Orientadores: Margareth Castro Ozelo, Joyce Maria Annichino Bizzacchi / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T06:42:30Z (GMT). No. of bitstreams: 1 Silva_JanainaBossoJoseda_M.pdf: 4876420 bytes, checksum: 5b610c8a9244d994e2a21f8261d30ef2 (MD5) Previous issue date: 2006 / Resumo: A iontoforese é uma técnica de transferência de drogas mediadas por um fluxo elétrico. Os benefícios terapêuticos da introdução de medicamentos pela iontoforese incluem a diminuição de efeitos colaterais sistêmicos aos quais o paciente apresenta intolerância e a ação localizada do medicamento podendo este estar em maior concentração na área alvo, onde sua ação é mais efetiva e prolongada. No caso da hemofilia, efeito adicional é observado, pois o paciente é poupado de um procedimento invasivo, como punção venosa ou aplicação intra-articular, que depende da reposição dos concentrados de fator. O emprego da iontoforese corrobora a idéia de intervenção direta nos quadros agudos de hemartrose e na sinovite crônica, de maneira não invasiva. Primeiramente, elaboramos um protocolo em conjunto com o Departamento de Medicina Nuclear do Hospital das Clínicas da Unicamp com o objetivo de comprovarmos, através de experimentos cintilográficos em humanos o transporte transdérmico dinâmico pela iontoforese. Uma vez comprovado o mecanismo iontoforético, avaliamos através de modelo experimental suíno o comportamento dos fármacos com potencial uso na hemofilia, seja nos episódios agudos de hemartrose (ácido e-aminocapróico - EACA) ou tratamento da sinovite crônica (ácido hialurônico e cloridrato de oxitetraciclina). O uso de fármacos com poder hemostático durante os episódios agudos de hemartrose, além do tratamento da sinovite crônica, permitem a longo e curto prazo uma recuperação mais rápida da articulação, além de otimizar o consumo final de hemoderivados ou qualquer outra forma de reposição de fator. Neste protocolo suíno foi possível confirmar que o ácido e-aminocapróico e o cloridrato de oxitetraciclina são drogas que efetivamente poderiam ser utllizadas em protocolos iontoforéticos. A determinação da concentração do ácido hialurônico neste experimento foi prejudicada por se tratar de um complexo polissacarídeo. Assim, acreditamos que estudos complementares utilizando outras técnicas mais sensíveis de quantificação de fármacos devem ser realizadas com este intuito no futuro. A avaliação do efeito da aplicação iontoforética do EACA, ácido hialurônico e cloridrato de oxitetraciclina em modelo experimental murino (camundongos portadores de hemofília A), foi realizada através de avaliação histológica que avaliou a área de lesão proliferativa correspondente à articulação tratada e não tratada. Embora em nenhum dos grupos estudados os resultados entre os animais tratados e não tratados tenha evidenciado uma diferença estatisticamente significativa, foi possível notar uma tendência de melhora sempre que as medicações foram administradas através da iontoforese. Desta forma, o princípio da aplicação assim como as questões práticas da terapêutica iontoforética foram reconhecidas como uma possível via de administração em condições clínicas apresentadas pelos pacientes hemofílicos. Novos estudos precisam ser realizados a fim de que sejam observados o comportamento farmacológico e as doses terapêuticas ideais das drogas utilizadas para o uso através de iontoforese / Abstract: Iontophoresis is technique of transferring drugs by an electric flow. The therapeutic benefits of introducing drugs by iontophoresis include lowering of systematic side effects and the local action of medication with a larger concentration into the damage area, where its action is more effective and prolonged. Besides that, the hemophilic patients are avoided to get venous puncture or an injection into their joint. The use of iontophoresis takes the idea of direct intervention in acute hemarthroses and chronic synovitis in one non aggressive way. First of all we created a protocol in association with Nuclear Medicine Department of the Clinical Hospital of UNICAMP and we standardize cintilographic experiments in humans to evaluate the transdermal dynamics delivered by iontophoresis, confirming iontophoretics mechanism. Once it proved the iontophoretic mechanism, we evaluate in a swine experimental model the behavior of drugs with potential use in hemophilia (e-aminocaproic acid during the acute episodes of hemarthroses; hyaluronic acid and oxitetracycline clorhydrate to treat chronic cases) by electrospray ionization mass spectrometry. The use of haemostatic drugs during the acute treatment of hemarthroses, besides the treatment of chronic synovitis, allows in long and short period of time, once recover faster of the joints also reduce the final consumption of replacement products. In swine protocol, we observed that e-aminocaproic acid and oxitetracycline clorhydrate are drugs which may actually cause and be used in iontophoretics¿s protocols. However new complementary studies are necessary to make possible the use of hyaluronic acid, once it¿s a large polissacaride. We believe that others studies using different methods more sensitive of drug quantifications should be used with this purpose of accomplishment in the future. The evaluation of the iontoforetic application¿s effect of these drugs in murino¿s experimental models (knockout mice with hemophilia A) was performed by the histologic analysis, showing that in both groups (EACA and OTC) iontophoretic treatment resulted in a lower average of damage when comparing the treated limb and the one not treated. / Mestrado / Clinica Medica / Mestre em Clinica Medica

Background: Obesity is a disease that is caused by genetic and environmental factors. However, epigenetic mechanisms of obesity are less well known. DNA methylation provides a mechanism whereby environmental factors can influence gene transcription. The aim of our study was to investigate skeletal muscle DNA methylation of sorbin and SH3 domain containing 3 (SORBS3) with weight loss induced by Roux-en-Y gastric bypass (RYGB). Results: Previously, we had shown increased methylation (5.0 to 24.4%) and decreased gene expression (fold change -1.9) of SORBS3 with obesity (BMI > 30 kg/m(2)) compared to lean controls. In the present study, basal muscle biopsies were obtained from seven morbidly obese (BMI > 40 kg/m(2)) female subjects pre-and3months post-RYGB surgery, in combination with euglycemic-hyperinsulinemic clamps to assess insulin sensitivity. We identified 30 significantly altered promoter and untranslated region methylation sites in SORBS3 using reduced representation bisulfite sequencing (RRBS). Twenty-nine of these sites were decreased (-5.6 to -24.2%) post-RYGB compared to pre-RYGB. We confirmed the methylation in 2 (Chr. 8: 22,423,690 and Chr. 8: 22,423,702) of the 29 decreased SORBS3 sites using pyrosequencing. This decreased methylation was associated with an increase in SORBS3 gene expression (fold change + 1.7) post-surgery. In addition, we demonstrated that SORBS3 promoter methylation in vitro significantly alters reporter gene expression (P < 0. 0001). Two of the SORBS3 methylation sites (Chr. 8: 22,423,111 and Chr. 8: 22,423,205) were strongly correlated with fasting plasma glucose levels (r = 0.9, P = 0.00009 and r = 0.8, P = 0.0010). Changes in SORBS3 gene expression post-surgery were correlated with obesity measures and fasting insulin levels (r = 0.5 to 0.8; P < 0.05). Conclusions: These results demonstrate that SORBS3 methylation and gene expression are altered in obesity and restored to normal levels through weight loss induced by RYGB surgery.

Aujourd’hui encore, le diagnostic des maladies génétiques et la compréhension des mécanismes pathologiques qui en découlent demeurent difficile. On dénombre à ce jour plus de deux cents formes de myopathies, en majorité d’origine génétique, mais dont les gènes ne sont pas toujours identifiés. Dans le cas où le gène causal est connu, il peut subsister des problèmes diagnostics. L'absence d’information génétique peut alors nuire à la prise en charge des malades ainsi qu’au développement d’outils thérapeutiques. Ma thèse a été conduite dans le but d’améliorer ces éléments : j’ai mis en évidence l’implication d’un nouveau gène dans la dystrophie facio-scapulo-humérale ; optimisé le diagnostic des calpaïnopathies en étudiant l’impact de mutations faux-sens sur l’épissage du gène responsable et analysé les interactions protéiques et ioniques mises en place lors de phénomènes d’entrée calcique. Enfin, j’ai participé au développement d’outils thérapeutiques dans le cadre des dysferlinopathies. / Nowadays, diagnosis and pathomechanisms of genetic disorders remain difficult to explore. There are actually more than 200 forms of myopathies, mostly genetics, even if the culprit gene is not always identified. However, even when the causative gene is known, it often remains diagnostic issues because of clinical and genetic heterogeneity and wide mutational spectrum. The lack of genetic information affects patients cares and impairs the development of new therapeutic tools. My thesis was conducted in order to extend these elements: I have shown that a new gene may be involved in facio-scapulo-humeral dystrophy; I have improved calpainopathie’s diagnosis by studying the impact of missense mutations on RNA splicing; I have also analyzed how proteins contributed to calcium entry in the cell. Finally, I contributed with a new therapeutic tools for dysferlinopathies.

Background: Patients with heart failure (HF) are characterized by exercise intolerance, breathlessness, fatigue and excessive neurohormonal activation associated with premature mortality. Recently, inflammatory activation has been described as an important factor in the progression of HF. Increased levels of certain pro-inflammatory cytokines (e.g., TNF-ɑ, IL-6) have been related to increased severity of left ventricular dysfunction, the activation of the sympathetic and renin-angiotensin systems and the catabolism of skeletal muscle. Although exercise training is important in the management of HF, acute bouts of exercise may lead to increases in proinflammatory cytokines. It is believed that the skeletal muscle abnormalities associated with HF may increase the risk of damage to skeletal muscle, (i.e., exercise-induced muscle injury (EIMI) with associated inflammatory activation) especially following unaccustomed exercise training. Recently, several training methods have been proposed for patients with HF that challenge the traditional “steady-state” (SS) training model, including interval training (IT). Interval training methods employ greater muscular loading than SS and therefore may increase the risk of inflammatory system activation EIMI, and/or reduced muscle function. There is no study that has examined the effects of IT on EIMI, muscle function and/or inflammatory markers. Material and Methods: Fourteen male participants with HF (mean age: 59 +/- 7.8 yrs; mean VO2 peak: 13.64 +/- 4.5 ml/kg/m-1; EF < 45%) were matched (for body mass and aerobic fitness) and randomized into SS or IT for 20 minutes. The IT involved 2 minute work:recovery phases of 90% and 40% of heart rate reserve, respectively. The SS involved continuous exercise at 65% of heart rate reserve. Biochemical markers of muscle damage and acute inflammation, concentric and eccentric isokinetic muscle torque, and subjective indicators of delayed onset muscle soreness (DOMS) and lower extremity function were evaluated at baseline, and then immediately following the training bout, and at 6, 24, and 48 hours post. Results: There were no significant differences between the IT and the SS training group for markers of skeletal muscle injury or inflammatory activation. Conclusions: The findings from the present study suggest that IT or SS do not result in excessive inflammatory system activation or skeletal muscle injury. These results have important implications for clinicians prescribing exercise regimes for HF patients who may be starting back into activity after a prolonged sedentary period. Additionally, results from this study indicate that there is a need for future research looking at the actual and perceived effect of even a single about of exercise on lower extremity function. / Education, Faculty of / Kinesiology, School of / Graduate

The inhibitor of apoptosis (IAP) proteins traditionally regulate programmed cell death by binding to and inhibiting caspases. Recent studies have uncovered a variety of alternate cellular roles for several IAP family members. The cellular inhibitor of apoptosis 1 (cIAP1) protein, for instance, regulates different axes of the NF-κB signalling pathway. Given the extensive functions of NF-κB signalling in muscle differentiation and regeneration, I asked if cIAP1 also plays critical roles in skeletal muscle myogenesis. In a primary myoblast cell-culture system, genetic and pharmacological approaches revealed that loss of cIAP1 dramatically increases the fusion of myoblasts into myotubes. NF-κB signalling occurs along a classical and an alternative pathway, both of which are highly active in cIAP1-/- myoblasts. Suppression of the alternative pathway attenuates myotube fusion in wildtype and cIAP1-/- myoblasts. Conversely, constitutive activation of the alternative pathway increases myoblast fusion in wildtype myoblasts. cIAP1-/- mice have greater muscle weight and size than wildtypes, as well as an increased number of muscle stem cells. These results identify cIAP1 as a regulator of myogenesis through its modulation of classical and alternative NF-κB signalling pathways. Loss of the structural protein dystrophin in the mdx mouse model of Duchenne muscular dystrophy leads to chronic degeneration of skeletal muscle. The muscle pathology is strongly influenced by NF-κB signaling. Given the roles demonstrated for cIAP1 in cell culture and in vivo, I asked whether loss of cIAP1 would influence muscle pathology in the mdx mouse. To address this question, double-mutant mice were bred lacking both cIAP1 and dystrophin (cIAP1-/-;mdx). Histological analyses revealed that double-mutant mice exhibited reduced indications of damage on several measures, as compared to single-mutant (cIAP1+/+;mdx) controls. Unexpectedly, these reductions were seen in the “slow-twitch” soleus muscle but not in the “fast-twitch” extensor digitorum longus (EDL) muscle. The improvements in pathology of double-mutant solei were associated with reductions in muscle infiltration by CD68-expressing macrophages. Finally, the double-mutant mice exhibited improved endurance and resistance to damage during treadmill-running exercise. Taken together, these results suggest that loss of cIAP1, through its multiple regulatory functions, acts to improve myogenesis and increase muscle resistance to damage.

Pax3 and Pax7 belong to a family of conserved transcription factors that play important and diverse roles in development. In the embryo, they carry out similar roles in neural and somite development, but Pax7 fails to compensate for critical functions of Pax3 in the development of limb musculature. Conversely, in the adult, Pax7 is necessary for the maintenance and survival of muscle satellite cells, whereas Pax3 cannot effectively fulfill these roles in the absence of Pax7. To identify the unique roles of Pax7 in adult muscle cells, we have analyzed global binding of Pax3 and Pax7 by ChIP-Seq. Here, we show that despite highly homologous DNA-binding domains, the majority of binding sites are uniquely recognized by Pax7 and are enriched for homeobox motifs. Genes proximal to conserved, unique Pax7 binding sites cluster into specific functional groups which may reflect the unique biological roles of Pax7. Combining Pax7 binding sites with gene expression data, we describe the regulatory networks directed by Pax7 and show that Pax7 binding is associated with positive gene regulation. Moreover, we show Myf5 is a direct target of Pax7 and identify a novel binding site in the satellite cell control region upstream of Myf5.

C/EBPβ is a bZIP transcription factor known to be involved in various physiological processes, including adipogenesis, osteogenesis and liver development. Previous studies in this laboratory revealed an inhibition of myogenesis and reduced myogenic protein expression in 5-azacytidine treated mesenchymal stem cells retrovirally transduced to overexpress C/EBPβ. The goal of this thesis was to evaluate the role of C/EBPβ in myogenic differentiation by overexpression in C2C12 myoblasts and primary myoblasts. We demonstrate reduced MyoD protein expression and subsequent downregulation of myogenic proteins during differentiation following C/EBPβ overexpression. We localized C/EBPβ to the quiescent Pax7+ satellite cells associated with the muscle fiber. Upon satellite cell activation, we observed the downregulation of C/EBPβ protein expression prior to MyoD protein expression. Furthermore, the re-expression of C/EBPβ correlated with the loss of MyoD expression later in differentiation. Histological analysis of C/EBPβ-/- mice revealed smaller fibers and a reduced Pax7+ satellite cell population as compared to control animals. In this thesis, we propose that C/EBPβ is a negative regulator of skeletal muscle differentiation by inhibiting the expression of MyoD, thus impairing proper progression through the myogenic program. In addition, we propose a role for C/EBPβ in the maintenance of undifferentiatied satellite cells.

Skeletal muscle is one of the largest tissues in humans and provides many pivotal functions to support life. Abnormality in skeletal muscle functions can lead to disease. For example, insulin resistance in skeletal muscle leads to type II diabetes. The underlying mechanisms that control energy balance in skeletal muscle remain largely elusive, especially at the genetic level. Here in the second chapter, I showed that MyoD mediated the transcriptional regulation of ACSL5, a mitochondrial protein, in C2C12 myoblasts via two E-box elements. A SNP rs2419621 (T) created a de novo E-box that together with the two pre-existing proximal E-boxes strongly enhances ACSL5 expression in both CV1 and C2C12 cells. In the third chapter, I identified a novel VGLL4-interacting protein IRF2BP2 and verified the interaction with co-immunoprecipitation and mammalian two-hybrid assays. Functionally, overexpression of IRF2BP2 and transcription factor TEAD1 activates mouse VEGF-A promoter in CV1 cells and enhances the biosynthesis of VEGF-A in C2C12 myoblasts. In vivo studies showed that ischemia induced the expression of IRF2BP2 by more than three fold, suggesting that IRF2BP2 could play a pivotal role during tissue ischemia. IRF2BP2 is a nuclear protein in both mouse cardiac myocytes and C2C12 myoblasts as demonstrated by immunohistochemistry and immunocytochemistry, respectively. Therefore, I sought to delineate the mechanism for the nuclear shuttling of IRF2BP2 in the fourth chapter. With various DNA alternations, I mapped the NLS to an evolutionarily conserved sequence 354ARKRKPSP361 in IRF2BP2. Deletion of the positively charged amino acids resulted in the abolishment of the NLS signal. Next, I showed that phosphorylation of serine 360 (S360) mediates the nuclear import of the protein. Whereas an alanine substitution (S360A) at the site resulted in perinuclear accumulation of the protein, an aspartic acid substitution (S360D) forced the nuclear accumulation. Nevertheless, the forced accumulation of the S360D mutant did not enhance the activation of VEGF-A promoter in CV1 cells as did the wild-type protein. My studies revealed two novel mechanisms by which skeletal muscle could harvest energy, thus providing new insight into the energy metabolism in skeletal muscle

Of all of the cancer patients throughout the world, approximately 50% of them are affected to some degree by cachexia. This syndrome involves significant skeletal muscle wasting, loss of adipose tissue and overall decrease in body weight in patients, particularly those with lung, pancreatic and gastric cancers. Cancer-induced cachexia is characterized by the presence of increased cytokines, notably TNF-α, IL-1β and IL-6. Most patients suffering of cancer-induced cachexia experience increased toxicity in response to chemotherapy, leading to fewer rounds of treatment and thus impeding the patients’ chances for recovery. More research into effective treatments for cancer-induced cachexia would therefore be indispensable. The inhibitor of apoptosis proteins (IAPs) have emerged as important cancer targets, primarily because of their roles as caspase inhibitors and regulators of NF-κB signalling. Small molecule IAP antagonists known as Smac mimetic compounds (SMCs) are currently in stage I/II clinical trials. They function by targeting cIAP1 and cIAP2 (and to a lesser extent, XIAP) resulting in a cytokine mediated death response in cancer cells. SMCs induce the production of TNF-α, a cytokine with which SMCs can potently synergize. However, limited efficacy occurs in some cancer cell lines (presumably because TNF-α cannot be induced in an autocrine fashion) and an exogenous source of the cytokine, such as that induced by using an oncolytic virus, is required. Notably, TNF-α (initially known as “cachectin”) is known to play a significant role in the induction of skeletal muscle atrophy. We therefore wanted to examine the effects of TNF-α induction by SMC and oncolytic virus co-treatment on both tumour regression and skeletal muscle in tumour bearing mice. We investigated the effects of SMC treatment on Lewis Lung Carcinoma (LLC) and B16F10 melanoma cell lines, both of which have been shown to be established cachectic cancer cell lines. Our in-vitro analysis of LLC and B16F10 cells revealed that LLC cells are sensitive to SMC and TNF-α co-treatment whereas B16F10 cancer cells remain resistant. SMC treatment, in combination with an oncolytic virus, VSVΔ51, increased tumour regression and survival time in LLC tumour bearing mice. Based on findings from previous studies, we investigated the role of cellular FLICE-like inhibitory protein (c-FLIP) in the resistance of the B16F10 melanoma cell line to SMC treatment. We were able to determine that the down-regulation of c-FLIP sensitizes the B16F10 cells to SMC and TNF-α induced cell death. In extending these findings, we found that SMC treatment alone can cause skeletal muscle wasting in the tibialis anterior muscle of LLC tumour bearing mice. However, the atrophic response was observed to be minimal as documented by a slight but significant decrease (approximately 10%) in muscle fibre cross-sectional area. Moreover, no biochemical evidence of muscle atrophy, as visualized by changes in the expression of myosin heavy chain (MHC) and Muscle RING Finger protein 1 (MuRF1), was found. Regardless, we speculate that the impact of SMC treatment on muscle wasting would be transient and reversible, and propose that the benefits of such a combination immunotherapy would greatly outweigh the risks.

Hyperkalemic periodic paralysis (HEPP) is an inherited, autosomal disorder characterized by myotonia and periodic paralysis in skeletal muscle. The hallmark of the disease is a severe sensitivity to the K+-induced force depression, the cause of the paralysis. Previous studies have provided evidence that the sensitivity to the K+-induced force depression can be alleviated when the Cl- conductance (GCl) is lowered. However, those studies were carried out at non-physiological temperatures (25°-30°C) and few stimulation frequencies. The overarching goal of this study was to examine whether manipulating GCl pharmacologically was a viable target for treating HEPP. This work sought to document the interactive effect of K+ and Cl- on force development in mouse skeletal muscle at 37°C, over a wide range of stimulation frequencies. Secondly, experiments were undertaken to determine if a reduction in GCl could protect against the severe K+ sensitivity in HEPP. The results show that in wildtype muscle, a reduction in GCl improved force generation at high [K+]e at stimulation frequencies that naturally occur in vivo for mouse EDL and soleus. While the effect in wildtype muscles was proof of principle that a reduction in GCl may be a potential approach to treat HEPP patients, the effects of reduced GCl at high [K+]e was quite variable in HEPP muscles. In a few cases, lowering GCl did improve force generation at high [K+]e. However, in most cases the decrease in GCl exacerbated the force depression at high [K+]e, suggesting that more studies will be necessary to understand the variability in the Cl- effect to conclude whether a decrease in GCl is a viable approach to treat HEPP patients.