INTRODUÇÃO: Perda óssea é um achado comum em pacientes com Nefrite Lúpica (NL), mesmo naqueles com diagnóstico recente. Algumas evidências indicam um aumento na osteoclastogênese como um dos distúrbios principais no processo de remodelamento ósseo. O objetivo deste estudo foi investigar algumas vias de sinalização (RANKL/OPG, Wnt/Beta-catenin and Th17/IL-17) possivelmente envolvidas na osteoclastogênese anormal detectada em mulheres jovens ao diagnóstico de nefrite lúpica ativa, assim como avaliar a ação da vitamina D (VitD) nesse cenário e sua correlação com fatores inflamatórios. MÉTODOS: Realizamos culturas com a linhagem de células osteoblásticas humanas hFOB 1.19 (ATCC) e as dividimos em um grupo suplementado com soro de pacientes lúpicas (NL) (n=15) e em um grupo com soro de controles saudáveis (CS) (n=15) em vez de soro fetal bovino (SFB). Em seguida, adicionamos 1,25-dihidroxivitamina D3 (1,25(OH)2D3) em dois subgrupos nas concentrações 10-9M e 10-7M, resultando em 6 grupos: CS, CS+vitD 10-9M, CS+vitD 10-7M, NL, NL+vitD 10-9M, NL+vitD 10-7M). Após 48h da adição de 1,25(OH)2D3 ao meio de cultura, células hFOB foram tripsinizadas e separado o lisato celular de cada grupo. Ensaios de citometria de fluxo e multiplex foram realizados para quantificação das seguintes proteínas do lisato cellular: CD166, CD54, fosfatase alcalina, RANKL, OPG, CD14, TLR4, NF-KappaB, SOST, DKK-1, Beta-catenina, IL-1-beta, IL-2, IL-6, TNF-alfa, IL-17A, IL-17F, IL-21 and IL-22. RT-PCR foi empregado para quantificação de mRNA dos genes RANKL, SOST, OPG e Beta-catenina. RESULTADOS: Pacientes com NL evidenciaram maiores níveis séricos de DKK-1 (2802,04 ± 1380,06 x 696,30 ± 421,22pg/ml, p < 0,001), OPG (560,12 ± 333,56 x 340,24 ± 102,08pg/ml, p=0,0212), TNF-alfa (9,63 ± 14,49 x 1,27 ± 0,35pg/ml, p=0,0337), IL-6 (15,58±39,08 x 8,02±3,49, p= 0,0053) and IL-2 (3,36 ± 3,06 x 1,54 ± 0,9pg/ml, p=0,0353) do que CS. Após exposição ao meio enriquecido com soro de pacientes com NL, células hFOB 1.19 apresentaram maior nível de mRNA de RANKL (p=0,045)) e menor nível de proteína OPG (178,81 ± 66,40 x 298,76 ± 114,94pg/mg, p=0,0016). Suplementação com 1,25(OH)2D3 aumentou a diferença da expressão das proteínas DKK-1 (673,03 ± 171,93 x 456,69 ± 234,53pg/mg, p=0,0215), IL-6 (0,80 ± 0,25pg/mg x 0,66 ± 0,18, p=0,0417) and IL-2 (4,97 ± 2,2 x 3,90 ± 1,66pg/mg, p=0,042) entre hFOB NL comparados com hFOB CS, enquanto diminuiu o nível de mRNA de Beta-catenina em células do grupo NL. DISCUSSÃO: Dentro das limitações deste estudo, os resultados sugerem que os maiores níveis séricos de citocinas pró-inflamatórias, como TNF-alfa, IL-6 e talvez IL-2, detectadas em pacientes com NL pode ter induzido a maior expressão osteoblástica de RANKL, representada pelo maior nível de mRNA RANKL em células do grupo NL, e suprimido OPG, conforme a diminuição observada na quantificação proteica de OPG nos lisatos celulares, o que pode ter contribuído para a aumentada osteoclastogênese evidenciada pela biópsia óssea dessas pacientes. A adição de 1,25(OH)2D3 não preveniu os efeitos inflamatórios do soro de pacientes com NL ativa em células hFOB 1.19 neste estudo / INTRODUCTION: Bone loss is a common finding in Lupus Nephritis (LN) patients even in those recently diagnosed. Some evidences indicate an increased osteoclastogenesis as the main disturb of the bone remodeling process. The aim of this study was to investigate some pathways (RANK-L/OPG, Wnt/?-catenin and Th17/IL-17) possibly involved in the abnormal osteoclastogenesis detected in women at the diagnosis of proliferative LN as well as evaluating the action of vitamin D (vitD) in this scenario and their correlation with inflammatory factors. METHODS: We cultured the human osteoblastic cell line hFOB 1.19 (ATCC), and divided cultures into those supplemented with serum from healthy controls (HC) (n=15) and LN patients (n=15) instead of fetal bovine serum (FBS). Then 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] was added in two subgroups at the concentrations of 10-9M e 10-7M while vitD was absent in one subgroup in both HC and LN cultures (HC, HC+vitD 10-9M, HC+vitD 10-7M, LN, LN+vitD 10-9M, LN+vitD 10-7M) . After 48h of vitD addition, hFOB cultures were trypsinized. Flow cytometry and multiplex assays were performed to test CD166, CD54, alkaline phosphatase, RANKL, OPG, CD14, TLR4, NF-KappaB, SOST, DKK-1, ?-catenin, IL-1Beta, IL-2, IL-6, TNF-alfa, IL-17A, IL-17F, IL-21 and IL-22 concentrations in the cell lysates. Polymerase reaction chain (RT-PCR) assays analyzed the expression of RANKL, SOST, OPG and Beta-catenin mRNA. RESULTS: LN patients showed higher serum levels of DKK-1 (2802.04 ± 1380.06 x 696.3 ± 421.22pg/ml, p < 0.001), OPG (560.12 ± 333.56 x 340.24 ± 102.08pg/ml, p=0.0212), TNF-alfa (9.63 ± 14.49 x 1.27 ± 0.35pg/ml, p=0.0337), IL-6 (15.58±39.08 x 8.02±3.49, 0.0053) and IL-2 (3.36 ± 3.06 x 1.54 ± 0.9pg/ml, p=0.0353) than HCs. After exposure to medium enriched with LN serum, osteoblasts expressed higher RANKL mRNA (fold change 1.573, p=0.045) and lower OPG protein (178.81 ± 66.40 x 298.76 ± 114.94pg/mg, p=0.0016). 1,25(OH)2D3 supplementation increased the difference between LN and HC expression of DKK-1 (673.03 ± 171.93 x 456.69 ± 234.53pg/mg, p=0.0215), IL-6 (0.80 ± 0.25pg/mg x 0.66 ± 0.18, p=0.0417) and IL-2 (4.97 ± 2.2 x 3.90 ± 1,66pg/mg, p=0.042) proteins and diminished Beta-catenin mRNA in LN cells. DISCUSSION: Within the limitations of this study, the results suggest that the higher serum levels of proinflammatory cytokines, such as TNF-alfa, IL-6 and perhaps IL-2, detected in LN patients would possibly have induced RANKL genes, as demonstrated by an enhanced RANKL mRNA expression in LN osteoblasts, and suppressed OPG protein in cell lysates, which would have contributed to the increased osteoclastogenesis detected in bone biopsies of women with new onset of LN. 1,25(OH)2D3 addition to osteoblast cultures did not prevent the effects of inflammatory LN serum in vitro

Το αξιόπιστο πειραματικό μοντέλο της ωοθηκεκτομής σε επίμυες εφαρμόστηκε για τη μελέτη των παθογενετικών μηχανισμών της οστεοπόρωσης. Σκοπός της παρούσας διδακτορικής διατριβής ήταν η διερεύνηση του ρόλου της λεπτίνης και των κυτοκινών RANKL και οστεοπροτεγερίνης (OPG) στην εξέλιξη της οστεοπόρωσης. Για την διεκπεραίωση της μελέτης χρησιμοποιήθηκαν 40 ενήλικοι θηλυκοί επίμυες ηλικίας 9 μηνών. Πριν την ωοθηκεκτομή στους επίμυες εφαρμόστηκε η τεχνική της ποσοτικής υπολογιστικής τομογραφίας (pQCT) παράλληλα με την πρωτοποριακή μη επεμβατική τεχνική του θερμοδυναμικού συντελεστή εσωτερικής απόσβεσης (MDF) ώστε να διαπιστωθεί η κατάσταση της οστικής πυκνότητας των πειραματόζωων. Σε χρονικά διαστήματα 20, 40 και 60 ημερών μετά την ωοθηκεκτομή πραγματοποιήθηκαν τυχαίες ομαδικές θυσίες με σκοπό τη συλλογή αίματος και την απομόνωση μηριαίων οστών και οστών κνήμης. Την 60η ημέρα πριν τη θυσία στην τελευταία ομάδα των ωοθηκεκτομήθέντων επίμυων επαναλήφθηκαν οι μετρήσεις pQCT και MDF για να διαπιστωθεί η εγκατάσταση σοβαρής οστεοπόρωσης με τη λήξη της πειραματικής πορείας. Οι οροί αίματος που συλλέχθηκαν από όλα τα χρονικά πειραματικά σημεία χρησιμοποιήθηκαν για τη διερεύνηση των επιπέδων έκφρασης των βιοχημικών δεικτών του οστικού μεταβολισμού NTx και οστεοκαλσίνης καθώς και της ελεύθερης λεπτίνης με την τεχνική της ενζυμικής ανοσοπροσρόφησης (ELISA). Στα οστά της κνήμης εφαρμόστηκε η τεχνική της ιστομορφομετρίας για τη μελέτη των μεταβολών της μικροαρχιτεκτονικής δομής των οστών κατά την εξέλιξη της οστεοπόρωσης. Επιπρόσθετα η τεχνική της ανοσοϊστοχημείας εφαρμόστηκε στα οστά της κνήμης για τη διερεύνηση των μεταβολών που προκαλεί η ωοθηκεκτομή στα επίπεδα έκφρασης του υποδοχέα της λεπτίνης και των κυτοκινών RANKL και οστεοπροτεγερίνης στους οστικούς κυτταρικούς πληθυσμούς. Στα μηριαία οστά εφαρμόστηκαν οι τεχνικές της ηλεκτροφόρησης σε πηκτή πολυακρυλαμιδίου (SDS-PAGE electrophoresis) και του ανοσοστυπώματος (Western Blot) για να συλλεχθούν επιπλέον πληροφορίες σχετικά με τις μεταβολές στα επίπεδα έκφρασης του υποδοχέα της λεπτίνης και των κυτοκινών RANKL και οστεοπροτεγερίνης κατά την εξέλιξη της οτεοπόρωσης. Τα συμπεράσματα που διεξάγονται από τα επιμέρους πειραματικά δεδομένα επιβεβαιώνουν την υπόθεση ότι η λεπτίνη κατέχει σημαντικό ρόλο στη ρύθμιση του οστικού μεταβολισμού και συμμετέχει ενεργά μέσω κάποιου άγνωστου μέχρι στιγμής μηχανισμού στη διαδικασία της οστικής ανακατασκευής στην οστεοπόρωση. Όσον αφορά τις ρυθμιστικές κυτοκίνες της οστεοκλαστογένεσης RANKL και OPG, διαπιστώθηκε ότι μεταβάλλονται σημαντικά κατά την εξέλιξη της οστεοπόρωσης στους ωοθηκεκτομηθέντες επίμυες, υποδηλώνοντας τη σημαντικότητα του ρόλου τους στον οστικό μεταβολισμό. / Ovariectomy in mature rats mimics the changes in bone metabolism observed in postmenopausal women and results in osteoporosis. The aim of this thesis was to investigate the role of leptin and the cytokine RANKL and Osteoprotegerin (OPG) in the progression of ovariectomy-induced osteoporosis. Nine–month-old female Wistar rats were bilaterally ovariectomized (n=40). Before the operation, pQCT and MDF technology were applied on rats in order to estimate the bone mineral density of the animals. On days 20, 40 and 60 after the operation the rats were randomly sacrificed and blood samples, dissected knees and femurs were collected. On day 60, pQCT and MDF techniques were applied in order to confirm the establishment of severe osteoporosis until the end of the experimental procedure. Leptin, and the biochemical markers of bone metabolism, osteocalcin and NTx, were measured in blood serum from all time points, by an ELISA method. Bone sections from the knees of the rats were examined by histomorphometric techniques in order to investigate the alterations in the micro-architectural structure of the skeleton caused by ovariectomy. Furthermore, immunohistochemistry was applied on knee sections and SDS-PAGE electrophoresis and western blot techniques were performed in femur homogenized tissueς, in order to investigate whether the expression levels of leptin receptor, RANKL and OPG were altered during the progression of osteoporosis. The results indicate that leptin is involved in the molecular mechanisms of bone remodeling in osteoporosis. The regulators of osteoclastogenesis, RANKL and OPG are also important players in the field of bone metabolism

Made available in DSpace on 2014-12-17T15:32:29Z (GMT). No. of bitstreams: 1 CassianoFWN_TESE.pdf: 3914655 bytes, checksum: c6fb9bd86bba433eb6a5a047a9337861 (MD5) Previous issue date: 2010-09-23 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The odontogenic keratocysts are distinguished from other odontogenic cystic lesions by their potentially aggressive clinical behavior and association, in some cases, with Gorlin syndrome. Studies have suggested that syndrome keratocysts, in comparison with sporadic lesions, have higher growth and infiltration capacity and higher recurrence tendency. The aim of this study was to analyze, by means of immunohistochemistry, the expressions of receptor activator of nuclear factor ?B ligand (RANKL) and osteoprotegerin (OPG), the angiogenic index (CD34) and the presence of myofibroblasts (?-SMA) in primary and recurrent sporadic keratocysts and in keratocysts associated with Gorlin syndrome. The sample was composed by 30 sporadic keratocysts (22 primary and 8 recurrent) and 22 syndrome keratocysts. In the epithelium and in the fibrous capsule of the lesions, the immunoexpression of RANKL and OPG was evaluated by determination of the percentage of positive cells, according to the following scores: 0 (less than 10% of positive cells), 1 (11% - 50% of positive cells), 2 (51% - 75% of positive cells) and 3 (more than 76% of positive cells). In addition, cases were classified according to the RANKL score/ OPG score ratio, as follows: RANKL > OPG, RANKL < OPG, and RANKL = OPG. The angiogenic index was analyzed by counting the microvessels immunoreactive to anti-CD34 antibody in 5 fields (200?). The analysis of myofibroblasts was performed by counting the cells immunoreactive to anti-?-SMA antibody in 10 fields (400?). The analysis of the expressions of RANKL and OPG in the epithelial lining and in the fibrous capsule did not reveal significant differences between groups (p > 0.05). Regarding the RANKL/ OPG ratio in the epithelial lining, most sporadic primary (54.5%) and syndrome lesions (59.1%) showed RANKL < OPG ratio and RANKL = OPG ratio, respectively (p > 0.05). With respect to the RANKL/ OPG ratio in the fibrous capsule, the majority of sporadic primary (81.8%) and sporadic recurrent lesions (75.0%) and most syndrome lesions (45.5%) showed RANKL = OPG ratio (p > 0.05). The mean number of microvessels was 69.2 in sporadic primary lesions, 67.6 in recurrent lesions, and 71.6 in syndrome lesions, with no significant differences between groups (p > 0.05). The mean number of myofibroblasts was 34.4 in sporadic primary lesions, 29.3 in recurrent lesions, and 33.7 in syndrome lesions, with no significant differences between groups (p > 0.05). In conclusion, the results of the present study suggest that the differences in the biological behavior between sporadic keratocysts and keratocysts associated with Gorlin syndrome may not be related to the expressions of RANKL and OPG, the RANKL/ OPG ratio, the angiogenic index or the number of myofibroblasts in these lesions / Os ceratocistos odontog?nicos se destacam em rela??o a outras les?es c?sticas odontog?nicas pelo comportamento cl?nico potencialmente agressivo e por se apresentarem associados, em alguns casos, ? s?ndrome de Gorlin. Estudos t?m sugerido que os ceratocistos sindr?micos, em compara??o ?s les?es isoladas, possuem maior capacidade de crescimento e infiltra??o e maior tend?ncia ? recorr?ncia. O objetivo do presente trabalho consistiu em analisar, por meio de imuno-histoqu?mica, as express?es do ligante do receptor ativador do fator nuclear ?B (RANKL) e da osteoprotegerina (OPG), o ?ndice angiog?nico (CD34) e a presen?a de miofibroblastos (?-SMA), em ceratocistos isolados prim?rios e recorrentes e ceratocistos associados ? s?ndrome de Gorlin. A amostra foi composta por 30 ceratocistos isolados (22 prim?rios e 8 recorrentes) e 22 ceratocistos sindr?micos. A express?o de RANKL e OPG foi avaliada no epit?lio e na c?psula fibrosa das les?es, estabelecendo-se o percentual de c?lulas imunopositivas, de acordo com os escores: 0 (? 10% das c?lulas positivas), 1 (11% - 50% das c?lulas positivas), 2 (51% - 75% das c?lulas positivas) e 3 (? 76% das c?lulas positivas). Al?m disso, os casos foram categorizados, segundo a propor??o RANKL/ OPG, em: RANKL > OPG, RANKL < OPG e RANKL = OPG. O ?ndice angiog?nico foi analisado por meio da contagem dos microvasos imunomarcados pelo anticorpo anti-CD34, em 5 campos (200?). Para a avalia??o dos miofibroblastos, foram quantificadas as c?lulas imunorreativas ao anticorpo anti-?-SMA, em 10 campos (400?). A an?lise das express?es de RANKL e OPG, no revestimento epitelial e na c?psula fibrosa, n?o revelou diferen?as significativas entre os grupos (p > 0,05). Em rela??o ? propor??o RANKL/ OPG no revestimento epitelial, grande parte das les?es isoladas prim?rias (54,5%) e sindr?micas (59,1%) exibiu propor??o RANKL < OPG e propor??o RANKL = OPG, respectivamente (p > 0,05). Em rela??o ? propor??o RANKL/ OPG na c?psula fibrosa, a maioria das les?es isoladas prim?rias (81,8%) e isoladas recorrentes (75,0%) e grande parte das les?es associadas ? s?ndrome de Gorlin (45,5%) revelaram propor??o RANKL = OPG (p > 0,05). O n?mero m?dio de microvasos foi de 69,2 nas les?es isoladas prim?rias, 67,6 nas les?es recorrentes e 71,6 nas les?es sindr?micas, sem diferen?as significativas entre os grupos (p > 0,05). A an?lise dos miofibroblastos revelou valores m?dios de 34,4 nas les?es isoladas prim?rias, 29,3 nas les?es recorrentes e 33,7 nas les?es sindr?micas, sem diferen?as significativas entre os grupos (p > 0,05). Em conclus?o, os resultados do presente estudo sugerem que as diferen?as no comportamento biol?gico entre ceratocistos isolados e associados ? s?ndrome de Gorlin podem n?o estar relacionadas ?s express?es de RANKL e OPG, ? propor??o RANKL/ OPG, ao ?ndice angiog?nico ou ? quantidade de miofibroblastos presentes nas les?es

INTRODUÇÃO: O hiperparatireoidismo secundário (HPTS) é uma complicação da doença renal crônica que compromete a integridade do esqueleto. Pacientes com HPS submetidos à paratireoidectomia (PTX) passam de uma condição de níveis séricos de paratormônio (PTH) muito elevados para outra, onde esses níveis hormonais caem drasticamente. Os efeitos da PTX no tecido ósseo são mal compreendidos, especialmente no que se refere às proteínas expressas por osteócitos, como o fator de crescimento de fibroblastos 23 (FGF23), dentin matrix protein 1 (DMP-1), fosfoglicoproteína de matriz extracelular (MEPE), esclerostina, Fator nuclear Kappa beta ligante (RANKL) e osteoprotegerina (OPG), que regulam a remodelação e a mineralização óssea. OBJETIVOS: Caracterizar a expressão óssea dessas proteínas por imuno-histoquímica e estabelecer relações com os dados da histomorfometria do tecido ósseo em pacientes com HPS, antes e após a PTX. MÉTODOS: Estudamos biópsias ósseas obtidas de um banco de biópsias de 23 pacientes com DRC e HPTS, que foram realizadas antes e 12 meses após a PTX. RESULTADOS: A avaliação dos parâmetros histomorfométricos demonstrou uma melhora da microarquitetura óssea, porém com um maior retardo em sua mineralização após a PTX. A análise da expressão das proteínas osteocíticas revelou um aumento significativo na expressão da esclerostina e da OPG e uma diminuição da relação RANKL/OPG após a PTX, sugerindo a participação dessas proteínas na melhora das lesões ósseas decorrentes do HPTS. Observamos um aumento significativo na expressão da OPG no grupo de pacientes que evoluiu com defeito de mineralização somente após a cirurgia, sugerindo a participação dessa proteína no retardo de mineralização óssea desses pacientes. A expressão das proteínas osteocíticas que participam da formação e mineralização óssea apresentou correlação com parâmetros envolvidos na remodelação óssea. CONCLUSÕES: Mudanças significativas na expressão óssea de proteínas osteocíticas que podem potencialmente regular a remodelação e a mineralização óssea foram observadas após a PTX / INTRODUCTION: Secondary hyperparathyroidism (SHPT) is a complication of chronic kidney disease that compromises skeletal integrity. Patients with SHPT undergoing parathyroidectomy (PTX) go from a very high serum parathyroid hormone (PTH) condition to another, where these hormonal levels dramatically fall. The effects of PTX on bone tissue are poorly understood, especially as regards proteins expressed by osteocytes, such as fibroblast growth factor 23 (FGF23), dentin matrix protein 1 (DMP-1), extracellular matrix phosphoglycoprotein (MEPE), sclerostin, Kappa beta ligand nuclear factor (RANKL) and osteoprotegerin (OPG), which regulate bone remodeling and mineralization. OBJECTIVES: Characterize bone expression of these proteins by immunohistochemistry and establish relations with bone tissue histomorphometry data in SHPT patients, before and after PTX. METHODS: We studied bone biopsies obtained from a biopsy database of 23 patients with CKD and SHPT, which were performed before PTX and 12 months after PTX. RESULTS: Evaluation of histomorphometric parameters showed improvement of bone microarchitecture, but with longer delay in mineralization after PTX. Analysis of osteocyte protein expression revealed significant increase in sclerostin and OPG expression and decrease in RANKL/OPG ratio after PTX, suggesting participation of these proteins in improvement of bone lesions due to SHPT. We observed significant increase in OPG expression in the group of patients who evolved with mineralization defect only after surgery, suggesting participation of this protein in bone mineralization delay of these patients. Expression of osteocyte proteins that participate in bone formation and mineralization correlated with parameters involved in bone remodeling. CONCLUSIONS: Significant changes in bone expression of osteocyte proteins that can potentially regulate bone remodeling and mineralization were observed after PTX

Collagen and glycosaminoglycans, such as hyaluronan and chondroitin sulfate, are the major components of bone extracellular matrix, and extracellular matrix composites are being evaluated for a wide range of clinical applications. The molecular and cellular effects of native and sulfatemodified glycosaminoglycans on osteocytes were investigated as critical regulators of bone remodeling. The effects of glycosaminoglycans on viability, necrosis, apoptosis, and regulation of gene expression were tested in two osteocyte-like cell lines, the murine MLO-Y4 and the rat UMR 106-01 cells. Glycosaminoglycans were non-toxic and incorporated by osteocytic cells. In MLO-Y4 cells, sulfation of glycosaminoglycans led to a significant inhibition of osteocyte apoptosis, 42% inhibition for highly sulfated chondroitin sulfate and 58% for highly sulfated hyaluronan, respectively. Cell proliferation was not affected. While treatment with highly sulfated chondroitin sulfate increased cell viability by 20% compared to the native chondroitin sulfate. In UMR 106- 01 cells, treatment with highly sulfated hyaluronan reduced the receptor activator of nuclear factor-κB ligand/osteoprotegerin ratio by 58% compared to the non-sulfated form, whereas highly sulfated chondroitin sulfate led to 60% reduction in the receptor activator of nuclear factor-κB ligand/osteoprotegerin ratio in comparison to the native chondroitin sulfate. The expression of SOST, the gene encoding sclerostin, was reduced by 50% and 45% by highly sulfated hyaluronan and chondroitin sulfate, respectively, compared to their native forms. The expression of BMP- 2, a marker of osteoblast differentiation, was doubled after treatment with the highly sulfated hyaluronan in comparison to its native form. In conclusion, highly sulfated glycosaminoglycans inhibit osteocyte apoptosis in vitro and promote an osteoblast-supporting gene expression profile.