Abstract Radiotherapy is used in the treatment of breast cancer in order to reduce local recurrence rate. However, radiation is known to cause both acute and delayed side-effects on normal tissues. A common late complication of radiotherapy is fibrosis of skin and other organs. Fibrosis has been described as excessive accumulation of extracellular matrix components, especially collagens. Collagens are a group of extracellular matrix proteins that provide connective tissues with tensile strength. Type I and III collagens are the major structural proteins in skin. Alterations in collagen synthesis occur in various pathological conditions, during ageing and in association with diverse medical therapies. Collagens are degraded by matrix metalloproteinase enzymes (MMPs). The activity of MMPs is restrained by their specific tissue inhibitors (TIMPs). Elastic fibres constitute about 2–4% of skin dry weight. Despite their low quantity, elastic fibres are responsible for the resilient and elastic properties of skin. Dermal elastic fibres may be affected by intrinsic ageing, by extrinsic reasons such as photodamage and in several connective tissue diseases. The effect of radiotherapy on human skin type I and III collagen synthesis was investigated in a group of women who had been treated for breast cancer surgically and with radiotherapy. The levels of MMP-9, MMP-2/TIMP-2 complex, TIMP-1 and TIMP-2 in irradiated skin were also analysed. The effect of radiotherapy on elastic fibres was analysed using skin samples. The physio-mechanical properties of radiotherapy-treated skin were studied using ultrasound and elastometer devices, and compared with those of non-treated skin. In addition, skin samples were stained for haematoxylin-eosin, tenascin and mast cells. Factor VIII immunostaining was performed to visualize dermal blood vessels. Wound regeneration in irradiated skin was also studied using suction blister as a model. The synthesis of type I and III collagens was markedly increased as a result of radiotherapy. An increased amount of cross-linked type I collagen was detected in irradiated skin, and collagen turnover was also increased in irradiated skin. No difference in the amount or structure of the elastic fibres could be found between radiotherapy-treated and non-treated skin. A slight increase of skin thickness and stiffness was found in irradiated skin compared to non-treated skin. Increased tenascin expression was found in irradiated skin. The number of dermal blood vessels visualized by FVIII immunostaining was slightly higher in irradiated than in control skin. The amount of mast cells positive for tryptase, Kit receptor and chymase was increased in the upper dermis of irradiated skin. No difference in epidermal regeneration was found between irradiated and non-treated skin. The results of this study suggest that alteration of collagen metabolism contributes to dermal side effects of therapeutic irradiation.

Abstract Collagen XI is a minor component of articular cartilage collagen fibrils together with collagen IX. They are in close functional relationship with the major cartilage collagen II. Collagen XI has been suggested to play a role in regulating the diameter of collagen II fibrils. Together these collagens form a supportive framework in the extracellular matrix. Besides articular cartilage, these three collagens can also be found in the vitreous body of the eye, the intervertebral disc, the inner ear and in various tissues during embryonic development. As the major cartilage collagen, collagen II has been studied quite extensively. Several syndromes ranging from lethal to milder ones have been shown to result from collagen II gene defects. Far less is known about defects in genes coding for the minor cartilage collagens, IX and XI. By identifying mutations in the coding genes and observing the resulting phenotypes, the function and importance of these genes start to unravel. The goal of this study was to provide more information about collagen XI. As a quantatively minor cartilage component, it is a good candidate for mild disease phenotypes. Collagen XI gene mutations have been shown to cause relatively mild phenotypes, such as Stickler and Marshall syndromes and non-syndromic hearing loss. Seven families with a recessive chondrodysplasia, otospondylomegaepiphyseal dysplasia (OSMED), were analysed for mutations in COL11A2. This study showed that OSMED is typically caused by the absence of the α2(XI) chains. Sixty-two patients with isolated Robin sequence, cleft palate or micrognathia were analysed for COL11A2 gene mutations. Six unique nucleotide changes were found that are likely to associate with the phenotype. The results showed that collagen XI gene defects can play a role in the etiology of oral clefting, but are not common causes of these phenotypes. Altogether 72 unrelated osteoarthrosis (OA) patients and one family with OA were analysed for mutations in genes coding for collagens II, IX and XI. Eighteen percent of them were found to have a unique sequence variation. An association analysis of OA patients failed to reveal any common predisposing alleles in these genes.

Studies have been made of the reactions which take place when zirconium compounds and vegetable tannins react with chromium tanned leather, in order to elucidate the mechanisms of the reactions which occur on retannage. Statistical procedures have been used in all investigations because of the variable nature of the substrate, and computer techniques have been applied to the repetitive statistical computations. Although chromium and vegetable tannages are well understood, further information on the reaction of zirconium with collagen was necessary before attempting to interpret the results of the studies of combination tannages with chromium, and this has been obtained by a comparative study of the reactions of chromium and zirconium with modified collagen. It is concluded that the mechanism of the reaction of basic zirconium sulphate with collagen is multipoint attachment of the tanning material by residual valency forces, although charge effects with basic groups may be supplementary. Zirconyl chloride reacts with carboxyl groups but does not form satisfactory, stable cross-links with collagen. Further evidence for this theory was obtained from the investigation of the reaction of zirconium compounds with chromium tanned collagen. Zirconyl sulphate does not interfere with effective chromium tannage and therefore can have little affinity for the carboxyl groups on the protein, but it displaces chromium complexes loosely held by auxiliary valencies without reducing the shrinkage temperature of the chromium leather Zirconyl chloride, although only fixed to a limited extent, apparently forms co-ordination compounds with the carboxyl groups, disrupting the chromium tannage because there is an over-all loss of hydrothermal stability. There is no evidence that zirconium co-ordinates with, or releases acid from chromium-collagen complexes, since combination chromium/zirconium tanned leathers are stable on storage. Retannage of chromium tanned leather with vegetable tanning materials generally results in loss of strength and a product which tends to deteriorate on ageing. Lower initial strength is probably due to the increased avidity of chromium tanned pelt for vegetable tannins, resulting from the liberation of internally neutralised reactive sites which are not normally available in vegetable tannage, and from the co- ordination of vegetable tannins and non-tannins to the chromium complex with the displacement of sulphate radicals. From a study of the retannage of chromium tanned modified collagen, it appears that basic groups probably play an important part in the rapid absorption of vegetable tannin. These reactions result in overloading of the fibre and an increased number of cross-links, both of which tend to produce weak leather. Deterioration with age is primarily a hydrolytic degradation of the protein which is catalysed by acid liberated from the chromium complexes by the entry of vegetable tannins, those factors which favour the formation of acid causing greater and more rapid deterioration.

M.Tech. (Biomedical Technology) / Collagen Type I (Col- I) as well as collagen types III and V, form most of the connective tissues, smooth muscle cells and, endothelial cells in wound healing (Stuart and Leaper, 2008). Col-I is also the main extracellular matrix (ECM) protein (Ricard-Blum and Ruggiero, 2005). Low intensity laser irradiation (LILI) is a non-invasive, photobiomodulatory therapy. Huang et al., (2009a) have shown LILI to be involved in Col-I production both in vitro and in vivo. Enhanced collagen production in human skin fibroblasts is common shortly after irradiation (Illsley et al., 2000). However, its synthesis in wounded fibroblasts has not been well established in an in vitro model. Healing is impaired in chronic diabetic wounds which exhibit reduced proliferation rate and collagen synthesis (Beldon, 2010; Falanga, 2005). Studies have shown that LILI using a wavelength of 632.8 nm was not the only wavelength biostimulated in cultured cells: biological responses were also generated from various wavelengths within the visible to Near Infrared (NIR) spectral region (Hawkins and Abrahamse, 2005; Karu and Kolyakov, 2005). This study aimed to establish if LILI influenced collagen production and related cellular responses at a wavelength of 660 or 830 nm, with a fluence of 5 J/cm2 in an in vitro normal and wounded fibroblasts model. The study also evaluated the expression profiling of genes related to the ECM and adhesion. This study was performed on isolated human skin fibroblasts collected from a consenting adult undergoing abdominoplasty. Cells were routinely cultured according to standard techniques (Houreld and Abrahamse, 2010; Hawkins and Abrahamse, 2007a; Hawkins and Abrahamse, 2006a; Hawkins and Abrahamse, 2005).

Orientadores: Mário Alexandre Coelho Sinhoreti. Americo Bortolazzo Correr / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-27T04:06:35Z (GMT). No. of bitstreams: 1 Abuna_GabrielFlores_M.pdf: 32440601 bytes, checksum: 93c6f8fada4bccad124db9dc6ea6c205 (MD5) Previous issue date: 2015 / Resumo: Objetivos: O objetivo no presente trabalho foi avaliar o potencial remineralizador e a as propriedades adesivas (resistência de união, análise das interfaces, nanoinfiltração) de um novo sistema adesivo baseado em fosfatos e dois análogos biomiméticos incorporados em um adesivo experimental autocondicionante de dois passos. Métodos: Foi preparado um primer-base, onde foram incorporados os análogos e um adesivo-base contendo os fosfatos. Para avaliar o potencial remineralizador foram desmineralizadas barras de dentina (n=5) (EDTA 17%), distribuídas em: Controle sem análogos e sem fosfatos; Primer+Fosfatos; Acido poliacrilico APA+Fosfatos; Trimetafosfato de sódio TMS+Fosfatos; e Analogos+fosfatos. tratadas com cada primer e fixados junto a uma barra do adesivo polimerizado, em 1,5 mL de solução fosfato tampão. Foi usado um Espectroscópio Infravermelho Transformado de Fourier (ATR-FTIR) para caracterizar os fosfatos formados. Os espectros foram obtidos depois das 24 h, 7 dias, 2 e 6 meses. Microscopia Eletrônica de Transmissão (MET) foi usada para avaliar a interação dos cristais de apatita com o colágeno. Para avaliar as propriedades adesivas 50 dentes molares humanos hígidos foram usados (n=5): O primer foi aplicado por 10 segundos e o adesivo por 20 segundos, seguido de fotoativação por 20 s. Após, foram restaurados (Filtek Z350) em incrementos de 2 mm. Após 24 h ou 6 meses de pressão pulpar simulada (PPS), os dentes foram cortados em palitos de 0.9 x 0.9 mm2 e foi testada a resistência da união (EZ-test; Shimadzu, Kyoto, Japan), analisado o modo de fratura em estereomicroscópio. Um palito por dente foi selecionado e avaliado no ensaio nanoinfiltração, usando nitrato de prata amoniacal. Ainda, foi selecionado um palito por dente para avaliar a camada híbrida em Microscópio Eletrônico de Varredura com 15 KV. O analise estatístico da resistência de união foi feita com teste ANOVA dois fatores, e normalizados com Teste de Tukey, (p<0.05) Resultados: Todos os espetros do ATR-FTIR foram normalizados em 1650 cm-1 Amida I. Foi observado após 6 meses de PPS, a presença de picos em 947 e o par em 1092 cm-1 atribuídos a união C=O da HAp, e picos de PO4 em 1033 cm-1 , além de outros picos representativos da HAp. A análise em MET mostrou que, sem a intervenção dos análogos, a mineralização só ocorre nos espaços extrafibrilares, contrário a imagem com ambos análogos, onde observou-se uma organização em forma de agulhas intrafibrilar das apatitas. A resistência de união demostrou como a presença dos análogos e fosfatos não atrapalhou a adesão mostrando uma resistência similar no grupo de Analogos+Fosfatos, comparando-se 24 h com 6 meses de PPS (35,12±5,16 MPa e 38,67 ±4,03 MPa, respectivamente). No MEV observou-se a qualidade da camada adesiva, mostrando os túbulos dentinários obstruídos após 6 meses de PPS. Após a análise da nanoinfiltração, observou-se que a sorção de água diminui proporcionalmente à mineralização do grupo Analogos+Fosfatos. Conclusão: O sistema remineralizador proposto formou núcleos de HAp caracterizados mediante o ATR-FTIR, alcançando zonas intrafibrilares do colágeno, e mantendo o desempenho do adesivo após armazenamento em pressão pulpar simulada / Abstract: Objective: The aim of this study was to assess the remineralization potential and bonding properties of a novel system based on phosphates and biomimetic analogs incorporated into a two-step self-etch adhesive. Methods: It was prepared a main primer where were added the analogs and one main blend where were incorporated the phosphates. To assess the remineralization properties, to assess the mineral deposition dentin slabs were (n=5) demineralized (EDTA 17%), treated in each primer and fixed next to a polymerized adhesive slab (Under 1.5 mL phosphate buffer solution). It was used an ATR-FTIR to characterize the new phosphates. The spectra were recorded after 24 hrs, 7 days, 2 months and 6 months. The Transmission electronic microscopy was used to assess the nanometric interaction of apatite crystals and demineralized dentin collagen. In order to assess Dentin bonding properties, 50 non-carious human molars were used. (Under 038/2014 CEP-FOP protocol) divided into 5 groups n=10: PAA+Phosphates- polyacrylic acid-containing primer and phosphates-doped bond; STMP+Phosphates- Sodium trimetaphosphate-containing primer and phosphates-doped bond; Analogs+Phosphates- both analogs in the primer and phosphates-doped bond. The primer was applied for 10 s, the adhesive was applied for 20 s and light cured for 20 s. Then were resin (Filtek z350) restored at 2 mm layers. After 24 hrs or 6 months of simulated pulpal pressure SPP, the teeth were sectioned in sticks of 0.9 mm2 tested the µTensile Bond Strength, and analyzed the failure mode at a stereomicroscope. One stick per teeth was chosen and assessed Nanoleakage, using ammoniacal silver nitrate solution to reveal the hybrid layer at a Scanning Electronic Microscopy. Results: All the spectra of ATR-FTIR were normalized at 1650 Amide I. It was observed after 6 months of SPP, the presence of peaks at 947 and its pair at 1092 cm-1 attributed to C=O of HAp, and peaks of PO4 at 1033 cm-1 besides other specific peaks that confirm the presence of HAp. The TEM analysis showed, without the intervention of analogs the mineralization occurs just at in the extrafibrilar spaces, opposite to the image with both analogs where it is showed an intrafibrilar organization of needles like apatites. The µTBS outcomes demonstrate how the presence of this analogs and phosphates did not jeopardize the bonding strength. Showing a µTBS similar at Analogs+Phosphates, comparing 24 hrs of SPP to 6 months of SPP (35.12+5.16 MPa and 38.67 +4.03 MPa) (?=0.05). With SEM we observed the quality of this adhesive layer, showing occluded tubules after 6 months of SPP and no degradation of Resin tags. After Nanoleakage evaluation we see how after remineralization the water income decrease proportional to the mineralization. Conclusion: The proposed remineralizing system nucleate HAp characterized by ATR-FTIR in this study. Achieving the intrafibrilar zones of collagen, and keeping the performance of the adhesive after storage under SPP, maintaining the bonding properties and decreasing the factors of common adhesive degradation / Mestrado / Materiais Dentarios / Doutor em Materiais Dentários

Předložená diplomová práce se zabývá charakterizací vlastností kolagenu po působení různých fyzikálních a chemických podmínek. Jejím cílem je popsat změny struktury kolagenu způsobené jeho modifikací, zhodnotit dopad těchto změn na další použití kolagenu a výběr vhodné metody pro determinaci vlastností kolagenu. V literární rešerši je popsána chemická struktura kolagenu, jeho využití jako biomateriálu, stabilita kolagenu a způsoby určení stupně porušení nativní kolagenní struktury. V experimentální části jsou vodné roztoky hovězího kolagenu typu I modifikovány působením různých podmínek - různé intenzity a délky dezintegrace (1 minuta při 6 000 otáčkám až 5 minut při 14 000 otáčkách), různé teploty přípravy (4 °C, pokojová teplota a 30 °C), různou dobou přípravy (1 až 5 dní), působením světla (1 až 14 dní) a úpravou pH (4 až 8). Za účelem popsání struktury kolagenu a změn, k nimž došlo během modifikace kolagenních vzorků působením různých podmínek jsou kolagenní roztoky analyzovány UV VIS spektrometrií a infračervenou spektrometrií. UV-VIS spektrometrií byly analyzovány barevné produkty reakce volných aminoskupin přítomných v kolagenu s vhodným činidlem. Jako činidlo byl použit vodný roztok kyseliny 2,4,6 trinitrobenzensulfonové a roztok ninhydrinu v alkoholu. V případě FT-IR spektrometrie byly kolagenní vzorky analyzovány buď v podobě KBr tablet nebo pomocí ATR techniky v podobě filmů. Pro vyhodnocení změn ve struktuře kolagenu byla využita dekonvulace amidu I, jednoho z charakteristických pásů v infračerveném spektru kolagenu, který leží v oblasti 1590 - 1720 cm-1. Na základě snímků pořízených pomocí SEM byla porovnána morfologie kolagenních vzorků. V souladu s teoretickými předpoklady bylo zjištěno, že k nejvýraznějšímu porušení kolagenní struktury dochází při dlouhodobém stání kolagenního roztoku na světle. Podstatné změny způsobuje i zvýšení teploty a téměř žádný vliv na strukturu kolagenu nemá intenzita dezintegrace kolagenního roztoku. V případě zvýšení pH, byly vzorky do pH 5 stabilní a homogenní, ale poté docházelo k oddělení kolagenní fáze a srážení kolagenu, což ovlivnilo a zkreslilo UV-VIS analýzu. Nejlepších vlastností dosahují vzorky zamražené čerstvě po přípravě, dezintegrované 4 minuty při 14 000 otáčkách při 30 °C a beze změny pH. Na základě výsledků analýz se jako vhodné metody pro stanovení stupně porušení kolagenní struktury ukázala UV VIS spektrometrie s využitím kyseliny 2,4,6 trinitrobenzensulfonové v kombinaci s infračervenou spektrometrií kolageních filmů.

The aim of the presented work is the study and biochemical characterization of some modified collagen materials (prepared on Institute of Material Science, Faculty of Chemistry, BUT), optimalization of collagen isolation from various types of animal tissues and testing of isolated collagen stability. First, isolation of collagen from five different animal tissues was performed with satisfactory yields. The concentration of total proteins was measured by Biuret and Hartree – Lowry method, the concentration of free amino groups was measured by TNBSA method. Protein analysis in colllagen preparatives was peformed by vertical electrophoresis PAGE-SDS and by microfluidic electrophoretic system Experion for comparison. Further purification and separation of collagen isolates by gel permeation chromatography was tested too. To detailed characterization thermal stability of collagen specimens was performed by high performance ultrasonic spectroscopy. Biological stability of collagen was tested in model physiological conditions.

Předložená diplomová práce v teoretické části shrnuje základní fakta o kolagenu, bílkovině, která je nejrozšířenější v lidském organismu a oxidované celulóze používané v medicíně po několik desetiletí. Hlavním tématem této časti je síťování kolagenu, které je důležitým faktorem pro stabilizaci kolagenu podporující odolnost proti jeho degradaci. Jako síťující činidlo lze použít právě oxidovanou celulózu, která má kromě hemostatického účinku i funkční karboxylové skupiny vhodné k síťování proteinů. Praktická část práce byla zaměřena na sledování vzájemného chování směsí roztoků oxidované celulózy a kolagenu. Filmy či pěnové lyofilizáty připravené z těchto polymerních směsí by mohly sloužit jako účinná hemostatika nebo jako antibakteriální krytí ran podporující hojení. Byla zvolena řada hmotnostních poměrů mezi kolagenem a oxidovanou celulózou (9:1, 3:1, 5:3, 1:1, 1:2, 1:3, 1:9) se zachováním konstantního množství kolagenu, ale se vzrůstajícím množstvím celulózy. Jejich schopnost chemicky se vázat a umožnit tak vznik amidových vazeb mezi volnými aminovými skupinami kolagenu a karboxylovými skupinami oxidované celulózy byla sledována pomocí dvou UV-VIS spektroskopických metod, které využívají barevné reakce chemického činidla (ninhydrinu či 2,4,6 trinitrobenzensulfonové kyseliny) se zbylými volnými aminovými skupinami kolagenu. Karboxylové skupiny oxidované celulózy byly navíc aktivovány jak v polymerním roztoku tak i ve formě filmu směsí činidel 1-ethyl-3-(3-dimethylaminopropyl)karbodiimidu a N hydroxysukcinimidu (EDC/NHS). Pomocí infračervené spektroskopie s Fourierovou transformací (FT-IR) byly vyšetřeny změny vzorků na úrovni sekundární struktury kolagenu. Stabilita připravených směsí byla sledována ve formě filmu pomoci hydrolytické degradace při 37 °C. Morfologické změny na dvou typech lyofilizovaných vzorků, vymražených rychle při 196 °C nebo pomaleji při -30 °C, byly sledovány pomocí rastrovací elektronové mikroskopie (SEM). Při přípravě polymerních směsí se obě složky (kolagen i celulóza) se vzrůstajícím obsahem celulózy srážely až do poměru 1:1. UV-VIS analýzy potvrdily pokles volných –NH2 skupin poukazující na síťování kolagenu s celulózou shodně s nárůstem odolnosti vůči hydrolytické degradaci získané z měření úbytků hmotností připravených filmů. Od poměru 1:2 se složky již nesrážely, polymerní roztok byl homogenní, ale z důvodu nárůstu počtu volných aminových skupin od tohoto poměru výše lze usoudit, že celulóza fungovala v malém obsahu pouze jako fyzikální síťovalo a po dosažení rovnovážného stavu s kolagenem funguje spíše jako rozpouštědlo. Tímto způsobem zřejmě mohlo dojít ke změnám kolagenu až na úrovni sekundární struktury zaznamenané pomocí FT-IR. Aktivace karboxylových skupin celulózy činidly EDC/NHS nebyla prokázána. Poměry složek ovlivnily i porozitu a velikosti pórů připravených lyofilizátů určených pomocí SEM. Do poměru 1:1 byla porozita skafoldů vymražených kapalným dusíkem mezi 46 – 60 %, po dalším přidání celulózy stoupla až na 81 % (u poměru 1:9). Průměrná velikost pórů samotného kolagenu byla velice malá (14 ± 5 m), oproti oxidované celulóze (79 ± 24 m), proto přídavek celulózy vždy zvýšil velikost pórů na cca 55 m s výjimkou poměru 1:9, mající vysokou průměrnou velikost pórů (186 ± 76 m) a velmi pravidelnou strukturu připomínající včelí plást, kterou má i samotná celulóza.

Cílem předložené diplomové práce byla in-situ příprava stříbrných nanočástic na kolagenové matrici jako antibakteriálního povlaku a studie vlivu podmínek přípravy na vlastnosti nanočástic, zejména jejich velikost, tvar, homogenita jejich distribuce a antibakteriální aktivita. V rámci práce byla rovněž sledována kinetika redukce stříbrných nanočástic z dusičnanu stříbrného a vliv teploty na její průběh. Připravený materiál a jeho vlastnosti byly analyzovány pomocí různých technik. UV-VIS absorpčních vlastností stříbra bylo využito pro kinetické studie redukce a uvolňování nanočástic. Pomocí rastrovací elektronové mikroskopie byla vyhodnocena homogenita stříbrného povlaku a přibližná velikost částic a jejich aglomerátů. Velikostní distribuce nanočástic byla pak přesně stanovena pomocí dynamického rozptylu světla. Pomocí infračervené spektrometrie s Fourierovou transformací s technikou úplného zeslabeného odrazu byla sledována interakce stříbra s funkčními, zejména karboxylovými skupinami. Termogravimetricky byla stanovena tepelná stabilita a procentuální obsah stříbra v materiálu. Vliv AgNPs povlaku na 3D strukturu kolagenního scaffoldu a fázový kontrast pro 3D zobrazovací techniky byl zkoumán pomocí rentgenové výpočetní nanotomografie. V neposlední řadě byla také stanovena antibakteriální aktivita připraveného materiálu a její závislost na koncentraci stříbra.

Keloids are benign hyper-proliferative growths of fibrous tissue, where increased fibroblast activity results in abnormal collagen deposition. Scientific literature related to the morphological features of keloids especially at an ultrastructural level is outdated. Therefore the aim of this study was to reassess present knowledge of the ultrastructural features of keloids and possibly through this process identify new cellular therapeutic targets. The research was conducted on normal (control) and keloid human skin samples collected from consenting patients undergoing keloid removal and skin transplantation surgeries at the Steve Biko Academic Hospital. The tissue structure of normal/control skin and keloids as well as mast cell and collagen distribution were evaluated using histological techniques. Transmission electron microscopy techniques were undertaken in order to investigate morphological and ultrastructural features of cells of the epidermis and dermis. A further detailed analysis of the ultrastructure of keloid fibroblasts and mast cells was undertaken. The findings of this study have lead to a new hypothesis related to keloid formation. Increased fibroblast activity, intracellular collagen production and fibroblast and mast cell interactions were seen in keloid tissue. Changes in the morphology of keratinocytes and melanocytes were observed, where the cytoplasmic processes of both cells were shorter and cells were packed closer together in keloids. Keloid tissue appeared to be in a hyperproliferative state similar to that of the granulation phase of wound healing. Increased amounts of collagen were found in the extracellular matrix (ECM) of keloid tissue. This is the first study in which the abnormal accumulation of insoluble collagen fibrils was observed in the cytoplasm. Degranulation of mast cells had occurred and these cells were found in close association with fibroblasts. In some instances phagocytosis of collagen by mast cells was also observed. These observations have led to the hypothesis that transforming growth factor β (TGF-β) derived from mast cells, inhibits keratinocyte proliferation and stimulates increased collagen production through increased expression of lysyl oxidase (LOX) by fibroblasts. Intracellular insoluble collagen formation then occurs due to the rapid, intracellular removal of the C terminal pro-peptide sequence by C-proteinase which initiates the cascade of insoluble collagen fibre formation within the fibroblast. Normally this process occurs only within the ECM in response to the increasing mass of collagen and in an attempt to establish normal tissue homeostasis the mast cells engulf the bundles of collagen fibres. Increased stress on the epidermal layer causes increased keratinocyte proliferation, which results in further growth factor mediated replication of fibroblasts. This creates an endless cycle of collagen synthesis, mast cell degranulation and mast cell mediated collagen phagocytosis, physical stress on the epidermal layer and subsequent growth factor release and fibroblast activation, collagen synthesis and subsequent crowding of keratinocytes and melanocytes. In conclusion, this study identified keloid formation as a defect of procollagen synthesis and processing. Phagocytosis of collagen by mast cells indicates that accumulation of these cells may be a secondary effect to excessive collagen synthesis. In addition, the release of interleukins, mediators and growth factors may further stimulate collagen fibril formation with the imbalance toward increased synthesis. This study also identified and confirmed the findings of other studies that procollagen C-proteinase is an important therapeutic target. / Dissertation (MSc)--University of Pretoria, 2014. / tm2015 / Anatomy / MSc / Unrestricted