A diabetes mellitus (DM) é considerada uma das principais epidemias mundiais deste século, sendo responsável direta ou indiretamente pelo óbito de 123 mil diabéticos no Brasil em 2010. Na diabetes mellitus do tipo 1 (DM1), que corresponde a 5-10% dos casos, há ausência ou um relativo déficit de insulina circulante, acarretando aumento na glicemia e em produtos glicosilados, que por sua vez, podem estar relacionados à perda de visão e doenças cardiovasculares. Além disso, a marcante perda de tecido adiposo verificada na DM1 também pode acarretar hipercolesterolemia e esteatose hepática, além de possivelmente contribuir para a inflamação crônica característica da doença. Neste contexto, o objetivo principal do presente estudo foi examinar o efeito do treinamento de força e suplementação da dieta com leucina no tecido adiposo de ratos portadores de diabetes mellitus tipo 1. Para a realização do estudo, ratos Wistar machos foram aleatoriamente distribuídos em quatros grupos: i) Grupo DA (controle) (n=8) - sem treinamento (sedentário) e suplementado com uma mistura de aminoácidos não-essenciais (água ad libitum); ii) Grupo DL (n=8) - sem treinamento (sedentário) e suplementado com leucina (água ad libitum); iii) Grupo DTA (n=8) - com treinamento de força e suplementado com uma mistura de aminoácidos não-essenciais (água ad libitum); iv) Grupo DTL (n = 8) - com treinamento de força e suplementado com leucina (água ad libitum). Após 12 semanas de intervenção, os animais foram eutanasiados. Foram avaliados os seguintes parâmetros: lactato, tolerância à glicose, sensibilidade à insulina, consumo semanal de ração e água, evolução semanal do peso total dos animais, peso total do tecido adiposo e dos diferentes coxins; no soro: triacilglicerol (TAG), lipoproteína de alta densidade (HDL), colesterol total, TNF-α, IL-6, IL-10, IL-1β, leptina, adiponectina e insulina; no tecido adiposo retroperitoneal: expressão gênica de mTOR, Akt, 4E-BP, eif4E, p70s6k, PPARy, LPL, leptina, adiponectina e CEBP-α; concentração total de TNF-α, IL-6, IL-10, e IL-1β. A tolerância à glicose, o consumo de ração e água, a concentração total do TAB e do TARP, assim como a expressão gênica de mTOR, 4E-BP1, eif4E, p70S6k, PPARγ e CEBP-α encontraram-se melhorados nos grupos DL, DTA e DTL em comparação ao grupo DA; e as concentrações de HDL, colesterol total, IL-10 e adiponectina no soro, bem como a expressão gênica de adiponectina e a concentração total de IL-10 no TARP apresentaram-se aumentadas somente nos grupos DTA e DTL quando comparados ao grupo DA. Como conclusão, ambas intervenções foram capazes de atenuar as alterações fisiológicas verificadas na DM1, dentre eles as perdas excessivas do TAB. No entanto, por servir de estímulo para uma maior síntese de citocinas e hormônios antiinflamatórios por parte TAB, o treinamento de força foi o principal responsável pela redução da inflamação sistêmica dos animais. / Diabetes mellitus (DM) is considered one of the most important world epidemics of this century, being responsible directly or indirectly for the death of 123000 diabetics in Brazil in 2010. In type 1 diabetes (DM1), which corresponds to 5-10% of cases, there is absence or relative deficit of circulating insulin, leading to an increased glycemia and glycosilated products, which might be related to loss of vision and cardiovascular diseases. Furthermore, the marked loss of white adipose tissue (WAT) associated with DM1 might induce liver steatosis and hypercholesterolemia, besides possibly contributing to an increased chronic systemic inflammation. In this context, the main objective of the present study was examine the effect of resistance training and supplementation with leucine in the adipose tissue of type 1 diabetic rats. To conduct this study, Wistar male rats were randomly distributed in 4 groups: i) DA group (control of the experiment) (n=8) - without RT and supplemented with a mixture containing non-essential amino acids (water ad libitum); ii) DL group - without RT and supplemented with leucine (water ad libitum); iii) DTA group (n=8) - with RT and supplemented with a mixture containing non-essential amino acids (water ad libitum); iv) DTL group - with RT and supplemented with leucine (water ad libitum). After 12 weeks of intervention, animals were euthanized. The following parameters were analyzed: blood lactate, glucose tolerance, insulin sensitivity, weekly consumption of chow and water, evolution of total weight, WAT total weight and depots; concentration of triacylglycerol, high density lipoprotein, total cholesterol, TNF-α, IL-6, IL-10, IL-1β, adiponectin, leptin and insulin in the serum; gene expression of mTOR, 4E-BP1, eif4E, p70S6k, PPARγ, CEBP-α, LPL, leptin and adiponectin; in addition to the concentration of TNF-α, IL-6, IL-10, and IL- 1β in the retroperitoneal adipose tissue. Glucose tolerance, weekly consumption of chow and water, WAT and RPAT total weight, such as gene expression of mTOR, Akt, 4E-BP1, eif4E, p70S6k, PPARγ and CEBP-α were improved in DL, DTA and DTL groups in comparison with DA group; and the concentrations of HDL, total cholesterol, IL-10 and adiponectin in the serum, as well as gene expression of adiponectin and total concentration of IL-10 in the serum were increased only in DTA and DTL groups when compared to DA group. In conclusion, both interventions were capable of improving some DM1 physiological alterations, including the excessive loss of WAT. However, because resistance training stimulates an increased synthesis of antiinflammatory cytokines and hormones by WAT, this intervention might be the main responsible by the reduction of systemic inflammation of the animals.

Introdução - A dieta hiperlipídica é uma das principais causas da obesidade, provocando importantes alterações metabólicas, como aumento de gordura corporal, dislipidemia e resistência à ação da insulina. Além disso, a obesidade gera um quadro inflamatório crônico e de baixa intensidade no tecido adiposo branco, que é caracterizado pela ativação de vias inflamatórias, como a via do fator de transcrição nuclear kappa B (NF-kB), que é responsável pela transcrição de genes com ação pró-inflamatória, como o fator de necrose tumoral (TNF)-alfa e a proteína quimiotática para monócitos (MCP)-1. A erva-mate (Ilex paraguariensis) contém compostos bioativos, como o ácido clorogênico, a quercetina e o kaempferol, os quais apresentam a capacidade de modular a expressão de genes envolvidos na resposta inflamatória. Objetivo - Investigar o efeito da ingestão do extrato aquoso de erva-mate sobre os parâmetros metabólicos e sobre a resposta inflamatória no tecido adiposo branco de ratos alimentados com ração hiperlipídica. Material e métodos - Ratos machos Wistar foram submetidos à ração controle ou hiperlipídica por 12 semanas. Após esse período, 12 animais de cada grupo foram eutanasiados, constituindo os grupos baseline. O restante dos animais foi distribuído em quatro grupos que receberam, por gavagem, o extrato aquoso de erva-mate (1 g/kg massa corporal/dia) ou água, durante quatro semanas. Após esse período, todos os animais foram eutanasiados. Durante a 12a e a 16a semana do protocolo experimental, os animais foram submetidos ao teste oral de tolerância à glicose e ao teste intraperitoneal de tolerância à insulina. A partir do sangue, foram determinadas as concentrações de glicose, de insulina e de biomarcadores inflamatórios, bem como o perfil lipídico. A composição corporal foi determinada por meio da análise química da carcaça. A partir do tecido adiposo periepididimal, foi avaliada a expressão das proteínas chaves envolvidas na inflamação crônica e na resistência à ação da insulina, por Western blot, bem como a expressão gênica de adipocinas por PCR em tempo real. Resultados - A ração hiperlipídica provocou aumento da adiposidade, alteração do perfil lipídico, intolerância à glicose e inflamação sistêmica. No tecido adiposo periepididimal, a ração hiperlipídica provocou redução da fosforilação da AKT nos animais estimulados agudamente com insulina. A ingestão do extrato aquoso de erva-mate, por quatro semanas, reduziu o ganho de peso corporal e melhorou o perfil lipídico nos animais alimentados com a ração hiperlipídica em relação ao correspondente grupo tratado com água. Contudo, o extrato aquoso de erva-mate não foi capaz de reverter as demais alterações metabólicas provocadas pela ingestão da ração hiperlipídica. Conclusão - A ingestão da ração hiperlipídica promoveu alterações metabólicas, todavia, não induziu inflamação crônica no tecido adiposo periepididimal. Por outro lado, a ingestão do extrato aquoso de ervamate foi capaz de reduzir o ganho de peso corporal e melhorar o perfil lipídico dos animais que consumiram a ração hiperlipídica / Introduction - High-fat diet is one of the main causes of obesity, inducing significant metabolic changes, such as increased fat mass, dyslipidemia and insulin resistance. Furthermore, obesity is associated with a chronic state of low-grade inflammation in white adipose tissue, which is characterized by activation of inflammatory pathways, like nuclear factor kappa B (NF-kB) pathway, implicated in the transcription of many genes with pro-inflammatory action, such as tumor necrosis factor (TNF)-alpha and monocyte chemotatic protein (MCP)-1. Yerba mate (Ilex paraguariensis) contains bioactive compounds, such as chlorogenic acid, quercetin and kaempferol that have the ability to modulate genes envolved in inflammatory response. Objective - To investigate the effect of yerba mate aqueous extract consumption on metabolic parameters and on inflammatory response in white adipose tissue of high-fat diet-fed rats. Material and methods - Male Wistar rats were submitted a control or a high-fat diet for 12 weeks. After this period, 12 rats of each group were euthanized, constituting the baseline groups. The remainder animals were distributed into four groups, which received by intragastric gavage the yerba mate aqueous extract or vehicle (1 g/kg body weight/day) for four weeks and then, all animals were euthanized. Oral glucose and intraperitoneal insulin tolerance tests were performed at 12 and 16 weeks of experimental protocol. Blood glucose, insulin, lipid profile and inflammatory markers were measured. Water, lipid, protein and ash content were analyzed by carcass chemical composition. Periepididymal adipose tissue were employed to evaluate key proteins involved in inflammatory and insulin signaling pathway by Western blot, and adipokines gene expression by real time PCR. Results - High-fat diet induced body adiposity, dyslipidemia, glucose intolerance and systemic inflammation. In periepididymal fat, high-fat diet decreased AKT phosphorylation in rats acutelly stimulated with insulin. The consumption of yerba mate aqueous extract for four weeks reduced body weight gain and improved lipid profile in high-fat diet group compared to non-treated group. However, yerba mate did not repair others dysfunctions induced by high-fat feeding. Conclusion - High-fat feeding produced some metabolic dysfunctions, but did not induce chronic inflammation in periepididymal adipose tissue. On the other hand, the yerba mate aqueous extract consumption reduced body weight gain and improved lipid profile of rats fed a high-fat diet

Atualmente, a obesidade é considerada uma epidemia mundial. Está associada a um estado de inflamação crônica e ativação do estresse do retículo endoplasmático (ERE), relacionados à patogênese de diversas doenças como diabetes mellitus tipo 2, doenças cardiovasculares, câncer, hipertensão, dentre outras. Nesse contexto, são necessários estudos para encontrar alternativas que melhorem o processo inflamatório. Vários estudos em humanos e animais já demostraram as propriedades anti-inflamatórias do ácido graxo ômega-3. O objetivo do nosso trabalho foi avaliar os efeitos da suplementação do ácido alfa-linolênico (ALA) no metabolismo e no estresse do retículo endoplasmático em obesos grau III. Foi conduzido um estudo prospectivo, randomizado, placebo-controlado, duplo-cego. No total, 52 pacientes foram randomizados para a suplementação com 3g/dia de ALA ou placebo, sendo 27 indivíduos do grupo ômega-3/ALA e 25 do grupo controle. Foi avaliado perfil lipídico, glicídico e inflamatório antes e após suplementação. O tecido adiposo visceral (TAV) foi coletado durante cirurgia bariátrica após suplementação. O perfil de ácidos graxos incorporados no TAV foi avaliado por cromatografia gasosa. Os genes foram avaliados através de PCR em tempo real. Não houve alteração nos níveis séricos de IL-6 (p=0,2201), TNF-? (0.7703) e PCR (p=0,57) após suplementação com ômega-3/ALA, porém observamos diminuição nos níveis séricos de Leptina (p=0.0154) e IP-10 (p=0.0410), citocinas inflamatórias, e aumento na IL-4 (p=0,0211), citocina anti-inflamatória. Foi observado incorporação significativa do ALA (p=0,0002), EPA (p<0,0001) e DHA (p=0,0005) no TAV. Avaliação molecular evidenciou um aumento da expressão gênica do XBP1 (p=0,0013), sXBP1 (p<0,0001), EIF2-? (p=0,0063) e da chaperona CCT4 (p=0,0001) e diminuição na expressão gênica da leptina (p=0,0410). Podemos concluir que o ALA pode modular o ERE através da via da IRE1/XBP, levando ao aumento das chaperonas (CCT4), o que pode demonstrar um potencial terapêutico do ALA em pacientes obesos. / Currently, obesity is considered a worldwide epidemic. It is associated with chronic inflammation and stress activation of the endoplasmic reticulum (ERE), related to the pathogenesis of various diseases such as type 2 diabetes mellitus, cardiovascular diseases, cancer, hypertension, among others. In this context, studies are needed to find alternatives that improve the inflammatory process. Several studies in humans and animals have already demonstrated the anti-inflammatory properties of omega-3 fatty acid. The objective of our study was to evaluate the effects of alpha-linolenic acid (ALA) supplementation on the metabolism and stress of the endoplasmic reticulum in obese patients. A prospective, randomized, placebo-controlled, double-blind study was conducted. In total, 52 patients were randomized to supplementation with 3 g / day of ALA or placebo, 27 individuals from the omega-3 / ALA group and 25 from the control group. Lipid, glycidic and inflammatory profile were evaluated before and after supplementation. Visceral adipose tissue (TAV) was collected during bariatric surgery after supplementation. The fatty acid profile incorporated in the TAV was evaluated by gas chromatography. Genes were evaluated by real-time PCR. There was no change in serum levels of IL-6 (p = 0.2201), TNF-? (0.7703) and CRP (p = 0.57) after supplementation with ALA, but we observed a decrease in serum Leptin levels (P = 0.0154) and IP-10 (p = 0.0410), inflammatory cytokines, and increase in IL-4 (p = 0.0211), anti-inflammatory cytokine. Significant incorporation of ALA (p = 0.0002), EPA (p <0.0001) and DHA (p = 0.0005) into the TAV was observed. Molecular evaluation showed an increase in the gene expression of XBP1 (p = 0.0013), sXBP1 (p <0.0001), EIF2-? (p = 0.0063), GADD34 (p=0,0117) and CCT4 chaperone (p = 0.0001), decrease in the gene expression of leptin (p = 0.0410) and ATF-6 (p=0,0305) and a tendency to decrease the gene expression of CHOP. We can conclude that ALA can modulate ERE through the IRE1 / XBP, PERK and ATF-6 pathways, leading to increased chaperones (CCT4), which may demonstrate a therapeutic potential of ALA in obese patients.

A inflamação sistêmica é uma das características que marcam o diagnóstico da caquexia associada ao câncer. Entre as interações tumor-hospedeiro, o tecido adiposo branco contribui à inflamação, uma vez que ele sofre uma reorganização morfológica e lipólise, liberando ácidos graxos livres (AGLs), mediadores lipídicos (LMs) e citocinas pró-inflamatórias, que acentuam a ativação de vias de sinalização pró-inflamatória e o recrutamento de células do sistema imunológico para o tecido. O objetivo deste projeto foi investigar quais fatores inflamatórios sistêmicos estão envolvidos na inflamação do tecido adiposo e qual é a influência desses fatores sobre as enzimas envolvidas no metabolismo dos AGs ou LMs em indivíduos saudáveis (Controle), pacientes com câncer gastrointestinal com peso estável (WSC) e pacientes com câncer e caquexia (CC). Os resultados demonstraram que a resposta inflamatória sistêmica é diferente da resposta encontrada no tecido adiposo. A inflamação sistêmica dos pacientes com câncer e caquexia (CC) foi caracterizada por níveis circulantes mais elevados de ácidos graxos saturados (SFAs), tumor-necrosis-factor-&#945 (TNF-&#945), Interleukin IL-6, IL-8 e proteina Creativa (PCR), enquanto os níveis de ácidos graxos poliinsaturados (PUFAs), especialmente n3-PUFAs, foram menores em CC que nos demais grupos. In vitro e em explantes de tecido adiposo, citocinas pró-inflamatórias e SFAs aumentaram a expressão das quimiocinas IL-8 e CXCL10. E também observamos um aumento na expressão destas quimiocinas na inflamação do tecido adiposo no CC, que era mais profundo no tecido adiposo visceral (VAT) quando comparado ao tecido adiposo subcutâneo (SAT). A inflamação sistêmica foi negativamente associada com a expressão de enzimas sintetizadoras dos PUFAs, embora a expressão gênica e protéica mostraram somente pequenas diferencias entre os grupos. Os efeitos dos fatores inflamatórios sobre as enzimas no tecido adiposo podem ter sido mascarados pela modulação diferenciada dos diversos tipos celulares constituintes desse tecido. Experimentos in vitro mostraram que a expressão de enzimas que modificam os AGs, tais como as dessaturases e elongases em adipócitos e macrófagos, foram reguladas em direções opostas por TNF-&#945, IL-6, LPS e palmitato. Mesmo os pacientes CC demonstrando uma maior concentração plasmática da Resolvina D1, que é um mediador lipídico de resolução da inflamação, ainda assim, a inflamação sistêmica é maior nesses pacientes, e os resultados indicam que as citoquinas inflamatórias interferem com as vias de síntese das LMs da resolução. Concluímos que, os dados revelaram um crosstalk inter-tecidual e intercelular complexo mediado por citocinas pró-inflamatórias e compostos lipídicos que aumentam a inflamação na caquexia associada ao câncer por mecanismos autoregulação. / Systemic inflammation is a hallmark of cancer cachexia. Among tumor-host interactions, the white adipose tissue (WAT) is an important contributor to inflammation as it suffers morphological reorganization and lipolysis, releasing free fatty acids (FA), bioactive lipid mediators (LM) and pro-inflammatory cytokines, which accentuate the activation of proinflammatory signaling pathways and the recruitment of immune cells to the tissue. This project aimed to investigate which inflammatory factors are involved in the local adipose tissue inflammation and what is the influence of such factors upon enzymes involved in FA or LM metabolism in healthy individuals (Control), weight stable gastro-intestinal cancer patients (WSC) and cachectic cancer patients (CC). The results demonstrated that the inflammatory signature of systemic inflammation is different from local adipose tissue inflammation. The systemic inflammation of the cachectic cancer patients was characterized by higher levels of circulating saturated fatty acids (SFA), tumor-necrosisfactor- &#945 (TNF- &#945), interleukins IL-6, IL-8 and CRP while levels of polyunsaturated fatty acids (PUFAs), especially n3-PUFAs, were lower in CC than in the other groups. In vitro and in adipose tissue explants, pro-inflammatory cytokines and SFAs were shown to increase the chemokines IL-8 and CXCL10 that were found to be augmented in adipose tissue inflammation in CC which was more profound in the visceral adipose tissue (VAT) than in subcutaneous adipose tissue (SAT). Systemic inflammation was negatively associated with the expression of PUFA synthesizing enzymes, though gene and protein expression did hardly differ between groups. The effects of inflammatory factors on enzymes in the whole tissue could have been masked by differentiated modulation of the diverse cell types in the same tissue. In vitro experiments showed that the expression of FA-modifying enzymes such as desaturases and elongases in adipocytes and macrophages was regulated into opposing directions by TNF- &#945, IL-6, LPS or palmitate. The higher plasma concentration of the pro-resolving LM resolvin D1 in CC cannot compensate the overall inflammatory status and the results indicate that inflammatory cytokines interfere with synthesis pathways of pro-resolving LM. In summary, the data revealed a complex inter-tissue and inter-cellular crosstalk mediated by pro-inflammatory cytokines and lipid compounds enhancing inflammation in cancer cachexia by feedforward mechanisms.

Il existe une relation étroite entre le cancer du sein et le poids. Si l’excès de poids est un facteur de risque de survenue du cancer du sein, l’obésité au diagnostic et les variations de poids (± 5 % du poids initial) au cours des traitements sont associées à un mauvais pronostic. La perte et le gain de poids résultent d’un déséquilibre de la balance énergétique (apports et dépenses). Les caractéristiques et les causes de ces variations ne sont pas encore totalement décrites. La prise de masse grasse semble être reconnue comme un facteur de mauvais pronostic d’où l’importance de bien comprendre l’évolution de la composition corporelle au cours des traitements du cancer du sein.Dans ce contexte, les objectifs de cette thèse ont été de caractériser la variation de poids et de composition corporelle tout au long des traitements du cancer du sein et d’étudier les facteurs impliqués dans le déséquilibre de la balance énergétique dont l’activité physique et certaines composantes de la dépense énergétique de repos.Les travaux menés dans le cadre de cette thèse se sont articulés autour de trois essais cliniques. En premier lieu, l’essai MétaCa2 qui vise à décrire l’évolution à long terme du poids et de la composition corporelle de patientes ménopausées atteintes d’un cancer du sein non métastatique (en moyenne 3 ans post-chimiothérapie). Les résultats cette étude ont montré qu’une perte de poids pendant la chimiothérapie est corrélée à une prise de poids dans la suite des traitements adjuvants. Cette étude a également permis de mettre évidence une prise de poids et de masse grasse au cours de l’hormonothérapie dans la population globale et plus particulièrement chez les patientes en excès de masse grasse au diagnostic. L’augmentation du temps assis entre la fin de la chimiothérapie et le début de l’hormonothérapie a été identifiée comme un facteur lié à la prise de masse grasse à long terme.Nous avons ensuite exploré une hypothèse avancée par notre équipe qui suggère que la chimiothérapie pourrait avoir un impact sur le tissu adipeux brun. Celui-ci est impliqué dans la thermogénèse adaptative, donc dans les dépenses énergétiques, et pourrait ainsi contribuer à la prise de poids. Pour cela, nous avons réalisé une étude ancillaire au protocole AVATAXHER sur 109 patientes atteintes d’un cancer du sein HER2+ et traitées par chimiothérapie néoadjuvante et thérapie ciblée anti-HER2. Les résultats ont mis en évidence une diminution significative de l’activité métabolique du tissu adipeux brun après une cure de chimiothérapie dans la population générale et plus particulièrement dans le sous-groupe de patientes qui prennent du poids au cours de la chimiothérapie.L’activité physique constitue une possible stratégie de prévention individuelle sur les variations de poids et de composition corporelle. Dans la sous-population de patientes HER2+, elle pourrait également permettre de limiter la cardiotoxicité des traitements standards utilisés. Nous avons mis en place un essai interventionnel prospectif afin d’étudier la faisabilité d’une intervention d’activité physique à domicile pour des patientes en cours de chimiothérapie néoadjuvante + thérapie ciblée pour un cancer du sein HER2 positif. L’intervention consiste à atteindre ou maintenir un niveau d’activité physique correspondant aux recommandations internationales soit 150 minutes par semaine à une intensité modérée grâce à un programme personnalisé combinant activité physique de type aérobie et renforcement musculaire. Ces résultats originaux ont ainsi conduit à apporter de nouvelles connaissances quant aux variations de poids et de composition corporelle au cours des traitements du cancer du sein à un stade précoce et sur les causes possibles du déséquilibre énergétique. / There is a close relationship between breast cancer and weight. If weight excess is a risk factor for the onset of breast cancer, obesity at diagnosis and weight variations (± 5 % of initial weight) during treatement are associated with poor prognosis. Weight loss and weight gain result in an energy imbalance (energy intake and energy expenditure). The caracteristics and causes of these variations are not well described. Fat mass gain seems to be recognized as a factor of poor prognosis hence the importance to understand body composition evolution during breast cancer treatment.In this context, the aims of this thesis were to characterized weight and body compostion variation throughout treatment and to study the factors involved in the energy imbalance of which physical activity and certain components of resting energy expenditure.This thesis works have been centered around three clinical trials. Firstly, MétaCa2 trial that attempted to describe the long term evolution of weight and body composition among no-metastatic postmenopausal breast cancer patients (on average 3 years post-chemotherapy). The results of this study have shown that weight loss during chemotherapy is associated with a later weight gain during adjuvant period of treatment. This study has also demonstrated a weight and fat mass gain during endocrine therapy in the overall population and more especially for the patients with an initial fat mass excess. The increase in time spent sitting between the end of chemotherapy and the initiation of endocrine therapy has been identified has a factor associated with long term fat mass gain.Then, we have explored a hypothesis, supported by our team, suggesting that chemotherapy could have an impact on brown adipose tissue. This one is implied in the adaptative thermogenesis and so in energy expenditure and could contribute to weight gain. For this end, we realised an ancillary study to AVATAXHER trial among 109 HER2+ breast cancer patients treated with neoadjuvant chemotherapy and HER2 targeted therapy. The results have highlighted a significant decrease of BAT metabolic activity after one course of chemotherapy in the overall population and specifically in the subgroup of patients who gained weight during chemotherapy. Physical activity constitutes a possible strategy for individual prevention against weight and body composition variation. In the HER2+ subpopulation, it could also limit the cardiotoxicity of standard treatements. We have set up a prospective interventional trial in order to study the feasibility of a home-based physical activity intervention among HER2+ breast cancer patients currently treated with neoadjuvant chemotherapy + targeted therapy. The objective of the intervention is to achieve or maintain a physical activity level corresponding to the international recommendations, i.e. at least 150 minutes of moderate-intensity physical activity per week thanks to a personalised program combining aerobic physical activity and muscular strengthening.These original results have contributed to provide new knowledge about weight and body composition variation during early breast cancer treatments and also about some potential causes imply in energy imbalance.

<p>The domestication of the pig began about 9 000 years ago and many of the existing domestic breeds have been selected for phenotypic traits like lean meat and fast growth. Domestic pigs are phenotypically very different from the ancestral wild boar that has adapted to survive in their natural environment. Because of their divergence, crosses between domestic pigs and wild boars are suitable for constructing genetic maps and Quantitative trait locus (QTL) analyses. A cross between the Large White and the European wild boar was thus initiated in the late 1980s. A major QTL for fat deposition and growth, denoted <i>FAT1</i>, was found on chromosome 4. The aim of this thesis was to further characterise the <i>FAT1</i> locus and to identify the causative gene(s) and mutation(s). We have identified new markers and constructed a high-resolution linkage and RH map of the <i>FAT1</i> QTL interval. We also performed comparative mapping to the human genome and showed that the pig chromosome 4 is homologous to human chromosomes 1 and 8. The gene order is very well conserved between the two species. In parallel we have narrowed down the <i>FAT1</i> QTL interval by repeated backcrossing to the domestic Large White breed for six generations. The QTL could be confirmed for fatness but not for growth. Furthermore, the data strongly suggested that there might be more than one gene underlying the <i>FAT1</i> QTL. Depending on which hypothesis to consider, the one- or two-loci model, the <i>FAT1</i> interval can be reduced to 3,3 or 20 centiMorgan (cM), respectively, based on the backcross experiments. In the last study we confirm the two-loci model with one locus primarily effecting abdominal fat and another locus primarily effecting subcutaneous fat. We have identified a missense mutation in the <i>RXRG</i> gene which is in strong association with the abdominal fat QTL and the mutation is a potential candidate for that locus.</p><p>Brown adipose tissue (BAT) is a specific type of fat essential for non-shivering thermogenesis in mammals. Piglets appear to lack BAT and rely on shivering as the main mechanism for thermoregulation. Uncoupling protein 1 (<i>UCP1</i>) gene is exclusively expressed in BAT and its physiological role is to generate heat by uncoupling oxidative phosphorylation. We show that the <i>UCP1</i> gene has been disrupted in the pig lineage about 20 years ago. The inactivation of <i>UCP1</i> provides a genetic explanation for the poor thermoregulation in piglets. </p>

Obesity is a major health problem in the United States and worldwide. It increases the risk for type-2 diabetes and cardiovascular diseases. A chronic low-grade inflammation occurring in white adipose tissue (WAT) is causally linked to the development of insulin resistance (IR), metabolic syndrome and obesity-associated chronic diseases. The aim of this dissertation research was to elucidate the WAT function in metabolic syndrome using genetic (overexpression of an adipose pro-inflammatory hormone, angiotensinogen) and nutritional manipulations/approaches (caloric restriction and omega-3 fatty acids), with specific emphasis on the role of inflammation. Previous research indicates that WAT renin-angiotensin system (RAS) is overactivated in obesity. However, its role in the pathogenesis of IR is hitherto unknown. Using mice overexpressing angiotensinogen (Agt), the only precursor for the hypertensive hormone angiotensin (Ang) II, in WAT, we showed that adipose-specific RAS overactivation leads to systemic IR. This is at least in part due to Ang II, NADPH oxidase and NF-kB-dependent increases in WAT inflammation. Caloric restriction is the main dietary intervention to treat obesity-associated metabolic disorders. While most health agencies recommend a low-fat diet, energy-restricted high-fat diets (HFR) are also claimed to be effective in this regard. Here, we show that weight loss due to HFR is accompanied by improvements of IR but only partial resolution of WAT inflammation. Further, this diet negatively impacted the adipokine profile supporting the current recommendations for low-fat diets. Dietary interventions targeted at reducing WAT inflammation have not been explored in detail. Eicosapentaenoic acid (EPA) is an omega-3 polyunsaturated fatty acid of marine origin with anti-inflammatory properties. We show that EPA is able to both prevent and reverse high-fat diet-induced IR and hepatic steatosis via modulation of WAT inflammation. In conclusion, primary changes occurring in WAT, such as overexpression of Agt, can lead to WAT inflammation and systemic IR. Moreover, nutritional interventions targeting at reducing adiposity (caloric restriction) and inflammation (EPA) can both lead to improvements in systemic IR. Our findings support the current recommendation of low-fat diets for improvement in metabolic profile and show that dietary modulation of WAT function can be used to improve metabolic derangements in obesity.

Einleitung<br /> Säugetiere haben zwei verschiedene Arten von Fettgewebe: das weiße Fettgewebe, welches vorwiegend zur Lipidspeicherung dient, und das braune Fettgewebe, welches sich durch seine Fähigkeit zur zitterfreien Thermogenese auszeichnet. Weiße und braune Adipozyten sind beide mesodermalen Ursprungs. Die Mechanismen, die zur Entwicklung von Vorläuferzellen in den weißen oder braunen Fettzellphenotyp führen, sind jedoch unbekannt. Durch verschiedene experimentelle Ansätze konnte gezeigt werden, daß diese Adipocyten vermutlich durch die Differenzierung zweier Typen unterschiedlicher Vorläuferzellen entstehen: weiße und braune Preadipozyten. Von dieser Hypothese ausgehend, war das Ziel dieser Studie, die Genexpression weißer und brauner Preadipozyten auf Unterschiede systematisch zu analysieren.<br /> <br /> Methoden<br /> Die zu vergleichenden Zellen wurden aus primären Zellkulturen weißer und brauner Preadipozyten des dsungarischen Zwerghamsters gewonnen. „Representational Difference Analysis“ wurde angewandt, um potentiell unterschiedlich exprimierte Gene zu isolieren. Die daraus resultierenden cDNA Fragmente von Kandidatengenen wurden mit Hilfe der Microarraytechnik untersucht. Die Expression dieser Gene wurde in braunen und weißen Fettzellen in verschiedenen Differenzierungsstadien und in braunem und weißem Fettgewebe verglichen.<br /> <br /> Ergebnisse<br /> 12 Gene, die in braunen und weißen Preadipozyten unterschiedlich exprimiert werden, konnten identifiziert werden. Drei Komplement Faktoren und eine Fettsäuren Desaturase werden in weißen Preadipozyten höher exprimiert; drei Struktur Gene (Fibronectin, Metargidin und a Actinin 4), drei Gene verbunden mit transkriptioneller Regulation (Necdin, Vigilin und das „small nuclear ribonucleoprotein polypeptide A“) sowie zwei Gene unbekannter Funktion werden in braunen Preadipozyten höher exprimiert. Mittels Clusteranalyse (oder Gruppenanalyse) wurden die gesamten Genexpressionsdaten charakterisiert. Dabei konnten die Gene in 4 typischen Expressionsmuster aufgeteilt werden: in weißen Preadipozyten höher exprimierte Gene, in braunen Preadipozyten höher exprimierte Gene, während der Differenzierung herunter regulierte Gene und während der Differenzierung hoch regulierte Gene.<br /> <br /> Schlußfolgerungen<br /> In dieser Studie konnte gezeigt werden, daß weiße und braune Preadipozyten aufgrund der Expression verschiedener Gene unterschieden werden können. Es wurden mehrere Kandidatengene zur Bestimmung weißer und brauner Preadipozyten identifiziert. Außerdem geht aus den Genexpressionsdaten hervor, daß funktionell unterschiedliche Gruppen von Genen eine wichtige Rolle bei der Differenzierung von weißen und braunen Preadipozyten spielen könnten, wie z.B. Gene des Komplementsystems und der extrazellulären Matrix. / Introduction<br /> Mammals have two types of adipose tissue: the lipid storing white adipose tissue and the brown adipose tissue characterised by its capacity for non-shivering thermogenesis. White and brown adipocytes have the same origin in mesodermal stem cells. Yet nothing is known so far about the commitment of precursor cells to the white and brown adipose lineage. Several experimental approaches indicate that they originate from the differentiation of two distinct types of precursor cells, white and brown preadipocytes. Based on this hypothesis, the aim of this study was to analyse the gene expression of white and brown preadipocytes in a systematic approach. <br /> <br /> Experimental approach<br /> The white and brown preadipocytes to compare were obtained from primary cell cultures of preadipocytes from the Djungarian dwarf hamster. Representational difference analysis was used to isolate genes potentially differentially expressed between the two cell types. The thus obtained cDNA libraries were spotted on microarrays for a large scale gene expression analysis in cultured preadipocytes and adipocytes and in tissue samples.<br /> <br /> Results<br /> 4 genes with higher expression in white preadipocytes (3 members of the complement system and a fatty acid desaturase) and 8 with higher expression in brown preadipocytes were identified. From the latter 3 coded for structural proteins (fibronectin, metargidin and a actinin 4), 3 for proteins involved in transcriptional regulation (necdin, vigilin and the small nuclear ribonucleoprotein polypeptide A) and 2 are of unknown function. Cluster analysis was applied to the gene expression data in order to characterise them and led to the identification of four major typical expression profiles: genes up-regulated during differentiation, genes down-regulated during differentiation, genes higher expressed in white preadipocytes and genes higher expressed in brown preadipocytes.<br /> <br /> Conclusion<br /> This study shows that white and brown preadipocytes can be distinguished by different expression levels of several genes. These results draw attention to interesting candidate genes for the determination of white and brown preadipocytes (necdin, vigilin and others) and furthermore indicate that potential importance of several functional groups in the differentiation of white and brown preadipocytes, mainly the complement system and extracellular matrix.

The domestication of the pig began about 9 000 years ago and many of the existing domestic breeds have been selected for phenotypic traits like lean meat and fast growth. Domestic pigs are phenotypically very different from the ancestral wild boar that has adapted to survive in their natural environment. Because of their divergence, crosses between domestic pigs and wild boars are suitable for constructing genetic maps and Quantitative trait locus (QTL) analyses. A cross between the Large White and the European wild boar was thus initiated in the late 1980s. A major QTL for fat deposition and growth, denoted FAT1, was found on chromosome 4. The aim of this thesis was to further characterise the FAT1 locus and to identify the causative gene(s) and mutation(s). We have identified new markers and constructed a high-resolution linkage and RH map of the FAT1 QTL interval. We also performed comparative mapping to the human genome and showed that the pig chromosome 4 is homologous to human chromosomes 1 and 8. The gene order is very well conserved between the two species. In parallel we have narrowed down the FAT1 QTL interval by repeated backcrossing to the domestic Large White breed for six generations. The QTL could be confirmed for fatness but not for growth. Furthermore, the data strongly suggested that there might be more than one gene underlying the FAT1 QTL. Depending on which hypothesis to consider, the one- or two-loci model, the FAT1 interval can be reduced to 3,3 or 20 centiMorgan (cM), respectively, based on the backcross experiments. In the last study we confirm the two-loci model with one locus primarily effecting abdominal fat and another locus primarily effecting subcutaneous fat. We have identified a missense mutation in the RXRG gene which is in strong association with the abdominal fat QTL and the mutation is a potential candidate for that locus. Brown adipose tissue (BAT) is a specific type of fat essential for non-shivering thermogenesis in mammals. Piglets appear to lack BAT and rely on shivering as the main mechanism for thermoregulation. Uncoupling protein 1 (UCP1) gene is exclusively expressed in BAT and its physiological role is to generate heat by uncoupling oxidative phosphorylation. We show that the UCP1 gene has been disrupted in the pig lineage about 20 years ago. The inactivation of UCP1 provides a genetic explanation for the poor thermoregulation in piglets.

Lipoprotein lipase (LPL) is the main enzyme hydrolyzing triglyceride-rich lipoproteins in plasma. Proteoglycan-bound LPL on the vascular endothelium represent the functional pool of active enzyme. LPL is regulated in a tissue specific manner according to metabolic demands. Rapid regulation of LPL activity is necessary to provide free fatty acids for storage or energy production. This regulatory mechanism appears to be post-translational and requires synthesis of other protein/proteins. Recently it was demonstrated that angiopoietin-like protein 4 (ANGPTL4) is involved in the metabolism of plasma triglycerides and that it is able to inhibit LPL activity in vitro. These properties were linked to the N-terminal coiled-coil domain of ANGPTL4 (ccd-ANGPTL4), but the mechanism for the inhibition was not known. The aim of this thesis was to investigate the molecular mechanism for inhibition of LPL by ccd-ANGPTL4, to characterize regions in ccd-ANGPTL4 that are important for inactivation of LPL and to study the role of ANGPTL4 for regulation of LPL in vivo. Binding of ccd-ANGPTL4 to LPL was demonstrated by several methods, including surface plasmon resonance. The interaction was transient and resulted in conversion of the enzyme from catalytically active dimers to inactive monomers with decreased affinity for heparin. We have shown that ANGPTL4 mRNA in rat adipose tissue turns over rapidly and that changes in the ANGPTL4 mRNA abundance were inversely correlated to LPL activity, both during the fed to fasted and the fasted to fed transitions. We conclude that ANGPTL4 is a fasting-induced controller of LPL in adipose tissue, acting extracellularly on the native conformation of LPL in an unusual fashion, like an unfolding molecular chaperone. Site directed mutagenesis was used to explore regions in ccd-ANGPTL4 important for inactivation of LPL, and for binding of ANGPTL4 to heparin. Others had shown that ccd-ANGPTL4 forms higher oligomers. Structure prediction analyses demonstrated that the coiled-coil domain of ccd-ANGPTL4 probably forms three consecutive α-helices with strong hydrophobic faces, and that there are clusters of positively charged residues both on the helices and in intervening sequences. We made replacements of hydrophobic residues, positively charged residues, cysteine residues and negatively charged residues in ccd-ANGPTL4. In addition, helix-breaking proline residues were introduced in all three helices. We found that hydrophobic residues are important for oligomer formation. The higher oligomers appeared to be stabilized by disulfide bonds, but cysteines are not crucial for oligomerization. Introduction of Pro-residues in the first and second helix prevented formation of higher oligomers and reduced the ability of ccd-ANGPTL4 to inactivate LPL. We found that negatively charged residues in ccd-ANGPTL4 are important for inactivation of LPL. A heparin binding site was localized in the C-terminal end of ccd-ANGPTL4 (amino acid residues 114-140). To investigate whether LPL is differently processed in different depots of adipose tissue we measured the levels of LPL mRNA, protein and activity in omental and subcutaneous adipose tissue in human subjects undergoing elective surgery. Our results show that, although the expression level of LPL was higher in subcutaneous adipose tissue, the specific LPL activity (ratio of activity over the LPL protein mass) was higher in omental adipose tissue. Interestingly, the levels of ANGPTL4 mRNA were lower in omental compared to subcutaneous adipose tissue in most of the studied subjects. This difference can possibly explain the higher specific activity of LPL in omental adipose tissue and indicated that ANGPTL4 is involved in regulation of LPL activity also in humans. LPL produced by macrophages in the artery wall promotes local accumulation of lipids in these cells, and thereby plays an important role in development of atherosclerosis. The known association between type 2 diabetes and atherosclerosis forwarded us to study production of LPL by THP-1 macrophages under hyperglycemic conditions and under treatment with a peroxisome proliferator-activated receptor delta (PPARδ) agonist (GW501516). We found that LPL activity (but not LPL mass) produced by macrophages was decreased by GW501516. The loss of LPL activity coincided with increased level of ANGPTL4 mRNA, indicating that the agonist regulates LPL activity through expression of ANGPTL4. This effect was even more pronounced in cells grown under hyperglycemic conditions. Our data suggest that a suitable PPARδ agonist, like GW501516, may have protective effects against development of atherosclerosis in subjects with diabetes type 2.