Im Verlauf der Knochenbildung und Frakturheilung kommt es zu einem Zusammenwirken verschiedener Zell- und Gewebearten. Die beteiligten Zellen unterliegen dabei der Regulation von Wachstumsfaktoren (WF), Zytokinen und Hormonen, die den regelhaften Ablauf kontrollieren und steuernd in Proliferation und Differenzierung von Zellen und deren Matrixsynthese eingreifen. Neben einer optimalen Osteosynthese zur Frakturstabilisation stellt die biologische Beeinflussung der Knochenheilung ein großes Forschungsfeld dar. In Vorarbeiten wurde ein Applikationssystem entwickelt, das mittels einer biodegradierbaren Polymerbeschichtung auf Osteosynthesematerialien die lokale Applikation von WF in biologisch aktiver Form ermöglicht. In vivo wurde an Ratten- und Schweinemodellen erfolgreich die Stimulation der Knochenheilung durch lokal applizierte Wachstumsfaktoren IGF-I, TGF-ß1 und BMP-2 gezeigt. Ziel dieser Arbeit war die Untersuchung zellulärer Prozesse während der beeinflussten und unbeeinflussten Knochenheilung sowie des Effektes der lokalen Applikation von Wachstumsfaktoren von beschichteten Osteosyntheseplatten. Anhand histologischer und immunhistochemischer Untersuchungen, der in situ Hybridisierung an Knochenschnitten und der ELISA-Methode konnte ein früherer Reifungsbeginn des Kallus durch die Wachstumsfaktorenapplikation gezeigt werden, ohne dass es zu Veränderungen der physiologischen Gewebszusammensetzung und der endogenen Wachstumsfaktoren-Expression kam. Durch Zellkulturstudien an primären Osteoblasten und Osteoklasten wurde an isolierten Zelltypen die Wirkung der applizierten WF untersucht und ihr Effekt auf die Zelltypen dargestellt. Die Bildung ektoper Ossifikation im Weichgewebe durch die Wachstumsfaktoren wurde im Schafsmodell ausgeschlossen. Dies stellt einen wichtigen Sicherheitsaspekt beim Einsatz von Wachstumsfaktoren zur Stimulation der Knochenheilung dar. Die lokale Applikation der Wachstumsfaktoren von einer Plattenosteosynthese zur Osteotomiestabilsierung im Rattenmodell zeigte eine signifikante Verbesserung der biomechanischen Stabilität und der Kallusheilung 42 Tage nach Osteotomie Die aus diesen Studien gewonnenen Erkenntnisse liefern Aufschluss zur Weiterentwicklung biologischer Einflussmöglichkeiten auf den Knochenstoffwechsel und die Rolle von WF während der Frakturheilung. / In the process of bone formation and healing, different cell- and tissue types are formed. The cells involved are regulated by growth factors (GF), cytokines and hormones, which control the healing and affect the proliferation and differentiation of cells and their matrix synthesis. Besides the use of the optimal osteosynthesis for fracture stabilization, the biological influence of the bone healing represents a large research field. In previous work an application system for local application of GF in biologically active form was developed. In vivo studies revealed a stimulating effect of locally applied IGF-I and TGF-ß1 in a rat and a pig model. Goal of this work was the investigation of cellular processes during the influenced and uninfluenced bone healing. A further aim was the transfer of the local application method to further stabilization systems (plate osteosynthesis). On the basis of the histology, the immunohistology, in situ hybridizing and ELISA methods an earlier beginning of maturing of the callus by the growth factors could be shown, without changes of the physiological callus composition and the endogenous growth factors expression. In further cell culture studies on primary osteoblasts and osteoclasts the effect of the applied growth factors was examined and their effect on the cell types analyzed. The avoidance of ectopic ossification, an important safety aspect with the use of growth factors to stimulate bone healing, was investigated in a sheep model. It was also possible to proof the efficacy of locally applied growth factors delivered extramedullary from plates. The results of these studies provide further explanations for the action of the used growth factors and are necessary for the ongoing development of the application of growth factors for a clinical use.

O principal controle do ciclo celular de mamíferos, que é dividido em G0/G1/S/G2/M, ocorre na transição G0→G1→S. Nesta tese mostramos que a proteína ciclina D1 desempenha um papel fundamental nos circuitos de transdução de sinais que regulam a transição G0→G1→S na linhagem Y-1 de células adrenocorticais de camundongo. Esta conclusão não é surpreendente, uma vez que, ao longo dos últimos anos, muitos laboratórios contribuíram para estabelecer a noção de que a atividade das diversas formas do complexo ciclina/CDK é essencial para a transição G0→G1→S, e também para outras etapas do ciclo celular. Em células Y-1, FGF-2 induz tardiamente (5-6h) a expressão do gene e da proteína ciclina D 1, através de um processo dependente de síntese de proteínas. Peptídeos hipofisários não identificados e vasopressina bloqueiam a indução de ciclina DI, antagonizando FGF-2. Por este mecanismo, vasopressina exerce um efeito anti-mitótico, bloqueando a transição G0→G1→S promovida por FGF-2. ACTH, que também exibe um forte efeito anti-mitótico sobre FGF-2 não afeta a indução de ciclina D1. A transfecção dupla de uma forma induzível de c-Myc (MycER) e constitutiva do cDNA de ciclina D1, em presença de ACTH mimetiza a ação mitogênica de FGF-2 em células Y-1 no estado G0. Estes resultados mostram que, em células adrenocorticais, c-Fos, c-Jun, c-Myc e ciclina D1 agem de forma independente e complementar, sendo necessários para a transição G0→G1→S do ciclo celular. / The main control of mammalian cell cycle, which is divided in G0/G1/S/G2/M, occurs in G0→G1→S transition. In this work we show that cyclin D1 protein plays a key role in signal transduction circuits underlying the G0→G1→S transition of mouse Y-1 adrenocortical cell line. This conclusion is not surprising, once in the last years, many laboratories have contributed to establish the notion that the activity of the distinct forms of cyclin/CDK complexes is essential for the G0→G1→S transition, and also for other phases transition of cell cycle. In Y-1 cells, FGF-2 causes a delayed (5-6h) induction of cyclin D1 gene and protein, through a process dependent on protein synthesis. Hypophisary peptides, not identified, as well as vasopressin, block cyclin D1 induction, antagonizing FGF-2. By this mechanism, vasopressin exert an antimitotic effect, blocking G0→G1→S transition promoted by FGF-2. ACTH, which also exhibit a strong anti-mitotic effect upon FGF-2, does not affect cyclin D1 induction. Double transfection of inducible c-Myc (MycER) and constitutive cyclin D1 cDNA, in the presence of ACTH, mimics the mitogenic action of FGF-2 in G0 Y-1 cells. Altogether, these results show that, in adrenocortical cells, c-Fos, c-Jun, c-Myc and cyclin D1 act in an independent and complementary manner, being necessary for the G0→G1→S transition of cell cycle.

Wachstumsfaktoren sind wichtige Steuerelemente des Knochenzellmetabolismus. Im Verlauf der Frakturheilung kommt es zur Ausschüttung von zahlreichen Wachstumsfaktoren, Zytokinen und Botenstoffen im und um den Bereich des Frakturspalts, die systemisch oder lokal, endokrin, parakrin oder autokrin wirksam werden können. Für verschiedene Wachstumsfaktoren konnten in zahlreichen Studien osteoinduktive und die Frakturheilung positiv beeinflussende Wirkungen nachgewiesen werden. In vitro und in vivo Studien belegen, dass einige dieser Faktoren wie Insulin-like growth factor-I (IGF-I), Transforming growth factor-beta1 (TGF-beta1) und Bone morphogenetic protein-2 (BMP-2) einen stimulierenden Effekt auf osteo- und chondrogene Zellen aufweisen und somit die Knochenheilung stimulieren. Der genaue Wirkmechanismus dieses positiven Effektes der Wachstumsfaktoren und ihre Interaktion im Verlauf der Frakturheilung ist nicht bekannt. Die lokale Applikation der Faktoren für einen therapeutischen Einsatz bei der Frakturheilung stellte bisher jedoch ein Problem dar. Mit der entwickelten biodegradierbaren Poly(D,L-Laktid)-Beschichtung von Implantaten können eingearbeitete Wachstumsfaktoren kontrolliert und lokal direkt an der Fraktur freigesetzt werden. Das beschichtete Implantat dient dabei der Stabilisation der Fraktur und gleichzeitig als Wirkstoffträger. Die Beschichtung weist eine hohe mechanische Stabilität auf. Die eingearbeiteten Wachstumsfaktoren behalten ihre biologische Aktivität in der Beschichtung und werden kontrolliert lokal freigesetzt. Um den Effekt lokal applizierter Wachstumsfaktoren auf die Frakturheilung zu untersuchen, wurde ein standardisiertes geschlossenes Frakturmodell entwickelt, das der klinischen Situation möglichst nahe ist und reproduzierbar durchgeführt werden kann. Untersucht wurde der Effekt der Wachstumsfaktoren IGF-I, TGF-beta1 und BMP-2 und des Trägermaterials PDLLA sowie lokale und systemische unerwünschte Wirkungen. Die Ergebnisse zeigten einen signifikant grösseren stimulierenden Effekt von IGF-I auf die Frakturheilung im Vergleich zur TGF-beta1 Applikation. Die kombinierte Gabe beider Faktoren ergab einen signifikant grösseren Effekt auf die torsionale Stabilität und die Kallusreifung im Vergleich zur Einzelapplikation. Beide Faktoren scheinen einen synergistischen Effekt auf die Frakturheilung zu haben. Die lokale Applikation von BMP-2 beschleunigte ebenso, wie die lokale Freisetzung von IGF-I und TGF-beta1 die Frakturheilung signifikant. Deutliche Unterschiede zwischen IGF-I / TGF-beta1 und BMP-2 konnten nicht festgestellt werden.Allerdings zeigte sich bei der Verwendung von BMP-2 auch ausserhalb der Frakturzone eine grössere Mineralisation der Kortikalis, die bei IGF-I / TGF-beta1 nicht zu beobachten ist. Auch im Grosstiermodell bestätigte sich die Wirksamkeit dieser bioaktiven Oberflächen-beschichtung auf die Osteotomieheilung. Die PDLLA-Beschichtung alleine, ohne eingearbeitete Wachstumsfaktoren, zeigte bereits einen positiven Effekt auf die Frakturheilung. Die Untersuchungen belegen, dass die lokale Freisetzung von Wachstumsfaktoren aus einer biodegradierbaren PDLLA-Beschichtung von Implantaten die Frakturheilung signifikant beschleunigt, wobei keine unerwünschten lokalen oder systemischen Wirkungen beobachtet werden konnten. Bei dem Vergleich lokaler (durch Wachstumsfaktoren) mit systemischer Stimulationsmöglichkeit (durch Wachstumshormon) der Frakturheilung lässt sich zusammenfassend feststellen, dass die kombinierte Anwendung beider Stimulationsmöglichkeiten zu keiner weiteren Steigerung der Heilungsvorgänge führte. Weitere Untersuchungen wurden hinsichtlich der genauen Rolle und Interaktion der Wachstumsfaktoren durchgeführt. Vor allem die Frühphase scheint hierbei eine entscheidende Rolle bei der Frakturheilung einzunehmen. Es zeigte sich hierbei eine deutliche Stimulation der Osteoblastendifferenzierung mit einer Erhöhung der Kollagen-1 Produktion in vitro sowie eine Steigerung der Proliferationsrate und Angiogenese mit einem schnelleren Ablauf der Phasen der Frakturheilung in vivo durch lokal appliziertes IGF-I und TGF-beta1. Weitere Anwendungen der entwickelten Beschichtungstechnologie stellen die lokale Applikation von Wachstumsfaktoren von beschichteten PDLLA-Cages bei der intervertebralen Spondylodese sowie die lokale Applikation von Antibiotika aus einer PDLLA-Beschichtung von Implantaten zur Prophylaxe der Implantat-assoziierten Osteomyelitis dar.Basierend auf diesen Ergebnissen steht der Einsatz PDLLA-Gentamicin beschichteter intramedullärer Tibianägel kurz vor der klinischen Anwendung.Eine Zulassung durch die entsprechenden Behörden ist erfolgt.Die klinische Anwendung Wachstumsfaktoren-beschichteter Implantate ist bereits in der Vorbereitung. / Growth factors are important regulators of bone metabolism. During fracture healing many growth factors or cytokines were locally released at the facture site. In several studies, different growth factors demonstrated osteoinductive and fracture stimulating properties. In vitro and in vivo studies showed a stimulating effect of Insulin-like growth factor-I (IGF-I), Transforming growth factor-beta1 (TGF-beta1) and Bone morphogenetic protein-2 (BMP-2) on osteo- and chondrogenetic cells. The exact effectiveness and the interaction of these growth factors during fracture healing is not known so far. Further, the local application of these factors for therapeutically use in fracture treatment is still a problem. The developed biodegradable poly(D,L-lactide)-coating of implants allows the local and controlled release of incorporated growth factors directly at the fracture site. The coated implant serves on the one hand for fracture stabilization and on the other hand as a drug delivery system. The coating has a high mechanical stability. The incorporated growths factors remain biologically active in the coating and were released in a sustained and controlled manner. To investigate the effect of locally released growth factors IGF-I, TGF-beta1 and BMP-2 and the carrier PDLLA on fracture healing, standardised closed fracture models were developed with a close relationship to clinical situation. Further, possible local and systemic side effects were analysed. The results demonstrated a significantly higher stimulating effect of IGF-I on fracture healing compared to TGF-beta1. The combined application of both growth factors showed a synergistic effect on the mechanical stability and callus remodeling compared to single treatment. The local release of BMP-2 also enhanced fracture healing significantly - comparable to combination of IGF-I and TGF-beta1. However, a higher rate of mineralisation was measurable outside the fracture region using BMP-2 in a rat fracture model. Using a large animal model on pigs with a 1 mm osteotomy gap, the effectiveness of locally released growths factors could be confirmed. Further, the PDLLA-coating without any incorporated growth factors demonstrated a significantly effect on healing processes in both models. These investigations showed, that the local release of growth factors from PDLLA coated implants significantly stimulate fracture healing without any local or systemic side effects. Comparing systemic with local stimulation techniques, we found an improvement of fracture healing by systemic administration of growth hormone and local application of IGF-I and TGF-beta1. However, the combined use of both simulation techniques did not lead to a further increase of healing processes. Investigations on the effectiveness and the interaction of growth factors during fracture healing demonstrated an dramatic effect in the early phases of healing processes. The growth factors stimulate the differentiation of osteoblasts with a higher production of collagen I in vitro and increase osteogenesis and vascularisation of the fracture callus in vivo. Further applications of the coating technology are the use of PDLLA and growth factor coated cages for the stimulation of intervertebral fusion and the use of PDLLA and Gentamicin coated implants in order to prevent implant associated infections. The clinical use of antibiotic and growth factor coated implants are in preparation.

O hormônio adrenocorticotrópico, ACTH, regula função (esteroidogênese) e proliferação das células da córtex das glândulas adrenais através de um único receptor específico, ACTHR, que pertence à superfamília GPCR (G-protein coupled receptors). Embora o ACTHR tenha sido clonado há 8 anos, os mecanismos moleculares das ações mitogênica e anti-mitogênica de ACTH permanecem obscuros, cuja elucidação é objeto de estudo deste trabalho. A abordagem experimental consistiu na clonagem do ACTHR de células adrenocorticais Y-1 de camundongo e expressão funcional em fibroblastos 3T3 e células AR-1. Clones transfectantes, expressando estavelmente ACTHR, mostraram-se responsivos a ACTH através de: a) ativação de adenilato ciclase e b) indução de genes das famílias fos e jun. Por outro lado, medidas de síntese de DNA e proliferação celular indicam que ACTH não tem nenhum efeito mitogênico ou anti-mitogênico nos transfectantes ACTHR. O gene c-fos foi usado como alvo para testar vias de transdução de sinal ativadas por ACTH nos transfectantes 3T3 ACTHR. Estes testes mostraram que PKA, PKC e MAPK tem pouca ou nenhuma participação na indução de c-fos por ACTH nos clones 3T3 ACTHR, sugerindo que ACTHR pode ativar vias ainda não identificadas e motivando a busca de novas vias ativadas por ACTH nas células Y-1. Verificou-se que células Y-1 apresentam níveis constitutivamente elevados de AKT/PKB ativada (fosforilada), dependentes de PI3K e SRC, e que ACTH promove rápida desfosforilação de AKT via Gs/Adenilato Ciclase/cAMP/PKA. Ao promover a inativação de AKT, ACTH promove simultaneamente a indução da proteína p27'IND.Kip1', um mecanismo que contribui para a atividade anti-mitogênica de ACTH. / The adrenocorticotropic hormone, ACTH, regulates both function and proliferation of adrenocortical cells binding to a specific receptor, ACTHR, which belongs to superfamily of GPCR (G-protein coupled receptors). ACTHR was cloned a few years ago, but the molecular mechanisms underlying the mitogenic and anti-mitogenic actions of ACTH remain unknown, whose elucidation is aim of this project. The experimental approach was to clone the ACTHR from mouse Y-1 adrenocortical cells and to express the functional receptor in Balb 3T3 fibroblasts and AR-1 cells. Transfectant clones stably expressing the ACTHR respond to ACTH treatments by: a) adenylate cyclase activation and b) induction of fos and jun genes. On the other hand, experiments of DNA synthesis and cellular proliferation showed that ACTH has not mitogenic or anti-mitogenic effects in ACTHR transfectants. c-fos gene was used as a target to test signal transduction pathways activated by ACTH into 3T3 ACTHR transfectants. The results showed that PKA, PKC and MAPK have no relevant contribution on the ACTH c-fos induction in 3T3 ACTHR transfectants suggesting that ACTHR can activate signal transduction pathways still not identified. This conclusion prompted us to search for another signal transduction pathways triggered by ACTHR in Y-1 adrenocortical cells. This search led to the detection of high constitutive levels of activated AKT/PKB in Y-1 adrenocortical cells, which are dependent on PI3K and SRC. ACTH causes a strong and rapid downregulation of activated AKT in a Gs/Adenylate Cyclase/cAMP/PKA dependent manner. Apparently, dephosphorylation of AKT promoted by ACTH releases transcription factors that induce p27'IND.Kip1', a likely mechanism underlying ACTH anti-mitogenic effects in adrenocortical cells.

La circulation collatérale non coronarienne (CCNC) perfuse le cœur en provenant d’artères bronchiques, médiastinales et péricardiques. L’éventualité que la CCNC puisse être artificiellement augmentée pour fournir un traitement alternatif pour les patients ischémiques représente une hypothèse intrigante sans réponse en raison de la nature difficile de ce champ de recherche. En se basant sur plusieurs aspects, tel que (1) l’existence des collatérales naturelles entre les artères coronaires et les artères thoraciques internes (ATIs), (2) les effets potentiels de la ligature des ATIs; (3) la capacité des ATIs de développer d’importantes branches collatérales ; (4) et la disponibilité actuelle des facteurs de croissance vasculaire, l’hypothèse ici décrite est que l’augmentation de la CCNC pourrait représenter une stratégie alternative d’apport sanguin au coeur.Ainsi, l’association d’occlusion des ATIs et de l’administration des facteurs de croissance pourrait représenter un moyen de poursuivre cet objectif. Pour le premier travail de recherche, nous avons établi un modèle canin. / Noncoronary collateral circulation (NCCC) comes to the heart from mediastinal, bronchial, and pericardial channels. Whether NCCC can somehow be augmented to provide an alternative therapy for ischemic patients is an intriguing hypothesis with no clear answer yet due to the challenging nature of this research field. Based on several aspects, such as (1) the occurrence of natural collaterals between coronary and the internal thoracic arteries (ITAs), (2) the potentialhemodynamic effects of ITAs ligation, (3) the potential of ITAs for developing important collateral branches, and (4) the current availability of angiogenic growth factors, the hypothesis herein is that enhancement of NCCC may represent an alternative myocardial blood supply strategy, and that combining ITAs occlusion with angiogenic growth factors may represent a way to achieve this objective. We established an ischemic canine model for first experiment.

No description available.

<p>Ekstrakcija zuba je intervencija prilikom koje se zub vadi iz svog leži&scaron;ta u zubnoj alveoli. Rana koja nastaje kao posledica ove intervncije je takvog oblika da njene ivice nije moguće približiti jednu drugoj , te zarasta per secundam intentionem. Ekstrakcija zuba ima za posledicu mnogobrojne promene na tvrdim i mekim tkivima alveolarnog nastavka u periodu od nekoliko meseci do godinu dana nakon intervencije. Savremena stomatologija se i dalje intenzivno bavi proučavanjem procesa zarastanja ekstrakcione rane iz potrebe da se &scaron;to bolje razumeju promene u tkivu koje nastaju po gubitku zuba da bi se mogle prevenirati i/ili usmeriti tako da se omogući kasnija lak&scaron;a protetska rehabilitacija pacijenata. Mnoge studije su pokazale efikasnost faktora rasta u tokom procesa zaceljivanja tkiva.Opisan je veliki broj tehnika za pripremu autolognih krvnih preparata koji sadrže faktore rasta, ali su njihova praktična primena i efikasnost su dalje nejasni zato &scaron;to svaka od ovih metoda dovodi do izrade različitog produkta sa različitom biologijom i potencijalnim indikacijama za upotrebu. Ekstrakcije mandibularnog trećeg molara spadaju u jednu od najče&scaron;ćih intervencija sa kojom se u svom radu svakodnevno sreću oralni i maksilofacijalni hirurzi. Ova hirur&scaron;ka procedura je povezana za postoperativnim efektima koji u velikoj meri utiču na kvalitet života pacijenta kao &scaron;to su bol, trizmus, edem, infekcija i alveolitis. U literaturi postoje dokazi da aplikacija nekog od autolognog krvnog preparata sa visokim sadržajem faktora rasta u određenoj meri može da pobolj&scaron;a proces zarastanja tkiva i da umanji neželjene propratne pojave hirur&scaron;ke intervencije nakon ekstrakcije mandibularnog trećeg molara. Cilj ovog rada je bio da utvrdimo da li primena autolognih krvnih preparata sa koncentrovanim faktorima rasta ubrzava stvaranje ko&scaron;tanog tkiva u ekstrakcionoj rani, kao i da li utiče na učestalost pojave alveolitisa i pojavu aproksimalinih parodontalnih džepova na susednim zubima nakon hirur&scaron;ke ekstrakcije donjeg trećeg molara. Studija je sprovedena kao prospektivna klinička studija split-mouth dizajna. U studiju je bilo uključeno 30 pacijenata kod kojih je indikovana ekstrakcija oba mandibularna treća molara i kod kojih su ovi zubi bilateralno u približno istom položaju u odnosu na drugi donji molar. Nakon hirur&scaron;ke ekstrakcije u jednu alveolu je aplikovan preparat koncentrovanih faktora rasta. Kontrolnu grupu u istraživanju činilo je 30 zubnih alveola u koje nije aplikovan preparat koncentrovanih faktora rasta. U eksperimentalnu grupu spadalo je 30 alveola u koje su aplikovani preparati koncentrovanih faktora rasta nakon ekstrakcije zuba. Pacijentima je prvi obavezan kontrolni pregled zakazivan za 7 dana nakon intervencije, tokom koga su uklanjane suture, a vr&scaron;en je i klinički pregled rane i parodontolo&scaron;kom sondom je proveravana dubina parodontalnog džepa na distalnoj povr&scaron;ini drugog molara. Druga postoperativna kontrola je zakazivana 4 nedelje nakon intervencije, a treća nakon 8 nedelja i na ovim kontrolama je merena dubina parodontalnog džepa na distalnoj povr&scaron;ini drugog molara. Ispitanicima su napravljena tri CBCT snimka operisanih regija i to po sledećoj dinamici- prvi snimak neposredno nakon ekstrakcije zuba, drugi 4 nedelje i treći 8 nedelja po intervenciji. Svaki CBCT snimak je analiziran da bi se prikupili željeni podaci: zapremina &scaron;upljine alveole koja je ostala nakon ekstrakcije zuba i gustina novostvorenog ko&scaron;tanog tkiva, &scaron;to su parametri na osnovu kojih procenjujemo proces zarastanja ko&scaron;tanog tkiva nakon intervencije. Ova metodologija je originalna , obzirom da su do sada kori&scaron;ćene dvodimenzionalne radiografske metode snimanja sa ciljem praćenja ko&scaron;tanog zarastanja nakon ekstrakcije zuba manje precizne i pouzdane. Dobijenu podaci su obrađeni odgovarajućim matematičko-statističkim postupcima. Najznačajniji rezultati istraživanja su zatim tabelarno i grafički prikazani. Na osnovu dobijenih rezultata do&scaron;li smo do zaključka da iako primena koncentrovanih faktora rasta dovodi do intenziviranja procesa ko&scaron;tanog zarastanja i smanjenja dubine parodontalnog džepa na distalnoj povr&scaron;ini susednih zuba, ta razlika nije statistički značajna. Obzirom da ni u jednom slučaju nije do&scaron;lo do pojave alveolitisa, nismo mogli zaključiti na koji način primena koncentrovanih faktora rasta utiče na učestalost ove komplikacije.</p> / <p>Tooth extraction is an intervention during which a tooth is removed from its socket. A wound that remains after this is of specific size and shape and it heals per secundam intentionem. Where once was a tooth, in following months and years, a large number of changes in composition of hard and soft tissues occure. Haeling of extraction wound in still in focus of contemporary dentistry, since it is imperative to understand all tissue changes in order to prevent and/or gide them and enable prosthodontic rehabilitation of the patient. Many studies confirm a benefitial effect of growth factors douring wound healing. A large number of techniques is developed to prepare autologous blood concentrates containing growth factors, like platelet-rich fibrin (PRF) , but their aplicability and efficancy are still unclear because each of these methods results in product with different biology and physical characteristics, as well as different potential indications. Third mandibular molar extraction is one of the most frequent interventions that oral and maxillofacial surgeon face in their everyday clinical practice. This procedure is usually followed by postoperative effects affecting such as pain, trismus, edema, infection and alveolitis. In contemporary literature there is enough evidence to suport beneficial role of autologous blood preparations in wound healing, and some authors even sugest that they can reduce incidence of postextraction complications afther third molar surgery. The aim of this study was to determin weather concentrated growth factors have beneficial effect on bone healing after tooth extraction, as well as their effect on the incidence of alveolitis and do they reduce pocket depth on distal side of adjacent tooth. This study was conducted as prospective clinical split-mouth designed study. 30 patients with both mandibular third molars indicated for the extraction, in similar position, were included in the study. On the same day surgical removal of both mandibular molars was performed, and in one socket PRF was placed. Patients were scheduled for a check-up and suture removals on the 7th postoperative day. During this visit, as well as after 4 and after 8 weeks, depth of distal pocket of the second molar was measured. CBCT was made on the day of surgery, 4 and 8 weeks afther surgery. On these radiographs volume of the bone defect was measured as well as density of newly formed bone tissue in the socket. This is original methodology, while previous studies used two-dimensional radiography methods in order to evaluate bone healing after tooth extractions, with less precision and liability. We processed and analyzed gained data using appropriate mathematical-statistical methods. According to our data we concluded that application of PRF in the extraction socket improves bone healing and reduces depth of pocket on the adjacent teeth, although this effects are not statistically significant. In our study, alveolitis did not occur neither in control nor in the experimental group, so we could not conclude if the application of PRF has any effect on prevention of this complication.</p>

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2016-09-29T20:17:35Z No. of bitstreams: 1 josehenriquemferreira_dissert.pdf: 1670640 bytes, checksum: 3707d57cc4f4e98d8edb6594786c1b7e (MD5) / Made available in DSpace on 2016-09-29T20:17:35Z (GMT). No. of bitstreams: 1 josehenriquemferreira_dissert.pdf: 1670640 bytes, checksum: 3707d57cc4f4e98d8edb6594786c1b7e (MD5) Previous issue date: 2014-10-20 / Introduction: Mammary neoplasms are the most common type of tumor in dogs. Some proteins play an important role in tumor progression, thus are candidate prognosis markers. During tumor growth, the transcription factor induced by hypoxia (HIF-1α) activates the expression of vascular endothelial growth factor (VEGF), promoting angiogenesis. Interleukin-8 (IL-8) is a pro-inflammatory and pro-angiogenic cytokine and has been associated with tumor progression. Objectives: To evaluate the prognostic value of HIF-1α, VEGF and IL-8 proteins in tumor tissue in dogs with mammary tumors, correlating them with clinicopathological parameters, clinical outcome and survival. Material and Methods: The concentrations of HIF-1α, VEGF and IL-8 proteins were evaluated by ELISA (Enzyme-linked immunosorbent) in macerated tumor of 25 bitches with mammary tumors and control samples and compared statistically. Results: The levels of HIF-1α, VEGF and IL-8 were higher in dogs over the age of 10 years and that had died (p <0.05). Moreover, HIF-1α concentrations were elevated in the tumors of dogs who developed metastases (p = 0.04), while VEGF levels were highest in tumors with clinical stages III and IV (p = 0.03) and IL-8 tumors in tumor with development greater than six months (p = 0.03). Still, high levels of HIF-1α, VEGF and IL-8 were also related to shorter overall survival (p <0.05). Conclusions: High levels of HIF-1α, VEGF and IL-8 are associated with features of poor prognosis, suggesting that the assessment of these proteins in tumor macerated has important prognostic value. / Introdução: As neoplasias mamárias são o tipo mais comum de tumor na espécie canina. Algumas proteínas exercem importante papel na progressão tumoral e portanto, são candidatos marcadores de prognóstico. Durante o crescimento tumoral, o fator de transcrição induzido por hipóxia (HIF-1α) ativa a expressão do fator de crescimento endotelial vascular (VEGF), promovendo a angiogênese. A interleucina-8 (IL-8) é uma citocina pró-inflamatória e pró-angiogênica e tem sido associada à progressão tumoral. Objetivos: Avaliar o valor prognóstico das proteínas HIF-1α, VEGF e IL-8 no tecido tumoral em cadelas com neoplasia mamária, relacionando-os com os parâmetros clínico-patológicos, evolução clínica e sobrevida. Material e Métodos: As concentrações das proteínas HIF-1α, VEGF e IL-8 foram avaliadas pelo método de ELISA (Enzyme-linked immunosorbent Assay) no macerado tumoral de 25 cadelas com neoplasia mamária e amostras controle e comparadas estatisticamente. Resultados: Os níveis de HIF-1α, VEGF e IL-8 foram maiores em cadelas com idade superior a 10 anos e que vieram a óbito (p < 0,05). Além disso, concentrações de HIF-1α foram elevadas nos tumores de cadelas que desenvolveram metástase (p = 0,04), enquanto os níveis de VEGF foram maiores em tumores com estadiamento clínico III e IV (p = 0,03), e de IL-8 em tumores com evolução tumoral maior que seis meses (p = 0,03). Ainda, níveis elevados de HIF-1α, VEGF e IL-8 também foram relacionados com menor tempo de sobrevida global (p < 0,05). Conclusões: Altas concentrações de HIF-1α, VEGF e IL-8 estão associadas com características de pior prognóstico, sugerindo que a avaliação dessas proteínas no macerado tumoral possui importante valor prognóstico.

Garantir la qualité des produits sanguins est crucial. Les lysats plaquettaires (LP) riches en facteurs de croissance (FC) s’imposent comme le complément idéal pour l’expansion ex vivo des cellules souches, et comme produit thérapeutique pour la régénération cellulaire. L’intérêt est croissant pour les microparticules (MPs) extracellulaires, mais l’expression de phosphatidylsérine à leur surface peut induire des effets thrombotiques et inflammatoires. L’autre risque transfusionnel, la transmission de virus, dont le virus de l’hépatite C (VHC), est maîtrisable par traitements de réduction virale par solvant/détergent (S/D), chauffage, ou nanofiltration. Nous avons étudié des technologies de sécurisation des produits sanguins: (a) élimination des MPs par nanofiltration sur filtres de 75 nm et (b) traitements S/D, chauffage à 56°C ou nanofiltration pour inactiver ou éliminer le VHC. Les informations ont été utilisées pour développer des LP utiles en médecine régénérative. L’un d’eux destiné à la neurorégénération, a été préparé en émettant l’hypothèse qu’un lysat de culot plaquettaire (LCP) enrichi en facteurs neurotrophiques et dépourvu de protéines plasmatiques se montrerait efficace contre les maladies neurodégénératives. Nos résultats montrent que la nanofiltration sur des filtres de 75 nm préserve la composition en protéines plasmatiques, et le pouvoir hémostatique. La nanofiltration retire les MPs et évite, in vitro, la génération de thrombine. Par ailleurs le traitement S/D à 31°C pour 30 minutes élimine le pouvoir infectieux du VHC. Pris globalement les traitements de nanofiltration et S/D apparaissent donc comme des méthodes de choix pour l’amélioration de la sécurité du plasma vis à vis de risques thrombogènes et infectieux. Nous avons ensuite préparé un LCP appauvri en protéines plasmatiques (dont le fibrinogène) et enrichi en un mélange pléiotrope physiologique de FC destiné à l’administration cérébrale. Les analyses par ELISA et par protéomique ont montré qu’un chauffage de 56°C pour 30 min réduisait le contenu en protéines et modifiait favorablement la composition relative en facteurs neurotrophiques. Par ailleurs le chauffage améliore l’action neuroprotectrice et, associé aux traitements S/D et de nanofiltration, contribue à l’inactivation du VHC. Ce LCP exerce une neuroprotection élevée dans des modèles de la maladie de Parkinson (MP) tout à la fois (a) in vitro (cellules LUHMES différentiées en neurones dopaminergiques et exposées au MPP+) et (b) in vivo (souris intoxiquées par MPTP). L’expression de la tyrosine hydroxylase (TH) dans la Substantia nigra pars compacta montre que l’administration intracérébroventriculaire (ICV) ou intranasale (i.n.) apparait comme une option thérapeutique possible des maladies neuro-dégénératives. Les études cellulaires In vitro sur LUHMES et NSC34 ont montré que l’inhibition spécifique des voies signalétiques relayées par AkT et ERK altère l’activité neuroprotectrice du LC. Des événements neuro-inflammatoires pouvant aggraver l’évolution des maladies neurodégénératives, nous avons vérifié que le LCP n’induit pas de marqueurs inflammatoires (COX-2, iNOS) chez des cellules microgliales BV2, et pouvait même diminuer celle de COX-2 après exposition à des lipopolysaccharides. De plus, nous avons identifié que le LCP contenait 1.7 x 1012 MP/mL d’une taille moyenne de 160 nm. Isolées, ces MPs pourraient exercer un rôle neuroprotecteur des cellules LUHMES exposées à des agents neurotoxiques. En conclusion, nos résultats montrent la faisabilité technique à préparer des lysats plaquettaires viro-inactivés pour des usages dans le domaine de la médecine régénérative, y compris comme agent neuroprotecteur du système nerveux central. / Ensuring quality and safety of blood products is crucial. Platelet lysates (PL) rich in growth factors (GFs) have emerged as ideal clinical-grade supplement for ex vivo expansion of mesenchymal stromal cells, and as therapeutic product promote cellular regeneration. Interest for platelet extracellular microparticles (MPs) is growing but expression of phosphatidylserine on their surface may cause thrombotic and inflammatory side effects. Another transfusional risk, transmission of viruses, including hepatitis C virus (HCV), can be fully controlled by dedicated viral reduction methods as solvent/detergent (S/D) or heat treatments, or nanofiltration. We have evaluated technologies to secure therapeutic blood products: (a) removal of MPs by 75nm-nanofiltration and (b) inactivation/removal of HCV by S/D or 56°C heat treatments, or nanofiltration. Data have been used to develop LP of interest for regenerative medicine. In particular, one, targeting neuroregenerative applications, has been prepared based on the hypothesis that a platelet pellet lysate (PPL) enriched in multiple neurotrophic growth factors and depleted of plasma proteins could exert potent neuroprotective actions in neurodegenerative disease models. Our data show that 75 nm-plasma nanofiltration preserved plasma protein biochemical profile, and hemostatic power. Nanofiltration removes MPs and avoids in vitro the generation of thrombin. In addition, the S/D treatment at 31°C for 30 minutes fully inactivates HCV infectivity. Therefore, altogether, nanofiltration and S/D emerge as choice procedures to improve the safety of plasma for thrombogenic and infectious risks. We have then prepared a PPL depleted of plasma proteins (in particular fibrinogen), and rich in a physiological pleiotropic mixture of neurotrophins for brain administration. ELISA and proteomics studies revealed that the heat-treatment at 56°C for 30 min decreased the protein content and favorably modified the relative composition in neurotrophic factors. Heat-treatment improved the neuroprotective activity and, together with S/D and nanofiltration contributed to HCV inactivation. This PPL exerted strong neuroprotective effects in Parkinson’s disease (PD) models (a) in vitro, using LUHMES cells exposed to MPP+ neurotoxin, and (b) in vivo, in mice intoxicated by MPTP neurotoxin. Expression of tyrosine hydroxylase (TH) in the Substantia nigra pars compacta indicated that brain delivery by intracerebroventricular (ICV) or intranasal (i.n.) administration may be a therapeutic option for disease-modifying strategies of neurodegenerative diseases. In vitro studies in LUHMES and NSC34 cells showed that specific inhibition of signal transduction pathways through AkT and ERK influenced PPL neuroprotective function. Since neuro-inflammation detrimentally affects neurodegenerative disorders, we verified that the PPL did not stimulate the release of inflammatory markers (e.g. COX-2, iNOS) by BV2 microglial cells in culture, and could even restrict COX-2 expression when cells were exposed to LPS. In addition, the PPL was found to contain 1.7 x 1012 MP/mL with a mean size of 160 nm. These MPs may exert neuroprotective activity on LUHMES cells exposed to neurotoxins. Altogether, our data demonstrate the technical feasibility of developing virally-safe customized platelet lysate preparations with specific applications for cell therapy and regenerative medicine, in particular as neuroprotective agents of the central nervous system.

<p>We treated 16 patients with somatostatin analogs combined with α-interferon and achieved a biochemical and/or radiological response in 56% (median duration 22 months). We consider this treatment a good alternative for patients who fail during chemotherapy or who do not want to/cannot receive cytotoxic drugs.</p><p>Thirty-six patients with neuroendocrine tumors were treated with cisplatin combined with etoposide. Of 14 patients with evaluable EPTs, 50% responded radiologically and/or biochemically (median duration 9 months). We consider this treatment useful as first-line medical treatment in aggressive EPTs or in patients failing prior chemotherapy.</p><p>Twenty-eight tumor tissues from EPTs were examined with immunohistochemistry regarding expression of somatostatin receptors (ssts) 1 to 5 on tumor cells and in intratumoral vessels. We found that sst₂ and sst₄ were highly expressed on tumor cells and in vessels. However, sst₃ and sst₅ were lacking in half of the tumor tissues and in most of the vessels. Because of the variability in sst expression, we recommend analysis of each individual’s receptor expression before starting treatment.</p><p>Endocrine pancreatic tumors (EPTs) are rare with an incidence of 4 per million inhabitants. In the majority of cases they grow slowly, but there are exceptions with very rapidly progressing malignant carcinomas. First-line medical treatment is streptozotocin combined with 5-fluorouracil.</p><p>We examined 38 tumor samples regarding expression of tyrosine kinase receptors platelet-derived growth factor receptors (PDGFRs), c-kit and epidermal growth factor receptor (EGFR). We found that the receptors were expressed in more than half of the tumor tissues. Further studies will reveal if tyrosin kinase antagonists can be part of the future treatment arsenal.</p>