Zugl.: München, Univ., Diss., 2008

La Chimiothérapie IntraPéritonnéale (CIP) est utilisée couramment pour traiter le cancer colorectal métastatique. Cependant il n'existe pas de protocole standardisé.Le but de ce projet a été de modéliser cette chimiothérapie in vitro et de comprendre le rôle de l'hypotonie dans ce modèle et son impact sur la mort des cellules cancéreuses.Nous avons déterminé les conditions optimales de traitement sur les cellules cancéreuses coliques humaines HCT116 à savoir une exposition des cellules pendant 30 minutes à 400µM d'oxaliplatine en conditions hypotoniques (G2.5%) à 37°C. Ces résultats ont été validés sur différentes lignées cancéreuses coliques humaines et murine. Nous avons également montré que ces conditions de traitements étaient également capables d’augmenter la cytotoxixité d’autres dérivés du platine comme le cisplatine et le carboplatine.La mort cellulaire induite par ce traitement en hypotonie est de type apoptotique, Et peut s’expliquer par une augmentation de l’incorporation intracellulaire d'oxaliplatine, en partie due à l'activation et à la trimérisation du transporteur du cuivre CTR1.Le traitement par l'oxaliplatine et le cisplatine (mais pas par le carboplatine) en hypotonie entraine également les stigmates de la mort immunogène, à savoir l'exposition de la calréticuline à la membrane, la libération d'ATP et le relargage d'HMGB1, suggérant que l'hypotonie permettrait d'entrainer la mort immunogène et une réponse du système immunitaire lors de cette modélisation de CIP.Enfin, in vivo nous avons pu mettre en évidence que le traitement de métastases intrapéritonéales de souris Balb/c par une injection intrapéritonéale d'oxaliplatine en hypotonie permettait un ralentissement de l’apparition de nodules tumoraux et une augmentation de la survie des souris.Ainsi, nous avons pu mettre en évidence dans ce travail que l'hypotonie est un des paramètres fondamentaux de la CIP et suggère que son utilisation pourrait permettre d'augmenter l’efficacité de la CIP et de prolonger la survie des patients. / IntraPeritoneal Chemotherapy (IPEC) is commonly used to treat colorectal cancer metastases. However there is no standardized protocol.The aim of this work was to model this chemotherapy in vitro and to understand the role of hypotonic conditions in this model and its impact on cell death.We determined that the optimal treatment parameters on HCT116 human colon cancer cells, were an exposure of the cells for 30 minutes to 400μM of oxaliplatin under hypotonic conditions (G2.5%) at 37 °C. These results have been validated on various human and murine colic cancer cell lines. We have also shown that these treatment conditions are also able to increase the cytotoxicity of other platinum derivatives such as cisplatin and carboplatin.The cell death induced by this treatment in hypotonia is apoptosis, and can be explained by an increase in the intracellular incorporation of oxaliplatin, partly due to the activation and trimerization of the CTR1 copper transporter.Treatment with oxaliplatin and cisplatin (but not carboplatin) in hypotonia also leads to the stigmata of immunogenic death, e.i. exposure of calreticulin at the membrane, release of ATP and HMGB1 in the supernatant, suggesting that hypotonia would entail immunogenic death and an immune system response during this IPEC modeling.Finally, we have been able to demonstrate in vivo that the treatment of intraperitoneal metastases of Balb/c mice by an intraperitoneal injection of oxaliplatin in hypotonia slowed down tumor nodules appearance and increased survival of the mice.Thus, in this work we highlighted that hypotonia is one of the fundamental parameters of IPEC which suggests that its use could make it possible to increase the efficacy of IPEC and maybe to prolong the survival of patients.

1 Abstract The subject of this thesis is hippotherapy as a supportive treatment method in children with Joubert syndrome and other hypotonic syndromes. In theoretical part is described Joubert syndrome in connection with education of students with special needs including legislation. In response to education of a child with disability there is further described therapy and basic therapeutic approaches that are often used concurrently with hippotherapy. Next part of thesis is focused on Joubert syndrome in terms of origin, causes, symptoms and diagnosis of the disease. With regards to research investigation in empiric part of the thesis there are further described specific educational approaches of individual with Joubert syndrome and other hypotonic syndromes. Theoretical part also comprises closer characteristics of hippotherapy as a possible supportive treatment method in terms of legislation, healthcare and social aspects. In empiric part there were used several methods of data collection within the qualitative research, these were analysis of studied literature, involved observation, case study, document analysis, narrative dialog with parent, discussion with hippotherapist and questionnaire submitted to parents of children attending hippotherapy. Key words: hippotherapy, Joubert syndrome, hypotonia,...

Spinal muscular atrophy (SMA) is a hereditary disease characterized by progressive loss of -motoneurons of the spinal front corners, the consequence of which atrofizaci of muscles occurs. As a result, children become disabled and infirm dependent on the help and care of others at an early age. This is a relatively rare disease, the prevalence is about 1: 6,000 children. Spinal muscular atrophy is divided into 4 types according to its severity and time of onset of symptoms. Despite significant longtime research, it has failed to find a drug that could cure this disease so far. To the present date, there are only methods that slow the progression. The survey also contained 4 research questions, namely: What are the principles of treating a child with spinal muscular atrophy ? What are the most common problems in the care of a child with spinal muscular atrophy ? Are parents adequately educated on the issue of child with spinal muscular atrophy ? What impact has the presence of a child with spinal muscular atrophy in his family? Qualitative research was used in the implementation of the empirical part . Two qualitative methods were used to collect the data, a semi-structured interview and a hidden observation of the participant . Interviews were conducted with 3 research files, with 11 general nurses from the České Budejovice Hospital and University Hospital Motol, 7 mothers of children with I and II. type SMA of a summer camp for children with SMA and with 5 personal assistants. This thesis should help nurses and the public to gain awareness of the disease of Spinal Muscular Atrophy. It refers to all aspects of care of such a sick child, with which their parents daily struggle. Caring for a child with SMA is very difficult for their caregivers and requires considerable restrictions for the whole family. Information observed during the research were presented at a seminar for nurses in the České Budejovice Hospital in January 2015.