Introdução: As radiações ionizantes produzem efeitos na molécula do DNA e o biomonitoramento in vivo pode ser utilizado para melhor avaliar o nível de exposição interna à radiação. Os agentes genotóxicos em populações expostas geram diferentes danos ao DNA e por existir uma variabilidade genética isso acarreta sensibilidades diferentes a estes agentes. Essa variação pode ser explicada pela existência de polimorfismos genéticos envolvidos no processo de reparo, entre eles o XRCC1 e XRCC3, responsáveis por manter a integridade do genoma das células frente a danos causados pelos agentes mutagênicos, como a radiação ionizante. Objetivo: Avaliar os efeitos mutagênicos da exposição à radiação x e gama em pacientes que realizam cintilografia miocárdica e angioplastia miocárdica e relacionar os possíveis resultados positivos com os polimorfismos dos genes de reparo, XRCC1 e XRCC3. Materiais e Métodos: Foram selecionados 57 pacientes expostos à radiação gama, e 57 expostos à radiação X. A análise da instabilidade genômica foi realizada através dos testes do micronúcleo e cometa, e a genotipagem através de sonda de TaqMan, para os polimorfismos do gene de reparo XRCC1 e XRCC3. Resultados e Conclusões: Em nosso estudo, os dados encontrados demonstram que ocorre dano ao DNA, após a exposição à radiação gama (ƿ=0,026). No entanto, não observamos ocorrer influência dos diferentes genótipos em ambos polimorfismos estudados, Arg399Gln e Thr241 Met, embora a presença do genótipo mutado Met/Met, parece ter indicado menor radiossensibilidade. Apesar desta diferença não ter alcançado os níveis de significância esperados, este resultado está de acordo com dados da literatura que indicam que este genótipo poderia estar associado à capacidade de reparação do DNA. Neste mesmo grupo, não encontramos diferenças estatisticamente significativas para aberrações cromossômicas (MN e NBUDs) após a exposição, para ambos polimorfismos, exceto para o genótipo normal Arg/Arg (ƿ=0,012), que parece ter indicado maior radiossensibilidade à exposição, estando de acordo com trabalhos da literatura, os quais demostram que, este genótipo pode ser associado com a diminuição da capacidade de reparo do DNA, apresentando níveis mais altos de quebras induzidas. As evidências de radiossensibilidade celular também podem ser explicadas pela alteração da proteína resultante do polimorfismo que não corrige os danos ao DNA, podendo aumentar o acúmulo de lesões no material genético, possivelmente pelo efeito da dose, tempo e tipo de exposição da radiação. Já no grupo de pacientes expostos à radiação X, observamos que não ocorre aumento nos níveis de danos ao DNA após a exposição (ƿ=0,004) e que não existe efeito de ambos polimorfismos estudados, exceto para o genótipo mutado Met/Met que parece determinar maior radiossensibilidade (ƿ=0,041). Para este grupo, observamos que ocorre aumento nas frequências de MN (ƿ<0,001) e NBUDs (ƿ<0,001), mas que os diferentes genótipos não influenciaram diferenças para estes achados. Para os dados de aberrações cromossômicas, encontrados neste grupo, a superexposição radiológica pode ser a interpretação dos achados, já que os detectores planos dos equipamentos utilizados aumentam em torno de 65% a exposição aos pacientes, quando comparados aos antigos intensificadores de imagens. / Introduction: Ionizing radiations produce effects on the DNA molecule and biomonitoring in vivo may be used to better assess the level of internal radiation exposure. Genotoxic agents in exposed populations generate different DNA damage, and there is a genetic variation in sensitivity to these agents. This variation can be explained by the existence of genetic polymorphisms involved in the repair process, including XRCC1 and XRCC3, responsible for maintaining genome integrity of the cell by the damage caused by mutagenic agents, such as ionizing radiation. Objective: Assess the mutagenic effects of exposure to x and gamma radiation in patients undergoing myocardial scintigraphy and coronary angioplasty and relate the possible positive result with polymorphisms of repair genes, XRCC1 and XRCC3. Materials and Methods: 57 patients exposed to gamma radiation, and 57 exposed to x radiation were selected. Analysis of genomic instability was performed by the micronucleus comet assay, and genotyping using TaqMan probe for polymorphisms XRCC1 and XRCC3 repairing genes. Results and Conclusions: In our study the data found demonstrate that DNA damage occurs after exposure to gamma radiation (ƿ=0.026). However, we did not observed influence of the different genotypes for both polymorphisms, Arg399Gln and Thr241Met, although the presence of the mutated genotype Met/Met seems to be less radiosensitive. Despite this difference did not reach statistical significance, this result is in agreement with data reported in the literature indicating that this genotype might be associated with the ability of DNA repair. In this group, we found no statistically significant differences in chromosomal aberrations (MN and NBUDs) after exposure for both polymorphisms, except for the normal genotype Arg/Arg (ƿ= 0.012), that seems to have shown greater radiosensitivity exposure, which is consistent with literature studies, which demonstrate that this genotype may be associated with decreased DNA repair capacity, showing higher levels of induced breaks. Evidence of cellular radiosensitivity may also be explained by the alteration of the protein resulting from polymorphism that does not correct the DNA damage and may increase the accumulation of lesions in the genetic material, possibly the effect of the dose, time and type of radiation exposure. In the group of patients exposed to x-radiation, we observe that no increase in the levels of DNA damage after exposure (ƿ=0.004) and that there is no effect of both polymorphisms studied, except for the mutated genotype Met / Met that seems to determine higher radiosensitivity (ƿ=0.041). For this group, we observed an increase in the frequency of MN (ƿ<0.001) and NBUDs (ƿ<0.001), but the different genotypes did not influence differences for these findings. For the data of chromosomal aberrations found in this group, radiological overexposure may be the interpretation of the findings, since the flat detectors of the equipment used increase around 65% exposure to patients, when compared to the old image intensifiers.

Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2016-04-08T12:56:51Z No. of bitstreams: 0 / Made available in DSpace on 2016-04-08T12:56:51Z (GMT). No. of bitstreams: 0 / O objetivo deste trabalho foi estabelecer uma metodologia de calibração em termos de dose absorvida na água para câmaras de ionização de placas paralelas a serem utilizadas em feixes de radiação X de energia baixa (10 kV a 100 kV) para fins terapêuticos. Atualmente, no Brasil nenhum laboratório de calibração está oferecendo este tipo de serviço. Para o estabelecimento desta metodologia de calibração foram utilizadas duas câmaras de ionização PTW modelos 23344. Ambas as câmaras foram caracterizadas e testadas qualitativamente segundo recomendações de normas internacionais. Os testes de caracterização realizados foram: a medição da taxa de dose mínima efetiva, a curva de saturação, a eficiência da coleção de íons, a resposta quanto ao efeito da polaridade e a linearidade da câmara com a resposta. Os testes de controle de qualidade aplicados foram: estabilidade em curto e longo prazos, fuga de corrente sem irradiação, fuga de corrente após-irradiação e tempo de estabilização. Para a implantação da metodologia, foram estabelecidas as qualidades de radiação de T-10 a T-100, seguindo as recomendações do código de prática da AIEA. Desta forma, foi possível determinar a grandeza de referência, dose absorvida na água, utilizando-se as duas câmaras de ionizações e em todas as qualidades estabelecidas. / Dissertação (Mestrado em Tecnologia Nuclear) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

A la suite des catastrophes nucléaires d’importantes quantités de radionucléides ont été rejetés dans l’environnement. Le Strontium 90 (90Sr) fait partie de ces rejets. Du fait de sa demi-vie de 29 ans, c’est un polluant persistant qui conduit à la contamination des populations vivant autour des territoires contaminés via l’ingestion chronique de faibles quantités de ce radionucléide. Les études épidémiologiques ont mis en évidence des effets au niveau du système immunitaire, du système hématopoïétique et de la physiologie osseuse chez l’homme. Le 90Sr qui s’incorpore principalement dans l’os pourrait contribuer à l’apparition de ces effets. Le but de ce travail a été de comprendre quels sont les mécanismes d’action du 90Sr qui permettent d’expliquer de tels effets. Un premier modèle in vitro utilisant une lignée de cellules stromales murines (MS5) contaminées par le milieu de culture à 1 ou 10 kBq.ml-1 a été utilisé. Il a permis de montrer que le 90Sr était capable d’induire des cassures double-brin de l’ADN dès 30 minutes d’exposition avec une induction de la senescence et une altération de la fonction de support aux progéniteurs hématopoïétiques. Dans le deuxième modèle in vivo d’effet dose, des souris Balb/c ont été contaminées durant 24 semaines à des concentrations de 90Sr de 4, 20 et 100 kBq.l-1 dans l’eau de boisson. Cette expérience a permis d’observer une augmentation des marqueurs de la résorption osseuse en fonction de la contamination au 90Sr ainsi et une augmentation de l’expression génique des enzymes impliquées dans la défense antioxydante. Une augmentation de p21, marqueur de la senescence et une diminution d’IL-6 ont également été observées. Les implications de ces résultats sur la physiologie osseuse, le système immunitaire et hématopoïétiques sont discutées. Globalement, l’ensemble de ce travail complète les données déjà existantes sur le 90Sr et permet de mieux comprendre les mécanismes d’action du 90Sr sur les cellules stromales médullaires qui sont au centre de la régulation immuno-hématopoïétique. / Abstract : After nuclear disasters, large amounts of radionuclides were released into the environment. Strontium 90 (90Sr) is part of these wastes. Because of its half-life of 29 years, it is a persistent pollutant which leads to the contamination of surrounding populations through the chronic ingestion of low quantities of this radioelement. Epidemiologic studies have demonstrated some effects on immune system, hematopoietic system and bone physiology in humans. 90Sr accumulates mostly in bones and could contribute to the appearance of such effects. The aim of this work is to understand the action mechanisms which could explain the previous observations. In the first in vitro model, a murine stromal cell line (MS5) contaminated through the culture medium with 1 or 10 kBq.ml-1 of 90Sr was used. Thank to this model, an increased number of DNA double-strand breaks in cells after 30 minutes of exposure, a senescence induction and a modification in the support of hematopoietic progenitors were observed. In the second model, Balb/c mice were contaminated during 24 weeks through drinking water containing 90Sr at 4, 20 and 100 kBq.l-1. Both an increase in genic expression of bone resorption markers and in antioxydative enzymes were observed. An increase in p21 expression, marker of senescence, and a decrease in IL-6 were also seen. The implications of these results on bone physiology, immune and hematopoietic systems are discussed. As a whole, all this work completed the preexistent data about 90Sr and contributes to a better understanding of the action mechanisms of 90Sr on marrow stromal cells which have a pivotal function in the regulation of the immune and hematopoietic system.

Der niedrig dosierte Dexamethason-Suppressionstest (LDDST) wird als Screeningverfahren in der Diagnostik des Cushing-Syndroms angewendet. Allerdings können Faktoren wie die variable Resorption, sowie ein gesteigerter Metabolismus von Dexamethason die Testergebnisse beeinflussen und zu falsch positiven Resultaten führen. Ein falsch positives Testresultat wird hierbei insbesondere bei adipösen Patienten häufiger beobachtet. In der vorliegenden Arbeit wurde daher der Einfluss des Körpergewichts auf das Ergebnis des Dexamethason-Suppressionstestes (DST) untersucht. Hierzu wurden hospitalisierte Patienten und ein aus gesunden Probanden bestehendes Kontrollkollektiv rekrutiert und diese einem regulären LDDST unterzogen. Es konnte gezeigt werden, dass übergewichtige Menschen im Rahmen des DST signifikant niedrigere Dexamethasonwerte erreichen als normalgewichtige Personen. Es ist daher davon auszugehen, dass Unterschiede im Body-Mass-Index (BMI) Einfluss auf die Resorptionsrate und den Metabolismus von Dexamethason nehmen und daraus resultierend die Serum-Dexamethasonspiegel wesentlich verringern können. Diese Prozesse scheinen allerdings keinen nachhaltigen Einfluss auf die Cortisolsuppression im DST zu haben, da die Cortisolwerte nach Dexamethasongabe zwischen adipösen und nicht adipösen Testpersonen nicht signifikant differierten. Diese Ergebnisse belegen, dass ein Zusammenhang zwischen BMI-Unterschieden und der Dexamethasonkinetik im LDDST besteht. Die erniedrigten Dexamethasonspiegel bei übergewichtigen Patienten scheinen hierbei insbesondere durch das wesentlich höhere Verteilungsvolumen und durch Unterschiede im hepatogenen Metabolismus bedingt zu sein. Trotz der erniedrigten Dexamethasonwerte bleibt die Feed-Back-Sensitivität der Hypothalamus-Hypophysen-Nebennieren-Achse (HHNA) auch bei Adipositas erhalten, weshalb der LDDST als zuverlässiges Screeningverfahren bei adipösen Patienten mit Verdacht auf Cushing-Syndrom einzustufen ist.

La reconnaissance des cellules tumorales par le système immunitaire, appelée immunosurveillance, permet le contrôle de lacroissance des tumeurs voir dans certains cas leur élimination. Cependant, de nombreuses études d’exploration du système immunitaire dans le contrôle de la réponse antitumorale ont mis en évidence des mécanismes complexes d’échappement à cette immunosurveillance,avec par exemple pour les lymphocytes TCD8+ (LT CD8+) principal acteur de cette réponse, un défaut de migration, de reconnaissance des cellules tumorales ou d’activation au sein de la tumeur. Cette inhibition de fonction des LTCD8+, peut être liée à un phénomène appelé exhaustion, lié à l’expression à leur surface de molécules de costimulation inhibitrices telles que PD1, TIM-3, Lag3, CTLA-4. L’interaction de ces récepteurs avec leurs ligands engendre une perte de contrôle de la réponse antitumorale, favorisant alors la progression tumorale. Afin de lever ce phénomène d’exhaustion induit sur les LT CD8+ et restaurer la réponse antitumorale, plusieurs stratégies de traitements, visant à inhiber ces « checkpoints inhibiteurs » ont étédéveloppées. L’effet clé de la ciclosporine-A(CsA) repose sur la modulation de l’activité des lymphocytes T, ce qui explique son rôle dans la prévention du rejet de greffe. Cependant, il reste à déterminer si la CsA exerce d'autres effets sur le système immunitaire.Les évidences scientifiques montrent un effet paradoxal de la faible dosage de cyclosporine-A (fd-CsA). Ces résultats nous ont permis d’émettre l’hypothèse d’un rôle de la fd-CsA dans la modulation de la réponse antitumorale des LT CD8+, Nous avons pu observer à l’inverse, qu’à faible dose de ciclosporine-A, soit une dose équivalente entre 10 et 30 ng/mL, l’expression de PD1 était significativement diminuée à la surface des LT CD8+ activé. En revanche, à cette faible dose, aucun effet significatif sur la diminution d’expression du marqueur d’activation CD69 n’a été observé. Des expériences effectuées in vivo dans le modèle murin de mélanome B16F10 et MCA nous ont par ailleurs permis de montrer une réduction de la croissance tumorale chez les souris traitées par fd-CsA par rapport aux souris non traitées. En utilisant un modèle murin de fibrosarcome MCA, nous avons montré que nous restaurions in vivo une réponse immunitaire antitumorale et qu’un traitement de ces souris par fd-CsA en combinaison avec l’anti PDL-1 permettait une guérison après traitement, alors que l’anti PDL-1 seul n’avait pas d’effet. Cet effet novateur de la fd-CsA permet donc de visualiser de nouvelles stratégies thérapeutiques dans la réponse antitumorale qui pourraient bénéficier aux futurs patientsdiagnostiqués d’un cancer. / The recognition of tumor cells by the immune system, called immunosurveillance, allows the control of tumor growth or in some cases their elimination. However, numerous studies of the immune system in the control of the antitumor response have revealed complex mechanisms by means of which this immunosurveillance can be evaded. Examples of this occurrence are CD8+ T lymphocytes, the main element of this response are defective migration, tumor cell non-recognition or non-activation within the tumor. This inhibition of CD8+ T cell function may be related to a phenomenon called exhaustion, which may be a result of the expression on their surface of inhibitory costimulatory molecules such as PD1, TIM-3, Lag3, CTLA-4. The interaction of these receptors with their ligands causes a loss ofcontrol of the antitumor response, thus promoting tumor progression. To overcome this phenomenon of exhaustion induced in CD8+ T cells and restore the antitumor response, several treatment strategies aimed at inhibiting these "inhibitory checkpoints" have been developed. The key effect of cyclosporin-A (CsA) is modulation of T-cell activity, which explains its role in the prevention of transplantrejection. However, it remains to be determined whether CsA has other effects on the immune system. Preliminary results have allowed us to demonstrate the paradoxical effect of cyclosporin-A (CsA) in the antitumor response. Thus, these unexpected results have allowed us to hypothesize a role for Ld-CsA in modulating the antitumor response of CD8+ Tcells. We observed that Ld-CsA at equivalent dose between 10 and 30 ng/mL, significantly decreased PD1 expression at the activated CD8+ T cell surface. Furthermore, at this lowdose, no significant effect was observed on the expression of the CD69 activation marker. We have also shown that Ld-CsA increases the vaccine response in vivo. In vivo experiments with the murine B16F10 melanoma model and MCA fibrosarcoma have also shown areduction in tumor growth in mice treated with d-CsA compared to untreated mice. More recently, using a mouse model of MCA-OVAfibrosarcoma, we have shown that we can restore the in-vivo antitumor immune response and that the treatment of these mice by Ld-CsAin combination with the anti PDL-1, allowed tumor regression, whereas anti PDL-1 alone had no effect. This novel effect of Ld-CsA allows us therefore to visualize new therapeutic strategies for the antitumor response which may benefit future patients diagnosed with cancer.

Introduction : Les travaux réalisés par Bascans ont permis de mieux comprendre la fonction des patients atteints d’une rupture de la coiffe des rotateurs au moment du diagnostic à l’aide de paramètres morphologiques osseux et musculaires intégrés dans un modèle de régression linéaire. Les paramètres osseux étudiés provenaient d’une méthode de reconstruction 3D de l’épaule à partir d’images EOS. Jusqu’à présent, aucune étude ne s’est intéressée à prédire l’évolution dans le temps des patients atteints d’une rupture de la coiffe des rotateurs à l’aide de ces paramètres ni à valider l’imagerie EOS pour l’évaluation de l’épaule. Objectif : Nous souhaitons prédire l’évolution de la fonction de l’épaule des patients atteints d’une rupture de la coiffe des rotateurs à partir de paramètres musculaires et de la morphologie osseuse. Ensuite, nous souhaitons comparer l’imagerie EOS à la radiographie standard de l’épaule pour l’évaluation des patients à la clinique externe d’orthopédie. Méthode : Dans un premier temps, 50 personnes ayant participé à une étude portant sur la fonction de l’épaule en 2009 furent réévaluées. Leur fonction mesurée fut corrélée à leur fonction prédite par le modèle de régression linéaire créé par Bascans. De nouveaux modèles ont ensuite été créés afin de mieux comprendre l’évolution de la douleur, de la force et de la fonction de leur épaule telle que mesurées par le score de Constant et le QuickDash. Dans un deuxième temps, 47 patients nécessitant une radiographie standard de l’épaule dans le cadre de leur consultation à la clinique externe d’orthopédie ont été recrutés. En plus de la radiographie standard, ils ont passé un examen radiographique EOS antéro-postérieur de leur épaule. Un comité d’expert formé de deux orthopédistes et d’une radiologiste a créé un questionnaire d’évaluation des images grâce à la méthode Delphi. Ces trois spécialistes ont ensuite analysé chaque image présentée dans un ordre aléatoire. Résultats : La majorité des participants atteints d’une rupture de la coiffe des rotateurs ont été opérés pendant le suivi. Nous ne pouvons donc pas prédire l’évolution naturelle de ces patients. Nous avons cependant produit des modèles de régression linéaire qui améliorent considérablement notre compréhension des paramètres ayant un impact sur la fonction initiale. Notamment, nos modèles expliquent 66,8% de la variabilité du score de Constant et 71,8% de celle du QuickDash pour les femmes. L’imagerie EOS antéro-postérieure de l’épaule permet d’obtenir des mesures de la distance sousacromiale et de l’espace acromio-claviculaire similaires à la radiographie standard, avec une différence moyenne de 1,4 mm entre les modes d’imagerie, ce qui n’est pas cliniquement significatif. L’imagerie EOS produit des images de qualité légèrement inférieure et pouvant présenter légèrement plus d’artéfacts de mouvement que la radiographie standard. Ces différences sont cependant mineures et ne semblent pas avoir d’impact sur la capacité des spécialistes à émettre avec confiance un diagnostic. Conclusions : Cette étude a permis de mieux comprendre les paramètres morphologiques ayant un impact sur la fonction de l’épaule des patients. Elle a également révélé que les paramètres corrélant avec le niveau fonctionnel ne sont pas les mêmes en fonction du sexe. Nous avons démontré que les images EOS sont légèrement inférieures à la radiographie standard, mais demeurent un mode d’imagerie adéquat et valide. L’imagerie EOS pourrait donc être utilisée en clinique externe d’orthopédie, ce qui diminuerait l’exposition aux radiations des patients et qui permettrait d’intégrer plus facilement en clinique les connaissances développées à partir de la reconstruction 3D de l’épaule. / Introduction : Bascans improved our understanding of shoulder function at diagnosis of rotator cuff tear using morphological bony and muscular paramaters in a linear regression model. The bony parameters were measured using a 3D reconstruction of the shoulder generated from EOS images. Up to now, no study tried to predict shoulder function of patients suffering from rotator cuff tear using these parameters. The EOS imaging system has not been compared to the standard X-rays for the evaluation of shoulders yet. Objectives : We aim to predict the evolution of shoulder function for patients with a rotator cuff tear using the same morphological parameters as Basacans. Our second objective is to compare the EOS imaging system to standard X-Rays for shoulder evaluation at the orthopedic outpatient clinic. Method : Fifty participants from a 2009 study on shoulder function were re-evaluated. Their measured shoulder function was correlated to their predicted shoulder function using a linear regression model. Moreover, new models were created to improve our understanding of pain, strength, and shoulder function as measured in the Constant Score and the QuickDash. Forty-seven other patients who needed to undergo shoulder X-Rays at the orthopeadic outpatient clinic were recruited. Besides their shoulder X-Rays, they underwent an anterioposterior EOS shoulder radiograph. An expert committee of two orthopedists and one radiologist created a shoulder radiographs’ evaluation survey using the Delphi methodology. The committee then evaluated each image in a random order. Results : The majority of participants who suffered from a rotator cuff tear have had a surgery since the first study. Therefore, we were not able to predict the natural evolution of these patients. However, we were able to produce linear regression models that considerably improve our understanding of the parameters that have an impact on shoulder function at diagnosis. Our regression models explain 66.8% of the variability of the Constant score and 71.8% of the variability of the QuickDash for female participants. The measure of the subacromial distance and the acromioclavicular space was similar in anteroposterior shoulder images from the EOS system and the standard X-rays, with a mean difference of 1.4 mm between the two imaging techniques, which is not clinically significant. EOS images are of slightly inferior quality than the standard X-rays. This difference remains minor and does not seem to have an impact on the specialists’ ability to make a confident diagnosis from these images. Conclusions : This study improves our understanding of the morphological parameters that have an impact on shoulder function. Moreover, it revealed that the parameters that have an impact on shoulder function are not the same depending on the patients’ sex. We demonstrated that shoulder EOS images are slightly inferior to standard X-Rays, but that they still produce images of a sufficient quality for diagnosis. Therefore, the EOS images could be used at the orthopedic outpatient clinic, which would reduce patients’ exposure to radiation and would facilitate the integration in the clinical setting of the research based on shoulder 3D reconstruction.

Ziel: Gewinnung neuer Erkenntnisse auf dem Gebiet der Glucocorticoidforschung. Die Arbeit gliedert sich in zwei Teile: 1. Klinische Studie zu Wirkungen und Nebenwirkungen einer niedrig bis mittelhoch dosierten Methylprednisolon(MP)-Therapie bei Patienten mit entzündlich-rheumatischen Erkrankungen. 2. Durchflusszytometrische Untersuchungen mit humanen PBMC mit dem Ziel, membranständige Glucocorticoidrezeptoren (mGCR) nachzuweisen. Methodik: 1. In einer klinischen Studie wurden zwei Patientengruppen mit jeweils 20 Patienten miteinander verglichen. Alle Patienten hatten entzündlich-rheumatische Erkrankungen und bekamen eine MP-Therapie über mindestens ein Jahr. Die Dosierungen in der ersten Gruppen entsprachen einer low-dose GC-Therapie, die Patienten in der zweiten Gruppe bekamen eine medium-dose GC-Therapie. Erwünschte, unerwünschte Wirkungen sowie die Lebensqualität der Patienten wurden erhoben. 2. Humane PBMC wurden durchflusszytometrisch untersucht. Es wurden konventionelle Färbemethoden sowie eine hoch-sensitive Liposomenfärbung zur Detektion spezifischer membranständiger Antigene angewandt. Ergebnisse: 1. In den meisten Fällen waren die relativ niedrigen Dosierungen von MP geeignet, die Krankheitsaktivität der entzündlich-rheumatischen Erkrankung wirksam zu kontrollieren. Einzelne Exazerbationen waren allerdings zu verzeichnen. Bei den meisten unerwünschten Wirkungen zeigten sich keine Unterschiede zwischen den Dosisgruppen. Osteoporosetypische Rückenschmerzen traten signifikant höher in der oberen Dosisgruppe auf (p=0,04), bei dem erhöhten Augeninnendruck zeigte sich eine Tendenz (p=0,1). Häufige Nebenwirkungen auch bei niedrigen Dosierungen waren: Unterblutungen der Haut und Pergamenthaut (76,2 % bzw. 73,8 % aller Patienten) bzw. eine Cushing-Symptomatik (61,9 % aller Patienten). 2. Mit der Liposomen-Färbetechnik ließen sich erstmals mGCR auf humanen PBMC systematisch nachweisen. Bis zu 5 % der B-Lymphozyten und bis zu 7 % der Monozyten exprimierten mGCR bei Gesunden. Stimulationen des Immunsystems durch Impfungen oder eine aktive rheumatoide Arthritis führten zu einer deutlichen Erhöhung des Anteils mGCR-positiver Monozyten auf über 20 %. Schlussfolgerungen: 1. Niedrig bis mittelhoch dosierte Therapien mit MP können effektiv die Aktivität von entzündlich-rheumatischen Erkrankungen kontrollieren. Die unerwünschten Effekte sind vermutlich dosisabhängig, für die meisten ist jedoch nicht relevant, ob mit einer low-dose oder einer medium-dose Therapie behandelt wird. 2. mGCR werden auf humanen PBMC unter physiologischen Bedingungen exprimiert. Unter bestimmten immunologischen Bedingungen werden sie hochreguliert. Herkunft und Funktion der Rezeptoren müssen noch genauer geklärt werden. / Purpose: Gaining new knowledge in glucocorticoid research. The dissertation consists of two parts: 1. Clinical study on effects and side-effects of a low-dose / medium-dose therapy with methylprednisolone (MP) in patients with inflammatory rheumatic diseases. 2. Flowcytometric investigation of human PBMC in order to detect membrane-bound glucocorticoid-receptors (mGCR). Methods: 1. In a clinical study two groups of patients - 20 patients each - were compared. All patients had inflammatory rheumatic diseases and recieved MP-therapy for at least one year. The first group recieved a low-dose GC-therapy, the second group a medium-dose GC-therapy. 2. Human PBMC were examined. We used conventional and high-sensitive liposome staining technique for the detection of specific membrane-bound antigens. Results: 1. In most cases rather low dosages of MP were able to control the disease activitiy of inflammatory rheumatic diseaeses. However, we observed disease exacerbation in some cases. Most side-effects showed the same characteristics in both groups. There was a significant higher appearance of typical osteoporotic back pain in the higher dosage group (p=0,04) and a tendency to higher intraophtalmic pressure in this group (p=0,1). Common side effects with even low dosages were: skin hematoma and thin skin (76,2 % and 73,8 % respective) and a Cushing-Syndrome (61,9 % of all patients). 2. With the liposome staining technique we showed for the first time systematically mGCR on human PBMC. Up to 5 % of B-lymphocytes and 7 % of monocytes presented mGCR in healthy blood donors. Stimulation of the immunological system by vaccination or in case of an active rheumatoid arthritis led to a marked increase of mGCR-positive monocytes to more than 20 %. Conclusions: 1. Low-dose and medium-dose methylprednisolone therapy can effectivly control the activity of inflammatory rheumatic diseases. The side effects are probably dose-dependent. However, for most side effects it doesn''t matter if patients are treated with a low-dose or a medium-dose therapy. 2. mGCR are expressed on human PBMC under physiological conditions and are up-regulated under certain immunological conditions. The function of these receptors has to be examined more profoundly.

At low doses, relevant to nuclear incidents and accidental releases of radioactivity, the detriment of radiation extends beyond direct effects. This thesis investigates genomic instability, a subclass of non-targeted effects where damage and lethality is transmitted vertically and expressed in the progeny of cells many generations after initial radiation exposure. Through a series of experiments using clonogenic assay of human and fish cell culture, studies described in this thesis describe lethal mutations, hyper radiosensitivity and increased radioresistance – processes involving repair mechanisms that dictate survival in cells exposed to low doses. Further study investigates the difference in the relative biological effect of alpha particle radiation compared to what is expected at high doses. Results demonstrate increased radioresistance in a human cell line while also revealing increased lethality in a fish cell line confirming the need for consideration of dose-dependence as well as variance in behaviors of different cell lines and species. It is hoped the conclusions of this thesis will inspire the creation of protocols with greater attention to the indirect consequences of exposure to radiation at doses relevant to nuclear incidents and accidents. / Thesis / Master of Science (MSc)

The structure, function and accessibility of epidermal skin provide aunique opportunity to study the DNA damage response (DDR) of a normaltissue. The in vivo response can be examined in detail, at a molecularlevel, and further associated to the structural changes, observed at atissue level. We collected an extensive skin biopsy material frompatients undergoing fractionated radiotherapy for 5 to 7 weeks. Several end-points inthe DDR pathways were examined before, during and after the treatment. Quantification of DNA double strand break (DSB) signalling focirevealed a hypersensitivity to doses below 0.3Gy. Furthermore, aconsiderable amount of foci persisted between fractions. The low dosehypersensitivity was observed throughout the treatment and was alsoobserved for several key parameters further downstream in the DDR-pathway, such as p21-associated checkpoint activation, apoptosisinduction and reduction in basal keratinocyte density (BKD).Furthermore, for dose fractions above 1.0 Gy, a distinct acceleration inDDR was observed half way into treatment. This was manifested as anaccelerated loss of basal keratinocytes, mirrored by a simultaneousincrease in DSBs and p21 expression. Quantifications of mitotic events revealed a pronounced suppression ofmitosis throughout the treatment which was clearly low dosehypersensitive. Thus, no evidence of accelerated repopulation could beobserved for fraction doses ranging from 0.05 to 2Gy. Our results suggest that the keratinocyte response primarily isdetermined by checkpoints, which leads to pre-mitotic cell elimination by permanent growth arrest and apoptosis. A comparison between the epidermal and dermal sub-compartments revealsa consistent up-regulation of the DDR response during treatment. Adifference was however observed in the recovery phase after treatment,where miR-34a and p21 remain up-regulated in dermis more persistentlythan in epidermis. Our observations suggest that the recovery phaseafter treatment can provide important clues to understand clinicalobservations such as the early and late effects observed in normaltissues during fractionated radiotherapy.

Widespread evidence indicates that exposure of cell cultures to α particles results in significant biological changes in both the irradiated and non-irradiated bystander cells in the population. The induction of non-targeted biological responses in cell cultures exposed to low fluences of high charge (Z) and high energy (E) particles is relevant to estimates of the health risks of space radiation and to radiotherapy. Here, we investigated the mechanisms underlying the induction of stressful effects in confluent normal human fibroblast cultures exposed to low fluences of 1000 MeV/u iron ions (linear energy transfer (LET) ~151 keV/µm), 600 MeV/u silicon ions (LET ~50 keV/µm) or 290 MeV/u carbon ions (LET ~13 keV/µm). We compared the results with those obtained in cell cultures exposed, in parallel, to low fluences of 0.92 MeV/u α particles (LET ~109 keV/µm).Induction of DNA damage, changes in gene expression, protein carbonylation and lipid peroxidation during 24 h after exposure of confluent cultures to mean doses as low as 0.2 cGy of iron or silicon ions strongly supported the propagation of stressful effects from irradiated to bystander cells. At a mean dose of 0.2 cGy, only ~1 and 3 % of the cells would be targeted through the nucleus by an iron or silicon ion, respectively. Within 24 h post-irradiation, immunoblot analyses revealed significant increases in the levels of phospho-TP53 (serine 15), p21Waf1 (also known as CDKN1A), HDM2, phospho-ERK1/2, protein carbonylation and lipid peroxidation. The magnitude of the responses suggested participation of non-targeted cells in the response. Furthermore, when the irradiated cell populations were subcultured in fresh medium shortly after irradiation, greater than expected increases in the levels of these markers were also observed during 24 h. Together, the results imply a rapidly propagated and persistent bystander effect. In situ analyses in confluent cultures showed 53BP1 foci formation, a marker of DNA damage, in more cells than expected based on the fraction of cells traversed through the nucleus by an iron or silicon ion. The effect was expressed as early as 15 min after exposure, peaked at 1 h and decreased by 24 h. A similar tendency occurred after exposure to a mean absorbed dose of 0.2 cGy of 3.7 MeV α particles, but not after 0.2 cGy of 290 MeV/u carbon ions.Analyses in dishes that incorporate a CR-39 solid state nuclear track detector bottom identified the cells irradiated with iron or silicon ions and further supported the participation of bystander cells in the stress response. Mechanistic studies indicated that gap junction intercellular communication, DNA repair, and oxidative metabolism participate in the propagation of the induced effects.We also considered the possible contribution of secondary particles produced along the primary particle tracks to the biological responses. Simulations with the FLUKA multi-particle transport code revealed that fragmentation products, other than electrons, in cells cultures exposed to HZE particles comprise <1 % of the absorbed dose. Further, the radial spread of dose due to secondary heavy ion fragments is confined to approximately 10-20 µm Thus, the latter are unlikely to significantly contribute to the stressful effects in cells not targeted by primary HZE particles.