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This dissertation presents an investigation of the impact of Multidrug Resistance-associated Protein 2/ATP-binding cassette superfamily C member 2 (Mrp2/Abcc2) and 3 (Mrp3/Abcc3) on the pharmacokinetics (PKs) of methotrexate (MTX) using gene knockout murine models. MTX is a substrate for numerous human ATP-binding cassette (ABC) efflux transporters, yet the impact of these transporters on the pharmacokinetics of MTX over a large dose range has not been examined. To investigate the effects of two transporters, Abcc2 (Mrp2) and Abcc3 (Mrp3), involved in MTX hepatobiliary disposition in vivo, MTX plasma, urine and feces concentrations were analyzed after 10, 50, and 200 mg/kg intravenous (IV) doses to groups of wild type (WT), Abcc2-/- and Abcc3-/- mice. The absence of Abcc2 caused a decrease in total clearance of MTX relative to WT mice at all dose levels yet was accompanied by compensatory increases in renal excretion and metabolism to 7-hydroxymethotrexate (7OH-MTX). In Abcc3-/- mice total clearance was elevated at the two lower dose levels that was attributed to stimulation of biliary excretion and confirmed by elevated fecal excretion; however at the high 200 mg/kg dose clearance was severely retarded and could be attributed to hepatotoxicity as conversion to 7OH-MTX was diminished. We also sought to characterize the effects of Abcc2 and Abcc3, on the PKs of MTX after oral dosing. Plasma, urine, and fecal concentrations of MTX were measured after 10, 50, and 200 mg/kg oral doses to cohorts of WT, Abcc2-/- and Abcc3-/- mice mouse strains. The absence of Abcc2 caused an approximate 2-fold increase in system exposure and a slight increase in oral bioavailability of MTX relative to WT mice at all dose levels. These elevations were accompanied by compensatory increases in conversion to 7OH-MTX, and based on AUC7OH-MTX/AUCMTX (area under the curve ratio of metabolite and parent drug) that ranged from 3% to 9% in WT mice increased to a range of 16% to 26% in Abcc2-/- mice. Renal excretion of unchanged MTX was unaltered in the Abcc2-/- strain; fraction urinary excretion (fr) ranged from about 4% to 11% in WT mice, whereas in Abcc2-/- mice fr ranged from about 7% to 23%. Abcc3-/- mice exhibited more than a 2-fold decrease in Cmax and significant reductions in AUCMTX when compared to WT mice at all dose levels. There were no compensatory increases in either metabolism or in renal and biliary excretion, which suggests future studies for investigating a potential unknown mechanism. Regardless of the mouse strain, increases in the MTX dose were not accompanied by proportional increases in AUCMTX. The PKs of MTX in different mouse strains was successfully modeled by a nonlinear semi-mechanistic 3-compartmental conditional model incorporating key efflux transporters. The model employed population-based analysis and conditional transport terms to well capture the nonlinear properties of MTX systemic disposition for a wide dose range of 10 - 200 mg/kg in WT and knockout strains. The model correlates the mechanistic nature of the nonlinear phenomenon with the key efflux transporters effects on MTX PKs and provides insight for preclinical therapeutic study design. Overall, the information obtained in this investigation underscores the significance of efflux transporters, Abcc2 and Abcc3, for they significantly influence the pharmacokinetics of MTX and their impact can be reflected by a nonlinear semi-mechanistic 3-compartmental conditional model. The studies also provide implication in the preclinical therapeutic study design and insights on the source of inter-patient variability as well as on the combination drug regimens to maximize drug activity yet without toxicity. / Pharmaceutical Sciences

The enzyme inosine triphosphate pyrophosphatase (ITPase) is responsible for controlling the levels of the by-products guanosine monophosphate (GMP) and adenosine monophosphate (AMP) through their precursor inosine monophosphate (IMP). ). Human ITPase consists of a 194-amino acid homodimer which relies upon either an Mg2+ ion or a Mn2+ ion for catalytic activity, and orthologs of this protein have been found in many different organisms. The purpose of this project was to try out methods learned throughout the education and to use this knowledge to gather new data about the human protein inosine triphosphate pyrophosphatase (ITPase). The protein was expressed in BL21/DE3 cells from a pre-made vector. Experiments performed during this project include secondary- and tertiary stability measurements, tryptophan fluorescence spectra, binding curve and thermic stability to ITPase with ANS and methotrexate. The Tm-value of human ITPase was examined with Trp-Fluorescence, ANS-fluorescence and Near-UV and Far-UV circular dichroism (CD). The stability of ITPase monitored by Near-UV as well as Far-UV coincides, indicating that secondary- and tertiary-unfolding occur simultaneously without any intermediates. The results of Trp-fluorescence showed that the tryptophans were already exposed and thus it did not yield a reliable result. The binding properties of ANS and MTX to ITPase were also examined.

Le MTX est un agent anticancéreux utilisé à hautes doses pour le traitement des hémopathies malignes et de certaines tumeurs solides. Il présente une importante variabilité pharmacocinétique (PK) traduite par des surexpositions à l'origine de toxicités très sévères, surtout lors d'une administration à haute dose. Les retards d'élimination du MTX surviennent encore de manière inattendue et il n'existe à ce jour aucun biomarqueur qui permette un diagnostic précoce du risque de surexposition. Nos travaux ont focalisé sur les déterminants de l'élimination rénale du MTX, et en particulier le rôle du transporteur MRP2/ABCC2 dans ce processus. Ce travail s'inscrit donc (1) dans la recherche de biomarqueurs métabolomiques urinaires prédictifs de la PK du MTX et (2) dans l'identification de substrats endogènes de MRP2 parmi un panel de 217 acides organiques urinaires analysés par chromatographie gazeuse couplée à la spectrométrie de masse. Nos analyses ont abouti à un profil de 28 anions organiques endogènes, prédictifs de la CL MTX. L'outil était en revanche mal adapté à la prédiction des retards d'élimination. Pour la 2eme partie, nos résultats tendent à montrer que 8 métabolites urinaires sont des bio-marqueurs potentiels de l'activité de MRP2. Leur utilisation en clinique nécessite encore des études confirmatoires. / MTX is an anticancer agent used at high doses for the treatment of malignant haemopathies and some solid tumors. It presents an important pharmacokinetic variability (PK), manifested by overexposures causing very severe toxicities, especially when administered at high doses. Delayed elimination of MTX still occurs unexpectedly and there is currently no biomarker that allows early diagnosis of the risk of overexposure. Our work focused on the determinants of renal elimination of MTX, and particularly on the role of MRP2 / ABCC2 in this process. This work is therefore devoted to (1) the search for metabolomic biomarkers predictive of MTX PK and (2) the identification of endogenous substrates of MRP2, from a panel of 217 urinary organic acids analyzed by gas chromatography-mass spectrometry. Our analyses resulted in a profile of 28 endogenous organic anions, predictive of CL MTX. The tool was, on the other hand, poorly adapted to the prediction of delayed elimination. For the second part, our results tend to show that 8 urinary metabolites are potential biomarkers of MRP2 activity. Their clinical use still requires confirmatory studies.

A aterosclerose é considerada, hoje, doença inflamatória e com intensa proliferação celular, daí o racional de se usar medicamentos antiproliferativos e com ação anti-inflamatória como o paclitaxel (PTX) e o metotrexato (MTX) no tratamento dessa condição. A nanoemulsão lipídica (LDE), de composição semelhante à da lipoproteína de baixa densidade (LDL), se liga a receptores de LDL após sua injeção endovenosa na corrente sanguínea. Como tais receptores estão superexpressos em células com altas taxas de proliferação, como ocorre no câncer e na aterosclerose, a LDE pode ser usada como veículo para direcionar agentes antiproliferativos a essas células, aumentando a sua eficácia e diminuindo a toxicidade. O paclitaxel é um quimioterápico com ação antiproliferativa usado em vários tipos de câncer e recobrindo stents farmacológicos, trabalhos anteriores, usando coelhos submetidos a uma dieta aterogênica, nos animais tratados com LDE-PTX houve redução de 60% da área lesionada. O metrotexato, além de ser usado em vários esquemas quimioterápicos, possui, também, ação anti-inflamatória, sendo usado em doenças inflamatórias crônicas, como a artrite reumatoide. Em outro estudo envolvendo, coelhos hipercolesterolêmicos, o uso de MTX comercial por 4 semanas demonstrou uma redução de 75% na área de placa aterosclerótica. Esse estudo tem por objetivo avaliar macroscopicamente a eficácia das terapias quimioterápicas combinada, composta de PTX-LDE com MTX-LDE, e monoterapia, apenas com PTX-LDE, na regressão da aterosclerose experimental. No presente trabalho, vinte e oito coelhos machos da raça New Zealand receberam dieta rica em colesterol a 1% durante 8 semanas. Depois desse período, foram divididos em quatro grupos: grupo CONTROLE, que foi sacrificado e as aortas fixadas para análise posterior, grupo DIETA, que apenas teve a ração enriquecida com colesterol a 1% suspensa, PTX, que recebeu tratamento com injeções endovenosas semanais de LDE-paclitaxel na dose de 4 mg/kg por 8 semanas, e PTX+MTX, que recebeu LDE-paclitaxel e LDE-metotrexato na dose de 4 mg/kg/semana por 8 semanas. Foram avaliados perfil hematológico, lipídico, bioquímico, ponderal e o consumo de ração. Após a eutanásia, foram medidas as lesões ateroscleróticas macroscópicas nas aortas dos coelhos. Em seguida, o arco aórtico foi analisado por morfometria e por imuno-histoquímica. Os marcadores inflamatórios foram analisados no plasma, por ELISA e por meio de expressão gênica por Qrt-pcr. Observou-se que não houve diferença no perfil ponderal e no consumo de ração entre os grupos de estudo. Não houve toxicidade hematológica, hepática e renal relacionada ao tratamento. No perfil lipídico, ao final do estudo, as concentrações de colesterol total, não HDL-C e triglicerídeos aumentaram significativamente em todos os grupos. Houve uma marcante regressão na área de placa aterosclerótica nos coelhos tratados com LDE-paclitaxel, da ordem de 64% e mais marcante no grupo LDE-metotrexato de 71%, quando comparados ao grupo CONTROLE. Na comparação com o grupo DIETA, houve, também, regressão, de 49% nos coelhos do grupo PTX e de 59% no grupo PTX+MTX. O tratamento quimioterápico também mostrou ação antiaterosclerótica nos outros parâmetros avaliados, destacando a intensa redução na relação íntima-média das aortas, na expressão proteica de MMP-9 e da redução na expressão gênica de TNF-? em relação ao grupo DIETA. Portanto, o tratamento quimioterápico com PTX e MTX associado à LDE possui potencial para uso clínico em pacientes com doença aterosclerótica, sendo muito eficaz e com boa tolerabilidade / Atherosclerosis is nowadays considered as an inflammatory disease with intense cell proliferation, hence the rationale of using antiproliferative drugs with an anti-inflammatory action such as paclitaxel (PTX) and methotrexate (MTX) in the treatment of this condition. The lipid nanoemulsion (LDE), with a similar composition to low density lipoprotein (LDL) binds to LDL receptors after their intravenous injection into the bloodstream. Since such receptors are overexpressed in cells with high proliferation rates, such as occurs in cancer and atherosclerosis, LDE can be used as a vehicle to direct antiproliferative agents to these cells, increasing their efficacy and reducing toxicity. Paclitaxel is a chemotherapeutic drug with an anti-proliferative action used in various types of cancer and drug-eluting stents. In previous studies using rabbits subjected to an atherogenic diet, animals treated with LDE-PTX had a 60% reduction in the injured area. Methotrexate in addition to being used in various chemotherapy regimens also has an anti-inflammatory action and is used for chronic inflammatory diseases such as rheumatoid arthritis; another study involving hypercholesterolemic rabbits using commercial MTX for 4 weeks showed a 75% reduction of the atherosclerotic plaque area. This study aims to evaluate the effectiveness of combined chemotherapy treatments, composed of PTX-LDE with MTX-LDE, and PTX-LDE in monotherapy, on the regression of experimental atherosclerosis. In this study, twenty eight male New Zealand breed rabbits received a diet enriched with 1% cholesterol for 8 weeks. After that time, they were divided into four groups: the CONTROL group, which was sacrificed and the aortas kept for later analysis, the DIET group, which only had the diet supplemented with 1% cholesterol suspended; the PTX group which received treatment with weekly intravenous injections of LDE paclitaxel, at a dose of 4 mg/kg for 8 weeks and the PTX+MTX group which received PTX - LDE + MTX-LDE at a dose of 4 mg/kg per week for 8 weeks. The hematological, lipid, biochemical, weight and food intake profiles were evaluated. After euthanasia, macroscopic atherosclerotic lesions in the aortas of the rabbits were measured. Then, the aortic arch was analyzed by morphology and immunohistochemistry. The inflammatory markers were analyzed in the plasma by ELISA and gene expression by qRT-PCR. There was no difference in weight profile and feed intake among the study groups. There was no hematological, hepatic or renal toxicity related to treatment. The lipid profiles of all the groups at the end of the study showed significantly increased concentrations of total cholesterol, non-HDL-C and triglyceride levels. There was a marked regression of 64% in the atherosclerotic plaque area, in the LDE-paclitaxel treated rabbits, and an even more striking 71% in the LDE-methotraxate group compared to the CONTROL group. There was also regression when compared to the DIET group, 49% in rabbits from the PTX group and 59% in the PTX+MTX group. The chemotherapy also showed an anti-atherosclerotic action in the other evaluated parameters, especially notable were the intense reduction in the intima-media ratio of the aortas in protein expression of MMP-9 and the reduction in gene expression of TNF-alpha compared to the DIET group. Therefore, chemotherapy with PTX and MTX associated with LDE, has potential for clinical use in patients with atherosclerotic disease, as it is very effective and well tolerated

A área das Ciências Farmacêuticas busca constantemente por tratamentos mais eficientes, direcionados para alvos específicos, com diminuição da dose necessária e com a minimização dos efeitos adversos. Neste contexto, a área de Nanotecnologia Farmacêutica apresenta grande potencial de aplicabilidade, com resultados bastante promissores para o tratamento de diversas doenças. Os sistemas nanoestruturados têm sido avaliados para a incorporação de fármacos já utilizados em tratamentos administrados formas farmacêuticas convencionais que apresentam problemas farmacocinéticos ou farmacodinâmicos quando administrados. E, também, para a incorporação de novas moléculas com potencial para o tratamento de determinada doença. Neste trabalho de tese, nanocápsulas de núcleo lipídico versáteis contendo metotrexato na forma ácida e éster, bromelina, etanercept e infliximab foram desenvolvidas buscando contornar as limitações e aumentar a eficácia terapêutica desses fármacos. Inicialmente, as propriedades anti-inflamatórias de nanocápsulas de núcleo lipídico revestidas por micelas de polissorbato 80 contendo metotrexato encapsulado foram avaliadas em experimentos in vitro e in vivo, em células mononucleares obtidas a partir do líquido sinovial de pacientes com artrite reumatoide e em ratos Lewis com artrite induzida por adjuvante completo de Freund, respectivamente. As nanocápsulas de núcleo lipídico demonstraram serem altamente eficazes no controle da inflamação, sendo que os efeitos anti-inflamatórios in vivo foram alcançados em doses 75% menores que o metotrexato em solução. Na sequência, o tratamento in vitro da linhagem de células de carcinoma de mama humano, MCF-7, com nanocápsulas de núcleo lipídico multiparede funcionalizadas com bromelina demonstrou uma redução de 160 vezes na concentração necessária para obter o mesmo efeito quando comparada a uma solução de bromelina. A influência das pseudofases aniônicas e catiônicas no mecanismo de distribuição da indometacina, tacrolimus, aciclovir, metotrexato e éster etílico de metotrexato, foram avaliadas aplicando um algoritmo desenvolvido para nanocápsulas de núcleo lipídico. Verificou-se que somente a indometacina sofreu influência da presença de cargas, aumentando a afinidade pela fase dispersa das formulações. Formulações de nanocápsulas de núcleo lipídico multiparede contendo metotrexato na forma ácida e éster encapsulados e/ou funcionalizando a superfície das nanocápsulas foram desenvolvidas e testadas in vitro em linhagens de células tumorais (MCF-7) e em linhagens de células sadias (HaCaT). Essas formulações demonstraram atividade antiproliferativa maior para as MCF-7 (com redução em mais de 50% na viabilidade celular) em comparação com as soluções de metotrexato e éster etílico de metotrexato e esta atividade foi maior para as formulações em que as moléculas foram funcionalizadas na superfície das nanopartículas. A captação das nanopartículas pelas células também foi maior para as formulações funcionalizadas com metotrexato ou éster etílico de metotrexato em comparação com a formulação em que o éster de metotrexato está encapsulado. As três formulações contendo metotrexato na forma ácida ou éster não demonstraram ação antiproliferativa em linhagens de células sadias (HaCaT). Devido à baixa expressão de receptores de folato nessas células, não houve aumento da captação celular em comparação à formulação sem fármaco. Por último, foram desenvolvidas satisfatoriamente formulações de nanocápsulas de núcleo lipídico multiparede funcionalizadas com os anticorpos monoclonais infliximab e etanercept, e contendo éster etílico de metotrexato encapsulado, demonstrando que são adequadas para futuros estudos visando o tratamento da artrite reumatoide. Esse conjunto de resultados demonstra que as nanocápsulas de núcleo lipídico com funcionalização de superfície versátil, sejam revestidas com polissorbato 80 ou multiparede funcionalizadas são um sistema bastante promissor para a administração de fármacos de modo a aumentar sua especificidade e eficácia. / The Pharmaceutical Sciences field is constantly searching for more effective treatments, aiming specific targets, with dose reduction and minimization of side effects. In this context, the Pharmaceutical Nanotechnology field presents great applicability potential, with highly promising results for the treatment of several diseases. Nanostructured systems have been evaluated for the encapsulation of drugs approved for use in conventional pharmaceutical dosage forms that, however, exhibit pharmacokinetic or pharmacodynamics problems when administered, and for the encapsulation of novel molecules with potential to treat a determined disease. In the present thesis, versatile lipid-core nanocapsules containing methotrexate in the acid and ester forms, bromelain, etanercept and infliximab were developed, seeking to circumvent the limitations and increase the therapeutic efficacy of these drugs. Initially, the anti-inflammatory properties of methotrexate-loaded lipid-core nanocapsules coated with polysorbate 80 micelles were evaluated in in vitro and in vivo experiments, using mononuclear cells obtained from the synovial fluid of rheumatoid arthritis patients and Lewis rats with Freund complete adjuvant-induced arthritis. Lipid-core nanocapsules demonstrated to be highly effective in the control of inflammation, and the in vivo anti-inflammatory effects were reached in a dose 75% lower than the methotrexate in solution. In the sequence, the in vitro treatment of a human breast cancer cell line, MCF-7, with bromelina-functionalized multiple-wall lipid-core nanocapsules demonstrated a 160-fold reduction of the concentration required to obtain the same effect when compared with a bromelain solution. The influence of the anionic and cationic pseudo-phases in the distribution mechanism of indomethacin, tacrolimus, acyclovir, methotrexate and methotrexate ethyl ester was evaluated through an algorithm developed for lipid-core nanocapsules. It was verified that only indomethacin underwent influence in the presence of charge, increasing the affinity by the disperse phase of the formulations. Multiple-wall lipid-core nanocapsules formulations containing methotrexate in the acid and ester forms encapsulated and/or functionalizing the surface of the nanoparticles were developed and tested in vitro in tumour MCF-7 cells and in a healthy cell line (HaCaT). These formulations demonstrated higher anti-proliferative activity for the MCF-7 cells (reduction of over 50 % in cellular viability) in comparison with the methotrexate and methotrexate ethyl ester solutions and this activity was higher for the formulations in which the molecules were functionalized in the surface of the nanoparticles. A higher cellular uptake was observed for the formulations functionalized with methotrexate or methotrexate ethyl ester in comparison with the formulations in which the methotrexate ester is encapsulated. The three formulations containing methotrexate in the acid or ester form did not demonstrate anti-proliferative activity in non-tumour cell lines (HaCaT). Since these cells have a small expression of folate receptors, the uptake was not increased in comparison with the formulation without drug. Lastly, formulations of methotrexate ethyl ester-loaded multiwall lipid core nanocapsules functionalized with monoclonal antibodies infliximab and etanercept were successfully developed demonstrating suitability for future studies aiming the treatment of rheumatoid arthritis. These groups of results demonstrate that versatile lipid core nanocapsules, either coated with polysorbate 80 or multiwalled functionalized are a very promising system for the administration of drugs aiming their specificity and efficacy.

O glioblastoma multiforme (GBM) é uma doença grave e sem tratamento eficaz, especialmente pelos agentes terapêuticos disponíveis causarem reações adversas importantes nas doses terapêuticas. O metotrexato (MTX) é um fármaco citotóxico utilizado para tratar diversas neoplasias, no entanto, sua utilização é limitada pela baixa biodisponibilidade e reações adversas. A nanotecnologia tem sido utilizada para aumentar a eficácia dos medicamentos antitumorais, com o intuito de direcioná-los para o sítio de ação e reduzir os efeitos adversos. Nesse sentido, realizamos ensaios com nanocápsulas lipídicas de MTX (LNC MTX) para avaliar os mecanismos de captação em linhagens celulares de glioblastoma e micróglia, além investigar a eficácia terapêutica da LNC MTX em ensaios in vitro e in vivo. Inicialmente, ensaios de microscopia de fluorescência, empregando bloqueadores farmacológicos específicos para transportes de membrana, mostraram que as LNC MTX marcadas com Rodamina B penetram em células tumorais GL261 por endocitose, dependente de caveolinas, e em células de micróglia da linhagem BV2 por fagocitose e macropinocitose. Os tratamentos com LNC MTX ou solução de MTX (em concentrações correspondentes) em células GL261 inibiram a proliferação; aumentaram a fragmentação de DNA, mas, somente as LNC induziram a morte celular por necrose e diminuíram o número de células na fase G1/G0 do ciclo celular. Na linhagem celular BV2, os tratamentos com LNC MTX ou solução de MTX inibiram a proliferação, reduziram a quantidade de células na fase G1/G0 do ciclo celular, aumentaram a fragmentação de DNA e induziram morte celular por apoptose e apoptose tardia. Os ensaios in vivo de microscopia intravital mostraram que a LNC MTX atravessa a barreira Hematoencefálica (BHE) de camundongos fêmea C57Bl/6 após administração intravenosa ou oral, sem danificar a sua estrutura. O tamanho do glioblastoma in vivo foi reduzido em animais tratados com LNC MTX por via oral em relação aos animais tratados com salina. Esta redução não foi detectada em animais tratados com solução de MTX. Em conjunto, os dados obtidos mostram que a LNC MTX penetram em células de glioma e da glia e causam toxicidade, atravessam a BHE in vivo e sugerem que a nanoencapsulação do MTX pode ser uma estratégia importante para o tratamento do glioblastoma. / Glioblastoma multiforme (GBM) is a serious disease and no effective treatment is availabe, especially because the drugs cause significant adverse reactions in therapeutic doses. Methotrexate (MTX) is a cytotoxic drug used to treat many neoplasms, however, their use is limited by the low bioavailability and adverse reactions. Nanotechnology has been used to increase the effectiveness of antitumor drugs in order to direct them to the site of action and to reduce adverse effects. Accordingly, we carried out an experimental approach with MTX lipid nanocapsules (MTX LNC) to evaluate the uptake mechanisms in glioblastoma and microglia cell lines, and the therapeutic efficacy of MTX LNC in vitro and in vivo systems. Initially, fluorescence microscopy assays employing specific pharmacological blockers for membrane transport showed that the MTX LNC stained with Rhodamine B penetrated into GL261 tumor cells by caveolae-mediated endocytosis, and in BV2 microglia cells by phagocytosis and macropinocytosis. Treatment with MTX solution or MTX LNC (at corresponding concentrations) on GL261 cells inhibited the proliferation; increased DNA fragmentation, but only the LNC induced cell death by necrosis and decreased the number of cells in the G1/G0 phase of the cell cycle. In BV2 cells, treatment with MTX solution or MTX LNC inhibited proliferation, reduced number of cells in the G1/G0 phase of the cell cycle, increased DNA fragmentation and cell death, induced by apoptosis and late apoptosis. Intravital microscopy study showed that the MTX LNC across the Blood-Brain Barrier (BBB) of C57BL/6 female mice after intravenous or oral administrations, without damaging its structure. The area of glioblastoma in vivo was reduced in animals oral treated with MTX LNC comparing to saline treated mice. This reduction was not observed in animals treated with MTX solution. Together, the data herein obtained show that MTX LNC penetrate the cell membrane and cause cell toxicity on glioma and neurons lineage, cross the BBB and suggest that the nanoencapsulation of MTX can be an important strategy for the treatment of glioblastoma.

O infarto agudo do miocárdio (IAM) é a principal causa de mortalidade mundial. O IAM é acompanhado de remodelamento cardíaco, caracterizado por alterações gênicas, moleculares e celulares, com consequentes alterações no tamanho, forma e função do coração, e resultante disfunção ventricular e insuficiência cardíaca. Evidências experimentais e clínicas indicam que a prevenção ou o tratamento do remodelamento cardíaco beneficiam a função ventricular. A LDE é uma nanopartícula lipídica, com estrutura semelhante à lipoproteína de baixa densidade (LDL). A LDE tem a capacidade de se concentrar em células com superexpressão de receptores de LDL, como em processos proliferativos e inflamatórios, sendo utilizada com um direcionador de fármacos a sítios específicos. Nosso laboratório demonstrou que o tratamento com metotrexato (MTX), um fármaco antiproliferativo e imunossupressor, associado à LDE reduziu acentuadamente as lesões ateroscleróticas na aorta de coelhos submetidos à dieta hipercolesterolêmica. Esses resultados nos levaram à hipótese de que a LDE-MTX possa ser utilizada para minimizar o processo inflamatório pós-IAM, determinante para o remodelamento cardíaco, e seus efeitos deletérios. O objetivo do trabalho foi investigar o efeito do tratamento da LDE-MTX sobre o remodelamento cardíaco em ratos submetidos ao IAM. Ratos machos Wistar (300-400g) foram submetidos ao modelo cirúrgico de IAM ou à cirurgia fictícia (SHAM). Os grupos foram divididos entre: SHAM (solução fisiológica), IAM-LDE, IAMMTXc (metotrexato comercial), IAM-LDE-MTX. Os animais foram tratados uma vez por semana na dose de 1 mg/kg intraperitonealmente, por 6 semanas. Após 24 horas do IAM e ao final do seguimento, foi realizado o ecocardiograma. O coração, o pulmão, o fígado e os rins foram coletados para obtenção do peso relativo dos órgãos. O tamanho do IAM foi estimado pela média dos tamanhos dos IAM externo e interno. A avaliação da necrose dos miócitos, processo inflamatório, diâmetro dos miócitos e fibrose miocárdica nas regiões subendocárdica (SE) e intersticial (INT) foi realizada na região remota ao IAM. Marcadores de estresse oxidativo, inflamação, fibrose, angiogênese e os receptores de lipoproteínas foram quantificados por PCR em tempo real. O tratamento com LDE-MTX diminuiu a dilatação do VE, hipertrofia cardíaca, volumes sistólicos e diastólicos, espessura do septo interventricular e da parede posterior e massa do VE, comparado aos grupos IAM-LDE e IAM-MTXc. Além disso, houve uma melhora de aproximadamente 40% da função sistólica do VE em relação aos demais grupos IAM. O tratamento com LDE-MTX não alterou a função diastólica. O peso relativo do coração e do pulmão foi menor no grupo IAM-LDE-MTX quando comparado ao IAM-LDE. Na histomorfometria, houve diminuição no tamanho do infarto no grupo IAM-LDE-MTX quando comparado com IAMLDE. A necrose, infiltrado inflamatório e fração de volume do colágeno nas regiões INT e SE foram menores no IAM-LDE-MTX em relação aos grupos IAM-LDE e IAM-MTXc, assim como o diâmetro dos miócitos. A expressão gênica dos marcadores de estresse oxidativo e fibrose foi menor no grupo IAM-LDE-MTX quando comparado ao grupo IAM-MTXc. Com relação à inflamação, o grupo IAM-LDE-MTX apresentou menor expressão do gene para TNF-alfa quando comparado aos grupos IAM-MTXc e SHAM. No que se refere ao receptor de lipoproteína, nos grupos IAM-LDE-MTX houve menor expressão do gene para receptor de lipoproteína de baixa densidade (LDLR) quando comparado ao grupo tratado com MTXc. Não foi observada toxicidade em nenhum grupo. Os resultados deste estudo indicam que o tratamento com LDE-MTX melhora significantemente a função cardíaca e atenua o remodelamento cardíaco em modelo experimental cirúrgico para IAM / Acute myocardial infarction (AMI) is the main cause of worldwide mortality. AMI is accompanied by cardiac remodeling, characterized by genetic, molecular and cellular alterations, with consequent changes in the size, shape and function of the heart, resulting in ventricular dysfunction and heart failure. Experimental and clinical evidence indicate that prevention or treatment of cardiac remodeling benefits the ventricular function. LDE is a lipid nanoparticle with a structure similar to low density lipoprotein (LDL). LDE has the ability to concentrate in cells with overexpression of LDL receptors, such as in proliferative and inflammatory processes, and is used with a drugtargeting agent at specific sites. Our laboratory demonstrated that the treatment with methotrexate (MTX), an antiproliferative and immunosuppressive drug, associated to LDE markedly reduced atherosclerotic lesions in aorta of rabbits submitted to the hypercholesterolemic diet. These results led us to the hypothesis that LDEMTX could be used to minimize the post-AMI inflammatory process, determinant for cardiac remodeling, and their deleterious effects. The aim of this study was to investigate the effect of LDE-MTX treatment on cardiac remodeling in rats submitted to AMI. Male Wistar rats (300-400g) were submitted to the surgical model of AMI or Sham surgery. The groups were divided into: SHAM (saline solution), AMI-LDE, AMI-MTXc (commercial methotrexate), AMI-LDE-MTX. The animals were treated once a week at a dose of 1 mg/kg intraperitoneally, for 6 weeks. After 24 hours of AMI and at the end of the follow-up, the echocardiogram was performed. The heart, lung, liver and kidneys were collected to obtain the relative weight of the organs. Infaction size was estimated by mean extern and intern size of IAM. Evaluation of myocyte necrosis, inflammatory process, myocyte diameter and myocardial fibrosis in the subendocardial (SE) and interstitial (INT) areas was performed in remote area from AMI. Markers of oxidative stress, inflammation, fibrosis, angiogenesis and lipoprotein receptors were quantified by quantitative real-time PCR. Treatment with LDE-MTX decreased LV dilation, cardiac hypertrophy, systolic and diastolic volumes, interventricular septum and posterior wall thickness and LV mass, compared to AMI-LDE and AMI-MTXc groups. In addition, there was an improvement of approximately 40% of LV systolic function compared to other AMI groups. Treatment with LDE-MTX did not alter diastolic function. The relative weight of the heart and lung were lower in the AMI-LDE-MTX group when compared to the AMI-LDE. In morphometry, infarct size decreased in the AMI-LDE-MTX group when compared to AMI-LDE. Necrosis, inflammatory infiltrate and collagen volume fraction in the INT and SE regions were lower in AMI-LDEMTX than in AMI-LDE and AMI-MTXc groups, as well as the myocyte diameter. The gene expression of oxidative stress and fibrosis markers were lower in the AMI-LDE-MTX group when compared to the AMI-MTXc. Regarding inflammation, the AMI-LDE-MTX group had lower expression of the TNF-alfa gene when compared to the AMI-MTXc group and the SHAM group. As regards the lipoprotein receptor, in the AMI-LDE-MTX there was lower expression of the gene for low-density lipoprotein (LDLR) receptor compared to MTXc treated animals. No toxicity was observed in any groups. The results of this study indicate that treatment with LDE-MTX significantly improves cardiac function and attenuates cardiac remodeling in an experimental surgical model for AMI