Hereditary tyrosinemia type 1 (HT1) is an autosomal recessive disorder of the tyrosine degradation pathway. The defective fumarylacetoacetate hydrolase enzyme causes the accumulation of upstream metabolites such as fumarylacetoacetate (FAA), maleylacetoacetate (MAA), succinylacetone (SA) and p-hydroxyphenylpyruvic acid (pHPPA). In vitro and in vivo studies showed that the accumulation of these metabolites are detrimental to cell homeostasis, by inducing cell cycle arrest, apoptosis, and endoplasmic reticulum stress, depleting GSH, inhibiting DNA ligase, causing chromosomal instability, etc. For in vivo studies different models of HT1 were developed. Most notably was the fah deficient mouse, whose neonatally lethal phenotype is rescued by the administration of 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione (NTBC). Although, this model most closely resembles the human phenotype with elevated tyrosine levels and the development of hepatocellular carcinoma (HCC), the model is not human genome based. Both the in vitro and in vivo studies suggested that DNA repair is affected in HT1. However, it is not yet clear which DNA repair mechanisms are affected and if only protein functionality is affected, or if expression of DNA repair proteins are also affected. Characteristic of HT1 is the high prevalence of HCC and the presence of liver mosaicism. The liver mosaicism observed in HT1 patients are the result of reversion of the inherited mutation to wild-type. The general consensus is that the reversion is the result of a true back mutation. However, the mechanism underlying the back mutation is still unresolved. It was suggested that cancer develops either through a chromosomal instability mutator phenotype, a microsatellite instability mutator phenotype, or a point mutation instability mutator phenotype. In HT1 only chromosomal instability was reported. The aims of this study were to contribute to the understanding of the molecular basis of the genetic mosaicism in hereditary tyrosinemia type 1. More specifically, determine whether baseand nucleotide DNA repair mechanisms are affected and to what extent, and to determine if microsatellite instability is found in HT1. To achieve these aims, a parallel approach was followed: i.e. to develop a HT1 hepatic cell model and to use HT1 related models and HT1 patient material. To assess the molecular basis of the genetic mosaicism in HT1, the comet assay, gene expression assays, microsatellite instability assays, high resolution melting and dideoxy sequencing techniques were employed. Results from the comet assay showed that the HT1 accumulating metabolites, SA and pHPPA, decreased the capacity of cells for base- and nucleotide excision repair. Gene expression assays showed that short term exposure to SA and/or pHPPA do not affect expression of hOGG1 or ERCC1. The expression of these genes were, however, low in HT1 patient samples. Microsatellite instability assays showed allelic imbalance on chromosome 7 of the mouse genome, and microsatellite instability in the lymphocytes of HT1 patients. Although high resolution melt and sequencing results did not reveal any de novo mutations in fah or hprt1, the appearance of de novo mutations on other parts of the genome can not be ruled out. To conclude, results presented in this thesis, for the first time show that in HT1 the initiating proteins of the base- and nucleotide repair mechanisms are affected, the gene expression of DNA repair proteins are low, and microsatellite instability is found in HT1. By contributing to the elucidation of the mechanism underlying the development of HT1-associated HCC, and providing evidence for the development of a mutator phenotype, the results presented in this thesis contributes to the understanding of the molecular mechanisms underlying the genetic mosaicism in HT1. In addition to these contributions, a hypothesis is posited, which suggests that a point mutation instability (PIN) mutator phenotype is the mechanism underlying the mutation reversions seen in HT1. / Thesis (Ph.D. (Biochemistry))--North-West University, Potchefstroom Campus, 2012

Hereditary tyrosinemia type 1 (HT1) is an autosomal recessive disorder of the tyrosine degradation pathway. The defective fumarylacetoacetate hydrolase enzyme causes the accumulation of upstream metabolites such as fumarylacetoacetate (FAA), maleylacetoacetate (MAA), succinylacetone (SA) and p-hydroxyphenylpyruvic acid (pHPPA). In vitro and in vivo studies showed that the accumulation of these metabolites are detrimental to cell homeostasis, by inducing cell cycle arrest, apoptosis, and endoplasmic reticulum stress, depleting GSH, inhibiting DNA ligase, causing chromosomal instability, etc. For in vivo studies different models of HT1 were developed. Most notably was the fah deficient mouse, whose neonatally lethal phenotype is rescued by the administration of 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione (NTBC). Although, this model most closely resembles the human phenotype with elevated tyrosine levels and the development of hepatocellular carcinoma (HCC), the model is not human genome based. Both the in vitro and in vivo studies suggested that DNA repair is affected in HT1. However, it is not yet clear which DNA repair mechanisms are affected and if only protein functionality is affected, or if expression of DNA repair proteins are also affected. Characteristic of HT1 is the high prevalence of HCC and the presence of liver mosaicism. The liver mosaicism observed in HT1 patients are the result of reversion of the inherited mutation to wild-type. The general consensus is that the reversion is the result of a true back mutation. However, the mechanism underlying the back mutation is still unresolved. It was suggested that cancer develops either through a chromosomal instability mutator phenotype, a microsatellite instability mutator phenotype, or a point mutation instability mutator phenotype. In HT1 only chromosomal instability was reported. The aims of this study were to contribute to the understanding of the molecular basis of the genetic mosaicism in hereditary tyrosinemia type 1. More specifically, determine whether baseand nucleotide DNA repair mechanisms are affected and to what extent, and to determine if microsatellite instability is found in HT1. To achieve these aims, a parallel approach was followed: i.e. to develop a HT1 hepatic cell model and to use HT1 related models and HT1 patient material. To assess the molecular basis of the genetic mosaicism in HT1, the comet assay, gene expression assays, microsatellite instability assays, high resolution melting and dideoxy sequencing techniques were employed. Results from the comet assay showed that the HT1 accumulating metabolites, SA and pHPPA, decreased the capacity of cells for base- and nucleotide excision repair. Gene expression assays showed that short term exposure to SA and/or pHPPA do not affect expression of hOGG1 or ERCC1. The expression of these genes were, however, low in HT1 patient samples. Microsatellite instability assays showed allelic imbalance on chromosome 7 of the mouse genome, and microsatellite instability in the lymphocytes of HT1 patients. Although high resolution melt and sequencing results did not reveal any de novo mutations in fah or hprt1, the appearance of de novo mutations on other parts of the genome can not be ruled out. To conclude, results presented in this thesis, for the first time show that in HT1 the initiating proteins of the base- and nucleotide repair mechanisms are affected, the gene expression of DNA repair proteins are low, and microsatellite instability is found in HT1. By contributing to the elucidation of the mechanism underlying the development of HT1-associated HCC, and providing evidence for the development of a mutator phenotype, the results presented in this thesis contributes to the understanding of the molecular mechanisms underlying the genetic mosaicism in HT1. In addition to these contributions, a hypothesis is posited, which suggests that a point mutation instability (PIN) mutator phenotype is the mechanism underlying the mutation reversions seen in HT1. / Thesis (Ph.D. (Biochemistry))--North-West University, Potchefstroom Campus, 2012

A deficiência da semi-aldeído succínico desidrogenase (SSADH) e a tirosinemia tipo II caracterizam-se pela presença de elevadas concentrações teciduais e plasmáticas de ácido γ-hidroxibutírico (GHB) e tirosina, respectivamente. Tanto os pacientes afetados pela deficiência da SSADH quanto aqueles com tirosinemia tipo II apresentam sinais e sintomas neurológicos. Embora os mecanismos responsáveis pela disfunção neurológica sejam pouco conhecidos, sabe-se que podem estar relacionados ao acúmulo de GHB e tirosina e seus possíveis efeitos tóxicos sobre o sistema nervoso central (SNC). Considerando ainda que o estresse oxidativo parece estar envolvido em diversas doenças ou alterações patológicas que afetam o SNC, os efeitos do GHB e da L-tirosina sobre vários parâmetros de estresse oxidativo foram investigados em homogeneizados de córtex cerebral de ratos jovens. Os efeitos in vivo do GHB, ou de seu precursor 1,4-butanodiol, foram semelhantes. Ambos mostraram comprometimento das defesas antioxidantes não-enzimáticas e indução da lipoperoxidação. Os efeitos in vitro e in vivo da L-tirosina, por sua vez, foram diferentes: in vitro, a L-tirosina provocou dano oxidativo ao DNA, diminuiu as defesas antioxidantes não-enzimáticas e enzimáticas e alterou o estado redox (razão SH/SS), enquanto que a administração aguda de L-tirosina causou dano oxidativo a lipídios e proteínas, modificou a razão SH/SS, diminuiu as defesas antioxidantes não-enzimáticas e estimulou a atividade da glicose-6-fosfato desidrogenase. Esses resultados sugerem que o GHB e a L-tirosina são capazes de promover o estresse oxidativo em córtex cerebral de ratos jovens. Desta forma, caso esses mesmos efeitos ocorrerem em seres humanos, é provável que o estresse oxidativo seja um dos mecanismos responsáveis pela neuropatologia característica da deficiência da SSADH e tirosinemia tipo II. / Succinic semialdehyde dehydrogenase (SSADH) deficiency and tyrosinemia type II are characterized by predominant tissue and blood accumulation of γ-hydroxybutyric acid (GHB) and tyrosine, respectively. Patients with SSADH deficiency and tyrosinemia type II present neurological signs and symptoms. Although mechanisms of brain damage remain unclear, they are probably related to the accumulation of GHB or tyrosine leading to possible noxious effects on central nervous system (CNS) development in those patients. Considering that the damaging consequences of oxidative stress have been implicated in a variety of disorders of CNS, the effect of GHB and L-tyrosine were investigated on some oxidative stress parameters in cerebral cortex homogenates of young rats. The in vitro and in vivo effects of GHB, or its precursor 1,4-butanediol (1,4-BD), were similar. It was observed that GHB or 1,4-BD impairs non-enzymatic antioxidant defenses and induces lipid peroxidation. On the other hand, the in vitro and in vivo effects of L-tyrosine were different. Oxidative damage to DNA was promoted while non-enzymatic and enzymatic antioxidant defenses, and thiol-disulfide redox state (SH/SS ratio) were markedly diminished by L-tyrosine in vitro. In contrast, the acute administration of L-tyrosine causes lipid peroxidation and protein oxidation, decreases non-enzymatic antioxidant defenses, alters SH/SS ratio and stimulates glucose-6-phosphate dehydrogenase activity. Taken together, it may be presumed that GHB and L-tyrosine elicit oxidative stress in cerebral cortex of young rats. If these effects also occur in the brain of patients affected by SSADH deficiency or tyrosinemia type II, it is possible that oxidative stress may contribute, at least in part, to the neurological dysfunction characteristic of these diseases.

A deficiência da semi-aldeído succínico desidrogenase (SSADH) e a tirosinemia tipo II caracterizam-se pela presença de elevadas concentrações teciduais e plasmáticas de ácido γ-hidroxibutírico (GHB) e tirosina, respectivamente. Tanto os pacientes afetados pela deficiência da SSADH quanto aqueles com tirosinemia tipo II apresentam sinais e sintomas neurológicos. Embora os mecanismos responsáveis pela disfunção neurológica sejam pouco conhecidos, sabe-se que podem estar relacionados ao acúmulo de GHB e tirosina e seus possíveis efeitos tóxicos sobre o sistema nervoso central (SNC). Considerando ainda que o estresse oxidativo parece estar envolvido em diversas doenças ou alterações patológicas que afetam o SNC, os efeitos do GHB e da L-tirosina sobre vários parâmetros de estresse oxidativo foram investigados em homogeneizados de córtex cerebral de ratos jovens. Os efeitos in vivo do GHB, ou de seu precursor 1,4-butanodiol, foram semelhantes. Ambos mostraram comprometimento das defesas antioxidantes não-enzimáticas e indução da lipoperoxidação. Os efeitos in vitro e in vivo da L-tirosina, por sua vez, foram diferentes: in vitro, a L-tirosina provocou dano oxidativo ao DNA, diminuiu as defesas antioxidantes não-enzimáticas e enzimáticas e alterou o estado redox (razão SH/SS), enquanto que a administração aguda de L-tirosina causou dano oxidativo a lipídios e proteínas, modificou a razão SH/SS, diminuiu as defesas antioxidantes não-enzimáticas e estimulou a atividade da glicose-6-fosfato desidrogenase. Esses resultados sugerem que o GHB e a L-tirosina são capazes de promover o estresse oxidativo em córtex cerebral de ratos jovens. Desta forma, caso esses mesmos efeitos ocorrerem em seres humanos, é provável que o estresse oxidativo seja um dos mecanismos responsáveis pela neuropatologia característica da deficiência da SSADH e tirosinemia tipo II. / Succinic semialdehyde dehydrogenase (SSADH) deficiency and tyrosinemia type II are characterized by predominant tissue and blood accumulation of γ-hydroxybutyric acid (GHB) and tyrosine, respectively. Patients with SSADH deficiency and tyrosinemia type II present neurological signs and symptoms. Although mechanisms of brain damage remain unclear, they are probably related to the accumulation of GHB or tyrosine leading to possible noxious effects on central nervous system (CNS) development in those patients. Considering that the damaging consequences of oxidative stress have been implicated in a variety of disorders of CNS, the effect of GHB and L-tyrosine were investigated on some oxidative stress parameters in cerebral cortex homogenates of young rats. The in vitro and in vivo effects of GHB, or its precursor 1,4-butanediol (1,4-BD), were similar. It was observed that GHB or 1,4-BD impairs non-enzymatic antioxidant defenses and induces lipid peroxidation. On the other hand, the in vitro and in vivo effects of L-tyrosine were different. Oxidative damage to DNA was promoted while non-enzymatic and enzymatic antioxidant defenses, and thiol-disulfide redox state (SH/SS ratio) were markedly diminished by L-tyrosine in vitro. In contrast, the acute administration of L-tyrosine causes lipid peroxidation and protein oxidation, decreases non-enzymatic antioxidant defenses, alters SH/SS ratio and stimulates glucose-6-phosphate dehydrogenase activity. Taken together, it may be presumed that GHB and L-tyrosine elicit oxidative stress in cerebral cortex of young rats. If these effects also occur in the brain of patients affected by SSADH deficiency or tyrosinemia type II, it is possible that oxidative stress may contribute, at least in part, to the neurological dysfunction characteristic of these diseases.

A deficiência da semi-aldeído succínico desidrogenase (SSADH) e a tirosinemia tipo II caracterizam-se pela presença de elevadas concentrações teciduais e plasmáticas de ácido γ-hidroxibutírico (GHB) e tirosina, respectivamente. Tanto os pacientes afetados pela deficiência da SSADH quanto aqueles com tirosinemia tipo II apresentam sinais e sintomas neurológicos. Embora os mecanismos responsáveis pela disfunção neurológica sejam pouco conhecidos, sabe-se que podem estar relacionados ao acúmulo de GHB e tirosina e seus possíveis efeitos tóxicos sobre o sistema nervoso central (SNC). Considerando ainda que o estresse oxidativo parece estar envolvido em diversas doenças ou alterações patológicas que afetam o SNC, os efeitos do GHB e da L-tirosina sobre vários parâmetros de estresse oxidativo foram investigados em homogeneizados de córtex cerebral de ratos jovens. Os efeitos in vivo do GHB, ou de seu precursor 1,4-butanodiol, foram semelhantes. Ambos mostraram comprometimento das defesas antioxidantes não-enzimáticas e indução da lipoperoxidação. Os efeitos in vitro e in vivo da L-tirosina, por sua vez, foram diferentes: in vitro, a L-tirosina provocou dano oxidativo ao DNA, diminuiu as defesas antioxidantes não-enzimáticas e enzimáticas e alterou o estado redox (razão SH/SS), enquanto que a administração aguda de L-tirosina causou dano oxidativo a lipídios e proteínas, modificou a razão SH/SS, diminuiu as defesas antioxidantes não-enzimáticas e estimulou a atividade da glicose-6-fosfato desidrogenase. Esses resultados sugerem que o GHB e a L-tirosina são capazes de promover o estresse oxidativo em córtex cerebral de ratos jovens. Desta forma, caso esses mesmos efeitos ocorrerem em seres humanos, é provável que o estresse oxidativo seja um dos mecanismos responsáveis pela neuropatologia característica da deficiência da SSADH e tirosinemia tipo II. / Succinic semialdehyde dehydrogenase (SSADH) deficiency and tyrosinemia type II are characterized by predominant tissue and blood accumulation of γ-hydroxybutyric acid (GHB) and tyrosine, respectively. Patients with SSADH deficiency and tyrosinemia type II present neurological signs and symptoms. Although mechanisms of brain damage remain unclear, they are probably related to the accumulation of GHB or tyrosine leading to possible noxious effects on central nervous system (CNS) development in those patients. Considering that the damaging consequences of oxidative stress have been implicated in a variety of disorders of CNS, the effect of GHB and L-tyrosine were investigated on some oxidative stress parameters in cerebral cortex homogenates of young rats. The in vitro and in vivo effects of GHB, or its precursor 1,4-butanediol (1,4-BD), were similar. It was observed that GHB or 1,4-BD impairs non-enzymatic antioxidant defenses and induces lipid peroxidation. On the other hand, the in vitro and in vivo effects of L-tyrosine were different. Oxidative damage to DNA was promoted while non-enzymatic and enzymatic antioxidant defenses, and thiol-disulfide redox state (SH/SS ratio) were markedly diminished by L-tyrosine in vitro. In contrast, the acute administration of L-tyrosine causes lipid peroxidation and protein oxidation, decreases non-enzymatic antioxidant defenses, alters SH/SS ratio and stimulates glucose-6-phosphate dehydrogenase activity. Taken together, it may be presumed that GHB and L-tyrosine elicit oxidative stress in cerebral cortex of young rats. If these effects also occur in the brain of patients affected by SSADH deficiency or tyrosinemia type II, it is possible that oxidative stress may contribute, at least in part, to the neurological dysfunction characteristic of these diseases.

Occupational risk management can be a catalyst in generating superior returns for all stakeholders on a sustainable basis. A number of companies in South Africa have implemented Cardinal Rules of Safety adopted from international companies to ensure the safety of their employees. The purpose of this study was to measure the impact of the cardinal rules on employee safety behaviour implemented at power stations in Mpumalanga. The empirical study was done by using a questionnaire as measuring instrument. The questionnaire was developed from a literature review and contains questions and items relevant to the initial research problem. The questionnaire comprised of five–point Likert scale type questions.The convenience sampling method was applied identifying 90 participants at three different power stations in Mpumalanga taking part in the study. Statistical analysis was performed by the Statistical Consulting Service of the North–West University using SPSS. Cronbach’s alpha co–efficients was used to determine the reliability of the factors. Descriptive statistics (Mean, standard, deviation, were used in the compiling of the profile of the results. While Spearman’s rho correlation coefficient was calculated to identify practically significant associations between variables and factors The research findings suggest that there is practical significant correlation between the factors that were measured. The opinion given by respondents suggests that cardinal rules of safety were implemented, given all the necessary support by management and enforced throughout the organisation. / Thesis (Ph.D. (Biochemistry))--North-West University, Potchefstroom Campus, 2012.

Occupational risk management can be a catalyst in generating superior returns for all stakeholders on a sustainable basis. A number of companies in South Africa have implemented Cardinal Rules of Safety adopted from international companies to ensure the safety of their employees. The purpose of this study was to measure the impact of the cardinal rules on employee safety behaviour implemented at power stations in Mpumalanga. The empirical study was done by using a questionnaire as measuring instrument. The questionnaire was developed from a literature review and contains questions and items relevant to the initial research problem. The questionnaire comprised of five–point Likert scale type questions.The convenience sampling method was applied identifying 90 participants at three different power stations in Mpumalanga taking part in the study. Statistical analysis was performed by the Statistical Consulting Service of the North–West University using SPSS. Cronbach’s alpha co–efficients was used to determine the reliability of the factors. Descriptive statistics (Mean, standard, deviation, were used in the compiling of the profile of the results. While Spearman’s rho correlation coefficient was calculated to identify practically significant associations between variables and factors The research findings suggest that there is practical significant correlation between the factors that were measured. The opinion given by respondents suggests that cardinal rules of safety were implemented, given all the necessary support by management and enforced throughout the organisation. / Thesis (Ph.D. (Biochemistry))--North-West University, Potchefstroom Campus, 2012.

Réalisé dans le cadre d'un mandat de l'Unité d'évaluation des technologies et des modes d'intervention en santé (UETMIS) du CHU Sainte-Justine / Introduction : La tyrosinémie de type I est une maladie génétique sévère. Elle se caractérise par des manifestations hépatiques, rénales et neurologiques. Depuis 1994, le NTBC représente la thérapie de première ligne. Ce médicament a conduit à une amélioration radicale de la morbidité et du pronostic de la maladie. Objectif : Évaluer les coûts directs des soins de santé reliés au traitement de cette maladie. Cette évaluation économique a été effectuée en trois groupes dont, un groupe historique de patients non traités; un groupe traitement tardif et un groupe traitement précoce par NTBC. Méthode : L’analyse coûts-conséquences inclut les coûts des hospitalisations, des services médicaux et des thérapies associées. Les données proviennent des banques de la RAMQ, de Med-Echo et des dossiers hospitaliers. Résultats : Le NTBC est associé à une réduction significative des hospitalisations, des séjours aux soins intensifs et des greffes hépatiques. Les coûts hospitaliers sont significativement moindres pour les groupes traités (13 979 $, 6 347 $ et 673 $ par année-patient pour les groupes historique, traitement tardif et traitement précoce,respectivement; valeur p < 0,0001). Les coûts des hospitalisations pour greffes par année-patient sont de 4 676$ pour le groupe historique et de 3 567 $ pour le groupe traitement tardif. Les coûts du NTBC par année-patient sont de 66 965 $ et de 51 493 $ pour les groupes traitement tardif et traitement précoce, respectivement. Conclusion : Les résultats démontrent l’impact majeur du NTBC sur la réduction de l’utilisation des ressources de santé, des greffes hépatiques et des coûts associés. / Introduction : Tyrosinemia type I is a severe genetic disorder. Symptoms include hepatic,renal and neurological manifestations. NTBC became the first-line therapy in 1994. This drug has led to a drastic improvement in the prognosis. Objective : To evaluate direct medical costs of healthcare services related to the treatment for this disease. This economic evaluation was conducted among the 3 following groups: an historical group of untreated patients, a late-treatment group and an early-treatment group with NTBC. Methods : The costs-consequences analysis includes costs incurred by hospitalizations, medical services and related treatments. Data are derived from the RAMQ and Med-Echo administrative databases and patients’ hospital charts. Results : NTBC treatment is associated with a significant reduction in hospitalizations, intensive care unit stays and liver transplantations. The cost of hospitalizations is significantly less for both treated groups (13,979 $, 6,347 $ and 673 $ per year-patient for the historical group, the late-treatment and the early-treatment group, respectively; pvalue< 0,0001). The cost of hospitalizations for liver transplantations per year-patient is 4,676 $ for the historical group and 3,567 $ for the late-treatment group. The cost of NTBC per year-patient is 66,965$ and 51,493$ for the late-treatment and the earlytreatment groups, respectively. Conclusion : These results demonstrate that NTBC treatment results in a major reduction in healthcare resources utilization, liver transplantations and associated costs.

Para otimizar um modelo experimental para o estudo do desbalanço redox em porfirias relacionadas ao acúmulo de ácido 5-aminolevulínico-(ALA), via inibição da ALA desidratase-(ALA-D), ratos foram tratados com o éster metílico de succinilacetona-(SAME), um catabólito da tirosina que inibe fortemente a ALA-O, mimetízando o estado metabólico observado nos portadores de portirias e tirosinemias. Estabeleceram-se modelos de tratamento agudo por 36 e 18 h. No primeiro, os animais receberam 3 injeções de SAME (10, 40 ou 80 mg/kg, grupos Ali-IV). No segundo, os animais receberam 3 injeções de 40 mg/kg de SAME, ALA ou éster metílico de ALA (grupos BII-IV), ALA:SAME (30: 10 mg/kg, grupo BV), ou 10 mg/kg SAME (grupo BVI). Paralelamente, avaliou-se se os sintomas neurológicos característicos das portirias decorriam de danos oxidativos mitocondriais. Para isso, aplicou-se uma tecnologia óptica para medidas da difusão da depressão cortical que determinou a oxigenação e o estado redox do cit c em mitocôndrias do córtex cerebral de ratos submetidos ao tratamento crônico com ALA (40 mg/kg), SAME (10 e 40 mg/kg) e ALA:SAME (30: 1O mg/kg), a cada 48 h, durante 30 dias. Tratamento agudo/36 h: Os níveis de ALA no plasma, fígado, cérebro e urina e o clearance renal do ALA aumentaram nos grupos tratados. A atividade de ALA-D e a coproporfirina urinária reduziram. A marcação para proteínas carboniladas, ferro e ferritina aumentou no fígado e cérebro dos grupos tratados, especialmente no All. Os níveis de malondialdeído hepático aumentaram no grupo AIV. A razão GSH/GSH+GSSG e a atividade de GPx cerebrais aumentaram nos grupos AIV e AIII, respectivamente. Consistentemente com estes dados indicando um desbalanço oxidativo induzido pelo SAME, alterações mitocondriais e citosólicas ultraestruturais foram reveladas, especialmente no fígado. Tratamento agudo/18 h: Os níveis de ALA plasmáticos aumentaram nos grupos tratados, exceto em BIV. O grupo BII mostrou aumento dos níveis hepáticos de ALA. Interessantemente, a inibição da atividade de ALA-D não foi evidenciada. O conteúdo de ferro plasmático aumentou no grupo BII. Para os grupos tratados com 10 e 40 mg SAME/kg, a atividade de SOD hepática reduziu ~50% com a extensão do tratamento de 18 para 36 h, sugerindo que este último é mais efetivo em promover danos oxidativos induzidos pelo ALA. Tratamento crônico/30 dias: Embora nenhuma alteração tenha sido evidenciada no estado redox dos animais tratados, o tratamento com ALA reduziu o fluxo sanguíneo cerebral (CBF) e o consumo de oxigênio-(CMRO2), sugerindo uma vasoconstrição mediada pelo ALA, efeito este confirmado por ensaios de reatividade vascular conduzidos em anéis de aorta de ratos incubados com ALA. O tratamento com ALA:SAME restaurou os níveis de CBF e CMRO2. Interessantemente, a disponibilidade do radical superóxido-(O2&#8226;-) estava reduzida nos anéis de aorta incubados com ALA. Juntos, estes dados: a)validam o modelo de tratamento agudo/36 h para o estudo bioquímico e dos possíveis efeitos fisiológicos induzidos pelo ALA, e b)sugerem que as alterações mediadas pelo ALA exógeno levam à vasoconstrição. / To optimize an experimental model for studying redox imbalance in porphyrias related to 5-aminolevulinic acid (ALA) accumulation through the inhibition of ALA dehydratase (ALA-D), rats were treated with methyl ester of succinylacetone (SAME), a tyrosine catabolite that strongly inhibits ALA-D, what mimics the metabolic state observed in patients suffering from porphyrías and tyrosinemias. Models of acute treatment were established during 36 and 18 h. In the first model, animals received 3 injections of SAME (10, 40 or 80 mg/kg, groups Ali-IV). In the second model, animals received 3 injections of 40 mg/kg SAME, ALA or methyl ester of ALA (groups BII-IV), ALA:SAME (30:10 mg/kg, group BV), or 10 mg/kg SAME (group BVI). Concomitantly, we evaluated if the neurologic symptoms characteristics of porphyrias were a consequence of the oxidative mitochondrial impairment. For this, an optical technology for the measurement of cortical spreading depression was applied. This techonology determined the cerebral oxygenation and the redox state of cit c in mitochondria of the cerebral cortex of rats submitted to a chronic treatment with ALA (40 mg/kg), SAME (10 and 40 mg/kg) and ALASAME (30:10 mg/kg), alternate days, during 30 days. Acute treatment/36 h: ALA levels in plasma, liver and urine and clearance of renal ALA increased in treated groups. ALA-D activities and urinary coproporphyrin were found to be decreased. Liver and brain proteins carbonyl, iron and ferritin were higher in the liver of treated groups, especially in All. Liver malondialdehyde levels were higher in group AIV. Cerebral GSH/GSH+GSSG ratio and GPx activities increased in groups AIV and AIII, respectively. Consistently with these data indicating SAME-induced oxidative imbalance, mitochondrial and cytosolic ultrastructural changes were revealed, especially in the liver. Acute treatment/18 h: Plasma ALA levels increased in all treated groups but BIV. Group BII showed increased hepatic ALA levels. Interestingly, inhibition in ALA-D activities was not evidenced. Plasma iron content increased in group BII. For the groups treated with 10 and 40 mg SAME/kg, liver SOD activities reduced ~50% by extending the treatment from 18 to 36 h, suggesting that the latter is more effective in ALA-induced oxidative damage. Chronic treatment /30 days: Despite no changes in the redox state of treated animals were observed, the treatment with ALA reduced the cerebral blood flow (CBF) and the consumption of oxygen (CMRO2), suggesting a vasoconstriction mediated by ALA. This effetc was confirmed by vascular reactivity assay performed in aortic rings of rats incubated with ALA. The treatment with ALA:SAME recovered the CBF and CMRO2 levels. Interestingly, the availability of superoxide radical (O2&#8226;-) was reduced in the aortic rings incubated with ALA. Altogether, these data a) validate the model of acute treatment/36 h for studying biochemical and possibly physiological effects induced by ALA, and b)suggest that the changes mediated by exogenous ALA lead to vasoconstriction.

Introduction : La tyrosinémie de type I est une maladie génétique sévère. Elle se caractérise par des manifestations hépatiques, rénales et neurologiques. Depuis 1994, le NTBC représente la thérapie de première ligne. Ce médicament a conduit à une amélioration radicale de la morbidité et du pronostic de la maladie. Objectif : Évaluer les coûts directs des soins de santé reliés au traitement de cette maladie. Cette évaluation économique a été effectuée en trois groupes dont, un groupe historique de patients non traités; un groupe traitement tardif et un groupe traitement précoce par NTBC. Méthode : L’analyse coûts-conséquences inclut les coûts des hospitalisations, des services médicaux et des thérapies associées. Les données proviennent des banques de la RAMQ, de Med-Echo et des dossiers hospitaliers. Résultats : Le NTBC est associé à une réduction significative des hospitalisations, des séjours aux soins intensifs et des greffes hépatiques. Les coûts hospitaliers sont significativement moindres pour les groupes traités (13 979 $, 6 347 $ et 673 $ par année-patient pour les groupes historique, traitement tardif et traitement précoce,respectivement; valeur p < 0,0001). Les coûts des hospitalisations pour greffes par année-patient sont de 4 676$ pour le groupe historique et de 3 567 $ pour le groupe traitement tardif. Les coûts du NTBC par année-patient sont de 66 965 $ et de 51 493 $ pour les groupes traitement tardif et traitement précoce, respectivement. Conclusion : Les résultats démontrent l’impact majeur du NTBC sur la réduction de l’utilisation des ressources de santé, des greffes hépatiques et des coûts associés. / Introduction : Tyrosinemia type I is a severe genetic disorder. Symptoms include hepatic,renal and neurological manifestations. NTBC became the first-line therapy in 1994. This drug has led to a drastic improvement in the prognosis. Objective : To evaluate direct medical costs of healthcare services related to the treatment for this disease. This economic evaluation was conducted among the 3 following groups: an historical group of untreated patients, a late-treatment group and an early-treatment group with NTBC. Methods : The costs-consequences analysis includes costs incurred by hospitalizations, medical services and related treatments. Data are derived from the RAMQ and Med-Echo administrative databases and patients’ hospital charts. Results : NTBC treatment is associated with a significant reduction in hospitalizations, intensive care unit stays and liver transplantations. The cost of hospitalizations is significantly less for both treated groups (13,979 $, 6,347 $ and 673 $ per year-patient for the historical group, the late-treatment and the early-treatment group, respectively; pvalue< 0,0001). The cost of hospitalizations for liver transplantations per year-patient is 4,676 $ for the historical group and 3,567 $ for the late-treatment group. The cost of NTBC per year-patient is 66,965$ and 51,493$ for the late-treatment and the earlytreatment groups, respectively. Conclusion : These results demonstrate that NTBC treatment results in a major reduction in healthcare resources utilization, liver transplantations and associated costs. / Réalisé dans le cadre d'un mandat de l'Unité d'évaluation des technologies et des modes d'intervention en santé (UETMIS) du CHU Sainte-Justine