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Frequência de tabagismo e das mutações N34S e P55S do gene Serine Protease Inhibitor Kazal-Type 1 (SPINK1) e da mutação R254W do gene Quimotripsina C (CTRC) em pacientes portadores de pancreatite crônica e em controle / Frequency of tabagism and N34S and P55S mutation of Serine Protease Inhibitor Kazal-Type 1 gene (SPINK1) and R254W mutation of Chymotrypsin C gene (CTRC) in patients with chronic pancreatitis and controlsMarianges Zadrozny Gouvêa da Costa 24 August 2015 (has links)
A pancreatite crônica é uma desordem complexa, na qual a interação entre fatores ambientais e genéticos resulta na enfermidade. O presente estudo incluiu 148 pacientes com diagnóstico de pancreatite crônica, 110 etilistas crônicos e 297 controles sadios com o objetivo de investigar a frequência de tabagismo e das mutações N34S e P55S do gene SPINK1 e R254W do gene CTRC nesta população. Foi aplicado questionário presencial e realizada reação de sequenciamento para a pesquisa das mutações genéticas, após assinatura do Termo de Consentimento Livre e Esclarecido. Os portadores de pancreatite crônica possuíam etiologia alcoólica em 74% das vezes e idiopática em 26%. A pancreatite alcoólica apresentou-se de maneira distinta da pancreatite crônica idiopática, sendo que o primeiro grupo é composto por maior prevalência do gênero masculino (88,18% versus 34,21%), por maior média de idade (55,64 anos versus 45,20 anos), menor frequência de caucasianos (63,89% versus 84,21%), menor escolaridade (23,30% concluíram ensino médio ou superior versus 57,89%) e maior frequência de repercussões da doença, como diarréia (54,21% versus 24,24%), emagrecimento (56,07% versus 24,24%), diabete melito (57,94% versus 36,36%) e ocorrência de pseudocistos pancreáticos (31,78% versus 12,12%), repercussões estas que não foram acompanhadas de maior frequência de alterações morfológicas, como calcificações pancreáticas ou dilatação do ducto pancreático principal. A frequência de tabagismo foi significativamente maior em pacientes com pancreatite crônica alcoólica do que em etilistas sem pancreatite crônica, podendo ser considerado cofator de risco para o desenvolvimento da pancreatite crônica entre alcoolistas (p = 0,002); a frequência da mutação N34S do gene SPINK1 em pacientes com pancreatite crônica foi de 3,38%, maior do que a frequência de 0,49% encontrada nos grupos controle (p = 0,016); a frequência de 2,03% da mutação P55S do gene SPINK1 e a frequência de 0,67% da mutação R254W do gene CTRC, encontradas nos pacientes com pancreatite crônica, não diferiram estatisticamente quando comparadas às frequências, de 0,49% de ambas mutações, encontradas nos grupos controle. (p = 0,120 e 0,751). Pela investigação da associação de tabagismo e da mutação N34S do gene SPINK1 com as características clínicas e morfológicas da pancreatite crônica, verificou-se que a mutação N34S não se associou a maior gravidade da apresentação clínica ou morfológica da pancreatite crônica; no entanto o tabagismo associou-se a maior frequência de diabete melito entre os portadores de pancreatite crônica. Concluiuse que o tabagismo e a mutação N34S do gene SPINK1 podem ser considerados cofatores de risco para o desenvolvimento da pancreatite crônica / Chronic pancreatitis is a complex disorder in which the interaction between environmental and genetic factors results in the disease. This study included 148 patients with chronic pancreatitis, 110 chronic alcoholics and 297 healthy controls in order to investigate the frequency of smoking and N34S and P55S mutation of SPINK1 gene and R254W of CTRC gene in this population. A questionnaire was applied and gene sequencing was done, after having the Informed Consent Statement. Those with chronic pancreatitis had alcoholic etiology in 74% of cases and idiopathic in 26%. Alcoholic pancreatitis presented in a distinct way of idiopathic chronic pancreatitis. The first group is composed of a higher prevalence of males (88.18% versus 34.21%), by higher mean age (55.64 years versus 45.20 years), lower frequency of Caucasians (63.89% versus 84.21%), lower education (23.30% completed secondary or higher education versus 57.89%) and worst impact from the disease such as diarrhea (54.21% versus 24.24%), weight loss (56.07% versus 24.24%), diabetes mellitus (57.94% versus 36.36%) and occurrence of pancreatic pseudocysts (31.78% versus 12 , 12%). These effects were not accompanied by increased frequency of morphological changes, such as pancreatic calcifications or dilation of the main pancreatic duct. The frequency of smoking was significantly higher in patients with alcoholic pancreatitis than in alcoholics without chronic pancreatitis, therefore tabagism may be considered as a cofactor for the development of chronic pancreatitis among alcoholics (p = 0.002); the frequency of N34S mutation of SPINK1 gene in patients with chronic pancreatitis was 3.38%, higher than the rate of 0.49% found in the control groups (p = 0.016); the frequency of 2.03% of the P55S mutation of SPINK1 gene and the frequency of 0.67% of the CTRC gene R254W mutation found in patients with chronic pancreatitis were not statistically different when compared to the frequencies of 0.49% of both mutations, found in the control groups. (p = 0.120 and 0.751) For the investigation of the association of smoking and N34S mutation of SPINK1 gene with the clinical and morphological features of chronic pancreatitis, it was noticed that the N34S mutation did not determine a greatest severity in the presentation of chronic pancreatitis, however smoking was associated with a higher frequency of diabetes mellitus in patients with chronic pancreatitis. It was concluded that smoking and the N34S mutation of SPINK1 gene are positively correlated with chronic pancreatitis
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Freqüência de polimorfismos do gene CFTR em pacientes portadores de pancreatite crônica alcoólica / Polymorphisms in patients with alcoholic chronic pancreatitisMarianges Zadrozny Gouvêa da Costa 19 March 2008 (has links)
A dependência de álcool acomete de 10 a 12% da população mundial, estando a associação entre uso abusivo do álcool e pancreatite crônica bem estabelecida. A suscetibilidade pancreática ao álcool é variável e apenas 5 a 10% dos etilistas crônicos desenvolvem pancreatite crônica, sendo o papel dos fatores genéticos neste processo praticamente desconhecido. O gene CFTR (cystic fibrosis transmenbrane conductance regulator) codifica proteína que funciona na membrana plasmática de células epiteliais e que tem papel chave na função pancreática exócrina normal, promovendo a regulação, da secreção de fluídos e bicarbonato, importantes para a diluição e a alcalinização do suco pancreático. Quando a função desta proteína é inadequada, observa-se obstrução de pequenos ductos por rolhas protéicas. Várias pesquisas buscam documentar a associação fibrose cística - pancreatite crônica, porém os resultados são conflitantes. Este trabalho pesquisou a freqüência de polimorfismos no trato de politiminas e poli TGs no intron 8 do gene CFTR em pacientes portadores de pancreatite crônica alcoólica. Foram estudados três grupos de pacientes: Grupo A - adultos alcoolistas com diagnóstico de pancreatite crônica; Grupo B - adultos alcoolistas sem pancreatopatia ou cirrose hepática e Grupo C - adultos sadios não alcoolistas. O DNA genômico para análise do gene CFTR foi extraído do sangue periférico, pesquisando-se a freqüência de polimorfismos no trato de politiminas e poli TGs no intron 8. O genótipo 5T/7T foi mais encontrado no grupo A do que no B (p = 0,0481), não havendo diferença quando comparados os grupos A e C (p = 0,1317). Pacientes com pancreatite crônica por álcool com o genótipo 5T/7T tiveram menor incidência de diabetes melito do que aqueles com outros genótipos (p = 0,0465). A combinação de haplótipos 10TG 7T / 11TG 7T foi mais freqüente nos grupos B e C do que no A e poderia, eventualmente, ser um fator protetor contra o desenvolvimento da pancreatite crônica. (p = 0,0080 e 0,0162). Em conclusão, há diferenças no intron 8 do gene CFTR em pacientes com pancreatite crônica alcoólica, quando comparados com alcoolistas não pancreatopatas e indivíduos com o genótipo 5T/7T teriam maior risco de desenvolver pancreatite crônica quando se tornam alcoolistas crônicos. / The alcohol dependence affects from 10 to 12% of the world-wide population, being the association between alcohol abuse and chronic pancreatitis well established. The pancreatic susceptibility to the alcohol is only 5 to 10%, being the paper of the genetic factors practically unknown. The CFTR gene (cystic fibrosis transmenbrane conductance regulator) codifies a protein that functions in the epithelial cells and has a role in pancreatic exocrine function, promoting regulation of the secretion of fluids and bicarbonate, important for the dilution and the alcalinization of the pancreatic juice. When the function of this protein is inadequate, blockage of small ducts occurs. Some research regist the association cystic fibrosis - chronic pancreatite, however the results are conflicting. This work searched the frequency of polymorphisms in the polyT and poly TGs tracts in intron 8 of CFTR gene in patients with alcoholic chronic pancreatitis. Three groups of patients have been studied: Group A - adult alcoholics with chronic pancreatitis; Group B - adult alcoholics without pancreatic disease or hepatic cirrhosis and Group C - non alcoholics healthy adults. DNA analysis of CFTR gene was made after extraction from peripheral blood samples. The 5T/7T genotype was more frequently found in group A that in B (p = 0.0481), with no difference when compared to group C (p = 0,1317). Patients with alcoholic chronic pancreatitis and 5T/7T genotype had less incidence of diabetes mellitus that those with other genotypes (p = 0,0465). The haplotype combination 10TG 7T / 11TG 7T was more frequent in groups B and C that in A and it could, eventually, be a protective factor against the development of alcoholic chronic pancreatitis. (p = 0,0080 and 0,0162). In conclusion, we found differences when these tree groups are compared and individuals with 5T/7T genotype would have greater risk to develop chronic pancreatitis if they become alcoholics.
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Expressão gênica de marcadores inflamatórios de pancreatite alcoólica crônica em ratos suplementados com vitamina E / Gene expression of inflammatory markers in alcoholic chronic pancreatitis in rats vitamin E supplemented.Thaís Helena Monteiro 28 January 2011 (has links)
O infiltrado inflamatório, a perda maciça de células acinares e a fibrose se destacam como alterações da pancreatite alcoólica crônica, o que é reflexo da expressão gênica. O -tocoferol regula a expressão de vários genes, entre eles moduladores de proteínas extracelulares e de inflamação. O presente trabalho teve como intuito avaliar o efeito da suplementação com vitamina E sobre a expressão gênica pancreática de marcadores inflamatórios, em ratos com pancreatite alcoólica crônica induzida por dieta líquida contendo etanol (com ou sem suplementação de -tocoferol), ciclosporina A e ceruleína, por meio da técnica quantitativa de PCR em tempo real. Além disso, foram realizadas determinações de -tocoferol plasmático e hepático, lipídeos totais hepáticos, e análise histopatológica do pâncreas e fígado dos animais submetidos aos diferentes tratamentos (Grupo 1: Controle; Grupo 2: Pancreatite alcoólica crônica; Grupo 3: Pancreatite alcoólica crônica e suplementação com vitamina E). Os animais que receberam suplementação com vitamina E apresentaram maiores valores de -tocoferol plasmático e hepático [(G1: 14,27 ± 1,5 umols/L plasma; 125,47 ± 18,5 nmols/g fígado; 5,1 ± 0,8 nmols/mg lipídeo hepático); (G2: 21,64 ± 3,0 umols/L plasma; 126,54 ± 10,5 nmols/g fígado; 2,8 ± 0,7 nmols/mg lipídeo hepático); (G3: 43,91 ± 6,1 umols/L plasma*; 1595,90 ± 802,7 nmols/g fígado*; 17,3 ± 8,8 nmols/mg lipídeo hepático*)] (*p<0,01). O pâncreas dos animais do Grupo 1 apresentou histologia normal, ao passo que nos Grupos 2 e 3 apresentou focos de destruição tecidual leve a moderada, presença de infiltrado de células mononucleares (linfócitos e plasmócitos) e proliferação de tecido conjuntivo de sustentação, mostrando um quadro ainda em estágios iniciais de pancreatite alcoólica crônica. O fígado do Grupo 1 apresentou histologia normal, e dos Grupos 2 e 3, esteatose macro e microvesicular em grau variável, entre 30 a 60%. A análise de PCR em tempo real mostrou aumento de expressão de todos os 13 genes biomarcadores do processo inflamatório nos Grupos 2 e 3, provocado pela pancreatite alcoólica crônica, em relação ao Grupo 1 (p<0,01). A suplementação com vitamina E na presença de pancreatite no Grupo 3, em relação ao Grupo 2, diminuiu o número de transcritos para 5 genes (-SMA, COX-2, IL-6, MIP-3, TNF-) (p<0,01), aumentou o número de transcritos para 1 gene (Pap) (p<0,01), e não modificou os 7 genes restantes (Col1a1, IL-4, IL-8, IL-10, MCP-1, Mif, MMP-2) (p>0,05). A suplementação com vitamina E apresentou efeitos anti-inflamatórios e benéficos na expressão gênica pancreática de alguns biomarcadores do processo inflamatório em ratos com pancreatite alcoólica crônica, comprovando sua participação em alguns mecanismos da resposta inflamatória no pâncreas. / The inflammatory infiltrate, the massive loss of acinar cells and fibrosis are highlighted as changes in alcoholic chronic pancreatitis, which is a gene expression reflection. The -tocopherol regulates many genes expression, including extracellular proteins and inflammation modulators. This study was aimed to evaluate the vitamin E supplementation effect on pancreatic gene expression of inflammatory markers in rats with alcoholic chronic pancreatitis induced by liquid diet containing ethanol (with or without -tocopherol supplementation), cyclosporin A and cerulein through the quantitative real time PCR technique. Moreover, -tocopherol content in plasma and liver were analyzed, total lipid content in liver, and pancreas and liver histopathology of animals subjected to different treatments (Group 1: Control, Group 2: Alcoholic chronic pancreatitis, Group 3: Alcoholic chronic pancreatitis and vitamin E supplementation). The animals that received vitamin E supplementation had higher -tocopherol amounts in plasma and liver [(G1: 14,27 ± 1,5 umols/L plasma; 125,47 ± 18,5 nmols/g liver; 5,1 ± 0,8 nmols/mg liver lipid); (G2: 21,64 ± 3,0 umols/L plasma; 126,54 ± 10,5 nmols/g liver; 2,8 ± 0,7 nmols/mg liver lipid); (G3: 43,91 ± 6,1 umols/L plasma*; 1595,90 ± 802,7 nmols/g liver*; 17,3 ± 8,8 nmols/mg liver lipid*)] (*p<0,01). The pancreas of animals in Group 1 had normal histology, whereas in Groups 2 and 3 presented tissue destruction foci with mild to moderate mononuclear cells infiltration (lymphocytes and plasma cells) and connective tissue proliferation, showing an early stage occurrence of alcoholic chronic pancreatitis. The Group 1 liver showed normal histology, and Groups 2 and 3, macro and microvesicular steatosis in varying degrees, from 30 to 60%. The quantitative real time PCR analysis showed increased expression of all 13 inflammatory biomarkers genes in Groups 2 and 3, caused by alcoholic chronic pancreatitis, compared to Group 1 (p<0,01). Vitamin E supplementation in the presence of pancreatitis in Group 3, compared to Group 2, decreased the transcripts number for five genes (-SMA, COX-2, IL-6, MIP-3, TNF-) (p<0,01), increased the transcripts number for one gene (Pap) (p<0,01), and did not alter the seven remaining genes (Col1a1, IL-4, IL-8, IL-10, MCP-1 , Mif, MMP-2) (p>0,05). Vitamin E supplementation showed anti-inflammatory and beneficial effects on pancreatic gene expression of some inflammation biomarkers in rats with alcoholic chronic pancreatitis, confirming its participation in the inflammatory response mechanisms in the pancreas.
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Implication du récepteur CCR5 et ses ligands au cours des phénomènes inflammatoires aigus des maladies hépatiques et pancréatiquesMoreno, Christophe 30 April 2007 (has links)
Malgré de nombreux progrès thérapeutiques, la seule réelle option thérapeutique des malades atteints d’une cirrhose terminale ou d’hépatite aiguë fulminante est la transplantation hépatique, cependant limitée par la pénurie d’organes. De même, la prise en charge des pathologies pancréatiques aigues et chroniques consiste essentiellement en traitements supportifs et des complications.<p>La réaction inflammatoire au cours des maladies hépatiques et pancréatiques joue un rôle majeur dans l’évolution de ces maladies car elle influence la sévérité de l’affection aiguë et se complique fréquemment de fibrose et de cirrhose. <p>Les chimiokines constituent une famille de peptides possédant des propriétés chimiotactiques et activatrices sur les leucocytes, et de ce fait jouent un rôle primordial dans la réaction inflammatoire en recrutant des cellules inflammatoires vers un site lésé. Les chimiokines exercent leurs activités en se liant à une famille de récepteurs à 7 hélices transmembranaires situés sur les leucocytes. <p>Le CCR5 est un récepteur pour les chimiokines CCL3 (MIP-1α), CCL4 (MIP-1β), CCL5 (RANTES) et CCL8 (MCP-2). Le CCR5 joue un rôle important de corécepteur dans l’infection par le virus de l’immunodéficience humaine. Chez l’humain, il existe une mutation relativement fréquente du CCR5, appelée CCR5Δ32, qui confère chez les patients homozygotes pour la mutation une protection presque complète contre l’infection par le virus de l’immunodéficience humaine. Plus récemment, la mutation CCR5Δ32 a été rapportée comme étant associée à certaines maladies hépatiques et des traitements expérimentaux chez l’homme par inhibiteurs du CCR5 ont entraînés des cas d’hépatotoxicité sévère. De même, il a été rapporté que l’expression pancréatique de CCR5 était augmentée chez les patients atteints de pancréatite chronique. Cependant, le rôle du récepteur CCR5 et de ses ligands dans la pathogénie des maladies hépatiques et pancréatiques n’est pas connu.<p>Dans un premier temps, nous avons démontré dans un modèle expérimental d’hépatite médiée par les lymphocytes T qu’il existe une production hépatique de CCL3, CCL4 et CCL5 au cours de la maladie et que le foie des souris malades est caractérisé par une infiltration accrue de cellules CCR5+. En utilisant des souris CCR5-déficientes, nous avons ensuite montré que l’absence de CCR5 est associée à une maladie plus sévère, à une production accrue de cytokines pro-inflammatoires et des chimiokines liant le CCR5 (CCL3, CCL4 et CCL5), ainsi que par un recrutement plus important de cellules inflammatoires, particulièrement des cellules CCR1+. Nous avons ensuite montré que la production accrue des ligands du CCR5 joue un rôle important dans l’exacerbation de la maladie observée chez les souris CCR5-déficientes, puisque leur neutralisation réduit fortement la sévérité de la maladie ainsi que le recrutement hépatique de cellules inflammatoires.<p>Dans un second temps, nous avons étudié l’expression et le rôle du CCR5 et de ses ligands dans un modèle murin de pancréatite aiguë sécrétagogue, induite par des injections répétées d’un analogue de la cholécystokinine. Précocément après l’induction de la maladie, nous avons observé une augmentation de l’expression de CCL2 (MCP-1), CCL3 et CCL4 alors que l’augmentation d’expression de CCL5 est observée plus tardivement au cours de la maladie. Nous avons ensuite montré que les souris CCR5-déficientes développent une pancréatite plus sévère, ainsi qu’une production accrue de CCL2, CCL3 et CCL4, et un infiltrat inflammatoire plus marqué que les souris ‘’wild-type’’. Nous avons également montré que la production accrue de ces chimiokines joue un rôle dans l’exacerbation de la pancréatite aiguë chez les souris CCR5-déficientes. En effet, la neutralisation simultanée de ces chimiokines par des anticorps monoclonaux réduit significativement la sévérité de la maladie pancréatique chez ces souris. De même, la neutralisation simultanée des ligands du CCR5 chez des souris wild-type réduit également la sévérité de la pancréatite aiguë, suggérant un rôle de ces molécules dans la pathogénie de la pancréatite aiguë.<p>En conclusion, nous avons montré que l’absence du récepteur CCR5 augmente la susceptibilité aux maladies inflammatoires hépatiques et pancréatiques expérimentales. Le développement d’inhibiteurs du CCR5 dans l’arsenal thérapeutique contre le virus de l’immunodéficience humaine devra tenir compte de ces données, d’autant plus que des cas d’hépatotoxicité sévère ont été récemment rapportés avec certains inhibiteurs en développement et que l’association du virus de l’immunodéficience humaine avec la présence de maladies hépatiques est fréquente. Enfin, ces travaux ouvrent de nouveaux champs d’investigation au niveau de l’étude d’association du CCR5Δ32 avec les maladies inflammatoires pancréatiques et hépatiques, et des perspectives thérapeutiques ciblant CCL3, CCL4 et CCL5. <p><p><p> / Doctorat en sciences médicales / info:eu-repo/semantics/nonPublished
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Clinical impact of duodenal pancreatic heterotopia – Is there a need for surgical treatment?Betzler, Alexander, Mees, Soeren Torge, Pump, Josefine, Schölch, Sebastian, Zimmermann, Carolin, Aust, Daniela E., Weitz, Jürgen, Welsch, Thilo, Distler, Marius 27 July 2017 (has links) (PDF)
Background
Pancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system. Most frequently, PH is detected incidentally by histopathological examination. The aim of the present study was to analyze a large single-center series of duodenal PH with respect to the clinical presentation.
Methods
A prospective pancreatic database was retrospectively analyzed for cases of PH of the duodenum. All pancreatic and duodenal resections performed between January 2000 and October 2015 were included and screened for histopathologically proven duodenal PH. PH was classified according to Heinrich’s classification (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts).
Results
A total of 1274 pancreatic and duodenal resections were performed within the study period, and 67 cases of PH (5.3%) were identified. The respective patients were predominantly male (72%) and either underwent pancreatoduodenectomy (n = 60); a limited pancreas resection with partial duodenal resection (n = 4); distal pancreatectomy with partial duodenal resection (n = 1); total pancreatectomy (n = 1); or enucleation (n = 1). Whereas 65 patients (83.5%) were asymptomatic, 11 patients (18.4%) presented with symptoms related to PH (most frequently with abdominal pain [72%] and duodenal obstruction [55%]). Of those, seven patients (63.6%) had chronic pancreatitis in the heterotopic pancreas. The risk of malignant transformation into adenocarcinoma was 2.9%.
Conclusions
PH is found in approximately 5% of pancreatic or duodenal resections and is generally asymptomatic. Chronic pancreatitis is not uncommon in heterotopic pancreatic tissue, and even there is a risk of malignant transformation. PH should be considered for the differential diagnosis of duodenal lesions and surgery should be considered, especially in symptomatic cases.
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Évaluation de la souche Lactococcus lactis recombinante produisant la protéine associée à la pancréatite humaine I dans le traitement de la colite induite par le DNBS et de la mucite induite par le 5-fluorouracile dans des modèles murins / Evaluation of recombinant Lactococcus lactis strain producing human Pancreatitis-associated Protein I in the treatment of DNBS-induced colitis and 5-Fluoracil-induced mucositis in mice modelsDias de Oliveira Carvalho, Rodrigo 04 November 2016 (has links)
Les maladies inflammatoires chroniques de l’intestin (MICI) regroupent la colite ulcéreuse (CU) et la maladie de Crohn (MD) qui sont des troubles intestinaux caractérisés par une inflammation chronique du tractus gastro-intestinal. Les MICI sont provoquées par un dysfonctionnement du système immunitaire de la muqueuse vers le microbiote intestinal chez les individus génétiquement prédisposés, menant à des réponses immunitaires pro-inflammatoires excessives. L'incidence de ces maladies augmente dans les pays développés et sont devenues de grands problèmes gastroentérologiques, surtout que les médicaments de traitement actuels sont associés à de graves effets collatéraux. Ainsi, les dernières recherches se concentrent sur le développement de nouvelles stratégies pour le traitement des MICI. Les probiotiques, en particulier celles qui appartiennent au groupe des bactéries lactiques (BL), se montrent capables de prévenir et de traiter les MICI en rétablissant l'équilibre du microbiote perturbé et en supprimant les réponses immunitaires pro-inflammatoires. Afin d'augmenter l’effet probiotique des BL, le clonage moléculaire et l'expression des molécules anti-inflammatoires ont été réalisés et les souches recombinantes des BL ont été évaluées comme un traitement alternatif pour les MICI. L'utilisation de ces souches, en particulier le modèle Lactococcus lactis, a montré son efficacité dans la lutte contre l'inflammation intestinale. Son administration comme thérapie pour traiter d'autres maladies inflammatoires du tractus gastro-intestinal, tels que la mucite, a également été évaluée. La mucite est un effet secondaire fréquent chez les patients subissant une radiothérapie ou une chimiothérapie qui affecte fortement leur qualité de vie. Comme pour les MICI, le traitement de la mucite est assez limité, seuls quelques médicaments et procédures décrits peuvent en effet contenir les ulcérations et l'inflammation. Par conséquent, ilest nécessaire de développer des traitementsalternatifs pour les MICI et la mucite. Le but de cette étude est de tester l'efficacité de la souche de L. lactis recombinante exprimant la protéine associée à la pancréatite I (PAP) afin de lutter contre les MICI et la mucite dans des modèles de souris. La PAP a été rapportée comme une protéine ayant des propriétés antimicrobiennes qui jouent un rôle important pour maintenir l'homéostasie intestinale. Tout d'abord, nous avons construit et confirmé l'expression de la PAP humaine par recombinant L. lactis. Ensuite, nous avons évalué l'effet thérapeutique de cette souche dans un modèle de souris de Dinitrobenzene acide sulfonique (DNBS) afin d’induire la colite. En outre, la livraison de PAP par lactocoques a protégé les animaux d’une perte de poids, de la perméabilité intestinale, et de lésions tissulaires. De plus, le traitement L. Lactis-PAP a diminué Th1 (IFN-y), Th2 (IL-4, IL-5) et Th17 (IL-17) de type-réponses immunitaires. On a également observé une expression élevée de régulation de cytokines TGF-β ainsi qu’une augmentation de la quantité de cellules T régulatrices chez les souris traitées. Les effets anti-inflammatoires des L. Lactis-PAP et des souches des produits laitiers L. lactis NZ9000 ont également été mesurés dans le modèle d'inflammation des muqueuses 5-Fluorouracil (5-FU). L'administration de L. lactis NZ9000 hébergeant le vecteur pSEC sans l'ADNc de PAP a été en mesure de prévenir les dommages histologiques, de réduire l’infiltration des éosinophiles et de la sécrétion d'IgA dans l'iléon de souris. D'autre part, L. lactis exprimant la PAP a conservé l'architecture muqueuse et a amélioré l'activité des cellules de Paneth. En même temps, nos résultats démontrent que L. lactis, exprimant PAP est une stratégie prometteuse pour traiter les MICI. En outre, la souche L. lactis NZ9000 de manière surprenante, a présenté des effets anti-inflammatoires chez les souris injectées avec du 5-FU. / Inflammatory Bowel Diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD) are complex intestinal disorders characterized by chronic inflammation of the gastrointestinal tract (GIT). IBD are caused by a deregulation of the mucosal immune system toward the native intestinal microbiota in genetically predisposed individuals, leading to excessive pro-inflammatory immune responses in the GIT. The incidence of both diseases is increasing in developed countries turning CD and UC a main gastroenterological problem as current treatment drugs are associated with serious side effects. Thus, recent research is focusing on the development of new strategies for the treatment of IBD. Probiotic bacteria especially the ones belonging to the lactic acid bacteria (LAB) group, were shown to be capable of preventing and treating IBD by restoring the balance of disrupted microbiota and suppressing pro-inflammatory immune responses. In order to increase LAB probiotic effect, molecular cloning and expression of anti-inflammatory molecules are being carried out and LAB recombinant strains are also being evaluated as an alternative treatment for IBD. As the use of these strains, especially the model Lactococcus lactis, showed to be very effective in fighting intestinal inflammation, its administration as a therapy for treating other human GIT inflammatory diseases, such as mucositis, are also being evaluated. This disorder is a common side effect of patients undergoing radiotherapy or chemotherapy that strongly affects their quality of life. Like IBD, treatment for mucositis is very limited with few medicaments and procedures described to contain inflammation. Therefore, given the need to develop alternative treatments for both IBD and mucositis, this study aimed to test theefficacy of either dairy L. lactis NZ9000 or recombinant L. lactis strain expressing Pancreatitis Associated Protein I (PAP) to fight inflammation in mouse models of IBD and mucositis. PAP has been reported as a protein with antimicrobial properties that plays important roles to keep intestinal homeostasis. Firstly, we constructed and confirmed the expression of human PAP by recombinant L. Lactis. Afterwards, we evaluated the therapeutic effect of this strain in a mice model of dinitrobenzenosulfonic acid (DNBS)-induced colitis. Moreover, PAP delivery by lactococci protected animals from weight loss, intestinal permeability, and tissue damage. In addition, L. lactis-PAP treatment decreased Th1 (IFNγ), Th2 (IL-4, IL-5) and Th17 (IL-17) type-immune responses. It was also observed a higher expression of regulatory TGF-β cytokine and increased amount of T regulatory cells in treated mice. The anti-inflammatory effects of both L. lactis-PAP and dairy L. lactis NZ9000 strains were also measured in 5-fluoracil mucositis model. We showed that this model was successfully reproduced in BALB/c mice with an induction of acute inflammation in the small bowel of animals. Administration of L. lactis NZ9000 harboring pSEC vector without the cDNA of PAP was able to prevent histological damage, reduce eosinophils infiltrate and IgA secretion in the ileum of mice. On the other hand, L. lactis expressing PAP preserved mucosal architecture and improved Paneth cells activity. Taking together, our results demonstrate that L. lactis, expressing PAP peptide is a promising strategy to treat IBD. Moreover, L. lactis NZ9000 strain, derived from dairy L. lactis MG1363, surprisingly presented anti-inflammatory effects in mice injected with 5-FU.
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Clinical impact of duodenal pancreatic heterotopia – Is there a need for surgical treatment?Betzler, Alexander, Mees, Soeren Torge, Pump, Josefine, Schölch, Sebastian, Zimmermann, Carolin, Aust, Daniela E., Weitz, Jürgen, Welsch, Thilo, Distler, Marius 27 July 2017 (has links)
Background
Pancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system. Most frequently, PH is detected incidentally by histopathological examination. The aim of the present study was to analyze a large single-center series of duodenal PH with respect to the clinical presentation.
Methods
A prospective pancreatic database was retrospectively analyzed for cases of PH of the duodenum. All pancreatic and duodenal resections performed between January 2000 and October 2015 were included and screened for histopathologically proven duodenal PH. PH was classified according to Heinrich’s classification (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts).
Results
A total of 1274 pancreatic and duodenal resections were performed within the study period, and 67 cases of PH (5.3%) were identified. The respective patients were predominantly male (72%) and either underwent pancreatoduodenectomy (n = 60); a limited pancreas resection with partial duodenal resection (n = 4); distal pancreatectomy with partial duodenal resection (n = 1); total pancreatectomy (n = 1); or enucleation (n = 1). Whereas 65 patients (83.5%) were asymptomatic, 11 patients (18.4%) presented with symptoms related to PH (most frequently with abdominal pain [72%] and duodenal obstruction [55%]). Of those, seven patients (63.6%) had chronic pancreatitis in the heterotopic pancreas. The risk of malignant transformation into adenocarcinoma was 2.9%.
Conclusions
PH is found in approximately 5% of pancreatic or duodenal resections and is generally asymptomatic. Chronic pancreatitis is not uncommon in heterotopic pancreatic tissue, and even there is a risk of malignant transformation. PH should be considered for the differential diagnosis of duodenal lesions and surgery should be considered, especially in symptomatic cases.
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Comparaison des effets d’une diète faible en lipides et d’une diète faible en glucides sur le profil cardiométabolique chez des sujets atteints de chylomicronémie multifactorielle : étude croisée randomiséeFantino, Manon 02 1900 (has links)
Le syndrome de chylomicronémie multifactorielle (MCS) est une maladie complexe au cours de laquelle les valeurs de triglycérides (TG) dépassent 10 mmol/L. Le MCS se manifeste à l'âge adulte et a une prévalence d’environ 1 adulte sur 600 au Québec. Deux conditions doivent être réunies pour développer cette maladie : une composante génétique (oligogénique ou polygénique) ainsi que la présence de facteurs de risque reliés au style de vie (une alimentation riche en gras et en sucres raffinés, une consommation excessive d'alcool, un diabète non contrôlé ou l'obésité). Le MCS est une condition de santé grave, puisqu’il augmente considérablement le risque de pancréatites aigües et peut doubler le risque de maladies cardiovasculaires. Actuellement, il n’y a pas d’étude d’intervention nutritionnelle, réalisée dans cette population, qui permette de connaitre l’approche nutritionnelle la plus bénéfique. Ce mémoire présente les résultats d’une étude croisée randomisée dont l’objectif était d’évaluer l’impact d’une diète faible en lipides et d’une diète faible en glucides sur le profil lipidique à jeun et postprandial chez des patients atteints de MCS en fonction de la présence d’un variant rare à l’état hétérozygote du gène de la lipoprotéine lipase (LPL). Les résultats de cette étude suggèrent qu’une diète faible en lipides permettrait une diminution plus importante des TG chez les sujets porteurs d’un variant rare à l’état hétérozygote de la LPL et pourrait ultimement contribuer à réduire le risque de pancréatite aigüe sur le long terme. / Multifactorial chylomicronemia syndrome (MCS) is a complex disease in which triglyceride (TG) values exceed 10 mmol/L. MCS occurs in adulthood and has a prevalence of approximately 1 in 600 adults in Quebec. Two conditions must be met to develop this disease: a genetic component (oligogenic or polygenic) as well as the presence of lifestyle risk factors (a diet high in fat and refined sugars, excessive alcohol consumption, uncontrolled diabetes or obesity). MCS is a serious health condition, as it significantly increases the risk of acute pancreatitis and can double the risk of cardiovascular disease. Currently, there are no nutritional intervention studies conducted in this population to determine the most beneficial nutritional approach. This thesis presents the results of a randomized crossover study whose objective was to evaluate the impact of a low-fat diet and a low-carbohydrate diet on the fasting and postprandial lipid profile in patients with SCD according to the presence of a rare heterozygous lipoprotein lipase (LPL) gene variant. The results of this study suggest that a low-fat diet would result in a greater reduction in TGs in subjects with a rare heterozygous variant of LPL and may ultimately help reduce the risk of acute pancreatitis in the long term.
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Aplikace vybraných metod k analýze oxidačního stresu / Application of Selected Methods for Oxidative Stress AnalysisLízalová, Martina January 2010 (has links)
Chronic pancreatitis (CP) is a heterogeneous disease defined as chronic inflammatory changes of the pancreatic tissue caused by variety of aetiologies. Oxidative stress accompanying the inflammatory processes has been suggested as an important factor contributing to CP development. The aim of this study was to determine levels of lipid peroxidation products malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE), together with nitrites, the total antioxidant capacity, cytokines, biochemical and haematological parameters in the plasma of patients with CP and control subjects. Levels of MDA and 4-HNE were analyzed using high-performance liquid chromatography. The total antioxidant capacity of plasma against peroxyl radicals was evaluated using chemiluminescence determination. Nitrites were determined using Griess reaction. Cytokines - TNF-alfa; TNF RI; PDGF-AB; TGF-beta, together with myeloperoxidase and hyaluronan were determined using ELISA Kits. Biochemical and haematological parameters were measured by standard methods.
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Concentration sérique de la lipase DGGR chez le chat lors d’insuffisance rénaleBua, Anne-Sophie 08 1900 (has links)
No description available.
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