Although two-thirds of colorectal cancer patients are cured by surgery, approximately 50% of the patients with this disease develop locally recurrent or distant metastases during the course of their illness. The aim of this study was to identify metastatic sites associated with poor prognosis in rectal cancer and then to investigate methods that can prevent the development and growth of metastases and optimise uptake of drugs at these sites in animal models. In a defined population, 151 patients with irresectable metastatic or local rectal cancer were identified. Bilateral liver involvement, abnormal liver function tests, paritoneal growth or abdominal lymph node metastases implied a poor prognosis. In a study on Wistar rats with liver metastases from colorectal cancer, blocking of hyaluronan uptake and elimination by the liver enhanced the hyaluronan uptake in liver metastases. Hyaluronan may thus be used to promote uptake of drugs in specific hyaluronan receptor-positive turnout sites. Adjuvant intravenous radioimmunotherapy delivered as a specific or unspecific monoclonal antibody prevented human colonic cancer calls inoculated into the portal vein of nude rats from developing into liver metastases. Furthermore, intraperitoneally administered radioimmunotherapy inhibited the growth of peritoneal metastases. Blocking of 5-FU absorption with a vasoconstrictive agent enhanced the uptake of 5-FU in peritoneal metastases. In addition, the uptake of 5-FU in peritoneal metastases could be improved when these turnouts were mechanically disintegrated by surgical turnout reduction and the drug was given intraperitoneally.

Peritoneal carcinomatosis (PC) is traditionally regarded as a terminal stage of disease with a poor prognosis and systemic chemotherapy is regarded as palliative treatment. In order to improve survival and even to achieve cure for selected patients with PC, cytoreductive surgery and intraperitoneal che-motherapy have been advocated. Despite complete macroscopic removal of tumour, residual microscopic malignant cells might result in recurrence. Intraperitoneal chemotherapy aims to kill residual malignant cells and thereby needs to be distributed in the entire peritoneal cavity. This aggres-sive combined loco-regional treatment has a high risk of morbidity and mor-tality. Whether the increased risks are acceptable to improve survival re-quires investigation and the impact of loco-regional treatment of PC on health-related quality of life (HRQL) needs to bee explored The overall aim of this thesis was to analyse the impact of cytoreductive surgery and intraperitoneal chemotherapy on patients with peritoneal carci-nomatosis. A significant survival improvement (median 32 months) was seen in 18 patients with PC of colorectal origin subjected to loco-regional treatment, in comparison to matched controls treated with systemic chemotherapy (me-dian survival 14 months, Paper I). The results of single-photon emission computer-tomography (SPECT) in 51 patients were correlated to the number of intraperitoneal chemotherapy courses that could be performed without further surgery (Paper II). Postoperative 30-days morbidity and 90-days mortality was investigated in 123 PC-patients after loco-regional treatment. Severe adverse events occurred in 51 (41%) patients. Five patients (4%) had treatment-related mortality. Stoma formation, duration of surgery, periopera-tive blood loss, and extent of PC was associated with morbidity (Paper III). HRQL was investigated in 64 patients. HRQL was negatively affected at 3 months but a partial recovery was seen at 8 months. 30-day morbidity did not have any impact on HRQL at 8 months (Paper IV). This treatment there fore appears justified despite considerable toxicity in view of possible life prolongation.

Peritoneal carcinomatosis (PC) is a common manifestation of both gastrointestinal and gynecologic malignancies. Until recently, this condition was considered beyond curative intent treatment. Since the 1980s, new treatment strategies combining cytoreductive surgery (CRS) with perioperative intraperitoneal and intravenous chemotherapy have emerged. The underlying hypothesis considers CRS responsible for the removal of the macroscopic disease and that perioperative chemotherapy should address the residual microscopic disease. These new treatment regimens have presented encouraging clinical results that contrast with prior failure. The parameters for perioperative chemotherapy are mainly extrapolated from literature on peritoneal dialysis and data from systemic chemotherapy. The overall aim of this thesis was to provide a pharmacokinetic and pharmacodynamic rationale for perioperative intraperitoneal (IP) and intravenous (IV) chemotherapy in PC patients and, to assess its toxicity. After intraoperative IV administration of 5-fluorouracil or ifosfamide, substantial levels of these drugs were found inside the peritoneal fluid and tumor nodules (Papers I and II). This created a pharmacologically advantageous situation whereby a normothermic administered IV drug was subject to the effect of the local hyperthermia in the peritoneal fluid and tumor nodule. High levels of 5-fluouracil, ifosfamide and doxorubicin were observed inside the tumor nodules (Papers I, II and III) and, the identical pharmacokinetic advantage (expressed as Area Under the Curve (AUC) IP/IV ratios)) resulted in different drug levels of doxorubicin according to the density of the tumor nodules (Paper III). These data stressed the importance of pharmacodynamic variables such as tumor nodule density, size, and, vascularity. Therefore, the tumor nodule is proposed as a more appropriate pharmacological endpoint than AUC ratios. After IP Mitomycin C administration in PC patients with a contracted abdomen, mitomycin clearance from the abdomen decreased (Paper IV), which indicated  these patients at risk of under-treatment. Consequently, these pharmacologic data indicate a change in dosimetry for these treatment protocols might be warranted according to the diffusion area. Although diffusional vectors are viewed the main driving force for these treatment protocols, only pharmacokinetic variables such as dose, volume and duration are considered. As pharmacodynamic variables are equally important in the pharmacological assessment of cytotoxic effect, the tumor nodule was proposed as the center of a new conceptual model (Paper I). Mitomycin C data on non-metabolizers ( Paper IV) indicated the cytotoxicity of these cancer chemotherapy protocols is at the level of the individual tumor nodules. The morbidity and mortality of a new bidirectional intraoperative chemotherapy regimen in PC patients was analyzed (Paper V) which provided a means for identifying subsets of patients at risk for increased toxicity. This thesis provides pharmacokinetic and pharmacodynamic guidance for improving perioperative chemotherapy treatment strategies in PC patients and reports its toxicity.

Ovarian cancer has the highest mortality rate of all gynecological malignancies, due to inadequate treatment strategies and poor early diagnosis. Intraperitoneal (IP) chemotherapy administered on an intermittent schedule has been pursued for ovarian cancer treatment. However, local toxicities and complications associated with indwelling IP catheters required to deliver the chemotherapeutics have been documented. Furthermore, shortening or completely removing treatment-free periods between each chemotherapy cycle has shown improved efficacy compared to intermittent chemotherapy. The focus of this thesis was to develop and characterize a biocompatible and biodegradable IP injectable depot sustained drug delivery system as a new treatment strategy for ovarian cancer. A polymer-lipid injectable formulation (PoLigel) was developed and used for sustained docetaxel (DTX) delivery. The PoLigel resulted in homogeneous DTX peritoneal distribution and sustained plasma levels in healthy mice, which was in contrast to Taxotere®, the clinically used formulation of DTX. Sustained plasma, tissue, tumor and ascites DTX concentrations were observed in mice bearing IP SKOV3 tumors or ID8 ascites over a 3 week period following IP administration of the PoLigel. The intratumoral distribution and tumor penetration of DTX in subcutaneous (SC) and IP SKOV3 tumors were characterized. DTX distributed more towards the tumor core and diffused 1.5 fold further from blood vessels of the IP tumors compared to the SC tumors. The high efficacy observed in the IP SKOV3 and ID8 models and the SC SKOV3 model was attributed to favorable drug distribution at the whole-body, peritoneal and intratumoral levels in combination with local and systemic sustained drug exposure. Sustained chemotherapy with DTX alone and in combination with a drug efflux transporter inhibitor was investigated in multidrug resistant (MDR) ovarian cancer. In vitro, combination delivery via the PoLigel resulted in more apoptosis, greater intracellular accumulation of DTX, and lower DTX efflux in MDR ovarian cancer cells. Sustained combination chemotherapy was more than twice as efficacious as intermittent Taxotere® treatment in MDR ovarian cancer. Significant anti-tumor efficacy was also observed in the MDR model following sustained DTX chemotherapy compared to intermittent Taxotere®. Overall, results presented here encourage the clinical investigation of IP sustained chemotherapy for ovarian cancer treatment.

Ovarian cancer has the highest mortality rate of all gynecological malignancies, due to inadequate treatment strategies and poor early diagnosis. Intraperitoneal (IP) chemotherapy administered on an intermittent schedule has been pursued for ovarian cancer treatment. However, local toxicities and complications associated with indwelling IP catheters required to deliver the chemotherapeutics have been documented. Furthermore, shortening or completely removing treatment-free periods between each chemotherapy cycle has shown improved efficacy compared to intermittent chemotherapy. The focus of this thesis was to develop and characterize a biocompatible and biodegradable IP injectable depot sustained drug delivery system as a new treatment strategy for ovarian cancer. A polymer-lipid injectable formulation (PoLigel) was developed and used for sustained docetaxel (DTX) delivery. The PoLigel resulted in homogeneous DTX peritoneal distribution and sustained plasma levels in healthy mice, which was in contrast to Taxotere®, the clinically used formulation of DTX. Sustained plasma, tissue, tumor and ascites DTX concentrations were observed in mice bearing IP SKOV3 tumors or ID8 ascites over a 3 week period following IP administration of the PoLigel. The intratumoral distribution and tumor penetration of DTX in subcutaneous (SC) and IP SKOV3 tumors were characterized. DTX distributed more towards the tumor core and diffused 1.5 fold further from blood vessels of the IP tumors compared to the SC tumors. The high efficacy observed in the IP SKOV3 and ID8 models and the SC SKOV3 model was attributed to favorable drug distribution at the whole-body, peritoneal and intratumoral levels in combination with local and systemic sustained drug exposure. Sustained chemotherapy with DTX alone and in combination with a drug efflux transporter inhibitor was investigated in multidrug resistant (MDR) ovarian cancer. In vitro, combination delivery via the PoLigel resulted in more apoptosis, greater intracellular accumulation of DTX, and lower DTX efflux in MDR ovarian cancer cells. Sustained combination chemotherapy was more than twice as efficacious as intermittent Taxotere® treatment in MDR ovarian cancer. Significant anti-tumor efficacy was also observed in the MDR model following sustained DTX chemotherapy compared to intermittent Taxotere®. Overall, results presented here encourage the clinical investigation of IP sustained chemotherapy for ovarian cancer treatment.

Skrandžio vėžys yra ketvirta pagal dažnį ir antra pagal mirtingumą onkologinė liga pasaulyje. Sergančių šia liga 5 metų išgyvenamumas siekia tik 25 proc. Esant didelei ligos atkryčio rizikai dažniausiai skiriama adjuvantinė chemoterapija, nors daugumoje atsitiktinių imčių studijų statistiškai reikšmingo išgyvenamumo pagerėjimo nenustatyta. Dažniausia skrandžio vėžio gydymo nesėkmės priežastis yra lokoregioninis recidyvas (40-65 proc. ligonių, kuriems atliktos radikalios operacijos) ir pilvaplėvės metastazės. Siekiant sumažinti lokoregioninių recidyvų dažnį, pradėtas taikyti suderintas chemospindulinis gydymas. Šio tyrimo tikslas- nustatyti adjuvantinio gydymo efektyvumą po radikalių skrandžio vėžio operacijų su D2 limfadenektomija ir pagrįsti šio gydymo metodo tikslingumą. Darbo tikslui įgyvendinti buvo suformuluoti šie uždaviniai. 1. Įvertinti radikaliai dėl skrandžio vėžio operuotų su D2 limfadenektomija pacientų išgyvenamumą taikant adjuvantinį chemospindulinį gydymą arba adjuvantinę chemoterapiją. 2. Įvertinti adjuvantinio chemospindulinio gydymo toksiškumą po radikalių operacijų su D2 limfadenektomija, palyginti jį adjuvantinės chemoterapijos 5-fluoruracilu ir leukovorinu sukeliamu toksiškumu. 3. Įvertinti ankstyvos pooperacinės intraperitoninės chemoterapijos toksiškumą ir palyginti jos efektyvumą taikant su adjuvantiniu chemospinduliniu gydymu. 4. Palyginti gyvenimo kokybę po radikalių operacijų dėl skrandžio vėžio atliekant gastrektomiją ir subtotalinę skrandžio... [toliau žr. visą tekstą] / Gastric cancer is the fifth most common cancer and the second leading cause of cancer-related death worldwide. The 5-year survival rate of these patients is approx. 25. Adjuvant chemotherapy is frequently used for treatment, despite the fact that many randomized studies failed to demonstrate a better patient survival. The high rate of recurrence, even in patients undergoing state-of-the art curative resection, suggests that effective adjuvant chemoradiation and chemotherapy might indeed be an attractive concept to improve the overall outcomes of patients with gastric cancer. The aim of this study was to evaluate the effectiveness of the adjuvant therapy after curative resection with D2 lymphadenectomy for gastric cancer and determine its role in the treatment of cancer patients. The goals of this study were: 1. To compare the survival of patients receiving adjuvant chemoradiation or adjuvant chemotherapy after the curative resection with D2 lymphadenectomy for gastric cancer. 2. To evaluate the toxicity of the adjuvant chemoradiation after the curative resection with D2 lymphadenectomy for gastric cancer and to compare it with the toxicity caused by adjuvant chemotherapy with 5- Fluorouracil and Leucovorin. 3. To assess the toxicity of the early postoperative intraperitoneal chemotherapy and compare its effectiveness with the combined intraperitoneal chemotherapy and adjuvant chemoradiation therapy. 4. To compare the quality of life after the total and subtotal... [to full text]

Nanopartículas poliméricas biodegradáveis têm recebido atenção como carreadores de fármacos ao longo dos últimos anos. Em muitos casos, a segurança destes nanocarreadores não foi demonstrada e pouco se sabe sobre a relação entre as suas características físico-químicas e suas propriedades toxicocinéticas e toxicodinâmicas. A nanotoxicologia está emergindo como uma especialidade importante da nanotecnologia e/ou toxicologia, e refere-se ao estudo da interação de nanoestruturas com sistemas biológicos. Nos últimos anos, a maioria das pesquisas foi centrada em estudos in vitro, entretanto, os resultados destes estudos necessitam também ser avaliados em experimentos in vivo para o avanço na utilização de nanocarreadores na área biomédica. Com isso, o objetivo deste trabalho foi avaliar a toxicidade de nanocápsulas de núcleo lipídico (LNC), de poli(-caprolactona), após administração intraperitoneal (i.p.) e intradérmica (i.d.) em ratos Wistar. Para a avaliação toxicológica aguda, foi administrada dose única em que se observaram sinais clínicos e fisiológicos, em ambas as vias. Após 14 dias, os animais foram eutanasiados e análises macroscópicas e histopatológicas foram realizadas. Além disso, sangue e urina foram coletados para análises laboratoriais e avaliação de funções teciduais. A avaliação toxicológica subcrônica foi procedida da mesma forma, exceto pela administração de doses repetidas diárias durante 28 dias. As suspensões de nanocápsulas foram preparadas pelo método de precipitação do polímero pré-formado, as quais apresentaram tamanho médio de partícula inferior a 250 nm, índice de polidispersão (IPD) < 1, potencial zeta negativo e pH em torno de 6,7. Os animais tratados pela via i.p. (n=6/grupo) receberam para avaliação da toxicidade aguda: solução salina ou polissorbato 80 (PS80) (12 ml/kg), utilizados como controles e diferentes doses de LNC (18,03, 36,06, e 72,12 × 1012 LNC/kg); no teste de toxicidade subcrônica foram utilizados os mesmos controles porém com doses de 3mL/kg e 6,01, 12,02 ou 18,03 × 1012 LNC/kg. Nos testes de toxicidade aguda, nos animais administrados pela via i.p., foi observada diminuição significativa de peso nos grupos tratados com LNC mesmo após 14 dias da administração (p<0,05). Entretanto no teste subcrônico esta alteração foi transitória, e ocorreu apenas no grupo que recebeu a maior dose até o quinto dia de administração (p<0,05). Houve aumento no peso relativo do baço nos animais que receberam a dose mais alta de LNC (p<0,05) no tratamento agudo. A análise histopatológica em ambos os tratamentos, demonstrou a presença de um granuloma de tipo corpo estranho no fígado e no baço dos animais que receberam a dose mais alta, provavelmente devido ao volume de LNC administrado. Não houve alteração nas análises bioquímicas de dano hepático, renal, dentre outros em todos os grupos tratados. Os dados hematológicos apresentaram uma leve alteração, entretanto foi demonstrada interferência metodológica, evidenciada por testes preliminares in vitro. Além disso, foram avaliados biomarcadores do estresse oxidativo (EO), marcadores inflamatórios e de genotoxicidade. Os resultados dos biomarcadores de oxidação de proteínas e lipídios não foram suficientes para iniciar um processo oxidativo, visto que não houve peroxidação lipídica. Ainda, não houve depleção de antioxidantes, dano ao DNA ou alteração nos marcadores inflamatórios. Nos ratos tratados pela via i.d., foi utilizada solução salina 1,2 ml/kg como grupo controle e uma dose de 7,2 × 1012 LNC/kg de LNC, para um estudo preliminar agudo e solução salina ou PS 80 (0,9ml/kg) e três doses de LNC (1,8, 3,6 ou 5,4 × 1012 LNC/kg) para avaliação da toxicidade subcrônica. No teste de toxicidade aguda, não houve alteração do peso corpóreo, entretanto no teste de toxicidade subcrônica houve uma diminuição reversível do peso no grupo que recebeu PS80 (p<0,05). Os dados histopatológicos não apresentaram alteração. Não houve alteração nos parâmetros bioquímicos, exceto uma leve diminuição da atividade da butirilcolinesterase no grupo que recebeu a dose mais alta (p<0,05). Por outro lado, houve aumento nos leucócitos no grupo que recebeu LNC, no teste de toxicidade aguda e nos grupos que receberam PS 80 e 5,4 × 1012 LNC/kg (p<0,05) após doses repetidas. Em relação à avaliação sanguínea e tecidual dos biomarcadores do EO e dos marcadores inflamatórios, foi observada uma indução nos marcadores de oxidação de proteínas juntamente com uma indução enzimática nos ratos que receberam a dose mais alta, além de uma diminuição dos níveis do IL-10 nos grupos que receberam PS80 e a dose mais alta (p<0.05). Pode-se concluir que nas condições dos experimentos, tanto pela via i.p. quanto pela via i.d., não foram demonstrados danos teciduais, pois os achados laboratoriais foram condizentes com os achados histopatológicos. Além disso, os mecanismos de reparo foram suficientes para contrabalançar eventuais danos oxidativos ou inflamatórios. Assim, o presente trabalho contribui para futuras avaliações toxicológicas de nanocápsulas poliméricas, visto que foram realizadas avaliações agudas e subcrônicas sistemáticas, com marcadores de dano renal precoce e possíveis mecanismos de toxicidade envolvidos após administração por ambas as vias. O aumento na utilização destas nanocápsulas e as lacunas nas informações toxicológicas fazem com que desafios importantes devam ser superados para permitir sua incorporação segura. Com isso, estudos nesta linha podem embasar a avaliação da resposta tóxica e, consequentemente, levar ao estabelecimento de regulamentações para avaliação da toxicidade da maioria das nanopartículas poliméricas biodegradáveis utilizadas como carreadoras de fármacos. / Biodegradable polymeric nanoparticles have received attention as drug carriers over the past years. In many cases, the safety of nanocarriers has not been demonstrated and little is known about the relationship of its physicochemical characteristics and their toxicokinetic and toxicodynamic properties. Nanotoxicology is emerging as an important field of nanotechnology and toxicology, and refers to the study of the interaction of nanostructures with biological systems. In recent years, most research has focused on in vitro studies; however, the results of these studies should also be evaluated trough in vivo experiments, in order to advance in biomedical application of nanocarriers. Thus, the objective of this study was to evaluate the toxicity of lipid-core nanocapsules (LNC), prepared with poly(ɛ-caprolactone), after intraperitoneal (i.p.) and intradermal (i.d.) administration in rats. For acute toxicological evaluation, it was administered a single dose, i.p. and i.d., clinical signs and physiological effects were observed. After 14 days, animals were euthanized and macroscopic and histopathological analyses were done. In addition, blood and urine were collected for laboratory analysis and evaluation of tissue functions. Subchronic toxicological evaluation was similar, except for the administration of repeated doses for 28 days. The suspension of nanocapsules were prepared by interfacial deposition of polymer, which had particle size less than 250 nm, polydispersity index (IPD) <1, negative zeta potential and pH around 6.7. Animals were treated via i.p. (N = 6/group), the doses used for acute toxicity test were: saline or polysorbate 80 (PS80) (12 ml/kg) as controls or three different doses of LNC (18.03, 36.06, e 72.12 × 1012 LNC/kg); for subchronic toxicity test, same controls were used but the doses were 3 ml/kg and 6.01, 12.02 ou 18.03 × 1012 LNC/kg administered daily for 28 days. In acute toxicity test, with i.p. administration, groups treated with LNC presented a significant reduction in relative weight even after 14 days of administration (p<0.05); however in the subchronic test, this change was transient, and occurred only in the group receiving the highest dose until the fifth day of administration (p<0.05). There was an increase in relative weight of spleen in animals that received the highest dose of LNC (p<0.05) in acute treatment. Histopathological analysis in both the treatments, showed a granulomatous foreign body reaction in liver and spleen of animals receiving the highest dose, probably because the volume of LNC administered. There were no changes in biochemical parameters of liver or kidney damage, among all treated groups. Hematological data showed a slight change; however it was demonstrated an interference of the methodology, further evidenced by preliminary in vitro tests. Furthermore, we evaluated biomarkers of oxidative stress (OS), inflammatory and genotoxicity markers. The results of the oxidation of proteins and lipids biomarker were not sufficient to initiate an oxidative process, since no lipid peroxidation occurred. Still, no depletion of antioxidants, DNA damage or change in inflammatory markers was observed. In rats treated via i.d., saline was used as control (1.2 ml/kg) and a dose of 7.2 × 1012 LNC/kg of LNC to a preliminary acute study, and saline or PS 80 (0.9ml/kg) used as controls or three doses of LNC (1.8, 3.6 ou 5.4 × 1012 LNC/kg) for subchronic toxicity evaluation. In acute toxicity test, there was no change in relative body weight, however, a decreased was found for the group receiving PS 80 in subchronic test (p <0.05). No histopathological alteration was found. Also, there was no change in biochemical parameters, except a slight decrease of butyrylcholinesterase activity in the group receiving the highest dose (p<0.05). Moreover, in acute toxicity test, it was found an increase in white blood cells in group receiving LNC; these increasing also occurred after repeate dose test, in PS 80 and 5.4 × 1012 LNC/kg of LNC groups (p <0.05). Regarding blood and tissue biomarkers of OS and inflammatory markers, an induction in protein oxidation marker along with antioxidant induction in rats which received the highest dose were observed, also reduced levels of IL-10 in rats that received the higher dose and PS80 (p <0.05). It can be concluded that, under the experimental conditions, for i.p. and i.d. administration, tissue damage was not found, since laboratorial analysis results were consistent with histopathological findings. Furthermore, mechanisms of repair were sufficient to offset oxidative damage or inflammation.Thus, this study contributes to future toxicological evaluations of polymeric nanocapsules, since a systematic acute and subchronic evaluation with early renal damage markers and possible mechanisms of toxicity involved after ip and id routes were performed. The increase in the use of these nanocapsules and the gaps in toxicological information make important to overcome these challenges in order to allow its safe incorporation. Thus, studies in this line are important to evaluate toxic response, and lead to establishing rules for evaluating the toxicity of most biodegradable polymer nanoparticles used as carrier of drugs.

Nanopartículas poliméricas biodegradáveis têm recebido atenção como carreadores de fármacos ao longo dos últimos anos. Em muitos casos, a segurança destes nanocarreadores não foi demonstrada e pouco se sabe sobre a relação entre as suas características físico-químicas e suas propriedades toxicocinéticas e toxicodinâmicas. A nanotoxicologia está emergindo como uma especialidade importante da nanotecnologia e/ou toxicologia, e refere-se ao estudo da interação de nanoestruturas com sistemas biológicos. Nos últimos anos, a maioria das pesquisas foi centrada em estudos in vitro, entretanto, os resultados destes estudos necessitam também ser avaliados em experimentos in vivo para o avanço na utilização de nanocarreadores na área biomédica. Com isso, o objetivo deste trabalho foi avaliar a toxicidade de nanocápsulas de núcleo lipídico (LNC), de poli(-caprolactona), após administração intraperitoneal (i.p.) e intradérmica (i.d.) em ratos Wistar. Para a avaliação toxicológica aguda, foi administrada dose única em que se observaram sinais clínicos e fisiológicos, em ambas as vias. Após 14 dias, os animais foram eutanasiados e análises macroscópicas e histopatológicas foram realizadas. Além disso, sangue e urina foram coletados para análises laboratoriais e avaliação de funções teciduais. A avaliação toxicológica subcrônica foi procedida da mesma forma, exceto pela administração de doses repetidas diárias durante 28 dias. As suspensões de nanocápsulas foram preparadas pelo método de precipitação do polímero pré-formado, as quais apresentaram tamanho médio de partícula inferior a 250 nm, índice de polidispersão (IPD) < 1, potencial zeta negativo e pH em torno de 6,7. Os animais tratados pela via i.p. (n=6/grupo) receberam para avaliação da toxicidade aguda: solução salina ou polissorbato 80 (PS80) (12 ml/kg), utilizados como controles e diferentes doses de LNC (18,03, 36,06, e 72,12 × 1012 LNC/kg); no teste de toxicidade subcrônica foram utilizados os mesmos controles porém com doses de 3mL/kg e 6,01, 12,02 ou 18,03 × 1012 LNC/kg. Nos testes de toxicidade aguda, nos animais administrados pela via i.p., foi observada diminuição significativa de peso nos grupos tratados com LNC mesmo após 14 dias da administração (p<0,05). Entretanto no teste subcrônico esta alteração foi transitória, e ocorreu apenas no grupo que recebeu a maior dose até o quinto dia de administração (p<0,05). Houve aumento no peso relativo do baço nos animais que receberam a dose mais alta de LNC (p<0,05) no tratamento agudo. A análise histopatológica em ambos os tratamentos, demonstrou a presença de um granuloma de tipo corpo estranho no fígado e no baço dos animais que receberam a dose mais alta, provavelmente devido ao volume de LNC administrado. Não houve alteração nas análises bioquímicas de dano hepático, renal, dentre outros em todos os grupos tratados. Os dados hematológicos apresentaram uma leve alteração, entretanto foi demonstrada interferência metodológica, evidenciada por testes preliminares in vitro. Além disso, foram avaliados biomarcadores do estresse oxidativo (EO), marcadores inflamatórios e de genotoxicidade. Os resultados dos biomarcadores de oxidação de proteínas e lipídios não foram suficientes para iniciar um processo oxidativo, visto que não houve peroxidação lipídica. Ainda, não houve depleção de antioxidantes, dano ao DNA ou alteração nos marcadores inflamatórios. Nos ratos tratados pela via i.d., foi utilizada solução salina 1,2 ml/kg como grupo controle e uma dose de 7,2 × 1012 LNC/kg de LNC, para um estudo preliminar agudo e solução salina ou PS 80 (0,9ml/kg) e três doses de LNC (1,8, 3,6 ou 5,4 × 1012 LNC/kg) para avaliação da toxicidade subcrônica. No teste de toxicidade aguda, não houve alteração do peso corpóreo, entretanto no teste de toxicidade subcrônica houve uma diminuição reversível do peso no grupo que recebeu PS80 (p<0,05). Os dados histopatológicos não apresentaram alteração. Não houve alteração nos parâmetros bioquímicos, exceto uma leve diminuição da atividade da butirilcolinesterase no grupo que recebeu a dose mais alta (p<0,05). Por outro lado, houve aumento nos leucócitos no grupo que recebeu LNC, no teste de toxicidade aguda e nos grupos que receberam PS 80 e 5,4 × 1012 LNC/kg (p<0,05) após doses repetidas. Em relação à avaliação sanguínea e tecidual dos biomarcadores do EO e dos marcadores inflamatórios, foi observada uma indução nos marcadores de oxidação de proteínas juntamente com uma indução enzimática nos ratos que receberam a dose mais alta, além de uma diminuição dos níveis do IL-10 nos grupos que receberam PS80 e a dose mais alta (p<0.05). Pode-se concluir que nas condições dos experimentos, tanto pela via i.p. quanto pela via i.d., não foram demonstrados danos teciduais, pois os achados laboratoriais foram condizentes com os achados histopatológicos. Além disso, os mecanismos de reparo foram suficientes para contrabalançar eventuais danos oxidativos ou inflamatórios. Assim, o presente trabalho contribui para futuras avaliações toxicológicas de nanocápsulas poliméricas, visto que foram realizadas avaliações agudas e subcrônicas sistemáticas, com marcadores de dano renal precoce e possíveis mecanismos de toxicidade envolvidos após administração por ambas as vias. O aumento na utilização destas nanocápsulas e as lacunas nas informações toxicológicas fazem com que desafios importantes devam ser superados para permitir sua incorporação segura. Com isso, estudos nesta linha podem embasar a avaliação da resposta tóxica e, consequentemente, levar ao estabelecimento de regulamentações para avaliação da toxicidade da maioria das nanopartículas poliméricas biodegradáveis utilizadas como carreadoras de fármacos. / Biodegradable polymeric nanoparticles have received attention as drug carriers over the past years. In many cases, the safety of nanocarriers has not been demonstrated and little is known about the relationship of its physicochemical characteristics and their toxicokinetic and toxicodynamic properties. Nanotoxicology is emerging as an important field of nanotechnology and toxicology, and refers to the study of the interaction of nanostructures with biological systems. In recent years, most research has focused on in vitro studies; however, the results of these studies should also be evaluated trough in vivo experiments, in order to advance in biomedical application of nanocarriers. Thus, the objective of this study was to evaluate the toxicity of lipid-core nanocapsules (LNC), prepared with poly(ɛ-caprolactone), after intraperitoneal (i.p.) and intradermal (i.d.) administration in rats. For acute toxicological evaluation, it was administered a single dose, i.p. and i.d., clinical signs and physiological effects were observed. After 14 days, animals were euthanized and macroscopic and histopathological analyses were done. In addition, blood and urine were collected for laboratory analysis and evaluation of tissue functions. Subchronic toxicological evaluation was similar, except for the administration of repeated doses for 28 days. The suspension of nanocapsules were prepared by interfacial deposition of polymer, which had particle size less than 250 nm, polydispersity index (IPD) <1, negative zeta potential and pH around 6.7. Animals were treated via i.p. (N = 6/group), the doses used for acute toxicity test were: saline or polysorbate 80 (PS80) (12 ml/kg) as controls or three different doses of LNC (18.03, 36.06, e 72.12 × 1012 LNC/kg); for subchronic toxicity test, same controls were used but the doses were 3 ml/kg and 6.01, 12.02 ou 18.03 × 1012 LNC/kg administered daily for 28 days. In acute toxicity test, with i.p. administration, groups treated with LNC presented a significant reduction in relative weight even after 14 days of administration (p<0.05); however in the subchronic test, this change was transient, and occurred only in the group receiving the highest dose until the fifth day of administration (p<0.05). There was an increase in relative weight of spleen in animals that received the highest dose of LNC (p<0.05) in acute treatment. Histopathological analysis in both the treatments, showed a granulomatous foreign body reaction in liver and spleen of animals receiving the highest dose, probably because the volume of LNC administered. There were no changes in biochemical parameters of liver or kidney damage, among all treated groups. Hematological data showed a slight change; however it was demonstrated an interference of the methodology, further evidenced by preliminary in vitro tests. Furthermore, we evaluated biomarkers of oxidative stress (OS), inflammatory and genotoxicity markers. The results of the oxidation of proteins and lipids biomarker were not sufficient to initiate an oxidative process, since no lipid peroxidation occurred. Still, no depletion of antioxidants, DNA damage or change in inflammatory markers was observed. In rats treated via i.d., saline was used as control (1.2 ml/kg) and a dose of 7.2 × 1012 LNC/kg of LNC to a preliminary acute study, and saline or PS 80 (0.9ml/kg) used as controls or three doses of LNC (1.8, 3.6 ou 5.4 × 1012 LNC/kg) for subchronic toxicity evaluation. In acute toxicity test, there was no change in relative body weight, however, a decreased was found for the group receiving PS 80 in subchronic test (p <0.05). No histopathological alteration was found. Also, there was no change in biochemical parameters, except a slight decrease of butyrylcholinesterase activity in the group receiving the highest dose (p<0.05). Moreover, in acute toxicity test, it was found an increase in white blood cells in group receiving LNC; these increasing also occurred after repeate dose test, in PS 80 and 5.4 × 1012 LNC/kg of LNC groups (p <0.05). Regarding blood and tissue biomarkers of OS and inflammatory markers, an induction in protein oxidation marker along with antioxidant induction in rats which received the highest dose were observed, also reduced levels of IL-10 in rats that received the higher dose and PS80 (p <0.05). It can be concluded that, under the experimental conditions, for i.p. and i.d. administration, tissue damage was not found, since laboratorial analysis results were consistent with histopathological findings. Furthermore, mechanisms of repair were sufficient to offset oxidative damage or inflammation.Thus, this study contributes to future toxicological evaluations of polymeric nanocapsules, since a systematic acute and subchronic evaluation with early renal damage markers and possible mechanisms of toxicity involved after ip and id routes were performed. The increase in the use of these nanocapsules and the gaps in toxicological information make important to overcome these challenges in order to allow its safe incorporation. Thus, studies in this line are important to evaluate toxic response, and lead to establishing rules for evaluating the toxicity of most biodegradable polymer nanoparticles used as carrier of drugs.

No / The aim of the present study was to investigate an opioid receptor involvement in the adaptation response to motion sickness in Suncus murinus. Different groups of animals were treated intraperitoneally with either saline, morphine (0.1 and 1.0 mg/kg), naloxone (1.0, 10.0 and 5.0 mg/kg) or a combination of naloxone plus morphine in the absence or 30 min prior to a horizontal motion stimulus of I Hz and 40 mm amplitude. For the study of adaptation, different groups received saline on the first trial, and in subsequent trials (every 2 days) they received either saline, naloxone (1.0 and 10.0 mg/kg, ip) or morphine (0.1 mg/kg, ip) 30 min prior to the motion stimulus. Pretreatment with morphine caused a dose-related reduction in emesis induced by a single challenge to a motion stimulus. Pretreatment with naloxone alone did not induce emesis in its own right nor did it modify emesis induced by a single challenge to a motion stimulus. However, pretreatment with naloxone (5.0 mg/kg, ip) revealed an emetic response to morphine (P<.001) (1.0 mg/kg, ip) and antagonised the reduction of motion sickness induced by morphine. In animals that received saline or naloxone (1.0 mg/kg), a motion stimulus inducing emesis decreased the responsiveness of animals to a second and subsequent motion stimulus challenge when applied every 2 days for 11 trials. However, the animals receiving naloxone 10.0 mg/kg prior to the second and subsequent challenges showed no significant reduction in the intensity of emesis compared to the first trial. The data are revealing of an emetic potential of morphine when administered in the presence of a naloxone pretreatment. The administration of naloxone is also revealing of an additional inhibitory opioid system whose activation by endogenous opioid(s) may play a role in the adaptation to motion sickness on repeated challenge in S. murinus.

Le cancer de l'ovaire est la première cause de décès par cancer gynécologique. Cette thèse avait pour objectif la prospection de nouvelles solutions thérapeutiques fondées sur la délivrance prolongée d'agents anti tumoraux à l'aide de systèmes macromoléculaires de synthèse. L'un des obstacles majeurs était la disposition d'un modèle de tumeur pertinent chez l'animal. Après un examen bibliographique des connaissances acquises, le deuxième chapitre examine le potentiel d'un panel de xénogreffes dérivées de tumeurs ovariennes humaines directement greffées chez la souris immunodéprimée. Il est montré que les principales caractéristiques phénotypiques et moléculaires des tumeurs originales sont maintenues au niveau des greffes. Les résultats traduisent la présence d'une hétérogénéité intra-tumorale et d'une oligoclonalité au niveau des tumeurs primaires. L'ensemble confirme l'importance du choix du modèle tumoral pour l'évaluation de nouveaux traitements et l'étude des mécanismes aboutissant aux rechutes de la maladie et au développement d'une chimiorésistance. Un troisième chapitre traite l'exemple d'un système de délivrance prolongée fondé sur le couplage d'un agent antitumoral modèle, la doxorubicine, associé de diverses manières à un vecteur macromoléculaire biorésorbable, le poly(L-lysine citramide). Le premier conjugué obtenu par couplage direct sur le vecteur étant trop stable, divers systèmes ont été conçus pour obtenir la libération souhaitée. L'utilisation d'un bras espaceur clivable de type ester-hydrazone a fourni le meilleur résultat. Pour pallier la complexité de ces conjugués, une stratégie innovante fondée sur le piégeage de la doxorubicine dans une gélatine artificielle à base de poly(N-acryloyl glycinamide) est prospectée qui devrait permettre l'utilisation simultanée de plusieurs principes actifs piégés temporairement par voie physique dans un gel adhésif et fournir des solutions mieux adaptées aux contraintes cliniques des traitements intrapéritonéaux. / Ovarian carcinoma is the most lethal gynecologic malignancy. The aim of this PhD thesis was to develop new therapeutic approaches based on novel synthetic macromolecular drug delivery systems for intraperitoneal chemotherapy. These objectives were limited by the requirement of reliable tumor models for experimental studies. After a concise review of knowledge published in the literature, the potential interest of the establishment of a collection of tumor grafts derived from samples of human tumors is examined in a second chapter. Data show that the major phenotypic and genotypic features of the original tumors are maintained in the xenografts. They also confirm the importance of this tumor model to test new drugs and to analyze intratumoral heterogeneity and oligoclonality in primary ovarian carcinoma. The collection will be also helpful to study the mechanisms leading to disease recurrences and resistance to chemotherapies. An example of drug delivery system based on the different associations of a model chemotherapeutic drug (doxorubicin) with a bioresorbable macromolecular vector, namely poly(L-lysine citramide), is addressed in a third chapter. Direct amid linkage in the first conjugate was too stable with respect to antitumoral cytotoxicity desired after in vivo administration and different systems were generated subsequently to increase drug release in tumor deposits. The best results were obtained with a hydrazone cleavable spacer containing an ester group. To overcome the complexity of these conjugates, a novel strategy based on doxorubicin entrapment in a synthetic gelatin made of (poly(N-acryloyl glycinamide) is developed. This strategy should allow physical temporary entrapment of different drug molecules in a adhesive gel and could provide new solutions to the therapeutic challenges of intraperitoneal administration.