A hipóxia é capaz de alterar muitos mecanismos bioquímicos nas células endoteliais. Dentre eles, a indução da expressão endotelial de moléculas de adesão, como o fator de von Willebrand (FVW) que, em resposta ao estímulo, é secretado em sua forma mais ativa na interação com as plaquetas, o que pode resultar em trombose. Nas condições fisiológicas, o padrão multimérico do FVW no plasma é essencialmente determinado pela ADAMTS-13 (uma desintegrina e metaloproteinase com domínios trombospondina). Este estudo teve como objetivo verificar se a atividade da enzima ADAMTS-13, assim como as características do FVW relacionáveis a ela, poderiam estar alteradas na presença de hipoxemia comparativamente à condição de oxigenação normal. Este estudo longitudinal envolveu 56 pacientes portadores de cardiopatias congênitas cianogênicas, em idades entre um e sete anos, candidatos ao tratamento cirúrgico. Os pacientes foram avaliados no pré-cirúrgico (basal), no pós-operatório imediato (pós 48 horas) e após 30 dias de cirurgia, e foram divididos em dois grupos (A e B) baseado na saturação periférica de oxigênio (SpO2) no momento pós 30 dias. Foram determinados o antígeno do FVW e a análise das suas subunidades, a atividade da ADAMTS-13 e a presença de inibidores da ADAMTS-13. Os pacientes de ambos os grupos apresentaram aumento significante da SpO2, da concentração antigênica do FVW e da atividade da ADAMTS-13 nos momentos pós 48 horas e pós 30 dias em comparação com o momento pré (basal). As densidades normalizadas da subunidade principal do FVW (225 kDa) e do fragmento de 176 kDa apresentaram tendência ao aumento nos momentos pós 48 horas e pós 30 dias nos dois grupos. A razão entre a atividade da ADAMTS-13 e o FVW estava menor do que 1 no momento pós 48 horas, indicando consumo da enzima; entretanto, no momento pós 30 dias a razão fica 1:1, e o FVW se aproxima dos valores de referência. Verificamos ainda que 29% destes pacientes apresentaram inibidores contra a ADAMTS-13 no momento pré-operatório. Ainda explorando as variáveis SpO2, FVW:Ag, atividade da ADAMTS-13 e a composição das subunidades do FVW, foi feito um estudo de correlação linear entre estas variáveis. Observamos uma baixa correlação entre a enzima ADAMTS-13 e o FVW:Ag, e da enzima com os fragmentos do FVW de 176 e 140 kDa, principalmente no grupo B. No grupo A, esta correlação no momento pós 48 horas mostrou tendência a ser negativa. A maioria dos pacientes apresentou melhoras na saturação periférica de oxigênio. O aumento das variáveis estudadas no pós-operatório imediato pode ter ocorrido em função da cirurgia, que provavelmente ocasionou um quadro de lesão endotelial com inflamação, indicando que pode existir um equilíbrio entre o FVW e a ADAMTS-13 em níveis fisiológicos. Entretanto, este equilíbrio pode ser quebrado quando ocorre aumento do FVW, provavelmente por consumo da enzima. Parece-nos, portanto, que a ADAMTS-13 pode funcionar como um mecanismo de proteção a estes pacientes com tendência à trombose / Hypoxia has been shown to alter several biochemical mechanisms in endothelial cells. In addition, hypoxia induces the endothelial expression of adhesion molecules, including von Willebrand factor (VWF). Increased release of high-molecular-weight VWF multimers is associated with higher risk for thrombotic events. In physiological conditions, the multimeric pattern of plasma VWF is essentially determined by the action of ADAMTS-13 (a desintegrin and metalloprotease with thrombospondin type 1 domains). The aim of this study was to investigate if ADAMTS-13 activity and VWF subunit fragments were altered by hypoxia in cyanotic congenital heart disease. Fiftysix patients (age 1 to 7 years) with cyanotic congenital heart disease admitted to the Heart Institute for heart surgery were included in this longitudinal study. Patients were evaluated before (baseline) corrective surgery, postoperative 48 hours and postoperative 30 days. Patients were classified in two groups (A and B) based on the peripheral oxygen saturation after 30 days surgery. VWF antigenic concentration, VWF subunit composition, ADAMTS-13 activity and presence of ADAMTS-13 inhibitors were determined. Peripheral oxygen saturation, VWF:Ag and ADAMTS-13 activity were all increased significantly in both groups, in postoperative 48 hours and postoperative 30 days in comparison with baseline moment. Normalized density of VWF main subunit (225 kDa) and proteolytic fragment with 176 kDa tended to increase in postoperative 48 hours and postoperative 30 days in both groups. The rate between ADAMTS-13 activity and VWF:Ag was lower than 1 in postoperative 48 hours, an indicating of enzyme consumption; however, in the postoperative 30 days the rate was 1:1 and VWF:Ag values were near those of reference. 29% of patients presented ADAMTS-13 inhibitors at the baseline moment. A study of correlation among variables as peripheral oxygen saturation, VWF:Ag, VWF subunit composition and ADAMTS-13 was done. It was observed that ADAMTS-13 correlated slightly positively with VWF:Ag and with VWF fragments 176 and 140 kDa, mainly in group B; in group A, the correlation at postoperative 48 hours tended to be negative. Most of the patients improved their peripheral oxygen saturation. The increased value of variables observed in postoperative 48 hours can be explained by the endothelial injury and inflammation caused by the surgery itself. This indicates an equilibrium between VWF:Ag and ADAMTS-13 in physiological conditions. However, this equilibrium could disappear when VWF is increased, probably by enzyme consumption. We conclude that ADAMTS-13 can act as a protective mechanism in these patients with thrombotic tendency

Staphylococcus aureus (S. aureus) is a significant pathogen that causes a wide variety of disease in humans and animals. Methicillin resistant S. aureus (MRSA) isolates carrying mecC, the gene that confers resistance to the antibiotic, have been isolated from humans but also from diverse animal species covering livestock, domestic and wild animals throughout Europe. Many of the known MRSA mecC isolates have been whole-genome sequenced by our group to gain insight into the evolution and epidemiology of these emerging lineages. For microbes and humans alike, iron is an essential cofactor in many biochemical reactions and S. aureus requires iron for colonisation and subsequent pathogenesis. The success of S. aureus is partly attributed to its ability to exploit the host iron pool. It does this through multiple iron uptake mechanisms, including at least two high-affinity iron scavenging siderophores (staphyloferrins A and B) and an iron-regulated surface determinant (Isd) pathway for haem-iron acquisition. Here I describe the identification of a novel locus encoding a siderophore-like non-ribosomal peptide synthetase (NRPS), directly downstream of the SCCmec insertion site in mecC S. aureus isolates. A homologous region was identified in Streptococcus equi 4047 (S. equi) which encodes a NRPS termed 'equibactin' that is involved in iron acquisition. I have therefore named the NRPS product 'staphylobactin' in MRSA, and the aim of this study was to determine the function of the staphylobactin biosynthesis cluster: is this region involved in iron acquisition and how might it be regulated? Analysis of the prevalence of isolates containing the staphylobactin locus showed it to be present in a large number of mecC strains in our collection but also identified homologues in other staphylococcus isolates. The region is highly conserved in all S. aureus isolates belonging to clonal complex (CC) 130 (broad host range lineage), suggesting that staphylobactin might impact on S. aureus's ability to infect a broad range of host species. The staphylobactin gene cluster contains 14 coding sequences, stbB-F, F1, G-M and O. Bioinformatic analysis results in predictions of domain and gene functions associated with iron acquisition. I hypothesized that staphylobactin might have been acquired to compensate for the lack of another siderophore, such as staphyloferrin B, but the staphyloferrin B biosynthesis cluster and transport is present in nearly all S. aureus strains, ruling out this model. Unlike the equibactin locus, however, the staphylobactin locus lacks a homolog for the iron-dependent regulator eqbA. Instead, expression of this locus appears to be regulated by MntR, a DtxR-like regulator. The staplylobactin gene cluster is flanked by direct repeats which suggest staphylobactin could have been gained by horizontal gene transfer. In order to study the role of the staphylobactin gene cluster, deletion mutants of MntR, the staphylobactin locus and staphyloferrins A and B, were generated using the pIMAY two step gene deletion procedure in the previously un-manipulated mecC S. aureus CC130 strains - a challenging protocol that required significant optimization given the difficulties with manipulating this bacterium. Analysis of the MntR mutant suggests that the staphylobactin operon is regulated by MntR, acting as a positive regulator, in an iron-dependent manner. By RT-PCR, I found that expression of the staphylobactin NRPS genes is increased when cultures are grown in the absence of iron, suggesting an involvement with iron acquisition. Genomic inactivation of the staphyloferrins resulted in a mutant severely incapacitated for growth in serum and transferrin as the sole iron source, and addition of iron reversed this phenotype. However, deletion of staphylobactin alone or in addition to the staphyloferrins, lacked an iron-dependent growth defect, and numerous assays failed to identify a clear role for staphylobactin in iron metabolism. Therefore, further experiments are needed to elucidate the function of this siderophore like NRPS. Analysis of the same sequenced CC130 mecC isolates from our strain collection in which the staphylobactin locus was found, led to the identification of a novel Von Willebrand (vwb) gene. In order to investigate possible reasons for these isolates to infect a wide range of host species, wild-type and vwb deletion mutant strains, along with the novel vwb expressed in lactococcus, were tested using a coagulation assay and were able to clot plasma from a broad range of host species. Thus the specificity of vWbp proteins can be used to infer the host specificity and evolutionary history of the S. aureus strains that harbour them. Although I was unable to generate definitive evidence revealing the biological role for the staphylobactin locus this study has generated valuable tools for further studies and thoroughly tested a number of hypotheses concerning its role in cation metabolism.

Der vWF ist ein sehr großes Protein, das im Plasma als Multimer vorliegt und an der Blutgerinnung beteiligt ist. Der Größe entsprechend handelt es sich um ein Protein, das zahlreiche Funktionen bei diesem Prozess übernimmt. Genauso vielfältig können sich auch unterschiedliche Defekte des vWF auf die Hämostase auswirken. Die genetische Analyse der zu Grunde liegenden Defekte kann bei der Diagnose der von-Willebrand-Erkrankung aber auch bei der Therapie zusätzliche Informationen liefern. Ziel dieser Arbeit war es, die Mutationen im vWF-Gen zweier Patienten auf cDNA-Ebene nachzuweisen und diese in Zusammenhang mit ihrem klinischen Erscheinungsbild und den Laborparametern zu stellen. Zu diesem Zweck wurde Thrombozyten-RNA der Patienten isoliert, durch RT-PCR in cDNA umgeschrieben und sequenziert. Bei Patient 1, der eine milde Klinik aufweist, fanden sich die nicht-gekoppelten Mutationen p.R760C und p.R854Q, die bereits von Casonato und Mitarbeitern 2007 beschriebenen wurden. Im Gegensatz zu den dort festgestellten quantitativen und funktionellen Veränderungen des vWF resultiert bei unserem Patienten ein rein quantitativer Defekt. Eine de novo Mutation könnte bei Patient 1 Ursache eines somatischen Mosaiks und damit des milden Phänotyps sein. Bei Patientin 2 fand sich ein Basenaustausch von Adenin nach Thymin an der Transkript-Position 3437 (c.3437A>G). Im Gegensatz zu dem von Goodeve et al. 2007 beschriebenen Patienten mit der von-Willebrand-Erkrankung vom Typ 1, der genau diese Mutation zeigte 51, konnte bei unserer Patientin keine weitere Mutation im vWF-Gen festgestellt werden. Diese Mutation alleine führt jedoch auch zu der von-Willebrand-Erkrankung vom Typ 1, die sich in einer Verringerung der vWF-Menge, also einem quantitativen Defekt, äußert. Die Etablierung der RNA-Isolation und cDNA-Synthese aus Plättchen konnte darüber hinaus eingesetzt werden, um spezifische Transkripte in Plättchen nachzuweisen. In dieser Arbeit wurde gezeigt, dass für die massenspektrometrisch in Plättchen nachgewiesene Metalloendopeptidase Nardilysin auch das Transkript detektiert werden kann. Durch RT-PCR konnte belegt werden, dass die mRNA der beiden Isoformen NRD1-001 und NRD1-002 in Thrombozyten vorkommt. / Von-Willebrand-factor is a large multimeric protein that is secreted into plasma and involved in primary haemostasis. Consistent with the size of the protein, vWF plays a key role in several functions in the haemostatic process. Genetic defects in the vWF result in numerous phenotypically different bleeding abnormalities. Mutation screening can be useful in diagnosis and therapy of the disease. Aim of this work was the confirmation of vWF-gene mutations in two patients on cDNA level and the classification in relation to phenotypic parameters. RNA was extracted from the patient´s platelets, transcribed reversely by RT-PCR and sequenced. Patient 1 shows only a mild bleeding phenotype. He is a carrier of two heterozygous mutations, p.R760C and p.R854Q, a combination already described by Casonato et al 2007 in a patient suffering of quantitative and qualitative vWF defects. Our patient only shows a qualitative reduction of vWF. One of the mutations found in patient 1 could be due to a de novo mutation, affecting only part of the cells and so resulting in a mild phenotype. In patient 2, the heterozygous mutation c.3437A>G was confirmed. A patient carrying this mutation was described by Goodeve et al 2007. This patient was a carrier of an additional mutation in the vWF-gene which could be excluded in our patient. The single mutation is sufficient to explain vWD type 1, characterized by reduced but structurally normal vWF. The establishment of RNA isolation and cDNA synthesis from platelets could also be used in transcript-profiling of platelets. After identifying Nardilysin, a metalloendopeptidase, in platelets by mass spectrometry tools we could confirm this observation on cDNA level. Two different alternatively spliced isoforms of Nardilysin, NRD1-001 and NRD1-002, could be verified in platelets.

In vivo analyses of the Von Willebrand Factor (VWF) promoter previously demonstrated that a fragment spanning sequences -487 to +247 targets promoter activation to brain vascular endothelial cells. This fragment is active in all embryonic vessels of transgenic mice but in adult mice its activity is restricted to brain vascular endothelial cells, while endogenous VWF gene is expressed in vasculature of all major organs. In this study we demonstrate that a DNase I hypersensitive (HSS) sequences in intron 51 of the VWF gene contain cis-acting elements that are necessary for the VWF gene transcription in a subset of lung endothelial cells in vivo. Our results demonstrated that Nuclear Factor 1 (NF1) and Nuclear transcription Factor Y (NFY) repressors contribute to VWF organ-specific regulation. Mutation of the NF1 binding site resulted in promoter activation in lung and heart, while mutation of the repressor corresponding to a novel binding site for NFY resulted in promoter activation in kidney vasculature. / Experimental Medicine

published_or_final_version / Pathology / Master / Master of Medical Sciences

No description available.

Proefschrift Universiteit van Amsterdam. / Auteursnaam op omslag: Hubert de Leeuw. Met lit. opg. - Met samenvatting in het Nederlands.

Würzburg, Univ., Diss., 2008

Ulm, Univ. Diss., 2005.

Thesis (Ph. D.)--Drexel University, 2006. / Includes abstract and vita. Includes bibliographical references (leaves 146-156).