CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / RESUMO As doenÃas trombÃticas constituem um sÃrio problema de saÃde pÃblica. Diversas desordens hereditÃrias e ambientais, que afetam o sistema fisiolÃgico anticoagulante, estÃo atualmente estabelecidas como fatores de risco para a ocorrÃncia do evento trombÃtico. Dentre os fatores hereditÃrios, as mutaÃÃes G1691A do gene do fator V e G20210A do gene da protrombina sÃo os mais freqÃentes. A associaÃÃo entre estas alteraÃÃes genÃticas e a ocorrÃncia de eventos trombÃticos desencadeou o desenvolvimento de diversas pesquisas. Neste estudo, 189 pacientes portadores de eventos trombÃticos, atendidos no ambulatÃrio de Hematologia do Centro de Hematologia e Hemoterapia do Cearà - HEMOCE/SESA/UFC, foram analisados para a detecÃÃo da presenÃa das mutaÃÃes G1691A do gene do fator V e G20210A do gene da protrombina. O grupo controle consistiu de 349 voluntÃrios. A freqÃÃncia encontrada na populaÃÃo controle foi de 2% (7/349) para a mutaÃÃo do fator V e 1,7% (6/349) para a mutaÃÃo da protrombina, enquanto que nos pacientes trombofÃlicos a freqÃÃncia destas mutaÃÃes foi de 9% (17/189) e 2,1% (4/349), respectivamente. Dentre os fatores hereditÃrios, apenas a mutaÃÃo do fator V foi significante (p<0,001). Considerando os fatores ambientais de risco, o tabaco, idade > 40 anos e sexo feminino apresentaram significÃncia estatÃstica (p<0,001). Os riscos foram estimados em anÃlises pareadas e nÃo pareadas para o fator V de Leiden (4,8; 5,3; 9,8), tabaco (17,6; 14,9; 33,3), idade idade > 40 anos (2) e sexo feminino (3,7 e 4,1). Os fatores de risco para eventos trombÃticos no Cearà foram tabagismo, idade > 40 anos, sexo feminino, e a mutaÃÃo G1691A do fator V.foram associados com o desenvolvimento de trombose no estado do CearÃ. / Thrombotic diseases are a serious problem for public health. Several hereditary and environmental factors, that affect physiological anticoagulant system, have been nowadays well established as risk factors for thrombosis. Among hereditary factor V Leiden and prothrombin G20210A mutation are the most frequents. The association between several modifications on factor V gene and prothrombin gene in the development of thrombotic events has brought about future searches. In this study, 189 patients with thrombosis attended at the Hematology and Hemoterapy Center of Cearà state âHEMOCE/ Brazil, were analyzed to find out the presence of factor V Leiden and prothrombin G20210A mutation The control group was made up 349 healthy volunteers. In this study, the frequency found of factor V Leiden the control population was of 2% (7/349) and in the patients was 9% (17/189) while the frequency found of prothrombin G20210A mutation the control population was of 1,7% (6/349) and in the patients was 2,1% (4/189). Among hereditary factors only factor V Leiden was significant statistic (p<0,001). Among environmental factors studied, tabagism, age > 40 anos and femele were significant statistic (p<0,001). The ODDS RATIO of the risk factors with significant statistic were factor V de Leiden (4,8; 5,3; 9,8), tabaco (17,6; 14,9; 33,3), age > 40 years old (2) and female (3,7 e 4,1). Our results demonstrate that factor V Leiden, tabagism, age > 40 years old and female were associated with development trombosis in CearÃ.

Os progestagênios isolados são contraceptivos indicados que em trombofílicas e/ou com passado de tromboembolismo venoso (TEV). Algumas dessas mulheres, também utilizam anticoagulantes orais (ATCO) o que pode implicar em alterações no padrão de sangramento menstrual associado ao uso de progestagênios isolados. Objetivo: avaliar os efeitos do uso de ATCO no padrão de sangramento associado ao sistema intrauterino liberador de levonorgestrel (SIU-LNG) em mulheres trombofílicas e/ou com passado de TEV . Métodos: Trata-se de um estudo de coorte prospectiva que dividiu as mulheres trombofílicas e/ou com passado de TEV em dois grupos, usuárias de ATCO e não-usuárias de ATCO. Padrão de sangramento, peso, índice de massa corpórea (IMC) e circunferência abdominal foram comparados entre os grupos antes, 6 e 12 meses após a inserção do SIU-LNG. Resultados: Foram incluídas 33 mulheres, entre 18 e 45 anos, 16 usuárias de ATCO e 17 não-usuárias. Houve aumento de 3,9% do peso e 3,8% do IMC em das usuárias de ATCO após 12 meses da inserção do SIU-LNG (p<0,01). Houve aumento de hemoglobina e hematócrito em ambos os grupos. Não se observou diferença entre o padrão de sangramento de ambos os grupos, sendo a amenorréia o padrão mais frequente nos dois grupos (41,2% em ambos) 12 meses após a inserção do SIU-LNG. Utilizar ATCO não aumentou a freqüência e a duranção de sangramento genital. Conclusão: As usuárias e não-usuárias de ATCO tiveram padrão de sangramento semelhante após a inserção do SIU-LNG. Os níveis de hemoglobina e hematócrito aumentaram em ambos os grupos / Background: Progestogen-only contraceptives (POCs) are suitable for women with thrombophilia and/or a history of venous thromboembolism (VTE). Several of these women, however, use oral anticoagulant therapy (OAT), which can impair the bleeding pattern associated with POC use. We evaluated the effects of OAT use on the bleeding pattern associated with the levonorgestrel-releasing intrauterine system (LNG-IUS) in women with thrombophilia and/or a history of VTE. Study Design: This prospective cohort study followed 2 groups of women, all of whom were thrombophilic and/or had a history of VTE: OAT users and non-users. Bleeding patterns, blood pressure, body mass index (BMI), weight, complete blood count and waist circumference were compared between the 2 groups before and 6 and 12 months after LNG-IUS insertion. Results: The patient cohort consisted of 33 women aged 18 to 45 years old, including 16 OAT users and 17 non-users. Body weight increased by 3.9% and BMI by 3.8% in OAT users 12 months after LNG-IUS insertion (p< 0,01). Hemoglobin and hematocrit levels increased by approximately 10% in both groups. There was no difference between the groups in bleeding patterns, with amenorrhea being the most frequent pattern in both groups (41.2% each) 12 months after LNG-IUS insertion. OAT did not increase the frequency of prolonged and/or frequent bleeding. Conclusion: OAT users and non-users had similar bleeding patterns after insertion of the LNG-IUS. Hemoglobin and hematocrit levels increased in both groups

Orientador: Joyce Maria Annichino Bizzacchi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T17:55:26Z (GMT). No. of bitstreams: 1 Bassora_FernandaDutraSantiago_D.pdf: 2667928 bytes, checksum: 612538a2c5c4e4e33577d2303de3a9c1 (MD5) Previous issue date: 2012 / Resumo: A trombose venosa é definida como a oclusão de um vaso do sistema venoso. Três fatores básicos para a formação de um trombo no interior dos vasos são: alteração do fluxo sangüíneo, da parede vascular e/ou dos elementos sangüíneos. A trombose venosa e a embolia pulmonar, que ocorre como uma complicação subseqüente representa uma causa importante de morbidade e mortalidade em pacientes hospitalizados. A freqüência da trombose venosa foi estimada em aproximadamente 1/1000 na população em geral. Na maior parte dos casos existe uma tendência para trombose determinada pela presença de um fator causal herdado ou adquirida, ou pela interação desses fatores, bem como por variações genéticas que determinam alterações nos níveis das proteínas pró-coagulantes e anticoagulantes. Dados da literatura têm sugerido a associação de mecanismos inflamatórios com a fisiopatologia da trombose venosa profunda (TVP). Os monócitos, estimulados por citocinas ou endotoxinas, expressam fator tecidual, o maior indutor da coagulação sangüínea, e que também tem a função de sinalização para a mobilidade celular e vascular. Os leucócitos apresentam receptores capazes de ligar e ativar o fator X da coagulação, servindo como via alternativa para a formação de trombina. As plaquetas podem aderir ao endotélio intacto e através da liberação de mediadores e citocinas como interleucina (IL)-1 e Fator de necrose tumoral-a (TNF-a), induzindo a expressão de moléculas de adesão e fator tecidual pela célula endotelial. Com base nestes dados e considerando que a migração leucocitária é um dos principais eventos que caracterizam o processo inflamatório, justificamos a escolha de células mononucleares (monócitos e linfócitos) como células centrais do nosso estudo. Utilizando técnicas de separação de células mononucleares por centrifugação em gradiente de "Ficoll-Hypaque", extração do Ácido ribonucléico (RNA) total, hibridação em Ácido desoxiribonucléico complementar (cDNA) -Microarray, e validação usando a reação em cadeia da polimerase em tempo real quantitativo (qRT-PCR) avaliamos do perfil de expressão gênica de alguns mediadores inflamatórios nessas células e a possível relação com a trombose venosa. Neste trabalho, usando a tecnologia de Microarray encontramos 60 induzidos e 56 genes reprimidos diferencialmente expressos nos pacientes com TVP, estes genes que estavam relacionados à resposta imune, inflamação, proteólise e transcrição. Destes genes diferencialmente expressos, selecionamos nove relacionados com inflamação para validação usando a técnica de qRT-PCR. Destes, somente houve aumento de expressão do gene da caspase 4 (CASP4) nos pacientes com TVP, sendo que, esta diferença se manteve no subgrupo com TVP espontâneo. Neste mesmo subgrupo, também foi verificado o aumento da expressão no gene Elong factor 1, alpha 2(EEF1A2) / Abstract: Venous thrombosis is defined as a vessel occlusion of the venous system. Three basic factors for the formation of a thrombus inside the vessel are: changes in blood flow, vascular wall and / or blood elements. Venous thrombosis and pulmonary embolism, which occurs as a subsequent complication is a major cause of morbidity and mortality in hospitalized patients. The frequency of venous thrombosis was estimated to be approximately 1 / 1000 in the general population. In most cases there is a tendency for thrombosis determined by the presence of a causal factor inherited or acquired, or by the interaction of these factors, as well as genetic variations that determine changes in protein levels of procoagulants and anticoagulants. Literature data have suggested the association of inflammatory mechanisms in the pathophysiology of deep venous thrombosis (DVT). Monocytes, stimulated by cytokines or endotoxin, express tissue factor, the greater inducer of blood coagulation, and also have the function of signaling for cell motility and vascular. Leukocytes have receptors that can bind and activate coagulation factor X, serving as an alternative route for the formation of thrombin. Platelets can adhere to intact endothelium and through the release of mediators and cytokines such as interleukin (IL)-1 and Tumor necrosis factor-a (TNF-a), inducing expression of adhesion molecules and tissue factor by endothelial cells. Based on these data and considering that leukocyte migration is one of the main events that characterize the inflammatory process, we justify the choice of mononuclear cells (monocytes and lymphocytes) as the central cells of our study. Using techniques of separation of mononuclear cells by gradient centrifugation "Ficoll-Hypaque," extraction of total RNA, cDNA-Microarray hybridization, and validation using real time qPCR assessed the gene expression profile of some inflammatory mediators in these cells and the possible relationship with venous thrombosis. In this work using Microarray technology we found 60 genes upregulated and 56 downrelated differentially expressed in patients with DVT. Genes that were related to immune response, inflammation, proteolysis and transcription. Of these differentially expressed genes, we selected nine genes that were related with inflammation to validation using qRT- PCR technique. Just one of then, the caspase 4 (CASP4) genes was differentially increased in DVT patients, this increase kept in patients with spontaneous DVT and an increased of Elong factor 1, alpha 2 (EEF1A2) gene too / Doutorado / Ciencias Biomedicas / Doutora em Ciências Médicas

Orientador: Joyce Maria Annichino-Bizzacchi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T22:19:23Z (GMT). No. of bitstreams: 1 Flores-Nascimento_MarianeCristina_D.pdf: 2045016 bytes, checksum: 26506f3c6c426ff227cd481188662275 (MD5) Previous issue date: 2011 / Resumo: A trombose venosa profunda (TVP) é uma doença multifactorial, e possui uma alta taxa de morbi-mortalidade devido a complicações como embolia pulmonar e a síndrome póstrombótica, e cerca de 25 % dos pacientes apresentarão recorrência em 5 anos. A identificação de novos fatores envolvidos na fisiopatologia da TVP pode ser convertida em implicações de grande importância no manejo destes pacientes, prevenção de recorrência e no desenvolvimento de novas terapias. O interesse em avaliar as plaquetas e as amostras de plasma se deve ao fato de que as funções plaquetárias não estão completamente compreendidas, e aparentemente o papel das plaquetas poderia ir além do seu envolvimento na hemostasia. Como o plasma potencialmente fornece uma janela para a observação do indivíduo como um todo, a análise proteômica tanto das plaquetas como do plasma poderia implementar o nosso conhecimento acerca da fisiopatologia da TVP. OBJETIVO: Neste estudo foram analisados os perfis proteicos de plaquetas e amostras de plasma de três pacientes com TVP, que foram comparados com os resultados obtidos a partir de amostras de 1 irmão e 1 vizinho para cada paciente, a fim de minimizar as interferências genéticas e ambientais. Estes pacientes apresentaram episódios espontâneos e recorrentes de TVP proximal e mencionaram um histórico familiar de distúrbios da coagulação. MÉTODOS: as plaquetas necessitaram ser lavadas e lisadas, e as amostras de plasmas tiveram a albumina depletada antes de as proteínas serem alquiladas, reduzidas, precipitadas com acetona e hidrolisadas com tripsina. Os peptídeos das plaquetas e das amostras de plasma foram fracionados por cromatografia de fase reversa e troca catiônica, respectivamente. Depois disto, os peptídeos plaquetários foram direcionados ao espectrômetro de massas LTQOrbitrap e a busca das proteínas foi realizadas através do Sorcerer/Sequest. Os peptídeos plasmáticos foram encaminhados ao espectrômetro de massas ESI Q-TOF Premier e as proteínas foram analisadas pelo Mascot. RESULTADOS: Cinco proteínas estiveram presentes apenas nas plaquetas dos pacientes, estando ausentes em todos os controles: a proteína ligante da Apolipoproteína A1, a sub-unidade ?1 do Coatômero, a Desidrogenase 11-17-? do Estradiol, a Leucotrieno A-4 Hidrolase e a Sorbitol Desidrogenase. Além disso, verificou-se que outras proteínas estiveram diferencialmente expressas em amostras de plasma pacientes e controles: a protease C4-A, o inibidor C1 da Inter-?-Tripsina, o inibidor H1 de cadeia pesada, a proteína Amilóide Sérica A, a glicoproteína ?-2-HS, a isoforma 2 da inter- ?-tripsina, a apolipoproteína A-IV e o inibidor de cadeia pesada H4. CONCLUSÕES: A avaliação de plaquetas e amostras de plasma de pacientes com TVP espontânea permitiu a identificação de proteínas diferencialmente expressas quando comparados a irmãos e vizinhos, que podem desempenhar importantes papéis na fisiopatologia da doença por se relacionarem a processos inflamatórios, imunes e no de transporte de lipídeos / Abstract: Deep venous thrombosis (DVT) is multi-causal disease associated to a high morbimortality due to complications as pulmonary embolism and post-flebitic syndrome, and about 25 % of the patients present recurrence in 5 years. The identification of new factors involved to the physiopathology of DVT can be translated into important implications for the management of these patients, prevention of recurrence, and for the development of new therapies. We were interested about platelets and plasma because the platelets functions are not completely understood and apparently their role goes beyond a hemostatic player, and as the plasma potentially provides a window into the individual's state of health and disease, both could improve our knowledge about the DVT physiopathology. AIM: In this study we analyzed the protein profile of platelets and samples of plasma of 3 DVT patients and compared to results obtained from 1 sibling and 1 neighbor for each patient in order to minimize the genetic and environmental interferences. These patients presented spontaneous and recurrent episodes of proximal DVT and mentioned a familiar history of coagulation disorders. METHODS: the platelets needed to be washed and lysed, and the plasmas samples required albumin depletion before the proteins being alkylated, reduced, precipitated with acetone and hydrolyzed by trypsin. The peptides were fractionated by reverse phase and cation exchange liquid chromatography for platelets and plasmas samples, respectively. After that, the platelets peptides were directed to LTQ-Orbitrap mass spectrometer and the proteins search were performed by Sorcerer/Sequest. The plasma peptides went to ESI Q-TOF Premier mass spectrometer and the proteins were searched by RESULTS: We identified 5 proteins that were present on platelets from patients and absent in all the controls: Apolipoprotein A1 Binding-Protein, Coatomer (?1 sub-unit), Estradiol 11-17-? Dehydrogenase, Leukotriene A-4 Hydrolase and Sorbitol Dehydrogenase. In addition, we verified 6 proteins that were differently expressed between patients and controls: C4-A plasma protease, C1 inhibitor Inter-alpha-trypsin, inhibitor heavy chain H1, the serum amyloid A, alpha-2-HS-glycoprotein, isoform 2 of inter-alphatrypsin, apolipoprotein A-IV and the inhibitor heavy chain H4. CONCLUSIONS: The evaluation of platelets and plasma samples from patients with spontaneous DVT allows the identification of proteins that are differently expressed when compared to siblings and neighbors, which can play important roles on the physiopathology of the disease due their relation to inflammatory, immune and lipid transportation / Doutorado / Biologia Estrutural, Celular, Molecular e do Desenvolvimento / Doutor em Fisiopatologia Medica

Ce projet de thèse concerne les 2 principales complications rencontrées en pratique clinique dans les suites de l’angioplastie-stenting artériel : la resténose et la thrombose aigüe. Pour remédier à ce problème, des stents enrobés d’agents antiprolifératifs sont déjà sur le marché, mais leurs résultats restent décevants en raison de l’augmentation du taux de thrombose tardive intrastent (RR 1,2 vs stent nu) à l’origine d’une surmortalité (RR 1,32 vs stent nu) [Lagerqvist Bo et al., N Eng J Med 2007]. Dans ce travail, nous proposons d’immobiliser sur le stent une ancre spécifique au substrat métallique soit pour immobiliser i) la molécule thérapeutique, soit pour immobiliser ii) une matrice polymère sur laquelle sera adsorbée une molécule thérapeutique dans le cas d’un système à libération prolongée; cette dernière ciblant la resténose et la thrombose. Cette ancre, issue des protéines permettant l’accroche des moules marinières à tout type de substrat [Waite JH et al., Science 1981], est la base commune pour une immobilisation par liaisons covalentes de la molécule thérapeutique ou du système polymère. La première partie du projet concernait la mise au point de l’ancre chimique spécifique dans le cadre d’une immobilisation de surface. Avec cette technique d’immobilisation, l’ancre dopamine inclue un ester activé, permettant de générer un polymère de longueur de chaine contrôlé et capable d’adsorber une quantité contrôlée et définie de molécule thérapeutique [C Zobrist et al., Macromolecules 2011]. Ce polymère de N-(Acryloyloxy)succinimide a pu être caractérisé et couplé à une molécule de glucosamine, protéoglycane aux caractéristiques pertinentes dans la problématique développée. Ce modèle a été validé sur le plan chimique et biologique. Les résultats restaient décevants concernant la prolifération des cellules musculaires lisses qui sont les cellules cibles dans la resténose.L’ancre dopamine a par la suite était modifiée dans le but de permettre le greffage d’autres fonctions chimiques, notamment amines et acides. Elle a finalement été utilisée en conditions basiques (pH 8,5) permettant d’obtenir une polydopamine [Lee et al., Science 2007].Cette polydopamine a permis l’interaction sur notre surface d’un polymère bien connu au sein de notre unité et déjà employé pour la fonctionnalisation des tissus dans le domaine biomédical, le polymère de cyclodextrine (CD) [Martel B et al., European Polymer Journal 1995]. Les CD sont des oligosaccharides cycliques sous forme de cône tronqué possédant une cavité hydrophobe interne et des groupements hydroxyles à l’extérieur engendrant un caractère hydrophile. Cette structure cyclique leur confère la capacité de former des complexes d’inclusion réversibles avec un grand nombre de molécules hydrophobes. Elles peuvent donc stocker une molécule thérapeutique en grande quantité et ont la capacité de la libérer dans le temps.L’ensemble des paramètres du procédé de fonctionnalisation permettant l’adsorption de ces 2 couches successives : polydopamine et polymère de CD a pu être optimisé. La complexation de deux molécules thérapeutiques d’intérêt à notre plateforme fonctionnalisée a pu être réalisée: la simvastatine et le paclitaxel. La simvastatine, de la famille des statines, est une molécule pléïotrope, régulatrice de la dysfonction endothéliale ; elle limite la réaction inflammatoire locale impliquée à la fois dans les phénomènes de resténose et de thrombose [Balk EM et al., Am J Med. 2004]. Le paclitaxel est un agent immunosuppresseur et antiprolifératif limitant la prolifération de la néointima [Creel CJ et al., Circ Res 2000]. Nous avons comparé notre plateforme avec un système actuellement sur le marché, le système PTX « polymer-free » mise au point par Dake et al. [Dake et al., JVIR 2011]. [...] / This work has focused on 2 major issues encountered after angioplasty and stenting of arterial occlusive disease: intra-stent restenosis and thrombosis.To prevent these postoperative complications, drug eluting stents (DES) have been developed and are currently available for clinical use; they elute antiproliferative drugs overtime which limit smooth muscle cells migration and proliferation. Long-term results of DES are jeopardized by a high late in-stent thrombosis rate (RR 1.2 vs bare metal stent) which is correlated to a higher late death rate (RR 1.32 vs bare metal stent) [Lagerqvist Bo et al., N Eng J Med 2007]. We present an original process of immobilization of a specific anchor on a metallic substrate which has the ability to directly immobilize drugs onto the metallic surface. It can also indirectly using specific biocompatible polymers load drugs onto the metallic surface which would be eluted overtime. The target for both systems is the cellular response involved in the restenosis and thrombosis process.This specific anchor, which is dedicated to several substrates, is developed from marine mussels gel [Waite JH et al., Science 1981]. It is currently a common basis for covalent immobilization of drugs and/or polymer systems able to sustain drug release.The first part of the project involved the development of a specific chemical anchor through an immobilization surface strategy. This dopamine anchor includes an activated ester, which is the starting point of the creation of a polymer with defined and controlled chain length. The generated polymer of N-(Acryloyloxy)succinimide has the ability to absorb a controlled and defined amount of drug; it has been linked with glucosamine to illustrate the potential of the system - glucosamine is a proteoglycan from the extracellular matrix of the arterial wall. The system has then been characterized and optimized for every parameters; unfortunately, results were not as good as expected regarding SMC proliferation.The Dopamine anchor has thus been modified to allow interactions with more chemical functions, including amino- and carboxylic functions. Finally, we used it under alkaline conditions (pH=8.5) where dopamine generated a network of polydopamine [Lee et al., Science 2007].Afterwards, we report an original functionalization of metallic surfaces with a hydrophilic, biocompatible and biodegradable cyclodextrin based polymer. This polymer acts as a reservoir for hydrophobic drugs allowing the sustained release of anti-proliferative drugs and promotes natural arterial wall healing. The polymer of CD is well-known in our research department and has already been used as an active coating onto textile for vascular devices [Martel B et al., European Polymer Journal 1995]. In this setting polydopamine was applied as a first coating layer onto the metallic surface in order to promote a strong anchorage of a cyclodextrin based polymer that was “in situ” generated from the native cyclodextrins and citric acid as a crosslinking agent through a polycondensation reaction. After optimization of the grafting process, the ability of this system to act as a drug eluting system was evaluated with paclitaxel (PTX) and simvastatine. PTX is a reference drug for current vascular drug eluting stents [Creel CJ et al., Circ Res 2000]. PTX is currently coated on vascular stents with a “polymer-free” method [Dake et al., JVIR 2011]. It is a highly lipophilic antiproliferative drug, and that “polymer free” system was compared as a positive control to our functionalized scaffold. We compared the results of our functionalized surface loaded of PTX and Simvastatin. Simvastatin is a pleiotropic molecule with targeted actions on arterial disease, inflammatory process and dyslipidemia [Balk EM et al., Am J Med. 2004]. [...]

CD154 joue un rôle important dans la pathogenèse de plusieurs maladies auto-immunes, ainsi que des dysfonctionnements vasculaires. CD154 est un membre de la famille du facteur de nécrose tumorale (tumor necrosis factor, TNF) d'une importance cruciale dans l'immunité humorale. Cependant, CD154 partage également des fonctions critiques inflammatoires grâce à son interaction avec son récepteur CD40 ou des partenaires de liaison récemment identifiés, à savoir αIIbβ3, α5β1 et αMβ2. Ces réponses impliquent CD154 comme un facteur clé dans les maladies inflammatoires chroniques, notamment les maladies auto-immunes et la thrombose. L’interruption de l'interaction de CD154 avec ses récepteurs par anticorps anti-CD154 inhibe de manière significative le développement de ces maladies, bien que des effets secondaires graves ont été associés à ces traitements. Pour remédier à ces effets indésirables, d'autres approches comme des souris defficientes (Knockout), oligonucléotide antisens et ARNi ciblage ont été développés. Ces approches ont été axées sur l’interaction de CD154 avec CD40 et ne traitent pas l'interaction de CD154 avec ses autres récepteurs. Par conséquent, il existe un besoin de nouveaux traitements pour la prévention/abrogation des maladies inflammatoires ou auto-immunes qui cibles tous les récepteurs de CD154. Notre groupe a profondément étudié l'interaction structurelle/fonctionnelle de CD154 avec ses différents récepteurs. Étant donné l'importance de la structure trimérique de CD154 pour son activité biologique, nous avons généré une forme monomère de la molécule qui peut se lier spécifiquement à un récepteur sans induire l'activation intracellulaire. Cet agent est un outil thérapeutique potentiel pour le traitement de maladies reliées au CD154, tels que les événements thrombotiques. / CD154 has emerged as an important player in the pathogenesis of several autoimmune diseases, as well as vascular dysfunctions. CD154 is a member of the tumour necrosis factor family of pivotal importance in humoral immunity. However, CD154 also shares critical inflammatory functions through its interaction with its classical CD40 receptor or recently identified binding partners, namely αIIbβ3, α5β1 and αMβ2. These responses imply CD154 as a key factor in chronic inflammatory disorders including autoimmune diseases and thrombosis. Disrupting the interaction of CD154 with its receptors through anti-CD154 Abs significantly inhibits the development of these diseases, albeit serious side effects have been associated with these therapies. To overcome these adverse effects, other approaches such as knockout, antisense oligonucleotide and siRNA targeting were developed. These approaches were focused on the CD154/CD40 interaction and did not address the interaction of CD154 with its other receptors. Thus, there is a need for novel CD154 treatments for the prevention/abrogation of inflammatory or autoimmune diseases that address all CD154 receptors. Our group profoundly investigated the structural/functional interaction of CD154 with its various receptors. Given the importance of the trimeric structure of CD154 for its biological activity, we generated monomeric form of the molecule that can specifically bind to one receptor without inducing intracellular activation. This agent represents a potential therapeutic tool for the treatment of CD154-mediated diseases such as thrombotic events.

Cerebral ischaemia by mechanism of thrombosis is one of the leading causes of disability and/or death worldwide, the outcome thereof increasing in severity with advancing age. Cerebral ischaemia triggers a cascade of events including inflammation, blood-brain barrier disruption and apoptosis. It is well known that oestrogen is neuroprotective through various mechanisms including the interruption of inflammation, regulation of thrombosis and delay of apoptosis. This creates a strong factorial interconnection in predicting the consequences of cerebral ischaemia. Since platelets have a central role in thrombosis and inflammation, their ultrastructure being altered in conditions of inflammatory and thrombotic derivation, the question arises whether chemical analysis of coagulation factors and ultrastructural analyses of platelet morphology may provide further insight into the role of oestrogen during ischaemic insult associated with stroke. Accordingly, an exclusively hyperglycaemic modification of the two-vessel occlusion model for inducing experimental cerebral ischaemia was established, since pre-ischaemic hyperglycaemia is known to intensify the outcome of cerebral ischaemic injury. Consequent neural tissue injury levels were correlated for three experimental groups (males, cyclic and acyclic females) of Sprague Dawley rats at vital times, to the presence of oestrogen as well as changes in coagulation factors and ultrastructure. This design allowed for an association to be formed between cerebral ischaemia, inflammation and thrombotic potential. Collectively the results strongly suggest that oestrogen is indeed neuroprotective through various actions including roles in the regulation of thrombosis and inflammation, targeting neural cells through the inhibition of apoptosis and exerting anti-inflammatory and antioxidant effects. It is evident that under the influence of oestrogen in cyclic females, there is reduced neural tissue injury as well as a lesser degree of inflammation evident in coagulation factor analysis and platelet activation morphology when compared to males and acyclic females. Oestrogen therefore exerts positive effects on the outcome of cerebral ischaemia through mechanisms which regulate inflammation, thrombosis and apoptosis. Furthermore it is unmistakeable that neural injury is closely shadowed, if not preceded, by inflammatory changes in the coagulation system, particularly manifested in platelet ultrastructure. It is therefore suggested that platelets may be used successfully to follow the progression of events of cerebral ischaemia and possibly assist in the assessment of treatment strategies and their effects on haemostasis. This research advances the understanding that inflammation is evident soon after ischaemic insult and if such inflammation is not curbed, necrosis of platelets and more severe injury to neural tissue may follow. Therefore, the development of agents which not only target thrombosis, but also which control inflammation must be explored to advance treatment strategies. It is proposed that even before it is determined whether a stroke has been caused by thromboembolism or haemorrhage; it will be beneficial to immediately target inflammation in order to prevent most severe consequences in human patients. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Anatomy / unrestricted

Thrombosis and colorectal cancer have a bi-directional relationship. The presence of a colorectal malignancy results in an increased risk of developing a thrombosis and the presence of a thrombosis results in a worse cancer prognosis. The physiology causing this is at present unclear but it is proposed that proteins from the tissue factor (TF) pathway may be the instigator of this bi-directional relationship. The in-vitro studies have shown that in colorectal cancer TF impairs that action of colorectal cancer stem cells as demonstrated by reduced cancer sphere formation and also lower expression of the stem cell marker ALDH. The ability for a colorectal cell to avoid anoikis is impaired by a reduced TF level. Proliferation is affected by the level of expression of TF with a significant increase in proliferation with additional expression of TF. The increase in proliferation is further increased by the presence of TF’s ligand factor VIIa. Paradoxically reduced expression of TF also increases colorectal cancer expression. The ERK1/2 pathway offers a possible method by which TF and factor VIIa may exert their proliferative effects. In the prospective clinical cohort study (CHAMPion) abnormal expression of TF pathway proteins (TF, PAR1, PAR2 and thrombin) by both malignant epithelial and cancer associated stromal cells has been demonstrated. The stromal expression was independent of the epithelial expression and was only in stroma in close contact (0.1mm) with epithelial cells suggesting that the TF pathway proteins may have a role in stromal/epithelial communication. There was no link between the expression of TF pathway proteins and clinicopathological markers of a poor prognosis. The plasma expression of markers of TF pathway activation did not demonstrate any role as a biomarker for colorectal cancer or prognosis. The CHAMPion study has demonstrated that 7% of patients undergoing surgery for colorectal cancer have asymptomatic pre-operative DVTs present. A further 6% who were DVT free pre-operatively developed a DVT in the peri-operative period despite receiving venous thromboprophylaxis in line with current national guidelines. Pre-operative d-dimer may have the potential to identify those patients at risk of a post-operative VTE.This thesis establishes the role that TF has in promoting proliferation and anoikis resistance. It also confirms the abnormal expression of TF pathway proteins by colorectal cancer epithelial cells and for the first time demonstrates abnormal expression by the cancer associated stroma. The interaction between the stroma and epithelial cells, combined with the cellular effects of TF suggests that targeting this interaction may have a therapeutic role. The incidence of DVTs pre-operatively suggests that screening patients for the asymptomatic presence of a DVT may have an impact on their clinical outcome. The development of DVTs despite prophylaxis suggests that the level of anticoagulation is insufficient and current guidelines need to be revisited.

L’élastine est la protéine de la matrice extracellulaire (MEC) responsable des propriétés de résilience et d'élasticité des tissus élastiques. Durant le vieillissement, les protéines de la MEC vasculaire sont exposées à des réactions délétères qui altèrent leurs propriétés structurales et fonctionnelles. Une des caractéristiques principales des protéines de la MEC est leur longue demi-vie, associée à un renouvellement très lent, comme pour l'élastine. Ainsi, tout dommage survenant sur l'élastine est essentiellement irréparable. La fragmentation des fibres élastiques génère des peptides d’élastine (EDP) bioactifs capables de modifier le comportement des cellules environnantes en se liant au complexe récepteur de l’élastine (CRE), composé de trois sous-unités dont la neuraminidase-1 (Neu-1), sous-unité catalytique du CRE. Cette thèse a consisté en l'étude, chez la souris, du rôle des EDP dans le développement du diabète de type 2 et dans la thrombose, deux pathologies vasculaires liées à l'âge, et s'est également focalisée sur la sous-unité Neu-1 du CRE. Dans un premier temps, nous avons montré que les EDP favorisent le développement d’une insulinorésistance et d’un diabète de type 2. Cet effet implique l'interaction de Neu-1 avec la sous-unité β du récepteur à l'insuline qui diminue son niveau de sialylation altérant ses voies de signalisation. Dans un second temps, nous avons identifié un mécanisme d'action des EDP à deux niveaux (matriciel et plaquettaire) et mis en évidence la présence d'un CRE fonctionnel dans les plaquettes régulant la thrombose. Enfin, nous avons étudié la topologie membranaire de Neu-1 par différentes approches technologiques et identifié un domaine transmembranaire potentiel jouant un rôle important pour sa dimérisation et son activité sialidase. En conclusion, les EDP sont des acteurs clefs du remodelage vasculaire physiopathologique et des pathologies vasculaires associées et de contribuer à faire avancer nos connaissances sur l'organisation de Neu-1 à la membrane plasmique. / Elastin is the extracellular matrix (ECM) protein responsible for resilience and elasticity of tissues such as arteries. During ageing, vascular ECM proteins are subjected to deleterious reactions that alter their structural and functional properties (addition reactions, proteolysis). One of the main features of ECM proteins is their long half-life, associated with a low, or even, inexistent turnover. This is the case for elastin with an estimated half-life at 70 years. Therefore, any damage occurring on elastin will be mostly irreparable. Fragmentation of elastic fibers produces bioactive elastin-derived peptides (EDP) able to modify the behavior of surrounding cells by binding to the elastin receptor complex (ERC). This receptor is composed of three subunits, among which neuraminidase-1 (Neu-1) is the catalytic subunit. The aim of this thesis was to study, in mice, the role of EDP in the development of type 2 diabetes and in thrombosis, two age-related vascular diseases, and to focus on the Neu-1 subunit of the ERC. In a first time, we have shown that EDP promote the development of insulin resistance and type 2 diabetes. This effect involves Neu-1 interaction with the β subunit of the insulin receptor and leads to its reduced sialylation level and signaling. In a second time, we have demonstrated that EDP are regulators of thrombosis. We identified a two-level mechanism (matrix and platelet) and the presence of a functional ERC in platelets. Finally, we have studied the membrane topology of Neu-1 by different biophysical, biochemical and molecular biology approaches, and identified a potential transmembrane domain involved in the dimerization and sialidase activity of Neu-1. In conclusion, this thesis consolidates the concept that EDP are crucial actors of pathophysiological vascular remodeling and related vascular diseases, and expands our knowledge on the plasma membrane organization of Neu-1.

A system for vessel characterization aimed at detecting deep vein thrombosis (DVT) in the lower limbs has been developed and evaluated using ultrasound image processing, location and force sensors measurements, blood flow information and a protocol based on the current clinical standard, compression ultrasound. The goal is to provide an objective and repeatable system to measure DVT in a rapid and standardized manner, as this has been suggested in the literature as an approach to improve overall detection of the disease. The system uses a spatial Kalman filter-based algorithm with an elliptical model in the measurement equation to detect vessel contours in transverse ultrasound images and estimate ellipse parameters, and temporal constant velocity Kalman filters for tracking vessel location in real-time. The vessel characterization also comprises building a 3-D vessel model and performing compression and blood flow assessments to calculate measures that indicate the possibility of DVT in a vessel. A user interface designed for assessing a vessel for DVT was also developed. The system and components were implemented and tested in simulations, laboratory settings, and clinical settings. Contour detection results are good, with mean and rms errors ranging from 1.47-3.64 and 3.69-9.67 pixels, respectively, in simulated and patient images, and parameter estimation errors of 5%. Experiments showed errors of 3-5 pixels for the tracking approaches. The measures for DVT were evaluated, independently and integrated in the system. The complete system was evaluated, with sensitivity of 67-100% and specificity of 50-89.5%. System learnability and memorability were evaluated in a separate user study, with good results. Contributions include a segmentation approach using a full parameter ellipse model in an extended Kalman filter, incorporating multiple measurements, an alternate sampling method for faster parameter convergence and application-specific initialization, and a tracking approach that includes a sub-sampled sum of absolutes similarity calculation and a method to detect vessel bifurcations using flow data. Further contributions include an integrated system for DVT detection that can combine ultrasound B-mode, colour flow and elastography images for vessel characterization, a system interface design focusing on usability that was evaluated with medical professionals, and system evaluations through multiple patient studies. / Applied Science, Faculty of / Electrical and Computer Engineering, Department of / Graduate