Extraction and purification of triterpenic acids from eucalypt bark

A indústria da pasta e do papel é um sector importante da economia mundial, particularmente a que assenta em espécies de Eucalyptus. No entanto, essas indústrias geram quantidades significativas de correntes secundárias de subprodutos e resíduos de biomassa que podem ser exploradas em aplicações de valor acrescentado em vez de serem queimadas para produção de energia. Um exemplo nobre pode ser a produção de ácidos triterpénicos com estruturas dos tipos lupano, oleanano e ursano, dada a sua abundância em alguns destes resíduos, em particular na casca, adotando o conceito de biorrefinaria integrada numa fábrica de pasta. Estes compostos são conhecidos pelas suas inúmeras actividades biológicas, por exemplo, antioxidante, anti-inflamatória e antitumoral, e podem encontrar aplicações em produtos de elevado valor, tais como cosméticos, nutracêuticos ou farmacêuticos. Neste sentido, o estudo das potencialidades das cascas das espécies de eucalipto mais exploradas enquanto fontes de compostos triterpénicos é um tópico relevante. Por conseguinte, foram analisados e comparados em pormenor os teores e composições em ácidos triterpénicos (TTAs) das cascas externas de várias espécies de eucalipto (E. globulus, E. grandis, E. urograndis, E. maidenii e E. nitens). Os teores dos principais TTAs identificados nestas espécies variaram entre 4.5 g/kg no E. urograndis e 21.6 g/kg no E. nitens. Observou-se que as cascas externas de Eucalyptus de zonas temperadas e Mediterrânicas, nomeadamente E. nitens e E. globulus, são mais ricas em TTAs que as espécies de regiões tropicais e subtropicais. Além disso, a casca externa do E. globulus é claramente a mais rica em ácidos com estruturas do tipo ursano enquanto a do E. nitens é a mais rica em ácidos do tipo oleanano e lupano. Estes resultados levaram-nos a estudar a extração dos TTAs da casca de Eucalyptus, bem como a sua posterior concentração e purificação, a qual foi efetuada por extração sólido-líquido convencional combinada com a precipitação de solutos, e por extração com fluidos supercríticos (SFE). No que diz respeito à primeira abordagem referida, foi desenvolvido neste trabalho um método patenteado que permite obter extratos enriquecidos em TTAs das cascas de eucalipto baseado em tecnologias disponíveis no imediato. Em relação à segunda abordagem, e de forma a apostar em processos de baixo impacto ambiental exigidos pelas biorrefinarias do futuro, a SFE surge como uma opção natural. Assim, foi efetuada a SFE da casca caduca do E. globulus com dióxido de carbono puro e modificado para recuperar a fração de TTAs, e os resultados foram comparados com os obtidos por extração em Soxhlet com diclorometano. Foram realizados estudos preliminares sobre a influência da pressão (100-200 bar), a adição de co-solvente (0, 5 e 8% m/m de etanol), e operação em múltiplos passos a fim de avaliar a aplicabilidade da alternativa supercrítica para a sua produção eficiente e selectiva. Os resultados destacaram a influência da pressão e o importante papel resumo (cont.) desempenhado pelo co-solvente neste processo, cujo efeito foi mais relevante do que o aumento da pressão em várias dezenas de bar. Este trabalho foi depois otimizado, usando o planeamento factorial de experiências e a metodologia de superfícies de resposta, para analisar a influência da temperatura (40-60 ºC), pressão (100-200 bar), e teor de etanol (0.0-5.0% m/m) na recuperação dos TTAs e respectiva concentração nos extractos. Nestes intervalos, as melhores condições de operação encontradas foram 200 bar, 40 °C e 5% de etanol, para as quais os modelos de regressão estatisticamente validados previram um rendimento de extração de 1.2% com 50% de concentração em TTAs, correspondendo ao rendimento em TTAs de 5.1 g/kg de casca e uma recuperação de 79.2% comparativamente ao valor do Soxhlet. Os TTAs livres e acetilados apresentaram tendências de extracção bastante distintas devido às suas diferentes afinidades para o CO2 causadas pelas diferentes polaridades: os derivados acetilados aproximam-se de um patamar máximo a cerca de 200 bar e 5% de etanol, enquanto a extração dos TTAs livres apresenta uma tendência sempre crescente no intervalo de condições estudado. Foram também medidas curvas cumulativas de SFE da casca do E. globulus de forma a analisar o comportamento cinético do processo em termos de rendimento total, rendimento em TTAs, rendimento em TTAs livres, rendimento em TTAs acetilados, e concentração dos TTAs nos extractos. Foi analisada a influência da pressão, temperatura, teor de co-solvente e caudal do dióxido de carbono sobre as respostas anteriores. Os dados experimentais foram modelados com os modelos Logístico, de Dessorção, de Placa Plana Simples, e de Difusão. Na globalidade, os resultados confirmaram que a pressão e o teor de etanol têm um efeito significativo sobre as curvas de extração, os rendimentos finais e as concentrações dos extratos, e mostraram a presença de limitações externas à transferência de massa em alguns ensaios. Mais uma vez, as famílias individuais de TTAs livres e acetilados apresentaram diferentes tendências de extracção. A modelação permitiu-nos confirmar não só o importante papel desempenhado pela difusão intraparticular na SFE, mas também a contribuição da resistência no filme em alguns ensaios. Após a análise de todos os resultados, foi efetuado um ensaio em duas etapas em série, possibilitando o enriquecimento do teor em TTAs no extracto devido às diferentes condições adotadas em cada etapa. Por último, um éster metílico de um ácido triterpénico do tipo oleanano - morolato de metilo - foi identificado pela primeira vez enquanto componente da casca de Eucalyptus na casca externa do Eucalyptus grandis x globulus, onde ocorre em teores elevados. A sua extração com CO2 supercrítico foi também realizada, visando a conceção de uma alternativa de extração ambientalmente benigna para este composto. A 200 bar e 60 ºC, a remoção do morolato de metilo atingiu um patamar às 6 h para 5.1 kg h-1 de CO2 / kg de casca. Em geral, e de forma semelhante à SFE da casca do E. globulus, os TTAs acetilados foram mais significativamente extraídos quando comparados com os seus ácidos livres, o que está diretamente relacionado com a natureza menos polar destas moléculas. O trabalho apresentado nesta tese é uma contribuição para a valorização de uma corrente de biomassa com baixo valor na indústria de pasta em duas vertentes complementares. Por um lado, aumentou o conhecimento da composição lipofílica das cascas de Eucalyptus spp. com interesse comercial para a produção de pasta, destacando o seu potencial enquanto fontes de ácidos triterpénicos. Por outro lado, foram desenvolvidos dois processos alternativos e facilmente integráveis numa fábrica de pasta para a sua exploração a partir da casca: um baseado em tecnologias convencionais bem estabelecidas a nível industrial, prevendo a sua aplicação a curto prazo, e um outro baseado na SFE, seguindo as tendências das futuras biorrefinarias.

Searching biocompounds in marine natural extracts with potential use in tumor prevention and treatment

Cancer is a multistage process characterized by three stages: initiation, promotion and progression; and is one of the major killers worldwide. Oxidative stress acts as initiator in tumorigenesis; chronic inflammation promotes cancer; and apoptosis inactivation is an issue in cancer progression. In this study, it was investigated the antioxidant, antiinflammatory and antitumor properties of hexane, ether, chloroform, methanol and water extracts of five species of halophytes: A. macrostachyum, P. coronopus, J. acutus, C. edulis and A. halimus. Antioxidant activity was assessed by DPPH• and ABTS•+ methods, and the total phenolics content (TPC) was evaluated by the Folin-Ciocalteau method. The anti-inflammatory activity of the extracts was determined by the Griess method, and by evaluating the inhibition of NO production in LPS-stimulated RAW- 264.7 macrophages. The cytotoxic activity of the extracts against HepG2 and THP1 cell lines was estimated by the MTT assay, and the results obtained were further compared with the S17 non-tumor cell line. The induction of apoptosis of J. acutus ether extract was assessed by DAPI staining. The highest antioxidant activities was observed in C. edulis methanol and the J. acutus ether extracts against the DPPH• radical; and J. acutus ether and A. halimus ether extracts against the ABTS•+ radical. The methanol extracts of C. edulis and P. coronopus, and the ether extract of J. acutus revealed a high TPC. Generally the antioxidant activity had no correlation with the TPC. The A. halimus chloroform and P. coronopus hexane extracts demonstrated ability to reduce NO production in macrophages (> 50%), revealing their anti-inflammatory capacity. The ether extract of J. acutus showed high cytotoxicity against HepG2 cancer cells, with reduced cellular viability even at the lowest concentrations. This outcome was significantly lower than the obtained with the non-tumor cells (S17). This result was complemented by the induction of apoptosis.

Antioxidant activities of eight Algerian plant extracts and two essential oils

Total phenol, hydroxycinnamic acid derivatives, flavone/flavonol and flavanones/dihydroflavonol contents of hydro-alcoholic extracts, obtained by sonication, from the aerial parts of Artemisia campestris L., Anthemis arvensis L., Haloxylon scoparium Pomel, Juniperus phoenicea L., Arbutus unedo L., Cytisus monspessulanus L., Thymus algeriensis Boiss et Reut, Zizyphus lotus L (Desf.) collected in Djebel Amour (Sahara Atlas, Algeria) were quantified by spectrophotometric methods. The chemical composition of the essential oils obtained by hydrodistillation from Artemisia campestris L. and Juniperus phoenicea I aerial parts were also evaluated by gas chromatography (GC) and gas chromatography coupled to mass spectrometry (GC-MS). The antioxidant activity of the extracts and essential oils was assessed measuring the capacity for preventing lipid peroxidation using two lipidic substrates (egg yolk and liposomes), the capacity for scavenging DPPH, ABTS, superoxide anion radicals, hydroxyl radicals and peroxyl radicals. Anti-inflammatory activity was assessed by measuring the capacity for inhibiting lipoxygenase. Reducing power and chelating capacity were also assayed. The results showed different amounts of total phenols depending on the method used: A. campestris extract had the highest levels of total phenols when the measurement was made at lambda = 280 nm, whereas H. scoparium and A. unedo extracts showed the highest levels of total phenols with Folin-Ciocalteau. C. monspessulanus had the highest levels of flavones/flavonols and flavanones/dihydroflavonols. The essential oils of A. campestris and J. phoenicea were mainly constituted by alpha-pinene, beta-pinene and sabinene; and a-pinene, respectively. The methods used for assaying the capacity for preventing lipid peroxidation revealed to be inadequate for extracts due to the great interferences detected. The essential oils were more active than the generality of extracts for scavenging peroxyl radicals and for inhibiting lipoxygenase, whereas A. unedo extract was the most active for scavenging ABTS, DPPH, superoxide anion radicals and it also had the best reducing capacity. In a general way, the great majority of the antioxidant activities correlated well with the phenol content although such correlation was not so clear with the flavonoid content. (c) 2013 Elsevier B.V. All rights reserved.

Nanotecnologia aplicada a formulações tópicas de fármacos anti-inflamatórios não esteróides

Tese de doutoramento, Farmácia (Tecnologia Farmacêutica), Universidade de Lisboa, Faculdade de Farmácia, 2014

The effect of melanocortin peptides on Interleukin 1-beta induced chondrocyte cell death and inflammation

ntroduction: Osteoarthritis (OA) is a degenerative joint disease affecting more than 8.5 million people in the UK. Disruption in the catabolic and anabolic balance, with the catabolic cytokine Interleukin 1 beta (IL-1β) being involved in the initiation and progression of OA (1). Melanocortin peptides (α-MSH and D[Trp8]-γ-MSH) exert their anti-inflammatory effects via activation of melanocortin receptors (MC), with both MC1 and MC3 being identified as promising candidates as novel targets for OA (2). This study aims to assess the chondroprotective and anti-inflammatory effects of the pan melanocortin receptor agonist α-MSH and MC3 agonist D[Trp8]-γ-MSH following IL-1β chondrocyte stimulation. Methods: RT-PCR/ Western Blot: Human C-20/A4 chondrocytic cell-line were cultured in 6 well plates (1x106 cells/well) and harvested to determine MC and IL-1β expression by RT-PCR, and Western Blot. Cell-Culture: Cells were cultured in 96 well plates (1x106 cells/well) and stimulated with H2O2 (0.3%), TNF-α (60 pg/ml) or IL-1β (0-5000pg/ml) for 0-72h and cell viability determined. Drug Treatment: In separate experiments cells were pre-treated with 3 μg/ml α-MSH (Sigma-Aldrich Inc. Poole, UK), or D[Trp8]-γ-MSH (Phoenix Pharmaceuticals, Karlsrhue, Germany) (all dissolved in PBS) for 30 minutes prior to IL-1β (5000pg/ml) stimulation for 6-24h. Analysis: Cell viability was determined by using the three cell viability assays; Alamar Blue, MTT and the Neutral Red (NR) assay. Cell-free supernatants were collected and analysed for Interleukin -6 (IL-6) and IL-8 release by ELISA. Data expressed as Mean ± SD of n=4-8 determination in quadruplicate. *p≤ 0.05 vs. control. Results: Both RT-PCR, and Western Blot showed MC1 and MC3 expression on C-20/A4 cells. Cell viability analysis: IL-1β stimulation led to a maximal cell death of 35% at 6h (Alamar Blue), and 40% and 75% with MTT and Neutral Red respectively at 24h compared to control. The three cell viability assays have different cellular uptake pathways, which accounts for the variations observed in cell viability in response to the concentration of IL-1β, and time. Cytokine analysis by ELISA: IL-1β (5000pg/ml) stimulation for 6 and 24h showed maximal IL-6 production 292.3 ±3.8 and 275.5 ±5.0 respectively, and IL-8 production 353.3 ±2.6 and 598.3 ±8.6 respectively. Pre-treatment of cells with α-MSH and D[Trp8]-γ-MSH caused significant reductions in both IL-6 and IL-8 respectively following IL-1β stimulation at 6h. Conclusion: MC1/3 are expressed on C-20/A4 cells, activation by melanocortin peptides led to an inhibition of IL-1β induced cell death and pro-inflammatory cytokine release.

Development and preclinical assessment of a bioartificial pancreas.

Transplantation of insulin secreting cells is regarded as a possible treatment for type 1 diabetes. One major difficulty in this approach is, however, that the transplanted cells are exposed to the patient's inflammatory and autoimmune environment, which originally destroyed their own beta-cells. Therefore, even if a good source of insulin-secreting cells can be identified for transplantation therapy, these cells need to be protected against these destructive influences. The aim of this project was to evaluate, using a clonal mouse beta-cell line, whether genetic engineering of protective genes could be a viable option to allow these cells to survive when transplanted into autoimmune diabetic mice. We demonstrated that transfer of the Bcl-2 anti-apoptotic gene and of several genes specifically interfering with cytokines intracellular signalling pathways, greatly improved resistance of the cells to inflammatory stresses in vitro. We further showed that these modifications did not interfere with the capacity of these cells to correct hyperglycaemia for several months in syngeneic or allogeneic streptozocin-diabetic mice. However, these cells were not protected against autoimmune destruction when transplanted into type 1 diabetic NOD mice. This suggests that in addition to inflammatory attacks by cytokines, autoimmunity very efficiently kills the transplanted cells, indicating that multiple protective mechanisms are required for efficient transplantation of insulin-secreting cells to treat type 1 diabetes.

Immune regulation and function of the NOD-like receptors NLRC5 and NLRP3

AbstractThe vertebrate immune system is composed of the innate and the adaptive branches. Innate immune cells represent the first line of defense and detect pathogens through pattern recognition receptors (PRRs), detecting evolutionary conserved pathogen- and danger- associated molecular patterns. Engagement of these receptors initiates the inflammatory response, but also instructs antigen-specific adaptive immune cells. NOD-like receptors (NLRs) are an important group of PRRs, leading to the production of inflammatory mediators and favoring antigen presentation to Τ lymphocytes through the regulation of major histocompatibility complex (MHC) molecules.In this work we focused our attention on selected NOD-like receptors (NLRs) and their role at the interface between innate and adaptive immunity. First, we describe a new regulatory mechanism controlling IL-1 production. Our results indicate that type I interferons (IFNs) block NLRP1 and NLRP3 inflammasome activity and interfere with LPS-driven proIL-Ια and -β induction. As type I IFNs are produced upon viral infections, these anti-inflammatory effects of type I IFN could be relevant in the context of superinfections, but could also help explaining the efficacy of IFN-β in multiple sclerosis treatment.The second project addresses the role of a novel NLR family member, called NLRC5. The function of this NLR is still matter of debate, as it has been proposed as both an inhibitor and an activator of different inflammatory pathways. We found that the expression of this protein is restricted to immune cells and is positively regulated by IFNs. We generated Nlrc5-deficient mice and found that this NLR plays an essential role in Τ, NKT and, NK lymphocytes, in which it drives the expression of MHC class I molecules. Accordingly, we could show that CD8+ Τ cell-mediated killing of target lymphocytes lacking NLRC5 is strongly impaired. Moreover, NLRC5 expression was found to be low in many lymphoid- derived tumor cell lines, a mechanism that could be exploited by tumors to escape immunosurveillance.Finally, we found NLRC5 to be involved in the production of IL-10 by CD4+ Τ cells, as Nlrc5- deficient Τ lymphocytes produced less of this cytokine upon TCR triggering. In line with these observations, Mrc5-deficient CD4+ Τ cells expanded more than control cells when transferred into lymphopenic hosts and led to a more rapid appearance of colitis symptoms. Therefore, our work gives novel insights on the function of NLRC5 by using knockout mice, and strongly supports the idea that NLRs direct not only innate, but also adaptive immune responses.

Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease.

The diagnosis of inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), continues to present difficulties due to unspecific symptoms and limited test accuracies. We aimed to determine the diagnostic delay (time from first symptoms to IBD diagnosis) and to identify associated risk factors. A total of 1591 IBD patients (932 CD, 625 UC, 34 indeterminate colitis) from the Swiss IBD cohort study (SIBDCS) were evaluated. The SIBDCS collects data on a large sample of IBD patients from hospitals and private practice across Switzerland through physician and patient questionnaires. The primary outcome measure was diagnostic delay. Diagnostic delay in CD patients was significantly longer compared to UC patients (median 9 versus 4 months, P < 0.001). Seventy-five percent of CD patients were diagnosed within 24 months compared to 12 months for UC and 6 months for IC patients. Multivariate logistic regression identified age <40 years at diagnosis (odds ratio [OR] 2.15, P = 0.010) and ileal disease (OR 1.69, P = 0.025) as independent risk factors for long diagnostic delay in CD (>24 months). In UC patients, nonsteroidal antiinflammatory drug (NSAID intake (OR 1.75, P = 0.093) and male gender (OR 0.59, P = 0.079) were associated with long diagnostic delay (>12 months). Whereas the median delay for diagnosing CD, UC, and IC seems to be acceptable, there exists a long delay in a considerable proportion of CD patients. More public awareness work needs to be done in order to reduce patient and doctor delays in this target population.

Aspirin and statin use and the subsequent development of depression in men and women: Results from a longitudinal population-based study.

OBJECTIVE: Low-grade chronic inflammation is one potential mechanism underlying the well-established association between major depressive disorder (MDD) and increased cardiovascular morbidity. Both aspirin and statins have anti-inflammatory properties, which may contribute to their preventive effect on cardiovascular diseases. Previous studies on the potentially preventive effect of these drugs on depression have provided inconsistent results. The aim of the present paper was to assess the prospective association between regular aspirin or statin use and the incidence of MDD. METHOD: This prospective cohort study included 1631 subjects (43.6% women, mean age 51.7 years), randomly selected from the general population of an urban area. Subjects underwent a thorough physical evaluation as well as semi-structured interviews investigating DSM-IV mental disorders at baseline and follow-up (mean duration 5.2 years). Analyses were adjusted for a wide array of potential confounders. RESULTS: Our main finding was that regular aspirin or statin use at baseline did not reduce the incidence of MDD during follow-up, regardless of sex or age (hazard ratios, aspirin: 1.19; 95%CI, 0.68-2.08; and statins: 1.25; 95%CI, 0.73-2.14; respectively). LIMITATIONS: Our study is not a randomized clinical trial and could not adjust for all potential confounding factors, information on aspirin or statin use was collected only for the 6 months prior to the evaluations, and the sample was restricted to subjects between 35 and 66 years of age. CONCLUSION: Our data do not support a large scale preventive treatment of depression using aspirin or statins in subjects aged from 35 to 66 years from the community.

Bone markers and cytokines in response to low-impact, high-intensity exercise

A low-impact, high-intensity interval exercise (HIE) bout was used to determine whether an association exists between cytokines and bone turnover markers following an acute bout of exercise. Twenty-three recreationally active males (21.8±2.4yr) performed a single HIE bout on a cycle ergometer at 90% relative intensity. Venous blood samples were collected prior to exercise, 5-minutes, 1-hour, and 24-hours post-exercise, and were analyzed for serum levels of pro-inflammatory (IL-6, IL-1α, IL-1β, and TNF-α) and anti- inflammatory cytokines (IL-10) and markers of bone formation (BAP, OPG) and resorption (NTX, RANKL). Significant effects were observed with all bone markers, especially 5-minutes post-exercise with BAP, OPG, and RANKL increasing from baseline (p<0.05). Significant effects were also observed for IL-1α, IL-1β, IL-6, and TNF-α (p<0.00, p=0.04, p=0.03, p<0.00). In addition, post-exercise changes in NTX, BAP, and OPG were significantly correlated pro- and anti-inflammatory cytokines, suggesting that an interaction exists between the immune and skeletal response to exercise.

Dietary Intakes and Periodontal Outcomes After Sanative Therapy

Diet has an important role in the maintenance of oral health, but the relationship between diet and clinical outcomes following sanative therapy (ST) has not been investigated. Due to their antioxidant and anti-inflammatory properties, we hypothesized that periodontal patients with higher intakes of vitamin C, vitamin D, eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) would have greater reductions in probing depth (PD) after ST. Patients completed the Block food frequency questionnaire, a supplement use questionnaire and had their serum 25-hydroxyvitamin D measured. There were no significant associations between intakes of vitamin C, vitamin D, EPA, DHA and PD. There were, however, negative associations between intakes of linoleic acid, α- linolenic acid or total vegetable intake and PD, as well as a positive association between the total omega-6/omega-3 ratio and PD (p < 0.05). Therefore, dietary intakes of essential fatty acids and vegetables may be important modulators of periodontal outcomes following ST.

Regulation of the memory T cell development and islet beta-cell survival by DAPK-related apoptosis-inducing protein kinase 2 (Drak2)

Drak2 est un membre de la famille des protéines associées à la mort et c’est une sérine/thréonine kinase. Chez les souris mutantes nulles Drak2, les cellules T ne présentent aucune défectuosité apparente en apoptose induite par activation, après stimulation avec anti-CD3 et anti-CD28, mais ont un seuil de stimulation réduit, comparées aux cellules T de type sauvage (TS). Dans notre étude, l’analyse d’hybridation in situ a révélé que l’expression de Drak2 est ubiquiste au stade de la mi-gestation chez les embryons, suivie d’une expression plus focale dans les divers organes pendant la période périnatale et l’âge adulte, notamment dans le thymus, la rate, les ganglions lymphatiques, le cervelet, les noyaux suprachiasmatiques, la glande pituitaire, les lobes olfactifs, la médullaire surrénale, l’estomac, la peau et les testicules. Nous avons créé des souris transgéniques (Tg) Drak2 en utilisant le promoteur humain beta-actine. Ces souris Tg montraient des ratios normaux entre cellules T versus B et entre cellules CD4 versus CD8, mais leur cellularité et leur poids spléniques étaient inférieurs comparé aux souris de type sauvage. Après activation TCR, la réponse proliférative des cellules T Tg Drak2 était normale, même si leur production d’interleukine (IL)-2 et IL-4 mais non d’interféron-r était augmentée. Les cellules T Tg Drak2 activées ont démontré une apoptose significativement accrue en présence d’IL-2 exogène. Au niveau moléculaire, les cellules T Tg Drak2 ont manifesté une augmentation moins élevée des facteurs anti-apoptotiques durant l’activation; un tel changement a probablement rendu les cellules vulnérables aux attaques subséquentes d’IL-2. L’apoptose compromise dans les cellulesT Tg Drak2 a été associée à un nombre réduit de cellules T ayant le phénotype des cellules mémoires (CD62Llo) et avec des réactions secondaires réprimées des cellules T dans l’hypersensibilité de type différé. Ces résultats démontrent que Drak2 s’exprime dans le compartiment des cellules T mais n’est pas spécifique aux cellules T; et aussi qu’il joue des rôles déterminants dans l’apoptose des cellules T et dans le développement des cellules mémoires T. En outre, nous avons recherché le rôle de Drak2 dans la survie des cellules beta et le diabète. L’ARNm et la protéine Drak2 ont été rapidement induits dans les cellules beta de l’îlot après stimulation exogène par les cytokines inflammatoires ou les acides gras libres et qui est présente de façon endogène dans le diabète, qu’il soit de type 1 ou de type 2. La régulation positive de Drak2 a été accompagnée d’une apoptose accrue des cellules beta. L’apoptose des cellules beta provoquée par les stimuli en question a été inhibée par la chute de Drak2 en utilisant petit ARNi. Inversement, la surexpression de Drak2 Tg a mené à l’apoptose aggravée des cellules beta déclenchée par les stimuli. La surexpression de Drak2 dans les îlots a compromis l’augmentation des facteurs anti-apoptotiques, tels que Bcl-2, Bcl-xL et Flip, sur stimulation par la cytokine et les acides gras libres. De plus, les expériences in vivo ont démontré que les souris Tg Drak2 étaient sujettes au diabète de type 1 dans un modèle de diabète provoqué par de petites doses multiples de streptozotocine et qu’elles étaient aussi sujettes au diabète de type 2 dans un modèle d’obésité induite par la diète. Nos données montrent que Drak2 est défavorable à la survie des cellules beta. Nous avons aussi étudié la voie de transmission de Drak2. Nous avons trouvé que Drak2 purifiée pouvait phosphoryler p70S6 kinase dans une analyse kinase in vitro. Lasurexpression de Drak2 dans les cellules NIT-1 a entraîné l’augmentation de la phosphorylasation p70S6 kinase tandis que l’abaissement de Drak2 dans ces cellules a réduit la phosphorylation. Ces recherches mécanistes ont prouvé que p70S6 kinase était véritablement un substrat de Drak2 in vitro et in vivo. Cette étude a découvert les fonctions importantes de Drak2 dans l’homéostasie des cellules T et le diabète. Nous avons prouvé que p70S6 kinase était un substrat de Drak2. Nos résultats ont approfondi nos connaissances de Drak2 à l’intérieur des systèmes immunitaire et endocrinien. Certaines de nos conclusions, comme les rôles de Drak2 dans le développement des cellules mémoires T et la survie des cellules beta pourraient être explorées pour des applications cliniques dans les domaines de la transplantation et du diabète.

Cerebral edema and acute liver failure : pathophysiological mechanisms and new therapeutic approaches

L’encéphalopathie hépatique (EH) se développe chez les patients atteints d’une maladie du foie et se caractérise par de nombreuses anomalies neuropsychiatriques. L’insuffisance hépatique aiguë (IHA) se caractérise par une perte progressive de l’état de conscience, par une augmentation rapide de l’œdème cérébral et une augmentation de la pression intracrânienne entraînant une herniation cérébrale et la mort. Plusieurs facteurs sont responsables du développement de l’EH mais depuis une centaine d’années, l’hyperammonémie qui peut atteindre des concentrations de l’ordre de plusieurs millimolaires chez les patients atteints d’IHA aux stades de coma est considérée comme un facteur crucial dans la pathogenèse de l’EH. La présente thèse comprend 4 articles suggérant l’implication de nouveaux mécanismes pathogéniques dans le développement de l’EH et de l’œdème cérébral associés à l’IHA et tente d’expliquer l’effet thérapeutique de l’hypothermie et de la minocycline dans la prévention de l’EH et de l’œdème cérébral: 1. L’IHA induite par dévascularisation hépatique chez le rat se caractérise par une augmentation de la production de cytokines pro-inflammatoires cérébrales (IL-6, IL-1, TNF-). Cette observation constitue la première évidence directe que des mécanismes neuro-inflammatoires jouent une rôle dans la pathogenèse de l’EH et de l’œdème cérébral associés à l’IHA (Chapitre 2.1, articles 1 et 2). 2. L’activation de la microglie telle que mesurée par l’expression de marqueurs spécifiques (OX42, OX-6) coïncide avec le développement de l’encéphalopathie (stade coma) et de l’œdème cérébral et s’accompagne d’une production accrue de cytokines pro-inflammatoires cérébrales (Chapitre 2.1, article 1 et 2). 3. Un stress oxydatif/nitrosatif causé par une augmentation de l’expression de l’oxyde nitrique synthétase et une augmentation de la synthèse d’oxyde nitrique cérébral participe à la pathogénèse des complications neurologiques de l’IHA (Chapitre 2.3, articles 3 et 4). 4. Des traitements anti-inflammatoires tels que l’hypothermie et la minocycline peuvent constituer de nouvelles approches thérapeutiques chez les patients atteints d’IHA (Chapitre 2.1, article 1; Chapitre 2.2, article 2). 5. Les effets bénéfiques de l’hypothermie et de la minocycline sur les complications neurologiques de l’IHA expérimentale s’expliquent, en partie, par une diminution du stress oxydatif/nitrosatif (Chapitre 2.3, article 3; Chapitre 2.4, article 4).

Use of anti-infective drugs during pregnancy : prevalence, predictors of use and the risk of preterm birth and small-for-gestational-age newborns

Résumé: Les anti-infectieux sont parmi les médicaments les plus utilisés pendant la grossesse. Les indications pour l’utilisation de ces médicaments, telles que les infections bactériennes, figurent parmi les facteurs de risque les plus importants pour la prématurité et les enfants nés petits pour l'âge gestationnel («Small-for-gestational-age », SGA). Ces complications de la grossesse peuvent avoir des incidences sur la santé du nouveau né et sur son développement futur. Compte tenu des impacts sur la santé de la mère et de l’enfant, la prise en charge et le traitement efficace de ces infections sont impératifs. Cependant, l'utilisation des anti-infectieux, pour éviter des issues de grossesse défavorables, fait l’objet d’une controverse dans la littérature. Cette controverse est en partie liée à la qualité méthodologique discutable des études disponibles sur le sujet. Les quatre études présentées dans cette thèse ont donc pour objectif d’investiguer l’utilisation des anti-infectieux durant la grossesse ainsi que d’évaluer le risque de prématurité et de SGA après utilisation de ces médicaments en période gestationnelle. Une révision systématique de la littérature sur l’utilisation du métronidazole durant la grossesse est également présentée. Nous avons utilisé, comme source de données le Registre des Grossesses du Québec, une cohorte longitudinale conçue à partir du jumelage de trois bases de données administratives de la province du Québec (RAMQ, Med-Echo et ISQ). Le registre fournit des informations sur les prescriptions, les services pharmaceutiques et médicaux, ainsi que des donnés sur les soins d’hospitalisation de courte durée et démographiques. Les deux premières études présentées dans cette thèse ont eu pour objectif d’évaluer la prévalence, les tendances, les indications et les prédicteurs de l’utilisation des anti-infectieux dans une cohorte, extraite du registre, de 97 680 femmes enceintes. A l’aide d’un devis cas-témoins, les 2 dernières études ont mesuré l’association entre l’utilisation d’anti-infectieux durant les 2 derniers trimestres de grossesse et le risque de prématurité et de SGA, respectivement. Un cas de prématurité a été défini comme un accouchement survenu avant 37 semaines de gestation. Un cas de SGA a été défini comme l’accouchement d’un enfant dont le poids à la naissance se situe sous le 10ème percentile du poids normalisé à la naissance (compte tenu de l’âge gestationnel et du sexe du bébé). Les données ont été recueillies pour les agents systémiques oraux, ainsi que pour les classes et les agents individuels. Nos résultats ont montré que la prévalence de l’utilisation des anti-infectieux durant la grossesse était comparable à celle d’autres études déjà publiées (25%). Nous avons observé une augmentation de l’utilisation des agents plus anciens et ayant des profils d’innocuité connus. Les prédicteurs de l’usage en début de grossesse identifiés sont : avoir eu plus de deux différentes prescriptions (OR ajusté = 3,83, IC 95% : 3,3-4,3), avoir eu un diagnostic d’infection urinaire (OR= 1,50, IC 95% : 1,3-1,8) et un diagnostic d’infection respiratoire (OR= 1,40, IC 95% : 1,2-1,6). L’utilisation des macrolides a été associée à une diminution du risque de prématurité (OR =0,65, IC 95% : 0,50-0,85). En revanche, les femmes ayant été exposées au métronidazole ont vu leur risque augmenté de 80% (OR=1,81, IC 95% : 1,30-2,54). L’utilisation d’azithromycine a été associée à une diminution importante du risque chez les femmes ayant un diagnostic de rupture prématurée des membranes (OR=0,31, IC 95% : 0,10-0,93). Cependant, l'utilisation de sulfaméthoxazole-triméthoprime (SXT) a été significativement associée à une augmentation du risque de SGA (OR= 1,61, IC 95% : 1,16-2,23), tandis que celle des anti-infectieux urinaires a été associée à une diminution du risque (OR= 0,80, 95%CI : 0.65-0.97). Les conclusions de nos travaux suggèrent que l’utilisation des macrolides et des pénicillines diminuent le risque de prématurité et de SGA. Nous devons considérer l'utilisation de différents choix thérapeutiques tels que l’azithromycine, lors de la prise en charge des infections pouvant induire la prématurité et le SGA.

Inflammation intestinale associée à la fibrose kystique : rôle du CFTR et propriétés anti-inflammatoires de la vitamine D

Les patients fibrose kystique (FK) souffrent de complications digestives qui incluent une inflammation intestinale modérée dont l’étiologie est méconnue. Les personnes atteintes de FK présentent également une malabsorption des vitamines liposolubles, telles la vitamine D. Or, la vitamine D possède des propriétés immunomodulatrices et anti-inflammatoires. Le présent projet vise à investiguer le rôle du CFTR, dont le gène est muté dans la FK, dans l’étiologie de cette inflammation intestinale et à étudier le potentiel anti-inflammatoire de la vitamine D sur celle-ci. Le CFTR a été invalidé génétiquement par la méthode des ARN interférents (shRNAi) et/ou inhibé pharmacologiquement par l’utilisation d’un antagoniste inhibiteur spécifique (CFTRinh-172). Un état inflammatoire a été induit par les cytokines pro-inflammatoires TNF-α et IL-1β. Afin d’évaluer le rôle anti-inflammatoire de la vitamine D, les cellules ont été pré-traitées avec la forme bioactive de la vitamine D, la 1,25(OH)2D3. La sécrétion et l’expression génique d’interleukine-8, ainsi que l’activation de la voie de signalisation p38MAPK et du facteur de transcription NFκB ont été évaluées. Pour explorer la voie par laquelle la vitamine D exerce ses actions anti-inflammatoires, les cellules ont été pré-incubées avec le BIRB796 pour inhiber la voie p38MAPK. Finalement l’expression génique du récepteur nucléaire de la vitamine D et des hydroxylases intestinales impliquées dans son métabolisme a été déterminée. Nos résultats suggèrent que le CFTR a un rôle dans l’étiologie de l’inflammation intestinale associée à la FK. De plus, la vitamine D semble moduler à la baisse la réponse inflammatoire de la cellule intestinale dont le CFTR a été génétiquement invalidé.