Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 6 uppsatser.

Local tissue factors, ischemia and infection (which are often the cause of re-ulceration) are the main pathogenetic factors for diabetic foot disease (DFD). Neuropathic bone metabolism disorder leads to Charcot osteoarthropathy (CHOA). The aim of this dissertation was to assess experimentally the effectiveness of new skin substitutes, evaluate local vasculogenesis in different types of cell therapy of DFD, the role of infection in recurrence of DFD and scintigraphic parameters of activity of CHOA. Our studies concerning local pathological processes in DFD experimentally proved that gelatine nanofibers accelerate wound healing and can be suitable scaffolds for cell transfer and skin regeneration and also that acellular porcine dermis is more effective in healing of chronic wounds then xenotransplants. Our studies concerning therapeutic vasculogenesis confirmed that efficacy of stem cells (SC) harvested from bone marrow is similar in efficacy to SC separated from peripheral blood after stimulation. We found no evidence for systemic vasculogenesis by means of a significant increase of pro-angiogenic cytokines, which confirms the paracrine effect of injected SC. We proved a significant correlation between angiogeneisis inhibitor (endostatin) and the number of injected SC, which could be an indicator of...

Skin is an organ with a complex structure which plays a crucial role in thebody’s defence against external threats and in maintaining major homeostatic functions. The need for in vitro models that mimic the in vivo milieu is therefore high and relevant with various applications including, among others, penetration, absorption, and toxicity studies. In this context, the choice of the biomaterial that will provide a 3D scaffold to the cultured cells is defining the model’s success. The FN-4RepCT silk is here suggested as a potent biomaterial for skin tissue engineering applications. This recombinantly produced spider silk protein (FN-4RepCT), which can self-assemble into fibrils, creates a robust and elastic matrice with high bioactivity, due to its functionalization with the fibronectin derived RGD-containing peptide. Hence it overcomes the drawbacks of other available biomaterials either synthetic or based on animal derived proteins. Additionally, the FN-4RepCT silk protein can be cast in various 3D formats, two of which are utilized within this project. We herein present a bilayered skin tissue equivalent supported by the FN-4RepCT silk. This is constructed by the combination of a foam format, integrated with dermal fibroblasts and endothelial cells, and a membrane format supporting epidermal keratinocytes. As a result, a vascularized dermal layer that contains ECM components (Collagen I, Collagen III, and Elastin) is constructed and attached to an epidermal layer of differentiated keratinocytes.The protocol presented in this project offers a successful method of evenly integrating cells in the FN-4RepCT silk scaffold, while preserving their ability to resume some of their major in vivo functions like proliferation, ECM secretion, construction of vascular networks, and differentiation. The obtained results were evaluated with immunofluorescence stainings of various markers of interest and further analysed, when necessary, with image processing tools. The results that ensued from the herein presented protocol strongly suggest that the FN-4RepCT silk is a promising biomaterial for skin tissue engineering applications.

Introdução: A imunização de coelhos saudáveis com colágeno do tipo V (COLV) reproduz as principais manifestações da esclerose sistêmica (ES), incluindo fibrose, vasculopatia e produção de autoanticorpos específicos da doença. Estudos preliminares mostraram que, tanto na derme de animais imunizados com COLV (COLV-IM), como na derme de pacientes com ES, observa-se deposição aumentada de COLV anômalo, mas não se sabe qual a relevância clínica deste achado. O remodelamento da matriz extracelular é precoce nos animais COLV-IM, ocorrendo já no sétimo dia após a imunização, o que sugere que o COLV esteja relacionado com a injúria endotelial, evento primário envolvido na patogênese da ES. Desta forma, os objetivos do presente estudo foram avaliar a expressão de COLV na derme de controles saudáveis e de pacientes com ES e sua correlação com espessamento cutâneo, atividade e duração da doença; assim como pesquisar uma possível associação entre a deposição deste colágeno na derme com a expressão de marcadores de apoptose e de ativação endotelial em pacientes e no modelo animal induzido pela imunização com COLV. Pacientes e Métodos: Biópsias de pele de pacientes com ES (N=18, 6 com doença precoce e 12 com doença tardia) e de controles (N=10) pareados por idade e sexo, assim como biópsias de pele de coelhos imunizados com COLV + adjuvante de Freund (COV-IM, N=6) ou adjuvante de Freund (N=6) foram avaliadas. Nos pacientes com ES, o espessamento cutâneo foi avaliado por meio do escore de Rodnan Modificado (MRSS) e a atividade da doença foi calculada pelo índice de atividade de Valentini. Para realizar a quantificação por histomorfometria, o COLV na derme foi identificado por imunofluorescência. Caspase-3, endotelina-1, CTGF, TGF e VEGF nas células endoteliais dérmicas foram marcados por imunohistoquímica. Nos pacientes e nos controles, o COLV proveniente da cultura de fibroblastos dérmicos foi quantificado por PCR RT em tempo real e caracterizado por eletroforese, imunoblotting e reconstrução tridimensional, por meio da microscopia confocal. Resultados: O depósito de COLV foi maior na derme de pacientes com doença precoce, quando comparados aos controles e aos pacientes com doença tardia. A atividade e a duração da ES estiveram associadas com o depósito de COLV. A expressão de RNA mensageiro das cadeias COLV1 COLV2 foi aumentada em relação aos controles e a reconstrução tridimensional confirmou a presença de fibras anômalas de COLV. Observou-se maior expressão de caspase-3, endotelina-1, CTGF, TGF e VEGF nas células endoteliais dos pacientes com ES, quando comparados aos controles. Houve correlação positiva entre o depósito de COLV e a expressão de caspase-3, endotelina-1 e CTGF. Ao comparar-se os coelhos COLV-IM com os controles, observou-se aumento significativo da expressão de COLV aos 7 dias e de endotelina-1 aos 210 dias após a imunização. Embora de maneira não significativa, verificou-se maior expressão de caspase-3, CTGF e VEGF nos animais COLV-IM e, quando os animais foram comparados ao longo do tempo, percebeu-se maior expressão de COLV no sétimo dia após a imunização na derme dos animais COLV-IM, diminuindo no trigésimo dia e voltando a subir aos 75 dias e aos 210 dias. A caspase-3 e a endotelina-1 comportaram-se de maneira semelhante. Conclusão: Estes resultados sugerem que o COLV possa agir como um possível gatilho envolvido na patogênese da ES, agindo como um indutor de ativação e de apoptose endotelial, que por sua vez poderia resultar em maior expressão de COLV, perpetuando o processo de remodelamento observado na pele dos pacientes com ES / Introduction: The immunization of healthy rabbits with type V collagen (COLV) reproduces the main characteristics of systemic sclerosis (SSc), such as fibrosis, vasculopathy and specific auto-antibodies. Preliminary studies demonstrated that both COLV-immunized rabbits (COLV-IM) and SSc patients exhibit increased expression of abnormal COLV in the dermis, but the clinical relevance of this finding is unknown. The remodeling of the extracellular matrix is an early event in COLV-IM rabbits that can be detected by the seventh day after immunization; this observation suggests that COLV is involved in endothelial injury, one of the first manifestations of the disease. Thus, the objectives of this study were to evaluate COLV expression in the dermis of healthy controls and SSc patients and to determine the correlation of this expression with skin thickness, disease activity and duration and search for a possible association between this collagen with apoptosis and activation of endothelial cells markers in patients and in animal model induced by immunization with COLV. Patients and Methods: Skin biopsies from 18 patients (6 early-stage and 12 late-stage) and 10 healthy controls as well as skin biopsies from rabbits immunized with COLV (COLV-IM) and Freund adjuvant (N=6) or Freund adjuvant alone (N=6) were evaluated. Skin thickening assessment was performed with the Modified Rodnan Skin Score (MRSS), and activity was calculated using the Valentini Disease Activity Index. To perform quantification by histomorphometry, COLV was identified by immunofluorescence, and caspase-3, endothelin-1, CTGF, TGF and VEGF in dermal endothelial cells were labeled by immunohistochemistry. In SSc patients and healthy controls, COLV from dermal fibroblast culture was quantified by real-time RT-PCR and characterized by electrophoresis, immunoblotting and tridimensional reconstruction by confocal microscopy. Results: COLV deposition was increased in the dermis of the patients with early disease compared with the healthy controls and the patients with late disease. SSc activity and disease duration were associated with dermal COLV deposition. COLV1 and COLV2 mRNA expression levels were higher in SSc, and a tridimensional reconstruction of SSc dermal heterotypic fibers confirmed the presence of abnormal COLV. The dermal endothelial cell expression of caspase-3, endothelin-1, CTGF, TGF and VEGF was higher in the SSc patients than in the controls. There was a positive correlation between COLV deposition and caspase-3, endothelin-1 and CTGF expression. When the COLV-IM rabbits were compared with the controls, there was a significant increase in the expression of COLV 7 days after the immunization and a significant increase in the expression of endothelin-1 210 days after the immunization. The expression of caspase-3, CTGF and VEGF was higher in the COLV-IM animals than in the control rabbits, although not significantly, and when the rabbits were compared over time, the expression of COLV was higher in the dermis of the COLV-IM animals 7 days after immunization, decreasing at 30 days and increasing again at 75 and 210 days. Caspase-3 and endothelin-1 exhibited similar behavior. Conclusion: these results suggest that COLV can be a possible trigger involved in the pathogenesis of SSc, acting as an inducer of endothelial apoptosis and activation that could result in higher expression of COLV, perpetuating the remodeling process observed in SSc skin

Introdução: A imunização de coelhos saudáveis com colágeno do tipo V (COLV) reproduz as principais manifestações da esclerose sistêmica (ES), incluindo fibrose, vasculopatia e produção de autoanticorpos específicos da doença. Estudos preliminares mostraram que, tanto na derme de animais imunizados com COLV (COLV-IM), como na derme de pacientes com ES, observa-se deposição aumentada de COLV anômalo, mas não se sabe qual a relevância clínica deste achado. O remodelamento da matriz extracelular é precoce nos animais COLV-IM, ocorrendo já no sétimo dia após a imunização, o que sugere que o COLV esteja relacionado com a injúria endotelial, evento primário envolvido na patogênese da ES. Desta forma, os objetivos do presente estudo foram avaliar a expressão de COLV na derme de controles saudáveis e de pacientes com ES e sua correlação com espessamento cutâneo, atividade e duração da doença; assim como pesquisar uma possível associação entre a deposição deste colágeno na derme com a expressão de marcadores de apoptose e de ativação endotelial em pacientes e no modelo animal induzido pela imunização com COLV. Pacientes e Métodos: Biópsias de pele de pacientes com ES (N=18, 6 com doença precoce e 12 com doença tardia) e de controles (N=10) pareados por idade e sexo, assim como biópsias de pele de coelhos imunizados com COLV + adjuvante de Freund (COV-IM, N=6) ou adjuvante de Freund (N=6) foram avaliadas. Nos pacientes com ES, o espessamento cutâneo foi avaliado por meio do escore de Rodnan Modificado (MRSS) e a atividade da doença foi calculada pelo índice de atividade de Valentini. Para realizar a quantificação por histomorfometria, o COLV na derme foi identificado por imunofluorescência. Caspase-3, endotelina-1, CTGF, TGF e VEGF nas células endoteliais dérmicas foram marcados por imunohistoquímica. Nos pacientes e nos controles, o COLV proveniente da cultura de fibroblastos dérmicos foi quantificado por PCR RT em tempo real e caracterizado por eletroforese, imunoblotting e reconstrução tridimensional, por meio da microscopia confocal. Resultados: O depósito de COLV foi maior na derme de pacientes com doença precoce, quando comparados aos controles e aos pacientes com doença tardia. A atividade e a duração da ES estiveram associadas com o depósito de COLV. A expressão de RNA mensageiro das cadeias COLV1 COLV2 foi aumentada em relação aos controles e a reconstrução tridimensional confirmou a presença de fibras anômalas de COLV. Observou-se maior expressão de caspase-3, endotelina-1, CTGF, TGF e VEGF nas células endoteliais dos pacientes com ES, quando comparados aos controles. Houve correlação positiva entre o depósito de COLV e a expressão de caspase-3, endotelina-1 e CTGF. Ao comparar-se os coelhos COLV-IM com os controles, observou-se aumento significativo da expressão de COLV aos 7 dias e de endotelina-1 aos 210 dias após a imunização. Embora de maneira não significativa, verificou-se maior expressão de caspase-3, CTGF e VEGF nos animais COLV-IM e, quando os animais foram comparados ao longo do tempo, percebeu-se maior expressão de COLV no sétimo dia após a imunização na derme dos animais COLV-IM, diminuindo no trigésimo dia e voltando a subir aos 75 dias e aos 210 dias. A caspase-3 e a endotelina-1 comportaram-se de maneira semelhante. Conclusão: Estes resultados sugerem que o COLV possa agir como um possível gatilho envolvido na patogênese da ES, agindo como um indutor de ativação e de apoptose endotelial, que por sua vez poderia resultar em maior expressão de COLV, perpetuando o processo de remodelamento observado na pele dos pacientes com ES / Introduction: The immunization of healthy rabbits with type V collagen (COLV) reproduces the main characteristics of systemic sclerosis (SSc), such as fibrosis, vasculopathy and specific auto-antibodies. Preliminary studies demonstrated that both COLV-immunized rabbits (COLV-IM) and SSc patients exhibit increased expression of abnormal COLV in the dermis, but the clinical relevance of this finding is unknown. The remodeling of the extracellular matrix is an early event in COLV-IM rabbits that can be detected by the seventh day after immunization; this observation suggests that COLV is involved in endothelial injury, one of the first manifestations of the disease. Thus, the objectives of this study were to evaluate COLV expression in the dermis of healthy controls and SSc patients and to determine the correlation of this expression with skin thickness, disease activity and duration and search for a possible association between this collagen with apoptosis and activation of endothelial cells markers in patients and in animal model induced by immunization with COLV. Patients and Methods: Skin biopsies from 18 patients (6 early-stage and 12 late-stage) and 10 healthy controls as well as skin biopsies from rabbits immunized with COLV (COLV-IM) and Freund adjuvant (N=6) or Freund adjuvant alone (N=6) were evaluated. Skin thickening assessment was performed with the Modified Rodnan Skin Score (MRSS), and activity was calculated using the Valentini Disease Activity Index. To perform quantification by histomorphometry, COLV was identified by immunofluorescence, and caspase-3, endothelin-1, CTGF, TGF and VEGF in dermal endothelial cells were labeled by immunohistochemistry. In SSc patients and healthy controls, COLV from dermal fibroblast culture was quantified by real-time RT-PCR and characterized by electrophoresis, immunoblotting and tridimensional reconstruction by confocal microscopy. Results: COLV deposition was increased in the dermis of the patients with early disease compared with the healthy controls and the patients with late disease. SSc activity and disease duration were associated with dermal COLV deposition. COLV1 and COLV2 mRNA expression levels were higher in SSc, and a tridimensional reconstruction of SSc dermal heterotypic fibers confirmed the presence of abnormal COLV. The dermal endothelial cell expression of caspase-3, endothelin-1, CTGF, TGF and VEGF was higher in the SSc patients than in the controls. There was a positive correlation between COLV deposition and caspase-3, endothelin-1 and CTGF expression. When the COLV-IM rabbits were compared with the controls, there was a significant increase in the expression of COLV 7 days after the immunization and a significant increase in the expression of endothelin-1 210 days after the immunization. The expression of caspase-3, CTGF and VEGF was higher in the COLV-IM animals than in the control rabbits, although not significantly, and when the rabbits were compared over time, the expression of COLV was higher in the dermis of the COLV-IM animals 7 days after immunization, decreasing at 30 days and increasing again at 75 and 210 days. Caspase-3 and endothelin-1 exhibited similar behavior. Conclusion: these results suggest that COLV can be a possible trigger involved in the pathogenesis of SSc, acting as an inducer of endothelial apoptosis and activation that could result in higher expression of COLV, perpetuating the remodeling process observed in SSc skin

The concept of immunosurveillance suggests that the innate and adaptative immune system eliminate developing tumors. However, tumor development is associated with important modifications of the stroma which, by multiple mechanisms, restrain the immune response notably by affecting dendritic cells (DC) recruitment and functions. My thesis project aims at deciphering how the tumor environment alters the mechanisms and pathways of DC recruitment and impairs their functions. First, we determine if the site of tumor transplantation affects tumor immunogenicity. We show that tumors transplanted in the dermis (i.d.), an environment containing multiple DC subsets, induce a protective anti-tumoral immune response and tumor rejection. By contrast, the same tumor implanted in the subcutaneous tissue (s.c), mainly containing monocytes, is not rejected. Rejection of i.d. tumor is associated with a rapid (within 2 days) recruitment of DC within the tumor and rapid migration of DC towards tumor draining lymph nodes (dLN) where they present the tumor antigens (TAA) to CD4 and CD8 T lymphocyte. These events also occur for s.c. tumors but with a delayed kinetic. Thus the kinetic of DC mobilisation is decisive for tumor immunogenicity. Analysis of the DC subpopulations (TIDC) infiltrating the i.d. or s.c. tumors at 4 days (D4) and 8 days (D8) post-tumor transplantation, revealed that the different DC subpopulations are present at similar frequencies. Based on these findings, we proposed that i.d. tumor are rapidly infiltrated by dermal DC (DDC), whereas in s.c. tumor, the absence of inflammatory signals would limit DDC recruitment. In this latter case, DC would mainly come from local differentiation of blood-born precursors of DC (pre-cDC). Local differentiation of pre-cDC within the immunosuppressor tumor environment may affect their differentiation program and functions. We found that pre-cDC infiltrate i.d. and s.c. tumors starting at D4 and their frequency increases at D8. To determine the DC origin in tumors, we use CD11c-DTR-GFP mice in which CD11c+ cells express a fusion protein constituted by the diphtheria toxin receptor (DTR) and GFP. To track DDC trafficking within tumors, we injected anti-MHCII antibody before tumor implantation and analysed MHCII+ CD11c+ DDC infiltration in tumor by biphotonic microscopy. At D3 post-tumor transplantation, the DDC infiltration was higher in i.d. than s.c. tumors. To analyse the impact of this early DDC recruitment on anti-tumor immunity, we inhibit early recruitment of DC by injection of pertussis toxin (PTX), a chemokine receptor protein G inhibitor, during the three first days of tumor development. For i.d. tumors, PTX treatment induced 60% reduction of DC recruitment starting at D4. In s.c. tumor, while this effect was observable at D3 (60% reduction) and increased to 80% at D4. These results suggest that early recruitment of DDC to i.d. tumors may be be chemokine independent. PTX treatment, which inhibits DDC migration from tumors to dLN inhibits the early TAA presentation to CD4 and CD8 T cells but did not impaired i.d. tumor rejection. Collectively, these results suggest that a first wave of DDC may infiltrate i.d. tumor. The initial wave of DDC may rapidly activate the adaptive immune system and induce protective anti-tumoral immune response. For s.c. tumor, this first wave in delayed or limited. Tumor neoangioenesis would permit an input of pre-cDC which would differentiate locally into cDC1 and cDC2. To consolidate this model we are developing new protocols to efficiently inhibit early recruitment of DDC in i.d. tumor. Moreover, to determine the DC origin and pathways of DC recruitment in tumors, we exploit several experimental approaches to directly analyse DDC migration toward i.d. and s.c. tumor. / Le concept d’immunosurveillance postule que le système immunitaire inné et adaptatif élimine les tumeurs naissantes. Cependant, le développement de tumeurs est associé à des modifications importantes du stroma qui, par des mécanismes multiples, inhibent la réponse immunitaire en affectant notamment le recrutement et la fonction des cellules dendritiques (DC). Mon projet de thèse vise à préciser comment l’environnement tumoral affecte les mécanismes et les voies de recrutement des DC dans les tumeurs et leurs fonctions. Tout d’abord, nous avons déterminé si la composition en DC du tissu d’implantation affecte l’immunogénicité tumorale. Nous avons montré que les tumeurs implantées dans le derme (i.d.), un environnement riche en DC dermales (DDC), induisent une réponse anti-tumorale protectrice. En revanche, une même tumeur transplantée dans le tissu sous-cutané (s.c.), contenant principalement des monocytes, n’est pas rejetée. Le rejet des tumeurs i.d. est associé à un recrutement précoce et rapide des DC dans la tumeur (dès 2 jours post-injection) et une migration, dans les ganglions drainants (dLN), de DC qui présentent les antigènes tumoraux (TAA) aux lymphocytes T (LT) CD4+ et CD8+. Dans les tumeurs s.c. ces événements sont présents mais retardés. Ceci indique que la cinétique de mobilisation des DC est déterminante pour l’immunogénicité tumorale.

Le travail présenté dans le manuscrit concerne la conception d'un dispositif médical de classe III pour des applications en ingénierie tissulaire du derme et du disque intervertébral.Il s'agit d'une solution aqueuse de chitosane, stérilisée par autoclave, et dont le pH et l'osmolarité ont été ajustés selon un procédé de dialyse classique. Cette solution possède des propriétés de gélification in situ innovantes, ce qui lui confère de très bonnes propriétés mécaniques quelques minutes après l'injection, sans l'utilisation d'agents de réticulation mais de façon modulable en fonction de la concentration en polymère. De plus, cette solution possède une bonne injectabilité favorisant le développement d'une technique d'implantation mini-invasive pour la régénération du derme et du disque intervertébral. Un critère de performance rhéologique a notamment été mis au point afin de relier l'injectabilité aux propriétés mécaniques de l'injectât (dermal filler).Les propriétés mécaniques de l'injectât gélifié doivent être comparables au tissu natif en particulier pour le dermal filler mais aussi pour le disque intervertébral. Le comportement mécanique viscoélastique du disque intervertébral a été évalué par des essais de relaxation de contraintes et modélisé avec un modèle de Maxwell solide à trois branches. Ces essais ont été conduits sur des disques sains, ayant subi une altération de structure (fenestration) et après l'injection de biopolymères.La solution de chitosane a été injectée (i) dans le tissu cutané de deux modèles animaux : le porc et le rat et (ii) dans le disque intervertébral de deux modèles animaux : le porc et le lapin. La biocompatibilité ainsi que la réponse biologique de solutions/gels physique de chitosane in vivo ont été validées pour tous ces modèles animaux / This work deals with the conception of a class III medical device for applications in tissue engineering of dermis and intervertebral disc.This device consists in an aqueous chitosan solution, sterilized by autoclaving, with pH and osmolality adjusted by a dialysis process. This chitosan solution shows in situ gelation ability with a post-injection increase of mechanical properties. This feature is related to polymer concentration, gelation time, and is performed without external cross-linking agent. In addition, the solution exhibits a good injectability allowing the development of minimally invasive techniques to treat dermis and intervertebral disc diseases. A rheological performance criterion was defined linking injectability to mechanical properties of the implant (dermal filler).Mechanical properties of gel implant formed in contact with body fluids, in situ, have to be similar to that of native tissues. The viscoelastic behavior characterization of intervertebral disc was performed using stress relaxation and was modeled using a generalized solid Maxwell model (composed of three Maxwell elements). The tests were performed on healthy disc, fenestrated discs and after biopolymers injection.Chitosan solutions were injected into (i) porcine and rat cutaneous tissue and (ii) porcine and rabbit intervertebral discs. The biocompatibility and biofunctionality of chitosan solutions and physical hydrogels was evidenced in vivo for all animals

No description available.

Pacientes submetidos ao tratamento cirúrgico da obesidade mórbida apresentam perda ponderal acentuada e dismorfismo corporal e, com frequência, solicitam cirurgias plásticas visando um contorno corporal mais adequado. Os resultados dessas cirurgias plásticas são, em parte, limitados pela qualidade da pele resultante do grande emagrecimento. O presente estudo observacional teve como objetivo comparar fragmentos de pele da região epigástrica de 20 pacientes após perda ponderal acentuada consequente à cirurgia bariátrica com 20 pacientes portadores de obesidade mórbida, no sentido de analisar as alterações estruturais da pele como consequência do emagrecimento. A análise histomorfométrica foi realizada sobre o sistema colagênico através da metodologia Picrossírius/luz polarizada, e sobre o sistema elástico através da metodologia resorcinafucsina de Weigert. Foram observados, a redução das fibras colagênicas grossas (p=0,048); o aumento das fibras colagênicas finas (p=0,0085); e o aumento da densidade das fibras elásticas (p=0,0000009033) no grupo de pacientes emagrecidas. Não houve diferença entre os grupos quanto à média de idades (p=0,917) e quantidade total de fibras colágenas (p=0,3619). Os resultados evidenciaram as alterações estruturais da derme decorrentes do emagrecimento acentuado, demonstradas por meio do remodelamento colagênico, com a consequente redução das fibras espessas, organizadas, estruturadas e direcionadas em prol do aumento de fibras finas, desalinhadas e frouxamente dispostas, isso em associação ao aumento da elasticidade da pele. Isto explica cientificamente a já estabelecida percepção clínica das alterações cutâneas dos pacientes emagrecidos após cirurgias bariátricas, apresentando menor resistência e maior flacidez, quando comparadas ao período anterior ao emagrecimento / Post-bariatric patients develop body contour deformities and need plastic surgery procedures for reduction of excess skin and subcutaneous tissue. The results of these contouring procedures are typically limited by the poor quality of the skin. This observational study compared the epigastric skin of 20 post-bariatric with massive weight loss women with 20 women with morbid obesity through histomorphometric analysis of collagen fibers (picrosiriuspolarization) and elastic fibers (Weigert\'s resorcin-fuchsin). A reduction of thick collagen fibers (p=0.048), increase of thin collagen fibers (p=0.0085) and increase of the density of elastic fibers (p=0.0000009) were observed in the group of post-bariatric patients. There was no difference between the groups for mean age (p=0.917) and the total amount of collagen fibers (p=0.3619). These results represent structural changes in the dermis due to the massive weight loss once it demonstrates collagen modifications with reduction of thickness, organized and structured fibers, increase of thin, misaligned and disarranged fibers, and augmentation of the density of elastic fibers. This brings the scientific explanation for the established clinical perception that the skins of post-bariatric patients are less resistant and with more laxity when compared with what they were before the bariatric surgery

La peau est un organe capable de se régénérer et de cicatriser. Elle constitue la première barrière de protection de notre organisme contre les agressions physico-chimiques extérieures. Depuis plusieurs décennies des recherches ont été menées pour maîtriser la culture du derme pour plusieurs applications telles que la greffe des grands brulés. L’aspect technologique de ce domaine a fait l’objet de plusieurs travaux. Dans les années 2000, l'équipe de notre laboratoire a proposé la méthode de culture du derme associée à des microsystèmes en silicium. C’est l’unique méthode actuelle qui permet la mesure des forces isométrique du derme équivalent lors de sa culture.Dans une première étude, nous avons proposé des nouvelles méthodes de mesure des forces isométriques qui s’exercent dans des peaux reconstruites en culture entre deux lames de silicium afin de fabriquer un bio-dispositif miniaturisé à faible coût. Ainsi, les dimensions optimales ont été calculées et des nouvelles lames ont été fabriquées. L’optimisation que nous avons retenue est relative à l’amélioration de la sensibilité de la mesure des forces. Afin de quantifier le fléchissement de lames due aux forces isométriques appliquées par le derme en culture, nous avons opté pour la mesure des déplacements des lames sous l’effets des forces isométriques, à l’aide d’ondes acoustiques de surface (SAW). Ce choix se justifie par la simplicité de l’intégration des transducteurs interdigités qui génèrent les ondes acoustiques, de la possibilité d’utiliser une interrogation sans fils et la réalisation physique de l’intercorrélation des ondes générées.A l’aide de simulation nous avons identifié les déformations des ondes et les écarts de fréquence qu’elles provoquent. En effet, la dissymétrie de la courbe d’intercorrélation des signaux transmis et reçus, par les transducteurs interdigités, est intiment liée à l’écart de fréquence de l’onde reçue. Nous avons démontré que le fléchissement engendre bien la dissymétrie dans l’axe du temps qui peut être mesurée plus précisément dans les limites d‘échantillonnage. Deux démonstrateurs sont modélisés et fabriqués dans la salle blanche afin de valider l’instrumentation et le principe de transduction d’un signal chirpé avec une onde acoustique de surface. Les résultats obtenus montrent que la méthode de mesure à l’aide d’une onde acoustique nous permet de faire de mesure de force mais dans une gamme d’intensité plus élevée que celle attendue. Par la suite, nous avons étudié la méthode de mesure de forces par les capteurs à base de piézorésistances. Sachant que la technique est basée sur la variation de résistivité du matériau déformé, nous avons décidé de replacer les grilles de lame prévue pour l’accrochage du derme en culture par le matériau piézorésistif implanté sur les micro poutres. Afin d’améliorer la résolution de détection de faibles forces une série de calcul et de simulations de la position et les dimensions du matériau piézorésistif et des micropoutres sont effectués et présentés. Une autre étude que nous avons menée en parallèle concerne le développement d’une instrumentation embarquée permettant de suivre la croissance du derme en culture basé sur un système de vision. Vu les conditions strictes de notre cahier de charges qui exigeait la portabilité et l’autonomie de système final, nous avons prévu le développement d’un système de vision embarqué basé sur un module de caméra et une carte FPGA. La caméra à haute définition montée sur le système de boite de culture finale avec un objectif permet de prendre des images de fluorescences des cellules en culture. / The skin is an organ which can regenerate and heal. It is the first shield of protection of our body against external physico-chemical aggression. For several decades, researches have been conducted to control the dermis culture for several applications such as grafting large burns. The technological aspect of this area has been the subject of several works. In the 2000s, the team of our laboratory proposed the dermis culture method associated with silicon microsystems. This is the only current method that allows the measurement of isometric forces of the equivalent dermis during its culture.In a first stage of study, in order to produce a miniaturized and low-cost bio-device, we proposed new methods to measure isometric forces in reconstructed skins in culture between two silicon beams. Thus, the optimal dimensions were calculated and new beams were fabricated. The chosen optimization is related to improve the sensitivity of the force measurement. To quantify the deflection of the beams due to the isometric forces applied by the dermis in culture, we opted for the measurement of the displacements of the beams under the influence of the isometric forces by using surface acoustic waves (SAW). This choice is justified by the simplicity of the integration of the interdigital transducers (IDT) that generate the SAW, the possibility of using a wireless interrogation and the physical realization of the cross-correlation of the generated waves.Using simulation, we have identified the frequency deviations caused by wave deformations. Indeed, the dissymmetry of the cross-correlation curve of the signals generated and received by IDT is closely related to the frequency deviation of the received wave. We have evidenced that the beam deflection generates the dissymmetry in the time axis which can be measured more precisely within the limits of sampling. Two demonstrators were designed and manufactured in the clean room to validate the instrumentation and the principle of transducing a chirped signal with a SAW. The obtained results show that the proposed SAW-based force measuring method allows us to measure force, but in a higher intensity range than expected. Subsequently, we studied the method of force measurement by piezoresistors. Considering that the technique is based on the variation of resistivity of the deformed material, we decided to replace the silicon grids provided for the attachment of the dermis in culture by the piezoresistive material implanted on the silicon micro-beams. To improve the low-resolution detection, a series of calculations and simulations of the positions and the dimensions of the piezoresistive material and the micro-beams have been carried out and presented. Another study that we conducted in parallel concerns the development of an on-board instrumentation to monitor the growth of the dermis in culture based on a vision system. Considering of the strict conditions of our specifications that required the portability and autonomy of the final system, we developed an embedded vision system based on a camera module and a FPGA card. The high definition camera mounted on the system of final culture box with a lens allows to take fluorescence images of cells in culture.