Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

A aterosclerose é considerada, hoje, doença inflamatória e com intensa proliferação celular, daí o racional de se usar medicamentos antiproliferativos e com ação anti-inflamatória como o paclitaxel (PTX) e o metotrexato (MTX) no tratamento dessa condição. A nanoemulsão lipídica (LDE), de composição semelhante à da lipoproteína de baixa densidade (LDL), se liga a receptores de LDL após sua injeção endovenosa na corrente sanguínea. Como tais receptores estão superexpressos em células com altas taxas de proliferação, como ocorre no câncer e na aterosclerose, a LDE pode ser usada como veículo para direcionar agentes antiproliferativos a essas células, aumentando a sua eficácia e diminuindo a toxicidade. O paclitaxel é um quimioterápico com ação antiproliferativa usado em vários tipos de câncer e recobrindo stents farmacológicos, trabalhos anteriores, usando coelhos submetidos a uma dieta aterogênica, nos animais tratados com LDE-PTX houve redução de 60% da área lesionada. O metrotexato, além de ser usado em vários esquemas quimioterápicos, possui, também, ação anti-inflamatória, sendo usado em doenças inflamatórias crônicas, como a artrite reumatoide. Em outro estudo envolvendo, coelhos hipercolesterolêmicos, o uso de MTX comercial por 4 semanas demonstrou uma redução de 75% na área de placa aterosclerótica. Esse estudo tem por objetivo avaliar macroscopicamente a eficácia das terapias quimioterápicas combinada, composta de PTX-LDE com MTX-LDE, e monoterapia, apenas com PTX-LDE, na regressão da aterosclerose experimental. No presente trabalho, vinte e oito coelhos machos da raça New Zealand receberam dieta rica em colesterol a 1% durante 8 semanas. Depois desse período, foram divididos em quatro grupos: grupo CONTROLE, que foi sacrificado e as aortas fixadas para análise posterior, grupo DIETA, que apenas teve a ração enriquecida com colesterol a 1% suspensa, PTX, que recebeu tratamento com injeções endovenosas semanais de LDE-paclitaxel na dose de 4 mg/kg por 8 semanas, e PTX+MTX, que recebeu LDE-paclitaxel e LDE-metotrexato na dose de 4 mg/kg/semana por 8 semanas. Foram avaliados perfil hematológico, lipídico, bioquímico, ponderal e o consumo de ração. Após a eutanásia, foram medidas as lesões ateroscleróticas macroscópicas nas aortas dos coelhos. Em seguida, o arco aórtico foi analisado por morfometria e por imuno-histoquímica. Os marcadores inflamatórios foram analisados no plasma, por ELISA e por meio de expressão gênica por Qrt-pcr. Observou-se que não houve diferença no perfil ponderal e no consumo de ração entre os grupos de estudo. Não houve toxicidade hematológica, hepática e renal relacionada ao tratamento. No perfil lipídico, ao final do estudo, as concentrações de colesterol total, não HDL-C e triglicerídeos aumentaram significativamente em todos os grupos. Houve uma marcante regressão na área de placa aterosclerótica nos coelhos tratados com LDE-paclitaxel, da ordem de 64% e mais marcante no grupo LDE-metotrexato de 71%, quando comparados ao grupo CONTROLE. Na comparação com o grupo DIETA, houve, também, regressão, de 49% nos coelhos do grupo PTX e de 59% no grupo PTX+MTX. O tratamento quimioterápico também mostrou ação antiaterosclerótica nos outros parâmetros avaliados, destacando a intensa redução na relação íntima-média das aortas, na expressão proteica de MMP-9 e da redução na expressão gênica de TNF-? em relação ao grupo DIETA. Portanto, o tratamento quimioterápico com PTX e MTX associado à LDE possui potencial para uso clínico em pacientes com doença aterosclerótica, sendo muito eficaz e com boa tolerabilidade / Atherosclerosis is nowadays considered as an inflammatory disease with intense cell proliferation, hence the rationale of using antiproliferative drugs with an anti-inflammatory action such as paclitaxel (PTX) and methotrexate (MTX) in the treatment of this condition. The lipid nanoemulsion (LDE), with a similar composition to low density lipoprotein (LDL) binds to LDL receptors after their intravenous injection into the bloodstream. Since such receptors are overexpressed in cells with high proliferation rates, such as occurs in cancer and atherosclerosis, LDE can be used as a vehicle to direct antiproliferative agents to these cells, increasing their efficacy and reducing toxicity. Paclitaxel is a chemotherapeutic drug with an anti-proliferative action used in various types of cancer and drug-eluting stents. In previous studies using rabbits subjected to an atherogenic diet, animals treated with LDE-PTX had a 60% reduction in the injured area. Methotrexate in addition to being used in various chemotherapy regimens also has an anti-inflammatory action and is used for chronic inflammatory diseases such as rheumatoid arthritis; another study involving hypercholesterolemic rabbits using commercial MTX for 4 weeks showed a 75% reduction of the atherosclerotic plaque area. This study aims to evaluate the effectiveness of combined chemotherapy treatments, composed of PTX-LDE with MTX-LDE, and PTX-LDE in monotherapy, on the regression of experimental atherosclerosis. In this study, twenty eight male New Zealand breed rabbits received a diet enriched with 1% cholesterol for 8 weeks. After that time, they were divided into four groups: the CONTROL group, which was sacrificed and the aortas kept for later analysis, the DIET group, which only had the diet supplemented with 1% cholesterol suspended; the PTX group which received treatment with weekly intravenous injections of LDE paclitaxel, at a dose of 4 mg/kg for 8 weeks and the PTX+MTX group which received PTX - LDE + MTX-LDE at a dose of 4 mg/kg per week for 8 weeks. The hematological, lipid, biochemical, weight and food intake profiles were evaluated. After euthanasia, macroscopic atherosclerotic lesions in the aortas of the rabbits were measured. Then, the aortic arch was analyzed by morphology and immunohistochemistry. The inflammatory markers were analyzed in the plasma by ELISA and gene expression by qRT-PCR. There was no difference in weight profile and feed intake among the study groups. There was no hematological, hepatic or renal toxicity related to treatment. The lipid profiles of all the groups at the end of the study showed significantly increased concentrations of total cholesterol, non-HDL-C and triglyceride levels. There was a marked regression of 64% in the atherosclerotic plaque area, in the LDE-paclitaxel treated rabbits, and an even more striking 71% in the LDE-methotraxate group compared to the CONTROL group. There was also regression when compared to the DIET group, 49% in rabbits from the PTX group and 59% in the PTX+MTX group. The chemotherapy also showed an anti-atherosclerotic action in the other evaluated parameters, especially notable were the intense reduction in the intima-media ratio of the aortas in protein expression of MMP-9 and the reduction in gene expression of TNF-alpha compared to the DIET group. Therefore, chemotherapy with PTX and MTX associated with LDE, has potential for clinical use in patients with atherosclerotic disease, as it is very effective and well tolerated

Dans la rétine, la protéine dystrophine Dp71 est principalement exprimée dans les cellules gliales de Müller (CGM), qui contribuent à la stabilisation de la barrière hémato-rétinienne (BHR). Les CGM sont aussi les principales sources de facteurs inflammatoires. Ainsi, nous avons étudié les effets de l’absence de Dp71 sur l’homéostasie potassique et aqueuse, ainsi que sur l’expression de médiateurs de l’inflammation et la perméabilité vasculaire rétinienne.L'absence de Dp71 diminue l'expression de la protéine AQP4 et induit la redistribution de Kir4.1 tout le long des CGM. Par ailleurs, nous avons également constaté que le décollement expérimental de la rétine chez les souris WT induit une diminution de Dp71 associée à une délocalisation de Kir4.1, une régulation à la baisse de la protéine AQP4 dans les CGM.Nos données montrent clairement que l'absence de la Dp71 entraîne une augmentation de l'expression du VEGF, d’ICAM-1, une augmentation du nombre de leucocytes adhérents rétiniens, une dégénérescence accrue des capillaires associée à une forte perméabilité vasculaire chez les souris Dp71-null.L’ensemble de nos résultats a mis en évidence le rôle de la Dp71 dans les mécanismes visant à réguler l'homéostasie rétinienne et à assurer la stabilisation de la BHR. Nous apportons la preuve que la perte de Dp71 favorise l'inflammation vasculaire rétinienne et la dégénérescence des capillaires associée à une perméabilité vasculaire. Ensemble, ces observations suggèrent que la souris Dp71-null serait un modèle approprié pour étudier les pathologies vasculaires rétiniennes telles que la rétinopathie diabétique, l’uvéite rétinienne et l’occlusion veineuse rétinienne. / In the retina, the Dp71 dystrophin protein is mainly expressed in Müller glial cells (MGC), which contribute to the stabilization of the blood-retinal barrier (BRB). MGC are also the main sources of inflammatory factors. Thus, in our thesis project we studied the effects of the absence of the Dp71 protein on potassium and water homeostasis, as well as the expression of inflammatory mediators and retinal vascular permeability.The absence of the Dp71 protein decreased the expression of AQP4 protein and induces the redistribution of Kir4.1, initially restricted to the end-feet of MGC and around vessels, all along the cell membrane. Moreover, we have also shown that the experimental retinal detachment in WT mice induces a reduction of Dp71 which is associated with Kir4.1 mislocation, a down regulation of AQP4 protein in MGC.Our data clearly demonstrate that the absence of the Dp71 leads to increased retinal VEGF and ICAM-1 expression in Dp71-null mouse compared to WT mouse strain. There is also an increase of the number of retinal adherent leukocytes, capillary degeneration associated with high BRB permeability observed in Dp71-null mice.Our findings highlight Dp71 as an important component in the mechanisms leading to the regulation of retinal homeostasis; and to the maintaining of the BRB stabilization. We provide evidence that deficiency of Dp71 promotes retinal vascular inflammation and significantly exacerbated degeneration of capillaries and BRB breakdown. Together these results suggest that the Dp71-null mouse could be a good model to study retinal vascular diseases such as diabetic retinopathy, retinal uveitis and retinal vein occlusion.

Osteopontin, also called cytokine Eta-1, is a multifunctional protein containing Arg-Gly-Asp-Ser (RODS) cell-binding sequence. It interacts with αvβ1, αvβ3 and αvβ5 integrins and CD44 receptors. OPN is suggested to play a role during inflammation via the recruitment and retention of macrophages and T-cells to inflamed sites. OPN regulates the production of inflammatory cytokines and nitric oxide in macrophages. In this review, we will discuss diverse roles of OPN related to cardiovascular diseases, including atherosclerosis, valvular stenosis, hypertrophy, myocardial infarction and heart failure.

Inhibition of cyclooxygenase (COX)-2 increases cardiovascular deaths. Identifying a biomarker of COX-2 is desirable but difficult, since COX-1 and COX-2 ordinarily catalyze formation of an identical product, prostaglandin H2. When acetylated by aspirin, however, COX-2 (but not COX-1) can form 15(R)-HETE, which is metabolized to aspirin-triggered lipoxin (ATL), 15-epi-lipoxin A4. Here we have used COX-1- and COX-2-knockout mice to establish whether plasma ATL could be used as a biomarker of vascular COX-2 in vivo. Vascular COX-2 was low but increased by LPS (10 mg/kg; i.p). Aspirin (10 mg/kg; i.v.) inhibited COX-1, measured as blood thromboxane and COX-2, measured as lung PGE2. Aspirin also increased the levels of ATL in the lungs of LPS-treated wild-type C57Bl6 mice (vehicle: 25.5±9.3 ng/ml; 100 mg/kg: 112.0±7.4 ng/ml; P<0.05). Despite this, ATL was unchanged in plasma after LPS and aspirin. This was true in wild-type as well as COX-1−/− and COX-2−/− mice. Thus, in mice in which COX-2 has been induced by LPS treatment, aspirin triggers detectable 15-epi-lipoxin A4 in lung tissue, but not in plasma. This important study is the first to demonstrate that while ATL can be measured in tissue, plasma ATL is not a biomarker of vascular COX-2 expression.—Kirkby, N. S., Chan, M. V., Lundberg, M. H., Massey, K. A., Edmands, W. M. B., MacKenzie, L. S., Holmes, E., Nicolaou, A., Warner, T. D., Mitchell, J. A. Aspirin-triggered 15-epi-lipoxin A4 predicts cyclooxygenase-2 in the lungs of LPS-treated mice but not in the circulation: implications for a clinical test.

One approach that has demonstrated success in the field of molecular imaging utilizes microparticles of iron oxide (MPIO) conjugated to specific antibodies and/or peptides to provide contrast effects on MRI in relation to the molecular expression of a specified target. The experimental aims of this thesis were 1) to investigate the ability of VCAM-1 and P-selectin targeted MPIO to detect the expression of VCAM-1 and P-selectin on the activated endothelium in-vitro and in-vivo in mouse models of renal and cerebral ischemia reperfusion injury, and 2) develop a novel contrast agent for imaging αvβ3-integrin expression in angiogenesis using RGD peptide conjugated MPIO (RGD-MPIO) in-vitro. MPIO (1.0 µm) were conjugated to monoclonal antibodies against VCAM-1 (VCAM-MPIO) or P-selectin (PSEL-MPIO). In vitro, MPIO bound in a dose-dependent manner to tumor necrosis factor (TNF)-alpha stimulated sEND-1 endothelial cells when conjugated to VCAM-1 (R² = 0.88, P<0.01) and P-selectin antibodies (R² = 0.93, P<0.01), reflecting molecular VCAM-1 and P-selectin mRNA and protein expression. Mice subjected to unilateral, transient (30 minutes) renal ischemia and subsequent reperfusion received intravenous VCAM-MPIO and PSEL-MPIO (4.5 mg iron/kg body weight). In ischemic kidneys, MR related contrast effects of VCAM-MPIO were 4-fold higher than unclamped kidneys (P<0.01) and 1.5-fold higher than clamped kidneys of PSEL-MPIO injected mice (P<0.05). VCAM-MPIO binding was less evident in IRI kidneys pre-treated with VCAM-1 antibody (P<0.001). VCAM-1 mRNA expression and VCAM-MPIO contrast volume were highly correlated (R² = 0.901, P<0.01), indicating that quantification of contrast volume reflected renal VCAM-1 transcription. In mice subjected to cerebral ischemia, contrast volume was 11-fold greater in animals injected with VCAM-MPIO versus control IgG-MPIO (P<0.05). Finally, S-nitroso-N-acetylpenicillamine (SNAP) stimulated HUVEC-C cells, which express αvβ3-integrin, showed 44-fold greater RGD-MPIO binding than unstimulated cells (P<0.001) and 4-fold greater RGD-MPIO binding than SNAP stimulated cells blocked with soluble RGD peptide (P<0.001) in-vitro. This thesis demonstrated that targeted MPIO exhibited contrast effects that defined and quantified the molecular expression of specific targets through the use of high-resolution MRI in in-vitro and in-vivo models of vascular inflammation.

Contexte : Des études récentes suggèrent que la colchicine permettrait de diminuer le risque d’événements cardiovasculaires. L’étude COLPET évaluait l’impact de la colchicine sur l’inflammation vasculaire mesurée par TEP/TDM chez des patients souffrant de MCAS stable. Méthodes : Dans cette étude randomisée à double insu de phase II, les patients étaient traités pendant 24 semaines avec 1 comprimé quotidien de colchicine 0.6 mg ou de placebo. L’inflammation vasculaire était évaluée par la captation de 18F-FDG dans l’aorte ascendante et les carotides à la TEP/TDM au début et à la fin de la thérapie. L’issue d’intérêt primaire était la variation de la moyenne du target-to-background ratio maximal des coupes d’images de l’aorte ascendante (Mean MAX TBR). Les issues d’intérêt secondaires incluaient plusieurs paramètres additionnels de TEP/TDM, ainsi que des mesures sériées de biomarqueurs inflammatoires sériques, dont la hs-CRP. Résultats : Cent-onze patients étaient randomisés dans l’étude, dont 56 au groupe placebo et 55 au groupe colchicine. La colchicine n’avait aucun impact significatif sur l’issue d’intérêt primaire (variation de la moyenne: 0.051; IC95% : -0.016 à 0.117; p=0.1346) ou sur les issues d’intérêt secondaires de TEP/TDM. Cependant, les patients traités à la colchicine présentaient une diminution de 28% de leurs niveaux de hs-CRP (p=0.0026). Conclusion : La thérapie à la colchicine pendant 24 semaines n’a eu aucun impact significatif sur la captation de 18F-FDG par l’aorte ascendante et les carotides. Cependant, une réduction de 28 % des niveaux de hs-CRP était observée chez les patients du groupe colchicine. L’étude randomisée multicentrique de phase III Colchicine Cardiovascular Outcomes Trial (COLCOT) est en cours pour évaluer les bénéfices cardiovasculaires à long terme de la colchicine (0.5 mg par jour), lorsque débutée pendant les trente jours suivant un infarctus du myocarde. / Background : Recent studies suggest that colchicine reduces cardiovascular risk. The COLPET Study evaluated the impact of colchicine on vascular inflammation, as measured by PET/CT, in patients with stable CAD. Methods: In this randomized, double-blind, placebo-controlled, phase II clinical trial, patients were treated for 24 weeks with a daily tablet of colchicine 0.6 mg or placebo. Vascular inflammation was assessed by uptake of 18F-FDG in the ascending aorta and carotid arteries on PET/CT at baseline and at the end of study drug therapy. The primary outcome was the change in the mean of maximal target-to-background ratio of the image slices of the ascending aorta (Mean MAX TBR). Secondary outcomes included various PET/CT parameters, as well as serial measures of inflammatory biomarkers, such as hs-CRP. Results: A total of 111 patients were randomized, with 56 in the placebo group and 55 in the colchicine group. Colchicine had no significant impact on the primary outcome (change in mean: 0.051; IC95% : -0.016 à 0.117; p=0.1346) or any of the PET/CT secondary outcomes. In contrast, patients treated with colchicine presented a decrease of 28% in hs-CRP levels (p=0.0026). Conclusion: Colchicine therapy for 24 weeks had no significant impact on vascular uptake of 18F-FDG in the ascending aorta or carotid arteries. However, a reduction of 28% in hs-CRP was observed in the colchicine group. The Colchicine Cardiovascular Outcomes Trial (COLCOT) is a multicenter randomized phase III trial, currently under way, evaluating the long-term cardiovascular benefits of therapy with colchicine (0.5 mg daily) when begun less than thirty days following acute myocardial infarction.

Le CD36 est un récepteur éboueur de classe B exprimé par plusieurs types cellulaires dont les macrophages et les cellules endothéliales de la microvasculature. Le CD36 présente une haute affinité de liaison pour les ligands lipidiques tels que les lipoprotéines oxydées de basse densité (LDLox). De part sa capacité à internaliser les LDLox au niveau des macrophages et de son implication dans la formation des cellules spumeuses, le CD36 joue un rôle critique dans le développement des lésions athérosclérotiques. Nous avons testé l'hypothèse selon laquelle le EP 80317, un ligand synthétique sélectif du CD36, exerce des effets anti-athérosclérotiques chez les souris déficientes en apolipoprotéine E. Un traitement prolongé (12 semaines) avec le EP 80317 réduit fortement (de 51%) la surface des lésions athérosclérotiques par comparaison aux souris témoins. L'effet anti-athérosclérotique est associé à une diminution des taux de cholestérol plasmatique, à une réduction de l’internalisation des LDLox au niveau des macrophages et à une augmentation de l’expression des protéines impliquées dans le transport inverse du cholestérol. De plus, un traitement par le EP 80317 est également associé une diminution de l’expression aortique et plasmatique de protéines pro-inflammatoires. Nos études ont aussi montré un rôle pour le CD36 dans le recrutement des phagocytes mononucléés au niveau des lésions athérosclérotiques, tel que démontré par une réduction de l’accumulation des phagocytes mononucléés radiomarqués CD36–/– par rapport aux cellules CD36+/+. À l’échelle moléculaire, nous avons montré que les phospholipides oxydés induisent la phosphorylation de la kinase Pyk2 des podosomes des monocytes/macrophages de manière dépendante de l’expression du CD36 et de Src. Cette phosphorylation est atténuée par un traitement par le EP80317. Nos résultats appuient le rôle important du CD36 dans l’athérosclérose et suggèrent que les ligands synthétiques qui modulent la fonction du CD36 représentent potentiellement une nouvelle classe d'agents anti-athérosclérotiques. Le CD36 exprimé par les cellules endothéliales de la microvasculature est un récepteur de l’hétérodimère protéique S100A8/A9. Ces protéines s’associent à l’acide arachidonique intracellulaire (AA) des neutrophiles polymorphonucléaires (PMN) et le complexe S100A8/A9/AA peut être sécrété par les PMN activés au contact de l’endothélium. Nous avons vérifié l’hypothèse selon laquelle le CD36 exprimé par la microvasculature est impliqué dans le métabolisme transcellulaire de l’AA par la liaison du complexe S100A8/A9/AA et la réponse inflammatoire. Chez deux modèles murins d'inflammation aiguë (ischémie/reperfusion des membres inférieurs et poche d’air dorsale), nous avons observé que la réponse inflammatoire, notamment l’accumulation des PMN au niveau des sites inflammatoires, est diminuée en moyenne de 63% chez les souris CD36-/-. De même, un traitement par le EP 80317 ou par les anticorps anti-S100A8/A9 diminue chacun de 60% en moyenne l’extravasation des PMN vers les tissus inflammatoires. L’administration simultanée des deux traitements n’a aucun effet supplémentaire, et ces traitements n’exercent aucun effet chez les souris CD36-/-. Nos résultats appuient le rôle du récepteur CD36 de la microvasculature dans la régulation de la réponse inflammatoire. L’utilisation des ligands synthétiques du CD36 pourrait représenter une nouvelle avenue thérapeutique dans le traitement des réponses inflammatoires aiguës. / CD36 is a class B scavenger receptor expressed by multiple cell types such as macrophages and microvascular endothelial cells. CD36 shows a high affinity binding towards lipid-based ligands such as oxidized low-density lipoproteins (oxLDL). Macrophage CD36 has been shown to play a critical role in the development of atherosclerotic lesions by its ability to internalize oxLDL and to lead to foam cell formation. We tested the hypothesis that EP 80317, a selective CD36 ligand, exerts anti-atherosclerotic effects in apolipoprotein E-deficient (apoE–/–) mice fed on atherogenic diet. Long term treatment (12 weeks) with EP 80317 results in a striking reduction (51%) of lesion areas in EP 80317-treated apoE–/– mice. This effect was associated with a decrease in plasma cholesterol, a reduced oxLDL internalization within macrophages and an up-regulation of proteins involved in cholesterol efflux. Additionally, treatment with EP 80317 was associated with a reduced expression of vascular and plasma pro-inflammatory proteins. Our studies also showed a role of CD36 in modulating the recruitment of mononuclear phagocytes to the arterial wall, as shown by a reduced migration of radiolabeled CD36-/- macrophages into atherosclerotic lesions compared to CD36+/+ cells. At the molecular level, our studies showed that oxidized phospholipids induced the phosphorylation of the adhesion kinase Pyk2 in monocytes/macrophages, in a CD36- and Src-dependent manner. The Pyk2 phosphorylation is attenuated by treatment with EP80317. Our results strongly support the role of CD36 in atherosclerosis development and suggest that synthetic ligands featuring modulatory effect on CD36 function may represent a novel class of anti-atherosclerotic agents. CD36 expressed by microvascular endothelial cells is a receptor for the heterodimer S100A8/A9. These proteins bind intracellular arachidonic acid (AA) within polymorphonuclear neutrophils (PMN) and the complex S100A8/A9-AA may be secreted at sites of inflammation where it exerts chemotactic activities. We aimed to delineate the role of microvascular CD36, as a receptor for the S100A8/A9, in the AA transcellular metabolism and the regulation of the associated PMN trafficking to inflammatory sites. In two mouse models of acute inflammation (hind limb ischemia/reperfusion and dorsal air pouch), CD36 regulated trafficking of PMN to inflammatory sites, as shown by a mean of 63% reduction of PMN accumulation in CD36-/- mice. Treatment with EP 80317 or with S100A8/A9 antibodies reduced, each by ~ 60%, the recruitment of PMN to inflammatory sites. The combined administration of anti-S100A8/A9 and EP 80317 did not exert any additional inhibitory effect and neither treatment featured a modulatory effect in CD36-/- mice. Our results strongly support a role for microvascular CD36 in regulating PMN trafficking to inflammatory sites. Targeting CD36 might represent a novel therapeutic avenue for the treatment of acute inflammatory responses.