Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Le canal Kv11.1, dont l’inhibition occasionne une prolongation de l’intervalle QT, est directement impliqué dans des cas d’effets secondaires cardiotoxiques. Depuis 2006, Santé Canada exige que les nouvelles molécules et leurs métabolites soient évalués en phase préclinique pour le risque d’allongement de l’intervalle QT. La méthode de référence évalue l’électrophysiologie des cardiomyocytes en culture lors d’une courte exposition au médicament (<30min). Bien que cette méthode soit la plus fiable actuellement, elle permet seulement d’identifier les molécules qui bloquent directement le passage des ions dans le pore du canal (effet aigu). La méthode HERG-BRET vise à identifier les molécules susceptibles d’interagir avec le canal Kv11.1 par le moyen d’une altération du trafic vésiculaire (effet chronique). Ce type d’interaction est considéré comme un biomarqueur de la capacité à bloquer l’activité de ce canal. L’étude présentée tente de déterminer si un test de localisation cellulaire de hERG basé sur le BRET permettra un criblage à haut débit et une meilleure évaluation de l’affinité d’interaction avec hERG, comparativement aux méthodes alternatives actuelles. Dans le modèle HERG-BRET, la protéine hERG fusionnée à la luciférase de renilla (donneur d’énergie) est exprimée dans une lignée cellulaire HEK293. Cette même lignée exprime également une protéine verte fluorescente modifiée (accepteur d’énergie) qui est ancrée à la membrane plasmique. L’échange d’énergie entre le donneur et l’accepteur est un indice de la localisation de hERG à la membrane plasmique. Les fluctuations de ratio BRET suite à une exposition de 16h à un composé pharmaceutique reflètent donc l’effet du composé sur la translocation de Kv11.1. Vingt-cinq composés pharmaceutiques déjà caractérisés dans la littérature scientifique ont été testés : 12 ont été classés comme chaperons pharmacologiques, 4 comme inhibiteurs du trafic, 1 comme inhibiteur ayant les deux effets mentionnés et 8 n’ont pas pu être classés. Le comportement du biosenseur à l’égard des composés testés suggère que la méthode HERG-BRET ne peut pas être utilisée seule pour évaluer le risque cardiotoxique des médicaments. Toutefois, elle peut fournir des informations complémentaires pertinentes quand à la nature de l’interaction entre un composé pharmaceutique et la sous unité hERG du canal Kv11.1. / The Kv11.1 channel is directly involved in cardiotoxic adverse effects since its inhibition is responsible for a prolongation of the QT interval. In 2006, Health Canada established a guideline that constrains drug developers to a preclinical evaluation of QT prolongation risks for new molecules and their metabolites. The gold standard method (patch-clamp) consists in electrophysiology measurements on cultured cardiomyocytes for a brief exposition to the tested compound (<30min). Even though this method is the most reliable, it only allows the identification of molecules that inhibit the channel by preventing ions from traveling through the pore (acute effect). The HERG-BRET method aims to identify molecules that can interact with Kv11.1 and alter its vesicular transport as a proxy for inhibiting the activity of the channel (chronic effects). This study attemps to determine if a BRET-based cellular localization assay will allow a high throughput screening and a better evaluation of the affinity of pharmaceuticals compounds with hERG, in comparison to alternative methods. In the HERG-BRET model, a fusion protein generated with the gene sequence for hERG and the one for the renilla luciferase (energy donor) is stably expressed in a HEK 293 cell line. The same cell line also stably expresses a green fluorescent protein (energy acceptor) that is anchored at the plasma membrane. The energy transfer that occurs between the donor and the acceptor suggests that hERG is located at the membrane. Variations of BRET ratios following a 16 hours inucabtion with a compound reflects the compound’s effects on Kv11.1’s translocation. Twenty-five compounds that have been previously characterized in the literature were tested: 12 were categorized as pharmacological chaperones, 4 as traffic inhibitors, 1 as an inhibitor that undergoes both effects and 8 remain uncategorized. The biosensor’s behavior towards the tested compounds suggests that the HERG-BRET method cannot be used alone to assess cardiotoxic liability, but it can bring interesting facts to our attention regarding the nature of the interaction between the hERG subunits of Kv11.1 and a tested compound.

Objectives: The inverse relationship between QT interval variability (QTV) and T wave amplitude potentially confounds QT variability assessment. We quantified the influence of the T wave amplitude on QTV in a comprehensive dataset and devised a correction formula. Methods: Three ECG datasets of healthy subjects were analyzed to model the relationship between T wave amplitude and QTV. To derive a generally valid correction formula, linear regression analysis was used. The proposed correction formula was applied to patients enrolled in the Evaluation of Defibrillator in Non-Ischemic Cardiomyopathy Treatment Evaluation trial (DEFINITE) to assess the prognostic significance of QTV for all-cause mortality in patients with non-ischemic dilated cardiomyopathy. Results: A strong inverse relationship between T wave amplitude and QTV was demonstrated, both in healthy subjects (R2 = 0.68, p < 0.001) and DEFINITE patients (R2 = 0.20, p < 0.001). Applying the T wave amplitude correction to QTV achieved 2.5-times better group discrimination between patients enrolled in the DEFINITE study and healthy subjects. Kaplan-Meier estimator analysis showed that T wave amplitude corrected QTVi is inversely related to survival (p < 0.01) and a significant predictor of all-cause mortality. Conclusion: We have proposed a simple correction formula for improved QTV assessment. Using this correction, predictive value of QTV for all-cause mortality in patients with non-ischemic cardiomyopathy has been demonstrated.

This thesis deals with the influence of the newly synthesized drug on the electrical activity of the isolated heart of rat. Part of the thesis is a theoretical analysis of the use laboratory animals in experiments and ethical aspects related to the use of laboratory animals. There is also an analysis of drug testing, test substances, electrocardiography and methods used to detect and measure ECG signal. The two algorithms used for the QT interval are automated. The QT interval is the main indicator of cardiotoxicity and is considered to be the gold standard in evaluating the effect of the drug. In the practical part the ECG records obtained at the Faculty of Medicine at Masaryk University in Brno are processed. These records are dimmed manually and automatically. The manual dimming was consulted with a specialist in cardiography and statistically processed. Statistical processing served to compare with the results of the automatic ECG measurement. The algorithm is used to automate the measurement, and the results are compared with the reference points obtained from cardiology experts and manual measurement results. This work serves as a pilot study for the development and testing of a new active substance.