Type 1 diabetes is an autoimmune disease in which patients' insulin-secreting beta cells in pancreatic islets are destroyed by their own immune system, leading to unregulated blood glucose levels and severe complications. Its only treatment is intensive insulin therapy, which carries the risk of hypoglycemic episodes and can result in seizures, coma, and even death. Islet transplantation has recently become an alternative, albeit experimental, treatment for type 1 diabetes patients. More than one donor graft is usually required to render recipients insulin independent, making the shortage of donor tissue an extremely important challenge in islet transplantation. Identifying the cell type that has the ability to differentiate into islet-like tissue is an important area of study. In this study, I hypothesized that insulin secreting human islet-like clusters could be generated from pancreatic ductal cells, a potential pancreatic progenitor cell type. Islet-like clusters were generated using crude exocrine tissue from human cadaveric donors. This crude exocrine tissue contained a large number of ductal cells, as well as other pancreatic cell types. To evaluate insulin secretion by human islet-like clusters, a static incubation system was set up and tested using Min6 cells, a known insulin-secreting cell line. Using static incubation, significant increases in insulin secretion by islet-like clusters were observed when the clusters were exposed to higher glucose levels and GLP-1, a known insulin secretagogue. Presence of corresponding C-peptide secretion demonstrated that de novo insulin secretion occurred. Furthermore, basal insulin secretion increased as culture stages progressed. An attempt was made to generate islet-like clusters using ductal cells purified by fluorescent activated cell sorting or magnetic activated cell sorting. Nevertheless, it was difficult to ensure survival and proliferation of purified ductal cells. Further studies will be necessary to confirm the role of ductal cells in the generation of islet-like clusters using the crude exocrine tissue, as well as to identify factors that can promote ductal cells proliferation after cell sorting.

Breast and pancreatic cancers are among the major causes of cancer mortality in our society. There has been a significant decline in mortality from breast cancer over the last two decades, while pancreatic cancer has an exceptionally poor prognosis. Although these malignancies have very different clinical outcomes they share the common feature that metastatic disease is almost uniformly fatal. The existence of cancer stem cells has been postulated as a major factor in tumour recurrence after traditional chemo- or radio-therapy. Addressing this important clinical question requires a deeper understanding of the biology of normal and cancer stem cells and the signalling pathways involved in their regulation. The identity of the pancreatic stem cell remains elusive. However, using a murine model of haematopoietic stem cell (HSC) transplantation I have demonstrated for the first time transdifferentiation of these bone marrow derived cells into mature pancreatic acinar cells, where they appear to contribute to cell turnover ultimately forming acini and lobules. These data show that HSC have surprising developmental plasticity and provide insight into a potential stem cell niche in the pancreas. The Hedgehog, Wnt and Notch signalling pathways play a critical role in early development and in the maintenance and self-renewal of stem cells. There is also increasing evidence that dysregulation of these pathways contributes to the development of many malignancies. There is relatively little information regarding their role in breast cancer development and progression. I used immunohistochemistry for key proteins in these pathways, sonic hedgehog, beta-catenin and Notch 1 in three substantial series of human breast lesions and determined that abnormal expression of these proteins is an early event in the development in breast cancer, and is associated with particular breast cancer subtypes, Shh and beta-catenin expression is associated predominantly with the basal-like phenotype and Notch 1 with the HER2 amplified phenotype. Overexpression of Shh in particular confers a worse clinical outcome in invasive ductal carcinoma. Furthermore, increased levels of Shh in a 3D culture model of non-transformed mammary epithelial cells resulted in disorganisation of acini and the development of an abnormal discohesive phenotype. Finally the role of Shh was investigated in a mammary epithelial transplantation model, where overexpression of Shh resulted in the development of hyperplasia of the mammary ductal epithelium. Together these data confirm that the Hedgehog, Wnt and Notch developmental pathways are dysregulated in breast cancer and represent viable targets for further investigation of potential novel therapies in breast cancer.

Proefschrift Universiteit van Amsterdam. / Met lit. opg. - Met samenvatting in het Nederlands.

Thesis (doctoral)--Nijmegen, 1983.

Thesis (M.S.)--San Francisco State University, 2002. / Includes bibliographical references (leaves 29-54).

Thesis (Ph. D. in Molecular Physiology and Biophysics)--Vanderbilt University, Aug. 2007. / Title from title screen. Includes bibliographical references.

Proefschrift Universiteit Maastricht. / Met lit. opg. - Met samenvatting in het Nederlands.

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O Diabetes mellitus tipo 1 (DM1), na maioria dos casos, é causado pela destruição de células β pancreáticas, levando à hiperglicemia. Atualmente a única fonte de novas células β e os únicos tratamentos capazes de restaurar o padrão fisiológico de secreção de insulina nesses pacientes são o transplante de pâncreas e de ilhotas pancreáticas. O transplante de ilhotas apresenta problemas relacionados a enxertia, devido principalmente a baixa vascularização, o que leva à morte de células β nos primeiros dias pós-transplante. Células-tronco mesenquimais apresentam características interessantes para o tratamento do DM1. A primeira aplicação explorada nesse trabalho foi a capacidade de diferenciação de MSCs humanas e murinas em células produtoras de insulina (CPIs). A identidade das células isoladas foi confirmada pela caracterização imunofenotípica e pela capacidade de diferenciação adipogênica e osteogênica in vitro. Quatro protocolos de diferenciação em CPIs foram testados em MSCs derivadas de ilhotas pancreáticas e um em MSCs derivadas de rim murino. A análise da expressão gênica de insulina em células diferenciadas em todos os protocolos testados mostrou níveis insignificantes ou nulos de expressão desse hormônio. A segunda aplicação explorou o co-transplante de ilhotas pancreáticas com MSCs derivadas de rim em camundongos diabéticos. Os resultados mostraram aumento da taxa de cura e melhora na glicemia pós-transplante, bem como uma tendência ao aumento do conteúdo total de insulina em animais co-transplantados em comparação com animais que receberam apenas ilhotas. Não houve diferenças no peso e teste de tolerância à glicose entre os grupos. Foi observado aumento na vascularização do enxerto nos animais que receberam MSCs. Paralelamente, foi estudada a associação de variantes alélicas dos genes PTPN22, KIR, HLA classe I e II e a susceptibilidade ao desenvolvimento de DM1 em uma população do Rio Grande do Sul. Foi observada associação entre o alelo 1858T e o risco aumentado de DM1. A genotipagem do KIR e HLA-C mostrou uma frequência maior de alelos do grupo 2 do HLA-C em controles não diabéticos, bem como o genótipo 2DL1/C2+, sugerindo um papel protetor desse genótipo. Além disso, indivíduos com haplótipo KIR2DL2/DR3+ e KIR2DL2/DR3/DR4+ tem risco aumentado de desenvolvimento de DM1. MSCs parecem possuir baixa capacidade de diferenciação em células β in vitro, entretanto, possuem efeitos benéficos importantes quando cotransplantadas com ilhotas pancreáticas. Essa aplicação tem grande potencial e deveria ser testada em estudos clínicos com o objetivo de melhorar a enxertia e diminuir o número de ilhotas necessárias para cada paciente. / Type 1 Diabetes (DM1), in almost all the cases, is caused by the destruction of beta-cells by cells of the immune system, leading to hyperglycemia. The only source for new beta-cells available is through the pancreas and islet transplantation, two treatments able to restore insulin secretion pattern in this patients. Islet transplantation presents issues related to grafting, caused mainly by poor vascularisation post-transplant, leading to betacell death in the first days after transplantation. Mesenchymal stem cells have interesting characteristics to the treatment of DM1. The first application explored in this work was testing the capacity of differentiation of human and mouse MSCs into insulin-producing cells (CPIs). Identity of isolated cells was confirmed by immunophenotyping and potential of adipogenic and osteogenic differentiation in vitro. Four protocols were tested in human islet-derived MSCs and one in mouse kidney-derived MSCs to generate CPIs. Analysis of insulin expression in differentiated cells from all protocols showed no or very little expression levels of this hormone. The second application was to evaluate the role of MSCs in the co-transplantation with pancreatic islets in diabetes mice. Our results showed an increased number of cured mice and a decrease in glycemic levels post transplant in islet+MSCs group, as well as a tendency to an increase in total insulin content in islet+MSCs compared with islet-only group. No differences could be found in weight and intraperitoneal glucose tolerance test between groups. An increase in graft vascularisation was observed in MSCs-receiving animals. At the same time, we studied the association of allelic variants in PTPN22, KIR, HLA class I and II genes and its association with the developing of DM1. We reported and association of the 1858T allele and an increased risk of DM1. Genotyping shows an increased frequency of group 2 alleles (C2) of HLA-C in controls as well as the 2DL1/C2+ genotype, suggesting a protective role of this genotype. Moreover, individuals with KIR2DL2/DR3+ and KIR2DL2/DR3/DR4+ haplotypes have increased risk of developing DM1. MSCs seem to have low capacity of in vitro differentiation in a beta-cell phenotype, however, they exert important benefic effects when co-transplanted with pancreatic islets in diabetic mice. This application has great potential and should be tested in clinical trials aiming the improvement of islet grafting and decrease in the number of islets needed for transplantation.

Made available in DSpace on 2016-08-12T18:48:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-26. Added 1 bitstream(s) on 2016-08-12T18:50:54Z : No. of bitstreams: 1 000865249_20170310.pdf: 411293 bytes, checksum: f8c1d02bfb772bbd81e4a7df20358928 (MD5) Bitstreams deleted on 2017-03-10T13:07:29Z: 000865249_20170310.pdf,. Added 1 bitstream(s) on 2017-03-10T13:08:14Z : No. of bitstreams: 1 000865249.pdf: 1415116 bytes, checksum: f43ae6a121d2b64591e3365fbace0d36 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Durante a gravidez diabética, a hiperglicemia materna pode prejudicar o desenvolvimento embrionário por uma associação de hipóxia e estresse oxidativo. Deste modo, nossa hipótese é de que a combinação desses mecanismos esteja envolvida no desenvolvimento pancreático alterado. Portanto, o objetivo do presente estudo foi avaliar os efeitos do estresse oxidativo e hipóxia no organismo materno sobre o desenvolvimento pancreático fetal em condições hiperglicêmicas. Foram utilizados ratos da linhagem Wistar que foram aleatoriamente distribuídos em: Controle (C); Diabete moderado (DM) e Diabete grave (DG). O diabete foi induzido em ratos pela administração de streptozotocin. As ratas foram acasaladas e, no 18º e 21º dias de prenhez, foram avaliados parâmetros como hiperglicemia e marcadores de hipóxia e de estresse oxidativo maternos. Nos mesmos momentos, os fetos foram coletados para análise das ilhotas pancreáticas. Foram encontradas alterações na tríade hormonal (insulina, glucagon e somatostatina) e marcadores de proliferação celular (PDX-1 e ki67) e morte celular (caspase-3). Essas alterações foram mais evidentes nos fetos advindos do grupo diabete grave. Além disso, a morfologia das ilhotas pancreáticas fetais e localização correta das células endócrinas foram claramente alteradas. Também houve correlação positiva entre glicemia, estresse oxidativo e hipóxia no organismo materno dos grupos diabéticos. Estes mecanismos também foram positivamente correlacionados com a redução no número de ilhotas e de células por ilhota nos descendentes. Portanto, a presença de estresse oxidativo e hipóxia, induzidos por alterações glicêmicas maternas, causou prejuízo no desenvolvimento pancreático fetal. Este fato demonstra que é necessário um rígido controle glicêmico materno para prevenir complicações embriofetais e perinatais / In diabetic pregnancy, hyperglycemia may impair embryonic development by a combination of hypoxia and oxidative stress. Therefore, we hypothesized that a combination of these factors was involved in the impaired pancreatic development in the offspring. Thus, the objective of the present study was to evaluate maternal oxidative stress and hypoxia status on fetal pancreatic development in hyperglycemic conditions. Wistar rats were randomly assigned into three groups: control (C); mild diabetes (MD) and severe diabetes (SD). Diabetes was induced by the beta-cytotoxic drug (streptozotocin) in rats. The female rats were mated and at days 18 (early period of maximum fetal development) and 21 (at term) of pregnancy the maternal hyperglycemia, hypoxia and oxidative stress markers were evaluated. In the fetus, the pancreatic islets were analyzed. The results showed alterations in pancreatic hormone triad (insulin, glucagon and somatostatin), beta cell marker (PDX-1), proliferation (ki67) and apoptosis (caspase-3), which were more pronounced in the SD group. Furthermore, the morphology of the fetal pancreatic islets was clearly changed. There was a positive correlation between blood glucose, oxidative stress and hypoxia of the mothers and the reduction in the number of islets and number of cells per islet in the fetuses from the diabetic groups. Therefore, oxidative stress and hypoxia induced by maternal hyperglycemia led to impairment of fetal pancreatic development. These observations indicate that a rigid glycemic control in diabetic pregnancy is required to prevent the embryofetal and perinatal complications / FAPESP: 11/23642-2