Considerando a mucosite oral (MO) e a hipofunção das glândulas salivares (HGS) consequências debilitantes da quimioterapia (QT), este trabalho teve como objetivo induzir, em hamsters, MO e HGS, através do quimioterápico 5- Fluorouracil (5-FU), e comparar, através de análises clínicas, bioquímicas e histológicas, diferentes fototerapias no tratamento da MO, assim como o efeito do laser no tratamento da HGS. Cento e oitenta animais foram divididos em dois grupos, controle e experimental, onde, o grupo controle foi subdividido em grupo C, o qual recebeu somente anestesia/veículo de diluição do quimioterápico e o CQ, o qual recebeu anestesia/quimioterapia e indução da MO. O grupo experimental foi também subdividido em grupo L: com indução de MO e tratamento com LED, 630nm, 1,2J/cm2; LA: MO e tratamento com laser de alta potência (LAP), 808nm, 10J/cm2; LB: MO e tratamento com laser de baixa potência (LBP), 660nm, 6J/cm2 e o LG: sem MO e tratamento com LBP, 780nm, 5J/cm², na região das glândulas salivares (GS) submandibulares (GSSM) e sublinguais GSSL). A MO foi induzida através de ranhuras após QT e foi avaliada, clinicamente, através de escalas específicas. Os animais foram sacrificados após 5, 7 e 10 dias de experimento e a mucosa oral e as GS removidas para análises bioquímicas (TNF- e análise de proteína total, LDH e parâmetros do sistema antioxidante, respectivamente) e histológicas (análise por microscopia de luz e imuno-histoquímica para as amostras de mucosa, e por microscopia de luz, eletrônica de transmissão e imunocitoquímica para as amostras de GS). Após análises estatísticas, os resultados clínicos, bioquímicos e histológicos mostraram que os tratamentos com LBP e LED foram eficazes no tratamento da MO, com diminuição da concentração de TNF- no dia 7 (p<0.05) e completa cicatrização das lesões ao termino do experimento, com maior formação de tecido de granulação e angiogênese. Além disso, a expressão de citoqueratina 10, analisada por imunohistoquímica, apresentou-se menos intensa comparada ao grupo CQ. O LAP não prejudicou a cicatrização final da MO quando comparada ao grupo CQ. O LBP também se mostrou eficaz para a HGS causada pelo 5-FU, uma vez que os parâmetros estudados para o grupo LG foram similares para os animais do grupo C na maior parte dos tempos experimentais. A HGS do grupo CQ foi representada por importantes alterações morfológicas, estruturais e bioquímicas, como a atrofia das unidades secretoras terminais, aumento do estroma glandular na GS sublingual e alterações na expressão de EGF, NGF e PIP2 nas GSSM, assim como alteração na expressão de mucina e p16 nas GSSL. De acordo com as análises bioquímicas, foram observadas alterações na atividade das enzimas antioxidantes catalase, peroxidase e superóxido dismutase e da atividade da enzima lactato desidrogenase (p<0.05) tanto para a GSSM quanto para a GSSL. Com base nos resultados, podemos concluir que as fototerapias com LBP e LED diminuem a severidade da MO por acelerar a reparação tecidual e diminuir o processo inflamatório, assim como o LBP é eficaz no tratamento da HGS induzida pelo quimioterápico 5-FU. / Considering oral mucositis (OM) and salivary glands hipofunction (SGH) debilitating consequences of chemotherapy (CT), the aim of this study was to compare, through clinical, biochemical and histological analysis, different photherapies on the treatment of OM and SGH induced by injections of the chemotherapic agent 5-Fluorouracil in hamsters. One-hundred-eighty animals were divided into two groups, control and experimental, which were subdivided in group C: anesthesia/chemotherapy vehicle and CQ: anesthesia, chemotherapy/OM induction, for control group and in group L: anesthesia, chemotherapy/OM and phototherapy with LED (1,2 J/cm², 1.2 J of total energy), LA: anesthesia, chemotherapy/OM and phototherapy with highpower laser (HPL) (10 J/cm², 10 J of total energy), LB: anesthesia, chemotherapy/OM and phototherapy with low-power laser (LPL) (6 J/cm², 1.2 J of total energy) and LG: anesthesia, chemotherapy and phototherapy with LPL (5 J/cm2) on salivary gland (SG) (submandibular and sublingual) areas for experimental group. The OM was induced by slots on oral mucosa, which were performed after chemotherapy treatment. The OM was analyzed through specific clinical scales and after 5, 7 and 10 days, the animals were sacrificed and the oral mucosa and submandibular and sublingual glands removed for biochemical (TNF- and total protein concentration, LDH and antioxidant system parameters, respectively) and histological (light microscopy and immune-histochemical for OM samples, and light microscopy, electronic transmission and immunocitochemical for SG samples) analysis. After statistical analysis, the clinical, biochemical and histological results showed Led and LPL as efficient treatments for OM, with decrease of TNF- concentration on day 7 (p<0.05) and complete lesions healing on last day of experiment, showing increase of granulation tissue and new blood vessels formation. In agreement, the citokeratin 10 expression by immunehistochemistry, showed less intensity when was compared with CQ group. The HPL had no interference on OM final healing in comparison with CQ group. The LPL also showed good results on treatment of SGH induced by 5- FU. The SGH on CQ group included important morphological, structural and biochemical changes, as acinar atrophy, increase of glandular stroma on sublingual glands and important changes for EGF, NGF and PIP2 expression on submandibular glands, and for mucin and p16 gene expression on sublingual glands. Furthermore, the biochemical analysis showed changes on antioxidant enzime system activity, catalase, peroxidase and superoxide dismutase, and also for dehidrogenase lactate activity (p<0.05). The results of the present study suggest the phototherapies with LPL and LED where efficient on decrease of OM severity, accelerating tissue repair and decreasing the inflammatory process, as well as, the LPL efficient as treatment of SGH induced by 5-FU.

銀屑病是一種免疫相關的慢性炎症性皮膚病，其發病率約占世界人口的1-3%，而現今仍然缺乏有效安全的根治方法。國內外使用中草藥治療銀屑病取得較好的療效，但目前缺少對其進行系統研究和開發。我們研究小組之前對61種常用治療銀屑病中藥進行篩選, 發現中藥茜草根和南蛇藤的乙醇提取物具有強大的抑制表皮細胞增生的作用，本博士研究課題的目的是確定新的安全有效的用于治療銀屑病的中藥化學成分, 並闡明其作用機制。 / 本研究篩選了28種存在于這兩種中藥中的化學單體成分，采用體外培養永生化的人類皮膚良性角質形成細胞株HaCaT, 應用MTT法, 繪制細胞生長曲線，獲得抑制50%細胞生長所需藥物濃度(IC50)。實驗結果發現1-羟基-3-甲基蒽醌（HMA）， 1，4-二氨基-2，3-（2-苯氧基乙氧基）蒽醌 （DBA）和南蛇藤表現了強大的抗表細胞生長作用，其48小時培養後的IC50分別爲17.9，15.8，1.1 μM. 值得一提的是這些化合物對正常人表皮角質細胞HEK和人類成纖維細胞Hs68只有相對輕微細胞毒性。 / 隨後進行的機理研究，通過熒光染色，DNA凝膠電泳，細胞周期檢測，流式細胞計檢測及Western blot 分析結果表明， HMA和南蛇藤素是通過誘導細胞凋亡作用抑制HaCaT細胞生長。其中南蛇藤素通過線粒體凋亡和死亡受體介導的兩種通路誘導細胞凋亡， 其誘導細胞凋亡作用與其抑制核因子-κB在HaCaT細胞中的表達和活化有關。 / 另一方面，DBA 抑制人體表皮角質細胞生長的作用機理在于其對角質細胞終末分化的誘導作用。DBA與HaCaT和HEK細胞共同培養96小時後，能顯著促進細胞角質化外膜形成，同時上調角蛋白K1/10，人體套膜蛋白，轉谷氨酰胺酶-1表達和下調角蛋白K5/14表達。而利用小鼠尾部鱗片表皮模型對HMA的外用制劑進行測試，結果顯示HMA誘導角質細胞終末分化能力較弱。 / 總而言之，本研究課題從兩種中藥中成功發現三個具有較強的抗銀屑病活性的化學單體成分，這些來自中藥的天然産物具有很好的開發成新的銀屑病治療外用制劑的應用前景。 / Psoriasis is an immunologically-mediated chronic inflammatory disease of the skin and joints affecting approximately 1-3% of the world’s population. Traditionally, Chinese medicine has been extensively used both inside and outside China for treating psoriasis with promising clinical results. Based on the promising findings in our previous screening project on 61 psoriasis-treating Chinese medicines which showed the root of Rubia cordifolia L. (Rubiae Radix) to have potent anti-psoriatic action, the present study aimed to identify active anti-psoriatic chemical constituents derived from Rubiae Radix and another Chinese herb namely Celastrus orbiculatus Thunb. and to elucidate the underlying mechanisms of action. / Microplate MTT assay was performed to evaluate the anti-proliferative actions of 28 selected Rubiae Radix-derived anthraquinones and other chemical ingredients on cultured HaCaT keratinocytes. Among them, 1-hydroxy-3-methyl-anthraquinone (HMA) and 1,4-diamino-2,3-bis(2-phenoxyethoxy)anthraquinone (DBA), as well as celastrol, a Celastrus orbiculatus-derived triterpene, were found to possess significant anti-proliferative action on HaCaT cells, with IC₅₀ value of 17.9, 15.8 and 1.1 μM, respectively. All DBA, HMA and celastrol showed only mild to moderate toxic effects on normal human keratinocyte HEK cells and human fibroblast Hs68 cells. / Mechanistically, celastrol and HMA was found to induce apoptosis in a dose-dependent manner in HaCaT cells as characterized by DNA fragmentation, phosphatidyl-serine externalization and activation of caspase 3. Further studies by flow cytometric and western blot analyses demonstrated that the celastrol-induced apoptosis on HaCaT cells was associated with the inhibition of NF-κB pathway and through caspase-related apoptotic pathway as characterized by activation of caspase proteins, regulation of Bcl-2 family proteins and depolarization of mitochondrial potential. / On the other hand, DBA showed an ability to induce terminal differentiation in cultured human keratinocytes and this capability is believed to be responsible for its growth inhibitory effects. DBA significantly accentuated the cornified envelope formation in HEK and HaCaT keratinocytes together with the augmentation of K1/K10, involucrin and transglutaminase 1 protein levels and decrease of expression of K5/K14 protein in DBA-treated cells. However, the subsequent in vivo study using a mouse tail model showed that HMA did not have significant effects on modulating keratinocyte terminal differentiation. / Taken together, our present PhD project successfully identified DBA, HMA and celastrol to have potent anti-psoriatic action on in vitro models, and the experimental findings render these naturally-occurring chemicals to be promising candidates for further development into anti-psoriatic pharmaceutical agents. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Zhou, Linli. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 213-244). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract (English) --- p.i / Abstract (Chinese) --- p.iii / Publications --- p.v / Acknowledgements --- p.vii / Table of Contents --- p.viii / List of Figures --- p.xvii / List of Tables --- p.xxi / List of Abbreviations --- p.xxii / Chapter Chapter One --- General Introduction / Chapter 1.1 --- Psoriasis --- p.2 / Chapter 1.1.1 --- Structure of skin --- p.2 / Chapter 1.1.2 --- Epidemiology of psoriasis --- p.3 / Chapter 1.1.3 --- Pathogenesis --- p.5 / Chapter 1.1.4 --- Classification --- p.8 / Chapter 1.1.4.1 --- Nonpustular (plaque type) psoriasis --- p.9 / Chapter 1.1.4.2 --- Guttate psoriasis --- p.9 / Chapter 1.1.4.3 --- Pustular psoriasis --- p.9 / Chapter 1.1.4.4 --- Erythrodermic psoriasis --- p.10 / Chapter 1.1.4.5 --- Nail psoriasis --- p.11 / Chapter 1.1.4.6 --- Psoriatic arthritis --- p.11 / Chapter 1.1.5 --- Comorbidities --- p.13 / Chapter 1.2 --- Treatment of Psoriasis --- p.16 / Chapter 1.2.1 --- Conventional treatment for psoriasis --- p.16 / Chapter 1.2.1.1 --- Topical therapy --- p.16 / Chapter 1.2.1.2 --- Phototherapy --- p.19 / Chapter 1.2.1.3 --- Systemic therapy --- p.21 / Chapter 1.2.2 --- Targeted immunotherapy --- p.24 / Chapter 1.2.3 --- Combination, rotational and sequential therapy --- p.25 / Chapter 1.2.4 --- Complementary treatment --- p.26 / Chapter 1.3 --- Traditional Chinese Medicine for Psoriasis --- p.30 / Chapter 1.3.1 --- Prescriptions for psoriasis based on pattern differentiation --- p.30 / Chapter 1.3.2 --- Clinical and experimental study of TCM for psoriasis --- p.34 / Chapter 1.3.3 --- Possible action mechanisms of Chinese herbs for psoriasis --- p.34 / Chapter 1.3.4 --- Previous studies on TCM for psoriasis conducted by our research group --- p.35 / Chapter 1.4 --- Aims and Objectives of the Present Study --- p.38 / Chapter Chapter Two --- Phytochemical and Apoptotic Studies of Rubiae Radix-derived Anthraquinones and Other Related Compounds / Chapter 2.1 --- Introduction --- p.41 / Chapter 2.2 --- Selection and Screening of Rubiae Radix-derived anthraquinones and Other Related Compounds for Anti-proliferative Action on Cultured HaCaT Human Keratinocytes --- p.43 / Chapter 2.2.1 --- Introduction --- p.43 / Chapter 2.2.2 --- Materials and methods --- p.45 / Chapter 2.2.2.1 --- Procurement of Rubiae Radix-derived anthraquiones and other related compounds --- p.45 / Chapter 2.2.2.2 --- Purification of anthraquinones from Rubiae Radix --- p.50 / Chapter 2.2.2.3 --- General cell culture --- p.54 / Chapter 2.2.2.4 --- SRB assay --- p.55 / Chapter 2.2.2.5 --- MTT assay --- p.56 / Chapter 2.2.2.6 --- Assessment of synergistic or antagonistic effects between two active anthraquiones --- p.56 / Chapter 2.2.2.7 --- Statistical analysis --- p.57 / Chapter 2.2.3 --- Results --- p.57 / Chapter 2.2.3.1 --- Anti-proliferative effects of 35 Rubiae Radix fractions on HaCaT cells by SRB assay --- p.57 / Chapter 2.2.3.2 --- Anti-proliferative effects of the 27 anthraquinones and related compounds on HaCaT cells by SRB assay --- p.59 / Chapter 2.2.3.3 --- Confirmation of the anti-proliferative action of 8 active pure compounds using MTT assay --- p.61 / Chapter 2.2.3.4 --- Cytotoxic effects of 1-hydroxy-3-methyl-anthraquinone and1,4-diamino-2,3-bis(2-phenoxyethoxy)anthraquinone on the growth of HEK and Hs68 cells --- p.64 / Chapter 2.2.3.5 --- Drug interactions between different active anthraquinones --- p.67 / Chapter 2.2.4 --- Discussion --- p.69 / Chapter 2.3 --- Investigations of the Apoptotic Effects of DBA and HMA on HaCaT cells --- p.71 / Chapter 2.3.1 --- Introduction --- p.71 / Chapter 2.3.2 --- Materials and methods --- p.76 / Chapter 2.3.2.1 --- Chemicals --- p.76 / Chapter 2.3.2.2 --- General cell culture methods --- p.76 / Chapter 2.3.2.3 --- Cell cycle analysis with PI staining --- p.76 / Chapter 2.3.2.4 --- Hoechst fluorescence staining for morphological evaluation --- p.77 / Chapter 2.3.2.5 --- DNA fragmentation assay --- p.77 / Chapter 2.3.2.6 --- Detection of apoptosis by flow cytometry --- p.78 / Chapter 2.3.2.7 --- Prepare cytosol fraction of HaCaT cells --- p.79 / Chapter 2.3.2.8 --- Western blot analysis --- p.79 / Chapter 2.3.2.9 --- Statistical analysis --- p.80 / Chapter 2.3.3 --- Results --- p.76 / Chapter 2.3.3.1 --- Action of DBA and HMA on cell cycle progression --- p.80 / Chapter 2.3.3.2 --- Alteration of cellular morphology --- p.84 / Chapter 2.3.3.3 --- Detection of DNA fragmentation --- p.86 / Chapter 2.3.3.4 --- Quantitative analysis of apoptotic cells by annexin V-PI staining --- p.88 / Chapter 2.3.3.5 --- Activation of procaspase-3 and release of cytochrome c protein --- p.91 / Chapter 2.3.4 --- Discussion --- p.94 / Chapter 2.4 --- General Discussion --- p.97 / Chapter Chapter Three --- Effects of Rubiae Radix and Its-derived Anthraquinones on Keratinocyte Terminal Differentiation / Chapter 3.1 --- Introduction --- p.100 / Chapter 3.2 --- Materials and Methods --- p.105 / Chapter 3.2.1 --- Chemicals --- p.105 / Chapter 3.2.2 --- General cell culture --- p.105 / Chapter 3.2.3 --- Cornified envelope (CE) formation assay --- p.106 / Chapter 3.2.4 --- Western blot analysis --- p.107 / Chapter 3.2.4 --- Statistical analysis --- p.107 / Chapter 3.3 --- Results --- p.108 / Chapter 3.3.1 --- EA fraction of Rubiae Radix, DBA and HMA stimulates CE formation --- p.108 / Chapter 3.3.2 --- EA fraction of Rubiae Radix, DBA and HMA regulated TG1 expression and involucrin production in cultured human keratinocytes --- p.112 / Chapter 3.3.3 --- Regulation of cytokeratins by EA fraction of Rubiae Radix, DBA and HMA --- p.118 / Chapter 3.4 --- Discussion --- p.128 / Chapter Chapter Four --- Anti-psoriatic Action of Celastrol from Celastrus orbiculatus / Chapter 4.1 --- Introduction --- p.136 / Chapter 4.2 --- Anti-proliferative Action of Celastrol on Cultured Human Keratinocytes and Other Cell Types --- p.138 / Chapter 4.2.1 --- Introduction --- p.138 / Chapter 4.2.2 --- Materials and methods / Chapter 4.2.2.1 --- Chemicals --- p.138 / Chapter 4.2.2.2 --- General cell culture --- p.139 / Chapter 4.2.2.3 --- MTT assay --- p.139 / Chapter 4.2.2.4 --- Statistical analysis --- p.139 / Chapter 4.2.3 --- Results --- p.142 / Chapter 4.2.3.1 --- Anti-proliferative effect of celastrol on cultured cells --- p.142 / Chapter 4.2.4 --- Discussion --- p.145 / Chapter 4.3 --- Induction of Apoptosis by Celastrol on Human Keratinocytes --- p.146 / Chapter 4.3.1 --- Introduction --- p.146 / Chapter 4.3.2 --- Materials and methods --- p.146 / Chapter 4.3.2.1 --- Chemicals --- p.146 / Chapter 4.3.2.2 --- General cell culture --- p.147 / Chapter 4.3.2.3 --- Cell cycle analysis with PI staining --- p.147 / Chapter 4.3.2.4 --- Detection of apoptosis by flow cytometry --- p.147 / Chapter 4.3.2.5 --- Measurement of the mitochondrial membrane potential (ΔΨm) --- p.148 / Chapter 4.3.2.6 --- Western blot analysis --- p.148 / Chapter 4.3.2.7 --- Statistical analysis --- p.148 / Chapter 4.3.3 --- Results --- p.149 / Chapter 4.3.3.1 --- Induction of sub-G1 phase by celastrol on HaCaT cells --- p.149 / Chapter 4.3.3.2 --- Quantitative analysis of apoptotic cells by Annexin V-PI staining --- p.151 / Chapter 4.3.3.3 --- Alteration of ΔΨm --- p.153 / Chapter 4.3.3.4 --- Activation of caspase family protein --- p.155 / Chapter 4.3.3.5 --- Celastrol regulates the Bcl-2 family members --- p.159 / Chapter 4.3.4 --- Discussion --- p.161 / Chapter 4.4 --- Inhibition of NF-κB Transcription Factor Activation by Celastrol --- p.164 / Chapter 4.4.1 --- Introduction --- p.164 / Chapter 4.4.2 --- Materials and methods --- p.165 / Chapter 4.4.2.1 --- Chemicals --- p.165 / Chapter 4.4.2.2 --- General cell cultrue --- p.165 / Chapter 4.4.2.3 --- Western blot analysis --- p.165 / Chapter 4.4.2.4 --- Detect nuclear p65 by ELISA assay --- p.166 / Chapter 4.4.2.5 --- Statistical analysis --- p.166 / Chapter 4.4.3 --- Results --- p.167 / Chapter 4.4.3.1 --- Celastrol inhibited the NF-κB activation --- p.167 / Chapter 4.4.4 --- Discussion --- p.170 / Chapter 4.5 --- Induction of Terminal Differentiation by Celastrol --- p.173 / Chapter 4.5.1 --- Introduction --- p.173 / Chapter 4.5.2 --- Materials and methods --- p.174 / Chapter 4.5.2.1 --- Chemicals --- p.174 / Chapter 4.5.2.2 --- General cell culture --- p.174 / Chapter 4.5.2.3 --- CE formation assay --- p.174 / Chapter 4.5.2.4 --- Western blot analysis --- p.174 / Chapter 4.5.2.5 --- Statistical analysis --- p.174 / Chapter 4.5.3 --- Results --- p.175 / Chapter 4.5.3.1 --- Regulation of CE formation by celastrol --- p.175 / Chapter 4.5.3.2 --- Modulation of terminal differentiation markers by celastrol --- p.178 / Chapter 4.5.4 --- Discussion --- p.181 / Chapter 4.6 --- General Discussion --- p.183 / Chapter Chapter Five --- In vivo Anti-psoriatic Effects of Topical Preparation of 1-hydroxy-3-methyl-anthraquinone / Chapter 5.1 --- Introduction --- p.187 / Chapter 5.2 --- Material and Methods --- p.191 / Chapter 5.2.1 --- Chemicals --- p.191 / Chapter 5.2.2 --- Formulation of topical preparation containing HMA --- p.191 / Chapter 5.2.3 --- Mouse tail model --- p.192 / Chapter 5.2.4 --- Histopathological evaluation --- p.193 / Chapter 5.2.5 --- Statistical analysis --- p.194 / Chapter 5.3 --- Results --- p.195 / Chapter 5.3.1 --- Body weight profile --- p.195 / Chapter 5.3.2 --- Histological resutls --- p.197 / Chapter 5.4 --- Discussion --- p.201 / Chapter Chapter Six --- General Conclusions and Future Perspectives / Chapter 6.1 --- General Conclusions --- p.205 / Chapter 6.2 --- Future Perspectives --- p.210 / References / References by alphabetical order --- p.213

銀屑病是一種慢性炎症性皮膚病，其發病率約佔全球1-3%的人口。銀屑病的病理特徵包括角質細胞增殖和分化異常，同時伴隨炎症反應，白細胞聚集於真皮和表皮以及血管擴張。證據顯示角質細胞能參與及延續免疫反應，以達致維持或促進該病的作用。研究亦建議角質細胞減少凋亡是引致銀屑病的一個特定現象；因此，長期以來誘導角質細胞凋亡就被用作為治療銀屑病的一種有效策略。 / 根據銀屑病的嚴重程度，治療方法可分為三級：外用藥物主要用於比較輕微的病患，而光療適合中等程度的病患；對於嚴重病例則可使用系統性治療或生物製劑。基於大約75%的銀屑病患者屬於輕微至中度病患，外用藥物是目前應用最為廣泛的治療方法。在中國銀屑病治療的歷史中曾經使用過中草藥，研究亦表明，其治療機制可能通過抑制角質細胞增殖和誘導角質細胞凋亡。比較研究也指出，傳統中藥比西藥的副作用相對較少，及具有較長的舒緩期和較低的復發率。 / 我們先前的研究發現，茜草根提取物能夠抑制一個和銀屑病相關的HaCaT角質細胞增殖。本研究證實，茜草根的乙酸乙酯提取物（EA）能誘導HaCaT細胞凋亡，其抑制角質細胞增殖的作用比茜草根的乙醇提取物（EE）更為有效，並可和一個流行於歐洲國家的重要外用銀屑病治療藥地蒽酚相比。另外，透過不同的檢測，包括形態學觀察，細胞凋亡雙染（磷脂結合蛋白V-碘化丙啶）分析，細胞週期分析，去氧核醣核酸斷裂測試，原位末端轉移酶標記技術，免疫熒光染色以及西方墨點法，我們發現一種在茜草中的化合物，1,4-二羥基-2-萘甲酸（DHNA）能通過死亡受體介導，線粒體介導或不依賴胱天蛋白酶的途徑導致HaCaT細胞凋亡。同時，在其中一種銀屑病動物模型，小鼠鼠尾鱗片表皮上的初步研究顯示DHNA亦可誘導角質細胞分化。此外，在細胞水平（存活率，釋放白细胞介素-1α）和動物上（Draize動物皮膚刺激性試驗）的實驗結果表明DHNA比地蒽酚的刺激性較小。 / 總括而言，本研究透過人類皮膚細胞和動物實驗說明EA和DHNA的細胞凋亡機制，以及DHNA對皮膚的潛在刺激性。這些結果顯示EA和DHNA有潛能發展成為安全及能有效治療銀屑病的替代藥物。EA和DHNA可在一個連續療程中結合使用，其中EA藥效媲美地蒽酚，應能迅速清除銀屑病皮損；而DHNA比地蒽酚的刺激性小，則比較適合應用在這個連續療程中後來的維護保養階段 / Psoriasis is a chronic inflammatory skin disorder that affects approximately 1-3% of the population worldwide. It is characterized by epidermal hyperplasia or abnormal differentiation, infiltration of leucocytes into the dermis and epidermis, dilation of blood vessels in dermis and inflammation. Evidence indicates keratinocytes contributed to the disease, and keratinocytes also participate in maintaining the chronically perpetuating immune response that sustains psoriasis. Decrease in keratinocytes apoptosis is suggested to be a specific pathogenic phenomenon, and induction of keratinocytes apoptosis have long been considered as an effective anti-psoriatic strategy. / Treatment of psoriasis is based on disease severity. Topical agents are predominantly for mild conditions; phototherapy for moderate conditions and systemic treatment or biological agents for severe cases. Topical treatment remains the most widely used method as an estimated 75% of psoriatic patients have mild to moderate disease. Chinese herbs have been used for the treatment of psoriasis in China, and studies showed their mechanism on treating psoriasis may through inhibition of keratinocyte proliferation and induction of apoptosis. Comparison studies also show that traditional Chinese medicine has relatively fewer side effects than western therapeutic agents, with a longer remission time and lower recurrence rate. / The extract of the root of Rubia cordifolia L. (Rubiae Radix et Rhizoma) was previously found to inhibit keratinocyte proliferation using a psoriasis-relevant HaCaT cells model. In this study, the ethyl acetate extract of the root of Rubia cordifolia L. (EA) was confirmed to induce apoptosis on HaCaT cell, and the antiproliferative effect of EA is more potent than the ethanol extract of the herb (EE) and is comparable to dithranol, an important and popular topical treatment for psoriasis among Europe countries. Besides, we identified one of the components in Rubia cordifolia L., 1,4-dihydroxy-2-naphthoic acid (DHNA), could induce HaCaT keratinocyte apoptosis through the death receptor and mitochondria mediated pathway as well as in a caspase independent manner using various assays such as morphological examination, annexin V-PI staining, cell cycle analysis, DNA fragmentation, TUNEL assay, immunofluorescence staining and Western blot analysis. Moreover, DHNA was found to induce keratinocyte differentiation in a preliminary study using the in vivo mouse tail model of psoriasis. Furthermore, results from in vitro (cell viability, IL-1α release) and in vivo (Draize animal skin irritation test) experiments suggested DHNA have less irritation problems than dithranol. / In summary, this study describes the apoptotic mechanism of EA and DHNA, as well as the irritation potential of DHNA using different human skin cells and animal model. These results suggest EA and DHNA have the potential to develop as safe and effective therapeutic alternative for the treatment of psoriasis. EA and DHNA can be used together in a sequential therapy, in which EA is effective in rapid clearing of psoriatic lesions as its potency is comparable to dithranol; whereas DHNA is better suited for the later maintenance therapy for its milder irritation effect compared with dithranol. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Mok, Chong Fai. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 164-183). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract (English version) --- p.iv / Abstract (Chinese version) --- p.vi / List of Publication and Presentation --- p.viii / Acknowledgements --- p.ix / Table of Contents --- p.x / List of Tables --- p.xvi / List of Figures --- p.xvii / List of Abbreviations --- p.xx / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1.1. --- Psoriasis --- p.1 / Chapter 1.1.1. --- Histological features --- p.2 / Chapter 1.1.2. --- Role of keratinocytes in psoriasis --- p.4 / Chapter 1.1.3. --- Decrease in skin cell apoptosis --- p.8 / Chapter 1.2. --- Treatment of psoriasis --- p.9 / Chapter 1.2.1. --- Conventional treatment --- p.9 / Chapter 1.2.1.1. --- Mild disease --- p.10 / Chapter 1.2.1.1.1. --- Corticosteroids --- p.10 / Chapter 1.2.1.1.2. --- Vitamin D₃ analogs --- p.11 / Chapter 1.2.1.1.3. --- Tazarotene --- p.11 / Chapter 1.2.1.1.4. --- Anthralin --- p.12 / Chapter 1.2.1.1.5. --- Coal tar --- p.12 / Chapter 1.2.1.2. --- Moderate disease --- p.12 / Chapter 1.2.1.2.1. --- Phototherapy --- p.12 / Chapter 1.2.1.3. --- Severe disease --- p.13 / Chapter 1.2.1.3.1. --- Retinoids --- p.13 / Chapter 1.2.1.3.2. --- Methotrexate --- p.14 / Chapter 1.2.1.3.3. --- Cyclosporine --- p.14 / Chapter 1.2.1.3.4. --- Fumaric acid --- p.15 / Chapter 1.2.1.3.5. --- Biological agents --- p.15 / Chapter 1.2.2. --- Alternative treatment --- p.16 / Chapter 1.2.2.1. --- Traditional Chinese Medicine (TCM) --- p.17 / Chapter 1.3. --- Aims and objectives of the present study --- p.19 / Chapter Chapter 2: --- Apoptotic Action of Ethyl Acetate Fraction of the Root of Rubia cordifolia L. (Rubiae Radix et Rhizoma) on HaCaT Human Keratinocytes --- p.21 / Chapter 2.1. --- Introduction --- p.21 / Chapter 2.1.1. --- Rubia cordifolia L. --- p.21 / Chapter 2.1.2. --- Apoptosis --- p.22 / Chapter 2.1.3. --- Study objectives --- p.28 / Chapter 2.2. --- Materials and Methods --- p.30 / Chapter 2.2.1. --- Sources of medicinal materials --- p.30 / Chapter 2.2.2. --- Preparation of extracts --- p.30 / Chapter 2.2.3. --- Reagents --- p.31 / Chapter 2.2.4. --- Cell culture --- p.31 / Chapter 2.2.5. --- Proliferation assay --- p.32 / Chapter 2.2.6. --- Fluorescent staining for morphological evaluation --- p.33 / Chapter 2.2.7. --- Annexin V/propidium iodide staining --- p.33 / Chapter 2.2.8. --- JC-1 staining --- p.34 / Chapter 2.2.9. --- Statistical analysis --- p.35 / Chapter 2.3. --- Results --- p.36 / Chapter 2.3.1. --- EA inhibits proliferation of human epidermal HaCaT keratinocytes --- p.36 / Chapter 2.3.2. --- Alteration of cellular morphology --- p.39 / Chapter 2.3.3. --- EA increases phosphatidylserine externalization in HaCaT cells --- p.41 / Chapter 2.3.4. --- EA decreases MMP --- p.45 / Chapter 2.4. --- Discussion --- p.47 / Chapter Chapter 3: --- Identification of Pure Compound for Possible Apoptotic Action on HaCaT Human Keratinocytes and Detailed Mechanistic Study --- p.51 / Chapter 3.1. --- Introduction --- p.51 / Chapter 3.1.1. --- Anthraquinone --- p.51 / Chapter 3.1.2. --- Study objectives --- p.52 / Chapter 3.2. --- Materials and Methods --- p.54 / Chapter 3.2.1. --- Reagents --- p.54 / Chapter 3.2.2. --- Cell culture --- p.54 / Chapter 3.2.3. --- Proliferation assay --- p.55 / Chapter 3.2.4. --- Fluorescent staining for morphological evaluation --- p.56 / Chapter 3.2.5. --- Annexin V/propidium iodide staining --- p.56 / Chapter 3.2.6. --- JC-1 staining --- p.56 / Chapter 3.2.7. --- Cell cycle analysis --- p.56 / Chapter 3.2.8. --- Detection of DNA fragmentation --- p.57 / Chapter 3.2.9. --- Terminal Deoxynucleotidyltransferase-Mediated dUTP Nick End Labeling (TUNEL) assay --- p.57 / Chapter 3.2.10. --- Western blot analysis --- p.58 / Chapter 3.2.11. --- Immunofluorescence staining --- p.59 / Chapter 3.2.12. --- Statistical analysis --- p.60 / Chapter 3.3. --- Results --- p.61 / Chapter 3.3.1. --- DHNA inhibits proliferation of human epidermal HaCaT Keratinocytes --- p.61 / Chapter 3.3.2. --- Alteration of cellular morphology --- p.70 / Chapter 3.3.3. --- DHNA increases phosphatidylserine externalization in HaCaT cells --- p.72 / Chapter 3.3.4. --- DHNA decreases MMP --- p.76 / Chapter 3.3.5. --- DHNA causes G0/G1 cell cycle arrest in HaCaT cells --- p.78 / Chapter 3.3.6. --- DHNA increases DNA fragmentation --- p.81 / Chapter 3.3.7. --- DHNA increases TUNEL positive cells in HaCaT cells --- p.83 / Chapter 3.3.8. --- Western blot analysis --- p.85 / Chapter 3.3.9. --- DHNA induced Fas aggregation in HaCaT cells --- p.88 / Chapter 3.3.10. --- Caspase inhibition assay --- p.90 / Chapter 3.3.11. --- DHNA induced caspase independent apoptosis in HaCaT cells --- p.93 / Chapter 3.3.12. --- Effects of DHNA on MAPK in HaCaT cells --- p.96 / Chapter 3.3.13. --- MAPK inhibition assay --- p.100 / Chapter 3.4. --- Discussion --- p.104 / Chapter Chapter 4: --- Anti-Psoriatic Effects of Topical 1,4-Dihydroxy-2-naphthoic acid Formulation on in vivo Mouse Tail Experiments --- p.111 / Chapter 4.1. --- Introduction --- p.111 / Chapter 4.1.1. --- Keratinocytes differentiation process --- p.111 / Chapter 4.1.2. --- Animal model for psoriasis --- p.114 / Chapter 4.1.3. --- Study objectives --- p.119 / Chapter 4.2. --- Materials and Methods --- p.122 / Chapter 4.2.1. --- Reagents --- p.122 / Chapter 4.2.2. --- Formulation and preparation of topical drug --- p.122 / Chapter 4.2.3. --- Mice for in vivo experiments --- p.123 / Chapter 4.2.4. --- Treatment with topical preparations --- p.124 / Chapter 4.2.5. --- Statistical analysis --- p.125 / Chapter 4.3. --- Results --- p.126 / Chapter 4.3.1. --- Tail skin appearance after topical treatment --- p.126 / Chapter 4.3.2. --- Histological examination and findings --- p.128 / Chapter 4.4. --- Discussion --- p.132 / Chapter Chapter 5: --- Prediction of Skin Irritation Potential of 1,4-Dihydroxy-2-naphthoic acid by in vitro and in vivo Experiments --- p.135 / Chapter 5.1. --- Introduction --- p.135 / Chapter 5.1.1. --- Skin irritation --- p.135 / Chapter 5.1.2. --- Viability test and IL-1α release --- p.136 / Chapter 5.1.3. --- Animal irritation test --- p.139 / Chapter 5.1.4. --- Study objectives --- p.139 / Chapter 5.2. --- Materials and Methods --- p.141 / Chapter 5.2.1. --- Reagents --- p.141 / Chapter 5.2.2. --- Cell culture --- p.141 / Chapter 5.2.3. --- Viability test --- p.141 / Chapter 5.2.4. --- IL-1α release assay --- p.142 / Chapter 5.2.5. --- Animal irritation test --- p.142 / Chapter 5.2.6. --- Statistical analysis --- p.143 / Chapter 5.3. --- Results --- p.144 / Chapter 5.3.1. --- Viability test --- p.144 / Chapter 5.3.2. --- IL-1α release assay --- p.144 / Chapter 5.3.3. --- Animal irritation test --- p.147 / Chapter 5.4. --- Discussion --- p.152 / Chapter Chapter 6: --- General Discussion and Conclusions --- p.155 / References --- p.164

Breastfeeding provides the optimum feed for the growth of a child. However, there are complications that hinder the success of the practice of breastfeeding, like nipple trauma. It is characterized by the presence of cracks, fissures and abrasions, as well as intense pain. The therapeutic approach includes orientation, dry treatment and wet treatment. However, none of these interventions provides satisfactory results. A new and promising alternative is low intensity phototherapy with LEDs. The aim of this work was to verify the efficacy of a prototype for phototherapy consisting of LEDs in the near infrared spectral range for thetreatment of nipple trauma. This is a randomized clinical trial and double-blind study. Ten participants with 19 nipple lesions (cracks, fissures and abrasions) were divided into two groups: experimental and control. The experimental group was submitted to standardtreatment (orientations on correct breastfeeding technique and nipple care) and prototype for phototherapy applications, while the control group received standard treatment and placebo prototype applications. Participants were subjected to phototherapy twice a week for eightsessions, and the prototype parameters were: wavelength of 860 nm, pulsed mode, frequency of 100 Hz, fluency rate of 50 mW/cm2 and fluency of 4 J/cm2 for 79 seconds. The nipple lesion area was measured by an image analysis software, and the pain intensity was measuredby the Numeric Visual Scale. The analysis showed a statistically significant reduction in the area of the nipple lesions of both experimental and control groups (p=0,00) and, also, a significant difference between them (p=0,00). In the first sessions of the intervention, therewas an acceleration of the healing process of the nipple lesions in the experimental group when compared to the control group. Pain intensity decreased in both groups with the increase in the number of sessions, but was statistically significant only for the experimental group(p=0,00). Moreover, a significant difference between groups (p=0,03) was observed for pain reduction. The results of this study showed that the prototype for phototherapy with LEDs in the near infrared spectral range was an effective tool in treatment of nipple trauma. / A amamentação fornece o alimento ideal para o crescimento de uma criança. Entretanto, há intercorrências que dificultam o sucesso da prática de amamentação, entre elas os traumas mamilares. Caracterizam-se pela presença de rachaduras, fissuras e escoriações mamilares, além de intensa dor. A abordagem terapêutica dos traumas mamilares compreende medidas educativas, tratamento seco e tratamento úmido. Contudo, nenhuma dessas intervençõesapresenta resultados satisfatórios. Uma nova e promissora alternativa é a fototerapia de baixa intensidade com LEDs. Este trabalho foi realizado com o objetivo de verificar a eficácia de um protótipo de fotobiomodulação constituído de LEDs na faixa espectral do infravermelho próximo no tratamento dos traumas mamilares. Trata-se de um estudo do tipo ensaio clínico randomizado e duplo-cego. Dez participantes com 19 lesões mamilares (rachaduras, fissuras eescoriações) foram divididas em dois grupos: experimental e controle. O experimental foi submetido a tratamento padrão (orientações sobre técnica adequada de amamentação e cuidados com os mamilos) e aplicações do protótipo de fotobiomodulação, enquanto o controle recebeu tratamento padrão e aplicações do protótipo placebo. As participantes foram tratadas duas vezes por semana, durante 8 sessões, com os seguintes parâmetros: comprimento de onda de 860 nm, modo de emissão pulsado, frequência de 100 Hz, taxa defluência de 50 mW/cm2 e fluência de 4 J/cm2 durante 79 segundos. Foram avaliadas a área da lesão mamilar, mensurada por um software de análise de imagem, e a intensidade da dor, mensurada pela Escala Visual Numérica. As análises demonstraram redução estatisticamentesignificativa da área das lesões mamilares nos grupos experimental e controle (p=0,00), mas houve diferença significativa entre eles (p=0,00). Nas primeiras sessões de tratamento, ocorreu uma aceleração do processo de cicatrização nas lesões mamilares do grupo experimental em relação ao controle. A intensidade da dor diminuiu nos dois grupos com o aumento das sessões, entretanto foi estatisticamente significativa apenas no grupo experimental (p=0,00). Além disso, houve diferença significativa entre os grupos (p=0,03) na redução da dor. Os resultados deste estudo mostraram que o protótipo de fotobiomodulação constituído com LEDs na faixa espectral do infravermelho próximo foi um recurso eficaz no tratamento dos traumas mamilares

The thesis is divided into theoretical and practical part. The theoretical part contains information about anatomy of the trapezius muscle and its myofascial pathology. Author further discusses trigger points, their histopathology and diagnostic and therapeutic capabilities. A significant section of the theoretical part explains the physical principle of ultrasound therapy and laser phototherapy, including clinical aspects and their use in the treatment of trigger points. The practical part is focused on comparing the efficacy and relative effectiveness of two methods of physical therapy - ultrasound therapy and laser phototherapy, where myofascial trigger points treatment effect can be expected. Research group is made up of 47 patients divided into two groups. These patients have a doctor confirmed trigger point in the upper portion of trapezius muscle. The first group of patients is treated by exactly parametrically defined ultrasound therapy. The second group of patients is treated by specifically defined laser phototherapy. The aim of this thesis is to compare the above mentioned physical procedures in terms of subjective and objective efficacy in the treatment of trigger points and also to compare their relative effectiveness.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A pele do bebà quando internado em uma Unidade de Terapia Intensiva Neonatal (UTIN), apresenta predisposiÃÃo a ser lesionada, diante da necessidade de muitos procedimentos especÃficos, acabando por expÃ-lo a manipulaÃÃes necessÃrias, mas um tanto desgastantes para o mesmo. Objetivou-se avaliar as lesÃes de pele que acometem recÃm-nascidos internados em uma UTIN. Estudo prospectivo, quantitativo, exploratÃrio descritivo, realizado no perÃodo de marÃo a maio/2007, numa instituiÃÃo pÃblica em Fortaleza-CE. ConstituÃram o universo e a amostra 137 recÃm-nascidos, que estiveram internados nas UTIN, os quais todos foram autorizados à participaÃÃo nesta pesquisa pelos pais. Destes, 36 apresentaram lesÃes de pele. Na coleta de dados, utilizou-se um instrumento que permitiu o registro das lesÃes atravÃs da observaÃÃo direta dos recÃm-nascidos durante a higiene corporal, trocas: de fralda, de sonda, de venda ocular; retiradas: de membrana semipermeÃvel, bandagem adesiva elÃstica e/ou micropore, eletrodos, hidrocolÃide que estavam fixados diretamente na pele destes, durante as punÃÃes, dentre outros procedimentos. Investigou-se 137 recÃm-nascidos, a maioria prematuro (80%), sexo masculino (63%), nascido de parto abdominal (61%), apgar de 7 a 10 no 1 minuto (40%), diagnosticados com prematuridade moderada (49%), baixo peso ao nascer (39%), adequado para a idade gestacional (74%), medindo entre 41 e 47cm (44%). Destes, 36 recÃm-nascidos (26%) apresentaram lesÃes de pele, totalizando 51 lesÃes. Foram identificadas: hematomas (46%), eritemas (18%), escoriaÃÃes (12%), equimoses (10%), pÃstulas (6%), descamaÃÃes (4%), mielomeningocele (2%) e gastrosquise (2%). Quando ocorreram as lesÃes, os recÃm-nascidos estavam em uso de hidrataÃÃo venosa (84%), antibiÃtico (78%), ventilaÃÃo mecÃnica (53%), fototerapia (33%), nutriÃÃo parenteral (27%), hemotransfusÃo (8%), oxihood (8%), cpap nasal (6%) e O2 circulante (4%); acomodados em incubadora aquecida (86%), incubadora de transporte (10%) e em berÃo de calor radiante (4%). Predominaram lesÃes nos membros (52%), no tronco (24%), na cabeÃa (16%) e em outros (8%). As associaÃÃes realizadas foram: punÃÃo arterial (32%), extravasamento (14%), assadura (14%), punÃÃo venosa (8%), impetigo (4%), indeterminada (4%), mà formaÃÃo congÃnita (4%), retirada da membrana transparente (4%), retirada da bandagem adesiva (4%), ressecamento da pele (4%), infecÃÃo (2%), retirada da fita hipoalergÃnica (2%) e tocotraumatismo (2%). Quanto a Ãrea da lesÃo (40%) eram < 1cm2, no tamanho 68% eram lesÃes entre 1 e 2cm. A maioria tinha a forma geogrÃfica (38%) e distribuiÃÃo localizada (92%). Os recÃm-nascidos que desenvolveram lesÃes tinham diagnÃsticos de âprematuridadeâ (92%), âsÃndrome do desconforto respiratÃrioâ (43%), âasfixiaâ (24%), ârecÃm-nascido a termoâ (8%); ârisco de infecÃÃoâ (6%), ârisco de hipoglicemiaâ (6%), âgastrosquiseâ (2%) e âmielomeningoceleâ (2%). A maioria nasceu com peso entre 550 - 999g, (47%), sendo o peso destes no dia em que ocorreu a lesÃo entre 455 - 999g, (47%). A maioria eram neonatos (84%) e as lesÃes (47%) surgidas antes do 7 dia de vida. Ao associar: tipos de lesÃes, diagnÃsticos, PN e IG dos RNâs, somente o diagnÃstico âprematuridadeâ apresentou associaÃÃo estatÃstica significante: âp de Fisher-Freeman-Halton = 0,496â. Consagra-se na trajetÃria deste estudo o cuidado de enfermagem ao RN que, indiscutivelmente, deve ser holÃstico e diferenciado, considerando suas peculiaridades. / Infants in the Neonatal Intensive Care Unit (NICU) often get skin lesions on account of the many stressful procedures they are exposed to. This prospective, quantitative and descriptive study was carried out at a public health facility in Fortaleza (Northeastern Brazil) from March to May 2007, in order to investigate skin lesion patterns in infants in the NICU setting. The study population consisted of 137 hospitalized infants. Informed written consent was obtained from the infantsâ caretakers. The data collection instrument registered skin lesions through direct observation during bathing, change of diapers, catheters and eye patches and during removal of semi-permeable membranes, elastic adhesive bandages and/or micropores, electrodes and hydrocolloid dressings applied to the skin during punction, among other procedures. Eighty percent of the infants were premature, 63% were male, 61% were caesarean births, 40% presented first-minute apgar scores of 7-10, 49% were diagnosed with moderate prematurity, 74% were full-term, 39% had low birth weight and 44% measured 41â47cm. Thirty-six infants had skin lesions (total 51 lesions) in the form of bruises (46%), erythema (18%), excoriation (12%), ecchymosis (10), pustulas (6%), scaling (4%), myelomeningocele (2%) or gastroschisis (2%). The lesions were inflicted while the infants were being treated with intravenous hydration (84%), antibiotics (78%), mechanical ventilation (53%), phototherapy (33%), parenteral nutrition (27%), blood transfusion (8%), oxygen hood (8%), nasal cpap (6%) or circulating oxygen (4%), or were in a heated incubator (86%), transport incubator (10%) or heated crib (4%). Lesions were observed most often on limbs (52%), torso (24%), head (16%) and other sites (8%). The causes identified were arterial puncture (32%), leaking (14%), contact dermatitis (14%), vein puncture (8%), impetigo (4%), undetermined (4%), congenital malformation (4%), removal of the caul (4%), removal of adhesive bandage (4%), skin dryness (4%), infection (2%), removal of hypoallergenic tape (2%) and birth traumatism (2%). Forty percent of lesions measured < 1cm2 and 68% measured 1-2cm. Most were well defined (38%) and/or localized (92%). Infants with lesions presented prematurity (92%), syndrome of respiratory distress (43%), asphyxia (24%), full-term delivery (8%); risk of infection (6%), risk of hypoglycemia (6%), gastroschisis (2%) or myelomeningocele (2%). Most (47%) weighed 550-999g at birth, with lesions occurring at 455-999g in 47%. Most were newborn (84%) and lesions appeared before the seventh day of life in 47% of cases. Among the parameters lesion type, diagnosis, PN, IG and prematurity, only the latter presented a statistically significant association (p=0.496, by the Fisher-Freeman-Halton test). The study shows the importance of providing the newborn with good-quality holistic nursing care with a view to the special needs of this patient population.

Este estudo teve por finalidade estudar os efeitos da fototerapia com laser em baixa intensidade (Low Level Laser Therapy LLLT) sobre a inflamação e reparação após lesão criogênica realizada no sitema nervoso central (SNC) de ratos. Foram realizados 3 experimentos. Em todos os experimentos foi utilizado um modelo de deformação cortical direta induzida por lesão criogênica. A LLLT foi realizada com laser de diodo em baixa intensidade emitindo no vermelho visível (InGaAlP, 660 nm) ou no infravermelho (AlGaAr, 780 nm). Os parâmetros de irradiação foram: potência de 40 mW, área do feixe de 0,04 cm2, densidades de energia de 3 J/cm2 (3 s) ou 5 J/cm2 (5 s) determinando energias por ponto de 0,12 J e 0,20 J, respectivamente. Foram realizadas 2 irradiações com intervalo de 3 h, no modo contato e em 2 pontos por lesão. No experimento 1, 50 ratos da linhagem Wistar foram utilizados para determinar os parâmetros de LLLT capazes de influenciar na dinâmica da produção de citocinas proinflamatórias (TNF-a, IL-1b, IL-6) e antiinflamatória (IL-10). As citocinas foram mensuradas pelo teste ELISA no cérebro e no sangue dos animais, 6 e 24h após a lesão. Os grupos experimentais foram: controle (não irradiado) e 4 grupos irradiados com 3 J/cm2 ou 5 J/cm2 para cada comprimento de onda (n=10 por grupo). Para os experimentos 2 e 3 foram utilizados 40 ratos (20 não irradiados controles e 20 irradiados). A LLLT foi realizada somente com o parâmetro de irradiação do laser no infravermelho e a densidade de energia de 3 J/cm2. Nestes experimentos o processo de reparação das lesões criogênicas no SNC foi acompanhado em 6 h, 1, 7 e 14 dias após a última irradiação (n=5 por grupo por tempo experimental). No experimento 2 foi realizada a análise morfométrica da região lesionada do SNC. No experimento 3 foi analisada a distribuição das células inflamatórias (linfócitos T, leucócitos e macrófagos). Os dados de cada experimento foram comparados estatísticamente por análise de variância (ANOVA) ou Kruskal-Wallis seguido dos testes de Tukey ou de Dunn, respectivamente (F=5%). O trauma criogênico foi capaz de criar lesões focais no córtex representadas por necrose, edema, hemorragia e infiltrado inflamatório. Os achados mais marcantes foram: no experimento 1 com a irradiação do laser no infravermelho e 3 J/ cm2, o TNF- a e a IL-6 se mantiveram nos mesmos níveis em 6 e 24 h, enquanto no controle houve aumento significativo. Experimento 2: as lesões não tratadas apresentaram maior perda tecidual em 6 h que as irradiadas. Experimento 3: as lesões irradiadas apresentaram menor quantidade de leucócitos e linfócitos T nas primeiras 24 h do que nas lesões controle. A quantidade de macrófagos foi similar nos dois grupos. Conclusões: Levando em consideração as condições experimentais deste estudo concluiu-se que LLLT exerce efeitos nos processos de inflamação e reparação diminuindo a concentração de citocinas próinflamatórias (TNF-F e IL-6) no sangue e mantendo a de IL-1I no cérebro. Adicionalmente, diminui a perda tecidual inicial pós- lesão criogênica e a infiltração inicial de leucócitos e linfócitos T. / This study aimed to study the effects of phototherapy with low-intensity laser (Low Level Laser Therapy - LLLT) on inflammation and repair after cryogenic injury held in central nervous system (CNS) of rats. There were 3 experiments. In all experiments a model of deformation induced by direct cortical cryogenic injury was used. The LLLT was carried out with a low intensity diode laser emitting in the visible red (InGaAlP, 660 nm) or infrared (AlGaAs, 780 nm). The irradiation parameters were: power of 40 mW, beam area of 0.04 cm2, energy densities of 3 J/cm2 (3 s) or 5 J/cm2 (5 s) providing energy per point of 0.12 J and 0.20 J, respectively. Two irradiations were performed at 3 h-intervals, in contact mode and in 2 points for lesion. In experiment 1, 50 Wistar rats were used to determine the parameters of LLLT able to influence the dynamics of production proinflammatory cytokines (TNF-, IL-1 and IL-6) and antiinflammatory cytokine (IL- 10). Cytokines were measured by ELISA in the brain and blood of animals, 6 and 24 hours after injury. The experimental groups were: control (non-irradiated) and 4 irradiated groups [3 J/cm2 and 5 J/cm2 for each wavelength (n = 10 per group)]. For experiments 2 and 3 40 rats (20 non-irradiated - controls and 20 irradiated).were used. The LLLT was performed only with the parameter of laser irradiation on the infrared and the energy density of 3 J/cm2. In these experiments, the process of repair of cryogenic injury in the CNS was followed in 6 h, 1, 7 and 14 days after the last irradiation (n = 5 per group and time trial). In experiment 2 a morphometric analysis of the injured area of the CNS was done. In experiment 3 the distribution of inflammatory cells (lymphocytes, leukocytes and macrophages) was analyzed. Data from each experiment were compared statistically by analysis of variance (ANOVA) or Kruskal-Wallis followed by tests of Tukey or Dunn, respectively ( = 5%). Cryogenic trauma was able to create focal lesions in the cortex represented by necrosis, edema, hemorrhage and inflammatory infiltrate. The most striking findings were: in experiment 1 with the laser irradiation in the infrared and 3 J/cm 2, TNF- and IL-6 remained at the same levels at 6 and 24 h, while in the control there was a significant increase. Experiment 2: untreated lesions showed greater tissue loss than irradiated lesions in 6 h. Experiment 3: lesions irradiated had fewer leukocytes and lymphocytes in the first 24 h than control lesions. The amount of macrophages was similar in both groups. Conclusions: Considering the experimental conditions of this study it was concluded that LLLT has effects in the processes of inflammation and repair by decreasing the concentration of proinflammatory cytokines (TNF- and IL-6) in blood and holding the IL-1 in the brain. Additionally, decreases the initial tissue loss after cryogenic injury and the initial infiltration of leukocytes and lymphocytes T.

INTRODUÇÃO: O conhecimento de valores de normalidade do fluxo sanguíneo da artéria mesentérica superior (AMS) em recém-nascidos prematuros (RNPT) saudáveis pode prevenir quadros de intolerância alimentar e a ocorrência da enterocolite necrosante. MÉTODOS: Com o objetivo de descrever a evolução dos índices de avaliação da dopplerfluxometria da AMS em RNPT saudáveis de idade gestacional entre 27 e 34 semanas completas, no primeiro, no terceiro, no sétimo e semanalmente (14, 21, 28, 35 e 42 dias de vida), foi realizado este estudo coorte prospectivo em RNPT de idade gestacional ao nascimento entre 27 e 34 semanas completas. O exame dopplerfluxométrico foi realizado, após o consentimento livre e esclarecido dos responsáveis pelos RNPT, através do aparelho Logic Book 8C-RS (General Eletric EUA); obtendo-se as seguintes medidas: pico de velocidade sistólica (PVS), pico de velocidade diastólica final (PVDF) e média de velocidade de fluxo; sendo, após, calculadas o Índice de Pourcelot, sendo: [pico de velocidade sistólico pico diastólico final] / pico de velocidade sistólico, que representa um índice de resistência (IR); e índice de pulsatilidade (IP). Foram excluídos: recém-nascidos com instabilidade hemodinâmica; em ventilação assistida com altos parâmetros; síndromes mal-formativas; intolerância alimentar ou enterocolite necrosante; fototerapia; presença de cateteres umbilicais, persistência de canal arterial e pequenos para a idade gestacional. O exame pré-prandial foi realizado antes da alimentação (até 30 minutos) e pós-prandial entre 15 e 60 minutos após a alimentação. Foram realizados no primeiro dia (entre 6 a 24 horas de vida), no terceiro, no sétimo, e após, semanalmente até 42 dias de vida. Os resultados foram expressos em médias e desvios-padrão e descritos de maneira evolutiva. RESULTADOS: Ao total, foram estudados 77 RNPT e realizados 125 exames. Os valores em média±desvio-padrão são descritos na seqüência do primeiro, terceiro, sétimo e, consecutivamente a cada semana, até 42 dias de vida; sendo: IR pré-prandial de 0,69±0,09; 0,67±0,15; 0,75±0,07; 0,74±0,07; 0,75±0,07; 0,76±0,07; 0,79±0,03; 0,78±0,05 e IR pós-prandial de 0,66±0,10; 0,70±0,21; 0,74±0,07; 0,73±0,08; 0,75±0,06; 0,76±0,06; 0,77±0,04; 0,77±0,03. Os resultados de IP pré-prandial foram: 1,45±0,30; 1,35±0,28; 1,68±0,29; 1,50±0,23; 1,47±0,22; 1,52±0,20; 1,62±0,09; 1,68±0,06 e IP pós-prandial: 1,38±0,39; 1,40±0,29; 1,58±0,26; 1,46±0,26; 1,45±0,24; 1,50±0,27; 1,58±0,10; 1,64±0,04. Obtivemos PVS pré-prandial: 60,51±22,24; 55,24±26,04; 90,61±12,74; 95,33±18,11; 92,89±15,40; 96,96±12,18; 63,18±14,08; 58,12±9,78 e pós-prandial: 59,60±24,14; 110,82±32,45; 118,10±20,15; 121,95±24,18; 124,15±25,16; 126,07±18,17; 96,68±11,12; 96,12±8,98. Quanto a PVDF pré-prandial, obtivemos: 18,85±6,09; 18,66±10,01; 20,99±8,12; 22,02±8,50; 23,04±7,89; 22,24±8,02; 11,99±6,15; 12,05±5,12 e PVDF pós-prandial: 20,63±6,89; 30,15±12,78; 27,98±9,72; 29,02±10,05; 34,56±9,00; 32,02±8,45; 19,02±4,95; 21,15±3,43. A partir dos resultados acima, demonstra-se que o fluxo sanguíneo da AMS em RNPT saudáveis apresenta uma evolução peculiar a partir do nascimento tanto dos valores basais quanto após a estimulação com a dieta, representados por uma evolução característica dos índices de resistência, melhora dos picos de velocidades sistólica e diastólica e melhora da resposta vasodilatadora após a alimentação enteral. CONCLUSÕES: RNPT saudáveis de idade gestacional ao nascimento de 27 a 34 semanas completas apresentam uma evolução do fluxo sanguíneo da artéria mesentérica superior de maneira peculiar, do nascimento até 42 dias de vida, tanto dos valores basais quanto em resposta à alimentação. O conhecimento destes valores pode indicar a dopplerfluxometria como um método preventivo de avaliação específico de cada RNPT para a introdução e progressão mais segura da alimentação, reduzindo a ocorrência de quadros gastrintestinais, melhorando os índices de morbi-mortalidade neonatal. / INTRODUCTION: The knowledge of the normal values of indices of Doppler velocimetry of the superior mesenteric artery in healthy premature neonates may help to prevent feeding intolerance situations and necrotizing enterocolitis. METHODS: In order to describe the indices for evaluation of Doppler velocimetry of the superior mesenteric artery in healthy premature neonates with gestational age between 27 and 34 weeks, on the first, third, seventh days, and then weekly, until six weeks of life; this is a prospective cohort study. The Doppler velocimetric examination was done by means of the Logic Book 8C-RS (General Electric USA), using a 8 MHz imaging transducer, with the pulsed color Doppler readings being obtained by sonographic waves at 4 MHz. The neonate was kept in a supine position, with the transducer positioned in the epigastric region, immediately below the xyphoid appendix, obtaining two-dimensional images of the celiac trunk and of the superior mesenteric artery, a few millimeters after its emergence from the aorta in the sagittal plane. The flux measurements were obtained in the longitudinal direction of the vessel and at an angle of insonation between 0 and 20 degrees. The blood flow curves were recorded after a sequence of five stable measurements, with respect to the quality of the waves, and with respect to their audible characteristics; thus obtaining the following measurements: peak systolic velocity (PSV), end diastolic velocity (EDV) and average flow velocity; with the Pourcelot Index being calculated subsequently, that is: [peak of systolic velocity end diastolic velocity / peak of systolic velocity, which represents a resitance index (RI); and pulsatility index (PI). The values obtained were expressed as averages and standard deviations. The results were stored in an Excel database, with blind analysis after the conclusion of data gathering. Uncomplicated and appropriate for gestational age premature neonates with gestational age between 27 and 34 weeks at birth were included in the study. We adopted as criteria for exclusion from the study: neonates in unstable hemodynamic conditions; needing assisted ventilation with high parameters; large deformations or clinical syndromes; feeding intolerance or diagnosis of necrotizing enterocolitis; conditions that alter the mesenteric flow, such as: phototherapy, presence of umbilical catheters, patent ductus arteriosus and sepsis. The exams were done prior to feeding (up to 30 minutes) and after feeding (between 15 and 60 minutes). If the neonate was fasting, only one of the above parameters was measured, in order to establish behavior of the basal mesenteric flow at that moment. The exams were done on the first day (between the 6th and 24th hours of life), third, seventh days, and then weekly, until six weeks of life. Data are shown as the mean ± standard deviation and described for each postnatal age group. RESULTS: A total of 77 neonates were studied and realized 125 exams. The values of the resistance and pulsatility indices (RI and PI); peaks of systolic (PSV) and final diastolic velocity (EDV) on the first, third, seventh days, and then, on sequentially for each week until six weeks of postnatal life; as mean and standard deviations, was described: RI prior to feeding were 0,69±0,09; 0,67±0,15; 0,75±0,07; 0,74±0,07; 0,75±0,07; 0,76±0,07; 0,79±0,03; 0,78±0,05 and RI after feeding were 0,66±0,10; 0,70±0,21; 0,74±0,07; 0,73±0,08; 0,75±0,06; 0,76±0,06; 0,77±0,04; 0,77±0,03. The results of PI prior to feeding: 1,45±0,30; 1,35±0,28; 1,68±0,29; 1,50±0,23; 1,47±0,22; 1,52±0,20; 1,62±0,09; 1,68±0,06 and PI after feeding: 1,38±0,39; 1,40±0,29; 1,58±0,26; 1,46±0,26; 1,45±0,24; 1,50±0,27; 1,58±0,10; 1,64±0,04. The values of PSV prior to feeding were: 60,51±22,24; 55,24±26,04; 90,61±12,74; 95,33±18,11; 92,89±15,40; 96,96±12,18; 63,18±14,08; 58,12±9,78 and after feeding: 59,60±24,14; 110,82±32,45; 118,10±20,15; 121,95±24,18; 124,15±25,16; 126,07±18,17; 96,68±11,12; 96,12±8,98. And the results of EDV prior to feeding: 18,85±6,09; 18,66±10,01; 20,99±8,12; 22,02±8,50; 23,04±7,89; 22,24±8,02; 11,99±6,15; 12,05±5,12 and EDV after feeding: 20,63±6,89; 30,15±12,78; 27,98±9,72; 29,02±10,05; 34,56±9,00; 32,02±8,45; 19,02±4,95; 21,15±3,43. These results shows that healthy premature neonates with gestational age between 27 and 34 weeks presents a peculiar evolution in blood flow in the superior mesenteric artery after birth, represented by the resistance patterns caracteristics, improvement in peaks of systolic and diastolic velocity, and improvement in vasodilation in response to feeding. CONCLUSION: These results suggest for the Doppler velocimetry as specific and preventive evaluation method for each premature neonate, as a way to a safer introduction and progression of feeding, reducing the prevalence of gastrointestinal inflammatory diseases in neonates, and improving the indices of neonatal morbidity and mortality. Knowledge of blood-flow velocity in the superior mesenteric artery in uncomplicated preterm infants might provide a clue in investigating the maturation of intestinal circulation and the pathogenesis or pathophysiology of gastrointestinal diseases in newborn infants.

O LED infravermelho tem sido considerado uma alternativa efetiva para o laser na bioestimulação. Entretanto, o efeito na remodelação óssea durante o movimento ortodôntico ainda deve ser esclarecido. Oitenta ratos machos com 10 semanas de idade, foram divididos em dois grupos de 40 animais cada: grupo LED (GLED) e grupo controle (GCON), e tiveram seu 1ºmolar superior esquerdo submetido a força de 10 g com uma mola helicoidal fixada entre o 1ºmolar superior esquerdo e incisivo superior esquerdo. Durante os primeiros cinco dias de movimentação dentária foi aplicada a luz infravermelha LED (850nm, 30mW) durante 5 minutos no GLED. O GCON não foi irradiado. Em 0, 7, 14 e 21 dias, 5 animais de cada grupo foram submetidos a microtomografia computadorizada. Para a avaliação histológica, todos os ratos foram subdivididos em subgrupos de 20 animais cada de acordo com a o dia da eutanásia 4, 7, 14 e 21 dias e as maxilas foram dissecadas e processadas para a microscopia de luz (HE e TRAP). A quantidade de movimento, segundo as microtomografias computadorizadas, foi maior no grupo LED em T1 (intervalo entre os dias 0 e 7) e em T3 (intervalo entre os dias 14 e 21). No dia 4 foi observada hialinização na área de pressão em ambos os grupos; nos períodos posteriores, 7, 14, a área hialina foi vista apenas no grupo controle. A reabsorção radicular ocorreu em ambos os grupos após o dia 7. A fototerapia LED melhora a movimentação dentária e minimiza a hialinização durante o movimento ortodôntico. Entretanto, não reduz o risco de reabsorção da superfície radicular. / Infrared LED has been considered an effective alternative to infrared LASER for biostimulation purposes. However, its effect on bone remodeling during orthodontic tooth movement (OTM) is unknown. Eighty 10 week-old male Wistar rats were divided into two groups of forty animals each: LED group (GLED) and control group (GCON) and had a coiled spring bonded to the first upper molar and upper incisor exerting 10g force to mesially move the molar. During the first five days of OTM the maxillae were daily irradiated with infrared LED (850nm, 30mW) during 5 minutes (LED group). The controls were not irradiated (GCON). At 0, 7, 14 and 21 days, 5 LED group and 5 CON group rats were submitted to ?CT. For the histological study, all rats were subvided into subgroups of 20 animal each according to the euthanasia day 4, 7, 14 e 21 days. The rats were euthanized after 4, 7, 14 and 21 days and the maxillae were processed to light microscopy and TRAP histochemistry. The amount of tooth movement was greater in the GLED on days 7 and 14. At 4 day, hyalinization was seen at the pressure areas in both groups; on the subsequent days it was seen only in the GCON. Root resorption occurred in both groups after 7 days. LED phototherapy enhances early tooth movement and minimizes periodontal hyalinization during OTM. However, it does not reduce the risk of tooth resorption.

Este estudo avaliou a influência da fototerapia a laser (FTL) na proliferação e diferenciação de células-tronco da polpa dentária humana (DPSCs; do inglês, Dental Pulp Stem Cells ) encapsuladas em carreador injetável e termoresponsivo (PL; Pluronic® F-127, Sigma-Aldrich, MO, EUA) com incorporação de proteína morfogenética óssea 4 recombinante humana (rhBMP4) (sistema PL/rhBMP4). O biomaterial foi caracterizado de acordo com seus perfis de embebição e dissolução, liberação de rhBMP4 e sua estrutura morfológica. DPSCs foram isoladas, caracterizadas e encapsuladas em PL para confirmar sua viabilidade e seu potencial de diferenciação (adipo e osteogênico) em comparação com células-tronco mesenquimais de medula óssea (BMMSCs; do inglês, Bone Marrow Mesenchymal Stem Cells). Quando encapsuladas no sistema PL/rhBMP4, DPSCs foram irradiadas com duas densidades de energia diferentes utilizando laser de diodo de fosfeto de índio-gálio-alumínio (InGaAlP), modos contínuo, pontual e em contato [660 nm, 0,028 cm2, 20 mW, 0,71 W/cm2, 3 J/cm2 (4 s) ou 5 J/cm2 (7 s)]. Os ensaios de PKH26 (do inglês, Red Fluorescent Cell Linker), CFU-F (do inglês, Coloning Forming Units - Fibroblastic), e MTT (do inglês, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide)) foram utilizados para avaliar adesão/proliferação, diferenças na capacidade formadora de colônias e viabilidade das DPSCs (neste último caso sob estresse nutricional), respectivamente. Finalmente, a diferenciação odonto/osteogênica foi analisada por qRT-PCR e confirmada por ensaio de vermelho de alizarina. O biomaterial embebeu e dissolveu rapidamente; densa rede tubular e reticular com poros interconectados foi observada. DPSCs e BMMSCs apresentaram alta viabilidade celular quando encapsuladas em PL. Ambas as linhagens celulares tiveram êxito em se diferenciar em tecidos adiposo e ósseo. De acordo com o PKH26, DPSCs puderam aderir e proliferar no sistema PL/rhBMP4. DPSCs irradiadas encapsuladas tanto em PL como em PL/rhBMP4 formaram mais CFU-F que os controles não irradiados. Sob estresse nutricional, DPSCs semeadas no PL e irradiadas com 5 J/cm2 exibiram maior taxa de viabilidade celular em relação aos grupos não irradiados e irradiados com 3 J/cm2. Na presença de rhBMP4, os grupos irradiados tanto com 3 J/cm2 quanto com 5 J/cm2 apresentaram deposição mineral precoce quando comparados aos grupos não irradiados. Ainda, após 21 dias de diferenciação odonto/osteogênica, DPSCs irradiadas produziram maior quantidade de nódulos mineralizados. A irradiação com 5 J/cm2 levou ao aumento significativo da expressão de genes envolvidos na diferenciação odonto/osteogênica, como colágeno tipo I (COL1A1), osteocalcina (OCN), proteína da matriz dentinária 1 (DMP1), sialofosfoproteina dentinária (DSPP) e proteína heat shock 27 kDa (HSPB1). A associação entre rhBMP4 e FTL promove proliferação e diferenciação odonto/osteogênica de DPSCs acelerando e aumentando notavelmente a formação de tecido mineralizado, em especial quando a densidade de energia de 5 J/cm2 é aplicada. / This study evaluated the influence of laser phototherapy (LPT) on dental pulp stem cells (DPSCs) proliferation and differentiation upon encapsulation in an injectable and thermo-responsive cell carrier (PL; Pluronic® F-127, Sigma-Aldrich, MO, USA) loaded with human recombinant bone morphogenetic protein 4 (rhBMP4)(PL/rhBMP4 system). The biomaterial was characterized according to its swelling and dissolution profiles, release of rhBMP4 and morphological structure. DPSCs were isolated, characterized and encapsulated in PL to confirm their viability and multilineage differentiation potential (adipo and osteogenic) in comparison to bone marrow mesenchymal stem cells (BMMSCs). When encapsulated in the PL/rhBMP4 system, DPSCs were irradiated with two different energy densities using a continuous-wave indium-gallium-aluminum-phosphide (InGaAlP) diode laser [660 nm, 0.028 cm2, 20 mW, 0.71 W/cm2, 3 J/cm2 (4 s) or 5 J/cm2 (7 s)] in punctual and contact modes. The PKH26 (Red Fluorescent Cell Linker), the CFU-F (Coloning Forming Units - Fibroblastic), and the MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide] assays were used to assess differences in cell adhesion/proliferation, colony forming units formation ability, and cell viability of DPSCs (in this case under nutritional stress), respectively. Then, alizarin red and qRT-PCR analyzes were used to evaluate odonto/osteogenic differentiation. The biomaterial swelled and dissolved rapidly; dense tubular and reticular network morphology with well-interconnected pores was observed. DPSCs and BMMSCs presented high cell viability when encapsulated in PL. Both cell lineages successfully differentiated into bone or adipose tissues. According to PKH26, DPSCs were able to adhere and proliferate in the PL/rhBMP4 system. Irradiated DPSCs encapsulated in either PL or PL/rhBMP4 system formed more CFU-F than non-irradiated controls. Under nutritional stress, DPSCs encapsulated in the hydrogels with no rhBMP4 and irradiated at 5 J/cm2 exhibited higher cell viability than the other groups. In the presence of rhBMP4, the groups irradiated both at 3 and 5 J/cm2 energy densities displayed earlier mineral deposition than the non-irradiated groups. Moreover, after 21 days of odonto/osteogenic differentiation, irradiated DPSCs produced greater nodule formation than the control groups. At the energy density of 5 J/cm2, there were significant upregulation of genes involved in odonto/osteoblast differentiation, such as type I collagen (COL1A1), osteocalcin (OCN), dentin matrix protein 1 (DMP1), dentin sialophosphoprotein (DSPP) and heat shock protein 27 kDa (HSPB1). The association between rhBMP4 and LPT promotes cell proliferation and odonto/osteogenic differentiation of DPSCs accelerating and increasing the formation of mineralized tissue, in particular when the energy density of 5 J/cm2 is applied.