Le syndrome de détresse respiratoire aiguë (SDRA) est caractérisé par des dommages au niveau de la barrière alvéolo-capillaire, résultant en la formation d’un œdème pulmonaire et une réponse inflammatoire exacerbée. Sans résolution rapide de ces paramètres, le syndrome progresse vers le développement de fibrose menant à l’insuffisance respiratoire. Or, il a été établi que la réparation de l’épithélium alvéolaire est une étape cruciale pour la résolution du SDRA. Une meilleure compréhension des mécanismes de réparation de l’épithélium alvéolaire est donc nécessaire afin de proposer de nouvelles thérapies pour le SDRA, pour lequel aucun traitement efficace n’existe. Il a été montré que les mécanismes de réparation sont régulés par des protéines membranaires, non seulement par les récepteurs aux facteurs de croissance et les intégrines, mais également par les canaux ioniques, en particulier les canaux potassiques. L’objectif principal de cette étude était donc de caractériser l’impact de la modulation des canaux potassiques KCa3.1 et KvLQT1 dans la résolution du SDRA. Dans un premier temps, nos résultats ont montré le rôle coopératif du canal potassique KCa3.1, de la matrice extracellulaire et de l’intégrine-β1 dans les processus de réparation de l’épithélium alvéolaire in vitro. Nous avons montré que la matrice de fibronectine et le KCa3.1 étaient impliqués dans la migration et dans la réparation de monocouches de cellules alvéolaires de cultures primaires de rat. Dans un deuxième temps, nous avons étudié l’impact de la modulation du canal potassique KvLQT1 dans certains aspects physiopathologiques du SDRA à l’aide de modèles in vivo. Nous avons montré que KvLQT1 n’était pas seulement impliqué dans les mécanismes de réparation de l’épithélium alvéolaire, mais également dans la résorption de l’œdème pulmonaire et la résolution de la réponse inflammatoire. Nos résultats démontrent que les canaux potassiques, tels que KCa3.1 et KvLQT1, pourraient être identifiés en tant que cibles thérapeutiques potentielles pour le SDRA. / Acute respiratory distress syndrome (ARDS) is characterized by alveolar-capillary barrier damage, resulting in the formation of pulmonary oedema and an exacerbated inflammatory response. Without rapid recovery of these parameters, there is a gradual development of fibrosis, leading to respiratory failure. It has been established that alveolar regeneration is a critical step for the resolution of ARDS. A better understanding of alveolar epithelial repair mechanisms is hence necessary to identify new therapies for ARDS, for which no effective treatment exist. It has been shown that repair mechanisms are regulated by membrane proteins, not only by growth factor receptors and integrins, but also by ion channels, in particular potassium channels. Therefore, the main objective of this study was to characterize the impact of KCa3.1 and KvLQT1 potassium channels modulation in the resolution of ARDS. First, our results have shown the cooperative role of the potassium channel KCa3.1, the extracellular matrix and the β1-integrin in alveolar epithelial repair processes in vitro. We have shown that the fibronectin matrix and KCa3.1 are involved in the migration and repair of primary cultures of rat alveolar cell monolayers. Our data also revealed a putative relationship between Kca3.1 and the β1-integrin. Second, we studied the impact of KvLQT1 potassium channel modulation on ARDS pathophysiological aspects with in vivo models. We showed that KvLQT1 was not only involved in alveolar epithelial repair, but also in the resolution of pulmonary oedema and inflammatory response. Taken together, our data demonstrate that potassium channels, such as KCa3.1 and KvLQT1, may be identified as potential therapeutic targets for the resolution of ARDS.

Dans mon projet de doctorat, j’ai étudié des fonctions primordiales de l’épithélium respiratoire telles que la régulation du transport ionique, la clairance liquidienne et la réparation épithéliale. J’ai particulièrement mis l’emphase sur le rôle des canaux potassiques qui interviennent dans ces trois fonctions de l’épithélium respiratoire. J’ai tout d’abord prouvé que la modulation des canaux potassiques régulait l’activité du promoteur de αENaC, en partie via la voie de signalisation ERK1/2, dans des cellules alvéolaires. Cette régulation entraîne une variation de l’expression génique et protéique du canal ENaC. Physiologiquement, il en résulte une augmentation du phénomène de clairance liquidienne suite à l’activation des canaux K+, tandis que l’inhibition de ces canaux la diminue sévèrement. J’ai aussi pu démontrer que l’absence de canal KvLQT1 entraînait une diminution du courant (ENaC) sensible à l’amiloride, dans les cellules de trachée en culture primaire, isolées de souris KO pour kcnq1. Dans la seconde partie de mon étude, j’ai évalué l’impact de l’hyperglycémie sur la capacité de transport ionique et de réparation de cellules épithéliales bronchiques saines ou Fibrose Kystique. Mes résultats montrent que l’hyperglycémie diminue le transport transépithélial de chlore et le transport basolatéral de potassium. Des études préalables du laboratoire ayant montré que les canaux K+ et Cl- contrôlent les processus de réparation, j’ai donc évalué si ceux-ci étaient modifiés par l’hyperglycémie. Et en effet, l’hyperglycémie ralentit la vitesse de réparation des cellules issues des voies aériennes (CFBE-wt et CFBE-ΔF508). J’ai donc démontré que le transport de potassium intervenait dans des fonctions clés de l’épithélium respiratoire, comme dans la régulation génique de canaux ioniques, le contrôle de la clairance liquidienne alvéolaire, et que l’hyperglycémie diminuait le transport ionique (K+ et Cl-) et la réparation épithéliale. / During my Ph.D. training, I studied 3 important functions of respiratory epithelium : regulation of ion transport, liquid clearance and epithelial repair. I focused on potassium channels, because they control these three respiratory epithelial functions. First, I proved that αENaC promoter activity was regulated following K+ channel modulation, in alveolar cells. This regulation of αENaC promoter which might be through a modification of ERK1/2 phosphorylation, was followed by ENaC mRNA and protein expression regulation. I then showed that activation of KvLQT1 and KATP channels increased alveolar liquid clearance, whereas inhibition of these K+ channels decreased the alveolar clearance. I showed that the absence of KvLQT1 channel inhibited the amiloride-sensitive current (ENaC), in tracheal epithelial cells isolated from KvLQT1-KO mice. In the second part of my Ph.D. project, I studied the impact of hyperglycemia on Cystic Fibrosis (CF) and non-CF epithelial cells. I first observed that K+ and Cl- currents were reduced by hyperglycemia. Because we have previously shown that wound-healing process was dependant on K+ and Cl- channels, I then evaluated the impact of hyperglycemia on wound-healing. As expected, hyperglycemia slowed the repair rate of non-CF (CFBE-wt) and CF (CFBE-ΔF508) cell monolayers.

O objetivo principal desta pesquisa foi justificar a proposta de utilização de um novo método tomográfico (cone beam) de avaliação das espessuras ósseas alveolares, maxilares e mandibulares, por meio de testes objetivos das Condições de Repetitividade e de Precisão Intermediária associadas à variação intra e interoperadores, e conforme a utilização de programa computacional independente (AutoCAD®) para a realização das medições, aplicadas à sequência do Procedimento Operacional Padrão (POP) definido para este experimento. A Fase I da pesquisa registrou os critérios de obtenção da qualidade final das imagens tomográficas definitivas, a partir de equipamento iCAT® (Imaging Sciences International, Hatfield, Pa), com parâmetros de aquisição de 120KVp, 37,7mA e 26,9s, e considerando FOV cilíndrico de 13cm e matriz de 512x512 pixels. A resolução do voxel foi de 0,25mm; A Fase II registrou os critérios exploratórios relativos às condições operacionais do software de visualização, registro (inspeção e identificação) e medição das grandezas selecionadas. A Fase III registrou a realização dos testes de repetitividade e de reprodutibilidade das medidas. Um total de 72 grandezas lineares foram previamente definidas e metodologicamente testadas em sua qualidade de inspeção, identificação e medição, a partir da avaliação de sete (7) operadores independentes, cinco dos quais eram especialistas e com Mestrado Acadêmico em Ortodontia pela FOUSP e, o outro, especialista em Radiologia Odontológica e Doutor em Diagnóstico Bucal (FOUSP). Os examinadores foram previamente instruídos, calibrados e treinados considerando os requerimentos necessários à execução dos testes propostos. O protocolo de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Odontologia da Universidade de São Paulo (Parecer CAAE 0120.0.017.000-11). A análise estatística dependeu da utilização de Modelo de Componentes de Variância (hierárquico), e foram consideradas como fontes de variação: as medidas, efetuadas por um mesmo operador ou por diferentes operadores; a face considerada, vestibular ou lingual/palatina; os locais (três níveis de espessura óssea alveolar) em cada uma das faces e, ainda, os diferentes dentes. Esta análise foi realizada de forma separada para mandíbula e maxila. Valores de p<0,05 indicaram significância estatística. Os resultados indicaram significativa confiabilidade geral no método proposto, considerando a Condição de Repetitividade, com apenas 0,24% da variabilidade maxilar total atribuível a um único operador, e mandibular de 0,53%; e com valores expressivos relativos às incertezas de medida maxilares (0,156mm) e mandibulares (0,091mm), desse modo atestando significativa consistência interna (repetibilidade) do método. Os testes da Condição de Precisão Intermediária também indicaram significativa confiabilidade geral no método proposto, com apenas 1,52% da variabilidade total mandibular atribuível à participação de diversos operadores, e maxilar de 0,25%; e com valores também expressivos relativos às incertezas de medida mandibulares (0,149mm) e maxilares (0,158mm), desse modo atestando significativa condição final de reprodutibilidade. Conclui-se que a utilização de imagens provenientes de tomógrafo iCAT®, conforme indicação de resolução de imagem com voxel de 0,25mm, em humanos vivos e a partir de cortes trans-axiais sistematicamente operacionalizados com auxílio de Software AutoCAD®, propicia a geração de condições metodológicas suficientemente favoráveis à obtenção de mapeamento quantitativo linear de espessuras ósseas alveolares, vestibulares e palatinas/linguais, tanto para a maxila quanto para a mandíbula. / This research aimed to justify the proposed use of a new tomography method (cone beam) in the clinical assessment of alveolar, maxillary and mandibular bone width, through objective tests of the Conditions of Repetitiveness and Intermediate Precision associated with intra- and inter-operator variation, using the independent computer program (AutoCAD®) for the execution of the measurements according to the Standard Operating Procedure (SOP) sequence defined for this experiment. Phase I of the research recorded the criteria for obtaining the final quality of the tomography images, using iCAT® (Imaging Sciences International, Hatfield, Pa, USA) equipment with acquisition parameters 120KVp, 37.7mA, and 26.9s, and considering cilindric field-of-view (FOV) of 13cm and 512x512 pixels matrix. The voxel resolution was 0.25mm. Phase II recorded the exploratory criteria relative to the operational conditions of the visualization software, registry (visual inspection and landmark identification) and measurement of the selected magnitudes. Phase III recorded the tests of repeatability and reproducibility of the measurements. A total of 72 linear magnitudes were previously defined and methodologically tested for their quality of inspection, identification and measurement, based on assessment by seven (7) independent operators, five of whom were specialists, with masters degrees in Orthodontics from FOUSP; and the other, a specialist in Dental Radiology and Doctor of Oral Diagnosis (FOUSP). The examiners were previously instructed, calibrated and trained according to the requirements for performing the proposed tests. The research protocol was approved by the Committee for Ethics in Research of the Faculty of Dentistry at the University of São Paulo (Protocol # 102/11-CAAE 0120.0.017.000-11). Statistical analysis used the (hierarchical) Components of Variation Model, and the sources of variation were considered to be: the measurements, made by the same operator or by different operators; the face considered, whether vestibular or lingual/palatal; the locations (three levels of alveolar bone thickness) in each of the faces and, also, the different teeth. This analysis was carried out separately for the mandible and the maxilla. Values of p<0.05 indicated statistical significance. The results indicated overall significant reliability in the proposed method considering the Condition of Repetitiveness, with only 0.24% of total maxillary, and 0.53% of mandibular, variability attributable to a single operator; and with expressive values relative to measurement uncertainties of maxillary (0.156 mm) and mandibular (0.091mm) averages, thereby attesting to significant internal consistency (\"repeatability\") of the method. Tests for the Condition of Intermediate Precision also indicated overall significant reliability of the proposed method, with only 1.52% total mandibular, and 0.25% maxillary, variability attributable to the participation of the various operators; and, also, with expressive values relative to measurement uncertainties of mandibular (0.149mm) and maxillary (0.158mm) averages, thereby attesting to the significant final condition of reproducibility. It is concluded that the use of images from iCAT® tomography, as indicated by image resolution with voxels of 0.25mm, in live humans and from transaxial cuts performed systematically with the help of AutoCAD® Software, provides methodological conditions sufficiently favorable for obtaining linear quantitative mapping of alveolar, vestibular and palatal/lingual bone thicknesses, for both the maxillary and mandibular dental arches.

Introdução: A regeneração óssea guiada baseia-se no princípio de seletividade celular, utilizando membranas para impedir a migração de células indesejadas dos tecidos moles e guiar a proliferação de células osteogênicas. A MDA é um biomaterial que tem sido amplamente utilizado em procedimentos regenerativos periodontais, não somente por ser biocompatível, mas também pela sua capacidade reconstrutiva em proporcionar um aumento da faixa de tecido queratinizado. Em pesquisas recentes, foi demonstrado o envolvimento de uma cadeia de 15 aminoácidos do colágeno (P-15) na diferenciação celular de fibroblastos e osteoblastos. A associação de matriz óssea inorgânica bovina com o P-15 (MOI/P-15) tem apresentado bons resultados. O objetivo dessa pesquisa foi avaliar a eficácia da MDA associada à MOI/P-15 na preservação da crista alveolar após extração dentária em humanos. Metodologia: Foram selecionados 18 pacientes que necessitavam de exodontia de dentes anteriores da maxila com pelo menos dois dentes não contíguos. Foi adotado o modelo boca dividida. Após as extrações dentárias foram realizadas cirurgias regenerativas de preservação da crista alveolar utilizando MOI/P-15 (GT) em um alvéolo e o coágulo sanguíneo no outro alvéolo (GC). Após a inserção do substituto ósseo, a MDA foi posicionada e fixada com parafusos sobre os dois alvéolos para servir como membrana. O retalho foi suturado deixando 2 mm da MDA expostos na porção central. As medidas clínicas MVEP, MVEV e MAH foram registradas na primeira cirurgia e após 6 meses, na cirurgia de reentrada, tomando-se como pontos de referência os parafusos de titânio. Resultados Na análise intragrupos, após seis meses, houve redução estatisticamente significante nas medidas MVEP, MVEV e MAH para ambos os grupos. Para o grupo teste, houve redução na MVEP de 2,80 ± 1,61 para 1,97 ± 1,67 mm; na MVEV de 5,80 ± 1,74 para 4,60 ± 2,05 mm e na MAH de 7,40 ± 2,16 para 4,87 ± 1,51 mm. Para o grupo controle, a MVEP variou de 2,50 ± 1,24 para 1,63 ± 1,32 mm; a MVEV de 6,27 ± 1,75 para 4,77 ± 1,59 mm e MAH de 7,60 ± 1,18 para 4,20 ± 1,00 mm. Para a comparação entre os grupos, além das medidas iniciais e finais, foram calculadas as diferenças entre elas para cada grupo. No grupo teste, a diferença para MVEP foi de 0,83 ± 1,53 e no controle foi de 0,87 ± 1,13 mm; e para MVEV foi de 1,20 ± 2,02 e 1,50 ± 1,15 mm para os grupos teste e controle, respectivamente. Na medida horizontal (MAH) foi encontrada diferença estatística quando comparadas as diferenças no grupo teste e controle que foi de 2,53 ± 1,81 mm para o grupo teste e 3,40 ± 1,39 mm para o grupo controle (p<0,05). Conclusão: Os resultados deste estudo mostram que a MDA, associada ou não a MOIP-15, pode ser utilizada com sucesso como membrana para preservação do rebordo alveolar após extração dentária de dentes maxilares anteriores. A associação com o enxerto favorece de maneira significativa a manutenção da espessura no sentido horizontal da crista alveolar. / Background: Preventing ridge collapse with the extraction of maxillary anterior teeth is vital to an esthetic restorative result. Several techniques are available to regenerative procedures and are used for socket preservation. The aim of this study was to analyze by clinical parameters the use of acellular dermal matrix (ADM) and anorganic bovine bone matrix (ABM) with a synthetic cell-binding peptide P-15 to preserve alveolar bone after tooth extraction. Methods: Eighteen patients in need of extraction of maxillary anterior teeth were selected and they were randomly assigned to the test (ADM plus ABM/P-15) or control (ADM only). Clinical measurements were recorded at initial and 6 months after ridge preservation procedures. Results: In the clinical measurements - External Vertical Palatal, External Vertical Buccal and Alveolar Horizontal (EVPM, EVBM and AHM) -, the statistical analysis showed no difference between test and control groups in the initial and at six months. The intragroup analysis, after six months, showed a statistically significant reduction in the measurements for both groups. In the comparison between the groups, the differences (mm), in the test group, were: EVLM=0.83±1.53, EVBM=1.20±2.02, AHM=2.53±1.81 and in the control were: EVLM=0.87±1.13, EVBM=1.50±1.15, AHM=3.40±1.39. The differences in EVLM and EVBM measurements were no statistically significant; however, in horizontal measurement (AHM), there was statistically difference (p<0.05). Conclusion: The results of this study show that ADM, with or without ABM/P-15, can be successfully when it is used as a membrane for preservation of alveolar ridge after tooth extraction of maxillary teeth earlier.

No mercado mundial existe uma visível tendência de tornar as obras mais industrializadas e racionalizadas com o objetivo de reduzir os desperdícios, acelerar a velocidade de execução das obras e garantir maior qualidade às mesmas. A adoção de elementos estruturais com certo grau de industrialização pode trazer benefícios em relação aos custos, à mão de obra, ao tempo de execução e ao impacto ambiental. Neste contexto, as estruturas mistas de aço e concreto satisfazem essa necessidade, pois tanto os elementos de aço quanto os elementos de concreto podem ser pré-fabricados, ficando apenas as etapas de içamento e montagem a serem realizadas na obra, reduzindo o uso de fôrmas e escoramentos. Os pisos mistos de aço e concreto de pequena altura caracterizam-se pelo embutimento da laje de concreto na altura do perfil de aço, sendo a principal vantagem, em relação ao piso misto convencional, a redução da altura total do composto. Portanto, este trabalho tem como objetivo analisar o comportamento de pisos mistos de aço e concreto de pequena altura com laje alveolar em concreto protendido por meio de ensaios de cisalhamento direto (push-out test) e de flexão. Na solução proposta, a transferência de esforços entre o perfil de aço e a laje alveolar foi feita por meio de conectores tipo pino com cabeça e concreto moldado no local. Os resultados demonstraram-se promissores em termos de comportamento do piso misto de pequena altura, aumentando significativamente a rigidez do sistema em relação à viga de aço isolada. Em complemento, foi desenvolvida uma simulação numérica dos modelos físicos ensaiados utilizando o pacote computacional DIANA®, fundamentado no método dos elementos finitos, na qual o modelo numérico representou adequadamente o comportamento dos pisos mistos de pequena altura, permitindo análises paramétricas. / On the world market, there is a visible tendency to turn buildings construction more industrialized and rationalized in order to reduce waste, accelerate the construction speed and ensure higher quality to them. The adoption of structural elements with a degree of industrialization can bring benefits regarding costs, labor, construction time and environmental impact. In this context, steel and concrete composite structures satisfy this need, since steel and concrete elements can be prefabricated, with only lifting and mounting steps to be performed on site, reducing use of formwork and shoring. A type of slim floor system consists in precast concrete hollow core slabs supported on the lower flange of steel beams. The major advantage of this solution, compared to conventional composite beam, is reducing the overall height of the floor. Therefore, this study aims to analyze the behavior of slim floor with prestressed concrete hollow core slabs through push-out and bending tests. In the proposed solution, the transfer of forces between steel beam and hollow core slabs was made by stud bolts and cast on site concrete. The obtained results proved to be promising in terms of slim floor behavior, significantly increasing the system stiffness regarding the isolated steel beam. In addition, a numerical modeling of the studied slim floor system was developed, using finite element based software DIANA®, in which the numerical model adequately represented the behavior of the composite beam, allowing parametric analysis.

Introdução: A regeneração óssea guiada baseia-se no princípio de seletividade celular, utilizando membranas para impedir a migração de células indesejadas dos tecidos moles e guiar a proliferação de células osteogênicas. A MDA é um biomaterial que tem sido amplamente utilizado em procedimentos regenerativos periodontais, não somente por ser biocompatível, mas também pela sua capacidade reconstrutiva em proporcionar um aumento da faixa de tecido queratinizado. Em pesquisas recentes, foi demonstrado o envolvimento de uma cadeia de 15 aminoácidos do colágeno (P-15) na diferenciação celular de fibroblastos e osteoblastos. A associação de matriz óssea inorgânica bovina com o P-15 (MOI/P-15) tem apresentado bons resultados. O objetivo dessa pesquisa foi avaliar a eficácia da MDA associada à MOI/P-15 na preservação da crista alveolar após extração dentária em humanos. Metodologia: Foram selecionados 18 pacientes que necessitavam de exodontia de dentes anteriores da maxila com pelo menos dois dentes não contíguos. Foi adotado o modelo boca dividida. Após as extrações dentárias foram realizadas cirurgias regenerativas de preservação da crista alveolar utilizando MOI/P-15 (GT) em um alvéolo e o coágulo sanguíneo no outro alvéolo (GC). Após a inserção do substituto ósseo, a MDA foi posicionada e fixada com parafusos sobre os dois alvéolos para servir como membrana. O retalho foi suturado deixando 2 mm da MDA expostos na porção central. As medidas clínicas MVEP, MVEV e MAH foram registradas na primeira cirurgia e após 6 meses, na cirurgia de reentrada, tomando-se como pontos de referência os parafusos de titânio. Resultados Na análise intragrupos, após seis meses, houve redução estatisticamente significante nas medidas MVEP, MVEV e MAH para ambos os grupos. Para o grupo teste, houve redução na MVEP de 2,80 ± 1,61 para 1,97 ± 1,67 mm; na MVEV de 5,80 ± 1,74 para 4,60 ± 2,05 mm e na MAH de 7,40 ± 2,16 para 4,87 ± 1,51 mm. Para o grupo controle, a MVEP variou de 2,50 ± 1,24 para 1,63 ± 1,32 mm; a MVEV de 6,27 ± 1,75 para 4,77 ± 1,59 mm e MAH de 7,60 ± 1,18 para 4,20 ± 1,00 mm. Para a comparação entre os grupos, além das medidas iniciais e finais, foram calculadas as diferenças entre elas para cada grupo. No grupo teste, a diferença para MVEP foi de 0,83 ± 1,53 e no controle foi de 0,87 ± 1,13 mm; e para MVEV foi de 1,20 ± 2,02 e 1,50 ± 1,15 mm para os grupos teste e controle, respectivamente. Na medida horizontal (MAH) foi encontrada diferença estatística quando comparadas as diferenças no grupo teste e controle que foi de 2,53 ± 1,81 mm para o grupo teste e 3,40 ± 1,39 mm para o grupo controle (p<0,05). Conclusão: Os resultados deste estudo mostram que a MDA, associada ou não a MOIP-15, pode ser utilizada com sucesso como membrana para preservação do rebordo alveolar após extração dentária de dentes maxilares anteriores. A associação com o enxerto favorece de maneira significativa a manutenção da espessura no sentido horizontal da crista alveolar. / Background: Preventing ridge collapse with the extraction of maxillary anterior teeth is vital to an esthetic restorative result. Several techniques are available to regenerative procedures and are used for socket preservation. The aim of this study was to analyze by clinical parameters the use of acellular dermal matrix (ADM) and anorganic bovine bone matrix (ABM) with a synthetic cell-binding peptide P-15 to preserve alveolar bone after tooth extraction. Methods: Eighteen patients in need of extraction of maxillary anterior teeth were selected and they were randomly assigned to the test (ADM plus ABM/P-15) or control (ADM only). Clinical measurements were recorded at initial and 6 months after ridge preservation procedures. Results: In the clinical measurements - External Vertical Palatal, External Vertical Buccal and Alveolar Horizontal (EVPM, EVBM and AHM) -, the statistical analysis showed no difference between test and control groups in the initial and at six months. The intragroup analysis, after six months, showed a statistically significant reduction in the measurements for both groups. In the comparison between the groups, the differences (mm), in the test group, were: EVLM=0.83±1.53, EVBM=1.20±2.02, AHM=2.53±1.81 and in the control were: EVLM=0.87±1.13, EVBM=1.50±1.15, AHM=3.40±1.39. The differences in EVLM and EVBM measurements were no statistically significant; however, in horizontal measurement (AHM), there was statistically difference (p<0.05). Conclusion: The results of this study show that ADM, with or without ABM/P-15, can be successfully when it is used as a membrane for preservation of alveolar ridge after tooth extraction of maxillary teeth earlier.

La fibrose pulmonaire idiopathique (FPI) et le syndrome de détresse respiratoire aiguë (SDRA) de l’adulte constituent des affections sévères du poumon distal, avec un pronostic sombre pour les patients. A ce jour, aucun traitement n’est réellement efficace. De manière intéressante, une hypoxie alvéolaire est retrouvée dans ces pathologies.La thérapie cellulaire utilisant des cellules souches mésenchymateuses humaines (CSMh) pourrait représenter un intérêt thérapeutique chez l’Homme. Cependant, leurs mécanismes d’action sont multiples et encore mal définis. Aussi, nous avons testé in vitro l’hypothèse selon laquelle les CSMh pourraient exercer un effet cytoprotecteur paracrine sur les cellules épithéliales alvéolaires (CEA) soumises à l’hypoxie.Dans une première étude, nous avons montré qu’une exposition prolongée à l’hypoxie telle que celle rencontrée au cours de la FPI induisait des modifications phénotypiques des CEA primaires de rat, évocatrices d’une transition épithélio-mésenchymateuse (TEM). On observe une perte progressive d’expression des marqueurs épithéliaux (TTF1, AQP5, ZO-1 et E-Cadhérine), couplée à l’apparition tardive de marqueurs mésenchymateux (α-SMA et Vimentine). Ces modifications phénotypiques s’accompagnent de l’expression dès les premières heures d’hypoxie de facteurs de transcription impliqués dans la TEM (SNAI1, TWIST1 et ZEB1) ou induits par l’hypoxie (HIF-1α et HIF-2α), et de protéines induisant la TEM (TGF-β1 et CTGF). La co-culture des CEA avec des CSMh en fond de puits prévient les modifications phénotypiques induites par l’hypoxie ainsi que l’expression des facteurs pro-TEM TWIST1, ZEB1, TGF-β1 et CTGF. Cet effet bénéfique des CSM est en partie expliqué par la sécrétion d’un facteur de croissance épithélial, le KGF.Dans une deuxième étude, nous avons confirmé que les CEA entraient en apoptose en condition hypoxique, via l’induction de deux voies de signalisations hypoxiques pro-apoptotiques. D’une part, les facteurs de transcription induits par l’hypoxie HIF sont stabilisés, et une cible pro-apoptotique, Bnip3, est induite. D’autre part, l’hypoxie induit une accumulation d’espèces réactives à l’oxygène délétère pour la cellule, perturbant l’équilibre redox de la cellule, endommageant l’ADN, et conduisant à l’apoptose. Cette accumulation pourrait résulter notamment d’une diminution de l’activité des enzymes anti-oxydantes SOD, en hypoxie. Le manque d’oxygène entraine également l’expression de CHOP, facteur de transcription pro-apoptotique impliqué dans le stress du réticulum endoplasmique, qui va13inhiber l’expression de la protéine anti-apoptotique Bcl-2. Nous avons montré que la culture des CEA en présence de milieu conditionné de CSMh (mc-CSMh) permet de prévenir partiellement l’apoptose des CEA en hypoxie, en modulant la voie de signalisation HIF, et en prévenant l’accumulation et les effets délétères des ROS. L’effet protecteur des CSM impliquerait le KGF comme observé lors de la première étude, mais également le HGF.Ces deux études indiquent que les CSMh sont susceptibles d’exercer des effets cytoprotecteurs paracrines vis-à-vis des CEA soumises à l’hypoxie aiguë ou prolongée, en limitant d’une part les modifications phénotypiques évocatrices de TEM, et d’autre part l’apoptose des CEA via la modulation des voies de signalisations hypoxiques. La sécrétion par les CSMh de KGF et de HGF, facteurs de croissance épithéliaux connus pour leurs effets bénéfiques sur les CEA, explique en partie les effets protecteurs paracrines des CSMh. Nos résultats suggèrent que les effets cytoprotecteurs des CSMh vis-à-vis des CEA pourraient contribuer aux effets bénéfiques des CSMh observés in vivo dans différents modèles animaux de fibrose induite, ou lors d’agressions alvéolaires aiguës. / Acute or chronic alveolar injuries provoke massive apoptosis of alveolar epithelial cells (AEC) that compromises an efficient repair of the alveolar epithelium and leads to lung diseases such as ARDS or IPF. These disorders are commonly associated with local alveolar hypoxia aggravating their progression through the stimulation of AEC apoptosis. Administration of allogenic mesenchymal stem cells (MSCs) has been shown to limit lung inflammation and fibrosis in murine models of alveolar injury, through a still poorly understood paracrine mechanism. In a first study, we showed that long term exposure of AEC in hypoxia leads to phenotypic alterations which looks like epithelio-mesenchymal transition (EMT). Co-culture with MSCs prevent hypoxia-induced EMT.In a second work, we studied whether MSC could protect AEC from hypoxia-induced apoptosis and the mechanisms involved. hMSC-conditioned media (hMSC-CM) significantly reduced hypoxia-induced apoptosis of AEC. Such a anti-apoptotic effect was also obtained with ROS scavenger N-acetylcystein or HIF1a inhibitor YC-1. hMSC-CM decreased the protein expression of HIF1α and HIF2α and of their pro-apoptotic target Bnip3 in hypoxic AEC. hMSC-CM also reduced ROS accumulation in hypoxic AEC by enhancing the activity of anti-oxidant enzymes and prevented the induction of CHOP, a pro-apoptotic factor induced by ROS signaling. The paracrine effect of hMSC was partly dependent on KGF and HGF secretion. hMSC prevent via a paracrine effect hypoxia-induced apoptosis of AEC by modulating hypoxic and ROS signaling.These two studies show that MSCs exert cytoprotective effects in vitro against hypoxia-induced apoptosis and EMT in AEC

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood, with two predominant histologic subtypes: embryonal and alveolar. These histologies display distinct clinical courses, and despite refinements in dose and duration of multimodality therapy, the 5-year overall survival of patients diagnosed with metastatic RMS remains <30%. Thus, there is an urgent need to define novel targets for therapeutic intervention. Interrogation of cancer cell signal transduction pathways that regulate the pathogenic behaviours of tumor cells has been successful in defining targets in numerous tumor types. These have ultimately yielded clinically-relevant drugs that have improved the disease-free and overall survival of patients diagnosed with cancer. Work contained in this thesis describes the interrogation of several potential targets for inhibition in RMS. Interruption of RMS cell proliferation, survival and apoptosis is examined through disruption of the protein kinase integrin-linked kinase (ILK) and the nuclear receptor estrogen-receptor β. ILK, in particular, is demonstrated to have dual competing functions through the regulation of c-jun amino-terminal kinase (JNK) signaling: an oncogene in alveolar, and a tumor suppressor in embryonal RMS. These findings are recapitulated in other tumor cell lines, indicating that expression levels of JNK1 correlate with ILK function in a broad spectrum of tumor types. Furthermore, interruption of rhabdomyosarcoma cell migration as a surrogate marker of metastasis is examined through disruption of the stromal-cell derived factor 1α/chemokine (CXC)receptor 4 signaling network, as well as through cooperative interactions between ILK and the mammalian target of rapamycin. Finally, we demonstrate that the insulin-like growth factor pathway is a potential target for therapeutic inhibition, which also distinguishes tumors of embryonal and alveolar histology. These studies provide a rationale for the development of novel agents, as well as the use of established drugs targeting these pathways in rhabdomyosarcoma.

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood, with two predominant histologic subtypes: embryonal and alveolar. These histologies display distinct clinical courses, and despite refinements in dose and duration of multimodality therapy, the 5-year overall survival of patients diagnosed with metastatic RMS remains <30%. Thus, there is an urgent need to define novel targets for therapeutic intervention. Interrogation of cancer cell signal transduction pathways that regulate the pathogenic behaviours of tumor cells has been successful in defining targets in numerous tumor types. These have ultimately yielded clinically-relevant drugs that have improved the disease-free and overall survival of patients diagnosed with cancer. Work contained in this thesis describes the interrogation of several potential targets for inhibition in RMS. Interruption of RMS cell proliferation, survival and apoptosis is examined through disruption of the protein kinase integrin-linked kinase (ILK) and the nuclear receptor estrogen-receptor β. ILK, in particular, is demonstrated to have dual competing functions through the regulation of c-jun amino-terminal kinase (JNK) signaling: an oncogene in alveolar, and a tumor suppressor in embryonal RMS. These findings are recapitulated in other tumor cell lines, indicating that expression levels of JNK1 correlate with ILK function in a broad spectrum of tumor types. Furthermore, interruption of rhabdomyosarcoma cell migration as a surrogate marker of metastasis is examined through disruption of the stromal-cell derived factor 1α/chemokine (CXC)receptor 4 signaling network, as well as through cooperative interactions between ILK and the mammalian target of rapamycin. Finally, we demonstrate that the insulin-like growth factor pathway is a potential target for therapeutic inhibition, which also distinguishes tumors of embryonal and alveolar histology. These studies provide a rationale for the development of novel agents, as well as the use of established drugs targeting these pathways in rhabdomyosarcoma.

RAGE (receptor for advanved glycation endproducts) was identified on endothelial cells as binding partner for AGE-modified molecules. The term &amp;quot;Advanced glycation endproducts&amp;quot; involves a number of structurally diverse molecules, which derive from multiple complex rearrangements of reducing sugars with free amino-groups of proteins. They evolve during food production and also in vivo during ageing and to an accelerated degree in diabetes, where AGEs cause receptor-mediated cellular perturbations. Due to the pathological relevance the aim of this thesis was to generate a &amp;quot;biosensor&amp;quot; for AGEs. To this end, the membrane-expressed receptor (flRAGE) as well as soluble RAGE (sRAGE) were expressed in mammalian cells and investigated in numerous binding studies. These did not reveal a specific interaction of AGE-modified ligands with RAGE. In addition, the expression of RAGE on endothelial cells, as described in the literature, could not be followed neither with the help of newly generated monoclonal anti-RAGE antibodies, nor in quantitative &amp;quot;real time&amp;quot; RT-PCR analysis. These results cast doubts on the meaning of RAGE as a proinflammatory receptor in AGE-mediated pathologies and on the adequacy of RAGE for the &amp;quot;biosensor&amp;quot;. At the same time the question concerning a physiological role of the receptor arose. RAGE-expression was analysed in different healthy human tissues by &amp;quot;real time&amp;quot; RT-PCR, which revealed an almost selective expression in lung tissue. An important indication for a possible physiological function of RAGE in lung provided the selective localization of RAGE on alveolar epithelial type I cells as demonstrated in frozen lung sections as well as in in vitro cultivated lung cells. RAGE could be identified as a novel, highly specific marker for the thin, expanded AT I cell, which form part of the air-blood-barrier. In the following, RAGE was found to be an interaction partner for collagen IV, a major component of the alveolar basal lamina. Membrane-expressed RAGE did not only strengthened adherence of cells but also induced cell spreading on collagen IV-coated surfaces. This preferential interaction of RAGE with collagen IV could substantially contribute to the functional morphology of AT I cells in vivo, thereby ensuring an effective bidirectional gas-exchange. The results of this thesis expose a novel, so far unnoticed aspect of the biology of RAGE, which presumably contributes to the phenotypic characteristic und function of normal human lung tissue. / RAGE (receptor for advanced glycation endproducts) wurde als Interaktionspartner auf Endothelzellen für AGE-modifizierte Moleküle identifiziert. Unter den &amp;quot;Advanced glycation endproducts&amp;quot; werden eine Vielzahl strukturell unterschiedlicher Moleküle zusammengefasst, die durch mehrstufige komplexe Umlagerungen zwischen reduzierenden Zuckern und freien Aminogruppen von Proteinen entstehen. Sie entstehen sowohl bei der Herstellung von Lebensmitteln, als auch in vivo während des Alterns und in erhöhtem Maß bei Diabetes, wobei sie Rezeptor-vermittelt Zellstörungen hervorrufen. In der vorliegenden Arbeit wurde zunächst aufgrund der pathologischen Relevanz eine Strategie zur Konzeption eines &amp;quot;Biosensors&amp;quot; für AGEs verfolgt. Hierfür wurde sowohl der membranständige Rezeptor (flRAGE) als auch löslicher RAGE (sRAGE) in Säugerzellen exprimiert und in zahlreichen Bindungs- und Funktionsanalysen getestet. Hierbei konnte keine spezifische Interaktion der AGE-modifizierten Moleküle mit RAGE nachgewiesen werden. Auch die in der Literatur beschriebene Expression von RAGE auf Endothelzellen konnte mit Hilfe neu generierter monoklonaler Antikörper, sowie in quantitativen &amp;quot;real time&amp;quot; RT-PCR-Analysen nicht nachvollzogen werden. Diese Ergebnisse warfen Zweifel an der grundlegenden Bedeutung von RAGE als proinflammatorischer Rezeptor in AGE-bedingten Krankheiten auf und stellten damit auch dessen Eignung für einen AGE-Biosensor in Frage. Gleichzeitig warf diese Skepsis die Frage nach einer möglichen physiologischen Funktion dieses Rezeptors auf. Eine vergleichende Analyse der RAGE-Expression in verschiedenen gesunden Geweben mittels &amp;quot;real time&amp;quot; RT-PCR ergab eine nahezu selektive Expression in Lungengewebe. Wichtige Anhaltspunkte für die Funktion von RAGE in der Lunge ergaben sich aus der selektiven Lokalisation des Rezeptors auf Alveolarepithelzellen Typ I (AT I) sowohl in Gefrierschnitten der Lunge als auch nach in vitro-Kultur von Lungenzellen. RAGE konnte als neuer, hoch spezifischer Marker für die lang gestreckten AT 1 Zellen, die einen Teil der Blut-Luft-Schranke bilden, definiert werden. In folgenden Funktionsanalysen konnte RAGE als spezifischer Interaktionspartner für Kollagen IV, einer Hauptkomponente der Alveolar-Basalmembran, identifiziert werden. Membranständiger RAGE verstärkte nicht nur die Adhärenz von Zellen an Kollagen IV-beschichtete Oberflächen, er induzierte auch Zell-&amp;quot;Spreading&amp;quot;. Dies gab Anlass für die Vermutung, dass die beobachtete präferentielle Interaktion von RAGE mit Kollagen IV maßgeblich zu der funktionellen Morphologie der AT I Zellen in vivo beitragen könnte, die die Voraussetzung für einen effektiven bidirektionalen Gasaustausch darstellt. Durch die Ergebnisse dieser Arbeit wurde ein neuer, bisher unbeachteter Aspekt der Biologie des RAGE aufgedeckt, der vermutlich entscheidend zur phänotypischen Ausprägung und Funktion des normalen humanen Lungengewebes beiträgt.