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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
161

Papel da eritropoetina na atenuação da fibrose miocárdica / The role of erythropoietin upon myocardial fibrosis

Fernanda Gallinaro Pessoa 06 June 2014 (has links)
Introdução: No processo de remodelamento miocárdico ocorre hipertrofia de miócitos e deposição exacerbada de colágeno no interstício, promovendo alteração na geometria e na função do coração. A eritropoetina (EPO) tem sido amplamente estudada nesse cenário, pois exerce efeitos cardioprotetores. Objetivo: Avaliar o papel da EPO na atenuação do remodelamento estrutural, geométrico e funcional do coração, em modelo experimental de infarto do miocárdio. Materiais e Métodos: Estudados 60 ratos Wistar machos divididos em 4 grupos (Controle; Controle+EPO; Infartado; Infartado+EPO). A fração do volume de colágeno intersticial do ventrículo esquerdo (FVCI-VE) e do ventrículo direito (FVCI-VD) foi determinada em cortes histológicos, corados com picrosirus red utilizando-se o programa QWIN Image Processing and Analysis Software (Leica Microsystems Cambridge Ltd.). Essas mesmas lâminas e o software foram utilizados para a medida do tamanho da área de infarto. A análise anatômica e funcional foi realizada por ecocardiograma, avaliando-se a fração de encurtamento do VE (FE) e o diâmetro diastólico do VE (DDVE). Para o estresse oxidativo, dois kits comerciais foram utilizados na determinação da glutationa e do ADMA. A sobrecarga ventricular, apoptose e inflamação foram realizadas por PCR, em tempo real. Na avaliação da angiogênese, utilizamos a técnica de imunohistoquímica. A análise hematológica foi realizada por exames laboratoriais para dosagem de hemoglobina e hematócrito. Resultados: A FVCI-VE (%) foi maior nos grupos infartados em relação aos grupos controles (p < 0,001), e atenuada pela EPO (p < 0,001, IAM vs IAM+EPO) (CT = 0,76 ± 0,21; CT+EPO = 0,63 ± 0,15; IAM+EPO = 1,43 ± 0,92; IAM= 3,47 ± 2,5). A FVCI-VD (%) também foi maior nos infartados em relação aos grupos controles (CT = 0,60 ± 0,2; CT+EPO = 0,83 ± 0,3; IAM+EPO = 1,01 ± 0,55; IAM = 1,60 ± 1,15) (p < 0,001), mas sem diferença estatística quando comparados os grupos IAM vs IAM+EPO. A EPO não influenciou o tamanho do IAM. Os grupos infartados tiveram piora na fração de encurtamento em relação aos controles (CT = 45,65% ± 6,4; CT+EPO = 40,81% ± 4,44; IAM+EPO = 17,32% ± 6,01 e IAM = 20,11% ± 9,49) (p < 0,001), mas sem proteção da EPO. Os grupos infartados também tiveram maior dilatação do VE (p < 0,001) (CT = 0,73 ± 0,06; CT+EPO = 0,74 ± 0,05; IAM+EPO = 0,81 ± 0,09; IAM = 0,87 ± 0,11) sem atenuação da EPO. Os marcadores de estresse oxidativo, ADMA e glutationa, não evidenciaram ação da EPO nessa via. No que se refere à sobrecarga ventricular, o gene BNP apresentou maior expressão nos grupos infartados, em relação aos controles, porém não foi atenuado pela EPO (p = 0,103). Com relação à apoptose, os genes Bcl-2 e p53 mostraram-se mais expressos nos grupos infartados em comparação aos controles (p < 0,05), mas o Bcl-2 não foi ativado e nem o p53 inibido pela EPO. Os genes estudados na avaliação da inflamação foram TNF-alfa, TGF-beta1 e Ccr-5, também não demonstraram efeito anti-inflamatório da EPO. A semiquantificação da angiogênese pela marcação do VEGF também não apresentou diferença significativa entre os grupos (p = 0,95). A análise da hemoglobina e do hematócrito apresentou diferença significativa em relação aos grupos tratados ou não com EPO (p = 0,003 e p = 0,001), respectivamente. Conclusões: EPO atenuou significativamente o acúmulo de colágeno intersticial, mas não protegeu o coração quanto à dilatação, à disfunção e à sobrecarga ventricular neste modelo. Na fase crônica do infarto, avaliada neste estudo, a EPO não modulou as vias da apoptose, estresse oxidativo e inflamação / Introduction: The process of myocardial remodeling include inappropriate collagen deposition in the interstitium developing an overall process of structural and geometric remodeling of the heart. Erythropoietin (EPO) may have a cardioprotective effects including inflammatory and oxidative stress modulation. Objective: The aim of this study was to assess the role of EPO upon structural, geometric and functional remodeling at the heart. Materials and Methods: 60 Wistar rats were divided into 4 groups: Control, Control+EPO, Infarcted, Infarcted+EPO. Interstitial collagen volume fraction in the left (LV-ICVF) and right ventricle (RV-ICVF) was quantified by videomorphometry using a QWIN Image Processing and Analysis Software (Leica Microsystems Cambridge Ltd.). These same slides and software were also used to measure the size of the infarct area. The analyzed echocardiographic parameters were the left ventricle shortening fraction (LVFS) and diastolic diameter (LVDD). For oxidative stress, two commercial kits were used in to quantify ADMA and glutathione. RT-PCR was used to assess ventricular overload, apoptosis and inflammatory cytokines. For angiogenesis we used immunohistochemistry and hematological analysis was performed by laboratory tests for hemoglobin and hematocrit. Non parametric analysis was performed and p <=0.05 was considered significant. Results: LV-ICVF (%) was greater in the infarcted groups compared to controls (p < 0.001), and attenuated by EPO (p = 0.05, MI vs MI+EPO) (CT = 0.76 ± 0.20; CT+EPO = 0.62 ± 0.16; MI+EPO = 1.22 ± 0.86; MI = 3.80 ± 2.6). The RV-ICVF (%) was also greater in the infarcted groups compared to controls (CT = 0.60 ± 0.2; CT+EPO = 0.82 ± 0.28; MI+EPO = 1.02 ± 0.58; IAM = 1.62 ± 1.20) (p = 0.007) but without statistical difference between MI vs MI+EPO. Regarding infarct size we did not observe any difference. The infarcted groups had a worsening shortening fraction compared to controls (CT = 45.65% ± 6.4; CT+EPO = 40.81% ± 4.44; MI+EPO = 17.32% ± 6.01 and MI = 20.11% ± 9.41) (p < 0,001), but without EPO protection. The infarcted groups also showed increased LV dilation (p < 0.001) (CT = 0.73 ± 0.06; CT+EPO = 0.74 ± 0.05; MI+EPO = 0.81 ± 0.08; MI = 0.90 ± 0.11) without EPO attenuation. Oxidative stress markers ADMA and glutathione did not show EPO action in this pathway. The BNP that evaluate ventricular overload, presented increased expression in infarcted groups (p = 0.04), but not attenuated by EPO (p = 0.103). The genes of apoptosis Bcl-2 and p53 were more expressed in infarcted groups when compared to controls (p < 0.05), but Bcl-2 was not activated and p53 inhibited by EPO. For Inflammation just 3 genes exhibit expression with statistical differences between groups (TGF-beta1, TNF-alfa, and CCr-5), but it did not show the EPO anti-inflammatory effect. The semi-quantification of angiogenesis by VEGF expression also did not show statistically significant differences between groups (p = 0.95).The analysis of hemoglobin and hematocrit presented significant differences compared to groups treated or not with EPO (p = 0.003 and p = 0.001), respectively. Conclusions: EPO significantly attenuated the accumulation of interstitial collagen, but it did not reflected in the protection of the heart dilation or dysfunction and oxidative stress, ventricular overload, apoptosis and inflammation of gene expression in this model
162

Functional characterization and molecular identification of neuroprotective receptors for erythropoietin-like ligands

Hahn, Nina 12 December 2021 (has links)
No description available.
163

Effects of iron supplementation on iron status, health and neurological development in marginally low birth weight infants.

Berglund, Staffan January 2012 (has links)
Background Due to small iron stores and rapid growth during the first months of life, infants with low birth weight (LBW) are at risk of iron deficiency (ID). ID in infancy is associated with irreversible impaired neurodevelopment. Preventive iron supplementation may reduce the risk of ID and benefit neurodevelopment, but there is also a possible risk of adverse effects. More than 50% of all LBW infants are born with marginally LBW (MLBW, 2000-2500g), and it is not known if they benefit from iron supplementation. Methods We randomized 285 healthy, Swedish, MLBW infants to receive 3 different doses of oral iron supplements; 0 (Placebo), 1, and 2 mg/kg/day from six weeks to six months of age. Iron status, during and after the intervention was assessed and so was the prevalence of ID and ID anemia (IDA), growth, morbidity and the interplay with iron and the erythropoetic hormones hepcidin and erythropoietin (EPO). As a proxy for conduction speed in the developing brain, auditory brainstem response (ABR) was analyzed at six months. In a follow up at 3.5 years of age, the children were assessed with a cognitive test (WPPSI-III) and a validated parental checklist of behavioral problems (CBCL), and compared to a matched reference group of 95 children born with normal birth weight. Results At six months of age, the prevalence of ID and IDA was significantly higher in the placebo group compared to the iron supplemented infants. 36% had ID in the placebo group, compared to 8% and 4 % in the 1 and 2mg/kg/day-groups, respectively. The prevalence of IDA was 10%, 3% and 0%, respectively. ABR-latencies did not correlate with the iron intake and was not increased in infants with ID or IDA. ABR wave V latencies were similar in all three groups. Hepcidin correlated to ferritin and increased in supplemented infants while EPO, which was negatively correlated to iron status indicators, decreased. At follow up there were no differences in cognitive scores between the groups but the prevalence of behavioral problems was significantly higher in the placebo group compared to those supplemented and to controls. The relative risk increase of CBCL-scores above a validated cutoff was 4.5 (1.4 – 14.2) in the placebo-group compared to supplemented children. There was no detected difference in growth or morbidity at any age. Conclusion MLBW infants are at risk of ID in infancy and behavioral problems at 3 years of age. Iron supplementation at a dose of 1-2 mg/kg/day from six weeks to six months of age reduces the risks with no adverse effects, suggesting both short and long term benefit. MLBW infants should be included in general iron supplementation programs during their first six months of life.
164

Tierexperimentelle Behandlungsversuche der Charcot-Marie-Tooth-Erkrankung 1A / Experimental therapy trials of the Carcot-Marie-Tooth Disease 1A in vivo

Weiss, Bernhard G. 03 March 2014 (has links)
No description available.
165

AVALIAÇÃO COMPARATIVA DE POTÊNCIA DE ERITROPOIETINA HUMANA RECOMBINANTE POR BIOENSAIO ALTERNATIVO E CORRELAÇÃO COM MÉTODOS FÍSICO-QUÍMICOS / COMPARATIVE POTENCY ASSESSMENT OF RECOMBINANT HUMAN ERYTHROPOIETIN BY ALTERNATIVE BIOASSAY AND CORRELATION WITH PHYSICOCHEMICAL METHODS

Schutkoski, Renato 09 August 2012 (has links)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Erythropoietin is a sialoglycoprotein which promotes the increase of erythropoiesis. Clinically is used for the treatment of anaemia associated to chronic renal failure. Identification and separation of isoforms of recombinant human erythropoietin (rhEPO) in biopharmaceuticals of different origins, was carried out by isoelectric focusing (IEF) western blotting and, also by lectin binding with Triticum vulgaris, showing 4-7 isoforms distributed in the isoeletric range of 4.4 to 5.2. N-acetylneuraminic acid content was quantified by reversed-phase liquid chromatography method with fluorescence detection giving values higher than 108.74 ηg/μg. Biological activity was evaluated by the normocythaemic mice bioassay, and investigating the TF-1 cell line in vitro. The correlation of the results of both of the methods were significant, as calculated by the Pearson s coefficient (r = 0.9967). In addition, the content/potency of the biopharmaceutical products was assessed by validated reversed phase and size exclusion liquid chromatography methods, showing mean values 2.11% and 1.21% lower, respectively, related to the in vivo bioassay. Sample was degraded under UV light to generate deamidate/sulphoxide forms and treatment at 65ºC for 12 hours to produce dimeric and aggregated forms. The potencies were evaluated by the normocythaemic mice assay and the TF-1 cell culture assay giving mean reduction of 14.05% and 32.87%, respectively, related to the intact molecule. The alternative in vitro assay investigated in the context of the reduction or replacement of the animals, and the evaluation of the correlations between physicochemical and biological methods, represent improvements which can be applied to the production steps and for the quality control of rhEPO, contributing to ensure the batch-to-batch consistency of bulk and finished biological products. / A eritropoietina é uma sialoglicoproteína que promove o aumento da eritropoiese. Clinicamente é usada para o tratamento de anemias associadas à falência renal crônica. No presente realizou-se identificação e separação das isoformas de eritropoietina humana recombinante (rhEPO) em produtos biofarmacêuticos de diferentes origens, por focalização isoelétrica (IEF), seguida de imunodetecção, e também por ligação à lectina Triticum vulgaris, demonstrando a presença de 4 a 7 isoformas, distribuídas na faixa de ponto isoelétrico de 4,4 a 5,2. Quantificou-se o conteúdo de ácido N-acetilneuramínico por cromatografia líquida por fase-reversa e detecção por fluorescência obtendo teores acima de 108,74 ηg/μg. Avaliou-se a atividade biológica pelo bioensaio em camundongos normocitêmicos e pesquisou-se o ensaio alternativo baseado na cultura da linhagem celular TF-1 in vitro. Os resultados dos bioensaios apresentaram correlação significativa, conforme calculado pelo coeficiente de correlação de Pearson (r = 0,9967). Paralelamente, determinou-se o teor/potência dos produtos pelas metodologias validadas por cromatografia líquida por fase reversa e por exclusão molecular, que forneceram média de resultados 2,11% e 1,21% menores, respectivamente, em relação ao bioensaio in vivo. Submeteu-se amostra à degradação por luz UV para obter as formas desamidadas/oxidadas e tratamento a 65°C por 12 horas para as diméricas e agregadas. Efetuou-se a avaliação pelo bioensaio in vivo e in vitro, que apresentaram redução média de 14,05% e 32,87% respectivamente, em relação à molécula intacta. Desse modo, o ensaio biológico alternativo in vitro, pesquisado no contexto da redução ou substituição do uso de animais, e as avaliações de correlação entre métodos físico-químicos e biológicos, representam aprimoramentos aplicáveis para as etapas do processo de produção e para o controle de qualidade de rhEPO, contribuindo para garantir a consistência lote-a-lote da solução concentrada e dos produto biológicos acabados.
166

VALIDAÇÃO DE BIOENSAIO POR CULTURA DE CÉLULAS PARA AVALIAÇÃO DE POTÊNCIA DE RHEPO E CORRELAÇÃO COM BIOENSAIO IN VIVO E MÉTODOS CROMATOGRÁFICOS / VALIDATION OF A CELL CULTURE BIOASSAY FOR THE POTENCY ASSESSMENT OF RHEPO AND ITS CORRELATION WITH THE IN VIVO BIOASSAY AND LIQUID CHROMATOGRAPHY METHODS

Machado, Francine Trevisan 12 August 2014 (has links)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Erythropoietin is a hematopoietic hormone and the main physiological function is the induction of erythropoiesis. Recombinant DNA technology enabled cloning and expression of rhEPO gene to produce recombinant human erythropoietin (rhEPO). It is a sialoglycoprotein composed of 165 amino acids chain and about 40% of the molecule consists of carbohydrates, important for biological activity due to the presence of sialic acid residues at the termini of chains affecting its half-life. In the present study an alternative in vitro cell culture-based assay using TF-1 cell line was validated, to be used in conjunction with a reversed-phase liquid chromatography method with fluorescence detection (F-RP-LC) validated to determine the content of sialic acids. The values obtained for the sialic acids were higher than 126.83 ng/μg, and the biotechnology-derived products were subjected to the cell culture bioassay giving potencies 2.91% ± 0.85 lower related to the bioassay in normocythaemic mice, with significant correlation calculated by the Pearson coefficient (r = 0.9947). In parallel, it was determined the content/potency of the products by the validated reversed-phase and size-exclusion liquid chromatography methods that showed mean results 3.14% higher and 2.87% lower, respectively, compared to the in vitro bioassay. It was demonstrated that in vitro cell culture bioassay represent a valid alternative to the in vivo bioassay for the potency assessment of rhEPO, in the context of the reduction and/or replacement of animals. Likewise, correlation of the results obtained with the physicochemical methods, represents advances for the characterization of the biomolecule, which can be applied to the production steps and for the quality control, contributing to assure the batch-to-batch consistency of the bulk and the finished biological products of rhEPO. / A eritropoietina é um hormônio hematopoiético cuja principal função fisiológica é a indução da eritropoiese. Através da tecnologia do DNA recombinante foi possível a clonagem e expressão do gene para produzir a eritropoietina humana recombinante (rhEPO). É uma sialoglicoproteína composta por cadeia de 165 aminoácidos e, aproximadamente, 40% da molécula é constituída de carboidratos, importantes para a atividade biológica devido à presença de resíduos de ácidos siálicos nas extremidades das cadeias, que influenciam na meia-vida da biomolécula. No presente estudo foi validado ensaio alternativo baseado na cultura da linhagem de células TF-1 in vitro, e método por cromatografia líquida por fase reversa com detecção por fluorescência para determinação de ácidos siálicos, para avaliação em conjunto da potência de rhEPO. Determinaram-se teores de ácidos siálicos acima de 126,83 ng/μg e os produtos biotecnológicos foram submetidos ao bioensaio por cultura de células fornecendo potências 2,91% ± 0,85 menores em relação ao ensaio biológico em camundongos normocitêmicos, com correlação significativa calculada pelo coeficiente de correlação de Pearson (r = 0,9947). Paralelamente, determinou-se o teor/potência dos produtos pelas metodologias validadas por cromatografia líquida por fase reversa e por exclusão molecular, que forneceram média de resultados 3,14% maior e 2,87% menor, respectivamente, em relação ao bioensaio in vitro. Demonstrou-se que o bioensaio por cultura de células in vitro, constitui-se em alternativa ao ensaio biológico in vivo para a avaliação de potência de rhEPO, no contexto da redução e/ou substituição do uso de animais. Do mesmo modo, a correlação com os resultados fornecidos pelos métodos físico-químicos, representa avanços para caracterização da biomolécula, que podem ser aplicados nas etapas do processo de produção e para o controle de qualidade, contribuindo para garantir a consistência lote-a-lote da solução concentrada e dos produtos biológicos acabados de rhEPO.
167

Role and expression of transferrin receptor 2 in erythropoiesis / Rôle et expression du récepteur de la transferrine de type 2 dans la lignée érythroïde

Vieillevoye, Maud 12 July 2013 (has links)
L’érythropoïèse est le processus de différentiation d’un progéniteur érythroïde multipotent en globules rouges. La différentiation érythroïde est essentiellement contrôlée par le récepteur à l’érythropoïétine (EPOR). Nous avons montré que le récepteur à la transferrine de type 2 (TFR2) est un membre important du complexe formé par l’EPOR. Le TFR2 présente, comme l’EPOR une expression restreinte qui dépend du type cellulaire. Ainsi son expression n’a pu être détectée que dans le foie, l’érythron et l’intestin grêle. Le rôle du TFR2 a été exploré dans les hépatocytes et il a été montré qu’il joue le rôle d’un senseur de fer dans cette lignée et de ce fait contribue à l’homéostasie du fer. Nous avons déterminé le rôle du TFR2 dans les érythroblastes et montré que TFR2 est une protéine escorte de l’EPOR qui contribue à l’érythropoïèse in vitro et in vivo. De plus, nos travaux montrent que le TFR2 est requis pour la production de GDF15 (Growth Differentiation Factor 15) dans les érythroblastes. D’autre part nous avons démontré que la production de GDF15 est augmentée par l’EPO, la déplétion intracellulaire en fer et l’activité transactivatrice de P53. L’inhibition de l’expression de P53, réalisée au cours de l’étude de son rôle dans la production de GDF15, a révélé son implication dans l’érythropoïèse normale. Nous avons mis en évidence l’existence de plusieurs formes du TFR2. Deux d’entre elles résultent de l’utilisation de sites distincts d’initiation de la traduction. Ces deux isoformes sont régulée différemment au cours de la maturation des érythroblastes. La troisième isoforme, appelée TFR2 soluble (sTFR2), est relargée dans le plasma suite au clivage du TFR2. Nous avons montré que la production du sTFR2 est inhibée en présence du ligand de TFR2, la transferrine saturée en fer (holoTF) alors que le TFR2 est stabilisé dans ces mêmes conditions. Les rôles spécifiques des trois formes du TFR2 doivent encore être élucidés. / Erythropoiesis is the differentiation process of a multipotent erythroid progenitor into red blood cells. Erythroid differentiation is primarily controlled by the erythropoietin receptor (EPOR). We showed that the Transferrin receptor 2 (TFR2) is an important member of the EPOR complex. TFR2 has like EPOR a lineage-restricted expression and can solely be detected in the liver, erythron and small intestine. TFR2 function has been explored in hepatocytes where it plays the role of an iron sensor and contributes to iron homeostasis. We determined the role of TFR2 in erythroblasts and showed that TFR2 is an escort protein for EPOR that contributes to optimal erythropoiesis in vitro and in vivo. Moreover we evidenced that TFR2 is absolutely required for the production of Growth differentiation factor 15 (GDF15) in erythroblasts. We further demonstrated that GDF15 production is increased by EPO levels, by intracellular iron depletion as well as by P53 trans-activation activity. The inhibition of P53 expression, realized for the study of its role in GDF15 production, revealed its implication in normal erythropoiesis. We evidenced that TFR2 is expressed under several forms, two of which result from the utilization of distinct translational initiation sites. These two isoforms are differently regulated during erythroid maturation. The third form called soluble TFR2 (sTFR2) is released in the plasma after TFR2 cleavage. We showed that sTFR2 production is inhibited in the presence of TFR2 ligand, iron loaded transferrin (holoTF) whereas cell surface TFR2 expression is stabilized by holoTF. The specific roles of the three forms of TFR2 expressed by erythroblasts remain to be elucidated.
168

Úloha cereblonu při terapii lenalidomidem u del(5q) myelodysplastického syndromu / The role of cereblon in lenalidomide therapy of del(5q) myelodysplastic syndrome

Bokorová, Radka January 2022 (has links)
Myelodysplastic syndrome (MDS) with deletion of the long arm of the chromosome 5 (5q - syndrome, del( 5q)) can be characterized by anemia, macrocytosis, a normal or high platelet count, and hypolobulated megakaryocytes in the bone marrow. 5q - syndrome belongs to low - risk MDS, which means low risk to transform to acute myeloid leukemia. 5q - syndrome is ass ociated with female predominance and older age. Another sign is transfusion burden that is treated by erythropoiesis - stimulating agents (ESA) as erythropoietin (EPO). Moreover, the response of MDS patients is around 30 - 60% with the median of the response b eing ~ 24 months. The second line of treatment is lenalidomide (LEN) which is a derivate of teratogenic analog thalidomide. LEN increases erythropoiesis and inhibits the growth of del(5q) erythroid progenitors in vivo and it does not have a significant effe ct on the growth of normal CD34+ progenitors or cytogenetically normal progenitors in MDS with del(5q) clones. LEN is used as therapy in multiple myeloma, myelodysplastic syndrome, and lymphoma. LEN is an expensive agent and not every MDS patient re sponds to this therapy. This is a reason why is a need to find a biomarker for the determination of successful treatment. Some multiple myeloma studies showed that cereblon can be the biomarker...
169

Clinical studies in diabetic vasculopathy to assess interactions between blood, bone and kidney

Singh, Dhruvaraj Kailashnath January 2010 (has links)
Diabetic vasculopathy (DV) is the most important consequence of chronic hyperglycemia in patients with diabetes mellitus (DM). This thesis explores the interaction of blood, bone and kidney in the pathogenesis of DV by i) reviewing the current understanding of pathogenesis of macrovascular and microvascular diseases in DM to identify gaps in literature and generate hypotheses relating to various facets of DV ii) undertaking a series of prospective studies to examine these hypotheses iii) analysing the findings and integrating any new information obtained from the clinical studies into the current knowledge base and iv) generating hypotheses upon which future work might be based. The literature search was carried out with the aim of understanding current concepts of pathogenesis of DV and its potential modulators. The original reviews resulting from this process are presented in chapters 2 to 4. A series of pilot studies reported in chapters 7 to 11, were then carried out to interrogate hypotheses originating from this process. The first study was carried out in healthy individuals to define the biological variation of potential modulators of DV, namely erythropoietin (EPO), parathyroid hormone, 25 hydroxyvitamin D and 1, 25-dihydroxyvitamin D to facilitate the design and interpretation of subsequent studies. It revealed a wide biological variation of these modulators in the healthy population thus,emphasizing the need to have a control group in the subsequent study population. To examine whether tubulointerstitial dysfunction occurs before the onset of microalbuminuria, a measurement of the above mentioned parameters was carried out along with markers of tubulointerstitial injury in patients with type 1 and type 2 DM without microalbuminuria and in non-diabetic controls. It was found that tubulointerstitial dysfunction with low levels of EPO and 1, 25-dihydroxyvitamin D and higher excretion of tubular injury markers, occurs before the onset of microalbuminuria. Subsequently, diabetic and nondiabetic chronic kidney disease (CKD) patients with EPO deficiency anaemia were examined to study the effects of EPO therapy on the excretion of tubular injury markers. However, in these patient groups, we were unable to demonstrate an effect of EPO therapy on the markers of tubular injury in spite of a beneficial haematological response. To examine whether vascular calcification (VC) and bone mineral density (BMD) were linked in patients with diabetes mellitus and to explore their relationship to modulators of DV, an assessment of VC and BMD was undertaken in patients with type 2 DM with different degrees of proteinuria and normoalbuminuria. VC was assessed by CT scan and BMD by a DEXA scan. Modulators of DV were measured including serum Osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-b-ligand (RANKL). The findings were i) a high prevalence of VC and osteopenia in normoalbuminuric type 2 DM patients with normal serum creatinine ii) a weak inverse relationship between VC and osteopenia iii) proteinuric patients had worse VC but not osteopenia iv) weak relationships between OPG levels and both VC and osteopenia, masked by age in multivariate analysis. The final study examined the relationship between modulators of DV, including OPG and RANKL, and the degree of CKD. It was found that abnormalities of OPG and RANKL occur before the onset of microalbuminuria and progress with deterioration of renal function. Compared to nondiabetics, DM patients have higher OPG levels in the predialysis phase and lower levels in haemodialysis phase, a phenomenon that might indicate endothelial exhaustion in dialysis patients with DM. The derangements associated with DV seem to occur earlier than previously thought. Further work is required to untangle these complexities and to define the contribution of factors such as the adverse blood milieu, the vasculature, abnormal bone and mineral metabolism, and early tubulointerstitial damage. The findings from the studies reported here may help in the formulation of new hypotheses, which might contribute to future work in this area.
170

Estudio en poblaciones seleccionadas de la fiabilidad de nuevos protocolos de detección de consumo de hormonas recombinantes (hgH y EPO)

Abellán Sánchez, María Rosario 07 July 2006 (has links)
Las hormonas recombinantes eritropoyetina (EPO) y hormona de crecimiento (GH), prácticamente iguales a las endógenas y de corta vida media en circulación, son de difícil detección directa en el control antidopaje. Se determinaron los valores poblacionales de los biomarcadores indirectos EPO, receptor soluble de la transferrina, insulin-like growth factor-I (IGF-I) y procolágeno tipo III péptido (P-III-P), en poblaciones seleccionadas de deportistas, y el efecto del ejercicio y los distintos tipos de entrenamiento sobre su concentración sérica. La comparación de resultados obtenidos mediante distintos ensayos demostró la necesidad de una validación exhaustiva previa a su utilización. A excepción del P-III-P, los biomarcadores séricos propuestos para la detección de rhEPO y rhGH no se encuentran directamente afectados por el nivel atlético, el ejercicio o la distinta carga de entrenamiento realizada a lo largo de la temporada deportiva. La edad es la principal influencia sobre las concentraciones séricas de IGF-I y P-III-P. / Direct detection of recombinant peptidic hormones erythropoietin (EPO) and growth hormone (GH), very similar to endogen molecules and with a short half life in blood, is difficult in antidoping control. The main objective of this work is to determine indirect biomarkers' values of EPO, soluble transferrin receptor, insulin-like growth factor-I (IGF-I) and procollagen type III peptide (P-III-P), in selected populations of athletes, and the effect of exercise and different types of training on their concentration in serum. The comparison of results obtained by the different assays showed the need of extensive validation of the analytical techniques before their use in the antidoping field. Excepting P-III-P, proposed biomarkers for the detection of rhEPO and rhGH abuse are not directly influenced by the athletic level, exercise or different training workload along the sport season. Age is the main factor affecting IGF-I and P-III-P concentrations in serum.

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