Background Ultrasmall superparamagnetic particles of iron oxide (USPIO)- enhanced magnetic resonance imaging (MRI) can detect tissue-resident inflammatory macrophages and identify cellular inflammation. Clinical studies using this non-invasive technique are now emerging. Objectives The aims of this thesis were (i) to determine whether USPIO-enhanced MRI can detect and serially monitor myocardial inflammation after myocardial infarction (MI) using single and repeated USPIO administration, (ii) to report a range of normal R2* (1/T2*) values at 1.5 tesla (T) and 3 T in healthy myocardium and other tissues before and after USPIO administration, (iii) to determine whether USPIO-enhanced MRI can detect myocardial inflammation in acute myocarditis, and (iv) to determine whether USPIO-enhanced MRI can detect myocardial inflammation in patients with a prior cardiac transplant. Methods Thirty-one patients were recruited following acute MI and followed up for 3 months with repeated T2 and USPIO-enhanced T2* mapping 3 T MRI. Twenty healthy volunteers were recruited: 10 imaged each at 1.5 T and 3 T. T2 and USPIO-enhanced T2* mapping MRI was conducted. Fourteen patients with suspected acute myocarditis underwent T2 and USPIO-enhanced T2* mapping 3 T MRI, with further imaging at 3 months. Eleven patients with prior cardiac transplant underwent T2 and USPIO-enhanced T2* mapping 1.5 T MRI with further imaging at 3 months. Regions of interest within the myocardium, along with other tissues, were selected for analysis. Pre-contrast T2 values, and the change in R2* due to USPIO from baseline to 24 hours after USPIO were compared for each region of interest. Results In patients with MI, USPIO uptake in the infarct zone peaked at days 2-3, and greater USPIO uptake was detected in the infarct zone compared to remote myocardium in the first 2 weeks after myocardial infarction. In contrast, T2-defined myocardial oedema peaked at days 3-9 and remained increased in the infarct zone throughout the 3-month follow up period. Histology confirmed colocalisation of iron and macrophages within the infarcted, but not the non-infarcted, myocardium. In healthy volunteers, we reported a range of normal myocardial and tissue R2* values at baseline, and following USPIO. Tissues showing greatest USPIO enhancement were organs of the reticuloendothelial system: the liver, spleen and bone marrow. Myocarditis was confirmed in 9 of the 14 suspected cases of myocarditis. There was greater myocardial oedema, but no demonstrable difference in USPIO enhancement, in inflamed myocardial regions in patients with myocarditis when compared to healthy myocardium. We recorded an improvement in cardiac function and reduced imaging measures of inflammation after 3 months. Ten patients with cardiac transplant were retained for analysis. Measures of myocardial oedema were greater in patients with cardiac transplant than healthy volunteers. There was no difference in the change in R2* due to USPIO between patients with transplantation and healthy volunteers. Imaging recordings did not change when repeated at 3 months. Conclusions Myocardial macrophage activity can be detected using USPIO-enhanced MRI in the first 2 weeks following acute MI. This observed pattern of cellular inflammation is distinct, and provides complementary information to, the more prolonged myocardial oedema detectable using T2 mapping. In patients with acute myocarditis, USPIO-enhanced MRI does not provide additional clinically relevant information to standard clinical MRI sequences. This suggests that tissue-resident macrophages do not provide a substantial contribution to the myocardial inflammation in this condition. Stable patients with cardiac transplantation have increased myocardial T2 values, consistent with resting myocardial oedema or fibrosis. In contrast, USPIO-enhanced MRI is normal and stable over time suggesting the absence of chronic macrophage-driven cellular inflammation. In conclusion, this imaging technique holds promise as a non-invasive method of assessing and monitoring macrophage-driven myocardial inflammation after myocardial infarction with potential application to diagnosis, risk stratification and assessment of novel anti-inflammatory therapeutic interventions. It remains to be determined whether USPIO-enhanced MRI may be able to identify myocardial inflammation in other myocardial inflammatory conditions including acute cardiac transplant rejection.

Os piretróides sintéticos, em especial os do tipo II, como a cialotrina, são extensivamente utilizados para o controle de uma ampla variedade de ectoparasitas que acometem os animais de produção. Entretanto, no Brasil e em outros países, sua utilização vai além da saúde animal, sendo utilizados também em saúde pública, no controle de diversos vetores, como é o caso do vetor da dengue, dentre outros. Visto que a cialotrina modifica a atividade de macrófagos peritoneais, o objetivo deste trabalho foi investigar os prováveis mecanismos através dos quais este piretróide modifica a atividade destas células. Os presentes resultados, analisados em seu conjunto, mostram de maneira inequívoca que a cialotrina tem um efeito direto e/ou indireto sobre a atividade de macrófagos peritoneais. Especificamente, observou-se neste trabalho que o praguicida causou em ratos: 1 ? marcação fos positiva em neurônios do núcleo paraventricular do hipotálamo (NPH), após a dose de 3,0 mg/kg/dia; 2 - diminuição do percentual e intensidade de fagocitose de macrófagos peritoneais ativados e avaliados por citometria de fluxo; 3 - diminuição dose-dependente da produção de nitrito (NO2); 4 ? diminuição do percentual e intensidade de fagocitose de macrófagos peritoneais ativados, em ratos adrenalectomizados e/ou tratados com metirapona (inibidor da síntese de corticosterona) e RU 486 (antagonista de receptores glicocorticóides) com a finalidade de modular os níveis de glicocorticóides, e tratados com 3,0 mg/kg/dia de cialotrina; 5 ? aumento dos níveis de noradrenalina hipotalâmica em animais tratados com a dose de 3,0mg/kg/dia de cialotrina; 6 - diminuição do percentual e intensidade de fagocitose, bem como diminuição da produção de nitrito de macrófagos peritoneais ativados, em ratos simpatectomizados químicamente com 6-OHDA; 7 - diminuição dose dependente do percentual e intensidade de fagocitose, bem como da produção de nitrito de macrófagos peritoneais ativados e tratados in vitro com 10 e 100 nM de cialotrina. No entanto, não observamos: 1 ? alterações na produção de nitrito realizada por macrófagos peritoneais ativados, em ratos adrenalectomizados e/ou tratados com metirapona e RU 486; 2 - alterações na viabilidade celular induzida pelo tratamento in vitro com a cialotrina na concentração de 10 e 100 nM e 3 ? alterações nos efeitos da cialotrina sobre a atividade de macrófagos tratados in vitro com os ligantes de receptores benzodiazepínicos periféricos. Em conjunto, os presentes dados mostram que a cialotrina interfere com a atividade de macrófagos por atuar indiretamente, através da ativação do eixo Hipotálamo-Hipófise-Adrenal (HHA), e/ou diretamente sobre os mesmos modulando sua atividade. É muito provável que o efeito resultante do tratamento in vivo com este praguicida esteja ligado à somatória destas ações / Synthetic pyrethroids, particularly those of type II, such as cyhalothrin, are extensively used in agriculture for the control of a broad range of ectoparasites in farm animals. However, in Brazil and some other countries, these pyrethroids have also been used in public health, for the control of insects that are known to be vectors of diseases such as dengue. Since it has been suggested that cyhalothrin alters activity of peritoneal macrophages, the objective of our study was to investigate the putative mechanisms for the changes induced by pyrethroid in these cells. The results presented here show, in an unequivocal manner, that cyhalothrin has a direct or indirect (or both) effect on the activity of peritoneal macrophages. We specifically observed in this work that this pesticide induced in rats: 1- Fos-positive immunostaining in neurons of the paraventricular nucleus of the hypothalamus (NPH), after 3.0 mg/kg/day; 2 ? a reduction in the percentage and intensity of phagocytosis by activated peritoneal macrophages, evaluated by flow cytometry; 3 ? a dose-dependent reduction in nitrite production (NO2); 4 ? a reduction in the percentage and intensity of phagocytosis by activated peritoneal macrophage from adrenalectomized rats treated or not with metirapone (inhibitor of corticosterone synthesis) or RU 486 (antagonist of glicocorticoids receptors) with the propose of modulating the levels of glicocorticoids, and treated with 3.0 mg/kg/day of cyhalothrin; 5 ? an increase in the hypothalamic levels of noradrenaline in rats treated with 3.0 mg/kg/day of cyhalothrin; 6 ? a reduction in the percentage and intensity of phagocytosis and also a decrease in the production of nitrite by activated peritoneal macrophages, after chemical sympatectomy with 6-OHDA; 7 ? a dose-dependent reduction of the percentage and intensity of phagocytosis, and also a decrement in nitrite production by activated peritoneal macrophages treated in vitro with 10 and 100 nM of cyhalothrin. However, we found no differences on: 1 ? nitrite production by activated peritoneal macrophages after adrenalectomy, treated or not with metirapone or RU 486; 2 ?cell viability of peritoneal macrophages treated in vitro with 10 and 100 nM of cyhalothrin, and 3 ? the effects of cyhalothrin on macrophage activity after in vitro treatment with peripheral benzodiazepine receptor ligands. Altogether, the present results show that cyhalothrin interferes with the activity of peritoneal macrophages by acting indirectly, via activation of the hypothalamus-pituitary-adrenal axis, or directly on these cells, altering their activity. As a matter of fact, it is quite possible that the results of in vivo cyhalothrin treatment on macrophage activity would be related to the combined effect of these direct and indirect influences

Os piretróides sintéticos, em especial os do tipo II, como a cialotrina, são extensivamente utilizados para o controle de uma ampla variedade de ectoparasitas que acometem os animais de produção. Entretanto, no Brasil e em outros países, sua utilização vai além da saúde animal, sendo utilizados também em saúde pública, no controle de diversos vetores, como é o caso do vetor da dengue, dentre outros. Visto que a cialotrina modifica a atividade de macrófagos peritoneais, o objetivo deste trabalho foi investigar os prováveis mecanismos através dos quais este piretróide modifica a atividade destas células. Os presentes resultados, analisados em seu conjunto, mostram de maneira inequívoca que a cialotrina tem um efeito direto e/ou indireto sobre a atividade de macrófagos peritoneais. Especificamente, observou-se neste trabalho que o praguicida causou em ratos: 1 ? marcação fos positiva em neurônios do núcleo paraventricular do hipotálamo (NPH), após a dose de 3,0 mg/kg/dia; 2 - diminuição do percentual e intensidade de fagocitose de macrófagos peritoneais ativados e avaliados por citometria de fluxo; 3 - diminuição dose-dependente da produção de nitrito (NO2); 4 ? diminuição do percentual e intensidade de fagocitose de macrófagos peritoneais ativados, em ratos adrenalectomizados e/ou tratados com metirapona (inibidor da síntese de corticosterona) e RU 486 (antagonista de receptores glicocorticóides) com a finalidade de modular os níveis de glicocorticóides, e tratados com 3,0 mg/kg/dia de cialotrina; 5 ? aumento dos níveis de noradrenalina hipotalâmica em animais tratados com a dose de 3,0mg/kg/dia de cialotrina; 6 - diminuição do percentual e intensidade de fagocitose, bem como diminuição da produção de nitrito de macrófagos peritoneais ativados, em ratos simpatectomizados químicamente com 6-OHDA; 7 - diminuição dose dependente do percentual e intensidade de fagocitose, bem como da produção de nitrito de macrófagos peritoneais ativados e tratados in vitro com 10 e 100 nM de cialotrina. No entanto, não observamos: 1 ? alterações na produção de nitrito realizada por macrófagos peritoneais ativados, em ratos adrenalectomizados e/ou tratados com metirapona e RU 486; 2 - alterações na viabilidade celular induzida pelo tratamento in vitro com a cialotrina na concentração de 10 e 100 nM e 3 ? alterações nos efeitos da cialotrina sobre a atividade de macrófagos tratados in vitro com os ligantes de receptores benzodiazepínicos periféricos. Em conjunto, os presentes dados mostram que a cialotrina interfere com a atividade de macrófagos por atuar indiretamente, através da ativação do eixo Hipotálamo-Hipófise-Adrenal (HHA), e/ou diretamente sobre os mesmos modulando sua atividade. É muito provável que o efeito resultante do tratamento in vivo com este praguicida esteja ligado à somatória destas ações / Synthetic pyrethroids, particularly those of type II, such as cyhalothrin, are extensively used in agriculture for the control of a broad range of ectoparasites in farm animals. However, in Brazil and some other countries, these pyrethroids have also been used in public health, for the control of insects that are known to be vectors of diseases such as dengue. Since it has been suggested that cyhalothrin alters activity of peritoneal macrophages, the objective of our study was to investigate the putative mechanisms for the changes induced by pyrethroid in these cells. The results presented here show, in an unequivocal manner, that cyhalothrin has a direct or indirect (or both) effect on the activity of peritoneal macrophages. We specifically observed in this work that this pesticide induced in rats: 1- Fos-positive immunostaining in neurons of the paraventricular nucleus of the hypothalamus (NPH), after 3.0 mg/kg/day; 2 ? a reduction in the percentage and intensity of phagocytosis by activated peritoneal macrophages, evaluated by flow cytometry; 3 ? a dose-dependent reduction in nitrite production (NO2); 4 ? a reduction in the percentage and intensity of phagocytosis by activated peritoneal macrophage from adrenalectomized rats treated or not with metirapone (inhibitor of corticosterone synthesis) or RU 486 (antagonist of glicocorticoids receptors) with the propose of modulating the levels of glicocorticoids, and treated with 3.0 mg/kg/day of cyhalothrin; 5 ? an increase in the hypothalamic levels of noradrenaline in rats treated with 3.0 mg/kg/day of cyhalothrin; 6 ? a reduction in the percentage and intensity of phagocytosis and also a decrease in the production of nitrite by activated peritoneal macrophages, after chemical sympatectomy with 6-OHDA; 7 ? a dose-dependent reduction of the percentage and intensity of phagocytosis, and also a decrement in nitrite production by activated peritoneal macrophages treated in vitro with 10 and 100 nM of cyhalothrin. However, we found no differences on: 1 ? nitrite production by activated peritoneal macrophages after adrenalectomy, treated or not with metirapone or RU 486; 2 ?cell viability of peritoneal macrophages treated in vitro with 10 and 100 nM of cyhalothrin, and 3 ? the effects of cyhalothrin on macrophage activity after in vitro treatment with peripheral benzodiazepine receptor ligands. Altogether, the present results show that cyhalothrin interferes with the activity of peritoneal macrophages by acting indirectly, via activation of the hypothalamus-pituitary-adrenal axis, or directly on these cells, altering their activity. As a matter of fact, it is quite possible that the results of in vivo cyhalothrin treatment on macrophage activity would be related to the combined effect of these direct and indirect influences