La paroi vasculaire est composée de cellules endothéliales, de cellules musculaires lisses vasculaires et de fibroblastes qui sont entourés d’un réseau structuré et complexe de protéines, la matrice extracellulaire. Les interactions réciproques entre la matrice et les cellules sont nécessaires à la croissance, au développement et au remodelage. Or, différents contextes pathologiques entraînent la perturbation de ces interactions et sont la cause de différentes maladies. Au cours du vieillissement, la matrice extracellulaire des grosses artères élastiques est modifiée. Ainsi, les lamelles élastiques de la paroi vasculaire se fragmentent ou sont dégradées, en plus de calcifier. De même, l’accumulation de protéines plus rigides, comme le collagène, entraîne le développement de la fibrose. Ces modulations vont mener à l’augmentation de la rigidité artérielle et au développement de l’hypertension systolique isolée. En utilisant un modèle animal de calcification basé sur l’inhibition d’une protéine anti-calcifiante, la matrix Gla protein, avec la warfarine, nous avons étudié la séquence des événements impliqués dans le développement de l’hypertension systolique isolée. Nous avons observé l’activation précoce et transitoire de MMP-9, puis du TGF-ß, précédant la modulation phénotypique des cellules musculaires lisses vasculaires, la calcification et les changements hémodynamiques. L’inhibition des métalloprotéinases et du TGF-ß a permis de prévenir la calcification vasculaire. Nous avons également étudié le rôle joué par une enzyme de la matrice extracellulaire, la transglutaminase 2, dans le développement de la calcification associée à l’hypertension systolique isolée. À l’aide d’un nouvel inhibiteur de cette enzyme, qui a permis de prévenir la calcification, nous avons établi que la transglutaminase était un élément clé dans le processus pathologique. Ces travaux ont permis de démontré l’intérêt de nouvelles avenues thérapeutiques ciblant directement la matrice extracellulaire, particulièrement la MMP-9, le TGF-ß et la transglutaminase 2, dans la pathologie de l’hypertension systolique isolée. / Within the vascular wall, endothelial cells, vascular smooth muscle cells and fibroblasts are surrounded by a complex and structured network of secreted macromolecules and proteins, the extracellular matrix. Reciprocal interactions between matrix and cells are essential to growth, development and remodeling. However, in pathological situations, the alteration of these interactions can lead to the development of different disease states. With aging, the extracellular matrix of large elastic arteries undergoes several modifications. The elastic lamellae are fragmented or degraded and calcify, whereas more rigid proteins, such as collagen, accumulate and cause fibrosis. These alterations are associated with the stiffening of arteries, which results in the development of isolated systolic hypertension. In order to study the sequence of events occuring in the development of this pathology, we used an animal model of calcification based on the inhibition of a matrix Gla protein, which physiologically prevents calcification, with warfarin. We observed an acute and transient activation of MMP-9 and TGF-ß, which preceded the phenotypic modulation of vascular smooth muscle cells, calcification and changes to hemodynamic parameters. Moreover, the inhibition of MMPs and TGF-ß prevented vascular calcification. We also studied the role of an extracellular matrix enzyme, transglutaminase 2, in the development of vascular calcification associated with isolated systolic hypertension. Using a novel inhibitor of this enzyme, we established a key role for transglutaminase 2 in this pathological process. This thesis demonstrates the relevance of directly targeting the extracellular matrix, particularly MMP-9, TGF-ß and transglutaminase 2, as a novel therapeutic avenue in the treatment of isolated systolic hypertension.

Les maladies cardiovasculaires (MCV) demeurent au tournant de ce siècle la principale cause de mortalité dans le monde. Parmi les facteurs de risque, l’hypercholestérolémie et l’obésité abdominale sont directement liées au développement précoce de l’athérosclérose. L’hypercholestérolémie familiale, communément associée à une déficience des récepteurs des lipoprotéines de basse densité (LDLR), est connue comme cause de maladie précoce d’athérosclérose et de calcification aortique chez l’humain. La subtilisine convertase proprotéine/kexine du type 9 (PCSK9), membre de la famille des proprotéines convertases, est trouvée indirectement associée aux MCV par son implication dans la dégradation du LDLR. Chez l'humain, des mutations du gène PCSK9 conduisent soit à une hypercholestérolémie familiale, soit à une hypocholestérolémie, selon que la mutation entraîne un gain ou une perte de fonction, respectivement. Il demeure incertain si les individus porteurs de mutations causant un gain de fonction de la PCSK9 développeront une calcification aortique ou si des mutations entraînant une perte de fonction provoqueront une obésité abdominale. Dans cette étude, nous avons examiné : 1) l’effet d’une surexpression de PCSK9 dans le foie de souris sur la calcification aortique ; 2) les conséquences d’une déficience en PCSK9 (Pcsk9 KO), mimant une inhibition pharmacologique, sur le tissu graisseux. Nous avons utilisé un modèle de souris transgénique (Tg) surexprimant le cDNA de PCSK9 de souris dans les hépatocytes de souris et démontrons par tomographie calculée qu’une calcification survient de façon moins étendue chez les souris PCSK9 Tg que chez les souris déficientes en LDLR. Alors que le PCSK9 Tg et la déficience en LDLR causaient tous deux une hypercholestérolémie familiale, les niveaux seuls de cholestérol circulant ne parvenaient pas à prédire le degré de calcification aortique. Dans une seconde étude, nous utilisions des souris génétiquement manipulées dépourvues de PSCK9 et démontrons que l’accumulation de graisses viscérales (adipogenèse) apparaît régulée par la PCSK9 circulante. Ainsi, en l’absence de PCSK9, l’adipogenèse viscérale augmente vraisemblablement par régulation post-traductionnelle des récepteurs à lipoprotéines de très basse densité (VLDLR) dans le tissu adipeux. Ces deux modèles mettent en évidence un équilibre dynamique de la PCSK9 dans des voies métaboliques différentes, réalisant un élément clé dans la santé cardiovasculaire. Par conséquent, les essais d’investigations et d’altérations biologiques de la PCSK9 devraient être pris en compte dans un modèle animal valide utilisant une méthode sensible et en portant une attention prudente aux effets secondaires de toute intervention. / Cardiovascular disease (CVD) is the leading cause of death in the 21st century. Among risk factors, hypercholesterolemia and abdominal obesity are directly linked to premature development of atherosclerosis. Familial hypercholesterolemia, commonly due to low-density lipoprotein receptor (LDLR) deficiency, is known to cause premature atherosclerosis and aortic calcification in humans. Proprotein convertase subtilisin/kexin 9 (PCSK9), a member of the proprotein convertase family, is indirectly associated with CVD through enhanced LDLR degradation. Mutations in the human PCSK9 gene lead to either familial hypercholesterolemia or hypocholesterolemia, depending on whether the mutation causes a gain or a loss of function, respectively. It is uncertain if individuals carrying mutations causing a gain-of-function of PCSK9 will develop aortic calcification or whether loss-of-function mutations will lead to abdominal obesity. In this thesis, we investigated: 1) the effect of PCSK9 overexpression on aortic calcification; 2) the consequences of PSCK9 deficiency, mimicking pharmacological inhibition of PCSK9 on fat tissue. We employed a transgenic (Tg) mouse model overexpressing mouse PCSK9 and illustrated by micro-computerized tomography that calcification occurs to a lesser extent in PCSK9 Tg mice than in LDLR-deficient mice. While both PCSK9 Tg and LDLR deficiency caused familial hypercholesterolemia, circulating cholesterol levels alone could not dictate the degree of aortic calcification. In another study, we used genetically modified mice lacking PCSK9 and demonstrated that visceral fat accumulation (adipogenesis) is regulated by circulating PCSK9. Thus in the absence of PCSK9, visceral adipogenesis increases likely via post-translational regulation of very-low-density lipoproteins receptors (VLDLR) in the adipose tissue. In conclusion, these two studies highlight the dynamic balance of PCSK9 in different metabolic pathways, making it a key element in cardiovascular health. Consequently, attempts to survey and/or alter PCSK9 biology should be performed in a valid animal model using sensitive methods and with careful attention to side effects of any given intervention.

Le phosphate inorganique (Pi) est un minéral essentiel de notre organisme, qui intervient dans la composition des acides nucléiques et des phospholipides, dans la minéralisation des os et des dents, dans la production d’énergie, et dans la régulation des voies de signalisation. L’homéostasie du Pi est étroitement régulée par différents transporteurs, et des anomalies du transport de Pi peuvent avoir des conséquences cliniques sévères. Chez l’homme, ils existent 3 transporteurs de Pi distincts de type SLC (solute carrier) avec une distribution tissulaire large et initialement identifiés en tant que récepteurs de rétrovirus : PiT1/SLC20A1, PiT2/SLC20A2, et XPR1/SLC53A1.Des mutations dans PiT2 sont associées à une maladie rare, la calcification cérébrale primaire familiale (PFBC), caractérisée par des dépôts de phosphate de calcium dans les noyaux gris centraux et par l’expression de troubles neuropsychiatriques. Alors que PiT1 ne semble pas être impliqué dans cette maladie, nous avons découvert que des mutations dans XPR1 étaient présentes chez des patients PFBC, renforçant le lien entre la maladie PFBC et les désordres de l’homéostasie du phosphate.Dans ce travail, nous avons cherché à comprendre comment PiT2 et XPR1, deux transporteurs de Pi mais de flux opposés peuvent conduire à une même maladie. Pour cela, nous avons étudié le lien entre PiT2 et XPR1 dans la régulation du Pi ainsi que les domaines de XPR1 impliqués dans le transport. Nous avons d’abord identifié de nouveaux variants PFBC dans PiT2 et XPR1 et confirmé l'effet délétère de ces mutations sur l’import et l’export. Nous avons pu distinguer des mutations qui abolissaient l’expression en surface de XPR1, et donc indirectement l’export de Pi, alors que d’autres avaient un impact fonctionnel direct sur les transporteurs pourtant présents à la membrane plasmique.L’inactivation de XPR1 dans des cellules haploïdes humaines induit une altération profonde de l’export de Pi sans effet notable sur l’import. De manière surprenante, l’inactivation de PiT2 entraine un effet modéré sur l’import, probablement dû à l'activité complémentaire de PiT1, avec une chute de l’export dépendant de XPR1. Cet effet identifie une boucle de régulation que nous avons montrée être essentielle au maintien des niveaux de phosphate et d’ATP. Ces résultats révèlent que le défaut d’export de phosphate par inactivation de PiT2 et XPR1 est susceptible d’être l’étape-clé qui conduit à une maladie commune, la PFBC.Nous nous sommes concentrés sur cette étape d‘export régulée en étudiant le domaine SPX de XPR1 dans lequel la plupart des mutations PFBC ont été retrouvées. Nous avons identifié la tankyrase (TNK) comme interactant cellulaire, et localisé son site d’interaction à la bordure carboxyle de SPX. Nous avons observé que la délétion de SPX entrainait un défaut d’export de Pi, et que la perte d’interaction de TNK à XPR1 par mutagenèse ponctuelle avait le même effet, suggérant que TNK et SPX sont 2 composants essentiels à l’export de phosphate. Enfin, nous avons identifié de nouvelles mutations de XPR1 à l'extrémité C-terminale qui abolissaient l’export de Pi, et montré que la délétion de ce domaine entrainait un défaut d’expression de XPR1 à la membrane plasmique. Nos résultats indiquent donc que les domaines N- et C-terminaux jouent un rôle clé dans l’export, et donc dans l’homéostasie du phosphate, avec le domaine C-terminal jouant plutôt un rôle dans le trafic en surface de XPR1.L’ensemble de ce travail a permis de documenter de nouvelles mutations PFBC dans les gènes PiT2 et XPR1, de démontrer que ces transporteurs étaient impliqués dans l’homéostasie intracellulaire du phosphate, en dévoilant que l’export de phosphate est vraisemblablement l’étape clé de la PFBC, ouvrant ainsi de nouvelles pistes dans la compréhension de cette maladie. Nous avons également identifié des domaines de XPR1 et un partenaire cellulaire, essentiels à l’export de Pi et/ou au trafic membranaire. / Phosphate (Pi) is a key mineral that participates directly in the synthesis of nucleic acids and membranes, bone and tooth mineralization, energy production, and signal transduction. Pi homeostasis is tightly regulated by transporter-mediated fluxes that adjust Pi concentration in real time, and defect in Pi transport has been associated with several pathologies. In humans, three Pi transporters, which belong to the solute carrier (SLC) superfamily, are widely expressed: PiT1/SLC20A1, PiT2/SLC20A2, and XPR1/SLC53A1. Interestingly, all three were initially identified as receptors for mammalian gammaretroviruses.Mutations in PiT2/SLC20A2 are responsible for a rare neurodegenerative disorder, the primary familial brain calcification (PFBC), characterized by deposits of calcium Pi in the basal ganglia and other regions of the brain, and associated with diverse neuropsychiatric clinical manifestations. While PiT1/SLC20A1 has not been involved in PFBC, we recently identified mutations in XPR1/SLC53A1 as causative for PFBC, thus linking further the disease with cellular Pi homeostasis dysfunction.In this work, we aimed to understand how defects of opposite Pi transport functions lead to PFBC, investigated the relationship between PiT2 and XPR1 in cellular Pi regulation, and studied XPR1 domains in Pi transport. We first identified several PFBC mutations in PiT2/SLC20A2 and XPR1/SLC53A1, and confirmed their impact on Pi import or export, respectively. Some of the mutations altered transporter cell surface expression, resulting in Pi transport impairment, while others did neither alter cell surface expression, nor retroviral receptor functions, confirming that Pi transport function and viral envelope glycoprotein binding can be structurally distinguished.Using single gene knock-out human haploid cells, we showed that depletion of XPR1/SLC53A1 resulted in a dramatic Pi export alteration, with no detectable effect on Pi import, in agreement with Pi exporter function of XPR1. Interestingly, depletion of PiT2/SLC20A2 had little impact on Pi uptake, most likely due to compensatory function of PiT1/SLC20A1, with, however, a surprising impact on Pi export mediated by XPR1. This effect is reminiscent to a regulation loop that we found to maintain both Pi and ATP constant. This results unveil for the first time that Pi export alteration, and not Pi import, is likely to be the common pathophysiological impact of mutations in both PiT2 and XPR1. This would explain the synonymous pathological effects of two transporters that have opposite transport activity.We further explored this regulated phosphate export by characterizing the SPX N-terminal cytoplasmic domain of XPR1, which harbors most of the PFBC mutations. We identified a cellular tankyrase (TNK) as a binding partner and mapped the TNK-binding site to the carboxyl border of SPX; furthermore, we found that mutations that abolished TNK binding resulted in loss of Pi export. Full deletion of SPX domain maintained cell surface expression but altered export, suggesting that both TNK and SPX are essential components for Pi export. Finally, during this work, we identified mutations in the XPR1 C-terminal domain as responsible for PFBC that also impaired Pi export, and showed that deletion of this domain prevented XPR1 cell surface expression. Our results therefore indicate that N- and C-terminal domains of XPR1 play a key role in phosphate homeostasis, the latter domain appearing to exert a more prominent role in XPR1 membrane trafficking and/or folding.

Biogeochemical processes of reefs have been studied for over fifty years, however, information is still lacking on several fundamental reef processes. This lack of information has been limited essentially by techniques that cannot repeatedly sample large spatial areas. These limitations can be reduced with the use of an optical model to estimate biogeochemical processes. This project applied Monteith's light-use efficiency model to coral reef communities for determining photosynthetic and calcification efficiency of light. Gross primary production and net calcification were pooled from the peer-reviewed literature to calculate efficiency. Process efficiency was then compared across functional types of reef communities (i.e., coral, algae/seagrasses, mixed, and sand), and by year, location, season, and depth. Photosynthetic efficiency was calculated from 19 studies, showing an average of 0.039 mol O2 mol-1 photons. Photosynthetic efficiency differed significantly for mixed communities between studies, and for algae/seagrass communities among depths. Calcification efficiency averaged at 0.007 mol CaCO3 mol-1 photons. Significant differences were found in calcification efficiency of algae/seagrasses and mixed reef communities among studies and localities. Additionally, calcification efficiency of algae/seagrasses varied significantly in accordance with depth. Future use of the light-use efficiency model will require determining the efficiency of each functional type to estimate gross production and calcification. Additionally, further investigation of the light-use efficiency model will require long-term measurements of APAR, which is the fraction of incident light absorbed, and the incorporation of environmental parameters that reduce efficiency.

Recent concern over the effects of ocean acidification upon calcifying organisms in the modern ocean has highlighted the aragonitic shelled thecosomatous pteropods as being at a high risk. Laboratory studies have shown that increased pCO2, leading to decreased pH and low carbonate concentrations, has a negative impact on the ability of pteropods to calcify and maintain their shells. This study presents the micropalaeontological analysis of marine cores from the Caribbean Sea, Mediterranean Sea and Indian Ocean. Pteropods, heteropods and planktic foraminifera were picked from samples to provide palaeoenvironmental data for each core. Determination of pteropod calcification was made using the Limacina Dissolution Index (LDX) and the average shell size of Limacina inflata specimens. Pteropod calcification indices were compared to global ice volume and Vostok atmospheric CO2 concentrations to determine any associations between climate and calcification. Results show that changes in surface ocean carbonate concentrations throughout the Late Pleistocene did affect the calcification of thecosomatous pteropods. These effects can be detected in shells from marine sediments that are located well above the aragonite lysocline and have not undergone post-depositional dissolution. The results of this study confirm the findings of laboratory studies, showing a decrease in calcification during interglacial periods, when surface ocean carbonate concentrations were lower. During glacial periods, calcification was enhanced due to the increased availability of carbonate. This trend was found in all sediments studied, indicating that the response of pteropods to past climate change is of global significance. These results demonstrate that pteropods have been negatively affected by oceanic pH levels relatively higher and changing at a lesser rate than those predicted for the 21st Century. Results also establish the use of pteropods and heteropods in reconstructing surface ocean conditions. The LDX is a fast and appropriate way of determining variations in surface water carbonate saturation. Abundances of key species were also found to constrain palaeotemperatures better than planktic foraminifera, a use which could be further developed.

Les maladies cardiovasculaires apparaissent précocement au cours de l'insuffisance rénale chronique (IRC) et représentent la première cause de mortalité. La 1ère étape pour apprécier la relation entre risque cardiovasculaire et progression de l'IRC consiste à améliorer l'estimation du débit de filtration glomérulaire (DFG). Nous avons donc évalué l'impact des conditions analytiques de mesure de la créatininémie et de la cystatinémie sur l'estimation du DFG. Les créatinines IDMS traçables (enzymatique et Jaffe compensé) améliorent l'estimation du DFG. Cependant, les méthodes enzymatiques non sensibles aux pseudochromogènes doivent être préférées. Concernant la cystatine C, nos résultats soulignent l'absence de standardisation du dosage. Chez des patients IRC non dialysés (stade I à V), nous avons identifié l'ostéoprotégérine (OPG) comme marqueur biologique de la présence de calcifications vasculaires. In vitro, nous avons démontré que le stress oxydant, majoré en présence de sérum urémique, jouait un rôle clé dans la transdifférenciation des cellules musculaires lisses vasculaires en ost oblastes. La mortalité en dialyse reste élevée et est largement dépendante des maladies cardiovasculaires. Il nous a donc paru nécessaire de rechercher les marqueurs pronostics et/ou d'en suivre l'évolution en transplantation. En dialyse, malgré une épuration significative par hémodiafiltration, les peptides natriurétiques sont des marqueurs du remodelage ventriculaire. La combinaison "NT-proBNP-CRP" est un puissant facteur pronostic de mortalité cardiovasculaire en hémodialyse. Après transplantation rénale, les calcifications vasculaires se stabilisent chez la majorité des patients et les taux d'OPG diminuent précocement. Les taux d'OPG sont significativement plus élevés chez les patients dont les calcifications progressent. Toutefois, seule l'intensité des calcifications avant transplantation permet de prédire la progression / Cardiovascular disease occurs in the early stage of chronic kidney disease (CKD) and is the leading cause of death. The first step, to appreciate the link between cardiovascular risk and CKD progression, is to improve glomerular filtration rate (GFR) estimation. We have therefore evaluated the impact of analytical conditions for creatinine and cystatin C measurement on estimated GFR. New creatinine ID-MS traceable methods (enzymatic and compensated Jaffe) improved estimation of GFR by predictive equations. However, enzymatic methods that are much less susceptible to interfere with non-creatinine chromogens may provide more reliable estimations of GFR. Regarding cystatin C, our results highlighted the lack of standardization. In non dialyzed CKD patients (stage I to V), we identified osteoprotegerin (OPG) as a biomarker for the presence of vascular calcification. In vitro, we demonstrated that oxidative stress, increased in the presence of uremi c serum, played a key role in the transdifferentiation of vascular smooth muscle cells into osteoblast-like cells. In dialysis, mortality is high and largely dependant on cardiovascular disease. We have therefore investigated prognostic markers and/or followed their evolution after transplantation. In dialysis, despite their removal by hemodiafiltration, natriuretic peptides could be potential markers of left ventricular remodelling. In addition, the combination of high CRP and circulating NT-proBNP dramatically impaired the hemodialysis survival rate. After renal transplantation, stabilization of vascular calcification was observed in the majority of patients and OPG levels are dramatically reduced. Despite a higher baseline OPG level in progressors vs. non-progressors patients, post transplant vascular calcification progression was only predicted by baseline score.

Para investigar se estresse oxidativo contribui para a progressão da calcificação/estenose valvar aórtica (VA), avaliamos a produção de espécies reativas de oxigênio (ERO) e efeitos dos antioxidantes tempol e ác. lipóico em modelo de calcificação VA em coelhos. Superóxido, H2O2 e 3-nitrotirosina aumentaram em células inflamatórias e principalmente nos núcleos de calcificação, juntamente com as subunidades p22phox, Nox2 da NADPH oxidase e da proteína dissulfeto isomerase, que co-localizam. PCR mostrou aumento da Nox4 em relação a Nox1. A calcificação foi menor com ác.lipóico e maior com tempol, coicidindo com resultados de modelo in vitro em células musculares lisas. VA humanas estenóticas tiveram aumento semelhante de ERO e da expressão protéica em torno da calcificação. Estresse oxidativo pode contribuir para a progressão da estenose aórtica. / To invetigate whether oxidative stress contributes to aortic valve (AV) calcification/stenosis progression, we assessed reactive oxygen species (ROS) production and effects of antioxidants tempol and lipoic acid in a rabbit AV calcification model. Superoxide, H2O2 and 3-nitrotyrosine increased in inflammatory cells and mainly in calcifying nuclei, coincident with NADPH oxidase subunits p22phox, Nox2 and protein disulfide isomerase, which co-localized. PCR showed switch from Nox1 to Nox4. Calcification was smaller with lipoic acid and greater with tempol, similar to an in vitro smooth muscle cell calcification model results. Human stenotic AV had analogous increase in ROS and protein expression around calcifying nuclei. Oxidative stress can contribute to AV stenosis progression.

Introdução: Neurocisticercose (NCC) é a principal causa evitável de epilepsia adquirida no mundo. NCC, além de ser, a doença parasitária mais comum do SNC, representa um importante problema de saúde pública, especialmente em países em desenvolvimento. Estudos de neuroimagem são cruciais no diagnóstico e planejamento terapêutico da NCC. Apesar da ressonância magnética (RM) fornecer maior número e detalhe de informações sobre a doença, a tomografia computadorizada (TC) ainda é o método mais sensível na detecção de calcificação intracraniana, o achado radiológico mais comum da NCC. Objetivo: Comparar performance das sequências de RM ponderadas em suscetibilidade magnética na identificação de calcificações intracranianas em pacientes com NCC. Métodos: Estudo prospectivo, unicêntrico, no qual 57 indivíduos foram submetidos a TC e RM de crânio. Todos os indivíduos foram provenientes do Ambulatório de Doenças Infecciosas do Departamento de Neurologia do Hospital das Clínicas - Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), com diagnóstico confirmado de NCC. O protocolo de RM incluiu uma sequência convencional 2D gradiente eco (2D-GRE) e duas relativamente novas sequências de suscetibilidade magnética: susceptibilityweighted imaging (SWI) e principles of echo shifting with a train of observations (PRESTO). A TC foi considerada método padrão de referência. Dois neurorradiologistas, cegos para os dados clínicos e demais achados radiológicos, analisaram independentemente as sequências 2D-GRE, SWI e PRESTO quanto à presença, número e localizações de calcificações intracranianas atribuídas a NCC. Resultados: Foram identificadas, pela TC, 739 lesões calcificadas relacionadas a NCC em 50 dos 57 indivíduos incluídos no estudo. A média de lesões calcificadas por paciente foi de 12,9 (± 19,8). A médias de lesões encontradas pelas sequências de suscetibilidade magnética, obtido através da média dos resultados dos observadores, foi de 10,8 (± 17,5) para PRESTO, 10,6 (± 17,3) para SWI e 8,3 (± 13,6) para 2D-GRE. Neste quesito não houve diferença estaticamente significativa entre PRESTO e SWI (p = 0,359) e ambos foram superiores a 2D-GRE (p < 0,05). A concordância foi fraca a moderada, provavelmente devido ao alto número de lesões falso-positivas encontradas (490), das quais 53,9% representavam lesões relacionadas a NCC em estágios não calcificados. A sensibilidade e especificidade das sequências estudadas em identificar corretamente indivíduos com NCC em estágio calcificado foi respectivamente de 85% e 100% para 2D-GRE, 90% e 100% para SWI e 93% e 100% para PRESTO. Conclusão: As sequências SWI, PRESTO e 2D-GRE apresentam boa sensibilidade na identificação de lesões calcificadas em pacientes com NCC. As sequências SWI e PRESTO tiveram melhor performance do que 2D-GRE. Todas as sequências estudadas mostrarem-se apropriadas para identificar indivíduos com NCC no estágio de calcificação. Sequências ponderadas em suscetibilidade magnética podem ajudar no entendimento da história natural, fisiopatologia e achados de imagem da NCC / Background: Neurocysticercosis (NCC) is the main preventable cause of acquired epilepsy. NCC, besides being the most common parasitic disease of the CNS, is an important public health problem, mainly in developing countries. Neuroimaging studies are crucial in the diagnosis and therapeutic planning of NCC. Although magnetic resonance imaging (MRI) provides countless and more detailed information about the disease, computed tomography (CT) is still the most sensitive method for detecting intracranial calcification, the most common radiological finding of NCC. Purpose: To compare the diagnostic performance of susceptibility-weighted MRI sequences in identification of intracranial calcifications in patients with NCC. Methods: A prospective study with 57 subjects who underwent CT and MRI of the brain. All individuals came from Department of Neurology of the Hospital das Clínicas - Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), with a stablished diagnosis of NCC. The MRI protocol included a conventional 2D gradient echo sequence (2D-GRE) and two relatively new susceptibility-weighted sequences: susceptibility-weighted imaging (SWI) and principles of echo shifting with a train of observations (PRESTO). CT was considered the standard reference method. Two neuroradiologists, blinded to clinical data and other radiological findings, independently analyzed the 2D-GRE, SWI and PRESTO sequences on behalf to presence, number and sites of intracranial calcifications attributed to NCC. Results: A total of 739 NCC-related calcified lesions were identified by CT in 50 of the 57 subjects included in the study. The mean number of calcified lesions per patient was 12.9 (± 19.8). The mean number of lesions found by the susceptibility-weighted MRI sequences, obtained through the mean of the observers\' results, was 10.8 (± 17.5) for PRESTO, 10.6 (± 17.3) for SWI and 8.3 (± 13.6) for 2D-GRE. There was no statistically significant difference between PRESTO and SWI (p = 0.359) and both were superior to 2D-GRE (p < 0.05). The concordance was weak to moderate, probably due to the high number of false-positive lesions found (490), of which 53.9% represented NCC-related lesions in non-calcified stages. The sensitivity and specificity of the sequences studied in correctly identifying individuals with calcified NCC were 85% and 100% respectively for 2D-GRE, 90% and 100% for SWI and 93% and 100% for PRESTO. Conclusion: SWI, PRESTO and 2D-GRE sequences have good sensitivity in the identification of calcified lesions in patients with NCC. SWI and PRESTO performed better than 2DGRE. All sequences studied are suitable for identifying individuals with NCC in the calcified stage. The new susceptibility-weighted MRI sequences may help in understanding the natural history, pathophysiology and imaging findings of NCC

Environmental change is a major threat to marine ecosystems worldwide. Understanding the key biological processes and environmental factors mediating spatial and temporal species' responses to habitat alterations underpins our ability to forecast impacts on marine ecosystems under any range of scenarios. This is especially important for calcifying species, many of which have both a high climate sensitivity and disproportionately strong ecological impacts in shaping marine communities. Although geographic patterns of calcifiers' sensitivity to environmental changes are defined by interacting multiple abiotic and biotic stressors, local adaptation, and acclimation, knowledge on species' responses to disturbance is derived largely from short- and medium-term laboratory and field experiments. Therefore, little is known about the biological mechanisms and key drivers in natural environments that shape regional differences and long-term variations in species vulnerability to global changes. In this thesis, I examined natural variations in shell characteristics, both morphology and biomineralisation, under heterogeneous environmental conditions i) across large geographical scales, spanning a 30° latitudinal range (3,334 km), and ii) over historical times, using museum collections (archival specimens from 1904 to 2016 at a single location), in mussels of the genus Mytilus. The aim was to observe whether plasticity in calcareous shell morphology, production, and composition mediates spatial and temporal patterns of resistance to climate change in these critical foundation species. For the morphological analyses, the combined use of new statistical methods and multiple study systems at various geographical scales allowed the uncoupling of the contribution of development, genetic status, and environmental factors to shell morphology. I found salinity had the strongest effect on the latitudinal patterns of Mytilus shape. Temperature and food supply, however, were the main predictor of mussel shape heterogeneity. My results suggest the potential of shell shape plasticity in Mytilus as a powerful indicator of rapid environmental changes. I found decreasing shell calcification towards high latitudes. Salinity was the best predictor of regional differences in shell deposition, and its mineral and organic composition. In polar, low-salinity environments, the production of calcite and organic shell layers was increased, while aragonite deposition was enhanced under temperate, higher-salinity regimes. Interacting strong effects of decreasing salinity and increasing food availability on compositional shell plasticity predict the deposition of a thicker external organic layer (periostracum) at high latitudes under forecasted future conditions. This response potential of Mytilus shell suggests an enhanced protection of temperate mussels from predators and a strong capacity for increased resistance of polar and subpolar individuals to dissolving water conditions. Analyses of museum specimens indicated increasing shell calcification during the last century. Deposition of individual shell layers was more closely related to temporal changes in the variability of key environmental drivers than to alterations of mean habitat conditions. Calcitic layer and periostracum showed marked responses to alterations of biotic conditions, suggesting the potential of mussels to trade-off between the deposition of calcareous and organic layers as a compensatory response to strategy-specific predation pressure. These changes in biomineralisation indicated a marked resistance to environmental change over the last century in a species predicted to be vulnerable, and how locally heterogeneous environments and predation levels can have a stronger effect on Mytilus responses than global environmental trends. My work illustrates that biological mechanisms and local conditions, driving plastic responses to the spatial and temporal structure of multiple abiotic and biotic stressors, can define geographic and temporal patterns of unforeseen species resistance to global environmental change.

Imatinib mesylate has been associated with the changes in bone turnover. We report a case of the development of tissue calcification in a patient on long-term therapy with this drug. A 48-year-old male patient with gastrointestinal stromal tumor and liver metastasis complained of abdominal pain. His treatment included hepatic artery chemoembolization and partial hepatectomy in addition to chronic imatinib mesylate for 4 years. On physical examination, he had a peritoneal mass just beneath the laparotomy incision scar that, after resection, was found to be dystrophic bone formation. Based on the previous studies suggesting bone changes due to chronic therapy with imatinib mesylate, we believe that the patient's new bone formation was causally related to the use of this drug. To our knowledge, there are no similar reported cases in the literature.