Preeclampsia results from incomplete trophoblast invasion of the spiral arteries during early pregnancy. Vascular endothelial growth factor (VEGF) and plasminogen activator inhibitor-1 (PAI-1) are critical factors involved in angiogenesis, invasion and hemostasis at the maternal-fetal interface. Both factors are transcriptionally regulated by hypoxia inducible factor (HIF), a heterodimeric complex consisting of HIF-1[beta] and either HIF-1[alpha] or -2[alpha] whose specificity or redundancy in gene regulation is cell-type specific. This study uses siRNA technology to dissect the mechanisms of hypoxia-mediated regulation of PAI-1 and VEGF expression in first trimester trophoblasts. Immortalized first trimester human extravillous trophoblasts (HTR8/SVneo cells) were maintained in serum-free and serum-containing media for 4h (n=3-4), 8h (n=6), 24h (n=5) and 48h (n=5) under normoxic (21% O2) and hypoxic (1-2% O2) conditions to determine a time of maximum induction of both VEGF and PAI-1. Subsequently, cells were maintained for 48h in the presence or absence of siRNA for HIF-1[alpha], HIF-2[alpha], HIF-1[alpha] + -2[alpha], a non-targeting (NT) sequence or Cyclophilin B (CB). Media were then removed, cells lysed, and Western blotting used to assess HIF-[alpha] knockdown. VEGF and PAI-1 levels in the media were quantified by ELISA and results expressed as pg or ng/[micro]g protein. Results from 3 to 8 independent experiments were analyzed using unpaired t-tests. Under hypoxic conditions treatment of cells with HIF-1[alpha], HIF-2[alpha] or HIF -1[alpha] + -2[alpha] siRNA resulted in >90% HIF-Ñ protein knockdown as determined by Western blotting. 48h of hypoxic treatment caused a statistically significant increase in PAI-1 levels (p<0.01) and VEGF levels (p<0.001) compared to normoxic controls. Under hypoxic conditions, PAI-1 levels were 4.75 [plus-minus] 0.46 ng/[micro]g protein and VEGF levels were 7.27 [plus-minus] 1.08 pg/[micro]g protein. Treatment with siRNA to HIF-1[alpha], HIF-2[alpha] and HIF-1[alpha] + -2[alpha] significantly reduced PAI-1 levels to 3.3 [plus-minus] 0.35 (p<0.02), 3.1 [plus-minus] 0.38 (p<0.03) and 2.4 [plus-minus] 0.19 (p<0.003), respectively. No significant difference in PAI-1 reduction was noted between the three HIF siRNA conditions. Under hypoxic conditions, levels of VEGF in cells treated with siRNA to HIF-1[alpha] (5.79 [plus-minus] 0.55), HIF-2[alpha] (5.50 [plus-minus] 1.24) and HIF-1[alpha] + -2[alpha] (4.24 [plus-minus] 0.93) were reduced compared to the hypoxic control (7.27 [plus-minus] 1.08), yet these effects did not reach statistical significance. However, when compared with the levels observed in cells treated with NT siRNA (9.90 [plus-minus] .98), all HIF siRNA treatments promoted a significant reduction in VEGF expression (p<0.003, p<0.02 and p<0.003 for HIF-1[alpha], HIF-2[alpha] and HIF-1[alpha]+ -2[alpha], respectively). In conclusion, these results indicate that hypoxia-mediated changes in PAI-1 and VEGF expression in trophoblasts are regulated similarly by both HIF-1[alpha] and HIF-2[alpha]. This provides important insight into the molecular mechanisms regulating hemostasis and trophoblast invasion as well as their potential dysfunction in pregnancies complicated by preeclampsia

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 4 uppsatser.

No description available.

Motivation In the black population of South Africa, cardiovascular disease (CVD) is rapidly increasing due to urbanisation. Stroke is usually accompanied by a prothrombotic haemostatic profile. Changing lifestyle factors that accompany the urbanisation process could have a negative impact on the haemostatic profile of black South Africans. Elevated levels of pro-coagulant factors, von Willebrand factor (vWF), fibrinogen and fibrin D-dimer have been reported in the black population, which could increase the black population’s susceptibility to CVD. However, low levels of plasminogen activator inhibitor-1 (PAI-1) previously reported in the black population could contribute towards a pro-fibrinolytic state, which may counteract the hypercoagulant state. This may have a beneficial effect on the haemostatic profile of the black population. More investigation into the haemostatic profile of black South Africans is therefore needed to determine if an altered haemostatic profile exists in this group, and if so, to what extent these alterations may relate to cardiovascular dysfunction. This study included markers of both the coagulation (vWF, fibrinogen, fibrin D-dimer) and fibrinolytic (PAI-1, fibrin D-dimer and fibrinolytic potential) systems in an attempt to investigate the haemostatic profile of the black population of South Africa, and for comparison purposes that of the white population as well. The relationship of these markers’ with selected markers of cardiovascular function was also examined to determine if they could possibly contribute to an increase in cardiovascular risk, especially in the black population. Aims The aims of this study were to first compare coagulation and fibrinolysis markers in the black and white populations of South Africa. Furthermore, to determine if associations exist between the selected components of the haemostatic system and markers of cardiovascular function, especially in the black population of South Africa, who tends to be at a higher cardiovascular risk due to altered metabolic and haemostatic profiles. Methodology The Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study was a prospective cohort study that consisted of 409 participants at baseline (2008-2009) that were equally distributed according to both ethnicity (200 black; 209 white) and gender (black, 101 men, 99 women; white, 101 men, 108 women). At follow-up (2011/2012) the cohort totalled 359 participants (170 black, 88 men and 82 women; 189 white, 93 men and 96 women). Data from baseline measurements were used for the first two manuscripts (chapters 2 and 3), while followup data was used for the third manuscript (chapter 4). vWF, fibrinogen, PAI-1, fibrin D-dimer, CLT, serum peroxides, glutathione, glutathione peroxidase and reductase activity were determined, and ambulatory blood pressure and the retinal vessel calibres were measured. The groups were stratified by ethnicity as specified by statistical interaction terms. T-tests and chi-square tests were used to compare means and proportions, respectively. Pearson and partial regression analyses were used to determine correlations between the components of the haemostatic system and cardiovascular function markers. This was followed by multiple linear regression analyses to investigate whether independent associations exist between the variables in both ethnic groups. P-values ≤0.050 were deemed significant. Results and conclusion of each manuscript The first manuscript (chapter 2) compares the haemostatic profiles of the black and white population to determine whether ambulatory blood pressure is related to components of the haemostatic system. The black participants displayed a prothrombotic profile with significantly higher vWF, fibrinogen, PAI-1, fibrin D-dimer and a longer CLT than their white counterparts. Furthermore, partial and multiple linear regression analyses showed a positive association of systolic and diastolic blood pressure with fibrin D-dimer in the black population, while a negative association existed between ambulatory blood pressure and CLT in the white population. These associations suggest that fibrin D-dimer may contribute, at least in part, to the high prevalence of hypertension in the black population. The second manuscript (chapter 3) determined associations between markers of the haemostatic and oxidant-antioxidant systems in the black and white populations. In addition to the prothrombotic profile that exists in the black population, this group also had significantly higher serum peroxides (oxidative stress) and lower glutathione peroxidase activity (antioxidant) levels. Multiple linear regression analyses indicated positive associations between fibrinogen and serum peroxides in both populations. In the white population, an additional positive association was found between serum peroxide and CLT. In the black population, vWF and CLT were negatively associated with GPx activity. The results suggest that there are ethnic-specific relationships between the haemostatic and oxidant-antioxidant systems. The third manuscript (chapter 4) investigated the relationships between the retinal vessel calibres and components of the haemostatic system in the black and white population. The investigation focussed specifically on arteriolar diameters in the lower median, since a narrow arteriolar diameter is known to be associated with elevated blood pressure. In both ethnic groups, a narrower arteriolar calibre was accompanied by narrower venular calibres. Independent positive associations were found between the central retinal vein equivalent (CRVE) and fibrinogen in the black population, as well as vWF and CLT in the white population. In addition, independent negative associations were found between the central retinal artery equivalent and CLT in the black population and with vWF in the white population. The results suggest that haemostatic alterations are linked to early vascular changes that may differ between ethnicities. General conclusion Ethnic-specific relationships between the components of the haemostatic system and measures of cardiovascular function are evident. The prothrombotic profile that is observed in the black population, together with the adverse associations of the haemostatic components with blood pressure, a compromised oxidant-antioxidant profile, and retinal vessel calibres may contribute, at least in part, to the high cardiovascular and cerebrovascular risk evident in this population group. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015

Motivation In the black population of South Africa, cardiovascular disease (CVD) is rapidly increasing due to urbanisation. Stroke is usually accompanied by a prothrombotic haemostatic profile. Changing lifestyle factors that accompany the urbanisation process could have a negative impact on the haemostatic profile of black South Africans. Elevated levels of pro-coagulant factors, von Willebrand factor (vWF), fibrinogen and fibrin D-dimer have been reported in the black population, which could increase the black population’s susceptibility to CVD. However, low levels of plasminogen activator inhibitor-1 (PAI-1) previously reported in the black population could contribute towards a pro-fibrinolytic state, which may counteract the hypercoagulant state. This may have a beneficial effect on the haemostatic profile of the black population. More investigation into the haemostatic profile of black South Africans is therefore needed to determine if an altered haemostatic profile exists in this group, and if so, to what extent these alterations may relate to cardiovascular dysfunction. This study included markers of both the coagulation (vWF, fibrinogen, fibrin D-dimer) and fibrinolytic (PAI-1, fibrin D-dimer and fibrinolytic potential) systems in an attempt to investigate the haemostatic profile of the black population of South Africa, and for comparison purposes that of the white population as well. The relationship of these markers’ with selected markers of cardiovascular function was also examined to determine if they could possibly contribute to an increase in cardiovascular risk, especially in the black population. Aims The aims of this study were to first compare coagulation and fibrinolysis markers in the black and white populations of South Africa. Furthermore, to determine if associations exist between the selected components of the haemostatic system and markers of cardiovascular function, especially in the black population of South Africa, who tends to be at a higher cardiovascular risk due to altered metabolic and haemostatic profiles. Methodology The Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study was a prospective cohort study that consisted of 409 participants at baseline (2008-2009) that were equally distributed according to both ethnicity (200 black; 209 white) and gender (black, 101 men, 99 women; white, 101 men, 108 women). At follow-up (2011/2012) the cohort totalled 359 participants (170 black, 88 men and 82 women; 189 white, 93 men and 96 women). Data from baseline measurements were used for the first two manuscripts (chapters 2 and 3), while followup data was used for the third manuscript (chapter 4). vWF, fibrinogen, PAI-1, fibrin D-dimer, CLT, serum peroxides, glutathione, glutathione peroxidase and reductase activity were determined, and ambulatory blood pressure and the retinal vessel calibres were measured. The groups were stratified by ethnicity as specified by statistical interaction terms. T-tests and chi-square tests were used to compare means and proportions, respectively. Pearson and partial regression analyses were used to determine correlations between the components of the haemostatic system and cardiovascular function markers. This was followed by multiple linear regression analyses to investigate whether independent associations exist between the variables in both ethnic groups. P-values ≤0.050 were deemed significant. Results and conclusion of each manuscript The first manuscript (chapter 2) compares the haemostatic profiles of the black and white population to determine whether ambulatory blood pressure is related to components of the haemostatic system. The black participants displayed a prothrombotic profile with significantly higher vWF, fibrinogen, PAI-1, fibrin D-dimer and a longer CLT than their white counterparts. Furthermore, partial and multiple linear regression analyses showed a positive association of systolic and diastolic blood pressure with fibrin D-dimer in the black population, while a negative association existed between ambulatory blood pressure and CLT in the white population. These associations suggest that fibrin D-dimer may contribute, at least in part, to the high prevalence of hypertension in the black population. The second manuscript (chapter 3) determined associations between markers of the haemostatic and oxidant-antioxidant systems in the black and white populations. In addition to the prothrombotic profile that exists in the black population, this group also had significantly higher serum peroxides (oxidative stress) and lower glutathione peroxidase activity (antioxidant) levels. Multiple linear regression analyses indicated positive associations between fibrinogen and serum peroxides in both populations. In the white population, an additional positive association was found between serum peroxide and CLT. In the black population, vWF and CLT were negatively associated with GPx activity. The results suggest that there are ethnic-specific relationships between the haemostatic and oxidant-antioxidant systems. The third manuscript (chapter 4) investigated the relationships between the retinal vessel calibres and components of the haemostatic system in the black and white population. The investigation focussed specifically on arteriolar diameters in the lower median, since a narrow arteriolar diameter is known to be associated with elevated blood pressure. In both ethnic groups, a narrower arteriolar calibre was accompanied by narrower venular calibres. Independent positive associations were found between the central retinal vein equivalent (CRVE) and fibrinogen in the black population, as well as vWF and CLT in the white population. In addition, independent negative associations were found between the central retinal artery equivalent and CLT in the black population and with vWF in the white population. The results suggest that haemostatic alterations are linked to early vascular changes that may differ between ethnicities. General conclusion Ethnic-specific relationships between the components of the haemostatic system and measures of cardiovascular function are evident. The prothrombotic profile that is observed in the black population, together with the adverse associations of the haemostatic components with blood pressure, a compromised oxidant-antioxidant profile, and retinal vessel calibres may contribute, at least in part, to the high cardiovascular and cerebrovascular risk evident in this population group. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015

La mort cellulaire programmée, ou MCP, est un processus dynamique où les cellules ont la capacité de déclencher et de contrôler leur propre mort. Elle est essentielle et présente chez tous les organismes multicellulaires. Chez les plantes, la MCP permet le développement optimal (ex : formation du xylème, morphologie des feuilles, etc.) de la plante tout en protégeant contre divers stress biotiques et abiotiques (ex : la sécheresse, la chaleur, les UV, etc.). Malgré les avancées de ces dernières années, peu de gènes impliqués dans la mise en place de la MCP induite par les UV-C ont été identifiés chez les plantes. L'objectif était donc de caractériser ces gènes chez Arabidopsis thaliana. L'un des candidats est le gène BI-1, pour Bax Inhibitor-1. Il code pour un facteur anti-apoptotique de la MCP animale également retrouvé chez Arabidopsis thaliana. BI-1 régule aussi le taux de calcium du réticulum endoplasmique, ainsi que la formation des espèces réactives de l'oxygène (ROS), permettant l'activation de la réponse de la cellule au stress. L'expression de ce gène suite à une exposition aux UV-C est augmentée, faisant de lui un candidat pour la réponse aux UV-C. Une fusion du promoteur du gène AtBI-1 au gène rapporteur de la luciférase (pAtBI-1::luciférase) a été insérée dans le génome d'Arabidopsis. Une plante homozygote pour l'insertion de l'ADN-T, 5PL20E, a été isolée. Cette lignée parentale a été ensuite mutagénéisée, et un crible effectué sur la descendance exposée aux UV-C a permis d'identifier un mutant, 2017, dont l'expression de la luciférase était modifiée. Le premier objectif de ce projet était de caractériser ce mutant et de déterminer le lien potentiel avec la régulation de BI-1. Dans une deuxième partie, nous nous sommes intéressés aux rôles des thiorédoxines (TRX) dans la MCP végétale. Ces protéines sont présentes chez tous les organismes vivants. Elles régulent les activités de beaucoup d'enzymes en réduisant leurs ponts disulfures. Peu représentées chez l'homme (deux gènes), elles ont néanmoins un rôle de protection dans la voie de signalisation de l'apoptose. Par contre, chez Arabidopsis, une vingtaine de gènes codant pour les thiorédoxines sont connus. Suite à un autre crible aux UV-C d'une banque de mutants d'insertion, un nouveau mutant pour lequel l'insertion de l'ADN-T était dans le promoteur du gène codant pour la thiorédoxine f1 (AtTRX f1) a été identifié. Chez Arabidopsis, deux gènes codent pour les TRX f. Ces protéines ont d’abord été étudiées en tant que régulateur d’enzymes du cycle de Calvin. Plus récemment, d’autres fonctions ont été attribuées, surtout à la TRX f1. Nous avons obtenu de simples mutants pour les deux gènes et produit par croisement des doubles mutants, pour étudier l'implication des TRX f dans la MCP végétale induite par les UV-C (ultraviolets de type C), le MV (methyl viologen) et l'ABA (acide abscissique). En parallèle, des surexpresseurs de la TRX f1 ont été analysés pour ces mêmes stress abiotiques. L'objectif était de déterminer s'il y a une redondance de fonction entre les deux gènes, puisque ces deux protéines, de la même sous-famille, sont localisées au niveau des chloroplastes. Suite à une induction de la MCP par l'un des stress abiotiques, les réponses observées chez les simples mutants sont similaires à celles des plantes sauvages. Par contre, les doubles mutants paraissent plus résistants aux divers stress, alors que les surexpresseurs semblent nettement plus sensibles que les plantes sauvages. Enfin, un dernier axe a été développé sur le rôle des TRX f dans le contrôle des voies de synthèse et de dégradation de l'amidon pour l'ensemble des plantes de notre essai. Il s'avère que les surexpresseurs produisent une plus grande quantité d'amidon que les plantes sauvages. À l'opposé, les simples mutants ont moins d'amidon au niveau des différents tissus étudiés que les plantes sauvages, et les doubles mutants n'en présentent quasiment pas. La présence d'une quantité plus importante d'amidon chez les surexpresseurs de TRX f influence la sensibilité de ces plantes aux stress abiotiques. À l'inverse, les doubles mutants sont plus résitants à ces mêmes stress, où cette quantité d'amidon est fortement diminuée pour ces plantes.

O endotélio reveste a parede vascular e possui função essencial na manutenção da homeostase. A célula endotelial é capaz de perceber estímulos extracelulares, como fatores químicos e mecânicos, transmitir a informação para dentro da célula e regular sua função e fenótipo. Neste sentido, investigamos os mecanismos moleculares associados as células endoteliais em dois contextos importantes de intervenções vasculares 1) nos stents farmacológicos, onde a rapamicina exerce funções antiproliferativas e pró-trombogênicas, e 2) na revascularização cardíaca por ponte de safena, onde o alto estiramento mecânico exerce grande impacto no remodelamento vascular e no fenótipo da célula endotelial. A rapamicina pertence à classe de drogas limus, bastante utilizadas nos stents farmacológicos usados no procedimento de desobstrução vascular. Além de sua função antiproliferativa, exploramos os efeitos deletérios associados a pró-trombogênese. Os dados demonstraram que a rapamicina ativa o receptor de TGF independentemente de seu ligante TGFbeta, promovendo aumento na expressão da PAI-1 (pró-trombogênica), alteração no fenótipo endotelial (Transição endotélio-mesenquimal - EndMT) e na formação de fibras de estresse. Os efeitos observados são dependentes da ativação de Smad2 e independentes da via clássica antiproliferativa por mTOR. Experimentos in vivo mostraram que o tratamento com inibidor do receptor de TGF diminui os efeitos pró-trombogênicos e a expressão de PAI-1 induzidos pela rapamicina em artérias carótidas de camundongos. A ponte de safena é um procedimento bastante utilizado na cirurgia de revascularização cardíaca e a arterialização do segmento venoso submetido ao estresse hemodinâmico arterial resulta em remodelamento vascular, que influencia o sucesso do procedimento. Nossos dados demonstram que a célula endotelial humana de veia safena humana (hSVEC), susceptível as modificações do tipo EndMT induzido quimicamente (estímulo pró-fibrótico e pró-inflamatório), não expressou o mesmo comportamento em resposta ao aumento de estiramento mecânico que ocorre durante a arterialização venosa. Entretanto, detectamos uma pronunciada redução dos filamentos de actina, modulação no padrão de ativação da cofilina e na proporção de actina glomerular (G-actina) entre citoplasma e núcleo, com redução da biodisponibilidade de NO. De modo interessante, demonstramos que a redução no filamento de actina é específica para a célula endotelial venosa, não sendo observado em células endoteliais de origem arterial de aorta e coronária. Em conjunto, os dados mostram que 1) efeitos pró-trombogênicos associados a rapamicina são mediados por ativação do receptor de TGF independente do seu ligante e da atividade antiproliferativa da droga e 2) a adaptação da célula endotelial venosa ao estiramento mecânico envolve modulação da síntese/degradação de filamentos de actina e redução na biodisponibilidade de NO. Estes novos elementos sobre o mecanismo de transdução de estímulos químicos e físicos pelo endotélio poderão ser explorados terapeuticamente para modular a plasticidade endotelial em disfunções cardiovasculares / Endothelium is the inner layer in vascular wall and displays an essential role in the maintenance of cardiovascular homeostasis. Endothelial cell senses the extracellular stimuli, such as chemical and mechanical factors, transduce and process these signals to regulate cell function and phenotype. Here, we investigated molecular underpinning of the endothelial cells under two important scenarios: 1) in drug-eluting stents, where rapamycin exerts antiproliferative and undesirable prothrombogenic functions, and 2) in vein graft bypass surgery, where increased stretch modulates vascular remodeling and endothelial cell phenotype. Rapamycin belongs to the class of limus drugs and is widely used in drug eluting stents (DES) to vascular restenosis. In addition to its antiproliferative function, we explore the deleterious effects associated with prothrombogenesis. Our data demonstrated that rapamycin activates TGF receptor independent of its ligand TGFbeta, in concert with promotion of PAI-1 expression (prothrombogenic), changes in endothelial phenotype (Endothelial to Mesenchymal Transition - EndMT) and stress fibers induction. These effects are Smad2 dependent and independent of the classical antiproliferative mTOR pathway of rapamycin. Our in vivo experiments showed that TGF receptor inhibitor treatment decreases prothrombogenic effects and PAI-1 expression induced by rapamycin in mice carotid arteries. Saphenous vein is widely used in coronary artery bypass surgery (CABG) and the vein arterialization remodeling in response to the increased stress influences graft patency. Our data demonstrated that human saphenous vein endothelial cell (hSVEC) is susceptible to chemically induced endothelial-to-mesenchymal transition (EndMT) by pro-fibrotic and pro-inflammatory stimuli. On the other hand, physical stimulus associated with high stretch failed to induce EndMT. However, we detected a pronounced decrease of actin filaments, modulation of the cofilin activation, changes in the proportion of glomerular actin (G-actin) between cytoplasm and nucleus, and reduction of NO bioavailability. Interestingly, the reduction of actin fibers by high stretch is specific to venous endothelial cell since arterial endothelial cells from aorta, and coronary artery failed to display the response. Altogether, our data show that 1) the thrombogenic effects of rapamycin are mediated by TGF receptor activation independent of its ligand and independent of the antiproliferative pathway of the drug, and 2) the adaptation of venous endothelial cell to mechanical stretch involves synthesis/degradation of actin filaments and reduced NO bioavailability. These new elements on signal transduction of endothelial cells in response to chemical and physical stimuli may be therapeutically explored to modulate endothelial plasticity in cardiovascular disorders

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-12-15T14:53:15Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) VersaoAtualizada2016 - Tese Georgge Gomes Oliveira - varsão para biblioteca UFPE.pdf: 3290385 bytes, checksum: 2ddc23c4486bcc121a9ea222566d1f09 (MD5) / Made available in DSpace on 2016-12-15T14:53:15Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) VersaoAtualizada2016 - Tese Georgge Gomes Oliveira - varsão para biblioteca UFPE.pdf: 3290385 bytes, checksum: 2ddc23c4486bcc121a9ea222566d1f09 (MD5) Previous issue date: 2015-04-27 / Ministério da Saúde do Brasil / Estudos recentes mostram que a síndrome metabólica (SM) é freqüente nas pessoas vivendo com HIV/AIDS (PLWHA). A importância na identificação da SM baseia-se no aumento do risco em cinco vezes de desenvolver diabetes mellitus tipo 2 (DM2) e em duas vezes de apresentar doença cardiovascular (DCV) trombóticas, embora os fatores de hipercoagulabilidade não estejam incluídos nos critérios de definição da síndrome. A SM é caracterizada pela presença concomitante de fatores reconhecidamente aterogênicos em um mesmo indivíduo. A freqüência de DCV em PLWHA vem aumentando ao longo dos anos. O PAI-1 é uma proteína importante na cascata de fibrinólise e seu aumento está associado ao estado de hipercoagulabilidade. Sua regulação depende de fatores genéticos, dentre eles, destaca-se o polimorfismo 4G5G do gene SERPINE1. A participação de substâncias protrombóticas na doença cardiovascular é conhecida em pessoas sem HIV, porém menos elucidada em PLWHA. Diante disto o objetivo deste trabalho foi determinar a freqüência do polimorfismo 4G5G em pessoas que vivem com HIV e verificar se o polimorfismo tem associação com a expressão do PAI-1 plasmático, com SM e com risco cardiovascular (RCV) estimado pelo escore de Framingham. Também objetivamos verificar associação dos níveis de PAI-1 com RDC e com SM. Para tanto foi desenvolvido estudo transversal para determinação da freqüência do polimorfismo 4G5G do PAI-1 e estudo tipo caso-controle para verificar associações entre polimorfismos com níveis plasmáticos de PAI-1 com SM e depois com RCV. Também foram testadas associações com fatores de risco tradicionais. Para primeiro estudo a amostra foi 185 pessoas sorteadas de um grupo de 2074 participantes da Cohort AIDS-PE Study Group. A prevalência de heterozigose foi de 86,8% e homozigose para 4G4G de 4,4%. A média de idade foi de 40,5 (DP ± 9,9 anos). A mediana de PAI-1 ativado foi de 13,6 ng/mL (IQ: 10,8-17,5). A freqüência de SM foi de 37,9% e de dislipidemia de 82,4%. Não encontramos associação do polimorfismo com os níveis plasmáticos de PAI-1, nem com SM. Para o segundo estudo houve perda de 23, restando 162 pessoas das quais 72,8% era do sexo feminino e a média de idade foi de 40 anos. A freqüência de RDCV estimado > 10% foi de 10,5%. O alelo 4G esteve presente em 91,0% das pessoas (genótipos 4G4G e 4G5G). Não houve associação entre polimorfismo e RDCV estimado > 10% (OR=0,6; IC95% 0,1 – 3,7), nem diferença dos níveis de PAI-1 em relação ao RDCV estimado (RCV>10% 14,6 ng/ml x RDCV < 10% 14,1 ng/ml; ρ=0,9). Hipercolesterolemia foi associada com genótipo 5G5G do polimorfismo (OR: 3,3; IC95%: 1,25 – 10) e com níveis plasmáticos mais elevados do PAI-1 (colesterol não HDL (CNHDL) > 130 mg/dl = 15,6 ng/ml versus CNHDL < 130 ng/ml = 13,8 ng/ml; ρ=0,04). Nesse estudo, encontramos alta prevalência do heterozigose para o polimorfismo 4G5G em pessoas vivendo com HIV/AIDS, no nordeste do Brasil. Entretanto, não encontramos associação entre o polimorfismo estudado com níveis plasmáticos de PAI-1 nem com SM. Também não verificamos associação do polimorfismo 4G5G do PAI-1 nem dos níveis plasmáticos de PAI-1 com RCV>10% pelo escore de Framingham, mas houve com hipercolesterolemia. / Recent studies show that the metabolic syndrome (MS) is common in people living with HIV / AIDS (PLWHA). The importance of identifying MS is based on an increased risk of developing fivefold type 2 diabetes mellitus (T2DM) and twice presenting cardiovascular disease (CVD) thrombotic, although hypercoagulability factors are not included in the definition of criteria syndrome. MS is characterized by the concomitant presence of known atherogenic factors in the same individual. The frequency of CVD in PLWHA has increased over the years. The PAI-1 is an important protein in the fibrinolytic cascade and its increase is associated with the hypercoagulable state. Its regulation depends on genetic factors, among them stands out the 4G5G polymorphism SERPINE1 gene. The participation of prothrombotic substances in cardiovascular disease is known in people without HIV, but less elucidated in PLWHA. In view of this the objective of this study was to determine the frequency of 4G5G polymorphism in people living with HIV and verify that polymorphism is associated with the expression of PAI-1 plasma with MS and cardiovascular risk (RCVD) estimated by the Framingham score . We aim to also assess the association of PAI- 1 levels with CVD and with MS. For this cross-sectional study was developed to determine the frequency of 4G5G polymorphism of PAI- 1 and case-control study to examine associations between polymorphisms and plasma levels of PAI- 1 with SM and then RCVD. Associations were also tested with traditional risk factors. For the first study sample was randomly selected 185 people of a group of participants 2074 of AIDS-PE Cohort Study Group. The prevalence of heterozygosity was 86.8% and homozygous for 4G4G 4.4%. The average age was 40.5 (SD ± 9.9 years). The PAI-1 activated median was 13.6 ng/mL (CI: 10.8 to 17.5). The frequency of MS was 37.9% and 82.4% dyslipidemia. We did not find polymorphism association with plasma levels of PAI-1 or with SM. For the second study, there was loss of 23, leaving 162 people of which 72.8% were female and the average age was 40 years. The frequency of RDCV estimated> 10% was 10.5%. The 4G allele was present in 91.0% of people (4G4G and 4G5G genotypes). There was no association between polymorphism and RDCV estimated> 10% (OR = 0.6; 95% CI 0.1 to 3.7), or difference of PAI-1 levels relative to estimated RDCV (RCV> 10% 14.6 ng / ml x RDCV <10% 14.1 ng/ml; ρ = 0.9). Hypercholesterolemia was associated with 5G5G genotype polymorphism (OR: 3.3; 95% CI: 1.25 to 10) and higher plasma levels of PAI-1 (non-HDL cholesterol (CNHDL)> 130 mg / dl = 15.6 ng/ml CNHDL versus <130 ng/ml = 13.8 ng/ ml; ρ = 0.04). In this study, we found a high prevalence of heterozygous for the polymorphism 4G5G in people living with HIV/AIDS, in northeastern Brazil. However, we found no association between the polymorphism studied with plasma levels of PAI-1 or with SM. Nor do we find polymorphism association 4G5G of PAI-1 or plasma levels of PAI-1 with RCV> 10% by Framingham score, but happened to hypercholesterolemia.

O endotélio reveste a parede vascular e possui função essencial na manutenção da homeostase. A célula endotelial é capaz de perceber estímulos extracelulares, como fatores químicos e mecânicos, transmitir a informação para dentro da célula e regular sua função e fenótipo. Neste sentido, investigamos os mecanismos moleculares associados as células endoteliais em dois contextos importantes de intervenções vasculares 1) nos stents farmacológicos, onde a rapamicina exerce funções antiproliferativas e pró-trombogênicas, e 2) na revascularização cardíaca por ponte de safena, onde o alto estiramento mecânico exerce grande impacto no remodelamento vascular e no fenótipo da célula endotelial. A rapamicina pertence à classe de drogas limus, bastante utilizadas nos stents farmacológicos usados no procedimento de desobstrução vascular. Além de sua função antiproliferativa, exploramos os efeitos deletérios associados a pró-trombogênese. Os dados demonstraram que a rapamicina ativa o receptor de TGF independentemente de seu ligante TGFbeta, promovendo aumento na expressão da PAI-1 (pró-trombogênica), alteração no fenótipo endotelial (Transição endotélio-mesenquimal - EndMT) e na formação de fibras de estresse. Os efeitos observados são dependentes da ativação de Smad2 e independentes da via clássica antiproliferativa por mTOR. Experimentos in vivo mostraram que o tratamento com inibidor do receptor de TGF diminui os efeitos pró-trombogênicos e a expressão de PAI-1 induzidos pela rapamicina em artérias carótidas de camundongos. A ponte de safena é um procedimento bastante utilizado na cirurgia de revascularização cardíaca e a arterialização do segmento venoso submetido ao estresse hemodinâmico arterial resulta em remodelamento vascular, que influencia o sucesso do procedimento. Nossos dados demonstram que a célula endotelial humana de veia safena humana (hSVEC), susceptível as modificações do tipo EndMT induzido quimicamente (estímulo pró-fibrótico e pró-inflamatório), não expressou o mesmo comportamento em resposta ao aumento de estiramento mecânico que ocorre durante a arterialização venosa. Entretanto, detectamos uma pronunciada redução dos filamentos de actina, modulação no padrão de ativação da cofilina e na proporção de actina glomerular (G-actina) entre citoplasma e núcleo, com redução da biodisponibilidade de NO. De modo interessante, demonstramos que a redução no filamento de actina é específica para a célula endotelial venosa, não sendo observado em células endoteliais de origem arterial de aorta e coronária. Em conjunto, os dados mostram que 1) efeitos pró-trombogênicos associados a rapamicina são mediados por ativação do receptor de TGF independente do seu ligante e da atividade antiproliferativa da droga e 2) a adaptação da célula endotelial venosa ao estiramento mecânico envolve modulação da síntese/degradação de filamentos de actina e redução na biodisponibilidade de NO. Estes novos elementos sobre o mecanismo de transdução de estímulos químicos e físicos pelo endotélio poderão ser explorados terapeuticamente para modular a plasticidade endotelial em disfunções cardiovasculares / Endothelium is the inner layer in vascular wall and displays an essential role in the maintenance of cardiovascular homeostasis. Endothelial cell senses the extracellular stimuli, such as chemical and mechanical factors, transduce and process these signals to regulate cell function and phenotype. Here, we investigated molecular underpinning of the endothelial cells under two important scenarios: 1) in drug-eluting stents, where rapamycin exerts antiproliferative and undesirable prothrombogenic functions, and 2) in vein graft bypass surgery, where increased stretch modulates vascular remodeling and endothelial cell phenotype. Rapamycin belongs to the class of limus drugs and is widely used in drug eluting stents (DES) to vascular restenosis. In addition to its antiproliferative function, we explore the deleterious effects associated with prothrombogenesis. Our data demonstrated that rapamycin activates TGF receptor independent of its ligand TGFbeta, in concert with promotion of PAI-1 expression (prothrombogenic), changes in endothelial phenotype (Endothelial to Mesenchymal Transition - EndMT) and stress fibers induction. These effects are Smad2 dependent and independent of the classical antiproliferative mTOR pathway of rapamycin. Our in vivo experiments showed that TGF receptor inhibitor treatment decreases prothrombogenic effects and PAI-1 expression induced by rapamycin in mice carotid arteries. Saphenous vein is widely used in coronary artery bypass surgery (CABG) and the vein arterialization remodeling in response to the increased stress influences graft patency. Our data demonstrated that human saphenous vein endothelial cell (hSVEC) is susceptible to chemically induced endothelial-to-mesenchymal transition (EndMT) by pro-fibrotic and pro-inflammatory stimuli. On the other hand, physical stimulus associated with high stretch failed to induce EndMT. However, we detected a pronounced decrease of actin filaments, modulation of the cofilin activation, changes in the proportion of glomerular actin (G-actin) between cytoplasm and nucleus, and reduction of NO bioavailability. Interestingly, the reduction of actin fibers by high stretch is specific to venous endothelial cell since arterial endothelial cells from aorta, and coronary artery failed to display the response. Altogether, our data show that 1) the thrombogenic effects of rapamycin are mediated by TGF receptor activation independent of its ligand and independent of the antiproliferative pathway of the drug, and 2) the adaptation of venous endothelial cell to mechanical stretch involves synthesis/degradation of actin filaments and reduced NO bioavailability. These new elements on signal transduction of endothelial cells in response to chemical and physical stimuli may be therapeutically explored to modulate endothelial plasticity in cardiovascular disorders

Le facteur 4 plaquettaire (PF4/CXCL4) est un tétramère constitué de quatre sous-unités identiques de 7,8 kDa qui est libéré en grande quantité par les plaquettes lors de l’hémostase primaire (ensemble des phénomènes permettant un colmatage initial d’une lésion vasculaire). L’étude de la formation d’un caillot de fibrine en présence de PF4 montre une augmentation de la turbidité finale du caillot : le PF4 modifie le réseau formé. Etant donné que la plupart des acteurs de la fibrinolyse se lie au caillot de fibrine et que le PF4 modifie sa structure, nous avons pensé qu’il serait intéressant de rechercher si le PF4 influençait aussi la fibrinolyse. La lyse d'un caillot est effectuée par la plasmine issue de l'activation du plasminogène par son activateur d’origine tissulaire (t-PA) en présence d’un cofacteur qui n'est autre que la fibrine. Nous avons étudié la lyse de caillots de plasma, obtenus par activation de la cascade de la coagulation, en condition statique et à l'aide d'un modèle de thrombose artérielle (système Chandler loop). Dans les deux cas, une diminution du temps de demi-lyse a été observée en présence de PF4. Cependant, la lyse de caillots préparés par simple ajout de thrombine sur du fibrinogène ne permet pas de retrouver cet effet du PF4. Ceci suggère que l’influence du PF4 sur la structure du caillot n’est pas à l’origine de l’effet sur sa lyse et que le PF4 n’influence pas (ou très peu) l'activation du plasminogène, ainsi que l'activité de la plasmine résultante. Cette hypothèse a été confirmée par l’étude de l’activité amydolytique du t-PA et de la plasmine (quelle soit ajoutée ou générée). En système purifié, les inhibiteurs plasmatiques de la fibrinolyse sont absents. Les deux principaux sont l'inhibiteur de l'activateur du plasminogène de type 1 (PAI-1) et l’α2-antiplasmine (α2-AP). La lyse de caillots préparés à partir de plasma déficient en α2-AP montre une diminution du temps de demi-lyse en présence de PF4 (comme pour le plasma normal), alors qu’avec le plasma dépourvu de PAI-1 le temps de demi-lyse n'est plus influencé. De plus, l’ajout de PAI-1 dans le système purifié entraine une diminution du temps de demi-lyse en présence de PF4. Ceci suggère que le PF4 prévient directement ou indirectement l'inhibition du t-PA par PAI-1. L’étude de la cinétique d'inhibition de l’activité amidolytique du t-PA par le PAI-1, la détermination de la stœchiométrie de cette inhibition, et l’analyse de ces cinétiques par immuno-empreinte montrent que le PF4 est un modulateur de la fibrinolyse qui agit en retardant la formation d'un complexe initial entre le t-PA et le PAI-1. Cette nouvelle fonction du PF4 est cohérente, et vient en complément de celle décrite récemment d’inhibiteur de l'activation du TAFI. / Platelet factor 4 (PF4/CXCL4) is a tetramer constituted of four identical 7,8 kDa subunits released in large quantities by platelets during primary heamostasis (allowing initial clogging of a vascular injury). Study of fibrin clot formation in the presence of PF4 shows an increase of the final clot turbidity: PF4 modifies the formed network. Given that most fibrinolysis actors are bound to the fibrin clot and that PF4 modifies its structure we thought it would be interesting to investigate if PF4 also influences fibrinolysis. Clot lysis is performed by plasmin originating from activation of its precursor by tissue plasminogen activator (t-PA) with fibrin itself as cofactor of the reaction. We have studied lysis of plasma clots formed by activation of the coagulation cascade in static condition and in a Chandler loop model mimicking arterial thrombosis. Half-times of lysis decreased in the presence of PF4 in both systems. However, PF4 had no longer detectable influence on the half-time of lysis with clots formed by direct addition of thrombin on purified fibrinogen. Observation suggested that the observed decrease of the half-time of lysis induced by PF4 did not originate from its influence on fibrin clot formation and that PF4 had little effect if any on plasminogen activation or plasmin activity. We confirmed this hypothesis by comparing amydolytic activities of t-PA and plasmin (added or generated through plasminogen activation). In purified system, fibrinolysis inhibitors are absent. The two main inhibitors are plasminogen activator inhibitor-1 (PAI-1) and α2-antiplasmin (α2-AP). Lysis of clots obtained from α2-AP deficient plasma showed a decrease of the half-time of lysis in the presence of PF4 (as in normal plasma), whereas in PAI-1 deficient plasma half-time of lysis was unchanged. Moreover if PAI-1 was added to the purified system, half-time of lysis decreased in the presence of PF4. Observations therefore suggested that PF4 prevented directly or indirectly t-PA inhibition by PAI-1. Kinetics of the amidolytic activity of t-PA inhibition by PAI-1 in the presence or not of PF4, determination of its stoichiometry and Western blot analysis of these inhibition kinetics revealed that PF4 is a fibrinolysis modulator which delays formation of the initial (Michaelis) complex between t-PA and PAI-1. This new feature of PF4 is consistent and complementary with its recently described role as a modulator of TAFI activation.