Les lésions d’Ischémie/Reperfusion (I/R) contribuent à la physiopathologie de l’infarctus du myocarde. Le stress induit par l’I/R entraîne la mort des cardiomyocytes, une forte réponse inflammatoire de type stérile et la mise en place d’un processus de réparation impliquant les fibroblastes cardiaques. Il a précédemment été montré au laboratoire que l’activation du récepteur purinergique P2Y11 par l’ATP diminuait la sécrétion d’IL-6 et d’IL- 12 par la cellule dendritique (DC), permettant une diminution de la polarisation vers une réponse adaptative Th1. Nous avons donc émis l’hypothèse que la signalisation purinergique pouvait également moduler la mortalité des cardiomyocytes et l’activation des fibroblastes cardiaques après I/R, en diminuant la mise en place de réponses cellulaires délétères à long terme pour l’organe. L’objectif de cette thèse a été de déterminer in vitro le rôle de la signalisation purinergique sur la réponse des cardiomyocytes et des fibroblastes cardiaques à l’Hypoxie/Réoxygénation (H/R). Nous avons pu montrer que l’activation des récepteurs purinergiques au moment de la réoxygénation, en particulier du récepteur P2Y11, permettait de réduire la mortalité des cardiomyocytes après H/R. Nous avons ensuite montré que la stimulation de P2Y11 au moment de la réoxygénation diminue la prolifération des fibroblastes cardiaques et leur switch phénotypique en myofibroblastes, mais aussi diminue leur sécrétion de facteurs pro-inflammatoires. Le sécrétome des fibroblastes cardiaques a également induit une diminution de la sécrétion d’IL-6 et d’IL-12 par les DC, ainsi qu’une diminution de la mortalité des cardiomyocytes soumis à une H/R. Ces effets immunomodulateurs et cardioprotecteurs étaient dépendants de l’activation du récepteur P2Y11 sur les fibroblastes cardiaques. Ces résultats suggèrent fortement que le récepteur P2Y11 est au centre des réponses cellulaires post-H/R, et que le cibler in vivo à la reperfusion pourrait améliorer le pronostic clinique des patients atteints d’infarctus du myocarde. / Ischemia/Reperfusion injuries are involved in the pathophysiology of myocardial infarction. I/R-induced stress leads to massive cardiomyocyte death, an acute inflammatory response and the establishment of a repair process by cardiac fibroblasts. Previous work in the laboratory showed that P2Y11 purinergic receptor activation by ATP decreased IL-6 and IL-12 secretion by dendritic cells (DC), inducing a decrease in polarization towards Th1 response. We hypothesized that purinergic signaling could also modulate cardiomyocyte death and activation of cardiac fibroblasts responses to hypoxia/reoxygenation (H/R). We showed that the activation of purinergic receptors at the onset of reoxygenation, especially P2Y11 receptor, improved cardiomyocytes survival following H/R. We then showed that P2Y11 stimulation at the onset of reoxygenation decreased cardiac fibroblasts proliferation and their phenotypic switch into myofibroblasts, but also decreased their secretion of pro-inflammatory factors. Cardiac fibroblasts secretome reduced IL-6 and IL-12 secretion by DC, and cardiomyocyte mortality. These immunomodulatory and cardioprotective effects were dependent on P2Y11 receptor activation in cardiac fibroblasts. These results suggest that P2Y11 receptor is strongly involved in post- H/R cellular responses, and that targeting this receptor in vivo could improve the clinical prognosis of patients with myocardial infarction.

Atualmente, define-se como translocação bacteriana o deslocamento de bactérias e/ou seus produtos, como as endotoxinas, da luz do TGI para sítios estéreis. A ocorrência de translocação bacteriana tem sido sugerida em diversos estudos experimentais e clínicos. Apesar de todos estes estudos sustentarem a hipótese da ocorrência de translocação bacteriana, eles não demonstram que a bactéria detectada no sangue e em sítios estéreis tem efetivamente origem no TGI do animal ou paciente. Portanto, o objetivo da primeira fase deste trabalho, consistiu no desenvolvimento de um modelo experimental que comprovasse que bactérias isoladas em sítios estéreis são realmente de origem intestinal e que pudesse posteriormente viabilizar o estudo da translocação bacteriana. Para isto, realizou-se a colonização de ratos através da inoculação, via gavagem, de solução de Enterococcus faecalis resistente a vancomicina (ERV) e E. coli produtora de Beta-lactamase de espectro estendido (ESBL). O perfil de resistência destas cepas foi utilizado como marcador. Posteriormente, este estudo avaliou a translocação bacteriana em ratos submetidos a isquemia-reperfusão hepática com e sem estase venosa intestinal, utilizando o modelo de colonização. Quarenta e seis animais foram divididos nos seguintes grupos: Grupo I (n=15) ratos submetidos a isquemia hepática e estase intestinal por 30 minutos, e 1h de reperfusão; Grupo II (n=15) ratos submetidos a 30 minutos de isquemia hepática parcial sem estase intestinal, e 1h de reperfusão;Grupo III (n=8) ratos controle que apenas sofreraam manipulação cirúrgica e Grupo IV (n=8) ratos controle não cirúrgico. Os grupos foram analisados em relação: a ocorrência de translocação bacteriana; proporção de animais com crescimento da cepa pré-definida de ERV e E. coli ESBL, por órgão ou tecido; Concentração de LPS no sangue portal e sistêmico. Os resultados obtidos evidenciaram presença marcante de crescimento microbiológico positivo para cepas inoculadas na maioria dos órgãos ou tecidos analisados nos diferentes grupos. Desta forma, conseguimos comprovar que a bactéria detectada em sítios estéreis tem efetivamente origem no TGI daquele animal. A translocação de bactérias, para os órgãos sólidos, ocorreu com maior freqüência nos ratos submetidos a isquemia e reperfusão com estase intestinal. A translocação bacteriana para o pulmão ocorreu com maior freqüência nos grupos cirúrgicos, inclusive controle, do que no controle não cirúrgico. A translocação de endotoxinas, medida pela concentração sangüínea sistêmica, ocorreu com maior intensidade nos ratos submetidos a isquemia e reperfusão hepática com estase intestinal. Não houve diferenças entre os grupos quanto a proporção de animais com cultura positiva no sangue sistêmico e porta e concentração de endotoxinas no sangue porta. / Bacterial translocation is defined as the passage of viable bacteria and/or their products, such as endotoxins, from inside the gastrointestinal tract (GIT) to normally sterile sites. Experimental studies demonstrate that increase of the permeability of the intestinal mucosa and other conditions such as intestinal bacterial overgrowth or host immune deficiency may be associated with this phenomenon. The occurrence of bacterial translocation has been suggested in some experimental and clinical studies. Although all these studies sustained the occurrence of the bacterial translocation but they did not demonstrate that it has effectively origin in the TGI of the animal or patient. The first objective of this study was to develop a GIT colonization experimental model in rats with resistant Enterococcus faecalis (E.faecalis) and E.coli, to be used in further studies of bacterial translocation intending, The resistance profile of these strains is used as a marker. Afterwards, this study evaluated the bacterial translocation in rats submitted to hepatic ischemic-reperfusion with or without intestinal vein stasis. Forty six animals were used as follows: Group I (n=15) mice submitted to ischemic hepatica and intestinal stasis for 30 minutes, and 1h of reperfusion; Group II (n=15) mice submitted to partial ischemic hepatica for 30 minutes without intestinal stasis, and 1h of reperfusion; Group III (n=8) control of mice which only suffered surgical manipulation and Group IV (n=8) Group of mice without surgical control. The groups were analyzed concerning: the occurrence of bacterial translocation; proportion of animals with predefined ERV and E.Coli ESBL growth increase per organ or tissue; LPS concentration in the portal and systemic blood. The results demonstrated remarkable appearance of positive microbiological growth for inoculated stains mostly in the analyzed tissues within the different groups. By this way, we were able to prove that the bacteria present in sterile sites have effectively their origin in the TGI of that animal. The bacteria translocation in solid organs occurred frequently in group I submitted to the ischemia-reperfusion with intestinal stasis. The bacterial translocation in lung occurred more frequently in the surgical groups including chirurgical control. The endotoxin in systemic blood concentration occurred more intensively in group I submitted to the ischemia-reperfusion with intestinal stasis.

Uma estreita relação entre a ação dos hormônios tireoidianos (HT) no sistema cardiovascular sendo mediada por componentes do sistema renina-angiotensina (SRA) tem sido descrita na literatura. Já foi demonstrado que o processo de isquemia/reperfusão (I/R) promove diminuição na expressão do receptor de angiotensina II do tipo 2 (AT2) no miocárdio, com consequente prejuízo funcional, enquanto o aumento de sua expressão melhorou a recuperação da função cardíaca. A hipótese do presente estudo é que o papel cardioprotetor exercido pelos HT ocorre com a participação do receptor AT2. Esta hipótese foi testada utilizando o modelo de I/R com a perfusão de coração isolado de camundongos selvagens e nocautes para o AT2, submetidos a tratamento por 14 dias com T3. Ainda foi avaliado o SRA mitocondrial, assim como o papel do óxido nítrico (NO) na recuperação pós-isquêmica. Os resultados apontam que a cardioproteção induzida pelo T3 é mediada pelo AT2, com consequente aumento na produção de NO e modulação de parâmetros do metabolismo mitocondrial. / Some authors have shown a close relationship between the action of thyroid hormone (TH) on cardiovascular system and renin angiotensin system (RAS) activation. Have been shown that ischemia/reperfusion (I/R) promotes decrease on angiotensin II type 2 receptor (AT2) expression in the myocardium, with functional worsening, on the other hand the AT2R increased improves the cardiac function after ischemia episodes. So, we have hypothesized that the cardioprotective effect of TH in I/R model may occur with the participation of AT2. This hypothesis was tested using I/R model in isolated hearts AT2 knockout and wild-type mice submitted to high levels of T3 by 14 days. The mitochondrial RAS was evaluated, as well as the nitric oxide (NO) role in post-ischemic recovery. The results show that TH induces cardioprotection through AT2 receptor, some mitochondrial metabolism parameters were modulated by TH and the NO production was increased.

Atualmente, define-se como translocação bacteriana o deslocamento de bactérias e/ou seus produtos, como as endotoxinas, da luz do TGI para sítios estéreis. A ocorrência de translocação bacteriana tem sido sugerida em diversos estudos experimentais e clínicos. Apesar de todos estes estudos sustentarem a hipótese da ocorrência de translocação bacteriana, eles não demonstram que a bactéria detectada no sangue e em sítios estéreis tem efetivamente origem no TGI do animal ou paciente. Portanto, o objetivo da primeira fase deste trabalho, consistiu no desenvolvimento de um modelo experimental que comprovasse que bactérias isoladas em sítios estéreis são realmente de origem intestinal e que pudesse posteriormente viabilizar o estudo da translocação bacteriana. Para isto, realizou-se a colonização de ratos através da inoculação, via gavagem, de solução de Enterococcus faecalis resistente a vancomicina (ERV) e E. coli produtora de Beta-lactamase de espectro estendido (ESBL). O perfil de resistência destas cepas foi utilizado como marcador. Posteriormente, este estudo avaliou a translocação bacteriana em ratos submetidos a isquemia-reperfusão hepática com e sem estase venosa intestinal, utilizando o modelo de colonização. Quarenta e seis animais foram divididos nos seguintes grupos: Grupo I (n=15) ratos submetidos a isquemia hepática e estase intestinal por 30 minutos, e 1h de reperfusão; Grupo II (n=15) ratos submetidos a 30 minutos de isquemia hepática parcial sem estase intestinal, e 1h de reperfusão;Grupo III (n=8) ratos controle que apenas sofreraam manipulação cirúrgica e Grupo IV (n=8) ratos controle não cirúrgico. Os grupos foram analisados em relação: a ocorrência de translocação bacteriana; proporção de animais com crescimento da cepa pré-definida de ERV e E. coli ESBL, por órgão ou tecido; Concentração de LPS no sangue portal e sistêmico. Os resultados obtidos evidenciaram presença marcante de crescimento microbiológico positivo para cepas inoculadas na maioria dos órgãos ou tecidos analisados nos diferentes grupos. Desta forma, conseguimos comprovar que a bactéria detectada em sítios estéreis tem efetivamente origem no TGI daquele animal. A translocação de bactérias, para os órgãos sólidos, ocorreu com maior freqüência nos ratos submetidos a isquemia e reperfusão com estase intestinal. A translocação bacteriana para o pulmão ocorreu com maior freqüência nos grupos cirúrgicos, inclusive controle, do que no controle não cirúrgico. A translocação de endotoxinas, medida pela concentração sangüínea sistêmica, ocorreu com maior intensidade nos ratos submetidos a isquemia e reperfusão hepática com estase intestinal. Não houve diferenças entre os grupos quanto a proporção de animais com cultura positiva no sangue sistêmico e porta e concentração de endotoxinas no sangue porta. / Bacterial translocation is defined as the passage of viable bacteria and/or their products, such as endotoxins, from inside the gastrointestinal tract (GIT) to normally sterile sites. Experimental studies demonstrate that increase of the permeability of the intestinal mucosa and other conditions such as intestinal bacterial overgrowth or host immune deficiency may be associated with this phenomenon. The occurrence of bacterial translocation has been suggested in some experimental and clinical studies. Although all these studies sustained the occurrence of the bacterial translocation but they did not demonstrate that it has effectively origin in the TGI of the animal or patient. The first objective of this study was to develop a GIT colonization experimental model in rats with resistant Enterococcus faecalis (E.faecalis) and E.coli, to be used in further studies of bacterial translocation intending, The resistance profile of these strains is used as a marker. Afterwards, this study evaluated the bacterial translocation in rats submitted to hepatic ischemic-reperfusion with or without intestinal vein stasis. Forty six animals were used as follows: Group I (n=15) mice submitted to ischemic hepatica and intestinal stasis for 30 minutes, and 1h of reperfusion; Group II (n=15) mice submitted to partial ischemic hepatica for 30 minutes without intestinal stasis, and 1h of reperfusion; Group III (n=8) control of mice which only suffered surgical manipulation and Group IV (n=8) Group of mice without surgical control. The groups were analyzed concerning: the occurrence of bacterial translocation; proportion of animals with predefined ERV and E.Coli ESBL growth increase per organ or tissue; LPS concentration in the portal and systemic blood. The results demonstrated remarkable appearance of positive microbiological growth for inoculated stains mostly in the analyzed tissues within the different groups. By this way, we were able to prove that the bacteria present in sterile sites have effectively their origin in the TGI of that animal. The bacteria translocation in solid organs occurred frequently in group I submitted to the ischemia-reperfusion with intestinal stasis. The bacterial translocation in lung occurred more frequently in the surgical groups including chirurgical control. The endotoxin in systemic blood concentration occurred more intensively in group I submitted to the ischemia-reperfusion with intestinal stasis.

A isquemia/reperfusão intestinal (I/R-i) se associa ao desenvolvimento de inflamação pulmonar aguda, que pode ser modulada por mediadores inflamatórios presentes na linfa. Avaliamos os efeitos da I/R-i sob a inflamação pulmonar e a participação do sistema linfático. Wistar machos foram submetidos a 45 min de isquemia intestinal e 24, 72 ou 120 h de reperfusão. Outro grupo teve o ducto linfático bloqueado antes da isquemia. Os resultados revelaram maior inflamação pulmonar nos animais reperfundidos por 120 h em relação aos outros períodos de reperfusão estudados. Os animais apresentaram aumento de MPO e permeabilidade. Aumento de VEGF e de IL-1<font face=\"Symbol\">&#946 e diminuição de IL-10 no explante pulmonar. Diminuição de vWf e aumento de integrina <font face=\"Symbol\">&#9461, PECAM-1 e colágeno I e IV no endotélio pulmonar. Os dados indicam que mecanismos temporais modulam a resposta inflamatória decorrente da I/R-i. Mediadores na linfa e na circulação participam do desencadeamento/manutenção da inflamação pulmonar alterando a integridade do endotélio e ativando o pulmão que libera mediadores adicionais. / Intestinal ischemia/reperfusion (i-I/R) is associated with the development of acute lung inflammation, which can be modulated by inflammatory mediators present in the lymph. We evaluated the effects of i-I/R in lung inflammation and the involvement of the lymphatic system. Wistar rats were subjected to 45 min of intestinal ischemia and 24, 72 or 120 h of reperfusion. Another group had the lymphatic duct blocked before ischemia. The results revealed greater lung inflammation in animals reperfused for 120 h in comparison to other periods studied. These animals showed increased MPO and permeability. Increased VEGF and IL-1<font face=\"Symbol\">&#946 and decreased IL-10 in lung explants. Decreased vWf and increased <font face=\"Symbol\">&#9461 integrin, PECAM-1 and collagen I and IV in the pulmonary endothelium. These data indicate that temporal mechanisms modulate the inflammatory response due to i-I/R. Mediators in the lymph and circulation participate in the initiation / maintenance of lung inflammation by altering the integrity of the endothelium and activating the lung which release additional mediators.

Alterações no mecanismo de transporte de oxigênio (O2) frequentes em inflamações, infecções, tumores, transplantes e isquemia, levam a hipóxia tecidual. Espécies reativas do O2 são produzidas e citocinas inflamatórias são liberadas engatilhando uma série de eventos, os quais são amplificados após a restituição do fluxo sanguíneo resultando em inflamação sistêmica. No presente estudo, caracterizamos a regulação da Resposta Inflamatória Aguda (AIR) após indução de isquemia e reperfusão intestinal (I/Ri) e a participação do HIF-1&alpha; neste fenótipo. Camundongos selecionados para alta (AIRmax) e baixa (AIRmin) AIR foram submetidos a I/Ri e avaliados em diferentes períodos de reperfusão (0, 1, 4 e 24h). Nossos resultados demonstraram maior sensibilidade da linhagem AIRmax frente a I/Ri, confirmada por: 1) maior mobilização de neutrófilos para circulação periférica; 2) maior adesão celular e aumento da migração granulocítica no intestino e pulmão; 3) aumento da expressão de genes de citocinas e daqueles expressos em hipóxia (Tnfa, Il1, Il6 e Hif1a); 4) Translocação Bacteriana (TB); 5) maior expressão pulmonar da proteína HIF-1&alpha; e de proteínas envolvidas em processos inflamatórios tais como S100A9, Anexina 1, Profilina 1, Tropomiosina. Por outro lado, a linhagem AIRmin foi considerada pouco responsiva aos efeitos da I/Ri. Diante do exposto, nós concluímos que a sensibilidade dos camundongos AIRmax à injuria após indução de IRi está associada ao agravamento da inflamação sistemica, a qual foi determinada pela indução de HIF-1&alpha; atrelada à expressão de proteínas pró- inflamatórias e TB, indicando o compartilhamento ou a co- segregação entre os genes envolvidos na AIR e na hipóxia. / Changes in oxygen transport mechanism (O2) frequent in inflammation, infection, tumors, transplantation and ischemia, lead to tissue hypoxia. Reactive species of O2 are produced and inflammatory cytokines are released triggering a series of events, which are amplified after blood flow refund resulting in systemic inflammation. In the present study, we characterized the regulation of Acute Inflammatory Response (AIR) after intestinal ischemia and reperfusion (I/Ri) induction and the involvement of HIF-1&alpha; in this phenotype. Mice selected for high (AIRmax) and low (AIRmin) AIR were subjected to I/Ri and evaluated in different periods of reperfusion (0, 1, 4 and 24h). Our results show sensitivity of AIRmax front line I/Ri, confirmed by: 1) higher neutrophils mobilization to peripheral circulation; 2) increase in cell adhesion and granulocyte migration in lung and intestine; 3) higher expression of cytokine genes and those expressed in hypoxia (TNFa, IL-1, IL-6 and HIF1a); 4) Bacterial Translocation (BT), 5) increase in HIF-1&alpha; pulmonary protein expression and those involved in inflammatory processes such as S100A9, Annexin 1, profilin 1 Tropomyosin. On the other hand, the AIRmin line was considered unresponsive to effects of I/Ri. We concluded that the I/Ri sensitivity of the AIRmax mice were associated with worsening of systemic inflammation, which was determined by HIF-1&alpha; induction linked to the expression of pro- inflammatory proteins and TB, indicating the share and/or co-segregation of the genes involved in AIR.

Les maladies cardiovasculaires constituent un problème de santé publique. Les pré et postconditionnement ischémiques mais aussi pharmacologiques constituent autant d‘avancées qui permettront l‘amélioration de la prise en charge des malades en situation d‘ischémie/reperfusion myocardique. Néanmoins, la morbi-mortalité des maladies cardiovasculaires reste importante et nécessite le développement de nouvelles techniques. Les premiers résultats de la thérapie cellulaire myocardique ont été décevants, et s‘il est désormais établi que l‘on ne peut régénérer le myocarde, les effets bénéfiques observés, notamment avec les cellules souches mésenchymateuses semblent en rapport avec un effet paracrine qui passe par l‘activation de la voie de signalisation PI3kinase/Akt sur un mécanisme comparable à celui du postconditionnement ischémique. Les médiateurs de cet effet sont vraisemblablement des facteurs de croissance comme le VEGF ou l‘IGF-1 même si un effet individuel direct de l‘une ou l‘autre de ces molécules n‘a pu être mis en évidence. La modulation de l‘activité de l‘ATP synthase mitochondriale est également une cible thérapeutique prometteuse. Cette enzyme inverse son activité et hydrolyse l‘ATP durant l‘ischémie, conduisant à dépléter le pool d‘ATP intracellulaire et accélérer la survenue de la mort cellulaire. De nouvelles molécules ayant un effet similaire à l‘IF1 permettent de bloquer cette inversion d‘activité de l‘ATP synthase, de préserver l‘ATP et donc d‘améliorer la survie cellulaire par un effet de type préconditionnement ischémique. Ces 2 techniques, très différentes mais non antinomiques, pourraient faire partie de l‘arsenal thérapeutique dans les années à venir / Cardiovascular diseases are a major problem of public health management. Ischemic and pharmacological pre and postconditioning should significantly improve the prognosis of patients suffering from myocardial ischemia/reperfusion. However, the morbi-mortality of these patients is still high and research must remain active. The first results of myocardial stem cell therapy show that we cannot regenerate myocardium but a recent meta-analysis reported positive effects that can be explained through a paracrine mechanism. Mesenchymal stem cells protect ischemic cardiomyocytes from reperfusion injury through a paracrine activation of the PI3kinase/Akt pathway in a similar way to ischemic postconditioning. The mediators of this protection could be growth factors such as VEGF or IGF-1 though we couldn’t demonstrate a direct effect of one or the other. Modulating the activity of the ATP synthase during ischemia is another promising therapeutic target. This enzyme reverses its activity and hydrolyses ATP when the supply in oxygen is impaired. This leads to the reduction of the cellular pool of ATP and accelerates cell death. We identified new small molecules with a similar effect to IF1 that can selectively inhibit the reverse activity of the ATP synthase, preserve ATP and thus increase cell survival in a preconditioning-like effect. These two different techniques could be part of the therapeutic arsenal against ischemia/reperfusion in the next decades.

Bien qu’il ait prouvé son efficacité dans différentes espèces (lapin, porc, souris,…) ainsi que dans différents organes (rein, foie coeur, poumon,…), le Postconditionnement (PostC) peut être limité par plusieurs facteurs. Parmi les limites du Post C, on note la nécessité de son application à l’initiation de la reperfusion. L’objectif de notre travail était d’évaluer la protection induite par la Basse pression de reperfusion (BP) après un décalage temporel de son application et d’étudier les principales fonctions mitochondriales connues pour être impliquées dans la cardioprotection. Nos résultats nous ont permis de démontrer que, contrairement au PostC, la BP pouvait s’appliquer avec succès même après un décalage temporel de 10 minutes après le début de la reperfusion. Cette protection décalée est en lien avec les fonctions mitochondriales, en particulier, l’inhibition du pore de transition de perméabilité mitochondriale (PTPm). L’utilisation de la cyclosporine A (CsA), puissant inhibiteur de l’ouverture du PTPm, permet également de décaler de 10 minutes la manœuvre de protection à la reperfusion dans le modèle de coeur isolé perfusé de rat. Le PostC, comme la BP, utilise deux sources de production de NO (NOS et Xanthine oxydase reductase) pour induire la cardioprotection. Ces résultats nous semblent importants dans le sens où ils proposent une nouvelle fenêtre thérapeutique pour combattre les dégâts liés à l’ischémie/reperfusion, la BP / Although its efficacy in various species (rabbit, pig, mouse,…) and various organs (kidney, liver heart, lung), Postconditioning (PostC) can be limited by many factors such as the necessity of its application in the initiation of the reperfusion. The objective of our work was to evaluate the protection by low pressure reperfusion (LPR) with delayed intervention at reperfusion and to study the mitochondrial functions which are known to be involved in the cardioprotection. Our results showed that, contrary to PostC, LPR can protect until 10 minutes of its delayed intervention at reperfusion. This delayed protection is in correlation with mitochondrial functions, particularly, inhibition of mitochondrial transition pore (PTPm). Cyclosporine, inhibitor of PTPm, has also shown protection until 10 minutes of delayed intervention, on isolated heart rat model. PostC, like LPR, use tow sources of prodution of NO (NOS and Xanthine oxydase reductase). These results seem, to us, very important because they propose LPR as a new therapeutic window to reduce ischemia/reperfusion injury

La reperméabilisation par thrombolyse, angioplastie ou chirurgie cardiaque des artères coronaires au décours d’un épisode d’ischémie myocardique est à l’origine d’une réduction spectaculaire de la morbi-mortalité de l’insuffisance coronaire aiguë. Elle est cependant la cause de lésions supplémentaires. La recherche de nouvelles approches cardioprotectrices complémentaires des méthodes de reperfusion actuelles est donc indispensable pour réduire les conséquences de l’ischémie myocardique. La découverte de puissants mécanismes cardioprotecteurs endogènes qui consistent en de brefs épisodes d’ischémie-reperfusion (IR) réalisés avant l’ischémie (pré-conditionnement ischémique, PCI) ou lors de la reperfusion (post-conditionnement ischémique) a permis de déterminer les mécanismes intervenant dans l’établissement des lésions d’IR. Le rôle prépondérant de la mitochondrie et l’augmentation de la perméabilité de ses membranes notamment via l’ouverture du pore de transition de perméabilité mitochondriale (mPTP) a pu être mis en évidence.Depré et al. (2001) ont décrit une stratégie cardioprotectrice novatrice : la surexpression de la protéine Hsp22 chez la souris protège le myocarde de l’infarctus et induit l’hypertrophie de ce dernier. Cette protéine est en effet capable d’activer des acteurs clés de la survie cellulaire notamment la voie des NO synthases qui est fortement impliquée dans le processus de PCI.Dans un premier temps, nous avons étudié les effets d’Hsp22 sur les fonctions mitochondriales et analysé le rôle du NO dans ces effets à l’aide d’un modèle murin sur-exprimant Hsp22 dans le myocarde. Nous avons montré qu’à l’état basal, la sur-expression d’Hsp22 augmente la production mitochondriale de NO, ce qui stimule la phosphorylation oxydative et s’accompagne de l’augmentation de la production d’espèces réactives de l’oxygène (ERO) par le complexe I de la chaîne respiratoire mitochondriale. Cette sur-expression réduit également la capacité maximale des complexes I et III à produire des ERO et limite l’ouverture du mPTP. Après anoxie, la sur-expression d’ Hsp22 exacerbe la diminution de phosphorylation oxydative par un mécanisme dépendant du NO et réduit la surproduction d’ERO par la chaîne respiratoire. Ces caractéristiques sont semblables à celles conférées par le PCI. La protéine Hsp22 induit donc au niveau mitochondrial des modifications qui pourraient participer à son effet cardioprotecteur. Une étude sur un modèle d’IR in vivo a permis de confirmer qu’Hsp22 limite fortement la taille de l’infarctus et de montrer que cet effet est associé à une réduction de l’atteinte des fonctions mitochondriales après IR. Les ERO sont des médiateurs clés dans le PCI mais également dans le développement de l’hypertrophie myocardique et du vieillissement prématuré. Or, Hsp22 stimule la production d’ERO mitochondriales, induit une hypertrophie myocardique et un effet cardioprotecteur similaire au PCI. Nous avons donc étudié le rôle des ERO dans les effets induits par Hsp22. Nos résultats ont montré qu’Hsp22 active les principales sources d’ERO cellulaires dans le myocarde aboutissant à un stress oxydant. Cet effet est associé à une forte réduction de la durée de vie des animaux sur-exprimant Hsp22 et à l’apparition de marqueurs de vieillissement prématuré dans le myocarde. Un traitement antioxydant permet de réduire cette sur-production d’ERO ainsi que l’hypertrophie myocardique et de rétablir l’espérance de vie des animaux transgéniques. Enfin, l’effet cardioprotecteur induit par Hsp22 est maintenu avec l’âge et n’est pas dépendant des ERO.En conclusion, l’effet cardioprotecteur durable induit par Hsp22 est associé à une protection des fonctions mitochondriales NO dépendante mais s’accompagne d’un stress oxydant responsable de l’hypertrophie myocardique et de la réduction de la durée de vie. Un traitement antioxydant est capable d’inhiber les effets délétères induits pas Hsp22 sans affecter son effet cardioprotecteur. / Development of reperfusion strategies such as thrombolysis, angioplasty and cardiac surgery to restore blood flow after myocardial ischemia is responsible for a spectacular reduction in deleterious consequences resulting from acute coronary syndrome. However reperfusion itself causes supplementary lesions. Research for new complementary cardioprotective strategies is needed to reduce the impact of myocardial ischemia. The discovery of powerful intrinsic cardioprotective processes consisting in repeated short cycles of ischemia-reperfusion (IR) before the ischemic episode (ischemic preconditioning) or at the moment of the reperfusion (ischemic postconditioning) has allowed to analyze the mechanisms involved in IR lesions and highlighted a crucial role of mitochondria and more particularly of the increase in its membrane permeability via the opening of the mitochondrial permeability transition pore (mPTP). Dr C. Depré et al. (2001) demonstrated that the over-expression of Hsp22 protein coding gene which induced myocardial hypertrophy protected from myocardial infarction. The mechanism of this innovative cardioprotective strategy is not fully understood but Hsp22 promotes the activation of cellular survival pathways such as the NO synthase pathway which is also involved in ischemic preconditioning (Depré et al., 2006).The goal of the first part of our study was to evaluate the effects of Hsp22 on mitochondrial functions and the role of NO in these effects using a transgenic mouse model overexpressing Hsp22 in the heart. Our results showed that Hsp22 overexpression increases mitochondrial NO production which stimulated oxidative phosphorylation in basal state. This was accompanied by an increased in reactive oxygen species (ROS) production by mitochondrial respiratory chain complex I. This overexpression also reduced the maximal capability of complex I and III to produce ROS production and limited mPTP opening. After anoxia, Hsp22 overexpression increaseed oxidative phosphorylation inhibition by a NO-dependent mechanism and limited the burst of ROS production from the respiratory chain.. Thus, Hsp22 modulates mitochondrial functions and this could participate to its cardioprotective effect as these characteristics replicate those of ischemic preconditioning. In the next step, we confirmed that Hsp22 overexpression highly reduced infarct size in an in vivo model of IR and showed that this was associated with a better preservation of mitochondrial functions.As ROS are key mediators of preconditioning but also of myocardial hypertrophy and aging and Hsp22 stimulates mitochondrial ROS production, induces a myocardial hypertrophy and a cardioprotective effect replicating preconditioning, we explored the role of ROS in Hsp22-induced effects in the last part of the study. Our results showed that Hsp22 overexpression activated major cellular sources of ROS leading to myocardial oxidative stress. This was associated with an extensive reduction of lifespan and the appearance of aging markers in the myocardium of young transgenic mice. Antioxidant treatment reduced the overproduction of ROS induced by Hsp22, decreased myocardial hypertrophy and restored lifespan in Hsp22 overexpressing mice showing the role of ROS in these effects. Finally, the cardioprotective effect induced by Hsp22 was maintained in old mice and was not dependent of ROS production. In conclusion, long-lasting cardioprotective effect induced by Hsp22 is associated with a NO-dependent preservation of mitochondrial functions and an oxidative stress responsible for myocardial hypertrophy and reduced lifespan. Antioxidant treatment is able to inhibit deleterious consequences of Hsp22 overexpression without affecting its cardioprotective effect.

Made available in DSpace on 2016-01-26T12:51:46Z (GMT). No. of bitstreams: 1 idamariamfernandescharpiot_tese.pdf: 2769759 bytes, checksum: f77da7f002a249ac9d78cbaceddbde38 (MD5) Previous issue date: 2011-12-12 / Introduction: Renal ischemia is the most important cause of acute kidney injury (AKI). Methylprednisolone (MP) has been shown to give protection against ischemia/reperfusion injury (I/R) in the liver and the heart. Objective: To examine a possible protective role of MP in renal I/R. Methods: Male Wistar rats were treated with 30mg/kg of intravenous MP or saline 1 hour before unilateral renal ischemia (RI), which lasted for 30 minutes. The animals were divided into 3 groups (8 in each group): Sham (sham surgery without RI), Vehicle (Veic)-I/R (saline infusion followed by RI), and the MP-I/R group (MP infusion followed by RI). The glomerular filtration rate (GFR) - which is inulin clearance in ml/min/100g, sodium fractional excretion (FENa), urinary osmolality, and histological analysis were assessed 2 days after RI. Additionally, immunohistochemical staining (2 days after RI) was performed to measure macrophages (ED-1 positive cells), neutrophils (No), and lymphocytes (Lo) and the nuclear factor-&#954;B (NF&#954;-B). Results are expressed as mean ± SD, and were compared by ANOVA, followed by Bonferroni test, with p < 0.05. Results: GFR was 0.92 ± 0.30 ml/min/100g in the MP-I/R group, 0.90 ± 0.27 ml/min/100g in the Sham group, and 0.47 ± 0.24 ml/min/100g in the Veic-I/R group (p < 0.05 vs. MP-I/R and Sham). The FENa was similar in the MP-I/R (0.19%) and Sham groups (0.35%, NS), and higher in the Veic-I/R group (0.62%, p < 0.05 vs. MP-I/R). Urinary osmolality was similar between the 3 groups. Acute epithelial degenerative changes and tubular dilatation were significantly more intense in the Veic-I/R group than the MP-I/R and Sham groups. Only the Veic-I/R group presented with focal acute tubular necrosis. In the cortex, the number of Lo was significantly greater in the Veic-I/R group when compared with the Sham and MP-I/R groups (14.36 ± 3.32 vs. 6.75 ± 1.18 and 5.31 ± 1.63, respectively, p < 0.05 Veic-I/R vs. Sham and MP-I/R) and in the outer medulla (OM) areas (10.58 ± 3.04 vs. 4.51 ± 1.29 and 3.70 ± 0.62, p < 0.05 Veic-I/R vs. Sham and MP-I/R). The number of macrophages was also significantly greater in the Veic-I/R group (9.84 ± 3.18) when compared with Sham (4.65 ± 1.12, p < 0.05) and MP-I/R groups (4.06 ± 1.84, p < 0.05). Similarly, the number of No in the OM was 3.13 ± 2.09 in Veic-I/R vs. 0.74 ± 0.51 in Sham group, and 1.44 ± 1.11 in the MP-I/R group (p < 0.05). The NF&#954;-B expression was more intense in the OM in the Veic-I/R group compared with the Sham and in the MP-I/R groups (0.61 ± 0.33 vs. 0.03 ± 0.03 and 0.12 ± 0.11 respectively, p < 0.05). Conclusion: The pretreatment with high doses of MP conferred striking protection against renal I/R. This protection effect was related to the modulation of I/R-induced inflammatory mechanisms and to inflammatory cell infiltration triggered by I/R. / Introdução: A isquemia renal é a causa mais importante de injúria renal aguda (IRA) hospitalar. A metilprednisolona (MP) tem se mostrado protetora contra a lesão de isquemia/reperfusão (I/R) em fígado e coração. Objetivo: Estudar o possível efeito protetor da MP na lesão de I/R renal. Métodos: Ratos machos Wistar foram tratados com 30mg/kg, por via intravenosa, de MP ou solução de NaCl 0,9%, 1 hora antes de isquemia renal (IR) unilateral de 30 min. Os animais foram divididos em três grupos (n de 8 em cada grupo): Sham (cirurgia sham sem IR), Veículo (Veic)-I/R (infusão de solução de NaCl 0,9% seguida por IR), e MP-I/R (infusão de MP seguida por IR). O RFG (depuração de inulina, ml/min/100g), a fração de excreção de sódio (FENa), a osmolalidade urinária e a análise histológica foram analisados dois dias após IR. Realizou-se também imuno-histoquímica (dois dias após IR) para quantificação de macrófagos (ED-1), neutrófilos (No), linfócitos (Lo) e fator-kapa-B nuclear (NF&#954;-B). Os resultados são expressos como média ± DP e foram comparados por ANOVA, seguido pelo teste de Bonferroni, com p < 0,05. Resultados: O RFG foi 0,92 ± 0,30 ml/min/100g no grupo MP-I/R, 0,90 ± 0,27 ml/min/100g no grupo Sham e 0,47 ± 0,24 ml/min/100g no grupo Veic-IR, (p < 0,05 vs. MP-I/R e Sham). A FENa foi semelhante nos grupos MP-I/R (0,19%) e Sham (0,35%, NS), e maior no grupo Veic-I/R (0,62%, p < 0,05 vs. MP-I/R). Volume e osmolalidade urinária foram similares entre os três grupos. Constataram-se alterações epiteliais degenerativas agudas e dilatação tubular significativamente mais intensas no grupo Veic-I/R em relação aos grupos MP-I/R e Sham. Apenas o grupo Veic-I/R apresentou focos de necrose tubular aguda. O número de Lo foi significativamente maior no grupo Veic-I/R comparado aos grupos Sham e MP-I/R no córtex (14,36 ± 3,32 vs. 6,75 ± 1,18 e 5,31 ± 1,63, respectivamente, p < 0,05 Veic-I/R vs. Sham e I/R-MP) e medula externa (ME) (10,58 ± 3,04 vs. 4,51 ± 1,29 e 3,70 ± 0,62; p < 0,05 Veic-I/R vs. Sham e MP-I/R). O número de macrófagos também foi significativamente maior no grupo Veic-I/R (9,84 ± 3,18) comparado com Sham (4,65 ± 1,12; p < 0,05) e MP-/IR (4,06 ± 1,84; p < 0,05). Da mesma forma, o número de No na medula externa foi 3,13 ± 2,09 em Veic-I/R vs. 0,74± 0,51 em Sham e 1,44 ±1,11 em MP-I/R (p < 0,05 Veic-I/R vs. Sham). A expressão de NF&#954;-B foi significativamente mais intensa na medula externa do grupo Veic-I/R comparada com os grupos Sham e MP-I/R (0,61 ± 0,33 vs. 0,03 ± 0,03 e 0,12 ± 0,11, respectivamente, p < 0,05). Conclusão: O pré-tratamento com doses elevadas de MP protegeu intensamente os animais contra a lesão de I/R renal. Este efeito protetor foi relacionado à modulação de mecanismos de inflamação e infiltração por células inflamatórias desencadeados pela I/R.