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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">abc</journal-id>
      <journal-title-group>
        <journal-title>Arquivos Brasileiros de Cardiologia</journal-title>
        <abbrev-journal-title abbrev-type="publisher">Arq. Bras. Cardiol.</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">0066-782X</issn>
      <issn pub-type="epub">1678-4170</issn>
      <publisher>
        <publisher-name>Sociedade Brasileira de Cardiologia - SBC</publisher-name>
        <publisher-loc>S&#227;o Paulo, SP, Brazil</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v3">PtLkRn5L8k6gMkLF3qFmWMm</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v2">S0066-782X2013000300004</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v1">S0066-782X(13)10000300004</article-id>
      <article-id pub-id-type="doi">10.5935/abc.20130045</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Artigos Originais</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Influ&#234;ncia de prolongados per&#237;odos de obesidade sobre a express&#227;o g&#234;nica mioc&#225;rdica</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Lima-Leopoldo</surname>
            <given-names>Ana Paula</given-names>
          </name>
          <xref ref-type="aff" rid="aff01"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Leopoldo</surname>
            <given-names>Andr&#233; Soares</given-names>
          </name>
          <xref ref-type="aff" rid="aff01"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Silva</surname>
            <given-names>Danielle Cristina Tomaz</given-names>
          </name>
          <xref ref-type="aff" rid="aff02"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Nascimento</surname>
            <given-names>Andr&#233; Ferreira do</given-names>
          </name>
          <xref ref-type="aff" rid="aff02"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Campos</surname>
            <given-names>Dijon Henrique Salom&#233; de</given-names>
          </name>
          <xref ref-type="aff" rid="aff02"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Luvizotto</surname>
            <given-names>Renata de Azevedo Melo</given-names>
          </name>
          <xref ref-type="aff" rid="aff02"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Oliveira J&#250;nior</surname>
            <given-names>Silvio Assis de</given-names>
          </name>
          <xref ref-type="aff" rid="aff03"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Padovani</surname>
            <given-names>Carlos Roberto</given-names>
          </name>
          <xref ref-type="aff" rid="aff02"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Nogueira</surname>
            <given-names>C&#233;lia Regina</given-names>
          </name>
          <xref ref-type="aff" rid="aff02"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Cicogna</surname>
            <given-names>Antonio Carlos</given-names>
          </name>
          <xref ref-type="aff" rid="aff02"/>
        </contrib>
      </contrib-group>
      <aff id="aff01">
        <addr-line>
          <named-content content-type="city">Vit&#243;ria</named-content>
          <named-content content-type="state">ES</named-content>
        </addr-line>
        <institution content-type="orgname">Universidade Federal do Esp&#237;rito Santo</institution>
      </aff>
      <aff id="aff02">
        <addr-line>
          <named-content content-type="city">Botucatu</named-content>
          <named-content content-type="state">SP</named-content>
        </addr-line>
        <institution content-type="orgname">Universidade Estadual Paulista</institution>
      </aff>
      <aff id="aff03">
        <addr-line>
          <named-content content-type="city">Campo Grande</named-content>
          <named-content content-type="state">MS</named-content>
        </addr-line>
        <institution content-type="orgname">Universidade Federal do Mato Grosso do Sul</institution>
        <country country="BR">Brasil</country>
      </aff>
      <pub-date date-type="collection" publication-format="electronic">
        <month>03</month>
        <year>2013</year>
      </pub-date>
      <volume>100</volume>
      <issue>3</issue>
      <fpage>229</fpage>
      <lpage>237</lpage>
      <history>
        <date date-type="received">
          <day>10</day>
          <month>08</month>
          <year>2012</year>
        </date>
        <date date-type="accepted">
          <day>26</day>
          <month>10</month>
          <year>2012</year>
        </date>
        <date date-type="rev-recd">
          <day>05</day>
          <month>09</month>
          <year>2012</year>
        </date>
      </history>
      <permissions>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/" xml:lang="en">
          <license-p>This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.</license-p>
        </license>
      </permissions>
      <abstract>
        <p>FUNDAMENTO: V&#225;rios autores mostraram que a deteriora&#231;&#227;o da fun&#231;&#227;o card&#237;aca associa-se com o grau e a dura&#231;&#227;o da obesidade. Os padr&#245;es de express&#227;o g&#234;nica ap&#243;s longos per&#237;odos de obesidade precisam ser estabelecidos. OBJETIVO: Este estudo testou a hip&#243;tese de que a exposi&#231;&#227;o prolongada &#224; obesidade leva &#224; redu&#231;&#227;o nos n&#237;veis de RNAm de prote&#237;nas envolvidas na homeostase do Ca2+ mioc&#225;rdico. Al&#233;m disso, este estudo avaliou se uma diminui&#231;&#227;o no horm&#244;nio tireoidiano causava redu&#231;&#227;o na express&#227;o de RNAm. M&#201;TODOS: Ratos Wistar machos de 30 dias de idade foram distribu&#237;dos em dois grupos: controle (C) e obeso (Ob). O grupo C recebeu uma dieta padr&#227;o e o grupo Ob recebeu dietas hiperlip&#237;dicas por 15, 30 e 45 semanas. A obesidade foi definida pelo &#237;ndice de adiposidade. A express&#227;o g&#234;nica foi avaliada por PCR em tempo real quantitativa. RESULTADOS: O &#237;ndice de adiposidade foi maior no grupo Ob do que no C em todas as etapas. Enquanto a obesidade nas semanas 15 e 45 determinou uma redu&#231;&#227;o no RNAm de Ca2+-ATPase do ret&#237;culo sarcoplasm&#225;tico (SERCA2a), trocador Na+/Ca2+ (NCX) e calsequestrina (CSQ), observou-se aumento da express&#227;o do RNAm de canal de Ca2+ do tipo L, receptor de rianodina, SERCA2a, fosfolamban (PLB), NCX e CSQ ap&#243;s a semana 30, em compara&#231;&#227;o ao grupo C. N&#227;o houve associa&#231;&#227;o significativa entre os n&#237;veis de T3 e a express&#227;o de RNAm. CONCLUS&#213;ES: Nossos dados indicam que a obesidade por curtos ou longos per&#237;odos de tempo pode promover altera&#231;&#227;o na express&#227;o g&#234;nica de prote&#237;nas reguladoras da homeostase do Ca2+ sem influ&#234;ncia do horm&#244;nio tireoidiano</p>
      </abstract>
      <kwd-group xml:lang="pt" kwd-group-type="author-generated">
        <kwd>Obesidade</kwd>
        <kwd>Express&#227;o G&#234;nica</kwd>
        <kwd>Horm&#244;nios Tireoideanos</kwd>
        <kwd>Mi&#243;citos Card&#237;acos</kwd>
        <kwd>Mioc&#225;rdio</kwd>
      </kwd-group>
      <pub-date publication-format="electronic" date-type="pub">
        <day>15</day>
        <month>04</month>
        <year>2013</year>
      </pub-date>
    </article-meta>
  </front>
  <body>
    <p>ARTIGO ORIGINAL </p>
    <p> BIOLOGIA MOLECULAR</p>
    <p>
      <bold>Influ&#234;ncia de prolongados per&#237;odos de obesidade sobre a express&#227;o g&#234;nica mioc&#225;rdica</bold>
    </p>
    <p>
      <bold>Ana Paula Lima-Leopoldo<sup>I</sup>; Andr&#233; Soares Leopoldo<sup>I</sup>; Danielle Cristina Tomaz Silva<sup>II</sup>; Andr&#233; Ferreira do Nascimento<sup>II</sup>; Dijon Henrique Salom&#233; de Campos<sup>II</sup>; Renata de Azevedo Melo Luvizotto<sup>II</sup>; Silvio Assis de Oliveira J&#250;nior<sup>III</sup>; Carlos Roberto Padovani<sup>II</sup>; C&#233;lia Regina Nogueira<sup>II</sup>; Antonio Carlos Cicogna<sup>II</sup></bold>
    </p>
    <p><sup>I</sup>Universidade Federal do Esp&#237;rito Santo, Vit&#243;ria, ES </p>
    <p><sup>II</sup>Universidade Estadual Paulista, Botucatu, SP </p>
    <p><sup>III</sup>Universidade Federal do Mato Grosso do Sul, Campo Grande, MS, Brasil</p>
    <p>
      <xref ref-type="corresp" rid="end">Correspond&#234;ncia</xref>
    </p>
    <p>
      <bold>RESUMO</bold>
    </p>
    <p><bold>FUNDAMENTO:</bold> V&#225;rios autores mostraram que a deteriora&#231;&#227;o da fun&#231;&#227;o card&#237;aca associa-se com o grau e a dura&#231;&#227;o da obesidade. Os padr&#245;es de express&#227;o g&#234;nica ap&#243;s longos per&#237;odos de obesidade precisam ser estabelecidos. </p>
    <p><bold>OBJETIVO:</bold> Este estudo testou a hip&#243;tese de que a exposi&#231;&#227;o prolongada &#224; obesidade leva &#224; redu&#231;&#227;o nos n&#237;veis de RNAm de prote&#237;nas envolvidas na homeostase do Ca2+ mioc&#225;rdico. Al&#233;m disso, este estudo avaliou se uma diminui&#231;&#227;o no horm&#244;nio tireoidiano causava redu&#231;&#227;o na express&#227;o de RNAm. </p>
    <p><bold>M&#201;TODOS:</bold> Ratos Wistar machos de 30 dias de idade foram distribu&#237;dos em dois grupos: controle (C) e obeso (Ob). O grupo C recebeu uma dieta padr&#227;o e o grupo Ob recebeu dietas hiperlip&#237;dicas por 15, 30 e 45 semanas. A obesidade foi definida pelo &#237;ndice de adiposidade. A express&#227;o g&#234;nica foi avaliada por PCR em tempo real quantitativa. </p>
    <p><bold>RESULTADOS:</bold> O &#237;ndice de adiposidade foi maior no grupo Ob do que no C em todas as etapas. Enquanto a obesidade nas semanas 15 e 45 determinou uma redu&#231;&#227;o no RNAm de Ca2+-ATPase do ret&#237;culo sarcoplasm&#225;tico (SERCA2a), trocador Na+/Ca2+ (NCX) e calsequestrina (CSQ), observou-se aumento da express&#227;o do RNAm de canal de Ca2+ do tipo L, receptor de rianodina, SERCA2a, fosfolamban (PLB), NCX e CSQ ap&#243;s a semana 30, em compara&#231;&#227;o ao grupo C. N&#227;o houve associa&#231;&#227;o significativa entre os n&#237;veis de T3 e a express&#227;o de RNAm. </p>
    <p><bold>CONCLUS&#213;ES:</bold> Nossos dados indicam que a obesidade por curtos ou longos per&#237;odos de tempo pode promover altera&#231;&#227;o na express&#227;o g&#234;nica de prote&#237;nas reguladoras da homeostase do Ca2+ sem influ&#234;ncia do horm&#244;nio tireoidiano</p>
    <p><bold>Palavras-chave:</bold> Obesidade, Express&#227;o G&#234;nica, Horm&#244;nios Tireoideanos, Mi&#243;citos Card&#237;acos, Mioc&#225;rdio.</p>
    <p>
      <bold>Introdu&#231;&#227;o</bold>
    </p>
    <p>A obesidade &#233; o dist&#250;rbio metab&#243;lico cr&#244;nico mais prevalente nos pa&#237;ses desenvolvidos e em desenvolvimento<sup>1</sup>. Essa doen&#231;a desempenha papel importante na morbidade cardiovascular atrav&#233;s de m&#250;ltiplos mecanismos, entre os quais a homeostase do c&#225;lcio (Ca<sup>2+</sup>) intracelular<sup>2-4</sup>. V&#225;rias prote&#237;nas e canais, como Ca<sup>2+</sup>-ATPase do ret&#237;culo sarcoplasm&#225;tico (SERCA2a), receptor de rianodina (RyR), fosfolamban (PLB), canal de Ca<sup>2+</sup> do tipo L, calsequestrina (CSQ) e trocador Na<sup>+</sup>/Ca<sup>2+</sup> (NCX), regulam a homeostase do Ca<sup>2+</sup> no m&#250;sculo card&#237;aco<sup>3,4</sup>. Portanto, altera&#231;&#245;es na express&#227;o e/ou fun&#231;&#227;o dessas prote&#237;nas reguladoras do Ca<sup>2+</sup> poderiam ser respons&#225;veis pela disfun&#231;&#227;o card&#237;aca em modelos humanos e experimentais. </p>
    <p>Estudos anteriores com avalia&#231;&#245;es por curtos per&#237;odos da express&#227;o g&#234;nica das prote&#237;nas reguladoras do Ca<sup>2+</sup> em modelos de obesidade experimental mostraram resultados d&#237;spares<sup>5-7</sup>. Estudos com c&#227;es alimentados com uma dieta hiperlip&#237;dica por seis semanas mostraram n&#237;veis semelhantes de RNAm do RyR nos grupos controle e de dieta hiperlip&#237;dica<sup>5</sup>. Outros estudos com c&#227;es recebendo uma dieta hiperlip&#237;dica por nove semanas mostraram redu&#231;&#227;o da express&#227;o g&#234;nica do RNAm de SERCA2a e PLB no mioc&#225;rdio<sup>6</sup>. Lima-Leopoldo e cols.<sup>7</sup> mostraram que ratos obesos recebendo um ciclo de dietas hiperlip&#237;dicas por 15 semanas, al&#233;m de solu&#231;&#227;o de &#225;gua e a&#231;&#250;car, apresentavam n&#237;veis elevados do RNAm de SERCA2a, PLB e RyR. Como muitos autores mostraram que a disfun&#231;&#227;o card&#237;aca est&#225; associada ao grau e &#224; dura&#231;&#227;o da obesidade, tornou-se necess&#225;rio estabelecer os padr&#245;es de express&#227;o g&#234;nica ap&#243;s longos per&#237;odos de obesidade.</p>
    <p>O cora&#231;&#227;o &#233; um importante &#243;rg&#227;o-alvo para a a&#231;&#227;o do horm&#244;nio tireoidiano (HT)<sup>8-10</sup>. Sugeriu-se que a habilidade do HT de regular a fun&#231;&#227;o card&#237;aca envolve seus efeitos gen&#244;micos<sup>11,12</sup>. Nesse aspecto, a influ&#234;ncia e/ou o papel do HT nas prote&#237;nas reguladoras de Ca<sup>2+</sup> tem sido objeto de grande investiga&#231;&#227;o<sup>12,13</sup> e v&#225;rios estudos relataram o envolvimento do HT como modulador da transcri&#231;&#227;o g&#234;nica<sup>8,9,14,15</sup>. Entretanto, pouco se sabe sobre a rela&#231;&#227;o entre a dura&#231;&#227;o da obesidade, a express&#227;o g&#234;nica de prote&#237;nas reguladoras do Ca2+ card&#237;acas e o HT.</p>
    <p>Considerando-se essa falta de informa&#231;&#227;o, este estudo teve como prop&#243;sito testar a hip&#243;tese de que a exposi&#231;&#227;o prolongada &#224; obesidade leva &#224; redu&#231;&#227;o dos n&#237;veis de express&#227;o do RNAm de prote&#237;nas envolvidas na homeostase do Ca<sup>2+</sup> mioc&#225;rdico. Ainda, este estudo verificou se tal diminui&#231;&#227;o na express&#227;o g&#234;nica acompanhou-se de redu&#231;&#227;o nos n&#237;veis de HT.</p>
    <p>
      <bold>Material e M&#233;todos</bold>
    </p>
    <p>
      <bold>Animais e procedimentos</bold>
    </p>
    <p>Todos os procedimentos envolvendo animais foram aprovados pelo Comit&#234; de &#201;tica em Pesquisa da Faculdade de Medicina de Botucatu, UNESP, S&#227;o Paulo, Brasil (protocolo 573) e realizados conforme o <italic>Guide for the Care and Use of Laboratory Animals </italic>publicado pelo National Research Council em 1996<sup>16</sup>.</p>
    <p>Este estudo usou ratos Wistar machos de 30 dias de idade, pesando cerca de 100 g, origin&#225;rios do biot&#233;rio central da Faculdade de Medicina de Botucatu. Os animais foram alojados individualmente em gaiolas, com livre acesso a &#225;gua, tendo sido submetidos aos diferentes regimes diet&#233;ticos descritos abaixo. Foram mantidos em condi&#231;&#245;es ambientais padr&#227;o, com controle de luz (ciclos claro/escuro de 12 h; luz a partir das 6 horas), de temperatura ambiente (23 &#177; 3&#186;C), e de umidade relativa (60 &#177; 5%).</p>
    <p>
      <bold>Desenho do estudo</bold>
    </p>
    <p>Ap&#243;s sete dias de aclimata&#231;&#227;o, os ratos foram randomizados em dois grupos: controle (C, n = 30) e obeso (Ob, n = 30). O grupo C recebeu dieta padr&#227;o e o grupo Ob recebeu, de forma alternada, quatro dietas hiperlip&#237;dicas palat&#225;veis. O ganho de peso e o peso corporal foram monitorados uma vez por semana.</p>
    <p>Na semana 3 deste estudo, estabeleceu-se o in&#237;cio da obesidade com base no ganho de peso previamente determinado pelo nosso grupo de estudo (dados n&#227;o publicados). Nessa ocasi&#227;o, semana 3, os ratos dos grupos C e Ob foram randomizados em seis novos grupos (C<sub>15</sub>, Ob<sub>15</sub>, C<sub>30</sub>, Ob<sub>30</sub>, C<sub>45</sub> e Ob<sub>45</sub>), tendo sido mantidas suas respectivas dietas por 15, 30 e 45 semanas consecutivas.</p>
    <p>
      <bold>Dietas</bold>
    </p>
    <p>As dietas experimentais foram preparadas sob a forma de pastilhas por Agroceres (Rio Claro, SP, Brasil). A dieta padr&#227;o (RC Focus 1765) consistiu em 12,3% kcal de gordura, 57,9% kcal de carboidratos, e 29,8% kcal de prote&#237;na. As quatro dietas hiperlip&#237;dicas palat&#225;veis (RC Focus 2413, 2414, 2415, e 2416) continham 49,2% kcal de gordura, 28,9% kcal de carboidratos, e 21,9% kcal de prote&#237;nas. Essas dietas hiperlip&#237;dicas eram hipercal&#243;ricas (dieta hiperlip&#237;dica = 3,65 kcal/g <italic>versus </italic>dieta hipolip&#237;dica = 2,95 kcal/g) devido ao maior conte&#250;do de energia proveniente da gordura. As dietas hiperlip&#237;dicas eram compostas de &#225;cidos graxos saturados e insaturados, que forneciam 20% e 80% das calorias derivadas de gordura, respectivamente. Os componentes das dietas padr&#227;o e hiperlip&#237;dica foram previamente descritos<sup>17</sup>.</p>
    <p>
      <bold>Caracteriza&#231;&#227;o de obesidade</bold>
    </p>
    <p>Utilizou-se um crit&#233;rio baseado no &#237;ndice de adiposidade para confirmar a obesidade dos animais. Ap&#243;s serem anestesiados (pentobarbital s&#243;dico 50 mg/kg, intraperitoneal), os animais foram decapitados e toracotomizados, e seus coxins adiposos dissecados e pesados. O &#237;ndice de adiposidade foi calculado de acordo com a seguinte f&#243;rmula: &#237;ndice de adiposidade = (gordura corporal total (GC)/peso corporal final) &#215; 100. A GC foi determinada a partir da soma dos pesos dos coxins adiposos, como se segue: GC = gordura epididimal + gordura retroperitoneal + gordura visceral. </p>
    <p>
      <bold>Comorbidades associadas &#224; obesidade</bold>
    </p>
    <p>Os ratos dos modelos de obesidade induzida por dieta podem desenvolver algumas caracter&#237;sticas da obesidade humana, como hipertens&#227;o, intoler&#226;ncia &#224; glicose (GL), resist&#234;ncia insul&#237;nica, dislipidemia, hiperinsulinemia e hiperleptinemia. As seguintes avalia&#231;&#245;es foram realizadas em todos os grupos.</p>
    <p>
      <bold>Press&#227;o arterial sist&#243;lica (PAS)</bold>
    </p>
    <p>Ap&#243;s per&#237;odos de observa&#231;&#227;o, a PAS da cauda foi medida em cada animal com o manguito semiautom&#225;tico para cauda Narco BioSystems<sup>&#174; </sup>PE 300 (International Biomedical, Austin, TX, EUA). A m&#233;dia de duas medidas foi registrada.</p>
    <p>
      <bold>Teste de toler&#226;ncia &#224; GL (TTG) e &#237;ndice do modelo homeost&#225;tico para avaliar resist&#234;ncia insul&#237;nica (HOMA-IR)</bold>
    </p>
    <p>Ap&#243;s 15, 30 e 45 semanas de tratamento, toler&#226;ncia &#224; GL e resist&#234;ncia insul&#237;nica foram avaliadas atrav&#233;s de TTG e HOMA-IR, respectivamente. Todos os ratos foram submetidos a jejum de 4-6 horas antes do TTG<sup>18</sup>. Ap&#243;s o per&#237;odo de jejum, uma amostra de sangue foi colhida da ponta da cauda em um tubo heparinizado. A glicemia basal de cada animal foi imediatamente determinada usando-se um glicos&#237;metro (Accuchek Advantage; Roche Diagnostics Co., Indianapolis, IN, EUA). Em seguida, 2 g/kg de GL (Sigma-Aldrich<sup>&#174;</sup>, St Louis, MO, EUA) foram injetados por via intravenosa e a glicemia medida ap&#243;s 15, 30, 60, 90, e 120 minutos<sup>18</sup>. A intoler&#226;ncia &#224; GL foi avaliada pela &#225;rea sob a curva (AUC) para GL. O HOMA-IR foi expresso como um &#237;ndice de resist&#234;ncia insul&#237;nica e calculado pela seguinte f&#243;rmula: HOMA-IR = [glicemia de jejum (mmol/l) &#215; insulinemia de jejum (&#181;U/ml)]/22,5. Todos os ratos alimentaram-se normalmente e recuperaram seus pesos corporais em at&#233; um dia ap&#243;s esse regime.</p>
    <p>
      <bold>Medida de triglicer&#237;deos (TG) e an&#225;lise hormonal</bold>
    </p>
    <p>Ao final de cada per&#237;odo experimental (15, 30 e 45 semanas), os animais foram submetidos a jejum por 12 - 15 h, anestesiados com pentobarbital s&#243;dico (50 mg / kg, intraperitoneal) e decapitados. Amostras de sangue foram colhidas em tubos heparinizados, e o soro separado por centrifuga&#231;&#227;o a 3000 &#215; <italic>g</italic> por 15 minutos e 4&#186;C, sendo armazenado a -80&#186;C para an&#225;lise posterior. Os n&#237;veis de TG, insulina e leptina foram medidos no soro. A concentra&#231;&#227;o s&#233;rica de TG foi medida com um <italic>kit</italic> comercial (CELM,<sup>&#174;</sup> S&#227;o Paulo, Brasil), utilizando-se um sistema de an&#225;lise enzim&#225;tica autom&#225;tico (Technicon, RA-XT<sup>TM</sup> System, Global Medical Instrumentation, Minnesota, EUA). Os n&#237;veis de leptina e insulina foram determinados com <italic>kits</italic> comerciais (Linco Research Inc., St. Louis, MO, EUA), utilizando-se ELISA.</p>
    <p>As concentra&#231;&#245;es s&#233;ricas de triiodotironina livre (T<sub>3</sub>) e horm&#244;nio tireoestimulante (TSH) foram analisadas usando Diagnostics Products Genese (S&#227;o Paulo, SP, Brasil) com Luminex Corporation's xMAP Technology<sup>TM</sup>, atrav&#233;s de imunoensaio multiplex, Lincoplex kits (Linco Research Inc, St. Louis, MO, EUA).</p>
    <p>
      <bold>Express&#227;o g&#234;nica de importantes prote&#237;nas reguladoras do Ca2+ intracelular</bold>
    </p>
    <p>O RNA total foi extra&#237;do do tecido card&#237;aco (ventr&#237;culo esquerdo) utilizando-se Trizol (Invitrogen), de acordo com orienta&#231;&#227;o do fabricante. O <italic>kit</italic> High Capacity cDNA Reverse Transcription (Applied Biosystems, CA, EUA) foi usado para a s&#237;ntese de DNA complementar (cDNA) a partir de 1000 ng de RNA total. Utilizou-se PCR em tempo real para medir quantitativamente os n&#237;veis de RNAm de SERCA2a (Rn00568762_m1), RyR (Rn01470303_m1), PLB (Rn01434045_m1), canal de Ca<sup>2+</sup> do tipo L (Rn00709287_m1), CSQ (Rn00567508_m1) e NCX (Rn00570527_m1). Para tal, utilizaram-se TaqMan Universal PCR Master Mix (Applied Biosystems, CA, EUA), conforme as instru&#231;&#245;es do fabricante, e o sistema de detec&#231;&#227;o Applied Biosystems StepOne Plus. Todas as amostras foram avaliadas tr&#234;s vezes. As condi&#231;&#245;es de ciclagem foram as seguintes: ativa&#231;&#227;o da enzima a 50&#186;C por 2 minutos; desnatura&#231;&#227;o a 95&#186;C por 10 minutos; amplifica&#231;&#227;o dos produtos de cDNA por 40 ciclos de desnatura&#231;&#227;o a 95&#186;C por 15 segundos; e anelamento/extens&#227;o a 60&#186;C por 1 minuto. A express&#227;o g&#234;nica foi quantificada em rela&#231;&#227;o aos valores dos grupos C (C<sub>15</sub>, C<sub>30</sub> e C<sub>45</sub>) ap&#243;s normaliza&#231;&#227;o por um controle interno (&#946;-actina, Rn00667869_m1), sendo determinada pelo m&#233;todo 2<sup>-</sup><sup>&#916;&#916;</sup>Ct, como anteriormente descrito<sup>19</sup>.</p>
    <p>
      <bold>An&#225;lise estat&#237;stica</bold>
    </p>
    <p>Todos os resultados foram apresentados como m&#233;dia &#177; desvio padr&#227;o. As caracter&#237;sticas gerais, comorbidades, dosagens hormonais e express&#227;o g&#234;nica das prote&#237;nas reguladoras do Ca<sup>2+</sup> intracelular foram avaliadas atrav&#233;s de an&#225;lise de vari&#226;ncia de dois fatores (ANOVA) para amostras independentes. Quando diferen&#231;as significativas foram encontradas (p&lt;0,05), aplicou-se o teste de Bonferroni <italic>post hoc</italic> para compara&#231;&#245;es m&#250;ltiplas. A associa&#231;&#227;o entre os n&#237;veis de HT e a express&#227;o g&#234;nica de prote&#237;nas reguladoras do Ca<sup>2+</sup> intracelular foi analisada pelo teste de correla&#231;&#227;o linear de Pearson. O n&#237;vel de signific&#226;ncia foi de 5%. </p>
    <p>
      <bold>Resultados</bold>
    </p>
    <p>
      <bold>Caracter&#237;sticas gerais e comorbidades</bold>
    </p>
    <p>A <xref ref-type="fig" rid="a04fig01">Figura 1</xref> apresenta as caracter&#237;sticas gerais dos animais. Em compara&#231;&#227;o aos animais controle, os obesos apresentaram valores significativamente maiores para as seguintes vari&#225;veis em todas as etapas do experimento: peso corporal final; ganho de peso; gordura corporal e &#237;ndice de adiposidade (Figura 1, Pain&#233;is A, B, C e D). Utilizando-se o &#237;ndice de adiposidade como indicador de obesidade, os ratos obesos apresentaram 79,5%, 82% e 69,5% mais gordura do que seus respectivos controles ap&#243;s 15, 30 e 45 semanas, respectivamente (<xref ref-type="fig" rid="a04fig01">Figura 1D</xref>). A exposi&#231;&#227;o prolongada &#224; dieta hiperlip&#237;dica n&#227;o influenciou o grau de obesidade, pois a gordura corporal e o &#237;ndice de adiposidade foram semelhantes nos diferentes grupos Ob (<xref ref-type="fig" rid="a04fig01">Figura 1C</xref> e <xref ref-type="fig" rid="a04fig01">D</xref>).</p>
    <p><fig id="a04fig01"/>&#13;
&#160;&#13;
</p>
    <p>
      <fig id="a04fig01a">
        <graphic xlink:href="1678-4170-abc-100-03-0229-30045-gf01.jpg"/></fig>
    </p>
    <p>&#13;
  <fig id="a04fig01xfig1b"/><fig id="a04fig01b"><graphic xlink:href="1678-4170-abc-100-03-0229-30045-gf02.jpg"/></fig></p>
    <p>A <xref ref-type="fig" rid="a04fig02">Figura 2</xref> resume as comorbidades associadas com obesidade. A AUC para GL e o HOMA-IR foram significativamente afetados pela exposi&#231;&#227;o &#224; obesidade. Os ratos dos grupos Ob apresentaram AUC para GL significativamente maior do que seus respectivos controles (Ob<sub>15</sub>&gt;C<sub>15, </sub>Ob<sub>30</sub>&gt;C<sub>30 </sub>e Ob<sub>45</sub>&gt;C<sub>45</sub>; p &lt; 0,05) (<xref ref-type="fig" rid="a04fig02">Figura 2A</xref>). Os valores de HOMA-IR foram tamb&#233;m significativamente maiores nos ratos dos grupos Ob do que naqueles dos grupos controle (Ob<sub>15</sub>&gt;C<sub>15 </sub>e Ob<sub>45</sub>&gt;C<sub>45</sub>; p &lt; 0,05) (Figura 2B). Embora os valores do HOMA-IR n&#227;o tenham diferido significativamente entre os grupos na semana 30, essa medida apresentou uma tend&#234;ncia a ser maior (p = 0,054) nos ratos dos grupos Ob do que nos controle (<xref ref-type="fig" rid="a04fig02">Figura 2B</xref>).</p>
    <p><fig id="a04fig02"/>&#13;
&#160;&#13;
</p>
    <p>
      <fig id="a04fig02a">
        <graphic xlink:href="1678-4170-abc-100-03-0229-30045-gf03.jpg"/></fig>
    </p>
    <p>&#13;
  <fig id="a04fig02xfigb"/><fig id="a04fig02b"><graphic xlink:href="1678-4170-abc-100-03-0229-30045-gf04.jpg"/></fig></p>
    <p>O TTG revelou comprometimento da toler&#226;ncia &#224; GL no grupo Ob em todas as etapas do experimento, o que &#233; consistente com a no&#231;&#227;o de que obesidade &#233; frequentemente acompanhada de resist&#234;ncia insul&#237;nica, que foi observada neste estudo e determinada pelo HOMA-IR. Al&#233;m disso, a Figura 2D mostra significativa altera&#231;&#227;o nos n&#237;veis s&#233;ricos de TG na obesidade induzida por dieta hiperlip&#237;dica em compara&#231;&#227;o &#224;queles nos tr&#234;s grupos C (Ob<sub>15</sub>&gt;C<sub>15</sub> e Ob<sub>30</sub>&gt;C<sub>30</sub>; p &lt; 0,05). Na semana 45, os n&#237;veis de TG n&#227;o diferiram significativamente entre os grupos (p = 0,086). A dura&#231;&#227;o da obesidade n&#227;o teve efeito na PAS nos grupos Ob (<xref ref-type="fig" rid="a04fig02">Figura 2C</xref>).</p>
    <p>
      <bold>An&#225;lise hormonal</bold>
    </p>
    <p>A <xref ref-type="table" rid="a04tab01">Tabela 1</xref> apresenta os valores de leptina, insulina, T<sub>3</sub> e TSH. A dieta hiperlip&#237;dica causou uma significativa eleva&#231;&#227;o nos n&#237;veis de leptina e insulina em todas as etapas do experimento. A dura&#231;&#227;o da obesidade afetou significativamente os n&#237;veis de leptina entre as semanas 15 e 45 (Ob<sub>45</sub>&gt;Ob<sub>15</sub>; p &lt; 0,05). No entanto, os n&#237;veis de leptina n&#227;o diferiram significativamente nos grupos Ob entre as semanas 15 e 30 ou 30 e 45 (Ob<sub>15</sub><italic>versus </italic>Ob<sub>30</sub>, p = 0,055; e Ob<sub>30 </sub><italic>versus</italic> Ob<sub>45</sub>,p = 0,09). Houve uma tend&#234;ncia &#224; eleva&#231;&#227;o nos n&#237;veis de leptina com o tempo, que foi influenciada pela dura&#231;&#227;o da exposi&#231;&#227;o &#224; obesidade (<xref ref-type="table" rid="a04tab01">Tabela 1</xref>). Al&#233;m disso, a obesidade prolongada (Ob<sub>45</sub> &gt; Ob<sub>15 </sub>e Ob<sub>30</sub>, p &lt; 0,05) causou uma maior eleva&#231;&#227;o dos n&#237;veis de insulina em compara&#231;&#227;o com a obesidade de curto e m&#233;dio prazo, indicando que a dura&#231;&#227;o da obesidade resultou em maior resist&#234;ncia insul&#237;nica (<xref ref-type="table" rid="a04tab01">Tabela 1</xref>). De acordo com os resultados obtidos para leptina e insulina, a obesidade em todas as etapas acompanhou-se de hiperinsulinemia e hiperleptinemia.</p>
    <p content-type="asset">
      <table-wrap id="a04tab01">
        <graphic xlink:href="1678-4170-abc-100-03-0229-30045-gt01.jpg"/></table-wrap>
    </p>
    <p>Os n&#237;veis s&#233;ricos de T<sub>3</sub> e TSH foram determinados para avaliar o papel dos HTs na transcri&#231;&#227;o g&#234;nica induzida por obesidade induzida por dieta hiperlip&#237;dica (<xref ref-type="table" rid="a04tab01">Tabela 1</xref>). A dura&#231;&#227;o da obesidade causou diferentes respostas nos n&#237;veis s&#233;ricos de TSH nas semanas 15 e 45 nos grupos C e Ob (C<sub>15</sub> &gt; Ob<sub>15</sub>; C<sub>45</sub> &lt; Ob<sub>45</sub>). Os n&#237;veis de TSH n&#227;o diferiram significativamente entre os grupos C e Ob ap&#243;s a semana 30 de obesidade. Al&#233;m disso, longos per&#237;odos de obesidade influenciaram os n&#237;veis de TSH nos grupos Ob nas semanas 15 <italic>vs</italic> 45 (Ob<sub>15</sub> &lt; Ob<sub>45</sub>). No entanto, a obesidade decorrente de exposi&#231;&#227;o prolongada &#224; dieta hiperlip&#237;dica n&#227;o causou altera&#231;&#245;es estatisticamente significativas nos n&#237;veis de T<sub>3</sub> entre os grupos C e Ob em todas as etapas do experimento (<xref ref-type="table" rid="a04tab01">Tabela 1</xref>). Os grupos Ob apresentaram menores n&#237;veis de T<sub>3</sub> na semana 15 (Ob<sub>15 </sub>&lt; C<sub>15</sub>, p = 0,068) e maiores na semana 45 (Ob<sub>45</sub> &gt; C<sub>45</sub>, p = 0,007) em compara&#231;&#227;o aos respectivos n&#237;veis nos grupos C. Tais resultados mostram que T<sub>3</sub> e TSH respondem de maneira similar com rela&#231;&#227;o &#224; dura&#231;&#227;o da exposi&#231;&#227;o &#224; obesidade (C<sub>15</sub> &gt; Ob<sub>15</sub>; C<sub>45</sub> &lt; Ob<sub>45</sub>).</p>
    <p>
      <bold>Express&#227;o g&#234;nica de importantes prote&#237;nas reguladoras do Ca2+ intracelular</bold>
    </p>
    <p>Os n&#237;veis de RNAm das prote&#237;nas reguladoras do Ca<sup>2+ </sup>intracelular foram analisados para explicar os mecanismos atrav&#233;s dos quais a exposi&#231;&#227;o prolongada &#224; obesidade modula a fun&#231;&#227;o card&#237;aca. As medidas do RNAm de SERCA2a, RyR, PLB, canais de Ca<sup>2+</sup> do tipo L, CSQ e NCX s&#227;o apresentadas nas Figuras <xref ref-type="fn" rid="a04fig03">3A</xref>, <xref ref-type="fn" rid="a04fig03">B</xref>, <xref ref-type="fn" rid="a04fig03">C</xref>, <xref ref-type="fn" rid="a04fig03">D</xref>, <xref ref-type="fn" rid="a04fig03">E</xref> e <xref ref-type="fn" rid="a04fig03">F</xref>. As <xref ref-type="fn" rid="a04fig03">Figuras 3A</xref>, <xref ref-type="fn" rid="a04fig03">E</xref> e <xref ref-type="fn" rid="a04fig03">F</xref> mostram que os diferentes per&#237;odos de obesidade induzida por dieta hiperlip&#237;dica resultaram em significativa redu&#231;&#227;o da express&#227;o g&#234;nica de SERCA2a, CSQ e NCX nas semanas 15 e 45 (C<sub>15</sub> &gt; Ob<sub>15</sub>; C<sub>45</sub> &gt; Ob<sub>45</sub>; p &lt; 0,05). Al&#233;m disso, os n&#237;veis de PLB e canal de Ca<sup>2+</sup> do tipo L diminu&#237;ram apenas com a exposi&#231;&#227;o de curto prazo &#224; obesidade (PLB: C<sub>15</sub>: 1,00 &#177; 0,18 <italic>vs</italic> Ob<sub>15</sub>: 0,53 &#177; 0,13; e canal de Ca<sup>2+</sup> do tipo L: C<sub>15</sub>: 1,00 &#177; 0,18 <italic>vs O</italic>b<sub>15</sub>: 0,54 &#177; 0,10; p &lt; 0,05). Os n&#237;veis de RNAm do RyR foram semelhantes nos grupos C e Ob ap&#243;s 15 e 45 semanas de obesidade. Na semana 45, a express&#227;o g&#234;nica de PLB e canal de Ca<sup>2+</sup> do tipo L n&#227;o diferiu significativamente entre os grupos C e Ob (<xref ref-type="fn" rid="a04fig03">Figuras 3C</xref> e <xref ref-type="fn" rid="a04fig03">D</xref>). &#201; importante notar que ap&#243;s 30 semanas de obesidade induzida por dieta hiperlip&#237;dica, os n&#237;veis de RNAm de todas as prote&#237;nas reguladoras do Ca<sup>2+ </sup>intracelular (SERCA2A, RyR, PLB, canal de Ca<sup>2+</sup> do tipo L, CSQ e NCX) estavam elevados em compara&#231;&#227;o &#224;queles do grupo C (<xref ref-type="fn" rid="a04fig03">Figura 3A</xref>, <xref ref-type="fn" rid="a04fig03">B</xref>, <xref ref-type="fn" rid="a04fig03">C</xref>, <xref ref-type="fn" rid="a04fig03">D</xref>, <xref ref-type="fn" rid="a04fig03">E</xref> e <xref ref-type="fn" rid="a04fig03">F</xref>). A exposi&#231;&#227;o prolongada &#224; obesidade induzida por dieta hiperlip&#237;dica tamb&#233;m resultou em diferen&#231;as estatisticamente significativas nos n&#237;veis de RNAm de SERCA2A, RyR, canal de Ca<sup>2+</sup> do tipo L, CSQ e NCX nos grupos Ob, como mostra a <xref ref-type="fn" rid="a04fig03">Figura 3</xref> (Ob<sub>30</sub> &gt; Ob<sub>15</sub> = Ob<sub>45</sub>). </p>
    <p content-type="html"><fn id="a04fig03"><p><fig id="a04fig03a"><graphic xlink:href="1678-4170-abc-100-03-0229-30045-gf05.jpg"/></fig></p><p>&#13;
  <fig id="a04fig03xfigb"/><fig id="a04fig03b"><graphic xlink:href="1678-4170-abc-100-03-0229-30045-gf06.jpg"/></fig></p><p>&#13;
  <fig id="a04fig03xfigc"/><fig id="a04fig03c"><graphic xlink:href="1678-4170-abc-100-03-0229-30045-gf07.jpg"/></fig></p></fn>&#13;
&#160;&#13;
</p>
    <p>O potencial dos HTs para alterar a express&#227;o g&#234;nica das prote&#237;nas reguladoras do Ca<sup>2+ </sup>intracelular tamb&#233;m foi avaliado. A <xref ref-type="table" rid="a04tab02">Tabela 2</xref> mostra os resultados do teste de correla&#231;&#227;o linear de Pearson. N&#227;o houve correla&#231;&#245;es significativas entre os n&#237;veis de T<sub>3</sub> livre e os do RNAm de SERCA2a, RyR, PLB, canal de Ca<sup>2+</sup> do tipo L, e NCX. Tais resultados demonstram que o T<sub>3</sub> livre n&#227;o influenciou e/ou n&#227;o regulou a transcri&#231;&#227;o das prote&#237;nas reguladoras do Ca<sup>2+</sup> intracelular ap&#243;s uma longa exposi&#231;&#227;o a obesidade (<xref ref-type="table" rid="a04tab02">Tabela 2</xref>).</p>
    <p content-type="asset">
      <table-wrap id="a04tab02">
        <graphic xlink:href="1678-4170-abc-100-03-0229-30045-gt02.jpg"/></table-wrap>
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    <p>
      <bold>Discuss&#227;o</bold>
    </p>
    <p>A obesidade alcan&#231;ou n&#237;veis epid&#234;micos recentemente, e seus efeitos adversos foram exaustivamente estudados em animais experimentais. No entanto, h&#225; pouca informa&#231;&#227;o dispon&#237;vel quanto &#224; rela&#231;&#227;o entre a dura&#231;&#227;o da obesidade e a regula&#231;&#227;o do Ca<sup>2+</sup>. A maior contribui&#231;&#227;o deste estudo &#233; a demonstra&#231;&#227;o de que a exposi&#231;&#227;o &#224; obesidade altera a express&#227;o g&#234;nica das prote&#237;nas reguladoras do Ca<sup>2+</sup> de maneira diferente. Enquanto a exposi&#231;&#227;o &#224; obesidade por 30 semanas promoveu eleva&#231;&#245;es nos n&#237;veis de RNAm, a exposi&#231;&#227;o &#224; obesidade por 15 e 45 semanas resultou em redu&#231;&#227;o dos n&#237;veis de RNAm, sugerindo que a obesidade de curta exposi&#231;&#227;o e a de longa exposi&#231;&#227;o possam diferir quanto ao processo de remodela&#231;&#227;o card&#237;aca. Al&#233;m disso, n&#227;o houve influ&#234;ncia dos HTs na express&#227;o g&#234;nica das prote&#237;nas reguladoras do Ca<sup>2+</sup> ap&#243;s longos per&#237;odos de exposi&#231;&#227;o &#224; obesidade. Acreditamos que este seja o primeiro estudo a relatar a express&#227;o de RNAm card&#237;aco de prote&#237;nas reguladoras do Ca<sup>2+</sup> em animais obesos e o papel dos HTs na regula&#231;&#227;o da express&#227;o g&#234;nica de prote&#237;nas reguladoras do Ca<sup>2+</sup> em longos per&#237;odos de tempo.</p>
    <p>Dietas ricas em gordura foram usadas por d&#233;cadas para os modelos de obesidade em roedores. A dieta hiperlip&#237;dica usada teve intensidade e dura&#231;&#227;o suficientes para promover obesidade em ratos em todas as etapas experimentais (15, 30 e 45 semanas). O desenvolvimento de obesidade ao longo do tempo caracterizou-se por diferen&#231;as significativas de peso corporal, gordura corporal, coxins adiposos e &#237;ndice de adiposidade em compara&#231;&#227;o a ratos controle. Segundo a literatura, o consumo aumentado de gordura pode n&#227;o se acompanhar de uma eleva&#231;&#227;o na oxida&#231;&#227;o, o que favorece uma maior deposi&#231;&#227;o de gordura em animais que recebem uma dieta hiperlip&#237;dica<sup>20</sup>. No entanto, neste estudo, o tempo de exposi&#231;&#227;o &#224; dieta hiperlip&#237;dica n&#227;o exacerbou aquela condi&#231;&#227;o, pois a obesidade n&#227;o foi acompanhada por uma eleva&#231;&#227;o na intensidade ou grau da adiposidade. Como em estudos anteriores<sup>21-26</sup>, a dieta hiperlip&#237;dica usada neste estudo foi eficiente para promover numerosas comorbidades associadas com obesidade de curto e longo prazo, tais como intoler&#226;ncia &#224; GL, hiperinsulinemia, resist&#234;ncia insul&#237;nica, hiperleptinemia e dislipidemia, observada pela eleva&#231;&#227;o de TG s&#233;ricos. Embora n&#227;o tenha havido altera&#231;&#245;es significativas nos n&#237;veis de TG ap&#243;s 45 semanas (p = 0,086), os n&#237;veis de TG tenderam a se elevar com o tempo e com a exposi&#231;&#227;o &#224; obesidade. Tais resultados demonstram que a obesidade prolongada causa altera&#231;&#245;es nos par&#226;metros metab&#243;licos e hormonais sem afetar a PAS. </p>
    <p>Sabe-se que a obesidade se acompanha de muitas altera&#231;&#245;es hormonais, como os n&#237;veis do HT. Neste estudo, a obesidade causou um aumento nos n&#237;veis s&#233;ricos de TSH ap&#243;s 45 semanas (Ob<sub>45</sub> &gt; C<sub>45</sub>), provavelmente devido aos n&#237;veis elevados de leptina no grupo Ob. Estudos com animais experimentais e com seres humanos mostraram que a leptina estimula a libera&#231;&#227;o de TSH<sup>27,28</sup>. Al&#233;m disso, estudos anteriores mostraram uma rela&#231;&#227;o positiva entre n&#237;veis s&#233;ricos de TSH e leptina, indicando que os HTs sofrem um processo de adapta&#231;&#227;o com a adiposidade crescente<sup>29,30</sup>. A aus&#234;ncia de altera&#231;&#245;es nos n&#237;veis de leptina e TSH no grupo C ao longo do tempo corrobora essa afirma&#231;&#227;o. Outro importante achado do presente estudo &#233; que as respostas de T<sub>3</sub> e TSH mostraram tend&#234;ncias semelhantes nos grupos Ob ao longo do tempo. Segundo a literatura<sup>31</sup>, altera&#231;&#245;es nos n&#237;veis de T<sub>3</sub> e TSH frequentemente se associam a altera&#231;&#245;es na gordura corporal, e nossos resultados sugerem que esse efeito possa ser influenciado pelos n&#237;veis elevados de leptina ao longo do tempo. </p>
    <p>Com rela&#231;&#227;o &#224; pesquisa usando modelos obesos, acreditamos ser este o primeiro estudo a avaliar a influ&#234;ncia da exposi&#231;&#227;o prolongada &#224; obesidade na express&#227;o g&#234;nica de prote&#237;nas reguladoras do Ca<sup>2+</sup>. Em cardiomi&#243;citos, as prote&#237;nas associadas com a regula&#231;&#227;o do Ca<sup>2+</sup> mioc&#225;rdico participam na libera&#231;&#227;o, recaptura e extrus&#227;o do Ca<sup>2+</sup>, desempenhando um papel chave na regula&#231;&#227;o da fun&#231;&#227;o card&#237;aca<sup>3,4</sup>. O presente estudo mostrou que a dura&#231;&#227;o da obesidade resultou em diferentes respostas na express&#227;o g&#234;nica de prote&#237;nas reguladoras do Ca<sup>2+</sup> ap&#243;s 15, 30 e 45 semanas. Nossos resultados mostraram que a obesidade induzida por uma dieta hiperlip&#237;dica causou inicialmente (semana 15) uma redu&#231;&#227;o da express&#227;o g&#234;nica. Em consequ&#234;ncia, na semana 30, os mecanismos celulares envolvidos no funcionamento do cora&#231;&#227;o aumentaram numa tentativa de reestabelecer os n&#237;veis de RNAm card&#237;aco molecular. Ap&#243;s a normaliza&#231;&#227;o desse processo, a transcri&#231;&#227;o de RNAm voltou a n&#237;veis normais e/ou reduzidos (semana 45). Tais achados sugerem que, no presente estudo, houve remodelamento dos processos card&#237;acos ap&#243;s longos per&#237;odos de exposi&#231;&#227;o &#224; obesidade. Rider e cols.<sup>32</sup> afirmaram que o remodelamento card&#237;aco &#233; uma caracter&#237;stica adaptativa da obesidade. Segundo Cohn e cols.<sup>33</sup>, o remodelamento card&#237;aco &#233; definido como uma express&#227;o gen&#244;mica que resulta em altera&#231;&#245;es moleculares, celulares e intersticiais, sendo clinicamente manifesta como altera&#231;&#245;es de tamanho, forma e fun&#231;&#227;o do cora&#231;&#227;o, e resultando de sobrecarga ou les&#227;o card&#237;aca. Al&#233;m disso, aqueles autores relatam que o remodelamento card&#237;aco &#233; influenciado por sobrecarga hemodin&#226;mica, ativa&#231;&#227;o neuro-hormonal e outros fatores ainda em investiga&#231;&#227;o. Logo, uma poss&#237;vel explica&#231;&#227;o para nossos resultados &#233; que esse processo possa estar relacionado &#224; sobrecarga de gordura imposta ao cora&#231;&#227;o. Ap&#243;s 15 semanas, tal sobrecarga representa uma agress&#227;o ao cora&#231;&#227;o (obesidade), que ent&#227;o se remodela para normalizar as altera&#231;&#245;es card&#237;acas moleculares e celulares na semana 30. Finalmente, o cora&#231;&#227;o se adapta, retornando aos n&#237;veis normais e/ou reduzidos de RNAm (semana 45), uma vez n&#227;o ser mais necess&#225;rio manter n&#237;veis aumentados de RNA. Esses resultados podem ser corroborados pelos nossos estudos anteriores e outros demonstrando que a obesidade induziu e promoveu disfun&#231;&#227;o mioc&#225;rdica<sup>17,34,35</sup>, que poderia estar relacionada a altera&#231;&#245;es nos n&#237;veis de RNAm ap&#243;s 15 semanas de obesidade. Al&#233;m disso, pesquisas conduzidas em nosso laborat&#243;rio mostraram que a fun&#231;&#227;o card&#237;aca volta ao normal ap&#243;s 30 e 45 semanas de obesidade (dados n&#227;o publicados).</p>
    <p>Uma explica&#231;&#227;o alternativa para a normaliza&#231;&#227;o do processo de remodelamento card&#237;aco ap&#243;s 45 semanas pode estar relacionada &#224; composi&#231;&#227;o da dieta. A dieta hiperlip&#237;dica usada neste estudo consistiu de grande quantidade de &#225;cidos graxos insaturados, o que pode ter sido um mecanismo de prote&#231;&#227;o para o cora&#231;&#227;o, mesmo na presen&#231;a de obesidade. Os mecanismos subjacentes aos efeitos da exposi&#231;&#227;o prolongada &#224; obesidade nos n&#237;veis de RNAm de prote&#237;nas reguladoras do Ca<sup>2+</sup> permanecem desconhecidos. Os agentes e as vias que podem mediar as respostas moleculares e celulares (altera&#231;&#245;es na express&#227;o g&#234;nica) envolvidas no remodelamento card&#237;aco incluem v&#225;rias citocinas, receptores &#946;-adren&#233;rgicos, neurotransmissores, mensageiros intracelulares e horm&#244;nios, como a insulina<sup>3,36-38</sup>.</p>
    <p>
      <bold>Conclus&#227;o</bold>
    </p>
    <p>Um importante mediador envolvido na ativa&#231;&#227;o de v&#225;rios fatores de transcri&#231;&#227;o e, portanto, fundamental nas respostas de express&#227;o g&#234;nica &#233; o HT. A literatura relata que os HTs podem desempenhar um papel positivo na express&#227;o g&#234;nica de SERCA, RyR e canal de Ca<sup>2+</sup> do tipo L, e um papel negativo na express&#227;o de PLB e NCX<sup>9</sup>. Entretanto, em desacordo com essa hip&#243;tese, o HT n&#227;o afetou a express&#227;o g&#234;nica de prote&#237;nas reguladoras do Ca<sup>2+</sup>mioc&#225;rdico, tendo por base a an&#225;lise de correla&#231;&#227;o, que demostrou nenhuma associa&#231;&#227;o significativa entre T<sub>3 </sub>e os n&#237;veis de RNAm de prote&#237;nas reguladoras do Ca<sup>2+</sup>. Como mostrado no processo de remodelamento card&#237;aco, diferentes est&#237;mulos externos podem ativar v&#225;rios fatores de transcri&#231;&#227;o<sup>36</sup>. Logo, podemos inferir que o mesmo mediador/est&#237;mulo possa ter ativado diferentes fatores de transcri&#231;&#227;o, levando a respostas semelhantes na express&#227;o g&#234;nica. Como a obesidade se associa a n&#237;veis elevados de endotelina, angiotensina II e citocinas<sup>39,40</sup>, que atuam atrav&#233;s de diferentes fatores de transcri&#231;&#227;o, parece prov&#225;vel que alguns desses fatores estejam envolvidos nas mudan&#231;as na express&#227;o de RNAm de prote&#237;nas reguladoras do Ca<sup>2+</sup>.</p>
    <p>Nossos dados indicam que a obesidade por curtos ou longos per&#237;odos de tempo pode promover altera&#231;&#227;o na express&#227;o g&#234;nica de prote&#237;nas reguladoras da homeostase do Ca<sup>2+</sup> sem influ&#234;ncia do HT. Um importante aspecto &#233; que o conhecimento das altera&#231;&#245;es do RNAm em diferentes etapas durante o desenvolvimento e estabelecimento da obesidade poderia contribuir para a compreens&#227;o dos mecanismos envolvidos na disfun&#231;&#227;o card&#237;aca causada pela obesidade. No entanto, estudos adicionais se fazem necess&#225;rios para determinar quais mediadores influenciam o comportamento do RNAm em cada etapa do processo de remodelamento induzido por obesidade.</p>
    <p>
      <bold>Contribui&#231;&#227;o dos autores</bold>
    </p>
    <p>Concep&#231;&#227;o e desenho da pesquisa: Lima-Leopoldo AP, Leopoldo AS, Nascimento AF, Luvizotto RAM, Padovani CR, Nogueira CR, Cicogna AC; Obten&#231;&#227;o de dados: Lima-Leopoldo AP, Leopoldo AS, Silva DAT, Nascimento AF, Campos DHS, Luvizotto RAM, Nogueira CR, Oliveira J&#250;nior SA, Cicogna AC; An&#225;lise e interpreta&#231;&#227;o dos dados: Lima-Leopoldo AP, Leopoldo AS, Silva DAT, Campos DHS, Luvizotto RAM, Padovani CR, Nogueira CR, Oliveira J&#250;nior SA, Cicogna AC; An&#225;lise estat&#237;stica: Lima-Leopoldo AP, Leopoldo AS, Padovani CR, Cicogna AC; Obten&#231;&#227;o de financiamento: Lima-Leopoldo AP, Leopoldo AS, Nascimento AF, Campos DHS, Cicogna AC; Reda&#231;&#227;o do manuscrito: Lima-Leopoldo AP, Leopoldo AS, Nascimento AF, Nogueira CR, Cicogna AC; Revis&#227;o cr&#237;tica do manuscrito quanto ao conte&#250;do intelectual: Lima-Leopoldo AP, Leopoldo AS, Silva DAT, Luvizotto RAM, Padovani CR, Nogueira CR, Oliveira J&#250;nior SA, Cicogna AC.</p>
    <p>
      <bold>Potencial Conflito de Interesses</bold>
    </p>
    <p>Declaro n&#227;o haver conflito de interesses pertinentes.</p>
    <p>
      <bold>Fontes de Financiamento</bold>
    </p>
    <p>O presente estudo foi financiado pela FAPESP.</p>
    <p>
      <bold>Vincula&#231;&#227;o Acad&#234;mica</bold>
    </p>
    <p>Este artigo &#233; parte de tese de Doutorado de Ana Paula Lima Leopoldo pela Universidade Estadual Paulista.</p>
    <p>
      <fn id="end" fn-type="corresp">
        <label>
          <bold>Correspond&#234;ncia:</bold>
        </label>
        <p>Ana Paula Lima-Leopoldo </p>
        <p> Av. Fernando Ferrari, 514, Goiabeiras </p>
        <p> CEP 29075-910, Vit&#243;ria, ES - Brasil </p>
        <p> E-mail: </p>
        <p><email xlink:href="anapaula@cefd.ufes.br">anapaula@cefd.ufes.br</email>, </p>
        <p>
          <email xlink:href="anapaulalimaleopoldo@gmail.com">anapaulalimaleopoldo@gmail.com</email>
        </p>
      </fn>
    </p>
    <p> Artigo recebido em 10/08/12, revisado em 05/09/12, aceito em 26/10/12.</p>
  </body>
  <back>
    <ref-list>
      <ref id="B1">
        <label>1</label>
        <mixed-citation>1.	Eckel RH, Barouch WW, Ershow AG. Report of the National Heart, Lung, and Blood Institute-National of Diabetes and Digestive and Kidney Diseases Working Group on the pathophysiology of obesity-associated cardiovascular disease. Circulation. 2002;105(24):2923-8.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Report of the National Heart, Lung, and Blood Institute-National of Diabetes and Digestive and Kidney Diseases Working Group on the pathophysiology of obesity-associated cardiovascular disease</article-title>
          <source>Circulation</source>
          <date>
            <year>2002</year>
          </date>
          <fpage>2923</fpage>
          <lpage>8</lpage>
          <issue>24</issue>
          <volume>105</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Eckel</surname>
              <given-names>RH</given-names>
            </name>
            <name>
              <surname>Barouch</surname>
              <given-names>WW</given-names>
            </name>
            <name>
              <surname>Ershow</surname>
              <given-names>AG</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B2">
        <label>2</label>
        <mixed-citation>2.	Relling DP, Esberg LB, Fang CX, Johnson WT, Murphy EJ, Carlson EC, et al. High-fat diet-induced juvenile obesity leads to cardiomyocyte dysfunction and upregulation of Foxo3a transcription factor independent of lipotoxicity and apoptosis. J Hypertens. 2006;24(3):549-61.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>High-fat diet-induced juvenile obesity leads to cardiomyocyte dysfunction and upregulation of Foxo3a transcription factor independent of lipotoxicity and apoptosis</article-title>
          <source>J Hypertens</source>
          <date>
            <year>2006</year>
          </date>
          <fpage>549</fpage>
          <lpage>61</lpage>
          <issue>3</issue>
          <volume>24</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Relling</surname>
              <given-names>DP</given-names>
            </name>
            <name>
              <surname>Esberg</surname>
              <given-names>LB</given-names>
            </name>
            <name>
              <surname>Fang</surname>
              <given-names>CX</given-names>
            </name>
            <name>
              <surname>Johnson</surname>
              <given-names>WT</given-names>
            </name>
            <name>
              <surname>Murphy</surname>
              <given-names>EJ</given-names>
            </name>
            <name>
              <surname>Carlson</surname>
              <given-names>EC</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B3">
        <label>3</label>
        <mixed-citation>3.	Bers DM. Cardiac excitation-contraction coupling. Nature. 2002;415(6868):198-205.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Cardiac excitation-contraction coupling</article-title>
          <source>Nature</source>
          <date>
            <year>2002</year>
          </date>
          <fpage>198</fpage>
          <lpage>205</lpage>
          <issue>6868</issue>
          <volume>415</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Bers</surname>
              <given-names>DM</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B4">
        <label>4</label>
        <mixed-citation>4.	Opie LH. Myocardial contraction and relaxation. In: Opie LH. The heart: physiology from cell to circulation. Philadelphia: Lippincott-Raven; 1998. p. 221-45.</mixed-citation>
        <element-citation publication-type="book">
          <source>The heart: physiology from cell to circulation</source>
          <date>
            <year>1998</year>
          </date>
          <fpage>221</fpage>
          <lpage>45</lpage>
          <person-group person-group-type="author">
            <name>
              <surname>Opie</surname>
              <given-names>LH</given-names>
            </name>
            <name>
              <surname>Opie</surname>
              <given-names>LH</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B5">
        <label>5</label>
        <mixed-citation>5.	Dincer UD, Araiza A, Knudson JD, Shao CH, Bidasee KR, Tune JD. Dysfunction of cardiac ryanodine receptors in the metabolic syndrome. J Moll Cell Cardiol. 2006;41(1):108-14.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Dysfunction of cardiac ryanodine receptors in the metabolic syndrome</article-title>
          <source>J Moll Cell Cardiol</source>
          <date>
            <year>2006</year>
          </date>
          <fpage>108</fpage>
          <lpage>14</lpage>
          <issue>1</issue>
          <volume>41</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Dincer</surname>
              <given-names>UD</given-names>
            </name>
            <name>
              <surname>Araiza</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Knudson</surname>
              <given-names>JD</given-names>
            </name>
            <name>
              <surname>Shao</surname>
              <given-names>CH</given-names>
            </name>
            <name>
              <surname>Bidasee</surname>
              <given-names>KR</given-names>
            </name>
            <name>
              <surname>Tune</surname>
              <given-names>JD</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B6">
        <label>6</label>
        <mixed-citation>6.	Philip-Couderc P, Smih F, Hall JE, Pathak A, Roncalli J, Harmancey R, et al. Kinetic analysis of cardiac transcriptome regulation during chronic high-fat diet in dogs. Physiol Genomics. 2004;19(1):32-40.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Kinetic analysis of cardiac transcriptome regulation during chronic high-fat diet in dogs</article-title>
          <source>Physiol Genomics</source>
          <date>
            <year>2004</year>
          </date>
          <fpage>32</fpage>
          <lpage>40</lpage>
          <issue>1</issue>
          <volume>19</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Philip-Couderc</surname>
              <given-names>P</given-names>
            </name>
            <name>
              <surname>Smih</surname>
              <given-names>F</given-names>
            </name>
            <name>
              <surname>Hall</surname>
              <given-names>JE</given-names>
            </name>
            <name>
              <surname>Pathak</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Roncalli</surname>
              <given-names>J</given-names>
            </name>
            <name>
              <surname>Harmancey</surname>
              <given-names>R</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B7">
        <label>7</label>
        <mixed-citation>7.	Lima-Leopoldo AP, Sugizaki MM, Leopoldo AS, Carvalho RF, Nogueira CR, Nascimento AF, et al. Obesity induces upregulation of genes involved in myocardial Ca2+ handling. Braz J Med Biol Res. 2008;41(7):615-20.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Obesity induces upregulation of genes involved in myocardial Ca2+ handling</article-title>
          <source>Braz J Med Biol Res</source>
          <date>
            <year>2008</year>
          </date>
          <fpage>615</fpage>
          <lpage>20</lpage>
          <issue>7</issue>
          <volume>41</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Lima-Leopoldo</surname>
              <given-names>AP</given-names>
            </name>
            <name>
              <surname>Sugizaki</surname>
              <given-names>MM</given-names>
            </name>
            <name>
              <surname>Leopoldo</surname>
              <given-names>AS</given-names>
            </name>
            <name>
              <surname>Carvalho</surname>
              <given-names>RF</given-names>
            </name>
            <name>
              <surname>Nogueira</surname>
              <given-names>CR</given-names>
            </name>
            <name>
              <surname>Nascimento</surname>
              <given-names>AF</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B8">
        <label>8</label>
        <mixed-citation>8.	Carr AN, Kranias EG. Thyroid hormone regulation of calcium cycling proteins. Thyroid. 2002;12(6):453-7.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Thyroid hormone regulation of calcium cycling proteins</article-title>
          <source>Thyroid</source>
          <date>
            <year>2002</year>
          </date>
          <fpage>453</fpage>
          <lpage>7</lpage>
          <issue>6</issue>
          <volume>12</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Carr</surname>
              <given-names>AN</given-names>
            </name>
            <name>
              <surname>Kranias</surname>
              <given-names>EG</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B9">
        <label>9</label>
        <mixed-citation>9.	Dillmann WH. Cellular action of thyroid hormone on the heart. Thyroid. 2002;12(6):447-52.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Cellular action of thyroid hormone on the heart</article-title>
          <source>Thyroid</source>
          <date>
            <year>2002</year>
          </date>
          <fpage>447</fpage>
          <lpage>52</lpage>
          <issue>6</issue>
          <volume>12</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Dillmann</surname>
              <given-names>WH</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B10">
        <label>10</label>
        <mixed-citation>10.	Kahaly GJ, Dillmann WH. Thyroid hormone action in the heart. Endocr Rev. 2005;26(5):704-28.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Thyroid hormone action in the heart</article-title>
          <source>Endocr Rev</source>
          <date>
            <year>2005</year>
          </date>
          <fpage>704</fpage>
          <lpage>28</lpage>
          <issue>5</issue>
          <volume>26</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Kahaly</surname>
              <given-names>GJ</given-names>
            </name>
            <name>
              <surname>Dillmann</surname>
              <given-names>WH</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B11">
        <label>11</label>
        <mixed-citation>11.	Dillmann WH. Biochemical basis of thyroid hormone action in the heart. Am J Med. 1990;88(6):626-30.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Biochemical basis of thyroid hormone action in the heart</article-title>
          <source>Am J Med</source>
          <date>
            <year>1990</year>
          </date>
          <fpage>626</fpage>
          <lpage>30</lpage>
          <issue>6</issue>
          <volume>88</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Dillmann</surname>
              <given-names>WH</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B12">
        <label>12</label>
        <mixed-citation>12.	Yen PM. Physiological and molecular basis of thyroid hormone action. Physiol Rev. 2001;81(3):1097-142.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Physiological and molecular basis of thyroid hormone action</article-title>
          <source>Physiol Rev</source>
          <date>
            <year>2001</year>
          </date>
          <fpage>1097</fpage>
          <lpage>142</lpage>
          <issue>3</issue>
          <volume>81</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Yen</surname>
              <given-names>PM</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B13">
        <label>13</label>
        <mixed-citation>13.	Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001;344(7):501-9.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Thyroid hormone and the cardiovascular system</article-title>
          <source>N Engl J Med</source>
          <date>
            <year>2001</year>
          </date>
          <fpage>501</fpage>
          <lpage>9</lpage>
          <issue>7</issue>
          <volume>344</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Klein</surname>
              <given-names>I</given-names>
            </name>
            <name>
              <surname>Ojamaa</surname>
              <given-names>K</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B14">
        <label>14</label>
        <mixed-citation>14.	Danzi S, Klein I. Thyroid hormone-regulated cardiac gene expression and cardiovascular disease. Thyroid. 2002;12(6):467-72.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Thyroid hormone-regulated cardiac gene expression and cardiovascular disease</article-title>
          <source>Thyroid</source>
          <date>
            <year>2002</year>
          </date>
          <fpage>467</fpage>
          <lpage>72</lpage>
          <issue>6</issue>
          <volume>12</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Danzi</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Klein</surname>
              <given-names>I</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B15">
        <label>15</label>
        <mixed-citation>15.	Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725-35.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Thyroid disease and the heart</article-title>
          <source>Circulation</source>
          <date>
            <year>2007</year>
          </date>
          <fpage>1725</fpage>
          <lpage>35</lpage>
          <issue>15</issue>
          <volume>116</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Klein</surname>
              <given-names>I</given-names>
            </name>
            <name>
              <surname>Danzi</surname>
              <given-names>S</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B16">
        <label>16</label>
        <mixed-citation>16.	National Research Council. Guide for the care and use of laboratory animals: Washington, (DC): National Academy Press; 1996.</mixed-citation>
        <element-citation publication-type="book">
          <source>Guide for the care and use of laboratory animals</source>
          <date>
            <year>1996</year>
          </date>
        </element-citation>
      </ref>
      <ref id="B17">
        <label>17</label>
        <mixed-citation>17.	Leopoldo AS, Lima-Leopoldo AP, Sugizaki MM, do Nascimento AF, de Campos DH, Luvizotto RA, et al. Involvement of L-type calcium channel and SERCA2A in myocardial dysfunction induced by obesity. J Cell Physiol. 2011;226(11):2934-42.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Involvement of L-type calcium channel and SERCA2A in myocardial dysfunction induced by obesity</article-title>
          <source>J Cell Physiol</source>
          <date>
            <year>2011</year>
          </date>
          <fpage>2934</fpage>
          <lpage>42</lpage>
          <issue>11</issue>
          <volume>226</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Leopoldo</surname>
              <given-names>AS</given-names>
            </name>
            <name>
              <surname>Lima-Leopoldo</surname>
              <given-names>AP</given-names>
            </name>
            <name>
              <surname>Sugizaki</surname>
              <given-names>MM</given-names>
            </name>
            <name>
              <surname>do Nascimento</surname>
              <given-names>AF</given-names>
            </name>
            <name>
              <surname>de Campos</surname>
              <given-names>DH</given-names>
            </name>
            <name>
              <surname>Luvizotto</surname>
              <given-names>RA</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B18">
        <label>18</label>
        <mixed-citation>18.	Ouwens DM, Boer C, Fodor M, de Galan P, Heine RJ, Maassen JA, et al. Cardiac dysfunction induced by high-fat diet is associated with altered myocardial insulin signaling in rats. Diabetologia. 2005;48(6):1229-37.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Cardiac dysfunction induced by high-fat diet is associated with altered myocardial insulin signaling in rats</article-title>
          <source>Diabetologia</source>
          <date>
            <year>2005</year>
          </date>
          <fpage>1229</fpage>
          <lpage>37</lpage>
          <issue>6</issue>
          <volume>48</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Ouwens</surname>
              <given-names>DM</given-names>
            </name>
            <name>
              <surname>Boer</surname>
              <given-names>C</given-names>
            </name>
            <name>
              <surname>Fodor</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>de Galan</surname>
              <given-names>P</given-names>
            </name>
            <name>
              <surname>Heine</surname>
              <given-names>RJ</given-names>
            </name>
            <name>
              <surname>Maassen</surname>
              <given-names>JA</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B19">
        <label>19</label>
        <mixed-citation>19.	Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2-[Delta][Delta] CT method. Methods. 2001;25(4):402-8.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Analysis of relative gene expression data using real-time quantitative PCR and the 2-[Delta][Delta] CT method</article-title>
          <source>Methods</source>
          <date>
            <year>2001</year>
          </date>
          <fpage>402</fpage>
          <lpage>8</lpage>
          <issue>4</issue>
          <volume>25</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Livak</surname>
              <given-names>KJ</given-names>
            </name>
            <name>
              <surname>Schmittgen</surname>
              <given-names>TD</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B20">
        <label>20</label>
        <mixed-citation>20.	Tentolouris N, Pavlatos S, Kokkinos A, Perrea D, Pagoni S, Katsilambros N. Diet-induced thermogenesis and substrate oxidation are not different between lean and obese women after two different isocaloric meals, one rich in protein and one rich in fat. Metabolism. 2008;57(3):313-20.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Diet-induced thermogenesis and substrate oxidation are not different between lean and obese women after two different isocaloric meals, one rich in protein and one rich in fat</article-title>
          <source>Metabolism</source>
          <date>
            <year>2008</year>
          </date>
          <fpage>313</fpage>
          <lpage>20</lpage>
          <issue>3</issue>
          <volume>57</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Tentolouris</surname>
              <given-names>N</given-names>
            </name>
            <name>
              <surname>Pavlatos</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Kokkinos</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Perrea</surname>
              <given-names>D</given-names>
            </name>
            <name>
              <surname>Pagoni</surname>
              <given-names>S</given-names>
            </name>
            <name>
              <surname>Katsilambros</surname>
              <given-names>N</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B21">
        <label>21</label>
        <mixed-citation>21.	Akiyama T, Tachibana I, Shirohara H, Watanabe N, Otsuki M. High-fat hypercaloric diet induces obesity, glucose intolerance and hyperlipidemia in normal adult male Wistar rat. Diabetes Res Clin Pract. 1996;31(1-3):27-35.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>High-fat hypercaloric diet induces obesity, glucose intolerance and hyperlipidemia in normal adult male Wistar rat</article-title>
          <source>Diabetes Res Clin Pract</source>
          <date>
            <year>1996</year>
          </date>
          <fpage>27</fpage>
          <lpage>35</lpage>
          <issue>1-3</issue>
          <volume>31</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Akiyama</surname>
              <given-names>T</given-names>
            </name>
            <name>
              <surname>Tachibana</surname>
              <given-names>I</given-names>
            </name>
            <name>
              <surname>Shirohara</surname>
              <given-names>H</given-names>
            </name>
            <name>
              <surname>Watanabe</surname>
              <given-names>N</given-names>
            </name>
            <name>
              <surname>Otsuki</surname>
              <given-names>M</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B22">
        <label>22</label>
        <mixed-citation>22.	da Silva AA, Kuo JJ, Tallam LS, Hall JE. Role of endothelin-1 in blood pressure regulation in a rat model of visceral obesity and hypertension. Hypertension. 2004;43(2):383-7.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Role of endothelin-1 in blood pressure regulation in a rat model of visceral obesity and hypertension</article-title>
          <source>Hypertension</source>
          <date>
            <year>2004</year>
          </date>
          <fpage>383</fpage>
          <lpage>7</lpage>
          <issue>2</issue>
          <volume>43</volume>
          <person-group person-group-type="author">
            <name>
              <surname>da Silva</surname>
              <given-names>AA</given-names>
            </name>
            <name>
              <surname>Kuo</surname>
              <given-names>JJ</given-names>
            </name>
            <name>
              <surname>Tallam</surname>
              <given-names>LS</given-names>
            </name>
            <name>
              <surname>Hall</surname>
              <given-names>JE</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B23">
        <label>23</label>
        <mixed-citation>23.	Dourmashkin JT, Chang GQ, Gayles EC, Hill JO, Fried SK, Julien C, et al. Different forms of obesity as a function of diet composition. Int J Obes. 2005;29(11):1368-78.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Different forms of obesity as a function of diet composition</article-title>
          <source>Int J Obes</source>
          <date>
            <year>2005</year>
          </date>
          <fpage>1368</fpage>
          <lpage>78</lpage>
          <issue>11</issue>
          <volume>29</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Dourmashkin</surname>
              <given-names>JT</given-names>
            </name>
            <name>
              <surname>Chang</surname>
              <given-names>GQ</given-names>
            </name>
            <name>
              <surname>Gayles</surname>
              <given-names>EC</given-names>
            </name>
            <name>
              <surname>Hill</surname>
              <given-names>JO</given-names>
            </name>
            <name>
              <surname>Fried</surname>
              <given-names>SK</given-names>
            </name>
            <name>
              <surname>Julien</surname>
              <given-names>C</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B24">
        <label>24</label>
        <mixed-citation>24.	Huang BW, Chiang MT, Yao HT, Chiang W. The effect of high-fat and high-fructose diets on glucose tolerance and plasma lipid and leptin levels in rats. Diabetes Obes Metab. 2004;6(2):120-6.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>The effect of high-fat and high-fructose diets on glucose tolerance and plasma lipid and leptin levels in rats</article-title>
          <source>Diabetes Obes Metab</source>
          <date>
            <year>2004</year>
          </date>
          <fpage>120</fpage>
          <lpage>6</lpage>
          <issue>2</issue>
          <volume>6</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Huang</surname>
              <given-names>BW</given-names>
            </name>
            <name>
              <surname>Chiang</surname>
              <given-names>MT</given-names>
            </name>
            <name>
              <surname>Yao</surname>
              <given-names>HT</given-names>
            </name>
            <name>
              <surname>Chiang</surname>
              <given-names>W</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B25">
        <label>25</label>
        <mixed-citation>25.	Li L, Yang G, Li Q, Tang Y, Li K. High-fat- and Lipid-induced insulin resistance in rats: the comparison of glucose metabolism, plasm resistin and adiponectin levels. Ann Nutr Metab. 2006;50(6):499-505.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>High-fat- and Lipid-induced insulin resistance in rats: the comparison of glucose metabolism, plasm resistin and adiponectin levels</article-title>
          <source>Ann Nutr Metab</source>
          <date>
            <year>2006</year>
          </date>
          <fpage>499</fpage>
          <lpage>505</lpage>
          <issue>6</issue>
          <volume>50</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Li</surname>
              <given-names>L</given-names>
            </name>
            <name>
              <surname>Yang</surname>
              <given-names>G</given-names>
            </name>
            <name>
              <surname>Li</surname>
              <given-names>Q</given-names>
            </name>
            <name>
              <surname>Tang</surname>
              <given-names>Y</given-names>
            </name>
            <name>
              <surname>Li</surname>
              <given-names>K</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B26">
        <label>26</label>
        <mixed-citation>26.	Nivoit P, Morens C, Van Assche FA, Jansen E, Poston L, Remacle C, et al. Established diet-induced obesity in female rats leads to offspring hyperphagia, adiposity and insulin resistance. Diabetologia. 2009;52(6):1133-42.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Established diet-induced obesity in female rats leads to offspring hyperphagia, adiposity and insulin resistance</article-title>
          <source>Diabetologia</source>
          <date>
            <year>2009</year>
          </date>
          <fpage>1133</fpage>
          <lpage>42</lpage>
          <issue>6</issue>
          <volume>52</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Nivoit</surname>
              <given-names>P</given-names>
            </name>
            <name>
              <surname>Morens</surname>
              <given-names>C</given-names>
            </name>
            <name>
              <surname>Van Assche</surname>
              <given-names>FA</given-names>
            </name>
            <name>
              <surname>Jansen</surname>
              <given-names>E</given-names>
            </name>
            <name>
              <surname>Poston</surname>
              <given-names>L</given-names>
            </name>
            <name>
              <surname>Remacle</surname>
              <given-names>C</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B27">
        <label>27</label>
        <mixed-citation>27.	Michalaki MA, Vagenakis AG, Leonardou AS, Argentou MN, Habeos IG, Makri MG, et al. Thyroid function in humans with morbid obesity. Thyroid. 2006;16(1):73-8.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Thyroid function in humans with morbid obesity</article-title>
          <source>Thyroid</source>
          <date>
            <year>2006</year>
          </date>
          <fpage>73</fpage>
          <lpage>8</lpage>
          <issue>1</issue>
          <volume>16</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Michalaki</surname>
              <given-names>MA</given-names>
            </name>
            <name>
              <surname>Vagenakis</surname>
              <given-names>AG</given-names>
            </name>
            <name>
              <surname>Leonardou</surname>
              <given-names>AS</given-names>
            </name>
            <name>
              <surname>Argentou</surname>
              <given-names>MN</given-names>
            </name>
            <name>
              <surname>Habeos</surname>
              <given-names>IG</given-names>
            </name>
            <name>
              <surname>Makri</surname>
              <given-names>MG</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B28">
        <label>28</label>
        <mixed-citation>28.	Ortiga-Carvalho TM, Oliveira KJ, Soares BA, Pazos-Moura CC. The role of leptin in the regulation of TSH secretion in the fed state: in vivo and in vitro studies. J Endocrinol. 2002;174(1):121-5.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>The role of leptin in the regulation of TSH secretion in the fed state: in vivo and in vitro studies</article-title>
          <source>J Endocrinol</source>
          <date>
            <year>2002</year>
          </date>
          <fpage>121</fpage>
          <lpage>5</lpage>
          <issue>1</issue>
          <volume>174</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Ortiga-Carvalho</surname>
              <given-names>TM</given-names>
            </name>
            <name>
              <surname>Oliveira</surname>
              <given-names>KJ</given-names>
            </name>
            <name>
              <surname>Soares</surname>
              <given-names>BA</given-names>
            </name>
            <name>
              <surname>Pazos-Moura</surname>
              <given-names>CC</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B29">
        <label>29</label>
        <mixed-citation>29.	Matzen LE, Kvetny J, Pedersen KK. TSH, thyroid hormones and nuclear-binding of T3 in mononuclear blood cells from obese and non-obese women. Scand J Clin Lab Invest. 1989;49(3):249-53.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>TSH, thyroid hormones and nuclear-binding of T3 in mononuclear blood cells from obese and non-obese women</article-title>
          <source>Scand J Clin Lab Invest</source>
          <date>
            <year>1989</year>
          </date>
          <fpage>249</fpage>
          <lpage>53</lpage>
          <issue>3</issue>
          <volume>49</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Matzen</surname>
              <given-names>LE</given-names>
            </name>
            <name>
              <surname>Kvetny</surname>
              <given-names>J</given-names>
            </name>
            <name>
              <surname>Pedersen</surname>
              <given-names>KK</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B30">
        <label>30</label>
        <mixed-citation>30.	Tagliaferri M, Berselli ME, Cal&#242; G, Minocci A, Savia G, Petroni ML, et al. Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile. Obes Res. 2001;9(3):196-201.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile</article-title>
          <source>Obes Res</source>
          <date>
            <year>2001</year>
          </date>
          <fpage>196</fpage>
          <lpage>201</lpage>
          <issue>3</issue>
          <volume>9</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Tagliaferri</surname>
              <given-names>M</given-names>
            </name>
            <name>
              <surname>Berselli</surname>
              <given-names>ME</given-names>
            </name>
            <name>
              <surname>Cal&#242;</surname>
              <given-names>G</given-names>
            </name>
            <name>
              <surname>Minocci</surname>
              <given-names>A</given-names>
            </name>
            <name>
              <surname>Savia</surname>
              <given-names>G</given-names>
            </name>
            <name>
              <surname>Petroni</surname>
              <given-names>ML</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B31">
        <label>31</label>
        <mixed-citation>31.	Reinehr T. Obesity and thyroid function. Mol Cell Endocrinol. 2010;316(2):165-71.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Obesity and thyroid function</article-title>
          <source>Mol Cell Endocrinol</source>
          <date>
            <year>2010</year>
          </date>
          <fpage>165</fpage>
          <lpage>71</lpage>
          <issue>2</issue>
          <volume>316</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Reinehr</surname>
              <given-names>T</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B32">
        <label>32</label>
        <mixed-citation>32.	Rider OJ, Francis JM, Ali MK, Byrne J, Clarke K, Neubauer S, et al. Determinants of left ventricular mass in obesity; a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2009;11:9.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Determinants of left ventricular mass in obesity; a cardiovascular magnetic resonance study</article-title>
          <source>J Cardiovasc Magn Reson</source>
          <date>
            <year>2009</year>
          </date>
          <fpage>9</fpage>
          <volume>11</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Rider</surname>
              <given-names>OJ</given-names>
            </name>
            <name>
              <surname>Francis</surname>
              <given-names>JM</given-names>
            </name>
            <name>
              <surname>Ali</surname>
              <given-names>MK</given-names>
            </name>
            <name>
              <surname>Byrne</surname>
              <given-names>J</given-names>
            </name>
            <name>
              <surname>Clarke</surname>
              <given-names>K</given-names>
            </name>
            <name>
              <surname>Neubauer</surname>
              <given-names>S</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B33">
        <label>33</label>
        <mixed-citation>33.	Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling-concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol. 2000;35(3):569-82.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Cardiac remodeling-concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling</article-title>
          <source>J Am Coll Cardiol</source>
          <date>
            <year>2000</year>
          </date>
          <fpage>569</fpage>
          <lpage>82</lpage>
          <issue>3</issue>
          <volume>35</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Cohn</surname>
              <given-names>JN</given-names>
            </name>
            <name>
              <surname>Ferrari</surname>
              <given-names>R</given-names>
            </name>
            <name>
              <surname>Sharpe</surname>
              <given-names>N</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B34">
        <label>34</label>
        <mixed-citation>34.	Leopoldo AS, Sugizaki MM, Lima-Leopoldo AP, do Nascimento AF, Luvizotto RA, de Campos DH, et al. Cardiac remodeling in a rat model of diet-induced obesity. Can J Cardiol. 2010;26(8):423-9.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Cardiac remodeling in a rat model of diet-induced obesity</article-title>
          <source>Can J Cardiol</source>
          <date>
            <year>2010</year>
          </date>
          <fpage>423</fpage>
          <lpage>9</lpage>
          <issue>8</issue>
          <volume>26</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Leopoldo</surname>
              <given-names>AS</given-names>
            </name>
            <name>
              <surname>Sugizaki</surname>
              <given-names>MM</given-names>
            </name>
            <name>
              <surname>Lima-Leopoldo</surname>
              <given-names>AP</given-names>
            </name>
            <name>
              <surname>do Nascimento</surname>
              <given-names>AF</given-names>
            </name>
            <name>
              <surname>Luvizotto</surname>
              <given-names>RA</given-names>
            </name>
            <name>
              <surname>de Campos</surname>
              <given-names>DH</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B35">
        <label>35</label>
        <mixed-citation>35.	Ren J, Zhu BH, Relling DP, Esberg LB, Ceylan-Isik AF. High-fat diet-induced obesity leads to resistance to leptin-induced cardiomyocyte contractile response. Obesity (Silver Spring). 2008;16(11):2417-23.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>High-fat diet-induced obesity leads to resistance to leptin-induced cardiomyocyte contractile response</article-title>
          <source>Obesity (Silver Spring)</source>
          <date>
            <year>2008</year>
          </date>
          <fpage>2417</fpage>
          <lpage>23</lpage>
          <issue>11</issue>
          <volume>16</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Ren</surname>
              <given-names>J</given-names>
            </name>
            <name>
              <surname>Zhu</surname>
              <given-names>BH</given-names>
            </name>
            <name>
              <surname>Relling</surname>
              <given-names>DP</given-names>
            </name>
            <name>
              <surname>Esberg</surname>
              <given-names>LB</given-names>
            </name>
            <name>
              <surname>Ceylan-Isik</surname>
              <given-names>AF</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B36">
        <label>36</label>
        <mixed-citation>36.	Katz AM. Heart failure. In: Katz AM. Physiology of the heart. Philadelphia: Lippincott Williams &amp; Wilkins; 2001. p. 510-48.</mixed-citation>
        <element-citation publication-type="book">
          <source>Physiology of the heart</source>
          <date>
            <year>2001</year>
          </date>
          <fpage>510</fpage>
          <lpage>48</lpage>
          <person-group person-group-type="author">
            <name>
              <surname>Katz</surname>
              <given-names>AM</given-names>
            </name>
            <name>
              <surname>Katz</surname>
              <given-names>AM</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B37">
        <label>37</label>
        <mixed-citation>37.	Proud CG. Ras, PI3-kinase and mTOR signaling in cardiac hypertrophy. Cardiovasc Res. 2004;63(3):403-13.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Ras, PI3-kinase and mTOR signaling in cardiac hypertrophy</article-title>
          <source>Cardiovasc Res</source>
          <date>
            <year>2004</year>
          </date>
          <fpage>403</fpage>
          <lpage>13</lpage>
          <issue>3</issue>
          <volume>63</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Proud</surname>
              <given-names>CG</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B38">
        <label>38</label>
        <mixed-citation>38.	Young LH, Dahl DM, Rauner D, Barrett EJ. Physiological hyperinsulinemia inhibits myocardial protein degradation in vivo in the canine heart. Circ Res. 1992;71(2):393-400.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Physiological hyperinsulinemia inhibits myocardial protein degradation in vivo in the canine heart</article-title>
          <source>Circ Res</source>
          <date>
            <year>1992</year>
          </date>
          <fpage>393</fpage>
          <lpage>400</lpage>
          <issue>2</issue>
          <volume>71</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Young</surname>
              <given-names>LH</given-names>
            </name>
            <name>
              <surname>Dahl</surname>
              <given-names>DM</given-names>
            </name>
            <name>
              <surname>Rauner</surname>
              <given-names>D</given-names>
            </name>
            <name>
              <surname>Barrett</surname>
              <given-names>EJ</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B39">
        <label>39</label>
        <mixed-citation>39.	Pausova Z. From big fat cells to high blood pressure: a pathway to obesity-associated hypertension. Curr Opin Nephrol Hypertens. 2006;15(2):173-8.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>From big fat cells to high blood pressure: a pathway to obesity-associated hypertension</article-title>
          <source>Curr Opin Nephrol Hypertens</source>
          <date>
            <year>2006</year>
          </date>
          <fpage>173</fpage>
          <lpage>8</lpage>
          <issue>2</issue>
          <volume>15</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Pausova</surname>
              <given-names>Z</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
      <ref id="B40">
        <label>40</label>
        <mixed-citation>40.	Rondinone CM. Adipocyte-derived hormones, cytokines, and mediators. Endocrine. 2006;29(1):81-90.</mixed-citation>
        <element-citation publication-type="journal">
          <article-title>Adipocyte-derived hormones, cytokines, and mediators</article-title>
          <source>Endocrine</source>
          <date>
            <year>2006</year>
          </date>
          <fpage>81</fpage>
          <lpage>90</lpage>
          <issue>1</issue>
          <volume>29</volume>
          <person-group person-group-type="author">
            <name>
              <surname>Rondinone</surname>
              <given-names>CM</given-names>
            </name>
          </person-group>
        </element-citation>
      </ref>
    </ref-list>
  </back>
  <sub-article article-type="translation" id="TRen" xml:lang="en">
    <front-stub>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original Articles</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title xml:lang="en">Influence of long-term obesity on myocardial gene expression</article-title>
      </title-group>
      <abstract xml:lang="en">
        <p>BACKGROUND: Several authors have shown that deterioration of cardiac function is associated with the degree and duration of obesity. It is necessary to establish the gene expression patterns after prolonged periods of obesity. OBJECTIVE: This study tested the hypothesis that increased duration of exposure to obesity leads to a reduction in the mRNA levels of proteins involved in regulation of myocardial Ca2+ homeostasis. In addition, this study verified whether the decrease in mRNA expression was caused by a reduction in thyroid hormone. METHODS: Thirty-day-old male Wistar rats were distributed in two groups: control (C) and obese (Ob). The C group was fed a standard diet and the Ob was fed with high-fat diets for 15, 30 and 45 weeks. Obesity was defined by adiposity index. The gene expression was assessed by quantitative real-time PCR. RESULTS: The adiposity index was higher in the Ob compared to the C after all periods. While obesity at 15 and 45 weeks resulted in a reduction in mRNA of sarcoplasmic reticulum Ca2+- ATPase (SERCA2a), Na+/Ca2+ exchanger (NCX), and calsequestrin (CSQ), L-type Ca2+ channels, ryanodine receptor, SERCA2a, phospholamban (PLB), NCX, and CSQ expression were increased compared to the C after 30 weeks. There was no significant association between T3 levels and mRNA expression. CONCLUSIONS: Our data indicate that obesity over the short and long periods of time may promote alteration in gene expression of Ca2+ homeostasis regulatory proteins without influence by thyroid hormone.</p>
      </abstract>
      <kwd-group xml:lang="en">
        <kwd>Obesity</kwd>
        <kwd>Gene Expression</kwd>
        <kwd>Thyroid Hormones</kwd>
        <kwd>Myocytes, Cardiac</kwd>
        <kwd>Myocardium</kwd>
      </kwd-group>
    </front-stub>
    <body>
      <p>
        <bold>ORIGINAL ARTICLE</bold>
      </p>
      <p>
        <fn id="enda-body2">
          <label>
            <bold>Influence of long-term obesity on myocardial gene expression</bold>
          </label>
          <p>
            <bold>Ana Paula Lima-Leopoldo<sup>I</sup>; Andr&#233; Soares Leopoldo<sup>I</sup>; Danielle Cristina Tomaz Silva<sup>II</sup>; Andr&#233; Ferreira do Nascimento<sup>II</sup>; Dijon Henrique Salom&#233; de Campos<sup>II</sup>; Renata de Azevedo Melo Luvizotto<sup>II</sup>; Silvio Assis de Oliveira J&#250;nior<sup>III</sup>; Carlos Roberto Padovani<sup>II</sup>; C&#233;lia Regina Nogueira<sup>II</sup>; Antonio Carlos Cicogna<sup>II</sup></bold>
          </p>
        </fn>
      </p>
      <p><sup>I</sup>Universidade Federal do Esp&#237;rito Santo, Vit&#243;ria, ES</p>
      <p><sup>II</sup>Universidade Estadual Paulista, Botucatu, SP</p>
      <p><sup>III</sup>Universidade Federal do Mato Grosso do Sul, Campo Grande, MS, Brasil</p>
      <p>Mailing Address</p>
      <p>
        <bold>ABSTRACT</bold>
      </p>
      <p><bold>BACKGROUND:</bold> Several authors have shown that deterioration of cardiac function is associated with the degree and duration of obesity. It is necessary to establish the gene expression patterns after prolonged periods of obesity.</p>
      <p><bold>OBJECTIVE:</bold> This study tested the hypothesis that increased duration of exposure to obesity leads to a reduction in the mRNA levels of proteins involved in regulation of myocardial Ca<sup>2+</sup> homeostasis. In addition, this study verified whether the decrease in mRNA expression was caused by a reduction in thyroid hormone.</p>
      <p><bold>METHODS:</bold> Thirty-day-old male Wistar rats were distributed in two groups: control (C) and obese (Ob). The C group was fed a standard diet and the Ob was fed with high-fat diets for 15, 30 and 45 weeks. Obesity was defined by adiposity index. The gene expression was assessed by quantitative real-time PCR.</p>
      <p><bold>RESULTS:</bold> The adiposity index was higher in the Ob compared to the C after all periods. While obesity at 15 and 45 weeks resulted in a reduction in mRNA of sarcoplasmic reticulum Ca<sup>2+-</sup>ATPase (SERCA2a), Na<sup>+</sup>/Ca<sup>2+</sup> exchanger (NCX), and calsequestrin (CSQ), L-type Ca<sup>2+ </sup>channels, ryanodine receptor, SERCA2a, phospholamban (PLB), NCX, and CSQ expression were increased compared to the C after 30 weeks. There was no significant association between T3 levels and mRNA expression.</p>
      <p><bold>CONCLUSIONS:</bold> Our data indicate that obesity over the short and long periods of time may promote alteration in gene expression of Ca<sup>2+</sup> homeostasis regulatory proteins without influence by thyroid hormone.</p>
      <p><bold>Keywords:</bold> Obesity; Gene Expression; Thyroid Hormones; Myocytes, Cardiac; Myocardium.</p>
      <p>
        <bold>Introduction</bold>
      </p>
      <p>Obesity is the most prevalent chronic metabolic disorder in developed and underdeveloped countries<sup>1</sup>. This disease plays an important role in cardiovascular morbidity through multiple mechanisms, including intracellular calcium (Ca<sup>2+</sup>) homeostasis<sup>2-4</sup>. Several proteins and channels, such as sarcoplasmic reticulum Ca<sup>2+</sup>-ATPase (SERCA2a), ryanodine receptor (RyR), phospholamban (PLB), L-type Ca<sup>2+</sup> channel, calsequestrin (CSQ) and Na<sup>+</sup>/Ca<sup>2+</sup> exchanger (NCX) regulate Ca<sup>2+</sup> homeostasis in cardiac muscle<sup>3,4</sup>. Thus, alterations in the expression and/or function of these Ca<sup>2+</sup> proteins could be responsible for cardiac dysfunction in human and experimental models. </p>
      <p>Previous studies with short periods evaluating the gene expression of Ca<sup>2+</sup> proteins in experimental obese models have shown disparate results<sup>5-7</sup>. Studies using dogs which were fed a high fat diet for 6 weeks, showed similar levels of RyR mRNA between control and high-fat diet groups<sup>5</sup>. Other studies using dogs fed a high-fat diet for 9 weeks, showed decreased mRNA expression of SERCA2a and PLB in the myocardium<sup>6</sup>. Lima-Leopoldo et al<sup>7</sup> showed that obese rats fed a cycle of high-fat diets for 15 weeks, plus a solution of sugar water, had increased mRNA levels of SERCA2a, PLB and RyR. Since several authors have shown that cardiac dysfunction is associated with the degree and duration of obesity, it has become necessary to establish the gene expression patterns after prolonged periods of obesity.</p>
      <p>The heart is an important target organ for thyroid hormone (TH) action<sup>8-10</sup>. The ability of TH to regulate cardiac function has been suggested to involve its genomics effects<sup>11,12</sup>. In this regard, the influence and/or role of TH on proteins of Ca<sup>2+</sup> handling has been an area of intense investigation<sup>12,13</sup> and several studies have reported the involvement of TH as modulators of gene transcription<sup>8,9,14,15</sup>. However, little is known about the relationship between the duration of obesity, gene expression of cardiac Ca<sup>2+</sup> proteins and TH. </p>
      <p>Considering the lack of information, the purpose of this study was to test the hypothesis that long-term exposure to obesity leads to a reduction in the mRNA expression levels of proteins involved in myocardial Ca<sup>2+</sup> homeostasis. Furthermore, this study verified whether the decrease in gene expression was accompanied by a reduction in TH levels.</p>
      <p>
        <bold>Material and Methods</bold>
      </p>
      <p>
        <bold>Animals and procedures</bold>
      </p>
      <p>All procedures involving animals were approved by the Ethics Committee of Botucatu Medical School (UNESP, SP, Brazil) under number (573) and performed in accordance with the <italic>Guide for the Care and Use of Laboratory Animals </italic>published by the National Research Council in the 1996<sup>16</sup>.</p>
      <p>Thirty-day-old male <italic>Wistar </italic>rats, weighing approximately 100g, were obtained from the Central Animal House of Botucatu Medical School (S&#227;o Paulo, Brazil). Rats were individually caged with free access to water and subjected to different dietary regimens as described below. Animals were kept under standard environmental conditions of controlled light (12 h light/dark schedule; lights on at 6 am), clean-air room temperature (23&#194;&#177;3&#186;C), and relative humidity (60&#194;&#177;5%). </p>
      <p>
        <bold>Experiment design</bold>
      </p>
      <p>After 7 days of acclimation, the rats were randomized into two groups: control (C, n = 30) and obese (Ob, n = 30). The C group was fed a standard diet and Ob group were alternately submitted to four palatable high-fat diets. Weight gain and body weight were monitored once a week.</p>
      <p>At week 3 of this study, the beginning of obesity based on body weight gain was established, previously determined by our group (<italic>unpublished data</italic>). At this time point, weeks 3, control and obese rats were randomized into six new groups (C<sub>15</sub>, Ob<sub>15</sub>, C<sub>30</sub>, Ob<sub>30</sub>, C<sub>45</sub> and Ob<sub>45</sub>) and maintained on their respective diets for 15, 30 and 45 consecutive weeks. </p>
      <p>
        <bold>Diets</bold>
      </p>
      <p>Experimental diets were prepared in pellet form by Agroceres (Rio Claro, SP, Brazil). The standard diet (RC Focus 1765) consisted of 12.3% kcal from fat, 57.9% kcal from carbohydrates, and 29.8% kcal from protein. Four palatable high-fat diets (RC Focus 2413, 2414, 2415, and 2416) contained 49.2% kcal from fat, 28.9% kcal from carbohydrates, and 21.9% kcal from protein. High-fat diets were calorically rich (high-fat diet = 3.65 kcal/g <italic>versus </italic>low-fat diet = 2.95 kcal/g) due to higher fat energy. The composition of the high-fat diets consisted of saturated and unsaturated fatty acids, which provided 20% and 80% of the fat-derived calories, respectively. Standard and high-fat diets components have been previously described<sup>17</sup>.</p>
      <p>
        <bold>Characterization of obesity</bold>
      </p>
      <p>A criterion based on adiposity index was utilized to confirm animals obesity. After animals had been anesthetized (sodium pentobarbital 50 mg/kg intraperitoneal [i.p.]), decapitated, and thoracotomized, the adipose tissue fat pads were dissected and weighed. The adiposity index was calculated by the following formula: adiposity index = (total body fat (BF)/final body weight) &#215; 100. BF was measured from the sum of the individual fat pad weights as follows: BF = epididymal fat + retroperitoneal fat + visceral fat.</p>
      <p>
        <bold>Comorbidities associated with obesity</bold>
      </p>
      <p>As rat models of diet-induced obesity may develop some characteristics of human obesity, such as hypertension, glucose (GL) intolerance, insulin resistance, dyslipidemia, hyperinsulinemia, and hyperleptinemia, the following evaluations were performed in all groups:</p>
      <p>
        <bold>Systolic blood pressure (SBP)</bold>
      </p>
      <p>After observation periods, the tail systolic blood pressure (SBP) was assessed in each animal by semi automated tail cuff device Narco BioSystems<sup>&#174;</sup> PE 300 (International Biomedical, Austin, TX, USA). The average of two pressure readings was recorded.</p>
      <p>
        <bold>GL tolerance test (GTT) and homeostatic model assessment index (HOMA)</bold>
      </p>
      <p>After 15, 30 and 45 weeks of treatment, GL tolerance and insulin resistance were evaluated by GTT and HOMA-IR, respectively. All rats were fasted for 4-6 h prior to GL tolerance test<sup>18</sup>. After fasting, a blood sample was collected from the tip of the tail in a heparinized tube. The basal blood GL level of each animal was immediately determined using a handheld glucometer (Accuchek Advantage; Roche Diagnostics Co., Indianapolis, IN). Subsequently, an injection of 2 g/kg GL (Sigma-Aldrich<sup>&#174;</sup>, St Louis, MO, USA) was given intravenously and blood GL levels were measured after 15, 30, 60, 90, and 120 min<sup>18</sup>. GL intolerance was evaluated by the area under the curve (AUC) for GL. The HOMA-IR was expressed as an index of insulin resistance and calculated by the following formula: HOMA-IR=[fasting GL (mmol/l) &#215; fasting insulin(&#181;U/ml)]/22.5. All rats ate normally and regained their body weights within 1 d after this regimen.</p>
      <p>
        <bold>Triglyceride determination and Hormonal analysis</bold>
      </p>
      <p>At the end of each experimental period (15, 30 and 45weeks), animals were fasted for 12-15 h, anesthetized with sodium pentobarbital (50 mg/kg i.p.), and euthanized by decapitation. Blood samples were collected in heparinized tubes, and the serum was separated by centrifugation at 3000 &#215; <italic>g</italic> for 15 minutes at 4&#186;C and stored at -80&#186;C until further analysis. Serum was analyzed for triglyceride levels (TG) and insulin and leptin hormones. Serum concentration of TG was assayed using a commercial kit (CELM,<sup>&#174;</sup> S&#227;o Paulo, Brazil) and measured with an automatic enzymatic analyzer system (Technicon, RA-XT<sup>TM</sup> System, Global Medical Instrumentation, Minnesota, USA). Leptin and insulin levels were determined by ELISA using commercial kits (Linco Research Inc., St. Louis, MO, USA).</p>
      <p>The serum concentrations of free triiodothyronine (T<sub>3</sub>) and thyroid stimulating hormone (TSH) were analyzed using Diagnostics Products Genese (S&#227;o Paulo, SP, Brazil) with Luminex Corporation's xMAP Technology<sup>TM</sup>, by reaction multiplex immunoassay, Lincoplex kits (Linco Research Inc, St. Louis, MO, USA).</p>
      <p>
        <bold>Gene expression of key intracellular Ca2+-cycling proteins</bold>
      </p>
      <p>Whole RNA was extracted from cardiac tissue (left ventricle) using Trizol (Invitrogen), according to the manufacturer's instructions. High Capacity cDNA Reverse Transcription Kit (Applied Biosystems, CA, USA) was utilized for the synthesis of complementary DNA (cDNA) from 1000 ng of whole RNA. Real-time PCR was used to quantitatively measure the messenger RNA (mRNA) levels of SERCA2a (Rn00568762_m1), RyR (Rn01470303_m1), PLB (Rn01434045_m1), L-type Ca<sup>2+</sup> channel (Rn00709287_m1), CSQ (Rn00567508_m1) and NCX (Rn00570527_m1). Quantitative mRNA was measured using TaqMan Universal PCRMaster Mix (Applied Biosystems, CA, USA), according to the manufacturer's instructions, and the Applied Biosystems StepOne Plus detection system. All samples were assayed in triplicate. Cycling conditions were as follows: enzyme activation at 50&#186;C for 2 min, denaturation at 95&#186;C for 10min, the cDNA products were amplified for 40 cycles of denaturation at 95&#186;C for 15 s and annealing/extension at 60&#186;C for 1 min. Gene expression was quantified in relation to the values of the control groups (C<sub>15</sub>, C<sub>30</sub> and C<sub>45</sub>, respectively) after normalization by an internal control (&#946;-actin, Rn00667869_m1) and determined by the method 2<sup>-</sup><sup>&#916;&#916;</sup>Ct, as previously described<sup>19</sup>.</p>
      <p>
        <bold>Statistical analysis</bold>
      </p>
      <p>All results were reported as mean &#194;&#177; standard deviation. General characteristics, comorbidities, hormonal measurements and gene expression of intracellular Ca<sup>2+</sup>-cycling proteins were evaluated using two-way analysis of variance (ANOVA) for independent samples. When significant differences were found (p&lt;0.05), Bonferroni's <italic>post hoc</italic> test for multiple comparisons was carried out. The association analysis between the levels of thyroid hormone and intracellular Ca<sup>2+</sup>-cycling protein gene expression was determined by Pearson's linear correlation test. The level of significance was 5%.</p>
      <p>
        <bold>Results</bold>
      </p>
      <p>
        <bold>General characteristics and comorbidities</bold>
      </p>
      <p>The general characteristics of rats are shown in <xref ref-type="fig" rid="en_a04fig01-body2">Figure 1</xref>. Obese animals had significantly greater final body weight, weight gain, body fat, and adiposity index compared to control rats in all experimental periods (Figure 1, Panel A, B, C and D). Using the adiposity index as the indicator of obesity, after 15, 30 and 45weeks Ob rats had 79.5%, 82% and 69.5% more fat, respectively, compared with their respective C rats (<xref ref-type="fig" rid="en_a04fig01-body2">Figure 1D</xref>). Long-term to exposure to high-fat diet did not influence the degree of obesity, since the body fat and adiposity index were similar between Ob rats in different Ob groups (<xref ref-type="fig" rid="en_a04fig01-body2">Figure 1C</xref> and <xref ref-type="fig" rid="en_a04fig01-body2">D</xref>).</p>
      <p content-type="html"><fig id="en_a04fig01-body2"><graphic xlink:href="https://minio.scielo.br/documentstore/1678-4170/PtLkRn5L8k6gMkLF3qFmWMm/da63c43920e6c633ae8689d9e8800fa210d7e39c.jpg"/><graphic xlink:href="1678-4170-abc-100-03-0229-30045-gf01-en.jpg"/></fig>&#13;
&#160;&#13;
</p>
      <p>The comorbidities associated with obesity are summarized in <xref ref-type="fig" rid="en_a04fig02-body2">Figure 2</xref>. The area under the curve for glucose (AUC) and HOMA index were significantly affected by exposure to obesity. The Ob rats had significantly greater glucose AUC than their respective C group (Ob<sub>15</sub>&gt;C<sub>15, </sub>Ob<sub>30</sub>&gt;C<sub>30 </sub>and Ob<sub>45</sub>&gt;C<sub>45</sub>; p &lt; 0.05), <xref ref-type="fig" rid="en_a04fig02-body2">Figure 2A</xref>. HOMA index were also significantly greater in the Ob rats compared to control group (Ob<sub>15</sub>&gt;C<sub>15 </sub>and Ob<sub>45</sub>&gt;C<sub>45</sub>; p &lt; 0.05), <xref ref-type="fig" rid="en_a04fig02-body2">Figure 2B</xref>. Although, the levels of HOMA index were not significantly different between groups at 30 week, there was a trend this measurement to be greater (p = 0.054) in Ob rats than C rats (<xref ref-type="fig" rid="en_a04fig02-body2">Figure 2B</xref>).</p>
      <p content-type="html"><fig id="en_a04fig02-body2"><graphic xlink:href="https://minio.scielo.br/documentstore/1678-4170/PtLkRn5L8k6gMkLF3qFmWMm/5c0c6d85375c90410945729fce317338b6b200fc.jpg"/><graphic xlink:href="1678-4170-abc-100-03-0229-30045-gf02-en.jpg"/></fig>&#13;
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      <p>Glucose tolerance test revealed compromised glucose tolerance in the Ob group in all experimental periods, consistent with the notion that obesity is often accompanied by insulin resistance, which was observed in this study determined by HOMA index. Furthermore, <xref ref-type="fig" rid="en_a04fig02-body2">Figure 2D</xref> shows that high-fat diet-induced obesity significantly altered serum triglycerides levels in relation to the 3 C groups (Ob<sub>15</sub>&gt;C<sub>15</sub> and Ob<sub>30</sub>&gt;C<sub>30</sub>; p &lt; 0.05). At weeks 45, there was no significant difference in TG levels between groups (p=0.086). The duration of obesity had no effect on systolic blood pressure in the Ob groups (<xref ref-type="fig" rid="en_a04fig02-body2">Figure 2C)</xref>.</p>
      <p>
        <bold>Hormonal analysis</bold>
      </p>
      <p><xref ref-type="table" rid="en_a04tab01-body2">Table 1</xref> presents the values for leptin, insulin, T<sub>3</sub> and TSH. The high-fat diet caused a significant elevation in leptin and insulin levels in all experiments periods. The duration of obesity affected leptin levels significantly between 15 and 45week (Ob<sub>45</sub>&gt;Ob<sub>15</sub>; p &lt; 0.05), however, leptin levels were not significantly different between obese groups at 15 <italic>vs </italic>30weeks or 30 <italic>vs</italic> 45 weeks (Ob<sub>15</sub><italic>versus </italic>Ob<sub>30,</sub> p=0.055; and Ob<sub>30 </sub><italic>versus</italic> Ob<sub>45, </sub>p = 0.09). There was a trend of increased leptin levels over time which was influenced by duration obesity exposure (<xref ref-type="table" rid="en_a04tab01-body2">Table 1</xref>). Furthermore, long-term obesity exposure (Ob<sub>45</sub> &gt; Ob<sub>15 </sub>and Ob<sub>30</sub>, p &lt; 0.05) promoted a greater rise in insulin levels compared to short- and mid-term obesity exposure, indicating that the duration of obesity resulted in higher insulin resistance (<xref ref-type="table" rid="en_a04tab01-body2">Table 1</xref>). According to these leptin and insulin results obtained, obesity in all time periods was accompanied by hyperinsulinemia and hyperleptinemia.</p>
      <p content-type="asset">
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      </p>
      <p>Serum T<sub>3</sub> and TSH were determined to evaluate the role of thyroid hormones on gene transcription induced by high-fat diet induced obesity (<xref ref-type="table" rid="en_a04tab01-body2">Table 1</xref>). The duration of obesity promoted different responses on serum TSH levels at 15and45 weeks between the C and Ob groups (C<sub>15</sub>&gt;Ob<sub>15</sub>; C<sub>45</sub>&lt;Ob<sub>45</sub>). TSH values were not significantly different between the C and Ob groups groups after 30weeks of obesity. Furthermore, long periods of obesity did influence TSH levels within the obese groups at 15<italic>vs</italic>45weeks (Ob<sub>15</sub>&lt;Ob<sub>45</sub>). However, long-term exposure to high-fat diet induced obesity did not cause statistically significant changes in T<sub>3</sub> levels between C and Ob groups at all experimental time periods (<xref ref-type="table" rid="en_a04tab01-body2">Table 1</xref>). T<sub>3</sub> values were reduced at 15 weeks (Ob<sub>15</sub>&lt;C<sub>15</sub>, p=0.068) and elevated at 45 weeks (Ob<sub>45</sub>&gt;C<sub>45</sub>, p=0.007) in the Ob groups compared to their respective C groups. These results showed that T<sub>3</sub> and TSH respond similarly in regards to duration of exposure to obesity (C<sub>15</sub>&gt;Ob<sub>15</sub>; C<sub>45</sub>&lt;Ob<sub>45</sub>).</p>
      <p>
        <bold>Gene expression of key intracellular Ca2+-cycling proteins</bold>
      </p>
      <p>Analysis of the mRNA levels for intracellular Ca<sup>2+</sup>-cycling proteins was performed to understand the mechanism by which long-term exposure to obesity modulates cardiac function. The mRNA measurements of SERCA2a, RyR, PLB, L-type Ca<sup>2+</sup> channel, CSQ and NCX are summarized in <xref ref-type="fig" rid="en_a04fig03-body2">Figures 3A</xref>, <xref ref-type="fig" rid="en_a04fig03-body2">B</xref>, <xref ref-type="fig" rid="en_a04fig03-body2">C</xref>, <xref ref-type="fig" rid="en_a04fig03-body2">D</xref>, <xref ref-type="fig" rid="en_a04fig03-body2">E</xref> and <xref ref-type="fig" rid="en_a04fig03-body2">F</xref>. <xref ref-type="fig" rid="en_a04fig03-body2">Figures 3A</xref>, E and F show that different periods of high-fat diet induced obesity resulted in significant decrease in gene expression of SERCA2a, CSQ and NCX at 15 and 45weeks (C<sub>15</sub> &gt; Ob<sub>15</sub>; C<sub>45</sub> &gt; Ob<sub>45</sub>; p &lt; 0.05). Furthermore, the levels of PLB and L-type Ca<sup>2+</sup> channel mRNA were decreased only with exposure to obesity in the short-term (PLB: C<sub>15</sub>: 1.00&#194;&#177;0.18<italic>versus</italic> Ob<sub>15</sub>: 0.53 &#194;&#177; 0.13 and L-type Ca<sup>2+</sup> channel: C<sub>15</sub>: 1.00 &#194;&#177; 0.18 <italic>versus O</italic>b<sub>15</sub>: 0.54&#194;&#177;0.10; p&lt;0.05). The RyR mRNA levels were similar between the C and Ob groups after 15 and 45 weeks of obesity. At week 45, the gene expression of PLB and L-type Ca<sup>2+</sup> channel was not significantly different between the C and Ob groups (<xref ref-type="fig" rid="en_a04fig03-body2">Figures 3C</xref> and <xref ref-type="fig" rid="en_a04fig03-body2">D</xref>). Importantly after 30weeks of high-fat diet induced obesity, the mRNA levels of all intracellular Ca<sup>2+</sup>-cycling proteins (SERCA2A, RyR, PLB, L-type Ca<sup>2+</sup> channel, CSQ and NCX) were elevated compared to the C group (<xref ref-type="fig" rid="en_a04fig03-body2">Figure 3A</xref>, <xref ref-type="fig" rid="en_a04fig03-body2">B</xref>, <xref ref-type="fig" rid="en_a04fig03-body2">C</xref>, <xref ref-type="fig" rid="en_a04fig03-body2">D</xref>, <xref ref-type="fig" rid="en_a04fig03-body2">E</xref> and <xref ref-type="fig" rid="en_a04fig03-body2">F</xref>). Long-term exposure to high-fat diet induced obesity also resulted in statistically significant differences in mRNA levels of SERCA2A, RyR, L-type Ca<sup>2+</sup> channel, CSQ and NCX within the obese groups as shown in <xref ref-type="fig" rid="en_a04fig03-body2">Figure 3</xref> (Ob<sub>30</sub>&gt;Ob<sub>15</sub> = Ob<sub>45</sub>). </p>
      <p content-type="html"><fig id="en_a04fig03-body2"><graphic xlink:href="https://minio.scielo.br/documentstore/1678-4170/PtLkRn5L8k6gMkLF3qFmWMm/d9a50b4d1ebc61f9c5e22fd4b14952b59dfe2d00.jpg"/><graphic xlink:href="https://minio.scielo.br/documentstore/1678-4170/PtLkRn5L8k6gMkLF3qFmWMm/77174e894f0c5c1bcf9848fb90b3c89b9fafc887.jpg"/><graphic xlink:href="1678-4170-abc-100-03-0229-30045-gf03-en.jpg"/></fig>&#13;
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</p>
      <p>The potential role of the thyroid hormones altering gene expression of intracellular Ca<sup>2+</sup>-cycling proteins was also evaluated. <xref ref-type="table" rid="en_a04tab02-body2">Table 2</xref> shows the results of Pearson's linear correlation test. There were no significant correlations between free T<sub>3</sub> concentrations and mRNA levels of SERCA2a, RyR, PLB, L-type Ca<sup>2+</sup> channel and NCX. These results demonstrate that free T<sub>3</sub> did not influence and/or regulate transcription of intracellular Ca<sup>2+</sup> handling proteins after long-term exposure to obesity (<xref ref-type="table" rid="en_a04tab02-body2">Table 2</xref>).</p>
      <p content-type="asset">
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      <p>
        <bold>Discussion</bold>
      </p>
      <p>Obesity is a condition that has reached epidemic levels in recent years, and its adverse effects have been extensively studied in experimental animals. Interestingly, little information is available on the relationship between the duration of obesity and Ca<sup>2+</sup> regulation. The major contribution of this current study is that we demonstrated that exposure to obesity alters the gene expression of Ca<sup>2+</sup> handling proteins differently. While exposure to obesity for 30 weeks promoted elevations in mRNA levels, in contrast, exposure to obesity for 15 and 45 weeks, resulted in decreased mRNA levels, which suggests a different cardiac remodeling process may occur in short-term <italic>vs </italic>long-term exposure to obesity. Furthermore, there was not an influence of thyroid hormones on the gene expression of Ca<sup>2+</sup> handling proteins after long periods of exposure to obesity. We believe that this is the first study to report the cardiac mRNA expression of Ca<sup>2+ </sup>handling proteins in obese animals as well as the role of thyroid hormones regulating the gene expression of Ca<sup>2+</sup> handling proteins over long periods of time.</p>
      <p>Fat-enriched diets have been used for decades to model obesity in rodents. The high-fat diet used was of sufficient intensity and duration to promote obesity in rats at all experimental time periods, 15, 30 and 45 weeks. The development of obesity over time was characterized by significant differences in body weight, body fat, fat pads and adiposity index in comparison to control rats. According to the literature, increased fat consumption may not be accompanied by an elevation of oxidation, which favors greater deposition of fat in animals fed a high-fat diet<sup>20</sup>. Nevertheless, in this study, the time of exposure to a high-fat diet did not exacerbate this condition, since obesity was not accompanied by an elevation of the intensity or degree of adiposity. Consistent with previous investigations<sup>21-26</sup>, the high-fat diet used in this study was effective at promoting numerous comorbidities associated with short and long-term obesity,including glucose intolerance, hyperinsulinemia, insulin resistance, hyperleptinemia, and dyslipidemia observed by elevation in serum TG. Although there were no significant changes in TG levels after 45 weeks (p = 0.086), TG levels showed an increasing trend over time and exposure to obesity. These results demonstrate that obesity over the long periods of time promotes alterations in metabolic and hormonal parameters without effecting on systolic blood pressure.</p>
      <p>It is well known that obesity is accompanied by many hormonal changes including thyroid hormone levels. In this study, obesity promoted an increase in serum TSH after 45 weeks (Ob<sub>45</sub> &gt; C<sub>45</sub>), probably caused by high levels of leptin in the obese group. Studies in experimental animals, as well as in human subjects have shown that leptin stimulates TSH release<sup>27,28</sup>. In addition, previous studies have shown a positive relationship between serum TSH and leptin levels indicating that thyroid hormones undergo a process of adaptation with increasing adiposity<sup>29,30</sup>. The absence of alterations in leptin and TSH levels in the control group over time corroborates this assertion. Another important finding from our current study is that T<sub>3</sub> and TSH response showed similar trends in the obese groups over time. As reported in the literature<sup>31</sup>, changes in T<sub>3</sub> and TSH levels are often associated with alterations in body fat, our results suggest that this effect may be influenced by elevated of leptin levels over time. </p>
      <p>Among research using obese models, we believe that this is the first study to verify the influence of long-term exposure to obesity on gene expression of Ca<sup>2+</sup> handling proteins. In cardiomyocytes, the proteins associated with myocardial Ca<sup>2+</sup> handling participate in the release, recapture and extrusion of Ca<sup>2+</sup>, executing a key role in the regulation of cardiac function<sup>3,4</sup>. The current study showed that the duration of obesity resulted in different responses in gene expression of Ca<sup>2+</sup> handling proteins after 15, 30 and 45 weeks. Our results showed that obesity, induced by a high-fat caused, initially (15 weeks), decreased gene expression. Consequently, in the 30&#170; week of induced obesity, the cellular mechanisms involved in functioning of the heart had to increase in an attempt to reestablish molecular cardiac mRNA levels. After normalization of this process, the mRNA transcription returned to normal and/or reduced levels (45 weeks). These findings suggest that, in the current study, there was a remodeling of cardiac processes after long periods of exposure to obesity. Rider et al<sup>32</sup> state that cardiac remodeling is an adaptive characteristic of obesity. According to Cohn et al<sup>33</sup>, cardiac remodeling is defined as genome expression resulting in molecular, cellular and interstitial changes, manifested clinically as changes in size, shape and function of the heart resulting from cardiac load or injury. Furthermore, they point out that cardiac remodeling is influenced by hemodynamic overload, neurohormonal activation and other factors still under investigation. Therefore, a possible explanation for our results is that this process may be related to fat overload imposed to heart, where initially, it suffer one aggression after 15 weeks (obesity), then the heart has to remodel to normalize the cardiac molecular and cellular changes in the week 30. Finally, the heart adapts, returning to normal and/or reduced mRNA levels (45 weeks), since, it was no longer necessary to sustain increased RNA levels. These results may be corroborated with our previous and other studies which demonstrate that obesity induced and promoted myocardial dysfunction<sup>17,34,35</sup>, where the myocardial dysfunction could be related to changes in mRNA levels after 15 weeks of obesity. Furthermore, researches conducted in our laboratory, shows that cardiac function returns to normal after 30 and 45 weeks of obesity (<italic>unpublished data).</italic></p>
      <p>An alternative explanation for the cardiac remodeling process to normalize after 45 weeks may be related to diet composition. The high-fat diet used in this study was composed of large amounts of unsaturated fatty acids and this could be a mechanism that protects the heart, even in the presence of obesity. The mechanisms underlying the effects of long-term to exposure to obesity on mRNA levels of Ca<sup>2+</sup> handling proteins remain unknown. Several agents and pathways which may mediate the molecular and cellular responses (alterations in gene expression) involved in cardiac remodeling, include various cytokines, &#946;-adrenergic receptors, neurotransmitters, intracellular messengers and hormones such as insulin<sup>3,36-38</sup>.</p>
      <p>One important mediator involved in the activation of several transcriptional factors, and, therefore, fundamental in to gene expression responses is thyroid hormone. The literature reports that thyroid hormones may play a positive role in gene expression of SERCA, RyR and L-type Ca<sup>2+</sup> channels, and a negative role in PLB and NCX expression<sup>9</sup>. However, in disagreement with our hypothesis, thyroid hormone did not affect the gene expression of myocardial Ca<sup>2+</sup> handling proteins, based on correlation analysis which showed no significant association between T<sub>3</sub> and mRNA levels of Ca<sup>2+</sup> handling proteins. As shown in the cardiac remodeling process, different external stimuli can activate several transcriptional factors<sup>36</sup>. Therefore, we can infer that the same mediator/stimuli may have activated different transcription factors, leading to similar responses in gene expression. Since obesity is associated with increase in endothelin, angiotensin II, cytokines concentrations, among others<sup>39,40</sup>, and they work via different transcriptional factors, it is likely that some of these factors may be involved in changes in mRNA expression of Ca<sup>2+</sup> handling proteins.</p>
      <p>
        <bold>Conclusion</bold>
      </p>
      <p>Our data indicate that obesity over the short and long periods of time may promote alteration in gene expression of Ca<sup>2+</sup> homeostasis regulatory proteins without influence by thyroid hormone. One aspect which is important is that the knowledge of mRNA alterations at different periods during the development and establishment of obesity could contribute to understanding the mechanisms involved in cardiac dysfunction promoted by obesity. Nevertheless, further studies are necessary to determine which mediators influence mRNA behavior at each time period of the remodeling process induced by obesity.</p>
      <p>
        <bold>Author contributions</bold>
      </p>
      <p>Conception and design of the research: Lima-Leopoldo AP, Leopoldo AS, Nascimento AF, Luvizotto RAM, Padovani CR, Nogueira CR, Cicogna AC; Acquisition of data: Lima-Leopoldo AP, Leopoldo AS, Silva DAT, Nascimento AF, Campos DHS, Luvizotto RAM, Nogueira CR, Oliveira J&#250;nior SA, Cicogna AC; Analysis and interpretation of the data: Lima-Leopoldo AP, Leopoldo AS, Silva DAT, Campos DHS, Luvizotto RAM, Padovani CR, Nogueira CR, Oliveira J&#250;nior SA, Cicogna AC; Statistical analysis: Lima-Leopoldo AP, Leopoldo AS, Padovani CR, Cicogna AC; Obtaining financing: Lima-Leopoldo AP, Leopoldo AS, Nascimento AF, Campos DHS, Cicogna AC; Writing of the manuscript: Lima-Leopoldo AP, Leopoldo AS, Nascimento AF, Nogueira CR, Cicogna AC; Critical revision of the manuscript for intellectual content: Lima-Leopoldo AP, Leopoldo AS, Silva DAT, Luvizotto RAM, Padovani CR, Nogueira CR, Oliveira J&#250;nior SA, Cicogna AC</p>
      <p>
        <bold>Potential Conflict of Interest</bold>
      </p>
      <p>No potential conflict of interest relevant to this article was reported.</p>
      <p>
        <bold>Sources of Funding</bold>
      </p>
      <p>This study was funded by FAPESP.</p>
      <p>
        <bold>Study Association</bold>
      </p>
      <p>This article is part of the thesis of doctoral submitted by Ana Paula Lima Leopoldo, from Universidade Estadual Paulista.</p>
      <p>
        <bold>References</bold>
      </p>
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