Die niedrige Inzidenz chronisch-entzündlicher Darmerkrankungen (CED) in ostasiatischen Ländern im Vergleich zu Westeuropa und den USA könnte auf unterschiedliche Lebensstile und Ernährungsgewohnheiten zurückzuführen sein. Asiaten nehmen mit der Nahrung viel höhere Mengen an Isoflavonen zu sich als Europäer und US-Amerikaner. Diese sind in der Lage, wie natürliche Östrogene an Östrogenrezeptoren (ER) zu binden. Für das Östrogen 17β-Östradiol (E2) sowie selektive Liganden des ERβ sind antiinflammatorische Wirkungen im Darm bereits nachgewiesen worden. Diese Arbeit untersuchte in Modellsystemen für CED die antiinflammatorischen Eigenschaften von Isoflavonen, speziell von Genistein, und stellte einen Vergleich mit synthetischen ER-selektiven Liganden sowie E2 her, um die Involvierung der beiden ER-Subtypen zu evaluieren. In tierexperimentellen Studien wurde der Einfluss der Testsubstanzen auf Ausprägung und Verlauf einer Kolitis in zwei Nagermodellen (HLA-B27 transgene Ratte und TNBS-induzierte Kolitis) analysiert. Ein Ernährungsexperiment, in dem eine Gruppe der Tiere bereits in utero sowie postnatal über Muttermilch und Futter hohen Phytoöstrogenspiegeln ausgesetzt war, zeigte wider Erwarten keine antiinflammatorischen Effekte auf die akute Ausprägung der induzierten Kolitis. Stattdessen waren die untersuchten Parameter bei dieser Ernährungsform gegenüber prä- und postnatal normal ernährten Tieren verstärkt. Dagegen bewirkte oral verabreichtes Genistein in der chronischen Phase der TNBS-induzierten Kolitis eine Unterdrückung der Entzündungsparameter im Darm. Die subkutane Verabreichung von Genistein, eines steroidalen ERβ-selektiven Agonisten, oder von E2 führte hingegen zu keiner signifikanten Einflussnahme auf die untersuchten Parameter in der akuten Phase der Inflammation. Zur Charakterisierung der molekularen Grundlagen einer antiinflammatorischen Wirkung von E2, synthetischen ER-selektiven Agonisten und Genistein wurden in vitro Studien mit Kolonkarzinomzelllinien (HT-29 und Caco-2) durchgeführt. Hierzu wurden die Zellen mit Interleukin-1β (IL-1β) stimuliert, was eine Induktion der inflammationsassoziierten Gene Cyclooxygenase-2 und Interleukin-6 auf mRNA Ebene bewirkte. Bis auf Genistein konnten für die getesteten Substanzen keine antiinflammatorischen Effekte auf die mRNA-Expression der induzierten Markergene beobachtet werden. Genistein bewirkte in Caco-2 Zellen eine Hemmung der untersuchten Gene. Weitere Analysen ergaben, dass die beiden Zelllinien ER nur schwach bzw. gar nicht exprimieren. Eine Transfektion von HT-29 Zellen mit ERα führte zu einer deutlichen Hemmung der Expression der Markergene durch E2, während eine Transfektion mit ERβ lediglich einen schwach hemmenden Effekt bewirkte. Die Ergebnisse der vorliegenden Arbeit legen nahe, dass die niedrigen CED-Inzidenzraten in Ostasien wohl nicht allein auf dem dortigen hohen Isoflavonkonsum beruhen, sondern auch anderen Komponenten des Lebensstils zuzuschreiben sind. Dennoch deutet sich an, dass das Genistein, bei oraler Administration, die Regeneration des geschädigten Darmgewebes im chronischen Erkrankungsverlauf unterstützen und damit auch zur Prävention von Kolonkarzinomen beitragen könnte. Bei antiinflammatorischen Effekten von ER-Liganden spielt die Transaktivierung von ER eine entscheidende Rolle. Die Wirkung von Genistein in untransfizierten Caco-2 Zellen legt jedoch auch die Teilnahme weiterer Mechanismen nahe, die noch zu untersuchen sind. Vor diesem Hintergrund erscheinen weiterführende Untersuchungen zum Einsatz von steroidalen ER-Agonisten und Genistein bei CED und den zugrunde liegenden Mechanismen als sinnvoll.

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There is increasing interest in the use of adjuvant hormonal therapies, which are given after the resection or destruction of all gross disease, in early-stage prostate cancer, as a significant proportion of patients experience progression and/or die from the disease despite undergoing therapy with curative intent. Several retrospective studies suggest that adjuvant hormonal therapy may improve long-term outcome after radical surgery in men with positive lymph nodes, although this approach has yet to be studied in a prospective setting. No studies of adjuvant therapy for patients with extracapsular extension at surgery have been completed, but in an interim analysis of an open controlled trial, adjuvant flutamide significantly improved progression-free survival at 4 years. Three prospective studies in the radiotherapy setting have shown that adjuvant luteinizing hormone-releasing hormone (LH-RH) agonist therapy significantly improves progression-free and/or overall survival. Future studies need to define patient subgroups who will benefit most from adjuvant therapy. The side effects of the different therapeutic options also need to be compared. It is hoped that many of the outstanding questions concerning adjuvant hormonal therapy will be answered by the ongoing Bicalutamide Early Prostate Cancer Programme. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Made available in DSpace on 2016-06-02T19:22:50Z (GMT). No. of bitstreams: 1 2381.pdf: 1192808 bytes, checksum: b6bdb4da58bced09244d3a1f38c4a657 (MD5) Previous issue date: 2009-04-24 / Universidade Federal de Sao Carlos / The exposure of animals to aversive situations, such as elevated plus-maze (EPM), activates serotonergic pathways with projections into structures involved in the defense system, such as the amygdala, septum, hypothalamus, hippocampus and periaqueductal grey matter (PAG), producing behavioral changes that can be characterized as anxiety. However the serotonin (5-HT) presents a dual role in this modulation. Thus, while the stimulation of the receptor subtype 5-HT1A and 5-HT2 prosencephalic in structures such as amygdala and hippocampus result in potentiation of responses of anxiety in rodents, the activation of these receptors in the PAG, often tends to reduce behaviors related to anxiety . This study focused the role of 5-HT3 receptors in the PAG in the anxiety in the mice EPM test. In experiments 1 and 2, mice received infusions intra-PAG of ondansetron (0, 0.3, 1.0, 3.0 nmol/0.1 μL) and mCPBG (0, 40, 80 and 160 nmol/0.1 μL), 5-HT3 receptors antagonist and agonist, respectively. As the mCPBG not changed any of the conventional indices (% open-arm entries and % open-arm time) and risk assessment, we investigated in experiment 3 the possibility of interaction between 5-HT3 and 5-HT2 receptors. For this, we perform combined microinfusions of intra-PAG ondansetron and mCPP, an agonist of 5-HT2B/2C receptors, on behavior of maze-naïve mice. The results showed that intra-PAG infusions of ondansetron (3.0 nmol) increased the behavioral indices of anxiety. None of the doses of intra-PAG infusions of mCPBG modified the conventional and ethological indices of anxiety. The anxiolytic-like effect produced by intra-PAG infusions of mCPP (0.03 nmol) was blocked by infusions of ondansetron (1.0 nmol) in the same mesencephalic structure. All effects were observed in the absence of significant changes in locomotor activity (closed-arm entries). Our results indicate that there is a possible interaction between 5-HT3 and 5-HT2B/2C receptors modulation into the PAG of anxiety in mice. / A exposição de animais a situações aversivas, tais como o labirinto em cruz elevado (LCE), ativa vias serotoninérgicas com projeções para estruturas envolvidas no sistema de defesa tais como, amídala, septo, hipotálamo, hipocampo e substância cinzenta periaquedutal (SCP), produzindo alterações comportamentais que podem ser caracterizadas como ansiedade. Entretanto, a serotonina (5-HT) apresenta um papel dual nesta modulação. Assim, enquanto a estimulação de receptores do subtipo 5-HT1A ou 5-HT2 em estruturas prosencefálicas como, amídala e hipocampo resultam na potencialização de respostas de ansiedade em roedores, a ativação dos mesmos receptores na SCP, freqüentemente tende a diminuir comportamentos relacionados à ansiedade. Este estudo investigou o papel dos receptores 5-HT3 da SCP na modulação da ansiedade em camundongos avaliados no LCE. Nos Experimentos 1 e 2, camundongos receberam microinjeções intra-SCP de ondansetron (0, 0,3, 1,0, 3,0 nmol/0,1 μl) e mCPBG (0, 40, 80 e 160 nmol/0,1 μl), antagonista e agonista dos receptores 5-HT3, respectivamente. Como o mCPBG não alterou nenhum dos índices convencionais de ansiedade (porcentagem de entrada e tempo gasto nos braços abertos) e de avaliação de risco, verificamos no experimento 3 a possibilidade de interação entre receptores 5-HT3 e 5-HT2. Para isso, realizamos microinjeções combinadas de ondansetron e mCPP, um agonista dos receptores 5-HT2B/2C. Os resultados mostraram que microinjeções de ondansetron (3,0 nmol) aumentaram os índices convencionais de ansiedade. Nenhuma das doses de mCPBG intra-SCP, alteraram os índices convencionais e etológicos de ansiedade. O efeito ansiolítico produzido pela administração intra-SCP do mCPP (0,03 nmol), foi bloqueado pela infusão de ondansetron (1,0 nmol) na mesma estrutura mesencefálica. Todos os efeitos foram observaA exposição de animais a situações aversivas, tais como o labirinto em cruz elevado (LCE), ativa vias serotoninérgicas com projeções para estruturas envolvidas no sistema de defesa tais como, amídala, septo, hipotálamo, hipocampo e substância cinzenta periaquedutal (SCP), produzindo alterações comportamentais que podem ser caracterizadas como ansiedade. Entretanto, a serotonina (5-HT) apresenta um papel dual nesta modulação. Assim, enquanto a estimulação de receptores do subtipo 5-HT1A ou 5-HT2 em estruturas prosencefálicas como, amídala e hipocampo resultam na potencialização de respostas de ansiedade em roedores, a ativação dos mesmos receptores na SCP, freqüentemente tende a diminuir comportamentos relacionados à ansiedade. Este estudo investigou o papel dos receptores 5-HT3 da SCP na modulação da ansiedade em camundongos avaliados no LCE. Nos Experimentos 1 e 2, camundongos receberam microinjeções intra-SCP de ondansetron (0, 0,3, 1,0, 3,0 nmol/0,1 μl) e mCPBG (0, 40, 80 e 160 nmol/0,1 μl), antagonista e agonista dos receptores 5-HT3, respectivamente. Como o mCPBG não alterou nenhum dos índices convencionais de ansiedade (porcentagem de entrada e tempo gasto nos braços abertos) e de avaliação de risco, verificamos no experimento 3 a possibilidade de interação entre receptores 5-HT3 e 5-HT2. Para isso, realizamos microinjeções combinadas de ondansetron e mCPP, um agonista dos receptores 5-HT2B/2C. Os resultados mostraram que microinjeções de ondansetron (3,0 nmol) aumentaram os índices convencionais de ansiedade. Nenhuma das doses de mCPBG intra-SCP, alteraram os índices convencionais e etológicos de ansiedade. O efeito ansiolítico produzido pela administração intra-SCP do mCPP (0,03 nmol), foi bloqueado pela infusão de ondansetron (1,0 nmol) na mesma estrutura mesencefálica. Todos os efeitos foram observados sem alteração da atividade locomotora (entrada nos braços fechados). Os nossos resultados sugerem uma possível interação entre receptores 5-HT3 e 5-HT2B/2C da SCP na modulação da ansiedade em camundongos.dos sem alteração da atividade locomotora (entrada nos braços fechados). Os nossos resultados sugerem uma possível interação entre receptores 5-HT3 e 5-HT2B/2C da SCP na modulação da ansiedade em camundongos.

O cachorro-do-mato (Cerdocyon thous) é um canídeo neotropical que necessita ser contido por meios farmacológicos para a realização de certos procedimentos médicos e de manejo, em função de características comportamentais de defesa e grande susceptibilidade ao estresse. A combinação de seis protocolos (tiletamina-zolazepam-xilazina-atropina e azaperone; dextrocetamina-diazepam-xilazina-atropina e azaperone; cetamina racêmica-diazepam-xilazina-atropina e azaperone; tiletamina-zolazepam-detomidina-atropina e azaperone; dextrocetamina-diazepam-detomidina-atropina e azaperone; cetamina racêmica-diazepam-detomidina-atropina e azaperone) foram administradas, por via intramuscular, a dez cachorros-do-mato (nove machos e uma fêmea) com pesos médio 5,85 ± 0,83 kg, para possibilitar a realização de procedimentos de que incluíam marcação, exame físico, colheita de amostras de sangue, colheita de medula óssea e outros procedimentos pouco invasivos de moderada duração em Cerdocyon thous de cativeiro. Após a verificação dos pesos de cada cachorro-do-mato, a dose individual de cada uma das drogas foi calculada por meio de extrapolação alométrica interespecífica. O método proposto mostrou-se plenamente adequado à contenção farmacológica de exemplares de Cerdocyon thous que necessitem ser submetidos a procedimentos medianamente dolorosos ou incômodos, como exame físico e colheita de sangue e medula óssea. Não é indicado, porém, para procedimentos cirúrgicos. / The Crab-eating Fox (Cerdocyon thous) is a neotropical carnivorous that requires chemical restraint for handling due to its susceptibility to stress and characteristics of defensive behavior. Ten Crab-eating Fox (9 males and 1 female) weighing 5.85 ± 0.83 kg were given the combination of six protocols (tiletamine-zolazepam-xylazine-atropine and azaperone; dextroketamine-diazepam-xylazine-atropine and azaperone; racemic ketamine-diazepam-xylazine-atropine and azaperone; tiletamine-zolazepam-detomidine-atropine and azaperone; dextroketamina-diazepam-detomidine-atropine and azaperone; racemic ketamine-diazepam-detomidine-atropine and azaperone) by i.m. injection during field procedures that included identification, physical examination, blood sampling, bone marrow harvesting and other mildly invasive procedures of moderate duration in Cerdocyon thous of captivity. After checking the weights of each Crab-eating Fox, the individual dose of each drug was calculated by means of interspecific allometric extrapolation. The proposed method was safe for both the animal and the human personnel and it is recommended for routine management and stressful but not painful medical procedures like physical examination, measuring, sexing, and bone marrow and blood collection in Cerdocyon thous. / Tese (Doutorado)

INTRODUÇÃO: A clonidina é um agonista seletivo do receptor adrenérgico alfa2 com propriedades sedativas, analgésicas e possibilita a redução do consumo de outros anestésicos. Suas ações podem mitigar o impacto hemodinâmico e psíquico da S+ Cetamina. Os grandes queimados são de difícil manejo e ainda não existe uma técnica anestésica padrão para estes pacientes, sendo a cetamina amplamente utilizada nestes pacientes em regimes muito variados, apresentando várias vantagens. Os objetivos do estudo foram avaliar os efeitos hemodinâmicos e psíquicos da interação da clonidina e da S+ cetamina e propor uma técnica anestésica para grandes queimados. MÉTODOS: O estudo foi prospectivo, duplo encoberto, aleatório e placebo controlado, planejado para 48 pacientes adultos grandes queimados, estado físico ASA II ou III, que foram agendados para trocas de curativos ou debridamentos cirúrgicos. Para a anestesia foi usado midazolam 0,07mg/kg e duas doses de 1 mg/kg de S+ cetamina. No Grupo Clonidina foi usada a dose de 2 mcg/kg e soro fisiológico no Grupo Placebo. Foram avaliadas as alterações hemodinâmicas durante o intra-operatório. Durante as duas primeiras horas foram avaliadas detalhadamente as alterações psíquicas utilizando 13 variáveis, o retorno da consciência, a analgesia e a ocorrência de complicações. Após 24 horas foram avaliadas a analgesia, a ocorrência de sonhos e delírios. RESULTADOS: O Grupo Clonidina apresentou redução estatisticamente significativa nas pressões arteriais durante o procedimento. Dentre as 13 variáveis psíquicas analisadas, 5 foram menores com significância estatística no Grupo Clonidina durante a avaliação de 30 minutos, incluindo Corpo, Arredores, Pensamento, Sonolento e Ansioso. Na avaliação de duas horas, apenas a variável Ansioso teve redução estatisticamente significativa no Grupo Clonidina. A frequência cardíaca, a ocorrência de delírio e sonhos e a analgesia pós-operatória foram similares nos dois grupos. Não houve diferença entre os grupos na ocorrência de complicações. CONCLUSÃO: O uso de Clonidina em anestesia para pacientes grandes queimados, com S+ cetamina e midazolam reduz as pressões arteriais durante o procedimento e os efeitos psíquicos, sem aumentar a ocorrência de complicações / Abstract: Clonidine is a selective alpha2-adrenoceptor agonist with sedative, analgesic and anesthetic sparing properties. Because of its sympathoinhibitory activity, it may reduce the hemodynamic and psychic effects of S+ ketamine and improve analgesia. The ketamine is commonly used in burned patients worldwide. The objectives of this study were to evaluate the interactions between clonidine and ketamine in hemodynamic and psychic effects and also to propose an anesthetic technique for major burned patients. Method: A prospective, double-blind, placebo controlled study designed for 48 patients with major burns, aged 18-60 years, physical status ASA II or III, that were scheduled for dressing changes and wound debridements. For the anesthesia was used midazolam 0,07mg/kg, two doses of S+ ketamine 1 mg/kg, placebo or clonidine 2mcg/kg. Intraoperative hemodynamic alterations over time were assessed. During the first two hours after the procedures were evaluated, psychic effects in detail using 13 variables, the return of conscience, analgesia, dreaming and delirium and after 24 hours, analgesia, dreaming and delirium. Results: The Clonidine Group had low arterial pressure during the procedure. At the 30 minute evaluation of the psychic variables 5 out of 13 were lower in the Clonidine Group with statistically significance, these being Body, Surroundings, Thoughts, Drowsy and Anxious. At the 2 hour evaluation only the Anxious variable was lower in the Clonidine Group with statistically significance. Cardiac frequency, postoperative analgesia, occurrence of delirium and dreaming weren\'t different between both groups. There wasn\'t any difference in complication rates between both groups. Conclusion: We concluded that the use of Clonidine in S+ ketamine plus midazolam anesthesia in patients with major burns reduces the arterial pressures and the postoperative psychic effects, without increasing the complications

Les β2-agonistes sont couramment utilisés pour prévenir et réduire les symptômes de l'asthme et de la bronchoconstriction induite par l'exercice. Mais, pris en quantités supérieures aux doses thérapeutiques, les β2-agonistes ont un effet anabolisant qui a été clairement démontré in vivo. Un certain nombre d’acteurs sont mis en jeu dans la réponse biologique du tissu musculaire aux β2-agonistes. L’un de ces acteurs est la voie de signalisation PI3K/Akt/mTOR, voie d’initiation de la traduction, ayant un rôle majeur dans la synthèse protéique. Dans ce contexte, notre première étude avait pour objectif de déterminer la cinétique des événements moléculaires responsables de l’hypertrophie du muscle squelettique de rat après administration de formotérol pendant 1 jour (J1), 3 jours (J3) et 10 jours (J10). Nous avons montré que l’administration de formotérol induisait une hypertrophie musculaire à J3 et J10 associée à l’activation transitoire de la voie de signalisation PI3K/Akt/mTOR (J1 et J3), et à une diminution de l’expression de l’E3 ubiquitine ligase MAFbx/Atrogin-1 (J3). La voie autophagie lysosome ne semblait pas être affectée. Ainsi, l’ensemble de ces résultats suggère que l’activation de la voie PI3K/Akt/mTOR est associée à la voie ubiquitine-protéasome mais pas à la voie autophagie-lysosome. La régulation transitoire de la voie PI3K/Akt/mTOR suggère que d’autres voies de signalisation sont impliquées dans l’hypertrophie musculaire induite par le formotérol. Le 007-AM, analogue de l’AMPc, a été décrit comme pouvant stimuler la voie de signalisation PI3K/Akt/mTOR via l’activation de la protéine Epac, suggérant que le 007-AM puisse constituer une molécule de substitution à l’utilisation des β2-agonistes. Notre seconde étude avait pour but de déterminer si le 007-AM avait une action anabolisante sur le tissu musculaire, mais également de déterminer si la 007-AM était une molécule stable permettant d’envisager son usage dans un cadre pharmacologique. L’administration de 007-AM pendant 7 jours chez des souris n’engendrait pas d’hypertrophie musculaire. En revanche, in vitro sur cellules C2C12, le 007-AM activait la voie de signalisation PI3K/Akt/mTOR comme en témoignait l’augmentation de la phosphorylation des protéines rpS6 et 4E-BP1. Nos résultats montraient également que le 007-AM était instable dans le plasma alors que son produit de dégradation, le 007 était plus stable. Pris ensembles, ces résultats suggèrent qu’un traitement de 7 jours au 007-AM n’est pas suffisant pour induire une hypertrophie musculaire et que l’absence d’hypertrophie musculaire pourrait provenir de l’instabilité du 007-AM dans le plasma. Toutefois, des études supplémentaires seront nécessaires pour confirmer ces résultats / Β2-agonists are traditionally used to prevent and reduce asthma symptoms and bronchoconstriction induced by exercise. Nevertheless, when administrated in vivo, at relatively high, far away from therapeutic doses, β2-agonists induce anabolic effects. Numerous actors are involved in biological response of the skeletal muscle, induced by β2-agonists. PI3K/Akt/mTOR signaling pathway, which initiates translation, is one of these actors. In this context, our first study aimed at determined the kinetic of molecular events responsible for skeletal muscle hypertrophy after 1 day (D1), 3 days (D3) and 10 days (D10) of formoterol administration. We have shown that formoterol administration induced skeletal muscle hypertrophy at D3 and D10 associated with a transient activation of PI3K/Akt/mTOR signaling pathway (D1 and D3), and, with a decrease in E3 ubiquitin ligase MAFbx/atrogin-1 expression (D3). The autophagy-lysosome pathway seems not to be regulated by formoterol administration. Taken together, these results suggest that PI3K/Akt/mTOR activation is temporally associated with the regulation of ubiquitin-proteasome but not the autophagy-lysosome pathway. The transient nature of the regulation of PI3K/Akt/mTOR signaling pathway also indicates that other unidentified pathways are probably activated to sustain the increase in skeletal muscle mass. Recently, 007-AM synthetic molecule has been described to stimulate PI3K/Akt/mTOR signaling pathway through Epac protein activation, suggesting that 007-AM could be an alternative to the use of β2-agonists. The purpose of our second study was to determine whether 007-AM had an anabolic action on skeletal muscle and if 007-AM was stable allowing considering its use in pharmacology. 007-AM administration for 7 days to mice does not lead to muscle hypertrophy. Nonetheless, in vitro on C2C12 cells, 007-AM activated PI3K/Akt/mTOR signaling pathway by increasing phosphorylation of rpS6 and 4E-BP1. Our results showed that contrary to 007, 007-AM was instable in plasma. Altogether, these results suggest that a 7-day 007-AM treatment is not sufficient to induce skeletal muscle hypertrophy. This lack of hypertrophy could be due to 007-AM instability in plasma. However, supplemental studies are needed to confirm these results

There is increasing interest in the use of adjuvant hormonal therapies, which are given after the resection or destruction of all gross disease, in early-stage prostate cancer, as a significant proportion of patients experience progression and/or die from the disease despite undergoing therapy with curative intent. Several retrospective studies suggest that adjuvant hormonal therapy may improve long-term outcome after radical surgery in men with positive lymph nodes, although this approach has yet to be studied in a prospective setting. No studies of adjuvant therapy for patients with extracapsular extension at surgery have been completed, but in an interim analysis of an open controlled trial, adjuvant flutamide significantly improved progression-free survival at 4 years. Three prospective studies in the radiotherapy setting have shown that adjuvant luteinizing hormone-releasing hormone (LH-RH) agonist therapy significantly improves progression-free and/or overall survival. Future studies need to define patient subgroups who will benefit most from adjuvant therapy. The side effects of the different therapeutic options also need to be compared. It is hoped that many of the outstanding questions concerning adjuvant hormonal therapy will be answered by the ongoing Bicalutamide Early Prostate Cancer Programme. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

L’asthme bronchique est caractérisé par un remodelage et une inflammation des voies aériennes. La masse du muscle lisse ainsi que la déposition de matrice extracellulaire sont augmentées dans la paroi des bronches asthmatiques, ce qui contribue à l’obstruction respiratoire. Peu d’études ont évalué les effets des traitements utilisés dans l’asthme sur le remodelage bronchique, et surtout peu de données sont disponibles concernant les effets sur le muscle lisse. La combinaison de corticostéroïdes et de β2-agonistes à longue durée d’action administrée par inhalation permet de mieux contrôler les crises d’asthme par rapport à la monothérapie avec des médicaments corticostéroïdes. Cependant, l’action spécifique de la combinaison sur le remodelage et sur l’inflammation des bronches périphériques n’est pas décrite. Surtout, il reste à clarifier si l’administration de la combinaison est avantageuse par rapport à la monothérapie corticostéroïde. La plupart des études réalisées chez l’homme utilisent des tissus bronchiques obtenus par biopsie endobronchique, qui ne sont pas représentatifs du processus pathologique affectant les voies respiratoires périphériques. Leur inaccessibilité par des méthodes non invasives est la raison pour laquelle si peu de données existent sur la pathophysiologie des voies périphériques chez les patients asthmatiques. L’asthme équin, aussi connu comme « le souffle », est une pathologie obstructive des chevaux adultes considérée comme un modèle animal d’asthme humain. Elle est caractérisée par un remodelage des bronches périphériques et par une inflammation bronchoalvéolaire de type neutrophilique. En étudiant le modèle équin, cette thèse a évalué la contribution des médicaments corticostéroïdes et de β2-agonistes à longue durée d’action, administrée comme monothérapies ou en combinaison, sur la réversibilité du remodelage et de l’inflammation de voies aériennes dans l’asthme bronchique. A cette fin, nous avons d’abord optimisé et validé l’application de la biopsie endobronchique et de l’échographie endobronchique chez le cheval adulte. Nos résultats indiquent que les échantillons obtenus par biopsie endobronchique sont inadéquats pour l’évaluation quantitative de la masse du muscle lisse chez le cheval. Cependant, ils permettent d’étudier les changements quantitatifs des structures épithéliales et de la lamina propria, ainsi que les aspects qualitatifs du muscle lisse. L’échographie endobronchique, quant à elle, permet d'estimer la masse du muscle lisse bronchique, et ce, chez des chevaux sains et chez des chevaux asthmatiques. Cette thèse démontre aussi que qu’un traitement de 12 semaines avec des corticostéroïdes induit une diminution significative de la masse du muscle lisse périphérique, qui n’est pas amélioré davantage par l’administration concomitante d’un β2-agoniste à longue durée d’action. Cette diminution est toutefois incomplète. Un effet positif et synergique de la combinaison a également été observé au niveau de la déposition de matrice extracellulaire. La combinaison a produit une diminution significative de la quantité de matrices déposées dans la lamina propria et dans la couche du muscle lisse dans les bronches centrales, alors que l’effet été limité à la couche du muscle lisse dans les bronches périphériques. La combinaison n’améliore pas le contrôle de l’inflammation bronchique ni bronchiolaire par rapport aux monothérapies ; cependant, elle diminue la neutrophilie bronchoalvéolaire de façon synergique. / Airway remodeling and inflammation are the hallmarks of asthma. Both airway smooth muscle (ASM) mass and extracellular matrix (ECM) deposition are increased in the central and peripheral airways of asthmatic patients, which contribute to airway obstruction. Few studies have investigated the ability of current asthma medications to reverse airway remodeling, especially the increased ASM mass. Inhaled corticosteroids (ICS) and long-acting β2-agonist combinations (ICS/LABA) are more effective than ICS monotherapy to control asthma exacerbations. However, their efficacy at modifying bronchial inflammation and remodeling at the peripheral level of the lung is not well-described. In fact, most work has been performed using endobronchial biopsy samples obtained from asthmatic subjects, which completely disregard the alterations occurring in peripheral airways. Ethical considerations limit the possibility of biopsying the peripheral airways in humans due to the invasiveness of the procedure. Equine asthma, or heaves, is a naturally-occurring disease of adult horses and a recognized animal model of human asthma characterized by neutrophilic inflammation as well as ASM and ECM remodeling of peripheral airways. This thesis has assessed the contribution of ICS and LABA, alone or combined, to the reversal of remodeling and inflammation in central and peripheral airways using the equine asthma model. To attain this goal, we have first optimized and validated the application of endobronchial biopsy and endobronchial ultrasound (EBUS) in the equine species. EBUS reliably estimates the bronchial ASM. Subsequently, asthmatic horses with ongoing airway remodeling and inflammation were treated with ICS, LABA, ICS/LABA, or antigen avoidance. Lung function, airway remodeling and inflammation were then assessed weekly for 3 months. Our results demonstrated a 30% decrease of peripheral ASM remodeling attained with ICS and ICS/LABA pharmacological treatment. A decrease of a similar magnitude of peripheral ASM was previously reported after 6 and 12 months of ICS monotherapy and antigen avoidance, respectively. A synergistic effect of ICS/LABA was observed on ECM deposition and airway lumen neutrophils. ICS/LABA decreased the ECM fraction of the ASM layer both peripherally and centrally, while the same effect on the lamina propria was observed only in central airways. Both ICS/LABA and ICS monotherapy decreased submucosal inflammation in central airways, while only ICS/LABA and antigen avoidance decreased bronchoalveolar neutrophilia. In conclusion, our results suggest that the enhanced therapeutic effect of ICS/LABA over ICS monotherapy in asthmatic horses was associated with a reduction of ECM deposition, mainly observed within the large airways, and possibly also with a decreased airway neutrophilia. However, ICS/LABA did not provide additional benefit to ICS monotherapy in terms of peripheral ASM remodeling as both induce a 30% decrease of the ASM mass in 3 months.

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