Background: There are no core outcome domain or measurement sets for Total Joint Replacement (TJR) clinical trials. Our objective was to achieve an International consensus by orthopaedic surgeons on the OMERACT core domain/area set for TJR clinical trials. Methods: We conducted surveys of two orthopaedic surgeon cohorts, which included (1) the leadership of international orthopaedic societies and surgeons (IOS; cohort 1), and (2) the members of the American Academy of Orthopaedic Surgeons' Outcome Special Interest Group (AAOS-Outcome SIG), and/or the Outcome Research Interest Group of the Orthopaedic Research Society (ORS; cohort 2). Participants rated OMERACT-endorsed preliminary core area set for TJR clinical trials on a 1 to 9 scale, indicating 1-3 as domain of limited importance, 4-6 being important, but not critical, and 7-9 being critical. Results: Eighteen survey participants from the IOS group and 69 participants from the AAOS-Outcome SIG/ORS groups completed the survey questionnaire. The median (interquartile range [IQR]) scores were seven or higher for all six proposed preliminary core areas/domains across both groups, IOS and AAOS-Outcome SIG/ORS, respectively: pain, 8 [8, 9] and 8 [7, 9]; function, 8 [8, 8] and 8 [7, 9]; patient satisfaction, 8 [7, 9] and 8 [7, 8]; revision surgery, 7 [6, 9] and 8 [6, 8]; adverse events, 7 [5, 8] and 7 [6, 9]; and death, 7 [7, 9] and 8 [5, 9]. Respective median scores were lower for two additional optional domains: patient participation, 6.5 [5, 7] and 6 [5, 8]; and cost, 6 [5, 7] and 6 [5, 7]. Conclusions: This study showed that two independent surveys dervied from three groups of orthopaedic surgeons with international representation endorsed a preliminary/draft OMERACT core domain/area set for Joint Replacement clinical trials.

Au cours du cycle réplicatif des rétrovirus, l’ADN viral rétro-transcrit est intégré dans l’ADN de la cellule hôte par l’intégrase virale (IN). L’IN possède un rôle clé dans le cycle rétroviral et représente une cible thérapeutique majeure pour le traitement des infections par le virus de l’immunodéficience humaine (VIH). L’IN est constituée de trois domaines (N-terminal, central et C-terminal) connectés par des boucles flexibles, qui la rendent difficilement cristallisable. Le Dr. C. Ronfort (Equipe Rétrovirus et Intégration Rétrovirale) et le Pr. P. Gouet (Laboratoire de BioCristallographie) collaborent depuis 2002 sur l’IN du Rous Associated Virus type 1 (RAV-1). Mes travaux de thèse s’inscrivent dans le cadre de cette collaboration. Il s’agissait de mener une étude cristallographique et moléculaire du domaine central de l’IN du RAV-1 pour pouvoir, ensuite, modéliser des mutants d’intérêt identifiés par l’équipe du Dr. C. Ronfort. Pour ce faire, le fragment protéique a été surproduit et purifié. Sa structure cristallographique a été résolue à une résolution de 1,8 Å. L’examen de cette structure révèle que le dimère de l’IN du RAV-1 peut s’assembler suivant une nouvelle interface moléculaire stabilisée par trois paires d’hélices α. Cet assemblage se caractérise également par la présence d’un étroit sillon basique à sa surface. Par des expériences in vitro de biochimie et in silico de docking, nous avons montré que ce sillon était susceptible de fixer un brin d’ARN. D’autre part, nos données expérimentales permettent d’expliquer comment les conditions de cristallisation, ainsi que la substitution d’un acide aminé de surface, favorisent la formation soit de ce nouvel arrangement dimérique, soit de l’arrangement dimérique classique. Ainsi, l’ensemble des données obtenues au cours de cette thèse suggère que l’intégrase possède des propriétés structurales modulables, lui permettant d’intervenir dans plusieurs étapes du cycle rétroviral en présence d’ADNdb (intégration) ou d’ARNsb (rétro-transcription et/ou encapsidation du génome ARN viral) / During the replicative cycle of retroviruses, the retrotranscribed viral DNA is integrated into the host chromosome by the viral integrase protein (IN). The integration reaction is essential for the viral life cycle. Therefore, IN is a key target for antiretroviral drug design to treat HIV infection. IN consists of three domains (N-terminal, central and Cterminal) connected by flexible loops, making the enzyme difficult to crystallize. Dr C. Ronfort (Team Retrovirus and Retroviral Integration) and Pr P. Gouet (BioCrystallography Laboratory) collaborate since 2002 in Lyon to study IN from the Rous Associated Virus type 1 (RAV-1). My thesis work lies within this collaboration. Its objective was to perform crystallographic and molecular studies of the central domain of RAV-1 IN and of mutants of interest identified by the team of Dr C. Ronfort. In this aim, the IN fragment has been overexpressed and purified. Its crystal structure has been solved to a resolution of 1.8 Å. The observation of this structure reveals that the RAV-1 IN can exhibit a novel dimeric arrangement with a molecular interface stabilized by three pairs of facing α-helices. This arrangement is also characterized by the presence of a basic narrow groove at its surface. Thanks to biochemical in vitro experiments and in silico docking studies, we have shown that this median groove could allow the binding of a linear singlestranded RNA. Moreover, our experimental data can explain how the crystallization conditions as well as the mutation of a specific residue located at the surface of the enzyme favor either this novel dimeric arrangement or the classical dimeric interface. Therefore, the data obtained during this thesis suggest that IN exhibits modular structural properties, allowing it to operate in several distinct steps of the retroviral cycle in presence of dsDNA (integration) or ssRNA (reverse transcription and/or encapsidation of the retroviral RNA genome)

No description available.

Au cours du cycle réplicatif des rétrovirus, l'ADN viral rétro-transcrit est intégré dans l'ADN de la cellule hôte par l'intégrase virale (IN). L'IN possède un rôle clé dans le cycle rétroviral et représente une cible thérapeutique majeure pour le traitement des infections par le virus de l'immunodéficience humaine (VIH). L'IN est constituée de trois domaines (N-terminal, central et C-terminal) connectés par des boucles flexibles, qui la rendent difficilement cristallisable. Le Dr. C. Ronfort (Equipe Rétrovirus et Intégration Rétrovirale) et le Pr. P. Gouet (Laboratoire de BioCristallographie) collaborent depuis 2002 sur l'IN du Rous Associated Virus type 1 (RAV-1). Mes travaux de thèse s'inscrivent dans le cadre de cette collaboration. Il s'agissait de mener une étude cristallographique et moléculaire du domaine central de l'IN du RAV-1 pour pouvoir, ensuite, modéliser des mutants d'intérêt identifiés par l'équipe du Dr. C. Ronfort. Pour ce faire, le fragment protéique a été surproduit et purifié. Sa structure cristallographique a été résolue à une résolution de 1,8 Å. L'examen de cette structure révèle que le dimère de l'IN du RAV-1 peut s'assembler suivant une nouvelle interface moléculaire stabilisée par trois paires d'hélices α. Cet assemblage se caractérise également par la présence d'un étroit sillon basique à sa surface. Par des expériences in vitro de biochimie et in silico de docking, nous avons montré que ce sillon était susceptible de fixer un brin d'ARN. D'autre part, nos données expérimentales permettent d'expliquer comment les conditions de cristallisation, ainsi que la substitution d'un acide aminé de surface, favorisent la formation soit de ce nouvel arrangement dimérique, soit de l'arrangement dimérique classique. Ainsi, l'ensemble des données obtenues au cours de cette thèse suggère que l'intégrase possède des propriétés structurales modulables, lui permettant d'intervenir dans plusieurs étapes du cycle rétroviral en présence d'ADNdb (intégration) ou d'ARNsb (rétro-transcription et/ou encapsidation du génome ARN viral)

Osteoclasts are multinucleated cells found exclusively in bone and are derived from the haematopoietic cells of monocytes/macrophage lineage. The cell-to-cell interaction between osteoblastic/stromal cells and osteoclast precursor cells is necessary for osteoclastogenesis. Receptor Activator of NF-κB ligand (RANKL) was identified as a membrane-bound TNF ligand family member that is the ‘master’ cytokine expressed on osteoblastic/stromal cells, which stimulate osteoclastogenesis through cell-to-cell contact with osteoclast precursors. RANKL is considered to be a factor that is necessary and sufficient for the induction of osteoclastogenesis (Lacey, et al., 1998). RANKL is a type II transmembrane cytokine of the TNF ligand superfamily and has an active TNF-like core domain at the extracellular domain. This active TNF-like core domain is thought to be the region through which it binds to it’s active receptor, RANK, for the activation of signal transduction pathways for the initiation of processes leading to osteoclastogenesis (Lacey, et al., 1998; Li, et al., 1999). It was hypothesized that any change in the active TNF-like core domain might affect the ability of RANKL binding to RANK and consequently affect the activation of signal transduction pathways and osteoclastogenesis. Hence, this thesis sought to investigate the effects of changes in the active TNF-like core domain by truncation mutation on the ability of RANKL binding to RANK and consequently affect the activation of signal transduction pathways and osteoclastogenesis. A cDNA fragment encoding the full-length TNF-like core domain of rat RANKL (rRANKL) (aa160-318) was cloned into the bacterial expression pGEX vectors and stably expressed in Eschechia coli as a fusion protein with the C-terminus of glutathione S-transferase (GST). Four mutants (aa160-302, aa160-268, aa239-318 and aa246-318) were also generated by truncation mutation in the TNF-like core domain, and cloned into the pGEX vector to produce GST-rRANKL mutants. The proteins were over-expressed and affinity purified to 95% in purity. GST-rRANKL (160-318) containing the full length TNF-like core domain was able to induced osteoclastogenesis in spleen cells in the presence of M-CSF and in RAW264.7 cells in the absence of M-CSF. It was also found to activate mature osteoclast activity in vitro, ex vivo and in vivo. It has the highest binding affinity to RANK and the greatest potency for NF-κB activation as well as the induction of osteoclastogenesis compared to the truncated mutants. Mutants generated by truncation of the TNF-like core domain revealed that the TNF-like core domain is important for the interaction with the RANK, for high binding affinity, NF-κB activation and induction of osteoclastogenesis. In general, the truncated mutants not only displayed a reduction in the binding affinity to RANK, but also a reduction in NF-κB activation, and significantly reduced potency in the induction of osteoclastogenesis. Interestingly, mutant GST-rRANKL (160-268) showed a higher affectivity than the other mutants did, in that it had greater binding affinity to RANK, and in NF-κB activation than the rest of the truncated mutants. Mutants GST-rRANKL (239-318) and GST-rRANKL (246-318) on the other hand, showed little potency in the induction of osteoclast formation, however, might have an inhibitory effect through competition with full length GST-rRANKL (160-318) as well as inducing a response in vivo resulting in an increase in the serum calcium level. In conclusion, this thesis demonstrated that the TNF-like core domain of RANKL is active, and imperative in the binding to RANK, activating signal transduction pathways and induction of osteoclastogenesis. Changes in the active TNF-like core domain affected the ability, affinity and efficiency of RANKL binding to the receptor, RANK and consequently affected the activation of signal transduction pathways and osteoclastogenesis.