Adipose tissue plays a central role in the regulation of lipid storage and mobilization. A tight control between adipose tissue lipid storage and mobilization functions must be exerted to prevent an overload of lipids at other organs such as the heart, liver and skeletal muscles, and favor the risk of developing metabolic disorders, such as Type 2 diabetes and cardiovascular diseases (CVD). There is strong evidence from animal studies that low oxygen levels (hypoxia) are noted in adipose tissue as the mass of the organ excessively expands and, in turn, exacerbates some adipose tissue functions. Whether hypoxia exposure, which could be derived from reduced environmental oxygen availability, disease or a combination of both, affects adipose tissue lipid storage and mobilization functions in humans is not well known. Using in vitro and in vivo approaches, this thesis aimed at characterizing the effects of hypoxia on human adipose tissue lipid storage and lipid mobilization functions. Study I investigated how hypoxia can modulate human adipose functions such as lipid storage and lipid mobilization in vitro. Study II examined whether acute intermittent hypoxia, which simulates obstructive sleep apnea, affects adipose tissue lipid storage/mobilization functions and triglyceride levels in healthy young men in postprandial state. Study III tested the effect of an acute 6-hour continuous exposure to hypoxia (fraction of inspired oxygen (FIO2) = 0.12)) on plasma triglyceride levels in healthy young men in the fasting state. Study I indicates that both acute (24h) and chronic (14d) hypoxia (3%, and 10% O2) modulate human adipose tissue lipid storage and mobilization functions in a different manner. Study II demonstrates that acute exposure to intermittent hypoxia (6h) is sufficient to increase plasma non-esterified fatty acids (NEFA) levels, as well as insulin levels, but does not alter circulating triglyceride or subcutaneous adipose tissue lipid storage and/or mobilization capacity ex vivo in healthy men. Study III shows that acute exposure to normobaric hypoxia increases circulating NEFA and glycerol concentrations but did not translate in altering circulating triglycerides in fasting healthy men. In conclusion, our observations suggest that an exposure to reduced oxygen levels impairs human adipose tissue storage and/or mobilization functions, a phenomenon known in the development of metabolic disorders, such as Type 2 diabetes and CVD.

Univerzita Karlova v Praze 1. lékařská fakulta Doktorský studijní program Studijní obor: Experimentální chirurgie MUDr. Filip Thieme Název závěrečné práce Chirurgické modely studia proinflamačního vlivu tukové tkáně v rozvoji aterosklerózy Title Surgical models of the study of the pro-inflammatory effect of adipose tissue in the development of atherosclerosis Typ závěrečné práce Disertační Školitel: doc. MUDr. Jiří Froněk, Ph.D., FRSC Konzultant doc. MUDr. Libor Janoušek, Ph.D. Klinika transplantační chirurgie, IKEM Praha, 2021 Abstract Background: Atherosclerosis is a serious inflammatory systemic disease. Surgery mainly addresses its vascular complications. Conversely, surgery may also lead to the development and acceleration of atherosclerosis, e.g., in a living kidney donor. This would especially be the case in a donor who meets internationally recognized donation criteria but suffers from metabolic syndrome. The effort to refine assessments of living kidney donors in terms of eliminating the risk of developing atherosclerosis is a long-term project. Our aim is to determine risk factors for living kidney donors and to prevent long-term complications after donation. Collecting tissue from a living donor involves not oly subcutaneous tissue (SCAT) but also visceral (VAT) and perivascular tissue (PVAT),...

Nicotinic acid (NA) has been clinically used for over 50 years to regulate lipid plasma levels. It is the only drug in current clinical use that significantly raises HDL cholesterol and reduces inflammatory markers. However, mechanistic understanding into its wide range of actions remains unclear. The recent identification of the Gi-coupled protein receptor HCAR2, for which NA is a potent agonist, provides intriguing insight due to its anti-lipolytic action and restricted, yet specific, expression in adipose tissue and immune cells. The HCAR2 gene is 96% homologous to HCAR3, but the HCAR3 receptor shares neither the specificity for NA, nor the range of functional effects. Moreover, the close homology makes it difficult to separate the genetic variability and regulation of the two genes. To this end, I resequenced HCAR2 and HCAR3 in a selected population to characterize the variability of the two genes and to inform the subsequent design of specific genotyping assays. The Oxford Biobank, which is a random population-based collection of 30-50 year old men and women in Oxfordshire with a wide range of collected phenotypes, was used to explore genetic associations. A preliminary trend with HDL and rs7314976 in HCAR2 motivated the further search associations. However after increasing the sample size, the HDL association did not reach significance. When looking at inflammatory phenotypes, a 20% lower level of systemic hsCRP was found in males with a promoter region variant in HCAR3 (N=1808, p=0.007 for rs55718746). Replication of this finding in two relevant cohorts (NPHS-II, N=2185 and Whitehall, N=4228) resulted in conflicting findings. After optimising the specific detection of both HCAR2 and HCAR3 transcripts, I characterized gene expression in human AT biopsies. This revealed an 18% increase in HCAR2 expression in the female abdominal depot (N=106, p<0.0001) and a reduction in abdominal HCAR2 in both males (β=-0.37, p<0.001, N=107) and females (β=-0.251, p=0.005, N=106) with increasing adiposity. The rs55718746 variant in HCAR3 was also seen to influence expression of both HCAR2 (N=182, p=0.018 in the abdominal depot) and HCAR3 (N=198, p=0.005) but surprisingly in opposite directions, establishing it as the first cis-eQTL for this genomic region. Finally, I used human adipocyte in vitro culture systems to setup a pilot to study the anti-inflammatory effects of NA. The gene expression of HCAR2 and HCAR3 increased significantly with adipocyte differentiation in vitro. NA led to a drop in IL-6 transcript abundance in two out of three of the in vitro differentiated human adipocytes. In conclusion, genetic variability in HCAR2 and HCAR3 shows weak associations with cardiovascular disease risk phenotypes relating to their respective pathways. The relevance of HCAR2 and HCAR3 gene expression and the role of the receptor in the control of inflammation will require further studies.

Background: Adipose-derived stem/stromal cells (ASCs) isolated from the stromal vascular fraction are a source of mesenchymal stem cells that have been shown to be beneficial in many regenerative medicine applications. ASCs are an attractive source of stem cells in particular, due to their lack of immunogenicity. This study examines differences between mitochondrial bioenergetic profiles of ASCs isolated from adipose tissue of five peri-organ regions: pericardial, thymic, knee, shoulder, and abdomen. Results: Flow cytometry showed that the majority of each ASC population isolated from the adipose tissue of 12 donors, with an n = 3 for each tissue type, were positive for MSC markers CD90, CD73, and CD105, and negative for hematopoietic markers CD34, CD11B, CD19, and CD45. Bioenergetic profiles were obtained for ASCs with an n = 4 for each tissue type and graphed together for comparison. Mitochondrial stress tests provided the following measurements: basal respiration rate (measured as oxygen consumption rate [pmol O-2/min], ATP production, proton leak, maximal respiration, respiratory control ratio, coupling efficiency, and non-mitochondrial respiration. Glycolytic stress tests provided the following measurements: basal glycolysis rate (measured as extracellular acidification rate [mpH/min]), glycolytic capacity, glycolytic reserve, and non-glycolytic acidification. Conclusions: The main goal of this manuscript was to provide baseline reference values for future experiments and to compare bioenergetic potentials of ASCs isolated from adipose tissue harvested from different anatomical locations. Through an investigation of mitochondrial respiration and glycolysis, it was demonstrated that bioenergetic profiles do not significantly differ by region due to depot-dependent and donor-dependent variability. Thus, although the physiological function, microenvironment and anatomical harvest site may directly affect the characteristics of ASCs isolated from different organ regions, the ultimate utility of ASCs remains independent of the anatomical harvest site.

Lipoprotein lipase (LPL) is the main enzyme hydrolyzing triglyceride-rich lipoproteins in plasma. Proteoglycan-bound LPL on the vascular endothelium represent the functional pool of active enzyme. LPL is regulated in a tissue specific manner according to metabolic demands. Rapid regulation of LPL activity is necessary to provide free fatty acids for storage or energy production. This regulatory mechanism appears to be post-translational and requires synthesis of other protein/proteins. Recently it was demonstrated that angiopoietin-like protein 4 (ANGPTL4) is involved in the metabolism of plasma triglycerides and that it is able to inhibit LPL activity in vitro. These properties were linked to the N-terminal coiled-coil domain of ANGPTL4 (ccd-ANGPTL4), but the mechanism for the inhibition was not known. The aim of this thesis was to investigate the molecular mechanism for inhibition of LPL by ccd-ANGPTL4, to characterize regions in ccd-ANGPTL4 that are important for inactivation of LPL and to study the role of ANGPTL4 for regulation of LPL in vivo. Binding of ccd-ANGPTL4 to LPL was demonstrated by several methods, including surface plasmon resonance. The interaction was transient and resulted in conversion of the enzyme from catalytically active dimers to inactive monomers with decreased affinity for heparin. We have shown that ANGPTL4 mRNA in rat adipose tissue turns over rapidly and that changes in the ANGPTL4 mRNA abundance were inversely correlated to LPL activity, both during the fed to fasted and the fasted to fed transitions. We conclude that ANGPTL4 is a fasting-induced controller of LPL in adipose tissue, acting extracellularly on the native conformation of LPL in an unusual fashion, like an unfolding molecular chaperone. Site directed mutagenesis was used to explore regions in ccd-ANGPTL4 important for inactivation of LPL, and for binding of ANGPTL4 to heparin. Others had shown that ccd-ANGPTL4 forms higher oligomers. Structure prediction analyses demonstrated that the coiled-coil domain of ccd-ANGPTL4 probably forms three consecutive α-helices with strong hydrophobic faces, and that there are clusters of positively charged residues both on the helices and in intervening sequences. We made replacements of hydrophobic residues, positively charged residues, cysteine residues and negatively charged residues in ccd-ANGPTL4. In addition, helix-breaking proline residues were introduced in all three helices. We found that hydrophobic residues are important for oligomer formation. The higher oligomers appeared to be stabilized by disulfide bonds, but cysteines are not crucial for oligomerization. Introduction of Pro-residues in the first and second helix prevented formation of higher oligomers and reduced the ability of ccd-ANGPTL4 to inactivate LPL. We found that negatively charged residues in ccd-ANGPTL4 are important for inactivation of LPL. A heparin binding site was localized in the C-terminal end of ccd-ANGPTL4 (amino acid residues 114-140). To investigate whether LPL is differently processed in different depots of adipose tissue we measured the levels of LPL mRNA, protein and activity in omental and subcutaneous adipose tissue in human subjects undergoing elective surgery. Our results show that, although the expression level of LPL was higher in subcutaneous adipose tissue, the specific LPL activity (ratio of activity over the LPL protein mass) was higher in omental adipose tissue. Interestingly, the levels of ANGPTL4 mRNA were lower in omental compared to subcutaneous adipose tissue in most of the studied subjects. This difference can possibly explain the higher specific activity of LPL in omental adipose tissue and indicated that ANGPTL4 is involved in regulation of LPL activity also in humans. LPL produced by macrophages in the artery wall promotes local accumulation of lipids in these cells, and thereby plays an important role in development of atherosclerosis. The known association between type 2 diabetes and atherosclerosis forwarded us to study production of LPL by THP-1 macrophages under hyperglycemic conditions and under treatment with a peroxisome proliferator-activated receptor delta (PPARδ) agonist (GW501516). We found that LPL activity (but not LPL mass) produced by macrophages was decreased by GW501516. The loss of LPL activity coincided with increased level of ANGPTL4 mRNA, indicating that the agonist regulates LPL activity through expression of ANGPTL4. This effect was even more pronounced in cells grown under hyperglycemic conditions. Our data suggest that a suitable PPARδ agonist, like GW501516, may have protective effects against development of atherosclerosis in subjects with diabetes type 2.

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

Toward the next generation of nerve guidance conduits (NGCs), novel biomaterials and functionalization concepts are required to address clinical demands in peripheral nerve regeneration (PNR). As a biological polymer with bioactive motifs, gelatinous peptides are promising building blocks. In combination with an anhydride-containing oligomer, a dual-component hydrogel system (cGEL) was established. First, hollow cGEL tubes were fabricated by a continuous dosing and templating process. Conduits were characterized concerning their mechanical strength, in vitro and in vivo degradation and biocompatibility. Second, cGEL was reformulated as injectable shear thinning filler for established NGCs, here tyrosine-derived polycarbonate-based braided conduits. Thereby, the formulation contained the small molecule LM11A-31. The biofunctionalized cGEL filler was assessed regarding building block integration, mechanical properties, in vitro cytotoxicity, and growth permissive effects on human adipose tissue-derived stem cells. A positive in vitro evaluation motivated further application of the filler material in a sciatic nerve defect. Compared to the empty conduit and pristine cGEL, the functionalization performed superior, though the autologous nerve graft remains the gold standard. In conclusion, LM11A-31 functionalized cGEL filler with extracellular matrix (ECM)-like characteristics and specific biochemical cues holds great potential to support PNR.

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

L’ingénierie du tissu osseux vise à concevoir un substitut tissulaire associant des cellules ostéoprogénitrices à une matrice tridimensionnelle capable de promouvoir la reconstruction osseuse, ouvrant la voie au développement de thérapeutiques substitutives à la pratique de la greffe dont les limitations sont bien connues.Le but de ce travail a été de développer un nouveau produit d’ingénierie tissulaire (PIT) destiné à la régénération osseuse constitué i) d’une matrice tridimensionnelle poreuse constituée de polysaccharides naturels biodégradables, ii) de cellules souches adultes issues du tissu adipeux humain (ADSCs) et d’identifier les conditions de culture optimales permettant le développement d’un produit fonctionnel pour une utilisation clinique. Nos résultats montrent que l’architecture et la composition de la matrice macroporeuse polysaccharidique permet de guider la différenciation ostéoblastique des ADSCs, en l’absence de facteurs ostéogéniques, et notamment en conditions de culture dynamique, grâce à l’organisation cellulaire en agrégats promouvant les interactions cellulaires. Les ADSCs peuvent être marquées à l’aide de nanoparticules superparamagnétiques et suivies in vivo de façon non invasive par imagerie par résonnance magnétique (IRM) au sein des matrices après leur implantation en site sous-cutané chez la souris. Les images IRM montrent que le matériau permet de délivrer une partie des cellules au niveau du site d’implantation participant probablement à un processus de réparation tissulaire. Enfin, en vue d’applications cliniques, un milieu de culture sans sérum répondant aux conditions GMP (Good Manufacturing Practices) pour la différenciation ostéoblastique a été développé par un industriel et validé au cours de ce travail de thèse.En conclusion de ces travaux, l’association d’une matrice macroporeuse composée de polysaccharides avec des ADSCs dans des conditions de culture spécifiques, en conditions dynamiques, semble pertinente et prometteuse pour des applications cliniques en ingénierie du tissu osseux. / Bone tissue engineering may associate osteoprogenitor cells to a tridimensional scaffold that can promote tissue reconstruction in order to replace bone grafting strategies whose limitations are well known. This study aims to develop a new tissue-engineered construct for bone regeneration constituted by i) a tridimensional polysaccharide-based scaffold, ii) adult stem cells extracted from human adipose tissue and identify the best culture conditions needed to develop a functional construct for clinical use. Our results show that this macroporous scaffold offers, without any osteoinductive factors, a suitable architecture and composition for driving osteoblastic differentiation of ADSCs especially when placing the tissue-engineered construct in dynamic conditions, thanks to cell aggregate conformation promoting cell-to-cell interactions. Thanks to ADSCs labeling, the tissue-engineered construct can be tracked in vivo in a non invasive way by magnetic resonance imaging (MRI), after their subcutaneous implantation. Results evidenced that this scaffold behaves as a cell carrier for of holding in its own cell fraction and delivering another fraction to the site of implantation for inducing a better tissue regeneration process. Finally, a serum free medium meeting standards GMPs (Good Manufacturing Practices) has been developed for inducing ADSCs osteoblastic differentiation as a first step towards clinical application.In conclusion, this polysaccharide-based scaffold associated with ADSCs, cultured under low fluid flow in a new bioreactor device, could be a relevant and promising tissue engineered construct for bone tissue engineering applications.