Polifarmácia entre idosos do Município de São Paulo - Estudo SABE

Foi avaliado o uso de cinco ou mais medicamentos (polifarmácia) e seus fatores associados por idosos do município de São Paulo. Realizou-se estudo transversal de base populacional: Estudo SABE - Saúde, Bem-estar e Envelhecimento, no ano de 2006. A amostra foi composta por 1.115 idosos com 65 anos e mais, que correspondiam a 422.377 indivíduos do Município de São Paulo. Utilizou-se regressão logística múltipla. A prevalência de polifarmácia foi de 36%. Sexo feminino (OR = 1,7; IC 95%: 1,0; 2,9), idade igual ou superior a 75 anos (OR = 1,9; IC 95%: 1,3; 2,7), maior renda (OR = 1,8; IC 95%: 1,2; 2,8), estar trabalhando (OR = 1,8; IC 95%: 1,1; 2,9), auto avaliação de saúde regular (OR = 1,6; IC 95%: 1,1; 2,3) ou ruim (OR = 2,6; IC 95%: 1,4; 4,9), hipertensão (OR = 2,0; IC 95%: 1,4; 2,9), diabetes (OR = 4,1; IC 95%: 2,2; 7,5), doença reumática (OR = 2,3; IC 95%: 1,5; 3,6) e problemas cardíacos (OR = 2,9; IC 95%: 1,9; 4,5) apresentaram associação positiva com polifarmácia. Usar apenas o sistema público de saúde (OR = 0,5; IC 95%: 0,3; 0,7) associou-se inversamente à polifarmácia. Os medicamentos mais utilizados foram os de ação no sistema cardiovascular e trato alimentar e metabolismo. No âmbito da farmacoepidemiologia, o conhecimento dos fatores associados a polifarmácia, como os identificados nesse estudo, pode ser útil para alertar os profissionais da saúde quanto à importância de identificar e monitorar os grupos de idosos mais vulneráveis a polifarmácia.

Effects of the administration of pentoxifylline and prednisolone on the evolution of portal fibrogenesis secondary to biliary obstruction in growing animals: immunohistochemical analysis of the expression of TGF-β and VEGF

OBJECTIVE: During the neonatal and infancy periods, some chronic liver diseases may lead to progressive hepatic fibrosis, which is a condition that can ultimately result in the loss of organ function and severe portal hypertension necessitating hepatic transplantation. In a previous report, pharmacological interventions were demonstrated to modulate hepatic fibrosis induced by bile duct ligation in young rats. The administration of pentoxifylline or prednisolone, or the combination of both, resulted in reduced fibrogenesis in portal spaces. The objectives of the present study were to evaluate the expression of transforming growth factor β and vascular endothelial growth factor after bile duct ligation in young rats and to assess the effect of those same drugs on cytokine expression. METHODS: In this experimental study, 80 young rats (21 or 22 days old) were submitted either to laparotomy and common bile duct ligation or to sham surgery. The animals were allocated into four groups according to surgical procedure, and the following treatments were administered: (1) common bile duct ligation + distilled water, (2) sham surgery + distilled water, (3) common bile duct ligation + pentoxifylline, or (4) common bile duct ligation + prednisolone. After 30 days, a hepatic fragment was collected from each animal for immunohistochemical analysis using monoclonal antibodies against transforming growth factor β and vascular endothelial growth factor. Digital morphometric and statistical analyses were performed. RESULTS: The administration of pentoxifylline reduced the transforming growth factor β-marked area and the amount of transforming growth factor β expressed in liver tissue. This effect was not observed after the administration of prednisolone. There was a significant reduction in vascular endothelial growth factor expression after the administration of either drug compared with the non-treatment group. CONCLUSIONS: The administration of pentoxifylline to cholestatic young rats resulted in the diminished expression of transforming growth factor β and vascular endothelial growth factor in liver tissue. The administration of steroids resulted in the diminished expression of vascular endothelial growth factor only. These pathways may be involved in hepatic fibrogenesis in young rats submitted to bile duct ligation and exposed to pentoxifylline or prednisolone.

Suppressive effect of low-level laser therapy on tracheal hyperresponsiveness and lung inflammation in rat subjected to intestinal ischemia and reperfusion

Intestinal ischemia and reperfusion (i-I/R) is an insult associated with acute respiratory distress syndrome (ARDS). It is not known if pro- and anti-inflammatory mediators in ARDS induced by i-I/R can be controlled by low-level laser therapy (LLLT). This study was designed to evaluate the effect of LLLT on tracheal cholinergic reactivity dysfunction and the release of inflammatory mediators from the lung after i-I/R. Anesthetized rats were subjected to superior mesenteric artery occlusion (45 min) and killed after clamp release and preestablished periods of intestinal reperfusion (30 min, 2 or 4 h). The LLLT (660 nm, 7.5 J/cm(2)) was carried out by irradiating the rats on the skin over the right upper bronchus for 15 and 30 min after initiating reperfusion and then euthanizing them 30 min, 2, or 4 h later. Lung edema was measured by the Evans blue extravasation technique, and pulmonary neutrophils were determined by myeloperoxidase (MPO) activity. Pulmonary tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), intercellular adhesion molecule-1 (ICAM-1), and isoform of NO synthase (iNOS) mRNA expression were analyzed by real-time PCR. TNF-α, IL-10, and iNOS proteins in the lung were measured by the enzyme-linked immunoassay technique. LLLT (660 nm, 7.5 J/cm(2)) restored the tracheal hyperresponsiveness and hyporesponsiveness in all the periods after intestinal reperfusion. Although LLLT reduced edema and MPO activity, it did not do so in all the postreperfusion periods. It was also observed with the ICAM-1 expression. In addition to reducing both TNF-α and iNOS, LLLT increased IL-10 in the lungs of animals subjected to i-I/R. The results indicate that LLLT can control the lung's inflammatory response and the airway reactivity dysfunction by simultaneously reducing both TNF-α and iNOS.

Humoral autoimmune response heterogeneity in the spectrum of primary biliary cirrhosis

Objective To compare autoantibody features in patients with primary biliary cirrhosis (PBC) and individuals presenting antimitochondria antibodies (AMAs) but no clinical or biochemical evidence of disease. Methods A total of 212 AMA-positive serum samples were classified into four groups: PBC (definite PBC, n = 93); PBC/autoimmune disease (AID; PBC plus other AID, n = 37); biochemically normal (BN) individuals (n = 61); and BN/AID (BN plus other AID, n = 21). Samples were tested by indirect immunofluorescence (IIF) on rat kidney (IIF-AMA) and ELISA [antibodies to pyruvate dehydrogenase E2-complex (PDC-E2), gp-210, Sp-100, and CENP-A/B]. AMA isotype was determined by IIF-AMA. Affinity of anti-PDC-E2 IgG was determined by 8 M urea-modified ELISA. Results High-titer IIF-AMA was more frequent in PBC and PBC/AID (57 and 70 %) than in BN and BN/AID samples (23 and 19 %) (p < 0.001). Triple isotype IIF-AMA (IgA/IgM/IgG) was more frequent in PBC and PBC/AID samples (35 and 43 %) than in BN sample (18 %; p = 0.008; p = 0.013, respectively). Anti-PDC-E2 levels were higher in PBC (mean 3.82; 95 % CI 3.36–4.29) and PBC/AID samples (3.89; 3.15–4.63) than in BN (2.43; 1.92–2.94) and BN/AID samples (2.52; 1.54–3.50) (p < 0.001). Anti-PDC-E2 avidity was higher in PBC (mean 64.5 %; 95 % CI 57.5–71.5 %) and PBC/AID samples (66.1 %; 54.4–77.8 %) than in BN samples (39.2 %; 30.9–37.5 %) (p < 0.001). PBC and PBC/AID recognized more cell domains (mitochondria, nuclear envelope, PML/sp-100 bodies, centromere) than BN (p = 0.008) and BN/AID samples (p = 0.002). Three variables were independently associated with established PBC: high-avidity anti-PDC-E2 (OR 4.121; 95 % CI 2.118–8.019); high-titer IIF-AMA (OR 4.890; 2.319–10.314); antibodies to three or more antigenic cell domains (OR 9.414; 1.924–46.060). Conclusion The autoantibody profile was quantitatively and qualitatively more robust in definite PBC as compared with AMA-positive biochemically normal individuals.

Estudio de la selección por el color del alimento en la tortuga boba Caretta caretta tras la eclosión

The behavior of newborn pups of loggerhead turtles (Caretta caretta) towards a potential food after hatching and before eating food for the first time was studied. There was no significant time trend approach and bite of potentially edible objects based on their color or size. However, a clear trend was observed for those objects that are transparent, white or red, independently the sex of the animal. Furthermore, it was verified that the turtles do not have a biting behavior to feed from first contact with water, but it comes after 3 or 4 days. There is also a learning process that determines the choice of targets of further attacks.

Similar carbohydrate but enhanced lactate utilization during exercise after 9 wk of acclimatization to 5,620 m

[EN] We hypothesized that reliance on lactate as a means of energy distribution is higher after a prolonged period of acclimatization (9 wk) than it is at sea level due to a higher lactate Ra and disposal from active skeletal muscle. To evaluate this hypothesis, six Danish lowlanders (25 +/- 2 yr) were studied at rest and during 20 min of bicycle exercise at 146 W at sea level (SL) and after 9 wk of acclimatization to 5,260 m (Alt). Whole body glucose Ra was similar at SL and Alt at rest and during exercise. Lactate Ra was also similar for the two conditions at rest; however, during exercise, lactate Ra was substantially lower at SL (65 micro mol. min(-1). kg body wt(-1)) than it was at Alt (150 micro mol. min(-1). kg body wt(-1)) at the same exercise intensity. During exercise, net lactate release was approximately 6-fold at Alt compared with SL, and related to this, tracer-calculated leg lactate uptake and release were both 3- or 4-fold higher at Alt compared with SL. The contribution of the two legs to glucose disposal was similar at SL and Alt; however, the contribution of the two legs to lactate Ra was significantly lower at rest and during exercise at SL (27 and 81%) than it was at Alt (45 and 123%). In conclusion, at rest and during exercise at the same absolute workload, CHO and blood glucose utilization were similar at SL and at Alt. Leg net lactate release was severalfold higher, and the contribution of leg lactate release to whole body lactate Ra was higher at Alt compared with SL. During exercise, the relative contribution of lactate oxidation to whole body CHO oxidation was substantially higher at Alt compared with SL as a result of increased uptake and subsequent oxidation of lactate by the active skeletal muscles.

Caratterizzazione ed isolamento di intermedi delle reazioni di sostituzione elettrofila e nucleofila in serie aromatica

1,3,5–Tris(N,N-dialkylamino)benzene derivatives are strongly activated neutral carbon nucleophiles able to stress some reactivity aspects toward more or less activated electrophilic substrates. These very interesting electron-rich benzenes have been firstly synthesized in 1967 and extensively studied. Their supernucleophilic character permits to perform reactions in particularly mild conditions, and make them suitable for mechanistic investigations. In many reactions they permit to isolate –complexes in electrophilic aromatic reactions. The possibility to form moderately stable Wheland intermediates depends both, on the activation of the reagents and on the experimental conditions which makes slow the proton elimination in the re-aromatization process. In presence of a carbon super electrophile reagent as 4,6-dinitrobenzofuroxan or 4,6-dinitrotetrazolepiridine, 1,3,5–tris(N,N-dialkylamino)benzene derivatives afford C–C coupling products which are “double σ complexes”, Wheland–like on the 1,3,5-tris(N,N-dialkylamino)benzene moiety, and Meisenheimer–like on the electrophile moiety. We named these complexes as Wheland–Meisenheimer (W-M) complexes. These complexes are moderately stable at low temperature and they were characterized by NMR spectroscopy methods. Others nucleophile reagents as 2-aminothiazole derivatives give a Wheland-Meisenheimer complex with 4,6-dinitrobenzofuroxan.

Design and synthesis of novel non peptidomimtic beta-secretase inhibitors in the treatment of Alzheimer's disease

The aspartic protease BACE1 (β-amyloid precursor protein cleaving enzyme, β-secretase) is recognized as one of the most promising targets in the treatment of Alzheimer's disease (AD). The accumulation of β-amyloid peptide (Aβ) in the brain is a major factor in the pathogenesis of AD. Aβ is formed by initial cleavage of β-amyloid precursor protein (APP) by β-secretase, therefore BACE1 inhibition represents one of the therapeutic approaches to control progression of AD, by preventing the abnormal generation of Aβ. For this reason, in the last decade, many research efforts have focused at the identification of new BACE1 inhibitors as drug candidates. Generally, BACE1 inhibitors are grouped into two families: substrate-based inhibitors, designed as peptidomimetic inhibitors, and non-peptidomimetic ones. The research on non-peptidomimetic small molecules BACE1 inhibitors remains the most interesting approach, since these compounds hold an improved bioavailability after systemic administration, due to a good blood-brain barrier permeability in comparison to peptidomimetic inhibitors. Very recently, our research group discovered a new promising lead compound for the treatment of AD, named lipocrine, a hybrid derivative between lipoic acid and the AChE inhibitor (AChEI) tacrine, characterized by a tetrahydroacridinic moiety. Lipocrine is one of the first compounds able to inhibit the catalytic activity of AChE and AChE-induced amyloid-β aggregation and to protect against reactive oxygen species. Due to this interesting profile, lipocrine was also evaluated for BACE1 inhibitory activity, resulting in a potent lead compound for BACE1 inhibition. Starting from this interesting profile, a series of tetrahydroacridine analogues were synthesised varying the chain length between the two fragments. Moreover, following the approach of combining in a single molecule two different pharmacophores, we designed and synthesised different compounds bearing the moieties of known AChEIs (rivastigmine and caproctamine) coupled with lipoic acid, since it was shown that dithiolane group is an important structural feature of lipocrine for the optimal inhibition of BACE1. All the tetrahydroacridines, rivastigmine and caproctamine-based compounds, were evaluated for BACE1 inhibitory activity in a FRET (fluorescence resonance energy transfer) enzymatic assay (test A). With the aim to enhancing the biological activity of the lead compound, we applied the molecular simplification approach to design and synthesize novel heterocyclic compounds related to lipocrine, in which the tetrahydroacridine moiety was replaced by 4-amino-quinoline or 4-amino-quinazoline rings. All the synthesized compounds were also evaluated in a modified FRET enzymatic assay (test B), changing the fluorescent substrate for enzymatic BACE1 cleavage. This test method guided deep structure-activity relationships for BACE1 inhibition on the most promising quinazoline-based derivatives. By varying the substituent on the 2-position of the quinazoline ring and by replacing the lipoic acid residue in lateral chain with different moieties (i.e. trans-ferulic acid, a known antioxidant molecule), a series of quinazoline derivatives were obtained. In order to confirm inhibitory activity of the most active compounds, they were evaluated with a third FRET assay (test C) which, surprisingly, did not confirm the previous good activity profiles. An evaluation study of kinetic parameters of the three assays revealed that method C is endowed with the best specificity and enzymatic efficiency. Biological evaluation of the modified 2,4-diamino-quinazoline derivatives measured through the method C, allow to obtain a new lead compound bearing the trans-ferulic acid residue coupled to 2,4-diamino-quinazoline core endowed with a good BACE1 inhibitory activity (IC50 = 0.8 mM). We reported on the variability of the results in the three different FRET assays that are known to have some disadvantages in term of interference rates that are strongly dependent on compound properties. The observed results variability could be also ascribed to different enzyme origin, varied substrate and different fluorescent groups. The inhibitors should be tested on a parallel screening in order to have a more reliable data prior to be tested into cellular assay. With this aim, preliminary cellular BACE1 inhibition assay carried out on lipocrine confirmed a good cellular activity profile (EC50 = 3.7 mM) strengthening the idea to find a small molecule non-peptidomimetic compound as BACE1 inhibitor. In conclusion, the present study allowed to identify a new lead compound endowed with BACE1 inhibitory activity in submicromolar range. Further lead optimization to the obtained derivative is needed in order to obtain a more potent and a selective BACE1 inhibitor based on 2,4-diamino-quinazoline scaffold. A side project related to the synthesis of novel enzymatic inhibitors of BACE1 in order to explore the pseudopeptidic transition-state isosteres chemistry was carried out during research stage at Università de Montrèal (Canada) in Hanessian's group. The aim of this work has been the synthesis of the δ-aminocyclohexane carboxylic acid motif with stereochemically defined substitution to incorporating such a constrained core in potential BACE1 inhibitors. This fragment, endowed with reduced peptidic character, is not known in the context of peptidomimetic design. In particular, we envisioned an alternative route based on an organocatalytic asymmetric conjugate addition of nitroalkanes to cyclohexenone in presence of D-proline and trans-2,5-dimethylpiperazine. The enantioenriched obtained 3-(α-nitroalkyl)-cyclohexanones were further functionalized to give the corresponding δ-nitroalkyl cyclohexane carboxylic acids. These intermediates were elaborated to the target structures 3-(α-aminoalkyl)-1-cyclohexane carboxylic acids in a new readily accessible way.

Stereoselective Catalytic Processes for the Synthesis of Polycyclic Aromatic Compounds

In this PhD-thesis, two methodologies for enantioselective intramolecular ring closing reaction on indole cores are presented. The first methodology represents a highly stereoselective alkylation of the indole N1-nitrogen, leading to 3,4-dihydro-pyrazinoindol-1-ones – a structural class which is known for its activity on the CNS and therefore of high pharmacological interest concerning related diseases. In this approach, N-benzyl cinchona-alkaloids were used for the efficient catalysis of intramolecular aza-Michael reactions. Furthermore, computational studies in collaboration with the research group Prof. Andrea Bottoni (Department of Chemistry “G. Ciamician”, Bologna) were accomplished in order to get insight into the key interactions between catalyst and substrate, leading to enantiomeric excesses up to 91%. The results of the calculations on a model system are in accordance with the experimental results and demonstrate the high sensibility of the system towards structural modifications. The second project deals with a metal catalyzed, intramolecular Friedel-Crafts (FC)-reaction on indolyl substrates, carrying a side chain which on its behalf is furnished with an allylic alcohol unit. Allylic alcohols are part of the structural class of “π-activated alcohols” – alcohols, which are more easily activated due to the proximity to a π-unit (allyl-, propargyl-, benzyl-). The enantioselective intramolecular cyclization event is catalyzed efficiently by employment of a chiral Au(I)-catalyst, leading to 1-vinyl- or 4-vinyl-tetrahydrocarbazoles (THCs) under the formation of water as byproduct. This striking and novel process concerning the direct activation of alcohols in catalytic FC-reactions was subsequently extended to similar precursors, leading to functionalized tetrahydro-β-carbolines. These two methodologies represent highly efficient approaches towards the synthesis of scaffolds, which are of enormous pharmaceutical interest and amplify the spectra of enantioselective catalytic functionalisations of indoles.

Combined Evaluation of ST-segment Elevation in lead AVR and ST-segment Depression in other Leads Enhances Prediction of in-hospital Cardiovascular Death in Patients with Non ST-segment Elevation Acute Coronary Syndrome

Objective: To investigate the prognostic significance of ST-segment elevation (STE) in aVR associated with ST-segment depression (STD) in other leads in patients with non-STE acute coronary syndrome (NSTE-ACS). Background: In NSTE-ACS patients, STD has been extensively associated with severe coronary lesions and poor outcomes. The prognostic role of STE in aVR is uncertain. Methods: We enrolled 888 consecutive patients with NSTE-ACS. They were divided into two groups according to the presence or not on admission ECG of aVR STE≥ 1mm and STD (defined as high risk ECG pattern). The primary and secondary endpoints were: in-hospital cardiovascular (CV) death and the rate of culprit left main disease (LMD). Results: Patients with high risk ECG pattern (n=121) disclosed a worse clinical profile compared to patients (n=575) without [median GRACE (Global-Registry-of-Acute-Coronary-Events) risk score =142 vs. 182, respectively]. A total of 75% of patients underwent coronary angiography. The rate of in-hospital CV death was 3.9%. On multivariable analysis patients who had the high risk ECG pattern showed an increased risk of CV death (OR=2.88, 95%CI 1.05-7.88) and culprit LMD (OR=4.67,95%CI 1.86-11.74) compared to patients who had not. The prognostic significance of the high risk ECG pattern was maintained even after adjustment for the GRACE risk score (OR = 2.28, 95%CI:1.06-4.93 and OR = 4.13, 95%CI:2.13-8.01, for primary and secondary endpoint, respectively). Conclusions: STE in aVR associated with STD in other leads predicts in-hospital CV death and culprit LMD. This pattern may add prognostic information in patients with NSTE-ACS on top of recommended scoring system.

Der Austausch von Stickstoffmonoxid zwischen Boden und Atmosphäre unter besonderer Berücksichtigung des Bodenwassergehaltes

Stickstoffmonoxid (NO) ist als reaktives Spurengas eine wichtige Komponente atmosphärenchemischer Prozesse und hat somit einen bedeutenden Einfluss auf die Zusammensetzung der Atmosphäre. Eine Hauptquelle des Spurengases stellen bodenmikrobiologische Prozesse dar, deren regionaler und globaler Anteil weiterhin mit größeren Unsicherheiten geschätzt wird. Ursache für die schwere Abschätzbarkeit der NO-Freisetzung aus Böden ist die hohe räumliche Variabilität der steuernden Faktoren. Als einer der wichtigsten Faktoren, die die Freisetzung von NO aus Böden regeln, gilt der Bodenwassergehalt. Ziel der vorliegenden Arbeit ist es, den Zusammenhang zwischen NO-Freisetzung, Bodenwassergehalt, den Bodeneigenschaften und den Standortbedingungen zu untersuchen und diesen möglichst zu quantifizieren. Dazu sind Bodenproben unterschiedlicher Landnutzungen in einem kleineren Wassereinzugsgebiet im Rheingau im Labor, unter kontrollierten Bedingungen, untersucht. Der charakteristische Zusammenhang zwischen Bodenfeuchte und NO-Freisetzung, die sogenannte Bodenfeuchtekurve, kann demnach weitestgehend auf die gemessenen Bodenmerkmale der untersuchten Proben zurückgeführt werden. Anhand der Bodenmerkmale kann die Bodenfeuchtekurve zufriedenstellend vorhergesagt werden. Dabei zeigt vor allem der Humusgehalt der Böden einen dominierenden Einfluss. Er ist die Variable, die die Unterschiede der Böden beim Zusammenhang zwischen Bodenfeuchte und NO-Freisetzung am besten und hinreichend erklären kann. Zur Konstruktion der Bodenfeuchtekurve müssen die optimale Bodenfeuchte und die dabei herrschende Freisetzung, sowie die obere Bodenfeuchte, bei der keine NO-Freisetzung mehr stattfindet, bekannt sein. Diese charakteristischen Punkte lassen sich durch lineare Regressionsmodelle gut aus den Bodeneigenschaften ableiten. Auf räumlicher Ebene werden die Bodeneigenschaften durch die standörtlichen Bedingungen geprägt, die wiederum Ausdruck der landschaftlichen Ausstattung sind. In der Kulturlandschaft kann der Mensch aufgrund seiner Landnutzungsansprüche als der dominierende Faktor angesehen werden. Die Landnutzung orientiert sich an den landschaftlichen Bedingungen und bestimmt in hohem Maße wichtige Bodeneigenschaften, die zu den erklärenden Merkmalen bei der Beziehung zwischen Bodenwassergehalt und NO-Freisetzung gehören. Die in erster Linie wirtschaftlich orientierten Kartenwerke Bodenschätzung, Weinbergsbodenkartierung und forstliche Standortkartierung sind dementsprechend geeignete Grundlagen, um eine Regionalisierung der Landschaft in - bezüglich der NO-Freisetzung - weitgehend homogene Flächen durchführen zu können. Eine hierauf beruhende Regionalisierung ist dazu geeignet, die räumliche Variabilität der NO-Freisetzung in räumlich sinnvoller Auflösung besser abschätzen zu können.

Reactivity of activated electrophiles and nucleophiles: labile intermediates and properties of the reaction products

The main topic of my Ph.D. thesis is the study of nucleophilic and electrophilic aromatic substitution reaction, in particular from a mechanistic point of view. The research was mainly focused on the reactivity of superactivated aromatic systems. In spite of their high reactivity (hence the high reaction’s rate), we were able to identify and in some case to isolate -complexes until now only hypothesized. For example, interesting results comes from the study of the protonation of the supernucleophiles tris(dialkylamino)benzenes. However, the best result obtained in this field was the isolation and structural characterization of the first stables zwitterionic Wheland-Meisenheimer complexes by using 2,4-dipyrrolidine-1,3-thiazole as supernucleophile and 4,6-dinitrobenzofuroxan or 4,6-dinitrotetrazolepyridine as superelectrophile. These reactions were also studied by means of computational chemistry, which allowed us to better investigate on the energetic and properties of the reactions and reactants studied. We also discovered, in some case fortuitously, some relevant properties and application of the compounds we synthesized, such as fluorescence in solid state and nanoparticles, or textile dyeing. We decided to investigate all these findings also by collaborating with other research groups. During a period in the “Laboratoire de Structure et Réactivité des Systèmes Moléculaires Complexes-SRSMC, Université de Lorraine et CNRS, France, I carried out computational studies on new iron complexes for the use as dyes in Dye Sensitized Solar Cells (DSSC). Furthermore, thanks to this new expertise, I was involved in a collaboration for the study of the ligands’ interaction in biological systems. A collaboration with University of Urbino allowed us to investigate on the reactivity of 1,2-diaza-1,3-dienes toward nucleophiles such as amino and phosphine derivatives, which led to the synthesis of new products some of which are 6 or 7 member heterocycles containing both phosphorus and nitrogen atoms.

Charakterisierung und funktionelle Analyse verschiedener Isoformen von Clusterin (Apolipoprotein J)

Clusterin (CLU), auch bekannt unter dem Namen Apolipoprotein J (ApoJ), wird von Zellen als hetreodimeres Glykoprotein exprimiert und in den extrazellulären Raum sezerniert. Es wird daher auch als sezerniertes CLU (sCLU) bezeichnet. Neben sCLU sind auch nicht-sezernierte Isoformen von CLU bekannt, die in der vorliegenden Arbeit erforscht wurden. Ziel dabei war es, die Expression, die Biogenese, sowie die Funktion dieser Proteine zu ergründen. Nicht-sezernierte CLU-Formen werden ausschließlich von Zellen exprimiert, die zuvor einer Stresssituation ausgesetzt wurden. Dies konnte insbesondere durch Kultur verschiedener Zelllinien bei erhöhter Temperatur oder durch Behandlung mit dem Proteasominhibitor MG 132 demonstriert werden, worauf neben sCLU auch 50 kDa bzw. 45 kDa große, nicht-sezernierte CLU-Proteine in geringen Mengen exprimiert wurden. Bezüglich der Biogenese dieser Proteine wurden mehrere Hypothesen bzw. Mechanismen diskutiert und in dieser Arbeit untersucht: alternative Translationsstartpunkte auf verschiedenen mRNAs, alternatives Splicing einzelner mRNAs sowie Retrotranslokation oder Mistranslokation von sCLU-Vorläuferproteinen. Um die Hypothesen eruieren zu können, musste zuerst eine Expressionsanalyse der bekannten CLU-mRNAs durchgeführt werden. Über 5’-RACE, semi-quantitative und quantitative PCRs wurde die Expression von vier CLU-mRNAs sowie deren Induktion auf Zellstress hin festgestellt. Variante 1 (BP211675) ist die dominante CLU-mRNA und macht über 99,5 % an CLU-mRNA in unbehandelten sowie in gestressten Zellen aus. Des Weiteren sind geringste Mengen der mRNA-Varianten 2 und 3 (NR_038335.1 und NR_045494.1) detektiert worden, deren Sequenzen sich lediglich in ihrem alternativen Exon 1 von Variante 1 unterscheiden. Schließlich konnte die Expression von Variante 1 [Δex2] festgestellt werden, welcher durch alternatives Splicing, i.e. Exon-skipping, das Exon 2 mit der ER-Signalsequenz-codierenden Region (SSCR) fehlt. HEK 293-Zellen, die transient mit je einer der rekombinanten CLU-mRNAs in Form rekombinanter cDNA transfiziert wurden, exprimierten neben großen Mengen sCLU auch geringe Mengen an den nicht-sezernierten CLU-Isoformen. Die anschließend durchgeführten in vitro Mutagenesen belegen, dass alle Isoformen ausgehend von distinkten Translationsstartpunkten aus synthetisiert werden. CLU1-449 (50 kDa) wird als prä-Proprotein von sCLU ausgehend von einem Startcodon auf Exon 2 unmittelbar vor der SSCR translatiert. Unter Zellstress-Bedingungen kann es zu einer Mistranslokation während der co-translationalen Translokation kommen, sodass Teile von CLU1-449 im Cytosol akkumulieren. CLU21-449 (50 kDa) wird ausgehend von einem CUG-Startcodon downstream der SSCR über interne Translationsinitiation gebildet. Analoges gilt für CLU34-449 (45 kDa), welches von einem AUG-Startcodon auf Exon 3 translatiert wird. CLU34-449 ist außerdem die einzige CLU-Form die von Variante 1 [Δex2] codiert wird. Somit konnten drei der in der Literatur postulierten Mechanismen zur Ent-stehung nicht-sezernierter CLU-Isoformen in gestressten Zellen verifiziert werden. Die Mistranslokation von sCLU-Vorläuferproteinen, welche entscheidend zum Auftreten der nicht-sezernierten CLU-Formen beiträgt, die Alternative Translationsinitiation an distinkten Startcodons sowie das alternative Splicing von CLU-mRNA-Variante 1. Weiterführende Experimente bestätigten, dass alle nicht-sezernierten CLU-Isoformen im Cytosol der Zellen lokalisiert sind und keine Glykosylierungen tragen. Somit konnte ein weiterer, in der Literatur kontrovers diskutierter Punkt bezüglich dieser Proteine geklärt werden. Abschließend wurde die physiologische Funktion der einzelnen CLU-Isoformen analysiert. Dabei zeigte sich, dass ausschließlich sCLU eine Chaperonaktivität zukommt, die es ermöglicht, durch Hitze denaturierte Zielproteine in Lösung zu halten. Diese Funktion konnte nicht für die cytosolischen Iso¬formen bestätigt werden. Weiterhin konnte keine Auswirkung einzelner CLU-Formen auf die intrinsische Apoptose oder auf den NF κB-vermittelten Signaltransduktionsweg festgestellt werden, obgleich entsprechende Einflüsse von anderen Arbeitsgruppen postuliert wurden. Die hier gemachten Beobachtungen werfen daher die Frage auf, ob den nicht-sezernierten, cytosolischen CLU-Isoformen überhaupt eine physiologische Funktion zukommt und stellen aktuelle Hypothesen bezüglich der Rolle von CLU bei pathophysiologischen Prozessen infrage.

Healing of two and three wall intrabony periodontal defects following treatment with an enamel matrix derivative combined with autogenous bone

BACKGROUND: There are still limited data on the outcomes of regenerative periodontal surgery using a combination of an enamel matrix protein derivative (EMD) and autogenous bone (AB). AIM: To evaluate the healing of deep intrabony defects treated with either a combination EMD+AB or EMD alone. MATERIALS AND METHODS: Forty patients with advanced chronic periodontitis, with one deep intrabony defect, were randomly treated with either EMD+AB (test) or EMD (control). Clinical assessments were performed at baseline and at 1 year after treatment. The primary outcome variable was relative attachment level (RAL). RESULTS: Healing was uneventful in all patients. The test sites showed a reduction in the mean probing pocket depth (PPD) of 5.6 +/- 0.9 mm (p<0.001), a gain in the mean RAL of 4.2 +/- 1.1 mm (p<0.001) and a gain in the mean probing bone level (PBL) of 3.9 +/- 1.0 mm (p<0.001). The control group displayed a mean PPD reduction of 4.6 +/- 0.4 mm (p<0.001), a mean RAL gain of 3.4 +/- 0.8 mm (p<0.001) and a mean PBL gain of 2.8 +/- 0.8 mm (p<0.001). RAL gains of > or =4 mm were measured in 90% of the test defects and in 55% of the controls. PBL gains of > or =4 mm were obtained in 85% of the test defects and in 25% of the control ones. The test treatment resulted in statistically higher PPD reductions, RAL gains and PBL gains compared with the control (p<0.01). CONCLUSIONS: Within their limits, the present results indicate that: (i) at 1 year after surgery, both therapies resulted in statistically significant clinical improvements compared with baseline and (ii) although the combination of EMD+AB resulted in statistically significant higher soft and hard tissue improvements compared with treatment with EMD, the clinical relevance of this finding is unclear.

Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi

Objective  Malnutrition is common in HIV-infected children in Africa and an indication for antiretroviral treatment (ART). We examined anthropometric status and response to ART in children treated at a large public-sector clinic in Malawi. Methods  All children aged <15 years who started ART between January 2001 and December 2006 were included and followed until March 2008. Weight and height were measured at regular intervals from 1 year before to 2 years after the start of ART. Sex- and age-standardized z-scores were calculated for weight-for-age (WAZ) and height-for-age (HAZ). Predictors of growth were identified in multivariable mixed-effect models. Results  A total of 497 children started ART and were followed for 972 person-years. Median age (interquartile range; IQR) was 8 years (4–11 years). Most children were underweight (52% of children), stunted (69%), in advanced clinical stages (94% in WHO stages 3 or 4) and had severe immunodeficiency (77%). After starting ART, median (IQR) WAZ and HAZ increased from −2.1 (−2.7 to −1.3) and −2.6 (−3.6 to −1.8) to −1.4 (−2.1 to −0.8) and −1.8 (−2.4 to −1.1) at 24 months, respectively (P < 0.001). In multivariable models, baseline WAZ and HAZ scores were the most important determinants of growth trajectories on ART. Conclusions  Despite a sustained growth response to ART among children remaining on therapy, normal values were not reached. Interventions leading to earlier HIV diagnosis and initiation of treatment could improve growth response.