Introdução: Ao ser usado o retalho de omento dissecado por videolaparoscopia no tratamento de deformidades da mama, foi constatado um significativo aumento do seu volume nos primeiros meses após a sua transposição, em todas as pacientes operadas, o que não é visto com essa magnitude em nenhum outro retalho adiposo. Métodos: Para se estudar o motivo desse aumento de volume, foram realizados estudos histológicos de amostras de omento coletadas no primeiro tempo cirúrgico, logo após sua transposição da cavidade abdominal para a região mamária e, no segundo tempo cirúrgico, durante a complementação de tratamento para a simetrização das mamas de oito pacientes. Foram documentadas as modificações nas medidas morfométricas dos adipócitos (perímetro, diâmetro e área), na densidade microvascular mediante o marcador endotelial CD31 e na expressão imunohistoquímica do fator de crescimento do endotélio vascular (VEGF). Resultados: O aumento do tamanho dos adipócitos e da densidade microvascular foi estatisticamente significativo (P≤0,012). O valor do VEGF foi menor na segunda amostra em relação com a primeira, redução esta que não atingiu significância considerável (P<0,093). Conclusão: Estes resultados sinalizam um aumento no volume celular que se mostrou consistente quando foram utilizados três diferentes processos de medida: perímetro, diâmetro e área dos adipócitos. Além disso, o aumento do número de vasos na segunda amostra sugere que tenha ocorrido neoangiogênese estimulada pelo aumento inicial dos valores do VEGF. Portanto o aumento do volume do retalho se deve a neovascularização e hipertrofia do adipócito. / Introduction: When laparoscopically harvested omentum flap was used to treat breast deformities, a significant volume increase, which had never been noticed in any other adipose flap, was observed in all the patients in the first months following its transposition. Methods: Histological studies of omentum samples were performed to study the reason for this increase. Samples were harvested at the first surgical time, right after the transposition of the omentum from the abdominal cavity to the breast region, and at the second surgical time, during treatment complementation for breast symmetrization of eight patients submitted to the transposition of the omentum flap. Modifications in the morphometric measurements of the adipocytes (perimeter, diameter, and area), in the microvascular density by the CD31 endothelial marker and in the imunohistochemic expression of VEGF were documented. Results: the increase in adipocyte size and microvascular density was statistically significant (P≤0.012). The value of VEGF was lower in the second sample, which was not significant (P<0.093). Conclusion: These results suggest an increase in cellular volume that was consistent when three different measurement procedures were used: adipocyte perimeter, diameter, and area. Moreover, the increase in the number of vessels in the second sample suggests neoangiogenesis stimulated by the initial increase in VEGF values obtained in the first sample. The flap increase was probably caused by adipocyte hypertrophy, resulting from the neoangiogenesis.

Introdução: Ao ser usado o retalho de omento dissecado por videolaparoscopia no tratamento de deformidades da mama, foi constatado um significativo aumento do seu volume nos primeiros meses após a sua transposição, em todas as pacientes operadas, o que não é visto com essa magnitude em nenhum outro retalho adiposo. Métodos: Para se estudar o motivo desse aumento de volume, foram realizados estudos histológicos de amostras de omento coletadas no primeiro tempo cirúrgico, logo após sua transposição da cavidade abdominal para a região mamária e, no segundo tempo cirúrgico, durante a complementação de tratamento para a simetrização das mamas de oito pacientes. Foram documentadas as modificações nas medidas morfométricas dos adipócitos (perímetro, diâmetro e área), na densidade microvascular mediante o marcador endotelial CD31 e na expressão imunohistoquímica do fator de crescimento do endotélio vascular (VEGF). Resultados: O aumento do tamanho dos adipócitos e da densidade microvascular foi estatisticamente significativo (P≤0,012). O valor do VEGF foi menor na segunda amostra em relação com a primeira, redução esta que não atingiu significância considerável (P<0,093). Conclusão: Estes resultados sinalizam um aumento no volume celular que se mostrou consistente quando foram utilizados três diferentes processos de medida: perímetro, diâmetro e área dos adipócitos. Além disso, o aumento do número de vasos na segunda amostra sugere que tenha ocorrido neoangiogênese estimulada pelo aumento inicial dos valores do VEGF. Portanto o aumento do volume do retalho se deve a neovascularização e hipertrofia do adipócito. / Introduction: When laparoscopically harvested omentum flap was used to treat breast deformities, a significant volume increase, which had never been noticed in any other adipose flap, was observed in all the patients in the first months following its transposition. Methods: Histological studies of omentum samples were performed to study the reason for this increase. Samples were harvested at the first surgical time, right after the transposition of the omentum from the abdominal cavity to the breast region, and at the second surgical time, during treatment complementation for breast symmetrization of eight patients submitted to the transposition of the omentum flap. Modifications in the morphometric measurements of the adipocytes (perimeter, diameter, and area), in the microvascular density by the CD31 endothelial marker and in the imunohistochemic expression of VEGF were documented. Results: the increase in adipocyte size and microvascular density was statistically significant (P≤0.012). The value of VEGF was lower in the second sample, which was not significant (P<0.093). Conclusion: These results suggest an increase in cellular volume that was consistent when three different measurement procedures were used: adipocyte perimeter, diameter, and area. Moreover, the increase in the number of vessels in the second sample suggests neoangiogenesis stimulated by the initial increase in VEGF values obtained in the first sample. The flap increase was probably caused by adipocyte hypertrophy, resulting from the neoangiogenesis.

Orientadores: Laura Sterian Ward, Andre Almeida Schenka / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T16:49:34Z (GMT). No. of bitstreams: 1 Britto_AnnaValeriaGervasiode_D.pdf: 2314134 bytes, checksum: 9649fbbb6951ebdd01f6e55f1f400f38 (MD5) Previous issue date: 2007 / Resumo: Objetivo: Avaliar a relação da angiogênese em carcinomas invasivos iniciais da mama com fatores clínico-patológicos indicativos de recorrência. Casuística e Métodos: Em 92 casos de pacientes com neoplasia maligna invasiva e inicial da mama e submetidas à pesquisa de comprometimento do linfonodo-sentinela (LS) pesquisou-se a imunoexpressão de VEGF-A, CD34 e D2-40 nos cortes dos tecidos tumorais previamente fixados e incluídos em parafina. Esta expressão foi analisada em relação ao estado do LS e às características clínico-patológicas, incluindo a classificação atual de risco para recidiva. Resultados: Não houve associação entre a imunoexpressão do VEGF-A e a avaliação da angiogênese com o estado do LS, nem tampouco com as demais características clínico-patológicas, incluindo grupos de risco para recidivas. Apenas o tamanho do tumor primário e a idade da paciente foram indicadores de acometimento linfonodal. O coeficiente linear de Spearman não indicou correlação da imunoexpressão dos marcadores entre si. A deteccção de linfáticos pela imunocoloração com anti-D2-40 possibilitou a alteração da classificação de risco em quatro pacientes. Conclusões: Não houve associação entre microdensidade de vasos sanguíneos (CD34) e linfáticos (D-2-40) ou da imunoexpressão de VEGF-A, com variáveis clínico-patológicas clássicas indicativas de maior recidiva, nos carcinomas analisados nesse estudo. Porém, a imunocoloração com anti-D2-40 aprimorou a determinação de invasão linfática, considerada fator de maior risco de recidiva em neoplasias malignas da mama com LS negativo / Abstract: Objective: To evaluate the relationship between early breast cancer angiogenesis and clinicopathological factors indicative of recurrence. Methods: Immunoexpression of VEGF-A, CD34 and D-2-40 was assessed in formalin-fixed, paraffin-embedded sections of primary breast cancer specimens from 92 patients submitted to sentinel lymph node (SN) investigation. The expression of these markers was confronted to SN status, clinicopathological features and the current risk groups classification. Results: No association between the immunoexpression of the three markers and SN status, clinicopathological features or risk assessment was detected. Only tumor's size and patient¿s age were predictors of SN status. There was no correlation among the three markers by the Spearman¿s linear correlation coefficient. The use of D2-40 as a marker of lymphatic vessels improved vascular invasion detection, changing the current risk groups classification in four patients. Conclusions: There was no association between tumoral microvascular (MVD) and lymphatic density (LVD), or immunoexpression of VEGF-A, with classical clinicopathological variables of tumour recurrence in this study. However, immunostaining for D2-40 proved to be useful in improving assessment of vascular invasion, an adverse feature in early breast cancer without node involvement / Doutorado / Clinica Medica / Doutor em Clínica Médica

No description available.

Restless legs syndrome (RLS) and Obstructive sleep apnoea syndrome (OSAS) are two sleep disorders that affect daily life with symptoms such as sleepiness and fatigue. It was therefore hypothesised that the skeletal muscle could be affected as symptoms from skeletal muscle are common. The overall aim of the thesis was to investigate aerobic capacity and structure of skeletal muscle in patients with OSAS and RLS and an age matched control group to provide information regarding the underlying mechanisms. The specific aims were to investigate muscle fibre composition, capillary network, capillary proliferation and sings of local inflammation in musculus tibialis anterior of RLS and OSAS.OSAS and RLS patients had a significantly lower predicted VO2 max expressed in ml/min/kg compared with the control group and in the OSAS group apnoes-hyponea index (AHI) was inversely correlated to maximal oxygen uptake Fibre type composition and muscle fibre cross sectional area in the tibialis anterior muscle was equal in all groups with a predominant proportion of slow type I fibres and a smaller fibre area in slow type I fibres compared to fast type II fibres. The distribution of fast fibres (I/IIA, IIA) did not differ except for the group IIX and IIA/IIX where OSAS and RLS had a significantly higher percentage. OSAS patients had a significantly higher number of capillaries per fibre (CAF) for slow type I fibres and CAF per fibre area (CAFA) for fast type II fibres. CFPE- index (capillary to fibre perimeter exchange) and LC/PF-index (length of capillary/perimeter of fibre) were higher in both patient groups. Vascular endothelial growth factor (VEGF) and proliferating endothelial cells were analysed by double-immunofluorescence staining and were presented to a greater extent in the patient groups compared with the healthy controls. Based on normal amounts of T-cells and macrophages in the histological picture it was also demonstrated that local inflammation was not present in the tibialis anterior muscle of RLS and OSAS whish was also supported by the absence of expression of major histocompatibility complex class I molecules (MHC class I) on the surface of the tibialis anterior muscle fibres.In conclusion, the low predicted VO2 max together with higher percentage of type IIX and IIA/IIX muscle fibres indicates a low central capacity in the patient groups. The increased capillary network and the absence of inflammation indicate the occurrence of local hypoxia in tibialis anterior muscle in patients OSAS and RLS.

Les mécanismes par lesquels les charges mécaniques et électriques agissent sur le tissu osseux dans son ensemble, et sur les ostéoblastes, en particulier, sont encore mal compris. La réponse des ostéoblastes soumis à un seul type de stimulus physique a été comparée à celle obtenue par des combinaisons de plusieurs signaux mécaniques et/ou électriques. Dans la perspective d’améliorer l’ostéointégration des biomatériaux, nos études ont porté principalement sur les deux composants essentiels pour le succès de la greffe d’un biomatériau : la matrice extracellulaire (MEC) qui sert d’interface entre le biomatériau et l’hôte ainsi que les facteurs angiogéniques. Nous avons étudié les réponses des ostéoblastes à des contraintes mécaniques complexes basées sur des signaux de « basse amplitude haute fréquence » (BAHF) appliquées à un modèle de culture 3D (hydroxyapatite macroporeux). Nous montrons donc qu’une stimulation mécanique simple (3Hz) peut être potentialisée par des BAHF appropriées (25 Hz). Un dispositif a été développé pour appliquer des contraintes mécaniques très BAHF sur des modèles de culture 2D. La synthèse de la MEC est favorisée et ses propriétés ostéogéniques sont augmentées sous BAHF. Les BAHF n’ont pas d’effet sur le VEGF. Un autre dispositif a permis d’appliquer un champ électrique aux cultures cellulaires. Quelques paramètres nous indiquent que les cellules perçoivent le champ électrique, mais nous retenons que le VEGF n’est pas affecté. En revanche, la combinaison de ces stimulations physiques (contrainte mécanique très BAHF et champ électrique) augmente l’expression de plusieurs facteurs impliqués dans l’angiogénèse (VEGF, TGFβ1, FGF2…). Les sollicitations complexes définies dans cette thèse pourraient être un outil pour fonctionnaliser un substitut osseux cellularisé / Over the course of a day, weight bearing bones experience numerous stimulations : mechanical loadings varying in magnitude and frequency, but also electric fields. However, the biological effects of mechanical strain or electrical field on bone cells are poorly understood. In the present in vitro study, osteoblasts were submitted to only one kind of physical stimulus or a combination of stimuli, and the responses were compared. In the perspective of improving the qualities of bone substitute, we analysed parameters essential for a successfull osteointegration : the extracellular matrice (ECM) as host-biomaterial interface, and angiogenic factors which induce implant vascularization. We investigated the effects of complex mechanical strains based on signals of "low magnitude / high frequency" (LMHF) applied to 3D cultures (macroporous hydroxyapatite). Our study shows that an appropriate combined strain regimen (3 Hz+25Hz) has the potential to functionalise cellularized bone-like constructs. ECM synthesis was promoted by LMHF and the osteogenic properties of this ECM were enhanced while VEGF was not affected. Another system was developed to apply an electric field to cell cultures. Some parameters indicated that cells are sensitive to electric fields ; however VEGF expression was not affected. In contrast, when the physical stimulations were combined (LMHF strain + electric field) gene expression of factors implicated in angiogenesis (VEGF, TGFß1, FGF2...) was increased. The complex stimuli whose effects were analysed in this work could be used as a tool for the functionalization of a cellularized bone substitutes

L’utilisation de modèles animaux a permis la découverte de mécanismes importants du développement en général, et du développement tumoral en particulier afin d’établir et mettre au point de nouveaux traitements. Le poisson zèbre (Danio rerio), est de plus en plus utilisé dans le cadre de ces recherches du fait de ses nombreux avantages comme par exemple la transparence de ses larves ou une forte homologie avec l’homme. Plusieurs approches ont été développées chez ce poisson comme l’invalidation transitoire d’un gène afin d’identifier le rôle d’une protéine dans le développement, ou alors la transplantation de cellules tumorales de mammifères et étudier les réponses aux traitements anti-tumoraux.C’est dans l’un de ces deux contextes que nous avons étudié le rôle du monoxyde d’azote dans le développement tumoral. Pour cela nous avons utilisé une sonde fluorescente et avons pu détecter in vivo une production de monoxyde d’azote associée aux cellules tumorales xénogreffées, dont l’utilisation d’un capteur du NO, le cPTIO s’est traduit par une perte de cellules tumorales et une baisse de l’expression d’un facteur angiogénique le VEGF, démontrant une utilisation potentielle dans du cPTIO comme molécule anti-tumorale.L’autre volet d’étude a été l’identification du rôle de HSF1 dans le développement et la différenciation des globules rouges chez le poisson zèbre comme modèle expérimental, dans des conditions de non stress thermique. Pour cela, nous avons inactivé transitoirement le gène hsf1 grâce aux morpholinos, et avons constaté des défauts dans le développement, mais aussi une altération de la différenciation des érythrocytes. / The use of animal models has led to the discovery of important mechanisms of biology development in general, and tumor development in particular, to establish and develop new treatments. The Zebrafish (Danio rerio) is increasingly used nowadays as part of this research because of its many advantages such as the transparency of the larvae, and the high homology with human. Several approaches have been developed in this fish, as the gene-knockdown in order to identify the role of a protein in the development, or the tumor transplantation of mammalian cells to study anti-tumor treatments response.It is in one of these two contexts that we studied the role of nitric oxide in tumor development in zebrafish. We used a fluorescent probe and were able to detect in vivo the production of nitric oxide associated with xenograft tumor cells. The use of an NO scanvenger, the cPTIO resulted in a loss of tumor cells and a decrease in the expression of an angiogenic factor VEGF, showing a potential in the use of cPTIO as antitumor molecule.We used also the transitory invalidation of hsf1 gene, in order to explore a potential new role in the development and red blood cells differentiation in zebrafish as an experimental model, in non heat-shocked conditions. We found that HSF1 was important for the differentiation of erythrocytes, and its inactivation also reflected defects in development.

In order to effectively treat disorders whose pathology is marked by neovascularization, a better understanding of the pathways that mediate the processes involved in angiogenesis is needed. To this end we have identified two important pathways that regulate endothelial cell capillary morphogenesis, a key process in angiogenesis. We have identified the small GTPase RhoB as being induced by vascular endothelial growth factor (VEGF) in human umbilical vein endothelial cells (HUVECs). Depletion of RhoB inhibited endothelial cell VEGF - mediated migration, sprouting, and cord formation. Cells depleted of RhoB showed a marked increase in RhoA activation in response to VEGF. Defects in cord formation in RhoB - depleted cells could be partially restored through treatment with the Rho inhibitor C3 transferase or ROCK I/II inhibitors, indicating increased RhoA activity and enhanced downstream signaling from RhoA contribute to the phenotype of decreased cord formation observed in cells depleted of RhoB. Interestingly, we did not observe a significant change in RhoC activity in RhoB - depleted cells suggesting differential regulation of RhoA and RhoC by RhoB in HUVECs. We have also identified microRNA - 30b (miR - 30b) as being negatively regulated by VEGF and as being a negative regulator of HUVEC capillary morphogenesis. Overexpression of miR - 30b significantly reduced HUVEC cord formation in vitro, while inhibition of miR - 30b enhanced cord formation. Neither overexpression nor inhibition of miR - 30b affected migration or viability of endothelial cells. Interestingly, miR - 30b regulated the expression of TGFβ2 but not TGFβ1, with overexpression of miR - 30b inducing expression of TGFβ2 mRNA and protein, and inducing phosphorylaton of Smad2 , suggesting TGFβ2 produced in response to miR - 30b overexpression functions in an iii autocrine manner to stimulate HUVECs . MiR - 30b effects on TGFβ2 expression were found to be regulated to an extent by ATF2, as miR - 30b overexpressing cells exhibited increased levels of phosphorylated ATF2 , with depletion of ATF2 via siRNA resulting in inhibition of miR - 30b - induced TGFβ2 expression. Treatment of HUVECs with TGFβ2 inhibited cord formation, while TGFβ1 had no effect, indicating a major difference in how endothelial cells respond to these two related growth factors. Inhibition of TGFβ2 with a neutralizing antibody restored cord formation in miR - 30b overexpressing cells to levels similar to control cells, thus identifying TGFβ2 expression as contributing to the inhibitory effects of miR - 30b overexpression on capillary morphogenesis. Thus, we have identified two signaling pathways regulated by VEGF in HUVECs that further our understanding of the process of angiogenesis and may provide novel targets for therapeutic intervention into diseases involving angiogenesis.

The ductus arteriosi (DA) are two blood vessels connecting the pulmonary arteries to the descending aorta in the avian embryo. Following hatching, the DA closes, separation of the systemic and pulmonary circulation. I present the morphological changes that occur in the chicken DA during prepipping, internal pipping, external pipping, and hatching. The avian DA consists of two distinct tissue types, a proximal and a distal portion. Histological examination shows developmental differences between the proximal and distal portions of the DA with regard to lumen occlusion, endothelial cells, smooth muscle and elastin. Endothelial cell proliferation begins to occur as early as external pipping, with the lumen almost completely occluded by the 3rd day of post-hatching life. Expression of vascular endothelial growth factor (VEGF) increases in avian endothelial cells during hatching. I provide a morphological timeline of changes in the DA as the chicken develops from embryo to hatchling.

Orientador: Joyce Maria Annichino-Bizzacchi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T17:15:50Z (GMT). No. of bitstreams: 1 Paula_ErichViniciusde_D.pdf: 3311580 bytes, checksum: 0e2725586b5aed078f6a78de1edd1d14 (MD5) Previous issue date: 2006 / Resumo: A doença arterial oclusiva (DAO) é a principal causa de morbidade e mortalidade em países industrializados. Com o aumento da expectativa de vida da população mundial a DAO tornou-se um problema de saúde publica também em países em desenvolvimento. O tratamento de uma das formas graves de DAO, a isquemia crítica de membros inferiores (ICMI), normalmente oferece alívio temporário e muitas vezes requer a amputação do membro afetado. No Brasil, a sobrevida desses pacientes é comparável a algumas formas de câncer. Desta forma, a busca de estratégias terapêuticas alternativas à amputação é fundamental para estes pacientes. Nesse estudo, nós exploramos o papel da angiogênese terapêutica induzida por terapia gênica (TG) em modelos animais ICMI. A angiogênese terapêutica se baseia na utilização de fatores de crescimento vascular sob a forma de proteínas recombinantes ou TG. A reposição de proteína deve ser mantida por períodos prolongados e normalmente requer administração sistêmica. Isto aumenta o risco de formação de vasos em locais indesejáveis como tumores ocultos ou retina. Estudos clínicos anteriores demonstraram que a indução de angiogênese terapêutica utilizando apenas um fator pró-angiogênico é eficaz. No entanto, esses estudos sugerem que integridade destes neovasos é deficiente pela ocorrência de edema de membros inferiores ou proteinúria após a monoterapia angiogênica.Neste trabalho avaliamos a eficácia da TG combinada usando vetores não virais com os genes de dois fatores de crescimento: FGF-2 e PDGF-BB, em comparação com a transferência gênica isolada do VEGF-A. A escolha destes dois fatores deveu-se ao fato de eles atuarem em etapas distintas e complementares do processo de formação vascular: formação e estabilização dos novos vasos, respectivamente. Para este fim utilizamos o modelo de isquemia da pata posterior em ratos, e um novo método não invasivo, o 99mTc-sestamibi para avaliação da neovascularização. A expressão combinada do FGF-2 e PDGF-BB induziu a formação de neovasos com a mesma intensidade e com a mesma relevância funcional que o uso do VEGF-A isolado. No entanto, a estratégia combinada se mostrou mais atraente por induzir a formação de vasos mais íntegros, e necessitar de doses individuais 50% menores de cada gene terapêutico. Em conjunto esses dados demonstram que a TG combinada com FGF-2/PDGF-BB é eficaz e potencialmente mais segura para o tratamento da ICMI. Com o objetivo de definir fatores que afetam a resposta angiogênica pós-natal, nós investigamos o papel da trombina durante a indução de neovasos. Animais receberam diversos inibidores da coagulação imediatamente ou após 72 horas da indução de isquemia periférica. Nós documentamos que a inibição da coagulação sangüínea na fase aguda da isquemia diminui a resposta angiogênica, mas esse efeito não é observado quando a anticoagulação é iniciada após 72 horas. A ativação dos receptores celulares da trombina (e outras proteases) pode oferecer um novo alvo para otimizar a resposta angiogênica pós- natal. Em conjunto, os resultados obtidos formam a base para estudos futuros utilizando a TG combinada com FGF-2/PDGF-BB como uma alternativa potencialmente eficaz e segura paro tratamento da ICMI / Abstract: Arterial occlusive disease (AOD) is the main cause of mortality and morbidity in industrialized countries. Global improvements in life expectancy have turned it into a public health problem in developing countries as well. The treatment of one of the severe presentations of DAO, which is critical limb ischemia (CLI) normally offers temporary relief to symptoms, often requiring major amputations of the affected limb. In Brazil, the prognosis of CLI is similar to that of some forms of cancer. Therefore, new therapeutic strategies alternative to amputations are necessary for these patients. In the present work we evaluated the role of therapeutic angiogenesis induced by gene therapy (GT) in animal models of CLI. Therapeutic angiogenesis consists in the use of vascular growth factors by means of recombinant proteins or GT. When using protein formulations, therapy must be maintained for prolonged periods and normally involves systemic administration. These requirements increase the risk of inducing the formation of neovessels in undesired places such as occult malignant lesions or retina. Previous studies have demonstrated that therapeutic angiogenesis using a single pro-angiogenic factor is effective. However, these studies suggest that the new formed vessels are leaky, as evidenced by the occurrence of lower limb edema and proteinuria after pro-angiogenic monotherapy. In the present work we evaluated efficacy of a combined GT strategy using non-viral vectors expressing two vascular growth factors: FGF-2 and PDGF-BB, and compared this strategy to the gene transfer of VEGF-A alone. The choice of these two growth factors was due to their complementary roles in the process of vascular development: formation and stabilization of new vessels. In order to do so we used a hindlimb ischemia model in rats, and a new non-invasive method based on 99mTc-sestabimi scintigrapy, to evaluate the neovascularization response. Dual gene transfer of FGF-2 and PDGF-BB using non-viral vectors was able to induce a similar revascularization response as VEGF-A alone, both in terms of anatomical and functional parameters. In regard to safety, the dual gene transfer strategy was more attractive because it was able to induce more stable capillaries, and required a 50% lower individual dose of each therapeutic gene. Taken together our data demonstrate that this dual gene transfer strategy is an effective safer strategy for the treatment of CLI by therapeutic angiogenesis. In order to investigate factors that might affect the revascularization post-natal response, we further investigated the role of thrombin during the induction of neovascularization. Animals were treated with different coagulation inhibitors immediately after or 72 hours after the creatin of hindlimb ischemia in rats. We documented that the inhibition of blood coagulation in the acute phase of ischemia impairs the angiogenic response. In contrast, this effect was not observed when anticoagulation was initiated after 72 hours of ischemia. The activation of cellular receptors of thrombin and other proteases might therefore offer an new target to optimize post-natal revascularization. Based on our results, future studies using combined GT with FGF-2 and PDGF-BB are warranted in order to translate these findings into a new and safer strategy for the treatment of CLI / Doutorado / Medicina Experimental / Doutor em Fisiopatologia