Aujourd’hui, face à l’épidémie d’obésité, de plus en plus de personnes ont recours à la chirurgie bariatrique, qui permet une perte de poids importante et une amélioration des conditions métaboliques associées à l’obésité. L’adaptation gastro-intestinale après la chirurgie et ses conséquences métaboliques sont cependant peu connues. Nous avons développé des modèles murins de bypass gastriques et de gastrectomie longitudinale (sleeve) et nous avons caractérisé l’adaptation morphologique et fonctionnelle de l’épithélium gastro-intestinal après ces chirurgies afin de comprendre l’origine des améliorations métaboliques. Nous avons montré que l’estomac était remodelé après les deux chirurgies, suggérant une augmentation de la production acide par les cellules pariétales et une altération de la production de gastrine et de ghréline. Après le bypass, l’anse alimentaire était hyperplasique et la consommation intestinale de glucose était augmentée chez le rat et l’homme; après la sleeve, l’absorption de glucose lors du repas était diminuée. De plus, l’augmentation du nombre de cellules entéroendocrines observée après le bypass, et l’augmentation de leur densité après la sleeve pourraient participer à l’hypersécrétion des hormones incrétines. L’ensemble de ces mécanismes pourrait contribuer à améliorer le contrôle de la glycémie. Enfin, le mini-bypass chez le rat a induit une malabsorption protéique et des fuites énergétiques majeures qui n’étaient pas compensées par l’hyperplasie intestinale ou l’augmentation de l’expression des transporteurs de peptides. Cette thèse montre l’importance du tractus gastro-intestinal dans les conséquences métaboliques de la chirurgie bariatrique / In today’s global epidemic of obesity, more and more people are undergoing bariatric surgery, which is the best known treatment available to lose weight and treat obesity-associated diseases. Yet, little is known about gastrointestinal (GI) adaptation and its metabolic consequences after surgery. We developed original models of Roux-en-Y gastric bypass (RYGB), mini-bypass (MGB) and vertical sleeve gastrectomy (VSG) in rats, and we characterized the morphological and functional adaptations of the GI epithelium after these surgeries in order to understand the origin of the observed metabolic improvements. We reported profound changes in the remaining gastric mucosa of rats having undergone RYGB and VSG, suggesting an increase in acid production by parietal cells and an impaired production of gastrin and ghrelin. In RYGB rats and patients, the alimentary limb was hyperplasic and intestinal glucose consumption was increased. After VSG, the absorption of glucose during meals appeared diminished. These adaptations could participate in the lowering of blood glucose after surgery. In addition, the increased number of enteroendocrine cells observed in RYGB rats and patients, and their increased density in VSG rats, could contribute to the higher secretion of incretin hormone and improved glycemic control in operated individuals. Finally, we demonstrated in rats that the MGB was more malabsorptive than the RYGB. Indeed, we observed an increased fecal loss of nitrogen and energy despite intestinal overgrowth and higher expression of peptide transporters. This thesis brings new insight to the role of the GI tract in the metabolic outcomes of bariatric surgeries

Au cours des dernières décennies, les antimicrobiens naturels d'origine bactérienne, telles que les bactériocines et la reutérine, ont reçu une attention considérable entant que conservateurs alimentaires ou comme alternatives aux antibiotiques pour les secteurs humain et animal. L'approbation des bactériocines et de la reutérine entant que bio-conservateurs ou assainisseurs par les organismes réglementaires repose non seulement sur les preuves d'efficacité mais également sur des données crédibles de cytotoxicité et de comportement dans l'environnement gastro-intestinal. Bien que les activités antimicrobiennes des bactériocines et de la reutérine soient largement documentées dans la littérature, très peu de données sont disponibles sur leur biodisponibilité dans les matrices biologiques et sur leur toxicité pour les différentes applications. Par conséquent, l'objectif général de cette thèse est d'évaluer, à travers différents modèles in vitro, la stabilité gastro-intestinale, l'activité biologique et la toxicité des bactériocines et de la reutérine en vue de leur utilisation dans différentes applications alimentaire, médicale et vétérinaire. Le premier objectif spécifique était de produire, purifier et évaluer l'activité antimicrobienne des bactériocines et de la reutérine seules et en combinaison contre un large panel de organismes pathogènes et d'altération d'intérêt pour les différents secteurs. Cinq consortia synergiques différents ont été identifiés, dont trois -microcine J25 + l'acide citrique + l'acide lactique, microcine J25 + reutérine + acide citrique, et microcine J25 + reutérine + acide lactique- ont montré une activité significative contre Salmonella enterica subsp. enterica serovar Newport ATCC6962 (indice FIC = 0,5). Deux autres combinaisons- pédiocine PA-1 + acide citrique+ acide lactique, et reutérine + acide citrique + acide lactique- ont montré des effets partiellement synergiques contre Listeria ivanovii HPB28 (indice FIC = 0,75). Le deuxième objectif spécifique était d'évaluer la stabilité gastro-intestinale de la reutérine à l'aide d'un modèl simulant des conditions digestives chez l'humain ainsi que l'activité hémolytique et la cytotoxicité in vitro de la reutérine par dosage au rouge neutre et dosage colorimétrique à la lactate déshydrogénase (LDH) en utilisant la lignée cellulaire Caco-2. La reutérine s'est révélée biologiquement très stable los du transit gastro-intestinal. L'exposition des cellules Caco-2 à différentes concentrations de réutérine n'a montré aucun effet négatif sur la viabilité ni sur l'intégrité des cellules à des concentrations allant jusqu'à 1080 mM. De plus, aucune hémolyse n'a été observée sur les cellules sanguines exposées à des concentrations allant jusqu'à 270 mM de reutérine. En conséquence, cette étude nous a permis de démontrer que la réutérine peut être utilisée de façon très sécuritaire à des concentrations n'excédant pas 270 mM, dans différentes applications. Le troisième objectif était d'évaluer la stabilité gastro-intestinale et l'activité de la microcine J25, de la pédiocine PA-1, de la bactofencine A et de la nisine à l'aide de modèles in vitro. De plus, la cytotoxicité et l'activité hémolytique de ces bactériocine sont été étudiées sur des cellules Caco-2 et des érythrocytes de rat, respectivement. Nos résultats ont montré que la pédiocine PA-1, la bactofencine A et la nisine sont dégradées à différents niveaux lors du transit gastro-intestinal, tandis que la microcine J25 n'est que partiellement dégradée. D'autre part, les études réalisées sur les cellules Caco-2 n'ont montré aucun effet cytotoxique jusqu'à des concentrations de 400 µg/mL. L'étude sur les érythrocytes de rat a montré un effet, hémolytique significatif lorsque la pédiocine PA-1, la bactofencine A et la nisine sont utilisées à des concentrations supérieures à 50 µg/mL, tandis que la microcine J25 n'a montré aucun effet hémolytique Dans le quatrième objectif, la toxicité cutanée de la reutérine, de la microcine J25, de la pédiocine PA-1, de la bactofencine A et de la nisine Z a été étudiée in vitro en utilisant des tests de libération de rouge neutre et de LDH sur des cellules NHEK. Les potentiels de sensibilisation et d'irritation cutanée de ces mêmes bactériocine sont également été déterminés en utilisant respectivement le test h-CLAT et le modèle épidermique humain EpiDerm™. Les essais réalisés sur les cellules NHEK ont montré que l'exposition de ces cellules aux bactériocines et à la reutérine à des concentrations allant à 400 µg/mL et 80 mg/mL respectivement, n'a entrainé aucun effet cytoxique. De plus, la microcine J25 et la reutérine n'ont montré aucune sensibilisation cutanée à des concentrations allant à 100 µg/mL et 40 mg/mL, respectivement, tandis que la pédiocine PA-1, la bactofencine A et la nisine Z ontprovoqué une sensibilisation à des concentrations supérieures à 100 µg/mL. La viabilité des tissus n'a pas été affectée en présence de bactériocines et de reutérine à des concentrations allant jusqu'à 200 µg/mL et 40 mg/mL, respectivement. L'ensemble de ces résultats montre que certaines bactériocines et la reutérine pourraient être incorporées en toute sécurité comme ingrédient antimicrobien dans différentes préparations topiques destinées à des applications humaines et animales Finalement, le dernier chapitre de la thèse a été consacré au développement et à la caractérisation de différents hydrogels à activité antimicrobienne et ayant comme principe actif des bactériocines ou de la réutérine. La reutérine, la pédiocine PA-1 et la microcine J25 ont été incorporées dans des formules d'hydrogel développées à partir de biopolymères à base de chitosan (1,5% , 2,5%) ou de carboxymethle cellulose (CMC 3% , 5%). Les hydrogels développés ont été caractérisés en termes d'aspect général, de viscosité, d'activité antimicrobienne et de stabilité pendant lors de l'entreposage à température ambiante. Les résultats obtenus ont montré que le chitosane à 1,5 % et 2,5 % contenant de la microcine J25 ou de la pédiocine PA-1demontré une activité inhibitrice significative durant toute la période d'entreposage. L'effet inhibiteur de la microcine J25 et de la reutérine dans les hydrogels CMC 3% et 5% est resté inchangé tandis que la pédiocine ajouté aux hydrogels de CMC 3% et 5% a perdu son activité dès la première semaine. En termes de viscosité, l'ajout d'antimicrobiens aux hydrogels n'a pas affecté leur viscosité et toutes les formules sont restées stables pendant les quatre semaines d'entreposage. Les résultats obtenus montrent que les formules développées présentent un fort potentiel d'application dans les secteurs alimentaire, médical et vétérinaire. En conclusion, le travail décrit dans cette thèse a permis de générer des résultats uniques sur le comportement, l'activité biologique, la stabilité et la toxicité de plusieurs composés antimicrobiens d'origine bactérienne incluant différentes bactériocines et la reutérine. Différents modèles in vitro récents et protocoles expérimentaux ont alors été utilisés et adoptés pour notre étude. Les résultats obtenus sont très pertinents et sont indispensable dans les démarches d'homologation de ces composés naturels par les différents organismes règlementaires pour différentes applications que ce soit pour le secteur alimentaire, médicale et/ou vétérinaire. En conclusion, le travail décrit dans cette these a permis de générer des résultats uniques sur le comportement, l'activité biologique, la stabilité et la toxicité de plusieurs composés antimicrobiens d'origine bactérienne incluant différentes bactériocines et la reutérine. Différents modèles in vitro récents et protocoles expérimentaux ont alors été utilisés et adoptés pour notre étude. Les résultats obtenus sont très pertinents et sont indispensable dans les démarches d'homologation de ces composés naturels par les différents organismes règlementaires pour différentes applications que ce soit pour le secteur alimentaire, médicale et/ou vétérinaire. / In recent decades, natural antimicrobials produced by bacteria, such as bacteriocins and reuterin, have received considerable attention as food preservatives or as alternatives to antibiotics for the human and animal sectors. Approval of bacteriocins and reuterin as bio-preservatives or sanitizers by regulatory agencies is based not only on evidence of efficacy but also on sufficient data on cytotoxicity and behavior in the gastrointestinal conditions. Although the antimicrobial activities of bacteriocins and reuterin have been widely studied, very little data is available on their behavior in biological matrices and their toxicity for different applications. Therefore, the general objective of this thesis was to evaluate the gastrointestinal stability, the biological activity, and the toxicity of bacteriocins and reuterin using different in vitro models for their intended use in food, medical, and veterinary applications. The first specific objective was to produce, purify and evaluate the antimicrobial activity of bacteriocins and reuterin alone and in combination against a wide range of pathogenic and spoilage organisms of interest to different sectors. Five different synergistic consortia were identified, of which three of them (microcin J25 + citric acid + lactic acid, microcin J25 + reuterin + citric acid, and microcine J25 + reuterin + lactic acid) showed significant activity against Salmonella enterica subsp. enterica serovar Newport ATCC 6962 (FIC index = 0.5). Two other combinations (pediocin PA-1 + citric acid + lactic acid, and reuterin + citric acid + lactic acid) showed partially synergistic effect against Listeria ivanovii HPB28 (FIC index = 0.75). The second specific objective was to evaluate the gastrointestinal stability of reuterin using an in vitro simulated digestion conditions in humans. Furthermore, the hemolytic activity, and in vitro cytotoxicity of reuterin using neutral red assay and lactate dehydrogenase (LDH) release assays were determined on assay on the Caco-2 cell line. Reuterin was observed to be very stable biologically during gastrointestinal transit. Moreover, exposure of Caco-2 cells to different concentrations of reuterin showed no negative effect on cell viability or membrane integrity at concentrations up to 1080 mM. In addition, no hemolysis was observed on erythrocytes exposed to concentrations up to 270 mM of reuterin. As a result, this study demonstrated that reuterin can be safely used at concentrations up to 270 mM, in various applications. The third objective was to assess the gastrointestinal stability and activity of microcin J25, pediocin PA-1, bactofencin A and nisin using in vitro models. In addition, the cytotoxicity and hemolytic activity of these bacteriocins were studied on Caco-2 cells and rat erythrocytes, respectively. According to the results, pediocin PA-1, bactofencin A and nisin were degraded at different levels during gastrointestinal transit, while microcin J25 was only partially degraded. Moreover, bacteriocins did not show cytotoxic effects on Caco-2 cells at concentrations up to 400 µg/mL. Finally, pediocin PA-1, bactofencin A, and nisin at concentrations higher than 50 µg/mL showed hemolytic potential, while microcin J25 did not cause hemolysis. In the fourth objective, the dermal toxicity of reuterin, microcin J25, pediocin PA-1, bactofencin A and nisin Z was studied in vitro using neutral red and LDH release assays on NHEK cells. The skin sensitization and irritation potentials of these bacteriocins and reuterin were also determined using the h-CLAT test and the human epidermal model EpiDerm ™, respectively. The results demonstrated that exposure of NHEK cells to these bacteriocins and reuterin at concentrations up to 400 µg/mL and 80 mg/mL, respectively, did not induce any cytotoxic effect. Inaddition, microcin J25 and reuterin showed no skin sensitization at concentrations up to 100 µg/mL and 40 mg/mL, respectively, while pediocin PA-1, bactofencin A and nisin Z caused sensitization at concentrations higher than 100 µg/mL. Tissue viability was not affected in the presence of bacteriocins and reuterin at concentrations up to 200 µg/mL and 40 mg/mL, respectively. Taken together, these results showed that certain bacteriocins and reuterin could be safely incorporated as an antimicrobial ingredient in various topical preparations intended for human and animal applications. Finally, the last chapter of the thesis was devoted to the development and characterization of different antimicrobial hydrogels based on bacteriocins or reuterin. Reuterin, pediocin PA-1, microcin J25 were incorporated into hydrogel formulations developed from biopolymers; chitosan (1.5%, 2.5%) or carboxymethyl cellulose (CMC, 3, 5%). The developed hydrogels were characterized in terms of general appearance, viscosity, antimicrobial activity, and stability during storage at room temperature. The results showed that the 1.5% and 2.5% chitosan containing microcin J25 or pediocin PA-1 have significant inhibitory activity throughout the storage period. The inhibitory effect of microcin J25 and reuterin in the 3% and 5% CMC hydrogels remained unchanged while the pediocin PA-1 added to the 3% and 5% CMC hydrogels totally lost its activity after one week. In terms of viscosity, the addition of antimicrobials to the hydrogels did not affect their viscosity and all formulations remained stable during the four weeks of storage. The results suggested that the formulas developed have great potential for application as sanitizer in the food, medical and veterinary sectors. In conclusion, this thesis has generated unique results on the gastrointestinal behavior, biological activity, stability, and toxicity of several bacterial drived antimicrobials including different bacteriocins and reuterin. Different in vitro models were adopted for this study. The results obtained are very relevant and are essential for the approval process of these natural compounds by the various regulatory agencies for different applications in food, medical or veterinary sector.

No / The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time. Design: OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy ( JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for <20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable. Results: Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, >90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion. Conclusions: There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate

Micropartículas contendo pantoprazol foram preparadas e caracterizadas a fim de se obter sistemas multiparticulados gastro-resistentes. O trabalho foi delineado buscando-se a melhor técnica de preparação das micropartículas, assim como o estudo do processo, aumento de escala e avaliação biológica. A metodologia analítica para quantificação do pantoprazol nas micropartículas foi desenvolvida e validada. O método mostrou-se seletivo, linear, preciso e exato. A estabilidade do pantoprazol em tampão fosfato pH 7,4 foi avaliada para verificar a viabilidade da utilização deste tampão como meio de dissolução. O pantoprazol apresentou-se estável durante 6 h e considerado adequado para estudos de dissolução. A primeira técnica utilizada na preparação de micropartículas foi a evaporação de solvente, utilizando uma emulsão O/O. O polímero utilizado foi Eudragit® S100. As micropartículas apresentaram diâmetro de 56 μm e, segundo análises de DSC e IV, o fármaco apresentou-se molecularmente disperso no polímero. As micropartículas apresentaram atividade anti-ulcerogênica em modelo de ulceração gástrica em ratos por etanol, enquanto a solução aquosa de pantoprazol não apresentou atividade. Estas micropartículas foram comprimidas e permaneceram intactas no interior dos comprimidos. Quanto à proteção do pantoprazol em meio ácido, 61 % da quantidade inicial do fármaco permaneceram estáveis após 30 min em meio ácido. Uma segunda formulação utilizando a mesma técnica foi preparada coma a adição de poli(ε-caprolactona) à formulação de Eudragit® S100. O objetivo da inclusão do segundo polímero foi a obtenção de uma blenda capaz de promover liberação controlada do pantoprazol e ao mesmo tempo conferir gastro-resistência. Esta formulação também apresentou atividade anti-ulcerogênica in vivo. Os comprimidos contendo estas micropartículas apresentaram liberação controlada e gastroresistência. A segunda técnica avaliada no desenvolvimento de micropartículas contendo pantoprazol foi a secagem por aspersão. Micropartículas contendo Eudragit® S100 foram produzidas e apresentaram bom rendimento, eficiência de encapsulação e estabilização do pantoprazol em meio ácido. As micropartículas foram avaliadas quanto a permeação intestinal utilizando modelo de intestino invertido. A permeação intestinal foi diretamente proporcional à liberação em tampão fosfato pH 7,4, estabelecendo uma correlação de nível A. Devido a esses fatores, estas micropartículas foram selecionadas para preparação em escala piloto. Diferentes condições operacionais foram testadas e o diâmetro médio das partículas xxiv variou entre 6.7 e 24.5 μm, influenciado pela concentração inicial de sólidos. As condições operacionais que produziram micropartículas com maior gastroresistência foram selecionadas para estudo de estabilidade. As micropartículas apresentaram-se estáveis por 6 meses em condições aceleradas de armazenamento e não adsorveram umidade ao longo do tempo. A avaliação in vivo demonstrou a atividade anti-ulcerogênica desta formulação. No entanto, a formulação apresentou baixa densidade e fluxo pobre, dificultando a granulação e compressão. A forma farmacêutica desenvolvida foram aglomerados ou soft pellets, contendo micropartículas de pantoprazol e um excipiente de manitol e lecitina preparado por spray-drying. Os aglomerados apresentaram adequadas características de fluxo e rápida desintegração não afetando a gastro-resistência das micropartículas. A técnica de spray-drying também foi utilizada com uma blenda de Eudragit® S100 e HPMC, também visando uma liberação controlada do pantoprazol. As micropartículas apresentaram alta eficiência de encapsulação e também reduziram a formação de úlceras gástricas por etanol em ratos. Os comprimidos contendo micropartículas preparadas com a blenda apresentaram mais de 90 % de estabilização em meio ácido. Este processo também foi escalonado e as melhores condições operacionais determinadas. O processo foi reprodutível em relação ao diâmetro, densidade, eficiência de encapsulação e gastro-resistência. Esta formulação foi estável por 6 meses a 40 °C e 75 % de umidade. As quatro formulações descritas neste trabalho foram testadas quanto à estabilização do pantoprazol frente à luz UVC. O pantoprazol demonstrou ser fotoinstável tanto em solução metanólica como sólido e apenas as micropartículas preparadas com Eudragit® S100 aumentaram a fotoestabilidade do pantoprazol. Baseado no conjunto de resultados, os aglomerados contendo micropartículas de Eudragit® S100 foram selecionadas para serem testadas quanto a sua farmacocinética, em comparação com o comprimido comercial de referência. Os aglomerados demonstraram ser mais rapidamente absorvidos, reduzindo o Tmax de 90 para 43 min, mantendo mesma biodisponibilidade oral. Desta forma, podemos concluir que o pantoprazol foi microencapsulado com sucesso e as micropartículas aumentaram a estabilidade do fármaco em meio ácido e frente à luz, além de reduzir o tempo para atingir a concentração máxima do mesmo. / The aim of the thesis is to develop, characterize and evaluate two drug delivery systems containing gastro-resistant pantoprazole microparticles, one for the prompt dissolution and the other one for controlled release of pantoprazole. First, an analytical method was developed and validated for the quantification of sodium pantoprazole by HPLC. The stability of pantoprazole in phosphate buffer at pH 7.4 was also evaluated during 22 days. The results showed that the method was specific, linear, precise and exact. Pantoprazole was stable in phosphate buffer pH 7.4 for 6 h. Then, the solvent evaporation technique was applied in the preparation of gastroresistant pantoprazole-loaded microparticles using an O/O emulsion. Furthermore, tablets containing the microparticles were also investigated. Microparticles presented spherical and smooth morphologies and they remained intact in the inner surface of tablets. DSC and IR analyses showed that pantoprazole was physically and molecularly dispersed in the polymer. In vivo anti-ulcer evaluation showed that the microparticles were able to protect the rat stomachs against ulcer formation by ethanol, while the drug aqueous solution did not present activity. Concerning the acid protection, tablets showed a satisfactory drug protection in acid medium (61 % after 30 min). As a second formulation, microparticles of poly(ε-caprolactone) blended with Eudragit® S100 were prepared in order to provide controlled release and gastroresistance. This formulation showed in vivo protection of stomachs against ulceration caused by ethanol in rats. These microparticles were tableted and the tablets demonstrated slower drug release and higher acid protection than the microparticles before tableting. The spray drying technique was also used to prepare pantoprazoleloaded microparticles. Microparticles containing pantoprazole and Eudragit S100® presented high encapsulation efficiency and good stabilization in acid medium. Microparticles prevented ulceration by ethanol in vivo. These microparticles showed more adequate characteristics for the preparation of a drug delivery system than the one prepared by solvent evaporation. The physical characteristics of pantoprazole microparticles produced in different spray dryers and operational conditions were investigated. In all conditions tested it was possible to obtain powders that presented spherical shape microparticles, with mean sizes from 6.7 to 24.5 μm. The size was xxvi mainly affected by the initial feed concentration (2.2 or 6.6% w/w). All powders presented very poor flow. Under accelerated conditions of storage, the selected microparticles were stable for 6 months. The microparticles couldn’t be tableted and then, the microparticles were agglomerated with mannitol/lecithin powder. The agglomerates presented good technological properties and did not influence the drug release and the gastro-resistance of the pantoprazole microencapsulated. The spray drying technique was also used to prepare microparticles aiming to provide gastroresistance and to control the drug release, using a blend of Eudragit S100® and HPMC. DSC analyses showed that the drug is molecularly dispersed in the microparticles, and in vivo anti-ulcer evaluation demonstrated that microparticles were effective in protecting stomach against ulceration. In vitro gastro-resistance study showed that the microparticles stabilized pantoprazole in 62.0 % and tablets containing the microparticles in 97.5 % and provided a controlled release of the drug. This formulation was also studied in different scales of production and spray-drier designs. The microparticles were produced in different spray-driers and operational conditions at laboratory and pilot scales. The microparticles produced with two fluid nozzle atomizer and 196 kPa were prepared in three consecutive days for the process validation. The powders showed reproducible diameter, low polydispersity, similar bulk densities, encapsulation efficiency and gastro-resistance. These microparticles were evaluated for their accelerate stability. The microparticles presented less than 5 % of degradation after 180 days at 40 °C and 75 % of RH. These same microparticles were agglomerated using mannitol/lechitin spray-dried as excipient. Different amounts of lecithin and mannitol were used, but only one formulation did not alter the pantoprazole release from the microparticles, as well as the gastro-resistance. The four different formulations of microparticles characterized in this study were tested for the stabilization of pantoprazol under UVC light. Only the microparticles prepared with Eudragit® S100 improved the drug photostability. Based on the results, the agglomerates containing microparticles prepared by spray-drying with Eudragit® S100 were selected for the pharmacokinetics study in dogs. The agglomerates presented similar AUC than the reference tablet, but reduced the Tmax. In conclusion, pantopazole-loaded microparticles were successfully prepared and the stability of pantoprazol in acid medium and under light was improved. Furthermore, the time to peak plasma was reduced.

Micropartículas contendo pantoprazol foram preparadas e caracterizadas a fim de se obter sistemas multiparticulados gastro-resistentes. O trabalho foi delineado buscando-se a melhor técnica de preparação das micropartículas, assim como o estudo do processo, aumento de escala e avaliação biológica. A metodologia analítica para quantificação do pantoprazol nas micropartículas foi desenvolvida e validada. O método mostrou-se seletivo, linear, preciso e exato. A estabilidade do pantoprazol em tampão fosfato pH 7,4 foi avaliada para verificar a viabilidade da utilização deste tampão como meio de dissolução. O pantoprazol apresentou-se estável durante 6 h e considerado adequado para estudos de dissolução. A primeira técnica utilizada na preparação de micropartículas foi a evaporação de solvente, utilizando uma emulsão O/O. O polímero utilizado foi Eudragit® S100. As micropartículas apresentaram diâmetro de 56 μm e, segundo análises de DSC e IV, o fármaco apresentou-se molecularmente disperso no polímero. As micropartículas apresentaram atividade anti-ulcerogênica em modelo de ulceração gástrica em ratos por etanol, enquanto a solução aquosa de pantoprazol não apresentou atividade. Estas micropartículas foram comprimidas e permaneceram intactas no interior dos comprimidos. Quanto à proteção do pantoprazol em meio ácido, 61 % da quantidade inicial do fármaco permaneceram estáveis após 30 min em meio ácido. Uma segunda formulação utilizando a mesma técnica foi preparada coma a adição de poli(ε-caprolactona) à formulação de Eudragit® S100. O objetivo da inclusão do segundo polímero foi a obtenção de uma blenda capaz de promover liberação controlada do pantoprazol e ao mesmo tempo conferir gastro-resistência. Esta formulação também apresentou atividade anti-ulcerogênica in vivo. Os comprimidos contendo estas micropartículas apresentaram liberação controlada e gastroresistência. A segunda técnica avaliada no desenvolvimento de micropartículas contendo pantoprazol foi a secagem por aspersão. Micropartículas contendo Eudragit® S100 foram produzidas e apresentaram bom rendimento, eficiência de encapsulação e estabilização do pantoprazol em meio ácido. As micropartículas foram avaliadas quanto a permeação intestinal utilizando modelo de intestino invertido. A permeação intestinal foi diretamente proporcional à liberação em tampão fosfato pH 7,4, estabelecendo uma correlação de nível A. Devido a esses fatores, estas micropartículas foram selecionadas para preparação em escala piloto. Diferentes condições operacionais foram testadas e o diâmetro médio das partículas xxiv variou entre 6.7 e 24.5 μm, influenciado pela concentração inicial de sólidos. As condições operacionais que produziram micropartículas com maior gastroresistência foram selecionadas para estudo de estabilidade. As micropartículas apresentaram-se estáveis por 6 meses em condições aceleradas de armazenamento e não adsorveram umidade ao longo do tempo. A avaliação in vivo demonstrou a atividade anti-ulcerogênica desta formulação. No entanto, a formulação apresentou baixa densidade e fluxo pobre, dificultando a granulação e compressão. A forma farmacêutica desenvolvida foram aglomerados ou soft pellets, contendo micropartículas de pantoprazol e um excipiente de manitol e lecitina preparado por spray-drying. Os aglomerados apresentaram adequadas características de fluxo e rápida desintegração não afetando a gastro-resistência das micropartículas. A técnica de spray-drying também foi utilizada com uma blenda de Eudragit® S100 e HPMC, também visando uma liberação controlada do pantoprazol. As micropartículas apresentaram alta eficiência de encapsulação e também reduziram a formação de úlceras gástricas por etanol em ratos. Os comprimidos contendo micropartículas preparadas com a blenda apresentaram mais de 90 % de estabilização em meio ácido. Este processo também foi escalonado e as melhores condições operacionais determinadas. O processo foi reprodutível em relação ao diâmetro, densidade, eficiência de encapsulação e gastro-resistência. Esta formulação foi estável por 6 meses a 40 °C e 75 % de umidade. As quatro formulações descritas neste trabalho foram testadas quanto à estabilização do pantoprazol frente à luz UVC. O pantoprazol demonstrou ser fotoinstável tanto em solução metanólica como sólido e apenas as micropartículas preparadas com Eudragit® S100 aumentaram a fotoestabilidade do pantoprazol. Baseado no conjunto de resultados, os aglomerados contendo micropartículas de Eudragit® S100 foram selecionadas para serem testadas quanto a sua farmacocinética, em comparação com o comprimido comercial de referência. Os aglomerados demonstraram ser mais rapidamente absorvidos, reduzindo o Tmax de 90 para 43 min, mantendo mesma biodisponibilidade oral. Desta forma, podemos concluir que o pantoprazol foi microencapsulado com sucesso e as micropartículas aumentaram a estabilidade do fármaco em meio ácido e frente à luz, além de reduzir o tempo para atingir a concentração máxima do mesmo. / The aim of the thesis is to develop, characterize and evaluate two drug delivery systems containing gastro-resistant pantoprazole microparticles, one for the prompt dissolution and the other one for controlled release of pantoprazole. First, an analytical method was developed and validated for the quantification of sodium pantoprazole by HPLC. The stability of pantoprazole in phosphate buffer at pH 7.4 was also evaluated during 22 days. The results showed that the method was specific, linear, precise and exact. Pantoprazole was stable in phosphate buffer pH 7.4 for 6 h. Then, the solvent evaporation technique was applied in the preparation of gastroresistant pantoprazole-loaded microparticles using an O/O emulsion. Furthermore, tablets containing the microparticles were also investigated. Microparticles presented spherical and smooth morphologies and they remained intact in the inner surface of tablets. DSC and IR analyses showed that pantoprazole was physically and molecularly dispersed in the polymer. In vivo anti-ulcer evaluation showed that the microparticles were able to protect the rat stomachs against ulcer formation by ethanol, while the drug aqueous solution did not present activity. Concerning the acid protection, tablets showed a satisfactory drug protection in acid medium (61 % after 30 min). As a second formulation, microparticles of poly(ε-caprolactone) blended with Eudragit® S100 were prepared in order to provide controlled release and gastroresistance. This formulation showed in vivo protection of stomachs against ulceration caused by ethanol in rats. These microparticles were tableted and the tablets demonstrated slower drug release and higher acid protection than the microparticles before tableting. The spray drying technique was also used to prepare pantoprazoleloaded microparticles. Microparticles containing pantoprazole and Eudragit S100® presented high encapsulation efficiency and good stabilization in acid medium. Microparticles prevented ulceration by ethanol in vivo. These microparticles showed more adequate characteristics for the preparation of a drug delivery system than the one prepared by solvent evaporation. The physical characteristics of pantoprazole microparticles produced in different spray dryers and operational conditions were investigated. In all conditions tested it was possible to obtain powders that presented spherical shape microparticles, with mean sizes from 6.7 to 24.5 μm. The size was xxvi mainly affected by the initial feed concentration (2.2 or 6.6% w/w). All powders presented very poor flow. Under accelerated conditions of storage, the selected microparticles were stable for 6 months. The microparticles couldn’t be tableted and then, the microparticles were agglomerated with mannitol/lecithin powder. The agglomerates presented good technological properties and did not influence the drug release and the gastro-resistance of the pantoprazole microencapsulated. The spray drying technique was also used to prepare microparticles aiming to provide gastroresistance and to control the drug release, using a blend of Eudragit S100® and HPMC. DSC analyses showed that the drug is molecularly dispersed in the microparticles, and in vivo anti-ulcer evaluation demonstrated that microparticles were effective in protecting stomach against ulceration. In vitro gastro-resistance study showed that the microparticles stabilized pantoprazole in 62.0 % and tablets containing the microparticles in 97.5 % and provided a controlled release of the drug. This formulation was also studied in different scales of production and spray-drier designs. The microparticles were produced in different spray-driers and operational conditions at laboratory and pilot scales. The microparticles produced with two fluid nozzle atomizer and 196 kPa were prepared in three consecutive days for the process validation. The powders showed reproducible diameter, low polydispersity, similar bulk densities, encapsulation efficiency and gastro-resistance. These microparticles were evaluated for their accelerate stability. The microparticles presented less than 5 % of degradation after 180 days at 40 °C and 75 % of RH. These same microparticles were agglomerated using mannitol/lechitin spray-dried as excipient. Different amounts of lecithin and mannitol were used, but only one formulation did not alter the pantoprazole release from the microparticles, as well as the gastro-resistance. The four different formulations of microparticles characterized in this study were tested for the stabilization of pantoprazol under UVC light. Only the microparticles prepared with Eudragit® S100 improved the drug photostability. Based on the results, the agglomerates containing microparticles prepared by spray-drying with Eudragit® S100 were selected for the pharmacokinetics study in dogs. The agglomerates presented similar AUC than the reference tablet, but reduced the Tmax. In conclusion, pantopazole-loaded microparticles were successfully prepared and the stability of pantoprazol in acid medium and under light was improved. Furthermore, the time to peak plasma was reduced.

Micropartículas contendo pantoprazol foram preparadas e caracterizadas a fim de se obter sistemas multiparticulados gastro-resistentes. O trabalho foi delineado buscando-se a melhor técnica de preparação das micropartículas, assim como o estudo do processo, aumento de escala e avaliação biológica. A metodologia analítica para quantificação do pantoprazol nas micropartículas foi desenvolvida e validada. O método mostrou-se seletivo, linear, preciso e exato. A estabilidade do pantoprazol em tampão fosfato pH 7,4 foi avaliada para verificar a viabilidade da utilização deste tampão como meio de dissolução. O pantoprazol apresentou-se estável durante 6 h e considerado adequado para estudos de dissolução. A primeira técnica utilizada na preparação de micropartículas foi a evaporação de solvente, utilizando uma emulsão O/O. O polímero utilizado foi Eudragit® S100. As micropartículas apresentaram diâmetro de 56 μm e, segundo análises de DSC e IV, o fármaco apresentou-se molecularmente disperso no polímero. As micropartículas apresentaram atividade anti-ulcerogênica em modelo de ulceração gástrica em ratos por etanol, enquanto a solução aquosa de pantoprazol não apresentou atividade. Estas micropartículas foram comprimidas e permaneceram intactas no interior dos comprimidos. Quanto à proteção do pantoprazol em meio ácido, 61 % da quantidade inicial do fármaco permaneceram estáveis após 30 min em meio ácido. Uma segunda formulação utilizando a mesma técnica foi preparada coma a adição de poli(ε-caprolactona) à formulação de Eudragit® S100. O objetivo da inclusão do segundo polímero foi a obtenção de uma blenda capaz de promover liberação controlada do pantoprazol e ao mesmo tempo conferir gastro-resistência. Esta formulação também apresentou atividade anti-ulcerogênica in vivo. Os comprimidos contendo estas micropartículas apresentaram liberação controlada e gastroresistência. A segunda técnica avaliada no desenvolvimento de micropartículas contendo pantoprazol foi a secagem por aspersão. Micropartículas contendo Eudragit® S100 foram produzidas e apresentaram bom rendimento, eficiência de encapsulação e estabilização do pantoprazol em meio ácido. As micropartículas foram avaliadas quanto a permeação intestinal utilizando modelo de intestino invertido. A permeação intestinal foi diretamente proporcional à liberação em tampão fosfato pH 7,4, estabelecendo uma correlação de nível A. Devido a esses fatores, estas micropartículas foram selecionadas para preparação em escala piloto. Diferentes condições operacionais foram testadas e o diâmetro médio das partículas xxiv variou entre 6.7 e 24.5 μm, influenciado pela concentração inicial de sólidos. As condições operacionais que produziram micropartículas com maior gastroresistência foram selecionadas para estudo de estabilidade. As micropartículas apresentaram-se estáveis por 6 meses em condições aceleradas de armazenamento e não adsorveram umidade ao longo do tempo. A avaliação in vivo demonstrou a atividade anti-ulcerogênica desta formulação. No entanto, a formulação apresentou baixa densidade e fluxo pobre, dificultando a granulação e compressão. A forma farmacêutica desenvolvida foram aglomerados ou soft pellets, contendo micropartículas de pantoprazol e um excipiente de manitol e lecitina preparado por spray-drying. Os aglomerados apresentaram adequadas características de fluxo e rápida desintegração não afetando a gastro-resistência das micropartículas. A técnica de spray-drying também foi utilizada com uma blenda de Eudragit® S100 e HPMC, também visando uma liberação controlada do pantoprazol. As micropartículas apresentaram alta eficiência de encapsulação e também reduziram a formação de úlceras gástricas por etanol em ratos. Os comprimidos contendo micropartículas preparadas com a blenda apresentaram mais de 90 % de estabilização em meio ácido. Este processo também foi escalonado e as melhores condições operacionais determinadas. O processo foi reprodutível em relação ao diâmetro, densidade, eficiência de encapsulação e gastro-resistência. Esta formulação foi estável por 6 meses a 40 °C e 75 % de umidade. As quatro formulações descritas neste trabalho foram testadas quanto à estabilização do pantoprazol frente à luz UVC. O pantoprazol demonstrou ser fotoinstável tanto em solução metanólica como sólido e apenas as micropartículas preparadas com Eudragit® S100 aumentaram a fotoestabilidade do pantoprazol. Baseado no conjunto de resultados, os aglomerados contendo micropartículas de Eudragit® S100 foram selecionadas para serem testadas quanto a sua farmacocinética, em comparação com o comprimido comercial de referência. Os aglomerados demonstraram ser mais rapidamente absorvidos, reduzindo o Tmax de 90 para 43 min, mantendo mesma biodisponibilidade oral. Desta forma, podemos concluir que o pantoprazol foi microencapsulado com sucesso e as micropartículas aumentaram a estabilidade do fármaco em meio ácido e frente à luz, além de reduzir o tempo para atingir a concentração máxima do mesmo. / The aim of the thesis is to develop, characterize and evaluate two drug delivery systems containing gastro-resistant pantoprazole microparticles, one for the prompt dissolution and the other one for controlled release of pantoprazole. First, an analytical method was developed and validated for the quantification of sodium pantoprazole by HPLC. The stability of pantoprazole in phosphate buffer at pH 7.4 was also evaluated during 22 days. The results showed that the method was specific, linear, precise and exact. Pantoprazole was stable in phosphate buffer pH 7.4 for 6 h. Then, the solvent evaporation technique was applied in the preparation of gastroresistant pantoprazole-loaded microparticles using an O/O emulsion. Furthermore, tablets containing the microparticles were also investigated. Microparticles presented spherical and smooth morphologies and they remained intact in the inner surface of tablets. DSC and IR analyses showed that pantoprazole was physically and molecularly dispersed in the polymer. In vivo anti-ulcer evaluation showed that the microparticles were able to protect the rat stomachs against ulcer formation by ethanol, while the drug aqueous solution did not present activity. Concerning the acid protection, tablets showed a satisfactory drug protection in acid medium (61 % after 30 min). As a second formulation, microparticles of poly(ε-caprolactone) blended with Eudragit® S100 were prepared in order to provide controlled release and gastroresistance. This formulation showed in vivo protection of stomachs against ulceration caused by ethanol in rats. These microparticles were tableted and the tablets demonstrated slower drug release and higher acid protection than the microparticles before tableting. The spray drying technique was also used to prepare pantoprazoleloaded microparticles. Microparticles containing pantoprazole and Eudragit S100® presented high encapsulation efficiency and good stabilization in acid medium. Microparticles prevented ulceration by ethanol in vivo. These microparticles showed more adequate characteristics for the preparation of a drug delivery system than the one prepared by solvent evaporation. The physical characteristics of pantoprazole microparticles produced in different spray dryers and operational conditions were investigated. In all conditions tested it was possible to obtain powders that presented spherical shape microparticles, with mean sizes from 6.7 to 24.5 μm. The size was xxvi mainly affected by the initial feed concentration (2.2 or 6.6% w/w). All powders presented very poor flow. Under accelerated conditions of storage, the selected microparticles were stable for 6 months. The microparticles couldn’t be tableted and then, the microparticles were agglomerated with mannitol/lecithin powder. The agglomerates presented good technological properties and did not influence the drug release and the gastro-resistance of the pantoprazole microencapsulated. The spray drying technique was also used to prepare microparticles aiming to provide gastroresistance and to control the drug release, using a blend of Eudragit S100® and HPMC. DSC analyses showed that the drug is molecularly dispersed in the microparticles, and in vivo anti-ulcer evaluation demonstrated that microparticles were effective in protecting stomach against ulceration. In vitro gastro-resistance study showed that the microparticles stabilized pantoprazole in 62.0 % and tablets containing the microparticles in 97.5 % and provided a controlled release of the drug. This formulation was also studied in different scales of production and spray-drier designs. The microparticles were produced in different spray-driers and operational conditions at laboratory and pilot scales. The microparticles produced with two fluid nozzle atomizer and 196 kPa were prepared in three consecutive days for the process validation. The powders showed reproducible diameter, low polydispersity, similar bulk densities, encapsulation efficiency and gastro-resistance. These microparticles were evaluated for their accelerate stability. The microparticles presented less than 5 % of degradation after 180 days at 40 °C and 75 % of RH. These same microparticles were agglomerated using mannitol/lechitin spray-dried as excipient. Different amounts of lecithin and mannitol were used, but only one formulation did not alter the pantoprazole release from the microparticles, as well as the gastro-resistance. The four different formulations of microparticles characterized in this study were tested for the stabilization of pantoprazol under UVC light. Only the microparticles prepared with Eudragit® S100 improved the drug photostability. Based on the results, the agglomerates containing microparticles prepared by spray-drying with Eudragit® S100 were selected for the pharmacokinetics study in dogs. The agglomerates presented similar AUC than the reference tablet, but reduced the Tmax. In conclusion, pantopazole-loaded microparticles were successfully prepared and the stability of pantoprazol in acid medium and under light was improved. Furthermore, the time to peak plasma was reduced.

Les tumeurs gastro-intestinales stromales (Gastro-Intestinal Stromal Tumours - GIST en Anglais) sont les sarcomes les plus fréquents du tube digestif. Sur base de leur profil d'expression génique et de similitudes morphologiques, il a été établi que les GIST dérivent des cellules interstitielles de Cajal (Interstitial Cells of Cajal - ICC en Anglais) ou d'un précurseur commun. Le développement et le maintient des ICC sont dépendant de voies de signalisation du récepteur tyrosine kinase KIT. Des mutations oncogéniques de KIT, conduisant indépendamment du ligand à l'activation des voies de signalisation en aval, sont présentes dans environ 85% des GIST. Depuis une dizaine d'années, des molécules de synthèse qui inhibent la phosphorylation -et donc l'activation - de KIT ont été introduites avec succès dans le traitement clinique des GIST. Cependant des résistances, souvent causées par des mutations secondaires, apparaissent fréquemment et environ 50% des patients traités rechutent dans les 2 ans. Le développement de nouvelles stratégies diagnostiques et thérapeutiques pour les GIST demeure donc essentiel. Ces dernières années, de nouveaux marqueurs diagnostiques ou cibles thérapeutiques potentielles ont été rapportés dans la littérature (p.ex. Discovered on GIST-1 (DOG1, anoctamin 1), Protein kinase C theta (PKC theta), Carbonic anhydrase II (CAII)) .Il faut relever que tous ces gènes sont aussi exprimés par les ICC KIT+ du tube digestif normal et que leur présence dans les GIST reflète donc vraissemblablement essentiellement leur parenté avec les ICC.<p>Dans la présente étude, nous nous sommes attachés à identifier de nouveaux marqueurs diagnostiques ou cibles thérapeutiques potentielles exprimés par les GIST mais absent des ICC KIT+ normales.<p>Pour ce faire, nous avons comparé le profile d'expression géniques de l'antre gastrique de souris porteuses de la mutation oncogénique Kit K641E et de souris contrôles (wild type WT en Anglais) par la technique de cDNA microarray. Les différences d'expression génique ont été ensuite confirmées par réactions de PCR quantitative (qPCR) en temps réel et l'immunoréactivité (-ir) pour les candidats les plus prometteurs a été localisée par immunofluorescence (IF) dans la muscularis propria du tube digestif, avec une attention spéciale pour les cellules KIT+.<p>Plusieurs gènes identifiés appartenaient tant au profil d'expression génique des GIST qu'au profil d'expression des ICC Kit+ de l'intestin grêle murin, validant ainsi la pertinence du modèle murin KitK641E pour l'approche choisie (Chapitre 3). D'autre part, trois gènes identifiés (Neurotensin receptor 1 (Ntsr1), Trophoblast glycoprotein (Tpbg/5T) et Sprouty homolog 4 (Spry4)) étaient quant à eux présents dans la couche hypertrophié de cellules Kit+ de l'antre des souris KitK641E mais absentes des ICC Kit+ chez les souris WT (Chapitres 3, 4, 5). Ces gènes représentant donc de nouveaux candidats potentiels comme marqueurs spécifiques et/ou comme cibles thérapeutiques dans les GIST, nous avons, dans la seconde partie de notre travail, approfondi l'étude de leur expression et de leur régulation en utilisant des modèles cellulaires et tissulaires murins, ainsi que du matériel anatomopathologique de GIST humains.<p>Dans le tube digestif normal, NTSR1 et TPBG/5T4 ir ont été identifiés dans les neurones myentériques mais pas dans les ICCKIT+. Deux "tissue arrays" indépendants, totalisants 97 spécimens humains de GIST, ont révélés la présence de NTSR1-ir dans tous les GIST, en ce compris les cas négatifs pour KIT, tandis que TPBG/5T4-ir était présente dans 36/49 GIST. Un fort immunomarquage pour TPBG/5T4 était statistiquement associée aux tumeurs malignes et de haut risque (Chapitre 5; Annexe 1).<p>L'expression différentielle de membres de la famille des "Sprouty homologues" (Spry) dans l'antre des souris KitK641E a aussi été identifiée. Spry4-ir n'était pas détectable dans les ICC KIT+ des souris WT alors que Spry4-ir était présente dans la couche hyperplasique des cellules Kit+ chez les souris KitK641E. A l'opposé, l'ARN messager de Spry2 présentait un niveau d'expression similaire et Spry2-ir était détectée dans les cellules musculaires lisses - mais pas dans les cellules Kit+ - dans tous les génotypes (Chapitre 3). Pour sa part, l'expression de Spry1 apparaissait réprimée par le mutant oncogénique KitK641E, tant in vivo qu'in vitro, conduisant à la dérégulation de la boucle de rétrocontrôle négatif de la voie Ras/Erk (Chapitre 4). <p>Dans la dernière partie de cette thèse, nous avons étudié l'expression Endoglin (ENG) - aussi connues sous le nom de CD105 – dans le modèle murin de GIST KitK641E, dans les GIST humains et dans le modèle cellulaire murin Ba/F3 in vitro. ENG est une glycoprotéine transmembraire et un composant auxiliaire du complexe du récepteur au TGF-& / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

Cette étude a pour objectifs 1) d'évaluer l'activité érythrocytaire de l'inosine triphosphate pyrophosphatase (ITPA) et de l'inosine monophosphate deshydrogénase (IMPDH) en lien avec le suivi des métabolites thiopuriques et le phénotypage de la thiopurine S-méthyltransférase (TPMT), 2) d'étudier le lien entre l'activité de l'ITPA et la survenue d'effets indésirables observés sous azathioprine (AZA).L'étude rétrospective réalisée sur une large population de sujets adultes et enfants, sains et atteints de maladies auto-immunes, a permis d'identifier une distribution quadrimodale de l'activité de l'ITPA à l'aide d'un modèle de mélange gaussien ainsi qu'une faible variabilité intra-individuelle de cette activité. Dans la population pédiatrique, une activité de l'ITPA basse est corrélée à une augmentation des dérivés méthylés suggérant un risque d'hépatotoxicité. Le lien observé entre l'activité ITPasique, le volume globulaire moyen et les gammaglobulines chez les enfants atteints de maladie inflammatoire chronique de l'intestin sous AZA suggère que la mesure de l'activité de l'ITPA permettrait d'anticiper la persistance d'un syndrome inflammatoire chez les sujets à activité élevée.L'étude phénotypique de l'IMPDH montre une importante variabilité inter-individuelle de l'activité de cette enzyme et l'absence d'influence de l'âge, du sexe et du traitement par AZA sur cette activité. Une distribution bimodale de l'activité de l'IMPDH érythrocytaire a été observée ainsi qu'un lien entre cette activité et les dérivés méthylés.En perspective, l'étude combinée des activités de l'ITPA, l'IMPDH et de la TPMT sur la variabilité de la réponse aux traitements thiopuriques sera envisagée / The aims of this study are 1) to evaluate inosine triphosphate pyrophosphatase (ITPA) and inosine monophoshate dehydrogenase (IMPDH) activities in red blood cells (RBCs) in relation to the monitoring of thiopurine metabolites and the phenotyping of thiopurine S-methyltransferase (TPMT), 2) to investigate a possible link between ITPA activity and the occurence of adverse effects observed under azathioprine (AZA) treatment.The retrospective study was carried out on a large population of healthy adults and children as well as those suffering from immunological diseases. A quadrimodal distribution of ITPA was identified among the population using a gaussian mixture model. A weak intraindividual variability of ITPA activity was found. In the paediatric population, a low ITPA activity is correlated with increased levels of methyl nucleotides, suggesting a risk of hepatotoxicity. The relationship observed between ITPA activity and both mean corpuscular volume and gammaglobulin levels in IBD children on AZA therapy suggests that the determination of ITPA activity may allow the prediction of a persistent inflammatory process in subjects with elevated ITPA activity.The phenotypic study of IMPDH shows no influence of age, sex and AZA therapy on the activity of IMPDH. Moreover a large interindividual variability in the activity of IMPDH was found. A bimodal distribution of IMPDH activity in RBCs was observed as well as a relation between this activity and the methyl nucleotides.Further study on the combined effect of the three enzymes ITPA, IMPDH and TPMT on the variability of response to thiopurine therapy will be considered

Contexte: Les infections gastro-intestinales constituent un important problème de santé publique. Si plusieurs études recensent l'épidémiologie des cas sporadiques, peu se penchent sur la répétition d'infections dans certains ménages. L'objectif de cette étude est de déterminer quels sont les facteurs de risque associés à une récidive à Campylobacter ou à Salmonella déclarés de 2001 à 2007 dans les ménages en Montérégie. Méthodologie: Deux études ont été réalisées. Une étude descriptive a été conduite afin de dresser un portrait des deux groupes à l'étude soit : ménages avec répétitions d'infections à Campylobacter ou à Salmonella et ménages sans répétition d'infection (avec cas sporadique seulement). L'ensemble des sujets de cette étude ont été sélectionnés à partir du registre MADO. Une étude cas-témoins a ensuite permis de comparer les facteurs de risque pour chaque groupe de ménages. Un questionnaire administré au téléphone permettait de recueillir les habitudes des ménages-cas et des ménages-témoins. Les analyses ont été effectuées par régression logistique conditionnelle adaptée pour un appariement 1 cas : 2 témoins. Résultats: L'analyse descriptive portait sur 4181 cas d'infections à Campylobacter et Salmonella , déclarés du ler janvier 2001 au 31 décembre 2007. Le pourcentage de cas partageant la même adresse a été estimé à 7,8% pour Campylobacter et 7,6% pour Salmonella . Les cas de récidive présentent les mêmes caractéristiques que les cas sporadiques en ce qui concerne l'agent le plus en cause, la saison de survenue, l'âge du cas et le milieu d'habitation. Les habitudes des cas provenant de 80 ménages avec récidive et 160 ménages sans récidive ont été comparées. Dans un modèle final, en tenant compte seulement des variables affectant le ménage, il apparaît que l'habitation dans un milieu rural (RC = 2,89 ; IC95% = 1,53 - 5,46), la présence d'enfants de moins de 5 ans (RC = 2,63 ; IC95% = 1,29 - 5,37), l'exposition à une source hydrique contaminée (RC = 2,6 ; IC95% = 1,18 - 5,93) et le travail en contact avec des animaux (RC = 2.39 ; IC95% = 1,06 - 5,36) soient associés à un risque de récidive dans le ménage. Conclusion: Cette étude révèle que les répétitions de cas à certaines adresses peuvent s'expliquer par des caractéristiques du ménage. Des habitudes de vie spécifiques dans les ménages avec récidives par rapport aux ménages avec cas sporadiques ont été identifiées.

Résumé : Introduction : La relation entre les réflexes vagaux à point de départ œsophagien et les événements cardiorespiratoires des nouveau-nés (apnées, bradycardies, désaturations en O[indice inférieur 2]) reste un sujet discuté. Des études antérieures ont montré que la stimulation des chémo- ou mécanorécepteurs de l’œsophage chez l’animal adulte anesthésié peut être la cause de différents réflexes (Jadcherla, 2012). De plus, l’implication des terminaisons nerveuses des fibres C (FCs) dans certains réflexes d’origine œsophagienne a été suggérée (Lang et al., 2001). Considérant qu’il reste beaucoup d’inconnues sur ces réflexes, en particulier en période néonatale, les objectifs de cette étude sont de i) caractériser les réflexes cardiorespiratoires lorsqu’un reflux gastro-œsophagien (RGO) est mimé; ii) déterminer l’effet du site de la stimulation sur la sévérité des réflexes; iii) déterminer le niveau d’implication des FCs. Méthodes : Huit agneaux nouveau-nés ont été instrumentés chirurgicalement; 48h plus tard, deux enregistrements polysomnographiques distincts ont été effectués sans sédation, avant et après blocage permanent des FCs (Diaz et al., 2000). Cinq stimulations randomisées ont été effectuées permettant de mimer un RGO à différents niveaux de l’œsophage. Résultats : Les stimulations œsophagiennes (RGO) entrainent des réflexes d’inhibition cardiorespiratoire. Les stimulations doubles provoquent des réflexes de plus grande amplitude. Cette inhibition cardiorespiratoire est moins marquée suite au blocage permanent et sélectif des FCs par la capsaïcine. Conclusion : Mes résultats expérimentaux montrent, pour la première fois, une relation entre les réflexes vagaux œsophagiens et des événements cardiorespiratoires chez un animal nouveau-né en l’absence de sédation et suggèrent aussi une certaine implication des FCs. Les reflux proximaux, quant à eux, sont ceux pouvant potentiellement conduire à un RGO pathologique étant donné qu’ils engendrent des réflexes de plus grande amplitude. / Abstract : Introduction : The relationship between vagal reflexes originating from the esophagus and cardiorespiratory events in neonates (apneas, bradycardias, O[subscript 2] desaturations) remains a controversial subject. Previous studies in an a esthetized adult animals have shown that stimulation of esophagal chemo- or mechanoreceptors may cause various reflexes (Jadcherla, 2012). In addition, the involvement of C-fiber endings in some of those reflexes has been suggested (Lang et al., 2001). Considering that many uncertainties remain about these reflexes, especially in the neonatal period, the goals of this study were to i) characterize the cardiorespiratory reflexes observed when a gastroesophageal reflux is mimicked; ii) determine the effect of the stimulation site on the amplitude of those reflexes; iii) determine whe ther C-fibers are involved. Methods: Eight newborn lambs were surgically instrumented; 48 hours later, two separate polysomnographic recordings were performed without sedation before and after permanent C-fiber blockade (Diaz et al., 2000). Five randomized stimulations were performed to mimic a gastroesophageal reflux at different levels of the esophagus. Results: Esophageal stimulations cause cardiorespiratory inhibitory reflexes. Double stimulation causes more important reflexes, including bradycardia and apnea. The cardiorespiratory inhibition response was less marked after permanent and selective blockade of C-fibers by capsaicïne. Conclusion: My experimental results show, for the first time, a relationship between esophageal vagal reflexes and cardiorespiratory events in a neonatal, non-sedated animal and suggest some involvement of C-fiber endings. Results also suggest that proximal gastroesophageal refluxes generate more important reflexes.