Accelerated partial breast irradiation (APBI): Are breath-hold and volumetric radiation therapy techniques useful?

Background: In a selective group of patients accelerated partial breast irradiation (APBI) might be applied after conservative breast surgery to reduce the amount of irradiated healthy tissue. The role of volumetric modulated arc therapy (VMAT) and voluntary moderately deep inspiration breath-hold (vmDIBH) techniques in further reducing irradiated healthy – especially heart – tissue is investigated.

Material and methods: For 37 partial breast planning target volumes (PTVs), three-dimensional conformal radiotherapy (3D-CRT) (3 – 5 coplanar or non-coplanar 6 and/or 10 MV beams) and VMAT (two partial 6 MV arcs) plans were made on CTs acquired in free-breathing (FB) and/or in vmDIBH. Dose-volume parameters for the PTV, heart, lungs, and breasts were compared. 

Results: Better dose conformity was achieved with VMAT compared to 3D-CRT (conformity index 1.24 0.09 vs. 1.49 0.20). Non-PTV ipsilateral breast receiving 50% of the prescribed dose was on average reduced by 28% in VMAT plans compared to 3D-CRT plans. Mean heart dose (MHD) reduced from 2.0 (0.1 – 5.1) Gy in 3D-CRT(FB) to 0.6 (0.1 – 1.6) Gy in VMAT(vmDIBH). VMAT is benefi cial for MHD reduction if MHD with 3D-CRT exceeds 0.5Gy. Cardiac dose reduction as a result of VMAT increases with increasing initial MHD, and adding vmDIBH reduces the cardiac dose further. Mean dose to the ipsilateral lung decreased from 3.7 (0.7 – 8.7) to 1.8 (0.5 – 4.0) Gy with VMAT(vmDIBH) compared to 3D-CRT(FB). VMAT resulted in a slight increase in the contralateral breast dose (DMean ) always remaining 1.9 Gy). 

Conclusions: For APBI patients, VMAT improves PTV dose conformity and delivers lower doses to the ipsilateral breast and lung compared to 3D-CRT. This goes at the cost of a slight but acceptable increase of the contralateral breast dose. VMAT reduces cardiac dose if MHD exceeds 0.5 Gy for 3D-CRT. Adding vmDIBH results in a further reduction of heart and ipsilateral lung dose. 

Intracellular antioxidant and DNA repair enzymes as correlates of stress resistance and longevity in vertebrates

In animals, both stress resistance and longevity appear to be influenced by the insulin/insulin-like growth factor-l signaling (lIS) pathway, the basic organization of which is highly conserved from invertebrates to vertebrates. Reduced lIS or genetic disruption of the lIS pathway leads to the activation of forkhead box transcription factors, which is thought to upregulate the expression of genes involved in enhancing stress resistance, including perhaps key antioxidant enzymes as well as DNA repair enzymes. Enhanced antioxidant and DNA repair capacities may underlie the enhanced cellular stress resistance observed in long-lived animals, however little data is available that directly supports this idea. I used three. experimental approaches to test the association of intracellular antioxidant and DNA base excision repair (BER) capacities with stress resistance and longevity: (1) a comparison of multiple vertebrate endotherm species of varying body masses and longevities; (2) a comparison of long-lived Snell dwarf mice and their normallittermates; and (3) a comparison of hypometabolic animals undergoing hibernation or estivation with their active counterparts. The activities of the five major intracellular antioxidant enzymes as well as the two rate-limiting enzymes in the BER pathway, apurininc/apyrimidinic (AP) endonuclease and polymerase ~, were measured. These measurements were performed in one or more of the following: (1) cultured dermal fibroblasts; (2) brain tissue; (3) heart tissue; (4) liver tissue. My results indicate that antioxidant enzymes are not universally upregulated in association with enhanced stress resistance and longevity. I also did not find that BER enzyme activity was positively correlated with longevity, in an inter-species context, though there was evidence for enhanced BER in long-lived Snell dwarf mice. Thus, while there were instances in which enhanced antioxidant and BER enzyme activities were associated with increased stress resistance and/or longevity, this was not universally the case, indicating that other mechanisms must be involved. These results suggest the need to re-examine existing 'oxidative stress' hypotheses of longevity and probe further into the molecular physiology of longevity to discover its mechanistic basis.

Reprogramming the cell cycle machinery to treat cardiovascular disease

Coronary artery disease is one of the most common heart pathologies. Restriction of blood flow to the heart by atherosclerotic lesions, leading to angina pectoris and myocardial infarction, damages the heart, resulting in impaired cardiac function. Damaged myocardium is replaced by scar tissue since surviving cardiomyocytes are unable to proliferate to replace lost heart tissue. Although narrowing of the coronary arteries can be treated successfully using coronary revascularisation procedures, re-occlusion of the treated vessels remains a significant clinical problem. Cell cycle control mechanisms are key in both the impaired cardiac repair by surviving cardiomyocytes and re-narrowing of treated vessels by maladaptive proliferation of vascular smooth muscle cells. Strategies targeting the cell cycle machinery in the heart and vasculature offer promise both for the improvement of cardiac repair following MI and the prevention of restenosis and bypass graft failure following revascularisation procedures.

Redox-sensitive prosurvival and proapoptotic protein expression in the myocardial remodeling post-infarction in rats

In this study, we investigated the oxidative stress influence in some prosurvival and proapoptotic proteins after myocardial infarction (MI). Male Wistar rats were divided in two groups: Sham-operated (control) and MI. MI was induced by left coronary artery occlusion. 28-days after surgery, echocardiographic, morphometric, and hemodynamic parameters were evaluated. Redox status (reduced to oxidized glutathione ratio, GSH/GSSG) and hydrogen peroxide levels (H(2)O(2)) were measured in heart tissue. The p-ERK/ERK, p-Akt/Akt, p-mTOR/mTOR and p-GSK-3 beta/GSK-3 beta ratios, as well as apoptosis-inducing factor (AIF) myocardial protein expression were quantified by Western blot. MI group showed an increase in cardiac hypertrophy (23%) associated with a decrease in ejection fraction (38%) and increase in left ventricular end-diastolic pressure (82%) when compared to control, characterizing ventricular dysfunction. Redox status imbalance was seen in MI animals, as evidenced by the decrease in the GSH/GSSG ratio (30%) and increased levels of H(2)O(2) (45%). This group also showed an increase in the ERK phosphorylation and a reduction of Akt and mTOR phosphorylation when compared to control. Moreover, we showed a reduction in the GSK-3 beta phosphorylation and an increase in AIF protein expression in MI group. Taken together, our results show increased H(2)O(2) levels and cellular redox imbalance associated to a higher p-ERK and AIF immunocontent, which would contribute to a maladaptive hypertrophy phenotype.

5-Lipoxygenase plays a role in the control of parasite burden and contributes to oxidative damage of erythrocytes in murine Chagas` disease

Chagas` disease is accompanied by severe anemia and oxidative stress, which may contribute to mortality. In this study, we investigated the role of 5-lipoxygenase (5-LO) in the control of parasitism and anemia associated with oxidative damage of erythrocytes in experimental Trypanosoma cruzi infection. Wild-type C57BL/6, 129Sv mice treated or not with nordihydroguaiaretic acid (NDGA, 5-LO inhibitor), mice lacking the 5-LO enzyme gene (5-LO(-/-)) and inducible nitric oxide synthase gene (iNOS(-/-)) were infected with the Y strain of T cruzi. impairment of 5-LO resulted in increased numbers of trypomastigote forms in the blood and amastigote forms in the heart of infected mice. We assessed oxidative stress in erythrocytes by measuring oxygen uptake, induction time and chemiluminescence following treatment with tert-butyl hydroperoxide (TBH). Our results show that 5-LO metabolites increased lipid peroxidation levels in erythrocytes during the early phase of murine T cruzi infection. NDGA treatment reduced oxidative damage of erythrocytes in C57BL/6 T cruzi-infected mice but not in C57BL/6 iNOS-/- infected mice, showing that the action of NDGA is dependent on endogenous nitric oxide (NO). In addition, our results show that 5-LO metabolites do not participate directly in the development of anemia in infected mice. We conclude that 5-LO products may not only play a major role in controlling heart tissue parasitism, i.e., host resistance to acute infection with T cruzi in vivo, but in the event of an infection also play an important part in erythrocyte oxidative stress, an NO-dependent effect. (C) 2009 Elsevier B.V. All rights reserved.

Orally administered [14C]DPA and [14C]DHA are metabolised differently to [14C]EPA in rats

Previous studies have revealed that C20 PUFA are significantly less oxidised to CO2 in whole-body studies compared with SFA, MUFA and C18 PUFA. The present study determined the extent to which three long-chain PUFA, namely 20 : 5n-3 EPA, 22 : 5n-3 docosapentaenoic acid (DPA) and 22 : 6n-3 DHA, were catabolised to CO2 or, conversely, incorporated into tissue lipids. Rats were administered a single oral dose of 2·5 μCi [1-14C]DPA, [1-14C]EPA, [1-14C]DHA or [1-14C]oleic acid (18 : 1n-9; OA), and were placed in a metabolism chamber for 6 h where exhaled 14CO2 was trapped and counted for radioactivity. Rats were euthanised after 24 h and tissues were removed for analysis of radioactivity in tissue lipids. The results showed that DPA and DHA were catabolised to CO2 significantly less compared with EPA and OA (P< 0·05). The phospholipid (PL) fraction was the most labelled for all three n-3 PUFA compared with OA in all tissues, and there was no difference between C20 and C22 n-3 PUFA in the proportion of label in the PL fraction. The DHA and DPA groups showed significantly more label than the EPA group in both skeletal muscle and heart. In the brain and heart tissue, there was significantly less label in the cholesterol fraction from the C22 n-3 PUFA group compared with the C20 n-3 PUFA group. The higher incorporation of DHA and DPA into the heart and skeletal muscle, compared with EPA, suggests that these C22 n-3 PUFA might play an important role in these tissues.

Hydroxymethylnitrofurazone Is Active in a Murine Model of Chagas' Disease

The addition of a hydroxymethyl group to the antimicrobial drug nitrofurazone generated hydroxymethylnitrofurazone (NFOH), which had reduced toxicity when its activity against Trypanosoma cruzi was tested in a murine model of Chagas' disease. Four groups of 12 Swiss female mice each received 150 mg of body weight/kg/day of NFOH, 150 mg/kg/day of nitrofurazone (parental compound), 60 mg/kg/day of benznidazole (BZL), or the solvent as a placebo. Treatments were administered orally once a day 6 days a week until the completion of 60 doses. NFOH was as effective as BZL in keeping direct parasitemia at undetectable levels, and PCR results were negative. No histopathological lesions were seen 180 days after completion of the treatments, a time when the levels of anti-T. cruzi antibodies were very low in mice treated with either NFOH or BZL. Nitrofurazone was highly toxic, which led to an overall rate of mortality of 75% and necessitated interruption of the treatment. In contrast, the group treated with its hydroxymethyl derivative, NFOH, displayed the lowest mortality (16%), followed by the BZL (33%) and placebo (66%) groups. The findings of histopathological studies were consistent with these results, with the placebo group showing the most severe parasite infiltrates in skeletal muscle and heart tissue and the NFOH group showing the lowest. The present evidence suggests that NFOH is a promising anti-T. cruzi agent.

Efeito de diferentes doses de hormônios tireoidianos sobre a expressão gênica e protéica de proteínas relacionadas ao trânsito de cálcio em animais obesos e obesos submetidos à restrição alimentar

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influência da taurina na remodelação ventricular após o infarto do miocárdio

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Evolução das modificações morfo-funcionais cardíacas no processo de adaptação crônica à insuficiência aórtica aguda experimental em ratos

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Influência do resveratrol sobre metabolismo energético, estresse oxidativo e expressão SIRT1 no miocárdio de ratos diabéticos

Pós-graduação em Ciências Biológicas (Farmacologia) - IBB

Antidepressivo modula o comportamento e a expressão gênica das cadeias de miosina, serca2 e fosfolambam em ratos com insuficiência aórtica?

Introduction: Aortic insufficiency (AoI), a volume overload, is characterized by the diastolic reflux of blood from the regurgitating aorta to the left ventricle. This effect results from malfunctioning aortic cusps. The main cause of AoI in developing countries is rheumatic fever, including Brazil, and valvar degeneration in developed countries. There is a strong association between cardiovascular diseases and depression. Selective serotonin reuptake inhibitors (SSRI) are one of the most prescribed antidepressants in the world. Previous studies of our laboratory showed that the utilization of a SSRI, paroxetine, improved cardiac function in rats with sub-chronic AoI and reduced the daily ingestion of hypertonic sodium (NaCl 0,3M). Cardiovascular diseases can determine behavior changes like increase of anxiety, and it is yet unknown if AoI would determine anxiety or anhedonia, incapacity of obtaining pleasure through physical or sensorial experiences. A possible target for SSRI action could be a change in the expression of enzyme isoforms that collaborate in the contractile function of the heart muscle, like the heavy chains of myosine, the sarcoplasmatic reticulum Ca2+/ATPase (SERCA) and its regulator protein, phospholamban (PLB). Objectives: Evaluation of behavior parameters for anxiety and anhedonia state and genic expression of a-myosine, b-myosine, SERCA2a and PLB in the heart tissue of rats with subchronic AoI that received treatment with an SSRI (paroxetine) for 4 weeks. Methods: Surgery to induce AoI was performed on male Wistar rats, anxiety was evaluated by the elevated plus-maze (EPM) and state of anhedonia was tested by ingestion of 2% sucrose solution. After euthanasia the heart tissue was collected and total RNA was extracted to be analyzed by the RT-qPCR method. Results: Heart fractional shortening was preserved in rats with AoI that were treated compared to rats with AoI that were not treated. There was no statistically ...

Stem Cells as a therapy for myocardial infarction in animal models

Advances in stem cell biology have challenged the notion that infarcted myocardium is irreparable. The pluripotent ability of stem cells to differentiate into specialized cell lines began to garner intense interest within cardiology when it was shown in animal models that intramyocardial injection of bone marrow stem cells (MSCs), or the mobilization of bone marrow stem cells with spontaneous homing to myocardium, could improve cardiac function and survival after induced myocardial infarction (MI) [1, 2]. Furthermore, the existence of stem cells in myocardium has been identified in animal heart [3, 4], and intense research is under way in an attempt to clarify their potential clinical application for patients with myocardial infarction. To date, in order to identify the best one, different kinds of stem cells have been studied; these have been derived from embryo or adult tissues (i.e. bone marrow, heart, peripheral blood etc.). Currently, three different biologic therapies for cardiovascular diseases are under investigation: cell therapy, gene therapy and the more recent “tissue-engineering” therapy . During my Ph.D. course, first I focalised my study on the isolation and characterization of Cardiac Stem Cells (CSCs) in wild-type and transgenic mice and for this purpose I attended, for more than one year, the Cardiovascular Research Institute of the New York Medical College, in Valhalla (NY, USA) under the direction of Doctor Piero Anversa. During this period I learnt different Immunohistochemical and Biomolecular techniques, useful for investigating the regenerative potential of stem cells. Then, during the next two years, I studied the new approach of cardiac regenerative medicine based on “tissue-engineering” in order to investigate a new strategy to regenerate the infracted myocardium. Tissue-engineering is a promising approach that makes possible the creation of new functional tissue to replace lost or failing tissue. This new discipline combines isolated functioning cells and biodegradable 3-dimensional (3D) polymeric scaffolds. The scaffold temporarily provides the biomechanical support for the cells until they produce their own extracellular matrix. Because tissue-engineering constructs contain living cells, they may have the potential for growth and cellular self-repair and remodeling. In the present study, I examined whether the tissue-engineering strategy within hyaluron-based scaffolds would result in the formation of alternative cardiac tissue that could replace the scar and improve cardiac function after MI in syngeneic heterotopic rat hearts. Rat hearts were explanted, subjected to left coronary descending artery occlusion, and then grafted into the abdomen (aorta-aorta anastomosis) of receiving syngeneic rat. After 2 weeks, a pouch of 3 mm2 was made in the thickness of the ventricular wall at the level of the post-infarction scar. The hyaluronic scaffold, previously engineered for 3 weeks with rat MSCs, was introduced into the pouch and the myocardial edges sutured with few stitches. Two weeks later we evaluated the cardiac function by M-Mode echocardiography and the myocardial morphology by microscope analysis. We chose bone marrow-derived mensenchymal stem cells (MSCs) because they have shown great signaling and regenerative properties when delivered to heart tissue following a myocardial infarction (MI). However, while the object of cell transplantation is to improve ventricular function, cardiac cell transplantation has had limited success because of poor graft viability and low cell retention, that’s why we decided to combine MSCs with a biopolimeric scaffold. At the end of the experiments we observed that the hyaluronan fibres had not been substantially degraded 2 weeks after heart-transplantation. Most MSCs had migrated to the surrounding infarcted area where they were especially found close to small-sized vessels. Scar tissue was moderated in the engrafted region and the thickness of the corresponding ventricular wall was comparable to that of the non-infarcted remote area. Also, the left ventricular shortening fraction, evaluated by M-Mode echocardiography, was found a little bit increased when compared to that measured just before construct transplantation. Therefore, this study suggests that post-infarction myocardial remodelling can be favourably affected by the grafting of MSCs delivered through a hyaluron-based scaffold

Ursachen der Anthrazyklin-induzierten Kardiotoxizität : Einfluss der individuellen genetischen Ausstattung, des oxidativen Stresses und der Metabolisierung

Doxorubizin (Dox) gehört zur Gruppe der Anthrazykline, welche seit mehreren Jahrzehnten erfolgreich gegen ein breites Spektrum an Tumoren eingesetzt wird. Neben der guten Wirksamkeit besitzt Dox jedoch auch ein sehr hohes Nebenwirkungspotential. Die wohl folgenschwerste Nebenwirkung stellt die irreversible Schädigung des Herzens dar. Zahlreiche Faktoren, wie zum Beispiel die kumulative Dox-Dosis konnten bereits mit einer erhöhten Inzidenz an kardialen Schäden in Verbindung gebracht werden. Bislang ungeklärt war jedoch die Frage, warum Patienten unterschiedlich sensibel auf die Verabreichung von Dox reagierten. rnAn dem Patientenkollektiv der Ricover60-Studie wurde der Einfluss der individuellen genetischen Ausstattung auf die Entstehung der Anthrazyklin-induzierten Herzschädigung untersucht. Alle Patienten mit Dox-induzierten Herzschäden wurden identifiziert und auf das Vorhandensein von genetischen Polymorphismen der NAD(P)H-Oxidase (CYBA, RAC2 und NCF4) und der Anthrazyklin-Transporter (MRP1 und MRP2) untersucht. Sowohl für CYBA als auch für RAC2 konnte eine Anreicherung bestimmter Genotypen (CYBA: CT/TT; RAC2: TA/AA) in der Gruppe der herzgeschädigten Patienten nachgewiesen werden. In der Multivariaten Analyse von RAC2 erreichte diese Anreicherung ein signifikantes Niveau (p=0.028). Damit konnte für diesen Polymorphismus die klinische Relevanz bestätigt werden.rnDie Ursachen der Dox-induzierten Toxizität wurden außerdem an verschiedenen Mäusestämmen und Zelllinien untersucht. Balb/c- und C57BL/6-Mäuse, die bekanntermassen unterschiedlich sensibel auf Dox reagierten, wurden mit Dox behandelt. Anschliessend wurden die Organe Herz, Leber und Blut via HPLC untersucht. Es konnte gezeigt werden, dass sich 1. die Hauptanreicherungsorte für Dox und Doxol (Balb/c: Herz und Blut versus C57BL/6: Leber), 2. die nachgewiesenen Gesamtmengen an Dox+Doxol+Doxon in den drei Organen (MengeC57BL/6 > MengeBalb/c) sowie 3. die An- und Abflutungsgeschwindigkeiten von Dox zwischen den beiden Mäusestämmen unterscheiden. Schlussendlich konnte im Vergleich zu den Balb/c-Mäusen, bei den C57BL/6-Mäusen eine stärkere kardiale Anreicherung von Dox nach der mehrmaligen Dox-Injektion nachgewiesen werden. Somit scheinen der deutlich höhere Dox-Gehalt und die längere Verweilzeit in den Herzen für die stärkere kardiale Schädigung der C57BL/6-Mäuse verantwortlich zu sein. Hingegen verlief die Art der Dox-Metabolisierung in beiden Mäusestämmen ähnlich. rnBei der Betrachtung des oxidativen Stresses konnte gezeigt werden, dass in den Herzen der C57BL/6-Mäusen ein gröβerer oxidativer Stress vorlag, als bei den Balb/c-Mäusen. Ähnlich wie bei der Ricover60-Studie ließ sich auch bei den Mäusen eine Beteiligung der NAD(P)H-Oxidase am Dox-induzierten oxidativen Stress nachweisen. rnMit der HTETOP-Zelllinie konnte gezeigt werden, dass Dox unter physiologischen Bedingungen oxidativen Stress auslösen kann. Die Art und die Konzentration der gebildeten ROS waren abhängig von der Dox-Konzentration, der Einwirkzeit und der Kompensationsfähigkeit der Zellen. Durch die Gabe von Dex ließ sich das Ausmaß des oxidativen Stresses lediglich in den Mäuseherzen reduzieren. In den HTETOP-Zellen zeigte Dex selbst stressauslösende Eigenschaften. Durch die Behandlung mit Dex / DOXY konnte gezeigt werden, dass die Hemmung der Topo IIα selbst oxidativen Stress in den HTETOP-Zellen auslöst. Jedoch scheint weder die Topo IIalpha-Hemmung, noch der Dox-induzierte oxidative Stress bei physiologischen Dox-Konzentrationen (< 1 µM) eine entscheidende Rolle für die Toxizität zu spielen. rnIn der Mikroarray-Analyse der HTETOP-Zellen konnten verschiedene Gene identifiziert werden, die in den oxidativen Stress involviert sind und die durch die Gabe von Dox differentiell reguliert werden. Durch die Komedikation mit Dex / DOXY ließen sich diese Veränderungen teilweise modulieren. rn

A 2-dimensional computational model to analyze the effects of cellular heterogeinity on cardiac pacemaking

The mechanical action of the heart is made possible in response to electrical events that involve the cardiac cells, a property that classifies the heart tissue between the excitable tissues. At the cellular level, the electrical event is the signal that triggers the mechanical contraction, inducing a transient increase in intracellular calcium which, in turn, carries the message of contraction to the contractile proteins of the cell. The primary goal of my project was to implement in CUDA (Compute Unified Device Architecture, an hardware architecture for parallel processing created by NVIDIA) a tissue model of the rabbit sinoatrial node to evaluate the heterogeneity of its structure and how that variability influences the behavior of the cells. In particular, each cell has an intrinsic discharge frequency, thus different from that of every other cell of the tissue and it is interesting to study the process of synchronization of the cells and look at the value of the last discharge frequency if they synchronized.