Este estudo teve, por finalidade, estabelecer o valor da ressonância magnética em 30 doadores potenciais do lobo direito do fígado, na determinação dos seguintes fatores: esteatose hepática; anatomia biliar; anatomias arterial hepática, venosas portal e hepática, e volume hepático lobar, comparando-os, respectivamente, com os achados anatomopatológicos da biópsia hepática, da colangiografia intraoperatória, da angiografia digital e/ou com os achados cirúrgicos, e com o peso real do enxerto. A RM subestimou a infiltração gordurosa hepática; permitiu identificar a anatomia biliar, com concordância em 83% dos casos; apresentou 100% de concordância na avaliação das anatomias arterial e venosas portal e hepática, e superestimou, em pequeno grau, o volume hepático lobar / The purpose of this study was to establish the value of the magnetic resonance in 30 potential donors for right lobe living liver transplantation. The main goal was to determine the following factors: steatosis; biliar anatomy; hepatic arterial anatomy; portal and hepatic venous anatomy, and lobar liver volume, comparing them to liver biopsy results, to intraoperative colangiography, to digital angiography and/or surgical findings, and to the real graft weight, respectively. The MR has underestimated liver steatosis; it has identified biliar anatomy with 83% of agreement; it has had 100% of agreement in the evaluation of arterial and portal and hepatic venous anatomy, and it has overestimated with small degree the lobar liver volume

Introdução: A quantidade e o tipo de gordura alimentar exercem importante influência no desenvolvimento de doença cardiovascular (DCV) e podem contribuir para o desenvolvimento de esteatose hepática. Os ácidos graxos saturados e trans são consensualmente apontados como aterogênicos; já os poli-insaturados parecem exercer ação antiaterogênica. Com relação a esteatose hepática, sabe-se que os ácidos graxos saturados estão associados com o seu desenvolvimento; porém, a ação dos ácidos graxos trans na gênese e no desenvolvimento de esteatose hepática não está totalmente elucidada. Neste estudo, avaliou-se o efeito do consumo de dietas enriquecidas com ácidos graxos saturados (SAT), poli-insaturados (POLI) ou trans (TRANS) sobre componentes envolvidos na indução e na progressão da placa aterosclerótica, bem como sobre o desenvolvimento da doença hepática gordurosa não alcoólica. Métodos: Camundongos com ablação gênica para o receptor de LDL (LDLr-KO) foram alimentados com dietas hiperlipídicas (40% do valor calórico total sob a forma de gordura), enriquecidas com ácidos graxos SAT, POLI ou TRANS por 16 semanas e ao final submetidos a: 1) análises plasmáticas: colesterol total (CT), triglicérides (TG), insulina, glicose, aspartato aminotransferase (AST) e alanina aminotransferase (ALT), interleucina-6 (IL-6), fator de necrose tumoral-? (TNF-alfa) e perfil de lipoproteínas; 2) determinação da lesão aterosclerótica: área de lesão (Oil Red-O), conteúdo de ATP-binding cassette transporter A1 (ABCA1) e infiltrado de macrófagos (imuno-histoquímica), colocalização de ABCA1 e macrófagos (microscopia confocal) e conteúdo de colágeno (Picrosirius-Red) na raiz aórtica; 3) conteúdo de CT, colesterol éster (CE) e colesterol livre (CL) na aorta total; 4) macrófagos peritoneais foram tratados com lipopolissacarídeo (LPS), e IL-6, TNF-alfa e interleucina-10 (IL-10) medidas no meio de cultura; 5) no fígado: grau da doença hepática gordurosa não alcoólica, concentração de CT e TG e expressão de RNA mensageiro (mRNA) de PPAR-gama, PPAR-gama, SREBP-1c, MTP, CPT-1 e ABCA1 por RT-qPCR; 6) determinação do conteúdo de tecido adiposo visceral e subcutâneo na carcaça. Resultados: O consumo de dieta não diferiu entre os grupos; comparado à dieta POLI, TRANS induziu menor ganho de peso refletido por menor conteúdo de tecido adiposo. TRANS induziu hepatomegalia, desenvolvimento de esteato-hepatite não alcoólica (NASH) e piora da sensibilidade insulínica (evidenciada pelo índice HOMAIR). As concentrações de AST e ALT não diferiram entre os grupos. A dieta TRANS elevou a expressão de mRNA de genes relacionados à lipogênese hepática (PPAR-gama e SREBP-1c) comparada à SAT e POLI e reduziu a expressão de MTP comparada à dieta POLI. Não houve diferença entre os grupos com relação à expressão de genes envolvidos na oxidação hepática de lípides (PPAR-gama e CPT-1). As concentrações plasmáticas de CT e TG foram maiores no grupo TRANS comparado a SAT e POLI. POLI apresentou menor área de lesão, infiltrado de macrófagos e conteúdo de ABCA1 comparados a SAT e TRANS. Macrófagos e ABCA1 não se colocalizaram na área de lesão. O conteúdo de CT na parede arterial foi menor no grupo POLI comparado a TRANS; CL foi menor no grupo POLI comparado a SAT e TRANS; CE não diferiu entre os grupos. Comparado a POLI, SAT e TRANS apresentaram maior conteúdo de colágeno e núcleos necróticos na placa aterosclerótica. A concentração plasmática de IL-6 não diferiu entre os grupos; já a concentração de TNF-alfa foi maior nos grupos POLI e TRANS em comparação a SAT. Em relação à resposta inflamatória de macrófagos ao LPS, POLI e TRANS apresentaram maiores concentrações de IL-6 e TNF-alfa comparadas a SAT. POLI apresentou menores concentrações de IL-10 em comparação aos demais grupos. A expressão hepática de ABCA1 não diferiu entre os grupos. Conclusão: O consumo de dieta TRANS induziu perfil lipídico proaterogênico, hipercolesterolemia, hipertrigliceridemia, hiperglicemia e severo desenvolvimento de aterosclerose, além de hepatomegalia, maior acúmulo hepático de lípides e desenvolvimento de NASH. Por outro lado, POLI preveniu o desenvolvimento de aterosclerose, independentemente de sua ação inflamatória. / Introduction: The amount and type of dietary fat play important roles on the development of cardiovascular disease (CVD) and on the development of hepatic steatosis. Saturated (SAT) and trans (TRANS) fatty acids are known as pro-atherogenic, while the polyunsaturated (POLY) fats seem to exert an antiatherogenic action. Regarding hepatic steatosis, it is known that SAT are associated with its development, however, the role of TRANS in the genesis and development of hepatic steatosis is not fully undestood. This study evaluated the effect of the intake of diets enriched with SAT, POLY or TRANS on the parameters involved in the progression of the atherosclerotic plaque and also on the development of the nonalcoholic fatty liver disease (NAFLD). Methods: LDL receptor knock-out (LDLR-KO) male mice were fed for 16 weeks a high fat diet (40% of calories as fat) enriched with SAT, POLY or TRANS, for 16 weeks. The following parameters were mesured: 1) plasma: total cholesterol (TC), triglyceride (TG), insulin, glucose, aspartate aminotransferase (AST) and alanine amino transferase (ALT), interleukin-6 (IL-6), tumor necrosis factor- ? (TNF-?) and lipoprotein profile; 2) atherosclerotic lesion - lesion area (Oil Red-O), ATP-binding cassette transporter A1 (ABCA1) content and macrophage infiltration (immunohistochemistry), co-localization of ABCA1 and macrophages (confocal microscopy) and collagen content (Picrosirius-Red); 3) TC, cholesteryl ester (CE) and free cholesterol (FC) content of the total aorta; 4) interleukin-6 and 10 (IL-6 and IL-10) and TNF-alfa in the culture medium of peritoneal macrophages after treatment with lipopolysaccharide (LPS); 5) liver: degree of fat liver disease, concentration of TC and TG and mRNA expression (RT-qPCR) of PPAR-gama, PPAR-gama, SREBP-1c, MTP, ABCA1 and CPT-1; 6) visceral and subcutaneous adipose tissue contents in the carcass of the animals. Results: Food intake did not differ amongst the groups, however, compared to POLY, TRANS induced less weight gain, due to lower adipose tissue content. TRANS induced hepatomegaly, nonalcoholic steatohepatitis (NASH) and worsening of insulin sensitivity, as evidenced by the index HOMAIR. The concentrations of ALT and AST did not differ among groups. TRANS increased the mRNA expression of the hepatic lipogenic genes (PPAR-gama and SREBP-1c) compared to the SAT and POLY and reduced the mRNA expression of MTP compared to POLI. There was no difference among the groups regarding the mRNA expression of genes involved in hepatic lipid oxidation (PPAR-gama and CPT-1). Plasma concentrations of TC and TG were higher in TRANS compared to SAT and POLY. POLY showed lower arterial lesion area, macrophage infiltration and ABCA1 content compared to SAT and TRANS. ABCA1 and macrophages did not colocalize in the lesion area. The TC content in the arterial wall was lower on POLY compared to TRANS; FC was lower on POLY compared to SAT and TRANS; CE did not differ among groups. Compared to POLY, SAT and TRANS showed higher collagen content and necrotic core in atherosclerotic plaques. The plasma concentration of IL-6 did not differ among groups, however, TNF-alfa plasma concentration was higher in POLY and TRANS compared to SAT. Regarding the macrophage inflammatory response to LPS, POLY and TRANS showed higher concentrations of IL-6 and TNF-alfa compared to SAT. Moreover, POLY had the lowest concentration of the anti-inflammatory cytokine IL-10. The hepatic expression of ABCA1 did not differ amongst the groups. Conclusion: TRANS induced pro-atherogenic lipid profile, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, and severe atherosclerosis, and in addition, elicted hepatomegaly, increased hepatic lipid accumulation and NASH. On the other hand, POLY prevented the development of atherosclerosis, independently of their pro-inflammatory activity.

Diese Arbeit beinhaltet Untersuchungen zu den unterschiedlichen Isoformen des Leptinrezeptors und dessen Regulation in primären humanen Hepatozyten. Leptin und der Leptinrezeptor nehmen in der Physiologie des menschlichen Energiehaushaltes eine wesentliche Funktion ein und sind an der Pathogenese der Adipositas mit Folgeerkrankungen wie der Entwicklung einer Fettleber beteiligt. Es wird erstmalig geprüft inwieweit das Modellsystem primärer humaner Hepatozyten für Analysen der Leptinrezeptor-Expression und der Abspaltung von löslichem Leptinrezeptor geeignet ist. Weiterhin werden untersucht, welchen Einfluss endokrine Regulatoren wie Dexamethason, Leptin und Glucagon auf die isoformspezifischen Rezeptormengen in primären Hepatozyten haben und wie der Rezeptor unter Apoptose reguliert ist, welche durch die lipotoxischen Effekte der freien Fettsäure Palmitat und den Apoptoseinduktor Staurosporin induziert wird. Hierdurch können Rückschlüsse auf eine möglicherweise veränderte Wirksamkeit des Leptins in der Leber gezogen werden.

This thesis focuses on the effects of n-3 polyunsaturated fatty acids (n-3 PUFA) on development of non-alcoholic fatty liver disease (NAFLD) in experiment, on prevalence of this condition in patients with type 2 diabetes mellitus and metabolic syndrome and also on non-invasive diagnostics. The aim was to study the effect of n-3 PUFA on NAFLD development in an experimental model and based on analysis of a group of patients with type 2 diabetes and metabolic syndrome to assess the prevalence of this condition. Lastly we aimed to evaluate non-invasive diagnostic methods of liver fibrosis and NASH. We demonstrated beneficial effects of n-3 PUFA administration on NAFLD development in a C57/Bl6 mice high fat methionin-cholin defficient dietary model of NAFLD. n-3 PUFA administration led to biochemical improvement, decrease of lipid accumulation in the liver as well as improvement of histology. These effects are determined by complex modulation of lipid metabolism, mainly due to decrease in availability of fatty acids for triglyceride synthesis in the liver, changes of adipokine levels and amelioration of proinflammatory status in the liver. In a group of type 2 diabetics we found NAFLD prevalence of almost 80%, 14% of these patients had also signs of liver fibrosis or cirrhosis. Non-invasive methods...

Les patients atteints de stéatose hépatique non alcoolique (NAFLD) développent fréquemment des manifestations cardiovasculaires. Bien que souvent liées à l'obésité, ces anomalies peuvent également se développer chez des patients non obèses atteints de NAFLD impliquant que cette pathologie hépatique joue, en soi, un rôle dans la pathogenèse des complications cardiaques. Pour répondre à cette question et étudier les mécanismes sous-jacents indépendamment de toutes perturbations métaboliques et comorbidités préexistantes, nous avons utilisé un modèle murin arborant une déficience mitochondriale hépatique associée à un défaut d'assemblage du complexe IV de la chaîne respiratoire. Ce modèle murin avait préalablement été caractérisé au niveau hépatique mettant alors en évidence le développement d'une stéatose microvésiculaire et un profil lipidomique similaire à celui observé chez les patients atteints d'une NAFLD sans obésité. L'identification des mécanismes qui sous-tendent le développement et la progression de la NAFLD sans obésité et de ces répercussions extra-hépatiques ne faisant pas l'objet d'un très grand nombre d'études fondamentales, l'objectif principal était donc d'étudier l'axe foie-coeur. Dans le cadre des travaux de ce mémoire, nous avons cherché à approfondir la caractérisation hépatique, préalablement faite à l'âge de 5 semaines et ayant fait l'objet de publications par des laboratoires collaborateurs. Nous avons par la suite investigué la glycémie, l'insulinémie et le profil des lipoprotéines plasmatiques pour finir par l'analyse du métabolisme et de la fonction cardiaque. L'ensemble de ces expériences ont été faites en prenant en compte l'impact non négligeable du sexe sur la physiopathologie de la NAFLD. Nos résultats ont dévoilé un important remodelage phénotypique sexe-dépendant allant au-delà des lésions hépatiques. Les mâles un peu plus que les femelles présentaient une hypoglycémie à jeun et une sensibilité accrue à l'insuline. Ils présentaient un léger dysfonctionnement diastolique soutenu par un remodelage des lipoprotéines circulantes et dans une certaine mesure, par un remodelage du lipidome cardiaque. À l'inverse, les femelles ne manifestaient aucun dysfonctionnement cardiaque, mais présentaient des déficiences cardiométaboliques soutenues par une altération de l’intégrité et la fonction mitochondriale, un remodelage des lipoprotéines circulantes et une accumulation intracardiaque de triglycérides. À la lumière de ces résultats, cette étude souligne que les défauts métaboliques dans le foie peuvent entraîner des anomalies significatives et dépendantes du sexe affectant à la fois le phénotype mitochondrial/métabolique et la fonction contractile indépendamment de l'obésité. Ce modèle expérimental pourrait s'avérer utile dans la compréhension des mécanismes sous-jacents à la variabilité liée au sexe dans la progression de la NAFLD chez l'homme non obèse. / Cardiac abnormalities often develop in patients with non-alcoholic fatty liver disease (NAFLD). Although frequently linked to obesity, these abnormalities can also develop in patients with lean-NAFLD, implying that the liver pathology per se plays a role in the pathogenesis of cardiac complications. To address this question and investigate the underlying mechanisms independent of any pre-existent metabolic disruptions and comorbidities, we used a murine model of hepatic mitochondrial deficiency associated with a defect in the assembly of respiratory chain complex IV. This mouse model had previously been characterized at the hepatic level, showing the presence of microvesicular steatosis, and a lipidomic profile similar to that observed in patients with lean-NAFLD. Because few fundamental studies have adressed the identification of mechanisms underlying the development and progression of lean-NAFLD and its extrahepatic repercussions, the main aim was to study the liver-heart axis. As a part of this master's project, we sought to deepen the hepatic characterization of this mouse model, previously done at 5-weeks of age, and published by collaborators. We then investigated glycemia, insulinemia and plasma lipoprotein profile, and finally examined cardiac metabolism and function. All these experiments were done in consideration of the non-negligible impact of sexe on the pathophysiology of NAFLD. Our results unveiled a sex-dependent multi-faceted phenotypic remodeling that went beyond liver damage. Males, slightly more than females, showed fasting hypoglycemia and increased insulin sensitivity. They exhibited mild diastolic dysfunction supported by remodeling of the circulating lipoproteins, and to some extent remodeling of cardiac lipidome. Conversely, females did not manifest cardiac dysfunction, but exhibited cardiometabolic impairments supported by impaired mitochondrial integrity and function, remodeling of circulating lipoproteins, and intracardiac accumulation of triglycerides. In light of these findings, this study underscores that metabolic defects in the liver can result in significant sex-dependent abnormalities that affect both the mitochondrial/metabolic phenotype and contractile function independent of obesity. This experimental model may prove useful to better understand the mechanisms underlying the sex-related variability in the progression of lean-NAFLD in humans.

Pour le diagnostic et la stratification de la fibrose hépatique, la rigidité du foie est un biomarqueur quantitatif estimé par des méthodes d'élastographie. L'élastographie par ondes de cisaillement (« shear wave », SW) utilise des ultrasons médicaux non invasifs pour évaluer les propriétés mécaniques du foie sur la base des propriétés de propagation des ondes de cisaillement. La vitesse des ondes de cisaillement (« shear wave speed », SWS) et l'atténuation des ondes de cisaillement (« shear wave attenuation », SWA) peuvent fournir une estimation de la viscoélasticité des tissus. Les tissus biologiques sont intrinsèquement viscoélastiques et un modèle mathématique complexe est généralement nécessaire pour calculer la viscoélasticité en imagerie SW. Le calcul précis de l'atténuation est essentiel, en particulier pour une estimation précise du module de perte et de la viscosité. Des études récentes ont tenté d'augmenter la précision de l'estimation du SWA, mais elles présentent encore certaines limites. Comme premier objectif de cette thèse, une méthode de décalage de fréquence revisitée a été développée pour améliorer les estimations fournies par la méthode originale de décalage en fréquence [Bernard et al 2017]. Dans la nouvelle méthode, l'hypothèse d'un paramètre de forme décrivant les caractéristiques spectrales des ondes de cisaillement, et assumé initialement constant pour tous les emplacements latéraux, a été abandonnée permettant un meilleur ajustement de la fonction gamma du spectre d'amplitude. En second lieu, un algorithme de consensus d'échantillons aléatoires adaptatifs (« adaptive random sample consensus », A-RANSAC) a été mis en œuvre pour estimer la pente du paramètre de taux variable de la distribution gamma afin d’améliorer la précision de la méthode. Pour valider ces changements algorithmiques, la méthode proposée a été comparée à trois méthodes récentes permettant d’estimer également l’atténuation des ondes de cisaillements (méthodes de décalage en fréquence, de décalage en fréquence en deux points et une méthode ayant comme acronyme anglophone AMUSE) à l'aide de données de simulations ou fantômes numériques. Également, des fantômes de gels homogènes in vitro et des données in vivo acquises sur le foie de canards ont été traités. Comme deuxième objectif, cette thèse porte également sur le diagnostic précoce de la stéatose hépatique non alcoolique (NAFLD) qui est nécessaire pour prévenir sa progression et réduire la mortalité globale. À cet effet, la méthode de décalage en fréquence revisitée a été testée sur des foies humains in vivo. La performance diagnostique de la nouvelle méthode a été étudiée sur des foies humains sains et atteints de la maladie du foie gras non alcoolique. Pour minimiser les sources de variabilité, une méthode d'analyse automatisée faisant la moyenne des mesures prises sous plusieurs angles a été mise au point. Les résultats de cette méthode ont été comparés à la fraction de graisse à densité de protons obtenue de l'imagerie par résonance magnétique (« magnetic resonance imaging proton density fat fraction », MRI-PDFF) et à la biopsie du foie. En outre, l’imagerie SWA a été utilisée pour classer la stéatose et des seuils de décision ont été établis pour la dichotomisation des différents grades de stéatose. Finalement, le dernier objectif de la thèse consiste en une étude de reproductibilité de six paramètres basés sur la technologie SW (vitesse, atténuation, dispersion, module de Young, viscosité et module de cisaillement). Cette étude a été réalisée chez des volontaires sains et des patients atteints de NAFLD à partir de données acquises lors de deux visites distinctes. En conclusion, une méthode robuste de calcul du SWA du foie a été développée et validée pour fournir une méthode de diagnostic de la NAFLD. / For diagnosis and staging of liver fibrosis, liver stiffness is a quantitative biomarker estimated by elastography methods. Ultrasound shear wave (SW) elastography utilizes noninvasive medical ultrasound to assess the mechanical properties of the liver based on the monitoring of the SW propagation. SW speed (SWS) and SW attenuation (SWA) can provide an estimation of tissue viscoelasticity. Biological tissues are inherently viscoelastic in nature and a complex mathematical model is usually required to compute viscoelasticity in SW imaging. Accurate computation of attenuation is critical, especially for accurate loss modulus and viscosity estimation. Recent studies have made attempts to increase the precision of SWA estimation, but they still face some limitations. As a first objective of this thesis, a revisited frequency-shift method was developed to improve the estimates provided by the original implementation of the frequency-shift method [Bernard et al 2017]. In the new method, the assumption of a constant shape parameter of the gamma function describing the SW magnitude spectrum has been dropped for all lateral locations, allowing a better gamma fitting. Secondly, an adaptive random sample consensus algorithm (A-RANSAC) was implemented to estimate the slope of the varying rate parameter of the gamma distribution to improve the accuracy of the method. For the validation of these algorithmic changes, the proposed method was compared with three recent methods proposed to estimate SWA (frequency-shift, two-point frequency-shift and AMUSE methods) using simulation data or numerical phantoms. In addition, in vitro homogenous gel phantoms and in vivo animal (duck) liver data were processed. As a second objective, this thesis also aimed at improving the early diagnosis of nonalcoholic fatty liver disease (NAFLD), which is necessary to prevent its progression and decrease the overall mortality. For this purpose, the revisited frequency-shift method was tested on in vivo human livers. The new method's diagnosis performance was investigated with healthy and NAFLD human livers. To minimize sources of variability, an automated analysis method averaging measurements from several angles has been developed. The results of this method were compared to the magnetic resonance imaging proton density fat fraction (MRI-PDFF) and to liver biopsy. SWA imaging was used for grading steatosis and cut-off decision thresholds were established for dichotomization of different steatosis grades. As a third objective, this thesis is proposing a reproducibility study of six SW-based parameters (speed, attenuation, dispersion, Young’s modulus, viscosity and shear modulus). The assessment was performed in healthy volunteers and NAFLD patients using data acquired at two separate visits. In conclusion, a robust method for computing the liver’s SWA was developed and validated to provide a diagnostic method for NAFLD.

La protéine mitochondriale LRPPRC (leucine-rich pentatricopeptide repeat motif containing), codée par le gène nucléaire du même nom, est impliquée dans la stabilisation des ARNm mitochondriaux, particulièrement les ARNm codants pour l’assemblage du complexe IV (COX) de la chaîne respiratoire mitochondriale (OXPHOS). Le syndrome de Leigh de type canadien français (LSFC) est une maladie mitochondriale neurodégénérative caractérisée par une mutation spécifique A354V du gène Lrpprc, et par une déficience de l’activité de COX. Les organes les plus affectés sont le foie et le cerveau mais, les mécanismes associés à la progression de la maladie restent encore peu compris. Un modèle murin à délétion hépato-spécifique en LRPPRC (H-LRPPRC KO) a été créé dans le but d’étudier l’aspect hépatique du LSFC caractérisé par des dommages et une stéatose hépatique. Représentant l’objectif 1 de ce mémoire, le modèle H-LRPPRC KO a été utilisé pour une étude de caractérisation de la stéatose hépatique non-alcoolique (SHNA) sans obésité dans laquelle nous avons pu mettre en évidence une progression plus avancée de la pathologie hépatique chez les souris mâles associée à la présence d’une dysfonction cardiaque diastolique. L’objectif 2 de ce mémoire a pour but la caractérisation d’un nouveau modèle murin plus représentatif du LSFC pour ultimement trouver de nouvelles signatures/approches thérapeutiques. Nous utilisons cette fois un modèle murin développé par nos collaborateurs, à délétion inductible (KI), par le tamoxifène, de Lrpprc sur un allèle tandis que le deuxième exprime la mutation A354V spécifique au LSFC pour ainsi caractériser la maladie d’un point de vue biochimique et moléculaire. Nos premiers résultats montrent des signatures et caractéristiques comparables à celles observées chez les patient(e)s LSFC et dans le modèle H-LRPPRC KO avec une perte de poids drastique, une diminution des niveaux de la protéine LRPPRC et de COX et plusieurs perturbations du profil lipidomique dans le foie, le plasma et le cerveau. Ces résultats posent les bases biochimiques et moléculaires de ce modèle pour justifier son utilisation ultérieure pour l’évaluation des manifestations cliniques comme les atteintes musculaires et encore cognitives tel qu’observé chez les personnes atteintes de LSFC. / The mitochondrial protein LRPPRC (leucine-rich pentatricopeptide repeat motif containing), encoded by the nuclear gene of the same name, is involved in the stabilization of mitochondrial mRNAs, particularly those coding for the assembly of complex IV (COX) of the mitochondrial respiratory chain (OXPHOS). Leigh syndrome French Canadian type (LSFC) is a mitochondrial neurodegenerative disease characterized by a specific A354V mutation in the Lrpprc gene as well as a deficiency in COX activity. The most affected organs are the liver and brain, but the mechanisms associated with disease progression remain poorly understood. A hepato-specific knockout of LRPPRC mouse model (H-LRPPRC KO) was created to study the hepatic aspect of LSFC which includes liver damage and steatosis. Defined as the first objective of this master’s thesis, the H-LRPPRC KO model was used for the characterization of non-alcoholic hepatic steatosis (NAHS) without obesity in which we were able to highlight a more advanced progression of liver pathology in male mice associated with the presence of cardiac diastolic dysfunction. Furthermore, the second objective of this master’s thesis aims to characterize a new mouse model more representative of LSFC to ultimately find new therapeutic signatures/approaches. Here, we use a mouse model developed by our collaborators with tamoxifen-inducible deletion (KI) of Lrpprc on one allele, while the second one expresses the LSFC-specific A354V mutation, to characterize the disease from a biochemical and molecular perspective. Our initial results show signatures and characteristics comparable to those observed in LSFC patients as well as in the H-LRPPRC KO model, with drastic weight loss, reduced protein levels of LRPPRC and COX, and several disturbances of the lipidomic profile in liver, plasma and brain. These results lay the biochemical and molecular foundations of this model, justifying its future use in the evaluation of clinical manifestations such as muscular and cognitive impairment as observed in LSFC patients.

INTRODUÇÃO: A esteato-hepatite não alcóolica (NASH) é considerada problema de saúde pública, dada sua crescente incidência e seu possível papel na carcinogênese hepato-celular. Terapias atuais envolvem alterações de dieta e estilo de vida, mas têm seu resultado prejudicado pela baixa aderência dos pacientes. Abordagens farmacológicas ainda são precárias. Uma grande dificuldade no manejo de NASH reside no limitado entendimento de sua fisiopatologia, que parece envolver complexas alterações metabólicas e inflamatórias. Ácidos graxos poli-insaturados ômega-3 (AGPIs n-3) são reconhecidos por suas propriedades moduladoras do metabolismo lipídico e da inflamação, e estão diminuídos em pacientes com NASH. O uso clínico de AGPIs n-3 tem mostrado benefício no controle da esteatose e na produção de marcadores da resposta metabólica e inflamatória em NASH, embora com algumas observações contraditórias. A compreensão de mecanismos moleculares modulados por AGPIs n-3 em NASH podem ser úteis para identificar alvos moleculares que auxiliem no desenho de intervenção farmacológica efetiva. Nesse sentido, ciências ômicas são particularmente úteis para a compreensão de mecanismos moleculares com alto valor translacional para a prática clínica e podem contribuir para a identificação desses alvos. OBJETIVO: O presente estudo avaliou a resposta proteômica hepática e lipidômica plasmática de pacientes com NASH perante o tratamento com AGPIs n-3. MÉTODO: As avaliações proteômicas e lipidômicas foram desenvolvidas por espectometria de massas e/ou cromatografia gasosa em amostras de biópsias hepáticas e plasma coletadas de pacientes envolvidos em estudo preliminar, realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O referido estudo envolveu pacientes adultos, de ambos os sexos e com diagnóstico de NASH tratados diariamente, durante 6 meses, com 3 cápsulas contendo mistura de óleo de linhaça e óleo de peixe [0,315 g AGPIs: sendo 0,065 g de ácido eicosapentaenoico (EPA), 0,050 g de docosahexaenoico (DHA) e 0,2 g alfa linolênico (ALA) por cápsula]. Pacientes, após o tratamento com AGPIs n-3, que apresentaram altas concentrações plasmáticas de ALA e/ou DHA e/ou baixas de ácido araquidônico (AA) mostraram melhora parcial das alterações de histologia hepática. No presente estudo, avaliamos as vias proteômicas e marcadores lipidômicos resultantes do tratamento com AGPIs n-3. Isto foi feito por meio da comparação, antes (grupo AT) e depois do tratamento (grupo DT), de pools de tecido hepático (análise por interactoma) e amostras de plasma (OPLS-DA). RESULTADOS: Foram identificadas proteínas hepáticas, exclusivamente e/ou alteradamente expressas, no grupo DT, relacionadas com vias de matriz celular, metabolismo lipídico, de estresse oxidativo, e de retículo endoplasmático e respiração celular. Com excessão da via de matriz celular, a análise do interactoma revelou alteração funcional significativa das vias moduladas por essas proteínas. Em conjunto, essas alterações foram sugestivas de diminuição de lipotoxicidade, estresse oxidativo e respiração anaeróbia, e aumento de respiração aeróbia após tratamento com AGPIs n-3. Estas modificações são marcadores potenciais de melhora de função de retículo endoplasmático e mitocondrial. Em adição, após o tratamento com AGPIs n-3, o perfil lipidômico plasmático mostrou-se alterado com significativo aumento de glicerofosfolípides, ALA e EPA, e diminuição de ácido araquidônico (n-6) e da razão AGPIs n-6/n-3. Estes dados são concordantes com potencial melhora das funções de retículo endoplasmático e mitocondriais. CONCLUSÃO: O tratamento com AGPIs n-3 em pacientes com NASH influenciou favoravelmente o perfil proteômico hepático e lipidômico sistêmico. Em conjunto, essas alterações sugerem melhora da função de retículo endoplasmático e mitocondrial, com potencial impacto na homeostase celular, por meio da modulação de diferentes vias biológicas / INTRODUCTION: Non-alcoholic steatohepatitis (NASH) is considered a public health problem, given its increasing incidence and its possible role in hepatocellular carcinogenesis. Current therapies involve diet and lifestyle changes, but its applicability suffers from low patients adherence. Pharmacological approaches are still missing. A main difficulty in the NASH management lies in the limited understanding of its pathophysiology, which seems to involve complex metabolic and inflammatory disturbances. Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are recognized for its modulatory properties on lipid metabolism and inflammation and are decreased in patients with NASH. The clinical use of these PUFAs has shown benefit in controlling steatosis and the production of metabolic and inflammatory response markers in NASH, despite some conflicting reports. Understanding mechanisms modulated by n-3 PUFAs in NASH may be useful for identifying molecular targets that could assist in the design of effective pharmacologic interventions. In this sense, omics sciences are particularly useful for understanding molecular mechanisms with high translational value to clinical practice and may contribute to the identification of these targets. AIM: This study evaluated the liver proteomic and plasma lipidomics responses of patients with NASH towards treatment with n-3 PUFAs. METHODS: The proteomic and lipidomic evaluations were studied by mass spectrometry and / or gas chromatography in samples from liver biopsies and plasma collected from patients enrolled in a preliminary clinical trial of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. This study involved adult patients of both sexes diagnosed with NASH treated daily for 6 months, with 3 capsules containing a mixture of linseed and fish oils [0.315 g PUFAs: 0.065 g eicosapentaenoic acid (EPA) , 0.050 g docosahexaenoic (DHA) and 0.2 g alpha linolenic acid (ALA) per capsule]. Patients, after treatment with n-3 PUFAs, with higher concentrations of ALA and DHA and lower arachidonic acid (AA) showed improvement of liver histology alterations. In the present study we evaluated the proteomics pathways and lipidomics markers resulted from treatment with PUFAs n-3. This was performed by comparing, before (BT group) and after (AT group) treatment, liver tissue pools (analysis interactome) and plasma samples (OPLS-DA). RESULTS: It was identified, in a way exclusive and altered, the expressed liver proteins in AT group, related to pathways of cellular matrix, lipid metabolism, oxidative and endoplasmic reticulum stress and cellular respiration. With the exception of cell matrix, the analysis of the interactome revealed substantial functional alterations of the pathways modulated by these proteins. Together, these changes were suggestive of decreased lipotoxicity, oxidative stress and anaerobic respiration and increased aerobic respiration following treatment with PUFAs n-3. These modifications are potential markers of endoplasmic reticulum and mitochondrial functions improvement. In addition, after treatment with n-3 PUFAs, the lipidomics profile was modified, with significant increase in glycerophospholipids, ALA and EPA and decrease of arachidonic acid (AA) and n-6/n-3 AGPIs ratio. These findings are concordant with potential improvement of reticulum endoplasmic and mitochondrial functions. CONCLUSION: In patients with NASH the treatment with n-3 PUFAs favorably influenced hepatic proteomic and systemic lipidomics profiles. Together, these changes suggest improved endoplasmic reticulum and mitochondrial functions, with potential impact on cellular homeostasis through the modulation of different biological pathways

INTRODUÇÃO: A esteato-hepatite não alcóolica (NASH) é considerada problema de saúde pública, dada sua crescente incidência e seu possível papel na carcinogênese hepato-celular. Terapias atuais envolvem alterações de dieta e estilo de vida, mas têm seu resultado prejudicado pela baixa aderência dos pacientes. Abordagens farmacológicas ainda são precárias. Uma grande dificuldade no manejo de NASH reside no limitado entendimento de sua fisiopatologia, que parece envolver complexas alterações metabólicas e inflamatórias. Ácidos graxos poli-insaturados ômega-3 (AGPIs n-3) são reconhecidos por suas propriedades moduladoras do metabolismo lipídico e da inflamação, e estão diminuídos em pacientes com NASH. O uso clínico de AGPIs n-3 tem mostrado benefício no controle da esteatose e na produção de marcadores da resposta metabólica e inflamatória em NASH, embora com algumas observações contraditórias. A compreensão de mecanismos moleculares modulados por AGPIs n-3 em NASH podem ser úteis para identificar alvos moleculares que auxiliem no desenho de intervenção farmacológica efetiva. Nesse sentido, ciências ômicas são particularmente úteis para a compreensão de mecanismos moleculares com alto valor translacional para a prática clínica e podem contribuir para a identificação desses alvos. OBJETIVO: O presente estudo avaliou a resposta proteômica hepática e lipidômica plasmática de pacientes com NASH perante o tratamento com AGPIs n-3. MÉTODO: As avaliações proteômicas e lipidômicas foram desenvolvidas por espectometria de massas e/ou cromatografia gasosa em amostras de biópsias hepáticas e plasma coletadas de pacientes envolvidos em estudo preliminar, realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O referido estudo envolveu pacientes adultos, de ambos os sexos e com diagnóstico de NASH tratados diariamente, durante 6 meses, com 3 cápsulas contendo mistura de óleo de linhaça e óleo de peixe [0,315 g AGPIs: sendo 0,065 g de ácido eicosapentaenoico (EPA), 0,050 g de docosahexaenoico (DHA) e 0,2 g alfa linolênico (ALA) por cápsula]. Pacientes, após o tratamento com AGPIs n-3, que apresentaram altas concentrações plasmáticas de ALA e/ou DHA e/ou baixas de ácido araquidônico (AA) mostraram melhora parcial das alterações de histologia hepática. No presente estudo, avaliamos as vias proteômicas e marcadores lipidômicos resultantes do tratamento com AGPIs n-3. Isto foi feito por meio da comparação, antes (grupo AT) e depois do tratamento (grupo DT), de pools de tecido hepático (análise por interactoma) e amostras de plasma (OPLS-DA). RESULTADOS: Foram identificadas proteínas hepáticas, exclusivamente e/ou alteradamente expressas, no grupo DT, relacionadas com vias de matriz celular, metabolismo lipídico, de estresse oxidativo, e de retículo endoplasmático e respiração celular. Com excessão da via de matriz celular, a análise do interactoma revelou alteração funcional significativa das vias moduladas por essas proteínas. Em conjunto, essas alterações foram sugestivas de diminuição de lipotoxicidade, estresse oxidativo e respiração anaeróbia, e aumento de respiração aeróbia após tratamento com AGPIs n-3. Estas modificações são marcadores potenciais de melhora de função de retículo endoplasmático e mitocondrial. Em adição, após o tratamento com AGPIs n-3, o perfil lipidômico plasmático mostrou-se alterado com significativo aumento de glicerofosfolípides, ALA e EPA, e diminuição de ácido araquidônico (n-6) e da razão AGPIs n-6/n-3. Estes dados são concordantes com potencial melhora das funções de retículo endoplasmático e mitocondriais. CONCLUSÃO: O tratamento com AGPIs n-3 em pacientes com NASH influenciou favoravelmente o perfil proteômico hepático e lipidômico sistêmico. Em conjunto, essas alterações sugerem melhora da função de retículo endoplasmático e mitocondrial, com potencial impacto na homeostase celular, por meio da modulação de diferentes vias biológicas / INTRODUCTION: Non-alcoholic steatohepatitis (NASH) is considered a public health problem, given its increasing incidence and its possible role in hepatocellular carcinogenesis. Current therapies involve diet and lifestyle changes, but its applicability suffers from low patients adherence. Pharmacological approaches are still missing. A main difficulty in the NASH management lies in the limited understanding of its pathophysiology, which seems to involve complex metabolic and inflammatory disturbances. Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are recognized for its modulatory properties on lipid metabolism and inflammation and are decreased in patients with NASH. The clinical use of these PUFAs has shown benefit in controlling steatosis and the production of metabolic and inflammatory response markers in NASH, despite some conflicting reports. Understanding mechanisms modulated by n-3 PUFAs in NASH may be useful for identifying molecular targets that could assist in the design of effective pharmacologic interventions. In this sense, omics sciences are particularly useful for understanding molecular mechanisms with high translational value to clinical practice and may contribute to the identification of these targets. AIM: This study evaluated the liver proteomic and plasma lipidomics responses of patients with NASH towards treatment with n-3 PUFAs. METHODS: The proteomic and lipidomic evaluations were studied by mass spectrometry and / or gas chromatography in samples from liver biopsies and plasma collected from patients enrolled in a preliminary clinical trial of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. This study involved adult patients of both sexes diagnosed with NASH treated daily for 6 months, with 3 capsules containing a mixture of linseed and fish oils [0.315 g PUFAs: 0.065 g eicosapentaenoic acid (EPA) , 0.050 g docosahexaenoic (DHA) and 0.2 g alpha linolenic acid (ALA) per capsule]. Patients, after treatment with n-3 PUFAs, with higher concentrations of ALA and DHA and lower arachidonic acid (AA) showed improvement of liver histology alterations. In the present study we evaluated the proteomics pathways and lipidomics markers resulted from treatment with PUFAs n-3. This was performed by comparing, before (BT group) and after (AT group) treatment, liver tissue pools (analysis interactome) and plasma samples (OPLS-DA). RESULTS: It was identified, in a way exclusive and altered, the expressed liver proteins in AT group, related to pathways of cellular matrix, lipid metabolism, oxidative and endoplasmic reticulum stress and cellular respiration. With the exception of cell matrix, the analysis of the interactome revealed substantial functional alterations of the pathways modulated by these proteins. Together, these changes were suggestive of decreased lipotoxicity, oxidative stress and anaerobic respiration and increased aerobic respiration following treatment with PUFAs n-3. These modifications are potential markers of endoplasmic reticulum and mitochondrial functions improvement. In addition, after treatment with n-3 PUFAs, the lipidomics profile was modified, with significant increase in glycerophospholipids, ALA and EPA and decrease of arachidonic acid (AA) and n-6/n-3 AGPIs ratio. These findings are concordant with potential improvement of reticulum endoplasmic and mitochondrial functions. CONCLUSION: In patients with NASH the treatment with n-3 PUFAs favorably influenced hepatic proteomic and systemic lipidomics profiles. Together, these changes suggest improved endoplasmic reticulum and mitochondrial functions, with potential impact on cellular homeostasis through the modulation of different biological pathways

This study explores the possible efficacy of a low carbohydrate and high fat nutritional intervention (LCHF) as a treatment possibility aiming to improve the ability of self-control and regulation in the context of carbohydrate-addiction. The study first outlines why increased simple carbohydrate consumption has been implicated as a risk-factor in numerous chronic conditions, and then explores the possibility that a reduction of such consumption could lower general medical expenditure in the healthcare sector of already overburdened institutions, especially in developing countries like South Africa. Since the neurobiological evidence for food addiction is compelling, this study investigates the impact of a low carbohydrate and high fat eating (LCHF) regimen by measuring the change in the severity of addictive behaviour in relation to a reduced carbohydrate consumption. Results indicate that a LCHF nutritional intervention lessened addictive behaviour after just 30 days, resulting in a statistically significant decrease in addiction symptoms from day 1 to day 30. The weight and BMI values of the participants recorded at the end of the study showed a reduction from those obtained during the pre- treatment stage, and the self-perceived ‘feeling in control’ also improved in all participants after the intervention. The introduction of a LCHF nutritional intervention presents a relatively cost-effective treatment and preventative measure to combat carbohydrate over-consumption and its numerous health complications, and it is therefore hoped that the positive findings of this study will foster further research, using larger samples, into this type of nutritional intervention against addictive eating behaviour. / Psychology / M.A. (Psychology)