Objetivos: O objetivo deste trabalho foi o estabelecimento de um modelo PK/PD capaz de descrever o efeito fungistático de fluconazol (FCZ) contra diferentes espécies de Candida. Método: a fim de atingir esse objetivo, as seguintes etapas foram realizadas: i) métodos bioanalíticos foram desenvolvidos e validados em CL-EM/EM e CLAE/UV para a determinação do FCZ em plasma e microdialisado renal de rato, respectivamente; ii) a verificação das condições da microdiálise do FCZ e sua recuperação in vitro pelos métodos da diálise (RRD) e retrodiálise (RRE) e in vivo por RRE; iii) avaliação das concentrações livres de FCZ no rim de ratos Wistar saudáveis e infectados por Candida albicans através do uso da microdiálise após a administração de 10 mg/kg de FCZ pela via intravenosa e de 50 mg/kg de FCZ pela via oral, a fim de estabelecer a relação entre os níveis livres renais e plasmáticos totais do FCZ em ambas as condições, iv) a modelagem PK/PD do efeito fungistático do FCZ contra Candida albicans, Candida parapsilosis e Candida tropicalis empregando o modelo de Emax-modificado e a determinação de seus parâmetros PK/PD utilizando um modelo de infecção in vitro, em que as concentrações renais livres de FCZ esperadas em seres humanos após diferentes posologias foram simuladas: a) concentrações flutuantes do fármaco - 200, 400 e 800 mg q8h, q12h e q24h - e concentrações constantes, múltiplas da concentração inibitória mínima (CIM) – 0,5, 1, 2, 4 e 8 vezes a CIM. Os dados de farmacocinética e farmacodinâmica foram modelados com o auxílio do software Scientist®. Resultados e Conclusões: i) os métodos analíticos para quantificação do FCZ foram desenvolvidos e validados, sendo específicos, exatos e precisos, com limites de quantificação de 100 ng/mL e 10 ng/mL para detecção em plasma e microdialisado, respectivamente, ii) as recuperações determinadas in vitro por RRD e RRE foram independentes do fluxo e da concentração. Os valores de recuperação das sondas de microdiálise determinada in vitro por RRD (53,4 ± 2,3%) e RRE (54,2 ± 1,8%) e in vivo por RRE (49,7 ± 2,2%) foram estatisticamente semelhantes nas condições experimentais investigadas (α = 0,05), indicando que o FCZ é um fármaco adequado para ser avaliado por esta abordagem; iii) não houve diferença estatística na área sob a curva de concentração versus tempo (AUC 0-∞) renal livre e plasmática total em ratos Wistar, saudáveis ou infectados por Candida albicans, pela mesma via de administração investigada. A penetração renal do FCZ foi semelhante para ambas as doses nas condições investigadas (variando entre 0,77 e 0,84) e a sua fração plasmática livre, determinada por microdiálise, foi independente da concentração (86,0 ± 2,0%). Utilizando as equações farmacocinéticas apropriadas, os parâmetros plasmáticos farmacocinéticos determinados foram capazes de prever os valores de concentrações livres renais em ratos sadios e infectados, assumindo que a ligação a proteínas plasmáticas é conhecida. Além disso, a candidíase sistêmica não interfere na penetração renal do FCZ, indicando que as suas concentrações plasmáticas livres são boas preditoras do valor de concentração tecidual livre (farmacologicamente ativa) em animais sadios e infectados, podendo ser utilizada para estabelecer e otimizar os regimes posológicos do FCZ para o tratamento de candidíase disseminada; iv) a concentração que causa 50% do efeito fungistático máximo (CE50) do FCZ foi estatisticamente menor para C. albicans (4.4 ± 1.4 μg/mL) do que para C. parapsilosis e C. tropicalis, 8.1 ± 1.6 μg/mL e 8.3 ± 1.8 μg/mL respectivamente, ao simular-se diferentes regimes de dose, bem como concentrações constantes do fármaco (CE50, C. albicans = 3.5 ± 1.3 μg/mL; CE50, C. parapisolosis = 6.1 ± 1.2 μg/mL; CE50, C. tropicalis = 6.5 ± 1.2 μg/mL) (α = 0.05). A taxa de morte fúngica (kmax) foi estatisticamente semelhante para todas as espécies de Candida estudadas. (aproximadamente 0,4 h-1) e sempre estatisticamente menor do que a taxa de crescimento fúngico, k0 (aproximadamente de 2 h-1) (α = 0,05). O modelo PK/PD foi capaz de descrever o efeito fungistático do FCZ contra as três espécies de Candida investigadas in vitro. O FCZ se mostrou igualmente eficaz contra essas leveduras, porém sua potência foi maior frente a C.albicans do que frente a C. parapsilosis e C. tropicalis. O modelo PK/PD utilizado pode ser empregado para simular esquemas posológicos alternativos, para comparar o efeito farmacológico do FCZ com o efeito de outros antifúngicos e, finalmente, para otimizar a terapia deste fármaco para o tratamento de candidíase sistêmica. / Objective: The aim of this work was the development of a pharmacodynamic/pharmacokinetic (PK/PD) model able to describe the fungistatic effect of fluconazole (FCZ) against Candida spp. Method: in order to reach this objective, the following steps were realized: i) bioanalytical methods were developed and validated in LC-MS/MS and HPLC/UV for determination FCZ in rat plasma and kidney microdialisate, respectively; ii) analysis of microdialysis of FCZ conditions and its recovery in vitro by dialysis (RRD) and retrodialysis (RRE) methods and in vivo by RRE; iii) evaluation of free levels of FCZ in the kidney of healthy and Candida albicans infected Wistar rats using microdialysis, after a 10 mg/kg i.v. dosing and 50 mg/kg oral dosing in order to establish the relationship between free renal and total plasma levels in both conditions; iv) the fungistatic pharmacological effect of FCZ against Candida albicans, Candida parapsilosis and Candida tropicalis ATCC strains by pharmacokinetic/pharmacodynamic (PK/PD) modeling of the time–kill curves employing an Emax model was determined using an in vitro infection model, where the free kidney concentrations of FCZ in humans after different posologies were simulated: a) fluctuating drug concentrations - 200, 400 and 800 mg q8h, q12h e q24h – and constant concentrations, multiples of the minimum inhibitory concentrations (MIC) – 0,5, 1, 2, 4 and 8 times the MIC. The pharmacokinetic and pharmacodynamic data were modeled with the software Sientist®. Results and Conclusions: i) the analytical methods developed were specific, precise, and accurate with limits of quantification of 100 ng/mL and 10 ng/mL for microdialisate and plasma, respectively; ii) the recoveries determined by RRD and RRE in vitro were concentration independent and flow rate dependent on the ranges investigated. The recoveries determined in vitro by RRD (53.4 ± 2.3%) and RRE (54.2 ± 1.8%) and in vivo by RRE (52.3 ± 2.3%) were statistically similar under the experimental conditions investigated (α = 0.05), indicating that FCZ is a suitable drug to be evaluated by microdialysis; iii) There were no statistical differences between the area under the free concentration-time curve (AUC 0–∞) in plasma and in tissue for either healthy or infected groups for the same dose regimen investigated. The antifungal tissue penetration was similar for both doses and all conditions investigated (ranging from 0.77 to 0.84). Unbound FCZ plasma fraction, determined by microdialysis, was concentration-independent (86.0 ± 2.0%). Using appropriate equations, pharmacokinetic (PK) parameters determined by fitting plasma concentration-time profiles were able to predict free renal levels.The results showed FCZ easily penetrates the kidney and PK parameters determined in plasma can be used to predict free tissue levels of the drug assuming the drug protein binding is known. Furthermore, systemic candidiasis does not interfere with the drug kidney penetration, indicating that free plasma concentrations are a good surrogate for active levels in both healthy and infected kidney and can be used to establish and optimize FCZ dosing regimens to treat disseminated candidiasis; iv) FCZ concentration necessary to produce 50% of the maximal fungistati effect (EC50) was statiscally smaller against C. albicans (4.4 ± 1.4 μg/mL) than against C. parapsilosis and C. tropicalis, 8.1 ± 1.6 μg/mL and 8.3 ± 1.8 μg/mL respectively, when simulating multiple dosing regimens as well as constant concentrations (EC50, C. albicans = 3.5 ± 1.3 μg/mL; EC50, C. parapisolosis = 6.1 ± 1.2 μg/mL; EC50, C. tropicalis = 6.5 ± 1.2 μg/mL) (α = 0.05). The maximum killing rate constant (kmax) was statistically similar for the Candida spp. (approximately 0.4 h-1) and always statistically smaller than the natural grown rate k0 (approximately 2 h-1) (α = 0.05). The PK/PD model was able to describe the fungistatic effect of fluconazole in vitro against the three Candida spp investigated. Fluconazole showed equivalent efficacy against these yeasts and higher potency against C. albicans than against C. parapsilosis and C. tropicalis. The model can be used to simulate alternative regimens, to compare its pharmacological effect with other antifungals and to optimize FCZ therapy to treat systemic candidiasis.

Objetivos: O objetivo deste trabalho foi o estabelecimento de um modelo PK/PD capaz de descrever o efeito fungistático de fluconazol (FCZ) contra diferentes espécies de Candida. Método: a fim de atingir esse objetivo, as seguintes etapas foram realizadas: i) métodos bioanalíticos foram desenvolvidos e validados em CL-EM/EM e CLAE/UV para a determinação do FCZ em plasma e microdialisado renal de rato, respectivamente; ii) a verificação das condições da microdiálise do FCZ e sua recuperação in vitro pelos métodos da diálise (RRD) e retrodiálise (RRE) e in vivo por RRE; iii) avaliação das concentrações livres de FCZ no rim de ratos Wistar saudáveis e infectados por Candida albicans através do uso da microdiálise após a administração de 10 mg/kg de FCZ pela via intravenosa e de 50 mg/kg de FCZ pela via oral, a fim de estabelecer a relação entre os níveis livres renais e plasmáticos totais do FCZ em ambas as condições, iv) a modelagem PK/PD do efeito fungistático do FCZ contra Candida albicans, Candida parapsilosis e Candida tropicalis empregando o modelo de Emax-modificado e a determinação de seus parâmetros PK/PD utilizando um modelo de infecção in vitro, em que as concentrações renais livres de FCZ esperadas em seres humanos após diferentes posologias foram simuladas: a) concentrações flutuantes do fármaco - 200, 400 e 800 mg q8h, q12h e q24h - e concentrações constantes, múltiplas da concentração inibitória mínima (CIM) – 0,5, 1, 2, 4 e 8 vezes a CIM. Os dados de farmacocinética e farmacodinâmica foram modelados com o auxílio do software Scientist®. Resultados e Conclusões: i) os métodos analíticos para quantificação do FCZ foram desenvolvidos e validados, sendo específicos, exatos e precisos, com limites de quantificação de 100 ng/mL e 10 ng/mL para detecção em plasma e microdialisado, respectivamente, ii) as recuperações determinadas in vitro por RRD e RRE foram independentes do fluxo e da concentração. Os valores de recuperação das sondas de microdiálise determinada in vitro por RRD (53,4 ± 2,3%) e RRE (54,2 ± 1,8%) e in vivo por RRE (49,7 ± 2,2%) foram estatisticamente semelhantes nas condições experimentais investigadas (α = 0,05), indicando que o FCZ é um fármaco adequado para ser avaliado por esta abordagem; iii) não houve diferença estatística na área sob a curva de concentração versus tempo (AUC 0-∞) renal livre e plasmática total em ratos Wistar, saudáveis ou infectados por Candida albicans, pela mesma via de administração investigada. A penetração renal do FCZ foi semelhante para ambas as doses nas condições investigadas (variando entre 0,77 e 0,84) e a sua fração plasmática livre, determinada por microdiálise, foi independente da concentração (86,0 ± 2,0%). Utilizando as equações farmacocinéticas apropriadas, os parâmetros plasmáticos farmacocinéticos determinados foram capazes de prever os valores de concentrações livres renais em ratos sadios e infectados, assumindo que a ligação a proteínas plasmáticas é conhecida. Além disso, a candidíase sistêmica não interfere na penetração renal do FCZ, indicando que as suas concentrações plasmáticas livres são boas preditoras do valor de concentração tecidual livre (farmacologicamente ativa) em animais sadios e infectados, podendo ser utilizada para estabelecer e otimizar os regimes posológicos do FCZ para o tratamento de candidíase disseminada; iv) a concentração que causa 50% do efeito fungistático máximo (CE50) do FCZ foi estatisticamente menor para C. albicans (4.4 ± 1.4 μg/mL) do que para C. parapsilosis e C. tropicalis, 8.1 ± 1.6 μg/mL e 8.3 ± 1.8 μg/mL respectivamente, ao simular-se diferentes regimes de dose, bem como concentrações constantes do fármaco (CE50, C. albicans = 3.5 ± 1.3 μg/mL; CE50, C. parapisolosis = 6.1 ± 1.2 μg/mL; CE50, C. tropicalis = 6.5 ± 1.2 μg/mL) (α = 0.05). A taxa de morte fúngica (kmax) foi estatisticamente semelhante para todas as espécies de Candida estudadas. (aproximadamente 0,4 h-1) e sempre estatisticamente menor do que a taxa de crescimento fúngico, k0 (aproximadamente de 2 h-1) (α = 0,05). O modelo PK/PD foi capaz de descrever o efeito fungistático do FCZ contra as três espécies de Candida investigadas in vitro. O FCZ se mostrou igualmente eficaz contra essas leveduras, porém sua potência foi maior frente a C.albicans do que frente a C. parapsilosis e C. tropicalis. O modelo PK/PD utilizado pode ser empregado para simular esquemas posológicos alternativos, para comparar o efeito farmacológico do FCZ com o efeito de outros antifúngicos e, finalmente, para otimizar a terapia deste fármaco para o tratamento de candidíase sistêmica. / Objective: The aim of this work was the development of a pharmacodynamic/pharmacokinetic (PK/PD) model able to describe the fungistatic effect of fluconazole (FCZ) against Candida spp. Method: in order to reach this objective, the following steps were realized: i) bioanalytical methods were developed and validated in LC-MS/MS and HPLC/UV for determination FCZ in rat plasma and kidney microdialisate, respectively; ii) analysis of microdialysis of FCZ conditions and its recovery in vitro by dialysis (RRD) and retrodialysis (RRE) methods and in vivo by RRE; iii) evaluation of free levels of FCZ in the kidney of healthy and Candida albicans infected Wistar rats using microdialysis, after a 10 mg/kg i.v. dosing and 50 mg/kg oral dosing in order to establish the relationship between free renal and total plasma levels in both conditions; iv) the fungistatic pharmacological effect of FCZ against Candida albicans, Candida parapsilosis and Candida tropicalis ATCC strains by pharmacokinetic/pharmacodynamic (PK/PD) modeling of the time–kill curves employing an Emax model was determined using an in vitro infection model, where the free kidney concentrations of FCZ in humans after different posologies were simulated: a) fluctuating drug concentrations - 200, 400 and 800 mg q8h, q12h e q24h – and constant concentrations, multiples of the minimum inhibitory concentrations (MIC) – 0,5, 1, 2, 4 and 8 times the MIC. The pharmacokinetic and pharmacodynamic data were modeled with the software Sientist®. Results and Conclusions: i) the analytical methods developed were specific, precise, and accurate with limits of quantification of 100 ng/mL and 10 ng/mL for microdialisate and plasma, respectively; ii) the recoveries determined by RRD and RRE in vitro were concentration independent and flow rate dependent on the ranges investigated. The recoveries determined in vitro by RRD (53.4 ± 2.3%) and RRE (54.2 ± 1.8%) and in vivo by RRE (52.3 ± 2.3%) were statistically similar under the experimental conditions investigated (α = 0.05), indicating that FCZ is a suitable drug to be evaluated by microdialysis; iii) There were no statistical differences between the area under the free concentration-time curve (AUC 0–∞) in plasma and in tissue for either healthy or infected groups for the same dose regimen investigated. The antifungal tissue penetration was similar for both doses and all conditions investigated (ranging from 0.77 to 0.84). Unbound FCZ plasma fraction, determined by microdialysis, was concentration-independent (86.0 ± 2.0%). Using appropriate equations, pharmacokinetic (PK) parameters determined by fitting plasma concentration-time profiles were able to predict free renal levels.The results showed FCZ easily penetrates the kidney and PK parameters determined in plasma can be used to predict free tissue levels of the drug assuming the drug protein binding is known. Furthermore, systemic candidiasis does not interfere with the drug kidney penetration, indicating that free plasma concentrations are a good surrogate for active levels in both healthy and infected kidney and can be used to establish and optimize FCZ dosing regimens to treat disseminated candidiasis; iv) FCZ concentration necessary to produce 50% of the maximal fungistati effect (EC50) was statiscally smaller against C. albicans (4.4 ± 1.4 μg/mL) than against C. parapsilosis and C. tropicalis, 8.1 ± 1.6 μg/mL and 8.3 ± 1.8 μg/mL respectively, when simulating multiple dosing regimens as well as constant concentrations (EC50, C. albicans = 3.5 ± 1.3 μg/mL; EC50, C. parapisolosis = 6.1 ± 1.2 μg/mL; EC50, C. tropicalis = 6.5 ± 1.2 μg/mL) (α = 0.05). The maximum killing rate constant (kmax) was statistically similar for the Candida spp. (approximately 0.4 h-1) and always statistically smaller than the natural grown rate k0 (approximately 2 h-1) (α = 0.05). The PK/PD model was able to describe the fungistatic effect of fluconazole in vitro against the three Candida spp investigated. Fluconazole showed equivalent efficacy against these yeasts and higher potency against C. albicans than against C. parapsilosis and C. tropicalis. The model can be used to simulate alternative regimens, to compare its pharmacological effect with other antifungals and to optimize FCZ therapy to treat systemic candidiasis.

Base teórica: O processo de implantação do embrião no ser humano é extremamente complexo e, ao mesmo tempo, essencial para que a mulher possa engravidar. Neste processo, em que o endométrio precisa sofrer uma série de mudanças para tornar-se receptivo, a adequada expressão de MFG-E8 (milk fat globule epidermal growth factor 8), seu receptor a integrina αvβ3 e LIF (leukemia inhibitory factor) parecem ter um papel importante. Além do mais, mulheres com infertilidade e endometriose podem apresentar a falha de implantação como uma grande barreira para obter seu sucesso terapêutico. Objetivos: Avaliar o papel de MFG-E8 e do seu receptor integrina αvβ3 em um modelo de implantação in vitro com uma linhagem celular trofoblástica e outra de epitélio endometrial. Comparar a expressão de MFG-E8, de integrina αvβ3 e de LIF no endométrio de pacientes férteis e inférteis com endometriose durante a janela de implantação. Métodos: No primeiro ensaio, utilizando-se uma linhagem celular bem diferenciada de adenocarcinoma de endométrio (células Ishikawa) e uma linhagem de coriocarcinoma de trofoblasto, o modelo in vitro de implantação humana foi estabelecido. Para investigação do impacto do bloqueio de MFG-E8 e integrina αvβ3, ambas linhagens celulares foram pré-tratadas com anticorpos contra estas proteínas em diferente concentrações antes do ensaio de adesão. No ensaio subsequente, para comparar a expressão de MFG-E8, de integrina αvβ3 e de LIF no endométrio humano, foram realizadas biópsias no período da janela de implantação (LH+7 a LH+10) com cateter de Pipelle. As amostras foram submetidas a imunohistoquímica, e analisadas através do HSCORE. Resultados: Na avaliação in vitro observamos que as células Ishikawa pré-tratadas com anticorpo anti-MFG-E8 causaram diminuição da adesão das esferas Jar dose-dependente. Por outro lado, o pré-tratamento das esferas Jar não resultou em diminuição significativa da adesão. Pré-tratamento com anticorpos anti-integrina αvβ3, tanto de células Ishikawa como de esferas Jar, causaram inibição significativa, dose-dependente, da adesão das esferas. A análise imunohistoquímica das biópsias realizadas durante a janela de implantação mostrou uma expressão aumentada de MFG-E8 em pacientes com endometriose e infertilidade. Além do mais, houve expressão diminuída de LIF no grupo em estudo. Contudo, não houve diferença estatisticamente significativa na expressão de integrina αvβ3 entre os grupos em estudo. Conclusão: Este estudo demonstrou que, quando se bloqueia MFG-E8 ou seu receptor integrina αvβ3 em células Ishikawa em um modelo in vitro, ocorre uma diminuição de adesão das células Jar. Além do mais, bloqueando-se a integrina αvβ3 nas esferas Jar, também ocorre uma diminuição da adesão destas nas células Ishikawa. No entanto, quando estudamos o endométrio in vivo de pacientes com endometriose e infertilidade, encontramos a expressão aumentada de MFG-E8 e diminuída de LIF durante a janela de implantação no endométrio. / Background: The human implantation process is very complex and, at the same time, it is essential for women to achieve pregnancy. In this process, where the human endometrium must go through a lot of changes in order to become receptive, an adequate expression of MFG-E8 (milk fat globule epidermal growth factor 8), integrin αvβ3 and LIF (leukemia inhibitory factor) appear to play an important role. Furthermore, women with endometriosis and infertility may have in their implantation process the key to achieve pregnancy. Objectives: To investigate the role of MFG-E8 and its receptor integrin αvβ3 in the attachment of trophoblast cells to the endometrial epithelium, in an in vitro model. To compare endometrial expression of MFG-E8, integrin αvβ3 and LIF between fertile patients and patients with endometriosis and infertility during the window of implantation. Methods: In our first assay, by using a well-differentiated endometrial adenocarcinoma cell line (Ishikawa cells) and choriocarcinoma human trophoblast cells (Jar cells), an in vitro model mimicking human implantation was established. To investigate the impact of blocking MFG-E8 and integrin αvβ3, the cell lines were pretreated with antibodies against those proteins at different concentrations before the attachment assay. Moreover, to compare endometrial expression of MFG-E8, integrin αvβ3 and LIF, endometrial biopsies were performed during the window of implantation (LH+7 to LH+10) with the Pipelle catheter. The samples were submitted immunochemistry, and analyzed with HSCORE. Results: Pretreatment of Ishikawa cells with anti-MFG-E8 antibody caused a dosedependent and significant inhibition of attachment is our in vitro assay. On the other hand, pretreatment of Jar spheroids did not result in a significant effect on the attachment rate. Pretreatment of Ishikawa cells as well as Jar spheroids with anti-integrin avb3 antibodies resulted in a dose-dependent, significant inhibition of attachment. The immunochemistry analysis of the endometrial biopsies performed during the window of implantation showed increased MFG-E8 expression in patients with endometriosis and infertility. Moreover, there was lower LIF expression in the study group. Conclusion: This study showed that blocking MFG-E8 and its receptor integrin αvβ3 in Ishikawa cells diminishes Jar spheroid attachment in an in vitro model. Moreover, blocking integrin αvβ3 in the trophoblastic cells also diminished their attachment to the Ishikawa monolayer. Nevertheless, when we studied the endometrium of patients with endometriosis and infertility, we saw an increased expression of MFG-E8 and decreased expression of LIF during the window of implantation.

Des études récentes ont montré que le microbiote participe à l’homéostasie intestinale en contribuant au développement morphologique, à l’éducation du système immunitaire, aux mécanismes de défense de l’hôte et à la régulation du métabolisme. Une dysbiose de ce microbiote ainsi qu’une réduction de la diversité bactérienne a été observé dans diverses pathologies chroniques telles que les maladies inflammatoires chroniques (MICI) et l’obésité. Le microbiote constitue donc une cible thérapeutique de choix dans la prise en charge de ces maladies chroniques. Les probiotiques, microorganismes bénéfiques pour l’hôte représentent une alternative intéressante, mais dont les critères de sélection nécessitent d’être améliorés.Dans une première étude, nous avons pu mettre en évidence les propriétés bénéfiques d’un mélange de deux probiotiques comprenant un bifide et un lactobacille dans un modèle murin d’obésité résultant d’une alimentation riche en graisses (Alard et al, 2016). Ce mélange probiotique a réduit significativement la prise de poids, amélioré les paramètres inflammatoires et métaboliques dont l’insulino-résistance, et augmenté l’expression intestinale des récepteurs aux acides gras à chaine courte (AGCC). Il a également favorisé dans un système d’intestin artificiel la production de butyrate et propionate ; principaux AGCCs. Les effets protecteurs ont été associés à l’amélioration de la dysbiose du microbiote, notamment la restauration de l’abondance d’Akkermansia muciniphila.L’objectif principal de cette thèse a été ensuite de sélectionner au sein d’une collection de 23 souches bactériennes provenant de la société PiLèJe, une ou plusieurs souche(s) probiotique(s) possédant des propriétés protectrices contre les MICI et l’obésité. Les propriétés immuno-modulatrices des souches ainsi que leur capacité à renforcer la barrière intestinale ont été étudiées in vitro à l’aide cellules mononuclées sanguines humaines, puis dans un modèle in vitro de perméabilité membranaire, induite par la sensibilisation d’une monocouche de cellules Caco-2 par de l’eau oxygénée. Six souches ont été sélectionnées, cinq souches induisant de forts niveaux de la cytokine anti-inflammatoire IL-10 et capables de restaurer la barrière intestinale et une souche capable de renforcer fortement cette barrière. Ces souches ont été ensuite évaluées en modèles in vivo de colite chronique et aigüe induite par du TNBS (2,4,6 trinitrobenzene sulfonic acid). De façon intéressante les souches protégeant en colite aigüe ne protègent pas aussi efficacement en colite chronique et inversement.Nous avons poursuivi la sélection de souches ou mélanges de souches dans le contexte de l’obésité et des maladies métaboliques associées. Nous avons utilisé les mêmes critères que précédemment (capacités anti-inflammatoires et à restaurer la barrière intestinale) complétés par l’étude de la capacité des souches à limiter l’accumulation des lipides dans un modèle in vitro de différenciation adipocytaire basé sur l’utilisation de la lignée 3T3-L1 et à induire la sécrétion de peptides entéro-endocrines impliqués notamment dans la satiété par l’utilisation de la lignée murine de cellules entéro-endocrine STC-1. Trois mélanges de souches et une souche seule ont été sélectionnées et évaluées dans un modèle murin d’obésité induite par un régime hyperlipidique à 45% de gras. Nous avons pu mettre en évidence des capacités positives d’un mélange de deux souches et d’une souche seule à réduire la prise de poids, ainsi que l’inflammation dans le tissu adipeux.Ces résultats indiquent que des criblages in vitro basés sur l’étude des propriétés immunomodulatrices, des capacités à restaurer la barrière, à diminuer l’accumulation des lipides et à induire des peptides de satiété, permettent une pré-sélection de souches ou mélanges de souches ayant un effet protecteur et démontrent à nouveau que les capacités bénéfiques des probiotiques sont souche-dépendantes et spécifiques des modèles ciblés. / Recent studies have reported that the microbiota is involved in intestinal homeostasis by contributing to the morphological development, the education of the immune system, the mechanisms of defense, and to metabolic regulation. Dysbiosis of this microbiota as well as reduction in bacterial diversity has been observed in various chronic pathologies such as chronic inflammatory diseases (IBD) and obesity. The microbiota thus constitutes a therapeutic target of choice in the management of these chronic diseases. Probiotics, which are beneficial microorganisms for the host represent therefore an interesting alternative, however their selection criteria need to be improved.In a first study, we were able to highlight the beneficial properties of a mixture of two probiotics comprising a bifidobacteria and a lactobacilli, in a murine model of high fat diet (HFD)-induced obesity (Alard et al., 2016). This probiotic mixture significantly reduced weight gain, improved inflammatory and metabolic parameters including insulin resistance, and increased intestinal expression of receptors involved in short-chain fatty acid (AGCC) recognition. It also promoted in an artificial intestinal system the production of butyrate and propionate, the two main AGCCs. The protective effects were associated with the improvement of microbiota dysbiosis, in particular the restoration of the abundance of Akkermansia muciniphila.The main objective of this thesis was then to select within a collection of 23 bacterial strains provided by PiLèJe, one or more probiotic strain (s) possessing protective properties against IBD and obesity. Immunomodulatory properties of the strains and their ability to strengthen the intestinal barrier were studied in vitro using human mononuclear blood cells and an in vitro model of epithelial permeability induced by the sensitization of a Caco-2 cells monolayer with hydrogen peroxide. Six strains were selected, five strains inducing high levels of the anti-inflammatory cytokine IL-10 and capable of restoring the intestinal barrier and a strain capable of strongly reinforcing this barrier. These strains were then evaluated in in vivo models of TNBS (2,4,6 trinitrobenzene sulfonic acid)-induced chronic and acute colitis. Interestingly, strains able to rescue mice from acute colitis did not protect as efficiently in chronic colitis and vice versa.The selection of strains or mixtures was then pursued in the context of obesity and associated metabolic diseases. We used the same criteria as previously (anti-inflammatory capacities and to restore the intestinal barrier) in addition with the capacity of the strains to limit the accumulation of lipids in an in vitro model of adipocyte differentiation based on the use of the 3T3-L1 cell line and to induce the secretion of entero-endocrine peptides, notably involved in satiety, by the use of the murine STC-1 entero-endocrine cell line. Three mixtures and one single strain were selected and evaluated in a mouse model of obesity induced by 45% HFD diet. We demonstrated the positive capacities of a mixture composed of two strains and the single strain to reduce weight gain, as well as adipose tissue inflammation.These results indicate that in vitro screenings based on the immunomodulatory properties, the capacity to restore the gut barrier, to decrease lipid accumulation and to induce gut peptides allow pre-selection of strains or mixtures exhibiting protective effects and demonstrate that the beneficial capacities of probiotics are strain-dependent and specific to the targeted models.

La compréhension du lien entre alimentation et santé est un challenge majeur pour les domaines des sciences de l'aliment et de la nutrition. L'effet d'un aliment sur la santé étant conditionné par son passage et sa déstructuration dans le tube digestif, explorer cette question implique donc nécessairement de progresser dans la compréhension du processus de digestion. L'œuf est un produit apprécié dans le monde entier et compte parmi les aliments les plus nutritifs pour l'Homme. La fraction blanc d'œuf, solution aqueuse de protéines, est un ovoproduit très utilisé par l'industrie alimentaire en raison de ses propriétés fonctionnelles et nutritionnelles. De plus, la possibilité de générer des structures d'aliment très différentes selon les modalités du traitement technologique, sans avoir à en modifier la composition, fait du blanc d'œuf un aliment modèle réaliste particulièrement intéressant. Cette étude a été menée dans l'objectif d'étudier l'impact des caractéristiques structurales de matrices protéiques agrégées et gélifiées sur leur déstructuration au cours de la digestion. Un modèle in vitro de digestion gastro-intestinale, permettant un suivi temporel, a été combiné avec un modèle in vivo (porcin), plus proche de la réalité physiologique et permettant un suivi spatio-temporel de la digestion. Dans le cas du blanc d'œuf, la structuration de la matrice protéique s'est avérée avoir une influence non seulement sur les aspects quantitatifs de la digestion comme le degré d'hydrolyse des protéines, mais également sur les aspects qualitatifs comme la nature des peptides libérés. De même in vivo, les niveaux de bioaccessibilité pourraient être impactés par les différences relatives aux caractéristiques structurales des matrices gélifiées. A l'échelle moléculaire, cette étude suggère ainsi que les changements structuraux induits par les traitements thermiques, variables selon les conditions du milieu, rendent accessibles aux enzymes digestives des zones variables des protéines. A l'échelle micro- et macroscopique, les caractéristiques structurales des gels impactent également le déroulement de la digestion. / Understanding the relationship between health and diet is a major challenge in Food Science and Nutrition. As the impact of a food product on health depends on its journey and breakdown in the gastrointestinal tract, exploring this question necessarily implies increasing our knowledge of the food digestion process. Eggs are popular worldwide and are among the most nutritious foods for humans. The egg white fraction, an aqueous protein solution, is an egg product widely used in the food industry because of its unique functional and nutritional properties. In addition, the ability to generate very different food structures depending on the technological process without modifying its composition, makes egg white a very interesting and realistic food model. The aim of the study was to investigate the impact of structural characteristics of aggregated and gelled protein matrices on their breakdown during digestion. An in vitro model of gastrointestinal digestion, enabling temporal tracking, was combined with an in vivo model (pig), closer to physiological reality and enabling spatio-temporal mapping of digestion. For egg white, the structural characteristics of the protein matrix were found to have an influence not only on the quantitative aspects of protein digestion such as the degree of hydrolysis, but also on the qualitative aspects such as the nature of the peptides released. Similarly, the in vivo bioaccessibility levels could be impacted by differences relating to the structural characteristics of the gelled matrices. At the molecular scale, this study suggests that the structural changes induced by heat treatments, depending on physicochemical conditions, render a number of protein regions accessible to digestive enzymes. At the micro- and macroscopic scale, the structural characteristics of the gels also impact the digestion process.

O Transtorno Depressivo Maior (TDM) é uma condição psiquiátrica que afeta 4,4% da população mundial, exibindo um substancial sofrimento pessoal, incapacidade e custos sociais, e estima-se que ele será a principal causa de incapacidade no mundo em 2030. O surgimento de novas ferramentas e modelos de pesquisa envolvendo o TDM irá auxiliar no entendimento desta doença. Deste modo, o objetivo deste trabalho foi gerar uma coleção de células-tronco pluripotentes induzidas humanas (hiPSCs) de um grupo de indivíduos com TDM. Foram coletadas amostras de células mononucleares (MNCs) de 66 indivíduos afetados, e geradas 6 linhagens de hiPSCs. Através de diversos testes de caracterização, a pluripotência destas células foi confirmada. Além disto, também foi padronizada a diferenciação destas hiPSCs em neurônios serotonérgicos. Neurônios derivados dessas hiPSCs poderão constituir material de estudo para outros grupos de pesquisa interessados no estudo da TDM, e ser utilizados em testes futuros para prever resposta a medicamentos. / Major Depressive Disorder (MDD) is a psychiatric condition that affects 4.4% of the world\'s population, exhibiting substantial personal suffering, disability and social costs, and is estimated to be the leading cause of disability in the world by 2030. Emergence of new tools and research models involving TDM will aid in the understanding of this disease. Thus, the objective of this work was to generate a collection of human induced pluripotent stem cells (hiPSCs) from a group of individuals with MDD. Samples of mononuclear cells (MNCs) of 66 affected individuals were collected, and 6 lines of hiPSCs were generated. Through several characterization tests, the pluripotency of these cells was confirmed. In addition, the differentiation of these hiPSCs into serotonergic neurons was also standardized. Neurons derived from these hiPSCs could constitute study material for other research groups interested in the study of MDD, and be used in future tests to predict drug response.

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.

[ES] Cada año, cientos de miles de nuevos casos en todo el mundo son diagnosticados anualmente con fibrilación auricular, estimándose que aproximadamente 33.5 millones de personas viven con esta compleja enfermedad. Sin embargo, se hizo evidente que la fibrilación auricular es una enfermedad multifacética y progresiva. Por lo tanto, se requiere el desarrollo de nuevos modelos experimentales que recapitulen este complejo mecanismo. Por esta razón, esta tesis ha navegado a través del intrincado panorama del remodelado de la fibrilación auricular desde un punto de vista electrofisiológico, estructural e inmunológico, utilizando un modelo in vitro de cardiomiocitos atriales derivados de células madre pluripotentes inducidas humanas (hiPSC-aCM). El modelo demostró ser capaz de recapitular mecanismos de reentrada, así como remodelados genéticos correlacionados con cambios electrofisiológicos, estructurales e inmunológicos similares a los observados en pacientes con fibrilación auricular, demostrando su valor como modelo para estudiar los mecanismos de iniciación de la arritmia. Además, la tesis exploró enfoques optogenéticos innovadores para la perturbación del potencial de acción en hiPSC-aCM, demostrando su posible uso para la terminación de la arritmia. En conclusión, esta tesis de doctorado realiza una contribución significativa al desarrollo y prueba de un nuevo modelo in vitro de fibrilación auricular en atrios humanos, proporcionando una base sólida para futuras mejoras en los objetivos terapéuticos y medicamentos. / [CA] Cada any, centenars de milers de nous casos a tot el món són diagnosticats anualment amb fibrilació auricular, estimantse que aproximadament 33.5 milions de persones viuen amb aquesta complexa malaltia. No obstant això, es va fer evident que la fibril·lació auricular és una malaltia multifacètica i progressiva. Per tant, es requereix el desenvolupament de nous models experimentals que recapitulen aquest complex mecanisme. Per aquesta raó, aquesta tesi ha navegat a través del intrincat panorama del remodelat de la fibrilació auricular des d'un punt de vista electrofisiològic, estructural i immunològic, utilitzant un model in vitro de cardiomiòcits atrials derivats de cèlules mare pluripotents induïdes humanes (hiPSC-aCM). El model va demostrar ser capaç de recapitular mecanismes de reentrada, així com remodelats genètics correlacionats amb canvis electrofisiològics, estructurals i immunològics similars als observats en pacients amb fibril·lació auricular, demostrant el seu valor com a model per estudiar els mecanismes d'iniciació de l'arítmia. A més, la tesi va explorar enfocs optogenètics innovadors per a la pertorbació del potencial d'acció en hiPSC-aCM, demostrant el seu possible ús per a la terminació de l'arítmia. En conclusió, aquesta tesi de doctorat realitza una contribució significativa al desenvolupament i prova d'un nou model in vitro de fibril·lació auricular en atris humans, proporcionant una base sòlida per a futures millores en els objectius terapèutics i medicaments. / [EN] Each year hundreds of thousands of new cases worldwide are annually diagnosed with atrial fibrillation (AF), estimating that approximately 33.5 million of people worldwide live with this complex disease. However, it became clear that AF is not only a prevalent cardiac arrhythmia but also a multifaceted and progressive one. Thus, the development of new experimental models that recapitulate this complex mechanism is required. For this reason, this thesis has navigated through the intricate landscape of AF remodeling under an electrophysiological, structural and immunological point of view using an in vitro model of human induced pluripotent stem cell-derived atrial cardiomyocytes (hiPSC-aCM). The model showed to be able to recapitulate re-entry mechanisms as well as genetic remodeling correlated to electrophysiological, structural and immunological changes similar to those observed in AF patients, demonstrating its value as model for studying initiation arrhythmia mechanisms. Furthermore, the thesis explored innovative optogenetic approaches for action potential perturbation in hiPSC-aCM, demonstrating their possible use for arrhythmia termination. In conclusion, this PhD thesis makes a significant contribution to the development and testing of a new human atrial in vitro model of AF, providing a strong basis for future improvements of therapeutic target and drugs. / Casini, M. (2024). The use of human induced pluripotent stem cell-derived atrial cardiomyocytes for studying arrhythmia mechanisms [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/204142

O Transtorno Depressivo Maior (TDM) é uma condição neuropsiquiátrica que resulta em um substancial sofrimento pessoal, incapacidade e custos sociais. Devido à inacessibilidade ao encéfalo humano por questões práticas, éticas e às limitações encontradas pelo uso de modelos animais, o desenvolvimento de modelos in vitro acurados torna-se fundamental para o estudo desta doença. Neste aspecto, o surgimento da tecnologia de células-tronco pluripotentes induzidas humanas (hiPSCs) apresenta-se como uma importante ferramenta, uma vez que permite a recapitulação da diversidade genética dos pacientes e possibilita a produção de tipos celulares de interesse para o estudo da doença, como neurônios e glia. Entretanto, até o momento, não há registros da produção de modelos in vitro a partir de hiPSCs de pacientes com TDM. Visando preencher esta lacuna, o presente estudo teve por objetivo a produção e caracterização de dois tipos de modelos in vitro a partir de hiPSCs de pacientes com TDM: neurônios serotoninérgicos, uma cultura celular em monocamada, e organóides cerebrais, uma cultura celular em suspensão. 5 linhagens de hiPSCs de pacientes foram diferenciadas em neurônios com sucesso e no ensaio de imunocitoquímica, expressaram os marcadores 5-HT (serotonina), T5-HT (transportador de serotonina), nestina (presente em diferentes tipos de células neuronais) e Tuj1 (proteína do citoesqueleto, neurônio-específica), confirmando o fenótipo de neurônios serotoninérgicos. As céluas diferenciadas obtiveram também resultados positivos nos testes de imageamento de cálcio e de medidas da alteração no potencial de membrana, indicando que os neurônios diferenciados eram fisiologicamente funcionais. De 5 linhagens de hiPSCs (sendo uma controle e as outras 4 de pacientes com TDM), somente 1 linhagem sobreviveu ao processo de diferenciação, originando organóides cerebrais e apresentou expressão dos marcadores Sox2 (progenitoras neurais) e Tuj1 (neurônios maduros), indicando ainda uma estruturação correta da citoarquitetura, com as progenitoras localizadas mais internamente, na zona ventricular, ao redor dos lúmens preenchidos com líquido e com os neurônios maduros localizados na placa cortical, região mais externa dos agregados celulares. Apesar de o processo de produção dos organóides cerebrais necessitar de aperfeiçoamento e melhor padronização, a produção destes dois tipos de modelos in vitro, feitos a partir de hiPSCs de pacientes com TDM configura-se como um importante passo para a futura redução do uso de modelos animais em pesquisa, elucidação de mecanismos subjacentes à doença, identificação de biomarcadores diagnósticos e triagem de fármacos de maneira personalizada, visando permitir tratamentos mais baratos, adequados e eficientes para o TDM / Major Depressive Disorder (MDD) is a neuropsychiatric condition that results in substantial personal distress, disability, and social costs. The inaccessibility to the human brain due to practical and ethical issues and the limitations encountered by the use of animal models turn the development of accurate in vitro models into an essential factor to study this disease. In this regard, the emergence of human induced pluripotent stem cell technology (hiPSCs) is an important tool, since it allows the recapitulation of patient\'s genetic diversity and allows the production of cell types of interest for studying the disease, such as neurons and glia. However, to date, there are no records of the production of in vitro models from hiPSCs of patients with MDD. In order to fill this gap, the present study aimed at the production and characterization of two types of in vitro models from hiPSCs of patients with MDD: serotonergic neurons, a monolayer cell culture, and cerebral organoids, a suspension cell culture. 5 patients\' hiPSCs lines were successfully differentiated into neurons and, in the immunocytochemistry assay, they expressed the 5-HT (serotonin), T5-HT (serotonin transporter), nestin (present in several neuronal cell types) and Tuj1 (cytoskeleton protein, neuron-specific), confirming the phenotype of serotonergic neurons. Differentiated cells also obtained positive results in calcium imaging tests and measurements of membrane potential changes, indicating that differentiated neurons were physiologically functional. Of 5 hiPSCs lines (one control and the other 4 of patients with MDD), only 1 survived to the differentiation process, originating cerebral organoids which presented expression of Sox2 (neural progenitor) and Tuj1 (mature neurons) markers and a correct structuring of the cytoarchitecture, with the progenitors located more internally in the ventricular zone, around the lumens filled with liquid and with the mature neurons located in the cortical plate, the outermost region of the cellular aggregates. Although the cerebral organoids production process needs improvement and better standardization, the production of these two types of in vitro models, made from hiPSCs of patients with MDD, is an important step for the future reduction of animal models use, elucidation of disease underlying mechanisms, identification of diagnostic biomarkers and drug screening in a personalized manner, in order to allow cheaper, more adequate and more efficient treatments for MDD

<p>  </p> <p>Thrombosis is the pathological formation of a blood clot in the body that blocks blood circulation, leading to high morbidity and mortality rates. Thrombolytic drugs that offer rapid clot dissolution are promising treatments yet current drugs are often associated with limited efficacy and high bleeding risks. While numerous animal thrombosis models have been developed for drug screening, the translation of therapeutic agents into and through clinical trials remains limited. This is largely due to animal models’ poor reproducibility and distinctive physiology to that of humans. <em>In-vitro</em> flow models that utilize both human blood components and physiologically relevant flow conditions can provide for a more representative testing environment to screen thrombolytic drugs. Developing better <em>in-vitro</em> models may not eliminate the need for preclinical animal testing but can help exclude inefficient agents earlier in the drug development pipeline to expedite the drug evaluation process. Existing <em>in-vitro</em> thrombolysis flow models are not ideal as they either adopt over-simplified clot substrates or utilize small-length-scale geometries that insufficiently mimic native hemodynamics. Thus, we propose to first develop a static fluorescently labeled clot lysis assay for an initial high throughput screening of thrombolytic drugs, and ultimately engineer a highly reproducible, physiological scale, flowing clot lysis model for more human relevant drug efficacy evaluation. Developing the static clot lysis assay not only helps to understand the mechanism of how diversified clotting conditions affect clot properties but also offer a chance to well-characterize fluorescence conjugations to fibrins. The ultimate flow model combines an <em>in-vivo</em>-like fluorescence incorporated synthetic clot (FISC) and a human-relevant flow system. Guided by results from static clotting experiments diversified FISCs are fluorescently optimized and fabricated dynamically using a Chandler loop setup at various conditions. The flow system is a tubing-based structure that comprises of a peristaltic pump, and a well-controlled flow chamber to provide for physiological shear and pulsatile levels. Therefore, the proposed synthetic clot model is a versatile platform that can mimic a variety of thrombosis conditions and offer representative drug testing and dosing results across numerous thrombolytic agents.</p>