No description available.

Le diabète de type 2 (DT2) apparaît lorsque la sécrétion d’insuline par les cellules β des îlots du pancréas ne parvient plus à compenser la résistance à l’insuline des organes cibles. Parmi les médicaments disponibles pour traiter le DT2, deux classes agissent en améliorant la sensibilité à l’insuline : les biguanides (metformine) et les thiazolidinediones (pioglitazone et rosiglitazone). Des études suggèrent que ces médicaments protègent également la fonction des cellules β. Dans le but d’identifier des mécanismes par lesquels les médicaments insulinosensibilisateurs protègent les cellules β, nous avons étudié les effets aigus de la metformine et de la pioglitazone sur le métabolisme et la fonction des cellules INS 832/13, sécrétrices d’insuline et des îlots pancréatiques isolés de rats. Nous avons aussi validé in vivo avec des rats Wistar les principales observations obtenues en présence de pioglitazone grâce à des clamps glucidiques et par calorimétrie indirecte. Le traitement aigu des cellules β avec de la pioglitazone ou de la metformine inhibe la sécrétion d’insuline induite par le glucose en diminuant la sensibilité des cellules au glucose (inhibition en présence de concentrations intermédiaires de glucose seulement). Dans les mêmes conditions, les traitements inhibent aussi plusieurs paramètres du métabolisme mitochondrial des nutriments et, pour la pioglitazone, du métabolisme des lipides. Les composés affectent le métabolisme en suivant un patron d’inhibition similaire à celui observé pour la sécrétion d’insuline, que nous avons nommé « décélération métabolique ». La capacité de la pioglitazone à inhiber la sécrétion d’insuline et à ralentir le métabolisme mitochondrial de façon aigüe se confirme in vivo. En conclusion, nous avons identifié la décélération métabolique de la cellule β comme nouveau mode d’action pour les médicaments insulinosensibilisateurs. La décélération métabolique causée par les agents insulinosensibilisateurs les plus utilisés semble provenir d’une inhibition du métabolisme mitochondrial et pourrait être impliquée dans les bienfaits de ceux-ci dans un contexte de stress métabolique. Le fait que les deux agents insulinosensibilisateurs étudiés agissent à la fois sur la sensibilité à l’insuline et sur la sécrétion d’insuline, les deux composantes majeures du DT2, pourrait expliquer pourquoi ils sont parmi les agents antidiabétiques les plus efficaces. La décélération métabolique est une approche thérapeutique à considérer pour le traitement du DT2 et d’autres maladies métaboliques. / Type 2 diabetes (T2D) appears when insulin secretion by pancreatic β-cells fails to compensate for insulin resistance. Two classes of anti-diabetic drugs have been used to target insulin resistance: biguanides (metformin) and thiazolidinediones (pioglitazone and rosiglitazone). Some studies suggest that these compounds also protect β-cell function. In order to identify the mechanisms whereby insulin-sensitizing agents protect β-cell function, we used INS 832/13 insulin secreting cells and isolated pancreatic rat islets to study the acute effects of pioglitazone and metformin on β-cell metabolism and function. Key observations obtained with pioglitazone were also validated in vivo in Wistar rats with the use of glucose clamps and indirect calorimetry. In vitro, acute pioglitazone or metformin treatment inhibits glucose-induced insulin secretion by lowering β-cell sensitivity to glucose (inhibition only at sub-maximal glucose concentrations). The same treatments also inhibit parameters of nutrient mitochondrial metabolism and, in the case of pioglitazone, parameters of lipid metabolism. Both compounds alter metabolism following a pattern similar to that observed with insulin secretion, a pattern that we label “metabolic deceleration”. Pioglitazone also acutely inhibits insulin secretion and slows down mitochondrial metabolism in vivo. In conclusion, we identified metabolic deceleration of the pancreatic β-cell as a new mode of action for insulin-sensitizing agents. Pioglitazone and metformin both seem to cause metabolic deceleration of the β-cell via inhibition of mitochondrial metabolism. This mode of action could participate in the beneficial effects of these compounds in the context of metabolic stress. The fact that these drugs affect both insulin sensitivity and insulin secretion, the two major components of T2D, may explain why they are among the most powerful anti-diabetic agents. Metabolic deceleration is a new therapeutic approach worth considering for the treatment of T2D and other metabolic diseases.

No description available.

Les leucémies aigues myéloïdes (LAM) sont des hémopathies malignes de mauvais pronostic dont les thérapies actuelles ne permettent d’obtenir des taux de survie à 5 ans chez les adultes que d’environ 40%. Par conséquent, il est nécessaire d’approfondir nos connaissances concernant les mécanismes d’oncogenèse pour développer de nouvelles approches thérapeutiques. Malgré leur hétérogénéité clinique et biologique, les LAM ont certaines caractéristiques communes comme l’activation de la voie de signalisation mTORCl qui est détectée dans la plupart des échantillons de LAM. MTORCl contrôle la survie, la croissance et la prolifération cellulaire, notamment via le contrôle de la traduction des ARNm et donc de la synthèse protéique. Au cours de ce travail, nous montrons qu’il existe, dans les LAM, une dérégulation de mTORCl qui explique les limites des effets anti-leucémiques observés avec la rapamycine (un inhibiteur allostérique de mTORCl) et qui est médiée en partie par l’activité de la sérine thréonine kinase Pim2, qui contrôle la phosphorylation de la cible de mTORCl, la protéine 4E-BP1. Cependant, cibler directement la traduction produit des effets anti-leucémiques importants, ce que nous avons montré en utilisant une molécule inhibant spécifiquement le complexe d’initiation de la traduction, le 4EGI-l. EIF4E est essentiel à l’initiation de la traduction et nous avons montré sa surexpression au niveau protéique dans la plupart des échantillons de LAM au diagnostic par comparaison à des cellules hématopoïétiques normales CD34+. Bien que son niveau d’expression n’ait pas de valeur pronostique intrinsèque, ce résultat suggère un potentiel important au blocage de la traduction dans la plupart des cas de LAM. Dans la perspective d’inhiber mTORCl, nous avons activé la voie LKBl/AMPK par la metformine, ce qui a induit des effets anti-leucémiques in vitro et in vivo via une modification du métabolisme cellulaire avec en particulier une inhibition de la synthèse de protéines oncogéniques. La metformine n’étant pas un candidat en thérapeutique dans les LAM du fait d’un index thérapeutique trop étroit, de nouvelles molécules modulant la voie LKBl/AMPK sont en cours de développement. Enfin, nous avons étudié le rôle de la sérine thréonine kinase Pim2, qui contrôle la traduction protéique et la survie dans les cellules de LAM Flt3-ITD+. Nous avons de plus montré que la sur-expression de Pim2 constitue un nouveau mécanisme de résistance aux inhibiteurs de Flt3 et représente donc une cible thérapeutique prometteuse dans cette catégorie de LAM. L’étude de la voie mTORCl et de la traduction permet donc d’envisager de multiples perspectives thérapeutiques dans les LAM dont certaines sont déjà en cours de développement clinique. / Acute myeloid leukemia (AML) are hematological malignancies with adverse prognosis in which therapies only gives 40% survival within 5 years in adults. Hence, it is important to increase our knowledge regarding oncogenesis to further develop new therapeutic approaches. Despite their clinical and biological heterogeneity, AML have in common the constitutive activation of mTORC1 signaling which is detected in most AML samples. MTORC1 controls cell survival, growth and proliferation, in particular through control of mRNA translation and protein synthesis. During this work, we show, in AML, that mTORC1 is deregulated which explain the poor effects observed with rapamycin (a mTORC1 allosteric inhibitor) and is partially mediated by the serine/threonine kinase Pim-2 which controls the mTORC1 target 4E-BP1. Nevertheless, directly targeting translation, using a specific translation initiation inhibitor named 4EGI-1, have important anti leukemic effects. EIF4E is described as essential in translation initiation and we show its protein overexpression in most AML samples at diagnosis compared with normal hematopoietic CD34+ cells. Whereas eIF4E level expression has no prognostic impact, this result suggests an important potential for treatment targeting translation initiation in AML. In our purpose of inhibiting mTORC1, we were able to activate LKB1/AMPK signaling pathway with metformin, which induces anti leukemic effects in vitro and in vivo through in particular oncogenic protein translation inhibition. Metformin is not a good AML therapeutic candidate because of a narrow therapeutic index, new compound targeting LKB1/AMPK are in development. Finally, we studied the role of the serine/threonine kinase Pim-2 and show that it controls protein translation and FLT3-ITD+ AML cells survival. Furthermore, we show that Pim-2 overexpression is a new mechanism of Flt3 inhibitors resistance and represent a new promising therapeutic target in this AML subtype. Overall, mTORC1 and protein translation study in AML show multiple therapeutics perspective, some of them are already in clinical development.

A metformina é a droga de escolha no tratamento inicial do diabetes mellitus tipo 2 (DM2). Não existe consenso na literatura sobre qual seria a segunda melhor opção terapêutica após a falência desta em longo prazo. Objetivo: avaliar a eficácia em longo prazo de gliflozinas e gliptinas após a falência do tratamento primário com metformina no DM2. Material e métodos: foi realizada uma revisão sistemática para o maior tempo de tratamento nas bases de dados bases Embase, Pubmed (via Medline), Lilacs e Cochrane Library e metanálise em rede com as sulfoniluréias (glimepirida e glipizida) como meta comparador. Desfechos: eficácia da medicação (valor final da HbA1c e porcentagem de pacientes com HbA1c < 7%), variação de peso e frequência de pacientes com hipoglicemia. Resultados: O maior tempo de segmento foi de quatro anos. Foram selecionados um artigo com empagliflozina, um artigo com dapagliflozina e um artigo com saxagliptina com dados faltantes. Após um ano de tratamento, mais de 50% dos pacientes estavam com HbA1c > 7%. O perfil de eficácia em quatro anos da empagliflozina (23%) foi melhor que da dapagliflozina (5%) e saxagliptina (7%), porém com valores de HbA1c não estatisticamente significantes (7,4 e 7,3% entre as gliflozinas), sem dados para a saxagliptina. Entretanto, a empagliflozina foi superior à glimepirida no período de quatro anos (diferença média padronizada/DMP: 0,40, intervalo de confiança/IC95%: 0,23- 0,56). A variação de peso permaneceu estável após um ano de tratamento, com vantagem em quatro anos para a empa (DMP: 1,56, IC95%: 1,23- 1,88). A frequência de pacientes com hipoglicemia não diferiu entre empagliflozina e dapagliflozina (razão de chances: 1,53, IC95%: 0,80- 2,91) e foi significativamente menor do que em relação às sulfoniluréias. Conclusões: a falência da segunda terapia com gliflozinas ocorre em menos de um ano de tratamento ( > 50% dos pacientes com HbA1c > 7%). A empagliflozina obteve um controle glicêmico melhor em relação às sulfoniluréias, porém semelhante à dapagliflozina. A perda de peso foi mantida por quatro anos, com superioridade para empagliflozina. Houve uma baixa frequência de hipoglicemia nas gliflozinas em comparação com as sulfoniluréias. Mais estudos são necessários para avaliar a eficácia de gliptinas e gliflozinas em longo prazo, após a falência terapêutica com metformina / Metformin is the first-choice treatment in people with type 2 diabetes (TD2). There is no consensus in the medical literature about which drug would be a second-best option of treatment in the case of metformin failure in long-term. Objective: to assess the long-term efficacy of gliflozins and gliptins once metformin has failed as the primary treatment for TD2. Materials and methods: a systematic review was performed considering the longest period found in Embase, Pubmed (via Medline), Lilacs and Cochrane Library databases and also network meta-analyses using sulfonylureas (glimepiride and glipizide) as a meta comparator. Clinical outcomes where efficacy of medical treatment (final value of HbA1c and percentage of patients with HbA1c < 7%), weight variation and frequency of patients with hypoglycemia. Results: the longest period of the segment was 4 years. It was selected 1 article on empagliflozin, 1 article on dapagliflozin, and 1 article on saxagliptin with missing data. After one year of treatment, over 50% of the patients presented HbA1c > 7%. Efficacy rate in 4 years of empagliflozin (23%) was better than dapagliflozin (5%) and saxagliptin (7%), however presenting statistically non-significant values for HbA1c (7.4 and 7.3% between gliflozins), and missing data for the saxaglifozin. Nonetheless, empagliflozin performed better than glimepiride in the 4-year period (standardized mean difference SMD 0.4, confidence interval CI 95% 0.23 to 0.56). Weight variation remained stable after one year of treatment, presenting empagliflozin better results in the 4-year period (SMD 1.56, CI 95% 1.23 to 1.88). The frequency of patients with hyperglycemia did not vary for empagliflozin and dapagliflozin (odds ratio 1.53, CI 95% 0.8 to 2.91), and it was significantly lower when compared to the sulfonylureas. Conclusions: the failure of the secondary treatment using gliflozins occurs in less than one year of treatment (less than 50% of the patients presenting HbA1c > 7 %). Empagliflozin offered a better glycemic control compared to the sulfonylureas, but similar to dapagliflozin. The weight loss was maintained for 4 years, being empagliflozin the one with better results. There was a low frequency of hypoglycemia for the gliflozins when compared to the sulfonylureas. Further studies are required to evaluate the efficacy of gliptins and gliflozins in the long-term after metformin failure

A metformina é a droga de escolha no tratamento inicial do diabetes mellitus tipo 2 (DM2). Não existe consenso na literatura sobre qual seria a segunda melhor opção terapêutica após a falência desta em longo prazo. Objetivo: avaliar a eficácia em longo prazo de gliflozinas e gliptinas após a falência do tratamento primário com metformina no DM2. Material e métodos: foi realizada uma revisão sistemática para o maior tempo de tratamento nas bases de dados bases Embase, Pubmed (via Medline), Lilacs e Cochrane Library e metanálise em rede com as sulfoniluréias (glimepirida e glipizida) como meta comparador. Desfechos: eficácia da medicação (valor final da HbA1c e porcentagem de pacientes com HbA1c < 7%), variação de peso e frequência de pacientes com hipoglicemia. Resultados: O maior tempo de segmento foi de quatro anos. Foram selecionados um artigo com empagliflozina, um artigo com dapagliflozina e um artigo com saxagliptina com dados faltantes. Após um ano de tratamento, mais de 50% dos pacientes estavam com HbA1c > 7%. O perfil de eficácia em quatro anos da empagliflozina (23%) foi melhor que da dapagliflozina (5%) e saxagliptina (7%), porém com valores de HbA1c não estatisticamente significantes (7,4 e 7,3% entre as gliflozinas), sem dados para a saxagliptina. Entretanto, a empagliflozina foi superior à glimepirida no período de quatro anos (diferença média padronizada/DMP: 0,40, intervalo de confiança/IC95%: 0,23- 0,56). A variação de peso permaneceu estável após um ano de tratamento, com vantagem em quatro anos para a empa (DMP: 1,56, IC95%: 1,23- 1,88). A frequência de pacientes com hipoglicemia não diferiu entre empagliflozina e dapagliflozina (razão de chances: 1,53, IC95%: 0,80- 2,91) e foi significativamente menor do que em relação às sulfoniluréias. Conclusões: a falência da segunda terapia com gliflozinas ocorre em menos de um ano de tratamento ( > 50% dos pacientes com HbA1c > 7%). A empagliflozina obteve um controle glicêmico melhor em relação às sulfoniluréias, porém semelhante à dapagliflozina. A perda de peso foi mantida por quatro anos, com superioridade para empagliflozina. Houve uma baixa frequência de hipoglicemia nas gliflozinas em comparação com as sulfoniluréias. Mais estudos são necessários para avaliar a eficácia de gliptinas e gliflozinas em longo prazo, após a falência terapêutica com metformina / Metformin is the first-choice treatment in people with type 2 diabetes (TD2). There is no consensus in the medical literature about which drug would be a second-best option of treatment in the case of metformin failure in long-term. Objective: to assess the long-term efficacy of gliflozins and gliptins once metformin has failed as the primary treatment for TD2. Materials and methods: a systematic review was performed considering the longest period found in Embase, Pubmed (via Medline), Lilacs and Cochrane Library databases and also network meta-analyses using sulfonylureas (glimepiride and glipizide) as a meta comparator. Clinical outcomes where efficacy of medical treatment (final value of HbA1c and percentage of patients with HbA1c < 7%), weight variation and frequency of patients with hypoglycemia. Results: the longest period of the segment was 4 years. It was selected 1 article on empagliflozin, 1 article on dapagliflozin, and 1 article on saxagliptin with missing data. After one year of treatment, over 50% of the patients presented HbA1c > 7%. Efficacy rate in 4 years of empagliflozin (23%) was better than dapagliflozin (5%) and saxagliptin (7%), however presenting statistically non-significant values for HbA1c (7.4 and 7.3% between gliflozins), and missing data for the saxaglifozin. Nonetheless, empagliflozin performed better than glimepiride in the 4-year period (standardized mean difference SMD 0.4, confidence interval CI 95% 0.23 to 0.56). Weight variation remained stable after one year of treatment, presenting empagliflozin better results in the 4-year period (SMD 1.56, CI 95% 1.23 to 1.88). The frequency of patients with hyperglycemia did not vary for empagliflozin and dapagliflozin (odds ratio 1.53, CI 95% 0.8 to 2.91), and it was significantly lower when compared to the sulfonylureas. Conclusions: the failure of the secondary treatment using gliflozins occurs in less than one year of treatment (less than 50% of the patients presenting HbA1c > 7 %). Empagliflozin offered a better glycemic control compared to the sulfonylureas, but similar to dapagliflozin. The weight loss was maintained for 4 years, being empagliflozin the one with better results. There was a low frequency of hypoglycemia for the gliflozins when compared to the sulfonylureas. Further studies are required to evaluate the efficacy of gliptins and gliflozins in the long-term after metformin failure

Impaired endothelial vasomotor function is a hallmark of many chronic disease states, including essential hypertension and type 2 diabetes mellitus. Loss of the homeostatic role of the endothelium in large conduit arteries can contribute to the pathogenesis of cardiovascular conditions in these vessels (e.g. stroke, atherosclerosis). A fundamental understanding of mechanisms controlling endothelial function in hypertension and type 2 diabetes mellitus is required for appropriate clinical strategies targeting the cardiovascular conditions associated with these diseases. The vast majority of basic science studies examining endothelial function in animal models of hypertension and type 2 diabetes have been conducted in males. Studying endothelial function in females is imperative for determining potential sex-specific mechanisms of dysfunction and thus appropriate therapeutic strategies. Thus the global purpose of this thesis is to identify and characterize the pathways controlling impaired vasomotor function in female animal models of two chronic disease states: hypertension and type 2 diabetes mellitus. Chapters 2 and 3 of this thesis examine sex differences in endothelium-dependent vasorelaxation (EDR) and vasocontraction (EDC) of aortic segments isolated from male and female spontaneously hypertensive rats (SHR), a model of essential hypertension, as the animals age between 16 and 30 wk old. All endothelial vasomotor data presented in the Abstract are peak responses to 10⁻⁵ M acetylcholine. Endothelial vasomotor impairment is represented by lower EDR or by higher EDC. These present data confirmed well-established findings from the literature that 16 wk old male SHR exhibit endothelial vasomotor impairments (EDR: 77±4 %; EDC: 76±7 %) compared to normotensive Wistar-Kyoto (WKY; EDR: 89±6 %; EDC: 59±8 %; p<0.05) controls, and that this impairment worsens with ageing in 30 wk male SHR (EDR: 63±2 %; EDC: 91±3 %; p<0.05). The observation that EDR was reduced in 30 wk female SHR (EDR: 76±4 %) compared to 16 wk counterparts (EDR: 101±2 %; p<0.05), however, was novel and interesting, as there were previously no reports of vasomotor responses in female SHR older than 19 wk. Moreover, the blunted EDR response of 30 wk female SHR approached the level of impairment exhibited by 30 wk male SHR (but was still slightly greater in females; p<0.05). The limited sex difference of the EDR within 30 wk SHR (males –13 % vs. females; p<0.05) contrasted that of 16 wk SHR (males –24 % vs. females; p<0.05), when the robust and unimpaired relaxation displayed by females was much greater than the significantly blunted response of males. Interestingly, endothelium-dependent contractions in quiescent rings were moderate and similar between 16 wk (EDC: 50±4 %) and 30 wk female SHR (EDC: 59±7 %; p=N/S) as compared to the greater contractions of males that were exacerbated with ageing (see above; p<0.05 both sex and ageing comparison). A major role has been established for the cyclooxygenase (COX)-1-thromboxane A₂/prostaglandin (TP) receptor pathway in the impaired endothelial vasomotor function of male SHR. Indeed, a similar mechanism appears to be responsible for the dysfunction observed in 30 wk female SHR in this thesis since robust endothelial function was restored in these animals with both antagonism of TP receptor (EDR: 111±2 %; EDC: 7±2 %; p<0.05) and preferential inhibition of COX-1 (EDR: 112±3 %; EDC: –5±3 %; p<0.05). In contrast, preferential inhibition of COX-2 only partially tempered endothelial impairments of 30 wk female SHR (EDR: 99±5 %; EDC: 27±3 %; p<0.05), suggesting that, similar to ageing male SHR, this isoform makes at most a secondary contribution to the dysfunction in 30 wk female SHR. Collectively, these data indicate that ageing female SHR exhibit a mechanism of endothelial impairment that is similar to that of male SHR and that is largely COX-1- and TP receptor-dependent. Chapter 4 examines the ability of chronic dietary administration of the n-3 polyunsaturated fatty acid (PUFA), docosahexaenoic acid (DHA, 22:6 n-3), to ameliorate endothelial vasomotor function in adult male SHR with established hypertension. The impaired endothelial function of aortic segments isolated from adult male SHR (EDR: 48±6 %) was not improved following 10–12 wk of DHA feeding (EDR: 45±5 %; p=N/S). This finding was unexpected since it has been shown in the literature that feeding other n-3 PUFAs improves vasomotor responses in younger SHR, in which hypertension and its associated consequences are still developing. This is the first report of the effects of n-3 PUFA on endothelial vasomotor responses in adult SHR with established hypertension. These data suggest that dietary DHA do not improve vasomotor function in adult SHR. Chapter 5 examines α₁ adrenergic contraction and EDR of aortic segments isolated from 14 wk old female Zucker diabetic fatty rats (ZDF), a genetic model of high fat diet-induced obesity and type 2 diabetes, and lean non-diabetic female Zucker Lean rats. Additionally, some ZDF received an 8 wk administration of anti-diabetic metformin drug therapy, aerobic exercise training, or a combination of the two. Maximal α₁ adrenergic contractions were over 2-fold higher in high fat-fed ZDF (1.69±0.16 g) compared to Lean (0.71±0.13 g; p<0.05). This elevation in ZDF was abolished by exercise training alone (1.02±0.17 g; p<0.05) but was not altered by metformin (1.56±0.19 g; p=N/S). In contrast to the severely impaired endothelial vasomotor function reported in male ZDF in the literature, robust EDR was observed in female ZDF (72±7 %) that was similar to Lean (75±6 %; p=N/S) and that was unaltered by exercise training (76±5 %; p=N/S) or metformin (76±6 %; p=N/S). These results indicate that enhanced α₁ adrenergic contraction is a mechanism of altered vasomotor function in female type 2 diabetic ZDF rats and that it could possibly be addressed by a chronic exercise training intervention. The main novelty of the thesis is the extension of the current understanding of endothelial vasomotor function to hypertensive and type 2 diabetic females. The knowledge gained from examining mechanisms involved in endothelial impairments in ageing hypertensive females and from testing the therapeutic potential of currently used anti-diabetic interventions in the type 2 diabetic female vasculature has interesting potential application. This basic scientific information could help direct clinical therapeutic strategies to target population-specific mechanisms of dysfunction. Understanding female sex-specific endothelial behaviour in patient populations is important for describing cardiovascular complications, defining mechanisms, and applying appropriate therapeutic targets. Findings from this thesis indicate a sex-dependence of the total divergence of endothelial function (e.g. female type 2 diabetic rats vs. male counterparts in the literature) and of the interaction of disease variables (e.g. age) and endothelial vasomotor responses.

Impaired endothelial vasomotor function is a hallmark of many chronic disease states, including essential hypertension and type 2 diabetes mellitus. Loss of the homeostatic role of the endothelium in large conduit arteries can contribute to the pathogenesis of cardiovascular conditions in these vessels (e.g. stroke, atherosclerosis). A fundamental understanding of mechanisms controlling endothelial function in hypertension and type 2 diabetes mellitus is required for appropriate clinical strategies targeting the cardiovascular conditions associated with these diseases. The vast majority of basic science studies examining endothelial function in animal models of hypertension and type 2 diabetes have been conducted in males. Studying endothelial function in females is imperative for determining potential sex-specific mechanisms of dysfunction and thus appropriate therapeutic strategies. Thus the global purpose of this thesis is to identify and characterize the pathways controlling impaired vasomotor function in female animal models of two chronic disease states: hypertension and type 2 diabetes mellitus. Chapters 2 and 3 of this thesis examine sex differences in endothelium-dependent vasorelaxation (EDR) and vasocontraction (EDC) of aortic segments isolated from male and female spontaneously hypertensive rats (SHR), a model of essential hypertension, as the animals age between 16 and 30 wk old. All endothelial vasomotor data presented in the Abstract are peak responses to 10⁻⁵ M acetylcholine. Endothelial vasomotor impairment is represented by lower EDR or by higher EDC. These present data confirmed well-established findings from the literature that 16 wk old male SHR exhibit endothelial vasomotor impairments (EDR: 77±4 %; EDC: 76±7 %) compared to normotensive Wistar-Kyoto (WKY; EDR: 89±6 %; EDC: 59±8 %; p<0.05) controls, and that this impairment worsens with ageing in 30 wk male SHR (EDR: 63±2 %; EDC: 91±3 %; p<0.05). The observation that EDR was reduced in 30 wk female SHR (EDR: 76±4 %) compared to 16 wk counterparts (EDR: 101±2 %; p<0.05), however, was novel and interesting, as there were previously no reports of vasomotor responses in female SHR older than 19 wk. Moreover, the blunted EDR response of 30 wk female SHR approached the level of impairment exhibited by 30 wk male SHR (but was still slightly greater in females; p<0.05). The limited sex difference of the EDR within 30 wk SHR (males –13 % vs. females; p<0.05) contrasted that of 16 wk SHR (males –24 % vs. females; p<0.05), when the robust and unimpaired relaxation displayed by females was much greater than the significantly blunted response of males. Interestingly, endothelium-dependent contractions in quiescent rings were moderate and similar between 16 wk (EDC: 50±4 %) and 30 wk female SHR (EDC: 59±7 %; p=N/S) as compared to the greater contractions of males that were exacerbated with ageing (see above; p<0.05 both sex and ageing comparison). A major role has been established for the cyclooxygenase (COX)-1-thromboxane A₂/prostaglandin (TP) receptor pathway in the impaired endothelial vasomotor function of male SHR. Indeed, a similar mechanism appears to be responsible for the dysfunction observed in 30 wk female SHR in this thesis since robust endothelial function was restored in these animals with both antagonism of TP receptor (EDR: 111±2 %; EDC: 7±2 %; p<0.05) and preferential inhibition of COX-1 (EDR: 112±3 %; EDC: –5±3 %; p<0.05). In contrast, preferential inhibition of COX-2 only partially tempered endothelial impairments of 30 wk female SHR (EDR: 99±5 %; EDC: 27±3 %; p<0.05), suggesting that, similar to ageing male SHR, this isoform makes at most a secondary contribution to the dysfunction in 30 wk female SHR. Collectively, these data indicate that ageing female SHR exhibit a mechanism of endothelial impairment that is similar to that of male SHR and that is largely COX-1- and TP receptor-dependent. Chapter 4 examines the ability of chronic dietary administration of the n-3 polyunsaturated fatty acid (PUFA), docosahexaenoic acid (DHA, 22:6 n-3), to ameliorate endothelial vasomotor function in adult male SHR with established hypertension. The impaired endothelial function of aortic segments isolated from adult male SHR (EDR: 48±6 %) was not improved following 10–12 wk of DHA feeding (EDR: 45±5 %; p=N/S). This finding was unexpected since it has been shown in the literature that feeding other n-3 PUFAs improves vasomotor responses in younger SHR, in which hypertension and its associated consequences are still developing. This is the first report of the effects of n-3 PUFA on endothelial vasomotor responses in adult SHR with established hypertension. These data suggest that dietary DHA do not improve vasomotor function in adult SHR. Chapter 5 examines α₁ adrenergic contraction and EDR of aortic segments isolated from 14 wk old female Zucker diabetic fatty rats (ZDF), a genetic model of high fat diet-induced obesity and type 2 diabetes, and lean non-diabetic female Zucker Lean rats. Additionally, some ZDF received an 8 wk administration of anti-diabetic metformin drug therapy, aerobic exercise training, or a combination of the two. Maximal α₁ adrenergic contractions were over 2-fold higher in high fat-fed ZDF (1.69±0.16 g) compared to Lean (0.71±0.13 g; p<0.05). This elevation in ZDF was abolished by exercise training alone (1.02±0.17 g; p<0.05) but was not altered by metformin (1.56±0.19 g; p=N/S). In contrast to the severely impaired endothelial vasomotor function reported in male ZDF in the literature, robust EDR was observed in female ZDF (72±7 %) that was similar to Lean (75±6 %; p=N/S) and that was unaltered by exercise training (76±5 %; p=N/S) or metformin (76±6 %; p=N/S). These results indicate that enhanced α₁ adrenergic contraction is a mechanism of altered vasomotor function in female type 2 diabetic ZDF rats and that it could possibly be addressed by a chronic exercise training intervention. The main novelty of the thesis is the extension of the current understanding of endothelial vasomotor function to hypertensive and type 2 diabetic females. The knowledge gained from examining mechanisms involved in endothelial impairments in ageing hypertensive females and from testing the therapeutic potential of currently used anti-diabetic interventions in the type 2 diabetic female vasculature has interesting potential application. This basic scientific information could help direct clinical therapeutic strategies to target population-specific mechanisms of dysfunction. Understanding female sex-specific endothelial behaviour in patient populations is important for describing cardiovascular complications, defining mechanisms, and applying appropriate therapeutic targets. Findings from this thesis indicate a sex-dependence of the total divergence of endothelial function (e.g. female type 2 diabetic rats vs. male counterparts in the literature) and of the interaction of disease variables (e.g. age) and endothelial vasomotor responses.

Pre-diabetes is a serious health problem in the United States. Distinguished by plasma glucose levels that are above the normal threshold, patients with pre-diabetes are 10 times more likely to develop type 2 diabetes. Patients with pre-diabetes suffer the same complications as patients with diabetes including diabetic retinopathy, nephropathy, and microalbuminuria. There is considerable evidence to support the idea that early identification and aggressive treatment of pre-diabetes has the potential to delay disease progression. The American Diabetes Association’s clinical practice guideline recommends management of with lifestyle modification and metformin for patients who are at risk for developing type 2 diabetes. The purpose of this project was to evaluate the implementation of the 2012 ADA clinical practice guidelines regarding the management of patients with pre-diabetes by the health care providers at a volunteer-run clinic located in a large metropolitan area in the southeastern United States. This study, even with a small sample size (n=26) revealed that the providers at the clinic had not implemented the 2012 ADA clinical practice guidelines. Clinical practice guidelines promote health care interventions that have proven benefits and improve the consistency of care provided to patients. The greatest benefits of implementing clinical practice guidelines for patients with pre-diabetes are early diagnosis and aggressive disease management. This would improve patient outcomes and in the long run, decrease the cost of medical care.

No / Hyperphosphorylated tau plays an important role in the formation of neurofibrillary tangles in brains of patients with Alzheimer's disease (AD) and related tauopathies and is a crucial factor in the pathogenesis of these disorders. Though diverse kinases have been implicated in tau phosphorylation, protein phosphatase 2A (PP2A) seems to be the major tau phosphatase. Using murine primary neurons from wild-type and human tau transgenic mice, we show that the antidiabetic drug metformin induces PP2A activity and reduces tau phosphorylation at PP2A-dependent epitopes in vitro and in vivo. This tau dephosphorylating potency can be blocked entirely by the PP2A inhibitors okadaic acid and fostriecin, confirming that PP2A is an important mediator of the observed effects. Surprisingly, metformin effects on PP2A activity and tau phosphorylation seem to be independent of AMPK activation, because in our experiments (i) metformin induces PP2A activity before and at lower levels than AMPK activity and (ii) the AMPK activator AICAR does not influence the phosphorylation of tau at the sites analyzed. Affinity chromatography and immunoprecipitation experiments together with PP2A activity assays indicate that metformin interferes with the association of the catalytic subunit of PP2A (PP2Ac) to the so-called MID1-alpha4 protein complex, which regulates the degradation of PP2Ac and thereby influences PP2A activity. In summary, our data suggest a potential beneficial role of biguanides such as metformin in the prophylaxis and/or therapy of AD.