Two polymorphisms in the promoter region of macrophage migration inhibitory factor (MIF)—rs755622 and rs5844572—exhibit prognostic relevance in inflammatory diseases. The aim of this study was to investigate a correlation between these MIF promoter polymorphisms and the severity of hepatitis C virus (HCV)-induced liver fibrosis. Our analysis included two independent patient cohorts with HCV-induced liver fibrosis (504 and 443 patients, respectively). The genotype of the single nucleotide polymorphism (SNP) -173 G/C and the repeat number of the microsatellite polymorphism -794 CATT5–8 were determined in DNA samples and correlated with fibrosis severity. In the first cohort, homozygous carriers of the C allele in the rs755622 had lower fibrosis stages compared to heterozygous carriers or wild types (1.25 vs. 2.0 vs. 2.0; p = 0.03). Additionally, 7 microsatellite repeats were associated with lower fibrosis stages (<F2) (p = 0.04). Comparable tendencies were observed in the second independent cohort, where fibrosis was assessed using transient elastography. However, once cirrhosis had been established, the C/C genotype and higher microsatellite repeats correlated with impaired liver function and a higher prevalence of hepatocellular carcinoma. Our study demonstrates that specific MIF polymorphisms are associated with disease severity and complications of HCV-induced fibrosis in a stage- and context-dependent manner.

Les infections humaines par Schistosoma japonicum et Schistosoma mansoni provoquent des pathologies hépatospléniques conduisant à la fibrose hépatique sévère chez 5 à 30% des sujets infectés vivant en zone endémique. Plusieurs études ont montré que le développement de cette fibrose était régulé par des cytokines mais aussi par des chimiokines. Les chimiokines sont des cytokines chimioattractantes produites par une variété des cellules immunes et non immunes, et qui ont été impliqués dans la régulation de l'inflammation granulomateuse et la fibrose pulmonaire et hépatique chez la souris et chez l'homme. Nous avons donc étudié la modulation des chimiokines et récepteurs dans le foie et la rate des patients hépatospléniques exposés à l'infection par S.japonicum. Notre étude démontre que les transcrits de chimiokines de type CXC et CC ainsi que des récepteurs sont augmentés dans le foie des patients hépatospléniques, lesquels ne sont pas significativement augmentés dans la rate au cours de l'infection. Cette augmentation des transcrits de chimiokines n'est pas restreinte aux chimiokines inflammatoires, une augmentation des transcrits des chimiokines homéostatiques CCL19 et CCL21 est aussi observée dans le foie des patients hépatospléniques. Nous avons également observé une corrélation des niveaux d'expression des ligands CXCR3 entre eux, dans le foie des sujets hépatospléniques. Ces observations suggèrent que les chimiokines régulent l'inflammation hépatique induite par les œufs de schistosomes et jouent probablement un rôle dans la fibrose hépatique. / Human infections with Schistosoma japonicum and Schistosoma mansoni causes hepatosplenic diseases leading to severe hepatic fibrosis in 5 to 30% of infected subjects living in endemic areas. Several studies demonstrated that the development of this fibrosis was regulated by cytokines but also by chemokines. Chemokines are the chemoattractant cytokines produced by a variety of immune and non-immune cells, and have been involved in the regulation of inflammation and granulomatous pulmonary and hepatic fibrosis in mice and humans. We therefore studied the modulation of chemokines and receptors in the liver and spleen of hepatosplenic patients exposed to infection with S.Japonicum. Our study demonstrates that the transcripts of CXC and CC chemokines and their receptors are increased in the liver of hepatosplenic patients, which were not significantly increased in the spleen during infection. This increase of transcripts of chemokines is not restricted to inflammatory chemokines, an increase of transcripts of homeostatic chemokines CCL19 and CCL21 is also observed in the liver of hepatosplenic patients. Moreover, the proportion of CD3+ lymphocytes but not CD14+ monocytes/macrophages is increased in the liver. We also observed a correlation of expression levels of CXCR3 ligands between them, in the liver of hepatosplenic subjects. These observations suggest that chemokines regulate hepatic inflammation induced by schistosoma eggs and probably play a role in liver fibrosis ensuing.

L’infection par le virus de l’hépatite B (VHB) reste un problème de santé publique avec plus de 880 000 décès chaque année dans le monde. Au stade chronique de l’infection virale B, des complications peuvent survenir comme la fibrose, la cirrhose et le carcinome hépatocellulaire. L'implication du VHB, de ses protéines ou de sa variabilité génétique dans la fibrose hépatique reste à élucider. Toutefois, des méta-analyses semblent montrer un lien statistiquement significatif entre la présence de la double mutation A1762T/G1764A dans le promoteur basal du core (PBC) du VHB et la fibrose sévère. C’est pourquoi nous avons orienté nos travaux de recherche selon deux axes : l’implication des mutations du PBC et de la région précore (PC) dans la sévérité des lésions hépatiques ainsi que le rôle des protéines HBc et HBe du VHB dans l’induction de la fibrogénèse. Dans un premier temps, deux études cliniques ont permis de confirmer l’association significative du double mutant PBC avec la fibrose sévère indépendamment du génotype viral. Nous avons également démontré un effet antagoniste de la mutation G1899A située dans la région PC vis-à-vis du double mutant PBC dans la sévérité de la fibrose. La deuxième partie de nos travaux a consisté à développer une technique innovante de production de protéines en utilisant la transduction de la lignée HepaRG par des vecteurs lentiviraux contenant la séquence de la protéine GFP (green fluorescent protein). En parallèle, nous avons synthétisé des particules lentivirales contenant les séquences sauvages et mutées du PBC et de la région PC, avec pour objectif de produire les protéines HBc et HBe dans les HepaRG. / The hepatitis B virus (HBV) infection remains a significant public health problem with more than 880 000 deaths every year worldwide. At the stage of chronic HBV infection, complications can occur such as fibrosis, cirrhosis and hepatocellular carcinoma. The role of HBV, its protein and its genomic variability in fibrosis are still unclear. Meta-analysis seems to indicate a strong link between the double mutation A1762T/G1764A detection in the basal core promotor (BCP) of HBV and the development of fibrosis. In this context, our work aimed to explore: i. the implication of BCP or precore (PC) regions mutations on the severity of fibrosis, and ii. the role of HBc and HBe proteins in fibrosis induction. For the first approach, our studies confirmed the association between the presence of the BCP double mutation and severe fibrosis, independently of the viral genotype. We also showed that the G1899A mutation in the PC region presents an antagonist effect regarding the double BCP mutant for fibrosis severity. In the second part of our work, we developed an innovative technology to produce protein via the transduction of HepaRG cells using lentiviral technology with a plasmid vector containing GFP (greenfluorescent protein) sequence. We also obtained lentiviral particles containing the wild and mutated sequences for the BCP and PC regions, in order to produce HBc and HBeprotein in HepaRG cells and to explore of the pathogenic role of BCP and PC mutants.

A doença hepática crônica causada pelo vírus da hepatite C (HCV) tornou-se, nos últimos anos, uma das principais comorbidades dos pacientes portadores do vírus da imunodeficiência humana (HIV) nos países desenvolvidos. Os pacientes coinfectados com HIV/HCV apresentam uma progressão mais rápida para a cirrose e as suas complicações que os pacientes monoinfectados com HCV. Embora os mecanismos responsáveis por esta evolução não estejam totalmente esclarecidos, a expressão da molécula de HLA-G, um HLA de classe Ib não clássico, que tem propriedades bem reconhecidas na regulação negativa da resposta imune, pode estar relacionada à progressão da doença hepática. Os objetivos deste trabalho foram analisar o perfil de expressão de HLA-G em tecido hepático de pacientes coinfectados HIV/HCV e identificar possíveis variáveis do hospedeiro, do HCV e do HIV que possam estar relacionadas com a expressão de HLA-G na biópsia hepática. Para isso, 57 amostras de biópsia hepática de pacientes coinfectados com HIV/HCV, nas quais a imuno-histoquímica para HLA-G foi realizada, foram analisadas retrospectivamente quanto à expressão desta molécula no tecido hepático. Avaliaram-se também outras características histopatológicas da biópsia como grau de fibrose, atividade inflamatória, deposição de ferro e gordura. Determinou-se o polimorfismo de inserção ou deleção de 14 pares de bases da região 3` não traduzida do exon 8 do gene do HLA-G, que está relacionada com a produção de RNA-mensageiro, em 43 destes pacientes, além do polimorfismo de IL-28B, relacionado com a resposta ao tratamento do HCV, em 44 deles. Características bioquímicas e virológicas, tanto do HIV quanto do HCV também foram avaliadas. O genótipo 1 do HCV foi o mais prevalente (87,75%), especialmente o subgenótipo 1a (60%). A expressão do HLA-G foi observada em 38 (66,7%) amostras de fígado, e foi mais frequente em estágios moderados e severos de fibrose do que em estágios mais leves (94,1% x 55%, P < 0,01). Não houve relação entre a expressão do HLA-G e os outros parâmetros estudados. Embora a progressão para a cirrose no contexto da coinfecção por HIV/ HCV seja um processo complexo, modulado por muitos factores, a associação da intensidade de fibrose com a expressão do HLA-G pode indicar que a expressão desta proteína desempenha um importante papel nos mecanismos que contribuem para a progressão da doença, por meio da regulação negativa da resposta imune contra o HCV na coinfecção pelo HIV. / Chronic liver disease induced by hepatitis C virus (HCV) infection has recently become one of the most common comorbidities in patients who are infected with the human immunodeficiency virus (HIV) in developed countries. HIV/HCV coinfected patients show faster progression to cirrhosis and its complications than the HCV monoinfected patients. Even though the responsible mechanisms for this evolution have not been entirely clarified yet, the expression of the HLA-G molecule, a HLA from the non-classic Ib class, with well-known properties of negatively regulating the immune response, may be related to the liver disease progression. The aims of the present work were to analyze the HLA-G expression profile in the liver micro ambience of HIV/HCV coinfected patients and to identify possible host factors, HIV or HCV, that may be related to the HLA-G expression on the liver biopsy. For this purpose, 57 liver biopsies of HIV/HCV coinfect patients, in which immunohistochemistry for HLA-G had been performed, were retrospectively analyzed according the HLA-G expression on the hepatic tissue. Other histopathological features in the liver biopsies, such as fibrosis degree, inflammatory activity, iron deposition and fat were also evaluated. The polymorphism of insertion or deletion in 14-base pairs of the 3`non-translated region of exon 8 of the HLA-G gene, which is related to the production of HLA-G messenger RNA, was evaluated in 43 of the patients. Also, the polymorphism of IL-28B, related to the response to HCV treatment, was evaluated in 44 of them. Biochemical and virological features of HIV and HCV were also evaluated. The HCV genotype 1 was the most prevalent (87.75%), especially the subgenotype 1a (60%). The expression of HLA-G was observed in 38 (66.7%) samples of the liver biopsies, and it was most frequent in moderate and severe stages of fibrosis than in the mild stages (94.1% x 55%, P < 0.01). There was no established relationship between HLA-G and other parameters studied. Although the progression to cirrhosis in the context of HIV/HCV coinfection is a complex process modulated by many factors, the association of HLA-G expression with the intensity of the liver fibrosis may indicate the protein expression play an important role in the mechanisms that contribute to the progression of the disease, through the negative regulation of the immune response against HCV setting of a coinfection with HIV.

Este trabalho teve como objetivo desenvolver um protocolo para a diferenciação in vitro de células-tronco mesenquimais (CTM) em hepatócitos e a padronização de um modelo animal de fibrose hepática induzida por dimetilnitrosamina (DMN) para ensaios pré-clínicos de transplante de CTM. CTM isoladas de fontes variadas apresentaram morfologia fibroblastóide e aderência ao plástico e o padrão de marcadores de superfície celular esperado na análise por citometria de fluxo. A capacidade de diferenciação osteogênica e adipogênica dessas células foi comprovada pelas colorações de vermelho de alizarina, oil red e azul de toluidina, respectivamente, confirmando, que as células isoladas para este estudo se comportaram como CTM conforme proposto pela Sociedade Internacional de Pesquisa em Células-tronco. A diferenciação hepática foi avaliada quanto à morfologia e capacidade das células diferenciadas de estocar glicogênio confirmada por PAS (ácido periódico-Schiff), de sintetizar albumina confirmada por imunofluorescência, além da capacidade de expressar genes hepato-específicos verificada por ensaios de PCR em tempo real. Com base na literatura para diferenciação hepática, diferentes protocolos de um, dois e três passos foram testados. CTM humanas mostraram capacidade de produzir e estocar glicogênio e de sintetizar albumina, apenas quando diferenciadas com protocolos de três etapas, porém sem uma expressão aumentada dos genes hepato-específicos albumina, &#945;-fetoproteína e c-Met. Uma etapa de diferenciação endodérmica, previamente aplicada à diferenciação hepática, aumentou a capacidade de produzir e estocar glicogênio das CTM diferenciadas. Para a padronização do modelo de fibrose hepática induzida por DMN, foram realizados experimentos de dose-resposta e foi verificado o efeito da hepatectomia em modelos mistos DMN/hepatectomia. A injúria hepática e o efeito do transplante de CTM foram avaliados por análise macroscópica dos fígados, histologia das biópsias de fígados corados com HE e tricromo de Masson e parâmetros bioquímicos séricos. Alterações macroscópicas, histológicas e nos níveis séricos de fosfatase alcalina indicam a indução da fibrose hepática nos ratos Wistar tratados com DMN na dose de 10 &#181;g/g de peso animal por três dias consecutivos durante quatro semanas, mas não observamos nenhum efeito induzido pela hepatectomia. Porém, este modelo com DMN se mostra semelhante a estágios iniciais de uma fibrose hepática. O transplante de 1 x 107 CTM de veia de cordão umbilical humano (VCUH) no modelo de injúria hepática induzida por DMN não resultou em melhora da fibrose, diminuição dos níveis séricos de fosfatase alcalina e nem em ganho de peso dos animais quando comparados aos animais tratados com PBSA após a injúria hepática (grupo placebo). Em conjunto, esses resultados sugerem que CTM humanas se diferenciam após tratamentos mais complexos, onde os indutores hepatogênicos são sequencialmente adicionados ao meio de modo a mimetizar a sinalização durante o desenvolvimento embrionário. O transplante de CTM de VCUH parece não ter efeito positivo em um modelo pré-clínico de injúria hepática similar a estágios iniciais de fibrose. Financiado por CNPq (573578/2008-7) e FAPESP (2007/54260-2). / This study aimed to develop an in vitro differentiation protocol of mesenchymal (MSC) stem cells to hepatocytes and to standardize an animal model for hepatic fibrosis induced by dimethylnitrosamine (DMN) for preclinical transplant assays of MSC. MSC isolated from various sources presented fibroblastoid morphology, plastic adherence, and the expected pattern of cell surface markers by flow cytometry analysis. The capacity of osteogenic, adipogenic and chondrogenic differentiation of these cells was confirmed by alizarin red, oil red and toluidine blue staining, respectively, confirming that the cells isolated for this study behave as MSC, as proposed by the International Society for Stem Cell Research. Hepatogenic differentiation was evaluated by analysis of cell morphology, capacity to store glycogen confirmed by PAS (periodic acid-Schiff), albumin synthesis confirmed by immunofluorescence, as well as hepatic-specific gene expression verified by real time PCR assays. Based on the published literature on hepatic differentiation, several protocols of one, two, and three steps were tested. Human MSC differentiated solely when treated in a three step-protocol, showing the ability to produce and store glycogen and synthesize albumin; however the expression of hepatic-specific genes such as albumin, &#945;-fetoprotein and c-Met was not increased. An endoderm differentiation stage, added to the hepatic differentiation protocol, increased the capacity to produce and store glycogen of differentiated MSC. In order to standardize the model of liver fibrosis induced by DMN, dose-response experiments were performed and the effect of hepatectomy in mixed models DMN/hepatectomy was observed. Severity of liver injury and the effect of cell transplantation were evaluated by macroscopic analysis of the livers, histology of liver biopsies stained with HE and Masson\'s trichrome, and evaluation of serum biochemical parameters. The macroscopic and histological observations, and altered alkaline phosphatase serum levels indicated the success in inducing liver fibrosis in DMN-treated rats at a dose of 10 &#181;g/g of animal weight for three consecutive days, during four weeks, without any additional effect upon hepatectomy. Transplanting 1 x 107 umbilical cord MSC in the model of liver injury induced by DMN did not result in improvement of the fibrosis, decrease of alkaline phosphatase serum levels, or in weight gain of the treated animals compared to animals treated with PBSA after liver injury (placebo group). Together, these results suggest that human MSC are capable of differentiating to hepatocyte-like cells after more complex protocols, where hepatogenic inducers are sequentially added to the medium in order to mimic signaling that occurs during fetal development. Transplantation of undifferentiated umbilical cord MSC did not have any positive effect in a preclinical liver injury model characterized by an early stage of fibrosis. Supported by CNPq (573578/2008-7) and FAPESP (2007/54260-2).

O colágeno XVIII é um componente das membranas basais com diversos domínios funcionais, como a endostatina e o domínio frizzled, que têm importante papel em processos celulares como proliferação e diferenciação. COL18A1 possui dois promotores alternativos: o promotor 1, que regula a síntese da variante NC11-303, e o promotor 2 responsável pelas variantes NC11- 728 e NC11-493, expressas por hepatócitos. Existe uma variação interindividual da endostatina circulante e da expressão do colágeno XVIII no fígado. A expressão do colágeno XVIII/endostatina foi correlacionada com a progressão tanto do hepatocarcinoma (HCC), quanto da fibrose/cirrose hepática. Elucidar a regulação da expressão de COL18A1 pode auxiliar na compreensão dessa variação interindividual e da progressão dessas doenças. Neste trabalho demos início a caracterização do promotor 2 do COL18A1. Identificamos na seqüência predita como promotora cinco regiões conservadas entre humanos e camundongos. A análise in silico e funcional dessas regiões revelou que os fatores de transcrição, Sp1, Sp3, YY1, Oct-1, C/EBP&#945; e C/EBP&#946;, interagem com as mesmas. Demonstramos que C/EBP&#946;&#61472;aumenta a taxa de transcrição do promotor 2 em hepatócitos, e que existe uma correlação positiva da expressão de NC11-493 com C/EBP&#945;&#61472;e C/EBP&#946;&#61472;em tecido hepático cirrótico e tumoral. As expressões de C/EBP&#945;&#61472;em tecido hepático cirrótico e tumoral estão diretamente correlacionadas, enquanto que os níveis de NC11-493 nos tumores estão inversamente correlacionados com o tamanho dos mesmos. Mostramos a existência de diversos SNPs no promotor 2. O SNP-700T/G, funcional in vitro, afeta a interação de Sp3 e YY1 com essa região regulatória. A deleção da região do SNP indicou que ela possui elementos importantes para a transcrição em hepatócitos, apesar deste SNP não estar relacionado com o nível de expressão do colágeno XVIII em fígado fibrótico ou com susceptibilidade a HCC. O SNP- 700T/G está em desequilíbrio de ligação com o SNPc.1135C/T, no domínio frizzled do colágeno XVIII. Não foi possível elucidar a funcionalidade do SNPs c.1135C/T in vitro, mas os haplótipos formados por esses dois SNPs têm diferentes frequências entre descendentes de europeus e de africanos. Nosso trabalho traz importantes contribuições e abre novas perspectivas para a compreensão da regulação do colágeno XVIII em fígado humano, tanto em situações fisiológicas, quanto em processos fibrogênicos e tumorigênicos¶ / Collagen XVIII is a basal membrane component with several funcional domains, such as endostatin and frizzled domains, which have important roles in cellular processes such as proliferation and differentiation. COL18A1 has two promoter regions: promoter 1, that regulates the synthesis of NC11-303 isoform, and promoter 2, localized in intron 2, responsible for NC11-728 and NC11-493 isoforms expressed by hepatocytes. There is a large interindividual variation in circulating endostatin and in collagen XVIII liver expression. Collagen XVIII/endostatin levels were correlated with hepatocellular carcinoma (HCC) progression, as well as liver fibrosis/cirrhosis, conditions that precede HCC. Elucidating the mechanisms that regulate COL18A1 expression in hepatocytes may help understanding its variation among individuals and liver disease stages, as well as contribute to new treatment strategies. In this work we began to characterize COL18A1 promoter region 2. We identified in the predicted promoter sequence five conserved regions between human and mouse. The in silico and functional analysis of these regions revealed that transcription factors Sp1, Sp3, YY1, Oct-1, C/EBP&#945; and C/EBP&#946; interact with them. We have demonstrated that C/EBP&#946; increases promoter 2 transcription rate in hepatocytes, and that there is a positive correlation of NC11-493 expression with that of C/EBP&#945; and C/EBP&#946; in cirrhotic and tumor liver samples. Non-tumor and tumor C/EBP&#945; expressions positively correlate between themselves, while NC11-493 tumor expression inversely correlates with tumor size. We also showed that there are several SNPs in COL18A1 promoter 2 region. SNP-700T/G, functional in vitro, affects Sp3 and YY1 interaction with the promoter 2 region and deletion of the SNP region indicated that this sequence has important hepatocyte regulatory elements. Our results suggest that this SNP does not significantly affects COL18A1 expression in fibrotic/cirrhotic liver and is not associated with HCC susceptibility. SNP-700T/G is in linkage disequilibrium with SNPc.1135C/T, at collagen XVIII frizzled domain. We could not elucidate SNPc.1135C/T functionality in vitro, but the haplotypes formed by these two SNPs have different frequencies in European and African descendants. In conclusion, our work brings important contributions and opens new perspectives for the comprehension of collagen XVIII regulation in human liver in physiological situations, as well as in fibrotic/cirrhotic and tumorigenic process.

Die Elastografie ist ein diagnostisches bildgebendes Verfahren zur Bestimmung der Geschwindigkeit oder Amplitude der ins Gewebe eingebrachten Scherwellen. Die Scherwellengeschwindigkeit c in der Leber ist ein Marker zur Fibrosegraduierung. Pathologische Elastizitätsveränderungen, wie sie bei der Herzinsuffizienz auftreten können mittels der Scherwellenamplitude in der Herzwand erfasst werden. Bisherige Verfahren sind durch eine geringe Eindringtiefe/Zeitauflösung limitiert. Dies erschwert die Untersuchung der Leber bei Patienten mit Adipositas oder Aszites und am Herzen. Daher wird in dieser Arbeit die zeitharmonische Vibrationen zur Anregung von Scherwellen im tiefen Gewebe mit der zeiteffizienten Ultraschallelastografie kombiniert. In der Leber wurde c als Maß für die Elastizität und die Dispersion von c als Maß für die Viskosität in 11 Probanden und 24 Patienten mit Leberzirrhose gemessen. Im Herzen wurde die Amplitude als Maß für die relative Elastizitätsänderung des Herzmuskels in Echtzeit bei 11 Probanden und einer Patientin mit Herzinsuffizienz bestimmt. In der Leber ergab sich für Probanden c=1,77(15)ms und für Patienten mit Zirrhose c=3,10(55)ms. Diese 100%ige Separation bestätigt die Stabilität und das diagnostische Potential des neuen Verfahrens. Für die Probanden ergab sich eine Abnahme der Scherwellenamplitude in der Herzwand 121(34)ms vor der Kontraktion des Herzens und ein Anstieg 56(29)ms vor der Relaxation entsprechend den isovolumetrischen Kontaktions- und Relaxationszeiten. Die zeitharmonische Ultraschallelastografie erlaubt erstmalig die Bestimmung der Scherwellengeschwindigkeit der gesamten Leber auch bei Adipositas und Aszites. Dies erweitert den Anwendungsbereich der Ultraschallelastografie in der klinischen Diagnostik wesentlich. Zudem wurde die Anspannungsänderung des Herzmuskels in vivo und in Echtzeit bestimmt. Diese neue Modalität bietet erstmalig die Möglichkeit pathologische Herzveränderungen mittels Elastografie zu diagnostizieren. / Elastography is a diagnostic imaging technology for the quantification of speed or amplitude of external induced shear waves. The shear wave speed c is used as diagnostic marker for the staging of liver fibrosis. In contrast, the shear wave amplitude in the myocardial wall is sensitive to pathologic elasticity alterations induced by cardiac insufficiency. Current methods have a less penetration depth or low spatial resolution. This limits the investigation of liver in patients with ascites or adiposity and of the heart. Therefore the time harmonic vibration, inducing shear waves in deep tissue is combined with the time efficient ultrasound elastography in this work. In the liver, c and the dispersion of c as marker for elasticity and for viscosity respectively was measured in 11 volunteers and 24 patient with cirrhosis. Relative elasticity changes of the myocardial muscle were assessed by measuring shear wave amplitude in real-time in 11 volunteers. As an outlook, one patient with diastolic dysfunction was investigated. The shear wave speed in liver is c=1.77(15)ms for the volunteers and c=3.10(55)ms for the patients with cirrhosis. The 100%age separation between both groups confirms the stability and the diagnostic potential of these new method. In volunteers the shear wave amplitude in the myocardial wall decreases by 121(34)ms prior to heart contraction and increases by 56(29)ms prior to relaxation. This times correlate to the cardiac isovolumetric contraction and relaxation times. for the first times, the new time harmonic ultrasound elastography allows the quantification of shear wave speed in the whole liver even in patients with ascites or adiposity. This extends the field of application for liver-elastography in clinical diagnostics substantially. Furthermore the tension changes in the myocardial wall can be measured in vivo and in real-time. For the first time, this new modality opens the possibility to diagnose pathological alterations by elastography.

Magnetresonanzelastographie (MRE) bietet die Möglichkeit, über die Aufnahme mechanischer Scherwellen im Körper auf die mechanischen Eigenschaften lebender Gewebe zu schließen. Dabei werden in der klassischen MRE Wellen mittels Einkopplung externer Vibrationen einer einzelnen Frequenz angeregt. Wegen der starken Absorption der Vibrationsenergie in biologischen Geweben und der damit verbundenen Dispersion der Phasengeschwindigkeit sowie der Dämpfung der Wellen können mit dieser Methode nur frequenzabhängige Größen, jedoch keine Materialkonstanten bestimmt werden. Die in dieser Arbeit entwickelte Methode erlaubt die synchrone Einkopplung und Aufnahme multipler Gewebeschwingungen, wodurch viskoelastische Gewebekenngrößen in einer zeitlich-zyklisierten MRE-Untersuchung erfasst werden können. Diese Technik wird in Phantomstudien, an Gewebeproben sowie am Menschen evaluiert. Mittels verschiedener rheologischer Modelle werden erstmalig die viskoelastischen Eigenschaften der Leber und des Gehirns in ihrem intakten, lebenden Umfeld bestimmt. Dabei zeigt sich die Überlegenheit eines zweiparametrischen Modells, mit dessen Hilfe die gewonnene, spektrale Information des komplexen Moduls des Gewebes in eine einzige diagnostisch-relevante Kenngröße zusammengefasst werden kann. / Magnetic resonance elastography (MRE) is capable of measuring the mechanical properties of living tissue by using externally introduced vibrations and phase contrast magnetic resonance imaging techniques. Until now, monofrequency shear wave excitation techniques have been used in conventional MRE. However, since biological tissue is highly dispersive due to its strong damping characteristics, the study of tissue rheology requires knowledge of wave propagation at multiple frequencies. The multifrequency-MRE method, which was engineered in this thesis, applies a superposition of multiple harmonics as the shear wave excitation signal. All vibrations are acquired simultaneously, which enables the determination of viscoelastic tissue parameters in one time-resolved MRE experiment. This technique is evaluated in studies on gel phantoms and excised tissue samples, as well as in human in-vivo studies. The viscoelastic properties of human brain and liver are determined in their in-vivo environment using several rheological models. A two-parameter fractional model demonstrates excellent stability and allows for combining the spectral information of the complex modulus acquired by multifrequency-MRE, which then results in a single viscoelastic parameter that is diagnostically relevant.

Les techniques de microscopie non linéaire connaissent un essor considérable ensciences du vivant, du fait de leur capacité à imager les tissus biologiques en profondeur et àexploiter différents contrastes dont les plus connus sont la fluorescence excitée à deux photons(2PEF) et la génération de second harmonique (SHG).Ce travail de thèse ’articule autour de la métrologie de milieux diffusants et d’applicationsbiomédicales de la microscopie non linéaire. Après une présentation générale de la technique, nousdécrivons une méthode originale de mesure du coefficient de diffusion μs et du facteur d’anisotropieg de milieux turbides épais basée sur la comparaison des intensités de fluorescence épi-collectéesselon trois modalités de notre microscope non-linéaire. Notre méthode est alors appliquée à lacaractérisation de gels biomimétiques et d’échantillons d’intérêt biologique. Le manuscrit abordeensuite le problème de l’imagerie en profondeur d’explants de peau humaine ré-innervée par desneurones sensoriels de rats nouveau-nés. Le choix du marqueur neuronal fluorescent fait l’objetd’une mesure in situ de la section efficace d’absorption à deux photons de différents fluorophores.La faisabilité d’une imagerie bimodale exploitant la fluorescence de ce marqueur et la réponse SHGdu collagène fibrillaire du derme est démontrée. Le manuscrit s’achève par une étude faisant suiteà des travaux de thèse antérieurs relatifs à la quantification de la fibrose hépatique par microscopieSHG/2PEF couplée. Nous appliquons la méthode de scoring SHG développée précédemment àune cohorte de patients infectés par le virus de l’hépatite C et comparons nos résultats aux testsMETAVIR et Ishak. / Nonlinear microscopy techniques are experiencing a considerable growth in lifescience, thanks to their ability to image biological tissues at high depth with different contrastssuch as two-photon excitation fluorescence (2PEF) and second harmonic generation (SHG).This manuscript focuses on metrology of scattering media and on biomedical applications ofnonlinear microscopy. After an overview of the technique, we describe a novel method for measuringthe scattering coefficient μs and anisotropy factor g of thick turbid media based on the comparisonof fluorescence intensities epi-collected through the three modalities of our nonlinear microscope.Our method is then applied to biomimetic gels and to biological samples. The manuscript thentackles the problem of imaging deeply human skin explants re-innervated by sensory neurons fromneonatal rats. The choice of the fluorescence probe is the subject of an in situ measurement ofthe two-photon action cross-sections of various fluorophores. The feasibility of bimodal nonlinearimaging of re-innervated skin explants based on the 2PEF signal of the molecular probe and onthe SHG response of fibrillar collagen of the dermis is demonstrated. The manuscript ends witha study subsequent to the work of previous thesis regarding the quantification of liver fibrosisby SHG/2PEF microscopy. We apply the method of fibrillar collagen scoring by SHG previouslydeveloped to a new cohort of patients infected with hepatitis C virus and we analyze our resultsin terms of METAVIR and Ishak tests.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A disfunção mitocondrial tem sido associada a várias doenças, incluindo a colestase hepática, caracterizada pela ativação de células de Kupffer e células fibrogênicas, as quais produzem matriz extracelular excessiva. O acúmulo de sais biliares tóxicos no parênquima hepático leva à lesão crônica com dano mitocondrial, redução da síntese de ATP, aumento de espécies reativas de oxigênio (ROS) e apoptose, resultando em comprometimento da função hepática. Trabalhos anteriores do nosso grupo mostraram o efeito positivo do transplante de células mononucleares da medula óssea (CMMO) na resolução da fibrose hepática e recuperação da função hepática em ratos com colestase, induzida pela ligadura de ducto biliar (LDB). Assim, o presente estudo teve como objetivo analisar a bioenergética mitocondrial após o transplante de CMMO no fígado de ratos com fibrose induzida por ligadura de ducto bilar (LDB). Ratos Wistar machos foram divididos em quatro grupos: animais normais, animais com fibrose hepática após 14 e 21 dias de LDB (F14d e F21d, respectivamente), e animais que após 14 dias de LDB receberam 1x107 CMMO, e foram eutanasiados sete dias após. Nossos dados demonstraram aumento do conteúdo de colágeno tipo I no grupo F21d em relação ao grupo normal, indicativo de fibrose, e sua diminuição após o transplante de CMMO. A análise da fisiologia mitocondrial do fígado mostrou diminuição significativa da taxa respiratória máxima estimulada por ADP (estado 3) nos grupos F14d e F21d, indicando redução da capacidade de oxidação de carboidratos e ácidos graxos. Além disso, a razão do controle respiratório (RCR), indicativa de acoplamento da fosforilação oxidativa com a produção de ATP, apresentou-se significativamente diminuída nos grupos F14d e F21d, sugerindo desacoplamento mitocondrial. No entanto, o transplante de CMMO aumentou significativamente nestes grupos tanto a capacidade oxidativa quanto o acoplamento mitocondrial a níveis semelhantes aos do grupo normal. Estes resultados foram confirmados por análise de western blotting, que mostrou aumento significativo no conteúdo de UCP2 e diminuição do conteúdo de PGC-1&#945; no grupo F21d, com consequente restauração após o transplante de CMMO. Além disso, os resultados mostraram um aumento significativo do conteúdo de 4-HNE no grupo F14d com redução após o transplante CMMO. Assim, podemos concluir que o transplante de CMMO tem um efeito positivo sobre a bioenergética mitocondrial de fígados de ratos com colestase, com aumento da capacidade oxidativa e redução do estresse oxidativo, o que, por sua vez, contribui para a recuperação da função hepática. / Mitochondrial dysfunction has been associated with several diseases, including liver cholestatis, which is characterized by activation of Kupffer cells and fibrogenic cells that produce excessive extracellular matrix. Toxic bile salt accumulation in liver parenchyma leads to chronic injury with mitochondrial damage, ATP synthesis reduction, ROS increase and apoptosis, resulting in liver function impairment. Our previous works showed the positive effect of bone marrow mononuclear cells (BMMNC) transplantation on liver fibrosis resolution and hepatic function recover in cholestatic rats. This study aimed to analyze mitochondrial bioenergetics in rats with hepatic fibrosis induced by bile duct ligation (BDL) after BMMNC transplantation. Wistar male rats were divided into four groups: normal animals, animals with cholestasis after 14 and 21 days BDL (F14d and F21d, respectively), and animals with cholestasis after 14 days of BDL that received 1x107 BMMNC, via jugular vein, and were euthanasia after 7 days. The livers were analyzed by high-resolution respirometry and western blotting. Our data demonstrated increased collagen type I content in livers of F21d group compared to normal group, indicative of fibrosis, and its decrease after BMMNC transplantation. Liver mitochondrial physiology analysis showed that F14d and F21d groups have significantly reduced maximum ADP-stimulated respiratory rates (State 3), indicating reduced carbohydrates and fatty acids oxidation capacity. In addition, respiratory control ratio (RCR), indicative of oxidative phosphorilation coupling to ATP production, was significantly decreased in F14d and F21d groups, suggesting mitochondrial uncoupling. However, BMMNC transplantation significantly increased both State 3 respiration and RCR to levels similar to those of normal group, recovering hepatic mitochondrial function. These results were confirmed by WB analysis, which showed that F21d group had a significantly increase in liver mitochondrial uncoupling protein content, UCP2, and reduced PGC-1&#945; content, a mitochondrial biogenesis co-factor. However, after BMMNC transplantation both proteins returned to levels similar to normal group. In addition, F14d group had a significantly increase in 4-HNE content compared to normal group, indicative of oxidative stress, but after BMMNC transplantation 4-HNE content significantly reduced, compared to normal group, suggesting oxidative stress reduction. Therefore, BMMNC transplantation had a positive effect on hepatic mitochondrial bioenergetics of cholestatic rats, increasing oxidative capacity and reducing oxidative stress, which, in turn, contribute to liver function recover.