Background: Obesity has become one of our times most endemic disease on a global scale and changes to lifestyle is the most cost-effective way to treat patients, when the cost for healthcare related treatment is staggeringly high for obesity and sequela diseases NAFLD, diabetes typ 2, dyslipidaemia and metabolic syndrome.The problem with this remedy is that it requires work and dedication. But changes require hard work, and in this patient group- low compliance, weight gain after treatment, dropping out of programs and small desire to change are the most common problems. Motivational studies report that readiness in obese patients is low and the best way to help patients to move forward is by motivational conversations. The obesity sequela disease NAFLD is an asymptomatic disease it displays no symptoms until very late stages. Therefore it’s a problem to get patients make the patient understand his illness and the seriousness of it. Aim: This literature work was aimed at investigating compliance in lifestyle changes in obese subject and to see if close contact with healthcare staff affected the achieved results. Method: In this literature study, the databases Pubmed, Science Direct, Medline and Sportdiscus were used to find information. Article inclusion criteria were that the articles were not older than 10 years and were in English. Result: Frequent and regular contacts between participants and professional staff provided good results both with regard to weight loss, biochemical response, and the participants' willingness to change. Also it shows that return visits at least every three months will improve weight loss if the participant is motivated to implement a change to lifestyle. Conclusion: Overall, this literature study shows the difficulties with lifestyle changes in people with obesity and sequela NAFLD. Close contacts of the patients with healthcare staff has proven to have a positive impact on treatment compliance, but there are other lifestyle difficulties in these patient groups which hamper compliance.

Il est estimé aujourd’hui que plus de 350 médicaments peuvent induire des lésions hépatiques entraînant différentes manifestations cliniques telles qu’une hépatite cytolytique, une stéatose voire une cirrhose. Bon nombre de médicaments hépatotoxiques induisent un dysfonctionnement mitochondrial. Cependant, les mécanismes induisant de tels effets délétères ne sont pas tous élucidés, en particulier ceux concernant l’ADN mitochondrial (ADNmt) et son homéostasie, qui ne sont pas souvent explorés. De plus, il existe peu d’informations concernant l’hépatotoxicité médicamenteuse dans un contexte de stéatose induite par l’obésité. Ainsi, l’objectif de ce travail a été tout d’abord de mettre au point un modèle de stéatose dans les cellules de la lignée hépatocytaire humaine HepaRG afin d’étudier ensuite, les effets de neuf médicaments hépatotoxiques et vraisemblablement mitochondriotoxiques – l’amiodarone, l’atorvastatine, la carbamazépine, l’imipramine, la lovastatine, la perhexiline, le ritonavir, la terbinafine et la troglitazone – sur l’homéostasie de l’ADNmt dans un contexte ou non de stéatose. En utilisant des concentrations peu ou non cytotoxiques, nous avons trouvé que parmi les neuf médicaments étudiés, le ritonavir et l’imipramine ont induit des effets mitochondriaux suggérant une altération de la traduction mitochondriale. De façon notable, la toxicité du ritonavir était plus importante dans les cellules non-stéatosées. De plus, aucun des neuf médicaments n’a induit de diminution des quantités d’ADNmt. Cependant, les quantités accrues d’ADNmt ont été retrouvées avec six des neuf médicaments, et notamment dans les cellules non-stéatosées. Cela était par ailleurs accompagné d’une modulation de l’expression des différents facteurs impliqués dans la biogenèse mitochondriale (PGC-1α, PGC-1β, AMPK, etc.). Ainsi, ces données laissent supposer qu’une altération de la traduction mitochondriale peut ne pas être une événement rare et que l’augmentation des quantités d’ADNmt et la modulation de la biogenèse mitochondriale pourraient être une réponse adaptative fréquente à des altérations mitochondriales pouvant être amoindrie par la stéatose. / It is currently estimated that more than 350 drugs can induce liver injury with different clinical presentations such as hepatic cytolysis, steatosis, even cirrhosis. Many hepatotoxic drugs can induce mitochondrial damage and dysfunction. However, not all mechanisms that lead to such deleterious effects are clarified, especially those concerning mitochondrial DNA (mtDNA) and its homeostasis, which are not often investigated. Moreover, there is little information regarding the impact of non alcoholic fatty liver disease (NAFLD) on drug-induced liver injury. Thus, the aim of this work was, first of all, to develop a model of NAFLD in the hepatic cell line HepaRG in order to study further effects of nine hepatotoxic and presumably mitochondriotoxic drugs – amiodarone, atorvastatin, carbamazepine, imipramine, lovastatin, perhexiline, ritonavir, terbinafine and troglitazone –, on mtDNA homeostasis in the context of NAFLD or not. By using drug concentrations that did not induce major cytotoxicity, we found that, among the nine drugs, studied, ritonavir and imipramine induced mitochondrial effects suggesting alteration of mtDNA translation. Notably, ritonavir toxicity was stronger in non-steatotic cells. Furthermore, none of the nine drugs decreased mtDNA levels. However, increased mtDNA was observed with six drugs, especially in non-steatotic cells. This result was also accompanied by a modulation of the expression of various factors involved in mitochondrial biogenesis (e.g. PGC-1α, PGC-1β, AMPK).Therefore, this data suggests that drug-induced impairment of mtDNA translation may not be a rare event and increased mtDNA levels and modulation of mitochondrial biogenesis could be a frequent adaptive response to mitochondrial impairments, which could be dampened by steatosis.

To compare ultrasound-based acoustic structure quantification (ASQ) with established non-invasive techniques for grading and staging fatty liver disease.

La stéatose hépatique non alcoolique (SHNA) est maintenant une des principales causes de cancer du foie. Cependant, les mécanismes physiopathologiques contribuant à son développement ou à la progression de la maladie sont peu connus. Il a été démontré que le niveau d’expression du coactivateur transcriptionnel PGC-1α est inversement proportionnel avec la sévérité de la stéatose hépatique le stress oxydatif et la résistance à l’insuline dans les foies de souris. Chez l’humain, on observe aussi une diminution de PGC-1α dans les foies de patients atteints de SHNA. De plus, il a été démontré que les souris avec une réduction de 50% des niveaux hépatique de PGC-1α mène à une sensibilité à l’insuline et à une tolérance au glucose altérée dans les tissus périphériques. Ces découvertes suggèrent qu’en plus d’être associés au développement de la SHNA, les niveaux hépatiques de PGC-1α altèrent l’expression de facteurs sécrétoires du foie afin d’influencer la régulation métabolique de tout le corps. Nous proposons qu’une réduction de l’expression de PGC-1α dans le foie influence les protéines sécrétées par le foie en situation de stress métabolique, révélant l’importance de PGC-1α dans la réponse adaptative du foie. L’analyse du sécrétome hépatique effectuée par spectrométrie de masse sur le milieu conditionné d’hépatocytes primaires a identifié SERPINA3N, une protéine sécrétée, dont les niveaux corrèlent avec les niveaux hépatiques de PGC-1α et sont influencés par la diète obésogène. Dans ce projet, les niveaux sanguins de cette protéine ont été quantifiés par western blot chez des souris mâles et femelles, sauvages ou hétérozygotes pour PGC-1α dans le foie et nourris avec une diète control ou riche en gras et en fructose. Nos résultats démontrent que les niveaux circulatoires de SERPINA3N augmentent avec la diète et corrèlent avec les niveaux hépatiques de PGC-1α de manière dépendante à la diète et le sexe. De plus, les niveaux sanguins de SERPINA3N diminuent avec la progression de la maladie. L’expression hépatique de SERPINA3N est grandement influencée par les niveaux de PGC-1α, mais indépendamment du facteur transcriptionnel NF-κB. Nous avons montré que les glucocorticoïdes augmentent les niveaux protéiques et circulatoires de SERPINA3N dans les hépatocytes primaires. De plus, cette augmentation par les glucocorticoïdes est influencée par les niveaux de PGC-1α. Ces résultats révèlent une nouvelle interaction entre PGC-1α et le récepteur des glucocorticoïdes sur l’expression hépatique et la sécrétion de SERPINA3N. Pour conclure, l’identification de protéines circulatoires régulées par PGC-1α nous aidera à mieux comprendre comment la perte d’expression de PGC-1α dans le foie affecte le métabolisme de tout le corps dans le contexte de la SHNA. / Non-alcoholic fatty liver disease (NAFLD) is becoming a serious public health problem and is now one of the leading causes of liver cancer. Although NAFLD is known to be associated with obesity, insulin resistance, metabolic syndrome and type II diabetes, the mechanisms contributing to its development are not fully understood. It is shown that hepatic PGC-1α levels correlate negatively with NAFLD development, oxidative liver damage and hepatic insulin resistance in murine models. In humans, decrease PGC-1α expression in NAFLD and NASH patients. Moreover, liver-specific PGC-1α reduction in mice also disrupts glucose tolerance and insulin sensitivity in muscle and adipose tissue, likely due to altered secretion of hepatic hormones. These findings suggest that in addition to contributing to NAFLD development, the hepatic disruption of PGC-1α alters the liver secretome, thereby influencing the whole-body energy metabolism. We hypothesize that decreased expression of PGC-1α in the liver alters the expression of hepatokines under metabolic challenges, revealing a potential novel role for PGC-1α in the adaptive response of the liver. The hepatocyte-specific secretome was analyzed by mass spectrometry (iTRAQ) in conditioned media from primary hepatocytes. We identified SERPINA3N, a secreted protein whose secreted levels correlated with hepatic PGC-1α levels in a diet-dependent manner. This hepatokine was measured in serum from male, female, wildtype and liver-specific PGC-1α heterozygote mice fed chow or high-fat, high-fructose diet using western blot. SERPINA3N circulating levels increased with the western diet and correlated with hepatic PGC-1α levels in a diet and sex-dependent manner. Its serum levels decreased with the progression of the disease. The hepatic SERPINA3N expression was greatly influenced by PGC-1α levels independently of NF-κB transcription factor. We showed that glucocorticoids increased SERPINA3N protein and secreted levels in primary hepatocytes. This increase was influenced by PGC-1α levels, revealing a novel interaction of PGC-1α and the glucocorticoid receptor on SERPINA3N expression and secretion. In conclusion, this project reveals a novel impact of hepatic PGC-1α levels on the liver secretome during NAFLD development. This work will provide insights on the role of hepatic PGC-1α levels on the regulation of hepatokines and how it influences the whole-body energy homeostasis in a context of NAFLD.

Spinal muscular atrophy (SMA) is a devastating recessive neurological disorder thought to be affecting primarily the motor neurons. As such, paralysis, motor weakness and death ensue. While SMA is most commonly seen in infants and children, it can span all ages. Its genetic etiology revolves around the homozygous deletion or mutation of the SMN1 gene, whose product (SMN protein) has critical and ubiquitous roles in mRNA splicing, amongst various other functions in mRNA metabolism. As such, SMN depletion in other non-neuronal cells type is likely to have physiological repercussions, and perhaps modulate the SMA phenotype. Herein, we identify the molecular pathways of atrophy in skeletal and cardiac muscle of two mouse models of SMA and their therapeutic modulation via the histone deacetylase inhibitor trichostatin A. We also identify dramatic changes in immune organs in mouse models of SMA, which could impact susceptibility to infections. Furthermore, we establish the presence of important defects in fatty acid homeostasis in the liver and plasma seen in both mouse models and SMA patients. Finally, we provide the first mild mouse model of SMA that reliably reproduces canonical features of SMA, permitting aging studies. This model presents with a prominent myopathic phenotype prior to motor neuron death, without extra-neuronal involvement during the course of its lifespan. Overall, our work shows multiple potentially clinically relevant defects in extra-neuronal organs, provides ways to abrogate them and provides a framework to study them over the course of aging.

No description available.

Motivation Alcohol consumption is one of the major risk factors of cardiovascular disease (CVD). Excessive alcohol drinking is the fifth leading cause of death worldwide and the prevalence of alcohol abuse continues to increase especially in low-income areas of sub-Saharan Africa. The alarming rate of urbanisation seems to be the driving force for excessive alcohol intake in the developing world. In addition to its influence on CVD, heavy drinking also results in a number of non-cardiovascular consequences that include injury, risky sexual behaviour, violent crime and family dysfunction among black South Africans, contributing to high mortality. Moreover, the highest number of individuals with human immunodeficiency virus (HIV) infection in South Africa is partly attributable to high intake of alcohol. HIV remains a major concern in South Africa with significant funding diverted to address the pandemic. The continued increases in mortality from preventable outcomes such as stroke, myocardial infarction and renal failure are largely due to urbanisation, poverty and dysfunctional health systems working with limited budgets. These are some of the factors requiring in-depth study of the scientific aspects of alcohol intake in South Africa. Although there is enough evidence that links excessive drinking with hypertension and CVD, the markers of alcohol intake – self reporting of alcohol, gamma-glutamyltransferase (GGT) and carbohydrate deficient transferrin – are still not specific enough to isolate other confounding factors in the association of alcohol intake with CVD. The markers of alcohol that independently predict CVD and mortality need to be explored. Finally, the severe lack of longitudinal investigations on alcohol-related hypertension development and total mortality in black South Africans has compromised the early identification of risk factors associated with these outcomes. This study will therefore attempt to address the limited availability of longitudinal studies and stimulate interest for continued investigation. Aim The aim of this study was to investigate whether alcohol intake of black South Africans is related to specific measures of cardiovascular function (change in blood pressure (BP), hypertension development) and mortality over a period of 5 years. Methodology This study was based on the international Prospective Urban and Rural Epidemiology (PURE) study which includes 26 countries, investigating the cause and development of cardiovascular risk factors in low, middle and high income countries. This South African leg of the PURE study started in 2005 in which the baseline data was collected from 2021 black South Africans from rural and urban areas in Ikageng, Ganyesa and Tlakgameng in the North West Province. Eleven participants presented with missing data, leaving 2010 participants with complete datasets at baseline. However, data from these 11 participants was useful, especially for Chapter 4. All participants gave informed consent and the Ethics committee of the North-West University (Potchefstroom Campus) approved the study. The follow-up data collection was done in 2010. General health questionnaires, anthropometric measurements, lipid profiles and cardiovascular measurements were taken both at baseline and follow-up using appropriate methods. We also collected blood samples and performed biochemical analyses for lipid markers, liver enzymes, inflammatory markers and percentage carbohydrate deficient transferrin (%CDT). Finally, we obtained data on cardiovascular and non-cardiovascular mortality through verbal autopsy and death certificates. We made use of analysis of variance (ANOVA) and Chi-square tests to compare means and proportions, respectively. We used dependent t-tests and the McNemar test to compare baseline and follow-up variables. Furthermore, we employed single and partial linear regression analyses to correlate alcohol markers with each other and with the cardiovascular measures. Multiple regression analyses were used to correlate dependent variables in the study with various independent variables as required. Finally, we employed multivariable-adjusted Cox regression analyses to assess the association of the selected alcohol markers with mortality while adjusting for several independent variables. Results and Conclusions of each manuscript - With the first research article (Chapter 4), we aimed to compare self-reported alcohol intake estimates with GGT and %CDT, considering their relationship with percentage change in brachial blood pressure (BP) and central systolic blood pressure (cSBP) over 5 years. The results indicated that only self-reported alcohol intake independently predicted % change in brachial BP and cSBP. This was not found for the biochemical markers GGT and %CDT. Self-reported alcohol intake seems to be an important measure to implement by health systems in low income areas of sub-Saharan Africa, where honest reporting is expected. - Given the likely presence of high GGT levels in both alcohol consumption and non-alcoholic fatty liver disease (NAFLD), the second manuscript (Chapter 5) aimed to compare the cardiovascular and metabolic characteristics of excessive alcohol users and individuals with suspected NAFLD (confirmed with self-report, GGT and %CDT). We found that different sex and cardiometabolic profiles characterised excessive alcohol users and individuals suspected with NAFLD. Lean body mass and male sex were the dominant characteristics in excessive alcohol use while the NAFLD group had a dysmetabolic profile with obese women making up the higher proportion of this group. In excessive alcohol users systolic blood pressure and pulse pressure were independently associated with high-density lipoprotein cholesterol. Diastolic blood pressure showed a significant correlation with waist circumference. These disparate profiles may guide healthcare practitioners in primary healthcare clinics to identify individuals with elevated GGT levels who may suffer from NAFLD or alcohol overuse. These results emphasise the importance of modifiable risk factors as the main contributors to CVD and that lifestyle change should be the main focus in developing countries such as South Africa. - The third manuscript (Chapter 6) aimed to determine the measure of alcohol intake (selfreported alcohol intake, GGT and %CDT) that related best with hypertension development, cardiovascular and all-cause mortality over 5 years in the same population of black South Africans. We found that GGT was the only independent predictor of hypertension development, cardiovascular as well as all-cause mortality. Moreover, self-reporting of alcohol intake predicted incident hypertension, confirming our findings from Chapter 4. The third marker, %CDT, a highly specific marker of alcohol intake, was not related with any outcome variable, perhaps due to its low sensitivity. Although self-reported alcohol intake is useful in low-resource primary healthcare settings, measurement of GGT is encouraged due to its predictive value for hypertension and mortality. GGT represents alcohol intake, non-alcoholic steatohepatitis and obesity - all known to have severe cardiovascular consequences. Discussion and Conclusions Excessive alcohol intake remains a major concern in the development of hypertension, CVD and premature death in sub-Saharan Africa. Despite their weaknesses such as bias and nonspecificity, self-reporting of alcohol consumption and GGT emerged as reliable alcohol markers that independently predicted 5-year change in BP, hypertension development and total mortality in this population. Serum %CDT did not show any association with the mentioned cardiovascular markers. Finally, we were also able to show that black South Africans with suspected NAFLD (i.e. with high GGT levels who do not consume alcohol) are typically obese women, whereas lean men were more likely to have high alcohol consumption. Further prospective investigations are encouraged regarding (a) these mentioned associations, as well as (b) other self-reporting estimates such as quantity and frequency of drinking and (c) the use of %CDT as a highly specific marker of alcohol intake. The simultaneous presence of HIV infection in alcohol abuse in this population also warrants further investigation. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015

Motivation Alcohol consumption is one of the major risk factors of cardiovascular disease (CVD). Excessive alcohol drinking is the fifth leading cause of death worldwide and the prevalence of alcohol abuse continues to increase especially in low-income areas of sub-Saharan Africa. The alarming rate of urbanisation seems to be the driving force for excessive alcohol intake in the developing world. In addition to its influence on CVD, heavy drinking also results in a number of non-cardiovascular consequences that include injury, risky sexual behaviour, violent crime and family dysfunction among black South Africans, contributing to high mortality. Moreover, the highest number of individuals with human immunodeficiency virus (HIV) infection in South Africa is partly attributable to high intake of alcohol. HIV remains a major concern in South Africa with significant funding diverted to address the pandemic. The continued increases in mortality from preventable outcomes such as stroke, myocardial infarction and renal failure are largely due to urbanisation, poverty and dysfunctional health systems working with limited budgets. These are some of the factors requiring in-depth study of the scientific aspects of alcohol intake in South Africa. Although there is enough evidence that links excessive drinking with hypertension and CVD, the markers of alcohol intake – self reporting of alcohol, gamma-glutamyltransferase (GGT) and carbohydrate deficient transferrin – are still not specific enough to isolate other confounding factors in the association of alcohol intake with CVD. The markers of alcohol that independently predict CVD and mortality need to be explored. Finally, the severe lack of longitudinal investigations on alcohol-related hypertension development and total mortality in black South Africans has compromised the early identification of risk factors associated with these outcomes. This study will therefore attempt to address the limited availability of longitudinal studies and stimulate interest for continued investigation. Aim The aim of this study was to investigate whether alcohol intake of black South Africans is related to specific measures of cardiovascular function (change in blood pressure (BP), hypertension development) and mortality over a period of 5 years. Methodology This study was based on the international Prospective Urban and Rural Epidemiology (PURE) study which includes 26 countries, investigating the cause and development of cardiovascular risk factors in low, middle and high income countries. This South African leg of the PURE study started in 2005 in which the baseline data was collected from 2021 black South Africans from rural and urban areas in Ikageng, Ganyesa and Tlakgameng in the North West Province. Eleven participants presented with missing data, leaving 2010 participants with complete datasets at baseline. However, data from these 11 participants was useful, especially for Chapter 4. All participants gave informed consent and the Ethics committee of the North-West University (Potchefstroom Campus) approved the study. The follow-up data collection was done in 2010. General health questionnaires, anthropometric measurements, lipid profiles and cardiovascular measurements were taken both at baseline and follow-up using appropriate methods. We also collected blood samples and performed biochemical analyses for lipid markers, liver enzymes, inflammatory markers and percentage carbohydrate deficient transferrin (%CDT). Finally, we obtained data on cardiovascular and non-cardiovascular mortality through verbal autopsy and death certificates. We made use of analysis of variance (ANOVA) and Chi-square tests to compare means and proportions, respectively. We used dependent t-tests and the McNemar test to compare baseline and follow-up variables. Furthermore, we employed single and partial linear regression analyses to correlate alcohol markers with each other and with the cardiovascular measures. Multiple regression analyses were used to correlate dependent variables in the study with various independent variables as required. Finally, we employed multivariable-adjusted Cox regression analyses to assess the association of the selected alcohol markers with mortality while adjusting for several independent variables. Results and Conclusions of each manuscript - With the first research article (Chapter 4), we aimed to compare self-reported alcohol intake estimates with GGT and %CDT, considering their relationship with percentage change in brachial blood pressure (BP) and central systolic blood pressure (cSBP) over 5 years. The results indicated that only self-reported alcohol intake independently predicted % change in brachial BP and cSBP. This was not found for the biochemical markers GGT and %CDT. Self-reported alcohol intake seems to be an important measure to implement by health systems in low income areas of sub-Saharan Africa, where honest reporting is expected. - Given the likely presence of high GGT levels in both alcohol consumption and non-alcoholic fatty liver disease (NAFLD), the second manuscript (Chapter 5) aimed to compare the cardiovascular and metabolic characteristics of excessive alcohol users and individuals with suspected NAFLD (confirmed with self-report, GGT and %CDT). We found that different sex and cardiometabolic profiles characterised excessive alcohol users and individuals suspected with NAFLD. Lean body mass and male sex were the dominant characteristics in excessive alcohol use while the NAFLD group had a dysmetabolic profile with obese women making up the higher proportion of this group. In excessive alcohol users systolic blood pressure and pulse pressure were independently associated with high-density lipoprotein cholesterol. Diastolic blood pressure showed a significant correlation with waist circumference. These disparate profiles may guide healthcare practitioners in primary healthcare clinics to identify individuals with elevated GGT levels who may suffer from NAFLD or alcohol overuse. These results emphasise the importance of modifiable risk factors as the main contributors to CVD and that lifestyle change should be the main focus in developing countries such as South Africa. - The third manuscript (Chapter 6) aimed to determine the measure of alcohol intake (selfreported alcohol intake, GGT and %CDT) that related best with hypertension development, cardiovascular and all-cause mortality over 5 years in the same population of black South Africans. We found that GGT was the only independent predictor of hypertension development, cardiovascular as well as all-cause mortality. Moreover, self-reporting of alcohol intake predicted incident hypertension, confirming our findings from Chapter 4. The third marker, %CDT, a highly specific marker of alcohol intake, was not related with any outcome variable, perhaps due to its low sensitivity. Although self-reported alcohol intake is useful in low-resource primary healthcare settings, measurement of GGT is encouraged due to its predictive value for hypertension and mortality. GGT represents alcohol intake, non-alcoholic steatohepatitis and obesity - all known to have severe cardiovascular consequences. Discussion and Conclusions Excessive alcohol intake remains a major concern in the development of hypertension, CVD and premature death in sub-Saharan Africa. Despite their weaknesses such as bias and nonspecificity, self-reporting of alcohol consumption and GGT emerged as reliable alcohol markers that independently predicted 5-year change in BP, hypertension development and total mortality in this population. Serum %CDT did not show any association with the mentioned cardiovascular markers. Finally, we were also able to show that black South Africans with suspected NAFLD (i.e. with high GGT levels who do not consume alcohol) are typically obese women, whereas lean men were more likely to have high alcohol consumption. Further prospective investigations are encouraged regarding (a) these mentioned associations, as well as (b) other self-reporting estimates such as quantity and frequency of drinking and (c) the use of %CDT as a highly specific marker of alcohol intake. The simultaneous presence of HIV infection in alcohol abuse in this population also warrants further investigation. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015

Abstract : Pro-inflammatory cytokines play a key role in pathogenesis of obesity and non-alcoholic fatty liver disease (NAFLD). IL-15 is a pro-inflammatory cytokine, which signals through a receptor complex composed of the IL-15 receptor (IL-15R) alpha chain, the IL-2/IL-15R beta chain and the common gamma chain. The functions of IL-15 have been extensively described in immune cells but less is known about its functions in others tissues such as the liver. The aim of this thesis is to investigate the role of IL-15 in fatty liver disease. C57BL/6 wildtype (WT) and IL-15 knockout (Il15[superscript -/-]) mice were maintained on high fat diet (HFD) or normal control diet (NCD). After 16 weeks, body weight, liver mass, fat accumulation in the liver, serum lipid levels and gene expression in the liver were evaluated. Intrahepatic lymphocytes (IHL) were also analysed. Primary hepatocytes were stimulated with IL-15 and chemokines gene expression was studied. IHLs were examined in WT, Il15[superscript -/-] and Il15ra[superscript -/-], as well as in macrophage- and hepatocyte-specific Il15ra[superscript -/-] mice. We found that IL-15 deficiency prevents weight gain and accumulation of lipids in the liver. Circulating levels of cholesterol and non-esterified fatty acids were elevated in WT mice but not in Il15[superscript -/-] mice. Hepatic expression of chemokines such as Ccl2, Ccl5 and Cxcl10 was increased in WT mice under HFD, but not in Il15[superscript -/-] mice. The livers of Il15[superscript -/-] and Il15ra[superscript -/-] mice also showed decreased expression of Tnfa and iNOS, and macrophage markers Cd68 and F4/80. Accordingly, stimulation of primary hepatocytes with IL-15 induced chemokine gene expression in WT but not in Il15ra[superscript -/-] hepatocytes. Furthermore, hepatocyte-specific ablation of IL-15Rαreduced infiltration of NK and NKT cells in the liver, suggesting that IL15Rα expression in the hepatocytes is needed for the recruitment and/or maintenance of the NK cell population in the liver. In conclusion, IL-15 promotes fat accumulation in the liver, and this is associated with increased inflammatory response in the liver. Increased availability of IL-15 in obesity may stimulate hepatocytes to secrete chemokines that promote hepatic inflammation resulting in fatty liver disease. IL-15Rα expression in hepatocytes appears to play a role in the maintenance of NK, NKT and iNKT cells. // Résumé : Les cytokines pro-inflammatoires jouent un rôle important dans la pathogenèse de l’obésité et la stéatose hépatique. L'IL-15 est une cytokine pro-inflammatoire qui est trans-présentée par l'IL-15Rα aux chaines IL-2/IL-15Rβ et γc. La fonction de l'IL-15 a été largement décrite dans les cellules immunitaires, mais ses fonctions dans d'autres tissus sont moins connues. Le but de ce mémoire est d'élucider le rôle de l'IL-15 dans la stéatose hépatique. Les souris C57BL/6 de type sauvage (WT) et Il15[indice supérieur -/-] ont été soumises à un régimehyperlipidique (HFD) ou à un régime normal. Après 16 semaines, le poids corporel, lamasse hépatique, l'accumulation de lipides dans le foie, les taux de lipides sériques et l'expression des différents gènes reliés à l’inflammation et au métabolisme dans le foie ont été évalués. Les lymphocytes intra-hépatiques (IHL) ont été également étudiés. Des hépatocytes primaires ont été stimulés avec IL-15, et l'expression génique de chimiokines a été déterminée. Les populations de IHLs ont été également caractérisées chez les souris WT, Il15[indice supérieur -/-] et Il15ra[indice supérieur -/-], ainsi que chez des souris dont la déficience dans l’expression d’IL-15Rα est ciblée aux macrophages ou aux hépatocytes. Nos résultats montrent que la déficience en IL-15 empêche l'accumulation de lipides dans le foie. Les taux de cholestérol et d’acides gras non estérifiés dans le sang étaient élevés chez les souris WT, mais pas chez les souris Il15[indice supérieur -/-]. L'expression hépatique des chimiokines Ccl2, Ccl5, Cxcl10 et des marqueurs de macrophages était augmentée chez les souris WT sous HFD, mais pas chez les souris Il15[indice supérieur -/-]. La stimulation des hépatocytes primaires avec l'IL-15 induit l'expression des gènes des chimiokines chez les hépatocytes WT, mais pas chez les Il15ra[indice supérieur -/-]. En outre, nous avons trouvé une infiltration réduite des cellules NK et NKT dans le foie des souris déficientes en Il15ra[indice supérieur -/-] dans les hépatocytes, ce qui suggère que l'expression d’IL15Rα chez les hépatocytes est nécessaire aurecrutement des cellules NK, NKT et / ou à leur maintien. En conclusion, nous proposons que l’IL-15 favorise l'accumulation de lipides dans le foie, et que ceci est associée à une réponse inflammatoire accrue. La disponibilité accrue de l'IL-15 dans l'obésité pourrait stimuler les hépatocytes à secréter des chimiokines ce qui favorise l'inflammation hépatique et conduirait à la stéatose hépatique. L’expression de l'IL-15Rα dans les hépatocytes semble jouer un rôle principal dans l’infiltration des cellules NK, NKT et iNKT dans le foie.

O carcinoma hepatocelular (HCC) é a sexta neoplasia mais comum e a terceira causa de mortalidade por câncer no mundo. Está relacionado, principalmente, à exposição a diversos fatores de risco, como a doença hepática gordurosa não alcoólica (NAFLD). O HCC apresenta mau prognóstico; neste sentido, é importante a adoção de medidas de controle, como a quimioprevenção. A quimioprevenção é o método mais apropriado para se evitar o câncer e consiste na prevenção, inibição ou reversão das etapas iniciais da carcinogênese, pela administração de um ou mais compostos químicos sintéticos ou naturais. Diversos compostos presentes nos alimentos podem apresentar atividade quimiopreventiva, dentre esses, a tributirina (TB), pró-fármaco do ácido butírico. Dessa forma, propôs-se avaliar o efeito quimiopreventivo da TB nas etapas de iniciação/promoção inicial, em ratos submetidos ao modelo de hepatocarcinogênese do hepatócito resistente (RH) associado à NAFLD. Ratos Wistar machos foram distribuídos em Grupo dos animais não tratados (NT), e dois outros grupos experimentais, o grupo RH + NAFLD + maltodextrina (grupo controle isocalórico, CI), e o grupo RH + NAFLD + tributirina (grupo TB). Os animais do grupo CI foram tratados diariamente, por gavagem, com emulsão hiperlipídica [1 mL/100 g de peso corpóreo (p. c)], e maltodextrina (300 mg/ 100 g p.c.), enquanto que os animais do Grupo TB foram tratados diariamente, por gavagem, com emulsão hiperlipídica [1 mL/100 g de p. c.], e TB (200 mg/ 100 g de p.c.), durante 13 semanas consecutivas quando foram eutanasiados. Após esse período, a análise por cromatografia a gás revelou que o grupo dos animais tratados com a tributirina apresentou uma concentração de AB 2.118 vezes superior (p < 0.05) às concentrações de AB constatadas no grupo controle. Em relação aos dados de morfometria de LPNs [lesões pré-neoplásicas persistentes (pLPN) ou em remodelação (rLPN)], a atividade quimiopreventiva da tributirina foi observada a partir da redução (p < 0,05) significativa do número de lesões pré-neoplásicas persistentes (pLPN) em comparação ao grupo controle. A área das pLPNs, contudo, foi maior (p < 0,05) no Grupo TB quando comparada à do grupo controle isocalórico. Não foram observadas diferenças estatisticamente significativas (p >= 0,05) no número e na área de rLPN, bem como na % da área do corte do fígado ocupada por LPNs entre os dois grupos experimentais. A quantificação da apoptose por H&E revelou maior (p < 0,05) índice apoptótico em pLPN e em rLPN nos animais tratados com TB, quando comparados aos animais do grupo 6 controle. Nesse sentido, observou-se que os animais tratados com a tributirina apresentaram maior (p < 0,05) ativação de Caspase 3 do que os ratos do grupo controle isocalórico. Em relação à avaliação da proliferação celular, o Grupo TB apresentou redução (p < 0,05) do índice de proliferação tanto em pLPNs como em rLPNs, quando comparado ao do grupo controle isocalórico. Não foi observada diferença estatisticamente significativa (p > 0,05) entre os surroundings dos dois grupos experimentais. A determinação do perfil lipídico sérico revelou que os animais tratados com a tributirina apresentaram menores (p < 0,05) concentrações séricas de LDL-colesterol e maiores (p < 0,05) concentrações séricas de HDL-colesterol, quando comparados às do grupo controle. Além disso, foram observadas menores (p < 0,05) concentrações hepáticas de colesterol no Grupo TB quando comparadas às do Grupo CI. Em relação a análise por PAS, embora, o presente estudo não tenha revelado diferença estatisticamente significativa (p >= 0,05) entre os dois grupos experimentais, o score entre os graus de marcação por PAS apresentou tendência (p = 0,07) a ser maior nos animais tratados com a tributirina quando comparados aos ratos do grupo controle. Em relação à expressão gênica de FGF-21, o Grupo TB apresentou maior (p < 0,05) expressão em comparação a seu grupo controle (Grupo CI). Além disso, esses dados são corroborados por meio da marcação imunoistoquímica de FGF-21, que revelou que os animais tratados com a tributirina apresentaram maior (p < 0,05) score desta marcação quando comparados aos ratos do grupo controle isocalórico. A análise de expressão em nível proteico de PPAR-&#945; revelou que o Grupo TB apresentou maior (p < 0,05) expressão em comparação ao Grupo CI. O presente estudo demonstrou que o tratamento com a tributirina apresentou um efeito quimiopreventivo quando administrada nas etapas de iniciação/promoção inicial em modelo de hepatocarcinogênese associado à NAFLD. Adicionalmente, sugere-se que a atividade como HDACi da TB poderia modular a expressão de genes supressores de tumor, bem como a daqueles relacionados ao metabolismo lipídico, atenuando os fatores de risco relacionados à NAFLD. / Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third leading cause of cancer mortality in the world. It is mainly related to exposure to several risk factors, such as non-alcoholic fatty liver disease (NAFLD). HCC presents poor prognosis; In this sense, it is important to adopt control measures, such as chemoprevention. Chemoprevention is the most appropriate method to avoid cancer and consists in the prevention, inhibition or reversal of the early stages of carcinogenesis by the administration of one or more synthetic or natural chemical compounds. Several compounds present in foods may present chemopreventive activity, among them, tributyrin (TB), a prodrug of butyric acid. Thus, it was proposed to evaluate the chemopreventive effect of TB in the initiation / initial promotion stages in rats submitted to the hepatocyte-resistant hepatocyte model (HR) associated with NAFLD. Male Wistar rats were divided into two groups: RH + NAFLD + maltodextrin (isocaloric control group, CI), and RH + NAFLD + tributyrin group (TB group). The animals of the CI group were treated daily with gavage with hyperlipid emulsion [1 mL / 100 g body weight (wt.)], and maltodextrin (300 mg / 100 g body wt.), while the animals of the TB Group were treated daily by gavage with hyperlipid emulsion [1 mL / 100 g of body wt.], and TB (200 mg / 100 g body wt.) for 13 consecutive weeks when they were euthanized. After this period, the gas chromatographic analysis revealed that the group of animals treated with tributyrin had a concentration of AB 2184 times higher (p < 0.05) than the concentrations of AB found in the control group. Regarding the morphometry data of PNLs [persistent pre-neoplastic lesions (pPNL) or remodeling (rPNL)], the chemopreventive activity of tributyrin was observed from a significant (p < 0.05) reduction in the number of pPNL compared to the control group. The area of the pPNLs, however, was higher (p < 0.05) in the TB Group when compared to the isocaloric control group. There were no statistically significant differences (p >= 0.05) in the number and area of rPNL, as well as in the area of the cut of the liver occupied by LPNs between the two experimental groups. The quantification of apoptosis by H&E revealed a higher (p < 0.05) apoptotic index in pPNL and rPNL in the TB treated animals, when compared to the animals in the control group. In this sense, animals treated with tributyrin showed greater (p < 0.05) activation of Caspase 3 than the rats of the isocaloric control group. In relation to the evaluation of cell proliferation, the TB group presented a reduction (p < 0.05) in the proliferation index in both pPNLs and rPNLs, when compared to the isocaloric control group. No statistically significant difference (p> 0.05) was observed between the two experimental groups. The determination of serum lipid profile revealed that the animals treated with tributyrin showed lower (p < 0.05) serum LDL-cholesterol concentrations and higher (p < 0.05) serum HDL-cholesterol concentrations when compared to those in the group control. In addition, lower hepatic concentrations (p < 0.05) of cholesterol were observed in the TB Group when compared to those in the CI Group. Regarding the SBP analysis, although the present study did not reveal a statistically significant difference (p >= 0.05) between the two experimental groups, the score between the PAS presented a tendency (p = 0.07) to be greater in animals 8 treated with tributyrin compared to the rats in the control group. In relation to the gene expression of FGF-21, the TB Group presented higher (p <0.05) expression in comparison to its control group (CI Group). In addition, these data are corroborated by FGF-21 immunohistochemical labeling, which revealed that animals treated with tributyrin showed a higher (p <0.05) score for this marker when compared to the isocaloric control rats. Analysis of protein-level expression of PPAR-&#945; revealed that the TB Group had higher (p <0.05) expression compared to the CI Group. The present study demonstrated that treatment with tributyrin had a chemopreventive effect when administered in the initiation / initial promotion steps in a hepatocarcinogenesis model associated with NAFLD. In addition, it is suggested that the activity as HDACi of TB could modulate the expression of tumor suppressor genes, as well as those related to lipid metabolism, attenuating the risk factors related to NAFLD.