En dépit de 4 décennies d'utilisation et de bons résultats cliniques pour le traitement de douleurs neuropathiques réfractaires, l'implantation de neurostimulateurs pour la stimulation des cordons postérieurs (SCP) demeure marginale en raison de son caractère thérapeutique invasif et d'une compréhension partielle du mécanisme d'action analgésique. L'inclusion de sujets, ayant des critères bien définis de douleurs neuropathiques, et l'enregistrement comparatif de données neurophysiologiques (EVA, le réflexe RIII et les potentiels évoqués somesthésiques (PES)), avec le neurostimulateur hors fonction (SCP "off") puis en fonction (SCP "on"), nous permettra d'étudier et de différencier les mécanismes spinaux et supraspinaux. L'utilisation de la douleur expérimentale, produite par la stimulation du nerf sural du membre inférieur affecté, s'avère un excellent model expérimental pour démontrer les phénomènes neurophysiologiques induites par la SCP : l'efficacité sur la douleur expérimentale, la sommation temporelle, l'intensité du réflexe RIII et les variations de l'enregistrement des différentes ondes des PES. Les résultats obtenus sur 8 patients, opérés par l'auteur et présentant un soulagement clinique significatif, ne démontrent aucune différence significative sur les résultats obtenus en mode SCP "on" versus SCP "off" mais démontrent par l'interprétation de corrélations non-paramétriques sur l'efficacité clinique, que la SCP a un rôle spinal et supraspinal. L'effet spinal de la SCP est démontré par une diminution de la sommation temporelle de la douleur expérimentale, évaluée subjectivement par l'EVA et par une corrélation de l'amplitude du réflexe RIII avec l'efficacité clinique. Également, on suspecte que la SCP a un rôle supraspinal indépendant du rôle spinal, par la corrélation entre l'efficacité clinique et l'abaissement de N34 (P45) au niveau des PES. Cette onde à courte latence est le reflet d'une activation (para) thalamique, nous suggérant un rôle analgésique de la SCP que l'on pourrait définir comme un portillon thalamique ("thalamic gate control").

The work presented in this thesis investigates novel modalities to guide Transcranial Magnetic Resonance guided Focused Ultrasound (TcMRgFUS). TcMRgFUS is an emerging and promising non-invasive technique for the treatment of neurological disorders, such as essential tremor or Parkinsonian tremor. A novel Magnetic Resonance Acoustic Radiation Force Imaging (MRARFI) has been used to image the location of the ultrasonic beam produced by a preclinical prototype: an accelerated 2D spin-echo MR ARFI pulse sequence has been introduced to generate undistorted ultrasound-induced displacement maps in ex vivo veal brains with minimum energy deposition. We then investigated direct effects of the ultrasonic beam on brain activity by conducting in vivo ultrasonic neuromodulation, similarly to what is currently achieved with transcranial magnetic stimulation (TMS) but with the millimetric targeting capabilities of the ultrasound. Experiments have been first conducted in an anesthetized rat model to investigate the motor threshold. Numerical simulations have shown that the acoustic pattern in the rat head is affected by reverberations and that special care must be taken when relating acoustic parameters to neurostimulation effects, especially at a low frequency and for small animals. Finally, for the first time, we used low intensity FUS stimulation to causally modulate behavior in an awake nonhuman primate brain. We showed that the latency of an anti-saccade task was delayed significantly in the presence of ultrasonic beam focused in the Frontal Eye Field. Sham experiments did not show any significant change in the latencies.

Nerve cells are organized into complex networks that comprise the building blocks of our nervous system. Neurons communicate by transmitting messenger molecules released from synaptic vesicles. Alterations in neuronal circuitry and synaptic signaling contribute to a wide range of neurological conditions, often with consequences for movement. Intrinsic neuronal networks in the spinal cord serve to coordinate vital rhythmic motor functions. In spite of extensive efforts to address the organization of these neural circuits, much remains to be revealed regarding the identity and function of specific interneuron cell types and how neuromodulation tune network activity. In this thesis, two novel genes initially identified as markers for spinal neuronal populations were investigated: Slc10a4 and Dmrt3. The orphan transporter SLC10A4 was found to be expressed on synaptic vesicles of the cholinergic system, including motor neurons, as well as in the monoaminergic system, including dopaminergic, serotonergic and noradrenergic nuclei. Thus, it constitutes a novel molecular denominator shared by these classic neuromodulatory systems. SLC10A4 was found to influence vesicular transport of dopamine and affect neuronal release and reuptake efficiency in the striatum. Mice lacking Slc10a4 displayed impaired monoamine homeostasis and were hypersensitive to the drugs amphetamine and tranylcypromine. These findings demonstrate that SLC10A4 is capable of modulating the modulatory systems of the brain with potential clinical relevance for neurological and mental disorders. The transcription factor encoded by Dmrt3 was found to be expressed in a population of inhibitory commissural interneurons originating from the dorsal interneuron 6 (dI6) domain in the spinal cord. In parallel, a genome-wide association study revealed that a non-sense mutation in horse DMRT3 is permissive for the ability to perform pace among other alternate gaits. Further analysis of Dmrt3 null mutant mice showed that Dmrt3 has a central role for spinal neuronal network development with consequences for locomotor behavior. The dI6 class has been suggested to take part in motor circuits but remains one of the least studied classes due to lack of molecular markers. To further investigate the Dmrt3-derived neurons, and the dI6 population in general, a Dmrt3Cre mouse line was generated which allowed for characterization on the molecular, cellular and  behavioral level. It was found that Dmrt3 neurons synapse onto motor neurons, receive extensive synaptic inputs from various neuronal sources and are rhythmically active during fictive locomotion. Furthermore, silencing of Dmrt3 neurons in Dmrt3Cre;Viaatlx/lx mice led to impaired motor coordination and alterations in gait, together demonstrating the importance of this neuronal population in the control of movement.

Em pacientes com esquizofrenia, sintomas obsessivo-compulsivos (SOC) são associados com taxas mais baixas de qualidade de vida e polifarmácia. Não há estudos controlados anteriores testando a eficácia da estimulação magnética transcraniana repetitiva (EMTr) para o tratamento de SOC nesta população. Este trabalho examinou os efeitos terapêuticos da EMTr aplicadas à Área Motora Suplementar (1 Hz, 20 min, 20 sessões) em SOC e sintomas gerais em pacientes com esquizofrenia ou transtorno esquizoafetivo, e se esta intervenção pode produzir alterações nos níveis plasmáticos do fator neurotrófico derivado do cérebro (BDNF). Inicialmente, foi realizado um relato de três casos, com o objetivo de fornecer uma evidência inicial de eficácia. Dois dos três pacientes que participaram apresentaram redução da Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS), com retorno aos valores iniciais 4 semanas após o término do tratamento. Foi realizado então um estudo duplo-cego randomizado controlado por placebo para confirmação dos efeitos terapêuticos. EMTr ativa e placebo foram entregues para 12 pacientes (6 em cada grupo). Os escores da Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e da Escala Breve de Avaliação Psiquiátrica (BPRS), bem como os níveis de BDNF, foram avaliados antes, depois, e 4 semanas após as intervenções. A EMTr não alterou significativamente os resultados após o tratamento e no follow-up (Y-BOCS: Χ2 = 3,172; p = 0,205; BPRS: X2 = 1.629; p = 0,443; BDNF: X2 = 2.930; p = 0,231). Parece haver uma tendência para a melhoria da pontuação BPRS 4 semanas após o tratamento no grupo ativo comparando com placebo (d de Cohen = 0,875, com 32,9% de poder estatístico). Não foram relatados efeitos colaterais. São necessários estudos futuros com amostras maiores. / In patients with schizophrenia, obsessive-compulsive symptoms (OCS) are associated with lower rates of quality of life and polypharmacy. No previous controlled studies have tested the efficacy of repetitive transcranial magnetic stimulation (rTMS) on the treatment of OCS in this population. The present study examined the therapeutic effects of rTMS applied to the supplementary motor area (1 Hz, 20 min, 20 sessions) on OCS and general symptoms in patients with schizophrenia or schizoaffective disorder, and whether this intervention can produce changes in plasma levels of brain-derived neurotrophic factor (BDNF). Initially, there was a report of three cases with the aim of providing initial evidence of efficacy. Two patients showed a reduction on the Yale-Brown Obsessive-Compulsive Symptoms Scale (Y-BOCS) scores, with return to baseline 4 weeks after completion of treatment. Then, a double-blind randomized controlled trial was conducted. Active and sham rTMS were delivered to 12 patients (6 on each group). Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Brief Psychiatric Rating Scale (BPRS) scores, as well as BDNF levels, were assessed before, after, and 4 weeks after treatment. rTMS did not significantly change the outcomes after treatment and on the follow-up (Y-BOCS: Wald’s Χ2=3.172; p=0.205; BPRS: X2=1.629; p=0.443; BDNF: X2=2.930; p=0.231). There seemed to be a trend towards improvement of BPRS scores 4 weeks after rTMS treatment comparing with sham (Cohen’s d=0.875, with 32.9% statistical power). No side effects were reported. Future studies with larger sample sizes are needed.

abstract: Transcranial electrical stimulation (tES) is a non-invasive brain stimulation therapy that has shown potential in improving motor, physiological and cognitive functions in healthy and diseased population. Typical tES procedures involve application of weak current (< 2 mA) to the brain via a pair of large electrodes placed on the scalp. While the therapeutic benefits of tES are promising, the efficacy of tES treatments is limited by the knowledge of how current travels in the brain. It has been assumed that the current density and electric fields are the largest, and thus have the most effect, in brain structures nearby the electrodes. Recent studies using finite element modeling (FEM) have suggested that current patterns in the brain are diffuse and not concentrated in any particular brain structure. Although current flow modeling is useful means of informing tES target optimization, few studies have validated tES FEM models against experimental measurements. MREIT-CDI can be used to recover magnetic flux density caused by current flow in a conducting object. This dissertation reports the first comparisons between experimental data from in-vivo human MREIT-CDI during tES and results from tES FEM using head models derived from the same subjects. First, tES FEM pipelines were verified by confirming FEM predictions agreed with analytic results at the mesh sizes used and that a sufficiently large head extent was modeled to approximate results on human subjects. Second, models were used to predict magnetic flux density, and predicted and MREIT-CDI results were compared to validate and refine modeling outcomes. Finally, models were used to investigate inter-subject variability and biological side effects reported by tES subjects. The study demonstrated good agreements in patterns between magnetic flux distributions from experimental and simulation data. However, the discrepancy in scales between simulation and experimental data suggested that tissue conductivities typically used in tES FEM might be incorrect, and thus performing in-vivo conductivity measurements in humans is desirable. Overall, in-vivo MREIT-CDI in human heads has been established as a validation tool for tES predictions and to study the underlying mechanisms of tES therapies. / Dissertation/Thesis / Doctoral Dissertation Biomedical Engineering 2017

La dislessia evolutiva (DE) è associata ad un deficit di elaborazione temporale degli stimoli uditivi, secondario ad un'attività oscillatoria neurale atipica, che si ritiene contribuisca alle difficoltà fonologiche e di lettura. Per favorire un entrainment più accurato alle proprietà spettro-acustiche degli stimoli uditivi negli studenti con DE, abbiamo esplorato la possibilità di sincronizzare la prosodia durante la lettura con una stimolazione ritmica uditiva. Pertanto, è stato realizzato un programma di intervento per la DE, chiamato Training Lettura Ritmica (TLR). Tre studi test-training-retest hanno mostrato l'efficacia di questa nuova metodologia nel miglioramento delle capacità di lettura in individui italiani con DE, sia in età evolutiva che adulti. Lo studio 1 ha mostrato che il TLR ha portato a miglioramenti della lettura in studenti di scuola primaria e secondaria di primo grado con DE paragonabili a quelli di un intervento risultante dalla combinazione di due trattamenti già validati per la DE, con un effetto lievemente maggiore sulla rapidità di lettura. Inoltre, la consapevolezza fonologica e la capacità di riproduzione ritmica sono migliorate. Lo studio 2 ha esplorato gli effetti a breve e medio termine del TLR, quando combinato con un allenamento uditivo specifico in bambini e preadolescenti con DE, che sono risultati comparabili a quelli di un intervento multi-componenziale personalizzato. Infine, nello studio 3 il TLR è stato applicato con successo ad una popolazione adulta, ossia studenti universitari con DE, anche quando somministrato in combinazione a neuromodulazione (tDCS), la quale aumenta la plasticità delle aree coinvolte. / Developmental dyslexia (DD) is associated with deficiencies in temporal processing of auditory stimuli, depending on atypical oscillatory neural activity, that are considered to contribute to phonological and reading impairments. To induce a more accurate entrainment to the spectral properties of auditory stimuli in students with DD, we explored the possibility to synchronize speech prosody during reading with an external rhythmical auditory stimulation. Accordingly, an intervention program for DD, called Rhythmic Reading Training (RRT), was devised. Three test-training-retest studies supported the efficacy of this novel methodology on reading skills of both young and older populations of Italian individuals with DD. Study 1 showed that RRT yielded reading improvements in primary and junior high-school students with DD comparable to those of an intervention resulting from the combination of two already validated treatments for DD, with a slightly larger effect on reading speed. Moreover, phonological awareness and rhythm reproduction improved along. Study 2 explored RRT short- and medium-term effects when combined with a specific auditory training in children and preadolescents with DD, which were found to be comparable to those of a personalized multi-componential intervention. Finally, in study 3 RRT was successfully applied to an older population, namely undergraduate students with DD, also when in combination with a neuromodulation technique (namely, tDCS) boosting plasticity of the involved networks.

Em pacientes com esquizofrenia, sintomas obsessivo-compulsivos (SOC) são associados com taxas mais baixas de qualidade de vida e polifarmácia. Não há estudos controlados anteriores testando a eficácia da estimulação magnética transcraniana repetitiva (EMTr) para o tratamento de SOC nesta população. Este trabalho examinou os efeitos terapêuticos da EMTr aplicadas à Área Motora Suplementar (1 Hz, 20 min, 20 sessões) em SOC e sintomas gerais em pacientes com esquizofrenia ou transtorno esquizoafetivo, e se esta intervenção pode produzir alterações nos níveis plasmáticos do fator neurotrófico derivado do cérebro (BDNF). Inicialmente, foi realizado um relato de três casos, com o objetivo de fornecer uma evidência inicial de eficácia. Dois dos três pacientes que participaram apresentaram redução da Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS), com retorno aos valores iniciais 4 semanas após o término do tratamento. Foi realizado então um estudo duplo-cego randomizado controlado por placebo para confirmação dos efeitos terapêuticos. EMTr ativa e placebo foram entregues para 12 pacientes (6 em cada grupo). Os escores da Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e da Escala Breve de Avaliação Psiquiátrica (BPRS), bem como os níveis de BDNF, foram avaliados antes, depois, e 4 semanas após as intervenções. A EMTr não alterou significativamente os resultados após o tratamento e no follow-up (Y-BOCS: Χ2 = 3,172; p = 0,205; BPRS: X2 = 1.629; p = 0,443; BDNF: X2 = 2.930; p = 0,231). Parece haver uma tendência para a melhoria da pontuação BPRS 4 semanas após o tratamento no grupo ativo comparando com placebo (d de Cohen = 0,875, com 32,9% de poder estatístico). Não foram relatados efeitos colaterais. São necessários estudos futuros com amostras maiores. / In patients with schizophrenia, obsessive-compulsive symptoms (OCS) are associated with lower rates of quality of life and polypharmacy. No previous controlled studies have tested the efficacy of repetitive transcranial magnetic stimulation (rTMS) on the treatment of OCS in this population. The present study examined the therapeutic effects of rTMS applied to the supplementary motor area (1 Hz, 20 min, 20 sessions) on OCS and general symptoms in patients with schizophrenia or schizoaffective disorder, and whether this intervention can produce changes in plasma levels of brain-derived neurotrophic factor (BDNF). Initially, there was a report of three cases with the aim of providing initial evidence of efficacy. Two patients showed a reduction on the Yale-Brown Obsessive-Compulsive Symptoms Scale (Y-BOCS) scores, with return to baseline 4 weeks after completion of treatment. Then, a double-blind randomized controlled trial was conducted. Active and sham rTMS were delivered to 12 patients (6 on each group). Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Brief Psychiatric Rating Scale (BPRS) scores, as well as BDNF levels, were assessed before, after, and 4 weeks after treatment. rTMS did not significantly change the outcomes after treatment and on the follow-up (Y-BOCS: Wald’s Χ2=3.172; p=0.205; BPRS: X2=1.629; p=0.443; BDNF: X2=2.930; p=0.231). There seemed to be a trend towards improvement of BPRS scores 4 weeks after rTMS treatment comparing with sham (Cohen’s d=0.875, with 32.9% statistical power). No side effects were reported. Future studies with larger sample sizes are needed.

A sonotrombólise pela combinação de ultrassom (US) e microbolhas com medicamento trombolítico tem indicado grande eficácia na quebra de coágulos in vitro, devido a efeitos de cavitação. Contudo, estudos in vivo sobre drug delivery demonstram que a cavitação de microbolhas é também capaz de abrir local e transientemente a barreira hematoencefálica (BHE) - estrutura de permeabilidade seletiva que protege o Sistema Nervoso Central. Um estudo clínico sobre sonotrombólise foi interrompido precocemente devido a evolução de casos de Acidente Vascular Cerebral isquêmicos para hemorrágicos associados a danos na BHE e formação de ondas estacionárias. Nesta tese, foram realizados estudos in vitro e in vivo sobre técnicas de US multifrequencial para trombólise. Além disso, verificou-se os limiares para a abertura da BHE e efeitos de neuromodulação ambos causados pelo ultrassom transcraniano. Foi demonstrado que o duplo feixe de US e a variação temporal de frequências (excitação codificada) são capazes de reduzir a formação de ondas estacionárias e gerar regiões focais mais confinadas do que feixes focalizados monofrequenciais. O duplo feixe foi incapaz de gerar ondas de baixa frequência para trombólise (menor ou igual a 1 Pa para feixes primários de 1,58 MPa). Exames histológicos e por imagens de ressonância magnética mostraram que a cavitação de microbolhas pode causar danos ao tecido cerebral para níveis de pressão de mesma ordem necessários para se observar efeito trombolítico. Além disso, foi observado que o US é capaz de disparar atividade neuronal causando respostas motoras e indícios de respostas associadas a modulação de atividades cognitivas. A focalização de feixes por excitação multifrequencial é um grande avanço para sonotrombólise. Contudo, a potencialização do efeito trombolítico do US por cavitação e medicamento é limitada devido a danos a BHE e critérios de exclusão do medicamento. / Sonothrombolysis by combining ultrasound (US) and microbubbles with thrombolytic drugs has been demonstrated capable of breaking blood clots in in vitro studies, due to cavitation effects. However, in vivo drug delivery studies have demonstrated that cavitation of microbubbles is also capable of opening locally and transiently the blood-brain barrier (BBB) - structure with selective permeability that protects the Central Nervous System. A sonothrombolysis clinical study was interrupted prematurely because of the occurrence of intracerebral hemorrhages after treatment associated with damages in the BBB and standing waves formation. In this dissertation, in vitro and in vivo studies evaluated techniques of multifrequency US for thrombolysis. Furthermore, the ultrasound pressure threshold to obtain the BBB opening and neuromodulation effects were explored during transcranial insonation. It has been demonstrated that the double US beam and the time variation of frequencies (coded excitation) are capable of reducing standing wave formation and generating more confined focus zones than monofrequency focused beams. The double US beam was not capable of generating low frequency waves for thrombolysis (less than or equal to 1 Pa obtained from primary beams with 1.58 MPa). Histological exams and magnetic resonance images demonstrated that microbubbles cavitation can damage the brain tissue with acoustic pressures of the same level necessary to observe thrombolytic effects. Furthermore, it was observed motor responses and other responses associated with cognitive activity triggered by US. The capability of multifrequency excitation in focusing US beams is an important advance for sonothrombolysis. However, the enhancement of fibrinolytic effect of US by microbubbles cavitation and with thrombolytic drugs is limited by associated damages to the BBB and by exclusion criteria for the use of the thrombolytic drugs.

Adenosina e óxido nítrico, importantes neuromoduladores endógenos, atuam modulando finamente o controle neural cardiovascular no núcleo de trato solitário (NTS). Embora se tenha conhecimento sobre a relação entre adenosina e NO periférica e centralmente, em particular, no bulbo, os mecanismos pelos quais a adenosina interfere na dinâmica da neurotransmissão nitrérgica, ainda não são totalmente conhecidos. Logo, alterações na interação entre esses sistemas podem ser especialmente relevantes para indivíduos predispostos à hipertensão. Dessa forma, os objetivos do presente estudo foram estudar a interação entre o sistema adenosinérgico e nitrérgico em culturas de células da porção dorsomedial do bulbo de ratos normotenso Wistar Kyoto (WKY) e espontaneamente hipertensos (SHR). Para tal, utilizou-se técnicas para quantificação dos níveis de nitrito, PCR em tempo real e RNA de interferência. Foi observada uma redução e um aumento concentração-dependente nos níveis de nitrito e do mRNA da nNOS induzido pelos agonistas dos receptores A1(A1R) e A2A(A>sub>2AR), CPA e CGS21680, respectivamente. Os efeitos nos níveis de nitrito foram atenuados pela administração dos antagonistas seletivos dos A1R e A2AR, CPT e ZM241385. Knockdown dos A1R e A2AR mostraram que a redução da expressão desses receptores aumentaram e diminuíram os níveis de expressão da nNOS, respectivamente. Pré-tratamento com o inibidor não seletivo da nNOS, L-NAME, aboliu os níveis aumentados de nitrito desencadeados pelo CGS21680 em células de WKY e SHR. Por fim, é mostrado que a via cAMP-PKA está envolvida na sinalização que deflaga tantos os níveis reduzidos de nitrito, via A1R, quantos os níveis aumentados de nitrito, via A2AR, em culturas de WKY e SHR. Em síntese, nossos resultados destacam a influência da adenosina sobre a síntese de NO em culturas de células da porção dorsomedial do bulbo de ratos WKY e SHR. Pelo menos em parte, o perfil modulatório é diferenciado em ratos SHR / Adenosine and nitric oxide, important endogenous neuromodulators, act on the fine tuning regulation of neural cardiovascular control in the nucleus tractus solitarius (NTS). Although the relationship between adenosine and NO peripheral and centrally, is well established, in particular, in the oblongata medulla, the mechanisms by which adenosine interferes in the dynamics of nitrergic neurotransmission, is not completely understood. Thus, changes in the interaction between these systems may be especially relevant for individuals predisposed to hypertension. The aim of this study was to evaluate the interaction between the adenosinergic and nitrergic systems in cell culture from the dorsomedial medulla oblongata of Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR). This purpose was performed the quantification of nitrite level, RT-PCR analysis and RNA interference. We observed a concentration-dependent decrease and increase of nitrite and nNOS mRNA levels in cultured cells of WKY and SHR rats induced by agonists of adenosine A1 (A1R) and A2A receptor (A2AR), CPA and CGS21680, respectively. These effects in nitrite level were attenuated by the administration of the A1R and A2AR selective antagonist, CPT and ZM241385. Furthermore, knockdown of A1R and A2AR showed an increase and decrease of nNOS mRNA levels, respectively. The pretreatment with nonselective inhibitor of NOS, L-NAME, abolished nitrite-increased levels triggered by CGS 21680 in WKY and SHR cells. Finally, it is shown that the cAMP-PKA pathway is involved in A1R and A2AR -mediated decrease and increase in nitrite levels in SHR and WKY cells. In summary, our results highlight the influence of adenosine on nitric oxide levels in cultured cells from dorsal medulla oblongata of WKY and SHR rats. In part, the modulatory profile is different in the SHR strain

Esta tese está organizada basicamente em quatro capítulos. O Capítulo I aborda as linhas gerais do presente trabalho, onde o sistema nervoso é caracterizado por um mosaico de redes neurais altamente organizadas, as quais promovem o controle e a manutenção das atividades vitais do corpo humano. Redes neurais geneticamente enfraquecidas podem predispor os indivíduos a desenvolver diversas patologias. Moléculas neuromodulatórias podem atuar fortalecendo estas redes, colaborando com o controle destas doenças. O objetivo geral deste trabalho é estudar a ação de duas moléculas neuromodulatórias endógenas, a adenosina e a co-chaperona BAG-2, sobre redes neurais específicas associadas à hipertensão essencial e à doença de Azheimer, contribuindo, assim, para o melhor entendimento, controle e prevenção destas patologias. O Capítulo II analisa os possíveis efeitos da adenosina sobre o controle neural da pressão arterial associado à patologia da hipertensão essencial, especificamente no núcleo do trato solitário (NTS) de ratos normotensos (WKY) e espontaneamente hipertensos (SHR). O primeiro artigo científico do presente trabalho (Capítulo II) demonstra que os receptores A1 de adenosina, além de estarem distribuídos de forma heterogênea dentro do NTS estão aumentados em ratos hipertensos quando comparados a ratos normotensos. Esta diferença parece preceder o desenvolvimento da hipertensão nestes animais. O segundo artigo científico (Capítulo II) descreve que os receptores A1 de adenosina são capazes de aumentar tanto o número como a afinidade dos receptores alfa2-adrenérgicos dentro de núcleos específicos do NTS. Esta ação modulatória é diferenciada em ratos hipertensos quando comparados a ratos normotensos, sugerindo uma importante alteração associada à hipertensão nestes animais. No terceiro artigo científico (Capítulo II) foi observado que a ação modulatória desencadeada pelos receptores A1 de adenosina sobre os receptores alfa2-adrenérgicos é dependente de fosfolipase C (PLC) e parece, também, ser diferenciada em ratos hipertensos quando comparados a ratos normotensos. Neste contexto, os resultados destes três trabalhos sugerem que a ativação dos receptores A1 de adenosina, em certas condições, poderia estar sensibilizando sistemas hipotensores dentro de subnúcleos específicos do NTS através dos receptores alfa2-adrenérgicos utilizando fosfolipase C como mensageiro intracelular. Este mecanismo poderia estar associado ao desenvolvimento da hipertensão essencial. O Capítulo III analisa os possíveis efeitos da co-chaperona BAG-2 sobre a proteína Tau. Agregados desta proteína são uma das características histopatológicas marcantes encontradas no encéfalo de pacientes com mal de Alzheimer. Foi demonstrado no presente trabalho um elegante mecanismo de degradação da proteína Tau fosforilada, uma isoforma considerada tóxica para o ambiente intracelular, através da co-chaperona BAG-2. Esta molécula tem a capacidade de inibir a atividade da chaperona CHIP, uma ligase de ubiquitina, impossibilitando a ubiquitinação e conseqüente degradação da proteína Tau pela via proteossomo ubiquitina-dependente. Foi observado que a proteína BAG-2 se associa fisicamente à proteína Tau, alterando a via de degradação ubiquitina-dependente para uma via não muito usual, ubiquitina-independente. A supressão da proteína BAG-2 leva a um aumento nos níveis de Tau em neurônios e sua superexpressão, uma diminuição. Foi observado, também, que a supressão da proteína BAG-2 pode levar a formação de agregados filamentosos, sugerindo que o efeito modulatório da proteína BAG-2 poderia estar relacionado com a remoção dos agregados intracelulares encontrados em pacientes com a doença de Alzheimer. Concluindo, BAG-2 poderia ser um importante alvo farmacológico para o tratamento desta patologia. Por fim, o capítulo IV encerra o presente trabalho com considerações finais importantes para o estudo, prevenção e controle de patologias multifatoriais como a hipertensão essencial e a doença de Alzheimer. Este estudo sugere que a adenosina e a co-chaperona BAG-2 poderiam ser alvos farmacológicos interessantes, que em conjunto com outras subtâncias, poderiam colaborar com o fortalecimento de redes neurais geneticamente enfraquecidas as quais predispõem os indivíduos a desenvolver tais patologias / Adenosine has been shown to modulate cardiovascular control at the levels of the nucleus tractus solitarii (NTS). This study shows the distribution and density of adenosine A1 receptor within the nucleus tractus solitarii (NTS) of Wistar Kyoto (WKY) and spontaneously hypertensive (SHR) rats from birth to adulthood (1,15,30 and 90 day-old). [3H]DPCPX was used as a ligant for in vitro autoradiography. The NTS shows heterogeneous distribution of adenosine A1 receptor in dorsomedial/dorsolateral, subpostremal and medial/intermediate subnuclei. Adenosine A1 receptor decrease in dorsomedial/dorsolateral according to rostral-caudal levels of 15, 30 and 90 day-old WKY and SHR rats. On the other hand, those receptors increase in subpostremal according to rostral-caudal levels of 30 and 90 days old WKY, and of 15, 30 and 90 day-old SHR. Furthermore, adenosine A1 receptors are increased in SHR as compared with WKY in dorsomedial/dorsolateral of 30 and 90 day-old rats and in subpostremal of 15, 30 and 90 day-old rats. Surprisingly, even in 15 days old SHR rats when hypertension is not yet apparent, [3H]DPCPX values were increased. Finally, adenosine A1 receptors increase from 1 to 30 day-old rats. Medial/intermediate did not show any changes in adenosine A1 receptors according rostral-caudal levels, age or strain. In summary, our result highlights the importance of A1 adenosine system regarding the neural control of blood pressure and the development of hypertension. Adenosine is known to modulate neuronal activity within the nucleus tractus solitarii (NTS). The modulatory effect of adenosine A1 receptors on alpha2-adrenoceptors was evaluated by quantitative radioautography within NTS subnuclei and by neuronal culture using normotensive (WKY) and hypertensive (SHR) rats. Radioautography was used to perform saturation experiment in order to obtain alpha2-adrenoceptors binding parameters (Bmax, KD) in the presence of 3 concentrations of CPA, an adenosine A1 receptor agonist. Neuronal culture was performed to confirm radioautoraphic results. [3H]RX821002, an alpha2-adrenoceptor antagonist, was used as a ligand for both approaches. Dorsomedial/dorsolateral subnucleus of WKY showed an increase in Bmax values (21%) induced by 10nM of CPA. However, subpostremal subnucleus showed a decrease in KD, values (24%) induced by 10nM of CPA. SHR showed the same pattern of changes within the same nuclei as compared with WKY; however the modulatory effect of CPA was induced by 1nM (increased Bmax, 17%; decreased KD, 26%). Cell culture confirmed these results, since 10-[5M and 10[-7M of CPA promoted an increase in [[3[H]RX821002 binding of WKY (53%) and SHR cells (48%), respectively. DPCPX, an adenosine A1 receptor antagonist, was used to block the modulatory effect promoted by CPA on alpha2-adrenoceptors binding. In conclusion, our study show, for the first time, a specific cross talk between adenosine A1 receptors increasing the binding of alpha2-adrenoceptors within the NTS, which might be important to understand the complex autonomic response induced by adenosine within the NTS. In addition, changes in the interaction between receptors might be relevant to understand the development of hypertension. Adenosine acts at many sites to modulate neuronal activity. The nucleus tractus solitarii (NTS) is known as a major brain site in cardiovascular control. Previous studies from our group have shown the adenosine A1 receptors increase the binding of alpha2-adrenoceptors within the NTS, suggesting the important role of adenosine in cardiovascular control. The aim of the present study is to evaluate the intracellular signaling responsible for such process using brainstem cell culture of Wistar (WR) rats by means of binding assay. 8 different concentration of CPA (10[-4 to 10[-11), an A1 adenosine agonist, were used to modulate [[3[H]RX821002 binding, an alpha2-adrenoceptor antagonist. DPCPX, an A1 adenosine antagonist, was used to block the modulatory effect of CPA on [3VH]RX821002 binding. 10-5M of CPA promote an increase in [[3H]RX821002 binding. The intracellular cascade involved in such modulatory process were evaluated using different intracellular signaling molecules inhibitors and two queletors [SQ22536, an adenylyl cyclase (AC) inhibitor, U-73122, an phospholipase C (PLC) inhibitor, Xestospongin C, an IP3 receptor inhibitor, Ro318220, an protein kinase calcium dependent (PKC), BAPTA, an intracellular calcium quelator, EGTA, an extracelular calcium quelator]. U-73122, Xestospongin C, Ro3326 and BAPTA were capable to inhibit the effect promoted by adenosine A1 receptor on [3H]RX821002 binding suggesting a modulation PLC, PKC, IP3 and Ca2+ dependent pathway. In conclusion, our study show, for the first time, that adenosine A1 receptor modulates the alpha2-adrenoceptors through a non-canonical phospholipase C dependent pathway. This result might be important to understand the adenosine role within the NTS in cardiovascular control. Tau inclusions are a prominent feature of many neurodegenerative diseases including Alzheimer\'s disease. Their presence suggests a failure in Tau degradation. The components of a Tau protein triage system consisting of CHIP/Hsc70 and other chaperones and co-chaperones have begun to emerge. However, the site of triage and the master regulatory elements have not yet been described. We have discovered an elegant mechanism of Tau degradation involving the co-chaperone BAG-2. BAG-2 binds to CHIP inhibiting its activity as an ubiquitine ligase preventing Tau ubiquitination. Tau bound to the microtubule and recruits BAG-2 where it clears Tau through an ubiquitin-independent proteossoma 20S dependent pathway. BAG-2 acts on Tau at precisely the site where it undergoes phosphorylation-dependent binding to the microtubule, more importantly, where it becomes vulnerable to misfolding and aggregation. Under conditions of proteasomal 26S blockade, Tau undergoes caspase mediated degradation. BAG-2 represents a critical point in clearing Tau that is prone to assembling into filaments. The suppression of BAG-2 leads to increased phosphorilated tau in neurons and its over-expression decreases phosphorilated tau.