No description available.

Alterations in glucocorticoid (GC) biosynthesis and metabolism are associated with a variety of pathophysiological disorders including cholestasis, diabetes and other metabolic disorders. Bile acids (BA) are also important modulators of metabolic functions and regulate cholesterol, triglyceride and glucose homeostasis as well as being critical for dietary fat digestion, enterohepatic function, and postprandial thermogenesis. In intact cells and in vivo, the 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) enzyme converts inactive GC precursors (cortisone in humans, and 11-dehydrocorticosterone in mice and rats) into their active forms (cortisol and corticosterone, respectively) thereby amplifying local intracellular GC levels. Interconversion by 11β-HSD1 of other sterols has also been described. These include conversions of 7keto-cholesterol to 7β-hydroxycholesterol, 7-oxodehydroepiandrosterone (7-oxo-DHEA) to 7α-hydroxy- and 7β-hydroxy DHEA, 7- oxo-lithocholic acid (LCA, a bile acid; BA) to chenodeoxycholic acid (CDCA, a 7α- hydroxylated BA) and ursodeoxycholic acid (UDCA, a 7β-hydroxylated BA) in human liver microsomes. In the liver, BA inhibit 11β-HSD1 but whether 11β-HSD1 regulates BA homeostasis is unclear. Evidence of molecular regulation of the enterohepatic recycling of bile acids by liver glucocorticoid receptor (GR) in mice does suggest a role for 11β-HSD1. It was therefore hypothesised that disruption of 11β-HSD1 expression in mice would impair BA recycling and might affect the relative concentrations of BA within the enterohepatic circuit. The primary objective of the current work was to investigate the impact of altered 11β-HSD1 on BA homeostasis. This was achieved using genetically modified mouse models with altered 11β-HSD1 expression, either globally or restricted to hepatocytes. BA are stored in the gall bladder and are released postprandially, to aid digestion. It was hypothesised that 11β-HSD1 deficiency might the affect the process of postprandial gall bladder emptying/refilling. Mice with global 11β-HSD1 knockout (Hsd11b1-/-) and age-matched control mice (C57Bl/6) were either fasted for 4h and culled or fasted for 4h and re-fed for another 4h before culling. Their response to fasting and re-feeding was assessed with specific focus on organs associated with BA recycling in the enterohepatic circuit (liver, gall bladder, serum and small intestine). Gall bladders of fasted Hsd11b1-/- and C57Bl/6 mice had similar volumes of bile but in fasted Hsd11b1-/- mice, BA concentrations were higher in serum and liver. As expected, re-feeding caused gall bladder emptying in C57Bl/6 mice with consequent increased serum and liver bile acid concentrations. In Hsd11b1-/- mice, the gall bladder did not empty and serum and liver BA concentrations were similar to the fasted state. To explore possible reasons for this, levels of mRNA encoding proteins known to be involved in hepatic BA transport were quantified using real-time q-PCR. Levels of mRNA encoding NTCP/ SCL10A1/ SCL10A1, the transporter responsible for most hepatocyte BA uptake, were increased in livers of fasted Hsd11b1-/- mice whereas levels of Slc51b mRNA, encoding the OST- transporter that facilitates BA removal from liver to the systemic circulation, and levels of Mrp2 and Atp8b1/FIC1 mRNAs (both encoding proteins which transport BA from liver into gall bladder) were decreased. This suggests that in fasted Hsd11b1-/- mice, BA transporter expression is altered to increase BA influx into hepatocytes and decrease efflux, to compensate for reduced levels of liver BA. These data together imply that bile acid recycling is controlled by 11β-HSD1 activity which regulates gall bladder emptying, hepatic BA concentration and BA transporter activity to ensure continuity of BA recycling within the enterohepatic circuit compartments. These changes may also affect digestion of lipids and fat-soluble micronutrients. Because 11β-HSD1 can directly metabolise secondary BA, it was predicted that 11β-HSD1 deficiency would lead to changes in the BA profile. Profiling of BA in the gall bladder was performed using mass spectrophotometry. In Hsd11b1-/- mice, 7α-hydroxylated BA predominated (cholic acid [CA]>α-muricholic acid [α- MCA]>CDCA>others), in contrast to C57Bl/6 mice in which 7β-hydroxylated BA predominated (ω-MCA>β-MCA>UDCA>others). The ratio of 7α:7β acids was therefore >100-fold greater in Hsd11b1-/- mice. This suggests that 11β-HSD1 either directly or indirectly controls the epimerisation of 7α- to 7β- hydroxylated BAs. Measurement of mRNAs encoding proteins important for hepatic BA biosynthesis in livers of fasted Hsd11b1-/- mice showed decreased expression of Scarb1/SR-B1, Cyp39a1 and Cyp27a1 (though with no change in levels of CDCA, the product of CYP27A1, in liver or bile fluid), compared to fasted control mice. Hepatic levels of Gpbar1/TGR5/GPBAR1 and Cyp3a11 mRNAs, encoding proteins important in BA detoxification, were increased and decreased, respectively. This suggests that Gpbar1/TGR5/GPBAR1, encoding G-protein coupled bile acid receptor (also called TGR5/GPBAR1) and an FXR target, could be induced to detoxify 7α-hydroxylated BA whereas expression of Cyp3a11, which catalyses the conversion of LCA to hyodeoxycholic acid (HDCA) is decreased; bile fluid of Hsd11b1-/- mice contained lower levels of LCA and little to no HDCA, though LCA and HDCA levels in liver were unaltered. Currently, the functional differences between 7α- and 7β- hydroxylated BA are not clear. However, these findings could have significant implications for bile acid-mediated transcription which, in turn, might affect lipid and sterol metabolism. Also, alterations in BA composition may have other physiological consequences via other pathways. Because cholesterol is the precursor of BA synthesis, it was hypothesised that western diet (WD) (containing cholesterol) would exacerbate and/or alter the phenotype of Hsd11b1-/- mice. Gall bladder weights of fasted Hsd11b1-/- and control C57Bl/6 mice did not change with western diet compared to chow diet. In control C57Bl/6 mice, the total BA concentration in the gall bladder increased in response to WD in comparison to chow diet. In contrast, Hsd11b1-/- mice showed no change in total BA concentration when fed on WD in comparison to chow. These data indicate that 11β-HSD1 is required by mice for the normal increase in total BA concentration in bile in response to dietary cholesterol. BA profiling of bile from control mice fed on WD showed no difference in the relative amounts of 7β-hydroxylated BA and 7α-hydroxylated BA to littermates fed on chow diet with the exception of β–MCA which increased, and α–MCA which decreased. Like chow-fed Hsd11b1-/- mice, BA profiling of bile from WD-fed Hsd11b1-/- mice showed a significant decrease in relative levels of 7β-hydroxylated BA (UDCA < β-MCA < others) and an increase in percentage of 7α-hydroxylated BAs (CA>α-MCA>CDCA>others) compared to C57Bl/6 controls. These data show that Hsd11b1-/- mice fail to show the normal increase in 7β-hydroxylated BA and decrease in 7α-hydroxylated BA observed in control mice in response to a cholesterol containing diet, suggesting 11β-HSD1 deficiency blunts the influence of cholesterol on BA composition. Measurement of hepatic mRNAs encoding BA transporters suggest that hepatocyte uptake of BA is decreased in C57Bl/6 on WD compared to those mice on chow diet, whereas this was not the case in Hsd11b1-/- mice where hepatic expression did not change with diet. Thus, Hsd11b1-/- mice failed to increase expression of Ntcp/ Scl10a1/ Scl10a1 appropriately, suggesting impaired hepatic BA uptake, while Slc51b (encoding OST-β) expression was increased, compared to control mice, possibly to reduce hepatic BA concentration by transporting BA out of hepatocytes into the systemic circulation. Therefore, Hsd11b1-/- mice may adapt to a cholesterol-induced increase in hepatic BA by blunting hepatic BA uptake via NTCP/ SCL10A1/ SCL10A1 and increasing hepatic efflux via OST-β. The effects of 11β-HSD1 deficiency upon BA recycling and BA profile and concentration within the enterohepatic circuit, could reflect 11β-HSD1 action within the liver or could be due to actions in other tissues. / To investigate the role of hepatic 11β-HSD1 specifically, 11β-HSD1 liver-specific knockout (Hsd11b1LKO), 11β- HSD1 liver-specific over-expressors (Hsd11b1LOE) and control mice with exon 3 of the Hsd11b1 gene “floxed” (Hsd11b1F) were studied. Findings from this study indicate a role for 11β-HSD1 in adaption to dietary cholesterol and suggest that hepatic 11β-HSD1 (as opposed to 11β-HSD1 in extra-hepatic tissues) is the main factor regulating BA metabolism. Also, work from this thesis demonstrates 11β-HSD1 is an important regulator of gall bladder emptying and filling, an important component of enterohepatic bile acid recycling. Based on these findings it is anticipated that therapeutic use of 11β-HSD1 inhibitors will result in BA imbalances within the enterohepatic circuit and therefore BA homeostasis. Care must therefore be observed when implementing therapeutic use of 11β-HSD1 inhibitors, with particular focus on patients with cholestasis, Addison’s disease and critically ill patients who already have known BA imbalances in their enterohepatic system.

Foi realizado o estudo prospectivo de uma amostra da população portadora de Síndrome de Down que procurou o Departamento de Genética do Hospital Infantil Darcy Vargas,no período de 1959 a 1996. Dos 2816 portadores de Síndrome de Down que compareceram a este Serviço, neste período , a amostra estudada consistiu de 518 pacientes que mantiveram períodos de retomo ambulatorial conforme previsto pelo Protocolo de segmento clínico adotado. O objetivo do estudo foi caracterizar a incidência de colecistopatia litiásica em pacientes portadores de Síndrome de Down . Para desenvolver este estudo, após o diagnóstico citogenético e clínico da Síndrome de Down, procurou-se correlacionar faixa etária dos genitores, uso de anticoncepcionais e principalmente promover a utilização de exames subsidiários específicos que permitiram melhores condições diagnósticas e definição de mecanismos fisiopatológicos eventuais relacionados à colilitiase. Verificou-se a presença de cálculos de vesícula biliar em 27 pacientes ( 3,28%) comparando-se à incidência descrita na população como um todo (0,07%). Estes dados caracterizam a prevalência de cálculos de vesícula biliar em portadores de Síndrome de Down ( a distribuição das probabilidades da frequência de cálculo de vesícula biliar em Sindrome de Down está dentro do intervalo de 95%, entre 3,6% e 7,7%). As correlações realizadas vieram a excluir,na amostra estudada, algumas etiologias comumente descritas para colelitíase e provavelmente vincula o fenômeno da colelitíase a mecanismos fisioembriopatológicos ligados à hipotonia e estase do conteúdo da vesícula biliar( e/ou redução na velocidade do seu esvaziamento). Em consequência torna-se importante propor uma investigação rotineira para esta patologia, com ênfase nos mecanismos fisiopatológicos, prováveis responsáveis pela incidência aumentada na população com Síndrome de Down. / The purpose of this study has been the prospective analysis of the Down syndrome population received by the Genetic Department of \"Hospital Infantil Darcy Vargas\", in the period from 1959 to 1996. The Department has received 2816 Down Syndrome patients\' in this period, and this study has selected 518 patients, clinical and cytogenetically diagnosed, which were studied following the specific clinical protocol, in periodical evaluations. The incidence of cholelithiasis was verified and it has been analysed the possible relationships among this disease and parentaI age, contraceptive use and clinical features leading to the discussion of eventual aetiologic mechanisms causing gallstones. It was verified 27 patients affected by Down Syndrome and presenting cholelithiasis in the survey of 518 patients ( 3.28 %) compared to the frequency of 7/10000 in the non Down population ( 0.07% ). The statistical analysis has shown that the distribution of the frequency probabilities have been between 3.6% and 7.7%, These studies have verified that the aetiology of the gallstones in the Down syndrome patients could be related to the hypotonic characteristic of the patients, leading to cholestasis, It is very important the suggestion of routine evaluation for this pathology, related to the eventual aetiologic features.

Foi realizado o estudo prospectivo de uma amostra da população portadora de Síndrome de Down que procurou o Departamento de Genética do Hospital Infantil Darcy Vargas,no período de 1959 a 1996. Dos 2816 portadores de Síndrome de Down que compareceram a este Serviço, neste período , a amostra estudada consistiu de 518 pacientes que mantiveram períodos de retomo ambulatorial conforme previsto pelo Protocolo de segmento clínico adotado. O objetivo do estudo foi caracterizar a incidência de colecistopatia litiásica em pacientes portadores de Síndrome de Down . Para desenvolver este estudo, após o diagnóstico citogenético e clínico da Síndrome de Down, procurou-se correlacionar faixa etária dos genitores, uso de anticoncepcionais e principalmente promover a utilização de exames subsidiários específicos que permitiram melhores condições diagnósticas e definição de mecanismos fisiopatológicos eventuais relacionados à colilitiase. Verificou-se a presença de cálculos de vesícula biliar em 27 pacientes ( 3,28%) comparando-se à incidência descrita na população como um todo (0,07%). Estes dados caracterizam a prevalência de cálculos de vesícula biliar em portadores de Síndrome de Down ( a distribuição das probabilidades da frequência de cálculo de vesícula biliar em Sindrome de Down está dentro do intervalo de 95%, entre 3,6% e 7,7%). As correlações realizadas vieram a excluir,na amostra estudada, algumas etiologias comumente descritas para colelitíase e provavelmente vincula o fenômeno da colelitíase a mecanismos fisioembriopatológicos ligados à hipotonia e estase do conteúdo da vesícula biliar( e/ou redução na velocidade do seu esvaziamento). Em consequência torna-se importante propor uma investigação rotineira para esta patologia, com ênfase nos mecanismos fisiopatológicos, prováveis responsáveis pela incidência aumentada na população com Síndrome de Down. / The purpose of this study has been the prospective analysis of the Down syndrome population received by the Genetic Department of \"Hospital Infantil Darcy Vargas\", in the period from 1959 to 1996. The Department has received 2816 Down Syndrome patients\' in this period, and this study has selected 518 patients, clinical and cytogenetically diagnosed, which were studied following the specific clinical protocol, in periodical evaluations. The incidence of cholelithiasis was verified and it has been analysed the possible relationships among this disease and parentaI age, contraceptive use and clinical features leading to the discussion of eventual aetiologic mechanisms causing gallstones. It was verified 27 patients affected by Down Syndrome and presenting cholelithiasis in the survey of 518 patients ( 3.28 %) compared to the frequency of 7/10000 in the non Down population ( 0.07% ). The statistical analysis has shown that the distribution of the frequency probabilities have been between 3.6% and 7.7%, These studies have verified that the aetiology of the gallstones in the Down syndrome patients could be related to the hypotonic characteristic of the patients, leading to cholestasis, It is very important the suggestion of routine evaluation for this pathology, related to the eventual aetiologic features.

No description available.

Karzinome der Gallenwege sind mit einer schlechten Prognose assoziiert. Eine potentiell kurative chirurgische Resektion ist bei der Mehrzahl der Patienten aufgrund des späten Zeitpunkts der Diagnosestellung nicht möglich, so dass derzeit vorrangig palliative Therapieansätze Anwendung finden. Das nur geringe Ansprechen auf konventionelle Radio- oder Zytostatikatherapie begründet die Notwendigkeit neuer Therapieansätze. Einen möglichen Angriffspunkt stellt hierbei die Polo-like-Kinase 1 (Plk1) dar, da ihre zentrale Rolle in der Regulation des Zellzyklus zunehmend erkannt und eine vermehrte Expression in malignem Tumorgewebe verglichen mit gesundem Gewebe nachgewiesen wurde. Das Dihydropteridinon BI 2536 ist ein poten-ter, niedermolekularer und selektiver Hemmstoff der Plk1 und sollte daher auf seine Wirksamkeit an Gallenwegskarzinomen untersucht werden. In der vorliegenden Arbeit konnte gezeigt werden, dass BI 2536 die untersuchten 14 Zelllinien von Gallenblasen- und Gallengangskarzinomen wirkungsvoll hemmt. Das Ansprechen unterschied sich zwischen den Zelllinien und ordnet sich vergleichbar zu Veröffentlichungen an anderen malignen Tumoren ein. Die Expression von Plk1 und dessen assoziierten Transkriptionsfaktor FoxM1 konnte bei Westernblot-Versuchen bei allen Zelllinien nachgewiesen werden, was eine Bedeutung in der Onkogenese vermuten lässt. Die Behandlung mit BI 2536 beeinflusste jedoch die Proteinmenge beider nicht. An für die folgenden Versuche ausgewählten drei Zelllinien zeigten sich in der reversen Transkription mit anschließender Echtzeit-Polymerase-Kettenreaktion (qRT PCR) ähnliche Ergebnisse in Bezug auf die exprimierte mRNA von Plk1. Westernblot-Analysen ermittelten keine signifikanten Veränderungen der an wichtigen intrazellulären Kaskaden beteiligten Proteine p42/44 und Akt sowie deren phosphorylierten Formen. Obwohl die Proteinmenge des Mitosemarkers Phospho-Histon H3 ebenso unverändert blieb, führte die Behandlung mit BI 2536 – dies zeigen Ergebnisse der Durchflusszytometrie – zu einer signifikanten, dosisabhängigen Zunahme der G2/M Fraktion des Zellzyklus und Zunahme der Apoptose-rate. Der maximale Hemmeffekt in der Behandlung von BI 2536 lag bei einer Inkubations-dauer von vier Tagen. Die Empfehlungen aus den klinischen Studien der Phase II von BI 2536 sowie dem Ziel der Vermeidung von Resistenzen ergibt sich die Notwendigkeit von Kombinationsversuchen mit Zytostatika, die in einer anderen Phase des Zellzyklus angreifen. Die in der Behandlung von Gallenwegskarzinomen etablierten Antimetaboliten 5-Fluorouracil und Gemcitabin wurden hierzu ausgewählt und es zeigten sich für 5 Fluorouracil synergistische, für Gemcitabin hingegen additive Kombinationseffekte. Zusätzlich wurde die Wechselwirkung mit dem IGF 1-Rezeptor-Inhibitor NVP-AEW541 untersucht, der ebenfalls einen neuen Behand-lungsansatz in der Krebstherapie darstellt und bei Gallenwegskarzinomen in vitro wirksam ist. Auch hier zeigen sich synergistische Effekte, die jedoch erst in höheren Behandlungs-dosen auftraten. Die Ergebnisse dieser Arbeit zeigen, dass die Hemmung der Plk1 bei Gallenblasen- und Gallengangskarzinomen einen wirksamen Behandlungsansatz darstellt. Auf der Grundlage der in dieser Arbeit beschriebenen Ergebnisse wird eine weitere präklinische und klinische Testung von selektiven Plk1-Hemmstoffen wie BI 2536 an Gallenwegskarzinomen empfohlen.

Karzinome der Gallenwege sind mit einer schlechten Prognose assoziiert. Eine potentiell kurative chirurgische Resektion ist bei der Mehrzahl der Patienten aufgrund des späten Zeitpunkts der Diagnosestellung nicht möglich, so dass derzeit vorrangig palliative Therapieansätze Anwendung finden. Das nur geringe Ansprechen auf konventionelle Radio- oder Zytostatikatherapie begründet die Notwendigkeit neuer Therapieansätze. Einen möglichen Angriffspunkt stellt hierbei die Polo-like-Kinase 1 (Plk1) dar, da ihre zentrale Rolle in der Regulation des Zellzyklus zunehmend erkannt und eine vermehrte Expression in malignem Tumorgewebe verglichen mit gesundem Gewebe nachgewiesen wurde. Das Dihydropteridinon BI 2536 ist ein poten-ter, niedermolekularer und selektiver Hemmstoff der Plk1 und sollte daher auf seine Wirksamkeit an Gallenwegskarzinomen untersucht werden. In der vorliegenden Arbeit konnte gezeigt werden, dass BI 2536 die untersuchten 14 Zelllinien von Gallenblasen- und Gallengangskarzinomen wirkungsvoll hemmt. Das Ansprechen unterschied sich zwischen den Zelllinien und ordnet sich vergleichbar zu Veröffentlichungen an anderen malignen Tumoren ein. Die Expression von Plk1 und dessen assoziierten Transkriptionsfaktor FoxM1 konnte bei Westernblot-Versuchen bei allen Zelllinien nachgewiesen werden, was eine Bedeutung in der Onkogenese vermuten lässt. Die Behandlung mit BI 2536 beeinflusste jedoch die Proteinmenge beider nicht. An für die folgenden Versuche ausgewählten drei Zelllinien zeigten sich in der reversen Transkription mit anschließender Echtzeit-Polymerase-Kettenreaktion (qRT PCR) ähnliche Ergebnisse in Bezug auf die exprimierte mRNA von Plk1. Westernblot-Analysen ermittelten keine signifikanten Veränderungen der an wichtigen intrazellulären Kaskaden beteiligten Proteine p42/44 und Akt sowie deren phosphorylierten Formen. Obwohl die Proteinmenge des Mitosemarkers Phospho-Histon H3 ebenso unverändert blieb, führte die Behandlung mit BI 2536 – dies zeigen Ergebnisse der Durchflusszytometrie – zu einer signifikanten, dosisabhängigen Zunahme der G2/M Fraktion des Zellzyklus und Zunahme der Apoptose-rate. Der maximale Hemmeffekt in der Behandlung von BI 2536 lag bei einer Inkubations-dauer von vier Tagen. Die Empfehlungen aus den klinischen Studien der Phase II von BI 2536 sowie dem Ziel der Vermeidung von Resistenzen ergibt sich die Notwendigkeit von Kombinationsversuchen mit Zytostatika, die in einer anderen Phase des Zellzyklus angreifen. Die in der Behandlung von Gallenwegskarzinomen etablierten Antimetaboliten 5-Fluorouracil und Gemcitabin wurden hierzu ausgewählt und es zeigten sich für 5 Fluorouracil synergistische, für Gemcitabin hingegen additive Kombinationseffekte. Zusätzlich wurde die Wechselwirkung mit dem IGF 1-Rezeptor-Inhibitor NVP-AEW541 untersucht, der ebenfalls einen neuen Behand-lungsansatz in der Krebstherapie darstellt und bei Gallenwegskarzinomen in vitro wirksam ist. Auch hier zeigen sich synergistische Effekte, die jedoch erst in höheren Behandlungs-dosen auftraten. Die Ergebnisse dieser Arbeit zeigen, dass die Hemmung der Plk1 bei Gallenblasen- und Gallengangskarzinomen einen wirksamen Behandlungsansatz darstellt. Auf der Grundlage der in dieser Arbeit beschriebenen Ergebnisse wird eine weitere präklinische und klinische Testung von selektiven Plk1-Hemmstoffen wie BI 2536 an Gallenwegskarzinomen empfohlen.:Vorbemerkung 1 Inhaltsverzeichnis 2 Abkürzungsverzeichnis 3 Bibliographische Beschreibung 4 1 Einleitung 5 1.1 Gallenwegskarzinome 5 1.1.1 Epidemiologie, Einteilung und Histologie 5 1.1.2 Klinische Symptomatik und Diagnostik 6 1.1.3 Therapie und Prognose 7 1.2 Polo like-Kinase 1 9 1.2.1 Entdeckung und Aufbau der Polo like-Kinasen 9 1.2.2 Funktionen 9 1.2.3 Regulation 11 1.2.4 Bedeutung in der Onkologie 12 1.2.5 Hemmung 12 1.3 BI 2536 14 1.4 Zielstellung der Arbeit 15 2 Publikation 17 3 Zusammenfassung 29 4 Summary 31 5 Literaturverzeichnis 32 6 Erklärung über die eigenständige Abfassung der Arbeit 45 7 Lebenslauf 46 8 Publikationen im Rahmen dieser Arbeit 48 9 Danksagung 49