Zu den bekannten Risikofaktoren der altersbedingten Makuladegeneration (AMD), häufigste Erblindungsursache des Erwachsenen in den Industrienationen, gehören unter anderem die arterielle Hypertonie und/ oder eine hohe Kochsalzzufuhr, Zustände, die mit Gewebehypoxie und Hyperosmolarität einhergehen können. Die vorgelegte Arbeit beschäftigt sich mit der wichtigen Aufklärung von Veränderungen des neuroprotektiven Osteopontins (OPN) in humanen retinalen Pigmentepithelzellen (RPE-Zellen) durch unterschiedliche pathogene Faktoren. Osteopontin erbringt wichtige supportive Leistungen für die Photorezeptoren der Netzhaut, so die Bereitstellung von Nährstoffen und die Regeneration des Sehpigments. Sowohl unter hypoxischen- wie auch unter hyperosmolaren Versuchsbedingungen kam es zu einer gesteigerten OPN-Genexpression, wobei je nach Art des Stimulus, unterschiedliche Signaltransduktionswege engagiert wurden. Es konnten viele positive Einflüsse von Osteopontin auf RPE- Zellen und Photozeptoren gezeigt werden, die neue Therapiemöglichkeiten unter Einschluss protektiv wirkender Osteopontin-Peptide nahelegen.:Inhaltsverzeichnis Abkürzungsverzeichnis 1 Einführung 1.1 Das retinale Pigmentepithel 1.2 Degenerative Erkrankungen der Netzhaut 1.2.1 Die altersbedingte Makuladegeneration 1.2.2 Risikofaktoren 1.2.3 Die Frühstadien der AMD 1.2.4 Die atrophe AMD 1.2.5 Die exsudative AMD 1.2.6 Therapie der AMD 1.3 Angiogener Wachstumsfaktor VEGF 1.4 Neuroprotektive Faktoren 1.4.1 GDNF 1.4.2 bFGF 1.4.3 Osteopontin (OPN) 2 Fragestellung 3 Material und Methoden 3.1 Arbeitsmaterialien 3.1.1 Substanzen 3.1.2 Pharmakologische Inhibitoren 3.1.3 Geräte und Materialien 3.1.4 Zellkulturmedien 3.1.5 Kits 3.1.6 Rekombinante Proteine 3.1.7 Primer für die PCR 3.2 Zellbiologische Methoden 3.2.1 Zellkultivierung 3.2.2 Zellstimulation 3.2.3 Transfektion mit siRNA 3.2.4 RNA Extraktion 3.2.5 Quantifizierung der RNA Menge 3.2.6 cDNA-Synthese 3.2.7 Real-Time-Polymerasekettenreaktion 3.2.8 Agarose-Gelelektrophorese 3.2.9 ELISA 3.2.10 Statistik 4 Ergebnisse 4.1 Expression des Osteopontin-Gens bei humanen RPE-Zellen 4.2 Regulation der Osteopontin-Gen- und Proteinexpression 4.3 OPN-Genexpression - Beteiligung intrazellulärer Signalwege 4.3.1 Regulation der hyperosmolaren Genexpression von Osteopontin 4.3.2 Regulation der hypoxischen Genexpression von Osteopontin 4.4 Rolle des extrazellulären Signalings bei hyperosmolarer und hypoxischer OPN-Genexpression 4.4.1 Wachstumsfaktor-Rezeptoren 4.4.2 Purinerge Rezeptoren 4.5 Funktion der Transkriptionsfaktoraktivität 4.5 Wirkung von Osteopontin auf die Expression und Sekretion angiogener Faktoren bei RPE-Zellen 5 Diskussion 6 Zusammenfassung 7 Literaturverzeichnis 8 Abbildungsverzeichnis 9 Tabellenverzeichnis 10 Selbstständigkeitserklärung 11 Anlagen (Lebenslauf, Danksagung, Nachweis der Teilnahme an der Vorlesung 'Gute Wissenschaftliche Praxis“)

La scoliose est la déformation de la colonne vertébrale la plus répandue. Elle atteint 3 à 4% de la population pédiatrique et dans 85% des cas, aucune cause n’a été identifiée. Ces cas sont appelés idiopathiques et les symptômes apparaissent durant la puberté; d’où le terme de ‘scoliose idiopathique de l’adolescent (SIA). Cette pathologie atteint le plus souvent les jeunes filles, en nombre et en sévérité. Ces dernières années, plusieurs hypothèses ont été proposées afin d’élucider l’étiologie de cette pathologie. Celles-ci ont mis de l’avant différents facteurs génétiques, biochimiques, mécaniques, neurologiques, musculaires ou hormonaux. Plusieurs études ont rapporté des formes familiales de scoliose, soutenant la thèse d’une prédisposition génétique. Nous avons démontré que les patients souffrant de SIA présentent un défaut de signalisation cellulaire médiée par les protéines Gi et un taux élevé d’ostéopontine (OPN) circulante. En utilisant une approche de type ‘gène candidat’, nous avons montré que la protéine tyrosine phosphatase μ (PTPμ) régule l’activité du complexe d’intégrines α5/β1 (récepteur de l’OPN) via la protéine kinase PIPKIγ. Dans ce but, nous avons utilisé des cultures primaires d’ostéoblastes issues de biopsies de patients et de cas traumatiques comme sujets contrôles. Les biopsies osseuses de patients ont été obtenues lors de l’intervention chirurgicale à partir des vertèbres T3 à L4, selon les différentes procédures. Les biopsies issues de cas traumatiques proviennent d’autres types d’os (tibia, crête iliaque, fémur). Les profils d’expression du gène PTPRM (codant pour la protéine PTPμ) ont été étudiés par PCR quantitative (qPCR). Les taux de protéines PTPμ ont été analysés par immunoprécipitation suivi d’un western blot. Pour évaluer le rôle de cette protéine, nous avons bénéficié d’un modèle murin. Machida et al. ont démontré qu’il existe un taux plus élevé de scoliose parmi les souris C57Bl/6 bipèdes obtenues suite à l’amputation des membres supérieurs, sous anesthésie, cinq semaines après la naissance. Nous avons utilisé des cultures primaires d’ostéoblastes issues de la colonne ii vertébrale de souris C57Bl/6 bipèdes, délétées du gène PTPRM (souris dites ‘KO’), afin d’évaluer le niveau de signalisation cellulaire spécifique des protéines Gi par un test fonctionnel: la technique de spectroscopie cellulaire di-électrique (SCD). Selon nos données, 85% des souris bipédales ‘KO’ pour le géne PTPRM développent une scoliose (modérée à sévère) contre 55% des souris contrôles C57Bl6 bipèdes. De plus, les niveaux de PTPμ exprimée par les ostéoblastes de 34 patients SIA se trouvent diminués par comparaison à 17 sujets contrôles. Nos études de souris bipèdes ont montré que l’inactivation du gène PTPRM augmente l’incidence et la sévérité de la scoliose, sans pour autant affecter les taux circulant d’OPN ou l’expression de ses récepteurs. Par ailleurs, dans ce même contexte, nous avons remarqué une augmentation de l’interaction entre l’OPN et l’intégrine β1 en l’absence du gène PTPRM. Les cellules issues de ces souris bipèdes KO montrent une réduction dans leurs niveaux de signalisation cellulaire médiée par les protéines Gi après stimulation par l’OPN. Cette diminution est en grande partie récupérée après traitement des cellules par un siRNA spécifique de la protéine PIPK1γ, substrat de PTPμ qui favorise la fixation de ligands aux intégrines. Ces études apportent les premières indications que la perte d’expression de PTPμ est impliquée dans le développement de la SIA, en amplifiant probablement l’effet inhibiteur de l’OPN sur la signalisation cellulaire médiée par les protéines Gi. Ces études permettent une meilleure compréhension de l’étiologie de la SIA. Elles pourraient avoir une contribution importante dans le développement futur de méthodes diagnostique et thérapeuthique dans le but d'arrete l’apparition et l’évolution de la maladie chez les enfants atteints. / Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis that affects 3-4% of the global pediatric population. In more than 85% of cases, no specific cause can be identified. Such cases are called idiopathic and occur mostly during adolescence. AIS affects mainly females in number and severity. Over the past years, many hypotheses were proposed to explain the etiology of AIS, including genetic, biochemical, mechanics, neurological, muscular and hormonal factors. Several studies have reported a high incidence of scoliosis in some families, which argues for a genetic cause of this disease. We demonstrated that AIS patients have a Gi protein signaling defect and exhibit high levels of circulating Osteopontin (OPN). The goal of this thesis is to identify the mechanisms regulating OPN signaling activity in AIS patients. We have used a candidate gene driven approach and discovered that protein tyrosine phosphatase μ (PTP μ) regulates α5β1 integrin (a known OPN receptor) through phosphate kinase type 1 gamma (PIPK1γ). To achieve our goal, we have used primary osteoblast cell cultures derived from AIS patients and biopsies from control subjects. Bone specimens were obtained intraoperatively from vertebras (varying from T3 to L4 according to the surgical procedure performed) while with trauma cases used as non-scoliotic controls, bone specimens were obtained from other anatomical sites (tibia, femur or iliac crest). Expression profiles of the RPTPM gene (encoding for PTPμ) were studied by qPCR. On the other hand, PTPμ protein levels were determined by immunoprecipitation followed by western blot. To evaluate the role of this protein in AIS etiopathogenesis, we took advantage of an animal model exhibiting a higher scoliosis incidence when maintained in a bipedal state. [1], [2] Bipedal surgeries were performed on C57Bl/6 mice after weaning (5-weeks after birth) by amputation of the forelimbs and tail under anesthesia as reported by Oyama et al. (2006). [1] We used the same approach with PTPμ knockout mice and primary osteoblast culture were derived from the spine of these mice to assess Gi protein signaling through a functional assay termed Cellular Dielectric Spectroscopy (CDS). Bipedal PTPμ knockout mice develop scoliosis more often (85%) in number and severity, than control C57Bl/6 bipedal mice (55%). Interestingly, functional analysis of osteoblasts derived from PTPμ KO mice by CDS method showed a flaw in the transmission of Gi protein coupled receptor signaling similar to a specific AIS patient subgroup. Furthermore, the clinical relevance of PTPμ was strengthened by the fact that a decrease in the gene expression level of PTPμ was observed in 34 AIS patients when compared to 17 control subjects. Such a decrease was also confirmed at the protein level. We demonstrated that genetic deletion of PTPμ enhances the incidence and severity of scoliosis without affecting plasma levels of OPN or the expression of its receptors. In contrast, increased interaction of OPN with β1 integrin was noticed in cells depleted of PTPμ. Furthermore, reduction of Gi- protein coupled receptor GiPCR signaling by OPN was also enhanced in these cells, while their response to GiPCR stimulation was improved with siRNA of phosphatidylinositol-phosphate kinase type 1 gamma (PIPK1γ), a PTPμ substrate that favours ligand binding to integrins. These studies provide the first indication that the loss of PTPμ influences the nature of idiopathic scoliosis, possibly by amplifying the inhibitory effect of OPN on GiPCR signaling. This study allows a better understanding of AIS etiology and could have an impact for the future development of innovative diagnostic methods and eventual pharmacological approaches in order to prevent AIS and stop its progression in affected children.

Kang, Ning. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references. / Abstract also in Chinese. / Abstracts --- p.i / Abbreviations --- p.v / List of Figures and Tables --- p.vii / Contents --- p.viii / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1. --- Saphenous vein graft patency after coronary artery bypass grafting --- p.1 / Chapter 2. --- Mechanism of vein graft failure and therapeutic strategies --- p.8 / Chapter 2.1 --- Mechanism --- p.15 / Chapter 2.2 --- Therapeutic strategies --- p.18 / Chapter 3. --- Summary --- p.22 / Chapter 4. --- References --- p.23 / Chapter Chapter 2: --- Animal model and laboratory investigations --- p.34 / Chapter 1. --- Surgical procedure --- p.35 / Chapter 2. --- Postoperative management --- p.37 / Chapter 3. --- Adenoviral-mediated gene transfer ex vivo for gene therapy study --- p.38 / Chapter 4. --- Laboratory investigations --- p.39 / Chapter 5. --- Statistical analysis --- p.40 / Chapter 6. --- Summary --- p.41 / Chapter 7. --- References --- p.41 / Chapter Chapter 3: --- "Impact of osteopontin expression in vein grafts on VSMC migration, proliferation, and neointimal formation" --- p.42 / Chapter 1. --- Introduction --- p.42 / Chapter 2. --- Methods and materials --- p.43 / Chapter 3. --- Results --- p.43 / Chapter 4. --- Discussion --- p.49 / Chapter 5. --- Summary --- p.52 / Chapter 6. --- References --- p.53 / Chapter Chapter 4: --- Potential Role of gene therapy in prevention of vein graft failure --- p.56 / Chapter 1. --- Vectors --- p.56 / Chapter 2. --- "Reporter gene, timing and titer" --- p.57 / Chapter 3. --- Candidate genes --- p.58 / Chapter 4. --- Summary --- p.64 / Chapter 5. --- References --- p.66 / Chapter Chapter 5: --- Conclusions --- p.70 / Acknowledgements --- p.72

Protein analysis is important to understanding biological systems, but sample diversity necessitates a multitude of analysis techniques and methods. Challenges that are addressed include analysis of low abundance samples, fractionation to reduce sample complexity, and automation to reduce time and cost. Matrix assisted laser desorption/ionization mass spectrometry (MALDI-MS) is an important technique for protein characterization. In Paper I, the sensitivity of MALDI-MS was enhanced through the fabrication of a hydrophobic coating for the MALDI target plate, yielding analyte concentration. The plate outperformed a commercial concentration plate. Capillary electrophoresis (CE) separation offers low sample consumption and high efficiency, and in Paper II, offline CE-MALDI-MS fractionation was employed. A robot system for automation was constructed and used in analysis of spermatophore proteins from the butterfly Pieris napi. The robot was also used in automated on-target trypsin digestion under a lid of liquid fluorocarbons, a simpler and cheaper alternative to controlled humidity chambers. An indication of indigenous proteolysis of the sample was seen. Electrospray ionization (ESI) is the other technique for protein analysis in MS. In Paper III, the biomarker protein osteopontin (OPN) was analyzed by ESI-MS in order to find suitable conditions for its detection. A preliminary optimization of solvents and ionization conditions was done, and tandem MS (MSn) performed to increase the reliability of identification. / Proteinanalys är viktigt för att förstå biologiska system, men mångfalden av prov kräver en mängd olika analystekniker och metoder. Utmaningar som tas upp inkluderar analys av små provmängder, fraktionering för att minska provkomplexiteten, och automatisering för att minska tidsåtgång och kostnad. Matris-assisterad laserjoniserings-masspektrometri (MALDI-MS) är en viktig teknik för proteinkarakterisering. I Artikel I förbättrades känsligheten i MALDI-MS genom tillverkning av en hydrofob beläggning på MALDI-provplattan, vilket gav en koncentration av provet. Provplattan gav bättre resultat än en kommersiell koncentrationsprovplatta. Kapillärelektroforesseparation (CE) har låg provåtgång och hög separationseffektivitet och i Artikel II användes offline CE-MALDI-MS-fraktionering. Ett robotsystem för automatisering konstruerades och användes för analys av spermatoforproteiner från fjärilen Pieris napi. Roboten användes även i automatiserad trypsinklyvning under en yta av en flytande fluorkolförening, ett billigare alternativ tilli nkubationskammare med kontrollerad luftfuktighet. En indikation på naturlig enzymatisk proteinklyvning i provet hittades. Elektrospray jonisering (ESI) är den andra tekniken för proteinanalys i MS. I Artikel III analyserades biomarkören osteopontin (OPN) med ESI-MS för att hitta lämpliga förhållanden för dess detektion. En preliminär optimering av lösningsmedel och jonisationsförhållanden gjordes, och tandem-MS (MSn) utfördes för att öka identifikationens tillförlitlighet. / <p>Full text will not be uploaded due to unpublished results. QC 20181121</p>

Background Pancreatic ductal adenocarcinoma (PDAC) patients have the poorest 5-year survival rates of all cancer forms. It is difficult to diagnose at early disease stages, tumour relapse after surgery is common, and current chemotherapies are ineffective. Carbohydrate antigen 19-9 (Ca 19-9), the only clinically implemented PDAC biomarker, is insufficient for diagnostic and screening purposes. PDAC tumours are characterised by a voluminous stroma that is rich in extracellular matrix (ECM) molecules such as collagens, hyaluronan (HA) and matricellular proteins. These stromal components have been suggested to promote PDAC cell migration, proliferation, evasion of apoptosis and chemotherapy resistance. Those events are mediated via interactions with adhesion receptors, such as integrins and CD44 receptors expressed on cancer cell surfaces. Micro-RNAs (miRNA) post-transcriptionally regulate gene expression in health and disease. At the time of PDAC diagnosis, miRNA levels are altered both in plasma and tumour tissue. Before PDAC diagnosis, tissue miRNA levels are altered in precursor lesions, raising the possibility that plasma miRNAs might aid in early detection. In this thesis, it is hypothesised that stromal components and miRNAs can serve as tissue or blood based biomarkers in PDAC. The aims are: (1) to characterise the expression of stromal components and their receptors in normal and cancerous tissue; (2) to find potential stroma-associated tissue and blood-based biomarkers for diagnosis and prognosis estimates; (3) to determine the cellular effects of type IV collagen (Col IV) in PDAC; (4) to determine if plasma miRNAs that are altered in manifest PDAC can be used to diagnose PDAC earlier. Methods The expression patterns of Col IV, Col IV-binding integrin subunits (α1, α2, β1), Endostatin, Osteopontin (OPN) and Tenascin C (TNC) were analysed in frozen PDAC and normal pancreatic tissue. A tissue microarray (TMA) was constructed using formalin-fixed, paraffin-embedded primary tumours and lymph node metastases. The TMA was used to study the expression levels and associations with survival of the standard CD44 receptor (CD44s), its variant isoform 6 (CD44v6), HA, OPN and Col IV. Circulating levels of HA, Col IV, Endostatin, OPN and TNC were measured in PDAC patients and healthy individuals, and compared with conventional tumour markers (Ca 19-9, CEA, Ca 125 and TPS). The functional roles of Col IV were studied in PDAC cell lines by: (1) growth on different matrices (2) blocking Col IV binding integrin subunits, (3) blocking the Col IV domains 7s, CB3 and NC1, and (4) by down regulation of PDAC cell synthesis of Col IV using siRNA transfection. Plasma miRNAs alterations were screened for in samples from patients with manifest disease, using real-time quantitative PCR (RT-qPCR). To find early miRNA alterations, levels of those miRNAs that were altered at diagnosis were measured in prediagnostic plasma samples. Results High tissue expression of both the standard CD44 receptor (CD44s) and its variant isoform CD44v6 as well as low expression of stromal OPN were associated with poor survival. In addition, high CD44s and low OPN predicted poor survival independent of established prognostic factors. Circulating Col IV, Endostatin, OPN, TNC and HA were increased in preoperative samples from PDAC patients. Preoperatively, higher levels of serum-HA and plasma-Endostatin were associated with shorter survival. Postoperatively, higher levels of Col IV, Endostatin and OPN were associated with shorter survival. On the contrary, only one of the conventional tumour markers was associated with survival (Ca 125). Col IV stimulated PDAC cell proliferation and migration and inhibited apoptosis in vitro, dependent on the collagenous domain (CB3) of Col IV and the Col IV binding integrin subunit β1. Reduced endogenous Col IV synthesis inhibited these effects, suggesting that PDAC cells synthesise Col IV to stimulate tumour-promoting events via a newly discovered autocrine loop. 15 miRNAs were altered in early stage PDAC patients and the combination of these markers outperformed Ca 19-9 in discriminating patients from healthy individuals. However, none of the miRNAs were altered in prediagnostic samples, suggesting that plasma miRNA alterations appear late in the disease course. Conclusions Up regulated stromal components in PDAC tumours are detectable in blood samples and are potential diagnostic and prognostic biomarkers in PDAC. High circulating levels of Col IV, Endostatin, OPN and HA predict poor survival, as well as high expression of CD44s and CD44v6 and low expression of OPN in tumour tissue. PDAC cells synthesise Col IV, which forms BM-like structures close to cancer cells and promote tumour progression in vitro via an autocrine loop. Several plasma-miRNAs are altered in PDAC, but are not useful for early discovery.

O trabalho teve como objetivo avaliar e quantificar o tecido ósseo neoformado, a distribuição e a importância das proteínas não colágenas (osteocalcina, osteopontina e osteonectina) no processo de reparação tecidual do alvéolo dental de ratos Wistar idosos após exodontia. Para sua realização, foram utilizados 80 Rattus Norvegicus albinus, linhagem Wistar, machos. Os animais foram distribuídos em dois grupos: Grupo Controle, correspondente a animais com 60 dias de vida; e Grupo Experimental correspondente aos animais com 2 anos de vida (700 dias em média). Cada grupo foi dividido em 4 subgrupos de 10 animais em cada grupo. Os animais foram submetidos à exodontia do incisivo superior direito e foram sacrificados com 05, 15, 21 e 28 dias de pós-operatório. Após a dissecção, 5 amostras foram submetidas à análise por microscopia convencional com coloração por Hematoxilina e Eosina e análise da imunohistoquímica e 5 amostras para análise por RT-PCR. Os resultados mostraram que o processo de envelhecimento não alterou a cronologia do reparo ósseo alveolar e não promoveu maior remodelação do alvéolo dental. A osteocalcina não apresentou atuação importante nos períodos pós-operatórios estudados. A osteonectina apresentou-se importante no processo de reparo, não sofrendo alterações no início da reparação óssea, apresentando marcação mais intensa durante a maturação óssea entre 21 e 28 dias de pós-operatório no grupo controle e diminuição da marcação no grupo experimental aos 28 dias de pósoperatório. O envelhecimento proporcionou uma diminuição da imunomarcação da osteonectina e demonstrou marcações positivas principalmente em osteoblastos e matriz mineralizada. A osteopontina apresentou-se importante no processo de reparo ósseo durante todos os períodos pós-operatório, apresentando marcações em osteoblastos, matriz osteóide, osteócitos e matriz mineralizada, apresentando maior marcação dos tipos celulares do no grupo experimental aos 28 de pós-operatório. Apesar desses achados, novos estudos são necessários para o melhor entendimento do processo de reparo ósseo alveolar em ratos adultos e idosos. / The aim of the present study was to evaluate and quantify the newly formed bone tissue, as well as the distribution and the importance of non-collagen proteins (osteocalcin, osteopontin and osteonectin) in the process of dental alveolar repair in Wistar aged rats submitted to tooth extraction. To perform that, about 80 male Rattus Norvegicus albinus, Wistar strain, were randomly distributed into two groups: Control Group corresponding to 60 days old rats; and Experimental Group corresponding to 2 years old animals (about 700 days old). Both groups were later subdivided into 4 subgroups consisting of 10 animals each. All animals were submitted to the upright incisive tooth extraction and were euthanized 05, 15, 21 and 28 days after the tooth extraction surgery. After the dissection, five samples from each subgroup underwent conventional microscopy analysis by hematoxylin-eosin stain as well as immunohistochemistry. Bone tissue from other five samples of each groups were subjected to Real Time RT-PCR analysis of non-collagen proteins expression The results obtained suggest that aging process was not able to change either the chronology of alveolar bone repair or the remodeling of dental alveolus. Osteocalcin did not present any important action in the post-operation periods evaluated. On the other hand, osteonectin showed an important role during the repair process, since its expression was increased in the control group and decreased in comparison to the experimental group at 28 days. Osteopontin was important in the bone repair in all times evaluated, since it was present in osteoblasts, osteiod matrix, osteocytes and mineralized matrix, being even more stained at 21 days after the surgery. Finally, besides the results obtained in the present work, other studies are necessary to better understand the alveolar bone repair in adult and aged rats.

L’adénomyose est une pathologie chronique bénigne de l’utérus caractérisée par une infiltration du myomètre par du tissu endométrial composé de glandes et de stroma avec une hypertrophie et une hyperplasie des cellules musculaires lisses adjacentes. Cette maladie fréquente de la femme en âge de procréer cause des symptômes invalidants comme des dysménorrhées, des saignements utérins anormaux et une infertilité. L’adénomyose utérine est souvent associée à d’autres pathologies gynécologiques bénignes œstrogéno-dépendantes comme les léiomyomes utérins et l’endométriose. Les options thérapeutiques médicamenteuses sont purement symptomatiques et non-curatives et l’adénomyose reste une cause majeure d’hystérectomie. Les mécanismes physiopathologiques qui aboutissent au développement de l’adénomyose sont probablement multifactoriels et ne sont que partiellement compris actuellement. Selon la théorie la plus communément admise, l’adénomyose trouve son origine dans la couche basale de l’endomètre avec une invagination de cellules entre les faisceaux musculaires et/ou le long de vaisseaux lymphatiques. De multiples facteurs pourraient être impliqués dans l’initiation de cette invasion, notamment une résistance à l’action de la progestérone, une production intra-lésionnelle d’œstrogènes par activation de l’aromatase, des anomalies myométriales prédisposant à l’invasion, des lésions tissulaires induites par la grossesse, l’accouchement, le dyspéristaltisme utérin ou iatrogènes et des anomalies de l’endomètre le prédisposant à l’invasion. Dans un premier temps nous détaillons, dans un article de revue, les traitements médicamenteux actuellement utilisés pour traiter les symptômes causés par l’adénomyose et discutons les mécanismes physiopathologiques qui pourraient être la cible de nouveaux traitements médicamenteux. Ensuite, nous exposons les résultats de l’étude in vitro des voies de signalisation cellulaires des mitogen-activated protein kinases (MAPKs) et phosphatidylinositol 3 kinase/Akt/mammalian target of rapamycin (PI3K/mTOR/Akt) dans les cellules musculaires lisses utérines issues de femmes avec de l’adénomyose et de témoins sans adénomyose. Nous montrons une augmentation de la prolifération des cellules myométriales avec une activation in vitro de la voie MAPK/ERK chez les femmes avec de l’adénomyose en comparaison avec les témoins. L’activation de la voie PI3K/mTOR/Akt n’est pas significativement différente. La production de dérivés réactifs de l’oxygène et leurs voies de détoxification ne sont pas différentes dans les cellules myométriales de femmes avec de l’adénomyose et celles de témoins, ce qui suggère une activation de la voie des MAPK/ERK indépendante des dérivés réactifs de l’oxygène. Nos résultats montrent que des inhibiteurs des protéines kinases et le rapanalogue temsirolimus contrôlent la prolifération des cellules myométriales in vitro, ce qui suggère une implication des voies de signalisation MAPK/ERK et PI3K/mTOR/Akt dans la prolifération des cellules musculaires lisses dans l’adénomyose et les léiomyomes. Finalement, nous avons étudié l’ostéopontine comme biomarqueur sérique dans une cohorte de femmes en âge de procréer opérées pour des pathologies gynécologiques bénignes. La présence d’endométriose a été déterminée chirurgicalement et les lésions endométriosiques ont été confirmées histologiquement et classées en lésions superficielles, endométriomes ou lésions invasives profondes. La présence d’adénomyose a été déterminée par imagerie par résonance magnétique préopératoire et deux types d’adénomyose ont été caractérisés : l’adénomyose diffuse, l’adénomyose focale avec ou sans lésions diffuses associées. L’ostéopontine sérique est diminuée en cas d’adénomyose focale et de lésions d’endométriose profonde en comparaison avec des témoins sains et augmentée dans l’endométriose superficielle en comparaison avec l’endométriose profonde. (...) / Adenomyosis is chronic benign uterine disease characterized by myometrial infiltration by endometrial tissue – both glands and stroma – with hypertrophy and hyperplasia of surrounding smooth muscle cells. This frequent disease occurring in reproductive age women causes invalidating symptoms such as dysmenorrhoea, abnormal uterine bleeding and infertility. Adenomyosis is frequently associated with other estrogen-dependant gynaecologic diseases such as uterine leiomyomas and endometriosis. Medical treatments are non-curative and act purely by alleviating symptoms and adenomyosis remains a major cause of hysterectomy. Physiopathological mechanisms underlying the disease are probably multifactorial and currently not fully elucidated. According to the most widely accepted theory adenomyosis originates from the basal layer of the endometrium which invaginates between smooth muscle cell bundles and/or along lymphatic vessels. Multiple factors could be implicated in triggering this invasion, amongst others resistance to progesterone, intra-lesional production of estrogens through aromatase activation, myometrial anomalies predisposing to invasion, tissue lesions induced by pregnancy, labour, uterine dysperistaltism or iatrogenic and endometrial anomalies predisposing to invasion. First, in a clinical review article, we detail current medical therapies used to alleviate adenomyosis-associated symptoms and discuss physiopathological mechanisms that could be targets for novel medical treatments. We then describe an in vitro study on the activation of the mitogen-activated protein kinases (MAPKs) and phosphatidylinositol three kinase/mammalian target of rapamycin/Akt (PI3K/mTOR/Akt) signalling pathways in uterine smooth muscle cells derived from women with adenomyosis and from adenomyosis-free controls. We show an increased proliferation of uterine smooth muscle cells related to the in vitro activation of the MAPK/ERK pathway in women with adenomyosis compared to controls. The activation of PI3K/mTOR/Akt was not significantly different. The production of reactive oxygen species and their detoxification enzymes were not different in uterine smooth muscle cells of women with adenomyosis compared to controls suggesting a reactive oxygen species independent activation of the MAPK/ERK pathway. Our results also show that inhibitors of protein kinases and the rapanalogue temsirolimus control the in vitro proliferation of uterine smooth muscle cells suggesting an implication of both MAPK/ERK and PI3K/mTOR/Akt in the proliferation of uterine smooth muscle cells in adenomyosis and leiomyomas. Finally, we studied osteopontin as a serum biomarker in a cohort of reproductive-age women undergoing surgery for benign gynaecological conditions. The presence of endometriosis was determined surgically and endometriosis lesions were confirmed histologically and classified into superficial lesions, endometriomas and deep infiltrating lesions. The presence of adenomyosis was determined by magnetic resonance imaging before surgery and women were classified according to two types of adenomyosis: diffuse adenomyosis, focal adenomyosis with or without associated diffuse lesions. Osteopontin levels were decreased in case of focal adenomyosis and deep infiltrating endometriosis compared to disease-free women and increased in superficial endometriosis compared to deep infiltrating endometriosis. Osteopontin, a secreted glycoprotein implicated in inflammation and in tumor-metastasis, is not a biomarker of disease severity in endometriosis and adenomyosis but could reflect events implicated in peritoneal dissemination of endometriosis lesions.

INTRODUÇÃO: Osteopontina (OPN) é uma glicoproteína presente em tecidos e fluidos orgânicos e envolvida em vários processos patológicos que incluem inflamação, proliferação celular, invasão da matriz extracelular, progressão tumoral e metástase. Em pacientes (pts) portadores de carcinoma epidermóide de cabeça e pescoço (CECCP), OPN tem sido associada a uma maior agressividade tumoral e empregada como marcador prognóstico. Nós investigamos o valor prognóstico e preditivo da OPN sérica em pacientes portadores de CECCP tratados de forma uniforme. MÉTODOS: Estudo longitudinal prospectivo de 47 pts portadores de CECCP localmente avançado e irressecável submetidos à quimioterapia e radioterapia. OPN sérica foi determinada pelo método ELISA (kit 1 com17 pts e kit 2 com 30 pts) com coleta realizada antes e após o término do tratamento e estudada a relação entre OPN, categorizada como alta ou baixa em relação ao valor mediano, e as características clínico-patológicas, resposta ao tratamento, sobrevida global (SG) e sobrevida livre de progressão (SLP). RESULTADOS: A OPN sérica mediana dos pacientes determinada pelo kit 1 (em ng/ml) foi de 2,1 e 1,9 pré e pós-tratamento, respectivamente; no kit 2 (em ng/ml) foi de 69,5 e 87,9 pré e pós-tratamento, respectivamente. Pacientes portadores de tumores de orofaringe foram mais freqüentemente associados a baixos níveis séricos de OPN pós-tratamento, em comparação com outros sub-sítios (p=0,03). Observada tendência à associação entre os valores séricos baixos de osteopontina pós-tratamento e a resposta tratamento (p=0,06). Houve associação entre os valores elevados da osteopontina pós-tratamento e menor SLP (p=0,09, log rank), com medianas de 11,9 meses e 14,5 meses, conforme valores séricos de OPN pós-tratamento altos e baixos, respectivamente. Não houve associação dos valores séricos de OPN pré e pós-tratamento e a SG (p=0,19 e p= 0,10, respectivamente). CONCLUSÃO: Neste grupo de pacientes portadores de CECCP, sugere-se que OPN sérica baixa após a quimioradioterapia associa-se à resposta ao tratamento e melhor SLP. / INTRODUCTION: Osteopontin (OPN) is a glycoprotein present in tissues and body fluids involved in several pathological processes that include inflammation, cell proliferation, invasion of the extracellular matrix, tumor progression and metastasis. In head and neck squamous cell carcinoma (HNSCC) patients, OPN has been associated with greater tumor aggressiveness and used as a prognostic marker. We investigated the prognostic and predictive value of plasma OPN in homogeneously treated (HNSCC) patients. METHODS: Longitudinal prospective study of 47 patients with locally advanced and inoperable HNSCC treated with exclusive platin based concomitant chemoradiotherapy. Plasma OPN was determined by ELISA (n=14 kit I, n=32 kit II) pre and postreatment and correlated with tumor response, overall survival (OS) and progression-free survival (PFS). RESULTS: Median OPN levels in ng/ml were 2,1 and 1,9 pre and postreatment, respectively, by kit I and 69,5 and 87,9 by kit II. Patients were categorized as OPN low or high, using the median as a cut-off point. Patients with oropharynx tumors, as compared to other subsites, were more frequently categorized as low OPN (p = 0,03). A low postreatment OPN level was associated with tumor response (p = 0,06) and a high postreatment OPN level was associated with poor PFS, 11.9 vs. 14.5 months (p=0.09, log rank). Mean OS was 16.2 and 13.7 months in low and high postreatment OPN pts, respectively (p=0.10, log rank). CONCLUSIONS: In this group of HNSCC patients, it is suggested that a low plasma OPN after chemoradiotherapy is associated with a lower response rate and a worse PFS.

Avec l'âge, les propriétés mécaniques des os se détériorent, conduisant à un risque accru de fracture. Bien que les mesures de densité minérale osseuse permettent de prédire, dans une certaine mesure, ces risques, elles restent insuffisantes dans un grand nombre de cas. Une compréhension plus complète des différents facteurs permettant de définir la « qualité » d'un os est donc souhaitable. Il est connu que la résistance à la fracture de tissus osseux est affectée non seulement par la glycosylation non-enzymatique du collagène, mais aussi par des protéines non collagéneuses comme l'ostéocalcine (OC) et l'ostéopontine (OPN). Cependant, le rôle structural de ces deux protéines dans l'os est mal connu, de même que la façon dont elles contribuent aux propriétés mécaniques globales. L'objectif de cette thèse est donc de répondre à ces deux points. Un modèle synthétique a ainsi été développé pour élucider quelles sont les interactions-clés gouvernant l'interaction de l'OC et l'OPN avec la phase minérale osseuse. Par ailleurs, en utilisant des os de souris génétiquement modifiées (déficientes en OC et/ou OPN), des études RMN solide ont été menées, pour élucider le rôle de l'OC et l'OPN à l'interface organique-inorganique. Leur lien avec les propriétés mécaniques a aussi été étudié en détail, via des tests de rupture, de fatigue et de fluage. Les résultats obtenus montrent que l'OC et l'OPN ont un rôle structural important dans les tissus osseux, et qu'elles contribuent aux propriétés mécaniques par le biais de leurs interactions ioniques, au niveau des interfaces entre les fibrilles de collagène minéralisés. / The decrease in bone mechanical properties occurs with age. The associated fragility fractures present a global public health concern. The use of bone mineral density as a predictor of risk of fracture is, however, limited. A more comprehensive understanding of bone quality and its link to bone fragility is thus desirable. Besides the brittleness caused by nonenzymatic glycation of collagen, bone fracture resistance is also influenced by noncollagenous components such as osteocalcin (OC) and osteopontin (OPN). The structural role of OC and OPN in bone and how they contribute to mechanical properties is however unclear. The objective of this thesis is to elucidate these two aspects. Key interactions associated with the binding of OC and OPN to bone mineral were studied in a synthetic model. Using genetically modified animal model lacking OC and/or OPN, the role of OC and OPN in organic-inorganic interface was examined by solid state NMR, and their link to mechanical properties was studied via a series of tissue level mechanical tests, measuring fracture toughness, creep, or fatigue. Based on the results obtained, it is concluded that OC and OPN are present as structural elements in bone and contribute to tissue mechanical properties via ionic interactions at the interfaces between mineralized fibrils.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2016-04-27T18:46:26Z No. of bitstreams: 1 Thiago Almeida Pereira. Participação...pdf: 128345460 bytes, checksum: 463e735ff04d1040b79e06171b01301e (MD5) / Approved for entry into archive by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2016-04-27T18:46:42Z (GMT) No. of bitstreams: 1 Thiago Almeida Pereira. Participação...pdf: 128345460 bytes, checksum: 463e735ff04d1040b79e06171b01301e (MD5) / Made available in DSpace on 2016-04-27T18:46:42Z (GMT). No. of bitstreams: 1 Thiago Almeida Pereira. Participação...pdf: 128345460 bytes, checksum: 463e735ff04d1040b79e06171b01301e (MD5) Previous issue date: 2015 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / INTRODUÇÃO/OBJETIVO: A esquistossomose mansonica é causa importante de fibrose hepática e hipertensão porta em regiões tropicais, e a patogênese da fibrose não está bem esclarecida. Como a via do hedgehog e um dos seus genes alvos, a osteopontina, estão envolvidos em fibroses hepáticas de outras etiologias o objetivo foi investigar a ativação destas vias na esquIsitossomose humana e murina experimental, no intuito de verificar o seu envolvimento no desenvolvimento da forma hepatoesplênica da esquistossomose mansonica (FHE). MATERIAL E MÉTODOS: 87 biópsias em cunha de fígados de pacientes com FHE submetidos a cirurgia e fragmentos de fígado de camundongos suiços infectados com Schistosoma mansoni foram submetidos a métodos imunohistoquímicos e de biologia molecular para avaliar a expressão de ligantes hedgehog (Ihh, Shh), receptor Patched, fatores de transcrição Gli 1 e 2 e osteopontina. Osteopontina sérica e ligante Shh do hedgehog foram avaliados em camundongos suíços infectados e os de osteopontina em camundongos CBA/J infectados e em pacientes com FHE e forma hepatointestinal da esquistossomose. In vitro foi avaliado o efeito de antígeno solúvel do ovo (SEA) em células de Kuppfer, células estreladas, macrófagos, colangiócitos e células endoteliais sinusoidais hepáticas. A relação com a via da IL-13 foi avaliada em camundongos geneticamente deficientes ou hiperexpressando a citocina. Foi avaliado in vitro se a IL-13 induz ligantes hedghog ou ativação da via em células de Kuppfer. RESULTADOS: Os resultados mostraram: (a) aumento expressão de ligantes Ihh, de fatores de transcrição Gli2 e de osteopontina no fígado de camundongos suíços infectados com Schistosoma mansoni, aumento de shh e osteopontina no plasma de camundongos suíços e de osteopontina no plasma de camundongos CBA/J infectados com S. mansoni; (b) aumento na expressão de Ihh, Shh, Gli1 e 2, receptor Patched e de osteopontina no fígado de pacientes com esquistossomose e aumento da osteopontina sérica em pacientes com a FHE; (c) A expressão de ligantes hedgehog e de Gli2 foi observada em macrófagos, células estreladas, ductos biliares e células endoteliais, e a de osteoponina em ductos biliares, macrófagos e células estreladas/miofibroblastos; (d) correlação positiva entre ativação do hedgehog (Gli2 e osteopontina) e fibrose, no modelo murino experimental e nos pacientes; nestes a correlação também foi observada com o grau de fibrose classificada pelo ultrassom e com a hipertensão porta; (e) Inibição in vitro do hedgehog com ciclopamina e vismodegib ou por nocauteamento condicional de receptor Smoothened bloqueou a ativação alternativa de macrófagos e inibiu a angiogênese a partir de células endoteliais sinusoidais hepáticas; (f) que o bloqueio da via da IL-13 reduziu e a hiperexpressão aumentou a ativação da via do hedgehog e IL-13 diretamente induziu, in vitro, produção de ihh em células de Kupffer de camundongos e de humanos, demonstrando a inter-relação das duas vias. CONCLUSÃO: Pode-se concluir que a via do hedgehog tem participação importante na patogênese da fibrose hepática esquistossomótica, atuando através de estímulos à fibrogênese e à angiogênese e que a osteopontina é candidata a ser um biomarcador de intensidade da fibrose e da hipertensão porta na doença. / BACKGROUND AND AIMS: Schistosomiasis is a major cause of liver fibrosis and portal hypertension in tropical regions, and the pathogenesis of fibrosis is not well established. As hedgehog pathway and one of its target genes, osteopontin, are involved in liver fibrosis of other etiologies our aims were to investigate the activation of these pathways in human and experimental murine schistosomiasis, in an attempt to verify their involvement in the development of hepatosplenic schistosomiasis mansoni (HS). METHODS: 87 wedge liver biopsies of patients with HS submitted to surgery and liver fragments Swiss mice infected with Schistosoma mansoni were submitted to immunohistochemistry and molecular biology methods to evaluate the expression of hedgehog ligands (Ihh, Shh), patched receptor , Gli transcription factors and osteopontin. Serum osteopontin and Shh were evaluated in infected Swiss mice and osteopontin was evaluated in serum of infected CBA/J mice and plasma from patients with hepatointestinal and HS forms of schistosomiasis. The effect of soluble egg antigen (SEA) on Kuppfer cells, stellate cells, macrophages, cholangiocytes and liver sinusoidal endothelial cells was evaluated in vitro. Relationship with IL-13 pathway was evaluated in mice genetically deficient or with hyperexpression of this cytokine. Whether IL-13 induces production of ligands and/or activation of the hedgehog pathway in Kuppfer cells was evaluated in vitro. RESULTS: Results demonstrated: (a) increased expression of Ihh, transcription factor Gli2 and osteopontin in the livers of Swiss mice infected with S. mansoni, increased plasma levels of shh and osteopontin in infected Swiss mice and increased osteopontin in plasma of S. mansoni infected CBA/J mice; (b) increased expression of ihh, shh, Gli1 and 2, patched and osteopontin receptor in the liver of patients with schistosomiasis and increased serum osteopontin in patients with HS; (c) expression of hedgehog ligands and Gli2 was observed in macrophages, stellate cells, endothelial cells and bile duct and expression of osteopontin was detected in macrophages and stellate/myofibroblast cells; (d) positive correlation between activation of the hedgehog (Gli2 and osteopontin) and fibrosis in experimental murine model and in patients; these correlation was also observed with the degree of fibrosis classified by ultrasound and with portal hypertension; (e) in vitro inhibition of hedgehog pathway with cyclopamine or vismogedib or by conditional knockout of Smoothened co-receptor blocked the alternative activation of macrophage and inhibited angiogenesis in liver sinusoidal endothelial cells; (f) reduction of IL-13 pathway or IL-13 over-expression respectively reduced or increased the activation of the hedgehog pathway and IL-13 directly induced in vitro ihh production in Kupffer cells from mice and human, demonstrating a cross-talk between the two pathways. CONCLUSION: In conclusion the hedgehog pathway plays an important role in the pathogenesis of liver fibrosis in schistosomiasis mansoni, acting through stimulation of angiogenesis and fibrogenesis and osteopontin is a putative candidate to be a biomarker of intensity of fibrosis and portal hypertension in the disease.