Orientador: Bruno Geloneze Neto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T00:23:51Z (GMT). No. of bitstreams: 1 Lima_MarceloMirandadeOliveira_D.pdf: 3942273 bytes, checksum: 81f08c914cf4cc2a6a59c186b12b161e (MD5) Previous issue date: 2015 / Resumo: A obesidade visceral está associada à resistência à insulina, à presença de síndrome metabólica, à presença do diabetes tipo 2 e risco cardiovascular e a mortalidade elevados. Entretanto, não está claro se existe uma relação causal. A ressecção cirúrgica (exérese) do tecido adiposo visceral (TAV) é um modelo ideal para esclarecer esta questão. Em modelos animais, este procedimento melhora a tolerância a glicose, a sensibilidade à insulina (SI), a função de célula beta, o perfil lipídico e o perfil de adipocinas. A omentectomia tem sido combinada com a cirurgia bariátrica em humanos para estudar seus efeitos sobre estes parâmetros metabólicos, com resultados controversos. Para investigar o papel do TAV no metabolismo, este estudo prospectivo randomizado avaliou vinte mulheres, em menacme, com obesidade grau III e Síndrome metabólica, randomizadas para submeterem-se ao bypass gástrico (RYGBP) isolado (grupo-controle, CT) ou combinado à omentectomia total (grupo OM). Sensibilidade à insulina (SI: índice M, obtido por clamp euglicêmico-hiperinsulinêmico), resposta aguda da insulina à glicose (acute insulin response = AIR, obtida pelo teste de tolerância à glicose intravenosa), disposition index (DI = AIR ? M), perfil lipídico, perfil de adipocinas (leptina, adiponectina, resistina, visfatina, interleucina-6, TNF-?, MCP-1), proteína C-reativa ultra-sensível (PCR), composição corporal e ecografia da gordura abdominal foram estudados pré-cirurgia (basal) e 1, 6-8 e 12-15 meses pós-cirurgia. A omentectomia foi associada a maior perda de peso em todos os tempos avaliados [OM vs CT, 1, 6-8 e 12-15 meses pós cirurgia, respectivamente: -12,6 (2,5) vs -9,3 (2,5) kg (p < 0,05); -34,2 (4,3) vs -28,4 (6,2) kg (p < 0,05); -42,8 (5,4) vs -35,5 (6,8) kg (p < 0,05)]. A SI melhorou de forma similar em ambos os grupos [M (umol/kg massa magra/min) em OM vs CT - basal, 1, 6-8, and 12-15 meses pós-cirurgia, respectivamente: 25,0 (7,6) vs 28,2 (6,5); 22,4 (8,3) vs 22,7 (3,5) (não significante vs basal, em ambos os grupos); 46,6 (13,2) vs 38,6 (9,4); 54,6 (11,1) vs 50,1 (17,6) (p<0,01 vs basal, em ambos os grupos, 6-8 e 12-15 meses pós-cirurgia)]. A omentectomia foi associada a níveis menores de PCR 12-15 meses pós-cirurgia mas não influenciou adipocinas e outros parâmetros metabólicos. Entre os pacientes sem diabetes, a omentectomia foi associada a manutenção da AIR após 12-15 meses, em relação ao basal (em oposição a diminuição no grupo-controle) e maior DI após 6-8 e 12-15 meses. Embora a omentectomia não tenha potencializado o efeito do RYGBP sobre a SI e as adipocinas, ela foi associada a maior secreção de insulina, maior perda de peso e menores níveis de PCR / Abstract: The visceral fat is linked to insulin resistance, the metabolic syndrome, type 2 diabetes and an increased cardiovascular risk, but it is not clear whether it has a causative role. Surgical resection of this fat depot is a research model to address this issue. In animal models, it has been shown to improve glucose tolerance, insulin sensitivity (IS), beta cell function, lipids and adipokine profile. The omentectomy has been combined to bariatric surgery in humans in order to study its effects on these metabolic parameters with controversial results. To approach the metabolic role of the visceral fat tissue, twenty premenopausal women with metabolic syndrome and grade III obesity were prospectively randomized to undergo Roux-en-Y gastric bypass (RYGBP) either alone or combined with omentectomy. Insulin sensitivity (IS: M index, from the euglycemic-hyperinsulinemic clamp), acute insulin response to glucose (AIR; intravenous glucose tolerance test), disposition index (DI = AIR ? M), lipid profile, adipokine profile (leptin, adiponectin, resistin, visfatin, interleukin-6, TNF-?, MCP-1), ultra-sensitive C-reactive protein (CRP), body composition, and abdominal fat echography were assessed prior to surgery and 1, 6-8, and 12-15 months post-surgery. Omentectomy was associated with greater weight loss at all time points [OM vs CT, 1, 6-8, and 12-15 months post-surgery, respectively: -12.6 (2.5) vs -9.3 (2.5) kg (p <0.05); -34.2 (4.3) vs -28.4 (6.2) kg (p <0.05); -42.8 (5.4) vs -35.5 (6.8) kg (p <0.05)]. IS improved similarly in both groups [M (umol/kg free fat mass/min) in OM vs CT, at baseline, 1, 6-8, and 12-15 months post-surgery, respectively: 25.0 (7.6) vs 28.2 (6.5); 22.4 (8.3) vs 22.7 (3.5) (no significant difference vs baseline, for both groups); 46.6 (13.2) vs 38.6 (9.4); 54.6 (11.1) vs 50.1 (17.6) (p<0.01 vs baseline, for both groups at 6-8 and 12-15 months post-surgery)]. Omentectomy was associated to lower CRP [(0.05 (0.05) vs 0.26 (0.23) mg/L, p <0.001] after 12-15 months but it did not influence adipokines and other metabolic parameters. Among non-diabetic subjects, omentectomy was associated with a maintanance of baseline AIR after 12-15 months (as opposed to lowering of AIR in the control group) and a greater DI after 6-8 and 12-15 months. Although omentectomy did not enhance the effect of RYGBP on insulin sensitivity and adipokines, it was associated with a greater insulin secretion, a greater weight loss, and lower CRP / Doutorado / Clinica Medica / Doutor em Clínica Médica

Evidências na literatura demonstraram que o aumento da adiposidade confere maior suscetibilidade ao desenvolvimento de diabetes tipo 2, pois o tecido adiposo branco (TAB) atua na regulação da homeostasia energética e da sensibilidade à insulina através da sua atividade endócrina e de interações com reguladores neuroendócrinos. O treinamento físico aeróbio tem sido fortemente recomendado para a prevenção e tratamento do diabetes tipo 2, pois promove adaptações no metabolismo energético que contribuem diretamente para a melhora da resposta glicêmica e para o controle de peso corporal. Embora esteja claro na literatura o papel do treinamento físico contra o desenvolvimento de distúrbios no metabolismo da glicose e obesidade, uma lacuna de conhecimento ainda existe quando buscamos informações a respeito da participação metabólica do TAB na prevenção do diabetes tipo 2 através do treinamento físico aeróbio. Dessa forma, o presente estudo teve como objetivo testar a hipótese de que o efeito protetor do treinamento físico contra o desenvolvimento de diabetes tipo 2 é mediado por adaptações funcionais do TAB. Para isso, foram utilizados camundongos alimentados com dieta normocalórica e de cafeteria submetidos ou não ao treinamento físico aeróbio. O treinamento físico aeróbio foi eficaz para a prevenção do diabetes tipo 2, e essa resposta foi associada à menor adiposidade corporal resultante do aumento da lipólise e da capacidade oxidativa do TAB induzido pela maior ativação via da AMPK/ACC / Evidence in the literature have shown that increased adiposity confers greater susceptibility to developing type 2 diabetes and white adipose tissue (WAT) acts in the regulation of energy homeostasis and insulin sensibility through its endocrine activity and interaction with neuroendocrine regulators. Aerobic physical training has been strongly recommended for the prevention and treatment of type 2 diabetes because it promotes adaptations in the energy metabolism that contribute directly to the improvement of glycemic metabolism and body weight control. Although it is clear in the literature the role of physical training against the development of disturbances in the glucose metabolism and obesity, the role of WAT to prevent type 2 diabetes through physical training was poorly investigated. Thus, the present study aimed to test the hypothesis that the protective effect of physical training against the development of type 2 diabetes is mediated by functional adaptations of WAT. For this, we used mice fed with control or cafeteria diet and submitted or not to aerobic physical training. The physical training was effective for the prevention of type 2 diabetes, and this response was associated with lower body fat due to increased lipolysis and oxidative capacity of WAT induced by the activation of AMPK/ACC

A profunda perda de tecido adiposo é considerada um marcador na caquexia associada ao câncer. O objetivo do estudo foi avaliar os efeitos da caquexia associada ao câncer em componentes da matriz extracelular do tecido adiposo subcutâneo (TAS) de pacientes. Pacientes do Hospital Universitário (HU) foram divididos em dois grupos: portadores de tumor com caquexia (TC) e controles (C). Amostras de TAS foram analisadas quanto aos aspectos morfológicos, morfométricos, ultraestruturais, moleculares por RT-PCR em tempo real para os genes: COL1A1, COL3A1, COL6A1, FN1 e MMP2, e por imunohistoquímica para colágeno (III, VI), fibronectina e metaloproteinase 2 (MMP2). O presente estudo relata alterações das características morfológicas dos adipócitos, bem como na expressão gênica do COL6A1, FN1 e MMP2 no TC. A imunopositividade observada estava modificada para colágeno III, VI, fibronectina e na MMP2. Conclusão: A caquexia associada ao câncer afeta profundamente o tecido adiposo conduzindo à fibrose tecidual. / Profound loss of adipose tissue is a hallmark of cancer cachexia. Nevertheless, the changes caused by cancer cachexia regarding the adipose tissue extracellular matrix have not yet been fully described. The aim of the study was to evaluate the effects of cancer cachexia upon extracellular matrix components of the subcutaneous adipose tissue (TAS) of cancer patients. Patients of the Hospital University (HU) were divided into two groups: tumour cachexia (TC) and control (C). Samples were analysed for morphological aspects, ultrastructurals, morphometric, molecular analyses by real time RT-PCR for gene COL3A1, COL1A1, COL6A1, FN1 and MMP2, and immunohistochemistry for collagen (III, VI), fibronectin and metalloproteinase 2 (MMP2). This study shows modifications of the morphological characteristics of the adipocytes as well as in gene expression of COL6A1, FN1 and MMP2 in TC. The imunopositivity also was modified to collagen III, VI, fibronectin and MMP2. Conclusion: cancer cachexia affects deeply the adipose tissue, leading to the emergence of tissue fibrosis.

A gordura pericárdica (GP), um componente do tecido adiposo visceral, tem sido consistentemente relacionada com aterosclerose coronária na população geral. Este estudo avaliou a associação entre GP e a calcificação arterial coronária (CAC) em pacientes com doença renal crônica (DRC) não dialítica. Este é um estudo transversal post-hoc da linha de base de coorte prospectiva de 117 pacientes com DRC em seguimento ambulatorial sem doença coronária manifesta (idade, 56,8 ± 11 anos; 64% do sexo masculino; 95,1% hipertensos; 25,2% diabéticos; 15,5% com história prévia de tabagismo; e estágios 2 a 5 da DRC e ritmo de filtração glomerular estimado de 36,8 ± 18,1 ml/min). O escore de CAC, volume de GP e gordura visceral abdominal (GVA) foram medidos por tomografia computadorizada. A associação da GP, como variável contínua, com a presença de CAC foi analisada por regressão logística multivariada. CAC (escore de cálcio>0) esteve presente em 59,2% dos pacientes. Na comparação com os pacientes sem CAC, aqueles com CAC eram 10 anos mais velhos, apresentaram maior proporção de homens (78,7% versus 42,9%, p < 0.001), tiveram maior circunferência de abdominal (95,9 ± 10,7 versus 90,2 ± 13,2 centímetros, p=0,02), maior volume de GP (224,8 ± 107,6 versus 139,1 ± 85,0 cm³, p < 0,01), e maior área de GVA (109,2 ± 81,5 versus 70,2 ± 62,9 cm², p=0,01). Em análise multivariada ajustada para idade, sexo, diabetes, história de tabagismo, história de tabagismo, e hipertrofia ventricular concêntrica; GP esteve significantemente associada com a presença de CAC (OR: 1,88 95% IC: 1,03-3,43 por desvio padrão, p=0,04). GP permaneceu associada com CAC mesmo após ajuste adicional para ritmo de filtração glomerular e fósforo sérico (OR: 1,85 95% IC: 1,00 - 3,42, p=0,05). A GP está independentemente associada com CAC em pacientes com DRC não dialítica. / Pericardial fat (PF), a component of visceral adipose tissue has been consistently related to coronary atherosclerosis in the general population. This study evaluated the association between PF and coronary artery calcification (CAC) in non-dialysis dependent chronic kidney disease (CKD) patients. This is a post-hoc cross sectional analysis of the baseline of a prospective cohort of 117 outward CKD patients without manifest coronary artery disease (age, 56.9 ± 11.0 years, 64,1% males, 95.1% hypertensive, 25.2% diabetics, 15.5% ever smokers, CKD stage 2 to 5 with estimated glomerular filtration rate 36.8 ± 18.1 ml/min). CAC scores, PF volume and abdominal visceral fat (AVF) areas were measured by computed tomography. The association of PF as a continuous variable with the presence of CAC was analyzed by multivariate logistic regression. CAC (calcium score >0) was present in 59.2% patients. On the comparison with patients with no CAC, those with CAC were 10 years older on average, had a higher proportion of male gender (78.7% vs. 42.9%, p < 0.001), and had higher values of waist circumference (95.9 ± 10.7 versus 90.2 ± 13.2 cm, p=0.02), PF volumes (224.8±107.6 versus 139.1±85.0 cm³, p < 0.01) and AVF areas (109.2 ± 81.5 versus 70.2 ± 62.9 cm², p=0.01). In the multivariate analysis, adjusting for age, gender, diabetes, smoking and, left ventricular concentric hypertrophy, PF was significantly associated with the presence of CAC (OR: 1.88 95% CI: 1.03-3.43 per standard deviation, p=0.04). PF remained associated with CAC even after additional adjustments for estimated glomerular filtration rate or serum phosphorus (OR: 1.85 95% CI: 1.00-3.42, p=0.05). PF is independently associated with CAC in non-dialysis dependent CKD patients

A manutenção do estado progenitor durante o cultivo de células mesenquimais progenitoras derivadas do tecido adiposo (MSCs-TA), caracterizado pelo potencial de diferenciação e da capacidade de autorrenovação, é atualmente um dos maiores desafios da terapia celular. Sabendo da influência da angiogênese no desenvolvimento de tecidos de origem mesenquimal, avaliamos se um ambiente pro-angiogênico mimetizado em cultura forneceria condições para manutenção de um estado progenitor durante o processo de expansão celular. Utilizando como modelo de um ambiente pró-angiogênico o cultivo no meio EGM-2, o qual é suplementado pelos fatores de crescimento EGF, FGF-2, IGF e VEGF, nós demonstramos que a presença de tais fatores pró-angiogênicos é fundamental para a manutenção do estado progenitor de MSCs-TA em cultura. Verificamos que a presença de tais fatores de crescimento possibilitaram às MSCs-TA apresentarem um alto potencial de diferenciação adipogênico e osteogênico em comparação ao meio convencional DMEM/F12 e ao meio EBM, ausente de fatores. Além disso, o cultivo na presença de fatores pró-angiogênicos aumentou o potencial clonogênico das MSCs-TA, ao mesmo tempo em que aumentou a capacidade proliferativa destas células. Dentre os fatores de crescimento, EGF e FGF-2 foram responsáveis pelos efeitos mais robustos. Ao mesmo tempo, células cultivadas nas presença destas citocinas foram capazes de manter a morfologia fibroblastóide e apresentaram alta expressão do fator de pluripotência Klf-4. Em concordância com estes achados, o transplante subcutâneo de MSCs-TA cultivadas nestas condições mostrou que aquelas mantidas em EGM-2 geram um tecido semelhante ao tecido formado pela fração estromal vascular não cultivada. Estes resultados reforçam o papel do ambiente pró-angiogênico na manutenção do estado progenitor de MSCs-TA, e que tal estado foi proporcionado pela ação dos fatores de crescimento pró-angiogênicos EGF, FGF-2, IGF e VEGF nas células em cultivo, com destaque para as citocinas EGF e FGF-2. Em conclusão, o uso do ambiente pró-angiogênico no cultivo de MSCs-TA mostrou-se como uma abordagem promissora para a manutenção do estado progenitor destas células in vitro. / The maintenance of the progenitor state in the culture of adipose tissue derived- mesenchymal progenitor cell (TA-MSCs), characterized by the differentiation potential and self-renewal capability, is currently one of the major challenges of cell therapy. The information that the angiogenesis influences the development of mesenchymal tissues, has led us to evaluate how a pro-angiogenic environment mimicked in culture would provide conditions for maintaining a progenitor state during the cell expansion process. We designe a model for a pro-angiogenic environment in which cells grown in EGM-2 supplemented with the following growth factors: EGF, FGF-2, IGF and VEGF, and demonstrated that the presence of such pro-angiogenic growth factors was crucial for maintenance of the progenitor of AT-MSCs in culture. We observed that the presence of such growth factors allowed to AT-MSCs a high potential of adipogenic and osteogenic differentiation compared to conventional DMEM/F12 medium and the EBM medium, in the absence of the factors. Furthermore, the culture in presence of pro-angiogenic growth factors increased the clonogenic potential of AT-MSCs and increased the proliferative capability of these cells. Among the growth factors, EGF and FGF-2 were responsible for most robust effects. At the same time, cells cultured in the presence of these cytokines were able to maintaining the fibroblastoid morphology and presented high expression levels of Klf-4 pluripotency factor. In agreement with these observations, the subcutaneous transplantation of AT-MSCs cultured under these conditions showed that those cells kept in EGM-2 generated a tissue-like to tissue formed by the stromal vascular fraction uncultivated. These results reinforce the role of the pro-angiogenic environment in the maintenance of the progenitor state of AT-MSCs, and that such a state was provided by the action of the pro-angiogenic growth factors EGF, FGF-2, IGF and VEGF in cultured cells, highlighting EGF and FGF-2 cytokines. In conclusion, we showed that the use of a pro-angiogenic environment in AT-MSCs culture is a promising approach to the maintain the progenitor state of these cells in vitro.

Pregnancy induces maternal metabolic adaptations including mild glucose intolerance and weight gain in order to support fetal development and lactation. Adipose tissue (AT) function in gestation is featured by reduced insulin sensitivity and fat mass accrual which partly accounts for the weight gain in pregnant women and adaptation of glucose metabolism. A common metabolic pregnancy complication is gestational diabetes mellitus (GDM), a disease characterized by impaired glucose tolerance with onset in gestation. However, the relationship between AT expandability and glucose metabolism in gestation is not well understood. The goal of this thesis was to investigate the adaptations of human AT expansion induced by pregnancy, how these changes are reflected in pregnancies complicated with GDM and characterize a mouse model to study the mechanisms underlying this disease. This dissertation illustrates that pregnancy promotes AT expandability by a signaling mechanism between placental pregnancy-associated plasma protein-A (PAPP-A) and AT- insulin-like growth factor binding protein-5 (IGFBP5). In addition, gravidas with GDM showed impaired AT expansion. Studies investigating the relationship between PAPP-A and glycemic state demonstrated that low levels of PAPP-A in the 1sttrimester are highly associated with the development of GDM. Moreover, PAPP-A knockout mice exhibit reduced insulin sensitivity and impaired AT growth exclusively in gestation. These results expand the knowledge of AT biology in gestation and have the potential to improve maternal care by proposing PAPP-A as an early biomarker and possible therapeutic for GDM. It also introduces a new mouse model to study the etiology of gestational diabetes.

Les vésicules extracellulaires (VE), incluant exosomes et microparticules (MP), vecteurs d’information biologique, peuvent moduler la fonction de cellules cibles. Une élévation du taux de VE circulantes est observée dans les pathologies cardiovasculaires dont l’obésité est l’un des facteurs de risque majeur. Cependant, il existe peu de données concernant la production de VE adipocytaires et leur capacité à moduler le métabolisme des adipocytes. Tout d’abord, nous avons caractérisé de manière morphologique et biochimique les MP et les exosomes adipocytaires. Nous montrons une production accrue de ces VE dans un contexte d’obésité murine. L’analyse protéomique des VE adipocytaires révèle un enrichissement spécifique des MP et des exosomes en protéines clé du métabolisme énergétique et de l’inflammation, respectivement. Dans une seconde partie, nous avons étudié l’effet de MP lymphocytaires portant le morphogène Hedgehog (MPHh+) sur la différenciation adipocytaire. A l’instar d’une activation classique de la voie de signalisation Hh, les MPHh+ inhibent l’adipogenèse. Bien que dépendant du récepteur Smoothened (Smo), cet effet inhibiteur est indépendant des facteurs de transcription Gli. Nous montrons que les MPHh+ activent un axe anti-adipogénique Smo/Lkb1/Ampk pouvant être stimulé par un nouvel agoniste de Smo, le GSA-10. Nos résultats démontrent, d’une part, la capacité des adipocytes à sécréter des VE, et d’autre part, le potentiel fonctionnel des MPHh+ à inhiber l’adipogenèse par une voie de signalisation Hhnon-canonique. Les VE pourraient contribuer aux dysfonctions métaboliques associées à l’obésité en véhiculant des messages métaboliques à l’échelle de l’organisme. / Extracellular vesicles (EV), including microparticles (MP) and exosomes, are able to modulate target cell function through exchange or transfer of biological material. Although EV are present in the blood of healthy individuals, an elevated quantity of circulating EV is associated with cardiovascular diseases, which obesity is a major cardiovascular risk factor. Nevertheless, few studies have reported the ability of adipocytes to release EV and their implication in adipose tissue metabolism. First of all, we could determine morphological and biochemical features of adipocyte-derived exosomes and MP through a combination of methods. We were able to demonstrate an increase in adipocyte EV production in a murine model of obesity. Proteomic analysis of adipocyte EV further revealed a specific enrichment of proteins crucial for glucose and lipid metabolism and related to inflammation in MP and exosomes respectively. We then evaluated the ability of lymphocytes-derived MP harboring the Sonic Hedgehog morphogen to control adipocyte differentiation. Activation of the Hedgehog canonical pathway inhibited adipogenesis, as did MPHh+. Surprisingly, although Smo dependent, inhibitory potential of such MP did not involve the Gli transcription factors. We show that MPHh+ inhibit adipocyte differentiation through a Smo/Lkb1/Ampk axis as does a new agonist of Smo, GSA-10. Our results demonstrate, on one hand, the ability of adipocyte to release EV and on the other hand, the capacity of MPHh+ to control adipogenesis through a non-canonical Hh signaling pathway. In conclusion, EV might contribute to obesity related metabolic dysfunctions through systemic regulation of metabolic pathways.

Le tissu adipeux (TA) est réparti dans tout le corps en différents dépôts. Il existe deux types distincts aux fonctions biens spécifiques : le tissu adipeux blanc sert de réservoir énergétique et stocke les lipides et le tissu adipeux brun permet la thermogénèse. Par ses fonctionnalités et son pouvoir endocrine, le TA assure le maintien de l’homéostasie énergétique. De graves désordres métaboliques résultent d’une surabondance retrouvée au cours de l’obésité ou lors d’un remodelage dans les lipodystrophies. Certaines ont une origine génétique, d’autres sont induites par des médicaments comme les inhibiteurs de la protéase (IP) du VIH administrés dans la thérapie antirétrovirale. Le pool de progéniteur adipeux (PA) présent dans chaque dépôt est essentiel au maintien de ce tissu car il permet de renouveler le stock d’adipocytes. Nous avons caractérisé et identifié de nouveaux gènes impliqués dans la boucle autocrine/paracrine de l’activineA qui est responsable de l’auto-renouvellement du pool de PA dont IER3. Son expression augmente chez les patients obèses et diminue sous traitement par les IP. La modélisation des différents dépôts montre que les IP inhibent préférentiellement l’auto-renouvellement ou la différenciation adipocytaire des PA en fonction de leur localisation. Les lipodystrophies induites par la thérapie antirétrovirale auraient des causes multifactorielles. Enfin, nos résultats révèlent que les IP diminuent drastiquement et sélectivement la production d’adipocytes bruns. Ces effets doivent être considérés dans un contexte de développement inopportun du tissu adipeux brun afin de corriger des désordres métaboliques associés à certaines pathologies. / The adipose tissue (AT) is distributed throughout the body in different depots. There are two distinct types with specific functions: the white adipose tissue is used as an energetic reservoir and stores the lipids whereas the brown adipose tissue allows the thermogenesis. By its functionalities and its endocrinal capacity, the AT ensures the energetic homeostasis maintenance. Severe metabolic disorders result from an excess found during obesity or a remodelling in the lipodystrophies. Some of them have a genetic origin, the others are induced by drugs such as the HIV-protease inhibitors (PI) administered in the antiretroviral therapy against HIV. The adipose progenitor (AP) pool present in each depot is necessary for the maintenance of this tissue because it allows to renew the adipocyte stock. We characterized and identified new genes involved in the autocrine/paracrine Activin A loop which is responsible for AP pool self-renewal of whom is IER3. Its expression increases in obese patients and decreases under PI treatment. The modelling of the different depots shows that PI inhibit preferentially PA self-renewal or adipose differentiation depending on their localisation. Thus, lipodystrophies induced by antiretroviral therapy would have multifactorial causes. Finally, our results reveal PI dramatically and selectively reduce the brown adipocyte production. These effects should be considered in the context of inappropriate brown adipose tissue development in order to correct metabolic disorders associated to some pathologies.

Multipotente mesenchymale Stromazellen (MSCs) stellen nicht nur beim humanen Patienten, sondern auch in der Veterinärmedizin einen vielversprechenden Therapieansatz in der Behandlung erkrankter muskuloskelettaler Gewebe dar. Ziel der Behandlung ist dabei die Regeneration der betroffenen Strukturen im Vergleich zur Reparation nach konservativer Therapie. Vor allem im Bereich von Sehnenerkrankungen können nach MSC-Applikation vielversprechende Ergebnisse im Hinblick auf niedrigere Rezidivraten beobachtet werden. Dennoch sind noch nicht alle Umstände einer optimalen MSC-Anwendung geklärt. Hierbei sind unter anderem Fragen bezüglich der Herkunft und Gewinnung von MSCs offen, da Unterschiede von MSCs aufgrund ihrer Gewebezugehörigkeit bereits nachgewiesen wurden. Grundlegende umfassende Arbeiten zum Vergleich von equinen MSCs aus verschiedenen Quellen sowie deren mögliche Beeinflussung durch die Isolierung aus dem Gewebe lagen bislang noch nicht vor. Ziel dieser Studie war es daher, equine MSCs aus verschiedenen Quellen zu gewinnen und mögliche Unterschiede in vitro aufzuzeigen. Weiterhin sollten Unterschiede zwischen den Zelleigenschaften nach Anwendung verschiedener Isolationsprotokolle untersucht werden. In der hier vorliegenden Studie wurden MSCs aus Fett- und Sehnengewebe, Knochenmark, Nabelschnurblut und Nabelschnurgewebe von Pferden isoliert und vergleichend charakterisiert. Dabei wurden für die soliden Körpergewebe zwei unterschiedliche Isolationsmethoden, die Digestion und die Explantation, angewendet, um mögliche Einflüsse auf die gewonnen Zellen zu ermitteln. Die untersuchten Kriterien beinhalteten Zellertrag, Proliferation, Differenzierungspotenz und das Migrationsverhalten von MSCs. Hinblickend auf eine Anwendung von MSCs bei Sehnenerkrankungen wurde auch die Expression von Sehnenmarkern verglichen. In der vorliegenden Studie konnte gezeigt werden, dass sich die MSCs aus verschiedenen Quellen hinsichtlich der Zellausbeute und ihres Wachstumspotentials unterschieden. Aus soliden Geweben konnten mittels Digestion im Vergleich zu Körperflüssigkeiten signifikant mehr MSCs isoliert werden (p < 0,001). Dabei erbrachte die Isolation von MSCs mittels Digestionsmethode einen deutlich höheren Zellertrag nach der Passage 0 im Vergleich zur Explantationsmethode (p < 0,05). Im weiteren Verlauf der Kultivierung zeigten MSCs aus Sehnengewebe und Fettgewebe ein signifikant besseres Proliferationsverhalten im Vergleich zu Knochenmark-MSCs und Nabelschnurblut-MSCs. Im Hinblick auf das Differenzierungspotential konnten signifikante Unterschiede zwischen den MSCs aus den verschiedenen Quellen beobachtet werden. MSCs aus Knochenmark zeigten eine sehr gute osteogene Differenzierungsfähigkeit im Vergleich zu MSCs aus den geburtsassoziierten Geweben (p < 0,05). Im Gegensatz dazu zeichneten sich diese MSCs durch eine deutlich bessere chondrogene Differenzierung im Vergleich zu Knochenmark-MSCs aus (p < 0,05). Im Hinblick auf die Isolationsmethode konnten keine Unterschiede im Differenzierungspotential beobachtet werden. Weitere Unterschiede aufgrund der Zellquelle lassen sich in der Genexpression der Sehnenmarker erkennen. MSCs aus Fettgewebe und Sehnengewebe exprimierten Kollagen 1A2 auf höchstem Niveau. Sklexaris hingegen wurde von MSCs aus Nabelschnurblut und Sehnengewebe am höchstem exprimiert. Dabei zeigten MSCs, die mittels Digestionsmethode isoliert worden waren, ein signifikant höheres Expressionslevel von Skleraxis im Vergleich zur Explantationsmethode (p < 0,05). Die Ergebnisse der vorliegenden Studie lassen einen Einfluss der Zellquelle auf die Zellcharakteristika erkennen. MSCs aus Fettgewebe stellen dabei eine vielversprechende Alternative zu Knochenmark-MSCs dar. Allerdings scheint für eine klinische Anwendung von MSCs eine selektive Auswahl der Zellquelle entsprechend der vorliegenden Erkrankung von Vorteil zu sein. Dabei ist eine Isolierung von MSCs aus soliden Geweben mittels Digestionsverfahren zu empfehlen, da hier deutlich höhere Zellzahlen gewonnen werden können. Eine negative Beeinflussung der Zelleigenschaften durch die enzymatische Digestion lässt sich nach den vorliegenden Ergebnissen nicht vermuten. Inwiefern die beobachteten Unterschiede bei in-vivo-Anwendungen von Bedeutung sind, muss jedoch noch umfassend untersucht werden. / Not only in humans but also in veterinary medicine, multipotent mesenchymal stromal cells (MSCs) are a promising treatment option in the therapy of injured musculoskeletal tissues. This is due to the improved tissue regeneration instead of the insufficient reparation following conventional therapies. With regard to an application of MSCs for treatment of tendinopathies in horses, lower rates of reinjury have been reported. However, further investigations to optimize the MSC treatment are still outstanding. Differences in MSCs from different origins have been already reported, but there are still remaining questions about the influence of origin and isolation procedures of MSCs. Fundamental research on equine MSCs derived from different sources and their potential impact due to the isolation process has not been published so far. The aim of this study was to isolate equine MSCs from different sources and to demonstrate potential differences in vitro. Furthermore, differences in cell features following different isolation methods were investigated. In the present study, MSCs from horses were isolated from adipose tissue, tendon tissue, bone marrow, umbilical cord blood and umbilical cord tissue and subsequently subjected to comparative characterization. In case of the solid tissues, two different isolation methods, digestion and explantation, were performed in order to analyze influences on obtained cells. Investigated cell features included cell yield, proliferation, differentiation and migration potential. Furthermore, expression of tendon markers was evaluated with regard to an application of MSCs in tendinopathies. In the present study it was shown that MSCs derived from different sources differ distinctly in cell yield and proliferation potential. In comparison to body fluids, significantly more MSCs could be isolated from solid tissues when using the digestion method (p < 0.001). Furthermore, the cell yield at first cell harvest was distinctly higher when performing the isolation by digestion in comparison to isolation by explantation (p < 0.05). With regard to further cultivation, MSCs derived from tendon tissue and adipose tissue displayed a significantly better proliferation potential compared to MSCs derived from other sources. Considering the differentiation potential, significant differences were obvious between the MSCs derived from different sources. Bone marrow-MSCs showed an excellent osteogenic differentiation capacity in comparison to MSCs derived from umbilical cord blood and tissue (p < 0.05). In contrast, the birth-associated MSCs displayed a distinctly better chondrogenic differentiation than MSCs derived from bone marrow (p < 0.05). No difference in the differentiation potential was noticeable following the different isolation procedures. Furthermore, differences in the gene expression of tendon markers were evident with regard to the cell source. MSCs derived from adipose tissue and tendon tissue expressed collagen 1A2 on the highest level. On the other hand, scleraxis was expressed highest in MSCs derived from umbilical cord blood and tendon tissue. In these cells, MSCs isolated by the digestion method showed a significantly higher expression level of scleraxis in comparison to MSCs isolated by explantation (p < 0.05). Based on the results obtained so far, a relevant impact of the source of MSCs on cell features was evident. MSCs derived from adipose tissue are a promising alternative to bone marrow-MSCs. However, with regard to a clinical application of MSCs, a selection of the MSC source depending on the respective intended use seems to be advantageous. For routine isolation of MSCs from solid tissues, the digestion method could be recommended due to the higher obtainable cell numbers. Furthermore, a negative influence of the enzymatic digestion on the cell features was not detectable. However, to what extent the observed differences in vitro are relevant for in-vivo-applications needs to be further investigated.

Recent studies suggested the persistence of brown adipocytes in adult humans, as opposed to being exclusively present in infancy. In this study, we investigated the presence of brown-like adipocytes in adipose tissue (AT) samples of children and adolescents aged 0 to 18 years and evaluated the association with age, location, and obesity. For this, we analysed AT samples from 131 children and 23 adults by histological, immunohistochemical and expression analyses. We detected brown-like and UCP1 positive adipocytes in 10.3% of 87 lean children (aged 0.3 to 10.7 years) and in one overweight infant, whereas we did not find brown adipocytes in obese children or adults. In our samples, the brown-like adipocytes were interspersed within white AT of perirenal, visceral and also subcutaneous depots. Samples with brown-like adipocytes showed an increased expression of UCP1 (>200fold), PRDM16 (2.8fold), PGC1α and CIDEA while other brown/beige selective markers, such as PAT2, P2RX5, ZIC1, LHX8, TMEM26, HOXC9 and TBX1 were not significantly different between UCP1 positive and negative samples. We identified a positive correlation between UCP1 and PRDM16 within UCP1 positive samples, but not with any other brown/beige marker. In addition, we observed significantly increased PRDM16 and PAT2 expression in subcutaneous and visceral AT samples with high UCP1 expression in adults. Our data indicate that brown-like adipocytes are present well beyond infancy in subcutaneous depots of non-obese children. The presence was not restricted to typical perirenal locations, but they were also interspersed within WAT of visceral and subcutaneous depots.