La dédifférentiation du chondrocyte peut être provoquée par le stress mécanique ou cytokinique ainsi que la diffusion des facteurs de croissance dans le cartilage. C’est un élément-clé de la dégradation irréversible qui accompagne l’arthrose (ostéoarthritis, OA). Notre but est de rechercher des mécanismes moléculaires susceptibles d’être des cibles thérapeutiques originales contre cette affection. Or, il a été montré récemment que la voie des récepteurs Notch est fortement exprimée dans l’OA humaine. Objectifs: Etudier le rôle de la voie de signalisation Notch /Hes1/Hey1 dans les effets de l’Interleukine-1 β (IL-1β) et du FGF2 sur la dédifférenciation in-vitro des chondrocytes. Méthodes: Des chondrocytes de cartilage articulaire humain ou murin sont mis en culture primaire, puis traités par IL-1β ou FGF2. L’expression de Notch1-R/Hes1/Hey1 est étudiée par immunocytochimie, immunoblot et q-RT-PCR. L’implication de Hes1 dans les effets de l'IL-1β et du FGF2 a été étudiée au moyen d’un siRNA spécifique anti Hes1. Résultats: En normoxie, le marquage de Notch-R1 est localisé à la membrane et dans le cytoplasme des chondrocytes, sans effet des effecteurs. Notch1-R est en revanche nucléaire en hypoxie. L’hypothèse d’un contrôle de la localisation de Notch1-R par la pO2 est confortée par l’inhibition de l’expression de la Préséniline (γ-secrétase) en hypoxie. L’étude des effets des effecteurs sur Hes1 et Hey1 a été réalisée dans les conditions classiques de culture en normoxie. Hes1 est cytoplasmique mais passe dans le noyau sous l’effet de l’IL1β ou de FGF2, suggérant la possibilité d’effets transcriptionnels. Les ARNm de Hes1 sont augmentés d’un facteur de 2,5 avec l’IL-1β et de 7-8 avec le FGF2. Hey1 est insensible à l’IL-1β mais augmente de 4-5 fois sous FGF2. Ces effets sont transcriptionnels directement pour Hes1 (DRB-) et indirectement pour Hey1 (DRB+). Ils passent par la voie NF-κB pour les deux facteurs mais en plus par p38 MAP pour le FGF2. L’induction de Hes1 est insensible au DAPT, inhibiteur de la γ-sécrétase, donc indépendant d’une activation de novo du Notch-R1. L’utilisation d’un siRNA spécifique contre Hes1 montre que l’induction de Hey1 par FGF2 dépend de Hes1 et permet de vérifier l’influence de Hes1 dans la modulation des marqueurs phénotypiques. Hes1 est impliqué dans l’induction par IL-1β de l’expression de MMP13 et ADMTS-5. Hes1 est aussi le médiateur de l’induction par le FGF2 des messagers de la MMP13 (en partie) et de l’isomère Col2A. La protéine Col2A immature est normalement absente du cartilage de souris post-natale, où Col2B est l’isoforme essentielle du collagène de type 2. A l’inverse, le cartilage de souris vieillissante réexprime Col2A, comme cela a été montré dans le cartilage arthrosique chez l’homme. Conclusion: Hes1 est le médiateur des effets d’IL-1β et du FGF2 sur la dédifférentiation in-vitro des chondrocytes (Col2A, MMP13). La voie de Hes1 apparaît donc comme une cible valide pour de nouvelles thérapeutiques contre la dégradation chondrocytaire et donc les maladies dégénératives du cartilage. / Chondrocyte dedifferentiation is a key element of irreversible cartilage degradation induced by mechanical or cytokinic stress, or growth factors, as in degenerative osteoarthritis (OA). Our goal is to search for new therapeutical targets within this process, and Notch signaling has been reported to be strongly expressed during human OA. Objectives: To investigate the involvement of the Notch1/Hes1/Hey1 pathway as mediators of interleukin 1 β (IL-1β) and FGF2 in chondrocytes in vitro. Methods: Mouse or human articular chondrocytes were established in primary culture then challenged with IL-1β or FGF2. Notch-R1, Hes1/Hey1 and chondrogenic target genes expression was monitored by immunocytochemistry, q-rt-PCR, and immunoblotting. Hes1 involvement in IL-1β/FGF2 induced gene expression was investigated with a specific siRNA against Hes1. Results: In normoxia, Notch1-R labeling remained nuclear and stable in intensity in chondrocytes, irrespective of treatment. This suggested steady-state activation of this pathway. In contrast, Notch1-R labeling was located almost exclusively at the membrane or cytoplasm of chondrocytes in hypoxia, irrespective of treatment. Notch-R1 activation may thus be, at least in part, regulated by pO2 as supported by the inhibition of γ-secretase (Presenilin1) expression in hypoxia versus normoxia. In normoxia, addition of IL1β or FGF2 to the cells induced Hes1 translocation to the nucleus, suggesting the possibility of transcriptional effects. This was associated with a transient increase of Hes1 mRNA cyclic expression with mechanistic differences between the two effectors. Hes1 mRNA was increased 2.5-fold by IL-1β and 7-8-fold by FGF2. IL-1β elicited a loss of cyclicity in Hes1 expression while FGF2 conserved the cycles, akin to the effect of serum. These effects were transcriptional and occurred through NF-κB for both effectors but only through the p38 pathway for FGF2. Hey1 expression was not modified by IL-1β, while a 4-5 fold transient increase was observed with FGF2, always posterior to the Hes1 peak. Hey induction by FGF2 was transcriptional and depended on Hes1 expression (DRB). Hes1/ Hey inductions by IL-1β or FGF2 were insensitive to DAPT, a γ-secretase inhibitor, confirming the independence from novel activation of Notch-R. Hes1 expression was silenced by a specific siRNA, showing that the FGF2-induced Hey1 expression is under Hes1 control and ascertaining the role of Hes1 in chondrocyte phenotype modulations. Hes1 mediated IL-1β induction of MMP-13 and ADAMTS-5. Hes1 also mediated FGF2 up-regulation of MMP13 (partly) and Col2A isomer expression. Col2A is normally absent in post-natal mice cartilage, Col2B being the essential isoform of Type 2 collagen. Conversely, aging mice cartilage re-expresses Col2A abundantly as shown for human OA cartilage. Conclusion: Hes1 mediates IL-1β and FGF2 modulations of dedifferentiating chondrocyte phenotype (MMP13, Col2A). Thus the Hes1 pathway appears a valid target for therapeutical research on chondrocytes dedifferentiation, hence degradative cartilage diseases.

Osteoarthritis and osteochondral defects are ailments that are increasing in frequency as the lifespan of the population increases and sedentary lifestyle becomes more common. Osteoarthritis is an inflammatory disease that causes the progressive degeneration of articular surfaces and the underlying bone. Accidents and injuries can cause osteochondral defects similar to osteoarthritis. In both cases the structure of the articular cartilage fails, leading to pain and disability. Articular cartilage has a naturally poor ability to regenerate since there is no vasculature and it is aneural. The sparse chondrocytes mainly act to maintain the healthy extracellular matrix. Once the defect is severe enough, a surgical intervention becomes necessary. For small defects and young patients, a cell-based treatment can be used, whereas for larger defects and severe osteoarthritis a partial or whole joint arthroplasty is performed. Methods to repair osteochondral defects have been improving over the years as the inter-disciplinary understanding of joints, and what is required to repair them, has increased. However, there are still issues to solve in order to achieve consistently good results in both joint replacement and repair of cartilage. The main issue faced with current techniques used for joint replacement is poor integration of the artificial joint, leading to loosening at the bone interface over time, while cartilage repair techniques face the problem of generating mechanically inferior fibrocartilage. It is known that surface chemistry and structures at micro- and nanoscale influence cell behaviour, which can be utilised to guide their attachment, proliferation and phenotype. Scaffold-free approaches and mechanical stimulation have previously given promising results in generating articular neocartilage. This thesis aims at exploring tools and solutions to the problems involved in implant integration, chondrocyte expansion and neocartilage tissue engineering. We hypothesised that 1) ultra-short pulsed laser deposition can be used to create biocompatible coatings; 2) micropillars with nanoscale features can improve the maintenance of the chondrocyte phenotype in culture and 3) hypergravity can aid in the production of more native-like neocartilage constructs. Our studies showed that ultra-short pulsed laser ablation can be used to create various surfaces for studying cell behaviour. Cell viability was slightly higher on a rough titanium oxide, whereas the cell area was significantly smaller on rough titanium oxide, indicating a lower amount of focal adhesions. Nanopatterned microstructures were not capable of maintaining the chondrocyte phenotype in culture, but they were not disadvantageous either. Hypergravity might help in creating a native-like distribution of collagen and proteoglycans. The constructs were more uniform in shape, but biomechanically the constructs were not different from non-centrifuged controls.

Articular cartilage defects in the knee are common, and can result in pain, decreased function and decreased quality of life. Untreated defects are considered to be a risk factor for developing osteoarthritis, a progressive degenerative joint disease with minimal treatment options. To address these issues, various surgical procedures are available to treat articular cartilage defects in the knee. While these procedures overall have positive results, after surgery patients experience large and persistent deficits in quadriceps strength. A contributing factor to this post-surgical weakness is believed to be the extended post-operative non-weight bearing period, with full weight bearing not initiated until approximately 4 – 6 weeks after surgery. During this non-weight bearing period a minimal amount of demand is placed upon the muscle. Subsequently, the quadriceps muscle undergoes a large degree of atrophy with a significant decrease in muscle strength. Muscular strength deficits reduce the knee joint stability, also increasing the risk of osteoarthritis development. Interventions that can be used to facilitate quadriceps strength while protecting the articular cartilage repair are needed. Neuromuscular electrical stimulation (NMES) is an effective post-knee surgery rehabilitation technique to regain quadriceps musculature. In recent years manufactures have been developing knee sleeve garments integrated with NMES allowing for portability of the NMES treatment. The primary aim of this study was to evaluate the effectiveness of a 12-week home-based neuromuscular electrical stimulation treatment on post-surgical clinical outcomes (quadriceps strength, lower extremity function, and patient reported outcomes) after articular cartilage knee surgery. Patients were randomized between a standard of care home-treatment group and a NMES home-treatment group. Patients completed isometric quadriceps strength testing, the Y-balance test, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) before surgery and at 3-months after surgery. The secondary aims of this study were to determine the most effective NMES parameters for post-surgical quadriceps strength; and to develop a framework to identify factors that may influence a patient’s adherence to a prescribed therapy program. From our results we can make several conclusions. First, we found only a small number of studies utilize similar parameters for post-surgical quadriceps strength treatments. The majority of the parameters reported in the literature were highly variable between studies. Second, clinicians can utilize the expanded Health Belief Model to identify situational and personal factors unique to a patient that may impact adherence to a prescribed treatment. Clinicians can then implement the proposed interventional strategies to address the identified situational and personal factors. Finally, there was no difference in quadriceps strength, lower extremity function, or self-reported scores at 3-month between a home-based NMES treatment and a standard of care home-based treatment. Patients’ adherence to the treatment protocols may have been a major factor contributing to these results. Utilizing a model, such as the proposed expanded Health Belief Model, may assist clinicians in improving a patients’ adherence to future prescribed home-treatment programs.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20754号 / 医博第4284号 / 新制||医||1024(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 松田 秀一, 教授 開 祐司, 教授 妻木 範行 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24787号 / 医博第4979号 / 新制||医||1066(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 松田 秀一, 教授 森本 尚樹, 教授 安達 泰治 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Osteoarthritis (OA) is a progressive cartilage degeneration disease with a complex pathologic mechanism. Although OA has devastating effects on patient quality of life and places a significant burden on the healthcare system, no disease-modifying drugs have been found, and surgical treatment options are often unsustainable. 3D bioprinting is a novel field within tissue engineering that focuses on developing biocompatible constructs that can be implanted to replace an organ or tissue. Such constructs have a great potential to become treatments for OA. Understanding cell mobility within hydrogels could play a vital role in advancing the development of biocompatible constructs. However, due to the novelty of bioprinting, limited research on cell mobility within hydrogels is available. Therefore, this project aims to fill the gap in existing research regarding cell mobility within bioprinted constructs with varying mechanical properties. To achieve this goal, green fluorescent protein-tagged mesenchymal stromal cells (MSCs) were developed to assess progenitor cell mobility in bioprinted hydrogel constructs. Constructs were printed with three zones: hydrogel with embedded chondrocytes or MSCs; hydrogel spacer; and chemoattractant. Designed constructs were bioprinted (BioAssemblyBot, Advanced Solutions) using GelMA:HAMA bioinks containing photoinitiator with varying bioink percentages. Cell viability and directional mobility within constructs were assessed by fluorescence viability assay and time-lapse fluorescence microscopy. The protocol to evaluate cell mobility in bioprinted constructs and optimized bioprinting settings for GelMA:HAMA bioinks were gained through this project. Overall, this project allowed us to fill the gap in existing knowledge regarding MSC and chondrocyte mobility in hydrogels and contribute to developing a novel treatment method for OA.

京都大学 / 新制・課程博士 / 博士(医科学) / 甲第24843号 / 医科博第151号 / 新制||医科||10(附属図書館) / 京都大学大学院医学研究科医科学専攻 / (主査)教授 齋藤, 潤, 教授 遊佐, 宏介, 教授 松田, 秀一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

This study was motivated by a theoretical formulation on mechanobiology of soft and hard skeletal tissue differentiation. To prove this formulation experimentally, I hypothesized that cartilaginous phenotype can be induced in vitro in a seemingly non-cartilaginous cell source from fibrous tissue. In testing this hypothesis, I have focused on cartilage as a target and fibrous tissue as an origin or the source of cell. Four different trials were pursued with one supposition in common, i.e. hydrostatic pressure is one of the main driving forces for chondroinduction in vitro. The first and second trials pertained to the influence of a relatively short and long duration cyclic hydrostatic compression on rat Achilles tendon fibroblasts. The third trial was to examine the effect of two different drugs on cytoskeletal elements of mesenchymal stem cells or mouse embryonic fibroblast lines in pellet cultures combined with the similar duration and/or frequency of cyclic hydrostatic pressure adopted in the aforesaid trials with no pharmacological agents added. Last, attempts were made to implement an advanced technique in molecular biology called 'PCR array' to further quantify expression levels of eighty four pathway-specific genes in mouse TGFbeta/BMP signaling traffic under the same physiological regimen of hydrostatic compression. Results demonstrated that transdifferentation in phenotype from tendon to fibrocartilage may have occurred in vitro in tendon fibroblasts in pellet cultures exposed to hydrostatic pressure. Experiments on the role of the cytoskeleton in mechanotransduction of the applied level of hydrostatic pressure demonstrated that disruption of microfilaments in the presence of cytochalasin-D did not significantly interfere with the anabolic effect of cyclic pressure. However, disruption of microtubule assembly by nocodazole abolished the pressure-induced stimulation in cartilage marker genes. These findings suggest that microtubules, but not microfilaments, are involved in mechanotransduction of hydrostatic pressure by mesenchymal stem cells.

Yes / Articular cartilage is an avascular and flexible connective tissue found in joints. It produces a cushioning effect at the joints and provides low friction to protect the ends of the bones from wear and tear/damage. It has poor repair capacity and any injury can result pain and loss of mobility. Transforming growth factor-beta (TGF-β), a cytokine superfamily, regulates cell function, including differentiation and proliferation. Although the function of the TGF-βs in various cell types has been investigated, their function in cartilage repair is as yet not fully understood. The effect of TGF-β3 in biological regulation of primary chondrocyte was investigated in this work. TGF-β3 provided fibroblastic morphology to chondrocytes and therefore overall reduction in cell proliferation was observed. The length of the cells supplemented with TGF-β3 were larger than the cells without TGF-β3 treatment. This was caused by the fibroblast like cells (dedifferentiated chondrocytes) which occupied larger areas compared to cells without TGF-β3 addition. The healing process of the model wound closure assay of chondrocyte multilayer was slowed down by TGF-β3, and this cytokine negatively affected the strength of chondrocyte adhesion to the cell culture surface.

The metabolic activity of cartilage cells (chondrocytes) is regulated by mechanical forces which act on them. Chondrocytes can respond to these forces through synthesis or degradation of extracellular matrix and changes in gene expression. The overall objective of this study was to investigate the effects of mechanical compression on gene regulation, proteoglycan (PG) synthesis and activation of signaling pathways. To achieve this goal a simple oscillatory displacement controlled device was designed to provide uniaxial unconfined strain to cell constructs. Static compression and dynamic compression with various waveforms are utilized with a stroke range of 0.25 mm to 4 mm and a frequency range of 0.1 Hz to 3 Hz. Poly-L-lactic acid (PLLA/)alginate disks and alginate disks with equine chondrocytes embedded in them were developed and showed unchanged viability for 24 hr under static and dynamic compression. Testing to relate the strains applied to forces experienced in cell constructs was completed and the simple procedure outlined for companion use with our device. Quantitative reverse transcription polymerase chain reaction (QRT-PCR) revealed changes in expression of collagen II and matrix metalloproteinase-3 under dynamic compression for 24 hr. Equine chondrocytes compressed for 48 hr showed lower PG synthesis for both static and dynamic compression when compared to uncompressed samples in replicate experiments. Repeatability of this experiment was problematic possibly due to decreased viability and inefficient extraction. Different patterns of extracellular signal regulated kinase (ERK) activation with time were found for uncompressed and compressed samples (static at 15% strain and dynamic at 15% strain, 1 Hz) and protein kinase B (also called Akt) was not regulated by compression. Results from experiments involving frequency and strain for dynamic compression were inconclusive. These studies show that regulation of gene expression, PG synthesis and intracellular signaling can be studied with our device but optimization of the experimental procedure is still needed. To our knowledge these studies are the first to show these types of studies utilizing equine chondrocytes. Despite issues encountered, our studies provide valuable insights into the effects of compression on equine chondrocytes and detail a simple device for use in a wide variety of compression studies. / Ph. D.