The androgen receptor (AR) fulfils important roles for both sexes. By mediating the biological function of androgens, the AR has remained the target for endocrine therapies treating prostate cancer. The AR also determines the effectiveness of medroxyprogesterone acetate (MPA) in treating AR positive breast cancer. Every man will be affected by prostate cancer if he lives long enough. Prostate cancer continues to be a leading cause of death for males despite research into this cancer covering more than 60 years since Huggins' seminal 1941 study showing that androgens play a key role in this cancer. Unfortunately, significant advances have not been forthcoming and the effect of treatment has remained largely the same over past decades, whereby initial treatment provides temporary remission but eventually advanced cases become refractory to further intervention and the disease recurs in a more aggressive form. A plethora of factors are exquisitely sensitive to minute changes in the AR's structural profile, which can be altered by a single mutation, resulting in aberrant activity. A principal feature of these variant ARs associated with prostate cancer, is enhanced capacity to bind a number of molecules other than its cognate ligand, dihydrotestosterone (DHT). The promiscuous activity of this receptor leads to continued AR signalling and stimulus for the cancer despite low androgen levels induced by treatment regimes. A key question is whether mutations occurring within the AR occur as a result of cancer or contribute to the propagation of the cancer. Recent research has demonstrated that treatments incorporating anti-androgens such as flutamide, which are designed to impede prostate cancer progression by inhibiting AR activity, may actually provide selective pressure favouring somatic mutation of the receptor to take place. The specific changes to the AR which are responsible for gains of function have not been resolved as their crystal structures, which are used to provide conformational analysis of proteins, are tremendously problematic to produce with little success found in literature. Generating representative crystals of the AR protein involves producing soluble recombinant protein. Unfortunately the AR is prone to aggregation and is highly unstable, especially in the presence of antagonistic molecules or absence of a stabilising ligand, preventing the protein from being maintained in the soluble state required for crystallization. In order to produce sufficient quantities of soluble material for crystallization, the androgen receptor's ligand binding domain (LBD) was produced as a recombinant protein in Escherichia coli bacteria strain BL21 (DE3) in the presence of DHT, flutamide, as well as in the absence of ligand. Since soluble unbound AR-LBD has not been produced until now, the bacterial culture containing no ligand was further processed to the stage of cleaving the purification tag from the recombinant protein and represents considerable progress into producing soluble material for crystallizing the troublesome yet considerably important AR in the absence of ligand. Although distinct from prostate cancer in males, AR activity in breast tissue is also a factor determining the action of drugs, such as MPA, included in therapies aimed at breast cancer. The use of MPA has declined primarily due to its adverse effects including unsuccessful generation of a biological response, as well as the advent of other drugs administered for hormonal therapies treating breast cancer. Alternative drugs are needed when breast cancer therapies fail as tumours develop resistance to primary drugs. Although there are a number of drugs on the market, success would be maximised if the determined therapy is matched with the patient, based for example, on their genetic makeup. There is a conundrum whereby some patients with an AR do not respond to MPA, a drug normally recognised by the receptor. In clinical trials it was discovered that an AR with threonine instead of methionine at residue 780 (M780T) fails to activate in response to MPA, but the exact mechanism has remained elusive and needs to be answered at the molecular level. The X-ray crystallographic studies that generate 3D images of macromolecules and wet chemistry, which have traditionally been used to provide insight into science in these dimensions, are incorporated with computer based molecular simulation. This is both complementary and distinct to traditional scientific methodologies, enabling further elucidation of protein-protein interactions, and the influence applied to such inter-relations by natural and drug ligands. This approach has been used, and is continually developed, to understand the binding mechanisms of current drugs as well as designing new drugs. In order to produce a receptor representing the M780T variant, the crystal structure representing the AR-LBD was mutated in silico, into which MPA was then docked. It was found that MPA binds into the M780T AR-LBD with considerably more spatial displacement compared to the position of DHT in the crystal structure, and is predicted to be the primary reason for the inability of MPA to activate this variant AR. The clarification of MPA binding and failure to elicit a response from the variant AR is significant for a cohort of breast cancer patients, as not only does the presence of an AR in the tumour determine the effectiveness of MPA, but correct composition of the AR, specifically, the absence of a M780T mutation. In the absence of this AR mutation, MPA could effectively be used either as an alternative to primary drugs, or in secondary therapies when primary therapies fail. Aberrant activity of variant ARs in response to MPA should also be taken into consideration when analysing drug studies about the effectiveness of MPA. The findings on the loss of response to MPA by the M780T variant AR have been included in the journal article &quotDecreased Androgen Receptor Levels and Receptor Function in Breast Cancer Contribute to the Failure of Response to Medroxyprogesterone Acetate" appearing in the September 2005 issue of Cancer Research journal.

[Truncated abstract] In recent years a better understanding of the biology of PPAR , a nuclear transcription factor, has emerged, leading to a resurgence in targeting PPAR for chemotherapy. The family of synthetic PPAR agonists, the thiazolidinediones (TZDs), and non-steroidal anti-inflammatory drugs (NSAIDs) have been implicated in the inhibition of cell proliferation, apoptosis and cell cycle arrest of androgen-sensitive (LNCaP) and androgen-independent (PC-3 and DU145) prostate cancer cells generating much interest in their use for potential curative cancer therapies. In light of the potential use of TZDs and NSAIDs in prostate cancer prevention and their ability to induce inhibitory effects in vitro and in vivo, the first aim of this project was to undertake a comprehensive study of the effects of ciglitazone (TZD) and indomethacin (NSAID) on the androgen-independent prostate cancer cell line DU145, using standardised concentrations and time-points to compare the effects of TZDs and NSAIDs on cell proliferation, cell cycle and apoptosis. Treating the cells with either 10 µM ciglitazone or 10 µM indomethacin resulted in a time-dependent decrease in DU145 cell proliferation. The anti-proliferative effects were found to be in-part attributed to the slowing of cell progression through the G1/S-phase checkpoint of the cell cycle, and in the case of ciglitazone, apoptosis also played a role in its anti-proliferative effects in this cell line. Interestingly, although indomethacin failed to induce apoptosis, its antiproliferative effects were more potent than ciglitazone. The second aim of this project was to further investigate the underlying mechanisms responsible for the anti-proliferative effects of ciglitazone and indomethacin by evaluating their ability to modulate PPAR mRNA and protein expression, and to induce PPAR transcriptional activity. ... In addition, ligandinduced regulation of secreted frizzled related protein 4 (sFRP4) expression, a Wnt/ - catenin antagonists, was investigated. It was demonstrated that both ciglitazone and indomethacin attenuated Wnt/ -catenin signalling via the down-regulation of total - catenin levels within the cells, inhibition or slowing of the translocation of cytoplasmic -catenin into the nucleus and inhibition of cyclin–D1 expression An inverse relationship between PPAR and -catenin protein levels was also detected, suggesting that PPAR may directly bind to -catenin itself. sFRP4 expression was transiently upregulated by ciglitazone and indomethacin-treatment, suggesting that the antiproliferative effects of the ligands may be mediated in part through regulation of sFRP4 mRNA and protein levels. In summary, the anti-proliferative effects of ciglitazone and indomethacin on the androgen-independent prostate cancer cell line, DU145, described in this thesis are progressive steps in characterising the role of PPAR in prostate cancer cell proliferation. The identification of indomethacin as a more potent PPAR agonist than ciglitazone represents a novel target for the development of preventative strategies for advanced disease, and the relationship between PPAR and the Wnt/ -catenin signalling pathway provide an insight into the mechanisms involved in the anti-proliferative effects of ciglitazone and indomethacin. Further studies into this relationship would advance help identify novel preventative and curative therapeutic strategies for advanced prostate cancer.

Studies in Europe, Japan, and North America have reported that wild fish exposed to treated sewage effluents can exhibit significant physiological and reproductive abnormalities consistent with exposure to hormonally active chemicals. The main objective of this research project was to examine the estrogenic and androgenic activity in treated sewage to determine the risk associated with treated sewage discharges in Australia and New Zealand. Several bioassays, including a sheep estrogen receptor and a rainbow trout androgen receptor binding assay, were set up and validated with model compounds. The assays were then used to measure the estrogenic and androgenic activity in sewage samples from 15 municipal sewage treatment plants (STP) utilizing a variety of treatment technologies. Raw sewage samples contained high levels of both estrogenic and androgenic activity, up to 185 ng/L estradiol equivalents (EEq) and up to 9330 ng/L testosterone equivalents (TEq), respectively. Secondary treatment processes such as activated sludge had the greatest impact on removal of biological activity from the wastewater. The estrogenic and androgenic activity in final treated effluents were <1 to 4.2 ng/L EEq and <6.5 to 736 ng/L TEq, respectively. Based on lowest observable effective concentrations reported in the literature, these levels are unlikely to induce biological effects in exposed fish in the short term. To examine potential long-term effects, resident mosquitofish chronically exposed to undiluted treated sewage were sampled. Several morphological biomarkers indicative of endocrine disruption were measured and compared with mosquitofish captured at a reference site. Mosquitofish captured in a constructed wetland for tertiary treatment of secondary treated sewage exhibited morphological differences such as elongated anal fins consistent with exposure to androgenic chemicals, although this effect was not measurable in fish collected at sites further downstream or at any of the other sites. Based on these results, it is unlikely that mosquitofish populations would be significantly affected by exposure to final treated sewage. A reverse transcription real-time polymerase chain reaction (RT-PCR) method to measure the production of a female-specific protein (vitellogenin) mRNA in adult male mosquitofish was developed, and this could be used as a rapid test to detect early changes in individuals exposed to estrogenic activity.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 4 uppsatser.

Evidências recentes em animais e humanos sugerem que níveis adequados de testosterona são necessários para as funções adequadas de diversos órgãos do sistema urogenital, incluindo a bexiga urinária. Estudos sobre os efeitos da testosterona na estrutura da parede da bexiga são raros. Portanto, o objetivo do presente trabalho é avaliar através de métodos qualitativos e quantitativos, as alterações estruturais da parede vesical de ratos submetidos à castração cirúrgica, bem como o papel da reposição hormonal na reversão das possíveis alterações estruturais. Foram usados 24 ratos machos Sprague-Dawley com aproximadamente 12 semanas de idade. Os animais foram divididos em 3 grupos compostos de 8 animais cada e tratados como a seguir. C = Grupo Castrado os animais foram submetidos a orquiectomia e sacrificados após 2 meses, S = Grupo Simulado os animais foram submetidos a operação simulada e sacrificados após 2 meses, T = Grupo Testosterona os animais foram submetidos a castração e após 1 mês foram submetidos a reposição hormonal com undecanoato de testosterona em dose única subcutânea de 100 mg/kg (T) e após 1 mês da reposição hormonal foram sacrificados. Foram realizadas análises quantitativa e qualitativa do colágeno (usando histoquímica, histomorfometria, bioquímica e microscopia eletrônica de varredura), e análise histomorfométrica do músculo liso e das fibras do sistema elástico na parede da bexiga em controles e em ratos submetidos apenas a castração, e em ratos submetidos a castração e reposição hormonal. A análise morfométrica da altura do urotélio não apresentou diferença entre os grupos. Não houve diferença significativa na análise quantitativa do colágeno, tanto por histomorfometria quanto por bioquímica. Entretanto, a análise qualitativa mostrou diferenças do colágeno no grupo castrado quando comparado aos controles e aos ratos com reposição hormonal. Existiu uma diminuição significativa nos valores absolutos das fibras do sistema elástico no grupo castrado. Por outro lado, o músculo liso apresentou um aumento significativo na massa muscular por densidade de área nos ratos castrados; entretanto, a contagem dos núcleos das células musculares não apresentou variação entre os grupos, demonstrando que o aumento foi devido a hipertrofia muscular e não por aumento do número de células. Interessantemente, a reposição hormonal com testosterona foi capaz de reverter todas as alterações observadas. Os resultados sugerem que a reposição hormonal, mesmo quando instituída em fase tardia, é efetiva na reversão das alterações da parede da bexiga produzidas por hipogonadismo secundário. / Recent evidences in animals and humans have suggested that adequate levels of testosterone are necessary to adequate functions of diverse organs of the urogenital system, including the urinary bladder. Studies on the effects of testosterone in the bladder wall structure are rare. Therefore, the objective of the present study is to evaluate, through qualitative and quantitative methods, the structural alterations in the bladder wall of rats submitted to surgical castration as well as the role of hormonal replacement in reversing the possible structural alterations. We used 24 male Sprague-Dawley rats that were approximately 12 weeks of age. The animals were divided into 3 groups composed of 8 animals each and treated as follows. Group C = group that underwent orchiectomy and were sacrificed after 2 months, Group S = sham group sacrificed after 2 months, and Group T = group that underwent orchiectomy, and after 1 month underwent testosterone replacement with a subcutaneous single dose of testosterone undecanoate at 100 mg/kg (T) and after 1 month of hormonal replacement, the animals were sacrificed. We performed a qualitative and quantitative analysis of collagen (by using histochemistry, histomorphometry, biochemistry, and scanning electron microscopy), and a histomorphometric analysis of smooth muscle and elastic system fibers in bladder wall of controls and rats submitted to orchiectomy alone and with hormonal replacement. The histomorphometric analysis on the epithelial height did not show differences among the groups. There was no statistically significant difference in the quantitative analysis for collagen, both by histomorphometry and biochemistry. Nevertheless, the qualitative analysis showed differences in collagen in the castrated group, when compared to controls and to rats with hormonal replacement. There was a significant decrease in the absolute values of elastic system fibers in the castrated group. On the other hand, the smooth muscle presented a significant increase in muscular mass by density of area in castrated rats; nevertheless, the counting of muscle cells nuclei did not present variation among the groups, demonstrating that this increase was due to cellular hypertrophy rather than by an increase in cells number. Interestingly, the hormonal replacement with testosterone was able to reverse all alterations observed. The results suggest that hormonal replacement, even when instituted at a late stage, is effective in reversing the bladder wall alterations produced by secondary hypogonadism.

La voie de signalisation du récepteur des androgènes (RA) reste une cible thérapeutique privilégiée dans les cancers de la prostate (CaP). Ce travail de thèse a abordé trois thématiques : 1) l’identification et l’étude fonctionnelle des mutations du RA, 2) l’étude du lien existant entre les RA tronqués, résultant de mutations non-sens, et l’angiogenèse tumorale et 3) l’étude exploratoire de l’hétérogénéité tumorale dans les CaP. Au cours de la 1e partie, nous avons identifié 90 mutations du RA à l’aide d’un test fonctionnel chez la levure et émis des hypothèses concernant leur implication dans de potentiels mécanismes de résistance à l’hormonothérapie (HT). La 2e partie nous a permis de montrer un lien entre les variants tronqués et l’expression du VEGF-A, médiateur principal de l’angiogenèse. Enfin dans la dernière partie nous avons étudié, par approche de séquençage à haut-débit, l’hétérogénéité tumorale en fonction du temps et du stade de la maladie. L’ensemble du travail a permis une meilleure connaissance des altérations de la voie de signalisation du RA, leur rôle dans les étapes clés de la progression tumorale et l’évolution des anomalies génomiques. / The androgen receptor signaling pathway (AR) remains a prime therapeutic target in prostate cancer (PCa). This work focused on three topics: 1) the identification of AR mutations and their functional impact, 2) the assessment of a link between the truncated AR, resulting from nonsense mutations and tumor angiogenesis and 3) an exploratory study of tumor heterogeneity in PCa. In the first part, we identified 90 AR mutations using a yeast-based functional assay and speculated about their involvement in potential mechanisms to hormone therapy (HT) resistance. In the second part we assessed a link between the truncated AR and the overexpression of VEGF-A, the main proangiogenic factor. In the last part we investigated the tumor heterogeneity within the primary tumor and metastasis using a whole exome sequencing approach. This work leads to a better knowledge of the AR signaling pathway alterations, their role in the key steps of tumor progression and the evolution of genomic abnormalities.

Recentemente, tem sido demonstrado que a maioria dos RNAs transcritos em células humanas são RNAs não-codificadores de proteínas (ncRNAs) originados de íntrons ou regiões intergênicas. Em trabalhos anteriores realizados por nosso grupo, foram descritos longos ncRNAs transcritos de regiões intrônicas de genes codificadores e cuja expressão foi correlacionada ao grau de diferenciação de tumores de próstata, apontando para a relevância fisiológica desta classe de transcritos. Apesar de sua abundância, as propriedades, funções e regulação da grande maioria dos ncRNAs ainda não foram elucidadas. O objetivo do presente trabalho foi investigar a biossíntese de ncRNAs intrônicos em células humanas, primordialmente a contribuição da RNA Polimerase II (RNAP II), bem como aspectos de sua regulação. Primeiramente, o modelo de regulação da expressão gênica por hormônio andrógeno foi utilizado para avaliação da participação direta de um fator de transcrição de RNAP II, o Receptor de Andrógeno (AR), na modulação da transcrição de ncRNAs intrônicos. Utilizando-se a técnica de imunoprecipitação da cromatina, foi detectada a ligação do AR ao elemento de resposta a andrógeno (ARE) presente em um possível promotor de um transcrito intrônico antisenso (derivado do locus Myo5A), cuja expressão é aumentada em células da linhagem LNCaP tratadas com o hormônio. A ligação ao ARE foi induzida pelo tratamento, sugerindo que o efeito do andrógeno na expressão do ncRNA é mediado pelo AR. Em uma segunda abordagem, o efeito da inibição da transcrição por RNAP II com &#945;-amanitina por 24 h em células LNCaP foi avaliado com o uso de microarranjos de oligonucleotídeos representando transcritos total ou parcialmente intrônicos, além de éxons de genes codificadores. A expressão de menos de 20 % dos transcritos intrônicos foi afetada, fração significativamente menor que a observada para os transcritos exônicos (40 %). Ainda que a maioria dos ncRNAs intrônicos diferencialmente expressos tenha sua abundância diminuída, interessantemente, 13 a 16 % foram aumentados, contrastando com aproximadamente 2 a 3 % de exônicos que aumentaram. Os resultados obtidos neste trabalho indicam que a RNAP II atua na transcrição de ncRNAs intrônicos, mas que uma fração considerável pode ser transcrita por outra RNA Polimerase. / It has been recently shown that the bulk of the transcription in human cells is comprised of non-protein-coding RNAs (or noncoding RNAs - ncRNAs) transcribed from introns and intergenic regions of the genome. Previous work from our group has demonstrated that expression of long intronic ncRNAs can be correlated to the degree of prostate tumor differentiation, underscoring the physiological relevance of these transcripts. However, the properties, functions, and regulation of this huge population of ncRNAs remain largely unknown. The present work aimed to investigate the biosynthesis of intronic ncRNAs and aspects of its regulation in human cells, focusing on the contribution of RNA Polymerase II (RNAP II). Initially, the model of regulation of gene expression by androgen hormone was used in order to evaluate the participation of the RNAP II transcription factor Androgen Receptor (AR) in the transcriptional regulation of intronic ncRNAs. Chromatin immunoprecipitation experiments revealed the binding of the AR in an androgen response element (ARE) present in a putative promoter driving the expression of an antisense intronic transcript in Myo5A locus in LNCaP cells. The interaction occurred in an androgen-inducible fashion, along with the up-regulation of the transcript, suggesting that hormone activation occurred in a direct manner mediated by the AR. In a different approach, the effect of RNAP II inhibition with &#945;-amanitin for 24 h in LNCaP cells was analyzed using an oligoarray representing totally and partially intronic transcripts, as well as exons of proteincoding genes. The expression of less than 20 % of the intronic transcripts was affected by the treatment, contrasting to a significantly higher fraction observed for exonic messages (40 %). Moreover, most differentially expressed intronic transcripts were down-regulated, but strikingly 13 to 16 % were up-regulated in cells with blocked RNAP II, while this fraction for exonic transcripts was about 2 %. The results described here demonstrate that RNAP II in fact plays a role in intronic transcription in human cells, but also highlight that another transcriptional system may account for the biogenesis of a fraction of intronic ncRNAs.

Evidências recentes em animais e humanos sugerem que níveis adequados de testosterona são necessários para as funções adequadas de diversos órgãos do sistema urogenital, incluindo a bexiga urinária. Estudos sobre os efeitos da testosterona na estrutura da parede da bexiga são raros. Portanto, o objetivo do presente trabalho é avaliar através de métodos qualitativos e quantitativos, as alterações estruturais da parede vesical de ratos submetidos à castração cirúrgica, bem como o papel da reposição hormonal na reversão das possíveis alterações estruturais. Foram usados 24 ratos machos Sprague-Dawley com aproximadamente 12 semanas de idade. Os animais foram divididos em 3 grupos compostos de 8 animais cada e tratados como a seguir. C = Grupo Castrado os animais foram submetidos a orquiectomia e sacrificados após 2 meses, S = Grupo Simulado os animais foram submetidos a operação simulada e sacrificados após 2 meses, T = Grupo Testosterona os animais foram submetidos a castração e após 1 mês foram submetidos a reposição hormonal com undecanoato de testosterona em dose única subcutânea de 100 mg/kg (T) e após 1 mês da reposição hormonal foram sacrificados. Foram realizadas análises quantitativa e qualitativa do colágeno (usando histoquímica, histomorfometria, bioquímica e microscopia eletrônica de varredura), e análise histomorfométrica do músculo liso e das fibras do sistema elástico na parede da bexiga em controles e em ratos submetidos apenas a castração, e em ratos submetidos a castração e reposição hormonal. A análise morfométrica da altura do urotélio não apresentou diferença entre os grupos. Não houve diferença significativa na análise quantitativa do colágeno, tanto por histomorfometria quanto por bioquímica. Entretanto, a análise qualitativa mostrou diferenças do colágeno no grupo castrado quando comparado aos controles e aos ratos com reposição hormonal. Existiu uma diminuição significativa nos valores absolutos das fibras do sistema elástico no grupo castrado. Por outro lado, o músculo liso apresentou um aumento significativo na massa muscular por densidade de área nos ratos castrados; entretanto, a contagem dos núcleos das células musculares não apresentou variação entre os grupos, demonstrando que o aumento foi devido a hipertrofia muscular e não por aumento do número de células. Interessantemente, a reposição hormonal com testosterona foi capaz de reverter todas as alterações observadas. Os resultados sugerem que a reposição hormonal, mesmo quando instituída em fase tardia, é efetiva na reversão das alterações da parede da bexiga produzidas por hipogonadismo secundário. / Recent evidences in animals and humans have suggested that adequate levels of testosterone are necessary to adequate functions of diverse organs of the urogenital system, including the urinary bladder. Studies on the effects of testosterone in the bladder wall structure are rare. Therefore, the objective of the present study is to evaluate, through qualitative and quantitative methods, the structural alterations in the bladder wall of rats submitted to surgical castration as well as the role of hormonal replacement in reversing the possible structural alterations. We used 24 male Sprague-Dawley rats that were approximately 12 weeks of age. The animals were divided into 3 groups composed of 8 animals each and treated as follows. Group C = group that underwent orchiectomy and were sacrificed after 2 months, Group S = sham group sacrificed after 2 months, and Group T = group that underwent orchiectomy, and after 1 month underwent testosterone replacement with a subcutaneous single dose of testosterone undecanoate at 100 mg/kg (T) and after 1 month of hormonal replacement, the animals were sacrificed. We performed a qualitative and quantitative analysis of collagen (by using histochemistry, histomorphometry, biochemistry, and scanning electron microscopy), and a histomorphometric analysis of smooth muscle and elastic system fibers in bladder wall of controls and rats submitted to orchiectomy alone and with hormonal replacement. The histomorphometric analysis on the epithelial height did not show differences among the groups. There was no statistically significant difference in the quantitative analysis for collagen, both by histomorphometry and biochemistry. Nevertheless, the qualitative analysis showed differences in collagen in the castrated group, when compared to controls and to rats with hormonal replacement. There was a significant decrease in the absolute values of elastic system fibers in the castrated group. On the other hand, the smooth muscle presented a significant increase in muscular mass by density of area in castrated rats; nevertheless, the counting of muscle cells nuclei did not present variation among the groups, demonstrating that this increase was due to cellular hypertrophy rather than by an increase in cells number. Interestingly, the hormonal replacement with testosterone was able to reverse all alterations observed. The results suggest that hormonal replacement, even when instituted at a late stage, is effective in reversing the bladder wall alterations produced by secondary hypogonadism.

Introdução: O homem transexual (HT) é um indivíduo de sexo genético feminino, com fenótipo feminino normal, que deseja viver e ser aceito como um membro do sexo masculino. O tratamento hormonal que é realizado no processo de redesignação sexual nesses pacientes consiste na administração de testosterona nas suas diversas apresentações, mais comumente ésteres de testosterona de curta ou longa ação. O tratamento hormonal visa induzir virilização, através da produção de um padrão masculino de crescimento dos pelos faciais e corporais, aumento da massa muscular e interrupção dos ciclos menstruais. O efeito da terapia androgênica na saúde cardiovascular de HT é pouco conhecido, principalmente em relação às repercussões em longo prazo. O HT representa um modelo ideal e único para a avaliação das ações da testosterona exógena administrada em doses suprafisiológicas em um organismo geneticamente feminino. Alguns estudos de farmacogenética demonstraram a influência da repetição CAG do gene do receptor androgênico (RA) nos efeitos observados durante terapia com testosterona em homens hipogonádicos e a maioria dos estudos confirmou a modulação desses polimorfismos sobre fatores de risco cardiovascular. Objetivos: avaliar em HT em tratamento androgênico a prevalência de fatores clássicos de risco cardiovascular e as propriedades estruturais e funcionais dos vasos arteriais; correlacionar a distribuição alélica do microssatélite CAG RA com a ocorrência de comorbidades e com as propriedades estruturais e funcionais dos vasos arteriais; comparar os valores das propriedades estruturais e funcionais dos vasos arteriais de HT com uma população controle (feminina e masculina). Pacientes: 46 pacientes com diagnóstico de HT (faixa etária 42 ± 10 anos) acompanhados no Ambulatório da Unidade de Disforia de Gênero do HCFMUSP e em tratamento com ésteres de testosterona há pelo menos um ano (variação de 1 a 38 anos) foram selecionados para o estudo. Métodos: Parâmetros clínicos (IMC, circunferência abdominal, relação cintura quadril, pressão arterial e pressão de pulso, composição corporal por bioimpedância), a presença de comorbidades (hipertensão arterial, dislipidemia, diabetes mellitus, obesidade) e vícios (tabagismo, etilismo e uso de drogas ilícitas), dados laboratoriais (hematócrito, glicemia de jejum, insulina, índice HOMA IR, hemoglobina glicada, colesterol total, HDL colesterol, LDL colesterol, triglicerídeos e creatinina) e parâmetros vasculares (espessura íntima média da carótida, diâmetro da carótida, percentual da variação sisto-diastólica da carótida e velocidade de onda de pulso dos vasos arteriais) foram avaliados no grupo de HT. Os mesmos parâmetros vasculares também foram avaliados em controles saudáveis masculinos e femininos pareados para idade e IMC com os HT. A distribuição alélica do microssatélite CAG RA foi avaliada em 44 HT através da análise do produto amplificado da região de repetições CAG do exon 1 do gene do RA, utilizando o software GeneMapper. Resultados e Conclusões: Neste grupo de HT em terapia com ésteres de testosterona observamos uma prevalência de dislipidemia de 42%, hipertensão arterial sistêmica de 35%, obesidade de 30%, diabetes de 4% e tabagismo de 20%. HT em tratamento androgênico apresentaram maior velocidade de onda de pulso carotídeo-femoral do que controles masculinos, mas não do que controles femininos, embora no subgrupo >= 42 anos os HT tenham apresentado maior VOP do que controles masculinos e femininos. Não houve diferença de diâmetro, distensão relativa e espessura íntima média carotídea entre HT e controles. Maior diâmetro, maior espessura íntima média e menor distensão relativa da carótida foram observados em HT obesos e hipertensos; e maior velocidade de onda de pulso aórtica em HT hipertensos. Os parâmetros correlacionados à medida funcional da artéria aorta foram a idade, o tempo de tratamento androgênico e a relação cintura-quadril, enquanto que as propriedades estruturais e funcionais da carótida se correlacionaram com idade, parâmetros antropométricos e glicêmicos. Não houve influência do trato CAG RA na comparação entre os HT com e sem comorbidades metabólicas. Repetições CAG RA curtas se associaram com níveis significativamente mais elevados de glicemia de jejum, insulina basal e HOMA IR. Em relação aos parâmetros antropométricos, pressóricos, lipídicos e arteriais, não foi identificada associação com o número de repetições CAG RA. Estes achados sugerem um potencial efeito deletério da terapia androgênica prolongada sobre os vasos arteriais e a necessidade de medidas preventivas em HT / Introduction: Transgender men (TM) are 46, XX individuals, with normal female phenotype, who desire to live and be accepted as a male member. Testosterone esters are used in sex reassignment therapy to induce virilization and to adapt the body to the male identity. The effects of androgen therapy on TM cardiovascular function are poorly known, particularly with regard to long-term androgen treatment. TM represents a good model for evaluation of high-dose exogenous testosterone action in biological women. Pharmacogenetic studies have demonstrated the influence of CAG polymorphic tract of the androgen receptor gene (AR) on the androgenic effects observed during testosterone therapy in hypogonadal men, and most studies confirmed the modulation of these polymorphisms on cardiovascular risk factors. Objective: to evaluate the prevalence of cardiovascular risk factors and the structural and functional properties of large arteries in TM on long-term cross sex hormone therapy compared to a male and female healthy control group; to correlate the allelic distribution of CAG AR polymorphic tract with the cardiovascular comorbidities and the structural and functional properties of large arteries in TM. Patients: Forty-six patients with a diagnosis of TM (42 ± 10 years old), followed at the Gender Dysphoria Unit-HCFMUSP, receiving cross-sex hormone treatment with testosterone esters for at least one year (ranging from 1 to 38 years) were selected for the study. Methods: Clinical parameters (BMI, waist circumference, waist-to-hip ratio, blood pressure, pulse pressure, body fat percentage), the presence of cardiovascular comorbidities (hypertension, dyslipidemia, diabetes mellitus, obesity) and addictions (smoking, alcohol and drug abuse), laboratory parameters (hematocrit, fasting plasma glucose, basal insulin, HOMA IR index, glycated hemoglobin, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and creatinine) and vascular parameters (carotid intima-media thickness, carotid diameter, carotid relative distensibility and aortic pulse wave velocity - PWV) were evaluated in the TM group. The same vascular parameters were also evaluated in healthy male and female control group, matched for age and BMI. The allelic distribution of the CAG AR polymorphic tract was evaluated in 44 TM using the GeneMapper software. Results and Conclusions: In the TM group, we observed dyslipidemia in 42%, hypertension in 35%, obesity in 30%, diabetes in 4% and smoking habit in 20%. The mean aortic PWV values in TM was higher than in male healthy controls (p=0.005), but not than in female controls (p=0.640). When categorized by age, considering the median age, TM >= 42 years had higher aortic PWV measures than male (p < 0.001) and female (p = 0.024) controls, regardless of their arterial blood pressure values. There was no difference in carotid diameter, carotid relative distensibility and carotid intima-media thickness between TM and controls. Obese and hypertensive TM presented significantly higher values of carotid diameter and carotid intima-media thickness, and lower values of carotid relative distensibility than healthy transgenders. Hypertensive TM showed higher aortic PWV values than non-hypertensive TM. The aortic stiffness correlated significantly and positively with age, androgen treatment duration and waist-to-hip ratio in TM. Properties of the carotid artery correlated with age, anthropometric parameters and glycemic parameters in TM. Shorter CAG polymorphic tracts of TM were associated with higher levels of fasting plasma glucose, basal insulin and HOMA IR index. There was no influence of the CAG polymorphic tract of TM on the presence of cardiovascular comorbidities, anthropometric, pressure, lipid and arterial parameters. These findings suggest a potential deleterious effect of the long-term testosterone therapy on vessels and the need for preventive measures in TM

Made available in DSpace on 2016-08-16T18:18:42Z (GMT). No. of bitstreams: 1 Tese MARCELO SOUZA DE ANDRADE.pdf: 1768433 bytes, checksum: 8051d8f14c6a38ec8166fcb2e817b674 (MD5) Previous issue date: 2012-04-25 / FUNDAÇÃO DE AMPARO À PESQUISA E AO DESENVOLVIMENTO CIENTIFICO E TECNOLÓGICO DO MARANHÃO / Introduction. The androgen insensitivity syndrome (AIS) is a rare disease (1:20,000 to 1:64.000)-linked X chromosome, which generates a disorder of sexual differentiation of the male fetus (XY) with a spectrum of phenotypes ranging from females complete (CAIS) to a male phenotype with discrete signs of androgen insensitivity. An increasing number of mutations have been cataloged and nearly 500 mutations have been related to CAIS and 1000 to the androgen receptor gene. The AR gene is located on Xq11-12, with eight exons, about 919 amino acids. Objective. To characterize the mutations in the AR gene families in the region of the "Bico do Papagaio" in the southwestern state of Maranhao. Methodology. We used molecular biology techniques such as DNA extraction, PCR, electrophoresis, purification of PCR products and sequencing. In addition, we analyzed the clinical and hormonal characteristics of 14 patients and their families. Results. In one family (with two twin affected), we found the mutation R753X and the third molecular diagnosis of CAIS in twins described in the World. In another family, with 12 patients, was identified a new mutation in exon 8, as described P893A, protein AR. Conclusion. This work enabled the application of molecular techniques for the accurate diagnosis of AIS, genetic counseling for relatives of affected patients, and contribute to the formation of more qualified human resources, aiming at the development of biotechnology in the state of Maranhão. / Introdução. A Síndrome de Insensibilidade Androgênica (AIS) é uma doença rara (1:20.000 a 1:64.000), de transmissão ligada ao cromossomo X, que gera um distúrbio da diferenciação sexual do feto masculino (XY) com um espectro de fenótipo que varia desde o feminino completo (CAIS) até um fenótipo masculino com discretos sinais de insensibilidade androgênica. Um número crescente de mutações tem sido catalogadas e quase 500 mutações já foram relacionadas à CAIS e cerca de 1000 ao gene do receptor androgênico. O gene AR localiza-se em Xq11-12, com 8 exons, com cerca de 919 aminoácidos. Objetivo. Caracterizar as mutações no gene AR em famílias da região do Bico do Papagaio , no sudoeste do Estado do Maranhão. Metodologia. Foram utilizadas técnicas de biologia molecular como extração de DNA, PCR, Eletroforese, Purificação de produtos de PCR e Sequenciamento automático. Além disso, foram analisados o quadro clínico e hormonal de 14 pacientes e de seus familiares. Resultados. Em uma das famílias (com duas gêmeas afetadas), foi encontrada a mutação R753X, sendo o terceiro diagnóstico molecular de CAIS em gêmeas descrito no Mundo. Em outra família, com 12 pacientes, foi a identificada uma mutação nova no exon 8, descrita como P893A, na proteína AR. Conclusão. Este trabalho possibilitou a aplicação de técnicas moleculares para o diagnóstico preciso de AIS, aconselhamento genético aos familiares das pacientes afetadas, além de contribuir para a formação de recursos humanos mais qualificados, visando o desenvolvimento da biotecnologia no Estado do Maranhão.