Conselho Nacional de Desenvolvimento Científico e Tecnológico / A diminuição do aporte de oxigênio e nutrientes na vida perinatal resulta em danos, como astrogliose, morte de neurônios e de células proliferativas. Déficits cognitivos podem estar relacionados a danos no hipocampo. Neste trabalho avaliamos a citoarquitetura do giro dentado (DG) durante o desenvolvimento e a memória de ratos submetidos à HI. Para tal, utilizamos a técnica de imunohistoquímica para marcador de proliferação celular (KI67), neurônio jovem (DCX), de astrócitos (GFAP) e de óxido nítrico sintase neuronal (NOSn). Para avaliar a memória de curta e de longa duração foi utilizado o teste de reconhecimento de objetos (RO). Ratas Wistar grávidas em E18 foram anestesiadas (tribromoetanol) e as quatro artérias uterinas foram ocluídas com grampos de aneurisma (Grupo HI). Após 45 minutos, os grampos foram removidos e foi feita a sutura por planos anatômicos. Os animais do grupo controle (SHAM) sofreram o mesmo procedimento, excetuando a oclusão das artérias. Os animais nasceram a termo. Animais com idades de 7 a 90 dias pós-natal (P7 a P90), foram anestesiados e perfundido-fixados com paraformaldeído a 4%, e os encéfalos submetidos ao processamento histológico. Cortes coronais do hipocampo (20m) foram submetidos à imunohistoquímica para KI67, DCX, GFAP e NOSn. Animais P90 foram submetidos ao RO. Os procedimentos foram aprovados pelo comitê de ética (CEA/019/2010). Observamos menor imunomarcação para KI67 no giro dentado de animais HI em P7. Para a marcação de DCX nesta idade não foi observada diferença entre os grupos. Animais HI em P15, P20 e P45 tiveram menor imunomarcação para DCX e Ki67 na camada granular. Animais P90 de ambos os grupos não apresentaram marcação para KI67 e DCX. Vimos aumento da imunomarcação para GFAP nos animais HI em todas as idades. A imunomarcação para NOSn nos animais HI foi menor em todas as idades. O maior número de células NOSn positivas foi visto em animais P7 em ambos os grupos na camada polimórfica. Em P15, animais HI apresentam células NOSn+ em todo o DG. Em P30 animais HI apresentam células NOSn+ nas camadas polimórfica e sub-granular. Animais adultos (P90) de ambos os grupos apresentam células NOSn positivas apenas nas camadas granular e sub-granular. Embora animais HI P90 não apresentaram déficits de memória, estes apresentaram menor tempo de exploração do objeto. Comportamento correspondente a déficits de atenção em humanos. Nossos resultados sugerem que HI perinatal diminui a população de células proliferativas, de neurônios jovens, de neurônios NOSn+, além de causar astrogliose e possivelmente déficits de atenção. O modelo demonstrou ser útil para a compreensão dos mecanismos celulares das lesões hipóxico-isquêmicas e pode ser usado para testar estratégias terapêuticas. / The supply of oxygen and nutrients decreasing in perinatal life may results in CNS damage such as deficits in memory and attention and increased susceptibility to epileptic disorders in adulthood. Perinatal hypoxia-ischemia ( HI ) results in astrogliosis in white matter and loss of cortical neurons (Robinson et al, 2005). Cognitive deficits may be related to hippocampal damage. In this study we evaluate the cytoarchitecture of the dentate gyrus (DG) during development and memory in rats submeted to HI. We used the immunohistochemistry marker of cell proliferation (Ki67), young neuron (DCX), astrocytes (GFAP) and neuronal nitric oxide synthase (nNOS). To evaluate the short-memory and long-lasting the recognition of objects (RO) test was used. Pregnant Wistar rats on E18 were anesthetized (tribromoethanol) and the four uterine arteries were occluded with aneurysm clips (Group HI). After 45 minutes, the clips were removed and the incision was sutured to the anatomical planes. The control group (SHAM) underwent the same procedure, except the occlusion of arteries. The animals were born at term. Animals aged 7 to 90 days postnatal (P7 to P90) were anesthetized and perfused-fixed with 4% paraformaldehyde, and their brains were subjected to histological processing. Coronal sections of the hippocampus (20μm) were subjected to immunohistochemistry for Ki67, DCX, GFAP and nNOS. Animals were subjected to RO P90. The procedures were approved by the ethics committee ( CEA/019/2010 ). We observed lower Ki67 immunostaining in the dentate gyrus of animals HI at P7. For marking DCX at this age is no difference between the groups was observed. HI animals at P15, P20 and P45 had less immunostaining for DCX and Ki67 in the granular layer. Animals P90 in both groups showed no labeling for Ki67 and DCX. We have seen an increase in GFAP immunostaining HI in animals at any age. The immunostaining for nNOS in HI animals was lower at all ages. The greater number of positive cells was seen in nNOS P7 animals in both groups in the polymorphic layer. In P15 animals HI nNOS + cells present in the whole DG. In P30 animals HI feature nNOS + cells in the polymorphic layer and sub-granular. Adult animals (P90) of both groups have positive nNOS granular cell layers, and only in the sub-granular. Although HI P90 animals showed no memory deficits, these patients had shorter holding the object. Corresponding to attention deficits in human behavior. Our results suggest that perinatal HI decreases the population of proliferative cells, young neurons, nNOS+ neurons, and astrocytic and possibly cause attention deficits. The model proved to be useful for understanding the cellular mechanisms of hypoxic- ischemic injury and can be used to test therapeutic strategies.

L’angiogenèse, indispensable à la mise en place d’un réseau vasculaire fonctionnel, est au cœur des stratégies thérapeutiques des pathologies ischémiques. L’hypoxie, caractérisant ces tissus ischémiques, est un stimulus majeur de l’angiogenèse, en induisant l’expression de facteurs de croissance tels que le VEGF et de protéines de la matrice extracellulaire endothéliale. Nous avons identifié la protéine ANGPTL4, comme une cible majeure de l’hypoxie et ayant des effets opposés au VEGF sur la perméabilité vasculaire. Le but de cette thèse a consisté en l’analyse du rôle d’ANGPTL4 sur la formation de capillaire et l’organisation des jonctions adhérentes dans un contexte dépendant du VEGF. J’ai démontré que le VEGF stimule la formation d’un dense réseau capillaire 3D alors qu’ANGPTL4 induit la formation de capillaires étroits et peu ramifiés. ANGPTL4 réduit la taille du réseau de capillaire induit par le VEGF en limitant le nombre de bourgeons, de branchements et la largeur des capillaires. ANGPTL4 renforce l’intégrité des capillaires formés en présence de VEGF en préservant des jonctions adhérentes stables. J’ai démontré qu’ANGPTL4 limite les processus de migration 3D et de prolifération induits par le VEGF. L’analyse de la voie de signalisation VEGF/ANGPTL4 a montré une potentialisation par ANGPTL4 de la phosphorylation Y1175 du VEGFR2, impliqué dans l’internalisation de VEGFR2. En conclusion, ce modèle révèle un effet d’ANGPTL4 dépendant du contexte 3D, qui stimule les processus d’angiogenèse en absence de VEGF et qui contrecarre la morphogenèse induite par le VEGF en renforçant l’intégrité des jonctions adhérentes et en régulant la signalisation en aval du VEGFR2. / Angiogenesis, by promoting new functional capillaries, is a main target of therapeutic strategies of ischemic pathologies. Ischemic tissues are characterized by hypoxic environment, which stimulates angiogenesis by inducing expression and secretion of growth factors such as VEGF and by remodeling endothelial extracellular matrix. Our team identified ANGPTL4 as a hypoxia-induced target and characterized its counteracting effect on VEGF-induced vascular permeability. This PhD study therefore aimed to decipher the role of ANGPTL4 on angiogenesis, capillary architecture and adherens junction (VE-cadherin) organization in a VEGF-dependent context. I demonstrated that VEGF induced formation of branched capillaries forming a dense 3D network while ANGPTL4 enhanced the formation of unbranched and tight capillaries. Remarkably, ANGPTL4 reduces VEGF-induced angiogenesis, by limiting branching and widening of the capillaries. Furthermore, ANGPTL4 regulates the local VE-cadherin patterning during the sprouting process by maintaining lateral linear structures and limiting the VEGF-induced formations involved in the migratory capacities. I demonstrated that ANGPTL4 limited VEGF-induced 3D endothelial cell migration and proliferation. Analysis of VEGF/ANGPTL4 signaling pathway pointed out that ANGPTL4 enhanced phosphorylation of Y1175 VEGFR2, known to enhance internalization of VEGFR2. In conclusion, this study modeled the 3D context-dependent effect of ANGPTL4 that stimulates angiogenesis in absence of VEGF whereas it counteracts VEGF-induced endothelial morphogenesis by regulating VEGFR2 trafficking and strengthening adherens junctions.

<p>Infrainguinal bypass grafting is an established method in the treatment of patients with femoropopliteal and crural occlusive disease leading to critical lower limb ischaemia (CLI). However, complications related to surgical procedure are not negligible and percutaneous transluminal angioplasty (PTA) has emerged as an alternative. The present thesis covers some aspects of infrainguinal PTA in patients with chronic severe lower limb ischaemia.</p><p>The records of 217 patients undergoing 272 PTA procedures at various infrainguinal arterial segments were analysed. The indication for intervention was subcritical ischaemia in 76 limbs and critical ischaemia in 177 limbs. The role of duplex ultrasound examination in the selection of patients for PTA was retrospectively evaluated following a prospective validation of the method against angiography.</p><p>A technically successful PTA was achieved in 89%. The overall 30-day mortality was 2.7%. No patient underwent amputation directly related to failed PTA. The primary success rates at 12 and 60 months following femoropopliteal PTA were 40% and 27% compared, to 51% and 36% in limbs undergoing crural artery PTA. Primary success rate in limbs with SFA occlusion longer than 5 cm was only 12% after 5 years, compared to 32% if the occlusion was equal or less than 5 cm in length (p<0.01). In patients undergoing distal PTA through patent infrainguinal grafts, the primary and primary assisted patency rates at 3 years were 32% and 53%, respectively. The sensitivity of duplex scanning in the selection of lesions for PTA was less satisfactory in the popliteal and crural arteries compared to the superficial femoral arteries.</p><p>In conclusion, the results of infrainguinal PTA performed for treatment of subcritical or CLI seemed to be inferior to the results of surgical interventions reported in the literature. However, due to the fact that the PTA procedure does not preclude the performance of bypass grafting, it might be an alternative to surgical intervention in limbs with stenotic or short occlusive lesions.</p>

<p>Randomised controlled trials (RCT) have demonstrated a net benefit of carotid endarterectomy (CEA) in stroke prevention for patients with severe carotid artery stenosis as compared to best medical treatment. Results in routine clinical practice must not be inferior to those in the RCTs. The carotid arteries are clamped during CEA which may impair the cerebral perfusion. </p><p>The aim of this thesis was to assess population-based outcomes from CEA, investigate risk factors for perioperative complications/late mortality and to evaluate effects of carotid clamping during CEA. In the Swedish vascular registry 6182 CEAs were registered during 1994-2003. Data on all CEAs were retrieved, analysed and validated. In the validation process no death or disabling stroke was unreported. The perioperative stroke or death rate was 4.3% for those with symptomatic and 2.1% for asymptomatic stenosis (the latter decreasing over time). Risk factors for perioperative complications were age, indication, diabetes, cardiac disease and contralateral occlusion. Median survival time was 10.8 years for the symptomatic and 10.2 years for the asymptomatic group. </p><p>Tolerance to carotid clamping during CEA under general anaesthesia was evaluated in 62 patients measuring cerebral oximetry, transit time volume flowmetry and stump pressure. High internal carotid artery flow before clamping and low stump pressure was associated with decreased oxygenation after clamping suggesting shunt indication. </p><p>In 18 patients undergoing CEA, jugular bulb blood samples demonstrated significantly altered levels of marker for inflammatory activation (IL-6) and fibrinolytic activity (D-dimer and PAI-1) during carotid clamping as compared to radial artery levels. This indicates a cerebral ischaemia due to clamping although clinically well tolerated. </p><p>In conclusion, the perioperative outcome after CEA in Sweden compared well with the RCTs results. Tolerance to carotid clamping may be evaluated by combining stump pressure and volume flow measurements. Although clinically tolerated clamping may induce a cerebral ischaemic response.</p>

Infrainguinal bypass grafting is an established method in the treatment of patients with femoropopliteal and crural occlusive disease leading to critical lower limb ischaemia (CLI). However, complications related to surgical procedure are not negligible and percutaneous transluminal angioplasty (PTA) has emerged as an alternative. The present thesis covers some aspects of infrainguinal PTA in patients with chronic severe lower limb ischaemia. The records of 217 patients undergoing 272 PTA procedures at various infrainguinal arterial segments were analysed. The indication for intervention was subcritical ischaemia in 76 limbs and critical ischaemia in 177 limbs. The role of duplex ultrasound examination in the selection of patients for PTA was retrospectively evaluated following a prospective validation of the method against angiography. A technically successful PTA was achieved in 89%. The overall 30-day mortality was 2.7%. No patient underwent amputation directly related to failed PTA. The primary success rates at 12 and 60 months following femoropopliteal PTA were 40% and 27% compared, to 51% and 36% in limbs undergoing crural artery PTA. Primary success rate in limbs with SFA occlusion longer than 5 cm was only 12% after 5 years, compared to 32% if the occlusion was equal or less than 5 cm in length (p&lt;0.01). In patients undergoing distal PTA through patent infrainguinal grafts, the primary and primary assisted patency rates at 3 years were 32% and 53%, respectively. The sensitivity of duplex scanning in the selection of lesions for PTA was less satisfactory in the popliteal and crural arteries compared to the superficial femoral arteries. In conclusion, the results of infrainguinal PTA performed for treatment of subcritical or CLI seemed to be inferior to the results of surgical interventions reported in the literature. However, due to the fact that the PTA procedure does not preclude the performance of bypass grafting, it might be an alternative to surgical intervention in limbs with stenotic or short occlusive lesions.

Randomised controlled trials (RCT) have demonstrated a net benefit of carotid endarterectomy (CEA) in stroke prevention for patients with severe carotid artery stenosis as compared to best medical treatment. Results in routine clinical practice must not be inferior to those in the RCTs. The carotid arteries are clamped during CEA which may impair the cerebral perfusion. The aim of this thesis was to assess population-based outcomes from CEA, investigate risk factors for perioperative complications/late mortality and to evaluate effects of carotid clamping during CEA. In the Swedish vascular registry 6182 CEAs were registered during 1994-2003. Data on all CEAs were retrieved, analysed and validated. In the validation process no death or disabling stroke was unreported. The perioperative stroke or death rate was 4.3% for those with symptomatic and 2.1% for asymptomatic stenosis (the latter decreasing over time). Risk factors for perioperative complications were age, indication, diabetes, cardiac disease and contralateral occlusion. Median survival time was 10.8 years for the symptomatic and 10.2 years for the asymptomatic group. Tolerance to carotid clamping during CEA under general anaesthesia was evaluated in 62 patients measuring cerebral oximetry, transit time volume flowmetry and stump pressure. High internal carotid artery flow before clamping and low stump pressure was associated with decreased oxygenation after clamping suggesting shunt indication. In 18 patients undergoing CEA, jugular bulb blood samples demonstrated significantly altered levels of marker for inflammatory activation (IL-6) and fibrinolytic activity (D-dimer and PAI-1) during carotid clamping as compared to radial artery levels. This indicates a cerebral ischaemia due to clamping although clinically well tolerated. In conclusion, the perioperative outcome after CEA in Sweden compared well with the RCTs results. Tolerance to carotid clamping may be evaluated by combining stump pressure and volume flow measurements. Although clinically tolerated clamping may induce a cerebral ischaemic response.

Brain death has adverse effects on the organ donor, increasing organ dysfunction and affecting transplantation outcomes. It can also render organs unsuitable for transplantation. Another determinant of organ quality is ischaemia-reperfusion injury, which limits ischaemic storage time for hearts to six hours. The aim of this thesis was to investigate the effectiveness of hormone resuscitation (HR) of the donor to ameliorate the effects of brain death. Another aim was to develop a donor management and organ preservation strategy to ameliorate the effects of ischaemia-reperfusion injury on the heart, thereby extending ischaemic preservation times. A porcine model of the brain-dead multi-organ donor with orthotopic cardiac transplantation was utilised. Donor HR was shown to improve cardiac contractility and haemodynamics, thereby reducing inotrope requirements. A follow-up study investigating the effects of three different donor management protocols demonstrated that donor haemodynamics, renal arterial flow and creatinine clearance were superior in HR animals compared with animals treated with noradrenaline or intravenous fluid alone. Noradrenaline was associated with a significant deterioration in pulmonary function (PaO2 and alveolar-arterial oxygen gradient) and a decline in donor pH. HR was not associated with any detrimental effects on the lungs, liver or pancreas compared with the other two groups. Preservation strategies incorporating glyceryl trinitrate (GTN) and cariporide, a Na+-H+ exchange inhibitor, were investigated to safely extend cardiac ischaemic preservation times. Pre-treatment with intravenous cariporide prior to heart explantation (donor) and reperfusion of the transplanted heart (recipient) was shown to effectively extend ischaemic time to 14 hours, evidenced by weaning off cardiopulmonary bypass. GTN and cariporide-supplemented Celsior, used as a cardioplegic/storage solution, was also effective in extending preservation time to 14 hours, with superior cardiac contractility compared with cariporide pre-treated hearts. Both treatments also ameliorated reperfusion injury, stabilising haemodynamics for up to three hours post-bypass. This thesis has demonstrated the effectiveness of HR to ameliorate the negative effects of donor brain death. It also provides evidence that combined GTN and cariporide-supplemented Celsior improves long-term preservation of the donor heart. These strategies offer the potential to increase the proportion of transplantable organs, to improve donor organ quality, and thereby improve transplantation outcomes.

Intra-dialytic haemodynamic instability is a common and disabling problem which may lead to morbidity and mortality though repeated organ ischaemia, but it has proven difficult to link any particular blood pressure threshold with hard patient outcomes. The relationship between blood pressure and downstream organ ischaemia during haemodialysis has not been well characterised. Previous attempts to predict and prevent intra-dialytic hypotension have had mixed results, partly due to patient and event heterogeneity. Using the brain as the indicator organ, we aimed to model the dynamic relationship between blood pressure, real-time symptoms, downstream organ ischaemia during haemodialysis, in order to identify the most physiologically grounded, prognostic definition of intra-dialytic decompensation. Following on from this, we aimed to predict the onset of intra-dialytic decompensation using personalised, probabilistic models of multivariate, continuous physiological data, ultimately working towards an early warning system for intra-dialytic adverse events. This was a prospective study of 60 prevalent haemodialysis patients who underwent extensive, continuous physiological monitoring of haemodynamic, cardiorespiratory, tissue oxygenation and dialysis machine parameters for 3-4 weeks. In addition, longitudinal cognitive function testing was performed at baseline and at 12 months. Despite their use in clinical practice, we found that blood pressure thresholds alone have a poor trade off between sensitivity and specificity for predicting downstream tissue ischaemia during haemodialysis. However, the performance of blood pressure thresholds could be improved by stratification for the presence or absence of cerebral autoregulation, and personalising thresholds according to the individual lower limit of autoregulation. For patients without autoregulation, the optimal blood pressure target was a mean arterial pressure (MAP) of 70mmHg. A key finding was that cumulative intra-dialytic exposure to cerebral ischaemia, but not to hypotension per se, corresponded to change in executive cognitive function over 12 months. Therefore we chose cerebral ischaemia as the definition of intra-dialytic decompensation for predictive modelling. We were able to demonstrate that the development of cerebral desaturation could be anticipated from earlier deviations of univariate physiological data from the expected trajectory for a given patient, but sensitivity was limited by the heterogeneity of events even within one individual. The most useful phys- iological data streams included peripheral saturation variance, cerebral saturation variance, heart rate and mean arterial pressure. Multivariate data fusion techniques using these variables created promising personalised models capable of giving an early warning of decompensation. Future work will involve the refinement and prospective testing of these models. In addition, we envisage a prospective study assessing the benefit of autoregulation-guided blood pressure targets on short term outcomes such as patient symptoms and wellbeing, as well as longer term outcomes such as cognitive function.

Background: Glucagon-like Peptide 1 (GLP-1) is a human incretin hormone that has been demonstrated to protect against non-lethal ischaemia reperfusion injury in the left ventricle in humans. It has been suggested from some animal research that this protection may be mediated through the pathway of ischaemic conditioning, of which the opening of the mKATP channel is a key step. Furthermore, it is uncertain whether the protection applies to the right ventricle. Finally, there is limited human evidence of a protective effect against lethal ischaemia reperfusion injury. Methods: Two studies use non-lethal ischaemia to test whether GLP-1 protection is maintained despite blockade of the mKATP channel with the sulfonylurea, glibenclamide. A demand ischaemia study uses dobutamine stress echo to compare LV function. The other uses transient coronary balloon occlusion to generate supply ischaemia during GLP-1 infusion, assessed by conductance catheter. A further transient balloon occlusion is also used to assess the effect of supply ischaemia on RV function. Finally, the GOLD PCI study assesses whether GLP-1 protects against periprocedural myocardial infarction when administered during elective PCI in a randomised, placebo controlled double blind trial. Results: Glibenclamide did not affect GLP-1 cardioprotection in either supply of demand ischaemia suggesting that GLP-1 protection is not mediated through the mKATP channel. The RV experienced stunning with RCA balloon occlusion but there was little evidence of cumulative ischaemic dysfunction with further occlusions. GOLD PCI is continuing to recruit patients. The nature of the study means results cannot be assessed until recruitment is complete. Conclusions: GLP-1 is an agent with potential for clinical use as a cardioprotective therapy. It’s mechanism of action in the heart remains uncertain.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A diminuição do aporte de oxigênio e nutrientes na vida perinatal resulta em danos, como astrogliose, morte de neurônios e de células proliferativas. Déficits cognitivos podem estar relacionados a danos no hipocampo. Neste trabalho avaliamos a citoarquitetura do giro dentado (DG) durante o desenvolvimento e a memória de ratos submetidos à HI. Para tal, utilizamos a técnica de imunohistoquímica para marcador de proliferação celular (KI67), neurônio jovem (DCX), de astrócitos (GFAP) e de óxido nítrico sintase neuronal (NOSn). Para avaliar a memória de curta e de longa duração foi utilizado o teste de reconhecimento de objetos (RO). Ratas Wistar grávidas em E18 foram anestesiadas (tribromoetanol) e as quatro artérias uterinas foram ocluídas com grampos de aneurisma (Grupo HI). Após 45 minutos, os grampos foram removidos e foi feita a sutura por planos anatômicos. Os animais do grupo controle (SHAM) sofreram o mesmo procedimento, excetuando a oclusão das artérias. Os animais nasceram a termo. Animais com idades de 7 a 90 dias pós-natal (P7 a P90), foram anestesiados e perfundido-fixados com paraformaldeído a 4%, e os encéfalos submetidos ao processamento histológico. Cortes coronais do hipocampo (20m) foram submetidos à imunohistoquímica para KI67, DCX, GFAP e NOSn. Animais P90 foram submetidos ao RO. Os procedimentos foram aprovados pelo comitê de ética (CEA/019/2010). Observamos menor imunomarcação para KI67 no giro dentado de animais HI em P7. Para a marcação de DCX nesta idade não foi observada diferença entre os grupos. Animais HI em P15, P20 e P45 tiveram menor imunomarcação para DCX e Ki67 na camada granular. Animais P90 de ambos os grupos não apresentaram marcação para KI67 e DCX. Vimos aumento da imunomarcação para GFAP nos animais HI em todas as idades. A imunomarcação para NOSn nos animais HI foi menor em todas as idades. O maior número de células NOSn positivas foi visto em animais P7 em ambos os grupos na camada polimórfica. Em P15, animais HI apresentam células NOSn+ em todo o DG. Em P30 animais HI apresentam células NOSn+ nas camadas polimórfica e sub-granular. Animais adultos (P90) de ambos os grupos apresentam células NOSn positivas apenas nas camadas granular e sub-granular. Embora animais HI P90 não apresentaram déficits de memória, estes apresentaram menor tempo de exploração do objeto. Comportamento correspondente a déficits de atenção em humanos. Nossos resultados sugerem que HI perinatal diminui a população de células proliferativas, de neurônios jovens, de neurônios NOSn+, além de causar astrogliose e possivelmente déficits de atenção. O modelo demonstrou ser útil para a compreensão dos mecanismos celulares das lesões hipóxico-isquêmicas e pode ser usado para testar estratégias terapêuticas. / The supply of oxygen and nutrients decreasing in perinatal life may results in CNS damage such as deficits in memory and attention and increased susceptibility to epileptic disorders in adulthood. Perinatal hypoxia-ischemia ( HI ) results in astrogliosis in white matter and loss of cortical neurons (Robinson et al, 2005). Cognitive deficits may be related to hippocampal damage. In this study we evaluate the cytoarchitecture of the dentate gyrus (DG) during development and memory in rats submeted to HI. We used the immunohistochemistry marker of cell proliferation (Ki67), young neuron (DCX), astrocytes (GFAP) and neuronal nitric oxide synthase (nNOS). To evaluate the short-memory and long-lasting the recognition of objects (RO) test was used. Pregnant Wistar rats on E18 were anesthetized (tribromoethanol) and the four uterine arteries were occluded with aneurysm clips (Group HI). After 45 minutes, the clips were removed and the incision was sutured to the anatomical planes. The control group (SHAM) underwent the same procedure, except the occlusion of arteries. The animals were born at term. Animals aged 7 to 90 days postnatal (P7 to P90) were anesthetized and perfused-fixed with 4% paraformaldehyde, and their brains were subjected to histological processing. Coronal sections of the hippocampus (20&#956;m) were subjected to immunohistochemistry for Ki67, DCX, GFAP and nNOS. Animals were subjected to RO P90. The procedures were approved by the ethics committee ( CEA/019/2010 ). We observed lower Ki67 immunostaining in the dentate gyrus of animals HI at P7. For marking DCX at this age is no difference between the groups was observed. HI animals at P15, P20 and P45 had less immunostaining for DCX and Ki67 in the granular layer. Animals P90 in both groups showed no labeling for Ki67 and DCX. We have seen an increase in GFAP immunostaining HI in animals at any age. The immunostaining for nNOS in HI animals was lower at all ages. The greater number of positive cells was seen in nNOS P7 animals in both groups in the polymorphic layer. In P15 animals HI nNOS + cells present in the whole DG. In P30 animals HI feature nNOS + cells in the polymorphic layer and sub-granular. Adult animals (P90) of both groups have positive nNOS granular cell layers, and only in the sub-granular. Although HI P90 animals showed no memory deficits, these patients had shorter holding the object. Corresponding to attention deficits in human behavior. Our results suggest that perinatal HI decreases the population of proliferative cells, young neurons, nNOS+ neurons, and astrocytic and possibly cause attention deficits. The model proved to be useful for understanding the cellular mechanisms of hypoxic- ischemic injury and can be used to test therapeutic strategies.