El objetivo central del presente trabajo de Tesis Doctoral fue restablecer in vitro la susceptibilidad antimicrobiana de cepas comensales de Escherichia coli (con fenotipo multirresistente-MDR-) aisladas de explotaciones pecuarias, mediante la asociación de diferentes antimicrobianos con el inhibidor de bombas de eflujo 1-(1-naphthylmethyl)-piperazine (NMP). De esta manera, se pretende contribuir al desarrollo de planes de dosificación de máxima eficacia antimicrobiana minimizando el riesgo de emergencia y diseminación de resistencia bacteriana; permitiendo así la obtención de productos de origen animal de excelencia sanitaria, en función de la correcta interpretación de los parámetros farmacocinéticos/farmacodinámicos (modelización PK/PD) para una correcta dosificación, del mecanismo de resistencia y del eventual bloqueo de éste último. Se obtuvieron muestras de materia fecal mediante hisopado rectal de vacas en ordeñe, terneros y animales de compañía, pertenecientes a tambos de la provincia de Buenos Aires; así como también de pozos sépticos, agua de consumo y bombas estercoleras. Se determinaron los perfiles de sensibilidad, mediante el método estandarizado de Kirby-Bauer de difusión en agar, frente a ocho antimicrobianos a todas las cepas de E.coli aisladas. Se hallaron diez cepas de E. coli multirresistentes a partir de los animales muestreados en el estudio de tipo transversal. Se emplearon cepas isogénicas de E. coli con diferentes grados de expresión de bombas de eflujo como control de calidad (AG100A con deleción total de bombas de eflujo, AG100 como cepa “normal” y AG112 con sobreexpresión de bombas). Se determinó la concentración inhibitoria mínima (CIM) y la concentración bactericida mínima (CBM) de florfenicol, ciprofloxacina, tetraciclina y ampicilina por el método de microdilución seriada en caldo Luria-Bertani (LB) con y sin NMP. Para la determinación de las interacciones entre los tres antimicrobianos seleccionados (florfenicol, ciprofloxacina y tetracilina) y el inhibidor de bombas se calculó el Índice de Concentración Inhibitoria Fraccionaria (CIF) a fin de evaluar la manifestación o no de efecto sinérgico. Para evaluar la cinética de muerte bacteriana se realizaron curvas de muerte bacteriana de las cepas de referencia y las cepas de campo MDR con y sin NMP. Con los datos obtenidos se realizó el análisis estadístico correspondiente. Por último, a partir de la información farmacodinámica obtenida se realizó una modelización farmacocinética/farmacodinámica (PK/PD), para lo cual se utilizaron datos obtenidos de estudios farmacocinéticos de florfenicol, danofloxacina y oxitetraciclina realizados previamente por el grupo de investigación de la Cátedra de Farmacología. Se aislaron cepas resistentes y multirresistentes con altos niveles de resistencia frente a tetraciclina y ampicilina. Todas las combinaciones de resistencia múltiple siempre incluyeron en su perfil a la tetraciclina. El NMP asociado a ampicilina tuvo un efecto nulo tanto en las cepas isogénicas como en las de campo. Sin embargo, ciprofloxacina, florfenicol y tetraciclina, demostraron ser claros sustratos de las bombas. Se evidenció la ocurrencia de sinergismo de potenciación ya que con una concentración de antimicrobiano varias veces inferior a la de su CIM, se logró un efecto antibacteriano mejorado con la incorporación de NMP. Se comprobó que es posible disminuir la concentración de los antimicrobianos -florfenicol, ciprofloxacina y tetraciclina- con la incorporación de NMP, sin modificar de manera importante la “cinética de muerte bacteriana”, tanto en las curvas de muerte de las cepas de referencia como en las cepas problema. En cuanto a la relación PK/PD, en la cepa AG112 se mejoraron notablemente los parámetros predictores de eficacia con la adición del inhibidor, con la consecuente disminución de la concentración de los antimicrobianos. Resulta prometedor el efecto de la combinación de un fármaco inhibidor de bombas de eflujo como coadyuvante de aquellos antimicrobianos sustratos de las bombas de eflujo sobreexpresadas como mecanismo inespecífico de resistenca bacteriana.

A signifficant obstacle facing the healthcare industry is the phenomenon of multidrug resistance (MDR) in which a cell acquires simultaneous resistance to many unrelated drugs that it has never been exposed to. At the molecular level, MDR can be characterised by a reduction of intracellular drug levels due to their active efflux by multidrug transporters such as P-glycoprotein (Pgp). Pgp is able to efflux a phenomenally wide variety of chemically unrelated drugs and causal relationships have been established between its expression and the acquisition of MDR to numerous anticancer and central nervous system (CNS) drugs. There has thus been much effort to understand the molecular biology of Pgp and how it functions. However, many aspects of its functioning remain unclear. From a drug discovery viewpoint, we have yet to fully understand what features make some drugs susceptible to Pgp-mediated efflux (substrates) and what makes others able to inhibit Pgp function (inhibitors). From a mechanistic viewpoint, it is still uncertain what the exact nature of Pgp's binding site is, the role of ATP binding and hydrolysis in transport and how both of these interplay with ligand binding. The work presented in this thesis attempts to answer these questions from two perspectives. Firstly the mouse Pgp crystal structure [PDB 3G60] was used as a unique starting point for molecular dynamics (MD) simulations to characterise the dynamics and conformational exibility of Pgp, properties believed to be integral to its function. The simulations revealed Pgp to be a highly dynamic molecule at both its transmembrane (TM) and nucleotide binding domains (NBDs). The latter exhibited a conformational asymmetry that supports the Constant Contact model of ATPase activity. In the presence of the Pgp substrate, daunorubicin, the NBDs exhibited tighter asymmetric dimerisation leading to increased affinity for ATP. In contrast, the presence of the Pgp inhibitor, QZ59-RRR led to NBD conformational changes that reduced their affinity for ATP. Thus providing an appealing mechanism for how QZ59-RRR inhibits Pgp ATPase activity. MD simulation was also used to provide atomic-detail interpretations of multiple binding stoichiometries of drug and lipid molecules observed by collaborator-led mass spectrometry experiments. This also provided opportunity to validate the Pgp simulations against novel experimental data. The second strand of the thesis explored the membrane permeation dynamics of CNS therapeutics in order to identify differences in protonation states, conformations, orientations and membrane localisation that might distinguish those that are Pgp substrates and from those that are not. These properties were studied using complementary MD simulation and nuclear magnetic resonance (NMR) techniques. The simulations revealed a novel set of criteria that in uence the likelihoodof a drug to 'flip-flop' across a membrane, a behaviour that may make drugs more susceptible to Pgp efflux. These observations were broadly consistent with the NMR experiments. However, the NMR data also highlighted limitations in the simulation approaches used in this thesis and emphasised the need to also consider the kinetics of permeation in addition to its thermodynamics.

P. aeruginosa e espécies de Acinetobacter são causas comuns de diversas infecções em pacientes hospitalizados, principalmente nos internados em centros de tratamento intensivo. Além disso, esses microrganismos se destacam por apresentarem resistência, intrínseca e adquirida, a várias classes de antibióticos, conferindo à bactéria fenótipos de multirresistência e panresistência. O objetivo deste estudo foi avaliar a participação de integrons (elementos genéticos que carreiam genes de resistência), de genes codificadores de metalo--lactamases, da perda de porinas (canais protéicos da membrana externa), e da atividade de efluxo aumentada, como determinantes do fenótipo de multirresistência e panresistência. Foram estudadas 147 P. aeruginosa e 57 Acinetobacter spp. isolados de pacientes hospitalizados no Hospital Universitário da Universidade Federal de Juiz de Fora, no período de 2003 a 2006. O perfil de sensibilidade destes isolados foi determinado por disco de difusão e utilizado para classificá-las como multirresistentes (MDR) e não multirresistentes (n-MDR). A variabilidade clonal dos isolados foi investigada por PFGE. Os isolados pertencentes aos grupos MDR e n-MDR foram investigados quanto a presença de integrons de classe 1, 2 e 3, por PCR e análise de RFLP. Os cassetes gênicos contidos nestes integrons, assim como genes codificadores de carbapenemases (ex. IMP, VIM e SPM), foram detectados por PCR e identificados por seqüenciamento. Avaliação da expressão gênica de bombas de efluxo (mexB, mexY, mexD e adeB) e de porina (OprD) foi conduzida por real-time RT-PCR. Os dados apresentados para os isolados do grupo MDR foram comparados àqueles do grupo n-MDR e a associação entre os determinantes de resistência e o fenótipo MDR foi calculada estatisticamente. Fenótipo de multiresistência foi observado em 42,2% e 84,2% das P. aeruginosa e Acinetobacter spp. estudadas. Nenhum isolado bacteriano apresentou fenótipo panresistente. Em 65 (44,2%) dos isolados de P. aeruginosa, foram detectados integrons de classe 1. Esses elementos apresentaram relação estatisticamente significativa com fenótipos MDR em P. aeruginosa. Entretanto, a maioria desses integrons não carreava nenhum cassete gênico (43/65) ou continham apenas cassetes gênicos de resistência a aminoglicosídeos (19/65). Entre os isolados de Acinetobacter spp., 11 (17,5%) apresentaram integrons de classe 1 e 30 (47,6%) integrons de classe 2. Apenas os últimos foram estatisticamente associados com fenótipos MDR. A pesquisa de metalo--lactamase (MBL) revelou a produção de enzimas SPM em 24 isolados de P. aeruginosa. Os estudos de expresão gênica demonstraram que, entre os sistemas de efluxo mais relatados para P. aeruginosa, MexXY-OprM foi o que mostrou maior diferença entre o nível de expressão dos grupos MDR e n-MDR, sugerindo que este sistema de efluxo desempenha importante papel no fenótipo MDR. Diminuição, em média de 66,4%, da produçãode OprD também foi um padrão encontrado nos isolados MDRem relação aos n-MDR. Dois grupos clonais de P. aeruginosa e dois de Acinetobacter spp. foram predominantes e tiveram relação com presença de integrons, produção de SPM-1 e com fenótipo MDR. Portanto, esse fenótipo pode ser consequência de acúmulo de determinantes de resistência em clones específicos. / The non-fermenting pathogenic bacteria Pseudomonas aeruginosa and Acinetobacter spp. are important causes of nosocomial infections. Theses species are often associated with a multidrug resistance (MDR) phenotype, due to intrinsic and acquired resistance genes. Some determinants of resistance, such as integrons, carbapenemases, overexpression of efflux systems and porins loss may be associated with the MDR phenotype. The aim of this study was to evaluate the association of non-MDR and MDR phenotypes in P. aeruginosa and Acinetobacter spp. to the presence of integrons and carbapenemases encoding genes, the overexpression of mexY, mexB, mexD and adeB genes and loss of the outer membrane protein, OprD. These resistance determinants were evaluated in 147 P. aeruginosa and 57 Acinetobacter spp., isolated from in-patients of University Hospital of UFJF. Isolates with different PFGE and non-susceptibility profiles were grouped according to MDR or non-MDR phenotypes. PCR and real-time RT-PCR were used to investigate the presence of class 1, 2 and 3 integrons and carbapenemase encoding genes and the expression of mexY, mexB, mexD and adeB efflux pumps and OprD porin, respectively. Class 1 integrons were one of the most common genetic elements present in MDR P. aeruginosa (44,2%), but the phenotype could not be attributed to these elements, since they showed empty (43/65) or only aminoglycoside gene cassettes (19/65). Class 2 integrons were the most common genetic elements in MDR Acinetobacter spp., and this association was statistically significant. SPM encoding gene was the only carbapenemase gene found in P. aeruginosa and, predominantly, in the PFGE cluster A. Expression of MexXY-OprM determined by real-time RT-PCR was the highest variable between MDR and non-MDR P. aeruginosa isolates (almost 10-fold). Reduction of 66.4% in OprD expression was observed in MDR P. aeruginosa, in comparison with non-MDR ones. It is concluded that the most important genetic determinants in the MDR phenotype of P. aeruginosa were SPM-1 production, followed by MexXY-OprM over expression and diminished production of OprD, while class 2 integrons was the most important genetic determinant of MDR phenotype in A. baumannii.

Resistenzen von Tumoren gegenüber der Behandlung mit Chemotherapeutika stellen ein wesentliches Hindernis für eine erfolgreiche Therapie in der onkologischen Klinik dar. Ein Verständnis der biologischen Mechanismen auf molekularer Ebene, die zu diesen Resistenzphänomenen führen, ist daher von entscheidender Bedeutung, um Strategien zu entwickeln, die darauf zielen, eine Therapieresistenz zu überwinden. Um diesem Ziel näher zu kommen, wurden im Verlaufe dieser Arbeit verschiedene Modelle aus unterschiedlichen Tumoren entwickelt und analysiert, die im Zellkultursystem Chemoresistenzen von neoplastischen Geweben simulieren. In einem ersten Schritt wurden diese in vitro Systeme zellbiologisch hinsichtlich dem Vorhandensein von verschiedenen, aus der wissenschaftlichen Literatur bekannten Resistenzmechanismen, charakterisiert. Hierbei konnte neben der verstärkten Expression von ABC-Transportern, wie P-Glykoprotein (P-Gp), "Breast Cancer Resistance Protein" (BCRP) sowie "canalicular Multispecific Organic Anion Transporter" (cMOAT), eine intrazelluläre Kompartimentierung von Zytostatika, Modulation der Aktivität von DNA-Topoisomerasen II (Topo II) sowie Veränderungen in der Aktivität von DNA-Reparatursystemen, wie z.B. dem DNA-Mismatch Repair System (DMM) oder der O6-Methyguanin-Methytransferase (MGMT) in resistenten Zellen wiedergefunden werden. Die Aktivierung dieser Mechanismen reichte jedoch nicht aus, das komplexe Geschehen von unterschiedlichen Kreuzresistenzen in den Zellen zu erklären. Es wurde daher gezielt nach neuen Resistenzmechanismen gesucht. Dafür wurden zwei unterschiedliche Strategien verfolgt: 1. Suche nach neuen Resistenz-assoziierten Faktoren auf Ebene der zellulären mRNA Expressionsprofile ("Transcriptomics"), sowie 2. Suche nach neuen Resistenz-assoziierten Faktoren auf Ebene der zellulären Proteinexpression ("Proteomics"). Mittels beider experimentellen Ansätze konnten mehrere Faktoren identifiziert werden, die potentiell neue Resistenzmechanismen in Tumorzellen vermitteln können. Für die Faktoren Glypican-3 (GPC3), DFNA5 und "Transporter associated with Antigen Presentation" (TAP) konnten funktionelle Analysen nachweisen, daß diese am Resistenzgeschehen beteiligt sind. Zur Überwindung von Chemoresistenzen, wurde neben dem Einsatz konventioneller chemischer Substanzen, eine gentherapeutische Strategie, die Ribozymtechnologie, gewählt. In dieser Arbeit wurden Ribozyme gegen GPC3 sowie die ABC-Transporter BCRP und cMOAT entwickelt. / Resistance to antitumor chemotherapy is a common problem in patients with cancer and a major obstacle to effective treatment of disseminated neoplasms. An understanding of the molecular mechanisms leading to these resistance phenomena is of vital interest to develop strategies to overcome therapy resistance in clinics. In order to gain further insides into the biological mechanisms mediating drug resistance, in this study various cell culture models derived from different origins were established and analyzed in detail. At first, these in vitro models were investigated concerning the activity of drug resistance mechanisms that were described in the scientific literature previously. By this approach the enhanced expression of the ABC-transporters P-glycoprotein (P-gp), "breast cancer resistance protein" (BCRP) and "canalicular multispecific organic anion transporter" (cMOAT) could be observed. In addition, an intracellular compartmentalization of the antineoplastic agents, a modulation of the activities of DNA-topoisomerases II (Topo II), and altered activities of DNA-repair systems, such as the DNA-mismatch repair system (DMM) or O6-methyguanine methyltransferase (MGMT) were detected. However, since the activation of these mechanisms do not explain all of the cross resistance pattern observed in these cell systems, other additional mechanisms must be operating in the drug-resistant cells. In order to identify potential new molecular mechanisms involved in drug resistance, in this study two different experimental strategies were performed: 1. Search of new resistance-associated factors on the level of the cellular mRNA expression profiles ("transcriptomics"), and 2. Search of new resistance-associated factors on the level of cellular protein expression ("proteomics"). By applying both experimental strategies, several cellular factors could be identified that potential play a role in drug resistance of tumor cells. Functional evidence was provided for glypican-3 (GPC3), DFNA5 and "transporter associated with antigen presentation" (TAP) to be involved in drug-resistant phenotypes. To overcome drug resistance, a gene therapeutic approach, a hammerhead ribozyme-based technology, was developed. In this study various ribozymes directed against GPC3 and the ABC-transporters BCRP and cMOAT were constructed.

Multidrug Resistenz (MDR), die simultane Resistenz gegenüber strukturell und funktionell nicht-verwandten Zytostatika, stellt eine wesentliche Ursache für unzureichende Behandlungserfolge maligner Erkrankungen dar. Die inherente Resistenz bzw. Resistenzentwicklung gegenüber chemotherapeutischen Substanzen ist vor allem die Folge der Präsens und Regulation unterschiedlicher Transportproteine wie MDR1, MRP1, BCRP und MVP. In der Konsequenz kommt es zu alteriertem Influx und/oder Efflux von Zytostatika, verminderter Akkumulation und Effektivität von Chemotherapeutika. Sowohl Zytostatika als auch Zytokine zeigten modulierende Einflüsse auf die Expression der MDR-Gene MDR1, MRP1 und MVP (Kapitel 2-9). Zytostatika wie Adriamycin resultierten vorwiegend in induzierten MDR1-Expressionen, dem hauptsächlichen Interventionstarget zur Überwindung des klassischen MDR-Phänotyps. Zytokine wie TNFa führten, extern appliziert als auch durch Gentransfer, zur Chemosensitivierung der Tumorzellen, verbunden mit Down-Regulationen von MDR1 und MVP. Die Zytokin-vermittelte Überwindung des klassischen MDR-Phänotyps weist auf die Inklusion definierter Zytokine in etablierte Chemotherapieprotokolle hin, wie bereits angewendet bei der hyperthermen isolierten Extremitätenperfusion mit TNFa (Kapitel 13). Die Verwendung BCRP-spezifischer Ribozyme demonstrierte deren Potential zur Überwindung des BCRP-bedingten, atypischen MDR-Phänotyps. Darüber hinaus wurde gezeigt, dass die Expression der ABC-Transporter als auch des MVP durch Hyperthermie temperatur- und zeitabhängig induzierbar ist (Kapitel 10-13). Diese Hyperthermie-Induktion wird für MDR1 und MRP1 über den Transkriptionsfaktor YB-1 zeitnah zum Stressereignis vermittelt. In der klinischen Situation konnte anhand verfügbarer Biopsien von Kolonkarzinomen, Sarkomen und Melanomen, jeweils mittels Hyperthermie im Kontext multimodaler Behandlungsregime behandelt, kein direktes, generelles Risiko einer MDR1- oder MRP1-vermittelten, Hyperthermie-bedingten Induktion/Verstärkung einer MDR beobachtet werden. Die Analyse der Promotoren MDR-assoziierter Gene wie MDR1 und MVP zeigte deren Induzierbarkeit durch unterschiedliche Therapie-relevante Faktoren wie Zytostatika und Hyperthermie in verschiedenen in vitro- und in vivo-Modellen (Kapitel 10,14-20). Spezifische Sequenzmotive sind für die Stressfaktor-induzierte Bindung von Transkriptionsfaktoren wie YB-1 verantwortlich; Mutationen in diesen Sequenzbereichen modulierten die Induzierbarkeit (Kapitel 14,15,20). Der Einsatz Therapie-induzierbarer Promotoren unterschiedlicher MDR-Gene wie MDR1 (Kapitel 14-18) und MVP (Kapitel 19,20) erlaubt somit generell die Anpassung an etablierte Behandlungsprotokolle verschiedener Tumorentitäten. In fortführenden Arbeiten bleibt die erfolgreiche Anwendung von Therapie-induzierbaren MDR-Promotorsequenzen zur Expression therapeutisch relevanter Gene im Kontext einer Gentherapie maligner Erkrankungen zu prüfen. / Multidrug resistance, the simultaneous resistance towards structurally and functionally unrelated cytostatic drugs, still represents a major cause of cancer treatment failure. Inherent or acquired resistance against a wide variety of chemotherapeutic drugs depends mainly on the presence and regulation of different transporter proteins, such as MDR1, MRP1, BCRP, and MVP. Thus, decreased uptake and/or increased efflux, lowered net accumulation, and in consequence, less efficiency of anti-cancer drugs is the clinical hurdle to struggle with. Cytostatics as well as cytokines showed modulating effects on the expression of the MDR-associated genes MDR1, MRP1, and MVP (chapter 2-9). Cytostatics such as adriamycin resulted mainly in increased expression of the MDR1 gene, the most prominent intervention target for the reversal of the classical MDR phenotype. Cytokines such as TNFa, externally applied or by gene transfer, led to chemosensitization of tumor cells, and to down regulation of MDR1 and MVP. This cytokine-mediated reversal of the classical MDR phenoype refer to the inclusion of defined cytokines into established chemotherapy protocols, as already realized by the hyperthermic isolated limb perfusion with TNFa (chapter 13). The employment of BCRP-specific ribozymes demonstrated their potential to reverse the BCRP-mediated atypical MDR phenotype. Furthermore it was shown, that the expression of the ABC transporters as well as of MVP was inducible by hyperthermia in a temperature and time-dependet manner (chapter 10-13). This hyperthermia-caused induction of MDR1 and MRP1 is mediated by the transcription factor YB-1 timely close to the stress event. However, no direct, general risk of a MDR1- or MRP1-mediated hyperthermia-caused induction/enhancement of the MDR phenotype was observed in clinical settings, analyzed by using biopsies available from colon carcinomas, sarcomas, and melanomas, which were treated with hyperthermia in the context of multimodal regimes. The analyses of promoters of the MDR-associated genes MDR1 and MVP revealed their inducibility by different therapy-related factors such as cytostatics and hyperthermia in several in vitro- and in vivo models (chapter 10,14-20). Specific sequence motifs were found to be responsible for the stress-induced binding of transcription factors; mutations within these sequence regions modulated their inducibility (chapter 14,15,20). Thus, the employment of therapy-inducible promoters of different MDR genes such as MDR1 (chapter 14-18) and MVP (chapter 19,20) allows the improvement of established treatment protocols for different tumor localizations. Based on this, the succesful use of therapy-inducible MDR promoter sequences for the expression of therapeutically relevant genes in the context of a gene therapy of cancer represents an ambitious goal for the future.

Blood-brain barrier (BBB) is a unique membranous barrier, which segregates brain from the circulating blood. It works as a physical and metabolic barrier between the central nervous system (CNS) and periphery. In mammals, endothelial cells were shown to be of BBB and are characterized by the tight junctions along with efflux system which are responsible for the restriction of movement of molecules within the cells. Efflux system consists of multidrug resistance proteins such as P-glycoprotein (P-gp). P-gp removes substances out back from the brain to the blood before they reach to the brain. So the barrier is impermeable to many compounds such as amino acids, ions, small peptides and proteins, making it the most challenging factor for the development of new drugs for targeting CNS. Curcumin is a bioactive compound that has a number of health promoting benefits such as anti-inflammatory, anticancer, anti-oxidant agent; as well as a role in neurodegenerative diseases, but low oral bioavailability is the major limiting factor. Low water solubility and rapid metabolism are the two important factors responsible for poor bioavailability of curcumin. Galaxolide is a musk compound and previously known for the bioaccumulation of toxic components in the aquatic animals by interference with the activity of multidrug/multixenobiotic resistance efflux transporters (MDR/MXR). The bioavailability of curcumin can be enhanced when administered with galaxolide. This study was carried out to investigate the effect of galaxolide on the permeation of curcumin through the epithelial cell monolayers. MDCKII-MDR1 cell monolayer is used an in vitro blood-brain barrier model while Caco-2 monolayer is used as an in vitro intestinal model, which also expresses the P-glycoprotein. The curcumin and galaxolide were separately solubilised in the DMSO and used in combination to perform permeation study, to determine the effect of galaxolide on curcumin permeation through epithelial cell monolayers. The galaxolide shows an efflux protein inhibition activity and this activity was used to enhance permeation of curcumin through the Caco-2 monolayer. In summary, galaxolide is a novel permeation enhancer molecule, which can be used for the improvement of drug delivery of other bioactive compounds in future.

Leung, Winnie. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 155-164). / Abstracts in English and Chinese. / Abstract --- p.i / 摘要 --- p.iii / Acknowledgements --- p.v / Table of Contents --- p.vi / List of Figures --- p.x / Abbreviations --- p.xii / Chapter Chapter 1 --- General Introduction --- p.1 / Chapter 1.1 --- Clinical management of Cancer --- p.2 / Chapter 1.2 --- Multidrug resistance --- p.8 / Chapter 1.3 --- Aim of study --- p.14 / Chapter Chapter 2 --- Identification of gene contributing to multidrug resistance in human uterine sarcoma cells --- p.16 / Chapter 2.1 --- Introduction --- p.17 / Chapter 2.2 --- Material and Methods / Chapter 2.2.1 --- Materials / Chapter 2.2.1.1 --- Cell lines --- p.20 / Chapter 2.2.1.2 --- "Cell culture medium, supplements and buffers" --- p.20 / Chapter 2.2.1.3 --- Gene expression assay reagents --- p.22 / Chapter 2.2.1.4 --- Western blotting reagents --- p.24 / Chapter 2.2.1.5 --- MTT assay reagents --- p.29 / Chapter 2.2.1.6 --- Apoptosis analysis by flow cytometry reagents --- p.29 / Chapter 2.2.2 --- Metho --- p.ds / Chapter 2.2.2.1 --- Cell Culture --- p.31 / Chapter 2.2.2.2 --- MTT assay --- p.32 / Chapter 2.2.2.3 --- Gene expression essay (RT-PCR) --- p.33 / Chapter 2.2.2.4 --- Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) of protein lysate and Western blotting --- p.37 / Chapter 2.2.2.5 --- Quantification of doxorubicin uptake by flow cytometry --- p.40 / Chapter 2.2.2.6 --- Apoptosis analysis by flow cytometry --- p.41 / Chapter 2.3 --- Results --- p.4 / Chapter 2.3.1 --- Cytotoxicity of doxorubicin on SA and DX5 cells --- p.43 / Chapter 2.3.2 --- mRNA expression of multidrug resistance related genes in SA and DX5 cells --- p.46 / Chapter 2.3.3 --- P-glycoprotein expression in SA and DX5 cells --- p.49 / Chapter 2.3.4 --- Doxorubicin (Dox) uptake by SA and DX5 cells --- p.51 / Chapter 2.3.5 --- Doxorubicin induced Apoptosis in SA and DX5 cells --- p.54 / Chapter 2.4 --- Discussion --- p.61 / Chapter 2.5 --- Conclusion --- p.65 / Chapter Chapter 3 --- Alternation in P-glycoprotein expression in DX5_Ninjl cells --- p.66 / Chapter 3.1 --- Introduction --- p.67 / Chapter 3.2 --- Materials and Methods / Chapter 3.2.1 --- Materials / Chapter 3.2.1.1 --- Cell lines --- p.70 / Chapter 3.2.1.2 --- "Cell culture medium, supplements and buffers" --- p.70 / Chapter 3.2.1.3 --- Gene expression assay reagents --- p.70 / Chapter 3.2.1.4 --- Western blotting reagents --- p.72 / Chapter 3.2.1.5 --- Plasmid DNA extraction --- p.75 / Chapter 3.2.1.6 --- Transient transfection --- p.76 / Chapter 3.2.1.7 --- MTT reagents --- p.76 / Chapter 3.2.2 --- Methods / Chapter 3.2.2.1 --- Cell culture --- p.78 / Chapter 3.2.2.2 --- Gene expression essay (RT-PCR) --- p.79 / Chapter 3.2.2.3 --- Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) of protein lysate and Western blotting --- p.81 / Chapter 3.2.2.4 --- DNA plasmid extraction --- p.83 / Chapter 3.2.2.5 --- Transient transfection --- p.84 / Chapter 3.2.2.6 --- MTT assay --- p.85 / Chapter 3.2.2.7 --- Quantification of doxorubicin (Dox) uptake by flow cytometry --- p.86 / Chapter 3.3 --- Results / Chapter 3.3.1 --- mRNA expression of Ninjurinl (Ninj1) in SA and DX5 cells --- p.87 / Chapter 3.3.2 --- The protein expression of Ninjurinl (Ninj1) in SA and DX5 cells --- p.89 / Chapter 3.3.3 --- Ninjurin1 (Ninj1) cDNA transfection in DX5 cells --- p.91 / Chapter 3.3.4 --- mRNA expression of MDR1 in Ninjurin1-transfected DX5 cells (DX5_Ninjl) --- p.93 / Chapter 3.3.5 --- P-glycoprotein expression in Ninjurin1-transfected DX5 cells --- p.95 / Chapter 3.3.6 --- "Cytotoxicity of doxorubicin (Dox) on DX5 control, DX5 vector control and DX5_Ninjl cells" --- p.97 / Chapter 3.3.7 --- "Doxorubicin (Dox) uptake by SA control, DX5 control and DX5_Ninjl cells" --- p.99 / Chapter 3.4 --- Discussion --- p.102 / Chapter 3.5 --- Conclusion --- p.105 / Chapter Chapter 4 --- Alternation in MDR1 expression in DX5一THBS1 cells --- p.106 / Chapter 4.1 --- Introduction --- p.107 / Chapter 4.2 --- Materials and Methods / Chapter 4.2.1 --- Materials / Chapter 4.2.1.1 --- Cell lines --- p.109 / Chapter 4.2.1.2 --- Cell culture medium； supplements and buffers --- p.109 / Chapter 4.2.1.3 --- Gene expression assay reagents --- p.109 / Chapter 4.2.1.4 --- Western blotting reagents --- p.111 / Chapter 4.2.1.5 --- Plasmid DNA extraction --- p.114 / Chapter 4.2.1.6 --- Transient transfection --- p.115 / Chapter 4.2.1.7 --- MTT reagents --- p.115 / Chapter 4.2.2 --- Methods / Chapter 4.2.2.1 --- Cell culture --- p.117 / Chapter 4.2.2.2 --- Gene expression essay (RT-PCR) --- p.118 / Chapter 4.2.2.3 --- Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) of protein lysate and Western blotting --- p.120 / Chapter 4.2.2.4 --- DNA plasmid extraction --- p.123 / Chapter 4.2.2.5 --- Transient transfection --- p.123 / Chapter 4.2.2.6 --- MTT assay --- p.124 / Chapter 4.2.2.7 --- Quantification of doxorubicin (Dox) uptake by flow cytometry --- p.125 / Chapter 4.3 --- Results / Chapter 4.3.1 --- mRNA expression of Thrombospondinl (THBS1) in SA and DX5 cells --- p.126 / Chapter 4.3.2 --- The protein expression of Thrombospondinl (THBS1) in SA and DX5 cells --- p.128 / Chapter 4.3.3 --- Thrombospondinl (THBS1) cDNA transfection in DX5 cells --- p.130 / Chapter 4.3.4 --- mRNA expression of MDR1 in Thrombospondinl-transfected DX5 cells (DX5_THBS1) --- p.132 / Chapter 4.3.5 --- P-glycoprotein expression in Thrombospondinl-transfected DX5 cells --- p.134 / Chapter 4.3.6 --- "Cytotoxicity of doxorubicin (Dox) on DX5 control, DX5 vector control and DX5一THBS1 cells" --- p.136 / Chapter 4.3.7 --- "Doxorubicin (Dox) uptake by SA control, DX5 control and DX5_THBS1 cells" --- p.138 / Chapter 4.4 --- Discussion --- p.141 / Chapter 4.5 --- Conclusion --- p.145 / Chapter Chapter 5 --- General discussion --- p.146 / Chapter 5.1 --- Doxorubicin induced multidrug resistance in human uterin sarcoma cells via upregulation of P-glycoprotein --- p.147 / Chapter 5.2 --- The down-regulation of Ninjurin1 in human uterine sarcoma cells contributed to multidrug resistance --- p.148 / Chapter 5.3 --- The down-regulation of Thrombospondin1 in human uterine sarcoma cells contributed to multidrug resistance --- p.150 / Chapter 5.4 --- Conclusion and Future Perspective --- p.153 / Reference --- p.155

<p>U skladu sa postavljenim ciljevima rada formirana je kolekcija&nbsp;<br />fenotipski i genotipski okarakterisanih multiplo rezistentnih&nbsp;<br />kultura genomske vrste <em>Acinetobacter baumannii</em>. Za sojeve iz&nbsp;<br />kolekcije kultura utvrđen je anti-<em>A. baumannii</em> efekat etarskih&nbsp;<br />ulja, biljnih ekstrakata i njihovih bioaktivnih komponenti, kao&nbsp;<br />nekonvencionalnih antimikrobnih agensa. Takođe, osim njihovog&nbsp;<br />pojedinačnog efekta utvrđen je i kombinovani efekat&nbsp;<br />konvencionalnih i nekonvencionalnih antimikrobnih agenasa, koji&nbsp;<br />je dovedo do redukcije minimalnih ihnibitronih koncentracija oba&nbsp;<br />agensa u kombinaciji. Kombinacije etarskih ulja i njihovih&nbsp;<br />bioaktivnih komponenti sa trenutno dostupnim konvencionalnim&nbsp;<br />antibioticima, čija je efikasnost smanjena kada se primenjuju&nbsp;<br />pojedinačno, predstavljaju novu perspektivnu strategiju u terapiji&nbsp;<br />infekcija multiplo rezistentnim sojevima vrste <em>A. baumannii</em>.</p> / <p>In accordance to the aims of the work the collection of phenotypic and<br />genotypic characterized multidrug-resistant cultures of genomic species<br /><em>Acinetobacter baumannii</em> was formed. For the strains from the culture<br />collection an anti-<em>A. baumannii </em>effect of the essential oils, plant extracts<br />and their bioactive components, as non-conventional antimicrobial<br />agents, was determined. Also, in addition to their individual effect the<br />combined effect of conventional and non-conventional antimicrobial<br />agents was determined, which lead to a reduction of the minimal<br />inhibitroy cocnentrations of both agents in combination. Combinations<br />of the essential oils and their bioactive components with the currently<br />available conventional antibiotics, whose efficiency reduced when<br />administered individually, represent a promising new strategy for the<br />treatment of infections caused by multidrug-resistant <em>A. baumannii.</em></p>

Cancer cells that survive chemotherapy treatment often develop resistance to the administered chemotherapeutics, as well as to many other types of drugs, because the cancer cells increase their production of efflux pumps in the cell. This undesired phenomenon of resistance to cancer drugs is known as multidrug resistance. This work uses a novel drug carrier, called an eLiposome, to achieve cytosolic drug delivery to kill multidrug-resistant cancer cells. An eLiposome consists of a perfluoropentane (PFC5) emulsion droplet inside of a liposome. Folate attached to the eLiposome facilitates uptake into the cell. The PFC5 droplet is metastable at body temperature, but will rupture the liposome as the droplet expands during vaporization, and will release any drugs encapsulated inside of the liposome directly to the cell cytosol. Laser and ultrasound were examined as triggers to initiate the vaporization of the PFC5 droplet and actuate the release of doxorubicin (Dox) from folated eLiposomes containing Dox (feLD). Gold nanorods (GNRs) were synthesized and transferred to PFC5 droplets. Although GNRs are efficient at converting irradiated laser light to heat, no vaporization of the PFC5 droplets was observed when irradiated with laser light. Further investigation into the energy required for vaporization of PFC5 droplets revealed that there are currently no portable and wearable lasers available to provide enough energy to vaporize PFC5 droplets. Two seconds of ultrasound can release 78% of encapsulated Dox from feLD. Dox-sensitive KB-3-1 cells and Dox-resistant KB-V1 cells treated with feLD (without ultrasound) had cell viabilities of 33% and 60%, respectively. Ultrasound had negligible additional effect on the cell viability of KB-3-1 and KB-V1 cells treated with feLD (33% and 53%, respectively). We hypothesized that the Dox fiber formed during the loading of Dox into the eLiposome is a site for heterogeneous nucleation once the feLD is endocytosed by the cell, and vaporization and drug release occurs with or without ultrasound. Blocking the efflux pumps with verapamil decreases the rate at which Dox is exported from multidrug-resistant cells. When verapamil is co-delivered with feLD, the cell viability of KB-3-1 and KB-V1 cells decreases to 29% and 25%, respectively; thereby reversing the multidrug resistance possessed by KB-V1 cells. The delivery of doxorubicin inside of folated eLiposomes with an efflux pump blocker is a novel way to kill multidrug-resistant cancer cells as effectively as non-resistant cancer cells independent of lasers or ultrasound.

Burkholderia pseudomallei est l’agent causal de la mélioïdose, une maladie tropicale endémique dans le Nord de l’Australie et en Asie du Sud-Est. Nous avons analysé le système d’efflux, mécanisme majoritairement impliqué la multi-résistance aux antibiotiques. Nous avons chercher à identifier des mutations dans les pompes d’efflux et des modulation de l’expression de ces dernières afin d’expliquer ces phénotypes de résistance. Les techniques de séquençage de l’ADN et de transcriptomique par RT-qPCR nous ont permis d’identifier deux mécanismes chez des souches cliniques. Un mécanisme transitoire responsable d'une résistance croisée du Cotrimoxazole, avec les quinolones, et le chloramphénicol, pour lequel nous suspectons une modulation de l’expression de l’efflux. Le second, impliqué dans la résistance au méropénème, par surexpression de l'efflux suite à une mutation dans le régulateur de la pompe AmrAB-OprA.Dans un second axe de recherche, nous avons également criblé plusieurs molécules afin d'identifier des candidats inhibiteurs de l'efflux, dérivant de la famille des phénothiazines et capables de restaurer une sensibilité aux antibiotiques. Nous avons analysé l’impact de ces molécules sur des souches modèles de multi-résistance (Burkholderia thailandensis) et sur des souches cliniques et environnementales de B. pseudomallei. Ces molécules sont capables d’impacter l’expression de l’efflux, mais nous pensons que le mécanisme majeur d’inhibition de cette famille de molécules reste l’entrée en compétition avec les antibiotiques efflués. Nous avons identifié une molécule, AST17, capable de restaurer la sensibilité au Cotrimoxazole, ainsi qu'aux quinolones. / Burkholderia pseudomallei is thecausal agent of melioidosis, a tropical disease, endemic in Notrhern Australia and South-East Asia. We have analyzed efflux systeme, known to be one of the main mecanism implicated in antibiotic resistance phenotypes. We have looked for mutations in efflux pumps and for transient modulations of the efflux pumps expression, that could explain resistance phenotypes. Whole genome sequencing and a the targeted method of RT-qPCR allowed us to identified two mecanisms in clinical strains. A transient mecanism, responsible of a cross-resistance to Cotrimoxazole, quinolones and chloramphenicol, and we suspect an implication of modulation of efflux. The second one is implicated in meropenem resistance by an overexpression of the AmrAB-OprA efflux pumps, due to a mutation of its regulator. In a second time, we also have screened several compounds, all derivated from phenothiazines, in order to identify efflux pump inhibitors for a restoration of the antibiotic susceptibility. We have analyzed the impact of these molecules in multi-resistant strain models, and on several clinical and environnemental strains. These molecules are able to modulate efflux pumps expression, however, we think that the main inhibition mecanism of these derivatives is about a competition between the molecule and the antibiotics. We have identified one molecule, AST17, that is able to restore Cotrimoxazole and quinolones susceptibilities.