La présence de la glycoprotéine P (P-gp) dans la barrière hémato-encéphalique (BHE) conduit à l’échec de nombreuses thérapies ciblant le système nerveux central (SNC). Cependant la P-gp protège aussi le cerveau contre des composés nocifs, essentiellement lipophiles, endogènes et exogènes susceptibles de passer la BHE par diffusion simple. Par conséquent, toute inhibition de la P-gp qui vise à améliorer la distribution des agents pharmacologiques dans le cerveau doit prendre en compte la neurotoxicité potentielle de cette inhibition. Les premiers travaux ont montré que l’elacridar et le tariquidar, deux modulateurs de la P-gp de troisième génération, augmentaient la distribution dans le cerveau de plusieurs de ses substrats. Malheureusement, d’autres études plus récentes, suggèrent l’utilisation de doses élevées de l’elacridar et du tariquidar pour moduler efficacement l’activité de la P-gp dans la BHE. Néanmoins, ces doses élevées en co-administration avec des substrats de la P-gp peuvent être associées à des interactions pharmacocinétiques et à des profils toxiques, limitant ainsi l'utilisation de ces inhibiteurs.Dans ce contexte, l’objectif principal de cette thèse est d’obtenir une modulation transitoire mais efficace de la P-gp dans la BHE par administration intraveineuse de doses faibles mais thérapeutiques de l’elacridar et du tariquidar sous leur forme libre ou co-encapsulé dans les liposomes. Le lopéramide, substrat de la P-gp, a été également administré sous sa forme libre comme une preuve in vivo d’une inhibition efficace de la P-gp dans la BHE.L'administration simultanée de ces deux modulateurs de la P-gp n’a pas modifié leurs concentrations plasmatiques ou celles du lopéramide, mais a entraîné une importante distribution du lopéramide dans le cerveau en raison de leur activité inhibitrice non- compétitive. De plus, la co-encapsulation de l’elacridar et du tariquidar dans des immunoliposomes stabilisées stériquement a amélioré la demi-vie et la distribution dans le cerveau des ceux deux composés. Par conséquent, la distribution dans le cerveau du lopéramide a été considérablement augmentée, sans aucune modification de sa pharmacocinétique ou distribution tissulaire. Par ailleurs, la diminution partielle de l'activité inhibitrice du tariquidar par des liposomes vides suggère l’utilisation de ce nanovecteur comme une approche de bio-détoxification pour le traitement des surdoses de tariquidar. En résumé, cette thèse propose différentes approches pour exploiter pleinement l’elacridar et le tariquidar. Les résultats décrits dans ce manuscrit devraient ouvrir des pistes intéressantes pour atteindre une inhibition efficace de la P-gp dans la BHE et pour réussir des thérapies ciblant le système nerveux central / Although the P-glycoprotein (P-gp) represents an obstacle in several central nervous system (CNS) pharmacotherapies, the P-gp also protects the brain from intoxication by endogenous and exogenous harmful lipophilic compounds that otherwise could penetrate the blood-brain barrier (BBB) by simple diffusion. Therefore, any modulation of the efflux transporter has to consider the potential neurotoxicity of such modulation. Early studies showed that elacridar and tariquidar, two third-generation P-gp modulators, increase the distribution of several P-gp substrates in the brain. Unfortunately, recent studies suggest the use of high doses of elacridar and tariquidar to efficiently modulate the P-gp at the BBB. Nevertheless, when co-administered with P-gp substrates, these high doses may be associated with pharmacokinetic interactions and toxic profiles, thus limiting the use of these compounds.Hence, this thesis aimed to attain a transient but efficient modulation of the P-gp at the BBB using elacridar and tariquidar but avoiding the use of large doses of these compounds. For this purpose we took advantage of the possible in vivo intravenous co-administration of low but therapeutic doses of elacridar and tariquidar, under their free form or co-encapsulated in liposomes. The brain distribution of free loperamide was determined as an in vivo probe of full inhibition of the P-gp activity at the BBB.The concurrent administration of both free P-gp modulators does not modify their plasma concentrations or those of the P-gp substrate but significantly increased the brain uptake of loperamide as a result of their non-competitive modulatory activity. Moreover, the co-encapsulation of elacridar and tariquidar in targeted sterically stabilized immunoliposomes improved the half-lives and brain distribution of both compounds. Consequently, the brain uptake of free loperamide was significantly enhanced without any modification of its pharmacokinetics or tissue distribution. Moreover, the partial impairment of the modulatory activity of tariquidar by empty liposomes, supports the use of this nanocarrier as a bio-detoxifying approach for the treatment of tariquidar overdoses.In summary, this thesis proposes different approaches for full exploitation of elacridar and tariquidar. The findings described in this manuscript should open interesting avenues to achieve an efficient overcoming of the P-gp at the BBB and succeed CNS pharmacotherapies.

The blood-brain barrier, formed by brain microvessel endothelial cells, is the restrictive barrier between the brain parenchyma and the circulating blood. It was previously demonstrated in our laboratory that knock down of fatty acid transport proteins FATP-1 and CD36 attenuated apical to basolateral monounsaturated fatty acid transport across human brain microvessel endothelial cells (HBMEC). Arachidonic acid (AA; 5,8,11,14 - cis-eicosatetraenoic acid) is a conditionally essential, polyunsaturated fatty acid [20:4(n-6)] and a major constituent of brain lipids. We examined transport of AA across confluent monolayers of HBMEC. Control cells or HBMEC with knock down of FATP-1 or CD36 were cultured on Transwell® plates and incubated apically with [3H]AA and incorporation of [3H]AA into the basolateral medium was determined temporally. [3H]AA was rapidly incorporated into the basolateral medium with time in control cells. Surprisingly, knock down of FATP-1 or CD36 did not alter [3H]AA movement into the basolateral medium. The increased permeability mediated by AA was likely caused by a metabolite of AA produced de novo and was confirmed by an increased movement of fluorescent dextran from apical to basolateral medium. HBMECs expressed PGE2 synthase, cyclooxygenase-1 and -2, PGE2 receptors, tight junction proteins and prostaglandin transporters. The AA-mediated increase in membrane permeability was not attenuated by cyclooxygenase inhibitor drugs (NSAIDs). Incubation of the HBMEC monolayers with exogenous PGE2 resulted in attenuation of the AA-mediated permeability increases. The results indicate that AA increases the permeability of the HBMEC monolayer likely via increased production of metabolites or by-products of the lipoxygenase or epoxygenase pathways. These observations may explain the rapid influx of AA into the brain previously observed upon plasma infusion with AA.

Parkinson's disease (PD) is one of the most common motor neurodegenerative diseases, affecting 1-2% of the world's population over the age of 65. It is characterised by a loss of dopamine neurons within the substantia nigra, which is an integral part of the basal ganglia (BG) where dopamine is the most important modulating neurotransmitter. As the BG is primarily involved with the execution of movement, the lack of dopamine input results in dysfunctional motor control. The current PD treatment, L-DOPA, improves these motor symptoms, however only provides patients 5 to 10 years of improved quality of life before debilitating side effects, often worse than the original symptoms, begin. The neuropeptide substance P (SP) is found in high concentration in the substantia nigra, and BG in general, where it is involved in dopamine release. In the late stages of PD, SP content within the substantia nigra and BG is decreased, thus implicating SP in the pathophysiology of PD. However, SP production has not been examined in the early stages of PD when dopaminergic degeneration is first initiated. This thesis therefore sought to characterise the role of SP in dopaminergic degeneration in an experimental model of early PD, the 6-hydroxydopamine model in rats. In contrast to the prevailing dogma that a decline in SP is associated with neurodegeneration in PD, this thesis demonstrates that SP is actually increased within the striatum in early PD, particular in perivascular tissue and within surviving dopaminergic neurons during the degenerative process. Increasing exposure of the dopaminergic neurons to SP, either by inhibition of substance P breakdown with Captopril or by direct injection with SP, exacerbated the disease progression as indicated by more profound neurogenic inflammation, functional deficits and increased dopaminergic cell death. However, when SP was inhibited by treatment with a SP NK₁ receptor antagonist, dopaminergic neurons were conserved, the inflammatory response was reduced and motor function was returned to near normal levels. We conclude that SP is increased in early PD, and that increased SP plays an important role in the degenerative process, specifically, in the genesis of BBB breakdown and initiation of neurogenic inflammation. Treatment with an NK1 antagonist may thus represent a novel therapeutic approach to early stage Parkinson’s disease. / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2009

Parkinson's disease (PD) is one of the most common motor neurodegenerative diseases, affecting 1-2% of the world's population over the age of 65. It is characterised by a loss of dopamine neurons within the substantia nigra, which is an integral part of the basal ganglia (BG) where dopamine is the most important modulating neurotransmitter. As the BG is primarily involved with the execution of movement, the lack of dopamine input results in dysfunctional motor control. The current PD treatment, L-DOPA, improves these motor symptoms, however only provides patients 5 to 10 years of improved quality of life before debilitating side effects, often worse than the original symptoms, begin. The neuropeptide substance P (SP) is found in high concentration in the substantia nigra, and BG in general, where it is involved in dopamine release. In the late stages of PD, SP content within the substantia nigra and BG is decreased, thus implicating SP in the pathophysiology of PD. However, SP production has not been examined in the early stages of PD when dopaminergic degeneration is first initiated. This thesis therefore sought to characterise the role of SP in dopaminergic degeneration in an experimental model of early PD, the 6-hydroxydopamine model in rats. In contrast to the prevailing dogma that a decline in SP is associated with neurodegeneration in PD, this thesis demonstrates that SP is actually increased within the striatum in early PD, particular in perivascular tissue and within surviving dopaminergic neurons during the degenerative process. Increasing exposure of the dopaminergic neurons to SP, either by inhibition of substance P breakdown with Captopril or by direct injection with SP, exacerbated the disease progression as indicated by more profound neurogenic inflammation, functional deficits and increased dopaminergic cell death. However, when SP was inhibited by treatment with a SP NK₁ receptor antagonist, dopaminergic neurons were conserved, the inflammatory response was reduced and motor function was returned to near normal levels. We conclude that SP is increased in early PD, and that increased SP plays an important role in the degenerative process, specifically, in the genesis of BBB breakdown and initiation of neurogenic inflammation. Treatment with an NK1 antagonist may thus represent a novel therapeutic approach to early stage Parkinson’s disease. / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2009

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Thesis (Ph.D.)--University of Alabama at Birmingham, 2009. / Title from PDF title page (viewed on July 15, 2010). Includes bibliographical references.

The use of nanocarriers is an intriguing approach in the development of efficacious treatment for brain disorders. The aim of the conducted research was to evaluate and quantify the impact of a liposomal nanocarrier formulation on the brain drug delivery. A novel approach for investigating the blood-brain barrier transport of liposomal DAMGO is presented, including in vivo microdialysis in rat, a high quality LC-MS/MS bioanalytical method and pharmacokinetic model analysis of the data. Factors limiting the brain distribution of the free peptide DAMGO were also investigated. Microdialysis, in combination with plasma sampling, made it possible to separate the released drug from the encapsulated and to quantify the active substance in both blood and brain interstitial fluid over time. The opioid peptide DAMGO entered the brain to a limited extent, with a clearance out of the brain 13 times higher than the clearance into the brain. The brain to blood ratio of unbound drug was not affected when the efflux transporter inhibitors cyclosporine A and elacridar were co-administered with DAMGO. Nor was the transport affected in the in vitro Caco-2 assay using the same inhibitors. This indicates that DAMGO is not transported by P-glycoprotein (Pgp) or breast cancer resistant protein (Bcrp). The blood-brain barrier transport was significantly increased for DAMGO when formulated in liposomes, resulting in 2-3 fold higher brain to blood ratio of unbound DAMGO. The increased brain delivery was seen both for glutathione tagged PEGylated liposomes, as well as for PEGyalted liposomes without specific brain targeting. The improvement in brain delivery was observed only when DAMGO was encapsulated into the liposomes, thus excluding any effect of the liposomes themselves on the integrity of the blood-brain barrier. Modeling of the data provided additional mechanistic understanding of the brain uptake, showing that endocytosis or transcytosis of intact liposomes across the endothelial cell membranes were unlikely. A model describing fusion of the liposomes with the luminal membrane described the experimental data the best. In conclusion, the studies presented in this thesis all contribute to an increased understanding of how to evaluate and improve brain delivery of CNS active drugs and contribute with important insights to the nanocarrier field.

Orientador: Sofia Fernanda Gonçalves Zorzella Pezavento / Resumo: A esclerose múltipla (EM) é uma doença inflamatória crônica e desmielinizante do Sistema Nervoso Central (SNC) que desencadeia diferentes graus de incapacidade física e cognitiva. Os tratamentos para a EM são baseados principalmente em drogas imunomoduladoras visando redução da gravidade e da frequência de recidivas, uma vez que não há cura para a doença. Estudos em modelo experimental de EM, denominado encefalomielite autoimune experimental (EAE) têm demonstrado o efeito imunomodulador da vitamina D (Vit D3) tanto na imunidade inata quanto na adaptativa. Neste contexto, nosso objetivo foi avaliar se a intervenção precoce com Vit D3 é capaz de bloquear a neuroinflamação em um modelo experimental de EM. Para isto, camundongos C57BL/6 fêmeas foram imunizados com MOG (glicoproteína da mielina do oligodendrócito) associada ao Adjuvante Completo de Freund e tratadas com Vit D3 por via intraperitoneal. A Vit D3 diminuiu, de forma significativa, a incidência e o escore clínico da doença. Este efeito protetor foi acompanhado da diminuição de entrada de linfócitos no SNC e também de redução no processo de desmielinização e expressão de MHCII em macrófagos e micróglia. A eficácia da Vit D3 também foi associada com controle local do estresse oxidativo, ou seja, nos animais tratados ocorreu normalização dos níveis de peroxidação lipídica e de proteína carbonil e também de enzimas antioxidantes (superóxido dismutase, catalase e glutationa peroxidase). A terapia com Vit D3 também determino... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Multiple sclerosis (MS) is a chronic and demyelinating inflammatory disease of the Central Nervous System (CNS) that triggers different degrees of physical and cognitive disability. Treatments for MS are mainly based on immunomodulatory drugs that reduce severity and frequency of relapses. Studies in an experimental model of MS, called experimental autoimmune encephalomyelitis (EAE), have demonstrated the immunomodulatory effect of vitamin D (Vit D3) in both innate and adaptive immunity. In this context, our objective was to evaluate whether early intervention with Vit D3 was able to block neuroinflammation in EAE. Encephalomyelitis was induced in female C57BL / 6 mice by immunization with MOG (myelin oligodendrocyte glycoprotein) associated with Freund's Complete Adjuvant and two doses of pertussis toxin. Mice were treated with Vit D3 intraperitoneally. Treatment significantly decreased the incidence and clinical score of the disease. This protective effect was associate to decreased lymphocyte infiltration in the CNS and also reduced demyelination and MHCII expression in macrophages and microglia. Vit D3 also determined local control of oxidative stress, that is, normalization of the levels of lipid peroxidation and carbonyl protein and also of antioxidant enzymes (superoxide dismutase, catalase and glutathione peroxidase). Vit D3 therapy reduced NLRP3, caspase-1 and local IL-1β mRNA expression in the CNS. In addition, this precocious Vit D3 therapy normalized the blood-bra... (Complete abstract click electronic access below) / Doutor

A hipertensão cursa com importante déficit autonômico e lesão da barreira hematoencefálica (BHE) enquanto que o treinamento aeróbio (T) de hipertensos reduz acentuadamente a lesão da BHE, mantendo sua integridade no PVN, NTS e RVLM mesmo na persistência de níveis pressóricos elevados. Esta rápida resposta ao T (2 semanas) é condicionada pela redução da disponibilidade de ANGII nas áreas encefálicas, simultâneo aumento da expressão de podócitos dos astrócitos e desativação da microglia, os quais ocorrem simultaneamente à redução do simpático vasomotor (2 semanas) e antes mesmo do aumento da variabilidade da frequência cardíaca, da atividade parassimpática ao coração, da instalação da bradicardia de repouso e queda parcial da pressão arterial, que se instalam a partir da 4ª semana de T. Alterações na permeabilidade da BHE de hipertensos (lesão com prejuízo estrutural/funcional) e treinados (manutenção da integridade estrutural/funcional) são importantes fatores a condicionar respectivamente a disfunção autonômica na hipertensão ou a sua correção pelo treinamento. / The arterial hypertension is accompanied by important autonomic dysfunction and blood-brain barrier (BBB) lesion while aerobic training (T) in hypertension strongly decreases the BBB lesion, maintaining its integrity on the PVN, NTS and RVLM even in the persistence of high blood pressure (BP) levels. This early response to T (2 weeks) is conditioned by the reduction of ANGII availability, increased expression of astrocytic podocytes and deactivation of the microglia in brain areas. These responses occurred simultaneously with the reduction of vasomotor sympathetic activity (2 weeks) and before the increase of both heart rate variability and parasympathetic activity, resting bradycardia and partial BP fall, appearing only at the 4th week. Changes on the BBB permeability in hypertension (lesion with structural/functional damage) and trained (maintenance of the structural/ functional integrity) are important factors to condition the autonomic dysfunction in hypertension or its correction by the training, respectively.

Pour exercer leur effet princeps, les médicaments doivent atteindre des concentrations nécessaires et suffisantes à leur site d'action tout en évitant la survenue d'effets indésirables. Les antibiotiques sont utilisés pour le traitement d'infection cérébroméningées dont la cible bactériologique se situe dans le liquide céphalorachidien (LCR) ou le liquide extracellulaire cérébral (LEC) un site d'action cérébral qui constitue aussi une cible pour des effets secondaires. La distribution de médicament dans le cerveau et le LCR est limitée par la présence des barrières hémato-encéphalique (BHE) et hématoliquidienne (BHL). De plus, des mécanismes d'efflux diminuent les concentrations tissulaires des médicaments. Pour optimiser l'usage des antibiotiques et diminuer les effets indésirables, il est important d'obtenir des informations pharmacocinétiques tissulaires. Le recueil de LEC par microdialyse cérébrale et le prélèvement de LCR permettent chez des patients de réanimation la comparaison des concentrations libres de médicament. Ce travail constitue une étude de la distribution dans le plasma, le LCR et le LEC de deux antibiotiques : le céfotaxime et le métronidazole. Des patients (après un traumatisme crânien ou un accident vasculaire) ont été traités par céfotaxime et métronidazole pour une pneumopathie. Quatre études pharmacocinétiques ont été réalisées à l'équilibre par microdialyse cérébrale (n=11) pour le recueil du LEC ou par prélèvement de LCR (n=9) par une dérivation ventriculaire externe. Les résultats ont montré que le métronidazole diffusait totalement dans les deux milieux alors que la diffusion du céfotaxime était limitée, probablement en raison de phénomènes d'efflux. / To exert their effect while avoiding adverse events, drugs must reach sufficient concentrations in their site of action. Antibiotics are used for treating infection that bacterial target is in the cerebrospinal fluid (CSF) or brain extracellular fluid (ECF) which is also a target for adverse events. Drug distribution in the brain and CSF may be limited by the presence of the blood-brain barrier (BBB) and blood-CSF barrier (BCSFB). In addition, efflux mechanisms may decrease tissue concentrations of drugs.To optimize the use of antibiotics and reduce adverse events, it is important to obtain tissue pharmacokinetics. Collecting ECF samples via brain microdialysis and CSF samples via external ventricular drain in critically ill patients allow comparison of free drug concentrations. This work is a study of the distribution in plasma, CSF and ECF of two antibiotics, cefotaxime and metronidazole.Patients (after a head injury or stroke) were treated with cefotaxime and metronidazole for pneumonia. Four pharmacokinetic studies were performed at equilibrium by brain microdialysis (n = 11) for collecting ECF or CSF samples (n = 9) by an external ventricular drain. The results showed that metronidazole distributes extensively in both ECF and CSF while the diffusion of cefotaxime was limited, probably due to efflux transporters.