A proteína S100B é considerada um marcador bioquímico para lesão cerebral. Entretanto, foi demonstrado que há liberação de S100B em coração isolado de rato. Neste estudo, investigou-se os níveis séricos de S100B em pacientes portadores de cardiomiopatia dilatada (CMD). Métodos e Resultados: Foram selecionados 21 pacientes com CMD, excluindo qualquer condição que pudesse influenciar os níveis séricos de S100B. O grupo controle foi composto por 21 indivíduos pareados por sexo e idade. Ambos os grupos foram submetidos à avaliação clínica, ecocardiográfica, mensuração da proteína S100B e de NT-proBNP (expressos como mediana [variação interquartil]). Os níveis de NT-proBNP no grupo de pacientes (1462 pg/ml [426 - 3591]) foram maiores do que no grupo controle (35 pg/ml [29 - 55]); P<0.001. Os níveis de S100B foram maiores no grupo de pacientes (0.051µg/L [0.022 - 0.144]) do que no grupo controle (0.017µg/L [0.003 - 0.036]); P=0.009. Houve correlação positiva entre os níveis séricos de S100B e NT-proBNP somente no grupo de pacientes (Coeficiente de Spearman r=0.534; P=0.013). Conclusão: A proteína S100B está aumentada na CMD. Embora não possamos excluir a influência de dano cerebral, houve uma correlação positiva entre os níveis séricos de S100B e NT-proBNP em pacientes com CMD / The S100B protein is considered a biochemical marker for brain injuries. However, the isolated rat heart releases S100B. In this study, the serum levels of S100B was investigated in dilated cardiomyopathy (DCM) patients in order to evaluate its levels in heart disease. Methods and Results: It was selected DCM patients, excluding any condition that could influence S100B serum levels. Control individuals were sex and age matched. Both groups were submitted to clinical evaluation and echocardiography. The S100B and NT-proBNP serum levels (expressed as median [interquartile range]) were measured. NT-proBNP levels in patients group (1462 pg/ml [426 - 3591]) were higher than in controls (35 pg/ml [29 - 55]); P<0.001. S100B serum levels were higher in patients group (0.051µg/L [0.022 - 0.144]) than in controls (35 pg/ml [29 - 55]); P<0.001. S100B serum levels were higher in patients group (0.051µg/L [0.022 - 0.144]) than in controls (0.017µg/L [0.003 - 0.036]); P=0.009. Additionally, a positive correlation between S100B and NT-proBNP serum levels only in patients group (Spearman\'s coefficient r=0.534; P=0.013) was found . Conclusions: Although the influence of S100B from brain cannot rule out, the positive correlation between S100B and NT-proBNP levels in DCM patients points to the myocardium as the main source for the rise in S100B serum levels

Abstract Abnormal placentation is associated with preeclampsia and placental insufficiency, both of which increase the risk for fetal growth restriction. So far the early recognition of the risk population for preeclampsia has been problematic. The first hypothesis of this study was that in preeclampsia, the maternal serum proteomic profile is different from that in uncomplicated pregnancies, and this difference is detectable already in early pregnancy. The findings of this study demonstrate that in clinical preeclampsia the maternal serum proteomic profile is different from that in uncomplicated pregnancies with increased levels of placental proteins and antiangiogenic factors in pregnancies with clinical preeclampsia. Furthermore, the early pregnancy maternal serum proteomic profile in women who later develop preeclampsia revealed a distinct and different pattern compared with the profile in clinical preeclampsia. In early pregnancy, the differentially expressed proteins belong to placental proteins, vascular and/or transport proteins and matrix and/or acute phase proteins, while angiogenic and antiangiogenic proteins were not significantly expressed in early pregnancy. Preeclampsia, placental insufficiency, fetal growth restriction and type-1 diabetes may have an impact on fetal cardiovascular hemodynamics. The second hypothesis in this thesis was that in placental insufficiency, abnormalities in fetal cardiovascular status correlate with biochemical markers of cardiac dysfunction and chronic hypoxia. In placental insufficiency, increases in fetal N-terminal pro-atrial (NT-proANP) and pro-B-type natriuretic peptide (NT-proBNP) and in fetal erythropoietin concentrations were related to increased pulsatility in the fetal umbilical artery and descending aorta. In addition, these fetuses demonstrated increased pulsatility in their systemic venous blood velocity waveforms. Thus, in placental insufficiency, biochemical markers of cardiac dysfunction and chronic hypoxia are associated with signs of increased fetal cardiac afterload and systemic venous pressure. Increased NT-proANP and NT-proBNP levels were also detected in fetuses of type-1 diabetic mothers with normal umbilical artery velocimetry. In these pregnancies, NT-proANP and NT-proBNP levels were related to poor maternal glycemic control during early pregnancy.

Abstract During cardiac hypertrophy individual cardiac myocytes increase in size, which is accompanied by augmented protein synthesis and selective induction of a subset of genes. These phenotypic changes of myocytes are a result from altered intracellular signaling mechanisms and molecules. B-type natriuretic peptide (BNP) gene was selected as a target gene for the study of cardiac signaling mechanisms, since it is activated by mechanical, neural and humoral stimuli during myocyte hypertrophy. To generate hypertrophy of cardiac myocytes, neonatal rat cardiac myocytes were subjected to exogenous hypertrophic agonists such as endothelin-1 (ET-1) or to cyclic mechanical stretch. The role and regulation of transcription factors were studied by utilizing promoter analysis together with site-specific mutations and measurement of DNA binding activity and phosphorylation. GATA-4 mediated signaling was inhibited by blocking DNA binding with decoy oligonucleotides or by decreasing GATA-4 synthesis via adenoviral antisense delivery. ET-1 activated GATA-4 via serine residue phosphorylation, and this effect was mediated via p38 kinase. Similarly, GATA-4 binding activity was increased by ET-1 and mechanical stretch, but it was essential for activation of BNP gene only in the latter stimulation. Importantly, downregulation of GATA-4 protein levels prevented mechanical stretch induced hypertrophy of cardiac myocytes. In contrast, separate mechanism for an ET-1 specific signaling was composed of p38 kinase regulated ETS-like transcription factor-1 (Elk-1). Finally, the effect of mechanical stretch on endogenous endothelin-1 (ET-1) synthesis in cardiac cells was studied. Intrinsic ET-1 synthesis was activated in stretched cardiac myocytes, yet the levels of ET-1 were relatively low. This work suggests that GATA-4 transcription factor is required for mechanical stretch mediated hypertrophic program, and Elk-1 may act as a downstream effector of ET-1 in cardiac myocytes. Taken together, induction of ET-1 and BNP genes as well as activation of GATA-4 and Elk-1 transcription factors are regulated via a network of mitogen activated protein kinase pathways.

Abstract There is a need to identify patients with an increased risk of dying after acute myocardial infarction (AMI), because sudden cardiac death (SCD) and potentially fatal ventricular tachyarrhythmias can be prevented by an implantable cardioverter-defibrillator, or in some cases, with aggressively optimized drug or revascularization therapy. The present study was designed to study the predictive power of non-invasive risk markers and all-cause, cardiac and arrhythmic mortality in 700 consecutive post-AMI patients discharged alive with optimal medication according to contemporary guidelines. Detrended fluctuation analysis of heart rate variability (HRV) predicted all-cause mortality beyond clinical variables as well as left ventricular function in post-AMI patients. The predictive power of the short-term scaling exponent α1 was higher than that of the traditional indexes of HRV (for α1 &lt; 0.65, the risk ratio (RR) in multivariate analysis was 5.1, with 95% confidence intervals (CI) 2.9-8.9; p &lt; 0.001). HRV results from a conventional 24-hour electrocardiographic (ECG) recording system differed significantly when compared to a system with a higher sampling frequency. The difference was generally more pronounced in post-AMI patients than in healthy subjects. The presence of sustained T-wave alternans during a predischarge exercise test after AMI was not a marker of mortality. However, the inability to perform an exercise test or to reach the heart rate of 105 beats/min predicted independently all-cause (RR 9.3, 95% CI 2.0-43.3, p &lt; 0.01) and cardiac mortality (RR 11.1, 95% CI 2.4-50.8, p &lt; 0.01). High levels of natriuretic peptides were associated with both sudden and non-sudden cardiac mortality. B-type natriuretic peptide provided more specific independent information on the risk for subsequent SCD (RR 3.9, 95% CI 1.2-12.3, p &lt; 0.05) than non-SCD. SCDs occurred mainly more than 18 months after AMI, and the proportion of SCD was less than 40% of all cardiac deaths. Common arrhythmia markers such as the presence of ventricular premature beats or episodes of nonsustained ventricular tachycardia during ambulatory recordings, the time domain parameters of HRV, baroreflex sensitivity, QT dispersion and QRS complex duration provided only limited predictive power on the risk of SCD or arrhythmic events in patients with optimized beta-blocking therapy. Many risk variables previously considered to predict SCD were better predictors of non-SCD than SCD. Conclusions: 1. The epidemiological pattern of SCD was different from that reported previously. 2. Many arrhythmia risk markers provided only limited information on the risk of SCD. 3. Short-term fractal scaling exponent α1 provided potentially useful information on the risk for all-cause mortality, and BNP was useful in predicting the risk of SCD in a post-AMI population with optimized therapy.

Plant natriuretic peptides (PNPs) comprise a novel class of hormones that share some sequence similarity in the active site with their animal analogues that function as regulators of salt and water balance. A PNP present in Arabidopsis thaliana (AtPNP-A) has been assigned a role in abiotic and biotic stress responses, and the recombinant protein has been demonstrated to elicit cyclic guanosine monophosphate (cGMP)-dependent stomatal guard cell opening, regulate ion movements, and induce osmoticum-dependent water uptake. Although the importance of the hormone in maintaining ion and fluid homeostasis has been established, key components of the AtPNP-A-dependent signal transduction pathway remain unknown. Since identification of the binding partners of AtPNP-A, including its receptor(s), is fundamental to understanding the mode of its action at the molecular level, comprehensive protein-protein interaction studies, involving yeast two-hybrid screening, affinity-based assays, protein cross-linking and co-immunoprecipitation followed by mass spectrometric (MS) analyses have been performed. Several candidate binding partners of AtPNP-A identified with at least two independent methods were subsequently expressed as recombinant proteins, purified, and the specificity of their interactions with the recombinant AtPNP-A was verified using surface plasmon resonance. Several specific binary interactants of AtPNP-A were subjected to functional assays aimed at unraveling the consequences of the interactions in planta. These experiments have revealed that reactive oxygen species (ROS) are novel secondary messengers involved in the transduction of AtPNP-A signal in suspension-cultured cells of A. thaliana (Col-0). Further insight into the AtPNP-A dependent signalling events occurring in suspension-cultured cells in ROS-dependent or ROS-independent manner have been obtained from the large-scale proteomics study employing tandem mass tag (TMT) labelling followed by MS analysis to identify and relatively quantify proteins that are differentially expressed upon the treatment with nano- and picomolar concentrations of the biologically active AtPNP-A peptide at different time-points post-treatment. Characterization of both the AtPNP-A interactome and AtPNP-A dependent proteome afforded novel insights into the signal transduction pathways altered by PNPs and shed new light on the mechanisms by which these candidate interactants operate. Taken together, indications are that PNP dependent mechanisms can be harnessed for possible biotechnological applications.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25000号 / 医博第5034号 / 新制||医||1070(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 尾野 亘, 教授 江藤 浩之 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23805号 / 医博第4851号 / 新制||医||1058(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 寺田 智祐, 教授 稲垣 暢也 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Les maladies cardiovasculaires apparaissent précocement au cours de l'insuffisance rénale chronique (IRC) et représentent la première cause de mortalité. La 1ère étape pour apprécier la relation entre risque cardiovasculaire et progression de l'IRC consiste à améliorer l'estimation du débit de filtration glomérulaire (DFG). Nous avons donc évalué l'impact des conditions analytiques de mesure de la créatininémie et de la cystatinémie sur l'estimation du DFG. Les créatinines IDMS traçables (enzymatique et Jaffe compensé) améliorent l'estimation du DFG. Cependant, les méthodes enzymatiques non sensibles aux pseudochromogènes doivent être préférées. Concernant la cystatine C, nos résultats soulignent l'absence de standardisation du dosage. Chez des patients IRC non dialysés (stade I à V), nous avons identifié l'ostéoprotégérine (OPG) comme marqueur biologique de la présence de calcifications vasculaires. In vitro, nous avons démontré que le stress oxydant, majoré en présence de sérum urémique, jouait un rôle clé dans la transdifférenciation des cellules musculaires lisses vasculaires en ost oblastes. La mortalité en dialyse reste élevée et est largement dépendante des maladies cardiovasculaires. Il nous a donc paru nécessaire de rechercher les marqueurs pronostics et/ou d'en suivre l'évolution en transplantation. En dialyse, malgré une épuration significative par hémodiafiltration, les peptides natriurétiques sont des marqueurs du remodelage ventriculaire. La combinaison "NT-proBNP-CRP" est un puissant facteur pronostic de mortalité cardiovasculaire en hémodialyse. Après transplantation rénale, les calcifications vasculaires se stabilisent chez la majorité des patients et les taux d'OPG diminuent précocement. Les taux d'OPG sont significativement plus élevés chez les patients dont les calcifications progressent. Toutefois, seule l'intensité des calcifications avant transplantation permet de prédire la progression / Cardiovascular disease occurs in the early stage of chronic kidney disease (CKD) and is the leading cause of death. The first step, to appreciate the link between cardiovascular risk and CKD progression, is to improve glomerular filtration rate (GFR) estimation. We have therefore evaluated the impact of analytical conditions for creatinine and cystatin C measurement on estimated GFR. New creatinine ID-MS traceable methods (enzymatic and compensated Jaffe) improved estimation of GFR by predictive equations. However, enzymatic methods that are much less susceptible to interfere with non-creatinine chromogens may provide more reliable estimations of GFR. Regarding cystatin C, our results highlighted the lack of standardization. In non dialyzed CKD patients (stage I to V), we identified osteoprotegerin (OPG) as a biomarker for the presence of vascular calcification. In vitro, we demonstrated that oxidative stress, increased in the presence of uremi c serum, played a key role in the transdifferentiation of vascular smooth muscle cells into osteoblast-like cells. In dialysis, mortality is high and largely dependant on cardiovascular disease. We have therefore investigated prognostic markers and/or followed their evolution after transplantation. In dialysis, despite their removal by hemodiafiltration, natriuretic peptides could be potential markers of left ventricular remodelling. In addition, the combination of high CRP and circulating NT-proBNP dramatically impaired the hemodialysis survival rate. After renal transplantation, stabilization of vascular calcification was observed in the majority of patients and OPG levels are dramatically reduced. Despite a higher baseline OPG level in progressors vs. non-progressors patients, post transplant vascular calcification progression was only predicted by baseline score.

No description available.

A obesidade é uma doença nutricional crescente em humanos e de alta prevalência nos cães. Este distúrbio nutricional e decorrente, principalmente, de um balanço energético inadequado. O excesso de peso pode exacerbar uma doença preexistente e predispor ao desenvolvimento de outros problemas de saúde, como Diabetes mellitus, aumento dos níveis de colesterol e triglicérides, doenças hepáticas, lesões osteoarticulares, hipertensão, alterações cardíacas e respiratórias. Em medicina humana, a associação entre hiperinsulinemia, hiperlipidemia, hiperleptinemia, hipertensão arterial, hipertrofia ventricular e disfunção cardíaca demonstra que a obesidade e um fator de risco para a doença cardiovascular. O aminoterminal peptídeo natriurético tipo B (Nt- proBNP) é um marcador útil de disfunção ventricular nas doenças cardíacas em humanos, bem como em cães e gatos. No entanto, ainda não está claro como interpretar os níveis de Nt- proBNP em pacientes obesos, visto que os níveis deste peptídeo parecem ter correlação negativa com o índice de massa corpórea. A disfunção diastólica é comumente observada em indivíduos obesos e pode ser detectada precocemente por meio de ecocardiograma Doppler tecidual pulsado. Assim, considerando que os diversos estudos corn Nt- proBNP em humanos obesos são controversos e a inexistência de estudos em animais obesos, o objetivo deste estudo foi avaliar o possível papel dos peptídeos natriuréticos como marcadores pré-clínicos de doença cardíaca na obesidade canina e sua relação com os parâmetros de função diastólica avaliados pelo Doppler tecidual pulsado. Para isto, selecionaram-se 49 cães com escore de condição corporal normal (ECC 5) e 48 obesos (ECC 8 e 9), pareados com relação ao gênero, raça e idade. Os cães obesos apresentaram concentração de Nt- proBNP major que os cães com ECC5/9, e alterações em algumas variáveis ecocardiográficas de função diastólica de VE, avaliadas pelo Doppler tecidual pulsado. Também foi observado aumento na relação Ef/Em associado a alta concentração de Nt-proBNP, sugerindo aumento na pressão de enchimento do ventrículo esquerdo em cães obesos. / Obesity is an increasing nutritional disease in humans, and highly prevalent in dogs. This nutritional disturbance is a consequence of an inadequate energetic balance. Weight excess may exacerbate a pre-existing disease and predisposes to the development of other health problems as diabetes mellitus, increased colesterol and triglyceride levels, hepatic diseases, osteoarticular diseases, hypertension, cardiac and respiratory problems. In human medicine, the association between hyperinsulinemia, hyperlipidemia, hyperleptinemia, arterial hypertension, ventricular hypertrophy and cardiac disfunction demonstrates that obesity is a risk factor for cardiovascular disease. Type B aminoterminal natriuretic peptide (Nt- proBNP) is a useful marker of ventricular dysfunction in heart disease in humans, as well as in dogs and cats. Nonetheless, it is still unclear how to interpret the levels of Nt-proBNP in obese patients, because it has been negatively correlated to body mass index. Diastolic dysfunction is frequently observed in obese patients and may be detected early by pulsed tissue Doppler imaging (TDI). Therefore, considering that controversial results in several studies on Nt-proBNP in obese humans, and the lack of studies in obese animals, the purpose of this study was to evaluate the possible role of Nt-proBNP as preclinical marker of cardiac disease in obese dogs, and the relationship with diastolic function parameters assessed by pulsed TDI. Foully-nine dogs with ideal body score condition (BCS5/9) and 48 obese dogs (BCS 8 and 9/9), were selected, paired for gender, breed/size and age. A higher Nt-proBNP concentration was found in obese dogs in relation to BCS 5/9 dogs, and some changes in echocardiographic variables of diastolic function, assessed by pulsed TDI. There was also increase Ef/Em ratio associated with a higher Nt-proBNP levels, suggesting an increased filling pressure of left ventricle in obese dogs.