Introduction : Issus des données animales, les modèles neurotrophiniques du mécanisme d’action des médicaments antidépresseurs pourraient permettre d’identifier chez l’Homme des biomarqueurs prédictifs de la réponse et de la rémission sous antidépresseurs. Nous évaluons l’intérêt clinique, chez les patients souffrant de trouble dépressif caractérisé unipolaire, de 11 biomarqueurs : polymorphismes nucléotidiques simples (SNP) du Brain Derived Neurotrophic Factor (BDNF) et de son récepteur, le Récepteur Tyrosine-Kinase B (TRKB), taux plasmatiques de BDNF et volume hippocampique sur la réponse/rémission sous antidépresseurs. Méthode : Les données originales de ce travail sont issues de la cohorte METADAP. Il s’agit d’une cohorte, prospective, multicentrique incluant 624 patients présentant un épisode dépressif caractérisé dans le cadre d’un trouble dépressif caractérisé unipolaire et nécessitant l’introduction d’un traitement antidépresseur. Le traitement antidépresseur est prescrit de façon naturaliste (tous antidépresseurs commercialisés en France). Les patients sont évalués 1, 3 et 6 mois après l’introduction du traitement antidépresseur. Les biomarqueurs étudiés sont les polymorphismes Val66Met du BDNF et 8 SNP du TRKB et les dosages de BDNF plasmatiques. Une étude ancillaire est menée à partir de 63 patients ayant bénéficié d’Imagerie par Résonnance Magnétique cérébrale réalisée en pratique courante à l’inclusion de cette cohorte afin d’évaluer les volumes hippocampiques. Résultats : 1) Une revue de la littérature met en évidence une association entre la réponse aux antidépresseurs et 12 SNP du BDNF/TRKB sur 242 étudiés, ainsi qu’une association entre allèle Met du polymorphisme Val66Met du BDNF et meilleure réponse sous antidépresseurs chez les patients asiatiques. 2) Nos données ne mettent pas en évidence d’impact de 8 SNP du TRKB sur la réponse/rémission après traitement antidépresseur, mais un effet différentiel du Val66Met du BDNF selon la classe de traitement antidépresseur. 3) L’étude des dosages de BDNF plasmatiques n’est pas concluante. 4) Concernant les volumes hippocampiques, notre méta-analyse montre que des volumes hippocampiques moindres prédisent une moindre réponse/rémission après traitement antidépresseur. 5) Concernant les liens entre les biomarqueurs étudiés, nous ne mettons pas en évidence d’association. Conclusion : Sur les 11 biomarqueurs étudiés, seuls 2 pourraient présenter une utilité en pratique clinique. Si nos travaux étaient répliqués, le polymorphisme Val66Met du BDNF et le volume hippocampique pourraient conduire à orienter le choix des antidépresseurs dans le traitement des épisodes dépressifs caractérisés. Malgré une littérature cohérente chez l’Animal, nous n’avons pas mis en évidence, dans l’échantillon étudié, de lien entre les biomarqueurs génétiques étudiés et les volumes hippocampiques. Nous poursuivons ce travail d’évaluation des biomarqueurs neurotrophiniques et neurogéniques avec des méthodes d’évaluations nouvelles : séquençage nouvelle génération pour la génétique et imagerie multimodale (acquisition répétée d’IRM structurelle, fonctionnelle et de diffusion) de l’hippocampe. Nous évaluerons également de nouveaux biomarqueurs. / Introduction: developed with Animal preclinical approachs, neurtrophinic and neurogenic models of antidepressant mechanism of action lead to identify biomarkers in Human which could be predict antidepressant response and remission in depressed patients. We assess the clinical benefit of 11 biomarkers in depressed patients: Brain Derived Neurotrophic Factor (BDNF) and its receptor Tyrosine Receptor -Kinase B (TRKB), Plasma BDNF and Hippocampal volumes to predict antidepressant response/remission. Methods: The original research data of this work are from METADAP cohort. It is a prospective, multicentric cohort including 624 patients with a diagnosis of major depressive disorder and a current major depressive episode at the start of the index antidepressant treatment. Antidepressant treatment is prescribed in naturalistic conditions (all commercialized antidepressant in France). Patient are assessed 1, 3 and 6 months after the start of antidepressant treatment. Studied biomarkers are BDNF Val66Met polymorphism, 8 TRKB SNP and plasma BDNF. Ancillary study are done with 63 patients which benefit in clinical practice of Magnetic Resonnance (MRI) at the inclusion of the cohort. Results: 1) A review of literature reports associations between antidepressant efficacy and 12 BDNF/TRKB SNP on 242 studied SNP and an association with Met allele of Val66Met BDNF polymorphism and a best antidepressant efficacy in Asian patients. 2) Our original data show no impact of 8 TRKB SNP on antidepressant response remission but a differential effect of Val66Met BDNF polymorphism depending on antidepressant treatment class. 3) Plasma BDNF study is not conclusive. 4) Concerning hippocampal volumes, our meta-analysis show that smaller hippocampal volumes predict lower response/remission rate after antidepressant treatment. 5) No association is found between studied biomarkers. Conclusion: 2 of the 11 studied biomarkers could be useful in clinical practice. After replication of our results, Val66Met polymorphism could lead to personalized antidepressant prescription in major depressive disorder. Although the animal prelinical littérature appar strong, we dont report association between genetic biomarker and hippocampal volume in ours ample. We will assess neurotrophinic and neurogenic biomarkers with new methods: next generation sequencing for genetic, multimodal imaging (repeated structural, functional and diffusion MRI) of hippocampus. We also will assess new biomarkers.

PEREIRA, V.S. Participação da via NMDA-NO do córtex pré-frontal medial ventral na modulação das consequências comportamentais do estresse de nado forçado: mecanismos intracelulares. 2015. 191p. Tese (Doutorado) Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 2014. A ativação dos receptores glutamatérgicos do tipo NMDA é capaz de desencadear a síntese de óxido nítrico (NO) no SNC. A administração de antagonistas NMDA (p.ex., ketamina) ou de inibidores da síntese de NO (p.ex., 7-NI) produz efeitos do tipo antidepressivo em animais e reforça o potencial dos sistemas glutamatérgico e nitrérgico como alvos terapêuticos para o tratamento da depressão. Trabalhos recentes sugerem o envolvimento de vias intracelulares no controle de mecanismos de plasticidade neural, como a via BDNF-TrkBmTOR, nos efeitos antidepressivos produzidos por antagonistas NMDA. Foi demonstrado, por exemplo, que os efeitos antidepressivos da ketamina dependem da síntese de BDNF e da ativação da mTOR no córtex pré-frontal medial (CPFMv) de ratos. O bloqueio farmacológico do CPFMv ou a administração de antagonista NMDA (LY235959) nessa estrutura também produz efeitos do tipo antidepressivo em animais. Porém, não se sabe se esses efeitos envolvem a via NMDA-NO do CPFMv, assim como não se sabe se o efeito antidepressivo induzido por inibidores da síntese de NO dependeria da via BDNF-TrkB-mTOR do CPFMv. Dessa forma, avaliamos a participação da neurotransmissão glutamatérgica e nitrérgica, bem como a participação da via BDNF-TrkB-mTOR, no CPFMv-pré límbico (PL), na modulação de respostas comportamentais de animais submetidos ao teste do nado forçado (TNF), um teste preditivo de efeito antidepressivo. Em um primeiro grupo de experimentos observou-se que a administração de inibidor da nNOS (NPA), da sGC (ODQ) ou de sequestrador de NO (c-PTIO) no PL de animais submetidos ao TNF promoveu efeito do tipo-antidepressivo, de forma similar ao que foi previamente descrito com a injeção local de LY235959. Posteriormente, os efeitos do LY235959, mas não os do NPA, foram bloqueados pelo tratamento prévio com antagonista dos receptores glutamatérgicos do tipo AMPA (NBQX), sugerindo que as vias NMDA e NO do PL estejam dissociadas na modulação das alterações comportamentais promovidas pelo TNF. A administração de BDNF no PL promoveu efeito tipoantidepressivo, o qual foi bloqueado pelo pré-tratamento com antagonista dos receptores TrkB (K252a) ou com inibidor da mTOR (rapamicina). Os efeitos tipo antidepressivo da administração de LY235959 ou NPA, no PL, não foram alterados na presença de K252a. No entanto, a administração prévia de rapamicina foi capaz de bloquear os efeitos do LY235959, mas não os do NPA, novamente sugerindo mecanismos distintos desencadeados por NMDA e NO no PL. Nossos dados indicam uma interação maior dos efeitos dos antagonistas NMDA com a via BDNF-TrkB-mTOR, enquanto os efeitos dos inibidores da via do NO parecem não modular essa via no PL. O tratamento sistêmico com ketamina (antagonista NMDA) ou 7-NI (inibidor preferencial da nNOS) foi capaz de produzir efeitos do tipo antidepressivo, sendo que esses tratamentos não alteraram a ativação ou expressão dos receptores TrkB e da mTOR, no CPFm de animais estressados ou não estressados. Assim, mais estudos são necessários para esclarecer a interação das neurotransmissões glutamatérgica e nitrérgica com a via BDNFTrkB-mTOR, no CPFMv-PL, no que diz respeito ao efeito antidepressivo em animais estressados, após administração sistêmica. Em conjunto, os dados do presente trabalho suportam o envolvimento da neurotransmissao glutamatérgica e nitrérgica do PL na neurobiologia das respostas comportamentais associadas a neurobiologia da depressão. Porém, a interação entre esses sistemas no PL e os mecanismos envolvidos se mostram consideravelmente complexos. / PEREIRA, V.S. Participation of NMDA-NO pathway from the medial préfrontal córtex on the behavioural consequences of forced swim stress: molecular mechanisms. 2015. 191p. Thesis (Doctoral) School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 2014. The activation of NMDA receptors is capable of increasing nitric oxide (NO) synthesis in the brain. The administration of NMDA antagonists (e.g., ketamine) or nitric oxide synthesis inhibitors (e.g., 7-NI) produce antidepressant-like effects in animals and highlights the potential of glutamatergic and nitrergic systems as therapeutic targets for the treatment of major depression. The involvement of intracellular mechanisms associated to neural plasticity, such as BDNF-TrkBmTOR pathway, has been implicated in the antidepressant-like effects induced by systemic administration of NMDA antagonists. For instance, the antidepressant effects of ketamine are associated with increased BDNF synthesis and mTOR in the medial prefrontal cortex (vMPFC). In addition, injection of an NMDA antagonist (LY235959) into the vMPFC-PL produces antidepressant-like effect in animals. However, it is not yet known if the aforementioned antidepressant-like effects involve the modulation of NO synthesis or the activation of the BDNF-TrkB-mTOR pathway in the vMPFC. Therefore, this work investigated the involvement of glutamatergic and nitrergic neurotransmission of the vMPFC, as well as the participation of local BDNF-TrkBmTOR pathway, in the modulation of behavioral responses of animals submitted to forced swimming test, an animal model predictive of antidepressant effects. The administration of nNOS inhibitor (NPA), sGC inhibitor (ODQ) or NO scavenger (c-PTIO) into the vMPFC-PL produced antidepressant-like effects, similarly to what has been previously described with the local injection of LY235959. The effects of LY235959 were blocked by pretreatment with an antagonist of AMPA receptors (NBQX), but not the NPA effects. Thus suggesting a possible dissociation between NMDA- and NO-induced mechanism in the PL. BDNF administration in the PL induced antidepressant-like effect, which was blocked by prior administration of the TrkB receptor antagonist (K252a) or the mTOR inhibitor (rapamycin). The antidepressant-like effects induced by intra-PL administration of LY235959 and NPA, into vMPFC-PL were not altered in the presence of K252a. However, the prior administration of rapamycin was able to block the effects of LY235959, but not NPA-induced effect. This result further supports the dissociation of the NMDA-NO system in the PL in the modulation of immobility in the FST. Systemic treatment with ketamine (NMDA antagonist) or 7-NI (nNOS inhibitor) produced antidepressant-like effects in the FST, although these treatments did not affect the activation or the expression of TrkB receptors or mTOR in the MPFC of stressed animals. These results further corroborate the involvement of the glutamatergic and nitrergic neurotransmission in the modulation of behavioral consequences of the forced swim stress and highlight that the interaction of these systems with mTOR and trkB in the PL is considerably complex. Altogether, our data supports the possible modulation of BDNF-TrkBmTOR pathway of the PL in the effects induced by NMDA antagonist injection.. However, the effects induced by inhibitors of the NO pathway semms dissociated from an interaction with the aforementioned pathway. Thus, further studies are necessary to clarify the interaction of glutamatergic and nitrergic neurotransmission with BDNF-TrkB-mTOR pathway into vMPFC-PL regarding the neurobiology of stress and depression.

PEREIRA, V.S. Participação da via NMDA-NO do córtex pré-frontal medial ventral na modulação das consequências comportamentais do estresse de nado forçado: mecanismos intracelulares. 2015. 191p. Tese (Doutorado) Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 2014. A ativação dos receptores glutamatérgicos do tipo NMDA é capaz de desencadear a síntese de óxido nítrico (NO) no SNC. A administração de antagonistas NMDA (p.ex., ketamina) ou de inibidores da síntese de NO (p.ex., 7-NI) produz efeitos do tipo antidepressivo em animais e reforça o potencial dos sistemas glutamatérgico e nitrérgico como alvos terapêuticos para o tratamento da depressão. Trabalhos recentes sugerem o envolvimento de vias intracelulares no controle de mecanismos de plasticidade neural, como a via BDNF-TrkBmTOR, nos efeitos antidepressivos produzidos por antagonistas NMDA. Foi demonstrado, por exemplo, que os efeitos antidepressivos da ketamina dependem da síntese de BDNF e da ativação da mTOR no córtex pré-frontal medial (CPFMv) de ratos. O bloqueio farmacológico do CPFMv ou a administração de antagonista NMDA (LY235959) nessa estrutura também produz efeitos do tipo antidepressivo em animais. Porém, não se sabe se esses efeitos envolvem a via NMDA-NO do CPFMv, assim como não se sabe se o efeito antidepressivo induzido por inibidores da síntese de NO dependeria da via BDNF-TrkB-mTOR do CPFMv. Dessa forma, avaliamos a participação da neurotransmissão glutamatérgica e nitrérgica, bem como a participação da via BDNF-TrkB-mTOR, no CPFMv-pré límbico (PL), na modulação de respostas comportamentais de animais submetidos ao teste do nado forçado (TNF), um teste preditivo de efeito antidepressivo. Em um primeiro grupo de experimentos observou-se que a administração de inibidor da nNOS (NPA), da sGC (ODQ) ou de sequestrador de NO (c-PTIO) no PL de animais submetidos ao TNF promoveu efeito do tipo-antidepressivo, de forma similar ao que foi previamente descrito com a injeção local de LY235959. Posteriormente, os efeitos do LY235959, mas não os do NPA, foram bloqueados pelo tratamento prévio com antagonista dos receptores glutamatérgicos do tipo AMPA (NBQX), sugerindo que as vias NMDA e NO do PL estejam dissociadas na modulação das alterações comportamentais promovidas pelo TNF. A administração de BDNF no PL promoveu efeito tipoantidepressivo, o qual foi bloqueado pelo pré-tratamento com antagonista dos receptores TrkB (K252a) ou com inibidor da mTOR (rapamicina). Os efeitos tipo antidepressivo da administração de LY235959 ou NPA, no PL, não foram alterados na presença de K252a. No entanto, a administração prévia de rapamicina foi capaz de bloquear os efeitos do LY235959, mas não os do NPA, novamente sugerindo mecanismos distintos desencadeados por NMDA e NO no PL. Nossos dados indicam uma interação maior dos efeitos dos antagonistas NMDA com a via BDNF-TrkB-mTOR, enquanto os efeitos dos inibidores da via do NO parecem não modular essa via no PL. O tratamento sistêmico com ketamina (antagonista NMDA) ou 7-NI (inibidor preferencial da nNOS) foi capaz de produzir efeitos do tipo antidepressivo, sendo que esses tratamentos não alteraram a ativação ou expressão dos receptores TrkB e da mTOR, no CPFm de animais estressados ou não estressados. Assim, mais estudos são necessários para esclarecer a interação das neurotransmissões glutamatérgica e nitrérgica com a via BDNFTrkB-mTOR, no CPFMv-PL, no que diz respeito ao efeito antidepressivo em animais estressados, após administração sistêmica. Em conjunto, os dados do presente trabalho suportam o envolvimento da neurotransmissao glutamatérgica e nitrérgica do PL na neurobiologia das respostas comportamentais associadas a neurobiologia da depressão. Porém, a interação entre esses sistemas no PL e os mecanismos envolvidos se mostram consideravelmente complexos. / PEREIRA, V.S. Participation of NMDA-NO pathway from the medial préfrontal córtex on the behavioural consequences of forced swim stress: molecular mechanisms. 2015. 191p. Thesis (Doctoral) School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 2014. The activation of NMDA receptors is capable of increasing nitric oxide (NO) synthesis in the brain. The administration of NMDA antagonists (e.g., ketamine) or nitric oxide synthesis inhibitors (e.g., 7-NI) produce antidepressant-like effects in animals and highlights the potential of glutamatergic and nitrergic systems as therapeutic targets for the treatment of major depression. The involvement of intracellular mechanisms associated to neural plasticity, such as BDNF-TrkBmTOR pathway, has been implicated in the antidepressant-like effects induced by systemic administration of NMDA antagonists. For instance, the antidepressant effects of ketamine are associated with increased BDNF synthesis and mTOR in the medial prefrontal cortex (vMPFC). In addition, injection of an NMDA antagonist (LY235959) into the vMPFC-PL produces antidepressant-like effect in animals. However, it is not yet known if the aforementioned antidepressant-like effects involve the modulation of NO synthesis or the activation of the BDNF-TrkB-mTOR pathway in the vMPFC. Therefore, this work investigated the involvement of glutamatergic and nitrergic neurotransmission of the vMPFC, as well as the participation of local BDNF-TrkBmTOR pathway, in the modulation of behavioral responses of animals submitted to forced swimming test, an animal model predictive of antidepressant effects. The administration of nNOS inhibitor (NPA), sGC inhibitor (ODQ) or NO scavenger (c-PTIO) into the vMPFC-PL produced antidepressant-like effects, similarly to what has been previously described with the local injection of LY235959. The effects of LY235959 were blocked by pretreatment with an antagonist of AMPA receptors (NBQX), but not the NPA effects. Thus suggesting a possible dissociation between NMDA- and NO-induced mechanism in the PL. BDNF administration in the PL induced antidepressant-like effect, which was blocked by prior administration of the TrkB receptor antagonist (K252a) or the mTOR inhibitor (rapamycin). The antidepressant-like effects induced by intra-PL administration of LY235959 and NPA, into vMPFC-PL were not altered in the presence of K252a. However, the prior administration of rapamycin was able to block the effects of LY235959, but not NPA-induced effect. This result further supports the dissociation of the NMDA-NO system in the PL in the modulation of immobility in the FST. Systemic treatment with ketamine (NMDA antagonist) or 7-NI (nNOS inhibitor) produced antidepressant-like effects in the FST, although these treatments did not affect the activation or the expression of TrkB receptors or mTOR in the MPFC of stressed animals. These results further corroborate the involvement of the glutamatergic and nitrergic neurotransmission in the modulation of behavioral consequences of the forced swim stress and highlight that the interaction of these systems with mTOR and trkB in the PL is considerably complex. Altogether, our data supports the possible modulation of BDNF-TrkBmTOR pathway of the PL in the effects induced by NMDA antagonist injection.. However, the effects induced by inhibitors of the NO pathway semms dissociated from an interaction with the aforementioned pathway. Thus, further studies are necessary to clarify the interaction of glutamatergic and nitrergic neurotransmission with BDNF-TrkB-mTOR pathway into vMPFC-PL regarding the neurobiology of stress and depression.

O sarcoma de Ewing (SE) é um dos mais agressivos tipos de câncer pediátrico. Apesar dos significativos avanços no tratamento dessa doença, ainda há uma grande necessidade no aumento das taxas de cura, redução da toxicidade quimioterápica e redução da resistência ao tratamento. Tem sido proposto que SE provém de precursores neuronais, podendo ter sua fisiologia afetada, pois, por neurotrofinas (NTs). Examinamos a influência de receptores de NTs (Trks) em SE. Foram avaliadas a expressão proteica de NTs (NGF e BDNF) e seus receptores (TrkA e TrkB, respectivamente) em amostras de tumores de pacientes com SE, e a expressão de mRNA nas linhagens celulares RD-ES e SK-ES-1. O tratamento das linhagens com o pan-inibidor de Trks (K252a) modificou a morfologia celular e diminuiu a expressão de mRNA de NGF, TrkA, BDNF e TrkB. Ainda, a inibição de Trks diminuiu drasticamente a proliferação e capacidade clonogênica celular. Efeitos sinérgicos foram observados quando as células foram tratadas em conjunto com baixas doses de quimioterápicos, tanto em células selvagens de SE, quanto nas quais induzimos quimiorresistência. Esse estudo sugere, pela primeira vez, que a inibição de Trks reduz a proliferação e sobrevivência celular em SE, além de aumentar a sensibilidade ao tratamento quimioterápico. / Ewing's sarcoma (ES) is one of the most aggressive types of pediatric cancer. Despite significant advances in the treatment of this disease, there is still a great need in increasing cure rates, reducing chemotherapy toxicity and treatment resistance. It has been proposed that ES might derive from neuronal precursors and may be influenced, therefore, by neurotrophins (NTs). We have examined the influence of Trk neurotrophin receptors in ES. Protein expression of NTs (NGF and BDNF) and their receptors (TrkA, and TrkB, respectively) was detected in tumor samples from patients with ES, and mRNA expression was analyzed in the RD-ES, SK-ES-1 cell lines. Treating cells with a Trk Pan-inhibitor (K252a) altered cell morphology and decreased the mRNA expression of NGF, TrkA, BDNF, and TrkB. In addition, Trk inhibition dramatically decreased cell proliferation and clonogenic capacity. Synergistic effects were observed when cells were treated in combination with low doses of cytotoxic chemotherapeutics, both in normal ES cells and cells in which chemoresistance was induced. The results suggest for the first time that Trk inhibition can reduce the proliferation and survival of ES cells and sensitize them to cytotoxic chemotherapy.

Orientador: Marcelo Augusto Christoffolete / Dissertação (mestrado) - Universidade Federal do ABC, Programa de Pós-Graduação em Biossistemas, 2012

O sarcoma de Ewing (SE) é um dos mais agressivos tipos de câncer pediátrico. Apesar dos significativos avanços no tratamento dessa doença, ainda há uma grande necessidade no aumento das taxas de cura, redução da toxicidade quimioterápica e redução da resistência ao tratamento. Tem sido proposto que SE provém de precursores neuronais, podendo ter sua fisiologia afetada, pois, por neurotrofinas (NTs). Examinamos a influência de receptores de NTs (Trks) em SE. Foram avaliadas a expressão proteica de NTs (NGF e BDNF) e seus receptores (TrkA e TrkB, respectivamente) em amostras de tumores de pacientes com SE, e a expressão de mRNA nas linhagens celulares RD-ES e SK-ES-1. O tratamento das linhagens com o pan-inibidor de Trks (K252a) modificou a morfologia celular e diminuiu a expressão de mRNA de NGF, TrkA, BDNF e TrkB. Ainda, a inibição de Trks diminuiu drasticamente a proliferação e capacidade clonogênica celular. Efeitos sinérgicos foram observados quando as células foram tratadas em conjunto com baixas doses de quimioterápicos, tanto em células selvagens de SE, quanto nas quais induzimos quimiorresistência. Esse estudo sugere, pela primeira vez, que a inibição de Trks reduz a proliferação e sobrevivência celular em SE, além de aumentar a sensibilidade ao tratamento quimioterápico. / Ewing's sarcoma (ES) is one of the most aggressive types of pediatric cancer. Despite significant advances in the treatment of this disease, there is still a great need in increasing cure rates, reducing chemotherapy toxicity and treatment resistance. It has been proposed that ES might derive from neuronal precursors and may be influenced, therefore, by neurotrophins (NTs). We have examined the influence of Trk neurotrophin receptors in ES. Protein expression of NTs (NGF and BDNF) and their receptors (TrkA, and TrkB, respectively) was detected in tumor samples from patients with ES, and mRNA expression was analyzed in the RD-ES, SK-ES-1 cell lines. Treating cells with a Trk Pan-inhibitor (K252a) altered cell morphology and decreased the mRNA expression of NGF, TrkA, BDNF, and TrkB. In addition, Trk inhibition dramatically decreased cell proliferation and clonogenic capacity. Synergistic effects were observed when cells were treated in combination with low doses of cytotoxic chemotherapeutics, both in normal ES cells and cells in which chemoresistance was induced. The results suggest for the first time that Trk inhibition can reduce the proliferation and survival of ES cells and sensitize them to cytotoxic chemotherapy.

O sarcoma de Ewing (SE) é um dos mais agressivos tipos de câncer pediátrico. Apesar dos significativos avanços no tratamento dessa doença, ainda há uma grande necessidade no aumento das taxas de cura, redução da toxicidade quimioterápica e redução da resistência ao tratamento. Tem sido proposto que SE provém de precursores neuronais, podendo ter sua fisiologia afetada, pois, por neurotrofinas (NTs). Examinamos a influência de receptores de NTs (Trks) em SE. Foram avaliadas a expressão proteica de NTs (NGF e BDNF) e seus receptores (TrkA e TrkB, respectivamente) em amostras de tumores de pacientes com SE, e a expressão de mRNA nas linhagens celulares RD-ES e SK-ES-1. O tratamento das linhagens com o pan-inibidor de Trks (K252a) modificou a morfologia celular e diminuiu a expressão de mRNA de NGF, TrkA, BDNF e TrkB. Ainda, a inibição de Trks diminuiu drasticamente a proliferação e capacidade clonogênica celular. Efeitos sinérgicos foram observados quando as células foram tratadas em conjunto com baixas doses de quimioterápicos, tanto em células selvagens de SE, quanto nas quais induzimos quimiorresistência. Esse estudo sugere, pela primeira vez, que a inibição de Trks reduz a proliferação e sobrevivência celular em SE, além de aumentar a sensibilidade ao tratamento quimioterápico. / Ewing's sarcoma (ES) is one of the most aggressive types of pediatric cancer. Despite significant advances in the treatment of this disease, there is still a great need in increasing cure rates, reducing chemotherapy toxicity and treatment resistance. It has been proposed that ES might derive from neuronal precursors and may be influenced, therefore, by neurotrophins (NTs). We have examined the influence of Trk neurotrophin receptors in ES. Protein expression of NTs (NGF and BDNF) and their receptors (TrkA, and TrkB, respectively) was detected in tumor samples from patients with ES, and mRNA expression was analyzed in the RD-ES, SK-ES-1 cell lines. Treating cells with a Trk Pan-inhibitor (K252a) altered cell morphology and decreased the mRNA expression of NGF, TrkA, BDNF, and TrkB. In addition, Trk inhibition dramatically decreased cell proliferation and clonogenic capacity. Synergistic effects were observed when cells were treated in combination with low doses of cytotoxic chemotherapeutics, both in normal ES cells and cells in which chemoresistance was induced. The results suggest for the first time that Trk inhibition can reduce the proliferation and survival of ES cells and sensitize them to cytotoxic chemotherapy.

Depression occurs in about one third of patients with stroke and cardiac arrest. Hyperactivity of the stress system is the most commonly observed neuroendocrine change in major depressive disorder (MDD), which involves elevated levels in the cerebrospinal fluid of corticotropin-releasing hormone (CRH), a key stress neurohormone. Substantial evidence suggests that normalization of the stress system may be a requirement for successful treatment of MDD through region-specific changes in the mesocorticolimbic circuitry. Thus, alteration in the stress system may underlie the emotional and functional impairments observed following brain ischemic events. In addition, recent findings suggest that ischemic brain injury triggers a restorative process, creating a cerebral environment similar to that of early brain development, a period characterized by rapid neuronal growth and neuroplasticity, critical to optimize functional recovery of individuals post stroke. In particular brain-derived neurotrophic factor (BDNF), has been shown to play an important role in the pathophysiology of major depression and cerebral ischemia. However, whether CRH can mediate the expression of BDNF in the reparative process triggered by ischemic injury remains to be characterized. Therefore, the purpose of the current thesis is to characterize the effect of pharmacological blockade of CRH signaling at the onset of a global ischemic stroke, on emotional and cognitive behaviors, alteration in the neuroendocrine stress system, and markers of neuroplasticity including BDNF. To do this, an animal model of global cerebral ischemia with subsequent behavioral testing and postmortem brain analysis was used to determine underlying biochemical and behavioral changes modulated by CRH signaling following brain ischemia. This doctoral work will help elucidate the relationship between CRH and BDNF in the context of cerebral ischemia, and may provide insights for therapies targeting the stress system. These studies address considerations such as: the interplay between stress, neuroplasticity and emotionality, and whether global ischemia can affect mood via changes in the HPA axis response.

Les plaquettes sont considérées comme l'un des réservoirs les plus importants non seulement des facteurs de croissance, mais aussi des facteurs neurotrophiques qui pourraient contribuer à la réparation des lésions vasculaires et à la prévention de la détérioration neurologique. Parmi ces facteurs, le facteur neurotrophique dérivé du cerveau (Brain-Derived Neurotrophic Factor ou BDNF) – une protéine appartenant à la famille des neurotrophines– est largement exprimée à la fois dans l'hippocampe et au niveau des plaquettes. Les plaquettes constituent un important réservoir de BDNF; cependant, on ne sait que peu de choses sur les facteurs modulant la libération de ce dernier dans la circulation et si les médicaments antiplaquettaires affectent cette sécrétion. Dans le cadre de ce projet, nous avons émis l’hypothèse principale que les différentes voies d’activation plaquettaire peuvent mener à une libération de BDNF, où celle-ci est affectée par les antiplaquettaires. A cette fin, les plaquettes ont été isolées à partir d’échantillons sanguins de volontaires sains (Groupe 1), de patients souffrant de maladies cardiovasculaires stables requérant la prise de médicaments antiplaquettaires [en prévention secondaire et en double thérapie à l’acide acétylsalicylique (ASA ou Aspirine) en association avec un antagoniste du récepteur P2Y12], (Groupe 2) ou en monothérapie à l’ASA (Groupe 3), versus de patients atteints de maladies valvulaires ou de cardiomyopathies ne requérant pas la prise de médicaments antiplaquettaires (Groupe 4). L’agrégation plaquettaire a été étudiée par agrégométrie optique en réponse à des agonistes spécifiques : adénosine diphosphate (ADP), acide arachidonique (AA), épinéphrine, collagène et Thrombin-receptor activated peptide 6 (TRAP-6 amide). Les antiplaquettaires testés sont dirigés contre la cyclo-oxygénase-1 ou COX-1 (ASA), contre le récepteur de P2Y12 de l’ADP (AR-C) et contre le récepteur αIIbβ3 du fibrinogène (Abciximab). La libération du BDNF a été quantifiée par ELISA. La présence du BDNF et de son récepteur Tropomyosin-Related Kinase Receptor type B (TrKB) a été détectée par immunobuvardage. Nous avons montré que l’activation des plaquettes par les différents agonistes testés induit une agrégation plaquettaire de l’ordre de 80% et permet de libérer jusqu’à 5 fois plus de BDNF, passant de 2500 pg / 250 x 106 plaquettes à l’état basal à approximativement 13000 pg / 250 x 106 plaquettes à l’état stimulé. Tous les antiplaquettaires testés réduisent la libération de BDNF par les plaquettes stimulées. Cependant, le niveau d’inhibition et sa significativité dépendent de la nature de l’agoniste; à savoir que l’ASA réduit significativement la sécrétion de BDNF en réponse à l’AA, à l’épinéphrine et au TRAP-6; alors que l’AR-C était plus efficace en réponse à l’ADP, l’AA et l’épinéphrine. L’Abciximab est un antagoniste qui inhibe la sécrétion de BDNF en réponse à tous les agonistes, en inhibant aussi l’agrégation plaquettaire. Notons que la libération de BDNF en réponse au collagène est inhibée par l’ASA et l’AR-C, alors que l’agrégation n’a pas été affectée. Ainsi, aucune corrélation positive et significative entre l’agrégation plaquettaire et la libération de BDNF n’a pu être obtenue. La présence des antiplaquettaires réduits à différents degrés la libération de BDNF chez les différents groupes des patients, malgré que son expression intraplaquettaire était similaire entre les groupes. On remarque que les antiplaquettaires réduisent plus significativement la quantité du BDNF relâchée chez les patients sous mono ou double thérapie antiplaquettaire en comparaison avec les volontaires sains et les patients atteints de maladies valvulaires. Nous avons aussi démontré que le BDNF exogène active les plaquettes isolées et lavées chez les volontaires sains, en induisant une forte agrégation stable et irréversible. Par contre, le BDNF exogène n’arrive pas à agréger les plaquettes en plasma riche en plaquettes. De plus, nos résultats indiquent que la forme tronquée du récepteur BDNF, le TrKB, est exprimée au niveau des plaquettes de volontaires sains. L’inhibition de l’activité kinase du TrKB abolit l’agrégation induite par le BDNF. Ces résultats suggèrent que l’action du BDNF dans les plaquettes lavées pourrait passer par l’intermédiaire du TrKB. Cette étude nous permet de conclure que le BDNF est présent dans les plaquettes et est libéré suite à l’activation plaquettaire et que cette libération est réduite par les antiplaquettaires. Cependant, l’agrégation plaquettaire ne semble pas être associée directement à la sécrétion du BDNF, ce qui suggère que d’autres mécanismes sous-jacents pourraient intervenir dans le contrôle de cette sécrétion. Les antiplaquettaires réduisent la libération de BDNF et il semble que l’action pro-agrégante du BDNF sur les plaquettes lavées passe par l’intermédiaire du TrKB, sans exclure la possibilité que d’autres types de récepteurs plaquettaires soient impliqués dans le signal déclenché par le BDNF. L’implication physiopathologique du BDNF libéré suite à l’activation plaquettaire ou sa biodisponibilité en présence des antiplaquettaires au niveau cardiovasculaire reste à être élucidée afin de révéler son potentiel diagnostique ou thérapeutique. / Platelets are considered one of the most important reservoirs not only of growth factors but also of neurotrophic factors that may contribute to the repair of vascular lesions and prevention of neurological deterioration. Among these factors, the Brain-Derived Neurotrophic Factor (BDNF), a protein belonging to the neurotrophin family, is largely expressed in both the hippocampus and platelets. In fact, platelets constitute an important reservoir of BDNF; however, little is known about the factors controlling its release into the circulation and whether antiplatelet drugs affect this secretion. Henceforth, the main hypothesis of this project is that platelet activation pathways lead to BDNF release which is affected by antiplatelet agents. For this purpose, platelets were isolated from the blood of four groups of human subjects following their consent. Group 1 consisted of healthy volunteers; Group 2 and Group 3 consisted of patients with stable cardiovascular disease on, respectively, dual antiplatelet therapy (aspirin + P2Y12 receptor antagonist) or monotherapy (aspirin) as secondary prevention; and Group 4 consisted of patients with valvular disease or cardiomyopathy who are not on antiplatelet therapy. Platelet aggregation was studied by optical aggregometry in response to the following agonists: adenosine diphosphate (ADP), arachidonic acid (AA), epinephrine, collagen, and thrombin-receptor activated peptide 6 (TRAP-6 amide). The antiplatelet agents that were tested antagonize cyclooxygenase-1 (COX-1) (acetylsalicylic acid (ASA) or aspirin), ADP P2Y12 receptor (AR-C), and fibrinogen receptor αIIbβ3 (Abciximab). BDNF release was quantified by ELISA. BDNF protein and its Tropomyosin-Related Kinase Receptor Type B (TrKB) receptor were detected by immunoblotting. Our results show that platelet activation in response to several agonists tested induced 80% platelet aggregation and augmented BDNF release by 5 folds, from 2500 pg / 250 x 106 platelets at baseline to approximately 13000 pg / 250 x 106 after stimulation. Moreover, all the tested antiplatelet agents reduced the release of BDNF by stimulated platelets. However, the level of reduction varied differentially between platelet antagonists depending on the platelet agonist used. Indeed, ASA significantly reduced BDNF secretion in response to AA, epinephrine, and TRAP-6, whereas AR-C was more effective in response to ADP, AA, and epinephrine. Abciximab inhibited BDNF secretion as well as platelet aggregation in response to all agonists. Noteworthy, the release of BDNF in response to collagen was inhibited by ASA and AR-C, while platelet aggregation was not affected. Accordingly, no significant correlation between platelet aggregation and BDNF release could be obtained. Although intra-platelet expression was similar in the different groups, the presence of antiplatelet agents reduced the release of BDNF to varying degrees between groups. As such, antiplatelet agents reduced BDNF release more significantly in patients on dual or mono antiplatelet therapy (Groups 2 and 3) as compared to healthy volunteers (Group 1) and valvular disease patients (Group 4). We have also shown that exogenous BDNF activated isolated/washed platelets from healthy volunteers, inducing strong, stable, and irreversible aggregation. In contrast, exogenous BDNF could not induce aggregation of platelets in platelet-rich plasma. In addition, our results indicate that the truncated form of the BDNF receptor, TrKB, is expressed in platelets of healthy volunteers. Hence, the inhibition of TrKB kinase activity abolished BDNF-induced aggregation. These results suggest that the action of BDNF in washed platelets might ensue through TrKB. We conclude from this study that BDNF is present in platelets and released following platelet activation, and its release is reduced by antiplatelet agents. However, platelet aggregation does not appear to be directly associated with BDNF secretion, suggesting that other underlying mechanisms may be involved in controlling its secretion. Antiplatelet agents reduce the release of BDNF, and it appears that the pro-aggregating action of BDNF on washed platelets ensues, non-exclusively, through TrKB, which means that other types of platelet receptors may also be involved in BDNF signaling. The pathophysiological implication of BDNF released following platelet activation or its bioavailability in the presence of antiplatelet agents in the cardiovascular system thus remain to be elucidated in order to reveal its diagnostic or therapeutic potential.

Alcohol represents the third leading cause of preventable death in the United States. Yet, despite its prevalent role in impeding human health, there is much to understand about how it elicits its effects on the body and how the body and brain change when an individual becomes physiologically dependent upon alcohol. The work presented herein represents an effort to elucidate the acute and chronic effects of alcohol on the nervous system. We investigate two specific protein pathways and their role in alcohol's effects on the body. The first begins with brain-derived neurotrophic factor (BDNF), which acts on TrkB, and ends with KCC2. We demonstrate that BDNF expression is increased in the VTA during withdrawal from chronic but not acute alcohol exposure and that this increase persists for at least seven days. Concomitantly, we demonstrate that the activation of GABAA channels on produces less inhibition of VTA GABA neurons in mice treated with chronic intermittent ethanol exposure than in alcohol naïve mice. This effect likewise persisted for at least seven days. We illustrate that BDNF has no apparent direct effect on VTA GABA neuron firing rate. The second pathway begins with the T cell marker CD5 and ends with the anti-inflammatory cytokine, IL-10. We demonstrate that in a genetic CD5 knockout (CD5 KO) mouse model both alcohol consumption as well as the sedative properties of alcohol are reduced. Since CD+ B cells secrete more IL-10 than CD5- B cells, we also demonstrate the effects of IL-10 on VTA neurons. We show that IL-10 has direct effects on VTA dopamine (DA) neurons by increasing their firing activity. We relatedly illustrate that IL-10 produces an increase in DA release in the nucleus accumbens (NAc). However, contrary to our hypotheses, we show that IL-10 produces conditioned place aversion rather than conditioned place preference in a place conditioning paradigm, suggesting that IL-10 might mediate pain-induced secretions of DA. Collectively, these results suggest two potential therapeutic targets to reduce alcohol consumption that need further validation. They also suggest a novel mechanism for the sedative effects of alcohol at moderate and high doses.