The aim of this dissertation is an analysis of the regulatory framework for the procurement and distribution of stem cells in South Africa. This research includes aspects of the law of obligations, medical law and human rights law as found in the Bill of Rights. More specifically however, this dissertation attempts to bring to attention the shortcomings of chapter 8 of the National Health Act. An examination is undertaken according to the multilayered approach and therefore the proposed regulatory framework is examined within a constitutional framework, an ethical framework, the framework as established by common law, in this case the doctrine of informed consent and lastly within the national legislation framework as found in the National Health Act of 2003 and the regulations made in terms of the Act. This dissertation further entails a brief comparative study of the regulatory mechanisms of the United Kingdom as entrenched in the Human Fertilisation and Embryology Act of 2008 and the Human Tissue Act of 2004 and as practiced by the Human Fertilisation and Embryology Authority and the Human Tissue Authority. The analysis in this dissertation firstly provides an overview of the clinical manifestations and science of stem cell technology. Secondly, the impact of the Constitution of the Republic of South Africa is discussed with particular reference to the Bill of Rights on stem cell research and therapy. The most noteworthy conclusion to be made in this regard is that the embryo is not the bearer of constitutional rights. The ethical guidelines which act as regulatory tools in this field are then discussed with attention to general ethical principles as provided for by the Health Professions Council of South Africa as well as the Medical research Council. The doctrine of informed consent further enjoys attention as it is discussed in context of medical research and key issues are addressed regarding the process of obtaining consent in context of stem cell technologies. Certain recommendations are then made pertaining to the minimum scope required for lawful consent. Lastly a critical analysis is made of chapter 8 of the National Health Act. The findings which are made here lead to further recommendations regarding the regulation of stem cells. / Dissertation (LLM)--University of Pretoria, 2011. / Public Law / unrestricted

Les réactions immunitaires de la peau sont initiées par les cellules dendritiques cutanées (dendritic cells, DCs). L'effet potentiellement sensibilisateur d'un composé peut être prédit in vitro en utilisant des monocytes humains différenciés en DCs (MonoDCs). Cependant, ces modèles simplistes restent imprécis car l'activation des DCs cutanés par les sensibilisateurs peut être déclenchée ou modulée par des interactions microenvironnementales avec de multiples types de cellules non immunitaires. Notre objectif est de développer une peau immunocompétente qui combinera des MonoDCs avec tous les éléments structurels et fonctionnels de la peau, c'est-à-dire une barrière épidermique posée sur un derme contenant une pseudo-vascularisation et des neurones nociceptifs. Une matrice de collagène a été ensemencée avec des fibroblastes et des cellules endothéliales, puis avec des précurseurs de fibres nerveuses dérivées soit de l'iPSC humaine, soit de la DRG embryonnaire murins. Enfin, nous avons introduit les MonoDC et les kératinocytes. Nous avons observé que les neurones différenciés in situ innervent l'épiderme comme observé habituellement dans la peau humaine normale. De plus, les neurones dérivées d’iPSCs, expriment neuropeptides et canaux calcique spécifiques des fibres nociceptives. Enfin, les Mono-DC intégrés au modèle restent stable pendant toute la durée nécessaire à la formation de l’épiderme et peuvent être stimulé. Le modèle sera utilisé pour prédire le potentiel irritant des composés chimiques et l'impact de l’innervation nociceptive sur l'activation des DCs. / Immune reactions in the skin are initiated by the cutaneous dendritic cells (DCs). The potential sensitizing effect of a compound can be predicted in vitro using human monocytes differentiated into DCs (Mono-DCs). However, these simplistic models remain inaccurate because the activation of cutaneous DCs by sensitizers may be triggered or modulated by microenvironmental interactions with multiple types of non-immune cells. Our goal is to develop an immunocompetent human tissue-engineered skin that will combine DCs with all structural and functional element of the skin, i.e. an epidermal barrier laid upon a dermis containing a pseudo-vascularization and nociceptive neurons. Collagen matrix was seeded with fibroblasts and endothelial cells, then with precursors of nerve fibers derived from either human iPSC or murine embryonic DRG. Finally, we introduced Mono-DCs and keratinocytes. We observed that in situ differentiated neurons grow axons towards the epidermis as usually observed in normal human skin. What's more, the neurons derive from iPSC, express neuropeptides and calcium channel as normal nociceptive fibers. Moreover, Mono-DCs settled as expected beneath the epidermis and remained sessile to stimulation for several weeks. The model will be used to predict the irritant potential of chemical compounds, and the impact of nerves on DC activation.

京都大学 / 0048 / 新制・課程博士 / 博士(医科学) / 甲第22379号 / 医科博第109号 / 新制||医科||7(附属図書館) / 京都大学大学院医学研究科医科学専攻 / (主査)教授 遊佐 宏介, 教授 武田 俊一, 教授 近藤 玄 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Tuberous sclerosis complex (TSC) is a multisystem tumor-forming disorder caused by biallelic inactivation of TSC1 or TSC2. The primary cause of mortality arises from mesenchymal manifestations in the lung and kidney: pulmonary lymphangioleiomyomatosis (LAM) and renal angiomyolipomas (RAMLs). Despite a well-described monogenic etiology, there remains an incomplete understanding of disease pathogenesis. Consequentially, tractable models which fully recapitulate disease characteristics are lacking. Here, I develop and study novel tissue-engineered models of TSC lung and kidney disease. In my first chapter, I demonstrate that lung-mimetic hydrogel culture of pluripotent stem cell-derived diseased cells more faithfully recapitulates human LAM biology compared to conventional culture on two-dimensional plastic. Leveraging this culture system, I conducted a three-dimensional drug screen using a custom 800-compound library, tracking cytotoxicity and invasion modulation phenotypes at the single cell level. I identified histone deacetylase (HDAC) inhibitors as a group of anti-invasive agents that are also selectively cytotoxic towards TSC2-/- cells. HDAC inhibitor therapeutic effects remained consistent in vivo upon xenotransplantation of LAM cellular models into zebrafish. In my second chapter, I develop a genetically-engineered human renal organoid model which recapitulates pleiotropic features of RAMLs in vitro and upon orthotopic xenotransplantation. I find that loss of TSC1/2 affects multiple developmental processes in the renal epithelial, stromal, and glial compartments. First, loss of TSC1/2 leads to an expanded stroma by favouring stromal cell fate acquisition and alters terminal stromal cell identity. Second, epithelial cells in the TSC1/2-/- organoids exhibit a rapamycin-insensitive epithelial-to-mesenchymal transition. Third, a melanocytic population forms exclusively in TSC1/2-/- organoids, branching from MITF+ Schwann cell precursors of a bona fide neural crest-to-Schwann cell differentiation trajectory. Through these two thesis chapters, I realize the power of tissue-engineered models for the study of TSC. This work offers novel insights into the pathogenesis of RAMLs and identifies a new class of therapeutics suitable for trialing in patients with pulmonary LAM.

No description available.

Retinal ganglion cells (RGCs) serve as a vital connection between the eye and the brain with damage to their axons resulting in loss of vision and/or blindness. Retinal organoids are three-dimensional structures derived from human pluripotent stem cells (hPSCs) which recapitulate the spatial and temporal differentiation of the retina, providing a valuable model of RGC development in vitro. The working hypothesis of these studies is that hPSC-derived RGCs are capable of extensive outgrowth and display target specificity and pathfinding abilities. Initial efforts focused on characterizing RGC differentiation throughout early stages of organoid development, with a clearly defined RGC layer developing in a temporally-appropriate manner expressing a compliment of RGC-associated markers. Beyond studies of RGC development, retinal organoids may also prove useful to investigate and model the extensive axonal outgrowth necessary to reach post-synaptic targets. As such, additional efforts aimed to elucidate factors promoting axonal outgrowth. Results demonstrated significant enhancement of axonal outgrowth through modulation of both substrate composition and growth factor signaling. Furthermore, RGCs possessed guidance receptors that are essential in influencing outgrowth and pathfinding. Subsequently, to determine target specificity, aggregates of hPSC-derived RGCs were co-cultured with explants of mouse lateral geniculate nucleus (LGN), the primary post-synaptic target of RGCs. Axonal outgrowth was enhanced in the presence of LGN, and RGCs displayed recognition of appropriate targets, with the longest neurites projecting towards LGN explants compared to control explants or RGCs grown alone. Generated from the fusion of regionally-patterned organoids, assembloids model projections between distinct regions of the nervous system. Therefore, final efforts of these studies focused upon the generation of retinocortical assembloids in order to model the long-distance outgrowth characteristic of RGCs. RGCs displayed extensive axonal outgrowth into cortical organoids, with the ability to respond to environmental cues. Collectively, these results establish retinal organoids as a valuable tool for studies of RGC development, and demonstrate the utility of organoid-derived RGCs as an effective platform to study factors influencing outgrowth as well as modeling long-distance projections and pathfinding abilities.

Amyotrophe Lateralsklerose (ALS) ist eine neurodegenerative Erkrankung, bei welcher speziell erste (kortikospinal) und zweite (spinal) Motorneurone (MN) von Neurodegeneration betroffen sind. Gegenwärtig bleibt ALS eine unheilbare Erkrankung. Der Tod tritt durchschnittlich 2 bis 5 Jahre nach Auftreten der Symptome ein. Circa 90% der Fälle treten sporadisch auf (sALS), während 10% familiär sind (fALS). Es ist von großem Interesse monogenetische Formen der fALS zu untersuchen um zugrundeliegende Pathologien und Mechanismen zu verstehen. Bislang wurden über 20 Gene mit ALS in Verbindung gebracht, einschließlich Fused in sarcoma (FUS) und Chromsosome 9 open reading frame (C9ORF72). Circa 4% der fALS Fälle sind durch dominante Mutationen in FUS verursacht und repräsentieren damit die dritthäufigste Form der fALS in Deutschland. Die G4C2 hexanucleotide repeat expansion (HRE) in C9ORF72 ist die häufigste Ursache für ALS und Frontotemporale Demenz (FTD). ALS Patienten unterscheiden sich erheblich in der Präsentation ihrer klinischen Symptome wie Ausbruchsort, Progressionsrate und Auftreten kognitiver Störungen. Diese Faktoren sind auch stark abhängig von der zugrundeliegenden Mutation in fALS. Ziel dieser Doktorarbeit ist die Modellierung von FUS- und C9ORF72-assozierter ALS in einem krankheits-relevanten in vitro Model von speziell kortikaler Neuropathologie mit Hilfe von Patienten-spezifischen iPSZs. Die Hypothese der vorliegenden Arbeit ist das in einer Zelltyp-abhängigen Art und Weise zugrundeliegende Erkrankungsmechanismen in kortikalen vs. spinalen Neuronen unterschiedlich betroffen sind. Humane iPSZ, generiert von gesunden Kontrollen und ALS Patienten mit FUS oder C9ORF72 Mutation, wurden für die gerichtete kortikale und spinale Differenzierung genutzt. Zusätzlich wurden zwei neue FUS-WT- und FUS-P525L-EGFP-markierte isogene Linien mittels CRISPR/Cas9n Technik generiert. Methoden basierend auf Immunfluoreszenz Färbungen und Lebendzell-Mikroskopie wurden angewendet um Krankheits-relevante Proteine, DNA Schäden und axonale Organell-Mobilität zu analysieren. In diesem Projekt konnte ein deutlicher Zelltyp-abhängiger Effekt auf analysierte Phänotypen beobachtet werden, während ALS-assoziierte Mutationen scheinbar nur geringfügige Effekte zeigten. Dementsprechend wurde ein Zelltyp-abhängiger Anstieg des basalen DNA Schadens in kortikalen Astrozyten vs. Neuronen und spinalen vs. kortikalen Neuronen detektiert. Jedoch konnte in FUS oder C9ORF72 mutierten kortikalen Zellen kein erhöhter DNA Schaden nachgewiesen werden, wie es zuvor in spinalen MN beobachtet wurde. Des Weiteren beeinflussen FUS Mutationen die Rekrutierung von FUS zu DNA-geschädigten Stellen, die Organell-Mobilität und die zytoplasmatische Fehllokalisation des Proteins in Abhängigkeit vom Zelltyp. In kortikalen Neuronen wurde in Bezug auf die Rekrutierung von mutiertem FUS und Organell-Mobilität nur leichte Mutations-abhängige und wesentlich schwächer ausgeprägte Effekte beobachtet als in spinalen MN. Zusammenfassend kann gesagt werden, dass Patienten-spezifische Zellmodelle ein wichtiges Instrument in der ALS Forschung sind und das vor allem Unterschiede zwischen kortikalen und spinalen MN weiter untersucht werden müssen, um zugrundeliegende Krankheits-relevante Mechanismen zu entschlüsseln und wie diese zum Fortschreiten der Erkrankung beitragen / Amyotrophic lateral sclerosis (ALS) is a of neurodegenerative diseases, in which neurodegeneration specifically affects upper (corticospinal) and lower (spinal) motor neurons (MNs). At present, ALS remains an incurable disease. Death occurs on average 2 to 5 years after symptom onset. About 90% are sporadic cases (sALS) and 10% are familial cases (fALS). It is of great interest to investigate monogenetic forms causing fALS to understand its underlying disease pathologies and mechanisms. Over 20 genes have been linked to ALS until now, including Fused in sarcoma (FUS) and Chromosome 9 open reading frame 72 (C9ORF72). About 4% of fALS cases are caused by dominant mutations within FUS, representing the third most common fALS form in Germany. The G4C2 hexanucleotide repeat expansion (HRE) in the C9ORF72 gene is the most common cause for ALS and Frontotemporal dementia (FTD). ALS patients differ significantly in their presentation of clinical symptoms, including site of onset, rate of progression, and presence of cognitive dysfunction. Those factors were also shown to highly depend on the underlying mutation in fALS cases. Aim of this thesis work is the modeling of FUS- and C9ORF72-associated ALS in a disease-related in vitro model of particularly cortical neuropathology using patient-derived iPSCs. The hypothesis of the current work is that underlying disease mechanisms do differentially affect cortical vs. spinal neurons and act in a cell type-dependent manner. Human iPSCs derived from healthy controls and ALS patients carrying mutations within FUS or C9ORF72 were used for directed cortical and spinal differentiation. Additionally, two new FUS-WT- and FUS-P525L-EGFP-tagged isogenic iPSC lines were generated by CRISPR/Cas9n gene editing. Immunofluorescence staining and live cell imaging approaches were implemented to analyze disease-associated proteins, DNA damage, and axonal trafficking. Within this project, a clear cell type-dependent effect on analyzed phenotypes was observed, while ALS-associated mutations seemed to have only minor effects. Accordingly, cell type-dependent increased basal DNA damage levels in cortical astrocytes vs. neurons and spinal vs. cortical neurons were detected. However, FUS or C9ORF72 mutant cortical cells do not recapitulate increased DNA damage levels as they have been observed in spinal MNs. Furthermore, FUS mutation affected recruitment to DNA damage sites, axonal trafficking, and cytoplasmic mislocalization differentially, depending on the analyzed cell type. In cortical neurons, recruitment and trafficking of mutant FUS showed only slight mutation-dependent effects and also less pronounced phenotypes than observed in spinal MNs. In conclusion, patient-specific cellular models are an important tool in ALS research and particularly differences between cortical and spinal MNs need to be further investigated to decipher underlying disease mechanisms, the interplay of cell types affected by the disease, and how they participate in disease progression.

Heart failure is the main cause of death for both men and women in the United States. The only proven treatment for patients with heart failure is heart transplantation. The goal of this research is to create patches of tissue that could mimic the function of the native heart to repair the damaged portions of the heart. In this study, whole porcine hearts were decellularized to create a 3D construct that was recellularized with cardiomyocytes (CM) differentiated from human induced pluripotent stem (IPS) cells. At day 4 of differentiation, IPS-derived CMs were implanted onto cardiac extracellular matrix (cECM) and ten days after recellularization, the cells started to beat spontaneously. After implantation, the progenitor CMs continued to proliferate and populate the cECM. A live/dead assay showed the potential of the cECM as a scaffold suitable for recellularization. Confocal microscopy images were taken to evaluate the organization of the cells within the matrix and the impact of the cECM on the growth and maturation of the CMs. Representative cardiac Troponin T (cTNT) and vimentin immunostaining images of CMs derived from iPSCs, on cECM and on standard cell culture plates showed that the cECM allowed the cells to organize and form fibrils with the fibroblasts, compared with CMs cultured in regular culture plates. The timeline of implantation of the cells was a key factor for the development of the heart tissue constructs. Progenitor CMs seeded onto cECM showed better organization and the ability to penetrate 96 µm deep within the collagen fibers and align to them. However, mature CMs seeded onto the matrix showed a disorganized network with very reduced interaction of CMs with fibroblasts, forming two different layers of cells; CMs on top of fibroblasts. In addition, the depth of penetration of the mature CMs within the matrix was only 20 µm. To evaluate the impact of the addition of support cells to the CM monolayer cultures, CMs were co-cultured with human umbilical vein endothelial cells (HUVEC) and it was demonstrated that at ratios of 2:1 HUVEC:CM the beating rate of the CMs was improved from 20 to 112 bpm, additionally, the CM monolayer cultures showed a more synchronized beating pace after the addition of HUVECs. Pharmacological stimulation was performed on CM monolayer cultures using norepinephrine as a stimulator and the results showed that the beating pace of the CMs was improved to 116 bpm after 5 minutes of drug exposure. For future studies, inosculation of the tissue constructs could be performed with the incorporation of membrane proteins to understand the mechanotransduction of the cells. As a preliminary study, the action of dual claudins was evaluated with HUVEC cultures and the results showed the potential of these membrane proteins in the healing of the damaged cell membrane.

Cellular cardiomyoplasty is a cell therapy using stem cells or progenitor cells for myocardial regeneration to improve cardiac function and mitigate heart failure. Since we first published cellular cardiomyoplasty in 1989, this procedure became the innovative method to treat damaged myocardium other than heart transplantation. A significant improvement in cardiac function, metabolism, and perfusion is generally observed in experimental and clinical studies, but the improvement is mild and incomplete. Although safety, feasibility, and efficacy have been well documented for the procedure, the beneficial mechanisms remain unclear and optimization of the procedure requires further study. This chapter briefly reviews the stem cells used for cellular cardiomyoplasty and their clinical outcomes with possible improvements in future studies.

Cellular cardiomyoplasty is a cell therapy using stem cells or progenitor cells for myocardial regeneration to improve cardiac function and mitigate heart failure. Since we first published cellular cardiomyoplasty in 1989, this procedure became the innovative method to treat damaged myocardium other than heart transplantation. A significant improvement in cardiac function, metabolism, and perfusion is generally observed in experimental and clinical studies, but the improvement is mild and incomplete. Although safety, feasibility, and efficacy have been well documented for the procedure, the beneficial mechanisms remain unclear and optimization of the procedure requires further study. This chapter briefly reviews the stem cells used for cellular cardiomyoplasty and their clinical outcomes with possible improvements in future studies.