Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

L'œdème cérébral et l'hypoxie cérébrale post-traumatiques sont les acteurs principaux de l'apparition des lésions ischémiques secondaires. L'erythropoïétine (Epo) sous sa forme recombinante humaine possède une activité anti-oedémateuse dans un modèle expérimental de TC diffus. Son action sur l'hypoxie cérébrale post-traumatique reste néammoins méconnue. De plus, les effets indésirables hématologiques de l'Epo ont conduit à la synthèse de dérivés de l'Epo ne possèdant pas d'activité hématopoïétique comme l'érythropoïetine carbamylée (CEpo). Dans ce contexte, mon travail de thèse a eu pour but d'évaluer les propriétés de l'Epo et de la CEpo dans le modèle de TC diffus. Un traitement intraveineux par CEpo à la dose de 50 µg/Kg a ainsi permis de diminuer précocemment l'œdème cérébral post-traumatique évalué in vivo par IRM de diffusion et ex vivo par gravimétrie spécifique. Cette propriété a impliqué l'inhibition de la phosphorylation de la voie Erk et s'est accompagnée de l'amélioration des fonctions motrices et cognitives jusqu'à 10 jours après le TC. Après une étude de validation sur des rats sains soumis à différentes conditions d'oxygénation, une méthode de mesure IRM de la saturation locale en oxygène (lSO2) cérébrale combinant l'effet BOLD avec la mesure du volume sanguin cérébral a montré une diminution de l'oxygénation cérébrale post-traumatique. Cette hypoxie cérébrale n'était pas en lien avec une diminution du débit sanguin cérébral attestée par méthode de premier passage d'un agent de constraste. Un collapsus des capillaires cérébraux était par ailleurs retrouvé en microscopie électronique. L'Epo à la dose de 5000 UI/Kg a été capable de restaurer l'oxygénation cérébrale en diminuant l'œdème astrocytaire péricapillaire. L'ensemble de ce travail a permis d'établir les bénéfices d'un traitement par Epo ou par CEpo sur l'œdème cérébral et l'hypoxie cérébrale post-traumatiques. / Post-traumatic brain oedema and brain hypoxia play a key role for the development of secondary ischaemic lesions. Erythopoïetin (Epo) is an anti-oedematous agent in the impact-acceleration model. However its action on brain hypoxia remains unkonwn. Neuroprotective derivatives of Epo that lack haematopoïétic properties, like carbamylated Epo (CEpo), have been developped to counter Epo side effects. In this context, our study aimed to assess the effect of Epo and CEpo on post-traumatic diffuse brain oedema and brain oxygenation. CEpo (50 µg/Kg) decreased brain oedema assessed by diffusion-weighted MRI and specific gravimetry 6 hours after the trauma. The anti-oedematous effect of CEpo was linked to Erk inhibition and was associated with an improvement of cognitive and motor functions, evaluated until 10 days after the insult. MRI using the combination of BOLD contrast and blood volume fraction measurement demonstrated a decrease of local brain oxygenation in our model, without franck ischemia (measurement of mild transit time by a first passage method). Epo (5000 UI/Kg) improved brain oxygenation by decreasing post-traumatic cerebral capillaries collapse due to astrocytic end-foot swelling. All these results demonstrated that Epo and CEpo could be seen as promising neuroprotective agents in traumatic brain injury.

Malgré de très nombreuses études expérimentales et cliniques dans le domaine de l'arrêt circulatoire, seulement 2% à 12% des patients quittent l'hôpital avec une bonne récupération neurologique. Il est donc nécessaire de proposer de nouvelles thérapeutiques pour tenter d'augmenter la survie après un arrêt circulatoire. Pour atteindre ce but il semble indispensable d'améliorer la qualité du massage cardiaque durant la réanimation et de protéger le myocarde et le cerveau contre les phénomènes d'ischémie-reperfusion. Dans la première partie de ce travail, nous avons évalués dans une étude pré hospitalière l'utilisation d'un dispositif innovant de massage cardiaque interne par minithoracotomie et montré une amélioration de l'hémodynamique en comparaison avec le massage cardiaque standard. Dans la deuxième partie, nous avons testés les possibles effets protecteurs de l'EPO (érythropoïétine) dans deux types d'arrêt circulatoire. Dans un modèle d'arrêt cardiaque expérimental chez le rat nous avons démontré que lorsque l'EPO était injectée avant l'arrêt cardiaque, la réanimation initiale était améliorée et la survie des animaux augmentée ce qui pouvaient suggérer un effet cardio et/ou neuroprotecteur de l'EPO contre les effets délétères de l'ischémie reperfusion. Dans une étude clinique en chirurgie cardiaque sous circulation extra corporelle, nous n'avons pas pu démontré d'effet bénéfique de l'EPO ni sur l'ischémie myocardique, ni sur l'ischémie cérébrale ni sur les paramètres de l'inflammation. Sur la base de ces deux études, il est donc difficile de conclure sur le potentiel rôle bénéfique de l'EPO dans l'arrêt circulatoire. Néanmoins, sur la seule base des résultats expérimentaux, l'EPO pourrait faire partie de l'arsenal thérapeutique pour mieux protéger le myocarde et le cerveau contre les effets délétères de l'ischémie reperfusion après un arrêt cardiaque. / Despite extensive experimental and clinical research on cardiac arrest, only 2-12% of resuscitated patients are discharged from hospital in good neurological conditions. There is, therefore, a dear need for new therapies that improve survival after cardiac arrest. It ‘s necessary to improve the quality of cardiac massage and to protect against cardiac and cerebral ischemia occurring during cardiac arrest. In a first part, we evaluated the prehospital feasibility of performing a new method of minimally invasive direct cardiac massage (MID-CM®) and we suggested that better haemodynamic results can be obtained than with standard cardiopulmonary resuscitation. In a second part, we tested erythropoietin (EPO) against placebo in two model of cardiac arrest. In an experimental model of cardiac arrest, we demonstrated that EPO, when administrated before cardiac arrest, improved initial resuscitation and increased the duration of post-resuscitation survival. In a second model of circulatory arrest during cardiac surgery with cardiopulmonary bypass, EPO administration did not protect against cerebral ischemia and inflammatory response occurring during cardiac surgery with CPB. It is difficult to make definitive conclusion on the potential role of EPO in myocardial and cerebral protection after circulatory arrest. We can hope that EPO administration will represent pharmacological approach in upcoming years to additional myocardial salvage of the reperfused myocardium after cardiac arrest.

Submitted by Priscila Nascimento (pnascimento@icict.fiocruz.br) on 2012-11-14T17:12:41Z No. of bitstreams: 1 luciana-carreiras-norte.pdf: 1395438 bytes, checksum: 31a432f41d7dee6ad0313c1c37736102 (MD5) / Made available in DSpace on 2012-11-14T17:12:41Z (GMT). No. of bitstreams: 1 luciana-carreiras-norte.pdf: 1395438 bytes, checksum: 31a432f41d7dee6ad0313c1c37736102 (MD5) Previous issue date: 2007 / Fundação Oswaldo Cruz. Instituto de Tecnologia em Imunobiológicos. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil. / Nesta avaliação, realizaram-se ensaios cromatográficos de purificação de eritropoetina humana recombinante, a partir do sobrenadante de cultura de células de mamíferos da linhagem CHO (células de ovário de hamster chinês), produtoras deste biofármaco. Compararam-se as membranas comerciais de troca iônica Sartobind (MA) Q e D, com o objetivo de avaliar a sua aplicabilidade a processos de purificação de EPO. Ambas as membranas apresentaram-se capazes de adsorver EPO nas condições avaliadas. EPO foi detectada nas amostrasde eluído de ambas as membranas, tendo-se verificado que o imunoensaio dotipo dot-blotfoi aquele que forneceu as informações mais conclusivas. Já nas análises de eletroforese, verificou-se um perfil difuso das bandas do eluído das membranas, o que foi creditado à heterogeneidade glicídica da EPO, como anteriormente demonstrado na literatura. / In the present work, the purification of recombinant human erythropoietin (rhEPO) from CHO (Chinese hamster ovary) cell culture supernatant was investigated using anion-exchange chromatography. Commercial membrane adsorbers (Sartobind D and Q) were compared, with the aim of evaluating their aplicability to EPO purification processes. Both membranes were able to adsorb EPO under the conditions evaluated in this work. EPO was detected in the eluate of both membranes. The immunoassay dot-blot was the most interesting analytical tool, giving the most conclusive results. Electrophoretic analyses showeda diffuse band, probably due to glycan heterogeneity in the EPO molecules, as previously reported in the literature.

Made available in DSpace on 2014-08-20T13:32:48Z (GMT). No. of bitstreams: 1 tese_thais_farias_collares.pdf: 1094762 bytes, checksum: 647dd933472bf9127c0164ee875617ea (MD5) Previous issue date: 2013-10-17 / The history of sports competition has been related to the use of methods for physical training associated with physiological methods to increase athlete performance. Ethical issues involving the high performance sport and doping are confused with the history of competitive sports. The World Anti - Doping Agency (WADA) prohibits the use of substances or methods to artificially increase sports performance. Currently, 258 substances are listed by WADA and athletes around the world are subjected to tests proving the non-use of doping. EPO is a glycoprotein hormone that has as its main physiological effect induction of erythropoiesis and thereby improving the capacity to transport oxygen in the blood. For these reason EPO has been included in WADA list. The analytical differentiation of endogenous erythropoietin from its recombinant counterpart, using isoelectric focusing and double blotting is a milestone in the detection of doping with recombinant erythropoietin. However, several analogs of the original recombinant EPO are not easily detectable by standard IEF method, requiring the development of alternatives for the detection of doping. In order to improve the current methods of EPO detection, monoclonal and polyclonal antibodies against EPO were obtained and used in various techniques for detection of EPO in biological samples. However, the specificity of these antibodies has been quite controversial and discussed. Therefore, it is necessary to obtain antibodies capable of reacting specifically with the EPO. In this study, rHuEPO was inoculated in New Zealand rabbits to generate a polyclonal antibody (pAb anti-rHuEPO). The pAb was characterized for its potential in detecting rHuEPO using different approaches. The pAb anti- rHuEPO identified the expression of recombinant protein in eukaryotic cells and was able to detect rHuEPO in a suspension at 0.1 μg/mL, showing its potential as a tool for detection of doping by rHuEPO. / A história da competição esportiva sempre esteve relacionada à utilização de metodologias de treinamento físico associadas a métodos de incremento fisiológico do atleta, visando sua máxima performance. Questões éticas envolvendo o esporte de alto rendimento e o doping se confundem com a própria história do esporte competitivo. A Agência Mundial Anti-Doping (WADA) proíbe o uso de substâncias ou métodos capazes de aumentar artificialmente o desempenho esportivo. Atualmente, 258 substâncias estão na lista da WADA e atletas do mundo inteiro são submetidos a testes comprobatórios da não utilização do doping. Entre essas substâncias ilícitas para uso por atletas destaca-se a eritropoetina (EPO). A EPO é um hormônio glicoproteico que possui como principal efeito fisiológico a indução da eritropoiese e consequente melhoria da capacidade de transporte de oxigênio no sangue. A diferenciação analítica da eritropoetina endógena produzida a partir de sua contraparte recombinante usando focalização isoelétrica e duplo blotting é um marco na detecção do doping com eritropoetina recombinante. Anticorpos monoclonais e policlonais específicos anti-EPO foram obtidos e utilizados em várias técnicas para a detecção da EPO em amostras biológicas a fim de melhorar os métodos atuais de detecção. Contudo, a especificidade destes anticorpos tem sido bastante controversa e discutida. Portanto, a obtenção de anticorpos específicos capazes de reagir especificamente com a EPO faz-se necessária. Neste estudo, a rHuEPO foi utilizada para imunizar coelhos New Zealand para gerar um anticorpo policlonal (pAb anti-rHuEPO). O pAb foi caracterizado quanto ao seu potencial na detecção da rHuEPO usando diferentes metodologias. O pAb anti-rHuEPO identificou a expressão da proteína recombinante em células eucarióticas e foi capaz de detectar rHuEPO em suspensão até 0,1 μg/mL, comprovando seu potencial como ferramenta para detecção do doping por rHuEPO.

Abstract Oxygen deprivation (hypoxia) is related to many disease conditions, such as anemia, but is also a critical regulatory signal during normal development. Cellular responses to hypoxia are largely mediated through alterations in gene regulation brought about by the transcription factor known as hypoxia inducible facor (HIF). One of the most extensively studied systemic consequences of hypoxia is the induction of red blood cell production, erythropoiesis, which occurs through a HIF-dependent increase in erythropoietin (EPO) gene expression. The amount of HIF in cells is regulated by three HIF prolyl 4-hydroxylases (HIF-P4Hs) while a fourth P4H possessing a transmembrane domain (P4H-TM) is able to act on HIF at least in vitro. The putative role of P4H-TM in regulating erythropoiesis is studied here by administering a HIF-P4H inhibitor, FG-4497, to P4h-tm null and wild-type mice. By comparing the observed effects with those seen in FG-4497 treated hypomorphic Hif-p4h-2 and Hif-p4h-3 null mice, it is demonstrated for the first time that P4H-TM is involved in the regulation of Epo production in the mammalian kidney, but not in the liver. Long bones are formed via endochondral ossification, in which a cartilaginous template, the growth plate, is first laid down and then replaced with bone. The growth plate is rich in extracellular matrix (ECM) and contains a hypoxic central region in which HIF has been shown to regulate chondrocyte function. Importantly, growth plate chondrocytes are highly active in collagen synthesis. Collagen prolyl 4-hydroxylases (C-P4Hs I-III) provide collagen molecules with thermal stability and are thus necessary for the formation of a proper ECM. Through an in vitro approach it is demonstrated that hypoxia increases the amount and activity of C-P4H in primary mouse epiphyseal growth plate chondrocytes in a HIF-1-dependent manner. Lastly, it was set out to characterize mouse lines with complete inactivation of C-P4H-II with or without partial inactivation of C-P4H-I. A significant reduction in the total amount of C-P4H and its activity was found to result in mild chondrodysplasia and altered bone properties. The above mouse models provided new information on the specific in vivo roles of the C-P4H isoenzymes I and II. / Tiivistelmä Kudosten alentunut happipitoisuus (hypoksia) liittyy osana moniin elimistön patologisiin tiloihin, kuten anemiaan. Lisäksi se on tärkeä säätelytekijä normaalin yksilönkehityksen aikana. Jotta solut havaitsisivat hypoksian ja reagoidakseen siihen, on niille kehittynyt säätelyjärjestelmä, jossa hypoksiassa indusoituva transkriptiotekijä, HIF, on tärkeässä asemassa. Yksi merkittävin HIF:n indusoima systeeminen vaikutus elimistössä on punasolujen tuotannon, erytropoieesin, kiihtyminen. Sitä tapahtuu erytropoietiinia koodittavan geenin (EPO) lisääntyneen ilmentymisen kautta. HIF-tekijän määrää soluissa säätelee kolme HIF-prolyyli-4-hydroksylaasientsyymiä (HIF-P4Ht 1-3). Transmembraanisen prolyyli-4-hydroksylaasin (P4H-TM) tiedetään myös vaikuttavan HIF-tekijän määrään soluissa in vitro, mutta sen vaikutusta nisäkkään erytropoieesiin ei ole aiemmin tutkittu. Käyttämällä hyväksi kolmea eri transgeenista hiirilinjaa (P4h-tm-/-, Hif-P4h-2gt/gt, Hif-p4h-3-/-) ja HIF-P4H entsyymeitä inhiboivaa lääkeainetta, FG-4497, tässä työssä osoitettiin ensimmäistä kertaa, että P4H-TM osallistuu nisäkkään Epo-hormonin tuoton säätelyyn. Pitkät luut muodostuvat endokondraalisen luutumisen kautta. Siinä ensin muodostuu rustoinen malli, kasvulevy, joka vähitellen korvaantuu luukudoksella. Kasvulevyn sisin kerros on sen soluille, kondrosyyteille, hypoksinen kasvuympäristö. HIF:illä on todettu olevan tärkeä rooli kondrosyyttien toiminnan säätelijänä. Kasvulevyn soluvälitila sisältää runsaasti kollageeneja. Kollageenin prolyyli-4-hydroksylaasit (C-P4Ht I-III) ovat avainasemassa kollageenien biosynteesissä ja siten niiden toiminta on välttämätöntä kestävän soluvälitilan muodostumiselle. Käyttämällä in vitro menetelmiä, tässä työssä osoitettiin, että hiiren epifyseaalisten kasvulevyjen kondrosyyteissä hypoksia lisää C-P4H:n määrää ja aktiivisuutta HIF-tekijästä riippuvalla mekanismilla. Eri C-P4H-isoentsyymeiden toiminnasta ja merkityksestä in vivo tiedetään vain vähän. Tässä työssä karakterisoitiin hiirilinja, jossa C-P4H-II on täysin inaktiivinen, ja hiirilinja, jossa lisäksi C-P4H-I on osittain inaktiivinen. Merkittävästi alentuneen C-P4H:n aktiivisuuden todettiin aiheuttavan hiirimallissa lievän kondrodysplasian sekä heikentyneet luun ominaisuudet.

The contamination of renal failure patients by metals can be associated to the presence of these metals in the medication, since they can be absorbed by the organism. The level of contamination caused by medication, in these cases, depends strongly on the quality of medication used in the treatment. Among the possible contaminants, there are metals such as aluminum, chromium and nickel. Therefore, the development of analytical methodologies for the quality control of medicaments used by anemic patients is of great importance. In the present work, the presence of Al, Cr and Ni as contaminants in erythropoietin formulations (EPO), a renal antianemic, was investigated by developing and optimizing an adsorptive cathodic stripping voltammetric (AdCSV) method. It involves the optimization of a pretreatment step of samples by using UV irradiation for decomposition of matrix organic components. The AdCSV method is based on the adsorptive deposition of the complex formed at the electrode surface and the subsequent reduction of ligand (or metal) during the cathodic potential scan. The results found for Al, Cr and Ni in the studied samples, after performing the pretreatment step, show the applicability of the method for the determination of Al, Cr and Ni as contaminants in this kind of samples. The developed voltammetric methods are advantageous in relation to other existing methods concerning the high sensitivity of measurement if associated to the pretreatment step by UV irradiation associated with the addition of H2O2. / A contaminação de pacientes com insuficiência renal por espécies metálicas pode estar associada à presença destas na medicação empregada, uma vez que estas espécies podem ser absorvidas pelo organismo do paciente. O nível de contaminação através da medicação, nestes casos, dependerá da qualidade da medicação utilizada no tratamento. Dentre os possíveis contaminantes, estão metais como alumínio, cromo e níquel. Desta forma, o desenvolvimento de metodologias analíticas adequadas ao controle de qualidade dos medicamentos administrados ao paciente é de grande importância. No presente trabalho, investigou-se a presença de Al, Cr e Ni como contaminantes em formulações de eritropoetina (EPO), um antianêmico renal, através do desenvolvimento e otimização de um método voltamétrico adsortivo de redissolução catódica (AdCSV) com a otimização de uma etapa de pré-tratamento das amostras empregando radiação UV para a decomposição dos componentes orgânicos da matriz. O método está baseado na deposição adsortiva do complexo formado (metal-ligante) na superfície do eletrodo e na redução do ligante ou do metal durante a varredura catódica dos potenciais. Os valores de Al, Cr e Ni encontrados nas amostras estudadas, após a etapa de pré-tratamento, demonstram a aplicabilidade do método para a determinação de Al, Cr e Ni como contaminantes neste tipo de matriz. O método voltamétrico desenvolvido é vantajoso em relação a outros métodos existentes, devido à alta sensibilidade da medida quando associada a uma etapa de pré-tratamento da amostra com radiação UV combinado com adição de H2O2.

Neurorehabilitation is a multidisciplinary rehabilitation process used in patients with neurological diseases. These patients have not only movement disorders but also cognitive and neurobehavioral problems as well as aphasias. Their rehabilitation is a long term process and the results are often unsatisfactory. Neuroplasticity - physiological basis for neurorehabilitation induces functional restitution or recovery after secondary brain damage. Various neuroprotective substances (e.g. erythropoietin - EPO) are tested to empower mechanisms of plasticity after brain injury. Preclinical studies testing efficacy of those substances in animal brain damage models are essential to prepare clinical trials. The aim of the study was to reveal the influence of EPO combined with rehabilitation on functional outcomes after global cerebral hypoxia. FIM (Functional independence measure) test was used for functional evaluation and Meilli test for visual memory of the patients who attended special program for rehabilitation in clinical part. Patients who came earlier had better prognosis than patients who came later. In experimental part three-months old male Wistar albino rats were exposed to hypobaric hypoxia for 60 minutes in an experimental chamber, simulating an altitude of 8000 m. Half of the animals received...

Neurorehabilitation is a multidisciplinary rehabilitation process used in patients with neurological diseases. These patients have not only movement disorders but also cognitive and neurobehavioral problems as well as aphasias. Their rehabilitation is a long term process and the results are often unsatisfactory. Neuroplasticity - physiological basis for neurorehabilitation induces functional restitution or recovery after secondary brain damage. Various neuroprotective substances (e.g. erythropoietin - EPO) are tested to empower mechanisms of plasticity after brain injury. Preclinical studies testing efficacy of those substances in animal brain damage models are essential to prepare clinical trials. The aim of the study was to reveal the influence of EPO combined with rehabilitation on functional outcomes after global cerebral hypoxia. FIM (Functional independence measure) test was used for functional evaluation and Meilli test for visual memory of the patients who attended special program for rehabilitation in clinical part. Patients who came earlier had better prognosis than patients who came later. In experimental part three-months old male Wistar albino rats were exposed to hypobaric hypoxia for 60 minutes in an experimental chamber, simulating an altitude of 8000 m. Half of the animals received...

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