<p>Injectable, in-situ gelling magnetic plum pudding hydrogel composites were fabricated by entrapping superparamagnetic iron oxide nanoparticles (SPIONs) and thermosensitive N-isopropylacrylamide (NIPAM)-co–N-isopropylmethacrylamide (NIPMAM) microgels in a pNIPAM-hydrazide/carbohydrate-aldehyde hydrogel matrix. The resulting composites exhibited significant, repeatable pulsatile release of 4 kDa FITC-dextran upon exposure to an alternating magnetic field. The pulsatile release from the composites could be controlled by altering the volume phase transition temperatures of the microgel particles (with VPTTs over 37°C corresponding to improved pulsatile release) and changing the microgel content of the composite (with higher microgel content corresponding to higher pulsatile release). By changing the ratio of dextran-aldehyde (which deswells at physiological temperature) to CMC-aldehyde (which swells at physiological temperature) in the composites, bulk hydrogel swelling and thus pulsatile release could be controlled; specifically, lower CMC-aldehyde contents resulted in little to no composite swelling, improving pulsatile release. <em>In vitro</em> cytotoxicity testing demonstrated that the composite precursors exhibit little to no cytotoxicity up to a concentration of 2000 µg/mL. Together, these results suggest that this injectable hydrogel-microgel composite hydrogel may be a viable vehicle for <em>in vivo</em>, pulsatile drug delivery.<strong></strong></p> / Master of Applied Science (MASc)

Des nanoparticules d’oxydes de fer superparamagnétiques (SPIONs) PEGylées ont servi de plateforme pour la formulation de nanovecteurs théragnostiques pour la délivrance d’un agent anticancéreux, la doxorubicine (DOX). Le chargement de la DOX sur les nanovecteurs à l’aide d’un complexe avec l’ion fer (II) a été optimisé. Ce complexe se dissocie en milieu acide, typique des compartiments intracellulaires. La spectroscopie Raman exaltée de surface (SERS) a confirmé que les nanovecteurs libèrent la DOX sous forme non complexée. La cytotoxicité in vitro induite par la libération de la DOX a été évaluée sur différentes lignées cellulaires de cancer du sein, et comparée à celle de la DOX en solution. Les voies d’internalisation des nanovecteurs ont été explorées en microscopie électronique en transmission (MET), et le devenir intracellulaire de la DOX a été suivi en imagerie confocale multispectrale (ICMS). Enfin, un protocole thérapeutique in vivo chez la souris tumorisée a permis d’évaluer la capacité de la nanoformulation à limiter la croissance tumorale, la possibilité d’un ciblage magnétique, et la réduction des effets secondaires induits par la DOX. / PEGylated superparamagnetic iron oxide nanoparticles (SPIONs) were used as a platform to build theranostic nanovectors for the delivery of an anticancer drug, doxorubicin (DOX). The DOX loading on nanocarriers via a DOX-iron (II) complex was optimized. The complex dissociates at low pH, typical of intracellular compartments. Surface enhanced Raman scattering (SERS) confirmed that the nanovectors released DOX under free form. In vitro cytotoxicity due to DOX loaded on nanocarriers was performed on different breast cancer cells, and compared to that of DOX in solution. Internalization pathways of nanovectors were explored with transmission electron microscopy (TEM), and intracellular fate of DOX was monitored by confocal spectral imaging (CSI). To finish, a therapeutical protocol was performed on tumorized mice, in order to evaluate the efficacy of the nanoformulation on tumor reduction, the possibility of magnetic targeting, and the decrease of side effects induced by DOX.

Die vorliegende Arbeit beschäftigt sich mit der Bildgebung magnetisch markierter Stammzellen im ZNS mittels Magnetresonanztomographie. Dazu wurden Stammzellen mit Eisenoxidnanopartikeln (VSOP, very small superparamagnetic iron-oxide particles) in vitro effizient und ohne zusätzliche Lipofektionsagenzien magnetisch markiert. Es zeigte sich keine wesentliche Beeinflussung der Vitalität, Proliferation und Differenzierungsfähigkeit sämtlicher untersuchter Zellpopulationen. Zur Evaluierung der Grenzen der zellulären MR-Bildgebung wurde das Detektionslimit magnetisch markierter embryonaler Stammzellen in vivo nach intrastriataler Injektion im Gehirn der Ratte untersucht. Es ließen sich bei einer Feldstärke von 17,6 T weniger als 100 magnetisch markierte Zellen sicher vom Hirnparenchym abgrenzen. Die histologische Korrelation bestätigte den zellulären Ursprung der beobachteten T2*-Hypointensitäten. In einem Rattenmodel des Morbus Parkinson konnte eine spezifische Detektion der intrastriatal injizierten magnetisch markierten embryonalen Stammzellen über einen Zeitraum von 6 Monaten erreicht werden. Es konnte keine signifikante Migration der Zellen festgestellt werden, jedoch fanden sich große interindividuelle Unterschiede in ihrer räumlichen Verteilung. In der histologische Analyse stellten sich auch sechs Monate nach der Transplantation im Bereich des Stichkanals eisenoxidmarkierte Stammzellen dar. In einem Mausmodell der cerebralen Ischämie wurde erstmals die Anreicherung systemisch injizierter magnetisch markierter mononukleärer Zellen kernspintomographisch erfasst. 24 - 48 h nach der Injektion magnetisch markierter Zellen stellten sich T2*-gewichtete Signalhypointensitäten im Randbereich der Ischämie dar. Insgesamt zeigte sich in dieser Studie die zelluläre Magnetresonanztomographie zu einem nicht-invasiven Nachweis einer geringen Anzahl magnetisch markierter Zellen über einen langen Zeitraum mit hoher Sensitivität in der Lage. / This thesis is dealing with the imaging of magnetically labeled stem cells in the CNS using magnetic resonance imaging (MRI). Stem cells were efficiently magnetically labeled with very small superparamagnetic iron-oxide particles (VSOP), without any lipofection agents. No significant impact on vitality, proliferation and ability to differentiate could be observed after the magnetic labeling of all cell populations investigated. Magnetically labeled embryonic stem cells were injected into the striatum of rats to evaluate their detection limit by MRI. At field strengths of 17.6 T, less than 100 cells could be discriminated from the brain parenchyma as T2*-weighted hypointensities. Histology proved the cellular origin of MRI-signal changes. In a rat model of Parkinsons’s Disease, magnetically labeled embryonic stem cells could be detected by MRI after intrastriatal injection for a time period of more than 6 months. No significant migration of transplanted cells could be observed, however significant inter-individual differences concerning the spatial distribution of cells could be found. Histologically, transplanted iron-oxide-labeled cells could still be detected in the vicinity of the injection tract six months after transplantation. In a mouse model of cerebral ischemia, the enrichment of systemically injected magnetically labeled mononuclear cells was detected non-invasively by MRI. 24 to 48 hours after injection of magnetically labeled cells, T2*-weighted hypointense signal changes could be observed in the border zone of the ischemia. Over all, this study showed that cellular MRI is capable of the sensitive non-invasive detection of small numbers of magnetically labeled cells over a long period of time.

Le sujet de cette thèse concerne l'élaboration depolymères hydrophiles biocompatibles et fonctionnelspour la stabilisation et la bio-fonctionnalisation denanoparticules d’oxyde de fer en vue d'une utilisation entant qu’agents de contraste en imagerie par résonancemagnétique et/ou en tant que vecteurs de principesactifs ou de thérapie génique. Pour ce travail de thèse,l'objectif a été de fonctionnaliser des poly(oxyded'éthylène)s (POE) commerciaux, connus pour leurspropriétés d'hydrophilie, de biocompatibilité et defurtivité par un groupement acide phosphonique, pourchélater les nanoparticules d'oxyde de fer, et par ungroupement furane, susceptible de réagir avec desbiomolécules à fonctionnalité maléimide, facilementaccessibles, selon une réaction de Diels-Alderthermoréversible.Des POEs à extrémité acide phosphonique et àfonctionnalité furane ont été synthétisés selon deuxstratégies originales combinant des réactionsd’Atherton-Todd ou de Kabachnik-Fields et lacycloaddition 1,3-dipolaire de Huisgen, réaction dechimie « click » très efficace, orthogonale, spécifique etréalisée dans des conditions douces.Les POEs obtenus ont ensuite été greffés à la surfacede nanoparticules d’oxyde de fer selon la stratégie‘grafting onto’. L’efficacité des POEs à stabiliser lesnanoparticules d’oxyde de fer a été mise en évidence.De plus, les tests de cytotoxicité ont montré que cessystèmes sont biocompatibles. De plus, lesnanoparticules d’oxyde de fer, une fois greffées, ontconservé leurs propriétés de relaxivité autorisant leurutilisation en imagerie médicale. Enfin, l’aptitude de cesnanoparticules fonctionnalisées par des groupementsfurane à immobiliser des molécules à fonctionnalitémaléimide a été mise en évidence ainsi que lapossibilité ultérieure à libérer ces molécules sous effetd’un stimulus thermique. Ce comportement réversibleouvre des perspectives tout à fait intéressantes dans ledomaine de la vectorisation de principes actifs. / The objective of this thesis was the preparation ofbiocompatible hydrophilic functionalized polymers forthe stabilization and bio-functionalization of iron oxidenanoparticles (IONPs) for biomedical applications suchas contrast agents in magnetic resonance imagingand/or targeted drug delivery. In this work, commerciallyavailable poly(ethylene oxide)s (PEO), which havehydrophilic, biocompatibility and furtivity properties havebeen functionalized by a phosphonic acid group, thatstrong anchors on IONPs, and by a furan group that canbe coupled to maleimide-terminated biomolecules by athermoreversible Diels-Alder reaction.Phosphonic acid-terminated PEOs fonctionalized by afurane group were synthesized according to two originalstrategies combining an Atherton-Todd or a Kabachnik-Fields reaction and a 1,3-dipolar cycloaddition reaction.This latter reaction, also named ‘click’ reaction, ischaracterized by high yields, simple reaction conditions,fast reaction times, and high selectivity.These PEOs were attached to the IONPs surface usingthe 'grafting onto' strategy. The subsequent polymerstabilizedIONPs were characterized, proving thepresence of polymers on IONPs surfaces. Cytotoxicitystudies revealed that the IONPs carriers werebiocompatible. In addition, studies on the protontransverse relaxation enhancement properties of thesestabilized IONPs indicated high relaxivities in the samerange as iron oxide based commercially availablecontrast agents. Finally, polymer-stabilized IONPs weresuccessfully functionalized by maleimide-functionalizedmolecules according to the Diels-Alder reaction and thesubsequent release of these molecules via a thermalstimulus has been proven. Consequently, this type ofcontrolled-release system could be expanded to drugtherapy responding to external stimuli.

Les travaux de cette thèse ont été consacrés à la synthèse de nanoparticules magnétiques d'oxyde de fer et d'oxyde de cobalt et de nanoparticules coeur-coquille constituées d'un coeur d'oxyde de fer recouvert d'oxyde de cobalt et à l'élaboration de nanomatériaux - composites nanostructures carbonées/nanoparticules d'oxyde métallique - pour des applications dans le domaine biomédical et celui de l'énergie. Pour la synthèse des NPs, la forme et la taille des NPs sont fortement dépendantes des conditions de réaction (nature des ligands, des solvants, température de réaction ... ) , ce qui affecte leurs propriétés magnétiques. De plus, des simulations ont montré que les chaînes de stéarate peuvent désorber plus facilement les atomes de fer que les atomes de cobalt et se libérer pour former des germes, ce qui pourrait expliquer le comportement distinctif entre les deux complexes. Ces nanoparticules magnétiques ont été synthétisées à l'intérieur de nanotubes de carbone en deux étapes aboutissant à des taux de remplissage très importants. Après fonctionnalisation, ces nanocomposites ont été introduits dans de cellules tumorales et ont été magnétiquement manipulées. Ils se sont révélés être très efficaces en tant qu'agents de contraste en IRM mais également dans le domaine de l'hyperthermie (activation sous éclairage dans le domaine de !'Infrarouge proche). Enfin, de nouveaux composites à partir de nanoparticules de Nb20 5 et de graphène (ou NTCs) ont été synthétisés et des résultat~prometteurs ont été obtenus dans des tests de batterie lithium-ion : leur utilisation en tant qu'anode a permis d'obtenir des capacités réversibles de 260 mAh/g. / This thesis was focused on the synthesis of magnetic nanoparticles of iron oxide and cobalt oxide and core-shell nanoparticles, consisting of a cobalt oxide coated iron oxide and on the development of composite nanomaterials - nanostructures carbon /metal oxide nanoparticles - for applications in the biomedical field and the energy. For the synthesis of NPs, the shape and size of NPs are dependent of the reaction conditions, which further affect their magnetic properties. Meanwhile, simulation showed that stearate chains can desorb more easily from iron atoms and release to form seeds than from cobalt atoms, which might explain distinctive behavior between the bath complexes. Regarding nanostructures carbon/metal oxide nanoparticles hybrid materials, the properties of the filled magnetic CNTs as heat mediator for photothermal ablation and as contrast agent for MRI were then evaluated and promising results have been obtained. Last, new composite materials (Nb205 nanoparticles/graphene or NTCs) were synthesized and promising results were obtaines in lithium battery tests : their use as anode allowed obtaining reversible capacities of 260 mAh/g.

La greffe d'îlots de Langerhans permet de traiter le diabète de type 1 en restituant une insuline-sécrétion. La moitié des patients reprend l'insuline dans les 5 ans. Cette perte de fonction s'explique par l'absence d'outils de monitoring. Le but de notre travail était de déterminer l'efficacité de l'IRM à diagnostiquer un rejet de greffe, et d'évaluer l'intérêt du monitoring cellulaire chez les patients.Imagerie IRM chez le ratMéthodes : Des îlots syngéniques, allogéniques ou xénogéniques ont été greffés par voie intra-portale à des rats diabétiques après marquage avec une nanoparticule de fer (ferucarbotran). Les IRM étaient réalisées dans une IRM clinique 3T.Résultats : La décroissance du signal était différente suivant les 3 types de greffes. Le signal IRM des greffes allogéniques était significativement plus bas à J4 alors que la glycémie était normale. En prenant un seuil de 84% à J4, l'IRM permet d'obtenir une sensibilité de 91% et une spécificité de 70% Innnuno-monitoring cellulaireMéthodes : Des réactions lymphocytaires mixtes étaient réalisées entre les PBMC des patients greffés, et les splénocytes des donneurs. La réaction immunitaire était évaluée par la sécrétion d'IFNy (ELISpot), par la prolifération cellulaire (cytométrie du flux du Ki67), et par le dosage des cytokines (Bioplex). Le résultat était corrélé à la fonction du greffon évaluée par le (3-score).Résultats : Les patients avec une mauvaise fonction montraient une plus grande réactivité anti-donneur avec l'ELISpot IFNy (p=0,007, r=-0,50) et l'index de prolifération (p=0,006, r=-0,51). Les patients avec une mauvaise fonction avaient des taux d'IFNy, IL-5 et IL-17 plus élevés. / Langerhans islet transplantation allows curingtype 1 diabetes by restoring an endogenous insulin secretion. Halfof patients will resume insulin withinyears. This loss of function may be explained by the lack of monitoring tools able to diagnose an ongoing graft failure. The aims of our work were toevaluate the efficiency of MRI to diagnose islet graft rejection, and to assess the feasibility of immune cellular monitoring in transplanted patients.MRI in the rat mortelMethods: Syngeneic, allogeneic and xenogeneic islets were transplanted intra-portally to diabetic rats after labeling with superparamagnetic ironoxide nanoparticles (ferucarbotran). Images were acquired on a clinical 3T MRI scanner.Results: The signal decreasing was different between the 3 types of transplantations. At day 4, the MRI signal in allogeneic group was significantlylower while glycaemia remained normal. With a cut-off value of 84% at day 4, sensitivity of 91% and specificity of 70% were obtained.Cellular immune monitoringMethods: Mixed lymphocyte cultures were performed with peripheral blood mononuclear cells from recipients and splenocytes from donors. Immunereactivity was assessed by the release of IFNy (ELISpot), cell prolifération (flow cytometry of Ki67), and cytokine quantification (Bioplex). Theresults were correlated to the islet graft function assessed by (5-score.Results: Patients with low islet function showed higher cellular reactivity against donor cells assessed by ELISpot IFNy ((p=0,007, r=-0,50) andproliferation index (p=0,006, r=-0,51). Patients with low graft function had higher levels of IFNy, IL-5 and 1L-17.

M. Tech. (Department of Chemistry, Faculty of Applied and Computer Sciences), Vaal University of Technology. / Water polluted by recalcitrant organics, such as methylene blue (MB), can be treated with the Fenton reaction. The Fenton reaction degrades the pollutants through catalytic oxidation. Unsupported iron oxide nanoparticles (IONPs) were used as catalysts in this study. Iron oxide nanoparticles were synthesised using a precipitation-oxidation method and effects of various preparation parameters on the shape, size and catalytic activity of the iron oxide nanoparticles were studied. Parameters investigated include preparation temperature, type and amount of precipitating agent. The precipitating agents used are sodium hydroxide, tetramethyl ammonium hydroxide (TMAOH), tetraethyl ammonium hydroxide (TEAOH) and ethylamine. The iron oxide nanoparticles were found to be spherical for most of the preparation conditions as determined by TEM. However, irregular flower-like shapes (hexagonal with rod extensions) were obtained when the amounts of the TMAOH and TEAOH bases were more than the stoichiometric amounts. The nature and amount of precipitating agent also influenced the degree of particle agglomeration and growth, with an increase in alkyl chains in the base giving lesser agglomeration. The preparation temperature did not influence the nanoparticles’ size when NaOH was used as a precipitating agent. In contrast, when an amine was used as a precipitation agent, caused a slight increase in the size of the nanoparticles. Different crystal phases like hematite, magnetite, maghemite and goethite-hematite mixture were identified in the X-ray diffractograms. UV-Vis spectroscopy showed that all the catalysts were red-shifted except for B3 sample, which was blue-shifted from the bulk materials. The highest catalytic activities were obtained when NaOH was used as a precipitation agent instead of amine since catalyst has shown to contain the traces amounts of the base used on the surface. The lower catalytic activities for the catalysts prepared using amines may be due to amines adsorbed on the surface and blocking the catalytic active sites. FTIR spectra showed the presence of trace amounts of ammine functional groups on the nanoparticles No correlation was found between the crystallite size and the Fenton catalytic activity of the catalyst. In the same vein, operational parameters such as the amount of H2O2 and temperatures did not show a direct effect on the Fenton catalytic efficiency. Kinetic studies show that the degradation of methylene blue followed the first-order models for all the catalysts prepared with NaOH. Overall, the study shows that different preparation parameters had an effect on the size, shape, phase and the catalytic performance of the synthesised IONPs.

M.Tech. (Department of Chemistry, Faculty of Applied and Computer Sciences), Vaal University of Technology. / Several industries utilize species of synthetic dyes that are found in their wastewater, which is passed out in the environment. Methylene blue is one of the organic dyes that causes water pollution. It causes damage to the aquatic eco-system and health problems to human beings. It is non-biodegradable due to its chemical nature. Advanced oxidation processes (AOP’s) have been developed for the degradation of these dyes, however, some of these methods are limited due to their high cost and low efficiency. Among these methods, Fenton catalysis has been proven to be an effective method due to its low cost, high efficiency, and re-usability. Iron oxide nanoparticles have been mainly used in Fenton process however they are also limitated due to the forming of secondary pollutants, due to catalysts recovery difficulties, hence they require supporting materials. In this work, iron oxide-based catalyst supported on silica nanofibers were fabricated via electrospinning of silica sol incorporated with iron oxide, using three different routes, (a) Method 1 - wetness incipient impregnation, (b) Method 2 - direct addition of iron precursor to the silica sol and (c) Method 3 - incorporation of iron oxide nanoparticles into silica sol. The effect of iron oxide concentration loadings (1 wt%, 2 wt% and 5 wt %) was studied. Increase in iron content resulted in agglomeration of nanoparticles as embedded in the fibers as evident from their SEM images in method 3.1. The SEM results showed diameters from method 1, 2 and 3 ranging from the distribution ranges of 276 – 288 nm, 243 – 265 nm and 188 nm, respectively. EDS showed the presences of Si, P, Fe, O and P. XRD showed a crystalline phase of magnetite (9 nm) and goethite (32 nm) method 1 and 3, with vibrational modes at 3300 cm-1, 1100 cm-1, 950 cm-1 and 580 cm-1 ascribed to O-H, Si-O-Si, Si-O and Fe-O on the FTIR spectra, it showed both the presence of silica and iron oxide. The degradation of methylene blue was monitored by UV-Vis spectroscopy, the Fenton catalytic activity of the iron-oxide supported on silica nanofibers showed higher catalytic activity compared to the unsupported iron-oxide nanoparticles. The catalyst prepared by wetness incipient impregnation (method 1) had a degradation efficiency of 69.1%, the direct addition of iron precursor to the silica sol (method 2) had 75.2% and incorporation of iron oxide nanoparticles magnetite and goethite with the silica sol had 53.7% and 34.7%, respectively. The catalyst prepared by the direct addition of iron precursor in the sol (method 2) showed a high catalytic activity compared to the other catalyst prepared by other methods. Unsupported Iron oxide nanoparticles had a higher degree of leaching of 1.28 ppm magnetite, and 1.68 ppm goethite, compared to the supported iron oxide in method 1 and method 3. The catalyst incorporated with goethite showed a high degree of leaching, 3.95 ppm and 1.33 ppm. The catalyst with high catalytic activity showed a lower degree of leaching with 0.05 ppm.

Zweck der molekularen Bildgebung ist es, biologische Prozesse auf zellulärer und molekularer Ebene zu messen und zu charakterisieren, um so die Ursachen von Krankheiten und Veränderungen im Organismus zu diagnostizieren. Sie basiert auf dem Einsatz molekularer Bildgebungssonden, welche einen spezifischen biologischen Vorgang darstellen oder sich spezifisch in dem zu untersuchenden Gewebe anreichern oder aktiviert werden. Ziel dieser Arbeit war die Entwicklung und Analyse neuer Bildgebungssonden für die spezifische in-vivo-Bildgebung der Apoptose und von Enzymaktivitäten mittels Magnetresonanztomographie (MRT) auf der Grundlage sehr kleiner Eisenoxidnanopartikel (very small iron oxide particles, VSOP). VSOP sind superparamagnetisch und durch ihre negativ geladene Citrathülle elektrostatisch stabilisiert. Für die Apoptose-Bildgebung sollte durch Bindung des Proteins Annexin A5 (AnxA5) an die Citrathülle der VSOP eine zielgerichtete Sonde hergestellt werden (AnxA5-VSOP). Für die Bildgebung von Enzymaktivitäten sollte eine durch die Matrixmetalloproteinase-9 (MMP-9) aktivierbare Sonde hergestellt werden (Protease-spezifische Eisenoxidpartikel, PSOP). / The goal of molecular imaging is to characterize and measure biological processes at cellular and molecular levels for the purpose of diagnosing the cause of diseases and molecular abnormalities. Molecular imaging is based on the use of probes with a high affinity to the target tissue and / or which are specifically activated. The aim of this study was to develop and analyze new molecular imaging probes for the in vivo imaging of apoptosis and enzyme activity using magnetic resonance imaging (MRI), based on very small iron oxide particles (VSOP). VSOP are superparamagnetic and electrostatically stabilized due to their negatively charged citrate surface. For the imaging of apoptosis the protein annexin A5 (AnxA5) was coupled to the citrate surface (AnxA5-VSOP). For the imaging of enzyme activities an activatable imaging probe with a cleavage site for the matrix metalloproteinase 9 (MMP-9) was synthesized (protease-specific iron oxide particles, PSOP).

Safety concerns arising from cytotoxic behavior of nanoparticles (NPs) in complex biological environment remain the main problem limiting NPs application in biomedicine. In this study, we have investigated cytotoxicity of NPs with different composition, shape and size, namely SiO2 NPs (SiNPs, 7-14 nm), superparamagnetic iron oxide NPs (SPIONs, 8 nm) and carboxylated multiwalled carbon nanotubes (CNTCOOHs, diameter: 60-100 nm, length: 1-2 μm). Cytotoxicity was evaluated with newly designed screening assay capable to simultaneously assess activity of cell dehydrogenases, activity of lactate dehydrogenase (LDH) released from cells into environment and number of intact cell nuclei and apoptotic bodies in human umbilical vein endothelial cell (HUVEC) culture growing in the very same well of the 96-well plate. Aforementioned attributes were subsequently utilized to obtain information about cell viability and necrotic and apoptotic aspects of cell death. Results from this "three-in-one" cell death screening (CDS) assay showed that SiNPs and CNTCOOHs evoked pronounced cytotoxic effect demonstrated as decrease of cell viability and development of apoptotic bodies formation. In contrast to this, SPIONs induced only mild cytotoxicity. Moreover, SiNPs impaired cell membrane leading to increased LDH release...