Abstract Osteoarthritis (OA) is the most common musculoskeletal disorder affecting Australians and is the leading cause of pain and disability in the country. There is no known cure for OA, but pharmacological and non-pharmacological treatments can relieve symptoms and improve quality of life for OA sufferers: two of these are glucosamine sulphate (GS) and physical activity. Little is known about physical activity behavior and the correlates of physical activity participation among Australians with OA, or about the benefits of combining physical activity and GS for the management of OA. More generally, there is little information on the treatments used by OA sufferers in Australia. The first main aim of this thesis was to describe OA symptoms in people with hip or knee OA; their use of treatments for these symptoms; their health status; their current, past and future participation in physical activities; and their perceptions that could influence physical activity participation (Study 1). The second main aim was to compare the effectiveness of different frequencies and durations of walking, combined with GS intake, for reducing symptoms of OA and improving well-being in people with hip or knee OA (Study 2). Descriptive study (Study 1) A questionnaire was mailed to 2200 members of the Arthritis Queensland Foundation who lived in the Brisbane environs. Of these, 588 participants with hip or knee OA completed the survey. The most common treatments being used to manage osteoarthritic symptoms were weight loss (57%), range of motion exercises (56%), and strengthening exercises (49%). The most popular pharmacological treatments were glucosamine and/or chondroitin (54%) and anti-inflammatory medications (40%). Paracetamol (73%), topical liniment rubs (45%) and anti-inflammatory gels (35%) were the most commonly used ‘as needed’ medications. Most participants had fair to good health (68%). Many reported moderate levels of anxiety and depression as well as other health problems. Hypertension was the most common health problem (43.3%). Twenty-five percent reported that health problems were preventing them from walking, and 33% reported that health problems were preventing them from doing other exercises. Fifty-nine percent were meeting Australian physical activity guidelines (30 minutes of moderate-intensity physical activity most days of the week). Participants reported taking part in a wide range of sports and exercises, walking being the most common. They had moderate levels of self-efficacy for, and perceived many health benefits from being physically active, but perceived a moderate number of barriers to being active. Significant associations between past participation in sports and current OA symptoms were only found for men (p < 0.05), with past participation in Australian Rules football, basketball, soccer, skiing or volleyball associated with more severe symptoms in men. Feasibility study (Study 2) Thirty-six participants were given GS for 18 weeks. Starting in Week 6, they also participated in the 12-week Stepping Out walking program (after being randomly assigned to walk 3 or 5 days each week). Assessments were conducted at baseline, at Weeks 6, 12, and 18 during the intervention, and at a final follow-up during Week 24 of the study. Primary outcome measures were WOMAC pain, stiffness, physical function, and total scores and time to complete a self-paced step test, an objective measure of physical function. Comparisons were made between groups and between assessment weeks. As the data were not normally distributed, non-parametric techniques were used. Given that the study was a feasibility study, data were analysed on a per protocol basis. No significant between-group differences were found at any assessment week for the primary outcome measures. Therefore, changes between assessments were examined for the two groups combined. After 6 weeks of GS intake, WOMAC stiffness (p = 0.01) and physical function scores (p = 0.05) improved, as did physical function, measured objectively (p < .001). Between Weeks 6 and 12, when participants were asked to increase their daily steps over their current steps to an extra 1500-3000 per day, physical activity minutes increased (p = 0.01), and improvements were found for WOMAC pain (p = 0.03), WOMAC physical function (p = 0.03), and objectively-measured physical function (p < .001). Between Weeks 12 and 18, when participants were instructed to increase their daily steps by 6000 from baseline, physical activity minutes increased (p < .001), and further improvements were found for objectively-measured physical function (p < .001). During the follow up between Week 18 and 24, physical activity minutes decreased (p = 0.01) while objectively-measured physical function improved (p < .001). Both studies add to the body of literature on the management of OA of the hip and knee. Study 1 provides information about OA sufferers’ use of over-the-counter medications and their adoption of self-management strategies, information not routinely available from other sources, while Study 2 provides preliminary evidence for the walking ‘dose’ appropriate to relieve OA symptoms and on the effects of difference ‘doses’ on OA symptoms.

Hyaline cartilage is a highly specialized tissue, which plays an important role in the articulating joints of an individual. It provides the joints with a nearly frictionless, impact resisting surface to protect the ends of the articulating bones. Articular cartilage has a poor self-repair capacity and, therefore, it rarely heals back to normal after an injury. Overweight, injuries, overloading and genetic factors may initiate a degenerative disease of the joint called osteoarthritis. Osteoarthiritis is a major global public health issue. Currently, the most used treatment for large articular cartilage defects is joint replacement surgery. However, possibilities to replace this highly invasive operation with strategies based on tissue engineering are currently investigated. The idea of the tissue engineering is to optimize the use of the cells, biomaterials and culture conditions to regenerate a new functional tissue for the defect site. The goal of this thesis was to manufacture cartilage tissue in cell culture conditions in vitro. Bovine primary chondrocytes isolated from the femoral condyles were used in all the experiments for neocartilage production. The samples were collected for histology, gene expression level quantifications, and analyses of proteoglycan (PG) content and quality. The histological sections were stained for type II collagen and PGs, the quantitative RT-PCR was used to observe the relative expressions of aggrecan, Sox9, procollagen α2(I) and procollagen α1(II) genes. The PGs were quantified using a spectrophotometric method, and agarose gel electrophoresis was used to separate the PGs according to their size. In the two first studies, we optimized the culture conditions of in vitro scaffold-free culture technique to produce the native-type hyaline cartilage of a good quality. We found out that high glucose concentration and hypertonic medium at 20% oxygen tension promoted the best hyaline-like neocartilage tissue production. Glucosamine sulfate supplementation, low oxygen tension, 5 mM glucose concentration and a transient TGF-β3 supplementation were not beneficial for the neocartilage formation in the scaffold-free cell culture system. In the third study, we used these newly defined, optimized culture conditions to produce the neocartilage tissues in the HyStem™ and the HydroMatrix™ scaffold materials and we compared these tissues to the ones grown as scaffold-free control cultures. We noticed that there was no difference between the controls and the scaffolds, and occasionally the scaffold-free controls had produced better quality cartilage than the ones with the scaffolds. Overall, the neocartilage tissues were of good hyaline-like quality in the third study. Their extracellular matrix contents were close to the native cartilage, although the neotissues lacked the zonal organization typical to the normal articular cartilage. The tissues had the right components, but their ultrastructure differed from the native cartilage. In conclusion, we were able to optimize our in vitro neocartilage culture method further, and discovered a good combination of the culture conditions to produce hyaline-like cartilage of good quality. Surprisingly, the scaffold materials were not beneficial for the cartilage formation. / Lasi- eli hyaliinirusto on pitkälle erikoistunutta kudosta, jolla on erittäin tärkeä rooli yksilön nivelten toiminnassa. Kudos suojaa ruston alapuolista luuta muodostamalla lähes kitkattoman ja joustavan liikkumista helpottavan pinnan. Lasiruston oma uusiutumiskyky on hyvin heikko, ja näin ollen kudos vain harvoin paranee alkuperäisen kaltaiseksi vaurion jälkeen. Ylipaino, vammat, liiallinen kuormitus tai geneettiset tekijät voivat käynnistää rustokudoksen rappeutumisen. Tätä tilaa kutsutaan nivelrikoksi. Nivelrikko on valtava kansanterveydellinen ongelma. Keinonivelleikkaus on nykyisellään ainoa hoitokeino pinta-alaltaan laajojen nivelruston vaurioiden hoitoon. Vaihtoehtoja tämän suuren ja invasiivisen kirurgisen operaation korvaamiseksi tutkitaan kuitenkin koko ajan ympäri maailmaa. Kudosteknologian ajatuksena on optimoida solujen, biomateriaalien ja erilaisten kasvatusolosuhteiden käyttö uuden, alkuperäisen kaltaisen toiminnallisen kudoksen luomiseksi vauriokohtaan. Väitöskirjan kaikissa kolmessa osatutkimuksessa uudisrustokudoksia tuotettiin käyttäen naudan polven rustosta eristettyjä primäärisiä rustosoluja. Näytteet kerättiin histologisia analyysejä, geenin ilmentymistutkimuksia ja proteoglykaanisisällön ja -jakauman (PG) analyyseja varten. Histologisista leikkeistä värjättiin tyypin II kollageeni ja PG:t, ja kvantitatiivista RT-PCR -menetelmää käytettiin aggrekaani-, Sox9-, prokollageeni α2(I)- ja prokollageeni α1(II)-geenien suhteellisten ilmentymistasojen määrittämiseen. Proteoglykaanisisältö analysoitiin käyttäen spektrofotometristä menetelmää, ja PG:t eroteltiin kokonsa perusteella agaroosigeelielektroforeesia käyttäen. Kahdessa ensimmäisessä osatutkimuksessa optimoitiin tukirakenteetta kasvattujen uudisrustojen kasvatusolosuhteita natiivin kaltaisen lasiruston tuottamiseksi. Havaitsimme, että korkea glukoosipitoisuus ja hypertoninen elatusaine yhdistettynä 20 % happiosapaineeseen tuotti parhaimman laatuista uudisrustokudosta tutkituista yhdistelmistä. Glukosamiinisulfaatin lisäys, matala happiosapaine, 5 mM glukoosi konsentraatio tai TGF-β3:n lisääminen alkuvaiheessa eivät edesauttaneet uudisrustokudosten muodostumisessa. Kolmannessa osatutkimuksessa otettiin käyttöön uudet, hyväksi havaitut kasvatusolosuhteet yhdistettynä HyStem™ and HydroMatrix™ -tukimateriaaleihin, ja niitä verrattiin tukirakenteettomaan kasvatusmenetelmään. Tutkimuksessa havaittiin, ettei tukirakenteettoman kontrollin tai tukimateriaalien välillä ollut mitään eroa, ja että kontrollikasvatukset tuottivat ajoittain jopa parempaa rustoa kuin tukimateriaalein kasvatetut. Kaiken kaikkiaan kaikki tuotetut uudiskudokset muistuttivat laadullisesti lasiruston kaltaista kudosta. Molekyylisisältö lähenteli natiivia rustoa, vaikkakin uudiskudoksista puuttui normaalille nivelrustolle tyypillinen vyöhykkeinen järjestäytyminen. Kudoksissa oli parhaimmillaan oikea määrä oikeita komponentteja, mutta ne eivät vain olleet järjestäytyneet oikealla tavalla. Onnistuimme optimoimaan uudisrustokudosten kasvatusmenetelmäämme. Löysimme hyvän kasvatusolosuhteiden yhdistelmän, jonka avulla kykenimme tuottamaan lasiruston kaltaista uudisrustokudosta. Hivenen yllättäenkin, tukimateriaalit eivät olleet avuksi tutkimuksessamme uudisrustokudoksia muodostettaessa.

Submitted by (lucia.rodrigues@ufrpe.br) on 2016-06-01T16:45:23Z No. of bitstreams: 1 Fernanda Katharine de Souza Lins Borba.pdf: 4059966 bytes, checksum: cce20c494a8d5b3926e4508d0ff50750 (MD5) / Made available in DSpace on 2016-06-01T16:45:23Z (GMT). No. of bitstreams: 1 Fernanda Katharine de Souza Lins Borba.pdf: 4059966 bytes, checksum: cce20c494a8d5b3926e4508d0ff50750 (MD5) Previous issue date: 2012-02-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Chondroitin Sulfate (CS) and Glucosamine Sulfate (GS) are functional constituents of vertebrate tissues. GS is an amino sugar and CS is part of the glucosaminoglycans group (GAGs). Studies have suggested CS and GS to have anti-inflammatory properties, however it has also been shown that these compounds promote scarring and proliferation of fibroblasts, which express molecules important for blood vessel growth (angiogenesis). This study was aimed at evaluating the effects of CS and GS on in vitro models regarding cell viability (cytotoxicity - MTT), proliferation (BrdU incorporation) and differentiation (tubulogenesis in Matrigel support) on human umbilical vein endothelial cells (HUVEC line). In vivo angiogenesis was also evaluated in (1) extraembryonic membranes of Gallus domesticus (number of chorioallantoic vessels - CAM assay and vitelinic YSM assay; and fractal geometry analysis); (2) and subcutaneous tissue of adult mice (Mus muscullus) by hemoglobin quantification (Spectroscopy) in Gelfoam implants. In the HUVEC assay, both CS and GS (1-3000 g/mL) displayed partial cytotoxic effect (~50% viability), but only in the highest tested concentrations (3000 and 1000 g/mL). It was observed that CS (3 g/mL), but not GS, promoted proliferation and tubulogenesis of HUVEC in 40% (P < 0.05) and 64% (P < 0.05), respectively, relative to control (RPMI-1640 medium). These effects did not significantly differ from the respective 28% and 53% promoted by the well known angiogenic growth factor FGF-2 (50 ng/mL). In the in vivo vasculoangiogenesis YSM assay on 2 to 4-day old embryos, GS (0.001-0.1mg/disk) and, to a lesser extent, CS (0.030-0.1mg/disk) increased the amount of vessels relative to control (P < 0.05). The effects of administration of CS and GS (0.1mg/disk) did not differ from what was observed in groups treated with 50 ng/mL FGF2. In the CAM angiogenesis assay on 6 to 8-days old embryos, again both CS and GS increased the amount of vessels relative to control, but only in concentrations as high as 2.0 mg/disk. This effect was no different from what was observed in groups treated with 50 ng/mL FGF2. The pro-angiogenic effects of CS (2 mg/disk) in embryonary angiogenesis were confirmed in the advanced angiogenesis of mice: only the group treated with CS (2 mg/implant) displayed a significant increase in the amount of blood vessels, expressed as hemoglobin content (0.52 ± 0.08g/dL), relative to control (vehicle; PBS; 0.20 ± 0.07 g/dL). This pro-angiogenic effect was no different than that of FGF2 (0.53 ± 0.1g/dL). The in vitro and in vivo results indicate the pro-angiogenic properties of CS and GS. However, CS (GAG) was the more effective compound in the tests performed. As a constituent of proteoglycans, it is suggested that CS exerts its effects by interacting with FGF and other angiogenic factors in the extracellular matrix, stabilizing the receptor, and thus positively modulating the pro-angiogenic signal in endothelial cells. While the cellular mechanisms underlying CS and GS activity demand more specific research, there is an evident potential therapeutic use for both compounds in clinical situations, such as those related to vascular discrepancy. / Sulfato de glucosamina (SG) e Sulfato de condroitina (SC) são constituintes funcionais dos tecidos de vertebrados. O SG é um aminoaçúcar e o SC integra o grupo das glicosaminoglicanas (GAG). Estudos apontam propriedades antiinflamatórias do SC e SG, e demonstram ainda que essas substâncias promovem a cicatrização e a proliferação de fibroblastos, os quais expressam moléculas que atuam na formação de vasos sanguíneos (angiogênese). Os objetivos deste estudo foram avaliar a ação do SC e SG em modelos in vitro sobre a viabilidade (citotoxicidade pelo MTT), proliferação (incorporação por BrdU) e diferenciação (tubulogênese em suporte matrigel) na linhagem de células endoteliais de veia umbilical humana (HUVEC). Também se investigou a angiogênese in vivo: (1) em membranas anexas de embriões de Gallus domesticus (número de vasos corioalantóides - ensaio da CAM, e vitelínicos – ensaio da YSM; e análise por geometria fractal); (2) e no tecido subcutâneo de camundongos adultos por meio de quantificação da hemoglobina em implantes de Gelfoam. No ensaio com HUVEC, SC e SG (1-3000 g/mL) exerceram efeito citotóxico parcial (~50% de viabilidade), e somente nas respectivas maiores concentrações (3000 e 1000 g/mL). Verificou-se que o SC (3 g/mL), mas não o SG, estimulou a proliferação e a tubulogênese de HUVEC em 40% (p < 0,05) e em 64% (p < 0,05) respectivamente, em relação ao controle (meio RPMI-1640). Estes efeitos não diferiram estatisticamente dos 28% e 53%, respectivamente, promovidos pelo bem conhecido fator de crescimento angiogênico FGF-2 (50 ng/mL). No ensaio de vasculo-angiogênese na YSM de embriões de 2-4 dias de idade o SG (0,001-0,1mg/disco) principalmente, e o SC (0,030-0,1mg/disco) aumentaram o número de vasos em relação ao grupo controle (p < 0,05). Os efeitos da administração de SC e SG (0,1 mg/disco) não diferiram do observado no grupo tratado com 50 ng/mL de FGF-2. No ensaio de angiogênese na CAM de embriões de 6-8 dias de idade, ambos, SC e SG também elevaram o número de vasos em relação ao controle na concentração elevada de 2,0 mg/disco. Este efeito também não diferiu do observado no grupo exposto a 50 ng/mL de FGF- 2. O efeito pró-angiogênico do SC (2 mg/disco) na angiogênese embrionária foi confirmado na angiogênese avançada de camundongos adultos. Apenas o grupo que recebeu SC (2 mg/implante) mostrou um aumento significativo de vasos sanguíneos, expresso como conteúdo de hemoglobina (0,52 ± 0,08g/dL), comparado ao controle (veículo; PBS; 0,20 ± 0,07 g/dL). Este efeito pró-angiogênico não diferiu do obtido com FGF2 (0,53 ± 0.1g/dL). Os resultados in vitro e in vivo demonstram as propriedades pró-angiogênicas do SC e SG, contudo o SC (GAG) foi o mais efetivo nos ensaios. Como um constituinte de proteoglicanas, o SC sugere exercer seus efeitos pela interação com o FGF e outros fatores angiogênicos na matriz extracelular, estabilizando-os nos receptores e modulando assim, positivamente, o sinal pró-angiogênico nas células endoteliais. Embora mecanismos celulares subjacentes à atividade de SC e SG demandem mais estudos, evidencia-se um potencial papel terapêutico das duas substâncias em situações clínicas relacionadas à defasagem vascular.