Le tissu osseux est caractérisé par sa matrice minéralisée qui est soumise à des activités de formation et de résorption assurant son renouvellement et son remaniement tout au long de la vie. En cas de lésions, l’os est capable de se réparer naturellement de façon à rétablir son intégrité et ses propriétés physiques. Cependant, certaines pathologies ou interventions chirurgicales peuvent aboutir à des pertes massives de substance osseuse et le processus naturel d’autoréparation est alors insuffisant. En première intention, la greffe osseuse est envisagée (autogreffe et allogreffe), néanmoins, du fait d’une disponibilité réduite et des risques de rejet et de transmission d’agents infectieux, cette technique n’est pas réalisable dans toutes les situations cliniques. Le chirurgien peut alors avoir recours à des biomatériaux ostéoconducteurs mais ceux-ci ne sont utilisables que dans le cas de comblement de défauts de petite taille car ils sont simplement un support passif à la néoformation osseuse. Ces limites pourraient être dépassées grâce au concept d’ingénierie tissulaire, en concevant des biomatériaux innovants ayant un fort pouvoir ostéogène conféré notamment par des facteurs de croissance ou des cellules ostéoprogénitrices. Dans notre travail, nous avons cherché à mettre au point un nouveau produit d’ingénierie tissulaire permettant la réparation de défauts osseux. La stratégie envisagée repose sur l’association d’un support tridimensionnel et de cellules souches adultes dérivées du tissu adipeux humain (ASC). L’originalité du système provient de la matrice tridimensionnelle, qui est un hydrogel thermosensible composé de monomère synthétique Glycosyl-Nucléoside-Fluoré (GNF) de faible poids moléculaire. Dans le domaine de la régénération osseuse, les hydrogels cellularisés sont généralement utilisés comme matrice associée à des molécules ostéogéniques (BMP2, Béta-Glycérophosphate) ou à des ions (Calcium : Ca2+, Phosphate : PO42-) pour permettre la differenciation ostéoblastique des cellules encapsulées dans le gel. Cependant, dans notre travail, nous n’avons pas fait appel à ces facteurs ostéogéniques. Notre étude a révélé que l’hydrogel de GNF possède les critères essentiels pour être utilisé en clinique : la non-toxicité, la biocompatibilité, la biodégradabilité, l’injectabilité et la biointégration. Des injections de complexe gel/ASC réalisées en site ectopique chez l’animal ont démontré que le gel se forme in situ en moins de 20 minutes et que les cellules encapsulées ont survécu pendant plusieurs mois. In situ, les ASC se sont différerenciées en ostéoblastes matures, exprimant la phosphatase alcaline et l’ostéocalcine et synthétisant une matrice extracellulaire riche en phosphate de calcium. Ces travaux ont donc permis de développer un produit d’ingénierie tissulaire innovant, associant un support tridimensionnel, l’hydrogel de GNF, à une composante cellulaire, les ASC. Cette matrice cellularisée apparaît prometteuse comme système injectable pour des applications cliniques de régénération osseuse. / Bone tissue is characterized by its mineralized matrix which is subject to formation and resorption activities ensuring its renewal and remodeling throughout the life. In case of damage, the bone can repair itself naturally to restore its integrity and its physical properties. Nevertheless, some pathologies or surgical procedures can lead to massive loss of bone and the natural process of self-repair is insufficient. First line, the bone graft is considered (autograft and allograft), however, due to reduced availability and risks of rejection and transmission of infectious agents, this technique is not feasible in all clinical situations. The surgeon can then make use of osteoconductive biomaterials but these are only usable in the case of filling of small defects because they are simply passive scaffold for bone formation. These limits may be exceeded through the concept of tissue enginee- ring, designing innovative biomaterials with high osteogenic power conferred by particular growth factors or osteoprogenitor cells. In our work we seek to develop a new product of tissue engineering to repair bone defects. The proposed strategy is based on the combination of a three-dimensional scaffold and adult stem cells derived from human adipose tissue (ASC). The originality of this system comes from the three-dimensional matrix, which is a thermosensitive hydrogel composed of synthetic monomeric Glycosyl-Nucleoside-Fluorinated (GNF) low molecular weight. In the field of bone regeneration, hydrogels are generally used as cellularized matrix molecules associated with osteogenic (BMP2, Beta-Glycerophosphate) or ions (Calcium : Ca2+, Phosphate : PO42-) to allow osteoblast differentiation of cells encapsulated in the gel. However, in our work, we have not used these osteogenic factors. Our study revealed that the hydrogel of GNF has the essential criteria to be used in clinical practice : non-toxicity, biocompatibility, biodegradability, injectability and biointegration. Injections of gel/ASC complex performed in animal ectopic site have showed that the gel is formed in situ within 20 minutes and encapsulated cells survived and proliferated for several months. In situ, ASC were differentiated into mature osteoblasts expressing alkaline phosphatase and osteocalcin and synthesizing an extracellular matrix rich in calcium phosphate. So, this work has allowed the development of an innovative product for tissue engineering, combining a three-dimensional scaffold, the GNF based hydrogel, a cellular component, the ASC. This cellularized matrix appears promising as injection system for clinical applications of bone regeneration.

Afin de résoudre la problématique des substituts osseux faiblement vascularisés, un des challenges majeurs en ingénierie tissulaire osseuse est de favoriser le développement précoce d’une microvascularisation. La reproduction du microenvironnement local et l’organisation cellulaire in situ sont des approches innovantes pour optimiser la formation osseuse. En Biofabrication, la Bioimpression Assistée par Laser (LAB) est une technologie émergente permettant l’impression de cellules et de biomatériaux avec une résolution micrométrique. L’objectif de ce travail était d’étudier l’effet de l’organisation de la pré-vascularisation par LAB sur la régénération osseuse. La station de bioimpression Novalase a été utilisée pour imprimer des motifs de cellules endothéliales sur un « biopaper » constitué de collagène et de cellules souches issues de la papille apicale. Les paramètres d’impression, densités cellulaires et conditions de recouvrement ont été optimisés afin de favoriser la formation d’un réseau microvasculaire avec une architecture définie in vitro. Ce modèle a ensuite été transposé in vivo, grâce à la bioimpression in situ de cellules endothéliales au niveau de défauts osseux critiques chez la souris, afin d’évaluer si la prévascularisation organisée par LAB permettait de promouvoir et contrôler spatialement le processus de régénération osseuse. Les résultats ont montré que la bioimpression permettait d’augmenter la densité de vaisseaux dans les défauts osseux et de favoriser la régénération osseuse. / In order to solve the issue of poorly vascularized bone substitutes, development of a microvasculature into tissue-engineered bone substitutes represents a current challenge. The reproduction of local microenvironment and in situ organization of cells are innovating approaches to optimize bone formation. In Biofabrication, Laser-Assisted Bioprinting (LAB) has emerged as a relevant method to print living cells and biomaterials with micrometric resolution. The aim of this work was to study the effect of prevascularization organized by LAB on bone regeneration. The laser workstation Novalase was used to print patterns of endothelial cells onto a « biopaper » of collagen hydrogel seeded with stem cells from the apical papilla. Printing parameters, cell densities and overlay conditions were optimized to enhance the formation of microvascular networks with a defined architecture in vitro. This model was then transposed in vivo, through in situ bioprinting of endothelial cells into mouse calvarial bone defects of critical size, to investigate if prevascularization organized by LAB can promote and spatially control bone regeneration. The results showed that bioprinting allowed to increase blood vessel density in bone defects and promote bone regeneration.

La technique des membranes induites par un conformateur en polymethylmethacrylate (PMMA) et greffe d’os spongieux autologue a été décrite par Masquelet pour la régénération des pertes de substance osseuse segmentaire des os longs. Cette technique en deux temps pourrait avantageusement être utilisée pour la reconstruction des pertes de substances osseuses segmentaires mandibulaires en cancérologie en cas d’échec ou de contre-indication des greffes osseuse revascularisées. Le premier objectif de ce travail était d’évaluer les propriétés histologiques et biologiques des membranes induites par un conformateur en PMMA avec radiothérapie, et de les comparer avec celles induites par un conformateur en silicone. Ce matériau plus souple que le PMMA a été choisi comme alternative au PMMA dans le but de faciliter l’ablation du conformateur. Les membranes induites par le PMMA ou le silicone en sous-cutané chez des rats Wistar avaient une structure histologique et des propriétés biologiques comparables mais les résultats étaient plus stables pour les membranes induites par le silicone. Le second objectif de ce travail était de proposer un procédé d’ingénierie tissulaire en alternative à la greffe d’os spongieux autologue. La néoformation osseuse au sein d’une membrane induite par un conformateur en silicone avec greffe de différentes combinaisons de céramique phosphocalcique biphasique macroporeuse (MBCP+™), de moelle osseuse totale, de simvastatine et de rhBMP-2 a été évaluée chez des rats Wistar en sous-cutané puis en site osseux fémoral. Les résultats n’ont pas permis de montrer de néoformation osseuse significative dans les groupes avec simvastatine. Par contre, une néoformation osseuse significative a été montrée dans les groupes avec rhBMP-2, avec ou sans radiothérapie. Un effet substantiel de l’adjonction de moelle osseuse totale a également été retrouvé. / Induced membrane technique with a polymethylmethacrylate (PMMA) spacer and autologous cancellous bone graft has been proposed by doctor Masquelet for segmental long bone reconstruction. This two stage technique could be proposed for segmental mandibular bone reconstruction in oncological situations in case of failure or contraindication of revascularized autologous bone graft. The first objective of this study was to evaluate the histological and biological properties of membranes induced by PMMA with radiotherapy, and to compare them to membranes induced by silicone. This material smoother than PMMA has been chosen to facilitate spacer removal. Membranes induced by both materials in subcutaneous models in rats had similar histological and biological properties, but membranes induced by silicone were less affected by radiotherapy. The second objective of this study was to propose a tissue engineering procedure as an alternative to autologous bone graft. The new bone formation inside silicone induced membranes has been analyzed after implantation of different combinations of macroporous biphasic phosphocalcic ceramic (MBCP+™), total bone marrow, simvastatine and rhBMP-2 in subcutaneous and femoral osseous models in rats. No significant new bone formation has been demonstrated in simvastatin groups. However, a significant new bone formation has been demonstrated in rhBMP-2 groups, with or without radiotherapy. An increased new bone formation has also been demonstrated with total bone marrow.

In this thesis, several types of scaffolds composed of different materials and designed structures and functions were fabricated by 3D plotting under mild conditions (room temperature and without using any organic solvent). Broad biomaterials including inorganic (such as calcium phosphate cement and mesoporous bioglass), organic (such as alginate and gelatin) and composite materials were prepared into printable pastes to plot as 3D scaffolds for bone tissue engineering. Organic/inorganic biphasic and bipartite structure, core/shell alginate/nano-hydroxyapatite and hollow fiber structure were designed and realized. Scaffolds with multi functions including suitable mechanical properties, sustained drug/protein delivery and in vitro vascularization were achievable. 3D plotting provided great achievements in the field of tissue engineering by preparing advanced scaffolds, as well as by plotting cell/matrix constructs, and even complex tissues and organs.

Bone is a remarkable multifunctional tissue with the ability to regenerate and remodel without generating any scar tissue. However, bone loss due to injury or diseases can be a great challenge and affect the patient significantly. Transplanting bone graft from one site in the patient to the site of fracture or bone void, i.e. autologous bone grafting is commonly used throughout the world. The transplanted bone not only fills voids, but is also bone inductive, housing the particular cells that are needed for bone regeneration. Nevertheless, a regenerative complement to autograft is of great interest and importance because the benefits from an off-the-shelf product with as good of healing capacity as autograft will circumvent most of the drawbacks with autograft. With a regenerative-medicine approach, the use of biomaterials loaded with bioactive molecules can avoid donor site morbidity and the problem of limited volume of material. Two such regenerative products that utilize bone morphogenetic protein 7 and 2 have been used for more than a decade in the clinic. However, some severe side effects have been reported, such as severe swelling due to inflammation and ectopic bone formation. Additionally, the products require open surgery, use of supra physiological doses of the BMPs due to poor localization and retention of the growth factors. The purpose of this thesis was to harness the strong inductive capability of the BMP-2 by optimizing the carrier of this bioactive protein, thereby minimizing the side effects that are associated with the clinical products and facilitating safe and localized bone regeneration at the desired site. We focused on an injectable hyaluronan-based carrier. The strategy was to use the body’s own regenerative pathway to stimulate and enhance bone healing in a manner similar to the natural bone-healing process. The hyaluronan-based carrier has a similar composition to the natural extracellular matrix and is degraded by resident hyaluronidase enzymes. Earlier studies have shown a more controlled release and improved mechanical properties when adding a weight of 25 percent of hydroxyapatite, a calcium phosphate that constitutes the inorganic part of the bone matrix. In Paper I, the aim was to improve the carrier by adding other forms of calcium phosphate. The results indicated that the bone formation was enhanced when using nano-sized hydroxyapatite. We wished to further develop the carrier system but were lacking an animal model with high output and easy access. We also wanted to provide paired data and were committed to the 3 Rs of refinement, reduction and replacement. To meet these challenges, we developed and refined an animal model, and this is described in Paper II. In Paper III, we characterized and optimized the handling properties of the carrier. In Paper IV, we discovered the importance of crushing the material, thus enhancing permeability and enlarging the surface area. In Paper V, we sought to further optimize biomaterial properties of the hydrogel through covalently bonding of bisphosphonates to the hyaluronan hydrogel. The results demonstrated exceptional retention of the growth factor BMP-2. In Paper VI, the in vivo response related to the release of the growth factor was examined by combining a SPECT/PET/µCT imaging method to visualize both the retention of the drug, and the in-vivo response in terms of mineralization.

Regeneration, a spontaneous response of bones in response to injuries, infections and fractures, is severely compromised in certain clinical circumstances. Unfortunately, several shortcomings are associated with the current treatment of bone grafting method such as donor shortage and immune response for allografts and donor morbidity for autografts. Thus, the development of clinical alternates is essential. One promising adjunct method is bone tissue engineering that includes the implantation of a scaffold containing the cells with the supplementation of suitable growth factors. Among the various classes of materials, biodegradable polymers are commonly preferred because their use does not necessitate a secondary surgery for their removal after the intended use. Commercially available polymers such as poly (lactic- co- glycolic acid) and polycaprolactone are expensive and degrade slowly. This motivates the development of novel synthetic biodegradable polymers that are affordable and can be tuned to tailor for specific biomedical applications. The primary aim of this thesis is to synthesize effective biodegradable polymers for drug delivery and bone tissue engineering. The properties of these polymers such as modulus, hydrophobicity and crosslinking etc. were tailored based on the variations in chemical bonds, chain lengths and the molar stoichiometric ratios of the monomers for specific clinical applications. Based on the above variations, degradation and release kinetics were tuned. The cytocompatibilty properties for these polymers were studied and suitable mineralization studies were conducted to determine their potential for bone regeneration.

This thesis focuses on testing and improving Ti-6Al-4V ELI biomaterials, which are currently one of the most used titanium alloys in biomedicine (predominantly in orthopaedics and dentistry), in cooperation with research institutions and private companies developing and producing such materials. The metallic samples were previously modified by plasma electrolytic oxidation (PEO) with use of electrolytes of a different composition to induce development of a homogeneous TiO2 layer on its surface. In vitro interactions of human osteoblast-like cell line Saos-2 with the surface of Ti-6Al-4V ELI alloy samples are investigated. Initial cell attachment, spreading, morphology, cell population density, viability, calcium deposition and expression of selected osteogenic markers, e.g. collagen type I, alkaline phosphatase and osteocalcin, were evaluated on cultured cells. The cells behavior were then correlated with physicochemical properties of the material surface, such as its topography, roughness, wettability, surface layer chemical composition etc. The results are also compared with those obtained in cells cultured on control samples of untreated alloys as well as microscopic glass coverslips and bottom of standard polystyrene cell culture wells. The aim of this thesis is to select the most promising...

In this thesis, several types of scaffolds composed of different materials and designed structures and functions were fabricated by 3D plotting under mild conditions (room temperature and without using any organic solvent). Broad biomaterials including inorganic (such as calcium phosphate cement and mesoporous bioglass), organic (such as alginate and gelatin) and composite materials were prepared into printable pastes to plot as 3D scaffolds for bone tissue engineering. Organic/inorganic biphasic and bipartite structure, core/shell alginate/nano-hydroxyapatite and hollow fiber structure were designed and realized. Scaffolds with multi functions including suitable mechanical properties, sustained drug/protein delivery and in vitro vascularization were achievable. 3D plotting provided great achievements in the field of tissue engineering by preparing advanced scaffolds, as well as by plotting cell/matrix constructs, and even complex tissues and organs.

En cas de pertes de substances osseuses de grande étendue, la capacité naturelle de réparation du tissu osseux n’est pas suffisante et nécessite d’être assistée. La greffe d’os autologue constitue actuellement la référence. Cependant, cette thérapeutique présente tout de même des inconvénients qui ont entrainé le développement de substituts osseux. Mais, aucun matériau à ce jour ne peut remplacer totalement l’os autologue, en raison notamment de la difficulté à recréer un système vasculaire fonctionnel au niveau du site lésé. Depuis quelques années, les espoirs se tournent vers la création d’un substitut osseux prévascularisé afin de pallier la principale limite des alternatives actuelles : l’établissement d’un réseau vasculaire au sein de ce biomatériau. Notre projet vise à évaluer l’effet stimulateur d’un composé naturel, les principes actifs de la nacre solubles dans l’éthanol (appelé Ethanol Soluble Matrix, ESM), à la fois sur les capacités angiogéniques de cellules de la lignée endothéliale et sur la différenciation ostéogénique de cellules souches mésenchymateuses (CSM) avec comme objectif le développement d’un substitut osseux prévascularisé. Dans un premier temps, nous avons montré que l’ESM stimulait les capacités angiogéniques des cellules de la lignée endothéliale : cellules endothéliales matures (HUVECs, cellules endothéliales issues de la veine ombilicale humaine) et cellules progénitrices endothéliales (CPEs) issues de sang de cordon. L'ESM, utilisé à la concentration de 200µg/mL, a permis de dépasser les résultats obtenus (expression génique et test fonctionnel) avec le milieu de culture de référence des CPEs : l’EGM-2 (Endothelial Growth Medium). Nous avons ensuite mis en évidence que l’ESM exerçait un effet stimulateur également sur les CSMs en augmentant l’expression de marqueurs spécifiques des chondrocytes et des chondrocytes hypertrophiques, suggérant une orientation de ces cellules vers une ossification endochondrale. En parallèle de ces travaux, nous avons étudié l’effet paracrine des CSMs sur les cellules de la lignée endothéliale, HUVECs et CPEs. Les vésicules extracellulaires de taille nanométrique (nEVs) ont montré leur capacité à induire une stimulation in vitro de la formation de réseaux vasculaires et de l’expression de gènes endothéliaux. Ces résultats encourageants soulignent la faisabilité de l’utilisation de l’ESM en tant que stimulus à la fois de l’angiogenèse des CPEs et de l’ostéogenèse des CSMs. Ce stimulus pourrait être associé aux nEVs issues de CSMs et aux CPEs au sein d’une matrice tridimensionnelle pour développer un substitut osseux prévascularisé / In case of critical-sized defects, the bone tissue ability of natural healing is not sufficient and needs to be assisted. The autologous bone graft is currently the gold standard. However, this solution has drawbacks that have led to the development of bone substitutes. Nowadays, no substitute is able to supply autogenous bone, due to the difficulties to mimic the vascular system. In recent years, the hopes are focusing on the creation of a prevascularized bone substitute to overcome the main limitation of current alternatives: the creation of a functional vascular network inside the substitute. Our project aims to evaluate the stimulating effect of a natural compound, the nacre extracts called Ethanol Soluble Matrix (ESM), both on the angiogenic abilities of endothelial cell lineage and on the osteogenic differentiation of mesenchymal stem cells (MSCs) to develop a pre-vascularized bone substitute. First, we showed that ESM stimulates the angiogenic potential of two types of endothelial cells: mature endothelial cells (HUVECs, human umbilical vein endothelial cells) and endothelial progenitor cells (EPCs) from cord blood. The ESM, used at the concentration of 200µg/mL, exceeded results obtained with the reference culture medium of EPCs: the EGM-2 (Endothelial Growth Medium). Then, we demonstrated that ESM also exerted a stimulating effect on MSC by increasing the expression of chondrocyte and hypertrophic chondrocyte specific markers, suggesting an orientation of these cells towards endochondral ossification. In line with this work, we studied the paracrine effect of MSCs on endothelial cell lineage, HUVECs and EPCs. Nanoscale extracellular vesicles (nEVs) have been shown to induce an in vitro stimulation of the vascular network formation and of the endothelial gene expression. These encouraging results highlight the feasibility of using ESM as a stimulus for both angiogenesis of EPCs and osteogenesis of MSCs. This stimulus could be associated with MSC-derived nEVs and EPCs within a three-dimensional matrix to develop a pre-vascularized bone substitute

Dans le cas de larges pertes de substance osseuse, l’ingénierie tissulaire représente une alternative intéressante aux greffes. Cette technique consiste à associer des cellules à des biomatériaux dans le but de réparer le tissu. L'objectif de ce travail est l'étude de l'amélioration du potentiel ostéogénique des cellules souches mésenchymateuses issues du tissue adipeux humain (ASC), afin d’augmenter la formation de matrice osseuse en territoire ischémique. Nous avons montré que le fucoïdane, un polysaccharide d’origine marine, était capable d’améliorer la différenciation ostéogénique des ASC in vitro. Cependant, la combinaison de ces cellules avec des biomatériaux (granules de biphosphate de calcium) ne suffit pas à permettre une formation osseuse dans un modèle de pousse osseuse en site ectopique chez la souris. Afin d’augmenter l’angiogenèse, essentielle dans la réparation osseuse, nous avons associé les ASC à des cellules progénitrices endothéliales (appelées ECFC), dans ce modèle. Cette association ne permet d’améliorer que faiblement la formation osseuse. Nos études in vitro d'association de CPE et d'ASC ont montré que ces cellules en coculture étaient capables de synthétiser un grand nombre de cytokines impliquées dans les différenciations ostéogénique et angiogénique, telles que le transforming growth factor (TGFß1), l’insulin like growth factor (IGF-1) ou encore le vascular endothelial growth factor (VEGF). Dans nos conditions de culture, le surnageant de l’association des ECFC avec des ASC induit, par rapport au surnageant des ASCs seules, une inhibition de la différenciation ostéogénique dont le mécanisme reste à identifier.L’ensemble de nos données démontre le potentiel du fucoïdane dans l’ingénierie tissulaire osseuse et que les ASC seules ne sont pas capables de former de matrice osseuse. / In the case of large bone defects, tissue engineering represents an attractive alternative to transplantation. Tissue engineering is a combination of cells with biomaterials in order to repair tissue. The aim of this work was the study of the improvement of the osteogenic potential of mesenchymal stromal/stem cells derived from human adipose tissue (ASC) in the order to increase the formation of bone matrix in the ischemic territory. We have shown that fucoidan, a marine polysaccharide, was able to improve the osteogenic differentiation of ASC in vitro. However, the combination of these cells with biomaterials (biphasic calcium phosphate particles) is not enough to have bone formation in an ectopic bone growth model in mice. To promote angiogenesis, a crucial step in bone repair, we associated ASC with endothelial progenitor cells (called ECFC), in our model. This association promotes only lightly the bone formation. Our in vitro coculture studies of ECFC with ASC showed that the cells in coculture were able to synthesize several cytokines involved in angiogenic and osteogenic differentiation, such as transforming growth factor (TGF-ß1), insulin like growth factor (IGF-1) or vascular endothelial growth factor (VEGF). However, ASC in coculture did not express the receptors of these cytokines. In our culture conditions, the supernatant of the association of ECFC + ASC induces, compare to ASC alone, an inhibition of osteogenic differentiation which mechanism has to be identified.Our data show the potential of fucoidan in bone tissue engineering and that ASC alone did not promote bone matrix formation.