deformation parameters. Study 4. In a meta-analysis of 28/282 studies including 1192 subjects, strain and strain rate values were established. Longitudinal strain normal mean values varied from -12.9 to -26.5 (mean, -20.5; 95 % CI, -20.0 to -21.0). Normal mean values of circumferential strain varied from -10.5 to -27.0 (mean, -22.06; 95 % CI, -21.5 to -22.5). Radial strain normal mean values varied from 24.9 to 62.1 (mean, 45.4; 95 % CI, 43.0 to 47.8). Meta-regression showed LV end-diastolic diameter as a significant determinant of variation of longitudinal strain. Longitudinal systolic strain rate was significantly determined by age and radial strain was influenced by the type of vendor used. Conclusion: The systematic review showed subclinical LV dysfunction in children with CoA before and after correction. However, since most of the patients were operated at an older age and had preserved LV EF, the effect of early intervention on LV function was only speculated. Our children with CoA who were operated at an earlier age showed LV subclinical dysfunction even at medium- term after intervention while the AoSA returned to normal shortly after intervention. Lower longitudinal strain values were found in patients with LV dysfunction (LV EF &lt;50%) before intervention and BAV. Finally, normal range values for strain and strain rate have been established and seem to be influenced by patients’ age, LV end-diastolic diameter and vendor used.