京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13031号 / 論医博第2113号 / 新制||医||1016(附属図書館) / 32989 / (主査)教授 妻木 範行, 教授 安達 泰治, 教授 開 祐司 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20077号 / 医博第4170号 / 新制||医||1018(附属図書館) / 33193 / 京都大学大学院医学研究科医学専攻 / (主査)教授 江藤 浩之, 教授 斎藤 通紀, 教授 山田 泰広 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20269号 / 医博第4228号 / 新制||医||1021(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 横出 正之, 教授 湊谷 謙司, 教授 瀬原 淳子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

<p>Glaucoma is a leading cause of blindness characterized by the progressive loss of retinal ganglion cells (RGCs), essentially severing the connection between the eye and the brain. Among many underlying causes of the disease, mutations in the Optineurin (OPTN) gene result in severe RGC neurodegeneration in the absence of elevated intraocular pressure, providing a novel opportunity to study molecular mechanisms that lead to RGC neurodegeneration associated with glaucoma. Efforts of this study establishing a human pluripotent stem cell (hPSC)-derived in vitro disease model by inserting OPTN(E50K) mutation via CRISPR/Cas9 genome editing and investigate the cellular mechanisms of RGC neurodegeneration associated with glaucoma. OPTN(E50K) RGCs revealed neurodegeneration phenotypes, including downregulation of RGCs transcription factors, neurite retraction, and hyperexcitability, suggesting that OPTN(E50K) RGCs can serve as an appropriate disease model to study glaucoma-associated neurodegeneration. Since OPTN serves a primary role as an autophagy receptor, we further hypothesized that the OPTN(E50K) mutation disrupts autophagy in RGCs, and modulation of autophagy by mammalian target of rapamycin (mTOR)-independent pathways can preserve RGC phenotypes by maintaining mTOR signaling. OPTN(E50K) RGCs exhibited a higher number of OPTN puncta along with an overall reduced expression of OPTN protein, indicating a gain of toxic protein accumulation or loss of protein function. Furthermore, OPTN(E50K) RGCs revealed an accumulation of the autophagosome protein LC3 in a punctal manner as well as increased expression of lysosomal proteins, suggesting a disruption of degradation pathway in autophagosome and lysosome fusion. As mTOR complex 1 (mTORC1) signaling serves as a negative regulator of autophagy, a downregulation of mTORC1 signaling via activation of stress sensor adenosine monophosphate-activated protein kinase (AMPK) was observed as a possible compensatory mechanism for autophagy deficits in OPTN(E50K) RGCs. Pharmacological inhibition of mTOR in wild-type hRGCs resulted in similar disease-related phenotypes, while preservation of the mTOR pathway in OPTN(E50K) RGCs by treatment with the mTOR-independent autophagy modulator trehalose cleared OPTN accumulated puncta, preserving mTORC1 signaling, as well as rescuing neurodegenerative phenotypes. To further validate these associations in an animal model, the microbead occlusion mouse model was established by injection of magnetic microbeads in the anterior chamber to block aqueous outflow resulting ocular hypertension. In agreement with our findings in hRGCs, a decrease in mTOR signaling associated with an increase in the expression of autophagy-associated proteins was observed in RGCs in the microbead occlusion model. Additionally, these disease-related phenotypes were observed specifically within RGCs but not cortical neurons with an underlying OPTN(E50K) mutation, demonstrating that autophagy represents an essential pathway in RGCs to maintain homeostasis, and selective disrupt of autophagy in RGCs leads to neurodegeneration. Taken together, the results of this study highlight an essential balance between autophagy and mTORC1 signaling that is essential for the homeostasis of RGCs, while disruption to these signaling pathways contributes to neurodegenerative features in glaucoma. These results also demonstrated the ability to pharmacologically intervene to experimentally manipulate these pathways and rescue neurodegenerative phenotypes, providing a potential therapeutic target to prevent glaucoma-associated neurodegeneration. </p>

Os tecidos da polpa dentária e vibrissa são dois microambientes celulares que compartilham a mesma origem embrionária. Ambos possuem o seu nicho especifico pós-natal que abrigam células tronco adultas (CTA). O objetivo do trabalho foi investigar a expressão diferencial dos marcadores de células pluripotentes, mesenquimais e neuroepiteliais nas populações de células tronco isoladas das vibrissas (CTV) e polpa de dente (CTPD) de camundongos C57BL-6. Resultados obtidos no presente trabalho, utilizando o método de imunofluorescência, revelaram que as CTA de ambos tecidos expressam um amplo painel de marcadores de pluripotência (Oct4, Nanog e Sox2), mesenquimais (CD73, CD90 e CD105), hematopoiético (CD34), crista neural (CKit), neuronal (Nestina) e epitelial (Integrina &#945;6, LGR5 e LGR6) e indica possível potencial destas células em diversas linhagens celulares. Desta forma, células isoladas destes tecidos podem ser interessantes para serem aplicadas em diversos tratamentos na medicina regenerativa. Portanto, o estudo comparativo da expressão de um amplo painel de marcadores de células tronco em CTV e CTPD pode vir a aumentar o leque de possibilidades de sua utilização na terapia celular. Com isso, as células isoladas de polpa dentária foram submetidas à análise de expressão de marcadores já citados e a outros conhecidamente positivos e específicos para os folículos piloso como Citoqueratina 15 (CK15), LRig1 e Blimp1. Foram realizados ensaios de imunofluorescência, imunohistoquímica, citometria de fluxo e RT-PCR. Os dados obtidos nos permitiram concluir, que as CTA isoladas das ambas as fontes são bastante semelhantes em relação ao seu imunofenótipo, porém as características da sua diferenciação precisam ainda ser analisadas. / The tissues of the dental pulp and vibrissae are two cellular microenvironments that share the same embryonic origin. Both have their postnatal specific niche that keep adult stem cells (ASC). The objective of this study was to investigate the differential expression of pluripotent markers, mesenchymal and neuroepithelial in populations of stem cells isolated from whiskers (WSC) and dental pulp (DPSC) C57BL-6 mice. Results obtained in this study, using immunofluorescence, revealed that the ASC both tissues express a broad panel of pluripotency markers (Oct4, Nanog and Sox2), mesenchymal cells (CD73, CD90 and CD105), hematopoietic (CD34), crest neural (cKIT), neuronal (Nestin) and epithelial (Integrin &#945;6, LGR5 and LGR6) and indicates possible potential of these cells in several cell lines. Thus, isolated cells of these tissues may be interesting for application in various treatments in regenerative medicine. Therefore, the comparative study of the expression of a broad panel of stem cell markers in WSC and DPSC could increase the range of possibilities for their use in cell therapy. Thus, the isolated cells were subjected to the dental pulp marker expression analysis cited above and others known to be positive and specific to hair follicles as Cytokeratin 15 (CK15), and LRig1 Blimp1. Immunofluorescence assays were performed, immunohistochemistry, flow cytometry and RT-PCR. The data allowed us to conclude that the ASC isolated from both sources are quite similar with respect to their immunophenotype, but the characteristics of differentiation remain to be analyzed.

Este estudo apresenta o desenvolvimento e validação de uma nova abordagem para a avaliação do cálcio intracelular em culturas de cardiomiócitos derivados de células-tronco pluripotentes induzidas humanas (hiPSC-CM - do inglês human induced pluripotent stem cell-derived cardiomyocytes) que pode ser aplicada para avaliar o efeito de drogas no acoplamento excitação-contração. O método consiste na estimulação elétrica e medição conjunta da fluorescência de forma automatizada e foi viabilizado a partir da inclusão de um sistema de estimulação elétrica em um leitor de ELISA (do inglês Enzyme-Linked Immunosorbent Assay). Um estimulador eletrônico compacto foi projetado para operar junto a um leitor de placas gerando pulsos quadrados monofásicos com duração de 5 ms e campo elétrico de 8 Vcm-1 aplicados por microeletrodos metálicos de platina-irídio em células em cultura. Uma placa de cultura normalmente utilizada em leitor de placas foi modificada para permitir a colocação do estimulador e dos eletrodos. A intensidade de fluorescência do cálcio intracelular foi avaliada utilizando um leitor de ELISA durante a estimulação elétrica em culturas de células marcadas com o indicador de Ca2+ Fluo-4 AM. A estimulação elétrica das células resultou em contrações regulares nas frequências de 0,1 Hz; 0,2 Hz; 0,3 Hz e 0,5 Hz induzidas pelo estimulador. Parâmetros dos transientes de cálcio foram estudados após a exposição de culturas de células ao Verapamil (0,05; 0,5 e 5,0 µM), a amplitude e a inclinação máxima da fase de subida foram progressivamente reduzidas com doses crescentes da droga. Os dados obtidos demonstraram que o método apresentado permite a avaliação automatizada de transientes de cálcio durante a estimulação elétrica de culturas de hiPSC-CM utilizando o sistema de estimulação em um leitor de ELISA. Esses resultados validaram a aplicabilidade do sistema ao estudo das alterações da dinâmica do cálcio intracelular induzidas por drogas em células sob estimulação elétrica. O sistema de avaliação automatizada desenvolvido pode ser ampliado para realizar a triagem de alto rendimento em bibliotecas de compostos que tem como alvo o acoplamento excitação-contração em células cardíacas humanas in vitro. / This study presents the development and validation of a new approach for the evaluation of intracellular calcium in cultures of cardiomyocytes derived from human induced pluripotent stem cells (hiPSC-CM), which can be applied to evaluate the effect of drugs on excitation-contraction coupling. The method consists of electrical stimulation and joint measurement of fluorescence in an automated manner and was made possible by the inclusion of an electrical stimulation system in an ELISA (Enzyme-Linked Immunosorbent Assay). A compact electronic stimulator was designed to operate inside a plate reader generating monophasic square pulses with duration of 5 ms and electric field of 8 Vcm-1 applied by platinum-iridium metal microelectrodes to cells in culture. A culture plate used in a plate reader was modified to allow placement of the stimulator and electrodes. Fluorescence intensity of intracellular calcium was measured during electrical stimulation of cell cultures loaded with Ca2+ Fluo-4 AM indicator using a plate reader. The electrical stimulation of the cells generated regularly spaced contractions following the pace of the stimulator at the frequencies of 0.1 Hz, 0.2 Hz, 0.3 Hz and 0.5 Hz. Transient profile parameters were studied after treating cell cultures with Verapamil (0.05, 0.5 and 5.0 µM) the amplitude and the maximum slope of rising phase were progressively reduced with increasing verapamil doses. The data obtained demonstrated that the method presented allows the automated evaluation of calcium transients during the electrical stimulation of hiPSC-CM cultures using the stimulation system in an ELISA reader. These results demonstrated the applicability of the system to the study of changes in the intracellular calcium dynamics induced by drugs in electrically stimulated cells. The system developed is amenable to scaling thus allowing high content automated drug library screening for compounds that target the excitationcontraction coupling in human heart cells in vitro.

L’hyperoxalurie primitive de type 1 (ou HP1) est une maladie héréditaire du métabolisme liée à un déficit en enzyme hépatocytaire AGT (alanine:glyoxylate aminotransférase), codée par le gène AGXT. Ce déficit entraîne, chez les patients atteints d’HP1, une excrétion hépatique accrue d’oxalate ; celui-ci est ensuite éliminé dans les urines où il se complexe avec le calcium pour former des néphrolithiases oxalo-calciques massives, pouvant conduire à une insuffisance rénale chronique. Le seul traitement curatif disponible pour cette pathologie est la greffe allogénique combinée hépatorénale, actuellement limitée par la disponibilité des donneurs de greffons, une morbi-mortalité significative et la nécessité d’un traitement immunosuppresseur au long cours. L’objectif du projet de recherche est de développer une thérapie génique de l’HP1 par greffe de cellules hépatiques autologues génétiquement corrigées. La faible disponibilité et la difficulté d’amplification in vitro des hépatocytes adultes nous a conduit à explorer la piste des cellules souches pluripotentes induites (iPSCs) pour produire des cellules hépatiques humaines utilisables en médecine régénérative. Nous avons dérivé et caractérisé des lignées de cellules iPSCs à partir de fibroblastes de patients atteints d’HP1, après expression transitoire des facteurs de reprogrammation par des vecteurs Sendai. Nous avons développé deux stratégies de thérapie génique additive par insertion d’un minigène codant une séquence optimisée de l’ADNc AGXT au moyen (1) d’un vecteur lentiviral à expression hépato-spécifique et (2) d’un processus de recombinaison homologue au locus AAVS1 facilité par le système de clivage ciblé de l’ADN « CRISPR/Cas9 ». Enfin, nous avons mis en évidence l’expression de la cassette thérapeutique après différenciation hépatocytaire des iPSCs génétiquement corrigées. Ces résultats ouvrent de nouvelles perspectives de médecine régénérative pour l’HP1 par transplantation de cellules hépatocytaires autologues génétiquement corrigées dérivées d’iPSCs de patients. / Primary hyperoxaluria type 1 (or PH1) is an inherited metabolic disorder related to the deficiency of the hepatic AGT enzyme (alanine:glyoxylate aminotransferase), which is encoded by the AGXT gene. In PH1 patients, this deficiency leads to oxalate overexcretion by liver, followed by urine filtration and complexation with calcium to form massive calcium-oxalate nephrolithiasis potentially leading to chronic renal failure. The only available curative treatment is combined hepatorenal allogeneic engraftment, which is currently limited by the availability of transplant donors, significant morbidity and mortality, and the need for long-term immunosuppressive treatment. The aim of our research project is to develop gene therapy for PH1, consisting in engraftment of genetically corrected autologous liver cells. Considering that adult hepatocytes are hardly available and expandable in vitro, we chose to explore the use of induced pluripotent stem cells (iPSCs) to produce human liver cells for application in regenerative medicine. We derived and characterized iPSC lines from PH1 patient fibroblasts after transient expression of reprogramming factors delivered by Sendai virus vectors. We developed two additive gene therapy strategies by inserting a minigene encoding an optimized AGXT cDNA sequence using (1) a lentiviral vector designed for liver-specific expression and (2) homologous recombination process at the AAVS1 locus favoured by the targeted DNA cutting system “CRISPR/Cas9”. Finally, we highlighted therapeutic cassette expression after hepatic differentiation of genetically corrected iPSCs. These results pave the way for regenerative medicine for PH1 by transplantation of genetically modified autologous hepatocyte-like cells derived from patient-specific iPSCs.

Este estudo apresenta o desenvolvimento e validação de uma nova abordagem para a avaliação do cálcio intracelular em culturas de cardiomiócitos derivados de células-tronco pluripotentes induzidas humanas (hiPSC-CM - do inglês human induced pluripotent stem cell-derived cardiomyocytes) que pode ser aplicada para avaliar o efeito de drogas no acoplamento excitação-contração. O método consiste na estimulação elétrica e medição conjunta da fluorescência de forma automatizada e foi viabilizado a partir da inclusão de um sistema de estimulação elétrica em um leitor de ELISA (do inglês Enzyme-Linked Immunosorbent Assay). Um estimulador eletrônico compacto foi projetado para operar junto a um leitor de placas gerando pulsos quadrados monofásicos com duração de 5 ms e campo elétrico de 8 Vcm-1 aplicados por microeletrodos metálicos de platina-irídio em células em cultura. Uma placa de cultura normalmente utilizada em leitor de placas foi modificada para permitir a colocação do estimulador e dos eletrodos. A intensidade de fluorescência do cálcio intracelular foi avaliada utilizando um leitor de ELISA durante a estimulação elétrica em culturas de células marcadas com o indicador de Ca2+ Fluo-4 AM. A estimulação elétrica das células resultou em contrações regulares nas frequências de 0,1 Hz; 0,2 Hz; 0,3 Hz e 0,5 Hz induzidas pelo estimulador. Parâmetros dos transientes de cálcio foram estudados após a exposição de culturas de células ao Verapamil (0,05; 0,5 e 5,0 µM), a amplitude e a inclinação máxima da fase de subida foram progressivamente reduzidas com doses crescentes da droga. Os dados obtidos demonstraram que o método apresentado permite a avaliação automatizada de transientes de cálcio durante a estimulação elétrica de culturas de hiPSC-CM utilizando o sistema de estimulação em um leitor de ELISA. Esses resultados validaram a aplicabilidade do sistema ao estudo das alterações da dinâmica do cálcio intracelular induzidas por drogas em células sob estimulação elétrica. O sistema de avaliação automatizada desenvolvido pode ser ampliado para realizar a triagem de alto rendimento em bibliotecas de compostos que tem como alvo o acoplamento excitação-contração em células cardíacas humanas in vitro. / This study presents the development and validation of a new approach for the evaluation of intracellular calcium in cultures of cardiomyocytes derived from human induced pluripotent stem cells (hiPSC-CM), which can be applied to evaluate the effect of drugs on excitation-contraction coupling. The method consists of electrical stimulation and joint measurement of fluorescence in an automated manner and was made possible by the inclusion of an electrical stimulation system in an ELISA (Enzyme-Linked Immunosorbent Assay). A compact electronic stimulator was designed to operate inside a plate reader generating monophasic square pulses with duration of 5 ms and electric field of 8 Vcm-1 applied by platinum-iridium metal microelectrodes to cells in culture. A culture plate used in a plate reader was modified to allow placement of the stimulator and electrodes. Fluorescence intensity of intracellular calcium was measured during electrical stimulation of cell cultures loaded with Ca2+ Fluo-4 AM indicator using a plate reader. The electrical stimulation of the cells generated regularly spaced contractions following the pace of the stimulator at the frequencies of 0.1 Hz, 0.2 Hz, 0.3 Hz and 0.5 Hz. Transient profile parameters were studied after treating cell cultures with Verapamil (0.05, 0.5 and 5.0 µM) the amplitude and the maximum slope of rising phase were progressively reduced with increasing verapamil doses. The data obtained demonstrated that the method presented allows the automated evaluation of calcium transients during the electrical stimulation of hiPSC-CM cultures using the stimulation system in an ELISA reader. These results demonstrated the applicability of the system to the study of changes in the intracellular calcium dynamics induced by drugs in electrically stimulated cells. The system developed is amenable to scaling thus allowing high content automated drug library screening for compounds that target the excitationcontraction coupling in human heart cells in vitro.

O Transtorno Depressivo Maior (TDM) é uma condição neuropsiquiátrica que resulta em um substancial sofrimento pessoal, incapacidade e custos sociais. Devido à inacessibilidade ao encéfalo humano por questões práticas, éticas e às limitações encontradas pelo uso de modelos animais, o desenvolvimento de modelos in vitro acurados torna-se fundamental para o estudo desta doença. Neste aspecto, o surgimento da tecnologia de células-tronco pluripotentes induzidas humanas (hiPSCs) apresenta-se como uma importante ferramenta, uma vez que permite a recapitulação da diversidade genética dos pacientes e possibilita a produção de tipos celulares de interesse para o estudo da doença, como neurônios e glia. Entretanto, até o momento, não há registros da produção de modelos in vitro a partir de hiPSCs de pacientes com TDM. Visando preencher esta lacuna, o presente estudo teve por objetivo a produção e caracterização de dois tipos de modelos in vitro a partir de hiPSCs de pacientes com TDM: neurônios serotoninérgicos, uma cultura celular em monocamada, e organóides cerebrais, uma cultura celular em suspensão. 5 linhagens de hiPSCs de pacientes foram diferenciadas em neurônios com sucesso e no ensaio de imunocitoquímica, expressaram os marcadores 5-HT (serotonina), T5-HT (transportador de serotonina), nestina (presente em diferentes tipos de células neuronais) e Tuj1 (proteína do citoesqueleto, neurônio-específica), confirmando o fenótipo de neurônios serotoninérgicos. As céluas diferenciadas obtiveram também resultados positivos nos testes de imageamento de cálcio e de medidas da alteração no potencial de membrana, indicando que os neurônios diferenciados eram fisiologicamente funcionais. De 5 linhagens de hiPSCs (sendo uma controle e as outras 4 de pacientes com TDM), somente 1 linhagem sobreviveu ao processo de diferenciação, originando organóides cerebrais e apresentou expressão dos marcadores Sox2 (progenitoras neurais) e Tuj1 (neurônios maduros), indicando ainda uma estruturação correta da citoarquitetura, com as progenitoras localizadas mais internamente, na zona ventricular, ao redor dos lúmens preenchidos com líquido e com os neurônios maduros localizados na placa cortical, região mais externa dos agregados celulares. Apesar de o processo de produção dos organóides cerebrais necessitar de aperfeiçoamento e melhor padronização, a produção destes dois tipos de modelos in vitro, feitos a partir de hiPSCs de pacientes com TDM configura-se como um importante passo para a futura redução do uso de modelos animais em pesquisa, elucidação de mecanismos subjacentes à doença, identificação de biomarcadores diagnósticos e triagem de fármacos de maneira personalizada, visando permitir tratamentos mais baratos, adequados e eficientes para o TDM / Major Depressive Disorder (MDD) is a neuropsychiatric condition that results in substantial personal distress, disability, and social costs. The inaccessibility to the human brain due to practical and ethical issues and the limitations encountered by the use of animal models turn the development of accurate in vitro models into an essential factor to study this disease. In this regard, the emergence of human induced pluripotent stem cell technology (hiPSCs) is an important tool, since it allows the recapitulation of patient\'s genetic diversity and allows the production of cell types of interest for studying the disease, such as neurons and glia. However, to date, there are no records of the production of in vitro models from hiPSCs of patients with MDD. In order to fill this gap, the present study aimed at the production and characterization of two types of in vitro models from hiPSCs of patients with MDD: serotonergic neurons, a monolayer cell culture, and cerebral organoids, a suspension cell culture. 5 patients\' hiPSCs lines were successfully differentiated into neurons and, in the immunocytochemistry assay, they expressed the 5-HT (serotonin), T5-HT (serotonin transporter), nestin (present in several neuronal cell types) and Tuj1 (cytoskeleton protein, neuron-specific), confirming the phenotype of serotonergic neurons. Differentiated cells also obtained positive results in calcium imaging tests and measurements of membrane potential changes, indicating that differentiated neurons were physiologically functional. Of 5 hiPSCs lines (one control and the other 4 of patients with MDD), only 1 survived to the differentiation process, originating cerebral organoids which presented expression of Sox2 (neural progenitor) and Tuj1 (mature neurons) markers and a correct structuring of the cytoarchitecture, with the progenitors located more internally in the ventricular zone, around the lumens filled with liquid and with the mature neurons located in the cortical plate, the outermost region of the cellular aggregates. Although the cerebral organoids production process needs improvement and better standardization, the production of these two types of in vitro models, made from hiPSCs of patients with MDD, is an important step for the future reduction of animal models use, elucidation of disease underlying mechanisms, identification of diagnostic biomarkers and drug screening in a personalized manner, in order to allow cheaper, more adequate and more efficient treatments for MDD

abstract: The pathophysiology of neurodegenerative diseases, such as Alzheimer’s disease (AD), remain difficult to ascertain in part because animal models fail to fully recapitulate the complex pathophysiology of these diseases. In vitro models of neurodegenerative diseases generated with patient derived human induced pluripotent stem cells (hiPSCs) and human embryonic stem cells (hESCs) could provide new insight into disease mechanisms. Although protocols to differentiate hiPSCs and hESCs to neurons have been established, standard practice relies on two dimensional (2D) cell culture systems, which do not accurately mimic the complexity and architecture of the in vivo brain microenvironment. I have developed protocols to generate 3D cultures of neurons from hiPSCs and hESCs, to provide more accurate models of AD. In the first protocol, hiPSC-derived neural progenitor cells (hNPCs) are plated in a suspension of Matrigel™ prior to terminal differentiation of neurons. In the second protocol, hiPSCs are forced into aggregates called embryoid bodies (EBs) in suspension culture and subsequently directed to the neural lineage through dual SMAD inhibition. Culture conditions are then changed to expand putative hNPC populations and finally differentiated to neuronal spheroids through activation of the tyrosine kinase pathway. The gene expression profiles of the 3D hiPSC-derived neural cultures were compared to fetal brain RNA. Our analysis has revealed that 3D neuronal cultures express high levels of mature pan-neuronal markers (e.g. MAP2, β3T) and neural transmitter subtype specific markers. The 3D neuronal spheroids also showed signs of neural patterning, similar to that observed during embryonic development. These 3D culture systems should provide a platform to probe disease mechanisms of AD and enable to generation of more advanced therapeutics. / Dissertation/Thesis / Masters Thesis Bioengineering 2016