Submitted by Vasti Diniz (vastijpa@hotmail.com) on 2017-09-06T11:48:54Z No. of bitstreams: 1 arquivototal.pdf: 1508850 bytes, checksum: d542c27a8bd2415bcff28c45c57ad705 (MD5) / Made available in DSpace on 2017-09-06T11:48:54Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1508850 bytes, checksum: d542c27a8bd2415bcff28c45c57ad705 (MD5) Previous issue date: 2015-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Diabetic retinopathy (DR) is an important cause of acquired blindness among diabetics. Clinical factors are related to the risk for DR, in addition, genetic markers have been investigated, among them VDR and MTHFR polymorphisms, however, the impact of rs1801131 and rs1801133 polymorphisms is still inconclusive, while for rs1544410 there is a shortage in the literature. In this work the relationship of polymorphisms rs1544410, rs1801131 and rs1801133 with DR was investigated by cross-sectional study in a sample of 109 individuals with type 2 diabetes (T2DM) duration between 5 and 10 years. After ophthalmological screening a group of 40 affected and 69 unaffected by DR was composed. Genomic DNA was extracted from buccal cells. Genetic data were obtained by PCR-RFLP and analyzed using Fisher's exact test. Blood sample and urine for metabolic markers determinations were obtained in 62 subjects and the mean values were compared to the allele and genotype distribution of rs1544410. There was no association between alleles or genotypes of polymorphisms rs1801131 and rs1801133 with RD. The polymorphic allele b and genotypic group Bb + bb of rs1544410 were more frequent in the affected group with mild significance: [OR 0.5 (95% CI 0.31-0.98) p = 0.0478] and [OR 3.4 (95% CI 1.07-10.9) p = 0.496], respectively. None of the clinical variables were associated with rs1544410 although a trend towards higher values of C-reactive protein in patients allele b has been identified but not statistically significant. In conclusion, this study suggests that the sample investigated rs1544410 polymorphism of the VDR was related to the risk of DR, but not rs1801131 and rs1801133 MTHFR polymorphisms. / A retinopatia diabética (RD) constitui importante causa de cegueira adquirida entre diabéticos. Fatores clínicos estão relacionados ao risco para RD, em adição, diversos marcadores genéticos têm sido investigados, dentre eles, polimorfismos do MTHFR e VDR. Atividade defeituosa desses genes podem atenuar mecanismos implicados na patogenia da RD, no entanto, o impacto dos polimorfismos rs1801131 e rs1801133 ainda é inconclusivo, enquanto que para o rs1544410 há uma escassez de estudos na literatura. Neste trabalho a relação dos polimorfismos rs1801131, rs1801133 e rs1544410 com RD foi investigada por meio de estudo transversal em amostra de 109 indivíduos com tempo de duração de diabetes mellitus tipo 2 (DM2) entre 5 e 10 anos. Após avaliação oftalmológica foi constituído um grupo de 40 afetados e 69 não afetados por RD. DNA genômico foi extraído de células bucais. Os dados genéticos foram obtidos por PCR-RFLP e analisados utilizando o teste exato de Fisher. Coleta de sangue e urina para determinações de marcadores metabólicos foi feita em 62 indivíduos e as médias dos valores foram comparados à distribuição alélica e genotípica do rs1544410. Não houve associação entre alelos ou genótipos dos polimorfismos rs1801131 e rs1801133 com RD. O alelo b e o grupo genotípico Bb+bb do rs1544410 foram mais frequentes no grupo de afetados apresentando leve significância: [OR 0.5 (95% IC 0.31-0.98) p=0,0478] e [OR 3.4 (95% IC 1.07-10.9) p=0,496] respectivamente. Nenhuma das variáveis clínicas estiveram associadas com rs1544410 embora uma tendência para valores maiores de proteína C-reativa em portadores do alelo b tenha sido identificada mas sem significância estatística. Em conclusão este estudo sugere que na amostra estudada o polimorfismo rs1544410 do VDR esteve relacionado ao risco de RD, mas não o rs1801131 e rs1801133 do MTHFR. Palavras-chave: diabetes mellitus tipo 2; MTHFR; retinopatia diabética; VDR.

Nuclear receptors play significant roles in the regulation of transporters and enzymes to balance the level of endogenous molecules and to protect the body from foreign molecules. The vitamin D receptor (VDR) and its natural ligand, 1alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3], was shown to upregulate rat ileal apical sodium dependent bile acid transporter (Asbt) to increase the reclamation of bile acids, ligands of the farnesoid X receptor (FXR). FXR is considered to be an important, negative regulator of the cholesterol metabolizing enzyme, Cyp7a1, which metabolizes cholesterol to bile acids in the liver. In rats, decreased Cyp7a1 and increased P-glycoprotein/multidrug resistance protein 1 (P-gp/Mdr1) expressions pursuant to 1,25(OH)2D3 treatment was viewed as FXR effects in which hepatic VDR protein is poorly expressed. In contrast, changes in rat intestinal and renal transporters such as multidrug resistance associated proteins (Mrp2, Mrp3, and Mrp4), Asbt, and P-gp after administration of 1,25(OH)2D3 were attributed directly as VDR effects due to higher VDR levels expressed in these tissues. Higher VDR expressions were found among mouse hepatocytes compared to those in rats. Hence, fxr(-/-) and fxr(+/+) mouse models were used to discriminate between VDR vs. FXR effects in murine livers. Hepatic Cyp7a1 in mice was found to be upregulated with 1,25(OH)2D3 treatment, via the derepression of the short heterodimer partner (SHP). Putative VDREs, identified in mouse and human SHP promoters, were responsible for the inhibitory effect on SHP. The increase in hepatic Cyp7a1 expression and decreased plasma and liver cholesterol were observed in mice prefed with a Western diet. A strong correlation was found between tissue Cyp7a1 and P-gp changes and 1,25(OH)2D3 plasma and tissue concentrations, confirming that VDR plays an important role in the disposition of xenobiotics and cholesterol metabolism. Moreover, renal and brain Mdr1a/P-gp were found to be directly upregulated by the VDR in mice, and concomitantly, increased renal and brain secretion of digoxin, a P-gp substrate, in vivo. The important observations: the cholesterol lowering and increased brain P-gp efflux activity properties suggest that VDR is a therapeutic target for treatment of hypercholesterolemia and Alzheimer’s diseases, since beta amyloid, precursors of plague, are P-gp substrates.

Nuclear receptors play significant roles in the regulation of transporters and enzymes to balance the level of endogenous molecules and to protect the body from foreign molecules. The vitamin D receptor (VDR) and its natural ligand, 1alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3], was shown to upregulate rat ileal apical sodium dependent bile acid transporter (Asbt) to increase the reclamation of bile acids, ligands of the farnesoid X receptor (FXR). FXR is considered to be an important, negative regulator of the cholesterol metabolizing enzyme, Cyp7a1, which metabolizes cholesterol to bile acids in the liver. In rats, decreased Cyp7a1 and increased P-glycoprotein/multidrug resistance protein 1 (P-gp/Mdr1) expressions pursuant to 1,25(OH)2D3 treatment was viewed as FXR effects in which hepatic VDR protein is poorly expressed. In contrast, changes in rat intestinal and renal transporters such as multidrug resistance associated proteins (Mrp2, Mrp3, and Mrp4), Asbt, and P-gp after administration of 1,25(OH)2D3 were attributed directly as VDR effects due to higher VDR levels expressed in these tissues. Higher VDR expressions were found among mouse hepatocytes compared to those in rats. Hence, fxr(-/-) and fxr(+/+) mouse models were used to discriminate between VDR vs. FXR effects in murine livers. Hepatic Cyp7a1 in mice was found to be upregulated with 1,25(OH)2D3 treatment, via the derepression of the short heterodimer partner (SHP). Putative VDREs, identified in mouse and human SHP promoters, were responsible for the inhibitory effect on SHP. The increase in hepatic Cyp7a1 expression and decreased plasma and liver cholesterol were observed in mice prefed with a Western diet. A strong correlation was found between tissue Cyp7a1 and P-gp changes and 1,25(OH)2D3 plasma and tissue concentrations, confirming that VDR plays an important role in the disposition of xenobiotics and cholesterol metabolism. Moreover, renal and brain Mdr1a/P-gp were found to be directly upregulated by the VDR in mice, and concomitantly, increased renal and brain secretion of digoxin, a P-gp substrate, in vivo. The important observations: the cholesterol lowering and increased brain P-gp efflux activity properties suggest that VDR is a therapeutic target for treatment of hypercholesterolemia and Alzheimer’s diseases, since beta amyloid, precursors of plague, are P-gp substrates.