A revascularização cardíaca utilizando a ponte de safena é um procedimento bastante utilizado para restabelecer o fluxo coronariano. Apesar do sucesso deste procedimento, a patência deste enxerto pode chegar a menos de 50% em 10 anos. Atribui-se parte deste insucesso a variações no processo adaptativo à nova condição hemodinâmica, onde o shear stress e o estiramento aumentados podem estar interferindo na função endotelial e vascular. Este processo envolve a participação de diversas proteínas e o estudo de como elas participam conjuntamente é uma importante abordagem para entender as alterações fisiológicas e patológicas que ocorrem no enxerto vascular. Neste trabalho, tecnologias proteômicas, gel 2-D e ICAT, foram utilizadas para identificar as proteínas que são modificadas nas fases precoces da arterialização do enxerto venoso. Foi utilizado um sistema ex vivo de perfusão controlada, desenvolvido em nosso laboratório, onde a veia safena humana foi cultivada tanto em regime hemodinâmico venoso (5 mL/min) e arterial (50 mL/min, 80 mmHg) por 24 horas. Dentre as proteínas identificadas, a maioria apresenta funções estruturais como, por exemplo, -actina de músculo liso, CRP1, colágeno VI, tropomiosina, miosina, desmina e vimentina. Para avaliação funcional foram selecionadas a -SMA e a CRP. A -SMA mostrou-se diminuída nas fases mais precoces da arterialização venosa, com quase desaparecimento após 3 dias da cirurgia, seguido de um aumento nos períodos subseqüentes. A CRP3 mostrou-se com expressão predominantemente arterial tanto em amostra humana como de rato. A arterialização de segmentos venosos induziu a expressão da CRP3, sendo dependente do aumento do estiramento (stretch) nas células musculares lisas e não do aumento do shear stress na superfície endotelial. Coletivamente, neste trabalho caracterizamos duas proteínas que foram modificadas durante o processo de arterialização e/ou adaptação da veia à condição hemodinâmica arterial. As proteínas identificadas contribuirão para o melhor entendimento do processo de arterialização venosa e poderão ser testadas como novos alvos terapêuticos para melhorar a patência destes enxertos / Coronary artery bypass surgery by saphenous vein graft is still widely used to revascularization of ischemic heart. Despite the success of this procedure, about 50% occlude after 5-10 years. The vein graft is subjected to increased tensile stress and the adaptive vein response to the arterial hemodynamic condition may predispose to bypass occlusion. Several proteins are modulated during arterialization, the understanding of the molecular changes of this process may be useful to new therapeutics approaches development attempting to increase vein graft patency. In this work, proteomics plataform, gel 2-D and ICAT, were used to identify the proteins that are modified in the early stages of vein graft rterialization. Human saphenous vein were cultured in an ex vivo flow through system in both venous (5 ml / min) and arterial (50 ml / min, 80 mm Hg) hemodymanic conditions for 24 hours. The identified proteins were related to cell structural function, such as -SMA, CRP1, collagen VI, tropomyosin, myosin, desmin and vimentin. To functional characterization, -SMA and CRP were selected. In rat vein arterialization model, - SMA showed to be decreased during the early stages of arterialization and almost disappeared after 3 days of surgery. Later on, -SMA-positive cells increase reaching similar expression levels of normal jugular vein. The expressiom of CRP3 showed to be predominantly to arterial beds both in human and rat. When vein segment were submitted to arterial hemodynamic condition, it was observed a significant induction of CRP3 expression. Interestingly, the increase of CRP3 is dependent of stretch stimulus in smooth muscle cells while shear stress did not modify its expression in endothelial cells. Collectively, we successfully identified proteins differentially expressed during the vein arterialization by using proteomic technique. -SMA and CRP3 were modified in vein segments exposed to arterial hemodynamic condition and efficiently discriminate smooth muscle cell phenotype. The identified proteins will contribute to the better understanding of the venous arterialization process and may be tested as new therapeutic targets for improving the patency these grafts

Orientador: Iguatemy Lourenço Brunetti / Banca: Luís Carlos Spolidorio / Banca: Marília Afonso Rabelo Buzalaf / Banca: Maria Teresa Pepato / Banca: Maria Lúcia Rubo de Rezende / Resumo: O tratamento cirúrgico da fissura congênita do processo alveolar superior compreende o enxerto ósseo, um procedimento bem aceito e de grande importância na restauração da forma e da função perdidas. Associado ao enxerto ósseo tem-se utilizado um produto atóxico, não imunoreativo e de fácil obtenção, denominado plasma rico em plaquetas (PRP). Neste estudo foi analisado o comportamento dos marcadores fosfatase alcalina, fosfatase alcalina isoforma óssea, osteocalcina e fosfatase ácida tartarato resistente em 50 pacientes, com idade entre 10 e 20 anos e que foram submetidos à cirurgia de enxerto ósseo autógeno alveolar pelo serviço de Cirurgia Buco-maxilofacial do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo. O objetivo foi acompanhar de forma sistêmica e em curto período a formação ou reabsorção óssea após a realização do enxerto ósseo alveolar, bem como avaliar a eficácia do uso do plasma rico em plaquetas no processo de formação óssea. O estudo concluiu que as propriedades restauradoras do PRP não puderam ser demonstradas por nenhum dos marcadores bioquímicos do metabolismo ósseo nos primeiros 70 dias do ato cirúrgico; a análise temporal dos marcadores de formação óssea testados demonstrou uma tendência de queda com 35 dias e retorno próximo aos níveis basais com 70 dias do ato cirúrgico nos dois grupos estudados; não houve uma correlação significativa dos marcadores com o número de plaquetas e nem com a área da fissura e o resultado do exame ao raio X foi considerado inconclusivo para a presença ou não de trabeculado ósseo organizado em fase inicial de formação. / Abstract: The surgical treatment of the congenital cleft of the upper alveolar process understands the bone graft, a well accepted procedure of great importance in the restoration of the lost form and function. Together with the bone graft it is being used a non-toxic, non imunoreactive and easily obtained product, denominated platelet-rich plasma (PRP). In this study it was analysed the behavior of the alkaline phosphatase, bone alkaline phosphatase, osteocalcin and tartrate-resistant acid phosphatase markers in 50 patients, with age between 10 and 20 years and that were undergone to alveolar autogenous bone graft performed by the Bucomaxillofacial Service of the "Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo". The aim was follow in a sistemic and early way the bone formation or reabsorption after the accomplishment of the alveolar bone graft, as well as to evaluate the effectiveness of the use of the platelet-rich plasma in the process of bone formation. The study concluded that the restorative properties of the PRP could not be demonstrated by of the biochemistry markers of the bone metabolism in the first 70 days of the surgery; the temporal analisys of the bone formation markers tested demonstrated a fall tendency in 35 days with return near to basal levels in 70 days in the two studied groups; there was not a significant correlation between markers and the number of platelets and neither with the area of the cleft and the result of the x-ray examination was not considered conclusive for the presence or not of organized bone trabeculae in the initial phase of formation. / Doutor

Survival of patients with poor prognosis or relapsed haematopoietic malignancies can be markedly improved by allogeneic haematopoietic stem cell transplantation (HSCT). HSCT reconstitutes the immune and haematopoietic systems after myeloablative conditioning and inhibits the recurrence of the malignancy by a graft-versus-leukaemia (GVL) response mediated by donor T cells. However, significant post-transplant complications such as graft-versus-host disease (GVHD) continue to plague the event-free survival of this curative procedure. GVHD is facilitated by donor T cells that recognise histocompatibility antigens on host antigen presenting cells (APC), such as dendritic cells (DC). Current treatment options for GVHD are focused on these T cells. However, these treatments result in an increased incidence of infection, graft rejection and relapse. A novel means of immunosuppression in GVHD is the use of multi-potent, mesenchymal stromal cells (MSC). MSC are non-immunogenic cells that actively suppress T cell function in vitro, and can resolve steroid-refractory GVHD in the clinic. Despite their use in the clinic, there is a paucity of pre-clinical data. Our aim was to investigate the in vivo efficacy of MSC to control GVHD while maintaining the beneficial GVL effect, and to begin to understand the mechanism by which MSC exert their immunosuppressive effects. We isolated and characterised MSC from murine bone/bone marrow and demonstrated that they suppressed T cell proliferation in vitro, even at low ratios of 1 MSC per 100 T cells. This was true of both donor-derived MSC, and MSC derived from unrelated donors (third party). Importantly, we observed that MSC significantly reduced T cell production of the pro-inflammatory cytokines TNFα and IFNγ in culture supernatants and that IFNγ plays a key role in the ability of MSC to suppress T cell proliferation. In vivo, we examined the effects of donor-derived MSC on GVHD severity and onset in two myeloablative murine models of HSCT. A major histocompatibility complex (MHC)-mismatched donor-recipient pair combination was used as a proof–of-principle model [UBI-GFP/BL6 (H-2b)àBALB/c (H-2d)], and an MHC-matched, minor histocompatibility antigen (miHA) mismatched donor-recipient pair combination was used to mimic MHC-matched sibling transplantation [UBI-GFP/BL6 (H-2b)àBALB.B (H-2b)]. We examined a number of variables related to MSC infusion including timing, dose and route of injection. We found that early post transplant infusion of MSC by the intraperitoneal injection was most effective at delaying death from GVHD, compared to pre-transplant infusion or intravenous injection. Furthermore, we found that the dose of MSC was critical, as infusion of too few MSC was ineffective and infusion of too many MSC exacerbated the development of GVHD. Taken together, these results suggest that timing, dose and route of injection are all important factors to be considered to ensure successful therapeutic outcome. To investigate the in vivo mechanism of action, we conducted timed sacrifice experiments in the MHC-mismatched model to determine if MSC altered cytokine secretion and cellular effectors, such as DC, known to play a key role in GVHD. Despite the fact that MSC given post-HSCT enter an environment full of activated DC and IFNγ levels, by day 3 and 6 post infusion, these activated DC and IFNγ levels are decreased compared to controls or mice infused with MSC pre-transplant (p<0.05). This confirmed our in vitro data that IFNγ played an important role in MSC-mediated immunosuppression. In addition, when we removed a major source of IFNγ production in vivo by administering the T cell depleting antibody KT3 to mice with or without MSC, we found that although T cell depletion prolonged survival, MSC were unable to further enhance this effect. This was also true when MSC were used in combination with the conventional immunosuppressant cyclosporine. Finally, we examined whether the infusion of MSC would compromise the GVL effect. We found that whilst MSC could delay the onset of GVHD, in our model they did not alter the anti-tumour effects of the donor T cells. Overall, we have shown that MSC can delay but not prevent death from GVHD when administered at an appropriate time and dose and that IFNγ is required for MSC-mediated immunosuppression in our model. These data suggest that patients undergoing HSCT should be monitored for IFNγ, and administered MSC when high levels are reached. Whilst MSC may be a promising therapy for patients with severe GVHD, we highlight that further investigation is warranted before MSC are accepted for widespread use in the clinic. The risks and benefits for transplant recipients should be carefully considered before utilising MSC to treat or prevent GVHD.

<p>Liquid Chromatography (LC) and Capillary Electrophoresis (CE) are modern analytical techniques that play very important roles in many areas of modern science such as life science, biotechnology, biomedicine, environmental studies, and development of pharmaceutics. Even though these two techniques have existed and been subjected to studies for several decades, the developments of new separation materials for them are still very important till now in order to meet the different new demands for improvement from other disciplines in science.</p><p>In this doctoral thesis, several novel covalently bonded sulfobetaine type zwitterionic separation materials are synthesized for the application in LC and CE. These materials carry both positively charged quaternary ammonium groups and negatively charged sulfonic groups, which result in a very low net surface charge compared to conventional separation materials with only anionic or cationic functional groups. Consequently, it is possible to employ these materials for separation of different ionic species under mild conditions. The surface properties have also been characterized, mainly by elemental analysis, sorption isotherm, ζ-potential measurements, and spectroscopic methods.</p><p>By using packed zwitterionic columns for liquid chromatography, small inorganic anions or cations, and acidic or basic proteins can be independently and simultaneously separated in a single run using optimal sets of separation conditions. This is a unique property compared to conventional ionic separation material for LC. When fused silica capillaries coated with zwitterionic polymer are used for capillary electrophoresis, good separations can be achieved for solutes as different as inorganic anions, peptides, proteins, and tryptically digested proteins.</p>

<p>The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered. </p><p>Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life. </p><p>SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process.</p>

Ziel dieser Arbeit war die Entwicklung neuer Substanzen für die Gentherapie. Diese beinhaltet die Behebung von erblich bedingten Krankheiten wie z.B. Mucoviscidose. Dabei werden im Zellkern defekte Gene durch normale, gesunde DNA-Sequenzen ersetzt. Zur Einschleusung des Genmaterials in die Zellen (Transfektion) werden geeignete Transport-Systeme bzw. Methoden benötigt, die dort die Freisetzung der neu einzubauenden Gene (Genexpression ausgedrückt in Transfektionseffizienzen) gestatten. Hierfür wurden neue Polykation-DNA-Komplexe (Vektoren) auf Basis kationischer Polymere wie Poly(ethylenimin) (PEI) hergestellt, charakterisiert und nachfolgend in Transfektionsversuchen an verschiedenen Zelllinien eingesetzt.<br> Sowohl das kationische Ausgangspolymer PEI als auch das Pfropfcopolymer PEI-g-PEO (PEO-Seitenketten zur Erhöhung der Biokompatibilität) wurden mit Rezeptorliganden modifiziert, um eine verbesserte und spezifische Transfektion an ausgesuchten Zellen zu erreichen. Als Liganden wurden Folsäure (Transfektion an HeLa-Zellen), Triiod-L-thyronin (HepG2-Zellen) und die Uronsäuren der Galactose, Mannose, Glucose sowie die Lactobionsäure (HeLa-, HepG2- und 16HBE-Zellen) verwendet.<br> Das PEI, die Pfropfcopolymere PEI-g-PEO und die Ligand-funktionalisierten Copolymere wurden hinsichtlich ihrer chemischen Zusammensetzung und molekularen Parameter charakterisiert. Die Molmassenuntersuchungen mittels Größenausschlusschromatographie zeigten, dass nach der Synthese unterschiedliche Polymerfraktionen mit nicht einheitlicher chemischer Zusammensetzung vorlagen.<br> Die anschließenden Transfektionsversuche wurden mit Hilfe einer speziellen DNA (Luciferase) an den Zelllinien HepG2 (Leberkrebszellen), HeLa (Gebärmutterhalskrebszellen) und 16HBE (Atemwegsepithelzellen) durchgeführt. Die T3(Triiod-L-thyronin)-Vektoren zeigten in Abhängigkeit vom eingesetzten Komplexverhältnis Polykation/DNA ein Maximum in der Transfektion an HepG2-Zellen. Die Hypothese der rezeptorvermittelten Endozytose ließ sich durch entsprechende T3-Überschuss-Experimente und Fluoreszenzmikroskopie-Untersuchungen bestätigen. Dagegen konnte bei den Folsäure-Vektoren keine rezeptorvermittelte Endozytose beobachtet werden.<br> Bei den Vektoren mit Mannuronsäure-Ligand (Man) konnte an allen drei Zelllinien (HepG2, HeLa, 16HBE) eine konstante, hohe Transfereffizienz nachgewiesen werden. Sie waren bei allen eingesetzten Polymer-DNA-Verhältnissen effizienter als der Vergleichsvektor PEI. Dieses Transfektionsverhalten ließ sich durch Blockierung der Zuckerstruktur unterbinden. In Transfektionsexperimenten mit einem Überschuss an freier Mannuronsäure und fluoreszenzmikroskopischen Untersuchungen konnte eine rezeptorvermittelte Endozytose der Man-Vektoren an den o.g. Zelllinien nachgewiesen werden. Die anderen Uronsäure-Konjugate zeigten keine signifikanten Abweichungen im Transfektionsverhalten im Vergleich zum PEI-Vektor. / The goal of this work was the development of new non-viral gene transfer systems for the somatic gene therapy. For these non-viral gene vectors (polycation-DNA-complexes) on the base of ligand-functionalized polycations were synthesized, characterized and tested in transfection trials on different cell cultures (HepG2, HeLa, 16HBE).<br> In preliminary investigations PEI-g-PEO copolymers with different grafting densities of poly(ethylene oxide) PEO8 were synthesized and characterized. This was followed by modification of PEI and the copolymer PEI-g-PEO(20) with specific receptor ligands for transfection studies to the cell lines mentioned above. Folic acid (transfection at HeLa cells), triiodo-L-thyronine (HepG2 cells) and the uronic acids of galactose, mannose, glucose as well as the lactobionic acid (HeLa, HepG2 and 16HBE cells) were used as ligands. The coupling of the ligands was performed either without a spacer or via PEO side chains and was realized by carbodiimids.<br> The PEI and the grafted copolymers PEI-g-PEO as well as the ligand-functionalized copolymers were characterized regarding to their chemical composition and molecular parameters. Molar masses from sedimentation rate experiments of the AUC were obtained within the range of 35000 to 70000 g/mol. The molar mass investigations by means of SEC-MALLS revealed that after the grafting process both copolymers with heterogeneous chemical composition and unmodified PEI were present. The polydispersity of all PEI-g-PEO(20) based copolymers increased significantly compared with unmodified PEI. The molar masses increased with higher conversion degree as expected. The highly-substituted products exhibited an increasingly more compact structure in aqueous solution.<br> The following transfection studies were accomplished with the help of a luciferase reporter genes at the cultures HepG2 (liver cancer cells), HeLa (cervix cancer cells) and 16HBE (lung epithelium cells). The grafted copolymers PEI-g-PEO were compared to the unmodified PEI vector in transfection experiments. Here an almost identical transfer efficiency compared to the unmodified PEI vector could be maintained accompanied by reduced toxicity up to a PEO content of 17% w/w.<br> Folic acid copolymers were tested on HeLa cells in further vector studies. All folic acid vectors showed a maximum in the transfection at a N/P ratio (complex of polycation with DNA) of 2.5 and/or 5.0, which refers to a receptor-mediated endocytosis. However, no receptor-mediated endocytosis was observed in transfection.<br> A similar transfection behavior was observed with the T3 vectors on HepG2 cells dependent on the N/P ratio. The hypothetical receptor-mediated endocytosis could be confirmed within the T3-functionalized vectors by appropriate T3 excess experiments. Herein the transfer efficiency of the T3 gene vectors decreased significantly while adding free low-molecular weight triiodo-L-thyronine. In contrast to this the transfer efficiency of the unmodified PEI vector decreased only negligibly. A receptor-mediated endocytosis was also confirmed by fluorescence microscopy investigation of T3-functionalized aminodextranes at transfection of HepG2 cells. Subsequently, the T3 vectors were tested at mice in vivo. Here high transfer efficiencies in comparison to the unmodified PEI vector were determined particularly in the spleen as well as in the kidneys and thyroid. The T3 vectors should be suitable for a gene transfer into hepatocytes.<br> The vectors with uronic acid conjugates as ligands (galacturonic-, glucuronic and lactobionic acid) did not show significant deviations in the transfer efficiencies compared with the PEI vector. In contrast to this the vectors with mannuronic acid exhibit a constant high transfer efficiency at the three cell cultures HepG2, HeLa and 16HBE. They are more efficient than the PEI vector over the examined N/P range. Here the transfection proceeds independently of the charge of the complex (N/P ratio). This transfection behavior could be prevented by blocking the glycosidic OH groups of the Man vector. A receptor-mediated endocytosis of the Man vectors at the three examined cell lines (HepG2, HeLa, 16HBE) could be verified by means of transfection experiments with an excess of free mannuronic acid and fluorescence microscopic investigations.<br> In continuing studies new gene vectors on the base of cationic starch graft copolymers were synthesized and tested in transfection studies at HepG2 and 16HBE cells. Beyond that peptide-functionalized PEI vectors, which exhibit a nuclear localization sequence (TAT), were established and their transfection in vitro was determined. Compared to the PEI vector lower transfections of the vectors on the base of cationic starch graft copolymers was observed. However, an increase is expected by coupling with T3 and mannuronic acid ligands.

Liquid Chromatography (LC) and Capillary Electrophoresis (CE) are modern analytical techniques that play very important roles in many areas of modern science such as life science, biotechnology, biomedicine, environmental studies, and development of pharmaceutics. Even though these two techniques have existed and been subjected to studies for several decades, the developments of new separation materials for them are still very important till now in order to meet the different new demands for improvement from other disciplines in science. In this doctoral thesis, several novel covalently bonded sulfobetaine type zwitterionic separation materials are synthesized for the application in LC and CE. These materials carry both positively charged quaternary ammonium groups and negatively charged sulfonic groups, which result in a very low net surface charge compared to conventional separation materials with only anionic or cationic functional groups. Consequently, it is possible to employ these materials for separation of different ionic species under mild conditions. The surface properties have also been characterized, mainly by elemental analysis, sorption isotherm, ζ-potential measurements, and spectroscopic methods. By using packed zwitterionic columns for liquid chromatography, small inorganic anions or cations, and acidic or basic proteins can be independently and simultaneously separated in a single run using optimal sets of separation conditions. This is a unique property compared to conventional ionic separation material for LC. When fused silica capillaries coated with zwitterionic polymer are used for capillary electrophoresis, good separations can be achieved for solutes as different as inorganic anions, peptides, proteins, and tryptically digested proteins.

The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered. Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life. SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process.

Chronic graft dysfunction (CGD) is an important post-transplant complication. CGD can be considered as an impaired repair process, which ultimately leads to the loss of graft function.To study non-immunological factors contributing to the development of CGD in kidney grafts we used in vitro and in vivo models, and clinical studies. We studied the actions of hyperlipidemia in vitro. LDL induced increased expression of TGF-β1 and TGF-β receptors type I and type II. Smad2 phosphorylation could be induced by conditioned medium from mesangial cells incubated with LDL. The effects of Fluvastatin and AT1 receptor blocker Candesartan cilexetil on aortic graft arteriosclerosis in the rat were evaluated. Fluvastatin neither alone nor in combination with Cyclosporine A affected allograft remodelling, but reduced neointima formation in isografts. Candesartan cilexetil treatment reduced graft arteriosclerosis. The effect is explained by the reduction of TGF-β1 expression. We investigated the effects of Carvedilol in patients with CGD. Carvedilol failed to alter the CGD progression despite the efficient control of blood pressure, and a beneficial effect on lipid pattern and oxidation. Close control of CyA blood levels is recommended due to interaction between CyA and Carvedilol. Measurement of Ab-oxLDL in kidney graft recipients demonstrated that these patients had lower Ab-oxLDL levels as compared with the control group. Decreased Ab-oxLDL levels were associated with graft loss due to acute rejection and with ischemic heart disease. In this thesis we have addressed several important complex issues, which are interconnected: (1) development of chronic graft dysfunction (2) lipoproteins and their role in inducing pathological conditions like atherosclerosis and graft damage, (3) oxidation, (4) TGF-β and its' role in different pathological conditions, including renal and vascular damage.

The Fas pathway is critical for the maintenance of normal T cell homeostasis. Humans and mice with defects in this pathway exhibit the accumulation of large numbers of peripheral lymphocytes and lupus-like autoimmunity. A major feature of these organisms is the accumulation of non-NK TCRαβ+CD4-CD8- “double negative” (DN) T cells. While regulatory T cells (Tregs) with the DN phenotype have been extensively characterized in Fas-sufficient mice and humans, limited data exist on the role of DN T cells as Tregs in Fas-deficient animals. In fact, most of the literature suggests that the DN T cells accumulating in Fas-deficiency states are pathogenic, contributing to secondary lymph node enlargement and autoimmune disease. In this body of work, data are presented that illustrate that Fas-deficient lymphoproliferative (LPR) DN T cells can act as Tregs in an interferon γ (IFNγ)- and Fas ligand (FasL)-dependent fashion toward Fas-sufficient T cells. LPR DN T cells needed to be able to secrete and respond to IFNγ in order to upregulate surface FasL, in order to ameliorate GVHD mediated by CD4+ T cells in vivo and to suppress the proliferation of and kill activated CD4+ T cells in vitro. FcRγ, a key molecule involved in innate immune responses, can substitute for CD3ζ in the T cell receptor (TCR) of mouse and human T cells in certain circumstances; in doing so, it is essential for the regulatory function of TCR transgenic DN Tregs. FcRγ-deficient LPR mice were found to have exacerbated T cell accumulation and early mortality. We show that while FcRγ expression was required for LPR DN T cells to regulate CD4+ and CD8+ T cells responding to alloantigens in vitro and in vivo, it does not control autologous lymphoproliferation in LPR mice by supporting the function of a regulatory cell, nor does it affect the rate of proliferation of LPR T cells in vivo. Instead, FcRγ-expressing LPR CD4+, CD8+ and DN T cells were found to be undergoing apoptosis at a high rate in vivo, and in contrast to their FcRγ-deficient counterparts, FcRγ+ LPR DN T cells were capable of undergoing TCR restimulation-induced cell death (RICD). The data presented in this thesis therefore show that LPR DN T cells can exhibit IFNγ-, FasL- and FcRγ-dependent regulatory function, and also illustrate a previously unknown function for FcRγ in controlling the expansion of Fas-deficient T cells. The implications of these data for autoimmune lymphoproliferative syndromes, and normal T cell homeostasis, are discussed.