Paget’s disease is characterised by focal regions of accelerated bone turnover. The aetiology is unknown, but genetic and environmental factors have been implicated. Pagetic lesions contain increased numbers of osteoclasts with abnormal morphology, so an osteoclast defect has been considered central to the pathogenesis. However, given osteoblasts regulate osteoclast differentiation and activity; osteoblast abnormalities may be important in the disease. This study aimed to identify features of pagetic osteoblasts that could clarify their role in Paget’s disease. Gene expression in osteoblasts and bone marrow cultured from pagetic lesions of 23 patients was compared to cells from unaffected tissue using both microarrays and real time RT-PCR. The results indicated global changes in gene expression in pagetic osteoblasts. A number of genes that can stimulate osteoclastogenesis, including interleukins 6 and 1β, and monocyte chemotactic factor 1 were up-regulated, but the RANKL/OPG ratio tended to be decreased. Genes involved in osteoblast differentiation were down-regulated, including the transcription factors RUNX2, DLX5 and SATB2, the osteogenic factor BMP2, and the matrix proteins osteocalcin and bone sialoprotein. Markers of less mature osteoblastic cells, alkaline phosphatase and matrix gla protein were up-regulated. The intermediate filament, keratin 18, was very significantly up-regulated in pagetic cells. Over-expression of this protein in osteoblasts using an adenoviral vector produced some changes in gene expression, but did not produce an overtly pagetic phenotype. Over-expression of SQSTM1 mutants found in some patients with Paget’s disease also produced only minor changes in osteoblast phenotype. The RNA from the primary cell cultures was also used to investigate the presence of measles virus and somatic mutations in SQSTM1 in the disease, but neither were identified in any of the patients. These results suggest that there are important changes in pagetic osteoblasts that are maintained when the cells are removed from the affected bone microenvironment. These include enhanced production of factors to stimulate osteoclastogenesis, while osteoblast differentiation and activity may be impaired. We were unable to identify genetic or environmental factors that could trigger these changes. The pagetic osteoblast is distinct from control cells, and is likely to contribute to the development of Paget’s disease.

Paget’s disease is characterised by focal regions of accelerated bone turnover. The aetiology is unknown, but genetic and environmental factors have been implicated. Pagetic lesions contain increased numbers of osteoclasts with abnormal morphology, so an osteoclast defect has been considered central to the pathogenesis. However, given osteoblasts regulate osteoclast differentiation and activity; osteoblast abnormalities may be important in the disease. This study aimed to identify features of pagetic osteoblasts that could clarify their role in Paget’s disease. Gene expression in osteoblasts and bone marrow cultured from pagetic lesions of 23 patients was compared to cells from unaffected tissue using both microarrays and real time RT-PCR. The results indicated global changes in gene expression in pagetic osteoblasts. A number of genes that can stimulate osteoclastogenesis, including interleukins 6 and 1β, and monocyte chemotactic factor 1 were up-regulated, but the RANKL/OPG ratio tended to be decreased. Genes involved in osteoblast differentiation were down-regulated, including the transcription factors RUNX2, DLX5 and SATB2, the osteogenic factor BMP2, and the matrix proteins osteocalcin and bone sialoprotein. Markers of less mature osteoblastic cells, alkaline phosphatase and matrix gla protein were up-regulated. The intermediate filament, keratin 18, was very significantly up-regulated in pagetic cells. Over-expression of this protein in osteoblasts using an adenoviral vector produced some changes in gene expression, but did not produce an overtly pagetic phenotype. Over-expression of SQSTM1 mutants found in some patients with Paget’s disease also produced only minor changes in osteoblast phenotype. The RNA from the primary cell cultures was also used to investigate the presence of measles virus and somatic mutations in SQSTM1 in the disease, but neither were identified in any of the patients. These results suggest that there are important changes in pagetic osteoblasts that are maintained when the cells are removed from the affected bone microenvironment. These include enhanced production of factors to stimulate osteoclastogenesis, while osteoblast differentiation and activity may be impaired. We were unable to identify genetic or environmental factors that could trigger these changes. The pagetic osteoblast is distinct from control cells, and is likely to contribute to the development of Paget’s disease.

La maladie de Paget est une ostéopathie caractérisée par une augmentation multifocale du remodelage osseux, qui débute par un front de résorption osseuse, suivi d'une formation osseuse excessive, avec un remodelage anarchique et intense. Les ostéoclastes "OCs" impliqués dans la phase initiale sont les cellules responsables dans l'initiation du processus pagétique. Les OCs pagétiques sont caractérisés par une résistance à l'apoptose, et des anomalies du processus de l'autophagie "en particulier défaut d'induction"; afin de voir si ces deux caractéristiques étaient liées, nous avons émis l'hypothèse d’un rôle des complexes Bcl2-Beclin1. Beclin-1 est une protéine inductrice de l'autophagie qui peut lier les protéines anti-apoptotiques de la famille Bcl-2; Bcl-2 inhibe alors Beclin-1 "et donc l'induction de l'autophagie" en conservant ses fonctions anti-apoptotiques. Dans le but d'étudier l'impact de l'expression de Bcl2 sur l’autophagie dans les OCs humains, nous avons utilisé un modèle de différenciation in vitro à partir de monocytes dérivés de sang de cordon ombilical, cultivés en présence de RANKL et MCSF pendant 21 jours. Ces conditions permettent d'obtenir des cellules multinucléées au phénotype ostéoclastique. Pour augmenter l’expression de Bcl-2 dans les OCs et analyser son impact sur l’autophagie par interaction avec Beclin-1, les cultures ont été stimulées par TNFα ou RANKL dans le but d'induire une activation de NF-κB. L'expression de Beclin1 et Bcl2 a été confirmée par immunobuvardage dans les OCs. L’autophagie était induite dans les cultures réalisées en conditions stringentes "milieu pauvre en nutriments", sans variation de l'expression de Bcl2 ou Beclin 1 selon les conditions, et sans impact de TNFa ou RANKL. TNFa stimulait de manière significative l'activation de NF-kB dans les cellules HEK mais pas dans les OCs. Toutefois, et quelque soit les conditions, les immunoprécipitations ne permettaient pas de retrouver d'association entre Beclin1 et Bcl2. En revanche, le partenaire d'interaction classique de Beclin1, PI3K type III, était associé à Beclin1. En conclusion, notre travail n'a pas permis d'étudier la formation des complexes Beclin1/Bcl2 et les relations entre apoptose et autophagie, en partie du fait de la complexité du modèle "effets multiples de NF-kB et TNFa" ce qui n'exclut pas l'hypothèse initiale "à ré-évaluer par une méthodologie plus appropriée". En revanche les différentes techniques d'analyse sont maintenant au point pour la poursuite de l'étude. / Abstract : Paget's disease is an osteopathy characterized by a multifocal increase in bone remodeling, which begins with excessive bone resorption followed by increased bone formation. Osteoclasts "OCs" were incriminated in the initiation of the pagetic process. Pagetic OCs are characterized by a resistance to apoptosis, and abnormalities in the process of autophagy “in particular induction defect”. In order to define whether these two characteristics were linked, we hypothesized the role of Bcl2-Beclin1 complexes. Beclin-1 is an autophagy-inducing protein that can bind anti-apoptotic proteins of the Bcl-2 family; Bcl-2 then inhibits Beclin-1 "and thus the induction of autophagy" while retaining its anti-apoptotic functions. To study the impact of Bcl2 expression on autophagy in human OCs, we used an in vitro differentiation model that uses monocytes, which are derived from umbilical cord blood and grown in the presence of RANKL and MCSF for 21 days. These conditions make it possible to obtain multinucleated cells with an osteoclastic phenotype. To increase the expression of Bcl-2 in OCs and analyze its impact on autophagy due to its interaction with Beclin-1, cultures were stimulated with TNFα or RANKL in order to induce NF-κB activation. The expression of Beclin1 and Bcl2 was confirmed by immunoblotting of Ocs cell lysates. Autophagy was induced in cultures carried out under stringent conditions "nutriment-deprived mediun", but we did not observe any variation in the expression of Bcl2 or Beclin 1 according to the culture conditions or TNFα or RANKL stimulation. TNFα significantly stimulated the activation of NF-κB in HEK cells but not in OCs. However, whatever the conditions, results from immunoprecipitaion experiments did not reveal any association between Beclin1 and Bcl2. On the other hand, the classic interaction partner of Beclin1, PI3K type III, was associated with Beclin1. In conclusion, our work did not allow us to demonstrate the formation of Beclin1 / Bcl2 complexes and the relationship between apoptosis and autophagy, partly because of the complexity of the model "multiple effects of NF-κB and TNFα". Our initial hypothesis should thereby be re-evaluated using a more appropriate methodology. On the other hand, the different techniques are now ready for further study.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21957号 / 医博第4499号 / 新制||医||1037(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 河本 宏, 教授 濵﨑 洋子, 教授 武藤 学 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20245号 / 医博第4204号 / 新制||医||1020(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 松田 道行, 教授 羽賀 博典, 教授 鈴木 茂彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Paget’s disease (PDB) is the second most common metabolic bone disease after osteoporosis, affecting up to 3% of adults over age 55. It is characterized by focal lesions of bone resorbed by hyperactive osteoclasts coupled with rapid formation of highly disorganized, low quality bone formed by osteoblasts. Such lesions cause skeletal deformity, fractures, and other symptoms that significantly decrease quality of life. In 2001, mutations in the SQSTM1/p62 gene were found in a subset of Paget’s patients. The work summarized in this dissertation sought to answer two broad questions: what is the function of p62 in normal bone homeostasis and how do PDB-associated mutations alter it? These studies took advantage of two mouse models: p62 knock-out (KO) mice, and p62P394L “knock-in” (KI) mice carrying the most common PDB-associated mutation. KO, KI, and wildtype (WT) controls were aged to one year for skeletal-histological characterization. No differences were observed in a variety of bone parameters between WT and KO bones, while bones from age-matched KI mice exhibited a 33% decrease in bone volume and a 25% increase in osteoclast formation. In vivo, TNF-α caused a potent induction of osteoclastogenesis in calvariae of WT and KI, but not KO, mice. In vitro, RANKL induced osteoclast formation in a dose-dependent manner in WT and KI, but not KO, cultures. Gene expression profiling of RANKL-treated osteoclast progenitors from WT, KO, and KI mice was then performed to identify the changes in signaling pathways responsible for these effects. Surprisingly, gene expression patterns from all three groups were consistent with robust activation of NFκB signaling in RANKL-treated samples, indicating that p62 is dispensable for RANKL activation of NFκB. Interestingly, gene expression patterns in KO cells suggested impaired proliferation and response to reactive oxygen species (ROS), a finding which was confirmed in cell culture experiments. In contrast, KI cells displayed enrichment for genes associated with the unfolded protein response, consistent with p62’s role in ubiquitin-mediated protein degradation via proteolysis and autophagy. These studies have therefore generated several novel hypotheses concerning the role of p62 in both normal bone homeostasis and Paget’s disease of bone.

Le terme « cément » est utilisé pour désigner l’ensemble des tissus conjonctifs minéralisés retrouvés sur la surface externe de la racine d’une dent ainsi que sur certaines zones de l’émail ou au niveau du foramen apical. Il appartient à deux unités fonctionnelles : la dent et le parodonte et constitue avec l’os alvéolaire un point d’attache essentiel du ligament alvéolo-dentaire. Dans certaines conditions non encore élucidées la synthèse de l’une de ses variétés, le cément cellulaire mixte stratifié, est excessive, elle dépasse la « normalité » : il s’agit d’une hypercémentose. Une revue critique de la littérature nous a permis de mettre en évidence un certain nombre de problématiques concernant sa définition, sa classification, sa fréquence, ses étiologies et certaines de ses caractéristiques anatomiques. Afin d’y répondre nous avons élaboré un protocole d’étude dont le matériel comprenait trois séries d’Hommes sub-actuels (675 individus ; 8861 dents dont 419 hypercémentosées) et dont les méthodes ont fait appel à la photographie, la radiographie, la stéréomicroscopie, la microscopie électronique à balayage et l’histologie. Au terme de notre étude nous avons mis au point une définition et une classification de l’hypercémentose reposant sur des critères reproductibles, nous avons évalué sa fréquence au sein de grands échantillons et déterminé ses principales étiologies (éruption continue liée à la perte des dents antagonistes, parodontite apicale, atteintes parodontales, inclusion dentaire, pathologies générales, syndromes génétiques, hérédité, idiopathie). Nous avons également fourni certaines données inédites concernant les épaisseurs du cément hyperplasique et l’anatomie des foramens apicaux. Nos résultats ont enfin été appliqué à un certain nombre de dents néandertaliennes ce qui nous a permis de reconsidérer l’hypothèse selon laquelle l’importance des contraintes occlusales au sein de ce taxon est la cause principale des hypercémentoses. / The term "cement" is used to refer to all mineralised connective tissue found on the external surface of the root of a tooth and also on certain areas of the enamel or around the apical foramen. It pertains to two functional units, the tooth and the periodontium, and together with the alveolar bone forms an essential point of attachment for the periodontal ligament. In certain conditions that have still to be clarified, synthesis of one variety of cement, cellular mixed stratified cementum, is excessive, going beyond "normal" levels: this is hypercementosis. From a review of the literature, we identified a certain number of questions relating to the definition, classification, frequency, and etiologies of this term, and also to some of its anatomical characteristics. To find answers to these questions, we set up a study protocol on material consisting of three series of modern Humans (675 individuals; 8,861 teeth, 419 with hypercementosis), using photography, radiography, stereomicroscopy, scanning electron microscopy and histology techniques. From this we were able to produce a definition and a classification of hypercementosis based on reproducible criteria, we assessed frequency using a large set of samples and determined the main etiologies (continuous eruption associated with the loss of opposing teeth, apical periodontitis, periodontal injuries, dental inclusion, general pathologies, genetic syndromes, heredity, idiopathy). We were also able to provide new data on hyperplastic cement thicknesses and the anatomy of apical foramens. Finally, our results were applied to a number of Neanderthal teeth, which led us to reconsider the hypothesis according to which the importance of occlusal stress in this taxon is the main cause of hypercementosis.