La transplantation hépatique est le seul traitement définitif des enfants ayant une hépatite fulminante sans résolution spontanée. L’évolution de cette maladie dans la population pédiatrique diffère de celle adulte, particulièrement en regard de l’encéphalopathie. Pour définir les indications de transplantation hépatique, plusieurs indicateurs précoces de pronostic furent étudiés chez les adultes. Ces indicateurs n’ont pu être transposés à la population pédiatrique. Objectif primaire : Déterminer les marqueurs de risque de mortalité des enfants recevant une transplantation hépatique pour une hépatite fulminante, se définissant par une insuffisance hépatique sévère sans antécédent au cours des huit semaines précédentes. Méthode : Il s’agit d’une étude rétrospective incluant tous les enfants ayant reçu une transplantation hépatique pour une hépatite fulminante à l’hôpital Sainte-Justine entre 1985 et 2005. Le score PELOD (Pediatric Logistic Organ Dysfunction) est une mesure de sévérité clinique d’un enfant aux soins intensifs. Il fut calculé à l’admission et avant la transplantation hépatique. Résultats : Quatorze enfants (cinq mois à seize ans) reçurent une transplantation hépatique pour une hépatite fulminante. Neuf enfants (64%) survécurent et cinq (36%) décédèrent. L’utilisation de la ventilation mécanique fut associée à un mauvais pronostic (p = 0,027). Entre l’admission et la transplantation hépatique, 88% des enfants ayant eu une variation du score PELOD inférieure à cinq survécurent. Tous ceux ayant eu une variation supérieure à cinq décédèrent. (p = 0,027) Conclusion : La variation du score PELOD pourrait aider à définir un indicateur précoce de l’évolution d’un enfant après une transplantation hépatique pour une hépatite fulminante. / Hepatic transplantation is the only definitive treatment for acute liver failure for those children who do not recover spontaneously. Early indicators of prognosis in acute liver failure have been studied in adults in order to define the indication for liver transplantation. The course of the disease in the pediatric population, particularly with respect to hepatic encephalopathy, differs from that in adults. Consequently, these criteria are not applicable to the pediatric population. Primary objective: To determine the risk markers for mortality in children receiving liver transplantation for acute liver failure. Liver failure is defined as being severe failure without prior liver disease within the last eight weeks. Method: A retrospective study was conducted with children who had received a liver transplantation for acute liver failure at Sainte-Justine’s Hospital between 1985 and 2005. Data including the PELOD (Pediatric Logistic Organ Dysfunction) Score, a clinical score (0-71) of illness severity in children in intensive care, were recorded from patients’ charts. Results: 14 children, aged from five months to sixteen years old, were transplanted for fulminant liver failure. Nine (64%) survived and five (36%) died. The need for mechanical ventilation was associated with a poorer survival (p= 0,027). Of all of the children who had a PELOD Score variation inferior to five, between admission and transplantation, 88% survived. None of those with a score variation superior to five survived (p=0,027). Conclusion: In our single centre study, the PELOD Score variation was a pre-transplant marker of mortality after liver transplantation for pediatric acute liver failure.

Introdução: O fígado é um órgão chave na manutenção da homeostasia corpórea e o transplante hepático ainda continua sendo o padrão-ouro no tratamento da insuficiência hepática aguda. A falta de doadores tem favorecido o desenvolvimento da terapia celular. Células derivadas de medula óssea podem se diferenciar em células tipo-hepatócitos em menos de 24 horas e a comunicação através de vesículas extracelulares (VEs) é um dos mecanismos propostos para explicar essa capacidade. Muitos estudos têm demonstrado que as células-tronco mesenquimais (CTMs) da medula tem alta plasticidade para se diferenciar em hepatócitos, mas os protocolos normalmente utilizados levam entre 7 e 28 dias. Objetivo: Analisar a capacidade de diferenciação das CTMs da medula em se tornar uma célula tipo-hepatócito através do mecanismo de comunicação celular por VEs em cultura (6 e 24 horas). Materiais e métodos: Para avaliar o efeito de hepatócitos primários isolados de ratos saudáveis e lesados com CCl4 na diferenciação das CTMs foi utilizado um sistema de co-cultivo com insertos que não permitem o contato entre as células colocando as CTMs na câmera superior e os hepatócitos na câmera inferior do sistema. Meio condicionado de hepatócitos com lesão foi utilizado para avaliar a capacidade das CTMs de capturar VEs e se diferenciar em célula-tipo hepatócito. Os marcadores de célula tipo-hepatócito avaliados foram expressão gênica (alfa fetoproteina, albumina e citoqueratina-18), armazenamento de glicogênio e liberação de ureia. Para rastrear VEs, hepatócitos de ratos lesados foram marcados com PKH-26. As VEs foram obtidas por ultracentrifugação do sobrenadante e analisadas por citometria de fluxo. Hepatócitos e CTMs também foram analisados por citometria de fluxo na busca de marcação positiva. Resultados: CTMs co-cultivadas durante 6 e 24 horas com hepatócitos não apresentaram expressão de genes hepáticos, mesmo quando expostas a um ambiente de lesão. Os ensaios funcionais confirmaram a falta de sinais de diferenciação, sendo que não foi observado armazenamento de glicogênio nem liberação de ureia nas CTMs. Um achado interessante foi que ao analisar o sobrenadante da câmera superior do sistema de co-cultivo, não foram achadas VEs marcadas com PKH-26 nem CTMs com rastros do marcador. Por outro lado, os experimentos utilizando meio condicionado mostraram que as CTMs têm capacidade de capturar VEs. A citometria de fluxo mostrou que às 6 horas e 24 horas respetivamente 2,28% e 3,97% das CTMs eram positivas para o marcador PKH-26. Quando analisadas no microscópio de fluorescência, foram vistos pontos vermelhos nas CTMs alguns dos quais parecem carregar a proteína albumina. Porém a expressão gênica e analise de ureia não se adequaram a um perfil de célula tipo-hepatócito. Conclusões: O sistema de co-cultivo não foi adequado para permitir a transferência e comunicação através de VEs entre hepatócitos e CTMs sendo que as VEs não conseguem atingir a câmara superior. Os experimentos com meio condicionado sugerem que as CTMs têm capacidade de capturar VEs derivadas de hepatócitos, porém a captação não conduz ao desenvolvimento de um perfil de célula tipo-hepatócito em 6 e 24 horas. São necessários mais estudos para esclarecer a dinâmica de transferência das VEs e suas consequências em longo prazo. / Introduction: Liver is a key organ for corporeal homeostasis maintenance and whole organ replacement still remains the gold standard procedure to treat acute liver failure. Shortage of liver donor has promoted the increase on cell-therapy research. Bone marrow (BM) derived cell have shown potential for differentiation into hepatocyte-like cells in a short time and extracellular vesicles communication (EVs) is one of the proposed mechanisms. Plasticity of bone marrow mesenchymal stem cells (BM-MSCs) is extensively supported by scientific literature but protocols applied to differentiation usually take from 7 to 28 days. Objective: To analyze in vitro differentiation potential of BM-MSCs into hepatocyte-like cells through EVs transfer mechanism in 6 and 24 hours. Materials and Methods: Co-culture system with cell-impermeable inserts and conditioned medium experiments were used to explore the effects of healthy and CCl4-injured hepatocytes, over BM-MSCs differentiation. Assessment of hepatocyte-like cell profile on BM-MSCs was revealed by gene expression (alpha fetoprotein, albumin and cytokeratin-18), glycogen storage and urea release. Hepatocytes from CCl4-injured rats were labeled by PKH-26 to track EVs. Ultracentrifugation was used to isolate EVs from supernatant medium of the two chamber of the co-culture system. PKH-26 positive EVs and PKH-26 positive cells were revealed by flow cytometry analysis and fluorescent microscopy. BM-MSCs cultured with conditioned medium were stained with ALB-FITC antibody. Results: Co-cultured BM-MSCs for 6 and 24 hours, showed no expression of hepatocyte-like genes, even after exposure to damaged microenvironment. Functional assays confirm the lack of differentiation signs there were no glycogen storage or urea release. Interestingly, EVs traffic analysis revealed no PKH-26 positive EVs at the upper chamber of co-culture system and no positive BM-MSCs were found either. On the other hand, conditioned medium experiment showed that BM-MSCs could uptake EVs. Flow cytometry analysis showed positive PKH-26 BM-MSCs at 6 (2.28%) and 24 (3.97%) hours. Flourescence microscopy revealed red points into BM-MSCs and immunofluorescence suggest that some EVs contain albumin. Gene expression and urea assay of BM-MSCs were not in accordance with a hepatocyte-like profile. Conclusions: Co-culture system, by using cell-impermeable membrane, was not adequate to promote EVs transfer between hepatocyte and BM-MSCs since EVs do not pass from the lower to the upper chamber. Conditioned medium experiments can suggest that BM-MSCs could uptake hepatocyte-derived EVs but this not drive to a hepatocyte-like profile in a short period of time. More studies will be necessary to clarify the dynamic of EVs transfer and their long time effects.

Acute liver failure is a major cause of death in the world, and effective treatments are greatly needed. Liver macrophages (Kupffer cells) play a major role in the pathology of acute liver failure, and drug delivery vehicles that can target therapeutics to Kupffer cells have great therapeutic potential for treating acute liver failure. Microparticles, formulated from biodegradable polymers, are advantageous for treating acute liver failure because they can passively target therapeutics to Kupffer cells. However, existing biomaterials are not suitable for the treatment of acute liver failure because of their slow hydrolysis and acidic degradation products. In this dissertation, I present the development of a new class of biodegradable materials, termed aliphatic polyketals, which have considerable potential as drug delivery vehicles for the treatment of acute liver failure because of their neutral degradation products and tunable hydrolysis kinetics. The anti-inflammatory enzyme, superoxide dismutase (SOD), was delivered using polyketal microparticles to the liver for treating acute liver Failure. Our results demonstrated that polyketal microparticles significantly improved the efficacy of SOD in treating LPS-induced acute liver damage in vivo, as evidenced by decreased levels of serum alanine transaminase, which corresponds to the extent of damage in the liver, and serum level of tumor necrosis factor-alpha, which corresponds to the secretion of pro-inflammatory cytokines. The completion of this thesis research demonstrates the ability of polyketal-based drug delivery systems for treating acute inflammatory diseases and creates a potential therapy for enhancing the treatment of acute liver failure.

Acute liver failure (ALF) is a rather rare clinical syndrome developing due to an acute massive dysfunction of the liver cells in previously healthy persons (at least 8 weeks there was no diagnosis of any liver disease) resulting in rapidly progressing multiple organ dysfunction syndrome. Without liver transplantation 80-95 % of the patients die. Factors, influencing the outcome are etiology, the patient's age and the course of the disease. Spontaneous recovery, however, is possible in 5-60 % of ALF cases when regeneration of the liver starts, therefore the main goal of the treatment is to create the most favorable conditions for regeneration. Causes of ALF may be different. The most common cause of ALF is viral hepatitis, but the prevailing causative agent of hepatitis is different in different countries. Drug-induced (acetaminophen, halotane) liver dysfunction ranks second. The order of other etiological factors according to their frequency is: mushroom (Amanita) poisoning, carbon tetrachloride toxicity, heat stroke, synthetic amphetamine ("Ecstasy") and disorders of liver blood vessels. In cases of unfavorable prognosis for patients with ALF the only method of treatment with good prognosis is liver transplantation (LT). From 50 to 70 % of patients with lethal ALF prognosis survive after emergency LT. There is no unified ALF prognostic system or indications for LT in the world, therefore a precise individual prognosis for every patient and well-timed decision about LT are... [to full text]

La transplantation hépatique est le seul traitement définitif des enfants ayant une hépatite fulminante sans résolution spontanée. L’évolution de cette maladie dans la population pédiatrique diffère de celle adulte, particulièrement en regard de l’encéphalopathie. Pour définir les indications de transplantation hépatique, plusieurs indicateurs précoces de pronostic furent étudiés chez les adultes. Ces indicateurs n’ont pu être transposés à la population pédiatrique. Objectif primaire : Déterminer les marqueurs de risque de mortalité des enfants recevant une transplantation hépatique pour une hépatite fulminante, se définissant par une insuffisance hépatique sévère sans antécédent au cours des huit semaines précédentes. Méthode : Il s’agit d’une étude rétrospective incluant tous les enfants ayant reçu une transplantation hépatique pour une hépatite fulminante à l’hôpital Sainte-Justine entre 1985 et 2005. Le score PELOD (Pediatric Logistic Organ Dysfunction) est une mesure de sévérité clinique d’un enfant aux soins intensifs. Il fut calculé à l’admission et avant la transplantation hépatique. Résultats : Quatorze enfants (cinq mois à seize ans) reçurent une transplantation hépatique pour une hépatite fulminante. Neuf enfants (64%) survécurent et cinq (36%) décédèrent. L’utilisation de la ventilation mécanique fut associée à un mauvais pronostic (p = 0,027). Entre l’admission et la transplantation hépatique, 88% des enfants ayant eu une variation du score PELOD inférieure à cinq survécurent. Tous ceux ayant eu une variation supérieure à cinq décédèrent. (p = 0,027) Conclusion : La variation du score PELOD pourrait aider à définir un indicateur précoce de l’évolution d’un enfant après une transplantation hépatique pour une hépatite fulminante. / Hepatic transplantation is the only definitive treatment for acute liver failure for those children who do not recover spontaneously. Early indicators of prognosis in acute liver failure have been studied in adults in order to define the indication for liver transplantation. The course of the disease in the pediatric population, particularly with respect to hepatic encephalopathy, differs from that in adults. Consequently, these criteria are not applicable to the pediatric population. Primary objective: To determine the risk markers for mortality in children receiving liver transplantation for acute liver failure. Liver failure is defined as being severe failure without prior liver disease within the last eight weeks. Method: A retrospective study was conducted with children who had received a liver transplantation for acute liver failure at Sainte-Justine’s Hospital between 1985 and 2005. Data including the PELOD (Pediatric Logistic Organ Dysfunction) Score, a clinical score (0-71) of illness severity in children in intensive care, were recorded from patients’ charts. Results: 14 children, aged from five months to sixteen years old, were transplanted for fulminant liver failure. Nine (64%) survived and five (36%) died. The need for mechanical ventilation was associated with a poorer survival (p= 0,027). Of all of the children who had a PELOD Score variation inferior to five, between admission and transplantation, 88% survived. None of those with a score variation superior to five survived (p=0,027). Conclusion: In our single centre study, the PELOD Score variation was a pre-transplant marker of mortality after liver transplantation for pediatric acute liver failure.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2014-05-22T16:58:19Z No. of bitstreams: 1 Bruno Solano de Freitas Souza Terapia... 2012.pdf: 11192595 bytes, checksum: bbf17ad75e0d20605c6fd2274da72034 (MD5) / Made available in DSpace on 2014-05-22T16:58:19Z (GMT). No. of bitstreams: 1 Bruno Solano de Freitas Souza Terapia... 2012.pdf: 11192595 bytes, checksum: bbf17ad75e0d20605c6fd2274da72034 (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / Introdução e objetivos: A insuficiência hepática aguda (IHA), apesar de rara, permanece como uma condição rapidamente progressiva e frequentemente fatal. A intoxicação por acetaminofen (APAP) induz necrose hepática maciça e frequentemente leva à morte por edema cerebral. Terapias celulares são de grande interesse como potenciais tratamentos para IHA. Neste projeto foi avaliado o potencial terapêutico das células mononucleares da medula óssea (CMMO) em um modelo experimental de IHA induzida por APAP em camundongos. Métodos: A IHA foi induzida em camundongos C57Bl/6, previamente submetidos à dieta alcoólica por três semanas, através da administração de APAP na dose de 300 mg/kg por via intraperitoneal. Após a indução da IHA, os camundongos foram transplantados, por via endovenosa, com 107 CMMO obtidas de doadores transgênicos para a proteína verde fluorescente (GFP) ou injetados com salina. As curvas de sobrevivência, os níveis plasmáticos de aminotransferases, amônia, uréia e creatinina, a extensão da necrose hepática, o infiltrado inflamatório e a expressão de citocinas e metaloproteinases foram avaliados. A microscopia confocal foi utilizada para estudar a migração das células transplantadas para o fígado. A permeabilidade da barreira hemato-encefálica foi avaliada pela injeção do corante azul de Evans (AE) por via endovenosa. Resultados: Observou-se que os camundongos tratados com CMMO apresentaram uma redução significativa da mortalidade, com uma taxa de 60% de sobrevivência quando comparados a 20% de sobrevivência do grupo controle. As células transplantadas migraram para o fígado, mas não foi observada a diferenciação destas em células hepáticas ou fusão celular. Não foram encontradas diferenças estatisticamente significativas na extensão de necrose hepática no fígado, nos níveis plasmáticos de transaminases e amônia, na intensidade do infiltrado inflamatório no fígado entre os dois grupos com IHA, bem como nos níveis hepáticos das citocinas TNF-a e IL-10 e de transcritos para adrenomedula e endotelina 1 no cérebro, assim como na atividade da metaloproteinase 9 no soro. No entanto, observou-se uma redução dos níveis séricos de TNF-a no grupo tratado com CMMO quando comparado ao grupo injetado com salina. Esta redução está correlacionada ao aumento do mRNA para IL-10 na medula óssea e no baço dos animais tratados com CMMO. A avaliação do extravasamento do corante azul de Evans para o cérebro demonstrou que o grupo tratado com células mononucleares da medula óssea apresentou uma redução da permeabilidade da barreira hemato-encefálica quando comparado ao grupo injetado com salina. Conclusão: As CMMO exercem um efeito protetor em camundongos com IHA induzida por APAP, sem alterar o dano hepático, provavelmente através da modulação da resposta inflamatória sistêmica e da diminuição da permeabilidade da barreira hemato-encefálica. / Introduction and objectives: Acute liver failure (IHA), although rare, remains a rapidly progressive and often fatal condition. Poisoning by acetaminophen (APAP) induces a massive hepatic necrosis and often leads to death by cerebral edema. Cell therapies are of great interest as potential treatments for IHA. In this project we evaluated the therapeutic potential of bone marrow mononuclear cells (BMC) in an experimental model of IHA induced by APAP in mice. Methods: The IHA was induced in C57BL/6 mice previously submitted to the alcohol diet for three weeks by the administration of APAP at a dose of 300 mg / kg, intraperitoneally. After induction of IHA, the mice were transplanted intravenously with 107 BMC obtained from donors transgenic for green fluorescent protein (GFP) or injected with saline. The survival curves, plasma levels of aminotransferases, ammonia, urea and creatinine, the extent of hepatic necrosis, inflammatory infiltrate and the expression of cytokines and metalloproteinases were evaluated. Confocal microscopy was used to study the migration of transplanted cells to the liver. The permeability of the blood-brain barrier was assessed by injection of Evans blue dye (AE) intravenously. Results: We found that mice treated with BMC showed a significant reduction in mortality, with a rate of 60% survival compared to 20% survival in the control group. The transplanted cells migrated to the liver, but we did not observe the differentiation of these cells or fusion with liver cells. There were no statistically significant differences in the extent of hepatic necrosis in the liver, plasma levels of transaminases and ammonia, and in the intensity of the inflammatory infiltrate in the liver between the two groups with IHA, as well as in hepatic levels of TNF-α and IL-10, transcripts for endothelin 1 and adrenomedullin in the brain and serum metalloproteinase 9 activity. However, there was a reduction of serum TNF-α in BMC-treated group compared to the group injected with saline. This decrease correlated with the increase in IL-10 mRNA expression in the bone marrow and spleen of BMC-treated mice. The assessment of Evans blue extravasation into the brain showed that the group treated with BMC had a reduced permeability of the blood-brain barrier compared to the group injected with saline. Conclusion: Bone marrow mononuclear cells exert a protective effect in mice with APAPinduced IHA, without changing the liver injury, probably through modulation of systemic inflammatory response and decrease the permeability of the blood-brain barrier.

Introdução: O fígado é um órgão chave na manutenção da homeostasia corpórea e o transplante hepático ainda continua sendo o padrão-ouro no tratamento da insuficiência hepática aguda. A falta de doadores tem favorecido o desenvolvimento da terapia celular. Células derivadas de medula óssea podem se diferenciar em células tipo-hepatócitos em menos de 24 horas e a comunicação através de vesículas extracelulares (VEs) é um dos mecanismos propostos para explicar essa capacidade. Muitos estudos têm demonstrado que as células-tronco mesenquimais (CTMs) da medula tem alta plasticidade para se diferenciar em hepatócitos, mas os protocolos normalmente utilizados levam entre 7 e 28 dias. Objetivo: Analisar a capacidade de diferenciação das CTMs da medula em se tornar uma célula tipo-hepatócito através do mecanismo de comunicação celular por VEs em cultura (6 e 24 horas). Materiais e métodos: Para avaliar o efeito de hepatócitos primários isolados de ratos saudáveis e lesados com CCl4 na diferenciação das CTMs foi utilizado um sistema de co-cultivo com insertos que não permitem o contato entre as células colocando as CTMs na câmera superior e os hepatócitos na câmera inferior do sistema. Meio condicionado de hepatócitos com lesão foi utilizado para avaliar a capacidade das CTMs de capturar VEs e se diferenciar em célula-tipo hepatócito. Os marcadores de célula tipo-hepatócito avaliados foram expressão gênica (alfa fetoproteina, albumina e citoqueratina-18), armazenamento de glicogênio e liberação de ureia. Para rastrear VEs, hepatócitos de ratos lesados foram marcados com PKH-26. As VEs foram obtidas por ultracentrifugação do sobrenadante e analisadas por citometria de fluxo. Hepatócitos e CTMs também foram analisados por citometria de fluxo na busca de marcação positiva. Resultados: CTMs co-cultivadas durante 6 e 24 horas com hepatócitos não apresentaram expressão de genes hepáticos, mesmo quando expostas a um ambiente de lesão. Os ensaios funcionais confirmaram a falta de sinais de diferenciação, sendo que não foi observado armazenamento de glicogênio nem liberação de ureia nas CTMs. Um achado interessante foi que ao analisar o sobrenadante da câmera superior do sistema de co-cultivo, não foram achadas VEs marcadas com PKH-26 nem CTMs com rastros do marcador. Por outro lado, os experimentos utilizando meio condicionado mostraram que as CTMs têm capacidade de capturar VEs. A citometria de fluxo mostrou que às 6 horas e 24 horas respetivamente 2,28% e 3,97% das CTMs eram positivas para o marcador PKH-26. Quando analisadas no microscópio de fluorescência, foram vistos pontos vermelhos nas CTMs alguns dos quais parecem carregar a proteína albumina. Porém a expressão gênica e analise de ureia não se adequaram a um perfil de célula tipo-hepatócito. Conclusões: O sistema de co-cultivo não foi adequado para permitir a transferência e comunicação através de VEs entre hepatócitos e CTMs sendo que as VEs não conseguem atingir a câmara superior. Os experimentos com meio condicionado sugerem que as CTMs têm capacidade de capturar VEs derivadas de hepatócitos, porém a captação não conduz ao desenvolvimento de um perfil de célula tipo-hepatócito em 6 e 24 horas. São necessários mais estudos para esclarecer a dinâmica de transferência das VEs e suas consequências em longo prazo. / Introduction: Liver is a key organ for corporeal homeostasis maintenance and whole organ replacement still remains the gold standard procedure to treat acute liver failure. Shortage of liver donor has promoted the increase on cell-therapy research. Bone marrow (BM) derived cell have shown potential for differentiation into hepatocyte-like cells in a short time and extracellular vesicles communication (EVs) is one of the proposed mechanisms. Plasticity of bone marrow mesenchymal stem cells (BM-MSCs) is extensively supported by scientific literature but protocols applied to differentiation usually take from 7 to 28 days. Objective: To analyze in vitro differentiation potential of BM-MSCs into hepatocyte-like cells through EVs transfer mechanism in 6 and 24 hours. Materials and Methods: Co-culture system with cell-impermeable inserts and conditioned medium experiments were used to explore the effects of healthy and CCl4-injured hepatocytes, over BM-MSCs differentiation. Assessment of hepatocyte-like cell profile on BM-MSCs was revealed by gene expression (alpha fetoprotein, albumin and cytokeratin-18), glycogen storage and urea release. Hepatocytes from CCl4-injured rats were labeled by PKH-26 to track EVs. Ultracentrifugation was used to isolate EVs from supernatant medium of the two chamber of the co-culture system. PKH-26 positive EVs and PKH-26 positive cells were revealed by flow cytometry analysis and fluorescent microscopy. BM-MSCs cultured with conditioned medium were stained with ALB-FITC antibody. Results: Co-cultured BM-MSCs for 6 and 24 hours, showed no expression of hepatocyte-like genes, even after exposure to damaged microenvironment. Functional assays confirm the lack of differentiation signs there were no glycogen storage or urea release. Interestingly, EVs traffic analysis revealed no PKH-26 positive EVs at the upper chamber of co-culture system and no positive BM-MSCs were found either. On the other hand, conditioned medium experiment showed that BM-MSCs could uptake EVs. Flow cytometry analysis showed positive PKH-26 BM-MSCs at 6 (2.28%) and 24 (3.97%) hours. Flourescence microscopy revealed red points into BM-MSCs and immunofluorescence suggest that some EVs contain albumin. Gene expression and urea assay of BM-MSCs were not in accordance with a hepatocyte-like profile. Conclusions: Co-culture system, by using cell-impermeable membrane, was not adequate to promote EVs transfer between hepatocyte and BM-MSCs since EVs do not pass from the lower to the upper chamber. Conditioned medium experiments can suggest that BM-MSCs could uptake hepatocyte-derived EVs but this not drive to a hepatocyte-like profile in a short period of time. More studies will be necessary to clarify the dynamic of EVs transfer and their long time effects.

Introdução: O fígado é um órgão chave na manutenção da homeostasia corpórea e o transplante hepático ainda continua sendo o padrão-ouro no tratamento da insuficiência hepática aguda. A falta de doadores tem favorecido o desenvolvimento da terapia celular. Células derivadas de medula óssea podem se diferenciar em células tipo-hepatócitos em menos de 24 horas e a comunicação através de vesículas extracelulares (VEs) é um dos mecanismos propostos para explicar essa capacidade. Muitos estudos têm demonstrado que as células-tronco mesenquimais (CTMs) da medula tem alta plasticidade para se diferenciar em hepatócitos, mas os protocolos normalmente utilizados levam entre 7 e 28 dias. Objetivo: Analisar a capacidade de diferenciação das CTMs da medula em se tornar uma célula tipo-hepatócito através do mecanismo de comunicação celular por VEs em cultura (6 e 24 horas). Materiais e métodos: Para avaliar o efeito de hepatócitos primários isolados de ratos saudáveis e lesados com CCl4 na diferenciação das CTMs foi utilizado um sistema de co-cultivo com insertos que não permitem o contato entre as células colocando as CTMs na câmera superior e os hepatócitos na câmera inferior do sistema. Meio condicionado de hepatócitos com lesão foi utilizado para avaliar a capacidade das CTMs de capturar VEs e se diferenciar em célula-tipo hepatócito. Os marcadores de célula tipo-hepatócito avaliados foram expressão gênica (alfa fetoproteina, albumina e citoqueratina-18), armazenamento de glicogênio e liberação de ureia. Para rastrear VEs, hepatócitos de ratos lesados foram marcados com PKH-26. As VEs foram obtidas por ultracentrifugação do sobrenadante e analisadas por citometria de fluxo. Hepatócitos e CTMs também foram analisados por citometria de fluxo na busca de marcação positiva. Resultados: CTMs co-cultivadas durante 6 e 24 horas com hepatócitos não apresentaram expressão de genes hepáticos, mesmo quando expostas a um ambiente de lesão. Os ensaios funcionais confirmaram a falta de sinais de diferenciação, sendo que não foi observado armazenamento de glicogênio nem liberação de ureia nas CTMs. Um achado interessante foi que ao analisar o sobrenadante da câmera superior do sistema de co-cultivo, não foram achadas VEs marcadas com PKH-26 nem CTMs com rastros do marcador. Por outro lado, os experimentos utilizando meio condicionado mostraram que as CTMs têm capacidade de capturar VEs. A citometria de fluxo mostrou que às 6 horas e 24 horas respetivamente 2,28% e 3,97% das CTMs eram positivas para o marcador PKH-26. Quando analisadas no microscópio de fluorescência, foram vistos pontos vermelhos nas CTMs alguns dos quais parecem carregar a proteína albumina. Porém a expressão gênica e analise de ureia não se adequaram a um perfil de célula tipo-hepatócito. Conclusões: O sistema de co-cultivo não foi adequado para permitir a transferência e comunicação através de VEs entre hepatócitos e CTMs sendo que as VEs não conseguem atingir a câmara superior. Os experimentos com meio condicionado sugerem que as CTMs têm capacidade de capturar VEs derivadas de hepatócitos, porém a captação não conduz ao desenvolvimento de um perfil de célula tipo-hepatócito em 6 e 24 horas. São necessários mais estudos para esclarecer a dinâmica de transferência das VEs e suas consequências em longo prazo. / Introduction: Liver is a key organ for corporeal homeostasis maintenance and whole organ replacement still remains the gold standard procedure to treat acute liver failure. Shortage of liver donor has promoted the increase on cell-therapy research. Bone marrow (BM) derived cell have shown potential for differentiation into hepatocyte-like cells in a short time and extracellular vesicles communication (EVs) is one of the proposed mechanisms. Plasticity of bone marrow mesenchymal stem cells (BM-MSCs) is extensively supported by scientific literature but protocols applied to differentiation usually take from 7 to 28 days. Objective: To analyze in vitro differentiation potential of BM-MSCs into hepatocyte-like cells through EVs transfer mechanism in 6 and 24 hours. Materials and Methods: Co-culture system with cell-impermeable inserts and conditioned medium experiments were used to explore the effects of healthy and CCl4-injured hepatocytes, over BM-MSCs differentiation. Assessment of hepatocyte-like cell profile on BM-MSCs was revealed by gene expression (alpha fetoprotein, albumin and cytokeratin-18), glycogen storage and urea release. Hepatocytes from CCl4-injured rats were labeled by PKH-26 to track EVs. Ultracentrifugation was used to isolate EVs from supernatant medium of the two chamber of the co-culture system. PKH-26 positive EVs and PKH-26 positive cells were revealed by flow cytometry analysis and fluorescent microscopy. BM-MSCs cultured with conditioned medium were stained with ALB-FITC antibody. Results: Co-cultured BM-MSCs for 6 and 24 hours, showed no expression of hepatocyte-like genes, even after exposure to damaged microenvironment. Functional assays confirm the lack of differentiation signs there were no glycogen storage or urea release. Interestingly, EVs traffic analysis revealed no PKH-26 positive EVs at the upper chamber of co-culture system and no positive BM-MSCs were found either. On the other hand, conditioned medium experiment showed that BM-MSCs could uptake EVs. Flow cytometry analysis showed positive PKH-26 BM-MSCs at 6 (2.28%) and 24 (3.97%) hours. Flourescence microscopy revealed red points into BM-MSCs and immunofluorescence suggest that some EVs contain albumin. Gene expression and urea assay of BM-MSCs were not in accordance with a hepatocyte-like profile. Conclusions: Co-culture system, by using cell-impermeable membrane, was not adequate to promote EVs transfer between hepatocyte and BM-MSCs since EVs do not pass from the lower to the upper chamber. Conditioned medium experiments can suggest that BM-MSCs could uptake hepatocyte-derived EVs but this not drive to a hepatocyte-like profile in a short period of time. More studies will be necessary to clarify the dynamic of EVs transfer and their long time effects.

Paracetamol (APAP) is commonly used analgesic and antipyretic, however high doses can induce damage hepatic. The metabolic N-acetyl-p-benzoquinone imine (NAPQI) is responsible for the toxic effects. The accumulation of this metabolic causes oxidative stress, cellular death and tissue necrosis. Toxicity of APAP is also related to development of inflammation, accumulation of neutrophils and release of proinflammatory mediators. The treatment consists of the N-acetylcysteine administration, which it must be administered quickly. The diphenyl diselenide (PhSe)2 is an organoselenium compound that exhibit antioxidant activity and pharmacological proprieties. The aim of this study is evaluate the ability of (PhSe)2 in reducing acute liver failure induced by APAP in mice. The animals received APAP 600 mg/kg, and after 1h were treated with (PhSe)2 15.6 mg/kg. After 4h APAP administration was collected serum and hepatic tissue for analysis. APAP administration caused severe damage hepatic, oxidative stress induction and glutathione levels reduction. APAP also caused increase of myeloperoxidase activity. The treatment with (PhSe)2 was effective in reduction of alterations caused by APAP, suggesting a promising therapeutic option for the treatment of acute liver failure. / O paracetamol (APAP) é comumente usado como analgésico e antipirético, porém doses elevadas podem induzir dano hepático. O metabólito N-acetil-p-benzoquinina imina (NAPQI), é responsável pelos efeitos tóxicos. O acúmulo deste metabólito ocasiona estresse oxidativo, morte celular e necrose tecidual. A toxicidade do APAP também está relacionada com desenvolvimento de inflamação, acúmulo de neutrófilos e liberação de mediadores pró-inflamatórios. O tratamento consiste na administração de N-acetilcisteína, a qual deve ser administrada relativamente cedo. O disseleneto de difenila (PhSe)2 é um composto orgânico de selênio que apresenta atividade antioxidante e propriedades farmacológicas. O objetivo deste estudo é avaliar a capacidade do (PhSe)2 em reduzir a falência hepática aguda induzida pelo APAP em camundongos. Os animais receberam APAP 600 mg/kg, e 1h após foram tratados com (PhSe)2 15,6 mg/kg. Após 4 h da administração de APAP coletou-se amostras de soro e tecido hepático para as análises. O APAP ocasionou severo dano hepático, indução de estresse oxidativo e redução dos níveis de glutationa. O APAP também provocou aumento na atividade da mieloperoxidase. O tratamento com (PhSe)2 mostrou-se efetivo na redução das alterações geradas pelo APAP, sugerindo uma opção terapêutica promissora para o tratamento da falência hepática aguda.

Acute liver failure (ALF) is a rare but devastating clinical syndrome with multiple causes and a variable course. The mortality rate is high. Orthotopic liver transplantation is the only therapy of proven survival benefit but the limited supply of donor organs, the rapidity of progression and the variable course of ALF limit its use. A need therefore exists for a method to ‘bridge’ patients, that is, provide temporary support, to either the spontaneous regeneration of the innate liver or transplantation. One possibility includes bio-artificial liver support systems (BALSS). This technology is composed of an extracorporeal circulation system incorporating a bioreactor that contains parenchymal liver cells (hepatocytes) to perform the detoxifying, transforming and synthetic properties of a liver. However, the development of a BALSS holds particular challenges. Despite approximately four decades of research, bio-artificial liver (BAL) technology globally remains in a pre-commercial stage. The University of Pretoria (UP) and the Council for Scientific and Industrial Research (CSIR) have developed a BALSS with novel characteristics. These include a computationally optimized radial-flow primary porcine hepatocyte bioreactor perfused with blood plasma, and a perfluorocarbon oxygen carrier which replaces hemoglobin. There are also novel design properties in the circulation system itself. Demonstrating the metabolic and clinical efficacy of a BAL device requires implementing, in vitro (cell biology), in vivo (animal) and mathematical modeling studies. These studies are a formal necessity but are inherently ‘models’ of the in vivo human clinical circumstance. That is, they are limited by their experimentally controlled configuration/s. In investigating these, this thesis firstly provides a foundation by reviewing the clinical and biological context of ALF and BAL technology, then presents and evaluates particular studies/models that have been implemented over several years in the course of the UP-CSIR BAL project. For each section, thoughts and recommendations regarding future work that will facilitate the development of BAL technology are discussed in detail. The thesis is concluded with an evaluation of success and the consensus-agreed requirement of continued research and innovation in the field. / Thesis (PhD)--University of Pretoria, 2010. / Chemical Engineering / unrestricted