Dados da literatura e do nosso grupo evidenciam que a desnutrição protéica compromete órgãos linfo-hematopoéticos e modifica a resposta imune. Sabendo que animais desnutridos apresentam hipoplasia severa de órgãos hematopoéticos e que o microambiente medular apresenta distintos moduladores que atuam sinergicamente para influenciar a sobrevivência, proliferação e o desenvolvimento das células hematopoéticas em todos os seus níveis de diferenciação, avaliamos em um modelo de desnutrição, alguns aspectos da complexa regulação do microambiente medular avaliando a expressão de fatores de transcrição envolvidos no processo de diferenciação da Célula Tronco Mesenquimal (CTM) e capacidade de produção de citocinas importantes para o controle da hematopoese. Camundongos Balb/C machos, adultos, adaptados em gaioleiros metabólicos foram separados nos grupos controles e desnutridos recebendo, respectivamente, ração normoprotéica (12% de proteínas) e hipoprotéicas (2% de proteínas). Após o grupo desnutrido perder cerca de 20% do peso inicial, os animais foram sacrificados para a avaliação nutricional e hematológica caracterizando a desnutrição. As células mesenquimais foram isoladas da medula óssea (MO) e caracterizadas imunofenotipicamente por citometria de fluxo mostrando populações de células em ambos os grupos com marcação positiva para CD90, CD271, Sca1, CD49e, CD13, baixa marcação para CD34 e negativa para CD14, CD45. Na quantificação de fatores de transcrição por Western Blot verificou-se que células mesenquimais medulares de animais desnutridos apresentaram maior expressão de PPARγ e RUNX2, fato este que pode ser explicado, em parte, pelo remodelamento microambiental observado nesses animais. Sobrenadantes de células mesenquimais de animais desnutridos quantificados por Elisa apresentaram uma maior concentração de SCF e uma redução na concentração de G-CSF e GM-CSF. As alterações encontradas nos permitem concluir que a desnutrição compromete as células mesenquimais tanto no aspecto regulatório de fatores de transcrição, bem como na capacidade de produção de citocinas, contribuindo para o comprometimento do microambiente hematopoético e induzindo a falência medular comumente observada em situações de desnutrição protéica. / Data from literature and our group showed that protein malnutrition compromises lympho-hematopoietic organs and modifies the immune response. Knowing that malnourished animals show severe hypoplasia of hematopoietic organs and the bone marrow microenvironment has distinct modulators that act synergistically to influence survival, proliferation and development of hematopoietic cells in all levels of differentiation, we evaluated in a model of protein malnutrition, some aspects of the complex regulation of bone marrow microenvironment evaluating the expression of transcription factors involved in the differentiation of Mesenchymal Stem Cells, and the production capacity of cytokines which are important in the regulation of the hematopoiesis. BALB/c mice, males, adults adapted in metabolic cages were separated in two groups: control and malnourished groups receiving, respectively, normal protein diet (12% protein) and low protein (2% protein). After the malnourished group lost about 20% of initial weight, the animals were sacrificed and evaluated the nutrition status, as well as hematological parameters. Mesenchymal Stem Cells were isolated from bone marrow and immunophenotypically characterized by flow cytometry showing cells populations in both groups stained positive for CD90, CD271, Sca1, CD49e, CD13, low marking for CD34 and negative for CD14, CD45. In the measurement of transcription factors by Western Blot found that Mesenchymal Cells of bone marrow malnourished animals showed higher expression of RUNX2 and PPARγ. This fact can be explained, in part, by microenvironmental remodeling observed in these animals. Mesenchymal stem cells supernatants of malnourished mice quantified by Elisa presented a higher concentration of SCF and a reduced concentration of G-CSF and GM-CSF. The alterations found in malnourished animals allow us to conclude that malnutrition commits Mesenchymal Stem Cells on the expression of transcription factors involved in the regulatory aspects of the differentiation process, as well as at the capacity of cytokine production, contributing to an impaired hematopoietic microenvironment and inducing the bone marrow failure commonly observed in protein malnutrition states.

La sclérodermie systémique (ScS) est une maladie rare et incurable, caractérisée par une fibrose cutanée et la production d’auto-anticorps (maladie auto-immune). Le pronostic vital est engagé dans les formes diffuses et rapidement progressives de la maladie, responsables de fibrose pulmonaire. Par leurs propriétés immunomodulatrices et anti-fibrotiques, les cellules souches mésenchymateuses (CSM) constituent une approche prometteuse pour traiter la ScS. Ce travail a pour objectif d’évaluer le potentiel thérapeutique des CSM dans un modèle préclinique de forme diffuse de la maladie (d-ScS).Patients et Méthodes : Nous avons évalué l’effet de différentes modalités d’injections des CSM par voie intraveineuse dans le modèle murin de ScS-HOCl. Ce modèle, basé sur l’injection d’acide hypochloreux (HOCl), induit un phénotype proche des formes d-ScS. Nous avons notamment comparé un traitement préventif et curatif, des approches syngénique, allogénique et xénogénique, et l’utilisation de CSM d’origine adipocytaire (ASC) à celle de CSM de moelle osseuse (CSM-MO).Résultats : Le modèle ScS-HOCl est caractérisé par l’installation d’un phénotype de d-ScS, avec fibrose cutanée, pulmonaire et production d’anticorps anti-topoisomérase 1. Nous montrons l’effet bénéfique d’une injection préventive ou curative de CSM syngéniques, réduisant la fibrose cutanée et pulmonaire. Cet effet thérapeutique passe par une diminution de la réponse immune réduisant l’inflammation tissulaire et la production d’auto-anticorps, ainsi que par l’induction du remodelage tissulaire via l’activation de métalloprotéases, et l’augmentation des défenses anti-oxydantes. Un bénéfice similaire est obtenu lors d’approches allogénique et xénogénique. Les ASC présentent des capacités immunosuppressives et de remodelage supérieures aux CSM-MO.Discussion et conclusion : Nos travaux démontrent l’effet anti-fibrotique des CSM dans un modèle préclinique pertinent de ScS, mimant les formes diffuses et rapidement progressives de la maladie, pour lesquelles les besoins thérapeutiques sont importants. Le mode d’action pléiotropique des CSM, combinant propriétés anti-inflammatoires, pro-remodelage et anti-oxydantes, est prometteur en vue des applications cliniques à venir dans cette maladie.Mots-clés : sclérodermie systémique, cellules souches mésenchymateuses, HOCl / Systemic sclerosis (SSc) is a rare intractable disease characterized by skin fibrosis and autoimmunity. Diffuse and rapidly progressive SSc (d-SSc) is associated with life-threatening involvements such as lung fibrosis, where there still is an unmet medical need. Displaying immunomodulatory and antifibrotic properties, mesenchymal stem cells (MSC) are an attractive cure for SSc. In this study, we aim at evaluating the therapeutic potential of MSC in a preclinical model of d-ScS.Patients and Methods: We evaluated the effects of MSC infusion in the murine model of ScS-HOCl, based on repeated injections of hypochlorite (HOCl). We compared several approaches using MSC in a preventive and curative approach, in syngeneic, allogeneic and xenogeneic settings, and using MSC isolated from adipose tissue (ASC) or bone marrow (BM-MSC).Results: ScS-HOCl is close to d-ScS phenotype, leading to skin and lung fibrosis, together with anti-topoisomerase 1 antibody production. We show beneficial effects of a preventive or curative injection of syngeneic MSCs, reducing tissue fibrosis. Fibrosis reduction following MSC treatment involves immunosuppressive effects, tissue remodeling via metalloprotease activation, and anti-oxydant activity. Similar benefits are observed in allogeneic and xenogeneic settings. ASC display greater immunosuppressive and remodeling capacities than BM-MSCs.Discussion and conclusion: Our study demonstrates the anti-fibrotic effects of MSCs in a relevant preclinical model of ScS, mimicking diffuse and rapidly progressive ScS. Pleiotropic capabilities of MSCs, combining anti-inflammatory, remodeling and antioxidant properties, are promising for future clinical applications in this disease.Keywords: systemic sclerosis, mesenchymal stem cells, HOCl

Periodontal disease affects 47% of Americans over 30. Characterized by microbial dysbiosis and unregulated inflammation, severe periodontitis causes degradation of bone and soft tissue around teeth. Current treatments have limited regenerative outcomes and frequent reinfection by harmful bacteria. Human mesenchymal stem cells (hMSCs) have been shown to promote wound healing and tissue regeneration. Many therapeutic benefits of hMSCs are due to their secretome products, like exosomes. Our long-term goal is to develop periodontal therapies with hMSC exosomes. The objectives of this study were to determine the effect of hMSC-derived exosomes on cellular activity of hMSCs and investigate whether hMSC exosome treatment reduces pro-inflammatory cytokine production in LPS-activated RAW264.7 cells. The specific aims of this study were: 1) Determine the characteristics of hMSC-derived exosomes, 2) Determine the biological effect of exosomes on cellular activity of hMSCs, 3) Determine whether exosomes treatment can inhibit cytokine production in activated RAW264.7 cells, and 4) Determine the role of exosomal miRNA in pro-inflammatory cytokine production of RAW264.7 cells. To investigate, exosomes were first harvested from hMSCs culture media through ultracentrifugation. Exosomes were then observed under a transmission electron microscope (TEM) and assessed for surface markers using Western Blot. A transwell migration assay was used to evaluate the chemotactic effect of exosomes. To study the effect of exosomes on stem cell proliferation, exosomes were administered to hMSCs. The immunogenicity of MSC exosome was also evaluated. After 72 hours, cells were lysed and DNA was measured. To study anti-inflammatory effects of exosomes, LPS stimulated RAW264.7 cells were treated with exosomes. Interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα) levels of supernatant were measured by ELISA. To study exosomal miRNA, exosomal miRNAs were overexpressed in RAW264.7 cells and these cells were stimulated with LPS. IL-6 and TNFα were measured by ELISA. TEM images showed that exosomes are nano-sized vesicles (~100 nm). Western blot images showed that CD63 and CD81 are enriched in exosomes compared to total cell lysates. Exosome treatment increased cell proliferation and migration in hMSCs. At the doses that are chemotactic and mitogenic, MSC exosomes had minimal effect on the inflammatory cytokine IL-6 production. Treatment with exosomes significantly decreased IL-6 and TNFα production in RAW264.7 cells activated by LPS. Transfecting RAW264.7 cells with exosomal miR-760 significantly decreased IL-6 production, but had minimal effect on TNFα. Our results indicate that exosomes have a pleiotropic activity, which includes stimulating stem cell migration and proliferation, and mitigating the inflammatory response. Therefore, hMSC exosome delivery is promising for the treatment of periodontal diseases.

The use of allograft bone is effective in the treatment of large bone loss following tumour removal or surgery. However, it is not osteogenic due to a lack of viable osteogenic cells and the remaining marrow material is potentially harmful to the recipient. Sterilisation techniques, such as gamma irradiation, are routinely used to improve the safety of these grafts; however this fails to remove the immunogenic material and may diminish the bones innate properties. Thus, wash techniques are being developed to remove the deleterious marrow, whilst retaining the native properties of the bone so that through tissue engineering, pre-osteogenic cells may be added to aid osseointegration. To this end, this study utilised a novel wash process (developed by the National Health Service Blood and Transplant Tissue services (NHSBT)) on whole human femoral heads, to assess the resulting material’s suitability as a biological scaffold for bone tissue engineering (BTE). Following the wash process, marrow removal efficiency was analysed by biochemical testing and histological assessment, and biocompatibility of fresh-frozen and washed human bone was assessed using extract cytotoxicity assays with BM-MSCs. The results showed a marrow removal efficiency of 99.5%, leaving a material with only 16.7 ng DNA/100mg of dry material, and which histologically displayed minimal cellular content demonstrating that this was an efficient wash process producing an acellular biological scaffold material (<50ng DNA/100mg bone). Extract cytotoxicity testing indicated the material was biocompatible. Uniaxial compression to failure was performed on 1cm3 cubes using bone samples from mirrored location of bilaterally halved femoral heads, with one half washed, whilst the other was fresh-frozen. A random orientated “clinical” model was also utilised, with samples processed as fresh-frozen, washed and irradiated for comparative assessment. There was no significant change in the mechanical strength of the washed material compared to fresh-frozen samples or between sterilisation types, suggesting the washed bone was mechanically comparable to existing bone allograft stock. BM-MSCs from both young (≤50 years) and old donors (≥70 years) were seeded on washed bone cubes from young and old donors, and cultured in standard or osteogenic media. Samples were analysed at 0, 14 and 28 day timepoints for cell viability, osteogenic gene expression, alkaline phosphatase activity and histological analysis. Results indicated significant fold increases in cell metabolism at day 14 and 28, in both medium types compared to day 0 (p≤0.001). QRT-PCR data showed increased expression of osteogenic markers RUNX2 (p≤0.001), osteopontin (p≤0.001) and osteocalcin (p≤0.001) in both standard and osteogenic media with significantly higher RUNX2 and osteocalcin in osteogenic medium samples at day 28. Expression of osteogenic genes was significantly higher in young donor cells seeded on the washed bone compared to old donor cells, as was expression in BM-MSCs cultured on old donor bone compared to young bone. This implies that the washed bone was able to induce osteogenic differentiation in BM-MSCs, that young donor cells were better able to differentiate than old, and that old donor bone was better able to induce osteogenic activity. Additionally, patient-matched BM-MSCs and ASCs, and BM-MSCs and BM-MNCs were seeded onto washed bone cubes and cultured for 28 days in standard or osteogenic media, with gene expression and metabolic activity assessed. The washed bone was able to induce osteogenic differentiation of ASCs. Moreover, BM-MNCs when cultured on washed bone also expressed osteogenic genes, indicative of osteogenic differentiation. These results indicate the efficacy of a novel wash process in producing a biological acellular scaffold suitable for bone tissue engineering. Interestingly, data also suggests that the age of the cell donor and bone donor may effect osteogenic differentiation of seeded cells which has significant implications clinically.

Intervertebral disc (IVD) degeneration is associated with low back pain (LBP). It has been suggested that changes in the IVD physio-chemical microenvironment (i.e. hypoxia, reduced nutrient and acidic conditions) may lead to disc degeneration. Studying the response of human nucleus pulposus (NP) cells to these conditions could establish the causal relationship between IVD microenvironment and aberrant cellular behaviour, characteristic of disc degeneration. Human bone marrow mesenchymal stem cells (BM-MSCs) are a promising cell population for disc regeneration. However, knowledge of their survival and functioning in the microenvironment of the IVD is still lacking. Moreover, in vitro co-culture model studies that are used to study MSC/disc cell interaction, also need to consider the effect of the microenvironment on cellular responses. BM-MSCs and degenerate NP cells were cultured alone or co-cultured in monolayer under hypoxia (2%O2), reduced nutritional (2% serum or/and 5mM glucose) and acidic (moderate pH 6.8 or severe pH 6.5) conditions alone or in combination for 7 days. Cell viability, proliferation, gene and protein expression was assessed. Degenerate NP cells and BM-MSCs maintained good cell viability under all conditions. Both cell types demonstrated overall similar proliferation and gene and protein responses under the majority of the conditions and combinations studied. Hypoxia promoted aggrecan and versican matrix biosynthesis in both cell types. Nutrient deprived and moderate acidic conditions (pH 6.8) inhibited proliferation of both cell types. Interestingly the combination of hypoxia with these conditions showed a protective effect in modulating cell proliferation. These results imply that hypoxia may be beneficial in some instances. Nutrient deprived conditions had a relatively minor effect on degenerate NP cell gene and protein expression but these conditions specifically inhibited VCAN expression in BM-MSCs. The combination of hypoxia with these conditions increased or restored VCAN expression. Interestingly the combination of hypoxia with reduced glucose conditions increased aggrecan and versican matrix biosynthesis in both NP cells and BM-MSCs. The combination of hypoxia and complete nutrient deprived conditions (both reduced serum and reduced glucose) impaired ACAN, VCAN and PAX-1 gene and aggrecan and versican protein expression in degenerate NP cells implicating disc hypoxia and complete nutrient deprived combined microenvironment in accelerating degenerate changes in NP cells. In contrast, these conditions showed no such detrimental effects on BM-MSC gene and protein expression. pH 6.5 was critical for both cell types proliferation and ACAN and VCAN gene expression suggesting that severe acidic conditions may exacerbate degenerative changes and be inhibitory for implanted MSCs. Finally, a combination of hypoxia, complete nutrient deprived and moderate acidic conditions, reduced cell proliferation without affecting the gene expression profile of both cell types. IVD-like physio-chemical microenvironmental conditions also appeared to influence differentiation of BM-MSC and modulation of degenerate NP cell phenotype observed during co-culture. Noticeably hypoxia, reduced serum or reduced glucose conditions stimulated BM-MSC differentiation and modulation of degenerate NP cell phenotype. Hypoxia also increased or recovered changes at gene expression level in both BM-MSCs and degenerate NP cells under nutrient deprived (reduced serum or/and reduced glucose) conditions during co-culture. Degenerate NP cell and BM-MSC co-culture also showed noticeable increase in aggrecan and versican biosynthesis under hypoxia and reduced glucose combine conditions, implicating these in improving the co-culture responses. Severe pH condition alone, pH 6.8 in combination with hypoxia and finally all IVD-like physio-chemical conditions together compromised co-culture responses. Such results imply that IVD-like physio-chemical microenvironmental conditions may influence MSC based regenerative outcomes. This work has increased our understanding about the influence of disc harsh microenvironment on degeneration and regeneration processes.

Fissura de lábio com ou sem fissura de palato não-sindrômica (FL/P NS) é uma malformação craniofacial frequente, com modelo de herança multifatorial, onde fatores de risco genéticos e ambientais atuam na manifestação da doença. Variações nos níveis de expressão gênica têm sido apontadas como um importante mecanismo de susceptibilidade a doenças complexas, e variantes no DNA que regulam esses níveis de expressão (eQTL) têm sido combinadas a estudos de associação para auxiliar no entendimento da etiologia de algumas doenças. No presente trabalho, integramos eQTLs e estudo de associação para 1) verificar se variantes já associadas com FL/P NS possuem um papel regulatório em células-tronco de músculo orbicular do lábio (OOMMSC, um tecido afetado em FL/P NS), e 2) verificar se eQTLs mapeados em OOMMSC teriam associação com a mesma. Para o primeiro objetivo, verificamos a correlação entre os genótipos das variantes rs642961 e rs590223 e os níveis de expressão de IRF6, e também entre rs987525 e os níveis de expressão de MYC. Não encontramos correlação para nenhuma das três variantes testadas. É possível que essas variantes possuam um papel funcional em algum momento específico da embriogênese, ou mesmo que não tenhamos detectado essa correlação devido ao número amostral analisado (N=46). Para o segundo objetivo, realizamos um estudo de associação do tipo caso-controle dos eQTLs rs5011163, rs1505443, rs4793213, rs4793229 e rs1242500. Não encontramos associação entre nenhuma das cinco variantes e FL/P NS. Uma possível explicação para a associação negativa seria a significância marginal dessas variantes como eQTLs em OOMMSC. Além disso, estudos com baixo poder, como o mapeamento de eQTLs em OOMMSC realizado em outro projeto pelo nosso grupo, geralmente detectam os eQTLs de maior efeito, sendo esses frequentemente compartilhados entre tecidos, e, assim, podem não ter relevância para a doença em si. Outros eQTLs de OOMMSC, selecionados por critérios diferentes do presente estudo, estão sendo testados para associação com FL/P NS, o que nos permitirá avaliar a relevância dessa abordagem para detectar variantes de susceptibilidade a FL/P NS / Nonsyndromic cleft lip with or without cleft palate (NSCL/P) is a frequent craniofacial malformation, with a multifactorial model of inheritance, in which genetic and environmental risk factors act in disease manifestation. Variation of gene expression has been pointed as an important susceptibility mechanism to complex diseases, and DNA variants that regulate expression levels (eQTLs) have been combined with association studies to help elucidate the etiology of some diseases. In the present work, we integrate eQTL and association studies to 1) verify if variants associated with NSCL/P have a regulatory role in orbicularis oris muscle mesenchymal stem cells (OOMMSC, a tissue affected by NSCL/P); and 2) verify if eQTLs mapped in OOMMSC are associated with the disease. For the first goal, we verified the correlation of the rs642961 and rs590223 genotype variants with IRF6 expression levels, and also between the rs987525 genotype and MYC expression levels. We did not find correlation for any of the three variants tested. Possibly, these variants have a functional role in specific moments of embryogenesis, or sample size (N=46) was insufficient to detect correlation. For the second goal, we did a case-control association study for eQTLs rs5011163, rs1505443, rs4793213, rs4793229 and rs1242500. We did not find association between these variants and NSCL/P. The negative association could be explained by the marginal significance of these variants as eQTLs in OOMMSC. Besides, low-power studies, as the OOMMSC eQTL mapping performed in another project by our group, usually detect eQTLs of larger effect, which are frequently shared among tissues; therefore, they may not be relevant for the disease itself. Other eQTLs, selected under different criteria, are currently being tested for association with NSCL/P, which will enable us to evaluate the relevance of this approach to detect susceptibility variants for NSCL/P

The current gold standard of therapy for treatment of tibial fracture nonunion is iliac crest bone graft. However, this intervention is associated with significant morbidity to the donor site. Research into alternative interventions highlights the role of mesenchymal stem cells (MSCs). MSCs are capable of differentiating into mature, organized osseous tissue as well as recruiting local vascular cells. However, there are few prospective studies demonstrating the therapeutic potential of MSCs in fracture nonunion. The proposed study is a multicenter single-blinded controlled study of MSC application compared to iliac crest bone graft in the setting of fracture nonunion of the tibia. The study subjects will be evaluated at each return to care with mRUST radiographic scoring as well as Short-Form 12 evaluation of general health. These results will be correlated with MSC concentrations as assessed by FACS analysis. The data from this study will help to characterize MSCs as a possible therapeutic intervention in fracture nonunion.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第17976号 / 医博第3840号 / 新制||医||1001(附属図書館) / 80820 / 京都大学大学院医学研究科医学専攻 / (主査)教授 戸口田 淳也, 教授 宮地 良樹, 教授 長澤 丘司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12831号 / 論医博第2080号 / 新制||医||1005(附属図書館) / 31369 / (主査)教授 川口 義弥, 教授 柳田 素子, 教授 小川 修 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12944号 / 論医博第2096号 / 新制||医||1010(附属図書館) / 32203 / 京都大学大学院医学研究科医科学専攻 / (主査)教授 川口 義弥, 教授 横出 正之, 教授 稲垣 暢也 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM