La barrière hémato-encéphalique (BHE) contrôle le passage des médicaments, en partie par la présence d’ATP Binding Cassette (ABC) transporteurs. Dans de nombreuses pathologies cérébrales, la BHE est altérée. Parmi elles, les hémorragies intracérébrales (HIC), qui sont un effet iatrogène des anticoagulants. Des analyses cliniques montrent que les patients sous Anticoagulants Oraux Directs (AODs) présentent moins d’HIC que les patients traités avec les anticoagulants de référence, les anti-vitamine K (AVK), sans que les mécanismes cellulaires soient élucidés. Une des différences entre les AODs et les AVK résident dans leur profil pharmacocinétique, effectivement, les AODs sont des substrats des ABC transporteurs contrairement aux AVKs. Au cours des HIC, la thrombine est activée et entraine une altération de la BHE par clivage et des récepteurs protease activated receptor (PAR). Les objectifs de ce travail de thèse ont été de mettre en place un modèle in vitro de BHE afin d’étudier les interactions des médicaments avec les ABC transporteurs. Ensuite, le modèle est utilisé pour étudier les interactions des AODs en condition pathologique. Le modèle développé est basé sur la lignée HBEC-5i, peu décrite dans la littérature. Les cellules ont été cultivées en monocouche sur insert avec milieu conditionné issu d’astrocytes humains. Le modèle permet l’étude de l’interaction de thérapeutiques avec des ABC transporteurs par des mesures d’efflux ratios. Le modèle a été validé par des études de transport de molécules pharmacologiques. Ensuite, nous avons comparé, sur notre modèle, les effets de l’exposition à la thrombine avec ou sans prétraitement d’anticoagulants (rivaroxaban, dabigatran, apixaban, warfarine et héparine). Les AODs limitent l’ouverture de la BHE induite par la thrombine contrairement aux autres anticoagulants. Nos résultats ont montré que l’altération de la BHE est médiée par le clivage du récepteur PAR-1 par la thrombine. Ce clivage n’est pas le même en fonction de la classe d’anticoagulants utilisée, les AODs minimisant ce clivage. L’ensemble de ce travail de thèse a permis de donner des premières explications cellulaires quant aux mécanismes d’ouverture de la BHE consécutifs aux HIC sous AODs. / The blood-brain barrier (BBB) controls the passage of drugs, in part through the expression of the ATP Binding Cassette (ABC) transporters. In many brain diseases, the BBB is altered. Among them, intracerebral haemorrhages (ICH), which are an iatrogenic effect of anticoagulants. Clinical analyses show that patients with Direct Oral Anticoagulants (DOACs) treatment have less HIC than patients treated with the reference anticoagulants, Vitamin K Antagonist (VKA), without understanding the cellular mechanisms. One of the differences between DOACs and VKA lies in their pharmacokinetic profile, indeed, DOACs are substrates of ABC transporters unlike VKA. During HIC, thrombin, is activated and causes alterations in the BBB by the cleavage of the protease activated receptor (PAR). The objectives of this thesis work were first to set up an in vitro model of the BBB in order to study the passage of drugs and their interactions with ABC transporters. In a second step, the model is used to study the interactions of DOACs in pathological conditions. The model developed is based on the HBEC-5i cell line seldom described in the literature. The cells were cultured in monolayer on insert with conditioned medium from human astrocytes. It allows the study of the interaction of therapeutics with ABC transporters by measuring efflux ratios. The model has been validated by transport studies of pharmacological molecules. In order to meet our second objective, we compared the effect of thrombin exposure with or without pretreatment with anticoagulants (rivaroxaban, dabigatran, apixaban, warfarin and heparin sodium) on our model. DOACs limit the BBB damage induced by the thrombin unlike other anticoagulants. Our results showed that alteration of the BBB is mediated by the cleavage of the PAR-1 receptor by thrombin. This cleavage is not the same depending on the class of anticoagulants used, DOACs minimizing this cleavage. All this thesis work made it possible to provide the first cellular explanations of the opening mechanisms of the BBB following HIC under DOACs.

Produtos de glicação avançada (AGE) prejudicam o metabolismo de lipoproteínas e o transporte reverso de colesterol, o que contribui para a aterosclerose no diabete melito (DM). Em particular, a albumina modificada por AGE (albumina-AGE) reduz a remoção de colesterol por diminuir o conteúdo do receptor ABCA-1 em macrófagos. Isto se vincula ao insulto oxidativo e inflamatório, os quais são indutores do estresse do retículo endoplasmático (RE). O objetivo do presente estudo foi avaliar, em macrófagos, os efeitos do tratamento com albumina-AGE sobre o estresse do RE e suas vias adaptativas (UPR), relacionando-os com o prejuízo na expressão do ABCA-1 e efluxo de colesterol celular. Albumina-AGE foi produzida pela incubação de albumina isenta em ácidos graxos com glicolaldeído 10 mM e, albumina controle (albumina-C) com PBS apenas. Albumina foi isolada do soro de pacientes portadores de DM com controle glicêmico inadequado (albumina-DM) ou indivíduos controles (albumina não- DM) por cromatografia para separação rápida de proteínas seguida por purificação alcoólica. Macrófagos de peritônio de camundongos ou macrófagos da linhagem J774 foram tratados com os diferentes tipos de albumina na presença ou ausência de ácido fenil butírico (PBA; chaperona química que alivia o estresse do RE) ou MG-132 (inibidor do sistema proteasomal) por diferentes intervalos de tempo. A expressão de marcadores do estresse do RE, UPR, proteína dissulfeto isomerase (PDI), calreticulina e ubiquitina foi determinada por imunoblot e o conteúdo de ABCA-1, por citometria de fluxo e imunocitoquímica. O efluxo de 14Ccolesterol foi avaliado, utilizando-se apoA-I como aceptora de colesterol. A albumina-AGE induziu aumento tempo-dependente na expressão das chaperonas marcadoras do estresse do RE - Gr78 e Grp94 - e de proteínas da UPR (ATF6 e eIF2-P) em comparação à albumina-C. O conteúdo de ABCA-1 e o efluxo de colesterol foram reduzidos em, respectivamente, 33% e 47% e ambos foram restaurados pelo tratamento com PBA, o qual também reduziu o estresse do RE. A associação entre estresse de RE e redução de ABCA-1 foi confirmada pelo uso da tunicamicina (indutor clássico de estresse do RE), que diminuiu em 61% o conteúdo de ABCA-1, prejudicando em 82% o efluxo de colesterol. A albumina-AGE aumentou o conteúdo total de ubiquitina. A inibição do sistema proteasomal não foi capaz de restaurar o conteúdo de ABCA-1 em células tratadas com albumina-AGE. Em macrófagos expostos à albumina-DM evidenciou-se maior expressão da PDI e calreticulina, com tendência à maior expressão da Grp94. A albumina-AGE (produzida in vitro ou isolada de portadores de DM) induz estresse de RE, o qual se vincula à redução no conteúdo de ABCA-1 e efluxo de colesterol. Estes eventos podem contribuir para a aterosclerose no DM. Chaperonas químicas, que aliviam o estresse do RE, podem ser ferramentas úteis na prevenção e tratamento da aterosclerose / Advanced glycation end products (AGE) disturb lipoprotein metabolism and reverse cholesterol transport, contributing to atherosclerosis in diabetes mellitus (DM). Particularly, advanced glycated albumin (AGE-albumin) reduces cell cholesterol removal by impairing the expression of ABCA-1 in macrophages. This is ascribed to the oxidative and inflammatory stress, conditions that elicit endoplasmic reticulum (ER) stress. In this study it was investigated the effect of AGE-albumin on ER stress and adaptative pathways (UPR) development in macrophages, and its relationship to the reduction in ABCA-1 expression and cholesterol efflux. AGE-albumin was prepared by incubating fatty acid free albumin with 10 mM glycolaldehyde and control albumin (C-albumin) with PBS only. Albumin was isolated from poorly controlled DM patients (DM-albumin) and control individuals (nonDMalbumin) by fast liquid chromatography and purified by alchoolic extraction. Mouse peritoneal macrophages or J774 cells were treated along time with the different types of albumin in the absence or presence of phenyl butiric acic (PBA; a chaperone that aleviates ER stress) or MG132 (a proteasomal inhibitor). The expression of ER stress and UPR markers, protein disulfide isomerase (PDI), calreticulin and ubiquitin was determined by immunoblot and ABCA-1 protein level, by flow cytometry and imunocytochemistry. 14Ccholesterol efflux was evaluated utilizing apo A-I as cholesterol acceptor. AGE-albumin induced a time-dependent increase in the expression of ER stress chaperone markers - Gr78 and Grp94 - and UPR proteins (ATF6 and eIF2-P) in comparison to C-albumin. ABCA-1 content and cholesterol efflux were diminished by, respectively, 33% and 47% and both were recovered by the treatment with PBA. The association between ER stress and ABCA-1 reduction was confirmed by the reduction, induced by tunicanycin (a classical ER stress inductior) in ABCA-1 protein level (61%) and cholesterol efflux (82%). AGE-albumin increased the amount of cellular total ubiquitin. The inhibiton of proteasomal system was unable to restore ABCA-1 protein level in cells treated with AGE-albumin. In macrophages exposed to DM-albumin a higher expression of PDI and calreticulin was observed together with a trend of enhanced Grp94 expression. In conclusion, AGE-albumin (produced in vitro or isolated from DM patients) induces ER stress which is related to the reduction in ABCA-1 level and cholesterol efflux in macrophages. These events can contribute to atherosclerosis in DM. Chemical chaperones that alleviate ER stress may be useful in the prevention and treatment of atherosclerosis

Este estudo investigou o efeito da glicose sobre a atividade e expressão da isoforma 1 do trocador Na+/H+ (NHE1) e da H+-ATPase do tipo vacuolar, em células MDCK (Mardin Darby Canine Kidney), linhagem derivada de rim de cão, que apresenta características similares às células principais e intercalares das porções distais do néfron. Por microscopia de fluorescência, se avaliou a velocidade de recuperação do pHi (dpHi/dt) e a capacidade tamponante (<font face=\"symbol\">bi). A partir desses parâmetros, se calculou o efluxo de H+ (JH+). Por Western blot, se avaliou a expressão de NHE1 e da subunidade E da H+-ATPase do tipo vacuolar. Resultados: Na condição controle o efluxo de H+ foi de 6.27 ± 0.51 mM/min (n = 9). O tratamento agudo com glicose (25 mM) aumentou o efluxo de H+ via NHE1, o qual foi modulado pela PI3 cinase. Na mesma condição, não se observou alterações na atividade da H+-ATPase. O tratamento crônico com glicose (25 mM) induziu significante aumento do efluxo de H+, via NHE1 e H+-ATPase. O efeito estimulador da glicose sobre a atividade de NHE1 e H+-ATPase foi dependente da atividade da p38 MAP cinase. Além disso, o tratamento crônico com glicose (25 mM) induziu fosforilação do sistema ezrin/radixin/moesin (ERM) e Akt. Conclusões: Nossos resultados indicam que no tratamento agudo com glicose (25 mM), o NHE1 foi modulado pela PI3 cinase. Contudo, no tratamento crônico com glicose (25 mM), a atividade do NHE1 foi modulada pelo sistema ERM/Akt e a atividade da H+-ATPase foi modulada pela p38 MAP cinase. / This study investigated the effect of glucose on the activity and expression of Na+/H+ exchanger isoform 1 (NHE1) and vacuolar H+-ATPase, in Mardin Darby Canine Kidney (MDCK) cells from dog kidney, with similar characteristics to principal and intercalated cells of the distal nephron. The pHi recovery rate (dpHi/dt) and the buffering capacity (<font face=\"symbol\">bi) was evaluated through fluorescence microscopy. From these parameters the H+ efflux (JH+) was calculated. By Western blot, the NHE1 and H+-ATPase (E subunit) expression was evaluated. Results: In the control situation the H+ efflux was 6.27 ± 0.51 mM/pH units (n = 9). Acute treatment with glucose (25 mM) increased the H+ efflux via NHE1, which was modulated by PI3 kinase. In the same condition, the H+-ATPase activity did not change. Chronic treatment with glucose (25 mM) induced significant increase in H+ efflux via NHE1 and H+-ATPase. The stimulatory effect of glucose on the NHE1 and H+-ATPase activity was dependent on p38 MAP kinase activity. Furthermore, chronic treatment with glucose (25 mM) induced Ezrin/radixin/moesin (ERM) and Akt phosphorylation. Conclusions: Our results indicate that during the acute treatment with glucose (25 mM), the NHE1 is modulated by PI3 kinase. However, during chronic treatment with glucose (25 mM), NHE1 activity was modulated by the ERM/Akt system and of H+-ATPase activity was modulated by p38 MAP Kinase.

Os transportadores da família ABC são proteínas transmembrânicas envolvidas com o tráfego de substâncias endógenas e exógenas do meio intracelular para o extracelular, sendo alvos de estudo na resistência celular a agentes quimioterápicos. O ABCC2 é um transportador transmembrânico que exporta ativamente fármacos aniônicos conjugados e facilita o transporte de agentes anticâncer. O ABCG2 é outro transportador transmembrânico que tem influência na farmacocinética e farmacodinâmica de certos xenobióticos e substratos endógenos; além disso, acredita-se que este gene contribui para a resistência a várias drogas. Por esses motivos identificamos por sequenciamento ou PCR-RFLP os polimorfismos dos genes ABCC2 (Val417Ile, Ser789Phe e Ala1450Thr) e ABCG2 (Val12Met, Gly126stop códon, Gly141Lys) em 90 pacientes portadores de carcinoma epidermóide de cabeça e pescoço (HNSCC) e tentamos correlacionar a presença do polimorfismo com resposta a tratamento que incluiu cisplatina em todos os pacientes. Não encontramos nenhuma correlação entre a presença de polimorfismo para Val12Met, Gly141Lys e Val417Ile, determinados em 68 pacientes tratados exclusivamente com cisplatina e radioterapia, e a resposta ao tratamento. As curvas de sobrevida, determinadas por Kaplan-Meier, considerando polimórfico os pacientes que continham pelo menos um dos alelos alterados e selvagem os que não tivessem nenhum deles, mostraram que os pacientes selvagens para o polimorfismo Val12Met tiveram tendência a uma pior sobrevida (sobrevida mediana de 18,7 meses) em relação aos pacientes polimórficos (sobrevida mediana não atingida; P=0,089 Teste de log-rank), já os pacientes selvagens para o polimorfismo Gly141Lys tiveram tendência a uma pior sobrevida (sobrevida mediana de 15,8 meses) em relação aos pacientes polimórficos (sobrevida mediana de 25,6 meses; P = 0,16 Teste de logrank). Não observamos correlação entre os outros polimorfismos e sobrevida. Quanto ao GLY126stop, somente um paciente foi identificado como polimórfico. Conclusões: No nosso estudo, a freqüência do polimorfismo Val12Met de 10% está próxima dos 18% descrito na população normal (Kobayashi 2004). Nosso trabalho foi o primeiro a correlacionar estes polimorfismos com resposta ao tratamento em pacientes com carcinoma epidermóide de cabeça e pescoço e indica que Val12Met e Gly141Lys e o gene ABCG2 como um todo são candidatos a um estudo maior / ATP binding cassette (ABC) transporters form one of the largest transmembrane protein families. These proteins use cellular ATP to drive the transport of various substrates across cell membranes including many exogenous and endogenous compounds, which includes drugs used in cancer treatment. ABCC2 is an ATP binding cassette transporter which accepts a diverse range of substrates, including glutathione, glucuronide, and sulfate conjugates of many metabolites and xenobiotics. ABCG2 is a member of the ATP binding cassette (ABC) transporters whose function is to pump out of the cell a wide variety of endogenous and exogenous compounds. Widely expressed in stem cells, ABCG2 is also recognized as a universal marker of stem cells. For these reasons we had identified the following polymorphisms of ABCC2 gene: -Val417Ile, Ser789Phe and Ala1450Thr- and of ABCG2 gene as well: -Val12Met, Gly126stop códon, Gly141Lys in 88 patients with head and neck squamous cell carcinoma (HNSCC). Methodology included PCR - RFLP and direct sequencing. Survival analysis was done using Kaplan-Meier curves and response measured by RECIST criteria. Comparisons were done between polymorphic patients in which at least one polymorphism was present as opposed to the patients without the polymorphism. Correlation with response to treatment was studied for Val12Met, Gly141Lys e Val417Il in 68 patients exclusively treated with concomitant cisplatin and radiotherapy and no correlation was found between these markers and treatment response. Patients without the Val12Met presented a trend towards shorter survival (median survival 18.7 months) as compared to polymorphic patients (median survival not reached, long rank p= 0.089). Although statistical significance was not reached, patients wild type for Gly141Lys polymorphism (median survival 15.8 months) had shorter survival than polymorphic patients (25.6 months, p=0.16). We did not observe any other correlation between other polymorphisms and survival. With respect to Gly126stop, only one patient was identified as polymorphic and survival analysis was not possible. As far as we know this is the first study to try to correlate these polymorphisms with treatment response and survival in HNSCC patients. Although we were unable to draw any definitive conclusions, our results indicate that Val12Met and Gly141Lys deserve to be further studied in the future.

La caractéristique neuropathologique majeure de la maladie de Parkinson (MP) est la perte progressive des neurones dopaminergiques (DA) de la substance noire (SN). Nous avons examiné si un dysfonctionnement aigu des EAATs pourrait contribuer au cercle vicieux entretenant la progression des pertes DA. Les effets du PDC, un inhibiteur substrat des EAATs, ont été analysés chez le rat. L'analyse cinétique (4-120 jours) des effets d'une seule injection intranigrale de PDC montre une perte progressive spécifique des neurones DA, avec une évolution unilatérale vers bilatérale et caudo-rostrale. Le processus dégénératif associe déplétion en glutathion et augmentation de l'activité de la γ-glutamyltranspeptidase, stress oxydatif, processus excitotoxiques, autophagie et réactivités gliales. L'antioxydant N-acétylcystéine et les antagonistes des récepteurs NMDA ifenprodil et mémantine exercent un effet neuroprotecteur. Des effets compensatoires transitoires au niveau de marqueurs de la fonction DA dans la SN et le striatum accompagnent la perte cellulaire et des dystrophies axonales. Des troubles moteurs apparaissent de façon tardive lorsque la perte neuronale ipsilatérale avoisine les 50%. Ces résultats montrent un lien fonctionnel entre dysfonctionnement des EAATs et plusieurs mécanismes pathogéniques ainsi que des caractéristiques neuropathologiques majeures de la MP, et fournissent le premier modèle progressif de la maladie induit de façon aiguë. / Parkinson's disease (PD) is characterized by the progressive degeneration of substantia nigra (SN) dopaminergic neurons. Central players in PD pathogenesis, including mitochondrial dysfunction and oxidative stress, might affect the function of excitatory amino acid transporters (EAATs). Here, we investigated whether acute EAATs dysfunction might in turn contribute to the vicious cycles sustaining the progression of dopamine neuron degeneration. PDC application on nigral slices triggered sustained glutamate-mediated excitation selectively in dopamine neurons. In vivo time-course study (4-120 days) revealed that a single intranigral PDC injection triggers progressive degeneration of exclusively dopamine neurons with unilateral to bilateral and caudorostral evolution. This degenerative process associates GSH depletion and specific increase in γ-glutamyltranspeptidase activity, oxidative stress, excitotoxicity, autophagy and glial reaction. The anti-oxidant N-acetylcysteine and the NMDA receptor antagonists ifenprodil and memantine provided significant neuroprotection Transient compensatory changes in dopamine function markers in SN and striatum accompanied cell loss and axonal dystrophy. Motor abnormalities (hypolocomotion and forelimb akinesia) showed late onset, when ipsilateral neuronal loss exceeded 50%. These findings outline a functional link between EAATs dysfunction and several PD pathogenic mechanisms and pathological hallmarks, and provide the first acutely-triggered rodent model of progressive parkinsonism.

Les ganglions de la base (GB) sont un ensemble de noyaux sous-corticaux impliqués dans les fonctions motrices, mnésiques et cognitives. Le globus pallidus externe (GPe) est un noyau GABAergique, qui tient la place de structure relais entre le striatum et le noyau sous-thalamique au sein du réseau des GB. Les changements de mode et de fréquence de décharge des neurones du GPe sont connus pour être les signatures électro-physiologiques des maladies de Parkinson (MP) et de Huntington (MH). Dans la MP, où les concentrations de GABA extracellulaires sont anormalement élevées dans le GPe, il est admis que la voie striato-pallidale (STR-GPe) est hyperactive, ce qui contribue à l’hypoactivité des neurones pallidaux. A l’inverse dans la MH, il est admis que l’hyperactivité des neurones du GPe est due à la dégénérescence de la voie STR-GPe levant la principale influence inhibitrice du GPe. Cependant, les mécanismes moléculaires impliqués dans ces changements d’activité pallidale sont encore peu connus. Nous avons donc entrepris des expériences de biologie moléculaire, d’immunohistochimie et d’électrophysiologie sur tranches, afin de mieux caractériser l’origine des modifications de transmission GABAergique conduisant aux changements d’activité électro-physiologique des neurones du GPe dans ces deux pathologies à l’aide de modèles animaux. Mes principaux résultats montrent l’apparition d’une inhibition tonique dans les neurones du GPe due à un déficit de recapture du GABA dans la MP et une réduction précoce de la transmission synaptique GABAergique dans la MH. Ces résultats suggèrent que les altérations de la transmission GABAergique contribuent à la physiopathologie de la MP et la MH. / The basal ganglia (BG) are a group of sub-cortical nuclei involved in motor, memory and cognitive functions. In the BG, the GABAergic external globus pallidus (GPe) holds a position of relay nucleus between the striatum (STR) and the sub thalamic nucleus within the indirect pathway of the BG. Modifications of rate and pattern of activity of this nucleus are known to be the electrophysiological signatures of Parkinson’s (PD) and Huntington’s diseases (HD). In PD, hyperactivity of the striato-pallidal (STR-GPe) pathway is thought to be responsible for the increase of the extracellular GABAergic concentrations in the GPe and participate to the hypoactivity of pallidal neurons observed in experimental Parkinsonism. In contrast, during HD, it is recognized that the hyperactivity of GPe neurons is due to the degeneration of striato-pallidal neurons and thus to the reduction of the main source of pallidal GABAergic inhibition. However, the molecular mechanisms involved in these modifications of pallidal activity are not well characterized. Therefore, using PD and HD animal models, the 6-OHDA rodents and the R6-1 transgenic mice respectively, we have performed molecular biology, immunohistochemistry and electrophysiological in vitro experiments in order to better understand the origin of GABAergic transmission alterations leading to changes in electrophysiological activity of GPe neurons into these two pathologies. My main results show the apparition of a tonic GABAergic inhibition due to a deficit of GABA uptake in PD and a early stage reduction of GABAergic synaptic transmission in HD. Altogether, these results suggest that alterations of GABAergic transmission contribute to the pathophysiology of PD and HD.

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

One major reason of CNS pharmacotherapy's impediment is the existence of "barriers" between blood and CNS, especially the Blood-Brain Barrier (BBB), a neurovascular structure localized at the level of brain microvasculature. Main factors responsible for this barrier function are drug efflux transporters type ABC (ATP-Binding Cassette) and SLC (SoLute Carrier) expressed at BBB level and known to be at the origin of multi-drug resistance phenomenon. Recent researches aim at unraveling the signaling mechanisms regulating these transporters in order to modulate their activity and improve pharmacotherapy in brain diseases. For years, these transporters have been studied in adult organism. But, there is a wide spread belief that the BBB in embryo, fetus, new born and infant is "immature", implying caution in giving drugs to infants. However, current knowledge on the functional status of the BBB in immature organism remains very limited.This study was performed in the aim of understanding: 1) The ontogenesis of ABC and SLC transporters during brain maturation, 2) the functional role of four BBB drug efflux transporters (P-glycoprotein (P-gp), Breast Cancer Resistance Protein (bcrp), Organic Anion Transporter 3 (oat3), and Transporting Peptide 1a4 (oatp1a4) transporters) in children's brain, and 3) the mechanisms that regulate their functional expression under normal and pathological conditions, mostly under inflammatory conditions, because indeed alterations in structural and functional components of the BBB have been reported in a long list of CNS pathologies in adults. Our results showed changing properties of the BBB during ontogenesis, as well as an age-related differential regulation of BBB drug efflux transporters under normal and inflammatory conditions.These findings highlight the importance of considering an age-related response of CNS to drugs and of taking into account the specific properties of juvenile BBB during definition of therapeutic strategies designed to treat childhood brain diseases, and this in the clinical perspective of developing new drugs with enhanced efficacy in children's CNS.

En lien avec l’augmentation constante de l’obésité, de plus en plus de personnes sont atteintes de résistance à l’insuline ou de diabète de type 2. Ce projet doctoral s’est surtout intéressé à l’une des conséquences majeures des pathologies cardiométaboliques, soit la dyslipidémie diabétique. À cet égard, les gens présentant une résistance à l’insuline ou un diabète de type 2 sont plus à risque de développer des perturbations lipidiques caractérisées essentiellement par des taux élevés de triglycérides et de LDL-cholestérol ainsi que de concentrations restreintes en HDL-cholestérol dans la circulation. Les risques de maladies cardiovasculaires sont ainsi plus élevés chez ces patients. Classiquement, trois organes sont connus pour développer l’insulino-résistance : le muscle, le tissu adipeux et le foie. Néanmoins, certaines évidences scientifiques commencent également à pointer du doigt l’intestin, un organe critique dans la régulation du métabolisme des lipides postprandiaux, et qui pourrait, conséquemment, avoir un impact important dans l’apparition de la dyslipidémie diabétique. De façon très intéressante, des peptides produits par l’intestin, notamment le GLP-1 (glucagon-like peptide-1), ont déjà démontré leur potentiel thérapeutique quant à l’amélioration du statut diabétique et leur rôle dans le métabolisme intestinal lipoprotéinique. Une autre évidence est apportée par la chirurgie bariatrique qui a un effet positif, durable et radical sur la perte pondérale, le contrôle métabolique et la réduction des comorbidités du diabète de type 2, suite à la dérivation bilio-intestinale. Les objectifs centraux du présent programme scientifique consistent donc à déterminer le rôle de l’intestin dans (i) l’homéostasie lipidique/lipoprotéinique en réponse à des concentrations élevées de glucose (à l’instar du diabète) et à des peptides gastro-intestinaux tels que le PYY (peptide YY); (ii) la coordination du métabolisme en disposant de l’AMPK (AMP-activated protein kinase) comme senseur incontournable permettant l’ajustement précis des besoins et disponibilités énergétiques cellulaires; et (iii) l’ajustement de sa capacité d’absorption des graisses alimentaires en fonction du gain ou de la perte de sa sensibilité à l’insuline démontrée dans les spécimens intestinaux humains prélevés durant la chirurgie bariatrique. Dans le but de confirmer le rôle de l’intestin dans la dyslipidémie diabétique, nous avons tout d’abord utilisé le modèle cellulaire intestinal Caco-2/15. Ces cellules ont permis de démontrer qu’en présence de hautes concentrations de glucose en basolatéral, telle qu’en condition diabétique, l’intestin absorbe davantage de cholestérol provenant de la lumière intestinale par l’intermédiaire du transporteur NPC1L1 (Niemann Pick C1-like 1). L’utilisation de l’ezetimibe, un inhibiteur du NPC1L1, a permis de contrecarrer cette augmentation de l’expression de NPC1L1 tout comme l’élévation de l’absorption du cholestérol, prouvant ainsi que le NPC1L1 est bel et bien responsable de cet effet. D’autre part, des travaux antérieurs avaient identifié certains indices quant à un rôle potentiel du peptide intestinal PYY au niveau du métabolisme des lipides intestinaux. Toutefois, aucune étude n’avait encore traité cet aspect systématiquement. Pour établir définitivement l’aptitude du PYY à moduler le transport et le métabolisme lipidique dans l’intestin, nous avons utilisé les cellules Caco-2/15. Notre étude a permis de constater que le PYY incubé du côté apical est capable de réduire significativement l’absorption du cholestérol et le transporteur NPC1L1. Puisque le rôle de l'AMPK dans l'intestin demeure inexploré, il est important non seulement de définir sa structure moléculaire, sa régulation et sa fonction dans le métabolisme des lipides, mais aussi d'examiner l'impact de l’insulino-résistance et du diabète de type 2 (DT2) sur son statut et son mode d’action gastro-intestinal. En employant les cellules Caco-2/15, nous avons été capables de montrer (i) la présence de toutes les sous-unités AMPK (α1/α2/β1/β2/γ1/γ2/γ3) avec une différence marquée dans leur abondance et une prédominance de l’AMPKα1 et la prévalence de l’hétérotrimère α1/β2/γ1; (ii) l’activation de l’AMPK par la metformine et l’AICAR, résultant ainsi en une phosphorylation accrue de l’enzyme acétylCoA carboxylase (ACC) et sans influence sur l'HMG-CoA réductase; (iii) la modulation négative de l’AMPK par le composé C et des concentrations de glucose élevées avec des répercussions sur la phosphorylation de l’ACC. D’autre part, l’administration de metformine au Psammomys obesus, un modèle animal de diabète et de syndrome métabolique, a conduit à (i) une régulation positive de l’AMPK intestinale (phosphorylation de l’AMPKα-Thr172); (ii) la réduction de l'activité ACC; (iii) l’augmentation de l’expression génique et protéique de CPT1, supportant une stimulation de la β-oxydation; (iv) une tendance à la hausse de la sensibilité à l'insuline représentée par l’induction de la phosphorylation d'Akt et l’inactivation de la phosphorylation de p38; et (v) l’abaissement de la formation des chylomicrons ce qui conduit à la diminution de la dyslipidémie diabétique. Ces données suggèrent que l'AMPK remplit des fonctions clés dans les processus métaboliques de l'intestin grêle. La preuve flagrante de l’implication de l’intestin dans les événements cardiométaboliques a été obtenue par l’examen des spécimens intestinaux obtenus de sujets obèses, suite à une chirurgie bariatrique. L’exploration intestinale nous a permis de constater chez ceux avec un indice HOMA élevé (marqueur d’insulinorésistance) (i) des défauts de signalisation de l'insuline comme en témoigne la phosphorylation réduite d'Akt et la phosphorylation élevée de p38 MAPK; (ii) la présence du stress oxydatif et de marqueurs de l'inflammation; (iii) la stimulation de la lipogenèse et de la production des lipoprotéines riches en triglycérides avec l’implication des protéines clés FABP, MTP et apo B-48. En conclusion, l'intestin grêle peut être classé comme un tissu insulino-sensible et répondant à plusieurs stimuli nutritionnels et hormonaux. Son dérèglement peut être déclenché par le stress oxydatif et l'inflammation, ce qui conduit à l'amplification de la lipogenèse et la synthèse des lipoprotéines, contribuant ainsi à la dyslipidémie athérogène chez les patients atteints du syndrome métabolique et de diabète de type 2. / In relation with the constant increase in obesity, more and more people suffer from insulin resistance and type 2 diabetes (DT2). This doctoral research program especially emphasizes lipid disorders, one of the major consequences of cardiometabolic diseases. In this respect, people with insulin resistance or DT2 are at higher risk of developing lipid disturbances characterized mainly by high levels of triglycerides and LDL-cholesterol concentrations and HDL cholesterol in the blood circulation. The risks of cardiovascular disease are higher in these patients. Classically, three organs are known to develop insulin resistance: muscle, adipose tissue and liver. Nevertheless, important studies begin to point out the small intestine as a major organ in the regulation of postprandial lipids, which may have a significant impact on the development of diabetic dyslipidemia. In addition, the intestine produces peptides, including GLP-1 (glucagon-like peptide-1), that have already demonstrated their therapeutic potential with regard to diabetic status and intestinal lipoprotein metabolism. Further evidence is also is provided by the advent of bariatric surgery that has a positive effect on radical and sustainable weight loss, metabolic control and reduction of comorbidities of DT2, following biliopancreatic diversion. The central objectives of this scientific program are therefore to determine the role of the intestine in (i) lipid/ lipoprotein homeostasis in response to high concentrations of glucose (mimicking diabetes) and to gastrointestinal peptides such as PYY; (ii) the coordination of metabolism by involving AMPK (AMP-activated protein kinase) as an essential sensor for fine tuning of cellular energy needs; and (iii) adjusting absorption capacity of dietary fat in the gain or loss of insulin sensitivity demonstrated in intestinal specimens collected during bariatric surgery. In order to confirm the role of the intestine in diabetic dyslipidemia, we first used the intestinal Caco-2/15 cell model. The use of this epithelial cell line has shown a marked stimulation of cholesterol uptake via the transporter NPC1L1 (Niemann-Pick C1-like 1) in the presence of high glucose concentrations (as is the case in diabetic conditions) in basolateral compartment (compared to apical). The use of ezetimibe, an inhibitor of NPC1L1, helped to counteract this elevation of cholesterol absorption, thus proving that NPC1L1 is indeed behind this effect. If previous reports have identified some clues as to the potential role of intestinal PYY (peptide YY) in lipid metabolism disorders, no study has yet addressed this issue systematically. To definitively establish the ability of PYY to modulate lipid transport and metabolism in the intestine, we have used Caco-2/15 cells. Our recent investigation has shown that PYY (administered in the apical compartment) is able to significantly reduce cholesterol absorption via NPC1L1 transporter. Since the role of AMPK in the intestine remains unexplored, it is important to define not only its molecular structure, regulation and function in lipid metabolism, but also its impact on insulin resistance and T2D on its status and mode of action in the gastrointestinal tract. Using Caco-2/15 cells, we have been able to show (i) the presence of all AMPK subunits (α1/α2/β1/β2/γ1/γ2/γ3) with a marked difference in their abundance, but with a predominance of AMPKα1 and the prevalence of α1/β2/γ1 heterotrimer; (ii) the activation of AMPK by metformin and AICAR, resulting in increased phosphorylation of the downstream target acetylCoA carboxylases (ACC) without no influence on HMG-CoA reductase; (iii) the negative modulation of AMPK by compound C and glucose concentrations with high impact on ACC phosphorylation. On the other hand, administration of metformin to Psammomys obesus with insulin resistance and T2D led to (a) an upregulation of intestinal AMPK signaling pathway essentially typified by ascending AMPKα-Thr172 phosphorylation; (b) a reduction in ACC activity; (c) an elevation in the gene and protein expression of CPT1, supporting a stimulation of β-oxidation; (d) a trend of increase in insulin sensitivity portrayed by augmentation of Akt and GSK3β phosphorylation; (e) an inactivation of the stress-responsive p38-MAPK and /ERK1/2 exemplified by their phosphorylation lessening; and (f) a decrease in diabetic dyslipidemia following lowering of intracellular events that govern lipoprotein assembly. Therefore these data suggest that AMPK fulfills key functions in metabolic processes in the small intestine. The clear evidence for the involvement of the gut in cardiometabolic events has been obtained through the scrutiny of intestinal specimens obtained from obese subjects after bariatric surgery. Intestine of insulin-resistant subjects shows defects in insulin signaling as demonstrated by reduced Akt phosphorylation but increased p38 MAPK phosphorylation. These defects were accompanied with increased oxidative stress and inflammation markers in intestine of insulin-resistant subjects. Enhanced de novo lipogenesis rate and apo B-48 biogenesis along with increased triglyceride-rich lipoprotein production was also observed in the intestine of insulin-resistant subjects. Concomitantly, fatty acid binding proteins (FABP) and microsomal transfer protein (MTP) expression was increased in the intestine of insulin-resistant subjects. In conclusion, the small intestine may be classified as an insulin-sensitive tissue. Its deregulation, possibly triggered by oxidative stress and inflammation, may lead to amplification of lipogenesis and lipoprotein synthesis and may therefore represent a key mechanism for atherogenic dyslipidemia in patients with metabolic syndrome and T2D.

The current understanding of lactate metabolism in fish is based almost entirely on interpretation of concentration measurements that cannot be used to infer changes in flux. Moreover, the transporters regulating these fluxes have never been characterized in rainbow trout. My goals were: (1) to quantify lactate fluxes in rainbow trout under normoxic resting conditions, during acute hypoxia, and exercise by continuous infusion of [U-14C] lactate; (2) to determine lactate uptake capacity of trout tissues by infusing exogenous lactate in fish rest and during graded exercise, and (3) to clone monocarboxylate transporters (MCTs) and determine the effects of exhausting exercise on their expression. Such information could prove important to understand the mechanisms underlying the classic “lactate retention” seen in trout white muscle after intense exercise. In normoxic resting fish, the rates of appearance (Ra) and disappearance (Rd) of lactate were always matched (~18 to 13 µmol kg-1 min-1), thereby maintaining a low baseline blood lactate concentration (~0.8 mM). In hypoxic fish, Ra lactate increased from baseline to 36.5 µmol kg-1 min-1, and was accompanied by an unexpected 52% increase in Rd reaching 30.3 µmol kg-1 min-1, accounting for a rise in blood lactate to 8.9 mM. In exercising fish, lactate flux was stimulated > 2.4 body lengths per second (BL s-1). As the fish reached critical swimming speed (Ucrit), Ra lactate was more stimulated (+67% to 40.4 μmol kg-1 min-1) than Rd (+41% to 34.7 μmol kg-1 min-1), causing an increase in blood lactate to 5.1mM. Fish infused with exogenous lactate stimulated Rd lactate by 300% (14 to 56 μmol kg-1 min-1) during graded exercise, whereas the Rd in resting fish increased by only 90% (21 to 40 µmol kg-1 min-1). Four MCT isoforms were partially cloned and characterized in rainbow trout: MCT1b was the most abundant in heart, and red muscle, but poorly expressed in gill and brain where MCT1a and MCT2 were prevalent. MCT4 was more expressed in the heart. Transcript levels of MCT2 (+260%; brain), MCT1a (+90%; heart) and MCT1b (+50%; heart) were stimulated by exhausting exercise. This study shows that: (i) the increase in Rd lactate plays a strategic role in reducing the lactate load imposed on the circulation. Without this response, blood lactate accumulation would double; (ii) a high capacity for lactate disposal in rainbow trout tissues is elicited by the increased blood-to-tissue lactate gradient when extra lactate is administered; and (iii) rainbow trout may be unable to release large lactate loads rapidly from white muscle after exhausting exercise (lactate retention) because they poorly express MCT4 in white muscle and fail to upregulate its expression during exercise.