Les récepteurs couplés aux protéines G (RCPG) représentent la plus grande famille de protéines membranaires. Ils sont activés par une grande variété d'hormones, de neurotransmetteurs, et par des stimuli sensoriels. Ces récepteurs jouent un rôle central dans le contrôle de la grande majorité des fonctions physiologiques et constituent une cible thérapeutique majeure. Plusieurs études supportent l'existence de plusieurs états conformationnels de ces récepteurs stabilisés par les ligands. Le caractère dynamique des RCPG est essentiel dans leur fonctionnement. Une question majeure est de déterminer comment un ligand modifie la structure et la fonction de son récepteur. Pour cela, nous avons analysé les changements conformationnels d'un récepteur prototype de la famille des récepteurs à ligands peptidiques, le sous-type V2 de la vasopressine (V2R). Le V2R présente un large éventail de ligands ayant des efficacités différentes (agoniste partiels et complets, agonistes inverses et antagonistes) ainsi que des agonistes biaisés vis-à-vis des voies de signalisation dépendantes de Gs et des arrestines. Afin de déterminer les bases structurales de l'efficacité (amplitude de la réponse biologique) et de la sélectivité fonctionnelle (la capacité d'un RCPG à activer ou à inactiver préférentiellement une voie de signalisation parmi l'ensemble des voies de transduction auxquelles il est couplé), nous avons purifié et stabilisé le V2R par reconstitution en amphipols neutres (Napols). La fonctionnalité du récepteur a été vérifiée par mesure de son interaction directe avec la protéine Gs et les arrestines purifiés. Les profils d'efficacité des ligands vis-à-vis des deux voies de signalisation sont cohérents avec ceux décrits dans des cellules vivantes. Afin d'aborder directement les changements conformationnels dépendants des ligands, nous avons développé deux approches de fluorescence, la fluorescence intrinsèque des tryptophanes et le LRET (Lanthanide Resonance Energy Transfer). La liaison des ligands ayant des efficacités opposées pour la voie Gs ont induit des variations opposées de la fluorescence intrinsèque des tryptophanes, suggèrant l'existence d'états conformationnels distincts. En parallèle, l'analyse des changements des signaux de LRET entre deux domaines fonctionnels du récepteur marqués par deux fluorophores compatibles, le domaine transmembranaire 6 (TM6) côté cytoplasme et l'extrémité C-terminale distale, a permis de calculer une distance moyenne de 33 Å. En accord avec les variations de fluorescence intrinsèque des tryptophanes, les ligands ayant des efficacités opposées pour la voie Gs ont induit un mouvement opposé de ces deux domaines. Les agonistes complets entraînent un éloignement de la boucle i3 et de l'extrémité C-terminale (+2.4 Å) alors qu'un rapprochement des deux domaines est associé à la liaison de l'agoniste inverse (-0.9 Å). Nos résultats démontrent qu'un récepteur à ligands peptidiques répond à la liaison de ses ligands spécifiques par des changements conformationnels dynamiques. Chaque ligand est caractérisé par un ou plusieurs états conformationnels distincts. De plus, les changements conformationnels du V2R jouant un rôle dans le couplage à Gs sont différents de ceux impliqués dans le recrutement des arrestines. Ces données apportent des éléments essentiels de compréhension des mécanismes moléculaires et structuraux de l'activation des RCPG. A plus long terme, une étude plus extensive de la dynamique des RCPG devrait guider le développement de molécules thérapeutiques possédant des propriétés de sélectivité fonctionnelle. / G protein-coupled receptors (GPCR) are seven-transmembrane proteins that mediate most cellular responses to hormones and neurotransmitters, representing the largest group of therapeutic targets. Several studies support the existence of multiple ligand-specific conformational states of GPCR. The dynamic character of GPCR is likely to be essential for their functioning, and a better understanding of this molecular plasticity might facilitate structure-based drug discovery. A major question is to determine how ligands modify receptor structure and function. To this end, we have been studying the structural dynamics of the human vasopressin type 2 receptor (V2R), a prototypical peptide-activated class A GPCR. The V2R is coupled to Gs protein and to β-arrestins, and it has been well characterized pharmacologically using a large panel of ligands with different efficacies. Several display functional selectivity (Gs activation and concomitant β-arrestin inhibition). To demonstrate that ligand efficacy and functional selectivity are achieved through the stabilization of multiple conformational states, we have purified and reconstituted the V2R in amphipathic polymers (amphipol) and developed fluorescence-based approaches. The functionality of the V2R was monitored by direct activation of the purified Gs protein and interaction with purified β-arrestin 1. In these two assays, the effect of ligands correlated well with their known efficacy in cellular systems. Binding of V2R ligands with opposite efficacies toward Gs pathway led to opposite variations in the tryptophan intrinsic fluorescence of the receptor, suggesting the presence of different conformational states of the receptor. In parallel, we used Lanthanide-based resonance energy transfer (LRET) to directly analyze dynamics of the V2R and more particularly conformational changes between fluorophore-labeled extreme C-terminus and transmembrane domain 6. We calculated a basal mean distance of 33 Å between these domains. Interestingly, ligands with different efficacies towards Gs protein elicited opposite LRET changes as for tryptophan fluorescence spectroscopy. Indeed, the two labeled domains moved away upon full agonist binding (+2.4 Å), and closer in presence of inverse agonist (-0.9 Å). These data provide the first evidence of ligand-specific conformational changes in a peptide-activated receptor, and demonstrate that receptor conformational changes involved in Gs coupling are different from those responsible for arrestin recruitment. The results shed some light into the molecular and structural mechanisms of GPCR activation that may be relevant to the design of signaling pathway-selective drugs.

Arginine vasopressin (AVP) is a hypothalamic nonapeptide which regulates the hypothalamic-pituitary-adrenal axis response to stress by stimulating the secretion of adrenocorticotropin (ACTH) from corticotroph cells of the anterior pituitary. This effect is mediated by binding of AVP to the pituitary vasopressin receptor (V1bR). The V1bR belongs to the G protein-coupled receptor (GPCR) super family. Repeated stimulation of anterior pituitary cells with AVP has been shown to produce a loss of responsiveness to subsequent AVP stimulation. This phenomenon appears to be mediated by desensitisation of the V1bR, and may be due to phosphorylation of the receptor by G protein-coupled receptor kinase 5 (GRK5). The aim of this research was to establish and validate methods that would allow the role of GRK5 in the desensitisation of V1bR to AVP stimulation to be investigated. As no isoform specific inhibitors for GRK5 were available, HEK293 cells transiently transfected with the rat V1bR were used as a model system for this research. This allowed RNA interference (RNAi) to be used to knockdown GRK5 expression. The protocol for RNAi-mediated knockdown of GRK5 was established as part of this research. Protocols for Western blotting and qRT-PCR were also established to allow the RNAi-mediated knockdown of GRK5 protein and mRNA to be measured. Transfection of HEK293 cells with 10nM GRK5-targeting small interfering RNAs (siRNAs) reduced the expression of GRK5 protein to 53.4% ± 3.4% (mean ± SEM) of that seen in untreated control cells at 84 hours after transfection, while GRK5 mRNA levels were reduced to 28.7% ± 1.9% (mean ± SEM) of that of control cells 48 hours after transfection. An experimental protocol was designed in this research that would coordinate the RNAi-mediated knockdown of GRK5 with transient transfection of the HEK293 cells with the rV1bR. Since, activated V1bRs couple to Gq/11 and stimulate the production of inositol phosphates (IPs), the responsiveness of the V1bR can be determined by measuring the accumulation of [H³]-IPs in cells labelled with [H³]-myo-inositol. In the protocol designed, the effect of GRK5 knockdown on V1bR desensitisation is determined by stimulating HEK293 cells expressing the rV1bR (and previously transfected with GRK5-targeting siRNA) with 0nM or 100nM AVP for 0, 5, 15, 30 or 60 minutes, and comparing the accumulation if IPs over time with that of cells that are not transfected with GRK5-targeting siRNA. This protocol can be used in future to investigate the role of GRK5 in V1bR desensitisation, and may be adapted to determine if other GRK isoforms are involved in V1bR desensitisation.

Orientadores: Desanka Dragosavac, Antonio Luis Eiras Falcão, Sebastião Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-03T18:11:32Z (GMT). No. of bitstreams: 1 Gasparotto_AnaPaulaDeviteCardoso_M.pdf: 633497 bytes, checksum: c02e20dc885b6507d1ed4dc92372343f (MD5) Previous issue date: 2002 / Resumo: Introdução - Alterações do sódio plasmático são freqüentemente encontradas no pós-operatório de pacientes submetidos à neurocirurgia e estão associadas à piora do estado neurológico desses pacientes. Essas alterações podem ser explicadas por três diferentes síndromes: Síndrome Perdedora de Sal (SPS), Síndrome da Secreção Inapropriada do Hormônio Antidiurético (SIADH) e Diabetes Insipidus (DI). A SPS e a SIADH apresentam características laboratoriais semelhantes como hiponatremia e natriurese, diferindo apenas quanto à volemia. Evidências recentes têm mostrado que a maioria dos pacientes hiponatrêmicos com doença intracraniana e que eram anteriormente diagnosticado como SIADH, na verdade são hipovolêmicos e apresentam SPS. Considerando que o tratamento adequado da SIADH (restrição volêmica) pode aumentar a incidência de infarto cerebral, piorando o prognóstico de pacientes com SPS (hipovolêmicos), e o tratamento para o DI envolve o uso de desmopressina (hormônio antidiurético sintético), a qual pode piorar a hiponatremia da SIADH e SPS, o correto diagnóstico diferencial entre essas síndromes torna-se essencial para um tratamento adequado. Objetivo - Verificar a incidência de alterações do sódio, correlacionando-as com alterações da AVP plasmática e identificar as síndromes responsáveis por essas alterações em pacientes neurocirúrgicos. Local - Hospital das Clínicas da Universidade Estadual de Campinas. Período - Novembro de 2000 a abril de 2001. Desenho - Estudo prospectivo, aberto, observacional. Metodologia - Foram estudados 30 pacientes submetidos à craniotomia para ressecção de tumor cerebral (grupo A) e clipagem de aneurisma (grupo B) no pré-operatório e durante os primeiros cinco dias de pós-operatório. Foram realizadas dosagens diárias de sódio e osmolaridade séricos e urinários (urina de 12h), além de dosagem da arginina-vasopressina (AVP) plasmática no 1º, 3º e 5º dias pós-operatórios. Resultados - O distúrbio do sódio mais freqüente foi a hiponatremia (sódio sérico < 135mEq/L), encontrada em 63,3% dos pacientes durante o pós-operatório, sendo a maior incidência observada no D1 (40%), estando presente no pré-operatório em 33,3% dos pacientes. A hipernatremia (sódio sérico > 146mEq/L) ocorreu em 3,5% dos pacientes do grupo A no pós-operatório. Natriurese (sódio urinário > 110mEq/12h) foi observada em 93,3% dos pacientes no pós-operatório, tendo sido maior no D1 e D2 e já estando presente no pré-operatório, sem diferença estatisticamente significativa entre os grupos. Poliúria (volume urinário > 30mL/kg/24h) foi observada em 100% dos pacientes, sendo mais freqüente no D2, estando presente também no pré-operatório. A AVP plasmática apresentou níveis elevados (>5,0pg/mL) em 10% e diminuídos (<0,5pg/mL) em 46,7% dos pacientes no pós-operatório, sendo esta mais freqüente no D3 (26,7%), sem diferenças estatisticamente significativas entre os grupos. A SPS foi encontrada em 27/30 pacientes (90%), sendo que 14 (46,7%) apresentaram SPS associada a DI e 13 (43,3%), apenas SPS. A SIADH foi encontrada em 3/30 pacientes (10%). Conclusão - A hiponatremia foi o distúrbio do sódio mais freqüentemente encontrado no pós-operatório de pacientes submetidos a neurocirurgia. A poliúria e a natriurese acompanham a hiponatremia e podem ser encontradas desde o pré-operatório, provavelmente, devido à presença de alterações cerebrais prévias (tumor ou HSA). A SPS foi a síndrome mais freqüente, estando associada com grande freqüência a níveis reduzidos de AVP plasmática. A SIADH foi a menos freqüente, podendo tratar-se apenas de resposta apropriada ao estresse cirúrgico, aumento de pressão intracraniana, dor, medicações ou perda de sangue durante a cirurgia / Abstract: Introduction - Alterations of plasmatic sodium are alterations frequently found in the neurosurgery postoperative period and are associate with the worsening of the these patients¿ neurological state. These alterations can be explained by three different syndromes: Cerebral Salt Wasting Syndrome (CSWS), Syndrome of the Inappropriate Secretion of Antidiuretic Hormone (SIADH) e Diabetes Insipidus (DI). The CSWS and the SIADH present similar laboratorial characteristics as hyponatremia and natriuresis, differing only to the volemy. Recent evidences have shown that the majority of the hyponatremic patients with intracranial disease were firstly diagnoses as SIADH, they are hypovolemic and present CSWS. Considering that the adequate treatment to the SIADH (volemic restriction) can increase the incidence of cerebral infarction, worsening the prognostic of patients with CSWS (hypovolemic) and that the treatment for the DI involves the desmopressin use (synthetic antidiuretic hormone), which can worsen the hyponatremia of the SIADH and CSWS; the differential diagnosis between these syndromes becomes essential for an adequate treatment. Objectives: To verify the occurrence of sodium alterations, correlating them with alterations of the plasmatic AVP and to identify the responsible syndromes for these alterations in neurosurgical patients. Local: Hospital of the Clinics of the State University of Campinas. Period: November of 2000 to April of 2001. Set: prospective, opened, observational study. Methodology: 30 patients submitted to the craniotomy for the cerebral tumor resection (group A) and aneurism correction (group B) were studied in the preoperative period and during the first 5 days of the postoperative period. Daily dosages of sodium and plasmatic and urinary osmolarity were used (12-hour urine); besides the dosage of the plasmatic arginine-vasopressin (AVP) in 1st, 3rd and 5th postoperative days. Results: The most frequent sodium disturbance was the hyponatremia (seric sodium <135meq/l), found in 63,3% patients during the postoperative period, being the major observed incidence in the 1st postoperative day (40%), presented in the preoperative in 33,3% of the patients. The hypernatremia (seric sodium > 146mEq/L) occurred in 3,5% of the group A patients in the postoperative period. Natriuresis (urinary sodium > 110mEq/12h) was observed in 93,3% of the patients in the postoperative day, being higher in the 1st and 2nd postoperative days and has already been presented in the preoperative period, without significant statistically difference between the groups. Poliury (urinary volume > 30ml/Kg/24h) was observed in 100% of the patients, being more frequent in the 2nd postoperative day when all the patients had presented poliury, being also present in the preoperative period. The plasmatic AVP presented high levels (> 5,0pg/ml) in 10% and decreased( <0,5pg/ml) in 46,7% of the postoperative patients, and more frequent in the 3rd postoperative day (26,7%), without significant statistically difference between the groups. The CSWS was found in 27/30 patients (90%), seeing that, 14 (46,7%) related to DI and 13 (43,3%), only CSWS. The SIADH was found in 3/30 patients (10%). Conclusion: Hyponatremia was the most frequently sodium disturbance found in the postoperative period of submitted patients to tumor resection and cerebral artery aneurism correction. The poliury and natriuresis follow the hyponatremia and can be found since the pre-operative period, probably, because of the presence of previous cerebral alterations (tumor or HSA). The CSWS was the most incident syndrome, being associated with high frequency to low plasmatic AVP levels. The SIADH was the least frequent and it could be just an appropriate reply to the surgical stress, increase of intracranial pressure, pain, drugs or loss of blood during the surgery / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

Cyclooxygenases (COXs) and their main renal product, prostaglandin E2 (PGE2), regulate many physiological renal functions and are involved in the pathogenesis of diabetic kidney disease. The PGE2 receptor EP3 has been repeatedly shown to be upregulated during diabetes. Physiologically, EP3 is best recognized to act as a diuretic by antagonizing arginine-vasopressin (AVP)-mediated water reabsorption. Incidentally, the first renal manifestation of diabetes is polyuria, which may trigger a cascade of events leading to DN. We hypothesize that EP3 contributes to polyuria and kidney dysfunction during diabetes. We injected EP3-/- mice with streptozotocin (STZ) and evaluated their renal function 12-weeks post injection. EP3-/- STZ mice exhibit attenuated polyuria while exhibiting increased urine osmolality suggesting enhanced water reabsorption. Western blots reveal that EP3-/- STZ mice have increased expression of aquaporin-1 and aquaporin-2 as well as reduced urinary AVP excretion compared to STZ mice. However, salt transporters were equivalently increased in STZ and EP3-/- STZ mice. In vitro microperfusion shows that EP3 completely abrogates AVP-mediated water reabsorption in STZ cortical collecting ducts. Furthermore, EP3-/- STZ mice showed blunted renal COX-2 expression as well as reduced renal hypertrophy, glomerular hyperfiltration, and albuminuria. Taken together, the data suggests that EP3 contributes to polyuria during diabetes by inhibiting expression of aquaporins. Additionally, EP3 seems to contribute to renal COX-2 induction during diabetes. The lack of an increase in renal COX-2 protein levels in EP3-/- STZ mice may be protective by preventing further renal damage.

No description available.

INTRODUÇÃO: A ressuscitação de baixo volume com solução salina hipertônica (SSH) ou terlipressina pode ser uma alternativa à administração de grandes volumes de cristaloides no tratamento do choque hemorrágico. O objetivo deste estudo foi avaliar os efeitos da HHS e terlipressina sobre a perfusão e oxigenação cerebral e investigar os mecanismos cerebrais envolvidos na microcirculação, função mitocondrial, atividade eletrocortical e vias apoptóticas cerebrais durante choque hemorrágico. MÉTODOS: Animais anestesiados com isofluorano foram submetidos ao choque hemorrágico [grupo Hemo; pressão arterial média (PAM) de 40 mmHg por 30 minutos] e tratados com Ringer lactato (RL) (3RL; 3x volume de sangue removido), terlipressina (grupo Terli; bolus) ou SSH (grupo SSH; 4 mL/kg bolus) e comparados ao grupo Sham. Um modelo porcino (n = 56) foi utilizado para avaliação da pressão de perfusão cerebral (PPC) e de oxigênio tecidual (PbtO2), e da expressão cerebral de marcadores teciduais da regulação de água (aquaporina-4), sódio (cotransportador-1 de Na-K-2Cl), estresse oxidativo (substâncias reativas ao ácido tiobarbitúrico e superóxido dismutase dependente de manganês) e apoptose. Um modelo murino (n = 179) foi utilizado para avaliação da microcirculação (fluorescência de FITC-dextrano) e função mitocondrial (potencial redox e de membrana mitocondrial, utilizando-se a fluorescência de flavoproteínas endógenas e do tetrametilrodamina metil éster, respectivamente) no córtex cerebral, utilizando-se a microscopia confocal in vivo, e para avaliação da atividade eletrocortical cerebral, por meio da monitorização do potencial evocado somatossensorial. No modelo murino foram avaliados três grupos adicionais, constituídos pela associação da terlipressina ao RL (1x, 2x ou 3x volume removido). RESULTADOS: No grupo Hemo porcino, houve uma redução significativa da PPC e PbtO2, associada ao aumento na expressão cerebral de marcadores da regulação do transporte de água e sódio, estresse oxidativo e apoptose em relação ao Sham. No modelo murino, a hipotensão induzida pelo choque hemorrágico foi correlacionada à diminuição na densidade vascular cortical e às disfunções mitocondriais e da atividade eletrocortical cerebral. No grupo 3RL porcino, a infusão de grandes volumes de RL recuperou a PbtO2, mas não a PPC, e foi acompanhada por uma maior expressão cerebral de marcadores da regulação de água, estresse oxidativo e apoptose comparada ao Sham. Nos ratos, a ressuscitação volêmica agressiva não recuperou a densidade vascular cortical, que foi correlacionada às disfunções mitocondrial e da atividade eletrocortical. No grupo Terli porcino, o aumento na PAM foi associado à restauração da PPC, PbtO2 e expressão dos marcadores da regulação de água e sódio, estresse oxidativo e apoptose no cérebro. Nos ratos tratados com terlipressina, associada ou não a 1x ou 2x RL, houve uma correlação positiva entre a recuperação da densidade vascular cortical e a restauração das funções mitocondrial e atividade eletrocortical cerebral. A SSH não promoveu melhora em nenhum dos modelos. CONCLUSÕES: RL e terlipressina recuperaram a oxigenação no córtex cerebral, mas apenas a terlipressina recuperou a perfusão cerebral, revertendo as disfunções mitocondrial e eletrocortical no cérebro e o aumento no transporte de água e sódio, estresse oxidativo e apoptose induzidos pelo choque hemorrágico. A SSH não recuperou a perfusão e oxigenação cerebral / INTRODUCTION: Small-volume resuscitation with hypertonic saline solution (HSS) or terlipressin can be an alternative to the administration of large amounts of crystalloids in haemorrhagic shock. The aim of this study was to evaluate the effects of HSS and terlipressin on cerebral perfusion and oxygenation and investigate the cerebral mechanisms associated with microcirculation, mitochondrial function, electrocortical activity and apoptotic pathways during haemorrhagic shock. METHODS: Isoflurane-anaesthetised animals were submitted to haemorrhagic shock [Haemo group; mean arterial pressure (MAP) of 40 mmHg for 30 minutes] and treated with lactated Ringer\'s solution (LR) (3LR group; 3x volume bled), terlipressin (Terli group; bolus) or HSS (HSS group; bolus 4 mL/kg) and were compared with a Sham group. A porcine model (n = 56) was used to assess the cerebral perfusion pressure (CPP) and tissue oxygenation (PbtO2) and the expression of tissue markers of water (aquaporin-4), sodium (Na-K-2Cl cotransporter-1), oxidative stress (thiobarbituric acid reactive substances and manganese superoxide dismutase) and apoptosis in cerebral samples. A murine model (n = 179) was used to assess microcirculation (FITC-dextran fluorescence) and mitochondrial function (redox and membrane potential, using the fluorescence of endogenous flavoproteins and tetramethylrhodamine methyl ester, respectively) in the cerebral cortex by using in vivo confocal microscopy, and to assess the electrocortical brain activity by monitoring the somatosensory evoked potential. In the murine model, three additional groups were evaluated, which received terlipressin associated to LR (1x, 2x or 3x blood withdrawn). RESULTS: In the porcine Hemo group, there was a significant decrease in the CPP and PbtO2, which were associated to an increased cerebral expression of markers of water and sodium transport, oxidative stress and apoptosis compared with Sham. In the murine model, the haemorrhagic shock-induced hypotension was correlated to a decrease in the cortical vascular density and to dysfunctions on brain mitochondria and electrocortical activity. In the porcine 3LR group, the infusion of large volumes of LR recovered the PbtO2, but not the CPP, and was accompanied by an increased cerebral expression of markers of water and sodium transport, oxidative stress and apoptosis compared with Sham. In the rats, the aggressive fluid resuscitation did not recover the cortical vascular density, which was correlated to the brain mitochondrial and electrocortical dysfunctions. In the porcine Terli group, the increase in the MAP was associated with the recovery of CPP, PbtO2, and expression of markers of water and sodium regulation, oxidative stress and apoptosis within the brain. In the rats treated with terlipressin, associated or not with 1x or 2x LR, there was a positive correlation between the recovery of the cortical vascular density and the recovery of the brain mitochondrial and electrocortical functions. Such improvements were not observed in none of the models treated with HSS. CONCLUSIONS: LR and terlipressin recovered tissue oxygenation in the cerebral cortex, but only terlipressin recovered the cerebral perfusion, reversing the brain mitochondrial and electrocortical dysfunctions and the increase in the markers of water and sodium transport, oxidative stress, and apoptosis induced by haemorrhagic shock. The HSS did not recover cerebral perfusion and oxygenation

Le but de notre travail était d'étudier des nouveaux aspects de la physiopathologie et de la thérapeutique du choc anaphylactique chez le rat Brown Norway. La première partie de notre thèse étudie la physiopathologie systémique et régionale du choc anaphylactique. Le choc anaphylactique s'accompagne d'une diminution rapide du débit cardiaque, d'une altération brutale de l'autorégulation du débit sanguin cérébral et d'une atteinte respiratoire associant un oedème des voies respiratoires et un bronchospasme. La deuxième partie de notre travail s'intéresse à la prise en charge thérapeutique du choc anaphylactique. L'adrénaline s'avère supérieure à la vasopressine, pour inhiber le bronchospasme et diminuer la perméabilité microvasculaire, permettant une meilleure préservation de l'oxygénation cérébrale, en particulier dans la région de l'hippocampe, mais aussi une correction du bronchospsme et une diminution de l'hyperperméabilté bronchique à la phase précoce du choc anaphylactique. Nous avons également comparé les effets de trois types de solutés de remplissage administrés en association avec l'adrénaline au cours du choc anaphylactique, démontrant la supériorité de l'administration de soluté macromoléculaires tels que l'HES et l'échec des solutés salés hypertoniques. Enfin nous avons pu mettre en évidence l'intérêt de l'administration de bleu de méthylène (3mg/kg) en démontrant l'existence d'un effet synergique avec l'adrénaline au cours du choc anaphylactique / The aim of our work was to study new aspects of the pathophysiology and treatment of anaphylactic shock in the Brown Norway rat. The first part of this thesis focuses on the systemic and regional pathophysiology of anaphylactic shock which is accompanied by a rapid decrease in cardiac output, a sudden alteration of autoregulation of cerebral blood flow and a respiratory dysfunction involving swelling of the airways and bronchospasm. The second part of our work focuses on the therapeutic management of anaphylactic shock. Epinephrine was found to be superior to vasopressin, to inhibit bronchospasm and decrease microvascular permeability, allowing a better preservation of the cerebral oxygenation, in particular in the region of the hippocampus. Furthermore, it provided also an alleviation of bronchospasm and of bronchial hyperperméabilté in the early phase of anaphylactic shock. We also compared the effects of three types of fluid therapy administered in combination with adrenaline during anaphylactic shock, demonstrating the superiority of the administration of a macromolecular solution such as HES compared to hypertonic saline fluids. Finally we were able to highlight the usefulness of the administration of methylene blue (3mg/kg) demonstrating the existence of a synergistic effect with adrenaline during anaphylactic shock

Background: Autosomal dominant familial neurohypophyseal diabetes insipidus (adFNDI) is a rare disease with symptoms of polydipsia, polyuria and dehydration caused by arginine vasopressin deficiency. Disease onset is within infancy or adolescence. A variety of disease-causing mutations of the arginine vasopressin neurophysin II gene (AVP) on chromosome 20p13 have been described. Methods: Two Polish families with adFNDI were screened for mutations. Processing of wild-type (WT) and mutant AVP was monitored using immunocytochemical methods in stably transfected Neuro2A cells. AVP secretion into the cell culture supernatant was investigated with an enzyme immunoassay. Results: In the first family a heterozygous p.G96D mutation was identified. Some patients additionally carried a novel heterozygous mutation p.A159T. The second family presented with a heterozygous mutation p.C98G. Confocal laser microscopy unveiled accumulation of p.G96D and p.C98G prohormones in the cellular bodies, whereas WT and p.A159T prohormones and/or processed products were located in the tips of cellular processes. Reduced levels of AVP in supernatant culture medium of p.G96D and p.C98G transfected cells in comparison to p.A159T and WT cells were found. Conclusions: We conclude that the p.G96D and p.C98G mutations cause adFNDI in the two reported families. The sequence variant p.A159T does not seem to have disease-causing effects. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Septic shock is a major cause of deaths resulting from uncontrolled inflammation and circulatory failure. Recent studies suggest that the vascular isoform of ATP-sensitive K+ (KATP) channels is an important contributor to septic susceptibility. To understand the molecular mechanisms for channel regulation during sepsis, we performed studies in isolated endothelium-denuded mesenteric rings. Lipopolysaccharides (LPS) induced vascular relaxation and hyporeactivity to phenylephrine. The LPS-treated aortic smooth muscle cells displayed hyperpolarization and augmentation of KATP channel activity. Both were due to an up-regulation of Kir6.1 and SUR2B surface expression. The up-regulation relied on transcriptional and translational mechanisms, in which nuclear factor-¦ÊB (NF-¦ÊB) and Protein kinase A (PKA) played a critical role. Oxidative stress occurs during sepsis and may act as another regulatory mechanism affecting KATP channel activity and vascular contractility. We found that micromolar concentrations of H2O2 impaired the pinacidil-induced vasodilation. The effect attributed to the suppression of KATP channel activity, which can be fully produced by reactivity oxidants. Unlike the Kir6.1/SUR2B channel, the Kir6.2/SUR2B channel was insensitive to 1mM H2O2, indicating that the modulation sites are located in Kir6.1. Site-directed mutational analysis showed that three cysteine residues located in N-terminus and the core region of Kir6.1 were likely to mediate the redox-dependent channel modulation. Arginine vasopressin (AVP) is a vasoconstrictor that is successfully applied to manage sepsis. However, the downstream target of AVP is uncertain. Our studies show that AVP-induced vasoconstriction depended on V1a receptor, Protein kinase C (PKC) and KATP channel. Additionally, AVP decreased Kir6.1/SUR2B channel activity through V1a receptor. The inhibitory effect was caused by a suppression of the channel open state probability. The channel inhibition was mediated by phosphorylation of the channel protein by PKC. The widespread involvement of the vascular KATP channel in vascular responses to endotoxemia strongly suggests that the temporospatial control of channel activity may constitute an important intervention to vascular tone, blood pressure and organ-tissue perfusion in septic shock. Such a control appears feasible by targeting several modulatory mechanisms of intracellular signaling, Kir6.1/SUR2B expression, redox state and channel protein phosphorylation as demonstrated in this dissertation.

INTRODUÇÃO: A ressuscitação de baixo volume com solução salina hipertônica (SSH) ou terlipressina pode ser uma alternativa à administração de grandes volumes de cristaloides no tratamento do choque hemorrágico. O objetivo deste estudo foi avaliar os efeitos da HHS e terlipressina sobre a perfusão e oxigenação cerebral e investigar os mecanismos cerebrais envolvidos na microcirculação, função mitocondrial, atividade eletrocortical e vias apoptóticas cerebrais durante choque hemorrágico. MÉTODOS: Animais anestesiados com isofluorano foram submetidos ao choque hemorrágico [grupo Hemo; pressão arterial média (PAM) de 40 mmHg por 30 minutos] e tratados com Ringer lactato (RL) (3RL; 3x volume de sangue removido), terlipressina (grupo Terli; bolus) ou SSH (grupo SSH; 4 mL/kg bolus) e comparados ao grupo Sham. Um modelo porcino (n = 56) foi utilizado para avaliação da pressão de perfusão cerebral (PPC) e de oxigênio tecidual (PbtO2), e da expressão cerebral de marcadores teciduais da regulação de água (aquaporina-4), sódio (cotransportador-1 de Na-K-2Cl), estresse oxidativo (substâncias reativas ao ácido tiobarbitúrico e superóxido dismutase dependente de manganês) e apoptose. Um modelo murino (n = 179) foi utilizado para avaliação da microcirculação (fluorescência de FITC-dextrano) e função mitocondrial (potencial redox e de membrana mitocondrial, utilizando-se a fluorescência de flavoproteínas endógenas e do tetrametilrodamina metil éster, respectivamente) no córtex cerebral, utilizando-se a microscopia confocal in vivo, e para avaliação da atividade eletrocortical cerebral, por meio da monitorização do potencial evocado somatossensorial. No modelo murino foram avaliados três grupos adicionais, constituídos pela associação da terlipressina ao RL (1x, 2x ou 3x volume removido). RESULTADOS: No grupo Hemo porcino, houve uma redução significativa da PPC e PbtO2, associada ao aumento na expressão cerebral de marcadores da regulação do transporte de água e sódio, estresse oxidativo e apoptose em relação ao Sham. No modelo murino, a hipotensão induzida pelo choque hemorrágico foi correlacionada à diminuição na densidade vascular cortical e às disfunções mitocondriais e da atividade eletrocortical cerebral. No grupo 3RL porcino, a infusão de grandes volumes de RL recuperou a PbtO2, mas não a PPC, e foi acompanhada por uma maior expressão cerebral de marcadores da regulação de água, estresse oxidativo e apoptose comparada ao Sham. Nos ratos, a ressuscitação volêmica agressiva não recuperou a densidade vascular cortical, que foi correlacionada às disfunções mitocondrial e da atividade eletrocortical. No grupo Terli porcino, o aumento na PAM foi associado à restauração da PPC, PbtO2 e expressão dos marcadores da regulação de água e sódio, estresse oxidativo e apoptose no cérebro. Nos ratos tratados com terlipressina, associada ou não a 1x ou 2x RL, houve uma correlação positiva entre a recuperação da densidade vascular cortical e a restauração das funções mitocondrial e atividade eletrocortical cerebral. A SSH não promoveu melhora em nenhum dos modelos. CONCLUSÕES: RL e terlipressina recuperaram a oxigenação no córtex cerebral, mas apenas a terlipressina recuperou a perfusão cerebral, revertendo as disfunções mitocondrial e eletrocortical no cérebro e o aumento no transporte de água e sódio, estresse oxidativo e apoptose induzidos pelo choque hemorrágico. A SSH não recuperou a perfusão e oxigenação cerebral / INTRODUCTION: Small-volume resuscitation with hypertonic saline solution (HSS) or terlipressin can be an alternative to the administration of large amounts of crystalloids in haemorrhagic shock. The aim of this study was to evaluate the effects of HSS and terlipressin on cerebral perfusion and oxygenation and investigate the cerebral mechanisms associated with microcirculation, mitochondrial function, electrocortical activity and apoptotic pathways during haemorrhagic shock. METHODS: Isoflurane-anaesthetised animals were submitted to haemorrhagic shock [Haemo group; mean arterial pressure (MAP) of 40 mmHg for 30 minutes] and treated with lactated Ringer\'s solution (LR) (3LR group; 3x volume bled), terlipressin (Terli group; bolus) or HSS (HSS group; bolus 4 mL/kg) and were compared with a Sham group. A porcine model (n = 56) was used to assess the cerebral perfusion pressure (CPP) and tissue oxygenation (PbtO2) and the expression of tissue markers of water (aquaporin-4), sodium (Na-K-2Cl cotransporter-1), oxidative stress (thiobarbituric acid reactive substances and manganese superoxide dismutase) and apoptosis in cerebral samples. A murine model (n = 179) was used to assess microcirculation (FITC-dextran fluorescence) and mitochondrial function (redox and membrane potential, using the fluorescence of endogenous flavoproteins and tetramethylrhodamine methyl ester, respectively) in the cerebral cortex by using in vivo confocal microscopy, and to assess the electrocortical brain activity by monitoring the somatosensory evoked potential. In the murine model, three additional groups were evaluated, which received terlipressin associated to LR (1x, 2x or 3x blood withdrawn). RESULTS: In the porcine Hemo group, there was a significant decrease in the CPP and PbtO2, which were associated to an increased cerebral expression of markers of water and sodium transport, oxidative stress and apoptosis compared with Sham. In the murine model, the haemorrhagic shock-induced hypotension was correlated to a decrease in the cortical vascular density and to dysfunctions on brain mitochondria and electrocortical activity. In the porcine 3LR group, the infusion of large volumes of LR recovered the PbtO2, but not the CPP, and was accompanied by an increased cerebral expression of markers of water and sodium transport, oxidative stress and apoptosis compared with Sham. In the rats, the aggressive fluid resuscitation did not recover the cortical vascular density, which was correlated to the brain mitochondrial and electrocortical dysfunctions. In the porcine Terli group, the increase in the MAP was associated with the recovery of CPP, PbtO2, and expression of markers of water and sodium regulation, oxidative stress and apoptosis within the brain. In the rats treated with terlipressin, associated or not with 1x or 2x LR, there was a positive correlation between the recovery of the cortical vascular density and the recovery of the brain mitochondrial and electrocortical functions. Such improvements were not observed in none of the models treated with HSS. CONCLUSIONS: LR and terlipressin recovered tissue oxygenation in the cerebral cortex, but only terlipressin recovered the cerebral perfusion, reversing the brain mitochondrial and electrocortical dysfunctions and the increase in the markers of water and sodium transport, oxidative stress, and apoptosis induced by haemorrhagic shock. The HSS did not recover cerebral perfusion and oxygenation