The goals of the thesis were to, in pig models, (1) assess manganese-enhanced magnetic resonance imaging (MEMRI) in the characterization of acute and chronic ischemia-induced myocardial infarction (MI), (2) characterize cryoinjury-induced MI with contrast-enhanced MRI and optical methods, and (3) observe the effects of locally released angiogenic factors on the repair of cryoinjury-induced MI. Firstly, after acute MI was established by occlusion of the coronary artery branches, the pig hearts were isolated and mounted onto an ex vivo perfusion system inside a 7T magnet. After administration of MnCl2, T1-weighted MR images showed gradual enhancement of signal intensity within the normal myocardium, whereas the ischemic counterpart remained hypointense. During chronic MI progression, the intensity increased slowly after exposure to MnCl2 within the infarcted myocardium. Secondly, a new MI model was tested via direct 2-min contact of left ventricular epicardium with a liquid nitrogen-cooled aluminum bar. Subsequent in vivo Gd-enhanced MRI showed a uniform hypointense area (~10 mm in depth) surrounded by a hyperintense rim. Histology showed erythrocytes embolism within the cryolesion with a thin necrotic rim neighboring the normal myocardium. Four weeks later, the cryoinjured myocardium was replaced by scar tissue. Thirdly, in vivo MEMRI was tested on this cryoinjury model. After intravenous administration of MnCl2 via intermittent bolus or continuous infusion, normal myocardium showed prolonged hyperintense, which led to significant signal contrast between it and cryoinjured myocardium. Continuous infusion scheme minimized hemodynamic fluctuation. Finally, angiogenic therapy was assessed by anchoring of vascular growth factors-loaded alginate beads or adipose-derived stem cells (ADSCs)-loaded agarose patch on top of the cryoinjured myocardium. Gd-enhanced MRI revealed (1) growth of new tissue wrapping the growth factors-loaded alginate beads and (2) higher perfusion within the ADSCs-treated cryoinjured myocardium as compared with the growth factors-treated counterpart. Histological and fluorescent microsphere examination revealed that ADSCs induced more significant growth of mature microvasculature within the cryoinjured myocardium. These results indicate that MnCl2 could characterize MI ex vivo and in vivo. Epicardial implantation of ADSCs-loaded agarose hydrogel can induce angiogenesis within the cryoinjured myocardium, a form of MI with similar progression features as that induced by ischemia.

The goals of the thesis were to, in pig models, (1) assess manganese-enhanced magnetic resonance imaging (MEMRI) in the characterization of acute and chronic ischemia-induced myocardial infarction (MI), (2) characterize cryoinjury-induced MI with contrast-enhanced MRI and optical methods, and (3) observe the effects of locally released angiogenic factors on the repair of cryoinjury-induced MI. Firstly, after acute MI was established by occlusion of the coronary artery branches, the pig hearts were isolated and mounted onto an ex vivo perfusion system inside a 7T magnet. After administration of MnCl2, T1-weighted MR images showed gradual enhancement of signal intensity within the normal myocardium, whereas the ischemic counterpart remained hypointense. During chronic MI progression, the intensity increased slowly after exposure to MnCl2 within the infarcted myocardium. Secondly, a new MI model was tested via direct 2-min contact of left ventricular epicardium with a liquid nitrogen-cooled aluminum bar. Subsequent in vivo Gd-enhanced MRI showed a uniform hypointense area (~10 mm in depth) surrounded by a hyperintense rim. Histology showed erythrocytes embolism within the cryolesion with a thin necrotic rim neighboring the normal myocardium. Four weeks later, the cryoinjured myocardium was replaced by scar tissue. Thirdly, in vivo MEMRI was tested on this cryoinjury model. After intravenous administration of MnCl2 via intermittent bolus or continuous infusion, normal myocardium showed prolonged hyperintense, which led to significant signal contrast between it and cryoinjured myocardium. Continuous infusion scheme minimized hemodynamic fluctuation. Finally, angiogenic therapy was assessed by anchoring of vascular growth factors-loaded alginate beads or adipose-derived stem cells (ADSCs)-loaded agarose patch on top of the cryoinjured myocardium. Gd-enhanced MRI revealed (1) growth of new tissue wrapping the growth factors-loaded alginate beads and (2) higher perfusion within the ADSCs-treated cryoinjured myocardium as compared with the growth factors-treated counterpart. Histological and fluorescent microsphere examination revealed that ADSCs induced more significant growth of mature microvasculature within the cryoinjured myocardium. These results indicate that MnCl2 could characterize MI ex vivo and in vivo. Epicardial implantation of ADSCs-loaded agarose hydrogel can induce angiogenesis within the cryoinjured myocardium, a form of MI with similar progression features as that induced by ischemia.

A descoberta das células tronco adultas tornou possível a sua aplicação clínica em protocolos de medicina regenerativa e de engenharia de tecidos para a reparação de órgãos danificados ou pouco funcionais. Neste sentido, são conhecidas muitas fontes diferentes de células tronco adultas, entre elas o tecido epitelial, o tecido muscular e a medula óssea. Recentemente, o tecido adiposo adulto foi reconhecido como uma fonte alternativa, acessível e rica em células tronco mesenquimais (MSCs), também denominadas de células tronco derivadas do tecido adiposo (hADSCs). As hADSCs são as células tronco adultas que apresentam a maior plasticidade, e são facilmente isoladas pela característica de aderência a substratos plásticos. Sob condições específicas de cultivo, as hADSCs podem diferenciar-se em células precursoras osteoblásticas. Dentre as proteínas necessárias para a diferenciação das hADSCs, o papel do complexo minichromosome maintenance (MCM) não é muito bem conhecido. A proteína MCM2 é parte do complexo MCM, fazendo parte do complexo pré-replicativo (pre-RC). Em células proliferativas, o gene MCM2 apresenta alta expressão, sendo que o seu produto gênico está relacionado com os mecanismos de reparação de DNA. Sendo assim, analisamos as mudanças na expressão do gene MCM2 durante a osteodiferenciação das hADSCs em diferentes meios de cultura, contendo BMP-4 ou OM. Os genes relacionados com a osteodiferenciação, como osteocalcina (OC), osteopontina (OP) e fosfatase alcalina (ALP) foram analisados por RT-PCR, por PCR em tempo real e citoquímica. Os dados obtidos pelas técnicas citoquímicas e de biologia molecular indicaram uma diminuição da expressão do gene MCM2 durante a osteodiferenciação, que pode estar relacionada com danos ao DNA ou senescência nas hADSCs. / The discovery of adult stem cells is a promise field in regenerative medicine and tissue engineering. There are many sources of adult stem cells among which of whom are the skin, muscle and bone marrow. Currently, the adipose tissue has been an alternative source of mesenchymal stem cells (MSCs), termed human adipose-derived stem cells (hADSCs). The MSCs are the most plastic adult stem cells known until now and are easily isolated by adherence in plastic substrates. Under specifics conditions of culture hADSCs can be differentiated in osteoblast cell precursors. Among proteins needed for hADSCs differentiation, the roles of minichromosome maintenance (MCM) complex remains poorly understood. The protein complex MCM2-7 is part of DNA pre-replicative complex (pre-RC), being abundant in proliferating cells and involved in DNA repair mechanisms. In this sense, the Mcm2 is essential for the activity of the MCM complex. Thus, we analysed MCM2 gene expression changes during osteoinduction by culturing hADSCs in different media containing BMP-4 or in osteogenic medium. Genes related to osteodifferentiation, like osteocalcin (OC), osteopontin (OP) and alkaline phosphatase (ALP) were analysed by molecular and cytochemistry approaches during osteodifferentiation. Interestingly, we observed a decrease in the MCM2 gene level osteoinduction of hADSCs in osteogenic medium, which could be related to an increase in genome damage and senescence in hADSCs.

A descoberta das células tronco adultas tornou possível a sua aplicação clínica em protocolos de medicina regenerativa e de engenharia de tecidos para a reparação de órgãos danificados ou pouco funcionais. Neste sentido, são conhecidas muitas fontes diferentes de células tronco adultas, entre elas o tecido epitelial, o tecido muscular e a medula óssea. Recentemente, o tecido adiposo adulto foi reconhecido como uma fonte alternativa, acessível e rica em células tronco mesenquimais (MSCs), também denominadas de células tronco derivadas do tecido adiposo (hADSCs). As hADSCs são as células tronco adultas que apresentam a maior plasticidade, e são facilmente isoladas pela característica de aderência a substratos plásticos. Sob condições específicas de cultivo, as hADSCs podem diferenciar-se em células precursoras osteoblásticas. Dentre as proteínas necessárias para a diferenciação das hADSCs, o papel do complexo minichromosome maintenance (MCM) não é muito bem conhecido. A proteína MCM2 é parte do complexo MCM, fazendo parte do complexo pré-replicativo (pre-RC). Em células proliferativas, o gene MCM2 apresenta alta expressão, sendo que o seu produto gênico está relacionado com os mecanismos de reparação de DNA. Sendo assim, analisamos as mudanças na expressão do gene MCM2 durante a osteodiferenciação das hADSCs em diferentes meios de cultura, contendo BMP-4 ou OM. Os genes relacionados com a osteodiferenciação, como osteocalcina (OC), osteopontina (OP) e fosfatase alcalina (ALP) foram analisados por RT-PCR, por PCR em tempo real e citoquímica. Os dados obtidos pelas técnicas citoquímicas e de biologia molecular indicaram uma diminuição da expressão do gene MCM2 durante a osteodiferenciação, que pode estar relacionada com danos ao DNA ou senescência nas hADSCs. / The discovery of adult stem cells is a promise field in regenerative medicine and tissue engineering. There are many sources of adult stem cells among which of whom are the skin, muscle and bone marrow. Currently, the adipose tissue has been an alternative source of mesenchymal stem cells (MSCs), termed human adipose-derived stem cells (hADSCs). The MSCs are the most plastic adult stem cells known until now and are easily isolated by adherence in plastic substrates. Under specifics conditions of culture hADSCs can be differentiated in osteoblast cell precursors. Among proteins needed for hADSCs differentiation, the roles of minichromosome maintenance (MCM) complex remains poorly understood. The protein complex MCM2-7 is part of DNA pre-replicative complex (pre-RC), being abundant in proliferating cells and involved in DNA repair mechanisms. In this sense, the Mcm2 is essential for the activity of the MCM complex. Thus, we analysed MCM2 gene expression changes during osteoinduction by culturing hADSCs in different media containing BMP-4 or in osteogenic medium. Genes related to osteodifferentiation, like osteocalcin (OC), osteopontin (OP) and alkaline phosphatase (ALP) were analysed by molecular and cytochemistry approaches during osteodifferentiation. Interestingly, we observed a decrease in the MCM2 gene level osteoinduction of hADSCs in osteogenic medium, which could be related to an increase in genome damage and senescence in hADSCs.

Clinically, injuries affecting the spinal cord or peripheral nerves can leave those affected with severe disability and, at present, there are limited options for treatment. Peripheral nerve injury with a significant gap between the proximal and distal stumps is currently treated with autologous nerve grafting but this is limited by availability of donor nerve and has associated morbidities. In contrast, injuries to the spinal cord lead to an inhibitory environment caused by the glial cells and thereby, limit potential axonal regeneration. This thesis investigates the effects of human adipose derived stem cells (ASC) on regeneration after peripheral nerve and spinal cord injury in adult rats. Human ASC expressed various neurotrophic molecules and growth factor stimulation of the cells in vitro resulted in increased secretion of BDNF, GDNF, VEGF-A and angiopoietin-1 proteins. Stimulated ASC also showed an enhanced ability to induce capillary-like tube formation in an in vitro angiogenesis assay. In contrast to Schwann cells, ASC did not induce activation of astrocytes and supported neurite outgrowth from the adult rat sensory DRG neurons in culture. In a peripheral nerve injury model, ASC were seeded into a fibrin conduit, which was used to bridge a 10 mm rat sciatic nerve gap. After 2 weeks, ASC enhanced GAP-43 and ATF-3 expression in the spinal cord, reduced c-jun expression in the DRG and increased the vascularity of the fibrin nerve conduits. The animals treated with stimulated ASC showed an enhanced axon regeneration and reduced caspase-3 expression in the DRG. After transplantation into the injured C3-C4 cervical spinal cord. ASC continued to express neurotrophic factors and laminin and stimulated extensive ingrowths of 5HT-positive raphaespinal axons into the trauma zone. In addition, ASC induced sprouting of raphaespinal terminals in C2 contralateral ventral horn and C6 ventral horn on both sides. Transplanted cells also changed the structure and the density of the astroglial scar. Although the transplanted cells had no effect on the density of capillaries around the lesion site, the reactivity of OX42-positive microglial cells was markedly reduced.

A descoberta das células tronco adultas tornou possível a sua aplicação clínica em protocolos de medicina regenerativa e de engenharia de tecidos para a reparação de órgãos danificados ou pouco funcionais. Neste sentido, são conhecidas muitas fontes diferentes de células tronco adultas, entre elas o tecido epitelial, o tecido muscular e a medula óssea. Recentemente, o tecido adiposo adulto foi reconhecido como uma fonte alternativa, acessível e rica em células tronco mesenquimais (MSCs), também denominadas de células tronco derivadas do tecido adiposo (hADSCs). As hADSCs são as células tronco adultas que apresentam a maior plasticidade, e são facilmente isoladas pela característica de aderência a substratos plásticos. Sob condições específicas de cultivo, as hADSCs podem diferenciar-se em células precursoras osteoblásticas. Dentre as proteínas necessárias para a diferenciação das hADSCs, o papel do complexo minichromosome maintenance (MCM) não é muito bem conhecido. A proteína MCM2 é parte do complexo MCM, fazendo parte do complexo pré-replicativo (pre-RC). Em células proliferativas, o gene MCM2 apresenta alta expressão, sendo que o seu produto gênico está relacionado com os mecanismos de reparação de DNA. Sendo assim, analisamos as mudanças na expressão do gene MCM2 durante a osteodiferenciação das hADSCs em diferentes meios de cultura, contendo BMP-4 ou OM. Os genes relacionados com a osteodiferenciação, como osteocalcina (OC), osteopontina (OP) e fosfatase alcalina (ALP) foram analisados por RT-PCR, por PCR em tempo real e citoquímica. Os dados obtidos pelas técnicas citoquímicas e de biologia molecular indicaram uma diminuição da expressão do gene MCM2 durante a osteodiferenciação, que pode estar relacionada com danos ao DNA ou senescência nas hADSCs. / The discovery of adult stem cells is a promise field in regenerative medicine and tissue engineering. There are many sources of adult stem cells among which of whom are the skin, muscle and bone marrow. Currently, the adipose tissue has been an alternative source of mesenchymal stem cells (MSCs), termed human adipose-derived stem cells (hADSCs). The MSCs are the most plastic adult stem cells known until now and are easily isolated by adherence in plastic substrates. Under specifics conditions of culture hADSCs can be differentiated in osteoblast cell precursors. Among proteins needed for hADSCs differentiation, the roles of minichromosome maintenance (MCM) complex remains poorly understood. The protein complex MCM2-7 is part of DNA pre-replicative complex (pre-RC), being abundant in proliferating cells and involved in DNA repair mechanisms. In this sense, the Mcm2 is essential for the activity of the MCM complex. Thus, we analysed MCM2 gene expression changes during osteoinduction by culturing hADSCs in different media containing BMP-4 or in osteogenic medium. Genes related to osteodifferentiation, like osteocalcin (OC), osteopontin (OP) and alkaline phosphatase (ALP) were analysed by molecular and cytochemistry approaches during osteodifferentiation. Interestingly, we observed a decrease in the MCM2 gene level osteoinduction of hADSCs in osteogenic medium, which could be related to an increase in genome damage and senescence in hADSCs.

Traumatic injuries resulting in peripheral nerve lesions often require a graft to bridge the gap. Although autologous nerve graft is still the first choice strategy in reconstructions, it has the severe disadvantage of the sacrifice of a functional nerve. Cell transplantation in a bioartificial conduit is an alternative strategy to create a favourable environment for nerve regeneration. Among adult stem cells, adipose-derived stem cells (ASC) are a useful tool in regenerative medicine as they can be induced towards multiple mesodermal and nonmesodermal lineages, being recently differentiated into cells showing Schwann cell-like morphology, glial cell markers and increased neurotrophic potential. The first two chapters of this work describe in vivo applications of Schwann cell-like differentiated ASC (dASC), seeded into biodegradable nerve guides made of fibrin, investigating both brief (2 weeks) and long (4 months) term effects on the regenerating nerves. Comparison was carried out with similarly differentiated bone marrow mesenchymal stem cells (dMSC), Schwann cells (SC)and empty fibrin conduits, as well as with autologous nerve grafts. Regeneration was evaluated in a 1cm gap total axotomy sciatic nerve injury model on rats. Results showed that dASC could improve regeneration distance in a similar manner to other regenerative cells inthe brief term. This effect was maintained and strengthened in the long term, where nerve morphology, spinal motoneurons regeneration, protection from muscle atrophy and electrophysiological performances of regenerated nerves were analysed. dASC positive effects lasted in the long term with functional results comparable to the autologous nerve grafts, which served as controls. The third chapter focuses on the possibility to further improve dASC regenerative performances using fibronectin and laminin, two key extracellular matrix (ECM) molecules involved in nerve regeneration, with the future aim to optimize cell host, directional cues and neurotrophism of tissue engineered conduits. Fibronectin and laminin protected dASC from stress-induced cell death in vitro, significantly increasing cell adhesion and viability. Laminin significantly improved neurotrophic properties of dASC enhancing neurite outgrowth of both primary sensory neurons and NG108-15 neurons co-cultured with dASC, suggesting a further activation of the neurotrophic effect of dASC by ECM molecules. These improved effects were increased when a direct contact was established between the laminin substrate, dASC and neurons, suggesting a primary role of laminin in contact signalling, finally boosting the neurotrophic potential of dASC. Further studies will be needed to clarify the interactions between dASC and the complexniche of peripheral nerve regeneration, including the ECM molecules. However, the neurotrophic potential of dASC expressed in both in vitro and in vivo experiments opens wide perspectives in tissue engineering applications among new methods to enhance peripheral nerve repair.

Magister Chirurgiae Dentium (MChD) / Oral submucous fibrosis (OSMF) is a chronic disorder characterized by the fibrosis of the mucosal lining of the upper digestive tract involving the oral cavity, oropharynx, hypopharynx and the upper third of the oesophagus. Areca nut chewing has been implicated in the aetiology of this condition. This condition is prevalent in Kwa-Zulu Natal (KZN), South Africa, with many patients suffering from varying degrees of severity of this disease. At Inkosi Albert Luthuli Central Hospital autogenous fat injections into the fibrous bands are being used as a means of treating OSMF. Anecdotal evidence suggested that this type of treatment modality helps to relieve the symptoms experienced by patients. There is no scientific data supporting this claim. The aim of the study was to establish the effectiveness of intralesional autogenous fat injections in patients with oral submucous fibrosis. The objectives of this study was to record the demographic details and medical information of the patients, evaluate the inter-incisal mouth opening, to assess the presence or absence of restricted tongue movements, record pain of the patients and record quality of life via a condition specific questionnaire prior to treatment and at six months post operatively

Radiotherapy has major therapeutic benefits for cancer patients, but ionizing radiation causes damage of surrounding healthy tissues with poor wound healing a common side effect. Therefore, further oncoplastic, reconstructive surgery is challenging and often problematic. Current research models use normal human dermal fibroblasts irradiated in vitro to mimic radiation damage, but this is not comparable to ionising radiation and only measures acute changes. Since radiotherapy may induce epigenetic changes leading to alterations in dermal fibroblast phenotype, the first aim of this study was to compare fibroblasts cultured from irradiated skin with non-irradiated skin. As mesenchymal stem cells isolated from adipose tissue may offer beneficial effects in the regenerative capacity of irradiated tissue, the second part of this study was to compare those cultured from non-irradiated and irradiated breast tissue. Histological changes in the structural organisation of breast tissue in situ from donors exposed to radiotherapy was compared to untreated breast. Primary cultures of dermal fibroblasts from irradiated and non-irradiated breast skin were established and comparisons quantitated in proliferation (CyQuant), metabolism (Alamar Blue), migration (scratch-wound assay), collagen production (Sircol), levels of proteases and protease inhibitors (human protease/protease inhibitor array) and gene expression of COL1A1, COL3A1, MMP1, MMP2, TIMP1 and PPAR-γ mRNA (qPCR). Cells from the stromal vascular fraction (SVF) were cultured and characterised by immunocytochemistry and compared to human preadipocytes sourced commercially. The secretion of FGF, adiponectin and VEGF by the preadipocyte and the SVF mesenchymal cells was compared and the ability of their secretome to modulate dermal fibroblast proliferation, metabolism and migration was evaluated. Radiotherapy caused extensive disorganisation of the reticular dermis and flattening of the epidermal-dermal junction. Dermal fibroblasts cultured from irradiated skin had a pronounced spindle shaped morphology with longer thinner projections and took approximately twice as long to explant and grow. They had a lower proliferative and higher basal metabolic rate and did not respond to FGF-2. While they secreted similar amounts of total collagen they demonstrated distinct differences in proteolytic enzyme and protease inhibitor expression. This is the first report to culture cells from the SVF of irradiated breast tissue. The cells expressed the preadipocyte markers CD10, CD73 and CD105 and no CD45 (negative marker). SVF cells cultured displayed a typical ASC fibroblastoid morphology. Analysis of the secretome identified the presence of FGF, adiponectin and VEGF, while functional analysis demonstrated a stimulatory effect on normal dermal fibroblast migration, although irradiated dermal fibroblasts were unresponsive. Radiotherapy induces long term, detrimental changes in breast skin. This is the first quantitative characterisation of dermal fibroblasts and mesenchymal cells from the SVF, subjected to ionising radiation in situ. Changes in their phenotype that alter their function will impact on wound healing. Further characterisation of these cells may explain their dysfunctional behaviour, and lead to therapies to reverse or reduce this deleterious side-effect and significantly improve treatments facilitating wound healing following radiation injury. / Plastic Surgery and Burns Research unit

No description available.