Die Studien der vorliegenden Habilitationsschrift hatten die Untersuchung der Abhängigkeit diffuser und tumorförmiger Hypervaskularisationen der Plazenta von angiogenen Wachstumsfaktoren zum Ziel. Kernaussagen sind, daß in Chorangiomen eine höhere Expression der Angiopoietine - 1 und - 2 vorliegt, bei morphologisch gleicher Rezeptorausstattung. Keine Differenzen zeigte die Expression von PDGF sowie seinem Rezeptor PDGF-ß. Bei Differenzierung solitärer und multipler Chorangiome (Chorangiomatosen) hinsichtlich klinischer Parameter sowie der Expression der angiogenen Wachstumsfaktoren Angiopoietin-1 und bFGF sowie hinsichtlich der Proliferationsrate konnten Unterschiede zwischen den plazentaren Läsionen deutlich werden. Die Expression der Wachstumsfaktoren war jeweils in Chorangiomatosen kräftiger als in solitären Veränderungen. Das Auftreten von Chorangiomatosen steht offensichtlich in Zusammenhang mit einer verstärkten Expression dieser Wachstumsfaktoren, die damit noch die ohnehin in Chorangiomen - gegenüber ortholog gereiftem Plazentaparenchym - gesteigerte Expression übertrifft. So deutet diese Studie nunmehr verstärkt auf eine Korrelation zwischen der Höhe der Wachstumsfaktorexpression und dem quantitativen Auftreten lokalisierter Angiopathien hin. Zudem ließen sich klinische Korrelationen aufzeigen. So lag das mütterliche Alter beim Auftreten lokalisierter hypervakularisierter Veränderungen deutlich über der bei unauffälligen Plazenten, ein Ergebnis, das vorherige Untersuchungen bestätigte. Geringe Differenzen das maternale Alter betreffend bestanden zwischen Chorangiomen und Chorangiomatosen. Hinsichtlich der Schwangerschaftskomplikationen fanden sich keine Unterschiede zwischen Chorangiomen und Chorangiomatosen. Begleitende Reifungsstörungen fanden sich auch in diesem Studienkollektiv, dahingehend, daß Chorangiome und häufiger noch Chorangiomatosen kombiniert mit diesen Auftreten. Untersuchungen zur Apoptose- und Proliferationsrate in Chorangiomen mit differierendem histologischen Subtyp erbrachten keinen Hinweis auf den Einfluß der Apoptose auf das Wachstum dieser tumorartigen Läsionen. In Chorangiomen zeigte sich im Vergleich zu regelhaft entwickeltem reifem Plazentagewebe eine leicht gesteigerte Proliferationsrate. Auffällig war einzig, daß Chorangiome endotheliomatösen Subtyps die höchste Proliferationsrate aufwiesen. Studien intrauteriner Todesfällen der frühen und mittleren Fetalperiode konnten zeigen, das diffuse Hypervaskularisationen offensichtlich reaktiver Natur sind. Untersuchungen zur Expression angiogener Wachstumsfaktoren zeigten, daß diese exprimiert werden und damit bereits an der Gefäßentwicklung der Plazenta in der Fetalperiode beteiligt sind. Unterschiede hinsichtlich der Expression der Wachstumsfaktoren in Plazenten mit Hypervaskularisationen und Kontrollproben fanden sich jedoch morphologisch nicht. Die gesteigerte Gefäßbildung in der frühen Fetalperiode ist offenbar eine reaktive Anpassung der Zotten auf die Hypoxie. Falldarstellungen zweier weiterer Plazentatumoren, eines inzidentellen Chorangiokarzinoms sowie eines Angiomyxoms der Nabelschnur erbrachten hinsichtlich der Gefäßkomponente in diesen Tumoren keine Abhängigkeit von den untersuchten Wachstumsfaktoren. Eine Studie von 136 Chorangiomen aus 22439 Plazenten ließen aussagefähigen Analysen der Häufigkeit, morphologischer Charakteristika und Korrelationen zwischen Chorangiomen und klinischen Befunden zu. So zeigten sich signifikante Abhängigkeiten zwischen dem Auftreten eines Chorangioms und dem mütterlichen Alter, der gestationsbedingten Hochdrucksymptomatik, der Parität, dem kindlichen Geschlecht und begleitender Reifungsstörungen der Plazenta. Insbesondere die Reifungsstörungen in Kombination zum Auftreten eines Chorangioms waren zuvor nie Gegenstand einer größeren wissenschaftlichen Studie. Einzelne Parameter fanden zwar sporadisch in einzelnen Publikationen mit wenigen Chorangiomen wissenschaftlich Beachtung, doch die dort publizierten Ergebnisse widersprachen sich vielfach. So ist die jetzt vorliegende Untersuchung in ihrer Größe und damit Aussagekraft sehr relevant. / The studies had the investigation of the dependence of vague and tumoric hypervascularisation of the placenta on angiogenic growth factors as a goal. Core statements are that in chorangiomas a higher expression of Angiopoietin-1 and - 2 is present, during morphologically same receptor equipment. The expression of PDGF as well as ist receptor did not show differences PDGF - beta. With differentiation of solitär and multiple chorangiomas (chorangiomatoses) regarding clinical parameters as well as the expression of the angiogenic growth factors Angiopoietin-1 and bFGF as well as regarding the proliferation rate could become clear differences between the placental lesions. The expression of the growth factors was in each case in chorangiomatoses stronger than in single changes. The occurrence of chorangiomatoses stands obviously in connection with a strengthened expression of these growth factors, which exceeds thereby still anyway the expression increased in chorangiomas - opposite ortholog matured placental tissue. Thus this study points now strengthened on a correlation between the height of the expression on growth factors and the quantitative occurrence of located angiopathia. Besides clinical correlations could be pointed out. Thus the maternal age was clearly with the occurrence of located such changes over with inconspicuous placentas, a result, which confirmed previous investigations. Small differences concerning the maternal age existed between chorangiomas and chorangiomatoses. Regarding the pregnancy complications were no differences between chorangiomas and chorangiomatoses. Accompanying maturing disturbances were in such a way also in this study collective, that chorangiomas combines and more frequently still chorangiomatoses with this occurrence. Investigations to the apoptoses and proliferation rate in chorangiomas with differing histological subtyp did not furnish a reference to the influence of the apoptoses on the growth of these tumor-like lesions. To chorangiomas an easily increased proliferation rate pointed itself compared with regularly developed ripe placental tissue. Remarkably it was only that chorangiomas with endotheliomatos subtyp the highest proliferation rate exhibited. Studies of intrauterin deaths of the early and middle fetal periode could show, which are vague hypervascularisation of obviously reactive nature. Investigations to the expression of angiogenic growth factors showed the fact that these are exprime and so that in the container development of the placenta in the fetal periode is involved already. Differences regarding the expression of the growth factors in plazentas with hypervascularisationen and inspection samples were not however morphologically. The increased container formation in the early fetal periode is obviously a reactive adjustment of the villous trees on the hypoxia. Drop representations of two further placenta tumors, a incidentially chorangiocarcinoma as well as a angiomyxoma of the umbilical cord did not furnish dependence on the examined growth factors regarding the container component in these tumors. Expressive analyses of the frequency, morphologic characteristics and correlations between chorangiomas and clinical findings permitted a study of 136 chorangiomas from 22439 plazentas. Thus significant dependence between the occurrence of a chorangioma and the maternal age, the gestational high pressure symptomatology, the parity, the childlike sex showed up and accompanying maturing disturbances of the placenta.

Die Hochdosischemotherapie stellt für Patienten unter 60 Jahren die Standardtherapie des multiplen Myeloms dar. Nach 600 Hochdosischemotherapiezyklen mit autologer peripherer Stammzelltransplantation zeigten sich erstmals Grundkrankheit, Alter und Zahl der transplantierten Stammzellen als unabhängige Einflußfaktoren für die Rate der dokumentierten Infektionen. Die Dauer der schweren Mukositis beeinflußte sowohl die Rate der Infektionen, als auch die therapieassoziierte Mortalität signifikant. Die Angiogenese im Knochenmark stellte bei Patienten mit multiplem Myelom einen unabhängigen Prognosefaktor für das Überleben dar. Myelom-Patienten wiesen im Vergleich zu gesunden Probanden eine signifikant erhöhte bFGF(basic fibroblast growth factor)-Konzentration im Serum auf. Es zeigte sich ein signifikanter Anstieg der bFGF Konzentration parallel zur Progression der Erkrankung vom Stadium I bis zum Stadium III. Eine effektive Chemotherapie ging mit signifikanten Reduktionen der Serum-Konzentrationen von drei angiogen wirksamen Zytokinen VEGF (vascular endothelial growth factor), bFGF und HGF (hepatocyte growth factor) sowie der Angiogenese im Knochenmark einher. Die Induktion der Knochenresorption stellt eines der wichtigsten weiteren Charakteristika von malignen Plasmazellen dar. In einer vergleichenden Untersuchung zeigte sich, daß unter den Knochenstoffwechselparametern ICTP (carboxyterminales quervernetztes Typ I Kollagen Telopeptid), NTx (aminoterminales Kollagen Typ I Telopeptid) und DPD (Desoxypyridinolin) das erstgenannte sich am besten zur Kontrolle der Progression eignet und dieser Parameter auch einen signifikanten Prognosefaktor für die Überlebenszeit darstellt. Die Hinweise, daß eine frühzeitige Bisphosphonattherapie die Progression des multiplen Myeloms hemmen könnte, hat uns veranlaßt, die erste prospektiv randomisierte Studie einer Bisphosphonattherapie beim multiplen Myelom im Stadium I in Zusammenarbeit mit der Deutschen Studiengruppe Multiples Myelom zu initiieren. Darüber hinaus wird in dieser Arbeit auf die prognostische Relevanz zytogenetischer und molekulargenetischer Befunde beim multiplen Myelom sowie auf die Möglichkeit immunphänotypischer Untersuchungen zur Differenzierung zwischen multiplem Myelom und monoklonaler Gammopathie unbestimmter Signifikanz (MGUS) eingegangen. / High-dose chemotherapy is the standard treatment for patients with multiple myeloma younger than 60 years. In 600 cycles of high-dose chemotherapy with autologous blood stem cell transplantation, we found that the type of the malignant disease, age and number of transplanted stem cells were independent prognostic factors for the rate of documented infections. The duration of severe mucositis was significantly associated both with the rate of infections and treatment-related mortality. The angiogenesis in bone marrow was found to be an independent prognostic factor for survival in patients with multiple myeloma. Myeloma patients had significantly elevated serum bFGF (basic fibroblast growth factor) levels in comparison to healthy controls. Serum bFGF levels increased parallel to the progression of multiple myeloma from stage I to stage III. Effective chemotherapy was associated with significant reductions in serum levels of three angiogenic cytokines VEGF (vascular endothelial growth factor), bFGF and HGF (hepatocyte growth factor) and the bone marrow angiogenesis. The induction of bone resorption is one of the most important characteristics of malignant plasma cells. In a comparative analysis of bone resorption parameters ICTP (carboxy-terminal telopeptide of type-I collagen), NTx (amino-terminal collagen type-I telopeptide) and DPD (deoxypyridinoline) we found that ICTP was the most suitable marker for the detection of progression in multiple myeloma and that ICTP was a significant prognostic factor for survival in this disease. The findings that an early start of a treatment with bisphosphonates might delay the progression of multiple myeloma has lead us to start the first prospective randomized trial of bisphosphonate treatment in stage I in collaboration with the German Study Group Multiple Myeloma. Furthermore the prognostic relevance of cytogenetic and moleculargenetic findings in multiple myeloma and the use of immunophenotypic analysis for the differentiation of multiple myeloma and monoclonal gammopathy of undetermined significance (MGUS) was discussed in this work.

Altas taxas de mortalidade embrionária ocorrem no período de implantação em embriões provenientes de IATF e FIV. Acredita-se que a falha no desenvolvimento do saco vitelino possa estar relacionada com estas perdas embrionárias. O objetivo deste trabalho foi descrever as características macroscópicas, microscópicas e expressão gênica do processo de involução do saco vitelino, visto que os dados da literatura são contraditórios ao descrever os processos de formação e involução do saco vitelino em embriões provenientes de IATF e FIV. Foram utilizados 19 embriões de IATF e 16 de FIV, provenientes da Sociedade Agropecuária Imaculada Conceição-Redenção/PA, Brasil. Observou-se que não houve diferença significativa no tamanho dos embriões nas idades de 25 (p=0,1), 35 (p=0,1), 40 (p=0,4) e 45 (p=0,36) dias, quando comparados os grupos de IATF e FIV. Entretanto entre os embriões de IATF e FIV com 30 dias de gestação, apresentaram diferença estatística (p= 0,03). A curva de crescimento (Crow-Rump) aumentou gradativamente e linearmente em função da idade gestacional. Macroscopicamente, observou-se que aos 25 dias de gestação, o saco vitelino apresentava formato de T e coloração translúcida. Uma porção central se encontrava próxima a região ventral do embrião emitindo duas extremidades que eram finas membranas, estas acompanhavam o alantóide juntamente com os vasos umbilicais. Aos 30 a 35 dias, apresentava coloração amarelada, sua parte central e extremidades bem diminuídas mostrando sinais de um início de regressão. Aos 40 a 45 dias, o seu processo de involução estava caracterizado, com extremidades enoveladas e região central assemelhando-se a um pequeno grão achatado que se encontrava em contato com o âmnio. Microscopicamente, o saco vitelino era formado por três camadas: o endoderma, camada única que reveste a cavidade vitelínica, uma camada intermediária mesenquimal vascular e o mesotélio, camada simples voltada ao exoceloma. O epitélio do saco vitelino formava dobras ou criptas que se projetavam para a luz. Imunohistoquímica notou-se marcação para os anticorpos VEGF, Flt-1 e KDR. Observou-se que não houve diferença significativa na expressão do mRNA do VEGF, KDR e Flt-1 entre os grupos e nas idades gestacionais analisadas, aos 30 dias notou-se uma tendência entre os grupos em relação a expressão do Flt-1. Os fatores de crescimento b FGF, FGFR-1 e FGFR-2, não apresentaram diferenças em suas expressões, somente aos 35 dias de gestação para o mRNA FGFR-1. Conclui-se que o saco vitelino está intensamente relacionado com o desenvolvimento embrionário, na qual sua involução e desaparecimento relacionam-se com o crescimento e \"maturação\" embrionária. / High mortality rates occur during embryonic implantation embryos from IVF and FTAI. It is believed that the failure in the development of the yolk sac may be related to these embryonic losses. The objective of this study was to describe the macroscopic, microscopic and mRNA expression features of the yolk sac involution process, since the literature relates contradictory information regarding the processes of formation and involution of the yolk sac in IVF and TAI embryos. Nineteen embryos were used for FTAI and 16 IVF; the specimes were obtained from the Sociedade Agropecuária Imaculada Conceição-Redenção/PA, Brazil. No significant differences were observed in the size of embryos aged 25 (p = 0.1), 35 (p = 0.1), 40 (p = 0.4) and 45 (p = 0.36) days in the groups of IVF and FTAI. However between FTAI and IVF embryos with 30 days of gestation, a difference (p = 0.03) was detectable. The growth curve (Crow-Rump) increased gradually and linearly with gestational age. Macroscopically, it was observed that after 25 days of gestation, the yolk sac was \"T-shaped\" and transparent colored. A central portion was observed in the vicinity of the ventral ends of the embryo exhibiting two thin membranes, which accompanied the allantois with the umbilical vessels. At 30 to 35 days this portion becomes yellowish and its central part together with the extremities was reduced displaying clearly signs of regression. At 40 to 45 days, the process of involution was presented in a curled fashion and ends with the central region resembling a flat small grain in contact with the amnion. Microscopically, the yolk sac was formed by three layers: the endoderm, single layer lining the vitelline cavity, an intermediate layer and vascular mesenchymal mesothelium, exoceloma focused on single layer. The epithelium of the yolk sac formed folds or crypts, which projected to the light. Immunohistochemistry marking was noted for antibodies VEGF, Flt-1 and KDR. No significant difference were observed in mRNA expression of VEGF, KDR and Flt-1 between groups and the gestational ages analyzed at 30 days there has been a trend among the groups regarding the expression of Flt-1. The growth factors bFGF, FGFR-1 and FGFR-2 showed no differences in their expressions, with the exception of 35 days of gestation for the m-RNA FGFR 1. It was concluded that the yolk sac is strongly related to embryonic development, in which the involution and disappearance are related to growth and \"maturity\" stage.

No description available.

Background: To assess acute effects of bevacizumab (anti-VEGF therapy) on cerebral microvessels and systemic cardiovascular regulation. Design and subjects: 20 consecutive patients with colorectal cancer (median age: 60.4 years, range 45.5-73.9 years) received bevacizumab intravenously (5 mg/kg) uncoupled of chemotherapy. Prior to and within the first 24 hours after bevacizumab infusion, patients were investigated for retinal endothelial function. A series of a triple 24-hour ambulatory blood pressure measurement was conducted. Retinal endothelial function was determined as flicker light-induced vasodilation. The integrity of baroreflex arc and autonomic cardiovascular control was examined by stimulatory manoeuvres. Results: Bevacizumab therapy significantly reduced the vasodilatory capacity of retinal arterioles in response to flicker light. A slight decrease in diastolic pressure and heart rate was observed after bevacizumab infusion but this was unrelated to changes in retinal function. The pressure response upon nitroglycerin was largely preserved after bevacizumab infusion. The proportion of patients with abnormal nocturnal blood pressure regulation increased under anti-angiogenic therapy. Autonomic blood pressure control was not affected by bevacizumab treatment. Conclusions: Bevacizumab acutely impairs microvascular function independent of blood pressure changes. Imaging of the retinal microcirculation seems a valuable tool for monitoring pharmacodynamic effects of bevacizumab.

Altas taxas de mortalidade embrionária ocorrem no período de implantação em embriões provenientes de IATF e FIV. Acredita-se que a falha no desenvolvimento do saco vitelino possa estar relacionada com estas perdas embrionárias. O objetivo deste trabalho foi descrever as características macroscópicas, microscópicas e expressão gênica do processo de involução do saco vitelino, visto que os dados da literatura são contraditórios ao descrever os processos de formação e involução do saco vitelino em embriões provenientes de IATF e FIV. Foram utilizados 19 embriões de IATF e 16 de FIV, provenientes da Sociedade Agropecuária Imaculada Conceição-Redenção/PA, Brasil. Observou-se que não houve diferença significativa no tamanho dos embriões nas idades de 25 (p=0,1), 35 (p=0,1), 40 (p=0,4) e 45 (p=0,36) dias, quando comparados os grupos de IATF e FIV. Entretanto entre os embriões de IATF e FIV com 30 dias de gestação, apresentaram diferença estatística (p= 0,03). A curva de crescimento (Crow-Rump) aumentou gradativamente e linearmente em função da idade gestacional. Macroscopicamente, observou-se que aos 25 dias de gestação, o saco vitelino apresentava formato de T e coloração translúcida. Uma porção central se encontrava próxima a região ventral do embrião emitindo duas extremidades que eram finas membranas, estas acompanhavam o alantóide juntamente com os vasos umbilicais. Aos 30 a 35 dias, apresentava coloração amarelada, sua parte central e extremidades bem diminuídas mostrando sinais de um início de regressão. Aos 40 a 45 dias, o seu processo de involução estava caracterizado, com extremidades enoveladas e região central assemelhando-se a um pequeno grão achatado que se encontrava em contato com o âmnio. Microscopicamente, o saco vitelino era formado por três camadas: o endoderma, camada única que reveste a cavidade vitelínica, uma camada intermediária mesenquimal vascular e o mesotélio, camada simples voltada ao exoceloma. O epitélio do saco vitelino formava dobras ou criptas que se projetavam para a luz. Imunohistoquímica notou-se marcação para os anticorpos VEGF, Flt-1 e KDR. Observou-se que não houve diferença significativa na expressão do mRNA do VEGF, KDR e Flt-1 entre os grupos e nas idades gestacionais analisadas, aos 30 dias notou-se uma tendência entre os grupos em relação a expressão do Flt-1. Os fatores de crescimento b FGF, FGFR-1 e FGFR-2, não apresentaram diferenças em suas expressões, somente aos 35 dias de gestação para o mRNA FGFR-1. Conclui-se que o saco vitelino está intensamente relacionado com o desenvolvimento embrionário, na qual sua involução e desaparecimento relacionam-se com o crescimento e \"maturação\" embrionária. / High mortality rates occur during embryonic implantation embryos from IVF and FTAI. It is believed that the failure in the development of the yolk sac may be related to these embryonic losses. The objective of this study was to describe the macroscopic, microscopic and mRNA expression features of the yolk sac involution process, since the literature relates contradictory information regarding the processes of formation and involution of the yolk sac in IVF and TAI embryos. Nineteen embryos were used for FTAI and 16 IVF; the specimes were obtained from the Sociedade Agropecuária Imaculada Conceição-Redenção/PA, Brazil. No significant differences were observed in the size of embryos aged 25 (p = 0.1), 35 (p = 0.1), 40 (p = 0.4) and 45 (p = 0.36) days in the groups of IVF and FTAI. However between FTAI and IVF embryos with 30 days of gestation, a difference (p = 0.03) was detectable. The growth curve (Crow-Rump) increased gradually and linearly with gestational age. Macroscopically, it was observed that after 25 days of gestation, the yolk sac was \"T-shaped\" and transparent colored. A central portion was observed in the vicinity of the ventral ends of the embryo exhibiting two thin membranes, which accompanied the allantois with the umbilical vessels. At 30 to 35 days this portion becomes yellowish and its central part together with the extremities was reduced displaying clearly signs of regression. At 40 to 45 days, the process of involution was presented in a curled fashion and ends with the central region resembling a flat small grain in contact with the amnion. Microscopically, the yolk sac was formed by three layers: the endoderm, single layer lining the vitelline cavity, an intermediate layer and vascular mesenchymal mesothelium, exoceloma focused on single layer. The epithelium of the yolk sac formed folds or crypts, which projected to the light. Immunohistochemistry marking was noted for antibodies VEGF, Flt-1 and KDR. No significant difference were observed in mRNA expression of VEGF, KDR and Flt-1 between groups and the gestational ages analyzed at 30 days there has been a trend among the groups regarding the expression of Flt-1. The growth factors bFGF, FGFR-1 and FGFR-2 showed no differences in their expressions, with the exception of 35 days of gestation for the m-RNA FGFR 1. It was concluded that the yolk sac is strongly related to embryonic development, in which the involution and disappearance are related to growth and \"maturity\" stage.

INTRODUÇÃO: O uso da laserterapia concernente ao estímulo da formação óssea e da revascularização tem tornado objeto de estudo na área de saúde. OBJETIVO: O presente trabalho in vivo teve como objetivo avaliar quantitativamente os efeitos do laser de baixa potência (LBP) na remodelação óssea após a expansão rápida da maxila (ERM) em ratos jovens, através da expressão do RNAm dos genes RANK, RANK-L, Osteoprotegerina (OPG), e o Fator do Crescimento do Endotélio Vascular (VEGF) bem como a análise histológica. MATERIAL E MÉTODO: Utilizou-se 105 ratos Wistar (Rattus norvegicus, albinus), machos, divididos em 4 grupos: Grupo Controle (n=10) animais não tratados (sem ERM e sem aplicação do LBP; Grupo Experimental I (n=40) animais que tiveram apenas a ERM; sendo 25 animais sacrificados nos dias 1, 2, 3, 7, e 10 dias após a ERM para análise com RT-PCR e western blotting e 15 animais foram sacrificados nos dias 0, 7 e 10 dias para análise histológica; Grupo Experimental II (n=40) animais que tiveram ERM + LBP com diodo de Ga-Al-As (Gálio-Alumínio-Arsênio:160J/cm2) no primeiro dia do experimento; os animais foram sacrificados nos mesmos períodos que o Grupo Experimental I; Experimental III (n=15) animais que receberam 3 aplicações de LBP após ERM, totalizando 480J/cm2. Os animais foram sacrificados nos dias 3, 7 e 10 dias após a ERM para análise com RT-PCR e western blotting. A extração do RNAt da maxila foi feita com trizol. A síntese da fita de DNA complementar (cDNA) foi feita a partir de 1&#181;g de RNA, por meio de uma reação de transcrição reversa, com a utilização da enzima transcriptase reversa, e a análise da expressão gênica foi realizada pela reação em cadeia pela polimerase em tempo real (qRT-PCR) no sistema TaqMan®. A análise protéica do VEGF, RANK, RANK-L e OPG foi realizada por meio da técnica western blotting. O teste de variância (ANOVA) foi usado comparando os grupos entre si e inter-grupos seguida pelo teste complementar de Tukey, com nível de significância de 5%. RESULTADOS: A separação dos incisivos induzida pela ERM foi semelhante nos grupos experimentais I e II, o espaço entre os incisivos foi mantido durante toda a fase experimental, e não houve diferença significativa entre os grupos laser e não-laser (p<0,05), demostramdo a eficiência da metodologia usada para abertura da sutura palatina mediana. Para o grau de abertura da sutura, foi quantificada, a área de abertura sutural em todos os grupos após a ERM, e observou-se aumentou significativo comparado com o grupo controle, sendo que no grupo de laser o grau de abertura final foi significativamente menor no grupo laser do que não-laser aos 7 e 14 dias, mostrando que a formação óssea no grupo laser foi mais acelerada, o que pode ser comprovado com os dados histológicos, demonstrando que o laser acelerou o processo de formação óssea. Em relação à expressão relativa dos genes RANK/RANK-L/OPG tanto o grupo com laser quanto o sem-laser mostraram um aumento significativo da expressão comparado ao grupo controle (p < 0,05), principalmente nos períodos iniciais e quando comparou-se o grupo irradiado com o não irradiado observou-se que no grupo com laser houve uma maior expressão desses genes do que no grupo sem laser. CONCLUSÃO: Os resultados sugerem que a formação óssea após a ERM foi observada dentro da sutura palatina e o uso do LBP influenciou a formação óssea acelerando o processo de osteogênese durante a fase inicial do experimento. / BACKGROUND: The use of low-level laser terapy with bone stimulation has been studied in the health science field. OBJECTIVE: The aim of the present in vivo study was to quantitatively evaluate the effects of low-level laser therapy (LLLT) on bone healing after rapid maxillary expansion (RME) in young rats, and the RANK, RANK-L, OPG and VEGF gene expressions; and histological analyses. MATERIALS and METHODS: A total of 105 rats Wistar (Rattus norvegicus, albinus), male were assigned tofour groups: Control Group (n=10) with no treatment (no RME and no LLLT); Experimental I (n=40) with RME without LLLT: 25 animals were euthanized at days 1, 2, 3, 7 and 10 after RME for real time reverse transcriptase polymerase chain reaction (RT-PCR) and western blotting analysis and 15 animals were euthanized at days 0, 7 and 10 after RME for histological evaluation; Experimental II (n=40) with RME and LLLT (160J/cm2): animals were euthanized at the same periods described for Experimental I. Experimental III (n=15) with RME and 3 aplication of LLLT (480J/cm2): animals were euthanized at days 3, 7 and 10 after RME for real time reverse transcriptase polymerase chain reaction (RT-PCR) and western blotting analysis. Part of the sample was kept at -80&#176;C for genes expression and protein production, and another for histological analysis. The total RNA was extracted using trizol. Complementary DNA (cDNA) was synthesized using 1&#181;g of RNA in a reverse transcription reaction and for genes expression we used RT-PCR in the TaqMan® system. The RANK, RANK-L, OPG, and VEGF and proteins analysis was made using western blotting. The ANOVA and Tukey tests were used and significance level was set at 5%. RESULTS: The expansion-induced opening of the incisors was similar among the groups, the space between the incisors was kept during all the experimental phase and there was no difference between laser and no laser therapy groups (p<0,05) showing that this methodology was efficient to open the palatine suture. The the opened along the suture was quantified, the area in all RME groups significantly increased compared with control group. Following laser therapy, the palatal suture opening decreased at 7 and 14 days, showing that bone formation in laser group was accelerate, and it was proved with histological analysis, that showed that LLLT accelerated bone formation. Regarding RANK/RANK-L/OPG gene expression, both laser and no-laser therapy groups showed a significant increased in these genes expression, compared to the control group, mainly at the initial periods of healing. Laser therapy group showed a higher expression of these genes than no laser group. CONCLUSIONS: The results suggest that bone formation after RME was observed within palatal suture and the application of the LLLT influenced bone formation accelerating the process of bone mineralization during the initial experimental phase.

Background: To assess acute effects of bevacizumab (anti-VEGF therapy) on cerebral microvessels and systemic cardiovascular regulation. Design and subjects: 20 consecutive patients with colorectal cancer (median age: 60.4 years, range 45.5-73.9 years) received bevacizumab intravenously (5 mg/kg) uncoupled of chemotherapy. Prior to and within the first 24 hours after bevacizumab infusion, patients were investigated for retinal endothelial function. A series of a triple 24-hour ambulatory blood pressure measurement was conducted. Retinal endothelial function was determined as flicker light-induced vasodilation. The integrity of baroreflex arc and autonomic cardiovascular control was examined by stimulatory manoeuvres. Results: Bevacizumab therapy significantly reduced the vasodilatory capacity of retinal arterioles in response to flicker light. A slight decrease in diastolic pressure and heart rate was observed after bevacizumab infusion but this was unrelated to changes in retinal function. The pressure response upon nitroglycerin was largely preserved after bevacizumab infusion. The proportion of patients with abnormal nocturnal blood pressure regulation increased under anti-angiogenic therapy. Autonomic blood pressure control was not affected by bevacizumab treatment. Conclusions: Bevacizumab acutely impairs microvascular function independent of blood pressure changes. Imaging of the retinal microcirculation seems a valuable tool for monitoring pharmacodynamic effects of bevacizumab.

Angiogenese ist an physiologischen Vorgängen wie der Embryogenese und der Wundheilung, aber auch bei pathologischen Abläufen wie bei Neoplasien und der Makula Degeneration beteiligt. Im Bereich des Tissue Engineering ist sie ebenfalls unersetzlich und ausschlaggebend für den Erfolg einer Gewebetransplantation. In dieser Studie wurde an 40 männliche Charles Lewis-Ratten das arteriovenöse (AV-) Loop-Modell angewandt, um spontane Angiogenese unter Einfluss wachstumshemmender Faktoren in vivo zu untersuchen. Der AV-Loop wurde in einer mit Fibrin gefüllten Teflonkammer gebettet. Für die statistische Auswertung wurde der Student t-Test mit ungepaarten Stichproben angewandt und das Signifkanzniveau betrug α=0,05. Multiple Testungen wurden nach der Bonferroni-Holm-Methode angepasst. In der Anfangsphase der Studie wurde der zeitliche Verlauf der AV-Loop assoziierten Angiogenese an 16 Tieren untersucht. Es wurde ein signifikanter Anstieg der Gefäßfläche über einen Zeitraum von 5 (n=2), 10 (n=3) und 15 Tagen (n=3) beobachtet und ebenfalls eine signifikant höhere Gefäßanzahl an Tag 15 im Vergleich zu Tag 5. Acht Tiere konnten nicht in die Studie miteingeschlossen werden infolge von Thrombosierungen des Loops. Diese erwartete Verlustrate trat aufgrund Lernkurve dieses komplexen mikrochirurgischen Modells, insbesondere zu Beginn des Projektes, auf. In der zweiten Phase der Studie wurde die Neoangiogenese auf drei unterschiedliche Verfahren gehemmt. Die Implantationszeit betrug bei allen Gruppen 15 Tage. In der ersten Gruppe (n = 6) wurde ein Inhibitor des Wachstumfaktors VEGF (vascular endothelial growth factor) intravenös appliziert, nämlich der monoklonale Antikörper Bevacizumab. Hier konnte ein signifikanter Unterschied zur Kontrollgruppe (n = 6) bei der Gefäßfläche (94 432 ± 17 903 μm2 gegenüber 268 682 ± 63 575 μm2) und ebenfalls bei der Gefäßdichte (18 ± 5 Gefäße pro mm2 versus 40 ± 9 Gefäße pro mm2 in der Kontrollgruppe) gemessen werden. Dieser Befund ließ darauf schließen, dass die Neovaskularisation durch VEGF vermittelt wurde. Die direkte Bestrahlung von 2 Gy auf den venösen Graft in der zweiten Versuchsgruppe (n = 7) löste eine signifikante Verringerung von Gefäßanzahl (311 ± 73), -fläche (43 137 ± 10 225 μm2) und –dichte (15 ± 7 Gefäße pro mm2) im Vergleich zur Kontrollgruppe (776 ± 123, 268 682 ± 63 575 μm2 und 40 ± 9 Gefäße pro mm2) aus. Dieses Verfahren hatte somit starken Einfluss auf den Reifeprozess der Neoangiogenese. Bei der Kombinationsgruppe (Bevacizumab und Bestrahlung, n = 5) konnte nur bei der Gefäßfläche ein signifikant geringerer Unterschied in der Angiogenese erhoben werden. Dies ließ vermuten, dass das hier zu findende physiologische und somit geordnete Gefäßwachstum nicht auf diese hemmende Methode anspricht, wie es bei chaotischen Tumorgefäßsystemen der Fall ist und der vermutete Synergismus ausbleibt. Zusätzlich wurde im Zuge dieser Studie ein standardisiertes Auswertungsprogramm etabliert. Dabei handelt es sich um ein selbstentwickeltes Computerprogramm, das nicht nur die hier gesammelten aber auch 2-D-Aufnahmen anderer Angiogenese-Modelle benutzerunabhängig und standardisiert evaluieren kann. Zusammenfassend kann gesagt werden, dass das AV-Loop-Modell sich ausgezeichnet für die Untersuchung der Angiogenese im gesunden Gewebe eignet. Es bietet die Möglichkeit verschiedene angiogene und anti-angiogene Faktoren zu applizieren sowie deren Einfluss auf eine physiologische Neovaskularisation zu beobachten.:1 EINLEITUNG 1 1.1 ZIELSETZUNG DIESER ARBEIT 3 2 LITERATURÜBERSICHT 5 2.1. ANGIOGENESE 5 2.1.1 PHYSIOLOGIE 5 2.1.1.1 Bildung von Blutgefäßen 5 2.1.1.2 Embryogenese 8 2.1.1.3 Angiogenese und Wundheilung 9 2.1.2 TUMOR-ASSOZIIERTE ANGIOGENESE 11 2.2 TISSUE ENGINEERING 22 2.3 DAS ARTERIOVENÖSE (AV) LOOP-MODELL 22 2.4 AUSWERTUNG VON ANGIOGENESEPROZESSEN 23 3 MATERIAL UND METHODEN 24 3.1 TIERE UND HALTUNG 24 3.2 OPERATIVE EINGRIFFE 24 3.2.1 KAMMER UND MATRIX 24 3.2.2 HERSTELLUNG DES AV-LOOPS 25 3.2.3 BESTRAHLUNG 29 3.3 EXPLANTATION 29 3.3.1 PERFUSION MIT INDIA INK 29 3.3.2 PERFUSION MIT MICROFIL® 31 3.4. HISTOLOGISCHE UND IMMUNHISTOLOGISCHE METHODEN 32 3.4.1 VORBEREITUNG DER SCHNITTE 32 3.4.2 HÄMATOXYLIN-EOSIN-FÄRBUNG 33 3.4.3 LEKTINFÄRBUNG 34 3.5 DATENVERARBEITUNG 36 3.5.1 MIKROSKOPISCHE AUFZEICHNUNGEN 36 3.5.2 AUSWERTUNG DER HISTOLOGISCHEN SCHNITTE 36 3.5.3 AUFNAHMEN DER MIKRO-CT-BILDER 41 3.5.4 AUSWERTUNG DER MIKRO-CT-BILDER 42 3.5.5 POWER ANALYSE 43 3.5.6 STATISTISCHE AUSWERTUNGEN 43 3.6 VERWENDETES MATERIAL 44 4 ERGEBNISSE 47 4.1 AV-LOOP-ASSOZIIERTE ANGIOGENESE 48 4.2 ZEITLICHER VERLAUF DER AV-LOOP-ASSOZIIERTEN ANGIOGENESE 50 4.3 HISTOMORPHOMETRISCHE ANGIOGENESE-CHARAKTERISIERUNG MITTELS HE- UND LEKTINFÄRBUNG 52 4.4 AUTOMATISCHE, COMPUTERGESTÜTZTE UND UNTERSUCHERUNABHÄNGIGE ANGIOGENESE- QUANTIFIZIERUNG 53 4.5 EINFLUSS VON VEGF AUF AV-LOOP-ANGIOGENESE 58 4.6 EINFLUSS VON BESTRAHLUNG AUF DIE NEOVASKULARISATION IM AV-LOOP-MODELL 62 4.7 WECHSELWIRKUNG VON VEGF UND IONISIERENDER BESTRAHLUNG AUF DIE ANGIOGENESE IM AV-LOOP-MODELL 65 5 DISKUSSION 71 6 ZUSAMMENFASSUNG 81 7 SUMMARY 83 8 LITERATURVERZEICHNIS 85 9 ANHANG 95 9.1 PROTOKOLL ZUR HERSTELLUNG DER PUFFER 95 9.1.1 CITRATPUFFER 95 9.1.2 TRISPUFFER 95 9.2 TABELLEN 95 9.3 ABBILDUNGEN 95 10 DANKSAGUNG 98 / Angiogenesis is evident in both physiological and pathological processes in the body. It is involved in events of embryogenesis and in wound healing as well as in neoplastic growth and macula degeneration. In the field of Tissue Engineering neovascularisation plays an irreplaceable role and determines the result of the transplantation. Here, an arterio-venous loop (AV-loop) model embedded in fibrin- filled teflon chambers in 40 Charles Lewis rats was applied to conduct in vivo investigations of the physiological processes of vessel growth in healthy tissue and to understand neovascularisation under the impact of anti-angiogenic factors such as monoclonal anti-bodies and ionizing radiation (IR). For statistical analysis the unpaired t-test was applied with a significance level of α = 0,05. Multiple testing was adapted according to the Bonferroni-Holm method. At the beginning of the study the AV-loop induced angiogenesis was examined on 16 animals and consecutively characterized. A significant increase in vessel area was observed over a time frame of 5 (n=2), 10 (n=3) and 15 days (n=3). Additionally the vessel count has increased significantly at day 15 in comparison to day 5. Eight of the animals had to be excluded due to thrombosis of the loop, which was expected due to the complex microsurgical model, especially at the onset of the project. In the second phase of the study three different anti-angiogenic procedures were investigated. Time of implantation was 15 days. In group one (n = 6) the monoclonal antibody of VEGF (vascular endothelial growth factor) named Bevacizumab was applied intravenously. As a result a significant lower vessel area (94 432 ± 17 903 μm2) and density (18 ± 5 vessels per mm2) could be measured in comparison to the control group (n = 6; 268 682 ± 63 575 μm2 respectively 40 ± 9 vessels per mm2). We concluded from these results that angiogenesis was mediated by VEGF. In comparison to the controlgroup direct IR of 2 Gy led in group two (n = 7) to a significant decrease in vessel number (311 ± 73 versus 776 ± 123), area (43137±10225μm2 versus 268682±63575μm2) and density (15±7 versus 40±9 vessels per mm2). Therefore this procedure has an obvious impact on the vessel maturation. In the combined group (n = 5) of both anti-angiogenic procedures (anti- VEGF and IR) a significant decrease was only evident in the vessel area. We assumed that this physiological and accordingly organized angiogenesis does not respond to the applied inhibiting methods, as it is observed in tumor vessel growth. Additionally, an evaluation program was established with the goal of designing a user-independent and standardized computer program to measure 2-D-images of both this and other angiogenesis models. In summary the AV-loop presents a proficient model to investigate angiogenesis in healthy tissue. It offers a variety of possibilities to apply pro- and anti-angiogenic factors and to examine their impact in vivo.:1 EINLEITUNG 1 1.1 ZIELSETZUNG DIESER ARBEIT 3 2 LITERATURÜBERSICHT 5 2.1. ANGIOGENESE 5 2.1.1 PHYSIOLOGIE 5 2.1.1.1 Bildung von Blutgefäßen 5 2.1.1.2 Embryogenese 8 2.1.1.3 Angiogenese und Wundheilung 9 2.1.2 TUMOR-ASSOZIIERTE ANGIOGENESE 11 2.2 TISSUE ENGINEERING 22 2.3 DAS ARTERIOVENÖSE (AV) LOOP-MODELL 22 2.4 AUSWERTUNG VON ANGIOGENESEPROZESSEN 23 3 MATERIAL UND METHODEN 24 3.1 TIERE UND HALTUNG 24 3.2 OPERATIVE EINGRIFFE 24 3.2.1 KAMMER UND MATRIX 24 3.2.2 HERSTELLUNG DES AV-LOOPS 25 3.2.3 BESTRAHLUNG 29 3.3 EXPLANTATION 29 3.3.1 PERFUSION MIT INDIA INK 29 3.3.2 PERFUSION MIT MICROFIL® 31 3.4. HISTOLOGISCHE UND IMMUNHISTOLOGISCHE METHODEN 32 3.4.1 VORBEREITUNG DER SCHNITTE 32 3.4.2 HÄMATOXYLIN-EOSIN-FÄRBUNG 33 3.4.3 LEKTINFÄRBUNG 34 3.5 DATENVERARBEITUNG 36 3.5.1 MIKROSKOPISCHE AUFZEICHNUNGEN 36 3.5.2 AUSWERTUNG DER HISTOLOGISCHEN SCHNITTE 36 3.5.3 AUFNAHMEN DER MIKRO-CT-BILDER 41 3.5.4 AUSWERTUNG DER MIKRO-CT-BILDER 42 3.5.5 POWER ANALYSE 43 3.5.6 STATISTISCHE AUSWERTUNGEN 43 3.6 VERWENDETES MATERIAL 44 4 ERGEBNISSE 47 4.1 AV-LOOP-ASSOZIIERTE ANGIOGENESE 48 4.2 ZEITLICHER VERLAUF DER AV-LOOP-ASSOZIIERTEN ANGIOGENESE 50 4.3 HISTOMORPHOMETRISCHE ANGIOGENESE-CHARAKTERISIERUNG MITTELS HE- UND LEKTINFÄRBUNG 52 4.4 AUTOMATISCHE, COMPUTERGESTÜTZTE UND UNTERSUCHERUNABHÄNGIGE ANGIOGENESE- QUANTIFIZIERUNG 53 4.5 EINFLUSS VON VEGF AUF AV-LOOP-ANGIOGENESE 58 4.6 EINFLUSS VON BESTRAHLUNG AUF DIE NEOVASKULARISATION IM AV-LOOP-MODELL 62 4.7 WECHSELWIRKUNG VON VEGF UND IONISIERENDER BESTRAHLUNG AUF DIE ANGIOGENESE IM AV-LOOP-MODELL 65 5 DISKUSSION 71 6 ZUSAMMENFASSUNG 81 7 SUMMARY 83 8 LITERATURVERZEICHNIS 85 9 ANHANG 95 9.1 PROTOKOLL ZUR HERSTELLUNG DER PUFFER 95 9.1.1 CITRATPUFFER 95 9.1.2 TRISPUFFER 95 9.2 TABELLEN 95 9.3 ABBILDUNGEN 95 10 DANKSAGUNG 98

Ischemic retinopathies (IR) are vision-threatening diseases that affect a substantial amount of people across all age groups worldwide. The current treatment options of photocoagulation and anti-VEGF therapy have side effects and are occasionally unable to prevent disease progression. It is therefore worthwhile to consider other molecular targets for the development of novel treatment strategies that could be safer and more efficient. During the manifestation of IR, the retina, normally an immune privileged tissue, encounters enhanced levels of cellular stress and inflammation that attract mononuclear phagocytes (MPs) from the blood stream and activate resident MPs (microglia). Activated MPs have a multitude of effects within the retinal tissue and have the potential to both counter and exacerbate the harmful tissue microenvironment. The present review discusses the current knowledge about the role of inflammation and activated retinal MPs in the major IRs: retinopathy of prematurity and diabetic retinopathy. We focus particularly on MPs and their secreted factors and cell–cell-based interactions between MPs and endothelial cells. We conclude that activated MPs play a major role in the manifestation and progression of IRs and could therefore become a promising new target for novel pharmacological intervention strategies in these diseases.