TGF-β is the founding member of a multifunctional family of cytokines that regulate many aspects of cell physiology, including cell growth, differentiation, motility and death and play important roles in many developmental and pathological processes. TGF-β signals by binding to a heterotetrameric complex of type I and type II serine/threonine kinase receptors. The type I receptor is phosphorylated and activated by the type II receptor and propagates the signal to the nucleus by phosphorylating and activating receptor-regulated Smad proteins (R-Smads). Once activated, the R-Smads translocate to the nucleus together with the common partner Smad, Smad4, in heteromeric complexes and regulate transcription of target genes. The cell cycle inhibitor p21Waf1/Cip1 (p21) is induced by a number of factors including p53 and TGF-β, and its high expression is associated with cellular differentiation and senescence. Low levels of p21 are required for the propagation of the cell cycle, where high levels of p21 expression result to cell cycle arrest. The mode of action of p21 is by interacting with and dissociating cyclin E- and cyclin A-CDK complexes. p21 is very potently upregulated by TGF-β in cell types of epithelial origin and this sustained upregulation is of utmost importance for TGF-β to exert its growth inhibitory effect. The aim of this study was to clarify the mechanisms by which the cell cycle inhibitor p21 is regulated during the TGF-β-induced cell growth inhibition. During the course of this work we established that TGF-β regulates p21 via the Smad pathway at the transcriptional level and that upregulation of the p21 levels cannot be achieved in the absence of proper Smad signaling. This regulation is achieved by Smad proteins interacting with the transcription factor Sp1 at the proximal p21 promoter region. We also established that p21 is regulated by all the TGF-β superfamily pathways as we showed that all type I receptors of the superfamily are able to upregulate p21. Despite that, we demonstrated that p21 induction by other members of the superfamily, such as BMPs, is not sufficient for growth suppression. This is because BMPs regulate additional genes such as Id2 that counteract the effect of p21 on cell growth. Furthermore, we examined the homeobox gene Meox2, which is regulated by TGF-β, and established that this factor is important for the sustained p21 regulation and the cell growth inhibitory program exerted by TGF-β. Simultaneously, we examined the cross-talk between Notch and TGF-β signaling pathways and established a synergy between Notch and TGF-β during epithelial cell growth inhibition. We showed that TGF-β-induced growth arrest requires intact Notch signaling. Abrogation of Notch signaling results in a blockage of sustained p21upregulation, required for the TGF-β-induced growth arrest to occur. This work contributes substantially to the mechanism of both immediate-early and prolonged-late regulation of p21 by TGF-β-superfamily pathways, leading to cell growth inhibition of epithelial cells.

La progression du cancer colorectal procède selon une série de transitions, de la crypte épithéliale normale vers l'adénome conduisant au carcinome primaire in situ et aux métastases généralement localisées au niveau du foie. Ces événements séquentiels sont orchestrés par un ensemble d'altérations géniques et moléculaires (syndromes familiaux HNPCC, FAP et cancers sporadiques CIN-LOH et MSI) qui se traduisent de manière générale par l'activation constitutive de (proto)oncogènes ou par la perte de gènes suppresseurs de tumeurs ou de métastases. Si les récepteurs du TGF-β et leurs réseaux de signalisation associés ont été tout particulièrement incriminés quant à leur rôle péjoratif pendant les phases tardives de la progression des tumeurs solides et des cancers du côlon chez l'homme, les informations concernant le rôle des cytokines BMP apparentées au TGF-β dans ce domaine ne sont que très fragmentaires. Quand ce projet a été initié, une étude attribuait à BMP-7 un rôle anti-inflammatoire dans l'intestin chez le rat, suggérant ainsi que cette cytokine pouvait exercer un rôle direct et bénéfique sur la muqueuse digestive et les cellules épithéliales intestinales en particulier. Les BMP agissent par l'intermédiaire de leurs récepteurs de type II (BMPRII, ActRII, ActRIIB) , de type I (ALK-2, ALK-3, ALK-6), et des protéines SMADs (SMAD1, SMAD4, SMAD5, SMAD8). Cependant, 50% des cancers du côlon métastatiques présentent une forme mutée de SMAD4. Des mutations germinales dans le gène codant le récepteur ALK-3 sont observées chez 38% des patients atteints de polypose juvénile (JPS). Enfin, 83% des cancers colorectaux présentant une instabilité des séquences microsatellites (MSI) montrent une mutation dans le gène codant le récepteur de l'activine ActR-II. Dans ce contexte, mon projet de thèse a été centré sur l'expression et le rôle de BMP-7 sur la progression des cellules cancéreuses colorectales humaines et dans les tumeurs associées. Nous avons démontré par RT-PCR, immunohistochimie, et en ELISA que BMP-7 et ses récepteurs sont présents dans des cryptes coliques histologiquement normales, les foci de cryptes aberrantes dans la sigmoïdite, les tumeurs colorectales humaines et plusieurs lignées de cellules cancéreuses coliques. Nous avons aussi démontré que BMP-7 est un facteur de dissémination inducteur du " scattering " et de l'invasion cellulaire dans le collagène de type I. Le pouvoir invasif de BMP-7 est indépendant de SMAD4 et de l'oncogène src, mais associé à l'activation différentielle et cyclique des GTPases (Rac1 et RhoA), de la tyrosine kinase FAK (phosphorylation de la tyr925 impliquée dans la signalisation invasive et l'angiogenèse), et des MAPK /SAPK (JNK et ERK1/2). L'ensemble de ces travaux suggère que BMP-7 se comporte comme un facteur de dissémination proinvasif, agissant par un mécanisme autocrine et paracrine au niveau des cellules cancéreuses du côlon et du stroma tumoral. Cette cytokine exerce donc des actions divergentes sur la progression des tumeurs coliques humaines, en s'opposant aux processus inflammatoires transitoires (rôle bénéfique), mais en favorisant la néoplasie lors des étapes plus tardives associées à l'acquisition du pouvoir invasif à la transition adénome- carcinome pendant la cancérogenèse (rôle péjoratif). Parallèlement, dans cette thèse, nous avons démontré que l'intégrine α1 fait partie de l'échafaudage moléculaire impliqué dans l'invasion cellulaire dépendant de l'oncogène src. D'une autre part, nous démontrons que le VEGF est un inducteur autocrine de l'invasion cellulaire par les cellules cancéreuses du côlon. Selon ce modèle, le VEGF sécrété par les cellules tumorales au sein de la tumeur primaire agit à la fois sur les cellules cancéreuses et les cellules endothéliales en induisant des signaux de survie, de prolifération et d'invasion nécessaires à la croissance des tumeurs primaires et à la génération des métastases.

Transforming growth factor-β (TGF-β) is the proto-type member of a super family of secreted proteins comprised of several structurally related, but functionally divergent proteins like the BMP, activin, inhibin, mullerian inhibitory substance etc. TGF-β was originally identified as a secreted factor, which in the presence of EGF was capable of transforming normal rat kidney fibroblasts. Studies over the years have shown that this protein is multifunctional that influences several processes including development, immune function, epithelial cell growth and motility, wound healing etc. TGF-β plays important role in the normal physiology as well as in pathological conditions in mammals. There are three mammalian isoforms that are involved in several developmental processes as has been shown by the knockout mice models. An important role for TGF-β has been implicated in several disease processes like fibrotic disorders (of liver, lung, kidney), inflammatory disorders (rheumatoid arthritis), autoimmune disorders (systemic lupus erythematosus) and cancer. TGF-β has a dual role in carcinogenesis. Initially it acts as a tumor suppressor and causes growth arrest of epithelial cells and cells in the early stages of cancer. But in an established tumor, TGF-β exerts an effect which is favorable for the survival, progression and metastasis of the tumor by promoting epithelial-mesenchymal transition (EMT), angiogenesis and escape from immune surveillance. Studies using mouse models have shown that an intact TGF-β signaling is essential for the metastasis of breast cancer. These observations indicate that the normal epithelial cells show differential response to TGF-β as compared to the tumor they give rise to. Supporting this, it has been shown that prostate tumor cells show invasive behavior in response to TGF-β and not non-tumorigenic cells. Most actions of TGF-β are brought about by regulation of gene expression and differential gene expression mediated by TGF-β has been reported in tumor cells and normal cells. For example, in response to TGF-β, tumorcells show increase in the production of proteases like uPA, MMPs etc and down regulation of the inhibitors of proteases TIMP isoforms, whereas this is not observed in the normal cells. However, there is no clear understanding of the mechanism (s) responsible for differential responses of various cell types to TGF-β. Since a role for TGF-β has been established in several pathological conditions particularly cancer and fibortic disorders, this pathway are a very attractive target for therapeutic intervention. Hence, if the TGF-β pathway has to be targeted for therapy of any disease, it becomes essential to identify the targets of TGF-β in different cell-types and their mechanism of regulation, particularly in un-transformed and transformed cells. Over the past few years, there have been several independent transcriptome analyses of cells in response to TGF-β treatment in various cell types such as HaCaT, fibroblasts, corneal epithelial cells etc. From a comparison of these studies, it is noted that TGF-β regulates genes in a cell type specific manner. Considering the dual role of TGF-β on normal and transformed cells, identification of genes and/or biochemical pathways regulated by TGF-β in these cells may allow identification of therapeutic targets for diseases involving TGF-β signaling pathway. With this background, the following objectives were set for the current investigation: 1. Identification of targets of TGF-β in normal and tumor cells and also the genes differentially regulated by TGF-β 2. Understand the mechanism of regulation of a few selected genes 3. Characterize novel targets of TGF-β with respect to their regulation by TGF-β and also their function Towards the aim of identification of targets of TGF-β in different cell-lines, expression profiling of genes in response to TGF-β was performed in a lung adenocarcinoma cell line (A549) and a matched immortalized lung epithelial cell line (HPL1D). Our data showed similar regulation of 267 genes in HPL1D and A549 cells by TGF-β. This suggests that the genes commonly regulated in both HPL1D and A549 are not tumor specific. Some of these genes were also reported to be regulated by TGF-β in other studies using micro array in various cell types. While 1757 genes are exclusively regulated by TGF-β in A549, only 733 genes are exclusively regulated in HPL1D cells. The reasons for this differential response are not known. However, some of the genes exclusively regulated in A549 such as Integrin αV, thrombospondin 1 have been shown to aid tumor survival, maintenance and metastasis. In contrast, in HPL1D, TGF-β regulates tumor suppressor genes like WT1, ECM proteins like collagen which are responsible for arrest of cell growth and apoptosis. This differential gene regulation in normal and tumor cells may explain the dual role of TGF-β in carcinogenesis. The differences in the effects of TGF-β on these two cell-lines could be due to the phenotypic properties of these cells, HPL1D being a non-transformed cell-line and A549 being a transformed cell-line. It is also possible that the differences are due to cell-type specific effects. In order to address this question, expression profiling in response to TGF-β was carried out using another cell-line namely HaCaT, which is an immortalized skin keratinocyte cell-line. When the expression profiles of the three celllines namely HPL1D, HaCaT and A549 in response to TGF-β treatment were compared, it was found that the genes regulated by TGF-β can be divided into seven categories based on the cell-line in which they are regulated. In this comparison, it was seen that there were several genes which were regulated by TGF-β in A549 and HaCaT despite the fact that these two cell-lines have little in common. The reason for these two celllines to show similarities in their gene expression profile in response to TGF-β is unclear. When the genes regulated by TGF-β in the three cell-lines were categorized based on their annotated functions using the DAVID tool, it was found that signaling pathways like MAP kinas, focal adhesion, Wnt signaling are regulated by TGF-β in all the celllines. On the other hand, Integrin αV was found to be regulated in A549 and HaCaT cells and very marginal regulation was seen in HPL1D cells. This could be one of the reasons for the similarities between A549 and HaCaT. There are studies which show the role of Integrin αV in some of the TGF-β mediated actions although the mechanism by which Integrin signaling modulates gene expression is not well understood. Our data shows that indeed thrombospondin 1 which is regulated by TGF-β in A549 and HaCaT is regulated through the integrin signaling pathways as blocking this pathway partially blocks the induction of this gene by TGF-β. TGF-β actions on cells are to a large extent are carried out by the phosphorylation of SMAD 2/3 by activated TGF-β type I receptor upon TGF-β signaling. Several genes that are transcriptionally regulated by TGF-β contain a SMAD complex binding element (SBE). However, over the last few years, evidences have accumulated which suggest that some actions of TGF-β could be independent of SMADs, mediated by the other signaling pathways like the MAP kinas, PKC and others. In order to understand the mechanism of regulation of a few selected genes by TGF−β, inhibitors for the three MAP kinas pathways (p38, ERK and JNK) were used prior to treatment with TGF-β. The expression of these genes was assessed by qRT-PCR analyses. These studies showed that most of the genes regulated by TGF-β require one or more of the MAP kinas pathways. In HaCaT and A549, the number of genes dependent on the MAP kinas pathways is more compared to HPL1D. Based on our data, we propose that activated MAP kinas pathway could be one of the essential determining factors for the various differential actions of TGF-β in tumor cells. However, the reason for the behaviour of HaCaT cells, which are untransformed cells in a manner similar to the A549 cells, is still unclear. One of the reasons for the similarity could be the activation of the integrin signaling pathway as described before. The expression profiling data identified several novel targets of TGF-β. One such target is S100A2, a calcium binding protein containing an EF hand motif that has been implicated in cancer. A progressive reduction in the expression of this gene has been reported with increasing grade of the tumor. Our studies show that this gene is regulated by TGF-β in HaCaT and HPl1D, but not in A549 cells. The induction of S100A2 by TGF-β in HaCaT cells is likely to be transcriptional as it is sensitive to actinomycin treatment. We further investigated role of other signaling pathways in the regulation of S100A2 by TGF-β and found that the regulation of this gene by TGF-β depends on the ERK and also the integrin signaling pathways. In order to characterize this gene with respect to its functions, A549 cells were chosen as they have very low endogenous expression of S100A2. Hence, in order to explore if there is any role for the loss of S100A2 expression in the progression of A549 cells, we cloned the DNA of S100A2 in a mammalian expression vector, transected A549 cells with this and isolated clones stably expressing this gene. We performed assays to assess cell proliferation, cell migration and potential to form colonies in soft agar. The data suggests phenotypic differences in the colonies that formed in soft agar and no major differences in other assays. Overall, our data has identified several novel targets regulated by TGF-β other than S100A2 like IGFBP7, FGFR1, and SPUVE etc. Further, regulation of several genes was found to be in a cell type specific manner involving MAP kinase and integrin signaling pathways. This study also identified major differences in the genes regulated by TGF-β in transformed and non-transformed lung epithelial cells.

Η χρόνια νεφρική ανεπάρκεια οφείλεται σε διάφορα αίτια βλάβης του σπειράματος και του διαμεσοσωληναριακού χώρου. Χαρακτηρίζεται ιστολογικά από την παρουσία σοβαρού βαθμού σπειραματικής σκλήρυνσης, ίνωσης του διάμεσου ιστού, ατροφίας των ουροφόρων σωληναρίων και υαλίνωσης των αρτηριδίων. Η αρχική βλάβη του σπειράματος που προκαλείται από διάφορα είδη ερεθισμάτων μπορεί να ακολουθήσει την οδό της αποκατάστασης ή να εξελιχθεί προς σκλήρυνση, διαδικασίες στις οποίες συμμετέχουν κυτταροκίνες και αυξητικοί παράγοντες που προέρχονται από ενδοθηλιακά, μεσαγγειακά, επιθηλιακά σωληναριακά κύτταρα, μονοκύτταρα και ινοβλάστες1 . Ο Transforming Growth Factor-β1 (TGF-β1) είναι ο κυριότερος αυξητικός παράγοντας που μέσω πολλαπλών μηχανισμών συμμετέχει στην ανάπτυξη σκληρυντικών αλλοιώσεων2. Προάγει την παραγωγή συστατικών της εξωκυττάριας θεμέλιας ουσίας και μειώνει την αποικοδόμησή τους, προκαλεί ενεργοποίηση των μυοϊνοβλαστών, δηλαδή κυττάρων με μεταναστευτικές ιδιότητες που παράγουν κολλαγόνο, συμμετέχει στη διαφοροποίηση των επιθηλιακών σωληναριακών κυττάρων προς ινοβλάστες και ευοδώνει την κυτταρική απόπτωση η οποία οδηγεί στην απογύμνωση του νεφρικού ιστού από τα φυσιολογικά του κύτταρα. Η χρήση αντισωμάτων κατά του TGF-β1 και αναστολέων του μετατρεπτικού ενζύμου της αγγειοτενσίνης σε διάφορα πειραματικά μοντέλα νεφρικής βλάβης έχει συμβάλλει στην κατανόηση μηχανισμών που συμμετέχουν στη διαδικασία εξέλιξής της. Σε πειραματικά μοντέλα έχει διαπιστωθεί ότι ο TGF–β ευθύνεται για την αυξημένη παρουσία μυοινοβλαστών, την εναπόθεση κολλαγόνου και την απώλεια του σωληναριακού επιθηλίου. Πιο πρόσφατα, ένα μέλος της υπερ-οικογένειας των ΤGF–β, η ΒΜΡ7, φάνηκε να εξουδετερώνει την ίνωση που προκαλείται μέσω του TGF–β. Οι δραστηριότητα των παραγόντων αυτών ελέγχεται από άλλες πρωτείνες οι οποίες μπορούν να αυξήσουν ή να καταστείλουν τη διέγερση των υποδοχέων των παραγόντων αυτών. Τα BMPs είναι ενδογενή μόρια που προστατεύουν το νεφρό από διάφορα είδη βλάβης όπως γενετικές βλάβες, ανοσολογικές αντιδράσεις, περιβαλλοντικοί παράγοντες, μεταβολικά αίτια και καταστάσεις οξείας ή χρόνιας νεφρικής βλάβης. / -

La Fibrose Pulmonaire idiopathique (FPI) est une maladie fibroproliférative pour laquelle il n'existe aucun traitement efficace. Les mécanismes à l'origine de cette pathologie sont méconnus et impliquent plusieurs types cellulaires et facteurs de croissance, comme le TGF-β responsable de la différenciation de fibroblastes en myofibroblastes. Pour mieux comprendre ces mécanismes physiopathologiques, nous nous sommes intéressés à l'implication des miARN dans ce processus. Une analyse par puces à ADN de l'ensemble des miARN modulés dans des échantillons pulmonaires de souris, résistantes ou sensibles à la fibrose pulmonaire induite par la bléomycine, nous a permis d'identifier miR-199a-5p comme le meilleur candidat associé à la fibrose pulmonaire mais aussi fibrose rénale et hépatique. J'ai ensuite démontré que l'expression de miR-199a-5p était induite par le TGF-β in vitro, et que sa surexpression ectopique induisait la différenciation des fibroblastes. Une combinaison d'approche in silico et expérimentale, m'a permis d'identifier la Cavéoline-1 (CAV-1) comme cible de ce miARN. La CAV-1 est impliquée dans la dégradation du récepteur TGF-β. Ainsi, l'inhibition de CAV-1 par miR-199a-5p constitue une boucle de rétrocontrôle positif exacerbant la voie TGF-β. De manière intéressante, l'inhibition de miR-199a-5p in vitro régule la différenciation, la prolifération et la migration des fibroblastes pulmonaires par le TGF-β. Par ailleurs, nos résultats précliniques indiquent que l'inhibition de ce miARN diminue les marqueurs de fibrose, permettant d'envisager le développement de nouvelles approches thérapeutiques dans le traitement de la FPI et d'autres maladies fibroprolifératives.

With the dawn of metazoans, the ability of cells to communicate with each other became of paramount importance in maintaining tissue homeostasis. The transforming growth factor β (TGF-β) signaling pathway, which plays important roles during embryogenesis and in the adult organism, signals via a heterodimeric receptor complex consisting of two type II and two type I receptors. After receptor activation through ligand binding, Smads mediate the signal from the receptor complex to the nucleus, where they orchestrate transcription. Depending on the context of activation, TGF-β can mediate a plethora of cellular responses, including proliferation, growth arrest, apoptosis and differentiation. In cancer, TGF-β can act as both as a tumor suppressor and promoter. During early stages of tumorigenesis, TGF-β prevents proliferation. However, TGF-β is also known to promote tumor progression during later stages of the disease, where it can induce differentiation of cancer cells towards a migratory phenotype. The aim of this thesis was to investigate how cells can differentiate their response upon TGF-β pathway activation. The first paper describes the role of Notch signaling in TGF-β induced growth arrest, demonstrating that TGF-β promotes Notch activity and that Notch signaling is required for prolonged TGF-β induced cell cycle arrest. In the second and third paper, we investigate the role of SIK, a member of the AMPK family of kinases, mediating signaling strength of TGF-β through degradation of the TGF-β type I receptor ALK5. While the second paper focuses on the effect of SIK on ALK5 stability and subsequent alterations in TGF-β signaling, the third paper emphasizes cooperation between SIK, Smad7 and the E3 ligase Smurf in degradation of ALK5. Finally, the fourth paper explores a novel role of SIK during TGF-β induced epithelial to mesenchymal transition (EMT). SIK binds to and degrades the polarity protein Par3, leading to enhanced EMT.

Schistosomiasis is probably the main cause of pulmonary arterial hypertension (PAH) in the world. Splenectomy is used as treatment of upper gastrointestinal bleeding due to rupture of gastroesophageal varices secondary to schistosomal portal hypertension. However, it is a risk factor to PAH in others clinical scenarios, being possible that it increases the risk of PAH in mansonic schistosomiasis. The risk factors that determine the expression of PAH in some individuals with schistosomiasis are unknown. A role of the interleukyn (IL)-13 and transforming growth factor (TGF)-beta is suggested in the pulmonary vascular changes found in animal models of schistosomiasis. This thesis had the main objectives: verify the association of splenectomy and others risk factors with PAH in patients with hepatosplenic schistosomiasis and assess the seric levels of TGF-β and interleukin IL-13 in patients with schistosomal periportal fibrosis with and without PAH. The first article (Splenectomy and others risk factors to pulmonary hypertension associated to mansonic schistosomiasis) describes one case-control study that recruted patients evaluated in outpatient clinic of schistosomiasis in Hospital das Clínicas – Universidade Federal de Pernambuco and outpatient clinic of PAH reference center of Pronto Socorro Cardiológico de Pernambuco. Sixty four patients with hepatosplenic schistosomiaisis splenectomized or not with PAH defined by cardiac catheterization (mean pulmonary arterial pressure ≥25mmHg and pulmonary capillary wedge pressure ≤ 15mmHg) and 173 patients with hepatosplenic schistosomiaisis splenectomized or not, without PAH by transthoracic Doppler echocardiogram (pulmonary arterial systolic pressure ≤ 36mmHg) were enrolled. In the multivariate logistic regression model, splenectomy, thyroid disease increased levels of D dimer were independently associated with an increased risk of PAH. Adrenergic blockers use, previous schistosomal treatment and previous upper gastrointestinal bleeding were associated with a decreased risk of PAH. The second article (TGF-β and interleukin-13 in pulmonary arterial hypertension associated with mansonic schistosomiasis) describes a study conducted with 34 patients without PAH by transthoracic Doppler echocardiogram and 34 patients with PAH by right cardiac catheterization and both groups with schistosomal periportal fibrosis on abdominal ultrasound. They were submitted to assessment of seric dosage of TGF-β and IL-13 by ELISA. A significantly increased median of TGF-β in patients with PAH was found compared to patients without PAH (p=0.006). There was no significant difference regarding the difference between the median of IL-13 in patients with and without PAH (p>0.05). Conclusion: splenectomy and increased levels of D-dimer were independently associated with an increased risk of PAH, suggesting that a pro-thrombotic state occurs in these patients. Thyroid disease was other risk factor. However, previous schistosomal treatment, history of upper gastrointestinal bleeding and use of adrenergic blockers were associated with a decreased risk of PAH. TGF-β may contribute to PAH pathogenesis in schistosomiasis and could be a target of treatment in PAH associated with schistosmisiasis / Submitted by Ramon Santana (ramon.souza@ufpe.br) on 2015-03-10T17:56:58Z No. of bitstreams: 2 Tese Rita de Cassia Ferreira.pdf: 1872861 bytes, checksum: 4e248d94fe004ff410acc217cf930086 (MD5) license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) / Made available in DSpace on 2015-03-10T17:56:58Z (GMT). No. of bitstreams: 2 Tese Rita de Cassia Ferreira.pdf: 1872861 bytes, checksum: 4e248d94fe004ff410acc217cf930086 (MD5) license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Previous issue date: 2013-05-24 / CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) / A esquistossomose é provavelmente a maior causa de hipertensão arterial pulmonar (HAP) no mundo. A esplenectomia é utilizada no tratamento da hemorragia digestiva secundária à ruptura de varizes gastroesofágicas decorrente da hipertensão portal esquistossomótica, mas, é um fator de risco para HAP em outras situações, sendo possível que aumente o risco de HAP na esquistossomose. Não se sabe quais são os fatores de risco que determinam o aparecimento de HAP em alguns indivíduos com esquistossomose. Estudos em camundongos sugerem um papel para a interleucina (IL)-13 e o transforming growth factor (TGF)-β nas alterações vasculares pulmonares encontradas na HAP esquistossomótica. Esta tese teve como objetivos principais: verificar a associação da esplenectomia e outros fatores de risco com HAP em pacientes com esquistossomose hepatoesplênica e dosagem de TGF-β e IL-13 em pacientes com fibrose periportal esquistossomótica com e sem HAP. O primeiro artigo (Esplenectomia e outros fatores de risco para hipertensão arterial pulmonar associada à esquistossomose mansônica) descreve um estudo caso controle onde foram recrutados pacientes do ambulatório de esquistossomose do Hospital das Clínicas – Universidade Federal de Pernambuco e do ambulatório de HAP do Pronto Socorro Cardiológico de Pernambuco. Foram selecionados 64 pacientes com esquistossomose hepatoesplênica esplenectomizados ou não com HAP diagnosticada pelo cateterismo cardíaco (pressão média de artéria pulmonar ≥25mmHg e pressão diastólica final de ventrículo esquerdo ≤ 15mmHg) e 173 pacientes com esquistossomose hepatoesplênica esplenectomizados ou não, sem HAP no ecodopplercardiograma transtorácico (pressão sistólica de artéria pulmonar ≤ 36mmHg). As variáveis independentemente associadas com risco aumentado de HAP no modelo multivariado de regressão logística foram: esplenectomia, tireoidopatia e níveis aumentados de D-dímeros. O uso de bloqueadores adrenérgicos, história de tratamento prévio para esquistossomose e história de hemorragia digestiva alta foram associados com um risco reduzido de HAP. O segundo artigo (TGF-β e interleucina-13 na hipertensão arterial pulmonar associada à esquistossomose mansônica) descreve um estudo onde foram recrutados 34 pacientes sem HAP no ecodopplercardiograma transtorácico e 34 pacientes com HAP confirmada pelo cateterismo cardíaco direito e todos com fibrose periportal na ultrassonografia de abdome que tiveram as dosagens séricas de TGF-β e IL-13 realizadas através de ELISA. Uma mediana significativamente maior de TGF-β foi encontrada em pacientes com HAP em relação aos pacientes sem HAP (p=0,006). Não houve diferença significativa entre a mediana de IL-13 nos pacientes com ou sem HAP (p>0,05). Conclusões: Esplenectomia e elevação de Ddímeros foram associados a um risco aumentado de HAP, sugerindo um estado prótrombótico nestes pacientes. História de tireoidopatia também foi fator de risco. Pacientes com história de tratamento para esquistossomose, história de hemorragia digestiva alta e uso de bloqueadores adrenérgicos tiveram menor chance de desenvolver HAP. TGF-β tem um possível papel na patogênese da HAP na esquistossomose e pode vir a ser alvo de terapia na HAP associada à esquistossomose.

Dysregulated wound healing is commonly associated with excessive fibrosis. Connective tissue growth factor (CTGF/CCN2) is characteristically overexpressed in fibrotic diseases and stimulated by transforming growth factor-β (TGF-β) in dermal fibroblasts. Reepithelialisation and epidermal wound coverage counteract excessive scar formation. We have previously shown that interleukin-1α (IL-1α) derived from keratinocytes conteracts TGF-β-stimulated CTGF-expression. The aim of this thesis was to further explore the effects of keratinocytes and IL-1α on gene and protein expression, as well as pathways, in TGF-β stimulated fibroblasts. Fibroblasts were studied in vitro by conventional two dimensional cell culture models and in a three dimensional keratinocyte-fibroblast organotypic skin culture model. The results showed that IL-1 suppresses basal and TGF-β-induced CTGF mRNA and protein, involving a possible TAK1 mechanism. Keratinocytes regulate the expression of fibroblast genes important for the turnover of the extracellular matrix. Most of the genes analysed (11/13) were regulated by TGF-β and counter regulated by keratinocytes. The overall results support a view that keratinocytes regulate fibroblasts to act catabolically (anti-fibrotic) on the extracellular matrix. Transcriptional microarray and gene set enrichment analysis showed that antagonizing effects of IL-1α on TGF-β were much more prominent than the synergistic effects. The most confident of these pathways was the interferon signaling, which were inhibited by TGF-β and activated by IL-1α. A proteomics study confirmed that IL-1α preferentially conteracts TGF-β effects. Six new fibroblast proteins involved in synthesis/ regulation were identified, being regulated by TGF-β and antagonized by IL-1α. Pathway analysis confirmed counter-regulation of interferon signaling by the two cytokines. These findings have implications for understanding the role of fibroblasts for inflammatory responses and development of fibrosis in the skin.

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