Les furocoumarines sont des métabolites secondaires qui dérivent de la voie de biosynthèse des phénylpropanoïdes. Ces phytoalexines interviennent notamment dans les mécanismes de défense des plantes tels que la résistance aux bioagresseurs. Le déterminisme moléculaire de cette voie de biosynthèse est encore mal connu mais il a néanmoins été démontré depuis les années 1960 que les enzymes catalysant les différentes étapes de la voie la synthèse des furocoumarines appartenaient à différentes familles. Les travaux présentés dans ce document se sont focalisés sur deux familles d'enzymes : les dioxygenases oxoglutarate dépendantes et les cytochromes P450s. La première étape de la voie de biosynthèse des furocoumarines consiste en une ortho-hydroxylation du p-coumarate qui mène à la formation de l'umbelliférone. Basé sur des travaux récents sur Arabidopsis, six gènes codants pour des dioxygénases ont été isolés chez Ruta graveolens, Citrus limetta et Pastinaca sativa. Les protéines correspondantes présentent plus de 58% d'identité avec la Féruloyle 6' Hydroxylase (F6'H) d'A. thaliana. La caractérisation fonctionnelle de ces enzymes a été réalisée dans un système d'expression hétérologue procaryote. Sur les 6 enzymes, trois n'ont pu être exprimée efficacement, et deux présentent une activité F6'H similaire à celle décrite pour A. thaliana. La dernière enzyme dispose de caractéristiques nouvelles non décrites à ce jour. Elle est en mesure de réaliser l'hydroxylation du féruloyle coA et du p-coumaroyle coA. Ces études in vitro ont été complétées par une exploration des fonctions de la protéine dans la plante. Une analyse fine du profil d'expression du gène a permis de mettre en évidence une expression qui est en corrélation avec le niveau de production d'umbelliférone. La fonction de la protéine a également été validée par une analyse des produits formés dans des feuilles de Nicotiana benthamiana transformées transitoirement. Les cytochromes P450 catalysent 60% des réactions de la voie de biosynthèse de furocoumarines. Un travail de criblage fonctionnel de cytochromes P450 identifiés au préalable chez Ammi majus et Thapsia garganica a été entrepris. Les analyses de bio-informatiques et les modifications apportées au niveau du mode opératoire pour l'expression dans la levure ont permis d'émettre des hypothèses concernant le rôle de certains P450 candidats. Ces travaux exploratoires et préliminaires font supposer de nouvelles conjectures relatives à cette voie de biosynthèse / Furanocoumarins are secondary metabolites deriving from the phenylpropanoid biosynthetic pathway. These phytoalexins are especially involved in plant defense mechanisms against insects or phytopatogenous fungi and bacteria. The molecular control of this biosynthetic pathway is still poorly understood even though it has been demonstrated since the 1960s that enzymes catalyzing the different steps are belonging to different enzymatic families. The work presented here is focused on two enzyme families: oxoglutarate dependent dioxygenases and cytochrome P450s. The first step in the furanocoumarins biosynthetic pathway is the ortho-hydroxylation of p-coumarate, which leads to the formation of umbelliferone. Based on a recent work done on Arabidopsis, we isolated six genes encoding dioxygenases from Ruta graveolens, Citrus limetta and Pastinaca sativa. The corresponding proteins share more than 58% identity with the A. thaliana féruloyle 6' Hydroxylase (F6'H). The functional characterization of these enzymes was performed in a prokaryotic heterologous expression system. Of the six enzymes, three could not be functionnaly expressed and two exhibited a similar F6'H activity as described for A. thaliana. The last enzyme has new properties not described to date. It is able to achieve both hydroxylation of féruloyle CoA and p-coumaroyle CoA. These in vitro studies were completed by a functional exploration of the protein in planta. A detailed analysis of the gene expression pattern highlighted a link with the level of umbelliferone synthesis. The function of the protein was also confirmed by an analysis of the products formed in transiently transformed Nicotiana benthamiana leaves. Cytochrome P450s catalyze 60% of the reactions of the furanocoumarin biosynthetic pathway. Therefore, a functional screening of cytochrome P450 previously identified in Ammi majus and Thapsia garganica was undertaken. The bioinformatic analyses and the changes undertaken in the procedure for expression in yeast allowed drawing hypotheses on the function of some of these P450 candidates. These exploratory and preliminary experiments allowed suggesting new hypotheses about the biosynthetic pathway

Les données épidémiologiques montrent une association inverse entre les taux de HDL-cholestérol (HDL-C) et le risque d'évènements cardiovasculaires. Des traitements ayant montré une augmentation significative du HDL-C, comme les inhibiteurs de la protéine de transfert des esters de cholestérol, devraient donc permettre de réduire le risque cardio-vasculaire. En utilisant différentes techniques de modélisation, nous avons tenté de quantifier l'efficacité attendue sur les événements cardiovasculaires de l'un d'entre eux, le dalcétrapib, ne disposant que de données pharmacocinétiques et pharmacodynamiques. Tout d’abord, afin d'établir la relation pharmacocinétique / pharmacodynamique entre les concentrations et la modification de HDL-C, nous avons analysé les données individuelles des patients dyslipidémiques par une approche de population. Une hausse moyenne de HDL-C de 26.4 % par rapport au placebo était alors anticipée. Nous avons ensuite tenté de corréler l'effet observé sur l'HDL-C et l'effet clinique à partir de données d'autres études par méta-régression des essais évaluant l'effet des principaux hypolipémiants en prévention secondaire. Cette modélisation n'a pas permis de montrer de corrélation entre le changement de l’HDL-C (P5 P95 :-3.0 et 36 %) et la réduction du risque cardiovasculaire. Une analyse de sensibilité par type de traitement suggère qu'une même hausse de HDL-C entre deux classes thérapeutiques pourrait se traduire par un effet clinique dissemblable, indiquant que HDL-C ne peut pas être utilisé comme critère intermédiaire puisqu'il ne serait pas un prédicteur indépendant du risque cardiovasculaire / Epidemiological data demonstrate an inverse correlation between HDL-cholesterol (HDL-C) levels and cardiovascular risk. Therefore, drugs as cholesteryl ester transfer protein (CETP) inhibitors that lead to a significant HDL-C increase are believed to reduce the occurrence of coronary events. We aimed to evaluate the clinical efficacy of one CETP inhibitor, dalcetrapib, by using various modeling techniques while only pharmacokinetic (PK) and pharmacodynamlc (PD) data were available. First, we analyzed individual data from dyslipidemic patients using a population approach in order to establish the PK/PD relationship between dalcetrapib concentrations and HDL-C change. The results show that an average raise of 26.4 % is expected in comparison to placebo with the 5th (P5) and 95th (P95) percentile of the mean average at 20.7 % and 31.9 % respectively. The increase in HDL-C is explained by a delayed catabolism following the transfer inhibition of cholesterol ester from HDL to Apo-B rich lipoproteins. We endeavored then to correlate HDL-C increase to coronary events by using a meta-regression analysis on randomized trials that evaluated the clinical efficacy of main dyslipidemic drugs on coronary events in secondary prevention. The modeling did not show a statistical association between HDL-C change (P5-P95:-3.0 and 36 %) and coronary risk reduction. A sensitivity analysis by drug class suggests that the same HDL-C increase resulting from different mechanisms of action may not impact the cardiovascular risk in the same way. This would indicate that HDL-C could not be used as a risk marker since it might not be an independent predictor of cardiovascular risk

INTRODUÇÃO: Diabetes mellitus tipo 2 (DM2) é um fator de risco isolado para coronariopatia, principalmente quando associado à microalbuminúria (MA). Alterações estruturais e funcionais das lipoproteínas não são totalmente esclarecidas nesse contexto. OBJETIVO: Avaliar, em pacientes DM2, a influência da presença da MA e do tratamento com estatina ou insulina nas transferências para HDL (T) de lípides e no tamanho desta lipoproteína. MÉTODOS: Estudamos 33 pacientes DM2 e 34 controles pareados para idade. Uma nanoemulsão lipídica artificial radiomarcada com 3H-Triglicéride (TG) e 14C-Colesterol Livre (CL) ou 3H-Colesterol Éster (CE) e 14C-Fosfolípide (FL) foi incubada com plasma. A nanoemulsão e as lipoproteínas foram precipitadas, exceto a HDL, que teve sua radioatividade contada. O diâmetro da HDL foi mensurado por método de dispersão da luz. RESULTADOS: A TFL (%) foi maior no grupo com DM2 que no grupo controle (25,2±3,2 e 19,7±3,2 respectivamente; p<0,001), assim como a TCL (%): 9,1±2,7 e 6,3±1,5 respectivamente; p<0,001. O diagnóstico de MA não se associou às mudanças da propriedade de transferência. O uso da insulina associou-se à menor TFL(%): 23,5±2,1 contra 26,1±3,3; p=0,018. Já o uso da estatina associou-se à queda de todas: TCE(%): 3,5±0,9; TFL(%):23,8±2,0; TTG(%): 3,9±0,8; TCL(%):7,4±1,3 quando comparado ao grupo que não usava estatina (TCE(%):5,9±2,4; TFL(%):26,9±3,6; TTG(%):6,4±2,2; TCL(%):11,1±2,6). O tamanho de HDL foi semelhante em qualquer condição analisada. CONCLUSÕES: DM2 aumenta a transferência de lípides de superfície para HDL, enquanto o uso de estatina diminuiu todas as transferências. A presença de MA não se associou às alterações das transferências de lípides / INTRODUCTION: Type 2 diabetes mellitus (DM2) is an isolated risk factor for coronary artery disease, especially when associated to microalbuminuria (MA). Structural and functional alterations of lipoproteins are not well known in this context. OBJECTIVE: To evaluate, in DM2 patients, the influence both of MA and the treatment with statins or insulin on the lipids transfer to HDL (T) and on the size of this lipoprotein. METHODS: We studied 33 DM2 patients and 34 controls paired for age. An artificial lipidic nanoemulsion radio labeled with 3H-Triglyceride (TG) and 14C-Free Cholesterol (FC) or 3H-Cholesterol Ester (CE) and 14C-Phospholipid (PL) was incubated with plasma. The nanoemulsion and the lipoproteins were precipitated, except for HDL, that had its radioactivity measured. The HDL diameter was measured by laser light scattering method. RESULTS: The TPL (%) was greater in the DM2 group then in the control group (25,2±3,2 and 19,7±3,2 respectively; p<0,001), as well as TFC (%): 9,1±2,7 and 6,3±1,5 respectively; p<0,001. The MA did not affect the transfer. Insulinotherapy was associated with less TPL(%): 23,5±2,1 against 26,1±3,3; p=0,018, and the statin therapy with less transfer of all lipids: TCE(%): 3,5±0,9; TPL(%):23,8±2,0; TTG(%): 3,9±0,8; TFC(%):7,4±1,3 when compared to the group that did not use statin: TCE(%):5,9±2,4; TPL(%):26,9±3,6; TTG(%):6,4±2,2; TFC(%):11,1±2,6. The HDL size was about the same under all the circumstances analyzed. CONCLUSIONS: DM2 is associated with greater transfer of superficial lipids to HDL, while the statin usage was associated with a smaller transfer of all lipids. The MA diagnosis was not associated with any change in lipids transfer

A disfunção microvascular, envolvendo células endoteliais, plaquetas e leucócitos, está presente na hipertensão arterial pulmonar (HAP), associando-se a risco aumentado de trombose e menor sobrevida. Estudos sobre disfunção microvascular são escassos em outras formas da doença que não a idiopática. Os objetivos do estudo foram: caracterizar a disfunção microvascular em diferentes formas de HAP através da dosagem de marcadores bioquímicos, avaliando possíveis correlações com índices de gravidade; investigar os efeitos da administração de rosuvastatina em níveis circulantes de marcadores de disfunção microvascular nesses pacientes; e investigar possível associação entre o nível plasmático dos marcadores e prognóstico. Foram incluídos sessenta pacientes: 14 com HAP idiopática ou hereditária, e 46 com HAP associada a cardiopatia congênita (HAPCCg) sem hipoxemia (N=18) ou com hipoxemia (N=28), com idades entre 13 e 60 anos. Foram dosados os níveis plasmáticos circulantes do antígeno do fator de von Willebrand (vWF:Ag), ativador tecidual do plasminogênio (t-PA); inibidor do ativador do plasminogênio (PAI-1), fator de necrose tumoral (TNF-), proteína C reativa (PCR), selectina-P; interleucina-6 (IL-6); e interleucina-10 (IL -10), na condição basal e após 30, 60 e 180 dias de tratamento, por método imunoenzimático. Após randomização, administrouse placebo (N=30) ou dose única oral diária (10mg) de rosuvastatina (N=30), por seis meses. Dados demográficos e funcionais como idade, distância caminhada em seis minutos, saturação periférica de oxigênio em repouso e após esforço, bem como hematócrito, também foram registrados. Pacientes com HAPCCg foram acompanhados por um período de 0,7 a 4,0 anos (mediana de 3,6 anos). Na condição basal, excetuando-se TNF- e PCR, todas as proteínas apresentaram-se significantemente elevadas em relação aos controles (p<0,001), havendo correlação com índices de gravidade clínica. No estudo com rosuvastatina, houve redução significante nos níveis de selectina-P em relação ao placebo (p=0,037), ao longo do tratamento. Houve melhora na saturação periférica de oxigênio após seis minutos de caminhada, no grupo estatina, em pacientes com HAPCCg com hipoxemia, em relação ao placebo. Considerando-se o período de acompanhamento, em portadores de HAPCCg, níveis plasmáticos persistentemente elevados do vWF:Ag (média de quatro determinações), acima do nível correspondente ao percentil 95 dos controles (139 U/d/L) associaram-se maior risco de morte (razão de risco 6,56, IC 95% 1,46 a 29,4, p=0.014), sem alteração após ajustamento para variáveis demográficas, funcionais e de tratamento, à análise multivariada. Assim, a disfunção microvascular está presente em indivíduos com HAP idiopática, hereditária ou associada a cardiopatias congênitas. Na HAP, o uso crônico de rosuvastatina em dose baixa associase à redução do nível circulante de selectina-P, e propicia aumento na saturação periférica de oxigênio ao final do exercício, em indivíduos com HAPCCg e hipoxemia. Em indivíduos portadores de HAPCCg, níveis plasmáticos persistentemente elevados do vWF:Ag são indicativo de pior prognóstico / Microvascular dysfunction, involving endothelial cells, platelets and leukocytes, is present in pulmonary arterial hypertension (PAH), and is associated to higher risk to thrombotic complications and mortality. Most data about microvascular dysfunction in PAH do not include other forms of the disease beyond idiopathic PAH. The present study was planned to measure plasma levels microvascular dysfunction markers in two different forms of PAH, and investigate possible correlations with indices of severity of the disease; to investigate the effects of chronic rosuvastatin administration versus placebo on the circulating levels of these markers; and to investigate possible associations between levels of these parameters and prognosis. Sixty patients (aged 13 to 60 years) were included, 14 with idiopathic or hereditary PAH, and 46 with congenital heart disease-associated PAH (CHDPAH), in the absence (N=18) or presence (N=28) of hypoxemia. Plasma levels of von Willebrand factor antigen (vWF:Ag), tissue-plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), tumor necrosis factor alpha (TNF-), reactive C protein (RCP), P-selectin, interleukin-6 (IL- 6), and interleukin-10 (IL-10) were measured before treatment and 30, 90, and 180 days on treatment using high-sensitivity enzyme-linked immunosorbent assay kits. Patients were randomly assigned to placebo (N=30) or a single oral dose of rosuvastatin (N=30), 10mg/day, for six months. Demographic and functional data such as age, six-minute walk distance, peripheral oxygen saturation at rest and at the end of the six-minute walk, as well as the hematocrit, were recorded. Patients with CHDPAH were followed-up for 0.7 to 4.0 years (median 3.6 years). At baseline, levels of all proteins (except TNF- and RCP) were significantly increased in patients versus controls (p<0,001), and correlated significantly with indices of severity of the disease. P-selectin level was lower in the rosuvastatin group compared with placebo throughout the treatment (p = 0.037). In hypoxemic CHDPAH patients, the peripheral oxygen saturation, at the end of the six-minute walk, was higher in the rosuvastatin group, compared with placebo. During the follow-up of patients with CHDPAH, an average vWF:Ag (mean of four determinations) above the level corresponding to the 95th percentile of controls (139 U/dL) was associated with a high risk of death (hazard ratio 6.56, 95% CI 1.46 to 29.4, p=0.014). This was not modified after adjustment for demographic, functional and treatment-related variables in multivariate analysis. In conclusion, microvascular dysfunction is present in individuals with idiopathic, hereditary and the congenital heart disease-associated PAH. The chronic use of low-dose rosuvastatin is associated to reduction of circulating levels of P-selectin. In patients with CHDPAH with hypoxemia, rosuvastatin also increases peripheral oxygen saturation during exercise. In CHDPAH patients, a sustained increase in plasma vWF:Ag is indicative of poor prognosis

El ácido 2-hidroxioleico (2OHOA) es un fármaco antitumoral diseñado para regular la estructura y composición de los lípidos de membrana y la función de importantes proteínas de membrana. El objetivo principal de este trabajo fue estudiar cómo el 2OHOA modula la composición lipídica y la estructura de membrana en las células tumorales. Se observó que el 2OHOA indujo profundas alteraciones en el contenido de fosfolípidos, aumentando el contenido de esfingomielina y disminuyendo el contenido de fosfatidiletanolamina y fosfatidilcolina. Este efecto fue específico contra las células cancerosas, ya que el tratamiento no afectó la composición lipídica de las células no tumorales MRC-5 de fibroblastos humanos. El aumento de SM se debió a una activación rápida y específica de las SM sintasas. Como consecuencia de la activación sostenida de la SMS, todo el metabolismo de los esfingolípidos se vio afectado. Finalmente, se evaluó el impacto de todos estos cambios sobre las propiedades biofísicas de membrana mediante espectroscopia de fluorescencia / 2-Hydroxyoleic acid (2OHOA) is a potent antitumor drug that was designed to regulate membrane lipid composition and structure and the function of important membrane proteins. The main goal of this work was to study how 2OHOA modulates the membrane lipid composition and structure of tumor cells. 2OHOA induced dramatic alterations in phospholipid content, increasing sphingomyelin mass, and decreasing phosphatidyl-ethanolamine and phosphatidylcholine. This effect was specific against cancer cells as it did not affect non-tumor MRC-5 cells. The increased SM mass was due to a rapid and highly specific activation of SM synthases. As a consequence of the sustained activation of SMS, the whole sphingolipid metabolism was affected. Then, the impact of all these changes on membrane biophysical properties was evaluated by fluorescence spectroscopy

Background: Genome-wide association studies (GWAs) have identified almost one hundred genetic loci associated with variances in human blood lipid phenotypes including very low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol and triglycerides. Nevertheless the revealed loci only explain a small fraction of heritability and therefore a subtile phenotype of cholesterol homoestasis was examined in our study for the very first time. Methods and Results: Using a multi-stage approach of a GWA, firstly, a genome-wide analysis (Affymetrix 500K GeneChip) for serum lanosterol and serum total cholesterol using LC-MS/MS was conducted in 1495 participants of the KORA-S3/F3 cohort with subsequent replication in two additional independent samples of the the KORA-S3/F3 cohort (n = 1157) and CARLA cohort (n = 1760). Two genetic variants, SNP rs7703051 and rs17562686, in the HMGCR locus were significantly associated with serum lanosterol and showed similar effects of elevated serum lanosterol for each minor allele (combined n = 4412: p = 1,4 x 10-10, +7,1% and p = 4,3 x 10-6, +7,8%). Furthermore, rs7703051 showed a nominal statistical significance to serum cholesterol (p = 0,04). A combined analysis of both SNPs demonstrated that observed associations of rs17562686 can be partly explained by LD with rs7703051 being the primary polymorphism in that study. Nevertheless, rs17562686 shows consistent independent effects on serum lanosterol, thus being associated to a lipid phenotype for the very first time. The following SNP-fine mapping of the HMGCR locus was carried out in the CARLA cohort with subsequent validation in the LE-Heart cohort (n = 1895). The recently published SNP rs3846662 being in tight LD with rs7703051 could be associated with variances of serum lanosterol in both cohorts and functional in vivo studies of gen expression using qRT-PCR assays demonstrated a highly significant association of higher expression of alternatively spliced HMGCR mRNA lacking exon 13 with homozygosity for the rs3846662 major allele in 51 human liver samples (p < 0,01) and 958 human PBMCs (p = 2,1 x 10-7). The overall HMGCR gen expression was not affected. Further investigation of in vivo HMG-CoA reductase enzyme activity in both human samples (n = 48 and n = 55) using anionic exchange column chromatography and scintillation counting of [3-14C]-HMG-CoA and [5-3H]-mevalonolacton did not show any significant results. In addition there was not any association in the LE-Heart cohort between these SNPs and the development of CAD. Finally, rs7703051 could be replicated for already published total cholesterol (combined n = 4412) and rs3846662 for LDL-cholesterol (LE-Heart n = 1895). Since fine mapping in CARLA showed several SNPs throughout the HMGCR locus being in LD with rs17562686 we performed a DNA sequencing of the extended 5´-HMGCR promotor region in six human liver samples. A unknown SNP was discovered in the promotor but could not be associated with any of the examined phenotypes mentioned above. The minor allele of SNP rs5909 situated next to the stop codon and being in high LD with rs17562686 was associated with elevated serum lanosterol and slightly reduced HMGCR gen expression, but further studies including the above mentioned as well as measurement of 3’-UTR transcript lengths using qRT-PCR assays did not produce significant results. Conclusion: The phenotype serum lanosterol could be associated with genetic polymorphisms (e.g. rs7703051) in the HMGCR locus. Therefore already published associations of HMGCR with total cholesterol and LDL-cholesterol can be explained by variances of cholesterol homeostasis. The SNP rs17562686 could be associated with a phenotype of human blood lipids for the very first time. Subsequent gen expression analyses demonstrated a highly significant association of rs3846662 with variant patterns of HMGCR alternative splicing. A significant effect of alternatively spliced protein on enzyme activity and a association of these SNPs with CAD could not be shown.

No description available.

La maladie d’Alzheimer (MA) est un problème majeur de santé publique. Elle se traduit par des atteintes de la mémoire reposant sur des dysfonctionnements synaptiques induits par les oligomères de peptide ß-amyloïde (Aß). Ceux-ci activent la phospholipase A2 cytosolique (cPLA2) qui libère l’acide arachidonique (ARA) des phospholipides (PL) membranaires neuronaux. L’acyl-CoA synthétase 4 (ACSL4) peut limiter cette libération en favorisant la réincorporation d’ARA dans les PL. Dans l’alimentation occidentale, il constitue une part croissante des apports lipidiques. Contrairement à l’acide docosahexaénoïque (DHA), l’influence de l’ARA dans la MA a été peu étudiée. C’est pourquoi nous avons étudié la mobilisation de l’ARA et son effet sur la sensibilité au peptide Aß. Nous avons montré dans un premier temps qu’un apport alimentaire en ARA affecte la mémoire à court terme et sensibilise les capacités d’apprentissage au peptide Aß. Ces altérations sont associées à des diminutions d’expression des récepteurs AMPA et de l’ACSL4, une prolifération astrocytaire et une incorporation accrue en ARA dans les espèces de PL phosphatidylsérine et phosphatidyléthanolamine (PE). D’autre part, la différenciation des cellules HT22 nous a permis de montrer que l’ACSL4 intervient dans l’incorporation de l’ARA et dans l’équilibre ARA/DHA, notamment dans les espèces PE. Cela indique qu’un excès en ARA dans l’alimentation peut constituer un facteur d’aggravation de la MA et que les enzymes assurant sa mobilisation, comme la cPLA2 et l’ACSL4, peuvent moduler ce risque. La caractérisation de leurs niveaux d’expression pourrait permettre de définir des groupes d’individus à risque vis-à-vis de la MA / Alzheimer’s disease (AD) is a major public health problem. This disease is characterized by memory impairments which are caused by synaptic dysfunctions induced by the oligomers of amyloid-ß peptide (Aß). These activate the cytosolic phospholipase A2 (cPLA2) which releases arachidonic acid (ARA) from neuronal membrane phospholipids (PL) whereas acyl-CoA synthetase 4 (ACSL4) potentially counteracts this release by favoring ARA reincorporation into PL. Western diets contain growing amount of ARA. Contrary to docosahexaenoic acid (DHA), a few studies were devoted to the influence of ARA in AD. This is why we decided to study the mobilization of ARA and its effects on the sensitivity to Aß oligomers. First we showed that dietary ARA reduces short-term memory abilities and increases the deleterious effects of Aß on learning abilities. These alterations of cognitive abilities are associated to reductions of expression levels of AMPA receptors and ACSL4, an astrocyte proliferation, and greater incorporation of ARA in PL species phosphatidylethanolamine (PE) and phosphatidylserine. Secondly, we used differentiated HT22 to show that ACSL4 modulate ARA incorporation and ARA / DHA balance in the PE species. These results indicate that excessive dietary intake of ARA may be a worsening factor in AD and the enzymes regulating ARA mobilization, such as cPLA2 and ACSL4, can modulate this risk. The characterization of their enzymatic activities could allow the identification of groups of individuals at AD risk.

A disfunção microvascular, envolvendo células endoteliais, plaquetas e leucócitos, está presente na hipertensão arterial pulmonar (HAP), associando-se a risco aumentado de trombose e menor sobrevida. Estudos sobre disfunção microvascular são escassos em outras formas da doença que não a idiopática. Os objetivos do estudo foram: caracterizar a disfunção microvascular em diferentes formas de HAP através da dosagem de marcadores bioquímicos, avaliando possíveis correlações com índices de gravidade; investigar os efeitos da administração de rosuvastatina em níveis circulantes de marcadores de disfunção microvascular nesses pacientes; e investigar possível associação entre o nível plasmático dos marcadores e prognóstico. Foram incluídos sessenta pacientes: 14 com HAP idiopática ou hereditária, e 46 com HAP associada a cardiopatia congênita (HAPCCg) sem hipoxemia (N=18) ou com hipoxemia (N=28), com idades entre 13 e 60 anos. Foram dosados os níveis plasmáticos circulantes do antígeno do fator de von Willebrand (vWF:Ag), ativador tecidual do plasminogênio (t-PA); inibidor do ativador do plasminogênio (PAI-1), fator de necrose tumoral (TNF-), proteína C reativa (PCR), selectina-P; interleucina-6 (IL-6); e interleucina-10 (IL -10), na condição basal e após 30, 60 e 180 dias de tratamento, por método imunoenzimático. Após randomização, administrouse placebo (N=30) ou dose única oral diária (10mg) de rosuvastatina (N=30), por seis meses. Dados demográficos e funcionais como idade, distância caminhada em seis minutos, saturação periférica de oxigênio em repouso e após esforço, bem como hematócrito, também foram registrados. Pacientes com HAPCCg foram acompanhados por um período de 0,7 a 4,0 anos (mediana de 3,6 anos). Na condição basal, excetuando-se TNF- e PCR, todas as proteínas apresentaram-se significantemente elevadas em relação aos controles (p<0,001), havendo correlação com índices de gravidade clínica. No estudo com rosuvastatina, houve redução significante nos níveis de selectina-P em relação ao placebo (p=0,037), ao longo do tratamento. Houve melhora na saturação periférica de oxigênio após seis minutos de caminhada, no grupo estatina, em pacientes com HAPCCg com hipoxemia, em relação ao placebo. Considerando-se o período de acompanhamento, em portadores de HAPCCg, níveis plasmáticos persistentemente elevados do vWF:Ag (média de quatro determinações), acima do nível correspondente ao percentil 95 dos controles (139 U/d/L) associaram-se maior risco de morte (razão de risco 6,56, IC 95% 1,46 a 29,4, p=0.014), sem alteração após ajustamento para variáveis demográficas, funcionais e de tratamento, à análise multivariada. Assim, a disfunção microvascular está presente em indivíduos com HAP idiopática, hereditária ou associada a cardiopatias congênitas. Na HAP, o uso crônico de rosuvastatina em dose baixa associase à redução do nível circulante de selectina-P, e propicia aumento na saturação periférica de oxigênio ao final do exercício, em indivíduos com HAPCCg e hipoxemia. Em indivíduos portadores de HAPCCg, níveis plasmáticos persistentemente elevados do vWF:Ag são indicativo de pior prognóstico / Microvascular dysfunction, involving endothelial cells, platelets and leukocytes, is present in pulmonary arterial hypertension (PAH), and is associated to higher risk to thrombotic complications and mortality. Most data about microvascular dysfunction in PAH do not include other forms of the disease beyond idiopathic PAH. The present study was planned to measure plasma levels microvascular dysfunction markers in two different forms of PAH, and investigate possible correlations with indices of severity of the disease; to investigate the effects of chronic rosuvastatin administration versus placebo on the circulating levels of these markers; and to investigate possible associations between levels of these parameters and prognosis. Sixty patients (aged 13 to 60 years) were included, 14 with idiopathic or hereditary PAH, and 46 with congenital heart disease-associated PAH (CHDPAH), in the absence (N=18) or presence (N=28) of hypoxemia. Plasma levels of von Willebrand factor antigen (vWF:Ag), tissue-plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), tumor necrosis factor alpha (TNF-), reactive C protein (RCP), P-selectin, interleukin-6 (IL- 6), and interleukin-10 (IL-10) were measured before treatment and 30, 90, and 180 days on treatment using high-sensitivity enzyme-linked immunosorbent assay kits. Patients were randomly assigned to placebo (N=30) or a single oral dose of rosuvastatin (N=30), 10mg/day, for six months. Demographic and functional data such as age, six-minute walk distance, peripheral oxygen saturation at rest and at the end of the six-minute walk, as well as the hematocrit, were recorded. Patients with CHDPAH were followed-up for 0.7 to 4.0 years (median 3.6 years). At baseline, levels of all proteins (except TNF- and RCP) were significantly increased in patients versus controls (p<0,001), and correlated significantly with indices of severity of the disease. P-selectin level was lower in the rosuvastatin group compared with placebo throughout the treatment (p = 0.037). In hypoxemic CHDPAH patients, the peripheral oxygen saturation, at the end of the six-minute walk, was higher in the rosuvastatin group, compared with placebo. During the follow-up of patients with CHDPAH, an average vWF:Ag (mean of four determinations) above the level corresponding to the 95th percentile of controls (139 U/dL) was associated with a high risk of death (hazard ratio 6.56, 95% CI 1.46 to 29.4, p=0.014). This was not modified after adjustment for demographic, functional and treatment-related variables in multivariate analysis. In conclusion, microvascular dysfunction is present in individuals with idiopathic, hereditary and the congenital heart disease-associated PAH. The chronic use of low-dose rosuvastatin is associated to reduction of circulating levels of P-selectin. In patients with CHDPAH with hypoxemia, rosuvastatin also increases peripheral oxygen saturation during exercise. In CHDPAH patients, a sustained increase in plasma vWF:Ag is indicative of poor prognosis

Introdução: As avaliações econômicas completas do tipo custo-utilidade, suportadas por dados de efetividade do mundo real, permitem uma perspectiva diferenciada da avaliação de tecnologia em saúde. Objetivo: Realizar uma análise de custo-utilidade do uso de estatinas para a prevenção secundária de eventos cardiovasculares em portadores de doença cardiovascular isquêmica, e avaliar a variabilidade da efetividade e da razão de custo-efetividade incremental com diferentes classificações de usuários de estatina (incidentes e prevalentes). Método: Um modelo de microssimulação de Markov com 5 estados, ciclos anuais e horizonte temporal de 20 anos, com taxas de desconto de 5% foi desenvolvido. As probabilidades de transição para mortalidade por todas as causas foram extraídas após pareamento por escore de propensão dos dados e tratamento de dados ausentes de uma base secundária de registro assistencial com linkage determinístico com a base de mortalidade do Ministério da Saúde. As probabilidades dos desfechos não-fatais foram obtidas na literatura. As medidas de efetividade (QALY) foram calculadas com dados publicados dos domínios do SF-36 de um estudo realizado com a população do mesmo hospital, no mesmo período e com as mesmas condições clínicas e transformados em medidas de utilidade por modelo validado. Somente custos diretos na perspectiva do reembolso do SUS foram considerados. Resultados: 3.150 pacientes foram pareados após o escore de propensão, 1.050 não usuários de estatina, 1.050 usuários de estatinas classificados como prevalentes e 1.050 usuários de estatinas classificados como incidentes, com diagnóstico de doença cardiovascular isquêmica prévia, com seguimento médio de 5,1 anos. A efetividade das estatinas quando considerados todos os usuários em relação aos não usuários resultou em um HR para mortalidade de 0,992 (IC 95% 0,85; 0,96) e de 0,90 (IC 95% 0,85; 0,96) para os usuários incidentes. A RCEI comparando todos os usuários de estatinas versus não usuários foi de R$5.846,10/QALY e de R$7.275,61/QALY para os usuários incidentes. Conclusão: As estatinas diminuíram a mortalidade por todas as causas, e a análise incluindo usuários prevalentes diminui o tamanho do efeito. O tratamento possui custo-efetividade favorável dentro do limiar de disponibilidade a pagar definido, sendo modificado pela forma de extração do dado de efetividade / Background: The complete economic evaluations, such as cost-utility analysis, supported by real world data of effectiveness lead to a more realistic perspective of a health technology assessment. Objective: Perform a cost-utility analysis of statins for secondary prevention in ischemic cardiovascular disease patients based on effectiveness from real world data and evaluate the variability of effectiveness and incremental cost-effectiveness ratio (ICER) considering prevalent and incident users. Methods: A Markov microssimulation model with five states, annual cycle and time horizon (TH) of 20 years, with discount rate of 5% was developed. Transition probabilities for all cause mortality was derived from a secondary database of a teaching hospital after record linkage with national registry of mortality database and an analysis of propensity score matching and multiple imputation analysis for missing data. Non-fatal endpoints were derived from a published meta-analysis. Utility measures was calculated with a validated model to derive values from published domains of SF-36 QoL questionnaire, domains was measured for a published RCT in the same teaching hospital, over the same period, with similar age and diagnostic characteristics. Only direct costs were analyzed from the Brazilian public health reimbursement perspective. Results: 3150 patients were matched, 1050 non-statins users (CG), 1050 prevalent statins users (PSU) and 1050 incident statins users (ISU) with previous cardiovascular disease, with mean follow-up of 5,1 years. Treatment effects on the treatment group considering all statins users for all cause mortality had a hazard ratio of HR:0,992 (IC 95% 0,85 - 0,96) and HR: 0,90 (IC 95% 0,85 - 0,96) only for ISU. The ICER comparing all users with non-users was R$5.846,10 per QALY and for ISU was R$7.275,61 per QALY. Conclusion: Real world evidence demonstrated that statins are an effective treatment to reduce all cause mortality in secondary prevention and are a cost-effective strategy considering the willingness to pay established, but the prevalent users resulted in less effectiveness of the drug when included in the analysis and influenced the ICER