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京都大学 / 新制・課程博士 / 博士(医学) / 甲第23809号 / 医博第4855号 / 新制||医||1058(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 渡邊 直樹, 教授 浅野 雅秀, 教授 安達 泰治 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Myocardial infarction (MI) leads to heart failure (HF) and premature death. The respective roles of myocyte death and depressed myocyte contractility in the induction of HF after MI have not been clearly defined. Cardiac ryanodine receptor (RyR2) has been linked to cardiac arrhythmias and HF. It has been controversial that protein kinase A (PKA) hyperphosphorylation of the RyR2 at a single residue, Ser-2808 is a critical mediator of progressive cardiac dysfunction after MI. We developed two mouse models. In one model with beta2a (LTCC subunit) overexpression we could prevent depressed myocyte contractility after MI and use it to test the idea that preventing depression of myocyte Ca2+ handling defects could avert post MI cardiac pump dysfunction. In the other model, mice with Ser2808 in RyR2 replaced by alanine (S2808A) to prevent the phosphorylation at this site were used to determine whether loss of functional PKA phosphorylation site at Ser2808 could protect against cardiac dysfunction progression after MI. beta2a myocytes had increased Ca2+ current; contraction and Ca2+ transients (versus controls) and beta2a hearts had increased performance before MI. After MI, ventricular dilation, myocyte hypertrophy, and depressed cardiac pump function was greater in beta2a versus control hearts. There was also an increased rate of myocyte death in beta2a hearts after MI and survival was significantly reduced in these animals. We concluded that maintaining myocyte contractility after MI, by increasing Ca2+ influx, depresses rather than improves cardiac pump function. Baseline cardiac function was similar in wild type (WT) and RyR-S2808A mice before MI. After MI, there was no significant difference between WT and RyR-S2808A mice in EF and FS at 4 weeks. ICa-L € in WT and RyR-S2808A myocytes was not significantly different. There were significant ISO responses in all myocytes, and no appreciable differences in responsiveness were found. Contractions and Ca2+ transients were not significantly different in WT and RyR-S2808A myocytes after MI. In conclusion, preventing PKA phosphorylation of RyR at Ser2808 after MI does not protect the heart or its myocytes. The role of RyR phosphorylation at other sites on abnormal Ca2+ handling in diseased hearts is yet to be defined. / Physiology

Obesity is strongly associated with hypertension and cardiovascular diseases. An activated renin-angiotensin system (RAS) has long been suggested as a critical contributor to elevated blood pressure with obesity. Angiotensin II (AngII), the main effector of an activated RAS, can be catabolized by angiotensin-converting enzyme 2 (ACE2) to form angiotensin-(1-7) (Ang-(1-7)), which, acting through the mas receptor (MasR), has been shown to oppose the effects of an activated RAS. Therefore, further understanding of the mechanisms of this counter-regulatory arm, called the ACE2/Ang-(1-7)/MasR axis, may lead to new therapies for obesity-induced hypertension. Previously, we demonstrated that differences in the regulation of ACE2 in a tissue-specific manner contribute to sexual dimorphism of diet-induced obesity-hypertension in mice. Whereas male mice fed a high fat (HF) diet developed hypertension, HF-fed female mice were protected from obesity-hypertension, and this was associated with increased activity of ACE2 in adipose tissue of females. Both upregulation of adipose ACE2 and protection against obesity-hypertension were lost when females were ovariectomized (OVX). We hypothesized that estrogen-mediated increases in adipose ACE2 reduce the AngII/Ang-(1-7) peptide balance and protect females from obesity-hypertension. To test this hypothesis, we first determined if estrogen restores protection of Ovx female mice from obesity-hypertension, and therapeutically protects male mice from obesity-hypertension. We demonstrated that estrogen administration to Ovx HF-fed females activates adipose ACE2, reduces plasma Ang II concentrations, and decreases blood pressure in wildtype, but not of ACE2-deficient obese females. In contrast, estrogen administration to HF-fed male mice had no on the development of obesity-hypertension, regardless of genotype. These results demonstrate that estrogen protects female mice from obesity-hypertension through an ACE2-dependent mechanism. Next we defined the role of MasR deficiency on the development of obesity-hypertension in male and female mice. In HF-fed MasR-deficient female mice, diastolic blood pressure (DBP) was significantly elevated compared to LF-fed controls, suggesting that protection from obesity-hypertension was abolished by MasR deficiency. In contrast, HF-fed male mice with MasR deficiency exhibited reduced blood pressure compared to wildtype controls which was associated with reduced cardiac function. Overall, these studies indicate that the ACE2/Ang-(1-7)/MasR axis plays an important role in sexual dimorphism of obesity-hypertension, and in the regulation of cardiac function. Moreover, these studies suggest that the effects of this counter-regulatory arm of the RAS may be sex-specific.

INTRODUÇÃO: A encefalopatia hipóxico-isquêmica (EHI) corresponde a uma das maiores causas de morbidade e mortalidade neonatal. Ocorre em consequência à asfixia perinatal aguda, representada por baixo escore de Apgar e evidências de distúrbios neurológicos ao nascimento. A hipotermia terapêutica (HT) tem mostrado benefícios relevantes no prognóstico neurológico a longo prazo, por reduzir o metabolismo cerebral, retardando o início da despolarização hipóxica celular. Os efeitos da HT no sistema cardiovascular foram pouco estudados, suscitando questionamentos quanto à adequada interpretação dos achados ecocardiográficos nesta condição terapêutica. OBJETIVO: avaliar o comportamento hemodinâmico e da função ventricular de recém-nascidos com EHI na vigência de HT, utilizando-se técnicas ecocardiográficas convencionais e avançadas. MÉTODO: trata-se de um estudo observacional desenvolvido em três instituições, em que 22 recém-nascidos com EHI foram avaliados por meio da ecocardiografia nas duas fases da HT (durante a hipotermia e após o reaquecimento). O grupo controle foi composto por 22 recém-nascidos saudáveis. Os bebês foram submetidos a HT seguindo critérios do protocolo de hipotermia de cada um dos serviços. RESULTADOS: Função ventricular esquerda: as frações de ejeção (FE) e de encurtamento foram maiores após o reaquecimento (74 ± 5% e 41 ± 5% respectivamente) em relação ao grupo controle (70 ± 5%, p = 0,003 e 37 ± 4%, p = 0,002). O índice de performance miocárdica (IPM) do ventrículo esquerdo (VE) avaliado pelo Doppler pulsado se manteve constante nas duas fases da HT (0,51 ± 0,13, hipotermia = reaquecimento) e foi menor na comparação destas com o grupo controle (0,63 ± 0,18, p = 0,02). Os valores do strain circunferencial e radial, do twist, da torção e do strain longitudinal global do VE (STLGLVE) foram semelhantes entre o grupo controle e o grupo estudo, tanto durante a hipotermia quanto após o reaquecimento. Função ventricular direita: Observou-se incremento da velocidade da onda s´ do ventrículo direito (VD) após o reaquecimento (de 0,07 ± 0,02 m/s durante a hipotermia para 0,09 ± 0,01 m/s, p < 0,001), sendo esta também mais elevada quando comparada aos valores do grupo controle (0,07 ± 0,01 m/s, p < 0,001). Houve queda dos valores da variação fracional das áreas (FAC) do VD após o reaquecimento (38 ± 11% durante a hipotermia, 36 ± 11% após o reaquecimento e 43 ± 10% grupo controle), com diferenças significativas entre esses dois últimos (p = 0,03). Quanto ao IPM do VD, o grupo controle apresentou médias menores (0,29 ± 0,13) que o grupo caso durante a hipotermia (0,46 ± 0,33, p = 0,03). O strain longitudinal global do VD (STLGLVD) foi significativamente pior tanto durante a hipotermia (-18 ± -5%, p = 0,02) quanto após o reaquecimento (-18 ± 4%, p = 0,01) quando comparados ao grupo controle (-21 ± 2%). Parâmetros hemodinâmicos: A pressão sistólica na artéria pulmonar foi mais elevada no grupo estudo durante as duas fases do tratamento (hipotermia 45 ± 24 mmHg, p = 0,02 e reaquecimento 53 ± 34 mmHg, p = 0,01 versus grupo controle 29 ± 11 mmHg). A FC foi significativamente mais baixa durante a hipotermia comparada ao período após o reaquecimento (FC 111 ± 19 bpm versus 144 ± 20 bpm, p < 0,001) e ao grupo controle (FC 130 ± 16 bpm, p < 0,001). Durante o reaquecimento, observou-se elevação do débito cardíaco (DC) esquerdo e direito em relação ao período de hipotermia (DC esquerdo 214 ± 39 ml/kg/min versus 155 ± 47 ml/kg/min, p < 0,001; DC direito 369 ± 141 ml/kg/min versus 269 ± 113 ml/Kg/min, p = 0,005) sendo significativamente mais elevado que no grupo controle (DC Esquerdo 174 ± 47 ml/kg/min, p = 0,004 e DC direito 288 ± 74 ml/Kg/min, p = 0,02). CONCLUSÕES: A função ventricular esquerda permanece estável nas duas fases da HT, demonstrando o baixo comprometimento cardíaco esquerdo do resfriamento induzido. Os valores da FE, da fração de encurtamento e da onda s´ do VD, maiores após o reaquecimento, podem ser consequentes a um estado hiperdinâmico do coração. Disfunção ventricular direita foi observada nos momentos em que a pressão pulmonar estava elevada. O STLGLVD foi a única ferramenta capaz de identificar o comprometimento da função sistólica do VD durante a HT. / INTRODUCTION: The hypoxic-ischemic encephalopathy (HIE) corresponds to one of the biggest causes of neonatal morbidity and mortality. It occurs in consequence to acute perinatal asphyxia, represented by low Apgar score and evidences of neurological disorders in birth. The therapeutic hypothermia (TH) has shown significant benefits in long term neurological prognosis, by reducing the cerebral metabolism, delaying the onset of the hypoxic depolarization in cellular level. The TH effects in cardiovascular system have been insufficiently researched, raising questions regarding the adequate reading of the echocardiographic results in this condition. OBJECTIVE: to evaluate the hemodynamic and the ventricular performance of neonates with HIE submitted to TH, using conventional and advanced echocardiographic techniques. METHODS: this research is an observational study developed in three institutions, in which 22 neonates with HIE were evaluated by echocardiography in the two phases of TH (during hypothermia and after rewarming). The control group was composed by 22 healthy neonates. The infants were submitted to TH following hypothermia protocol criteria of each services. RESULTS: Left ventricular function: the ejection fraction (EF) and the shortening fraction were higher after rewarming (74 ± 5% and 41 ± 5% respectively) compared to the control group (70 ± 5%, p = 0.003 and 37 ± 4%, p = 0.002). The myocardial performance index (MPI) of the left ventricle (LV), evaluated by pulsed wave Doppler, remained constant in the two phases of TH (0.51 ± 0.13, hypothermia = rewarming) and this MPI was lower in comparison to the control group (0.63 ± 0.18, p = 0.02). The values of the circumferential and radial strain, the twist, the torsion and the global longitudinal strain (GLS) of the LV were similar between the control group and the study group, as during hypothermia as after rewarming. Right ventricular function: it was noted increment of the right ventricle (RV) s´ wave velocity after rewarming (from 0.07 ± 0.02 m/s during hypothermia to 0.09 ± 0.01 m/s, p < 0.001), also it was higher when compared to the control group (0.07 ± 0.01 m/s, p < 0.001). There was decrease of the RV fractional area change (FAC) values after rewarming (38 ± 11% during hypothermia, 36 ± 11% after rewarming and 43 ± 10% in control group), with significant differences between these two last values (p = 0.03). Regarding RV\'s MPI, the control group presented lower averages (0.29 ± 0.13) than the case group during hypothermia (0.46 ± 0.33, p = 0.03). The RV GLS was worse as during hypothermia (-18 ± -5%, p = 0.02) as after rewarming (-18 ± 4%, p = 0.01) when compared to the control group (-21 ± 2%). Hemodynamic parameters: The pulmonary artery systolic pressure was higher in the study group during the two phases of the treatment (hypothermia 45 ± 24 mmHg, p = 0.02 and rewarming 53 ± 34 mmHg, p = 0.01 versus control group 29 ± 11 mmHg). The heart rate (HR) was significantly lower during hypothermia compared to the after rewarming period (HR 111 ± 19 bpm versus 144 ± 20 bpm, p < 0.001) and to the control group (HR 130 ± 16 bpm, p < 0.001). After rewarming it was seen increase of the left and right cardiac output (CO) compared to the hypothermia period (left CO 214 ± 39 ml/kg/min versus 155 ± 47 ml/kg/min, p < 0.001; right CO 369 ± 141 ml/kg/min versus 269 ± 113 ml/Kg/min, p = 0.005), remaining significantly higher than in the control group (left CO 174 ± 47 ml/kg/min, p = 0.004 and right CO 288 ± 74 ml/Kg/min, p = 0.02). CONCLUSIONS: The LV function remains stable in the two phases of TH, showing low left cardiac impairment of the induced cooling. The values of EF, shortening fraction and RV s´ wave were higher after rewarming, possibly due to a hyperdynamic heart state. A right ventricular dysfunction was observed when the pulmonary artery systolic pressure was high. The RV GLS was the only tool able to identify the RV systolic impairment during TH.

Introduction : Malgré une réanimation bien conduite, un certain nombre de patients en choc septique présentent une tachycardie persistante. Dans ce contexte, cette élévation de la fréquence cardiaque peut être le reflet d’un certain degré de dysautonomie. L’objectif de cette thèse est d’évaluer, sur un modèle expérimental de choc septique, l’impact d’un ralentissement de la fréquence cardiaque soit par un β-bloquant cardiosélectif aux effets anti inflammatoires (esmolol, travail 1) soit par l’ivabradine, un inhibiteur des canaux if sans effets anti-inflammatoires majeurs en situation aiguë, (travail 2) sur les fonctions cardiaque, vasculaire et le profil inflammatoire systémique et tissulaire. Matériels et Méthodes : Le choc septique était induit par une ligature et ponction cæcale (CLP) chez des rats Wistar. Les rats du travail 1 étaient randomisés à 4 heures de la chirurgie dans les groupes : Contrôle, Esmolol (débuté à 4 heures), Noradrénaline (débuté à 18 heures), Esmolol + Noradrénaline. Les rats du travail 2 étaient randomisés à 4 heures de la chirurgie dans les groupes Contrôle, Ivabradine (débutée à 4 heures). Un groupe Sham était réalisé dans chaque travail. Les évaluations étaient réalisées à 18 heures de la chirurgie et portaient sur la fonction cardiaque (micro PET et Millar pour le travail 1, échocardiographie pour le travail 2) in vivo, ex vivo sur la vasoréactivité (par myographie) ainsi que sur les profils inflammatoires systémique et tissulaire (cardiaque et vasculaire). Résultats : Dans les deux travaux, comparé au groupe Sham, la CLP induisait un tableau de choc septique incluant dysfonction cardiaque et hypovasoréactivité aux vasopresseurs Dans le travail 1, l’adjonction d’esmolol réduisait la fréquence cardiaque et améliorait l’inotropisme myocardique ainsi que la vasoréactivité mésentérique. Ces effets étaient associés à une réduction des cytokines inflammatoires systémiques et à une diminution de l’expression de NF-κB dans le cœur et les vaisseaux. Dans le travail 2, l’ivabradine réduisait aussi efficacement la fréquence cardiaque mais sans aucun impact sur la fonction myocardique ou la vasoréactivité. Aucun effet n’était retrouvé sur les mêmes paramètres inflammatoires. Conclusion : Dans le choc septique expérimental, l’adjonction d’un traitement β-bloquant permet une amélioration des fonctions cardiaques et vasculaires via des effets anti-inflammatoires. Néanmoins, la réduction isolée de la fréquence cardiaque semble n’apporter aucun bénéfice en termes de fonction cardiovasculaire ainsi que sur les paramètres inflammatoires. L’objectif de réduction systématique de la fréquence cardiaque n’apparaît donc pas comme un objectif intéressant dans la prise en charge du choc septique et les effets bénéfiques de l’Esmolol sont essentiellement anti-inflammatoires. / Introduction: Despite adequate initial resuscitation, some septic shock patients continue to display persistent tachycardia likely due to autonomic dysregulation. The purpose of the present study was to determine the consequences of heart rate reduction by a β-blocker (study 1) or by Ivabradine (study 2) on cardiac function, vasoreactivity and inflammatory pattern in) an experimental model of septic shock. Material and Methods: Septic shock was induced in Wistar rats by cecal ligation and puncture. In the first study, four hours after the surgery, Wistar rats were randomly allocated to the following groups: control, esmolol, norepinephrine (started at H18), and esmolol (started at H4) + norepinephrine (started at H18). In the second study, four hours after the surgery, Wistar rats were randomly allocated to the following groups: Control and Ivabradine (administered per os four hours after the surgery). A Sham- operated group was included in each study. Assessment at 18 hours included hemodynamics, in vivo cardiac function (by Micro-PET and Millar in study 1 and echocardiography in study 2) and ex vivo vasoreactivity by myography. Circulating cytokine levels were measured by ELISA while cardiac and vascular inflammatory protein expressions were assessed by Western blotting. Results: In both studies compared to sham animals, CLP animals developed hypotension, cardiac depression and vascular hyporesponsiveness to vasopressor treatment. In study 1, esmolol infusion decreased the heart rate with increased cardiac contractility and restored mesenteric vasoreactivity. These effects were associated with a decrease in systemic inflammatory cytokines as well as NF-κB activation both at the cardiac and vessel level. In study 2, compared to the CLP group, adjunction of Ivabradine also decreased the heart rate but without any impact on cardiac contractility or vasoreactivity. Adjunction of Ivabradine to CLP rats had no impact on the same tested inflammatory parameters. Conclusion: Adjunction of selective β1-blockade in experimental septic shock enhances cardiac contractility and vascular responsiveness to catecholamines whereas isolated heart rate reduction by Ivabradine does not. These protective cardiovascular effects in study 1 appear to be attributed to the anti- inflammatory effects of esmolol while in study 2, Ivabradine does not affect any of the above parameters. It is likely that heart rate reduction is not a promising target in septic shock and that the observed benefits of esmolol are mostly likely attributable to its anti-inflammatory effects.

A terapia celular representa uma abordagem promissora para o tratamento de cardiopatia isquêmica, porém aspectos-chave dessa estratégia permanecem incertos. Neste trabalho avaliamos a eficiência da retenção cardíaca de células da medula óssea marcadas com tecnécio (99m Tc-CMO) transplantadas, de acordo com o tempo após o infarto (1, 2, 3 e 7 dias) e a via de administração dessas células (intravenosa [IV], intraventricular [IC], intracoronariana [ICO] e intramiocárdica [IM]), em ratos submetidos à isquemia-reperfusão cardíaca [I&R]. Após 24 horas, a retenção cardíaca de 99m Tc-CMO foi maior na via IM comparada com a média alcançada pelas demais (6,79% do total injetado vs. 0,53%). O uso de fibrina como veículo para a injeção de células incrementou a retenção em 2.5 vezes (17,12 vs. 6,84%) na via IM. Curiosamente, quando administradas após 7 dias, a retenção de células na via IM alcançou valores próximos dos observados com da matriz de fibrina injetadas 24 h após a I&R (16,55 vs. 17,12%), enquanto que para as demais vias as mudanças foram insignificantes. Nos animais em que as CMO foram administradas por via intramiocárdica 24 horas após a I&R, com ou sem fibrina, observou-se melhora significante do desempenho cardíaco frente ao estresse farmacológico com fenilefrina quando comparados aos controles. Em conjunto, os dados mostram a biodistribuição das células injetadas após a I&R por 4 diferentes vias e 4 intervalos de tempo pós-lesão e indicam que a via IM é a que produz maior retenção cardíaca. O uso do biopolímero de fibrina aumenta a retenção das células e a eficácia deste efeito sobre a função cardíaca e mortalidade dos animais em longo prazo, além de 30 dias pós I&R, merecerá ser investigada no futuro. / Cell therapy represents a promising approach for ischemic cardiac disease, but key aspects of this strategy remain unclear. We examined the effects of timing and route of administration of bone marrow cells (BMCs) after myocardial ischemia/reperfusion injury (I&R). 99mTc-labeled BMCs were injected by 4 different routes: intravenous (IV), left ventricular cavity (LV), left ventricular cavity with temporal aorta occlusion (LV+) and intramyocardial (IM). The injections were performed 1, 2, 3, or 7 days after infarction. Cardiac retention was higher following the IM route compared to the average values obtained by all other routes (6.79% of the total radioactivity injected vs. 0.53%). Use of a fibrin biopolymer as vehicle during IM injection led to a 2.5-fold increase in cardiac cell accumulation (17.12 vs. 6.84%). Interestingly, the retention of cells administered with culture medium at day 7 post-MI by the IM route was similar to that observed when cells were injected 24 h post-IM using fibrin (16.55 vs 17.12%), whereas no significant changes were observed for the other routes. Cell therapy 24 hs post MI by IM injection, with or without fibrin, resulted in comparable improvement in cardiac function under pharmacological stress compared to control animals. Together, we provide evidence for the biodistribution of 99mTc-labeled BMCs injected post MI by 4 different routes and times post-injury, which shows that the IM rout is the most effective for cardiac cell retention. The use of a fibrin biopolymer further increased cardiac cell retention and its potential long term benefits, beyond 30, on reducing mortality and improving cardiac function deserve to be explored in the future.

Com base na relevância das doenças cardiovasculares para a saúde pública mundial, buscamos entender as associações entre o metabolismo da homocisteína (Hcy) e este sistema, o estresse oxidativo (EO) e a possível influência da modulação do sistema nervoso simpático (SNS) sobre esta associação. Além disso, testamos o efeito da vitamina B6 sobre a função cardíaca e o EO. Para isso foram realizados dois experimentos: no primeiro testamos dois modelos de hiper-homocisteinemia (Hhe): o tratamento com metionina e homocisteína tiolactona em dois diferentes protocolos experimentais. No primeiro protocolo foram avaliados parâmetros morfofuncionais cardíacos e associações com o balanço redox no miocárdio. Já no segundo protocolo foi avaliada a variabilidade da freqüência cardíaca (VFC) e da pressão arterial sistólica (VPAS) e suas associações com o estresse oxidativo (EO) nos eritrócitos. Como resultados, observamos que os dois tratamentos resultam em igual aumento na concentração plasmática de Hcy, piora na função cardíaca e aumento no EO cardíaco. Além disso, foram encontradas fortes correlações entre as variáveis que sugerem piora da função cardíaca e desbalanço redox. O segundo protocolo demonstrou redução da VFC, com aumento do componente de baixa frequência (BF), associado ao SNS, e redução da modulação do sistema nervoso parasimpático ou de alta freqüência (AF), em valores normalizados. Quanto à VPAS foi demonstrado um aumento somente no componente de AF em ambos os tratamentos. Comparados ao grupo controle, a sensibilidade barorreflexa estava reduzida nos dois tratamentos (MET e HcyT), provavelmente devido ao aumento da modulação simpática vascular. Foi observado também um aumento da atividade das enzimas superóxido dismutase (SOD) e catalase (CAT) nos eritrócitos e redução na concentração das carbonilas. Esses resultados sugerem alteração no controle autonômico em favor da modulação simpática cardíaca e vascular, com piora na sensibilidade barorreflexa após o tratamento com HcyT. Além disso, estão associadas a uma maior mobilização das defesas enzimáticas resultando em redução do dano oxidativo. O segundo experimento consistiu do estabelecimento da Hhe após tratamento com HcyT, seguido por adição de vitamina B6 a água de beber como proposta terapêutica. Neste experimento avaliamos a concentração de Hcy e cisteína, parâmetros morfofuncionais cardíacos, atividade das enzimas antioxidantes sistêmicas, a concentração cardíaca de peróxido de hidrogênio (H2O2), imunoconteúdo da glutationa S-transferase (GST) e do fator de transcrição nuclear (Nrf2). O tratamento com vitamina B6 demonstrou redução na Hcy plasmática. Por outro lado, o tratamento com HcyT e vitamina B6 provocou aumento significativo da espessura da parede posterior cardíaca e da massa do ventrículo, todos corrigidos pelo peso corporal. Esses resultados sugerem uma hipertrofia ventricular compensatória. Além disso, o mesmo tratamento melhorou a função global miocárdica e a fração de ejeção. A atividade da SOD e CAT nos eritrócitos estava diminuída após o tratamento com vitamina B6, o que pode ocorrer devido às propriedades antioxidantes conhecidas da vitamina. Tanto a GST, quanto o Nrf2 apresentam aumento após o tratamento com HcyT, o que pode ser uma resposta adaptativa ao aumento de cisteína. O mesmo aumento foi observado no H2O2 após o tratamento com HcyT, sugerindo sinalização para o aumento do EO. A vitamina B6 possui propriedades que lhe conferem ação antioxidante, o que pode estar auxiliando no seu papel protetor no miocárdio e na condição de Hhe. Com esse trabalho, sugere-se que a Hhe seja vista de uma forma mais ampla que o simples aumento da Hcy no plasma, pois o seu metabolismo no organismo pode ter efeitos tóxicos, com repercussão na função cardíaca e modulação do SNS associados ao EO. Além disso, a vitamina B6 pode ser avaliada com proposta terapêutica isolada, pois atua reduzindo a concentração de Hcy e beneficiando o equilíbrio redox. / Based on the relevance of cardiovascular diseases to public health worldwide, we seek to understand its association to the homocysteine (Hcy) metabolism, the oxidative stress (OS) and the possible influence of the sympathetic nervous system (SNS) modulation. In addition, we tested the effect of vitamin B6 on cardiac function and OS. For this purpose two experiments were conducted: in the first experiment we tested two different hiperhomocysteinemia experimental models: methionine and homocysteine thiolactone, this experiment was divided into two protocols. At the first protocol to evaluate morpho-functional cardiac and associations to redox balance in the heart. Already at the other protocol was studied heart rate variability (HRV) and blood pressure (VPAS), and their associations with OS. The first experiment showed the effect of methionine (MET) and homocysteine thiolactone (HcyT) treatment on cardiac function and their associations with the OS. We found that both treatments result in equal increases in plasma Hcy, poor cardiac function and increase in cardiac OE. Furthermore, we found strong correlation between the variables that suggest worsening of cardiac function and increase in the OE. The toxicity of the thiolactone metabolite is known mainly in the nervous system, and the proposed mechanism for their deleterious effects on cardiac function is probably associated with a higher OE. The second protocol showed that HRV was reduced probably due to the increase in lowfrequency (LF), associated with the SNS, and a reduction in parasympathetic nervous system modulation or high-frequency (HF), in normalized values. The systolic blood pressure variability was demonstrated due to an increase in the HF component. Compared to the control group, baroreflex sensitivity was reduced in both treatments (MET and HcyT), probably due to the increase in sympathetic modulation. We also observed an increase in superoxide dismutase (SOD) and catalase (CAT) activity in erythrocytes, and also a reduced carbonyl concentration. These results suggest changes in cardiovascular autonomic control in favor to sympathetic modulation, with worsening in baroreflex sensitivity after HcyT treatment. They are also associated with greater enzymatic defenses mobilization resulting in reduced oxidative damage. The second experiment aim was study the effects of B6 treatment after Hhe, and we evaluated the Hcy and cysteine plasma concentration, the morphofunctional cardiac transcription factor of the antioxidant enzymes (Nrf2), glutathione S-transferase (GST), the hydrogen peroxide (H2O2) cardiac concentration and the enzymatic antioxidant activity. Vitamin B6 treatment reduced plasma homocysteine concentration. Furthermore, vitamin B6 and HcyT treatment caused a significant increase in posterior wall thickness and cardiac ventricular mass, all adjusted to body weight. These results suggest a compensatory ventricular hypertrophy. Moreover, the same treatment improved global myocardial function and ejection fraction. Both, Nrf2 and GST, have increased after HcyT treatment, which may be an adaptive response to increased cysteine. The same increase was observed in H2O2 after HcyT treatment, suggesting an increase in the OE. These results are confirmed by the increased SOD and CAT activity in erythrocytes. Vitamin B6 has antioxidant properties which may be aiding in its protective role in the myocardium and provided Hhe. Our results suggest that Hhe is seen in a broader than the simple increase of plasma Hcy, because their metabolism in the body can have toxic effects, with impact on cardiac function and SNS modulation associated with OE. In addition, vitamin B6 could be evaluated with therapeutic purposes by reducing the Hcy concentration and benefiting the redox balance.

A menopausa fisiológica associada ao envelhecimento aumenta a morbimortalidade por doenças cardiocasculares decorrente de alterações vasculares, hemodinâmicas e morfofuncionais cardíacas. Entretanto, a menopausa precoce pode promover prejuízos cardiovasculares ainda mais importantes, os quais podem ser exacerbados quando associados ao envelhecimento. Nesse contexto, há evidências de que o treinamento físico aeróbio e a inibição da enzima conversa de angiotensina promovam efeitos benéficos sobre a hemodinâmica e a morfofuncionalidade cardíaca. Objetivos: Investigar em ratas velhas (82 semanas) os efeitos da privação precoce dos hormônios ovarianos sobre a morfologia e a funcionalidade cardíaca, bem como os efeitos do treinamento físico aeróbio e da inibição crônica da enzima conversora de angiotensina com Maleato de Enalapril. Métodos: Ratas Wistar (N=96) foram divididas em dois grandes grupos; grupo submetido à ovariectomia (N=72) e grupo submetido à cirurgia sham (N=24), ambos na 10a semana de idade. O grupo ovariectomizado foi dividido em seis subgrupos (N=12); grupo sedentário (OVX); grupo submetido ao treinamento físico aeróbio (OVX-T); grupo tratado com 10mg.kg- 1 .d-1 de Maleato de Enalapril (OVX-ME); e grupo treinado e tratado com Maleato de Enalapril (OVX-MET). O treinamento físico aeróbio e o tratamento com ME foram realizados durante a 62ª a 82ª semanas de idade. Por sua vez, o grupo submetido à cirurgia sham foi dividido em dois subgrupos (N=12); grupo sedentário (SHAM) e grupo treinado (SHAM-T). Ao final da 82a semana, os animais foram submetidos ao exame ecocardiográfico, avaliação da função cardíaca isolada por meio da técnica de Langendorff e à quantificação da expressão de receptores ?-adrenérgicos cardíacos pela técnica de Western Blot. Resultados: O grupo OVX apresentou maiores valores da espessura da parede do septo interventricular e da pressão intraventricular esquerda máxima à administração de dobutamina quando comparado ao grupo SHAM. Contudo, ambos os grupos treinados, OVX-T e SHAMT apresentaram redução da pressão intraventricular à administração de dobutamina, bem como da expressão dos receptores ?1-adrenérgicos, em relação aos seus respectivos grupos sedentários. Quando comparado ao grupo OVX, os grupos OVX-ME e OVX-T apresentaram menores valores da espessura das paredes do VE, pressão intraventricular esquerda máxima à administração de dobutamina, bem como redução da expressão dos receptores ?1-adrenérgicos. Conclusão: A privação precoce dos hormônios ovarianos associada ao envelhecimento promoveu discretas alterações na morfologia cardíaca, porém um importante aumento da contratilidade. Por sua vez, o treinamento físico aeróbio e o tratamento com Maleato de Enalapril promoveram efeitos semelhantes na morfologia cardíaca. Também reduziram a contratilidade cardíaca e a expressão de receptores ?1-adrenérgicos. Contudo, a combinação dos dois tratamentos não potencializou os efeitos observados. / Physiological menopause associated with aging increases the incidence of cardiovascular morbidity and mortality due to cardiac morphofunctional, hemodynamic and vascular changes. However, early menopause may lead to increased cardiovascular damage, which may be exacerbated when associated with aging. On the other hand, aerobic physical training and inhibition of the angiotensin-converting enzyme may promote beneficial effects on hemodynamics and cardiac morphofunctionality. Objective: To investigate the effects of early ovarian hormone privation (ovariectomy at the 10th week of age) on the morphology and cardiac function in old rats (82 weeks), as well as the implications of these parameters after aerobic physical training and the angiotensin converting enzyme inhibition with Enalapril Maleate (EM). Methods: Wistar rats (N=96) were divided into two large groups; group submitted to ovariectomy (N=72) and sham group (N=24), both at the 10th week of age. The ovariectomized group was divided into six subgroups (N=12); sedentary group (OVX), a group submitted to aerobic physical training between 62 and 82 weeks of age (OVX-T), a group treated with 10mg.kg-1.d-1 of Enalapril Maleate (OVX-ME) between 62 and 82 weeks of age and group trained and treated with Enalapril Maleate (OVX-MET). The group undergoing sham surgery was divided into two subgroups (N=12); sedentary group (SHAM) and trained group (SHAMT). At the end of the 82nd week, the animals were submitted to echocardiographic examination, evaluation of cardiac function isolated by the Langendorff technique and quantification of cardiac ?-adrenergic receptor expression by the Western Blot technique. Results: The OVX group presented higher values of the interventricular septum wall thickness and the maximum left intraventricular pressure to dobutamine administration when compared to the SHAM group. However, both trained groups, OVX-T and SHAM-T, had reduced intraventricular pressure to dobutamine administration, as well as expression of ?1-adrenergic receptors compared to their respective sedentary groups. When compared to the OVX group, the OVX-ME and OVX-T groups presented lower values of LV wall thickness, maximal left intraventricular pressure to dobutamine administration, as well as reduced ?1-adrenergic receptor expression. Conclusion: Early aging associated with ovarian hormones promoted few alterations in cardiac morphology, but an important increase in cardiac contractility. In turn, aerobic physical training and treatment with Enalapril Maleate promoted similar effects on cardiac morphology. They also reduced cardiac contractility and ?1-adrenergic receptor expression. However, the combination of the two treatments did not potentiate the observed effects.