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TESI Versió Definitiva Impremta Reedició Corregida 20160330 EVIDÈNCIES EN TEIXIT ADIPÓS D'ALTERACIONS GÈNIQUES DELS VASOS LIMFÀTICS EN L'OBESITAT Alfons Horra Pueyo ADVERTIMENT. L'accés als continguts d'aquesta tesi doctoral i la seva utilització ha de respectar els drets de la persona autora. Pot ser utilitzada per a consulta o estudi personal, així com en activitats o materials d'investigació i docència en els termes establerts a l'art. 32 del Text Refós de la Llei de Propietat Intel·lectual (RDL 1/1996). Per altres utilitzacions es requereix l'autorització prèvia i expressa de la persona autora. En qualsevol cas, en la utilització dels seus continguts caldrà indicar de forma clara el nom i cognoms de la persona autora i el títol de la tesi doctoral. No s'autoritza la seva reproducció o altres formes d'explotació efectuades amb finalitats de lucre ni la seva comunicació pública des d'un lloc aliè al servei TDX. Tampoc s'autoritza la presentació del seu contingut en una finestra o marc aliè a TDX (framing). Aquesta reserva de drets afecta tant als continguts de la tesi com als seus resums i índexs. ADVERTENCIA. El acceso a los contenidos de esta tesis doctoral y su utilización debe respetar los derechos de la persona autora. Puede ser utilizada para consulta o estudio personal, así como en actividades o materiales de investigación y docencia en los términos establecidos en el art. 32 del Texto Refundido de la Ley de Propiedad Intelectual (RDL 1/1996). Para otros usos se requiere la autorización previa y expresa de la persona autora. En cualquier caso, en la utilización de sus contenidos se deberá indicar de forma clara el nombre y apellidos de la persona autora y el título de la tesis doctoral. No se autoriza su reproducción u otras formas de explotación efectuadas con fines lucrativos ni su comunicación pública desde un sitio ajeno al servicio TDR. Tampoco se autoriza la presentación de su contenido en una ventana o marco ajeno a TDR (framing). Esta reserva de derechos afecta tanto al contenido de la tesis como a sus resúmenes e índices. WARNING. Access to the contents of this doctoral thesis and its use must respect the rights of the author. It can be used for reference or private study, as well as research and learning activities or materials in the terms established by the 32nd article of the Spanish Consolidated Copyright Act (RDL 1/1996). Express and previous authorization of the author is required for any other uses. In any case, when using its content, full name of the author and title of the thesis must be clearly indicated. Reproduction or other forms of for profit use or public communication from outside TDX service is not allowed. Presentation of its content in a window or frame external to TDX (framing) is not authorized either. These rights affect both the content of the thesis and its abstracts and indexes. UNIVERSITAT ROVIRA I VIRGILI EVIDÈNCIES EN TEIXIT ADIPÓS D'ALTERACIONS GÈNIQUES DELS VASOS LIMFÀTICS EN L'OBESITAT Alfons Horra Pueyo Alfons Horra Pueyo EVIDÈNCIES EN TEIXIT ADIPÓS D’ALTERACIONS GÈNIQUES DELS VASOS LIMFÀTICS EN L’OBESITAT TESI DOCTORAL Dirigida per Dr. Joan Josep Vendrell Ortega Departament de Medicina i Cirurgia UNIVERSITAT ROVIRA i VIRGILI TARRAGONA 2016 UNIVERSITAT ROVIRA I VIRGILI EVIDÈNCIES EN TEIXIT ADIPÓS D'ALTERACIONS GÈNIQUES DELS VASOS LIMFÀTICS EN L'OBESITAT Alfons Horra Pueyo UNIVERSITAT ROVIRA I VIRGILI EVIDÈNCIES EN TEIXIT ADIPÓS D'ALTERACIONS GÈNIQUES DELS VASOS LIMFÀTICS EN L'OBESITAT Alfons Horra Pueyo UNIVERSITAT ROVIRA I VIRGILI Departament de Medicina i Cirurgia Joan Josep Vendrell Ortega, Professor titular del departament de Medicina i Cirurgia de la Universitat Rovira i Virglili, Cap d’Endocrinologia i Nutrició de l’Hospital Universitari Joan XXIII de Tarragona FAIG CONSTAR que: aquest treball, titulat “EVIDÈNCIES EN TEIXIT ADIPÓS D'ALTERACIONS GÈNIQUES DELS VASOS LIMFÀTICS EN L’OBESITAT”, que presenta Alfons Horra Pueyo. per a l’obtenció del títol de Doctor, ha estat realitzat sota la meva direcció al Departament Medicina i Cirurgia d’aquesta universitat. Tarragona, 31 de desembre del 2015 El director de la tesi doctoral Professor Dr Joan Josep Vendrell Ortega UNIVERSITAT ROVIRA I VIRGILI EVIDÈNCIES EN TEIXIT ADIPÓS D'ALTERACIONS GÈNIQUES DELS VASOS LIMFÀTICS EN L'OBESITAT Alfons Horra Pueyo UNIVERSITAT ROVIRA I VIRGILI EVIDÈNCIES EN TEIXIT ADIPÓS D'ALTERACIONS GÈNIQUES DELS VASOS LIMFÀTICS EN L'OBESITAT Alfons Horra Pueyo AGRAÏMENTS Concretar les paraules que han de mostrar la meva gratitud no és sempre una tasca fàcil. La realització d’aquesta tesi va acompanyada de moltes circumstàncies i persones. Quan contactes amb persones proposant-los idees i projectes, moltes vegades un es pot trobar que la porta es tanca. A totes aquelles portes que es van tancar agraeixo la seva honestedat perquè gràcies a elles s’ha pogut fluir vers la consolidació d’aquest projecte. Gràcies, moltes gràcies. Més enllà de les idees calen persones que en facilitin la seva realització i en aquest punt han estat determinants certes persones. Aquesta tesi respon a la voluntat d’una persona que quan la vaig contactar no va dir que NO. Aquesta persona és el Dr Joan Vendrell i Ortega, sense ell no hi hagués hagut projecte, sense ell no hi hauria respostes. Gràcies, moltes gràcies. El camí vers aquesta tesi no ha sigut casual al mateix temps que no ha estat mancada de causalitats. La passió per la limfa arriba per dues persones a qui tinc gran estima. El Professor Albert Leduc i el Doctor Olivier Leduc, professors meus en la meva inoblidable etapa a la Universitat Lliure de Brussel·les. Ells em van inocular el virus del dubte, de la recerca constant de respostes i la passió irrefrenable pel coneixement de la limfa. Gràcies, moltes gràcies. No està de més considerar que qualsevol acció humana precisa de molta gent darrera i no puc oblidar en aquest sentit totes aquelles persones, el personal tècnic del laboratori, que amb la seva feina han estat un gran suport per a mi. Gràcies, moltes gràcies. Sense molts dels meus amics no hauria pogut desenvolupar aquest projecte; pels seus coneixements, per la seva paciència, pels seus consells, pels diàlegs, debats i confrontacions tingudes, moltes gràcies. Per vosaltres i amb vosaltres van sorgir reflexions, idees, arguments i sobretot amistat. Molts sou i no podria recordar-vos a tots i totes en cada detall i circumstància. Gràcies, moltes gràcies, per tantes coses. Voldria recordar a totes aquelles investigadores i investigadors que m’heu precedit. A totes aquelles persones que amb el vostre treball i dedicació heu facilitat observacions, reflexions, certeses i respostes a qüestions que m’han fet créixer i reflexionar. Gràcies, moltes gràcies. Si no hi haguéssiu estat, jo no hauria arribat on he arribat. No puc tampoc menystenir aquells que donen sentit a la recerca, aquells que han hagut de marxar abans d’hora fruit de la incapacitat humana de respondre a les seves necessitats de supervivència. Magdeleine, Olatz, Roberto, Alex, Joan, Maria, Josep, Matilde i molts anònims als meus ulls que formeu part d’aquelles morts primerenques. No sé si aquest projecte aportarà molt, poc, o res a la ciència. En tot cas, lamento no haver-ho fet abans si això hagués suposat no perdre-us tan aviat. Gràcies, moltes gràcies per motivar-me a seguir endavant. UNIVERSITAT ROVIRA I VIRGILI EVIDÈNCIES EN TEIXIT ADIPÓS D'ALTERACIONS GÈNIQUES DELS VASOS LIMFÀTICS EN L'OBESITAT Alfons Horra Pueyo Les raons que ens fan viure són moltes i potser moltes són, a ulls d’alguns, irrellevants: un cafè amb llet en una cafeteria, un somriure entre amics, un llibre que dóna respostes a qüestions no resoltes, una abraçada, un petó, unes paraules... Un llibre, el cervell i el sentit de la vida del Paul Thagard, em va il·lustrar sobre que el sentit de la vida estava en l’amor, la feina i el joc. Reflexions que comparteixo. L’amor: l’amor a la vida, a les persones, a la ciència, a la feina, al plaer de l’art, de la música, de la pintura... Possiblement l’amor no defineix el seu sentit en l’objecte del nostre amor sinó en la voluntat de sentir amor. Agraeixo a la meva família per haver-me fet créixer en l’amor a la llibertat; llibertat de pensar, estimar i de viure. M’heu ensenyat el més important que es pot ensenyar a ningú, possiblement des de la inconsciència d’haver-ho fet. M’heu ensenyat que poc importa el que pensis; el més important és que ho facis des de l’honestedat i el respecte. La llibertat no s’ensenya sinó que s’exerceix, i ho heu fet molt bé. M’heu ensenyat l’amor en la seva vessant humana, m’heu ensenyat voluntat, perseverança, raó i dubte. M’heu ensenyat tantes coses ! Gràcies, moltes gràcies. La feina: la meva feina ha donat i dóna sentit a la meva vida en tant que em fa créixer. A nivell personal, pel diàleg amb els meus pacients i, professionalment, pel que aprenc de les seves dolences. Dels meus pacients, n’aprenc els matisos de la natura, del seu sentit de desordre i d’equilibri. Saviesa continguda que sempre és un gran gaudi descobrir. Gràcies, moltes gràcies. El joc: el joc és el sentit més bàsic del nostre creixement com a individus. El vivim en la infantesa des de la seva espontaneïtat i el vivim en tant que adults des de la seva racionalitat. L’esport, la música, el lleure amb els amics en formen part. Què faríem sense el joc? De ben segur que la vida perdria sentit. Gràcies, moltes gràcies. No voldria acabar aquestes pàgines sense agrair a l’atzar la meva existència.
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