Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-09-04T15:18:51Z No. of bitstreams: 0 / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-09-04T15:53:06Z (GMT) No. of bitstreams: 0 / Made available in DSpace on 2018-09-04T15:53:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-07-31 / A colite ulcerativa (CU) é uma doença inflamatória crônica cujas manifestações podem afetar drasticamente a qualidade de vida do indivíduo sendo por isso importante a adesão ao tratamento a fim de mantê-la em fase de remissão. Fatores individuais podem interferir na continuidade do tratamento do paciente em remissão. Assim, o objetivo deste estudo foi avaliar a prevalência de não adesão e a possível influência das características sóciodemográficas, clínicas e farmacoterapêuticas associadas com a não adesão ao tratamento da CU em remissão. Trata-se de estudo transversal com adultos portadores de CU em remissão acompanhados no Centro de Doenças Inflamatórias Intestinais do Hospital Universitário da Universidade Federal de Juiz de Fora, Minas Gerais, conduzido entre agosto de 2017 e janeiro de 2018. Os fatores associados à não adesão ao tratamento foram investigados por meio da aplicação de questionário padronizado contendo dados sociodemográficas, clínicos e farmacoterapêuticos dos pacientes, além da Escala de Adesão Terapêutica de Morisky (MMAS-8), Inventario de Depressão de Beck (IDB) e Subescala de Ansiedade de sete itens da Escala Hopitalar de Ansiedade e Depressão. O total de 90 pacientes foi incluído neste estudo com média de idade de 50,4±12,9. A prevalência de não adesão foi de 77,8% e não foram encontradas dentre as 21 variáveis analisadas, nenhuma relacionada com o comportamento de não adesão. A prevalência de não adesão em pacientes com CU em remissão foi elevada. Nenhuma das características sociodemográficos, clínicas e farmacoterapêuticas analisadas foram associadas com este comportamento, alertando para a necessidade de maior atenção dos profissionais de saúde a esse importante aspecto do tratamento. / Ulcerative colitis (UC) is a chronic inflammatory disease whose manifestations can drastically affect the quality of life of patients. Therefore, treatment adherence is important in order to keep it in remission. Individual factors may interfere with the continuity of the patient's treatment in remission. To verify the prevalence of non-adherence and the influence of the sociodemographic, clinical and pharmacotherapeutic characteristics associated with non-adherence to the treatment of UC in remission. A cross-sectional study was conducted with adults presenting UC in remission followed at the Clinical Gastroenterology outpatient clinic of the Clinical Gastroenterology Ambulatory of Universitary Hospital, in Juiz de Fora, Minas Gerais, Brazil, between August 2017 and January 2018. Factors of risk for non-adherence to treatment were investigated by applying a questionnaire on sociodemographic, clinical and pharmacotherapeutic characteristics of the patient. The Morisky Therapeutic Adhesion Scale (MMAS-8), Beck Depression Inventory (BDI) and Subscale of Anxiety of seven items of the Hopitalar Anxiety and Depression Scale were also applied. A total of 90 patients were included, with a mean age of 50.41±12.94 years. The prevalence of non-adherence to therapy was 77.8% and we did not identified among 21 variables analyzed anyone associated with non-adherence prevalence. High proportions of patients with UC in remission presented non-adherents to therapy; however, we did not found characteristics among sociodemographic, clinical and pharmacotherapeutic data that would be able to explain this behavior, alerting the need for greater attention of health professionals to this important aspect of treatment.

Orientador: Mário Roberto Maróstica Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimentos / Made available in DSpace on 2018-08-24T07:02:00Z (GMT). No. of bitstreams: 1 Cazarin_CinthiaBauBetim_D.pdf: 7421314 bytes, checksum: 3937f33ea2104648545ff81374161389 (MD5) Previous issue date: 2014 / Resumo: A doença inflamatória intestinal (DII) édoença crônica recidivante que atinge milhões de pessoas no mundo, englobando a Doença de Crohn (DC) e a Retocolite Ulcerativa (RCU). A diferença entre as duas éa sua localização, sendo a RCU específica da região do cólon e reto. O tratamento atual para estas patologias é realizado a base de corticosteróides, imunomoduladores ou anti -TNF-a, conhecido como terapia biol ógica, os quais apresentam diversos efeitos colaterais ao paciente. A patogênese desta doença está relacionada com fatores gen éticos, imunol ógicos e ambientais. Acredita-se que o desequilíbrio da microbiota, assim como a ruptura na barreira natural exercida pela mucosa intestinal seja o primeiro passo para o desencadeamento da resposta inflamatória. As fibras alimentares apresentam função sobre a modulação da microbiota, sendo utilizada como substrato para a formação de ácidos graxos de cadeia curta (AGCC), gerados por meio do processo de fermentação. Em adição, os compostos fenólicos presentes nos alimentos apresentam atividade antioxidante e anti -inflamatória que podem atuar na modulação do processo inflamatório. Sendo assim, o objetivo deste trabalho foi avaliar a utilização de um subproduto da indústria de alimentos, a casca do maracujá, como fonte de fibras e compostos fenólicos, na alimentação de ratos com colite induzida por TNBS e sua influência no processo inflamatório. Ratos Wistar foram alimentados com dieta AIN-93, sendo substituídos 50% da celulose da dieta padrão (AIN) por fibras da casca do maracujá (PFF), em dois ensaios biológicos: prevenção e tratamento. O dano causado àmucosa foi avaliado macro e microscopicamente, assim como a expressão de marcadores inflamatórios. Avaliação da microbiota e formação de AGCC foram realizadas no conteúdo cecal. Embora a avaliação macroscópica da mucosa tenha apresentado um escore maior para o grupo PFF no ensaio prevenção, a avaliação microscópica em ambos os ensaios não mostrou diferença no dano àmucosa entre os grupos. O ensaio tratamento mostrou diminuição da peroxidação lipídica do cólon, diminuição na contagem de enterobactérias e aeróbios totais, assim como aumento de ácido acético e butírico nas fezes do grupo PFF. Jáno ensaio prevenção foi observada modulação dos lactobacilos e bifidobactérias. Com relação aos marcadores inflamatórios, foram observadas modulações significativas da expressão de IKK?, COX-2 e iNOS nos animais alimentados com a dieta PFF. Estes resultados sugerem que a casca do maracujá Passiflora edulis pode modular a microbiota aumentando a produção de AGCC, assim como a expressão de marcadores inflamatórios observados na colite induzida por TNBS. Desta forma, a casca do maracujá poderia ser utilizada como coadjuvante na terapêutica da DII como fonte de fibras e polifenóis / Abstract: Inflammatory bowel disease (IBD) is a chronic relapsing disease that affects millions of people worldwide, encompassing Crohn's disease (CD) and ulcerative colitis (UC). UC is an inflammation specific to the region of the colon and rectum. Current treatments for these diseases are based on the use of corticosteroids, immunomodulators or biological therapy, which have various side effects to the patient. The pathogenesis of IBD is related to genetic, immunological and environmental factors. It is believed that the microbial imbalance as well as natural break in the barrier exerted by the intestinal mucosa is the first step in triggering the inflammatory response. Food dietary fiber presents capacity to modulate the microbiota and improve short chain fatty acids (SCFA) formation, by fermentation process. In addition, the phenolic compounds present in the food have antioxidant and anti-inflammatory activities that can modulate the inflammatory process. Thus, this study aimed to evaluate the use of a byproduct of the food industry, the passion fruit peel, as a source of fiber and phenolic compounds in the diet of rats with TNBS-induced colitis and its influence on the inflammatory process. Wistar rats were fed a modified AIN-93 (50% of cellulose was replaced by passion fruit peel PFF) to evaluate prevention and treatment of colitis induced by TNBS. The damage to the mucosa was evaluated macroscopically and microscopically, as well as the expression of inflammatory markers. Evaluation of the microbiota and formation of SCFA in cecal contents were performed. The macroscopic appearance of the mucosa damage in the group PFF was higher than AIN in prevention trial. However, the microscopic evaluation in both trials showed no difference in mucosal damage amongst the groups. Treatment trial showed that PFF could promote a decrease in lipid peroxidation of the colon, decrease in enterobacteria and total aerobics counts, as well as increase in acetic and butyric acid in the stool. On the other hand, the prevention trial showed that the ingredient could exert modulation on lactobacilli and bifidobacteria. The inflammatory markers showed significant modulation, mainly IKK?, COX-2 and iNOS in animals fed with PFF diet. These results suggest that the passion fruit peel, Passiflora edulis, can modulate the microbiota, increase the production of SCFA, and modulate the expression of inflammatory markers observed in TNBS-induced colitis. Passion fruit peel could be used in the treatment of IBD as a source of fiber and polyphenols / Doutorado / Nutrição Experimental e de Alimentos / Doutora em Alimentos e Nutrição

As doenças inflamatórias intestinais (DII) são causadas por desequilíbrio entre as respostas imunes efetoras e reguladoras na mucosa intestinal e podem ser moduladas pelo eixo hipotálamo-hipófise-adrenal (HPA) por meio de interações neuroimunoendócrinas e secreção de cortisol. Embora os glicocorticóides (GC) sejam utilizados para tratar a DII, o cortisol produzido pelas glândulas supra-renais também está envolvido na resposta ao estresse, que pode levar a doenças inflamatórias descontroladas. Portanto, o objetivo deste trabalho é avaliar a participação do eixo HPA na modulação da resposta imune de mucosa intestinal. Para tal, camundongos C57BL/6 foram submetidos à remoção das glândulas adrenais seguida por indução de colite pela administração de água contendo 3% de dextran sulfato de sódio (DSS). Os resultados demonstraram que a ausência das adrenais levou à maior suscetibilidade à doença e mortalidade precoce, fenômeno que não foi prevenido pela reposição de GC. Os animais adrenalectomizados com colite apresentaram níveis significativamente menores de LPS, concomitantemente ao aumento de IL-6 no soro quando comparados aos camundongos não adrenalectomizados. Além disso, os animais adrenalectomizados apresentaram menor celularidade na lâmina própria (LP), menos áreas de erosão e menor escore histopatológico associado ao aumento de IFN-? e FasL, no intestino, sem produção local compensatória de corticosterona. Houve aumento na atividade das enzimas mieloperoxidase (MPO), N- acetilglicosaminidase (NAG) e eosinófilo-peroxidase (EPO) no intestino dos animais expostos ao DSS quando comparados ao grupo de camundongos controles saudáveis, independentemente da presença do eixo HPA intacto e o tratamento com GC nos animais adrenalectomizados levou à redução significativa da atividade de MPO. Também foi observado na LP dos camundongos adrenalectomizados aumento significativo na frequência de células dendríticas tolerogênicas CD11b+CD11c+CD103+, T auxiliares (CD3+CD4+), T citolíticas (CD3+CD8+) e NKT (CD3+CD49b+), além de redução significativa da população de células dendríticas pró-inflamatórias CD11b+CD11c+CD103-, leucócitos CD11b+ e linfócitos intra-epiteliais, de maneira dependente de GC. A ausência do eixo HPA intacto levou à diminuição de leucócitos totais no baço quando comparados ao grupo com colite, relacionada principalmente à redução significativa na frequência de células NKT (CD3+CD49b+), as quais foram restauradas nos camundongos tratados com GC exógenos. Durante a exposição ao DSS houve aumento de células Th2 e Th1 no baço dos camundongos não adrenalectomizados, enquanto que a remoção das adrenais levou a notável redução na população de células T CD4 produtoras de IL-4, IL-10, IFN-? ou IL-17, com aumento de células Th17 e diminuição significativa de células Th1 no baço dos camundongos adrenalectomizados e tratados com GC. De forma interessante, houve menor acúmulo de células T reguladoras juntamente à redução na intensidade média de fluorescência (MFI) de FOXP3 em células T CD4+CD25+ do baço dos camundongos adrenalectomizados expostos ao DSS, de maneira geral dependente de GC. Por fim, esta diminuição de mecanismos reguladores foi acompanhada de menor índice de proliferação e aumento de IL-10 no sobrenadante de cultura de esplenócitos de camundongos com o eixo HPA não ii funcional, indicando que a ausência de GC endógenos pode alterar significativamente a homeostase do sistema imunológico. Juntos, nossos resultados demonstram que o eixo HPA é importante na modulação da resposta imunológica durante a colite induzida experimentalmente / Inflammatory bowel diseases (IBD) are caused by imbalance between regulatory and effector immune responses in the intestinal mucosa and can be modulated by the hypothalamic-pituitary-adrenal (HPA) axis via neuroimmune endocrine interactions and secretion of cortisol. Although glucocorticoids (GC) are used to treat IBD, cortisol produced by the adrenals glands is also involved in the stress response, which can lead to uncontrolled inflammatory diseases. Therefore, the aim of this study was to evaluate the HPA axis in the modulation of the immune response of intestinal mucosa. C57BL/6 mice were subjected to removal of the adrenal glands followed by induction of colitis by administration of water containing 3% dextran sulfate sodium (DSS). The results showed that the absence of adrenals led to increased susceptibility to disease and early mortality, a phenomenon that was not prevented by GC replacement. Adrenalectomized animals exposed to DSS had significantly lower levels of LPS, concomitantly to increased IL-6 in the serum when compared to non-adrenalectomized mice. In addition, adrenalectomized animals had lower cellularity in the lamina propria (LP), less erosion areas and less histopathologic score associated with increased IFN-? and FasL in the intestine, without compensatory local production of corticosterone. There was an increase in the activity of the myeloperoxidase (MPO) enzyme, N- acetilglicosaminidase (NAG) and eosinophil-peroxidase (EPO) in the intestines of DSS-exposed animals when compared to the healthy control group of mice, regardless of the presence of intact HPA axis, while treatment with GC led to significantly reduced MPO activity. It was also observed in the LP of adrenalectomized mice significant increase in the frequency of tolerogenic dendritic cells CD11b+CD11c+CD103+, helper T (CD3+ CD4+), cytolytic T (CD3+ CD8+) and NKT (CD3+ CD49b+) besides significant reduction in the population of pro-inflammatory dendritic cells CD11c+ CD11b+ CD103-, leukocyte CD11b+ and intraepithelial lymphocytes, GC-dependent manner. The absence HPA intact carried decrease in total leukocytes in spleen when compared to the group with colitis, related mainly to significant reduction in the frequency of NKT cells (CD3+CD49b+), which were restored in the GC treated mice. During exposure to DSS there was increased Th2 and Th1 cells in the spleen of non-adrenalectomized mice, while the removal of the adrenals was associated to a marked reduction in the population of CD4 T cells producing IL-4, IL-10, IFN-? or IL-17 with increased Th17 cells and significant decrease in Th1 cells in the spleen of adrenalectomized mice treated with GC. Interestingly there was less accumulation of regulatory T cells together to a reduction in mean fluorescence intensity (MFI) of FOXP3 in CD4+CD25+ T cells in the spleen of mice exposed to DSS after adrenalectomy, most dependent on GC. Finally, the decline of regulatory mechanisms was accompanied by lower rates of proliferation and increased IL-10 in the supernatant culture of splenocytes of mice with disrupted HPA axis, indicating that the absence of endogenous GC altered significantly the homeostasis of the immune system. Together, our results demonstrate that the HPA axis is important in modulating the immune response during experimentally induced colitis

Les maladies inflammatoires chroniques de l’intestin (maladie de Crohn, rectocolite hémorragique, colite inclassée) de l’enfant peuvent occasionner des séquelles anatomiques telles que la fibrose intestinale responsable de sténoses, ainsi que! des troubles fonctionnels intestinaux (TFI) persistants lors de la rémission de la maladie. L’objectif de la thèse était d’estimer l’impact de ces complications et de rechercher une association avec les caractéristiques antérieures de la maladie. Nous avons utilisé pour cela deux séries pédiatriques et deux modèles animaux. Dans l’étude TFI\MICI, nous avons montré que 20% des enfants et adolescents avec MICI en rémission clinique et biologique avaient des TFI, et 15% des douleurs abdominales fonctionnelles (DAF). Les DAF étaient associées à une fatigue accrue, à des symptômes dépressifs et une diminution de la qualité de vie, mais pas à de l’anxiété. Il n’y avait pas d’association entre la gravité de la MICI et la présence de DAF. Dans l’étude STENO\PED, nous avons montré que les seuls critères cliniques et radiologiques associés à la nécessité de résection chirurgicale des enfants ayant une maladie de Crohn sténosante du grêle étaient une dilatation sus-sténotique > 30 mm et un PCDAI > 22,5 au diagnostic de sténose. L’administration d’un traitement anti-TNF après le diagnostic de sténose était un facteur protecteur par rapport au risque de chirurgie. Il manque de modèles expérimentaux permettant de suivre l’histoire naturelle de la fibrose intestinale en lien avec l’inflammation et l’effet des traitements, notamment chez l’animal pré-pubère. Nous avons adapté au rat pré-pubère un modèle de colite aiguë (1 dose de TNBS) et chronique (3 doses de TNBS) et avons montré que les rats développaient une inflammation significative dans les 2 modèles, basé sur un score histologique. L’IRM montrait un épaississement de la paroi colique et des sténoses dans les 2 modèles, et des ulcérations de la muqueuse dans le modèle aigu. En histologie, il y avait une fibrose légère à modérée dans le modèle TNBS chronique et une ébauche non significative de fibrose dans le modèle aigu. Le traitement des rats par MODULEN IBD® exclusif dès le début de l’induction de l’inflammation n’a pas entraîné de diminution de l’inflammation ni de la fibrose histologiques dans les deux modèles. La prise en charge des séquelles anatomiques et fonctionnelles des MICI pédiatriques devient un enjeu majeur même si la prévalence des douleurs fonctionnelles nous est apparue comme non augmentée par rapport à la population générale. Les modèles animaux pré-pubères pourraient permettre de mieux analyser la cinétique de la fibrogenèse et l’impact d’une suppression précoce de l’inflammation et/ou de nouvelles thérapeutiques anti-fibrosantes. / The course of pediatric-onset inflammatory bowel disease (Crohn’s diseae, ulcerative colitis and IBDD unclassified) can be complicated by structural or functional sequelae. Structural complications include intestinal fibrosis which can cause bowel strictures. IBD can be associated with functional abdominal pain persisting despite remission of inflammation. The purpose of our work was to determine the burden of these complications and search for association with previous severity of inflammation, based on!two clinical studies and two animal models. In the first study, TFI-MICI, we showed that 20% of children and adolescents with IBD in clinical and biochemical Remission had functional gastrointestinal disorders, among which 15% had functional abdominal pain disorders (FAPD). FAPD was! Ssociated with increased fatigue, depressive symptoms and reduced quality of life, but not with anxiety. There was no association between the severity of IBD and presence of FAPD. The second study, STENO-PED, focused on imaging and clinical predictors of response!to treatment in children and adolescents with stricturing small bowel Crohn’s disease. We showed that the predictors for surgery were a dilation proximal to the stricture of >30mm, and a PCDAI score at diagnosis of stricture > 22.5. Receiving an anti-TNFα treatment after diagnosis of stricture was a protective factor from surgery. Experimental models allowing to follow the progression of fibrosis along with inflammation and assess response to Treatment are lacking, in particular for pre-pubertal animals. We adapted to Sprague-Dawley pre-pubertal rats a model of acute (1 dose of! TNBS) and chronic (3 doses of TNBS) hapten-induced colitis. The rats in both models developed significant inflammation, based on histology and magnetic resonance colonography. Rats in the chronic colitis model developed histologic fibrosis. There was a non-significant trend to fibrosis in the acute model. !We treated rats in both models with MODULEN IBD® from induction of colitis to collection of colonic samples. This treatment did not reverse inflammation nor fibrosis. Fibrosis and functional abdominal pain in pediatric-onset IBD are two important problems, although functional pain appeared to be not more frequent than in the general population. Animal models could be of great assistance in order to better decipher the link between inflammation and fibrosis, and see if an effective early suppression of inflammation along with new anti-fibrotic therapies could halt the progression of fibrosis.

Des études de liaison et d’association génétiques ont permis d’identifier certains des facteurs de risque génétiques aux maladies inflammatoires de l’intestin (MII) dans la région chromosomique 3p21. Dans cette région, le polymorphisme nucléotidique simple (SNP) codant non-synonyme du gène MST1, rs3197999, encodant pour la mutation R689C, a été associé et répliqué à la fois à la colite ulcéreuse (CU) et à la maladie de Crohn (MC). Un autre SNP, corrélé à des SNP codants non-synonymes du gène MST1R, a également été associé à la MC. Afin de déterminer si d’autres variantes des gènes MST1 et MST1R sont associés à la CU, nous avons testé pour association des SNP de ces gènes. Seul un proxy de R689C a montré un signal d’association significatif aux MII, ce qui suggère que R689C est la variante causale aux MII dans le gène MST1. En cherchant à déterminer si la région 3p21 contenait plusieurs signaux d’association mutuellement indépendants, trois SNP ont été identifiés comme possible facteurs de risque indépendants, et ont été génotypés dans des cas de CU et de MC et des témoins, puis nos résultats d’association ont été combinés à ceux provenant de trois autres cohortes indépendantes. Les trois SNP, R689C (MST1), rs6802890 et rs7629936 (CDHR4), sont associés aux MII, mais une étude d’association conditionnelle suggère qu’il existe en fait deux signaux d’association mutuellement indépendants dans la région 3p21. Le signal principal provient de R689C, une mutation de la protéine MSP. Cette protéine a un rôle dans l’inflammation chez les macrophages murins, et la migration, la cicatrisation et la survie chez les cellules épithéliales. Dans cette étude, le rôle de la MSP a été investigué dans des modèles de macrophages humains et de cellules épithéliales de côlon, et seule la phosphorylation d’AKT, un acteur dans la voie de signalisation de la survie cellulaire, a été modulée par la MSP dans nos modèles. Ce projet a donc permis d’apporter des connaissances sur les facteurs de risques génétiques aux MII dans la région 3p21, en identifiant 2 signaux d’association indépendants, et en nous informant sur le rôle de MST1, duquel provient le signal d’association principal, chez les cellules humaines. / Linkage studies and association studies allowed the discovery of some of the genetic risk factors of inflammatory bowel disease (IBD) in the chromosomal region 3p21. In this region, the non-synonymous coding single nucleotide polymorphism (SNP) rs3197999, situated in the gène MST1 and encoding for the mutation R689C, has been associated to UC and CD multiple times, and an other SNP, correlated to non-synonymous coding SNPs in the gene MST1R, has also been associated to CD. In order to verify if other variants of MST1 and MST1R are associatied to UC, we tested the association of some of their SNPs. Apart from R689C, only its proxy showed a significative association signal to IBD. It suggests that R689C might be the causal variant of IBD in the region 3p21. In the aim to determine if the region 3p21 has multiple independant association signals, 3 SNPs have been identified, from the results of a published meta-analysis of UC genome-wide association studies, as being possibly independant risk factors for UC based on their correlation. Their association to IBD and their independance have been tested by genotyping them in a cohort composed of controls, and UC and CD cases. The results of the association tests have been combined, in a meta-analysis, to the results of 3 other independent association studies. The 3 SNPs, R689C (MST1), rs6802890 and rs7629936 (CDHR4) are associated to IBD, but the results of the subsequent conditional association tests suggest that there is only 2 independant association signals in the region 3p21. The main signal is raising from R689C, a mutation of the protein MSP. According to published studies, this protein has a function in the inflammation in murine macrophages, and also in the scattering, wound healing and survival of epithelial cells. In this thesis, we investigated the role of MSP in human macrophage models and in human côlon epithelial cells, and it has been show that MSP modulates the phosphorylation of AKT, an actor in the pathway of cellular survival. This project brought some knowledges about the IBD genetic risk factors in the region 3p21. We identified 2 independent association signals to IBD in this region, and the main signal is coming from a SNP in MST1, a gene which has a role, based on our results, in the survival in human colon epithelial cells.

HNF4[alpha] est un facteur de transcription de la famille des récepteurs nucléaires hormonaux dont le rôle dans l'organogenèse et le maintien des fonctions hépatiques est de mieux en mieux décrit. Cependant, son rôle dans le développement et le maintien des fonctions gastrointestinales est peu connu. Il en va de même pour le facteur de transcription CUX1 au sein de de la muqueuse intestinale. Nous avons ainsi décidé d'utiliser l'invalidation conditionnelle d' HNF4[alpha] (HNF4[alpha] [exposant]fx/fx) dans l'épithélium intestinal grâce à l'expression de la Cre-recombinase sous le contrôle du promoteur de 12.4 kb de la Villine (12.4kb-Villin .Cre). Les épithélia de l'intestin grêle et du côlon ont été étudiés au niveau de leur morphologie, de leur prolifération, de leur différenciation et de leur fonction à différents temps du développement de la souris. Nous avons dans un premier temps constaté que la morphogenèse de ces tissus se déroule normalement. Nous avons cependant observé que l'épithélium de l'intestin grêle présentait une légère augmentation de la prolifération et une modification des populations différenciées au profit des cellules entéroendocrines et caliciformes. Nous avons également identifié une réduction de la conductance de l'épithélium colique du à une dérégulation des canaux, transporteurs et pores impliqués dans la régulation du transport ionique. Des cibles directes d'HNF4[alpha], tel que la claudine-15, ont vu leur expression diminuer chez les animaux mutants ainsi que dans les maladies inflammatoires intestinales durant lesquelles HNF4[alpha] est réduit en expression. Cette modification dans le rôle crucial de la réabsorption des fluides auquel l'épithélium colique participe a eu pour effet d'entrainer une colite spontanée ressemblant à la colite ulcéreuse chez l'humain. En effet, une augmentation de l'inflammation, une augmentation du recrutement de leucocytes, une augmentation de la prolifération et une apparition de dysplasie épithéliale ont été observées. Les épithélia du grêle et du côlon ont également présenté une augmentation du stress oxydatif et de l'apoptose qui s'est avérée être protectrice contre la perte d'hétérozygocité de l'allèle Apc dans le modèle murin de tumorigenèse Apc Min/+ . En effet, les animaux pour lesquels l'invalidation de l'expression d'HNF4[alpha] a été effectuée par la Villine-Cre (Apc[exposant Min/+] HNF4[alpha] [exposant [delta]1EC] ), ont montré une réduction de 70% du nombre de polypes dans l'intestin grêle et une réduction de 90% du nombre de polypes dans le côlon. L'analyse des gènes impliqués dans la réduction des espèces réactives de l'oxygène a permis d'identifier la GSTK1 comme une nouvelle cible directe d'HNF4[alpha] tant dans l'épithélium de l'intestin grêle que dans le cancer colorectal. En effet, l'expression d'HNF4[alpha] chez les patients atteints du cancer colorectal s'est avérée augmentée chez 31 patients sur les 40 analysés. Ces augmentations oscillent entre 50 et 100% chez 22% des patients et de 100% et plus chez 40% des patients analysés ( n = 40). Les animaux Cux1[delta]HD ont quant à eux été étudiés au niveau de leur susceptibilité à un stress inflammatoire. Nous avons démontré que l'expression de CUX1 est nécessaire à la protection de l'inflammation aigüe et chronique et que les patients atteints des maladies inflammatoires intestinales répondent en augmentant l'expression de ce facteur. Nous croyons que l'expression de CUX1 permet de tempérer la réponse inflammatoire et permet aussi la migration et la prolifération de l'épithélium colique en réponse aux blessures causées par l'inflammation soutenue. Collectivement, ces études démontrent l'importance du réseau de régulation transcriptionnelle dans les voies gastrointestinales pour le maintien de l'homéostasie proliférative, fonctionnelle et inflammatoire de l'épithélium. La modulation de ces facteurs durant les pathologies suggère la possibilité d'intervenir thérapeutiquement sur ces facteurs afin de contrôler leurs cibles et ainsi contrer l'apparition, la progression ou la chronicité de ces maladies.

Les patients atteints de maladies inflammatoires de l'intestin (MII) ont un risque accru de développer un cancer colorectal dû aux lésions épithéliales secondaires à l’inflammation chronique. La vitamine D (vD) régule NOD2, gène impliqué dans la réponse inflammatoire et dans la susceptibilité aux MII, et induit son expression dans les monocytes et dans l’épithélium intestinal. Dans ce projet, nous avons d’abord induit le cancer colorectal associé à la colite ulcéreuse (CAC) en administrant un traitement combiné d’azoxyméthane (AOM) et de dextran de sulfate de sodium (DSS) aux souris C57BL/6J. Par la suite, nous avons étudié l'effet d’une carence en vD3 sur le développement du CAC et évalué la capacité préventive d’une supplémentation en vD3 sur la tumorigenèse, et vérifié si cet effet est médié par NOD2, en utilisant les souris Nod2-/-. Les C57BL/6J et les Nod2-/-, ayant reçu une diète déficiente en vD3, étaient moins résistantes au CAC par rapport aux souris supplémentées. Le pourcentage de perte de poids, l’indice d’activation de la maladie (DAI), le taux de mortalité et le poids relatif du côlon (mg/cm) chez les souris déficientes en vD3 étaient plus élevés en comparaison avec celles supplémentées en vD3. Une augmentation du score d'inflammation et de la multiplicité tumorale corrélait avec une expression accentuée de l’Il6 dans les colonocytes des souris déficientes en vD3. La vD3 régulait l’expression génétique de Cyp24, Vdr et de gènes pro-inflammatoires chez les C57BL/6, comme chez les Nod2-/-. En conclusion, la supplémentation en vD3 peut prévenir le développement du CAC indépendamment de NOD2. / Patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer due to continuing epithelial cell injury from the chronic inflammatory process. Vitamin D (vD) regulates NOD2, a gene involved in the inflammatory response and in IBD susceptibility, and induces its expression in monocytes and intestinal epithelial cells. In this project, we first established an azoxymethane (AOM)/dextran sodium sulfate (DSS) murine model of colitis-associated colorectal cancer (CAC) using C57Bl/6J. We then investigated the effect of vD3 deficiency on CAC development, and evaluated the ability of vD3 supplementation to prevent tumorigenesis. Lastly, we assessed whether the preventive benefits of vD3 on colon carcinogenesis are mediated via NOD2 using Nod2 knockout mice (Nod2-/-). vD3 deficient C57Bl/6J and Nod2-/- mice displayed increased severity of AOM/DSS-induced CAC compared to mice given vD3 supplemented diets. In vD3 deficient mice, body weight loss, Disease Activity Index (DAI), mortality rate and the colon weight/length ratio were higher compared to vD3-supplemented mice. An increased inflammation score was observed in the mucosa of vD3 deficient mice along with augmentation in the expression level of IL-6. Higher tumour multiplicity was also observed in vD3 deficient groups compared to vD3-supplemented groups. In both C57Bl/6J and Nod2-/- mice, vD3 regulated Cyp24, Vdr and pro-inflammatory genes. In conclusion, vD3 supplementation can prevent CAC independently of NOD2.

Il est maintenant établi que les facteurs alimentaires participent à la survenue des maladies inflammatoires chroniques de l’intestin (MICI). Le traitement thermique des aliments génère des substances néoformées telles que les produits de Maillard (MRPs) dont les effets sur la santé sont controversés. D’autres contaminants retrouvés dans les aliments sont issus des emballages. L’ensemble de ces molécules ont été associées à des réactions inflammatoires mais peu de données existent sur leurs conséquences sur la sphère digestive. L’objectif de cette thèse était d’étudier l’effet du traitement thermique des aliments sur la modulation d’une colite chez la souris. Dans un premier temps, nous avons dosé quelques marqueurs des MRPs dans deux régimes : peu et fortement chauffés. Ensuite, nous avons évalué l’impact de ces matrices sur la réponse inflammatoire chez des souris soumises à deux modèles de colites (DSS, TNBS). Enfin, nous avons observé les conséquences de l’effet cumulé de l’ingestion de MRPs et d’un contaminant d’emballage (le phtalate DEHP) chez les animaux atteints d’une colite. Le niveau de traitement thermique de la matrice était proportionnel aux teneurs en produits avancés et terminaux de la réaction de Maillard. Un fort traitement thermique a permis de prévenir la réponse inflammatoire chez les animaux soumis aux colites mais nous n’avons observé aucune modification de la réponse inflammatoire colique suite à l’ingestion couplée de MRPs et de DEHP. A terme, ces résultats descriptifs pourraient, sous réserve d’en identifier les mécanismes, servir à l’élaboration de recommandations nutritionnelles pour les patients souffrant de MICI. / It is acknowledged that alimentary factors participate in the etiology of inflammatory bowel diseases (IBD). On the other hand, food heat treatment generates neoformed compounds such as Maillard Reaction Products (MRPs) with controversial effects on human health but also results in contamination coming from packaging. All of these compounds are incriminated in inflammatory reactions but there are few data related to their consequences on gut. This work was aimed at determining the effect of food heat treatment on the modulation of an experimental colitis in mice. At first, we assessed some markers of MRPs in two moderately and highly heated diets. We then evaluated the consequences of these diets on the inflammatory response of animals submitted to two models of experimental colitis (DSS, TNBS). At last, we observed the consequences of cumulative effects of oral repeated exposure to MRPs and to a packaging contaminant the phthalate DEHP in DSS colitic mice. We revealed that the thermic level treatment was proportional to level of advanced and terminal MRPs and that the highest heat treatment resulted in the prevention of both the colitis models. By contrast, we observed no change in the inflammatory response following the coupled exposure to DEHP and the highly treated diet. While being descriptive, those results are promising and, after understanding the mechanisms involved, could be of interest in the conception of nutritional recommendations for IBD patients.

Dans l'alimentation des pays industrialisés, l'apport en protéines est bien supérieur à l'apport nutritionnel conseillé (ANC). De plus, cet apport peut être encore supérieur lors de la consommation de régimes riches en protéines utilisés à des fins de perte de poids par des personnes obèses ou en surpoids. Cependant, les conséquences des régimes riches en protéines au niveau de l'écosystème du gros intestin sont encore très mal connues. Dans la première partie de cette thèse, nous avons étudié l'impact d'un régime hyperprotéique sur le microbiote, le contenu endoluminal du gros intestin et le métabolisme des colonocytes. Les rats ont consommé pendant 15 jours soit un régime hyperprotéique (53% de protéines) soit un régime normoprotéique (14% de protéines). Nous avons observé que le régime hyperprotéique réduit la quantité des groupes bactériens majeurs comme Clostridium coccoides et Clostridium leptum, ainsi que Faecalibacterium prausnitzii dans le microbiote du gros intestin avec conjointement des modifications sur sa biodiversité. En même temps, les quantités des produits finaux de la fermentation des acides aminés par le microbiote, les acides gras à chaîne courte (AGCC) et les acides gras à chaîne branchée sont fortement augmentées. Cependant, l'expression des transporteurs des acides monocarboxyliques et l'oxydation du butyrate par les colonocytes ne sont pas modifiés en lien avec des modifications mineures des concentrations en AGCC dues à une augmentation des contenus du gros intestin après l'ingestion du régime hyperprotéique. Il en résulte une augmentation de l'excrétion des AGCC dans les fèces. Ces phénomènes permettraient une homéostasie du métabolisme du butyrate dans les colonocytes, en lien avec le rôle crucial de cet AGCC sur l'épithélium du côlon. Dans la deuxième partie de cette thèse, nous avons testé l'effet d'un mélange d'acides aminés (Thr, Met et Glu) sur la cicatrisation de la muqueuse colique après une colite induite par le DSS (dextran sodium sulfate) ; un modèle d'étude des maladies inflammatoires intestinales souvent utilisé. Une optimisation de la cicatrisation de la muqueuse intestinale émerge comme une cible thérapeutique, dans la prise en charge de ces maladies. La colite a été induite chez le rat avec 5% (w/v) de DSS pendant 6 jours, puis, à l'arrêt du traitement DSS, les animaux ont soit reçu le mélange d'acides aminé soit l'Ala comme témoin iso-azoté, pendant 3, 7 et 10 jours. Nous avons observé que 10 jours de complément en mélange d'acides aminés améliorent la cicatrisation post-colite, avec des modifications sur le taux de synthèse protéique dans la muqueuse colique, sans toutefois modifier la résolution de l'inflammation. Nos résultats suggèrent que l'utilisation des mélanges d'acides aminés améliore la cicatrisation de la muqueuse colique après colite chimio-induite. / In industrialized countries, protein intake is largely higher than the recommended dietary allowance (RDA). Furthermore, high protein diets are used for their slimming effect by obese or overweight people. However, little is known regarding to the consequences of a high protein diet on the large intestinal ecosystem. We thus study the influence of a high protein diet on the microbiota, on the endoluminal composition of the large intestine and on the butyrate metabolism by isolated colonocytes. Rats received during 15 days either a high protein diet (53% of proteins) or a normo protein diet (14% of proteins). We observed that the quantity of major bacterial groups Clostridium coccoides and Clostridium leptum, but also Faecalibacterium prausnitzii was reduced in the microbiota of the large intestine together with modifications of its biodiversity. In the same time, the quantities of short-chain fatty acids (SCFA) and branched-chain fatty acids, final products of bacterial fermentation of amino acids, were increased. However, the expression of monocarboxylic acid transporters and butyrate oxidation in colonocytes remained unchanged, in association with minor changes of the SCFA concentrations due to marked increase of the weight of the large intestine content. We then observed an increase in the amount of SCFA in the feces. These phenomena would allow homeostatic metabolism of butyrate in colonocytes, in relationship with its crucial role on the colonic epitheliumIn. In the second part of this thesis, we have tested the effects of a mixture of amino acids (Thr, Met and Glu) on the colonic mucosa healing after colitis induced by DSS (dextran sodium sulphate); a model to study intestinal inflammatory bowel diseases largely used. Optimization of intestinal mucosa healing is more and more considered as a therapeutic goal. Colitis was induced in rats by 5% (w/v) DSS during 6 days, then at the end of the treatment with DSS, animals received either the amino acid mixture or Ala as iso-nitrogenous control, during 3, 7 or 10 days. We observed that 10 days amino acid mixture supplementation was able to improve the colonic mucosal healing, with modification of the protein synthesis rate, without however changes in the resolution of inflammation. Our results suggest that the supplementation with the amino acid mixture improve the mucosal healing after experimental colitis.

Pacientes com retocolite ulcerativa inespecífica,quando submetidos à colectomia, apresentam aumento na freqüência de cálculos vesiculares de colesterol. A hipomotilidade da vesícula biliar tem sido apontada como um importante fator na formação dos cálculos vesiculares de colesterol, ao lado da supersaturação biliar de colesterol e da nucleação dos cristais de colesterol (fatores nucleantes e antinucleantes). A estase vesicular aumenta o tempo de reabsorção de água pela mucosa da vesícula biliar com conseqüente superconcentração dos solutos, além de gerar o tempo necessário para a nucleação do colesterol, retenção e fusão dos cristais e,finalmente,formação dos cálculos. Embora a composição biliar já tenha sido estudada em pacientes colectornizados, não há informações sobre o comportamento da motilidade da vesícula biliar em pacientes com retocolite ulcerativa inespecífica com e sem colectomia. No presente trabalho,o esvaziamento vesicular foi estudado através do método ultra-sonográfico e após ingestão de dieta líqüida gordurosa em indivíduos controles (n=40), pacientes com retocolite ulcerativa inespecífica sem (n=30) e com colectomia (n =20). Como o esvaziamento gástrico pode interferir no vesicular, o tempo de esvaziamento gástrico, medido por método ultra-sonográfico, foi calculado nos três grupos. O esvaziamento vesicular foi significantemente diminuído nos pacientes com retocolite ulcerativa inespecífica com colectomia e após estímulo alimentar: esta alteração não foi conseqüência de esvaziamento gástrico retardado pois o tempo de esvaziamento gástrico foi semelhante nos três grupos. Ademais, a redução da motilidade vesicular nos pacientes colectomizados relacionou-se com a colectomia propriamente dita, uma vez que indivíduos controles e pacientes com retocolite ulcerativa inespecífica sem colectomia apresentaram esvaziamentos vesiculares semelhantes. Além disso,os resultados desta investigação reforçam a relevância do papel da motilidade vesicular na colelitíase e sua participação, juntamente com a diminuição do \"pool\" de ácidos biliares,na patogênese da calculo se vesicular de colesterol em pacientes com retocolite ulcerativa inespecífica submetidos à colectomia. / Patients with ulcerative colitis, who have their colon removed, are at increased risk of developing cholesterol gallstones. Gallbladder hypomotility has been quoted as being an important factor for cholesterol gallstone formation, together with biliary supersaturation of cholesterol and nucleation of cholesterol crystals (nucleating and antinucleating factors). Gallbladder stasis increases the time for water reabsorption by the gallbladder mucosa with ensuing solute superconcentration; moreover, gallbladder stasis renders enough time for cholesterol nucleation. crystal retention and fusion, and finally, stone formation. Although bile composition, in these patients, has already been studied, there is no information concerning the nature of gallbladder motility in patients with ulcerative colitis with or without colectomy. ln the present work, gallbladder emptying was studied by means of ultrasound examination, and after ingestion of a standard liquid fatty meal in controls (n=40), ulcerative colitis patients without colectomy (n=30) and with colectomy (n=20). Also, in order to rule out the influence of gastric emptying on gallbladder motility, the gastric emptying time was calculated, in the three groups, using the ultrasound method. Gallbladder emptying was significantly impaired in patients with ulcerative colitis with colectomy after a fatty-meal stimulus. and this abnormality was not a consequence of delayed gastric ernptying. since gastric emptying time was similar in the three groups. Furthermore. impaired gallbladder motility in ulcerative colitis patients with colectomy was related to the colectorny itself, since controls and ulcerative colitis