Thesis (Ph.D.)--University of Melbourne, Howard Florey Institute & Centre for Neuroscience, 2009. / Typescript. Includes bibliographical references (leaves [1]-[10])

Thesis (Ph.D.)--Ohio University, August, 2001. / Title from PDF t.p.

Ο Λείος Μυϊκός Φαινότυπος (ΛΜΦ) χαρακτηρίζεται από σημαντική πλαστικότητα και παίζει κομβικό λειτουργικό ρόλο τόσο σε φυσιολογικές όσο και σε παθολογικές καταστάσεις. Στις αρτηρίες, η μεταβολή του ΛΜΦ στο φάσμα από φυσιολογικός-συσταλτός μέχρι συνθετικός-παθολογικός εμπλέκεται αιτιολογικά σε διάφορες ανθρώπινες ασθένειες όπως στην αθηροσκλήρωση, στην υπέρταση και στην επαναστένωση των αγγείων μετά από εγχείρηση. Η έκφραση γονιδίων ΛΜΦ έιναι επίσης μεγάλης σημασίας σε ασθένειες άλλων οργάνων, όπως η ίνωση των νεφρών και του ήπατος και η μετάσταση του καρκίνου. Συνεπώς, η μελέτη των μοριακών μηχανισμών μέσω των οποίων επηρεάζεται ο ΛΜΦ είναι πολύ σημαντική για την ανάπτυξη νέων τεχνικών περιορισμού της εξέλιξης αυτών των νόσων. Η λειτουργία πολλών ιστών όπως είναι τα αγγεία ελέγχεται σε σημαντικό βαθμό από το συμπαθητικό νευρικό σύστημα. Σκοπός λοιπόν της παρούσας εργασίας ήταν πρώτα-πρώτα να εξετάσουμε εάν in vitro η διέγερση των α και β αδρενεργικών υποδοχέων πιθανώς ρυθμίζει την έκφραση γονιδίων ΛΜΦ και προκαταρκτικά να διακριβώσουμε μέσω ποιών μοριακών μηχανισμών οι α1 (υπότυποι α1Α και α1Β) και οι β-ΑΥς επηρεάζουν και ελέγχουν το ΛΜΦ. Κατά δεύτερο λόγο θελήσαμε να εξετάσουμε εάν η εξωγενής έκφραση του μεταγραφικού παράγοντα Μυοκαρδίνη προκαλεί επιθηλιο-μεσεγχυματική μετάβαση (ΕΜΤ-Epithelial to Mesenchymal Transition) σε ενδοθηλιακά κύτταρα in vitro. Για τα πρώτα πειράματά μας χρησιμοποιήσαμε δύο διαφορετικούς κυτταρικούς πληθυσμούς: α) διαφοροποιημένα λεία μυϊκά κύτταρα αορτής αρουραίου της κυτταρικής σειράς A7r5, και β) κύτταρα ινοβλαστών της κυτταρικής σειράς ΝΙΗ3Τ3 προερχόμενα απο ποντικό, προκειμένου να δούμε αντίστοιχα πως η δράση των ΑΥ ελέγχει την έκφραση των γονιδίων αυτών σε διαφοροποιημένα ΛΜΚ (A7r5) και σε αδιαφοροποίητα κύτταρα που όμως μπορούν να μετατραπούν σε «ΛΜΚ» (ΝΙΗ3Τ3). Ως δείκτη για την έκφραση του ΛΜΦ, εξετάσαμε την έκφραση κυτταροσκελετικών, δομικών πρωτεϊνών-δεικτών, όπως η λείου μυϊκού τύπου α-Ακτίνη (SM-α-Αctin),, η λείου μυϊκού τύπου βαριά αλυσίδα της Μυοσίνης (SM-MHC), η λείου μυϊκού τύπου Καλπονίνη (SM-Calponin) και η λείου μυϊκού τύπου πρωτεΐνη 22α (τρανσγελίνη) (SM22α), σε δύο επίπεδα: α) είτε χρησιμοποιώντας αντισώματα, είτε β) με την χρήση πλασμιδίων αναφοράς όπου minimal υποκινητές των παραπάνω γονιδίων ελέγχουν την προσμετρούμενη έκφραση λουσιφεράσης. Η ενεργοποίηση της μεταγραφής αυτών των γονιδίων ρυθμίζεται, σε μεγάλο μέρος, από τις αλληλουχίες CArG (CArG boxes) στους υποκινητές τους, στις οποίες προσδένεται ο παράγοντας Serum Response Factor (SRF). Στα ΛΜΚ, ο μεταγραφικός παράγοντας SRF ενεργοποιεί τη μεταγραφή των γονιδίων-δεικτών μέσω δημιουργίας ενός απαραίτητου συμπλόκου με έναν μεταγραφικό παράγοντα της οικογένειας των Μυοκαρδινών, η οποία αποτελείται από 3 μέλη : τη Μυοκαρδίνη και τις συγγενείς πρωτεΐνες MRTF-A και MRTF-B. Στη μελέτη που πραγματοποιήσαμε, αρχικά παρατηρήσαμε ότι οι δύο αυτοί κυτταρικοί πληθυσμοί δεν εκφράζουν τους α1-ΑΥς (α1Α και α1Β υπότυποι) ενδογενώς, αλλά, με εισαγωγή του αντίστοιχου πλασμιδίου των α1Α ή α1Β ΑΥς, το σύστημα καθίσταται λειτουργικό. Επιπλέον ανακαλύψαμε ότι τα κύτταρα A7r5 εκφράζουν ενδογενώς τους β-ΑΥς. Από τα πειράματα που πραγματοποιήσαμε, καταλήξαμε στο συμπέρασμα ότι οι υποδοχείς αυτοί επηρεάζουν και καθορίζουν με διαφορετικό τρόπο το ΛΜΦ, ανάλογα με τον υπότυπο των ΑΥς και ανάλογα με τον τύπο των κυττάρων. Πιο αναλυτικά, όσον αφορά στα κύτταρα A7r5 παρατηρήσαμε ότι: α) η ενεργοποίηση των α1Α-ΑΥ επάγει την έκφραση και των τεσσάρων γονιδίων-δεικτών που καθορίζουν το ΛΜΦ τόσο σε μεταγραφικό όσο και σε πρωτεϊνικό επίπεδο, β) η ενεργοποίηση του υποκινητή της SM22α από τους α1Α-ΑΥς εξαρτάται από τα στοιχεία CΑrG ενώ η ενεργοποίηση του υποκινητή της SM-Calponin δεν εξαρτάται από τα στοιχεία αυτά, γ) η ενεργοποίηση των α1Β-ΑΥ επάγει τη μεταγραφική ενεργότητα των υποκινητών των γονιδίων SM22α και SM-Calponin ενώ δεν επηρεάζει την μεταγραφική ενεργότητα των υποκινητών των γονιδίων SM-α-Αctin και της SM-MHC, δ) η ενεργοποίηση των υποκινητών της SM22α και της SM-Calponin από τους α1Β-ΑΥς εξαρτάται από τα στοιχεία CΑrG, ε) οι β-ΑΥς, σε αντίθεση με τους α1-ΑΥς, επηρεάζουν με διαφορετικό τρόπο τη μεταγραφή των γονιδίων-δεικτών που καθορίζουν το ΛΜΦ, κυρίως ελαττώνοντας τη μεταγραφική ενεργότητα των υποκινητών των γονιδίων SM-Calponin, SM-α-Αctin και SM-MHC ενώ δεν επηρεάζουν τη μεταγραφική ενεργότητα του SM22α. Επίσης, όταν παρόμοια πειράματα έγιναν στα κύτταρα ΝΙΗ3Τ3 παρατηρήσαμε ότι: α) οι α1Α-ΑΥs επάγουν τη μεταγραφή των υποκινητών και των τεσσάρων γονιδίων-δεικτών που καθορίζουν το ΛΜΦ, β) στα κύτταρα αυτά η ενεργοποίηση των υποκινητών της SM22α και της SM-Calponin από τους α1Α-ΑΥς δεν εξαρτάται από τα στοιχεία CΑrG, γ) η ενεργοποίηση των α1Β-ΑΥs επάγει τη μεταγραφική ενεργότητα των υποκινητών των γονιδίων SM22α, SM-Calponin και SM-MHC ενώ δεν επηρεάζει την ενεργότητα του υποκινητή της SM-α-Αctin. Από τα παραπάνω λοιπόν, καταλήξαμε στα εξής συμπεράσματα: 1) Η διέγερση των α1-ΑΥ οδηγεί σε άυξηση της έκφρασης των γονιδίων-δεικτών του ΛΜΦ, και άρα οι α1-ΑΥς λειτουργούν, τουλάχιστον in vitro, ως παράγοντες προώθησης του ΛΜΦ. 2) Η δράση των α1-ΑΥ εξαρτάται μόνο μερικώς απο την ύπαρξη στοιχείων CArG (SRE), και διαφέρει ανάλογα με τον υποκινητή, άρα οι διάφοροι υποκινητές χρησιμοποιούν διαφορετικά τα στοιχεία CArG που περιέχουν, πράγμα που ενισχύει την υπόθεση συνδυαστικής χρήσης μεταφραφικών παραγόντων για την «πλαστική» έκφραση του λειτουργικού ΛΜΦ. 3) Οι δύο υπότυποι των α1-ΑΥ που εξετάστηκαν, α1Α-ΑΥς και α1Β-ΑΥς, έχουν προφανείς διαφορές ως πρός την διέγερση της έκφρασης των ΛΜ γονιδίων, και άρα πιθανώς θα παίζουν διαφορετικό λειτουργικό ρόλο στα αγγεία και στους άλλους ιστούς όπου εκφράζονται. 4) Αντίθετα με τους α1-ΑΥς, οι β-ΑΥς λειτουργούν ανασταλτικά στην έκφραση των γονιδίων του ΛΜΦ, και άρα το τελικό προϊόν της συμπαθητικής διέγερσης στα αγγεία θα είναι η συνισταμένη των δράσεων α και β ΑΥ, που θα διαφέρει στα διάφορα αγγεία ανάλογα με την σχετική έκφραση των υποδοχέων αυτών. Παράλληλα, εξετάζοντας ενδοθηλιακά κύτταρα φλέβας ανθρώπινου ομφάλιου λώρου (HUVEC), είδαμε ότι η εξωγενής έκφραση της Μυοκαρδίνης προκαλεί αλλαγές στο φαινότυπό τους, τόσο σε μορφολογικό επίπεδο όσο και μέσω de novo έκφρασης της SM-α-Ακτίνης και της SM-Καλπονίνης σε πρωτεϊνικό επίπεδο. Παρατηρήσαμε δηλαδή αλλαγές που είναι συμβατές με την επιθηλιο-μεσεγχυματική μετάβαση (ΕΜΤ-Epithelial to Mesenchymal Transition), διαδικασία με πολύ σπουδαίο ρόλο στην εμβρυογένεση, στη διαμόρφωση ιστών και οργάνων, αλλά επίσης και στην ίνωση, στη μετάσταση του καρκίνου και στην παθολογική αγγειογένεση. Συμπερασματικά, τα ενδοθηλιακά κύτταρα των αγγείων συμμετέχουν στη μετάβαση αυτή και μπορεί να συμβάλλουν σε διεργασίες κυτταρικής διαφοροποίησης και ιστικής δόμησης. Συμπεραίνουμε ότι η έκφραση της Μυοκαρδίνης επαρκεί για να προκαλέσει ΕΜΤ σε ανθρώπινα ενδοθηλιακά κύτταρα, με πιθανές συνέπειες για τη δυνατότητα trans-διαφοροποίησης και συνεισφοράς αυτών των κυττάρων, σε ανακατασκευή και αναδιοργάνωση ιστών, όπως πχ. στην αθηροσκλήρωση και την καρδιακή ανεπάρκεια. / The Smooth Muscle Cell (SMC) Phenotype is characterized by important plasticity and it plays crucial functional role in physiological and pathological conditions. Modulation of SMC Phenotype in arteries is a key etiological feature of some major human pathologies, including atherosclerosis, hypertension and vessel restenosis. Expression of SMCs marker-genes is also important in chronic diseases of other organs, such as in kidney or hepatic fibrosis and in cancer metastasis. So, study of the molecular mechanisms which affect SMC phenotype is necessary in order to develop new therapeutic approaches to combat to these diseases. Function of many tissues such as the vasculature is regulated by the sympathetic nervous system. The aim of this study was first, to examine in vitro whether the stimulation of alpha (α) and beta (β) adrenergic receptors (ARs) can control the expression of SMCs marker-genes in vitro and in case it did, to probe the molecular mechanisms via which α1-ARs (subtypes α1A and α1B) and β-ARs affect and regulate SMC Phenotype. Secondly, we wanted to investigate if the exogenous expression of Myocardin can cause Epithelial to Mesenchymal Transition (ΕΜΤ)-like changes in endothelial cells in vitro. For our experiments, we used two different cell populations : a) A7r5, which are differentiated Smooth Muscle Cells isolated from rat embryonic aorta, and b) ΝΙΗ3Τ3, mouse fibroblasts, in order to examine how stimulation of ARs modulates the expression of these marker-genes in differentiated SMCs (A7r5) and in mesenchymal cells which can convert to SMCs (ΝΙΗ3Τ3), respectively. As a marker for the expression of SMC Phenotype, we monitored the expression of cytoskeletal, structural protein-markers, such as Smooth Muscle-α-Actin (SM-α-Actin), SM-Myosin Heavy Chain (SM-MHC), h1-Calponin (SM-Calponin) and SM22α (transgelin) at two levels: a) using specific antibodies or b) using reporter plasmids in which the minimal promoters of the above genes drive luciferase gene transcription and hence activity. The coordinate transcriptional activation of these genes is, in major part, regulated by the function of CArG boxes in their promoters, which bind Serum Response Factor (SRF). In SMCs, SRF mediates its transcriptional effects via essential complex formation with members of the Myocardin family, which includes Myocardin (Myocd), Myocardin-Related Transcription Factor-A (MRTF-A) and MRTF-B. In our study, we initially noticed that these two cell populations do not express α1-ARs (subtypes α1Α and α1Β) endogenously, but when we transfect them with the plasmids expressing α1Α and α1Β ARs, the cells respond to α1-ARs agonist stimulation. In addition, we discovered that A7r5 cells express endogenous β-ARs. From our experiments, we concluded that these receptors can modulate SMC Phenotype in distinct way. This depends on both the specific subtype of receptor as well as on the cellular background (cell type). More specific, we observed that in A7r5 cells: a) activation of α1A-ARs by phenylephrine induces the expression of all four marker-genes at a transcriptional and at a protein level, b) activation of the SM22α minimal promoter by α1A-ARs depends on CΑrG boxes, while activation of the SM-Calponin minimal promoter does not depend on the presence of CΑrG boxes, c) activation of α1B-ARs induces the transcriptional activity of the minimal promoters of SM22α and SM-Calponin but does not affect the transcriptional activity of the minimal promoter of SM-α-Αctin and SM-MHC, d) activation of both the SM22α and the SM-Calponin minimal promoters by α1B-ARs depends on the presence of CΑrG boxes, e) on the contrary, β-ARs affect the transcription of SMCs marker-genes in an opposite way to α1-ARs reducing the transcriptional activity of the minimal promoters of SM-Calponin, SM-α-Αctin and SM-MHC genes, without affecting the transcriptional activity of the SM22α promoter. Additionally, we noticed that in ΝΙΗ3Τ3 cells: a) α1Α-ARs induce transcriptional activity of minimal promoters of SMC marker-genes, b) activation of minimal promoters of SM22α and SM-Calponin by α1A-ARs does not depend on CΑrG boxes, c) activation of α1B-ARs induce the transcriptional activity of the minimal promoters of SM22α, SM-Calponin και SM-MHC but does not affect the transcriptional activity of the minimal promoter of SM-α-Αctin. Based on the above findings, we conclude that: 1) Stimulation of α1-ARs drives an increased expression of SMC marker genes and consequently α1-ARs function, at least in vitro, as factors which have the ability to induce/maintain the SMC Phenotype. 2) The activity of α1-ARs depends variably on the presence of CArG boxes (SREs) and differs between these minimal promoters. In essence, different promoters use their CArG boxes in a different way. This is in support of the hypothesis that combinational use of transcriptional factors is essential for «plastic» expression of the SMC Phenotype. 3) The two subtypes of α1-ARs examined, α1Α and α1Β, display obvious differences in stimulating SM-specific gene expression and consequently these subtypes may play different functional role in vessels and in other tissues in which they are expressed. 4) On the contrary, β-ARs inhibit the expression of SMC marker-genes. Therefore, the final result of vascular sympathetic stimulation would depend on the combined action of α και β ARs. This action will differ in different vessels, depending on the relative expression of these receptors and their subtypes. In addition, adenoviral expression of Myocardin in human umbilical vein endothelial Cells (HUVECs) induced phenotypic alterations, evidenced by morphological changes and by de novo expression of SM-α-Αctin and SM-Calponin at the protein level. These observations are compatible with an Epithelial to Mesenchymal Transition (EMT), a process which plays an important role in embryogenesis, tissue and organs formation and angiogenesis, but also participates, in fibrosis and cancer metastasis. Consequently, vascular endothelial cells can undergo in EMT and may contribute in cellular differentiation and in tissue formation. We conclude that the expression of Myocardin is sufficient to cause EMT-like changes in human endothelial cells. This may lead to cellular trans-differentiation and contribution of these cells in active tissue remodeling such as in atherosclerosis and in cardiac failure.

Submitted by JOSÉ WILLIAM ZUCCHI null (jwzucchi@hotmail.com) on 2018-04-02T23:13:39Z No. of bitstreams: 1 Dissertação Mestrado José W. Zucchi.pdf: 2342865 bytes, checksum: 860bbd3c7b2672c61b7ca6b121b0e8f9 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-04-03T12:55:11Z (GMT) No. of bitstreams: 1 zucchi_jw_me_bot.pdf: 2342865 bytes, checksum: 860bbd3c7b2672c61b7ca6b121b0e8f9 (MD5) / Made available in DSpace on 2018-04-03T12:55:11Z (GMT). No. of bitstreams: 1 zucchi_jw_me_bot.pdf: 2342865 bytes, checksum: 860bbd3c7b2672c61b7ca6b121b0e8f9 (MD5) Previous issue date: 2018-02-28 / Introdução: Os pacientes com doença pulmonar obstrutiva crônica (DPOC) exibem características clínicas heterogêneas que estão associados a diferentes respostas a tratamentos e prognósticos. A complexidade da doença faz com que sejam buscadas ferramentas alternativas como o agrupamento de cluster para a identificação de características específicas e que possam tratadas diferentemente dentro da mesma doença. Entretanto, ainda são escassos dados da América Latina em relação aos possíveis clusters da DPOC. Objetivo: Avaliar os possíveis clusters na DPOC em dois centros de estudo no Brasil. Métodos: Os pacientes foram submetidos à avaliação composta por doenças associadas, Índice de Charlson, composição corporal, fármacos atuais, história de tabagismo (anos/maço), monóxido de carbono exalado, histórico de exacerbações/ hospitalizações no último ano, espirometria, teste de caminhada de seis minutos, questionários de qualidade de vida, dispneia e escala hospitalar de ansiedade e depressão. Também foram coletadas amostras de sangue para dosagens de proteína C reativa (PCR), gases sanguíneos, análise laboratorial e hemograma. Resultados: Foram avaliados 334 pacientes portadores de sintomas respiratórios e fator de risco para DPOC. Desse total, 13 pacientes foram excluídos do estudo por não terminarem o protocolo, 20 pacientes sem diagnóstico de DPOC e 10 por não terem sido classificados em nenhum cluster. Assim, foram incluídos 291 pacientes [53,6% homem, 67,5 ± 9,6 anos e volume expiratório forçado no primeiro segundo (VEF1) = 45,5 ± 17,9]. Para a construção dos clusters foram selecionadas 13 variáveis continuas e realizado análise com o método de Ward e método K means que determinaram quatro clusters. O primeiro cluster foi caracterizado por menor gravidade sintomática e funcional da doença, o segundo grupo por maior valor de eosinófilos periféricos, o terceiro grupo por serem mais inflamados sistemicamente e o quarto grupo por serem com maior gravidade obstrutiva e pior troca gasosa. O cluster 2 apresentou média de 959± 3 eosinófilos periféricos, cluster 3 apresentou maior prevalência de depleção nutricional (46,1%) e o cluster 4 apresentou maior índice BODE. Em relação as comorbidades associadas identificamos que apenas a síndrome de apneia obstrutiva do sono e o tromboembolismo pulmonar foram mais prevalentes no cluster 4. Conclusão: As manifestações clínicas e comorbidades associadas da DPOC identificadas nos quatros diferentes clusters deste estudo mostram as características heterogêneas da doença e isso pode estar relacionado à desfechos prognósticos diferentes em cada cluster podem diferenciar o tratamento em cada agrupamento com maior efetividade. / Introduction: Patients with chronic obstructive pulmonary disease (COPD) exhibit heterogeneous clinical features that are associated with different responses to treatments and prognoses. The complexity of the disease causes alternative tools such as clustering to identify specific characteristics and that can be treated differently within the same disease. However, there are still little data from Latin America regarding possible clusters in COPD. Objective: To evaluate possible clusters in COPD in two Brazilian centers. Methods: We assesses the comorbidities, Charlson's index, body composition, pharmacological treatment, smoking history (pack-years), exhaled carbon monoxide, exacerbations/hospitalizations rate in the last year, spirometry, six-minute walk test, quality of life questionnaires, dyspnea and hospital anxiety and depression scale. We also collected blood gases, laboratory and blood counts. Results: A total of 334 patients with respiratory symptoms and a risk factor for COPD were evaluated. From the total, 13 patients were excluded from the study because they didn’t complete the protocol, 20 patients without a diagnosis of COPD and 10 because they were not classified in any cluster. Thus, 291 patients were included [53.6% male, 67.5 ± 9.6 years and forced expiratory volume in the first second (FEV1) = 45.5 ± 17.9]. For the construction of the clusters, 13 continuous variables were selected and an analysis was performed with the Ward method and K method, which determined four clusters. The first cluster was characterized by lower symptomatic and mild COPD. The second cluster was characterized by higher value of peripheral eosinophils, the third cluster with systemic inflammation and the fourth cluster had severe COPD and worst gas exchange. Cluster 2 presented a mean of 959 ± 3 peripheral eosinophils, cluster 3 presented a higher prevalence of nutritional depletion (46.1%) and cluster 4 presented higher BODE index. In relation to the associated comorbidities, we identified that only obstructive sleep apnea syndrome and pulmonary thromboembolism were more prevalent in cluster 4. Conclusion: The clinical manifestations and associated comorbidities of COPD identified in the four different clusters of this study show the heterogeneous characteristics of the disease and this may be related to different outcomes and treatment.

Orientador: Suzana Erico Tanni Minamoto / Resumo: Introdução: Os pacientes com doença pulmonar obstrutiva crônica (DPOC) exibem características clínicas heterogêneas que estão associados a diferentes respostas a tratamentos e prognósticos. A complexidade da doença faz com que sejam buscadas ferramentas alternativas como o agrupamento de cluster para a identificação de características específicas e que possam tratadas diferentemente dentro da mesma doença. Entretanto, ainda são escassos dados da América Latina em relação aos possíveis clusters da DPOC. Objetivo: Avaliar os possíveis clusters na DPOC em dois centros de estudo no Brasil. Métodos: Os pacientes foram submetidos à avaliação composta por doenças associadas, Índice de Charlson, composição corporal, fármacos atuais, história de tabagismo (anos/maço), monóxido de carbono exalado, histórico de exacerbações/ hospitalizações no último ano, espirometria, teste de caminhada de seis minutos, questionários de qualidade de vida, dispneia e escala hospitalar de ansiedade e depressão. Também foram coletadas amostras de sangue para dosagens de proteína C reativa (PCR), gases sanguíneos, análise laboratorial e hemograma. Resultados: Foram avaliados 334 pacientes portadores de sintomas respiratórios e fator de risco para DPOC. Desse total, 13 pacientes foram excluídos do estudo por não terminarem o protocolo, 20 pacientes sem diagnóstico de DPOC e 10 por não terem sido classificados em nenhum cluster. Assim, foram incluídos 291 pacientes [53,6% homem, 67,5 ± 9,6 anos e volume expi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Patients with chronic obstructive pulmonary disease (COPD) exhibit heterogeneous clinical features that are associated with different responses to treatments and prognoses. The complexity of the disease causes alternative tools such as clustering to identify specific characteristics and that can be treated differently within the same disease. However, there are still little data from Latin America regarding possible clusters in COPD. Objective: To evaluate possible clusters in COPD in two Brazilian centers. Methods: We assesses the comorbidities, Charlson's index, body composition, pharmacological treatment, smoking history (pack-years), exhaled carbon monoxide, exacerbations/hospitalizations rate in the last year, spirometry, six-minute walk test, quality of life questionnaires, dyspnea and hospital anxiety and depression scale. We also collected blood gases, laboratory and blood counts. Results: A total of 334 patients with respiratory symptoms and a risk factor for COPD were evaluated. From the total, 13 patients were excluded from the study because they didn’t complete the protocol, 20 patients without a diagnosis of COPD and 10 because they were not classified in any cluster. Thus, 291 patients were included [53.6% male, 67.5 ± 9.6 years and forced expiratory volume in the first second (FEV1) = 45.5 ± 17.9]. For the construction of the clusters, 13 continuous variables were selected and an analysis was performed with the Ward method and K method, which dete... (Complete abstract click electronic access below) / Mestre

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Creutzfeldt-Jakob disease (CJD) is the commonest form of human prion disease and occurs in sporadic, genetic and acquired forms. The causative agents (prions) appear to be composed entirely of a modified host protein, the prion protein, which undergoes misfolding to a disease-associated isoform closely associated with infectivity that is resistant to conventional methods of decontamination. Prions can be transmitted from one individual to another by medical and surgical procedures, resulting in iatrogenic CJD (iCJD). The commonest cause of iCJD is the inoculation of cadaveric pituitary-derived human growth hormone (hGH) to treat growth hormone deficiency in children; this form of treatment was abandoned in 1985 after the first UK case of iCJD in a hGH recipient was identified. Seventy-eight cases of iCJD have since occurred in the UK cohort of 1849 hGH recipients, including a case in 2016. This thesis describes a comprehensive tissue-based and molecular genetic analysis of the largest series (35 cases) of UK hGH-iCJD cases reported to date, including in vitro kinetic molecular modelling of genotypic factors influencing prion transmission. The results show that the polymorphism at codon 129 of the prion protein gene strongly influences the disease incubation period in hGH-iCJD (from 7.8-32.3 years in this series) and interacts with the infectious prion strain to govern the molecular and pathological characteristics of iCJD. The findings are consistent with the hypothesis that the UK hGH-iCJD epidemic resulted from transmission of the V2 human prion strain, which is found in the second most common form of sporadic CJD. The investigation also found accumulation of the amyloid beta (Aβ) protein associated with Alzheimer’s disease (AD) in the brains and cerebral blood vessels in 18/35 hGH-iCJD patients and 5/12 control patients who had been treated with hGH, but died from causes other than iCJD. In contrast, Aβ accumulation was markedly less prevalent in age-matched patients who died from sporadic CJD (1/15 cases) and variant CJD (2/33 cases). These results are consistent with the hypothesis that Aβ, which can accumulate in the pituitary gland, was present in the inoculated hGH preparations and seeded into the brains of around 50% of all hGH recipients, producing AD-like neuropathology and cerebral amyloid angiopathy (CAA). This provides further evidence of the prion-like properties of Aβ and gives insight into the potential for possible transmission of AD/CAA. It is uncertain whether any Aβ seeding within the brains of surviving patients in the UK hGH recipient cohort will ultimately result in clinical AD; however, the CAA in these patients may be complicated by intracerebral haemorrhage resulting from rupture of the blood vessels damaged by Aβ accumulation within their walls.

A falência ovariana prematura (FOP) é uma patologia rara, definida como a falência da função ovariana antes dos 40 anos de idade, causando amenorréia, hipogonadismo e níveis elevados de gonadotrofinas. Na maioria dos casos, apresenta-se na forma esporádica, pois apenas 5% apresentam história familial. Com relativa freqüência, a causa etiológica não é obtida, sendo então denominada de idiopática. Entre as causas conhecidas estão as alterações dos genes ligados ao cromossomo X e cromossomos autossômicos, doenças autoimunes, alterações tóxicas e iatrogênicas. Vários estudos têm sugerido que a FOP possa ser uma desordem genética, sendo o gene do receptor do FSH (FSHR) considerado um dos principais genes candidato. A primeira mutação inativadora do gene do receptor do FSH (FSHR) foi descrita por Aittomaki et al., 1995, em mulheres de famílias finlandesas que apresentavam amenorréia primária e uma mutação em ponto C566T no exon 7. Posteriormente, outras mutações inativadoras foram descritas: Ile169Thr e Arg573Cys (BEAU et al.,1998), Asp224Val e Leu601Val (TOURAINE et al.,1999), Ala419Thr (DOHERTY et al., 2002), Pro348Arg (ALLEN et al., 2003) e Pro519Thr (MEDURI et al., 2003). Por outro lado, duas variantes polimórficas, Ala307Thr e Ser307Asn, também, foram identificadas em pacientes com FOP (DA FONTE KOHEK et al., 1998, SUNDBLAD et al., 2004), embora uma relação com o fenótipo não tenha sido sistematicamente investigada.Assim, estudou-se uma coorte de 39 mulheres com FOP (casos esporádicos e familiais) que estão em acompanhamento na Unidade de Endocrinologia Ginecológica, Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre, com o objetivo de determinar a presença de mutações e/ou polimorfismos no gene do FSHR e verificar se estão associadas com o fenótipo clínico. Para este fim foram realizados 2 trabalhos, o primeiro analisando 36 casos com FOP esporádica e incluindo 2 pacientes probantes de 2 familias com FOP. O segundo estudo descrevendo o genótipo e fenótipo de 5 pacientes oriundas de 2 famílias com FOP. Variáveis clínicas e hormonais foram determinadas de todas pacientes. O DNA foi isolado de leucócitos periféricos. Os exons 6, 7, 9 e 10 do gene do FSHR foram analisados pela reação de polimerização em cadeia (PCR), seguidos por análise de restrição enzimática, eletroforese em gel com gradiente de desnaturação (DGGE) e seqüenciamento direto. Também foram medidos o volume uterino, espessura endometrial e volume ovariano porultrassonografia pélvica transvaginal. Embora não se tenha encontrado nenhuma mutação no gene do FSHR, identificou-se uma alta prevalência dos polimorfismos Ala307Thr e Ser680Asn, que se encontram em desequilíbrio de ligação. Não foram observadas associações entre a presença destes polimorfismos com os níveis séricos de FSH, LH, estradiol, bem como com volume ovariano e presença de folículos. No entanto, as pacientes com FOP esporádicas, com o polimorfismo Ala307Thr, apresentaram a última menstruação mais precocemente (A: idade=33.3 ± 7.1 anos vs. T: 28.6 ± 11.4 anos, p=0.04). A genotipagem dos casos de FOP familial evidenciou a presença dos 2 polimorfismos do gene do FSHR nas 5 pacientes e o fenótipo foi semelhante ao apresentado pelas mulheres com FOP esporádica. Em conclusão, a presença do polimorfismo Ala307Thr pode estar associada com um início mais precoce das manifestações clínicas em pacientes com FOP. Entretanto, estudos longitudinais são necessários para confirmar os resultados do presente estudo. / Premature ovarian failure (POF) is a rare pathology, defined as the failure of ovarian function before age 40, causing amenorrhea, hypogonadism and high gonadotropin levels. In most cases, premature ovarian failure is sporadic and only 5% of the affected individuals have a family history. Relatively often, the etiological cause is not determined and POF is thus labeled idiopathic. Among the known causes are alterations associated with the X chromosome and autosomal chromosomes, autoimmune diseases, and toxic and iatrogenic alterations. Several studies have suggested that POF may be a genetic disorder, the FSH receptor (FSHR) gene being considered one of the main candidate genes.The first inactivating mutation in the FSHR gene was described by Aittomaki et al., in 1995, in women of Finnish families with primary amenorrhea and a C566T point mutation in exon 7. Other inactivating mutations have since then been described: Ile169Thr and Arg573Cys (BEAU et al., 1998), Asp224Val and Leu601 Val (TOURAINE et al., 1999), Ala419Thr (DOHERTY et al., 2002), Pro348Arg (ALLEN et al., 2003), and Pro519Thr (MEDURI et al., 2003). On the other hand, two polymorphic variants, Ala307Thr and Ser307Asn, were also identified in POF patients (DA FONTE KOHEK et al., 1998, SUNDBLAD et al., 2004), although a relation with the phenotype has not been systematically investigated. Thus, a cohort was studied comprising 39 women with POF (sporadic and familial cases) being followed at the Gynecological Endocrinology Unit, Service of Endocrinology, Hospital de Clínicas de Porto Alegre, in order to determine the presence of mutations and/or polymorphisms in the FSHR gene and to ascertain if these are associated with the clinical phenotype. For this purpose, 2 studies were conducted, the first assessing 36 cases with sporadic POF, including 2 patients from 2 families with POF and the second describing the genotype and phenotype of 5 patients from 2 families with POF. Clinical and hormonal variables were determined for all patients. The DNA was isolated from peripheral leukocytes. Exons 6, 7, 9 and 10 of the FSHR gene were analyzed by polymerase chain reaction (PCR), followed by restriction enzyme analysis, denaturating gradient gel electrophoresis (DGGE), and direct sequencing. Also, uterine size, endometrial thickness and ovarian size were measured by transvaginal pelvic ultrasonography. Although no mutation of the FSHR gene was found, a high prevalence for Ala307Thr and Ser680Asn polymorphisms was found, that are in linkagedisequilibrium. No association was observed between the presence of these polymorphisms and the serum levels of FSH, LH and estradiol, as well as ovarian size and presence of follicles. However, patients with sporadic POF, presenting Ala307Thr polymorphism, had their latest menses earlier (A: age=33.3 ± 7.1 years vs. T: 28.6 ± 11.4 years, p = 0.04). The genotyping of cases with familial-related POF showed the presence of 2 polymorphisms in the FSHR gene in 5 patients, and the phenotype was similar to that presented by women with sporadic POF. In conclusion, the presence of Ala307Thr polymorphism may be associated with an earlier onset of clinical manifestations in POF patients. However, longitudinal studies are needed to confirm the results of the present study.

O autismo apresenta uma alta herdabilidade e uma etiologia heterogênea, com o provável envolvimento de vários genes. Estudos recentes sugerem que características presentes nos pais de crianças com autismo apresentam paralelo com as apresentações de traços associados nos filhos. Este estudo avaliou 15 famílias de autistas, de Porto Alegre e região metropolitana, e controles. Foram utilizados quatro instrumentos de avaliação no estudo: dois avaliando as características nos filhos (ADI-R e Protocolo de Bosa) e dois aplicados aos pais (ITC e EDS). Os resultados deste estudo apontaram para a confirmação da agregação familiar de características fenotípicas herdadas independentemente. Apesar de diferirem dos resultados dos controles (pais de crianças com desenvolvimento típico), não comprovou-se a existência de uma diferença significativa na severidade de apresentações fenotípicas em pais de crianças autistas. Foi possível estabelecer a presença de uma configuração de características fenotípicas ligadas a aspectos do autismo em pais e crianças com autismo. Esta pesquisa aponta pistas para a existência de um padrão de herança dentro das famílias autistas. / The autism is a neuropsychiatric disturbance characterized by a retard pattern and by deficits in the development of the social abilities, of communication and by a restricted repertory of activities and interests. The beginning of this disturbance occurs at the first years of life. The autism presents a high inheritability and a heterogeneous etiology, with the probable involvement of several genes. Recent studies suggest that present characteristics in the parents of children with autism present parallel with the presentations of associated features in the children. This study evaluated 15 families of autists, from Porto Alegre and metropolitan region and controls. Four evaluation instruments was utilized in the study: two of them evaluating the characteristics in the children (ADI-R and Bosa's Protocol) and two of them applied to the parents (TCI and SAD). The results of this study pointed to the confirmation of the familiar aggregation of independently inherited phenotypical characteristics. Albeit they differ from the controls results (parents of children with typical development), it was not possible to prove the existence of a significative difference in the severity of phenotypical presentations in parents of autistic children. It was possible to establish a presence of a configuration of phenotypical characteristics connected to autism aspects in parents and children with autism. This research indicates clues for the existence of a inheritance pattern within the autistic families.

142f. / Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-05-24T13:11:05Z No. of bitstreams: 1 Elisangela Adorno.pdf: 3379043 bytes, checksum: 972521d9aae8561da326946dd4da678a (MD5) / Approved for entry into archive by Flávia Ferreira(flaviaccf@yahoo.com.br) on 2013-05-30T00:18:31Z (GMT) No. of bitstreams: 1 Elisangela Adorno.pdf: 3379043 bytes, checksum: 972521d9aae8561da326946dd4da678a (MD5) / Made available in DSpace on 2013-05-30T00:18:31Z (GMT). No. of bitstreams: 1 Elisangela Adorno.pdf: 3379043 bytes, checksum: 972521d9aae8561da326946dd4da678a (MD5) Previous issue date: 2005 / Introdução. A hemoglobina S (HbS) resulta da troca de nucleotídeo (GAG GTG) no sexto codon do gene da globina beta, levando à substituição do ácido glutâmico por valina na cadeia da globina beta. A anemia falciforme ou a homozigose para a HbS, freqüentemente apresenta manifestações clínicas heterogêneas, fortemente relacionadas aos níveis de hemoglobina fetal (HbF). Objetivo. O presente estudo investigou as características fenopíticas e os marcadores moleculares presentes em portadores da anemia falciforme de Salvador-BA, identificando seqüências gênicas potencialmente importantes para a expressão dos genes gama. Métodos. O perfil de hemoglobinas e o nível de HbF foram determinados por cromatografia líquida de alta performance (HPLC). Informações sobre o perfil clínico dos pacientes foram obtidas através da análise de prontuários. A talassemia α2 3.7Kb foi investigada pela reação em cadeia da polimerase (PCR) e os haplótipos ligados ao grupo de genes da globina berta S foram investigados por PCR e análise de sítios polimórficos utilizando endonucleases de restrição (RFLP). As regiões promotoras dos genes yG e γA e o HS2-LCR foram amplificados assimetricamente e seqüenciadas no ABI Prism 3100 prism DNA Sequencer. As análises estatísticas foram desenvolvidas no software EPI-INFO versão 6.04 e a significância foi estabelecida para p < 0.05. Resultados. Foram analisados 131 pacientes, dos quais 125 tiveram identificado o genótipo beta S, tendo sido encontrado 64 (51,2%) CAR/Ben; 36 (28,8%) Ben/Ben; 18 (14,4%) CAR/CAR; dois (1,6%) CAR/Aty;dois (1,6%) Ben/Cam; um (0,8%) CAR/Cam; um (0,8%) Car/Arabia-India e um (0,8%) Sen/Aty. A talassemia 2 3.7Kb foi estudada em 110 pacientes, onde 30 (27,3%) foram heterozigotos e dois (1,8%) homozigotos. O uso de transfusão sangüínea foi maior em pacientes com HbF menor que ou igual a 10,0% (p=0,009). Pacientes com genótipos α diferentes apresentaram diferenças para os valores de Hb (p=0,018); Ht (p=0,019); VCM (p=0,0004) e HCM (p=0,039). Os níveis de HbF foram maiores entre os pacientes Ben/Ben que entre os CAR/CAR (p=0,007) e CAR/Ben (p=0,013). A análise das seqüências do HS2-LCR de dez indivíduos demonstrou a substituição G A na posição ?10.677, presente apenas entre os portadores do haplótipo Ben com nível elevado de HbF, sugerindo uma possível associação entre este polimorfismo, a expressão dos genes γ e a síntese da HbF. A análise da região promotora do gene γG demonstrou a substituição T C na posição -157, que parece ser uma seqüência característica entre os pacientes estudados. Também foi encontrada a deleção de 4 pb na posição ?222 a ?225 no gene γG e relacionado ao haplótipo Cam. Conclusões. Os dados demonstraram um novo polimorfismo localizado no HS2-LCR e na região promotora do gene γG da globina, justificando a realização de estudos adicionais, associando os níveis de HbF, marcadores biológicos e mecanismos relacionados, visando esclarecer um possível papel no desenvolvimento do fenótipo da doença. / Salvador