INTRODUÇÃO: A ressuscitação de baixo volume com solução salina hipertônica (SSH) ou terlipressina pode ser uma alternativa à administração de grandes volumes de cristaloides no tratamento do choque hemorrágico. O objetivo deste estudo foi avaliar os efeitos da HHS e terlipressina sobre a perfusão e oxigenação cerebral e investigar os mecanismos cerebrais envolvidos na microcirculação, função mitocondrial, atividade eletrocortical e vias apoptóticas cerebrais durante choque hemorrágico. MÉTODOS: Animais anestesiados com isofluorano foram submetidos ao choque hemorrágico [grupo Hemo; pressão arterial média (PAM) de 40 mmHg por 30 minutos] e tratados com Ringer lactato (RL) (3RL; 3x volume de sangue removido), terlipressina (grupo Terli; bolus) ou SSH (grupo SSH; 4 mL/kg bolus) e comparados ao grupo Sham. Um modelo porcino (n = 56) foi utilizado para avaliação da pressão de perfusão cerebral (PPC) e de oxigênio tecidual (PbtO2), e da expressão cerebral de marcadores teciduais da regulação de água (aquaporina-4), sódio (cotransportador-1 de Na-K-2Cl), estresse oxidativo (substâncias reativas ao ácido tiobarbitúrico e superóxido dismutase dependente de manganês) e apoptose. Um modelo murino (n = 179) foi utilizado para avaliação da microcirculação (fluorescência de FITC-dextrano) e função mitocondrial (potencial redox e de membrana mitocondrial, utilizando-se a fluorescência de flavoproteínas endógenas e do tetrametilrodamina metil éster, respectivamente) no córtex cerebral, utilizando-se a microscopia confocal in vivo, e para avaliação da atividade eletrocortical cerebral, por meio da monitorização do potencial evocado somatossensorial. No modelo murino foram avaliados três grupos adicionais, constituídos pela associação da terlipressina ao RL (1x, 2x ou 3x volume removido). RESULTADOS: No grupo Hemo porcino, houve uma redução significativa da PPC e PbtO2, associada ao aumento na expressão cerebral de marcadores da regulação do transporte de água e sódio, estresse oxidativo e apoptose em relação ao Sham. No modelo murino, a hipotensão induzida pelo choque hemorrágico foi correlacionada à diminuição na densidade vascular cortical e às disfunções mitocondriais e da atividade eletrocortical cerebral. No grupo 3RL porcino, a infusão de grandes volumes de RL recuperou a PbtO2, mas não a PPC, e foi acompanhada por uma maior expressão cerebral de marcadores da regulação de água, estresse oxidativo e apoptose comparada ao Sham. Nos ratos, a ressuscitação volêmica agressiva não recuperou a densidade vascular cortical, que foi correlacionada às disfunções mitocondrial e da atividade eletrocortical. No grupo Terli porcino, o aumento na PAM foi associado à restauração da PPC, PbtO2 e expressão dos marcadores da regulação de água e sódio, estresse oxidativo e apoptose no cérebro. Nos ratos tratados com terlipressina, associada ou não a 1x ou 2x RL, houve uma correlação positiva entre a recuperação da densidade vascular cortical e a restauração das funções mitocondrial e atividade eletrocortical cerebral. A SSH não promoveu melhora em nenhum dos modelos. CONCLUSÕES: RL e terlipressina recuperaram a oxigenação no córtex cerebral, mas apenas a terlipressina recuperou a perfusão cerebral, revertendo as disfunções mitocondrial e eletrocortical no cérebro e o aumento no transporte de água e sódio, estresse oxidativo e apoptose induzidos pelo choque hemorrágico. A SSH não recuperou a perfusão e oxigenação cerebral / INTRODUCTION: Small-volume resuscitation with hypertonic saline solution (HSS) or terlipressin can be an alternative to the administration of large amounts of crystalloids in haemorrhagic shock. The aim of this study was to evaluate the effects of HSS and terlipressin on cerebral perfusion and oxygenation and investigate the cerebral mechanisms associated with microcirculation, mitochondrial function, electrocortical activity and apoptotic pathways during haemorrhagic shock. METHODS: Isoflurane-anaesthetised animals were submitted to haemorrhagic shock [Haemo group; mean arterial pressure (MAP) of 40 mmHg for 30 minutes] and treated with lactated Ringer\'s solution (LR) (3LR group; 3x volume bled), terlipressin (Terli group; bolus) or HSS (HSS group; bolus 4 mL/kg) and were compared with a Sham group. A porcine model (n = 56) was used to assess the cerebral perfusion pressure (CPP) and tissue oxygenation (PbtO2) and the expression of tissue markers of water (aquaporin-4), sodium (Na-K-2Cl cotransporter-1), oxidative stress (thiobarbituric acid reactive substances and manganese superoxide dismutase) and apoptosis in cerebral samples. A murine model (n = 179) was used to assess microcirculation (FITC-dextran fluorescence) and mitochondrial function (redox and membrane potential, using the fluorescence of endogenous flavoproteins and tetramethylrhodamine methyl ester, respectively) in the cerebral cortex by using in vivo confocal microscopy, and to assess the electrocortical brain activity by monitoring the somatosensory evoked potential. In the murine model, three additional groups were evaluated, which received terlipressin associated to LR (1x, 2x or 3x blood withdrawn). RESULTS: In the porcine Hemo group, there was a significant decrease in the CPP and PbtO2, which were associated to an increased cerebral expression of markers of water and sodium transport, oxidative stress and apoptosis compared with Sham. In the murine model, the haemorrhagic shock-induced hypotension was correlated to a decrease in the cortical vascular density and to dysfunctions on brain mitochondria and electrocortical activity. In the porcine 3LR group, the infusion of large volumes of LR recovered the PbtO2, but not the CPP, and was accompanied by an increased cerebral expression of markers of water and sodium transport, oxidative stress and apoptosis compared with Sham. In the rats, the aggressive fluid resuscitation did not recover the cortical vascular density, which was correlated to the brain mitochondrial and electrocortical dysfunctions. In the porcine Terli group, the increase in the MAP was associated with the recovery of CPP, PbtO2, and expression of markers of water and sodium regulation, oxidative stress and apoptosis within the brain. In the rats treated with terlipressin, associated or not with 1x or 2x LR, there was a positive correlation between the recovery of the cortical vascular density and the recovery of the brain mitochondrial and electrocortical functions. Such improvements were not observed in none of the models treated with HSS. CONCLUSIONS: LR and terlipressin recovered tissue oxygenation in the cerebral cortex, but only terlipressin recovered the cerebral perfusion, reversing the brain mitochondrial and electrocortical dysfunctions and the increase in the markers of water and sodium transport, oxidative stress, and apoptosis induced by haemorrhagic shock. The HSS did not recover cerebral perfusion and oxygenation

Le but de notre travail était d'étudier des nouveaux aspects de la physiopathologie et de la thérapeutique du choc anaphylactique chez le rat Brown Norway. La première partie de notre thèse étudie la physiopathologie systémique et régionale du choc anaphylactique. Le choc anaphylactique s'accompagne d'une diminution rapide du débit cardiaque, d'une altération brutale de l'autorégulation du débit sanguin cérébral et d'une atteinte respiratoire associant un oedème des voies respiratoires et un bronchospasme. La deuxième partie de notre travail s'intéresse à la prise en charge thérapeutique du choc anaphylactique. L'adrénaline s'avère supérieure à la vasopressine, pour inhiber le bronchospasme et diminuer la perméabilité microvasculaire, permettant une meilleure préservation de l'oxygénation cérébrale, en particulier dans la région de l'hippocampe, mais aussi une correction du bronchospsme et une diminution de l'hyperperméabilté bronchique à la phase précoce du choc anaphylactique. Nous avons également comparé les effets de trois types de solutés de remplissage administrés en association avec l'adrénaline au cours du choc anaphylactique, démontrant la supériorité de l'administration de soluté macromoléculaires tels que l'HES et l'échec des solutés salés hypertoniques. Enfin nous avons pu mettre en évidence l'intérêt de l'administration de bleu de méthylène (3mg/kg) en démontrant l'existence d'un effet synergique avec l'adrénaline au cours du choc anaphylactique / The aim of our work was to study new aspects of the pathophysiology and treatment of anaphylactic shock in the Brown Norway rat. The first part of this thesis focuses on the systemic and regional pathophysiology of anaphylactic shock which is accompanied by a rapid decrease in cardiac output, a sudden alteration of autoregulation of cerebral blood flow and a respiratory dysfunction involving swelling of the airways and bronchospasm. The second part of our work focuses on the therapeutic management of anaphylactic shock. Epinephrine was found to be superior to vasopressin, to inhibit bronchospasm and decrease microvascular permeability, allowing a better preservation of the cerebral oxygenation, in particular in the region of the hippocampus. Furthermore, it provided also an alleviation of bronchospasm and of bronchial hyperperméabilté in the early phase of anaphylactic shock. We also compared the effects of three types of fluid therapy administered in combination with adrenaline during anaphylactic shock, demonstrating the superiority of the administration of a macromolecular solution such as HES compared to hypertonic saline fluids. Finally we were able to highlight the usefulness of the administration of methylene blue (3mg/kg) demonstrating the existence of a synergistic effect with adrenaline during anaphylactic shock

O núcleo supraquiasmático (NSQ), principal relógio biológico circadiano em mamíferos, contem população variada de neurônios produtores de diferentes substâncias neuroativas. Em roedores, as pesquisas avançaram na investigação dos mecanismos moleculares e substâncias neuroativas, que em conjunto determinam a função do relógio biológico. Entretanto, há poucas informações em espécies diurnas, especialmente primatas sobre esta organização intrínseca que não raramente apresenta diferenças nas espécies estudadas. O presente estudo busca identificar a natureza química dos principais grupamentos neuronais do NSQ no primata diurno Cebus apella, relacionando a localização destes grupamentos com as três principais projeções aferentes deste núcleo. Os resultados obtidos evidenciam organização complexa do NSQ, caracterizada por grupos celulares contendo vasopressina, polipeptídeo intestinal vasoativo e marcador de diferenciação neural com localização semelhante a de roedores e células que contém calbindina e calretinina com localização diferente da de roedores. / The suprachiasmatic nucleus (SCN), the main circadian clock in mammals, contains diverse population of neurons of different neuroactive substances. In rodents, there has been extensive research in the recent past looking into the molecular basis and mechanisms of the biological clock. However, there is little information in diurnal species, especially primates about this organization seldom has no intrinsic differences in the species studied. This study seeks to identify the chemical nature of the main groups of SCN neurons in diurnal primate Cebus apella, relating the location of these groups with the three major afferent projections from this nucleus. The results show complex organization of the SCN, characterized by cell groups containing vasopressin, vasoactive intestinal polypeptide and neuronal differentiation marker in the same location and rodent cells that contain calbindin and calretinin with location different from that of rodents.

O monóxido de carbono (CO) tem um importante papel na fisiologia animal incluindo plasticidade sináptica, processos de memória e aprendizagem, inflamação e liberação de neuropeptídios hipotalâmicos. Recentemente tem sido demonstrado que a liberação de vasopressina (AVP) e ocitocina (OT) em resposta a alterações no balanço hidromineral pode ser modulada por esse neuromodulador gasoso, contudo, os mecanismos pelos quais essa modulação ocorre ainda não foram elucidados. Nesse sentido, nós mapeamos possíveis alvos intracelulares do CO pelos quais esse gás poderia afetar as respostas neuroendócrinas tais como as propriedades passivas de membrana de neurônios magnocelulares do núcleo supraóptico (SON), via de sinalização da p38 MAPK, sistema óxido nítrico (NO)/óxido nítrico sintase (NOS), participação de astrócitos hipotalâmicos e a resposta antioxidante à diferentes condições de hidratação: euhidratação, 24 e 48 horas de privação hídrica. Nós observamos que a inibição da formação central de CO reduziu o aumento das concentrações plasmáticas de AVP e OT induzido pela privação hídrica, bem como inibiu a atividade NOS nos grupos hidratado e desidratado por 48 horas (PH 48); enquanto a razãoe p-p38 MAPK/p38 MAPK ratio foi aumentada pela doação central de CO em todas as condições de hidratação analisadas. Além do mais, nós demonstramos a expressão de HO-1, p38 MAPK e p-p38 MAPK em astrócitos hipotalâmicos. Em relação à resposta antioxidade, observamos que camundongos silenciados para Nrf2 no SON tem a resposta à desidratação prejudicada. Esses dados indicam o papel do CO como uma molécula neuromodulatória nas respostas neuroendócrinas à desidratação onde pode exercer sua função via resposta antioxidante em tempo mais curto de restrição hídrica e via sistema do NO em tempo mais prolongado / Carbon monoxide plays important roles in animal physiology including synaptic plasticity, learning and memory processes, inflammation and hypothalamic neuropeptide release. Recently it has been demonstrated that the AVP and OT release in response to changes in hydromineral balance can be modulated by this gaseous neuromodulator; however, the mechanisms by which this modulation occurs need to be elucidated. In order to answer this questioning, we evaluated the CO effect on neuroendocrine responses, SON magnocellular neurons passive membrane properties, p38 MAPK signaling, NO/NOS system and astrocytes participation in rats during control or 24/48 WD conditions. We observed that CO formation inhibition reduced the water deprivation-induced increase in plasma AVP and OT concentration and NOS activity in basal and 48 WD groups; while p-p38 MAPK/p38 MAPK ratio was increased by central CO donation in both euhydrated and dehydrated conditions. Furthermore, we demonstrated HO-1, p38 MAPK and p-p38 MAPK expression in MBH astrocytes. These data indicate the CO role as neuromodulatory molecule in neuroendocrine responses to dehydration where it might play its biological functions through p38 MAPK phosphorylation and NOS activity in a water restriction longer period

O sistema endocanabinóide (eCB) tem sido reconhecido como um importante modulador da homeostase energética e recentemente estudos o apontam como um possível integrador da homeostase hidroeletrolítica. Estudos recentes do nosso laboratório demonstraram a participação do receptor canabinóide do tipo 1 (CB1R) no controle da secreção neurohipofisária em resposta a expansão hipertônica do volume extracelular. Dessa forma, o presente trabalho visou esclarecer a participação do sistema eCB, particularmente do CB1R, nas respostas neuronais, neuroendócrinas e comportamentais induzidas pela sobrecarga salina de 4 dias (SS). Uma vez que os animais em SS apresentam hipofagia induzida pela hiperosmolalidade, buscou-se avaliar as vias de integração do controle da homeostase energética e do balanço hidroeletrolítico por meio da introdução de um grupo em dieta pareada (pair fed, PF). De forma a investigar a hipótese acima, utilizou-se como ferramenta farmacológica o agonista seletivo CB1R, araquidonil-2-cloroetilamida (ACEA - 0,1g/5L), administrado por via intracerebroventricular (icv). Inicialmente, nosso trabalho mostrou que a SS promoveu aumento da expressão de CB1R tanto nos núcleos supra-óptico (NSO) e paraventricular (NPV) do hipotálamo quanto em estruturas da lâmina terminal [órgão subfornicial (SFO), o órgão vasculoso da lâmina terminal (OVLT) e o núcleo pré-óptico mediano (MnPO)]. Tais observações foram reforçadas pela análise microscópica destas regiões cerebrais por imunofluorescência, que evidenciou aumento da imunomarcação para CB1R no NPV, NSO e SFO em animais submetidos a SS. Estes resultados também mostraram que a maioria dos terminais pré-sinápticos CB1R-positivos estão localizados predominantemente na porção ventral do NSO, na qual predominam neurônios vasopressinérgicos. Os dados mostram ainda que todas as respostas induzidas pela SS foram revertidas após a reintrodução dos líquidos (RL, água e NaCl 0,3M). Já no grupo PF, não foram observadas alterações na expressão de CB1R em nenhuma das áreas avaliadas. No entanto, após a RL, os animais PF apresentaram hipoosmolalidade plasmática e aumento da expressão de CB1R na LT, sendo este último efeito aparentemente mediado por um aumento da expressão deste receptor no SFO. Em animais normoidratados, a administração central de ACEA produziu um aumento significativo na ingestão alimentar, sendo esta resposta ausente nos animais submetidos a SS, apesar do aumento da expressão de CB1R no hipotálamo verificada neste grupo. Entretanto, o pré-tratamento com ACEA foi capaz de potencializar a ingestão de água induzida pela SS, não produzindo efeitos significativos sobre este parâmetro no grupo PF. Este estudo demonstrou ainda que a SS não alterou as concentrações plasmáticas de angiotensina II (ANGII), porém promoveu aumento signficativo nas concentrações plasmáticas de corticosterona, vasopressina (AVP) e ocitocina (OT), além de diminuir a secreção de peptídeo natriurético atrial (ANP). Em animais submetidos a SS, o prétratamento com ACEA potencializou a secreção de corticosterona e preveniu o aumento da secreção de AVP e OT. Por outro lado, não foram observados efeitos da administração de ACEA sobre a secreção de ANP e ANGII induzida pela SS. Após a RL, o grupo SS apresentou normalização das concentrações plasmáticas hormonais, não sendo observados quaisquer efeitos da administração de ACEA nestas condições experimentais. No grupo PF, por sua vez, após a RL foi observada diminuição na secreção de OT e aumento nas concentrações plasmáticas de ANGII, efeitos estes não alterados pelo pré-tratamento com ACEA. Em conjunto, nossos dados sugerem que o CB1R participa ativamente das respostas homeostáticas comportamentais e neuroendócrinas desencadeadas pela SS, sendo estas respostas especificamente relacionadas ao controle da homeostase hidrossalina e não secundárias à hipofagia induzida pela hiperosmolalidade. Desta forma, conclui-se que a participação do CB1R na homeostase hidroeletrolítica ocorre em paralelo e independentemente da modulação exercida por este receptor sobre a homeostase energética. / The endocannabinoid system (eCB) has been recognized as an important modulator of energy homeostasis and recent studies suggest that this system may play a possible integrator role on hydromineral homeostasis. Recent studies from our laboratory demonstrated the involvement of the type 1 cannabinoid receptor (CB1R) in the control of neurohypophyseal secretion in response to hypertonic extracellular volume expansion. Therefore, the present study aimed to clarify the involvement of the ECB system, particularly of CB1Rs, in neuronal, neuroendocrine and behavioral responses induced by 4 days of salt load (SS). Since the animals submitted to SS exhibit a well known state of hyperosmolality-induced hypophagia, we attempted to evaluate the integrated control of energy homeostasis and hydroelectrolytic balance through the introduction of a paired diet group (pair fed, PF). In order to achieve these goals, this study employed as a pharmacological tool the CB1R selective agonist, arachidonoyl-2\'-chloroethylamide (ACEA-0.1g/5L), administered intracerebroventricularly (icv). Initially, our work showed that SS increased the expression of CB1R in both supraoptic (SON) and paraventricular (PVN) nuclei of the hypothalamus, as well as in the structures of the lamina terminalis [subfornical organ (SFO), organum vasculosum of the lamina terminalis (OVLT) and median preoptic nucleus (MnPO)]. These observations were reinforced by the microscopic analysis of these brain regions by immunofluorescence, which showed increased immunostaining for CB1R in the PVN, SON and SFO in animals submitted to SS. These results also showed that most of the presynaptic CB1R-positive terminals are located predominantly in the ventral part of the SON, which is characterized by the presence of vasopressinergic neurons. The data also showed that all SS-induced responses were reversed after reintroduction of fluids (RF, water and 0,3M NaCl). On the other hand, no changes in the expression of CB1R in any of the evaluated areas were observed in the PF group. However, after RF, PF animals showed hypoosmolality and increased expression of CB1R in the LT, being the latter effect apparently mediated by increased expression of this receptor in SFO. In euhydrated animals, the central administration of ACEA produced a significant increase in food intake, being this response absent in animals submitted to SS, despite the increased expression of CB1R in the hypothalamus observed in this group. However, pretreatment with ACEA was able to potentiate SS-induced water intake, producing no significant effect on this parameter in the PF group. This study also demonstrated that SS did not alter plasma concentrations of angiotensin II (ANG II), but significantly increased plasma concentrations of corticosterone, vasopressin (AVP) and oxytocin (OT), and decreased the secretion of atrial natriuretic peptide (ANP). In animals submitted to SS, pretreatment with ACEA enhanced the secretion of corticosterone and prevented the increased secretion of AVP and OT. Moreover, no effect of ACEA was observed on the SS-induced ANG II and ANP secretion. After RF, the SS group showed normalization of hormonal plasma concentrations, and no effects of ACEA administration were verified under these experimental conditions. After RF, the PF group exhibited a decrease in OT secretion and increased plasma concentrations of ANG II, effects that were not altered by pretreatment with ACEA. Taken together, our data suggest that CB1Rs actively participate in behavioral and neuroendocrine homeostatic responses triggered by SS, and that these responses were specifically related to the control of hydromineral homeostasis and not secondary to the hyperosmolality-induced hypophagia. Therefore, we conclude that the involvement of CB1R in electrolyte homeostasis occurs in parallel and independently of the modulation exerted by this receptor on energy homeostasis.

O monóxido de carbono (CO) tem um importante papel na fisiologia animal incluindo plasticidade sináptica, processos de memória e aprendizagem, inflamação e liberação de neuropeptídios hipotalâmicos. Recentemente tem sido demonstrado que a liberação de vasopressina (AVP) e ocitocina (OT) em resposta a alterações no balanço hidromineral pode ser modulada por esse neuromodulador gasoso, contudo, os mecanismos pelos quais essa modulação ocorre ainda não foram elucidados. Nesse sentido, nós mapeamos possíveis alvos intracelulares do CO pelos quais esse gás poderia afetar as respostas neuroendócrinas tais como as propriedades passivas de membrana de neurônios magnocelulares do núcleo supraóptico (SON), via de sinalização da p38 MAPK, sistema óxido nítrico (NO)/óxido nítrico sintase (NOS), participação de astrócitos hipotalâmicos e a resposta antioxidante à diferentes condições de hidratação: euhidratação, 24 e 48 horas de privação hídrica. Nós observamos que a inibição da formação central de CO reduziu o aumento das concentrações plasmáticas de AVP e OT induzido pela privação hídrica, bem como inibiu a atividade NOS nos grupos hidratado e desidratado por 48 horas (PH 48); enquanto a razãoe p-p38 MAPK/p38 MAPK ratio foi aumentada pela doação central de CO em todas as condições de hidratação analisadas. Além do mais, nós demonstramos a expressão de HO-1, p38 MAPK e p-p38 MAPK em astrócitos hipotalâmicos. Em relação à resposta antioxidade, observamos que camundongos silenciados para Nrf2 no SON tem a resposta à desidratação prejudicada. Esses dados indicam o papel do CO como uma molécula neuromodulatória nas respostas neuroendócrinas à desidratação onde pode exercer sua função via resposta antioxidante em tempo mais curto de restrição hídrica e via sistema do NO em tempo mais prolongado / Carbon monoxide plays important roles in animal physiology including synaptic plasticity, learning and memory processes, inflammation and hypothalamic neuropeptide release. Recently it has been demonstrated that the AVP and OT release in response to changes in hydromineral balance can be modulated by this gaseous neuromodulator; however, the mechanisms by which this modulation occurs need to be elucidated. In order to answer this questioning, we evaluated the CO effect on neuroendocrine responses, SON magnocellular neurons passive membrane properties, p38 MAPK signaling, NO/NOS system and astrocytes participation in rats during control or 24/48 WD conditions. We observed that CO formation inhibition reduced the water deprivation-induced increase in plasma AVP and OT concentration and NOS activity in basal and 48 WD groups; while p-p38 MAPK/p38 MAPK ratio was increased by central CO donation in both euhydrated and dehydrated conditions. Furthermore, we demonstrated HO-1, p38 MAPK and p-p38 MAPK expression in MBH astrocytes. These data indicate the CO role as neuromodulatory molecule in neuroendocrine responses to dehydration where it might play its biological functions through p38 MAPK phosphorylation and NOS activity in a water restriction longer period

La vasopressine (AVP) et la corticolibérine (CRF) agissent de manière synergique lors de la réponse aux stimuli stressants. Elles régulent de manière concertée la sécrétion d'adrénocorticotrophine hypophysaire et la libération de catécholamines surrénalienne. Dans ces deux structures, les isoformes de récepteurs présents sont les récepteurs V1B et CRF1. Nous avons démontré que deux mécanismes moléculaires sous-tendent la synergie fonctionnelle de l'AVP et du CRF : un croisement des voies de seconds messagers propres à chacun des récepteurs d'une part, et une modification de leurs propriétés pharmacologiques résultant de leur interaction (hétérodimérisation) d'autre part. Pour valider ce dernier mécanisme, nous avons recherché des formes naturelles ou mutées de récepteurs à l'AVP et au CRF conservant leurs propriétés de couplage aux protéines G, mais incapables d'hétérodimériser, et avons analysé les conséquences de cette rupture d'hétérodimérisation sur leur aptitude à agir en synergie. Grâce à une approche de mutagénèse dirigée, nous avons commencé à résoudre la question des portions de récepteurs engagées dans l'hétérodimérisation. Les résultats obtenus apportent les premières évidences permettant de comprendre la synergie AVP/CRF au niveau moléculaire, et particulièrement le rôle de l'hétérodimérisation. L'hétérodimère V1B/CRF1 pourrait être impliqué dans le stress et ses états pathologiques que sont l'anxiété et la dépression. Nous montrons que les récepteurs V1B et CRF1 sont co-exprimés dans les neurones de certaines structures cérébrales régulant ces phénomènes comportementaux. Démontrer l'existence de l'hétérodimère V1B/CRF1 dans des tissus natifs sera la prochaine étape de ce travail. Si elle est validée, le complexe V1B/CRF1 pourra être considéré comme une cible pharmacologique de première importance dans le traitement de l'anxiété et de la dépression. Travail soutenu par l'Institut de Recherches SERVIER et la Fondation pour la Recherche Médicale. / Vasopressin (AVP) and Corticotropin-Releasing Factor (CRF) are involved in the stress response, mainly by regulating ACTH secretion from the pituitary and by increasing catecholamine and corticosteroids secretion from the adrenal medulla. In these two structures, AVP and CRF have been shown to act in synergism via V1B and CRF1 receptors. Recently, our group demonstrated that such synergism operates via both second messenger crosstalk and putative mechanism involving receptors heterodimerization. To further validate this last original mechanism, we monitored the influence of receptor heterodimerization selectivity and of receptor heterodimerization disruption on functional synergism. We also deciphered receptor dimers interface by synthesizing receptor mutants that do not heterodimerize anymore.These results give clues to the comprehension of AVP/CRF synergism at the molecular level and trigger the potential role of receptors heterodimerization in stress-related behaviours. Indeed both V1B and CRF1 are also co-expressed in neurons of relevant brain area. Establishing the physical association of V1B/CRF1 as heterodimers in native tissue, the next step of our project, would be of considerable importance.Work supported by SERVIER (France) an d the FRM.

<p>Ischemic neuronal injury continues to be a major delimiting factor in achieving successful clinical outcomesafter resuscitation from cardiac arrest. In this thesis, a pig model of cardiopulmonary resuscitation (CPR) wasused to address the effects of different interventions on cerebral blood flow and oxygenation during CPR and theinitial postresuscitation period. A novel technique is presented to quantify the reperfusion oxidative injury.</p><p>Maximization of cerebral blood flow during CPR by open-chest cardiac compression, continuous aortic balloon occlusion, and intra-aortic administration of hypertonic saline-dextran (HSD) did not ameliorate thepostresuscitation hypoperfusion or improve the cerebral oxygen extraction ratio or tissue pH. These findings disaffirm earlier studies suggesting that conserving brain viability after global ischemia is mostly a question ofmaintaining high perfusion pressure.</p><p>Despite an increased cerebral perfusion pressure during CPR, intra-aortic administered epinephrineabove the aortic balloon occlusion did not further improve cerebral blood flow and oxygenation. This findingmay indicate adverse effects of epinephrine on cerebral vascular beds, possibly induced by a relatively highconcentration of epinephrine when administered above the site for aortic balloon occlusion.</p><p>The IV administration of equipotent doses of epinephrine or vasopressin during CPR resulted incomparable hemodynamic changes. The peak increase in cerebral cortical blood flow, however, was reachedapproximately 30 sec later by vasopressin. Furthermore, the second bolus of vasopressin during CPR did notaugment cerebral perfusion, whereas epinephrine did. Consequently, reports suggesting that vasopressin issuperior to epinephrine with respect to its effects on central hemodynamics and vital organ blood flow may bebiased by the pharmacodynamic differences between the drugs, depending on the time point at which blood flowmeasurements are performed.</p><p>In comparison with IV vasopressin, vasopressin administered above the aortic balloon occlusion resulted in a significant increase in cerebral perfusion pressure during CPR, but not after restoration of spontaneous circulation (ROSC). Cerebral cortical blood flow was, however, not improved <i>during</i> CPR, whereas a significant increase was recorded <i>after</i> ROSC. Relatively higher concentrations of vasopressin above the sitefor intra-aortic balloon occlusion may, therefore, predominantly induce cerebral cortical vasoconstriction duringCPR but induce vasodilatation after ROSC.</p><p>Assessment of oxidative stress or inflammation have been extremely difficult to attain. In our pig model of resuscitation, an association wasobserved between the duration of cardiac arrest and jugular bulb levels of 8-iso-PGF_2α, a major isoprostane and a novel index of oxidative injury. 8-iso-PGF_2α, and the prostaglandin 15-K-DH-PGF_2α, increased within 5 min after ROSC and remained so up to 2 h, indicating the interval of time during which cerebral reperfusion oxidative injury and inflammatory response may occur and are potentially preventable.</p>

Ischemic neuronal injury continues to be a major delimiting factor in achieving successful clinical outcomesafter resuscitation from cardiac arrest. In this thesis, a pig model of cardiopulmonary resuscitation (CPR) wasused to address the effects of different interventions on cerebral blood flow and oxygenation during CPR and theinitial postresuscitation period. A novel technique is presented to quantify the reperfusion oxidative injury. Maximization of cerebral blood flow during CPR by open-chest cardiac compression, continuous aortic balloon occlusion, and intra-aortic administration of hypertonic saline-dextran (HSD) did not ameliorate thepostresuscitation hypoperfusion or improve the cerebral oxygen extraction ratio or tissue pH. These findings disaffirm earlier studies suggesting that conserving brain viability after global ischemia is mostly a question ofmaintaining high perfusion pressure. Despite an increased cerebral perfusion pressure during CPR, intra-aortic administered epinephrineabove the aortic balloon occlusion did not further improve cerebral blood flow and oxygenation. This findingmay indicate adverse effects of epinephrine on cerebral vascular beds, possibly induced by a relatively highconcentration of epinephrine when administered above the site for aortic balloon occlusion. The IV administration of equipotent doses of epinephrine or vasopressin during CPR resulted incomparable hemodynamic changes. The peak increase in cerebral cortical blood flow, however, was reachedapproximately 30 sec later by vasopressin. Furthermore, the second bolus of vasopressin during CPR did notaugment cerebral perfusion, whereas epinephrine did. Consequently, reports suggesting that vasopressin issuperior to epinephrine with respect to its effects on central hemodynamics and vital organ blood flow may bebiased by the pharmacodynamic differences between the drugs, depending on the time point at which blood flowmeasurements are performed. In comparison with IV vasopressin, vasopressin administered above the aortic balloon occlusion resulted in a significant increase in cerebral perfusion pressure during CPR, but not after restoration of spontaneous circulation (ROSC). Cerebral cortical blood flow was, however, not improved during CPR, whereas a significant increase was recorded after ROSC. Relatively higher concentrations of vasopressin above the sitefor intra-aortic balloon occlusion may, therefore, predominantly induce cerebral cortical vasoconstriction duringCPR but induce vasodilatation after ROSC. Assessment of oxidative stress or inflammation have been extremely difficult to attain. In our pig model of resuscitation, an association wasobserved between the duration of cardiac arrest and jugular bulb levels of 8-iso-PGF2α, a major isoprostane and a novel index of oxidative injury. 8-iso-PGF2α, and the prostaglandin 15-K-DH-PGF2α, increased within 5 min after ROSC and remained so up to 2 h, indicating the interval of time during which cerebral reperfusion oxidative injury and inflammatory response may occur and are potentially preventable.

Thesis (Ph. D.)--University of Missouri--Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 189-210). Also available on the Internet.