Einleitung: Das ARDS (acute respiratory distress syndrome) stellt mit einer schweren Hypoxämie aufgrund eines hohen pulmonalen Recht-Linksshunts, mit einer pulmonalen Hypertonie und einer diffusen inflammatorischen Reaktion der gesamten Lunge trotz einiger etablierter Therapieansätze ein häufig letal endendes Krankheitsbild dar. Neben zahlreichen neuen klinisch-experimentellen Therapieansätzen erlangt die i.v.-Aplikation von Almitrindimesilat größere Beachtung. Zuerst verabreicht bei chronisch obstruktiven Atemwegserkrankungen erkannte man bald, daß neben der ventilationssteigernden Wirkung auch Effekte an der pulmonalen Gefäßstrombahn im Sinne einer Optimierung des Ventilations-Perfusions-Verhältnisses für die zu beobachtende Verbesserung der pulmonalen Oxygenation verantwortlich sind. Eine Potentierung der Hypoxischen Pulmonalen Vasokonstriktion (HPV) wird dafür verantwortlich gemacht. Kontrovers diskutierte Dosierungen in Tierversuchen und vereinzelten Anwendungen am Menschen legten nahe, daß systemische Dosis-Wirkungsanalysen erfolgen mußten. Desweiteren sollte untersucht werden ob die im Rahmen des ARDS zu beobachtende Pulmonalarterielle Hypertonie durch das Medikament zunimmt. Methoden: Mit Hilfe eines durch repetitive saline bronchoalveoläre Lavage induzierten ARDS-Modells am Schwein wurden an 14 Schweinen in Narkose prospektiv randomisiert entweder sechs ansteigende Dosen (0,5, 1, 2, 4, 8, und 16 (g/kgKG/min) Almitrindimesilat oder dessen Solvens Apfelsäure appliziert. Während des Versuches wurde volumenkontrolliert beatmet (FiO2 1,0 , PEEP 5 cm H2O). Nach je 30 minütiger Infusion der entsprechenden Dosierungen wurde Parameter des Gasaustausches und der pulmonalen sowie der systemischen Hämodynamik erhoben. Innerhalb der Gruppen wurde mittels des einfachen ANOVA-Test mit Bonferonikorrekturfaktor, zwischen den Gruppen mit dem Mann-Whitney-Test auf signifikante Unterschiede hin untersucht. Signifikanz der Unterschiede wurde bei einer Irrtumswahrscheinlichkeit p ( 0,05 angenommen. Ergebnisse: Niedrige Dosierungen, 0,5 - 2 (g/kgKG/min, reduzieren die venöse Beimischung und führen zu einem statistisch signifikanten Anstieg des Sauerstoffpartialdruckes mit einem Optimum für diesen günstigen Einfluß bei einer Infusionsrate von 1 µg/kgKG/ min. Hohe Dosierungen hingegen erhöhen die venöse Beimischung und senken den Sauerstoffpartialdruck und führen damit zu einer erheblichen Verschlechterung des Krankheitsbildes im Vergleich zu niedrigen Dosen und der Ausgangssituation bzw. dem nichttherapierten Tieren. Der Pulmonalarterielle Mitteldruck nahm nach Almitrindimesilatgabe geringfügig zu. Mit zunehmender Dosierung erreichte der MPAP höhere Werte als zum Zeitpunkt des stabilen Lungenschadens, jedoch waren keine dieser Steigerungen statistisch signifikant. Diskussion: Almitrindimesilat zeigte einen dosisabhängigen Einfluß auf den pulmonalen Gasaustausch. Dieser wirkt sich in niedrigen Dosierungen positiv auf die Hypoxämie aus. Der Pulmonalarterielle Druck bleibt konstant. Als Mechanismus der positiven Auswirkung liegt eine Potenzierung der HPV für niedrige Dosierungen nahe. / Objectives: The ARDS (acute respiratory distress syndrome) is characterized by a diffuse inflammatory response, a pulmonary hypertension and a severe hypoxemia mainly because of ventilation-perfusion-mismatching. Despite of some new therapeutical strageties the mortality remains high. Almitrine bismesylate was first described to improve arterial oxygenation in COPD- patients primary by increasing alveolar ventilation due to a stimulating effect on peripheral chemoreceptors. Furthermore several experimental studies have confirmed that almitrine improves PaO2 possibly because of reducing the ventilation- perfusion-mismatching by enhancing the hypoxic pulmonary vasoconstriction (HPV). Controversal results have been reported concernig the doses of intravenous Almitrine to be beneficial. Furthermore it remains unclear to what extend the pulmonary hypertension is augmented by a drug which is inhancing or restroring the HPV. Therefore we determined a dose-response-curve of almitrine in a animal model of ARDS. Methods: After induction of anaesthesia the ARDS-Modell was induced by repeated saline wash-0,5-2 ?g/kgKG/minout of surfactant. 14 swine received almitrine or the solvent in a prospective randomized manner. During the experiment the volume controlled mode of mechanical ventilation remained unchanged (FiO2 1,0 , PEEP 5 cm H2O). After the increasing doses of 0,5, 1, 2, 4, 8 and 16 ?g/kgKG/min each for 30 min we investigated the effects of i.v. almitrine on the pulmonary gasexchange and the pulomanry and systemic hemodynamics. Statistics were carried out by Two way Analysis of Variance p

Vaccinia virus (VACV) is the most intensively studied orthopoxvirus and acts as an excellent model to investigate host-pathogen interactions. VACV encodes about 200 proteins, many of which modulate the immune response. This study focusses on two of these: C16 and C4, that share 43.7 % amino acid identity. Given the sequence similarity, we explored whether C16 and C4 have any shared functions, whilst also searching for novel functions. To gain mechanistic insight, we sought to identify binding partners and determine the residues responsible. C16 has two reported functions. Firstly, it inhibits DNA-PK-mediated DNA sensing, and this study found that C4 can perform this function as well. Like C16, C4 associates with the Ku heterodimer to block its binding to DNA leading to reduced production of cytokines and chemokines. For both proteins, the function localised to the C termini and was abrogated by mutating three residues. Secondly, C16 induces a hypoxic response by binding to PHD2. This function was mapped to the N-terminal 156 residues and a full length C16 mutant (D70K,D82K) lost the ability to induce a hypoxic response. In contrast, C4 did not bind PHD2. C4 inhibits NF-κB signalling by an unknown mechanism. Reporter gene assays showed that C16 also suppresses NF-κB activity and, intriguingly, this was carried out by both the N and C termini. C16 acts at or downstream of p65 and the N terminus of C16 associated with p65 independently of PHD2-binding. Conversely, C4 acted upstream of p65, did not display an interaction with p65, and the function was restricted to its C-terminal region. Novel binding partners were identified by a screen utilising tandem mass tagging and mass spectrometry, and selected hits were validated. The C terminus of C16 associated with VACV protein K1, a known NF-κB inhibitor. Additionally, C16 bound to the transcriptional regulator ARID4B. C4 did not interact with these proteins, but the N-terminal region of C4 associated with filamins A and B. The functional consequences of these interactions remain to be determined. In vivo, C4 and C16 share some redundancy in that a double deletion virus exhibits an attenuated virulence phenotype that is not observed by single deletion viruses in the intradermal model of infection. However, non-redundant functions also contribute to virulence in that both single deletion viruses display attenuated virulence compared to a wild-type Western Reserve virus in the intranasal model of infection. Data presented also reveal that C4 inhibits the recruitment of immune cells to the site of infection, as was previously described for C16. Overall, this investigation highlights the complexity of host-pathogen interactions showing that VACV encodes two multifunctional proteins with both shared and unique functions. Moreover, their inhibition of DNA-PK emphasises the importance of this PRR as a DNA sensor in vivo.

No description available.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This work investigated the effect of intermittent hypoxic training (IHT) sessions under bodyweight, food intake and biochemical parameters in Wistar rats fed normo fat (NF) and high fat (HF) diets. Forty rats were divided in two groups, which were fed a NF or a HF diet. Afterwards the rats were subdivided in four groups and submitted to intermittent hypoxia (IH) or normoxia (N) sessions for 30 days. Groups formed: NF/N, NF/IH, HF/N and HF/IH. The groups submitted to IHT followed this protocol: 15 minutes hypoxia, 10-15% inspired O2 and 5 minutes for reoxigenation). Sham group was exposed to the same conditions but with normal O2 concentrations (21%). Bodyweight and food intake were measured every two days. The rats were anesthetized on day 31 and the blood was sampled by cardiac punction for analyses. The biochemical parameters analyzed were: total cholesterol (TC), triglycerides (TG), high density cholesterol (HDL), glucose, lactate dehidrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and muscle and hepatic glycogen. In regard to diets, the HF group promoted the biggest weight gain just in normoxia groups.The food intake decrease significantly in HF/IH subgroup compared to HF/N. Although the average of the corporal weight did not decrease significantly, the differences in percentages had shown a reduction in HF/IH subgroup. In the profile biochemist, the IHT only modified the LDH, increasing it in NF subgroup and the AST, diminishing it in HF subgroup. Our findings allow to suggest that the IHT can have a promising role in the prevention of the obesity and more studies are needed to evaluate its effect in the prevention/treatment of other diseases. / Este trabalho investigou o efeito de sessões de treinamento hipóxico intermitente (THI) sobre o peso corporal, consumo calórico e variáveis bioquímicas em ratos Wistar alimentados com dieta padrão (DP) ou dieta hipercalórica (DH). Quarenta ratos foram divididos em dois grupos e alimentados com DP ou DH. Na seqüência foram subdivididos em quatro grupos e submetidos às sessões de hipóxia intermitente (HI) ou normóxia (N) por 30 dias. Os grupos formados foram: DP/N, DP/HI, DH/N e DH/IH. Os grupos submetidos ao THI seguiram o seguinte protocolo: 15 minutos de hipóxia com a concentração de O2 inspirado variando entre 10 a 15% e 5 minutos para reoxigenação. Os grupos normóxia foram expostos às mesmas condições, porém com concentrações normais de O2 (21%). O peso corporal e o consumo de ração foram avaliados a cada dois dias. No dia 31, os animais foram anestesiados e o sangue foi coletado por punção cardíaca. As variáveis bioquímicas analisadas foram: colesterol total (CT), triglicerídeos (TG), lipoproteína de alta densidade (HDL), glicose, lactato desidrogenase (LDH), alanina aminotransferase (ALT), aspartato aminotransferase (AST), glicogênio muscular e hepático. Com relação às dietas, a DH promoveu maior ganho de peso somente nos grupos em normoxia. A ingesta calórica diminuiu significativamente no subgrupo DH/HI. Embora a média do peso corporal não tenha diminuído significativamente, as diferenças em percentagens mostraram uma redução no subgrupo DH/HI. No perfil bioquímico, o THI alterou somente a LDH, aumentando-a no subgrupo DP e a AST, diminuindo-a no subgrupo DH. Nossos achados permitem sugerir que o THI pode ter um papel promissor na prevenção da obesidade e mais estudos são necessários para avaliar seus efeitos na prevenção/tratamento de outras patologias.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-09T12:38:26Z No. of bitstreams: 2 Dissertação - Maisa Ribeiro - 2015.pdf: 1621645 bytes, checksum: 2b3a1e65f1e53b4a1264cf3febb2c630 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-09T12:41:15Z (GMT) No. of bitstreams: 2 Dissertação - Maisa Ribeiro - 2015.pdf: 1621645 bytes, checksum: 2b3a1e65f1e53b4a1264cf3febb2c630 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-09T12:41:15Z (GMT). No. of bitstreams: 2 Dissertação - Maisa Ribeiro - 2015.pdf: 1621645 bytes, checksum: 2b3a1e65f1e53b4a1264cf3febb2c630 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-02-19 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / In the lesions carcinomatous, low oxygen tension plays a crucial step in the self-renewal, metastatic potential, and therapy resistance of cancers. To adapt to the hypoxic microenvironment, neoplastic cells activate hypoxia-induced factor-1 alpha (HIF-1 alpha), which may mediates invasion and metastasis. In addition, the human THY-1 (CD90) cell surface protein mediates cell adhesion expressed in stem cells, and seens to drive tumor development in some malignant tumors. The present study investigates HIF-1 alpha (n=98) and CD90 (n=97) expression in oral squamous cell carcinoma (OSCC) and metastatic lymph nodes (n=24), the intratumoral region and the invasive front, by immunohistochemistry. Furthermore, clinicopathological data revised from the medical records. In superficial OSCCs, most tumor cells overexpressed HIF-1 alpha, whereas was restricted in the intratumoral region in invasive conventional SCCs. Interestingly, metastatic lymph nodes (91.7%, p=0.001), and intratumoral regions of its corresponding primary tumors (83.3%, p<0.001) were invaded by HIF-1 alpha-positive neoplastic cells. Overall survival was poor in patients with nodal involvement. CD90 was expressed mostly in microvessels and granulocyte cells similar to mast cells. These cells expressed CD90 mostly in the peritumoral region of invasive SCC (p<0.001). Microvessels CD90 positive were higher in the intratumoral region (p=0.032). Interesting, mast cell and microvessels positively correlated in OSCC (p=0.006; r²=0.077). In conclusion, hypoxic environment may facilitate regional metastasis and serve as a potential diagnostic and prognostic marker in OSCC primary tumors. Microvessels CD90 positive seems to promote tumor growth except in BSCC. Mast cell may occur via CD90 for tumor progression. / Nas lesões carcinomatosas a baixa tensão de oxigênio desempenha um passo crucial para a auto-renovação, potencial metastático, e resistência à terapia no câncer. Para se adaptar ao ambiente hipóxico, células neoplásicas ativam o fator induzido por hipóxia-1 alfa (HIF-1 alfa), que pode facilitar a invasão e metástase. Além disso, o THY-1 (CD90) humano, uma proteína de superfície celular expressa em células estaminais, medeia a adesão celular, e parece promover o desenvolvimento em alguns tumores malignos. O presente estudo analisou a expressão das proteínas HIF-1 alfa (n = 98) e CD90 (n = 97) no carcinoma espinocelular de boca (CEC de boca) e linfonodos metastáticos (n=24), na região intratumoral e no fronte de invasão, por meio de imunoistoquímica. Além disso os dados clinicopatológicos foram revisados a partir dos prontuários médicos e a sobrevida foi analisada. No CEC microinvasivo, a maioria das células tumorais apresentaram superexpressão do HIF-1 alfa, enquanto que no CEC invasivo a superexpressão foi restrita na região intratumoral. Verificou-se que em linfonodos metastáticos (91,7%, p = 0,001), e regiões intratumorais dos seus tumores primários correspondentes (83,3%, p <0,001) houve forte expressão do HIF-1 alfa em células neoplásicas. A sobrevida global foi pior em pacientes com metástase regional. A proteína CD90 foi expressa principalmente em microvasos e células de granulócitos semelhantes aos mastócitos. Estas células expressaram CD90 principalmente na região fronte de invasão do CEC invasivo (p<0,001). A média de microvasos CD90 positivo foi maior na região intratumoral (p=0,032). Interessantemente, mastócitos e microvasos foram positivamente correlacionados no CEC de boca (p=0,006; r²=0,077). Em conclusão, o ambiente hipóxico pode facilitar metástases regionais e funcionar como um potencial marcador de diagnóstico e prognóstico em tumores primários do CEC de boca. Os microvasos CD90 positivo parecem promover o crescimento do tumor, exceto no carcinoma escamoso basalóide (CEB). Os mastócitos ativados via CD90 podem contribuir com a progressão do tumor.

L’hypoxie désigne une baisse de la biodisponibilité en oxygène au niveau tissulaire. La combinaison de l’hypoxie intermittente et de l’hypercapnie est identifiée dans le cadre de plusieurs maladies respiratoires comme un élément physiopathologique déterminant. Cependant, des travaux de recherche suggèrent qu’une exposition à l’hypoxie hypo- ou normocapnique à l’éveil peut améliorer la santé cardiovasculaire. La combinaison d’une exposition hypoxique et de l’entraînement à l’effort est utilisée par les athlètes pour améliorer la performance sportive aérobie. Des études pilotes récentes y compris chez le malade chronique indiquent que l’exposition à l’hypoxie modérée au repos ou à l’effort chez le patient est susceptible d’induire des gains significatifs en termes de santé cardiovasculaire, de composition corporelle et de statut métabolique.Nous nous sommes intéressés aux effets cardiorespiratoires et tissulaires de l’exposition hypoxique normobarique chez le sujet sain et chez la personne en surpoids ou obèse présentant un risque ou des anomalies cardio-métaboliques. Nous avons étudié l’efficacité de 2 types de conditionnement au repos consistant en une hypoxie continue ou une hypoxie intermittente et un entraînement à l’effort hypoxique par comparaison à la situation normoxique. Nous avons tout d’abord étudié les effets d’une exposition hypoxique à court terme au repos chez 14 sujets sains. Nous avons ensuite étudié les effets cardiorespiratoires, tissulaires, vasculaires et métaboliques d’un programme de conditionnement hypoxique normobarique à moyen terme au repos chez 35 patients en surpoids ou obèse. Nous avons de plus réalisé chez 24 sujets sains une étude préliminaire afin de vérifier la faisabilité et de caractériser les réponses cardio-respiratoires et l’oxygénation tissulaire au cours d’un exercice aigu à charge constante d’intensité modérée ou intermittent intense en hypoxie comparé à une condition placébo normoxique. La dernière étude a consisté à étudier les conséquences cardiorespiratoires, tissulaires, vasculaires et métaboliques d’un programme d’entraînement à l’effort en hypoxie par rapport au même programme en normoxie chez 23 patients en surpoids ou obèses.L’étude réalisée chez le sujet sain met en évidence l’intérêt à court terme d’un conditionnement hypoxique intermittent au repos sur des variables associées aux risques cardiovasculaires (diminution de la pression artérielle systolique en normoxie et augmentation de la variabilité sinusale) et une modulation de l’hypoxie tissulaire. Nous avons montré chez le sujet sain que l’hypoxie combiné à l’exercice aigu provoque une diminution de l’oxygénation musculaire similaire mais une diminution de l’oxygénation du cortex préfrontal plus importante par comparaison à un effort normoxique à même intensité relative. Ensuite, chez le sujet en surpoids ou obèse, nous avons montré que le conditionnement hypoxique passif chronique induit une diminution de la pression artérielle diastolique de repos en normoxie, une augmentation de la réponse ventilatoire hypoxique et une diminution de la variabilité cardiaque (après conditionnement par hypoxie intermittente seulement) et que le conditionnement hypoxique actif chronique améliore l’aptitude maximale aérobie par rapport à une situation placébo normoxique.Les résultats obtenus montrent la faisabilité de plusieurs conditionnements hypoxiques prometteurs au plan vasculaire y compris chez le sujet en surpoids ou obèse limité à l’exercice musculaire. Le conditionnement hypoxique actif montre également des bénéfices accrus sur l’aptitude aérobie. Ces protocoles de conditionnement doivent être affinés en vue d’optimiser leur efficacité en termes de perte de poids et d’amélioration du risque cardio-vasculaire et métabolique dans des populations présentant une obésité associée à une morbidité cardio-métabolique. Ils représentent également une piste thérapeutique innovante dans d’autres pathologies chroniques / Hypoxia refers to a decrease in the oxygen bioavailability at the tissue level. The combination of intermittent hypoxia and hypercapnia is identified in several respiratory diseases as a critical pathophysiological element. However, research suggests that exposure to hypo- or normocapnic hypoxia can improve cardiovascular health. The combination of hypoxic exposure and exercise training has been used by athletes to improve aerobic exercise performance. Recent pilot studies in patients with chronic diseases indicate that exposure to moderate hypoxia at rest or during exercise is likely to induce significant gains in cardiovascular health, body composition and metabolic status.We investigated the effects of normobaric hypoxic exposure on cardiorespiratory and tissue function in healthy subjects, overweight or obese subjects at risk or with cardio-metabolic abnormalities. We assessed the efficacy of 2 types of passive hypoxic conditioning consisting in sustained hypoxia or intermittent hypoxia and hypoxic exercise training in comparison with normoxic condition. First, we assessed the effects of short-term hypoxic exposure at rest in 14 healthy subjects. Then, we evaluated the cardiovascular and metabolic effects of a 8-week normobaric hypoxic conditioning program at rest (intermittent or sustained hypoxia) in 35 overweight or obese patients, compared to placebo normoxic exposure. Next, we conducted a preliminary study in 24 healthy subjects to assess the acute responses to submaximal constant-load and high intensity interval cycling exercise performed in normoxia and in hypoxia. The last study aimed to compare the effect of an 8-week exercise training program performed either in normoxia or hypoxia on maximal aerobic capacity in overweight or obese subjects.In the healthy subject, we emphasized the rapid benefits of intermittent hypoxic conditioning on cardiovascular function (lower baseline systolic blood pressure and increased heart rate variability) and the modulation of tissue deoxygenation in response to hypoxia. We have also shown in healthy subjects that acute exercise (combined with hypoxia causes a similar decrease in muscle oxygenation but a greater prefrontal cortex deoxygenation compared to normoxic condition. Then, in the overweight or obese subject, we have shown that chronic passive hypoxic conditioning induces a decrease in diastolic blood pressure at rest in normoxia, an increase in the hypoxic ventilatory response and a decrease in heart rate variability after intermittent hypoxic conditioning only. In addition, chronic active (exercise training) hypoxic conditioning improves the maximal aerobic capacity compared to placebo normoxic training.Our results show the feasibility of several hypoxic conditioning strategies and their interesting effects on the vascular function in overweight/obese subjects presenting exercise limitations impeding exercise reconditioning. In addition, active hypoxic conditioning showed a greater effect on physical fitness than normoxic exercise training. These hypoxic conditioning strategies must be further optimized to improve their efficacy regarding weight loss and cardiometabolic morbidity in obese. They also represent promising therapeutic opportunities for other chronic diseases

Cognitive and psychosocial sequelae following hypoxic brain injury Abstract in English Hypoxic brain injury leads to neuronal necrosis and to other cerebral changes which may affect psychosocial functioning. Although the pathophysiology of cerebral hypoxia is multifactorial, and it is not possible to reliably describe the unified clinical picture of hypoxia patients, the most commonly described psychosocial consequences of cerebral hypoxia are cognitive impairment, increased anxiety and depressive symptoms. The aim of the present study is to characterize cognitive functioning and psychosocial changes of the patients exposing mild intermittent cerebral hypoxia (=chronic form of hypoxia, model of obstructive sleep apnea diagnosed by neurologist) and patients after severe one-time cerebral hypoxia (=acute form of hypoxia, model of cardiac arrest diagnosed by cardiologist). Regardless of the different etiology of particular hypoxia forms described in the theoretical part of the thesis, both forms may lead to neuronal death. In the experimental part we test a hypothesis comparing healthy individuals to patients with acute or chronic form of hypoxia in cognitive performance or anxiety and depressive symptoms. We document a decreased cognitive performance and higher level of state anxiety in a group of patients...

Contexte théorique : L’encéphalopathie hypoxique ischémique (EHI) est une condition du nouveau-né dans laquelle les mécanismes des variables métaboliques ne sont pas totalement compris. Cette population est particulièrement à risque d’hypo- ou d’hyperglycémie néonatales (HHN). Devant le manque de données sur le fonctionnement métabolique à la suite d’une EHI, cette étude vise à déterminer l’association entre une HHN et l’activité cérébrale mesurée par électroencéphalographie (EEG). Méthodologie : 49 participants avec EHI ont été recrutés au CHU Sainte-Justine peu après leur naissance. Ils ont été monitorés en continu à l’aide de l’EEG et des segments d’intérêt se retrouvant dans les 48 premières heures de vie ont été analysés. L’anormalité de l’activité cérébrale est déterminée selon une analyse quantitative du niveau de discontinuité caractérisée par une proportion de faibles amplitudes (seuils de 25, 15, 12,5, 10 et 7,5 uV) dans le tracé EEG. Les données de glycémie ont été recueillies de façon intermittente par le biais de prises de sang et de glucomètres de chevet. Les participants ont été répartis en 4 groupes : normoglycémie, hyperglycémie, hypoglycémie et glycémie variable (hypo- et hyper-). Résultats : L’analyse de covariation non -paramétrique a relevé une différence significative entre les ratios de discontinuité pour le seuil de 15 uV (F = 3,070 p = 0,037). Les analyses de comparaisons appariées ont montré une différence positive entre le groupe VARIABLE et le groupe contrôle (NORMO-) pour tous les seuils ainsi qu’une différence positive entre le groupe HYPER- et le groupe contrôle pour 4 des 5 seuils (25, 15, 12,5 et 7,5 uV). Aucune différence n’a été relevé entre le groupe HYPO- et le groupe contrôle pour tous les seuils. Conclusions : La variabilité glycémique et l’hyperglycémie seule ont été montrées comme étant associées à une activité cérébrale altérée caractérisée par un tracé de plus faible amplitude mesurée avec l’EEG. / Background: Hypoxic ischemic encephalopathy (HIE) is a newborn condition in which the underlying mechanisms still require further understanding. This clinical population is particularly prone to neonatal hypo- and hyperglycemia (NHH). Given the need to improve our understanding of metabolic functioning following HIE, this study aims to determine the association of NHH on the brain’s background electrophysiological activity measured by electroencephalography (EEG). Methodology: Forty-nine newborns with HIE were recruited at Sainte-Justine University Hospital Center. Continuous EEG monitoring was started as soon as possible and segments of interest in the first 48h of life were analyzed. Brain activity was quantitatively assessed according to an index of discontinuity characterized by the proportion of low EEG amplitudes per segment (< 25, 15, 12.5, 10 and 7.5 uV cutoffs). Glucose measurements were intermittently collected using blood samples and bedside glucometers and were retrospectively retrieved from medical charts. Participants were separated in 4 groups : normoglycemia, hyperglycemia, hypoglycemia and both (hyper- and hypo-). Results: The non-parametric covariance analyses revealed a significant difference between the discontinuity index for the 15 uV threshold (F = 3.070 p = 0.037). The pairwise comparisons showed a positive difference between the group BOTH and the control group (NORMO-) for every thresholds, the labile glucose group having a higher discontinuity index. A similar difference was found between the HYPERGLYCEMIA group and the control group for 4 out 5 thresholds (25, 15, 12.5 and 7.5 uV). No difference was found between the HYPOGLYCEMIA group and the control group. Conclusion: An abnormal glycemic profile, particularly glucose lability and hyperglycemia alone, were shown to be associated with abnormal brain activity characterized by a higher discontinuity index on the EEG.

The mammalian adrenal gland (or suprarenal gland) is a small organ located on the superior aspect of the kidney. The central region of the gland, the medulla, consists of chromaffin cells, which release catecholamines into the blood during periods of stress. This is best known as the 'fight or flight' response and is regulated, in the adult animal, by neuronal signals from the cholinergic sympathetic fibres of the splanchnic nerve. Interestingly, in some mammals, such as rat and human, sympathetic innervation is immature at birth, yet the chromaffin cells can still secrete catecholamines in response to physiological stessors, e.g. hypoxia. Increased plasma catecholamines is thought to provide a vital protective role for the neonatal animal during, and following birth. This is mediated in part by promoting lung fluid absorption, surfactant secretion, heart rate stabilization, and brown fat mobilization. The observation that, in the neonate, catecholamines are secreted in the absence of functional sympathetic innervation suggests that the chromaffin cells possess other mechanisms for directly 'sensing' a fall in blood O2 tension (hypoxia). The primary goal of this thesis was to uncover the mechanisms of oxygen-sensing in developing chromaffin cells from the rat and mouse, using primary short-term cell cultures of chromaffin cells. The experimental approaches relied on patch clamp techniques to record ionic currents and membrane potential, carbon fibre electrochemistry to record catecholamine secretion from cell clusters, and fluorescent indicators to measure reactive oxygen species generation. Hypoxic chemosensitivity was found in embryonic and neonatal, but not juvenile chromaffin cells from both the rat and mouse. Exposure to hypoxia or anoxia caused a reversible suppression of whole-cell current, which was comprised of the differential modulation of three K+ currents: (1) suppression of a large-conductance Ca2+-dependent K+ current; (2) suppression of a delayed rectifier K+ current; and (3) activation of an ATP-sensitive K+ current. Hypoxia also induced membrane depolarization that was not initiated by any of these three voltage-dependent K+ currents. Additionally, hypoxia broadened action potentials in chromaffin cells that showed spontaneous activity, and this was mediated by a prolongation of the time course of membrane repolarization. All of these factors likely contribute to catecholamine secretion by enhancing the influx of Ca2+ through depolarization-activated L-type Ca2+ channels. Two sets of experiments were designed to identify the oxygen sensor in neonatal chromaffin cells. First, cells from transgenic mice, deficient in the gp91^phox component of the putative O2-sensor protein, NADPH oxidase, responded to hypoxia in the same way as wild type cell, indicating that NADPH oxidase is not primarily responsible for oxygen sensitivity in these cells. Second, inhibitors of the proximal electron transport chain (e.g. rotenone and antimycin A) mimicked and attenuated the hypoxic response, while inhibitors of the distal electron transport chain (cyanide) and uncouplers of oxidative phosphorylation (2,4-dinitrophenol) had no effect. Furthermore, reactive oxygen species production, primarily H2O2, decreased during exposure to hypoxia or inhibitors of the proximal electron transport chain, revealing a potential mitochondrial mechanism for 'sensing' of the hypoxic stimulus. Reduced oxygen availability to the electron transport chain is proposed to cause a fall in cellular reactive oxygen species (ROS), principally H2O2. This fall in ROS signals closure of Ca2+-dependent and Ca2+-independent K+ channels, which causes broadening action potentials and increases Ca2+ influx. The latter is further enhanced by the hypoxia-induced membrane depolarization, which in turn increases the probability of cell firing. The rise in intracellular Ca2+ then acts as the signal for catecholamine release from the chromaffin cells. / Thesis / Doctor of Philosophy (PhD)

Le potentiel acoustique évoqué (PAE) est influencé par l’âge dans de nombreuses espèces. Chez l’homme, l’augmentation de la fréquence de stimulation améliore la détection des anomalies du tronc cérébral. Son utilisation chez le poulain demeure anecdotique. Les buts de cette étude étaient: 1) de déterminer les valeurs de référence du PAE pour 3 différents protocoles de stimulation (11.33 Hz/70 dBNHL; 11.33 Hz/90 dBNHL; 90 Hz/70 dBNHL); 2) d’évaluer les effets de l’âge et de la fréquence de répétition de la stimulation acoustique sur les tracés du PAE chez le poulain de moins de 6 mois; 3) de comparer les données obtenues chez les poulains normaux à celles recueillies chez des poulains présentant des troubles neurologiques. Trente-neuf poulains normaux et 16 poulains avec des déficits neurologiques ont été inclus dans l’étude. Aucun effet de l’âge n’a été mis en évidence (p> 0,005). Aucune différence significative n’a été mise en évidence lorsque les latences absolues et relatives des poulains neurologiques ont été comparées à celles des poulains normaux (p>0,005). L’augmentation de la fréquence de stimulation acoustique n’a pas amélioré la détection d’anomalies sur les tracés de PAE chez les poulains neurologiques. Bien que toutes leurs valeurs de latences absolues et relatives soient demeurées à l’intérieur des valeurs de référence, 78,6% des poulains avec un déficit neurologique présentaient une asymétrie entre les tracés des deux oreilles. Cela démontre une différence de conduction de l’influx nerveux entre le côté droit et le côté gauche du tronc cérébral chez ces sujets. En conclusion, nous présentons ici les valeurs de référence du PAE chez le poulain de moins de 6 mois pour 3 protocoles de stimulation différents. D’autres études seraient nécessaire afin de déterminer si l’utilisation d’une fréquence de stimulation acoustique plus élevée est utile dans la détection d’anomalies du PAE chez les poulains souffrant de troubles neurologiques. La majorité des poulains avec des déficits neurologiques ont présenté des anomalies du PAE ce qui valide son utilisation pour le diagnostic de troubles neurologiques chez le poulain de moins de 6 mois. / Age and rate of acoustic stimulation are reported to affect peak latencies in brainstem auditory evoked responses (BAER) in different species. In foals, its use remains quite anecdotic but, as in humans and dogs, could be useful in the early diagnosis of central nervous system (CNS) disorders. The goals of this study were to 1) establish the reference values for BAER in foals using 3 different stimulation protocols (11.33 Hz/70 dBNHL; 11.33 Hz/90 dBNHL; 90 Hz/70 dBNHL), 2) evaluate the effects of age and rate of stimulation on BAER traces in foals up to 6 months old, and 3) compare these data with BAER obtained from foals with CNS disorders. Thirty-nine neurologically normal foals and 16 foals with neurological deficits were included in this study. No effects of age were observed in normal foals (p> 0.005). No significant differences were observed for latencies and interpeak latencies (IPL) when neurological foals were compared to normal foals (p> 0.05). Increasing the stimulation rate did not improve detection of CNS disorders. All neurologically abnormal foals had latencies and IPL within reference values. However, 78.6% of them had an asymmetry in their traces, reflecting a difference in conduction time between the left and right size of the brainstem. In conclusion, we provide reference values of BAER for foals up to 6 months using 3 different protocols. Further investigations are needed to conclude on the use of an increased rate of acoustic stimulation in foals. Most importantly, most foals with neurological deficits had also an abnormal BAER. This proves BAER is useful is the early diagnosis of neurological disorders in foals