A doença cardiovascular é a principal causa de morte no mundo ocidental e as estatinas são os medicamentos mais prescritos para prevenção e tratamento. Apesar de serem os fármacos mais prescritos, ainda são subutilizados, tendo como principal causa de interrupção do tratamento a miopatia. Entre os mecanismos envolvidos na fisiopatologia da miotoxicidade, a deficiência da coenzima Q10 vem sendo apontada como a principal responsável deste efeito colateral. A creatinofosfoquinase (CPK) é um biomarcador de gravidade dos danos musculares sendo utilizado de rotina na prática clínica. Contudo, seus níveis podem estar normais ou aumentados em pacientes em uso de estatinas e apresentando sintomas musculares. Sendo assim, a espectroscopia do hidrogênio por ressonância magnética (EHRM) poderia auxiliar no diagnóstico da toxicidade muscular causada pelas estatinas, através de um estudo metabólico de alterações decorrentes dos vários mecanismos envolvidos isolados ou associados. O objetivo deste estudo é avaliar as concentrações das gorduras intramiocelulares (IMCL) e extramiocelulares (EMCL), creatina total (Cr total) e trimetilamina (TMA), nos músculos tibial anterior e sóleo, nos pacientes em uso de estatina e com sintomas musculares e comparar com indivíduos hipercolesterolêmicos (LDL>=160mg/dL) e normocolesterolêmicos (LDL<160mg/dL), ambos sem tratamento. Também avaliar o efeito da redução do colesterol plasmático (após três meses de tratamento com estatinas) nas concentrações de gorduras IMCL e EMCL. Além disso, fazer uma correlação entre os níveis de CPK destes pacientes com as variáveis da espectroscopia. Noventa e um pacientes (média de 44 anos, 54 mulheres e 37 homens) foram submetidos à coleta de sangue para avaliação do perfil lipídico, TGO, TGP, CPK, TSH, T4 livre, creatinina e glicemia, e H-MRS para avaliação dos metabólitos IMCL, EMCL, Cr total e TMA. Os pacientes foram divididos em três grupos: grupo 1 (pacientes com LDL-C<160mg/dL, sem uso de medicação hipolipemiante) n=49, grupo 2 (pacientes em uso de estatina e apresentando sintomas musculares) n=18 e grupo 3 (pacientes com LDL-C>=160mg/dL, sem uso de estatina) n=24. Os pacientes do grupo 3 foram submetidos à coleta de sangue e a EHRM em dois momentos: antes e três meses após o tratamento com sinvastatina 20mg. Os exames foram realizados utilizando o aparelho de ressonância magnética SIGNA 1,5 T (Tesla) (General Electric, Milwaukee, WI, USA) e as imagens foram analisadas e processadas automaticamente utilizando o programa LCModel versão 6.2 (http://s-provencher.com/). Foram obtidos 115 exames de espectroscopia. Os pacientes do grupo 2 (55±9 anos) eram mais velhos do que os dos grupos 1 (38±11 anos) e 3 (48±9 anos) respectivamente, p<0,001. Houve diferença significante entre os grupos, pré-tratamento, em relação ao colesterol total, LDL-colesterol, triglicérides e TGO (p<0,001). Não foi observada diferença significante nos níveis de CPK entre os grupos 1, 2 e 3 (p=NS). No grupo 3, houve redução significante nos níveis de colesterol total, LDL-C e triglicérides após tratamento com estatina (p<0,05). Não houve diferença significante entre as variáveis IMCL, EMCL, Cr total e TMA, assim como suas razões entre os grupos avaliados e no grupo 3 antes e após o tratamento com estatinas (p=NS).Em relação aos valores de CPK e os resultados encontrados nas espectroscopias dos pacientes do grupo 2, observamos uma correlação positiva e significante entre a análise sérica da CPK e a razão da gordura IMCL e creatina total no músculo tibial anterior (r=0,253; p=0,018). A EHRM é um exame factível para ser utilizado na prática clínica, porém não foi possível demonstrar alterações nas concentrações dos metabólitos nos músculos tibial anterior e sóleo entre os grupos estudados. Os achados de correlações entre a CPK e a razão da gordura IMCL e creatina total podem sugerir uma manifestação precoce de toxicidade muscular causada pelas estatinas, em pacientes com sintomas musculares. / Cardiovascular disease is the leading cause of death in the western world and statins are the most prescribed medications for prevention and treatment. Despite being the most prescribed drugs, they are still under-used. The main cause of interruption of statin treatment is myopathy. Among the mechanisms involved in the pathophysiology of myotoxicity, deficiency of coenzyme Q10 has been described as the main cause of this side effect. Creatine kinase (CK) is a biomarker for severity of muscle damage, but its levels may be normal or increased in patients on statin use and muscle symptoms. Thus, proton magnetic resonance spectroscopy (H-MRS) could assist in the diagnosis of muscle toxicity caused by statins, through a study of the metabolic changes. The aim of this study is to evaluate the concentrations of intramyocellular (IMCL) and extramyocellular lipids (EMCL), total creatine and trimethylamine (TMA), on tibialis anterior and soleus muscles in patients on statin use and muscle symptoms and compare with hypercholesterolemic subjects (LDL >= 160mg/dL) and normal subjects (LDL<160mg/dL), both without treatment. Also, the effect on LDL serum levels (after three month statin treatment), and concentrations of IMCL and EMCL lipids. In addition, make a correlation between the levels of CK and the variables of spectroscopy. Ninety-one patients (mean age=44, 54 women and 37 men) were submitted to blood sampling for evaluation of serum total cholesterol, LDL-C, HDL-C, triglycerides, AST, ALT, CK, glucose, TSH and creatinine, and H-MRS for evaluation of metabolites, IMCL and EMCL lipids, total creatine and TMA. Patients were divided in 3 groups: 1 (patients with LDL-C<160mg/dL, without statin use) n=49, 2 (patients on statin use and muscle symptoms) n=18 and 3 (patients with LDL-C>=160mg/dL, without statin use) n=24.Group 3 were subjected to blood sampling and the H-MRS on two occasions: before and three months after treatment with simvastatin 20 mg. The tests were carried out in a MRI SIGNA 1.5 Tesla (General Electric, Milwaukee, WI, USA) magnet and the images were processed automatically using the software LCModel version 6.2 (http://s-provencher.com/). From the 91 study subjects a total of 115 H-MRS scans were performed. Patients in group 2 (age 55.0 ± 9.0 years) were older, respectively, than in groups 3 (48.0 ± 9.0 years) and 1 (38.0 ± 11.0 years), p<0.001. There was a statistically significant difference between the groups before treatment in relation to the total cholesterol, LDL-cholesterol, triglycerides and AST (p<0.001). There were no significant differences on plasma CK levels, in patients presenting muscle symptoms (p=NS). In Group 3, there was significant reduction in levels of total cholesterol, LDL-C and triglycerides after treatment with statin (p<0.05).There were no significant differences regarding median IMCL variables, EMCL, total creatine and TMA, in the tibialis anterior and soleus muscles as well as their ratios among the three groups and after group 3 three month treatment (p=NS). A significant and positive correlation (r=0.253, p=0.018), was found in group 2 between serum CK and the ratio of intramyocellular and total creatine in tibialis anterior muscle. H-MRS is a feasible exam to be used in clinical practice; however it has not been possible to demonstrate changes in concentrations of the metabolites in the tibialis anterior and soleus muscles. The findings of correlations between CK and intramyocellular and total creatine may suggest an early manifestation of muscle toxicity caused by statins in patients with muscle symptoms.

C-reactive protein (CRP) is made in liver and its serum concentration increases in inflammation. Measurement of serum CRP is recommended for use as an indicator of inflammation and predictor of atherosclerosis. Cholesterol-lowering drugs statins also lower CRP. To evaluate statin-mediated CRP reduction and to reassess clinical usefulness of CRP, we investigated regulation of CRP gene expression. Here, we show that pravastatin and simvastatin prevent the induction of CRP expression in human hepatoma Hep3B cells exposed to proinflammatory cytokines IL-6 and IL-1β. The nitric oxide (NO) donor, sodium nitroprusside, also prevented the induction of CRP expression while the CRP inducers IL-6 and IL-1β were present with the cells. The effect of NO on CRP expression was at the level of transcription. These findings suggest that the decrease in CRP level in vivo after statin-treatment does not necessarily reflect absence of inflammation, and that NO-releasing drugs have the potential to reduce serum CRP levels. Thus, the measurement of serum CRP levels alone in individuals on statin/NO-therapy is not as useful as was imagined.

No description available.

Il a déjà été démontré que les statines (ou inhibiteurs de la HMG-CoA réductase) sont efficaces pour réduire le LDL-cholestérol et elles se sont depuis établies comme étant le pilier dans le traitement de la dyslipidémie. Toutefois, environ 10 pourcent des utilisateurs de statines souffrent d'effets indésirables, généralement sous forme de myopathie qui est souvent accompagnée d’un taux élevé de la créatine kinase (CK) plasmatique. Il est fréquent que les patients doivent arrêter les statines à cause d’un taux de CK dépassant un seuil de référence. Nous avons examiné le taux de CK de près de 6000 participants de la biobanque de l’ICM, qui ont récemment été génotypés à l'aide de la micropuce d'ADN ExomChip d'Illumina. Des études antérieures ont démontré une association significative entre le taux de CK plasmatique et des polymorphismes génétiques et nous avons cherché à répliquer ces résultats par association génétique et à l'aide du test SKAT pour les polymorphismes rares. Nous avons répliqué les résultats dans le gène CKM (rs11559024, p=1.59x10-23) et le gène LILRB5 (rs12975366, p=1.44x10-26) dans le chromosome 19. Nous espérons que ces résultats seront éventuellement utilisés en clinique pour la prédiction des taux de référence de CK personnalisés selon le profil génétique des patients utilisateurs de statines. / Statins (HMG-CoA reductase inhibitors) have been shown to reduce LDL-cholesterol and are undoubtedly the mainstay in the treatment of hyperlipidemia. Approximately 10 percent of statin users suffer from adverse side effects, the most common being muscle myopathy. Muscle myopathy is often accompanied by elevated levels of plasma creatine kinase (CK). Oftentimes, patients are taken off statins after their CK levels surpass a reference threshold. We looked at CK levels in the MHI Biobank, which have recently been genotyped in over 6000 participants with the Illumina ExomChip. Prior studies have found significant association between plasma CK levels and genetic variants and we aimed to replicate these findings using a genome wide association and a SKAT burden test for rare variants. We were able to replicate findings in the CKM gene (rs11559024, p=1.59x10-23) and LILRB5 gene (rs12975366, p=1.44x10-23) in chromosome 19. We hope that these results will eventually be utilized in clinical statin care by aiding in the prediction of personalized reference CK levels based on genetic information for patients using statins.

Neste trabalho foram estudadas duas abordagens para a obtenção de novos metabólitos secundários a partir de fungos. Na primeira, o ácido hidroxâmico suberoilanilida (SAHA) e cinco análogos foram sintetizados. Sua atividade como modificadores epigenéticos foi avaliada em oito linhagens fúngicas do ambiente marinho. Os fungos Penicillium sp. e Acremonium sp. apresentaram modificações no seu perfil metabolómico quando foram crescidos em pequena escala em presença do derivado 4F-SAHA, enquanto Microphaeropsis sp. apresentou modificação em presença do 3AM-SAHA. O fungo P. decaturense foi crescido em maior escala e os compostos de interesse foram isolados. Na segunda abordagem, uma nova estratégia de extração utilizando mistura de resinas XAD 2-4-7 permitiu a extração e posterior isolamento de seis novos alcaloides peptídicos (72-77) e dois peptídeos (78-79) a partir da fração aquosa do meio de cultivo do fungo antártico Penicillium solitum IS1-A. Utilizando a mesma metodologia, o metabolismo secundário do fungo antártico Thelebolus globosus E2 foi estudado. A partir de seu extrato metanólico do meio liquido PDB foram isoladas a ciclopenina (86) e o ciclopenol (87) e foram detectados os alcaloides viridicatina (88) e viridicatol (89). O fungo Thelebolus globosus mostrou-se produtor de estatinas, sendo isoladas como composto majoritário a mevastatina (90). / In this work two approaches to obtain new secondary metabolites from fungi were studied. Suberoylanilide hydroxamic acid (SAHA) and five analogues were synthesized and assessed as epigenetic modifiers in eight marine-derived fungi. The fungus Penicillium sp. and Acremonium sp. presented changes in their metabolomic profile when they were grown on a small scale in presence of 4F-SAHA derivative and Microphaeropsis sp. presented a modification in the presence of the 3 AM-SAHA. In the second approach a new extraction strategy using XAD 2-4-7 resin mixture allowed the extraction and subsequent isolation of six new peptide alkaloids (72-77) and two peptides (78-79) from the aqueous fraction of the culture medium of the Antarctic fungus Penicillium solitum IS1-A. Using the same methodology, the secondary metabolism of the Antarctic fungus Thelebolus globosus E2 was studied. From the methanolic extract of the PDB liquid medium cyclopenine (86) and cyclopenol (87) were isolated and the viridicatine (88) and viridicatol (89) alkaloids were detected. The fungus Thelebolus globosus was shown to be a producer of statins, mainly of mevastatin (90).

Neste trabalho foram estudadas duas abordagens para a obtenção de novos metabólitos secundários a partir de fungos. Na primeira, o ácido hidroxâmico suberoilanilida (SAHA) e cinco análogos foram sintetizados. Sua atividade como modificadores epigenéticos foi avaliada em oito linhagens fúngicas do ambiente marinho. Os fungos Penicillium sp. e Acremonium sp. apresentaram modificações no seu perfil metabolómico quando foram crescidos em pequena escala em presença do derivado 4F-SAHA, enquanto Microphaeropsis sp. apresentou modificação em presença do 3AM-SAHA. O fungo P. decaturense foi crescido em maior escala e os compostos de interesse foram isolados. Na segunda abordagem, uma nova estratégia de extração utilizando mistura de resinas XAD 2-4-7 permitiu a extração e posterior isolamento de seis novos alcaloides peptídicos (72-77) e dois peptídeos (78-79) a partir da fração aquosa do meio de cultivo do fungo antártico Penicillium solitum IS1-A. Utilizando a mesma metodologia, o metabolismo secundário do fungo antártico Thelebolus globosus E2 foi estudado. A partir de seu extrato metanólico do meio liquido PDB foram isoladas a ciclopenina (86) e o ciclopenol (87) e foram detectados os alcaloides viridicatina (88) e viridicatol (89). O fungo Thelebolus globosus mostrou-se produtor de estatinas, sendo isoladas como composto majoritário a mevastatina (90). / In this work two approaches to obtain new secondary metabolites from fungi were studied. Suberoylanilide hydroxamic acid (SAHA) and five analogues were synthesized and assessed as epigenetic modifiers in eight marine-derived fungi. The fungus Penicillium sp. and Acremonium sp. presented changes in their metabolomic profile when they were grown on a small scale in presence of 4F-SAHA derivative and Microphaeropsis sp. presented a modification in the presence of the 3 AM-SAHA. In the second approach a new extraction strategy using XAD 2-4-7 resin mixture allowed the extraction and subsequent isolation of six new peptide alkaloids (72-77) and two peptides (78-79) from the aqueous fraction of the culture medium of the Antarctic fungus Penicillium solitum IS1-A. Using the same methodology, the secondary metabolism of the Antarctic fungus Thelebolus globosus E2 was studied. From the methanolic extract of the PDB liquid medium cyclopenine (86) and cyclopenol (87) were isolated and the viridicatine (88) and viridicatol (89) alkaloids were detected. The fungus Thelebolus globosus was shown to be a producer of statins, mainly of mevastatin (90).

A obesidade é um estado inflamatório crônico. As estatinas têm efeito antiinflamatório e podem afetar a homeostase glicêmica. Estudos, nesse sentido são contraditórios e pouco se sabe sobre os mecanismos moleculares envolvidos. Este estudo verificou em animais obesos por glutamato monossódico (MSG) que além de apresentaram resistência à insulina in vivo, o tecido adiposo branco (TAB) desses animais mostrou aumento de infiltração de macrófagos, fosforilação de IKK-a/b, expressão de mRNA de TNF-a and IL-6, e redução de mRNA e proteína de GLUT4. O tratamento com atorvastatina por 4 semanas restabeleceu a sensibilidade à insulina in vivo, reduziu a inflamação e restabeleceu a expressão de GLUT4 no TAB dos animais obesos. Adicionalmente, esse trabalho encontrou sítios de ligação de NF-kB no promotor do gene GLUT4, sugerindo ligação entre resistência à insulina e inflamação. Em conclusão, a obesidade induzida por MSG em camundongos acompanha-se de resistência à insulina in vivo e atividade inflamatória crônica no tecido adiposo, com prejuízo da expressão de GLUT4. A atorvastatina melhorou esses aspectos, sugerindo que essa estatina tenha efeitos antiinflamatórios que podem melhorar a resistência à insulina na obesidade. / Obesity is a chronic inflammatory state. Statins have anti-inflammatory effects and may affect glucose homeostasis; therefore, few are known about the molecular mechanisms. Considering that inflammation contributes to insulin resistance, the aim of the present study was to investigate if atorvastatin treatment has anti-inflammatory, and consequently insulin sensitization action in white adipose tissue (WAT) of obese mice. WAT of insulin-resistant obese mice showed increased macrophage infiltration, IKK-a and IKK-b phosphorylation, TNF-a and IL-6 mRNA expression and decreased GLUT4 mRNA and protein expression. Atorvastatin restored whole-body insulin sensitivity, decreased macrophage infiltration and normalized IKK-a/b phosphorylation, TNF-a, IL-6 and GLUT4 mRNA and GLUT4 protein to control levels. Moreover, NF-kB binding sites were found in GLUT4 gene promoter, pointing out an association between insulin resistance and inflammation. Together, atorvastatin anti-inflammatory effects on WAT may be important to its local and whole-body insulin sensitization effects.

La maladie de Parkinson (MP) est caractérisée par une perte progressive des terminaisons présynaptiques dopaminergiques et reste actuellement incurable. Néanmoins, dans les études épidémiologiques, il a été montré que l’utilisation des statines, médicaments hypocholestérolémiants, diminue le risque de développer une MP. Les statines sont également capables d'inhiber les effets neurodégénératifs dans les modèles précliniques in-vitro et in-vivo de la MP. Cependant, les mécanismes moléculaires à l’origine de ces effets neuroprotecteurs ne sont pas encore complétement élucidés. Ainsi, nous avons étudié les effets potentiels des statines sur l'expression des marqueurs synaptiques et sur le transport de la dopamine. Dans nos études, les statines induisent la croissance des neurites dans les cellules dopaminergiques et déclenchent une augmentation de l’expression des protéines synaptiques dopaminergiques telles que le transporteur vésiculaire des monoamines (VMAT2) et le transporteur de la dopamine. Les statines induisent une diminution de la recapture de la dopamine cellulaire et des changements d’affinités aux niveaux des sites de liaison des inhibiteurs sélectifs du VMAT2. L’activation du facteur de transcription nucléaire protéine-1 se liant à l'élément de régulation des stérols (SREBP-1), cholestérol-dépendent, serait l’élément inducteur de la surexpression des marqueurs dopaminergiques présynaptiques induite par les statines. En outre, ces résultats soutiennent un potentiel thérapeutique neuroprotecteur et/ou neurorestaurateur des statines précédemment proposées dans la MP et permettent de mettre en évidence de nouvelles cibles thérapeutiques comme le facteur SREBP. / Parkinson disease (PD) is characterized by a progressive loss of dopaminergic presynaptic terminals and remains incurable. However in epidemiological studies, it has been shown that the use of statins, which are hypocholesterolemic drugs, diminishes the risk to develop a PD. Statins are able to inhibit the neurodegenerative effects in in-vitro and in-vivo models of PD. However, the molecular mechanisms driving neuroprotective effects are not yet fully understood. Consequently, we investigated the potential effects of statins on the synaptic expression and dopamine transport function in the dopaminergic system. In our studies, statins enhance the neurite outgrowth in the dopaminergic cells and trigger an increase in the expression levels of presynaptic dopaminergic proteins such as vesicular monoamine transporter 2 (VMAT2) and dopamine transporter. Statins induce a reduction of dopamine cellular uptake and modulate the binding-affinity of the specific inhibitors for VMAT2. The activation of the nuclear transcriptional factor sterol regulatory element-binding protein 1 (SREBP-1), cholesterol-dependent, could be the key element of the overexpression of dopaminergic presynaptic markers induced by the statins. Furthermore, these findings highlight the therapeutic neuroprotective and/or neurorestorative potentials of statins previously proposed in PD and allow to bring out new potential therapeutic targets such as SREBP factor.

Abdominal aortic aneurysm (AAA) is a common disease that develops gradually over several years and is characterised by weakening and dilatation of the aortic wall. AAAs also demonstrates a marked inflammatory infiltrate throughout the aortic wall. Chlamydophila pneumoniae (C. pneumoniae), is a common bacterium. About 50% of the population has been infected in adolescence. Thirteen studies report the presence of either C. pneumoniae or its antigens in 35-100% of AAA specimens. The overall aim of this thesis was to evaluate the possible role of C. pneumoniae in inflammatory response and expansion of AAA from a clinical point of view. In paper I, viable C. pneumoniae was detected in a majority of 26 patients with AAA having open surgery. Patients operated for AAA had higher C. pneumoniae antibodies titers than controls. In paper II, 247 patients were randomised in a double-blind trial, to evaluate the effect of azithromycin on the expansion of small AAAs. No such effect was seen and there was no correlation between C. pneumoniae antibody titers and AAA expansion. In paper III, 42 patients with AAA were compared to 100 age- and sex matched controls with normal aortas. C. pneumoniae antibodies were analysed in plasma samples obtained at screening, and in samples from a study conducted 5-15 (mean 12) years previously on the same population. There was no significant difference between the groups. In paper IV, were 211 patients were analysed, we could not find an association between levels in plasma of three markers of inflammation (IL-6, MMP-9 and CRP) and AAA expansion. A significant reduction in AAA expansion rate was found in patients treated with a combination of ASA and statins. In conclusion, viable C. pneumoniae is found at the scene of the crime, but we were unable to reverse or halt expansion of AAA with antibiotic treatment. C. pneumoniae antibody titers cannot be used, to detect small AAA, or to evaluate AAA expansion. From a clinical point of view, based on the methods and analyses used in this thesis, the role of C. pneumoniae in the inflammatory response and expansion of abdominal aortic aneurysms is limited.

The endothelium plays an essential role in the regulation of vascular homeostasis and a state of endothelial dysfunction, which develops in the presence of cardiovascular risk factors, may contribute to the development and progression of cardiovascular disease. As such, the measurement of endothelial function, beyond being an experimental tool, may serve as an important tool to complement current risk assessment algorithms in the identification of high-risk patients. Flow-mediated dilation (FMD) is a non-invasive measure of peripheral conduit artery endothelial function that holds great promise. Presently, FMD suffers from methodological heterogeneity and a poor understanding of the various biological components involved in eliciting the dilatory response to a given shear stimulus. We compared both traditional and alternative methods of arterial diameter characterization with regards to their repeatability, nitric oxide-dependency, and their sensitivity in distinguishing between normal and dysfunctional endothelial responses. Our findings emphasize the importance of continuous arterial diameter measurement and suggest that the time to peak FMD is not a useful adjunctive measure of the FMD response. Given that endothelial dysfunction may be of clinical importance, strategies to correct it or prevent it from occurring may be of benefit. The 3-hydroxy-3-methylglutaryl coenzyme A inhibitors are agents that have demonstrated marked cholesterol-independent, endothelial-protective effects. We investigated the ability of rosuvastatin and atorvastatin to protect against endothelial dysfunction associated with ischemia and reperfusion (IR) injury, and chronic nitrate therapy. Using the FMD technique, we demonstrated, for the first time in humans, that acute rosuvastatin administration protects against IR-induced conduit artery endothelial dysfunction. Additionally, we demonstrated that this effect likely occurred by a cyclooxygenase-2-dependent mechanism, which may provide mechanistic insight into the observed cardio-toxicity with cyclooxygenase-2 inhibitors. In contrast, we observed that this endothelial-protective effect was lost upon sustained rosuvastatin administration, which may have important implications regarding the generation of sustained cardioprotective phenotypes. Finally, we demonstrated that atorvastatin co-administration prevented the development of tolerance and endothelial dysfunction associated with continuous transdermal nitroglycerin therapy in humans, likely through an antioxidant mechanism. Future studies are needed in disease patients to determine whether the concept of nitrate tolerance needs reconsideration in the presence of vascular-protective agents.