<p>Enterochromaffin-like (ECL) and ghrelin cells, in the human gastric mucosa and in gastric endocrine tumours (GETs), were subclassified with respect to immunohistochemical reaction <i>vs.</i> vesicular monoamine transporter 2 (VMAT-2), ghrelin/obestatin, and histidine decarboxylase (HDC). The immunohistochemical expression of ghrelin/obestatin and HDC in GETs was related/correlated to plasma ghrelin/obestatin and urinary methyl imidazole acetic acid (U-MeImAA) excretion respectively, with the intention of identifying markers for these tumour types. </p><p>ECL cells in the gastric mucosa appear either with VMAT-2 only, or with HDC immunoreactivity only, or they can express both proteins; but in GETs the transporter protein and the enzyme were almost always co-expressed in the same cells. Furthermore, ghrelin and obestatin were co-localized in the same cells in the gastric mucosa and in the tumours. In the gastric mucosa, occasional ghrelin/obestatin cells expressed VMAT-2, but in GETs these proteins were always co-localized. Ghrelin expressing cells were non-immunoreactive to HDC. Plasma ghrelin/obestatin concentrations remained low in patients with GETs, irrespective of the relative incidence of these cells in the mucosa and in tumours. The plasma values were not related/correlated to various clinico-pathological parameters. A malignant ghrelinoma was however an exception. The tumour released high total and active ghrelin concentrations into the blood circulation. The patient suffered from diarrhoea, hypothyroidism and diabetes mellitus, but it is not clear if these conditions were due to hyperghrelinaemia. The excretion U-MeImAA was increased in a few patients with GETs, but this increase was not always related to clinical symptoms.</p><p>In conclusion, ECL cells are an heterogeneous group according to VMAT-2 and HDC immunoreactivity. Ghrelin and obestatin are expressed in the same cells in the gastric mucosa, and a few of these cells display VMAT-2 immunoreactivity. Ghrelinoma is a new gastric tumour entity.</p>

The consequences of ingesting different carbohydrate solutions on fluid movement and availability have not been systematically examined. In addition, the role of carbohydrate in the post-exercise rehydration period has received little attention despite the need for substrate replenishment following exercise and the role of carbohydrates in stimulating water absorption in the intestine. The aims of this thesis were to assess fluid absorption characteristics and availability of solutions containing increasing concentrations of glucose and to evaluate their role in the restoration and maintenance of fluid balance following a period of exercise-induced dehydration. The ingestion of a single bolus of a commercially available hypertonic 18% carbohydrate solution (chapter 3) and a hypertonic 10% glucose solution (chapter 4) resulted in reductions in plasma volume that are most likely due to acute net secretion of water into the intestinal lumen. When investigating recovery of whole body hydration status after sweat loss, a hypertonic 10% glucose-electrolyte solution maintained whole body fluid balance for a longer period than a hypotonic 2% glucose-electrolyte solution and an electrolyte only solution when a fixed volume of fluid was consumed during a rehydration period of one hour following cycle exercise in the heat (chapter 5). When fluid was consumed ad libitum over a two hour period following similar cycle exercise in the heat, a hypertonic 10% glucose-electrolyte solution was as effective in restoring and maintaining fluid balance as a 2% hypotonic glucose-electrolyte solution and an electrolyte only solution (chapter 6). The reduced rate of gastric emptying that accompanies the ingestion of high carbohydrate solutions was likely to be the primary cause for the difference in urine production reported between thetrials during this study (chapter 7). In conclusion, ingestion of hypertonic carbohydrate solutions results in a reduction in extracellular fluid volume that is most likely due to secretion of water into the intestinal lumen and the carbohydrate content of an ingested solution is of importance in the post-exercise rehydration period.

The present study was a retrospective chart review (N=128) that investigated the efficacy of profiles derived from the three factors of the Eating Inventory® test (EI) - cognitive restraint, disinhibition, and hunger - to predict successful weight loss in post surgical laparoscopic banding patients at 6 and 9 months post surgery. Although the EI is commonly used in bariatric presurgical assessment, few studies have found consistent relationships between presurgical factor scores and subsequent weight loss in this population. Based on restraint theory, 7 profiles (high CR, super high CR, high D, super high D, high H, super high H, and null) were derived from the raw scores on the subscales of the EI and tested for weight loss predictive ability using direct logistic regression. Results were mixed with high CR, super high CR, and null profiles accurately predicting successful weight loss. Raw scores on the three factors (cognitive restraint, disinhibition, and hunger) were tested individually for predictive ability using direct logistic regression. Overall results indicated that the profile model accurately predicted more cases than the general factor model. This study significantly contributes to both the bariatric presurgical assessment literature and the restraint theory literature. Suggestions for future research are offered.

Les microARNs, régulateurs post-transcriptionnels de l’expression des gènes eucaryotes, sont impliqués dans la défense contre les pathogènes. Afin de favoriser leur multiplication, les virus et les bactéries ont développé des stratégies pour altérer la voie des miRNAs. Dans ce travail, nous avons montré que Helicobacter pylori, une bactérie responsable chez l’Homme de pathologies gastriques sévères, telles que l’ulcère ou le cancer, réprime un cluster de microARNs spécifique des cellules souches embryonnaires dans une lignée épithéliale gastrique. En utilisant une technique de séquençage à haut débit, nous avons identifié miR-372 comme le miRNA le plus exprimé dans cette lignée gastrique. Avec miR-373, miR-372 permet la prolifération cellulaire réprimant l’expression d’un inhibiteur du cycle cellulaire, the LArge Tumor Suppressor 2 (LATS2). Au cours de l’infection par H. pylori, l’expression de miR-372&373 est réprimée, provoquant une accumulation de LATS2 et un arrêt du cycle cellulaire. De manière importante, la répression de ces miRNAs est dépendante de la translocation de l’effecteur bactérien CagA dans la cellule hôte. Ces données constituent un nouvel exemple d’interaction hôte-pathogène impliquant les miRNAs et ont identifié le couple LATS2/miR-372&373 comme un mécanisme inattendu dans l’arrêt du cycle cellulaire observé au cours de l’infection. Ce mécanisme pourrait refléter l’inhibition de l’auto-renouvellement de l’épithélium gastrique, processus impliqué dans la défense contre les infections bactériennes. / MicroRNAs, post-transcriptionnal regulators of eukaryotic gene expression, are implicated in host defense against pathogens. Viruses and bacteria have evolved strategies to suppress miRNA functions with the aim to establish a sustainable infection. In this work, we report that Helicobacter pylori, a bacterium responsible for severe human gastric inflammatory diseases and cancers, down-regulates an embryonic-specific microRNAs cluster in a gastric epithelial cell line. We reveal by using a deep sequencing approach that hsa-miR-372 is the most abundant miRNA expressed in this gastric cell line where, together with hsa-miR-373, it promotes cell proliferation by silencing the expression of a cell cycle inhibitor, the LArge Tumor Suppressor 2 (LATS2). Upon H. pylori infection, miR-372&373 synthesis is inhibited, leading to the derepression of LATS2 and thus, to a cell cycle arrest at the G1/S transition. Importantly, this down-regulation of a specific cell cycle-regulating microRNA is dependent on the translocation of the bacterial effector CagA into the host cells. These data constitute a novel example of host-pathogen interplay involving microRNAs and unveil the couple LATS2/miR-372&373 as an unexpected mechanism in infection-induced cell cycle arrest in proliferating gastric cells which may be relevant of inhibition of gastric epithelium renewal, a major host defense mechanism against bacterial infections.

No description available.

Truncal adiposity impairs ventilation in obese adults by altering normal ventilatory mechanics. Leptin, an inflammatory adipocytokine, is elevated in obesity and has been shown to alter ventilatory responses to exercise. Leptin’s bioavailability appears to be regulated by its soluble receptor (LRe), which is reduced in obesity. Roux-en-Y gastric bypass surgery (RYGBS) is a weight loss intervention that reduces total fat mass and improves several obesity related co-morbidities including pulmonary dysfunction. The purpose of this study was to first evaluate the differences between ventilatory responses to carbon dioxide (VE/VCO2 slope) during progressive treadmill walking in morbidly obese and normal weight females. Second, we will analyze the relationships between the VE/VCO2 slope, truncal adiposity, serum leptin, and LRe. Lastly, we want to evaluate the changes in the ventilatory responses to exercise (VE/VCO2 slope), truncal adiposity, serum leptin, and LRe 3 months following Roux-en Y gastric bypass surgery. Thirteen obese (OB 37.7 ±11.4 years, 42.0 ± 4.8 kg/m2) and 12 normal weight females (NW 36.1 ±8.0 years, 22.8 ± 1.2 kg/m2) participated in this study. Blood samples for measure of fasting serum leptin and soluble leptin receptor were obtained prior to exercise. Cardiopulmonary variables were measured throughout exercise. Regional adiposity was determined through dual energy x-ray absorptiometry. Truncal adiposity was significantly greater in the obese group than the normal weight group. Serum leptin was greater in the obese group while LRe was lower than the normal weight group. The VE/VCO2 slopes were lower in obese group when compared to the normal weight group. There were no significant group differences in maximal ventilation, tidal volume or respiratory rate. Stepwise regression determined that truncal adiposity accounted for 31.5% of variance in VE/VCO2 slope (R= 0.561, R2 =0.315, p = 0.004). At 3 months post-surgery we observed significant reductions in the obese group in total percentages of fat, truncal adiposity, serum leptin. The soluble leptin receptor was not changed at any measured time point following RYGBS. There were no changes in 3 months post-surgery VE/VCO2 slopes in the obese group. Truncal adiposity, serum leptin and LRe were associated with reduced ventilatory responses to weight bearing exercise (VE/VCO2 slope) in obese females when compared to normal weight females. There were no differences between obese and normal weight females in maximal minute ventilation, tidal volume or respiratory rate. This result suggests that differences in VE/VCO2 slopes may not be entirely from maximal pulmonary capacity. Rather, the differences in VE/VCO2 slope may be attributed to truncal adiposity and its positive relationship with leptin. Elevated leptin in the obese group may indicate a state of central leptin resistance which has been shown to reduce the ventilatory responses to exercise. At 3 months post RYGBS significant reductions in total percent fat, serum leptin, truncal adiposity and BMI were observed. However, despite improvement in fat mass and serum leptin there were no changes in the VE/VCO2 slope and LRe at 3 months post RYGBS. Therefore, it is possible that the improvements in body composition and leptin following RYGBS were not sufficient to increase ventilation responses to weight bearing exercise in obese females.

The purpose of this study was to examine the experiences and perceptions of behavioral factors that contribute to successful weight loss in male bariatric patients. By analyzing participant experiences and perceptions, this study contributes to a better understanding of which factors are most important in the postoperative phase of gastric bypass in males owing to successful weight loss. Although there is a tremendous amount of quantitative research within the bariatric population, there is a significant gap within the qualitative literature as it relates to male outcomes. As such, by conducting interviews with 10 postoperative male gastric bypass patients, this study was able to further understand how and why these participants obtained successful weight loss. Furthermore, by identifying relevant categories and thematic responses from the participants, this study may serve future researchers in designing other qualitative studies that target best practices in males for successful weight loss outcomes. The findings of this study indicate that participants found greater weight loss success by following proper eating behaviors and engaging in physical activity whereas support group attendance was not found to be an important factor in successful weight loss. This study also revealed that follow up with the bariatric nurse coordinator was greatly viewed as a positive step in adjusting to lifestyle postsurgery. As such, this supportive role by the nurse coordinator may provide further impetus for the ways in which bariatric personnel interact with patients who might not always be able to see their surgeon for follow-up.

L’infection par Helicobacter pylori touche environ la moitié de la population mondiale et est responsable de plusieurs pathologies gastro-intestinales incluant l’adénocarcinome gastrique. Les mécanismes de la carcinogénèse induite par H. pylori ne sont pas clairement élucidés. Mais, l’oncoprotéine CagA que possèdent certaines souches est très impliquée dans la carcinogénèse gastrique ; elle induit l’apparition d’un phénotype particulier, dit colibri, qui mime une transition épithélio-mésenchymateuse (EMT). De plus, CagA déstabilise les jonctions cellulaires en perturbant la E-cadhérine. Les objectifs de ces travaux ont été de déterminer si H. pylori induit une véritable EMT et si cette EMT est à l’origine de l’émergence de cellules souches cancéreuses (CSC). De plus, nous avons étudié le rôle joué par la protéine IQGAP1, protéine assurant le maintien des jonctions cellulaires, dans la carcinogénèse gastrique induite par H. pylori. Ces travaux ont montré que H. pylori induit une EMT in vitro. Cette EMT est à l’origine de l’émergence de cellules CD44high présentant les caractéristiques de CSC. L’étude du rôle de IQGAP1 au cours de la carcinogénèse gastrique liée à H. pylori a permis de déterminer son implication dans l’apparition de lésions néoplasiques dans un modèle de souris transgéniques hétérozygotes pour IQGAP1. En outre, IQGAP1 apparaît comme une protéine dont l’expression est modifiée par l’infection à H. pylori et par l’EMT induite par cette bactérie in vitro. Nos résultats permettent de mieux comprendre le mécanisme physiopathologique de l’adénocarcinome gastrique et seront potentiellement utiles au développement de nouvelles thérapeutiques anti-cancéreuses. / Helicobacter pylori infection is found in about half of the world population and is responsible for several gastrointestinal pathologies, including gastric adenocarcinoma. The mechanisms of the carcinogenesis due to H. pylori remain unclear. However, the link with gastric adenocarcinoma is partly due to the H. pylori CagA oncoprotein. CagA is responsible for a particular cell phenotype in vitro, the “hummingbird” phenotype which corresponds to an elongation of the cells, mimicking an epithelial to mesenchymal transition (EMT). EMT participates to carcinogenesis, and is involved in the generation of cancer stem cells (CSC). Moreover, CagA destabilize the cell junctions. This study aimed to determine wether H. pylori induces a true EMT, and if so, wether this EMT can generate CSCs. The role of IQGAP1, which is a scaffold protein involved in cell adhesion, was also studied in cases of gastric carcinogenesis due to H. pylori. We demonstrated that H. pylori induces an EMT in vitro. Moreover, we showed that this EMT is responsible for the emergence of CD44high cells which have the same characteristics as the CSCs. IQGAP1 has been identified as a protein implicated in neoplastic lesion development in a transgenic mouse model heterozygous for IQGAP1. Moreover, in vitro, the expression of IQGAP1 was modified by H. pylori infection and more specifically by the EMT induced by H. pylori. Our results allow a better understanding of gastric adenocarcinoma pathophysiology and will be helpful in developing new cancer chemotherapies.

Le système endocannabinoïde (SEC) est un système clé de la régulation de la balance énergétique. Les rares études réalisées chez l’Homme concluent à une augmentation des concentrations plasmatiques des endocannabinoïdes, anandamide (AEA) et 2-arachidonoylglycerol (2-AG), chez les sujets obèses ou diabétiques de type 2. Cependant plusieurs questions restent posées et cette thèse s’est spécifiquement intéressée : i) à l’existence d’une cinétique prandiale et au rôle des endocannabinoïdes circulants par rapport à la prise alimentaire, ii) aux effets d’une perte de poids obtenue par court-circuit gastrique sur ces concentrations et iii) aux liens physiopathologiques entre insulinorésistance et SEC. Enfin, nous avons tenté de développer un outil non invasif pour faciliter l’étude du SEC chez l’Homme. Dans la 1ère étude, nous avons mis en évidence pour la première fois une augmentation préprandiale de l’AEA indépendante du poids. Ceci suggère que l’AEA plasmatique pourrait jouer un rôle dans l’initiation de la prise alimentaire chez l’Homme. De façon intéressante, la réduction post prandiale de l’AEA est émoussée chez les sujets obèses insulinorésistants, ce qui peut créer un cercle vicieux vis à vis de l’obésité. Dans la 2ème étude, des résultats préliminaires montrent qu’une même perte de poids obtenue par court-circuit gastrique ou par règles hygiéno-diététiques modifie différemment les concentrations plasmatiques d’AEA qui tendent à augmenter après court-circuit gastrique alors qu’elles ne sont pas modifiées après règles hygiéno-diététiques. Ainsi, le court-circuit gastrique pourrait directement affecter le fonctionnement du SEC localisé au niveau du tractus gastro-intestinal. Dans la 3ème étude, 72 heures de régime hypoglucidique permettent de diminuer significativement la glycémie à jeun et la résistance à l’insuline de 8 sujets diabétiques de type 2, mais pas les concentrations plasmatiques d’endocannabinoïdes, qui ne sont par ailleurs pas modifiées chez ces sujets en fonction du statut nutritionnel. Enfin, nous avons pu déterminer les concentrations des endocannabinoïdes dans la salive humaine, qui sont plus élevées chez les sujets obèses par rapport aux normopondéraux, avec une diminution de l’AEA salivaire associée à la perte de poids, mais sans variation en fonction de la prise alimentaire. La salive pourrait donc constituer un outil non invasif pour l’étude du SEC chez l’Homme.Ainsi, notre travail confirme les liens entre SEC et pathologies métaboliques chez l’Homme. Nos résultats suggèrent en particulier un rôle physiologique de l’AEA dans la prise alimentaire ainsi que l’importance potentielle du SEC du tractus gastro-intestinal. Nous confirmons la dérégulation statique et dynamique du SEC dans la situation de diabète de type 2. Enfin nous développons un nouvel outil pour l’exploration du SEC chez l’Homme. Nos résultats sont importants car la meilleure connaissance des systèmes impliqués dans la régulation de la balance énergétique est nécessaire pour le développement de nouvelles stratégies thérapeutiques efficaces contre l’obésité et ses pathologies associées. / The endocannabinoid system (ECS) is a key system for the regulation of energy balance. Only few studies have been so far carried out in humans but they all lead to conclude that obese subjects have higher plasma fasting levels of the 2 major endocannabinoids, anandamide (AEA) and 2-arachidonoylglycerol (2-AG). However, many questions concerning the role of the ECS in the physiopathology of obesity in humans remain still unanswered. This thesis has therefore attempted to address some of these questions by investigating i) the changes of plasma endocannabinoids in response to food intake, ii) the effect of weight loss induced by gastric bypass or lifestyle intervention on these plasma levels and iii) the potential link between insulin resistance and circulating endocannabinoids. Lastly, we have also tested the possibility to develop a non-invasive tool to ease the investigation of the ECS in humans. In the 1st study, we have described for the first time the existence of a pre-prandial peak in plasma AEA, which is independent of body weight. This evidence suggests that circulating AEA levels might work as a meal initiator factor in humans. Importantly, the AEA postprandial decrease is blunted in obese insulin resistant subjects and might therefore favor the persistence of the obese phenotype. In our 2nd study, preliminary results suggest that the same body weight loss obtained through gastric-bypass or lifestyle intervention differently affects plasma AEA levels. In particular, while AEA tend to increase in subjects who have undergone gastric bypass, no changes are observed after a comparable weight loss induced by lifestyle intervention. Thus, a possibility is that the bypass might directly affect the function of the ECS localized within the gastrointestinal tract. In our 3rd study, which was carried out on 8 type 2 diabetic patients, we have shown that 72 hours of a low carbohydrate diet significantly decreases glycaemia and insulin resistance, without affecting the levels and the kinetic of circulating endocannabinoids. Lastly, we demonstrated that endocannabinoids are reliably measured in saliva. Salivary endocannabinoids are higher in obese as compared to normal weight subjects. Body weight loss significantly decreases salivary AEA, while the consumption of a meal does not influence salivary endocannabinoids levels. Altogether our studies confirm the association between ECS deregulation and metabolic disease in humans. In particular, we have demonstrated that plasma AEA might have a physiological role in the regulation of human feeding behavior, and have hinted the potential relevance of the gastro-intestinal ECS in our studies on gastric-bypass patients. We have also shown that in type 2 diabetes, there is a flattening of the kinetics of circulating endocannabinoids. Finally, we have shown that measurement of salivary endocannabinoids is reliable and might be of clinical value. These findings extend our knowledge on one of the systems majorly implicated in energy balance regulation. Such knowledge is a necessary step towards the development of novel therapeutic strategies needed to halt obesity and metabolic disease.

Die laparoskopische Implantation eines Magenbandes gilt als etabliertes Verfahren der bariatrischen Chirurgie. Im Rahmen der vorliegenden retrospektiven Studie an 127 Patienten wurden die Kurz- und Langzeitergebnisse des Laparoskopischen Gastric Banding (LAGB) untersucht. 60 Patienten wurden in Pergastrischer Technik, 67 Patienten in Pars flaccida Technik operiert. Untersucht wurde Sicherheit, Effizienz und Qualität des LAGB insbesondere im Hinblick auf die Art der angewandten Operationstechnik. Die mittlere Nachbeobachtungszeit betrug 63 Monate. Der mittlere prozentuale Übergewichtsverlust (EBWL %) war 50,6 %. Bei 39 Patienten traten ein oder mehrere Komplikationen auf. Die häufigsten Komplikationen waren Slippage und Pouchdilatation. Die Mortalitätsrate lag bei 0 %. Über 2/3 der Patienten dokumentierten eine Steigerung der subjektiven Lebensqualität durch das LAGB. Im Vergleich der Ergebnisse zweier verschiedener Operationstechniken stellte sich heraus, dass die Wahl des operativen Zugangsweges weder einen Einfluss auf die Effektivität der Gewichtsabnahme noch auf die Reduktion der körpergewichtsbedingten Komorbidität hat. In Übereinstimmung mit Ergebnissen anderer Studien zeigten sich Vorteile der Pars flaccida Technik im Sinne einer niedrigeren postoperativen Komplikationsrate. Insbesondere die sehr häufigen Komplikationen Pouchdilatation und Slippage traten in der Pars flaccida Gruppe signifikant seltener auf als bei den Patienten, die in Pergastrischer Technik operiert wurden. Zur Erhöhung der Effizienz sowie Reduktion der Komplikationsrate des LAGB ist - über die Optimierung operativ-technischer Aspekte hinaus- eine professionelle, interdisziplinäre und langfristige Nachbetreuung der Patienten unabdingbar. / The Laparoscopic Adjustable Gastric Banding (LAGB) has become a common bariatric procedure. Within this study 127 patients were analysed retrospectively after LAGB in terms of preoperative characteristics, weight loss, co-morbidities, short and long-term complications and quality of life. 60 patients were operated using the pergastric pathway (PG), 67 patients were operated using the pars flaccida technique (PF). The median follow-up was 63 month. Mean excess body weight loss (EBWL %) was 50.6 %. 39 patients experienced one ore more postoperative complications. The most frequent complications were slippage and pouch dilatation (34 %). Mortality rate was 0 %. Two-thirds of the patients reported an increase in quality of life after LAGB. Comparing the two different operation techniques (PF and PG-technique) there was no difference in weight loss or reduction of co-morbidities. In accordance with similar studies we documented a lower postoperative complication rate in the pars flaccida group. Especially the very frequent complications slippage and pouch dilatation occurred significantly less often using the pars flaccida technique.