Doctor of Philosophy / Department of Chemistry / Duy H. Hua / Three research projects are described in this dissertation, and they are: (i) discovery of piperidine derivatives as T-type calcium channel inhibitors for the treatment of epilepsy and neuropathic pain and as protein disulfide isomerase inhibitors for the treatment of influenza viral infection; (ii) discovery of peptide-based calcitonin gene-related peptide receptor antagonists for the treatment of inflammatory pain; and (iii) synthesis of substituted 6-(dimethylamino)-2-phenylisoindolin-1-ones for the inhibition of luciferase. T-type calcium channels are important regulators of nervous system, and upregulated T-type calcium channel activities have been found to link to various types of neurological disorders, such as epilepsy and neuropathic pain. To discover novel T-type calcium channel blockers, a series of 1,4-disubstituted piperidine derivatives were designed and synthesized. Among them, compound 1-4 was found to be a good T-type calcium channel inhibitor with an IC₅₀ of 1 nM for Ca[subscript v]3.2 inhibition. It also showed 86% suppression of seizure induced death in mice and good in vivo analgesic effects on both thermal and mechanical pain thresholds in Spared Nerve Injury rat models. Therefore 1-4 can potentially be used as a T-type calcium channel blocker in the treatment of epilepsy and neuropathic pain. Influenza is a respiratory viral infection. Since viruses rely on host cell proteins for their entry, survival and replication, development of drugs targeting host cell proteins has identified as an effective strategy in controlling viral infections. We synthesized a series of 1,4-disubstituted piperidine derivatives for the inhibition of protein disulfide isomerase enzyme and influenza. Among them, 1-29 was found to possess strong anti-influenza activity (EC₅₀ = 2.5 µM). This suggests the potential use of piperidine scaffold in designing anti-influenza drugs in future. Calcitonin gene-related peptide (CGRP) receptor antagonism has been identified as a successful approach for the treatment of inflammatory pain. Therefore, a novel class of peptide antagonists of CGRP receptor was synthesized and screened for their binding affinities to the CGRP receptor and their analgesic effects on inflammatory-induced pain in rats. Among them, peptide 2-3 showed a higher binding affinity towards the CGRP receptor than previously reported peptide antagonists and exhibited analgesic effects up to 2 h in both Aδ and c-fiber pain tests. Therefore 2-3 indicates its potential use as a CGRP receptor antagonist in the treatment of inflammatory pain. Firefly luciferase is commonly used as a reporter in cells expressing a luciferase gene or its enzymatic activity under the control of a promoter of interest to assess its transcriptional activity. It has been found that some molecules such as molecules with carboxylic acid moiety can directly inhibit luciferase activity in cells. However, it is suggested that carboxylic acid moiety of the compounds may also be associated with side reactions in cells. Therefore, to study whether carboxylic acid moiety causes side effects, we designed two probe molecules, 3-1 and 3-2. Synthesis of probe molecule 3-2 is discussed. Synthesis of probe molecule 3-1 and further investigation of its luciferase inhibition will therefore be useful to understand the toxicity of carboxylic acid containing drugs in future.

A stanniocalcina-1 (STC1) é uma glicoproteína caracterizada como um fator endócrino com ação anti-hipercalcêmica/hipocalcêmica originalmente descoberta em peixes. Em mamíferos, esse hormônio está expresso em praticamente todos os tecidos, regula diversas funções biológicas e atua como um fator autócrino/ parácrino. Diversas evidências demonstram o envolvimento da STC1 no desenvolvimento ósseo. Durante a embriogênese, a STC1 é expressa nos primeiros estágios de condensação mesenquimal e, posteriormente, se mantém restrita a preosteoblastos e osteoblastos maduros. Além disso, a STC1 estimula a mineralização óssea através do aumento da expressão de transportadores de fosfato e da osteopontina, uma sialoglicoproteína que atua na mineralização óssea. Células-tronco adultas simbolizam atualmente a fonte mais acessível de células progenitoras utilizadas em terapias celulares e engenharia de tecidos. O tecido adiposo contém uma população de células biológica e clinicamente interessantes denominada células tronco adiposo derivadas (CTADs). Atualmente as CTADs são a melhor fonte de células tronco adultas podendo ser obtidas através de procedimentos minimamente invasivos. Um grande número de estudos têm demonstrado o potencial osteogênico dessas células, no entanto, ainda é um desafio a compreensão dos mecanismos envolvidos na diferenciação osteogênica a partir das CTADs. Neste estudo, foi demonstrado que sete dias de indução osteogênica das CTADs na presença de 50 ng/mL de STC1 aumentaram significativamente a expressão gênica e proteica dos marcadores osteogênicos: fosfatase alcalina (FA), runt related gene 2 (RUNX2) e osteopontina (OPN) O aumento na atividade da enzima FAS foi relacionado diretamente com a maior expressão gênica e proteica. Além disso, a STC1 modula a via de sinalização pAKt/pGSK3-β/βcatenina em preosteoblastos de 7 dias sugerindo que seus efeitos sobre a osteogênese sejam mediados por essa via de sinalização. O peptídeo neuroendócrino CGRP (peptídeo relacionado ao gene da calcitonina) possui similaridades com STC1 e desempenha um importante papel nas fases iniciais da diferenciação dos osteoblastos. O CGRP ativa o receptor CALCRL, formando um dímero com a proteína transmembrana acessória RAMP1. Para elucidar o envolvimento da STC1 nas vias de sinalização relacionadas a receptores de calcitonina foi investigado o efeito desse hormônio na modulação 8 do receptor do CGRP e receptor de calcitonina (CTR) em CTADs diferenciadas para preosteoblastos e células Hek 293 superexpressoras de CALCRL/RAMP1 e CTR. A STC1 não alterou a expressão dos genes CALCRL e ramp1 durante a osteoblastogênese mas provocou alterações na distribuição espacial do complexo CALCRL/RAMP1 na membrana plasmática de preosteoblastos, induzindo a formação de clusters Além do efeito sobre a sinalização do CGRP a STC1 demonstrou inibir a sinalização da calcitonina diminuindo a produção de cAMP em células transfectadas com CTR. A STC1 não alterou os níveis intracelulares de cálcio e ATP. Esses resultados indicam que, embora não atue diretamente via os receptores CALCRL/RAMP1 e CTR, a STC1 modula a sinalização dos peptídeos CGRP e CT. Estudos mais detalhados sobre os efeitos da STC1 nas diferentes vias de sinalização são necessários para desvendar completamente os mecanismos de diferenciação osteogênicos das CTADs estimuladas por esse hormônio. / The stanniocalcin-1 (STC1) is a glycoprotein characterized as an endocrine factor with anti-hypercalcemic / hypocalcemic action, originally identified in fish. The hormone in mammals is expressed in virtually all tissues and regulates diverse biological functions, acting as an autocrine / paracrine factor. Many evidences demonstrate that STC1 is able to regulate bone development. During embryogenesis the STC1 is expressed in early stages of mesenchymal condensation and thereafter remains restricted to preosteoblast and mature osteoblast. Furthermore, STC1 stimulates bone mineralization by increasing the phosphate transporter expression and osteopontin, a sialoglycoprotein involved in bone mineralization. Adult stem cells currently symbolize the most accessible source of stem cells used in cell therapy and tissue engineering. Adipose tissue contains a population of biological cells clinically interesting called adipose derived stem cells (ASC). Currently, the ASCs are the best source of adult stem cells and can be harvested using minimally invasive procedures. A large number of studies had shown osteogenic potential of these cells, however, it is still a challenge to understand the mechanisms involved in osteogenic differentiation from ASCs This study demonstrated that 7-day preosteoblast in the presence of 50 ng / ml STC1 significantly increased gene and protein expression of osteogenic markers: alkaline phosphatase (ALP), runt related gene 2 (RUNX2), and osteopontin (OPN ). Also, there was an increase in the enzymatic activity of the ALP, possibly related to both gene and protein expression. Furthermore, STC1 modulates pAkt / pGSK3-β / βcatenina signaling in 7-day preosteoblast, suggesting that the STC1 effects on the osteogenesis is mediated by this pathway. The neuroendocrine peptide CGRP (calcitonin gene related peptide) has similarities to STC1 and plays an important role in the early stages of osteoblast differentiation. The active CGRP receptor form a dimer with the receptor activity-modifying protein 1 (RAMP1). To elucidate the involvement of STC1 in signaling pathways related to calcitonin receptors, it was investigated the STC1 effect on peptide receptor modulating the calcitonin gene related peptide (CGRP) and the calcitonin receptor (CTR) in 7-day preosteoblast, and in Hek 293 cells transfected with CALCRL / RAMP1 and CTR The STC1 did not change the expression of genes CALCRL and ramp1 during osteoblastogenesis but modified the plasma membrane spatial distribution of 10 CALCRL/RAMP1 in preosteoblast. Besides the effect on CGRP signaling, STC1 inhibited the calcitonin signaling by decreasing cAMP production in cells transfected with CTR. The STC1 did not alter intracellular calcium levels and ATP. These results indicated that STC1 does not act on the same receptors for calcitonin and CGRP, but modulates the action of these peptides. Studies on the effects of STC1 in different signaling pathways are necessary for understanding the mechanisms underlying the STC1 ability in enhancing osteoblastogenesis from hASCs.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-12-10T09:47:46Z No. of bitstreams: 2 Dissertação - Allison Filipe Lopes Martins - 2015.pdf: 3205167 bytes, checksum: 5c24397e18241a8a809af753bb233428 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-12-10T10:03:57Z (GMT) No. of bitstreams: 2 Dissertação - Allison Filipe Lopes Martins - 2015.pdf: 3205167 bytes, checksum: 5c24397e18241a8a809af753bb233428 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2015-12-10T10:03:57Z (GMT). No. of bitstreams: 2 Dissertação - Allison Filipe Lopes Martins - 2015.pdf: 3205167 bytes, checksum: 5c24397e18241a8a809af753bb233428 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2015-03-27 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The Central Giant Cell Lesion (CGCL) is an intraosseous lesion that can be classified into non aggressive and aggressive. Due to the aesthetic and functional defects of surgical treatment of CGCL, therapies with drugs have been reported, such as glucocorticoid injections and calcitonin. The studies reported in the literature support the use of these drugs through the investigation of the presence of glucocorticoid receptors (RGC) and calcitonin (RCT) in CGCL; however there is no consensus if all lesions express these receptors and if there is any difference between non aggressive and aggressive lesion. In addition, there are no studies that evaluated the bone formation potential through the investigation of Osteocalcin (OC) in aggressive and non-aggressive lesions. The aim of this study was to compare, using immunohistochemistry, the GR and CTR and osteocalcin protein (OC) expression in non aggressive (n = 20) and aggressive (n = 11) CGCL, and the correlation between the OC expression and these receptors determined in both groups of lesions. The number of mononuclear cells in mitosis (MOC), and the number of multinucleated giant cells (MGC) were also investigated using immunohistochemical techniques (hematoxylin and eosin). Our results show that all the cases express the GR and CTR and that there is no difference in the expression of these receptors or the number of mitosis between non aggressive and aggressive lesions. The OC expression was rare and higher in non aggressive lesions, however, not statistically significant (p> 0.05). There was a correlation between the CTR expression in MOC and MGC (r = 0.45; p <0.01). Considering the different variants of CGCL, there was a correlation between CTR expression in MOC and MGC in non aggressive lesions (r = 0.66; p <0.01) and between the CTR and OC expression in MGC (r = 0.718; p = 0.01). There was a higher number of MGC in aggressive lesions (p = 0.01). The results indicate that all cases express GR and CTR and that there are no differences between non aggressive and aggressive CGCL lesions of these receptors expression, these results strengthens CGCL treatment with glucocorticoids and calcitonin. Aggressive lesions have a higher number of MGC. The CGCL express glucocorticoid and calcitonin receptors and this finding give biological basis to the CGCL treatment with intralesional glucocorticoid and calcitonin either in non aggressive and aggressive cases. It was also identified osteocalcin positive cells, that may be related to bone repair, it is believed that these cells may also serve as a therapeutic target. / A Lesão Central de Células Gigantes (LCCG) é uma lesão intraóssea que pode ser classificada em não agressiva e agressiva. Devido aos defeitos estéticos e funcionais do tratamento cirúrgico da LCCG, terapias medicamentosas tem sido relatadas, como injeções de glicocorticoide e calcitonina. Há na literatura estudos que suportam o uso desses medicamentos através da investigação da presença de receptores de glicocorticoides (RGC) e de calcitonina (RCT) em LCCG. No entanto não existe consenso se todas as LCCG expressam esses receptores e se existe alguma diferença entre lesões agressivas e não agressivas. Além disso, não existem estudos sobre a avaliação do potencial de formação óssea através da Osteocalcina (OC) em lesões agressivas e não agressivas. O propósito deste estudo foi avaliar comparativamente, por meio de imunohistoquímica, a expressão de RGC e RCT e da OC em LCCG não agressivas (n= 20) e agressivas (n= 11) e a correlação entre a expressão da OC e desses receptores nos dois grupos de lesões estudados. O número de mitoses nas células mononucleares e o número de células gigantes multinucleadas também foram investigados, utilizando técnica histoquímica (hematoxilina e eosina). Nossos resultados mostram que todos os casos analisados expressam o RGC e RCT e que não existe diferença na expressão do RGC, RCT ou do número de mitoses entre lesões não agressivas e agressivas. A expressão de OC em células mononucleares foi rara e maior em lesões não agressivas, no entanto, sem diferenças estatisticamente significantes (p>0,05). Houve correlação entre a expressão do RCT em células mononucleares e células gigantes multinucleadas (r=0,45; p<0,01). Considerando as diferentes variantes foi verificada correlação do RCT entre o componente mononuclear e as células gigantes multinucleadas nas lesões não agressivas (r=0,66; p<0,01) e entre a expressão de OC e RCT em células gigantes multinucleadas (r= 0,718; p=0,01). Houve maior número de células gigantes em lesões agressivas (p= 0,01). Os resultados indicam que todos os casos expressam RGC e RCT e que não há diferenças entre lesões agressivas e não agressivas de LCCG quanto à expressão desses receptores, fortalecendo a recomendação o tratamento da LCCG com o uso de glicocorticoide e calcitonina. Lesões agressivas apresentam maior número de CGM. As células da LCCG expressam o RGC e RCT e esse achado pode fornecer bases biológicas para o tratamento com injeções intralesionais de glicocorticoides e o uso de calcitonina, seja em lesões não agressivas ou agressivas. Adicionalmente, foram identificadas células expressando OC, que podem estar relacionadas ao reparo ósseo, acredita-se que essa linhagem celular também pode se tornar um alvo terapêutico.

L’existence de douleurs neuropathiques et/ou de perte de la sensibilité douloureuse sont souvent le reflet d’une neuropathie sensitive affectant plus particulièrement les fibres nerveuses sensitives amyélinique Aδ et C, dites neuropathie des petites fibres (NPF). Ces fibres innervent, notamment, le derme et l’épiderme de la peau. Elles communiquent la sensibilité thermique et algique au système nerveux central et contribuent à l’homéostasie cutanée, entre autres, par la libération de neuropeptides en périphérie. De nombreuses pathologies sont associées à une altération de ces petites fibres dans la peau. Deux pathologies impliquant une NPF ont été étudiées au cours de ce travail : les escarres et la maladie de Charcot-Marie-Tooth type 1A. Un travail expérimental a été réalisé chez la souris pour répondre à la question suivante ; est-ce qu’une seule atteinte des fibres nociceptives, responsables de la perte de sensibilité peut entraîner un déséquilibre de l’homéostasie cutanée, responsable de l’apparition des escarres ? La mise en place d’un modèle de neuropathie sensitive fonctionnelle réversible a permis de mettre en en évidence l’implication des neuropeptides, substance P (SP) et « calcitonin gene-related peptide » (CGRP), libérés par les fibres nerveuses cutanées, dans la formation d’ulcères de pression. Un traitement préventif à la rhEPO (Recombinant Human Erythropoietin) dans ce modèle associant une neuropathie et des plaies de pression, protège la peau contre une pression ischémiante induisant une escarre par son effet neuroprotecteur sur les petites fibres cutanées. L’association CMT1A et NPF a été étudiée à partir de biopsies cutanées humaines. La quantification des fibres intraépidermiques révèle que 48% des patients CMT1A sont atteints d’une NPF. L’analyse des biopsies cutanées révèle également une altération du nombre et de la morphologie de cellules de Langerhans dans la maladie de CMT1A. L'ensemble de ces résultats confirme l'intérêt de l'étude des petites fibres dans des pathologies variées et confirme le potentiel thérapeutique neuroprotecteur de l'EPO / The neuropathic pain and/or hypoalgesia often reflect a sensory neuropathy that affects particularly sensory, Aδ (thinly myelinated) and C (unmyelinated) nerve fibers. This kind of neuropathy is named "small fiber neuropathy" (SFN). These small fibers innervate the dermis and epidermis. C and Aδ free nerve endings respond to a variable range of stimuli including mechanical, thermal and pain stimuli. They conduct nociceptive signals to central nervous system and contribute to skin homeostasis, among others, by the release of neuropeptides in the periphery. Many diseases are associated with an alteration of these cutaneous small fibers. Two pathologies involving SFN were studied in this work: pressure ulcers and Charcot-Marie-Tooth disease Type 1A (CMT1A). Experimental studies on mice were performed to determine if impairment of nociceptive fibers could lead to an imbalance of skin homeostasis and could be involved in development of pressure ulcers, apart from its role in pain signal transduction. A functional reversible sensory neuropathy mouse model was set up and helped to demonstrate the involvement of the neuropeptides, substance P (SP) and "calcitonin gene-related peptide" (CGRP), released by cutaneous nerve fibers in the formation of pressure ulcers. By its neuroprotective effect on small nerve fibers, a preventive rhEPO (Recombinant Human Erythropoietin) treatment in this model protects the skin against an ischemic pressure-induced Stage 2 ulcer. The CMT1A and SFN association has been studied from human skin biopsies. Quantification of intraepidermal nerve fibers reveals that 48% of CMT1A patients have a SFN. The analysis of skin biopsies also revealed an alteration in the number and morphology of Langerhans cells in CMT1A disease. All these results confirm the interest of the study of small fibers in various pathologies and confirm the neuroprotective therapeutic potential of EPO.

<p>Therapeutic peptides have become a clinically and commercially important drug class providing novel treatment options in variety of disease areas. Today, more than 80 peptide drugs are marketed worldwide and hundreds more are in development. However, the development of peptide drugs can be hindered by their tendency to self-associate to form fibrils, an impurity that can affect potency and increase the potential for adverse immune responses in patients. Fibrillation of therapeutic peptides can present significant quality concerns and poses challenges for manufacturing and storage. From a pharmaceutical development perspective, early detection of instabilities can inform the development of mitigation strategies to minimize the risk of product failure and avoid costly delays in clinical development. A fundamental understanding of the mechanisms of fibrillation is critical for the rational design of fibrillation-resistant peptide drugs and formulations.</p> <p>The objective of this dissertation was to develop structurally modified fibrillation-resistant peptides based on a mechanistic understanding of the fibrillation process. The therapeutic peptides studied were human calcitonin (hCT), a glucagon/GLP-1 analog, and human insulin B-chain (INSB). Pulsed hydrogen-deuterium exchange mass spectrometry (HDX-MS) and other biophysical methods were used to provide mechanistic understanding of the intermolecular interactions and structural transitions during peptide fibrillation. Coupled with proteolytic digestion, pulsed HDX-MS of fibrillating peptides enabled identification of the residues involved in the early interactions leading to fibrillation based on their differential deuterium exchange rates. The high-resolution residue level information was used to make site-specific modifications to hCT, with phosphorylation in the central region resulting in complete inhibition of fibrillation for the phospho-Thr-13 hCT analog under the stress conditions employed. Reversible ‘prodrug’ modifications such as phosphorylation can aid the rational design of fibrillation-resistant therapeutic peptides. Furthermore, the effects of structural modifications on peptide fibrillation were evaluated by reducing the Cys1-Cys7 disulfide bond in hCT, and by C-terminal amidation or substitution with a helix-stabilizing residue (α-aminoisobutyric acid, Aib) in the glucagon/GLP-1 analog peptide. Finally, studies of insulin B-chain probed fibrillation mechanisms of this therapeutically important peptide, contributing to our understanding of the mechanisms of insulin fibrillation with the broad goal of developing fibrillation-resistant, rapid-acting, monomeric insulin analogs. Overall, the results demonstrate that small structural changes can have significant effects on peptide fibrillation, that pulsed HDX-MS can be used to probe these effects, and that an understanding of these effects can inform the rational development of fibrillation-resistant peptide drugs. </p>

Les récepteurs couplés aux protéines G (RCPGs) constituent la plus grande classe de récepteurs membranaires impliqués dans la transmission des signaux extracellulaires. Traditionnellement, la transmission de la signalisation par les RCPGs implique l’activation d’une protéine G hétéro-trimérique qui pourra à son tour moduler l’activité de divers effecteurs intracellulaires. Ce schéma classique de signalisation s’est complexifié au fils des années et l’on sait maintenant qu’en plus d’interagir avec les protéines G, les RCPGs s’associent avec une panoplie d’autres protéines afin de transmettre adéquatement les signaux extracellulaires. En particulier, la découverte d’une famille de protéines transmembranaires modulant la fonction des RCPGs, baptisées protéines modifiant l’activité des récepteurs (« receptor activity-modifying proteins » ; RAMPs), a changé la façon de concevoir la signalisation par certains RCPGs. Dans le cas du récepteur similaire au récepteur de la calcitonine (« calcitonin-like receptor » ; CLR), l’association avec les RAMPs permet l’acheminement à la surface cellulaire du récepteur tout en modulant ses propriétés pharmacologiques. Lorsqu’il est associé avec RAMP1, le CLR fonctionne comme un récepteur du peptide relié au gène de la calcitonine (« calcitonin gene-related peptide » ; CGRP), alors qu’il devient un récepteur de l’adrénomedulline lorsqu’il interagit avec RAMP2 ou RAMP3. D’autre part, en plus d’interagir avec des protéines accessoires transmembranaires telles les RAMPs, les RCPGs peuvent aussi s’associer entre eux pour former des oligomères de récepteurs. Dans cette thèse, nous nous sommes penchés sur les interactions entre les RCPGs et les RAMPs, et plus particulièrement sur l’interrelation entre ce type d’association RCPG/RAMP et l’assemblage en oligomères de récepteurs, en utilisant le récepteur du CGRP comme modèle d’étude. Une première étude nous a tout d’abord permis de confirmer l’interaction entre le récepteur CLR et RAMP1, dans un contexte de cellules vivantes. Nous avons démontré que ce complexe CLR/RAMP1 active la protéine G et recrute la protéine de signalisation -arrestine suite à une stimulation par le CGRP. Ensuite, nous avons déterminé que même s’il doit obligatoirement former un hétéro-oligomère avec les RAMPs pour être actif, le CLR conserve malgré tout sa capacité à interagir avec d’autres RCPGs. En plus d’observer la présence d’homo-oligomère de CLR, nous avons constaté que tout comme les RCPGs, les RAMPs peuvent eux-aussi s’associer entre eux pour former des complexes oligomériques pouvant comprendre différents sous-types (RAMP1/RAMP2 et RAMP1/RAMP3). Cette observation de la présence d’homo-oligomères de CLR et de RAMP1, nous a amené à nous questionner sur la stœchiométrie d’interaction du complexe CLR/RAMP1. Dans une deuxième étude ayant pour but d’établir la composition moléculaire du récepteur CGRP1 in vivo, nous avons développé une nouvelle approche permettant l’étude de l’interaction entre trois protéines dans un contexte de cellules vivantes. Cette technique baptisée BRET/BiFC, est basée sur le transfert d’énergie de résonance de bioluminescence entre un donneur luminescent, la Renilla luciférase, et un accepteur fluorescent, la protéine fluorescente jaune (YFP), reconstituée suite au ré-assemblage de ces deux fragments. En utilisant cette approche, nous avons pu déterminer que le récepteur CGRP1 est constitué d’un homo-oligomère de CLR interagissant avec un monomère de RAMP1. En démontrant un assemblage oligomérique asymétrique pour le récepteur CGRP1 à partir d’une nouvelle approche biophysique, nous croyons que les travaux présentés dans cette thèse ont contribué à élargir nos connaissances sur le fonctionnement de la grande famille des RCPGs, et seront utile à la poursuite des recherches sur les complexes protéiques impliqués dans la signalisation. / G protein coupled receptors (GPCRs) constitute the largest family of membrane receptors involved in signal transduction. Traditionally, signal transduction by GPCRs involves the activation of a hetero-trimeric G protein which will then modulate the activity of several intracellular effectors. We can now appreciate the fact that in addition to their interaction with G proteins, GPCRs also associate with several other proteins, in order to allow proper signal transduction. In particular, the discovery of a family of proteins called receptor activity-modifying proteins (RAMPs) has challenged the traditional views of signal transduction by some GPCRs. In the case of the calcitonin-like receptor (CLR), the association with RAMPs allows the proper cell surface targeting of the receptor in addition to modulate it’s pharmacological properties. Co-expression of CLR with RAMP1 leads to a calcitonin gene-related peptide (CGRP) receptor, whereas CLR association with RAMP2 or RAMP3 promotes the formation of an adrenomedullin receptor. In addition to their interaction with transmembrane accessory proteins such as RAMPs, GPCRs can also interact with other receptors to form receptors oligomers. In this thesis, we were interested in the interactions between GPCRs and RAMPs, and particularly, in the link between these GPCR/RAMP interactions and the assembly of receptor oligomers, using CGRP1 receptor as a model. We first confirmed the interaction between CLR and RAMP1 in living cells. We showed that this CLR/RAMP1 complex activates G proteins and recruits the signalling protein -arrestin upon CGRP stimulation. Next, we demonstrated that even if the CLR requires hetero-oligomeric assembly with RAMPs in order to be active, this receptor can still interact with other GPCRs. In addition to CLR homo-oligomers, we observed that RAMPs can also self-associate to form oligomeric complexes which can involve different subtypes (RAMP1/RAMP2 and RAMP1/RAMP3). This observation of the presence of CLR and RAMP1 homo-oligomers raised the question of the stoiechiometry of interaction of the CLR/RAMP1 complex. In order to establish the molecular composition of the CGRP1 receptor in vivo, we developed a novel approach allowing the detection of the interaction between three proteins in living cells. This method called BRET/BiFC is based on the bioluminescence resonance energy transfer between a luminescent energy donor, Renilla luciferase, and a fluorescent energy acceptor, the yellow fluorescent protein (YFP), reconstituted after the re-association of its two fragments. Using this approach, we showed that the CGRP1 receptor consist of a homo-oligomer of CLR interacting with a monomer of RAMP1. By demonstrating the asymmetrical organization of the CGRP1 receptor complex using a novel biophysical approach, we believe that the results presented herein have contributed to increase our knowledge of the mechanisms of function of the large family of GPCRs and will be useful for the pursuit of research on protein complexes involved in signalling pathways.

Die bakterielle Meningitis (BM) ist trotz antibiotischer Therapie eine Erkrankung mit einer hohen Mortalität und Morbidität. Kopfschmerzen und Meningismus sind Hauptsymtome und ein klinischer Hinweis für die Aktivierung trigeminaler Fasern. Ziel dieser Arbeit war es zu prüfen ob die freigesetzten Neuropeptide einen proinflammatorischen Effekt auf zerebrale Endothelzellen, einen wesentlichem Bestandteil der Blut-Hirn-Schranke haben. Wir verwendeten primär kultivierte zerebrale Kapillarendothelzellen (BMEC) der Ratte und als Stimulus Neuropeptide und/oder Pneumokokkenzellwände (PCW). Beide Neuropeptide, CGRP mehr als SP, verstärken den Effekt von PCW auf die mRNA Expression und Freisetzung von TNF-alpha, IL-1beta, IL-6, IL-10 und MIP-2 aus den BMEC. CGRP und SP haben nur eine geringe Wirkung. PCW regulieren die Dichte der CRLR (CGRP1-R) bzw. NK-1 Rezeptoren und erklären damit die kostimulatorische Wirkung. Zudem untersuchten wir den Effekt von PCW und/oder CGRP auf die Adrenomedullin (AM)- Synthese. AM ist ein vasodilatorisch wirkendes Peptid, dass vorwiegend in Endothelzellen konstitutiv gebildet wird und am CRLR Rezeptor wirkt. PCW und CGRP verstärken die Synthese von AM. Mit dieser Arbeit konnte gezeigt werden, dass PCW zur Hochregulation von Neuropeptidrezeptoren führt und CGRP und SP über diese Rezeptoren einen modulatorischen Effekt auf die Zytokinproduktion in BMEC haben. Ein genaues Verständnis dieser Interaktionen könnte die Entwicklung immunmodulatorischer Interventionen und damit eine Verbesserung der Prognose der bakteriellen Meningitis bewirken. / Despite antibiotic treatment bacterial meningitis is still associated with a high mortality and morbidity. Headache and meningismus as key symptoms, provide clear evidence for the activation of trigeminal nerve fibers. Aim of the study was to test whether the released neuropeptides have a proinflammatory effect in cerebral endothelial cells the major compartment of the blood brain barrier. We used primary brain microvascular endothelial cells of the rat (BMEC) which were stimulated with CGRP, SP and/or pneumococcal cell walls (PCW). Both neuropeptides CGRP more than SP enhanced PCW-induced mRNA expression and the release of TNF-alpha, IL-1-beta, IL-6, IL-10 and MIP-2. Neuropeptides alone were not able to induce these cytokines. PCW upregulate the density of CRLR receptor and regulate the NK-1 receptor and therefore may explain the costimulatory effect. Furthermore the effect of PCW and/or CGRP on adrenomedullin synthesis in BMEC was investigated. Adrenomedullin is a vasodilatatory peptide, which is constitutivly produced by endothelial cells and act on the CRLR receptor. PCW as well as CGRP enhance the synthesis of AM. Our data suggest that PCW upregulate neuropeptide receptors and modulate via these specific receptors the cytokine production. A detailed understanding of these interactions may open new immunmodulatory interventions and therefore may contribute to a better prognosis of bacterial meningitis.

Wong Cheuk Ying. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 101-124). / Abstracts in English and Chinese. / Abstract --- p.i / 摘要 --- p.iv / Acknowledgement --- p.vi / List of Abbreviations --- p.vii / Chapter Chapter 1. --- General Introduction --- p.1 / Chapter Chapter 2. --- Methods --- p.4 / Chapter 2.1 --- Measurement of cAMP and cGMP in VSMCs --- p.4 / Chapter 2.1.1 --- Cell culture --- p.4 / Chapter 2.1.2 --- Enzyme-immunoassay colorimetric measurement for cAMP and cGMP --- p.5 / Chapter 2.1.3 --- Statistical analysis --- p.6 / Chapter 2.2 --- Measurement of apoptosis in VSMCs and bone marrow-derived stem cells --- p.6 / Chapter 2.2.1 --- Cell culture --- p.6 / Chapter 2.2.2 --- Hoechst33258 --- p.7 / Chapter 2.2.3 --- Cell Death ELISA plus --- p.7 / Chapter 2.2.4 --- Protein extraction and Western blot analysis of PKG expression --- p.8 / Chapter 2.2.5 --- Statistical analysis --- p.9 / Chapter 2.3 --- Measurement of cell proliferation in VSMCs and bone marrow-derived stem cells --- p.9 / Chapter 2.3.1 --- Cell culture --- p.9 / Chapter 2.3.2 --- Cell count --- p.10 / Chapter 2.3.3 --- MTT assay --- p.11 / Chapter 2.3.4 --- BrdU-(5`Bromo-2-deoxyuridine) ELISA colorimetric assay --- p.11 / Chapter 2.3.5 --- Statistical analysis --- p.12 / Chapter Chapter 3. --- Effects of hyperglycemia on CGRP-induced cAMP response in VSMCs / Chapter 3.1 --- Introduction --- p.13 / Chapter 3.2 --- Results --- p.18 / Chapter 3.3 --- Discussion --- p.22 / Chapter Chapter 4. --- Role of cGMP and protein kinase G in regulation of apoptosis in VSMCs / Chapter 4.1 --- Introduction --- p.26 / Chapter 4.2 --- Results --- p.30 / Chapter 4.3 --- Discussion --- p.44 / Chapter Chapter 5. --- Role of protein kinase G in regulation of proliferation in VSMCs / Chapter 5.1 --- Introduction --- p.55 / Chapter 5.2 --- Results --- p.58 / Chapter 5.3 --- Discussion --- p.67 / Chapter Chapter 6. --- Effects of aging and eNOS- and iNOS-gene deletion (using eNOS- and iNOS-knockout mice) on apoptosis of VSMCs / Chapter 6.1 --- Introduction --- p.73 / Chapter 6.2 --- Results --- p.76 / Chapter 6.3 --- Discussion --- p.79 / Chapter Chapter 7. --- Role of protein kinase G in regulation of apoptosis and proliferation of bone marrow stromal stem cells / Chapter 7.1 --- Introduction --- p.81 / Chapter 7.2 --- Results --- p.84 / Chapter 7.3 --- Discussion --- p.92 / Chapter Chapter 8. --- Overall discussion --- p.95 / Chapter Chapter 9. --- References --- p.101

Les récepteurs couplés aux protéines G (RCPGs) constituent la plus grande classe de récepteurs membranaires impliqués dans la transmission des signaux extracellulaires. Traditionnellement, la transmission de la signalisation par les RCPGs implique l’activation d’une protéine G hétéro-trimérique qui pourra à son tour moduler l’activité de divers effecteurs intracellulaires. Ce schéma classique de signalisation s’est complexifié au fils des années et l’on sait maintenant qu’en plus d’interagir avec les protéines G, les RCPGs s’associent avec une panoplie d’autres protéines afin de transmettre adéquatement les signaux extracellulaires. En particulier, la découverte d’une famille de protéines transmembranaires modulant la fonction des RCPGs, baptisées protéines modifiant l’activité des récepteurs (« receptor activity-modifying proteins » ; RAMPs), a changé la façon de concevoir la signalisation par certains RCPGs. Dans le cas du récepteur similaire au récepteur de la calcitonine (« calcitonin-like receptor » ; CLR), l’association avec les RAMPs permet l’acheminement à la surface cellulaire du récepteur tout en modulant ses propriétés pharmacologiques. Lorsqu’il est associé avec RAMP1, le CLR fonctionne comme un récepteur du peptide relié au gène de la calcitonine (« calcitonin gene-related peptide » ; CGRP), alors qu’il devient un récepteur de l’adrénomedulline lorsqu’il interagit avec RAMP2 ou RAMP3. D’autre part, en plus d’interagir avec des protéines accessoires transmembranaires telles les RAMPs, les RCPGs peuvent aussi s’associer entre eux pour former des oligomères de récepteurs. Dans cette thèse, nous nous sommes penchés sur les interactions entre les RCPGs et les RAMPs, et plus particulièrement sur l’interrelation entre ce type d’association RCPG/RAMP et l’assemblage en oligomères de récepteurs, en utilisant le récepteur du CGRP comme modèle d’étude. Une première étude nous a tout d’abord permis de confirmer l’interaction entre le récepteur CLR et RAMP1, dans un contexte de cellules vivantes. Nous avons démontré que ce complexe CLR/RAMP1 active la protéine G et recrute la protéine de signalisation -arrestine suite à une stimulation par le CGRP. Ensuite, nous avons déterminé que même s’il doit obligatoirement former un hétéro-oligomère avec les RAMPs pour être actif, le CLR conserve malgré tout sa capacité à interagir avec d’autres RCPGs. En plus d’observer la présence d’homo-oligomère de CLR, nous avons constaté que tout comme les RCPGs, les RAMPs peuvent eux-aussi s’associer entre eux pour former des complexes oligomériques pouvant comprendre différents sous-types (RAMP1/RAMP2 et RAMP1/RAMP3). Cette observation de la présence d’homo-oligomères de CLR et de RAMP1, nous a amené à nous questionner sur la stœchiométrie d’interaction du complexe CLR/RAMP1. Dans une deuxième étude ayant pour but d’établir la composition moléculaire du récepteur CGRP1 in vivo, nous avons développé une nouvelle approche permettant l’étude de l’interaction entre trois protéines dans un contexte de cellules vivantes. Cette technique baptisée BRET/BiFC, est basée sur le transfert d’énergie de résonance de bioluminescence entre un donneur luminescent, la Renilla luciférase, et un accepteur fluorescent, la protéine fluorescente jaune (YFP), reconstituée suite au ré-assemblage de ces deux fragments. En utilisant cette approche, nous avons pu déterminer que le récepteur CGRP1 est constitué d’un homo-oligomère de CLR interagissant avec un monomère de RAMP1. En démontrant un assemblage oligomérique asymétrique pour le récepteur CGRP1 à partir d’une nouvelle approche biophysique, nous croyons que les travaux présentés dans cette thèse ont contribué à élargir nos connaissances sur le fonctionnement de la grande famille des RCPGs, et seront utile à la poursuite des recherches sur les complexes protéiques impliqués dans la signalisation. / G protein coupled receptors (GPCRs) constitute the largest family of membrane receptors involved in signal transduction. Traditionally, signal transduction by GPCRs involves the activation of a hetero-trimeric G protein which will then modulate the activity of several intracellular effectors. We can now appreciate the fact that in addition to their interaction with G proteins, GPCRs also associate with several other proteins, in order to allow proper signal transduction. In particular, the discovery of a family of proteins called receptor activity-modifying proteins (RAMPs) has challenged the traditional views of signal transduction by some GPCRs. In the case of the calcitonin-like receptor (CLR), the association with RAMPs allows the proper cell surface targeting of the receptor in addition to modulate it’s pharmacological properties. Co-expression of CLR with RAMP1 leads to a calcitonin gene-related peptide (CGRP) receptor, whereas CLR association with RAMP2 or RAMP3 promotes the formation of an adrenomedullin receptor. In addition to their interaction with transmembrane accessory proteins such as RAMPs, GPCRs can also interact with other receptors to form receptors oligomers. In this thesis, we were interested in the interactions between GPCRs and RAMPs, and particularly, in the link between these GPCR/RAMP interactions and the assembly of receptor oligomers, using CGRP1 receptor as a model. We first confirmed the interaction between CLR and RAMP1 in living cells. We showed that this CLR/RAMP1 complex activates G proteins and recruits the signalling protein -arrestin upon CGRP stimulation. Next, we demonstrated that even if the CLR requires hetero-oligomeric assembly with RAMPs in order to be active, this receptor can still interact with other GPCRs. In addition to CLR homo-oligomers, we observed that RAMPs can also self-associate to form oligomeric complexes which can involve different subtypes (RAMP1/RAMP2 and RAMP1/RAMP3). This observation of the presence of CLR and RAMP1 homo-oligomers raised the question of the stoiechiometry of interaction of the CLR/RAMP1 complex. In order to establish the molecular composition of the CGRP1 receptor in vivo, we developed a novel approach allowing the detection of the interaction between three proteins in living cells. This method called BRET/BiFC is based on the bioluminescence resonance energy transfer between a luminescent energy donor, Renilla luciferase, and a fluorescent energy acceptor, the yellow fluorescent protein (YFP), reconstituted after the re-association of its two fragments. Using this approach, we showed that the CGRP1 receptor consist of a homo-oligomer of CLR interacting with a monomer of RAMP1. By demonstrating the asymmetrical organization of the CGRP1 receptor complex using a novel biophysical approach, we believe that the results presented herein have contributed to increase our knowledge of the mechanisms of function of the large family of GPCRs and will be useful for the pursuit of research on protein complexes involved in signalling pathways.

<p>UVOD: Kolorektalna anastomoza koja se formira u dubini karlice radi uspostavljanja kontinuiteta gastrointestinalnog trakta nakon resekcije dijela crijeva ima svoje specifičnosti u toku formiranja, zarastanja, kao i kada se jave komplikacije. Na sam proces zarastanja kolorektalnih anastomoza utiču sistemski, lokalni i tehnički faktori. Bilo kakav kompromis po pitanju ovih principa nosi povećan rizik od komplikacija! Najteža komplikacija na anastomozi je dehiscencija. &bdquo;Samo neučinjena anastomoza neće dehiscirati&ldquo;. Ova stara hirur&scaron;ka poslovica je važeća i danas, a &scaron;to je anastomoza distalnija, mogućnost dehiscencije je veća, posebno kod niskih subperitonealnih anastomoza sa rektumom ili anusom. Učestalost dehiscencija ovih anastomoza u literaturi varira od 0,5 - 69 %, &scaron;to može ukazivati na kvalitet hirur&scaron;kog rada, kori&scaron;ćenje definicije dehiscencije, način dijagnostike, itd. Međunarodna grupa za karcinom rektuma definisala je dehiscenciju anastomoze kao defekt crijevnog zida, uključujući &scaron;avnu ili staplersku liniju neorektalnog rezervoara, &scaron;to dovodi do komunikacije između intra i ekstra luminalnog prostora. CILJEVI: Osnovni cilj ove studije je bio da se utvrde preoperativni i perioperativni faktori rizika značajni za nastanak dehiscencija kolorektalnih anastomoza, kao i značaj prokalcitonina i C-reaktivnog proteina u detekciji dehiscencija kolorektalnih anastomoza u subkliničkoj fazi bolesti. MATERIJAL I METODOLOGIJA: Istraživanjem je obuhvaćeno 100 pacijenata operisanih u elektivnom programu, kod kojih je urađena radikalna operacija karcinoma rektuma uz kreiranje dvostruke staplerske kolorektalne anastomoze. Svi pacijenti uključeni u istraživanje, odabrani metodom slučajnog izbora, bili su podijeljeni u dvije grupe. Grupa A: pacijenti kod kojih je urađena radikalna operacija karcinoma rektuma i kreirana primarna staplerska kolorektalna anastomoza. Grupa B: pacijenti kod kojih je urađena radikalna operacija karcinoma rektuma Hartmanovom procedurom u prvom aktu, a rekonstrukcija kontinuiteta gastrointestinalnog trakta uspostavljena u drugom aktu kreiranjem sekundarne staplerske kolorektalne anastomoze. Primjenom statističkih testova analizirani su preoperativni (pol, godine života, komorbiditeti, ASA skor, indeks tjelesne mase preoperativna primjena hemoradioterapije, laboratorijske analize) i perioperativni (vrijeme trajanja operacije, udaljenost anastomoze od anokutane linije, veličina tumora u cm, intraoperativna primjena krvi) faktori rizika za nastanak dehiscencije anastomoze kod obje grupe. Kod svih pacijenata drugog i četvrtog postoperativnog dana kontrolisane su vrijednosti C reaktivnog proteina i prokalcitonina u serumu, bez obzira da li su postojali ili ne klinički manifestni znaci dehiscencije anastomoze. Takođe, primjenom ROC krive analizirana je senzitivnost, specifičnost i dijagnostička tačnost C reaktivnog proteina i prokalcitonina drugog i četvrtog postoperativnog dana u detekciji dehiscencije kolorektalne anastomoze. REZULTATI: Nema statistički značajne razlike u pojavi dehiscencije anastomoze između primarnih i sekundarnih dvostrukih staplerskih anastomoza. Incidencija dehiscencija anastomoza je bila 11% u ukupnom uzorku. Osam pacijenata je reoperisano, dok su tri pacijenta tretirana konzervativno. Kod tri pacijenta, kod kojih je nastala dehiscencija i koji su reoperisani, zbog posljedice sepse i septičnog &scaron;oka nastupio je smrtni ishod. Pol, godine života, komorbiditeti, stadijum bolesti, dužina trajanja operacije, intraoperativna primjena krvi, nisu statistički značajni faktori rizika (p&gt;0,05) za nastanak dehiscencije primarnih i sekundarnih dvostrukih staplerskih kolorektalnih anastomoza. Udaljenost anastomoze od anokutane linije (&lt;7cm), veličina tumora preko 5 cm su statistički značajni faktori rizika za nastanak dehiscencije anastomoze. Postoji visoko statistički značajna razlika (p&lt;0,001) vrijednosti CRP-a i PCT-a četvrtog postoperativnog dana kod bolesnika sa i bez prisutne dehiscenecije kolorektalne anastomoze. Na osnovu ROC analize CRP&ndash;a za četvrti postoperativni dan, za graničnu vrijednost od 130 mg/l senzitivnost iznosi 82%, specifičnost 96% i dijagnostička tačnost 94%. Za graničnu vrijednost PCT-a od 0,78 ng/ml za četvrti postoperativni dan primjenom ROC krive utvrđena je sezitivnost 91%, specifičnost 92%, dok je dijagnostička tačnost bila 86%. Četvrti postoperativni dan CRP ima veću dijagnostičku tačnost i specifičnost u detekciji dehiscencije kolorektalne anastomoze u odnosu na PCT. ZAKLJUČAK: I pored velikog tehnolo&scaron;kog napretka, usavr&scaron;avanja hirur&scaron;kih tehnika, boljeg razumijevanja prirode maligne bolesti, unapređivanja intraoperativnog i postoperativnog kontinuiranog praćenja bolesnika, uvođenja novih antimikrobnih lijekova, problem u liječenju i pojava dehiscencija kolorektalnih anastomoza su i dalje značajno prisutni. Otkrivanjem dehiscencija kolorektalnih anastomoza u subkliničkoj fazi, identifikovanje preoperativnih i perioperativnih faktora rizika značajnih za nastanak dehiscencija, omogućilo bi da se dehiscencija ranije uoči i efikasnije rije&scaron;i.</p> / <p>INTRODUCTION: Colorectal anastomosis, which is formed deep in the pelvis because of establishment of continuity of gastrointestinal tract after resection of the part of intestines, has got its specifities during forming and healing process and when complications occur. Systemic, local and technical factors influence the healing process of anastomosis itself. Any kind of compromise in terms of these principles causes higher risk of complications! The most serious complication of anastomosis is dehiscence. &ldquo;Only anastomosis which is not carried out will not dehisce.&rdquo; This old surgical saying is still true, and the more distal anastomosis is, the possibility of development of dehiscence is higher, especially in lower subperitoneal anastomosis with rectum and anus. Incidence of dehiscence of these anastomosis in literature varies from 0,5 to 69 %, which may indicate the quality of surgical work, use of definition of dehiscence, kind of diagnostics etc. International group for rectal cancer defined dehiscence of anastomosis as a defect of intestinal wall, including suturing or stapler line of neorectal reservoir, which leads to communication between intra and extra luminal space. AIMS: Basic aim of this study was to determine preoperative and postoperative risk factors significant for the development of dehiscence of colorectal anastomosis, as well as significance of procalcitonin and C-reactive protein in detection of dehiscence of colorectal anastomosis at the subclinical stage of the disease. MATERIAL AND METHODOLOGY: The study included 100 patients operated on in the elective programme, on which radical operation of the rectal cancer was carried out with creation of double stapler colorectal anastomosis. All patients included in the study were randomly chosen and divided into two groups. Group A: the patients on which radical operation of the rectal cancer was carried out and primary stapler colorectal anastomosis created. Group B: the patients on which radical operation of the rectal cancer was carried out using Hartman&#39;s procedure in the first act, and reconstruction of the continuity of gastrointestinal tract was established in the second act by creation of secondary stapler colorectal anastomosis. By application of statistical tests preoperative (sex, age, comorbidities, ASA score, body mass index, preoperative application of haemoradiotherapy, laboratory analyses) and perioperative (duration of operation, distance of anastomosis from anocutaneous line, size of tumor in cm, intraoperative application of blood) risk factors for development of dehiscence of anastomosis in both groups were analysed. In all patients on the second and fourth postoperative day values of C-reactive protein and procalcitonin in the serum were analysed, regardless of the existence of clinically or non-clinically manifested signs of dehiscence of anastomosis. Also, sensitivity, specifity and diagnostically accurate C-reactive protein and procalcitonin on the second and fourth postoperative day in detection of dehiscence of colorectal anastomosis were analysed by application of ROC curve. RESULTS: There is no statistically significant difference in the development of dehiscence of anastomosis between primary and secondary double stapler anastomosis. Incidence of dehiscence of anastomosis was 11% in all samples. Eight patients were reoperated on, whereas three patients were treated conservatively. In three patients who developed dehiscence and were reoperated on, the death occurred due to sepsis and septic shock. Sex, age, comorbidities, stage of the disease, duration of operation, intraoperative application of blood were not statistically significant risk factors (p&gt;0,05) for the development of dehiscence of primary and secondary double stapler colorectal anastomosis. Distance of anastomosis from anocutaneous line (&lt;7cm), size of tumor over 5 cm were statistically significant risk factors for the development of dehiscence of anastomosis. There is highly statistically significant difference (p&lt;0,001) values of CRP and PCT on the fourth postoperative day in patients with and without dehiscence of colorectal anastomosis. On the basis of ROC analysis of CRP for the fourth postoperative day, for the bordering value of 130 mg/l sensitivity is 82%, specificity 96% and diagnostic accuracy 94%. For bordering value of PCT of 0,78 ng/ml for the fourth postoperative day, by application of ROC curve, the following values were determined: sensitivity 91%, specificity 92% and diagnostic accuracy 86%. CRP for the fourth postoperative day has got higher diagnostic accuracy and specificity in detection of dehiscence of colorectal anastomosis in relation to PCT. CONCLUSION: In spite of huge technological advance, improvement of surgical techniques, better understanding of the nature of malignant diseases, improvement of intraoperative and postoperative continuous follow up of the patient, introduction of new antimicrobial medicines, the problem in treating and development of dehiscence of colorectal anastomosis is still significantly present. Detection of dehiscence of colorectal anastomosis at the subclinical stage, identification of preoperative and perioperative risk factors significant for the development of dehiscence would help in early detection of dehiscence and contribute to more effective operations.</p>