A sepse causa uma alta taxa de mortalidade no mundo. A fisiopatologia da doença envolve uma rede complexa de mediadores inflamatórios que promovem a lesão de diversos tecidos, além de diversas alterações hemodinâmicas e disfunção do sistema nervoso autonômico (SNA). Assim sabe-se que o sistema nervoso cumpre um papel importante no controle da inflamação sistêmica mediante a via colinérgica anti-inflamatória (VCA) através do receptor nicotínico de acetilcolina alfa7 (alfa7nAChR). O uso das células-tronco mesenquimais (CTM) tem mostrado efeitos benéficos em diversos ensaios clínicos de doenças inflamatórias. Neste contexto, as células-tronco mesenquimais derivadas da geleia de Wharton do cordão umbilical (CTM-GW) tornam-se promissórias, uma vez que essas células são reconhecidas pela regulação da resposta imunológica, reparação neural, efeito anti-apoptose, assim como a melhora da sobrevida na sepse, em modelos experimentais. Nossa hipótese foi de que as CTM-GW poderiam cumprir um papel neuroimunomodulador através da VCA e atenuar a disfunção de múltiplos órgãos em um modelo animal de sepse de ligadura e punção do ceco (LPC). Inicialmente células da matriz do cordão umbilical foram isoladas e caracterizadas de acordo com o consenso internacional vigente. Ratos Wistar machos adultos foram subdivididos em grupos: 1) sham (operação simulada); 2) LPC; 3) LPC+CTM-GW (injetado 106 CTM-GW via intraperitoneal, i.p. 6 h após LPC) e 4) LPC+MLA+CTM-GW (MLA: Metillicaconitine, antagonista do alfa7nAChR, i.p., 5:30 h após LPC e 106 CTM-GW 6h após). Às 24 horas após LPC, foram avaliadas a função cardiovascular, hemodinâmica assim como os outros parâmetros. Interessantemente, o tratamento com CTM-GW na sepse atenuou a disfunção diastólica e protegeu a sensibilidade baroreflexa. Além disso, as CTM-GW estimularam a atividade autonômica, simpática e parassimpática no coração. Observamos que o tratamento celular induziu uma regulação da expressão do receptor alfa7nAChR e TLR4 no baço e no coração, assim como a redução da relação p-STAT3TYR705 e STAT3 total no baço. Outros efeitos importantes e adicionais foram a diminuição da infiltração de leucócitos e a regulação das citocinas pró-inflamatórias pelas células. O bloqueio da VCA usando MLA confirmou que o receptor alfa7nAChR pode ser um provável alvo, chave da ação das CTM entre vários outros mecanismos envolvidos na resposta imune. Finalmente, as CTM-GW conseguiram reduzir a apoptose no pulmão e no baço independentemente da VAC reforçando o conceito de que as células-tronco tem efeitos diversos além da imuno-regulação. Em conclusão, as CTM-GW na sepse foram capazes de atenuar a lesão cardiopulmonar assim como modular a atividade autonômica, reduzindo a inflamação sistêmica, pelo menos em parte, através da via colinérgica anti-inflamatória. Indubitavelmente todos estes efeitos anteriormente descritos e em associação se demonstraram fundamentais no mecanismo de reparo e proteção tecidual em resposta a sepse. Mais estudos pré-clínicos e futuros testes clínicos precisam ser realizados para maior compreensão destes mecanismos bem como uma possível validação terapêutica / Sepsis induces organ dysfunction due to overexpression of the inflammatory host response, involving cardiorespiratory and autonomic dysregulation, thus increasing the associated morbidity and mortality. The cholinergic anti-inflammatory pathway (CAP) is mediated by nervous system through alpha7 nicotinic acetylcholine receptor (alpha7nAChR). This receptor has an important role in systemic inflammation control. Wharton\'s jelly-derived mesenchymal stem cells (WJ-MSCs) are known to express genes and secreted factors related to neurological and immunological protection, as well as to improve survival in experimental sepsis. We hypothesized that WJ-MSCs play a modulatory role through the CAP and attenuate sepsis-induced organ injury in a cecal ligation and puncture (CLP) model. Rats were randomly divided into 4 groups: 1) Control (sham-operated); 2) submitted to CLP without treatment; 3) submitted to CLP and treated with 106 WJ-MSCs 6 h later and 4) CLP+MLA+WJ-MSC group (MLA: Methyllycaconitine, alpha7nAChR antagonist). All experiments were performed 24 h post-surgery. Echocardiographic parameters and heart rate variability were assessed. Importantly, treatment with WJ-MSCs attenuated diastolic heart failure and recovered barorreflex sensitivity. Moreover, WJ-MSCs injection increased cardiac sympathetic and cardiovagal activity. In cardiac and splenic tissue, WJ-MSC treatment downregulated TLR4 and alpha7nAChR expression, as well as it reduced p-STAT3/Total STAT3 ratio in the spleen. In addition, WJ-MSC reduced leukocyte infiltration and pro-inflammatory cytokines, which only were abolished by MLA treatment. Finally, WJ-MSC treatment diminished apoptosis in lung and spleen tissue. Together these findings suggest that treatment with WJ-MSCs appears to protect against sepsis-induced organ injury reducing systemic inflammation, at least in part, through cholinergic anti-inflammatory pathway

O objetivo deste estudo foi caracterizar a influência da melatonina sobre a atividade de colinoceptores nicotínicos em miotubos de rato em cultura e determinar seu mecanismo de ação. Neste modelo verificamos que a melatonina reduz a densidade de sítios de ligação para ?-bungarotoxina e também a produção de AMP cíclico induzida por forscolina, adenosina e CGRP, mas não por isoprenalina. Estes efeitos foram mimetizados por N-acetilserotonina e 4-P-PDOT, mas não por 2-Iodo-melatonina e 5-MCA-NAT, e foram bloqueados por luzindol. A redução da produção de AMP cíclico não foi inibida por toxina pertussis. O calmidazolium bloqueia tanto a redução da densidade dos colinoceptores nicotínicos quanto a inibição da produção de AMP cíclico. Avaliando a via da guanilil ciclase determinamos que melatonina e calmidazolium inibem a produção de GMP cíclico induzida por KCl. Podemos concluir que a melatonina não está atuando via receptores de membrana, mas provavelmente, está atuando internamente bloqueando a enzima calmodulina. / The objective of this study was characterize the influence of melatonin on the nicotinic-colinoceptors activity in myotube culture from rats and seeks its action mechanism. In this model we demonstrated that melatonin decreases the binding-sites density to ?-bungarotoxin and cyclic AMP synthesis induced by forskolin, adenosine and CGRP, but not by isoprenaline. These effects were mimetized by N-acetylserotonin and 4-P-PDOT, but not by 2-iodomelatonin and 5-MCA-NAT and were blocked by luzindol. Reduction of the cyclic AMP synthesis was not inhibited by pertussis toxin. Calmidazolium blocked both the reduction of nicotinic colinoceptors density and the inhibition of AMP cyclic synthesis. After evaluate the guanylyl cyclase via, we determined that melatonin and calmidazolium inhibit the cyclic GMP synthesis induced by KCl. Then we concluded that melatonin does not act via membrane receptors, but probably, acts blocking the calmodulin enzyme.

A lesão pulmonar aguda (LPA) é caracterizada por inflamação pulmonar de início súbito com recrutamento de polimorfonucleares e liberação de mediadores próinflamatórios. É uma condição grave que evolui com óbito em aproximadamente 40% dos casos. Diversos estudos que elucidaram a fisiopatologia da LPA, o tratamento ainda é insatisfatório. O sistema colinérgico anti-inflamatório foi descrito no pulmão e está relacionado a um reflexo via nervo vago que inibe a liberação de citocinas inflamatórias por efeitos relacionados a ação da acetilcolina em receptores nicotínicos. Nossa hipótese é de que a redução de VAChT, que está relacionada ao déficit na liberação de ACh, module a resposta inflamatória pulmonar em modelo de LPS. Objetivo: 1. Avaliar se a deficiência de VAChT modula a resposta pulmonar em animais geneticamente modificados; 2. Avaliar se a deficiência colinérgica induzida por redução de VAChT está envolvida na resposta pulmonar ao LPS e elucidar alguns mecanismos envolvidos; 3. Avaliar o potencial terapêutico do PNU, um agonista de alfa7nAChR nas alterações funcionais e histopatológicas em modelo de LPA em animais C57Bl6. Metodologia: Foram utilizados camundongos machos geneticamente modificados mutante (VAChT KDHOM) ou selvagem (WT) e C57BL/6. Inicialmente avaliamos a função pulmonar e a histopatologia pulmonar em animais VAChT KDHOM. Após, animais WT e VAChT KDHOM receberam instilação intranasal de LPS ou salina e a resposta inflamatória foi avaliada de 1,5h até 72 horas após. Ainda, foi avaliado a resposta pulmonar em VAChT KDHOM e WT após a instilação de LPS intraperitoneal. Por fim, animais C57BL/6 instilados com LPS intranasal, receberam tratamento prévio ou após com PNU, agonista do receptor nicotínico alfa7. Resultados: Animais mutante apresentaram maior quantidade de células recuperadas no lavado bronco alveolar (LBA) e aumento de citocinas próinflamatórias, aumento de edema peribrônquico e piora da função pulmonar. Ainda, observamos aumento da expressão de NF-kB e redução de JAK2. A deficiência de VAChT induziu aumento de células inflamatórias em animais que receberam LPS somente em 1.5h após a indução, sendo os valores iguais ao dos animais WT em 24 e 72 horas. Nos animais WT, o estimulo do receptor nicotínico melhora a inflamação, enquanto o estímulo de receptores muscarínicos parece contribuir com a piora da resposta da inflamação pulmonar. Os efeitos do PNU parecem que dependem da via colinérgica intacta, uma vez que esta droga não teve o mesmo efeito em animais mutante. Entretanto, o tratamento com PNU em animais C57BL/6 reduziu a inflamação, a produção de citocinas, a deposição de colágeno no tecido pulmonar e os níveis de MMP-2, MMP-9 e TIMP-1, melhorando a função pulmonar. Estes efeitos parecem estar associados a redução de macrófagos perfil M1, e a inibição de NF-kB. Conclusão: Estes dados claramente demonstram que o sistema colinérgico anti-inflamatório está envolvido no controle da resposta inflamatória pulmonar, seja na manutenção da homeostasia ou ainda nas fases iniciais do desenvolvimento da LPA. Ainda, está claro que o estímulo de receptores nicotínicos tem grande potencial como alvo terapêutico a ser explorado na SDRA / Acute lung injury (ALI) is characterized by acute lung inflammation with recruitment of polymorphonuclear and release of proinflammatory mediators. It is a severe condition since leads to death 40% of the cases. Several studies have elucidated the pathophysiology of ALI, however the treatment is still unsatisfactory. The anti-inflammatory cholinergic system was described in the lung and is related to a vagal nerve reflex that inhibits the release of inflammatory cytokines by the action o ACh on nicotinic receptors. Our hypothesis is that the VAChT reduction, which is related to the deficit in the release of ACh, modulates the pulmonary inflammatory response in a model of LPS. Aim: 1. To assess whether VAChT deficiency modulates the pulmonary response in genetically modified animals; 2. Assess whether cholinergic deficiency induced reduction VAChT is involved in pulmonary response to LPS and elucidate some mechanisms involved; 3. To evaluate the therapeutic potential of PNU, an agonist alfa7nAChR, in functional and histological changes in C57BL6 mice with LPA. Methods: Mutant genetically modified male mice (VAChT KDHOM) or wild (WT) and C57BL/6 were used. First, we evaluated lung function and lung histopathology in VAChT KDHOM animals. After, WT animals and VAChT KDHOM received intranasal instillation of LPS or saline and the inflammatory response was assessed 1.5 hours to 72 hours. Moreover, the pulmonary response was evaluated in WT and VAChT KDHOM after instillation of LPS intraperitoneally. Finally, C57BL6 instilled with intranasal LPS received prior or post-treatment with PNU, an alfa7 nicotinic receptor agonist. Results: Mutant animals had higher number of cells recovered in brochoalveolar lavage (BAL) and increased pro-inflammatory cytokines, peribronchial edema and worsening of lung function. Still, there was an increase of NF_kB expression and reduction of JAK2. The VAChT deficiency induced increase in inflammatory cells in animals receiving LPS only 1.5h after the LPS instilation, and the values were similar to WT in 24 and 72 hours. In WT mice, the stimulation of the nicotinic receptor improves inflammation, while the stimulation of muscarinic receptors appears to contribute to the worsening of the pulmonary inflammatory response. The effects of PNU seem to depend on the intact cholinergic pathway, since this drug had no effects on mutant animals. However, treatment with PNU in C57BL6 reduced pulmonar inflammation, cytokine production, collagen deposition in lung tissue and the levels of MMP-2, MMP-9 and TIMP-1, improving pulmonary function. These effects appear to be associated with reduced profile M1 macrophages and the inhibition of NF-kB. Conclusion: These data clearly demonstrate that the anti-inflammatory cholinergic system is involved in the control of lung inflammatory response, both to maintain the lung homeostasis or in the early stages of the development of ALI. Finally, it is clear that the stimulation of nicotinic receptors has great potential as a therapeutic target to be explored in ARDS

A lesão pulmonar aguda (LPA) é caracterizada por inflamação pulmonar de início súbito com recrutamento de polimorfonucleares e liberação de mediadores próinflamatórios. É uma condição grave que evolui com óbito em aproximadamente 40% dos casos. Diversos estudos que elucidaram a fisiopatologia da LPA, o tratamento ainda é insatisfatório. O sistema colinérgico anti-inflamatório foi descrito no pulmão e está relacionado a um reflexo via nervo vago que inibe a liberação de citocinas inflamatórias por efeitos relacionados a ação da acetilcolina em receptores nicotínicos. Nossa hipótese é de que a redução de VAChT, que está relacionada ao déficit na liberação de ACh, module a resposta inflamatória pulmonar em modelo de LPS. Objetivo: 1. Avaliar se a deficiência de VAChT modula a resposta pulmonar em animais geneticamente modificados; 2. Avaliar se a deficiência colinérgica induzida por redução de VAChT está envolvida na resposta pulmonar ao LPS e elucidar alguns mecanismos envolvidos; 3. Avaliar o potencial terapêutico do PNU, um agonista de alfa7nAChR nas alterações funcionais e histopatológicas em modelo de LPA em animais C57Bl6. Metodologia: Foram utilizados camundongos machos geneticamente modificados mutante (VAChT KDHOM) ou selvagem (WT) e C57BL/6. Inicialmente avaliamos a função pulmonar e a histopatologia pulmonar em animais VAChT KDHOM. Após, animais WT e VAChT KDHOM receberam instilação intranasal de LPS ou salina e a resposta inflamatória foi avaliada de 1,5h até 72 horas após. Ainda, foi avaliado a resposta pulmonar em VAChT KDHOM e WT após a instilação de LPS intraperitoneal. Por fim, animais C57BL/6 instilados com LPS intranasal, receberam tratamento prévio ou após com PNU, agonista do receptor nicotínico alfa7. Resultados: Animais mutante apresentaram maior quantidade de células recuperadas no lavado bronco alveolar (LBA) e aumento de citocinas próinflamatórias, aumento de edema peribrônquico e piora da função pulmonar. Ainda, observamos aumento da expressão de NF-kB e redução de JAK2. A deficiência de VAChT induziu aumento de células inflamatórias em animais que receberam LPS somente em 1.5h após a indução, sendo os valores iguais ao dos animais WT em 24 e 72 horas. Nos animais WT, o estimulo do receptor nicotínico melhora a inflamação, enquanto o estímulo de receptores muscarínicos parece contribuir com a piora da resposta da inflamação pulmonar. Os efeitos do PNU parecem que dependem da via colinérgica intacta, uma vez que esta droga não teve o mesmo efeito em animais mutante. Entretanto, o tratamento com PNU em animais C57BL/6 reduziu a inflamação, a produção de citocinas, a deposição de colágeno no tecido pulmonar e os níveis de MMP-2, MMP-9 e TIMP-1, melhorando a função pulmonar. Estes efeitos parecem estar associados a redução de macrófagos perfil M1, e a inibição de NF-kB. Conclusão: Estes dados claramente demonstram que o sistema colinérgico anti-inflamatório está envolvido no controle da resposta inflamatória pulmonar, seja na manutenção da homeostasia ou ainda nas fases iniciais do desenvolvimento da LPA. Ainda, está claro que o estímulo de receptores nicotínicos tem grande potencial como alvo terapêutico a ser explorado na SDRA / Acute lung injury (ALI) is characterized by acute lung inflammation with recruitment of polymorphonuclear and release of proinflammatory mediators. It is a severe condition since leads to death 40% of the cases. Several studies have elucidated the pathophysiology of ALI, however the treatment is still unsatisfactory. The anti-inflammatory cholinergic system was described in the lung and is related to a vagal nerve reflex that inhibits the release of inflammatory cytokines by the action o ACh on nicotinic receptors. Our hypothesis is that the VAChT reduction, which is related to the deficit in the release of ACh, modulates the pulmonary inflammatory response in a model of LPS. Aim: 1. To assess whether VAChT deficiency modulates the pulmonary response in genetically modified animals; 2. Assess whether cholinergic deficiency induced reduction VAChT is involved in pulmonary response to LPS and elucidate some mechanisms involved; 3. To evaluate the therapeutic potential of PNU, an agonist alfa7nAChR, in functional and histological changes in C57BL6 mice with LPA. Methods: Mutant genetically modified male mice (VAChT KDHOM) or wild (WT) and C57BL/6 were used. First, we evaluated lung function and lung histopathology in VAChT KDHOM animals. After, WT animals and VAChT KDHOM received intranasal instillation of LPS or saline and the inflammatory response was assessed 1.5 hours to 72 hours. Moreover, the pulmonary response was evaluated in WT and VAChT KDHOM after instillation of LPS intraperitoneally. Finally, C57BL6 instilled with intranasal LPS received prior or post-treatment with PNU, an alfa7 nicotinic receptor agonist. Results: Mutant animals had higher number of cells recovered in brochoalveolar lavage (BAL) and increased pro-inflammatory cytokines, peribronchial edema and worsening of lung function. Still, there was an increase of NF_kB expression and reduction of JAK2. The VAChT deficiency induced increase in inflammatory cells in animals receiving LPS only 1.5h after the LPS instilation, and the values were similar to WT in 24 and 72 hours. In WT mice, the stimulation of the nicotinic receptor improves inflammation, while the stimulation of muscarinic receptors appears to contribute to the worsening of the pulmonary inflammatory response. The effects of PNU seem to depend on the intact cholinergic pathway, since this drug had no effects on mutant animals. However, treatment with PNU in C57BL6 reduced pulmonar inflammation, cytokine production, collagen deposition in lung tissue and the levels of MMP-2, MMP-9 and TIMP-1, improving pulmonary function. These effects appear to be associated with reduced profile M1 macrophages and the inhibition of NF-kB. Conclusion: These data clearly demonstrate that the anti-inflammatory cholinergic system is involved in the control of lung inflammatory response, both to maintain the lung homeostasis or in the early stages of the development of ALI. Finally, it is clear that the stimulation of nicotinic receptors has great potential as a therapeutic target to be explored in ARDS

Les données épidémiologiques montrent une association inverse entre les taux de HDL-cholestérol (HDL-C) et le risque d'évènements cardiovasculaires. Des traitements ayant montré une augmentation significative du HDL-C, comme les inhibiteurs de la protéine de transfert des esters de cholestérol, devraient donc permettre de réduire le risque cardio-vasculaire. En utilisant différentes techniques de modélisation, nous avons tenté de quantifier l'efficacité attendue sur les événements cardiovasculaires de l'un d'entre eux, le dalcétrapib, ne disposant que de données pharmacocinétiques et pharmacodynamiques. Tout d’abord, afin d'établir la relation pharmacocinétique / pharmacodynamique entre les concentrations et la modification de HDL-C, nous avons analysé les données individuelles des patients dyslipidémiques par une approche de population. Une hausse moyenne de HDL-C de 26.4 % par rapport au placebo était alors anticipée. Nous avons ensuite tenté de corréler l'effet observé sur l'HDL-C et l'effet clinique à partir de données d'autres études par méta-régression des essais évaluant l'effet des principaux hypolipémiants en prévention secondaire. Cette modélisation n'a pas permis de montrer de corrélation entre le changement de l’HDL-C (P5 P95 :-3.0 et 36 %) et la réduction du risque cardiovasculaire. Une analyse de sensibilité par type de traitement suggère qu'une même hausse de HDL-C entre deux classes thérapeutiques pourrait se traduire par un effet clinique dissemblable, indiquant que HDL-C ne peut pas être utilisé comme critère intermédiaire puisqu'il ne serait pas un prédicteur indépendant du risque cardiovasculaire / Epidemiological data demonstrate an inverse correlation between HDL-cholesterol (HDL-C) levels and cardiovascular risk. Therefore, drugs as cholesteryl ester transfer protein (CETP) inhibitors that lead to a significant HDL-C increase are believed to reduce the occurrence of coronary events. We aimed to evaluate the clinical efficacy of one CETP inhibitor, dalcetrapib, by using various modeling techniques while only pharmacokinetic (PK) and pharmacodynamlc (PD) data were available. First, we analyzed individual data from dyslipidemic patients using a population approach in order to establish the PK/PD relationship between dalcetrapib concentrations and HDL-C change. The results show that an average raise of 26.4 % is expected in comparison to placebo with the 5th (P5) and 95th (P95) percentile of the mean average at 20.7 % and 31.9 % respectively. The increase in HDL-C is explained by a delayed catabolism following the transfer inhibition of cholesterol ester from HDL to Apo-B rich lipoproteins. We endeavored then to correlate HDL-C increase to coronary events by using a meta-regression analysis on randomized trials that evaluated the clinical efficacy of main dyslipidemic drugs on coronary events in secondary prevention. The modeling did not show a statistical association between HDL-C change (P5-P95:-3.0 and 36 %) and coronary risk reduction. A sensitivity analysis by drug class suggests that the same HDL-C increase resulting from different mechanisms of action may not impact the cardiovascular risk in the same way. This would indicate that HDL-C could not be used as a risk marker since it might not be an independent predictor of cardiovascular risk

Abstract not available

ΜΕΛΕΤΗ Α΄ Στόχος: Να διερευνηθεί αν ο κινητικός υπότυπος της αστάθειας κορμού και δυσχέρειας της βάδισης (ΑΚΔΒ) σχετίζεται με τη γνωστική δυσλειτουργία που εμφανίζουν οι ασθενείς με νόσο του Parkinson (NP) χωρίς άνοια. Μέθοδοι: Χορηγήσαμε μια συστοιχία επιλεγμένων νευροψυχολογικών δοκιμασιών σε δύο ομάδες μη ανοϊκών ασθενών με ήπια έως μέτριας βαρύτητας νόσο κατηγοριοποιημένους είτε στον υπότυπο της ΑΚΔΒ είτε σε υπότυπο μη ΑΚΔΒ, καθώς και σε μια ομάδα υγιών μαρτύρων. Οι ομάδες εξισώθηκαν κατά το δυνατόν όσον αφορά δυνητικούς συγχυτικούς παράγοντες που επηρεάζουν τις νευροψυχολογικές επιδόσεις. Αποτελέσματα: Δε διαπιστώθηκαν σημαντικές διαφορές μεταξύ των δύο ομάδων ασθενών στην επίδοση σε οποιαδήποτε από τις χορηγηθείσες νευροψυχολογικές δοκιμασίες. Παρόλα αυτά, σε σχέση με τους μάρτυρες υπήρξε μια τάση διαφοροποίησης ως προς το κυρίαρχο πρότυπο της γνωστικής δυσλειτουργίας. Η ομάδα με τον υπότυπο της ΑΚΔΒ είχε βραδύτερες επιδόσεις σε μια δοκιμασία ψυχοκινητικής ταχύτητας και γνωστικής ευελιξίας, ενώ η ομάδα με υπότυπο της νόσου μη ΑΚΔΒ είχε χειρότερες επιδόσεις στις μετρήσεις της λεκτικής μάθησης και της οπτικοχωρικής αντίληψης. Συμπεράσματα: Ο υπότυπος της ΑΚΔΒ δε συσχετίσθηκε με σοβαρότερα γνωστικά ελλείμματα και έτσι είναι πιθανό οι μηχανισμοί της γνωστικής δυσλειτουργίας να είναι, έως ένα ορισμένο βαθμό, κοινοί ανεξάρτητα από τον κινητικό υπότυπο της νόσου. ΜΕΛΕΤΗ Β Στόχος: Να διερευνηθεί αν υπάρχει συσχέτιση μεταξύ της ΝΡ και του γονιδίου CHRNA4, το οποίο κωδικοποιεί την α4 υπομονάδα του α4β2 νικοτινικού υποδοχέα της ακετυλοχολίνης (nAChR). Mέθοδοι: Στη μελέτη συμμετείχαν 100 ασθενείς με ΝΡ και 105 μάρτυρες, εξισωμένοι ως προς την ηλικία και το φύλο και ανήκοντες στην ίδια πληθυσμιακή ομάδα με τους ασθενείς. Ο γενετικός δείκτης που εξετάσθηκε είναι ένας μονονουκλεοτιδικός πολυμορφισμός στο 5ο εξόνιο του γονιδίου CHRNA4 (dbSNP rs1044396). Έγινε απομόνωση DNA γονιδιώματος από περιφερικό αίμα και ακολούθησε ανάλυση μεγέθους περιοριστικών τμημάτων μετά από αλυσωτή αντίδραση πολυμεράσης και κατάτμηση των προϊόντων αυτής με το ένζυμο Hha I. Μια υποομάδα 42 ασθενών υποβλήθηκαν επίσης σε λεπτομερή κλινική και νευροψυχολογική εκτίμηση. Η στατιστική ανάλυση για τη σύγκριση της συχνότητας των αλληλομόρφων και των γονοτύπων μεταξύ των ομάδων έγινε με τη δοκιμασία χ2, και τον ακριβή έλεγχο Fisher εάν έστω ένα κελί είχε n<5. Υπολογίστηκαν οι σχετικοί κίνδυνοι και τα κατά 95% διαστήματα αξιοπιστίας τους που αντιστοιχούσαν στα αλληλόμορφα και τους γονότυπους. Χρησιμοποιήθηκε η λογιστική ανάλυση παλινδρόμησης εάν ήταν απαραίτητη η προσαρμογή για την ηλικία ή το φύλο. Αποτελέσματα: Οι συχνότητες των γονοτύπων στην ομάδα των ασθενών (TT 34%; CT 58%; CC 8%) σε σύγκριση με τις συχνότητες των γονοτύπων στην ομάδα των μαρτύρων (TT 28.6 %; CT 47.6%; CC 23.8 %) παρουσίασαν στατιστικά σημαντική διαφορά (χ2 = 9.48, df = 2, p = 0.009). Η ομοζυγωτία CC συσχετίσθηκε με χαμηλότερο κίνδυνο παρουσίας της ΝΡ (CC vs φορείς T: OR = 0.28; 95% CI = 0.12–0.65; p = 0.002; στατιστική ισχύς 93.1%). Παρατηρήθηκε επίσης απόκλιση στην κατανομή των αλληλομόρφων μεταξύ των ασθενών και των μαρτύρων. Υπήρχε σημαντικά χαμηλότερη συχνότητα του αλληλόμορφου C μεταξύ των ασθενών (37%) σε σχέση με τους μάρτυρες (47.6%) (χ2 = 4.73; df = 1; OR=0.65; 95% CI = 0.44–0.96; p = 0.03). Η ανάλυση διαστρωμάτωσης έδειξε ότι η διαφορά στην κατανομή των γονοτύπων μεταξύ ασθενών και μαρτύρων ήταν στατιστικά σημαντική και συγκριτικά μεγαλύτερη στο θήλυ φύλο σε σχέση με το άρρεν φύλο και στους ασθενείς με εκδήλωση ΝΡ σε όψιμη ηλικία ( > 50 ετών) σε σχέση με αυτούς που εμφάνισαν πρώιμης έναρξης νόσο (< 50 ετών). Οι ασθενείς με ΝP που ανιχνεύθηκαν να φέρουν το γονότυπο CC και υποβλήθηκαν σε νευροψυχολογική αξιολόγηση έτειναν να έχουν καλύτερα διατηρημένες τις γνωστικές λειτουργίες που σχετίζονται με την προσοχή και την ταχύτητα επεξεργασίας των πληροφοριών. Συμπεράσματα: Η παρουσία του αλληλομόρφου C (dbSNP rs1044396) του γονιδίου CHRNA4 συνδέεται με μειωμένο κίνδυνο ΝΡ κατά 35%. Επίσης, τα άτομα με το γονότυπο CC εμφανίζουν σχεδόν τρισήμισυ (3,5) φορές χαμηλότερο κίνδυνο νόσου του Parkinson. Η ποικιλομορφία του γονιδίου CHRNA4 φαίνεται ότι σχετίζεται ιδιαίτερα με την επιρρέπεια εκδήλωσης της ΝΡ με ηλικιακά όψιμη έναρξη της νόσου, και επίσης με τις γνωστικές λειτουργίες των ασθενών χωρίς άνοια, ειδικά αυτές που εξαρτώνται από την προσοχή και την οπτικοκινητική αντίληψη. / Study A Aim: To investigate whether there is an association of the postural instability and gait difficulty (PIGD) motor subtype with cognitive dysfunction in non-demented Parkinson’s disease (PD) patients. Methods: We administered a battery of selected neuropsychological tests to assess attention, psychomotor speed, executive functions (set shifting ability and inhibitory control), visuospatial perception and visual constructive ability to two groups of non-demented patients with mild to moderate disease classified either as PIGD or as non-PIGD subtype and to a group of healthy controls. Groups were matched on potential confounders of neuropsychological performance. Results: No significant differences were revealed between the two groups of patients in the performance of any of the administered neuropsychological tests. However, relative to controls there was a tendency towards a differential pattern of cognitive dysfunction. The PIGD group had slower performance in a test of psychomotor speed and cognitive flexibility, whilst the non-PIGD group performed worse in measures of verbal learning and visuo-spatial perception. Conclusions: The PIGD subtype was not associated with more severe cognitive deficits and may to a certain extent share common mechanisms of cognitive dysfunction with non-PIGD subtypes. Study B Aim: to investigate whether there is an association between PD and a variation in the CHRNA4 gene coding for the α4 subunit, the primary subunit of the α4β2 brain nicotinic acetylcholine receptors. Methods: Patients (N=100) and controls (N=105), matched on the basis of sex, age and ethnicity, were genotyped for a single nucleotide polymorphism at cDNA position 1860 lying within the 5th exon of the CHRNA4 gene. DNA was extracted from peripheral blood samples and genotyping was done by PCR-based restriction fragment length polymorphism analysis. A subset of 42 patients also received detailed clinical and cognitive assessments. Comparisons of allele and genotype frequencies between groups were performed using the χ2 test, and the Fisher exact test if one cell had n<5. The relative risk for genotypes and alleles was estimated through calculation of odds ratios (ORs) with 95% confidence intervals (CIs). Logistic regression analysis was used if adjustment for age or sex was necessary. Results: The genotype frequencies in the patients group (TT 34%; CT 58%; CC 8%) vs. the genotype frequencies in the control group (TT 28.6 %; CT 47.6%; CC 23.8 %) demonstrated a statistically significant difference (χ2 = 9.48, df = 2, p = 0.009). CC homozygosity was associated with a lower risk of PD (CC vs T carriers: OR = 0.28; 95% CI = 0.12–0.65; p = 0.002). Also, the allelic distribution was significantly different between patients and controls. There was a significantly lower frequency of the C allele among the patients with PD (37%) as compared with the controls (47.6%) (χ2 = 4.73; df = 1; OR=0.65; 95% CI = 0.44–0.96; p = 0.03). Stratified analysis showed that the difference in the genotypic distribution between cases and controls was significant among females but did not reach significance among males. The frequency of CC homozygotes was also significantly lower in the group of patients with late onset PD than in the controls, but it was not significantly different between the early onset group of patients and the controls. CC homozygotes also tended to have better performance than T carriers on measures of attention and psychomotor speed (Trail Making Test part A and Symbol Digit Modalities Test). Conclusions: The presence of the C allele at SNP rs1044396 of the CHRNA4 gene is associated with a decreased risk for PD by 35%. Moreover, the CC genotype lowers the risk for PD by ~ 3.5 fold. Variation in the CHRNA4 gene may particularly influence susceptibility for late onset PD and further be associated with measurable effects on overt cognitive performance of yet not-demented PD patients, specifically the part loading on attentional capacities.

Οι νικοτινικοί υποδοχείς της ακετυλοχολίνης (nAChRs) ανήκουν στην υπερ-οικογένεια των ιοντικών καναλιών που ενεργοποιούνται από τη δέσμευση ενός προσδέτη (LGICs) και αποτελούνται από πέντε ομόλογες υπομονάδες. Κάθε μονομερής υπομονάδα αποτελείται από μία Ν-τελική εξωκυττάρια περιοχή (ΕΚΠ), από τέσσερεις διαμεμβρανικές α-έλικες και από μία κυτταροπλασματική περιοχή. Στην ΕΚΠ βρίσκεται η χαρακτηριστική Cys-θηλιά της υπερ-οικογένειας, καθώς και οι θέσεις πρόσδεσης αγωνιστών και ανταγωνιστών του υποδοχέα. Οι γνώσεις μας γύρω από τη δομή των nAChRs προέρχονται κυρίως από κρυσταλλογραφικές δομές ομολόγων πρωτεϊνών δέσμευσης της ACh (AChBP) μαλακίων, από μια δομή του nAChR από ιχθείς του γένους Torpedo που προέρχεται από ηλεκτρονική μικροσκοπία, από την κρυσταλλογραφική δομή της α1-ΕΚΠ ποντικού σε σύμπλοκο με α-μπουγκαροτοξίνη (α-Btx) και από κρυσταλλογραφικές δομές δύο προκαρυωτικών LGICs. Παρά τη μεγάλη πρόοδο που πραγματοποιήθηκε με τα παραπάνω επιτεύγματα, ακόμη δεν έχει επιλυθεί πειραματικά η δομή ανθρώπινου υποδοχέα. Επίσης λίγα είναι γνωστά για την επίδραση της γλυκοζυλίωσης των ΕΚΠ στη λειτουργία του nAChR. Χρησιμοποιώντας ως εκμαγείο την κρυσταλλογραφική δομή του συμπλόκου α1-ΕΚΠ ποντικού/α-Btx δημιουργήθηκαν υπολογιστικά μοντέλα της ανθρώπινης α1-ΕΚΠ προσδεμένης στις τοξίνες α-μπουγκαροτοξίνη (α-Btx), α-κομπρατοξίνη (α-Cbtx), α-κωνοτοξίνη (α-Ctx) ImI και α-κωνοτοξίνη GI. Στα σύμπλοκα με α-Btx και α-Cbtx προστέθηκε η υδατανθρακική αλυσίδα, συνδεδεμένη με το κατάλοιπο Asn141, που συγκρυσταλλώθηκε μαζί με την α1-ΕΚΠ ποντικού. Για να μελετηθεί η δυναμική συμπεριφορά της αλληλεπίδρασης υποδοχέα-τοξίνης καθώς και η συνεισφορά των σακχάρων σε αυτήν πραγματοποιήθηκαν προσομοιώσεις Μοριακής Δυναμικής σε υδατικό περιβάλλον. Με τη χρήση υπολογιστικών εργαλείων για τη μελέτη των συμπλόκων προσδιορίστηκαν σε ατομικό επίπεδο οι αλληλεπιδράσεις που καθοδηγούν την πρόσδεση τοξινών στην α1-ΕΚΠ. Βρέθηκε ότι η υδατανθρακική αλυσίδα συμμετέχει δυναμικά στη δέσμευση της τοξίνης στον υποδοχέα. Τα σάκχαρα συγκλίνουν προς την προσδεμένη τοξίνη στηριζόμενα στα κατάλοιπα Ser187 και Trp184 της α1 υπομονάδας. Η τοξίνη επίσης μετακινείται φέρνοντας τη θηλιά Ι σε επαφή με τα σάκχαρα. Αναγνωρίστηκαν σημαντικές αλληλεπιδράσεις των σακχάρων με τα τοξινικά κατάλοιπα Thr6, Ser9, και Th15 της α-Btx και Thr6 και Pro7 της α-Cbtx. Επίσης επιβεβαιώθηκε η ύπαρξη μιας υδρόφιλης κοιλότητας στο εσωτερικό του υδρόφοβου πυρήνα της α1-ΕΚΠ, η οποία πιθανόν εμπλέκεται στο άνοιγμα του ιοντικού καναλιού του nAChR. Τα αποτελέσματα αυτά παρέχουν σημαντικά δεδομένα για την κατανόηση της επίδρασης της υδατανθρακικής αλυσίδας στη λειτουργία του υποδοχέα, η οποία μπορεί να αξιοποιηθεί στην αντιμετώπιση των πολλών παθολογικών καταστάσεων στις οποίες εμπλέκονται οι nAChRs. / Nicotinic acetylcholine receptors (nAChRs) belong to the superfamily of ligand-gated ion channels (LGICs). LGICs form homo- or hetero-pentamers of related subunits, and each of them consists of a N-terminal extracellular ligand-binding domain (ECD), four transmembrane α-helixes and an intracellular region. The characteristic Cys-loop of the superfamily is found in the ECD of each subunit. The ECD also contains binding sites for agonists and competitive antagonists. Our knowledge regarding the nAChR structure mainly derives from the X-ray crystal structures of the molluscan ACh-binding proteins (AChBPs), the electron microscopy structure of the Torpedo nAChR, the X-ray crystal structure of the mouse nAChR α1-ECD bound to α-bungarotoxin (α-Btx), and the X-ray crystal structures of two prokaryotic LGICs. Despite the progress made by these achievements, the determination of any human nAChR structure has not yet been accomplished. Furthermore, the effect of glycosylation on nAChR function has not yet been explored. Based on the crystal structure of the extracellular domain of the mouse nAChR α1 subunit bound to α-Btx we have generated in silico models of the human nAChR α1-ECD bound to the toxins α-bungarotoxin (α-Btx), α-cobratoxin (α-Cbtx), α-conotoxin (α-Ctx) ImI and α-conotoxin GI. In the case of the α1-ECD/α-Btx and α-Cbtx complexes, a Asn141-linked carbohydrate chain was modeled, its coordinates taken from the crystal structure of the mouse α1-ECD. To gain further insight into the structural role of glycosylation molecular dynamics (MD) simulations were carried out in explicit solvent so as to compare the conformational dynamics of the binding interface between nAChR α1 and the two toxins. The use of computational methods allowed the monitoring of the interactions that govern toxin binding. The MD simulations revealed the strengthening of the receptor-toxin interaction in the presence of the carbohydrate chain. A shift in the position of the sugars towards the bound toxin was observed. Residues Ser187 and Trp184 of nAChR act as critical anchor points for the stabilization of the sugar chain in a close position to the toxin. Toxin Finger I shifts closer to the mannoses, forming important toxin-sugar interactions that implicate residues Thr6, Ser9, and Thr15 of α-Btx, as well as Thr6 and Pro7 of α-Cbtx. Additionally the MD simulations of the human α1 ECD–toxin complexes confirmed the possible accommodation of two water molecules into a hydration cavity inside the hydrophobic core of the subunit, which may contribute to the gating mechanism of the receptor. These findings provide additional structural data that are intended to inspire biophysical studies on the functional role of glycosylation in the gating mechanism of nAChR and also guide the development of novel therapeutic agents for the treatment of nAChR-associated diseases.

O objetivo deste estudo foi caracterizar a influência da melatonina sobre a atividade de colinoceptores nicotínicos em miotubos de rato em cultura e determinar seu mecanismo de ação. Neste modelo verificamos que a melatonina reduz a densidade de sítios de ligação para ?-bungarotoxina e também a produção de AMP cíclico induzida por forscolina, adenosina e CGRP, mas não por isoprenalina. Estes efeitos foram mimetizados por N-acetilserotonina e 4-P-PDOT, mas não por 2-Iodo-melatonina e 5-MCA-NAT, e foram bloqueados por luzindol. A redução da produção de AMP cíclico não foi inibida por toxina pertussis. O calmidazolium bloqueia tanto a redução da densidade dos colinoceptores nicotínicos quanto a inibição da produção de AMP cíclico. Avaliando a via da guanilil ciclase determinamos que melatonina e calmidazolium inibem a produção de GMP cíclico induzida por KCl. Podemos concluir que a melatonina não está atuando via receptores de membrana, mas provavelmente, está atuando internamente bloqueando a enzima calmodulina. / The objective of this study was characterize the influence of melatonin on the nicotinic-colinoceptors activity in myotube culture from rats and seeks its action mechanism. In this model we demonstrated that melatonin decreases the binding-sites density to ?-bungarotoxin and cyclic AMP synthesis induced by forskolin, adenosine and CGRP, but not by isoprenaline. These effects were mimetized by N-acetylserotonin and 4-P-PDOT, but not by 2-iodomelatonin and 5-MCA-NAT and were blocked by luzindol. Reduction of the cyclic AMP synthesis was not inhibited by pertussis toxin. Calmidazolium blocked both the reduction of nicotinic colinoceptors density and the inhibition of AMP cyclic synthesis. After evaluate the guanylyl cyclase via, we determined that melatonin and calmidazolium inhibit the cyclic GMP synthesis induced by KCl. Then we concluded that melatonin does not act via membrane receptors, but probably, acts blocking the calmodulin enzyme.

A sepse causa uma alta taxa de mortalidade no mundo. A fisiopatologia da doença envolve uma rede complexa de mediadores inflamatórios que promovem a lesão de diversos tecidos, além de diversas alterações hemodinâmicas e disfunção do sistema nervoso autonômico (SNA). Assim sabe-se que o sistema nervoso cumpre um papel importante no controle da inflamação sistêmica mediante a via colinérgica anti-inflamatória (VCA) através do receptor nicotínico de acetilcolina alfa7 (alfa7nAChR). O uso das células-tronco mesenquimais (CTM) tem mostrado efeitos benéficos em diversos ensaios clínicos de doenças inflamatórias. Neste contexto, as células-tronco mesenquimais derivadas da geleia de Wharton do cordão umbilical (CTM-GW) tornam-se promissórias, uma vez que essas células são reconhecidas pela regulação da resposta imunológica, reparação neural, efeito anti-apoptose, assim como a melhora da sobrevida na sepse, em modelos experimentais. Nossa hipótese foi de que as CTM-GW poderiam cumprir um papel neuroimunomodulador através da VCA e atenuar a disfunção de múltiplos órgãos em um modelo animal de sepse de ligadura e punção do ceco (LPC). Inicialmente células da matriz do cordão umbilical foram isoladas e caracterizadas de acordo com o consenso internacional vigente. Ratos Wistar machos adultos foram subdivididos em grupos: 1) sham (operação simulada); 2) LPC; 3) LPC+CTM-GW (injetado 106 CTM-GW via intraperitoneal, i.p. 6 h após LPC) e 4) LPC+MLA+CTM-GW (MLA: Metillicaconitine, antagonista do alfa7nAChR, i.p., 5:30 h após LPC e 106 CTM-GW 6h após). Às 24 horas após LPC, foram avaliadas a função cardiovascular, hemodinâmica assim como os outros parâmetros. Interessantemente, o tratamento com CTM-GW na sepse atenuou a disfunção diastólica e protegeu a sensibilidade baroreflexa. Além disso, as CTM-GW estimularam a atividade autonômica, simpática e parassimpática no coração. Observamos que o tratamento celular induziu uma regulação da expressão do receptor alfa7nAChR e TLR4 no baço e no coração, assim como a redução da relação p-STAT3TYR705 e STAT3 total no baço. Outros efeitos importantes e adicionais foram a diminuição da infiltração de leucócitos e a regulação das citocinas pró-inflamatórias pelas células. O bloqueio da VCA usando MLA confirmou que o receptor alfa7nAChR pode ser um provável alvo, chave da ação das CTM entre vários outros mecanismos envolvidos na resposta imune. Finalmente, as CTM-GW conseguiram reduzir a apoptose no pulmão e no baço independentemente da VAC reforçando o conceito de que as células-tronco tem efeitos diversos além da imuno-regulação. Em conclusão, as CTM-GW na sepse foram capazes de atenuar a lesão cardiopulmonar assim como modular a atividade autonômica, reduzindo a inflamação sistêmica, pelo menos em parte, através da via colinérgica anti-inflamatória. Indubitavelmente todos estes efeitos anteriormente descritos e em associação se demonstraram fundamentais no mecanismo de reparo e proteção tecidual em resposta a sepse. Mais estudos pré-clínicos e futuros testes clínicos precisam ser realizados para maior compreensão destes mecanismos bem como uma possível validação terapêutica / Sepsis induces organ dysfunction due to overexpression of the inflammatory host response, involving cardiorespiratory and autonomic dysregulation, thus increasing the associated morbidity and mortality. The cholinergic anti-inflammatory pathway (CAP) is mediated by nervous system through alpha7 nicotinic acetylcholine receptor (alpha7nAChR). This receptor has an important role in systemic inflammation control. Wharton\'s jelly-derived mesenchymal stem cells (WJ-MSCs) are known to express genes and secreted factors related to neurological and immunological protection, as well as to improve survival in experimental sepsis. We hypothesized that WJ-MSCs play a modulatory role through the CAP and attenuate sepsis-induced organ injury in a cecal ligation and puncture (CLP) model. Rats were randomly divided into 4 groups: 1) Control (sham-operated); 2) submitted to CLP without treatment; 3) submitted to CLP and treated with 106 WJ-MSCs 6 h later and 4) CLP+MLA+WJ-MSC group (MLA: Methyllycaconitine, alpha7nAChR antagonist). All experiments were performed 24 h post-surgery. Echocardiographic parameters and heart rate variability were assessed. Importantly, treatment with WJ-MSCs attenuated diastolic heart failure and recovered barorreflex sensitivity. Moreover, WJ-MSCs injection increased cardiac sympathetic and cardiovagal activity. In cardiac and splenic tissue, WJ-MSC treatment downregulated TLR4 and alpha7nAChR expression, as well as it reduced p-STAT3/Total STAT3 ratio in the spleen. In addition, WJ-MSC reduced leukocyte infiltration and pro-inflammatory cytokines, which only were abolished by MLA treatment. Finally, WJ-MSC treatment diminished apoptosis in lung and spleen tissue. Together these findings suggest that treatment with WJ-MSCs appears to protect against sepsis-induced organ injury reducing systemic inflammation, at least in part, through cholinergic anti-inflammatory pathway