A tuberculose permanece como um dos maiores problemas de saúde pública mundial. O diagnóstico precoce e o tratamento rápido e eficiente dos indivíduos com tuberculose pulmonar ativa são medidas essenciais para a redução da morbidade, mortalidade e da incidência da tuberculose no mundo. As limitações encontradas nos métodos microbiológicos tradicionais, fizeram com que metodologias alternativas fossem desenvolvidas para melhorar o diagnóstico e o prognóstico da tuberculose humana. Neste trabalho verificamos o desempenho diagnóstico do Western blotting para pesquisa de anticorpos IgG anti - Mycobacterium tuberculosis, a utilização do teste QuantiFERON® - TB Gold e a detecção de moléculas de adesão celular (ICAM-1 e selectinas) como marcadores de prognóstico. Foram acompanhados até o final do tratamento 31 pacientes com tuberculose pulmonar diagnosticados por critérios clínicos e laboratoriais. Como controles, selecionamos população de indivíduos sadios, doadores de banco de sangue e indivíduos com outras pneumopatias. Os resultados mostraram que o Western blotting apresentou sensibilidade de 94% e especificidade de 96% no diagnóstico da tuberculose pulmonar, atendendo os requisitos da OMS para testes sorológicos. O QuantiFERON® - TB Gold apresentou sensibilidade de 83% e especificidade de 100%, após ajuste do limiar de reatividade. Os resultados das moléculas de adesão celular sugerem potencial para serem utilizadas como marcadores de prognóstico da doença. Ao associarmos os resultados do Western blotting ou do QuantiFERON® - TB Gold com a baciloscopia obtivemos sensibilidade superior a 95%; e quando associados à cultura a sensibilidade encontrada foi de 100%. O Western blotting mostrou ser uma ferramenta útil como auxiliar no diagnóstico da tuberculose pulmonar mesmo em pacientes com baciloscopia negativa. / Tuberculosis remains a major public-health problem. Rapid diagnosis and prompt treatment is the cornerstone to reduce morbidity, mortality and incidence of tuberculosis in the world. Alternative methods have been developed to overcome the limitations presented by conventional microbiological methods and to improve the diagnosis and prognosis of tuberculosis. In this study we verified the diagnostic performance of Western blotting for IgG anti-M.tuberculosis antibodies detection, QuantiFERON® - TB Gold and circulating adhesion molecules (ICAM-1 and Selectins) as prognosis markers. Thirty-one patients were followed-up during the treatment. Active pulmonary tuberculosis was diagnosed by clinical and laboratorial criteria. As group control healthy individuals, blood donors and patients with other lung diseases were included. Western blotting results showed a high performance with sensitivity of 94% and specificity of 96% for the diagnosis of pulmonary tuberculosis, attending WHO requirements for serological tests. After adjusting the threshold, QuantiFERON® - TB Gold showed sensitivity of 83% and specificity of 100%. The results of adhesion molecules suggested potential to use the test as prognosis markers. Combining Western blotting or QuantiFERON® - TB Gold with acid-fast bacilli (AFB) smear results, the overall sensitivity increase to more than 95%, and when combined with culture the overall sensitivity was 100%. Together, these findings, suggest that Western blotting could be a very useful supplementary tool for pulmonary tuberculosis, especially in patients with AFB smear negative.

RESUMO STOCCO, B. Avaliação do efeito de contraceptivos hormonais sobre a hemostasia. 2011. 92f. Dissertação (Mestrado). Faculdade de Ciências Farmacêuticas de Ribeirão Preto Universidade de São Paulo, Ribeirão Preto, 2011. Introdução: Mais de 100 milhões de mulheres no mundo fazem uso de métodos contraceptivos hormonais. Apesar de seu desejado efeito na contracepção, sua metabolização ocorre no fígado estimulando a síntese de proteínas plasmáticas, dentre elas, as que controlam os sistemas de coagulação e fibrinólise, conferindo um estado de hipercoagulabilidade em suas usuárias. A literatura aponta também alterações no metabolismo dos lipídios e carboidratos, além de modular a expressão de moléculas de adesão presentes no endotélio. Para combater os efeitos indesejáveis destes medicamentos, baixas concentrações de estrógenos e diferentes progestágenos foram introduzidos, pois, a estes últimos é conferida a atividade anti estrogênica destas formulações. Estudos independentes sugerem que progesteronas de terceira e quarta geração possuem atividade anti-estrogênica menor em relação as de segunda geração. Objetivos: avaliar a ocorrência de alterações hemostáticas, analisar o perfil lipídico e quantificar moléculas de adesão no soro ou plasma da população feminina brasileira usuária de contraceptivos orais de segunda e quarta gerações. Materiais e Métodos: 70 participantes distribuídas em quatro grupos a saber : grupo I (controle- 20 pacientes); grupo II (DRSP/30EE- 20 pacientes); grupo III (DRSP/20EE- 16 pacientes) e grupo IV (LNG/30EE-14 pacientes). Foram avaliados os seguintes parâmetros: TP, Fator VII, TTPA, Fator XII, Fibrinogênio, Fator 1+2, Proteína C, Proteína S, Antitrombina, D dímeros, PAI 1, VCAM, ICAM, E- selectina, HDL, LDL,VLDL, Colesterol total e Triglicérides. Resultados e discussões: grupo II promoveu diminuição em TP e Prot. S; e aumento em HDL,VLDL,Col. total e TG; grupo III diminuiu TP, TTPA, Prot.S, ICAM e VCAM ; e aumentou Fibrinogênio, D-dímeros, HDL,VLDL,Col. total e TG e grupo IV diminuiu TP, Prot.C e aumentou ICAM e VCAM. Conclusões: Dos medicamentos estudados apontamos que: o grupo II promoveu alterações significativas no perfil lipídico caracterizando um estado pró-trombótico, apesar de apresentar o maior aumento nos valores de HDL e poucas alterações associadas à hipercoagulabilidade; o grupo III promoveu o maior número de alterações hipercoagulantes, alterou também perfil lipídico contribuindo para um estado pró- trombótico, embora tenha apresentado proteção endotelial e o grupo IV foi o medicamento que promoveu melhor proteção endotelial, não alterou perfil lipídico e ocasionou poucas alterações associadas à hipercoagulabilidade / Introduction: More than 100 million women in the world make use of hormonal contraceptives. In spite of its desired effect on contraception, its metabolization occurs at liver, estimulating the synthesis of the plasmatic proteins, among them, the ones that control the coagulation system and fibrinolysis, confering a hypercoagulability state in their users. The literature also points changes in the metabolism of lipids and carbohydrates, besides modulate the expression of adhesion molecules present in the endothelium. Trying to combat undesirable effects of these drugs, low concentrations of estrogen and different progestogens were introduced, because, the antiestrogenic activity of these drugs is assigned to the progesterone used. Independent papers suggest that third and fourth generation progesterones have a smaller antiestrogenic activity in relation to the second generation one. Objectives: evaluate the occurrence of hemostatic alterations, analyze the lipid profile and quantify adhesion molecules in serum or plasma on the Brazilian female population who is user of contraceptives from second and fourth generation. Material and Methods: 70 participants were distributed into four groups: group I (control- 20 patients); group II (DRSP/30EE- 20 patients); group III (DRSP/20EE- 16 patients) and group IV (LNG/30EE- 14 patients). From these were assessed the following parameters: PT, Factor VII, APTT, Factor XII, Fibrinogen, Factor 1+2, Protein C, Protein S, Antithrombin, Ddimmers, PAI 1,VCAM, ICAM, E- selectin, HDL, LDL, VLDL, Total Cholesterol and Triglycerides.Results and discussion: group II promoted a decrease in PT and Prot.S; and an increase in HDL,VLDL, Total cholesterol and TG; group III decreased PT, APTT, Prot.S, ICAM and VCAM ; and increased Fribrinogen, D- dimers, HDL,VLDL,Total Cholesterol and TG and group IV decreased PT, Prot.C and increased ICAM and VCAM.Conclusions: among the drugs studied we aim that: the group II promoted significant changes in lipid profile featuring a pro- thrombotic state, in spite of presented the highest increase in the levels of HDL and few alterations associated to hypercoagulability; group III promoted the biggest number of hypercoagulability alterations, this drug also changed the lipid profile contributing to a pro-thrombotic state, although it has presented endothelial protection and the group IV it was the drug that promoted the best endothelial protection, did not change lipid profile and caused few alterations associated with hypercoagulability

Resultados preliminares do nosso grupo de pesquisa demonstraram que a inibição da síntese de NO por período de tempo prolongado reduz o recrutamento de leucócitos para focos inflamatórios, dependente, pelo menos em parte, da inibição da interação leucócito-endotélio e da expressão de L-selectina. 0 presente trabalho visou complementar os estudos sobre os mecanismos envolvidos nesta ação antiinflamatória. Para tanto, ratos Wistar machos (180 a 220g) receberam L-NAME (20mg/Kg; v.o.; 14 dias) ou água pela mesma via e período de tempo. Foi avaliada a atividade das enzimas óxido nítrico sintases (NOS) no tecido cerebral por radioimunoensaio; o recrutamento leucocitário para cavidade peritoneal induzido pelo LPS (5mg/kg, 4 horas); as expressões de moléculas de adesão em leucócitos do sangue circulante, no músculo cremaster e nos sinusóides hepáticos por ensaios de citometria de fluxo ou imunohistoquímica; as expressões gênicas de moleculas de adesão, quantificadas por PCR e a secreção/produção de mediadores inflamatórios em leucócitos por ensaios imunoenzimáticos, reacao de Griess ou quimiluminescência. Os resultados obtidos mostraram que: 1) o tratamento com L-NAME reduziu em torno de 90% a atividade das NOS dependentes de Ca+2 em condições basais ou após estimulação in vivo com LPS; 2) as concentrações de NO no plasma e no peritônio inflamado estavam reduzidos em animais tratados com L-NAME (30% vs. controles); 3) a migração de leucócitos polimorfonucleares (PMN) para o peritônio inflamado estava reduzida em animais tratados com L-NAME (40% vs. controles); 4) as expressões de L-selectina e PECAM-1 em leucócitos circulantes; de PECAM-1 no endotélio do músculo cremaster e de VAP-1 no endotélio dos sinusóides hepáticos e músculo cremaster de animais tratados com L-NAME estavam reduzidas; 5) a redução na expressão de L-selectina foi dependente de inibição de sua síntese; 6) a concentração de IL-10 estava major no soro de animais tratados com L-NAME em relação aos controles; 7) a maior concentração de IL-10 circulante pode refletir a produção desta citocina por leucócitos na circulação, uma vez que a concentração de IL-10 também estava maior no sobrenadante de leucócitos circulantes de animais tratados com L-NAME; 8) concentrações reduzidas de IL-1β e LTB4 foram detectadas nos sobrenadantes de neutrófilos obtidos de animais tratados com L-NAME; 9) macrófagos obtidos de animais tratados com L-NAME produziram maiores concentrações de IL-1β, TNF-α e IL-6, e menores concentrações de IL-10 na ausência de estimulação; na vigência estimulação in vitro com LPS os macrófagos de animais tratados com L-NAME produziram menores concentrações de NO. Em conjunto, os resultados obtidos neste trabalho mostram que o tratamento com L-NAME por período prolongado de tempo inibe a atividade das NOS dependentes de Ca+2 e nesta condição reduz as concentrações de NO circulante e no foco da inflamação, além de inibir a migração de leucócitos para o foco inflamatório, confirmando propriedades pro-inflamatórias do NO. Os mecanismos envolvidos na inibição da migração celular parecem compreender a modulação da expressão e/ou síntese das moléculas de adesão constitutivas expressas em leucócitos e no endotélio, além da modulação da secreção de mediadores pró ou antiinflamatórios em leucócitos circulantes e neutrófilos. Por outro lado, os efeitos do tratamento com L-NAME sobre a secreção de mediadores químicos por macrófagos induzem a secreção destes e corroboram a dualidade dos efeitos do NO no processo de recrutamento celular. / Our previous results have demonstrated that in vivo chronic inhibition of nitric oxide synthesis reduces leukocyte recruitment into inflammatory focus, dependent, at least in part, on impaired leukocyte-endothelial interactions and expression of L-selectin. This study aimed to clarify the mechanisms involved in the reduced leukocyte migration observed in L-NAME-treated rats. For this purpose, male Wistar rats (180-220g) were treated with L-NAME (20 mg/kg, oral route, 14 days, dissolved in drinking water); controls animals received water by the same route and period of time. The effectiveness of L-NAME treatment was investigated by examining the activity of nitric oxide synthases (NOS) in the brain tissue using radioimmunoassay. In addition, effects of L-NAME treatment were evaluated in LPS-induced leukocyte recruitment into peritoneal cavity (5mg/kg, 4 hours); expression of adhesion molecules was determined in circulating leukocytes, cremaster muscle and liver sinusoids by flow cytometry and immunohistochemistry assay; gene expressions of adhesion molecules were quantified by PCR and leukocyte secretion of inflammatory mediators was measured by immunoenzimatics assays, Griess reaction or chemiluminescence. Our results show that: 1) L-NAME treatment reduced, around 90%, Ca+2 - dependent NOS activity in the presence or not of in vivo inflammation; 2) concentrations of NO in the plasma and into inflamed peritoneum were reduced in L-NAME-treated animals (30% vs. control animals); 3) migration of PMN leukocytes into inflammed peritoneum was impaired in L-NAME-treated rats (40% vs. control animals); 4) expressions of L-selectin and PECAM-1 in circulating leukocytes, PECAM-1 in endothelium from cremaster muscle and VAP-1 in endothelium from liver sinusoids and cremaster muscle were reduced in L-NAME-treated rats; 5) decrease in L-selectin expression was dependent on inhibition of its synthesis; 6) concentrations of IL-10 was higher in serum from L-NAME-treated rats in comparison to control rats; 7) these higher concentrations of circulating IL-10 can reflect the production of this cytokine by leukocytes from circulation, as IL-10 levels was greater in the supernatant of circulating leukocytes obtained from L-NAME-treated animals; 8) L-NAME treatment disturbed neutrophils ability to secrete IL-1β e LTB4, since these concentrations were lower in the supernatants of neutrophils from L-NAME-treated animals; 9) in absence of stimulation, macrophages obtained from L-NAME-treated rats produced higher concentrations of IL-1β, TNF-α e IL-6, and lower concentrations of IL-10, whereas in presence of in vitro LPS these cells produced lower concentrations of NO. Taken together, our results show that L-NAME treatment administrated for a prolonged period of time inhibits Ca+2 -dependent NOS activity, and in this condition, reduces concentrations of NO in plasma and into inflammatory focus and decreases leukocyte migration to the inflammatory focus thus confirming pro-inflammatory properties of NO. The mechanisms involved in impaired cellular migration seem to involve the modulation of expression and/or synthesis of constitutive adhesion molecules in leukocytes and endothelium, and to interfere in the secretion of pro or anti inflammatory mediators. On the other hand, actions of NO in secreation of chemical mediators by macrophages induces the production of inflammatory mediators and support the duality of NO in the cellular recruitment process.

Introdução: Caderinas e integrinas são importantes para a manutenção da integridade tecidual e transdução de sinal durante o desenvolvimento da pele. A distribuição destas moléculas no desenvolvimento da pele humana foi investigada e associada com os marcadores de diferenciação, Citoqueratinas (CK) e involucrina (INV). Método: Usando a técnica de imunoistoquímica foram investigadas as proteínas E- e P- caderinas, integrinas beta- 1 e -4, CK 10, CK 14 e INV em fragmentos de pele de várias regiões corpóreas de 7 fetos humanos (semana gestacional de 4 a 24, todos pesando até 500 g). Resultados: Na fase inicial do desenvolvimento, integrinas beta-1 e -4 and E- and P- caderinas estavam presentes na membrana plasmática das células epiteliais em todos as camadas do epitélio. CK14 e CK10 foram observadas em todas as camadas epiteliais e a INV fracamente detectada em células da camada mais superficial. Em estágios mais avançados, integrinas foram detectadas em todas as camadas epiteliais, com expressão polarizada principalmente na camada basal. E- caderina foi detctada em todas as camadas, menos no estrato cornificado e a P- caderina foi observada em camadas mais profundas do epitélio. CK14 estava presente na camada basal, CK 10 no estrato suprabasal e a INV foi observada no estrato cornificado. Conclusão: Caderinas e integrinas são essenciais para o desenvolvimento da pele, sendo espacialmente e temporalmente regulados. Suas expressões são relatas com a expressão da maturação de marcadores da epiderme. / Introduction: Cadherins and integrins are important for maintenance of tissue integrity and in signal transduction during skin development. Distribution of these molecules in human skin development was investigated and associated with markers of differentiation, cytokeratins (CK) and involucrin (INV). Methods: Using immunohistochemistry expression of E- and P- cadherins, integrins beta-1 and -4, CK10, CK 14 and INV was assessed in skin fragments of 7 human fetuses (gestacional weeks ranged from 4 to 24, all weighing up to 500 g). Results: At initial phases of development, integrins beta-1 and -4 and E- and P- cadherins were present on epithelial cell membranes in all layers. CK 14 and CK 10 were expressed in all epithelial layers and INV weakly detected in the superficial layer. In more advanced stages, integrins were detected in all layers, but a marked polarized expression was seen in basal layer. E- cadherin was detected in all layers, but the cornified stratum and P- cadherin were observed in the lower layers. CK 14 was expressed in layer, CK 10 in suprabasal stratum and INV was observed in cornified layer. Conclusions: Cadherins and integrins are essential for skin development, being spatially and temporally regulated. Their expression is related with the expression of maturation markers of the epidermis.

La technique de clonage par transfert nucléaire de cellules somatiques (SCNT) présente une page importante dans les annales scientifiques, mais son application pratique demeure incertaine dû à son faible taux de succès. Les anomalies placentaires et de développement fœtal se traduisent par des pertes importantes de gestation et des mortalités néonatales. Dans un premier temps, la présente étude a caractérisé les changements morphologiques des membranes fœtales durant la gestation clonée en les comparant à des gestations contrôles obtenues à partir de l’insémination artificielle. Les différentes anomalies morphologiques des placentomes telles que l’œdème chorioallantoique, la présence de zones hyperéchoiques et irrégulières dans la membrane amniotique et la présence de cellules inflammatoires dégénérées compromettent le développement fœtal normal de la gestation clonée. L’examen ultrasonographique représente une technique diagnostique importante pour faire le suivi d’une gestation et de caractériser les changements placentaires dans le cadre d’évaluation globale du bien-être fœtal. Le profil hormonal de trois stéroïdes (progestérone (P4), estrone sulfate (E1S), et œstradiol (E2)) et de la protéine B spécifique de gestation (PSPB) dans le sérum des vaches porteuses de clones SCNT a été déterminé et associé aux anomalies de gestations clonées. Une diminution de la P4 sérique au jour 80, une élévation du niveau de la concentration de la PSPB au jour 150, et une augmentation de la concentration d’E2 sérique durant le deuxième et troisième tiers de la gestation clonée coïncident avec les anomalies de gestation déjà reportées. Ces changements du profil hormonal associés aux anomalies phénotypiques du placenta compromettent le déroulement normal de la gestation clonée et gênent le développement et le bien-être fœtal. Sur la base des observations faites sur le placenta de gestation clonée, le mécanisme moléculaire pouvant expliquer la disparition de l’épithélium du placenta (l’interface entre le tissue maternel et le placenta) a été étudié. L’étude a identifié des changements dans l’expression de deux protéines d’adhérence (E-cadhérin et β-catenin) de cellules épithéliales pouvant être associées aux anomalies du placenta chez les gestations clonées. Le tissu de cotylédons provenant de gestations clonées et contrôles a été analysé par Western blot, RT-PCR quantitatif, et par immunohistochimie. Les résultats présentaient une diminution significative (p<0.05) de l’expression des dites protéines dans les cellules trophoblastiques chez les gestations clonées. Le RT-PCR quantitatif démontrait que les gènes CCND1, CLDN1 et MSX1 ciblés par la voie de signalisation de la Wnt/β-catenin étaient significativement sous exprimés. La diminution de l’expression des protéines E-cadherin et β-catenin avec une réduction de l’activation de la protéine β-catenin durant le période d’attachement de l’embryon peut potentiellement expliquer l’absence totale ou partielle de l’attachement des membranes fœtales au tissu maternel et éventuellement, l’insuffisance placentaire caractéristique des gestations clonées chez la vache. La caractérisation morphologique et fonctionnelle du placenta durant les gestations clonées à haut risque est essentielle pour évaluer le statut de la gestation. Les résultats de la présente étude permettront de prédire le développement et le bien-être fœtal de façon critique à travers un protocole standardisé et permettre des interventions médicales pour améliorer le taux de succès des gestations clonées chez les bovins. / Although somatic cell nuclear transfer (SCNT) has been shown to be successful, there are still problems with this technique that is inhibiting its use in industry. Altered placental formation and development results in the high incidence of pregnancy loss and prenatal morbidity and mortality found in SCNT pregnancies. The objective of the initial study was to characterize morphological changes in fetal membranes of a group of bovine recipients carrying cloned fetuses and comparing them with control AI fetuses at various stages of gestation. Several morphological anomalies of placentomes such as edematous chorioallantoic membrane, hyper-echodense spikes or irregularities in the amniotic membrane as well as the pathological presence of degenerated inflammatory cells accompanied by disappearance of the placental epithelium were observed. It was concluded that these anomalies compromise fetal development. The results of this work also showed that ultrasonography may be a reliable technique to monitor and to characterize the placental changes in bovine pregnancies that can be used to assess fetal well-being. The next study compared the functionality of the placenta of cloned fetuses with controls. The concentration of three steroids (progesterone (P4), estrone sulphate (E1S), and estradiol (E2)) and pregnancy-specific protein B (PSPB) in maternal peripheral circulation were assessed and their associations with gestational anomalies were determined. The hormones profiles in the SCNT recipients deviated from the control group at certain stages of pregnancy. We observed higher concentrations of E2 throughout the study period, lower levels of P4 at day 80 as well as elevated PSPB concentrations at day 150 in SCNT recipients which coincided with high rate of abortion in these animals shortly after this stage. So, it is proposed that these hormonal changes together with the morphological anomalies of the placenta result in compromised fetal development. Finally, the molecular mechanism that could be responsible for the abnormal disappearance of the epithelial layer observed in SCNT placenta was investigated. To do so, we measured the expression of two major epithelial adherens junction proteins (E-cadherin and β-catenin) and determined if their expression is altered in relation to the aberrant placentation in SCNT embryos. Cotyledonary tissues from SCNT gestations and control pregnancies were analyzed by Western blot, quantitative RT-PCR and immunohistochemical analysis. Both candidates were significantly (P < 0.05) under-expressed in SCNT trophoblast cells at the protein level. Also, qRT-PCR confirmed that the Wnt/β-catenin signaling pathway target genes CCND1, CLDN1 and MSX1 were significantly down-regulated in SCNT placentas. So, we inferred that impaired E-cadherin and β-catenin protein expression, along with defective β-catenin signaling during embryo attachment, specifically in the window of placentation, results in loose attachment and contributes to insufficient placentation in bovine SCNT-derived embryos. Overall, we concluded that during the high-risk pregnancy of cloned fetuses, characterization of the morphological and functional changes of the placenta is critical to enable us to predict normal fetal development and wellbeing through a standardized procedure during clone gestations and to intervene medically in emergency cases to improve the overall efficiency of cloning in cattle.

We examined the effect of cyclosporin A, tacrolimus, sirolimus and everolimus on the cell growth, viability, proliferation, expression of cellular adhesion molecules (CAM) and leukocyte (PBMC) binding of human macrovascular (coronary artery, saphenous vein) and microvascular endothelial cells (EC). Tacrolimus did not affect EC integrity, growth or expression of CAM. Exclusively, EC from the coronary arteries showed a reduced cellular growth (about 30%) under cyclosporin A and tacrolimus treatment. In contrast, treatment with mTOR inhibitors reduced EC proliferative activity by about 40%, independently of the EC origin. No induction of apoptosis (caspase-3/7 activity) or cytotoxicity (MTS test) was observed. Long-term treatment with high concentrations of sirolimus and everolimus did not enhance the expression of CAM. Stimulation with tumor necrosis factor significantly increased the expression of CAM, independently of the drugs used. None of the mTOR inhibitors influenced the tumor necrosis factor-induced expression of CAM, whereas adhesion of PBMC increased significantly, as described by other papers. In summary, neither calcineurin inhibitors nor mTOR inhibitors activate human micro- and macrovascular EC. Therefore, the investigated drugs are unlikely to contribute to EC activation during transplant-associated vasculopathy. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Thesis (Ph. D.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Vita. Bibliography: 108-115.

Με την ηλικία, νόσοι που σχετίζονται με δομικά ελαττώματα των οστών που οφείλονται σε κατάγματα ή εκφυλισμούς, αναμένονται να αυξηθούν σε συχνότητα. Επιπλέον, η αύξηση του προσδόκιμου ζωής επιβάλλει τη χρήση βελτιωμένων συνθετικών υλικών για την αντικατάσταση νοσούντων οστών, για παράδειγμα κατά τη χρήση μεταλλικών ράβδων σε περιπτώσεις βλαβών μη-ένωσης και στις χειρουργικές επεμβάσεις αντικατάστασης ισχίου. Τα υπάρχοντα υλικά σχετίζονται με υπο-βέλτιστη οστεοενσωμάτωση και προβληματική μακροπρόθεσμη επιβίωση του σύνθετου εμφυτεύματος. Για το λόγο αυτό, η βελτίωση των υλικών επικάλυψης και των μηχανικών ιδιοτήτων των νέων, κυτταρικά συμβατών, συστατικών είναι επιτακτική. Για να αντιμετωπιστεί αυτό το πρόβλημα, υλικά νέας γενιάς είναι διαθέσιμα, ενδεχομένως με καλύτερες ιδιότητες ως υπόστρωμα προσκόλλησης για τα κύτταρα των οστών. Ο σκοπός της παρούσας εργασίας ήταν να εκτιμηθεί η ικανότητα ενός νέου, ειδικά κατασκευασμένου υλικού απο νανοσωλήνες άνθρακα ως προς τη διατήρηση της σωστής έκφρασης των χαρακτηριστικών γονιδίων των οστεοβλαστών, με έμφαση στην έκφραση των γονιδίων που εμπλέκονται στις αλληλεπιδράσεις οστεοβλαστών-υποστρώματος και έτσι προωθούν την σταθερή προσκόλληση των κυττάρων στο υπόστρωμα. Παράλληλα, ερευνήσαμε και την επίδραση της μηχανικής καταπόνησης στην έκφραση των γονιδίων αυτών σε κύτταρα που καλλιεργήθηκαν σε νανοσωλήνες άνθρακα. Χρησιμοποιήσαμε δύο ανεξάρτητες απομονώσεις οστεοβλαστών διαφοροποιημένων από ανθρώπινα μεσεγχυματικά βλαστικά κύτταρα μυελού των οστών, δηλαδή προχωρήσαμε σε δύο ανεξάρτητα πειράματα. Και στα δύο, για να γίνει ο πειραματισμός όσο εγγύτερα στις πραγματικές συνθήκες, καλλιεργήσαμε τους οστεοβλάστες υπο στατικές συνθήκες όσο και υπό συνθήκες μηχανικής καταπόνησης, για την προσομοίωση "in vivo" συνθηκών, και συγκρίθηκε η γονιδιακή έκφραση οστεοβλαστών που καλλιεργήθηκαν σε πλαστικό έναντι επιφανειών επικαλυμμένων με νανοσωλήνες άνθρακα. Απομονώσαμε το RNA από τους οστεοβλάστες μετά από την καλλιέργειά τους για 3 και 24 ώρες και προσδιορίσαμε, χρησιμοποιώντας την τεχνική real time RΤ-PCR, την έκφραση των ακόλουθων γονιδίων σε επίπεδο mRNA: κολλαγόνο-α1, αλκαλική φωσφατάση, οστεοποντίνη, βινκουλίνη και ιντεγκρίνες α4, αV, β1 και β3. Συνολικά, τα αποτελέσματα της ανάλυσης του κυτταρικού mRNA έδειξαν ότι η γονιδιακή έκφραση μετά από 3 ώρες καλλιέργειας είναι πολύ μεταβλητή, και οριστικά συμπεράσματα δεν θα μπορούσαν να εξαχθούν. Ωστόσο, αφού δίνεται η ευκαιρία στα κύτταρα να προσκολληθούν σταθερά, στις 24 ώρες, κατέστη σαφές ότι: α) η κυτταρική ταυτότητα των διαφοροποιημένων οστεοβλαστών διατηρείται, με βάση το γεγονός ότι η έκφραση αυτών των χαρακτηριστικών γονιδίων, που σχετίζονται με την προσκόλληση, συντηρείται σωστά, αν και σε διάφορα επίπεδα, β) σε στατικές συνθήκες, το επίπεδο της έκφρασης των εξετασθέντων γονιδίων είναι κατά τι χαμηλότερο σε οστεοβλάστες που καλλιεργηθήκαν σε επικαλυμμένη επιφάνεια με νανοσωλήνες άνθρακα σε σύγκριση με τα κύτταρα που καλλιεργηθήκαν σε πλαστικό, και γ) σε σύγκριση με τις στατικές συνθήκες, το μηχανικό ερέθισμα ενισχύει την έκφραση αυτών των γονιδίων οστεοβλαστών όταν καλλιεργούνται σε νανοσωλήνες άνθρακα, για την επίτευξη υψηλών επιπέδων mRNA έκφρασης των γονιδίων κυτταρικής προσκόλλησης. Τα αποτελέσματα της τελευταίας ανάλυσης της γονιδιακής έκφρασης είναι επίσης συμβατά με τις συνολικές ποσότητες RNA που λαμβάνονται, υποστηρίζοντας έμμεσα τη σταθερή προσκόλληση και επιβίωση των οστεοβλαστών σε νανοσωλήνες άνθρακα υπο συνθήκες μηχανικής καταπόνησης. Συμπεραίνουμε λοιπόν ότι το νέο υπόστρωμα από νανοσωλήνες άνθρακα που αναλύθηκε σε μηχανικές συνθήκες διέγερσης που προσομοιάζουν, κατά το δυνατόν, συνθήκες καταπόνησης in vivo, συνιστά ένα κατάλληλο κυτταρικό υπόστρωμα, συμβατό με την επιβίωση των οστεοβλαστών, τη διαφοροποίηση, την ανάπτυξη και την σταθερή προσκόλλησή τους στο υπόστρωμα νανοσωλήνων. Η εργασία αυτή υποστηρίζει την πιθανότητα της χρήσης αυτών των νέων υλικών στο μέλλον για την επικάλυψη σκελετικών προσθέσεων, με σκοπό την απόκτηση βέλτιστης οστεοενσωμάτωσης. / As population ages, diseases related to bone structural defects due to fracture or degeneration are expected to increase in frequency. In addition, the increase in life expectancy necessitates better composite materials for replacement of diseased/fractured bones, for example during the use of metal rods for non-union defects and in hip replacement surgery. The existing materials are associated with sub-optimal osseointegration and problematic long-term survival of the composite graft. For this reason, improvement of coating materials and engineering of novel cell-compatible components is imperative. To address this problem, new-generation materials are available, with possibly better bone cell adherence properties. The Aim of this work was to evaluate the ability of a novel, specially-constructed carbon nanotube material to sustain proper expression of characteristic osteoblast genes, with emphasis on the expression of genes that are functionally involved in osteoblast-matrix interactions and promote firm cell adherence to substrate. We used two independent isolates of osteoblasts differentiated from human bone marrow mesenchymal stem cells, ie we proceeded to two independent experimental runs. In both, to make the experimentation more context-relevant, we grew the osteoblasts in static as well as under mechanical strain, to simulate in vivo conditions, and also compared gene expression in osteoblasts grown on plastic versus carbon nanotube-coated surface. We isolated RNA from the osteoblasts at 3 hours and 24 hours after seeding them on the culture vessels and determined, using real-time RT-PCR techniques, the level of expression of the following genes at the mRNA level: α1-collagen, alkaline phosphatase, osteopontin, vinculin, and integrins α4, αV, β1 and β3. All in all, the results on cell mRNA analysis indicated that gene expression at 3h post-plating is too variable and no firm conclusions could be drawn. However, once the cells are given a chance to firmly adhere, at 24h, it became clear that: a) osteoblast cell identity is maintained, based on the fact that the expression of these characteristic matrix- and adhesion-related genes is properly maintained, albeit in various levels, b) in static conditions, the level of expression of the examined genes is lower in cells grown on nanotube-coated surface compared to cells grown on plastic, and c) in comparison to static conditions, mechanical stimulation enhances expression of these genes in osteoblasts grown on nanotubes, to attain robust levels of cell adherence gene mRNA expression. The results of the latter gene expression analysis are also compatible with total RNA quantities obtained, indirectly arguing firm osteoblast adhesion/survival on nanotubes under mechanical strain conditions. We therefore conclude that the novel carbon nanotubes assayed herein in lifelike mechanical stimulation conditions, constitute an appropriate cell-bearing surface, compatible with osteoblast survival, differentiation, growth and firm adherence to substrate. This work raises the possibility of using this novel material in the future to coat skeletal prostheses, in order to obtain improved osseointegration.

LFA-1 (Lymphocyte Function Associated antigen-1) est une intégrine centrale dans la fonction cytotoxique des lymphocytes T CD8+ car elle permet la formation de la synapse immunologique avec les cellules cibles. La régulation de cette interaction cellulaire est contrôlée par la qualité de l'engagement de LFA-1 avec son ligand ICAM-1 (Intracellular Adhesion Molecule-1). Un support clef au contrôle spatio-temporel de l'activation de LFA-1 est le cytosquelette d'actine corticale dans lequel est ancré LFA-1 par son domaine intracellulaire. Comment LFA-1 est organisée à la synapse immunologique et comment la coordination entre LFA-1 et cytosquelette d'actine s'opère de manière précise au sein des lymphocytes T CD8+ cytotoxiques sont des questions non résolues. Le but de ce projet de thèse a été d'étudier l'organisation précise de la distribution de LFA-1 à la synapse immunologique en relation avec l'actine corticale sous-jacente au contact entre lymphocytes T cytotoxiques et les cellules présentatrices d'antigènes. Pour ce faire, des approches de microscopies de super-résolution SIM (Structured Illumination Microscopy), dSTORM (direct STochastic Optical Reconstruction Microscopy) et TIRF (Total Internal Reflexion Fluorescence microscopy) ont été développées. Elles ont été appliquées à des lymphocytes T humains non transformés dérivés de contrôles sains et de patients atteints d'une immunodéficience congénitale, le Syndrome de Wiskott-Aldrich (WAS), caractérisé par un défaut de remodelage du cytosquelette d'actine à la synapse immunologique. L'emploi de l'approche de dSTORM en mode TIRF nous a permis de révéler que dans sa conformation activée, LFA-1 forme à la synapse une ceinture radiale composée de centaines de nano-clusters. L'intégrité du cytosquelette d'actine et notamment la protéine WASP s'avèrent importantes pour la formation de la ceinture de nano-clusters de LFA-1, comme le montre le défaut de formation de cette ceinture dans les lymphocytes de patients WAS. L'approche de SIM multi-couleur nous a permis de révéler le rôle de la ceinture de LFA-1 dans le confinement des granules lytiques. Par comparaison de marquages avec des anticorps spécifiques de différentes conformations de LFA-1, notre travail montre également que l'activation de LFA-1 s'opère de manière digitale, dans le sens où les nano-clusters fonctionnent comme des unités au sein desquelles l'activation de LFA-1 suit une loi du tout ou rien. En conclusion, ce travail de thèse démontre l'intérêt des approches de microscopie de super-résolution pour révéler des mécanismes clefs de l'activation des lymphocytes T et pour appréhender la nature des défauts à l'origine de dérèglements pathologiques de la fonction de ces cellules. / LFA-1 (Lymphocyte Function Associated antigen-1) is a central integrin in the function of cytotoxic CD8+ T lymphocytes since it allows the formation of the immunological synapse with target cells. The regulation of this cellular interaction is controlled by the quality of the engagement of LFA-1 with its ligand, ICAM-1 (Intracellular Adhesion Molecule- 1). A key support for the spatio-temporal control of LFA-1 activation is the cortical actin cytoskeleton in which LFA-1 is anchored by its intracellular domain. How LFA-1 is organized at the immunological synapse and how the coordination between LFA-1 and actin cytoskeleton operates accurately within cytotoxic CD8+ T lymphocytes are unresolved issues. The aim of this thesis project was to study the precise organization of the LFA-1 distribution at the immunological synapse in relation to the cortical actin underlying the contact between cytotoxic T lymphocytes and target cells. For this purpose, super-resolution microscopy approaches, including SIM (Structured Illumination Microscopy), dSTORM (direct STochastic Optical Reconstruction Microscopy) and TIRF (Total Internal Reflection Fluorescence microscopy) were developed. They were applied to untransformed human T lymphocytes derived from healthy donors and patients with a congenital immunodeficiency, the Wiskott-Aldrich Syndrome (WAS), characterized by actin cytoskeleton remodeling defects at the synapse. The use of the dSTORM approach revealed that activated LFA-1 forms a radial belt composed of hundreds of nanoclusters. The assembly of this belt depends on the integrity of the actin cytoskeleton, as shown by the impairment of this structure in the T lymphocytes derived from the WAS patients. The multi-color SIM approach allowed us to investigate the role of the LFA-1 belt in the confinement of lytic granules. Furthermore, the combination of staining with antibodies specific of LFA-1 conformation states shows that LFA-1 activation is a digital process, whereby nanoclusters operate as units in which LFA-1 activation follows an on / off rule. In conclusion, this PhD work exemplifies the great asset of super-resolution microscopy approaches to reveal key activation mechanisms in T lymphocytes and explore the nature of the defects causing pathological dysregulation of the function of these cells.

CXCR4, récepteur de la chimiokine SDF-1 (stromal cell-derived factor 1) joue un rôle capital dans l’hématopoïèse normale mais aussi dans la biologie de la cellule leucémique. Ce récepteur est exprimé à la surface des blastes et participe à « l’ancrage » de la cellule souche leucémique (CSL) au sein de la niche médullaire. Les interactions de la CSL avec le micro-environnement sont source de signaux de survie et de résistance à l’apoptose. La première partie de ce travail correspond à deux analyses en cytométrie en flux de l’expression de CXCR4 et de molécules d’adhérence sur des échantillons diagnostiques de LAM (leucémie aiguë myéloïde). Ce travail confirme la valeur pronostique péjorative de l’expression de CXCR4 et propose un modèle de stratification pronostique des patients, en fonction de leur phénotype d’adhérence. La deuxième partie s’intéresse à l’identification de potentielles cibles thérapeutiques dans un modèle de LAL à chromosome Philadelphie, pathologie au pronostic sombre malgré les progrès thérapeutiques liés aux ITK (inhibiteurs de tyrosine kinase). L’inhibition de CXCR4 par l’AMD3100 permet de potentialiser l’efficacité de l’aracytine et du dasatinib dans un modèle de co-culture stromale avec la lignée SUPB15. Une deuxième piste de ciblage thérapeutique de la LAL Phi+ est l’inhibition de la protéine chaperone HSP90. Une expression forte de HSP90 (dans les LAL Phi+ par rapport aux LAL Phi-) s’associe à une plus grande cytotoxicité du 17-AAG. En conclusion, CXCR4 est un récepteur clé de la cellule leucémique. L’étude de son niveau d’expression permet des stratifications pronostiques des patients et son blocage en fait une cible thérapeutique prometteuse / CXCR4, receptor of the chemokine SDF-1 (stromal cell-derived factor 1) plays a major role in the normal hematopoiesis but also in the biology of the leukaemic cell. This receptor is expressed on the surface of blasts and is a key molecule in "the anchoring" of the leukaemic stem cell (LSC) within the bone marrow niche. The interactions of the LSC with the bone marrow microenvironment promote survival signals and drug resistance. The first part of this work consists of two flow cytometry analyses of CXCR4 and adhesion molecules expression in patients with AML (acute myeloid leukaemia) at diagnosis. The results confirm that CXCR4 expression is associated with poor prognosis and this work proposes to stratify patients, according to their adhesive phenotype, in order to establish risk-adapted strategies. The second part deals with the identification of potential therapeutic targets in a model of ALL with chromosome Philadelphia. Despite therapeutic improvements with the ITK (tyrosine kinase inhibitors) era, long term survival remains poor. The inhibition of CXCR4 by the AMD3100 enhances the sensitivity of SUPB15 cell line to cytarabine and dasatinib therapy in a model of stromal co-culture. A second way of therapeutic targeting of the ALL Phi + is the inhibition of the heat-shock protein HSP90. High percentage of HSP90-positive cells (in Ph+ ALL samples) is associated with high sensitivity to 17-AAG. In conclusion, CXCR4 appears as a key receptor of the leukaemic cell. The analysis of its level of expression allows prognostic stratifications and its blockade represents a promising therapeutic target