Introdução: O tratamento da Insuficiência Venosa Crônica (IVC) é baseado na correção dos refluxos e obstruções ao fluxo sanguíneo venoso. A detecção, a gravidade e o tratamento dessas obstruções venosas, responsáveis pelos sinais e sintomas da IVC, têm sido recentemente estudados e melhor compreendidos. Estes estudos não definem qual o grau de obstrução significativa nem os critérios ultrassonográficos para sua detecção. O objetivo deste estudo foi determinar critérios ultrassonográficos para o diagnóstico das obstruções venosas ilíacas, avaliando a concordância deste método com o ultrassom intravascular (UI) em pacientes portadores de IVC avançada. Métodos: Foram avaliados 15 pacientes (30 membros; 49,4 ± 10,7 anos; 1 homem) com IVC inicial (Classificação Clínica-Etiológica-Anatômica-Physiopatológica - CEAP C1-2) no grupo I (GI) e 51 pacientes (102 membros; 50,53 ± 14,5 anos; 6 homens) com IVC avançada (CEAP C3-6) no grupo II (GII) pareados por sexo, idade e etnia. Todos pacientes foram submetidos à entrevista clínica e à ultrassonografia vascular com Doppler (UV-D), sendo obtidas as medidas de fasicidade de fluxo, os índices de fluxo e velocidades venosas femorais, e as relações de velocidade e de diâmetro da obstrução ilíaca. Foi analisado o escore de refluxo multisegmentar. Os indivíduos do GI foram avaliados por 3 examinadores independentes. Os pacientes do GII foram submetidos ao UI, sendo obtidos a área dos segmentos venosos comprometidos e comparados com os resultados obtidos pelo UV-D, agrupados em 3 categorias: obstruções < 50%; obstruções entre 50-79% e obstruções >= 80%. Resultados: A classe de severidade clinica CEAP predominante no GI foi C1 em 24/30 (80%) membros, e C3 em 54/102 (52,9%) membros no GII. O refluxo foi severo (escore de refluxo multisegmentar >= 3) em 3/30 (10%) membros no grupo I, e em 45/102 (44,1%) membros no grupo II (p<0,001). Houve uma concordância moderadamente elevada entre o UV-D e o UI, quando agrupadas em 3 categorias (K=0,598; p<0,001), e uma concordância elevada quando agrupadas em 2 categorias (obstruções <50% e >= 50%) (K= 0,784; p<0,001). Os melhores pontos de corte e sua correlação com o UI foram: índice de velocidade (0,9; r=-0,634; p<0,001); índice de fluxo (0,7; r=-0,623; p<0,001); relação de obstrução (0,5; r=0,750; p<0,001); relação de velocidade (2,5; r= 0,790; p<0,001); A ausência de fasicidade de fluxo esteve presente em 88,2% dos pacientes com obstrução >=80% ao UV-D. Foi construído um algoritmo ultrassonográfico vascular, utilizando as medidas e os pontos de corte descritos obtendo-se uma acurácia de 79,6% para 3 categorias (K=0,655; p<0,001) e de 86,7% para 2 categorias (k=0,730; p<0,001). Conclusões: O UV-D apresentou uma concordância elevada com o UI na detecção de obstruções >= 50%. A relação de velocidade na obstrução >= 2,5 é o melhor critério para detecção de obstruções venosas significativas em veias ilíacas. / Introduction: The treatment of Chronic Venous Insufficiency (CVI) is based on correction of reflux and obstruction of venous blood flow. The detection, severity and treatment of venous obstructions, responsible for signs and symptoms of CVI have been recently studied and better understood. These studies did not define the degree of significant obstruction or the sonographic criteria for its detection. The purpose of this study was to determine the sonographic criteria for diagnosis of iliac venous outflow obstruction by assessing the correlation of this method with intravascular ultrasound (IVUS) in patients with advanced chronic venous insufficiency (CVI). Methods: The evaluation included 15 patients (30 limbs, age 49.4 ± 10.7 years; 1 man) with initial CVI symptoms (Clinical-Etiology-Anatomy-Pathophysiology classification - CEAP C1-2) in group I (GI) and 51 patients (102 limbs, 50.53 ± 14.5 years, 6 men) with advanced CVI symptoms (CEAP C3-6) in group II (GII). Patients from both groups were matched by gender, age and ethnicity. All patients underwent a clinic interviews and Duplex Ultrasound (DU), measuring the flow phasicity, the femoral volume flows and velocities, and the velocities and obstructions ratios in the iliac vein. The Reflux Multisegment Score were analyzed. Three independent observers evaluated individuals in GI. GII patients were submitted to IVUS, in which the area of the impaired venous segments was obtained and compared to the DU results, and then grouped into 3 categories: obstructions < 50%; obstructions between 50 and 79% and obstructions >= 80%. Results: The predominant clinical severity CEAP class was C1 in 24/30 (80%) limbs in GI and C3 in 54/102 (52.9%) limbs in GII. Reflux was severe (reflux multisegment score >= 3) in 3/30 (10%) limbs in GI and 45/102 (44.1%) limbs in GII (p<0.001). There was a moderately high agreement between DU and IVUS findings when grouped into 3 categories (k= 0.598; p<0.001), and high agreement when grouped into 2 categories (obstructions <50% and >= 50%) (k=0.784; p<0.001). The best cut-off points and their correlation with IVUS were 0.9 for the velocity index (r =-0.634; p< 0.001); 0.7 for the flow index (r=-0.623; p<0.001); 0.5 for the obstruction ratio (r=0.750; p<0.001), and 2.5 for the velocity ratio (r=0.790; p<0.001). Absence of flow phasicity was observed in 62.5% of patients with obstructions >= 80%. An ultrasound algorithm was created using the measures and the described cut-off points with accuracy of 86.7% for detecting significant obstructions (>= 50%) with high agreement (k=0.73; p< 0.001). Conclusions: DU presented high agreement with IVUS for detection of obstructions >= 50%. The velocity ratio in obstructions >= 2.5 is the best criteria for detection of significant venous outflow obstructions in iliac veins.

Hemólise intravascular, causada pelo envenenamento por aranhas Loxosceles, é dependente da ação da esfingomielinase D, toxina do veneno que se liga à membrana dos eritrócitos e ativa proteases responsáveis pela clivagem de glicoforinas, tornando as células sensíveis à ação lítica do Sistema Complemento autólogo. O objetivo do estudo foi identificar possíveis proteases envolvidas nesse processo. A toxina foi expressa, purificada e apresentou suas funções biológicas ativas. O tratamento de eritrócitos humanos com a toxina removeu glicoforinas da membrana, não teve ação sobre Kell, CD59, DAF e CR1 e induziu a deposição de C1q, C3, C4, C5b-9, fator B e properdina. O pré-tratamento das células com os inibidores galardina, bestatina e fenantrolina reduziu a hemólise dependente de complemento autólogo. A ativação de proteases das membranas sobre o substrato fluorescente Abz-FRSSR-EDDnp, induzida pela toxina, foi prevenida por PMSF, simvastatina e fenantrolina, sugerindo o envolvimento de metalo- e serinoproteases no modelo de hemólise dependente de complemento estudado. / Intravascular hemolysis caused by poisoning by spiders Loxosceles, is dependent on the sphingomyelinase D action, a toxin that binds to the erythrocytes membrane and activates proteases responsible for the glycophorins cleavage, rendering the cells sensitive to the lytic action of the autologous complement system. This study aimed to identify possible membrane proteases involved in this process. The toxin was expressed, purified and showed to be functionally active. Treatment of human erythrocytes with the toxin caused the removal of the membrane glycophorins, but did not act on Kell, CD59, DAF and CR1 and induced deposition of C1q, C3, C4, C5b-9, factor B and properdin. Pretreatment of cells with inhibitors galardin, phenanthroline and bestatin reduced the complement-dependent hemolysis. The action of membrane proteases upon the fluorescent substrate Abz-FRSSR-EDDnp, induced by the toxin, was prevented by PMSF, simvastatin, and phenanthroline, suggesting the involvement of metallo- and serine proteases in this complement-dependent hemolysis model.

Acute necrotizing pancreatitis (ANP) is a common gastrointestinal cause of emergency admissions in dogs and humans and can lead to a systemic inflammatory response syndrome resulting in multiple organ dysfunction syndrome. Among the various complications associated with ANP, acute lung injury (ALI) or its more severe form, acute respiratory distress syndrome (ARDS), are major contributors leading to high mortality rates associated with severe acute pancreatitis (AP) in human patients. The incidence of ALI/ARDS in ANP dogs is not well characterized. However, signs of respiratory complications have been reported clinically in dogs suffering from AP. The pathophysiology of ANP and its systemic complications in dogs and humans are not well understood. Most of the data related to AP comes from rodent models of AP, which may not always represent the true mechanisms occurring in the lungs of dogs or humans with ANP. I decided to undertake evaluation of pancreas and lungs from dogs (N=21) that died of ANP. The cases were selected through the search of the medical records of the Veterinary Medical Center of the Western College of Veterinary Medicine (WCVM). Six healthy SPCA dogs were used as controls. The histology of pancreas was first graded to record the range of ANP severities within dog cases included in this study. Then, characterization of lung inflammation was done with histological grading and qualitative analysis of immunohistochemical staining for von Willebrand Factor (vWF), Toll-Like Receptor-4 (TLR4), interleukin-6 (IL6), and inducible nitric oxide synthase (iNOS). Quantification of the recruitment of septal macrophages in the lungs, designated as pulmonary intravascular macrophages (PIMs), in ANP dogs was achieved by counting the number of positive cells in alveolar septa using a macrophage antibody (MAC387). The results revealed that dogs suffering from ANP have variable lung inflammation, which was characterized by a significant infiltration of mononuclear phagocyte cells in the alveolar septa of all ANP dogs (median, 138; range 31-935) compared to control dogs (median: 1.5; range 0-16; p < 0.001), which suggested that PIMs are induced in ANP. In addition, robust staining for vWF in alveolar septal capillaries in lungs of ANP dogs suggested a strong microvascular inflammatory response. Finally, TLR4, IL6, and iNOS expression was increased in lungs of ANP dogs compared to control dogs. The second study was to investigate whether PIMs are induced in a mouse model of L-arginine-induced ANP. Therefore, lungs of L-arginine treated mice (n=7 per time point) were evaluated at various time points (24 hours, 72 hours and 120 hours) using histology and immunohistochemical staining for CD68 cells and vWF. Nine control mice were used. Counting of CD68-positive cells in the lungs of mice treated with L-arginine showed increased numbers of mononuclear phagocytes in alveolar septa at every time point (p<0.001). Also, the lung’s vasculature from L-arginine-treated mice showed increased vWF staining. Taken together, the data showed that ANP in dogs caused significant recruitment of PIMs, increased expression of vWF, TLR4, IL-6, and iNOS suggesting presence of lung inflammation. The mouse model of L-arginine-induced ANP also showed recruitment of PIMs and increased vascular expression of vWF suggesting that this model may be relevant to study the mechanisms of PIMs recruitment and their functions in lung physiology associated with ANP.

La Lipoprotéine lipase (LPL) est une enzyme essentielle de la lipolyse intravasculaire dont la régulation est complexe. La découverte des miRs, régulateurs de l'expression posttranscriptionnelle des gènes via leurs interactions avec les régions 3' non traduite (3'UTR), apporte de nouvelles perspectives pour la compréhension de la régulation de la LPL et de ses gènes régulateurs. Nous présentons à travers deux études, l'implication des microARNs (miRs) dans la régulation de la LPL et d'un de ses gènes activateurs APOA5. Dans le premier travail, nous avons mis en évidence la création d'un site de liaison fonctionnel du miR-485-5p par expliquons ainsi le mécanisme potentiellement impliqué dans l'association de ce polymorphisme aux hypertriglycéridémies sévères et modérées en population générale. Dans un second travail, nous avons identifié un haplotype de la LPL, incluant la mutation p.Ser474Ter (rs328) et sept single nucleotide polymorphisme (SNPs) de la région 3'UTR, significativement associés à une diminution des triglycérides (TG) plasmatiques en population générale. Nous avons ensuite démontré la fonctionnalité des sept SNPs de la région 3'UTR par la suppression de sites de liaison de plusieurs miRs. Ainsi ces résultats suggèrent que l'association du variant p.Ser474Ter (rs328) à la triglycéridémie pourrait au moins partiellement être liée à son déséquilibre de liaison avec les sept SNPs fonctionnels de la région 3'UTR. Nos travaux sont parmi les premiers à mettre en évidence l'implication des miRs dans la régulation de la LPL et de ses gènes régulateurs chez l'homme. Ils permettent ainsi d'accroitre la connaissance des mécanismes impliqués dans la régulation de la lipolyse intravasculaire. Enfin, ils éclairent les mécanismes fonctionnels mis en jeu par deux polymorphismes significativement associés à la triglycéridémie / The lipoprotein lipase (LPL) is a key enzyme which regulates plasma triglycerides (TG) intravascular lipolysis involving a complex regulation. The microRNAs (miR) are implicated in gene post-transcriptional regulation through their interaction with the 3’untranslated region (3’UTR). Their discovery provides new insights in the understanding of the LPL regulation and its regulator genes. We present two works regarding the implication of miRs in the regulation of the LPL and one of its activator APOA5. First, we identified a functional miR-485-5p binding site creation induced by the minor C allele of the c.*158C>T (rs22667882) located in APOA5 3’UTR.We therefore provide an explanation of the mechanism potentially involved in this polymorphism association with both mild and severe hypertriglyceridemia in general population. In a second work, we identified a LPL haplotype harboring p.Ser474Ter (rs328) polymorphism and seven single nucleotide polymorphisms (SNPs) located in the 3’UTR. This haplotype is significantly associated with lower plasma triglycerides (TG) concentration in general population. We demonstrated that the SNPs located in the 3’UTR induce several functional miRs binding-site suppressions that could lead to an increase of LPL expression. Finally, p.Ser474Ter association with triglyceridemia could be at least partially explained by its strong linkage disequilibrium with these functional 3’UTR SNPs. These works are amongst the first studies to bright to light the miRs implication in the regulation of LPL or its regulator genes in human. They provide a better knowledge of the mechanisms involved in intravascular lipolysis. Finally, they also explain the functional mechanisms of two polymorphisms, significantly associated with the plasma TG concentration

The application of high frequency ultrasound is the key to higher resolution intravascular ultrasound (IVUS) images. The need to further improve the IVUS spatial resolution may drive the transducer center frequency even higher than the current 40 MHz range. However, increasing the center frequency may be challenging as it leads to stronger scattering echoes from blood. The high level of blood scattering echoes may obscure the arterial lumen and make image interpretation difficult. Blood backscatter levels increase with transmission center frequency at a much greater rate compared to arterial tissue. These different frequency dependencies provide a potential method to distinguish blood from tissues by means of multi-frequency processing techniques. To obtain a good blood-tissue contrast with sufficient signal-to-noise ratio, a system with a wider bandwidth is highly desirable. The method described in this paper is based on the ratio of the received signal power between the high (60 MHz) and low (25 MHz) frequency ranges from a novel 40 MHz wideband IVUS catheter. In this paper we will present our in vitro experiment work on porcine blood and a tissue-mimicking arterial wall. Results of multi-frequency processing indicate that blood, at higher frequencies, has a greater backscatter power that is 8X greater than arterial tissue, suggesting this technique will provide a greater contrast between the blood-wall lumen boundary for coronary imaging.

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis-induced hospitalization in young children. A natural RSV infection fails to elicit long-lasting immunity, further increasing the need for an effective vaccine. Despite the significant healthcare burden, there is no licensed RSV vaccine currently available. While most RSV vaccine strategies focus on the induction of humoral immunity, high antibody titers do not prevent RSV infection. It remains unclear if protective immunity can be achieved through robust cellular immunity. Previous work has indicated that a relatively low frequency of virus-specific CD8 T cells is induced following an RSV infection in human infants. In addition, RSV-specific memory CD8 T cells diminish to almost undetectable frequencies in the blood of the elderly. The lack of long-lasting immunity against RSV may be explained by an absence or low frequency of memory CD8 T cells within the lung following infection. However, I determined that the majority of effector CD8 T cells reside within the lung tissue following infection with either RSV or influenza A virus (IAV), both of which replicate primarily in the airways. In addition, approximately 70% of antigen-experienced memory CD8 T cells persist in the lung tissue at day 30 following RSV infection. In contrast, the majority of CD8 T cells remain in the pulmonary vasculature following intranasal infection with either of the systemically replicating viruses lymphocytic choriomeningitis virus or vaccinia virus. Therefore, the tissue tropism of a virus will determine if CD8 T cells preferentially accumulate in the lung tissue following infection of the respiratory tract. An experimental formalin-inactivated RSV (FI-RSV) vaccine caused enhanced respiratory disease in vaccinated children following a natural RSV infection. Incomplete knowledge of the underlying immunological mechanisms that were responsible for mediating the enhanced disease has greatly hampered vaccine development. Previous studies have indicated that eosinophils, non-neutralizing antibodies, and CD4 T cells may be required to elicit FI-RSV vaccine-enhanced disease. I determined that distinct CD4 T cell subsets mediate individual disease parameters. The Th2-biased immune response, but not eosinophils specifically, was responsible for induction of airway hyperresponsiveness and mucus hypersecretion. On the other hand, the Th1-associated pro-inflammatory cytokine TNF-α was required to mediate baseline pulmonary dysfunction and weight loss. Lastly, while depletion of CD4 T cells ameliorated all disease parameters evaluated, the antibody titers remained unaltered in depleted mice. Thus, antibodies induced by FI-RSV immunization were not required for vaccine-enhanced disease. My data demonstrate that discrete disease manifestations associated with FI-RSV immunization are orchestrated by distinct subsets of CD4 T cells. The CD8 T cell response is believed to contribute to both pathogen clearance and immunopathology following an acute RSV infection. However, it is unclear if robust memory CD8 T cell responses will protect against an RSV infection. I determined that induction of a high-magnitude, epitope-specific memory CD8 T cell pool mediated increased viral clearance following RSV challenge. However, mice with robust secondary CD8 T cell responses exhibit increased airway dysfunction, weight loss, and mortality as compared to mock-immunized mice undergoing an acute RSV infection. The enhanced disease severity was unique to the context of an RSV infection as similarly immunized mice were protected from chge with a lethal dose of a recombinant IAV engineered to express an RSV-derived epitope. In addition, the increased morbidity and mortality was associated with an elevated amount of both IFN-γ and TNF-α in the serum of immunized mice. Neutralization of either IFN-γ or TNF-α led to a significant reduction in disease severity and survival of all mice. These results demonstrate that robust memory CD8 T cell responses enhance viral clearance, but also lead to severe pulmonary immunopathology following RSV infection. Overall, I establish that the majority of effector CD8 T cells are localized within the lung tissue following a respiratory infection, and determine that either memory CD4 or CD8 T cell responses elicits severe immunopathology following a RSV infection.

Close integration of front-end electronics and the transducer array within the catheter is critical for successful implementation of CMUT-based intravascular ultrasound (IVUS) imaging catheters to enable next generation imaging tools. Therefore, this research developed and implemented custom-designed electronic circuits and systems integrated with an IC compatible transducer technology for realization of miniature IVUS imaging catheters operating at 10-50 MHz frequency range. In one path of this research, an IC is custom designed in a 0.35-um CMOS process to monolithically integrate with a CMUT array (CMUT-on-CMOS) to realize a single-chip, highly-flexible, forward-looking (FL) IVUS imaging system. The amplifiers that are custom-designed achieved transducer thermal-mechanical noise dominated receive performance in a CMUT-on-CMOS implementation. In parallel to the FL-IVUS effort, for realization of a side-looking IVUS catheter based on an annular phased array, a dynamic receive beamformer IC is custom designed also in a 0.35-um CMOS process. Overall, the circuits and systems developed as part of this dissertation form a critical step in the translation of the research on CMUT-based IVUS catheters into real clinical applications for better management of coronary arterial diseases.

ABSTRACT Heaves is triggered by exposure to dust and its components, such as endotoxin, and is characterized by clinical signs such as coughing, decreased exercise tolerance, difficulty breathing and abnormal lung sounds which are due to bronchoconstriction and accumulation of neutrophils in the airways. Pulmonary intravascular macrophages (PIMs) are believed to increase horses sensitivity to endotoxemia-induced lung inflammation. The first objective of this study was to investigate a hitherto unknown role of PIMs in equine heaves. I used mouldy hay (MH) to induce heaves and gadolinium chloride (GC) to deplete PIMs in order to compare responses between non-treated and GC-treated heaves horses. A modified randomized crossover study (2X2 factorial) was conducted in which mares (N=9) were exposed to 4 different treatments: alfalfa cubes (Cb), alfalfa cubes + GC (Cb-GC), mouldy hay (MH) and MH + GC (MH-GC). Each treatment was followed by broncholaveolar lavage (BAL). MH was fed for 7 days to induce heaves followed by Cb for 21 days to achieve remission, whereas the treatments in which heaves was not induced (Cb; Cb-GC), the cubes were fed prior to the BAL and for 14 days after the BAL to allow recovery from the BAL procedure. BAL fluids were processed to investigate total cell, neutrophil and alveolar macrophage concentrations. In addition, TNFá protein levels as well as TNFá, IL-8, and TLR4 mRNA expression in BAL cells were assessed in order to infer on their activation state.<p> Data showed higher concentration of dust (3X), endotoxin (20X), and endotoxin per milligram of dust (7X) in MH compared to the Cb environment. Clinical scores and neutrophil concentrations in BAL were higher when mares received MH compared to MH and GC (MH-GC). Real time reverse transcriptase PCR revealed a significant lower expression of IL-8 and TLR4 mRNA in BAL cells from MH-GC mares compared to MH. TNFá mRNA expression as well as protein concentration were not affected by the different treatments. In vitro secondary LPS challenge significantly increased IL-8 mRNA expression in cells from MH treatment compared to without LPS, but not in the MH-GC treatment. TLR4 expression was not affected by the secondary challenge. Although secondary LPS challenge increased expression of TNFá mRNA and protein, the differences among treatment groups were not meaningful. In conclusion, PIM depletion attenuates clinical scores, migration of inflammatory cells into the alveolar space and expression of pro-inflammatory molecules in BAL cells of heaves horses.<p> The observations on the role of PIMs in heaves in horses prompted me to examine the occurrence of PIMs in human lungs. I found a trend for higher numbers of septal macrophages in autopsied lungs from human patients who died of non-pulmonary pathologies compared to those having either COPD or asthma. If these septal macrophages indeed represent the PIMs, this finding is contrary to existing belief that humans, unlike horses, do not have PIMs.

ABSTRACT Heaves is triggered by exposure to dust and its components, such as endotoxin, and is characterized by clinical signs such as coughing, decreased exercise tolerance, difficulty breathing and abnormal lung sounds which are due to bronchoconstriction and accumulation of neutrophils in the airways. Pulmonary intravascular macrophages (PIMs) are believed to increase horses sensitivity to endotoxemia-induced lung inflammation. The first objective of this study was to investigate a hitherto unknown role of PIMs in equine heaves. I used mouldy hay (MH) to induce heaves and gadolinium chloride (GC) to deplete PIMs in order to compare responses between non-treated and GC-treated heaves horses. A modified randomized crossover study (2X2 factorial) was conducted in which mares (N=9) were exposed to 4 different treatments: alfalfa cubes (Cb), alfalfa cubes + GC (Cb-GC), mouldy hay (MH) and MH + GC (MH-GC). Each treatment was followed by broncholaveolar lavage (BAL). MH was fed for 7 days to induce heaves followed by Cb for 21 days to achieve remission, whereas the treatments in which heaves was not induced (Cb; Cb-GC), the cubes were fed prior to the BAL and for 14 days after the BAL to allow recovery from the BAL procedure. BAL fluids were processed to investigate total cell, neutrophil and alveolar macrophage concentrations. In addition, TNFá protein levels as well as TNFá, IL-8, and TLR4 mRNA expression in BAL cells were assessed in order to infer on their activation state.<p> Data showed higher concentration of dust (3X), endotoxin (20X), and endotoxin per milligram of dust (7X) in MH compared to the Cb environment. Clinical scores and neutrophil concentrations in BAL were higher when mares received MH compared to MH and GC (MH-GC). Real time reverse transcriptase PCR revealed a significant lower expression of IL-8 and TLR4 mRNA in BAL cells from MH-GC mares compared to MH. TNFá mRNA expression as well as protein concentration were not affected by the different treatments. In vitro secondary LPS challenge significantly increased IL-8 mRNA expression in cells from MH treatment compared to without LPS, but not in the MH-GC treatment. TLR4 expression was not affected by the secondary challenge. Although secondary LPS challenge increased expression of TNFá mRNA and protein, the differences among treatment groups were not meaningful. In conclusion, PIM depletion attenuates clinical scores, migration of inflammatory cells into the alveolar space and expression of pro-inflammatory molecules in BAL cells of heaves horses.<p> The observations on the role of PIMs in heaves in horses prompted me to examine the occurrence of PIMs in human lungs. I found a trend for higher numbers of septal macrophages in autopsied lungs from human patients who died of non-pulmonary pathologies compared to those having either COPD or asthma. If these septal macrophages indeed represent the PIMs, this finding is contrary to existing belief that humans, unlike horses, do not have PIMs.

The persistence of high global mortality rates directly attributable to cardiovascular disease drives ongoing research into novel approaches for improved diagnosis and treatment of its primary underlying cause, atherosclerosis. Combined intravascular ultrasound and photoacoustic (IVUS/IVPA) imaging is one such modality, actively being developed as a tool for improved characterization of high-risk atherosclerotic plaques. The pathophysiology associated with progression and destabilization of atherosclerotic plaques leads to characteristic changes in arterial morphology and composition. IVUS/IVPA imaging seeks to expand upon the ability of clinically utilized intravascular ultrasound (IVUS) imaging to assess vessel anatomy by adding improved sensitivity to image the underlying cellular and molecular composition through intravascular photoacoustic (IVPA) imaging of either endogenous chromophores (e.g. lipid) or exogenously delivered contrast agents. This dissertation focuses on the expansion of IVUS/IVPA imaging using exogenous contrast agents to enable the detection and subsequent optically-triggered therapy of atherosclerotic plaques. The passive extravasation and aggregation of systemically injected plasmonic gold nanorods absorbing within the near infrared tissue optical window within plaques of atherosclerotic rabbit models is first demonstrated, along with the ability to localize the contrast agents using ex vivo IVUS/IVPA imaging. The motivation for nanoparticle labeling of atherosclerosis is then expanded from that of purely image contrast agents to vehicles for image-guided, dual-modality phototherapy. The integrated IVUS/IVPA imaging catheter is utilized for photothermal delivery with simultaneous IVPA temperature monitoring using the high optical absorption of gold nanorod contrast agents to enable localized heating. Subsequently, the potential role for IVUS/IVPA-guided phototherapy is further expanded through the characterization and in vitro assessment of novel multifunctional theranostic nanoparticles comprised of a gold nanorod core with a degradable, photosensitizer-doped silica shell. Together, the results presented within this dissertation provide a framework for ongoing research into the expansion of IVUS/IVPA imaging as a platform for complimentary diagnosis and local treatment of atherosclerotic plaques using multifunctional theranostic nanoparticle contrast agents. / text