Les « Facteurs de croissance des fibroblastes» (FGF) agissent comme des régulateurs locaux sur la qualité des follicules et sont connus pour promouvoir la prolifération des cellules de granulosa, réduire l’apoptose et la stéroïdogenèse. Parmi la sous-famille FGF8, FGF18 est une exception puisqu’il semblerait avoir une fonction pro-apoptotique alors que FGF8 n’a pas été jusqu’à présent rapporté comme altérant la viabilité des cellules de la granulosa. Ces deux ligands ont un mode d’activation similaire et il pourrait être proposé que toute la sous-famille FGF8 ait la même réponse. L’objectif de cette étude était de déterminer si FGF8 et FGF18 activaient la même réponse précoce de gènes dans des cultures de granulosa bovine. Pour répondre à cette question, nous avons cultivé des cellules de la granulosa dans du milieu de culture sans sérum pendant 5 jours. Le jour 5, les cellules ont été traitées avec FGF8 ou FGF18. Nous avons eu recours à une approche de « puce à ADN » afin d’identifier la réponse précoce de gènes induite par FGF8 et FGF18, et les données ont été confirmées par des PCRs en temps réel lors d’une expérience in vitro où les cellules de granulosa ont été traitées avec FGF8 et FGF18 pendant différents temps. L’analyse du puce à ADN a identifié 12 gènes surexprimés par FGF8, incluant SPRY2, NR4A1, XIRP1, BAMBI, EGR1, FOS et FOSL1. A l’inverse, FGF18 n’a régulé aucun gène de manière significative. Les analyses de PCR ont confirmé l’augmentation d’ARNm codant pour EGR1, EGR3, FOS, XIRP1, FOSL1, SPRY2, NR4A1 et BAMBI après 2 h de traitement. FGF18 a entrainé seulement une augmentation de l’expression de EGR1 après 2 h de traitement parmi tous les gènes testés. Ces résultats démontrent donc que FGF8 et FGF18, malgré leur similarité dans le mode d’activation de leurs récepteurs, agissent sur les cellules de la granulosa via différentes voies de signalisation. FGF8 et FGF18, sont donc tous les deux capables de stimuler l’expression de EGR1, mais les voies de signalisation induites par la suite divergent. / Fibroblast growth factors (FGF) act as local regulators of follicular health and are known to increase granulosa cell (GC) proliferation, reduce apoptosis and decrease steroidogenesis. One exception is FGF18, which appears to be a pro apoptotic member of the FGF8-subfamily while FGF8 has not been reported to alter GC health. These two ligands have similar activation patterns and it could be proposed that all FGF8-subfamilies would have the same response. The objective of this study was to determine if FGF8 and FGF18 activate the same early response genes in cultured bovine GC. To address this we cultured GC in serum free medium for five days. On day 5, cells were challenged with FGF8 or FGF18. We used a microarray approach to identify early response genes altered by FGF8 and FGF18, and data were confirmed by real-time PCR in an independent time-course experiment. Microarray identified 12 genes up-regulated by FGF8, including SPRY2, NR4A1, XIRP1, BAMBI, EGR1, FOS and FOSL1. In contrast FGF18 did not result in significant regulation of any gene. PCR analysis confirmed the stimulation of abundance of mRNA encoding EGR1, EGR3, FOS, XIRP1, FOSL1, SPRY2, NR4A1 and BAMBI after 2 hours of challenge. FGF18 resulted in an increase of EGR1 mRNA abundance at 2 h, but not of the other genes tested. These results demonstrate that FGF8 and FGF18, despite reportedly similar receptor activation patterns, act on granulosa cells through different intracellular pathways. Both FGF8 and FGF18 stimulate EGR1 expression, but thereafter their signaling pathways diverge.

Le dysfonctionnement endothélial et le dérèglement du système immunitaire sont les deux principaux mécanismes physiopathologiques responsables de la fibrose de la peau et des organes internes dans la sclérodermie systémique (ScS). La pneumopathie interstitielle diffuse (PID) est devenue la principale cause de mortalité de la maladie. L'inflammation pulmonaire est la conséquence de l'activation du système immunitaire, qui stimule la NO synthase inductible (NOS-2) et augmente la production alvéolaire de monoxyde d'azote (NO). L'augmentation de la concentration alvéolaire de NO (CANO) est significativement corrélée à la sévérité de la PID chez les patients atteints de ScS. L'augmentation de la CANO est liée à l'effet inducteur du sérum des malades sur la prolifération des fibroblastes pulmonaires et leur différentiation en myofibroblastes, faisant ainsi le lien biologique entre l'inflammation alvéolaire et la fibrose pulmonaire dans la ScS. Nous avons ensuite testé la valeur prédictive de la CANO dans la détérioration de la PID. Les patients ayant une CANO supérieure à 5,3 ppb présentent un risque élevé (> 6 fois) de voir survenir l'aggravation de la fibrose pulmonaire ou le décès (évènement combiné) par rapport à ceux qui ont une CANO inférieure ou égale à 5,3 ppb. Une valeur de CANO supérieure ou égale à 8,5 ppb permet de détecter les patients avec un risque de 90% de survenue d'évènement combiné dans les trois ans. Ces patients pourraient alors bénéficier d'un traitement approprié précoce. Nous avons évalué l'inflammation pulmonaire dans deux modèles murins de fibrose pulmonaire induite par l'acide hypochloreux et la bléomycine, par la mesure non-invasive du NO expiré (FENO). Le pic d'augmentation de FENO se situe 4 semaines après le début des injections, et précède la fibrose pulmonaire, qui ne devient significative qu'à partir de 6 semaines d'intoxication. L'augmentation de la FENO est liée à l'augmentation de l'expression de la NOS-2 aussi bien aux niveaux des bronches qu'aux niveaux des alvéoles. Enfin, la forte production de NO constatée provoque un effet délétère direct sur le tissu pulmonaire attesté par la présence de 3-nitrotyrosines, marqueurs du stress nitrosatif.Mots-clés: sclérodermie systémique, pneumopathie interstitielle diffuse, monoxyde d'azote, physiopathologie. / Summary not transmitted

Le coiffage pulpaire direct, dans des situations pathologiques critiques où la vitalité de la dent est menacée, vise à stimuler le potentiel de cicatrisation de la pulpe et induire une régénération dentinaire. Afin d'optimiser cette thérapeutique, le Laboratoire IMEB-ERT 30 a développé en partenariat avec la société SEPTODONT un nouveau matériau, le Biodentine™. Ce ciment, composé essentiellement de silicate tricalcique, possède des qualités physiques permettant son utilisation comme substitut dentinaire. Le premier objectif de notre travail a été d'évaluer les propriétés biologiques du Biodentine™ et ses interactions avec les cellules cibles en culture. La bioactivité du nouveau ciment a ensuite été étudiée à l'aide du modèle de culture de dents entières humaines ex vivo. Ce modèle expérimental original a été mis au point dans notre laboratoire et permet d'étudier les phases précoces de la régénération dentinaire lors du coiffage direct. Grâce à ce modèle, nous avons démontré l'activation, la prolifération et la migration de cellules progénitrices pulpaires périvasculaires en réponse à une lésion cavitaire profonde. Le coiffage direct avec les ciments de silicates tricalciques a induit la formation de foyers minéralisés à proximité de la lésion. La caractérisation moléculaire de ces foyers a montré qu'il s'agit d'une forme de dentine réparatrice synthétisée par des cellules odontoblast-like. Le deuxième objectif de notre travail a été d'étudier l'effet du nouveau biomatériau sur la sécrétion de certains facteurs de croissances, impliqués dans les phases précoces de la cicatrisation pulpaire, et de le comparer à celui d'autres matériaux de coiffage. / The objective of direct pulp capping is to stimulate the pulp healing potential and to induce dentin regeneration. This is of prime importance in critical pathologic situations compromising the tooth vitality. To improve the outcome of this treatment, the IMEB-ERT30 Laboratory, in collaboration with the SEPTODONT Company, has developed a new restorative material called Biodentine™. This cement, essentially composed of tricalcium silicates, has the required physical properties to be used as a dentin substitute. The first aim of this work was to evaluate the biological properties of Biodentine™ and its interactions with the target cells in cell culture. Then, the bioactivity of the new cement was studied using an entire human tooth culture model ex vivo. This original experimental model, developed in our Laboratory, is suitable in studying the early steps of dentin regeneration after direct pulp capping. With this model, we demonstrated the activation, proliferation, and migration of perivascular pulpal progenitor cells in response to pulp injury. The direct pulp capping with tricalcium silicate cements induced mineral foci formation in the vicinity of the pulp lesion. Molecular characterization of these foci confirmed it was of a reparative dentin type produced by odontoblast-like cells. The second objective of our work was to study the effect of the new cement on the secretion of some growth factors involved in the early steps of pulp wound healing, and compare it to that of other pulp capping materials. The results demonstrated an up-regulation of b-FGF, VEGF and PDGF-AB secretion in response to the target cells injuries, suggesting a stimulation of angiogenesis.

Von TRAIL, FasL und APRIL, drei Mitgliedern der TNF-Liganden-Familie, ist bekannt, dass Trimerstabilität und Oligomerisierungsstatus maßgeblich das Rezeptoraktivierungspotential dieser Liganden beeinflussen. Für die immunstimulatorischen TNF-Liganden CD27L, CD40L, OX40L, 41BBL und GITRL war hingegen vor der Durchführung dieser Arbeit praktisch nicht bekannt, inwieweit Trimerbildung, Stabilisierung und Oligomerisierung wichtig für deren Aktitvität sind. Dies wurde in dieser Arbeit systematisch untersucht. CD40L besaß bereits als trimeres Molekül eine hohe Aktivität, die durch sekundäre Oligomerisierung nur wenig gesteigert wurde. Die spezifische Aktivität konnte durch Stabilisierung mit Hilfe der Tenascin-C (TNC)-Trimerisierungsdomäne nur geringfügig gesteigert werden. CD27L war als lösliches Flag-markiertes sowie als hexameres Fc-Protein selbst nach Quervernetzen nicht in der Lage, seinen Rezeptor CD27 zu binden und zu aktivieren. Die TNC-stabilisierte trimere Form des CD27L hingegen induzierte nach Oligomerisierung mit einem anti-Flag-Antikörper ein starkes Signal. Trimerer OX40L und trimerer 41BBL konnten nur in oligomerisierter Form ihre Rezeptoren aktivieren, wobei die Aktivität der TNC-stabilisierten Form signifikant stärker ausgeprägt war. GITRL aktivierte seinen Rezeptor bereits als stabilisiertes Trimer und Hexamer, die Aktivität konnte durch Quervernetzen nur gering gesteigert werden. Zusammenfassend kann man sagen, dass CD27L, OX40L und 41BBL zu der Untergruppe der TNF-Ligandenfamilie gehört, für die eine Stabilisierung des trimeren Moleküls und dessen Oligomerisierung nötig sind, um eine starke Rezeptoraktivierung zu ermöglichen. Im Gegensatz dazu zeigten CD40L und GITRL bereits oligomerisierungsunabhängig eine hohe Aktivität. GITRL benötigte allerdings die Stabilisierung des trimeren Moleküls durch die TNC-Domäne, um gute Aktivität zu zeigen. Im Weiteren wurden Antikörperfragment (scFv-)-TNF-Ligand-Fusionsproteine konstruiert und untersucht, die ein Zelloberflächenantigen binden. Eine starke Zelloberflächenantigen-spezifische Aktivierung des jeweiligen Rezeptors konnte für scFv-41BBL und für scFv-OX40L gezeigt werden, wohingegen scFv-CD40L und scFv-GITRL bereits auf antigennegativen Zellen stark aktiv waren. scFv-CD27L war selbst auf antigenpositiven Zellen inaktiv. Verwendet man an Stelle des Antikörperfragments eine extrazelluläre Proteinbindedomäne, z.B. die eines TNF-Rezeptors, erhält man Fusionsproteine, die zum einen eine selektive Aktivierung der TNF-Ligandendomäne und somit die Aktivierung des korrespondierenden Rezeptors auf der Zielzelle ermöglichen, zum anderen aber durch die Bindung an den membranständigen Liganden dessen Aktitvät neutralisieren können. Für CD40-, RANK- und B7-2-FasL konnte der immobilisationabhängige Aktivierungseffekt auf entsprechenden Zelloberflächenmolekül-exprimierenden Zellen gezeigt werden. Anhand von T47D-Zellen, die durch eine autokrine CD40L-CD40-Signalschleife vor Apoptose geschützt sind, konnte gezeigt werden, dass durch die Bindung von CD40-FasL an membranständigen CD40L die CD40L-CD40-Interaktion gestört und gleichzeitig Apoptose verstärkt induziert werden kann. Das Prinzip der antigenabhängigen Aktivierung von TNF-Liganden könnte Anwendung in der Tumortherapie finden, da bei Verwendung entsprechender selektiv exprimierter Marker eine lokale Rezeptoraktivierung erreicht und so Nebenwirkungen minimiert werden können. / Trimer stability and oligomerization status of TRAIL, FasL and APRIL, three members of the TNF ligand family, critically determine their receptor activating potential. However, detailed information for the immunostimmulatory ligands CD27L, CD40L, OX40L, 41BBL and GITRL regarding the importance of trimer formation, stabilization and oligomerization for ligand activity was lacking. These aspects were investigated systematically in this work. CD40L was highly active as a trimeric molecule. Secondary oligomerization and/or stabilization via the tenascin-C (TNC) trimerization domain slightly enhanced its specific activity. As soluble Flag-tagged and as hexameric Fc protein CD27L failed to bind and activate its cognate receptor CD27, even after crosslinking. However, the TNC stabilized form of CD27L induced a strong signal after oligomerization with anti-Flag antibody. Receptor signaling was only activated by oligomerized molecules of trimeric OX40L and 41BBL whereas the respective TNC fusion protein showed significant stronger activity. Stabilized GITRL trimers and hexamers already activated their receptor whereas oligomerization of GITRL just slightly enhanced the specific activity. Taken together, CD27L, OX40L and 41BBL belong to a TNF ligand family subgroup which requires oligomerization and stabilization of the trimeric molecule to ensure strong receptor activation. In contrast, CD40L and GITRL already display high oligomerization-independent activity, though the latter needs stabilization by the TNC domain. Furthermore, antibody fragment (scFv)-ligand fusion proteins targeting specific cell surface antigens were designed and analyzed. Strong cell surface antigen-selective TNF receptor activation was achieved for scFv-41BBL and scFv-OX40L whereas scFv-CD40L and scFv-GITRL already induced signaling in the absence of antigen-positive cells. scFv-CD27L lacked activity even on antigen-positive cells. Using an extracellular protein binding domain for example the ligand binding domain of a TNF receptor instead of an antibody fragment resulted in fusion proteins that on the one hand activate the TNF ligand domain and thus the corresponding receptor on target cells and on the other hand neutralize membrane ligand activity by binding. The effect of cell surface immobilization-mediated activation of these fusion proteins on cells expressing the corresponding target molecule was shown here for CD40-, RANK- and B7-2-FasL. The CD40-FasL fusion protein simultaneously blocked CD40L-CD40 interaction and induced strong apoptosis in T47D cells displaying an antiapoptotic autocrine CD40L-CD40 signaling loop. The principle of antigen-dependent activation of TNF ligands could be of use in tumor treatment due to the fact that tumor specific marker targeting leads to locally restricted receptor activation on antigen positive cells, promising a reduction in potential off target effects.

Les lésions d’Ischémie/Reperfusion (I/R) contribuent à la physiopathologie de l’infarctus du myocarde. Le stress induit par l’I/R entraîne la mort des cardiomyocytes, une forte réponse inflammatoire de type stérile et la mise en place d’un processus de réparation impliquant les fibroblastes cardiaques. Il a précédemment été montré au laboratoire que l’activation du récepteur purinergique P2Y11 par l’ATP diminuait la sécrétion d’IL-6 et d’IL- 12 par la cellule dendritique (DC), permettant une diminution de la polarisation vers une réponse adaptative Th1. Nous avons donc émis l’hypothèse que la signalisation purinergique pouvait également moduler la mortalité des cardiomyocytes et l’activation des fibroblastes cardiaques après I/R, en diminuant la mise en place de réponses cellulaires délétères à long terme pour l’organe. L’objectif de cette thèse a été de déterminer in vitro le rôle de la signalisation purinergique sur la réponse des cardiomyocytes et des fibroblastes cardiaques à l’Hypoxie/Réoxygénation (H/R). Nous avons pu montrer que l’activation des récepteurs purinergiques au moment de la réoxygénation, en particulier du récepteur P2Y11, permettait de réduire la mortalité des cardiomyocytes après H/R. Nous avons ensuite montré que la stimulation de P2Y11 au moment de la réoxygénation diminue la prolifération des fibroblastes cardiaques et leur switch phénotypique en myofibroblastes, mais aussi diminue leur sécrétion de facteurs pro-inflammatoires. Le sécrétome des fibroblastes cardiaques a également induit une diminution de la sécrétion d’IL-6 et d’IL-12 par les DC, ainsi qu’une diminution de la mortalité des cardiomyocytes soumis à une H/R. Ces effets immunomodulateurs et cardioprotecteurs étaient dépendants de l’activation du récepteur P2Y11 sur les fibroblastes cardiaques. Ces résultats suggèrent fortement que le récepteur P2Y11 est au centre des réponses cellulaires post-H/R, et que le cibler in vivo à la reperfusion pourrait améliorer le pronostic clinique des patients atteints d’infarctus du myocarde. / Ischemia/Reperfusion injuries are involved in the pathophysiology of myocardial infarction. I/R-induced stress leads to massive cardiomyocyte death, an acute inflammatory response and the establishment of a repair process by cardiac fibroblasts. Previous work in the laboratory showed that P2Y11 purinergic receptor activation by ATP decreased IL-6 and IL-12 secretion by dendritic cells (DC), inducing a decrease in polarization towards Th1 response. We hypothesized that purinergic signaling could also modulate cardiomyocyte death and activation of cardiac fibroblasts responses to hypoxia/reoxygenation (H/R). We showed that the activation of purinergic receptors at the onset of reoxygenation, especially P2Y11 receptor, improved cardiomyocytes survival following H/R. We then showed that P2Y11 stimulation at the onset of reoxygenation decreased cardiac fibroblasts proliferation and their phenotypic switch into myofibroblasts, but also decreased their secretion of pro-inflammatory factors. Cardiac fibroblasts secretome reduced IL-6 and IL-12 secretion by DC, and cardiomyocyte mortality. These immunomodulatory and cardioprotective effects were dependent on P2Y11 receptor activation in cardiac fibroblasts. These results suggest that P2Y11 receptor is strongly involved in post- H/R cellular responses, and that targeting this receptor in vivo could improve the clinical prognosis of patients with myocardial infarction.

Avaliamos os efeitos da glicação do colágeno (CG) e da glicose elevada sobre a migração de fibroblastos. Utilizamos células de ratos controle e diabéticos (D) e células NIH-3T3, cultivadas em glicose 5 mM ou 30 mM (HG). Para glicação utilizou-se ácido glioxílico. O CG apresentou menor resistência à tração e elasticidade. Fibroblastos migraram menos sob HG e sobre o CG. As células D no CG não se deslocaram, apresentaram menos integrina β141 e expressaram mais α-actina de músculo liso. A viscoelasticidade do citoesqueleto foi menor em células D, especialmente sobre o CG. Sobre fibronectina, células NIH-3T3 em HG apresentaram menos fibras de estresse e deficiência na retração da parte traseira. A expressão de miosinas IIA (MIIA), IIB (MIIB) e MRLC não foi alterada, mas a fosforilação de MII diminuiu. A distribuição de MIIB ficou mais difusa, enquanto MIIA não mudou. Células HG exerceram menor força sobre o substrato. A migração de fibroblastos em ambiente hiperglicêmico é deficiente, especialmente frente ao CG, em parte devido a uma redução da contratilidade celular. / We evaluated the effects of collagen glycation (GC) and high glucose concentrations on fibroblasts migration. Fibroblasts derived from control and diabetic rats (D) and NIH-3T3 cells were cultured under 5 mM or 30 mM glucose (HG). For glycation, glyoxylic acid was used. The GC showed lower tensile strength and elasticity. Fibroblasts migrated less in HG and over the GC. D cells did not move on GC, showed less β141 integrin and a higher expression of smooth muscle α-actin. The viscoelasticity of the cytoskeleton was lower in D cells, especially on the GC. On fibronectin, NIH-3T3 cells under HG had fewer stress fibers and showed impaired contraction at the rear, presenting long tails. The expression of myosin IIA (MIIA), IIB (MIIB) and MRLC has not changed, but the phosphorylation of MII decreased. The distribution of MIIB became more diffuse, while MIIA has not changed. Cells under HG exerted less force on the substrate. The migration of fibroblasts in hyperglycemic environment is impaired, especially on GC, partly due to a reduction of cell contractility.

INTRODUÇÃO: Os níveis séricos de fósforo (P) têm sido associados a doenças cardiovasculares e mortalidade em pacientes com doença renal crônica e na população geral. Estudos in vitro demonstram que altas concentrações de fósforo extracellular são capazes de induzir calcificação vascular e disfunção endotelial. O Fibroblast Growth Factor 23 (FGF-23) é um hormônio fosfatúrico e foi relacionado à presença de aterosclerose em pacientes idosos. OBJETIVO: O objetivo deste estudo foi investigar as relações entre P, FGF-23 e outros atores do metabolismo mineral e a ocorrência de doença arterial coronariana em pacientes com função renal preservada. MÉTODOS: Duzentos e noventa pacientes clinicamente estáveis com indicação de cineangiocoronariografia eletiva e clearance de creatinina superior a 60 ml/min/1.73 m2 foram submetidos à Tomografia Computadorizada Multislice para avaliação da calcificação coronariana e coleta de sangue para dosagens bioquímicas. A calcificação coronariana foi quantificada através do Escore de Agatston (EA) e os Escores de Friesinger e Gensini foram calculados para quantificar a obstrução coronariana. RESULTADOS: A média de idade dos pacientes foi 58,1± 9,3 anos, 81% eram hipertensos e 35,5% diabéticos. Os pacientes foram divididos em grupos de acordo com o EA utilizando-se como ponto de corte o valor de 10 Unidades Hounsfield (HU). O P sérico foi maior no grupo de pacientes com EA > 10 HU (3,63 0,55 vs 3,49 0,52mg/dL; p=0,019). Cada 1 mg/dL de elevação no P sérico associou-se a um aumento de 92% no risco de apresentar o EA > 10HU [Odds Ratio (OR) =1,92, CI 1,56-3,19; p=0,01]. Quando os pacientes foram divididos de acordo com a mediana do Escore de Friesinger (4 pontos), o grupo com valores superiores à mediana apresentou P sérico maior (3,6 0,5 vs. 3,5 0,6 mg/dl; p=0,04) e FGF-23 menor (mediana 40,3 pg/mL intervalo interquartil 24,1-62,2 vs. 45,7 pg/mL intervalo interquartil 31,7-76,1; p=0,01) quando comparado àquele com valores menores ou iguais a 4. Pacientes no tercil mais alto do escore de Gensini também apresentaram P sérico mais elevado que os demais (p<0,05). Nas análises de regressão logística uni e multivariadas, cada 1 mg/dL de elevação no P sérico implicou em um aumento de 74% no risco de apresentar o Escore de Friesinger superior à mediana (OR 1,74, CI 1,06- 2,88; p=0,03) e o FGF-23 sérico foi preditor negativo do Escore de Friesinger (OR 0,26, CI 0,11-0,63; p=0,002) Os níveis séricos de cálcio e paratormônio não mostraram associação com a presença de doença coronariana. CONCLUSÃO: Em pacientes com suspeita de doença arterial coronariana e função renal preservada, o fósforo sérico foi preditor da presença de calcificação e obstrução coronariana e houve uma associação negativa entre o FGF-23 sérico e a presença de obstrução coronariana. / INTRODUCTION: Serum phosphorus (P) has been associated with cardiovascular diseases and mortality in chronic kidney disease patients and in the general population. In vitro studies suggest that excessive phosphorus induces vascular calcification and endothelial dysfunction. Fibroblast growth factor 23 (FGF-23) is a phosphaturic hormone and has been correlated to atherosclerosis in the community. AIM: This study intended to investigate the associations between P, FGF-23 and other mineral metabolism players and coronary artery disease in patients with preserved renal function. METHODS: Two-hundred ninety patients with a creatinine clearance higher than 60ml/min/1,73m2 undergoing elective coronary angiography were submitted to Multislice Computed Tomography in order to evaluate coronary calcification and blood was collected for biochemical analyses. Coronary artery calcification was quantified using the Agatston Score (AS). Friesinger (FS) and Gensini Scores (GS) were calcutalet to quantify coronary obstruction. RESULTS: Considering the whole population, mean age was 58.1±9.3 anos, 81% were hypertensive and 35.5% were diabetics. Patients were divided according to AS using the value of 10 Hounsfield Units (HU) as the cutoff.point. Serum phosphorus was higher in patients with an AS > 10HU when compared to the group with an AS 10 HU (3.63 0.55 vs 3.49 0.52mg/dL, p=0.019). Each 1 mg/dL of elevation in the serum phosphorus implied a 92% additional risk of presenting an AS > 10 HU [Odds Ratio (OR) =1.92, CI 1.56-3.19; p=0.01]. Patients were also divided using the median Friesinger score (4 points) as the cutoff value. Serum phosphorus was higher (3.6 0.5 vs. 3.5 0.6 mg/dl, p=0.04) and intact FGF-23 was lower (median 40.3 interquartile range 24.1-62.2 pg/mL vs. 45.7 interquartile range 31.7- 76.1 pg/mL, p=0.01) in the FS > 4 group. Patientis in the higher Gensini Score tertile presented elevated serum phosphorus when compared to the other groups (p<0,05). In the uni and multivariate logistic regression analyses, a rise of 1 mg/dL of serum phosphorus carried a 74% increase in the risk of having a FS higher than 4 (OR 1.74, CI 1.06-2.88; p=0.03) and FGF-23 was a negative predictor of FS (OR 0.26, CI 0.11-0.63; p=0.002). Serum calcium and parathormone were not associated with the presence of coronary artery disease. CONCLUSIONS: In patients with suspected coronary artery disease and preserved renal function, phosphorus was predictive of both coronary artery calcification and obstruction. There was a negative association between FGF-23 and coronary obstruction

Dissialogangliosídios, como GD3 e derivados são marcadores da progressão de melanomas. Para avaliar as possíveis funções desta molécula, transfectamos células de melanócitos com o gene da enzima ST8Sia I, que converte GM3 em GD3. Mostramos que GD3 não interfere na capacidade proliferativa dessas células, porém a expressão de GD3 mostrou-se associada à sobrevivência celular. Melanomas adquirem autonomia quanto às vias dependentes do fator de crescimento de fibroblastos (FGF-1 e -2). A expressão de GD3 não interfere na resposta proliferativa a estes fatores, porém GD3 e outros glicoesfingolipídios de membrana modulam a resposta migratória induzida por FGF-2. A expressão de GD3 sensibiliza as células à morte celular induzida por diferentes quimioterápicos, como cisplatina e vimblastina; porém, torna as células resistentes ao tratamento com temozolamida. A sensibilização ao tratamento com vimblastina, mas não às outras drogas, depende da presença de GD3, como observado por ensaios de depleção metabólica / Disialoganglioside GD3 and its derivatives are melanoma progression markers. To evaluate the possible roles of these molecules along melanoma progression, we have transfected the GD3 synthase gene (ST8Sia I) in a melanocyte cell line. Accumulation of GD3 did not confer any proliferative advantage to melanocytes. However, GD3 expression was associated with cell survival. The autonomic growth of melanomas is in part related to a constitutive activation of fibroblast growth factor dependent pathways. GD3 expression did not alter the proliferative response to either FGF-1 or FGF-2. However, GD3 and other membrane glycospingolipids modulate the motogenic activity of FGF-2. GD3 expression sensitizes melanocytes to chemotherapeutic agent-induced cell death, as cisplatin and vimblastin. On the other hand, GD3 turned melanocytes more resistant to temozolomide. Chemosensitization to vimblastin, but not to the other drugs, was dependent on the presence of GD3 within the cells, as shown by metabolic depletion of glycosphingolipids

Feridas nos membros inferiores são a principal causa de hospitalização e morbidade nos pacientes portadores de diabetes mellitus (DM). Atualmente, atribuem-se as complicações tardias do DM ao acúmulo de produtos finais de glicação avançada (AGE) nos diversos órgãos-alvo, incluindo a pele. Já foi demonstrado que a função deficitária dos fibroblastos de diabéticos está relacionada diretamente ao acúmulo de AGEs. Neste cenário, o uso de células-tronco mesenquimais tem ganhado destaque, tendo sido demonstrado, na literatura, que células-tronco derivadas de medula óssea (BMSC) produzem lisozima, um anti-AGE fisiológico. As células-tronco derivadas do tecido adiposo (ADSC) são de fácil captação e apresentam melhor rendimento em cultura celular quando comparadas às BMSC. Neste estudo, investigamos se as ADSC sintetizam lisozima e avaliamos se o produto das ADSC tem a capacidade de diminuir os efeitos deletérios dos AGEs nos fibroblastos. Para esse fim, foram cultivadas ADSC provenientes de lipoaspiração de pacientes hígidos, fibroblastos provenientes de feridas de pacientes diabéticos e fibroblastos provenientes de pacientes hígidos. Os fibroblastos de pacientes diabéticos ou hígidos foram submetidos a três meios de cultura diferentes: normoglicêmico (controle), contendo AGE ou contendo AGE mais o meio de cultura proveniente de ADSC (eluato) e, nesses grupos, foi feito ensaio de migração de fibroblastos. Observamos que, nos meios contendo AGE, não ocorreu migração dos fibroblastos, e na cultura contendo AGE mais eluato, os fibroblastos apresentaram migração semelhante à do grupo controle. Concluímos que as ADSC produzem lisozima e que os produtos sintetizados por essas células têm a capacidade de inibir os efeitos deletérios dos AGEs em fibroblastos in vitro / Lower limb ulcers are one of the major causes of morbidity and hospital admission in diabetic patients. Current researches indicate that diabetes mellitus (DM) complications are related to the accumulation in target organs, including the skin of advanced glycation end products (AGEs). It has been shown that cutaneous fibroblasts dysfunction in DM patients is directly dependent on AGE accumulation. In this context, the use of mesenchymal stem cells has been proposed, since bone marrow stem cells (BMSC) produce lysozyme, a physiological anti-AGE enzyme. Adipose tissue derived stem cells (ADSC) are easier to harvest and proliferate faster in cell cultures compared to BMSC. In this study, we investigated whether ADSC are able to produce lysozyme and also the ability of those stem cells to reduce the deleterious effects of AGEs in fibroblasts. ADSC were isolated and cultured from liposuction samples from non diabetic patients; fibroblasts were also isolated and cultured from wounds of diabetic patients and from non diabetic patients\' skin. Fibroblasts were maintained in three different conditions: in normoglycemic culture medium (control), a culture medium containing AGE or a culture medium previously in contact with ADSC for 24 hours (eluate) with addition of AGE. A fibroblast migration assay was performed. There was a lack of fibroblast migration in fibroblast culture with AGE-supplemented medium, whereas fibroblast culture containing ADSC\'s eluate and AGE showed fibroblast migration similar to the control group. Our study demonstrates that ADSC can synthesize lysozyme and we infer that the products of ADSC are able to inhibit in vitro AGE deleterious effects in fibroblas

INTRODUÇÃO: Tumores indutores de osteomalácia (TIOs) são raros, geralmente apresentam origem mesenquimal, têm produção excessiva de fosfatoninas sendo a mais comum o FGF23 (Fibroblast Growth Factor 23) que, em níveis elevados, provoca osteomalácia hipofosfatêmica. A cura dos TIOs envolve a remoção completa do tumor, o que torna essencial sua localização. OBJETIVOS: (1) caracterizar nove pacientes com TIO ao diagnóstico e avaliá-los evolutivamente em longo prazo; (2) avaliar a eficácia da cintilografia com Octreotida (Octreoscan®) e a da cintilografia de corpo inteiro com Mibi (MIBI) na detecção dos TIOs. MÉTODOS: O acompanhamento dos pacientes consistiu na avaliação clínica, na avaliação laboratorial com ênfase no metabolismo ósseo e na realização de exames de imagem para caracterização das deformidades esqueléticas. Para a localização dos TIOs, os pacientes foram submetidos a exames de Octreoscan®, MIBI, ressonância magnética (RM) e tomografia computadorizada (TC). RESULTADOS: O período de observação dos pacientes variou de dois a 25 anos. Ao diagnóstico, todos exibiam fraqueza muscular, dores ósseas e fraturas de fragilidade. Em relação à avaliação laboratorial, apresentavam: hipofosfatemia com taxa de reabsorção tubular de fosfato reduzida, fosfatase alcalina aumentada e níveis elevados de FGF23. O Octreoscan® permitiu a identificação dos TIOs nos nove pacientes e o MIBI possibilitou a localização dos TIOs em seis pacientes, sendo que ambos os exames foram concordantes entre si e com os exames topográficos (RM ou TC). Os achados histopatológicos das lesões dos nove pacientes confirmaram tratar-se de oito tumores mesenquimais fosfatúricos (PMTs) benignos e um PMT maligno. Após a primeira intervenção cirúrgica para a remoção dos TIOs, quatro pacientes encontram-se em remissão da doença e cinco evoluíram com persistência tumoral. Dos cinco, quatro foram reoperados e um aguarda nova cirurgia. Dos que foram reoperados, um paciente se mantém em remissão da doença, um foi a óbito por complicações clínicas, uma teve doença metastática e o último apresentou recidiva tumoral três anos após a segunda cirurgia. Deformidades ósseas graves foram observadas nos pacientes cujo diagnóstico e/ou tratamento clínico foram tardios. O tratamento da osteomalácia foi iniciado com fosfato e perdurou até a ressecção tumoral, tendo sido reintroduzido nos casos de persistência/recidiva tumoral. Quatro pacientes que fizerem uso regular desse medicamento por mais de seis anos evoluíram com hiperparatireoidismo terciário (HPT). CONCLUSÕES: O estudo revelou que tanto o Octreoscan® como o MIBI foram capazes de localizar os TIOs. Por isso, incentivamos a realização do MIBI nos locais onde o Octreoscan® não for disponível. Uma equipe experiente é indispensável para o sucesso cirúrgico visto que os tumores, embora benignos, costumam ser infiltrativos. Recomendamos o seguimento por tempo indeterminado em função do risco de recidiva tumoral. Assim como o FGF23, consideramos o fósforo um excelente marcador de remissão, persistência e recidiva dos TIOs. O diagnóstico e o tratamento precoce são fundamentais para a melhora dos sintomas podendo minimizar as deformidades esqueléticas e as sequelas ósseas. O uso prolongado do fosfato no tratamento da osteomalácia hipofosfatêmica foi associado ao desenvolvimento do HPT / BACKGROUND: Tumor-induced osteomalacia (TIO) is rare. The tumor usually has mesenchymal origin and produces excessive phosphatonins, most commonly FGF23 (Fibroblast Growth Factor 23), which at high levels causes hyphophostatemic osteomalacia. The cure for TIO is achieved through complete removal of the tumor. It is therefore essential identify its location. OBJECTIVES: (1) to characterize nine patients with TIO at diagnosis and to evaluate their follow-up over a long-term period; (2) to evaluate the efficacy of whole-body scintigraphy 111In-octreotide (Octreoscan®) and 99mTc-sestamibi (MIBI) in TIO detection. METHODS: Evaluations consisted of clinical and laboratory testing of bone metabolism and imaging to characterize skeletal deformities. To locate TIO, patients underwent Octreoscan®, MIBI, magnetic resonance (MRI), and computed tomography (TC). RESULTS: Patients were followed-up from two to 25 years. At diagnosis, all patients presented with muscle weakness, bone pain and fragility fractures. Laboratorial evaluation revealed hypophosphatemia with reduced tubular reabsorption of phosphate, increased alkaline phosphatase, and high levels of FGF23. TIO was identified in nine patients through Octreoscan® and in six patients through MIBI. Results of both types of scintigraphies matched one another as well with topographic examination (MR or CT). Histopathological findings of the lesions in the nine patients confirmed the existence of eight benign phosphaturic mesenchymal tumors (PMTs) and one malign PMT. After the first surgery for tumor resection, four patients were in remission, whereas five revealed tumoral persistence. Four of the latter five were re-operated, and one is still waiting for another surgery. Of those four patients, one became in remission, one died of clinical complications, one disclosed metastatic disease, and the last one had tumoral recurrence three years after the second surgery. Severe bone deformations were observed in patients whose diagnosis and/or clinical treatment were delayed. Osteomalacia treatment was initiated with oral phosphate, which continued until tumor resection. In case of tumor persistence or recurrence, oral phosphate was reintroduced. Four patients treated with this medication regularly for six years or more developed tertiary hyperparathyroidism (HPT). CONCLUSIONS: The present study revealed that Octreoscan® and MIBI were able to locating TIO. Therefore, we suggest that MIBI should be encouraged in places where Octreoscan® is not available. An expert team of surgeons is essential to the success of TIO\'s treatment, because of their infiltrative, albeit benign nature. Long-term follow-up is important due to the risk of tumor recurrence. Along with FGF23, phosphorous was considered an excellent hallmarker of TIO remission, persistence and recurrence. Early diagnosis and treatment are essential to improve symptoms and minimize skeletal deformities and skeletal disabilities. Long-term treatment of osteomalacia with oral phosphate was associated with the development of HPT