Diversos estudos tem demonstrado que as células-tronco mesenquimais (CTM) são imbuídas de uma forte atividade imunossupressora in vitro, no entanto, os resultados de imunoterapias utilizando CTM têm sido variáveis até o momento. Nossa hipótese para tal variação são interações que devem ocorrer entre as CTM e fragmentos de patógenos circulantes nos pacientes, resultando na modulação da atividade imunossupressora. Para avaliar a ocorrência deste fenômeno em CTM de medula óssea, inicialmente foi avaliado a presença de diversos TLR através da marcação com anticorpos e posterior quantificação por citometria de fluxo, sendo observada a presença dos TLR2, TLR3, TLR4 e TLR9. No intuito de avaliar alterações no potencial imunossupressor, linfócitos T ativados e marcados a nível intracelular foram co-cultivados com CTM estimuladas com LPS, POLY IC e oligonucleotídeos com motivos CpG: DSP30, CpG-A e CpG-B, sendo sua proliferação quantificada por citometria de fluxo. Como resultados, foi observado que a estimulação com LPS e DSP30 levaram a perda e acentuação da capacidade supressora, respectivamente, enquanto o estímulo simultâneo com LPS e DSP30 resultou em sua manutenção. Tais modulações na imunossupressão foram corroboradas ao serem avaliadas modulações na expressão gênica, tendo em vista que o estímulo por LPS e DSP30 induziram no aumento da expressão de IL1 e TGF, respectivamente. Em seguida, foi avaliado o efeito das mesmas condições experimentais na indução a proliferação das CTM, ao ser mensurada alterações na quantidade de células em um equipamento de High content Screening (HCS). Como resultados, foi possível observar que somente o tratamento com DSP30 foi capaz de aumentar significativamente a quantidade de células, fenômeno corroborado ao ser mensurada a síntese de DNA, através da utilização de um produto comercial, seguido de análise por citometria de fluxo. No intuito de avaliar possíveis modulações na via NF-B, CTM estimuladas com LPS ou DSP30 foram sujeitas ao ensaio de imunoprecipitação de cromatina, utilizando anticorpos específicos a subunidades de RelA e RelB, sendo o DNA imunoprecipitado sujeito a PCR quantitativo com primers específicos para a regiões promotoras do gene VCAM-1. Como resultados, foi observado que o estímulo com LPS aumentou a atividade do RelA, enquanto não foram observados efeitos após o estímulo com DSP30. No entanto, o estímulo simultâneo com ambos os ligantes levou ao aumento de atividade de RelA e RelB. Ao serem avaliadas estas condições em um ensaio de imunofluorescência analisado em HCS, foi possível observar maiores níveis da proteína RelB no citoplasma das células tratadas com DSP30, sugerindo um aumento da sua formação. Apesar dos mecanismos moleculares subjacentes aos resultados observados ainda necessitarem de maior elucidação, nosso trabalho indica que a estimulação das CTM com DSP30 pode trazer benefícios no sentido de potencializar a imunossupressão e proliferação celular, além de impedir a perda da imunossupressão, decorrente da interação com LPS. Tais resultados poderão servir como diretrizes para o aprimoramento de imunoterapias utilizando CTM de medula óssea, principalmente em casos de pacientes com infecções por patógenos. / Several studies have shown that mesenchymal stem cells (MSCs ) are imbued with a strong immunosuppressive activity in vitro , however , the results of immunotherapies using CTM has been mixed so far. Our hypothesis for this variation are interactions that must occur between the CTM and fragments of circulating pathogens in patients , resulting in the modulation of the immunosuppressive activity. To evaluate the occurrence of this phenomenon in bone marrow MSCs was initially evaluated the presence of various TLR by staining with antibodies and subsequent quantification by flow cytometry , the presence of TLR2 , TLR3 , TLR4 and TLR9 was observed . To assess changes in the immunosuppressive , activated T lymphocytes and labeled intracellularly potential were co-cultured with MSC stimulated with LPS , poly IC and oligonucleotides with CpG motifs : DSP30 , CpG - A and CpG - B , and their proliferation measured by flow cytometry. As a result , it was observed that stimulation with LPS and DSP30 led to loss of stress and suppressing ability , respectively, while simultaneous stimulation with LPS and DSP30 resulted in maintenance. Such modulations in immunosuppression were corroborated when assessing modulations in gene expression , given that the stimulus induced by LPS and DSP30 in increased expression of TGFb and IL1 , respectively. Then , the effect of the same experimental conditions inducing proliferation of MTC to be measured changes in the amount of cells in a High Content Screening equipment (HCS ) was measured . As a result , it was observed that only the DSP30 treatment was able to significantly increase the amount of cells, phenomenon to be measured supported DNA synthesis through the use of a commercial product followed by analysis by flow cytometry . In order to evaluate possible modulations in NF-kB pathway , CTM stimulated with LPS or DSP30 were subjected to chromatin immunoprecipitation assay , using antibodies specific to subunits RelA and RelB , and the immunoprecipitated DNA subjected to quantitative PCR with primers specific to the promoter regions of VCAM-1 gene. As a result , it was observed that stimulation with LPS increased the activity of RelA , while effects were not observed after stimulation with DSP30 . However , simultaneous stimulation with both ligands led to increased activity of RelA and RelB . When these conditions are evaluated in an assay in HCS immunofluorescence analysis , we observed higher levels of RelB protein in the cytoplasm of cells treated with DSP30 , suggesting an increase in their formation. Although the molecular mechanisms underlying the observed results still require further elucidation , our work indicates that stimulation of MSC with DSP30 can bring benefits in terms of enhancing immunosuppression and cell proliferation , and prevent loss of immunosuppression resulting from the interaction with LPS . These results can serve as guidelines for the improvement of immunotherapies using CTM bone marrow , especially in cases of patients with infections caused by pathogens.

Diversos estudos tem demonstrado que as células-tronco mesenquimais (CTM) são imbuídas de uma forte atividade imunossupressora in vitro, no entanto, os resultados de imunoterapias utilizando CTM têm sido variáveis até o momento. Nossa hipótese para tal variação são interações que devem ocorrer entre as CTM e fragmentos de patógenos circulantes nos pacientes, resultando na modulação da atividade imunossupressora. Para avaliar a ocorrência deste fenômeno em CTM de medula óssea, inicialmente foi avaliado a presença de diversos TLR através da marcação com anticorpos e posterior quantificação por citometria de fluxo, sendo observada a presença dos TLR2, TLR3, TLR4 e TLR9. No intuito de avaliar alterações no potencial imunossupressor, linfócitos T ativados e marcados a nível intracelular foram co-cultivados com CTM estimuladas com LPS, POLY IC e oligonucleotídeos com motivos CpG: DSP30, CpG-A e CpG-B, sendo sua proliferação quantificada por citometria de fluxo. Como resultados, foi observado que a estimulação com LPS e DSP30 levaram a perda e acentuação da capacidade supressora, respectivamente, enquanto o estímulo simultâneo com LPS e DSP30 resultou em sua manutenção. Tais modulações na imunossupressão foram corroboradas ao serem avaliadas modulações na expressão gênica, tendo em vista que o estímulo por LPS e DSP30 induziram no aumento da expressão de IL1 e TGF, respectivamente. Em seguida, foi avaliado o efeito das mesmas condições experimentais na indução a proliferação das CTM, ao ser mensurada alterações na quantidade de células em um equipamento de High content Screening (HCS). Como resultados, foi possível observar que somente o tratamento com DSP30 foi capaz de aumentar significativamente a quantidade de células, fenômeno corroborado ao ser mensurada a síntese de DNA, através da utilização de um produto comercial, seguido de análise por citometria de fluxo. No intuito de avaliar possíveis modulações na via NF-B, CTM estimuladas com LPS ou DSP30 foram sujeitas ao ensaio de imunoprecipitação de cromatina, utilizando anticorpos específicos a subunidades de RelA e RelB, sendo o DNA imunoprecipitado sujeito a PCR quantitativo com primers específicos para a regiões promotoras do gene VCAM-1. Como resultados, foi observado que o estímulo com LPS aumentou a atividade do RelA, enquanto não foram observados efeitos após o estímulo com DSP30. No entanto, o estímulo simultâneo com ambos os ligantes levou ao aumento de atividade de RelA e RelB. Ao serem avaliadas estas condições em um ensaio de imunofluorescência analisado em HCS, foi possível observar maiores níveis da proteína RelB no citoplasma das células tratadas com DSP30, sugerindo um aumento da sua formação. Apesar dos mecanismos moleculares subjacentes aos resultados observados ainda necessitarem de maior elucidação, nosso trabalho indica que a estimulação das CTM com DSP30 pode trazer benefícios no sentido de potencializar a imunossupressão e proliferação celular, além de impedir a perda da imunossupressão, decorrente da interação com LPS. Tais resultados poderão servir como diretrizes para o aprimoramento de imunoterapias utilizando CTM de medula óssea, principalmente em casos de pacientes com infecções por patógenos. / Several studies have shown that mesenchymal stem cells (MSCs ) are imbued with a strong immunosuppressive activity in vitro , however , the results of immunotherapies using CTM has been mixed so far. Our hypothesis for this variation are interactions that must occur between the CTM and fragments of circulating pathogens in patients , resulting in the modulation of the immunosuppressive activity. To evaluate the occurrence of this phenomenon in bone marrow MSCs was initially evaluated the presence of various TLR by staining with antibodies and subsequent quantification by flow cytometry , the presence of TLR2 , TLR3 , TLR4 and TLR9 was observed . To assess changes in the immunosuppressive , activated T lymphocytes and labeled intracellularly potential were co-cultured with MSC stimulated with LPS , poly IC and oligonucleotides with CpG motifs : DSP30 , CpG - A and CpG - B , and their proliferation measured by flow cytometry. As a result , it was observed that stimulation with LPS and DSP30 led to loss of stress and suppressing ability , respectively, while simultaneous stimulation with LPS and DSP30 resulted in maintenance. Such modulations in immunosuppression were corroborated when assessing modulations in gene expression , given that the stimulus induced by LPS and DSP30 in increased expression of TGFb and IL1 , respectively. Then , the effect of the same experimental conditions inducing proliferation of MTC to be measured changes in the amount of cells in a High Content Screening equipment (HCS ) was measured . As a result , it was observed that only the DSP30 treatment was able to significantly increase the amount of cells, phenomenon to be measured supported DNA synthesis through the use of a commercial product followed by analysis by flow cytometry . In order to evaluate possible modulations in NF-kB pathway , CTM stimulated with LPS or DSP30 were subjected to chromatin immunoprecipitation assay , using antibodies specific to subunits RelA and RelB , and the immunoprecipitated DNA subjected to quantitative PCR with primers specific to the promoter regions of VCAM-1 gene. As a result , it was observed that stimulation with LPS increased the activity of RelA , while effects were not observed after stimulation with DSP30 . However , simultaneous stimulation with both ligands led to increased activity of RelA and RelB . When these conditions are evaluated in an assay in HCS immunofluorescence analysis , we observed higher levels of RelB protein in the cytoplasm of cells treated with DSP30 , suggesting an increase in their formation. Although the molecular mechanisms underlying the observed results still require further elucidation , our work indicates that stimulation of MSC with DSP30 can bring benefits in terms of enhancing immunosuppression and cell proliferation , and prevent loss of immunosuppression resulting from the interaction with LPS . These results can serve as guidelines for the improvement of immunotherapies using CTM bone marrow , especially in cases of patients with infections caused by pathogens.

Fundação de Amparo a Pesquisa do Estado de Minas Gerais / Doutor em Genética e Bioquímica / CHAPTER II: Purpose: We performed a meta-analysis of randomized trials to assess the effect of metformin on inflammatory markers and metabolic parameters in subjects with diabetes. Methods: We performed comprehensive searches on NCBI, Cochrane, Science Direct databases from 1966 to Jun of 2015. We included randomized trials of at least 4 weeks duration that compared groups with diabetes before and after the treatment with metformin or metformin plus other drugs, and evaluated body mass index, blood glucose, HbA1c and inflammatory parameters such as C-reactive protein, tumor necrosis factor and adiponectin. Results: Pooled results of the 26 trials, with 1760 participants at the end of treatment reduce BMI in 0.9% p=0,0043, as well as, decrease of blood glucose level [SMD -0,411 mg/dL, 95%CI -0,463 to -0,369, I2= 56.62%], HbA1c [SMD -0.479%, 95%CI -0,568 to -0,390, I2= 55.02%], CRP levels [SMD -0,274mg/dL, 95%CI -0,419 to -0,129, I2= 72.78%], TNFα concentration [SMD -0,103pg/ml, 95%CI -0,514 to 0,309, I2= 87.67%] and increase of adiponectin [SMD 0,171μg/ml, 95%CI 0,098 to 0,440, I2= 81.09%] compared with pretreatment. Conclusion: The long-treatment with metformin monotherapy or metformin plus other drugs improves metabolic parameters and induced changes in inflammatory markers in diabetic subject. CHAPTER III: Background: Metformin increases insulin sensitivity by decreasing hepatic glucose production and increasing glucose disposal in skeletal muscle. However, modulation of inflammatory response and CaMKKβ/AMPK/Myosin V activation in gastrocnemius muscle by metformin treatment has not been demonstrated in hypoinsulinemic diabetic rats. Objective: The present study investigated how the metformin improve insulin sensitivity in skeletal muscle of hypoinsulinemic diabetic rats. Methods: Diabetes was induced by streptozotocin (45 mg/kg, intraperitoneally) 10 days prior treatments. On 11th day, diabetic rats were treated with metformin (500 mg/kg, oral gavage), insulin (2U at 08:00 h and 4U at 17:00 h, subcutaneously) or untreated. After 20 days, glycemia was measured and insulin sensitivity was determined by KITT. Serum Insulin, GLUT4, IRSthr, inflammatory markers (NF-κB, IκB, TNF-α and p-JNK) and CAMKK, AMPK and Myosin V in gastrocnemius muscle were determined by ELISA. Results: As expected, insulin and metformin improved the insulin sensitivity. Besides, metformin treatment promoted reduction in inflammatory response mediated by NF-κB, IκB, TNF-α and p-JNK, and that was accompanied by increased CaMKKβ/AMPK/Myosin V/GLUT4 pathway activity in gastrocnemius muscle of diabetic rats. Conclusion: Our findings suggest that metformin induces significant reductions in several inflammatory markers in skeletal muscle of diabetic rats. Metformin-induced increase in CaMKKβ/AMPK/Myosin V/GLUT4 pathway activity was associated with higher insulin sensitivity. CHAPTER IV: Diabetes is characterized by a proinflammatory state which can activate TLR2 and TLR4, and these receptors could induce NF-κB and JNK activation in skeletal muscle. In this study, we investigated the inflammatory and apoptotic signaling pathways triggered by TLRs/NF-κB and JNK activation in skeletal muscle of diabetic rats treated with metformin before and after an insulin tolerance test. Metformin treatment decreased p-JNK and NF-κB, and increased IκB concentrations. This attenuation leads to a decrease of TNFα and CXCL1/KC, and an increase of p-AMPK, BAX and Bcl2 concentration. Furthermore, KITT revealed an improvement of the insulin sensitivity in the diabetic rats treated with metformin. In addition, metformin was not capable of attenuating the changes in the inflammatory pathway triggered by insulin injection as the increase of TNFα and TLR4 in metformin treated rats, and IκB, CXCL1/KC, TNFα and p-AMPK increase in the untreated group. Taken together, these results point out that metformin may attenuate the activation of the inflammatory pathway TLRs/NF-κB/TNFα/CXCL1/KC and the apoptotic signaling BAX/Bcl2/p-JNK, which could be accompanied by a reduction of the inflammatory damage caused by hyperglycemia and an improvement of insulin sensitivity in diabetic rats.