Orientador: Sebastião Roberto Taboga / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-10T18:00:13Z (GMT). No. of bitstreams: 1 Corradi_LaraSilvia_D.pdf: 6064748 bytes, checksum: 6595f8861a86f33fa6761af9a8f6b0a8 (MD5) Previous issue date: 2008 / Resumo: Os andrógenos têm papel central na biologia da próstata, mas os estrógenos também podem afetar o crescimento e a diferenciação desta glândula. Em tecidos específicos do corpo, a proporção entre andrógenos e estrógenos pode diferir significativamente daquela encontrada no plasma sanguíneo. As concentrações intracelulares desses esteróides nos tecidos alvos são reguladas pelo metabolismo local de hormônios, altamente dependente de enzimas específicas metabolizadoras de esteróides, como a 5a-redutase (5a-r) e a Aromatase (aro). Na próstata, a ação androgênica é acentuada devido à conversão de testosterona em dihidrotestosterona por ação da enzima 5a-r, enquanto que a aro é responsável pela aromatização da testosterona em estrógenos. Assim, a síntese local destes esteróides assume grande importância em doenças que acometem tecidos glandulares, como o câncer de próstata, onde níveis anormais de hormônios promovem o desenvolvimento e o aumento de ocorrência de malignidades. Desse modo, os papéis dos andrógenos e estrógenos ativados podem ainda ser melhor compreendidos na manutenção das interações homeostáticas epitélio-estromais prostáticas. Estudos com inibidores específicos destas enzimas vêm sendo desenvolvidos a fim de se tentar esclarecer os reais papéis enzimáticos na manutenção da fisiologia prostática, assim como no surgimento e desenvolvimento de doenças. De modo geral, após 30 dias consecutivos de inibição, simultânea ou não, das enzimas 5a-r e aro, respectivamente por ação da Finasterida e do Letrozol, a próstata de gerbilos jovens, adultos e velhos mostrou-se com o compartimento epitelial e o estromal alterados e reorganizados na tentativa de adaptar-se à nova condição hormonal induzida. Imediatamente após o término de administração das drogas, na fase inicial do período de pós-tratamentos, as concentrações de testosterona e estrógenos modificaram-se, as células epiteliais tiveram o padrão de atividade secretora alterada e, no estroma, a matriz extracelular ficou totalmente remodelada, além das células musculares lisas e dos fibroblastos fenotipicamente alterados. Na fase final do período de pós-tratamento, ficou evidente a tentativa da próstata em se normalizar morfologica e fisiologicamente, porém, em nenhuma das idades isso aconteceu de modo efetivo. O bloqueio da metabolização de hormônios esteróides na próstata pode ser uma ferramenta importante para o estudo da interação epitélio-estroma tanto na fisiologia normal, quanto nas doenças da próstata. Sugere-se portanto, que o desbalanço entre as concentrações de andrógenos e estrógenos provocados pela Finasterida e de Letrozol, juntos ou separados, alterou significativamente a interação epitélio-estroma. Todos os resultados obtidos parecem ser indicativos de importantes sinais do novo cenário hormonal intraprostático. A recuperação do equilíbrio entre as concentrações hormonais da próstata fica comprometida após o bloqueio enzimático, dando, portanto, às enzimas em estudo, status de crucial importância para o desenvolvimento e manutenção da próstata. O estabelecimento de modelos experimentais para o estudo das relações entre epitélio e estroma e o conhecimento dos componentes celulares e macromoleculares da próstata tornam-se instrumentos muito importantes para o entendimento do desenvolvimento, da estrutura e da fisiologia desta glândula / Abstract: Androgens have substantial role in the biology of the prostate, but estrogens also can affect the growth and differentiation of this gland. In specific tissues of the body, the ratio between androgens and estrogens can differ significantly from that found into plasma. The intracellular concentrations of these steroids in target tissues are mediated by a local hormone metabolism, by specifcs steroid-metabolizing enzymes, as the 5a-redutase (5a -r) and the aromatase (aro). In the prostate, the androgenic action is accented due to the conversion of testosterone in dihydrotestosterone by the activity of the 5a -r, while aro enzyme is an alternative pathway for the aromatization of testosterone into estrogens. These locally syntheses of steroids hormones assume thus, a great importance to the prostate cancer, where abnormal hormone levels can promote development and proliferation of malignancy to this gland. The activated functions of androgens and estrogens may be better understood focusing the maintenance of homeostatic prostatic epithelial-stromal interactions. Studies conducted with inhibitors of these specific enzymes have been carried out in an effort to clarify the real role of steroid-metabolizing enzymes in the maintenance of prostatic physiology, as well as into malignant progression prostatic cancer. After 30 consecutive days of inhibition, simultaneous or not, of the enzymes 5a -r and aro, respectively by Finasterida and Letrozol, the prostate of young, adult and old gerbils revealed that epithelial and estromal compartments were totally modified and reorganized in the attempt to adapt it to the new induced hormonal condition. Immediately after the end of drugs administration, in the early phase of the post-treatments period, the concentrations of testosterone and estrogens had been altered, the epithelial cells had their secretore activity pattern modified and, in the stromal compartment, the extracellular matrix was totally remodeled. The smooth muscle cells and fibroblasts became fenotipically modified. In the late phase of the post-treatments period, it was evident the attempt of the prostate gland in became morphologically and physiologically as a normal gland, however, this was not achieved in any analyzed gerbil. These steroids hormone metabolization blockade seems to be a good tool for the study of the epithelium-stroma interaction both in normal and abnormal prostate gland. Based on this data, it is suggested that the unbalance between androgens and estrogens intraprostatic concentrations provoked by Finasteride and Letrozol, together or not, interfered into the prostatic compartments interactions significantly. The results seem to be indicative of important signals of the new locally hormonal scene within the prostate gland. The recovery of balance hormonal concentrations of the prostate is damaged after the enzymatic blockade what gives, therefore, to this to 5a -r and aro enzymes, a status of crucial key for the normal and abnormal prostate gland. The establishment of experimental models for this kind of study and the knowledge of the cellular and macromolecular components of the prostate are also fundamental for the agreement of development, structure and physiology of prostate / Doutorado / Biologia Celular / Doutor em Biologia Celular e Estrutural

Abstract The stem cell is a primitive cell that is capable of dividing to reproduce itself and can give rise to a selection of differentiated progeny. Stem cells are thought to be involved in or even main factors in many diseases. In postnatal humans, mesenchymal tissues have the capacity to regenerate from stem cells called mesenchymal stem cells (MSC). It is currently thought that these cells will become the basis of therapy for many diseases. In the present study, a novel in vitro method was developed to examine human bone marrow derived MSC differentiation into osteoblast lineage, and to study the role of MSC in a variety of mesenchymal diseases. The ability of MSCs to differentiate into osteoblasts was investigated during aging. In addition, the interindividual variability in the osteogenesis of MSCs and in the osteoblastic response of MSC to estrogen and testosterone was studied. Furthermore, an ex vivo model using a human aortic valve microenvironment was developed to explore whether the extracellular matrix influences the osteoblastic differentiation of the MSC. Finally, the role of MSC in neurofibromatosis type 1 (NF1) related congenital pseudarthrosis of the tibia (CPT) was studied. It was found that after menopause the osteogenic potential of MSCs does not decrease. It was also found that estrogen receptor (ER) alpha genotype confers interindividual variability of response to estrogen and testosterone in MSC derived osteoblasts. In addition, it was found that the non-calcified valves with living valve cells inhibited osteogenesis of co-cultured MSCs, whereas the calcified and devitalised valves promoted differentiation towards an osteoblastic lineage. Finally, MSCs from NF1-related pseudarthrosis showed altered NF1 gene expression, poor osteoblastic differentiation and bone formation. In conclusion, MSC can be easily isolated from the bone marrow and MSC has the capacity to regenerate tissue even at later stages of life. These results could help explain the contradictory effects of 17β-estradiol (E2) on osteoblasts in vitro and might also provide new insights into understanding the differences in responses to hormone replacement therapy. It seems that adult stem cells from bone marrow undergo milieu-dependent differentiation to express phenotypes that are similar to cells in the local microenvironment. Finally, the NF1 gene was shown to have a role in bone development and remodelling.

Fibroadenome (FA) sind die häufigsten gutartigen Tumoren der weiblichen Brust und treten vor allem im reproduktionsfähigen Alter der Frau auf. Ziel dieser retrospektiven Studie war es, mittels immunhistochemischer Färbung und Datenrecherche herauszufinden, ob sich die FA von 113 Patientinnen in der Ausprägung ihrer Steroidhormonrezeptoren, ihres Proliferationspotenzials (Ki-67) und ihrer Größe bezogen auf diverse Anamnesefaktoren unterscheiden. Damit könnten Rückschlüsse auf die Entstehung von FA allgemein, aber auch auf ihr Wachstumsverhalten in Abhängigkeit dieser Faktoren gezogen werden. Besonderes Interesse galt dabei der Einnahme oraler hormoneller Kontrazeptiva (oral hormonal contraceptives, OHC), da die Inzidenz von FA ihren Gipfel in der Altersgruppe der 20- bis 30-jährigen Frauen hat. Es zeigten sich hochsignifikante Unterschiede in Abhängigkeit vom Patientinnenalter. Die FA älterer Frauen waren kleiner, zeigten weniger proliferative Aktivität, wiesen jedoch deutlich mehr Östrogenrezeptoren (ER) auf, was als Reaktion auf den postmenopausalen Hormonmangel zu werten sein könnte. Frauen mit Nikotinkonsum zeigten eine stärkere Ausprägung des Androgenrezeptors (AR), was auf einen beschleunigten Alterungsprozess, induziert durch Nikotinkonsum, hindeutet. Für die Anamnesefaktoren Körpermasseindex (Body-Mass-Index, BMI), Parität und das Vorliegen eines simultanen Mammakarzinoms zeigten sich keine Unterschiede in Bezug auf die Fibroadenomgröße und das immunhistochemische Profil. Die Einnahme von OHC bedingte analog normalem Brustgewebe lediglich eine verminderte Expression des Progesteronrezeptors (PR). Es ergaben sich keine Unterschiede hinsichtlich proliferativer Aktivität oder Fibroadenomgröße im Ultraschall. Die Exzidate der FA von Frauen mit OHC-Einnahme waren größer; der Größenunterschied verlor jedoch mit besserer Anpassung der Vergleichsgruppen hinsichtlich des Patientinnenalters an statistischer Signifikanz. Insgesamt hatte das Alter der Patientinnen in unserer Studie den größten Einfluss auf die betrachteten abhängigen Variablen (immunhistochemisches Profil und Fibroadenomgröße) und scheint daher eine wichtige Rolle für das klinische Erscheinungsbild von FA zu spielen. Daraus lassen sich möglicherweise in Zukunft verschiedene therapeutische Strategien zur Behandlung von FA in Abhängigkeit vom Patientinnenalter ableiten.:Inhaltsverzeichnis Inhaltsverzeichnis I Abbildungsverzeichnis V Tabellenverzeichnis VI Abkürzungsverzeichnis VIII 1. Einleitung 1 1.1. Fibroadenome 1 1.1.1. Definition 1 1.1.2. Epidemiologie 1 1.1.3. Pathogenese 1 1.1.4. Makroskopie und Histologie 1 1.1.5. Klinisches Erscheinungsbild 2 1.1.6. Diagnostik 2 1.1.7. Therapie 3 1.2. Orale Hormonelle Kontrazeptiva 3 1.2.1. Statistik 3 1.2.2. Wirkungsprinzip 4 1.2.3. Weitere Anwendungsgebiete 4 1.2.4. Einteilung 5 1.2.5. Verschreibungshäufigkeit der einzelnen OHC in Deutschland 5 1.2.6. OHC in der Studie 6 1.3. Weitere Hormonpräparate in der Studie 6 1.3.1. Mirena® 6 1.3.2. Dreimonatsspritze 7 1.3.3. Clomifen 7 1.3.4. Activelle 7 1.3.5. Chlormadinon 7 1.3.6. Estreva-Gel und Utrogest 8 1.3.7. Tamoxifen 8 1.4. Steroidhormonrezeptoren und Ki-67 8 1.4.1. Steroidhormonrezeptoren allgemein 8 1.4.1.1. Definition 8 1.4.1.2. Einteilung der NR3 Superfamilie 8 1.4.1.3. Aufbau der Steroidhormonrezeptoren 9 1.4.1.4. Wirkmechanismus 9 1.4.2. Östrogenrezeptor 10 1.4.3. Progesteronrezeptor 10 1.4.4. Androgenrezeptor 11 1.4.5. Ki-67 11 2. Zielstellung 12 3. Methoden 13 3.1. Erfassung des Patientinnenkollektivs 13 3.2. Deskription des Patientinnenkollektivs 13 3.3. Material 14 3.3.1. Geräte und Hilfsmittel 14 3.3.2. Chemikalien 15 3.3.2.1. Standardchemikalien 15 3.3.2.2. Färbekits für Immunhistochemie 15 3.4. Methoden 16 3.4.1. Prinzip der immunhistochemischen Färbung 16 3.4.2. Gemeinsame Schritte der immunhistochemischen Färbung 16 3.4.2.1. Gemeinsame Schritte vor der immunhistochemischen Färbung 16 3.4.2.2. Gemeinsame Schritte während der immunhistochemischen Färbung 17 3.4.2.3. Gemeinsame Schritte nach der immunhistochemischen Färbung 17 3.4.3. Färbeschritte für Ki-67 und den Androgenrezeptor 17 3.4.4. Färbeschritte für Östrogen- und Progesteronrezeptor 20 3.4.5. Bewertung der Färbeergebnisse 22 3.5. Statistische Auswertung 23 4. Ergebnisse 24 4.1. Lokalisation der Fibroadenome 24 4.1.1. Lokalisation bezüglich der Brust 24 4.1.2. Lokalisation intramammär 24 4.2. Kliniko-pathologische Anlage 25 4.2.1. Anamnesedaten als Variablen 25 4.2.2. Variablen aus der Immunhistochemie 28 4.2.3. Die Variablen Schalldurchmesser und Exzidatgröße 30 4.2.4. Tests auf Normalverteilung und daraus resultierende statistische Tests 30 4.2.5. Korrelation der Variablen nach Spearman 33 4.3. Alter der Patientinnen 34 4.3.1. Beschreibung der Altersverteilung 34 4.3.2. Auswertung nach Altersklassen 34 4.4. BMI der Patientinnen 36 4.4.1. Beschreibung der Gewichtsverteilung 36 4.4.2. Auswertung mit dem BMI nach WHO 36 4.4.3. Auswertung nach BMI-Cut-Off (Trennwert) von 25 kg/m² 37 4.5. Einfluss von BMI und Alter 37 4.5.1. Auswertung nach Altersklassen getrennt nach BMI-Cut-Off 37 4.5.1.1. Auswertung nach Altersklassen (I, II, III) für Frauen mit einem BMI <25 kg/m² 37 4.5.1.2. Auswertung nach Altersklassen (I, II, III) für Frauen mit einem BMI ≥25 kg/m² 37 4.5.2. Auswertung nach BMI-Cut-Off getrennt für jede Altersklasse 37 4.5.2.1. Auswertung nach BMI-Cut-Off für Frauen der Altersklasse I (<30 Jahre) 38 4.5.2.2. Auswertung nach BMI-Cut-Off für Frauen der Altersklasse II (≥30 und <60 Jahre) 38 4.5.2.3. Auswertung nach BMI-Cut-Off für Frauen der Altersklasse III (≥60 Jahre) 38 4.5.3. Vergleichende Korrelationen nach Spearman für Alter und BMI 38 4.5.4. Schlussfolgerung 38 4.6. Nikotinkonsum 39 4.7. Menopausenstatus 40 4.7.1. Deskription der postmenopausalen Frauen 40 4.7.2. Auswertung anhand des Menopausenstatus 40 4.8. Parität 40 4.8.1. Auswertung anhand der Parität für alle Patientinnen 40 4.8.2. Auswertung anhand der Parität für Frauen von 26 bis 52 Jahren 41 4.9. Hormoneinnahme 41 4.9.1. Hormoneinnahme allgemein 41 4.9.2. Auswertung nach Hormoneinnahme für Frauen von 32-66 Jahren; exklusive Einnahme von OHC 41 4.10. Einnahme von OHC 42 4.10.1. Auswertung anhand der Einnahme von OHC; Vergleich mit allen Frauen ohne Einnahme von OHC inklusive und exklusive anderer Hormoneinnahme 42 4.10.2. Auswertung anhand der Einnahme von OHC für Frauen ≤52 Jahre 42 4.10.3. Auswertung anhand der Einnahme von OHC getrennt für jüngere und ältere Frauen 42 4.10.3.1. Auswertung anhand der Einnahme von OHC für Frauen ≤25 Jahre 43 4.10.3.2. Auswertung anhand der Einnahme von OHC für Frauen >25 und ≤52 Jahre 43 4.10.3.3. Zusammenfassende Betrachtung 44 4.10.3.4. Auswertung für jüngere vs. ältere Anwenderinnen von OHC 45 4.10.4. Lokalisation der Fibroadenome bei Einnahme von OHC 45 4.10.5. OHC geordnet nach Östrogengehalt 46 4.10.6. OHC geordnet nach Gestagengruppe 46 4.11. Einnahme von Valette 47 4.11.1. Einnahme von Valette vs. Einnahme von anderen OHC 47 4.11.2. Einnahme von Valette vs. Einnahme von anderen OHC vs. keine Einnahme von OHC 47 4.12. Simultanes Mammakarzinom 49 4.12.1. Deskription der Patientinnen mit Mammakarzinom 49 4.12.2. Auswertung anhand des Vorliegens eines simultanen Mammakarzinoms für alle Patientinnen 49 4.12.3. Auswertung anhand des Vorliegens eines simultanen Mammakarzinoms für Frauen ≥48 Jahre 49 5. Diskussion 51 5.1. Lokalisation der Fibroadenome 51 5.2. Größe der Fibroadenome 51 5.3. Einfluss der Steroidhormonrezeptoren 52 5.4. Einfluss von Ki-67 55 5.5. Einfluss des Alters der Patientinnen 55 5.6. Einfluss des BMI 58 5.7. Einfluss des Nikotinkonsums 59 5.8. Einfluss des Menopausenstatus 60 5.9. Einfluss der Parität 61 5.10. Einfluss der Hormoneinnahme, exklusive Einnahme von OHC 61 5.11. Einfluss der Einnahme von OHC 62 5.12. Einfluss eines simultanen Mammakarzinoms 65 5.13. Einfluss anderer Entstehungsfaktoren 66 6. Zusammenfassung 68 7. Literaturverzeichnis 71 8. Eidesstattliche Erklärung 81 9. Danksagung 82 10. Lebenslauf 83

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<p>Disease-specific compounds (biomarkers) are analyzed in clinical laboratories to assist with diagnosing diseases. This thesis describes development and validation of liquid chromatography tandem mass spectrometry (LC-MS/MS) based tests for diagnosing a diverse group of endocrine and metabolic diseases. The analytical methods used on-line and off-line sample extraction and analytical derivatization as means of enhancing the analytical sensitivity, specificity and clinical utility. All developed methods were extensively validated and reference intervals for the biomarker concentrations were established in blood samples of healthy adults and children. Advantages of the LC-MS/MS as an analytical technique include possibility of simultaneous measurement of multiple analytes and ability of confirming their identity. In this thesis we proposed and evaluated approaches for the assessment of the specificity of analysis in the methods that use tandem mass spectrometry detection. To enhance throughput of the LC-MS/MS tests for the biomarkers that have endogenous or exogenous isomers an approach was developed for quantitation of isomers from unresolved chromatographic peaks. Using methods developed in this thesis we performed a study of the steroidogenesis in ovarian follicles of healthy women and women with polycystic ovary syndrome (PCOS). Obtained data on the steroid concentrations and associations between the steroid metabolites in the pathway would be helpful for better understanding of the ovarian pathophysiology. Potential biomarkers of PCOS were identified in the thesis; further studies will be necessary to confirm their clinical utility.</p>

The importance of sex hormones in formation, development and regulation of sexually dimorphic behavior does not need to be stressed. However, their actual organizational and activational effects and interactions in sexual differentiation and determination are not fully understood yet. The aim of our study was to explore the effects of hormonal manipulation in eyelid-geckos (family Eublepharidae) and enlighten the role of steroid hormones in formation of sexual differences. In the first part of our work we tried to reverse sex of Yucatán banded gecko (Coleonyx elegans) by hormonal manipulation in the early embryogenesis. This species has genotypic sex determination with chromosome set X1X2Y. In reverted individuals we aimed to examine the effects of steroid hormones on sexually dimorphic traits and in case of full sexual reversion and fertility of progeny, we would search for the sex-determining gene. In the second part, we studied masculinization effects of testosterone in females of leopard gecko (Eublepharis macularius). In contrast with the Coleonyx elegans mentioned above, this species has temperature dependent sex determination, even though these two species are closely related. Experimental females were implanted with testosterone implants and therefore their testosterone levels were increased in...

A matriz extracelular (MEC) dos tecidos uterinos é altamente remodelada na gestação de camundongos. Os objetivos deste estudo foram avaliar a influência dos hormônios ovarianos estrógeno (E2) e progesterona (P4) sobre a estrutura dos tecidos uterinos de camundongo e a deposição dos proteoglicanos decorim, biglicam, fibromodulim, lumicam, perlecam e versicam nestes tecidos. Para isto, utilizamos um modelo de castração e reposição hormonal, e o ciclo estral como parâmetro fisiológico. Verificamos que, como na gestação, durante o ciclo estral ocorre intensa remodelação na estrutura e na MEC dos tecidos uterinos. Verificamos ainda que a resposta aos hormônios ovarianos é: compartimento-específica; hormônio-específica e molécula-específica. Notável foi a modulação do versicam pelos hormônios ovarianos. P4 induz a deposição de versicam no estroma, enquanto o miométrio responde apenas a E2. A modulação dos proteoglicanos pelos hormônios ovarianos mostra a relevância destas moléculas para a composição de um ambiente uterino propício para o desenvolvimento do embrião. / The extracellular matrix (ECM) of the mouse uterine tissues is highly remodeled during pregnancy. The aim of this study was to demonstrate the influence of estrogen (E2) and progesterone (P4) on the uterine structure and on the deposition of the proteoglycans decorin, biglycan, fibromodulin, lumican, perlecan and versican in these tissues. For that purpose, we used a model of castration e hormone replacement as main strategy, and the estrous cycle as physiological parameter. We verified that, as in pregnancy, during the estrous cycle an intense remodeling occurs on the structure and the ECM of the uterine tissues. We also showed that the response to the ovarian hormones is: compartment-; hormone- and molecule- specific. Noteworthy was the modulation of versican by the hormones: P4 induces the deposition of versican in the stroma, whereas the myometrium responds only to E2. The modulation of proteoglycans by the ovarian hormones indicates the relevance of these molecules for the composition of a proper microenvironment for embryo development.

INTRODUÇÃO: A prevalência global da obesidade duplicou desde 1980, alcançando mais de 600 milhões de adultos obesos em 2014. Em paralelo a este aumento, alguns autores relataram uma tendência mundial de declínio da concentração de espermatozoides no ejaculado nas últimas décadas. Consequentemente, surge a hipótese da relação entre esses dois fatos temporais. Dentre todas as formas de tratamento da obesidade, a cirurgia bariátrica é a que apresenta melhores resultados em termos de perda de peso e melhor efetividade a longo-prazo. Há evidências na literatura que sugerem que a obesidade é capaz de alterar os níveis dos hormônios reprodutivos e função erétil. No entanto, seus efeitos sobre os parâmetros seminais clássicos e no índice de fragmentação do DNA espermático (IFD) são pouco estabelecidos. Além disso, o impacto da cirurgia bariátrica sobre estas alterações ainda não foi devidamente esclarecido. OBJETIVO: Identificar os efeitos da obesidade sobre a função erétil, hormônios reprodutivos, função testicular e IFD de homens obesos. Adicionalmente, avaliar se a cirurgia bariátrica é capaz de afetar estes mesmos parâmetros. MÉTODOS: Este estudo foi organizado em duas fases. Na primeira fase, indivíduos com índice de massa corpórea (IMC) menor que 30 kg/m2 e fertilidade comprovada foram comparados a pacientes obesos em programação para cirurgia bariátrica, com IMC maior que 35 kg/m2. Todos os pacientes foram submetidos a dosagem de hormônios reprodutivos, análise seminal e aferição do IFD pelo método do cometa alcalino. O questionário do Índice Internacional de Função Erétil (IIEF-5) foi aplicado. Na segunda fase, parte dos indivíduos obesos foi submetida à cirurgia bariátrica e todos foram convocados para reavaliação em 6 meses. RESULTADOS: Homens obesos apresentam maiores níveis séricos de estradiol, LH e FSH, e menores níveis séricos de testosterona total (TT) quando comparados com homens férteis eutróficos. Além disso, apresentam piores parâmetros seminais, com redução do volume ejaculado, concentração seminal, número total de espermatozoides no ejaculado, motilidade total, motilidade progressiva e percentual de espermatozoides com morfologia normal, e elevação do IFD. Na fase 2, homens obesos submetido a cirurgia bariátrica apresentaram elevação dos valores de FSH, SHBG, TT e testosterona livre (TL), e redução dos níveis de prolactina sérica. Além disso, apresentam queda da concentração seminal e do número total de espermatozoides no ejaculado, e queda na fragmentação do DNA espermático. Controles obesos, por outro lado, não apresentaram alterações nas variáveis estudadas. Além disso, maior intensidade da perda de peso esteve associada com alterações mais importantes do número total de espermatozoides no ejaculado, e dos níveis séricos de TT, TL, SHBG e FSH. CONCLUSÕES: A obesidade é capaz de induzir alterações importantes dos hormônios reprodutivos, parâmetros seminais e IFD. A cirurgia bariátrica, entretanto, pode reverter os efeitos deletérios sobre os hormônios reprodutivos e fragmentação do DNA, mas pode trazer piora de parâmetros seminais em 6 meses de seguimento / INTRODUCTION: Worldwide obesity prevalence has duplicated since 1980, reaching more than 600 million obese adults in 2014. Parallel to this increase, several authors have reported a global tendency of ejaculated sperm concentration decline in the last decades. Therefore, comes to light the hypothesis that these two temporal trends are related. Among all forms of obesity treatments, the one that reaches the best results and long-term effectiveness is the bariatric surgery. Growing evidence in the literature suggests that obesity is capable of altering reproductive hormones levels and erectile function. Effects on classic semen parameters and DNA fragmentation index (DFI), however, have not been properly established. OBJECTIVE: Determine the effects of obesity over erectile function, reproductive hormones, testicular function, and DFI in obese men. Additionally, evaluate if bariatric surgery can also impact those parameters. METHODS: This study was divided into two phases. On the first phase, individuals with body mass index (BMI) lower than 30 kg/m2 and proven fertility were compared to obese men, with BMI higher than 35 kg/m2, waiting to be submitted to bariatric surgery. Reproductive hormones evaluation, semen analysis and evaluation of DFI by the alkaline comet assay were performed in all patients. The International Index of Erectile Function (IIEF-5) was used to assess erectile function. On phase two, part of the obese patients was submitted to bariatric surgery, and all were invited to 6-month revaluation. RESULTS: Obese men have higher blood levels of estradiol, LH and FSH, and lower levels of total testosterone (TT) when compared to eutrophic fertile men. Additionally, they present worse semen parameters, with a reduction in ejaculated volume, sperm concentration, total number of sperm in the ejaculate, total motility, progressive motility, and percentage of normal sperm, and higher sperm DFI. On phase two, obese men submitted to bariatric surgery showed higher FSH, SHBG, TT, and free testosterone (FT) levels, and reduction of blood prolactin levels. Moreover, they exhibited a reduction in sperm concentration and total ejaculated sperm count, and a reduction in sperm DNA fragmentation. Obese controls, however, did not experience changes in the studied variables. Finally, the intensity of weight loss was associated with greater changes in total ejaculated sperm count and in TT, TL, SHBG and FSH blood levels. CONCLUSIONS: Obesity can induce important changes in reproductive hormones, semen parameters, and DFI. Bariatric surgery, however, can revert the deleterious effects in reproductive hormones and DFI, but can result in worsening of semen parameters on 6-month follow-up

INTRODUÇÃO: A insuficiência cardíaca (IC) é uma síndrome sistêmica, cuja uma das possíveis evoluções se caracteriza pela perda de massa magra e intolerância aos esforços, quadro conhecido como caquexia cardíaca (CC). Estudos realizados usando homens e ratos demonstram que na associação da IC com hipogonadismo há um pior quadro clínico e desenvolvimento de CC, levando a um mal prognóstico e aumento da mortalidade. Para o sexo feminino, tanto no período pré ou pós-menopausa, não é conhecida a associação de possível deficiência de hormônios sexuais, tampouco seu impacto no prognóstico, mortalidade e desenvolvimento de CC em pacientes com IC. Os objetivos deste estudo foram: 1) Avaliar o efeito da IC sobre o possível desenvolvimento de CC em ratas. 2) Avaliar o efeito da IC sobre a produção de hormônios sexuais: Testosterona total, estradiol, FSH. MÉTODOS: Ratas da linhagem Sprague Dawley, com 60 dias de vida, foram divididas de acordo com os procedimentos cirúrgicos: Ratas intactas (INT) ou com ooforectomia (OVX), ratas com cirurgia fictícia (SHAM) do infarto do miocárdio (IM) ou cirurgia IM. A combinação destes procedimentos originou quatro grupos experimentais: INT+SHAM, INT+IM, OVX+SHAM e OVX+IM. Trinta dias após a OVX, amostras de sangue foram coletadas, para a dosagem hormonal e os animais foram submetidos à cirurgia de indução ao IM ou SHAM. Após oitos semanas, as ratas passaram pela avaliação ecocardiográfica. A partir desta, estabeleceu-se um corte de Fração de Ejeção (FE) <= 50% para definir o desenvolvimento de disfunção cardíaca a partir da realização do IM, constituindo dessa forma, os grupos INT+IM e OVX+IM. Com quatro semanas adicionais (totalizando 12 semanas após a indução do IM), houve a consolidação do quadro crônico de IC; então as ratas foram submetidas à avaliação hemodinâmica, da capacidade funcional e a nova coleta de sangue para dosagem hormonal. Após a eutanásia, os tecidos foram coletados para as análises morfológicas e histológicas. RESULTADOS: As ratas dos grupos OVX (OVX+SHAM e OVX+IM) não apresentaram ciclos ovarianos, demonstraram hipertrofia dos úteros e aumento do peso corporal final quando comparadas aos grupos INT (INT+SHAM e INT+IM), além de alterações na morfologia das glândulas adrenais - caracterizando o quadro de privação de hormônios ovarianos. As ratas dos grupos IM (INT+IM e OVX+IM) não tiveram alterações hemodinâmicas, contudo demonstraram reduzida capacidade funcional e piora nas variáveis ecocardiográficas (FE, FS, DSVE, TCIV) quando comparadas aos grupos SHAM (INT+SHAM e OVX+SHAM); as avaliações histológicas apontam valores de área infartada entorno de 40% e hipertrofia de septo nos grupos IM. Os animais não caracterizaram quadro de CC - caracterizada por diminuição do peso corporal, diminuição da densidade capilar na musculatura e atrofia das fibras musculares (m. sóleo) - após12 semanas de disfunção cardíaca / Introduction: Heart failure (HF) is a systemic disease, which one of the possible progress is characterized by lean mass loss and intolerance to efforts, this framework is known as cardiac cachexia (CC). Studies in men and rats have shown that when HF is associated with hypogonadism it has a worse clinical condition and CC evolution, leading to a poor prognosis and increased mortality. For females, both in the pre menopause period than in the post menopause it is not known how the association of sex hormones deficiency with HF can impact the prognosis and mortality of female patients, as well as the development of CC. The objectives of this study were: 1) Evaluate the effect of HF on the possible CC development in female rats. 2) Evaluate the effect of HF on the production of sex hormones: Total testosterone, estradiol, FSH. METHODS: Female rats (Sprague Dawley strain, 60 days old) were divided according to the surgical procedures: intact rats (INT) or ovariectomy (OVX) rats with sham surgery (SHAM) of myocardial infarction (MI) or MI surgery. The combination of these procedures led to four groups: INT + SHAM, INT + MI, OVX + SHAM and OVX + MI. 30 days after OVX, blood samples were collected for hormone dosage and the animals have been underwent to surgery to the MI induction or SHAM. After eight weeks, the rats have gone through echocardiographic evaluation. From this procedure, it was established a cutting Ejection Fraction (EF) <= 50% to define the development of cardiac dysfunction from the realization of MI, constituting INT + IM and IM + OVX groups. With four additional weeks (totaling 12 weeks after MI induction), there was the consolidation of HF\'s chronic condition; female rats were subjected to evaluation of functional and hemodynamic capacity and a new blood collection for hormonal dosage. After euthanasia, tissues were collected for morphological and histological analyzes. RESULTS: The rats of the OVX groups (OVX + SHAM and OVX + MI) showed no ovarian cycles, demonstrated uterus\' hypertrophy and an increase in final body weight when compared to INT groups (INT + SHAM and INT + MI), changes in morphology of the adrenal glands - evidencing the situation of ovarian hormones deprivation. The rats of the MI group (INT + MI and OVX + MI) had no hemodynamic changes, but showed reduced functional capacity and deterioration of echocardiographic variables (EF, FS, LVSD, IVCT) when compared to SHAM groups (INT + SHAM and OVX + SHAM ); the histological evaluations indicate infarcted area values around 40% and septal hypertrophy at MI groups. The animals did not characterize CC - characterized by decreased body weight, decreased capillary density in the muscle and muscle fiber atrophy (m. soleus) - even after 12 weeks of cardiac dysfunction

Jiang, Jieying. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 170-186). / Abstract also in Chinese. / ACKNOWLEDGEMENT --- p.II / ABBREVIATIONS --- p.III / ABSTRACT OF THESIS ENTITLED: --- p.VI / 摘要 --- p.IX / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- Individual variations of blood sex steroid levels and their determinants --- p.1 / Chapter 1.1.1 --- Introduction to Sex steroids --- p.1 / Chapter 1.1.2 --- Androgens --- p.1 / Chapter 1.1.2.1 --- Types of androgens --- p.1 / Chapter 1.1.2.2 --- Androgens plasma concentration and relative biological potencies --- p.2 / Chapter 1.1.2.3 --- Androgen biosynthesis and metabolism --- p.3 / Chapter 1.1.2.4 --- Testosterone transportation in plasma --- p.6 / Chapter 1.1.2.5 --- Measurement of free testosterone --- p.7 / Chapter 1.1.2.6 --- The hypothalamus-pituitary-testicular axis and testosterone secretion --- p.8 / Chapter 1.1.2.7 --- Androgen action --- p.10 / Chapter 1.1.2.8 --- Androgen biological function and diseases in men --- p.11 / Chapter 1.1.3 --- Estrogen biological function and diseases in men --- p.12 / Chapter 1.1.4 --- Factors influencing circulating sex steroid levels --- p.13 / Chapter 1.1.4.1 --- Genetic determinants affecting sex steroid levels --- p.15 / Chapter 1.2 --- Genetic variants in sex steroid metabolic pathway and hepatocellular carcinoma (HCC) --- p.18 / Chapter 1.2.1 --- Epidemiology of HCC --- p.18 / Chapter 1.2.2 --- Etiological factors of HCC --- p.22 / Chapter 1.2.3 --- The male predominance in HCC --- p.24 / Chapter 1.2.4 --- Genetic predisposition to HCC --- p.26 / Chapter CHAPTER 2 --- PART A STUDY: GENETIC VARIATIONS IN SEX STEROID METABOLIC PATHWAY AND ASSOCIATION WITH SEX STEROID LEVELS --- p.28 / Chapter 2.1 --- Introduction --- p.28 / Chapter 2.1.1 --- Candidate genes association with sex steroid levels --- p.28 / Chapter 2.1.2 --- Genes involved in androgen metabolism --- p.29 / Chapter 2.1.2.1 --- SRD5A --- p.29 / Chapter 2.1.2.2 --- HSD3B1 --- p.30 / Chapter 2.1.2.3 --- HSD17B2 --- p.31 / Chapter 2.1.2.4 --- AKR1C3 and AKRlC4 --- p.31 / Chapter 2.1.2.5 --- AKR1D1 --- p.32 / Chapter 2.1.3 --- Genes involved in estrogen metabolism --- p.32 / Chapter 2.1.3.1 --- CYP19A1 --- p.32 / Chapter 2.1.3.2 --- Other genes involved in estrogen metabolism --- p.33 / Chapter 2.1.4 --- Association of sex steroid related genes and blood concentrations of sex steroid levels --- p.33 / Chapter 2.1.4.1 --- Genes involved in androgen metabolic pathway and association with sex steroid levels --- p.33 / Chapter 2.1.4.2 --- Genes involved in estrogen metabolic pathway and association with sex steroid levels --- p.36 / Chapter 2.1.5 --- Aims of the study (Part A) --- p.37 / Chapter 2.2 --- Materials and methods --- p.38 / Chapter 2.2.1 --- Study subjects and biological samples --- p.38 / Chapter 2.2.2 --- TagSNP selection --- p.39 / Chapter 2.2.3 --- Genotyping of tagging SNPs --- p.41 / Chapter 2.2.4 --- Genotyping methods comparison --- p.52 / Chapter 2.2.5 --- Statistics --- p.53 / Chapter 2.3 --- Results --- p.54 / Chapter 2.3.1 --- Characteristics of study population --- p.54 / Chapter 2.3.2 --- Replication study for the association of CYP19A1 --- p.55 / Chapter 2.3.2.1 --- Association of the SNP rs2470152 and rs2899470 with serum estrogen and testosterone levels --- p.55 / Chapter 2.3.2.2 --- Halotype analysis and haplotype association in the tertile groups --- p.61 / Chapter 2.3.2.3 --- Haplotype construction of 3 SNPs --- p.63 / Chapter 2.3.3 --- SRD5A1 --- p.65 / Chapter 2.3.3.1 --- Association of SRD5A1 and sex steroid levels --- p.65 / Chapter 2.3.3.2 --- Haplotype analysis and haplotype association in the tertile groups --- p.71 / Chapter 2.3.4 --- SRD5A2 --- p.72 / Chapter 2.3.4.1 --- Association of SRD5A2 and sex steroid levels --- p.72 / Chapter 2.3.4.2 --- Haplotype association analysis of SRD5A2 in tertile groups --- p.76 / Chapter 2.3.5 --- HSD3B1 --- p.77 / Chapter 2.3.5.1 --- Association of HSD3B1 and sex steroid levels --- p.77 / Chapter 2.3.6 --- HSD17B2 --- p.80 / Chapter 2.3.6.1 --- Association of HSD17B2 and sex steroid levels --- p.80 / Chapter 2.3.6.2 --- Halotype association analysis of HSD17B2 in the tertile groups --- p.87 / Chapter 2.3.7 --- AKR1C4 --- p.89 / Chapter 2.3.7.1 --- Association of AKR1C4 and sex steroid levels --- p.89 / Chapter 2.3.7.2 --- Halotype association analysis of AKR1C4 in the tertile groups --- p.93 / Chapter 2.3.8 --- AKR1D1 --- p.94 / Chapter 2.3.8.1 --- Association of AKR1D1 and sex steroid levels --- p.94 / Chapter 2.3.8.2 --- Haplotype association analysis of AKR1D1 in the tertile groups --- p.99 / Chapter 2.3.9 --- AKR1C3 --- p.100 / Chapter 2.3.9.1 --- Association of AKR1C3 and sex steroid levels --- p.100 / Chapter 2.3.9.2 --- Haplotype association analysis of AKR1C3 in the tertile groups --- p.104 / Chapter 2.3.10 --- Overall association of polymorphisms in sex steroid metabolism genes and metabolites levels in blood --- p.105 / Chapter 2.4 --- Discussion --- p.106 / Chapter 2.4.1 --- SRD5A and sex steroid levels --- p.106 / Chapter 2.4.2 --- HSD17B2 and sex steroid levels --- p.110 / Chapter 2.4.3 --- "AKR1D1, AKR1C4, AKR1C3 and catabolic intermediates of sex steroids" --- p.112 / Chapter 2.4.4 --- HSD3B1 and sex steroid levels --- p.114 / Chapter 2.4.4 --- CYP19A1 and sex steroid levels --- p.114 / Chapter CHAPTER 3 --- PART B STUDY: GENETIC VARIATIONS IN SEX STEROID METABOLIC PATHWAY AND ASSOCIATION WITH HCC --- p.119 / Chapter 3.1 --- Introduction --- p.119 / Chapter 3.1.1 --- Previous genetic association studies of HCC on sex steroid metabolic pathways --- p.119 / Chapter 3.1.2 --- Previous genetic association studies of HCC in other pathways --- p.120 / Chapter 3.1.3 --- "Association of sex steroid related genes and other cancers, like prostate cancer" --- p.121 / Chapter 3.1.4 --- Aims of the study (Part B) --- p.123 / Chapter 3.2 --- Materials and method --- p.125 / Chapter 3.2.1 --- "Study subjects, Genomic DNA extraction" --- p.125 / Chapter 3.2.2 --- Tissue specimen and cell lines --- p.125 / Chapter 3.2.3 --- TagSNP selection --- p.126 / Chapter 3.2.4 --- Genotyping of tagging SNPs --- p.126 / Chapter 3.2.5 --- Statistics --- p.127 / Chapter 3.2.6 --- Extraction of RNA and Reverse-Transcription-PCR --- p.128 / Chapter 3.3 --- Results --- p.130 / Chapter 3.3.1 --- SRD5A1 --- p.130 / Chapter 3.3.1.1 --- SRD5A1 polymorphisms and risk of HCC --- p.130 / Chapter 3.3.2 --- SRD5A2 --- p.134 / Chapter 3.3.2.1 --- SRD5A2 polymorphisms and risk of HCC --- p.134 / Chapter 3.3.2.2 --- Haplotype analysis --- p.136 / Chapter 3.3.3 --- HSD3B1 --- p.137 / Chapter 3.3.3.1 --- HSD3B1 polymorphisms and risk of HCC --- p.137 / Chapter 3.3.3.2 --- Haplotype analysis --- p.139 / Chapter 3.3.4 --- HSD17B2 --- p.140 / Chapter 3.3.4.1 --- HSD17B2 polymorphisms and risk of HCC --- p.140 / Chapter 3.3.4.2 --- Haplotype analysis --- p.143 / Chapter 3.3.5 --- CYP19A1 --- p.144 / Chapter 3.3.5.1 --- CYP19A1 polymorphisms and risk of HCC --- p.144 / Chapter 3.3.5.2 --- Haplotype analysis --- p.146 / Chapter 3.3.6 --- AKR1C4 --- p.147 / Chapter 3.3.6.1 --- AKR1C4 polymorphisms and risk of HCC --- p.147 / Chapter 3.3.6.2 --- Haplotype analysis --- p.148 / Chapter 3.3.7 --- AKR1D1 --- p.149 / Chapter 3.3.7.1 --- AKR1D1 polymorphisms and risk of HCC --- p.149 / Chapter 3.3.7.2 --- Haplotype analysis --- p.150 / Chapter 3.3.8 --- AKR1C3 --- p.151 / Chapter 3.3.8.1 --- AKR1C3 polymorphisms and risk of HCC --- p.151 / Chapter 3.3.8.2 --- Haplotype analysis --- p.152 / Chapter 3.3.9 --- mRNA expression study of the 5 α -reductase isoforms --- p.153 / Chapter 3.3.9.1 --- Expression of SRD5A1 and SRD5A2 mRNAin HCC patients --- p.153 / Chapter 3.3.9.2 --- Expression of SRD5A1 and SRD5A2 mRNAin prostate and HCC cell lines --- p.154 / Chapter 3.3.10 --- Overall association of polymorphisms in sex steroid metabolism genes and risk of HCC --- p.154 / Chapter 3.3.11 --- GMDR analysis --- p.156 / Chapter 3.4 --- Discussion --- p.159 / Chapter 3.4.1 --- 5 α-reductase and risk of HCC --- p.159 / Chapter 3.4.1.1 --- SRD5A2 --- p.160 / Chapter 3.4.1.2 --- SRD5A1 --- p.161 / Chapter 3.4.2 --- Other genes and association with HCC --- p.162 / Chapter 3.4.2.1 --- HSD17B2 and risk of HCC --- p.162 / Chapter 3.4.2.2 --- "HSD3B1, AKR1C3, AKR1C4, AKR1D1 and risk of HCC" --- p.163 / Chapter 3.4.2.3 --- CYP19A1 and risk of HCC --- p.164 / Chapter 3.4.3 --- Gene-Gene interactions associated with HCC --- p.165 / Chapter CHAPTER 4 --- CONCLUSIONS AND PROSPECT FOR FUTURE WORK --- p.166 / Chapter 4.1 --- Conclusion --- p.166 / Chapter 4.2 --- Future works and prospect --- p.169 / REFERENCES --- p.170