Class of 2013 Abstract / Specific Aims: To determine efficacy of alendronate (ALN) and risedronate (RIS) for treatment of osteoporosis and osteopenia in men. Methods: Literature search was primarily via PubMed. Inclusion criteria were: randomized controlled trials or observational studies assessing treatment of osteoporosis in men, either of primary or secondary etiology. Exclusion criteria were: minority population with baseline osteoporosis, inclusion of women, lack of control group. Primary outcomes were bone mineral density (BMD) of femoral neck (FN) and lumbar spine (LS); secondary outcomes were vertebral or non-vertebral fractures incidence. Data were synthesized using a random effects meta-analysis. Main Results: Eleven ALN and six RIS studies were included; most provided LS and FN data, but trials longer than 1-year were infrequent (ALN 3, RIS 4) as were fracture data (ALN 4, RIS 3). For both FN and LS BMD, both drugs showed significant treatment effects at one and two-years (p<0.001). For FN BMD, 2-year treatment effects were ALN: SDM= 0.638, p<0.001; RIS: SDM= 0.391, p<0.001; heterogeneity was insignificant (p> 0.05). For LS BMD, treatment effects were: 2-year ALN: SDM= 1.206, p<0.001; 1-year RIS: SDM= 0.0.574; p<0.001; heterogeneity was insignificant (p>0.05). For fracture, both drugs showed significant treatment effects at vertebral sites: ALN: OR 0.450, p<0.05; RIS: OR 0.423, p=0.001; heterogeneity was insignificant (p>0.05). RIS also showed a promising effect at non-vertebral sites (p<0.05), however only two studies provided data at this site. Conclusion: Both ALN and RIS are effective to increase BMD and decrease vertebral fracture occurrence in men with osteoporosis or osteopenia.

Orientador: Fernando Gomes Romeiro / Resumo: A osteoporose é uma complicação frequente da cirrose hepática (CH) que pode levar a fraturas, comprometendo a qualidade e a expectativa de vida. Bisfosfonatos são frequentemente utilizados para reduzir o risco de fraturas por osteoporose, mas podem provocar danos à mucosa gastrointestinal. O objetivo deste estudo foi avaliar a segurança do risedronato em pacientes com CH e varizes de esôfago (VE). De 354 pacientes com CH, 164 foram considerados elegíveis e alocados de acordo com a densidade mineral óssea após densitometria. No grupo intervenção, 52 indivíduos com osteoporose receberam tratamento com risedronato oral (35 mg / semana), suplementação de cálcio e vitamina D. No grupo controle, 51 indivíduos com osteopenia receberam apenas suplementação de cálcio e vitamina D. Todos foram submetidos a endoscopias de vigilância durante 1 ano e à densitometria ao final do estudo. A média etária e a proporção de mulheres foi maior no grupo intervenção. O MELD (Model of End-Stage Liver Disease) no grupo intervenção e controle foi 9,6 (5,9-15,5) e 10,3 (6,5-19), respectivamente (p= 0,047). O grupo controle teve mais casos de doença hepática alcoólica (p< 0,001). Em ambos os grupo a maioria dos indivíduos tinha classificação Child-Pugh A e VE de baixo risco de sangramento. Não houve diferença entre os grupos quanto aos achados endoscópicos observados durante a intervenção. Não houve hemorragia digestiva alta no grupo intervenção, mas em 2 casos do grupo controle. O grupo intervenção foi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Osteoporosis is a common complication of liver cirrhosis that can lead to fractures, compromising quality of life and survival rate. Bisphosphonates are often used to reduce the risk of fractures caused by osteoporosis, but can lead to digestive mucosal damage. The aim of this study was to evaluate the safety of risedronate for patients with cirrhosis and esophageal varices. Of the 354 cirrhotic patients invited to participate, 164 were considered eligible and allocated according to the bone mineral density after densitometry. In the intervention group, 52 individuals with osteoporosis received oral risedronate 35 mg weekly plus calcium and vitamin D supplementation. In the control group, 51 individuals with osteopenia received only calcium and vitamin D supplementation. All the subjects underwent surveillance endoscopies within 1 year and another bone densitometry at the end of the trial. The mean age and the proportion of women were higher in the intervention group. The Model of End-Stage Liver Disease (MELD) scores in the intervention and control group were 9.6 (5.9-15.5) and 10.3 (6.5-19), respectively (p= 0.047). The control group had more subjects with alcoholic liver disease (p< 0.001). In both groups the majority of the individuals had Child-Pugh A classification and low-risk bleeding esophageal varices. There was no difference between the groups regarding esdoscopic findings during the intervention. There was no upper gastrointestinal bleeding in the intervention gro... (Complete abstract click electronic access below) / Doutor

Made available in DSpace on 2014-06-11T19:23:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-07-26Bitstream added on 2014-06-13T18:09:15Z : No. of bitstreams: 1 werkman_c_me_sjc.pdf: 536599 bytes, checksum: 7def8f8672e76b8811df840d31139525 (MD5) / A osteoporose, doença caracterizada pela perda de massa óssea, tem sido alvo de estudos nos últimos anos. Fraturas decorrentes da osteoporose são muito comuns e podem apresentar consolidação mais lenta. O objetivo deste trabalho foi avaliar o efeito do risedronato (medicamento alopático) e da Calcarea phosphorica 6CH (medicamento homeopático) no processo de reparo ósseo em ratos machos com osteoporose induzida por castração. Para tanto, foram utilizados oitenta e quatro ratos de três meses de idade separados em quatro grupos de vinte e um animais, sendo três grupos submetidos à castração e um grupo a falsa cirurgia (sham). Um mês após, foram realizadas lesões ósseas monocorticais na tíbia de todos os animais e a partir do dia seguinte, os respectivos tratamentos foram iniciados de acordo com os seguintes grupos: CR - castrado/ risedronato (1mg/kg/dia); CCp - castrado/Calcarea phosphorica 6CH (três gotas/dia); CP - castrato/placebo e SP - sham/placebo que receberam apenas três gotas ao dia de água destilada. Os animais foram sacrificados aos sete, catorze e vinte e oito dias após o início do tratamento e as tíbias removidas. Radiografias digitais foram realizadas e avaliadas pelo programa Image Tool para obter a densidade óptica na área do defeito. Então as tíbias foram descalcificadas e processadas para a realização das análises histológicas. A histomorfometria mediu a porcentagem de osso formado utilizando um retículo graduado colocado no centro da lesão através do programa Image J. Para a análise estatística, os dados foram submetidos aos testes de ANOVA, Tukey e Dunnett, ao nível de 5%. Segundo a análise da densidade óptica, o grupo CCp apresentou os melhores resultados aos sete e catorze dias, mas foi superado pelo grupo CR aos vinte e oito dias. Segundo a histomorfometria o grupo SP apresentou o melhor resultado aos sete dias,... / Osteoporosis, a disease characterized by progressive bone loss, has been the target of several studies lately. It results in a much higher risk for fractures and might cause slower bone consolidation. The aim of this work was to study the effects of Risedronate (allopathic medicine) and Calcarea phosphorica 6CH (homeopathic medicine) to repair bone lesions in male rats with osteoporosis, induced by castration. For this, eighty-four three-months-old rats were used divided in four groups of twenty-one animals. Three groups where castrated and one group was submitted to Sham surgery. One month later, monocortical lesions were made in all animals' tibiae and after one day they began the different treatments according to the following groups: CR - castrated/Risedronate (1mg/kg/day); CCp - castrated/Calcarea phosphorica 6CH (3 drops/day); CP - castrated/placebo and SP - Sham/placebo that received 3 drops/day of distilled water. The animals were sacrificed at seven, fourteen and twenty-eight days after the beginning of treatment and had their tibiae removed. The tibiae's digital XR was analyzed in order to evaluate optical density, using the Image Tool program. Then, they were decalcified and processed for histologic analysis. Histomorphometric measures of bone percentual formation were evaluated using a graticule in the central area of the lesion, with the Image J program. Data was submitted to ANOVA, Tukey and Dunnett tests (5% level). According to the optical density, the CCp group showed the best results at seven and fourteen days, but it was surpassed by the CR group at the 28th day. The histomorphometrical analyses showed that the SP group had the best result at seven days but the CR group formed more bone than all the other groups at 14 and 28 days.Measuring the bony callus, the CR group had the thicker callus at seven and 28 days. It... Complete abstract, click electronic address below)

Submitted by Talles Bazeia Lima (tallesbazeialima@gmail.com) on 2018-04-25T11:46:30Z No. of bitstreams: 1 Tese de Doutorado.pdf: 14703661 bytes, checksum: c158c5e515319db12071983670b54172 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-04-26T17:26:01Z (GMT) No. of bitstreams: 1 lima_tb_dr_bot.pdf: 14703661 bytes, checksum: c158c5e515319db12071983670b54172 (MD5) / Made available in DSpace on 2018-04-26T17:26:01Z (GMT). No. of bitstreams: 1 lima_tb_dr_bot.pdf: 14703661 bytes, checksum: c158c5e515319db12071983670b54172 (MD5) Previous issue date: 2018-02-28 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A osteoporose é uma complicação frequente da cirrose hepática (CH) que pode levar a fraturas, comprometendo a qualidade e a expectativa de vida. Bisfosfonatos são frequentemente utilizados para reduzir o risco de fraturas por osteoporose, mas podem provocar danos à mucosa gastrointestinal. O objetivo deste estudo foi avaliar a segurança do risedronato em pacientes com CH e varizes de esôfago (VE). De 354 pacientes com CH, 164 foram considerados elegíveis e alocados de acordo com a densidade mineral óssea após densitometria. No grupo intervenção, 52 indivíduos com osteoporose receberam tratamento com risedronato oral (35 mg / semana), suplementação de cálcio e vitamina D. No grupo controle, 51 indivíduos com osteopenia receberam apenas suplementação de cálcio e vitamina D. Todos foram submetidos a endoscopias de vigilância durante 1 ano e à densitometria ao final do estudo. A média etária e a proporção de mulheres foi maior no grupo intervenção. O MELD (Model of End-Stage Liver Disease) no grupo intervenção e controle foi 9,6 (5,9-15,5) e 10,3 (6,5-19), respectivamente (p= 0,047). O grupo controle teve mais casos de doença hepática alcoólica (p< 0,001). Em ambos os grupo a maioria dos indivíduos tinha classificação Child-Pugh A e VE de baixo risco de sangramento. Não houve diferença entre os grupos quanto aos achados endoscópicos observados durante a intervenção. Não houve hemorragia digestiva alta no grupo intervenção, mas em 2 casos do grupo controle. O grupo intervenção foi o único em que houve ganho de massa óssea (coluna lombar): média do T score -3,2 e -2,7 pré e pós-tratamento, respectivamente (p= 0,001). Porém houve mais casos de artralgia e mialgia nesse grupo (p= 0,031 e 0,006), respectivamente. Esses resultados, de efeito prático imediato, sugerem que o risedronato é seguro na CH compensada com VE de baixo risco de sangramento sob vigilância endoscópica. / Osteoporosis is a common complication of liver cirrhosis that can lead to fractures, compromising quality of life and survival rate. Bisphosphonates are often used to reduce the risk of fractures caused by osteoporosis, but can lead to digestive mucosal damage. The aim of this study was to evaluate the safety of risedronate for patients with cirrhosis and esophageal varices. Of the 354 cirrhotic patients invited to participate, 164 were considered eligible and allocated according to the bone mineral density after densitometry. In the intervention group, 52 individuals with osteoporosis received oral risedronate 35 mg weekly plus calcium and vitamin D supplementation. In the control group, 51 individuals with osteopenia received only calcium and vitamin D supplementation. All the subjects underwent surveillance endoscopies within 1 year and another bone densitometry at the end of the trial. The mean age and the proportion of women were higher in the intervention group. The Model of End-Stage Liver Disease (MELD) scores in the intervention and control group were 9.6 (5.9-15.5) and 10.3 (6.5-19), respectively (p= 0.047). The control group had more subjects with alcoholic liver disease (p< 0.001). In both groups the majority of the individuals had Child-Pugh A classification and low-risk bleeding esophageal varices. There was no difference between the groups regarding esdoscopic findings during the intervention. There was no upper gastrointestinal bleeding in the intervention group but 2 in the control group. The intervention group was the only one that achieved increase in bone density (lumbar spine): Mean T score -3,2 and -2,7 pre and post treatment, respectively (p= 0,001). However, arthralgia and myalgia were more frequent in this group (p= 0.031 and 0.006 respectively). The results, which are of immediate practical effect, suggest that risedronate is safe in compensated liver cirrhosis with low-risk bleeding esophageal varices under endoscopic surveillance and allowed a gain of bone mass. / FAPESP: 2016/07117-9

Orientador: Fernando Gomes Romeiro / Resumo: Introdução: O tratamento das alterações ósseas em portadores de cirrose ainda não está bem definido, fazendo com que vários pacientes permaneçam sem tratamento e venham a ter complicações graves como fraturas e dores crônicas. Objetivos: Avaliar a segurança e a eficácia do tratamento da osteoporose e osteopenia em indivíduos com cirrose e varizes de esôfago de baixo risco de sangramento. Materiais e métodos: indivíduos com osteoporose receberam risedronato associado a suplementação de cálcio e vitamina D, e os com osteopenia receberam somente a suplementação nutricional. A análise sobre a segurança foi realizada por endoscopias pré-tratamento, após 6 e 12 meses, bem como por consultas após um ano para avaliar se houve eventos adversos. Esses resultados foram comparados entre o grupo osteoporose e o grupo osteopenia pelo teste exato de Fisher. A análise sobre a eficácia foi realizada por meio da Dual Energy X-Ray Absorptiometry (DXA), comparando valores pré-tratamento e após 2 anos em cada indivíduo através da estimativa do intervalo de confiança e pelo teste t de Student. Resultados: Os achados endoscópicos e eventos adversos foram semelhantes entre os grupos. No grupo osteoporose houve aumento do T-escore da coluna lombar (p<0,001), sem sinais de perda óssea no colo femoral. O grupo osteopenia não teve melhora óssea vertebral e sofreu redução do T-escore do colo do fêmur (p= 0,019). Conclusão: Os tratamentos foram seguros, mas somente o com risedronato proporcionou melhora ó... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The treatment of bone loss in patients with cirrhosis is not well defined, so that many patients do not receive effective therapy and develop complications such as fractures and chronic pain. Aim: To evaluate the safety and the efficacy of osteoporosis and osteopenia treatment in patients with liver cirrhosis and low-risk esophageal varices. Materials and methods: The osteoporosis treatment consisted of risedronate associated with calcium and vitamin D supplementation, while the osteopenia treatment comprised only the nutritional supplementation. The safety assessment was done by endoscopic exams before and during the treatment (6 and 12 months), as well as by outpatient appointments carried out 1 year after starting the treatment. These results were compared between the osteoporosis and osteopenia groups through the Fisher exact test. The efficacy analysis was measured through the T-score assessed by Dual Energy X-Ray Absorptiometry (DXA), which was performed before and at 2 years of treatment by calculating the 95% confidence interval and applying the t-Student test. Results: The endoscopic findings and the adverse events were similar between the groups. The osteoporosis group had a significant increase in the lumbar spine T-score (p <0.001), with no bone loss in the femoral neck. The osteopenia group had no improvement in vertebral bones and suffered a clear reduction in the femoral neck T-score (p = 0.019). Conclusion: The treatments were safe but only the o... (Complete abstract click electronic access below) / Doutor

Thèse diffusée initialement dans le cadre d'un projet pilote des Presses de l'Université de Montréal/Centre d'édition numérique UdeM (1997-2008) avec l'autorisation de l'auteur.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This work aimed the development of polymeric microparticles containing sodium risedronate from Eudragit S100® (MP-EUD) and the blend, Eudragit S100® and Pullulan (MP-EUD-PUL), through spray-drying technique. MP-EUD were obtained with a yield of 54%, encapsulation efficiency of 90%, average particle size of 3.3 μm and presented spherical shape. The moisture content was 8% and the Carr Index and Hausner Factor indicated poor flowability. At pH 1.2 23% risedronate sodium was released after 120 min, while the drug at pH 6.8 took 90 min to reach 99.5%. The mathematical modeling showed that the drug release followed first order kinetics and Fickian diffusion. Tablets prepared by direct compression of MP-EUD using different polyvinylpirrolidone concentrations showed low weight variation, thickness and drug content. Furthermore, they presented low friability and adequate hardness. In vitro studies indicated that no more than 16% of the drug was released in 120 min at pH 1.2. At pH 6.8 the risedronate release was prolonged for 270 min and folowed first order kinetics and Fickian diffusion. Concerning MP-EUD-PUL, three proportions of Eudragit S100® and Pullulan (1:2, 1:1 and 2:1) were studied. Microparticles were obtained with yields ranging from 31% to 42%, encapsulation efficiencies close to 100%, moisture contents lower than 11%, mean particle size in the range of 2.9 μm - 4.8 μm and narrow size distributions. Carr index and Hausner ratio indicated poor flowability. In gastric simulated fluid the microparticles prepared with the highest amount of Eudragit S100® showed the best gastroresistance. In intestinal simulated fluid blend microparticles were able to prolong the drug release. MP-EUD-PUL 2:1 were compressed into tablets with or without a binder. Both tableted microparticles could be obtained with acceptable average weights, drug content close to 100%, sufficient hardness and low friability. In vitro studies showed that tablets maintained the gastroresistance observed for untableted microparticles and were also able to prolong risedronate release. Finally, the formulations developed in this study represent promising alternatives for sodium risedronate oral delivery. / Este trabalho objetivou o desenvolvimento de micropartículas poliméricas contendo risedronato de sódio a partir de Eudragit S100® (MP-EUD) e da blenda, Eudragit S100® e Pullulan (MP-EUD-PUL), através da técnica de secagem por aspersão. As MP-EUD foram obtidas com um rendimento de 54%, eficiência de encapsulamento de 90%, tamanho médio de partícula de 3,3 μm e apresentaram formato esférico. O teor de umidade foi de 8%, o Índice de Carr e o Fator de Hausner indicaram baixa fluidez. Em pH 1,2, 23% do risedronato de sódio foi liberado em 120 min, enquanto que em pH 6,8 o fármaco levou 90 min para ser liberado. A modelagem matemática mostrou que a liberação do fármaco seguiu cinética de primeira ordem e se deu por difusão Fickiana. Comprimidos preparados pela compressão direta das MP-EUD a partir de diferentes concentrações de polivinilpirrolidona apresentaram baixas variações de peso médio, espessura e teor de fármaco. Além disso, apresentaram baixa friabilidade e dureza adequada. Os estudos in vitro mostraram que não mais que 16% do fármaco foi liberado durante 120 min em pH 1,2 enquanto que em pH 6,8 a liberação do fármaco foi prolongada por 270 min, seguindo cinética de primeira ordem e difusão Fickiana. Com relação às MP-EUD-PUL, três proporções de Eudragit S100® e Pullulan (1:2, 1:1 e 2:1) foram estudadas. As micropartículas foram obtidas com rendimento variando entre 31% e 42%, com eficiência de encapsulamento próxima de 100% e umidade abaixo de 11%. O tamanho médio de partícula variou entre 2,9 μm e 4,8 μm com estreita distribuição de tamanho. O Índice de Carr e o Fator de Hausner indicaram baixa fluidez. Em meio gástrico simulado, as micropartículas com maior proporção de Eudragit S100® apresentaram melhor perfil de gastrorresistência, enquanto que em meio intestinal simulado todas foram capazes de prolongar a liberação do fármaco. As MP-EUD-PUL 2:1 sofreram compressão direta na ausência ou na presença de polivilpirrolidona. Os comprimidos microparticulados apresentaram pesos médios aceitáveis, teor de fármaco próximo a 100%, dureza e friabilidade dentro do especificado. Os estudos in vitro mostraram que a gastrorresistência foi mantida e que os comprimidos microparticulados também foram capazes de prolongar a liberação do risedronato. Finalmente, as formulações desenvolvidas neste estudo representam alternativas promissoras para a administração oral do risedronato de sódio.

Made available in DSpace on 2015-03-26T13:46:33Z (GMT). No. of bitstreams: 1 texto completo.pdf: 201136 bytes, checksum: d353460c52709971fecf3b8e2ee9ed29 (MD5) Previous issue date: 2007-12-18 / This work consisted of a biological test with the objective to study the influences of the bifosfonates alendronate of sodium and sodic risedronate and of the statins calcic atorvastatine and lovasatatine in the recuperation of fractures of shin-bones of osteoporotics rats induced by the dexamethasone, in rats of the race Wistar, adults, weighing 250 ± 20g. The process of the induction of the osteoporosis consisted of the administration of dexamethasone, of the dosis of 7,5 mg / kg of physical weight, for road IM, once weekly, during four weeks, of six animals of all the groups, with the exception of the animals that there appointed the control group (G1). The animals of the group 2 (G2), called osteoporotics, received only dexamethasone. After the period of induction of the osteoporosis, the animals of all the groups were subjected to the proceeding of shut fracture of the leftt shin-bones, carried out by a veterinary doctor. Immediately after the induction of the fractures, one began the treatments where the group 3 (G3) received alendronate of sodium in the dosis of 0,25mg/kg; the group 4 (G4) received risedronate of sodium in the dosis of 1 mg / kg; the group 5 (G5) that received calcic atorvastatine in the dosis of 1,2 mg / kg and the group 6 (G6) what it received lovastatine in the dosis of 2mg/kg. All the substances were administered by oral road, daily. In the period of 35 days, after the beginning of the treatments, samples of blood were collected for dosages of calcium, phosphorus, albumin and total proteins in the multiparametric equipment of biochemistry Alizé with kits of the mark BioMerieux, and phosphatase alkaline bone in the equipment of quimioluminescence Access Immunoassay System of Beckman Coulter with kits Ostase. After the sacrifice, there was collected the left shin-bone of each animal what, once fixed they were morfometric analysed, X- rayed and when it was prosecuted for getting the blades, which parliament Masson Tricrômic was colored, for hitological study in light microscopie. The right shin-bone was collected to subject to biomechanical tests. All s measures of height, width and of the bone callus of the shin-bones they were carried out with help of a paquimeter. Besides, there were carried out gauging of the density of these bones, which took place through the relation of the values of weighing and dislocation of liquid in graduated container. The left shin- bones were X-rayed then in profile and the obtained image was subjected to an analysis of radiografic density through the program Image Tool he will be Windows 3.0, for tones of ash obtained of the image. The areas of the analyses were delimited in all the radiografic images of the shin-bones and only the selected areas were taken into account for analysis. Tests of flexing, in the right shin-bones they were carried out with the help of the appliance Instrom (Laboratory of Paper and Cellulose of the Department of Engineering Florestal/UFV). One proceeded the percentage calculation of the density trabecular bone, from the image amostral of trabecular bone, contained in the region subcondral, of each histological cut, in optical microscope equipped with digital camera (TCL-984 P), analysed in monitor of microcomputer of 14 inches, making use of the technique of histomorfometric of counting of points. The biological test was carried out according to delineation completely casualizado, with six treatments in six repetitions. The obtained results were subjected to the variance analysis and to the test F (p <0,05). Control the groups (G1 and G2) they were compared between you, through the test F. The treated groups (G3, G4, G5 and G6) were compared between you, through the test of Tukey to 5% of probability. The comparisons also were carried out between the treated groups and the controls G1 and G2, being that, for the same thing, the test of Dunnet was applied to 5 % of probability. The results did not show significant differences between the group control (G1) and the osteoporotic group (G2), as well as, between them and the treated groups (G3, G4, G5 and G6) and, also, between the groups treated between you, in all the periods, as for the values silken of calcium, phophorus and phosphatase alkaline bone. Through the morfometric and histomorfometric was possible the induction of the osteoporose noted with the glucorticoid, as well as the improvement in the bone density, density trabecular bone and thickness of the bone callus in all the treated groups when the group is prevailing treated with alendronate of sodium that presented better results. The results radiografics and biomechanical tests corroborate with the histomorfometric results. The biochemical results, principally phosphatase alkaline bone, what remained without significant differences in all the groups, when valued together with the morfometric, histomorfometri, radiografic and biomechanical test demonstrate what prevailed the properties antirreabsortives in relation the forming ones of bone in all the treated groups. In spite of the predominance of the properties antirreabsortives in all the treatments, the morfometric, histomorfometric, X-ray and biomechanical tests showed comparable results to the bone recuperation of the normal group, which demonstrates what same do not interfere negatively and which positively in the process of recuperation of fractures in osteoporotics animals. Is excepted, however, which subsequent studies of the dosages, interactions, biodisponibility, besides the toxicological effects of these pharmacological substances, make to themselves necessary. / Este trabalho consistiu de um ensaio biológico com o objetivo de estudar as influências do bifosfonatos alendronato de sódio e risedronato sódico e das estatinas atorvastatina cálcica e lovasatatina na recuperação de fraturas de tíbias de ratas osteoporóticas induzida pelo glicocorticóide dexametasona, em ratas da raça Wistar, adultas, pesando 250 ± 20g. O processo da indução da osteoporose consistiu na administração de dexametasona, na dose de 7,5 mg/kg de peso corporal, por via IM, uma vez por semana, durante quatro semanas, nos seis animais de todos os grupos, à exceção dos animais que constituiu o grupo controle (G1). Os animais do grupo 2 (G2), chamado osteoporótico, receberam apenas dexametasona. Após o período de indução da osteoporose, os animais de todos os grupos foram submetidos ao procedimento de fratura fechada das tíbias esquerdas, realizado por um médico veterinário. Imediatamente após a indução das fraturas, iniciou-se os tratamentos onde o grupo 3 (G3) recebeu alendronato de sódio na dose de 0,25mg/kg; o grupo 4 (G4) recebeu risedrnato de sódio na dose de 1 mg/kg ; o grupo 5 (G5) que recebeu atorvastatina cálcica na dose de 1,2 mg/kg e o grupo 6 (G6) que recebeu lovastatina na dose de 2mg/kg. Todas as substâncias foram administradas por via oral, diariamente. No período de 35dias, após o início dos tratamentos, foram coletados amostras de sangue para dosagens de cálcio, fósforo, albumina e proteínas totais no equipamento multiparamétrico de bioquímica Alizé com kits da marca BioMerieux, e fosfatase alcalina óssea no equipamento de quimioluminescência Access Immunoassay System da Beckman Coulter com kits Ostase. Após o sacrifício, foi coletado a tíbia esquerda de cada animal que, uma vez fixados foram analisados morfometricamente, radiografados, submetidas e processado rotineiramente para obtenção das lâminas, cujos cortes foram corados Tricrômico de Masson, para estudo histologico em microscopia de luz. As tíbias direitas foram também coletadas para realização de testes biomecânicos. Medidas de altura, largura e do calo ósseo das tíbias foram realizadas com auxílio de um paquímetro. Além disso, foram realizados aferições da densidade desses ossos, que ocorreram através da relação dos valores de pesagem e deslocamento de líquido em recipiente graduado. As tíbias esquerdas foram então radiografadas em perfil e a imagem obtida foi submetida a uma analise de densidade radiográfica através do programa Image Tool for Windows 3.0, por tons de cinza obtidos da imagem. As áreas das análises foram delimitadas em todas as imagens radiográficas das tíbias e só foram levadas em consideração para análise as áreas selecionadas.Testes de flexão, nas tíbias direitas foram realizados com o auxílio do aparelho Instrom (Laboratório de Papel e Celulose do Departamento de Engenharia Florestal/UFV). Procedeu-se o cálculo percentual da densidade trabecular óssea, à partir da imagem amostral de osso trabecular, contida na região subcondral, de cada corte histológico, em microscópio óptico equipado com câmara digital (TCL-984 P), analisada em monitor de microcomputador de 14 polegadas, utilizando-se da técnica de histomorfometria de contagem de pontos. O ensaio biológico foi realizado segundo delineamento inteiramente casualizado, com seis tratamentos em seis repetições. Os resultados obtidos foram submetidos à análise de variância e ao teste F (p<0,05). Os grupos controles (G1 e G2) foram comparados entre si, por meio do teste F. Os grupos tratados (G3, G4, G5 e G6) foram comparados entre si, através do teste de Tukey à 5% de probabilidade. As comparações também foram realizadas entre os grupos tratados e os controles G1 e G2, sendo que, para o mesmo, foi aplicado o teste de Dunnet à 5% de probabilidade. Os resultados não mostraram diferenças significativas entre o grupo controle (G1) e o grupo osteoporótico (G2), bem como, entre eles e os grupos tratados (G3, G4,G5 e G6) e, também, entre os grupos tratados entre si, em todos os períodos, quanto aos valores sérico de cálcio, fósforo e fosfatase alcalina óssea. Através da morfometria e histomorfometria foi possível constatar a indução da osteoporose com o glicorticóide, assim como a melhoria na densidade óssea, densidade trabecular óssea e espessura do calo ósseo em todos os grupos tratados prevalecendo o grupo tratado com alendronato de sódio que apresentou melhores resultados. Os resultados radiográficos e biomecânicos corroboram com os resultados histomorfometricos. Os resultados bioquímicos, principalmente fosfatase alcalina óssea, que permaneceram sem diferenças significativas em todos os grupos, quando avaliados em conjunto com a morfometria, histomorfometria, radiografia e teste biomecânicos demonstram que prevaleceram as propriedades antirreabsortivas em relação as formadoras de osso em todos os grupos tratados. Apesar da prevalência das propriedades antirreabsortivas em todos os tratamentos, a morfometria, histomorfométria, radiografia e testes biomecânicos mostrou resultados equiparáveis à recuperação óssea do grupo normal, o que demonstra que os mesmos não interferem negativamente e sim positivamente no processo de recuperação de fraturas em animais osteoporóticos. Ressalva- se, no entanto, que estudos posteriores das dosagens, interações, biodisponibilidades, além dos efeitos toxicológicos dessas substâncias farmacológicas, fazem-se necessários.

Les lymphocytes T Vγ9Vδ2 sont impliqués dans la réponse immunitaire contre de nombreux pathogènes et contre les cellules tumorales. Ils reconnaissent des antigènes solubles, non peptidiques, ayant une faible masse moléculaire, qui sont appelés phosphoantigènes. Dans ce contexte, l’isopentenyl pyrophosphate (IPP) et un métabolite de l’ATP (ApppI) sont des phosphoantigènes qui s’accumulent dans les cellules suite à l’inhibition par les amino-bisphosphonates de l’activité d’une enzyme clé de la voie du mévalonate, la farnesyl pyrophosphate synthase (FPPS). Les bisphosphonates sont utilisés en clinique dans le traitement et la prévention des complications liées aux ostéolyses malignes. Les études pré-cliniques montrent que les bisphosphonates (et en particulier les amino-bisphosphonates) ont également une activité anti-tumorale qui peut être directe et/ou indirecte. Ils peuvent bloquer différentes fonctions des cellules tumorales (adhésion, invasion, prolifération) en inhibant l’activité de la FPPS. Ils agissent aussi sur les cellules endothéliales et inhibent l’angiogenèse tumorale. Les amino-bisphosphonates activent aussi l’activité cytotoxique des lymphocytes T Vγ9Vδ2 vis-à-vis des cellules tumorales. Les mécanismes moléculaires sous-jacents responsables de cette activation sont par contre méconnus. Les travaux réalisés dans cette thèse montrent tout d’abord que les aminobisphosphonates (zolédronate et risédronate) induisent l’accumulation d’IPP et d’ApppI dans différentes lignées humaines de cancer du sein et qu’il existe une corrélation entre le niveau de production d’IPP/ApppI et la capacité des lymphocytes T Vγ9Vδ2 à détruire ces cellules tumorales in vitro. Nous avons ensuite montré que le traitement de souris immunodéficientes NOD-SCID avec des aminobisphosphonates stimule la différenciation des lymphocytes T Vγ9Vδ2 humains à partir des cellules du sang périphérique lorsque celles-ci sont injectées par voie intrapéritonéale aux animaux. Par ailleurs, ces lymphocytes T vont ensuite venir infiltrer des tumeurs mammaires sous-cutanées qui ont été préalablement greffées chez les animaux traités. Cette infiltration lymphocytaire survient uniquement lorsque les tumeurs produisent de l’IPP/ApppI. Il en résulte alors une régression des tumeurs chez les souris NOD-SCID. L’infiltration des tumeurs par les lymphocytes T Vγ9Vδ2 humains s’explique par le fait que l’IPP et l’ApppI stimulent la migration des lymphocytes T. Les lymphocytes T Vγ9Vδ2 interagissent alors avec les cellules tumorales par le biais de mécanismes faisant intervenir ICAM-1, puis les lymphocytes sécrètent des facteurs (interféron γ, perforine) qui sont cytotoxiques pour les cellules tumorales. L’ensemble de nos travaux montre donc que les amino-bisphosphonates pourraient être utilisés en immunothérapie dans le traitement des cancers du sein. / Vγδ9Vδ2 T lymphocytes are involved in the immune response against several pathogens and tumoral cells. They recognize non-peptidic, low molecular weight soluble antigens, so called phosphoantigens. In this context, isopentenyl pyrophosphate (IPP) and a metabolite of ATP (ApppI) are phosphoantigens which accumulate in many cells following the inhibition by amino-bisphosphonates of farnesyl pyrophosphate synthase (FPPS), a key enzyme in the mevalonate pathway. Bisphosphonates are commonly used in the clinic for the treatment and prevention of complications associated with malignant osteolysis. Preclinical studies demonstrate that bisphosphonates (in particular amino-bisphosphonates) also have direct and indirect anti-tumor activity. They are able to block different functions in tumor cells, such as adhesion, invasion and proliferation, by inhibiting FPPS activity. Bisphosphonates also act on endothelial cells and inhibit tumor angiogenesis. Amino-bisphosphonates also activate the cytotoxic activity of Vγδ9Vδ2 T lymphocytes against tumor cells. However, the underlying molecular mechanisms responsible for this activation are still unknown. In the present thesis, we first demonstrate that amino-bisphosphonates (e.g. zoledronate and risedronate) induce the accumulation of IPP and ApppI in different human breast cancer cell lines and that a correlation exists between the levels of IPP/ApppI production and the capacity of Vγδ9Vδ2 T lymphocytes to destroy tumor cells in vitro. We then demonstrate that the treatment of immunodeficient NOD-SCID mice with amino-bisphosphonates stimulates the differentiation of Vγδ9Vδ2 T lymphocytes from human peripheral blood mononuclear cells injected intraperitoneally in animals. Following their expansion, the T lymphocytes are then able to infiltrate subcutaneous mammary tumors, which were grafted in treated animals. This infiltration of γδ T lymphocytes arises only when the tumors produce IPP/ApppI, resulting in the regression of tumor growth in NOD-SCID mice. The infiltration of tumors by human Vγδ9Vδ2 T lymphocytes is explained by the capacity of IPP and ApppI to stimulate the migration of γδ T lymphocytes. Vγδ9Vδ2 T lymphocytes then interact with tumor cells through a mechanism involving ICAM-I and several secretion factors (i.e. interferon γ, perforine) which are cytotoxic for tumor cells. Thus, our work demonstrates that amino-bisphosphonates could be useful for breast cancer immunotherapy.

Thèse diffusée initialement dans le cadre d'un projet pilote des Presses de l'Université de Montréal/Centre d'édition numérique UdeM (1997-2008) avec l'autorisation de l'auteur.