Calpains, a highly conserved family of calcium-dependent cysteine proteases, are divided in two groups; classical and non-conventional calpains. Calpain-1 and calpain-2, the classical ones, are ubiquitously expressed and abundant in the CNS. Findings through different experimental approaches, predominantly pharmacological calpain inhibitors, proposed the necessity of the proteases for the modulation of various biological events particularly in the CNS, or a functional link between calpain and neurodegeneration. Significant functions associated with calpain activity are neuronal proliferation/differentiation, signal transduction, apoptosis, and synaptic plasticity; or neuronal death in Alzheimer’s disease, Huntington’s disease, Parkinson’s disease, and ischemic stroke. However, due to limited insights of the approaches taken, such as non-specificity of the inhibitors, the exact roles of calpains in the CNS and the key mechanisms underlying them remain controversial. Calpain-1/calpain-2 germline knock-out are embryonic lethal at a very early stage hindering the use of these lines as mouse models for CNS studies. Accordingly, this thesis research introduced a unique brain-specific calpain-1/calpain-2 knock-out and explored the role of the proteases in brain development/function and in neuronal death. The first set of analyses examined how the elimination of calpain-1/calpain-2 activities in mouse brain impacts CNS development in general and synaptic plasticity in CA1 neurons of hippocampus. CNS-specific elimination of CAPNS1, the common small subunit, abolished calpain-1/calpain-2 activities in mouse brain. In contrast to Calpain-1/calpain-2 germ line knock-outs, the brain-specific knock-outs are viable and the general development of mouse brain is normal. However, morphology of dendrites in pyramidal neurons of the hippocampal CA1 region showed significantly decreased dendritic branching complexity and spine density. Consistent with dendrite morphological abnormalities, electrophysiological analyses revealed a significant decrease in field excitatory postsynaptic potentials, long term potentiation, and learning and memory in the hippocampal CA1 neurons of the mutants. In the second part of this research we investigated the direct role of the calpains in neuronal death and their potential downstream targets in in vitro models of PD and ischemic stroke. Our findings indicated that ablation of calpains activity improves survival of different types of neurons against mitochondrial toxin 1-methyl-4-phenylpyridinium (MPP+), glutamate, and hypoxia. Importantly, we demonstrated an increase in p35-cleavage to p25, a cyclin dependent kinase 5 (Cdk5) activator, and that restoration of p25 significantly suppresses the neuronal survival associated with calpain deficiency. Taken together, this work unequivocally establishes two central roles of calpain-1/calpain-2 in CNS function in plasticity and neuronal death.

The goal of this study was to derive a clinical prediction rule for transient ischemic attack (TIA) and non-disabling stroke to predict a treatment change based on echocardiogram. Methods: We conducted a cohort sub-study for TIA and non-disabling stroke patients collected over five years from 8 Emergency Departments. We compiled a list of 27 potential predictors to look for treatment change based on echocardiogram findings. We used a univariate, logistic regression and recursive partitioning analysis to develop the final prediction model. Results: The frequency of treatment change was seen in 87 (3.1%) of 2804 cases. The final model contains six predictors: age less than 50 years old, coronary artery disease history, history of heart failure, any language deficit, posterior circulation infarct and middle cerebral artery infarct on neuroimaging. Conclusions: We have developed a highly sensitive clinic prediction rule to guide in the use of echocardiogram in TIA and non-disabling stroke.

An increasing body of evidence points to a key role of endoplasmic reticulum (ER) stress in chronic and acute neurodegenerative diseases. Indeed, markers of ER stress are common features of neurons destined to die in these conditions. In the present study we demonstrate that PUMA, a BH3-only member of the Bcl-2 family is essential for ER stress-induced cell death. PUMA is known to be a key transcriptional target of p53, however we have found that ER stress triggers PUMA induction and cell death through a p53-independent mechanism involving instead the ER stress inducible transcription factor ATF4. Specifically, we demonstrate that ectopic expression of ATF4 sensitizes neurons to ER stress induced apoptosis, and that ATF4-deficient neurons exhibit markedly reduced levels of PUMA expression and cell death. However, chromatin immunoprecipitation experiments suggest that ATF4 does not directly regulate the PUMA promoter. Rather, we found that ATF4 induces expression of the transcription factor CHOP, and that CHOP in turn directly activates PUMA induction. Specifically, we demonstrate that CHOP binds to the PUMA promoter during ER stress and that CHOP knockdown attenuates PUMA induction and neuronal apoptosis. In summary, we have identified a key signaling pathway in ER stress induced neuronal death involving ATF4-CHOP mediated transactivation of the pro-apoptotic Bcl-2 family member PUMA. Protein aggregates and markers of ER stress response have also been observed in dying neurons in several animal models of cerebral ischemia. Therefore, to decipher the significance of the ER stress apoptotic response, we investigate the role of ATF4-CHOP signaling pathway in ischemic neuronal injury. Ischemic stroke results from a transient or permanent reduction in cerebral blood flow in the brain. In spite of much research in trying to develop therapeutic strategies, most clinical trials have failed. These failures demonstrate that effective treatments require a more complete understanding of molecular signals that lead to neuronal death. However, stroke is a complex scenario since distinct mechanisms may involve in rapid and/or delayed neuronal death. The signaling pathways regulating these mechanisms however are not fully defined. Previous studies had suggested that ER stress playing a pivotal role in post-ischemic neuronal death. Yet, the relevance of ER stress signals was not fully known in ischemic neuronal injury. Accordingly, this thesis research attempts to explore the functional role of ER stress -inducible pathway, ATF4-CHOP axis, in different models of neuronal death (delayed and excitotoxic cell death) evoked by ischemia. The data indicates that ATF4 is essential in delayed type of death in vitro. In focal ischemia model (tMCAO) ATF4 also plays a role as a mediator of death signal in vivo. However, CHOP function looks more complex, and our data did not support the role of CHOP in ischemic neuronal death.

L’accident vasculaire cérébral ischémique reste un problème majeur de santé publique, contre lequel l’arsenal thérapeutique reste très limité. L’atorvastatine (AT), utilisée en prévention cardiovasculaire, possède des effets pléiotropes lui conférant un pouvoir protecteur dans l’AVC. Les objectifs de cette thèse étaient d’évaluer et de caractériser les effets neuro- et vasculoprotecteurs de l’AT dans l’ischémie cérébrale, et la part jouée par le récepteur nucléaire PPARα. Des souris C57BL/6J sauvages et KO-PPARα ont été soumises à ischémie-reperfusion (I/R) cérébrale. Elles étaient traitées par AT préventivement pendant 14 jours ou après I/R pendant 24 ou 72 heures. L’effet neuroprotecteur est évalué histologiquement et par des tests fonctionnels moteurs. L’effet vasculoprotecteur est évalué sur l’artère cérébrale moyenne par étude de la fonction endothéliale et sur les microvaisseaux cérébraux par étude de leur structure et des interactions leucocytes-endothélium. Le traitement préventif et aigu par AT induit une diminution du volume lésionnel, et une amélioration de la récupération fonctionnelle chez les animaux traités à la phase aiguë. Le traitement aigu permet de préserver la fonction endothéliale et l’intégrité des microvaisseaux cérébraux, et de limiter les interactions leucocytes-endothélium. PPARα est nécessaire aux effets neuro- et vasculoprotecteurs de l’AT dans l’ischémie cérébrale. Ce travail met en évidence l’intérêt de l’atorvastatine en tant qu’agent neuroprotecteur pléiotrope dans l’ischémie cérébrale. / Ischemic stroke still is a heavy public health burden, as effective therapeutic means remain scarce. Atorvastatin (AT), widely used as a preventive treatment in the cardiovascular field, possesses pleiotropic effects that give it protective properties in stroke. The goals of this work were to assess and characterize the neuro- and vasculoprotective effects of AT in cerebral ischemia, and the part played by PPARα. Wild-type and PPARα-KO C57BL/6J mice were submitted to cerebral ischemia-reperfusion (I/R). They were treated with AT before I/R for 14 days or acutely after I/R for 24 or 72 hours. Neuroprotection is assessed histologically and by a motor functional evaluation. Vasculoprotection is assessed on the middle cerebral artery by evaluating the endothelial function and on cerebral microvessels by evaluating their structure and the interactions between leukocytes and the vascular wall. Preventive and acute treatments with AT induce a reduction in lesion volumes, functional recovery was improved in acutely treated animals. The acute treatment with AT preserves the endothelial function and the microvascular integrity, and reduces the interactions between leukocytes and the endothelium. PPARα is necessary for AT neuro- and vasculoprotective effects to take place. This works highlights the interest of atorvastatin as a pleiotropic neuroprotective agent in ischemic stroke.

Hydrogen sulfide (H2S) is a gasotransmitter that has shown cardioprotective effects in the setting of myocardial injury such as acute myocardial infarction (MI) and pressure overload-induced heart failure. However, there are shortcomings in precision and control release from the use of traditional formulations of H2S in the form of inorganic salts. In this thesis, we sought to determine if the novel, orally active, slow-releasing H2S-compound SG1002 plays a role in attenuating MI-induced left ventricular (LV) dysfunction and adverse remodeling. We also evaluated the effect of SG1002 on changes in ECG parameters such as QT interval, in addition to 28-day survival post MI. SG1002 protects against ischemic cardiomyopathy in mice by mitigating LV dysfunction as measured by echocardiography and decreasing LV scar size as measured by histopathological methods. The improvement in survival might be due to the reduction in QT interval prolongation hence lessening the likelihood of forming lethal arrhythmias post MI. Western blot analyses of SG1002 treated mice showed restoration of VEGF levels indicating a pivotal role played by pro-angiogenic signaling in the improvement of cardiac function and attenuation of adverse remodeling. We propose that SG1002 can be a promising pharmacotherapeutic means for the treatment of ischemic heart failure.

INTRODUÇÃO: Baseados em estudo que evidenciou menor área de infarto do miocárdio (IM) em ratos submetidos a treinamento físico (TF),na ausência de reperfusão; e na liberação de endorfinas que ocorre durante o TF, nossos objetivos são: demonstrar se não só TF, mas também opióides e isquemia/reperfusão (IR) intermitente são capazes de reduzir área de IM, na ausência de reperfusão; se TF e opióides exibem efeito sinérgico e se o mecanismo de redução da área de IM pelo TF envolve receptores opióides. MATERIAIS E MÉTODOS: Ratos Wistar machos (n=76) foram divididos em 7 grupos:1- controle;2- TF (esteira elétrica,1 hora/dia,5 vezes/semana,por 12 semanas), antes do IM; 3- morfina antes do IM; 4- morfina+TF; 5- grupo com 3 ciclos de IR antes do IM; 6- naloxone antes da morfina; 7- naloxone antes de cada dia de TF. Todos os ratos foram submetidos à mensuração da pressão diastólica final (PDF) e a IM através da oclusão da artéria descendente anterior. A eficácia do TF foi avaliada através do consumo de oxigênio (VO2) e da distância máxima percorrida. Os ratos foram sacrificados no 8o pós-IM e a área de IM mensurada por planimetria. RESULTADOS: Não houve diferença no peso inicial (p=0,94), mortalidade (p=0,99), e relação peso cardíaco/peso corporal (p=0,29) entre os grupos. Entretanto, houve aumento do deltaVO2 (VO2 pico - VO2repouso) (p=0,0001)e da distância máxima percorrida (p=0,0001), nos grupos treinados. A PDF aumentou no pós-IM, em todos os grupos (p=0,0001). Os grupos tratados tiveram menor área de IM (p=0,0001), com exceção dos grupos morfina + naloxone e TF+ naloxone sendo que não houve maior redução no grupo TF+morfina. Os grupos TF e TF+morfina apresentaram maior espessura do septo inter-ventricular, em relação ao grupo controle (p=0,0008). Já o grupo TF + naloxone não apresentou maior espessura do septo IV, em relação aos outros grupos. Também não houve diferença na densidade capilar (p=0,88). CONCLUSÃO: Não só TF, mas também morfina e IR reduzem a área de IM, na ausência de reperfusão, sendo que não há efeito sinérgico entre TF e morfina. Esta redução não ocorre através do aumento da densidade capilar. Além disto, a ação do TF sobre a área de IM provavelmente ocorre através do estímulo de receptores opióides, visto que seu bloqueio anulou o efeito cardioprotetor do TF / BACKGROUND AND OBJECTIVES: Studies have shown a decrease in infarcted area in rats submitted to exercise training (ET), in the absence of reperfusion. Based on that, we tested four hypotheses: 1- not only ET but also another stimulus that causes myocardial protection, like opioid infusion and brief periods of ischemia-reperfusion (IR) before irreversible left anterior descending (LAD) coronary occlusion could reduce infarct area, 2- ET plus opioid infusion could have additive effects in reducing infarct size, 3- blocking the opioid system we could lose the myocardial protection caused by ET, 4-myocardial protection given by different strategies could occur due to the increase in capillary density. METHODS: Male Wistar rats (n=76) were randomly assigned to 7 groups: control (n=11); ET (n=12); morphine infusion before myocardial infarction (MI) (n=14); ET plus morphine (n=11); naloxone (a non selective opioid receptor blocker) plus morphin (n=9); intermittent IR (n=12) before MI; naloxone before each ET session (n=7). All groups were submitted to MI by LAD ligation technique and to measurement of left ventricular end-diastolic pressure (LVEDP) before and 5 min after MI. ET was performed on a treadmill for 60 min, 5 times/week for 12 weeks at 60% peak oxygen (peak VO2). To evaluate the efficacy of ET, we tested the exercise capacity and the peak VO2 before and after experimental period. Seven days after MI induction, rats were killed and hearts were harvested. Infarct size was expressed by evaluation of necrotic area, expressed as a % of the risk region (total left ventricle area). RESULTS: There were no differences in initial weight, cardiac/animal weight or mortality among groups. Exercise training increased exercise capacity (p=0.0001) and delta VO2 (VO2 peak-VO2 rest) (p=0.0001). Inter-ventricular septum thickness was higher in the ET and ET plus morphine groups, compared to the control group (p=0.0008). The LVEDP increased in the post-MI period, for all groups (p=0.0001). All treatment groups but not morphine plus naloxone and ET plus naloxone showed a decrease in infarcted area (p=0.0001). There was no additional decrease in infarct size in the ET+ morphine group, comparing with each group alone . There was no difference in capillary density for all groups. CONCLUSION: Not only ET, but also morphine and IR decrease infarcted area, in the absence of reperfusion. There is no additional effect between ET and morphine. Moreover, this reduction is not due to an increase in capillary density. The effect of ET in decreasing infarct size might occur by opioid receptor stimulus

From gametogenesis until death an organism’s genome is under constant bombardment from endogenous and exogenous sources of DNA damage. To maintain genomic integrity amid this damage, cells have evolved responses which allow them to either preserve viability for recovery or initiate self-destructive pathways depending on the severity of DNA damage. One protein involved in initiating and carrying out these responses is the protein kinase ataxia telangiectasia and Rad3-related (ATR). ATR is known primarily for its regulatory role in initiating the checkpoint-signaling cascade following DNA damage and replicative stress. These signaling events lead to cell cycle arrest, DNA repair, or apoptosis when damage is too extreme. In addition to these kinase-dependent roles, ATR also is capable of directly blocking the intrinsic apoptotic pathway through structural sequestration of the proapoptotic protein tBid. The sum of these regulatory events is a delicate balancing act resulting in either cell death or cell survival depending on the severity of the damage and the differentiation state of the cell in question. In the following studies, we sought to investigate the complex interplay of ATR’s kinase and structural roles in determining cellular fate. First, we investigated the structural role of prolyl isomerization of ATR across development by using mouse models of two isomerically locked forms of ATR which were previously shown to lock cytoplasmic ATR into a single isomer. Studies showed that ATR which is locked in ATR-L (trans-ATR, hATR-P429A/mATR-P432A) is embryonically lethal and that heterozygotes tend to have neurological and other developmental abnormalities. This contrasts with ATR-H (cis-ATR, hATR-S428A/mATR-S431A), which is viable, but naturally prone to cancer development. Next, we used various in vitro stroke-like conditions to test if ATR inhibition could serve as a therapeutic target for stroke. We found that ATR inhibition is protective in non-dividing neuron-like cells; whereas, it potentiates death in cycling glial and immune-like cycling cells. Thus, ATR inhibition could likely be a target for both neuron sparing and immunosuppressive anti-stroke therapeutic strategies. Taken together, these studies provide insightful information into the structural and pathological roles of ATR in development and disease.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22336号 / 医博第4577号 / 新制||医||1041(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 高橋 淳, 教授 渡邉 大, 教授 伊佐 正 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13380号 / 論医博第2214号 / 新制||医||1047(附属図書館) / 京都大学大学院医学研究科外科系専攻 / (主査)教授 山下 潤, 教授 木村 剛, 教授 浅野 雅秀 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

The final publication is available at http://dx.doi.org/10.1016/j.jtcvs.2013.11.054. Motoaki Ohnaka, Akira Marui, Kenichi Yamahara, Kenji Minakata, Kazuhiro Yamazaki, Motoyuki Kumagai, Hidetoshi Masumoto, Shiro Tanaka, Tadashi Ikeda, Ryuzo Sakata, Effect of microRNA-145 to prevent vein graft disease in rabbits by regulation of smooth muscle cell phenotype, The Journal of Thoracic and Cardiovascular Surgery, Volume 148, Issue 2, August 2014, Pages 676-682.e2, ISSN 0022-5223. / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18544号 / 医博第3937号 / 新制||医||1006(附属図書館) / 31444 / 京都大学大学院医学研究科医学専攻 / (主査)教授 木村 剛, 教授 野田 亮, 教授 瀬原 淳子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM