Cell surface receptors such as adhesion molecules and connexins are involved in interactions between cells and their surroundings. They play important roles in the normal function of healthy tissues and in the responses of cells to injury. In many cases aberrant repair mechanisms are thought to result in disease and this thesis will assess the expression of cell adhesion molecules (principally the pi integrins) and the connexin43 gap junction protein in normal and diseased kidney The expression of pi integrins on normal human mesangial cells was localised using the alkaline phosphatase anti-alkaline phosphatase immunochemical technique (APAAP) and Western blotting. Expression of mRNA coding for integrins was also assessed using reverse-transcription polymerase chain reaction (RT-PCR). Human mesangial cells in culture expressed the a2, a3, av, pi av and P3 integrin chains. Messenger RNA was detected for these integrin subunits plus the al, a4, a5 and a6 chains. Normal human kidney sections were stained using APAAP and monoclonal antibodies towards a wide range of integrin chains. Within the glomerulus, mesangial cells express al, a2 and pi, epithelial cells a3, av and pi and endothelial cells al, a5 and pi. Tubules express a2, a3, a6, av and pi and the interstitium al and pi. In renal biopsies from patients with IgA disease the main alterations in integrin expression were upregulation of a2, a3, av and pi on damaged tubules, with increased pi expression and de novo a5 and av staining within areas of interstitial damage. These changes were replicated in a wide range of other renal pathologies and correlate with the degree of tubulointerstitial histological damage. Connexin43 (Cx43) is distributed extensively on normal human kidney, particularly on glomerular epithelial cells and intra- and extra-glomerular endothelium. Human mesangial cells in vitro express Cx43 protein and its coding mRNA. There is, however, no expression of Cx43 by the mesangium in vivo. In biopsies from patients with inflammatory renal disease there is strong expression of Cx43 on infiltrating inflammatory cells, in areas of interstitial damage and on damaged tubules. The pattern of Cx43 expression in inflammatory renal disease was very similar to that of intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1. The work in this thesis has demonstrated the large repertoire of cell surface receptors expressed on normal kidney. The principal alterations in diseased kidney are found within the tubulointerstitum. The potential relevance of these changes in the pathogenesis of renal disease are discussed and possible future avenues of research are suggested.

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The regenerative potential of tissue injury declines with age. Recently, a significant role for Wnt/β-catenin signaling has been shown in tissue specific stem cell aging, leading to increased tissue fibrosis. Wnt/β-catenin signaling regulates the differentiation of multipotent mesenchymal stem cells into osteoblasts during fracture repair. We investigated the potential role of dysregulated Wnt/β-catenin signaling in delayed fracture union and tissue fibrosis in the elderly. Old mice displayed increased total β-catenin protein levels at 4 and 7 days post-fracture and tissue fibrosis at 14 and 21 days post-fracture compared to young mice. Furthermore, treatment with a pharmalogical agent decreased total β-catenin protein levels in the fracture callus at 4 days post-fracture and prevented tissue fibrosis at 21 days post-fracture. Our data suggests that dysregulated Wnt/β-catenin signaling in the elderly contributes to delayed fracture repair and tissue fibrosis and offers a potential therapeutic strategy to improve fracture outcome in the elderly.

The regenerative potential of tissue injury declines with age. Recently, a significant role for Wnt/β-catenin signaling has been shown in tissue specific stem cell aging, leading to increased tissue fibrosis. Wnt/β-catenin signaling regulates the differentiation of multipotent mesenchymal stem cells into osteoblasts during fracture repair. We investigated the potential role of dysregulated Wnt/β-catenin signaling in delayed fracture union and tissue fibrosis in the elderly. Old mice displayed increased total β-catenin protein levels at 4 and 7 days post-fracture and tissue fibrosis at 14 and 21 days post-fracture compared to young mice. Furthermore, treatment with a pharmalogical agent decreased total β-catenin protein levels in the fracture callus at 4 days post-fracture and prevented tissue fibrosis at 21 days post-fracture. Our data suggests that dysregulated Wnt/β-catenin signaling in the elderly contributes to delayed fracture repair and tissue fibrosis and offers a potential therapeutic strategy to improve fracture outcome in the elderly.

Fibrose du tissu adipeux humain: relations avec l'élasticité du tissu, des changements de poids et les comorbiditiés de l'obésité.Contexte Le remodelage de la matrice extracellulaire (MEC), e.g. la fibrose, est une altération pathologique du tissu adipeux sous-cutané (TAsc) dans l'obésité. La fibrose du TAsc est associée aux troubles métaboliques et à la perte de poids à la chirurgie bariatrique (CB). Un outil non-invasif a été développé pour évaluer l'élasticité du TAsc (la VS) et son lien avec les comorbidités de l'obésité.Hypothèses 1) La VS associée aux troubles métaboliques prédit la perte de poids et les améliorations cardiométaboliques à la CB; 2) La VS est liée avec les collagènes et avec d'autres caractères du TAsc; 3) la VS change avec le remodelage de la MEC du TAsc durant la perte de poids; 4) le développement de l'outil évaluant la VS est utile dans la pratique clinique. Méthodes Une étude clinque a été réalisée chez plus de 100 obèses candidats à la CB, avec les mesures transcriptomique, histologique et secretomique in vitro et ex vivo pour évaluer des altérations du TAsc. La validation de l'outil a été aussi réalisée. Résultats 1) La VS est associée à la fibrose du TAsc, aux paramètres biocliniques, aux anomalies cardiométaboliques chez les obèses morbides; 2) La VS pré-CB prédit la perte de poids d'un an à la CB; 3) Le TAsc subit un remodelage majeur durant la perte de poids, en particulier une augmentation des collagènes qui est lié à une élévation de la dégradation des collagènes, à une diminution du pontage de la MEC, non à un changement détectable de la VS. Ces observations suggèrent une adaptation adéquate de la MEC du TAsc durant la perte de poids. Conlusion : L’exploration du remodelage du TAsc (e.g. la fibrose et la VS) est un intérêt principal dans cette maladie complexe. / Context Extracellular matrix (ECM) remodeling, e.g. fibrosis, is a hallmark pathological alteration of subcutaneous adipose tissue (scAT) in obesity. ScAT fibrosis associates with metabolic disorders and bariatric surgery (BS)-induced weight loss. ScAT fibrosis increases mechanical stress on adipocytes and induces fibro-inflammation. A non-invasive tool was recently developed to evaluate scAT stiffness, shear wave speed (SWS) and its link with obesity comorbidities. Hypotheses 1) SWS associates with metabolic disorders and predicts BS-induced weight loss and cardiometabolic improvements, 2) SWS is explained by collagen deposition and other structural features; 3) SWS changes with scAT ECM remodeling during weight loss; 4) developing a relevant tool to measure SWS is helpful in clinical practice.Methods We conducted a clinical study in more than 100 obese candidates for BS, combined with a series of in vitro and ex vivo transcriptomic, histological and secretomic measures of tissue alteration. Validation steps were realized to confirm the clinical use of the tool. Results 1) SWS associated with scAT fibrosis, various bioclinical parameters, cardiometabolic abnormalities at baseline in morbid obesity; 2) pre-BS SWS has a predictive role in one-year BS-induced weight loss; 3) scAT underwent major remodeling, particularly collagens accumulation, during BS-induced weight loss. This was related to increased collagen degradation, decreased cross-linking, but not with detectable change in SWS. These observations reflected an adequate ECM adaptation during fat mass loss. Conclusion Exploring scAT remodeling (e.g. fibrosis and stiffness) is of main interest in this complex disease.

The pathogenesis of oral submucous fibrosis (OSMF) is due to a complex interplay between the production and degradation of extracellular matrix (ECM) protein components. In tissue fibrosis, there is a net accumulation of collagen as a result of an imbalance between enhanced production, deposition and impaired degradation of ECM components. OSMF is a chronic inflammatory condition of the oral cavity and regulation of a number of pro-inflammatory and fibrogenic cytokines such as interleukine-1, -6 and -8 isoforms, TGF-β, PDGF, bFGF, IFN-γ and TNF-α has been reported in OSMF tissues. The expression of these growth factors has a bearing on the epithelial changes as well as proliferation and differentiation of oral fibroblasts into ECM protein producing myofibroblast cells. One key modulator of fibrosis in several organs has been TGF-β. Overproduction of TGF-β mRNA and protein has been reported in several fibrotic disorders including that of skin, lungs, liver, kidney and heart. This is mainly due to stimulation of ECM genes by TGF-β. Although there have been few reports suggesting the over production of TGF-β in OSMF tissues, the specific isoforms involved or the mechanisms are poorly understood. Areca nut components, especially arecoline have been implicated in the pathophysiology of OSMF. Few reports indicate the involvement of arecoline in the regulation of collagen production and activity of collagenases and their inhibitors in oral fibroblast cells. Moreover, the alkaloid is involved in initiating epithelial inflammation by inducing COX-2, prostaglandin E2, IL-1α, IL-6 and IL-8 in KB oral carcinoma cells and oral fibroblast cells. These and other reports strongly suggest that changes in gene expression mediated by Arecoline may be central to the progression of OSMF. Not much is known about arecoline-mediated cellular signaling events except for few recent reports that suggest the activation of MAPK pathways. In neuronal and colonic smooth muscle cells of mouse, rat and rabbit, the actions of Arecoline have been reported to be through the activation of muscarinic acetylcholine receptors. Direct binding of arecoline to human M1, 2 and 3 muscarinic receptor isoforms have been shown in brain tissues. Stimulation of these receptors alters the intracellular levels of Ca+2 and cAMP, which are important second messengers. The cholinergic potential of arecoline may be important for their roles in arecoline-mediated signaling events. The expression of muscarinic acetylcholine receptors has been reported in several cell types besides neuronal and excitatory cells. Although several gene expression changes have been reported following Arecoline treatment of a variety of cells, the mechanism of such regulations is not established. Hence in order to understand the role of arecoline in OSMF disease process, we undertook studies that provide insights into arecoline action in epithelial and fibroblast cells and possible molecular mechanisms. The objectives are to study: 1. The role of arecoline in cellular proliferation, cell-cycle regulation and apoptosis in human normal keratinocytes. 2. Mechanism of regulation of gene expression by arecoline in normal keratinocytes. 3. Mechanism of regulation of gene expression by arecoline in human normal oral fibroblasts. In order to achieve the above objectives, a human keratinocyte cell line, HaCaT and an oral periodontal fibroblast cell line (PDC) were utilized. The cells were treated with arecoline and a variety of assays including RT-PCR analysis of mRNA of several genes, phosphorylation status of MAPK pathway intermediates, cell cycle analysis and other cellular and molecular methods have been employed. Following arecoline treatment, there is induction of oxidative stress, growth arrest and epithelial cell death. Since actions of TGF-β are central to most fibrotic disorders and arecoline has been implicated in OSMF, it is hypothesized that arecoline may influence fibrosis via TGF-β pathway. Towards this, several TGF-β target genes that may have a possible role in fibrosis have been studied in arecoline treated epithelial and fibroblast cells. Since arecoline mediated oxidative stress has been reported, the regulation of genes that are involved in stress response pathway have been studied for induction by arecoline in epithelial cells. The results presented in this thesis suggest the up regulation of oxidative stress-responsive genes in HaCaT cells including HOX-1, FTL, G6PD, GCLC and GRD in HaCaT cells. Oxidative stress is a major inducer of inflammatory response in the epithelial tissues. The expression of IL-1α, an important inflammatory cytokine is induced by arecoline in HaCaT cells in response to oxidative stress via the activation of p38 MAPK pathway. Interestingly, activation of MAPK pathways by arecoline is involved in the regulation of common target genes of arecoline and TGF-β and also in the induction of TGF-β−responsive promoter reporter construct, p3TP-lux activity in HaCaT cells. Due to the involvement of TGF-β in fibrosis, regulation of TGF-β pathway genes by arecoline has been studied both in HaCaT and PDC cells. In HaCaT cells, arecoline induces the expression of TGF-β2 mRNA while TβRII expression is down regulated. The expression of the rest of TGF-β/SMAD pathway genes including TGF-β1, β3, TβRI, SMAD1, 2, 3, 4 and 7 are not affected by arecoline in HaCaT cells. Over expression of TGF-β2 is also observed in most of the OSMF tissues compared to normal oral tissues. However, in normal oral fibroblast cells, we observed that the TGF-β/SMAD pathway genes are not regulated by arecoline. These results suggest the possible involvement of arecoline-mediated induction of TGF-β2 in epithelial cells in OSMF disease development. We investigated the signaling pathways involved in the regulation of TGF-β2 and found that stimulation of M3 muscarinic receptor by arecoline leads to the induction of TGF-β2 expression in HaCaT cells via PKC pathway. TGM-2 is an important TGF-β target gene involved in the cross linking of ECM proteins. Arecoline-mediated induction of TGM2 mRNA and transglutaminase activity are observed in oral fibroblast cells, PDC. The induction of TGM-2 was found to be independent of oxidative stress and TGF-β, but dependent on muscarinic acid receptor activation by arecoline and involves cytosolic cAMP. When tested in OSMF tissues, there was an increased expression of TGF-β2, TSP1 and TGM2 as compared to normal tissues suggesting a possible role of these genes in arecoline-mediated progression of OSMF. Interleukin-8 (IL-8), which is involved in inflammation has been reported to be regulated by TGF-β in a cell type specific manner. In several cell types including human endometrial stromal cells, LnCaP (prostate cancer cells), human retinal pigment epithelial cells and rat lung alveolar epithelial (LM5) cells etc., TGF-β up regulates the expression of IL-8 mRNA. Arecoline was found to down regulate IL-8 expression in PDC cells as measured by RT-PCR. Interestingly, the presence of serum along with arecoline induces the expression of IL-8 in PDC cells suggesting the modulation of arecoline-mediated gene regulation by a serum activated signaling pathway. Intriguingly, arecoline treatment led to down regulation of collagens in PDC cells. However, collagen genes are induced in PDC cells in the presence of HaCaT spent medium by arecoline suggesting a role for factor(s) secreted by epithelial cells in the regulation of collagen genes by arecoline. This factor could be an isoform of TGF-β as shown by blocking the induction of collagens by the TGF-β inhibitor, βLAP. Taken together, all these results indicate the ability of arecoline to cause fibrosis in a tissue environment where both epithelial and fibroblasts respond to arecoline and mutually contribute to the disease manifestation. Major conclusions from this study includes, 1] cell death in epithelial cells due to oxidative stress following arecoline treatment, 2] regulation of gene expression by arecoline involves MAPK, PKC pathways, 3] muscarinic acid receptor and oxidative stress are also important for regulation gene expression by arecoline. The most important inference from this study is the possible paracrine influence of TGF-β isoforms secreted by epithelial cells on the oral fibroblasts in determining the progression of OSMF. In summary, in this thesis, an attempt has been made to study the molecular mechanisms and role of arecoline, an alkaloid in conferring gene expression changes that may lead to the initiation and progression of oral sub mucous fibrosis.