"Recent data show that 7.6 million Americans have survived a myocardial infarction (MI), and 5.1 million Americans suffer from severe heart failure. Stem cell therapy has the potential to improve cardiac function after MI. Two promising cells for cardiovascular regeneration therapies include human mesenchymal stem cells (hMSCs) and pluripotent stem cell derived cardiomyocytes (hPS-CM) each with their own unique method for improving cardiac function post-infarct. However, a limiting factor to cell therapies is that the methods currently used to deliver cells to the myocardium, including intramyocardial injection (considered the gold standard), suffer from low retention rates. To promote localization of delivered cells to the infarct and increase retention rates, our lab has developed a fibrin biological suture that can deliver human mesenchymal stem cells (hMSCs) with an efficiency of 64% compared to just 11% with intramyocardial injection in the normal rat heart. In this dissertation we sought to examine the functionality of hMSC and hPS-CM seeded sutures and their impact on cardiovascular regeneration applications. We began by delivering hMSC seeded fibrin sutures to an infarcted rat heart and found that the sutures are an effective method to deliver cells to the infarcted myocardium and demonstrated a trend towards improved regional mechanical function in the infarct region over infarct alone. Next, we transitioned to using hPS-CM and developed methods to seed the sutures, as well as a method to measure hPS-CM contractility with high spatial and temporal resolution, while concurrently capturing calcium transients. This technique allowed us to examine the contractile behavior in terms of contractile strain and conduction velocity of hPS-CM seeded on fibrin microthreads over 21 days in culture. We found that the fibrin microthread is a suitable scaffold for hPS-CM attachment and contraction and that extended culture promotes cell alignment along the length of the suture as well as improvements in contractile function in terms of increases in contractile strain and conduction velocity. Finally, we delivered the hPS-CM seeded microthreads to an uninjured rat heart and found a delivery efficiency of 67%. Overall, we further demonstrated the technology of the fibrin suture to deliver cells to an infarct as well as the ability to support the attachment, contraction and delivery of hPS-CM to cardiac tissue. "

"Recent evidence suggests that delivering human mesenchymal stem cells (hMSCs) to the infarcted heart reduces infarct size and improves ventricular performance. However, cell delivery systems have critical limitations such as inefficient cell retention and poor survival, and lack targeted localization. Our laboratories have recently developed a method to produce discrete fibrin microthreads that can be attached to a needle and delivered to a precise location within the heart wall. We hypothesize that fibrin microthreads will support hMSC proliferation, survival and retention of multipotency, and may therefore facilitate targeted hMSC delivery to injured tissues such as infarcted myocardium. To test this hypothesis, we bundled 100 μm diameter microthreads to provide grooves to encourage initial cell attachment. We seeded hMSCs onto the microthread bundles by applying 50,000 cells in 100 μL of media. The number of cells adhered to the microthreads was determined up to 5 days in culture. Cell density on the fibrin microthreads increased over time in culture, achieving an average density of 730 ± 101 cells/mm2. A LIVE/DEAD assay confirmed that the cells were viable and Ki-67 staining verified the increase in cell number over time was due to proliferation. Additionally, functional differentiation assays proved that the hMSCs cultured on microthreads retained their ability to differentiate into adipocytes and osteocytes. The results of this study demonstrate that delivering 1 to 4 cell seeded microthread bundles to the infarcted rat myocardium has the potential to produce a positive improvement in mechanical function and these microthreads support hMSC proliferation and survival. Additionally these findings suggest that cell-seeded microthreads may serve a platform technology to improve localized delivery of viable cells to infarcted myocardium to promote functional tissue regeneration. "

O diabetes mellitus tipo 1 é uma doença autoimune causada pela destruição das células β produtoras de insulina, presentes nas ilhotas pancreáticas, por células autorreativas do sistema imune. A opção de tratamento mais utilizada são injeções diárias de insulina exógena, o que configura um tratamento não curativo. Para alcançar a independência de insulina, alternativas como o transplante de ilhotas vêm sendo estudadas. Entretanto, a disponibilidade de pâncreas de doadores cadavéricos para o isolamento destas ilhotas é pequena e os métodos de isolamento, pouco eficazes, sendo necessários de 2 a 4 doadores para atingir o número adequado de ilhotas. Além disso, o transplante apresenta problemas relacionados à enxertia, devidos principalmente à baixa vascularização, o que leva à morte de células β nos primeiros dias pós-transplante. Desta forma, estudos explorando alternativas que aumentem a sobrevivência e a funcionalidade dos transplantes e diminuam o número de ilhotas exigido por receptor fazem-se muito necessários. As células-tronco mesenquimais apresentam propriedades interessantes para aplicação em terapia celular. Entre elas, destaca-se o efeito parácrino, que exerce diversas funções benéficas, como o aumento da vascularização, nos locais onde estas células estão presentes. Sendo assim, este trabalho explorou o co-transplante de ilhotas pancreáticas com células-tronco mesenquimais derivadas de tecido adiposo, para o tratamento do diabetes mellitus em modelo murino. Os resultados mostraram que a presença destas células no grupo que recebeu o co-transplante não aumentou a taxa de cura, em relação ao grupo que recebeu somente ilhotas. No entanto, o fenômeno de reversão do diabetes foi antecipado no grupo co-transplantado, o que sugere um possível efeito angiogênico das células-tronco adiposo-derivadas presentes neste grupo. Desta forma, conclui-se que estas células podem exercer atividades benéficas, quando co-transplantadas com ilhotas pancreáticas, para o tratamento do diabetes. / Type 1 diabetes mellitus is an autoimmune disease caused by destruction of insulin-producing β cells, present in pancreatic islets, by auto-reactive cells of the immune system. The most widely used treatment option are daily injections of insulin, which configures a non-curative treatment. To achieve insulin independence, alternatives such as islet transplantation have been studied. However, the availability of pancreas from cadaveric donors for the isolation of these islets is poor and the methods for isolation, ineffective, requiring 2 to 4 donors to achieve the appropriate number of islets. In addition, transplantation presents problems related to engraftment, mainly due to poor vascularization, which leads to β cell death in the first days after transplantation. Thus, studies exploring alternatives that increase the survival and function of transplants and reduce the number of islets required by the recipient are very necessary. Mesenchymal stem cells have interesting properties for application in cell therapy. Among them is the paracrine effect, which has several beneficial functions, such as promoting vascularization in the tissues where these cells are present. Thus, the present study explored the co-transplantation of pancreatic islets with mesenchymal stem cells derived from adipose tissue for the treatment of diabetes mellitus in mice. The results showed that the presence of these cells in the group that received co-transplantation did not increase the cure rate, compared to the group that received islets alone. However, the phenomenon of diabetes reversion was anticipated in co-transplanted animals, which suggests a possible angiogenic effect of adipose-derived stem cells present in this group. Thus, we conclude that these cells may exert beneficial functions when co-transplanted with pancreatic islets for the treatment of diabetes.

O carcinoma espinocelular de cabeça e pescoço (CECP) é um problema de saúde pública que apresenta alta taxa de mortalidade, frequentemente relacionado à presença de recorrências locais e metástases. A descoberta de um pequeno subconjunto de células tumorais com características semelhantes às células-tronco, conhecidas como células-tronco tumorais (CTTs), tem sido relatadas como as principais responsáveis pelo início, progressão e recidiva do CECP. O processo de metástase nestas neoplasias é bastante complexo e envolve o desprendimento de células epiteliais tumorais do local de aparecimento primário devido à subexpressão ou superexpressão de algumas proteínas específicas nestas células, caracterizando um processo conhecido como transição epitélio-mesenquimal (EMT). A compreensão dos mecanismos envolvidos no processo de EMT têm sido investigados para o desenvolvimento de terapias específicas. O ácido retinoico (AR) vem sendo empregado em diversas terapias devido a sua capacidade de controlar a proliferação e promover diferenciação celular, entretanto, anormalidades na expressão ou função de seus receptores são relatadas em muitos tipos de células do câncer. Este estudo tem por objetivo correlacionar a expressão de marcadores do processo de EMT, marcador de célula tronco tumoral (ALDH1) e receptores do ácido retinoico e de retinoide X (isoformas α e β) em amostras teciduais provenientes de portadores de CECP primários, além, de correlacionar os resultados obtidos com os parâmetros clínicos, características histopatológicas e prognóstico destes pacientes em um período de acompanhamento de 7 anos. / The head and neck squamous cell carcinoma (HNSCC) is a public health problem that presents high mortality rates in relation to the presence of local recurrences and metastases. A finding of a small subset of tumor cells with stem like-cells characteristics, known as cancer stem cells (CTTs), has been reported as being primarily responsible for the onset, progression and recurrence of CECP. The metastasis process in these neoplasms is quite complex and involves the tumor epithelial cells detachment from the primary site of appearance due to underexpression or overexpression of some specific proteins in these cells, characterizing the epithelial-mesenchymal transition (EMT) process. An understanding of the mechanisms involved in the EMT process has been investigated for the development of specific therapies. Retinoic acid (AR) has been used in several therapies because its ability to control the proliferation and promote cell differentiation, however, abnormalities in the expression and function of its receptors are reported in many types of cancer cells. The aim of this study was to correlate the expression EMT process markers, tumor stem cell marker (ALDH1), retinoic acid and retinoic acid X receptors (α and β isoforms) in tissue samples from primary CECP, in addition, to correlate the results with the clinical parameters, histopathological and prognostic characteristics of these patients in a 7 years follow-up.

Le cancer épithélial de l’ovaire (EOC) a la particularité d’être diagnostiqué à un stade avancé chez 75% des patientes et de récidiver dans un grand nombre de cas malgré une bonne réponse initiale à la chimiothérapie, expliquant ainsi son pronostic sombre. Le rôle du microenvironnement tumoral semble être de premier plan dans le développement et la survie des cellules cancéreuses mais il existe encore peu de données concernant les cellules mésenchymateuses souches (MSC). Dans ce travail nous avons donc cherché à déterminer les mécanismes moléculaires entre les MSC et les cellules tumorales ovariennes. Dans la première partie de ce travail, nous avons mis en évidence l’émergence d’un profile pro-métastatique des cellules tumorales ovariennes après contact avec les MSC. Nous avons ensuite développé un modèle d’infiltration tumorale 3D révélant que les MSC augmentaient la dissémination tumorale ovarienne par la sécrétion d’IL6. Enfin nous avons démontré que les MSC étaient capables d’induire chez les cellules tumorales ovariennes un phénotype thermotolérant lié à la sécrétion CXCL12. Ces données vont donc toutes dans le même sens en démontrant les propriétés pro-tumorales des MSC et ouvrent de nouvelles perspectives de thérapies ciblant les interactions entre le stroma et la tumeur. / Patients with epithelial ovarian cancer (EOC) are diagnosed with advanced stage in 75% of cases and most of them will relapse despite a good primary response to chemotherapy, thus explaining the bad prognosis of EOC. While tumor microenvironment seems to play an important role for the development and survival of cancer cells, there is only few data regarding the mesenchymal stem cells (MSC) in EOC. In this work we therefore aimed at identifying the molecular determinant between MSC and ovarian cancer cells. In the first part of this work, we demonstrated that ovarian cancer cells acquired pro-metastatic profile upon contact with MSC. We then showed that MSC could enhance ovarian cancer cells infiltration through IL6 secretion in an amniochorionic membrane based 3D model. Finally we showed that MSC could protect ovarian cancer cells from hyperthermia through CXCL12 secretion. Taken together, our data are concordant to reveal the pro-tumoral properties of MSC. Cytokine inhibitors interrupting the cross-talk between OCC and MSC should now be tested as new therapies for EOC.

This dissertation reviews the development and implementation of integrative, systems biology methods designed to parse driver mutations from high- throughput array data derived from human patients. The analysis of vast amounts of genomic and genetic data in the context of complex human genetic diseases such as Glioblastoma is a daunting task. Mutations exist by the hundreds, if not thousands, and only an unknown handful will contribute to the disease in a significant way. The goal of this project was to develop novel computational methods to identify candidate mutations from these data that drive the molecular differentiation of glioblastoma into the mesenchymal subtype, the most aggressive, poorest-prognosis tumors associated with glioblastoma.

The anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee, with upwards of 100,000 ACL reconstructions performed annually. Current grafting techniques are limited by insufficient integration with subchondral bone and donor site morbidity issues related to graft harvest, potentially resulting in revision surgery and long-term joint pain. Therefore, significant demand exists for alternative grafting solutions that do not require additional surgery and can regenerate the native ACL-to-bone interface to promote biological fixation of the implanted ACL graft. To address this need, the ideal system must be able to withstand the functional demands of the native tissue by demonstrating physiologically equivalent mechanical properties, be comprised of compositionally varying phases in order to recapitulate the inherent heterogeneity of the native ligament to bone transition and be biodegradable such that it is gradually replaced by the regenerated tissue following implantation. It is hypothesized that a biomimetic, multi-phased scaffold comprised of optimized bone, interface and ligament regions coupled with controlled chemical and/or mechanical stimulation in vitro will guide phase-specific differentiation of mesenchymal stem cells (MSC) and result in a biologically integrated bone-ligament-bone complex in vivo. Mesenchymal stem cells are particularly attractive for this application as they can be routinely harvested from bone marrow, have been shown to respond to chemical, mechanical and structural cues, and are capable of differentiating towards the primary cell types (fibroblasts, osteoblasts and chondrocytes) found within ligament, bone and the ligament-to-bone interface. To this end, a nanofiber-based synthetic graft was designed with compositionally-varying phases to regenerate ligament, bone and interface tissues. The ligament phase was optimized in terms of nanofiber alignment, composition, mechanical stimulation and chemical stimulation. It was demonstrated that an aligned nanofiber substrate coupled with controlled mechanical stimulation was necessary to differentiate MSCs towards a fibroblastic phenotype. The bone phase was optimized in terms of ceramic content and it was shown that a threshold of mineral incorporation into nanofibers was necessary to differentiate MSCs towards an osteogenic phenotype. Lastly, a mechanoactive nanofiber collar was designed to induce interface formation. It was demonstrated that compressive stimulation applied via nanofiber collar contraction induced chondrogenic differentiation of MSCs. Subsequently, the three phases were incorporated to form a synthetic graft, for which graft architecture and cell seeding density were optimized. The resulting graft was cultured in vitro under the optimized parameters, demonstrating the formation of distinct and structurally continuous regions of bone, interface and ligament tissue. The graft was implanted in vivo where it was shown to be suitable for ACL reconstruction as it maintained knee stability and promoted ligament regeneration. In summary, this thesis focuses on the design of a biomimetic, nanofiber-based, integrated bone-ligament-bone construct, and elucidates chemical, mechanical and scaffold design-related parameters that can guide MSC differentiation towards desired tissue types. The impact of these studies extends beyond ligament reconstruction as they yield valuable scaffold design criteria, establish scaffold and culturing-related parameters to induce stem cell differentiation and can readily be applied to the formation of interfaces between soft-to-hard tissues as well as other complex tissues.

Metástases para a região oral podem ocorrer nos tecidos moles ou nos ossos maxilares. Tumores metastáticos para a cavidade oral são raros, compreendendo aproximadamente 1% das neoplasias encontradas na região oral. Devido à sua raridade, o diagnóstico de uma lesão metastática na região oral é difícil; tanto para o clínico como para o patologista, ao reconhecer que uma lesão é metastática e na determinação do local de origem. Foram revisados 9 casos sendo 5 mulheres e 4 homens com idades entre 57 e 80 anos e realizada uma crítica revisão da literatura. No presente estudo não foi possível determinar a prevalência das metástases para os ossos maxilares ou para os tecidos moles da cavidade oral; Entretanto, nosso estudo mostra que o exame das estruturas orais é absolutamente fundamental no acompanhamento desses pacientes, pois a presença de possíveis massas metastáticas pode indicar uma neoplasia oculta ou mesmo a falha terapêutica. / Metastasis to the oral region may occur in the soft tissue or jaw bone. Metastatic tumors to the oral cavity are rare, comprising about 1% of neoplasms found in the oral region. Because of its rarity, the diagnosis of a metastatic lesion in the oral region is difficult; both for the clinician and for the pathologist to recognize that an injury is metastatic and determination of the place of origin. 9 cases with 5 women and 4 men aged between 57 and 80 years and performed a critical review of the literature were reviewed. In the present study could not determine the prevalence of metastasis to the jaw bones or the soft tissues of the oral cavity; However, our study shows that the examination of oral structures is absolutely essential to monitor these patients, because the presence of possible metastatic masses may indicate a hidden cancer or treatment failure.

Glioblastoma is the most common adult malignant primary brain tumor with one of the worst prognosis. With a survival of 10 to 12 months, glioblastoma remains one of the most challenging disease to treat. The standard treatment method involves maximal possible resection of the tumor followed by radiation and chemotherapy. However, the short half-life of most chemotherapeutic drugs, high systemic toxicity and inability to cross the blood brain barrier inhibits effective delivery of the chemotherapeutics to the tumor. An ideal drug delivery system can reach the tumor site with high efficiency and continuously release the drug at the tumor site for an extended period. Adult stem cells including neural stem cells (NSC) and mesenchymal stem cells (MSC) have inherent tumor trophic properties allowing for site-specific delivery of chemotherapeutics. They can also be genetically engineered to secrete the chemotherapeutic drug continuously making them ideal candidates for cell-based delivery system for treating glioblastoma. MSC have been isolated from a wide range of sources including bone marrow, umbilical cord, adipose tissue, liver, multiple dental tissues and induced pluripotent stem cells. MSC are also easily amenable to viral modification allowing for easy manipulation to produce chemotherapeutic drugs. Additionally, more than 350 clinical trials using MSC have successfully established the safety of using MSC for cell-based therapies. Collectively these factors have led to the widespread use of MSC in cancer therapy. MSC have been successfully transduced to produce chemotherapeutic drugs to treat glioma, melanoma, lung cancer, ovarian cancer and breast cancer. Despite the multitudes of advantages that cell therapy provides they are limited in three main domains (1) Low cell retention and survival at the site of the tumor (2) In ability to co-deliver multiple therapeutics and (3) In ability to deliver drugs other than peptide based drugs. This thesis details the work to engineer mesenchymal stem cells to tackle these three issues and develop a system that can increase the efficacy of glioblastoma treatment. To increase the cellular retention and survival we engineered MSC to form multicellular spheroids and cell sheets. To co-delivery multiple therapeutics we engineered MSC to form MSC/DNA-templated nanoparticle hybrid cluster to co-deliver drugs for cancer therapy. The system showed superior performance due to the increased retention of the cells and nanoparticle at the tumor site. Finally, to deliver drugs other peptide based we engineered graphene oxide cellular patches for mesenchymal stem cells. Graphene oxide can carry diverse therapeutics and can kill the cancer cells without affecting the cellular viability of MSC.

<div>Mesenchymal stem cells (MSCs) are responsive to mechanical stimuli that play an essential role in directing their differentiation to the chondrogenic lineage. A better</div><div>understanding of the mechanisms that allow MSCs to respond to mechanical stimuli is important to improving cartilage tissue engineering and regenerative medicine. Hydrostatic pressure (HP) in particular is known to be a primary mechanical force in joints. However, little is known about the underlying mechanisms that facilitate HP</div><div>mechanotransduction. Understanding the signaling pathways in MSCs in transducing HP to a beneficial biologic response and their interrelationship were the focus of this thesis. Studies used porcine marrow-derived MSCs seeded in agarose gel. Calcium ion Ca++ signaling, focal adhesion kinase (FAK) involvement, and sirtuin1 activity were investigated in conjunction with HP application.</div><div><br></div><div><div>Intracellular Ca++ concentration was previously shown to be changed with HP application. In our study a bioreactor was used to apply a single application of HP to the MSC-seeded gel structures and observe Ca++ signaling via live imaging of a fluorescent calcium indicator in cells. However, no fluctuations in Ca++ concentrations were observed with 10 minutes loading of HP. Additionally a problem with the biore actor design was discovered. First the gel was floating around in the bioreactor even without loading. After stabilizing the gel and stopping it from floating, there were still about 16 µm of movement and deformation in the system. The movement and deformation was analyzed for the gel structure and different parts of the bioreactor. </div><div><br></div><div>Furthermore, we investigated the role of FAK in early and late chondrogenesis and also its involvement in HP mechanotransduction. A FAK inhibitor was used on MSCs from day 1 to 21 and showed a dose-dependent suppression of chondrogenesis. However, when low doses of FAK inhibitor added to the MSC culture from day 21 to 42, chondrogenesis was not inhibited. With 4 hour cyclic HP, FAK phosphorylation increased. The beneficial effect of HP was suppressed with overnight addition of the</div></div><div><div>FAK inhibitor to MSC medium, suggesting FAK involvement in HP mechanotransducation by MSCs.</div></div><div><br></div><div>Moreover, sirtuin1 participation in MSC chondrogenesis and mechanotransduction was also explored. The results indicated that overnight sirtuin1 inhibition increased chondrogenic gene expression (Agc, Col2, and Sox9) in MSCs. Additionally, the activity of sirtuin1 was decreased with both 4 hour cyclic hydrostatic pressure and inhibitor application. These two together demonstrated that sirtuin1 inhibition enhances chondrogenesis.</div><div><br></div><div><div>In this research we have investigated the role of Ca++ signaling, FAK involvement, and sirtuin1 activity in the mechanotransduction of HP in MSCs. These understandings about the mechanisms regulating the chondrogenesis with respect to HP could have important implications for cartilage tissue engineering and regenerative studies.</div></div>