A hipercolesterolemia é o maior fator de risco para doença arterial coronária e é responsável por um número significante de doenças e mortes. Há evidências que o exercício físico diminui o risco cardiovascular exercendo efeitos benéficos sobre os fatores de risco, incluindo o metabolismo lipídico. Mudanças que ocorrem no metabolismo da LDL podem não ser detectadas através das dosagens rotineiras de lípides plasmáticos. Portanto, avaliamos os efeitos do exercício físico no metabolismo de uma nanoemulsão lipídica artificial com comportamento metabólico semelhante ao da LDL. Foram avaliados 12 indivíduos hipercolesterolêmicos sedentários (H) e 12 indivíduos normolipidêmicos sedentários (N) que foram submetidos a treinamento durante 4 meses. Nos grupos controle, foram estudados 8 indivíduos hipercolesterolêmicos sedentários controle (HC) e 8 indivíduos normolipidêmicos sedentários controle (NC) que não realizaram exercício físico. A emulsão marcada com éster de colesterol -14C (EC-14C) foi injetada endovenosamente. Amostras de sangue foram coletadas em tempos prédeterminados (5 min, 1, 2, 4, 6, 8, 24 horas) após a injeção, para determinação da radioatividade, das curvas de decaimento plasmático e cálculo da taxa fracional de remoção (TFR) dos lípides marcados, por análise compartimental. As avaliações foram feitas antes e após o protocolo de treinamento físico e nos grupos controle foram realizadas 2 avaliações, sendo a segunda 4 meses após a primeira. No grupo H, as concentrações plasmáticas de colesterol total e LDL-c diminuíram (5%, p= 0,0334 e 14%, p= 0,0058), respectivamente, enquanto que, HDL-c, TFR-EC-14C e lag time aumentaram (13%, p= 0,0142; 36%, p= 0,0187; 37%, p= 0,0039), respectivamente após o treinamento físico. No grupo N, a concentração plasmática da HDL foi maior (15%, p= 0,0243), após o treinamento. Nos grupos HC e NC os parâmetros avaliados foram semelhantes. Portanto, o exercício físico acelera a remoção plasmática da LDL em indivíduos hipercolesterolêmicos, indicado pela maior TFR-EC-14C. Este efeito pode ser um dos mecanismos pelos quais o exercício previne a doença arterial coronária. / Hypercholesterolemia has become one of the major risk factors for arterial coronary disease. As such, it is also responsible for a significant number of diseases and deaths. Evidence suggests that physical exercise can, in fact, decrease the risk of cardiovascular diseases by exerting beneficial effects upon the risk factors, including lipid metabolism. The changes that do occur in LDL metabolism are generally not detected by routine clinical laboratory plasma lipid exams. In the present study, the effects of physical exercise on the metabolism of an artificial lipidic nanoemoulsion with similar LDL metabolic behavior were analyzed. 12 hypercholesterolemic sedentary individuals (H) and 12 normolipidemic sedentary individuals (N) were studied. These 24 participants were submitted to a routine training program during a 4-month period. The control group was divided into two groups: one of 8 hypercholesterolemic sedentary individuals (CH) and the other with 8 normolipidemic sedentary individuals (CN) which did not partake in any exercise program. An emulsion labeled with 14Ccholesteryl ester (14C-CE) was endovenously injected into all 4 groups. Blood samples were collected at pre-determined periods (5 min, 1, 2, 4, 6, 8 and 24 hours) after the injection of the emulsion, in order to determine the radioactivity of the plasma decay curves and calculate the fractional clearance rate (FCR) of the labeled lipids for compartimental analysis. Evaluations were made before and after the exercise training protocol. The control groups under went 2 evaluations, the second one 4 months after the first evaluation. In the H group, total cholesterol and LDL-c plasma concentrations decreased (5%, p=0.0334 and 14%, p=0.0058), respectively. HDL-c, 14C-CE-FCR and lag time, on the other hand, increased (13%, p=0.0142; 36%, p=0.0187; 37%, p=0.0039) after exercise training. HDL plasma concentration for the N group was higher (15%, p=0.0243), after exercise training. In groups CH and CN the parameters evaluated were similar. Therefore, exercise accelerates the removal of LDL plasma in hypercholesterolemic individuals as indicated by a higher 14C-CE-FCR. This effect can thus be one of the mechanisms by which exercise can prevent arterial coronary disease.

Recentemente foi demonstrado que na insuficiência cardíaca (IC), a via final das doenças circulatórias e a maior causa de internação em idosos no Brasil, os danos morfo-funcionais da musculatura esquelética representam um preditor independente de mortalidade. Por outro lado, é conhecido que o treinamento físico aeróbico previne o aparecimento desses prejuízos, que potencialmente podem ter relação com alterações no transporte intracelular de Ca2+. Nesse sentido, o objetivo principal do presente estudo foi avaliar o efeito da IC e do treinamento físico aeróbico na IC em relação à função da musculatura esquelética, à expressão de proteínas que transportam Ca2+ no sóleo e no plantar (DHPRα1, DHPR α2, DHPR β1, RYR, NCX, SERCA 1, SERCA 2, parvalbumina) e à atividade da via proteolítica dependente deste íon nestes músculos (calpaína e calpastatina). Foram utilizados camundongos machos C57B7/6J controle e com inativação dos genes para os receptores α2A e α2C adrenérgicos com 7 meses de idade, quando estes apresentam IC induzida por hiperatividade simpática e 50% de mortalidade. A função muscular foi avaliada pelos testes de deambulação e resistência à inclinação. Tanto a expressão protéica como a atividade proteolítica foram avaliadas por Western blot. Os animais com IC apresentaram disfunção muscular, prejuízos nas proteínas relacionadas ao transiente de Ca2+ tanto no sóleo como no plantar, além de alterações na via proteolítica dependente deste íon em relação aos controle. O treinamento físico, por sua vez, preveniu o aparecimento dessas alterações funcionais e moleculares nos animais com IC. Em conclusão, o treinamento físico aeróbico mostrou-se uma terapia efetiva para a síndrome / Heart failure (HF) is a clinical syndrome with poor prognosis characterized by exercise intolerance, early fatigue and skeletal muscle myopathy, which has been considered an independent predictor of mortality. Conversely, aerobic exercise training prevents skeletal muscle dysfunction, which might be related to altered intracellular Ca2+ handling. Therefore, we tested whether HF would lead to alterations in skeletal musculature function related to changes in Ca2+ handling proteins expression (DHPRα1, DHPR α2, DHPR β1, RYR, NCX, SERCA 1, SERCA 2, parvalbumin) and activity of the Ca2+-dependent proteolysis (calpain and calpastatin) in soleus and plantaris muscles. The potential role of exercise training in preventing Ca2+ handling alterations was also studied. Male wild type and α2A e α2C adrenoceptor knockout (KO) mice on a C56BL/6J genetic background were studied at 7 months of age, when KO mice display HF and skeletal muscle myopathy associated with sympathetic hyperactivity and 50% of mortality. KO mice displayed skeletal muscle dysfunction paralleled by altered Ca2+ handling protein expression and Ca2+- induced proteolysis in both soleus and plantaris. Interestingly, exercise training prevented skeletal muscle dysfunction and Ca2+-induced proteolysis in both soleus and plantaris. Collectively, we provide evidence that improved net balance of Ca2+ handling proteins and decreased Ca2+-induced proteolysis upon exercise training is, at least in part, a compensatory mechanism against skeletal muscle myopathy of sympathetic hyperactivity-induced HF

Die chronische Herzinsuffizienz gehört zu den häufigsten internistischen Krankheitsbildern in Europa. Eine wichtige Rolle in der Therapie der chronischen Herzinsuffizienz spielt das moderate körperliche Ausdauertraining. HDL ist als Vasoprotektor bekannt und ist in der Lage, über die Regulation der endothelialen Stickstoffmonoxidsynthase (eNOS) die Dilatationsfähigkeit von Gefäßen zu regulieren. Da eine gestörte Endothelfunktion verbunden mit einer geringeren eNOS-Expression einen wichtigen Aspekt in der Pathophysiologie der Herzinsuffizienz darstellt, war das Ziel dieser Arbeit zunächst, die HDL-induzierte eNOS-Aktivierung und NO-Produktion in Endothelzellen bei chronisch Herzinsuffizienten mit der von Gesunden zu vergleichen. Des Weiteren wurde der Einfluss körperlichen Ausdauertrainings auf die HDL-Funktion bei chronischer Herzinsuffizienz untersucht. Dafür wurde HDL jeweils aus Blutserum von herzgesunden Probanden und Herzinsuffizienten vor und nach körperlichem Ausdauertraining isoliert. Damit wurden humane aortale Endothelzellen inkubiert und anschließend mittels Western Blot die HDL-induzierte Phosphorylierung der endothelialen Stickstoffmonoxidsynthase (Regulation der eNOS-Aktivierung), der Proteinkinase C-βII sowie der p70S6K ermittelt. Des Weiteren wurde ESR-spektroskopisch die HDL-induzierte NO-Produktion in Endothelzellen gemessen. Letztendlich bestand die Frage, worin der Unterschied zwischen HDL von Gesunden und HDL von Herzinsuffizienten besteht, der die funktionalen Differenzen erklären kann. Dazu wurde die Menge des HDL-gebundenen Malondialdehyds ermittelt. Die Endothelfunktion wurde sonographisch als Fluss-vermittelte Vasodilatation bestimmt. Die Ergebnisse der Untersuchungen belegen, dass die HDL-induzierte eNOS-Aktivierung bei Patienten mit chronischer Herzinsuffizienz im Vergleich zu Gesunden vermindert ist. Des Weiteren kann der Einfluss von HDL auf die eNOS-Aktivierung durch körperliches Ausdauertraining bei Patienten mit chronischer Herzinsuffizienz verbessert werden. Die Verbesserung der HDL-induzierten NO-Produktion korreliert dabei mit der verbesserten Fluss-vermittelten Vasodilatation. Als Unterschied zwischen HDL von Gesunden und dem von chronisch Herzinsuffizienten konnte bei den Letztgenannten eine höhere Menge von gebundenem Malondialdehyd nachgewiesen werden.

Bisher existiert keine nicht-invasive/ nicht-operative Therapie der Aortenklappenstenose. Als wichtiger Zeitpunkt für eine präventive Maßnahme, zur Verhinderung der Ausbildung einer hömodynamisch relevanten Aortenklappenstenose, kann das Stadium der Aortenklappensklerose angesehen werden. Dieses frühe Erkrankungsstadium verfügt über zahlreiche pathophysiologische Parallelen zur Atherosklerose, für die eine positive Rolle der Prävention durch körperliche Aktivität erwiesen ist. Ziel dieser Arbeit war die Durchführung der Sekundärprävention der kalzifizierenden Aortenklappenerkrankung durch körperliches Training. Um mögliche Effekte dieser Intervention zu eruieren, wurden LDLR-/--Mäuse mit bereits bestehenden pathologischen Aortenklappenveränderungen über einen Zeitraum von 16 Wochen körperlichem Training unterzogen. Durch morphologische, serumanalytische, immunhistochemische und Genexpressionsanalysen konnte abschließend eine Quantifizierung der Effekte körperlichen Trainings - in der Zielsetzung der Sekundärprävention - realisiert werden.

Metabolic syndrome (MetS) – a clustering of pathological conditions, including abdominal obesity, hypertension, dyslipidemia and hyperglycaemia – is closely associated with the development of type 2 diabetes mellitus (T2DM) and a high risk of cardiovascular disease. A combination of multigenetic predisposition and lifestyle choices accounts for the varying inter-individual risk to develop MetS and T2DM, as well as for the individual amount of the increase in cardiovascular risk in those patients. A physically active lifestyle can offset about half of the genetically mediated cardiovascular risk. Yet, the extent to which standardized exercise programmes can reduce cardiovascular risk differs between patients. Exercise parameters, such as frequency, intensity, type and duration or number of repetitions, differentially target metabolic function, vascular healthand physical fitness. In addition, exercise-induced molecular mechanisms are modulated by other patient-specific variables, such as age, diet and medication. This review discusses the molecular and cellular mechanisms underlying the effects of exercise training on cardiovascular risk specifically in patients with MetS and T2DM.

Ischemic heart disease and resulting heart failure (HF) belong to the leading causes of death in developed countries. In order to prevent HF and improve clinical outcome in patients with myocardial infarction, novel therapies are required to protect the heart against the detrimental effect of ischemic injury. Due to the failure to translate numerous available experimental cardioprotective strategies into clinical practice, the need for novel protective treatments persists. We have, therefore, tried to apply a novel approach to cardiac protection against the postischemic HF induced in rats by ligation of the coronary artery. For this purpose, we have studied (i) the preventive and therapeutic effects of adaptation to continuous normobaric hypoxia (CNH; 12% O2) and exercise training (ExT; treadmill running), and (ii) the possible cardioprotective potential of epoxyeicosatrienoic acid (EET)-based therapy in order to attenuate the postischemic HF in rats. Adaptation to CNH and ExT is known for their cardioprotection in acute ischemia/reperfusion (I/R) injury manifested as reduction of infarct size. EETs exert antihypertensive effects and thus seem to be perspective for the research in clinically relevant models of cardioprotection in hypertensive animals. Our results have revealed that: - CNH prior to...

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Cardiac rehabilitation (CR) exercise training, which traditionally involves the prescription of moderate intensity continuous exercise, can slow the progression of heart disease and improve cardiorespiratory fitness (CRF). Cardiac function is typically investigated using calculations of ejection fraction (EF) from echocardiography, yet EF measures do not provide information about the unique twisting motion of the heart. Novel measures of cardiac function, such as LV twist, myocardial performance index (MPI) and global longitudinal strain (GLS), may provide additional information about changes in LV mechanics associated with exercise training for individuals with coronary artery disease (CAD). The aims of this study were to investigate the changes in cardiac function, using both standard and novel measures, at baseline (0 weeks; T1), post-initial training (4 weeks; T2), and post-training (12 weeks; T3) in response to either stair climbing-based high intensity interval training (STAIR) or traditional moderate intensity continuous training (TRAD). We recruited 16 individuals with CAD (61±7years; 1W) and randomized them into TRAD and STAIR groups (n=8/group). Standard (CRF and EF), and novel (LV twist, MPI, GLS), measures of cardiovascular function were assessed at all three timepoints. CRF improved in both groups, after 4 and 12 weeks (STAIR: T1:22.1±4.2, T2:24.7±4.9, T3:25.4±5.2 and TRAD: T1:22.8±2.5, T2:25.2±4.9, T3:26.0±5.0 mL/kg/min; P<0.005) of CR exercise. We observed an increase in apical rotation (P=0.01) and LV twist (P=0.03), but no changes in either traditional (EF P=0.15), or novel (MPI P=0.19; GLS P=0.81) measures of cardiac function over time, in either group. It is possible that the relatively short training period (12 weeks) was not sufficient to result in significant changes in cardiac function, despite improvements in CRF. Future research should assess both standard and novel indices of cardiac function over longer exercise training periods to determine the ideal indices for tracking changes over time with interventions in this population. / Thesis / Master of Science (MSc) / Cardiac rehabilitation exercise is an important part of recovery after a heart attack, and it has been shown to improve heart function measured using standard ultrasound assessments. Studies have suggested that novel measures of heart function may be more sensitive in comparison to these standard ultrasound measures, yet these novel measures have not been examined in individuals completing stair-climbing based high intensity cardiac rehabilitation exercise training. This work examined the changes in both novel and standard ultrasound measures of heart function after either stair climbing-based high intensity interval training or traditional moderate intensity exercise training in individuals who have heart disease. While this study found that both stair climbing based high intensity interval training and traditional cardiac rehabilitation both resulted in increases in cardiorespiratory fitness after 12 weeks of training, no changes were observed in any of the standard measures of heart function. Supporting the concept that novel measures of heart function might be more sensitive, as some training associated changes were observed in the novel measures of heart function.

As doenças cardiovasculares são a principal causa de morte no mundo, sendo a cardiomiopatia isquêmica a mais prevalente. Independente da sua etiologia, a via final comum da maioria das doenças cardiovasculares é a insuficiência cardíaca. Nos últimos anos, tem sido reportado que o acúmulo de proteínas mal enoveladas no retículo endoplasmático (estresse do RE) pode contribuir para redução da função cardíaca e instalação da insuficiência cardíaca. Apesar do mecanismo responsável pela disfunção contrátil induzida pelo estresse do RE ainda não ser conhecido, evidências sugerem que a inibição da via de sinalização PI3K/AKT pela proteína JNK pode estar envolvida nessa resposta. Na primeira parte desta tese, verificamos que a indução do estresse do RE em cardiomiócitos isolados ativou a JNK, mas não inibiu a via de sinalização PI3K/AKT. A inativação de JNK reverteu a disfunção contrátil e a redução da amplitude do transiente de Ca+2 de cardiomiócitos causados pelo estresse do RE. Pelo fato da via sinalização PI3K/AKT não estar envolvida na disfunção contrátil causada pelo estresse do RE, analisamos outro alvo de JNK, a proteína BNIP3, proteína pró-apoptótica e envolvida no controle de qualidade mitocondrial promovendo mitofagia quando ativada. O estresse do RE aumentou a expressão de BNIP3, a qual foi atenuada pela inibição de JNK. A depleção de BNIP3 impediu a disfunção contrátil dos cardiomiócitos e a redução da amplitude do transiente de Ca+2 induzidos pelo estresse do RE. Na segunda parte da tese, o objetivo foi avaliar se os efeitos observados em cardiomiócitos submetidos a estresse do RE poderiam ser observados em modelo experimental de doença cardiovascular. Nesse sentido, observamos que a disfunção cardíaca provocada pelo infarto do miocárdio em ratos foi acompanhada pelo quadro de estresse do RE e pela ativação da via de sinalização JNK/BNIP3. Entretanto, o treinamento físico aeróbico (TFA), uma das principais terapias não farmacológicas mais eficazes das doenças cardiovasculares, foi capaz de atenuar o estresse RE, a ativação da via de sinalização JNK/BNIP3 e a disfunção cardíaca de ratos infartados. Na terceira parte da tese, verificamos que o TFA aumentou a expressão proteica de DERLIN-1, uma proteína que atua retro-translocando proteínas mal enoveladas para o citosol, no miocárdio de ratos saudáveis. O aumento dos níveis proteicos de DERLIN-1 observado em ratos infartados foi atenuado pelo TFA. Apesar do aumento da proteína DERLIN-1, observamos que nos animais infartados as proteínas mal enoveladas acumulavam na forma de oligômeros e que o TFA atenuou essa resposta. Em conjunto, os resultados da presente tese sugerem que a ativação da via de sinalização JNK/BNIP3 pelo estresse do RE causa disfunção contrátil de cardiomiócitos e que o TFA é capaz de atenuar essa resposta no coração de ratos infartados, melhorando o controle de qualidade de proteína no músculo cardíaco / Cardiovascular diseases are currently the main cause of death worldwide, with the ischemic cardiomyopathy as the most prevalent ethiology. This is of particular interest, since ischemic cardiomyopathy advances to heart failure, a common endpoint of the most cardiovascular disease. In the last years, it has been showed that accumulation of unfolded protein in the endoplasmic reticulum (ER stress) may cause cardiac dysfunction and heart failure development. Despite the mechanisms behind this cardiac deterioration is still unknown, evidences suggest that ER stress-induced cardiomyocytes contractile dysfunction results from PI3K/AKT signaling pathway inhibition, which would be caused by JNK activation. In the first part of this thesis, we found that the ER stress activated JNK, but different from our hypothesis it was not accompanied by an inactivation of PI3K/AKT signaling pathway. The inhibition of JNK mitigated the reduction in cardiomyocytes shortening and amplitude of Ca+2 transient caused by ER stress. Once the PI3K/AKT signaling pathway was not involved in the ER stress-induced cardiomyocytes contractile dysfunction, we have analyzed protein expression of BNIP3, another JNK target involved in apoptosis and mitochondria quality control. We observed that the elevation in BNIP3 proteins levels after ER stress induction was prevented by inhibition of JNK. BNIP3 depletion attenuated the reduction in cardiomyocytes contractility and amplitude of Ca+2 transient induced by ER stress. In the second part of the thesis, we found that myocardial infarction-induced cardiac dysfunction in rats was accompanied by ER stress and activation of JNK/BNIP3 signaling pathway. However, the AET mitigated ER stress, activation of JNK/BNIP3 signaling pathway and cardiac dysfunction in infarcted rats. In third part of the thesis, we have identified that AET increased the protein expression of DERLIN-1 an ER membrane protein that retro-translocates unfolded proteins to cytosol in the myocardial of healthy rats. We observed that the increased DERLIN-1 protein levels in infarcted rats were mitigated by AET. Despite increased DERLIN-1 protein expression, we found high levels of oligomers in the myocardium of infarcted rat, which was reduced by AET. It suggests that unfolded protein degradation was reduced in infarcted hearts. Taken together, these results suggest that ER stress causes cardiomyocytes contractile dysfunction through JNK/BNIP3 signaling pathway activation and that AET mitigates the myocardial infarction-induced ER stress and activation of JNK/BNIP3 signaling pathway by restoring of ER-associated protein quality control in the cardiac muscle

A atrofia está associada ao aumento da degradação protéica em doenças sistêmicas, sendo o sistema proteolítico ubiquitina proteassoma (SUP) uma das principais vias envolvidas. Contudo, pouco é conhecido sobre a contribuição do SUP à atrofia desencadeada pela insuficiência cardíaca (IC). Sabendo dos benefícios do treinamento físico aeróbico (TFA) e que os mecanismos moleculares envolvidos na atrofia na IC ainda não estão esclarecidos, nessa dissertação investigamos: 1) a contribuição do SUP para a atrofia associada à IC em 2 modelos experimentais: um modelo genético de camundongos com hiperatividade simpática (HS), e um modelo de infarto do miocárdio (IM) em ratos e 2) o efeito do TFA sobre a atrofia associada à IC e sobre o SUP. Na HS verificamos aumento da expressão das E3 ligases, da deubiquitinase USP28, das proteínas ubiquitinadas e da atividade do proteassoma no sítio quimiotripsina, sendo que o TFA reduziu a expressão dos componentes alterados. No IM, observamos disfunção cardíaca não associada à IC, porém, com aumento da expressão de Atrogin-1; enquanto o TFA não produziu efeitos significantes. Dessa forma, os dados sugerem a participação do SUP na atrofia desencadeada pela IC na HS e, que o TFA previne a atrofia por reduzir a expressão/atividade de alguns componentes do SUP; e, que no IM, o aumento da expressão de Atrogin-1 precedeu a perda de massa muscular / Skeletal muscle atrophy is associated with increased protein degradation in systemic diseases, which seems to be mainly related to ubiquitin-proteasome system (UPS). However, little is known about UPS contribution to the heart failure-induced muscle atrophy (HF-MA). Likewise, aerobic exercise training (AET) has been established as an adjuvant therapy for HF and molecular mechanisms underlying HF-MA has not been clarified yet. The objectives of the study were: 1) to verify UPS contribution for HF-MA in 2 experimental models: sympathetic hyperactivity-induced HF (&#945;2A/&#945;2CARKO) in mice, and myocardial infarction model (MI) in rats and 2) AET effects on HF-MA and UPS. In &#945;2A/&#945;2C ARKO mice, we observed activation of UPS characterized by increased mRNA levels of E3 ligases Atrogin-1 and E3-a, deubiquitinating enzyme USP28, increased levels of ubiquitinated proteins and chymotrypsin-like proteasome activity. AET prevented HF-MA in the &#945;2A/&#945;2C ARKO by reducing of UPS activity. In MI model, rats displayed cardiac dysfunction and exercise intolerance with no signs of atrophy. However, Atrogin-1 mRNA and protein levels were increased. Therefore, alterations in Atrogin-1expression might precede atrophy and HF in this model. In conclusion, our data provide evidence for skeletal muscle anti-atrophic effect upon AET in &#945;2A/&#945;2C ARKO that is related, at least in part, to a reduced UPS