Objetivo: Avaliar o uso da bromocriptina na prevenção da síndrome do hiperestímulo ovariano (SHO) precoce moderada ou grave em mulheres de alto risco submetidas a fertilização in vitro. Pacientes e Métodos: Estudo duplo-cego, prospectivo e randomizado, foi realizado entre fevereiro de 2006 e novembro de 2007 no Centro de Reprodução Humana da Divisão de Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, na Huntington Centro de Medicina Reprodutiva e no Centro de Reprodução Humana do Hospital e Maternidade Santa Joana. Foram estudadas 28 mulheres entre 20 e 39 anos de alto risco para desenvolver a SHO (presença de 20 folículos ou mais ao ultrassom transvaginal no dia anterior à administração de gonadotrofina coriônica humana (hCG); níveis séricos de estradiol no dia da administração do hCG ou previamente a esta data iguais ou maiores que 3000 pg/ml e/ou aumento significativo ovariano bilateral). Foram divididas randomicamente, em dois grupos: A (n=17) e B (n=11), que receberam, respectivamente, um comprimido diário de ácido fólico (2,0 mg) e de bromocriptina (2,5 mg), por via oral, durante 14 dias, com início no dia da administração de hCG. As pacientes foram avaliadas no dia da administração do hCG (D1) e sete dias após (D2), quando foram realizados : ultrassom abdominal para verificar a presença de ascite; coleta de sangue para dosagens séricas de hemoglobina, hematócrito, leucócitos, plaquetas, uréia, creatinina, TGO, TGP e do fator de crescimento endotelial vascular (VEGF), e coleta de urina de 24 h para determinação de clearance de creatinina e concentração urinária de sódio. Resultados: Da série total (28 pacientes) que concluíram todo o estudo, 14 apresentaram ascite em D2, das quais 10 pertenciam ao grupo A (58,8%) e 4 (36,4%) ao grupo B (p=0,246). Destas 14 pacientes, 7 preencheram os critérios de gravidade, sendo que 6 pertenciam ao grupo A e, somente uma, ao grupo B. Observou-se aumento dos valores médios de VEGF no Grupo A (134,93 pg/ml) em D2, enquanto no Grupo B, houve diminuição (119,11pg/ml) (p=0,462).Conclusões: A bromocriptina não preveniu a SHO precoce moderada ou grave em pacientes de alto risco submetidas a fertilização in vitro, no entanto, houve diminuição da quantidade de líquido intraperitoneal e dos níveis séricos de VEGF. / Objective: To evaluate the effect of bromocriptine for the prevention of either early moderate or severe ovarian hyperstimulation syndrome (OHSS) in high risk women submitted to in vitro fertilization. Patients and Methods: A double-blind, prospective, randomized study was carried out between February 2006 and November 2007 at the Human Reproduction Center, Department of Gynecology, Teaching Hospital of the School of Medicine, University of São Paulo, at the Huntington Center of Reproductive Medicine and at the Human Reproduction Center of Santa Joana Hospital and Maternity Home. Twenty-eight women between 20 and 39 years of age, considered high risk for the development of OHSS (presence of 20 follicles at transvaginal ultrasonography on the day prior to human chorionic gonadotrophin [hCG] administration; serum estradiol levels 3000 pg/ml prior to or on the day of hCG administration and/or a significant bilateral increase in ovarian diameter), were included. The participants were randomly allocated to one of two groups. Women in group A (n=17) took a 2.0 mg tablet of folic acid and women in group B (n=11) took a 2.5 mg tablet of bromocriptine. Both treatments were taken orally daily for 14 days beginning on the day of hCG administration. Patients were evaluated on the day of hCG administration (D1) and seven days later (D2) at which time the following tests were performed: abdominal ultrasonography to detect the presence of ascites; blood sampling for the assessment of hemoglobin, hematocrit, leukocytes, platelets, urea, creatinine, SGOT, SGPT and vascular endothelial growth factor (VEGF). In addition, a 24-hour urine sample was collected to determine creatinine clearance and urinary sodium concentration. Results: All patients concluded the study. Fourteen had ascites at D2, 10 in group A (58.8%) and 4 (36.4%) in group B (p=0.246). Of these 14 patients, 7 fulfilled the criteria for severe OHSS, 6 in group A and 1 in group B. An increase was identified in mean VEGF values in group A (134.93 pg/ml) at D2, while a reduction was found in group B (119.11 pg/ml) (p=0.462). Conclusions: Bromocriptine did neither prevent early moderate nor severe OHSS in high risk patients submitted to in vitro fertilization; however, a reduction occurred in the intraperitoneal fluid volume and in serum VEGF levels.

Ma thèse a pour but d'étudier l'impact des molécules immunosuppressives TGFβ et VEGF exprimées par les cellules tumorales dans la tolérance mise en place contre les tumeurs par les lymphocytes T régulateurs (Tregs). Pour cela, j'ai utilisé des lignées tumorales murines de mélanome B16 invalidées pour l'expression de TGFβ ou de VEGF par shRNA. J'ai pu observer que les invalidations induisent de profondes modifications de la réponse immunitaire contre les tumeurs, qui se traduisent par une forte diminution de son bras régulateur et une forte augmentation de son bras effecteur. Ces modifications sont le fait d'évènements très précoces et différents entre le VEGF et le TGFβ. Le ciblage simultané de TGFβ et de VEGF induit alors un rejet spontané des tumeurs chez 40% des animaux inoculés, et leur ciblage additionnel dans la stratégie thérapeutique utilisant les anticorps anti-PD-1 et anti-CTLA-4 induit un effet additif important. Nos résultats montrent donc que le VEGF et le TGFβ exprimés par les tumeurs sont des facteurs importants pour la tolérance immunitaire aux tumeurs et particulièrement pour la mobilisation des Tregs, et qu'il y a un fort rationnel à chercher à combiner leur ciblage avec les différentes stratégies thérapeutiques anti-tumorales existantes. / My thesis aims at studying the impact tumor-derived immunosuppressive molecules TGFβ and VEGF on the dominant tolerance establishment by regulatory T cells (Tregs). For this I used murine B16 melanoma tumor cell lines knocked-down by shRNA for the expression of TGFβ or VEGF. I observed that these silencings induce dramatic changes in the immune response against tumors, which result in a large decrease of its regulatory arm and a strong increase of its effector arm. These changes result from very early mechanisms that differ between VEGF and TGFβ silencings. Accordingly, simultaneous targeting of TGFβ and VEGF induces significant tumor rejection, and their additional targeting in the anti-PD-1 / anti-CTLA-4 therapeutic strategy brings obvious additive effect. Globally, our results show that tumor-derived VEGF and TGFβ are important factors for the mobilization of Tregs and more generally for immune tolerance to tumors, and that there is a strong rational to combine their targeting with the different existing anti-tumor therapies.

Receptor tyrosine kinases (RTK) are key regulators of growth, differentiation and survival of epithelial cells and play a significant role in the development and progression of cancers derived from these tissues. In malignant cells, these receptors and their downstream signalling pathways are often deregulated, leading to cell hyper-proliferation, enhanced cell survival and increased metastatic potential. Furthermore, endothelial expressed RTKs regulate tumor angiogenesis allowing for tumor growth and maintenance by promoting their vascularization. Epithelial malignancies such as squamous cell carcinomas (SCC), non-small cell lung (NSCLC) and malignant mesotheliomas have very limited treatment options when presenting as metastatic disease. RTKs, particularly the epidermal growth factor (EGFR) and the vascular endothelial growth factor (VEGFR) receptors, have been shown to play significant roles in the pathogenesis of these tumor types. Statins are potent inhibitors of HMG-CoA reductase, the rate limiting enzyme of the mevalonate pathway, that are widely used as hypercholesterolemia treatments. The mevalonate pathway produces a variety of end products that are critical for many different cellular pathways, thus, targeting this pathway can affect multiple signalling pathways. Our laboratory has previously shown that lovastatin can induce tumor specific apoptosis especially in SCC and that 23% of recurrent SCC patients treated with lovastatin as a single agent showed disease stabilization in our Phase I clinical trial. Subsequently, our lab was able to demonstrate that lovastatin in combination with gefitinib, a potent inhibitor of the EGFR showed co-operative cytotoxicity when combined (Chapter 2). Furthermore, the pro-apoptotic and cytotoxic effects of these agents were found to be synergistic and to be manifested in several types of tumor cell lines including SCC, NSCLC and glioblastoma. I was able to expand upon these important findings and demonstrated that lovastatin, through its ability to disrupt the actin cytoskeleton, inhibited EGFR dimerization and activation (Chapter 3). This novel mechanism targeting this receptor has clinical implications as lovastatin treatment combined with gefitinib showed co-operative inhibitory effects on EGFR activation and downstream signalling. The RTK family of proteins share similar features with respect to activation, internalization and downstream signalling effectors. I further demonstrated that lovastatin can inhibit the VEGFR-2 in endothelial cells and mesotheliomas, where VEGF and its receptor are co-expressed driving their proliferation, and induces synergistic cytotoxicity in mesothelioma cells in combination with VEGFR-2 tyrosine kinase inhibitors (Chapter 4). These findings suggest that statins may augment the effects of a variety of RTK inhibitors in a similar fashion representing a novel combinational therapeutic approach in a wide repertoire of human cancers. More importantly, based on this work, we initiated a Phase I/II study evaluating high dose rosuvastatin and the EGFR inhibitor tarceva in SCC and NSCLC patients at our institute. This clinical evaluation will provide invaluable data that will play a role in developing this novel therapeutic strategy. Together, the work embodied in this thesis provides a model for the regulation of EGFR/VEGFR-2 activation and signalling by targeting the rho family of proteins that demonstrates a novel mechanism that can be exploited to refine current therapeutic paradigms.

Orientador: Erich Vinicius de Paula / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T13:46:04Z (GMT). No. of bitstreams: 1 Alves_BrunnaEulalio_D.pdf: 4762678 bytes, checksum: 34eea414d90830a52ed9c9b044538888 (MD5) Previous issue date: 2011 / Resumo: Pacientes portadores de neoplasia hematológica e neutropenia febril representam um grupo de risco elevado de sepse e choque séptico. Nas últimas décadas, estratégias terapêuticas alvo-específicas para a sepse não modificaram de forma significativa a sobrevida dos pacientes e o tratamento permanece baseado em antibioticoterapia e cuidados de suporte, com altas taxas de mortalidade. A quebra da barreira endotelial é um evento fundamental na fisiopatologia do choque séptico e a compreensão dos mecanismos envolvidos neste evento tem o potencial de auxiliar na identificação de novos biomarcadores de gravidade e de novos alvos terapêuticos para estes pacientes. Estudos recentes demonstraram a participação do fator de crescimento do endotélio vascular (VEGF-A), do seu receptor solúvel (sFlt-1) e das angiopoietinas 1 e 2, proteínas envolvidas na angiogênese e na regulação da integridade da barreira endotelial na fisiopatogenia do choque séptico em pacientes não oncológicos internados em unidade de terapia intensiva. Neste trabalho, avaliamos prospectivamente a cinética do VEGF-A, do sFlt-1 e das angiopoietinas 1 e 2 durante as 48 horas inicias da neutropenia febril em 41 pacientes portadores de neoplasia hematológica submetidos a quimioterapia intensiva ou a regime de condicionamento para transplante de células progenitoras hematopoiéticas, através da dosagem dos mesmos por ensaio imuno-enzimático. Exploramos também a associação dos níveis séricos destes biomarcadores com a gravidade da sepse através da correlação com o MASCC, um índice desenvolvido para identificar pacientes com neutropenia febril de baixo risco, e com o SOFA, um escore de avaliação de disfunção orgânica em pacientes com sepse, ambos amplamente aceitos. A evolução para choque séptico foi associada a níveis significativamente maiores de VEGF-A, sFlt-1 e angiopoietina-2 48 horas após o início da neutropenia febril quando comparado aos valores em pacientes com sepse não complicada e a estimativa da acurácia diagnóstica sugere a capacidade de discriminar os pacientes que evoluíram com choque séptico. Estes biomarcadores também apresentaram correlação com os escores gravidade, sugerindo a relevância biológica da associação. Em conclusão, nossos achados sugerem que a avaliação destes biomarcadores em pacientes com neutropenia febril deve ser avaliada em estudos com maior número de pacientes, quanto ao seu potencial de incorporação na prática clínica. Além disso, os resultados reforçam o potencial terapêutico da intervenção nestas vias para o tratamento da sepse / Abstract: Patients with hematologic malignancy and neutropenia represent a group at high risk of sepsis and septic shock. In recent decades, target-specific therapeutic strategies for sepsis did not change significantly the survival of patients and treatment is still based on antibiotic therapy and supportive care, with high mortality rates. The breakdown of the endothelial barrier is a key event in the pathophysiology of septic shock and understanding of the mechanisms involved in this event has the potential to assist in the identification of new biomarkers and severity of new therapeutic targets for these patients. Recent studies have demonstrated the involvement of endothelial growth factor (VEGF-A), its soluble receptor (sFlt-1) and angiopoietins 1 and 2, proteins involved in angiogenesis and in regulation of endothelial barrier integrity in the pathogenesis of shock septic patients without cancer admitted to the intensive care unit. In this study, we prospectively evaluated the kinetics of VEGF-A, sFlt-1 and angiopoietins 1 and 2 during the initial 48 hours of febrile neutropenia in 41 patients with hematological malignancy undergoing intensive chemotherapy or conditioning regimen for stem cell transplantation hematopoietic cells by the same dosage by enzyme immunoassay. We also explored the association of serum levels of these biomarkers with the severity of sepsis through correlation with the MASCC, an index developed to identify patients with febrile neutropenia at low risk, and the SOFA score for assessment of organ dysfunction in patients with sepsis, both widely accepted. Progression to septic shock was associated with significantly higher levels of VEGF-A, sFlt-1 and angiopoietin-2 48 hours after the onset of febrile neutropenia when compared to values in patients with uncomplicated sepsis and the estimation of diagnostic accuracy suggests the ability to discriminate among patients who developed septic shock. These biomarkers also correlated with the severity scores, suggesting the biological relevance of the association / Doutorado / Clinica Medica / Doutor em Clínica Médica

Objetivo: Avaliar os efeitos da panfotocoagulação a laser (PRP) comparando com a PRP associada com injeção de 0,5 mg de ranibizumabe intravítreo (IVR) em pacientes com retinopatia diabética proliferativa (RDP) com características de alto risco. Métodos: Estudo prospectivo incluindo pacientes portadores de RDP de alto risco sem tratamento prévio, distribuídos aleatoriamente em dois grupos: grupo PRP e grupo PRPplus. Avaliações oftalmológicas padronizadas, incluindo melhor acuidade visual corrigida (MAVC), de acordo com o Early Treatment Diabetic Retinopathy Study (ETDRS), medidas da área de vazamento de fluoresceína na angiofluoresceinografia (FLA), medida da espessura do subcampo macular (ESM) na Tomografia de Coerência Óptica (OCT) foram realizadas na visita inicial e nas semanas 16 (±2), 32 (±2) e 48 (±2), além de eletrorretinograma (ERG) de campo total, realizado na visita inicial e na semana 48 (±2). Resultados: Vinte e nove de 40 pacientes (n=29) completaram as 48 semanas do estudo. Na visita inicial, a média ± erro-padrão da média (EPM) de FLA (mm2) foi de 9,0 ± 1,3 e 11,7 ± 1,3 (p=0,1502); MAVC (logMAR), 0,31 ± 0,05 e 0,27 ± 0,06 (p=0,6645) e ESM (µm), 216,3 ± 10,7 e 249,4 ± 36,1 (p=0,3925), nos grupos PRP e PRPplus, respectivamente. Foi notada significativa (p<0,05) redução na FLA em todas as visitas do estudo em ambos os grupos; porém significativamente maior no grupo PRPplus, em relação ao grupo PRP, no final da visita 48 (PRP = 2.9 ± 1.3 mm2; PRPplus = 5.8 ± 1.3 mm2; p = 0.0291). Observou-se piora na MAVC em todas as visitas após o tratamento no grupo PRP (p<0,05), enquanto que no grupo PRPplus não foram encontradas mudanças na MAVC. Aumento significativo na ESM foi observado em todas as avaliações do estudo no grupo PRP e significativa diminuição na ESM foi detectada na semana 16 do grupo PRPplus, e não foi encontrada diferença significativa, em relação à visita inicial, nas semanas 32 e 48. Quanto ao ERG, foi notada significativa diminuição na amplitude da onda-b dos bastonetes para 46 ± 5% (p<0,05) do valor da visita inicial no grupo PRP e para 64 ± 6% no grupo PRPplus. Essa regressão foi significativamente maior no grupo PRP do que no grupo PRPplus (p=0,024). Resultados similares foram observados para resposta máxima combinada (MC) da amplitude da onda-b, com redução na semana 48, comparada com a visita inicial, de 45 ± 4% no grupo PRP e 62 ± 5% no grupo PRPplus. A diminuição deste parâmetro foi significativamente maior no grupo PRP do que no grupo PRPplus (p=0,0094). A MC da amplitude da onda-a, os potenciais oscilatórios (PO) e a resposta ao flicker de 30 Hz mostraram redução estatisticamente significativa na análise intragrupos, mas sem diferenças na análise entre os grupos. Conclusão: Após a PRP foi associado IVR com maior redução na FLA na semana 48, comparado com PRP isoladamente, em olhos com RDP de alto risco, sendo que o uso adicional de IVR à PRP parece proteger contra discreta perda de acuidade visual e espessamento macular observado em olhos tratados com PRP isoladamente. Na análise do ERG, resultados sugerem que o tratamento de RDP de alto risco com PRP associado com IVR é efetivo para o controle da RDP e permite menor uso do laser, que, consequentemente, leva à perda funcional menor da retina do que o tratamento com PRP isoladamente. / Objective: To evaluate the effects of panretinal photocoagulation (PRP) compared with PRP plus intravitreal injection of 0.5 mg of ranibizumab (IVR) in patients with high-risk proliferative diabetic retinopathy (PDR). Methods: Prospective study included patients with high-risk PDR and no prior laser treatment randomly assigned to receive PRP (PRP group) or PRP plus IVR (PRPplus group). Standardized ophthalmic evaluations including best-corrected visual acuity (BCVA) measured according to the methods used in the Early Treatment Diabetic Retinopathy Study (ETDRS), fluorescein angiography to measure area of fluorescein leakage (FLA) and optical coherence tomography (OCT) for the assessment of central subfield macular thickness (CSMT), were performed at baseline and at weeks 16 (±2), 32 (±2) and 48 (±2). Eletroretinographic (ERG) was measured according to ISCEV standards at baseline and at week 48 (±2). Results: Twenty-nine of 40 patients (n = 29 eyes) completed the 48-week study follow-up period. At baseline, mean ± SE FLA (mm2) was 9.0 ± 1.3 and 11.7 ± 1.3 (p = 0.1502); BCVA (logMAR) was 0.31 ± 0.05 and 0.27 ± 0.06 (p = 0.6645); and CSMT (µm) was 216.3 ± 10.7 and 249.4 ± 36.1 (p = 0.3925), in the PRP and PRPplus groups, respectively. There was a significant (p < 0.05) FLA reduction at all study visits in both groups, with the reduction observed in the PRPplus group significantly larger than that in the PRP group at week 48 (PRP = 2.9 ± 1.3 mm2; PRPplus = 5.8 ± 1.3 mm2; p = 0.0291). Best-corrected visual acuity worsening was observed at 16, 32 and 48 weeks after treatment in the PRP group (p < 0.05), while no significant BCVA changes were observed in the PRPplus group. A significant CSMT increase was observed in the PRP group at all study visits, while a significant decrease in CSMT was observed in the PRPplus group at week 16, and no significant difference in CSMT from base- line was observed at weeks 32 and 48. ROD b-wave amplitude was significantly reduced to 46 ± 5 % (p<0.05) of baseline in the PRP group and 64±6% (p<0.05) in the PRPplus group. This reduction was significantly larger in the PRP group than in the PRPplus group (p=0.024). Similar results were observed for the dark-adapted Combined Response (CR) b-wave amplitude, with a reduction at 48 weeks compared to baseline of 45 ± 4 % in the PRP group and 62 ± 5 % in the PRPplus group; the reduction in CR b-wave amplitude was significantly larger in the PRP group than in the PRPplus group (p=0.0094). CR a-wave, oscillatory potentials, cone single flash, and 30 Hz flicker responses showed statistically significant within-group reductions, but no differences in between-group analyses. Conclusions: Intravitreal ranibizumab after PRP was associated with a larger reduction in FLA at week 48 compared with PRP alone in eyes with high-risk PDR, and the adjunctive use of IVR appears to protect against the modest visual acuity loss and macular swelling observed in eyes treated with PRP alone. In ERG analyses, the results suggest that treating high-risk PDR with PRP plus IVR is effective for PDR control, and permits the use of less extensive PRP which, in turn, induces less retinal functional loss, than treatment with PRP alone.

Objetivo: Avaliar o uso da bromocriptina na prevenção da síndrome do hiperestímulo ovariano (SHO) precoce moderada ou grave em mulheres de alto risco submetidas a fertilização in vitro. Pacientes e Métodos: Estudo duplo-cego, prospectivo e randomizado, foi realizado entre fevereiro de 2006 e novembro de 2007 no Centro de Reprodução Humana da Divisão de Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, na Huntington Centro de Medicina Reprodutiva e no Centro de Reprodução Humana do Hospital e Maternidade Santa Joana. Foram estudadas 28 mulheres entre 20 e 39 anos de alto risco para desenvolver a SHO (presença de 20 folículos ou mais ao ultrassom transvaginal no dia anterior à administração de gonadotrofina coriônica humana (hCG); níveis séricos de estradiol no dia da administração do hCG ou previamente a esta data iguais ou maiores que 3000 pg/ml e/ou aumento significativo ovariano bilateral). Foram divididas randomicamente, em dois grupos: A (n=17) e B (n=11), que receberam, respectivamente, um comprimido diário de ácido fólico (2,0 mg) e de bromocriptina (2,5 mg), por via oral, durante 14 dias, com início no dia da administração de hCG. As pacientes foram avaliadas no dia da administração do hCG (D1) e sete dias após (D2), quando foram realizados : ultrassom abdominal para verificar a presença de ascite; coleta de sangue para dosagens séricas de hemoglobina, hematócrito, leucócitos, plaquetas, uréia, creatinina, TGO, TGP e do fator de crescimento endotelial vascular (VEGF), e coleta de urina de 24 h para determinação de clearance de creatinina e concentração urinária de sódio. Resultados: Da série total (28 pacientes) que concluíram todo o estudo, 14 apresentaram ascite em D2, das quais 10 pertenciam ao grupo A (58,8%) e 4 (36,4%) ao grupo B (p=0,246). Destas 14 pacientes, 7 preencheram os critérios de gravidade, sendo que 6 pertenciam ao grupo A e, somente uma, ao grupo B. Observou-se aumento dos valores médios de VEGF no Grupo A (134,93 pg/ml) em D2, enquanto no Grupo B, houve diminuição (119,11pg/ml) (p=0,462).Conclusões: A bromocriptina não preveniu a SHO precoce moderada ou grave em pacientes de alto risco submetidas a fertilização in vitro, no entanto, houve diminuição da quantidade de líquido intraperitoneal e dos níveis séricos de VEGF. / Objective: To evaluate the effect of bromocriptine for the prevention of either early moderate or severe ovarian hyperstimulation syndrome (OHSS) in high risk women submitted to in vitro fertilization. Patients and Methods: A double-blind, prospective, randomized study was carried out between February 2006 and November 2007 at the Human Reproduction Center, Department of Gynecology, Teaching Hospital of the School of Medicine, University of São Paulo, at the Huntington Center of Reproductive Medicine and at the Human Reproduction Center of Santa Joana Hospital and Maternity Home. Twenty-eight women between 20 and 39 years of age, considered high risk for the development of OHSS (presence of 20 follicles at transvaginal ultrasonography on the day prior to human chorionic gonadotrophin [hCG] administration; serum estradiol levels 3000 pg/ml prior to or on the day of hCG administration and/or a significant bilateral increase in ovarian diameter), were included. The participants were randomly allocated to one of two groups. Women in group A (n=17) took a 2.0 mg tablet of folic acid and women in group B (n=11) took a 2.5 mg tablet of bromocriptine. Both treatments were taken orally daily for 14 days beginning on the day of hCG administration. Patients were evaluated on the day of hCG administration (D1) and seven days later (D2) at which time the following tests were performed: abdominal ultrasonography to detect the presence of ascites; blood sampling for the assessment of hemoglobin, hematocrit, leukocytes, platelets, urea, creatinine, SGOT, SGPT and vascular endothelial growth factor (VEGF). In addition, a 24-hour urine sample was collected to determine creatinine clearance and urinary sodium concentration. Results: All patients concluded the study. Fourteen had ascites at D2, 10 in group A (58.8%) and 4 (36.4%) in group B (p=0.246). Of these 14 patients, 7 fulfilled the criteria for severe OHSS, 6 in group A and 1 in group B. An increase was identified in mean VEGF values in group A (134.93 pg/ml) at D2, while a reduction was found in group B (119.11 pg/ml) (p=0.462). Conclusions: Bromocriptine did neither prevent early moderate nor severe OHSS in high risk patients submitted to in vitro fertilization; however, a reduction occurred in the intraperitoneal fluid volume and in serum VEGF levels.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20986号 / 医博第4332号 / 新制||医||1027(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 富樫 かおり, 教授 羽賀 博典, 教授 別所 和久 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Preclinical testing is necessary to investigate the safety and efficacy of novel therapeutics before moving to clinical trials, yet approximately 90% of these therapies fail once tested in humans. This has led to increased interest in developing robust preclinical models that accurately mimic the complex human in vivo physiology. Microfluidic devices that can introduce dynamic conditions to 3D cell/organoid cultures, also known as tissue-on-a-chip, have emerged as physiologically relevant in vitro preclinical models that can achieve high throughput screening of therapeutics. The research presented here aimed to develop an angiogenic environment within a novel microfluidic device to stimulate formation of endothelial networks that will eventually be integrated into a vascularized tumor model for screening chemotherapeutics. The novel microfluidic devices were fabricated using photolithography to create a patterned mold, casting polydimethylsiloxane (PDMS) over the mold, and bonding patterned PDMS to a glass slide. Three sets of experiments were then conducted, with each introducing different angiogenic stimuli to human umbilical vein endothelial cells (HUVECs) co-cultured with human dermal fibroblasts (HDFs) within the devices. The first set of experiments sought to develop a standard protocol for plating human cells in the novel microfluidic device and to investigate if the mechanism of nutrient transport and interstitial flow would induce an angiogenic response resulting in endothelial network formation. A working protocol was developed but it was determined that further development of an angiogenic environment within the device was necessary to stimulate endothelial network formation. The second set of experiments investigated if seeding HUVECs in a peripheral channel of the device and introducing a concentration gradient of vascular endothelial growth factor (VEGF) would stimulate endothelial network formation directed by a growth factor gradient, similar to angiogenesis in vivo. This was repeated under hypoxic conditions to more accurately mimic the in vivo angiogenic environment, but significant endothelial network formation was not observed and seeding of HUVECs in the peripheral channel presented no perceptible improvements. The final set of experiments investigated if v returning HUVECs to the center chamber in local co-culture with HDFs and exposing devices to hypoxic conditions would provide the necessary angiogenic environment to stimulate endothelial network formation within the microfluidic device. Lack of quantifiable endothelial network formation in the final set of experiments led to an analysis of 3D HUVEC colony formation, however, no statistically significant trends were discovered. Even though no significant differences were found, these experiments succeeded in developing a protocol for plating human cells in the novel microfluidic device that can be translated to the tumor side of the Microphysiological Systems lab. From these experiments we can also conclude that co-cultures of HUVECs and HDFs can survive and form into colonies within the novel microfluidic device but additional angiogenic stimuli are necessary to develop robust endothelial networks. Based on the current literature and knowledge gained throughout the experiments presented here, several suggestions are presented to potentially stimulate angiogenesis and develop endothelial networks in the device such as increasing cell densities, varying length of incubation, introducing mediators of angiogenesis like nitric oxide, and addition of tumor cells.

No description available.

No description available.