Trois dérivés d’amino acides sont reconnus d’une manière stéréo sélective par l’albumine du sérum bovin. Cette propriété a été observée dans le cas de la phosphatase alcaline de tissu non spécifique, (TNAP). Des inhibiteurs agissant à trois niveaux distincts sur les processus de minéralisation ont été cherchés: 1) TNAP ; 2) Formation de l’hydroxyapatite (HA); 3) Vésicules maticielles (VMs). Nous avons trouvé que des dérivés de benzothiophènes et de tétramisoles, solubles dans l’eau, sont des inhibiteurs spécifiques de TNAP. Un modèle qui permet de produire du HA, a été développé et a confirmé que les nucléotides sont des inhibiteurs de formation de HA. Nous avons montré que le médicament anti-rhumatisme sinomenine, n’ayant aucun effet sur le TNAP, ainsi que la théophylline ralentissaient tous les deux la formation de HA induits par les VMs. Ces modèles de minéralisation présentent un grand potentiel lors du criblage de médicaments pour le traitement de l’ostéoarthrose / Three amino acid derivatives were stereoselectively recognized by bovine serum albumin. Such property was also observed in the case of tissue non-specific alkaline phosphatase (TNAP), a marker in mineral formation. Inhibitors acting at three distinct levels on mineral formation were searched: 1) TNAP; 2) Hydroxyapatite (HA) formation; 3) Matrix vesicle (MV). We found that benzothiophene derivative of tetramisole are water soluble inhibitors of TNAP. A model producing HA as MVs was developed and served to screen HA inhibitors, confirming that several nucleotides inhibited HA formation. We demonstrated that the anti-rheumatic Chinese medicine sinomenine, having no effect on TNAP and theophylline, slowed down HA induced by MVs. The mineralization models presented a great potential to screen putative drugs to cure ostoarthritis.

La rigidité artérielle est considérée comme un facteur de risque important pour le développement du déclin cognitif. Toutefois, les effets précis de la rigidité artérielle sur le cerveau sont peu connus et, à ce jour, aucun modèle animal ne permet d’étudier l’effet isolé de ce facteur sur l’homéostasie cérébrale. Dans cette étude, nous avons développé un nouveau modèle de rigidité artérielle qui se base sur la calcification de l’artère carotide chez la souris. Au niveau artériel, ce modèle présente une fragmentation de l’élastine, une augmentation de la distribution du collagène et de l’épaisseur intima-média ainsi qu’une diminution de la compliance et de la distensibilité artérielles démontrant la rigidité artérielle. De plus, le modèle ne présente pas d’augmentation de pression artérielle ni de changement de rayon du lumen indiquant une absence d’hypoperfusion globale et d’anévrisme. Au niveau cérébral, les résultats montrent que la rigidité artérielle induit une augmentation de la pulsatilité du flux sanguin cérébral menant ainsi à une augmentation du stress oxydatif. Ce dernier induit une inflammation cérébrale, détectée par l’activation de la microglie et des astrocytes, induisant ultimement une neurodégénérescence. Ces effets sont surtout observés au niveau de l’hippocampe, la région cruciale pour la mémoire et la cognition. Ainsi, cette étude montre que la rigidité artérielle altère l’homéostasie cérébrale et mérite d’être considérée comme une cible potentielle dans la prévention et le traitement des dysfonctions cognitives chez les personnes âgées. / Arterial stiffness is considered as an important risk factor for the development of cognitive decline in the elderly population. However, its precise effects on the brain are unknown and, to date, no animal model allows to study the precise outcome of arterial stiffness on the brain homeostasis. In this study, we developed a new animal model of arterial stiffness based on the calcification of the carotid artery in mice. On the arterial level, this model shows a fragmentation of elastin, increased collagen distribution and intima-media thickness as well as decreased arterial compliance and distensibility, thus fulfilling the major arterial stiffness properties. In addition, this model does not a show an increase in blood pressure or change in arterial lumen radius indicating a lack of global hypoperfusion and aneurysm. Regarding the brain, the results show that arterial stiffness induces an increase in cerebral blood flow pulsatility leading to increased oxidative stress. Oxidative stress induces brain inflammation, detected by the activation of microglia and astrocytes, ultimately leading to neurodegeneration. These effects are particularly observed in the hippocampus, a crucial area for memory and cognition. Thus, this study shows that arterial stiffness alters brain homeostasis and therefore should be considered as a potential therapeutical target for the prevention and treatment of cognitive dysfunction in the elderly.

Les maladies cardiovasculaires sont la première cause de mortalité dans le monde. Une meilleure compréhension des mécanismes physiopathologiques est nécessaire. Dans ce travail de thèse nous nous sommes intéressés à deux pathologies cardiovasculaires : l’athérosclérose et l’insuffisance cardiaque. Récemment, nous avons identifié le récepteur LRP1 et la protéine adaptatrice ShcA comme étant deux protéines impliquées dans deux de ces pathologies cardiovasculaires. Nousavons montré que ShcA joue un rôle protecteur dans l’insuffisance cardiaque. Chez les souris déficientes en ShcA au niveau cardiaque, nous observons une cardiomyopathie caractérisée par une dilatation du ventricule gauche associée à une perte de la contractilité. Nous avons montré que ShcA est essentiel à l’organisation des sarcomères et ceci très tôt durant l’embryogenèse. Dans une deuxième partie nous avons montré qu’en l’absence de PPARgamma, LRP1 était nécessaire à la calcification vasculaire en activant la voie prochondrogénique de Wnt5a. Nous avons montré que PPARgamma protège de la calcification vasculaire en induisant l’expression de Sfrp2 qui agit comme un antagoniste de Wnt5a. / Cardiovascular disease is the number one cause of death worldwide. A better understanding of the pathophysiological mechanisms is necessary. In this thesis we are focused on two cardiovascular diseases: atherosclerosis and heart failure. Recently, we identified the LRP1 receptor and the adapter protein ShcA as two proteins involved in two of these cardiovascular diseases. We have shown that ShcA exerts a protective role against heart failure. Mutant mice lacking ShcA in the heart exhibit a dilated cardiomyopathy with reduced cardiac contractility. Myocyte ultrastructure analysis shows that Shc A is essential to maintain sarcomeric intégrity in early embryonic heart development. in last part we have shown vascular calcification in the absence of PPARgamma requires expression of LRP1 in vascular smooth muscle cells. LRP1 promotes a Wnt5a-dependent prochondrogenic pathway. We show that PPARgamma protects against vascular calcification by inducing the expression of secreted frizzled-related protein-2 (Sfrp2, wich functions as a Wnt5a antagonist.

Introduction and Objectives Calcific aortic valve disease (CAVD) is the most common valvular disease, accounting for 50% of all valve disorders and is the third most common cardiovascular disease following coronary disease and hypertension.[1,2] Currently, there is no pharmacological agent capable of reversing or slowing down the progression of CAVD and treatment of severe cases consists of surgical repair or valve replacement[2]. Hence, there is a crucial need for earlier detection using predictive biomarkers that will allow for preventative intervention as opposed to post-symptomatic disease treatment or management. Namely, one target of particular interest is the expression of matrix metalloproteinases (MMPs) (specifically MMP-1, -2, and -9) which are upregulated in CAVD prior to calcification events and have been previously shown to serve as an attractive molecular imaging target.1–3 The primary objective of this study is to assess the feasibility of detecting biomarkers of CAVD by various in vivo imaging modalities, such as PET and echocardiography. In addition, this study assesses disease progression in various mouse strains to qualify an appropriate CAVD animal model. Methods In vivo and ex vivo imaging of C57Bl/6 and ApoE-/- (n = 8 per strain cohort) mouse models are used to link unique features of matrix remodelling with CAVD progression. At baseline and longitudinal follow-up (4, 8, and 12 months), in vivo hemodynamic impairment is assessed through echocardiography, and calcification and MMP activity are measured using PET with a series of radiotracers: [18F]NaF for calcification, [18F]BR351 for the molecular targets of MMP-2 and -9, and [18F]FMBP with molecular target specificity for MMP-13. Following imaging, aortic valve (AV) tissue is harvested, sectioned, and analyzed for calcification, inflammatory markers, collagen types, and MMP activity in AV leaflets. Tracer autoradiography, immunofluorescence, and in situ zymography are used to confirm in vivo imaging results with improved resolution and quantification in valves. Histological sample preparation, experimentation, and analyses are then repeated in human AV tissue samples for relative comparison of biomarker expression in animal models. Results Echocardiography suggests positive signs of disease progression in experimental animal models. In comparison to WT, ApoE-/- mice show: increased peak velocity (p<0.0001), decreased aortic valve area (p<0.001), and irregular valve dynamics. [18F]NaF PET imaging shows expected bone uptake and low calcium-burden in young and WT animals. [18F]FMBP shows increased uptake in the valve area of diseased models at later timepoints, 1.530 compared to <0.001 %ID/g (p<0.005), in disease vs control animals respectively. Furthermore, confirmation of sought-after biomarkers has also been assessed by analysis of various histological sample preparations including the presence of leaflet calcification, upregulation of MMP-2, -9, and -13, matrix remodelling, lipids, inflammatory markers, and activated MMP expression. Conclusion Findings from this study suggest that molecular imaging techniques using target-specific radiotracers, as well as echocardiography for assessment of hemodynamic impairment, are feasible solutions in predicting disease onset in CAVD specific animal models.

L’hypercholestérolémie familiale (FH) est un désordre lipidique associé aux maladies cardiovasculaires les plus fréquentes. La FH est causée par des mutations dans les gènes LDLR, APOB et PCSK9. Toutefois, chez 20% des patients souffrant de FH, aucune mutation dans ces gènes n'a été détectée et ceci suggère que d’autres gènes seraient à l’origine de la FH. Actuellement, le seul traitement de la FH est une thérapie aux statines. En général les statines sont bien tolérées, cependant, une monothérapie ne permet pas d’atteindre des niveaux thérapeutiques acceptables et dans bien des cas, une thérapie combinée devient nécessaire. De plus, l’intolérance aux statines est présente dans environ 12% des patients. Dans les trois dernières décennies, la survie des patients avec la FH a augmentée de façon notoire mais on observe aussi l’apparition d’une calcification vasculaire sévère chez certains d’entre eux. Il est donc primordial de développer des nouvelles approches thérapeutiques afin de prévenir ces complications tardives. Dans cette thèse doctorat, nous présentons l’étude d’une famille avec un phénotype de FH sévère non causé par des mutations dans les gènes LDLR, APOB et PCSK9. Par des études biochimiques et par séquençage d’ADN utilisant les technologies de nouvelle génération (NextGenSeq), nous avons découvert une mutation dans le gène de l’APOE (Leu167del). Ceci nous permet de proposer le gène codant pour l’APOE comme le 4e locus responsable de la FH (FH4). Par la suite, nous avons effectué deux études de cohortes chez les patients atteints de FH. Premièrement, dans l’étude JUPITER, nous avons démontré que la rosuvastatin augmente les niveaux sanguins de la protéine PCSK9 et ceci limiterait l’efficacité du traitement aux statines. Nous avons aussi étudié l’influence du mutant naturel R46L (perte de fonction de la PCSK9) dans la réponse aux statines. Deuxièmement, nous avons examiné les effets de la perte de fonction de la PCSK9 sur le profil cardiométabolique au sein d’une population pédiatrique. Nous avons déterminé que le génotype de l’APOE est déterminant dans ce profil cardiométabolique. Enfin, nous avons étudié la calcification vasculaire chez les patients atteints de FH. Cette calcification vasculaire progresse de façon indépendante des niveaux de cholestérol sérique et n’est pas associée aux anomalies de l’homéostasie du calcium. En utilisant des modèles murins, nous avons démontré que les souris Ldlr-/- et Tg(Pcsk9) développent des calcifications vasculaires semblables à celles observées chez l’homme. De plus, nous avons confirmé l’implication de la voie de signalisation LRP5/Wnt dans la pathophysiologie de la calcification artérielle. Avec une étude interventionnelle, nous avons trouvé que l’inhibition de l’interleukine 1β (IL-1β) diminue fortement l’apparition de calcifications vasculaire dans notre modèle murin. En conclusion, nos études ont permis l’identification d’un nouveau gène impliqué dans la FH, ont démontré aussi que les statines augmentent les niveaux sériques de PCSK9 et que la perte de fonction de la PCSK9 altère le profil cardiométabolique. Enfin, nous avons établi que la calcification vasculaire représente une complication tardive chez les patients atteints de FH et que, dans notre modèle murin, la calcification vasculaire peut être retardée par l’inhibition d’IL-1β. Ces découvertes peuvent avoir d’importantes répercussions cliniques chez l’humain. / Familial Hypercholesterolemia (FH) is the most common lipoprotein disorder associated with premature cardiovascular disease. Mutations in the LDLR, APOB and PCSK9 genes cause the FH phenotype, but in 20% of FH patients, no mutations in these genes are identified, suggesting that mutations in other genes cause FH. Treatment with statins has been the cornerstone of therapy. While statins are generally well tolerated, statin intolerance is found in approximately 12% of patients. Furthermore, statin use may not allow reaching LDL-C goals and combination therapy is often required. Nevertheless, survival of FH patients over the past 3 decades has improved significantly. As FH patients live longer, severe vascular calcifications have been described as a late complication in these patients. Given the increased survival rate and late complications, novel approaches and therapies are needed. In the present thesis we examined a kindred with a severe FH phenotype, where sequencing of candidate genes failed to identify a causal mutation. Through biochemical analysis and next-generation exome sequencing we report a mutation (Leu167del) within the APOE gene that identifies the 4th locus causing FH (FH4). Next, we performed two cohort-based studies. Firstly, in the JUPITER trial we report that 20mg rosuvastatin treatment increases PCSK9 levels by 30%, thereby possibly limiting the efficacy of statin therapy. Then we show the effect of a loss-of-function (LOF) mutation of PCSK9, p.R46L, on the response to rosuvastatin. Secondly, we report that two PCSK9 gene variants, p.R46L and insLEU, were more frequent in French Canadian individuals. We also report that the APOE genotype determine the metabolic risk profile in these mutations. Finally, we studied vascular calcifications in FH individuals. These calcifications appear to progress independently of cholesterol levels and are not associated with disturbances in calcium homeostasis. Using mouse models, we show that Ldlr-/- and Tg(Pcsk9) mice develop aortic calcifications similar to that observed in humans. Furthermore, the involvement of the LRP5/Wnt pathway in the pathogenesis of calcification is illustrated. In a proof-of-concept experiment, inhibiting the upstream pro-inflammatory cytokine IL-1β attenuates calcification in mice. In conclusion, we have contributed to the identification of a novel locus responsible for FH, reported the increase in PCSK9 levels with a statins treatment and the associated altered cardiometabolic profile in PCSK9 LOF. Finally, we demonstrated that vascular calcifications represent a severe complication of FH that can be prevented by inhibiting IL-1β in a mouse model. The latter novel approach may have an important translational application in human.

A maioria das calcificações em tecidos moles na região de cabeça e pescoço são achados radiográficos incidentais. Com o crescente uso da Tomografia Computadorizada de Feixe Cônico na Odontologia (TCFC) há um aumento do número desses achados, visto que o exame permite a visualização das estruturas em três dimensões. Esse estudo estabeleceu uma metodologia para identificar algumas dessas calcificações. Um observador calibrado analisou 100 exames de TCFC e as respectivas panorâmicas, quanto à presença de Ossificação do Complexo Estilo-Hióideo (OCEH), tonsilólitos e ateromas. Adicionalmente os processos estilóides foram mensurados. As correlações para as radiografias panorâmicas foram estatisticamente significante entre idade e comprimento do processo estilóide. As correlações para os exames de TCFC foram estatisticamente significantes entre idade e tonsilólitos, idade e o comprimento do processo estilóide e idade e ateromas. Houve diferença estatística significante (Wilcoxon p<0,05) entre os exames de TCFC e panorâmicas quanto à presença de tonsilólitos, presença de OCEH e para as mensurações dos processos estilóides. Foi detectada maior quantidade de calcificações em tecidos moles nos exames de TCFC. A identificação das calcificações em tecidos moles é importante no diagnóstico diferencial de muitas patologias incluindo os flebólitos. Portanto o profissional deve ficar atento a correta interpretação dessas estruturas, buscando evitar erros e omissões, para que possa oferecer ao paciente opção correta de tratamento se for necessário. / The most common soft tissue calcifications in head and neck region are incidental findings in radiographic images. The use of Cone Beam Computed Tomography in Dentistry, has increased these incidental findings mainly, because CBCT allows a third dimension view. The goal of this study was to differentiate the styloid chain ossification (SHCO), tonsilloliths and calcified atheromas. Based on a specific methodology, one calibrated observer analysed 100 panoramic and CBCT exams from the same patients regarding these alterations. Afterwards, the styloid process was measured at the same exams. The correlations tests for the panoramic exams were statistically significant between age and styloid process length. The correlations tests for CBCT exams were statistically significant between age and tonsilloliths, age and styloid process length and age and calcified atheromas. There was a difference statistically significant (Wilcoxon p<0.05) between CBCT and panoramic exams regarding: presence of tonsillolith, presence of SHCO and styloid process length. It was detected more quantity of soft tissues calcifications in CBCT exams. The identification of soft tissues calcifications is important for the differential diagnoses of many pathologies including phlebolits. Therefore the professional should be able to do a correct image interpretation in some cases in order to avoid mistakes and offer the patient a treatment if is necessary.

O período embrionário apresenta maior susceptibilidade a teratógenos, sendo a fase que as primitivas camadas germinativas e rudimento dos órgãos são formados. Cada órgão tem uma fase crítica de desenvolvimento e os processos bioquímicos envolvidos no crescimento e diferenciação tem uma seqüência ordenada, controlada por vários genes. A ossificação endocondral tem inicio sobre um molde de cartilagem hialina, com formato semelhante ao osso que irá se originar, sendo o principal responsável pela formação dos ossos curtos e longos. Assim, julgamos ser de grande valia um estudo embasado no desenvolvimento normal dos membros de embriões e fetos bovinos provenientes de vacas criadas em ambiente natural, através de estudos em microscopia de luz e microscopia eletrônica de transmissão. No processo de formação, desenvolvimento e ossificação dos membros observamos a formação de tecido mesenquimal condensado em embriões por volta da quarta semana gestacional, passando pelo processo de diferenciação em células cartilaginosas. Ao redor da sétima semana gestacional inicia-se o processo de calcificação da cartilagem com depósitos de cálcio e fósforo para formação de tecido ósseo, seguido de morte dos condrócitos. / The embryonary period presents a bigger susceptibility to theratogens, being the phase in which the primitive germinative layers and rudiment of organs are been formed. Each organ has a critical phase of development and the biochemical processes involved in growing and differentiation have an ordered sequence, controlled by several genes. The endochondrial ossification has begun over a hyaline cartilage mould, having a shape similar to the bone that will be grow, being the principal responsible for the short and long bones formation. Thus, we think it is much valid a study based on normal development of bovine embryos and fetuses\' limbs coming from cows bred in a natural environment, through studies in light microscopy and transmission electronic microscopy. In the process of formation, development and ossification of limbs, we saw condensed mesenchymal tissue formation in the embryos at around the gestational fourth week, passing through differentiation process in cartilaginous cells. At around the gestational seventh week, it has begun the calcification process of cartilage with calcium and phosphorous deposits to the bone tissue formation, followed by chondrocites death.

As atividades humanas nos últimos dois séculos vêm provocando um aumento na concentração de dióxido de carbono (CO2) atmosférico. Um dos efeitos desse aumento é um incremento na produtividade primária de algumas espécies vegetais terrestres, que dessa maneira atuam como sequestradoras de carbono. Nos oceanos, o CO2 é armazenado principalmente na forma de carbonato de cálcio (CaCO3), e o aumento na sua concentração leva a uma acidificação da água do mar e a uma menor disponibilidade de íons carbonato. Os animais que precipitam CaCO3 não serviriam como sequestradores de carbono porque o processo de calcificação produz CO2. Porém, a maioria das medidas de balanço de CO2 em comunidades calcárias marinhas negligenciam as formações de algas. Nas algas calcárias o CO2 produzido pela calcificação é aproveitado pela fotossíntese. Além disso, aumentos na concentração de CO2 podem levar a aumentos na taxa de crescimento, embora essas taxas possam ser afetadas por uma queda na disponibilidade de íons carbonato. O objetivo deste trabalho foi verificar se o aumento na concentração de CO2, e a acidificação da água do mar por ela causada, afetam o crescimento de algas calcárias. Tendo em vista a ausência de referências sobre trabalhos desse tipo com algas calcárias e considerando que as coralináceas não-articuladas, grupo de algas com maior calcificação, são difíceis de trabalhar em laboratório, a primeira etapa do projeto foi dedicada ao estabelecimento de cultivos e de metodologias de trabalho. Foram analisadas algas calcárias de diversos grupos, sendo escolhidas as coralináceas não-articuladas pois sua calcificação, além de constante em relação ao crescimento, é bastante alta, o que compensa seu lento crescimento. Para os experimentos de injeção de CO2 estabeleceu-se o uso de frascos de 50 mL com 35 mL de meio artificial MCM, irradiância de 42 &#956;mol.m-2.s-1, temperatura de 25°C e período de incubação de uma semana. Os experimentos de enriquecimento com CO2 foram feitos com nódulos de Lithophyllum sp. incubados após borbulhamento com diferentes volumes desse gás. Para isolar o efeito da acidificação foram feitas injeções de CO2 em meio com e sem adição de CaCO3 como tampão. Também foram feitas incubações em meio acidificado com HCl de modo a verificar o efeito da acidificação independente de um aumento de CO2. O crescimento foi estimado pela calcificação, medida através da técnica de anomalia de alcalinidade. Para os grupos experimentais em meio tamponado, a injeção de quantidades cada vez maiores de CO2 levou a um aumento proporcional nas taxas de crescimentos para volumes até 0,2 L, acima dos quais essas taxas permanecem as mesmas independente do aumento de CO2; esse limite é provavelmente devido à saturação do meio e não da alga, uma vez que o borbulhamento foi feito apenas no início do período de incubação. Nos grupos sem tamponamento, pequenos volumes de CO2 (0,06 L) provocam um aumento na taxa de calcificação; volumes um pouco maiores (0,2 L) provocam queda na taxa de crescimento; acima desse valor ocorre a morte das algas após algumas semanas. Os resultados das injeções em meio sem adição de tampão são consistentes com os valores obtidos com a acidificação do meio sem enriquecimento com CO2. Lithophyllum sp. não apresenta variação na taxa de crescimento entre pH 8,0 e 7,5. Em pH 7,0 ocorre queda da taxa de crescimento e morte em pH abaixo de 6,5. Os resultados, embora não sejam conclusivos devido à limitações metodológicas, indicam que Lithophyllum sp., e provavelmente as demais algas coralináceas, podem sequestrar carbono dentro de certos valores de pH. Devido à utilização de meio de cultura artificial rico em carbonatos, o limite obtido de pH 7,0 para crescimento deve ser maior em ambiente natural. Este estudo mostrou ser necessária a realização de trabalhos mais extensos, para os quais as técnicas e procedimentos aqui descritos trabalho podem ser utilizados. / Human activities over the last two centuries provoked an increase in the concentration of carbon dioxide (CO2) in the atmosphere. One of the effects of this increase is an increment in the primary production of some terrestrial plants which in this way act carbon sinks. In the oceans the CO2 is stored mainly as calcium carbonate (CaCO3). An increase in the concentration of CO2 leads to seawater acidification and to a decrease in carbonate ions availability. Calcareous organisms, in principle, does not act as carbon sinks because the calcification process produces CO2. However, the majority of CO2 measurements in marine communities neglect the calcareous seaweed formations. In calcareous seaweeds the CO2 produced during the calcification process is utilized by photosynthesis. Moreover, increases in the CO2 concentration can lead to an increase in growth rates, although these rates can be negatively affected by a decrease in the availability of carbonate ions. The objective of this work is to test if an increase in the CO2 concentration, and seawater acidification, affects the growth rate of marine calcareous seaweeds. Information on seaweed calcification is scarce, specially on the non-articulated coralline algae, which are the main group of calcareous seaweeds. This group is difficult to work with in laboratory, and therefore the first stage of the project was dedicated to establish seaweed cultures and work methodologies. We tested different calcareous seaweeds including non Corallinaceae, articulated and non articulated coralline algae. Calcification presents a constant relation with growth and is higher on non articulated corallines, what compensates their slow growth. For the experiments of CO2 injection we utilizes vials of 50 mL with 35 mL of MCM artificial medium, irradiance of 42 &#956;mol.m-2·s-1, temperature of 25°C and one week incubation time. The experiments of CO2 enrichment were made with nodules of Lithophyllum sp. incubated after bubbling different volumes of CO2. To isolate the acidification effect from the effect of CO2, injections were made in media with, and without, addition of CaCO3 as buffer. Incubations in medium acidified with HCl were also performed to verify the effect of acidification independent of CO2 increment. The growth was estimated by calcification, measured trough the alkalinity anomaly technique. For the buffered medium, injections of gradually higher volumes of CO2 led to a proportional increase in growth rates until the limit of 0.2 L; above this limit the growth rates remained the same, regardless the increase of CO2. This limit is probably due to saturation of the medium and not of the seaweed, once the bubbling was limited only to the beginning of the incubation time. In the groups without buffering, small volumes of CO2 (0.06 L) resulted in an increase in the growth rate. Volumes slightly higher (0.2 L) resulted in a decrease in the growth rate. In higher volumes seaweed began to die. These results are consistent with those obtained by acidifying with HCl. Lithophyllum sp. presented no variation in growth rate between pH 8.0 and 7.5. A decrease in growth rates occurred at pH 7.0, and death occurred at pH below 6.5. The results are not conclusive due to methodological limitations, but indicate that Lithophyllum sp., and probably other coralline algae, can act as carbon sinks under certain pH values. Due to the utilization of a carbonate rich artificial culture medium the observed pH 7.0 limit for growth must be higher in natural environment. More extensive work is necessary to understand the role of these seaweeds on the global atmospheric CO2 increase, for which the techniques and procedures described in this work can be utilized.

Introduction. Fused Positron Emission Tomography and Computed Tomography (PET/CT) is an emerging investigative tool in cardiovascular disease that provides an imaging-based quantification of pathophysiological processes of interest. The purpose of this thesis was to study the application of PET to identify fundamental pathophysiological processes driving 3 forms of cardiovascular disease: aortic stenosis, myocardial infarction, and atherosclerosis. Methods. Aortic Stenosis. Patients with a spectrum of calcific aortic valve disease (n=121) who underwent PET-CT imaging for the identification of valvular calcification (18Ffluoride) and inflammation (18F-fluorodeoxyglucose, 18F-FDG) underwent serial imaging and clinical follow-up over 2 years. Baseline imaging findings were compared with echocardiographic and CT markers of disease progression and clinical outcome. Myocardial Infarction. Patients underwent PET-CT imaging with 18F-fluciclatide (a novel αvβ3-selective radiotracer highlighting active angiogenesis, inflammation and fibrosis) after ST-segment elevation MI (n=21), alongside stable patients with chronic total occlusion (CTO) of a major coronary vessel (n=7), and healthy volunteers (n=9). Myocardial radiotracer uptake was compared with clinical and cardiac magnetic resonance imaging (CMR) markers of infarction and remodeling. Atherosclerosis. Patients with a spectrum of atherosclerotic disease categorized as stable or unstable (recent MI) underwent PET/CT imaging with 18F-fluciclatide (n=46). Thoracic aortic 18F-fluciclatide uptake was compared with aortic atherosclerotic burden quantified by CT plaque thickness, plaque volume and calcium scoring. Histological validation. Tissue from the aortic valve, myocardium and carotid arteries of study subjects was acquired and examined ex vivo using histology and autoradiography. Results. Aortic Stenosis. Baseline valvular 18F-fluoride uptake correlated strongly with the rate of progression in AVC (r=0.80, p < 0.001) and with haemodynamic progression (mean aortic valve gradient r=0.32, p=0.001). It emerged as independently associated with clinical outcome after age and sex-adjustment (HR 1.55 [1.33-1.81], p < 0.001). 18F-FDG demonstrated moderate correlations with disease progression as assessed by CT (r=0.43, p=0.001) and echocardiography (18F-FDG r=0.30, p=0.001), and was associated with clinical outcomes independent of age and sex (HR 1.35 [1.16-1.58], p < 0.001). Valvular 18F-fluoride uptake correlated with immunohistochemical markers of calcification activity. There was no correlation between 18F-FDG uptake and inflammation. Myocardial Infarction. 18F-Fluciclatide binding was demonstrated in ex vivo peri-infarct myocardium and uptake was increased in vivo at sites of acute infarction compared to remote myocardium (tissue-to-background ratio (TBRmean) 1.34±0.22 vs 0.85±0.17 respectively, p < 0.001) and myocardium of healthy volunteers (TBRmean 1.34±0.22 vs 0.70±0.03; p < 0.001). There was no 18F-fluciclatide uptake at sites of established prior infarction in patients with CTO, with myocardial activity similar to healthy volunteers (TBRmean 0.71±0.06 vs. 0.70±0.03,p=0.83). 18F-Fluciclatide uptake occurred at sites of regional wall hypokinesia (wall motion index ≥1 vs 0; TBRmean 0.93±0.31 vs 0.80±0.26 respectively, p < 0.001), was increased in segments displaying functional recovery (TBRmean 0.95±0.33 vs 0.81±0.27, p=0.002) and associated with increase in probability of regional recovery. Atherosclerosis. 18F-Fluciclatide vascular binding ex vivo co-localised with regions of increased αvβ3 integrin expression, and markers of inflammation and angiogenesis. 18F-Fluciclatide uptake in vivo correlated with measures of aortic atherosclerotic burden: plaque thickness (r=0.57, p=0.001), total plaque volume (r=0.56, p=0.001) and the CT aortic calcium score (r=0.37, p=0.01). Patients with recent MI had greater aortic 18F-fluciclatide uptake than those with stable disease (TBRmax 1.33 vs 1.21, p=0.01). Conclusions. In a range of cardiovascular diseases, PET-CT can provide insights into key pathophysiological processes, guide patient risk stratification and prognosis, and identify important biomarkers of disease activity that can be used for the development of future therapeutic interventions.

Calcific aortic valvular disease (CAVD) is the most common valvular pathology in the developed world. CAVD results in calcifications forming on the aortic valve leaflets, inhibiting proper closure and causing complications of stenosis and regurgitation. Although, the mechanisms behind the disease initiation are unknown, it is believed to be a cell-mediated phenomenon, and not the result of passive degradation of the valve as once believed due to the increased prevalence with age. Currently, there are no pharmaceutical options for the prevention or reversal of calcifications, the only treatment option is complete valve replacement, an imperfect solution. Hindering the development of potential therapeutics is that currently there are no adequate animal models which replicate the calcification and cell death seen in disease explanted valves. An in vitro model has been develop where valvular interstitial cells (VICs), the main cell type of the valve, are seeded at high density into tissue culture polystyrene dishes and cultured with TGF-β1. This results in VICs activating to the myofibroblast phenotype and forming cell aggregates. Due to currently unknown mechanisms, apoptosis occurs within the center of the aggregates and calcification ensues. Although simplistic, this model has been used to show that rate and frequency of aggregation is affected by cellular tension; conditions of high tension increase aggregation response, while conditions of low tension prevent aggregation and calcification from occurring. It is important to note; however, that despite its wide usage, the current model is limited as the aggregation and subsequent calcification are random occurrences and are not consistent across literature where same conditions for control samples are used. The motivation of the presented work is two-fold. First, high intracellular tension has been suggested as one of the mechanisms leading to disease in the valve. Despite the clear and important role of cell tension, VIC tension has never before been measured in a dynamic environment. The ways in which dynamic stimulation affects individual VIC tension is not known. In aim one, a method is developed to allow for long-term cyclic stretch of VICs with measurement of cell traction force. It was found that cyclic stretch decreased cell tension in cells with high prestress and increased cell tension for conditions of low prestress. Combined, these findings indicate a homeostatic cellular tension which is dependent upon the mechanical environment. In the second aim, a novel method for creating VIC aggregates is validated. Micro-contact printing, essentially “stampingâ€� of a protein in a defined pattern, is used to create circular aggregates on polyacrylamide gels. This method allows for the separation of the aggregation from the subsequent calcification, an improvement over the current in vitro model. The method is then used to explore the role of the distribution of tension in the initiation of disease