Studies demonstrate neuro-retinal damage in patients with diabetes and no clinically visible diabetic retinopathy. It is unknown which retinal regions are most vulnerable to diabetes. We hypothesized that the standard and slow-flash (sf-) multifocal electroretinogram (mfERG) and adaptive optics (AO) imaging will localize retinal regions of vulnerability. Fifty-five adolescents with diabetes and 54 controls underwent mfERG testing to isolate predominately retinal bipolar cell activity and sf-mfERG testing to isolate three oscillatory potentials (OPs) from intraretinal amacrine and interplexiform cells. Greatest mfERG delays were in the superior temporal quadrant and at 5°-10° eccentricity. Greatest sf-mfERG delays were found at different eccentricities for each OP. Twenty adolescents with diabetes and 14 controls underwent AO imaging. No significant differences in cone photoreceptor density were found; however, patients showed a trend towards reduced density in the superior nasal region. Inner retinal structures may be more susceptible to damage by diabetes than outer retinal structures.

Studies demonstrate neuro-retinal damage in patients with diabetes and no clinically visible diabetic retinopathy. It is unknown which retinal regions are most vulnerable to diabetes. We hypothesized that the standard and slow-flash (sf-) multifocal electroretinogram (mfERG) and adaptive optics (AO) imaging will localize retinal regions of vulnerability. Fifty-five adolescents with diabetes and 54 controls underwent mfERG testing to isolate predominately retinal bipolar cell activity and sf-mfERG testing to isolate three oscillatory potentials (OPs) from intraretinal amacrine and interplexiform cells. Greatest mfERG delays were in the superior temporal quadrant and at 5°-10° eccentricity. Greatest sf-mfERG delays were found at different eccentricities for each OP. Twenty adolescents with diabetes and 14 controls underwent AO imaging. No significant differences in cone photoreceptor density were found; however, patients showed a trend towards reduced density in the superior nasal region. Inner retinal structures may be more susceptible to damage by diabetes than outer retinal structures.

科学研究費補助金 研究種目:基盤研究(C)(2) 課題番号:10672124 研究代表者:大澤 功 研究期間:1998-2001年度

The aim of this study was to determine the prevalence and causes as well as the risk factors of visual impairment (VI) and blindness among Black South Africans with diabetes mellitus (DM) aged 40 years and older in Mopani District, Limpopo province, South Africa. This was a cross-sectional study in which Black South Africans with DM aged ≥40 years old were examined for VI and blindness. In addition, anthropometric as well as risk factors for VI and blindness were studied. A total of 225 participants were selected from seven Public Health Facilities in Mopani District. Data was collected using standard optometric instruments, anthropometric instruments and structured interviews. Data analysis was done using the Statistical Analysis System (SAS) and Microsoft Excel software packages. The ages of the participants ranged from 40 to 90 years with a mean of 61.5±10.49 years. There were more females (71.5%) than males (28.4%). The prevalence of uncorrected VI and blindness in the right eyes of the participants was 70.7% and 3.6%, respectively. In the left eyes, it was 72% and 3.1%, respectively. However, following optical correction, the prevalence in right eyes was 41.3% and 3.6%, respectively. In the left eyes, it was 42.2% and 3.1%, respectively. Risk factors that were individually associated with VI and blindness include age, educational qualification, monthly income, knowledge of DM types, oral DM treatment (pills), losing weight, compliance to losing weight, family history of DM, physical activity, and date of last eye examination .When logistic regression was used, knowledge of DM types, pills, and compliance to losing weight, family history of DM, monthly income and physical activity remained associated with VI and blindness. The high prevalence of VI in this diabetes population was not primarily due to DM itself, but due to refractive error and cataract, conditions which have effective and easy treatments. A total of 84% of the participants were visually impaired due to either refractive error or cataract or both and only 3.8% due to diabetes retinopathy. It is therefore recommended that appropriate and affordable refraction and cataract surgical services be made available and accessible to this population / Health Studies / D. Litt. et Phil. (Health Studies)

INTRODUÇÃO: Fatores associados à etiopatogenia das complicações diabéticas, incluindo hiperglicemia e estresse oxidativo, podem causar alterações epigenéticas que modificam a expressão de genes em células-alvo, sem alterar sua sequência de DNA. São considerados mecanismos epigenéticos: (1) as modificações pós-traducionais das histonas; (2) a metilação do DNA e (3) a ação dos micro-RNAs (miRNAs); todos já foram reconhecidos na patogênese da \"memória metabólica\", situação na qual a hiperglicemia continua a exercer efeitos deletérios prolongados mesmo depois de ser normalizada. A sirtuína-1 é uma enzima que causa modificações pós-traducionais das histonas por sua atividade de histona desacetilase, silenciando a transcrição gênica. O silenciamento gênico também pode ocorrer pela ação da DNA metiltransferase 1 (DNMT1), enzima que adiciona um grupamento metil (CH3) na posição 5 de resíduos de citosina localizadas em ilhas CpG presentes nas regiões promotoras dos genes. Os miRNAs constituem uma classe de pequenos RNAs não codificadores com cerca de 19 a 25 nucleotídeos que controlam a expressão gênica por meio da repressão da tradução ou da degradação do RNA mensageiro-alvo. As hipóteses do presente estudo são (1) que exista um perfil sérico de miRNAs associado à presença ou ausência de complicações crônicas e (2) que existam variantes em genes relacionados à desacetilação das histonas e à metilação de citosinas que poderiam predispor ao aparecimento das complicações diabéticas, o que se constituiria na \"genética da epigenética\". OBJETIVOS: (1) caracterizar e comparar o perfil de miRNAs sérico de pacientes com diabetes mellitus tipo 1 (DM1) sem nenhuma complicação microvascular versus aqueles com três complicações microvasculares: retinopatia diabética (RD), doença renal diabética (DRD) e neuropatia diabética, para identificar vias epigeneticamente moduladas nesses dois grupos de pacientes e (2) avaliar a frequência de polimorfismos de um único nucleotídeo nos genes que codificam as enzimas DNMT1 e sirtuína-1 e suas associações com cada uma das complicações microvasculares em pacientes com DM1. MÉTODOS: O perfil sérico de 381 miRNAs foi avaliado com o uso do estojo comercial Taqman® Human MicroRNA Array A em 10 pacientes bem caracterizados clínica e laboratorialmente divididos em dois grupos: Pacientes com DM1 sem complicações [sem DRD (Clearance de creatinina > 90 ml/min/1,73 m2 e excreção urinária de albumina < 20 mg/g de creatinina), sem polineuropatia sensitivo-motora distal (ausência de sintomas sugestivos de neuropatia, sensibilidade térmica e dolorosa e reflexo aquileu normais), sem neuropatia autonômica cardiovascular (NAC) e sem RD] e Pacientes com DM1 com complicações [DRD (Clearance de creatinina < 60 ml/min/1,73 m2 e excreção urinária de albumina > 200 mg/g de creatinina), com polineuropatia sensitiva-motora distal, com NAC instalada e RD moderada ou grave]. Os cinco miRNAs mais diferencialmente expressos foram validados em uma casuística bem caracterizada de 20 pacientes com DM1 sem nenhuma complicação e 27 com todas as complicações microvasculares, com o emprego do estojo comercial TaqMan(TM) Advanced miRNA cDNA Synthesis. A avaliação da frequência de polimorfismos de um único nucleotídeo nos genes que codificam as enzimas DNMT1 (rs8112895, rs7254567, rs11085721, rs17291414, rs10854076) e sirtuína-1 (rs10997870; rs12766485) foi realizada após a genotipagem por reação em cadeia da polimerase em tempo real, em uma casuística composta por 466 pacientes com DM1. RESULTADOS: Do total de 377 miRNAs-alvo avaliados no soro dos pacientes com DM1, um total de 21 miRNAs estava superexpresso no grupo com complicações. Dos 5 miRNAs para os quais foi realizada a validação na casuística de 47 pacientes com DM1, dois foram confirmados como superexpressos na população com complicações (hsa-miR-518d-3p e hsa-miR-618). O polimorfismo rs11085721 no gene que codifica a DNMT1 associou-se à presença de NAC no sexo feminino, sendo o alelo raro C considerado de risco e conferindo um odds ratio (intervalo de confiança de 95%) de 2,44 (1,26-5,28). Nenhum polimorfismo da sirtuína-1 associou-se às complicações microvasculares avaliadas. CONCLUSÃO: o perfil de miRNAs séricos difere entre pacientes com DM1 com e sem complicações. O achado de uma variante em um gene que codifica a enzima de uma via epigenética conferir suscetibilidade a uma complicação crônica sugere que também exista a \"genética da epigenética\" modulando o desenvolvimento das complicações / INTRODUCTION: Factors associated with the etiopathogenesis of diabetic complications, including hyperglycemia and oxidative stress, may cause epigenetic changes that modify the expression of genes in target cells without altering their DNA sequence. The following mechanisms are considered epigenetics: (1) post-translational modifications of histones; (2) methylation of DNA and (3) action of micro-RNAs (miRNAs); all have already been recognized in the pathogenesis of \"metabolic memory\", a situation in which hyperglycemia exerts prolonged deleterious effects even after its normalization. Sirtuin-1 is an enzyme that causes post-translational modifications of histones by their histone deacetylase activity, silencing gene transcription. Gene silencing may also occur through the action of DNA methyltransferase 1 (DNMT1), an enzyme that adds a methyl group (CH3) at position 5 of cytosine residues located in CpG islands from gene-promoter regions. miRNAs are a class of small non-coding RNAs with about 19 to 25 nucleotides that control gene expression by promoting translation repression or degradation of target messenger RNAs. The hypotheses of the present study are (1) there is a serum profile of miRNAs associated with the presence or absence of chronic complications and (2) there are variants in genes related to histone deacetylation and cytosine methylation that could predispose to diabetes complications, which would constitute the \"genetics of epigenetics\". OBJECTIVES: (1) to characterize and compare the serum miRNA profile of patients with type 1 diabetes mellitus (T1D) without any microvascular complications versus those with three microvascular complications: diabetic retinopathy (DR), diabetic kidney disease (DKD) and diabetic neuropathy to identify signaling pathways epigenetically modulated in these two groups of patients and (2) to assess the frequency of single nucleotide polymorphisms in the genes encoding DNMT1 and sirtuin-1 and their associations with each of the microvascular complications in T1D patients. METHODS: The serum profile of 381 miRNAs was evaluated using the Taqman® Human MicroRNA Array A kit in 10 clinical and laboratory well-characterized patients divided into two groups: Patients without microvascular complications: without DKD (creatinine clearance> 90 ml/min/1.73 m2 and urinary albumin excretion < 20 mg / g creatinine), without distal sensory-motor polyneuropathy (absence of symptoms suggestive of neuropathy and normal thermal and pain sensitivity and Achilles reflex), without cardiovascular autonomic neuropathy (CAN) and without DR; and T1D patients with complications: with DKD (creatinine clearance < 60 ml / min / 1.73 m2 and urinary albumin excretion> 200 mg / g creatinine), with distal sensory-motor polyneuropathy, with CAN and with DR moderate or severe. The five most differentially expressed miRNAs were validated in a well-characterized case series of 20 patients with no complications and 27 patients with all microvascular complications using the TaqMan (TM) Advanced miRNA cDNA Synthesis kit. The evaluation of the frequency of single nucleotide polymorphisms in genes encoding the DNMT1 (rs8112895, rs7254567, rs11085721, rs1729414, rs10854076) and sirtuin-1 (rs10997870; rs12766485) was performed by genotyping using real-time polymerase chain reaction in a sample of 466 T1D patients. RESULTS: Of the total of 377 target miRNAs evaluated in the serum of T1D patients, 21 miRNAs were overexpressed in the group with complications. Of the 5 miRNAs for which validation was performed in 47 patients, two were confirmed as overexpressed in the group with complications (hsa-miR-518d-3p and hsa-miR-618). The polymorphism rs11085721 in the gene encoding DNMT1 was associated with the presence of CAN in female patients, with the minor allele C being considered of risk and conferring an odds ratio (95% confidence interval) of 2.44 (1.26 - 5.28). Polymorphisms in the gene encoding Sirtuin-1 did not associate with microvascular complications. CONCLUSION: the serum miRNA profile differs between patients with and without microvascular complications. A variant in a gene encoding a enzyme of an epigenetic pathway conferring susceptibility to a chronic complication suggests that there is also the \"genetics of epigenetics\" modulating the development of complications

O presente texto descreve métodos e apresenta resultados do projeto de pesquisa de mestrado intitulado \"Dois Problemas em Análise de Formas de Estruturas de Ramificação\". Ambos os problemas abordados estão relacionados às sub-áreas da Análise de Formas denominadas Caracterização e Descrição de Formas. O primeiro problema consiste na investigação de um conjunto de características propostas para distingüir, primeiramente, entre estruturas de ramificação de vasos sangüíneos em imagens de retina segmentadas manualmente e automaticamente. A seguir, as mesmas características são aplicadas para discernir entre estruturas de ramificação de vasos sangüíneos em imagens de retina com e sem retinopatia diabética proliferativa (Proliferative Diabetic Retinopathy - PDR). A PDR é uma das patologias associadas à diabetes, que pode culminar na cegueira do indivíduo. Diagnósticos são possíveis por meio de imagens de fundo de olho e, quando efetuados precocemente, viabilizam intervenções oportunas evitando a perda da visão. Neste trabalho, 27 imagens digitais de fundo de olho foram segmentadas por dois processos distintos, isto é, segmentação manual por um especialista e a segmentação automática, mediante a transformada contínua Wavelet - CWT e classificadores estatísticos. Visando à caracterização destas formas, um conjunto de 08 características foi proposto. Este conjunto foi formado por três grupos, a saber: descritores tradicionais geométricos (Área, Perímetro e Circularidade), descritores associados à transformada wavelet ( 2o momento estatístico da distribuição de módulos da CWT, Entropia de Orientação da distribuição de fases da CWT e Curvatura) e um descritor fractal (Dimensão de Correlação - Global e Mediana). Uma Análise Discriminante Linear LDA revelou que as características geométricas tradicionais não detectam o início da retinopatia diabética proliferativa. A maior capacidade discriminante individual foi exibida pela Curvatura, com Área sob a curva ROC de 0.76. Um subconjunto com 6 características apresentou grande capacidade discriminante com Área sob a curva ROC de 0.90. O segundo problema diz respeito à extração de contorno de estruturas de ramificação bidimensionais de neurônios tridimensionais. Este trabalho contribui originalmente com uma solução para este problema, propondo dois algoritmos desenvolvidos para Rastreamento de Ramos e Extração do Contorno Paramétrico de estruturas de ramificação, capazes de transpor regiões críticas formadas por cruzamentos ocasionados pela projeção de estruturas 3D no plano das imagens 2D. Grande parte dos métodos baseados em contorno para análise de formas de estruturas de ramificação de células neuronais não produz representações corretas destas formas, devido à presença de sobreposições entre processos neuronais, levando os algoritmos tradicionais de extração de contorno a ignorar as regiões mais internas destas estruturas, gerando representações incompletas. O sistema proposto neste trabalho foi desenvolvido objetivando a solução do problema de extração de contorno, mesmo na presença de múltiplas sobreposições. Inicialmente, a imagem de entrada é pré-processada, gerando um esqueleto 8-conexo com ramos de um pixel de largura, um conjunto de sementes de sub-árvores dendríticas e um conjunto de regiões críticas (bifurcações e cruzamentos). Para cada sub-árvore, o algoritmo de rastreamento rotula todos os pixels válidos de um ramo, até chegar em uma região crítica, onde o algoritmo decide a direção em que deve continuar o rastreamento. Nosso algoritmo mostrou-se robusto, mesmo quando aplicado a imagens com segmentos paralelos muito próximos. Resultados obtidos com imagens reais (neurônios) são apresentados. / This document describes methods and presents results from the Master of Science\'s research project in computer science entitled \"Two Problems in Shape Analysis of Branching Structures\". Both tackled problems herein are related to Shape Analysis sub-fields, namely Characterization and Description of shapes. The former problem consists of an investigation on a proposed set of features aimed at discriminating, firstly, between blood vessels branching structures manually and automatically segmented. In the sequel, the same features are used to assess their discriminative capability in distinguishing between blood vessels branching structures with and withoud proliferative diabetic retinopathy (PDR). The PDR is a pathology related to diabetes, which may lead to the blindness. Diagnosis is possible through optic fundus image analysis, which may allow timely interventions preventing vision loss. In this work, 27 digital optic fundus images were segmented by two distinct segmentation processes, i.e. manual segmentation carried out by an especialist and automated segmentation, through the CWT (Continuous Wavelet Transform) and statistical classifiers. In order to characterize such a shapes, a set of 8 features has been proposed. The aforementioned set was comprised of three features groups, that is: traditional geometric descriptors (Area, Perimeter and Circularity), wavelet-based descriptors (2nd statistical moment from the CWT Modulus distribution, Orientation Entropy from the CWT Phase distribution and Curvature) and a fractal descriptor (Correlation Dimension - global and median). Linear Discriminant Analysis LDA revelead that the traditional geometric features are not able to detect early proliferative diabetic retinopathy. The largest singular discriminant capability was shown by the Curvature, with area under the ROC curve of 0.76. A subset of 6 features presented a good discriminating power with area under the curve of 0.90. The second problem concerns contour extraction from 2D branching structures of 3D neurons. This work contributes with an original solution for such a problem, proposing two algorithms devised for Branches Tracking and Branching Structures Contour Extraction. The proposed algorithms are able to traverse critical regions implied by the projection of 3D structures onto a 2D image plane. Most of contour-based methods intended to shape analysis of neuronal branching structures fall short of yielding proper shape representations, owing to the presence of overlapings among neuronal processes, causing the traditional algorithms for contour following to ignore the innermost regions, thus generating incomplete representations. The proposed framework system was developed aiming at the solution of the contour extraction problem, even in the presence of multiple overlapings. The input image is pre-processed, so as to obtain an 8-connected skeleton with one-pixel wide branches, a set of seeds of dendritic sub-trees and a set of critical regions (bifurcations, crossings and superpositions). For each sub-tree, the Branches Tracking Algorithm labels all valid pixels of a branch, until reaching a critical region, where the algorithm decides about the direction to go on with the tracking. Our algorithm has shown robustness, even in images plenty of very close parallel segments. Results with real images (neurons) are presented.

En los ultimos años el número de casos de ceguera se ha reducido significativamente. A pesar de este hecho, la Organización Mundial de la Salud estima que un 80% de los casos de pérdida de visión (285 millones en 2010) pueden ser evitados si se diagnostican en sus estadios más tempranos y son tratados de forma efectiva. Para cumplir esta propuesta se pretende que los servicios de atención primaria incluyan un seguimiento oftalmológico de sus pacientes así como fomentar campañas de cribado en centros proclives a reunir personas de alto riesgo. Sin embargo, estas soluciones exigen una alta carga de trabajo de personal experto entrenado en el análisis de los patrones anómalos propios de cada enfermedad. Por lo tanto, el desarrollo de algoritmos para la creación de sistemas de cribado automáticos juga un papel vital en este campo. La presente tesis persigue la identificacion automática del daño retiniano provocado por dos de las patologías más comunes en la sociedad actual: la retinopatía diabética (RD) y la degenaración macular asociada a la edad (DMAE). Concretamente, el objetivo final de este trabajo es el desarrollo de métodos novedosos basados en la extracción de características de la imagen de fondo de ojo y clasificación para discernir entre tejido sano y patológico. Además, en este documento se proponen algoritmos de pre-procesado con el objetivo de normalizar la alta variabilidad existente en las bases de datos publicas de imagen de fondo de ojo y eliminar la contribución de ciertas estructuras retinianas que afectan negativamente en la detección del daño retiniano. A diferencia de la mayoría de los trabajos existentes en el estado del arte sobre detección de patologías en imagen de fondo de ojo, los métodos propuestos a lo largo de este manuscrito evitan la necesidad de segmentación de las lesiones o la generación de un mapa de candidatos antes de la fase de clasificación. En este trabajo, Local binary patterns, perfiles granulométricos y la dimensión fractal se aplican de manera local para extraer información de textura, morfología y tortuosidad de la imagen de fondo de ojo. Posteriormente, esta información se combina de diversos modos formando vectores de características con los que se entrenan avanzados métodos de clasificación formulados para discriminar de manera óptima entre exudados, microaneurismas, hemorragias y tejido sano. Mediante diversos experimentos, se valida la habilidad del sistema propuesto para identificar los signos más comunes de la RD y DMAE. Para ello se emplean bases de datos públicas con un alto grado de variabilidad sin exlcuir ninguna imagen. Además, la presente tesis también cubre aspectos básicos del paradigma de deep learning. Concretamente, se presenta un novedoso método basado en redes neuronales convolucionales (CNNs). La técnica de transferencia de conocimiento se aplica mediante el fine-tuning de las arquitecturas de CNNs más importantes en el estado del arte. La detección y localización de exudados mediante redes neuronales se lleva a cabo en los dos últimos experimentos de esta tesis doctoral. Cabe destacar que los resultados obtenidos mediante la extracción de características "manual" y posterior clasificación se comparan de forma objetiva con las predicciones obtenidas por el mejor modelo basado en CNNs. Los prometedores resultados obtenidos en esta tesis y el bajo coste y portabilidad de las cámaras de adquisión de imagen de retina podrían facilitar la incorporación de los algoritmos desarrollados en este trabajo en un sistema de cribado automático que ayude a los especialistas en la detección de patrones anomálos característicos de las dos enfermedades bajo estudio: RD y DMAE. / In last years, the number of blindness cases has been significantly reduced. Despite this promising news, the World Health Organisation estimates that 80% of visual impairment (285 million cases in 2010) could be avoided if diagnosed and treated early. To accomplish this purpose, eye care services need to be established in primary health and screening campaigns should be a common task in centres with people at risk. However, these solutions entail a high workload for trained experts in the analysis of the anomalous patterns of each eye disease. Therefore, the development of algorithms for automatic screening system plays a vital role in this field. This thesis focuses on the automatic identification of the retinal damage provoked by two of the most common pathologies in the current society: diabetic retinopathy (DR) and age-related macular degeneration (AMD). Specifically, the final goal of this work is to develop novel methods, based on fundus image description and classification, to characterise the healthy and abnormal tissue in the retina background. In addition, pre-processing algorithms are proposed with the aim of normalising the high variability of fundus images and removing the contribution of some retinal structures that could hinder in the retinal damage detection. In contrast to the most of the state-of-the-art works in damage detection using fundus images, the methods proposed throughout this manuscript avoid the necessity of lesion segmentation or the candidate map generation before the classification stage. Local binary patterns, granulometric profiles and fractal dimension are locally computed to extract texture, morphological and roughness information from retinal images. Different combinations of this information feed advanced classification algorithms formulated to optimally discriminate exudates, microaneurysms, haemorrhages and healthy tissues. Through several experiments, the ability of the proposed system to identify DR and AMD signs is validated using different public databases with a large degree of variability and without image exclusion. Moreover, this thesis covers the basics of the deep learning paradigm. In particular, a novel approach based on convolutional neural networks is explored. The transfer learning technique is applied to fine-tune the most important state-of-the-art CNN architectures. Exudate detection and localisation tasks using neural networks are carried out in the last two experiments of this thesis. An objective comparison between the hand-crafted feature extraction and classification process and the prediction models based on CNNs is established. The promising results of this PhD thesis and the affordable cost and portability of retinal cameras could facilitate the further incorporation of the developed algorithms in a computer-aided diagnosis (CAD) system to help specialists in the accurate detection of anomalous patterns characteristic of the two diseases under study: DR and AMD. / En els últims anys el nombre de casos de ceguera s'ha reduït significativament. A pesar d'este fet, l'Organització Mundial de la Salut estima que un 80% dels casos de pèrdua de visió (285 milions en 2010) poden ser evitats si es diagnostiquen en els seus estadis més primerencs i són tractats de forma efectiva. Per a complir esta proposta es pretén que els servicis d'atenció primària incloguen un seguiment oftalmològic dels seus pacients així com fomentar campanyes de garbellament en centres regentats per persones d'alt risc. No obstant això, estes solucions exigixen una alta càrrega de treball de personal expert entrenat en l'anàlisi dels patrons anòmals propis de cada malaltia. Per tant, el desenrotllament d'algoritmes per a la creació de sistemes de garbellament automàtics juga un paper vital en este camp. La present tesi perseguix la identificació automàtica del dany retiniano provocat per dos de les patologies més comunes en la societat actual: la retinopatia diabètica (RD) i la degenaración macular associada a l'edat (DMAE) . Concretament, l'objectiu final d'este treball és el desenrotllament de mètodes novedodos basats en l'extracció de característiques de la imatge de fons d'ull i classificació per a discernir entre teixit sa i patològic. A més, en este document es proposen algoritmes de pre- processat amb l'objectiu de normalitzar l'alta variabilitat existent en les bases de dades publiques d'imatge de fons d'ull i eliminar la contribució de certes estructures retinianas que afecten negativament en la detecció del dany retiniano. A diferència de la majoria dels treballs existents en l'estat de l'art sobre detecció de patologies en imatge de fons d'ull, els mètodes proposats al llarg d'este manuscrit eviten la necessitat de segmentació de les lesions o la generació d'un mapa de candidats abans de la fase de classificació. En este treball, Local binary patterns, perfils granulometrics i la dimensió fractal s'apliquen de manera local per a extraure informació de textura, morfologia i tortuositat de la imatge de fons d'ull. Posteriorment, esta informació es combina de diversos modes formant vectors de característiques amb els que s'entrenen avançats mètodes de classificació formulats per a discriminar de manera òptima entre exsudats, microaneurismes, hemorràgies i teixit sa. Per mitjà de diversos experiments, es valida l'habilitat del sistema proposat per a identificar els signes més comuns de la RD i DMAE. Per a això s'empren bases de dades públiques amb un alt grau de variabilitat sense exlcuir cap imatge. A més, la present tesi també cobrix aspectes bàsics del paradigma de deep learning. Concretament, es presenta un nou mètode basat en xarxes neuronals convolucionales (CNNs) . La tècnica de transferencia de coneixement s'aplica per mitjà del fine-tuning de les arquitectures de CNNs més importants en l'estat de l'art. La detecció i localització d'exudats per mitjà de xarxes neuronals es du a terme en els dos últims experiments d'esta tesi doctoral. Cal destacar que els resultats obtinguts per mitjà de l'extracció de característiques "manual" i posterior classificació es comparen de forma objectiva amb les prediccions obtingudes pel millor model basat en CNNs. Els prometedors resultats obtinguts en esta tesi i el baix cost i portabilitat de les cambres d'adquisión d'imatge de retina podrien facilitar la incorporació dels algoritmes desenrotllats en este treball en un sistema de garbellament automàtic que ajude als especialistes en la detecció de patrons anomálos característics de les dos malalties baix estudi: RD i DMAE. / Colomer Granero, A. (2018). Fundus image analysis for automatic screening of ophthalmic pathologies [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/99745 / TESIS

Les accouchements prématurés restent un défi pour la médecine moderne. Malgré les efforts de préventions déployés, les taux de naissances prématurés sont en constante augmentation dans les pays industrialisés. Le récepteur interleukine-1 (IL-1R) a été étudié dans le but de développer des agents thérapeutiques pouvant prolonger la gestation et mener à des prognostiques néonataux. Dans cette optique, il y a été démontré que le peptide 101.10 possède a démontré une capacité à moduler le récepteur IL-1R, retarder les accouchements prématurés et réduire l’incidence de la rétinopathie prématurée par un mécanisme allostérique impliquant une signalisation biaisée. Dans le but d’étudier la conformation active du peptide 101.10 et d’en améliorer l’activité, nous avons développé une méthode pour introduire des α-amino γ-lactames β-substituées dans des séquences peptidiques. Appliquer cette stratégie au peptide 101.10 a permis d’améliorer la compréhension de la relation structure-activité pour la modulation allostérique du récepteur IL-1R. Les composés peptidomimétiques ont le potentiel de mimer la conformation et l’activité des peptides bioactifs. Ils offrent le potentiel d’améliorer la reconnaissance moléculaire, d’optimiser le transport à travers des différentes membranes biologiques et d’augmenter la résistance métabolique. Parmi les différentes classes de composés peptidomimétiques, les α-amino γ-lactames (Agl) permet de rigidifier par des liens covalents la chaine peptidique principale favorisant les structures secondaires de type tour β. Les analogues Agl β-substituées mimer et rigidifier la chaine latérale des acides aminés. Cette thèse introduit des méthodes efficaces pour la synthèse stéréocontrolée des résidus α-amino γ-lactames β-substituées possédant diverses fonctionnalités. L’introduction de ces résidus dans différents peptides bioactifs a été effectuée pour étudier leur relation structure-activité. En utilisant le peptide modulateur du récepteur IL-1R 101.10 comme peptide représentatif, la présente recherche a permis d’identifier de nouveaux agents tocolytiques qui peuvent prolonger la gestation et améliorer le pronostique néonatal. Dans le chapitre 2, des stéréo-isomères de (Agl) et β-hydroxy-α-amino-γ-lactam (Hgl) ont été utilisés pour étudier l’influence de la configuration du groupement hydroxyle sur la conformation et l’activité du peptide 101.10. L’orientation de ce groupement dans les peptides Agl et Hgl s’est avéré avoir une influence conformationnelle et sur l’activité. La spectroscopie par dichroïsme circulaire (CD) a illustré la propension de certains analogues, comme le [(3R,4S)-Hgl3]-101.10, à adopter des tours β. Les analogues Agl et Hgl ont été examinés dans une série d’essais in vitro et in vivo modélisant les accouchements prématurés. Dépendant de leur structure et configuration, les analogues lactames ont démontré une sélectivité fonctionnelle différente dans diverse processus biologiques, démontrant les particularités de divers phénotypes. Par exemple, l’inhibition des JNK et ROCK kinases s’est avérée importante respectivement dans leurs effets tocolytiques et dans la diminution de la vaso-oblitération. Notamment, parmi les douze analogues testés, [(3R,4S)-Hgl3]-101.10 s’est avéré démontrer la même activité in vitro et in vitro que le peptide parent. Dans le chapitre 3, des méthodes de déplacement du groupement hydroxyle des résidus Hgl ont permis l’introduction stéréosélective de substituent en position β des résidus Agl. Une combinaison de réaction de Mitsunobu sur les résidus trans Hgl et une ouverture nucléophile les sulfamidates cycliques dérivés des lactames cis, ont mené à l’obtention de mime rigidifiés de résidus Ser, Thr, Cys, Dap, Dab, His et Met. Dans le chapitre 4, différentes lactames β-substitués ont été introduits dans la séquence du peptide 101.10 par une combinaison de chimie en solution et sur support solide pour étudier d’avantage les éléments structurels nécessaire pour réguler l’activité et la signalisation de cette cytokine clef dans la médiation de l’inflammation. Considérant l’activité de l’analogue [(3R,4S)-Hgl3]-101.10, plusieurs analogues β-substitués possédant une orientation similaire pour la chaine principale et latérale ont été synthétisés. Certains analogues ont démontré une activité biologique prometteuse dans des modèles de rétinopathie et seront étudiés dans le futur. En conclusion, des méthodes de synthèse d’α-amino-γ-lactames et de leur contrepartie β-substitués et leur introduction dans des peptides d’intérêt pour étudier leur relation structure-activité ont été développés. En utilisant ces méthodologies sur le modulateur allostérique du récepteur IL-1R 101.10, le conformère actif in vivo responsable de l’activité tocolytique et protectrice contre la rétinopathie associée aux accouchements prématures ont été identifiés. Considérant l’utilité de la synthèse de lactames pour le développement d’agents susceptibles de prolonger la gestation et d’améliorer le prognostique associé aux accouchements prématurés, cette thèse a permis la conception de prototypes de médicaments pour traiter les accouchements prématurés ainsi que l’évaluation des contraintes structurelles pertinentes pour la biologie des peptides. / Preterm birth (PTB) is an unmet biomedical need. Despite efforts to counter the onset of preterm labor, the rate of premature birth has increased steadily in developed countries. The interleukin-1 receptor (IL-1R) has been pursued as a target for designing agents which can prolong labor and improve neonatal outcomes. Towards these goals, a lead peptide 101.10 had been shown to modulate the IL-1R, to delay PTB and to mitigate associated retinopathy of prematurity (ROP) by an allosteric mechanism featuring biased signaling. With the goals of understanding the active conformers and improving the activity of 101.10, methods were conceived for the synthesis and introduction of β-substituted α-amino γ-lactams into peptides. Applying such methods on 101.10 has provided insight into the structure-activity relationships required for allosteric modulation of the IL-1R. Peptidomimetics are promising structures that replicate peptide function and conformation. They offer the potential to improve molecular-recognition, to enhance transport across biological membranes, and to resist metabolism. Among peptidomimetic classes, α-amino γ-lactam (Agl) residues introduce covalent constraint to rigidify the peptide backbone and have been employed to favor turn secondary structures. β-Substituted Agl analogs offer additional potential to mimic and restrict peptide side-chain geometry. This thesis introduces effective methods for the stereo-controlled synthesis of β-substituted α-amino γ-lactams residues having various side chain functionality. Introduction of the parent Agl residue and β-substituted counterparts into biologically active peptides has been explored to study structure-activity relationships. Employing the IL-1R modulator 101.10 as a representative peptide, the described research has furnished novel labor delaying agents that can improve neonatal outcomes. In chapter 2, α-amino-γ-lactam (Agl) and β-hydroxy-α-amino-γ-lactam (Hgl) stereoisomers were employed to study the influence of configuration and hydroxyl group side chain on conformation and activity of the interleukin-1 receptor modulator peptide 101.10. The configuration and hydroxyl group side chain influenced the conformation and biological activity of Agl and Hgl-101.10 analogs. Circular dichroism (CD) spectroscopy illustrated β-turn conformers for specific analogs, such as [(3R,4S)-Hgl3]-101.10. The Agl and Hgl analogs were examined in a series of in vitro assays and in vivo models of PTB. Contingent on their structure vi and configuration, the lactam analogs exhibited different functional selectivity in the various biological pathways, and indicated the requirement for specific phenotypes. For example, inhibition of the JNK and ROCK kinase pathways were respectively shown to be important for delaying labor and diminishing vaso-obliteration in the PTB and ROP models. Notably, among the twelve analogs, [(3R,4S)-Hgl3]-101.10 was found to exhibit identical in vitro and in vivo activity as the parent peptide. In chapter 3, methods were developed for displacement of the β-hydroxy-α-amino-γ-lactam (Hgl) residue alcohol to introduce stereo-selectively different β-substituents on Agl residues. A combination of Mitsunobu chemistry on the trans Hgl residue, and nucleophilic ring opening of the cyclic sulfamidate derived from the cis lactam counterpart provided constrained mimics of Ser, Thr, Cys, Dap, Dab, His and Met residues. In chapter 4, various β-substituted lactams were introduced into the sequence of 101.10 by combination of solution and solid phases chemistry to further study the structural requirements for regulating the activity and signaling of this key cytokine mediator of inflammasome activation. Considering the activity of [(3R,4S)-Hgl3]-101.10, the β-substituted Agl analogs were synthesized possessing similar backbone and side chain configurations. Certain analogs exhibited promising biological activity in the ROP model meriting further study. In sum, methods were conceived for the synthesis and application of α-amino-γ-lactams and their β-substituted analogs to study peptide structure-activity relationships. Employing this chemistry on the IL-1R allosteric modulator 101.10 has identified the active conformer and in vitro activity responsible for ability to delay labor and mitigate retinopathy of prematurity. Considering the utility of the lactam synthesis methods for the development of improved agents for delaying labor and improving neonatal outcomes, this thesis has conceived useful prototypes for drugs to treat PTB, as well as useful methods for dissecting the structural requirements for peptide chemical biology.