A destruição crônica do aparato periodontal devido a resposta inflamatória a bactérias, leva a um quadro clínico conhecido como doença periodontal. Patógenos periodontais podem ser translocados e liberados do sulco gengival à circulação sanguínea e apresentar efeitos periféricos. A bolsa periodontal também é importante reservatório de mediadores inflamatórios. A periodontite pode apresentar efeitos em órgãos distantes. Estudos passaram a documentar a relação entre doença periodontal e disfunção endotelial, reversível pelo tratamento odontológico. Nosso laboratório estudou a resposta vasomotora in vitro de anéis de aorta de ratos com periodontite, e os resultados preliminares mostram um aumento da resposta contrátil destes anéis à norepinefrina, quando comparado aos animais controle. O presente estudo objetiva avaliar a influência da periodontite induzida por ligadura em ratos sobre a resposta vasomotora in vitro de anéis de artéria mesentérica. Ainda, caracterizar os mediadores envolvidos, com ênfase nas enzimas ciclooxigenase e óxido nítrico sintase. / Chronic destruction of periodontal apparatus due to an intense inflammatory response to bacteria leads to a clinical condition known as periodontal disease. Periodontal pathogens can then translocate to the gingival sulcus and reach the bloodstream, and thus have peripheral effects. The periodontal pocket is also an important reservoir of inflammatory mediators. The periodontitis may have effects on organs distant. Studies have also documented the relationship between periodontal disease and endothelial dysfunction, which was reversible by dental treatment. In our laboratory we are studying the vasomotor response \"in vitro\" of aortic rings from rats with periodontitis, and the preliminary results show an increase in the contractile response of the rings to norepinephrine, when compared with control animals. This project aims to evaluate the influence of ligature-induced periodontitis in rats on the \"in vitro\" vascular reactivity of mesenteric artery vessels. Also, the characterization of the mediators involved, with emphasis on the enzyme of cyclooxygenase and nitric oxide synthase.

Introdução: As doenças cardiovasculares representam a principal causa de morte no mundo, sendo o aumento da concentração de colesterol sanguíneo um dos seus principais fatores de risco. O processo aterosclerótico envolve não apenas a deposição de colesterol nas artérias, mas a inflamação tem papel central em todas as fases do processo aterosclerótico. Estudo em animais mostrou, por sua vez, que a proteína de feijão caupi é um potente redutor na concentração de colesterol sangüíneo. Objetivo: Avaliar a influência da proteína de feijão caupi sobre o perfil lipídico, apolipoproteínas, glicose, insulina, HOMA-IR, marcadores de inflamação e de disfunção endotelial em pacientes hipercolesterolêmicos. Métodos: A proteína de feijão caupi foi isolada por precipitação isoelétrica da farinha de feijão caupi desengordurada. O isolado protéico de caupi (IPC) foi utilizado no desenvolvimento do shake à base de proteína de caupi, caseinato de cálcio foi utilizado para desenvolvimento do shake controle. Realizou-se um ensaio clínico do tipo crossover, aleatorizado, cego e controlado. Uma amostra de 44 indivíduos hipercolesterolêmicos foi dividida em 2 grupos (Grupo Controle e Grupo IPC), cada grupo recebeu shake caseína e shake IPC, respectivamente, por 6 semanas cada. Depois do washout de 4 semanas, os indivíduos receberam o shake oposto por mais 6 semanas. Foram quantificadas as variáveis bioquímicas: colesterol total, LDL-c, HDL-c, triglicerídeos, colesterol não-HDL, apo A1, apo B, razão LDL/HDL, razão TG/HDL, razão apo B/apo A1, glicose de jejum, insulina de jejum, HOMA-IR (modelo de avaliação da homeostase), proteína C reativa (PCR), molécula de adesão intercelular solúvel-1 (sICAM-1) e molécula de adesão vascular solúvel-1 (sVCAM- 1) antes e após cada período experimental. A diferença entre os shakes foi analisada com ANOVA para medidas repetidas ao nível de significância de 5 por cento . Resultados: A amostra final foi composta por 38 indivíduos com idade média de 57 anos. A redução em cadeia (delta após consumo de proteína de feijão caupi menos delta após consumo de caseína) no colesterol total foi de 21,0 mg.dL-1 (p < 0,001), CT( por cento ) foi de 8,4 por cento (p < 0,001), LDL( por cento ) foi de 14,4 por cento (p < 0,001), colesterol não-HDL foi de 24,3 mg.dL-1 (p < 0,001) e apo B foi de 15,5 mg.dL-1 (p < 0,001). A ingestão de proteína de caupi afetou significativamente o HDL-c e a mudança em cadeia observada foi um aumento de 3,2 mg.dL-1 (p =0,044). Os marcadores de metabolismo glicídico (glicose de jejum, insulina de jejum e HOMA-IR), bem como os marcadores de inflamação (PCR) e de disfunção endotelial (sVCAM-1 e sICAM- 1) não sofreram modificações significativas após consumo de proteína de feijão caupi (p > 0,05). Conclusão: O presente estudo mostra que a ingestão diária de 25 g de proteína de feijão caupi durante 6 semanas é capaz de reduz os níveis de colesterol sanguíneo, em especial a fração LDL-c; no entanto, não parece exercer influência sobre os marcadores de inflamação subclínica e de disfunção endotelial. Portanto, o aumento do consumo de feijão caupi pode representar uma alternativa eficaz, barata e viável na melhora dos níveis lipídicos em indivíduos hipercolesterolêmicos / Introduction: Cardiovascular diseases are the leading cause of death worldwide, and the increase of cholesterol in blood is one of their main risk factors. The atherosclerotic process involves not only the deposition of cholesterol in the arteries, inflammation plays a central role in all stages of atherosclerosis. Animal study showed that the protein of cowpea is a potent reducer of blood cholesterol. Objective: To evaluate the influence of cowpea protein on blood lipids, apolipoproteins, glucose, insulin, HOMA-IR, markers of inflammation and endothelial dysfunction in hypercholesterolemic patients. Methods: The protein of cowpea was isolated by isoelectric precipitation of defatted flour of cowpea. Cowpea protein isolate (CPI) was used to develop the cowpea protein shake, and calcium caseinate was used for development of the control shake. A cross-over, randomized, blinded and controlled clinical trial was conducted with a sample of 44 hypercholesterolemic subjects, which was divided into two groups (control group and CPI group). Each group received casein shake and CPI shake, respectively, for taken for 6 weeks. After this period and a 4-week washout, subjects received the opposite shake for taken for 6 weeks. Biochemical variables were measured: total cholesterol, LDL-C, HDL-C, triglycerides, non-HDL cholesterol, apo A1, apo B, LDL/HDL ratio, TG/HDL ratio, apo B/apo A1 ration, fasting glucose, fasting insulin, HOMA-IR (homeostasis model assessment), C-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular adhesion molecule-1 (sVCAM-1) before and after each experimental period. The difference between the shakes was analyzed with repeated measures analysis of variance (ANOVA) at a significance level of 5 per cent . Results: The final sample consisted of 38 subjects with mean age of 57 years. The net changes in serum total cholesterol concentrations was a decrease of -21.05 mg.dL-1 (p < 0.001), in total cholesterol was -8.42 per cent (p < 0.001), in LDL-c was -14.36 per cent (p < 0.001), in non-HDL cholesterol was -24.29 mg.dL-1 (p < 0.001) and apoB was -15.55 mg.dL-1 (p < 0.001). Cowpea protein intake significantly affected serum HDL-c concentrations, the net change was a increase of 3.24 mg.dL-1 (p= 0,044). Markers of glycemic control (fasting glucose, fasting insulin and HOMA-IR) and inflammation markers (CRP) and endothelial dysfunction (sICAM-1 and sVCAM-1) have not changed significantly after consumption of cowpea protein (p > 0.05). Conclusion: This study shows that daily intake of 25 g of cowpea protein for 6 weeks can reduce levels of blood cholesterol, especially LDL-c, however did not exhibit influence on markers of subclinical inflammation and endothelial dysfunction. Therefore, the consumption of cowpea can be an effective, inexpensive and feasible way to control blood lipids of hypercholesterolemic subjects

A privação do sono é um problema sério nos tempos atuais e pode ter graves conseqüências para a fisiologia humana. De fato, a redução no tempo de sono tem sido associada a um notável aumento na incidência de hipertensão arterial, diabetes mellitus, infarto do miocárdio, acidente vascular cerebral e estresse, porém os mecanismos envolvidos são pobremente compreendidos. Objetivos: Avaliar o impacto da privação parcial do sono na função endotelial venosa e no controle autonômico cardiovascular em homens saudáveis. Métodos: Treze voluntários do sexo masculino, saudáveis e com idade média de 31±2 anos, tiveram o sono monitorado por diário de sono e actigrafia de pulso durante 12 noites consecutivas, nas quais foram divididas em 2 dois períodos. Um período de 5 noites denominado de privação parcial do sono (dormir<5h por noite) e outro de 5 noites denominado de sono controle (dormir>7h por noite). Entre estes períodos, foi interposto por 2 noites de sono irrestrito (com pelo menos de 7 horas de sono por noite). A escolha do período inicial de sono foi randomizada. Ao término de cada período de 5 dias, foi analisada a reatividade vascular venosa (com a técnica da veia do dorso da mão, Dorsal Hand Vein), a sonolência diurna excessiva (através da Escala de Sonolência de Epworth), realizada avaliação hemodinâmica e autonômica (no momento em repouso e mediante o teste de inclinação postural tilt test), exames de sangue e dosagem de norepinefrina plasmática. A freqüência cardíaca e pressão arterial de batimento a batimento na posição supina e com a manobra de \"tilt test\" foi monitorado com intervalo (RR) e variabilidade de pressão arterial. Resultados: Os indivíduos dormiram em média 8.0 h durante o período de sono controle e 4.5 h no período de privação parcial do sono, sendo a diferença significativa entre os mesmos (p<0.01). O período privação de sono não mudou a frequência cardíaca e a pressão arterial basal significativamente, mas promoveu um aumento significante em baixas freqüências cardíacas e variabilidade da pressão arterial, como também na norepinefrina plasmática. O \"tilt test\" promoveu uma queda em PA sistólica depois da privação parcial do sono, que foi significativamente maior depois do período de sono controle (p<0.05). A privação parcial do sono causou uma redução significantiva na venodilatação endotélio-dependente e não mudou venodilatação endotélio-independente. Conclusão: Privação parcial do sono durante só 5 noites já é o suficiente para causar disfunção endotelial venosa, um aumento significantivo na atividade simpática e no prejuízo do controle da pressão arterial / Background: Sleep curtailment is a serious and common problem in western societies and can have significant consequences in the human physiology. In fact epidemiological studies showed that sleep deprivation (reduction in sleeping time) is associated with increased blood pressure, higher incidence of diabetes mellitus, myocardial heart attack, strokes in the brain, and stress, however the mechanisms are poorly understood. Objectives: Evaluate the impact of partial sleep deprivation in the venous endothelial function and the autonomic cardiovascular autonomic control in healthy men. Methods: Thirteen healthy male volunteers (average age: 31±2 years) had their sleep monitored by sleep diary and wrist actigraphy during 12 consecutive nights, these were divided into two periods. The subjects were randomized and crossed over to 5 nights of control sleep (> 7hs) and 5 nights of partial sleep deprivation (<5hs), interposed by 2 nights of unrestricted sleep (at least 7 hours sleep per night). The choice of the initial sleeping period was randomized. At the end of each period of 5 days heart rate and beat-to-beat blood pressure in the supine position and head up tilt test maneuver were monitored with off line determination of RR-interval and blood pressure variability. In addition, serum norepinephrine and venous endothelial functions were measured by dorsal hand vein technique; also we performed the evaluation of excessive day sleepiness (evaluated through the Epworth Sleepiness Scale), hemodynamic and autonomous evaluation (during sleep and through the tilt test). Results: The subjects slept 8.0 and 4.5 hs during control and partial sleep deprivation periods, respectively (p<0.01). Sleep deprivation did not change significantly the resting heart rate and blood pressure but promoted a significant increase in the low frequency bands of heart rate and blood pressure variability as well as serum norepinephrine. Tilt test promoted a significantly greater drop in systolic BP after partial sleep deprivation than after control sleep (p<0.05). Partial sleep deprivation caused a considerable reduction of acetylcholine induced venodilatation (endothelium dependent) and did not change sodium nitroprusside venodilatation (independent from the endothelium). Conclusion: Partial sleep deprivation for only 5 nights is sufficient to cause significant increase in sympathetic activity, impairment of blood pressure control and endothelial dysfunction

Made available in DSpace on 2017-07-21T14:13:10Z (GMT). No. of bitstreams: 1 Willian Moreira Machado.pdf: 833860 bytes, checksum: b7acc75cbcbeaee87101553fc891d9af (MD5) Previous issue date: 2013-02-22 / Fundação Araucária de Apoio ao Desenvolvimento Científico e Tecnológico do Paraná / Periodontitis is a chronic inflammatory disease initiated and perpetuated by Gram-negative anaerobic bacteria that colonize the subgingival area. This disease is characterized by destruction of periodontal tissue insertion, bone resorption, leukocyte infiltration and formation of periodontal pockets. Studies show a significantly increased risk of cardiovascular disease, especially atherosclerosis and hypertension, among people with periodontitis. It is believed that systemic inflammation induced by periodontal disease and decreased nitric oxide bioavailability would cause endothelial dysfunction, which consequently leads to cardiovascular disease. Interestingly, studies show that statins that has been providing consistent and satisfactory results in reversal of endothelial dysfunction. Thus, the purpose of this study was to evaluate the effect of systemic administration of simvastatin on inflammatory parameters induced periodontitis and correlate their possible actions in the cardiovascular system and in alveolar bone loss. Wistar rats were subjected to induction of periodontitis by placement of ligatures or were subjected to false-surgery (the ligatures were immediately placed and removed). On day 8, the animals were randomized to treatment with simvastatin (10 mg/kg/day p.o.) or vehicle.During the experiment, on days 1, 7 and 14 the rats were prepared for analysis of systolic blood pressure and heart rate. And on day 14, the rats were prepared for analysis of cardiovascular parameters, lipid profile, systemic inflammatory markers and tissue injury. The maxilla and mandible were removed for analysis of bone loss. Our data show that animals with untreated periodontitis showed an endothelium-dependent vasodilator response (acetylcholine) reduced a characteristic of endothelial dysfunction in animals with periodontal disease. In contrast, we found an increased vasodilatory response in animals with periodontitis treated with simvastatin. The vascular changes induced by treatment with simvastatin were associated with a decrease in lipid profile, and lymphocytic inflammatory markers such as IL-6 and C-reactive protein, which are traditionally associated with cardiovascular risk. And interestingly, simvastatin decreased alveolar bone loss in animals with periodontitis. Our data show that simvastatin reduces alveolar bone loss, systemic inflammation and damage to the endothelium induced periodontitis. Thus, simvastatin can be considered a promising drug for the treatment of periodontal disease and prevention of cardiovascular complications. / A periodontite é uma doença inflamatória crônica iniciada e perpetuada por bactérias anaeróbicas Gram-negativas que colonizam a área subgengival. Esta doença é caracterizada pela destruição do tecido periodontal de inserção, reabsorção óssea, infiltração de leucócitos e formação de bolsa periodontal. Estudos mostram um aumento significativo do risco de doenças cardiovasculares, principalmente aterosclerose e hipertensão, entre pessoas com periodontite. Acredita-se que a inflamação sistêmica induzida pela doença periodontal e a diminuição da biodisponibilidade de óxido nítrico seriam a causa da disfunção endotelial, que consequentemente leva a doenças cardiovasculares. Interessantemente, estudos mostram que as estatinas vêm proporcionando resultados consistentes e satisfatórios na reversão da disfunção endotelial. Assim, a proposta deste trabalho foi avaliar o efeito da administração sistêmica da sinvastatina sobre parâmetros inflamatórios de periodontite induzida e correlacionar suas possíveis ações no sistema cardiovascular e na perda óssea alveolar. Ratos Wistar foram submetidos a indução da periodontite através da colocação de ligaduras ou eram submetidos a falsa-cirurgia (as ligaduras eram colocadas e imediatamente removidas). No dia 8, os animais foram novamente randomizados para receber o tratamento com a sinvastatina (10 mg/kg/dia v.o.) ou veículo. Durante o experimento, nos dias 1, 7 e 14 os ratos eram preparados para análise da pressão arterial sistólica e frequência cardíaca. E no dia 14, os ratos foram preparados para análise de parâmetros cardiovasculares, perfil lipídico, marcadores inflamatórios sistêmicos e de lesão tecidual. A maxila e a mandíbula eram retiradas para a análise da perda óssea. Nossos dados mostram que os animais com periodontite não tratados apresentaram uma resposta vasodilatadora endotélio-dependente (acetilcolina) reduzida, uma característica da disfunção endotelial em animais com doença periodontal. Em contrapartida, foi encontrada uma resposta vasodilatadora aumentada em animais com periodontite tratados com sinvastatina. As alterações vasculares induzidas pelo tratamento com sinvastatina foram associadas com uma diminuição do perfil lipídico, linfocitário e marcadores inflamatórios como IL-6 e proteína C-reativa, que são tradicionalmente associados com o risco cardiovascular. E interessantemente, a sinvastatina diminuiu a perda óssea alveolar nos animais com periodontite. Nossos dados mostram que a sinvastatina reduz a perda óssea alveolar, inflamação sistêmica e o dano ao endotélio induzidos pela periodontite. Desta forma, a sinvastatina pode ser considerada uma droga promissora para o tratamento da doença periodontal e prevenção de complicações cardiovasculares.

Made available in DSpace on 2017-07-21T14:13:13Z (GMT). No. of bitstreams: 1 Luiz Renato Olchanheski Junior.pdf: 1811415 bytes, checksum: 57ce362be4cfc124e9a1788156185688 (MD5) Previous issue date: 2014-02-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Periodontitis is defined as a disease characterized by the formation of a biofilm which promotes colonization of microorganisms responsible for the initiation of a local inflammatory process. Studies have shown that the inflammatory process is not restricted to the oral cavity, reaching the circulation and causing systemic effects, such as endothelial dysfunction. The dysfunction is mainly characterized by reduced nitric oxide production/ bioavailability which increased platelet aggregation, leukocyte adhesion and rolling, and result in a loss in the ability of vasodilation. Therefore predisposing to an increased risk of cardiovascular disease. According to research by our group, animals with experimental periodontitis showed a decrease in endothelium-dependent vasodilator response fourteen days after the induction of periodontitis, however, this reduced vasodilator response is not evident twenty one days. The purpose of this study was to evaluate a possible increase in compensatory mechanisms of vasodilation in animals with experimental periodontitis. For this, rats received ligatures for induction of periodontitis, or were sham. Twenty one days after the procedure, the animals were prepared for blood pressure recording. Two consecutive dose-response curves to acetylcholine and sodium nitroprusside were obtained before and 20 min after LNAME (NOS inhibitor) + indometacin (COX inhibitor) + TEA (selective inhibitor of potassium channels) or LNAME or indometacin, or TEA or indometacin + TEA or Apamin + TRAM-34 injection. Only the selective and simultaneous blockade of small and intermediate-conductance calcium-activated potassium channels by selective inhibitors (Apamin and TRAM-34, respectively) was able to reduce acethylcholine-induced reduction on blood pressure at periodontitis animals. The inhibition of NOS, COX and use of a non-selective inhibitor of potassium channels, did not change the endothelium-depended vasodilatation. Altogether, these results show that IKca and SKca may balance the endothelial function and therefore mask the impairment on NO production and endothelial dysfunction. / A periodontite é definida como uma doença caracterizada pela formação de um biofilme dental, que favorece a colonização de microrganismos que iniciam um processo inflamatório local. Este processo inflamatório não fica restrito a cavidade bucal, ele ganha a circulação causando efeitos sistêmicos, como a disfunção endotelial. A disfunção é caracterizada principalmente pela redução da produção e biodisponibilidade de óxido nítrico, predispondo o indivíduo a um aumento no risco de doenças cardiovasculares. Trabalhos recentes mostram que animais com periodontite experimental apresentam uma disfunção endotelial quatorze dias após a indução da periodontite, porém, esta redução da resposta vasodilatadora não é evidente vinte e um dias após o mesmo procedimento. A proposta do presente trabalho foi avaliar um possível aumento de mecanismos compensatórios de vasodilatação em animais com periodontite experimental. Para isso, os ratos receberam as ligaduras para indução da periodontite, ou passaram pela falsa-cirurgia. Vinte e um dias após o procedimento, todos os animais passaram pela administração intravenosa de três doses crescentes de acetilcolina e nitroprussiato de sódio. Em seguida, os animais receberam as seguintes administrações: LNAME (inibidor da NOS) + indometacina (inibidor da COX) + TEA (inibidor não seletivo dos canais de potássio), ou LNAME, ou indometacina, ou TEA, ou administração de indometacina + TEA ou Apamina (inibidor seletivo dos SKCa) + TRAM-34 (inibidor seletivo dos IKCa). Após um período de 20 minutos, todos os grupos passaram por uma nova administração dos dois agentes vasodilatadores. Vinte e um dias após a indução da periodontite, os animais, não apresentaram disfunção, e a inibição de NOS, COX e a utilização de um inibidor não seletivo dos canais de potássio, evidenciou uma alteração no tempo de vasodilatação do grupo ligadura. A combinação dos demais inibidores não resultou em alterações significativas. A administração de inibidores de SKCa e IK Ca resultou em uma diminuição do tempo da resposta vasodilatadora dependente de endotélio, demonstrando a importância destes canais no mecanismo de compensação vasodilatadora 21 dias após a indução da doença periodontal.

A privação do sono é um problema sério nos tempos atuais e pode ter graves conseqüências para a fisiologia humana. De fato, a redução no tempo de sono tem sido associada a um notável aumento na incidência de hipertensão arterial, diabetes mellitus, infarto do miocárdio, acidente vascular cerebral e estresse, porém os mecanismos envolvidos são pobremente compreendidos. Objetivos: Avaliar o impacto da privação parcial do sono na função endotelial venosa e no controle autonômico cardiovascular em homens saudáveis. Métodos: Treze voluntários do sexo masculino, saudáveis e com idade média de 31±2 anos, tiveram o sono monitorado por diário de sono e actigrafia de pulso durante 12 noites consecutivas, nas quais foram divididas em 2 dois períodos. Um período de 5 noites denominado de privação parcial do sono (dormir<5h por noite) e outro de 5 noites denominado de sono controle (dormir>7h por noite). Entre estes períodos, foi interposto por 2 noites de sono irrestrito (com pelo menos de 7 horas de sono por noite). A escolha do período inicial de sono foi randomizada. Ao término de cada período de 5 dias, foi analisada a reatividade vascular venosa (com a técnica da veia do dorso da mão, Dorsal Hand Vein), a sonolência diurna excessiva (através da Escala de Sonolência de Epworth), realizada avaliação hemodinâmica e autonômica (no momento em repouso e mediante o teste de inclinação postural tilt test), exames de sangue e dosagem de norepinefrina plasmática. A freqüência cardíaca e pressão arterial de batimento a batimento na posição supina e com a manobra de \"tilt test\" foi monitorado com intervalo (RR) e variabilidade de pressão arterial. Resultados: Os indivíduos dormiram em média 8.0 h durante o período de sono controle e 4.5 h no período de privação parcial do sono, sendo a diferença significativa entre os mesmos (p<0.01). O período privação de sono não mudou a frequência cardíaca e a pressão arterial basal significativamente, mas promoveu um aumento significante em baixas freqüências cardíacas e variabilidade da pressão arterial, como também na norepinefrina plasmática. O \"tilt test\" promoveu uma queda em PA sistólica depois da privação parcial do sono, que foi significativamente maior depois do período de sono controle (p<0.05). A privação parcial do sono causou uma redução significantiva na venodilatação endotélio-dependente e não mudou venodilatação endotélio-independente. Conclusão: Privação parcial do sono durante só 5 noites já é o suficiente para causar disfunção endotelial venosa, um aumento significantivo na atividade simpática e no prejuízo do controle da pressão arterial / Background: Sleep curtailment is a serious and common problem in western societies and can have significant consequences in the human physiology. In fact epidemiological studies showed that sleep deprivation (reduction in sleeping time) is associated with increased blood pressure, higher incidence of diabetes mellitus, myocardial heart attack, strokes in the brain, and stress, however the mechanisms are poorly understood. Objectives: Evaluate the impact of partial sleep deprivation in the venous endothelial function and the autonomic cardiovascular autonomic control in healthy men. Methods: Thirteen healthy male volunteers (average age: 31±2 years) had their sleep monitored by sleep diary and wrist actigraphy during 12 consecutive nights, these were divided into two periods. The subjects were randomized and crossed over to 5 nights of control sleep (> 7hs) and 5 nights of partial sleep deprivation (<5hs), interposed by 2 nights of unrestricted sleep (at least 7 hours sleep per night). The choice of the initial sleeping period was randomized. At the end of each period of 5 days heart rate and beat-to-beat blood pressure in the supine position and head up tilt test maneuver were monitored with off line determination of RR-interval and blood pressure variability. In addition, serum norepinephrine and venous endothelial functions were measured by dorsal hand vein technique; also we performed the evaluation of excessive day sleepiness (evaluated through the Epworth Sleepiness Scale), hemodynamic and autonomous evaluation (during sleep and through the tilt test). Results: The subjects slept 8.0 and 4.5 hs during control and partial sleep deprivation periods, respectively (p<0.01). Sleep deprivation did not change significantly the resting heart rate and blood pressure but promoted a significant increase in the low frequency bands of heart rate and blood pressure variability as well as serum norepinephrine. Tilt test promoted a significantly greater drop in systolic BP after partial sleep deprivation than after control sleep (p<0.05). Partial sleep deprivation caused a considerable reduction of acetylcholine induced venodilatation (endothelium dependent) and did not change sodium nitroprusside venodilatation (independent from the endothelium). Conclusion: Partial sleep deprivation for only 5 nights is sufficient to cause significant increase in sympathetic activity, impairment of blood pressure control and endothelial dysfunction

Cerebral small vessel disease (SVD) is a vascular neurodegenerative disease which is the leading cause of vascular dementia and causes 20% of strokes. 20-30% of those over 80 show signs of the disease as white matter hyperintensities on MRI scans, doubling their risk of stroke and trebling their risk of dementia. Sporadic SVD is thought to be caused by hypertension but 30% of sufferers are normotensive and an alternative hypothesis implicates loss of integrity of the blood brain barrier (BBB). To investigate this, I studied brains from normotensive people with early stage SVD and found reduced capillary endothelial claudin-5 (a BBB tight junction protein), more oligodendrocyte precursor cells (OPCs; the precursors to myelinating oligodendrocytes), and more microglia/macrophages compared to controls. Furthermore, in a relevant rat model of spontaneous SVD, the Stroke Prone Spontaneously Hypertensive Rat (SHRSP; disease model; DM) I found that reduced endothelial claudin-5 was the earliest change, appearing at 3 weeks of age, followed by OPC proliferation, appearing at 4 weeks, and then increased number of microglia/macrophages, appearing at 5 weeks. Importantly, all these changes occurred at a young age (< 5 weeks), before any measurable hypertension. These changes were confirmed in an ex vivo slice culture model (i.e. removing blood flow), ruling out direct damage by leakage of blood components through an impaired BBB and suggesting an inherent endothelial cell dysfunction as the primary cause, with secondary BBB defects. This hypothesis of endothelial dysfunction is supported by increased endothelial cell proliferation in both human SVD tissue and the DM rats, and lower levels of endothelial nitric oxide synthase (eNOS) in brains of DM rats. To study this further I isolated primary brain microvascular endothelial cells (BMECs) from DM and control rats and found that those from DM rats formed less mature tight junctions (less membranous claudin-5) than control BMECs. I also found that conditioned media (CM) from DM BMECs causes OPCs in culture to proliferate more and mature less. This indicates that the endothelial dysfunction is inherent to the endothelial cells, rather than induced by other cell types, and through secreted factors causes OPC changes mirroring what is seen in vivo. Using an antibody array, I identified HSP90α as a candidate secreted factor and showed that it is necessary (by blocking the protein in CM) and sufficient (by adding recombinant HSP90α) to induce the maturation phenotype in OPCs, but not the proliferation phenotype. The idea that endothelial dysfunction causes SVD begs the question of what causes endothelial dysfunction, especially in our inbred DM rat strain. To establish this, I reanalysed sequencing data of the DM and control rats from a previously published study, searching for mutations which lead to truncated proteins in genes expressed in brain endothelial cells. We confirmed the candidate gene Atp11b, a phospholipid flippase, was mutated as predicted. I found that knocking down Atp11b using siRNA in a control endothelial cell line caused endothelial dysfunction and a loss of tight junction maturity, and that CM from these cells causes OPCs to proliferate more and mature less, mirroring what we see in primary DM BMECs and suggesting that Atp11b has a key function in promoting normal endothelial function. Furthermore, I showed that knocking down Atp11b causes cells to secrete increased levels of HSP90α. I propose a mechanism whereby ATP11B regulates the retention of HSP90α within endothelial cells, which in turns regulates eNOS levels and activity, as has been shown previously. In summary, this work shows that there are many pre-symptomatic changes which occur in the brain in the development of SVD in DM rats, and that these are ultimately caused by endothelial dysfunction. As these changes are similar to those found in spontaneous human SVD, I propose that endothelial dysfunction is a key mechanism of human SVD, which may in the future lead to new therapies.

For over a century, there have been suggestions of a link between what is currently called bipolar disorder and cardiovascular mortality. In the contemporary epidemiological literature, this risk has been confirmed and approximates twice that expected based on age and gender. To date, however, this information has come primarily from clinical samples, which carry considerable risk of selection bias. The studies contained in this dissertation sought to assess this relationship using methods less vulnerable to selection bias and to determine the role that course of illness and treatments for illness may play in the development of vascular disease. In a nationally representative sample, we confirmed a link between mood disorders and vascular disease, which was particularly pronounced in women with bipolar disorder. In subsequent studies, a dose-response relationship between the duration of clinically significant hypomanic or manic symptoms and both cardiovascular mortality and endothelial function was seen. While medication exposure did not appear related to mortality or endothelial function, first generation antipsychotics were associated with arterial stiffness, an effect apparently mediated by elevations in blood pressure. In cross-sectional samples, our data suggests that vasculopathy is not present early in the course of bipolar disorder although is much greater than expected later in the course of illness. This dissertation purports that vasculopathy develops over the long-term course of bipolar disorder, is proportional to symptom burden, and is influenced by health behaviors and treatments. These findings may provide opportunities for clinicians and those afflicted to intervene to address this excess risk of vascular morbidity and mortality.

Angiotensin II (Ang II) promotes vascular disease and hypertension in part by the formation of pro-inflammatory cytokines, oxidative stress and inflammation. Signal transducer and activator of transcription 3 (STAT3) is a transcription factor known to play key roles in cytokine signaling and growth in immune cells. We tested the hypothesis that STAT3 plays an essential role in Ang II-induced vascular dysfunction and hypertension. Responses of carotid arteries from C57BL6 mice were examined in vitro after 22-hour incubation with vehicle or Ang II (10 nM) in the presence or absence of a small molecule inhibitor of STAT3 activation, S3I-201. The endothelium-dependent agonist acetylcholine (Ach) produced relaxation in arteries treated with vehicle and the response was inhibited by ~50% by Ang II (P<0.01). S3I-201 (10 πM) co-incubation prevented the Ang II-induced dysfunction. Relaxation to nitroprusside, an endothelium-independent agonist, was not altered in any group. Ang II increased vascular superoxide more than 2-fold (P<0.05) measured by chemiluminescence. S3I-201 (10 πM) prevented the Ang II induced increase of superoxide. Similar findings were obtained with STATTIC, a second small molecule inhibitor of STAT3 activation. In contrast to these findings, lipopolysaccharide (0.5 πg/ml)-induced endothelial dysfunction was not altered by S3I-201. Blood pressure and responses of carotid arteries and small resistance arteries within the brain were examined in C57BL6 mice with either saline or Ang II (1000 ng/kg/min) infused for 14 days via osmotic minipump, which were also treated with dimethyl sulfoxide (vehicle) or S3I-201 (5 mg/kg, IP, every two days). Infusion with Ang II increased systolic blood pressure compared to saline-infused animals (155±2 and 112±2 mmHg, respectively; P<0.001). S3I-201 reduced pressure slightly in saline infused mice but protected against Ang II-induced increase in pressure at 14 days (102±2 and 114±3 mmHg, respectively). Following systemic treatment with Ang II, carotid artery relaxation responses to Ach were significantly impaired compared to vehicle infused mice (72±3% and 101±1%, respectively, P<0.05). S3I-201 treatment significantly prevented Ang II-induced impairment (94±4%, P<0.05). Ang II treated mice exhibited 55% impaired dilator responses to Ach in small resistance arteries within the brain studied in vitro and S3I-201 treatment prevented most of this impairment (P<0.05). Vasorelaxation to nitroprusside was not altered in any group. In summary, these findings provide the first evidence that STAT3 plays an essential role in Ang II-induced vascular dysfunction and hypertension. Targeting STAT3 with small molecule inhibitors or other approaches may have beneficial effects during hypertension and other disease states in which Ang II contributes to vascular dysfunction (e.g. diabetes and aging).

Angiogenic cell therapy is currently being developed as a treatment for coronary artery disease (CAD); however, endothelial dysfunction (ED), commonly found in patients with CAD, impairs the ability for revascularization to occur. We hypothesized that culture on a collagen matrix will improve survival and function of circulating progenitor cells (CPCs) isolated from a mouse model of ED. Overall, ED decreased the expression of endothelial markers in CPCs and impaired their function, compared to normal mice. Culture of CPCs from ED mice on collagen was able to increase cell marker expression, and improve migration and adhesion potential, compared to CPCs on fibronectin. Nitric oxide production was reduced for CPCs on collagen for the ED group; however, CPCs on collagen had better viability under conditions of serum deprivation and hypoxia, compared to fibronectin. This study suggests that a collagen matrix may improve the function of therapeutic CPCs that have been exposed to ED.