Introdução: Diabetes Mellitus é caracterizada por hiperglicemia crônica, e este aumento excessivo de glicose circulante pode gerar danos vasculares e microvasculares pela deposição de produtos de gliclação avançada (AGE), principalmente em estruturas com alta vascularização, como é o caso da sinóvia. Por todas estas razões, o presente estudo estabeleceu, de maneira temporal, o processo de acomentimento sinovial, através do grau de remodelamento e as proteínas envolvidas neste processo, tido como o gatilho na lesão da articulação do joelho. Foram utilizados ratos wistar (n=60), divididos em três grupos, conforme tempo de indução ( 7, 30 e 60 dias), cada grupo era composto de 10 animais diabéticos, induzido por estreptozotocina (35mg/kg de peso) e 10 animais controle, recebendo infusão do mesmo volume de solução salina, após o tempo estipulado os animais foram sacrificados e a sinóvia coletada para as análises propostas. Análise morfológica através de colorações de hematoxilina-eosina para análise do perfil celular do tecido sinovial e Picrosírius para avaliação da histoarquitetura das fibras colágenas. A quantificação das fibras colágenas foi realizada pela coloração do Picrosírius em microscópio de luz polarizada e a caracterização e distribuição de seus tipos por imunofluorescência, para quantificação total da proteina de colágeno foi realizado a medição da 4-hidroxiprolina (HPO). Os produtos de glicação avançada foram analisados e quantificados por imufluorescência. A detecção e quantificação da imunoexpressão de marcadores bioquímicos como ET-1, TGF-B e IL17 foi realizado por método estereológico de contagem de pontos em reticulo, e como método de confirmação dos achados imunohistoquimicos foi realizado análise de expressão gênica dos Colágenos I,III, e V alfa- 1, alfa-2), por Reação de Transcrição Reversa com amplificação por PCR em Tempo Real (qRT-PCR). Resultados: Foi observado modificação da estrutura sinovial de forma temporal, acometendo inicialmente os vasos subsinoviais e tecidos adjacentes a ele, isso foi observado em tanto em análise morfológica como confirmado em quantificação por Picro em luz polarizada, as modificações se mostraram significantes nos grupos de 30 e 60 dias, quando comparado ao respectivo grupo controle, houve aumento do colágeno total, através do Picrosirius, como por dosagem de HOP. Os resultados foram confirmados por imunofluorescência com o aumento progressivo do COLI e diminuição de COLIII e COLV, o RAGE e AGE também tiveram sua expressão aumentada conforme a evolução no tempo de indução dos animais. Em análise da expressão de outras proteínas foi possível observar a detecção da ET-1 e da IL-17 nos animais diabéticos em comparação ao controle, houve também expressão significativa do TGF-B quando comparado ao respectivo controle. Na análise da expressão gênica foi possível observar aumento do COLV inicialmente, principalmente da cadeia alfa 2, do COLIII e COLI, confirmando achados histomorfométricos. Conclusão: O tecido sinovial demonstra remodelamento precoce ao redor dos vasos, essa mediação envolve o COL1 e os produtos de glicação avançada. Esta alteração no tecido sinovial pode ser responsável por desencadear o acometimento articular no diabetes mellitus / Introduction: Diabetes Mellitus is characterized by chronic hyperglycemia, and this excessive increase of circulating glucose can cause vascular and microvascular damage by the deposition of advanced glycation products (AGE), especially in structures with high vascularization, as is the case of synovium. For all these reasons, the present study established, in a temporal way, the process of synovial concomitance, through the degree of remodeling and the proteins involved in this process, considered as the trigger in the lesion of the knee joint. Wistar rats (n = 60), divided into three groups, according to induction time (7, 30 and 60 days), each group consisted of 10 diabetic animals, induced by streptozotocin (35 mg / kg body weight) and 10 animals control, receiving infusion of the same volume of saline solution, after the stipulated time the animals were sacrificed and the synovium collected for the proposed analyzes. Morphological analysis using hematoxylineosin staining for analysis of the cellular profile of the synovial tissue and Picrosírius for evaluation of the histoarchitecture of the collagen fibers. The quantification of the collagen fibers was performed by the Picrosírius staining in a polarized light microscope and the characterization and distribution of its types by immunofluorescence, the measurement of 4-hydroxyproline (HPO) was performed for the total quantification of the collagen protein. Advanced glycation products were analyzed and quantified by impuluorescence. The detection and quantification of the immunoexpression of biochemical markers such as ET- 1, TGF-B and IL17 was performed by stereological method of reticule dot counting, and as a method of confirming the immunohistochemical findings, the analysis of the collagen I, III , and V alpha-1, alpha-2), by Reverse Transcription Reaction with Real-Time PCR Amplification (qRT-PCR). Results: Modification of the synovial structure was observed temporally, initially affecting subsynovial vessels and tissues adjacent to it, this was observed in both morphological analysis and confirmed in quantification by Picro in polarized light, the modifications were significant in the groups of 30 and 60 days, when compared to the respective control group, there was increase of the total collagen, through Picrosirius, as per HOP dosage. The results were confirmed by immunofluorescence with progressive increase of COLI and decrease of COLIII and COLV, RAGE and AGE also had their expression increased as the evolution in the induction time of the animals. In the analysis of the expression of other proteins it was possible to observe the detection of ET-1 and IL-17 in diabetic animals in comparison to the control, there was also significant expression of TGF-B when compared to the respective control. In the analysis of the gene expression it was possible to observe an increase of the COLV initially, mainly of the alpha 2 chain, of the COLIII and COLI, confirming histomorphometric findings. Conclusion: Synovial tissue demonstrates early remodeling around vessels, this mediation involves COL1 and advanced glycation products. This change in synovial tissue may be responsible for triggering joint involvement in diabetes mellitus

A glicação não enzimática das proteínas é um fator comum para a fisiopatologia de uma série de transtornos relacionados ao envelhecimento e a doenças como o diabetes mellitus (DM). O geração dos produtos de glicação, os AGEs (do inglês: Advanced Glycation End Products) se dá através de reações de glicação da mariz extracelular (MEC) na derme e têm sido apontado como um dos fatores responsáveis pela perda de elasticidade e deficiência de cicatrização da pele. A permeação cutânea de compostos anti-AGE é uma limitação importante para eficiência terapêutica de compostos que devem atingir camadas mais profundas da pele. Modelos de pele reconstruída contendo equivalente dérmico glicado são estruturas tridimensionais geradas in vitro que mimetizam a pele humana e representam um eficiente modelo para o estudo de células e modificações provocadas na MEC no processo de envelhecimento e DM. O modelo 3D de pele reconstruída tem características metabólicas, de permeabilidade e atividade semelhantes à da pele original, potencializando seu papel nas investigações sobre permeabilidade de drogas, toxicidade, irritação, eficácia e segurança de compostos e diferenciação de queratinócitos. Uma série de compostos naturais ou sintéticos inibidores de AGEs têm sido descobertos e apresentados recentemente e podem representar inovação terapêutica no tratamento de modificações causadas pela a formação e acúmulo destes AGEs também na pele. Este estudo avaliou o desenvolvimento da pele reconstruída glicada e posteriormente, a avaliação da eficácia e toxicidade de compostos anti-glicação como aminoguanidina e carnosina em modelo de pele reconstruída glicada. Em perspectiva, este estudo contribuiu para o desenvolvimento de uma nova tecnologia in vitro, a pele reconstruída glicada, que auxiliará a compreensão da biologia da interação célula-MEC mimetizando processos fisiopatológicos importantes como o envelhecimento e o DM. / The Advanced Glycation End Products (AGEs) of proteins is a common factor to the pathophysiology of a number of disorders related to aging and diseases such as diabetes mellitus (DM). The generation of the AGEs products on skin occurs mainly through non-enzymatic glycation reactions of the dermal extracellular matrix and has been touted as one of the factors responsible for loss of elasticity and disability of skin healing. The skin permeation of compounds is an important limitation for therapeutic/cosmetic efficacy of anti-AGE compounds, which must reach the deepest layers of the skin. Reconstructed skin model containing dermal equivalent modified by in vitro glycation is able to mimic the elderly human skin and represent an efficient model for the study of cells interactions and changes in extracellular matrix induced by aging and diabetes. The 3D reconstructed skin model has metabolic characteristics, permeability and activity similar to the original skin, reinforcing its role in drug permeability of investigations toxicity, irritation, safety and efficacy evaluation of compounds and differentiation of keratinocytes. A number of natural or synthetic AGEs inhibitor compounds have been recently discovered and displayed and can represent therapeutic innovation for the treatment of changes caused by the aging of the skin. In this study we performed the development of reconstructed glycated skin model and evaluated the efficacy and toxicity of anti-glycation compounds such as aminoguanidine and carnosine. In perspective, this study has contributed to the development of a new technology in vitro, and for the understanding cell-extracellular matrix interaction during the aging of skin.

Peritoneal dialysis (PD) is a form of renal replacement therapy using the peritoneum as a dialysis membrane. PD solutions employed to remove nitrogen metabolites and excess plasma fluid, and to restore electrolyte and acid-base balance are being developed to minimize local and systemic inflammatory responses while maintaining peritoneal homeostasis and host defense. The effect of chronic action of PD solutions on the peritoneum results in its remodeling and, possibly, eventual loss of peritoneal ultrafiltration capacity. Factors most responsible for late complications and peritoneal remodeling include high glucose levels in PD solutions, and the presence and formation of glucose degradation products (GDP) and advanced glycation end - products (AGEs) in the peritoneal cavity. The aim of our study described in this dissertation was to test various PD solutions with different glucose content and GDP and, using AGEs receptor ligands, to define their systemic effects and identify PD solutions with highest biocompatibility. This part of the dissertation characterizes conventional glucose - based solutions, low - glucose and GDP load solutions as well as glucose polymer (icodextrin) - based PD solutions while determining the plasma and dialysate levels of soluble receptor for AGEs (s - RAGE) and its...

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Le syndrome de détresse respiratoire aiguë (SDRA) est caractérisé par des lésions alvéolaires diffuses menant à un œdème alvéolaire lésionnel et une insuffisance respiratoire aiguë hypoxémique. Malgré les progrès récents dans la prise en charge des patients de réanimation, le SDRA reste un syndrome fréquent et associé à une morbimortalité importante. Deux mécanismes principaux du SDRA semblent associés à une mortalité plus élevée et à des réponses thérapeutiques différentes : la déficience de la clairance liquidienne alvéolaire (AFC, pour alveolar fluid clearance), l’incapacité pour l’épithélium alvéolaire de résorber l’œdème alvéolaire, et la présence d’un phénotype « hyper-inflammatoire ». Les approches pharmacologiques du traitement du SDRA restent limitées et il est nécessaire de poursuivre l’étude des voies biologiques impliquées dans la pathogénie du SDRA et dans sa résolution afin de développer des approches innovantes des prises en charge diagnostique et thérapeutique du SDRA. RAGE, le récepteur des produits de glycation avancée, est un récepteur multi-ligands, exprimé abondamment par les cellules épithéliales alvéolaires du poumon (pneumocytes), qui module de nombreuses voies de signalisation intracellulaire. De nombreuses études récentes suggèrent que sRAGE, la forme soluble principale de RAGE, pourrait servir de marqueur lésionnel du pneumocyte de type I, et que RAGE pourrait jouer un rôle-pivot dans la pathophysiologie du SDRA, en initiant et en entretenant la réponse inflammatoire alvéolaire. Nos objectifs étaient de caractériser les rôles de RAGE au cours du SDRA, grâce à une approche translationnelle combinant études cliniques et précliniques. D’abord, des études cliniques observationnelles et interventionnelles ont été conduites afin de caractériser sRAGE comme un véritable biomarqueur dans le SDRA. Ensuite, des cultures in vitro de cellules épithéliales et de macrophages, ainsi qu’un modèle expérimental in vivo de SDRA murin par instillation trachéale d’acide chlorhydrique ont été utilisés pour décrire les effets de la voie RAGE sur les mécanismes d’AFC et l’inflammation macrophagique médiée par l’inflammasome « Nod-Like Receptor family, Pyrin domain containing 3 » (NLRP3). Enfin, l’effet d’une inhibition de RAGE, par sRAGE recombinant ou par anticorps monoclonal anti-RAGE, était testée en modèle murin. Nos résultats issus des études cliniques suggèrent que sRAGE présente toutes les caractéristiques d’un biomarqueur au cours du SDRA, avec un intérêt dans le diagnostic, le pronostic et la prédiction du risque de développer un SDRA dans une population à risque. Pris ensemble, notre travail suggère que la voie RAGE joue un rôle important dans la régulation de l’atteinte pulmonaire, de l’AFC et de l’activation macrophagique au cours du SDRA. Toutefois, les mécanismes précis de cette régulation restent incertains. La forme soluble de RAGE (sRAGE), lorsqu’elle est dosée dans le plasma, présente toutes les caractéristiques d’un biomarqueur pouvant être utile en pratique clinique, mais son intérêt dans la sélection de sous-groupes (ou « phénotypes ») de patients pouvant bénéficier de traitements ciblés reste à étudier. La voie RAGE pourrait enfin représenter une cible thérapeutique prometteuse. Bien que des études de validation restent nécessaires, ces résultats pourraient ouvrir de nouvelles perspectives dans la prise en charge des patients atteints de SDRA. / The acute respiratory distress syndrome (ARDS) is associated with diffuse alveolarinjury leading to increased permeability pulmonary edema and hypoxemic respiratory failure. Despite recent improvements in intensive care, ARDS is still frequent and associated with high mortality and morbidity. Two major features of ARDS may contribute to mortality and response to treatment: impaired alveolar fluid clearance (AFC), i.e. altered capacity of the alveolar epithelium to remove edema fluid from distal lung airspaces, and phenotypes of severe inflammation. Pharmacological approaches of ARDS treatment are limited and further mechanistic explorations are needed to develop innovative diagnostic and therapeutic approaches. The receptor for advanced glycation endproducts (RAGE) is a multiligand pattern recognition receptor that is abundantly expressed by lung alveolar epithelial cells andmodulates several cellular signaling pathways. There is growing evidence supporting sRAGE (the main soluble isoform of RAGE) as a marker of epithelial cell injury, and RAGE may be pivotal in ARDS pathophysiology through the initiation and perpetuation of inflammatory responses. Our objectives were to characterize the roles of RAGE in ARDS through a translational approach combining preclinical and clinical studies. First, observational and interventional clinical studies were conducted to test sRAGE as a biomarker during ARDS.Then, cultures of epithelial cells, macrophages and a mouse model of acidinduced lung injury were used to describe the effects of RAGE pathway on AFC and inflammation, with special emphasis on a macrophage activation through NodLikeReceptor family, Pyrindomain containing 3 (NLRP3) inflammasome. Acidinjured mice were treated with an antiRAGE monoclonal antibody or recombinant sRAGE to test the impact of RAGE inhibition on criteria of experimental ARDS. Results from clinical studies support a role of sRAGE as a biomarker of ARDS, withdiagnostic, prognostic and predictive values. In addition, plasma sRAGE is correlated with a lung imaging phenotype of nonfocal ARDS and could inform on therapeutic response. Herein, we also describe in vivo and in vitro effects of RAGE activation on transepithelial fluid transport and expression levels of epithelial channels (aquaporin 5, αNa,KATPaseandαENaC) and on macrophage activation through NLRP3 inflammasome. Finally, RAGE inhibition improves AFC and decreases lung injury in vivo. Taken together, our findings support a role of RAGE pathway in the regulation of lung injury, AFC and macrophage activation during ARDS, albeit precise regulatory mechanisms remain uncertain. sRAGE has most features of a validated biomarker that could be used in clinical medicine, but whether it may help to identify subgroups (or phenotypes) of patients that would benefit from tailored therapy remains underinvestigated. Modulation ofRAGE pathway may be a promising therapeutic target, and though validation studies are warranted, such findings may ultimately open novel diagnostic and therapeutic perspectivesin patients with ARDS.

Aquesta tesi demostra que el peroxinitrit produït com a conseqüència del pèptid beta-amiloide (A) contribueix l'augment de la relació A42/A40 que ocorre a la malaltia d'Alzheimer. L'A42 contribueix a l'aparició de la malaltia degut a la seva major toxicitat (quan es compara amb l'A40) que resulta d'una gran estabilitat i capacitat agregativa. A més el peroxinitrit incrementa la toxicitat d'aquest degut a què potencia la seva agregació en forma d'oligomers altament tòxics. De fet els oligomers formats de nitro-A42 presenten una major toxicitat que aquells formats de A42 . En conjunt aquest resultats senyalen l'important paper que l'A42 té en la malaltia d'Alzheimer. Per altra banda, des de la identificació dels agregats d'A i la subseqüent formació dels cabdells neurofibrilars (NFT) com a els dos trets distintius de la malaltia, un gran esforç s'ha dedicat a establir els mecanismes moleculars que uneixen ambdós processos. Aquesta tesi demostra que el peroxinitrit format a partir de l'agregació de d'Ai la conseqüent nitrotirosinació de proteïnes, potencia l'agregació de la proteïna tau en forma de fibres. D'aquesta forma, la nitrotirosinació de la proteïna triosafosfat isomerasa (TPI) podria ser el vincle entre la toxicitat derivada del agregats d'Ai la patologia derivada de la proteïna tau. Per tant, la nitrotirosinació de la TPI podria explicar la progressió temporal que ocorre als cervells de pacients amb la malaltia d'Alzheimer des de la toxicitat induïda per l'Ai l'aparició dels NFT. Els resultats presentats en aquesta tesi podrien obrir nous aspectes en la recerca de la malaltia d'Alzheimer així com en altres malalties que cursin amb estrès oxidatiu i plegament erroni de proteïnes. / This thesis demonstrates that amyloid ß-peptide (Aß)-induced peroxynitrite contributes to the switch of the Aβ42/Aβ40 ratio that occurs in Alzheimer's disease (AD). Since Aβ42 is more toxic due to its higher aggregation and stability, it contributes to the trigger of the disease. In addition the aggregation of Aβ42 in form of the highly toxic oligomers is incremented by the presence of peroxynitrite. Moreover, these nitro-Aß42 oligomers are more toxic than those non-nitrated. All these results support the important role of peroxynitrite in AD etiology. Furthermore, since the identification of Aß accumulation and the subsequent formation of neurofibrillary tangles (NFT) as the two defining pathological hallmarks of AD, a fair amount of research on AD has been driven by the need to find the molecular mechanism linking Aß and NFT. This thesis shows the Aß-induced peroxynitrite, and the consequent nitrotyrosination of proteins, promotes tau fibrillization. Thus triosephosphate isomerase (TPI) nitrotyrosination could be the link between Aß-induced toxicity and tau pathology. Therefore, TPI nitrotyrosination may explain the temporal progression from Aß toxicity to NFT formation in AD brain. The work presented in this thesis could open a novel angle in the research of the pathophysiology of AD and could also have an impact to the research in other neurodegenerative diseases involving oxidative stress and protein misfolding.

Chronic kidney disease (CKD) and acute kidney injury (AKI) are major public health problems. It is important to be able to identify those at high risk of adverse outcome, CKD progression and associated cardiovascular disease. The aim of the thesis was to study novel promising biomarkers, their relationship to kidney function, chronic inflammation and/or cardiovascular risk - placental growth factor (PlGF), pregnancy associated plasma protein A (PAPP-A), matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), soluble receptor for advanced glycation end products (sRAGE), calcium binding protein S100A12 or extracellular newly identified RAGE binding protein (EN-RAGE), and high mobility group box protein-1 (HMGB-1) in patients with renal diseases including CKD, haemodialysis (HD), AKI patients, and healthy controls for comparison. First study revealed that PlGF is elevated in patients with decreased renal function. Second study demonstrated the association of MMP-2 and PAPP-A with proteinuria in patients with CKD. Moreover, serum MMP-2, MMP-9 and PAPP-A levels significantly differed in patients with various nephropathies. EN-RAGE levels are not elevated in patients with CKD, but are related to inflammatory status. PAPP-A, EN-RAGE and HMGB-1 levels are significantly elevated, but sRAGE and PlGF...

Chronic kidney disease (CKD) and acute kidney injury (AKI) are major public health problems. It is important to be able to identify those at high risk of adverse outcome, CKD progression and associated cardiovascular disease. The aim of the thesis was to study novel promising biomarkers, their relationship to kidney function, chronic inflammation and/or cardiovascular risk - placental growth factor (PlGF), pregnancy associated plasma protein A (PAPP-A), matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), soluble receptor for advanced glycation end products (sRAGE), calcium binding protein S100A12 or extracellular newly identified RAGE binding protein (EN-RAGE), and high mobility group box protein-1 (HMGB-1) in patients with renal diseases including CKD, haemodialysis (HD), AKI patients, and healthy controls for comparison. First study revealed that PlGF is elevated in patients with decreased renal function. Second study demonstrated the association of MMP-2 and PAPP-A with proteinuria in patients with CKD. Moreover, serum MMP-2, MMP-9 and PAPP-A levels significantly differed in patients with various nephropathies. EN-RAGE levels are not elevated in patients with CKD, but are related to inflammatory status. PAPP-A, EN-RAGE and HMGB-1 levels are significantly elevated, but sRAGE and PlGF...