Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2007.

Posttraumatic stress disorder (PTSD) is a severe anxiety disorder characterised by hypothalamic-pituitary-adrenal (HPA)-axis abnormalities, hyperarousal, anxiety, flashbacks of trauma memories and avoidance. Increasing evidence is now accumulating that the disorder is also associated with shrinkage of the hippocampus and cognitive dysfunction that may have its origin in stress-induced excitotoxicity. Animal studies have indeed highlighted a potential role of the excitotoxic glutamatenitric oxide (NO) pathway in the stress response. Since PTSD appears to be an illness that progresses and worsens over time after an initial severe traumatic event, this study has used an animal model that emphasises repeated trauma to investigate the effect of stress on hippocampal NO synthase (NOS) activity, the release of the nitrogen oxide metabolites of NO (NOx), and also the evoked release of cGMP. Furthermore, the modulation and dependency of these responses on glutamate, NO and cGMP activity using drugs selective for these targets, will also be investigated. Rats (n=10/group) were exposed to repeated stress together with saline or drug administration immediately after the stress procedure and continuing for one week post-stress. The animals were then sacrificed for assay of hippocampal NOS activity, NO, and cGMP accumulation. Animals received either the glutamate-NMDA receptor antagonist, memantine (MEM;5mg/kg ip/d), the neuronal NOS selective inhibitor, 7- nitroindazole monosodium salt (7-NINA;20mg/kg ip/d), the cGMP-specific PDE inhibitor, sildenafil (SIL;10mg/kg ip/d) or the NFkb antagonist, pyrollidine dithiocarbamate (PDTC;70mg/kg ip/d). The latter inhibits the nuclear transcription factor, NFkb, responsible for inducing the expression of iNOS, while it also appears to mediate the glutamatergic actions on NOS expression, Stress significantly increased hippocampal NOS activity, as well as significantly increased hippocampal cGMP and NO, levels. These increases were blocked by pretreatment with either PDTC or 7-NINA, while memantine was without effect. Sildenafil significantly augmented stress induced NO, accumulation, as well as cGMP. although the latter failed to reach significance. 7-NINA and memantine significantly blocked the increase in cGMP evoked by time-dependent sensitisation (TDS)-stress, with PDTC attenuating this response, but not significantly. Additionally, administration of each drug separately for seven days without exposure to stress, did not evoke significant changes in NOx levels, compared to the control group. However, significant increases in cGMP levels, compared to the control group, were found with all four drugs. Repeated trauma therefore activates the NO-cGMP pathway, possibly involving actions on both nNOS and iNOS. The NMDA receptor appears less involved after chronic repeated stress, and may have limited therapeutic implications. Sub-cellular NO-modulation, however, may represent an important therapeutic strategy in preventing the effects of severe stress and in treating PTSD. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2005.

Posttraumatic stress disorder (PTSD) is a severe anxiety disorder characterised by hypothalamic-pituitary-adrenal (HPA)-axis abnormalities, hyperarousal, anxiety, flashbacks of trauma memories and avoidance. Increasing evidence is now accumulating that the disorder is also associated with shrinkage of the hippocampus and cognitive dysfunction that may have its origin in stress-induced excitotoxicity. Animal studies have indeed highlighted a potential role of the excitotoxic glutamatenitric oxide (NO) pathway in the stress response. Since PTSD appears to be an illness that progresses and worsens over time after an initial severe traumatic event, this study has used an animal model that emphasises repeated trauma to investigate the effect of stress on hippocampal NO synthase (NOS) activity, the release of the nitrogen oxide metabolites of NO (NOx), and also the evoked release of cGMP. Furthermore, the modulation and dependency of these responses on glutamate, NO and cGMP activity using drugs selective for these targets, will also be investigated. Rats (n=10/group) were exposed to repeated stress together with saline or drug administration immediately after the stress procedure and continuing for one week post-stress. The animals were then sacrificed for assay of hippocampal NOS activity, NO, and cGMP accumulation. Animals received either the glutamate-NMDA receptor antagonist, memantine (MEM;5mg/kg ip/d), the neuronal NOS selective inhibitor, 7- nitroindazole monosodium salt (7-NINA;20mg/kg ip/d), the cGMP-specific PDE inhibitor, sildenafil (SIL;10mg/kg ip/d) or the NFkb antagonist, pyrollidine dithiocarbamate (PDTC;70mg/kg ip/d). The latter inhibits the nuclear transcription factor, NFkb, responsible for inducing the expression of iNOS, while it also appears to mediate the glutamatergic actions on NOS expression, Stress significantly increased hippocampal NOS activity, as well as significantly increased hippocampal cGMP and NO, levels. These increases were blocked by pretreatment with either PDTC or 7-NINA, while memantine was without effect. Sildenafil significantly augmented stress induced NO, accumulation, as well as cGMP. although the latter failed to reach significance. 7-NINA and memantine significantly blocked the increase in cGMP evoked by time-dependent sensitisation (TDS)-stress, with PDTC attenuating this response, but not significantly. Additionally, administration of each drug separately for seven days without exposure to stress, did not evoke significant changes in NOx levels, compared to the control group. However, significant increases in cGMP levels, compared to the control group, were found with all four drugs. Repeated trauma therefore activates the NO-cGMP pathway, possibly involving actions on both nNOS and iNOS. The NMDA receptor appears less involved after chronic repeated stress, and may have limited therapeutic implications. Sub-cellular NO-modulation, however, may represent an important therapeutic strategy in preventing the effects of severe stress and in treating PTSD. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2005.

Sildenafil, a selective phosphodiesterase type 5 (PDE5) inhibitor, is registered for the treatment of male erectile dysfunction (Viagra®) and pulmonary hypertension (Revatio®) in the United States. PDE5 is found in the endothelium of blood vessels in the penile corpus cavernosum, pulmonary vessels and also brain and other peripheral tissue. Sildenafil crosses the blood brain barrier, leading to side-effects such as headache and dizziness, as well as behavioural manifestations including depression, anxiety and aggression (Milman & Arnold, 2002). According to the Food and Drug Administration (2001), 12378 adverse events were reported after the use of sildenafil and 274 of these reports implicated sildenafil in neurologic, emotional, or psychological disturbances between January 1998 and 21 February 2001. In addition, in vivo studies in rats indicate that sildenafil has anxiogenic and stressogenic actions (Harvey et al., 2005; Volke et al., 2003). This is a clear indication that sildenafil influences neurological processes in the brain and may influence various signalling systems, which play major roles in the neural circuitry of the above-mentioned disturbances. Recent in vitro studies in our laboratory suggest that sildenafil may potentiate cholinergic muscarinic receptor signalling (Eager, 2004). These results suggest potential depressogenic actions, since an increase in acetylcholine is associated with depression-like symptoms (El- Yousef et al., 1973). It was therefore postulated that sildenafil may in fact possess antidepressant activity that is masked by a cholinergic-driven depressogenic activity. In a study conducted by Muller and Benkert in 2000, patients reported a decrease in depression-like symptoms when treated with sildenafil for erectile dysfunction. This implied that sildenafil not only had a direct effect on erectile function in about 50-80% of men with erectile dysfunction (Langtry and Markham, 1999; Padma-Nathan, 1999) but might also improve anhedonia and depression. The substantial correlation between the International Index of Erectile Function and Epidemiologic Studies-Depression Scale scores supported this assumption (Muller & Benkert, 2000). In addition, Raffaele et al. (2002) reported an indirect improvement in depressive-like symptoms in patients treated for erectile dysfunction with idiopathic Parkinson's disease. Aims: The current study investigated the behavioural and neuroreceptor properties of sildenafil in a rat model of depression. We also investigated a hypothesis that sildenafil displays antidepressant-like properties, but which are masked by its potentiation of the cholinergic system. Methods: The experimental layout was divided into three pilot studies. Pilot Study 1 validated the FST under our laboratory conditions, Sprague-Dawley rats received saline intraperitoneally (i.p.) for 7 days, whereafter half of the rats were pre-exposed to a 15 minute swim trial, while the remaining rats were not pre-exposed. All rats were then evaluated 24 hours later in the 5 minute scored swim trial. In Pilot Study 2 Sprague-Dawley rats were treated for 3, 7 or 11 days with vehicle (control) or 20 mg/kg fluoxetine to establish the time-dependency of the onset of antidepressant-like effects in a rat model of depression. We measured immobility in the rat forced swim test (FST), as well as changes in P-adrenergic receptor (P-AR) concentration in rat frontal cortex. In pilot study 3, rats were treated for 7 days with vehicle (control), 20 mg/kg fluoxetine, 10 mg/kg sildenafil, 1 mg/kg atropine or various combinations of these drugs. Again we employed the FST and measured cortical p-AR concentration. Results: In the FST pre-exposure to a 15 minute swim trial 24 hours before the scored swim trial significantly increased immobility. Fluoxetine inhibited this development of increased immobility in FST and decreased P-AR concentration after 7 and 11 days of treatment with fluoxetine, but not after 3 days. Seven days of treatment with atropine and sildenafil alone did not exert any changes in immobility in the FST or changes in p-AR concentration. However, a combination of atropine and sildenafil exerted a significant antidepressant-like behavioural effect, comparable with fluoxetine. Moreover, the combination of atropine and fluoxetine as well as the a triple combination of fluoxetine, sildenafil and atropine was superior to fluoxetine alone. Conclusion: Muscarinic cholinergic mechanisms mask the antidepressant-like properties of sildenafil in a rat model of depression. The antidepressant properties of the combination of sildenafil and atropine are comparable to that of fluoxetine in an animal model of depression. The combination of fluoxetine with atropine, and atropine and sildenafil enhances the antidepressant-like properties of fluoxetine. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2007.

Sildenafil, a selective phosphodiesterase type 5 (PDE5) inhibitor, is registered for the treatment of male erectile dysfunction (Viagra®) and pulmonary hypertension (Revatio®) in the United States. PDE5 is found in the endothelium of blood vessels in the penile corpus cavernosum, pulmonary vessels and also brain and other peripheral tissue. Sildenafil crosses the blood brain barrier, leading to side-effects such as headache and dizziness, as well as behavioural manifestations including depression, anxiety and aggression (Milman & Arnold, 2002). According to the Food and Drug Administration (2001), 12378 adverse events were reported after the use of sildenafil and 274 of these reports implicated sildenafil in neurologic, emotional, or psychological disturbances between January 1998 and 21 February 2001. In addition, in vivo studies in rats indicate that sildenafil has anxiogenic and stressogenic actions (Harvey et al., 2005; Volke et al., 2003). This is a clear indication that sildenafil influences neurological processes in the brain and may influence various signalling systems, which play major roles in the neural circuitry of the above-mentioned disturbances. Recent in vitro studies in our laboratory suggest that sildenafil may potentiate cholinergic muscarinic receptor signalling (Eager, 2004). These results suggest potential depressogenic actions, since an increase in acetylcholine is associated with depression-like symptoms (El- Yousef et al., 1973). It was therefore postulated that sildenafil may in fact possess antidepressant activity that is masked by a cholinergic-driven depressogenic activity. In a study conducted by Muller and Benkert in 2000, patients reported a decrease in depression-like symptoms when treated with sildenafil for erectile dysfunction. This implied that sildenafil not only had a direct effect on erectile function in about 50-80% of men with erectile dysfunction (Langtry and Markham, 1999; Padma-Nathan, 1999) but might also improve anhedonia and depression. The substantial correlation between the International Index of Erectile Function and Epidemiologic Studies-Depression Scale scores supported this assumption (Muller & Benkert, 2000). In addition, Raffaele et al. (2002) reported an indirect improvement in depressive-like symptoms in patients treated for erectile dysfunction with idiopathic Parkinson's disease. Aims: The current study investigated the behavioural and neuroreceptor properties of sildenafil in a rat model of depression. We also investigated a hypothesis that sildenafil displays antidepressant-like properties, but which are masked by its potentiation of the cholinergic system. Methods: The experimental layout was divided into three pilot studies. Pilot Study 1 validated the FST under our laboratory conditions, Sprague-Dawley rats received saline intraperitoneally (i.p.) for 7 days, whereafter half of the rats were pre-exposed to a 15 minute swim trial, while the remaining rats were not pre-exposed. All rats were then evaluated 24 hours later in the 5 minute scored swim trial. In Pilot Study 2 Sprague-Dawley rats were treated for 3, 7 or 11 days with vehicle (control) or 20 mg/kg fluoxetine to establish the time-dependency of the onset of antidepressant-like effects in a rat model of depression. We measured immobility in the rat forced swim test (FST), as well as changes in P-adrenergic receptor (P-AR) concentration in rat frontal cortex. In pilot study 3, rats were treated for 7 days with vehicle (control), 20 mg/kg fluoxetine, 10 mg/kg sildenafil, 1 mg/kg atropine or various combinations of these drugs. Again we employed the FST and measured cortical p-AR concentration. Results: In the FST pre-exposure to a 15 minute swim trial 24 hours before the scored swim trial significantly increased immobility. Fluoxetine inhibited this development of increased immobility in FST and decreased P-AR concentration after 7 and 11 days of treatment with fluoxetine, but not after 3 days. Seven days of treatment with atropine and sildenafil alone did not exert any changes in immobility in the FST or changes in p-AR concentration. However, a combination of atropine and sildenafil exerted a significant antidepressant-like behavioural effect, comparable with fluoxetine. Moreover, the combination of atropine and fluoxetine as well as the a triple combination of fluoxetine, sildenafil and atropine was superior to fluoxetine alone. Conclusion: Muscarinic cholinergic mechanisms mask the antidepressant-like properties of sildenafil in a rat model of depression. The antidepressant properties of the combination of sildenafil and atropine are comparable to that of fluoxetine in an animal model of depression. The combination of fluoxetine with atropine, and atropine and sildenafil enhances the antidepressant-like properties of fluoxetine. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2007.

Orientador: Heitor Moreno Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T19:55:16Z (GMT). No. of bitstreams: 1 Melo_SilviaElainedeSousaFerreiraCarvalhode_D.pdf: 6801672 bytes, checksum: d5d157af717b53ac33305c8ec554a2d0 (MD5) Previous issue date: 2005 / Resumo: O óxido nítrico (NO) é um mediador biológico multifuncional que serve como molécula chave em muitos processos fisiopatológicos, sintetizado nas células endoteliais em resposta a estímulos fisiológicos ou patológicos. Sua síntese se dá a partir da clivagem do terminal nitrogênio-guanidina do aminoácido L-arginina, em uma reação catalizada pela enzima óxido nítrico sintase (NOS). Há três isoformas de NOS: a NOS endotelial (eNOS), a NOS neuronal (nNOS) e a NOS induzível (iNOS). A eNOS e a nNOS são isoformas expressas constitutivamente nas células endoteliais vasculares e nas células neuronais, respectivamente; e a iNOS que a forma induzível, expressa em células inflamatórias após a indução por citocinas e outros mediadores inflamatórios. Após sua síntese o NO se difunde para as células do músculo liso vascular ativando a enzima guanilato ciclase solúvel (GCs), que converte guanosina-tri-fostato (GTP) em guanosina-3¿,5¿-monofosfato cíclica (GMPc), um segundo mensageiro para seus diversos efeitos biológicos, dentre os quais o relaxamento da musculatura lisa vascular. A síntese de NO pode ser inibida por vários compostos análogos à L-arginina, como L-NMMA, L-NAA, L-NAME e L-NIO de forma dose-dependente. A inibição crônica da síntese de óxido nítrico pela administração crônica de L-NAME é um modelo complexo e bem estabelecido de hipertensão arterial e miocardiopatia hipertensiva. É caracterizado por elevação da pressão arterial (PA) de forma severa, redução na freqüência cardíaca, no fluxo coronário e débito cardíaco (DC), aumento da resistência vascular periférica total (RVPT), diminuição do relaxamento vascular e alterações na contratilidade cardíaca, hipertrofia cardíaca, aumento do tamanho cardiomiócito, remodelamento miocárdico e microvascular com fibrose perivascular, sendo que o índice peso cardíaco/peso corporal e peso ventricular esquerdo/peso corporal estão usualmente aumentados. As fosfodiesterases são enzimas que degradam os nucleotídeos cíclicos GMPc e AMPc nas suas formas inativas. São conhecidas 11 famílias de enzimas (PDE1 ¿ PDE11) que diferem com relação ao padrão distribuição, especificidade de substrato, regulação pelas PKs e proteínas ligantes. Estão envolvidas em diversos processos fisiológicos e patológicos, tais como ereção peniana, asma, hipertensão pulmonar, aterosclerose, insuficiência cardíaca e diabetes. Consequentemente, os inibidores seletivos de PDE são interessantes e promissores alvos farmacológicos. Os inibidores das PDEs inpedem a degradação do AMPc, GMPc, elevando seus níveis intracelulares. Esses inibidores mimetizam as estruturas do AMPc e GMPc, mas não são degradados. Sildenafil é um inibidor seletivo da PDE5 induzindo o e relaxamento do músculo vascular liso e têm sido utilizados com sucesso no tratamento da disfunção erétil. A base racional para este projeto é a hipótese de que o sildenafil, por inibir de forma seletiva a PDE5 e conseqüentemente aumentar a disponibilidade de GMPc, possa ter efeitos cardiovasculares benéficos na inibição crônica da síntese de NO que reduz os níveis de GMPc no músculo cardíaco e vascular. Para isso foram estudados 4 grupos experimentais divididos aleatoriamente em: CONTROLE, L-NAME, SILDENAFIL e SILDENAFIL + L-NAME, durante 8 semanas de tratamento. Analisamos as alterações hemodinâmicas através das medidas da pressão arterial média, débito cardíaco, freqüência cardíaca e resistência vascular. As análises histológicas foram feitas através de técnicas morfométricas para determinação do diâmetro de miócito, lesões miocárdicas e espessura da camada média vascular e análises imunohistológicas. Nossos resultados demonstraram que a administração crônica de sildenafil altera os padrões hemodinâmicos e histolólgicos do modelo de miocardiopatia hipertensiva induzida pela inibição da síntese de NO por L-NAME. A inibição da PDE5 restaurou parcialmente os padrões hemodinâmicos, avaliados através da PA, DC e RVPT, além de protege parcialmente o miocárdio e músculo vascular liso contra as lesões e remodelamento cardiovascular característicos deste modelo experimental. A biodisponibilidade de GMPc, nos animais do grupo L-NAME + sildenafil, foi totalmente restaurada após 8 semanas de tratamento e a expressão das enzimas PDE3 e PDE5 estavam modificadas no músculo vascular liso e nos discos intercalares dos miócitos. Dessa forma, concluimos que o sildenafil, através da inibição da PDE5, aumentando a biodisponibilidade do GMPc, resulta em um efeito cardioprotetor e antiproliferativo contra as alterações cardiovasculares descritas no modelo de miocardiopatia hipertensiva induzida pela inibição crônica da síntese de NO em ratos Wistar / Abstract: Many of the physiological responses to nitric oxide (NO) are mediated by cyclic 5'-guanosine monophosphate (cGMP), the intracellular levels of which are regulated by phosphodiesterase type 5 (PDE5). In situations of reduced NO formation, the inhibition of PDE5 by selective inhibitors such as sildenafil could be beneficial in restoring physiological functions by enhancing the intracellular levels of cGMP. In this study, we evaluated the effects of sildenafil on the hemodynamic and histological alterations induced by the chronic treatment of rats with Nw¿nitro-L¿arginine¿methyl ester (L-NAME). After 8 weeks of concomitant treatment with sildenafil and L-NAME, arterial blood pressure was significantly lower (P<0.05) than in L-NAME treated rats. The fall in blood pressure was associated with a slight reduction in the total peripheral vascular resistance (P<0.05). Sildenafil partially restored the decrease in cardiac output seen in L-NAME-treated rats. Morphologically, sildenafil reduced the total area of the myocardial lesions and attenuated the cardiomyocyte and vascular smooth muscle remodeling seen with L-NAME. These results show that sildenafil reversed the deleterious hemodynamic and morphological alterations associated with L-NAME-induced hypertension. This beneficial effect was probably mediated by an increase in cardiac and vascular cGMP levels as reflected in circulating plasma cGMP levels / Doutorado / Doutor em Farmacologia

Orientador: José Eduardo Tanus dos Santos / Texto em português e inglês / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T01:21:52Z (GMT). No. of bitstreams: 1 Muniz_JaquelineJoice_D.pdf: 7837632 bytes, checksum: 844dee1536b7f55bbad3427a977bde29 (MD5) Previous issue date: 2012 / Resumo: A disfunção erétil (DE) é uma doença que atinge milhões de homens em todo o mundo e tem sua prevalência aumentada com a idade. O tratamento via oral mais utilizado para pacientes com DE é o sildenafil, um inibidor de fosfodiesterase do tipo 5, que age aumentando níveis de monofosfato cíclico de guanosina, melhorando assim a função erétil. O óxido nítrico (NO) é o principal responsável pela dilatação dos corpos cavernosos e consequente ereção peniana. Polimorfismos no gene da enzima sintase de NO endotelial (eNOS) foram mostrados estarem associados a formação de NO e suscetibilidade à DE. O objetivo do presente trabalho foi avaliar se marcadores genéticos e bioquímicos poderiam afetar a resposta ao tratamento com sildenafil em pacientes com DE. Polimorfismos no gene da eNOS (SNP na região promotora, T-786C; VNTR no intron 4, 4b4a; SNP no exon 7, Glu298Asp), marcadores da formação de NO (nitrito no sangue total) e estresse oxidativo (glutationa reduzida, FRAP, TBARS e proteínas carboniladas) foram utilizados para avaliar uma possível correlação com resposta terapêutica ao sildenafil em dois estudos. A função erétil de todos participantes foi avaliada utilizando o questionário Índice Internacitonal de Função Erétil (IIEF). No estudo de marcadores genéticos e resposta ao sildenafil foram selecionados 118 pacientes (63 pacientes com DE pós operatória e 55 pacientes com DE clínica) divididos em bons e maus respondedores ao sildenafil de acordo com a pontuação no IIEF. Foi observado neste estudo que a presença do alelo C para o polimorfismo T-786C em pacientes com DE pós operatória, e do alelo 4a para o polimorfismo 4b4a em pacientes com DE clínica, foi mais frequente em bons respondedores comparado aos maus respondedores ao sildenafil. Além do mais, em pacientes com DE pós operatória, o haplótipo constituído pelos alelos C 4a Glu foi mais comum em bons respondedores comparados aos maus respondedores ao sildenafil. No estudo de marcadores bioquímicos e resposta ao sildenafil foram recrutados 44 pacientes e 28 homens saudáveis. Os 44 pacientes foram divididos em dois grupos: 26 pacientes com DE (grupo DE) e 18 pacientes com DE e diabetes mellitus do tipo II (grupo DE/DM). Os resultados do nosso estudo bioquímico sugerem que baixos níveis de NO em pacientes nos dois grupos de DE clínica (grupo DE e grupo DE/DM) são benéficos em relação ao tratamento com sildenafil nesses pacientes. Além disso, baixo nível do marcador antioxidante FRAP mostrou ser melhor para resposta ao sildenafil em pacientes do grupo DE/DM. Em conclusão, nossos achados mostram que polimorfismos no gene da eNOS e marcadores da formação de NO e estresse oxidativo estão associados a resposta ao tratamento com sildenafil em pacientes com DE / Abstract: Erectile dysfunction (ED) affects millions of men around the world. Its prevalence increases with age. The most common treatment for patients with ED is sildenafil, an inhibitor of phosphodiesterase type 5, which acts by increasing levels of cyclic guanosine monophosphate, thereby improving erectile function. Nitric oxide (NO) is the mainly responsible for the corpus cavernosum dilatation, and consequent penile erection. Polymorphisms in the gene of the enzyme NO synthase (eNOS) have been shown to be associated with the formation of NO and susceptibility to DE. The objective of this study was to evaluate if genetic and biochemical markers could affect response to treatment with sildenafil in patients with ED. Polymorphisms in eNOS gene (SNP in the promoter region, T-786C; VNTR in the intron 4, 4b4a; SNP in the exon 7, Glu298Asp) and markers of NO formation (whole blood nitrite) and oxidative stress (reduced glutathione, FRAP, TBARS and carbonyl) were used to evaluate a possible association with therapeutic response to sildenafil in two studies. The erectile function of all participants was assessed using the IIEF questionnaire. In the study of genetic markers and response to sildenafil were selected 118 patients (63 patients with postoperative ED and 55 patients with clinic ED) divided into good and poor responders to sildenafil according to IIEF score. It was observed in that study that the C allele for the SNP T-786C in patients with postoperative ED, and the 4a allele for the VNTR 4b4a in patients with clinical ED were more common in good responders compared to poor responders to sildenafil. Moreover, in patients with postoperative ED, the haplotype consisting of C 4a Glu alleles was more common in good responders compared to poor responders to sildenafil. In the study of biochemical markers and response to sildenafil were recruited 44 patients and 28 healthy men. The 44 patients were divided into two groups: 26 patients with ED (ED group) and 18 patients with ED and type II diabetes mellitus (ED/DM group). The results of our biochemical study suggest that lows level of NO in patients in two clinical groups of DE (DE and ED/DM groups) are beneficial in the treatment with sildenafil in that patients. Moreover, low level of the antioxidant FRAP marker showed be better for sildenafil responsiveness in ED/DM group. In conclusion, our findings show that eNOS gene polymorphisms and markers of NO formation and oxidative stress affect the response to treatment with sildenafil in patients with ED / Doutorado / Farmacologia / Doutora em Farmacologia

Introduction : Les séquelles érectiles de la prostatectomie totale pour cancer concernent la majorité des patients. Des protocoles de remplacement nerveux, prometteurs sur des modèles animaux, n’ont pas amélioré la récupération chez l’homme dont l’anatomie nerveuse pelvienne est plus complexe.Matériel et méthodes : Trois études expérimentales chez le rat ont évalué différentes stratégies, seules ou combinées, de réparation de nerfs caverneux lésés par écrasement : l’engainement synthétique ou autologue et l’adjonction locale ou systémique de traitements pharmacologiques. Deux études anatomiques ont consisté à mettre au point et à appliquer une technique de dissection assistée par ordinateur permettant une analyse morphologique et fonctionnelle de l’innervation péri-prostatique chez 7 fœtus masculins et 4 sujets cadavériques.Résultats : L’engainement synthétique du nerf caverneux lésé a permis une récupération érectile partielle. En y associant une délivrance locale de Triiodothyronine ou systémique de sildénafil, la récupération était complète. Un traitement par sildénafil seul permettait également une récupération complète. L’engainement autologue était inefficace. Les fibres nerveuses de la bandelette neuro-vasculaire se distribuaient en fibres antérieures destinées au sphincter urétral, antéro-latérales (nerfs caverneux) destinées aux corps caverneux et postéro-latérales (nerfs spongieux) destinées aux corps spongieux.Conclusion : Les nerfs destinés aux corps érectiles ont une position plus antérieure que celle décrite dans les traités chirurgicaux de référence. Ce trajet doit être pris en compte avant d’envisager des études cliniques de réparation nerveuse. Les stratégies de réparation du nerf caverneux devraient être adaptées au plan d’éxérèse envisagé et à la qualité de la préservation nerveuse réalisée. / Introduction : Erectile dysfunction occurs in more than half of the patients after a radical prostatectomy despite nerve-preserving surgical techniques. Nerve replacement protocols have been successful in animal models but they failed in improving the erectile function recovery in men where the pelvic nervous anatomy is more complex.Methods : Three experimental studies in rats have evaluated three different strategies, alone or in combination, to repair cavernous nerves after a crush-injury : guiding the nerve with an autologous or a synthetic disposal and adding local or systemic pharmacological treatments. Two anatomical studies have developped and applied a computer-assisted anatomical dissection technique to perform a morphological and a functional analysis of the peri-prostatic innervation in 7 male fetuses and 4 cadaveric subjects.Results : The erectile function recovery was partial after implantation of artificial conduits and complete with an additional local delivery of Triiodothyronine or systemic delivery of sildenafil. Sildenafil treatment alone also allowed full recovery. Autologous conduits were ineffective. The neurovascular bundles had distal divisions : anterior fibers innervated the urethral sphincter, antero-lateral fibers (cavernous nerves) innervated the corpora cavernosa and postero-lateral fibers (spongious nerves) innervated the corpora spongiosa.Conclusion : The position of the erectile fibers of the neurovascular bundles is more anterior than classically described. This pathway has to be considerated before any clinical study for cavernous nerve repair. For each patient, the planned type of nerve-preservation should determine the strategy for the nerve repair.

On sait depuis longtemps que l’exposition à l’altitude est associée à une réduction de l’aptitude aérobie. Différentes hypothèses ont été posées pour expliquer cette limitation à l’effort en hypoxie (une limitation ventilatoire ou diaphragmatique, une altération de la diffusion pulmonaire et une disconcordance entre de la perfusion et la diffusion tissulaire, etc.) mais généralement, la limitation de l’effort aérobie en hypoxie est attribuée à une diminution du transport sanguin de l’O2 (TO2) parc convection vers les muscles. Le TO2 dépend du débit cardiaque (Q) et du contenu artériel en O2 (CaO2). <p>Le CaO2 est diminué en altitude à cause d’une diminution de la pression partielle inspirée en O2. Cependant, le chémoréflexe hypoxique tente de contrebalancer cet effet en élevant la ventilation et en diminuant la pression alvéolaire en CO2 afin de maintenir la pression alvéolaire en O2 constante. De plus, avec l’acclimatation, le rein produit de l’érythropoïétine permettant au taux d’hémoglobine d’augmenter. Ces deux principales adaptations à l’altitude ramènent le CaO2 à sa valeur de base du niveau de la mer en 2 à 3 semaines passées à 5000 m d’altitude mais sans amélioration de l’aptitude à l’effort aérobie.<p>L’exposition à l’altitude est aussi associée à une diminution du Q maximal. Les mécanismes à l’origine de cette limitation du Q maximal restent, à l’heure actuelle, incompris. Les principales explications évoquées sont, une diminution de la réserve chronotrope, une diminution de la commande nerveuse centrale vers le cœur ou une diminution de la demande périphérique. Récemment, des études sur des sujets sains en hypoxie suggérèrent qu’au moins une partie de la limitation du Q maximal à l’effort est liée à une élévation de la postcharge ventriculaire droite suite à l’hypertension pulmonaire induite par l’hypoxie. C’est cette hypothèse que nous avons voulu vérifier dans une première étude.<p>Nous avons étudié l’effet d’une inhibition de l’hypertension pulmonaire d’altitude par le sildénafil, un inhibiteur de la phosphodiestrérase-5, chez des sujets sains, en normoxie, en hypoxie aiguë et en hypoxie chronique. Les résultats de cette étude ont confirmé l’effet vasodilatateur pulmonaire du sildénafil et une augmentation de la VO2max en hypoxie aiguë. Cependant, la prise de ce dernier était couplée à une amélioration de l’oxygénation, si bien que l’élévation de la performance aérobie observée en hypoxie aiguë sous sildénafil ne pouvait être entièrement attribuée à une réduction de l’hypertension pulmonaire. <p>Nous conclurent que cette amélioration de la performance était probablement d’avantage liée à une amélioration de l'oxygénation qu’à un effet vasodilatateur pulmonaire.<p>Les résultats équivoques obtenus lors de cette première étude nous ont incité à tester les effets d’une amélioration de l’oxygénation sur la performance aérobie en haute altitude. Pour ce faire, quinze sujets sains ont été testés au niveau de la mer et après acclimatation à 4700 m d’altitude soit sous placebo, soit sous acétazolamide, un inhibiteur de l’anhydrase carbonique augmentant l’oxygénation par stimulation ventilatoire en réponse à une acidose métabolique. La prise d’acétazolamide n’eut aucun effet sur l’hémodynamique pulmonaire et sur la VO2max et la charge maximale. Nous avons toutefois observé qu’une amélioration de l’oxygénation durant l’effort retarde l’apparition du seuil ventilatoire améliorant ainsi la phase aérobie de l’effort. Cette étude confirme donc qu’une élévation du CaO2 permet une amélioration de l’aptitude aérobie. <p>Finalement, la dernière étude a pour but d’étudier les effets isolés d’une vasodilatation pulmonaire sur la performance aérobie en altitude. Les résultats d’une étude préliminaire montrent que l’inhibition de la vasoconstriction hypoxique par un agent pharmacologique antagoniste des récepteurs de l’endothéline ETA et ETB, le bosentan, permet une élévation de l’aptitude aérobie en hypoxie aiguë, sans effets sur l’oxygénation, confirmant ainsi notre hypothèse initiale qu’une postcharge ventriculaire droite augmentée en hypoxie peut contribuer à une limitation de l’aptitude à l’effort aérobie en hypoxie. <p><p>Conclusions :<p>L’ensemble de nos résultats suggère que l’aptitude aérobie en altitude est déterminée par le transport d’O2 qui peut être augmenté par manipulation pharmaceutique du débit ventriculaire droit maximal après inhibition de la vasoconstriction pulmonaire hypoxique (bosentan), amélioration de l’oxémie (acétazolamide) ou des deux (sildénafil).<p> / Agrégation de l'enseignement supérieur en kinésithérapie et réadaptation / info:eu-repo/semantics/nonPublished

Over the past several decades, the rate of pulmonary nontuberculous my- cobacterial (PNTM) disease has been increasing. PNTM patients gener- ally consist of lean and tall women presenting with symptoms in the sixth decade of life. They have a de nitive morphophenotype, but no consistent immunological abnormalities despite extensive investigation. I hypothesized that respiratory epithelial dysfunction might play a critical role in PNTM disease predisposition because diseases with defects of mucociliary transport have high rates of PNTM disease that increase with age, suggesting a direct connection between airway epithelial function and PNTM disease. I found that PNTM patients have a distinct respiratory epithelial phenotype ex vivo and decreased nasal nitric oxide levels in vivo. The PNTM ex vivo phenotype consists of an abnormally low resting ciliary beat frequency (CBF) and abnormal CBF response to toll-like receptor (TLR) agonists. The depressed baseline CBF response in PNTM patient cells can be normalized ex vivo by augmenting the nitric oxide-cyclic guanosine monophosphate pathway without appreciable e ect on CBF in healthy controls. In healthy controls, bacterial TLR agonists increase CBF and viral TLR agonists decrease CBF. In PNTM patients these responses are impaired and are not normalized with the normalization of the resting CBF rate. Inhibitor-induced disruption of signalling pathways associated with CBF regulation demonstrated that the majority of the CBF response to TLR agonists involves the PI-3K pathway and PKC. Inhibition of the PI-3K pathway (PI-3K , Akt1, and PDK1) closely mimicked the ex vivo phenotype seen in PNTM patient respiratory epithelia. These data identify a novel aspect of PNTM disease with in vivo and ex vivo correlates that suggest that PNTM infection is associated with abnormal function at both the CBF and TLR response levels. This phenotype is novel, reproducible, and provide a foundation with which to determine the genetic basis of PNTM infection.