Em trabalho anterior verificamos que neutrófilos oxidam o hormônio melatonina a N1-acetil-N2-formil-5-metoxiquinuramina (AFMK), numa reação catalisada por mieloperoxidase e dependente de ânion superóxido. Neste trabalho acompanhamos a cinética de formação de AFMK e de seu produto de deformilação N1-acetil-5-metoxiquinuramina (AMK) quando neutrófilos foram ativados por diferentes estímulos. No sentido de obtermos informações sobre a relevância biológica destas reações, avaliamos o efeito de melatonina, AFMK e AMK sobre a formação de HOCl, sobre a liberação de citocinas pró-inflamatórias (TNF-&#945 e IL-8) e sobre a apoptose de neutrófilos. Uma forte inibição da liberação de HOCl foi observada em concentrações de melatonina igual ou superior a 0,05 mM. Embora menos efetivo, AMK também inibiu a formação de HOCl, enquanto AFMK não teve efeito. Adicionalmente mostramos que todos estes compostos inibiram a produção de TNF-α e IL-8 por neutrófilos ativados e que AFMK foi o mais potente deles. Por exemplo, enquanto 1µM de AFMK inibiu eficientemente a liberação de TNF-α, efeito similar foi obtido com melatonina apenas a partir de 1mM. O mesmo padrão de resposta foi observado na morte celular. AFMK e AMK (1mM), mas não melatonina, inibiram significativamente (aproximadamente 25%) a morte celular de neutrófilos. Nossos dados sugerem que neutrófilos são um alvo importante para AFMK e que a rota de metabolização da melatonina pode ser útil no controle da intensidade do processo inflamatório através do consumo de ERO, controle da liberação de citocinas e da sobrevida dos neutrófilos. Este conjunto de dados associados com o fato de que células mononucleares ativadas sintetizam melatonina e que o foco inflamatório é uma fonte de espécies reativas de oxigênio (ERO), levou-nos a verificar se a oxidação de melatonina ocorreria in vivo em situações inflamatórias. Para isso, analisamos amostras de liquor de pacientes com meningite viral. AFMK foi detectado em 16 das 20 amostras de liquor de pacientes com meningite viral e em nenhuma das 8 amostras controle. Das 16 amostras nas quais AFMK foi detectado, ele pôde ser quantificado em 6 (concentrações variando de 50 a 500 nM). Adicionalmente analisamos a correlação entre a presença de AFMK com alguns parâmetros inflamatórios como: celularidade, concentração de proteínas totais, TNF-α, IL-8 e IL-1β. Verificamos que todos estes parâmetros diminuíram nas amostras de liquor onde a concentração de AFMK era maior. Em conjunto, nossos resultados mostram que pelo menos parte dos efeitos antiinflamatórios descritos para melatonina pode ser originado da ação de seus produtos de oxidação. Nossos resultados contribuem significativamente para a compreensão do papel biológico da melatonina e seus produtos de oxidação na imunomodulação durante a inflamação. / In a previous study we described that activated neutrophils are able to oxidize the pineal hormone melatonin to N1-acetyl-N2-formyl-5-methoxykynuramine (AFMK) in a reaction dependent on myeloperoxidase and superoxide anion. Here we followed the formation of AFMK and its deformylated product N1-acetil-5-metoxiquinuramina (AMK) when neutrophils were activated by different stimuli. The biological significance of this reaction has been one of our research interests, therefore we study the effect of melatonin, AFMK and AMK on the HOCl formation, on the release of pro-inflammatory cytokines (TNFα- and IL-8) and on the apoptosis process. Melatonin caused an almost complete inhibition of HOCl formation at concentrations up to 0.05 mM. Although less effective, AMK also inhibited HOCl formation, while AFMK had no effect. Additionally all the compounds assayed efficiently inhibited the production of TNF-α and IL-8 by activated neutrophils. Moreover, the inhibitory activity of AFMK was stronger than that of melatonin and could be observed already at 1µM. A significant inhibition of neutrophil death (approximately 25 %) was triggered by AFMK and AMK (1 mM) but not by melatonin. Our data suggest that neutrophils are an important target for AFMK and that the route of melatonin metabolism may be useful in controlling the intensity of the inflammatory process by the consumption of reactive oxygen species, control of cytokine production and neutrophils life span. These findings, associated with the efficient synthesis of melatonin by activated-mononuclear cells and the presence of reactive oxygen species in the inflammatory focus, led us to verify if inflammation triggers the oxidation of melatonin in vivo. In this way we analyzed the cerebrospinal fluid (CSF) of patients with meningitis. AFMK was detected in 16 CSF from 20 samples of patients with viral meningitis and in none of 8 control samples. From the 16 samples in which AFMK was detected, it was quantified in 6 (at the concentration range of 50 500 nM). We also analyzed the correlation between the presences of AFMK with some inflammatory parameters like: cellularity and concentration of total proteins, TNF-α, IL-8 and IL-1β. We verify that all these parameters were decreased in samples in which AFMK was in higher concentrations. Our results show that, at least part of the antiinflammatory effects described for melatonin is indeed caused by its oxidation product. These findings add a new insight in the comprehension of the biological role of melatonin and its oxidation products in immunomodulation and during inflammation.

Adriamycin is a first line cancer treatment drug for breast cancer and many soft tissue carcinomas. Adriamycin is a highly effective anti-cancer drug. It has a fused ring system that is planar, hydrophobic and electron rich. These features allow intercalation into DNA which, along with its topoisomerase inhibition, results in its anti-cancer effectiveness. Despite its success, its use is limited by a dose-dependent cardiotoxicity. Adriamycin forms tight complexes with iron in varying iron:drug ratios. The chelated complex [Fe+3-Adriamycin (1:2)] oxidatively cleaves DNA via the generation of reactive oxygen species (ROS). Enzymes associated specifically with heart mitochondria increase ROS formation explaining why adriamycin is selectively cardiotoxic. Pretreatment of mice with the neural hormone melatonin eliminates the cardiotoxic effectiveness of adriamycin therapy without reducing the drugÆs antitumor effect (Wahab et al. 2000, Tumori 86: 157-162). This has recently been verified in human cancer patients (Lissoni et al. 1999, European Journal of Cancer 35: (12) 1688-1692). Melatonin is soluble in both lipid and aqueous environments and has no known side-effects. This study analyzes the mechanistic features of DNA damage by Fe+3-Adriamycin and how melatonin ameliorates this damage. An Fe+3-Adriamycin (1:2) complex + glutathione cleaves DNA; this oxidative DNA cleavage does not occur with adriamycin +/- glutathione or with FeADR in the absence of glutathione. Melatonin reduces this oxidative DNA cleavage by 67%. Using a supercoiled-to-nicked-circular-conversion assay in conjunction with spectroscopic analyses give results revealing : 1) Fe+3-Adriamycin (1:2) complex + glutathione forms a reactive intermediate. 2) Melatonin protects the DNA from cleavage by this reactive intermediate. 3) Enzymatic assays show that H2O2 is the primary ROS formed with downstream production of the hydroxy radical via the Fenton reaction. 4) Fe+3-Adriamycin (1:2) intercalates into DNA to the same degree as uncomplexed adriamycin. 5) Melatonin also binds to DNA but not by intercalation. These experiments indicate that the cardioprotective effect of melatonin in adriamycin therapy may stem from melatoninÆs interaction with a reactive intermediate from Fe+3-Adriamycin(1:2) complex + glutathione and/or a direct interaction of melatonin with DNA.

Melatonin, a nontoxic natural antioxidant, is of interest as a possible spin trap for use in spectroscopic methods to observe and identify short-lived free radicals, which have been linked to oxidative stress that may result in serious health problems. However, the reaction mechanisms for the oxidation of melatonin to form the product N1-acetyl-N2-formyl-5-methoxykynuramine are still not well understood. Computational quantum chemistry studies have been done on four proposed reaction mechanisms, involving the following major intermediate structures: a dioxetane, an epoxide, a melatonin radical cation, and a spin radical adduct. Molecular geometries were optimized at the DFT/B3LYP/cc-pVTZ level of theory, and single point energies were extrapolated to the complete basis set limit at the Hartree-Fock and second-order Møller-Plesset perturbation levels of theory using the cc-pVXZ (X = D, T, Q) basis sets. The lowest energy pathway was found to be the single electron transfer pathway, involving the melatonin radical cation intermediate.

Bibliography: leaves 131-150.

<p>Porphyrias are inherited metabolic disorders characterised by an impairment of heme biosynthesis. Acute intermittent porphyria (AIP) is the most common of the acute porphyrias in Sweden. Acute attacks of AIP are characterised by neuro-psychiatric symptoms, including epileptic seizures. Environmental and acquired factors are related to the induction of symptoms. Acute attacks of AIP are treated with high doses of glucose and/or hematin infusions.</p><p>The pathogenesis of the neuro-psychiatric symptoms is not known. Reversible white-matter lesions, probably due to vasospasm, have been seen on brain MRI. Similarities between multiple sclerosis (MS) and AIP have previously been described, but to our knowledge no study has investigated whether AIP-gene carriers have white-matter lesions seen on brain MRI or oligoclonal bands (OB) in cerebrospinal fluid (CSF).</p><p>The percentage of AIP-gene carriers who have experienced epileptic seizures has been calculated at 10-20%, but previous investigations are derived from highly selected clinic-based studies. Studies were therefore undertaken to investigate the prevalence of epileptic seizures, the relationship of seizures to AIP, the type of seizures and the relationship of seizures to other factors such as melatonin.</p><p>A case report described the disappearance of porphyric attacks after the onset of diabetes mellitus (DM). In our study, we investigated the rate of attacks after the onset of DM. For many years, clinical issues relating to AIP have not been a focal area. We therefore carried out a study to update our knowledge of the clinical course of AIP in order to improve prevention, control and treatment. In our studies of AIP-gene carriers and epileptic seizures, we found that epileptic seizures are less common than has previously been described (3.7%) and they are not very different from what is expected in the general population, but the prevalence of 5.1% of seizures with manifest AIP is higher than in the general population. The seizures may be generalised or partial and the seizure frequency was generally low. The AIP-gene carriers who had had epileptic seizures had a lower melatonin excretion level in their urine compared with gender- and aged-matched AIP-gene carriers’ relatives without epileptic seizures, which may indicate that melatonin plays a possible anti-convulsive role.</p><p>In our study of AIP and DM, no subject had an attack of AIP after the onset of DM. White-matter lesions on brain MRI were seen in 25% of the AIP-gene carriers examined outside attacks. One carrier had elevated protein levels in the CSF, but no carrier had cells or OB in the CSF.</p><p>In our population-based study, 356 DNA-confirmed AIP-gene carriers from northern Sweden participated. Manifest AIP (MAIP) was identified in 42%, 65% of whom were women. Eight mutations were found. Women were more severely stricken by AIP attacks in terms of number and duration, hospital admission and early onset. Men (30%) reported most attacks > 40 years of age. The most commonly reported symptoms during attacks were severe abdominal pain (86%), fatigue (42%), constipation (41%), vomiting (36%), muscle pain (30%), psychiatric symptoms (29%), pareses (20%) and sensory impairment (10%). Chronic AIP symptoms were reported by 18%. Precipitating factors were often reported: menstruation (31%), psychological strain (30%), certain drugs and fasting (20%), infection and alcohol (14%), physical strain (12%) and pregnancy (5%). Smoking was more frequent in MAIP and was associated with the number of AIP attacks. Some 30% of MAIP carriers used drugs that were not considered safe (in 1999), mainly diuretics, calcium antagonists and ACE inhibitors. Twenty per cent of MAIP carriers reported that they were receiving a disability pension due to AIP. Elevated levels of ASAT, bile acids, creatinine, creatinine clearance, U-ALA and U-PBG were often found in MAIP-gene carriers. Hypertension, renal impairment and pain in the legs were associated with MAIP. Hepatoma was strikingly over-represented.To summarise; epileptic seizures are less common than has previously been described, melatonin may have an anti-convulsive effect and DM may have a beneficial effect on MAIP-gene carriers. White-matter lesions are seen on brain MRI. The lesions are unspecific but may relate to the patients’ porphyria. AIP is not a harmless disease. A large percentage of the AIP-gene carriers had frequent attacks, severe symptoms, long-lasting fatigue and chronic AIP and women were more severely stricken. Effects on the kidneys, blood pressure and the liver, including HCC, were evident. Measures should be taken to improve the quality of life and prognosis for AIP-gene carriers.</p>

<p>Weight loss and other nutritional problems are common in cancer patients. The problems are of importance for response to treatment and survival and the well-being of the patients.</p><p>Nutritional support can be carried out in different ways. The efforts considered in this thesis are; assessment of nutritional status to find the patients who are at risk to become or already are malnourished, assessment of dietary intake, dietary advice, information and support to the families, information and education to the caregivers, and supplementation with drugs that possibly could influence the weight development. The Swedish version of the Patient Generated Subjective Global assessment of nutritional status, PG-SGA, is useful in assessment of nutritional status in cancer patients. Dietary advice and support to patients and their families combined with information and education to the staff, at the hospital and in the home care, turned out to have a positive influence at the weight development and other parameters related to nutrition. The effects were seen in consecutive patients with small cell lung cancer in comparison with a historical control group, and in patients in a randomised trial. Fish oil and melatonin could stabilise weight development in patients with advanced gastrointestinal cancer, but had no marked influence on factors reflecting cachexia. Problems with nutrition in cancer patients are possible to recognise and various interventions may be beneficial.</p>

Weight loss and other nutritional problems are common in cancer patients. The problems are of importance for response to treatment and survival and the well-being of the patients. Nutritional support can be carried out in different ways. The efforts considered in this thesis are; assessment of nutritional status to find the patients who are at risk to become or already are malnourished, assessment of dietary intake, dietary advice, information and support to the families, information and education to the caregivers, and supplementation with drugs that possibly could influence the weight development. The Swedish version of the Patient Generated Subjective Global assessment of nutritional status, PG-SGA, is useful in assessment of nutritional status in cancer patients. Dietary advice and support to patients and their families combined with information and education to the staff, at the hospital and in the home care, turned out to have a positive influence at the weight development and other parameters related to nutrition. The effects were seen in consecutive patients with small cell lung cancer in comparison with a historical control group, and in patients in a randomised trial. Fish oil and melatonin could stabilise weight development in patients with advanced gastrointestinal cancer, but had no marked influence on factors reflecting cachexia. Problems with nutrition in cancer patients are possible to recognise and various interventions may be beneficial.

Estrogen therapy (ET) is most effective to reduce menopausal symptoms and prevent other disorders associated with estrogen deficiency. However, Women's Health Initiative studies found that hormone therapy (HT) containing estrogen plus progestogen, but not estrogen-alone increases breast cancer (BC) risk. To prevent the increase in BC risk and yet relieve menopausal symptoms, a novel HT with 17&#946;-estradiol (E2) for symptom relief, progesterone (P4) for uterine protection and melatonin (Mel) for both BC and uterine protection was designed. Inclusion of Mel was postulated to offer uterine protection with lower P4 dose and protect against BC. The goal of this study was to assess the efficacy of E2, P4 and Mel Therapy (EPMT) on mammary cancer (MC) and uterine protection in MMTV-Neu mouse model that mimics HER2 BC. Starting at 2 months age, female mice received Mel in drinking water at night to supplement endogenous Mel surge; while E2 and P4 Therapy (EPT) was provided continuously in diet until 14 months with weekly MC onset and growth monitoring. Normal mammary, uterus and mammary tumors harvested by month 14 were analyzed for potential mechanisms. The results from this study revealed that EPMT delayed tumor onset leading to a decrease in MC incidence. In addition, mice in the EPMT group had no increase in relative uterine weight as opposite to an increase of this parameter in EPT group versus control. The percent tumor-bearing mice with gross metastatic lung lesions were reduced in Mel, EPT and EPMT groups. Mel receptor, estrogen receptor (ER) and progesterone receptor (PR) expression revealed that all tissues examined have Mel receptors. However, ER and PR expression varied. In normal mammary tissue, both ER&#945; and PR were detected by immunohistochemistry. However, no ER&#945; and PR were detected in mammary tumors of same mice. In uterus, mice given Mel or EPMT had significant decreases in PR expression but no change in ER&#945; expression compared to control suggesting that Mel-mediated inhibition of ER binding to estrogen response elements may be involved in the down regulation of uterine PRs. Overall, this study reveal that EPMT prevents mammary cancer and may protect against uterotrophy. / Mylan School of Pharmacy and the Graduate School of Pharmaceutical Sciences; / Pharmacology / PhD; / Dissertation;

El objetivo de este trabajo es estudiar la influencia de distintos niveles de actividad pineal sobre la inducción y el crecimiento de tumores mamarios hormonodependientes. El aumento de la actividad pineal obtenido por asociación de ceguera con bulbectomía olfatoria, subnutrición o exposición a bajas temperaturas produjo: a) descenso de la incidencia tumoral y aumento del tiempo de latencia de aparición de los tumores; b) descenso en el número de tumores y en la superficie tumoral; c) descenso de la concentración de receptores estrogénicos tumorales y de los niveles circulantes de estradiol; d) inhibición del crecimiento de tumores previamente inducidos. Los efectos antitumorales de la actividad pineal pueden ser explicados por acciones antiestrogénicas directas a nivel del tumor, dado que manteniendo constantes los niveles de estradiol, mediante ovariectomía y administración de estrógenos, la hiperactividad pineal indujo una marcada regresión tumoral acompañada de un descenso de la concentración de receptores estrogénicos en el tejido tumoral. / The aim of this work was to study the influence of different levels of pineal activity on the genesis and growth of hormonodependent mammary tumors. The enhancement of pineal actions by experimental manipulations like blindness+anosmia, blindness+underfeeding or blindness+cold exposure, in relation with pinealectomized animals, produced the following effects: a) a decrease in tumor incidence and an increase in the latency in the appearance of tumors; b) a decrease in tumor number and tumor size; c) a decrease in tumor estrogen receptor concentration and serum estradiol; d) an inhibition of tumors previously induced.. A pineal-induced decrease in serum estradiol levels as well as in the concentration of estrogenic receptors in tumoral tissue could be in part responsible for these pineal antitumoral actions.

Thesis (M.Sc. (Pharmacy)) - Rhodes University, 2008.