Osteomyelitis is an infection of bone or bone marrow, usually caused by pyogenic bacteria. It can cultivate by hematogen way or it can cultivate by the help of local soft tissue infection. Osteomyelitis often requires prolonged antibiotic therapy and surgery. But for therapy / antibiotic must reach to effective dose in the bone. So that / for prevention and treatment of osteomyelitis controlled antibiotic release systems can be used. These systems have been developed to deliver antibiotics directly to infected tissue. As a carrier material / polymers are widely use. Polymer can be biodegradable or non biodegradable. The advantage of biodegradable polymers is / you do not need a second surgery for the removal of the carrier material from the body. In this study / vancomycin loaded PLLA/TCP composites were developed and characterized to treat implant related chronic osteomyelitis in experimental rat osteomyelitis model. Some of the composites were prepared by coating the vancomycin loaded composites with PLLA to observe the difference between the coated and uncoated composites. Also, some composites were developed free from the vancomycin to determine the biocompatibility of the composite for the bone tissue. The coating extended the release of the vancomycin up to 5 weeks and changed the surface morphology of the composites. According to the cell culture studies, vancomycin loaded PLLA/TCP composites promoted cell adhesion, cell proliferation and mineralization so / the composite was biocompatible with bone tissue. Radiological and microbiological evaluations showed that vancomycin loaded and coated vancomycin loaded PLLA/TCP composites inhibited MRSA proliferation and treat implant related chronic osteomyelitis.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

A administração indiscriminada de antimicrobianos sistêmicos tem como principais efeitos indesejáveis a seleção antimicrobiana, hipersensibilidade, comprometimento gastrointestinal e toxicidade. A busca por uma alternativa à terapêutica antimicrobiana sistêmica em Odontologia através do uso de um material biodegradável de aplicação local pode apresentar inúmeras vantagens. As características estruturais, de citocompatibilidade e facilidade de fabricação do polímero sintético ácido poli-L-lactídeo (PLLA) permitem que este seja um carreador de fármacos como amoxicilina (AM), azitromicina (AZ), clindamicina (CL) ou metronidazol (ME) mantendo concentrações inibitórias constantes e por tempo prolongado, sendo capazes de prevenir a colonização dos principais patógenos orais. Objetivo: Avaliar e comparar o comportamento de filmes ou malhas de PLLA associados aos quatro antimicrobianos mais utilizados em Odontologia como uma alternativa local. Metodologia: 180 (N) discos poliméricos com 15 ou 6 mm de diâmetro foram preparados em associação a 20% do antimicrobiano amoxicilina, azitromicina, clindamicina ou metronidazol sendo classificados como grupo F (filme) e M (malha). Foram confeccionados segundo os métodos de deposição e eletrofiação (fibras) respectivamente. Todos os discos foram armazenados em solução tampão (pH 5 ou 7.4) e alíquotas foram coletadas e analisadas por cromatografia líquida de alta performace (HPLC) em 8, 24, 48, 72, 96, 120, 144 e 168 horas. As espécimes foram pesadas após 3 e 6 meses de armazenamento nas soluções tampões para análise de degradação. Para a análise de citotoxicidade, os materiais foram cultivados com fibroblastos humanos por 24h, 48h e 72h e analisados por ensaio de MTT. A capacidade antimicrobiana dos discos foi determinada em cultura de P.gingivalis e S.pyogenes. Para o controle estrutural foram realizadas fotografias digitais e MEV dos espécimes controle, das interfaces (criofratura) e das espécimes degradadas. Resultados: A liberação farmacológica para os antimicrobianos na ordem pH levemente básico (7.4) e ácido (5.0) foi respectivamente: ME 70.03% (F) e 100% (M); 88,01% (F) e 19,4% (M). Para AM 38,73% (F) e 18,63% (M); 61,44% (F) e 47,93% (M). Para AZ 32,53% (F) e 82,85% (M); 46,78% (F) e 73,15% (M). Para CL 68,42% (F) e 81,10% (M); 76,47% (F) e 72,76% (M). A análise antimicrobiana demonstrou capacidade inibitória para S.pyogenes e P.gingivalis para todos os materiais testados, não havendo diferença significativa entre filme e malha dentro de cada grupo (p>0.05). A reação de citotoxicidade por MTT comprovou que os biomateriais testados são compatíveis com fibroblastos humanos e mais citocompatíveis que o controle PLLA, controle de vida e morte (p<0.05). As malhas demonstraram favorecimento do crescimento celular principalmente em 24 e 48 horas. A MEV demonstra um filme com superfície rugosa e malha com fibras e poros mimetizando a matriz extracelular. Após criofratura a MEV da interface comprovou incorporação do fármaco ao filme e malha, exceto para o ME, com cristais externos ao polímero. Após a degradação, os filmes de amoxicilina apresentaram maior degradação que PLLA no pH 5.0 (p=0.007) e pH 7.4 (p=0.046). Já para as malhas a azitromicina apresentou maior degradação que PLLA no pH 7.4 (p=0.031). Conclusão: O PLLA é um polímero cuja associação aos antimicrobianos utilizados mostrou-se segura, citocompatível e promissora na liberação de doses inibitórias contra os microrganismos P.gingivalis e S. pyogenes. A liberação farmacológica foi influenciada pela característica química do fármaco, apresentação do polímero (filme e malha) e pH da solução de armazenamento. Este estudo comprovou ser possível através de uma terapêutica medicamentosa local controlar ou prevenir infecções localizadas, sem que seja necessário o fármaco sistêmico. / Indiscriminate administration of systemic antimicrobial has undesirable effects such as antimicrobial selection, hypersensitivity, gastrointestinal commitment and toxicity. For an alternative to systemic antimicrobial therapy in Dentistry, use a biodegradable material of local application can present numerous advantages. The structural characteristics, cytocompatibility and ease of fabrication of the synthetic polymer poly-L- lactide acid (PLLA) enable this to be a carrier biomaterial. When associated with antimicrobials as amoxicillin (AM), azithromycin (AZ), clindamycin (CL) or metronidazole (ME) it can maintain constant the inhibitory concentrations for a long time, being able to prevent colonization of the main oral pathogens. Objective: To evaluate and compare the behavior of PLLA associated with the most useful antimicrobials in Dentistry as an alternative for prevention and treatment of infections. Methodology: 180 (N) polymer discs with 15 or 6 mm diameter were prepared in association with the antimicrobial concentration of 20% amoxicillin, metronidazole, clindamycin or azithromycin being classified as Group F (film) and M (mesh). They were made using the methods of deposition and electrospinning (nanofibers) respectively. All discs were stored in buffer solutions (pH 5 or 7.4) and aliquots were collected and analyzed by high performance chromatography (HPLC) on 8, 24, 48, 72, 96, 120 , 144 and 168 hours. Cytotoxicity of human fibroblasts was tested after 24h, 48h and 72h by the MTT reaction. The antimicrobial capacity of the disks was determined against P. gingivalis and S. pyogenes cultures. The specimens were weighed after 3 and 6 months of storage for degradation analysis. Specimens were also carried out by digital photos for structural control. SEM was used to control interfaces (freeze-fracture) and degradation description. Results: The drug release for antimicrobials in order slightly basic pH (7.4) and acid ( 5.0 ) was respectively : ME 70.03 % (F ) and 100% (M ) ; 88.01 % (F) and 19.4 % ( F ) . For AM 38.73 % (F) and 18.63% ( F ) ; 61.44 % (F) and 47.93 % ( F ) . To AZ 32.53 % (F) and 82.85 % (F ) ; 46.78 % (F) and 73.15% ( F ) . Cl 68.42 % (F) and 81.10 % ( F ) ; 76.47 % (F) and 72.76 % ( F ) . Antimicrobial analysis showed inhibitory capacity against S. pyogenes and P. gingivalis for all tested polymers. ANOVA showed no difference between film and mesh within each group (p> 0.05). The MTT reaction demonstrated that the biomaterials tested are compatible with human fibroblasts (p < 0.05). The meshes have shown a tendency to cell growth especially in 24 to 48 hours. The SEM images showed a film with a rough surface and mesh of nanofibers and pores mimicking the extracellular matrix and also proved incorporation of the drug to the film and mesh after the freeze-fracture interface, except for ME that was external to the polymer crystals. Degradation showed differences among Amoxicillin-film and PLLA pH 5.0 (p = 0.007) and pH 7.4 (p = 0.046). As for the meshes differences occurred only between azithromycin and the PLLA pH 7.4 (p = 0.031). Conclusion: The PLLA is a polymer biomaterial whose association to antimicrobial is safe, biocompatible and promising. It can inhibit P. gingivalis and S. pyogenes microorganisms. The drug release was influenced by the chemical characteristics of the drug, polymer performance (mesh and film) and the pH of the storage solution. This study proved a local drug system therapy to control or prevent localized infections without systemic doses.

Surface modification techniques have played important roles in various aspects of modern technology. They have been employed to improve substrates by altering surface physicochemical properties. An ideal surface modifying technique would be a method that is applicable to any kind of materials prepared from a wide range of polymers and that can occur under mild reaction conditions. The work in this thesis has utilized four main concepts: I) the development of a ‘grafting-from’ technique by covalently growing polymer grafts from particle surfaces, II) the presence of steric and electrosteric forces due to long-range repulsive interactions between particles, III) a combined surface grafting and layer-by-layer approach to create polyelectrolyte multilayers (PEMs) on particle surfaces to fabricate strong and functional materials, and IV) the roles of hydrophilic polymer grafts and substrate geometry on surface degradation. A non-destructive surface grafting technique was developed and applied to polylactide (PLA) particle surfaces. Their successful modification was verified by observed changes to the surface chemistry, morphology and topography of the particles. To quantify the aggregation behavior of grafted and non-grafted particles, force interaction measurements were performed using colloidal probe atomic force microscopy (AFM). Long-range repulsive interactions were observed when symmetric systems, i.e., hydrophilic polymer grafts on two interacting surfaces, and asymmetric system were applied. Electrosteric forces were observed when the symmetric substrates interacted at pH 7.4. When PEMs were alternately assembled on the surface of poly(L-lactide) (PLLA) particles, the grafted surfaces played a dominated role in altering the surface chemistry and morphology of the particles. Three-dimensional scaffolds of surface grafted particle coated with PEMs demonstrated high mechanical performance that agreed well with the mechanical performance of cancellous bone. Nanomaterials were used to functionalize the scaffolds and further influence their physicochemical properties. For example, when magnetic nanoparticles were used to functionalize the scaffolds, a high electrical conductivity was imparted, which is important for bone tissue regeneration. Furthermore, the stability of the surface grafted particles was evaluated in phosphate buffered saline (PBS) solution. The nature of the hydrophilic polymer grafts and the geometry of the PLLA substrates played central roles in altering the surface properties of films and particles. After 10 days of PBS immersion, larger alterations in the surface morphology were observed on the film compared with microparticles grafted with poly(acrylic acid) (PAA). In contrast to the PAA-grafted substrates, the morphology of poly(acrylamide) (PAAm)-grafted substrates was not affected by PBS immersion. Additionally, PAAm-grafted microparticulate substrates encountered surface degradation more rapidly than PAAm-grafted film substrates. / <p>QC 20151002</p>

A administração indiscriminada de antimicrobianos sistêmicos tem como principais efeitos indesejáveis a seleção antimicrobiana, hipersensibilidade, comprometimento gastrointestinal e toxicidade. A busca por uma alternativa à terapêutica antimicrobiana sistêmica em Odontologia através do uso de um material biodegradável de aplicação local pode apresentar inúmeras vantagens. As características estruturais, de citocompatibilidade e facilidade de fabricação do polímero sintético ácido poli-L-lactídeo (PLLA) permitem que este seja um carreador de fármacos como amoxicilina (AM), azitromicina (AZ), clindamicina (CL) ou metronidazol (ME) mantendo concentrações inibitórias constantes e por tempo prolongado, sendo capazes de prevenir a colonização dos principais patógenos orais. Objetivo: Avaliar e comparar o comportamento de filmes ou malhas de PLLA associados aos quatro antimicrobianos mais utilizados em Odontologia como uma alternativa local. Metodologia: 180 (N) discos poliméricos com 15 ou 6 mm de diâmetro foram preparados em associação a 20% do antimicrobiano amoxicilina, azitromicina, clindamicina ou metronidazol sendo classificados como grupo F (filme) e M (malha). Foram confeccionados segundo os métodos de deposição e eletrofiação (fibras) respectivamente. Todos os discos foram armazenados em solução tampão (pH 5 ou 7.4) e alíquotas foram coletadas e analisadas por cromatografia líquida de alta performace (HPLC) em 8, 24, 48, 72, 96, 120, 144 e 168 horas. As espécimes foram pesadas após 3 e 6 meses de armazenamento nas soluções tampões para análise de degradação. Para a análise de citotoxicidade, os materiais foram cultivados com fibroblastos humanos por 24h, 48h e 72h e analisados por ensaio de MTT. A capacidade antimicrobiana dos discos foi determinada em cultura de P.gingivalis e S.pyogenes. Para o controle estrutural foram realizadas fotografias digitais e MEV dos espécimes controle, das interfaces (criofratura) e das espécimes degradadas. Resultados: A liberação farmacológica para os antimicrobianos na ordem pH levemente básico (7.4) e ácido (5.0) foi respectivamente: ME 70.03% (F) e 100% (M); 88,01% (F) e 19,4% (M). Para AM 38,73% (F) e 18,63% (M); 61,44% (F) e 47,93% (M). Para AZ 32,53% (F) e 82,85% (M); 46,78% (F) e 73,15% (M). Para CL 68,42% (F) e 81,10% (M); 76,47% (F) e 72,76% (M). A análise antimicrobiana demonstrou capacidade inibitória para S.pyogenes e P.gingivalis para todos os materiais testados, não havendo diferença significativa entre filme e malha dentro de cada grupo (p>0.05). A reação de citotoxicidade por MTT comprovou que os biomateriais testados são compatíveis com fibroblastos humanos e mais citocompatíveis que o controle PLLA, controle de vida e morte (p<0.05). As malhas demonstraram favorecimento do crescimento celular principalmente em 24 e 48 horas. A MEV demonstra um filme com superfície rugosa e malha com fibras e poros mimetizando a matriz extracelular. Após criofratura a MEV da interface comprovou incorporação do fármaco ao filme e malha, exceto para o ME, com cristais externos ao polímero. Após a degradação, os filmes de amoxicilina apresentaram maior degradação que PLLA no pH 5.0 (p=0.007) e pH 7.4 (p=0.046). Já para as malhas a azitromicina apresentou maior degradação que PLLA no pH 7.4 (p=0.031). Conclusão: O PLLA é um polímero cuja associação aos antimicrobianos utilizados mostrou-se segura, citocompatível e promissora na liberação de doses inibitórias contra os microrganismos P.gingivalis e S. pyogenes. A liberação farmacológica foi influenciada pela característica química do fármaco, apresentação do polímero (filme e malha) e pH da solução de armazenamento. Este estudo comprovou ser possível através de uma terapêutica medicamentosa local controlar ou prevenir infecções localizadas, sem que seja necessário o fármaco sistêmico. / Indiscriminate administration of systemic antimicrobial has undesirable effects such as antimicrobial selection, hypersensitivity, gastrointestinal commitment and toxicity. For an alternative to systemic antimicrobial therapy in Dentistry, use a biodegradable material of local application can present numerous advantages. The structural characteristics, cytocompatibility and ease of fabrication of the synthetic polymer poly-L- lactide acid (PLLA) enable this to be a carrier biomaterial. When associated with antimicrobials as amoxicillin (AM), azithromycin (AZ), clindamycin (CL) or metronidazole (ME) it can maintain constant the inhibitory concentrations for a long time, being able to prevent colonization of the main oral pathogens. Objective: To evaluate and compare the behavior of PLLA associated with the most useful antimicrobials in Dentistry as an alternative for prevention and treatment of infections. Methodology: 180 (N) polymer discs with 15 or 6 mm diameter were prepared in association with the antimicrobial concentration of 20% amoxicillin, metronidazole, clindamycin or azithromycin being classified as Group F (film) and M (mesh). They were made using the methods of deposition and electrospinning (nanofibers) respectively. All discs were stored in buffer solutions (pH 5 or 7.4) and aliquots were collected and analyzed by high performance chromatography (HPLC) on 8, 24, 48, 72, 96, 120 , 144 and 168 hours. Cytotoxicity of human fibroblasts was tested after 24h, 48h and 72h by the MTT reaction. The antimicrobial capacity of the disks was determined against P. gingivalis and S. pyogenes cultures. The specimens were weighed after 3 and 6 months of storage for degradation analysis. Specimens were also carried out by digital photos for structural control. SEM was used to control interfaces (freeze-fracture) and degradation description. Results: The drug release for antimicrobials in order slightly basic pH (7.4) and acid ( 5.0 ) was respectively : ME 70.03 % (F ) and 100% (M ) ; 88.01 % (F) and 19.4 % ( F ) . For AM 38.73 % (F) and 18.63% ( F ) ; 61.44 % (F) and 47.93 % ( F ) . To AZ 32.53 % (F) and 82.85 % (F ) ; 46.78 % (F) and 73.15% ( F ) . Cl 68.42 % (F) and 81.10 % ( F ) ; 76.47 % (F) and 72.76 % ( F ) . Antimicrobial analysis showed inhibitory capacity against S. pyogenes and P. gingivalis for all tested polymers. ANOVA showed no difference between film and mesh within each group (p> 0.05). The MTT reaction demonstrated that the biomaterials tested are compatible with human fibroblasts (p < 0.05). The meshes have shown a tendency to cell growth especially in 24 to 48 hours. The SEM images showed a film with a rough surface and mesh of nanofibers and pores mimicking the extracellular matrix and also proved incorporation of the drug to the film and mesh after the freeze-fracture interface, except for ME that was external to the polymer crystals. Degradation showed differences among Amoxicillin-film and PLLA pH 5.0 (p = 0.007) and pH 7.4 (p = 0.046). As for the meshes differences occurred only between azithromycin and the PLLA pH 7.4 (p = 0.031). Conclusion: The PLLA is a polymer biomaterial whose association to antimicrobial is safe, biocompatible and promising. It can inhibit P. gingivalis and S. pyogenes microorganisms. The drug release was influenced by the chemical characteristics of the drug, polymer performance (mesh and film) and the pH of the storage solution. This study proved a local drug system therapy to control or prevent localized infections without systemic doses.

No description available.

[EN] Articular cartilage is a tissue with low capacity for self-restoration due to its avascularity and low cell population. It is located on the surface of the subchondral bone covering the diarthrodial joints. Degeneration of articular cartilage can appear in athletes, in people with genetic degenerative processes (osteoarthritis or rheumatoid arthritis) or due to a trauma; what produces pain, difficulties in mobility and progressive degeneration that finally leads to joint failure. Self-restoration is only produced when the defect reaches the subchondral bone and bone marrow mesenchymal stem cells (MSCs) invade the defect. However, this new formed tissue is a fibrocartilaginous type cartilage and no a hyaline cartilage, which finally leads to degeneration. Transplantation of autologous chondrocytes has been proposed to regenerate articular cartilage but this therapy fails mainly to the absence of a material support (scaffold) for the adequate stimulation of cells. Matrix-induced autologous chondrocyte implantation uses a collagen hydrogel as scaffold for chondrocytes; however, it does not have the adequate mechanical properties, does not provide the biological cues for cells and regenerated tissue is not articular cartilage but fibrocartilage. Different approaches have been done until now in order to obtain a scaffold that mimics better articular cartilage properties and composition. Hydrogels are a good option as they retain high amounts of water, in a similar way to the natural tissue, and can closely mimic the composition of natural tissue by the combination of natural derived hydrogels. Their three-dimensionality plays a critical role in articular cartilage tissue engineering to maintain chondrocyte function, since monolayer culture of chondrocytes makes them dedifferentiate towards a fibroblast-like phenotype secreting fibrocartilage. Recently, injectable hydrogels have attracted attention for the tissue engineering of articular cartilage due to their ability to encapsulate cells, injectability in the injury with minimal invasive surgeries and adaptability to the shape of the defect. Following this new approach we aimed at synthesizing two new families of injectable hydrogels based on the natural protein gelatin for the tissue engineering of articular cartilage. The first series of materials consisted on the combination of injectable gelatin with loose reinforcing polymeric microfibers to obtain injectable composites with improved mechanical properties. Our results demonstrate that there is an influence of the shape and distribution of the fibers in the mechanical properties of the composite. More importantly bad fiber-matrix interaction is not able to reinforce the hydrogel. Due to this, our composites were optimized by improving matrix-fiber interaction through a hydrophilic grafting onto the microfibers, with very successful results. The second series of materials were inspired in the extracellular matrix of articular cartilage and consisted of injectable mixtures of gelatin and hyaluronic acid. Gelatin molecules in the mixtures provided integrin adhesion sites to cells, and hyaluronic acid increased the mechanical properties of gelatin. This combination demonstrated ability for the differentiation of MSCs towards the chondrocytic lineage and makes these materials very good candidates for the regeneration of articular cartilage. The last part of this thesis is dedicated to the synthesis of a non-biodegradable material with mechanical properties, swelling and permeability similar to cartilage. This material intends to be used as a platform in a bioreactor in which the typical loads of the joint are simulated, so that the hydrogels or scaffolds would fit in the recesses in the platform. The function of the platform is to simulate the effect of the surrounding tissue on the scaffold after implantation and could reduce animal experimentation by simulating in vivo conditions. / [ES] El cartílago articular es un tejido con baja capacidad de auto-reparación debida a su avascularidad y baja población celular. Se encuentra en la superficie del hueso subcondral cubriendo las articulaciones. La degeneración del cartílago articular puede aparecer en atletas, en personas con procesos genéticos degenerativos o debido a un trauma; lo que produce dolor, dificultades en la movilidad y degeneración progresiva que lleva al fallo de la articulación. La auto-reparación sólo se produce cuando el defecto alcanza el hueso subcondral y las células madre (MSCs) de la médula ósea invaden el defecto. Sin embargo, este nuevo tejido es un cartílago de tipo fibrocartilaginoso y no un cartílago hialino, el cual finalmente lleva a la degeneración. El trasplante de condrocitos autólogos ha sido propuesto para regenerar el cartílago articular pero esta terapia falla principalmente por la ausencia de un material soporte (scaffold) que estimule adecuadamente a las células. El implante de condrocitos autólogos mediante un hidrogel de colágeno no tiene las propiedades mecánicas apropiadas, no proporciona las señales biológicas a las células y el tejido regenerado no es cartílago articular sino fibrocartílago. Se han realizado diferentes enfoques para obtener un scaffold que mimetice mejor las propiedades y la composición del cartílago articular. Los hidrogeles son una buena opción ya que retienen elevadas cantidades de agua, de forma similar al tejido natural, y pueden imitar de cerca la composición del tejido natural mediante la combinación de derivados de hidrogeles naturales. Su tridimensionalidad juega un papel crítico para mantener la función de los condrocitos, ya que el cultivo en monocapa de los condrocitos hace que desdiferencien hacia un fenotipo similar al fibroblasto secretando fibrocartílago. Los hidrogeles inyectables han acaparado la atención en la ingeniería tisular de cartílago articular debido a su capacidad para encapsular células, su inyectabilidad en el daño con cirugías mínimamente invasivas y su adaptabilidad a la forma del defecto. Siguiendo este nuevo enfoque hemos sintetizado dos nuevas familias de hidrogeles inyectables basados en la proteína natural gelatina para la ingeniería tisular del cartílago articular. La primera serie de materiales combina una gelatina inyectable con microfibras poliméricas sueltas de refuerzo para obtener composites inyectables con propiedades mecánicas mejoradas. Nuestros resultados demuestran que hay una influencia de la forma y la distribución de las fibras en las propiedades mecánicas del composite. Además, la mala interacción entre las fibras y la matriz no es capaz de reforzar el hidrogel. Debido a esto, nuestros composites han sido optimizados mediante la mejora de la interacción fibra-matriz a través de un injerto hidrófilo sobre las microfibras, con resultados muy exitosos. La segunda serie de materiales se ha inspirado en la matriz extracelular del cartílago articular y ha consistido en mezclas inyectables de gelatina y ácido hialurónico. Las moléculas de gelatina proporcionan los dominios de adhesión mediante integrinas a las células, y el ácido hialurónico aumenta las propiedades mecánicas de la gelatina. Esta combinación ha demostrado la habilidad para la diferenciación de MSCs hacia el linaje condrocítico y convierte a estos materiales en buenos candidatos para la regeneración del cartílago articular. La última parte de esta tesis se dedica a la síntesis de un material no biodegradable con propiedades mecánicas, hinchado y permeabilidad similar al cartílago. Este material pretende ser empleado como plataforma en un biorreactor en el que se simulan las cargas típicas de las articulaciones, de forma que los scaffolds encajarían en los huecos de la plataforma. Su función es simular el efecto del tejido circundante en el scaffold después de su implantación y podría reducir la experimentación anim / [CA] El cartílag articular es un teixit amb baixa capacitat d'auto-reparació deguda a la seua avascularitat i baixa població cel·lular. Es troba en la superfície de l'ós subcondral cobrint les articulacions. La degeneració del cartílag articular pot aparèixer en atletes, en persones amb processos genètics degeneratius o degut a un trauma; produeix dolor, dificultats a la mobilitat i degeneració progressiva que finalment porta a la fallida de l'articulació. L'auto-reparació es produeix quan el defecte arriba fins a l'ós subcondral i les cèl·lules mare (MSCs) de la medul·la òssia envaeixen el defecte. No obstant això, aquest nou teixit format es un cartílag de tipus fibrocartilaginós i no un cartílag hialí, el qual finalment porta a la degeneració. El transplantament de condròcits autòlegs ha sigut proposat per a regenerar el cartílag articular però aquesta teràpia falla principalment per la absència d'un material de suport (scaffold) que estimuli adequadament a les cèl·lules. L'implant de condròcits autòlegs en un hidrogel de col·lagen per als condròcits no té les propietats mecàniques apropiades, no proporciona les senyals biològiques a les cèl·lules i el teixit regenerat no és cartílag articular sinó fibrocartílag. Diferents enfocs han sigut realitzats fins ara per a obtenir un scaffold que mimetitzi millor les propietats i la composició del cartílag articular. Els hidrogels son una bona opció ja que retenen elevades quantitats d'aigua, de forma similar al teixit natural, i poden imitar acuradament la composició del teixit natural mitjançant la combinació d'hidrogels naturals. La seua tridimensionalitat juga un paper crític per a mantenir la funció dels condròcits, ja que el cultiu en monocapa dels condròcits fa que aquests desdiferencien cap a un fenotip similar al fibroblàstic secretant fibrocartílag. Recentment, els hidrogels injectables han acaparat l'atenció en l' enginyeria tissular de cartílag articular degut a la seua capacitat per a encapsular cèl·lules, la seua injectabilitat en el dany amb cirurgies mínimament invasives i la seua adaptabilitat a la forma del defecte. Seguint aquesta nova aproximació hem sintetitzat dues noves famílies d'hidrogels injectables basats en la proteïna natural gelatina per a l'enginyeria tissular del cartílag articular. La primera sèrie de materials combina una gelatina injectable amb microfibres polimèriques soltes de reforç per a obtenir compòsits injectables amb propietats mecàniques millorades. Els nostres resultats demostren que hi ha una influència de la forma i la distribució de les fibres en les propietats mecàniques del compòsit. Més importantment, la mala interacció entre les fibres i la matriu no és capaç de reforçar l'hidrogel. Degut a això, els nostres compòsits han segut optimitzats mitjançant la millora de la interacció fibra-matriu a traves d'un empelt hidròfil sobre les fibres, amb resultats molt exitosos. La segona sèrie de materials està inspirada en la matriu extracel·lular del cartílag articular i ha consistit en mescles injectables de gelatina i àcid hialurònic. Les molècules de gelatina proporcionen els dominis d'adhesió mitjançant integrines a les cèl·lules, i l'àcid hialurònic augmenta les propietats mecàniques de la gelatina. Esta combinació ha demostrat l'habilitat per a la diferenciació de MSCs cap al llinatge condrocític i converteix a aquests materials en bons candidats per a la regeneració del cartílag articular. L'última part d'aquesta tesi és dedicada a la síntesi d'un material no biodegradable amb propietats mecàniques, inflat i permeabilitat similar al cartílag. Aquest material pretén ser utilitzat com a plataforma a un bioreactor que simula les cargues típiques de les articulacions, de manera que els hidrogels o scaffolds encaixarien als buits de la plataforma. La seua funció es simular l'efecte del teixit circumdant al scaffold després d / Poveda Reyes, S. (2016). Protein-based injectable hydrogels towards the regeneration of articular cartilage [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/61392 / Premios Extraordinarios de tesis doctorales

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[EN] Nowadays, one of the biggest concerns that permanently keep the attention of main important sectors of human society is health. Modern medical science is compromised with not only providing good adequate treatments but also effective specific solutions for each type of disease or human pathology. In this direction, innovative approaches like tissue engineering or regenerative medicine, controlled drug delivery systems and nanomedicines emerge to bring alternatives to situations hard to solve with conventional treatment and strategies, including the replacement of damaged or diseases tissues and/or organs. Specifically, this research is mainly aimed to design a combined system for controlled, stable and localized release of therapeutic agents that are able to exert their effect selectively on the area that warrants treatment. This construct will have enough versatility to be adapted to almost any kind of treatment, from cancer to tissue regeneration, always that the key requirement of the treatment was the need to provide the treatment of localized, stable and controlled manner. With the purposes of making easier the understanding as well as the design of the system, I was decided, for the proof of concept, to use drugs and materials with known activity applied on tissue regeneration and for the treatment of chronic wounds. The system in question consists of three main elements: 1) The first element is the polymer conjugates of therapeutic agents, which contribute to increasing the selectivity of the therapeutic action of the drug, as well as improved stability, bioavailability and biocompatibility thereof. If the drug is hydrophobic, conjugation contributes to increase its solubility in water, and in the case of proteins used as therapeutic agents, the combination helps reduce the body's immune response, increasing the chance of successful of the treatment. 2) The second element are the biodegradable polymeric microparticles, which in this case act like encapsulation agents for polymeric conjugate , thus allowing to have a second control point in the release kinetics of the therapeutic agents . Simultaneously, the microparticles also play a role in modifying the texture of the final construct, ascribing mechanical and physicochemical properties that help to improve some biological properties of the final material, such as the affinity, adhesion and cell proliferation. 3) The third element consists of a nanoporous membrane made of a biodegradable polymer by electrospinning, which constitute the unifier element of the whole system. This membrane provides manageability to the construct and is itself the last point of control in the release kinetics of the therapeutic agent or agents. Besides, it must be biocompatible and stable at ambient conditions, since this probably is going to be exposed to the environment while protecting the wound, in the case of this kind of application. These three elements, which themselves are complex systems separately, are systematically combined to achieve a synergistic relationship between them so that each one power the qualities of the other two. The resulting construct was characterized and it demonstrated to have characteristic properties that can be used as a control parameter during manufacture of this new material. Also, preliminary biological studies developed "in vitro" indicated that the proposed system may be a good candidate for deeper studies as alternative treatment for chronic wounds and other pathologies that require localized administration for long periods of time. / [ES] Actualmente, una de las mayores preocupaciones que permanentemente laman la atención de los principales sectores de la sociedad humana es la salud. La ciencia médica moderna está comprometida no solo con suministrar tratamientos adecuados, sino más bien ofrecer soluciones efectivas y específicas para cada tipo de enfermedad o patología humana. En este sentido, estrategias innovadoras como la ingeniería de tejidos o la medicina regenerativa, los sistemas de liberación controlada de fármacos y las nanomedicinas, surgen como buenas alternativas para abordar situaciones difíciles de resolver aplicando los tratamientos y estrategias terapéuticas convencionales, como es el caso cuando se hace necesario reemplazar tejidos o incluso órganos dañados por algún traumatismo o enfermedad. Concretamente, el presente trabajo de investigación tiene por objetivo principal diseñar un sistema combinado para la liberación controlada, estable y localizada de agentes terapéuticos que sean capaces de ejercer su efecto de forma selectiva sobre la zona que amerita el tratamiento. Este constructo tendrá la versatilidad suficiente como para poder adaptarse a casi cualquier tipo de tratamiento, desde el cáncer hasta la regeneración de tejido, siempre que el requisito clave del tratamiento sea la necesidad de suministrar el tratamiento de manera localizada, estable y controlada. Para efectos de facilitar la compresión y el diseño del sistema se escogió para la prueba de concepto materiales y fármacos asociados a la regeneración de tejidos, como tratamiento para casos de heridas crónicas. El sistema en cuestión está constituido por tres elementos principales: 1) El primer elemento son los conjugados poliméricos de agentes terapéuticos que contribuirán a aumentar la selectividad de la acción terapéutica del fármaco, así como también a mejora la estabilidad, biodisponibilidad y biocompatibilidad de los mismos. En caso de que el fármaco sea hidrofóbico, la conjugación contribuye a aumentar su solubilidad en agua, y en el caso de usar proteínas como agentes terapéuticos, la conjugación contribuye a disminuir la respuesta inmunológica del cuerpo incrementando las posibilidad de éxito del tratamiento. 2) El segundo elemento son micropartículas poliméricas biodegradables, que en este caso actúan con agentes de encapsulación para los conjugados poliméricos, permitiendo así contar con un segundo punto de control en la cinética de liberación de los agentes terapéuticos. Simultáneamente, las micropartículas también cumplen un papel de modificador de la textura del constructo final, adjudicándole propiedades mecánica y fisicoquímicas que contribuyen a mejorar las propiedades biológicas del material final, como son la afinidad, la adhesión y la proliferación celular. 3) El tercer elemento consiste en una membrana polimérica biodegradable nanoporosa hecha por electrospinning, que constituyen el elemento unificados del sistema, aporta manejabilidad al constructo y es en sí mismo el último punto de control en la cinética de liberación del agente terapéutico. Este último debe ser biocompatible y estable en condiciones ambientales, puesto que probablemente este expuesto al ambiente mientras protege la herida, en el caso concreto de este tipo de aplicación. Estos tres elementos, que en sí mismos constituyen sistemas complejos por separado, se han combinado sistemáticamente para alcanzar una relación sinérgica entre ellos de manera que cada uno potencia las cualidades de los otros dos. El constructo resultante se caracterizó demostrando tener propiedades características que se pueden utilizar como parámetro de control durante la fabricación del mismo. Así mismo estudios in vitro del sistema desarrollado señalan que puede ser un buen candidato para el tratamiento de heridas crónicas entre otras patologías que requieran tratamientos localizados. / [CA] Actualment, una de les majors preocupacions que permanentment llepen l'atenció dels principals sectors de la societat humana és la salut. La ciència mèdica moderna està compromesa no solament amb subministrar tractaments adequats, sinó més aviat oferir solucions efectives i específiques per a cada tipus de malaltia o patologia humana. En aquest sentit, estratègies innovadores com l'enginyeria de teixits o la medicina regenerativa, els sistemes d'alliberament controlat de fàrmacs i les nanomedicines, sorgeixen com a bones alternatives per a abordar situacions difícils de resoldre aplicant els tractaments i estratègies terapèutiques convencionals, com és el cas quan es fa necessari reemplaçar teixits o fins i tot òrgans danyats per algun traumatisme o malaltia. Concretament, el present treball de recerca té per objectiu principal dissenyar un sistema combinat per a l'alliberament controlat, estable i localitzada d'agents terapèutics que seguen capaços d'exercir el seu efecte de forma selectiva sobre la zona que amirita el tractament. Aquest constructe tindrà la versatilitat suficient com per a poder adaptar-se a quasi qualsevol tipus de tractament, des del càncer fins a la regeneració de teixit, sempre que el requisit clau del tractament sega la necessitat de subministrar el tractament de manera localitzada, estable i controlada. Per a efectes de facilitar la compressió i el disseny del sistema es va escollir per a la prova de concepte materials i fàrmacs associats a la regeneració de teixits, com a tractament per a casos de ferides cròniques. El sistema en qüestió està constituït per tres elements principals: 1) El primer element són els conjugats polimèrics d'agents terapèutics que contribuiran a augmentar la selectivitat de l'acció terapèutica del fàrmac, així com també a millora l'estabilitat, biodisponibilitat i biocompatibilitat dels mateixos. En cas que el fàrmac sega hidrofòbic, la conjugació contribueix a augmentar la seua solubilitat en aigua, i en el cas d'usar proteïnes com a agents terapèutics, la conjugació contribueix a disminuir la resposta immunològica del cos incrementant les possibilitat d'èxit del tractament. 2) El segon element són microparticles polimèriques biodegradables, que en aquest cas actuen amb agents d'encapsulació per als conjugats polimèrics, permetent així comptar amb un segon punt de control en la cinètica d'alliberament de l'agent terapèutics. Simultàniament, les microparticles també compleixen un paper de texturitzant del constructe final, adjudicant-li propietats mecànica i fisicoquímiques que contribueixen a millorar la propietats biològiques del material final, com són l'afinitat, l'adhesió i la proliferació cel·lular. 3) El tercer element consisteix en una membrana polimèrica biodegradable nanoporosa feta per electrospinning, que constitueixen el element unificats del sistema, aporta manejabilitat al constructe i és en si mateix el ultimi punt de control en la cinètica d'alliberament de l'agent terapèutic. Aquest últim ha de ser biocompatible i estable en condicions ambientals, ja que probablement aquest exposat a l'ambient mentre protegeix la ferida, en el cas concret d'aquest tipus d'aplicació. Aquests tres elements que en si mateixos constitueixen sistemes complexos per separat, s'han combinat sistemàticament per a aconseguir una relació sinergètica entre ells de manera que cadascun potencia les qualitats dels altres dos. El constructe resultant es va caracteritzar demostrant tenir propietats característiques que es poden utilitzar com a paràmetre de control durant la fabricació del mateix. Així mateix estudis in vitro del sistema desenvolupat assenyalen que pot ser un bon candidat per al tractament de ferides cròniques entre altres patologies que requeriren tractaments localitzats. / Rodríguez Escalona, GDJ. (2016). DEVELOPMENT OF CONTROLLED DRUG DELIVERY SYSTEMS OF POLYMERIC NANOMEDICINES ASSOCIATED TO SCAFFOLDS FOR TISSUE REGENERATION [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/63231