<p>Cancer occurs when cells acquire a number of mutations that trigger uncontrolled cell growth. The normal cellular response to this dysregulation of growth is the activation of programmed cell death. While focus in cancer research has been mainly concentrated in the mechanism of programmed cell death at the mitochondria, endoplasmic reticulum is slowly emerging as an essential platform for this regulatory mechanism.</p> <p>Bcl-2 is the founding member of the Bcl-2 family of protein, which contributes to the regulation of cell death at the mitochondria and at the endoplasmic reticulum. Previously in our lab, we have shown using MCF-7 cells stably expressing Bcl-2 targeted to the endoplasmic reticulum; they were protected from estrogen deprivation induced cell death. Thus the regulatory mechanism of Bcl-2 at the endoplasmic reticulum represents an interesting avenue to improve current cancer therapeutics.</p> <p>Two approaches were utilized to identify and characterize Bcl-2 and its interacting partners at the endoplasmic reticulum. Using an affinity tag fused to Bcl-2 that has been engineered to target the endoplasmic reticulum, tandem affinity purification was utilized to identify novel Bcl-2 interacting partners when estrogen receptor positive cells are treated with estrogen deprivation. Using fluorescent protein fused to the proteins of interest, Fluorescent Lifetime Imaging Measurement (FLIM) was used to characterize the interactions of Bcl-2 and its known interacting partner at the endoplasmic reticulum. The findings of this thesis verify the applications of the two aforementioned methods in the study of Bcl-2 interacting proteins at the endoplasmic reticulum.</p> / Master of Science (MSc)

<p>Bcl-2 family of proteins regulate apoptosis at the level of the mitochondrial outer membrane (MOM) through both protein-protein and protein-membrane interactions. While the role of the membrane as the “locus of action” has been recognized, the detailed molecular mechanisms and the consequences of the interactions of Bcl-2 family members with the membrane are yet to be fully understood. The findings presented here focus on the dynamic interactions of Bcl-2 proteins, most notably tBid with the MOM, and their functional significance on mitochondrial outer membrane permeabilization. We show that the activation of tBid is a multi-step process that is regulated by MOM lipids and proteins. The rate-limiting step in the activation of tBid is an elaborate conformational change that is facilitated by Mtch2, and is required for the activation and recruitment of Bax to the MOM. Furthermore, we demonstrate that binding of both tBid and Bax to the membrane is reversible and is governed by dynamic equilibria that potentially contribute to the propagation of the permeabilization signal within the cell for the regulation of apoptosis. We report that the transfer of tBid between membranes is accelerated by Bax and restricted by Bcl-XL, whereas the transfer of Bax between membranes is slower than and not influenced by tBid. Finally, by studying the effect of varying lipid composition on Bax-mediated permeabilization, we establish that electrostatic interactions mediate the binding of both tBid and Bim to the membrane. We demonstrate that while Bim does not exhibit any preference for a specific anionic lipid, tBid requires cardiolipin in order to undergo its conformational change at the membrane in the absence of Mtch2. Taken together, our work contributes to the growing understanding of the dynamic interactions and changes in conformation of Bcl-2 proteins at the MOM.</p> / Doctor of Science (PhD)

<p>Bid is a member of the Bcl-2 family of proteins, which are known as the regula- tors of apoptosis. Bid recruits Bax, another Bcl-2 family protein, which forms large oligomers that permeabilize the mitochonrdial outer membrane during apoptosis. In this thesis, Bid complexes embedded in a mitochondria-like supported lipid bilayer were investigated using single molecule fluorescence techniques. The bilayer, con- taining a lipophilic tracer, was formed on a mica surface and ATTO647 labelled Bid was added to it. For experiments where the effect of Bax on Bid complexes was investigated, a wild type Bax or a HiLyte488 labelled Bax was added as well. The protein-bilayer sample was imaged using total internal reflection fluorescence (TIRF). The formation of a fluid bilayer was confirmed by the observation of the lateral diffusion of DiD. Single particle tracking of the lipid molecules was used to measure the diffusion coefficent of DiD which was determined to be 2.2μm2 /s. The TIRF images also revealed two populations of Bid complexes, immobile and mobile. The diffusion coefficient of the observed Bid complexes was determined to be about three times slower than that of DiD (0.8±0.5μm2 /s). This provides evidence that mobile Bid is embedded in the bilayer. Image analysis of immobile Bid complexes showed a step-wise decrease in the fluorescence intensity due to photobleaching. The oligomeric distribution of the immobile Bid complexes was determined from the num- ber of steps, which corresponds to the number of particles in each complex. From these distributions it was concluded that the imaged immobile Bid existed mainly as monomers. However dimer and trimer complexes of Bid were also observed. The detected oligomeric distribution was not affected by the presence of either wild type Bax or Hilyte488 Bax. However Bid was imaged for the first time participating in Bax complexes. The acquired results somewhat differ from what had been observed in confocal imaging of the same samples, where mostly larger Bid complexes (dimers and up) were detected. We attribute the difference to the superior sensitivity of the TIRF method presented here.</p> / Master of Science (MSc)

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Tableau d’honneur de la Faculté des études supérieures et postdoctorales, 2004-2005 / La mort cellulaire programmée (PCD) est un processus physiologique ou pathologique permettant l’élimination sélective de cellules devenues inutiles, endommagées ou infectées pour le maintien de l’intégrité ou l’adaptation (fitness) de l’organisme ou de la population cellulaire. Chez les végétaux, les mécanismes moléculaires régulant la PCD ne sont pas encore élucidés, mais la découverte que la protéine humaine anti-PCD Bax Inhibitor-1 (BI-1) est conservée chez les plantes, pourtant dépourvues de la protéine pro-PCD Bax, en a fait un candidat fort prometteur pour l’élucidation de sentiers de mort évolutivement conservés. En ce sens, cette thèse décrit la caractérisation d’orthologues de BI-1 isolés de Brassica napus (BnBI-1) et de Nicotiana tabacum (NtBI-1). Nous avons déterminé par des analyses informatiques et des études d’expression que BI-1 est une protéine membranaire intégrale possédant sept domaines transmembranaires putatifs et localisée au réticulum endoplasmique. Des essais fonctionnels dans des cellules humaines HEK 293 ont révélé que des orthologues végétaux de BI-1 peuvent inhiber la PCD (apoptose) induite par Bax dans ces cellules. Par ailleurs, des lignées cellulaires de tabac présentant des niveaux inférieurs de la protéine NtBI-1 grâce à l’expression d’un ARNm antisens entament un programme précoce de PCD suite à une déficience en carbone, démontrant ainsi le rôle anti-PCD intrinsèque de BI-1 dans des cellules végétales. Nous avons également découvert que la protéine NtBI-1 est surexprimée en présence de cytokinines (CK) dans des cultures cellulaires de tabac, et ce à des concentrations coïncidant avec l’établissement d’une réponse de stress, un phénomène impliquant des mécanismes de régulation post-transcriptionnels. La réponse cellulaire envers les CK comprend également un influx rapide de Ca2+ de l’apoplaste vers le cytosol. Cet influx est partiellement impliqué dans l’induction de la PCD mais non dans la signalisation menant à la surexpression de BI-1. L’ensemble de nos résultats indique que BI-1 est bel et bien un régulateur négatif de la PCD végétale, qui agirait au sein d’un sentier de mort évolutivement conservé. L’augmentation de l’accumulation de la protéine NtBI-1 lors de la réponse de stress envers les CK pourrait contribuer à la survie des cellules et laisse supposer que la protéine est impliquée dans l’activité anti-sénescence des CK. BI-1 s’insère dans un sentier où son niveau d’expression influence la capacité cellulaire à résister aux stress générés entre autres par une disette en carbone, et ce potentiellement via la modulation de l’homéostasie du Ca2+ intracellulaire. / Programmed cell death (PCD) is a physiological or pathological process allowing the selective elimination of useless, damaged or infected cells with the aim of maintaining the integrity or fitness of the remaining organism or cell population. In plants, molecular mechanisms regulating PCD are not yet elucidated, but the identification of functional plant orthologs of the human anti-PCD protein Bax Inhibitor-1 (BI-1), given that the pro-PCD protein Bax is absent in the plant kingdom, revealed the potential of BI-1 as an evolutionary conserved cell death regulator. Accordingly, this thesis describes the characterization of BI-1 orthologs isolated from Brassica napus (BnBI-1) and Nicotiana tabacum (NtBI-1). While combining bioinformatics analysis and localization studies using a fusion between BnBI-1 and the green fluorescent protein, we determined that BI-1 is an integral membrane protein provided with seven putative transmembrane domains localized at the endoplasmic reticulum. We also proceeded to functional assays in human HEK 293 cells, and we demonstrated that plant BI-1 orthologs can inhibit Bax-induced PCD (apoptosis) in these mammalian cells. On the other hand, we demonstrated that tobacco cell lines expressing lower levels of the NtBI-1 protein via an antisens mRNA induced an early PCD program under carbon starvation. We also discovered the up-regulation of NtBI-1 when cultured cells were grown in the presence of cytokinins (CKs), which correlated with the establishment of a stress response. The phenomenon involved post-transcriptional regulatory mechanisms of the BI-1 protein accumulation. Cellular response to CKs also involved a rapid influx of Ca2+ from the apoplast to the cytosol and this influx is partly involved in PCD induction but not in signaling leading to BI-1 modulation. Taken together, our data indicate that BI-1 is a negative regulator of plant PCD that would act in an evolutionary conserved death pathway. NtBI-1 protein over-accumulation in the stress response to CKs could contribute to cell survival and suggests the involvement of the protein in the senescence-delay activities of CKs. BI-1 is part of a pathway where its expression level influence cellular ability to resist to carbon starvation- or senescence-induced stresses, potentially via modulation of intracellular Ca2+ homeostasis.

Apoptosis represents one of the cell death mechanisms which is realized after the application of taxanes in breast cancer cell lines. Apoptosis induction can be principally triggered either by outer or inner pathway. The aim of the diploma thesis is to contribute to the elucidation of role and mechanisms of the inner mitochondrial pathway of apoptosis induction after taxane application (paclitaxel and SB-T-1216) employing a model of breast carcinoma cell lines SK- BR-3 (nonfunctional p53, functional capase-3) and MCF-7 (functional p53, nonfunctional caspase-3). Specifically, we tested the effect of both employed taxanes on mitochondrial membrane potential, ROS level and the expression and localization of proteins regulating inner mitochondrial pathway. Taxane application resulted in mitochondrial membrane dissipation in SK-BR-3 cell line. However, this was not shown in MCF-7 cell line. We found no changes in Bax and Smac/DIABLO expression after taxane application in both tested cell lines. There was a decrease of Bid expression after taxane application in SK-BR-3 line, but not in MCF-7 line. Taxane application did not lead to the translocation of Bax and Bid (tBid) proteins from cytosol to mitochondria in both tested cell lines. Similarly, there was no Smac/DIABLO release from mitochondria to...

Le cancer de la vessie représente un vrai problème de santé publique, avec une surveillance et suivi clinique à long terme en raison de l’importance des fréquences de récidives. La chimiothérapie reste souvent inefficace. L’objectif de cette thèse est donc la recherche de marqueurs sérologiques et moléculaires à valeur pronostique dans le cancer de la vessie qui peuvent servir à prédire la maladie. D’abord, nous avons étudié trois facteurs de transcriptions des lymphocytes T activées qui sont T-bet, GATA-3 et Bcl-6. Nous avons montré une surexpression de T-bet chez les malades à stade invasif et de haut grade, cependant, la surexpression de GATA-3 et Bcl-6 a été corrélée au stade superficiel et de bas grade. La survie a été corrélée avec le groupe des malades sans histoires de récidive ou progression et avec la surexpression de Bcl-6 et GATA-3. Cependant les malades qui expriment fortement T-bet répondent mieux au BCG. Ensuite, nous avons visé la détection de FasL et TRAIL solubles dans le sérum des malades atteints du cancer vésicale. Nous avons montré une surexpression de sFasL et sTRAIL chez les malades à stade superficiel et de bas grade. Le rôle anti-tumoral de ces cytokines a été confirmé sur deux lignées du cancer de la vessie montrant que le traitement avec le sérum riche en sFasL ou en sTRAIL diminue la viabilité cellulaire in vitro. A la fin de cette thèse, nous avons testé l’activation p-Akt dans la tumeur vésicale. Nous avons montré une surexpression de p-Akt au sein des tumeurs comparées au tissu sain adjacent, et au sein des malades à stade invasif et de haut grade. Akt semble être un marqueur de progression tumorale dans le cancer de la vessie. / Bladder cancer is the first most common urogenital cancer in men in Tunisia, with a high recurrence rate. Patients with muscle-invasive disease develop metastasis. The need for expensive continuous surveillance. In this thesis we try to search some candidate biomarkers. Their use for cancer staging and personalization of therapy at the time of diagnosis in order to identify a better treatment could improve patient care. The aim of this first part of our study was to investigate the clinical significance of three immune cell-related transcription factors, T-bet, GATA-3 and Bcl-6 in Tunisian patients with bladder cancer. We found that T-bet level was significantly higher in invasive carcinoma with high- grade. However, T-bet is predictive of response to BCG. On the contrary, the expression of GATA-3 and Bcl-6 was significantly higher in non-invasive carcinoma with low grade. We furthermore studied the effect of activation of soluble FasL and TRAIL molecule in bladder cancer. We demonstrate that the mean serum level of sFasL was higher in patients than in normal donors. sFasL was only higher than in sera of healthy donors where patients had superficial stage and low- and medium-grade cancer. sTRAIL was significantly lower in sera from patients with invasive and high-grade bladder carcinoma than in controls. Finally, we demonstrate that p-Akt levels in patients with invasive carcinoma and high-grade bladder cancer were significantly elevated compared to patients with non-invasive and low grade bladder cancer. Altogether, our results suggest that Akt activation can provide useful prognostic information.

O transplante autólogo de tecido ovariano constitui alternativa relevante na preservação da fertilidade e da função hormonal ovariana em mulheres sujeitas à falência ovariana prematura e infertilidade, por causas malignas, tratamentos adjuvantes ou cirurgias. É a única opção para crianças, fase pré-puberal e para mulheres que não podem retardar a quimioterapia ou não podem ser submetidas à estimulação do ciclo. O transplante ovariano autólogo pode ser, quanto ao local de reimplantação, ortotópico ou heterotópico e, quanto à conservação, a fresco ou após o período de criopreservação. As várias etapas envolvidas neste transplante são estudadas mundialmente na atualidade, como a retirada e preservação do tecido ovariano, as técnicas de criopreservação, o local apropriado para o reimplante e as possibilidades de redução da perda folicular. A avaliação da apoptose - morte celular programada - é útil na avaliação da rejeição e viabilidade dos enxertos de transplantes estabelecidos na prática clínica, tanto autólogos como heterólogos. Com o intuito de utilizar animais de maior porte, conseguir seguimento de médio prazo e realizar os procedimentos cirúrgicos por via laparoscópica, padrão ouro em humanos, o presente estudo utilizou como modelo experimental fêmeas suínas, em idade reprodutiva, da raça Minipig. Este projeto teve como propósito avaliar a influência da criopreservação e do local de implante na qualidade e na viabilidade do transplante autólogo de ovário, a fresco e após criopreservação, no tecido celular subcutâneo e na região intraperitoneal peri-infundibular. Foram avaliados a quantidade e a densidade folicular dos implantes e os aspectos morfológicos e histomorfométricos, bem como a apoptose, por meio da imunoexpressão de proteínas proapoptóticas- Bax e antiapoptóticas-Bcl-2, além da Caspase 3-clivada, fase final das vias extrínseca e intrínseca dos mecanismos de apoptose.Quarenta animais foram divididos em cinco grupos: Controle com ooforectomia (Grupo I), ooforectomia e transplante a fresco subcutâneo (Grupo II), a ooforectomia e transplante fresco intraperitoneal (Grupo III), ooforectomia e transplante criopreservado subcutâneo (Grupo IV) e ooforectomia e transplante criopreservado intraperitoneal (GrupoV). Os resultados mostraram que independente da técnica empregada, havia folículos em desenvolvimento e corpos lúteos em todos os tecidos ovarianos transplantados; que a contagem de folículos antrais não degenerados foi menor nos grupos após criopreservação em relação ao grupo controle e que a imunoexpressão sugestiva de apoptose ocorreu em todos os grupos transplantados, sendo maior nos transplantes intraperitoneais. Concluiu-se que a técnica utilizada para o transplante de ovário e criopreservação foi viável no modelo suíno, em tecido celular subcutâneo e na região intraperitoneal peri-infundibular. O transplante autólogo heterotópico subcutâneo apresentou melhores taxas de apoptose que o transplante ortotópico. / Autotransplantation of ovarian tissue is an important alternative to preserve fertility and hormonal ovarian function in women undergoing ovarian failure and premature infertilidade, because of cancer or surgery. It is the only option for infants, pre-pubertal patients and for women who can not delay chemotherapy or not may be subjected to stimulation of the cycle. The various steps involved in the transplant are studied worldwide today, as the removal and preservation of ovarian tissue, the techniques of cryopreservation, the appropriate site and mechanisms to reduce follicular loss. Assessment of apoptosis - programmed cell death-is useful in the study of the viability of the grafts and rejection of transplants established in clinical practice, both autologous and heterologous. In order to use larger animals, getting following medium term (over 21 days) and to perform surgical procedures by laparoscopy (gold standard in humans), this study used an experimental model sows, reproductive age, Minipig race. This project aims to evaluate the influence of cryopreservation and implantation site of the quality and viability of ovarian autografts, fresh and after cryopreservation, at subcutaneous site and at intraperitoneal site. We analyzed the quantity and density of follicular implants and the morphological and histomorphometric as well as apoptosis, by proteins immunoexpression antiapoptotic and proapoptotic. Forty animals were divided into five groups: Control with oophorectomy (Group I), oophorectomy and fresh transplantation to subcutaneous site (Group II), oophorectomy and fresh transplantation to intraperitoneal site (Group III), oophorectomy and transplantation of cryopreserved ovarian tissue to subcutaneous site (Group IV) and oophorectomy and transplantation of cryopreserved ovarian tissue to intraperitoneal site (Group V). We concluded that the autologous ovarian transplantation was feasible in the technical proposals, in subcutaneous and intraperitoneal site in the porcine model; that regardless of the technique, there was developing follicles and corpora lutea in all ovarian tissue transplanted; that antral non-degenerate follicle count was lower in groups after cryopreservation that in the control group and that the immunoexpression of apotposis occurred in all transplanted groups, more evident in intraperitoneal transplants

INTRODUÇÃO: O carcinoma de pulmão de pequenas células (CPPC) e o carcinoma neuroendócrino (CNE) extra-pulmonar apresentam características histopatológicas e tratamentos similares, porém os desfechos encontrados nos dois grupos podem ser diferentes. Avaliamos a expressão de alguns biomarcadores e a associação destes com taxa de resposta (TR) à quimioterapia baseada em platina e sobrevida global (SG) nos dois grupos. METODOS: Realizamos estudo retrospectivo de pacientes com CPPC e CNE extra-pulmonares tratados com quimioterapia baseada em platina. Todas as amostras tumorais foram revisadas pelo mesmo patologista (R.S.S.M.) e analisadas quanto a expressão imunoistoquímica de Ki-67, ERCC1, Bcl-2 e Lin28a, a qual foi determinada através do H-escore (calculado multiplicando o produto da intensidade da coloração - 0 a 3 - com a porcentagem de células positivas - 0 a 100 -, podendo variar de 0 a 300 - positivo quando >= 200). Os biomarcadores foram analisados tanto como variáveis contínuas quanto categóricas e a TR foi determinada por RECIST 1.1. A associação entre a expressão de cada biomarcador e a TR foi avaliada através do teste de qui-quadrado ou teste exato de Fisher para variáveis categóricas e regressão logística simples para variáveis contínuas. Sobrevida global foi estimada por Kaplan-Meier e as curvas foram comparadas por log-rank. O modelo de regressão de cox foi utilizado para avaliar associação entre SG e a expressão de biomarcadores como variável contínua. RESULTADOS: Entre Julho de 2006 e Julho de 2014, 142 pacientes foram identificados: N=82 (57,7%) com CPPC e N=60 (42,3%) com CNE extra-pulmonar. As características clínicas eram semelhantes em ambos os grupos. Mediana de ki67 foi de 60% (7-100) no CPPC e de 50% (20-95%) no segundo grupo (p=0,858). Com uma mediana de 5 ciclos por paciente (N=123 elegíveis para análise de TR), a TR foi de 86,8% no CPPC, enquanto nos com CNE extra-pulmonar, foi de 44,6% (p < 0.001). A mediana de SG (N=132 elegíveis para análise da SG) foi similar entre os grupos (10,3 meses em CPPC e 11,1 meses em CNE extra-pulmonar; p=0,069). Não houve diferença no padrão de expressão do ERCC1 (p=0,277) e do Lin28a (p=0,051) entre os grupos. Bcl2 foi expresso em 38 pacientes (46,3%) com CPPC e em 17 pacientes (28,3%) com CNE extra-pulmonar (p=0,030). Apenas no grupo com CNE extra-pulmonar, a alta expressão do Bcl2 foi associada com pior prognóstico (8,0 meses vs 14,7 meses; p=0,025). A expressão dos demais marcadores em CNE extra-pulmonar e dos quatro em CPPC não apresentou influência sobre a SG, não havendo também associação entre estes e a taxa de resposta à quimioterapia. Dentre os pacientes com CNE extra-pulmonar, não houve diferença na SG ou na TR entre os pacientes com carcinoma bem diferenciado (N=13;) e com carcinoma pouco diferenciado (N=47). CONCLUSÃO: Apesar do CPPC e do CNE extra-pulmonar serem tratados de forma semelhante, nesta coorte a taxa de resposta entre os grupos foi significativamente diferente. Quando comparado com CPPC, os pacientes com CNE extra-pulmonar apresentam uma menor responsividade à quimioterapia baseada em platina, mas com tendência a maior SG. Dentre os CNE extra-pulmonares, a alta expressão de Bcl-2 foi associada a pior prognóstico. Os demais biomarcadores não apresentaram papel preditor de resposta ou prognóstico / INTRODUCTION: Small cell lung cancer (SCLC) and high-grade extrapulmonary neuroendocrine carcinomas (EPNEC) share similar histopathological features and treatment, but outcomes may differ. We evaluated the expression of biomarkers and their association with response rate (RR) to platin-based chemotherapy and overall survival (OS) in these entities. METHODS: We conducted a retrospective analysis of patients with advanced EPNEC and SCLC treated with platinum-based chemotherapy. A single pathologist (R.S.S.M.) revised all samples. Paraffin-embedded tumor samples were tested for Ki-67, ERCC1, Bcl-2 and Lin28a expression by immunohistochemistry (IHC). Final IHC score (H-score) was calculated multiplying the intensity of staining by grading (0-300, with >= 200 considered positive). Biomarkers were analyzed as both categorical and continuous variables. RR was determined by RECIST 1.1. Associations between each biomarkers expression and RR were assessed using Chi-square or Fisher\'s exact test for categorical variables and univariate logistic regression for continuous variables. OS was estimated by the Kaplan-Meier method and curves were compared by log-rank. Cox regression analysis was used to evaluate any association between biomarkers expression (continuous variables) and OS. RESULTS: From July 2006 to July 2014, 142 patients were identified: N=82 (57,7%) with SCLC and N=60 (42,3%) with EPNEC. Baseline clinical characteristics were similar. Median Ki67 was 60% (7-100) among SCLC patients and 50% (20-95%) in EPNEC (p=0,858). With a median of 5 cycles per patient in both groups (N=123 evaluable patients), the RR was significantly higher in the SCLC group (86,8% vs 44.6%; p < 0.001). Median OS (N=132 evaluable patients) was similar between the groups (10.3 months in SCLC and 11.1 months in EPNEC; p=0,069). In the EPNEC group, there wasn\'t any difference in OS or RR between the patients with welldifferentiated (N=13) and poorly differentiated carcinoma (N=47). ERCC1 (p=0.277) and Lin28a (p=0.051) were similarly expressed between the groups. Bcl2 was expressed in 38 SCLC patients (46.3%) and in 17 EPNEC patients (28.3%; p=0.030). Only in the EPNEC group, Bcl2 high expression was associated with worse survival (8.0 months vs 14.7 months; p = 0.025). RR to chemotherapy was not influenced by the expression of the ERCC1, Lin28a, Bcl-2, Ki-67 in either EPNEC or SCLC groups. CONCLUSION: Even though SCLC and EPNEC are treated similarly, in this cohort, the rate response differed significantly. When compared with SCLC, patients with EPNEC apparently had tumors less responsive to platin-based chemotherapy, but tended to live longer. In EPNEC treated with platin, high expression of Bcl2 was associated with poor prognosis. We could not identify additional predictive or prognostic biomarkers

INTRODUÇÃO: As alterações da mucosa do estômago excluso após Derivação Gástrica em Y-de-Roux (DGYR) para tratamento da obesidade mórbida não são bem conhecidas. Atualmente, pouco se sabe a respeito das consequências da cirurgia, especialmente, considerando que tal técnica necessita de vigilância para possíveis alterações de mucosa. Adicionalmente, é possível que o refluxo duodenal biliopancreático para dentro do estômago excluso, sem tamponamento pela ingestão de alimentos, pode, após décadas, danificar a mucosa gástrica e provavelmente aumentar o risco de câncer gástrico. OBJETIVO: Analisar as alterações da mucosa do estômago excluso através de: índice de proliferação celular (Ki-67), apoptose (caspase 3 e Bcl-2), função hormonal (gastrina) e infiltrado inflamatório (CD3 e CD8). MÉTODOS: Enteroscopia de duplo balão foi realizada em 35 pacientes submetidos à DGYR com mais de 36 meses de cirurgia. Foram realizadas múltiplas biópsias no coto gástrico funcional e na mucosa do estômago excluso. Biópsias gástricas de 32 pacientes obesos não operados foram utilizadas como grupo controle. Biópsias endoscópicas foram seccionadas a partir de blocos de tecidos fixados em formalina e embebidos em parafina. Amostras de 4 m de espessura foram examinadas por imuno-histoquímica pelo método de estreptavidina-biotinaperoxidase. RESULTADOS: Os dois grupos foram comparados por idade, gênero, presença de gastrite, metaplasia intestinal e de Helicobacter pylori. O número médio de células de gastrina positivas foi de 55,5 (desvio padrão (DP) = 11,7) no grupo controle e 29,6 (DP = 7,9), nos casos, p= 0,0003. Índice de proliferação (Ki-67) nos casos (corpo=24,7%, antro=24,9%) foi significativamente maior em comparação com os controles (corpo=15% e antro=17,7%), p = 0,002 e 0,01 ,respectivamente. Imunoexpressão de caspase 3 foi maior nos controles em comparação ao estômago excluso (31 x 46%), p = 0,02. Não houve diferença estatística entre as expressões de CD3 , CD8 , e Bcl- 2 nos controles e nos casos. Não houve associação entre os resultados imuno-histoquímicos e a presença de Helicobacter pylori ou alterações histológicas. CONCLUSÕES: Proliferação celular está aumentada e a apoptose está diminuída na mucosa do estômago excluso em comparação com os controles obesos não operados. Alterações na renovação celular e nas secreções hormonais nestas condições podem ser relevantes em seguimento a longo prazo / INTRODUCTION: Mucosal alterations in the excluded stomach mucosal after Roux-en-Y gastric bypass for morbid obesity have not been clearly clarified. Currently, little is known regarding the long-term consequences of the surgical specially considering that the technique hinders surveillance for possible mucosal alterations. Indeed, it is possible that duodenal reflux of bile and pancreatic secretions without any buffering offered by food intake may, after decades, damage the gastric epithelium and lead to an increase gastric cancer risk. OBJECTIVE: This study aims to analyze the mucosal alterations (proliferative status (Ki-67), apoptosis (caspase 3 and Bcl-2), inflammatory response (CD3 and CD8) and for hormonal function (gastrin)) in the excluded stomach. METHODS: Double-balloon enteroscopy was performed in 35 patients who underwent Roux-en-Y gastric bypass longer than 36 months. Multiple biopsies of the proximal pouch and the excluded gastric mucosa were collected. Gastric biopsies from 32 non-operated obese patients were utilized as controls. Endoscopic biopsies were cut from tissue blocks fixed in formalin and embedded in paraffin. Sections 4 m thick were examined for immunoexpression using the streptavidin-biotin-peroxidase method. RESULTS: The two groups were compared for age, gender, gastritis, intestinal metaplasia, and presence of Helicobacter pylori. The mean number of positive gastrin cells was 55.5 (standart deviation (SD) = 11.7) in the control group and 29.6 (SD=7.9) in the cases, p=0.0003. Ki-67 proliferative index in cases (body=24.7%, antrum=24.9%) was significantly higher compared to controls (body=15.0% and antrum=17.7%), p=0.002 and 0.01, respectively. Caspase 3 immunoexpression was higher in the controls compared to the excluded stomach (46 vs. 31%), p=0.02. There was no statistical difference between CD3, CD8, and Bcl-2 immunoexpressions among the controls and cases. CONCLUSIONS: Cell proliferation is increased and apoptosis is downregulated in the excluded gastric mucosa compared to the non-operated obese controls. Alterations in cell turnover and in hormonal secretions in these conditions may be of important in long-term follow-up