INTRODUÇÃO: Testes provocativos com drogas serotonérgicas não apresentaram resultados consensuais em pacientes com TOC, sugerindo que a atividade serotonérgica seja heterogênea neste transtorno. É possível que a disfunção serotonérgica se relacione à resistência ao tratamento com inibidores de recaptura de serotonina (IRS) neste transtorno. O objetivo deste estudo foi comparar a atividade serotonérgica em pacientes com TOC resistente e responsivo ao tratamento com IRS e voluntários normais através de teste provocativo com citalopram. MÉTODOS: Foram estudados 30 pacientes com TOC resistente a IRS (RT), 30 pacientes com TOC respondedor (RP) e 30 voluntários sem transtorno mental (CN) pareados por sexo e idade. Cada indivíduo recebeu 20 mg de citalopram intravenoso. Foram dosados: prolactina, cortisol, hormônio de crescimento no plasma e serotonina em plasma rico em plaquetas nos seguintes tempos: -20, 0, 20, 40, 60, 80, 100, 120, 140 e 160 minutos. Como medidas da variação hormonal foram comparadas a variação percentual máxima (delta%) e a área sob a curva da variação. RESULTADOS: O citalopram não induziu sintomas ansiosos ou piora dos sintomas obsessivo-compulsivos nos pacientes. Também não houve mudanças significativas na concentração periférica de serotonina e na concentração de GH. A droga induziu um pico de secreção de prolactina no grupo controle (delta%=65,76 ± 105,1) maior que nos grupos RT e RP (RT delta%=17,41 ± 31,06; RP delta%=15,87 ± 31,71; p<0,05 em relação ao grupo controle). A secreção de cortisol mostrou-se atenuada apenas no grupo RT: (RT delta%=20,98 ± 58,14; RP delta%= 47,69 ± 66,94; CN delta%= 63,58 ± 88,4; p<0,05). CONCLUSÕES: Tanto pacientes resistentes como respondedores ao tratamento com IRS apresentaram resposta atenuada de prolactina ao citalopram em comparação a voluntários saudáveis, mas apenas pacientes resistentes apresentaram também resposta atenuada de cortisol, sugerindo maior disfunção serotonérgica neste grupo. / INTRODUCTION: Serotonergic pharmacological challenge tests have failed to produce consensual results in patients with OCD diagnosis, suggesting a heterogeneous 5-HT activity in this disorder. It is possible that serotonergic dysfunction is related with inadequate response to treatment with serotonin reuptake inhibitors (SRI). The aim of this study was to compare the neuroendocrine response to a serotonergic challenge in serotonin reuptake inhibitors treatment resistant and responders OCD patients and healthy volunteers. Methods: Thirty OCD resistant patients, 30 responders patients and 30 healthy volunteers, age and sex matched, were included. Each subject received 20 mg of intravenous citalopram. Prolactin, cortisol, growth hormone and serotonin were determined at the following times after the onset of citalopram infusion: -20, 0, 20, 40, 60, 80, 100, 120, 140 and 160 minutes. The maximal percentage variation (delta%) and area under the curve were compared as measures of hormonal variation. RESULTS: Citalopram has not induced any worsening of anxious or obsessive-compulsive symptoms among patients. No significant changes were observed either at platelet rich plasma serotonin concentration or at plasma growth hormone concentration. Citalopram has induced an increase in prolactin secretion in the control group (delta%=65.76 ± 105.1) while RT and RP groups showed blunted prolactin response (RT delta%=17.41 ± 31.06; RP delta%=15.87 ± 31.71; p<0.05). The cortisol response to citalopram was attenuated only in the RT group: (RT delta%=20.98 ± 58.14; RP delta%= 47.69 ± 66.94; CN delta%= 63.58 ±88.4; p<0.05). CONCLUSIONS: We concluded that either treatment resistant as responders patients have blunted prolactin response to citalopram, but only resistant patients also show an attenuated cortisol response, suggesting a more disrupted central serotonergic transmission in this group.

A l'interface de la génétique et de l'environnement, l'épigénétique contribue à la diversité phénotypique. Déterminer l'impact de la variation épigénétique sur les caractères quantitatifs (QT) est un nouveau défi. La croissance staturale fournit l’opportunité d’étudier la variabilité de plusieurs traits phénotypiques liés entre eux : des QT cliniques (la taille, l’accélération de la vitesse de croissance en réponse à l'hormone de croissance, GH) et des QT biologiques tels que la concentration d’IGF1 et la réponse de cette concentration à la GH. L’ « Insulin-like Growth Factor 1 » (IGF1) contrôle la croissance postnatale chez les mammifères, y compris l'homme. Nous l’avons choisi comme locus candidat pour nos études épigénétiques. Nous avons quantifié la méthylation des deux promoteurs P1 et P2 de ce gène, qui régulent son expression. Notre objectif était d’évaluer la contribution de la méthylation d’ADN de ces promoteurs i) à la taille des enfants en croissance, ii) à l’IGF1 circulant, iii) et à la réponse de ces paramètres à un traitement par la GH. Taille et IGF1 circulant. La relation entre la méthylation des promoteurs d’IGF1 et la taille a été étudiée au sein de deux cohortes du service d'endocrinologie pédiatrique, totalisant 216 enfants prépubères de différentes statures. Nous avons montré que la méthylation d'un groupe de six CGs situés dans la partie proximale du promoteur P2 du gène IGF1 présentait une corrélation inverse avec la croissance et l'IGF1 circulant. Les enfants les plus grands sont ainsi moins méthylés sur ces CGs que les enfants de petite taille. La contribution de la méthylation à la variance de la taille a été évaluée à environ 13%, et à 10% pour la variance de l'IGF1 sérique. Pour montrer que l’association observée reflète une causalité biologique, nous avons étudié le lien entre la méthylation des promoteurs P1 et P2 et l'activité transcriptionnelle du gène IGF1 in vivo et in vitro. Nous avons montré que les quantités de transcrits de classe II, issus du promoteur P2, sont inversement corrélés à la méthylation du promoteur P2 dans les cellules sanguines mononucléées. In vitro, nous avons cloné le promoteur P2 déméthylé ou méthylé dans un plasmide rapporteur (luciferase) transfecté dans la lignée HEK293 : le promoteur déméthylé s’est révélé nettement plus actif (+57%). Finalement, nous suggérons que l’hyperméthylation de certains CGs du P1 et du P2 d’IGF1 pourrait être un des nombreux mécanismes moléculaires responsables d’une moindre expression du gène et d’un phénotype de petite taille. La réponse au traitement par la GH. Une fraction des enfants de petite taille est traitée par l'hormone de croissance (GH) pour accélérer sa croissance, mais l’efficacité du traitement est très variable entre les individus. Les causes de cette variabilité sont partiellement comprises : la génétique joue un rôle, mais il reste une place possible pour la variabilité épigénétique. Dans ce but, nous avons étudié l'effet direct de la variabilité épigénétique sur la transcription du gène IGF1 et l’IGF1 circulant, dans un test aigu d’administration de GH, puis sur la réponse thérapeutique à un traitement d’un an par la GH. Après une injection de GH, nous avons constaté une augmentation variable du nombre de transcrits d’IGF1 chez les enfants étudiés. L'augmentation des transcrits de la classe II était inversement corrélée à la méthylation des CGs du P2. La variabilité de méthylation au CG-137 contribuait pour 20% à 67% de l’expression d’IGF1 en réponse à la GH. Chez 136 enfants de petite taille, nous avons montré que la méthylation de l'ADN du promoteur P2 était associée à la réponse au traitement par la GH au cours de la première année. Cette association est observée pour l'augmentation de la vitesse de croissance et pour les taux d’IGF1. (...) / At the interface of genetics and environment, epigenetics contributes to phenotypic diversity. Quantifying the impact of epigenetic variation on quantitative traits (QT), an emerging challenge in humans. Growth provides a handset of quantitative traits to epigenetic studies. We studied the variability of several inter-related QTs: clinical QTs (height, height reponse to growth hormone and biological QT (serum IGF1 and serum IGF1 response to GH). Since insulin-like growth factor 1 (IGF1) controls postnatal growth in mammals including human, we tested whether the CG methylation of the two promoters (P1 and P2) of the IGF1 gene could be a epigenetic contributor to the individual variation i) in circulating IGF1 and stature in growing children. ii) on response of these parameters to treatment with (GH). Child height and circulating IGF1. To explore the relation between IGF1 promoter methylation and height, we studied two cohorts of pedriatric endocrinology department, totalling 216 prepubertal children with various statures. The methylation of a cluster of six CGs located within the proximal part of the IGF1 P2 promoter showed a strong negative association with serum IGF1 and growth. These correlations were observed in two cohorts of growing children. Tall children show lower levels of methylation in several CGs in P2 and P1 promoters of IGF1 gene than short children with idiopathic short stature. CG methylation contributed 13% to the variance of height and 10% to the variance of serum IGF1. To test if the found association reflected biological causality, we tested if methylation at the P2 promoter affects the transcriptional activity of the IGF1 gene. The transcriptional activity of the P2 promoter was inversely correlated with the CG methylation in mononuclear blood cells. We established that high levels of CG methylation at the two promoters of IGF1 contributed to the many molecular mechanisms responsible for “idiopathic” short stature. Response to treatment with (GH). Short children using growth hormone (GH) to accelerate their growth respond to this treatment with a variable efficacy. The causes of this individual variability are partially understood and could involve epigenetics. In this aim, we investigated the contribution of DNA methylation to the response to GH at two levels: direct effect of GH on transcription of IGF1 gene, on circulating IGF1 and on the growth response to GH. Following a GH injection, we found a variable increase in IGF1 transcripts across the studied children. The increase in P2-driven transcripts showed a strong inverse correlation with 4/8 of P2 CGs. Among the CGs of P1 promoter, only CG-611 showed an inverse correlation with P1-driven transcripts. Variability of DNA methylation in these CGs contributes with 27% to 67% of increase in transcripts. In 136 children with idiopatic short stature, we showed that DNA methylation of the P2 promoter is associated with growth response to GH during the first year of GH administration, for both increment in growth rate and circulating IGF1. CG-137 methylation of P2 promoter contributes 25% to variance of growth response to GH. The link between DNA methylation and the response to a treatment in humans illustrating the role of epigenetic marks as potent contributors to conclusion « pharmacoepigenetics». Our work can find application in growth physiology and therapeutics, as well as for studies in aging, longevity or cancer where IGF1 has a prominent role.

INTRODUÇÃO: Testes provocativos com drogas serotonérgicas não apresentaram resultados consensuais em pacientes com TOC, sugerindo que a atividade serotonérgica seja heterogênea neste transtorno. É possível que a disfunção serotonérgica se relacione à resistência ao tratamento com inibidores de recaptura de serotonina (IRS) neste transtorno. O objetivo deste estudo foi comparar a atividade serotonérgica em pacientes com TOC resistente e responsivo ao tratamento com IRS e voluntários normais através de teste provocativo com citalopram. MÉTODOS: Foram estudados 30 pacientes com TOC resistente a IRS (RT), 30 pacientes com TOC respondedor (RP) e 30 voluntários sem transtorno mental (CN) pareados por sexo e idade. Cada indivíduo recebeu 20 mg de citalopram intravenoso. Foram dosados: prolactina, cortisol, hormônio de crescimento no plasma e serotonina em plasma rico em plaquetas nos seguintes tempos: -20, 0, 20, 40, 60, 80, 100, 120, 140 e 160 minutos. Como medidas da variação hormonal foram comparadas a variação percentual máxima (delta%) e a área sob a curva da variação. RESULTADOS: O citalopram não induziu sintomas ansiosos ou piora dos sintomas obsessivo-compulsivos nos pacientes. Também não houve mudanças significativas na concentração periférica de serotonina e na concentração de GH. A droga induziu um pico de secreção de prolactina no grupo controle (delta%=65,76 ± 105,1) maior que nos grupos RT e RP (RT delta%=17,41 ± 31,06; RP delta%=15,87 ± 31,71; p<0,05 em relação ao grupo controle). A secreção de cortisol mostrou-se atenuada apenas no grupo RT: (RT delta%=20,98 ± 58,14; RP delta%= 47,69 ± 66,94; CN delta%= 63,58 ± 88,4; p<0,05). CONCLUSÕES: Tanto pacientes resistentes como respondedores ao tratamento com IRS apresentaram resposta atenuada de prolactina ao citalopram em comparação a voluntários saudáveis, mas apenas pacientes resistentes apresentaram também resposta atenuada de cortisol, sugerindo maior disfunção serotonérgica neste grupo. / INTRODUCTION: Serotonergic pharmacological challenge tests have failed to produce consensual results in patients with OCD diagnosis, suggesting a heterogeneous 5-HT activity in this disorder. It is possible that serotonergic dysfunction is related with inadequate response to treatment with serotonin reuptake inhibitors (SRI). The aim of this study was to compare the neuroendocrine response to a serotonergic challenge in serotonin reuptake inhibitors treatment resistant and responders OCD patients and healthy volunteers. Methods: Thirty OCD resistant patients, 30 responders patients and 30 healthy volunteers, age and sex matched, were included. Each subject received 20 mg of intravenous citalopram. Prolactin, cortisol, growth hormone and serotonin were determined at the following times after the onset of citalopram infusion: -20, 0, 20, 40, 60, 80, 100, 120, 140 and 160 minutes. The maximal percentage variation (delta%) and area under the curve were compared as measures of hormonal variation. RESULTS: Citalopram has not induced any worsening of anxious or obsessive-compulsive symptoms among patients. No significant changes were observed either at platelet rich plasma serotonin concentration or at plasma growth hormone concentration. Citalopram has induced an increase in prolactin secretion in the control group (delta%=65.76 ± 105.1) while RT and RP groups showed blunted prolactin response (RT delta%=17.41 ± 31.06; RP delta%=15.87 ± 31.71; p<0.05). The cortisol response to citalopram was attenuated only in the RT group: (RT delta%=20.98 ± 58.14; RP delta%= 47.69 ± 66.94; CN delta%= 63.58 ±88.4; p<0.05). CONCLUSIONS: We concluded that either treatment resistant as responders patients have blunted prolactin response to citalopram, but only resistant patients also show an attenuated cortisol response, suggesting a more disrupted central serotonergic transmission in this group.

A Arginina (Arg) regula a secreção de GH e insulina, e é o único precursor biológico do NO. Previamente demonstramos que animais tratados cronicamente com Arg (35mg/dia) desenvolvem resistência à insulina (RI), e o presente estudo investigou as suas bases moleculares. A RI baseou-se na redução da atividade e/ou expressão do IRS 1/2 e Akt, e do conteúdo de GLUT4; sendo o GH crucial na gênese desses efeitos. Doses mais elevadas de Arg (70mg/dia/30 dias), a maior geração de NO e a melhora do fluxo sangüíneo reverteram este quadro. Experimentos com células musculares demonstraram que a Arg estimula o metabolismo de glicose e lipídios, via NO/c-GMP. Esses achados indicam que a Arg pode ser benéfica para o tratamento de distúrbios metabólicos, como obesidade e DM2; e que ao estimular a secreção de GH, em doses adequadas, seria eficaz na terapia de distúrbios da secreção deste hormônio. Todavia, estudos adicionais são necessários para investigar a melhor dose e os efeitos crônicos in vivo da Arg, uma vez que o GH em excesso apresenta um efeito diabetogênico importante. / Arginine (Arg) regulates the secretion of GH and insulin, and it is the main biological precursor of NO. We have previously shown that animals chronically-treated with Arg (35 mg/day) developed insulin resistance (IR), and this study investigated its molecular basis. The RI relies on the reduction of the activity and/or expression of IRS 1/2 and Akt, and of the GLUT4 content; and GH has a crucial role in the genesis of these effects. Higher doses of Arg (70 mg/dia/30 days), the increased NO generation and the improvement of the blood flow reversed the RI. Experiments with muscle cells showed that Arg stimulates glucose and lipids metabolism, via NO/c-GMP activation. These findings indicate that Arg may be beneficial for the treatment of metabolic disorders, such as obesity and T2DM, and by stimulating GH secretion, Arg can, in appropriate doses, be effective for the therapy of GH secretion disorders. However, further studies are needed to investigate the best dose and the chronic effects of Arg in vivo, since that GH in excess is potentially diabetogenic.

A deficiência de hormônio de crescimento (DGH) é tratada convencionalmente com repetidas injeções do hormônio recombinante. Este trabalho teve como objetivo estabelecer uma alternativa de tratamento baseada na transferência dos genes do hormônio de crescimento humano (hGH) ou de camundongo (mGH), em camundongos anões lit/lit ou lit/scid, mediante administração de DNA plasmidial associada à eletrotransferência, com a finalidade de atingir a máxima recuperação de crescimento em comparação ao camundongo normal (catch-up growth). Inicialmente foi realizada a administração do plasmídeo contendo o gene do mGH no músculo quadríceps exposto ou tibial anterior (TA) não exposto. Utilizando diferentes condições de eletrotransferência, baseadas em pulsos alternados de baixa (100 V/cm) e alta (1000 V/cm) voltagem (HV/LV, HV/8LV) ou em pulsos seguidos de baixa voltagem (8 pulsos de 150 V/cm), o músculo TA na condição HV/LV apresentou os maiores níveis de expressão de mGH: 6,7 ± 2,5 ng/mL. O tempo de exposição e a quantidade da enzima hialuronidase (HI) necessária para a eletrotransferência foram também analisados. O tempo de 30 minutos e a dose de 20 U de HI proporcionaram os melhores resultados de expressão. Diferentes quantidades de DNA foram também testadas, mas a administração de 50 &mu;g DNA/animal foi confirmada como a melhor. Na padronização do volume de solução do plasmídeo administrado no TA, foi observado que a injeção de 20 &mu;L de DNA apresentou expressão significativamente maior da proteína em comparação a de 10 &mu;L. Buscando uma maior expressão de GH, foi realizado experimento adicionando poli-L-glutamato ao diluente do DNA, comparando também diferentes condições de eletrotransferência (HV/LV e 375 V/cm). A condição de 375 V/cm, sem a adição do polímero, proporcionou as maiores concentrações, tanto de hGH como de mGH, no soro de camundongos lit/scid e lit/lit, respectivamente. Quando utilizados 3 pulsos de 375 V/cm e a administração do plasmídeo com o gene do mGH em dois locais de cada músculo TA, foram obtidos os mais altos níveis de expressão atingindo 14,7 ± 3,7 ng mGH/mL. Estes foram os parâmetros utilizados em um bioensaio, no qual foi também determinada a medida do comprimento inicial e final do fêmur por radiografia. Neste bioensaio de 36 dias, a curva de crescimento dos camundongos lit/lit tratados foi similar a de camundongos heterozigotos não tratados e os níveis de mGH do grupo DNA foram significativamente maiores (P<0,0002) em relação ao grupo controle. Os camundongos tratados também apresentarem concentração de mIGF-I no soro superior a do grupo controle. Considerando os parâmetros de crescimento avaliados, o grupo tratado com DNA apresentou percentuais de incremento altamente significativos em relação ao grupo controle, com P<0,001 para o peso corpóreo e P<0,002 para o comprimento do corpo, da cauda e para ambos os fêmures, com valores de catch-up da ordem de 79% para o comprimento dos fêmures. Podemos concluir que foi estabelecida uma metodologia eficiente de transferência gênica não viral, que poderá levar a uma completa normalização de crescimento de camundongos anões mediante utilização de animais mais jovens, como mencionado na literatura e em trabalho recente do nosso grupo. / Growth hormone deficiency (GHD) is conventionally treated with repeated injections of the recombinant hormone. This work aimed at establishing an alternative treatment based on the transfer of the human (hGH) or mouse growth hormone (mGH) genes into lit/lit or lit/scid dwarf mice, using plasmid DNA administration associated with electrotransfer, in order to achieve the maximum growth recovery compared to normal mice (catch-up growth). Administration of the plasmid containing the mGH gene was first carried out in the exposed quadriceps or non-exposed anterior tibialis (TA) muscle. Using different electrotransfer conditions, based on alternate pulses of high (1000 V/cm) and low (100 V/cm) voltage (HV/LV, HV/8LV) or consecutive pulses of low voltage (8 pulses of 150 V/cm), the TA muscle in the HV/LV condition showed the highest levels of mGH expression: 6.7 ± 2.5 ng/mL. Exposure time and amount of the enzyme hyaluronidase (HI) required for electrotransfer were also analyzed. The time of 30 minutes and the dose of 20 U HI provided the best results of expression. Different amounts of DNA were also tested, but the administration of 50 &mu;g DNA/animal was confirmed as the best. In the optimization of the volume of plasmid solution administered to TA, it was observed that injection of 20 &mu;L of DNA showed a significantly higher expression of the protein compared with 10 &mu;L. Aiming at a higher GH expression, an experiment was carried out by adding poly-L-glutamate to the DNA diluent, comparing also different electrotransfer conditions (HV/LV and 375 V/cm). The condition of 375 V/cm, without the polymer addition, provided the higher concentrations of both hGH and mGH in the serum of lit/scid or lit/lit mice, respectively. Using 3 pulses of 375 V/cm and administration of mGH-DNA in two locations on each TA muscle, the highest expression levels of up to 14.7 ± 3.7 ng mGH/mL were obtained. These were the parameters utilized in a bioassay, which was also carried out by measurement of the initial and final femur length by radiography. In this 36-day bioassay, the growth curve of treated lit/lit mice was similar to that of heterozygous untreated mice and the mGH levels of DNA group were significantly higher (P<0.0002) than the control group. Treated mice also showed a higher mIGF-I concentration in the serum compared to the control group. Concerning growth parameters, DNA-treated group showed percentages of increase highly significant compared to the control group, with P<0.001 for body weight and P<0.002 for body, tail and both femurs lengths, with catch-up values of the order of 79% for femur lengths. We can conclude that an efficient non-viral gene transfer methodology has been established, which lead to a complete growth normalization of the dwarf mice through the use of younger animals, as reported in the literature and in a recent paper of our group.

Mong, Lok Yee. / Thesis submitted in: December 2007. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 124-145). / Abstracts in English and Chinese; some text in appendix also in Chinese. / Acknowledgements --- p.i / Abstract (English version) --- p.iii / Abstract (Chinese version) --- p.v / Table of Contents --- p.vii / List of Tables --- p.ix / List of Figures --- p.xi / List of Abbreviations --- p.xiii / Chapter Chapter 1 - --- Introduction / Chapter 1.1 --- Childhood obesity: a worldwide epidemic --- p.1 / Chapter 1.2 --- Health consequences of childhood obesity --- p.3 / Chapter 1.3 --- Determinants of childhood obesity --- p.5 / Chapter 1.4 --- Hormonal dysregulation and obesity --- p.9 / Chapter 1.5 --- Project objectives and long term significance --- p.14 / Chapter Chapter 2 - --- Research Plan and Methodology / Chapter 2.1 --- Study cohort / Chapter 2.1.1 --- Subject recruitment --- p.15 / Chapter 2.1.2 --- Ethics --- p.16 / Chapter 2.1.3 --- Measurements and blood sample collections --- p.16 / Chapter 2.1.4 --- Subgroup for dietary assessment --- p.18 / Chapter 2.1.5 --- Cohort re-visits in 2006 --- p.19 / Chapter 2.2 --- Genetic study / Chapter 2.2.1 --- Sample size estimation and research subjects --- p.21 / Chapter 2.2.2 --- DNA samples --- p.22 / Chapter 2.2.3 --- Candidate genes --- p.24 / Chapter 2.2.4 --- SNP tagging and prioritizing --- p.25 / Chapter 2.2.5 --- Genotyping methods & quality control --- p.28 / Chapter 2.2.6 --- Statistical analysis --- p.31 / Chapter 2.3 --- Dietary assessment / Chapter 2.3.1 --- Three-day 24-hour dietary recalls --- p.36 / Chapter 2.3.2 --- Lifestyle questionnaire --- p.37 / Chapter 2.3.3 --- Data management --- p.38 / Chapter 2.3.4 --- Statistical methods --- p.39 / Chapter Chapter 3 - --- Results Page / Chapter 3.1 --- Study cohort --- p.41 / Chapter 3.2 --- Genetic study / Chapter 3.2.1 --- Subjects --- p.41 / Chapter 3.2.2 --- SNPs selection --- p.41 / Chapter 3.2.3 --- Factor analysis of adiposity in the study population --- p.44 / Chapter 3.2.4 --- Genotyping and association testing in stage1 --- p.50 / Chapter 3.2.5 --- Genotyping and association testing in stage2 --- p.52 / Chapter 3.2.6 --- Association of the CART gene with adiposity --- p.55 / Chapter 3.2.7 --- Association of the GHR gene with adiposity --- p.60 / Chapter 3.2.8 --- Association of the GHRHR gene with adiposity --- p.69 / Chapter 3.2.9 --- Association of the IGFBP3 gene with adiposity --- p.75 / Chapter 3.2.10 --- Association of the POMC gene with adiposity --- p.83 / Chapter 3.2 --- Dietary assessment / Chapter 3.3.1 --- Nutrient intakes of the subgroup in2004 --- p.87 / Chapter 3.3.2 --- Nutrient intakes of the subgroup in2006 --- p.92 / Chapter 3.3.3 --- Lifestyle pattern of the cohort in2006 --- p.97 / Chapter Chapter 4 - --- Discussion / Chapter 4.1 --- The role of GH-related genes with adolescent adiposity --- p.102 / Chapter 4.2 --- Nutrient intakes and lifestyle pattern of the adolescents --- p.120 / Chapter 4.3 --- Conclusion of this study --- p.123 / References --- p.124 / Appendices / Chapter A --- Information of the SNPs selected --- p.146 / Chapter B --- Comparison of SNPs minor allele frequency (MAF) among two genotyping stages and HapMap data --- p.154 / Chapter C --- Hardy-Weinberg Equilibrium (HWE) of SNPs in two genotyping stages --- p.162 / Chapter D --- Factor score coefficient matrix --- p.170 / Chapter E --- Association of SNPs with factors scores --- p.172 / Chapter F1 --- Consent form (English version) --- p.207 / Chapter F2 --- Consent form (Chinese version) --- p.209 / Chapter G1 --- 24-hour dietary recall forms (English version) --- p.211 / Chapter G2 --- 24-hour dietary recall forms (Chinese version) --- p.218 / Chapter H --- Food photo booklet --- p.225 / Chapter I1 --- Lifestyle questionnaire (English version) --- p.236 / Chapter I2 --- Lifestyle questionnaire (Chinese version) --- p.238

INTRODUÇÃO: A Síndrome de Prader-Willi (SPW) é uma doença multigênica causada pela perda de expressão de genes na região 15q11- q13. As principais características incluem hipotonia e disfunção hipotalâmica, que pode ser responsável pela hiperfagia levando a obesidade durante a infância, por controle ventilatório anormal e deficiência do Hormônio de Crescimento (GH). O objetivo deste estudo foi descrever e comparar o sono dos pacientes com SPW, descrever o IGF-I e correlacionar o IAH com IGF-I. MÉTODOS: Foram realizadas polissonografias em 17 pacientes (idade entre 3 anos e 18 anos) com SPW divididos em dois grupos, GH+ (n=9) e GH- (n=8). Trata-se de um estudo prospectivo realizado com pacientes do ambulatório de Endocrinologia do Instituto da Criança da Universidade de São Paulo, tendo sido obtido de seus prontuários resultados de IGF-I sérico anterior à realização do exame. RESULTADOS: Os grupos GH+ e GHforam homogêneos. Quatorze (82,3%) dos pacientes eram obesos, 8 (88,9%) GH+. Todos os pacientes apresentaram Índice de Apneia e Hipopneia (AH) 1. 88,2% dos pacientes apresentaram ronco. A eficiência do sono foi menor em 7 (41,2%) pacientes, sendo 6 (85,7%) do grupo GH+. 23,5% dos pacientes apresentaram porcentagem diminuída do sono de ondas lentas e 29,4% dos pacientes de sono REM. Cinco (29,5%) pacientes apresentaram latência de sono REM diminuída, sendo 2 (40%) paciente GH+ e 4 (23,6%) pacientes latência de sono aumentada, sendo 2 (50%) GH+. Todos os pacientes apresentaram fragmentação do sono. Os eventos mais comuns foram as hipopneias e as apneias obstrutivas. Três (17,7%) pacientes, sendo 1 (11,1%) GH+ apresentaram episódios de dessaturação importantes com mínima 65% e média 85%. Não foram encontradas correlação entre o IAH e IGF-I (p = 0,606). Não houve diferença estatisticamente significante entre os dados polissonográficos de ambos os grupos. CONCLUSÕES: Todos os pacientes apresentaram IAH 1, dessaturação de oxigênio com predomínio em sono REM e fragmentação do sono. Não foram encontradas diferenças na correlação do IGF-1 com IAH. Não foram encontradas diferenças entre os grupos GH+ e GH- em relação aos dados antropométricos e polissonográficos / BACKGROUND: Prader-Willi syndrome (PWS) is a multigenic disorder caused by the loss of expression of genes in the 15q11-q13 region. The main features include hypotonia and hypothalamic dysfunction that may be responsible for hyperphagia leading to obesity during childhood, abnormal ventilatory control and Growth Hormone (GH) deficiency. The aim of this study is to describe and compare the sleep of patients with PWS, describe the IGF-I and correlate IGF-I with AHI. METHODS: All polysomnographic (PSG) studies were performed in 17 patients (aged between 3 years and 18 years) with PWS divided in 2 groups, as follows: GH + (n = 9) and GH- (n = 8). This prospective study was conducted at the Endocrinologic Outpatient Clinic (Children\'s Hospital, University of São Paulo) and results of IGF-I serum were obtained from their medical records prior to the PSG. RESULTS: The groups GH + and GH-were homogeneous. 82,3% patients were obese, 8 (88.9%) GH +. All patients had AHI 1. 88,2% patients presented snoring. The sleep efficiency was lower in 7 (41.2%) patients, 6 (85.7%) GH +. 23,5% patients showed reduced percentage of slow wave sleep and 29,4% patients showed reduced percentage of REM sleep . Five (29.5%) patients had reduced REM latency, 2 (40%) GH + and 4 (23.6%) patients had increased REM latency, 2 (50%) GH+. All patients had sleep fragmentation. The most common events were hypopneas and obstructive apneas. Three (17.7%) patients, 1 (11.1%) GH+ had important desaturation (SatO2 minimum 65% and SatO2 average 85%. No correlation was found between the AHI and IGF-I (p = 0.606). There were no statistically significant differences between polysomnographic data from both groups. CONCLUSIONS: All patients had AHI 1, oxygen desaturation predominating in REM sleep and sleep fragmentation. No differences were found in the correlation of IGF-1 with IAH. No differences were found between groups GH + and GH- in relation to anthropometric and polysomnographic data

Pancreatic endocrine tumors and gastrointestinal stromal tumors are rare. Evidence regarding prognostic factors, and in the former also treatment, is scarce. We evaluated the survival and prognostic factors in a consecutive series of 324 patients with pancreatic endocrine tumors treated at a single institution. Radical surgery, WHO classification, TNM stage, age and Ki67 ≥2% emerged as independent prognostic factors. Having a non-functioning tumor was not an independent prognostic marker, and neither was hereditary tumor disease. We present the first evaluation of the newly proposed TNM staging system for these patients. A separate analysis of well-differentiated neuroendocrine carcinomas is reported, suggesting tumor size ≥5cm and Ki67 ≥2% as negative prognostic markers in this group. The first 36 patients with advanced neuroendocrine tumors treated with temozolomide at our clinic were evaluated. The median time to progression was seven months. Fourteen percent showed partial regression and 53% stabilization of disease. Side effects were generally mild. Investigation of O6-methylguanine DNA methyltransferase revealed a low expression in a subset of tumors. Four out of five patients responding to treatment had tumors with low expression. Concomitant expression of the orexigen ghrelin and its receptor in pancreatic endocrine tumors is demonstrated. No significant difference in mean plasma ghrelin between patients and controls were found, but elevated plasma ghrelin was seen in five patients. We provide the first report of expression of ghrelin and its receptor in gastrointestinal stromal tumors. Concomitant expression was frequent, indicating the presence of an autocrine loop. The tumors also expressed the neuroendocrine marker synaptic vesicle protein 2. Together, these findings are suggestive of neuroendocrine features.

The use of a new, more sensitive immunoassay for growth hormone (GH) revealed that the serum levels in men were lower than expected in sera drawn ambulatory in the morning after an overnight fast and that the gender difference was more than 10 times greater than reported. These observations led to a more thorough study on the impact of gender and sex steroids on the levels of GH and other hormones in ambulatory morning samples and over a 24-hour period. Furthermore, the impact of gender was studied in GH deficient (GHD) patients and healthy young adults treated with GH, and in patients with acromegaly treated with octreotide. An 80-fold gender difference in the morning GH levels was observed in young individuals as a reaction to ambulation, with decreased levels in men and increased in women. Oral contraceptives (OCs) given to women further increased the morning GH levels. During the day, higher outputs of epinephrine and lower levels of GH were seen in the men, while no gender differences were seen at night. The gender difference in morning GH levels decreased with age due to opposite changes in men and women. Administration of 17β-estradiol (E2) via subcutaneous implants in postmenopausal women, which increased the E2-concentrations to luteal phase levels, had no effect on the morning GH levels, indicating that the different reactions to ambulation do not appear to result from a direct sex steroid effect alone. Short-term administration of GH to young, healthy adults resulted in larger effects on insulin-like growth factor I (IGF-I) and other key metabolic parameters in men than in women. The smallest response was noted in women taking OCs. The clinical studies involving long-term GH treatment of patients with GHD demonstrate a gender difference in GH responsiveness, with women being less sensitive than men, a fact which should have a therapeutic impact in patients with GH disorders. A further gender difference of therapeutic importance was observed in men and women with acromegaly. Long-term treatment with a slow-release formulation of octreotide resulted in higher IGF-I levels in the men, despite equal doses of the drug and similar levels of GH.

Drug dependence is a serious and increasing problem in our society, especially among adolescents. The use of the large variety of substances available can result in a range of physiological and psychological adverse effects on individuals and negative consequences on the society overall. Several different types of drugs induce neurotoxicological damages, which in turn can generate impairment in for example the reward system and affect cognitive parameters.  The drug gamma-hydroxybutyrate (GHB) is usually considered a harmless compound among abusers, but has now shown to be highly addictive. Furthermore, GHB can cause memory impairments in both humans and animals. On the contrary, growth hormone (GH) and its main mediator insulin-like growth factor 1 (IGF-1) have recently been suggested to improve memory and learning in several studies. The hormones exhibit certain neuroprotective capabilities and have also previously been demonstrated to reverse opioid induced apoptosis in hippocampal cells. These effects and the fact that GHB is shown to increase GH secretion, which attracted considerable attention among body builders, led us to initiate studies on GHB and its impact on relevant systems in the central nervous system (CNS). Thus, the main purpose of the present investigation was to elucidate some of the underlying mechanisms that could account for the effects exerted by GH and GHB in the CNS. We found that a) GH affects the density and functionality of GABAB-receptors and opioid receptors in the male rat brain, b) GHB induces cognitive deficits and down-regulates GABAB-receptors, c) GHB treatment creates an imbalance between the endogenous opioids Met-enkaphalin-Arg6Phe7 (MEAP) and dynorphin B and increases the levels of MEAP in regions of the brain that are associated with drug dependence, and d) GHB affects the expression of IGF-1 receptors but not the plasma levels of IGF-1. In conclusion, the present work demonstrates that GH interacts with both opioid and GABAB-receptors in the male rat CNS and that GHB has an impact on brain regions associated with cognition and the development of dependence. These observations may be of relevance in many aspects related to addiction and might be translated into humans.