A utilização de microrreatores nas indústrias químico-farmacêuticas possibilita uma série de vantagens, no entanto essa tecnologia ainda é pouco difundida na indústria brasileira que historicamente utiliza reatores batelada. Neste trabalho são apresentados os resultados dos estudos da aplicação de microrreatores na síntese de compostos derivados da tiazolidina-2,4-diona (TZD) que podem ser utilizados na síntese de moléculas com atividade biológica. Foi realizada a transposição do processo batelada para o processo em fluxo em microrreator. Adicionalmente, foi realizada a determinação das melhores condições operacionais das sínteses estudadas. Os solventes metanol, etanol e n-propanol foram testados, sendo que no metanol foram obtidos os maiores rendimentos, além disso foi verificada a influência do tempo de reação no processo batelada, temperatura, tempo médio de residência no processo em fluxo no microrreator, concentração da base promotora e posição do substituinte NO2 no anel do aldeído, os melhores resultados foram obtidos com a base pirrolidina e o aldeído 3-nitrobenzaldeído. Os processos em batelada e em microrreator foram comparados em termos de conversão, rendimento, produção e produtividade e ainda pela determinação do número de microrreatores necessários para se atingir a mesma produção do reator batelada para cada uma das condições estudadas. Foi realizado um estudo da cinética das reações para determinação da energia de ativação e grandezas termodinâmicas que auxiliou na compressão dos resultados obtidos. Dentre as vantagens do microrreator destacou-se a redução dos tempos de reação, devido à eliminação dos efeitos da mistura ineficiente, redução da geração de resíduos, aumento da transferência de massa e de calor, facilidade de controle da pressão e temperatura, que permitiu atingir rendimentos maiores do que os obtidos em batelada. A indústria químico-farmacêutica é a maior beneficiária desta tecnologia, pois os microrreatores podem diminuir em anos o tempo para produção comercial de um novo fármaco e podem ser unidades industriais compactas, reduzindo assim, o custo para produção de novos fármacos. Com isso, é evidente a necessidade de que a Tecnologia de Microrreatores (TMR) seja melhor difundida na indústria químico-farmacêutica e ficam comprovadas as vantagens de sua aplicação. / The Microreactor Technology (TMR) in the chemical-pharmaceutical industries offers a number of advantages, however, this technology is still not widespread in the brazilian industry that historically uses batch reactors. In this work area presented the results of the application of microreactors in the synthesis of compounds derived from thiazolidine-2,4-dione (TZD) that can be used in the synthesis of molecules with biological activity. The batch process was transposed to the flow process in a microreactor. In addition, the best operating conditions of the syntheses studied were determined. The methanol, ethanol and n-propanol solvents were tested, and the highest yields were obtained in methanol; in addition, the influence of the time of reaction on the batch process, temperature, mean residence time in the flow process in the microreactor, concentration of the promoter base and position of the NO2 substituent on the aldehyde ring. The best results were obtained with pyrrolidine, as promoter base, and the 3-nitrobenzaldehyde aldehyde. The batch and microreactor processes were compared in terms of conversion, yield, production, productivity and also the number of microreactors needed to reach the same batch reactor production for each of the studied conditions. A study of the kinetics of the reactions was carried out to determine the activation energy and thermodynamic parameters that aided in the comprehension of the results. Among the advantages of the microreactor, the most relevant were the reduction of time of reaction due to the elimination of inefficient mixing, reduction of waste generation, increase in mass and heat transfer, ease of pressure and temperature control, yields higher than those obtained in the batch process. The chemical-pharmaceutical industry is the main beneficiary of this technology because microreactors can lessen the time to produce commercially a new drug in years and can be compact industrial units, thus reducing the cost of producing new drugs. Thus, the need for Microreactor Technology to be better disseminated in the chemical-pharmaceutical industry is evident and the advantages of its application are proven.

A utilização de microrreatores nas indústrias químico-farmacêuticas possibilita uma série de vantagens, no entanto essa tecnologia ainda é pouco difundida na indústria brasileira que historicamente utiliza reatores batelada. Neste trabalho são apresentados os resultados dos estudos da aplicação de microrreatores na síntese de compostos derivados da tiazolidina-2,4-diona (TZD) que podem ser utilizados na síntese de moléculas com atividade biológica. Foi realizada a transposição do processo batelada para o processo em fluxo em microrreator. Adicionalmente, foi realizada a determinação das melhores condições operacionais das sínteses estudadas. Os solventes metanol, etanol e n-propanol foram testados, sendo que no metanol foram obtidos os maiores rendimentos, além disso foi verificada a influência do tempo de reação no processo batelada, temperatura, tempo médio de residência no processo em fluxo no microrreator, concentração da base promotora e posição do substituinte NO2 no anel do aldeído, os melhores resultados foram obtidos com a base pirrolidina e o aldeído 3-nitrobenzaldeído. Os processos em batelada e em microrreator foram comparados em termos de conversão, rendimento, produção e produtividade e ainda pela determinação do número de microrreatores necessários para se atingir a mesma produção do reator batelada para cada uma das condições estudadas. Foi realizado um estudo da cinética das reações para determinação da energia de ativação e grandezas termodinâmicas que auxiliou na compressão dos resultados obtidos. Dentre as vantagens do microrreator destacou-se a redução dos tempos de reação, devido à eliminação dos efeitos da mistura ineficiente, redução da geração de resíduos, aumento da transferência de massa e de calor, facilidade de controle da pressão e temperatura, que permitiu atingir rendimentos maiores do que os obtidos em batelada. A indústria químico-farmacêutica é a maior beneficiária desta tecnologia, pois os microrreatores podem diminuir em anos o tempo para produção comercial de um novo fármaco e podem ser unidades industriais compactas, reduzindo assim, o custo para produção de novos fármacos. Com isso, é evidente a necessidade de que a Tecnologia de Microrreatores (TMR) seja melhor difundida na indústria químico-farmacêutica e ficam comprovadas as vantagens de sua aplicação. / The Microreactor Technology (TMR) in the chemical-pharmaceutical industries offers a number of advantages, however, this technology is still not widespread in the brazilian industry that historically uses batch reactors. In this work area presented the results of the application of microreactors in the synthesis of compounds derived from thiazolidine-2,4-dione (TZD) that can be used in the synthesis of molecules with biological activity. The batch process was transposed to the flow process in a microreactor. In addition, the best operating conditions of the syntheses studied were determined. The methanol, ethanol and n-propanol solvents were tested, and the highest yields were obtained in methanol; in addition, the influence of the time of reaction on the batch process, temperature, mean residence time in the flow process in the microreactor, concentration of the promoter base and position of the NO2 substituent on the aldehyde ring. The best results were obtained with pyrrolidine, as promoter base, and the 3-nitrobenzaldehyde aldehyde. The batch and microreactor processes were compared in terms of conversion, yield, production, productivity and also the number of microreactors needed to reach the same batch reactor production for each of the studied conditions. A study of the kinetics of the reactions was carried out to determine the activation energy and thermodynamic parameters that aided in the comprehension of the results. Among the advantages of the microreactor, the most relevant were the reduction of time of reaction due to the elimination of inefficient mixing, reduction of waste generation, increase in mass and heat transfer, ease of pressure and temperature control, yields higher than those obtained in the batch process. The chemical-pharmaceutical industry is the main beneficiary of this technology because microreactors can lessen the time to produce commercially a new drug in years and can be compact industrial units, thus reducing the cost of producing new drugs. Thus, the need for Microreactor Technology to be better disseminated in the chemical-pharmaceutical industry is evident and the advantages of its application are proven.

Class of 2008 Abstract / Objectives: To determine the cost-effectiveness of adding a thiazolidinedione (TZD) versus insulin glargine (glargine) as a triple regimen for treatment of Type 2 diabetes mellitus for patients not controlled with metformin and a sulfonylurea. Methods: A decision analytic model was developed to compare the clinical outcomes and costs of triple therapy with either a TZD or glargine. Published literature was used to determine treatment efficacy and the frequency of clinically important adverse effects. Cost data were obtained from the 2007 Physician Fee Reference and North Carolina Industrial Commission website. The decision tree was built using TreeAge software. Clinical outcome measures included HgA1c (A1C) control, hypoglycemia frequency, and the development of edema associated with the use of these medications. A Monte Carlo probabilistic sensitivity analysis was conducted to determine the mean and 95% CIs for both treatment efficacy and costs. Results: There was no statistically significant difference in the efficacy of adding either a TZD or glargine in achieving a goal A1C ≤ 7%. However, glargine triple therapy was estimated to be significantly less costly than TZD triple therapy ($3,161/yr; 95% CI $3,116 to $3,356 versus $3,769/yr; 95% CI $3,667 to $3,902, respectively). Conclusions: Most patients requiring triple therapy for the management of T2DM should receive glargine rather than a TZD due to the significantly lower cost producing similar clinical efficacy.

Equine Metabolic Syndrome (EMS) is a unique condition of horses characterized by adiposity, insulin resistance, and an increased risk of laminitis. Reducing insulin resistance may decrease the incidence of laminitis in horses with EMS. Pioglitazone, a thiazolidinedione class of anti-diabetic drug, has proven efficacy in humans with type 2 diabetes, a syndrome of insulin resistance sharing some similarities with EMS. The ability of pioglitazone to influence insulin sensitivity in an endotoxin-infusion model of induced insulin resistance was investigated. Our hypothesis was that piogltiazone would preserve insulin sensitivity in a model of induced insulin resistance. The specific aims were to investigate the pharmacokinetics and pharmacodynamics of pioglitazone in an endotoxin infusion model of insulin resistance. 16 normal adult horses were enrolled. Pioglitazone was administered to 8 horses (1 mg/kg, PO, q24h) for 14 days, and 8 horses served as their controls. Liquid chromatography with tandem mass spectroscopy was used to quantitate plasma concentration of pioglitazone. A frequently sampled intravenous glucose tolerance test with minimum model analysis was used to compare indices of glucose and insulin dynamics prior to, and following, endotoxin infusion in horses treated with pioglitazone and their controls. Parameters of clinical examination and lipid metabolism were compared prior to, and following, endotoxin administration. Pioglitazone administered orally at 1 mg/kg q 24 h resulted in plasma concentrations lower, and more variable, compared to those considered therapeutic in humans. No significant effect of drug treatment was detected on clinical parameters or indices of insulin dynamics or lipid homeostasis following endotoxin challenge. / Master of Science

Os microrreatores de fluxo contínuo têm sido usados como uma alternativa aos reatores batelada devido às suas características, como o controle sobre a mistura reacional, excelente transferência de calor e massa e redução do tempo de reação, resultando no aumento do rendimento, diminuição da geração de resíduos e segurança no trabalho. Este trabalho tem como objetivo a transposição da reação de síntese do (Z)-5-benzilideno-2,4-tiazolidinadiona do processo batelada para o microrreator de fluxo contínuo. Este produto é um intermediário farmacêutico utilizado para sintetizar fármacos da classe das glitazonas, utilizados especialmente no combate à diabetes mellitus tipo 2. Foram selecionados o metanol, etanol e n-propanol como solventes da reação, pois são considerados verdes pela indústria químico-farmacêutica. No processo batelada foram definidas as melhores condições operacionais nos três solventes, onde foi observado que o solvente que produziu o maior rendimento foi o etanol, cerca de 90% em 480 min de reação. A reação foi transposta para o microrreator, onde foi possível realizar a reação em temperaturas e pressões elevadas. Os resultados mostraram que o metanol e o etanol atingem os melhores resultados em termos de conversão do reagente e rendimento do produto. Na última etapa da transposição foi realizada uma estimativa de quantos microrreatores são necessários para se obter a mesma produção do processo batelada. Em metanol são necessários 0,6 microrreatores (tempo médio de residência 8 min e T = 140°C), enquanto em etanol (tempo médio de residência 16 min e T = 140°C) e n-propanol (tempo médio de residência 16 min e T = 140°C), 2 microrreatores. Os resultados finais deste trabalho indicaram que os dois processos possuem suas vantagens. Além disto, foi possível sugerir a continuação deste trabalho de pesquisa que terá como objetivo sintetizar um fármaco da classe das glitazonas. / Continuous flow microreactors have been used as an alternative over batch reactors due to its characteristics, such as control of the reaction mixture, excellent heat and mass transfer and reduction of reaction time, which results in increased yield, waste minimization and work safety. This work aims at transposing the synthesis of (Z)-5-benzylidene-2,4-thiazolidinedione from the batch process to continuous flow in microreactor. This product is a pharmaceutical intermediary used to synthesize drugs of the glitazones class, especially in the fight against type 2 of diabetes mellitus. Methanol, ethanol and n-propanol were selected as solvents since they are considered green by the chemical-pharmaceutical industry. In the batch process it was determined the most favorable operational conditions for the three solvents, where in ethanol the highest product yield was obtained, about 90% in 480 min of reaction. The reaction was transposed to the microreactor where it was possible to perform the reaction under high temperatures and pressures. The results showed in the microreactor methanol and ethanol were responsible for the best results in terms of reactant conversion and product yield. An estimate was made of how many microreactors it would be needed to obtain the same production of the batch process. It was determined that in methanol, 0.6 microreactors are required (residence time 8 min and T = 140°C), while in ethanol (residence time 16 min and T = 140°C) and n-propanol (residence time 16 min and T = 140°C), 2 microreactors are required. The experimental results of this research work indicated that both processes have their advantages. In addition, it was possible to suggest the continuation of this research work with the objective of synthesize an API of the glitazone class.

A utilização de microrreatores nas indústrias químico-farmacêuticas pode possibilitar uma série de vantagens devido ao seu tamanho reduzido comparado aos reatores batelada, sendo estes mais comumente utilizados por esse tipo de indústria. Essas vantagens podem ser associadas à redução dos tempos de reação da ordem de minutos e à redução da geração de resíduos e subprodutos. Existe um aumento de qualidade expressivo na transferência de massa e de calor, o que acarreta em um processo facilmente controlável e seguro, permitindo maior rendimento e seletividade. A indústria químico-farmacêutica beneficia-se desta tecnologia, pois os microrreatores podem gerar uma grande variedade de compostos, em alguns casos várias ordens de grandeza maior em comparação ao processo batelada tradicional e podem diminuir em anos o tempo para produção comercial de um novo fármaco devido à maior facilidade no aumento da escala de produção. O objetivo deste trabalho foi transpor a reação de síntese de um derivado da tiazolidina-2,4-diona, um intermediário utilizado na produção de fármacos no combate à diabetes millitus II, do processo batelada para microrreator em fluxo contínuo. Por meio dos resultados foi determinado que não existe a necessidade de mais de 80 min. de reação para se atingir aproximadamente 98% de rendimento do produto em batelada, tendo o etanol como solvente e utilizando pirrolidina como base ideal na concentração de 0,040 M. Além disso, com o Screening de solventes foi possível entender melhor os aspectos da reação e determinar que tanto o metanol como o etanol são os mais adequados para a reação. Diferentes bases promotoras da reação foram testadas como substitutas da piperidina referenciada na literatura, que teve sua comercialização proibida no país. O processo em fluxo contínuo no microrreator a 140°C, proporcionou maior conversão e rendimento do que o processo batelada. Foi possível estudar os limites do microrreator em termos de temperatura e concentração de base promotora, sendo possível a aplicação dos princípios da intensificação de processos. Esses dados corroboram com os encontrados para o número equivalente de microrreatores (n°MR), onde para o etanol na mesma temperatura de ebulição do solvente (78°C) são necessários aproximadamente 9 microrreatores para ter a mesma produção de um batelada. Porém, com o aumento de temperatura para 140°C, são necessários 2 microrreatores para ter a mesma produção de um batelada. / The use of microreactors in the chemical-pharmaceutical industries may provide a number of advantages due to their reduced size compared to batch reactors, these being more commonly used by this type of industry. These advantages can be associated with the reduction of reaction times and the reduction of generation of residues and byproducts. There is an expressive quality increase in the transfer of mass and heat, which results in an easily controllable and safe process, allowing greater yield and selectivity. The chemical-pharmaceutical industry benefits from this technology because microreactors can generate a wide variety of compounds, in some cases several orders of magnitude larger than the traditional batch process, and may decrease the time for commercial production of a new drug in years due to the possibility of increasing the production through numbering-up. The objective of this project was to transpose the synthesis reaction of a thiazolidine-2,4-dione derivative, an intermediate used in the production of drugs in the fight against diabetes mellitus II, from batch process to microreactor in continuous flow. Through the results it was determined that there is no need for more than 80 min. of reaction to achieve approximately 98% product yield in the batch process, with ethanol as the solvent and using pyrrolidine as the best base at the optimum concentration of 0.040 M. In addition, with the screening of solvents it was possible to better understand the aspects of the reaction and to determine that both methanol and ethanol are the most suitable for the reaction. Different base reaction promoters were tested as substitutes of the usual base used for this type of reaction, piperidine, often cited in the literature, that had its commercialization prohibited in Brazil. The continuous flow process in the microreactor at 140°C, provided higher conversion and yield than the batch process. It was possible to study the limits of the microreactor in terms of temperature and concentration of promoter base, being possible to apply the principles of process intensification. These data corroborate with those found for the equivalent number of microreactors (nºMR), where for ethanol, at the same boiling temperature of the solvent (78ºC), approximately 9 microreactors are required to have the same production of a batch operated for 8 h. However, for higher temperatures the yields are even higher, and for 140°C, 2 microreactors are required to have the same production of a batch.

Os microrreatores de fluxo contínuo têm sido usados como uma alternativa aos reatores batelada devido às suas características, como o controle sobre a mistura reacional, excelente transferência de calor e massa e redução do tempo de reação, resultando no aumento do rendimento, diminuição da geração de resíduos e segurança no trabalho. Este trabalho tem como objetivo a transposição da reação de síntese do (Z)-5-benzilideno-2,4-tiazolidinadiona do processo batelada para o microrreator de fluxo contínuo. Este produto é um intermediário farmacêutico utilizado para sintetizar fármacos da classe das glitazonas, utilizados especialmente no combate à diabetes mellitus tipo 2. Foram selecionados o metanol, etanol e n-propanol como solventes da reação, pois são considerados verdes pela indústria químico-farmacêutica. No processo batelada foram definidas as melhores condições operacionais nos três solventes, onde foi observado que o solvente que produziu o maior rendimento foi o etanol, cerca de 90% em 480 min de reação. A reação foi transposta para o microrreator, onde foi possível realizar a reação em temperaturas e pressões elevadas. Os resultados mostraram que o metanol e o etanol atingem os melhores resultados em termos de conversão do reagente e rendimento do produto. Na última etapa da transposição foi realizada uma estimativa de quantos microrreatores são necessários para se obter a mesma produção do processo batelada. Em metanol são necessários 0,6 microrreatores (tempo médio de residência 8 min e T = 140°C), enquanto em etanol (tempo médio de residência 16 min e T = 140°C) e n-propanol (tempo médio de residência 16 min e T = 140°C), 2 microrreatores. Os resultados finais deste trabalho indicaram que os dois processos possuem suas vantagens. Além disto, foi possível sugerir a continuação deste trabalho de pesquisa que terá como objetivo sintetizar um fármaco da classe das glitazonas. / Continuous flow microreactors have been used as an alternative over batch reactors due to its characteristics, such as control of the reaction mixture, excellent heat and mass transfer and reduction of reaction time, which results in increased yield, waste minimization and work safety. This work aims at transposing the synthesis of (Z)-5-benzylidene-2,4-thiazolidinedione from the batch process to continuous flow in microreactor. This product is a pharmaceutical intermediary used to synthesize drugs of the glitazones class, especially in the fight against type 2 of diabetes mellitus. Methanol, ethanol and n-propanol were selected as solvents since they are considered green by the chemical-pharmaceutical industry. In the batch process it was determined the most favorable operational conditions for the three solvents, where in ethanol the highest product yield was obtained, about 90% in 480 min of reaction. The reaction was transposed to the microreactor where it was possible to perform the reaction under high temperatures and pressures. The results showed in the microreactor methanol and ethanol were responsible for the best results in terms of reactant conversion and product yield. An estimate was made of how many microreactors it would be needed to obtain the same production of the batch process. It was determined that in methanol, 0.6 microreactors are required (residence time 8 min and T = 140°C), while in ethanol (residence time 16 min and T = 140°C) and n-propanol (residence time 16 min and T = 140°C), 2 microreactors are required. The experimental results of this research work indicated that both processes have their advantages. In addition, it was possible to suggest the continuation of this research work with the objective of synthesize an API of the glitazone class.

Plusieurs études ont démontré que les agonistes du PPARgamma, dont la pioglitazone (PGZ), améliorent les paramètres métaboliques et histologiques de la stéatohépatite non-alcoolique (NASH) chez l'homme et la souris, et qu’ils ont des effets bénéfiques sur la fibrose hépatique chez le rat. Les mécanismes d’action sont mal connus. La NASH, caractérisée par de la stéatose, des lésions hépatocytaires, de l’inflammation et une fibrose variable, est considérée comme une complication hépatique du syndrome métabolique. L'obésité, un des facteurs de risque pour le développement de la NASH, est caractérisée par de faibles taux d'adiponectine sérique. Cette adipocytokine, dont l'expression génique est régulée par le PPARgamma, possède des propriétés anti-stéatosique et anti-fibrotique chez la souris. L'activité intracellulaire de l'adiponectine est médiée via ses récepteurs spécifiques qui activent la protéine kinase AMPK et/ou le PPARalpha. Une fois activée, l’AMPK induit les voies cataboliques de production d’énergie (telles que l'oxydation des acide gras) et inhibe les voies consommant de l’ATP (telles que la lipogenèse). L'activation du PPARalpha augmente l'oxydation des acides gras et inhibe la réponse inflammatoire. Le but de notre travail est d’évaluer l'implication de la voie PGZ–adiponectine–AMPK et/ou PPARalpha dans la prévention de la NASH et de la fibrose hépatique. Nous avons tout d’abord évalué l'effet de la PGZ sur la fibrose hépatique chez la souris. Nos observations montrent que, contrairement aux résultats observés chez le rat, la PGZ n’inhibe pas le développement de la fibrose hépatique chez la souris in vivo. Ces résultats ont été confirmés par des études sur les cellules stellaires hépatiques (HSCs), les cellules effectrices de la fibrose, in vitro. Dans une seconde étude, nous avons évalué l'impact de l’AMPK sur la fibrose hépatique in vivo et sur l’activation des HSCs in vitro. Nous avons constaté que l’AMPK jouait un rôle dans le contrôle de la trans-différentiation des HSCs in vitro mais pas dans le développement de la fibrose hépatique chez la souris in vivo. Finalement, nous avons évalué l'hypothèse que l'effet bénéfique de la PGZ sur la NASH résulte de la stimulation de l'AMPK et/ou du PPARalpha par l’adiponectine. Nos résultats ont montrés que cet effet de la PGZ était strictement dépendant de l’adiponectine mais ne semblait pas impliquer l'AMPK ni le PPARalpha. Nous avons également identifié SREBP-1c, régulant la lipogenèse de novo, comme cible thérapeutique potentielle pour le développement de la NASH. Les résultats obtenus dans le cadre de ce travail de thèse fournissent une meilleure compréhension de l’axe PPARgamma–adiponectine–AMPK dans le contrôle du développement de la NASH et de la fibrose hépatique chez la souris. / Several studies have demonstrated that peroxisome proliferator-activated receptor gamma (PPARg) agonists, such as pioglitazone (PGZ), improve metabolic parameters and histology of nonalcoholic steatohepatitis (NASH) development in humans and mice, and have beneficial effects on liver fibrosis in rats. NASH, characterized by steatosis, hepatocellular damage, inflammation and variable fibrosis, is recognised as the hepatic complication of the metabolic syndrome. Obesity, one of the risk factors for NASH development, is characterized by low serum adiponectin levels. This adipocytokine, of which gene expression is regulated by PPARg, demonstrates anti-steatotic and anti-fibrotic properties in mice. Intracellular activity of adiponectin is mediated through its specific receptors which activate AMP-activated protein kinase (AMPK) and PPARalpha. Once activated, AMPK switches on catabolic pathways (such as fatty acid oxidation and glycolysis) and switches off ATP-consuming pathways (such as lipogenesis). Activation of PPARalpha increases fatty acid oxidation and reduces inflammatory reaction. The aim of the present work is to analyse the activation of the axis PGZ-adiponectin-AMPK and/or PPARalpha as a way to control NASH and hepatic fibrosis development. We first evaluated the effect of PGZ on hepatic fibrosis in mice. We observed that, by contrast with results in rats, PGZ did not prevent hepatic fibrosis development in vivo in mice. These results were confirmed by in vitro studies on the key effector cells of fibrogenesis, the hepatic stellate cells (HSCs). We then assessed the impact of AMPK on hepatic fibrosis in vivo and on HSC trans-differentiation/activation phenomenon in vitro. We found that AMPK played a role in the control of HSC trans-differentiation in vitro but was not implicated in the wound-healing fibrosis in vivo in mice. Finally, we tested the hypothesis that the beneficial effect of PGZ on steatohepatitis results from the adiponectin-dependent stimulation of AMPK and/or PPARalpha. We found that this preventive effect was clearly dependent of adiponectin but did not involve AMPK or PPARalpha activation. We have also identified SREBP-1c, implicated in the regulation of de novo lipogenesis, as a potential therapeutic target for the control of the development of NASH. The present thesis provides a better understanding of the axis PPARg–adiponectin–AMPK in the control of NASH and hepatic fibrosis development in mouse.

Diabetes is a chronic and debilitating disease that affects nearly half a billion people worldwide with the vast majority of diabetics suffering from Type 2 diabetes mellitus (T2DM), a disease characterized by insulin insensitivity that often requires pharmacotherapy to effectively maintain target blood sugar levels. The thiazolidinedione (TZD) class of drugs consists of oral hypoglycaemic agents used alone or in combination with other antidiabetic drugs to treat T2DM. The drugs within this class, which include rosiglitazone and pioglitazone, were originally heralded as providing novel first and second-line treatment of T2DM with glycaemic control and physiological effects comparable to, and in some cases, better than, first-line treatments such as metformin. However, over time they have also been associated with adverse cardiovascular, osteological, and carcinogenic effects in some, but not all clinical trials, observational studies, and meta-analyses. Given the conflicting evidence to date on the safety of TZD drugs, their role in the treatment of T2DM continues to be debated and epidemiological gaps remain. The objectives of this doctoral research are fourfold: 1) to conduct an in-depth review of the epidemiology of TZD pharmacotherapy including pharmacokinetics and modes of action, the results of previous studies investigating health risks and benefits associated with TZD treatment, and new and future uses for this class of drugs; 2) to determine whether diabetic patients treated with TZDs are at increased risk of adverse cardiovascular outcomes; 3) to assess whether TZD pharmacotherapy is associated with an increased risk of bone fractures and whether risks differ depending on fracture site and patient sex; and, 4) to investigate associations between TZD use and risk of bladder cancer. Specific research questions were investigated using nested case-control analyses designed to capture incident users of antidiabetic drugs and electronic health data from Cerner Health Facts®, an electronic medical record database that stores time-stamped patient records from more than 480 contributing hospitals throughout the United States. Findings from this work are reported in a series of manuscripts, including a published review paper. Key findings include: 1) TZD use was associated with an increased risk of incident myocardial infarction and congestive heart failure compared to never use of TZD drugs with a trend towards a potential early treatment effect within the first year of exposure to pioglitazone; 2) TZD use was associated with an increased risk of closed bone fractures among Type 2 diabetics with use of pioglitazone or rosiglitazone associated with an increased risk across multiple fracture sites in women, but only rosiglitazone use in men and only at peripheral fracture sites; 3) use of either pioglitazone or rosiglitazone were associated with an increased risk of incident bladder cancer compared to never users, however, a low number of bladder cancer cases resulted in underpowered analyses; and, 4) insulin use in a hospital setting may replace a patient's normal course of antidiabetic therapy which, when combined with other potential sources of bias in traditional nested case-control studies using hospital-based data, may lead to overestimation or underestimation of adverse health risks associated with non-insulin antidiabetic therapies. Although these findings warrant replication, the results of the research contained within this dissertation suggest that caution should be exercised when prescribing diabetic patients TZD drugs if they have cardiovascular, osteological, or carcinogenic risk factors. Additional pharmacovigilance studies should also continue to strive to better understand the health risks related to TZD therapy, especially as new therapeutic roles for TZDs in the prevention and treatment of some cancers, inflammatory diseases, and other conditions in non-diabetic populations are being explored.

Le diabète de type 2 (DT2) apparaît lorsque la sécrétion d’insuline par les cellules β des îlots du pancréas ne parvient plus à compenser la résistance à l’insuline des organes cibles. Parmi les médicaments disponibles pour traiter le DT2, deux classes agissent en améliorant la sensibilité à l’insuline : les biguanides (metformine) et les thiazolidinediones (pioglitazone et rosiglitazone). Des études suggèrent que ces médicaments protègent également la fonction des cellules β. Dans le but d’identifier des mécanismes par lesquels les médicaments insulinosensibilisateurs protègent les cellules β, nous avons étudié les effets aigus de la metformine et de la pioglitazone sur le métabolisme et la fonction des cellules INS 832/13, sécrétrices d’insuline et des îlots pancréatiques isolés de rats. Nous avons aussi validé in vivo avec des rats Wistar les principales observations obtenues en présence de pioglitazone grâce à des clamps glucidiques et par calorimétrie indirecte. Le traitement aigu des cellules β avec de la pioglitazone ou de la metformine inhibe la sécrétion d’insuline induite par le glucose en diminuant la sensibilité des cellules au glucose (inhibition en présence de concentrations intermédiaires de glucose seulement). Dans les mêmes conditions, les traitements inhibent aussi plusieurs paramètres du métabolisme mitochondrial des nutriments et, pour la pioglitazone, du métabolisme des lipides. Les composés affectent le métabolisme en suivant un patron d’inhibition similaire à celui observé pour la sécrétion d’insuline, que nous avons nommé « décélération métabolique ». La capacité de la pioglitazone à inhiber la sécrétion d’insuline et à ralentir le métabolisme mitochondrial de façon aigüe se confirme in vivo. En conclusion, nous avons identifié la décélération métabolique de la cellule β comme nouveau mode d’action pour les médicaments insulinosensibilisateurs. La décélération métabolique causée par les agents insulinosensibilisateurs les plus utilisés semble provenir d’une inhibition du métabolisme mitochondrial et pourrait être impliquée dans les bienfaits de ceux-ci dans un contexte de stress métabolique. Le fait que les deux agents insulinosensibilisateurs étudiés agissent à la fois sur la sensibilité à l’insuline et sur la sécrétion d’insuline, les deux composantes majeures du DT2, pourrait expliquer pourquoi ils sont parmi les agents antidiabétiques les plus efficaces. La décélération métabolique est une approche thérapeutique à considérer pour le traitement du DT2 et d’autres maladies métaboliques. / Type 2 diabetes (T2D) appears when insulin secretion by pancreatic β-cells fails to compensate for insulin resistance. Two classes of anti-diabetic drugs have been used to target insulin resistance: biguanides (metformin) and thiazolidinediones (pioglitazone and rosiglitazone). Some studies suggest that these compounds also protect β-cell function. In order to identify the mechanisms whereby insulin-sensitizing agents protect β-cell function, we used INS 832/13 insulin secreting cells and isolated pancreatic rat islets to study the acute effects of pioglitazone and metformin on β-cell metabolism and function. Key observations obtained with pioglitazone were also validated in vivo in Wistar rats with the use of glucose clamps and indirect calorimetry. In vitro, acute pioglitazone or metformin treatment inhibits glucose-induced insulin secretion by lowering β-cell sensitivity to glucose (inhibition only at sub-maximal glucose concentrations). The same treatments also inhibit parameters of nutrient mitochondrial metabolism and, in the case of pioglitazone, parameters of lipid metabolism. Both compounds alter metabolism following a pattern similar to that observed with insulin secretion, a pattern that we label “metabolic deceleration”. Pioglitazone also acutely inhibits insulin secretion and slows down mitochondrial metabolism in vivo. In conclusion, we identified metabolic deceleration of the pancreatic β-cell as a new mode of action for insulin-sensitizing agents. Pioglitazone and metformin both seem to cause metabolic deceleration of the β-cell via inhibition of mitochondrial metabolism. This mode of action could participate in the beneficial effects of these compounds in the context of metabolic stress. The fact that these drugs affect both insulin sensitivity and insulin secretion, the two major components of T2D, may explain why they are among the most powerful anti-diabetic agents. Metabolic deceleration is a new therapeutic approach worth considering for the treatment of T2D and other metabolic diseases.