A fibrose cística (FC) é diagnosticada na presença de achados fenotípicos, história familiar ou triagem neonatal positiva acompanhada de evidência laboratorial de disfunção da CFTR, seja pelo teste do suor, diferença de potencial nasal ou pela identificação de duas mutações conhecidas como causa de FC nos genes da CFTR. Objetivos: Avaliar a contribuição da análise molecular do gene CFTR na investigação diagnóstica da fibrose cística em pacientes com suspeita de FC leve ou doença atípica. Secundariamente, comparar as características dos pacientes em 3 grupos: grupo com identificação de duas mutações conhecidas como causadoras da FC, grupo com identificação de apenas uma mutação e grupo sem mutação identificada. Métodos: Estudo transversal em adolescentes e adultos (≥14 anos). Os pacientes foram submetidos à avaliação clínica, laboratorial e radiológica; espirometria, microbiologia do escarro, ecografia hepática, teste do suor e análise molecular do gene CFTR. Resultados: Foram avaliados 37 pacientes com achados fenotípicos de FC, com ou sem confirmação pelo teste do suor. Houve predomínio do sexo feminino (75,7%) com média de idade de 32,5 ± 13,6 anos. A análise molecular contribuiu para o diagnóstico definitivo de FC em 3 casos (8,1%) dentre 37 pacientes em avaliação. Em 7 pacientes (18,9%) foram identificadas apenas uma mutação causadora de FC e em 26 pacientes (70,3%) não foram identificadas mutações. Nenhuma característica clínica estudada se associou com o diagnóstico genético. A mutação p.F508del foi a mais comum, encontrada em 5 pacientes. A associação de p.V232D e p.F508del foi encontrada em 2 pacientes. Outras mutações encontradas foram: p.A559T, p.D1152H, p.T1057A, p.I148T, p.V754M, p.P1290P e p.R1066H e p.T351S. Conclusão: A análise molecular da região codificante do gene CFTR apresentou contribuição limitada para investigação diagnóstica de pacientes com suspeita de fibrose cística leve ou doença atípica. Além disso, não houve associação entre as características clínicas e o diagnóstico genético. / Cystic fibrosis (CF) is diagnosed in the presence of phenotypic findings, family history or positive neonatal screening accompanied by laboratory evidence of CFTR dysfunction, either by sweat test, nasal potential difference or the identification of two mutations known to cause CF in the CFTR gene. Objectives: To evaluate the contribution of molecular analysis of CFTR gene in cystic fibrosis diagnostic investigation in patients with suspected mild FC or atypical disease. Secondarily, to compare the characteristics of patients into 3 groups: group with identification of two mutations known to cause CF, group with identification of just one mutation and group without mutations. Methods: Cross-sectional study in adolescent and adult (≥ 14 years). The patient underwent clinical, laboratory and radiological spirometry, sputum microbiology, liver ultrasound, sweat test and molecular analysis of the CFTR gene. Results: We evaluated 37 patients with phenotypic findings of FC, with or without confirmation by the sweat test. There was a predominance of females (75.7%) with a mean age of 32.5 ± 13.6 years. Molecular analysis contributed to the definitive diagnosis of CF in 3 cases (8.1%) among 37 patients under evaluation. In 7 patients (18.9%) were identified only one mutation that causes CF and in 26 patients (70.3%) were not identified mutations. No clinical feature studied was associated with genetic diagnosis. The P.F508del mutation was the most common, found in 5 patients. The association p.V232D and p.F508del was found in 2 patients. Other mutations found were: p.A559T, p.D1152H, p.T1057A, p.I148T, p.V754M, and p.P1290P p.R1066H and p.T351S. Conclusion: Molecular analysis of the CFTR gene coding region showed limited contribution to the diagnostic investigation of patients with suspected cystic fibrosis mild or atypical disease. Moreover, there was no association between clinical features and genetic diagnosis.

Orientadores: Antônio Fernando Ribeiro, Jose Dirceu Ribeiro, Francisco Ubaldo Vieira Júnior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T21:55:40Z (GMT). No. of bitstreams: 1 Servidoni_MariadeFatimaCorreaPimenta_D.pdf: 12508528 bytes, checksum: b3b02333b5c69daaf09a90ff457cc849 (MD5) Previous issue date: 2014 / Resumo: A Fibrose Cística (FC) é uma doença genética autossômica recessiva, comum em caucasianos. Tem incidência de 1: 2.500 a 1: 6.000 nascidos vivos e 1: 25 em portadores sãos na Europa e EUA e no Brasil a incidência estimada é de 1:10.000 nascidos vivos. É causada pela presença de dois genes CFTR (do inglês Cystic Fibrosis Transmembrane Conductance Regulator) mutados, que codificam uma proteína também denominada CFTR. A CFTR é o principal canal de Cloro (Cl-), é expressa na membrana apical das células epiteliais dos tratos respiratório e digestório (pâncreas, fígado e intestino), nas glândulas sudoríparas e salivares, e no aparelho reprodutor masculino. Regula o transporte de iôns e de água. O comprometimento ou a ausência da função da CFTR promove a desidratação das mucosas com produção de um muco viscoso com consequente obstrução das vias respiratórias e ductos das glândulas exócrinas determinando o fenótipo da FC. O grau de função da CFTR será determinante da gravidade da doença. Até à data, já foram descritas cerca de 2000 mutações no gene CFTR. A F508del é a mutação mais prevalente, está presente em 85% dos pacientes a nível mundial e em 65% no Brasil. As mutações podem ser classificadas em 6 grupos de acordo com o defeito molecular e celular e determina o fenótipo da FC. Pode ser classificado em: clássico e não-clássico. O clássico é o mais conhecido e frequente e apresenta sintomas graves. O não-clássico ocorre em cerca de 15% dos doentes e apresenta sintomas mais brandos, com diagnóstico em geral complexo e tardio. A FC é assim um "espectro de doenças" e o seu rastreio precoce na triagem neonatal (TNN), antes mesmo dos primeiros sintomas, abre novas perspectivas de prognóstico por isso é emergente a necessidade de métodos acurados que determinem a função da CFTR, direcionando uma terapia individualizada, em busca da cura. A primeira parte deste trabalho procurou consolidar a medição da função do canal CFTR em biopsias retais como um marcador biológico para diagnóstico e prognóstico da FC; a segunda descreveu a realização da biópsia retal e suas particularidades sob a ótica dos pacientes e da técnica. A terceira abordou a realização do teste do suor (TS) no estado de São Paulo (SP) expressando o panorama brasileiro do TS. Desta forma, entre 2007 e 2010 foi realizado estudo prospectivo de pacientes atendidos no ambulatório de FC do Hospital das Clínicas (HC) da Universidade Estadual de Campinas (Unicamp) com e sem FC submetidos à biópsia retal. Em 2013 foi aplicado em 14 serviços (9 públicos, 5 privados) que realizam o TS, um questionário qualitativo através de visita às sete cidades que contam com Centros de Referência para atendimento de pacientes com FC em SP. Nossos resultados demonstraram que a determinação de Cl- em biópsias retais mediadas pela CFTR é um biomarcador robusto, sensível, preditivo e reprodutível para o diagnóstico e prognóstico da FC e com potencial uso para ensaios pré-clínicos de terapias moduladoras da CFTR. A pinça jumbo e a solução salina fisiológica determinaram as melhores amostras para os estudos bioquímicos e de eletrofisiologia, a grande maioria dos indivíduos entrevistados não relataram maiores desconforto (76%), sendo a técnica utilizada segura e reprodutível. O estudo do TS em SP demonstrou a necessidade urgente de equipamentos adequados de estimulação e dosagem do Cl- no suor, associado à normatização da técnica e treinamento de pessoal capacitado para a sua realização. Dando seguimento a este trabalho, estamos implementando novas ferramentas diagnósticas para a FC: a avaliação eletrofisiológica da CFTR em câmara de Ussing através da cultura de células nasais e/ou organoides e da unção da CFTR na glândula sudorípara pelo evaporímetro. Por fim, todos os métodos de avaliação diagnóstica devem respeitar procedimentos operacionais padrão (POP), sendo que alguns nomeadamente os de eletrofisiologia, ainda dispõem de aplicação limitada a poucos centros no mundo / Abstract: Cystic Fibrosis (CF) is an autosomal recessive genetic disease, common among Caucasians. In Europe and USA, it has an incidence of 1:2,500-1:6,000 in newborns and 1: 25 for healthy carriers. In Brazil, the estimated incidence is 1:10,000 in newborns. It is caused by the presence of two mutated CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) genes encoding for CFTR protein, a Chloride (Cl-) channel expressed at the apical membrane of epithelial cells. CFTR is the main regulator of ion transport and water. Its defect leads to dehydrated epithelia and to the production of viscous mucus secretions that clogs the airways and ducts of exocrine glands, leading to the clinical manifestations of CF disease, mostly affecting the respiratory and digestive tracts (pancreas, liver and intestine). CFTR is also expressed in the sweat and salivary glands, and in the male reproductive system. The degree of CFTR function will determine the severity of the disease. About 2000 mutations have been already described in the CFTR gene. The F508del is the most prevalent, present in 85% of patients worldwide and 65% in Brazil. Mutations can be classified into six groups, depending on the molecular and cellular defect, and also determining the severity of the CF phenotype: Classical and Non-Classical. The Classical phenotype is best-known and frequent, presenting severe symptoms; but the Non-Classical phenotype, representing ~15 % of all CF patients, shows atypical symptoms, with variable organ involvement, which make the diagnosis difficult and often late. CF thus includes a "spectrum of diseases" and its early detection in newborn screening, even before the first symptoms, opens up new perspectives for prognosis. Since CF diagnosis requires proof of CFTR dysfunction, there is an emerging need for accurate methods capable of detecting CFTR function with high sensitivity and of directing CF therapy, in the quest for the most appropriate treatment. The first part of this study sought to consolidate the measurements of CFTR channel function in rectal biopsies as a biomarker for CF diagnosis and prognosis. The second part focused on the rectal biopsies procedure and its technical aspects and also on how it is perceived in the patients' perspective. The third part, approached how the sweat test (ST) procedure is carried out in CF centers in the state of São Paulo (SP), so as to assess the Brazilian scenario for the ST. To this end, between 2007 and 2010, we conducted a prospective study of patients seen at CF outpatient clinic, of the Clinical Hospital (HC) ¿ State University of Campimas (Unicamp) who underwent rectal biopsy and we also included non-CF subjects as controls. In 2013, a qualitative questionnaire was applied to 14 services (9 public, 5 private) which perform the ST by visiting the 7 cities of SP which have reference CF care centers. Data shown that determination of CFTR-mediated Cl- secretion in rectal biopsies proved to be a robust, sensitive, and reproducible predictive biomarker for CF diagnosis and prognosis, besides being a safe technique with the potential for use in preclinical trials of CFTR modulating therapies. The jumbo forceps and saline solution determined the best samples for electrophysiology and biochemical studies. Moreover, the great majority of the individuals tested by this procedure did not report major discomfort (76%). The work assessing the achievement of ST in SP, demonstrated an urgent need for adequate equipment for the stimulation of sweat and also for the measurement of Cl- in sweat, associated with standardization and training of specialized personnel for its implementation. As a follow up of this work, we are already implementing new diagnostic tools for CF, namely: the study of CFTR function in the sweat gland by the evaporimeter and in cultured nasal cells by Ussing chamber. Finally, all diagnostic methods must comply with strict standardized operation procedures (SOP) and some, including electrophysiology, still have limited use in few centers worldwide / Doutorado / Saude da Criança e do Adolescente / Doutora em Ciências

Orientador: Carmen Sílvia Bertuzzo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T19:02:25Z (GMT). No. of bitstreams: 1 Bonadia_LucianaCardoso_D.pdf: 3915251 bytes, checksum: 0ec73a6295f4f385eff99d2de851f6c8 (MD5) Previous issue date: 2011 / Resumo: A Fibrose Cística (FC) é uma doença autossômica recessiva letal com alta incidência na região sudeste brasileira. É causada por mutações no gene CFTR que codifica uma proteína que se localiza na membrana apical das células epiteliais das vias aeríferas, pâncreas, glândulas salivares e sudoríparas, intestino e aparelho reprodutor, constituindo um canal de cloro. O aumento da viscosidade do muco extracelular é responsável pela maioria das complicações clínicas relacionadas à FC, sendo o acometimento respiratório a principal causa de morbidade e mortalidade. Mais de 1500 mutações foram associadas à FC, divididas em seis classes de acordo com o efeito que causam na produção e atividade da proteína CFTR, sendo a F508del a mais frequente delas. Com o aumento do diagnóstico precoce e melhora da abordagem terapêutica, cada vez mais pacientes chegam à idade adulta. A atenção ao paciente deve acompanhar a mudança demográfica tendo em vista as necessidades específicas da idade sejam clínicas, psicológicas ou sociais. O objetivo desse projeto foi caracterizar uma amostra de pacientes adultos com hipótese diagnóstica de FC e correlacionar os aspectos clínicos, moleculares e fisiológicos. A caracterização clínica foi realizada por pesquisa de dados clínicos no arquivo médico dos pacientes; a molecular foi realizada por métodos de genotipagem como DHPLC, sequenciamento do DNA e MLPA e a fisiológica foi realizada por medidas de corrente intestinal por micro-câmara de Ussing. Foi observado que pacientes sem atividade da CFTR tendem a ser diagnosticados mais cedo. Houve associação entre as classes de mutação de CFTR e a atividade do canal e uma relação entre a gravidade da mutação/inatividade de CFTR e a idade ao diagnóstico, função pulmonar e gravidade avaliada por Escore de Shwachman. Houve associação entre a colonização crônica por Pseudomonas aeruginosa e a obstrução pulmonar avaliada por dados de espirometria. As principais contribuições desse estudo foram: implementação de um método pioneiro no Brasil que além de servir como ferramenta diagnóstica tem sido muito utilizado na pesquisa de novos fármacos para tratamento mutação-dirigidos; caracterização clínica, molecular e fisiológica dos adultos com hipótese diagnóstica de fibrose cística, um grupo de pacientes cada vez mais frequente no atendimento médico dessa doença / Abstract: Cystic Fibrosis (CF) is a lethal autosomal recessive disease with high incidence in Southeast Brazil. It is caused by mutations in the CFTR gene, which encodes a protein that is located in the apical membrane of epithelial cells of airway tract, pancreas, salivary and sweat glands, intestine and reproductive system, forming a chloride channel. The increasing of the viscosity of extracellular mucus is responsible for most clinical complications related to CF, with pulmonary impairment as a major cause of morbidity and mortality. More than 1500 mutations have been associated with CF, divided in six different classes according to the effect on CFTR protein production and activity, F508del being the most common type. With the increase of early diagnosis and improved therapeutic approach, more and more patients reach adulthood. The patient care should follow the demographic shift regarding the specific needs of the age are clinical, psychological or social. The aim of this study was to characterize a sample of adult CF patients with diagnosis of CF and to correlate the clinical, molecular and physiological features. Clinical characterization was obtained from archived medical records. Molecular characterization was performed by genotyping methods such as DHPLC, MLPA and sequencing and physiological characterization was performed by intestinal current measurements by micro-Ussing chamber. It was observed that patients in whom the CFTR channel does not show any residual activity tend to be diagnosed earlier. There was an association between the classes of CFTR mutation and the activity of the channel and a relationship of mutation severity/inactivity of CFTR with the age at diagnosis, lung function and severity score assessed by Shwachman-Kulczycki. There was an association between chronic colonization by Pseudomonas aeruginosa and pulmonary obstruction. The main contributions of this study were: implementation of a method pioneered in Brazil that serves as a diagnostic tool and has been used in researching new drugs for treatment of specifics mutation and clinical, physiological and molecular characterization of adults with cystic fibrosis, a growing group in medical care / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas

Class of 2012 Abstract / Specific Aims: The epithelial sodium channels (ENaC) found on the apical membranes of epithelial cells including those lining the respiratory tract are the rate limiting step of the absorption of excess fluid from the airspace of the alveoli. ENaC function is modulated by the effects of various physiologic signals such as the adrenergic and purinergic pathways, in addition to other local channels which control the flow of negatively charged ions such as the cystic fibrosis transmembrane conductance regulator (CFTR). We sought to determine the influence of genetic variation on the alpha subunit of ENaC at amino acid position 663 on baseline exhaled ions and pulmonary function in patients with CF. Methods: We assessed pulmonary function ( forced vital capacity[FVC], forced expiratory volume in one second [FEV1], forced expiratory flow maximum[FEFmax]) using a Medical Graphics cardiopulmonary testing device (Minneapolis, MN). Measures of exhaled sodium (Na+) and chloride (Cl-) were obtained using exhaled breathe condensate collected on a Jaeger Ecoscreen condenser unit (Cardinal Health, Yorba Linda, CA) with Na+ quantification using an atomic absorption spectrophotometer (Analyst 100; Perkin Elmer, Norwalk, CT) and Cl- anion quantification using a Dionex AS11 HC column. Healthy n=31 (n=18[58%], 9[29%], and 4[13%] subjects; Body mass index (BMI)=23±1, 25±2, and 25±2kg/ m2 for AA, AT and TT groups respectively). CF n= 42 (n=33[79%], 7[16%], and 2[5%] subjects; BMI equals 23±7, 19±0.4, and 20±2.2kg/m2 for AA, AT and TT groups respectively). Main Results: We found that the distribution of genotypes in CF differed from healthy subjects, with the AA genotype in 80% of CF and 59% in healthy. No significant difference were demonstrated in healthy subjects between genotype groups for pulmonary function and exhaled chloride while the genotypes did differ in exhaled Na (Na=2.9±0.4, 1.7±0.3, and 3.7±1.1mmol/L for AA, AT, and TT respectively, ANOVA p=0.07). CF subjects with the AA genotype had a higher baseline exhaled Cl-, FEV1, and FEFmax than those in the AA group (Cl=0.125±0.038,0.0 27±0.007, and 0.033±0.02 mmol/L ; FEV1=71±5, 68±11, and 40±22L; FEFmax=86±4, 72±7, and 44±24L/sec; for AA, AT, and TT respectively, ANOVA p<0.05, Tukey [AA vs. TT] p<0.05) while exhaled Na+ and FVC were similar between genotypes. Conclusions: Our results suggest that CF subjects with the AA genotype of the alpha subunit of the ENaC have a higher baseline exhaled Cl- and a resulting increase in pulmonary function when compared to the overactive TT groupCF patients with the TT αENaC genotype are likely candidates for early identification and treatment with inhaled ENaC inhibitors or other modulators of this pathway in order to improve survival.

CFTR基因突變或者功能缺失是否導致包括胃腸道在內的各種組織惡性腫瘤的發生風險增加目前仍然是一個充滿爭議的問題。同時，眾所周知，緊密連接分子在腫瘤發生和轉移的過程發揮了關鍵的作用。本論文首次發現了CFTR基因與一種緊密連接分子AF-6/afadin的在人類結直腸腫瘤中的表達水平呈高度相關，并研究了CFTR和AF-6/afadin之間潛在的相互作用及其在結直腸腫瘤轉移中的功能。 / 論文的第一部份首先用實時定量PCR和免疫組織化學的方法比較了CFTR在結直腸腫瘤和正常組織的表達情況，發現CFTR表達水平在腫瘤組織中有顯著的下降。令人感興趣的是，我們同時發現CFTR和AF-6/afadin在腫瘤組織中的表達呈高度正相關，并由此展開了後續的體外實驗，研究對CFTR與AF-6/afadin之間可能的相互聯繫。利用免疫螢光染色和免疫共沉澱的方法，我們發現了這兩種蛋白分子共表達在結直腸腫瘤細胞的接觸面，并存在相互作用。用CFTR突變蛋白的免疫共沉澱實驗進一步發現，這種相互作用需要CFTR分子在細胞膜表面的正確定位及其PDZ結構域結合位點。實驗還發現與CFTR的相互作用加強了AF-6/afadin與細胞骨架蛋白系統的結合。在結直腸腫瘤細胞中CFTR基因敲减导致了AF-6/afadin蛋白定位混亂，從細胞連接位點轉移到細胞漿內，并因此破壞了上皮細胞的緊密性。極性生長細胞的跨上皮電阻降低而滲透性增強的實驗結果證實了CFTR基因敲減導致的上皮細胞緊密性的破壞。同時，AF-6/afadin蛋白水平也隨著CFTR基因敲減而降低，但mRNA水平未發生明顯的改變。蛋白降解系統的抑製劑逆轉了CFTR基因敲減細胞中AF-6/afadin蛋白的減少，提示CFTR基因敲減增加了AF-6/afadin的蛋白降解。這些實驗結果揭示了通過與細胞連接分子AF-6/afadin的相互作用以及調節，CFTR可能在上皮細胞極性的調節以及腫瘤發展過程中起重要作用。 / 論文的第二部份研究了CFTR和AF-6/afadin在結直腸腫瘤細胞上皮細胞間充質化（EMT）和轉移過程中的功能及機制。我們之前的工作已經揭示抑制CFTR的功能可以誘導結直腸腫瘤LIM1863細胞的EMT過程。本研究在另外三株不同的結直腸腫瘤細胞（SW480，SW1116和HRT-18）中進一步證實了抑制CFTR誘導的EMT過程。細胞形態轉變，上皮細胞標誌物的下調，間充質細胞標誌物的上調以及受損的上皮細胞緊密性均證實了對CFTR的抑制可以在這三種細胞中成功誘導EMT的發生。我們發現在以上所有細胞EMT的過程中，AF-6/afadin的蛋白表達水平都發生了顯著的下調。在HRT-18細胞中過表達AF-6/afadin，可以逆轉由CFTR抑製劑誘導的上皮細胞標誌分子的下調和間充質標誌分子的上調，表明抑制CFTR誘導的EMT過程是由AF-6/afadin參與介導的。此外，CFTR基因敲減導致結直腸腫瘤細胞的惡性表型強化，包括減弱的細胞粘附性，增強的貼壁依賴性生長、侵襲和遷移。另外，CFTR基因敲減激活了ERK的磷酸化，過表達AF-6/afadin可以阻斷ERK途徑的激活。CFTR基因敲減而增強的細胞侵襲性也可以被外源性AF-6/afadin或者ERK途徑的抑製劑U0126完全逆轉，提示作為AF-6/afadin的下游靶信號，ERK介導了CFTR在腫瘤侵襲中的作用。更重要的是，我們分析了CFTR和AF-6/afadin的表達水平與結直腸癌病人腫瘤進展的關係，發現在嚴重TNM腫瘤分期或者有腫瘤遠處轉移的病人中CFTR的表達水平顯著低於輕型分期或未发生转移的病人中的水平，而且CFTR和/或AF-6/afadin低表達的病人的預後更差。這些實驗結果顯示CFTR的缺失可能通過抑制AF-6/afadin和激活ERK通路而與EMT和結直腸癌癥轉移的過程高度相關。 / 綜上所述，本研究揭示了以往未報道過的CFTR在結直腸腫瘤發病機理中的功能，提示CFTR可以用作一種新的腫瘤的潛在預後指標。 / The question whether mutation or dysfunction of CFTR increases the risk of malignancies in various tissues, including the gastrointestinal tract, remains highly controversial. Meanwhile, it is well-known that adherens junctions play critical roles in the process of cancer development and metastasis. In this thesis we found for the first time a highly correlation between expression levels of CFTR and an adherens junction molecule AF-6/afadin in human colorectal tumours, and investigated the potential interaction between CFTR and AF-6/afadin and their functional roles in the metastasis of colorectal cancer. / In the first section of this thesis, we started our studies with comparing the expression of CFTR between human colorectal tumours and normal colorectal tissues. Real time quantitative PCR and immunohistochemistry results revealed a dramatically reduced CFTR level in the cancer tissues. Intriguingly, we noticed a highly positive correlation between CFTR and AF-6/afadin expression in tumours, which prompted the further in vitro investigation of possible interaction between CFTR and AF-6/afadin. Using immunofluoresent staining and co-immunoprecipitation, we found that the two proteins were colocalized at cell-cell junctions and interacted with each other in colorectal cancer cell lines. Further Co-IP experiments performed with CFTR mutations revealed that this protein interaction requires the proper localization of CFTR in cell membrane and its PDZ-interacting domain. Moreover the interaction with CFTR strengthens the binding of AF-6/afadin to the cytoskeleton system. Knockdown of CFTR in colorectal cancer cells resulted in the disorganized localization of AF-6/afadin protein from junctional sites to the cytoplasm and impaired epithelial tightness, which was confirmed by significantly reduced transepithelial resistance and increased permeability of polarized cells. Meanwhile, the protein level of AF-6/afadin was down-regulated in CFTR-knockdown cells, while no significant changes were detected at the mRNA level. Protein degradation inhibitor reversed the repression of AF-6/afadin protein in CFTR knockdown cells, suggesting the protein degradation of AF-6/afadin was increased by CFTR knockdown. These data revealed that CFTR interacts with and regulates the cell adhesion molecular AF-6/afadin in colorectal cells, which may be important in the regulation of epithelial cell polarity and cancer development. / In the second section of this thesis, we studied the functional roles and mechanisms of CFTR and AF-6/afadin in the epithelial-mesenchymal transition (EMT) and metastasis of human colorectal cancer cells. Our previous work has revealed inhibition of CFTR can induce EMT in a colorectal cancer cell line, LIM1863. This study further confirmed the induction of EMT by inhibiting CFTR in several other colorectal cancer cell lines (SW480, SW1116 and HRT-18), which was evaluated by morphological changes, down-regulation of epithelial markers or up-regulation of mesenchymal markers, and impaired epithelial cell tightness. In all these cell lines, we found that the protein levels of AF-6/afadin were significantly reduced. Over-expression of AF-6/afadin in HRT-18 cells reversed the down-regulated epithelial markers and up-regulated mesenchymal markers induced by CFTR inhibition, indicating that the CFTR inhibition-induced EMT is mediated by AF-6/afadin. Moreover, knockdown of CFTR in HRT-18 or RKO cells resulted in enhanced malignant phenotypes, including decreased cell adhesion, increased anchorage-independent cell growth, invasion, and migration. In addition, extracellular signal-regulated kinase (ERK) phosphorylation was activated by CFTR knockdown, which was abolished by over-expression of AF-6/afadin. The enhanced invasiveness of CFTR knockdown cells was also completely inhibited by either exogenous AF-6/afadin or ERK inhibitor, U0126, suggesting that ERK, the downstream target of AF-6/afadin, is involved in mediating the effect of CFTR in cancer invasion. More importantly, we analyzed the association of CFTR and AF-6/afadin expression levels with tumour progression of patients with colorectal cancer, and revealed that CFTR expression was significantly lower in patients with more severe TNM stage or with metastasis to distant organs than those with milder stage or with no metastasis. The prognosis was poorer in patients with lower expression of CFTR and/or AF-6/afadin than those with higher expressions. These data showed that dysfunction of CFTR is highly associated with EMT and colorectal cancer metastasis, probably via repression of AF-6/afadin and activation of ERK pathways. / In summary, the present study has revealed a previously undefined role of CFTR in the pathogenesis of colorectal cancer and indicated its potential as a new prognostic indicator. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Sun, Tingting. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 113-127). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract --- p.i / 中文摘要 --- p.iv / Publications --- p.vi / Conference Abstract --- p.vii / Declaration --- p.viii / Acknowledgements --- p.x / List of Figures --- p.xi / List of Tables --- p.xiii / List of Abbreviations --- p.xiv / Chapter Chapter 1 --- General Introduction --- p.1 / Chapter 1.1. --- Colorectal Cancer --- p.1 / Chapter 1.1.1. --- Structure of Human Normal Colon and Rectum Epithelium --- p.1 / Chapter 1.1.2. --- Staging of Colorectal Cancer --- p.3 / Chapter 1.1.3. --- Metastasis of Colorectal Cancer --- p.3 / Chapter 1.1.4. --- K-Ras mutation and It Downstream Pathways in Colorectal Cancer Metastasis --- p.11 / Chapter 1.1.5. --- Prognosis of Colorectal Cancer --- p.14 / Chapter 1.2. --- Epithelial Cell Junctional Complexes --- p.14 / Chapter 1.2.1. --- Junctional Complexes and Epithelial Cell Polarity --- p.15 / Chapter 1.2.2. --- Classic Cadherin-catenin Complex --- p.17 / Chapter 1.2.3. --- Novel Nectin-afadin Complex --- p.19 / Chapter 1.2.4. --- Cell Polarity and Cancer Progression --- p.23 / Chapter 1.3. --- Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) --- p.24 / Chapter 1.3.1. --- Structure of CFTR --- p.24 / Chapter 1.3.2. --- Mutations of CFTR --- p.24 / Chapter 1.3.3. --- Functions of CFTR --- p.26 / Chapter 1.3.4. --- Cancer Risk of CF Patients --- p.33 / Chapter 1.4. --- Hypothesis and Aims --- p.34 / Chapter Chapter 2 --- Materials and Methods --- p.35 / Chapter 2.1. --- Materials --- p.35 / Chapter 2.1.1. --- Reagents and Chemicals --- p.35 / Chapter 2.1.2. --- Antibodies --- p.35 / Chapter 2.1.3. --- Primers --- p.35 / Chapter 2.1.4. --- Solutions and Buffers --- p.35 / Chapter 2.1.5. --- Human Specimens --- p.36 / Chapter 2.2. --- Methods --- p.36 / Chapter 2.2.1. --- Cell Culture --- p.36 / Chapter 2.2.2. --- Transfection --- p.36 / Chapter 2.2.3. --- Selection of Stable Clones --- p.40 / Chapter 2.2.4. --- RNA Extraction and RT-PCR --- p.40 / Chapter 2.2.5. --- Quantitative Real Time PCR --- p.41 / Chapter 2.2.6. --- Protein Extraction and Western Blotting --- p.42 / Chapter 2.2.7. --- Immunostaining --- p.45 / Chapter 2.2.8. --- In vitro Cell Functional Assays --- p.46 / Chapter 2.2.9. --- Epithelial Tightness Measurement --- p.48 / Chapter 2.2.10. --- Statistical Analysis --- p.49 / Chapter Chapter 3 --- Interaction of CFTR with AF-6/afadin and Its Importance in Maintaining Colorectal Epithelial Cell Polarity --- p.50 / Chapter 3.1. --- Introduction --- p.50 / Chapter 3.2. --- Objectives --- p.53 / Chapter 3.3. --- Experimental plan --- p.54 / Chapter 3.4. --- Results --- p.55 / Chapter 3.4.1. --- The expression of CFTR and AF-6/afadin is decreased and positively correlated in human colorectal cancer --- p.55 / Chapter 3.4.2. --- CFTR colocalizes and interacts with AF-6/afadin in human colorectal cancer cells --- p.58 / Chapter 3.4.3. --- PDZ binding motif and membrane localization of CFTR are necessary for the interaction between CFTR and AF-6/afadin --- p.64 / Chapter 3.4.4. --- Knockdown of CFTR interferes with cell junction formation in colorectal cancer cells --- p.66 / Chapter 3.5. --- Discussion --- p.71 / Chapter Chapter 4 --- CFTR as a Suppressor and Prognosis Indicator of Metastasis in Human Colorectal Cancer --- p.77 / Chapter 4.1. --- Introduction --- p.77 / Chapter 4.2. --- Objectives --- p.80 / Chapter 4.3. --- Experimental plan --- p.81 / Chapter 4.4. --- Results --- p.82 / Chapter 4.4.1. --- CFTR inhibition-induced EMT in colorectal cancer cells involves AF-6/afadin --- p.82 / Chapter 4.4.2. --- Knockdown of CFTR aggravates malignant phenotype of colorectal cancer cells --- p.86 / Chapter 4.4.3. --- AF-6/afadin mediates the effect of CFTR on cell invasion in colon cancer through ERK --- p.91 / Chapter 4.4.4. --- CFTR and AF-6/afadin expression is correlated with the prognosis of colorectal cancer --- p.97 / Chapter 4.5. --- Discussion --- p.100 / Chapter Chapter 5 --- General Discussion and Conclusion --- p.105 / Chapter 5.1. --- The diversified roles of CFTR in epithelial cells --- p.105 / Chapter 5.2. --- The unfolding relationship between CFTR and cancer development --- p.107 / Chapter 5.3. --- Future studies --- p.109 / Chapter 5.4. --- Conclusions --- p.112 / Reference List --- p.113 / Chapter Appendix A --- Reagents and Chemicals --- p.128 / Chapter Appendix B --- Antibody List --- p.131 / Chapter Appendix C --- Primer List --- p.132 / Chapter Appendix D --- Solution Recipe --- p.133

環氧合酶-2(COX-2)是在花生四烯酸(AA)轉化為前列腺素H₂(PGH₂)的過程中最重要的限速酶，PGH2再進一步被合成為各種前列腺素，包括前列腺素E₂(PGE₂), 因此，COX-2在前列腺素的合成中起著舉足輕重的作用。COX-2在受到例如感染和炎症等刺激的情況下被誘導，迅速大量地產生。越來越多的證據證明瞭COX-2在許多細胞反應和病理生理過程中起重要作用, 其中, 對COX-2在炎症中的作用研究最深入。 / 囊性纖維化病(CF)是一種由於編碼囊性纖維化跨膜轉導調節器(CFTR)基因的突變所引起的常染色體隱性遺傳疾病。CFTR是在上皮細胞中廣泛表達的環磷酸腺苷(cAMP)依賴的陰離子通道。愈來愈多的證據顯示, CF的呼吸道上皮處於過量炎症因子和前列腺素的微環境中, 最終導致了在CF肺部病變中觀察到的超炎症反應. 但其中的機制仍未闡明. 本研究觀察到, 相對於野生型人類支氣管上皮細胞系(16HBE14o-), CF的人類支氣管上皮細胞系(CFBE41o-)中NFκB的活化, COX-2的表達和PGE₂的產量增加. 此外, CFTR基因敲除小鼠顯示出升高的NFκB活性和COX-2表達水準, 提示CFTR基因的缺失介導了超炎症反應的信號. 我們還驗證了一條PKA和CREB參與介導的PGE₂產生的正回饋通路. 更重要的是, 在CFBE41o-細胞中過表達CFTR顯著地抑制了COX-2的表達. 用LPS或者PGE₂處理16HBE14o-細胞導致了野生型CFTR表達的顯著升高. 這些實驗結果提示了CFTR可能參與對COX-2/PGE₂的負調節. 因此, CFTR負調節PGE₂介導的炎症反應. 這個調節機制的缺陷可能導致在CF炎症反應的組織中觀察到的過量的NFκB活化和過量PGE₂產生. / 我們證實了睾丸中也存在這條CFTR負調節COX-2/PGE₂的通路. 由於隱睾處於比陰囊溫度高的腹腔中, 在隱睾中, 我們觀察到了高溫導致的CFTR下調,伴隨著COX-2的上調以及緊密連接蛋白(ZO-1, occludin)的下調. 這種CFTR和COX-2的負相關在小鼠睾丸高熱動物模型以及CFTR基因敲除小鼠模型中也被證實. 為了模擬隱睾的病理狀況, 我們提高原代睾丸支援細胞的培養溫度至37°C. 與在32°C培養條件下的對照細胞相比, 37C培養的支持細胞中CFTR表達顯著下調, 而COX-2表達顯著上調. 用CFTR的抑制劑CFTRinh-172處理支持細胞48小時後, COX-2的表達也上升了. 抑制或者敲除支持細胞中的CFTR都引起了ZO-1和occludin表達水準的下降, 從而損傷了支持細胞間的緊密連接. NFκB或者PGE₂的抑制劑都能逆轉ZO-1和occludin表達水準的下降. PGE₂同樣導致了支援細胞間緊密連接的損傷. 以上結果提示CFTR對緊密連接的調節作用是通過NFκB/COX-2/PGE₂通路實現的. 本研究闡明了在支持細胞中, CFTR通過負調節NFκB/COX-2/PGE₂通路調節緊密連接, 從而參與了隱睾導致的生精障礙的病理過程. / 總之, 本研究論證了CFTR/COX-2/PGE₂通路在CF呼吸道的超炎症反應以及隱睾導致的生精障礙兩個病理過程中的作用, 說明了CFTR在呼吸系統和男性生殖系統中維持細胞因子穩態的重要作用. CF肺中CFTR的缺失或者隱睾病中CFTR表達水準的下降可能導致了呼吸道中過剩炎症反應和生精障礙. / Cyclooxygenase-2 (COX-2) is a pivotal rate-limiting enzyme responsible for the production of prostaglandins by converting arachidonic acid (AA) to prostaglandin H₂ (PGH₂), which is further metabolized to various prostaglandins, including PGE₂. COX-2 is inducible and increases dramatically upon stimulation, such as infection and inflammation. Accumulating evidences have demonstrated the important role of COX-2 in many cellular responses and pathophysiological processes, especially inflammation. / Cystic Fibrosis (CF) is an autosomal recessive disorder caused by mutations of the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR), a cAMP-dependent anion channel expressed in many epithelia. Accumulating evidence suggests that CF airway epithelia are overwhelmed by excessive inflammatory cytokines and prostaglandins (PGs), which eventually lead to the over-inflammatory condition observed in CF lung disease. However, the exact underlying mechanism remains elusive. In this study, we observed increased COX-2 expression and over-production of prostaglandin E₂ (PGE₂) in human CF bronchial epithelial cell line (CFBE41o-) with elevated NFκB activity compared to a wild-type bronchial epithelial cell line (16HBE14o-). Moreover, we demonstrated that CFTR knockout mice had inherently higher levels of COX-2 and NFκB activity, supporting the notion that lack of CFTR results in hyper-inflammatory signaling. In addition, we identified a positive feedback loop for production of PGE₂ involving PKA and transcription factor, CREB. More importantly, overexpression of wild-type CFTR significantly suppressed COX-2 expression in CFBE41o- cells, and wild-type CFTR protein expression was significantly increased when 16HBE14o- cells were challenged with LPS as well as PGE₂, indicating possible involvement of CFTR in the negative regulation of COX-2/PGE₂. These results suggest that CFTR is a negative regulator of PGE₂-mediated inflammatory response, defect of which may result in excessive activation of NFκB, leading to over production of PGE2 as seen in inflammatory CF tissues. / This negative regulation of COX-2/PGE₂ pathway by CFTR was also identified in the testis in the present study. Downregulation of CFTR accompanied by upregulation of COX-2/PGE₂ and downregulation of tight junction proteins, including ZO-1 and occludin, were observed in a cryptorchidism mouse model with elevated testis in the abdomen, at which the temperature is several degrees higher than that in the scrotum. The inverse correlation of CFTR and COX-2 was further confirmed in a mouse testis hyperthermia model and in CF mice. Culturing primary Sertoli cells at a temperature of 37°C, which mimics the pathological condition of cryptorchidism, led to a significant decrease in CFTR and increase in COX-2 expression compared to the physiological condition of 32°C. Increase of COX-2 expression was also detected 48 hours after administrating CFTRinh-172 to the cells. Inhibition or knockdown of CFTR led to decreased ZO-1 and occludin expression and impaired tight junction in Sertoli cells, which could be mimicked by PGE₂, but reversed by NFκB and COX-2 inhibitors, suggesting that regulation of tight junction by CFTR is mediated by NFκB /COX-2/PGE₂ pathway. This study illustrates that CFTR may be involved in regulating testicular tight junctions through its negative regulation of NFκB/COX-2/PGE₂ pathway in Sertoli cells, defect of which may result in spermatogenesis defect in cryptorchidism. / Taken together, the present study has demonstrated the role of CFTR/ NFκB /COX-2/PGE₂ pathway in two pathological processes, exaggerated inflammation in CF airway and defective spermatogenesis in cryptorchidism, indicating that CFTR is critical for maintaining cytokine homeostasis in respiratory system and male reproductive system. Defect of CFTR in CF lung and downregulation of CFTR in cryptorchidism may contribute to the excessive lung inflammation and impaired spermatogenesis respectively. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chen, Jing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 109-121). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / ABSTRACT --- p.i / 摘要 --- p.iv / ACKNOWLEDGEMENT --- p.vi / LIST OF PUBLICATIONS --- p.vii / ABBREVIATIONS --- p.xii / LIST OF FIGURES AND TABLES --- p.xvi / Chapter 1 --- Chpter 1: Overview --- p.1 / Chapter 1.1 --- CFTR and Cystic Fibrosis --- p.1 / Chapter 1.1.1 --- Cystic Fibrosis --- p.1 / Chapter 1.1.2 --- Structure of CFTR --- p.2 / Chapter 1.1.3 --- Mutations of CFTR --- p.2 / Chapter 1.1.4 --- Channel and signal transduction function of CFTR --- p.3 / Chapter 1.1.5 --- Interaction of CFTR with other proteins --- p.4 / Chapter 1.1.6 --- Regulation of CFTR --- p.5 / Chapter 1.2 --- COX-2 and PGE₂ --- p.6 / Chapter 1.2.1 --- Biosynthesis of PGE₂ --- p.6 / Chapter 1.2.2 --- Pathophysiologic roles of COX-2 and PGE₂ --- p.7 / Chapter 1.2.3 --- Role of COX-2/PGE₂ in inflammation --- p.7 / Chapter 1.2.4 --- Regulation of COX-2 --- p.8 / Chapter 1.2.4.1 --- Regulation of COX-2 by NF-κB --- p.9 / Chapter 1.2.4.2 --- Regulation of COX-2 by CREB --- p.10 / Chapter 1.3 --- Link between CFTR and NF-κB --- p.11 / Chapter 1.4 --- General hypothesis and aims of study --- p.12 / Chapter 2 --- Chapter 2: CFTR negatively regulates COX-2/PGE₂ positive loop in feedback loop in inflammation --- p.13 / Chapter 2.1 --- Introduction --- p.13 / Chapter 2.1.1 --- Airway inflammation in Cystic Fibrosis --- p.13 / Chapter 2.1.2 --- Current theories on the causes of pulmonary inflammation in CF --- p.13 / Chapter 2.1.2.1 --- Theory one --- p.14 / Chapter 2.1.2.2 --- Theory two --- p.16 / Chapter 2.1.3 --- Role of airway epithelia in CF airway inflammation --- p.16 / Chapter 2.1.4 --- Link between CFTR and NF-κB in pulmonary inflammation --- p.17 / Chapter 2.1.5 --- Link between CFTR and COX-2/PGE₂ in pulmonary inflammation --- p.18 / Chapter 2.1.6 --- Hypothesis and aims of study --- p.18 / Chapter 2.2 --- Materials and methods --- p.20 / Chapter 2.2.1 --- Cell culture materials --- p.20 / Chapter 2.2.2 --- Animals --- p.20 / Chapter 2.2.3 --- Chemicals, drugs and assay kits --- p.20 / Chapter 2.2.4 --- Antibodies --- p.22 / Chapter 2.2.5 --- Cell culture. --- p.22 / Chapter 2.2.6 --- Animal models and procedures --- p.23 / Chapter 2.2.7 --- Manipulation of RNA and QRT-PCR --- p.23 / Chapter 2.2.8 --- Manipulation of protein and Western blot --- p.25 / Chapter 2.2.9 --- Histological and morphological --- p.27 / Chapter 2.2.9.1 --- Tissue section. --- p.28 / Chapter 2.2.9.2 --- Hematoxylin and eosin staining --- p.28 / Chapter 2.2.9.3 --- Immunohistochemistry --- p.28 / Chapter 2.2.10 --- PGE₂ EIA --- p.29 / Chapter 2.2.11 --- Statistical analysis --- p.30 / Chapter 2.3 --- Results --- p.30 / Chapter 2.3.1 --- Increased expression of NF-κB and COX-2 in the lung of CF mice --- p.31 / Chapter 2.3.2 --- Defect of CFTR leads to increased COX-2 expression in CF cell line --- p.31 / Chapter 2.3.3 --- Increased expression of COX-2 in CF cells is attributed to NF-κB activation --- p.33 / Chapter 2.3.4 --- A positive feedback loop from PGE₂ to COX-2 is mediated by PGE₂/cAMP/PKA/p-CREB pathway --- p.34 / Chapter 2.3.5 --- PGE₂ increase the expression of CFTR protein in 16HBE14o- but not in CFBE41o- cells --- p.35 / Chapter 2.4 --- Discussion --- p.47 / Chapter 2.5 --- Conclusion --- p.51 / Chapter 3 --- Chapter 3: Role of CFTR/COX-2/PGE₂ Pathway in the Regulation of Junctional Complex Proteins in Sertoli Cells and its Implication in Spermatogenesis Defect in Cryptorchidism --- p.53 / Chapter 3.1 --- Introduction --- p.53 / Chapter 3.1.1 --- Spermatogenesis.p53 / Chapter 3.1.1.1 --- Structure of the seminiferous tubules --- p.53 / Chapter 3.1.1.2 --- Role of Sertoli cells in spermatogenesis --- p.55 / Chapter 3.1.1.3 --- Role of junctional complexes in spermatogenesis --- p.55 / Chapter 3.1.2 --- Junctional complexes in the testis --- p.59 / Chapter 3.1.2.1 --- Tight Junction --- p.59 / Chapter 3.1.2.2 --- Anchoring Junction. --- p.60 / Chapter 3.1.2.3 --- Cross talk between TJs and AJs --- p.60 / Chapter 3.1.3 --- Cryptorchidism --- p.61 / Chapter 3.1.3.1 --- Causes and consequences of Cryptorchidism --- p.61 / Chapter 3.1.3.2 --- Elevated temperature caused by cryptorchidism greatly contributes to defective spermatogenesis --- p.62 / Chapter 3.1.3.3 --- Changes of Sertoli cells in cryptorchidim contributing to defective spermatogenesis. --- p.62 / Chapter 3.1.3.4 --- Disruption of junctional complexes in heat shock and cryptorchidism. --- p.65 / Chapter 3.1.4 --- CFTR and spermatogenesis --- p.66 / Chapter 3.1.4.1 --- Expression of CFTR in Sertoli cells in testis --- p.66 / Chapter 3.1.4.2 --- Temperature sensitive processing of CFTR protein --- p.66 / Chapter 3.1.4.3 --- CFTR and junctional complex --- p.67 / Chapter 3.1.4.4 --- CFTR and male reproduction --- p.68 / Chapter 3.1.4.5 --- Role of CFTR in spermatogenesis --- p.68 / Chapter 3.1.5 --- Prostaglandins and male fertility --- p.69 / Chapter 3.1.5.1 --- Expression of COX-2 in testis. --- p.69 / Chapter 3.1.5.2 --- Role of prostaglandins in spermatogenesis --- p.70 / Chapter 3.1.5.3 --- Regulation of junctional complexes by PGE₂ --- p.70 / Chapter 3.1.5.4 --- Prostaglandins in cryptorchidism --- p.72 / Chapter 3.1.6 --- Hypothesis and aims of study --- p.73 / Chapter 3.2 --- Materials and Methods --- p.74 / Chapter 3.2.1 --- Cell culture materials --- p.74 / Chapter 3.2.2 --- Drugs and Reagents --- p.74 / Chapter 3.2.3 --- Antibodies --- p.74 / Chapter 3.2.4 --- Animals --- p.75 / Chapter 3.2.4.1 --- Mice artificial cryptorchidism model --- p.75 / Chapter 3.2.4.2 --- Mice testes hyperthermia model --- p.75 / Chapter 3.2.5 --- Sertoli cell primary culture --- p.76 / Chapter 3.2.6 --- siRNA against CFTR and transfection --- p.76 / Chapter 3.2.7 --- Examination of assembly and destruction of assembly of inter-Sertoli TJs --- p.77 / Chapter 3.2.8 --- Manipulation of RNA and Real-Time Quantitative RT-PCR (QRT-PCR) --- p.77 / Chapter 3.2.9 --- Manipulation of protein and western blot --- p.77 / Chapter 3.2.10 --- Histological and morphological studies --- p.78 / Chapter 3.2.10.1 --- Immunofluorescence of ZO-1 Staining in Sertoli cells --- p.78 / Chapter 3.2.10.2 --- Immunofluorescent staining of ZO-1, Occludin and β-Catenin in testes --- p.78 / Chapter 3.2.11 --- PGE₂ EIA --- p.79 / Chapter 3.2.12 --- Statistical Analysis --- p.79 / Chapter 3.3 --- Results --- p.79 / Chapter 3.3.1 --- Downregulation of CFTR is associated with upregulation of COX-2 in mice cryptorchidism model, mice testes hyperthermia model, and CF mice testes --- p.79 / Chapter 3.3.2 --- Negative regulation of COX-2 by CFTR is mediated by NF-κB --- p.81 / Chapter 3.3.3 --- Decreased tight junction proteins expression and increased anchoring junction proteins expression in cryptorchid testes. --- p.81 / Chapter 3.3.4 --- Elevation of culture temperature results in downregulation of CFTR and upregulation of COX-2 in primary cultured rat sertoli cells --- p.82 / Chapter 3.3.5 --- Defect of functional CFTR leads to increased COX-2 expression. --- p.83 / Chapter 3.3.6 --- CFTR regulates TJ protein expression and TJ formation through NF-κB/COX-2/PGE₂. --- p.83 / Chapter 3.4 --- Discussion --- p.100 / Chapter 3.5 --- Conclusion --- p.104 / Chapter 4 --- Chapter 4: General Discussion --- p.105 / Chapter 4.1 --- The immunosuppressive function of PGE₂ in CF lung disease and cryptorchidism-induced infertility. --- p.105 / Chapter 4.2 --- Importance of CFTR/ NF-κB /COX-2/PGE₂ pathway in inflammation-based diseases. --- p.106 / Chapter 4.3 --- Possible implications of CFTR/NF-κB /COX-2/PGE₂ pathway in cancer --- p.107 / Chapter 4.4 --- Concluding remarks --- p.108

Thesis (Ph.D. in Toxicology) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 130-174).

Thesis (Ph. D.)--University of Missouri--Columbia, 1998. / Typescript. Vita. Includes bibliographical references (l. 140-148). Also available on the Internet.

Orientador: Carmen Silvia Bertuzzo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T09:38:13Z (GMT). No. of bitstreams: 1 Arruda_LeonardoVicentini_M.pdf: 2764603 bytes, checksum: 06a4165f1f812c7be015b1e98fdfc702 (MD5) Previous issue date: 2006 / Resumo: A incidência da fibrose cística no Brasil é significativamente variável, com diferenças de até 20 vezes de acordo com o grupo étnico e região geográfica estudada. A população brasileira é composta da mistura de muitos grupos étnicos. Os portugueses começaram a colonização no século XVI. Os holandeses invadiram o nordeste em 1630. Os africanos foram trazidos ao Brasil, numa contínua migração forçada, que perdurou do século XVI ao século XIX. No final do século XIX, tiveram início novos movimentos migratórios, principalmente da Alemanha, Itália, Arábia e Espanha. Durante as três primeiras décadas do século XX, nova corrente migratória ocorreu, principalmente da Itália, Espanha e Portugal Após a segunda guerra mundial, o Brasil recebeu novos imigrantes (japoneses, judeus) compondo esta população. Este estudo gerou os primeiros dados sobre a incidência da FC no nordeste e também foram obtidos novos dados para a região sudeste. Na época do estudo, na cidade de Campinas estão sob atendimento no ambulatório 70 pacientes não aparentados com dois testes de suor alterados. Nestes pacientes, foram triadas as seguintes mutações. ?F508 (50%), G542X (4,29%), R1162X (2,14%), N1303K (1,43%) e R553X (0,71%). A mutação G551D não foi encontrada. A mutação ?F508 também foi analisada em 1.138 mulheres saudáveis, sendo 694 da cidade de Campinas - SP e 444 de João Pessoa ¿ PB com idade média de 26,3 anos (15-39, ±6,8), que participaram voluntariamente de projeto de pesquisa anterior. Nas amostras coletadas em Campinas n=694 não foi encontrado nenhum alelo mutante 0/1.388, o que nos impediu de calcular a incidência nesta cidade através deste método. Dos 888 alelos analisados de João Pessoa, foram encontrados quatro alelos mutantes (p=0,0045). Sabendo que a mutação ?F508 corresponde a aproximadamente 50% dos alelos de indivíduos com FC no Brasil, a freqüência dos alelos causadores da FC foi estimada utilizando a proporção: (0,0045/0,5)=0,0090. Com isso, para a cidade de João Pessoa a incidência estimada desta doença autossômica recessiva é de 1:12.321 indivíduos. Esta incidência é similar à encontrada por afro-brasileiros, entretanto difere por exemplo, da encontrada na população do RS. Quando utilizamos o método de cruzamento de dados étnicos das duas regiões estudadas com dados literários da doença nos diferentes grupos étnicos, na cidade de Campinas a incidência da FC ficaria em 1/4.434 e na cidade de João Pessoa ficaria 1/6.087 / Abstract: The incidence of the Cystic Fibrosis (CF) is significantly variable in Brazil, with differences larger than 20 fold, according with the ethnic group and geographic studied region. Brazilian population is composed by ethnic admixture. Portuguese started colonization in the 16th century. The Netherlander invaded the northeast in 1630. The Africans were brought to Brazil, in a continuous forced migration, which lasted from 16th to 19th centuries. In the 19th century, new migratory movements have begun from Germany, Italy, Arab and Spain. In the first three decades of the 20th century, started a new migratory flow, mainly from Italy, Spain and Portugal. After the World War II, Brazil received additional immigrants (Japanese, Jewish) compounding its population. These studies generated the first data about the CF incidence on the Brazilian northeast and also were obtained new data about the southeast region. At the time of this study, 70 non related patients were attended at the local CF center in Campinas, with two positive sweat tests in the city of Campinas-SP. On theses patients were screened the following mutations: ?F508 (50%), G542X (4.29%), R1162X (2.14%), N1303K (1.43%) and R553X (0.71%). The mutation G551D wasn¿t found. The ?F508 mutation was also analyzed in 1,138 healthy voluntary women, 694 from Campinas ¿ SP and 444 from João Pessoa ¿ PB, with average age of 26.3 years (15-39, ±6.8), who previously participated from another research. In the samples collected in Campinas ¿ SP n=694 wasn¿t found any mutated allele 0/1,388 and so, we wasn¿t able to make any incidence calculation through this method. In the 888 alleles from João Pessoa, four carry the ?F508 mutation (p=0.0045). Knowing that this mutation accounts for approximately 50% of the FC patients alleles in Brazil, the incidence of the CF in this region was estimated using the proportion: (0.0045/0.5)=0.009. Thus, the estimated incidence of this recessive disease in João Pessoa was 1:12,321. This incidence is similar to the found in African-Brazilians, although differs for example, to the found on the RS population. When we use the method of crossing ethnic data of both studied regions with literary data of the disease in the different ethnic groups, in the city of Campinas, the incidence of the CF would be in 1/4,434 and in the city of João Pessoa would be 1/6,087 / Mestrado / Mestre em Farmacologia

Orientadores: José Dirceu Ribeiro, Francisco Ubaldo Vieira Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T00:51:01Z (GMT). No. of bitstreams: 1 SouzaGomez_CarlaCristina_M.pdf: 3648408 bytes, checksum: 8fc98c01df413aea0740fb6bb16723a1 (MD5) Previous issue date: 2014 / Resumo: Introdução: O teste do suor clássico (TSC) é aceito como padrão-ouro para o diagnóstico da fibrose cística (FC). Objetivo: Comparara estimulação e peso do suor produzido, os efeitos colaterais associados ao uso das correntes, contínua pulsada (CCP) e contínua constante (CCC) e determinar o tempo ideal para a estimulação e para a coleta de suor em indivíduos com e sem FC. Método: Estudo de intervenção prospectivo de corte transversal. Experimento 1(braço direito): CCC e CCP. Tempo de estimulação (TE) de 10min e o de coleta do suor de 30min. Correntes de 0,5; 0,75; 1,0; e 1,5mA e frequências de 0; 200; 1000; e 5000Hz. Experimento 2 (braço esquerdo): Corrente de 1,0mA; TE: 5 e 10min e coleta de 15 e 30min com frequências de 0; 200; 1000; e 5000Hz. Ambos os experimentos foram testados com densidade de corrente (DC) de 0,07 a 0,21mA/cm2. Experimento 3: Avaliar a CCP e a CCC como métodos diagnósticos para a FC comparando com diagnósticos estabelecidos por estudos na biópsia retal e sequenciamento do gene CFTR(do inglês, Cystic Fibrosis Transmembrane Condutance Regulator). Resultados: Participaram do estudo48 sujeitos (79,16% do sexo feminino), com média de 29,54±8,87 anos de idade. Não houve diferença estatística entre a interação da frequência e da corrente no peso do suor (p=0,75). Houve associação do peso do suor com a frequência de estímulo (p=0,0088) e corrente utilizada para a obtenção de sudorese (p=0,0025). A produção de suor foi maior no tempo de 10min de estimulação (p=0,0023). A coleta do suor foi maior no tempo de 30min (p=0,0019). A impedância da pele não foi influenciada pelo TE e de coleta do suor (p>0,05). A frequência da corrente utilizada mostrou associação inversa com a impedância da pele (p<0,0001). A temperatura da pele mensurada antes da estimulação foi maior que a temperatura após a estimulação (p=0,0001). No experimento 3 (29 indivíduos)a CCP mostrou melhor índice kappa comparada a CCC (0.92versus 0.52, respectivamente). Conclusão: A realização do TSC tanto com CCC quanto CCP utilizando DC de 0,14 a 0,21mA/cm2 mostrou eficácia nas etapas de estimulação e coleta de suor, sem efeitos colaterais. O tempo ideal para a estimulação e para a coleta de suor foi, respectivamente, 10 e 30min / Abstract: Background: The classic sweat test (CST) is still accepted as the goldstandard method for cystic fibrosis (CF) diagnosis. Objective: To compare the production and volume of sweat, the side-effects caused by direct pulsed current (DPC) and direct constant current (DCC) and to determine the stimulation time for stimulation and sweat for collection in CF and non-CF individuals. Method: Prospective study of cross-sectional intervention. Experiment 1 (right arm): DPC and DCC. Stimulation time (ST) of 10min and sweat collection every 30min. Currents of 0.5; 0.75; 1.0; and 1.5mA and frequencies of 0; 200; 1000; and 5000Hz. Experiment 2 (left arm): current of 1mA, ST: 5 and 10min and collection at 15 and 30min interval with frequencies of 0; 200; 1000; and 5000Hz. Both experiments were tested with current density (CD) ranging from 0.07 to 0.21mA/cm2. Experiment 3: To assess CF diagnosis by DPC and DCC methods by comparison with the established by rectal biopsy diagnosis studies and sequencing of the CFTR (Cystic Fribrosis Transmembrane Condutance Regulator) gene. Results: 48 subjects (79.16% female) with mean average of 29.54 ± 8.87 years old participated in this study. There was no statistical differences between the interaction of frequency and current in sweat weight (p=0.7488). An association was found between sweat weight with the frequency of stimulation (p=0.0088) and the current used for sweating (p=0.0025). The sweat production was higher for the 10min stimulation interval (p=0.0023). The best time interval for sweat collection was 30min (p=0.0019). The skin impedance was not influenced by ST and sweat collection time (p>0.05). The frequency of the current used was inversely associated with skin impedance (p<0.0001). The skin temperature measured before the stimulation was higher than after stimulation (p=0.0001). In experiment 3 (29 subjects), the DPC showed better kappa index compared to DCC (0.92 versus 0.52, respectively). Conclusion: ST performance with both DCC and DPC using a CD of 0.14 to 0.21mA/cm2 showed efficacy in both of stimulation and sweat collection steps, without side-effects. The optimal time for stimulation and sweat collection were, respectively, 10 and 30min / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências