O diagnóstico da doença de Wilson (DW) é realizado por exames clínicos, laboratoriais, anatomopatológicos e de imagem. Mais de 500 mutações no gene ATP7B foram descritas como causadoras da DW. Para avaliar a importância da detecção de mutações no diagnóstico da DW em nosso meio, analisamos 35 pacientes com DW, 20 familiares de wilsonianos a partir de rastreamento familiar, 18 com hepatite crônica criptogênica e sete com insuficiência hepática aguda grave. Para o diagnóstico da DW foi utilizado o sistema de escore sugerido pela Sociedade Europeia para o Estudo do Fígado de 2012. Os dados demográficos, clínicos, laboratoriais e histológicos foram obtidos retrospectivamente. Obteve-se o DNA genômico de cada paciente a partir de sangue periférico e realizou-se o sequenciamento direto dos 21 éxons e suas bordas intrônicas do gene ATP7B. Todos os pacientes com DW apresentavam no mínimo quatro pontos. No grupo de rastreamento familiar o sequenciamento foi importante para o diagnóstico de DW em 14 familiares; no grupo de hepatite crônica criptogênica em oito pacientes e no grupo de insuficiência hepática aguda grave em três pacientes. Foi caracterizada uma família com cinco genótipos diferentes (dois homozigotos p.A1135Qfs/p.A1135Qfs e p.M645R/p.M645R), um heterozigoto composto (p.A1135Qfs/p.M645R) e dois heterozigotos simples (p.A1135Qfs/0 e p.M645R/0) com fenótipos variados. Foram detectadas duas mutações em heterozigose simples em pacientes com insuficiência hepática aguda grave. A mutação p.A1135Qfs e p.L708P foram as mais frequentes em todos os grupos. Foi identificada pela primeira vez a mutação p.M645R em homozigose. Concluímos que os resultados confirmaram que o sequenciamento do gene ATP7B foi útil: 1) para confirmar que as mutações p.A1135Qfs e p.L708P são as mais importantes na população brasileira; 2) para demonstrar que a mutação tida como a mais frequente na Europa, a p.H1069Q, tem bem menor importância em nosso meio, embora mais frequentemente do que o observado anteriormente; 3) para confirmar (ou excluir) precocemente o diagnóstico e evitar a realização de exames desnecessários e invasivos e iniciar (ou não realizar) o tratamento, com base mais sólida, em pacientes com hepatopatia crônica idiopática e em familiares de portadores de DW; 4) para definir o diagnóstico de DW em casos de insuficiência hepática aguda grave, diagnóstico ainda que tardio, mas de suma importância para realização de estudo familiar subsequente, 5) para identificação não esperada de heterozigotos simples e polimorfismos de significado ainda não esclarecido em pacientes com insuficiência hepática aguda grave; 6) para identificação de casos inusitados de três genótipos diferentes causadores da doença na mesma família (homozigose de duas mutações diferentes e heterozigose composta); 7) para melhor definir que a mutação p.M645R em homozigose tem potencial para desenvolver a DW, embora resultados de estudos em in vitro sugiram função normal da proteína defeituosa sintetizada; 8) para definir que há casos de doentes com a mutação p.M645R em heterozigose composta de evolução extremamente benigna, com diagnóstico após a quinta década de vida, com discretas alterações hepáticas. Porém há casos com evolução mais grave tanto do ponto de vista hepático quanto neurológico, possivelmente influenciados pelas mutações que a acompanham / Wilson\'s disease (WD) is an autosomal recessive disorder secondary to mutations in the ATP7B gene resulting in toxic accumulation of copper in various tissues. The diagnosis of WD is made by the analysis of clinical, laboratory, histological findings and imaging tests. More than 500 mutations have been described in the ATP7B gene as the cause of WD. In order to expand the knowledge of the importance of mutation detection in the diagnosis of WD, we analyzed 36 patients with WD, 20 individuals from family screening, 18 with cryptogenic chronic hepatitis and seven with severe acute liver failure. For the diagnosis of WD the International Scoring System suggested by the European Association for the Study of the Liver (EASL) in 2012 was used. Demographic, clinical, laboratory and histological data were obtained retrospectively. Direct sequencing of 21 exons and intron boundaries of ATP7B gene was performed in genomic DNA extracted from peripheral blood leucocytes of all subjects. All patients with WD have at least four points of the scoring system without considering the DPA challenge test. In the family screening group, sequencing was important for the diagnosis of DW in fourteen patients; eight patients in the group of cryptogenic chronic hepatitis, and three patients in the group of severe acute liver failure. Five different genotypes were identified in one family (two homozygous, p.A1135Qfs/p.A1135Qfs and p.M645R/p.M645R, one compound heterozygous p.A1135Qfs/p.M645R, and two simple heterozygous p.A1135Qfs/0 and p.M645R/0). Two patients with acute liver failure were detected as simple heterozygous. The p.A1135Qfs and p.L708P were the most frequent mutations in all groups. It is the first time p.M645R mutation was detected in homozygosity. The ATP7B gene sequencing was useful: 1) to confirm that p.A1135Qfs and p.L708P mutations are the most frequent in the Brazilian population; 2) to confirm that the most common mutation in Europe, p.H1069Q has lower frequency in our area; 3) to confirm (or exclude) an early diagnosis and to avoid unnecessary and invasive tests and to initiate (or not) the specific treatment with a stronger basis in patients with chronic liver disease and individuals from family screening of patients with Wilson disease; 4) to confirm the diagnosis, although late, of cases with severe acute liver failure, but very important to perform family screening; 5) to identify simple heterozygotes in patients with severe acute liver failure; 6) to describe unusual cases of three different genotypes of WD patients in a same family (two different homozygous mutations and one compound heterozygous); 7) to better define that p.M645R mutation in homozigosity develops WD, although the results from in vitro studies suggested a normal function for the defective synthesized protein; 8) to define that there are patients with p.M645R mutations in compound heretozigosity with a very benign clinical picture, with late diagnosis, after the fifth decade of life, with mild liver alterations. However, there are patients with a more severe clinical evaluation, hepatic or neurologic, probably secondary to the influence of the other mutation

Esse estudo foi realizado para verificar se a exposição a separações repetidas (por diferentes intervalos de tempo) de mães dos seus filhotes no período neonatal poderiam ser classificadas como indutoras de um estado do tipo deprimido em genitoras. Sessenta ratas Wistar prenhes foram divididas em 3 grupos: controle, separação por 10 minutos e separação por 3 horas. As intervenções neonatais foram realizadas nos dias 1-10 pós parto. Após o desmame as genitoras foram submetidas ao teste do nado forçado, ao teste do labirinto em cruz elevado e ao teste do odor de predador. Também foi avaliado o comportamento alimentar e os padrões de reatividade a um sabor doce e a um sabor amargo. Foi medido os níveis de ocitocina no líquido cefaloraquidiano, corticosterona plasmática e atividade hipocampal Na+, K+-ATPase, assim como a atividade das enzimas antioxidantes catalase, glutationa peroxidase, superoxido dismutase, produção de radicais livres, e a produção de óxido nítrico, além dos níveis dos receptores A2A de adenosina e D2 de dopamina no estriado dorsoventral e no hipocampo. Foi observado que somente a separação por 3 h induziu um aumento significativo no tempo de imobilidade no teste do nado forçado, o que é consistente com estudos prévios. A atividade hipocampal da Na+, K+-ATPase se mostrou diminuída no grupo separado por 10 minutos e mais significativamente diminuída nas genitoras submetidas a separação por 3 horas de seus filhotes. Adicionalmente, os níveis de ocitocina no líquido cefaloraquidiano se encontravam aumentados no grupo separado por 10 minutos, o que pode estar relacionado a um aumento no cuidado materno, induzido por esta manipulação dos filhotes, por parte das genitoras, como reportado na literatura. Uma redução nos níveis de óxido nítrico no hipocampo das genitoras separadas por 3 horas foi observado Nessas genitoras também foi verificado um aumento no comportamento de risco, uma diminuição no sentimento prazeroso frente a uma solução doce e aumento na sensibilidade a uma solução aversiva, o que é congruente a um perfil de estado do tipo deprimido. Além disso, nós verificamos uma diminuição na quantidade do receptor de dopamina D2 no estriado das mães submetidas a separação por 3 horas dos filhotes, o que poderia ser relacionado com uma diminuição no prazer (anedonia) que acontece na depressão. Conclui-se que a retirada dos filhotes das mães por longos períodos tornam essas mães mais susceptíveis ao desenvolvimento de características depressivas. / This study was carried out to ascertain whether exposure to repeated separations (different times) of mothers from their pups in the neonatal period could be classified as an induction of a depressive-like state in dams. Sixty Wistar rats were divided into 3 groups: control, brief separation and long-term separation. The neonatal interventions were done on postpartum days 1-10. After weaning, the dams were subjected to the forced swimming test, elevated plus maze and predator odor test. It was also evaluated the feeding behavior and the taste reactivity patterns to a sweet and to a bitter solution. It was mesaured cerebral spinal fluid oxytocin, plasma corticosterone, and hippocampal Na+, K+-ATPase activity, as well as the activity of the antioxidant enzymes catalase, glutathione peroxidase, superoxide dismutase, free radicals production, and the production of nitric oxide and the levels of adenosine A2A and dopamine D2 receptors in the dorsoventral striatum and hippocampus. It was observed that only the 3 h separation induced a significant increase in the immobility time of rats in the forced swimming test, which is consistent with previous studies. Hippocampal Na+, K+-ATPase activity was decreased in the brief separated group and more significantly decreased in dams subjected to 3h separation from their pups. Additionally, cerebral spinal fluid oxytocin was increased in dams of the brief separated group, which may be related to the increased handled-induced maternal care, as reported in the literature. A reduction in nitric oxide levels in the hippocampus in dams of the long separated group was also observed. It was also verify an increase in the risk-taking behavior by the 3h separated mothers. The 3h separated mother also demonstrated a diminished feeling of pleasure with a sucrose solution and a increased sensibility to a aversive solution, wich is congruent with a depressive like state profile. Furthermore, we shown a decrease in the dopamine D2 receptor quantity in the striatum of the 3 h separated mothers, wich could be related to a decrease in pleasure feeling (anhedonia) experienced in depression. It is concluded that the withdrawal of pups from their mothers for long periods make the mothers more susceptible to the development of depressive features.

Introdução: A privação de sono (PdS) tem sido utilizada como um estratégia alternativa para o tratamento do Transtorno Depressivo Maior (TDM), contudo sua eficácia e efetividade carecem de estudos homogêneos e de bom delinemento para dar um grau de evidência científica para seu uso na prática diária. Assim sendo, desde a primeira publicação, em 1971, num relato de caso de um paciente com TDM grave tipo melancólico, por Plug e Tölle, o mesmo estava assintomático no dia seguinte à privação total de sono. Contudo, na noite seguinte de sono seus sintomas depressivos retornaram. Nestes quase 40 anos desde esta publicação houve dezenas de estudos em sua maioria relatos de caso, série de casos ou até estudos abertos só que misturando pacientes com TDM com Depressão Bipolar sem mesmo distinguir se tipo I ou II. A cafeína com seu efeito estimulador poderia ser uma alternativa para facilitar a privação de sono. No entanto, não há dados sobre o sua potencial influência no efeito antidepressivo da PdS. O objetivo deste estudo é avaliar o efeito da cafeína na PdS em pacientes deprimidos unipolares moderados a graves não psicóticos. Métodos: Ensaio Clínico randomizado, duplo cego, cruzado, comparando cafeína contra placebo em pacientes deprimidos moderados a graves submetidos à privação total de sono (PdS). Os pacientes foram avaliados por itens da escala de Lader, HAMD- 6 itens, CGI Severidade e Melhora Global. Resultados: Foram avaliados 20 pacientes. Os pacientes que usaram cafeína mantiveram o mesmo escore de energia pré e pós-privação de sono (item energético-letárgico da escala de Lader) enquanto os do grupo placebo diminuíram o escore de energia pós-privação de sono. (p = 0,0045). Não houve diferença entre o grupo cafeína e placebo nos demais itens da escala de Lader. Conclusão: O uso combinado de cafeína e PdS pode ser uma estratégia útil para manter os pacientes mais acordados sem o prejuízo do cansaço da PdS em pacientes ambulatoriais deprimidos. Contudo, mais estudos envolvendo pacientes que tenham 10 respondido à PdS são necessários para verificar se a cafeína também não interfere nos resultados deste grupo. / Introduction: Sleep deprivation (SD) has been used as an alternative approach to treat major depressive disorder (MDD), however the efficacy and the effectiveness needs studies with homogeneity and better delineament to strengthen the evidence based medicine to the use in the practical daily use. Besides, since the 1° puplication in 1971 of a case report, by Plug and Tölle, in that one patient with severe melancholic depressive disorder achieved remission in the next day after a total sleep deprivation. However his depressive sintomtology was back after the next night of sleep. Since this almost 40 years, a lot of papers were puplished, and the majority where case report, case reports and open trials with patients with MDD, bipolar depression without make difference between tipe I or II. Caffeine, due to its stimulating effect, could be an alternative to promote sleep deprivation. However, there are no data about its potential influence on the antidepressive effect of SD. The objective of this study is to assess the effect of caffeine on SD in non-psychotic patients with moderate to severe unipolar depression. Methods: Randomized, double-blind, crossover clinical trial comparing caffeine and placebo in moderate to severe depressed patients who underwent total sleep deprivation (SD). The patients were assessed with items of the Bond-Lader Scale, the 6-item Hamilton Depression Rating Scale (HAMD-6), and the Clinical Global Impression (CGI)-Severity/Improvement. Results: Twenty patients participated in this study. The patients who consumed caffeine presented the same score of energy before and after sleep deprivation (lethargicenergetic item of the Bond-Lader scale), while the patients in the placebo group had a reduced score of energy after sleep deprivation (p = 0.0045). There was no difference between the caffeine and placebo groups in the other items of the Bond-Lader scale. Conclusion: The combined use of caffeine and SD can be a useful strategy to keep the 12 patient awake without impairing the effect of SD on depressed outpatients. However, further studies involving patients who have responded to SD are needed in order to verify if caffeine also does not interfere with the results in this group.

Les ganglions de la base forment un réseau neuronal mettant en jeu une circuiterie complexe et jouant un rôle essentiel dans la régulation des fonctions motrices, dans différentes formes d'apprentissage sensorimoteur, ainsi que dans les processus motivationnels. Cette régulation met en jeu une boucle cortico-striato-thalamo-corticale dans laquelle le striatum tient une position centrale en étant la principale structure d’entrée de ce réseau. Il joue le rôle de filtre en intégrant et traitant l’ensemble des informations qui y parviennent. Ce réseau neuronal complexe peut être altéré par différentes pathologies humaines (maladie de Parkinson, schizophrénie, chorée de Huntington, addiction aux drogues, …) qui résultent d’une perturbation ou d’une lésion au niveau d’une ou plusieurs structures composant le système des ganglions de la base.<p>Le striatum, premier relais du système des ganglions de la base, reçoit deux afférences principales :les voies dopaminergique nigro-striatale et glutamatergique cortico-striatale. En plus de ces deux afférences majeures, l’adénosine, par son action sur ses récepteurs, joue de nombreux rôles de régulation dans ce système. Ainsi, l’activité neuronale des neurones épineux moyens du striatum est modulée par les récepteurs de la dopamine qui sont en étroites interactions avec les récepteurs de l’adénosine. Bien que la signalisation de la dopamine et de l’adénosine ait été l’objet de nombreuses attentions, les mécanismes impliqués dans la régulation, par les récepteurs D2 de la dopamine et A2A de l’adénosine, dans le contrôle du potentiel membranaire et de l’excitabilité intrinsèque des neurones épineux moyens du striatum et leurs conséquences sur cette excitabilité en cas de déplétion en dopamine (mimant la maladie de Parkinson) restent encore très méconnues.<p>Dans ce travail de thèse, nous avons donc tenté d’élucider les mécanismes de régulation des récepteurs D2 et A2A et leurs interactions dans la modulation de la transition du potentiel membranaire et de l’excitabilité intrinsèque des neurones striataux, ainsi que les conséquences d’une déplétion en dopamine sur cette excitabilité neuronale. <p><p>Dans le premier travail de thèse, sur un modèle in vitro de transition du potentiel membranaire et par l’utilisation de peptides compétitifs, nous avons montré que les récepteurs D2 et A2A régulent le plateau de dépolarisation du potentiel membranaire induit par le NMDA via un mécanisme d’interaction protéine-protéine intramembranaire. En effet, l’activation du récepteur D2 supprime la transition entre un potentiel membranaire hyperpolarisé, le « down-state » et un plateau de dépolarisation du potentiel membranaire, le « up-state » par la régulation de l’activité du canal calcique Cav1.3a interagissant avec la protéine d’ancrage Shank. L’activation du récepteur A2A per se n’a pas d’effet, mais il réverse totalement la modulation de la transition du potentiel membranaire par le récepteur D2 selon un mécanisme dans lequel l’hétéromérisation des récepteurs A2A-D2 est strictement nécessaire, démontrant ainsi un intérêt physiologique direct de ces hétéromères. Nos travaux démontrent que la transition du potentiel membranaire et la fréquence de décharge des potentiels d’action des neurones striataux sont étroitement contrôlées par les récepteurs D2 et A2A via des interactions spécifiques protéine-protéine impliquant une hétéromérisation des récepteurs A2A-D2.<p><p>Dans la seconde étude présentée dans cette thèse, nous avons mis en évidence une régulation antagoniste de l’excitabilité intrinsèque des neurones épineux moyens du striatum par les récepteurs D2 et A2A via des mécanismes impliquant la modulation d’une conductance potassique de type A (IA). Par ailleurs, nous avons montré qu’une déplétion en dopamine conduit à une augmentation de l’excitabilité intrinsèque de ces neurones via une diminution d’une conductance IA. Malgré une forte diminution des afférences synaptiques excitatrices déterminées par une diminution de la densité des épines dendritiques et une augmentation du courant minimal nécessaire pour induire un premier EPSP, l’augmentation de l’excitabilité intrinsèque induite par la déplétion en dopamine résulte en un renforcement de la réponse des synapses restantes, permettant aux neurones striataux de répondre à une stimulation en provenance des afférences excitatrices de manière similaire voire même, plus efficace que dans les conditions contrôles. De plus, cette augmentation de l’excitabilité intrinsèque via la régulation d’une conductance IA représente une forme de plasticité homéostatique permettant au neurone de compenser une perturbation de l’activité neuronale ou de la transmission synaptique et donc d’assurer une stabilité de son patron de décharge des potentiels d’action. Ces données montrent la capacité de cette homéostasie à maintenir la fréquence de décharge des neurones striataux dans une gamme fonctionnelle, et ce dans des conditions pathologiques, permettant de stabiliser l’activité neuronale dans un réseau altéré.<p><p><p>En conclusion, l’ensemble de ce travail de thèse a permis de mettre en évidence une interaction fonctionnelle des récepteurs D2 de la dopamine et A2A de l’adénosine dans la régulation du contrôle de l’excitabilité des neurones épineux moyens du striatum. Il a également permis d’établir l’existence d’un mécanisme de plasticité homéostasique intervenant dans ce système neuronal altéré, afin de maintenir une activité électrique fonctionnelle des neurones striataux.<p> / Doctorat en sciences biomédicales / info:eu-repo/semantics/nonPublished

A ecocardiografia com perfusão miocárdica em tempo real (EPMTR) permite a quantificação do fluxo sangüíneo miocárdico e, quando realizada durante o estresse, da reserva de fluxo miocárdico (reserva Axß). Essa técnica tem potencial para ser uma importante ferramenta para o diagnóstico não-invasivo da doença arterial coronariana (DAC). Apesar do conhecimento atual das alterações fisiológicas que ocorrem com o uso de agentes vasodilatadores ou catecolaminas na circulação coronariana, não há dados na literatura comparando diretamente o valor da EPMTR, sob estresse pela dobutamina e pela adenosina, para a detecção de DAC em humanos. Os objetivos deste estudo foram: avaliar, em um mesmo grupo de pacientes, a exeqüibilidade e a acurácia da EPMTR, sob estresse pela dobutamina e pela adenosina, para a detecção de estenose arterial coronariana angiograficamente significativa e determinar o valor adicional da análise quantitativa da perfusão miocárdica sobre o eletrocardiograma de 12 derivações, da motilidade segmentar e da análise qualitativa da perfusão miocárdica obtidas durante o estresse pela dobutamina e pela adenosina. Estudamos 54 pacientes (média etária de 60±9 anos, 33 homens) com suspeita clínica de DAC e indicação de angiografia coronariana. Todos os pacientes foram submetidos à EPMTR sob estresse pela adenosina na dose de 140 g/kg/min por seis minutos e, após um intervalo de três a cinco horas, à EPMTR sob estresse pela dobutamina-atropina. O contraste ecocardiográfico utilizado foi o PESDA (Perfluorocarbon-Exposed Sonicated Dextrose and Albumin), administrado por via intravenosa periférica de forma contínua. Para ambas as EPMTR sob estresse pela dobutamina e pela adenosina, foram feitas análises do eletrocardiograma em 12 derivações (ECG), da motilidade segmentar e análise qualitativa e quantitativa da perfusão miocárdica. A quantificação da velocidade do fluxo miocárdico (ß) e do fluxo sangüíneo miocárdico (Axß) foi realizada por meio da utilização do programa computacional QLab 3.0 (Philips Medical Systems, Bothell, WA, USA). Todos os pacientes foram submetidos à angiografia coronariana quantitativa (ACQ) em um intervalo de até 30 dias da EPMTR. Foi considerada DAC a presença de lesão coronariana > 50% do diâmetro luminal. Dos 54 pacientes estudados, 25 (46%) apresentaram lesão coronariana >50% e 29 (54%) não apresentaram lesão coronariana significativa. A exeqüibilidade da quantificação da reserva Axß foi semelhante para a EPMTR sob estresse pela adenosina e pela dobutamina (91% versus 90% dos territórios arteriais; p = ns). A variabilidade da quantificação interobservador para os parâmetros de reserva ß e Axß foi de 6,8% (r = 0,98) e 5,5% (r = 0,97), respectivamente. A variabilidade intra-observador para os mesmos parâmetros foi de 2,1 % (r = 0,99) e 7,4 % (r = 0,95), respectivamente. A análise quantitativa da perfusão miocárdica, obtida pela EPMTR sob estresse pela dobutamina, apresentou sensibilidade de 84%, especificidade de 76% e acurácia de 80% para a detecção de DAC, enquanto que a EPMTR sob estresse pela adenosina apresentou sensibilidade de 88%, especificidade de 72% e acurácia de 80%. O valor incremental das modalidades estudadas para o diagnóstico de DAC foi analisado em modelo que incluiu o ECG, ECG e motilidade segmentar, ECG e motilidade segmentar e perfusão qualitativa e, por último, ECG e motilidade segmentar e perfusão qualitativa e quantitava, tanto para a EPMTR sob estresse pela dobutamina como pela adenosina (2 de 4,9 versus 20,1 versus 23,7 versus 38,4) e (2 de 9,9 versus 20,1 versus 26,7 versus 59,4), respectivamente. Concluímos que a avaliação quantitativa da EPMTR apresenta boa exeqüibilidade. A EPMTR sob estresse pela dobutamina e a pela adenosina apresentam acurácias diagnósticas similares para a detecção de lesão angiograficamente significativa. A análise quantitativa da perfusão miocárdica apresenta valor diagnóstico adicional aos outros parâmetros obtidos durante o estresse pela dobutamina e adenosina. / Real time myocardial contrast echocardiography (RTMCE) has allowed for the quantification of myocardial blood flow reserve (MBFR). This technique is a valuable tool for the noninvasive detection of coronary artery disease (CAD). Both adenosine and dobutamine are currently used stressor agents during RTMCE. Although it has already been shown the effects of these drugs on the coronary physiology, no study has directly compared both agents during RTMCE. The aims of this study were to determine the feasibility and diagnostic accuracy of adenosine versus dobutamine stress RTMCE for the detection of angiographically significant CAD. In addition, we sought to determine the additional value of quantitative RTMCE over the electrocardiogram, wall motion, and qualitative analysis of myocardial perfusion. The study involved 54 patients (60±9 years, 33 men) with suspected CAD. Patients underwent RTMCE at rest and during continuous infusion of 140g/kg/min of adenosine for six minutes, and dobutamine stress. The contrast agent used in the study was PESDA (Perfluorocarbon-Exposed Sonicated Dextrose and Albumin) administered in continuous intravenous infusion. Quantification of plateau of acoustic intensity (A) and microbubble velocity () was performed off line using a specific software (QLab 3.0, Philips Medical Systems, Bothell, WA, USA). Myocardial blood flow was determined as Ax. Quantitative coronary angiography was performed in all patients within 30 days of RTMCE, and CAD was defined as >50% luminal diameter coronary stenosis. There were 25 (46%) patients with CAD and 29 (54%) patients without obstructive lesion. The feasibility of quantitative MBFR was the same for adenosine and dobutamine stress RTMCE (91% versus 90% in all arterial territories; p=ns). The intraobserver variabilities for the measurements of ß and Axß reserve were 2.1% (r = 0.99) and 7.4% (r = 0.95), respectively. The interobserver variabilities for the same parameters were 6.8% (r = 0.98) and 5.5% (r = 0.97), respectively. The sensitivity, specificity and diagnostic accuracy of ß reserve obtained during dobutamine stress RTMCE for detecting CAD were 84%, 76%, and 80%, respectively, and during adenosine stress RTMCE they were 88%, 72% and 80%. The incremental value for the diagnosis of CAD was analyzed in a model that included the EKG, EKG and wall motion, EKG and wall motion and qualitative perfusion analysis and finally, EKG and wall motion and qualitative and quantitative perfusion analysis, for dobutamine and adenosine RTMCE (2= 4,9 versus 20,1 versus 23,7 versus s 38,4) and (2= 9,9 versus 20,1 versus 26,7 versus 59,4), respectively. In conclusion, quantitative RTMCE is a feasible technique in patients with suspected CAD. Dobutamine and adenosine stress RTMCE had similar diagnostic accuracy for the detection of angiographically significant lesion. Quantitative analysis of myocardial perfusion had incremental diagnostic value over the other parameters obtained during both dobutamine and adenosine stress RTMCE.

Les astrocytes protoplasmiques de la matière grise corticale sont des cellules gliales dont les prolongements très fins et ramifiés sont en contact avec les éléments neuronaux pré- et post-synaptiques d’une part, et les vaisseaux sanguins d’autre part. Ils expriment plusieurs récepteurs des neurotransmetteurs, entre autres des récepteurs purinergiques dont l'activation facilite l’activité calcique astrocytaire et la libération de gliotransmitters (par exemple, le glutamate, le GABA, l'ATP, et la D sérine) qui régulent l’activité des neurones et des cellules gliales situées au voisinage. L’objectif de ma thèse était d’étudier in situ l’activité calcique des astrocytes et de leurs prolongements en réponse à l’application des agonistes purinergiques. Lors de ma thèse, j’ai tout d'abord testé la possibilité d’induire l’expression spécifique de gènes d’intérêt par les astrocytes corticaux de souris adultes par la technique de recombinaison Cre-LoxP. J’ai comparé les performances d’un virus adeno-associé de type 5 (AAV5) flexé (AAV5.FLEX.EGFP) et d’une souris qui exprime un indicateur calcique (GCaMP3) sous contrôle de la recombinase (souris Rosa-CAG-LSL-GCaMP3). L’injection d’AAV5.FLEX.EGFP dans le cortex d’une souris hGFAPcre n’a pas permis l’expression spécifique d’EGFP. La combinaison des souris exprimant le cre recombinase sous contrôle d’un promoteur sélectif des astrocytes (GLAST-CreERT2 et Cx30-CreERT2) avec le AAV5.FLEX.EGFP ou avec une lignée des souris Rosa-CAG-LSL-GCaMP3 permet l’expression spécifique des gènes d’intérêt (EGFP et GCaMP3) par les astrocytes corticaux. J’ai ensuite analysé l’activité calcique des astrocytes qui expriment GCaMP3. J’ai utilisé la microscopie biphotonique et enregistré l’activité calcique spontanée et évoquée par application d’agonistes purinergiques sur des tranches de cortex somatosensoriel primaire de souris adultes GLAST-CreERT2. L’activité calcique spontanée est complexe, généralement locale et désynchronisée, répartie dans les prolongements et la région somatique. Les régions actives ont été identifiées à partir d’une carte de corrélation temporale calculée en MATLAB, et leurs caractéristiques (amplitude, durée, position, fréquence) mesurées grâce à des routines établies sous IGOR. La fréquence et l’amplitude de l’activité calcique paraissent augmenter lors de l’enregistrement, ce qui suggère une sensibilité significative et une photoactivation des astrocytes, en imagerie biphotonique. La durée des impulsions laser modulerait ce phénomène. En présence d'adénosine (1-100 µM) et d’ATP (100 µM), et de façon marginale en présence d’un agoniste P2X7 non sélectif (BzATP 50-100 µM), une activité calcique synchronisée accrue est visible dans le soma et les prolongements astrocytaires en présence de tétrodotoxine qui bloque les potentiels d'action et minimise l’activité synaptique. Le mécanisme de ces réponses synchronisées reste à étudier. Aucun effet significatif n’a été observé en présence d’un agoniste spécifique P2Y1 (MRS2365 50 uM). Mon travail a permis le développement : i) de modèles murins pour l’adressage sélectif de protéines d’intérêt au niveau des astrocytes protoplasmiques ; ii) d’outils d’analyse des signaux calciques astrocytaires au niveau sub-cellulaire. Il a mis en évidence des limites possibles des protocoles standards d'enregistrement de l’activité calcique des astrocytes en imagerie biphotonique. Il confirme l’importance de l’ATP et de l’adénosine pour la signalisation astrocytaire. / Grey matter protoplasmic astrocytes are compact glial cells with highly branched processes, enwrapping synapses, and one or two endfeet contacting the blood vessels. Several neurotransmitter receptors are expressed by astrocytes, among them purinergic receptors. Upon activation of these receptors, intracellular calcium (Ca2+) transients can be induced, that, in turn, trigger gliotransmitter release (e.g. glutamate, GABA, ATP, D-serine) and participate in astrocyte-to-astrocyte signaling as well as in the communication between astrocytes and neurons or other glia. During my PhD work, I first implemented and validated several approaches for targeting transgene expression specifically to cortical astrocytes and employed them to study purinergic signaling in astrocytes. To achieve astrocyte-specific transgene expression, I used either floxed adeno-associated viral (AAV) vectors or a Cre-dependent mouse line and several mouse lines expressing the Cre recombinase under astrocyte-specific promoters. Intracerebral injections of a Cre-dependent AAV serotype 5 containing the ubiquitous CAG promoter and an enhanced green fluorescent protein (AAV5.CAG.flex.EGFP) in adult mice expressing Cre recombinase under the human glial fibrillary protein (hGFAP) promoter resulted in a non-astrocyte specific expression in the cortex. Combining inducible mouse lines expressing Cre recombinase under the glutamate aspartate transporter (GLAST) promoter with the same AAV vector resulted in a virtually astrocyte-specific expression of the reporter gene. As an alternative approach for astrocyte-specific transgene expression, we used a Cre-dependent mouse line expressing the genetically encoded Ca2+ indicator GCaMP3. Crossing this mouse line with the above described GLAST-CreERT2 mouse line or a Connexin30 (Cx30)-CreERT2 line led to selective GCaMP3 expression in cortical astrocytes. Second, I investigated both spontaneous and agonist-evoked Ca2+ transients in astrocytic processes, the investigation of which has presented a major challenge in earlier studies, due to the unspecific and weak labeling by membrane-permeable chemical Ca2+ indicators. Using the strategy developed in the first part of my work allowing an astrocyte-specific expression of the genetically encoded Ca2+ indicator GCaMP3. Using two-photon excitation fluorescence (2PEF) imaging in acute slices of the primary somatosensory cortex, I recorded Ca2+ transients in the astrocytic soma and processes. By aid of a custom-made MATLAB routine based on a temporal Pearson correlation coefficient, active regions could be identified in an unbiased manner. Evoked Ca2+ transients were quantified using custom IGOR routines. Spontaneous desynchronized Ca2+ transients occurred in the processes and rarely in the soma. Ca2+ signals appeared localized in distinct microdomains. Their frequency appeared to increase during long recordings of several hundred images, suggesting that fine astrocytes are vulnerable to photodamage under imaging conditions routine in 2PEF microscopy. The possibility to minimize photodamage, by varying the length of the femtosecond laser pulses is under investigation. Bath application of adenosine (1-100 µM) and adenosine-triphosphate (ATP, 100 µM), as well as the application of the non-selective P2X7 receptor agonist (2'(3')-O-(4-Benzoylbenzoyl)adenosine-5'-triphosphate, BzATP, 50-100 µM), in the presence of tetrodotoxin to block neuronal action potentials, evoked synchronized Ca2+ rises in the soma and the processes of astrocytes. The effect of adenosine was dose-dependent. No significant effect of the specific P2Y1 agonist (MRS2365, 50 µM) was seen. Altogether, my work sets up a powerful and versatile toolbox for studying astrocytic Ca2+ signaling at the sub-cellular level. It also pinpoints possible limits of standard two-photon recording protocols to investigate the local Ca2+ signals in fine astrocytic processes.

Among heat shock proteins, Hsp90 is unusual because it is not required for the proper folding of most cellular proteins but rather is disproportionally linked to the activation of signal transduction proteins including over forty kinases and many steroid hormone receptors. Mutated forms of many Hsp90 clients are causative agents in cancer, making Hsp90 a promising pharmacological target. Many small molecular inhibitors have been identified that competitively bind to the ATP binding site of Hsp90, some of which are in clinical trials as anticancer agents. Although the activation of kinase and hormone receptor clients by Hsp90 and its co-chaperones has been extensively studied, the molecular mechanism of client protein activation is poorly understood. Hsp90 is a dimeric chaperone containing three domains: the N-terminal (N) and middle (M) domains contribute directly to ATP binding and hydrolysis and the C-terminal (C) domain mediates dimerization. At physiological concentration, Hsp90 predominantly forms dimers, but the possibility that full-length monomers might also function in cells has not been tested. In Chapter 3, we used a single-chain strategy to design a full-length Hsp90 monomer (NMCC). The resulting construct was predominantly monomeric at physiological concentration and did not function to support yeast viability as the sole Hsp90. NMCC Hsp90 was also defective at ATP hydrolysis and the activation of kinase and steroid hormone receptor clients in yeast cells. The ability to support yeast growth was rescued by the addition of a coiled-coil dimerization domain, indicating that the parental single-chain construct is functionally defective because it is monomeric. After finding that a full-length Hsp90 monomer containing only one ATPase site was unable to support yeast viability or activate Hsp90 clients, we set out to further explore the role of ATPase activity in client protein activation. Approximately 10 % of the yeast proteome binds to Hsp90 making it important to study Hsp90 function in the cellular environment where all binding partners are present. In Chapter 4, we observed that co-expression of different Hsp90 subunits in Saccharomyces cerevisiae caused unpredictable synthetic growth defects due to cross-dimerization. We engineered super-stabilized Hsp90 dimers that resisted cross-dimerization with endogenous Hsp90 and alleviated the synthetic growth defect. We utilized these super-stabilized dimers to analyze the ability of ATPase mutant homodimers to activate known Hsp90 client proteins in yeast cells. We found that ATP binding and hydrolysis by Hsp90 are both required for the efficient maturation of the glucocorticoid hormone receptor (GR) and v-src confirming the critical role of ATP hydrolysis in the maturation of steroid hormone receptors and kinases in vivo. In addition to its role in the activation of signal transduction client proteins, Hsp90 has been shown to suppress the in vitro aggregation of numerous hard-to-fold proteins. In Chapter 5, we examine the role of charge in Hsp90 anti-aggregation activity. The charge on Hsp90 is largely concentrated in two highly acidic regions. We found that deletion of both charge-rich regions dramatically impaired Hsp90 anti-aggregation activity. Addition of an acid-rich region with a distinct amino acid sequence to our double-deleted Hsp90 construct rescued the anti-aggregation activity of Hsp90 indicating that the net charge contributes to its anti-aggregation activity. The in vitro anti-aggregation activity of Hsp90 studied in Chapter 5 occurs in the absence of ATP. However, all of the biologically important functions of Hsp90 in cells identified to date, including the maturation of kinases and nuclear steroid hormone receptors, clearly require ATP hydrolysis. Why does Hsp90 robustly hinder the aggregation of hard-to-fold proteins without ATP in vitro, but in vivo uses ATP hydrolysis for all of its essential functions? By utilizing separation of function Hsp90 variants (that specifically lack in vitro anti-aggregation activity) we have begun to address this question. We find that anti-aggregation deficient Hsp90 is unable to support yeast growth under stressful conditions, potentially due to reduced cellular expression. Interestingly, the ATP-independent anti-aggregation activity of Hsp90 has no measureable impact on cellular function. Thus, hindering the aggregation of most hard-to- fold proteins by Hsp90 (independent of ATP hydrolysis) does not appear to be important for cell function. These results suggest a cellular model where the Hsp40/60/70 machinery is responsible for hindering the aggregation of most hard-to-fold proteins while Hsp90 assists in the maturation of a select set of clients in an ATP-dependent fashion, potentially aided by its inherent anti-aggregation properties.

First of all, this thesis sets itself a goal to introduce some common technics for datamining in genomics and as a next step to implement own algorithm like algorithm BLAST. In the concrete, this work is pointed to sequences of DNA. The DNA sequence contains in itself genetic information, which is template for living organism. For explanation this information can be used number of technics. This paper describes algorithm Fasta and algorithms from BLAST family. With these algorithms, it is possible to gain a lot of important information even about such DNA sequences, where only primary structure is known. Principle of these algorithms is based on alignments of one query sequence, which we want to obtain some information from, with many sequences stored in database. According to result alignment, it is possible to determine many features of the query sequence.

Les fonctions immunitaires déclinent au cours du vieillissement, un phénomène qui pourrait être lié à l'accumulation de cellules sénescentes dans les tissus. La sénescence est un état irréversible d'arrêt de croissance qui s'engage principalement en réponse à des dommages irréparables de l'ADN. Les cellules sénescentes ont un phénotype sécrétoire pro-inflammatoire (SASP) qui affecte les tissus voisins. CD73 est une enzyme qui travaille en collaboration avec CD39 pour produire de l’adénosine à partir d‘adénosine triphosphate (ATP). Il a été démontré que des concentrations plus élevées d'adénosine dans un microenvironnement tumoral nuisent aux fonctions des cellules immunitaires. L'objectif de ce projet est de déterminer si les fibroblastes sénescents ont la capacité d'induire l'expression de CD39/CD73 à la surface des cellules tueuses naturelles (NK) et d'inhiber la réponse immunitaire antitumorale. Nos résultats montrent que les cellules NK-92, NKAES (cellules tueuses naturelles amplifiées) et les cellules NK primaires expriment des niveaux plus élevés de CD39/CD73 lorsqu'elles sont cultivées avec des fibroblastes sénescents. De plus, nous avons observé que le marqueur CD73 est aussi augmenté dans les fibroblastes sénescents. L'augmentation était cependant plus prononcée lorsque la sénescence était induite en raison de la surexpression de l’oncogène hRASv12 plutôt que suite à l'exposition à des radiations ionisantes. En outre, la cytotoxicité des cellules NK diminue lorsque celles-ci sont exposées à un environnement sénescent et lorsqu'on traite les cellules avec 2-Chloro Adénosine (CADO), un analogue de l'adénosine. Nous supposons que l'augmentation de l'expression de CD39/CD73 conduira à une production accrue d'adenosine, créant ainsi un environnement immunosuppressif. La caractérisation de l'impact de la sénescence cellulaire sur les fonctions des cellules NK pourrait donner un aperçu du développement de stratégies visant à augmenter la capacité du système immunitaire à éliminer les cellules tumorales, améliorant potentiellement les résultats du traitement du cancer. / Immune functions decline during aging, a phenomenon that may be linked to the accumulation of senescent cells in tissues. Senescence is an irreversible state of cell growth arrest often in response to irreparable DNA damage. Senescent cells have a proinflammatory secretory phenotype (SASP) that affects nearby tissues. CD73 is an enzyme that works in collaboration with CD39 to produce adenosine from adenosine triphosphate (ATP). Higher concentrations of adenosine in a tumor microenvironment were shown to impair immune cell functions. The objective of this project is to determine whether senescent fibroblasts have the ability to induce CD39/CD73 expression at the surface of natural killer (NK) cells and inhibit the antitumoral immune response. Our results show that NK-92, NKAES and primary NK cells express higher levels of CD39/CD73 when grown in co-culture with senescent fibroblasts. Similarly, we also observed that the CD73 marker is increased in senescent fibroblasts. The effect was, however, more pronounced when fibroblasts were induced to senesce because of the overexpression of oncogenic hRASv12 compared to when induced to senesce following exposure to ionizing radiation. In addition, the cytotoxicity of NK cells decreases when NK cells are exposed to a senescent environment and when treated with 2- Chloroadenosine (CADO), an analog of adenosine. We hypothesize that increased CD39/CD73 expression will lead to an increased production of adenosine creating an immunosuppressive environment. Characterization of the impact of cellular senescence on the function of NK cells could provide insights into the development of strategies to increase the ability of the immune system to eliminate tumor cells, potentially improving cancer treatment outcomes.

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