Final publication is avilable at http://www.sciencedirect.com/science/article/pii/S0954611115300172 / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19577号 / 医博第4084号 / 新制||医||1013(附属図書館) / 32613 / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 平家 俊男, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The complex pathobiologic mechanisms of emphysema are not fully understood, leaving this deadly disease without effective pharmacotherapy for a cure. This project hypothesized that the sulfated dehydropolymer of caffeic acid (CDSO3) exhibits Fe2+ chelation-based hypoxia inducible factor-1a (HIF-1a) up-regulatory protective activities against in vitro emphysematous cell death and for in vivo reversal of emphysema induced with SU5416, a vascular endothelial growth factor blocker. Using in vitro chromogenic competitive inhibition assays, CDSO3 was shown to chelate Fe2+ (IC50 of 23 µM), but not Fe3+ ions. The trypan blue exclusion and lactate dehydrogenase assays were then employed to examine the cytoprotective activities of CDSO3 against inflammatory, oxidative, elastolytic, and apoptotic cell death using alveolar macrophages, epithelial and endothelial cells. CDSO3 at 10 µM produced significant protective activities against these emphysematous cell deaths by 50-154 %. These protective effects were opposed by the addition of the HIF-1a inhibitors, CAY10585 and echinomycin, and excess Fe2+, but not Fe3+, ions. Emphysema was then induced in rats following a subcutaneous injection of SU5416 at 20 mg/kg, after which CDSO3 at 60 µg/kg was administered to the lungs 3 times/week for two weeks. Treadmill exercise endurance (EE) was measured to assess the functional impairment, while lung tissues were removed for morphological assessments of alveolar airspace enlargement (MLI) and destruction (DI), as well as to measure protein levels using Western blot. SU5416 significantly impaired EE, MLI, and DI by 81 %, 47 %, and 5-fold, compared to the healthy animals, and these were significantly reversed by CDSO3 by 66, 74, and 87 %. CDSO3 treatment did not change the lung cytoplasmic expression of histone deacetylase 2 (HDAC2), HIF-1a, or a pro-apoptotic marker, BAX. However, induction with SU5416 significantly reduced VEGF expression by 52 % and increased cleaved caspase-3 expression by 1.5-fold, compared to the healthy animals, while CDSO3 normalized the expressions of both proteins in these emphysematous animals. However, when CDSO3 was pre-mixed with excess Fe2+, the reversal activities of CDSO3 were diminished. In conclusion, this study has demonstrated the Fe2+ chelation-based HIF-1a up-regulatory dependent in vitro and in vivo lung repairing efficacies for CDSO3 in emphysema.

Il existe plusieurs types d’agressions environnementales : biologiques (virus, bactéries…), chimiques (gaz, fumées, métaux…), physiques (bruits, rayonnements…), et d’autres telles que le stress par exemple. L’appareil respiratoire, qui représente une interface majeure avec l’environnement, est particulièrement vulnérable vis-à-vis de ces agressions, qui ont souvent des conséquences pulmonaires, pouvant parfois conduire au décès. Le tabac notamment est la cause de près de 100 millions de décès au cours du XXème siècle d’après l’Organisation Mondiale de la Santé (OMS), et sera la cause d’environ un milliard de décès au prochain siècle. L’exposition à la fumée de cigarette engendre une inflammation chronique et est souvent corrélée au développement de cancers (1), mais induit aussi de nombreuses autres pathologies pulmonaires telles que la broncho-pneumopathie chronique obstructive (BPCO) / There are several types of environmental attacks: biological (viruses, bacteria …), chemical (gases, smokes, metals …), physical appearances (rumours, brilliances …), and others such as the stress for example. The respiratory system, which represents a major interface with the environment, is particularly vulnerable towards these attacks, which often have lung consequences, being able to sometimes lead to the death. The tobacco in particular is the cause of about 100 million deaths during the XXth century according to the World Health Organization (WHO), and will be the cause about a billion deaths in the next century. The exhibition in the smoke of cigarette engenders a chronic inflammation and is often correlated in the development of cancers (1), but also leads of numerous

Emphysema, a subset of COPD, occurs due to an abnormal inflammatory response to noxious gases or particles leading an influx of immunologic cells. Recent studies have demonstrated endothelial dysfunction in COPD subjects and are suggestive of a vascular phenotype present in COPD that is not fully characterized. We hypothesize that processes affecting the pulmonary vasculature lead to early changes important in the pathogenesis of COPD. This work focuses on the use of multidetector-row computed tomography (MDCT)-based measures of pulmonary blood flow (PBF), mean transit time (MTT) and pulmonary vascular volume (TPVV) to gain new insights into vasculature-related changes present in COPD. As a precursor to using perfusion MDCT imaging to phenotype lung disease, we demonstrated good regional correlation of PBF measurements obtained with MDCT imaging and fluorescent microspheres (FMS) at a FMS piece size resolution of 1.9 cm3 and regional volume level of 8-10 cm3. Additionally, we developed an ex vivo perfusion system, and applied quantitative image analysis techniques to study the lung preparation's stability over 120 minutes. We further validated CT-based PBF and MTT measurements by demonstrating physiologically appropriate responses to a range of flow rates with this new system. Finally, quantitative MDCT-based measurements were used to characterize a novel phenotype of emphysema and test hypotheses regarding vasculature-related changes in smokers and COPD subjects. We demonstrated increased heterogeneity in regional MTT and PBF measurements in smokers with preclinical emphysema compared with smokers with normal lung function and imaging studies and nonsmokers. This data is supportive of the notion that inflammatory-based vascular responses to hypoxia are occurring in smokers susceptible to COPD, but are successfully blocked in smokers without signs of emphysema. A new CT-based measure, TPVV, was studied and we demonstrate its association with total lung volume and body size metrics. TPVV measurements correlated with measures of COPD severity. A trend linking increased TPVV with increased endothelial dysfunction was observed, suggesting that pathological changes of COPD have an effect on the pulmonary vasculature. This work demonstrates the importance of functional information that can compliment structural, anatomical information to answer questions based on the lung physiology and pathological disease processes.

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Erratum pages inserted inside back cover. / Bibliography: leaves 163-200. / xvi, 215 leaves, [13] leaves of plates : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Measurement of elastin derived peptides may be a powerful tool to evaluate mechanisms of elastin breakdown in vivo and in vitro. In human studies EDP levels may provide an early indicator of subjects undergoing increased elastin degradation that may lead to emphysema, and may serve as a biological marker of the effectiveness of therapeutic antielastases. / Thesis (Ph.D.)--University of Adelaide, Dept. of Pathology, 1994

Erratum pages inserted inside back cover. / Bibliography: leaves 163-200. / xvi, 215 leaves, [13] leaves of plates : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Measurement of elastin derived peptides may be a powerful tool to evaluate mechanisms of elastin breakdown in vivo and in vitro. In human studies EDP levels may provide an early indicator of subjects undergoing increased elastin degradation that may lead to emphysema, and may serve as a biological marker of the effectiveness of therapeutic antielastases. / Thesis (Ph.D.)--University of Adelaide, Dept. of Pathology, 1994

ALVES, Calebe de Andrade. Dinâmica de degradação e reparação de fibras elásticas sob tensão. 2013. 71 f. Dissertação (Mestrado em Física) - Programa de Pós-Graduação em Física, Departamento de Física, Centro de Ciências, Universidade Federal do Ceará, Fortaleza, 2013. / Submitted by Edvander Pires (edvanderpires@gmail.com) on 2015-10-23T18:48:28Z No. of bitstreams: 1 2013_dis_caalves.pdf: 1922274 bytes, checksum: beae2409f015f4b21f8f423815937fa0 (MD5) / Approved for entry into archive by Edvander Pires(edvanderpires@gmail.com) on 2015-10-23T19:38:27Z (GMT) No. of bitstreams: 1 2013_dis_caalves.pdf: 1922274 bytes, checksum: beae2409f015f4b21f8f423815937fa0 (MD5) / Made available in DSpace on 2015-10-23T19:38:27Z (GMT). No. of bitstreams: 1 2013_dis_caalves.pdf: 1922274 bytes, checksum: beae2409f015f4b21f8f423815937fa0 (MD5) Previous issue date: 2013 / Extracelular matrix, the biological structure that supports cells in animal tissue, is composed of elastic fibers such as collagen and elastin. It is known that enzymes activity plays an important role in maintenance of these elastic fibers. The imbalance between destruction and repair of the elastic fibers can lead to diseases such as fibrosis and emphysema. In this study, we present a simple model to simulate enzymatic digestion and repair of elastic fibers under tension. The fiber is represented by a chain of linearly elastic springs in series surrounded by two layers of sites along which particles representing enzymes and fragments can diffuse. These particles can biding-unbinding in the fiber simulating the reaction process by changing the local stiffness by a multiplicative factor. We study the distribution of the number of visits of particles to the springs as function of time and the consequent change of the fiber stiffness, under different initial conditions (model parameters). We show that, due to no linearity of the model, the degradation effect prevails even when the concentrations of the two type of agents are the same. There is no relation between the number of degradative and rigidifying particles that garantee that the fiber stiffness remains constant. When an anisotropy factor is included on the model and the system behaviour becomes dependent on the tension applied to the fiber, we show that the increase of tension in general contributes to the increase on enzymatic activity. We believe this study can help better understand progression of diseases such as emphysema and fibrosis. / A Matriz Extracelular, a estrutura biológica que sustenta as células em tecidos animais, é composta de fibras elásticas como colágeno e elastina. Sabe-se que a atividade enzimática desempenha papel fundamental na manutenção dessas fibras elásticas. O desequilíbrio entre destruição e reparo das fibras elásticas pode levar a doenças como fibrose e enfizema. Neste estudo, nós apresentamos um modelo simples para simular digestão enzimática e reparo de fibras sob tensão. A fibra é representada por uma cadeia de molas linearmente elásticas em série. A fibra é cercada por duas camadas de sítios ao longo dos quais partículas representantes de enzimas e fragmentos podem se difundir. Estas partículas podem se ligar e se desligar da fibra, simulando o processo de reação ao alterar a constante elástica local por um fator multiplicativo. Estuda-se a distribuição do número de visitas de partículas degradadoras e enrijecedoras às molas em função do tempo de difusão e a consequente variação da rigidez da fibra, sob diversas condições iniciais (parâmetros do modelo). Mostra-se que, devido a características matemáticas intrínsecas ao modelo, o efeito de degradação prevalece sobre o de enrijecimento ainda quando a concentração de agentes de ambos os tipos é a mesma. Não há relação entre o número de partículas degradadoras e enrijecedoras que garanta a estabilidade da constante elástica da fibra. Quanto um fator de anisotropia é incluído no modelo e o comportamento do sistema passa a depender da tensão aplicada à fibra, mostra-se que o aumento da tensão em geral contribui para o aumento da atividade enzimática. Este estudo poderá ajudar a entender a progressão da degradação de tecidos em doenças como enfisema e fibrose.

La sénescence, perte irréversible des capacités réplicatives des cellules associée à la sécrétion de médiateurs inflammatoires, pourrait participer au développement de l'atteinte pulmonaire dans la bronchopneumopathie chronique obstructive (BPCO) en initiant, maintenant et propageant un état inflammatoire. L'objectif de ce travail était d'évaluer les mécanismes de la sénescence impliqués dans l'induction et le maintien de l'inflammation au cours de la BPCO. Ainsi, des fibroblastes pulmonaires de témoins et de patients atteints de BPCO ont été mis en culture à long terme. Un phénotype sénescent majoré associée à un sécrétome pro-inflammatoire était détectée dans les fibroblastes de patients avec BPCO par rapport aux témoins. Par ailleurs, ces fibroblastes présentaient une expression accrue des récepteurs à la PGE2 (EP2 /4)au stade non sénescent et une production accrue de PGE2, un médiateur lipidique pro-inflammatoire, au stade sénescent. Dans cette optique, une partie du travail a consisté à déterminer si la PGE2 pouvait induire la sénescence et l'inflammation des fibroblastes pulmonaires de sujets atteints ou non de BPCO. Nous avons pu démontrer que la PGE2 synthétisée par les fibroblastes sénescents induisait, maintenait (effet autocrine) et propageait (effet paracrine) la sénescence et l'inflammation associée via une voie EP2/4 / COX-2 / oxydants / p53. L'implication des oxydants dans l'induction de la sénescence nous a conduit à étudier les effets de l'hème oxygénase (HO)-1, un système anti-oxydant et anti-inflammatoire sur la prévention de la sénescence des fibroblastes pulmonaires. Ainsi, des fibroblastes pulmonaires ont été traités chroniquement avec des substances pharmacologiques modulant l'activité d'HO-1. Des résultats préliminaires nous ont permis d'observer que l'activation de HO-1 prévenait l'induction de la sénescence chez des fibroblastes pulmonaires de témoins et de BPCO. Au total, la modulation des voies de la PGE2 et de l'HO-1 pourrait contribuer à limiter la sénescence des fibroblastes pulmonaires dans la BPCO / Cellular senescence, a state of irreversible loss of replicative capacity associated with the secretion of inflammatory mediators, could participate in the development of chronic obstructive pulmonary disease (COPD) by initiating, maintaining and propagating an inflammatory state. The aim of this PhD project was to evaluate the mechanisms involved in senescence induction in COPD lung fibroblasts. COPD fibroblasts exhibited an increased senescent phenotype as compared to control cells. In addition, COPD fibroblasts showed an increased PGE2 receptors (EP2 /4) expression at non senescent stage and PGE2 production, apro-inflammatory lipid mediator at senescent stage. In this context, one part of the study was devoted to determine whether PGE2 could induce senescence of lung fibroblasts of subjects with and without COPD. We have shown that PGE2 synthesized by senescent fibroblasts induced, maintained (autocrine effect) and propagated (paracrine effect) senescence and associated inflammation via EP2 /4 / COX-2 / oxidants / p53 pathway. The essential role of oxidants production in the induction of senescence in COPD led us to study the effects of heme oxygenase (HO)-1, an antioxidant and anti-inflammatory system on the prevention of senescence in COPD fibroblasts. Pharmacological activation of HO-1 by hemin prevented the induction of senescence in lung fibroblasts from COPD patients probably in relation with an anti -oxidant effect. The modulation of PGE2 and HO-1 pathways may contribute to attenuate fibroblasts senescence in COPD

BACKGROUND SUMMARY: Pulmonary rehabilitation programs are an important component of the multidisciplinary approach to minimizing the symptomatology of patients with chronic obstructive pulmonary disease. Within the program, patients learn about how to live with their non-curable disease and how to minimize exacerbations. Although patients learn about their disease process, breathing techniques, and exercise, there are no specific components that bridge the mind and body gap to promote mindfulness through the patients’ efforts within the program. LITERATURE REVIEW FINDINGS: This thesis contains a comprehensive literature review composed largely of randomized trials. These trials and studies summarize the framework of pulmonary rehabilitation programs and how yoga is implemented within treatment options for chronic diseases. The literature review highlights that pulmonary rehabilitation programs improve the quality of life in patients with emphysema through patient education on breathing and exercise. However, there is a lack of literature on the use of yoga techniques of breathing and exercise within the framework of pulmonary rehabilitation programs to promote mindfulness when living with a chronic disease. PROPOSED PROJECT: This thesis proposes a randomized controlled study to identify a more mindful approach to a pulmonary rehabilitation program for emphysema patients through the use of timed ujjayi pranayama (mindful breathing) and yoga asanas (poses). CONCLUSIONS: The results will be analyzed to determine if yoga techniques lead to statistically significant improvement in patient outcomes in emphysema patients enrolled in a pulmonary rehabilitation program. SIGNIFICANCE: The compiled data will reveal how yoga breathwork and movement will be beneficial for emphysema patients enrolled within a pulmonary rehabilitation program.