There is evidence that athermal radiofrequency radiation can alter Heat Shock Protein (HSP) expression or protein phosphorylation, or alter MAP kinase signalling. Effects of long-term exposure in brain tissue due to repeated HSP perturbation (eg an inhibition of apoptosis) have been hypothesised (French et al, 2001). This study aimed to investigate the RNA expression profile (12,000 genes) and HSP family protein expression levels after either acute 1-hour or chronic 4-day intermittent exposures to simulated GSM radiation in a human primary fibroblast model. The results found minimal or no effects of GSM. Flasks were exposed to 900 MHz (217 Hz modulation) at 0.18 W/kg SAR within a Transverse Electromagnetic Mode chamber (TEM cell). Cultures rested for 2 hours before exposures. Affymetrix U95A microarray analysis of a single pilot set of experiments showed that about 40 genes were reported as upregulated &gt=2.5 fold in each condition. There was no evidence of altered expression of any MAPK-associated genes. Target genes reported in both conditions (CBFA2T1, ZNF148, ITGA1), and genes altered in one condition (CCS, PLEC1, BIRC5), and marginally altered HSP72 were selected for PCR analysis. No other members of the HSP family were altered. In three replicate experiments assayed by real-time PCR, six genes were either unchanged or showed randomly variable expression. However HSP72 RNA showed possible consistent slight upregulation of 1.37 +/- 0.21 in the chronic condition. Western immunoblots of HSP-60, -70, -72 and -V90 proteins showed no significant changes 5 hours after exposure. In preliminary studies using a serum starvation protocol, ERK-1 phosphorylation was unaltered after 5 or 30 minutes GSM (single experiments). When flasks were transiently cooled, ERK-1 phosphorylation was increased 20 minutes later, indicating a source of artefact in some protocols. An inflammatory challenge experiment with a low-dose of the cytokine IL-1???? found that acute GSM exposure post-challenge inhibited NF????B-mediated GRO???? induction by 1.5 fold (2 experiments). Preconditioning with mild heat induces transient inhibition of both NF????B signalling and apoptosis. Other studies indicate that EMF exposures similarly evoke cytoprotection. It is suggested that GSM evoked cytoprotective signalling in this inflammatory model.

Cheddar Cheese samples (good cheese, weak cheese, cheese made with pasteurized milk, cheese made with heat-shocked milk, cheese from production plant A, cheese from production plant B, cheese made with adjunct culture, and cheese made without adjunct culture), were evaluated during the ripening stage. Proteolysis was studied by a fractionation scheme, resulting in an insoluble fraction analyzed by urea polyacrylamide gel electrophoresis (Urea-PAGE), and a soluble fraction which was further investigated through water soluble nitrogen (WSN), trichloroacetic acid soluble nitrogen (TCA-SN) and phosphotungstic acid soluble nitrogen (PTA-SN) analyzed by total Kjeldahl nitrogen content (TKN). Reversed phase high performance liquid chromatography (RP-HPLC) was used to study the peptide profile of the water soluble fraction. Lipolyisis was studied by levels of individual free fatty acids determined through gas chromatography-flame ionization detection (GC-FID) after isolation employing solid phase extraction (SPE). Volatile sulfur compounds were studied using head space solid phase micro-extraction (SPME) coupled with gas chromatography-pulsed flame photometric detection (PFPD). It was found that Urea-PAGE is capable to differentiate samples according their age, but cannot discriminate samples regarding the treatment assessed, quality or origin of the samples. However, measurements of total Kjeldahl Nitrogen (TKN) of the WSN, TCA-SN, and PTA-SN fractions, and the principal component analysis of the RP-HPLC peptide profile of the WSN fraction, revealed differences in the rate and pattern of proteolysis for each one of the manufacturing cases. Good cheese, cheese produce in plant TCCA, cheese made in plant CRP with adjunct culture isolated from plant TCCA cheese, and cheese made with heat-shocked milk developed higher level of total nitrogen for the WSN, TCA-SN and PTA-SN fractions, indicating that primary and secondary proteolysis were faster for these samples. This is supported by a PCA model with three principal components that account for the 80-83% of the variability of the data from the RP-HPLC peptide profile analysis, which discriminates the samples according to age and manufacturing practice. In addition, FFA profiles demonstrated higher levels of low and medium chain free fatty acids for good cheese, cheese produce in plant TCCA, cheese made in plant CRP with adjunct culture, and cheese made with heat-shocked milk samples, which suggest faster lipolysis during ripening. The Volatile Sulfur Compounds (VSC) analysis showed higher levels of DMS and MeSH and lower levels of H2S, suggesting faster catabolism of sulfur containing amino acids in good cheese, cheese produce in plant TCCA, cheese made in plant CRP with adjunct culture, and cheese made with heat-shocked milk. / Graduation date: 2013

The major evolutionary transition from single-celled to multicellular life is believed to have occurred independently of the main metazoan lineages in the cellular slime moulds, of which Dictyostelium discoideum is the best-studied species. Unusually, in this case multicellular development is a facultative trait and part of an asexual life cycle. It is triggered by starvation and involves aggregation of hitherto independent and possibly unrelated free-living cells. The consequences of multicellularity in D.discoideum are strongly influenced by the environment and meaningful external perturbations are easily carried out. This makes the organism ideally suited to a study of epigenetic factors that regulate development. In an attempt to understand how conserved epigenetic pathways are integrated within the developmental framework, two likely players were chosen for investigation - heat shock protein 90 (Hsp90) and histone deacetylases (HDACs). Hsp90 has been implicated in diverse biological processes such as protein folding, cell cycle control, signal transduction, and morphological evolution. The role of Hsp90 in D.discoideum life cycle was studied using a specific inhibitor, geldanamycin. Inhibition of Hsp90 function in D.discoideum caused a delay in aggregation and an arrest of development at the ‘mound’ stage. A reduction in Hsp90activity in starving cells of D.discoideum resulted in the generation of a range of phenotypes. The study suggests that Hsp90 is required for a specific developmental transition of the social amoeba and is important in generating a reliable outcome of the developmental process. Histone acetylation regulates gene expression and leads to the establishment and maintenance of cellular phenotypes during development of plants and animals. To study the roles of HDACs in D.discoideum, biochemical, pharmacological and genetic approaches were employed. The inhibition of HDAC activity by trichostatin A resulted in histone hyperacetylation and a delay in cell aggregation and differentiation. Cyclic AMP oscillations were normal in starved amoebae treated with trichostatin A but the expression of a subset of cAMP-regulated genes was delayed. Bioinformatic analysis indicated that there are four genes encoding putative HDACs in D.discoideum. One of these four genes, hdaB, was found to be dispensable for growth and development under laboratory conditions; but formed spores with lower efficiency than the wild type in chimeras. The work shows that HDAC activity is important for regulating two aspects of multicellular development: (a) heterochrony, namely the relative timing of developmental events, and (b) modulating the behaviour of single cells in a manner that is sensitive to their social environment.

Transforming growth factor beta (TGF-β) has been implicated in anterior subcapsular cataract (ASC) development. In the first section of this thesis, an in-vitro rat lens model was used to determine the role of matrix metalloproteinases during TGF-β-induced ASC. In the second part, an in-vivo TGF-β transgenic and Smad3 knockout model was used to examine the role of Smad3 signaling pathway in TGF-β-induced ASC development. Lastly, an in-vitro rat lens epithelial explant culture model was used to investigate the potential role of heat shock proteins (Hsps) in TGF-β-induced epithelial-mesenchymal transition (EMT). Optical, morphological and molecular changes were analyzed in theses studies. Results from cultured rat lenses show a significant increase of back vertex distance variability (decrease of sharpness and focus) during ASC development. Inhibition of MMPs eliminated the TGF-β-induced plaque formation. Similarly, the overexpression of TGF-β1 in transgenic mouse lenses leads to ASC formation and a decrease in lens optical quality in comparison to wild-type lenses, while TGF-β1/Smad3-/- (null) lenses show diminished TGF-β-induced effects. The plaques formed in the TGF-β1/Smad3-/- lenses are substantially smaller than in the TGF-β1/Smad3+/+ lenses. The morphological and molecular changes of TGF-β2/FGF-2 treated rat lens epithelial explants are similar to those found in the TGF-β2 treated rat lenses and transgenic TGF-β1 mouse lenses. Heat shock treatment prior to TGF-β treatment significantly reduced the effects of EMT in rat LECs. In conclusion, MMP inhibition prevented TGF-β-induced ASC formation whereas heat shock treatment and the absence of Smad3 protein expression only reduced the severity of TGF-β-induced effects.

Transforming growth factor beta (TGF-β) has been implicated in anterior subcapsular cataract (ASC) development. In the first section of this thesis, an in-vitro rat lens model was used to determine the role of matrix metalloproteinases during TGF-β-induced ASC. In the second part, an in-vivo TGF-β transgenic and Smad3 knockout model was used to examine the role of Smad3 signaling pathway in TGF-β-induced ASC development. Lastly, an in-vitro rat lens epithelial explant culture model was used to investigate the potential role of heat shock proteins (Hsps) in TGF-β-induced epithelial-mesenchymal transition (EMT). Optical, morphological and molecular changes were analyzed in theses studies. Results from cultured rat lenses show a significant increase of back vertex distance variability (decrease of sharpness and focus) during ASC development. Inhibition of MMPs eliminated the TGF-β-induced plaque formation. Similarly, the overexpression of TGF-β1 in transgenic mouse lenses leads to ASC formation and a decrease in lens optical quality in comparison to wild-type lenses, while TGF-β1/Smad3-/- (null) lenses show diminished TGF-β-induced effects. The plaques formed in the TGF-β1/Smad3-/- lenses are substantially smaller than in the TGF-β1/Smad3+/+ lenses. The morphological and molecular changes of TGF-β2/FGF-2 treated rat lens epithelial explants are similar to those found in the TGF-β2 treated rat lenses and transgenic TGF-β1 mouse lenses. Heat shock treatment prior to TGF-β treatment significantly reduced the effects of EMT in rat LECs. In conclusion, MMP inhibition prevented TGF-β-induced ASC formation whereas heat shock treatment and the absence of Smad3 protein expression only reduced the severity of TGF-β-induced effects.

This thesis entitled “Mechanism of Anticancer and Antimalarial Action of a Modulator of Heat Shock Proteins” describes the successful elucidation of the mechanism of anticancer and antimalarial action of 15-Deoxyspergualin (DSG). DSG, a relatively well known immunosuppressant and antitumor molecule has been demonstrated to kill the malaria parasite in vitro and in vivo (Midorikawa et al., 1997; Midorikawa et al., 1998). A highly polar molecule, DSG binds the carboxy terminal “EEVD” motif of heat shock proteins, Hsp70 and Hsp90, enhances the ATPase activity of Hsp70 (Nadler et al., 1992; Nadler et al., 1998), and modulates several seemingly unrelated cellular processes. DSG has also been demonstrated to inhibit protein synthesis and polyamine synthesis in cells (Kawada et al., 2002; Hibasami et al., 1991), and previously speculated to inhibit malaria parasite growth by inhibiting polyamine synthesis. The grim situation with regard to malaria infection and mortality, principally an offshoot of the emergence of chloroquine resistant strains of the causative agent of malaria - Plasmodium falciparum, calls for intense efforts towards developing efficacious antimalarial agents with few side effects. DSG, having been used already in graft rejection cases in man and demonstrated to potently inhibit malaria in mice (Midorikawa et al., 1997), offers promise in this regard. It was, therefore, of interest to solve the mystery of its mechanism of antimalarial action. Chapter 1 surveys literature related to DSG mechanism of action and presents the thesis objective. Chapter 1 also gives an overview of heat shock proteins and their role in cancer, and the biology of the malaria parasite (Plasmodium falciparum), the working of the principal metabolic pathways existing in it, and a description of processes related to the intriguing, relict plastid present in apicomplexans. The metabolic processes previously speculated to be targeted by DSG, and those later found to be involved in DSG mechanism of action – polyamine synthesis and transport, protein synthesis and apicoplast processes are dealt with in more detail. Though DSG has been speculated to kill the malaria parasite by inhibiting polyamine synthesis, that DSG could clear malaria infection in Plasmodium berghei infected mice did not corroborate with the observation that inhibitors of polyamine biosynthesis are incapable of inhibiting the malaria parasite in vivo probably because the parasites make do with polyamines salvaged from the host (Assaraf et al., 1984; Bitonti et al., 1987). On the other hand, DSG is known to bind heat shock proteins, and inhibit protein synthesis, and heat shock proteins are speculated to be involved in the activation of HRI (heme regulated inhibitor), a type of eIF2á kinase that phosphorylates the eukaryotic initiation factor, eIF2á in conditions of heme deficiency or other cellular stress. eIF2á phosphorylation leads to stalling of protein synthesis. It seemed likely that if HRI is activated upon sequestration of heat shock proteins by DSG, it would culminate in protein synthesis inhibition and ultimately, cell death. With the intention to investigate this line of thought, the PlasmodB database was mined for proteins essential to the existence of heme dependent protein synthesis in Plasmodium falciparum. Two Hsp70 proteins from Plasmodium falciparum, one with the carboxy terminal “EEVD” motif implicated in DSG binding, and one without, and an Hsp70 interacting protein were cloned and expressed in their recombinant form in Escherichia coli. The preliminary characterization of these heat shock proteins described in Chapter 2 revealed that they were functionally active. DSG did not inhibit either the chaperone activity of the Hsp70s or the interaction of Hsp70 with Hip, but stimulated their ATPase activity as anticipated. Chapter 3 gives a complete picture of the mechanism of protein synthesis inhibition by DSG in the standard protein synthesis system – reticulocyte lysate. The experiments carried out revealed that DSG inhibits protein synthesis precisely through the mechanism envisaged, i.e. through phosphorylation of HRI following sequestration of Hsp70. Experiments involving exogenous addition of heat shock protein to in vitro translation reactions confirmed this hypothesis. Moreover, DSG inhibited protein synthesis in cancer cells in vivo, too, and HRI knockdown cells were not affected by DSG. Interestingly, the Hsp70 levels in various cancer cell lines inversely correlated with the inhibitory activity of DSG, and modulation of Hsp70 levels through standard methods altered DSG inhibition of protein synthesis in these cells. It was thus confirmed that DSG did indeed inhibit mammalian cells through the pathway envisaged. Its previously reported antitumor property is probably through this outlined mechanism of interference with protein regulation. In the malaria parasite, too, DSG inhibited protein synthesis through eIF2 alpha phosphorylation following Hsp70 sequestration as outlined in Chapter 4. However, while the concentration of DSG required for inhibition of malaria parasite growth was in the nanomolar range, high micromolar concentrations of DSG were required to effect protein synthesis inhibition in the malaria parasite, indicating that yet another target for DSG existed in the malaria parasite. With protein synthesis no longer a candidate target of DSG, I looked into the previously implicated polyamine synthesis pathway. In the event of DSG inhibiting polyamine transport in addition to polyamine biosynthesis, it would be expected to clear malaria infection in vivo contrary to other inhibitors of polyamine biosynthesis. In Chapter 5, evidence for the polyamine synthesis pathway in the malaria parasite is provided. Experiments involving incorporation of radiolabeled precursors in the malaria parasite and in mammalian cells, however, revealed that only high micromolar concentrations of DSG inhibit polyamine synthesis. Polyamine transport was also studied in considerable detail in malaria parasite infected red blood cells. Though infected red blood cells demonstrated different kinetic parameters, implying that new polyamine transporters were employed by the parasite on the red blood cell upon infection, DSG did not potently inhibit polyamine transport, either. The mystery of the target of DSG in the malaria parasite was, however, close to solution, when the growth inhibition of the malaria parasite by DSG was studied carefully. DSG invoked “delayed death” – a phenomenon wherein death is invoked only one cycle after incubation with the inhibitor. “Delayed death” is typical of inhibitors that target apicoplast processes (Fichera and Roos, 1997). DSG did not inhibit either fatty acid synthesis or prokaryotic protein synthesis – processes that occur in the apicoplast, but effected a decrease in the amount of nucleus encoded proteins that are targeted to the apicoplast, suggesting that it inhibited the trafficking of nucleus encoded proteins to the apicoplast. Confocal microscopy of parasites transfected with GFP fusion protein confirmed these findings, and is described in Chapter 6. The thesis ends with a summary of the findings in Chapter 7. Apicoplast processes have always been considered to harbor immense potential in the development of antimalarial agents, thanks to the absence of an equivalent organelle and hence pathways, in the human host. Trafficking of nucleus encoded proteins to the apicoplast has remained unexplored however. The work done in this thesis not only serves to demystify DSG with regard to its mechanism of action, but also paves the way for further studies in this area of intracellular trafficking, which could help in the development of more efficacious antimalarial agents. It also adds a new dimension to previous work conducted with regard to the anticancer action of DSG. Appendix 1 revolves around inhibitors which target various apicoplast processes. Apicoplast processes have been conventionally linked to the intriguing but unfortunate (with respect to clinical application) “delayed death”. Results presented in this section demonstrate that not all apicoplast processes invoke “delayed death”. Inhibition of apicoplast processes such as fatty acid biosynthesis and heme synthesis evoke rapid death. Inhibitors designed to target these processes could, therefore, be highly efficacious.

O ψευδάργυρος -Zn ελέγχει τον μεταβολισμό των λιπιδίων και γλυκόζης μέσω Ζn-μεταγραφικών παραγόντων. Δίαιτες υψηλών λιπαρών οδηγούν στην ενδοκυτταρική συσσώρευση ελευθέρων ριζών, μειώνουν την μεταγραφική έκφραση των εκκαθαριστών τους και την ενεργότητα αντιοξειδωτικών ενζύμων και οδηγούν σε μεταβολικό σύνδρομο. Οι πρωτεϊνες του θερμικού shock (Heat shock proteins-HSP) παίζουν σημαντικό ρόλο στην αντίσταση στο κυτταρικό stress ως προσαρμογή ,μετά από έκθεση, σε διάφορα ερεθίσματα. ΣΚΟΠΟΣ : Μελέτη της επίδρασης του διατροφικού Ζn και των Hsp70,στην μεταβονομική των λιπιδίων αίματος και ήπατος ποντικών ΥΛΙΚΟ-ΜΕΘΟΔΟΙ :Ενήλικα αρσενικά ποντίκια: 1. Wild type (Wt) Hybrid (F1/F1) C57Bl/6 x CBA και 2. Transgenic (Tg) human HSP70 overexpressing mice, από ηλικίας ενός μηνός εντάχθηκαν στις παρακάτω διατροφές ,επί 10 εβδομάδες. Διατροφή Αριθμός Wt Αριθμός Tg Chow Diet (30 Zn) 6 10 High Fat Diet (3 Zn) 13 12 High Fat Diet (30 Zn) 9 8 High Fat Diet (300 Zn) 12 12 Σύνθεση των τριών διαιτών υψηλών λιπαρών -HFD: 3mg, 30mg, 300mg Zn /kg τροφής (mucedoola s.r.l Ιtaly-55% Cal από λιπαρά στοιχεία), Chow : δίαιτα ελέγχου Βιοχημικές αναλύσεις: Cholesterol ,Triglycerides ,HDL-cholesterol, Glucose ,Insulin Μετρήσεις μετάλλων και αντιοξειδωτικών παραγόντων: SOD (ερυθρά αιμοσφαίρια ) TAC (ορός αίματος) Zn , Cu (ερυθρά αιμοσφαίρια και ιστός ήπατος) Μεταβονομική ανάλυση και αξιολόγηση λιπιδίων :Εκχύλιση ορού αίματος και ηπατικού ιστού για λήψη Φάσματος 1H-NMR ΣΥΜΠΕΡΑΣΜΑΤΑ 1. Η HF δίαιτα αύξησε σημαντικά ,το τελικό βάρος και τον ρυθμό αύξησης βάρους ,τη χοληστερόλη -CL και την λιποπρωτεϊνη υψηλής πυκνότητας-ΗDL ,την ινσουλίνη –Ins, στα WT & Tg και μείωσε την ολική αντιοξειδωτική ικανότητα-TAC στο πλάσμα και την δραστηριότητα της σουπεροξείδιο-δισμουτάσης-SOD στα ερυθροκύταρα των WΤ και Tg 2. Ο επαρκής διατροφικός Zn (30mg/kgτροφής) φαίνεται να αποτελεί κρίσιμο παράγοντα διαμόρφωσης προστατευτικού ηπατολιπιδαιμικού προφίλ, ποντικών σε υπερλιπιδική δίαιτα. Η αύξηση ή μείωση του Zn σε HFDς φαίνεται να μειώνει την TAC του πλάσματος σε WΤ και Tg ενώ η δραστικότητα της SOD φαίνεται ανάλογη των επιπέδων του Zn Η ανεπάρκεια ή περίσσεια Zn αυξάνει τα αθηρογόνα SFA και μειώνει τα αντι-αθηρογόνα λιπίδια, PC, DU, LA DIAL ,UFA στις HDL, nonHDL και το ήπαρ, στα WΤHFD και στα ΤgHFD 3. Οι HSP70 : Τα διαγονιδιακά ζώα που φέρουν το γονίδιο hHsp70, φαίνεται ότι είτε σε έλλειψη είτε σε περίσσεια Ζn, που συνήθως συνοδεύoνται από μεταβολικό σύνδρομο, κατορθώνουν να διατηρούν καλλίτερους δείκτες λιπιδικού προφίλ σε σχέση με τα WT ζώα. Τα Τg εμφάνισαν σημαντικά χαμηλότερη CL ,TG , HDL σε σύγκριση με τα WT ενώ η HSP70 αύξησε σημαντικά την ενεργότητα της ολικής SOD στα ερυθρά αιμοσφαίρια. Η HSP70 μείωσε τα αθηρογόνα SFA και αύξησε τα αντιαθηρογόνα λιπίδια DIAL, DU, LA, UFA, SM στις HDL, nonHDL , και στο ήπαρ ποντικών που εκτέθηκαν σε HFD και σε όλες τις συγκεντρώσεις Zn. / Zinc –Zn controls lipid and glucose metabolism via Zn-transcription factors. High fat diets –HFDs lead to intracellular free radicals accumulation, decrease the transcriptional expression of their scavengers and anti-oxidative enzymes’ activity leading finally to metabolic syndrome. Heat shock proteins-HSPs play a significant role in cellular resistance response , as an adaptation mechanism, after exposure to various stimuli. SCOPE: To study the effects of nutritional Zn and HSP70s on the metabonomics of serum and liver lipids in mice MATERIALS-METHODS: Male mice: 1. Wild type (Wt) Hybrid (F1/F1) C57Bl/6 x CBA και 2. Transgenic (Tg) human HSP70 overexpressing mice, one month old, were subjected for 10 weeks to the following diets : Diet Number of Wt Number of Tg Chow Diet (30 Zn) 6 10 High Fat Diet (3 Zn) 13 12 High Fat Diet (30 Zn) 9 8 High Fat Diet (300 Zn) 12 12 Composition of the three HF Diets: 3mg, 30mg, 300mg Zn /kg τροφής (mucedoola s.r.l Ιtaly-55% Cal from greasy ingredients),Chow :control diet Biochemical analyses: Cholesterol ,Triglycerides ,HDL-cholesterol, Glucose ,Insulin Metals and antioxidative factors levels: SOD (red blood cells )TAC (blood serum) Zn , Cu (red blood cells and liver tissue) Lipids metabonomics : Blood serum and liver tissue extracts for 1H-NMR spectrum analysis and evaluation CONCLUSIONS 1. HFDiet significantly increased the rate of mice body weight gaining, as well as, cholesterol-CL, high density lipoproteins-HDL, insulin, in WT and Tg mice and decreased plasma total antioxidant capacity-TAC and red blood cell super oxide dismutase –SOD activity , in WT and Tg mice 2.Suficient nutritional Zn (30 mg/kg food) prevails as a crucial modulator of a protective hepato-lipidaemic profil of mice in high fat diet. Zinc deficiency or excessiveness , in HFDiets , decreases plasma TAC in WT and Tg mice, while SOD activity shows proportional to Zn levels. Zinc deficiency or excessiveness increases the atherogenic SFA and decreases the anti –atherogenic lipids : PC, DU, LA DIAL ,UFA, in HDL, nonHDL and liver, in WΤ-HFD and Τg-HFD mice 3. HSP70s : Transgenic mice over-expressing hHsp70 gene and exposed either to Zn deficiency or Zn excessiveness , both driving usually to metabolic syndrome , reveal significantly better lipid profile indicators, comparing to WT mice. Tg mice revealed significantly lower CL , TG , HDL levels compared to WT, while HSP70 in Τg mice significantly increased total SOD activity in red blood cells. HSP70 also decreased the atherogenic SFAs and increased the anti-atherogenic lipids DIAL, DU, LA, UFA, SM in HDL, nonHDL and in the liver of mice exposed to HFDiets and all Zn concentrations

Το Μυελοδυσπλαστικό Σύνδρομο (ΜΔΣ) αποτελεί μια ετερογενή ομάδα κλωνικών αιματολογικών διαταραχών με κοινό χαρακτηριστικό τη μη αποδοτική αιμοποίηση που οδηγεί σε ανθεκτικές κυτταροπενίες και συχνή εκτροπή προς Οξεία Λευχαιμία (ΟΛ). Η παράδοξη συνύπαρξη ενός πληθωρικού ή νορμοκυτταρικού μυελού των οστών και κυτταροπενιών στην περιφέρεια έχει αποδοθεί στην αυξημένη απόπτωση προγονικών και ώριμων αιμοποιητικών κυττάρων του μυελού των ασθενών αυτών. Παρ'όλ'αυτά, αιτιοπαθογενετική σχέση της υπέρμετρης απόπτωσης με την ανεπαρκή κλωνογόνο ικανότητα των προγονικών αιμοποιητικών κυττάρων του μυελοδυσπλαστικού μυελού δεν τεκμηριώνεται επαρκώς από τα υπάρχοντα ερευνητικά δεδομένα. Αντίθετα, αδιαμφισβήτητη είναι η συσχέτιση της κατάργησης των μηχανισμών του προγραμματισμένου κυτταρικού θανάτου στο προχωρημένο ΜΔΣ με την εκτροπή της νόσου προς ΟΛ. Η αυξημένη έκφραση αντιαποπτωτικών πρωτεϊνών όπως οι Bcl-2, Bcl-xL, IAPs, survivin έχει προταθεί ότι υποστηρίζει την πρόοδο της νόσου και την επακόλουθη λευχαιμική εξέλιξη. Οι Heat Shock Proteins αποτελούν θεμελιώδεις πρωτεΐνες, ως προς τις αποφάσεις των κυττάρων σχετικά με την επιβίωση ή το θάνατό τους. Η Hsp73, ένα σταθερά εκφραζόμενο μέλος, και οι Hsps 72 και 27, δύο ισχυρά επαγόμενες από ποικίλα στρεσσογόνα ερεθίσματα πρωτεΐνες, είναι τρεις από τις πιο σημαντικές Hsps εκδηλώνοντας πολυδιάστατη αντι-αποπτωτική δράση και παρέχοντας ισχυρή κυτταροπροστασία. Σε αρκετά είδη συμπαγών όγκων αλλά και αιματολογικών κακοηθειών έχει δειχθεί υπερέκφραση των Hsps, ενώ έχει προταθεί ακόμη και αιτιοπαθογενετική σχέση της διαταραχής της έκφρασης των πρωτεϊνών αυτών με την ογκογένεση. Σκοπός της παρούσας εργασίας ήταν η εκτίμηση του βαθμού της απόπτωσης στα προγονικά και ώριμα κύτταρα μυελού ασθενών με ΜΔΣ και η περαιτέρω διερεύνηση της ουσιαστικής συνεισφοράς του φαινομένου στην ανεπαρκή κλωνογόνο ικανότητα των προγονικών κυττάρων και, κατ' επέκταση, στη μη αποδοτική αιμοποίηση που χαρακτηρίζει το σύνδρομο. Εν συνεχεία, διερευνήθηκαν οι αποπτωτικές μεταβολές κατά την πρόοδο της νόσου οι οποίες συσχετίσθηκαν με την έκφραση των αντι-αποπτωτικών Heat Shock Proteins. Η έκφραση των Hsps 72, 27 & 73 μελετήθηκε υπό συνθήκες ηρεμίας (βασική έκφραση, ΒΕ), ενώ ελέγχθηκε η επαγωγιμότητα των Hsps 72 και 27 κατόπιν εφαρμογής θερμικού shock ή ο-αποπτωτικής διέγερσης με συνδυασμό κυτταροκινών (TNFα+IFNγ). Η προσδιοριζόμενη έκφραση των Hsps συσχετίσθηκε, κατόπιν, με την απόπτωση και το στάδιο της νόσου. Η παρούσα μελέτη επιβεβαιώνει την παρουσία αυξημένης απόπτωσης τόσο στα ώριμα CD34- όσο και στα προγονικά CD34+ κύτταρα του μυελού ασθενών με ΜΔΣ με αξιοσημείωτη ετερογένεια να διέπει τα αποτελέσματα ακόμη και μεταξύ ασθενών της ίδιας κατά FAB κατηγορίας νόσου. Τα επίπεδα ανιχνευόμενης απόπτωσης υπερείχαν σημαντικά στο μυελό των ασθενών με "πρώιμη" (RA και RARS) έναντι εκείνων με "προχωρημένη" (RAEB και RAEB-t) νόσο, ενισχύοντας τη θεωρία της κατάργησης των αποπτωτικών μηχανισμών κατά την πρόοδο της νόσου. Μετά από 24 ώρες υγρής καλλιέργειας, το ποσοστό των ανιχνευόμενων πρώιμων αποπτωτικών CD34+ κυττάρων μυελού ασθενών με ΜΔΣ μειώθηκε σημαντικά. Προκειμένου να διερευνηθεί η πραγματική συμβολή της απόπτωσης στη μη αποδοτική αιμοποίηση του ΜΔΣ in vitro, αποπτωτικά και μη αποπτωτικά προγονικά CD34+ φρέσκα κύτταρα μυελού διαχωρίστηκαν με τη μέθοδο του Κυτταροδιαχωρισμού ενεργοποιούμενου από φθορισμό και τοποθετήθηκαν σε βραχείας διάρκειας ημιστερεές καλλιέργειες, όπου ελέγχθηκε η σχετική κλωνογόνος ικανότητά τους. Τόσο τα αποπτωτικά όσο και τα μη αποπτωτικά CD34+ κύτταρα των ασθενών με ΜΔΣ επέδειξαν εξίσου ανεπαρκή ανάπτυξη in vitro, υποδεικνύοντας ότι η παρουσία απόπτωσης δεν επηρεάζει σημαντικά τη συμπεριφορά των κυττάρων στην καλλιέργεια. Η βασική ενδοκυττάρια έκφραση των αντιαποπτωτικών Hsps 27, 72 και 73 βρέθηκε σημαντικά αυξημένη στο μυελό ασθενών με ΜΔΣ. Η υπερέκφραση των Hsps αφορούσε κυρίως τα ολικά μονοπύρηνα κύτταρα του μυελού των ασθενών, ενώ τα προγονικά CD34+ κύτταρα δεν επέδειξαν σημαντικά υψηλότερα επίπεδα των υπό μελέτη πρωτεϊνών. Επιπλέον, η εφαρμογή θερμικού shock οδήγησε επιτυχώς στην επαγωγή των Hsps 27 και 72 στο μυελό ασθενών και μαρτύρων, προσεγγίζοντας όμως υψηλότερα τελικά επίπεδα έκφρασης στο μυελό των ασθενών. Tόσο η βασική όσο και η εκ θερμικού stress επαγόμενη έκφραση της Hsp72 βρέθηκε σημαντικά ενισχυμένη στα μονοπύρηνα κύτταρα του μυελού ασθενών με "προχωρημένου τύπου" ΜΔΣ, ενώ σημαντικά θετική συσχέτιση τεκμηριώθηκε μεταξύ της έκφρασης ηρεμίας των τριών Hsps και του ποσοστού των βλαστών του μυελού των ασθενών. Τα ευρήματα αυτά υποδηλώνουν ενδεχόμενο ρόλο της υπερέκφρασης των Hsps στην ευνοϊκή επιλογή και εξάπλωση των κλωνικών κυττάρων και, συνεπακόλουθα, στην πρόοδο της νόσου. Η συνδυασμένη επίδραση κυτταροκινών σε κύτταρα φυσιολογικών μυελών οδήγησε σε σημαντική μείωση της έκφρασης της Hsp72, ενώ στο 36% των ασθενών παρατηρήθηκε αύξηση της έκφρασης της Hsp72. Τέλος, αρνητική ήταν η συσχέτιση της βασικής ή επαγόμενης έκφρασης των Hsps με την αυτόματη ή προκλητή απόπτωση σε ολικά ή προγονικά κύτταρα μυελού ασθενών με ΜΔΣ, επιβεβαιώνοντας τον κυτταροπροστατευτικό τους ρόλο. Συνοψίζοντας, τα ευρήματα της παρούσας μελέτης επιβεβαιώνουν την παρουσία αυξημένης απόπτωσης στο μυελό των ασθενών με ΜΔΣ, ιδιαίτερα πρώιμου τύπου. Τα πρώιμα αποπτωτικά προγονικά κύτταρα επιδεικνύουν δυνατότητα διαφυγής από τον κυτταρικό θάνατο και σχετική λειτουργική ανάνηψη κατά την απομάκρυνσή τους από το προαποπτωτικό μικροπεριβάλλον του μυελού. Εναλλακτικά, πρόκειται για κύτταρα που, εξ'αιτίας αποτυχίας του αποπτωτικού μηχανισμού να περατωθεί, υφίστανται "ατελή απόπτωση" και διασώζονται, φέροντα όμως δυνητικά ογκογόνες μεταλλάξεις. Η γενική αντίληψη, πάντως, που καθιστά την απόπτωση ως την αιτία της μη αποδοτικής αιμοποίησης του συνδρόμου κλονίζεται, καθώς αποπτωτικά και μη αποπτωτικά προγονικά κύτταρα διαθέτουν παρόμοια κλωνογόνο ικανότητα, in vitro; φαίνεται ότι επιπρόσθετες ενδογενείς ανωμαλίες περιορίζουν το κλωνογόνο δυναμικό αποπτωτικών και μη προγονικών κυττάρων. Η υπερέκφραση Hsps που τεκμηριώθηκε στο μυελό ασθενών με ΜΔΣ ενδεχομένως υποστηρίζει την διαδικασία κακοήθους εξαλλαγής μέσω της σιωπηρής συσσώρευσης μεταλλάξεων στα κύτταρα του κλώνου. Επιπλέον, τα αυξημένα επίπεδα των αντι-αποπτωτικών αυτών πρωτεϊνών θα μπορούσε να ευθύνεται για την προτεινόμενη ατελή απόπτωση των κυττάρων του μυελοδυσπλαστικού μυελού. Όπως προκύπτει από τη σημαντική συσχέτιση της έκφρασης των Hsps τόσο με το ποσοστό βλαστών όσο και με το στάδιο της νόσου, τα υπερεκφράζοντα ώριμα με τα αντίστοιχα προγονικά τους παθολογικά κύτταρα, ενέχοντας πλεονέκτημα επιβίωσης έναντι των φυσιολογικών στο προ-αποπτωτικό μικροπεριβάλλον του δυσπλαστικού μυελού, φαίνεται ότι επιλέγονται και επικρατούν κατά την πρόοδο της νόσου. Σε ένα τέτοιο υπόστρωμα αντίστασης στην απόπτωση ένα επιγενετικό συμβάν που αναστέλλει τη διαφοροποίηση ενδέχεται να πυροδοτήσει τη λευχαιμική εκτροπή. / Myelodysplastic syndrome comprises a heterogeneous group of clonal stem cell disorders characterized by ineffective hematopoiesis leading to refractory cytopenias and frequent evolution to acute myeloid leukemia (AML). The existing inconsistency between normal or hypercellular bone marrow and peripheral blood cytopenias remains a paradox that has been attributed to excessive intramedullary apoptosis. However, a causative relationship of apoptosis to the progenitor’s defective clonogenic growth has not been sufficiently demonstrated. On the other hand, it is widely accepted that abrogation of apoptotic control in advanced MDS favours the expansion of the malignant clone and contributes to the frequently observed evolution to acute myeloid leukaemia (AML). Enhanced expression of antiapoptotic proteins Bcl-2, Bcl-xL, IAPs, survivin has been proposed to contribute to elimination of apoptosis, disease progression and subsequent leukemic evolution. Heat Shock Proteins (Hsps) are fundamental for cell life and death decisions and essential for the coordination between proliferation, differentiation and apoptosis. Hsp73, one of the constitutively expressed Hsps, and Hsps 72 and 27, two strongly inducible by several stress stimuli proteins, are three of the most important Hsps. These three Hsps regulate programmed cell death by interfering with multiple key-regulatory points of the apoptotic cascade, acting as apoptosis inhibitors and conferring strong cytoprotection. Hsps 72 and 27 are overexpressed in a number of human cancers and haematological malignancies, while a causative relationship of these proteins to oncogenesis has even been proposed. The aim of our study was to determine the degree of programmed cell death in progenitor and mature bone marrow cells of MDS patients. Moreover, apoptosis' actual contribution to defective clonogenic capacity of MDS progenitors and, subsequently, to ineffective hematopoiesis in MDS was assessed. Furthermore, apoptosis modifications during disease progression were detected and correlated to the expression of antiapoptotic Hsps. Hsps 72, 27 and 73 intracellular expression was studied under conditions of tranquillity in bone marrow and progenitor cells of MDS patients, while the inducibility of Hsps 27 and 72 was further tested after application of an environmental type of stress (heat shock) and pro-apoptotic stimulation under combined cytokine treatment (TNFα+IFNγ). Finally, we determined an existing link between Hsps' levels, apoptosis and disease progression. Apoptosis was significantly augmented in both progenitor and mature bone marrow cell fractions from MDS patients. Apoptosis determined in the bone marrow of patients with "early" MDS (RA and RARS) significantly exceeded cell death levels detected in those with "advanced" (RAEB and RAEB-t) disease, supporting the theory of apoptosis' abrogation as the disease evolves. We should remark, however, that even inside the same FAB-category, a great heterogeneity existed in results. After 24 hours of liquid culture the percentage of early apoptotic progenitors in MDS BM significantly decreased. In order to determine apoptosis' actual contribution to defective clonogenic capacity of MDS progenitors, “apoptotic” and “non-apoptotic” bone marrow CD34+ cells were sorted by FACS (Fluorescence Activated Cell Sorting) and their differential clonogenic capacity was assessed in a short-term semisolid culture system. There was no correlation between apoptosis’ existence and culture performance, since non-apoptotic as well as apoptotic CD34+ bone marrow cells both exhibited similar defective growth. Basal intracellular expression of antiapoptotic Hsps 27, 72 and 73 was found significantly elevated in bone marrow cells of MDS patients. Hsps overexpression mainly involved total BMMC, while higher protein levels were also detected within patients’ progenitor bone marrow cells, but the differences noted did not attain statistical significance. Moreover, HS treatment provoked the effective induction of Hsps 27 and 72 in both MDS and normal subjects leading to the achievement of even higher final protein levels in the patients’ marrow, despite the already enhanced basal expression. Both basal and HS-induced Hsp72 expression were significantly enhanced in BMMC of MDS patients with advanced disease, while a positive correlation between all three Hsps basal expression and blast percentage was established in the patients' marrow. These findings suggest a probable role of Hsps overexpression in the favored selection and expansion of clonal cells, further hematopoiesis depression and disease progression. Combined pro-apoptotic treatment of normal BM cells caused a significant downregulation of Hsp72. On the contrary, BM cells from MDS patients responded by elevating the expression of cytoprotective Hsp72 in about 36% of cases. Finally, in accordance to the well-demonstrated cytoprotective role of Hsps, an inverse correlation was noted between spontaneous or induced apoptosis and Hsps basal or induced expression. In conclusion, our findings support the previous observations of increased apoptosis in MDS marrow, especially in "early" disease. Interestingly, early apoptotic MDS progenitors exhibit the potential to escape from apoptosis and even recover functionally, as shown in CFU-assays, when separated from the bone marrow microenvironment, the main source of pro-apoptotic signalling. Alternatively, these cells, due to intrinsic defects in cell death activated pathways, may undergo incomplete apoptosis and get rescued possibly carrying, though, potentially transforming mutations. However, apoptosis does not seem to be the only cause of impaired clonogenic growth in MDS, as apoptotic and non-apoptotic progenitors exhibit similar patterns of growth, both defective compared to normal. Apparently, additional intrinsic abnormalities limit the clonogenic potential of apoptotic and non-apoptotic progenitors. Augmented Hsps expression established in MDS marrow may support the underlying transformation process through the suppression and silent gathering of mutations, probably promoting viability and growth of otherwise mutant cells. Moreover, increased levels of anti-apoptotic Hsps may account for the proposed incomplete apoptosis of MDS marrow cells. Hsps appear to provide resistance against spontaneous or induced apoptosis to the overexpressing cell population. Hsps' positive correlation to blast count and disease stage implies that the overexpressing mature cells along with their abnormal progenitors, encompassing a survival advantage over normal cells in the pro-apoptotic MDS marrow, get selected and expanded during disease progression. On such a background of non-susceptibility to apoptosis a secondary event blocking differentiation could lead to leukaemic transformation.

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Critical illness associated muscle weakness and muscle dysfunction in intensive care unit (ICU) patients lead to severe morbidity and mortality as well as significant adverse effect on quality of life. Immobilization, mechanical ventilation, neuromuscular blocking agents, corticosteroids, and sepsis have been implicated as important risk factors, but the underlying molecular and cellular mechanisms remain unclear.  A unique porcine ICU model was employed to investigate the effect of these risk factors on the expression profiles, gene expression and contractile properties of limb and diaphragm muscle, in the early phase of ICU stay. This project has focused on unraveling the underlying molecular and cellular pathways or networks in response to ICU and critical illness interventions. Upregulation of heat shock proteins indicated to play a protective role despite number of differentially transcribed gene groups that would otherwise have a negative effect on muscle fiber structure and function in response to immobilization and mechanical ventilation.  Mechanical ventilation appears to play a critical role in development of diaphragmatic dysfunction. Impaired autophagy, chaperone expression and protein synthesis are indicated to play a pivotal role in exacerbating muscle weakness in response to the combined effect of risk factors in ICU. These results may be of therapeutic importance in alleviating critical illness associated muscle weakness.