L'administration chronique de rHuEPO peut engendrer de graves effets secondaires. Une augmentation de l’hématocrite provoquée par la rHuEPO, en augmentant l'érythrocytose, la viscosité sanguine et les forces de cisaillement à la surface vasculaire, peut être responsable d'hypertension artérielle (HTA) et de thromboses artérielles. La présence d'une fonction endothéliale normale et de monoxyde d'azote (NO) peut contrer les effets délétères thrombogène et hypertenseur de l'EPO. Sur ces bases, nous avons étudié les effets cardiovasculaires d'une administration chronique de rHuEPO dans différentes situations : dans le cadre du dopage, chezdes rats "sportifs" présentant une dysfonction endothéliale NO-dépendante induite par l'administration chronique de L-NAME et dans le cadre d'un traitement chez des rats urémiques développant une dysfonction endothéliale NO-dépendante résultante d'une néphrectomie de 5/6de la masse rénale. Chez nos rats entrainés, dopés et traités au L-NAME, nous avons observé une altération de la performance physique avec une mortalité importante (51%). Une HTA sévères'est développée chez ces rats, avec des valeurs de pression artérielle (> 220 mmHg) bien plusélevées que celles des rats recevant le L-NAME seul, associée à une altération de la vasorelaxation NO-dépendante aortique (< 60%). Les rats insuffisants rénaux (IRC) ont eux aussi montré une augmentation de la pression artérielle et une dysfonction endothéliale en réponse àl'acétylcholine au niveau de l'aorte et en réponse à une élévation du flux au niveau de l'artère mésentérique perfusée. Ces différents paramètres ont été améliorés par l'exercice. Les coupes de rein colorées au rouge Sirius ont montré une fibrose accentuée chez les rats CKD. La fibrose, la créatinémie et l'albuminurie ont été diminuées par l'exercice seul mais ont été aggravées chez les rats du groupe CKD+EPO+Ex. L'activité NADPH oxydase et l'expression des Nox4, p67phox etMAPK erk1/2 ont été augmentées chez les les rats CKD. L'exercice ou la rHuEPO ont prévenuces augmentations. Cependant, l'activité de la NAD(P)H oxydase et l’expression des MAPKerk1/2 sont restées élevées dans le rein des rats CKD+EPO+Ex. Nos données suggèrent que l'exercice seul a un effet protecteur contre les dysfonctions vasculaire et rénale et la fibrose rénale. Ces effets protecteurs sont associés à une inhibition de l'activité de la NADPH oxydase et des voies de signalisation MAPK erk1/2. Par contre, l'exercice combiné avec le traitement rHuEPO, a des effets délétères sur la structure et la fonction rénale des rats CKD. Ces effets nocifs semblent liés à la stimulation de la NADPH oxydase et des voies de signalisation MAPKerk1/2. Malgré les effets protecteurs cardiovasculaire et rénal de l'entraînement physique, ces résultats mettent en évidence que la fonction rénale peut être potentiellement endommagée ainsique la structure du rein en combinant l'exercice avec le traitement rHuEPO dans l'insuffisance rénale. En conclusion, nous pouvons dire que la rHuEPO affecte gravement la fonction cardiovasculaire du rat entraîné présentant une dysfonction endothéliale. Ce risque étant fatal,beaucoup de sportifs, voulant augmenter leur performance, mettent leur vie en danger. Par ailleurs, ayant remarqué les effets délétères au niveau rénal, en associant exercice et traitement rHuEPO dans des conditions expérimentales sur un modèle d'insuffisance rénale, nous suggérons une investigation clinique afin de vérifier la transposition de nos résultats aux patients insuffisants rénaux. / The chronic administration of rHuEPO can engender side effects. An increase of the hematocritinduced by rHuEPO, by increasing the erythrocytosis, the blood viscosity and the shear stress onvascular surface, can be responsible of arterial high blood pressure and arterial thrombosis. Thepresence of a normal endothelial function and nitric oxide (NO) can counter the noxious effectsof rHuEPO. On these bases, we studied the cardiovascular effects of a chronic administration ofrHuEPO in various frames: within doping field, to trained rats with L-NAME-induced NOdependentendothelial dysfunction and within the framework of a treatment, to chronic kidneydisease (CKD) rats developing endothelial dysfunction caused by the "5/6 nephrectomy". In ourdoped rats, we observed an important mortality (51%). A severe arterial high blood pressuredeveloped in these rats (> 220 mmHg) associated with an impairment of the NO-dependentvasorelaxation (< 60 %). CKD rats also showed an increase in blood pressure and an endothelialdysfunction, in response to acetylcholine in the aorta and in response to a rise in flow in perfusedmesenteric artery. These parameters were improved by exercise. Kidney sections stained withSirius red showed marked fibrosis in CKD rats. Fibrosis, creatinine and albumin were decreasedby exercise alone but were increased in rats from the CKD + EPO + Ex group. NAD(P)H oxidaseactivity and the expression of Nox4, p67phox, and MAPK erk1/2 were increased in CKDrats. Exercise or rHuEPO prevented these increases. However, the NAD(P)H oxidase activityand the expression of MAPK erk1/2 remained high in the kidney of rats from the CKD+EPO+Exgroup. Our data suggest that exercise alone has a protective effect against vascular and renaldysfunction and renal fibrosis. These protective effects are linked to the downregulation of theNADPH oxidase activity and MAPK erk1/2 signaling pathways. However, exercise combinedwith rHuEPO treatment has deleterious effects on kidney structure and function in CKDrats. These adverse effects appear to be related to the stimulation of NADPH oxidase and MAPKerk1/2 signaling pathways. Despite the cardiovascular and renal protective effects of physicaltraining, these results highlight the potentially damaging renal function and structure bycombining exercise with rHuEPO therapy in renal failure. In conclusion, we can say that therHuEPO affects seriously cardiovascular function in trained rat with endothelial dysfunction. Thisrisk being fatal, many sportsmen, looking to increase their performance, put their life in danger.Moreover, having noticed the deleterious effects in the kidney by combining exercise andrHuEPO therapy under experimental conditions on a model of renal failure, we suggest a clinicalinvestigation to verify the transposition of our results to patients with renal failure

O endotélio vascular é responsável por várias funções, dentre elas, o controle do tônus vascular realizado por meio da produção e liberação de substâncias constritoras (EDCFs) e relaxantes (EDRFs) derivadas das células endoteliais. Essas substâncias então envolvidas em várias ações como relaxamento ou contração do músculo liso vascular. Em algumas doenças como na hipertensão arterial, ocorre um desequilíbrio entre esses mecanismos. Essas alterações podem ocorrer devido ao aumento nas concentrações de espécies reativas de oxigênio (EROs) que reduzem a biodisponibilidade do óxido nítrico (NO), principal EDRF, assim como aumentar os níveis de prostanóides como prostaglandinas (PGs) e tromboxano A2 (TXA2), principais EDCFs produzidos pela COX. Dessa forma, a liberação de NO e inibição da COX podem ser efetivas nesses casos. Os anti-inflamatórios não esteroidais associados a doadores de NO (CINODs) tem importantes ações no sistema vascular. O leito vascular coronariano pode sofrer com o desequilíbrio na produção de fatores endoteliais e apresentar disfunção endotelial. Porém, apesar da sua relevância, a microcirculação coronariana não tem sido explorada como alvo para os CINODs. O presente trabalho teve como objetivo avaliar as alterações vasculares do leito coronariano no modelo de hipertensão renal (2R-1C) e determinar a ação do composto NCX 2121 em artéria coronária de ratos normotensos (2R) e hipertensos 2R-1C. Observamos alterações cardíacas com hipertrofia do coração e menor aumento da pressão de perfusão coronariana (PPC) sob aumentos de fluxo, pela técnica de Langendorff em corações de 2R-1C. Na artéria coronária isolada houve aumento da expressão da enzima cicloxigenase (COX-2), redução na expressão de Cav-1 e em canais para potássio, ausência de disfunção endotelial e redução na resposta contrátil ao agonista do receptor TP (U46619) mediada pela atividade de COX, bem como resposta relaxante dependente do endotélio também dependente de COX em 2R-1C. Ainda o U46619 induziu uma grande produção de PGI2 somente em artérias coronárias de 2R-1C. O composto NCX2121 promoveu relaxamento de baixa magnitude em artérias coronárias, sem diferenças entre a resposta entre artérias de ratos 2R e 2R-1C e sem a participação de EROs. Verificamos que o L-NAME induziu um ganho de contração nas artérias dependente de atividade de COX. . Nossos resultados sugerem que durante a hipertensão a via da COX com produção de PGI2 pode estar aumentada justificando a baixa magnitude de relaxamento ao composto NCX2121, um inibidor de COX / as prostaglandins (PGs) and thromboxane A2 (TXA2) the main EDCFs produced by COX. Thus, NO release and COX inhibition may be effective in these cases. Non-steroidal anti-inflammatory drugs associated with NO donors (CINODs) have important actions in the vascular system. The imbalance between the production of endothelial factors is recognized as endothelial dysfunction. However, despite its relevance the coronary microcirculation has not been explored as a target for CINODs. The objective of this study was to evaluate the vascular alterations of the coronary vascular bed in renovascular hypertension model (2K-1C) and determine the action of the compound NCX 2121. We observed cardiac changes with hypertrophy of the heart and lower increase of coronary perfusion pressure (CPP) under increases of flow, by the Langendorff technique in 2K-1C hearts. In the isolated coronary artery there was an increase in the expression of the cyclooxygenase 2 (COX-2) enzyme, reduction in Cav-1 expression and in potassium channels, absence of endothelial dysfunction and reduction in the contractile response to TP-receptor agonist (U46619) mediated by COX activity, as well as endothelium-dependent relaxing response dependent of COX in 2K-1C. Furthermore, U46619 induced a large production of PGI2 only in 2R-1C coronary arteries. The compound NCX2121 promoted low magnitude relaxation in coronary arteries with no differences between the arteries from 2K and 2K-1C rats also without participation of EROs. We found L-NAME induced contraction dependent on COX activity in 2K-1C. Our results suggest that during hypertension the COX pathway with PGI2 production may be increased justifying the low magnitude of relaxation to the compound NCX2121, a COX inhibitor.

Afin d’identifier de nouveaux composés prévenant la dysfonction et l’immunogénicité des cellules endothéliales qui sont impliquées dans la survenue des rejets de greffe,nous nous sommes intéressés aux métabolites secondaires de différentes espèces de Clusiaceae et de Calophyllaceae. Tout d’abord, 4 extraits DCM de Calophyllaceae malaisiennes ont été sélectionnés sur la base d’une étude déréplicative et d’un criblage biologique anti-inflammatoire. Puis, l’étude phytochimique de l’extrait de fruits de Mesua lepidota a permis d’isoler 9 coumarines de type mammea, dont 7 constituent 2 nouvelles séries : Les lépidotols et les lépidotines. L’étude des extraits de 2 lots de feuilles de Calophyllumtetrapterum a quant à elle conduit à l’isolement de dérivés polyphénoliques distincts : Desacylphloroglucinols polyprénylés dans le lot A, dont le composé majoritaire, la tétraptérone, est un dérivé acide original, et des pyranochromanones acides dans le lot B, dont un nouveau dérivé appelé acide tétraptérique. Le même protocole appliqué à l’extrait de feuilles de Mesuaassamica a montré que les fractions cytotoxiques sont riches en xanthones, tandis que les fractions anti inflammatoires renferment des coumarines de type mammea. Parallèlement à ces études phytochimiques, un panel de polyphénols représentatifs des classes chimiques retrouvées dans les Clusiaceae et les Calophyllaceae ont été évalués pour leurs effets sur divers marqueurs endothéliaux de l’inflammation et de l’immunité. Il apparaît ainsi que les coumarines de type mammea et la guttiférone J, une benzophénone polyprénylée, inhibent significativement l’expression de VCAM-1 ainsi que des molécules HLA de classe II, HLAE et MICA. / In order to identify new compounds preventing endothelial cells dysfunction and immunogenicity which are involved in the emergence of graft rejection, the secondary metabolites of different Clusiaceae and Calophyllaceae specious were investigated. Firstly 4DCM extracts originating from Malaysian Calophyllaceae specious were selected through a dereplication analysis combined with an anti-inflammatory screening. Then, the phytochemical study of the fruits extract of Mesualepidota allowed us to isolate 9 mammea coumarins, among which 7 represent 2 novel series, i.e. lepidotols and lepidotins. The phytochemical study of 2 different batches of Calophyllum tetrapterum leaves led to the isolation of distinct polyphenolic derivatives : polyprenylated acylphloroglucinols were identified in batch A, with the major compound, tetrapterone, as a new acid derivative, whilst chromanone acids were identified in batch B, including a new derivative named as tetrapteric acid. The same protocol applied to Mesuaassamica leave extract showed that cytotoxic fractions were rich in xanthones whereas anti-inflammatory fractions contained numerous mammea coumarins. Along with these phytochemical studies, a panel of polyphenols representative of the chemical classes generally identified in Clusiaceae and Calophyllaceae specious were evaluated for their effects on various endothelial markersof inflammation and immunity. Mammea coumarins and guttiferone J, a polyprenylated benzophenone, appeared to significantly inhibit the expression of VCAM-1 as well as that of HLA class II molecules, HLA-E and MICA.

A Hipertensão Arterial Pulmonar (HAP) é uma patologia grave e incapacitante, caracterizada por modificações bioquímicas, morfofuncionais e estruturais que gera aumento progressivo da resistência vascular pulmonar (RVP), da pressão arterial pulmonar média (PAPm) e alterações no ventrículo direito (VD) que culminam com a insuficiência cardíaca direita (ICD), seguida de óbito. O efeito do exercício físico aeróbio sobre o estresse oxidativo e sobre o metabolismo do óxido nítrico (NO) e endotelina-1 (ET-1), no tecido pulmonar é desconhecido. Assim, este estudo teve como objetivo verificar a influência de um protocolo de exercício físico sobre o estresse oxidativo pulmonar e o seu papel modulador no metabolismo do NO e da ET-1 em ratos com HAP. Para isso, foram utilizados 28 ratos machos Wistar, divididos em quatro grupos experimentais (5-7 animais): CS (controle sedentário), MS (monocrotalina sedentário), CT (controle treinado) e MT (monocrotalina treinado). Os animais dos grupos CT e MT participaram de duas semanas de pré-treinamento em esteira adaptada para ratos. No final desse período, os animais dos grupos MS e MT receberam dose única (60 mg/Kg) intraperitoneal de monocrotalina (MCT), enquanto que os animais dos grupos CS e CT, receberam salina na mesma dose. Em seguida, os animais dos grupos CT e MT foram submetidos a três semanas de treinamento aeróbio, com frequência de cinco vezes por semana e utilização de 60% do VO2 máximo. Análises ecocardiográficas foram realizadas 24 horas após a última sessão de exercício físico aeróbio. Os parâmetros de tempo de aceleração/tempo de ejeção do fluxo pela artéria pulmonar (TAC/TEJ), volume sistólico (VS), débito cardíaco (DC), excursão sistólica do plano do anel da tricúspede (TAPSE), fração de enchimento (FEC), mudança da área fracional (FAC), índice de performance do miocárdio (IPM) e velocidade de enchimento rápido/lento do ventrículo direito (E/A) foram analisados e, em seguida, os ratos foram mortos por sobrecarga anestésica, confirmada por deslocamento cervical. Seus órgãos (coração, fígado e pulmão) foram coletados para realização posterior das análises. A massa do coração foi utilizada para analisar a hipertrofia cardíaca (HC) e a massa do fígado, para analisar a congestão hepática. O lobo direito do pulmão foi separado para realização das análises bioquímicas e moleculares e, o lobo esquerdo para realização das análises imuno-histoquímicas. A administração de MCT promoveu hipertrofia do VD, redução dos parâmetros TAC/TEJ, DC, VS e TAPSE, sendo que o exercício físico aeróbio acentuou essa redução nas análises do TAC/TEJ e DC. Nos demais parâmetros ecocardiográficos e na congestão hepática, não encontramos diferenças significativas entre os grupos experimentais. Nos resultados bioquímicos encontramos aumento da concentração do radical superóxido (O2.-) nos grupos MCT, principalmente no grupo MT, inalteração da concentração de peróxido de hidrogênio (H2O2) e da atividade da enzima NADPH Oxidase (NOX). Em relação às enzimas antioxidantes, encontramos redução da atividade da superóxido dismutase (SOD) nos animais que participaram do protocolo de treinamento físico e inalteração da sua expressão por Western Blot. A catalase (CAT), por sua vez, teve sua atividade reduzida nos animais que receberam MCT e também na sua expressão no grupo MS quando comparado ao CS. Já o grupo MT teve aumento da expressão da CAT quando comparado ao grupo MS.Em relação à atividade da enzima glutationa peroxidase (GPx) houve aumento nos grupos que receberam a MCT, principalmente no grupo MT. Encontramos ainda, redução nos danos oxidativos a proteínas e lipídios nos grupos que receberam MCT. O metabolismo do NO também foi afetado, uma vez que evidenciamos redução da atividade da óxido nítrico sintase (NOS) nos animais que participaram do protocolo de treinamento aeróbio e também naqueles que receberam a MCT. A concentração de nitritos totais e da expressão de enzima óxido nítrico sintase endotelial (eNOS) não apresentaram diferenças significativas entre os diferentes grupos experimentais. Houve aumento na marcação da enzima óxido nítrico sintase induzível (iNOS) e na nitrotirosina em arteríolas pulmonares dos animais que receberam MCT, sendo mais acentuada nos animais do grupo MT. Ainda, não encontramos alterações significativas na expressão do receptor A (ET-A) da ET-1, mas sim, redução da expressão do receptor B (ET-B). Em conclusão, o modelo experimental de HAP induzido por MCT, foi reproduzido nesse estudo e a realização do protocolo de treinamento físico mostrou-se incapaz de atenuar e/ou reverter as alterações no metabolismo do NO e da ET-1, bem como o aumento do estresse oxidativo causados pela droga, no tecido pulmonar. Na verdade, em muitas análises, foram encontrados efeitos prejudiciais do exercício físico, potencializando a progressão e severidade da doença. / Pulmonary arterial hypertension (PAH) is a serious and disabling condition characterized by biochemical, morphological, functional and structural alterations, which generate a progressive increase in pulmonary vascular resistance (PVR) and in mean pulmonary arterial pressure (mPAP), together with changes in right ventricle (RV). This scenario leads to right heart failure, followed by death. The effects of aerobic exercise on oxidative stress, metabolism of nitric oxide (NO) and endothelin-1 (ET-1) in lung tissue are unknown. This study aimed to verify the influence of a physical exercise protocol on pulmonary oxidative stress and also the modulatory role of exercise in the metabolism of NO and ET-1 in rats with PAH. Then, 28 male Wistar rats were used, divided into four groups (5-7 animals/group): SC (sedentary control), SM (sedentary monocrotaline), TC (trained control), and TM (trained monocrotaline). Animals of TC and TM groups participated in two weeks of pre-training on a treadmill adapted to rats. At the end of this period, the animals of TM and SM groups received a single injection (60 mg/kg, i.p.) of monocrotaline (MCT), whereas animals of SC and TC groups received saline at the same volume. Then, the animals of TC and TM groups underwent three weeks of aerobic training, five times a week, using 60% of maximum VO2. Echocardiographic analysis was performed 24 hours after the last aerobic exercise session. The parameters of acceleration /ejection time of pulmonary artery flow (AT/ET), stroke volume (SV), cardiac output (CO), tricuspid annular plane systolic excursion (TAPSE), filling fraction (FF), fractional area change (FAC), myocardial performance index (MPI) and fast/slow rate of right ventricular filling (E/A ratio) were analyzed, and then rats were euthanized with anesthetic overload, confirmed by cervical dislocation. Heart, liver and lungs were collected to perform later analysis. Heart mass was used to analyze cardiac hypertrophy (CH), and liver mass to analyze hepatic congestion. The right lobe of lung was separated to biochemical and molecular measurements and the left lobe to perform immunohistochemical analysis. The administration of MCT promoted RV hypertrophy, and reduced AT/ET, CO, SV, and TAPSE. However, aerobic exercised groups had an accentuated reduction in the analysis of the AT/ET and CO. We found no significant differences between the experimental groups in other echocardiographic parameters and liver congestion analysis. Biochemical results showed increased concentrations of superoxide radical (O2.-) in the MCT group, especially in the TM group, with no changes in hydrogen peroxide concentration (H2O2) and NADPH oxidase enzyme activity (NOX). Regarding the antioxidant enzymes, we found reduced activity of superoxide dismutase (SOD) in animals that underwent physical training protocol, with no changes in expression by Western blot. Catalase (CAT), in turn, reduced its activity in animals that received MCT and in its expression in the SM group, when compared to SC. However, animals in TM group had increased expression of CAT when compared to SM group. Regarding the activity of glutathione peroxidase enzyme (GPx) there was an increase in the groups that received MCT, mainly in the TM group. The groups that received MCT presented reduction in oxidative damage to proteins and lipids. NO metabolism was also affected, once reduction in the activity of nitric oxide synthase (NOS) was observed in animals that participated in the aerobic training protocol and also in those who received MCT. The concentration of total nitrites and the endothelial nitric oxide synthase enzyme (eNOS) expression showed no significant differences between the different experimental groups. There was an increase in the immunohistochemical analysis of the inducible nitric oxide synthase enzyme (iNOS) and nitrotyrosine in pulmonary arterioles of animals that received MCT, being more pronounced in the animals of TM group. Although no significant changes in the A receptor of ET-1 (ET-A) expression were identified, it was detected a decrease in the B receptor of ET-1 (ETB) expression. In conclusion, the experimental model of PAH induced by MCT was reproduced in this study and physical training protocol execution proved to be unable to mitigate and/or reverse changes in the metabolism of NO and ET-1, as well as the increased oxidative stress caused by the drug in lung tissue. In fact, in many analyzes, harmful effects of exercise were found, contributing to progression and severity of the disease.

L’hypertension artérielle pulmonaire (HTAP) est une maladie grave caractérisée par une obstruction progressive des artères pulmonaires de petit calibre, conduisant à une augmentation des résistances vasculaires pulmonaires et, à terme, à une défaillance cardiaque droite et au décès du patient. La vasoconstriction, le remodelage vasculaire et la dysfonction endothéliale pulmonaire sont autant de facteurs qui contribuent au développement et à la progression de la maladie. Plusieurs arguments sont également en faveur d’une hypothèse de désordres immunologiques, voire autoimmuns, dans la physiopathologie de l’HTAP. Malgré ces données, le lien entre endothélium pulmonaire et système immunitaire dans cette maladie restent peu connus. Ce travail de thèse a donc eu pour objectif d’étudier et mieux comprendre la nature et les conséquences d’une communication aberrante entre cellules endothéliales pulmonaires et système immunitaire dans la pathogénèse de l‘HTAP, afin d’identifier de nouvelles cibles thérapeutiques. Pour cela, nous avons analysé le rôle de la dysfonction endothéliale dans la régulation de deux processus de la dysfonction immunitaire : l’autoimmunité pour la réponse adaptative d’une part, et la sécrétion de cytokines en ce qui concerne la réponse innée d’autre part. A travers ce travail de thèse, nous avons mis en évidence l’existence d’une communication aberrante entre endothélium pulmonaire et système immunitaire dans l’HTAP et montré que l‘endothélium pulmonaire jouait un rôle primordial dans le contrôle des réponses adaptatives, en régulant la fonction des lymphocytes T régulateurs via la leptine, et dans la participation active à la réponse innée, en acquérant un phénotype pro-inflammatoire. Cette meilleure compréhension du rôle de la dysfonction endothéliale dans la dérégulation du système immunitaire présente dans l’HTAP pourrait aider au développement de nouvelles stratégies thérapeutiques dans cette maladie. / Pulmonary arterial hypertension (PAH) is a severe disease characterized by a progressive obstruction of small pulmonary arteries, leading to an increase in pulmonary vascular resistance and ultimately right heart failure and death. Vasoconstriction, vascular remodeling and pulmonary endothelial dysfunction contribute to the disease development and progression. Increasing evidence are also suggesting the importance of immune disorders, such as autoimmunity, in PAH pathophysiology. Despite these data, the link between pulmonary endothelium and immune system is still unclear. The objective of this work was to investigate and elucidate the nature and the consequences of an aberrant communication between pulmonary endothelial cells and immune system in PAH pathogenesis, in order to identify new therapeutical targets. Therefore, we analyzed the role of endothelial dysfunction in the control of two types of altered immune responses: autoimmunity for the adaptive response and cytokine secretion for the innate response. In this work, we highlighted the existence of an aberrant communication between pulmonary endothelium and immune system in PAH and showed that pulmonary endothelium played a key role in the control of adaptive responses, by regulating regulatory T lymphocyte function in a leptin-dependent manner, and by actively participating to the innate responses through a pro-inflammatory phenotype. A better understanding of the role of endothelial dysfunction in PAH immune system dysregulation may help to the development of new therapeutical strategies for this disease.

O café, rico em substâncias bioativas, está entre os maiores contribuintes para a ingestão de antioxidantes em vários países. O tipo de torra dos grãos influencia em sua atividade antioxidante. Estudos indicam que o consumo moderado de café filtrado está envolvido na redução do risco de doenças crônicas não-transmissíveis, geralmente associadas entre si e que se constituem em graves problemas de saúde pública. Entretanto, a literatura não apresenta consenso sobre a ação benéfica do café na redução do risco destas doenças. Objetivos: Comparar a atividade antioxidante de dois graus de torras de café (torra média-clara e média) e seus efeitos sobre biomarcadores de risco cardiovascular em indivíduos saudáveis. Métodos: A caracterização de antioxidantes nas bebidas foi realizada pelas análises de compostos fenólicos totais, perfil de ácidos fenólicos, cafeína, melanoidinas e capacidade antioxidante total - TAC (sequestro do radical DPPH e capacidade de absorbância do radical oxigênio - ORAC). Após 1 semana de washout, vinte voluntários saudáveis (20 a 65 anos) ingeriram café filtrado preparado com torra média-clara ou torra média por 4 semanas e com o outro tipo de torra por mais 4 semanas em um ensaio clínico randomizado do tipo crossover, o qual durou 9 semanas. Lipídeos plasmáticos, lipoproteína (a), homocisteína total, biomarcadores glicêmicos e pressão arterial de 24 horas foram medidos antes do período de intervenção a após a ingestão de cada torra. A atividade antioxidante foi avaliada no plasma e em eritrócitos respectivamente pela TAC (kit Total Antioxidant Status e ORAC) e da atividade das enzimas antioxidantes (superóxido dismutase - SOD, glutationa peroxidase - GPx e catalase - CAT). A capacidade de inibição da peroxidação lipídica foi avaliada no plasma pelas determinações de lipoproteínas de baixa densidade (LDL) oxidadas e 8-isoprostano. Biomarcadores inflamatórios relacionados à disfunção endotelial foram medidos no plasma por imunoensaios. Resultados: Vinte voluntários saudáveis (49,5 + 8,9 anos) foram avaliados. A torra média-clara apresentou maior teor de ácidos clorogênicos (334 mg/150 mL; p < 0,001) e menor teor de cafeína (231 mg/150 mL; p = 0,003) que a torra média (210 mg/150 mL e 244 mg/150 mL, respectivamente). Os teores de melanoidinas foram significamente maiores na torra média (p < 0,001). A TAC não diferiu entre as bebidas. A ingestão de ambas as torras causou aumento nas concentrações de colesterol total e LDL (10 e 12 por cento para a torra média-clara; 12 por cento e 14 por cento para a torra média) (p < 0,05). A ingestão da torra média também aumentou a concentração da lipoproteína de alta densidade (HDL) em 7 por cento (p = 0,003). Houve aumento nos índices de Castelli após o consumo da torra média-clara (5 por cento no índice I; p = 0,01 e de 6 por cento no índice II; p = 0,03). O TAS dos indivíduos aumentou 21 por cento e 26 por cento , respectivamente, após consumo da torra média-clara e média (p < 0,001). Os indivíduos também tiveram aumento de 13 por cento e 13 por cento na atividade da CAT, 52 por cento e 75 por cento na SOD e 62 por cento e 49 por cento na GPx após a ingestão da torra média-clara e torra média (p < 0,001), respectivamente. Ambas as torras aumentaram as concentrações da molécula de adesão celular vascular-1 solúvel (sVCAM-1), sendo 18 por cento para a torra média-clara e 14 por cento para a torra média) (p < 0,05). A concentração de fibrinogênio plasmático aumentou 8 por cento após ingestão da torra média (p = 0,01) e a selectina-E solúvel (sE-selectina) aumentou 12 por cento após a torra média-clara (p = 0,02). Embora o consumo de café tenha elevado os níveis de colesterol total e LDL, não se relacionou à alteração de homocisteína total, lipoproteína (a) e biomarcadores de diabetes e de peroxidação lipídica. Conclusão: O consumo moderado de café filtrado apresentou alguns efeitos maléficos sobre o perfil de risco cardiovascular em indivíduos saudáveis, independente de sua atividade antioxidante / Introduction: Coffee is rich in bioactive substances and it is among the major contributors to the total antioxidant ingestion in several countries. The roasting degree of coffee is important for its antioxidant activity. Studies indicate that the moderate consumption of filtered coffee is involved in the prevention of chronic diseases, which are usually associated and constitute serious problems of public health. However, literature does not present consensus about the beneficial effects of coffee in the prevention of these diseases. Objectives: To compare the antioxidant activity of the two coffee roasts (medium light and medium roast) and their effects on biomarkers of the cardiovascular risk in healthy volunteers. Methods: The antioxidant characterization of the coffee beverages was performed by the total phenolic content analysis, phenolic profile, caffeine, melanoidins and total antioxidant capacity - TAC (DPPH radical scavenging capacity and Oxygen radical absorbance capacity - ORAC assays). After 1-week washout, twenty healthy volunteers (20 to 65 years old) consumed medium light roast or medium roast paperfiltered coffee for 4 weeks and then switched to the other roast for an additional 4 weeks in a randomized crossover trial that lasted 9 weeks. Plasma lipids, lipoprotein (a), total homocysteine, serum glycemic biomarkers, and twenty-four hours blood pressure were measured at baseline and after each intervention. Levels of total antioxidant status (TAS) and ORAC were evaluated in plasma, and antioxidant enzymes activities (superoxide dismutase - SOD, glutathione peroxidase - GPx and catalase - CAT) in erythrocytes. Lipid peroxidation inhibition capacity was determined in plasma by oxidized LDL and 8-isoprostane assays. Endothelial dysfunction-related inflammation biomarkers were measured in plasma by immunoassays. Results: Twenty healthy volunteers (49.5 + 8.9 years) were evaluated. Medium light roast coffee showed higher chlorogenic acids (334 mg/150 mL; p < 0.001) and less caffeine (231 mg/150 mL; p = 0.003) than medium roasting (210 mg/150 mL and 244 mg/150 mL, respectively). Melanoidins were significant higher in medium roast than medium light roast (p < 0.001). There was an increase in the Castelli indexes after medium light roast consumption (5 per cent in the index I; p = 0.01, and 6 per cent in the index II; p = 0.03). No significant differences were observed for TAC between the medium light roast and medium roast. Both roasts increased plasma total cholesterol and LDL concentrations (10 per cent , and 12 per cent for medium light roast; 12 per cent , and 14 per cent for medium roast, respectively) (p < 0.05). Medium roast also increased HDL concentration by 7 per cent (p = 0.003). Compared with baseline, subjects had an increase of 21 per cent and 26 per cent in TAS, 13 per cent and 13 per cent in CAT, 52 per cent and 75 per cent in SOD, and 62 per cent and 49 per cent in GPx after medium light and medium roast consumption (p < 0.001), respectively. Both roasts increased soluble vascular cell adhesion molecule-1 (sVCAM-1) concentrations (18 per cent for medium light roast and 14 per cent for medium roast) (p < 0.05). Plasma fibrinogen concentration increased 8 per cent after medium roast intake (p = 0.01), and soluble E-selectin (sE-selectin) increased 12 per cent after medium light roast intake (p = 0.02). Although coffee beverages have increased total cholesterol and LDL levels, they were not related to elevation in total homocysteine, lipoprotein (a), and biomarkers of diabetes and lipid peroxidation. Conclusion: Moderate paper-filtered coffee consumption may have some undesirable impact on cardiovascular risk in healthy subjects regardless of its antioxidant content.

INTRODUÇÃO: A Injúria Renal Agurda (IRA) é uma síndrome com morbidade e mortalidade elevadas. O desenvolvimento de IRA e disfunção cardíaca aguda (DCA) no período pós-operatório de cirurgias vasculares compartilham fatores de risco e mecanismos fisiopatológicos. Neste estudo, levantamos a hipótese que o desenvolvimento de IRA em pacientes submetidos a cirurgias vasculares aumentaria o risco de DCA. Também avaliamos a Dilatação mediada pelo Fluxo (FMD), como medida de disfunção endotelial e testes de agregabilidade plaquetária com o intuito de identificar características relacionadas ao mecanismo fisiopatológico que levam a estes eventos em pacientes submetidos a cirurgias vasculares. MÉTODOS: Utilizamos dados coletados prospectivamente de uma coorte de pacientes submetidos a revascularização periférica, aórtica ou carotídea. A injúria renal aguda e eventos cardiovasculares foram avaliados nos primeiros sete dias após a cirurgia. Em um subgrupo de pacientes, o Doppler da artéria braquial foi realizado antes do procedimento cirúrgico para acessar a Dilatação mediada pelo Fluxo (FMD). Em outro subgrupo, foram realizados testes de agregabilidade plaquetária. RESULTADOS: Dos 287 pacientes incluídos na análise, 102 apresentaram IRA e 59 tiveram eventos cardiovasculares (EvCv). O número de pacientes com EvCv foi progressivamente maior conforme a gravidade da IRA com base no KDIGO; 15% no grupo sem IRA, 22% no KDIGO 1, 42,8% no KDIGO 2 e 55% no KDIGO 3, p < 0,001. Os pacientes com IRA apresentaram maior permanência na UTI (2,5 vs. 6 dias) e uma maior taxa de mortalidade (6,6 versus 23,5%), p < 0,001. A taxa de mortalidade em pacientes com IRA e EvCv foi duas vezes a mortalidade de pacientes com EvCv apenas (47,1 vs 19,4%). A mediana de FMD foi de 5,7%, sem diferença entre os grupos IRA e não IRA, p = 0,6. Uma maior agregabilidade plaquetária foi associada ao desenvolvimento de IRA (5 vs 6,9 ?). Na análise multivariada, a presença de IRC (clearance de creatinina < 60 ml / min / 1,73m²), instabilidade hemodinâmica, evento cardiovascular e agregabilidade plaquetária foram preditores independentes de IRA. CONCLUSÃO: Este estudo confirmou que o desenvolvimento de injúria renal aguda e eventos cardiovasculares aumenta significativamente a morbidade e mortalidade de pacientes submetidos a cirurgia vascular eletiva. Nossos dados sugerem que a realização de testes de agregabilidadade plaquetária antes da cirurgia pode ser usada para avaliar a eficácia da terapia antiplaquetária e estratificar o risco de IRA e EvCv após a cirurgia vascular / BACKGROUND: Acute Kidney Injury (AKI) is a common syndrome with increased morbidity and mortality. The development of AKI and acute cardiac dysfunction (ACD) in the post-operative period of vascular surgery share risk factors and pathophysiological mechanisms. In this study, we hypothesized that the development of AKI in patients submitted to vascular surgeries would increase the risk of ACD. We also assessed the Flow-mediated Dilation (FMD), as a measure of endothelial dysfunction, and Platelet Aggregability tests to predict AKI and cardiovascular events in the early post-operative period of vascular surgeries. METHODS: We utilized a prospectively collected data from a cohort of patients undergoing peripheral, aortic or carotid revascularization. Acute kidney injury and cardiovascular events were assessed during the first seven days after surgery. In a subgroup of patients, brachial artery Doppler was performed prior to the surgery to access the Flow-Mediated Dilation (FMD). In another subgroup, platelet aggregability tests were performed. RESULTS: Of 287 patients included in the analysis, 102 had AKI and 59 developed cardiovascular events (CvEv). Number of patients with CvEv was progressively higher by maximum KDIGO stage during first week of surgery; 15% in the non-AKI group, 22% in KDIGO 1, 42.8% in KDIGO 2 and 55% in KDIGO 3, p < 0.001. Patients with AKI had a longer ICU stay (2.5 vs. 6 days) and a higher mortality rate (6.6 vs. 23.5%), p < 0.001. Mortality rate in patients with AKI and CvEv was two-fold the mortality of patients with CvEv only (47,1 vs 19.4%). The median FMD was 5.7%, with no difference between the AKI and non-AKI groups, p = 0.6. Higher platelet aggregability was associated with AKI development (5 vs 6,9 ?). In the multivariate analysis, presence of CKD (creatinine clearance < 60 ml/min/1,73m²), hemodynamic instability, cardiovascular event and platelet aggregability were independent predictors of AKI. CONCLUSION: This study confirmed that the development of acute kidney injury and cardiovascular events significantly increase morbidity and mortality of patients undergoing elective vascular surgery. Our data suggests that Platelet Aggregability before surgery can be used to evaluate efficacy of antiplatelet therapy and stratify risk for AKI and CvEv after vascular surgery

La fibrillation atriale est l'arythmie cardiaquela plus fréquente. Les études sur les modèles animaux ont fourni beaucoup de renseignements sur les mécanismes de cette arythmie, mais, à ce jour, nous ne disposons pas de modèle animal d'arythmie atriale spontanée.Nous avons cherché à développer un modèle d'arythmie atriale spontanée chez le rat et àidentifier les mécanismes physiopathologiques de ces arythmies. Nous avons également cherché àévaluer la présence et la sévérité de l'inflammation et de la dysfonction endothéliale, impliquées dansla survenue des complications de la fibrillation atriale comme les accidents vasculaires cérébraux, chezles patients avec fibrillation atriale. Nous avons également constaté des niveauxélevés de facteur de croissance endothélial vasculaire et de facteur von Willebrand chez les patientsavec fibrillation atriale par rapport aux contrôles. Ces résultats suggèrent un profil spécifique du risquethromboembolique en fonction de la forme clinique de l'arythmie et mettent en évidence une évolutionparallèle de la fibrillation atriale et de la dysfonction endothéliale.Ce nouveau modèle animal permettra d'étudier les mécanismes physiopathologiques desarythmies atriales et d'évaluer de nouveaux agents thérapeutiques dans un cadre qui reproduitfidèlement la présentation clinique de l'arythmie / Atrial fibrillation is the most prevalent form of cardiac arrhythmia. Studies in animal modelshave provided important insights into arrhythmia mechanisms. However, to date, we do not dispose ofanimal models of spontaneous atrial arrhythmia.Thus, we aimed to develop a model of spontaneous atrial arrhythmia in rats and to assesspathophysiological mechanisms of these arrhythmias by using a multidisciplinary approach. We alsoaimed to assess the presence and the extent of inflammation and endothelial dysfunction, incriminatedin atrial fibrillation-related complications such as stroke, in atrial fibrillation patients.The animal study describes the first animal model of spontaneous atrial arrhythmias. We alsoprovide evidence that multiple mechanisms participate in arrhythmia occurrence in this model,particularly autonomic imbalance with relative vagal hyperactivity, left atrial endocardial fibrosis, anddecreased left atrial expression of the Pitx2 gene. In our clinical study, we found high levels ofvascular endothelial growth factor and von Willebrand factor in atrial fibrillation patients compared tosinus rhythm controls. These results suggest specific thromboembolic risk patterns according to theclinical form of arrhythmia and highlight a parallel evolution of atrial fibrillation and endothelialdysfunction. These results add new insights into the understanding of atrial arrhythmias. This new animalmodel could facilitate studies of pathophysiological mechanisms involved in atrial arrhythmias andallow assessment of efficacy and toxicity of therapeutic agents in a setting that faithfully reproducesthe clinical presentation of the arrhythmia

Le syndrome métabolique (SM) est défini comme l'association de troubles favorisant les risques cardiovasculaires et le développement d'un diabète de type 2. Une personne atteinte de SM doit présenter au moins 3 critères sur les 5 suivants : une obésité abdominale; un taux élevé en triglycérides ; un faible taux en cholestérol HDL ; une hypertension et une hyperglycémie. Le SM est caractérisé par une dysfonction endothéliale, qui est définie par une diminution de la production de monoxyde d'azote (NO), et l'augmentation d’espèces réactives de l’oxygène, comme l'anion superoxyde (O2-), participant au stress oxydant. Dans notre étude, nous avons émis l’hypothèse que les exosomes pouvaient participer à la dysfonction endothéliale chez ces patients. Les exosomes sont des vésicules extracellulaires de petite taille (entre 30 à 100 nm), formées à partir du compartiment endo-lysosomal et libérées par la plupart des cellules. Suite à leur libération, elles peuvent interagir avec des cellules cibles et servir ainsi de vecteurs d'information biologique. Il a été montré que les exosomes pouvaient être impliqués dans de nombreuses pathologies. Ainsi, nous avons montré que les patients atteints de SM présentent un taux d’exosomes circulants augmenté, dont la taille est diminuée. De plus, les exosomes provenant de patients SM diminuent la production de NO dans les cellules endothéliale, qui s’accompagne d’une augmentation de l’O2-mitochondriale. Chez la souris, les exosomes de patients SM induisent une diminution du relâchement vasculaire. Les exosomes pourraient ainsi participer au développement de la dysfonction endothéliale chez les patients atteints de SM et pourraient être de biomarqueurs intéressants pour cette pathologie. / Metabolic syndrome (MetS) is defined as the combination of metabolic disorders leading to cardiovascular diseases and the development of type 2 diabetes. To be diagnosed with MetS, a person must present at least 3 of the following 5 metabolic risk factors: (i) abdominal obesity, (ii) high triglyceride levels,(iii) low HDL cholesterol levels, (iv) hypertension and (v) hyperglycaemia. MetS is characterized by endothelial dysfunction, which is defined by a decreased nitric oxide (NO) production, and an increased in reactive oxygen species such as superoxide (O2-), involved in oxidative stress. In our study, we hypothesized that exosomes could participate in the endothelial dysfunction observed in MetS patients. Exosomes are nanoscaled (30-100nm) extracellular vesicles produced from the endolysosomal compartment and released by most of the cells of the organism. Following their release, they can interact with their target cells and be considered as biological information carriers. Exosomes have been shown to be involved in many pathologies. Thus, we have shown that MetS patients displayed an increased circulating rate of exosomes whose sizes were decreased. In addition, we have observed that exosomes from MetS patients induced (i) a decrease of NO production in endothelial cells, and (ii) an increase in mitochondrial O2-. Furthermore, the exosomes originating from MetS patients induced a decrease invascular relaxation in mice. Thus, the exosomes could participate in the development of endothelial dysfunction in MetS patients and could be considered as biomarkers of interest for this pathology.

<p>Kidney dysfunction increases cardiovascular disease (CVD) risk. The mechanisms for the risk increase seem to involve a combination of traditional and non-traditional CVD risk factors.</p><p>We studied renal dysfunction as CVD and mortality risk factor in middle-aged men free from diabetes and CVD. The risk for myocardial infarction (MI) and CVD mortality was increased by ~40% in the 16.5% of men with worse renal function, independent of other CVD risk factors.</p><p>Renal transplant dysfunction as CVD and mortality risk factor was also studied. Renal transplant dysfunction was a risk factor for mortality and for combined CVD endpoint. The risk by renal transplant dysfunction was independent of traditional CVD risk factors as well as transplantation-specific risk factors. Only moderate increase in serum creatinine resulted in mortality and CVD risk comparable to diabetes, older age and higher low density lipoprotein levels.</p><p>In haemodialysis patients, the effects of a dialysis session on non-traditional CVD risk factors were studied. A HD session reduced asymmetric dimethylarginine (ADMA) and homocysteine levels, as well as augmentation index (AIx). The change in AIx was related to ADMA plasma level change.</p><p>In patients with stage 3-5 chronic kidney disease (CKD), endothelium dependent vasodilation (EDV) was studied together with markers of oxidative stress and C-reactive protein (CRP). CRP was related to lipid peroxidation, while EDV was related to intracellular antioxidative capacity measured by reduced glutathione levels.</p><p>These studies demonstrate that mild to moderate renal dysfunction is independently associated with increased CVD risk in apparently healthy people, as well as in renal transplant recipients. The mechanisms by which renal dysfunction increases CVD risk are yet to be elucidated. We suggest that arterial stiffness could be reduced in haemodialysis patients by increasing nitric oxide bioavailability. In stage 3-5 CKD patients, improving intracellular antioxidative capacity may result in endothelial function improvement.</p>