A depressão tem sido considerada uma das principais causas de incapacidade e caracteriza-se pela a presença de humor triste e perda de interesse ou prazer, acompanhada de alterações somáticas e cognitivas que afetam significativamente a capacidade de funcionamento do indivíduo. Evidências sugerem que o hormônio relacionado ao estresse, o cortisol, está envolvido na fisiopatologia da depressão em adultos. Isso pode estar relacionado com estresse precoce durante o desenvolvimento inicial, o que poderia levar a uma maior vulnerabilidade para desenvolver depressão e risco de tentativa de suicídio na fase adulta. O cortisol tem sua liberação mediada pelo eixo hipotálamo-hipófise-adrenal (HPA) e a alteração deste eixo pode afetar significativamente a biodisponibilidade do cortisol circulante. É comprovado também que fatores ambientais e genéticos permeiam a causa da depressão e o eixo HPA tem sido implicado na fisiopatologia de transtornos depressivos. O gene HSD11B1 que codifica a enzima 11?-hidroxiesteróide desidrogenase tipo1 que é a responsável por converter cortisona em cortisol permeia a função do eixo HPA. Com isso, polimorfismos genéticos no gene HSD11B1 podem afetar o risco para desenvolver depressão e o risco de suicídio. O objeto foi avaliar se genótipos e haplótipos do gene HSD11B1 estão associados com risco de depressão, com a gravidade dos sintomas e com o comportamento suicida, considerando o estresse precoce como um fator ambiental. Foram incluídos 107 pacientes depressivos e 67 pacientes saudáveis incluídos como controles. Todos os sujeitos foram submetidos a uma avaliação psicométrica com a Escala MINI, escala GRID-HAMD21, Questionário de Traumas Infantis CTQ e Escala Beck de Ideação Suicida. Foi encontrada associação significativa com o polimorfismo rs11119328 nos genótipos para risco aumentado de pelo menos uma tentativa de suicídio (OR: 12,53, p = 0,045) E uma associação de genótipos variantes do polimorfismo rs11811440 com humor eutímico para tratamento farmacológico otimizado (OR: 0,05, P = 0,027). Concluímos que os polimorfismos do gene HSD11B1 podem ser biomarcadores relevantes para detectar indivíduos geneticamente vulneráveis a desenvolver depressão e a cometer suicídio. / Depression has been considered one of the main cause of disability and is characterized by the presence of sad mood and loss of interest or pleasure, accompanied by somatic and cognitive changes that significantly affect the ability of the individual to function. Evidence suggests that the stress-related hormone, cortisol, is involved in the pathophysiology of depression in adults. This may be related to adverse experiences in childhood during early development, which could lead to increased vulnerability to developing depression and suicide attempt risk in adulthood. Cortisol has its release mediated by the hypothalamic-pituitary-adrenal axis (HPA) and the alteration of this axis can significantly affect the bioavailability of the circulating cortisol. It is also proven that environmental and genetic factors permeate the cause of depression and the HPA axis has been implicated in the pathophysiology of depressive disorders. The HSD11B1 gene encoding the 11?-hydroxysteroid dehydrogenase type 1 enzyme that is responsible for converting cortisone to cortisol permeates HPA axis function. Thus, genetic polymorphisms in the HSD11B1 gene may affect the risk of developing depression and the risk of suicide. The objective was to evaluate if genotypes and haplotypes of the HSD11B1 gene are associated with risk of depression, with severity of symptoms and with suicidal behavior, considering early stress as an environmental factor. We included 107 depressive patients and 67 healthy patients included as controls. All subjects underwent a psychometric evaluation with the MINI Scale, GRID-HAMD21 Scale, Child Trauma Questionnaire CTQ and Beck Scale of Suicidal Ideation. It was found a significant association with rs11119328 polymorphism in genotypes at increased risk of at least one suicide attempt (OR: 12.53, p = 0.045) and an association of rs11811440 polymorphism genotypes with euthymic humor for optimized pharmacological treatment (OR: 0.05, P = 0.027). We conclude that HSD11B1 gene polymorphisms may be relevant biomarkers for detecting genetically vulnerable individuals to develop depression and commit suicide.

京都大学 / 0048 / 新制・課程博士 / 博士(人間・環境学) / 甲第21875号 / 人博第904号 / 新制||人||215(附属図書館) / 2018||人博||904(吉田南総合図書館) / 京都大学大学院人間・環境学研究科相関環境学専攻 / (主査)教授 瀬戸口 浩彰, 教授 加藤 眞, 教授 市岡 孝朗, 准教授 西川 完途 / 学位規則第4条第1項該当 / Doctor of Human and Environmental Studies / Kyoto University / DGAM

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22384号 / 社医博第106号 / 新制||社||医11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 妹尾 浩, 教授 古川 壽亮, 教授 中川 一路 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Introduction – Treatment for breast cancer is associated with a risk of chronic shoulder and upper limb morbidity in up to 30% of patients. There is currently no consensus for the possible reason for this often repeated finding in the literature. Previous research has suggested that development of fibrotic tissue in response to cancer treatments such as surgery and radiotherapy could be an underlying cause of musculoskeletal dysfunction and pain. This study investigated if any genetic variants in several key fibrosis-modulating genes could be shown to be associated with risk of upper limb musculoskeletal dysfunction and pain in breast cancer survivors. Participants and Methods – A cross sectional study design was employed, using a candidate gene approach. A total of 326 South African breast cancer survivors were recruited from a tertiary hospital in the Western Cape (343 total, minus 17 samples with insufficient data collected). Each participant was scored for symptom severity using the shoulder pain and disability index (SPADI) questionnaire. Participants were then grouped for symptom severity using low, med or high SPADI scores. The low SPADI group served as controls (controls n=273, cases n=70). Participants were invited to donate a blood sample from which DNA was extracted. Each DNA sample was genotyped at seven polymorphic sites; three in TGF-ß, two in ATM, one in SOD2 and one in XRCC1, using PCR technologies and TaqMan allelic-discrimination probes. The resultant genotypes were analysed using multivariate analysis, including inferred haplotype analysis to search for association to shoulder pain and morbidity after treatment. A logistic regression analysis was also performed to investigate the association between SPADI score and age of participant. Results – When participant age was compared with symptom severity, it was found that younger participants were more likely to have moderate-to-severe symptoms than older participants. There was a significant difference in the minor allele frequencies between case and control groups for the rs4880 (C>T, SOD2) polymorphism. The T allele was present more in the case group than in controls, with minor allele frequencies of 0.67 vs 0.55 respectively. No other independent associations were noted for any of the remainder variants tested. When haplotypes were inferred for genes SOD2 and ATM, combinations between the rare alleles at rs4880 and rs1800058 (C>T, ATM) were associated (F=4.35, pT and ATM rs1800058 is recommended for further study, in addition to the rs4880 polymorphism in SOD2. These novel results are suggesting that there may be an association between fibrotic genes and the development of upper limb sequelae after treatment for breast cancer. A larger case-control study would be required to validate and explore these findings.

Ziel der vorliegenden Arbeit war die Charakterisierung von Punktmutationen in ifng und ncam1 in Hinblick auf eine veränderte Funktionalität von NK-Zellen bei der Interaktion mit A. fumigatus. Die gewonnenen Erkenntnisse sollen langfristig zur Verbesserung der Diagnostik, Prophylaxe und Therapie einer Invasiven Aspergillose, die zum Beispiel im Rahmen einer Stammzelltransplantation auftreten könnte, beitragen. In dieser Arbeit wurde die DNA von zwanzig gesunden Spendern auf einen ifng-SNP (rs2069705) und einen ncam1-SNP (rs10502171) untersucht. Von je drei ausgewählten Spendern mit SNP und sechs Kontrollspendern wurden NK-Zellen isoliert. Diese wurden unstimuliert belassen, mit Interleukin 2/15 oder A. fumigatus stimuliert. Bei der Versuchsreihe zum ifng-SNP wurde eine qPCR zur Ermittlung der relativen Expression von ifng und ccl4, bei den Versuchen zum ncam1-SNP eine durchflusszytometrische Analyse zur Messung der Expression verschiedener Oberflächenmarker durchgeführt. Bei beiden wurde mittels ELISA die Freisetzung von IFN-gamma bzw. CCL4/MIP-1ß bestimmt. Die in dieser Arbeit gewonnenen Ergebnisse zum ifng-SNP lassen vermuten, dass das Vorliegen dieses ifng-SNP keine durch NK-Zellen vermittelten Auswirkungen auf das Risiko der Patienten, an einer Invasiven Aspergillose zu erkranken, hat. In Bezug auf den ncam1-SNP konnte die Hypothese bestätigt werden, dass der SNP die Interaktion zwischen der NK-Zelle und A. fumigatus verändert. Der SNP korreliert zwar mit einer erhöhten Grundaktivierung von NK-Zellen, jedoch auch mit einem schwächeren Aktivierungspotential bei Stimulation mit dem Pilz. / The aim of this thesis was the characterization of point mutations in ifng and ncam1 with respect to an altered functionality of NK cells during interaction with A. fumigatus. In the long term, the findings should contribute to the improvement of the diagnosis, prophylaxis and therapy of invasive aspergillosis, which can occur, for example, after stem cell transplantation. In this work, the DNA of twenty healthy donors was examined for one ifng-SNP (rs2069705) and one ncam1-SNP (rs10502171). NK cells were isolated from three donors for each SNP and six control donors. These were left unstimulated, stimulated with interleukin 2/15 or A. fumigatus. In the ifng-SNP series qPCR was performed to determine the relative expression of ifng and ccl4, in the ncam1-SNP series flow cytometric analysis was performed to measure the expression of different surface markers. In both cases the release of IFN-gamma and CCL4/MIP-1ß was determined by ELISA. The results obtained in this study on ifng-SNP suggest that the presence of this ifng-SNP has no NK cell mediated effects on the risk of patients suffering from invasive aspergillosis. With regard to the ncam1-SNP, the hypothesis that the SNP alters the interaction between the NK cell and A. fumigatus was confirmed. The SNP correlates with an increased basic activation of NK cells, but also with a weaker activation potential when stimulated with the fungus.

Cocrystals have attracted much interest in recent years. It was once thought that cocrystals could be a means to prevent polymorphism but many recent examples of cocrystal polymorphism have been discovered and reported. In this contribution, we present a survey of polymorphic cocrystals. Polymorphism is the ability of a specific chemical compound to crystallize in more than one crystalline form. Polymorphs have different arrangements of the molecules in the given crystal lattice and may exhibit different characteristics such as packing properties, thermodynamic properties, spectroscopic properties, kinetic properties, surface properties, and mechanical properties. Polymorphs can be classified in various groups such as crystalline, amorphous, hydrates, and solvates. The main characterization methods used in this thesis are X-ray diffraction and solid-state NMR spectroscopy. The concept of variable stoichiometry cocrystallization is explored in halogen-bonded systems. Three novel cocrystals of 1,4-diiodotetrafluorobenzene and 3-nitropyridine with molar ratios of 1:1, 2:1, and 1:2, respectively, are prepared by slow evaporation methods. Powder X-ray diffraction experiments carried out on the 1:1 and 2:1 cocrystals confirm that gentle grinding does not alter the crystal forms. 1H → 13C and 19F →13C cross-polarization magic angle spinning (CP/MAS) NMR experiments performed on powdered samples of the 1:1 and 2:1 cocrystals are used as spectral editing tools to select for either the halogen bond acceptor or donor, respectively. I also describe the formation of a new cocrystal of 1, 3, 5-trifluoro-2, 4, 6-triiodobenzene and piperazine with a 2:1 molar ratio that was prepared by the slow evaporation method. In addition of that, I have prepared the cocrystal (1,4- VII diiodotetrafluorobenzene)(coumarin ) already reported. After preparation and purification process of this compound, I obtained a small amount powder, but could not characterize it by solid-state NMR; rather I performed powder X-ray diffraction to study this compound. Overall, this work contributes new examples to the field of polymorphism in halogen-bonded systems and to variable stoichiometry cocrystal engineering with halogen bonds.

Molecular typing of strains among the highly diverse population of Helicobacter pylori (H. pylori) is an important approach for both basic and clinical studies. Genomic DNAs prepared from 18 gastric biopsy specimens, 21 H. pylori clinical isolates obtained from gastric biopsy specimens, and five isolates collected from a single patient at weekly intervals, were subjected to a combined single- and double-stranded conformational polymorphism (SDSCP) assay. The results showed that 19 of 21 isolates tested were discriminated by SDSCP analysis. SDSCP analysis of five H. pylori isolates collected from the same patient at different times resulted in five identical profiles, suggesting the reproducibility of the method. When DNA preparations from 18 gastric biopsy specimens were subjected to SDSCP analysis, 18 unique profiles were generated that matched those of their corresponding cultured H. pylori isolates from each patient. For comparison, polymerase chain reaction (PCR)-based restriction fragment length polymorphism analysis yielded only nine profiles for 20 strains. The data suggest that SDSCP analysis may be an effective and reliable method for differentiation of H. pylori strains directly from gastric biopsy specimens without requiring isolation of the organisms by culture.

Altered intracellular calcium homeostasis and oxidative stress are involved in the pathophysiology of bipolar disorder (BD)-I. To explore the genes contributing to these abnormalities, we examined the association with BD of the iPLA2β (PLA2G6), a signaling enzyme that mobilizes the arachidonic acid signaling cascade and activates oxidative stress, and assessed whether it interacts genetically with type 2 transient receptor potential channel gene (TRPM2), an oxidative stress-responsive calcium channel implicated both functionally and genetically in BD-I. Two tag single nucleotide polymorphisms rs4375 and rs3788533 in iPLA2β were genotyped in 446 White case-control individuals and 296 BD families using a 5′-nuclease TaqMan assay. The results were analyzed using χ-test and transmission disequilibrium tests, and Haploview. In a secondary analysis, we tested gene-gene interactions between TRPM2 and iPLA2β on BD vulnerability by logistic regression using a case-only design in PLINK. iPLA2β-rs3788533 showed a borderline association with BD-I in patients with a history of psychosis in both case-control and family designs. Association with BD as a whole was observed in the family study (significant over transmissions of rs3788533-allele C, P=0.015, PBonferroni=0.03, TDTPHASE). A borderline interaction was found between rs749909 within TRPM2 and rs4375 within iPLA2β (Puncorrected=0.009), on the basis of the case-only design analyzed with PLINK. A significant association of iPLA2β variants with BD-I and a trend gene-gene interaction between iPLA2β and TRPM2 provides additional support for the notion that genetic variation in these two functionally implicated candidates contributes toward the risk and pathophysiology of this illness.

Altered intracellular calcium homeostasis and oxidative stress are involved in the pathophysiology of bipolar disorder (BD)-I. To explore the genes contributing to these abnormalities, we examined the association with BD of the iPLA2β (PLA2G6), a signaling enzyme that mobilizes the arachidonic acid signaling cascade and activates oxidative stress, and assessed whether it interacts genetically with type 2 transient receptor potential channel gene (TRPM2), an oxidative stress-responsive calcium channel implicated both functionally and genetically in BD-I. Two tag single nucleotide polymorphisms rs4375 and rs3788533 in iPLA2β were genotyped in 446 White case-control individuals and 296 BD families using a 5′-nuclease TaqMan assay. The results were analyzed using χ-test and transmission disequilibrium tests, and Haploview. In a secondary analysis, we tested gene-gene interactions between TRPM2 and iPLA2β on BD vulnerability by logistic regression using a case-only design in PLINK. iPLA2β-rs3788533 showed a borderline association with BD-I in patients with a history of psychosis in both case-control and family designs. Association with BD as a whole was observed in the family study (significant over transmissions of rs3788533-allele C, P=0.015, PBonferroni=0.03, TDTPHASE). A borderline interaction was found between rs749909 within TRPM2 and rs4375 within iPLA2β (Puncorrected=0.009), on the basis of the case-only design analyzed with PLINK. A significant association of iPLA2β variants with BD-I and a trend gene-gene interaction between iPLA2β and TRPM2 provides additional support for the notion that genetic variation in these two functionally implicated candidates contributes toward the risk and pathophysiology of this illness.

With the beginning of the Human Genome Project, an emerging field of science was brought to the forefront of the pharmaceutical community. Pharmacogenetics facilitates optimization of the current patient-centered care model and pharmacotherapy as a whole. Utilizing these ever-expanding branches of science to nonsteroidal anti-inflammatory drugs (NSAIDs) can provide novel opportunities to affect patient care. With a wide range of NSAID choices available as treatment options for relieving pain and/or reducing inflammation or fever, a more systematic way of selecting the ideal agent for the patients based upon their genetic information could spare them from a potentially permanent health-care condition. Furthermore, if a patient possesses or lacks certain alleles, serious adverse events can be anticipated and avoided. The tailoring of drug therapy can be achieved using the published data and cutting-edge genetic testing to attain a higher standard of care for patients.