L’objectif de ces travaux de thèse, inscrits dans le projet ERC Advanced Grant «TERNANOMED», était de développer un nanomédicament squalèné à base d’adénosine (NPs d’AdSQ) pour le traitement des accidents vasculaires cérébraux et des traumatismes de la moelle épinière. La première partie de ce travail décrit la préparation et la caractérisation des NPs d’AdSQ, et la mise en évidence d’une activité thérapeutique spectaculaire dans des modèles pré-cliniques d’ischémie cérébrale et de neurotrauma. Afin de mieux comprendre le mécanisme d’action des NPs, la deuxième partie de cette thèse a été consacrée à l’étude détaillée de la transcytose des NPs à travers la barrière hémato-encéphalique, et a permis de démontrer le désassemblage des NPs au sein des cellules endothéliales. Cette étude confirme que l’action des NPs d’AdSQ résulte en premier lieu d’une activité vasculaire via l’amélioration de la microcirculation, et dans un second temps, permet la protection des neurones, vraisemblablement grâce au couplage neurovasculaire et à l’action pléiotropique et multi-cibles de l’adénosine. La troisième partie de ce travail de thèse avait pour but de décrire en détail le profil pharmacocinétique et la biodistribution des NPs d’AdSQ à l’aide de techniques innovantes de radiomarquage. Enfin, une dernière partie présente des résultats préliminaires sur le développement d’un outils théranostic via l’encapsulation d’USPIO comme agent de contraste IRM au sein des NPs d’AdSQ. Dans son ensemble, ce travail de thèse a permis d’établir les fondements de l’extension de la plateforme de «squalènisation» au traitement des pathologies du système nerveux central. / This PhD work, as a part of the ERC Advanced Grant project «TERNANOMED», aimed at developing a squalenoyl nanomedicine of adenosine (SQAd NAs), for the treatment of stroke and spinal cord injury (SCI). The first part of this research was dedicated to the preparation and characterization of SQAd NAs, and highlighted their dramatic therapeutic activity in pre-clinical models of cerebral ischemia and SCI. To further understand the mechanism of action of these NAs, the second part of this thesis was devoted to the detailed study of their transcytosis across the Blood-Brain Barrier. It was shown that the NAs were disassembled inside the endothelial cells, confirming that the pharmacological mechanism of the SQAd NAs action appeared to be a primary vascular protection via the improvement of microcirculation, leading to a secondary neuronal preservation, likely thanks to neurovascular coupling and to the pleiotropic multitargeted abilities of adenosine. The third part of this work aimed to describe the pharmacokinetic profile and tissue distribution of SQAd NAs, thanks to innovative techniques of radiolabeling. Finally, the fourth part presented preliminary results on the development of a theranostic tool, by incorporating USPIO as a MRI contrast agent inside the SQAd NAs. Overall, this PhD work established the foundation to the extension of the squalenoylation platform to the treatment of neurological diseases.

La résistance aux médicaments antiépileptiques (MAEs) est un des problèmes majeurs des épilepsies infantiles, comme par exemple le syndrome de Dravet. La pharmacoresistance de l’épilepsie pourrait s’expliquer par une diminution du passage des MAEs dans le cerveau, à travers la Barrière Hémato-Encéphalique (BHE). La BHE comporte des transporteurs des familles « ATP-binding cassette » (ABC) et « SoLute Carrier » (SLC) localisés au niveau de la membrane des cellules endothéliales qui contrôlent leur passage entre le sang et le cerveau. La pharmacoresistance des épilepsies a été associée à ces transporteurs car des MAEs ont été identifiés comme substrats de transporteurs comme la glycoprotéine-P (P-gP) et la « Breast Cancer Resistance Protein » (BCRP). L’hypothèse de cette relation est confortée par l’observation de l’augmentation de l’expression de ces transporteurs d’efflux dans le foyer épileptogène et par l’identification des polymorphismes dans les gènes des transporteurs chez des patients pharmacorésistants. L’interaction au cours du développement cérébral entre les cellules endothéliales et les neurones et astrocytes pourrait modifier le profil des transporteurs de la BHE. Les MAEs sont aussi connus pour être soit des inducteurs, soit des inhibiteurs des enzymes du métabolisme des médicaments et des transporteurs membranaires. Ces données nous permettent de faire les hypothèses suivantes: 1) La BHE en développement présente un profil de transporteurs différent de la BHE mature qui pourrait modifier le passage des MAEs vers le cerveau ; et 2) le traitement chronique administré au cours du syndrome de Dravet pourrait changer le phénotype des transporteurs de la BHE en développement. Nous résultats ont montré que la P-gP et la BCRP augment leur expression au cours du développement. La maturation de la BHE a aussi un impact sur le passage des MAEs étudiés. Nous avons constaté une augmentation de l’expression des différents transporteurs ABC et SLC étudiés pendant le développement de la BHE, suite au traitement chronique avec la thérapie du Syndrome de Dravet. L’acide valproïque, un des MAEs utilisé dans ce traitement, diminue l’activité d’efflux de la P-gP chez les rats en développement et adultes, ce qui a été confirmé dans un modèle in-vitro de BHE immature. Ces résultats mettent en évidence l’interaction entre la BHE en développement et le traitement chronique par les MAEs peut modifier leur distribution au niveau du cerveau et la réponse aux MAEs. / Resistance to Antiepileptic Drugs (AEDs) has been a major concern in infantile epilepsies such as for example the Dravet Syndrome. One hypothesis concerning the pharmacoresistance in epilepsy is that a decreased delivery of these drugs to the brain may occur in relation to changes in the Blood-Brain Barrier (BBB) function. BBB exhibits ATP-binding cassette (ABC) and SoLute Carrier (SLC) transporters at the surface of endothelial cells that control the blood-brain transport. Pharmacoresistance in epilepsy may be linked to changes in the functions of these transporters since some AEDs are substrates of the P-glycoprotein (P-gP) and Breast Cancer Resistance Protein (BCRP) transporters. The increased expression of efflux transporters in epileptogenic tissue and the identification of polymorphisms in the efflux transporters genes of resistant patients further support this potential relationship. The interaction of endothelial cells with astrocytes and neurons during brain development could change the pattern of transporters in the BBB. AEDs are also known as either inducers or inhibitors of drug metabolic enzymes and membrane transporters. Taken together, these facts led us to test the following hypothesis: 1) the developing BBB in immature animals presents a different pattern of transporters that could change AEDs disposition in the brain of immature subjects; and 2) the chronic pharmacotherapy used in infantile epilepsies such as the Dravet Syndrome may change the transporters phenotype of the BBB. Our work showed that the expression of P-gP and BCRP increases during development as a function of age. We also showed the maturation of the BBB has an impact on brain disposition of the studied AEDs. We finally observed an increase in the expression of various ABC and SLC transporters induced by the pharmacotherapy of the Dravet Syndrome in immature animals. One of the drugs used, valproic acid, appeared nonetheless to reduce the efflux activity of P-gP in developing and adult animals, which was confirmed in an in-vitro model of the immature BBB. Taken together, these results demonstrated that the interaction between the developing BBB and the AEDs chronic treatment may lead to differences in brain disposition of the AEDs that may impact on the response to AEDs.

Le système nerveux central est un organe privilégié et protégé, notamment grâce à l’existence des barrières histologiques entre le sang et les tissus nerveux. La barrière-hémato encéphalique (BHE) et la barrière hémato-rétinienne (BHR) séparent respectivement le parenchyme cérébral et la rétine des composés contenus dans l’espace vasculaire, grâce à l’expression de jonctions serrées et de transporteurs membranaires permettant une régulation spécifique des échanges entre le sang et le parenchyme nerveux. Ce travail a porté sur l’étude d’un nouveau transporteur de cations organiques mis en évidence fonctionnellement à la BHE de la souris. Ce transporteur appartenant très probablement à la superfamille des solute carrier (SLC), fonctionne comme un antiport proton. Actuellement, sa présence ne peut être démontrée que de façon fonctionnelle car son identité moléculaire est encore inconnue. Cet antiport proton constitue un nouvel acteur de la perméabilité cérébrale et ouvre une nouvelle voie d’accès au cerveau. Nous nous sommes tout d’abord attachés à approfondir les connaissances fonctionnelles de ce transporteur en étudiant de nouveaux substrats et tissus d’expression. Le transport cérébral de psychotropes a été étudié in vivo par la technique de perfusion carotidienne in situ chez la souris et in vitro grâce à une lignée de cellules endothéliales cérébrales humaines immortalisées (hCMEC/D3). Nous avons démontré que la haute perméabilité cérébrale de la cocaïne fait intervenir à la fois une diffusion passive et surtout une diffusion médiée par un antiport proton. La vitesse d’entrée des substances d’abus dans le cerveau est associée à un plus fort risque d’addiction et fait de ce transporteur un nouvel acteur critique de la régulation du passage cérébral. En effet, d’autres substances comme la nicotine et certaines amphétamines comme le MDPV et l'ecstasy sont également des substrats de cet antiport. Ce transporteur apparaît comme une cible pharmacologique potentielle dans la prise en charge de toxicomanies. Malgré la diversité chimique et pharmacologique d’interactions des composés avec cet antiport, les concentrations nécessaires pour l’inhiber dépassent celles retrouvées dans le sang. Pour aider l’identification d’inhibiteurs sélectifs et efficaces nous avons développé un modèle pharmacophorique d’inhibiteurs du transporteur à partir de données générées in vitro et de l’approche FLAPpharm. Ce modèle semble prédictif de nouveaux composés pouvant constituer de meilleurs inhibiteurs de ce transporteur. L’étude des échanges in vivo au niveau du tissu nerveux nous a menés à étudier l’impact de transporteurs ABC et de l’antiport-proton au niveau cérébral et rétinien à l’aide de substances spécifiques ou de substrats mixtes comme le vérapamil. L’antiport proton est fonctionnel au niveau de la BHR et transporte notamment la clonidine, le DPH et le vérapamil. Cependant, dans le cas d’un substrat mixte P-gp et SLC (ex : vérapamil), ce transport d’influx n’est visible à la BHE que lorsque la P-gp est neutralisée. Au contraire, à la BHR l’influx lié à cet SLC est visible naturellement. L’impact de la P-gp à la BHR étant 6.3-fois plus faible ce processus est probablement moins masqué. Cette étude illustre la difficulté actuelle de prédire l’impact fonctionnel d’un transporteur pour des substrats multi-spécifiques et l’existence d’une priorisation du transport. Enfin, nous avons essayé d’identifier l’antiport proton au niveau moléculaire par une méthode de photo-activation à l’aide d’un composé adapté. Cette méthode s’est avérée efficace pour fixer une molécule sur le transporteur, permettant par la suite de l’isoler plus facilement. En conclusion, ce travail a permis de mettre en évidence l’importance de l’antiport proton dans la distribution cérébrale de psychotropes et d’ouvrir de nouvelles perspectives dans l’addiction et la compréhension du transport de substrats multi-spécifiques. / The central nervous system is a privilege organ protected by histological barriers between the blood and the nervous tissue. The blood-brain barrier (BBB) and the blood-retinal barrier (BRB) separate cerebral parenchyma and retina from the circulating blood and both express tight junctions and membrane transporters, allowing a precise regulation of the exchanges between the blood and nervous tissues. We studied a new cationic transporter functionally evidenced at the mouse BBB. This molecularly unknown transporter belong to the solute carrier super family (SLC) and is a proton antiporter. It could constitute a new actor in the cerebral permeability and may be a new brain access pathway. First, we worked on the functional identification studying new substrates and new localization. Psychotropic brain transport was studied in vivo by brain in situ perfusion on mouse and in vitro with human immortalized endothelial cells (hCMEC/D3). We showed that cocaine brain entry depends on passive diffusion but also mainly on a proton antiporter. Brain entry rate of drugs of abuse is associated with modulation of addiction liability, making this transporter a new component of brain entry of cocaine, and also nicotine and some amphetamines such as ecstasy and MDPV. This proton antiporter appears to be a new potential target in addiction. Various chemical entities interact with this transporter; however concentrations used to inhibit the transporter are much higher than the one possibly found in the blood. In order to help find or design new selective and potent inhibitors, we developed a pharmacophore model of the proton antiporter inhibitors using in vitro data and the FLAPpharm approach. The model predicts well new possible inhibitors of this transporter. We also studied the impact of the ABC transporters and the proton antiporter at the BBB and the BRB using specific or multi-specific substrates such as verapamil. The proton antiporter is functionally expressed at the BRB and transports clonidine, DPH and verapamil. However, for the multi-specific (P-gp and SLC) compound verapamil, influx transport by the proton antiporter is visible at the BBB only when P-gp efflux is neutralized. On the contrary, at the BRB, the proton antiporter influx is always visible. This is certainly due to the lower impact (by 6.3 fold) of P-gp at the BRB compared to the BBB. These results show the difficulty to predict the functional impact of a transporter for multi-specific compounds and a probable transport prioritization. Finally we worked on the molecular identification of the proton antiporter using a photolabeling method. This work evidenced the importance of the proton antiporter in the brain distribution of psychotropic and drugs of abuse and opened toward new perspectives in addiction and transport comprehension.

"Manganese (Mn2+) has recently gained acceptance as a magnetic resonance imaging (MRI) contrast agent useful for generating contrast in the functioning brain. The paramagnetic properties of Mn2+, combined with the cell's affinity for Mn2+ via voltage-gated calcium channels, makes Mn2+ sensitive to cellular activity in the brain. Compared with indirect measures of brain function, such as blood oxygenation level dependent (BOLD) functional MRI, manganese-enhanced MRI (MEMRI) can provide a direct means to visualize brain activity. MEMRI of the brain typically involves osmotic opening of the blood-brain barrier (BBB) to deliver Mn2+ into the interstitial space prior to initiation of a specific neuronal stimulus. This method assumes that the BBB-disruption process itself does not induce any apparent stimuli or cause tissue damage that might obscure any subsequent experimental observations. However, this assumption is often incorrect and can lead to misleading results for particular types of MRI applications. One aspect of these studies focused on characterizing the confounding effects of the BBB-opening process on MRI measurements typically employed to characterize functional activity or disease in the brain (Chapters 4 and 5). The apparent diffusion coefficient (ADC) of tissue water was found to decrease (relative to the undisrupted contralateral hemisphere) following BBB opening, obscuring similar ADC changes associated with ischemic brain tissue following stroke. Brain regions exhibiting reduced ADC values following osmotic BBB disruption also experienced permanent tissue damage, as validated by histological measures in the same vicinity of the brain. Non-specific MEMRI-signal enhancement was also observed under similar conditions and was found to be correlated to regions with BBB opening as verified by Evans Blue histological staining. In this case, MEMRI may prove to be a useful alternative for monitoring BBB-permeability changes in vivo. MEMRI was also investigated as a method for visualizing regions of BBB damage following ischemic brain injury (Chapter 6). BBB disruption following stroke has been investigated using gadolinium-based MRI contrast agents (e.g., Gd-DTPA). However, as an extracellular MRI contrast agent, Gd-DTPA is not expected to provide information regarding cell viability or function as part of MR image contrast enhancement. By comparison, brain regions with ischemia-induced BBB damage, and blood-flow levels sufficient to deliver Mn2+, show MEMRI-signal enhancement that correlates to regions with tissue damage as verified by histological staining. This approach should allow us to better understand the factors responsible for ischemia-induced BBB damage. Furthermore, MEMRI should be a useful tool for monitoring therapeutic interventions that might mitigate the damage associated with BBB disruption following stroke. "

L’acide docosahexaénoïque (DHA, 22:6n-3) est le principal acide gras oméga-3 des tissus cérébraux et est essentiel au développement et aux fonctions du cerveau. Une diminution de la concentration cérébrale du DHA est observée chez les patients souffrant de maladies neurodégénératives telles que les maladies d'Alzheimer et de Parkinson. Un apport ciblé du DHA au cerveau pourrait compenser ces carences. Le DHA sanguin est transporté à travers la barrière hémato-encéphalique (BHE) plus efficacement lorsqu’il est estérifié en position sn-2 de la lysophosphatidylcholine (lysoPC). Nous produisons au laboratoire une phosphatidylcholine structurée pour mimer la 2-docosahexaénoyl-lysoPC (lysoPC-DHA), nommée AceDoPC (1-acétyl,2-docosahexaénoyl-glycérophosphocholine), qui peut être considérée comme une forme stabilisée de la lysoPC-DHA physiologique et qui est neuroprotectrice dans l’accident ischémique cérébral. Le premier objectif de ce travail a été de comparer le passage du DHA marqué non estérifié ou estérifié dans l’AceDoPC ou dans une phosphatidylcholine (PC-DHA), lié au plasma, à travers un modèle in vitro de la BHE. Nous montrons un passage préférentiel à travers la monocouche endothéliale et une captation préférentielle par les cellules gliales de l’AceDoPC comparativement au DHA non estérifié et à la PC-DHA. Le deuxième objectif de ce travail a été de confirmer si cette préférence pour la forme AceDoPC était également observée in vivo. Nous avons donc étudié, chez des rats âgés de 20 jours, la captation cérébrale des différentes formes d’apport du DHA précédemment utilisées (DHA, AceDoPC, PC-DHA). Nous démontrons que l’AceDoPC apporte le DHA au cerveau plus efficacement que les autres formes d’apport de DHA et que cette préférence pour l’AceDoPC est spécifique au cerveau puisqu’elle n’est pas observée pour les autres organes étudiés. L’AceDoPC est trouvée, en partie, sous forme intacte dans le cerveau. L’autoradiographie ex vivo du cerveau de rat révèle que le DHA provenant de l’AceDoPC est localisé dans des régions cérébrales spécifiques jouant un rôle important dans la mémoire et les fonctions cognitives. Enfin, en utilisant des approches de modélisation moléculaire, nous démontrons que les potentiels électrostatiques et hydrophobes sont distribués de manière très similaire au niveau des surfaces de l’AceDoPC et de la lysoPC-DHA. En conclusion, nos études montrent que l’AceDoPC est un transporteur privilégié et spécifique du DHA au cerveau. En considérant les rôles essentiels du DHA pour le cerveau, cette nouvelle approche de ciblage cérébral du DHA offre des perspectives prometteuses dans le développement de stratégies préventives et thérapeutiques pour les maladies neurologiques. / Docosahexaenoic acid (DHA, 22:6n-3) is the main essential omega-3 fatty acid in brain tissues required for normal brain development and function. A decrease in the cerebral concentration of DHA is observed in patients suffering from neurodegenerative diseases such as Alzheimer’s and Parkinson’s. Targeted intake of DHA to the brain could compensate for these deficiencies. Blood DHA is transported across the blood-brain barrier (BBB) more efficiently when esterified at the sn-2 position of lysophosphatidylcholine (lysoPC). We produce in the laboratory a structured phosphatidylcholine to mimic 2-docosahexaenoyl-lysoPC (lysoPC-DHA), named AceDoPC (1-acetyl,2-docosahexaenoyl-glycerophosphocholine), that may be considered as a stabilized form of the physiological lysoPC-DHA and that is neuroprotective in experimental ischemic stroke. The first objective of this work was to compare the passage of either labeled unesterified DHA or DHA esterified in AceDoPC or in phosphatidylcholine (PC-DHA), bound to plasma, through an in vitro model of the BBB. This model is constituted of a co-culture of bovine brain capillary endothelial cells and glial cells from newborn rats. We show a preferential passage through the endothelial monolayer and a preferential uptake by glial cells of AceDoPC compared to unesterified DHA and PC-DHA. We also show that AceDoPC is hydrolyzed, partly, into lysoPC-DHA and that phosphatidylcholine (PC) and phosphatidylethanolamine (PE) are the most labeled lipid classes in endothelial cells and glial cells. AceDoPC is found, partly, as a whole molecule in the cells. The second objective of this work was to confirm whether this preference for AceDoPC was also observed in vivo. We studied, in 20 days old rats, the brain uptake of different forms of DHA previously used (DHA, AceDoPC, PC-DHA). We demonstrate that AceDoPC provided the brain with DHA more efficiently than the other forms of DHA and that this preference for AceDoPC is specific for the brain because it is not observed for other studied organs. AceDoPC is found, partly, intact in the brain. Ex vivo autoradiography of rat brain reveals that DHA provided from AceDoPC is localized in specific brain regions playing key roles in memory and cognitive functions. Finally, by using molecular modelling approaches, we demonstrate that electrostatic and hydrophobic potentials are distributed very similarly at the surfaces of AceDoPC and lysoPC-DHA. In conclusion, our studies demonstrate that AceDoPC is a privileged and specific carrier of DHA to the brain. Considering the essential roles of DHA for the brain, this new approach to target the brain with DHA offers promising perspectives in the development of preventive and therapeutic strategies for neurological diseases.

Au cours de cette thèse, réalisée dans le cadre du projet Iseult/INUMAC, nous avons réalisé un travail de développements méthodologiques et technologiques, dans l'optique de permettre à l'IRM de devenir un outil quantitatif pour l'imagerie moléculaire de pathologies cérébrales sur des modèles rongeurs. Pour cela, nous avons développé une stratégie de quantification, utilisant des séquences de cartographie T1 et T2, pour acquérir des cartes de concentration en agents de contraste paramagnétiques et superparamagnétiques avec une excellente sensibilité, une résolution spatiale élevée, ainsi qu'une résolution temporelle compatible avec l'imagerie in vivo. La méthodologie générale que nous avons mise en place lors de ces travaux de thèse nous a permis d'aborder un certain nombre de problématiques propres à l'imagerie moléculaire de pathologies cérébrales par IRM. Dans un premier temps, nous nous sommes intéressés à l'imagerie d'un biomarqueur endovasculaire de l'angiogenèse tumorale sur un modèle de glioblastome cérébral induit chez des souris immuno-déprimées. Nous avons étudié la fixation d'une émulsion paramagnétique, fonctionnalisée par l'ajout de peptides RGD, sur l'intégrine alpha-nu-beta-3 surexprimée à la surface des cellules endothéliales de capillaires tumoraux. Nous nous sommes ensuite intéressés à la délivrance des agents de contraste aux tissus cérébraux. À l'aide d'un protocole optimisé d'ouverture de la barrière hématoencéphalique (BHE) par ultrasons focalisés sous IRM, nous avons étudié les caractéristiques de cette ouverture, ainsi que la dynamique de refermeture sur des modèles de rats et souris sains. Dans une autre étude, la mesure du coefficient de diffusion apparent d'agents de contraste dans les tissus cérébraux de rats sains nous a permis d'évaluer le temps nécessaire à ces agents de tailles différentes pour atteindre leurs cibles, une fois la BHE franchie. Ces caractéristiques représentent des informations capitales dans le cadre de la délivrance d'agents de contraste aux tissus cérébraux. Ils sont en effet susceptibles d'intéresser les industriels pharmaceutiques pour optimiser la conception d'agents diagnostiques et thérapeutiques dédiés aux pathologies cérébrales. / In this thesis, which was part of the Iseult/INUMAC project, we propose several methodological and technological developments aiming to allow MRI to become a quantitative tool for molecular imaging of brain pathologies. To do so, we developed a quantification strategy based on T1 and T2 mapping sequences in order to acquire quantitative concentration maps of paramagnetic and superparamagnetic contrast agents with excellent sensitivity, high spatial resolution and temporal resolution compatible with in vivo imaging. This general methodology allowed us to address several issues specific to molecular imaging of cerebral pathologies using MRI. First, we focused on the imaging of a vascular biomarker of tumor angiogenesis on a glioblastoma mouse model. We studied the binding of a paramagnetic emulsion, functionalized using RGD peptides, on alpha-nu-beta-3 integrin over-expressed at the surface of freshly formed endothelial cells. Then, we focused on the delivery of contrast agents to brain parenchyma. A system was developed and optimized to open transiently and non-invasively rodents blood brain barrier (BBB) using focalized ultrasound monitored by MRI. The BBB opening features and closure dynamics induced by this protocol were extensively characterized. In another study, we measured the apparent diffusion coefficient of contrast agents with different sizes in cerebral tissues of healthy rats. From these measures we could estimate the time necessary for these particles to reach their targets once the BBB is crossed. These parameters are highly valuable in the context of drug delivery to the brain. They might indeed be used by pharmaceutical industries to optimize the design of diagnostic and therapeutic agents dedicated to cerebral diseases.

INTRODUÇÃO: As imagens de lesões hiperdensas encontradas em exames de tomografia (TC) de crânio após o tratamento endovascular do acidente vascular cerebral isquêmico (AVCi) agudo têm sido correlacionadas ao risco de transformação hemorrágica após o AVC. Entretanto, a correlação entre as lesões hiperdensas e a área cerebral infartada é desconhecida. O objetivo deste estudo é determinar a correlação entre as lesões hiperdensas encontradas em TC de crânio realizadas logo após tratamento endovascular do AVCi agudo e a área de AVC isquêmico. MATERIAIS E MÉTODOS: Foram coletados retrospectivamente dados radiológicos de pacientes com AVCi agudo por oclusão de grandes vasos da circulação anterior submetidos ao tratamento endovascular. Foram analisadas imagens de TC de crânio nas primeiras 24 horas e até 21 dias após o tratamento. As áreas hiperdensas foram classificadas utilizando o escore ASPECTS e comparadas com as áreas de AVC isquêmico final pelo mesmo escore. As imagens foram analisadas independentemente por dois avaliadores, sendo que um terceiro avaliador analisou os casos discordantes. A concordância entre avaliadores (CCI) e os valores de sensibilidade, especificidade, preditivos positivo e negativos e acurácia foram calculados. RESULTADOS: Lesões hiperdensas foram encontradas em 71 dos 93 (76,34%) pacientes com AVC isquêmico de circulação anterior. As áreas captantes de contraste corresponderam às áreas de AVC final segundo o escore ASPECTS (CCI=0,58 [0,40 0,71]). Os valores para cada região individual foram avaliados e a sensibilidade variou de 58,3% a 96,9%, a especificidade de 42,9% a 95,6%, os valores preditivos positivos de 71,4% a 97,7%, os valores preditivos negativos de 53,8% a 79,5% e os valores de acurácia de 0,68 a 0,91. Os maiores valores de sensibilidade foram encontrados para os núcleos lentiforme (96,9%) e caudado (80,4%) e para a cápsula interna (87,5%) e os menores para os córtices M1 (58,3%) e M6 (66,7%). CONCLUSÕES: A aplicação do escore ASPECTS para avaliação das imagens de tomografia de crânio após o tratamento endovascular do AVCi agudo que apresentam captação de contraste, demonstrou ser uma ferramenta útil para a predição da área final de infarto cerebral. A predição foi maior na região profunda e menor nos córtices cerebrais, provavelmente devido maior circulação colateral cortical. Além disso, o método se mostrou reprodutível e de fácil utilização. / INTRODUCTION: The hyperdense lesions images found in head computed tomography (CT) scan after endovascular treatment have been correlated to risk of hemorrhagic transformation after stroke. However, the correlation between hyperdense lesions and the infarcted brain area is unknown. The aim of this study is to determine the correlation between the hyperdense lesions found on CT scan performed after endovacular treatment of acute stroke and final ischemic stroke area. MATERIALS AND METHODS: It was collected radiological data of patients with acute ischemic stroke by occlusion of large vessels in the anterior circulation were treated with endovascular treatment. Head CT scan were evaluated in the first 24 hours and by 21 days after treatment. The hyperdense areas were rated using the ASPECTS score and compared with final ischemic stroke by the same score. The images were analyzed independently by two reviewers, and a third evaluator examined the discordant cases. The interrater agreement (ICC) and the sensitivity, specificity, positive and negative predictive values and accuracy were calculated. RESULTS: hyperdense lesions were found in 71 of 93 (76.34%) patients with ischemic stroke of anterior circulation. The contrast iodineaccumulating areas corresponded to the final stroke areas (ICC = 0.58 [0.40 to 0.71]) as the ASPECTS score. The values for each individual region were evaluated and the sensitivity ranged from 58.3% to 96.9%, specificity of 42.9% to 95.6%, the positive predictive value of 71.4% to 97, 7%, the negative predictive value of 53.8% to 79.5% and the accuracy of values from 0.68 to 0.91. The higher sensitivity found for lenticular nuclei (96.9%) and caudate (80.4%) and the internal capsule (87.5%) and lower for M1 (58.3%) and M6 (66.7%) cortices. CONCLUSIONS: The use of the ASPECTS score for evaluation of CT head scan after endovascular treatment of acute ischemic stroke images that exhibit contrast enhancement proved to be a useful tool for predicting the final ischemic stroke area. The prediction was higher in the deep region and lower in the cerebral cortex, probably because the cortical collateral circulation. Futhermore, these method was reproducible and easy to use.

Hypertension is the chronic elevation in blood pressure that is regulated in part through the retention and regulation of sodium retention and excretion in the kidneys. Hence the kidney has been considered the organ that regulates blood pressure. There are a cohort of patients that suffer with high blood pressure due to lack of 11β-hydroxysteroid dehydrogenase-type 2 (11β-HSD2) expression (which inactivates glucocorticoids (GCs), allowing selective activation of mineralocorticoid receptors (MR) by aldosterone) that results in hypertensive and increased salt appetite phenotypes - a condition known as syndrome of apparent mineralocorticoid excess (SAME). This disorder can be recapitulated in the mouse through the global deletion of 11β-HSD2, which results in over activation of the MR driving an elevation in blood pressure. However, the distinction between blood pressure elevation because of kidney dysfunction with loss of 11β-HSD2 or increased salt appetite due to loss of brain 11β-HSD2 expression is not clear from the global 11β-HSD2 knockout model. Salt appetite is regulated by regions of the brain out-with the blood-brain barrier, known as circumventricular organs. In the mouse, salt appetite is controlled by aldosterone-sensitive cells in the nucleus of the solitary tract (NTS) in the brain stem, where 11β-HSD2 is expressed to provide mineralocorticoid selectivity. However, in the fetal brain, 11β-HSD2 is widely expressed, protecting against adverse GC action that alters brain development and increases susceptibility to psychiatric disorders as adults. 11β-HSD2 deletion solely in the brain from embryonic day 12 resulting in GC fetal programming (HSD2BKO) causes effects on both behaviour and salt appetite. To determine the role of developmental versus adult expression of brain 11β- HSD2, mice with deletion of brain 11β-HSD2 from mid gestation (HSD2BKO) and mice with adult deletion of 11β-HSD2 in the NTS using lentivirus (HSD2.v- BKD) were compared. The phenotypes (salt appetite, blood pressure (BP), baroreceptor response (BRR) and cognition), can be categorised as either due to GC fetal programming (as indicated by HSD2BKO groups), or increased activation of MR in adult 11β-HSD2 expressing neurons (recapitulated in the HSD2.v-Cre groups). Salt appetite increased in both HSD2BKO and HSD2.v-BKD cohorts (mean percentage increase 65% n=8 and 46% n=6, compared to their respective controls), leading to an increased BP in both groups (+12% and +8%, respectively) as well as an impaired BRR, indicating all phenotypes are mediated by adult NTS neurons. However, spatial recognition memory (Object-in-Place task) is abolished in HSD2BKO mice, whereas, HSD2.v-BKD mice still retain short-term memory. Our data suggest that neural 11β-HSD2 protects against inappropriate activation of MR by corticosterone to regulate salt appetite and salt-induced rises in blood pressure. However, spatial recognition memory is not influenced by deletion of 11β-HSD2 in the adult brain, confirmation that this phenotype is underpinned by developmental programming by GCs, which is observed in the 11β-HSD2 brain KO. Salt appetite has been shown to be centrally regulated through the adult deletion of 11β-HSD2. From this, our data suggest that an increased salt appetite is due to adult loss of function of 11β-HSD2 rather than GC programming during development. Highlighting the NTS as a region for drug delivery to try and control salt appetite in salt sensitive individuals who struggle with administering a recommended change in diet. To develop this further, minimally invasive modes of delivery of viruses and drugs into the brain were investigated. In so doing, a non-invasive and reversible method to temporarily disrupt the blood brain barrier (BBB) was optimised. The technique required acoustic insonation of ultrasonic contrast agents (CAs) (gas microbubbles) adjacent to the BBB. These microbubbles (SonoVueTM, Bracco) were delivered via tail vein injection into the vasculature. To target the BBB, an ultrasonic transducer was suspended and focused through coupling gel onto the area of interest in the brain with skull the intact. The optimisation of this technique required determination of the focal position of the 3.5MHz transducer that was utilised, in addition to optimisation of the pulse length, pulse repetition frequency and power output of the ultrasound beam to enable the BBB to be disrupted. In addition, measurement of the attenuation of the ultrasound beam through ex vivo mouse skulls were measured. These results showed a 50% reduction in pressure amplitude from the baseline of 335.2mV (Baseline mean = 100% +/-SEM 0 n=3 (No skull), five regions across the skull averaged 47.79% +/-SEM 1.913 n=25 (using 5 different animals). In in vivo mice, after co-injection of the microbubbles with Evans Blue and insonation of the brain, disruption of the BBB was confirmed by the presence of Evans Blue dye in the brain, with no measurable damage occurring in the brain. This was confirmed by cell and nuclear morphology with no red blood cell extravasation into the surrounding tissue. The parameters used to open the BBB used a peak negative pressure of 2.1MPa (single pulse), transducer frequency 3.5MHz, 35,000 cycles over a 10ms burst at a pulse repetition frequency of 10Hz. The technique when applied in vivo in recovery animals is speculated to work by the focused ultrasound causing the microbubbles to oscillate within the vasculature adjacent to the BBB, resulting in high-shear stresses being generated on the tight junctions within the BBB. The resultant gaps in the BBB allow free circulating compounds (e.g. large dye molecules (Evans Blue - 960.8g/mol molecular weight) and adeno-associated-viruses (25nm with a packing capacity of 4.5kb) within the blood to pass into the brain, but there is no penetration of red blood cells (7μm). Longitudinal mouse experiments demonstrated that within 12-hours these gaps close with no long-term damage observed. Currently, utilising this technique, successful passage of an adeno-associated virus expressing GFP (as a marker) has been shown to pass into the brain (n=6 for each cohort including control) - indicating that the virus requires the ultrasound and microbubbles to facilitate its movement into the brain. Further technique optimisation is being explored looking at the role of CAs used in the opening and disruption of the BBB, comparing composition and size of the CAs. Microbubbles (2-3μm) and nanobubbles (200nm) were compared as well as lipid and non-ionic surfactant surface compositions, using volume of drug delivery and degree of disruption as outputs. Using this technique, the hydrophilic drug mimic calcein was delivered into the brain (n=5 non-ionic surfactant nanobubble, n=5 lipid nanobubble). Results have indicated that the delivery of calcein is most efficient when using non-ionic surfactant nanobubbles as opposed to lipid nanobubbles - with a greater volume of the drug being delivered into the cerebral tissue. Furthermore, the concentration and surface composition of the nanobubble have an effect as to the size and potential damage to the brain when opening the BBB. In conclusion, it has been shown that it is possible to non-invasively open the BBB and deliver viruses and dye into the brain. In addition, this thesis has investigated the use of nanobubbles as both facilitators to opening the BBB and delivery vectors for potentially therapeutic drugs. Finally, a non-invasive opening of the BBB has been achieved using focused ultrasound. Ultimately this non-invasive opening of the BBB can be used to achieve delivery of larger molecules (such as antibodies and viruses) into the brain to target treatments. Focused ultrasound brain targeting can be applied to the potential treatment of salt appetite regulation in the NTS. For the individuals who suffer from salt sensitive hypertension, the NTS can be targeted to reduce the drive to ingest high salt diets. Furthermore, the continuation of research into the central control of BP, salt appetite and baroreceptor reflex control can become better understood, using less invasive delivery techniques to the brain.

Breast cancer metastasizes to the brain in 15-30% of all breast cancer cases, and metastasis is the predominant cause of breast cancer-related deaths. Patients with HER2-enriched and triple-negative breast cancers (TNBCs) are more likely to develop brain metastases. While targeted therapies exist for HER2-enriched breast cancers, there are no effective treatments for TNBCs. Thus, a greater understanding of how these cancers spread to the brain is critical. In order to spread to the brain, disseminated breast cancer cells must overcome 2 major steps—crossing the blood-brain barrier (BBB) and survival and successful colonization of the distinctive and mostly cellular brain environment. Here, we report a novel role for breast cancer cell surface receptor, Syndecan-1 (Sdc1), a heparan sulfate proteoglycan, in promoting breast cancer cell transmigration across the BBB. We found that when we silenced Sdc1 expression in a highly metastatic TNBC cell line, MDA-MB-231, these cells exhibited reduced migration across an in vitro BBB model system. Further, in an in vivo experimental model of metastasis, mice injected with MDA-MB-231 Sdc1 KD (knock-down) cells developed less brain metastases than mice injected with control non-silencing (NS1) cells. Conversely, we found that overexpression of Sdc1 in a metastatic triple-negative mouse mammary carcinoma cell line, 4T1, led to an increase in brain metastases compared to empty vector control-treated mice. We predicted that a secreted factor(s) facilitated BBB disruption that allowed for Sdc1-mediated BBB transmigration, and found that silencing Sdc1 led to decreases in the production and/or release of various cytokines and chemokines implicated in BBB permeability and transmigration. In addition to supporting BBB transmigration, through an in vitro tissue section adhesion assay, we found that Sdc1 also facilitates adhesion of breast cancer cells to the brain, and not to the liver or lungs, revealing specificity for the brain. Further, we report that Sdc1 is expressed in 81% of breast cancer patient brain metastases in our tissue microarray study and that patients with TNBC and high Sdc1 expression have shorter disease-free survival based on a study performed using data from The Cancer Genome Atlas. Taken together, we predict that breast cancer cell Sdc1-regulated cytokines and chemokines promote BBB permeability and/or support transmigration to facilitate breast cancer metastasis to the brain. We also provide evidence for breast cancer-secreted extracellular vesicles, namely exosomes, in supporting the formation of a pro-metastatic brain environment. We compared exosomes derived from the metastatic 4T1 mouse mammary carcinoma cell line to a non-metastatic counterpart, the 67NR cell line, to assess their microRNA and protein composition and their effect(s) on recipient astrocytes, known mediators of brain metastasis. We found that there are inherent differences in both the microRNA and protein cargo from the metastatic 4T1 cells compared to the non-metastatic 67NR cells, whereby the metastatic 4T1 cells contained various tumor-promoting microRNAs and proteins, and also contained 4.5-fold more protein than the non-metastatic 67NR cells. Mouse astrocytes treated with the metastatic 4T1 exosomes exhibited a shift towards a pro-metastatic phenotype, characterized by upregulation of pro-inflammatory genes, and genes associated with astrocyte reactivity and cancer, whereby 67NR exosome-treated astrocytes exhibited a response profile that overlapped with untreated controls. Overall, these findings reveal an important role for exosomes in driving changes in the brain microenvironment to create a site conducive for cancer growth. Together, both studies help to elucidate how breast cancer cells can invade and colonize the unique brain environment.

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