Carvedilol protects against apoptotic cell death induced by cisplatin in renal tubular epithelial cells

Cisplatin is a highly effective chemotherapeutic drug; however, its use is limited by nephrotoxicity. Studies showed that the renal injury produced by cisplatin involves oxidative stress and cell death mediated by apoptosis and necrosis in proximal tubular cells. The use of antioxidants to decrease cisplatin-induced renal cell death was suggested as a potential therapeutic measure. In this study the possible protective effects of carvedilol, a beta blocker with antioxidant activity, was examined against cisplatin-induced apoptosis in HK-2 human kidney proximal tubular cells. The mitochondrial events involved in this protection were also investigated. Four groups were used: controls (C), cisplatin alone at 25 mu M (CIS), cisplatin 25 mu M plus carvedilol 50 mu M (CV + CIS), and carvedilol alone 50 mu M (CV). Cell viability, apoptosis, caspase-9, and caspase-3 were determined. Data demonstrated that carvedilol effectively increased cell viability and minimized caspase activation and apoptosis in HK-2 cells, indicating this may be a promising drug to reduce nephrotoxicity induced by cisplatin.

Summary of the II Brazilian Guideline Update on Acute Heart Failure 2009/2011

In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009. In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinical-hemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined. The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated. This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.

Persistent Periodontal Disease Hampers Anti-Tumor Necrosis Factor Treatment Response in Rheumatoid Arthritis

Objective: This study aimed to evaluate prospectively the influence and the evolution of periodontal disease (PD) in rheumatoid arthritis (RA) patients submitted to anti-tumor necrosis factor (TNF) therapy. Methods: Eighteen patients with RA (according to the American College of Rheumatology criteria) were assessed for PD before (BL) and after 6 months (6M) of anti-TNF treatment: 15 infliximab, 2 adalimumab, and 1 etanercept. Periodontal assessment included plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level. Rheumatologic evaluation was performed blinded to the dentist's assessment: demographic data, clinical manifestations, and disease activity (Disease Activity Score using 28 joints [DAS28], erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]). Results: The median age and disease duration of patients with RA were 50 years (25-71 y) and 94% were female. Periodontal disease was diagnosed in 8 patients (44.4%). Comparing BL to 6M, periodontal parameters in the entire group remained stable (P > 0.05) throughout the study (plaque and gingival bleeding indices, probing pocket depth, cementoenamel junction, and clinical attachment level), whereas an improvement in most analyzed RA parameters was observed in the same period: DAS28 (5.5 vs. 3.9, P = 0.02), ESR (21 vs. 12.5 mm/first hour, P = 0.07), and CRP (7.8 vs. 2.8 mg/dL, P = 0.25). Further analysis revealed that this improvement was restricted to the group of patients without PD (DAS28 [5.5 vs. 3.6, P = 0.04], ESR [23.0 vs. 11.5 mm/first hour, P = 0.008], and CRP [7.4 vs. 2.1, P = 0.01]). In contrast, patients with PD had lack of response, with no significant differences in disease activity parameters between BL and 6M: DAS28 (5.2 vs. 4.4, P = 0.11), ESR (17.0 vs. 21.0, P = 0.56), and CRP (9.0 vs. 8.8, P = 0.55). Conclusions: This study supports the notion that PD may affect TNF blocker efficacy in patients with RA. The possibility that a sustained gingival inflammatory state may hamper treatment response in this disease has high clinical interest because this is a treatable condition.

The effect of beta-blockade on myocardial remodelling in Chagas' cardiomyopathy

OBJECTIVE: Chagas' disease has spread throughout Latin America because of the high rate of migration among these countries. Approximately 30% of Chagas' patients will develop cardiomyopathy, and 10% of these will develop severe cardiac damage leading to heart failure. Beta-blockade improves symptoms and survival in heart failure patients; however, its efficacy has not been well established in Chagas' disease. We evaluated the role of carvedilol in cardiac remodeling and mortality in a Chagas' cardiomyopathy animal model. METHODS: We studied Trypanosoma cruzi infection in 55 Syrian hamsters that were divided into three groups: control (15), infected (20), and infected + carvedilol (20). Animals underwent echocardiography, electrocardiography, and morphometry for collagen evaluation in ventricles stained with picrosirius red. RESULTS: The left ventricular diastolic diameter did not change between groups, although it was slightly larger in infected groups, as was left ventricular systolic diameter. Fractional shortening also did not change between groups, although it was slightly lower in infected groups. Collagen accumulation in the interstitial myocardial space was significantly higher in infected groups and was not attenuated by carvedilol. The same response was observed in the perivascular space. The survival curve showed significantly better survival in the control group compared with the infected groups; but no benefit of carvedilol was observed during the study. However, in the acute phase (up to 100 days of infection), carvedilol did reduce mortality. CONCLUSION: Carvedilol did not attenuate cardiac remodeling or mortality in this model of Chagas' cardiomyopathy. The treatment did improve survival in the acute phase of the disease.

Angiotensin II type 2 receptor (AT2R) is associated with increased tolerance of the hyperthyroid heart to ischemia-reperfusion

Background Thyroid hormone induces cardiac hypertrophy and preconditions the myocardium against Ischemia/Reperfusion (I/R) injury. Type 2 Angiotensin II receptors (AT2R) are shown to be upregulated in cardiac hypertrophy observed in hyperthyroidism and this receptor has been reported to mediate cardioprotection against ischemic injury. Methods The aim of the present study was to evaluate the role of AT2R in the recovery of myocardium after I/R in isolated hearts from T3 treated rats. MaleWistar rats were treated with triiodothyronine (T3; 7 μg/100 gBW/day, i.p.) in the presence or not of a specific AT2R blocker (PD123,319; 10 mg/Kg) for 14 days, while normal rats served as control. After treatment, isolated hearts were perfused in Langendorff mode; after 30 min of stabilization, hearts were subjected to 20 min of zero-flow global ischemia followed by 25 min, 35 min and 45 min of reperfusion. Results T3 treatment induced cardiac hypertrophy, which was not changed by PD treatment. Post-ischemic recovery of cardiac function was increased in T3-treated hearts after 35 min and 45 min of reperfusion as compared to control and the ischemic contracture was accelerated and intensified. AT2R blockade was able to return the evaluated functional parameters of cardiac performance (LVDP, +dP/dtmáx and −dP/dtmin) to the control condition. Furthermore, AT2R blockade prevented the increase in AMPK expression levels induced by T3, suggesting its possible involvement in this process. Conclusion AT2R plays a significant role in T3-induced cardioprotection.

Emerging role of angiotensin type 2 receptor (AT2R)/Akt/NO pathway in vascular smooth muscle cell in the hyperthyroidism

Hyperthyroidism is characterized by increased vascular relaxation and decreased vascular contraction and is associated with augmented levels of triiodothyronine (T3) that contribute to the diminished systemic vascular resistance found in this condition. T3 leads to augmented NO production via PI3K/Akt signaling pathway, which in turn causes vascular smooth muscle cell (VSMC) relaxation; however, the underlying mechanisms involved remain largely unknown. Evidence from human and animal studies demonstrates that the renin-angiotensin system (RAS) plays a crucial role in vascular function and also mediates some of cardiovascular effects found during hyperthyroidism. Thus, in this study, we hypothesized that type 2 angiotensin II receptor (AT2R), a key component of RAS vasodilatory actions, mediates T3 induced-decreased vascular contraction. Marked induction of AT2R expression was observed in aortas from T3-induced hyperthyroid rats (Hyper). These vessels showed decreased protein levels of the contractile apparatus: α-actin, calponin and phosphorylated myosin light chain (p-MLC). Vascular reactivity studies showed that denuded aortic rings from Hyper rats exhibited decreased maximal contractile response to angiotensin II (AngII), which was attenuated in aortic rings pre-incubated with an AT2R blocker. Further study showed that cultured VSMC stimulated with T3 (0.1 µmol/L) for 24 hours had increased AT2R gene and protein expression. Augmented NO levels and decreased p-MLC levels were found in VSMC stimulated with T3, both of which were reversed by a PI3K/Akt inhibitor and AT2R blocker. These findings indicate for the first time that the AT2R/Akt/NO pathway contributes to decreased contractile responses in rat aorta, promoted by T3, and this mechanism is independent from the endothelium.

Effects of MK-801 and amphetamine treatments on allergic lung inflammatory response in mice

Glutamate acts as a neurotransmitter within the Central Nervous System (CNS) and modifies immune cell activity. In lymphocytes, NMDA glutamate receptors regulate intracellular calcium, the production of reactive oxygen species and cytokine synthesis. MK-801, a NMDA receptor open-channel blocker, inhibits calcium entry into mast cells, thereby preventing mast cell degranulation. Several lines of evidence have shown the involvement of NMDA glutamate receptors in amphetamine (AMPH)-induced effects. AMPH treatment has been reported to modify allergic lung inflammation. This study evaluated the effects of MK-801 (0.25mg/kg) and AMPH (2.0mg/kg), given alone or in combination, on allergic lung inflammation in mice and the possible involvement of NMDA receptors in this process. In OVA-sensitized and challenged mice, AMPH and MK-801 given alone decreased cellular migration into the lung, reduced IL-13 and IL10 levels in BAL supernatant, reduced ICAM-1 and L-selectin expression in granulocytes in the BAL and decreased mast cell degranulation. AMPH treatment also decreased IL-5 levels. When both drugs were administered, treatment with MK-801 reversed the decrease in the number of eosinophils and neutrophils induced by AMPH in the BAL of OVA-sensitized and challenged mice as well as the effects on the expression of L-selectin and ICAM-1 in granulocytes, the IL-10, IL-5 and IL-13 levels in BAL supernatants and increased mast cell degranulation. At the same time, treatment with MK-801, AMPH or with MK-801+AMPH increased corticosterone serum levels in allergic mice. These results are discussed in light of possible indirect effects of AMPH and MK-801 via endocrine outflow from the CNS (i.e., HPA-axis activity) to the periphery and/or as a consequence of the direct action of these drugs on immune cell activity, with emphasis given to mast cell participation in the allergic lung response of mice.

An assessment of the concentrations of pharmaceutical compounds in wastewater treatment plants on the island of Gran Canaria(Spain)

[EN] An assessment of the concentrations of thirteen different therapeutic pharmaceutical compounds was conducted on water samples obtained from different wastewater treatment plants (WWTPs) using solid phase extraction and high- and ultra-high-performance liquid chromatography with mass spectrometry detection (HPLC-MS/MS and UHPLC-MS/MS), was carried out. The target compounds included ketoprofen and naproxen (anti-inflammatories), bezafibrate (lipid-regulating), carbamazepine (anticonvulsant), metamizole (analgesic), atenolol (?-blocker), paraxanthine (stimulant), fluoxetine (antidepressant), and levofloxacin, norfloxacin, ciprofloxacin, enrofloxacin and sarafloxacin (fluoroquinolone antibiotics). The relative standard deviations obtained in method were below 11%, while the detection and quantification limits were in the range of 0.3 ? 97.4 ng·L-1 and 1.1 ? 324.7 ng·L-1, respectively. The water samples were collected from two different WWTPs located on the island of Gran Canaria in Spain over a period of one year. The first WWTP (denoted as WWTP1) used conventional activated sludge for the treatment of wastewater, while the other plant (WWTP2) employed a membrane bioreactor system for wastewater treatment. Most of the pharmaceutical compounds detected in this study during the sampling periods were found to have concentrations ranging between 0.02 and 34.81 ?g·L-1.

Characterization of L-type Calcium Channel Binding-Site of a new class of Calcium modulators by a Multidisciplinary approach

Many potential diltiazem related L-VDCC blockers were developed using a multidisciplinary approach. This current study was to investigate and compare diltiazem with to the newly developed compounds by mouse Langendorff-perfused heart, Ca2+-transient and on recombinant L-VDCC. Twenty particular compounds were selected by the ligand-based virtual screening procedure (LBVS). From these compounds, five of them (5b, M2, M7, M8 and P1) showed a potent and selective inotropic activity on guinea-pig left atria driven 1 Hz. Further assays displayed an interesting negative inotropic effect of M2, M8, P1 and M7 on guinea pig isolated left papillary muscle driven at 1 Hz, a relevant vasorelaxant activity of 5b, M2, M7, M8 and P1 on K+-depolarized guinea-pig ileum longitudinal smooth muscle and a significant inhibition of contraction of 5b, M2, M8 and P1 on carbachol stimulated ileum longitudinal smooth muscle. Wild-type human heart and rabbit lung α1 subunits were expressed (combined with the regulatory α2δ and β3 subunits) in Xenopus Leavis oocytes using a two-electrode voltage clamp technique. Diltiazem is a benzothiazepine Ca2+ channel blocker used clinically for its antihypertensive and antiarrhythmic effects. Previous radioligand binding assays revealed a complex interaction with the benzothiazepine binding site for M2, M7 and M8. (Carosati E. et al. J. Med Chem. 2006, 49; 5206). In agreement with this findings, the relative order of increased rates of contraction and relaxation at lower concentrations s(≤10-6M) in unpaced hearts was M7>M2>M8>P1. Similar increases in Ca2+ transient were observed in cardiomyocytes. Diltiazem showed negative inotropic effects whereas 5b had no significant effect. Diltiazem blocks Ca2+current in a use-dependent manner and facilitates the channel by accelerating the inactivation and decelerating the recovery from inactivation. In contrast to diltiazem, the new analogs had no pronounced use-dependence. Application of 100 μM M8, M2 showed ~ 10% tonic block; in addition, M8, M2 and P1 shifted the steady state inactivation in hyperpolarized direction and the current inactivation time was significantly decreased compared with control (219.6 ± 11.5 ms, 226 ± 14.5 vs. 269 ± 12.9 vs. 199.28 ± 8.19 ms). Contrary to diltiazem, the recovery from the block by M8 and M2 was comparable to control. Only P1 showed a significantly decrease of the time for the recovery from inactivation. All of the compounds displayed the same sensitivity on the Ca2+ channel rabbit lung α1 except P1. Taken together, these findings suggest that M8, M2 and P1 might directly decrease the binding affinity or allow rapid dissociation from the benzothiazepine binding site.

Pharmaceutical residues in aquatic systems: mode of action and effects on mussel physiology

Pharmaceutical residues contaminate aquatic ecosystems as a result of their widespread human and veterinary usage. Since continuously released and not efficiently removed, certain pharmaceuticals exhibit pseudo-persistence thus generating concerns for the health of aquatic wildlife. This work aimed at assessing on mussels Mytilus galloprovincialis, under laboratory conditions, the effects of three pharmaceuticals, carbamazepine (antiepileptic), propranolol (β-blocker) and oxytetracycline (antibiotic), to evaluate if the human-based mode of action of these molecules is conserved in invertebrates. Furthermore, in the framework of the European MEECE Programme, mussels were exposed to oxytetracycline and copper at increasing temperatures, simulating variations due to climate changes. The effects of these compounds were assessed evaluating a battery of biomarkers, the expression of HSP70 proteins and changes in cAMP-related parameters. A decrease in lysosomal membrane stability, induction of oxidative stress, alterations of cAMP-dependent pathway and the induction of defense mechanisms were observed indicating the development of a stress syndrome, and a worsening in mussels health status. Data obtained in MEECE Programme confirmed that the toxicity of substances can be enhanced following changes in temperature. The alterations observed were obtained after exposure to pharmaceuticals at concentrations sometimes lower than those detected in the aquatic environment. Hence, further research is advisable regarding subtle effects of pharmaceuticals on non-target organisms. Furthermore, results obtained during a research stay in the laboratories of Cádiz University (Spain) are presented. The project aimed at measuring possible effects of polluted sediments in Algeciras Bay (Spain) and in Cádiz Bay, by assessing different physiological parameters in caged crabs Carcinus maenas and clams Ruditapes decussatus exposed in situ for 28 days. The neutral red retention assay was adapted to these species and proved to be a sensitive screening tool for the assessment of sediment quality.

Modulation der Genexpression und des neuronalen Zelltods durch das Amyloid-Vorläufer-Protein (APP)

Das Amyloid-Vorläufer-Protein (APP) spielt eine zentrale Rolle in der Entstehung und Entwicklung von Morbus Alzheimer. Hierbei ist die proteolytische Prozessierung von APP von entscheidender Bedeutung. Das Verhältnis von neurotoxischen und neuroprotektiven Spaltprodukten, die über den amyloidogenen und nicht-amyloidogenen Weg der APP-Prozessierung gebildeten werden, ist für das Überleben von Neuronen und deren Resistenz gegen zytotoxische Stress-Stimuli von hoher Relevanz. Störungen der Calcium-Homöostase sind ein bekanntes Phänomen bei Morbus Alzheimer. Im ersten Teil der vorliegenden Arbeit wurde die Rolle von überexprimiertem APP in der Regulation des neuronalen Zelltods nach Calcium Freisetzung untersucht. Die Calcium Freisetzung aus dem endoplasmatischen Retikulum wurde durch die Inhibition der sarko- und endoplasmatischen Calcium-ATPasen (SERCA) ausgelöst. Dies führt zur Induktion der sogenannten „unfolded protein response“ (UPR) und zu einer Aktivierung von Effektor-Caspasen. Für APP-überexprimierende PC12 Zellen konnte bereits zuvor eine im Vergleich zur Kontrolle nach der durch Calcium Freisetzung-induzierten Apoptose eine erhöhte intrazelluläre Calcium Konzentration nachgewiesen werden. Über die Messung der Aktivierung von Effektor-Caspasen konnte zudem ein gesteigerter Zelltod in den APP-überexprimierenden Zellen gemessen werden. Zudem konnte gezeigt werden, dass der pro-apoptotische Transkriptionsfaktor CHOP, nicht aber die klassischen UPR-Zielgene spezifisch hochreguliert wurden. Die APP-modulierte gesteigerte Induktion von Apoptose nach Calcium Freisezung konnte durch Komplexierung der intrazellulären Calcium Ionen und durch Knockdown von CHOP im Vergleich zur Kontrolle gänzlich unterdrückt werden. Ferner bewirkte die Inhibition der Speicher-aktivierten Calcium-Kanälen (SOCC) eine signifikante Unterdrückung der beobachteten erhöhten intrazellulären Calcium Konzentration und der gesteigerten Apoptose in den APP-überexprimierenden PC12 Zellen. In diesem Teil der Arbeit konnte eindeutig gezeigt werden, dass APP in der Lage ist den durch Calcium-Freisetzung-induzierten Zelltod zu potenzieren. Diese Modulation durch APP verläuft in einer UPR-unabhängigen Reaktion über die Aktivierung von SOCC’s, einer erhöhten Aufnahme von extrazellulärem Calcium und durch erhöhte Induktion des pro-apoptotischen Transkriptionsfaktors CHOP. Im zweiten Teil dieser Arbeit wurde die sAPPα-vermittelte Neuroprotektion untersucht. Dabei handelt es sich um die N-terminale Ektodomäne von APP, die über die Aktivität der α-Sekretase prozessiert wird und anschließend extrazellulär abgegeben wird. Ziel dieser Versuchsreihe war die neuroprotektive physiologische Funktion von APP im Hinblick auf den Schutz von neuronalen Zellen vor diversen für Morbus Alzheimer relevanten Stress-Stimuli bzw. Apoptose-Stimuli zu untersuchen. Durch die Analyse der Effektor-Caspasen konnte gezeigt werden, dass sAPPα in der Lage ist PC12 Zellen potent vor oxidativem Stress, DNA-Schäden, Hypoxie, proteasomalem Stress und Calcium-Freisetzung zu schützen. Außerdem konnte gezeigt werden, dass sAPPα in der Lage ist den pro-apoptotischen Stress-induzierten JNK/Akt-Signalweg zu inhibieren. Eine Beteiligung des anti-apoptotischen PI3K/Akt-Signalwegs bei der sAPPα-vermittelten Protektion konnte über die Inhibition der PI3-Kinase ebenfalls demonstriert werden, die eine Aufhebung der sAPPα-vermittelten Neuroprotektion bewirkte. Diese Daten zeigen neue molekulare Mechanismen auf, die dem sAPPα-vermittelten Schutz vor pathophysiologisch relevanten Stress-Stimuli in neuronalen Zellen zugrunde liegen. Im letzten Teil der Arbeit wurden verschieden Gruppen von pharmakologischen Substanzen im Hinblick auf ihre neuroprotektive Wirkung untersucht und mit ihren Effekten auf den APP-Metabolismus korreliert. Die Untersuchungen ergaben, dass Galantamin, ein schwacher Acetycholinesterase Inhibitor und allosterisch potenzierender Ligand von nikotinischen Acetylcholin-Rezeptoren in der Lage war, naive, und mit noch höherer Effizienz APP-überexprimierende Zelllinien vor dem Stress-induzierten Zelltod zu schützen. Zudem bewirkte Galantamin in APP-überexprimierenden HEK293 Zellen eine rasche Erhöhung der sAPPα Sekretion, so dass hier von einer Rezeptor-vermittelten Modulation des APP Metabolismus ausgegangen werden kann. Omega-3 Fettsäuren wirken sich positiv auf die Membranfluidität von Zellen aus und es konnte bereits gezeigt werden, dass die Bildung des toxischen Aβ Peptids hierdurch vermindert wird. In Analogie zu Galantamin schützte die Omega-3 Fettsäure Docosahexaensäure (DHA) neuronale Zellen vor dem Stress-induzierten Zelltod, wobei der Schutz in APP-überexprimierenden Zellen besonders effizient war. Diese Daten legen nahe, dass die Aktivierung des antiamyloidogenen Wegs der APP-Prozessierung ein viel versprechender Ansatz für die Entwicklung neuer Therapien gegen Morbus Alzheimer sein könnte.

Aktivitätsabhängige Kontrolle der Apoptose in neonatalen kortikalen Neuronen und Etablierung eines Biosensors zur Echtzeitanalyse der Caspase-3-Aktivierung

Die Apoptose spielt eine entscheidende Rolle während der normalen Entwicklung des zentralen Nervensystems. Elektrische Aktivität und die Versorgung mit trophischen Faktoren sind ausschlaggebend für das Überleben von Neuronen. Um zu untersuchen, welche zellulären Prozesse die aktivitätsabhängige Apoptose in organotypischen Schnittkulturen des neugeborenen Neokortex beeinflussen, wurde in der vorliegenden Arbeit immunzytochemisch das Auftreten aktivierter Caspase-3, nach pharmakologischer Beeinflussung von Ionenkanälen und membranständigen Rezeptoren analysiert. Die Unterdrückung neuronaler Aktivität durch den Natriumionenkanalblocker TTX führte zu einem signifikanten Verlust kortikaler Neuronen. Ein ähnlicher Anstieg der Zahl apoptotischer Neurone konnte durch Applikation von Antagonisten ionotroper Glutamatrezeptoren, GABAA-Rezeptoren oder neuronaler Gap Junctions induziert werden. Jedoch konnte bei einigen Antagonisten die apoptosefördernde Wirkung erst nach längerer Einwirkung beobachtet werden. Im Weiteren wurde eine Methode etabliert, mit deren Hilfe eine Echtzeitanalyse der Apoptose kortikaler Neurone unter dem Entzug trophischer Faktoren in Gegenwart unterschiedlicher extrazellulärer Kaliumkonzentrationen ermöglicht wurde. Dazu wurden dissoziierte kortikale Kulturen mit dem pCaspase3-sensor Vektor transfiziert. Das durch dieses Plasmid codierte fluoreszente Protein wird Caspase-3 abhängig gespalten. In der vorliegenden Arbeit konnte gezeigt werden, dass der Caspase3-sensor spezifisch für die Aktivierung der Caspase-3 ist, und dass die Überlebensfähigkeit der transfizierten Neurone durch das Transfektionsprotokoll nicht beeinflusst wird.

Rare and complicated forms of infantile hemangiomas: new therapeutic outlooks

Infantile hemangiomas (IHs) are the most common benign neoplastic pathology of childhood; their natural history generally involves three phases: after the onset, which usually occurs in the first weeks of life, there is the proliferation phase where the IH reaches its maximum development and it is followed by the spontaneous involution which leads to the IH regression. The duration and the extent of these phases may vary widely even though in most of the cases the involution process begins around twelve months of life and the regression, complete or partial, is completed around seventh-ninth year of life. The majority of the IHs does not require any treatment. However, 10%-20% is likely to develop serious complications, functional impairments or aesthetic alterations and entail a timely treatment. Although there is no treatment protocol currently shared, therapies usually used in cases with a complication risk consist in: systemic or intralesional steroids as a first choice; interferon α, vincristine and/or bleomicin as second or third choice and/or surgical treatment. Propranolol, a non-selective beta-blocker, has been used for cardiovascular diseases even in childhood for decades. Since 2008 it has been widely used in the IHs treatment, although it is still "off-label". In literature there are hundreds of cases and some clinical studies that show the effectiveness and safety of this drug for this indication. Thanks to a multidisciplinary team (Dermatologists, Cardiologists, Paediatricians, and Radiologists) of S. Orsola-Malpighi Hospital, a clinical study, which has been previously approved by the ethics committee, is carried out in order to evaluate the efficacy and safety of systemic propranolol in the treatment of IHs in paediatric age. At the end of 2012, 78 patients underwent this treatment: the results we have obtained so far show a good efficacy and safety profile in agreement with the data provided by the literature.

Computational Modeling of Cardiac Excitation-Contraction Coupling in Physiological and Pathological Conditions

The cardiomyocyte is a complex biological system where many mechanisms interact non-linearly to regulate the coupling between electrical excitation and mechanical contraction. For this reason, the development of mathematical models is fundamental in the field of cardiac electrophysiology, where the use of computational tools has become complementary to the classical experimentation. My doctoral research has been focusing on the development of such models for investigating the regulation of ventricular excitation-contraction coupling at the single cell level. In particular, the following researches are presented in this thesis: 1) Study of the unexpected deleterious effect of a Na channel blocker on a long QT syndrome type 3 patient. Experimental results were used to tune a Na current model that recapitulates the effect of the mutation and the treatment, in order to investigate how these influence the human action potential. Our research suggested that the analysis of the clinical phenotype is not sufficient for recommending drugs to patients carrying mutations with undefined electrophysiological properties. 2) Development of a model of L-type Ca channel inactivation in rabbit myocytes to faithfully reproduce the relative roles of voltage- and Ca-dependent inactivation. The model was applied to the analysis of Ca current inactivation kinetics during normal and abnormal repolarization, and predicts arrhythmogenic activity when inhibiting Ca-dependent inactivation, which is the predominant mechanism in physiological conditions. 3) Analysis of the arrhythmogenic consequences of the crosstalk between β-adrenergic and Ca-calmodulin dependent protein kinase signaling pathways. The descriptions of the two regulatory mechanisms, both enhanced in heart failure, were integrated into a novel murine action potential model to investigate how they concur to the development of cardiac arrhythmias. These studies show how mathematical modeling is suitable to provide new insights into the mechanisms underlying cardiac excitation-contraction coupling and arrhythmogenesis.

Funktionelle Charakterisierung des TRPM5-Gens

In der vorliegenden Promotionsarbeit wurde der zur TRP (transient receptor potential)-Familie gehörende TRPM5-Kanal funktionell charakterisiert. Elektrophysiologische Analysen TRPM5-überexprimierender HEK 293-Zellen zeigten, dass TRPM5 einen Ca2+-aktivierbaren, nicht-selektiven Kationenkanal darstellt, der monovalente Ionen leitet. Die Aktivierung des TRPM5-Kanals hängt insbesondere von der Geschwindigkeit des intrazellulären Ca2+-Anstiegs ab. Somit stellt TRPM5 eine Komponente der zellulären Signaltransduktionskaskaden dar: Nach Rezeptoraktivierung induziert TRPM5 einen raschen, transienten Kationeneinstrom, der zur Depolarisation der Zellmembran führt. Die Expression der beiden humanen TRPM5-Spleißformen als TRPM5/EGFP-Fusionsproteine in HEK 293-Zellen zeigte eine vorwiegende Lokalisation in der Zellmembran. In elektrophysiologischen Analysen wurde nachgewiesen, dass TRPM5-short als TRPM5-Kanalblocker funktioniert. Für die funktionelle in vivo-Charakterisierung des TRPM5-Kanals wurde ein auf RNAi (RNA interference) basierendes, transgenes Trpm5-knock down-Mausmodell hergestellt. Obwohl in drei der vier etablierten Knock down-Mauslinien eine Trpm5-Herunterregulation in der Leber und/oder in der Zunge nachgewiesen werden konnte, zeigten alle Mäuse einen wildtyp-ähnlichen Phänotyp. Weiterführende Untersuchungen an den von Zhang et al. (Cell, 2003) hergestellten Trpm5-knock out-Mäusen offenbarten, dass Trpm5 für eine geregelte Glukosetoleranz essentiell ist. Insulinsekretionsanalysen mit isolierten Langerhans’schen Inseln dieser Mäuse zeigten, dass ohne Trpm5 eine beeinträchtigte Insulinsekretionskinetik in den pankreatischen Betazellen vorliegt. Somit stellt TRPM5 einen neuen Kandidaten für Erkrankungen wie Diabetes Typ 2 dar, die durch eine Fehlregulation der Insulinsekretion gekennzeichnet sind.