Cardiovascular disease (CVD) is a major cause of adult morbidity and mortality in developed as well as in developing countries. In black population groups, stroke is more prominent than ischaemic heart disease. This may be attributed to a combination of risk factors seen in this population group inter alia raised haemostatic markers, which favour the development of stroke since it is well known that a disturbance in the haemostatic balance (a hypercoagulable and a hypofibrinolytic state) predisposes to CVD. It is generally accepted that childhood genetic, environmental and behavioural factors lay the groundwork for the manifestation of adult CVD. Therefore, one of the studies that form part of this dissertation was a cross-sectional study to determine whether haemostatic abnormalities are already present in black African adolescents and to determine whether high risk groups exist [in relation to the following haemostatic markers: fibrinogen, factor VIII (FVIII), plasminogen activator inhibitor type 1 activity (PAI-Iact), and thrombin anti-thrombin complex (TAT)] for the development of CVD later in life. The population subdivisions were made according to gender, body fat %, maturity status, height for age Z-score, and habitual PA levels. Since behavioural factors [diet, physical activity (PA), smoking and drinking habits] are controllable determinants, it could be possible to improve CVD risk to a certain degree. Therefore, the second study that forms part of this dissertation attempted to establish whether a PA programme will successfully reduce haemostatic variables in a subset of the study population used in the first study. The reader is referred to the abstracts at the beginning of each separate study manuscript (Chapters 3 and 4), for a description of the subjects, study design and methods used in each study. The results of the cross-sectional study showed that in African adolescents (a) gender independently contributed to the variability in PAI-Iact, but that the gender difference in fibrinogen and TAT could be explained by the significant differences in fat mass and PA levels observed between the genders; (b) fibrinogen was significantly higher in the stunted compared to the non-stunted children indicating that childhood chronic malnutrition may possibly predispose independently to CVD; (c) fitness influences TAT concentrations positively and that (d) no significant differences in FVIII could be found between any of the subdivisions. As these determinants seem to be modifiable through behavioural changes and optimal nutrition status through early life, it raises a sense of urgency to develop strategies for the prevention and treatment of these risk factors. The results of the intervention study showed that an 11-week outdoor PA intervention programme had no significant effect on the haemostatic markers of African adolescents, but the results of this study should be interpreted with caution since (a) seasonal variations could have clouded the effect of the PA intervention as baseline measurements were taken in the summer and end measurements in the winter; (b) attendance of the PA sessions does not necessarily implicate compliance to the exercises given; (c) baseline values seem to play a prominent role in the changes that could be expected during an intervention and, therefore, improvements in the haemostatic profile would most likely be more significant in individuals with raised baseline levels. Similar research on African children is warranted since studies investigating PA's effect on haemostatic variables remain a topic of debate and speculation and data on African population groups are scanty. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2007

Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2007.

Cardiovascular disease (CVD) is a major cause of adult morbidity and mortality in developed as well as in developing countries. In black population groups, stroke is more prominent than ischaemic heart disease. This may be attributed to a combination of risk factors seen in this population group inter alia raised haemostatic markers, which favour the development of stroke since it is well known that a disturbance in the haemostatic balance (a hypercoagulable and a hypofibrinolytic state) predisposes to CVD. It is generally accepted that childhood genetic, environmental and behavioural factors lay the groundwork for the manifestation of adult CVD. Therefore, one of the studies that form part of this dissertation was a cross-sectional study to determine whether haemostatic abnormalities are already present in black African adolescents and to determine whether high risk groups exist [in relation to the following haemostatic markers: fibrinogen, factor VIII (FVIII), plasminogen activator inhibitor type 1 activity (PAI-Iact), and thrombin anti-thrombin complex (TAT)] for the development of CVD later in life. The population subdivisions were made according to gender, body fat %, maturity status, height for age Z-score, and habitual PA levels. Since behavioural factors [diet, physical activity (PA), smoking and drinking habits] are controllable determinants, it could be possible to improve CVD risk to a certain degree. Therefore, the second study that forms part of this dissertation attempted to establish whether a PA programme will successfully reduce haemostatic variables in a subset of the study population used in the first study. The reader is referred to the abstracts at the beginning of each separate study manuscript (Chapters 3 and 4), for a description of the subjects, study design and methods used in each study. The results of the cross-sectional study showed that in African adolescents (a) gender independently contributed to the variability in PAI-Iact, but that the gender difference in fibrinogen and TAT could be explained by the significant differences in fat mass and PA levels observed between the genders; (b) fibrinogen was significantly higher in the stunted compared to the non-stunted children indicating that childhood chronic malnutrition may possibly predispose independently to CVD; (c) fitness influences TAT concentrations positively and that (d) no significant differences in FVIII could be found between any of the subdivisions. As these determinants seem to be modifiable through behavioural changes and optimal nutrition status through early life, it raises a sense of urgency to develop strategies for the prevention and treatment of these risk factors. The results of the intervention study showed that an 11-week outdoor PA intervention programme had no significant effect on the haemostatic markers of African adolescents, but the results of this study should be interpreted with caution since (a) seasonal variations could have clouded the effect of the PA intervention as baseline measurements were taken in the summer and end measurements in the winter; (b) attendance of the PA sessions does not necessarily implicate compliance to the exercises given; (c) baseline values seem to play a prominent role in the changes that could be expected during an intervention and, therefore, improvements in the haemostatic profile would most likely be more significant in individuals with raised baseline levels. Similar research on African children is warranted since studies investigating PA's effect on haemostatic variables remain a topic of debate and speculation and data on African population groups are scanty. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2007

Les accidents vasculaires cérébraux (AVC) constituent la 3e cause de mortalité dans les pays industrialisés, et sont à 80% de type ischémique (AVCi). A l’heure actuelle, le seul traitement disponible est l’activateur tissulaire du plasminogène recombinant (rt-PA), dont l’utilisation est très limitée, en raison d’une fenêtre thérapeutique étroite et de l’augmentation du risque de transformations hémorragiques (TH). Après un AVCi, les cliniciens sont confrontés, entre autres, à 3 objectifs d’ordre vasculaire: (1) reperfuser les tissus ischémiés, (2) éviter les TH, ainsi que (3) les ré-occlusions précoces ou tardives. Les travaux du laboratoire ont précédemment établi qu’après une ischémie cérébrale (IC), l’hyperactivation de la poly(ADP-ribose)polymérase (PARP), une enzyme nucléaire, est (1) neurotoxique et (2) contribue aux TH spontanées ou induites par le rt-PA. Par ailleurs, des études suggèrent que les inhibiteurs de PARP pourraient également réduire les phénomènes de ré-occlusion, en inhibant l’activation/agrégation plaquettaires, et ceci via 2 mécanismes : (1) « PARP-indépendant », lié à une analogie structurale de certains inhibiteurs de PARP avec des agonistes plaquettaires, comme l’ADP, et (2) « PARP-dépendant », lié à leur effet anti-inflammatoire. Cependant, à l’heure actuelle, il n’existe aucune donnée dans l’IC. Dans ce contexte, ce travail a consisté à évaluer les effets de plusieurs inhibiteurs de PARP sur l’activation et l’agrégation plaquettaire. Il nous est notamment apparu nécessaire de rechercher si la réduction des TH par les inhibiteurs de PARP pourrait être liée, au moins en partie, à une activité pro-agrégante, qui compromettrait leur association avec le rt-PA. A l’inverse, une activité anti-agrégante, bien que favorisant les hémorragies, pourrait améliorer la reperfusion ou diminuer les risques de ré-occlusion. Dans la 1ère partie, nos résultats montrent in vitro que deux inhibiteurs de PARP (PJ34 et minocycline) sont anti-agrégants plaquettaires, et que cet effet serait « PARP-indépendant », puisque deux autres inhibiteurs de PARP, le 3-aminobenzamide et l’INO-1001, n’ont pas modifié l’agrégation. De plus, sur du sang humain, mais pas murin, le PJ34 exerce un effet anti-agrégant, qui pourrait être lié à un antagonisme du récepteur à l’ADP, P2Y12. La 2nde partie a été réalisé sur des modèles in vivo chez la souris. L’utilisation de 3 tests d’exploration des fonctions plaquettaires (temps de saignement, modèles de thromboembolie pulmonaire et de thrombose carotidienne par le FeCl3) a mis en évidence l’absence d’effet du PJ34 et de la minocycline sur les fonctions plaquettaires, et notamment, pas d’effet pro-agrégant pouvant expliquer la réduction des TH. Dans un modèle de thrombose de l’artère cérébrale moyenne par le FeCl3, le PJ34 n’entrave pas la thrombolyse par le rt-PA, mais au contraire, pourrait tendre à l’améliorer. Parallèlement, dans un modèle d’IC chez la souris, nos travaux ont mis en évidence une augmentation cérébrale de l’adhésion des plaquettes et de l’expression d’ICAM-1. La suite de cette étude sera d’étudier si les inhibiteurs de PARP, en protégeant la paroi vasculaire, pourraient réduire les phénomènes de ré-occlusion. L’ensemble de ce travail s’inscrit dans une thématique plus globale de notre laboratoire qui vise à identifier l’intérêt d’associer un inhibiteur de PARP au rt-PA pour une meilleure prise en charge de la thrombolyse post-AVCi. / Stroke is the 3rd leading cause of death in industrialized countries and 80% are ischemic. The recombinant tissue-plasminogen activator (rt-PA) is currently the only available treatment but its use remains very limited due to a narrow therapeutic window and an increased risk of hemorrhagic transformation (HT). After ischemic stroke, the key vascular objectives of clinicians are : (1) to reperfuse ischemic tissue, (2) to avoid both HT and (3) early or late reocclusions. Our laboratory previously established that after cerebral ischemia (CI), the overactivation of poly(ADP-ribose)polymerase (PARP), a nuclear enzyme, is (1) neurotoxic and (2) contributes to spontaneous or rt-PA-induced HT. Moreover, studies suggest that PARP inhibitors could also reduce the risk of reocclusion by inhibiting platelet activation/aggregation via two mechanisms : (1) one is "PARP-independent" and linked to a structural analogy of certain PARP inhibitors with platelet agonists such as ADP, and (2) the second one is "PARP-dependent" and due to their anti-inflammatory effect. However, so far, there is no data in CI.In this context, the aim of this work was to evaluate the effects of several PARP inhibitors on platelet activation and aggregation. In particular, it appeared necessary to examine whether the reduction of HT by PARP inhibitors could be related, at least in part, to a pro-aggregatory activity, which would then compromise their association with rt-PA. By contrast, an anti-aggregatory activity could improve reperfusion or reduce the risk of reocclusion, although it would also contribute to hemorrhage. In the 1st part, our results show that, in vitro, two PARP inhibitors (PJ34 and minocycline) are antiplatelet agents and that this effect is "PARP-independent" since two other PARP inhibitors, 3-aminobenzamide and INO-1001 did not alter the aggregation. Moreover, in human blood but not in murine one, PJ34 exerts an anti-aggregatory effect which may be related to the antagonism of the ADP receptor P2Y12. The 2nd part was performed on in vivo models in mice. The use of three tests of platelet function exploration (bleeding time and models of pulmonary thromboembolism and FeCl3-induced carotid thrombosis) showed no effect of minocycline and PJ34 on platelet function and in particular, no pro-aggregatory effect which may explain the reduction of HT. In a thrombosis model of the middle cerebral artery by FeCl3, PJ34 does not impede the thrombolysis induced by rt-PA, but even tends to improve it. Meanwhile, in a CI model in mice, our work shows an increase of platelet adhesion and ICAM-1 expression in the brain. The next step will be to investigate whether PARP inhibitors could reduce reocclusions by protecting the vascular wall. All this work is part of a broader topic of our laboratory aims to identify the interest of combining a PARP inhibitor with rt-PA for a better management of post-ischemic thrombolysis.

Fibronectin is an extracellular multidomain glycoprotein that directs and regulates a variety of cell processes such as proliferation, development, haemostasis, embryogenesis, and wound healing. As a major component of blood, fibronectin exists as a soluble disulphide linked dimer, but it can also be incorporated into an insoluble cross-linked fibrillar network to form a major component of the extracellular matrix. Fibronectin is composed of an extended chain of module repeats termed Fn1, Fn2, and Fn3 that bind to a wide range of transmembrane receptors and extracellular matrix components, including collagen. The gelatin binding domain of fibronectin was first isolated as a 45kDa proteolytic fragment and has since been found to be composed of six modules: 6Fn1-1Fn2-2Fn2-7Fn1-8Fn1-9Fn1 (in this notation nFX represents the nth type X module in the native protein). This domain has been reported to bind to both collagen and denatured collagen (gelatin), but with 10-100 times higher affinity to the latter; it can be purified to homogeneity on a gelatin affinity column. In the work presented here, fragments of the gelatin binding domain are expressed in P. pastoris, purified to homogeneity, and investigated at the molecular level. Through a dissection approach, surface plasmon resonance (SPR) is used to characterise the recombinantly produced protein, to accumulate more information about the function of the full domain. NMR is used to assess the folding of the protein fragments at atomic resolution. In particular, the secondary structure of 8Fn1-9Fn1 is mapped using inter-strand NOEs, which suggests that the construct takes the fold of a pair of typical Fn1 modules. Gelatin affinity chromatography is used to confirm that both Fn1 and Fn2 modules contribute to gelatin binding, possibly in two clusters (1Fn2-2Fn2 and 8Fn1-9Fn1). The 7Fn1 module may perform a structural role in linking together these two interaction sites, in the same way as suggested for 6Fn1, which is thought to act in a structural manner to enhance the binding of 1Fn2-2Fn2 to gelatin. Three carbohydrate moieties are found on this domain, one on 2Fn2 and two on 8Fn1. Here, by means of expressing different protein length fragments, and by site directed mutagenesis, the role of each sugar chain is investigated independently. The sugar chain on 2Fn2 does not appear to promote binding to collagen, nor does the first sugar chain on 8Fn1 (N-linked to N497), implying another role for these sugars such as protection from proteolysis. However, the presence of at least a single GlcNAc sugar residue on the second sugar chain site on 8Fn1 (N- linked to N511) is essential for full affinity binding to collagen. Direct binding of the 8Fn1-9Fn1 module pair to collagen is assessed with a short collagen peptide and the binding is monitored by NMR. The peptide appears to bind, predominantly to the final strand of 8Fn1, the first β- strand of 9Fn1, and the linker between the two modules, with μM affinity. A model for bound peptide is proposed. The highly conserved amino acid motif Ile-Gly-Asp (IGD) is found on four of the nine N-terminal Fn1 modules of fibronectin. Tetrapeptides containing the IGD were demonstrated to promote the migration of fibroblast cells into a native collagen matrix. Two of these “bioactive” IGD motifs are found within the gelatin binding domain, one on 7Fn1 and one on 9Fn1. In this study, the motif in the 8Fn1-9Fn1 module pair is shown to be located in a tightly constrained loop within 9Fn1. By site directed mutagenesis, the IGD motifs of 7Fn1 and 9Fn1 are subjected to single amino acid substitutions, and their ability to stimulate cell migration assessed in our assay. By NMR, the fold of the IGD mutant proteins is found to be unaffected by the mutation with respect to the wild type, with the exception of small perturbations around the substitution site. While the wild type module is able to stimulate fibroblast migration, the mutant proteins show reduced or negligible bioactivity. The larger fragments show far more potency in stimulating fibroblast migration, with 8Fn1-9Fn1 (one IGD motif) 104 times more potent than the IGD peptide, and the full gelatin binding domain (two IGD motifs) 106 times more potent than the 8Fn1-9Fn1. Potential mechanisms for this enormous enhancement of the IGD potency in different contexts are discussed.

Acute myocardial infarction (AMI), caused by ischaemic heart disease (IHD), is a leading cause of death in both men and women in the western society. Hypertension, diabetes, and smoking are examples of well-known risk factors of IHD, but also there are psychosocial factors, such as stress, vital exhaustion (unusual fatigue, irritability, and demoralization) and depression that have been associated with an increased risk in both genders. After an AMI, however, women are more likely than men to be psychosocially impaired resulting in suffering and a presumed increase in the risk of recurrent cardiac events. Psychosocial factors may be targeted in secondary prevention, complementary to drug treatment and conventional lifestyle advice. There is some evidence of beneficial effects on both psychosocial well-being and cardiac outcomes by psychosocial interventions in men. Far fewer women have been studied and the results have been inconsistent. It is not clear how psychosocial factors convey the increased risk of cardiac events, but many possible psychopathological mechanisms, including biochemical and physiological links, have been suggested. In the Women’s Hearts study we have, in a randomised controlled trial, evaluated a one-year cognitive-behavioural stress management programme designed specifically for women with IHD. We included 198 women with IHD, with a mean age of 61 years and from the county of Västerbotten in Northern Sweden, who were randomised to either conventional treatment and follow-up, or to stress management in addition to conventional care. Extensive questionnaires, blood samplings, and biomedical and physiologic data were obtained before randomisation, as well as at follow-ups approximately one and two years after randomisation. Two groups of healthy controls were included for comparisons with women with IHD. Compared to women without IHD, women with IHD reported more stress behaviour and vital exhaustion. Women with IHD also had a lower heart rate variability (HRV) than the healthy controls, possibly reflecting a dysfunctional autonomic nervous regulation of the heart. Reduced HRV has been shown to increase the risk of cardiac arrhythmias and sudden death. At the first follow-up, performed at the end of the one-year stress management programme, women who had participated in the programme had reduced the stress behaviour and vital exhaustion, compared to the women in the conventional care group. We could not find any evidence of a direct cause-effect relationship between stress management and biological cardiovascular risk indicators, or HRV; the intervention and control groups did not differ in insulin resistance, inflammatory, haemostatic and fibrinolytic factors, or HRV. At second follow-up one year later, several additional psychosocial domains were studied. The stress management programme had accelerated psychosocial recovery at the first follow-up over and above that observed in the control group. At the second follow-up, there was further marked improvement in the control group, so the differences in psychosocial variables between the intervention and control groups were no longer significant. In conclusion, a cognitive-behavioural stress management programme could accelerate psychosocial improvement in women with IHD, and thus reduce the amount of psychological and psychosocial suffering. We could not find any evidence that the stress management programme was associated with a concomitant improvement in biological cardiovascular risk indicators, or HRV. Our results suggest that the women with the greatest psychosocial burden should be identified and targeted in new clinical trials of cognitive-behavioural interventions in women with IHD. Future studies within the Women’s Hearts project will evaluate the psychosocial effects at a five-year follow-up, as well as investigations of other possible pathways by which psychosocial interventions might mediate beneficial effects on cardiac events.

La drépanocytose est associée à un état d’hypercoagulabilité qui se manifeste sur le plan clinique par un risque augmenté de thromboses artérielles et veineuses. L’exploration de la coagulation chez les patients drépanocytaires montrait surtout une activation de la coagulation et des altérations des acteurs pro- et anticoagulants du système hémostatique. Les tests de coagulation globale de routine tels que l’aPTT et le PT sont peu sensibles aux états d’hypercoagulabilité. La fonction hémostatique globale des patients drépanocytaires était donc peu connue. Le test de génération de thrombine est un test de coagulation globale, sensible aux états d’hypo- et d’hypercoagulabilité, facile à réaliser de nos jours avec une bonne reproductibilité. Nous l’avons utilisé pour démontrer que la coagulation globale des enfants drépanocytaires était caractérisée par une accélération des réactions de formation de la thrombine et par une augmentation du potentiel de thrombine endogène. Nous avons par la suite montré que les taux élevés de microparticules pro-coagulantes et du facteur VIII chez les enfants drépanocytaires seraient les facteurs déterminant l’accélération des réactions de formation de thrombine tandis que la réduction de l’activité anticoagulante du système protéine C / protéine S serait le facteur déterminant l’augmentation du potentiel de thrombine endogène. Les marqueurs de l’hémolyse corrélaient significativement avec ces facteurs ainsi qu’avec les paramètres de génération de thrombine, suggérant que l’hémolyse serait le mécanisme pathologique à la base de l’augmentation du potentiel de génération de thrombine chez les enfants drépanocytaires. Les paramètres de génération de thrombine n’étaient pas significativement différents entre l’état de stabilité clinique et l’état de crise vaso-occlusive. Chez les enfants hétérozygotes composites, ces paramètres avaient des valeurs intermédiaires entre celles des enfants contrôles et celles des enfants drépanocytaires homozygotes. Près de 40 % des enfants drépanocytaires homozygotes avaient un potentiel hémostatique supérieur à la moyenne + 2DS des enfants contrôles du même âge. Ces enfants présentant une génération de thrombine élevée se distinguaient des autres par leur plus jeune âge, une plus grande intensité de l’hémolyse, une plus courte durée de traitement par l’hydroxyurée et des vélocités du flux sanguin au doppler transcrânien plus élevées. Ces données suggèrent davantage un lien entre le potentiel de génération de thrombine et la vasculopathie cérébrale chez les enfants drépanocytaires. L’analyse de 4 enfants ayant reçu une greffe de cellules souches hématopoïétiques montrait une tendance à la réduction du potentiel de génération de thrombine et des autres altérations de la coagulation trois mois après la greffe. Le test de génération de thrombine permet une meilleure exploration de la coagulation globale des enfants drépanocytaires. Sa réalisation sur sang total permettrait une analyse plus globale en intégrant la participation des éléments figurés du sang particulièrement les globules rouges./<p>Sickle cell disease is associated with a hypercoagulable state that express clinically by an increased risk of arterial and venous thrombosis. The exploration of coagulation in sickle cell patients showed mainly activation of coagulation and alterations pro-and anticoagulants actors of the hemostatic system. Routine global testing of coagulation such as the prothrombin time and the activated partial thromboplastin time are insensitive to hypercoagulable states. The overall hemostatic function in sickle cell disease was so little known. The thrombin generation test is a test of overall coagulation. It is sensitive to both hypo- and hypercoagulable states. It is easy to perform nowadays with good reproducibility. We used it to demonstrate that the overall coagulation of sickle cell disease children was characterized by an acceleration of the reactions of thrombin formation and an increase of the endogenous thrombin potential. We have subsequently shown that high levels of procoagulant microparticles and high levels of factor VIII in children with sickle cell disease are the factors determining the acceleration of reactions leading to thrombin formation. Our results also showed that the reduced activity of the protein C / S anticoagulant pathway is a determining factor of the increased endogenous thrombin potential in sickle cell children. Markers of hemolysis correlated significantly with these factors as well as the parameters of thrombin generation, suggesting that hemolysis is probably the pathological mechanism underlying the increased potential for thrombin generation in children with sickle cell disease. Nearly 40% of children with homozygous sickle cell disease had their hemostatic potential above the mean + 2SD that of controls children of the same age. These children with high thrombin generation differed from others by their younger age, greater intensity of hemolysis, a shorter duration of treatment with hydroxyurea. They also had higher velocity of blood flow using transcranial Doppler. These data further suggest a potential link between thrombin generation and cerebral vasculopathy in children with sickle cell disease. Analysis of four children who received hematopoietic stem cells transplantation showed a tendency towards a reversibility of thrombin generation and other alterations of coagulation three months after the transplant. Thrombin generation assay allows a better exploration of the global coagulation of sickle cell disease children. Its realization on whole blood would be a more comprehensive analysis as it would integrate the participation of blood cells particularly red blood cells. / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished