Carnitine is an essential metabolite in the human body. It carries out several roles in human metabolism, including that in fatty acid metabolism. γ-Butyrobetaine hydroxylase (BBOX) is an Fe(II) and 2-oxoglutarate dependent oxygenase, which catalyses the final step of carnitine biosynthesis, i.e. hydroxylation of γ-butyrobetaine (GBB) to carnitine. Inhibition of BBOX has potential in the treatment for cardiovascular diseases. The work described in this thesis focussed on mechanistic and inhibition aspects of BBOX catalysis. Firstly, a set of analytical tools for BBOX activity measurements was developed. The synthesis of fluorinated substrate analogues provided the basis for development of two assays for use in vitro with the isolated protein and in lysates, with detection by fluorescence or ¹⁹F NMR, respectively. Furthermore, the use of ¹⁹F NMR to monitor protein-ligand interactions was exemplified with the work on metallo-β-lactamases. The developed fluoride-release assay was then used to screen a library of small molecules and led to recognition of scaffolds with potential applications as inhibitors. Further structure-activity relationship studies led to the identification of potent BBOX inhibitors, which were then evaluated for their activity in cells. The crystal structure of human BBOX with one of the lead inhibitors revealed that BBOX can undergo significant conformational changes, involving a movement of an active site loop. BBOX conformational flexibility may have a role in the GBB mediated substrate inhibition observed both with isolated protein and in cells. In addition to the mechanistic and functional studies, the potential of BBOX as a biocatalytic tool was examined. BBOX has been shown to catalyse a hydroxylation of the symmetrical dialkyl piperidine carboxylic acids, leading to formation of up to three stereocentres in one reaction. In the last part of this work properties of human BBOX were compared to BBOX from Pseudomonas sp. AK1, revealing differences in kinetic behaviour and substrate specificity. Novel substrates for bacterial BBOX were identified. Pseudomonas sp AK1 BBOX was shown to hydroxylate amino acid analogues leading to formation of 1,2-amino alcohols.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

Einleitung: L-Carnitin spielt eine zentrale Rolle im Energiestoffwechsel. Da dieser in der Frühlaktation bei Hochleistungskühen besonders beansprucht und z.T. überlastet wird, ergibt sich die Frage, ob durch L-Carnitinsupplementation ein stabilerer Stoffwechsel und damit bessere Leistungen erreicht werden können. Zielstellung: Es wurde geprüft, ob bei Hochleistungskühen mit einer mittleren Milchleistung von 12000 kg/Jahr die orale Supplementation von L Carnitin im peripartalem Zeitraum bei zwei verschiedenen Applikationszeiträumen Stoffwechsel-, Leistungs- und Gesundheitsverbesserung erbringt. Versuchsanordnung: Aus einer Gesamtherde von 322 Kühen wurden 81 Tiere randomisiert auf vier Gruppen aufgeteilt. Zwei dieser Gruppen erhielten L-Carnitin (Supplementationsgruppen) und die anderen zwei Gruppen stellten die Kontrollgruppen (KG 1 n = 14/ KG 2 n = 11) dar. Von den supplementierten Gruppen erhielt Car. 1 (n = 26) von 3 Wochen (Wo.) ante partum (a.p.) bis zur Kalbung über das Futter täglich 5g L Carnitin (Carnipas®). Post partum bekamen die Tiere 1g L Carnitin von der Kalbung bis vier Wo. p.p. Parallel wurden einer zweiten supplementierten Gruppe, Car. 2 (n = 30), täglich 5g L Carnitin 3 Wochen a.p. bis zur Kalbung verabreicht. Klinische und Blutkontrollen erfolgten 28 Tage (d) a.p., drei d p.p, 28 d p.p. sowie 56 d p.p. Es wurden das Gesamtcarnitin (GC, n = 5), das freie Carnitin (FC, n = 5), Carnitinester (CE, n = 5), FFS, BHB, Bilirubin, Glucose, Cholesterol, Harnstoff, TTP, Albumin, CK, AST, Pi, Ca, Fe bei allen Tieren analysiert. Zusätzlich erfolgte die Erfassung der Laktationsleistung, der Milchinhaltsstoffe, der Rastzeit (RZ), der Zwischentragezeit (ZTZ) und der Morbidität. Ergebnisse: Das GC, FC und die CE besitzen in den supplementierten Gruppen Car 1 drei d p.p. höhere Konzentrationen als die Kontrollgruppen, die bei Car. 2 (p < 0,05) im GC und FC auch im weiteren Verlauf beobachtet wurden. Ein deutlicher Konzentrationsabfall aller L-Carnitinfraktionen vier Wo. p.p. wurde in den supplementierten Gruppen beobachtet. In den Kontrollgruppen stiegen sie zur gleichen Zeit nicht einheitlich an. Acht Wochen p.p. sanken die L-Carnitinkonzentrationen im Blut sowohl in den Kontrollgruppen, als auch in der supplementierten Gruppen weiter ab. In allen Gruppen stiegen drei d p.p. die FFS-Konzentrationen an (p < 0,05), das BHB auch in den supplementierten Gruppen, die Glucose- und Cholesterolkonzentration fielen ab (p < 0,05). Vier und 8 Wo. p.p. ließen sich ein Abfallen der FFS- (p < 0,05) und der BHB-Konzentrationen (p < 0,05) erkennen. Die Cholesterol- (p < 0,05) und verzögert auch die Glucosekonzentration stiegen an. Drei d p.p. stiegen die Bilirubinkonzentration (p < 0,05) und die AST-Aktivität (p < 0,05) an, dem ein ebensolcher Abfall (p < 0,05) folgte. Präpartal trat in der supplementierten Gruppen Car. 2 eine höhere Bilirubinkonzentration als in der Kontrollgruppe (p < 0,05) auf, was bei den AST-Aktivitäten zwischen den supplementierten Gruppen postpartal (p < 0,05) der Fall war. Drei d p.p waren niedrigere Konzentrationen des Proteins (p < 0,05), des Albumins (p < 0,05) in Car. 2 und in der Kontrollgruppe sowie des Harnstoffs (p < 0,05) in den Kontrollgruppen zu beobachten. Die CK-Aktivität nahm drei d p.p. zu (p < 0,05), um vier Wo. p.p. wieder abzufallen (p < 0,05). Gleichzeitig war einen Anstieg des Proteins (p < 0,05) und des Albumins in den Kontrollgruppen (p < 0,05), verzögert auch in den supplementierten Gruppen (p < 0,05), messbar. In allen Gruppen waren drei d p.p. niedrigere Ca- (p < 0,05), Fe- (p < 0,05) und Pi- Konzentrationen (p < 0,05) auffällig, die später wieder anstiegen. Im Verlauf war die Ca-Konzentration bei Car. 2 gegenüber der Kontrollgruppe höher (p < 0,05). Die Leistungsparameter differierten weder bei den Milchleistungs-, noch bei den Fruchtbarkeitskennzahlen gesichert. Bezüglich der Morbidität war auffällig, dass das GC und FC bei gesunden Kühen a.p. gegenüber den im Laktationsverlauf erkrankten gesichert höher war (p < 0,05). Schlussfolgerungen: Orale L Carnitinapplikation bei Kühen mit hohem Milchleistungsniveau erbrachte keine Stoffwechsel-, Leistungs- und Morbiditätsunterschiede gegenüber den Kontrollgruppen. Die Ergebnisse entsprechen aber der Hypothese einer gesteigerten ß-Oxidation durch die Carnitinsupplementation mit erhöhten BHB-Konzentrationen als Folge. Post partum gesunde Kühe hatten a.p. signifikant höhere L-Carnitinkonzentrationen als kranke.

Background: Long QT syndrome (LQTS) is a cardiac condition which predisposes individuals to syncope, seizures, and sudden cardiac death. There is a high prevalence of congenital LQTS in a First Nations community in Northern British Columbia due to the founder variant p.V205M in the KCNQ1 gene. Additionally, two other variants of interest are present in this population: the KCNQ1 p.L353L variant, previously noted to modify the phenotype of LQTS in adults, and the CPT1A p.P479L variant, a metabolic variant common in Northern Indigenous populations associated with hypoglycemia and sudden unexpected infant death. Methods: We performed a mixed methods study to better understand the impact of LQTS in children and youth in this First Nations community. To learn about the clinical impact of LQTS, and better understand the effects of the KCNQ1 and CPT1A variants in children, we used statistical analysis to compare the cardiac phenotypes of 211 First Nations children with and without the p.V205M, p.L353L and p.P479L variants, alone and in combination. Ordinary Least Squares linear regression was used to compare the highest peak corrected QT interval (QTc). The peak QTc is an electrocardiogram measurement used in risk stratification of LQTS patients. Logistic regression was used to compare the rates of syncope and seizures experienced in childhood. Additionally, to learn about the lived-experience of LQTS, we interviewed one young First Nations adult about her experiences growing up with LQTS as a teenager. From this interview, we conducted a qualitative case study analysis using Interpretative Phenomenological Analysis. All research was done in partnership with the First Nations community using community-based participatory methods. Results: We found that the p.V205M variant conferred a 22.4ms increase in peak QTc (p<0.001). No other variants or variant interaction effects were observed to have a significant impact on peak QTc. No association between the p.V205M variant and loss of consciousness (LOC) events (syncope and seizures) was observed (OR(95%CI)=1.3(0.6-2.8); p=0.531). However, children homozygous for p.P479L were found to experience 3.3 times more LOC events compared to non-carriers (OR=3.3(1.3-8.3); p=0.011). With regard to the qualitative portion of the thesis, four superordinate (main) themes emerged from the case study: Daily life with Long QT Syndrome, Interactions with Medical Professionals, Finding Reassurance, and The In-Between Age. We found that even though our participant was asymptomatic and felt that she was not impacted by LQTS in her daily life, she considered certain elements of the condition to be stressful, such as taking a daily beta-blocker. Conclusion: These results suggest that while the KCNQ1 p.V205M variant is observed to significantly prolong the peak QTc, the CPT1A p.P479L variant is more strongly associated with LOC events in children from this community. More research is needed to further determine the effect of these variants; however, our preliminary findings suggest management strategies, such as whether beta-blockers are indicated for p.V205M carriers, may need to be reassessed. The importance of developing a holistic, well-balanced approach to medical care, taking into consideration the personal perspectives and unique medical circumstances of each child is exemplified in this study. / Graduate

Introdução. A criopreservação de oócitos é importante, tanto para a tentativa de preservação da fertilidade feminina, como nos tratamentos de reprodução assistida. Hipotetizamos que novas formulações de meios crioprotetores, contendo biomoléculas que participam da estrutura e funcionalidade celular, em particular da função mitocondrial e da dinâmica do sistema de membranas, poderiam melhorar a criotolerância e segurança da vitrificação. Objetivos. Este estudo teve como objetivo investigar os efeitos do meio padrão de vitrificação (T4) e T4 suplementado com L-carnitina (LC), LC-ácidos graxos (T4-AG) e LC-AGfosfatidilcolina (T4-PC) sobre a sobrevida e qualidade de oócitos criopreservados, mensurada por parâmetros do desenvolvimento in vitro de embriões, como número de núcleos totais (NT), de células na massa celular interna (MCI) e trofectoderma (TE) dos blastocistos oriundos de oócitos vitrificados nestes meios, assim como sobre os padrões de atividade mitocondrial oocitária. Materiais e métodos. Estudo experimental usando o camundongo da cepa C57BL/6 como modelo. Oócitos maturados in vivo, foram distribuídos em 5 grupos: controle a fresco (CT) e 4 grupos vitrificados: T4, T4-LC, T4-AG e T4-PC. Após a desvitrificação, foi analisada a sobrevida oocitária e os oócitos viáveis foram submetidos a fertilização in vitro ou utilizados para análise da atividade mitocondrial, por meio da análise de espécies reativas de oxigênio (EROs) intracelular por Intensidade de Fluorescência emitida pelo diacetato de 2,7- diclorodihidrofluoresceína, metabolismo oxidativo pela autofluorescência de dois fluoróforos endógenos [dinucleótideo de flavina adenina oxidado e o dinucleotideo reduzido de nicotinamida adenina (fosfato)] e potencial de membrana mitocondrial por Intensidade de Fluorescência (IF) emitida pelo JC1. Os oócitos dos 5 grupos submetidos a FIV foram cultivados por 96 horas, sendo comparados entre os grupos: taxa de fertilização e formação de blastocisto, assim como o número de NT, células MCI e TE e tamanho dos blastocistos. Resultados. A taxa de sobrevivência dos oócitos vitrificados em T4 foi superior a dos demais grupos T4-LC, T4-AG e T4-PC (respectivamente 100%, 97,07%, 96,75% e 97,95%). A taxa de fertilização do grupo CT (77,5%) foi superior a dos grupos T4, T4-LC e T4-PC, não diferindo do grupo T4-AG. Não foram evidenciadas diferenças estatisticamente significativas nas taxas de formação de blastocistos entre os grupos CT, T4, T4-LC, T4-AG e T4-PC (58,07%, 48,05%, 47,44%, 57,89% e 51,06%,respectivamente). Comparando-se o número NT e de células do TE dos blastocistos, observou-se que o os valores do grupo controle foram maiores do que o dos outros 4 grupos, que não apresentaram diferenças entre si. O número de células da MCI dos blastocistos do grupo controle foi superior ao dos grupos T4 e T4-LC e similar ao dos grupos T4-AG e T4- PC. Para o perfil de atividade mitocondrial, foram analisados 15 oócitos/grupo. Os níveis de EROs foram maiores no grupo CT comparado ao grupo T4 e menor quando comparado aos grupos T4-LC e T4-AG, mas sem diferença significativa em relação ao grupo T4-PC. Para Resumo analise do estado redox, o grupo CT teve maiores valores do que a dos grupos T4, T4-LC e T4- AG e o grupo T4-PC foi maior do que a dos outros quatro grupos. Para o potencial de membrana mitocondrial, o grupo CT teve maiores valores do que a do grupo T4-LC, menor do que a do grupo T4 e sem diferença estatisticamente significativa com a dos grupos T4-AG e T4-PC. Conclusão. O número de NT, células do TE e tamanho do blastocistos foram inferiores nos grupos vitrificados/desvitrificados em meio padrão e suplementados comparados ao controle. Porém, o número de células da MCI não foi diferente entre o grupo controle e os vitrificados T4- AG e T4-PC, sugerindo que a suplementação dos meios padrão com LC, AG e PC possa melhorar a competência do oócito e a subsequente qualidade embrionária, o que precisa ser melhor investigado antes da aplicação clínica dos novos meios. Apesar dos oócitos vitrificados no meio T4 terem apresentado taxa de sobrevivência estatisticamente superior a dos demais grupos, sugerimos que estas diferenças não apresentariam potencial relevância clínica. Os resultados de atividade mitocondrial revelam que há uma diferença importante entre oócitos controle e vitrificados com ou sem suplementos na eficiência da função mitocondrial, regulação do estado redox e controle intracelular das EROs, demonstrando que mais trabalhos são necessários para entender esta via metabólica e os diferentes efeitos dos meios de vitrificação. / Introduction. Cryopreservation of oocytes is important, both for the attempt to preserve female fertility and for assisted reproduction treatments. We hypothesize that novel cryoprotective formulations containing biomolecules that participate in cellular structure and functionality, particularly mitochondrial function and membrane system dynamics, could improve cryotolerance and safety of vitrification. Objeticve. The objective of this study was to investigate the effects of the standard vitrification medium (T4) and T4 supplemented with L-carnitine (LC), LC-fatty acids (T4-AG) and LC-AGphosphatidylcholine (T4-PC) on survival and quality of cryopreserved oocytes, measured by in vitro embryo development parameters, such as number of total nuclei (NT), cells in the internal cell mass (ICM) and trophoectoderma (TE) of the blastocysts derived from vitrified oocytes in these media, as well as on the patterns of oocyte mitochondrial activity. Materials and methods. Experimental study using the C57BL/6 mouse as a model. Matured in vivo oocytes were distributed into 5 groups: fresh (CT) control and four vitrified groups: T4, T4-LC, T4-AG and T4-PC. After devitrification, oocyte survival was analyzed and viable oocytes were submitted to in vitro fertilization or used for analysis of mitochondrial activity, through the analysis of intracellular reactive oxygen species (ROS) by Fluorescence Intensity emitted by diacetate of 2, 7-dichlorodihydrofluorescein, oxidative metabolism by the autofluorescence of two endogenous fluorophores [oxidized flavin adenine dinucleotide and the reduced dinucleotide of nicotinamide adenine (phosphate)] and mitochondrial membrane potential by Fluorescence Intensity (FI) emitted by JC1. The oocytes of the 5 groups submitted to IVF were cultured for 96 hours, being compared between the groups: fertilization rate and blastocyst formation, as well as number of NT, MCI and TE cells and size of blastocysts. Results. The survival rate of vitrified oocytes in T4 was higher than in the other groups T4-LC, T4-AG and T4-PC (respectively 100%, 97.07%, 96.75% and 97.95%). The fertilization rate of the CT group (77.5%) was higher than that of the T4, T4-LC and T4-PC groups, not differing from the T4-AG group. There were no statistically significant differences in the rates of blastocyst formation between the groups CT, T4, T4-LC, T4-AG and T4-PC (58.07%, 48.05%, 47.44%, 57.89% and 51.06%, respectively). Comparing the NT and TE cells of the blastocysts, it was observed that the values of the control group were higher than that of the other 4 groups, which did not present differences between them. The number of MCI cells from the blastocysts of the control group was higher than that of the T4 and T4-LC groups and similar to that of the T4-AG and T4-PC groups. For the mitochondrial activity profile, 15 oocytes/group were analysed. The levels of EROs were higher in the CT group compared to the T4 group and lower when compared to the T4-LC and T4-AG groups, but without significant difference in relation to the T4-PC group. For the analysis of the redox state, the CT group had higher values than the T4, T4-LC and T4-AG groups and the T4-PC group was higher than the other four groups. For the mitochondrial membrane potential, the CT group had higher values than the T4-LC group, lower than the T4 group and without a statistically significant difference with the T4-AG and T4-PC groups. Conclusion. The number of NT, TE cells and blastocyst size were lower in the vitrified/devitrified groups in standard medium and supplemented compared to control. However, the MCI cell number was not different between the control group and the vitrified T4-AG and T4-PC, suggesting that the supplementation of the standard media with LC, GA and CP could improve oocyte competence and subsequent embryo quality, which needs to be better investigated before the clinical application of the new media. Although vitrified oocytes in the T4 medium had a statistically higher survival rate than the other groups, we suggested that these differences would not present potential clinical relevance. The results of mitochondrial activity reveal that there is an important difference between control and vitrified oocytes with or without supplements in the efficiency of mitochondrial function, regulation of the redox state and intracellular control of ROS, demonstrating that more work is needed to understand this metabolic pathway and the different effects of the vitrification media.

Introdução. A criopreservação de oócitos é importante, tanto para a tentativa de preservação da fertilidade feminina, como nos tratamentos de reprodução assistida. Hipotetizamos que novas formulações de meios crioprotetores, contendo biomoléculas que participam da estrutura e funcionalidade celular, em particular da função mitocondrial e da dinâmica do sistema de membranas, poderiam melhorar a criotolerância e segurança da vitrificação. Objetivos. Este estudo teve como objetivo investigar os efeitos do meio padrão de vitrificação (T4) e T4 suplementado com L-carnitina (LC), LC-ácidos graxos (T4-AG) e LC-AGfosfatidilcolina (T4-PC) sobre a sobrevida e qualidade de oócitos criopreservados, mensurada por parâmetros do desenvolvimento in vitro de embriões, como número de núcleos totais (NT), de células na massa celular interna (MCI) e trofectoderma (TE) dos blastocistos oriundos de oócitos vitrificados nestes meios, assim como sobre os padrões de atividade mitocondrial oocitária. Materiais e métodos. Estudo experimental usando o camundongo da cepa C57BL/6 como modelo. Oócitos maturados in vivo, foram distribuídos em 5 grupos: controle a fresco (CT) e 4 grupos vitrificados: T4, T4-LC, T4-AG e T4-PC. Após a desvitrificação, foi analisada a sobrevida oocitária e os oócitos viáveis foram submetidos a fertilização in vitro ou utilizados para análise da atividade mitocondrial, por meio da análise de espécies reativas de oxigênio (EROs) intracelular por Intensidade de Fluorescência emitida pelo diacetato de 2,7- diclorodihidrofluoresceína, metabolismo oxidativo pela autofluorescência de dois fluoróforos endógenos [dinucleótideo de flavina adenina oxidado e o dinucleotideo reduzido de nicotinamida adenina (fosfato)] e potencial de membrana mitocondrial por Intensidade de Fluorescência (IF) emitida pelo JC1. Os oócitos dos 5 grupos submetidos a FIV foram cultivados por 96 horas, sendo comparados entre os grupos: taxa de fertilização e formação de blastocisto, assim como o número de NT, células MCI e TE e tamanho dos blastocistos. Resultados. A taxa de sobrevivência dos oócitos vitrificados em T4 foi superior a dos demais grupos T4-LC, T4-AG e T4-PC (respectivamente 100%, 97,07%, 96,75% e 97,95%). A taxa de fertilização do grupo CT (77,5%) foi superior a dos grupos T4, T4-LC e T4-PC, não diferindo do grupo T4-AG. Não foram evidenciadas diferenças estatisticamente significativas nas taxas de formação de blastocistos entre os grupos CT, T4, T4-LC, T4-AG e T4-PC (58,07%, 48,05%, 47,44%, 57,89% e 51,06%,respectivamente). Comparando-se o número NT e de células do TE dos blastocistos, observou-se que o os valores do grupo controle foram maiores do que o dos outros 4 grupos, que não apresentaram diferenças entre si. O número de células da MCI dos blastocistos do grupo controle foi superior ao dos grupos T4 e T4-LC e similar ao dos grupos T4-AG e T4- PC. Para o perfil de atividade mitocondrial, foram analisados 15 oócitos/grupo. Os níveis de EROs foram maiores no grupo CT comparado ao grupo T4 e menor quando comparado aos grupos T4-LC e T4-AG, mas sem diferença significativa em relação ao grupo T4-PC. Para Resumo analise do estado redox, o grupo CT teve maiores valores do que a dos grupos T4, T4-LC e T4- AG e o grupo T4-PC foi maior do que a dos outros quatro grupos. Para o potencial de membrana mitocondrial, o grupo CT teve maiores valores do que a do grupo T4-LC, menor do que a do grupo T4 e sem diferença estatisticamente significativa com a dos grupos T4-AG e T4-PC. Conclusão. O número de NT, células do TE e tamanho do blastocistos foram inferiores nos grupos vitrificados/desvitrificados em meio padrão e suplementados comparados ao controle. Porém, o número de células da MCI não foi diferente entre o grupo controle e os vitrificados T4- AG e T4-PC, sugerindo que a suplementação dos meios padrão com LC, AG e PC possa melhorar a competência do oócito e a subsequente qualidade embrionária, o que precisa ser melhor investigado antes da aplicação clínica dos novos meios. Apesar dos oócitos vitrificados no meio T4 terem apresentado taxa de sobrevivência estatisticamente superior a dos demais grupos, sugerimos que estas diferenças não apresentariam potencial relevância clínica. Os resultados de atividade mitocondrial revelam que há uma diferença importante entre oócitos controle e vitrificados com ou sem suplementos na eficiência da função mitocondrial, regulação do estado redox e controle intracelular das EROs, demonstrando que mais trabalhos são necessários para entender esta via metabólica e os diferentes efeitos dos meios de vitrificação. / Introduction. Cryopreservation of oocytes is important, both for the attempt to preserve female fertility and for assisted reproduction treatments. We hypothesize that novel cryoprotective formulations containing biomolecules that participate in cellular structure and functionality, particularly mitochondrial function and membrane system dynamics, could improve cryotolerance and safety of vitrification. Objeticve. The objective of this study was to investigate the effects of the standard vitrification medium (T4) and T4 supplemented with L-carnitine (LC), LC-fatty acids (T4-AG) and LC-AGphosphatidylcholine (T4-PC) on survival and quality of cryopreserved oocytes, measured by in vitro embryo development parameters, such as number of total nuclei (NT), cells in the internal cell mass (ICM) and trophoectoderma (TE) of the blastocysts derived from vitrified oocytes in these media, as well as on the patterns of oocyte mitochondrial activity. Materials and methods. Experimental study using the C57BL/6 mouse as a model. Matured in vivo oocytes were distributed into 5 groups: fresh (CT) control and four vitrified groups: T4, T4-LC, T4-AG and T4-PC. After devitrification, oocyte survival was analyzed and viable oocytes were submitted to in vitro fertilization or used for analysis of mitochondrial activity, through the analysis of intracellular reactive oxygen species (ROS) by Fluorescence Intensity emitted by diacetate of 2, 7-dichlorodihydrofluorescein, oxidative metabolism by the autofluorescence of two endogenous fluorophores [oxidized flavin adenine dinucleotide and the reduced dinucleotide of nicotinamide adenine (phosphate)] and mitochondrial membrane potential by Fluorescence Intensity (FI) emitted by JC1. The oocytes of the 5 groups submitted to IVF were cultured for 96 hours, being compared between the groups: fertilization rate and blastocyst formation, as well as number of NT, MCI and TE cells and size of blastocysts. Results. The survival rate of vitrified oocytes in T4 was higher than in the other groups T4-LC, T4-AG and T4-PC (respectively 100%, 97.07%, 96.75% and 97.95%). The fertilization rate of the CT group (77.5%) was higher than that of the T4, T4-LC and T4-PC groups, not differing from the T4-AG group. There were no statistically significant differences in the rates of blastocyst formation between the groups CT, T4, T4-LC, T4-AG and T4-PC (58.07%, 48.05%, 47.44%, 57.89% and 51.06%, respectively). Comparing the NT and TE cells of the blastocysts, it was observed that the values of the control group were higher than that of the other 4 groups, which did not present differences between them. The number of MCI cells from the blastocysts of the control group was higher than that of the T4 and T4-LC groups and similar to that of the T4-AG and T4-PC groups. For the mitochondrial activity profile, 15 oocytes/group were analysed. The levels of EROs were higher in the CT group compared to the T4 group and lower when compared to the T4-LC and T4-AG groups, but without significant difference in relation to the T4-PC group. For the analysis of the redox state, the CT group had higher values than the T4, T4-LC and T4-AG groups and the T4-PC group was higher than the other four groups. For the mitochondrial membrane potential, the CT group had higher values than the T4-LC group, lower than the T4 group and without a statistically significant difference with the T4-AG and T4-PC groups. Conclusion. The number of NT, TE cells and blastocyst size were lower in the vitrified/devitrified groups in standard medium and supplemented compared to control. However, the MCI cell number was not different between the control group and the vitrified T4-AG and T4-PC, suggesting that the supplementation of the standard media with LC, GA and CP could improve oocyte competence and subsequent embryo quality, which needs to be better investigated before the clinical application of the new media. Although vitrified oocytes in the T4 medium had a statistically higher survival rate than the other groups, we suggested that these differences would not present potential clinical relevance. The results of mitochondrial activity reveal that there is an important difference between control and vitrified oocytes with or without supplements in the efficiency of mitochondrial function, regulation of the redox state and intracellular control of ROS, demonstrating that more work is needed to understand this metabolic pathway and the different effects of the vitrification media.

Artificial divergent selection of chickens for high and low body weight at 8 weeks of age has produced two lines: the high (HWS) and low (LWS) body weight chicken lines. In addition to the difference in body weight, the lines show extreme differences in feeding behaviour and body composition. The aim of this study was to uncover the genetic and molecular factors that contribute to and determine these differences, especially regarding body energy regulation and appetite. In papers I and II, genome-wide gene expression in a brain sample containing hypothalamus and in dissected hypothalamus was analysed using DNA microarray and qRT-PCR. We found that levels of differential expression were generally moderate, which was consistent with the idea that polygenic factors were involved in the establishment of the chicken lines. Genes associated with neural plasticity, lipid metabolism and body energy regulation were differentially expressed. This result indicated that the neural systems regulating feeding behaviour and body weight were altered in the chicken lines. However, genes that were involved in the central melanocortin system were not systematically differentially expressed. Interestingly, the biggest differences in expression between the lines found in endogenous retrovirus sequences of the ALV subgroup E. Thus, in paper III, we characterized the number of integrations, the expression of ALVE retroviral elements and their effects on body weight. A significant correlation between low body weight and high ALVE expression was observed in female F9 birds from an HWS x LWS advanced intercross line. This implied that ev-loci contributing to increased ALVE expression levels were genetically linked to loci influencing the low body weight of the pullets. In paper IV, the carnitine palmitoyltransferase-1b gene (CPT1B), which was highly differentially expressed in the hypothalami, was investigated. We mapped chicken CPT1B to the distal tip of chromosome 1p. The levels of CPT1B mRNA in the HWS line were higher in the hypothalamus and lower in muscle than in the LWS line. This pattern of differential expression indicates that this gene could contribute to the remarkable phenotypic differences between HWS and LWS chickens. However, comparison with quantitative trait loci data showed that the expression of CPT1B is a trans effect, rather than a direct causative locus. In conclusion, the data suggested that the long-term selection for body weight resulted in differential gene expression in the brains of the selected chicken lines. These results may have relevance for the poultry industry and will also contribute to increasing knowledge about human diseases such as obesity and anorexia.

Zusammenfassung: Effekte der L-Carnitinsupplementierung auf das metabolische Profil adipöser und insulinre- sistenter Ponys im Verlaufe einer mehrwöchigen Körpergewichtsreduktion Author: Uta Schmengler Institut für Tierernährung, Ernährungsschäden und Diätetik, Veterinärmedizinische Fakultät, Universität Leipzig Eingereicht im September 2012 76 S., 16 Abb., 23 Tab., 169 Lit., Anhang Einleitung: Das ”Equine Metabolische Syndrom” ist gekennzeichnet durch eine regionale oder generalisierte Adipositas, eine periphere Insulinresistenz sowie akute oder chronische Hufreheschübe. Die Ursache ist in einer bedarfsübersteigenden, hochkalorischen Fütterung und einem relativen Bewegungsmangel zu suchen, wobei auch der genetischen Prädisposition spezieller Rassen eine gewisse Bedeutung zukommt. Ziel dieser Studie war die Untersuchung der Effekte einer L-Carnitinsupplementierung in Kombination mit einer restriktiven Füt- terung und täglicher moderater Bewegung auf Körpermasseverlust, Insulinsensitivität und ausgewählte Parameter des Energiestoffwechsels adipöser und insulinresistenter Ponys. Material und Methoden: Für die placebokontrollierte Doppelblindstudie wurden 16 adipöse Ponys per Losverfahren in zwei Gruppen (N=8) eingeteilt. Zu Versuchsbeginn wiesen die Ponys einen mittleren Body Condition Score von 8,0±2,0 (Skala 1-9) und einen mittleren Cresty Neck Score von 4,0±1,0 (Skala 0-5) auf. Während des 14-wöchigen Körpermassere- duktionsprogramms wurden die Ponys restriktiv gefüttert mit 1 - 1,2 kg Heu/100 kg KM/d. Zusätzlich erhielten 8 Ponys eine L-Carnitin-Zulage (1,3 g/100 kg KM/2d) und 8 Tiere ein Placebo in Form einer Kieselsäureverbindung (1,3 g/100 kg KM/ 2d). Die Ergänzungen wur- den in einem Gemisch aus Grünmehl (50 g/2d) und Mineralfutter verabreicht. Über die 14-wöchige Versuchszeit wurde ein Bewegungsprogramm an sechs Tagen in der Woche durch- geführt, das 25 Minuten Schritt und 15 Minuten Trab beinhaltete. Zu Versuchsbeginn und nach Versuchsende wurde mit beiden Versuchsgruppen ein Frequently sampled intravenous glucose tolerance test (FSIGTT) zur Überprüfung der Insulinsensitivität durchgeführt. Über die gesamte Versuchszeit wurden wöchentlich Blutproben gewonnen zur Bestimmung der ba- salen Serum-Insulinaktivität und Plasma-Glucosekonzentration sowie der Konzentration der Freien Fettsäuren (FFS), Triacylglyceride (TAG), Harnstoff und Betahydroxybutyrat (BHB) im Serum. Die Körpermasseverluste wurden über wöchentliche Wägungen sowie Ermittlung von BCS und CNS kontrolliert. Die statistische Überprüfung wurde anhand parametrischer (ANOVA) und nicht-parametrischer Tests (Wilcoxon signed rank test) durchgeführt, die Kal- kulation der Insulinsensitivität erfolgte über das Minimalmodell anhand eines Computerpro- gramms (MINMOD). Ergebnisse: Im Mittel verloren die Ponys über den Versuchszeitraum von 14 Wochen 1- 3% ihrer Körpermasse pro Woche (Zeit: p < 0, 01, Behandlung: p=0,79), was einem totalen Körpermasseverlust von 14,3±% entsprach. Der BCS reduzierte sich in beiden Versuchs- gruppen um eine Differenz von 3 Einheiten, der CNS verringerte sich in der Carnitingrup- pe (GC ) um eine Differenz von 1,4 und in der Placebogruppe (GP ) um eine Differenz von 1,9 Einheiten. Der Körpermasseverlust war von einer signifikanten Verbesserung der Insu- linsensitivität (Zeit p < 0, 01, Behandlung: p=0,39) begleitet. Die Kalkulation der Insulin- sensitivität im Minimalmodell zeigte eine signifikante Erhöhung der SI-Werte am Versuch- sende in beiden Versuchsgruppen (Beginn Studie GC : 0,76±0,88 l/min/μU*10−4 und GP : 1,61±1,31 l/min/μU*10−4 ; Ende Studie GC : 5,45±0,81 l/min/μU*10−4 und GP : 6,08±2,98 l/min/μU*10−4 ). Signifikante, zeitabhängige Veränderungen wurden auch für die metabo- lischen Parameter beobachtet: Plasma-Glucose und Serum-Insulin reagierten mit einem si- gnifikanten Abfall (Glucose GC : 4,5±0,32 mmol/l vs. 4,21±0,61 mmol/l und Glucose GP : 4,34±0,62 mmol/l vs. 3,86±0,34 mmol/l; Insulin GC : 23,71±32,77 μU/ml vs. 3,67±3,94 μU/ml und GP : 13,55±12,67 μU/ml vs. 1,01±1,09 μU/ml). Dabei kam es zu einem signi- fikanten Anstieg des Serum-Harnstoffs (GC : 3,47±0,73 mmol/l vs. 4,31±1,06 mmol/l und GP : 3,71±0,79 mmol/l vs. 4,9±1,23 mmol/l) sowie der Serum-FFS (GC : 157±95 μmol/l vs. 731±138 μmol/l und GP : 113±63 μmol/l vs. 686±142 μmol/l) und Serum-TAG (GC : 0,53±0,28 mmol/l vs. 0,94±0,61 mmol/l und GP : 0,45±0,23 mmol/l vs. 0,64±0,25 mmol/l). Bezüglich der L-Carnitinsupplementierung wurden keine weiteren Effekte verzeichnet. Schlussfolgerungen: Die restriktive Energiezufuhr von 7 MJ DE/100 kg KM entspre- chend einer Heuzulage von 1 kg/100 kg KM führte zu KM-Verlusten von 1-3 %. Eine Kör- permassereduktion zeigte deutliche Auswirkungen auf den Glucose- und Lipidmetabolismus und führte zu einer signifikanten Verbesserung der Insulinsensitivität, wohingegen die L- Carnitinsupplementierung keine weiteren Effekte auf den Glucosestoffwechsel herbeiführte. Eine bedarfsdeckende Eigensynthese von L-Carnitin ist beim Pony offensichtlich auch im Zu- stand der Insulinresistenz gewährleistet und reicht aus um die obligatorischen Funktionen L-Carnitins im Energiestoffwechsel zu erfüllen. / Summary: The effects of L-carnitine supplementation on body weight losses and metabolic profile in obese and insulin resistant ponies during a several weeks lasting bodyweight reduction pro- gramme Author: Uta Schmengler Institute of Animal Nutrition, Nutrition Diseases and Dietetics, Faculty of Veterinary Medi- cine, University of Leipzig Submitted in September 2012 76 p., 16 fig., 23 tab., 169 ref., appendix Introduction: Insulin resistance, local or general adiposity and the predisposition towards acute or chronical laminitis are components of the equine metabolic syndrome. Contributing factors for this syndrome are the intake and the quality of a high caloric feed by a lack of physical exersice. Howewer, the genetically predisposition of so called ”easy keepers” seems to play a role in pathogenesis. The objective of this study was to investigate the effects of L- carnitine supplementation in combination with a body weight reduction programme (BWRP) on body weight (BW) losses, insulin sensitivity and selected metabolic parameters in obese and insulin resistant ponies. Material und methods: 16 obese ponies (mean BCS = 8.0±2.0, mean CNS = 4.0±1.0) were assigned to a randomized double blind, placebo-controlled study. The ponies werde di- vided into two equal groups (N=8). During a 14 weeks lasting BWRP the ponies were fed 1.0-1.2 kg hay/100 kg BW daily. Additionally, 8 ponies were supplemented with L-carnitine (1.3g/100 kg BW) and 8 ponies were supplemented with a placebo (1.3g/100 kg BW). The supplements were offered in a mixture of 50 g grass meal and 50 g of a commercial mineral mixture, twice a day. During BWRP ponies were exercised a low-intensity protocol 6 days a week (daily 25 min walk and 15 min trot across the countryside). A frequently sampled intravenous glucose tolerance test (FSIGTT) was undertaken in order to assess insulin sen- sitivity at the beginning and the end of the study. Routine blood samples were collected for analysis of plasma glucose, serum insulin, free fatty acids (FFA), triglycerides (TG), urea and beta-hydroxybutyrate (BHB). Ponies were weighed weekly after 12 h of feed restriction by using an electronic scale for large animals. BCS and CNS were recorded weekly by the same 2 observers throughout the study. The statistical analysis was performed by parametric and non-parametric tests (ANOVA and Wilcoxon ranked test). The minimal modell calcu- lation of insulin sensitivity (SI) from FSIGTT was calculated by the computer programme (MINMOD). Results: Ponies lost 1-3% BW per week over the BWRP (time P<0.01, L-carnitine supple- mentation P=0.79), meaning a total body weight loss of 14.3%. BCS decreased in both groups with a difference of three points and CNS was reduced with a difference of 1.4-1.9 points. BW losses were accompanied by a significant improvement in insulin sensitivity (Time: P<0.01, L-carnitine supplementation: P=0.39). The calculation for SI-values by the minimalmodell showed a significant increase in L-carnitine group (GC ) and placebo group (GP ) in the end of the study. (GC : 0.76±0.88 L/min/μU*10−4 to 5.45±0.81 L/min/μU*10−4 , GP : 1.61±1.31 L/min/μU*10−4 to 6.08±2.98 L/min/μU*10−4 ). Significant time related decreases were observed for plasma glucose (GC : 4.5±0.32 mmol/L to 4.21±0.61 mmol/L, GP : 4.34±0.62 mmol/L to 3.86±0.34 mmol/L) and serum insulin (GC : 23.71±32.77 μU/mL to 3.67±3.94 μU/mL, GP : 13.55±12.67 μU/mL to 1.01±1.09 μU/mL). A significant increase was observed for serum urea (GC : 3.47±0.73 mmol/L to 4.31±1.06 mmol/L, GP : 3.71±0.79 mmol/L to 4.9±1.23 mmol/L), FFA (GC : 157±95 μmol/L to 731±138 μmol/L und GP : 113±63 μmol/L to 686±142 μmol/L) and TG (GC : 0.53±0.28 mmol/L to 0.94±0.61 mmol/L, GP : 0.45±0.23 mmol/L to 0.64±0.25 mmol/L) during BWRP. There was no further improvement in metabolic responses by L-carnitine supplementation. Conclusions: Energy intake of 7 MJ DE/100 kg BW leads to bodyweight losses of 1- 3%, herby improving insulin sensitivity and glucose metabolism. L-carnitine supplementation does not further improve glucose or fat metabolism, suggesting that endogenous L-carnitine synthesis was sufficient to facilitate energy metabolism in obese and insulin resistant ponies.

A doença da urina do xarope do bordo (MSUD) é causada pela deficiência na atividade do complexo da desidrogenase dos U-cetoácidos de cadeia ramificada (BCKAD), promovendo o acúmulo dos aminoácidos de cadeia ramificada (BCAA) leucina (Leu), isoleucina (Ile) e valina (Val) e seus U-cetoácidos correspondentes (BCKA). A MSUD caracteriza-se por cetoacidose, ataxia, coma, retardo mental e psicomotor. Estudos em animais demonstraram que BCAA e BCKA estimulam a lipoperoxidação e reduzem capacidade antioxidante cerebral em ratos. Também há evidências de que o estresse oxidativo ocorra em pacientes com MSUD no diagnóstico e durante o tratamento e que devido à terapia com dieta restrita e hipoproteica eles possuam deficiência de L-carnitina (L-car), um importante composto para o metabolismo energético. Recentemente, estudos demonstraram o papel antioxidante e anti-inflamatório da L-car, através de sua ação antiperoxidativa, sequestradora de espécies reativas e efeito estabilizador de danos às membranas celulares. Considerando que a fisiopatologia da MSUD ainda é pouco compreendida e que existe um crescente número de estudos enfatizando o envolvimento do estresse oxidativo na doença, neste trabalho foi investigado o efeito in vitro e in vivo da L-car sobre o estresse oxidativo e o dano inflamatório na MSUD tendo como objetivos: A) estudar a indução ao dano oxidativo pelos metabólitos acumulados na MSUD, verificando o possível papel antioxidante da L-car sobre o dano ao DNA in vitro; B) avaliar o efeito in vivo da suplementação de 50 mg/kg/dia de L-car sobre: b.1) a indução do dano ao DNA em leucócitos de pacientes com a MSUD tratados com dieta de restrição proteica, correlacionando as concentrações dos principais metabólitos acumulados nesta doença e verificando o possível papel antioxidante da suplementação da Lcar; b.2) a concentração de citocinas pró-inflamatórias em plasma de pacientes com MSUD tratados com dieta de restrição proteica e a correlação com o estresse oxidativo; b.3) os parâmetros de dano oxidativo à biomoléculas em urina de pacientes com MSUD sob dieta de restrição proteica; C) avaliar o efeito da L-car sobre o estresse oxidativo causado pelos metabólitos acumulados na MSUD em córtex cerebral e cerebelo de ratos Wistar, através de um modelo crônico de indução química da doença. Verificou-se que a Leu e o seu - cetoácido correspondente, o ácido -cetoisocapróico (KIC), causaram danos ao DNA in vitro e L-car foi capaz de diminuir significativamente essas alterações, principalmente as causadas pelo KIC. Quando testado o efeito da suplementação de L-car sobre o dano ao DNA em pacientes MSUD, observou-se um aumento significativo de lesões ao DNA em pacientes com dieta de restrição proteica quando comparados aos controles e a terapia com L-car foi capaz de diminuir significativamente os níveis desses danos. Também foram verificadas correlações do tipo negativa entre as concentrações de L-car e os índices de dano ao DNA e do tipo positiva entre as lesões ao DNA e níveis de MDA, marcador de lipoperoxidação, explicitando uma relação entre o dano ao DNA observado nos pacientes com MSUD, estresse oxidativo e o benefício da suplementação de L-car. Também averiguou-se o efeito da terapia de L-car sobre as citocinas pró-inflamatórias interleucina 1Y (IL-1Y), interleucina 6 (IL-6) e interferon gama (INF- Z). Constatou-se aumentos significativos de IL-1Y, IL-6 e INF- Z no plasma de pacientes com MSUD antes da suplementação de L-car e uma reversão completa desses valores aos níveis dos controles para IL-1Y e INF- Z após a administração de L-car. Ainda, verificou-se que a L-car pode auxiliar na defesa celular contra a inflamação e o estresse oxidativo, observando-se uma correlação negativa entre todas citocinas testadas e as concentrações de L-car, e uma correlação positiva entre o conteúdo de MDA e níveis de IL-1Y e IL-6. Constatou-se também que as medidas de di-tirosina (dano oxidativo a proteínas) e isoprostanos (dano de lipoperoxidação) estavam aumentadas e a capacidade antioxidante total diminuída na urina de pacientes com MSUD sem terapia com L-car e a suplementação deste composto induziu efeitos benéficos sobre estes parâmetros, reduzindo os níveis de di-tirosina e isoprostanos e aumentando a capacidade antioxidante medida em urina. Foi também observado um aumento de KIC urinário após dois meses de tratamento com L-car, quando comparado com o grupo controle, demonstrando um incremento da excreção deste metabolito tóxico. Desta forma, esses resultados sugerem um efeito de reversão de dano oxidativo pela L-car e que a urina pode ser utilizada para monitorar este tipo de lesão em pacientes afetados pela MSUD. Por fim, foram analisados em córtex cerebral e cerebelo de ratos Wistar submetidos ao modelo crônico de MSUD: espécies reativas ao ácido tiobarbitúrico (TBARS), para avaliar lipoperoxidação, conteúdo de carbonilas (dano oxidativo proteico), oxidação de diclorofluoresceína (DCF), para quantificar produção de espécies reativas teciduais, conteúdo de glutationa reduzida (GSH) que é um importante antioxidante não enzimático e a atividade das enzimas antioxidantes catalase (CAT), superóxido dismutase (SOD), glutationa peroxidase (GPx) e glicose-6-fosfato-desidrogenase (G6PD). Os resultados mostraram que a administração crônica de BCAA estimulou a lipoperoxidação, o dano oxidativo proteico, aumento de espécies reativas e diminuição das defesas antioxidantes enzimáticas e não enzimáticas, especialmente em córtex cerebral e o tratamento com L-car foi capaz de prevenir estes efeitos, exceto o dano oxidativo a proteínas. Em conjunto, estes resultados demonstram que os metabólitos acumulados na MSUD induzem dano oxidativo a biomoléculas (lipídios, proteínas e DNA), diminuem o status antioxidante e promovem aumento de processos inflamatórios. Ainda, estes dados podem contribuir para a compreensão dos mecanismos de ação dos efeitos citotóxicos dos metabólitos acumulados na MSUD e evidenciar o papel do estresse oxidativo e da inflamação na neuropatofiosiologia desta doença, além do efeito protetor da L-car sobre este processo. O estudo de antioxidantes, como a L-car, pode propor uma abordagem terapêutica adicional ao que é empregado atualmente para pacientes com MSUD, que é essencialmente dietética e, portanto, de difícil manejo. / Maple syrup urine disease (MSUD) is caused by deficiency of the activity of the mitochondrial enzyme complex branched-chain U-ketoacid dehydrogenase (BCKAD). The metabolic defect leads to accumulation of the branched chain amino acids (BCAA) leucine (Leu), isoleucine (Ile) and valine (Val) and the corresponding branched-chain U-keto acids. The clinical features of MSUD include ketoacidosis, seizures, coma, psychomotor delay and mental retardation. Treatment consists in Leu, Val and Ile restricted diet. Studies in animals have demonstrated that lipid peroxidation is stimulated by BCAA and BCKA in brain of rats and these metabolites reduce in vitro and in vivo the cerebral capacity to modulate the damage associated to increased free radical production. Also, there is evidence that oxidative stress occurs in MSUD patients at diagnosis and during treatment and that due to terapy with protein restricted diet they present L-carnitine (L-car) deficiency, an important compound for energy metabolism. Recent studies have demonstrated the antioxidant and anti-inflammatory role of L-carnitine (L-car), through its action against peroxidation in different tissues by various mechanisms, a scavenger of reactive oxygen species and the stabilizing effect of damage to cell membranes. Considering that the pathophysiology of MSUD is still poorly understood, and that there is an increasing number of studies emphasizing the oxidative stress involvement in the disease, this study investigated the in vitro and in vivo effect of L-car on oxidative stress and inflammatory damage in MSUD with the following purposes: A) to study the induction of damage by accumulated metabolites in MSUD, analyzing the possible antioxidant role of L-car on DNA damage in vitro; B) to evaluate the in vivo effect of 50 mg/kg/day of L-car supplementation about: b.1) the induction of DNA damage in leukocytes of MSUD patients treated with protein-restricted diet, correlating this damage with the concentrations of the major metabolites accumulated in this disorder and checking the possible antioxidant role of L-car supplementation; b.2) plasma inflammatory cytokines in treated MSUD patients with protein-restricted diet and the correlation with oxidative stress; b.3) oxidative damage parameters in urine of MSUD patients with protein-restricted diet supplemented with L-car; C) to investigate the BCAA effect on some oxidative stress parameters and evaluate the L-car efficacy against these possible pro-oxidant effects in cerebral cortex and cerebellum of rats submitted to a chronic chemically-induced model of MSUD. DNA damage index (DI) showed that Leu and -ketoisocaproic acid (KIC) groups was significantly higher than that of the control group, and that L-car was able to significantly prevent this damage, especially that due to KIC. Accordingly, DNA DI in MSUD patients under BCAA-restricted diet was significantly increased as compared to controls and L-car supplementation was able to significantly decrease this parameter. It was also verified a significant positive correlation between DNA DI and MDA content, a marker of lipid peroxidation. Furthermore, we found an inverse significant correlation between DI and L-car levels. These results strengthen a relationship between DNA damage observed in MSUD patients, oxidative stress and the L-car supplementation benefit. The role of L-car on plasma inflammatory cytokines interleukin-1Y (IL-1Y), interleukin-6 (IL-6) and interferon-gamma (INF- Z) was also evaluated in these patients. Significant increases of IL-1Y, IL-6, and INF- Z were observed before the treatment with L-car. Moreover, there is a negative correlation between all cytokines tested and L-car concentrations and a positive correlation among the MDA content and IL-1Y and IL-6 values after L-car supplementation. It was also demonstrated that the oxidative stress parameters di-tyrosine (oxidative protein damage) and isoprostanes (lipid peroxidation assay) were increased and the antioxidant capacity was reduced in urine of MSUD patients without L-car therapy and that the supplementation of this compound induced beneficial effects on these parameters, so reducing the di-tyrosine and isoprostanes levels and increasing the antioxidant capacity. It was also showed a significant increase in urinary KIC after 2 months of L-car treatment compared to control group, demonstrating an increased excretion of this toxic metabolite. In conclusion, these results suggest a reversion effect of the oxidative damage by L-car and that urine can be used to monitorize oxidative damage in patients affected by this disease. The following parameters were analysed in cerebral cortex and cerebellum of Wistar rats submitted to MSUD chemically-induced chronic model: thiobarbituric acid reactive species (TBA-RS), to evaluate lipid peroxidation, carbonyl content to evaluate protein oxidative damage, DCF oxidation to quantify reactive species production, reduced glutathione (GSH), an important non-enzymatic antioxidant and the activities of antioxidant enzymes catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx) and glucose-6-phosphate dehydrogenase (G6PD). The results showed that the chronic administration of BCAA was able to promote both lipid and protein oxidation, increase of reactive species production and decreased brain antioxidant defenses, especially in cerebral cortex and that L-car was able to prevent these effects, except for oxidative damage to proteins. Taken together, these results demonstrate that the metabolites accumulated in MSUD cause oxidative damage to biomolecules (lipids, proteins and DNA), decrease antioxidant status and promote increased inflammatory processes. These results may contribute to the understanding of the mechanism of action of the cytotoxic effect of the metabolites accumulated in MSUD and the role of oxidative stress and inflammation in the MSUD neuropathophysiology besides the protective effect of L-car on this process. The study of antioxidants like L-car can opens an additional therapeutic approach to that currently employed for MSUD patients, which is primarily dietary and therefore difficult to handle.

A doença da urina do xarope do bordo (MSUD) é causada pela deficiência na atividade do complexo da desidrogenase dos U-cetoácidos de cadeia ramificada (BCKAD), promovendo o acúmulo dos aminoácidos de cadeia ramificada (BCAA) leucina (Leu), isoleucina (Ile) e valina (Val) e seus U-cetoácidos correspondentes (BCKA). A MSUD caracteriza-se por cetoacidose, ataxia, coma, retardo mental e psicomotor. Estudos em animais demonstraram que BCAA e BCKA estimulam a lipoperoxidação e reduzem capacidade antioxidante cerebral em ratos. Também há evidências de que o estresse oxidativo ocorra em pacientes com MSUD no diagnóstico e durante o tratamento e que devido à terapia com dieta restrita e hipoproteica eles possuam deficiência de L-carnitina (L-car), um importante composto para o metabolismo energético. Recentemente, estudos demonstraram o papel antioxidante e anti-inflamatório da L-car, através de sua ação antiperoxidativa, sequestradora de espécies reativas e efeito estabilizador de danos às membranas celulares. Considerando que a fisiopatologia da MSUD ainda é pouco compreendida e que existe um crescente número de estudos enfatizando o envolvimento do estresse oxidativo na doença, neste trabalho foi investigado o efeito in vitro e in vivo da L-car sobre o estresse oxidativo e o dano inflamatório na MSUD tendo como objetivos: A) estudar a indução ao dano oxidativo pelos metabólitos acumulados na MSUD, verificando o possível papel antioxidante da L-car sobre o dano ao DNA in vitro; B) avaliar o efeito in vivo da suplementação de 50 mg/kg/dia de L-car sobre: b.1) a indução do dano ao DNA em leucócitos de pacientes com a MSUD tratados com dieta de restrição proteica, correlacionando as concentrações dos principais metabólitos acumulados nesta doença e verificando o possível papel antioxidante da suplementação da Lcar; b.2) a concentração de citocinas pró-inflamatórias em plasma de pacientes com MSUD tratados com dieta de restrição proteica e a correlação com o estresse oxidativo; b.3) os parâmetros de dano oxidativo à biomoléculas em urina de pacientes com MSUD sob dieta de restrição proteica; C) avaliar o efeito da L-car sobre o estresse oxidativo causado pelos metabólitos acumulados na MSUD em córtex cerebral e cerebelo de ratos Wistar, através de um modelo crônico de indução química da doença. Verificou-se que a Leu e o seu - cetoácido correspondente, o ácido -cetoisocapróico (KIC), causaram danos ao DNA in vitro e L-car foi capaz de diminuir significativamente essas alterações, principalmente as causadas pelo KIC. Quando testado o efeito da suplementação de L-car sobre o dano ao DNA em pacientes MSUD, observou-se um aumento significativo de lesões ao DNA em pacientes com dieta de restrição proteica quando comparados aos controles e a terapia com L-car foi capaz de diminuir significativamente os níveis desses danos. Também foram verificadas correlações do tipo negativa entre as concentrações de L-car e os índices de dano ao DNA e do tipo positiva entre as lesões ao DNA e níveis de MDA, marcador de lipoperoxidação, explicitando uma relação entre o dano ao DNA observado nos pacientes com MSUD, estresse oxidativo e o benefício da suplementação de L-car. Também averiguou-se o efeito da terapia de L-car sobre as citocinas pró-inflamatórias interleucina 1Y (IL-1Y), interleucina 6 (IL-6) e interferon gama (INF- Z). Constatou-se aumentos significativos de IL-1Y, IL-6 e INF- Z no plasma de pacientes com MSUD antes da suplementação de L-car e uma reversão completa desses valores aos níveis dos controles para IL-1Y e INF- Z após a administração de L-car. Ainda, verificou-se que a L-car pode auxiliar na defesa celular contra a inflamação e o estresse oxidativo, observando-se uma correlação negativa entre todas citocinas testadas e as concentrações de L-car, e uma correlação positiva entre o conteúdo de MDA e níveis de IL-1Y e IL-6. Constatou-se também que as medidas de di-tirosina (dano oxidativo a proteínas) e isoprostanos (dano de lipoperoxidação) estavam aumentadas e a capacidade antioxidante total diminuída na urina de pacientes com MSUD sem terapia com L-car e a suplementação deste composto induziu efeitos benéficos sobre estes parâmetros, reduzindo os níveis de di-tirosina e isoprostanos e aumentando a capacidade antioxidante medida em urina. Foi também observado um aumento de KIC urinário após dois meses de tratamento com L-car, quando comparado com o grupo controle, demonstrando um incremento da excreção deste metabolito tóxico. Desta forma, esses resultados sugerem um efeito de reversão de dano oxidativo pela L-car e que a urina pode ser utilizada para monitorar este tipo de lesão em pacientes afetados pela MSUD. Por fim, foram analisados em córtex cerebral e cerebelo de ratos Wistar submetidos ao modelo crônico de MSUD: espécies reativas ao ácido tiobarbitúrico (TBARS), para avaliar lipoperoxidação, conteúdo de carbonilas (dano oxidativo proteico), oxidação de diclorofluoresceína (DCF), para quantificar produção de espécies reativas teciduais, conteúdo de glutationa reduzida (GSH) que é um importante antioxidante não enzimático e a atividade das enzimas antioxidantes catalase (CAT), superóxido dismutase (SOD), glutationa peroxidase (GPx) e glicose-6-fosfato-desidrogenase (G6PD). Os resultados mostraram que a administração crônica de BCAA estimulou a lipoperoxidação, o dano oxidativo proteico, aumento de espécies reativas e diminuição das defesas antioxidantes enzimáticas e não enzimáticas, especialmente em córtex cerebral e o tratamento com L-car foi capaz de prevenir estes efeitos, exceto o dano oxidativo a proteínas. Em conjunto, estes resultados demonstram que os metabólitos acumulados na MSUD induzem dano oxidativo a biomoléculas (lipídios, proteínas e DNA), diminuem o status antioxidante e promovem aumento de processos inflamatórios. Ainda, estes dados podem contribuir para a compreensão dos mecanismos de ação dos efeitos citotóxicos dos metabólitos acumulados na MSUD e evidenciar o papel do estresse oxidativo e da inflamação na neuropatofiosiologia desta doença, além do efeito protetor da L-car sobre este processo. O estudo de antioxidantes, como a L-car, pode propor uma abordagem terapêutica adicional ao que é empregado atualmente para pacientes com MSUD, que é essencialmente dietética e, portanto, de difícil manejo. / Maple syrup urine disease (MSUD) is caused by deficiency of the activity of the mitochondrial enzyme complex branched-chain U-ketoacid dehydrogenase (BCKAD). The metabolic defect leads to accumulation of the branched chain amino acids (BCAA) leucine (Leu), isoleucine (Ile) and valine (Val) and the corresponding branched-chain U-keto acids. The clinical features of MSUD include ketoacidosis, seizures, coma, psychomotor delay and mental retardation. Treatment consists in Leu, Val and Ile restricted diet. Studies in animals have demonstrated that lipid peroxidation is stimulated by BCAA and BCKA in brain of rats and these metabolites reduce in vitro and in vivo the cerebral capacity to modulate the damage associated to increased free radical production. Also, there is evidence that oxidative stress occurs in MSUD patients at diagnosis and during treatment and that due to terapy with protein restricted diet they present L-carnitine (L-car) deficiency, an important compound for energy metabolism. Recent studies have demonstrated the antioxidant and anti-inflammatory role of L-carnitine (L-car), through its action against peroxidation in different tissues by various mechanisms, a scavenger of reactive oxygen species and the stabilizing effect of damage to cell membranes. Considering that the pathophysiology of MSUD is still poorly understood, and that there is an increasing number of studies emphasizing the oxidative stress involvement in the disease, this study investigated the in vitro and in vivo effect of L-car on oxidative stress and inflammatory damage in MSUD with the following purposes: A) to study the induction of damage by accumulated metabolites in MSUD, analyzing the possible antioxidant role of L-car on DNA damage in vitro; B) to evaluate the in vivo effect of 50 mg/kg/day of L-car supplementation about: b.1) the induction of DNA damage in leukocytes of MSUD patients treated with protein-restricted diet, correlating this damage with the concentrations of the major metabolites accumulated in this disorder and checking the possible antioxidant role of L-car supplementation; b.2) plasma inflammatory cytokines in treated MSUD patients with protein-restricted diet and the correlation with oxidative stress; b.3) oxidative damage parameters in urine of MSUD patients with protein-restricted diet supplemented with L-car; C) to investigate the BCAA effect on some oxidative stress parameters and evaluate the L-car efficacy against these possible pro-oxidant effects in cerebral cortex and cerebellum of rats submitted to a chronic chemically-induced model of MSUD. DNA damage index (DI) showed that Leu and -ketoisocaproic acid (KIC) groups was significantly higher than that of the control group, and that L-car was able to significantly prevent this damage, especially that due to KIC. Accordingly, DNA DI in MSUD patients under BCAA-restricted diet was significantly increased as compared to controls and L-car supplementation was able to significantly decrease this parameter. It was also verified a significant positive correlation between DNA DI and MDA content, a marker of lipid peroxidation. Furthermore, we found an inverse significant correlation between DI and L-car levels. These results strengthen a relationship between DNA damage observed in MSUD patients, oxidative stress and the L-car supplementation benefit. The role of L-car on plasma inflammatory cytokines interleukin-1Y (IL-1Y), interleukin-6 (IL-6) and interferon-gamma (INF- Z) was also evaluated in these patients. Significant increases of IL-1Y, IL-6, and INF- Z were observed before the treatment with L-car. Moreover, there is a negative correlation between all cytokines tested and L-car concentrations and a positive correlation among the MDA content and IL-1Y and IL-6 values after L-car supplementation. It was also demonstrated that the oxidative stress parameters di-tyrosine (oxidative protein damage) and isoprostanes (lipid peroxidation assay) were increased and the antioxidant capacity was reduced in urine of MSUD patients without L-car therapy and that the supplementation of this compound induced beneficial effects on these parameters, so reducing the di-tyrosine and isoprostanes levels and increasing the antioxidant capacity. It was also showed a significant increase in urinary KIC after 2 months of L-car treatment compared to control group, demonstrating an increased excretion of this toxic metabolite. In conclusion, these results suggest a reversion effect of the oxidative damage by L-car and that urine can be used to monitorize oxidative damage in patients affected by this disease. The following parameters were analysed in cerebral cortex and cerebellum of Wistar rats submitted to MSUD chemically-induced chronic model: thiobarbituric acid reactive species (TBA-RS), to evaluate lipid peroxidation, carbonyl content to evaluate protein oxidative damage, DCF oxidation to quantify reactive species production, reduced glutathione (GSH), an important non-enzymatic antioxidant and the activities of antioxidant enzymes catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx) and glucose-6-phosphate dehydrogenase (G6PD). The results showed that the chronic administration of BCAA was able to promote both lipid and protein oxidation, increase of reactive species production and decreased brain antioxidant defenses, especially in cerebral cortex and that L-car was able to prevent these effects, except for oxidative damage to proteins. Taken together, these results demonstrate that the metabolites accumulated in MSUD cause oxidative damage to biomolecules (lipids, proteins and DNA), decrease antioxidant status and promote increased inflammatory processes. These results may contribute to the understanding of the mechanism of action of the cytotoxic effect of the metabolites accumulated in MSUD and the role of oxidative stress and inflammation in the MSUD neuropathophysiology besides the protective effect of L-car on this process. The study of antioxidants like L-car can opens an additional therapeutic approach to that currently employed for MSUD patients, which is primarily dietary and therefore difficult to handle.