The 21st century brought about a dramatic increase in knowledge about genetic and molecular profiles of cancer. This information has validated the complexity of tumor cells and increased awareness of “nodal proteins”, but has yet to advance the development of rational targeted cancer therapeutics. Nodal proteins are critical cellular proteins that collect biological inputs and distribute the information across diverse biological processes. Survivin acts as a nodal protein by interfacing the multiple signals involved in mitosis and apoptosis and functionally integrate proliferation, cell death, and cellular homeostasis. By characterizing survivin as a target of both Type 1 Insulin-like Growth Factor (IGF-1) and Notch developmental signaling, we contribute to the paradigm of survivin as a nodal protein. The two signaling systems, Notch and IGF-1, regulate survivin by two independent mechanisms. Notch activation induces survivin transcription preferentially in basal breast cancer, a breast cancer subtype with poor prognosis and lack of molecular therapies. Activated Notch binds the transcription factor RBP-Jк and drives transcription from the survivin promoter. Notch mediated survivin expression increases cell cycle kinetics promoting tumor proliferation. Inhibition of Notch in a breast xenograft model reduced tumor growth and systemic metastasis. On the other hand, IGF-1 signaling drives survivin protein translation in prostate cancer cells. Binding of IGF-1 to its receptor activates downstream kinases, mammalian target of rapamycin (mTOR) and p70 S6 protein kinase (p70S6K), which modulates survivin mRNA translation to increase the apoptotic threshold. The multiple roles of survivin in tumorigenesis implicate survivin as a rational target for the “next generation” of cancer therapeutics.

Background Obesity is an important risk factor for resistance to insulin-mediated glucose disposal, and is a precursor of type 2 diabetes and other disorders. Objectives To identify molecular pathways in adipose tissue and inflammatory cells that may result in obesity-associated insulin resistance, we exploited the fact that not all obese individuals are prone to insulin resistance. Thus the degree of obesity as a variable was removed by studying obese subjects of similar body mass index (BMI) who are insulin-sensitive (IS) versus insulin-resistant (IR). Methods Combining gene expression profiling with computational approaches, we determined the global gene expression signatures of omental and subcutaneous adipose tissue samples obtained from 10 obese-IR and 10 obese-IS patients undergoing gastric bypass surgery. In a secondary study, we isolated monocytes from 4 obese-IR, 3 obese-IS, and 4 nonobese-IS adolescent and young adult subjects for purposes of assessing differences in expression of inflammatory genes in monocytes using RT-PCR. Results Gene sets related to chemokine activity and chemokine receptor-binding were identified as most highly enriched in the omental tissue from obese-IR compared to obese-IS subjects, independent of BMI. Strikingly, insulin resistance, but not BMI, was associated with increased macrophage infiltration in the omental adipose tissue, as was adipocyte size. In the adolescent and young adult cohort, expression of two cytokine signaling molecules (IL8, SOCS3) and two downstream products of the JNK pathway (JunB, c-Fos) showed increased expression in the obese-IR subjects compared to the obese-IS and nonobese-IS subjects, suggesting the presence of a proinflammatory phenotype in monocytes in obesity, which is exacerbated in the insulin resistant state. Conclusions Our findings demonstrate that inflammation of omental adipose tissue and activation of proinflammatory monocytes is strongly associated with insulin resistance in human obesity. Manipulation of these pathways may result in the prevention of or delay in the onset of obesity-related co-morbidities.

Although once considered a simple energy storage depot, the adipose tissue is now known to be a powerful regulator of whole body insulin sensitivity and energy metabolism. This metabolically dynamic organ functions to safely store excess fatty acid as triglyceride, thereby preventing lipotoxicity in peripheral tissues and the development of insulin resistance. In addition, the adipose tissue acts as an endocrine organ and secretes factors, called adipokines, which influence whole body insulin sensitivity and glucose homeostasis. Therefore, understanding adipose tissue development and biology is essential to understanding whole body energy metabolism. A master regulator of adipose tissue development and whole body insulin sensitivity is the nuclear receptor, PPARγ. Due to the importance of this nuclear receptor in maintaining adipocyte function, disruptions in PPARγ activity result in severe metabolic abnormalities, such as insulin resistance and type 2 diabetes. Conversely, PPARγ activation by synthetic agonists ameliorates these conditions, demonstrating the potent control this nuclear receptor has on whole body metabolism. Therefore, understanding how PPARγ expression and activity are regulated, particularly in the adipose tissue, is paramount to understanding the pathogenesis of type 2 diabetes. While there are several synthetic PPARγ agonists available, identifying the endogenous ligand or ligands is still an area of intense investigation. Since fatty acids can induce PPARγ activation, in the first part of this thesis, I screened several fatty acid metabolizing enzymes present in the adipocyte to identify novel modulators of PPARγ activity. These studies revealed that the fatty acid Δ9 desaturase, Stearoyl CoA Desaturase 2 (SCD2), is absolutely required for 3T3-L1 adipogenesis and to maintain adipocyte-specific gene expression in fully differentiated cells. Although SCD2 does not appear to regulate PPARγ ligand production, it does potently regulate PPARγ activity by maintaining the synthesis of PPARγ protein. Surprisingly, this effect was found only with SCD2 and not with the highly homologous protein, SCD1. Therefore, these findings identify separate cellular functions for these SCD isoforms and reveal a novel and essential role for fatty acid desaturation in the adipocyte. Equally important to understanding PPARγ regulation is identifying the downstream mechanisms by which PPARγ activation improves insulin sensitivity. Evidence suggests that the PPARγ target gene, Cidea, is involved in mediating insulin sensitivity by binding to lipid droplets and promoting lipid storage in the adipocyte. Therefore, the second part of thesis provides mechanistic detail into Cidea function by showing that the carboxy terminal 104 amino acids is necessary and sufficient for lipid droplet targeting and the stimulation of triglyceride storage. However, these studies also identified a novel function for Cidea, which requires both the carboxy and amino termini: to induce larger and fewer droplets from smaller dispersed droplets, indicating the possible fusion of droplets. Perhaps this striking change in lipid droplet morphology allows tighter packing and more efficient storage of triglyceride and identifies a novel role for Cidea in lipid metabolism. The results presented in this thesis elucidate key aspects of lipid metabolism that maintain adipocyte function: SCD2 is required to maintain PPARγ protein expression in the mouse; Cidea is a downstream effector of PPARγ activity by promoting efficient triglyceride storage. Therefore, these findings enhance our understanding of adipocyte biology.

The advent of intravenous thrombolytic agents has revolutiontzed the management of patients with acute myocardial infarction and has dramatically altered the morbidity and mortality associated with this condition. The aims of this study in patients presenting with acute myocardial infarction and treated with thrombolytic agents are: 1. To evaluate the efficacy of thrombolytic agents used at Groote Schuur Hospital in terms of (a) patency of the infarct related artery; ( b) short and long-term mortality. 2. To assess the feasibility and safety of combining intravenous beta-adrenergic blockade with intravenous thrombolytic therapy in patients presenting with acute nyocardial infarction. 3. To assess the need for coronary angiography in all patients treated with thrombolytic agents for acute myocardial infarction. 4. To assess the effect on mortality of offering coronary angioplasty or coronary artery bypass grafting only to those patients manifesting spontaneous or inducible ischaemia post infarction.

Die extrakorporale Zirkulation unter Einsatz einer Herz-Lungen-Maschine kann postoperativ zu kontraktilen ventrikulären Funktionsstörungen führen, die Morbidität und Mortalität für betroffene Patienten erhöht. Diese kardiale Dysfunktion bezeichnet man als myokardiales Stunning, welche durch die globale Ischämie ausgelöst wird. Das Phänomen der reversiblen kontraktilen Dysfunktion weißt eine hohe klinische Relevanz auf und ist somit in den vergangenen Jahrzehnten sowohl klinisch als auch experimentell intensiv erforscht worden. Dabei kamen unterschiedlichste Spezies, Methoden und Modelle zum Einsatz. Ziel der vorliegenden Arbeit ist die Etablierung eines neuartigen akut instrumentierten Tiermodells, anhand dessen Folgen des kardiopulmonalen Bypasses und Wirkung des endogenen Opioidsystems auf myokardiales Stunning untersucht werden können. Mit Hilfe des entwickelten Versuchsmodells können die Auswirkungen applizierter Opioidrezeptorantagonisten und die Effekte der kardiopulmonalen Zirkulation auf die kontraktile myokardiale Dysfunktion valide untersucht werden. Als Versuchstiere wurden 50 männlich kastrierte Schweine der Rassenkreuzung „Deutsche Landrasse“ und „Yorkshireschwein“ eingesetzt. In Allgemeinanästhesie wurden die Tiere über eine Thorakotomie instrumentiert und anschließend elektrisch Kammerflimmern induziert. Nach Erreichen einer stabilen extrakorporalen Zirkulation unter der Herz-Lungen-Maschine wurde nach Ablauf der ischämischen Phase eine standardisierte Reaninmation und Weaning durchgeführt. Alle 50 Tiere konnten den Versuch erfolgreich durchlaufen. Die Analyse und Auswertung sämtlicher archivierter Daten und Proben der Versuchstiere wurde zu einem späteren Zeitpunkt durchgeführt.

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Beta adrenergic antagonists and antianginal drugs are used with the aim to ultimately decrease mortality and enable patients to lead an improved quality of life by avoidance of anginal episodes. Each class of medications used for this purpose has a variety of actual or potential side effects associated with their use. Side effects and drug interactions involving these medications are discussed in the following chapter. Evidence presented should be used in the context of the patient populations described and may aid clinical decision making through avoidance or identification of actual or potential side effects. This review includes literature published from January 2019 to January 2020 written in English.