La carcinose péritonéale (CP) correspond le plus souvent à l'envahissement métastatique de la cavité péritonéale survenant dans 85 à 90% des cas de l'ovaire et 5 à 20% des cancers colorectaux. La pauvreté de des signes cliniques explique que le diagnostic se fasse à un stade souvent avancé. Jusque récemment, le traitement d'une CP était exclusivement palliatif avec une chirurgie de nécessité incomplète et une chimiothérapie systémique, et une survie médiocre. La cause du décès est dans la majorité des cas la carcinose elle-même. Les avancées en matière de chirurgie péritonéale extensive et de chimiothérapie intrapéritonéale combinée ou non à une hyperthermie ont fait naître de nombreux espoirs de curabilité. La chirurgie de cytoreduction complète représente le facteur pronostic essentiel, quelque soit l'origine tumorale primitive. L'association d'une chirurgie et d'une chimiothérapie intraperitonéale a été développée dans le cancer de l'ovaire avec des taux de survie impressionnants. L'hyperthermie induit une destruction sélective des cellules en hypoxie, dans des zones tumorales en acidose, tout en préservant le tissu sain environnant. Pour les patients atteints de CP, une technique nommée CHIP a été developpée permettant de délivrer une chimiothérapie intrapéritonéale en condition d'hyperthermie. Une augmentation importante de la survie de patients atteints de CP colorectal ou de maladie rare du péritoine a été mise en évidence. Des essais cliniques sont en cours afin de vérifier le bénéfice attendu de l'HIPEC dans différentes pathologies. Premièrement, compte tenu de large développement de la laparoscopie, l'adressage de patients avec une carcinose localisée est fréquent. Nous avons développé, sur modèle animal, une technique de péritonectomie laparoscopique avec CHIP à l'oxaliplatine. Les paramètres pharmacocinétiques (PK) en terme d'absorption de la drogue et de pénétration intra-tissulaire ont été analysés avec mise en évidence du rôle favorable de l'hyperpression intraabdominale. Ces travaux ont été publié dans Gynecologic Oncology, dans Annals of Surgical Oncology (2 articles) et inclus dans un chapitre de livre international (Humana Press) concernant la pharmacologie et la PK des sels de platine. Ensuite, nous avons établi un nouveau modèle de pharmacocinétique des populations que nous avons appliqué à la comparaison de deux modes d'administration de la chimiothérapie lors des CHIP à l'oxaliplatine, sur 24 patients. Ce travail a été publié dans Cancer Chemotherapy and Pharmacology. Enfin, différentes études cliniques et pharmacodynamiques (PD) ont été réalisée afin d'évaluer et de prédire la toxicité spécifique des CHIP réalisées au Cisplatine et à l'Oxaliplatine. Trois travaux successifs ont été réalisés pour évaluer la toxicité rénale liée au Cisplatine. Dans une étude pilote de PK, non publiée, de désescalade de dose, nous avons montré que le risque d'insuffisance rénale n'est pas expliqué par la PK (présentation au Congrès de Pharmaco-Oncologistes). Cela a été confirmé dans une étude rétrospective bicentrique avec mise en évidence de facteurs de risque. Ce travail est soumis à publication dans European Journal of Surgical Oncology. Enfin une étude de phase I d'escalade de dose a été réalisée permettant de déterminer la dose optimale de Cisplatine en CHIP et est soumise à publication dans Journal of Clinical Oncology. Compte tenu de la toxicité rénale du cisplatine, une étude prospective de phase II a évalué la morbidité de l'oxaliplatine en CHIP dans le cancer de l'ovaire. Cet essai a été clos de façon anticipée compte tenu du taux d'hémopéritoine et publié dans European Journal of Surgical Oncology. Afin d'analyser et prédire ce risque, une étude PK-PD a été conduite sur 75 patients traités par CHIP à l'oxaliplatine avec une corrélation PK entre l'absorption et la survenue de thrombopénie et d'hémoperitoine. Ce travail est publié dans Cancer Chemotherapy and Pharmacology / Peritoneal carcinomatosis (PC) is usually caused by widespread cancer metastatic cells within the peritoneal cavity and occurred in 85% of ovarian cancer patients and 5-20% of colorectal carcinoma patients. Because of the poverty of symptoms, patients are diagnosed with an advanced stage. PC will be the leading death cause of these patients. Recently, the treatment was limited to standard palliative surgery and intravenous chemotherapy with very poor results in term of survival. The development of new surgical techniques combined with intraperitoneal chemotherapy associated or not with hyperthermia provided new hope of a potential cure for patients with PC. Indeed, complete cytoreductive surgery represents the most important prognostic factor for patients with PC whatever the primary cancer locations. Combined treatment using complete cytoreductive surgery and intraperitoneal chemotherapy has been developed leading to unprecedented survival. Hyperthermia induces a selective destruction of tumor cells in hypoxic and acidic parts of tumors, but leaves normal tissues intact. In addition heat is acting for synergy with the cytotoxic agent. A new technique to deliver intraoperative intraperitoneal chemotherapy associated with hyperthermia, called HIPEC, was developed for patient with PC. It significantly increases survival in patients with colic cancer PC, peritoneal mesothelioma and pseudomyxoma peritonei. Several ongoing trails have been designed to establish the real role of HIPEC for different pathology. First, because of the major development and the widespread use of minimal invasive surgery, recruitment of patients has been profoundly changed with localized PC. We have demonstrated in an experimental study the feasibility and reliability of laparoscopic peritonectomy followed by oxaliplatin based intraperitoneal chemotherapy and its pharmacokinetics consequences regarding the peritoneal drug absorption, the increased tissue diffusion, and the role of intraperitoneal pressure. Several articles were published in Gynecologic Oncology and in Annals of Surgical Oncology and in an international book chapter (Humana Press) concerning pharmacology and pharmacokinetics of platinum salts. Then, to establish a new population pharmacokinetic model and to compare two procedures of drug's delivery during HIPEC, data from 24 patients treated with oxaliplatin based HIPEC were collected and analyzed. This work was published in Cancer Chemotherapy and Pharmacology. Finally, different clinical and pharmacodynamic studies were performed to evaluate the toxicity for patients who underwent complete cytoreductive surgery associated to Cisplatin or Oxaliplatin based HIPEC. Three different works were performed to evaluate the renal toxicity of cisplatin based HIPEC. An unpublished PK study regarding acute renal failure in a dose-deescalation study was presented at a Pharmaco-oncologists Meeting. The results were confirmed in a bicentric retrospective study highlighting some risk factors (Submitted to the European Journal of Surgical Oncology). Finally, a phase I study dose escalation of hyperthermic intraperitoneal cisplatin was conducted with the establishment of the recommended dose of cisplatin for HIPEC (Submitted to the Journal of Clinical Oncology). Because of renal toxicity related to cisplatin based HIPEC, a phase II prospective study was conducted to evaluate the morbidity of oxaliplatin based HIPEC. As a result of this high morbidity rate (hemoperitoneum), this trial was prematurely closed and published in the European Journal of Surgical Oncology. Finally, to evaluate the relationship between oxaliplatin exposure and observed toxicity, a population pharmacokinetics was conducted in 75 patients treated with CRS and oxaliplatin based HIPEC. A PK contribution, relative to the absorption phenomenon, on the severity of the thrombocytopenia and hemoperitoneum was shown. This work was published in Cancer Chemotherapy and Pharmacology

To compare the efficacy and duration of the immune response to local and systemic vaccination, Balb/c mice were vaccinated either intraperitoneally (i.p.) with an inactivated A/PR/8/34 (H1N1) vaccine or intranasally (i.n.) with a vaccinia recombinant containing the H1 gene of influenza. The i.p. inactivated vaccine stimulated high serum IgG anti-influenza titres and protected the lungs against viral challenge for the duration of the experiment (17 months). Little nasal wash IgA was induced and the noses were susceptible to challenge. Animals vaccinated i.n. with the recombinant had lower serum IgG titres and the lungs showed poor protection against challenge. Nasal wash IgA titres were higher, however, and the noses were largely protected from viral challenge for 17 months.

Ovarian cancer is the second most common, and first most lethal gynecological cancer. It will affect one in seventy-eight women, and is commonly diagnosed in the later stages of the disease. The majority of the cancer’s lifespan is spent within the peritoneal cavity. Hyperthermic intraperitoneal chemotherapy (HIPEC) is an innovative new treatment that has been proven as an effective treatment in other peritoneal cancers. There is strong scientific evidence to support HIPEC as an ideal treatment for advanced ovarian cancer. Over the past two decades, there has been an increase in the number of studies focused on the efficacy of HIPEC with regards to advanced ovarian cancer. These studies have shown great promise, with two very recent phase III studies showing resounding results. It is also clear that there is a need for standardization throughout these scientific studies in order to reasonably introduce HIPEC as a standard of treatment.

Os surtos de doença de Chagas aguda estão relacionados ao consumo de comidas e bebidas contaminadas por fezes de triatomíneos contendo tripomastigotas de T. cruzi, tornando assim a infecção oral uma importante via de transmissão. Ambas as infecções vetoriais e orais desencadeiam importantes manifestações cardíacas nos hospedeiros e que estão relacionadas a uma desregulada resposta imune. O objetivo deste estudo foi avaliar a parasitemia sanguínea durante a fase aguda da infecção, a produção de macrófagos peritoneais, alterações nas sub-populações de linfócitos CD4+/CD8+, citocinas Th1 e Th2, concentração de nitrito e a histopatologia cardíaca. Um grupo de ratos Wistar foi intraperitonealmente infectados com 1X105 com cepa Y de tripomastigotas sanguíneos de T. cruzi e outro grupo de ratos Wistar foi infectado oralmente com 8X105 de tripomastigotas metacíclicos da mesma cepa. A infecção intraperitoneal desencadeou um aumento estatístico no aumento do número de parasitas, macrófagos peritoneais, proliferação de células T CD4+ e CD8+, aumento na concentração de NO, IL-12 e elevado foco inflamatório cardíaco quando comparado à infecção oral. Entretanto nossos resultados demonstraram que a infecção oral pode levar a uma doença sistêmica e que as diferentes vias de inoculação promovem respostas imunes distintas. / Acute Chagas disease outbreaks are related to the consumption of food or drink contaminated by triatomine feces containing trypomastigotes of T. cruzi, thus making oral infection an important route of transmission. Both vectorial and oral infections trigger important cardiac manifestations in the host that are related to a dysregulated immune response. The aims of this work were to evaluate the number of blood trypomastigotes during the acute phase of infection, peritoneal macrophages, possible alterations of lymphocyte CD4+/CD8+ sub-populations, Th1 and Th2 cytokines, nitrite concentrations and cardiac histopathology. One group of male Wistar rats was intraperitoneally infected with 1X105 blood trypomastigotes of the T. cruzi Y strain, and another group of Wistar rats was orally infected with 8X105 metacyclic trypomastigotes of the same strain. The intraperitoneal infection triggered statistically enhanced parasite numbers, peritoneal macrophage numbers, proliferation of CD4+ and CD8+ T cells, increased concentrations of NO and IL-12 and elevated cardiac inflammatory foci when compared to the oral infection. Therefore, our results demonstrate that oral infection can lead to systemic disease and that the different inoculation routes promoted distinct immune responses.

Este trabalho apresenta a pesquisa de interação de organismos aquáticos com metais, especificamente cobre e cádmio assim como da combinação deles. Para tanto, descreve-se um protocolo baseado em ensaios de toxicidade com tilápias Oreochromis niloticus, desenvolvido com a finalidade de estabelecer a concentração letal 50 (CL50) 96h. Como recurso adicional, focando a translocação de metais, foram utilizadas soluções enriquecidas isotopicamente de 65Cu (99,7%) e 111Cd (95,5%), as quais foram aplicadas através de injeções intraperitoneais. As concentrações dos metais nos tecidos e nas frações citosólicas do fígado, brânquias e músculo foram determinadas a partir dos extratos preparados em solução tampão tris-HCl 50 mmolL-1, agentes redutores e antiproteolíticos, na proporção 3:1 (m/v). Adicionalmente, foram determinados os teores de proteínas totais seguidos da etapa de isolamento das metalotioneínas. As concentrações letais (CL50) 96h calculadas pelo método Trimmed Spearman-Karber (95% de confiança), foram iguais a 20,13, 3,53 e 1,36 mg L-1 para cádmio, cobre e cobre+cádmio respectivamente. Estes valores indicam uma significativa diferença na sensibilidade dos organismos aos diferentes tratamentos. Observou-se uma redução na bioconcentração dos metais em função da concentração do metal e do tecido analisado, esta é maior para o Cu do que para o Cd e menor para o musculo em relação a brânquia e ao fígado. Os teores de proteínas totais nos tecidos foram determinados e os valores encontrados estiveram entre 3,25 mg/mL para fígados e 11,83 mg/mL para músculo. A presença de MTs nos diferentes tecidos e respectivos tratamentos, foi pesquisada empregando-se eletroforese capilar e separação de proteínas utilizando a eletroforese em gel de poliacrilamida. Por ambas as técnicas eletroforéticas foi possível identificar as metalotioneínas. Contudo, as análises dos extratos dos tecidos por espectrometria de massas, MALDI-TOF/TOF (matrix-assisted laser desorption/ionization) e ESI-MS (electrospray tandem mass spectrometry ) não mostraram-se adequadas para identificação de metalotioneínas / This paper discuss the interactions of Cd, Cu and it mixture upon aquatic organisms. To reach for these goals lethal 50 (LC50) acute toxicity 96h assays were carried out. In order to assess for the metals translocation in fish, isotopically enriched solutions of 65Cu (99,7%) and 111Cd (95,5%), were used, through an intra-peritoneal injections. Metals concentrations in tissue and in the citossolic fractions of liver, and muscular tissue were analysed in the 50 mmol-1 tris-HCl buffer solutions, reducing and un-proteolitic (3:1) solutions. In addition the total protein content were determinate, followed by the metalothyonein isolation. Lethal concentrations were calculated by the Spearman-Karber method at 95% confidence interval, as 20.13, 3.53 and 1.36 mgL-1 for Cd, Cu and Cd+Cu respectively, which denote differences in organisms sensitivity according to the treatment. Metal bio-concentration was reduced depending on the analyte concentration and kind of tissue, being higher to Cu than to Cd. Total protein concentration varied from 3.35 mg L-1 for liver to 11.83 mg L-1 in the muscular tissue. The occurrence of MTs in tissues and in all treatments were investigated by using both, capillary electrophoresis and gel of polyacrilamide. In all situations the occurrence and identification of Mts were verified, but even with MALDI-TOF/TOF (matrix-assisted laser desorption/ionization) and ESI-MS (electronspray tandem mass spectrometry), or actual instrumental facilities no satisfactory results were obtained, being not possible the identification of MTs in the analysed samples

Os surtos de doença de Chagas aguda estão relacionados ao consumo de comidas e bebidas contaminadas por fezes de triatomíneos contendo tripomastigotas de T. cruzi, tornando assim a infecção oral uma importante via de transmissão. Ambas as infecções vetoriais e orais desencadeiam importantes manifestações cardíacas nos hospedeiros e que estão relacionadas a uma desregulada resposta imune. O objetivo deste estudo foi avaliar a parasitemia sanguínea durante a fase aguda da infecção, a produção de macrófagos peritoneais, alterações nas sub-populações de linfócitos CD4+/CD8+, citocinas Th1 e Th2, concentração de nitrito e a histopatologia cardíaca. Um grupo de ratos Wistar foi intraperitonealmente infectados com 1X105 com cepa Y de tripomastigotas sanguíneos de T. cruzi e outro grupo de ratos Wistar foi infectado oralmente com 8X105 de tripomastigotas metacíclicos da mesma cepa. A infecção intraperitoneal desencadeou um aumento estatístico no aumento do número de parasitas, macrófagos peritoneais, proliferação de células T CD4+ e CD8+, aumento na concentração de NO, IL-12 e elevado foco inflamatório cardíaco quando comparado à infecção oral. Entretanto nossos resultados demonstraram que a infecção oral pode levar a uma doença sistêmica e que as diferentes vias de inoculação promovem respostas imunes distintas. / Acute Chagas disease outbreaks are related to the consumption of food or drink contaminated by triatomine feces containing trypomastigotes of T. cruzi, thus making oral infection an important route of transmission. Both vectorial and oral infections trigger important cardiac manifestations in the host that are related to a dysregulated immune response. The aims of this work were to evaluate the number of blood trypomastigotes during the acute phase of infection, peritoneal macrophages, possible alterations of lymphocyte CD4+/CD8+ sub-populations, Th1 and Th2 cytokines, nitrite concentrations and cardiac histopathology. One group of male Wistar rats was intraperitoneally infected with 1X105 blood trypomastigotes of the T. cruzi Y strain, and another group of Wistar rats was orally infected with 8X105 metacyclic trypomastigotes of the same strain. The intraperitoneal infection triggered statistically enhanced parasite numbers, peritoneal macrophage numbers, proliferation of CD4+ and CD8+ T cells, increased concentrations of NO and IL-12 and elevated cardiac inflammatory foci when compared to the oral infection. Therefore, our results demonstrate that oral infection can lead to systemic disease and that the different inoculation routes promoted distinct immune responses.

Este trabalho apresenta a pesquisa de interação de organismos aquáticos com metais, especificamente cobre e cádmio assim como da combinação deles. Para tanto, descreve-se um protocolo baseado em ensaios de toxicidade com tilápias Oreochromis niloticus, desenvolvido com a finalidade de estabelecer a concentração letal 50 (CL50) 96h. Como recurso adicional, focando a translocação de metais, foram utilizadas soluções enriquecidas isotopicamente de 65Cu (99,7%) e 111Cd (95,5%), as quais foram aplicadas através de injeções intraperitoneais. As concentrações dos metais nos tecidos e nas frações citosólicas do fígado, brânquias e músculo foram determinadas a partir dos extratos preparados em solução tampão tris-HCl 50 mmolL-1, agentes redutores e antiproteolíticos, na proporção 3:1 (m/v). Adicionalmente, foram determinados os teores de proteínas totais seguidos da etapa de isolamento das metalotioneínas. As concentrações letais (CL50) 96h calculadas pelo método Trimmed Spearman-Karber (95% de confiança), foram iguais a 20,13, 3,53 e 1,36 mg L-1 para cádmio, cobre e cobre+cádmio respectivamente. Estes valores indicam uma significativa diferença na sensibilidade dos organismos aos diferentes tratamentos. Observou-se uma redução na bioconcentração dos metais em função da concentração do metal e do tecido analisado, esta é maior para o Cu do que para o Cd e menor para o musculo em relação a brânquia e ao fígado. Os teores de proteínas totais nos tecidos foram determinados e os valores encontrados estiveram entre 3,25 mg/mL para fígados e 11,83 mg/mL para músculo. A presença de MTs nos diferentes tecidos e respectivos tratamentos, foi pesquisada empregando-se eletroforese capilar e separação de proteínas utilizando a eletroforese em gel de poliacrilamida. Por ambas as técnicas eletroforéticas foi possível identificar as metalotioneínas. Contudo, as análises dos extratos dos tecidos por espectrometria de massas, MALDI-TOF/TOF (matrix-assisted laser desorption/ionization) e ESI-MS (electrospray tandem mass spectrometry ) não mostraram-se adequadas para identificação de metalotioneínas / This paper discuss the interactions of Cd, Cu and it mixture upon aquatic organisms. To reach for these goals lethal 50 (LC50) acute toxicity 96h assays were carried out. In order to assess for the metals translocation in fish, isotopically enriched solutions of 65Cu (99,7%) and 111Cd (95,5%), were used, through an intra-peritoneal injections. Metals concentrations in tissue and in the citossolic fractions of liver, and muscular tissue were analysed in the 50 mmol-1 tris-HCl buffer solutions, reducing and un-proteolitic (3:1) solutions. In addition the total protein content were determinate, followed by the metalothyonein isolation. Lethal concentrations were calculated by the Spearman-Karber method at 95% confidence interval, as 20.13, 3.53 and 1.36 mgL-1 for Cd, Cu and Cd+Cu respectively, which denote differences in organisms sensitivity according to the treatment. Metal bio-concentration was reduced depending on the analyte concentration and kind of tissue, being higher to Cu than to Cd. Total protein concentration varied from 3.35 mg L-1 for liver to 11.83 mg L-1 in the muscular tissue. The occurrence of MTs in tissues and in all treatments were investigated by using both, capillary electrophoresis and gel of polyacrilamide. In all situations the occurrence and identification of Mts were verified, but even with MALDI-TOF/TOF (matrix-assisted laser desorption/ionization) and ESI-MS (electronspray tandem mass spectrometry), or actual instrumental facilities no satisfactory results were obtained, being not possible the identification of MTs in the analysed samples

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21997号 / 医博第4511号 / 新制||医||1037(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 妹尾 浩, 教授 伊達 洋至 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Various methods were tried in an attempt to obtain a technique for quantifying the gnawing effects of apomorphine on rats. A technique using a restraining tube was developed. Under a 2 milligram per kilogram intraperitoneal injection of apomorphine, four female Long Evans hooded rats were placed on continuous and fixed reinforcement schedules using a gnawable pine block. Subjects would learn to turn their heads away from the gnawable object in order to obtain 15 seconds of gnawing time. The rate of response increased from less than one response in 5 minutes to over 3 responses per minute in 10 one-half hour conditioning sessions. Rates of response stabilized during the last 5 experimental sessions and fixed ratio schedules of up to 5:1 were obtained in five additional 1 '1/ 2 hour sessions.

No description available.