Selective Serotonin Reuptake Inhibitors (SSRIs) are the most frequently prescribed class of drugs worldwide and are implemented in the treatment of depression and other psychiatric disorders. SSRIs relieve depressive symptoms by modulating levels of the neurotransmitter serotonin in the brain. SSRIs block the function of the serotonin transporter, thereby increasing concentrations of extracellular serotonin. However, serotonin levels in the neurons of the brain only account for 5% while the remaining 95% is present outside the brain. Serotonin receptors and transporter are located on bone resident cells (mesenchymal stem cells (MSCs)), osteoblasts and osteoclasts, and serotonergic activity is believed to affect bone homeostasis. Consequently, alterations in serotonin levels by SSRI treatment have the potential to alter bone formation and remodeling. Clinical reports correlate increase risk of bone fractures and delayed bone healing with SSRI use. Metallic implants are commonly used as orthopedic and dental implants to fix bony defects. Surface modifications have been used to increase the level of bone to implant contact by controlling the differentiation of MSCs into an osteoblastic linage and facilitate bone production. However, it is not known if SSRIs can affect MSCs osteoblastic differentiation and bone remodeling signaling in response to microstructured biomaterials. The aims of this study were: 1) Investigate the effects of SSRIs on MSCs differentiation on microstructured titanium (Ti), 2) Determine the effects of SSRIs on bone remodeling signaling and osteoclast activation, and 3) Elucidate the effects of SSRIs on serotonin receptors and their effect on bone remodeling. To investigate this, human MSCs were grown on tissue culture polystyrene (TCPS), smooth Ti (PT) or microstructured Ti (SLA) surfaces under exposure to therapeutic concentrations of commonly prescribed antidepressants (SSRIs (fluoxetine, sertraline, paroxetine), Selective Norepinephrine Reuptake Inhibitor (SNRI) (duloxetine) and other regularly prescribed antidepressants (bupropion)) during differentiation toward osteoblasts. Osteoblastic differentiation was assessed in MSCs after treatment with the drugs (0.1μM, 1μM, 10μM) by alkaline phosphatase activity and osteocalcin levels. Antidepressant treatment decreased levels of MSC differentiation markers on microstructured Ti surfaces. Furthermore, treatment dose-dependently decreased protein levels secreted by MSCs which are important for bone formation (BMP2, VEGF, Osteoprotegerin), and increased those involved in bone resorption (RANKL). To determine the effect of SSRIs on bone remodeling signaling and osteoclast activation, human osteoclasts were either directly exposed to antidepressants or conditioned media obtained from MSCs treated with antidepressants on Ti surfaces, after which, enzymatic tartrate-resistant acid phosphatase (TRAP) activity was assessed. Antidepressants increased TRAP activity both directly and through treated MSCs, with the highest levels evident after treatment with conditioned media from MSCs on microstructured Ti surfaces. To elucidate the effects of serotonin receptors and their effect on bone remodeling, receptors were pharmacologically inhibited. Surface roughness decreased gene expression of HTR2A, HTR1B, and HTR2B, and antidepressant treatment increased their expression. Inhibition of HTR2A decreased RANKL protein levels, while inhibition of other serotonin receptors had no effect on RANKL or OPG levels. These studies suggest that antidepressants inhibit MSCs differentiation on microstructured Ti surfaces and increase levels of proteins associated with bone resorption. Additionally, our results showed that RANKL is regulated by serotonin receptor HTR2A. Taken together, our results suggest that antidepressants have a negative effect on osteoblastic differentiation, compromising bone formation and enhancing bone resorption, which can be detrimental to patients under orthopedic and dental treatment.

Evidências sugerem interação entre o hormônio tireoideano (T3) e os fatores de crescimento fibroblásticos (FGF) no desenvolvimento esquelético. Para estudarmos essa interação, avaliamos o efeito do T3 e do seu antagonista NH3 em células mesenquimais periósticas humanas de pacientes normais e portadores da Síndrome de Apert (SA), que é caracterizada por craniossinostose e causada por mutações no receptor de FGF tipo 2 (FGFR2). Nas células SA, o T3 aumentou o número de células e o NH3 bloqueou esse efeito do T3. O T3 e/ou NH3 aumentaram a atividade da fosfatase alcalina durante a diferenciação osteoblástica das células normais, mas não das mutadas. O T3 aumentou a diferenciação osteoblástica e o NH3 bloqueou esse efeito do T3 em células normais. Nas células mutadas, o NH3 limitou a diferenciação osteoblástica, enquanto o T3 não teve efeito. Concluímos que as células mesenquimais periósticas humanas normais e SA são responsivas ao T3 e NH3, e que o T3 e FGF podem atuar através de vias de sinalização comuns na regulação da diferenciação osteoblástica. / Evidence suggests that there is an interaction between the thyroid hormone (T3) and fibroblast growth factors (FGFs) in the skeletal development. To study this interaction, we evaluated the effect of T3 and its antagonist, NH3, in human periosteal mesenchymal cells from normal and Apert Syndrome (AS) patients, which is characterized by craniosynostosis and is caused by mutations in FGF receptor type 2 (FGFR2). In AS cells, the T3 increased the number of cells and NH3 blocked this effect of T3. T3 and/or NH3 increased the alkaline phosphatase activity in osteoblast differentiation of normal cells, but not in the mutated cells. T3 increased osteoblast differentiation and NH3 blocked this effect of T3 on normal cells. In the mutated cells, NH3 limited osteoblast differentiation while T3 had no effect. We concluded that normal and AS human periosteal mesenchymal cells are responsive to T3 and NH3, and T3 and FGF may act through common signaling pathways in the regulation of osteoblastic differentiation.

Evidências sugerem interação entre o hormônio tireoideano (T3) e os fatores de crescimento fibroblásticos (FGF) no desenvolvimento esquelético. Para estudarmos essa interação, avaliamos o efeito do T3 e do seu antagonista NH3 em células mesenquimais periósticas humanas de pacientes normais e portadores da Síndrome de Apert (SA), que é caracterizada por craniossinostose e causada por mutações no receptor de FGF tipo 2 (FGFR2). Nas células SA, o T3 aumentou o número de células e o NH3 bloqueou esse efeito do T3. O T3 e/ou NH3 aumentaram a atividade da fosfatase alcalina durante a diferenciação osteoblástica das células normais, mas não das mutadas. O T3 aumentou a diferenciação osteoblástica e o NH3 bloqueou esse efeito do T3 em células normais. Nas células mutadas, o NH3 limitou a diferenciação osteoblástica, enquanto o T3 não teve efeito. Concluímos que as células mesenquimais periósticas humanas normais e SA são responsivas ao T3 e NH3, e que o T3 e FGF podem atuar através de vias de sinalização comuns na regulação da diferenciação osteoblástica. / Evidence suggests that there is an interaction between the thyroid hormone (T3) and fibroblast growth factors (FGFs) in the skeletal development. To study this interaction, we evaluated the effect of T3 and its antagonist, NH3, in human periosteal mesenchymal cells from normal and Apert Syndrome (AS) patients, which is characterized by craniosynostosis and is caused by mutations in FGF receptor type 2 (FGFR2). In AS cells, the T3 increased the number of cells and NH3 blocked this effect of T3. T3 and/or NH3 increased the alkaline phosphatase activity in osteoblast differentiation of normal cells, but not in the mutated cells. T3 increased osteoblast differentiation and NH3 blocked this effect of T3 on normal cells. In the mutated cells, NH3 limited osteoblast differentiation while T3 had no effect. We concluded that normal and AS human periosteal mesenchymal cells are responsive to T3 and NH3, and T3 and FGF may act through common signaling pathways in the regulation of osteoblastic differentiation.

L’ingénierie du tissu osseux est un domaine qui représente un enjeu majeur dans le cadre de la médecine régénératrice. Trois composants sont généralement décrits dans le cadre de l’ingénierie tissulaire : un biomatériau pour pallier le volume de tissu défectueux, une source de cellules progénitrices qui seront responsables de la synthèse des composants tissulaires ainsi que des facteurs de croissance ou des signaux issus des propriétés physico-chimiques du biomatériau afin de guider la prolifération et la différenciation cellulaire. Le but de cette étude a été de synthétiser des substrats phospho-calciques à l’aide de la technique de pulvérisation simultanée d’espèces réactives et de caractériser les différentes propriétés physico-chimiques des substrats obtenus. Nous avons pu démontrer la possibilité d’inclure des molécules organiques (chitosane et acide hyaluronique) à la phase minérale avec cette technique. Nous avons aussi montré la possibilité de faire varier des propriétés telles la rugosité (entre 300 et 700 nm), l’élasticité (entre 2 à 6 GPa), la composition chimique (phosphate octacalcique ou phosphate dicalcique dihydraté) et la bioactivité (précipitation des phosphates de calcium à la surface des substrats) avec la technique de pulvérisation. Par ailleurs, des cellules souches issues de la gelée de Wharton de cordons ombilicaux humains ont été isolées, puis caractérisées sur le plan génique et protéique. Ces cellules étant candidates pour l’utilisation en ingénierie tissulaire osseuse, nous nous sommes intéressés à plusieurs types de marqueurs dont les marqueurs mésenchymateux et les cytokines immuno-modulatrices.La dernière partie de cette thèse a concerné l’association des cellules souches isolées à partir de la gelée de Wharton aux substrats phospho-calciques obtenus à l’aide de la technique de pulvérisation. Nous avons pu démontrer que les cellules adhéraient sur ces substrats et s’organisaient en structures nodulaires au sein desquelles a été observée une couche de cellules sécrétrices entourant des fibres de collagène, des formations cristallines faîtes de phosphates de calcium et des cellules dont la morphologie rappelait celle des ostéocytes. Des variations dans l’expression de marqueurs ostéoblastiques ont aussi été observées, et ce en l’absence de facteurs solubles ostéogéniques dans le milieu de culture. En conclusion, les substrats phospho-calciques obtenus avec la technique de pulvérisation sont capables d’induire la différenciation de cellules souches issues du cordon ombilical en ostéoblastes. Ce modèle se révèle être prometteur pour la mise en place de thérapies en vue de la régénération du tissu osseux. / Bone tissue engineering is a major issue within regenerative medicine. There are three main components in the field of tissue engineering: a scaffold providing a structure for tissue development, a source of stem cells for tissue formation and growth factors or physical stimuli from the biomaterial to direct growth and differentiation of cells. The purpose of this study was to synthesize calcium phosphate substrates by simultaneous spraying of interacting species and to carry out the physico-chemical characterization of the built substrates. We showed that the spraying technique allows the inclusion of organic molecules such as chitosan and hyaluronic acid. The spraying technique allows several physio-chemical characteristics to be varied, rugosity (300 – 700 nm), elasticity (2 – 6 GPa), chemical composition (octacalcium phosphate or dicalcium phosphate dehydrate), but also studied the bioactivity of the substrates (calcium phosphate from the culture medium precipitates at thesurface of the substrates). In another hand, our aim was to isolate stem cells from human umbilical cords’ Wharton’s Jelly and to carry out their genic and proteic characterization by focusing on mesenchymal markers and immunomodulating cytokines, knowing that these cells are candidates for a use in bone regeneration therapy.The last purpose of our study was to evaluate the potential of Wharton’s jelly stem cells to adhere and proliferate onto the sprayed substrates, and also the formation of nodules. The ultrastructural analysis of nodules formed by Wharton’s jelly stem cells showed a layer of secretory cells surrounding collagen fibers, calcium phosphate crystals and cells with a similar morphology to that of osteocytes. Osteoblastic markers appeared to be regulated in cells cultured without osteogenic supplements. To conclude, sprayed calcium phosphate substrates seem to induce osteoblastic differentiation of Wharton’s jelly stem cells through the substrate’s physico-chemical properties. Our model appears as promising for further bone regenerative therapies.

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

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