Cyclin D1, a proto-oncogene, is required for progression from the G1 phase into the S phase of the cell cycle. Over-expression of cyclin D1 causes an increase in cell cycle progression and cell proliferation, implicating it in a variety of cancers including renal cell carcinoma (RCC). The rodent RCC cell model, QTRRE, and human RCC cell models, ACHN, 786-O and Caki-2, exhibit elevated levels of cyclin D1. Pentoxifylline (PTX), a non-specific phosphodiesterase inhibitor, is an FDA-approved hemorheologic agent used to treat intermittent claudication, stemming from peripheral vascular diseases, as well as other diseases involving defective locoregional blood flow. Treatment of QTRRE, ACHN, 786-O and Caki-2 with PTX caused a time- (0-24 hrs) and dose- (0-1.0 mg/mL) dependent decrease of cyclin D1 protein and p-Rb levels in whole cell lysate as well as cytosolic and nuclear fractions, albeit, to different extents within the models. Concomitant with cyclin D1 and p-Rb decrease, enhanced G1 phase cell cycle arrest was observed in the RCC models. Mechanistic studies in these RCC cell models were carried out to determine PTXs mechanism of action with regard to cyclin D1 protein level decrease. RT-PCR analysis showed no significant changes in cyclin D1 mRNA copy number in time- (0-24 hrs) and dose- (0-1.0 mg/mL) dependent PTX treatments. However, such treatments caused decrease in p-4EBP1 (Ser65), p-4EBP1 (Thr70), and p-4EBP1 (Thr37/46). Because PTX's ability to decrease cyclin D1 protein was prevented in the presence of the proteasome inhibitor, MG-132, studies were performed to determine whether cyclin D1 stability was decreased during PTX treatment. Cyclin D1 degradation is initiated by phosphorylation of residue Thr286 by GSK-3β. Inhibition of GSK-3β with LiCl or knockdown via siRNA in the presence of PTX failed to block cyclin D1 decrease. Moreover, PTX treatment in the presence of MG-132 revealed no significant increase in cyclin D1 p-Thr286 compared to control. Finally, using the protein synthesis inhibitor, CHX, PTX caused no significant decrease in cyclin D1 t₁/₂ (wt-HA and T286A-HA) compared to control. Sorafenib, a broad-spectrum (cRAF, bRAF, KIT, FLT-3, VEGFR-2, VEGFR-3, and PDGFR-β) kinase inhibitor, is FDA-approved for the treatment of RCC. Studies with sorafenib and PTX in the ACHN cell model were carried out to determine PTXs possible adjuvant role in inhibiting cell growth via cyclin D1 decrease and G1 phase arrest. MTS data showed PTX potentiates the anti-proliferative effects of sorafenib. PTX pre-treatment for 24 hrs was also lowered the effective dose of sorafenib from 50 μM to 5 μM. Further, ACHN xenograft tumor volumes from mice treated with PTX and sorafenib displayed significantly higher tumor growth inhibition compared to either drug treatment alone or vehicle. Finally, drug treated ACHN xenograft tissue displayed significantly lower cyclin D1, p-RB and p-4EBP1 levels. These results demonstrate a novel anti-cancer property of PTX and suggest its use as a possible adjuvant therapy in RCC treatment should be further explored.

Despite intense research efforts, the repair of large bone defects is still not satisfactory and remains a major challenge in Orthopaedic Surgery. In this context bone tissue engineering has emerged as a promising strategy. However, one of the fundamental principles underlying tissue engineering approaches is that newly formed tissue must maintain sufficient vascularization to support its growth. Thus an active blood vessel network is an essential pre-requisite for scaffold constructs to integrate within existing host tissue. Currently, great efforts are made to address this problem employing transplantation of vascular cells and loading of appropriate biological factors. Endothelial progenitor cells (EPCs) are a heterogeneous subpopulation of bone marrow mononuclear progenitor cells with potential for differentiation to the endothelial lineage and thus vasculogenic capacity. However, clinical studies reported that with the increase of age, increased susceptibility to apoptosis and accelerated senescence may contribute to the numerical and functional impairments observed in EPCs, which may lead to a reduced angiogenic capacity and an increased risk of vascular disease. Hence attention has increasingly been paid to enhance mobilization and differentiation of EPCs for therapeutic purposes. A large body of evidence indicates that in Traditional Chinese Medicine (TCM) a plethora of herbs and herbal extracts are effective in the treatment of vascular diseases such as chronic wounds, diabetic retinopathy and rheumatoid arthritis. Thus, it seems rational to explore these medicinal plants as potential sources of novel angiomodulatory factors. In this thesis we demonstrated that treatment with TCM herbal extracts promote cell growth, cell migration, cell-matrix and capillary-like tube formation of BM-EPCs. Among these TCM extracts, Salidroside (SAL) and Icariin (ICAR) incubation increased VEGF and nitric oxide secretion, which in turn mediated the enhancement of angiogenic differentiation of BM-EPCs. A mechanic evaluation provided evidence that SAL stimulates the phosphorylation of Akt, mammalian target of rapamycin (mTOR) and ribosomal protein S6 kinase (p70S6K), as well as phosphorylated ERK1/2, which is associated with the cell migration and tube formation. Furthermore, a pilot in vivo study showed that SAL has the potential to enhance bone formation in a murine femoral critical-size bone defects model. Another new finding of the present study is that hydrogen peroxide (H2O2)-induced cytotoxicity is counteracted by TCM extracts. We found that SAL, Salvianolic acid B (SalB) and ICAR significantly abrogated H2O2-induced cell apoptosis, reduced the intracellular level of reactive oxygen species (ROS) and nicotinamide adenine dinucleotide phosphate-oxidase (NADPH) expression, and restored the mitochondrial membrane potential of BM-EPCs. Our data suggest that this protective effect of SalB is mediated by the activation of mTOR, p70S6K, 4EBP1, and by the suppression of MKK3/6-p38 MAPK-ATF2 and ERK1/2 signaling pathways after H2O2 stress. In addition, the investigation also demonstrates that ICAR owns the ability to inhibit apoptotic and autophagic programmed cell death via restoring the loss of mTOR and attenuation of ATF2 activity upon oxidative stress. Based on the outcomes of the present work, we propose SAL, SalB and ICAR as novel proanigiogenic and cytoprotective therapeutic agents with potential applications in the fields of systemic and site-specific tissue regeneration including ischaemic disease and extended musculoskeletal tissue defects.

Despite intense research efforts, the repair of large bone defects is still not satisfactory and remains a major challenge in Orthopaedic Surgery. In this context bone tissue engineering has emerged as a promising strategy. However, one of the fundamental principles underlying tissue engineering approaches is that newly formed tissue must maintain sufficient vascularization to support its growth. Thus an active blood vessel network is an essential pre-requisite for scaffold constructs to integrate within existing host tissue. Currently, great efforts are made to address this problem employing transplantation of vascular cells and loading of appropriate biological factors. Endothelial progenitor cells (EPCs) are a heterogeneous subpopulation of bone marrow mononuclear progenitor cells with potential for differentiation to the endothelial lineage and thus vasculogenic capacity. However, clinical studies reported that with the increase of age, increased susceptibility to apoptosis and accelerated senescence may contribute to the numerical and functional impairments observed in EPCs, which may lead to a reduced angiogenic capacity and an increased risk of vascular disease. Hence attention has increasingly been paid to enhance mobilization and differentiation of EPCs for therapeutic purposes. A large body of evidence indicates that in Traditional Chinese Medicine (TCM) a plethora of herbs and herbal extracts are effective in the treatment of vascular diseases such as chronic wounds, diabetic retinopathy and rheumatoid arthritis. Thus, it seems rational to explore these medicinal plants as potential sources of novel angiomodulatory factors. In this thesis we demonstrated that treatment with TCM herbal extracts promote cell growth, cell migration, cell-matrix and capillary-like tube formation of BM-EPCs. Among these TCM extracts, Salidroside (SAL) and Icariin (ICAR) incubation increased VEGF and nitric oxide secretion, which in turn mediated the enhancement of angiogenic differentiation of BM-EPCs. A mechanic evaluation provided evidence that SAL stimulates the phosphorylation of Akt, mammalian target of rapamycin (mTOR) and ribosomal protein S6 kinase (p70S6K), as well as phosphorylated ERK1/2, which is associated with the cell migration and tube formation. Furthermore, a pilot in vivo study showed that SAL has the potential to enhance bone formation in a murine femoral critical-size bone defects model. Another new finding of the present study is that hydrogen peroxide (H2O2)-induced cytotoxicity is counteracted by TCM extracts. We found that SAL, Salvianolic acid B (SalB) and ICAR significantly abrogated H2O2-induced cell apoptosis, reduced the intracellular level of reactive oxygen species (ROS) and nicotinamide adenine dinucleotide phosphate-oxidase (NADPH) expression, and restored the mitochondrial membrane potential of BM-EPCs. Our data suggest that this protective effect of SalB is mediated by the activation of mTOR, p70S6K, 4EBP1, and by the suppression of MKK3/6-p38 MAPK-ATF2 and ERK1/2 signaling pathways after H2O2 stress. In addition, the investigation also demonstrates that ICAR owns the ability to inhibit apoptotic and autophagic programmed cell death via restoring the loss of mTOR and attenuation of ATF2 activity upon oxidative stress. Based on the outcomes of the present work, we propose SAL, SalB and ICAR as novel proanigiogenic and cytoprotective therapeutic agents with potential applications in the fields of systemic and site-specific tissue regeneration including ischaemic disease and extended musculoskeletal tissue defects.