<p>The physiology of the tumor microenvironment is characterized by lower oxygen (hypoxia), higher lactate, extracellular acidosis and glucose starvation. We examined the global, transcriptional cellular responses to each of these microenvironmental stresses in vitro, projected them onto clinical breast cancer patients' samples in vivo, and returned to perform further in vitro experiments to investigate the potential mechanisms involved in these stress responses. The reciprocal exchange of information was critical and advanced our understanding of the potential clinical relevance of cellular responses. </p> <p>Our expression array result showed that lactic acidosis induces a strong response, distinct from that of hypoxia in human mammalian epithelial cells (HMECs), indicating lactic acidosis is not only a by-product of hypoxia but has a unique role as a stimulant to cells in the tumor microenvironment. Cellular responses to lactosis and acidosis further demonstrated that acidosis was the main driving force in the lactic acidosis response. These responding gene signatures were then statistically projected into clinical breast cancer patients' expression data sets. The hypoxia response, as reported previously, was associated with bad prognosis, where as the lactic acidosis and acidosis responses, were associated with good prognosis. Additionally, the acidosis response could be used to separate breast tumors with high versus low aggressiveness based on its inversed correlation with metastatic character. We further discovered that lactic acidosis, in contrast to hypoxia, abolished Akt signaling. Moreover, it downregulated glycolysis and shifted energy utilization towards aerobic respiration.</p> <p>We continued to examine the cellular response to lactic acidosis temporally in MCF7 cells, a breast cancer cell line. The lactic acidosis response of MCF7 cells also showed the prognostic result of better clinical outcomes in datasets of breast cancer patients. The lactic acidosis responses of HMEC and MCF cells were highly correlated. Strikingly in MCF7 cells, lactic acidosis and glucose deprivation actually induced similar transcriptional profiles, with only a few genes being oppositely regulated. Furthermore, lactic acidosis, similar to glucose starvation, induced AMPK signaling and abolished mTOR. However, lactic acidosis and glucose deprivation induced opposite glucose uptake phenotypes. Lactic acidosis significantly repressed glucose uptake whereas glucose deprivation significantly induced it. Among the genes differentially regulated by these two stresses, thioredoxin-interacting protein (TXNIP) was among the most different. The negative regulatory role of TXNIP on glucose uptake has been demonstrated previously. In the cancer research field, TXNIP is recognized as a tumor suppressor gene. We observed that lactic acidosis induced TXNIP strongly and most importantly, TXNIP played a critical role in regulating glucose uptake in cells under lactic acidosis. Furthermore, MondoA, the transcription factor and glucose sensor previously reported to regulate TXNIP induction upon glucose exposure, was also responsible for regulating TXNIP under lactic acidosis. We demonstrated that TXNIP not only plays an important role in the lactic acidosis response but also has strong prognostic power to separate breast cancer patients based on survival.</p> / Dissertation

The basis of this thesis is intended to inform the reader about the general complications of acute diabetes mellitus and its consequences. It focuses on the general definitions of the diseases, etiology, morbidity, mortality, pathogenesis of the disease, clinical presentation, treatment, and future developments in hopes of treating the disease. The major focus highlights the differences between diabetic ketoacidosis and hyperglycemic hyperosmolar state, as well as understanding the complications of diabetic hypoglycemia. The most critical effects of these disorders are also emphasized; cerebral edema, vascular thrombosis, and hyperchloremic metabolic acidosis.

Theses (Msc.(Med.)(Pharmacy))--University of Limpopo, 2010. / With the availability of Highly Active Antiretroviral Therapy (HAART), one of the limitations of treatment safety is the occurrence of adverse events associated with antiretroviral agents. The aim of this study was to establish whether stavudine dosage reduction prevents toxicity from developing and minimizes the incidence of symptomatic hyperlactataemia/lactic acidosis (LA) in adults female HIV/AIDS infected patients. This retrospective study covered adult patients treated at the adult ARV clinic, Dr George Mukhari Hospital. The records of 88 patients aged between 27 and 59 years, initiated and treated from August 2004 to January 2006, were analyzed ( 67 females and 21 males). Twenty nine females started their treatment on a regimen containing 40 mg stavudine while 38 females were started on 30 mg stavudine. A group of male patients (n=21) were included for comparison. Seven males started on 40 mg stavudine and 14 were on 30 mg stavudine. Ten out of twenty nine females who started treatment on 40 mg stavudine developed elevated lactate levels while nineteen received 30 mg stavudine as reduced dose. Eight out of nineteen further developed elevated lactate levels when on 30 mg stavudine but eleven out of nineteen remained stable on treatment with 30 mg stavudine as reduced dose. In the group started on 30 mg stavudine, thirteen females out of thirty seven developed elevated lactate levels while twenty four were stable on their treatment. Key words: stavudine, dosage reduction, lactate levels, hyperlactataemia, lactic acidosis.

Organic acids, including L- and D-lactate, explain most but not the entire elevated anion gap in diarrhea-associated metabolic acidosis. Also, D-lactate has been implicated in the neurological symptoms associated with this condition. Less-common organic compounds may influence the anion gap and neurological symptoms. This research aimed to characterize and attempt to identify a previously unidentified compound, Compound X, first noted in diarrheic acidotic calves with elevated anion gap (Omole, 1999).<p> High performance liquid chromatography (HPLC) was used to measure Compound X in biological fluids from diarrheic and healthy calves; diarrheic piglets, foals, and human infants; and calves experimentally infused with saline or acid. Attempts were made to identify Compound X using HPLC with tandem and Fourier-transform mass spectrometry.<p> Compound X was significantly higher in diarrheic calf serum (p<0.001) and lower in feces (p<0.001) and rumen fluid (p<0.001) than those fluids from healthy calves. Compound X in serum from acid-infused calves (median peak area ratio = 1.5 1.9) was lower than that of diarrheic calves (median = 4.8) and only slightly greater than that of healthy calves (median = 1.2). Serum Compound X correlated with serum D-lactate in diarrheic and healthy calves combined; however, no such correlation was observed in acid-infused calves. Conversely, a relationship between Compound X and neurological disturbance was present in acid-infused calves, but not in diarrheic calves. In other species, Compound X was highest in diarrheic infants and lowest in diarrheic piglets. Although mass spectrometry and database library searches revealed several compounds as putative matches for Compound X, none of the compounds made sense within the context of acidosis and mammalian biological fluids. Therefore, the identity of Compound X remains unknown.<p> Compound X has been established as a ubiquitous compound(s) present in the biological fluids of mammals. Compound X may be a normal intestinal compound or bacterial metabolite that crosses the intestinal epithelium during diarrhea. In spite of this, Compound X was associated with the neurological manifestations of D-lactic acidosis. Compound X`s identity was not determined, and some reasons for this and future directions are discussed.

Organic acids, including L- and D-lactate, explain most but not the entire elevated anion gap in diarrhea-associated metabolic acidosis. Also, D-lactate has been implicated in the neurological symptoms associated with this condition. Less-common organic compounds may influence the anion gap and neurological symptoms. This research aimed to characterize and attempt to identify a previously unidentified compound, Compound X, first noted in diarrheic acidotic calves with elevated anion gap (Omole, 1999).<p> High performance liquid chromatography (HPLC) was used to measure Compound X in biological fluids from diarrheic and healthy calves; diarrheic piglets, foals, and human infants; and calves experimentally infused with saline or acid. Attempts were made to identify Compound X using HPLC with tandem and Fourier-transform mass spectrometry.<p> Compound X was significantly higher in diarrheic calf serum (p<0.001) and lower in feces (p<0.001) and rumen fluid (p<0.001) than those fluids from healthy calves. Compound X in serum from acid-infused calves (median peak area ratio = 1.5 1.9) was lower than that of diarrheic calves (median = 4.8) and only slightly greater than that of healthy calves (median = 1.2). Serum Compound X correlated with serum D-lactate in diarrheic and healthy calves combined; however, no such correlation was observed in acid-infused calves. Conversely, a relationship between Compound X and neurological disturbance was present in acid-infused calves, but not in diarrheic calves. In other species, Compound X was highest in diarrheic infants and lowest in diarrheic piglets. Although mass spectrometry and database library searches revealed several compounds as putative matches for Compound X, none of the compounds made sense within the context of acidosis and mammalian biological fluids. Therefore, the identity of Compound X remains unknown.<p> Compound X has been established as a ubiquitous compound(s) present in the biological fluids of mammals. Compound X may be a normal intestinal compound or bacterial metabolite that crosses the intestinal epithelium during diarrhea. In spite of this, Compound X was associated with the neurological manifestations of D-lactic acidosis. Compound X`s identity was not determined, and some reasons for this and future directions are discussed.

Foram utilizados neste experimento quatro garrotes Jersey (J) e quatro Gir (G), providos de cânula ruminal. Dois meses antes da indução da acidose láctica ruminal (ALR), os animais foram alimentados com dieta padronizada a base de feno e concentrado. A ALR foi induzida experimentalmente por meio da administração de sacarose intraruminal, correspondente ao peso metabólico corrigido, segundo técnica descrita por ORTOLANI (l995). Colheitas de sangue, suco de rúmen, urina, fezes e exames clínicos foram realizados nos seguintes momentos após a indução: zero, 14, 16, 18, 20, 22 e 24 horas. O pH e as concentrações de ácido láctico total, D e L e de seus sais foram determinados em todos os materiais biológicos colhidos. No sangue foram avaliados o hematócrito, os exames gasométricos e a concentração de creatinina; esta última substância também foi determinada na urina. Após a última colheita, todo o conteúdo ruminal foi completamente retirado para a determinaçãodo seu volume. Os bovinos de ambas as raças apresentaram marcante e idêntica acidose ruminal, não ocorrendo diferença no pH e na concentração de ácido láctico total, L e D no suco de rúmen. A acidose metabólica sistêmica foi moderada em ambas as raças, porém esta foi mais intensa nos bovinos J, confirmada pelas menores concentrações médias de bicarbonato e TCO2 (P < 0,00001) e pelo menor pH sangüíneo, (p < 0,025). Os garrotes J absorveram maiores quantidades de ácido láctico total e do isômero D; este último apresentou correlação negativa com o pH sangüíneo nesta raça (r = -O,78). Os garrotes G apresentaram maior capacidade homeostática de manutenção de pH sangüíneo no final da indução, provavelmente pela maior metabolização do lactato-L. Entretanto, os mesmos animais tiveram maior grau de desidratação, evidenciado pelas maiores porcentagens de hematócrito e de déficit de volume plasmático (p < 0,00001). Nessa raça ocorreu uma menor filtração glomerular, demonstrada pela maior concentração sérica de creatinina (p < 0,00001), menor depuração deste catabólito (p < 0,003) e menor volume urinário estimado (p < 0,05). Não ocorreram diferenças significativas no pH fecal entre as raças estudadas. Houve correlação negativa entre a concentração de lactato total fecal e o correspondente pH (r = - 0,65). / Four Jersey (J) and four Gir (G) rumen-cannulated steers were used. The steers were fed, for two months before the beginning of the rumen lactic acidosis (RLA) induction, a standard diet of hay and concentrates. The RLA was induced experimentally through the administration of sucrose into the rumen, according to the corrected metabolic weight, after ORTOLANI (1995). Blood, rumen fluid, urine, and fecal samples were collected and clinical examination carried out in the following times after the induction: zero, 14, 16, 18, 20, 22 and 24 hours. The pH, the total lactic acid and its L and D isomers were determined in all samples. The hematocrit, acid-base variables and the creatinine concentration were determined in the blood samples; creatinine was also determined in the urine samples. All the rumen content was evacuated in order to evaluate its volume at the 24th h. A intense rumen acidosis was reached; no differences in the rumen fluid pH and in the concentration of the total lactic acid and its isomers were found in both studied breeds. A moderate level of systemic metabolic acidosis was reached in both breeds, but lower overall mean of bicarbonate and TCO2 (p < 0.0001) as well as blood pH (p < 0.025) were found in the J steers. These steers absorbed higher amounts of total lactic and its D isomer than the G animals; the higher the blood D-lactate concentration, the lower the blood pH (r = - O.78) in the former breed. Better blood pH homeostasis were kept, at the end of induction, by the G steers, probably by their higher efficiency to metabolize L-lactate. However, the G steers exhibited a higher level of dehydration as seen by the greater hematocrit and plasma volume deficit (p < 0.00001). They also presented a lower glomerular filtration as evidenced by the higher creatinine serum levels (p < 0.00001), its lower urinary clearance (p < 0.003) and the lower estimated urinary volume (p < 0.05). There were no differences in the fecal pH values presented by both breeds. There was a negative correlation between the fecal total lactate concentration and the fecal pH (r = - 0.65).

Hereditary myopathy with lactic acidosis (HML, OMIM#255125) is an autosomal recessive disorder which originates from Västerbotten and Ångermanland in the Northern part of Sweden. HML is characterized by severe exercise intolerance which manifests with tachycardia, dyspnea, muscle pain, cramps, elevated lactate and pyruvate levels, weakness and myoglobinuria. The symptoms arise from malfunction of the energy metabolism in skeletal muscles with defects in several important enzymes involved in the TCA cycle and the electron transport chain. All affected proteins contain iron-sulfur (Fe-S) clusters, which led to the suggestion that the disease was caused by malfunctions in either the transportation, assembly or processing of Fe-S clusters. The aim of my thesis was to identify the disease causing gene of HML and to investigate the underlying disease-mechanisms. In paper I we identified a disease-critical region on chromosome 12; a region containing 16 genes. One of the genes coded for the Fe-S cluster assembly protein ISCU and an intronic base pair substitution (g.7044G&gt;C) was identified in the last intron of this gene. The mutation gave rise to the insertion of intron sequence into the mRNA, leading to a protein containing 15 abberant amino acids and a premature stop. In paper II we investigated why a mutation in an evolutionary well conserved protein with a very important cellular role, which in addition is expressed in almost all tissues, gives rise to a muscle-restricted phenotype. Semi-quantitative RT-PCR analysis showed that the mutant transcript constituted almost 80% of total ISCU mRNA in muscle, while in both heart and liver the normal splice form was dominant. We could also show that, in mice, complete absence of Iscu protein was coupled with early embryonic death, further emphasizing the importance of the protein in all tissues. These data strongly suggested that tissue-specific splicing was the main mechanism responsible for the muscle-specific phenotype of HML. In paper III the splicing mechanisms that give rise to the mutant ISCU transcript was further investigated. We identified three proteins; PTBP1, IGF2BP1 and RBM39, that could bind to the region containing the mutation and could affect the splicing pattern of ISCU in an in vitro system. PTBP1 repressed the inclusion of the intronic sequence, while IGF2BP1 and RBM39 repressed the total ISCU mRNA level though the effect was more pronounced for the normal transcript. Moreover, IGF2BP1 and RBM39 were also able to reverse the effect of PTBP1. IGF2BP1, though not a splicing factor, had higher affinity for the mutant sequence. This suggested that the mutation enables IGF2BP1 binding, thereby preventing the PTBP1 induced repression seen in the normal case. In conclusion, we have determined the genetic cause of HML, identifying a base pair substitution in the last intron of the ISCU gene that gives rise to abnormally spliced transcript. The muscle-specific phenotype was also analyzed and tissue-specific splicing was identified as the main disease-mechanism. Furthermore, nuclear factors with ability to affect the splicing pattern of the mutant ISCU gene were identified. This work has thoroughly investigated the fundamental disease mechanisms, thus providing deeper understanding for this hereditary myopathy.

<p>In order to propagate a solid tumor, cancer cells must adapt to and survive under various tumor microenvironment (TME) stresses, such as hypoxia or lactic acidosis. Additionally, cancer cells exposed to these stresses are more resistant to therapies, more likely to metastasize and often are worse for patient prognosis. While the presence of these stresses is generally negative for cancer patients, since these stresses are mostly unique to the TME, they also offer an opportunity to develop more selective therapeutics. If we achieve a better understanding of the adaptive mechanisms cancer cells employ to survive the TME stresses, then hopefully we, as a scientific community, can devise more effective cancer therapeutics specifically targeting cancer cells under stress. To systematically identify genes that modulate cancer cell survival under stresses, we performed shRNA screens under hypoxia or lactic acidosis. From these screens, we discovered that genetic depletion of acetyl-CoA carboxylase alpha (ACACA or ACC1) or ATP citrate lyase (ACLY) protected cancer cells from hypoxia-induced apoptosis. Furthermore, the loss of ACLY or ACC1 reduced the levels and activities of the oncogenic transcription factor ETV4. Silencing ETV4 also protected cells from hypoxia-induced apoptosis and led to remarkably similar transcriptional responses as with silenced ACLY or ACC1, including an anti-apoptotic program. Metabolomic analysis found that while α-ketoglutarate levels decrease under hypoxia in control cells, α-ketoglutarate was paradoxically increased under hypoxia when ACC1 or ACLY were depleted. Supplementation with α-ketoglutarate rescued the hypoxia-induced apoptosis and recapitulated the decreased expression and activity of ETV4, likely via an epigenetic mechanism. Therefore, ACC1 and ACLY regulated the levels of ETV4 under hypoxia via increased α-ketoglutarate. These results reveal that the ACC1/ACLY-α-ketoglutarate-ETV4 axis is a novel means by which metabolic states regulate transcriptional output for life vs. death decisions under hypoxia. Since many lipogenic inhibitors are under investigation as cancer therapeutics, our findings suggest that the use of these inhibitors will need to be carefully considered with respect to oncogenic drivers, tumor hypoxia, progression and dormancy. More broadly, our screen provides a framework for studying additional tumor cell stress-adaption mechanisms in the future.</p> / Dissertation

Foram utilizados neste experimento quatro garrotes Jersey (J) e quatro Gir (G), providos de cânula ruminal. Dois meses antes da indução da acidose láctica ruminal (ALR), os animais foram alimentados com dieta padronizada a base de feno e concentrado. A ALR foi induzida experimentalmente por meio da administração de sacarose intraruminal, correspondente ao peso metabólico corrigido, segundo técnica descrita por ORTOLANI (l995). Colheitas de sangue, suco de rúmen, urina, fezes e exames clínicos foram realizados nos seguintes momentos após a indução: zero, 14, 16, 18, 20, 22 e 24 horas. O pH e as concentrações de ácido láctico total, D e L e de seus sais foram determinados em todos os materiais biológicos colhidos. No sangue foram avaliados o hematócrito, os exames gasométricos e a concentração de creatinina; esta última substância também foi determinada na urina. Após a última colheita, todo o conteúdo ruminal foi completamente retirado para a determinaçãodo seu volume. Os bovinos de ambas as raças apresentaram marcante e idêntica acidose ruminal, não ocorrendo diferença no pH e na concentração de ácido láctico total, L e D no suco de rúmen. A acidose metabólica sistêmica foi moderada em ambas as raças, porém esta foi mais intensa nos bovinos J, confirmada pelas menores concentrações médias de bicarbonato e TCO2 (P < 0,00001) e pelo menor pH sangüíneo, (p < 0,025). Os garrotes J absorveram maiores quantidades de ácido láctico total e do isômero D; este último apresentou correlação negativa com o pH sangüíneo nesta raça (r = -O,78). Os garrotes G apresentaram maior capacidade homeostática de manutenção de pH sangüíneo no final da indução, provavelmente pela maior metabolização do lactato-L. Entretanto, os mesmos animais tiveram maior grau de desidratação, evidenciado pelas maiores porcentagens de hematócrito e de déficit de volume plasmático (p < 0,00001). Nessa raça ocorreu uma menor filtração glomerular, demonstrada pela maior concentração sérica de creatinina (p < 0,00001), menor depuração deste catabólito (p < 0,003) e menor volume urinário estimado (p < 0,05). Não ocorreram diferenças significativas no pH fecal entre as raças estudadas. Houve correlação negativa entre a concentração de lactato total fecal e o correspondente pH (r = - 0,65). / Four Jersey (J) and four Gir (G) rumen-cannulated steers were used. The steers were fed, for two months before the beginning of the rumen lactic acidosis (RLA) induction, a standard diet of hay and concentrates. The RLA was induced experimentally through the administration of sucrose into the rumen, according to the corrected metabolic weight, after ORTOLANI (1995). Blood, rumen fluid, urine, and fecal samples were collected and clinical examination carried out in the following times after the induction: zero, 14, 16, 18, 20, 22 and 24 hours. The pH, the total lactic acid and its L and D isomers were determined in all samples. The hematocrit, acid-base variables and the creatinine concentration were determined in the blood samples; creatinine was also determined in the urine samples. All the rumen content was evacuated in order to evaluate its volume at the 24th h. A intense rumen acidosis was reached; no differences in the rumen fluid pH and in the concentration of the total lactic acid and its isomers were found in both studied breeds. A moderate level of systemic metabolic acidosis was reached in both breeds, but lower overall mean of bicarbonate and TCO2 (p < 0.0001) as well as blood pH (p < 0.025) were found in the J steers. These steers absorbed higher amounts of total lactic and its D isomer than the G animals; the higher the blood D-lactate concentration, the lower the blood pH (r = - O.78) in the former breed. Better blood pH homeostasis were kept, at the end of induction, by the G steers, probably by their higher efficiency to metabolize L-lactate. However, the G steers exhibited a higher level of dehydration as seen by the greater hematocrit and plasma volume deficit (p < 0.00001). They also presented a lower glomerular filtration as evidenced by the higher creatinine serum levels (p < 0.00001), its lower urinary clearance (p < 0.003) and the lower estimated urinary volume (p < 0.05). There were no differences in the fecal pH values presented by both breeds. There was a negative correlation between the fecal total lactate concentration and the fecal pH (r = - 0.65).

Mitochondrial disorders are considered to be the most common cause of metabolic abnormalities in the paediatric neurology population (Zeviani et al., 1996). These authors reported that the phenotypes observed in 25-30% of the paediatric patients in their neurology clinics were due to a mitochondrial aetiology. The genetic aetiology in an equivalently affected paediatric population in South Africa is currently unknown. This study investigated the possibility that reported mutations could account for the mitochondrial phenotypes observed in the South African population. It focussed on the most frequent paediatric mitochondrial disorders namely: Leigh Syndrome (LS), mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS), and myoclonic epilepsy and ragged red muscle fibres (MERRF). A clinically well characterised group of 25 patients with mitochondrial disorders was included in this study. The molecular analysis of the mitochondrial genome was initially based on a restriction fragment length polymorphism (RFLP) screening strategy for the ten most common mitochondrial DNA (mtDNA) mutations associated with the above¬mentioned three disorders. However, during the study the mutation analysis strategy was modified to a sequencing strategy as this provided more information than the RFLP approach. The modified sequencing strategy extended the study to incorporate fifteen additional mtDNA mutations, associated with other mitochondrial disorders, and individuals included in the study were thus investigated for the presence of 25 mtDNA mutations. Moreover, the modified strategy provided additional information of the regions encompassing the reported mutations. A single patient was observed to harbour the reported A3243G MELAS mutation. This mutation was noted to be heteroplasmic in the proband and two of her maternal relatives. None of the other 24 reported mutations were observed in this patient population. One novel mtDNA alteration in the tRNALeu(UUR) gene was observed in a single patient, although the pathogenicity of this mutation remains to be investigated. Novel and reported polymorph isms, some of which are associated with specific haplogroups, were also observed when comparing sequencing data against the Cambridge reference sequence. The data generated during this study contributed towards the understanding of the uniqueness of the South African population in the global context. This was apparent from the fact that only one of the reported mutations was observed in our patient population who were clinically well characterised and displayed phenotypes similar to those reported internationally. Results form this study underlined the complexity of mitochondrial disorders and argues in favour of whole mitochondrial genome sequence information to be used for diagnostic purposes. Moreover, the results confer with the hypothesis that novel mitochondrial mutations may account for the majority of mitochondrial phenotypes observed in the South African population. / Dissertation (MSc (Human Genetics))--University of Pretoria, 2007. / Genetics / unrestricted