Made available in DSpace on 2018-06-27T18:56:25Z (GMT). No. of bitstreams: 2 Ricardo Lorenzoni.pdf: 2169381 bytes, checksum: 9b086c1fe18c612a1d43ebe5f91c0f8f (MD5) Ricardo Lorenzoni.pdf.jpg: 3465 bytes, checksum: 60fb1578356f3148589233475ed9e01a (MD5) Previous issue date: 2012-04-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The hypothesis of Alzheimer s Disease (DA) may be related to high serum cholesterol levels made lipid-lowering drugs, as lovastatin (LV) and simvastatin (SV), potential choices of treatment against this disease. However, low levels of simvastatin and lovastatin are able to cross the blood brain barrier (BHE) and side effects associated to these drugs are a problem for their use in diseases affecting the central nervous system (SNC). Therefore, considering the therapeutic potentials of nanocapsules, the aim of this work was develop, characterize and evaluate the biological effect of NC containing SV or LV in animal models of DA induced by hypercholesterolemia. NC polymeric suspensions were prepared with SV (NCSV) or LV (NCLV) by interfacial deposition of preformed polymers. NCLV and NCSV exhibited average particle size of 204.0 ± 1.5 nm and 205.5 ± 0.5 nm, respectively, as monodispersed systems, with slightly acid pH (around 6) and negative zata potential (-23.29 ± 0.80 for NCLV and -19.5 ± 0.13 mV for NCSV). The analysis by fourier transform infrared spectroscopy and differential canning calorimetry (DSC) indicated that no chemical reactions occurred among components during nanocapsule preparation. The DSC analysis showed that sorbitan monostearate was dissolved in the oil core. The X-ray diffractometry, scanning electron microscopy (SEM), optical microscopy and drug content showed that a large amount lovastatine was presented in a crystalline form in NCLV, and they were not encapsulated. On the other hand, for NCSV, simvastatin was amorphous, indicating absent of drug crystals and that the drug was molecularly dispersed in NC. The encapsulation efficacy of LV was low (21.52 ± 1.4 %) while of SV was very high (99.18 ± 0.7 %). The animals fed with hyperlipemic diet showed significantly increase of serum cholesterol levels and LDL-cholesterol, however the treatment with unencapsulated SV and nanocapsules loading SV 1 mg/kg/dia and 3 mg/kg/day, during 45 days, not sufficient for reducing these biochemistry parameters. The serum triglycerides and VLDL-cholesterol levels did not show significant variations. The HDL-cholesterol was higher for animals treated with free SV (3mg/kg/day). The animals fed with hyperlipemic diet and/or treated with free drug or loaded in nanocapsules didi not show any increase of liver transaminases, indicating that there was no liver damage. The activity of pyruvate kinase and creatine kinase suggested that there were not any changes in neuronal energy metabolism. The hypercholesterolemia was capable of inducing alterations in cognition in Wistar rats. The NCSV showed promising effects in DA, once the animals were able to enhance memory when subjected to passive avoidance test. Free SV led to no significant alterations in learning and memory. The histology results suggested the presence of some brain lesions in some groups, indicating a possible neurodegeneration. Based on these results, we can conclude that simvastatin nanocapsules are a promising alternative in the treatment of cognitive loss due to high cholesterol levels and deserves more studies. / A hipótese de que o desenvolvimento da Doença de Alzheimer (DA) pode estar relacionado com altos níveis de colesterol plasmático faz dos fármacos hipolipemiantes, como Lovastatina (LV) e Sinvastatina (SV), potenciais terapêuticos frente a esta enfermidade. Contudo, a baixa penetração da LV e da SV através da barreira hematoencefálica (BHE) e os efeitos colaterais que elas podem ocasionar apresentam-se como um impasse para a utilização destes fármacos frente a doenças que acometem o sistema nervoso central. Deste modo, considerando as potencialidades terapêuticas que as nanocápsulas poliméricas (NC) podem promover, este trabalho teve como objetivo, desenvolver, caracterizar e avaliar o efeito biológico de NC contendo SV ou LV frente ao modelo animal da DA induzida por hipercolesterolemia. Assim, foram desenvolvidas suspensões de NC poliméricas contendo SV (NCSV) ou LV (NCLV) através do método de deposição interfacial do polímero pré-formado. As suspensões exibiram tamanho médio de partícula homogêneo (204,0 ± 1,5 nm para as NCLV e 205,5 ± 0,5 nm para as NCSV), com baixo índice de polidispersão, caracterizando sistema monodispersos, com pH levemente ácido (em torno de 6) e potencial zeta negativo (-23,29 ± 0,80 mV para as NCLV e -19,5 ± 0,13 mV para as NCSV). As análises de espectroscopia na região do infravermelho com transformada de Fourier e calorimetria exploratória diferencial (DSC) indicaram que não houve reação química entre os componentes da formulação durante a produção das formulações. A avaliação por DSC mostrou que o monoestearato de sorbitano encontra-se dissolvido no núcleo oleoso das partículas. A difração de raios-X, a microscopia eletrônica de varredura (MEV), microscopia óptica revelaram que grande quantidade de fármaco apresentou-se sob a forma cristalina nas suspensões de NCLV. Por outro lado, a difração de raios-X, MEV e microscopia óptica revelaram que a SV encontra-se molecularmente dispersa nas suspensões de NCSV. Assim, a eficiência de encapsulação da LV foi baixa (21,52 ± 1,4 %) enquanto que para a SV foi alta (99,18 ± 0,7 %). Os animais alimentados com dieta hiperlipídica apresentaram aumento significativo do colesterol total e do LDL-colesterol, porém os tratamentos com SV livre e nanoencapsulada nas doses de 1 mg/kg/dia e 3 mg/kg/dia, durante 45 dias, não foram suficientes para reduzir estes parâmetros bioquímicos. Os triglicerídeos séricos e VLDL-colesterol não apresentaram variações significativas induzidas pela dieta ou como consequência do tratamento medicamentoso. O HDL-colesterol apresentou-se mais elevado apenas para os animais tratados com SV livre. Não houveram evidências de aumento das aminotransferases séricas, sugerindo ausência de dano hepático. As atividades da piruvatoquinase e da creatinoquinase indicaram que não houve alteração no metabolismo energético neuronal. A hipercolesterolemia foi capaz de induzir alterações cognitivas em ratos. A SV nanoencapsulada apresentou efeitos promissores frente à cognição, pois foram capazes de melhorar a memória dos animais submetidos ao teste de esquiva passiva. A SV livre não provocou alterações significativas no aprendizado e na memória dos animais neste teste. Os resultados histopatológicos indicam que houveram lesões cerebrais em alguns grupos de animais, indicando um possível efeito de neurodegeneração. Com base nos resultados, podemos concluir que as nanocápsulas de sinvastina são uma alternativa de uso terapêutico promissora e que merece mais estudos nos casos de perdas cognitivas por excesso de colesterol plasmático.

A monitorização terapêutica permite a individualização do regime de dosagem, assegurando a eficácia clínica e minimizando os efeitos adversos dos fármacos prescritos. Atualmente, as estatinas têm sido monitoradas, pois, embora eficazes e muito utilizadas, apresentam alguns efeitos adversos não desejáveis. Neste trabalho, as técnicas SPME e cromatografia gasosa acoplada à espectrometria de massas (GC-MS) foram avaliadas para a análise de estatinas (fluvastatina, simvastatina e atorvastatina) em plasma humano para fins de monitorização terapêutica. As condições de extração e derivatização foram otimizadas empregando planejamento experimental e avaliando a influência dos principais parâmetros envolvidos. Para otimização das condições de extração avaliou-se parâmetros como tempo e temperatura de extração, pH, volume de solução tampão e força iônica; e para otimização das condições de derivatização avaliou-se parâmetros como volume de reagente derivatizante, volume de agente pareador iônico e pH. A extração foi realizada utilizando fibras de PDMS-DVB, e a dessorção feita termicamente no injetor do cromatógrafo a gás. O método desenvolvido foi validado segundo normas da ANVISA, apresentando linearidade na faixa de 20 a 500 ng mL-1, precisão com coeficientes de variação menor que 14% e recuperação relativa de 20 a 40%. Concluída a validação analítica, a metodologia proposta foi aplicada em amostras reais de plasma de pacientes em terapia com simvastatina concedidas pelo Laboratório Médico Dr. Maricondi e pela Casa de Saúde de São Carlos. / Therapeutic drug monitoring allows individualization of dosage regimen, ensuring the clinical efficacy and minimizing the adverse effects of prescribed drugs. Currently, statins have been monitored; despite they are effective, some statins have undesirable adverse effects. In this work, SPME technique and gas chromatography / mass spectrometry (GC-MS) were evaluated for analysis of statins (fluvastatin, simvastatin and atorvastatin) in human plasma for therapeutic drug monitoring. The extraction and derivatization conditions were optimized using experimental design and evaluating the influence of the main parameters involved in the SPME procedure. To optimize the extraction conditions were evaluated parameters such as time and extraction temperature, pH, volume of buffer and ionic strength, and to optimize the derivatization conditions were evaluated parameters as derivatization reagent volume, ionic agent pareador volume and pH. The extraction was performed using PDMS-DVB fibers, and thermal desorption performed in the injector of the gas chromatograph. The method was validated according to ANVISA, showing linearity in the range 20 to 500 ng mL-1, the precision with coefficients of variation less than 14% and relative recovery from 20 to 40%. The proposed methodology was applied to real samples of plasma from patients on therapy with simvastatin provided by the Laboratório Médico Dr. Maricondi and Casa de Saúde of São Carlos.

Contexto: a eficácia dos inibidores da 3-hidróxi-3-metilglutaril-coenzima (HMG-CoA) redutase (estatinas) na prevenção primária e secundária na doença cardiovascular é bem estabelecida na literatura. Contudo os benefícios destes fármacos na prevenção secundária de mortalidade e eventos cardiovasculares no paciente com Síndrome Coronariana Aguda (SCA), ainda não foram completamente esclarecidos. Objetivo: analisar os benefícios do uso das estatinas comparadas a placebo ou cuidados usuais nos pacientes com SCA quanto a redução de mortalidade (por todas as causas), infarto agudo do miocárdio (fatal e não-fatal), intervenção coronária percutânea, revascularização cirúrgica do miocárdio e hospitalização. Base de Dados: trata-se de uma revisão sistemática finalizada em 29 de Janeiro de 2012, cuja seleção dos ensaios clínicos controlados e randomizados (ECCR) foi realizada nas bases de dados eletrônicas PubMed/MEDLINE, EMBASE, Cochrane Central, LILACS e Banco de Teses - CAPES. Coleta de Dados: a extração das informações sobre características basais dos estudos incluídos, avaliação da qualidade metodológica e desfechos não combinados foi realizada por dois investigadores de forma independente. Resultados: foram incluídos na metanálise 18 ECCR, que envolveram 15.370 pacientes com SCA. O uso das estatinas mostrou benefício na redução da mortalidade por todas as causas, diferença de risco (rd) = -0,0066 (IC 95% -0,0121 a -0,001; P=0,8459; I2=0%) e hospitalização rd = -0,0101 (IC 95% -0,0188 a -0,0014; P=2,1496; I2=76%). Quanto aos desfechos mortalidade cardiovascular, infarto agudo do miocárdio fatal e não fatal, intervenção coronária percutânea e revascularização cirúrgica do miocárdio não houve diferença estatisticamente significante entre os grupos estatinas versus placebo ou cuidados usuais. Conclusões: as evidências disponíveis apontam que as estatinas causam redução na mortalidade por todas as causas e na hospitalização, porém não demonstram diferença quando comparadas ao placebo ou cuidados usuais em outros eventos de importante magnitude clínica e econômica no âmbito dos serviços de saúde e da sociedade. / Context: the effectiveness of inhibitors of 3-Hydroxy-3-methylglutaryl-Coenzyme (HMG-CoA) reductase (statins) in primary and secondary prevention of cardiovascular disease is well established in the literature. However, the benefits of these drugs in secondary prevention of mortality and cardiovascular events in patients with Acute Coronary Syndrome (ACS) have still not been fully clarified. Objective: to analyze the benefits of using statins compared to placebo or usual care in patients with SCA on the reduction of mortality (from all causes), myocardial infarction (fatal and non-fatal), percutaneous coronary intervention, revascularization and hospitalization. Database: this is a systematic review completed on January 29, 2012, whose selection of randomized and controlled clinical trials (ECCR) was held in electronic databases MEDLINE, EMBASE, PubMed/Cochrane Central, LILACS and Theses database-CAPES. Data collection: two researchers performed the extraction of information about Basal characteristics of included studies, evaluation of methodological quality and outcomes not independently combined. Results: were included in the meta-analysis, involving 18 ECCR 15,370 patients with SCA. The use of statins has shown benefit in reducing mortality from all causes, risk difference (rd) = -0.0066 (CI 95% -0.0121 to -0.001; P = 0.8459; I2 = 0%) and hospitalization rd = -0.0101 (CI 95% -0.0188 to -0.0014; P = 2.1496; I2 = 76%). As to cardiovascular, myocardial infarction fatal and non-fatal coronary intervention, and percutaneous revascularization mortality outcomes, there was no statistically significant difference between the groups statins versus placebo or usual care. Conclusions: the available evidence suggests that statins cause a reduction in mortality from all causes and hospitalization, but do not demonstrate difference when compared to placebo or usual care in other important events within cost-effective clinic and economic magnitude of health services and society.

Encefalite auto-imune experimental (EAE) é o modelo animal da doença humana esclerose múltipla. Foi demonstrado que as estatinas podem ter efeitos benéficos na EAE. Diversos mecanismos de ação foram descritos para explicar esses efeitos, entre eles: estímulo a expressão de HO-1, inibição da expressão de Toll-like receptors (TLR) e inibição da produção de citocinas de padrão Th1. Estudamos o efeito de uma estatina, a sinvastatina, na evolução clínica da EAE e seus mecanismos de ação. Também avaliamos o papel do TLR4 na EAE. O tratamento com sinvastatina melhorou a evolução clínica da EAE nas doses de 1 e 5 mg/kg/dia. A análise do infiltrado celular no SNC mostrou mudança do padrão de diferenciação dos linfócitos com menor porcentagem de células produtoras de IL-17 nos grupos tratados em relação aos controles. Os animais TLR-4 -/- apresentaram melhor evolução da doença. Concluímos que o tratamento com sinvastatina melhora a evolução clínica da EAE através da inibição da produção de IL-17 e que animais TLR-4 -/- têm melhor desfecho clínico na EAE que os controles. / Experimental autoimmune encephalomyelitis (EAE) is considered the experimental model for the human multiple sclerosis disease. It has been demonstrated that statins, used as lipid-lowering agents, can have beneficial effects on EAE. Several actions have been described to explain these effects: enhancement of HO-1 expression, inhibition of Toll-like receptors expression and inhibition of Th1 cytokines. We have investigated the effect of a statin, simvastatin, on EAE clinical development and the mechanisms behind those effects. Simvastatin treatment ameliorated EAE clinical outcome at doses 1 and 5 mg/kg/day. SNC cellular infiltrates analysis showed altered pattern of differentiation with decreased percentage of IL-17-producing T lymphocytes in treated group comparing with controls. TLR4 -/- mice showed better clinical development. We concluded that simvastatin treatment ameliorates EAE clinical outcome through inhibition of IL-17 production. Mice TLR4 -/- have better EAE clinical outcome than WT controls.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-02-06T10:56:50Z No. of bitstreams: 1 paulogiovannidealbuquerquesuassuna.pdf: 2986435 bytes, checksum: 601a570e293e2ce7dbca44808cdfce4a (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-02-06T16:04:12Z (GMT) No. of bitstreams: 1 paulogiovannidealbuquerquesuassuna.pdf: 2986435 bytes, checksum: 601a570e293e2ce7dbca44808cdfce4a (MD5) / Made available in DSpace on 2017-02-06T16:04:12Z (GMT). No. of bitstreams: 1 paulogiovannidealbuquerquesuassuna.pdf: 2986435 bytes, checksum: 601a570e293e2ce7dbca44808cdfce4a (MD5) Previous issue date: 2007-07-30 / INTRODUÇÃO: Os fatores de risco cardiovasculares tradicionais e os relacionados à Doença Renal Crônica contribuem para a alta taxa de mortalidade cardiovascular na população em diálise. A coexistência nesta população de desnutrição, inflamação, aterosclerose, anemia e calcificação vascular têm enorme impacto na sobrevida dos pacientes. Como na população geral, as estatinas reduzem a mortalidade geral e cardiovascular na população em diálise através da redução lipídica e seus efeitos pleiotrópicos, destacadamente a capacidade de reduzir a resposta inflamatória crônica destes pacientes, evidenciada pela redução dos níveis de Proteína CReativa ultra-sensível (PCR-us). O grupo de pacientes em hemodiálise com baixo LDL-colesterol (LDL-c), níveis elevados de PCR-us e anemia apresentam alto risco cardiovascular e ainda não existem evidências definitivas de benefício com uso de estatinas. OBJETIVO: Avaliar a eficácia de uma baixa dose de sinvastatina que visa apenas efeitos pleiotrópicos em comparação com uma dose padrão na redução da resposta inflamatória evidenciada pelos níveis de PCR-us, parâmetros hematimétricos, resistência à eritropoetina (IR-EPO), índice de massa corpóreo (IMC) e escore de inflamação-desnutrição (MIS). MÉTODO: Quarenta e dois pacientes estáveis em hemodiálise há mais de seis meses, maiores de 18 anos e sem evidência de processos inflamatórios foram divididos segundo os níveis de LDL-c. Os pacientes com LDL-c<100mg/dl receberam apenas 20mg de sinvastatina após hemodiálise (HD) (grupo-1), enquanto os pacientes com LDL-c>100mg/dl (grupo-2) receberam 20mg/dia durante oito semanas. Antes e após o tratamento foram medidos os níveis de PCR-us, hemoglobina (Hb), hematócrito (Hct) e calculado o IR-EPO, IMC e MIS. Os dados foram analisados com o programa estatístico SPSS. Foi considerado significante p<0.05. RESULTADOS: Houve redução significativa dos níveis de LDL-c e PCR-us em ambos os grupos, sendo a redução do LDL-c significantemente maior no grupo-2 (16,26±17,51% vs 37,73±11,73%, p<0,0001) enquanto a redução da PCR-us foi equivalente em ambos os grupos (35,97±49,23% vs 38,32±32,69%, p=0,86). Houve também queda da IR-EPO e melhora dos parâmetros hematimétricos. Não houve mudança no IMC ou MIS. CONCLUSÃO: A baixa dose de sinvastatina mostrou-se tão eficaz quando a dose usual em reduzir os níveis de PCR-us, a IR-EPO e melhorar os parâmetros hematimétricos, apontando para uma importante redução do risco cardiovascular nestes pacientes. / BACKGROUND: The traditional cardiovascular risk factors and the Chronic Kidney Disease (CKD) related risk factors contribute to the extremely high rate of cardiovascular mortality seems in dialysis population. The coexistence of malnutrition, inflammation, accelerated atherosclerosis, vascular calcification and anemia has an enormous impact in the life span of these patients. As in the general population, statins reduce cardiovascular mortality in dialysis population through lipid lowering and its pleiotropic effects, mainly by the chronic inflammatory process reduction capacity, shown up by the high-sensitive C-reactive protein levels (CRP-hs) reduction. The group of dialysis patients with low LDL-cholesterol (LDL-c), elevated CRP-hs levels and anemia present the highest cardiovascular risk and there are no definite evidences of benefit with statins use. OBJECTIVE: To evaluate the efficacy of a low dose of simvastatin that aims only pleiotropic effects in comparison with a standard dose in CRP-hs levels reduction, hematimetric parameters, erythropoietin resistance (EPO-RI), body mass index (BMI) and inflammation score (MIS). METHODS: Forty-two stable dialysis patients with more than six months on maintenance dialysis program, with more than 18 years old and without inflammation evidence were divided based on LDL-c basal levels. The patients with LDL-c <100mg/dl received only 20mg of simvastatin after hemodialysis session (HD) (group-1), while the patients with LDL-c >100mg/dl (group-2) received 20mg/day during eight weeks follow-up phase. Before and after the statin use, the CRP-hs levels and hematimetric parameters was measured and calculated the EPO-RI, BMI and MIS. The data were analyzed with the SPSS statistic program, through. Was considered significant p<0.05. RESULTS: We found a significant reduction of LDL-c and CRP-hs levels in both groups, but the LDL-c levels reduction was significantly bigger in group-2 (16,26±17,51% vs 37,73±11,73%, p<0,0001) while the PCR-hs levels reduction was equivalent in both groups (35,97±49,23% vs 38,32±32,69%, p=0,86). Lowering of EPO-RI and improvement of hematimetric parameters were also observed. There were no changes in BMI or MIS. CONCLUSION: The pleiotropic dose showed itself as efficient as the usual dose in CRP-hs levels, EPO-RI reduction and improvement of hematimetric parameters, showing an important cardiovascular risk reduction in these patients.

O processo inflamatório tem um papel fundamental na gênese e desenvolvimento da aterosclerose, sendo que a disfunção endotelial é considerada um dos estágios iniciais da aterogênese. Por meio da inibição da enzima hidroxi-metil-glutaril coA redutase (HMGCR), as estatinas reduzem a biossíntese do colesterol e a formação de isoprenóides, produtos intermediários da síntese do colesterol que são importantes na modificação pós-transcricional de GTPases pequenas que estão envolvidas na disfunção endotelial e inflamação vascular. A ezetimiba é um inibidor da absorção do colesterol através da inibição da proteína NPC1L1. Com a finalidade de esclarecer os mecanismos moleculares da inibição da síntese e da absorção do colesterol sobre a modulação de biomarcadores inflamatórios e de adesão celular foram utilizados modelos in vitro com células endoteliais (HUVEC) e monócitos (células THP-1), e in vivo com células mononucleares do sangue periférico (CMSP) de indivíduos hipercolesterolêmicos (HC). O efeito das estatinas, atorvastatina e sinvastatina, e da ezetimiba na expressão de RNAm e proteínas de moléculas de adesão endoteliais e moduladores do processo inflamatório, como citocinas e óxido nítrico (NO), foi estudado em células HUVEC. O efeito desses fármacos sobre a expressão de moléculas de adesão monocitárias foi estudado em células THP-1. O efeito da terapia hipolipemiante sobre essas moléculas foi também estudada em CMSP de HC tratados com ezetimiba (10 mg/dia/4 semanas), sinvastatina (10 mg/dia/8 semanas) e sinvastatina combinada com ezetimiba (10 mg de cada/dia/4 semanas). A expressão de RNAm foi avaliada por RT-qPCR. A expressão de moléculas de adesão na superfície de células THP-1 e HUVEC foi estudada por citometria de fluxo. A quantificação de citocinas secretadas no sobrenadante de células HUVEC e no plasma dos HC foi analisada pela tecnologia Milliplex. A quantificação do perfil lipífico, Proteína C reativa ultra-sensível (PCRus) e NO foi realizada por métodos laboratoriais convencionais. O papel do NO na modulação dos marcadores inflamatórios pelas estatinas foi também estudada, usando modelo de células HUVEC com NOS3 silenciado por interferência de RNAm e também por meio do uso do inibidor da síntese do óxido nítrico, L-NAME. Também foi avaliado o efeito de hipolipemiantes na expressão dos microRNAs (miRs) 221, miR-222 e miR-1303 em células HUVEC por meio do stem-loop RT-qPCR. O tratamento com atorvastatina e sinvastatina reduziu a expressão de RNAm e proteínas das moléculas de adesão LSelectina, PSGL-1 e VLA-4, em células THP-1 pré-tratadas com TNF&#945; por 12 h. A ezetimiba reduziu a expressão de L-Selectina apenas no nível transcricional. Em células HUVEC, as estatinas diminuíram a expressão de RNAm de IL1B e SELP, entretanto aumentaram a de VCAM1. A ezetimiba reduziu a expressão de RNAm do IL1B. Entretanto as expressões de SELE, MMP9, IL6 e MMP9 não foram afetadas pelos tratamentos. A expressão das proteínas ICAM-1 e P-Selectina, na superfície de células HUVEC, foi diminuída pelo tratamento com as estatinas, mas não pela ezetimiba. Da mesma forma, a secreção das citocinas IL-6 e MCP-1 foram reduzidas pelas estatinas, entretanto a secreção de IL-8 não foi modificada por nenhum dos tratamentos. A expressão de NOS3 e a liberação de NO em células HUVEC foi aumentada pelas estatinas, porém não foi estimulada pela ezetimiba. Entretanto, os efeitos antiinflamatórios exercidos pelas estatinas foram independentes dessa via devido a que estes efeitos foram mantidos em células HUVEC com NOS3 silenciado por interferência de RNAm. Apesar de que o efeito sobre ICAM-1 e MCP-1 foi atenuado quando as células foram simultaneamente tratadas com L-NAME, os efeitos das estatinas parecem ser independentes da liberação de NO. As estatinas e a ezetimiba reduziram a expressão do miR-221, em células HUVEC. A expressão do miR-222 foi reduzida só pelo tratamento com atorvastatina. A expressão do miR-1303 não foi modulada pelos tratamentos hipolipemiantes. Em pacientes HC, a terapia de associação da sinvastatina e ezetimiba demonstrou melhorar o perfil lipídico de forma mais efetiva que ambas monoterapias. Da mesma forma, o tratamento combinado resultou em maior beneficio pela redução da expressão de RNAm em CMSP e da concentração plasmática das proteínas IL-1 &#946;, MCP-1, IL-8 e TNF&#945;. A expressão de ICAM1 foi diminuída apenas no nível transcricional, entretanto a expressão de RNAm mas não da proteína do TNF&#945; foi também reduzida pela sinvastatina em monoterapia. Não houve modulação de RNAm ou proteínas de outros marcadores estudados no modelo in vivo. Por outro lado, os efeitos anti-inflamatórios observados nos indivíduos HC foram independentes da modulação de PCRus e NO que não foram modificados pelos tratamentos hipolipemiantes. Neste estudo, foram confirmados os propostos efeitos pleiotrópicos das estatinas em modelos células de monócito e endotélio vascular in vitro e em pacientes HC. Por outro lado, apesar de ser menos potente que as estatinas foi mostrado que a inibição da absorção do colesterol tem também um efeito anti-inflamatório. A redução adicional do colesterol causado pela combinação das terapias hipolipemiantes outorga um maior beneficio cardiovascular em pacientes hipercolesterolêmicos. / The inflammatory process has a key role in the genesis and development of atherosclerosis and the endothelial disfunction is considered as a first step in atherogenesis. By inhibiting the hydroxyl-methyl-glutaryl coA reductase (HMGCR)m statins reduce the cholesterol synthesis and isoprenoid generation, which are intermediary products of cholesterol synthesis with important role in posttranscriptional modifications of small GTPases that are involved in endothelial disfunction and vascular inflammation. The ezetimibe is an inhibitor of cholesterol absorption by inhibiting the NPC1L1 protein. To clarify the molecular mechanisms of the inhibition of cholesterol synthesis and absorption modulating inflammatory and cell adhesion biomarkers we used in vitro models of endothelial cells (HUVEC) and monocytes (THP-1), and an in vivo model of peripheral blood mononuclear cells (PBMC) from hypercholesterolemic (HC) patients. The effect of the statins, atorvastatin and simvastatin, and the ezetimibe on mRNA and protein expression of endothelial adhesion molecules and modulators of the inflammatory process, as citokynes and nitric oxide (NO), was analyzed in HUVEC. The effect of these drugs on the expression of monocyte adhesion molecules was also studied in THP-1. The influence of hypolipemiant therapy on the adhesion molecules was also analyzed in PBMC from HC treated with ezetimibe (10 mg/day/4-weeks), simvastatin (10 mg/day/8-weeks) and simvastatin combined with ezetimibe (10 mg each/day/4-weeks). The mRNA expression was evaluated by RT-qPCR. The expression of adhesion molecules on the surface of THP-1 and HUVEC cells was analyzed flow cytometry. The citokynes in the supernatants of HUVEC were quantified using the milliplex technology. The Lipid profile, high-sensivity PCR (hsPCR) and NO were determined by conventional laboratory methods. The role of the NO on the statin-modulation of inflammatory markers was also studied using a model with silenced NOS3 by interference of mRNA and by the use of the inhibitor of NO synthesis, L-NAME. The effect of hypolipemiants on the expression of microRNAs (miRs) 221, miR-222 and miR-1303 was also evaluated in HUVEC using the stem-loom RT-qPCR. Atorvastatin and simvastatin reduced the mRNA and protein expression of the adhesion molecules L-Selectin, PSGL-1 and VLA-4 in THP-1 cells pre-treated with TNF&#945; for 12 h. The ezetimibe reduced the L-Selectin expression only at transcriptional level. In HUVEC, statins diminished IL1B and SELP mRNA expression, whereas VCAM1 was increased. The ezetimibe reduced the IL1B mRNA expression. However, SELE, MMP9, IL6 and MMP9 mRNA expressions were not affected by the treatments. The protein expression of ICAM-1 and P-Selectin on the surface of HUVEC was reduced by statins, but not by the ezetimibe. Similarly, IL-6 and MCP-1 secretion were reduced by statins, whereas IL-8 secretion was not modified by the treatments. The NO release and NOS3 expression in HUVEC was increased by the statins, however it was not stimulated by ezetimibe. Moreover, the anti-inflammatory statin effects were independent of this pathway due to statin effects were maintained in HUVEC with silenced NOS3. Although the statin effect on ICAM-1 and MCP-1 were attenuated by L-NAME co treatment, the statin effects seem to be independent of NO release. Statins and ezetimibe reduced miR221 in HUVEC. miR-222 expression was reduced only by atorvastatin. miR-1303 was not affected by the treatments. In HC patients, the improvement of the lipid profile simvastatin combined with ezetimibe was more efficient than both monotherapies. Similarly, the association therapy was better in reducing the mRNA expression in PBMC and plasma concentration of IL-1&#946;, MCP-1, IL-8 and TNF&#945;. ICAM1 expression was reduced only at transcriptional level, whereas mRNA but not protein expression of TNF&#945; was also reduced by the simvastatin monotherapy. There was no modulation mRNA or protein expression of other studied markers in the in vivo model. Additionally, the anti-inflammatory effects observed in the HC were independent of PCRus or NO modulation, which were not altered by the hypolipemiant treatments. In this study, the proposed plitropic effects of statins were confirmed in monocytes and endothelial cells in vitro and in HC patients. Moreover, although it was less potent than statins, an anti-inflammatory effect was also observed for the inhibition of cholesterol absorption. An additional reduction of the cholesterol caused by combined hypolipemiant therapies gives a greater cardiovascular beneffict in hypercholesterolemic patients.

Abstract The aim of this study was to investigate the nature of the association between obesity and periodontal infection and the association of statin medication with periodontal infection. This study was based on the nationally representative Health 2000 Survey, conducted by the National Institute for Health and Welfare (former National Public Health Institute of Finland) in 2000–2001. Article I included 396 dentate, non-diabetic subjects, aged 30–59 years, who had never smoked and who participated in the Follow-up Study on Finnish Adults’ Oral Health about four years later. Article II included 2,784 dentate, non-diabetic subjects, aged 30–49 years. Article III included 425 dentate, non-diabetic, non-rheumatic subjects, aged 45–64 years, who had never smoked and who participated in the in-depth examinations of the Health 2000 Survey. Article IV included 1,297 dentate, non-diabetic subjects, aged 30–49 years, who had never smoked. Article V included 2,032 dentate, non-diabetic, non-rheumatic subjects, aged 40–69 years, who did not smoke. The data used in this study were collected via home-visit interviews, self-administered questionnaires, clinical health examinations and laboratory measurements. In this general population of Finnish adults, high BMI was found to be associated with the incidence of new teeth with pathologically deepened periodontal pockets during four-year follow-up. On the other hand, the presence of teeth with deepened periodontal pockets was found to be associated with obesity in an exposure-response manner. Serum IL-6 levels were found to be associated with the number of teeth with deepened periodontal pockets, but no consistent association was found between serum TNF-&#945;, triglyceride, HDL-C or LDL-C levels and periodontal infection. Statin medication was found to be inversely associated with the number of teeth with deepened periodontal pockets among subjects with visible signs of gingival inflammation, whereas among subjects with no signs of inflammation, statin medication was associated with an increased likelihood of having periodontal infection. The results of this study support the view that obesity could be causally related to the development of periodontal infection, but does not provide evidence that high body weight could be considered a major risk factor. The present study also suggests that a bi-directional association between obesity and periodontal infection is possible. The present study suggests that elevated serum IL-6 could mediate the association of obesity with periodontal infection. The results of this study also suggest that statins could be beneficial as a part of periodontal treatment. / Tiivistelmä Tämän tutkimuksen tarkoituksena oli selvittää lihavuuden ja parodontaali-infektion välisen yhteyden luonnetta sekä statiinien käytön yhteyttä parodontaali-infektioon. Tutkimus perustui kansalliseen Terveys 2000 -tutkimukseen, jonka toteutti Terveyden ja hyvinvoinnin laitos (entinen Kansanterveyslaitos) vuosina 2000 ja 2001. Artikkeli I perustui 396 hampaalliseen henkilöön, jotka olivat ei-diabeetikkoja, 30–59-vuotiaita, eivät koskaan olleet tupakoineet sekä olivat osallistuneet suunterveyden seurantatutkimukseen neljä vuotta myöhemmin. Artikkeli II perustui 2784 hampaalliseen henkilöön, jotka olivat ei-diabeetikkoja, 30–49-vuotiaita eivätkä olleet koskaan tupakoineet. Artikkeli III perustui 425 hampaalliseen henkilöön, joilla ei ollut diabetesta tai reumaa, olivat 45–64-vuotiaita, eivät koskaan olleet tupakoineet ja olivat osallistuneet Terveys 2000 -tutkimuksen täydentäviin tutkimuksiin. Artikkeli IV perustui 1297 hampaalliseen henkilöön, jotka olivat ei-diabeetikkoja, 30–49-vuotiaita eivätkä olleet koskaan tupakoineet. Artikkeli V perustui 2032 hampaalliseen henkilöön, jotka olivat ei-diabeetikkoja, ei-reumaatikkoja, 40–69-vuotiaita, jotka olivat hampaallisia eivätkä tupakoineet. Tutkimuksen aineisto kerättiin kotihaastattelusta, kyselyistä, kliinisestä tutkimuksesta sekä laboratoriomittauksista. Korkean painoindeksin todettiin olevan yhteydessä uusien ientaskuhampaiden ilmaantumiseen seurannan aikana. Toisaalta ientaskuhampaiden esiintymisen todettiin olevan yhteydessä lihavuuteen altistus-vastesuhteen mukaisesti. Seerumin IL-6 pitoisuuden todettiin olevan yhteydessä ientaskuhampaiden lukumäärään, mutta seerumin TNF-&#945;-, triglyseridi-, LDL-kolesteroli- tai HDL-kolesterolipitoisuudella ei todettu yhteyttä ientaskuhampaiden lukumäärään. Statiinien käytön todettiin olevan käänteisesti yhteydessä ientaskuhampaiden lukumäärään henkilöillä, joilla oli näkyviä merkkejä ikenen inflammaatiosta. Henkilöillä, joilla ei ollut näkyviä merkkejä inflammaatiosta, statiinien käyttö oli yhteydessä suurentuneeseen todennäköisyyteen ientaskuhampaiden esiintymiseen. Tämän tutkimuksen tulokset tukevat käsitystä, että lihavuus voi olla kausaalisesti yhteydessä parodontaali-infektion kehittymiseen, mutta ei puolla käsitystä, että sitä voitaisiin pitää merkittävänä riskitekijänä. On myös mahdollista, että lihavuuden ja parodontaali-infektion välillä on kaksisuuntainen yhteys. Tämän tutkimuksen tulosten mukaan on mahdollista, että kohonnut seerumin IL-6 pitoisuus voi välittää lihavuuden yhteyden parodontaali-infektioon. Tutkimuksen tulosten mukaan on myös mahdollista, että statiineista voi olla hyötyä osana parodontaalihoitoa.

Les statines sont des inhibiteurs sélectifs de la 3-hydroxy-3-méthylglutaryl-coenzyme A réductase, utilisées pour diminuer la biosynthèse du cholestérol. Ces molécules possèdent en plus de leur capacité à réduire le cholestérol des effets pléiotropiques comme les propriétés anti-inflammatoires et anti-oxydantes. Les cucurbitacines sont des triterpènes dérivés des plantes, ayant des propriétés biologiques diverses comme les effets anti-inflammatoires et anticancéreux, associées toutefois à une toxicité élevée. Les dérivés de thiazole sont des molécules contenant un noyau hétérocyclique formé de trois atomes de carbones, un atome de sulfure et un atome d'azote, disposant des effets anti-inflammatoires importantes. Les cyclooxygénases et les hème-oxygénases jouent un rôle dans l'inflammation et le stress oxydatif et sont les cibles des statines et des cucurbitacines in vitro. Les dérivés de thiazole peuvent inhiber plutôt l'activité enzymatique des cyclooxygénases. Le but de ma thèse est d'étudier les effets de ces 3 molécules in vivo et d'analyser si possible les mécanismes impliqués, comme par exemple pour les statines. Pour cela, nous avons eu recours chez les souris C57BL/6 au modèle d'inflammation de la poche à air-stérile injecté par le zymosan.Nous avons d'abord montré que le traitement des souris avec l'atorvastatine pendant 10 jours a réduit la migration des cellules dans l'exsudat de la poche à air ainsi que l'expression de gènes des marqueurs pro-inflammatoires tels que les cytokines, les chimiokines, la cyclooxygénase-2 et la nitric oxide synthase -II. Le taux de la prostaglandine E2 et de l'interleukine-6 a été également réduit. L'inhibition de l'hème-oxygénase-1 par son inhibiteur sélectif, tin protoporphyrine, a partiellement réduit l'effet inhibiteur de l'atorvastatine sur la migration des cellules et sur certaines cytokines suggérant un rôle important de la l'hème-oxygénase-1 dans les propriétés anti-inflammatoires in vivo.En parallèle, nous avons utilisé ce modèle animal tester l'effet de la cucurbitacine E sur l'inflammation et évaluer le rôle d'encapsulation in vivo dans des liposomes à base de phosphatidylcholine. Nous avons démontré que la cucurbitacine E libre (12.5 μg/poche ou 25 μg/poche) a tendance à diminuer l'interleukine-6, l'hème oxygénase-1 et la cyclooxygénase-2 alors que la cucurbitacine E encapsulée (12.5 μg/poche) a significativement réduit la prostaglandine E2, l'interleukine-6 et le taux de nitrite sans affecter le niveau d'ARNm de la cyclooxygénase-2 et l'hème oxygénase-1. Nos résultats suggèrent que l'incorporation de la cucurbitacine E dans des liposomes améliore son effet anti-inflammatoire et réduit sa cytotoxicité.Finalement, deux dérivés de thiazole qui diffèrent dans leur structure par la présence d'un groupement butyle- ou benzyle- sur leur chaîne latérale, ont été explorés dans ce modèle. Nous avons montré que le dérivé de thiazole contenant le groupe benzyle est sélectif de la cyclooxygénase-2 dans les macrophages et le modèle in vivo chez la souris.En résumé, mon travail de thèse met en évidence in vivo les effets anti-inflammatoires des statines et le rôle de l'hème oxygénase-1, et permet en plus la caractérisation des effets anti-inflammatoires des cucurbitacines et des dérivés de thiazole. L'ensemble de ces résultats renforcent les effets anti-inflammatoires de ces substances et démontre in vivo leur effet et les suggèrent comme molécules anti-inflammatoires. / Statins are selective competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase used to lower cholesterol biosynthesis and have multiple pleiotropic effects beyond lowering cholesterol such as anti-inflammatory and anti-oxidant properties. Cucurbitacins are triterpenoid derived from plants and exhibit potential anti-inflammatory and anticancer properties though they have a high cytotoxicity. Thiazole derivatives are molecules containing heterocyclic ring with three carbons, one sulfur and one nitrogen atom, with important anti-inflammatory activities. Cyclooxygenases and heme-oxygenases play a role in inflammation and oxidative stress and are targets for statins or cucurbitacins in vitro. Thiazole derivatives are potential inhibitors of cyclooxygenases. The aim of my thesis is to investigate the anti-inflammatory effect of these three compounds in vivo and attempt to analyze the mechanisms involved, mainly for statins. Thus we set up an animal model of inflammation in C57BL/6 corresponding to the zymosan -injected dorsal sterile air pouch.First we have shown that treatment of mice with atorvastatin for 10 days reduced cell migration in the exudate of the air pouch as well as the expression of inflammatory markers such as cytokines, chemokines, cyclooxygenase-2 and nitric oxide synthase -II. The synthesis of prostaglandin E2 and interleukin-6 was also reduced. Inhibition of heme-oxygenase-1 by the selective inhibitor tin protoporphyrin partially diminished the inhibitory effect of statins on cell migration and some cytokines suggesting a significant role of HO-1 in the anti-inflammatory properties for atorvastatin in vivo.For cucurbitacins, we used the same animal model to investigate the effect of this substance in vivo and further assess the beneficial effect of encapsulating cucurbitacin in phosphatidylcholine-liposomes. Free cucurbitacin E (12.5 μg/pouch or 25 μg/pouch) tended to increase interleukin-6, decrease heme oxygenase-1 and cyclooxygenase-2 whereas cucurbitacin E loaded liposomes (12.5 μg/pouch) significantly reduced prostaglandin E2, interleukin-6 and nitrite without affecting cyclooxygenase-2 and heme oxygenase-1 mRNA levels. We demonstrated that the incorporation of Cuc E into liposomes enhances its anti-inflammatory effect and reduces its cytotoxicity.Finally, we used the dorsal air pouch model to investigate the anti-inflammatory effect of two thiazole derivatives that differ in their side chain by the presence of butyl or benzyl group. In addition to analyzing their effect on cyclooxygenase activity in human blood platelets, on recombinant COX-1 and in culture macrophage cell lines, we demonstrated their capacity to block cyclooxygenase-dependent prostaglandin synthesis in the lumen of the air pouch.In summary, my thesis presents in vivo evidence for the anti-inflammatory effects of atorvastatin dependent on HO-1 activity. My studies characterized the anti-inflammatory effects of cucurbitacins and thiazole derivatives. All these results support the anti-inflammatory effects of these substances and suggested them as potential anti-inflammatory substances.

The thesis deals with trends of drug consumption for the ATC group C10A (HMG-CoA reductase) in the Czech Republic in the years 2005 - 2015. The goal of this work is to analyse the consumption of statins (cholesterol lowering drugs), as well as to analyse the consumption trends (expressed in terms of prescribed daily doses) and subsequently explain the causes of the detected trends. The main method used in this work is the analysis and interpretation of data provided by the State Institute for Drug Control (SUKL). Individual consumption data sets are compared to each other and global trends are inferred based on the obtained results. In the practical part I analyse the consumption for the individual ATC groups according to their increasing lipid-lowering efficacy, according to the pharmaceutical companies involved and according to the experts' recommendations (within the framework of cardiovascular disease treatment). The conclusion of my work shows that the overall drug consumption for the the studied ATC group (given by the DDD/package total) was steadily increasing during the studied period while the consumption expressed in financial units was decreasing (ie. the financial burden on the health system was reduced). The total number of sold packages shows a slight decrease due to the sale of bigger packages with more powerful statins during the studied period.

Please note: this work is permanently embargoed in OpenBU. No public access is forecasted for this item. To request private access, please click on the locked Download file link and fill out the appropriate web form. / Poems written by Sean Beckett, many inspired by walks with his father, William Stewart Beckett, in 2020-2021. / 2999-01-01T00:00:00Z