Introduction: Dupuytren's disease (DD) is an ill-defined fibroproliferative disorder affecting the palms of the hands of certain patient groups. Whether changes in DD fibroblasts are due to genetic alterations alone or related to metabolic dysregulation has not yet been investigated. Hypotheses: 1. DD is a disease of several networks rather than of a single gene. 2. DD may be investigated more effectively by employing systems biology. 3. Strict definition of cell passage number is important for the revelation of any DD phenotype. 4. Some of the differences between DD and healthy tissues reside in a difference in their respiratory metabolism. 5. Any such differences are akin the Warburg effect noted for tumour cells in the literature. Methods: We induced hypoxia in healthy and disease cells to test whether the difference in disease cell types and healthy is the same as the difference in control fibroblasts cultured in normoxia and hypoxia. We investigated both at the metabolic level (intracellular and extracellular) and at the transcript level. This study also employed Fourier transform infrared spectroscopy to permit profiling of cells: (1) DD cords and nodules against the unaffected transverse palmar fascia (internal control), (2) those (1) with carpal ligamentous fascia (external controls) (3) those in (1) against DD fat surrounding the nodule, and skin overlying the nodule. We then compared metabolic profiles of the above to determine the effect of serial passaging by assessment of reproducibility. Subsequently, a novel protocol was employed in carefully controlled culture conditions for the parallel extraction of the metabolome and transcriptome of DD-derived fibroblasts and control at normoxic and hypoxic conditions to investigate this hypothesis. Gas chromatography-mass spectrometry combined with microarrays was employed to identify metabolites and transcript characteristic for DD tissue phenotypes. The extracellular metabolome was also studied for a selected subset. The metabolic and transcriptional changes were then integrated employing a network approach. Results: Carefully controlled culture conditions combined with multivariate statistical analyses demonstrated metabolic differences in DD and unaffected transverse palmar fascia, in addition to the external control. Differences between profiles of the four DD tissue phenotypes were also demonstrated. In addition early passage (0-3) metabolic differences were observed where a clear separation pattern in clusters was observed. Subsequent passages (4-6) displayed asynchrony, losing distinction between diseased and non-diseased sample phenotypes. A substantial number of dysregulated metabolites involved in amino acid metabolism, carbohydrate metabolism and also metabolism of cofactors and vitamins including downregulated cysteine and aspartic acid have been identified from the integrative analyses. Metabolic and transcriptional differences were revealed between fibroblast cell samples (passage number 3) cultured in 1% and 21% oxygen. The hypothesis that the difference in disease and healthy cells maybe akin to the differences in healthy cells in normoxia and hypoxia was rejected as only a very small number of significant molecules from these studies coincided in perturbed fascia and disease samples. No lactic acid was observed and little difference in the pyruvate concentrations. Yet, upon perturbation several of these transcripts and metabolites involved in the afore-mentioned pathways were significantly dysregulated. Conclusion: Early, but not late, passage numbers of primary cells provide representative metabolic and transcript fingerprinting for investigating DD. A unique parallel analysis of transcript and metabolic profiles of DD fibroblasts and control, enabled a robust characterization of DD and correlation of parameters across the various levels of systemic description. The tools that should facilitate our understanding of these complex systems are immature, but the pleiotropy of the difference between healthy and DD tissue suggest the aetiology of a network-based disease.

Capsaicin, prostaglandin E2 (PGE2) and polydopamine (PDA) were used to target macrophage and myofibroblast activity to reduce biomaterial-induced fibrosis. The lifetime and efficacy of implantable biomedical devices are determined by the foreign body response. Immediately after implantation, proteins nonspecifically adsorb onto the material and initiate inflammation. Macrophages recruited to the site can differentiate into M1 and M2 phenotypes and upregulate inflammation and fibrosis which interferes with the intended function. M1 macrophages secrete pro-inflammatory mediators that induce chronic inflammation and promote myofibroblast differentiation while M2 macrophages are wound healing cells that suppress inflammation and regulate fibroblast activity. The fibrotic tissue is developed by myofibroblasts which produce collagen in an unregulated fashion. Collagen thickening and biomaterial encapsulation decreases efficacy and sensitive of biomedical devices. We investigated the in vitro and in vivo effects of capsaicin, PGE2 and polydopamine surface modification on macrophages and myofibroblasts. Capsaicin and PGE2 reduced poly(lactic-co-glycolic) acid (PLGA)-induced fibrosis by promoting M2 macrophage phenotype to secrete anti-inflammatory IL-10 and suppressing myofibroblast marker α-smooth muscle actin (α-SMA). Capsaicin decreased collagen by 40% and upregulated IL-10 secretion by 35% while PGE2 reduced collagen by 55% after 14 days of implantation and 40% less collagen after 42 days. PDA was used to bind an anti-fibrotic compound to the surface of a poly(dimethyl siloxane) (PDMS-PDA) to reduce fibrosis. However, PDMS-PDA controls gave an unexpected result by reducing fibrosis to the same extent as anti-fibrotic compound bound PDMS- v PDA. PDA modification reduced cellularity by 50% and significantly decreased collagen thickness by 30%. Overall, our results showed that biomaterial-induced fibrosis can be reduced by promoting M2 macrophage activity and inhibiting myofibroblast differentiation. This research demonstrates three compounds that have potential to reduce fibrosis and extend the lifetime and efficacy of implantable biomedical devices. / Thesis / Master of Applied Science (MASc) / Capsaicin, prostaglandin E2 (PGE2) and polydopamine were used to reduce scar tissue development around implanted polymers. Biomedical devices implanted in the body can undergo severe scar tissue formation, or fibrosis, and fail. Fibrosis is described by the accumulation of collagen and encapsulation of an implanted polymer. Macrophages regulate fibrosis by secreting pro-fibrotic compounds and myofibroblasts produce unregulated amounts of collagen. In this thesis, capsaicin, PGE2 and polydopamine were incorporated into implants to target macrophage and myofibroblast activity and reduce fibrosis in mice. Capsaicin and PGE2, released from a degradable polymer, altered macrophages to secrete anti-fibrotic compounds and decreased collagen by 40% and 55%, respectively. Polydopamine surface modified implants gave an unexpected result and suppressed overall cell activity to reduce fibrosis by 30%. The research conducted shows the potential of these compounds to reduce fibrosis and extend the lifetime of implantable devices.

No description available.

The regulation of transcription of tens of thousands of genes in a vertebrate organism is an enormously complex phenomenon which entails the participation of thousands of various regulatory proteins. The largest functional category of these regulators is accounted for by sequence-specific DNA-binding proteins known as transcription factors. Proteins of the EGR and Myb families of transcription factors are long-studied regulators of a variety of physiological processes including cellular proliferation and differentiation. The structural and physical aspects of their function have been well characterized. Their cell-type specific participation in complex gene-regulatory networks, on the other hand, is still incompletely understood and represents a major challenge in the respective research areas. Preliminary analysis of gene expression data from metastasizing PR9692 and non- metastasizing PR9692-E9 chicken sarcoma cell lines revealed that the transcription factor EGR1 is expressed at a higher level in metastasizing cells and can thus take part in the regulatory processes that underlie the differences between the two cell lines. Further investigation demonstrated that the introduction of exogenous EGR1 into PR9692-E9 cells restored their metastatic potential to a level indistinguishable from PR9692...

Um das Langzeitüberleben eines Kreuzbandtransplantates nach Ersatz des VKB zu gewährleisten muß das Transplantat revaskularisiert werden. Trotz zahlreicher Studien zu diesem Thema gibt es noch immer eine kontroverse Diskussion bezüglich der Revaskularisierung von Kreuzbandtransplantaten. Ziel der vorliegenden Studie war es die endoligamentäre mikrokapilläre Revaskularisierung eines freien Sehnentransplantates mit Hilfe immunhistochemischer Färbetechnik darzustellen und ihren Verlauf über die Zeit zu dokumentieren. Darüber hinaus sollten die im Rahmen des Remodelingprozesses nach vorderem Kreuzbandersatz ablaufenden Ab- und Aufbauprozesse der Extrazellulärmatrix des Transplantates weiter aufgeklärt werden. Bei der Heilung des medialen Kollateralband des Kniegelenkes wurden kontraktile fibroblastische Zellen entdeckt, die eine mögliche Rolle bei der Wiederherstellung der Matrixhomöostase spielen. Nach Entdeckung dieses Zelltyps im intakten vorderen Kreuzbandes wurde gemutmaßt, Myofibroblasten könnten eine entscheidende Rolle bei der Entstehung der Kollagentertiärstruktur spielen. In der vorliegenden Studie sollte aufgeklärt werden, ob Myofibroblasten im intakten ovinen vorderen Kreuzband und seinem freien Sehnentransplantat nach VKB-Ersatz während des Remodelings wieder auftaucht. 36 ausgewachsene Merinoschafe erhielten einen vorderen Kreuzbandersatz mittels ipsilateralem Flexorsehnentransplantat. Nach je 6, 9, 12, 24, 52 und 104 Wochen wurden 6 Tiere getötet und das mittlere Drittel des Kreuzbandtransplantates histologisch aufgearbeitet. Neben konventionellen Färbungen zur Auswertung von Gesamtzellzahl und Crimpstruktur wurden immunhistochemische Färbungen mit anti-v. Willebrandt Factor (Factor VIII) zum Nachweis von Endothelzellen der Gefäßwand und anti-alpha-smooth-muscle Aktin zum Nachweis von Myofibroblasten durchgeführt. In Querschnittpräparaten, je in 3 Zonen (subsynovial, intermediär und zentral) unterteilt, wurden Gefäßanschnitte ausgezählt. In Längsschnittpräparaten wurden Myofibroblasten nachgewiesen. Die Auswertungen wurden mit Hilfe eines digitalen Bildanalysesystems vorgenommen. Die Untersuchungen zur Revaskularisierung zeigten von peripher nach zentral über die Zeit einwachsende Kapillaren. Die größte Dichte an Gefäßanschnitten wurde nach 6 Wochen gefunden, der Gefäßstatus des nativen VKB wurde nach 24 Wochen erreicht. Myofibroblasten konnten sowohl im intakten VKB als auch im Flexorsehnentransplantat vor Implantation nachgewiesen werden. Weiterhin konnten Myofibroblasten erstmalig auch im remodelierenden Bandgewebe bereits nach 6 Wochen innerhalb neu gebildeter Kollagenfasern identifiziert werden. Die vorliegende Studie konnte damit erstmalig die Kinetik der endoligamentären Revaskularisierung auf kapillärer Ebene darstellen. Im vorliegenden Modell war die Revaskularisierung wesentlich früher abgeschlossen als zuvor beschrieben. Myofibroblasten stellen einen regulären Bestandteil sowohl des nativen als auch des remodelierenden VKB dar. Dabei könnten diese Zellen eine wichtige Rolle bei der Wiedererlangung der Gewebehomöostase durch die Ausbildung der Kollagentertiärstruktur spielen. Die Präsenz dieser Zellen während der frühen Remodellingphase läßt weiterhin vermuten, daß alpha smooth muscle Actin exprimierende Zellen in der frühsten Phase der Bildung von Kollagenfibrillen mitbeteiligt sind. / After replacement of the anterior cruciate ligament with a free tendon autograft, the substitute initially is avascular and without a synovial surface. To ensure long-term survival, the graft must become revascularised. Despite numerous studies on the topic, there still is controversial discussion regarding revascularisation. The first aim of the current study was to investigate the endoligamentous microcapillary revascularisation of the free tendon graft after anterior cruciate ligament replacement with time. Furthermore degeneration and reformation of the extracellular matrix during remodeling of the anterior cruciate ligament graft was to elucidate. Contractile fibroblastic cells expressing the alpha-smooth muscle actin isoform, so called myofibroblasts, have been identified to play a possible role during the healing of the medial collateral ligament by means of restoring the tissue s in situ strain via extracellular matrix contraction. Recently, these cells have also been identified to be a normal part of the human anterior cruciate ligament. It has been hypothesised that myofibroblasts play a role in wrinkling of the extracellular matrix. Therefore the second aim of the current study was to identify myofibroblasts in the intact ovine anterior cruciate ligament and their reoccurrence in a free autologous tendon graft during remodeling after anterior cruciate ligament reconstruction. Thirty-six mature sheep had an anterior cruciate ligament reconstruction with an ipsilateral flexor tendon split graft. Besides conventional staining to analyse total cell density and collagen crimp, midsubstance tissue samples were immunostained for von Willebrandt factor (Factor VIII) to detect the endothelial cells of capillaries and for a-smooth muscle actin to identify myofibroblasts. For vessel detection cross sections of the samples were determined in three zones (subsynovial, intermediate, and center of the graft). Myofibroblast distribution was analysed in longitudinal sections. Evaluation was performed at 6, 9, 12, 24, 52, and 104 weeks by means of histomorphometry using a digital imaging analysis system. The observations showed that capillary vessels, which originate from the synovial envelope, invaded the avascular graft tissue from the surface toward the center zone. The highest level of vascular density was found after 6 weeks, reaching the vascular status of the native anterior cruciate ligament after 24 weeks. Myofibroblasts were identified in the intact ovine anterior cruciate ligament as well as in the flexor tendon graft prior to implantation. During remodeling first myofibroblasts were found at 6 weeks within newly formed fibre bundles. At 24, 52, and 104 weeks myofibroblast distribution and cell density was similar to that of the intact ovine anterior cruciate ligament. The current study has shown, for the first time, the kinetics of an endoligamentous revascularisation of a free tendon graft at the capillary level. In the current model, the process of revascularisation terminated earlier than previously described. Furthermore the current study has shown that alpha-smooth muscle actin containing fibroblastic cells are a regular part of the intact as well as the remodeled anterior cruciate ligament. There is evidence, that myofibroblasts may be involved in maintaining tissue homeostasis in the mature ligament e.g. by means of crimp formation. The presence of these cells during the early remodeling may further indicate that alpha-smooth muscle actin containing fibroblastic cells are involved in the earliest stages of fibre bundle formation.

Die Expansion des renalen Tubulointerstitiums aufgrund einer Akkumulation zellulärer Bestandteile und extrazellulärer Matrix ist eine charakteristische Eigenschaft der chronischen Nierenerkrankung (CKD) und führt zu einer Progression der Erkrankung in Richtung eines terminalen Nierenversagens. Die Fibroblasten Proliferation und ihre Transformation hin zum sekretorischen Myofibroblasten-Phänotyp stellen hierbei Schlüsselereignisse dar. Signalprozesse, die zur Induktion der Myofibroblasten führen, werden aktiv beforscht um anti-fibrotische Therapieansätze zu identifizieren. Das anti-inflammatorische Protein Annexin A1 und sein Rezeptor Formyl-Peptid Rezeptor 2 (FPR2) wurden in verschiedenen Organsystemen mit der Regulation von Fibroblastenaktivität in Verbindung gebracht, jedoch wurden ihre Expression und Funktion bei renalen fibrotischen Erkrankungen bisher nicht untersucht. Ziel der aktuellen Studie war daher die Untersuchung der renalen Annexin A1- und FPR2-Expression in einem Tiermodell des chronischen Nierenversagens, sowie die Charakterisierung der funktionellen Rolle von Annexin A1 in der Regulation des Fibroblasten Phänotyps und ihrer Syntheseleistung. Dazu wurden neugeborene Sprague-Dawley Ratten in den ersten zwei Wochen ihres Lebens entweder mit Vehikel oder mit einem Angiotensin II Typ I Rezeptor Antagonisten behandelt und ohne weitere Intervention bis zu einem Alter von 11 Monaten (CKD Ratten) gehalten. Die Regulation und Lokalisation von Annexin A1 und FPR2 wurden mit Hilfe von Real-Time PCR und Immunhistochemie erfasst. Annexin A1- und FPR2-exprimierende Zellen wurden weiter durch Doppelimmunfluoreszenzfärbungen charakterisiert. Gefärbt wurde mit Antikörpern gegen endotheliale Zellen (rat endothelial cell antigen), Makrophagen (CD 68), Fibroblasten (CD73) und Myofibroblasten (alpha-smooth muscle actin (α-sma)). Zellkulturstudien wurden an immortalisierten renalen kortikalen Fibroblasten aus Wildtyp- und Annexin A1-defizienten Mäusen, sowie an etablierten humanen und murinen renalen Fibrolasten durchgeführt. Eine Überexpression von Annexin A1 wurde durch eine stabile Transfektion erreicht. Die Expression von Annexin A1, α-sma und Kollagen 1α1 wurde durch Real-Time PCR, Western Blot und Immuhistochemie erfasst. Die Sekretion des Annexin A1 Proteins wurde nach TCA-Fällung des Zellkulturüberstandes im Western Blot untersucht. Wie zu erwarten zeigten die CKD Ratten eine geringere Anzahl an Nephronen mit deutlicher glomerulären Hypertrophie. Der tubulointerstitielle Raum war durch fibrilläres Kollagen, aktivierte Fibroblasten und inflammatorische Zellen expandiert. Parallel dazu war die mRNA Expression von Annexin A1 und Transforming growth factor beta (TGF-β) signifikant erhöht. Die Annexin A1-Lokalisation mittels Doppelimmunfluorsezenz identifizierte eine große Anzahl von CD73-positiven kortikalen Fibroblasten und eine Subpopulation von Makrophagen als Annexin A1-positiv. Die Annexin A1-Menge in Myofibroblasten und renalen Endothelien war gering. FPR2 konnte in der Mehrzahl der renalen Fibroblasten, in Myofibroblasten, in einer Subpopulation von Makrophagen und in renalen Epithelzellen nachgewiesen werden. Eine Behandlung der murinen Fibroblasten mit dem pro-fibrotischen Zytokin TGF-β führte zu einem parallelen Anstieg der α-sma-, Kollagen 1α1- und Annexin A1-Biosynthese und zu einer gesteigerten Sekretion von Annexin A1. Eine Überexpression von Annexin A1 in murinen Fibroblasten reduzierte das Ausmaß der TGF-β induzierten α-sma- und Kollagen 1α1-Biosynthese. Fibroblasten aus Annexin A1-defizienten Mäusen zeigten einen starken Myofibroblasten-Phänotyp mit einer gesteigerten Expression an α-sma und Kollagen 1α1. Der Einsatz eines Peptidantagonisten des FPR2 (WRW4) resultierte in einer Stimulation der α-sma-Biosynthese, was die Vermutung nahe legte, dass Annexin A1 FPR2-vermittelt anti-fibrotische Effekte hat. Zusammenfassend zeigen diese Ergebnisse, dass renale kortikale Fibroblasten eine Hauptquelle des Annexin A1 im renalen Interstitium und einen Ansatzpunkt für Annexin A1-Signalwege in der Niere darstellen. Das Annexin A1/FPR2-System könnte daher eine wichtige Rolle in der Kontrolle des Fibroblasten Phänotyp und der Fibroblasten Aktivität spielen und daher einen neuen Ansatz für die anti-fibrotischen pharmakologischen Strategien in der Behandlung des CKD darstellen. / Expansion of the renal tubulointerstitium due to an accumulation of cellular constituents and extracellular matrix is a characteristic feature of chronic kidney disease (CKD) and leads to the progression towards renal failure. Fibroblast proliferation and transformation to the secretory myofibroblast phenotype present key events herein. The signaling process which leads to the generation of myofibroblasts is actively investigated to identify targets for antifibrotic therapeutic strategies. The antiinflammatory protein annexin A1 and its receptor formyl peptide receptor 2 (FPR2) have been implicated in the regulation of fibroblasts from various organs but the expression and function of the two products in renal fibrotic disease have not been elucidated so far. Aim of the present study was therefore to investigate the renal expression of annexin A1 and FPR2 in an animal model of chronic kidney disease and to characterize the role of annexin A1 in the regulation of fibroblast phenotype and synthetic activity. To this end, newborn Sprague-Dawley rats were treated either with vehicle or with an angiotensin II type I receptor antagonist during the first two weeks of their life and kept without further intervention until the age of 11 month (CKD rats). Regulation and localization of annexin A1 and FPR2 were studied using real-time PCR and immunohistochemistry. Annexin A1 and FPR2 expressing cells were further characterized by double labeling immunofluorescence with markers for endothelial cells (rat endothelial cell antigen), macrophages (CD68), fibroblasts (CD73), and myofibroblasts (alpha-smooth muscle actin (α-sma)). Cell culture studies were conducted in immortalized renal cortical fibroblast derived from wildtype and from annexin A1-deficient mice as well as in established cell lines of human and murine renal fibroblasts. Overexpression of annexin A1 was achieved by stable transfection. Expression of annexin A1, α-sma and collagen 1α1 was determined using real-time PCR, Western blotting and immunohistochemistry. Secretion of annexin A1 was studied using trichloroacetic acid protein precipitation of cell culture supernatants and Western blotting. As expected, CKD rats had an overall lower number of nephrons with a marked glomerular hypertrophy. The tubulointerstitial space was expanded due to an accumulation of fibrillar collagens, activated fibroblasts and inflammatory cells. In parallel, mRNA expression for Annexin A1 and transforming growth factor beta (TGF-β) was significantly increased. Double labeling immunofluorescence localization of annexin A1 demonstrated a high abundance in CD73 positive cortical interstitial fibroblasts and in a subset of CD68 immunoreactive macrophages. The abundance in myofibroblasts and renal endothelia was low. FPR2 was found in the majority of renal fibroblasts, myofibroblasts, a subset of macrophages, and in renal endothelial cells. Treatment of cultured murine fibroblasts with the profibrotic cytokine TGF-β resulted in a parallel induction of α-sma-, collagen 1α1- and annexin A1 biosynthesis. In addition, annexin A1 secretion was markedly increased. Overexpression of annexin A1 in murine fibroblasts reduced TGF β-induced α-sma- and collagen 1α1-biosynthesis. Fibroblasts derived from annexin A1-deficient mice showed a strong myofibroblast phenotype with increased expression of both, α-sma-, and collagen 1α1. Application of a peptide antagonist of FPR2 receptor (WRW4) caused a stimulation of α-sma biosynthesis thus suggesting a role of FPR2 in the antifibrotic effects of annexin A1. In conclusion, these results identify renal cortical interstitial fibroblasts as major source and as a target for annexin A1 signalling in the kidney. The annexin A1/FPR2 signalling system may therefore play an important role in the control of fibroblast phenotype and activity and may therefore provide a novel target for antifibrotic pharmacological strategies in the treatment of CKD.

Cardiovascular diseases are one of the leading causes of mortality. A common denominator across most of the cardiovascular diseases like diabetic cardiomyopathy, hypertrophic cardiomyopathy, myocardial infarction and dilated cardiomyopathy is the pathological remodelling of heart leading to fibrosis. Cardiac fibrosis is characterized by the excessive production and deposition of extracellular matrix components due to unwarranted proliferation of fibroblasts. Under normal conditions, following cardiac remodelling, my fibroblasts undergo programmed cell death. However, this does not happen under pathological conditions ultimately leading to fibrosis. Although the molecular events and signalling pathways that contribute to the development of cardiac fibrosis is well established, there are limited studies which try to understand the mechanisms by which fibroblasts persist and resist programmed cell death. Here we demonstrate that SIRT6, one of the members of sirtuin family of histone deacetylases, plays an important role in regulating my fibroblast cell death. When we analysed the mice hearts and isolated fibroblasts deficient in SIRT6, we observed increased expression of my fibroblast markers, suggesting that SIRT6 deficient hearts might have a high proportion of resident my fibroblasts. Also, when SIRT6 deficient fibroblasts were subjected to genotoxic stress, they showed reduced cell death and impaired mitochondrial to nuclear AIF translocation as compared to WT controls. An important regulator of AIF mediated cell death is the protein PARP-1. When we checked the expression levels of this protein under SIRT6 deficient conditions, it was found to be low. PARP-1 was also found to degrade faster under SIRT6 deficient conditions. Further qPCR analysis revealed that the transcript levels of PARP-1 were unaffected by SIRT6 suggesting that the regulation might not be at the transcriptional level. When we studied the acetylation of PARP-1 under SIRT6 deficient conditions we found the protein to be hypo-acetylated indicating a more complex mechanism of regulation.

[ES] La fibrilación auricular es la arritmia cardíaca más común. Durante la fibrilación auricular, el sustrato auricular sufre una serie de cambios o remodelados a nivel eléctrico y estructural. La remodelación eléctrica se caracteriza por la alteración de una serie de canales iónicos, lo que cambia la morfología del potential de transmembrana conocido como potencial de acción. La remodelación estructural es un proceso complejo que involucra la interacción de varios procesos de señalización, interacción celular y cambios en la matriz extracelular. Durante la remodelación estructural, los fibroblastos que abundan en el tejido cardíaco, comienzan a diferenciarse en miofibroblastos que son los encargados de mantener la estructura de la matriz extracelular depositando colágeno. Además, la señalización paracrina de los miofibroblastos afecta a los canales iónicos de los miocitos circundantes. Se utilizaron modelos computacionales muy detallados a diferentes escalas para estudiar la remodelación estructural inducida a nivel celular y tisular. Se realizó una adaptación de un modelo de fibroblastos humanos a nivel celular para reproducir la electrofisiología de los miofibroblastos durante la fibrilación auricular. Además, se evaluó la exploración de la interacción del calcio en la electrofisiología de los miofibroblastos ajustando el canal de calcio a los datos experimentales. A nivel tisular, se estudió la infiltración de miofibroblastos para cuantificar el aumento de vulnerabilidad a una arritmia cardíaca. Los miofibroblastos cambian la dinámica de la reentrada. Una baja densidad de miofibroblastos permite la propagación a través del área fibrótica y crea puntos de salida de actividad focal y roturas de ondas dentro de esta área. Además, las composiciones de fibrosis juegan un papel clave en la alteración del patrón de propagación. La alteración del patrón de propagación afecta a los electrogramas recogidos en la superficie del tejido. La morfología del electrograma se alteró dependiendo de la disposición y composición del tejido fibrótico. Se combinaron modelos detallados de tejido cardíaco con modelos realistas de los catéteres de mapeo disponibles comercialmente para comprender las señales registradas clínicamente. Se generó un modelo de ruido a partir de señales clínicas para reproducir los artefactos de señal en el modelo. Se utilizaron electrogramas de modelos de dos dominios altamente detallados para entrenar un algoritmo de aprendizaje automático para caracterizar el sustrato fibrótico auricular. Las características que cuantifican la complejidad de las señales fueron extraídas para identificar la densidad fibrótica y la transmuralidad fibrótica. Posteriormente, se generaron mapas de fibrosis utilizando el registro del paciente como prueba de concepto. El mapa de fibrosis proporciona información sobre el sustrato fibrótico sin utilizar un valor único de corte de 0,5 milivoltios. Además, utilizando la medición del flujo de información como la entropía de transferencia combinada con gráficos dirigidos, en este estudio, se siguió la dirección de propagación del frente de onda. La transferencia de entropía con gráficos dirigidos proporciona información crucial durante la electrofisiología para comprender la dinámica de propagación de ondas durante la fibrilación auricular. En conclusión, esta tesis presenta un estudio in silico multiescala que proporciona información sobre los mediadores celulares responsables de la remodelación de la matriz extracelular y su electrofisiología. Además, proporciona una configuración realista para crear datos in silico que pueden ser usados para aplicaciones clínicas y servir de soporte al tratamiento de ablación. / [CA] La fibril·lació auricular és l'arrítmia cardíaca més freqüent, en la qual el substrat auricular patix una sèrie de remodelacions elèctriques i estructurals. La remodelació de tipus elèctric es caracteritza per l'alteració d'un conjunt de canals iònics que modifica la morfologia del voltatge transmembrana, conegut com a potencial d'acció. La remodelació estructural és un fenomen complex que implica la relació entre diversos processos de senyalització, interaccions cel·lulars i canvis en la matriu extracel·lular. Durant la remodelació estructural, els abundants fibroblasts presents en el teixit cardíac comencen a diferenciar-se en miofibroblasts, els quals s'encarreguen de mantenir l'estructura de la matriu extracel·lular dipositant-hi col·lagen. A més, la senyalització paracrina dels miofibroblasts amb els miòcits circumdants també afectarà els canals iònics. Es van utilitzar models computacionals molt detallats a diferents escales per estudiar la remodelació estructural induïda a nivell tissular i cel·lular. Es va fer una adaptació a nivell cel·lular d'un model de fibroblasts humans per reproduir-hi l'electrofisiologia dels miofibroblasts durant la fibril·lació auricular. A més, l'exploració de la interacció del calci amb l'electrofisiologia dels miofibroblasts va ser avaluada mitjançant l'adequació del canal de calci a les dades experimentals. A nivell tissular es va estudiar la infiltració de miofibroblasts per tal de quantificar l'augment de vulnerabilitat que això conferia per patir una arrítmia cardíaca. Els miofibroblasts canvien la dinàmica de la reentrada, i presentar-ne una baixa densitat permet la propagació a través de la zona fibròtica, tot creant punts de sortida d'activitat focal i trencaments d'ones dins d'aquesta àrea. A més, les composicions de fibrosi tenen un paper clau en l'alteració del patró de propagació, afectant els electrogrames recollits en la superfície del teixit. La morfologia dels electrogrames es va veure alterada en funció de la disposició i la composició del teixit fibròtic. Per comprendre els senyals clínicament registrats es van combinar models detallats de teixits cardíacs amb models realistes dels catèters de cartografia disponibles comercialment. Es va generar un model de soroll a partir de senyals clínics per reproduir-hi els artefactes de senyal. Es van utilitzar electrogrames de models de bidominis molt detallats per entrenar un algoritme d'aprenentatge automàtic destinat a caracteritzar el substrat fibròtic auricular. Les característiques que quantifiquen la complexitat dels senyals van ser extretes per identificar la densitat i transmuralitat fibròtica. Posteriorment, es van generar mapes de fibrosi mitjançant la gravació del pacient com a prova de concepte. El mapa de fibrosi proporciona informació sobre el substrat fibròtic sense utilitzar un sol valor de tensió de tall de 0,5 mV. A més, utilitzant la mesura del flux d'informació com l'entropia de transferència combinada amb gràfics dirigits, en aquest estudi es va fer un seguiment de la direcció de propagació de l'ona. L'entropia de transferència amb gràfics dirigits proporciona informació crucial durant l'electrofisiologia per entendre la dinàmica de propagació d'ones durant la fibril·lació auricular. En conclusió, aquesta tesi presenta un estudi multi-escala in silico que proporciona informació sobre els mediadors cel·lulars responsables de la remodelació de la matriu extracel·lular i la seva electrofisiologia. A més, proporciona una configuració realista per crear dades in silico que es poden traduir a aplicacions clíniques que puguen donar suport al tractament de l'ablació. / [EN] Atrial fibrillation is the most common cardiac arrhythmia. During atrial fibrillation, the atrial substrate undergoes a series of electrical and structural remodeling. The electrical remodeling is characterized by the alteration of specific ionic channels, which changes the morphology of the transmembrane voltage known as action potential. Structural remodeling is a complex process involving the interaction of several signalling pathways, cellular interaction, and changes in the extracellular matrix. During structural remodeling, fibroblasts, abundant in the cardiac tissue, start to differentiate into myofibroblasts, which are responsible for maintaining the extracellular matrix structure by depositing collagen. Additionally, myofibroblasts paracrine signalling with surrounding myocytes will also affect ionic channels. Highly detailed computational models at different scales were used to study the effect of structural remodeling induced at the cellular and tissue levels.At the cellular level, a human fibroblast model was adapted to reproduce the myofibroblast electrophsyiology during atrial fibrillation. Additionally, the calcium handling in myofibroblast electrophysiology was assessed by fitting calcium ion channel to experimental data. At the tissue level, myofibroblasts infiltration was studied to quantify the increase of vulnerability to cardiac arrhythmia. Myofibroblasts alter the dynamics of reentry. A low density of myofibroblasts allows the propagation through the fibrotic area and creates focal activity exit points and wave breaks inside this area. Moreover, fibrosis composition plays a key role in the alteration of the propagation pattern. The alteration of the propagation pattern affects the electrograms computed at the surface of the tissue. Electrogram morphology was altered depending on the arrangement and composition of the fibrotic tissue. Detailed cardiac tissue models were combined with realistic models of the commercially available mapping catheters to understand the clinically recorded signals. A noise model from clinical signals was generated to reproduce the signal artifacts in the model. Electrograms from highly detailed bidomain models were used to train a machine learning algorithm to characterize the atrial fibrotic substrate. Features that quantify the complexity of the signals were extracted to identify fibrotic density and fibrotic transmurality. Subsequently, fibrosis maps were generated using patient recordings as a proof of concept. Fibrosis map provides information about the fibrotic substrate without using a single cut-off voltage value of 0.5 mV. Furthermore, in this study, using information theory measurements such as transfer entropy combined with directed graphs, the wave propagation direction was tracked. Transfer entropy with directed graphs provides crucial information during electrophysiology to understand wave propagation dynamics during atrial fibrillation. In conclusion, this thesis presents a multiscale in silico study atrial fibrillation mechanisms providing insight into the cellular mediators responsible for the extracellular matrix remodeling and its electrophysiology. Additionally, it provides a realistic setup to create in silico data that can be translated to clinical applications that could support ablation treatment. / Sánchez Arciniegas, JP. (2021). A Multiscale in Silico Study to Characterize the Atrial Electrical Activity of Patients With Atrial Fibrillation. A Translational Study to Guide Ablation Therapy [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/171456 / TESIS

Il a été suggéré que l’autophagie pouvait participer au processus fibrotique en favorisant la différenciation du fibroblaste en myofibroblaste. La sénescence cellulaire a aussi été montrée comme impliquée dans la réparation tissulaire et la fibrose. Des liens ont été établis entre autophagie et sénescence. Cette étude a pour but d’investiguer les liens possibles entre autophagie, sénescence et différenciation myofibroblastique afin de mieux comprendre les mécanismes moléculaires régulant la réparation tissulaire et la fibrose. Les fibroblastes carencés en sérum pendant quatre jours montrent des ratios LC3B-II/-I élevés et des niveaux de SQSTM1/p62 diminués. L’augmentation de l’autophagie est accompagnée d’une augmentation de l’expression des marqueurs de différenciation myofibroblastique ACTA2/αSMA et collagènes de type 1 et 3 et de la formation de fibres de stress. Les fibroblastes autophagiques expriment les marqueurs de sénescence CDKN1A (p21) et p16INK4a (p16) et montrent une augmentation de l’activité beta-galactosidase associée à la sénescence. L’inhibition de l’autophagie à l’aide de différents inhibiteurs de phosphoinositide 3-kinase de classe I et de phosphatidylinositol 3-kinase de classe III (PtdIns3K) ou par inhibition génique à l’aide d’ARN interférant ATG7 bloquent l’expression des marqueurs de différenciation et de sénescence. L’expression et la sécrétion de CTGF (connective tissue growth factor) sont augmentées chez les fibroblastes autophagiques. L’inhibition de l’expression du CTGF par interférence génique prévient la différenciation myofibroblastique, démontrant l’importance de ce facteur pro-fibrotique pour la différenciation induite par l’autophagie. La phosphorylation de la kinase RPS6KB1/p70S6K, cible du complexe MTORC1, est abolie dans les fibroblastes autophagiques. La phosphorylation d’AKT à la Ser473, une cible du complexe MTORC2, diminue lors de la carence en sérum des fibroblastes mais est suivie d’une rephosphorylation après 2 jours. Ce résultat suggère la réactivation de MTORC2 lors d’une autophagie prolongée. Ceci a été vérifié par inhibition de l’autophagie dans les fibroblastes carencés en sérum. Les inhibiteurs de PtdIns3K et le siRNA ATG7 bloquent la rephosphorylation d’AKT. L’inhibition de la réactivation de MTORC2, et donc de la rephosphorylation d’AKT, est aussi obtenue par exposition des fibroblastes à la rapamycine, le Torin 1 ou par inhibition génique de RICTOR. Ces traitements inhibent l’augmentation de l’expression du CTGF ainsi que des marqueurs de différenciation et de sénescence, démontrant le rôle central joué par MTORC2 dans ces processus. Le stress oxydant peut induire la sénescence et la carence en sérum est connue pour augmenter la quantité de ROS (reactive oxygen species) dans les cellules. Afin d’investiguer le rôle des ROS dans la différenciation et la sénescence induites par l’autophagie, nous avons incubés les fibroblastes carencés en sérum en présence de N-acetyl-L-cysteine (NAC). Le NAC diminue la production de ROS, diminue les marqueurs d’autophagie, de sénescence et de différenciation myofibroblastique. Le NAC inhibe aussi la phosphorylation d’AKT Ser473. L’ensemble de ces résultats identifient les ROS en association avec une autophagie prolongée comme des nouveaux activateurs du complexe MTORC2. MTORC2 est central pour l’activation subséquente de la sénescence et de la différenciation myofibroblastique. / Recent evidence suggests that autophagy may favor fibrosis through enhanced differentiation of fibroblasts in myofibroblasts. Cellular senescence is also involved in tissue repair and fibrosis. Autophagy has been linked with senescence. This study focuses on understanding the molecular mechanisms linking autophagy, senescence and myofibroblast differentiation and the roles they could play in wound healing and fibrosis. Fibroblasts, serum starved for up to 4 days, showed increased LC3B-II/-I ratios and decreased SQSTM1/p62 levels. Autophagy was associated with acquisition of markers of myofibroblast differentiation including increased protein levels of ACTA2/αSMA (actin, α 2, smooth muscle, aorta), enhanced gene and protein levels of COL1A1 (collagen, type I, α 1) and COL3A1, and the formation of stress fibers. Autophagic fibroblasts showed expression of the senescence markers CDKN1A (p21) and p16INK4a (p16) and also exhibit increase in Senescence Associated-beta-galactosidase activity. Inhibiting autophagy with different class I phosphoinositide 3-kinase and class III phosphatidylinositol 3-kinase (PtdIns3K) inhibitors or through ATG7 silencing prevented myofibroblast differentiation and senescence markers expression. Autophagic fibroblasts showed increased expression and secretion of CTGF (connective tissue growth factor), and CTGF silencing prevented myofibroblast differentiation. Phosphorylation of the MTORC1 target RPS6KB1/p70S6K kinase was abolished in starved fibroblasts. Phosphorylation of AKT at Ser473, a MTORC2 target, was reduced after initiation of starvation but was followed by spontaneous rephosphorylation after 2 d of starvation, suggesting the reactivation of MTORC2 with sustained autophagy. Importantly, inhibition of autophagy with PtdIns3K inhibitors or ATG7 silencing blocked AKT rephosphorylation. Inhibiting MTORC2 activation with long-term exposure to rapamycin, Torin 1 or by silencing RICTOR, a central component of the MTORC2 complex, abolished AKT rephosphorylation. RICTOR silencing, Torin 1 and rapamycin treatments prevented CTGF and ACTA2 upregulation and induction of senescence markers demonstrating the central role of MTORC2 activation in CTGF and senescence induction for myofibroblast differentiation. Since oxidative stress is a known inducer of senescence, we investigated the role of reactive oxygen species (ROS) in autophagy-induced myofibroblast differentiation and senescence markers induction. Exposing fibroblasts to N-acetyl-L-cysteine (NAC) decreased production of ROS during serum starvation, inhibited autophagy and significantly decreased the expression of senescence and myofibroblast differentiation markers. NAC also inhibited the phosphorylation of AKT Ser473, establishing the importance of ROS in fuelling MTORC2 activation. Collectively, these results identify ROS production in association with sustained autophagy as novel inducers of MTORC2 signaling which in turn concomitantly activate senescence and myofibroblast differentiation.

Globally, cancer is one of the leading causes of mortality, with an estimated 18.1 million cancer cases, 10 million deaths, and 1.9 million new cases diagnosed in 2020 (Sung et al., 2021). However, during the past several decades, cancer survival has improved such that 82% of children and >2/3 of adults diagnosed with cancer will survive beyond five years (World Health Organization (WHO) - Childhood Cancer, 2021). Skeletal muscle atrophy and fibrosis are long-term adverse effects experienced by 80% of cancer survivors for which there is no available therapy (Paulino, 2004). These long-term consequences are related to the toxicity from the cancer treatment, leading to alterations in skeletal muscle function which can lead to comorbidities and increased mortality among cancer survivors (Paulino, 2004; Williams et al., 2016). Thus, novel approaches to address the long-term effects of cancer therapy on skeletal muscle are critically needed. Exercise training is a potential non-pharmacological strategy that improves common cancer- and treatment-related side effects (Mustian et al., 2012). Specifically, exercise programs that combine resistance and endurance training (RET) have been shown to improve muscle strength and cardiovascular fitness in cancer survivors (Tong et al., 2020). The mechanisms responsible for these effects remain unknown. The remarkable plasticity of skeletal muscle relies primarily on muscle stem (satellite) cells (MuSCs) (Lepper et al., 2011) that are regulated, in part, by muscle-resident stromal cells (Bentzinger et al., 2013). These different stromal cell types, including: vascular endothelial cells (ECs), immune cells, and mesenchymal progenitors, also known as fibro-adipogenic progenitors (FAPs), create the muscle stem cell niche (Yin et al., 2013). FAPs possess a dual role as they are involved in skeletal muscle maintenance and regeneration by secreting pro-myogenic trophic factors (Biferali et al., 2019; Joe et al., 2010; Uezumi et al., 2010; Wosczyna et al., 2019), but also contribute to fibrotic and fatty tissue accumulation in chronic degenerative conditions (Uezumi et al., 2010). The divergent features of FAPs highly depend on signals they receive from their microenvironment (Giuliani et al., 2021); however, FAP's contribution to cancer treatment-induced muscle pathology in cancer survivors remains unknown. The overall objective of this thesis is to begin to develop an understanding of the role of FAPs in cancer treatment-induced muscle pathology and to determine if RET represents an effective therapy to prevent the long-term muscle defects of juvenile cancer plus therapy.