CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A viscossuplementaÃÃo à uma tÃcnica terapÃutica utilizada no tratamento de osteoartrite, a qual busca substituir o lÃquido sinovial (lubrificante das articulaÃÃes) por soluÃÃes viscoelÃsticas de derivados do Ãcido hialurÃnico com propriedades reolÃgicas melhores que a deste lÃquido. Este tratamento à caro e comercialmente sà se utilizada o Ãcido hialurÃnico. O estudo de outros polissacarÃdeos, tais como a goma guar e a quitina, para aplicaÃÃo em viscossuplementaÃÃo, aumenta a possibilidade de substituir o Ãcido hialurÃnico por outros de fontes mais abundantes e viÃveis. A goma guar (GGNP) foi purificada por vÃrios mÃtodos com a finalidade de reduzir contaminantes, como polissacarÃdeos (que nÃo galactomanana) e principalmente proteÃnas. O mÃtodo de maior eficiÃncia na reduÃÃo destes contaminantes foi o mÃtodo fÃsico+Fehling, resultando em uma guar (GGFISFEH) com 96% de galactomanana e 0% de proteÃnas. A goma comercial (GGNP) e a purificada (GGFISFEH) foram reticuladas com glutaraldeÃdo para originar hidrogÃis fluidos de alta viscosidade. O aumento da viscosidade do polissacarÃdeo com o tempo de reaÃÃo de reticulaÃÃo à gradativo e pode ser interrompido no momento em que se obtÃm um hidrogel fluido, por diÃlise contra Ãgua. Os hidrogÃis obtidos tem viscosidade quarenta vezes (GelGGNP) e oitocentas vezes (GelGGFISFEH) a viscosidade das soluÃÃes iniciais das gomas. A goma guar purificada (GGFISFEH) foi modificada por reaÃÃo de oxidaÃÃo com reagente TEMPO e por reaÃÃo de sulfataÃÃo, com a finalidade de introduzir grupos carboxilato e sulfato, assemelhando a estrutura desta ao Ãcido hialurÃnico e ao condroitim sulfato. As reaÃÃes foram eficientes na modificaÃÃo, resultando em grau de substituiÃÃo (GS) de 0,36 para a goma oxidada (GGOXID) e 0,60 para a sulfatada (GGSULF). AnÃlises de RMN de 13C e 1H indicam que a sulfataÃÃo ocorreu no C6 da galactose e a oxidaÃÃo no C6 da manose. A quitina foi carboximetilada para originar um polieletrÃlito solÃvel em Ãgua e com grupo acetil glicosamina semelhante ao do Ãcido hialurÃnico. Esta reaÃÃo foi testada em vÃrias condiÃÃes reacionais, resultando em GS diferentes. O melhor rendimento foi de 92% com um GS de 0,53. Os testes farmacolÃgicos foram realizados em ratos Wistar. Avaliou-se o efeito per si na cavidade articular de GGNP e GGFISFEH, ambas em soluÃÃo e gel. A GGNP causou incapacitaÃÃo e influxo celular dosedependente, efeito nÃo demonstrado por GGFISFEH. A incapacitaÃÃo articular foi maior com a administraÃÃo do GelGGNP. Avaliou-se tambÃm, o efeito terapÃutico da GGFISFEH em soluÃÃo e gel, e Hilano G-F20 em osteoartrite induzida pelo modelo de transecÃÃo do ligamento cruzado anterior. A inibiÃÃo da incapacitaÃÃo articular obtida pelo gel ou pela soluÃÃo de guar foram absolutamente semelhantes ao resultado obtido com o Hilano G-F 20. A goma guar apresenta potencial como agente viscossuplementador. / The viscosupplementation is a therapeutic technique used in the osteoarthritis treatment, in which the sinovial fluid (lubricant of the ligaments) is replaced by viscoelastic solutions derived from hyaluronic acid with rheological properties better than the starting material. This treatment is expensive and commercially, only hialuronic acid is used. The research of other polysaccharides such as the guar gum and chitin, for the application on viscosupplementation, increases the possibility of substituting the hyaluronic acid with other from more abundant sources and more viable. The guar gum (GGNP) was purified through various methods with the aim to reduce contaminants, such as polysaccharides (but not galactomannan) and most importantly, proteins. The method with best efficiency in the reduction of these contaminants was the physic+Fehling method, resulting in a guar (GGFISFEH) with 96% of galactomannan and 0% of proteins. The commercial gum (GGNP) and the purified (GGFISFEH) were crosslinked with glutaraldehyde to originate fluids hydrogel of high viscosity. The increase in viscosity of the polysaccharides with the increase of the crosslinking reaction time is gradual and can be interrupted at the moment a hydrogel fluid is obtained through dialysis against water. The hydrogels obtained have viscosity forty times (GelGGNP) and eight hundred times (GelGGFISFEH) than the initial viscosities of the gums. The purified guar gum (GGFISFEH) was modified through oxidative reaction with a TEMPO reagent and through a sulfatation reaction, with the aim of introducing carboxylated and sulphate groups, making their structure similar to the one from the hyaluronic acid and the chondroitin sulfate. The reactions were efficient in the modification, resulting in degree of substitution (DS) of 0.36 for the oxidated gum (GGOXID) and 0.60 for the sulfated gum(GGSULF). 13C and 1H NMR analyses indicated that the sulfatation occurred in C6 of galactose and the oxidation on C6 of mannose The chitin was carboxylated to form a water soluble polyeletrolite and with a group of acetyl glucosamine similar to the hyaluronic acid. This reaction was tested in various conditions, resulting in different DS. The best yield was of 92% with a DS of 0.53. The pharmacological tests were conducted on rats Wistar. The effect, per si, in the articulate cavity of GGNP and GFISFEH, both in solution and gel was also studied. The GGNP caused incapacitation and dosage-dependant cell influx, an effect not demonstrated by GGFISFEH. The articular incapacitation was greater with the administration of GelGGNP. It was also evaluated the therapeutic effect of GGFISFEH in solution and gel, and Hilano G-F20 in osteoarthritis induced by the transection of the anterior cruciate ligament. The inhibition of the articular incapacitation obtained through gel or through the guar solution were entirely similar to the results obtained with the Hilano G-F20. The guar gum presents potential as a viscosuplemented agent.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Animal models have been employed for the study of osteoarthritis (OA), but the articular hyperalgesia has received little attention. In this study, we standardized a method to study hyperalgesia in an OA model in rats, through the anterior cruciate ligament transection (ACLT), as well as the role of Nitric Oxide (NO). High molecular weight (MW) polysaccharides, such as Hylan G-F 20, as a gel preparation, have been used to relive pain in OA patients. Whether their activity is due to the high MW or to the gel state (viscossuplementation) is a matter of debate. We used the ACLT model to evaluate the effect of a polysaccharide from gum guar (GG) in the hyperalgesia. Wistar rats were subjected to ACLT (OA group). The hyperalgesia was measured using the test for articular incapacitation (AI) in rats (Tonussi & Ferreira, 1992), until 28 days. The joint lavage was used for determining cell influx (CI) and NO levels. The activity of the inducible NO synthase enzyme (iNOS) was evaluated by immunohistochemistry of the synovia. The articular cartilage was evaluated by quantifying the glycosaminoglycans (GAG) content of the cartilage of the femoral condyles. The animals of the OA group were compared to a sham group and to naive animals. Animals of the OA group received indomethacin (2mg/kg/d s.c.), L-NAME (30mg/kg i.p.) or 1400W (0,5mg/kg/d s.c.), NOS inhibitors, 30 min before the surgery and until sacrifice, at 7 days (prophylactic intervention). Animals of the OA group were compared to sham and naive groups. Other animals of the OA group received L-NAME or 1400W 3 days after the surgery, until sacrifice, at 7 days (therapeutic intervention). Still other animals of the OA group received GG (100&#956;g i. art.), as a gel or as solution, from 4 through 7 days of OA and were compared to both a sham group and to a group that received Hylan G-F 20 (100microg i. art.), as a gel. Control groups received the vehicles. The OA group displayed significantly increased AI during the first 7 days (P<0.001). There was no difference in CI among all groups. NO release, at 7 days, was increased in the OA group (P<0.05), that was associated with an increased activity of the iNOS in the synovia. The GAG content was significantly increased in the OA group, measured at 14 days (P<0.05). Indomethacin significantly reduced the AI, as compared to the OA group (P<0.05). L-NAME and 1400W reduced the AI, only when given prophylactically (P<0.01), that was reversed by the co-administration of L-NAME and L-arginine. GG, either as a gel or as a solution, as well as the Hylan G-F20, significantly reduced the AI (P<0.05), as compared to the OA group. This is the first demonstration of a model to study hyperalgesia, quantitatively, in OA experimental models. There is increased release of NO in the ACLT model, probably via iNOS activation. The administration of NOS inhibitors inhibits the AI only if given prophylactically. This is also the first demonstration that GG promotes analgesia in the ACLT model in rats. Moreover, the anti-nociceptive effect of polysaccharides, at least in this model, is independent of their colloidal state. / Modelos animais sÃo usados para estudo da Osteoartrite (OA), mas a hiperalgesia articular tem sido pouco investigada. Nesse trabalho, padronizamos um mÃtodo para estudo da hiperalgesia no modelo de OA em ratos, por transecÃÃo do ligamento cruzado anterior (TLCA) e investigamos a participaÃÃo do Ãxido NÃtrico (NO). PolissacarÃdeos de alto peso molecular (PM), como o Hilano GF-20, na forma de gel, sÃo usados para reduzir a dor em pacientes com OA, mas nÃo està claro se sua aÃÃo à atribuÃvel ao alto PM ou à forma em gel (viscossuplementaÃÃo). Usamos o modelo de TLCA para avaliar o efeito de um polissacarÃdeo de goma guar (GG) na hiperalgesia. Ratos Wistar foram submetidos à TLCA (grupo OA). A hiperalgesia foi avaliada pelo teste de incapacitaÃÃo articular (IA) para ratos (Tonussi & Ferreira, 1992), por atà 28 dias. O exsudato articular foi usado para medida do influxo celular (IC) e da liberaÃÃo de NO. A atividade da enzima NO sintase indutÃvel (iNOS) foi avaliada por imunohistoquÃmica das sinÃvias. A cartilagem articular foi avaliada pela quantificaÃÃo dos glicosaminoglicanos (GAG) da cartilagem dos cÃndilos femorais. Os animais do grupo OA foram comparados a grupos falso-operados (Sham) e a controles normais (Naive). Animais do Grupo OA receberam indometacina (2mg/kg/d s.c.), L-NAME (30mg/kg i.p.) ou 1400W (0,5mg/kg/d s.c.), inibidores da NOS, 30 min antes da cirurgia e atà o sacrifÃcio, aos 7 dias (intervenÃÃo profilÃtica). Outros animais do grupo OA receberam L-NAME ou 1400W a partir de 3 dias apÃs a cirurgia, atà o sacrifÃcio, aos 7 dias (IntervenÃÃo terapÃutica). Outros grupos OA receberam GG (100microg i. art.), como gel ou soluÃÃo, dos 4 aos 7 dias de OA e foram comparados ao grupo sham e a um grupo que recebeu Hilano G-F 20 (100&#956;g i. art.), como gel. Grupos controle receberam o veÃculo. O grupo OA apresentou IA significantemente maior durante os primeiros 7 dias (p<0,001). NÃo houve diferenÃa no IC entre todos os grupos. A liberaÃÃo de NO, aos 7 dias, foi maior no grupo OA (p<0,05), que foi associada a maior atividade da iNOS na sinÃvia. A quantidade de GAG foi maior no grupo OA, medida aos 14 dias (p<0,05). Indometacina reduziu significantemente a IA, em relaÃÃo ao grupo OA (p<0,05). L-NAME e 1400W inibiram a IA, apenas quando dados profilaticamente (p<0,01) sendo revertida pela co-administraÃÃo de L-NAME e L-arginina. A GG, em gel ou soluÃÃo, da mesma forma que o Hilano G-F 20, reduziu significantemente a IA (p<0,05), em relaÃÃo ao grupo OA. Esta à a primeira demonstraÃÃo de um modelo de estudo de hiperalgesia, de forma quantitativa, em modelos experimentais de OA. Existe aumento na liberaÃÃo de NO no modelo de TLCA, provavelmente via ativaÃÃo da iNOS. A administraÃÃo de inibidores de NOS inibe a IA nesse modelo apenas se feita de forma profilÃtica. Esta à tambÃm a primeira demonstraÃÃo que a GG promove analgesia no modelo de TLCA em ratos. Ainda, o efeito antinociceptivo de polissacarÃdeos, pelo menos nesse modelo, independe do seu estado coloidal.

La bioinspiration consiste à analyser les systèmes naturels qui se sont adaptés parfaitement à leurs environnements pour développer des solutions ingénieuses. Ce projet de thèse aborde la thématique de la lubrification articulaire dans le but de développer un traitement contre l'ostéoarthrite (OA). Nous nous sommes inspirés des articulations synoviales, systèmes tribologiques très performants grâce aux interactions synergiques entre la structure unique du cartilage et les molécules lubrifiantes (ML) du fluide synovial (SF). Cependant, lors de l'OA des mécanismes inflammatoires et d'érosion mécanique aboutissent à la dégénérescence progressive du cartilage et la dégradation spécifique des ML du SF (aggrécane et lubricine). Des mimes des ML du SF ont été synthétisés reprenant leur structure particulière dite en écouvillon moléculaire (BB), structure responsable de la lubrification. Des tests tribologiques (SFA, tribomètre) ont montré que les BB garantissent à la fois une faible friction et une résistance à l'usure sur des surfaces dures de mica. Ceci est dû à la présence, sur nos EM, de groupements d'ancrage spécifiques assurant l’adsorption sur la surface de mica et à la formation d'enchevêtrements et d’interactions intermoléculaires avec l'acide hyaluronique de haut poids moléculaire, composant essentiel du SF. Des mimes de cartilage à base d'hydrogels de chitosane multicouches ont été également réalisés reprenant les principales propriétés architecturales du cartilage. En combinaison avec nos EM, ces hydrogels, matériaux poroélastiques fragiles, sont capables d’être lubrifiés avec une friction dans la gamme physiologique et une nette amélioration de leur usure / Bioinspiration consists in the design of materials inspired by biological systems which have developed ingenious solutions to suit their environment. This project deals with bioinspiration for joint lubrication and in particular for the development of treatments for patients suffering from osteoarthritis (OA). To do so, we took our inspiration from joints which are amongst the most efficient aqueous tribological systems. Their unique properties arise from the complex synergistic interactions between cartilage structure and the lubricant macromolecules of the synovial fluid (SF). However, during OA, inflammatory mechanisms as long as mechanical erosion result in the degeneration of cartilage and lubricant macromolecules (aggrecan and lubricin). Polymeric mimes of the SF have been synthesized based on the bottle-brush (BB) architecture of LUB and AGG which is responsible for the joint lubrication. Tribological tests (SFA, tribometer) showed that BB polymers provided mica surfaces with a low friction and a wear protection up to several megapascals, typically in the range of natural joints. This wear protection was essentially due to the incorporation of anchoring groups specific to mica tribopairs on the BB polymers and the intermolecular bridging and entanglements emerging between BB polymers and high molecular weight HA, another main SF component. Cartilage mimes composed of multilayered chitosan hydrogels were designed to mimic the basic features of cartilage. Along with our BB polymers, the hydrogels, which are poroelastic and fragile materials, provided a low friction and a great decrease of wear

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2018-01-09T12:25:20Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ANDRE CAMPOS.pdf: 1231707 bytes, checksum: 3e1489a22081a3ec5a3ec05965d5052d (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2018-01-09T12:25:28Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ANDRE CAMPOS.pdf: 1231707 bytes, checksum: 3e1489a22081a3ec5a3ec05965d5052d (MD5) / Made available in DSpace on 2018-01-09T12:25:28Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ANDRE CAMPOS.pdf: 1231707 bytes, checksum: 3e1489a22081a3ec5a3ec05965d5052d (MD5) Previous issue date: 2017 / Hospital dos Servidores do Estado do Rio de Janeiro / A artroplastia é o tratamento mais eficiente para a osteoartrite grave do joelho sintomática. No nosso meio, o tempo de espera entre a indicação e a realização de tal procedimento, pelo sistema público de saúde, é demasiadamente demorado. A motivação deste estudo era tentar melhorar a qualidade de vida dos pacientes enquanto aguardam a cirurgia. O objetivo, portanto, foi avaliar os resultados, no seguimento de curto prazo, da viscossuplementação nos pacientes com osteoartrite grave do joelho e compará-los com a Triancinolona e com a associação entre ambas. Foi realizado um ensaio clínico randomizado duplo cego com 143 joelhos divididos em 3 grupos. Grupo 1: infiltração de Triancinolona; Grupo 2: infiltração de Hilano G-F 20; Grupo 3: infiltração de Triancinolona + Hilano G-F 20. Todos os pacientes foram submetidos à avaliação através de escores funcionais de Lysholm e KSS pré-infiltração e pós-infiltração com um, três e seis meses. Na comparação dentro de cada grupo, houve melhora da pontuação média do Lysholm em todos os grupos na avaliação de 1 mês comparadas à avaliação pré-infiltração (p<0,01) e essa melhora foi mantida na média da avaliação de 3 meses (p>0,05). Na avaliação de 6 meses, houve uma piora em relação às avaliações pós-infiltração anteriores (p<0,05), mas ainda com média superior àquela realizada antes do tratamento (p<0,05). Na comparação do KSS, todos os grupos também apresentaram melhor pontuação do escore na avaliação de 1 mês em relação àquela pré-infiltração (p<0,01). Essa melhora se manteve para as avaliações de KSS funcional de 3 meses no grupo da triancinolona (p>0,05). Já nos grupos com o uso do Hilano houve piora no escores subsequentes (p<0,05). Não houve diferença estatisticamente significativa na comparação entre os três tratamentos (p>0,05). O tratamento com viscossuplementação apresentou melhora dos escores funcionais, principalmente, até 3 meses após a infiltração em pacientes com gonartrose avançada. Porém, não se mostrou superior quando comparado ao uso de triancinolona intra-articular e à associação de ambas as substâncias / The final treatment for symptomatic severe osteoarthritis of the knee is total knee replacement. In our country, the time between indication and accomplishment of such procedure by the public health system is too time consuming. This study was born from the idea of trying to improve the quality of life of patients while awaiting surgery. The purpose of this research is to analyze the early outcomes of viscosupplementation in patients with severe knee osteoarthritis and compare it to the use of triamcinolone and the association of both. A randomized double-blind clinical trial was performed with 143 knees divided into three groups. Group 1: intra-articular injection of Triamcinolone; Group 2: Hylan G-F 20; Group 3: Triamcinolone + Hylan G-F 20. The outcome was measured using Lysholm and KSS scores before treatment and after one month, three and six months. In comparison within each group, there was improvement in average Lysholm score in all groups in the 1 month evaluation compared to initial evaluation (p<0,01) and this improvement was maintained at the average of third month evaluation (p>0,05). At 6 months, there was a decrease compared to previous post- infiltration ratings (p<0,05), but still higher than average performed before treatment (p<0,05). In comparing KSS, all groups also had better scores in the evaluation of 1 month compared to that pre-infiltration (p<0,01). This improvement remained up to 3rd and 6th months in the corticosteroid injection group (p>0,05). The groups using the Hylan presented lower scores in subsequent evaluation (p<0,05). There is no statistically difference among the three groups (p>0,05). Viscosupplementation increased functional scores in patients with severe osteoarthritis of the knee, especially within 3 months of injection. However, it was not superior when compared to the use of triamcinolone or the association of both

L’arthrose du genou est une maladie rhumatismale dégénérative touchant tous les tissus de l’articulation. Elle est classée parmi les dix affections les plus invalidantes dans le monde et l’absence de traitement curatif efficace en fait un véritable problème de santé publique. Dans le cas d’arthrose post-traumatique, les lésions méniscales sont fréquentes et entravent leurs fonctions de répartition des efforts, d’absorption des chocs et de stabilité. Les objectifs de ce travail de thèse sont (1) d’analyser les changements de propriétés mécaniques des ménisques à un stade précoce de développement de l’arthrose et de les corréler avec les modifications morphologiques, biochimiques et microstructurales, et (2) d’évaluer l’effet d’une thérapie de viscosupplémentation commerciale. Le modèle d’arthrose post-traumatique choisi dans cette étude est la rupture du ligament croisé antérieur chez le lapin. Les ménisques de lapins sains, arthrosiques non traités et arthrosiques traités ont été caractérisés six semaines après l’opération par un score macroscopique, puis par indentation – relaxation grâce au développement d’une méthode de test adaptée, ainsi que par microspectroscopie Raman, microscopie confocale biphotonique et histologie. Cette étude a révélé la formation de lésions à la surface des ménisques arthrosiques et une diminution de leurs propriétés viscoélastiques, s’expliquant par une désorganisation de leurs fibres de collagène et une diminution de leur quantité de glycosaminoglycanes. Bien que le traitement améliore significativement l’état de surface des ménisques et joue un rôle dans la régulation des glycosaminoglycanes, il a peu d’effet sur l’organisation des fibres de collagène et sur les propriétés viscoélastiques. Ce travail de thèse apporte une meilleure compréhension des modifications affectant le ménisque, dans l’optique de développer de nouveaux traitements. / Knee osteoarthritis (OA) is a rheumatic degenerative disease affecting all tissues of the joint. It is classified among the ten most disabling affections in the world and the lack of efficient curative treatment makes it a real public health issue. In case of post-traumatic OA, meniscal tears are frequent and interfere with their functions of load distribution, shock absorption and stability. The aims of this work are (1) to analyze the changes of mechanical properties of the menisci at an early stage of OA development and to correlate them with morphological, biochemical and microstructural modifications, and (2) to assess the effect of a commercial viscosupplementation therapy. For this study, an anterior cruciate ligament transection model of post-traumatic OA was used in rabbits. Menisci from healthy, non-treated OA and treated OA rabbits were characterized six weeks after surgery through macroscopic grading, indentation-relaxation with the development of an adapted test method, Raman microspectroscopy, biphotonic confocal microscopy and histology. This study revealed the formation of tears at the surface of OA menisci and a decrease in their viscoelastic properties, which was explained by a disorganization of their collagen fibers and a decrease in their glycosaminoglycan content. Although the treatment significantly improves the surface integrity of the menisci and plays a role in the glycosaminoglycan regulation, it has little effect on the organization of their collagen fibers and on their viscoelastic properties. This work brings a better understanding of the disease processes affecting the meniscus, for the purposes of developing new treatments.

Orientador: Evanisi Teresa Palomari / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-27T08:27:28Z (GMT). No. of bitstreams: 1 Lemos_GeorgeAzevedo_M.pdf: 2430384 bytes, checksum: e0763d6d63c12784a5888085434f8dd8 (MD5) Previous issue date: 2015 / Resumo: A Disfunção temporomandibular (DTM) é uma expressão coletiva que engloba vários sinais e sintomas clínicos relacionados aos músculos da mastigação, articulações temporomandibulares (ATMs) e estruturas associadas. As principais queixas relatadas são ruídos e dor na região da ATM, com maior prevalência em adultos jovens, especialmente mulheres. A inflamação intra-articular é considerada uma das mais importantes fontes de dor nesta disfunção. O processo inflamatório pode se localizar na membrana sinovial, cápsula articular ou tecidos retrodiscais, e na presença de alterações degenerativas articulares recebe o nome de artrite. Assim, o laser de baixa potência (LBP) e o hialuronato de sódio de alto peso molecular (HSAPM) tem sido utilizados para o tratamento de distúrbios inflamatórios da ATM e, resultados clínicos promissores têm sido descritos. Estudos experimentais, sob a óptica da biologia celular e molecular, fazem-se necessários para melhor compreensão de seus respectivos efeitos biológicos e elaboração de protocolos clínicos seguros. Desta forma, o objetivo do presente estudo foi caracterizar a ação morfológica e bioquímica da terapia com LBP e HSAPM sobre a artrite induzida na ATM. Utilizou-se 48 ratos machos, Wistar, divididos nos grupos: GA, animais com artrite induzida por meio de injeção intra-articular de adjuvante completo de Freund (CFA); GL, animais com artrite e tratados com LBP; GH, animais com artrite e tratados com HSAPM e; GHL, animais com artrite e tratados com LBP e HSAPM. Todos os experimentos ocorreram na ATM esquerda. As ATMs direitas no GA foram utilizadas como controle (GC). Foram realizadas análises morfológicas por meio de cortes corados em hematoxilina-eosina (HE), azul de toluidina e Picrosirius. Nos discos articulares, também foram realizadas análises histomorfométricas e birrefringência de fibras colágenas (microscopia de polarização). As análises bioquímicas dos tecidos da ATM foram realizadas por meio de dosagens de glicosaminoglicanos sulfatados (GAGs) e zimografia para avaliação das metaloproteinases (MMPs) 2 e 9. Os dados obtidos foram analisados por meio dos testes ANOVA one-way com pós-teste de Tukey e, Kruskal-Wallis seguido do pós-teste de Dunn. O GA exibiu acentuadas alterações morfológicas nos componentes da ATM tais como: elevada espessura do disco articular; hiperplasia da membrana sinovial e formação de pannus; reabsorção óssea da fossa mandibular; aplainamento do côndilo mandibular e presença de intenso infiltrado de células inflamatórias mononucleares no tecido subsinovial. A microscopia de polarização mostrou menor birrefringência das fibras colágenas, indicando alto grau de desorganização das fibras colágenas. Os GL, GH e GHL apresentaram menor espessura do disco articular e maior birrefringência das fibras colágenas em comparação ao GA (p<0,05). Na análise bioquímica, ficou demonstrado que a concentração de GAGs e atividades de MMP-2 e MMP-9 foram estatisticamente maiores no GA em comparação ao GC (p<0,05). Os GL, GH e GHL exibiram menores atividades das isoformas ativas da MMP-2 e MMP-9 em comparação ao GA (p<0,05). Com base nos resultados, concluiu-se que o LBP e HSAPM demonstraram efeitos anti-inflamatórios e protetores sobre as estruturas articulares. A terapia com uso simultâneo do LBP e HSAPM não foi superior aos respectivos tratamentos isolados / Abstract: Temporomandibular disorder (TMD) is a collective term that encompasses several clinical signs and symptoms related to mastigation muscles, temporomandibular joint (TMJ) and its associated structures. The main complaints reported are noise and pain at TMJ region showing higher prevalence in young adults, especially women. The intra-articular inflammation is considered one of the main sources of pain in the development of TMD. The inflammatory process may be located in the synovial membrane, articular capsule or retrodiskal tissues, and the presence of degenerative joint changes is called arthritis. Currently, Low-level laser (LLL) and high molecular weight sodium hyaluronate (HMWSH) have been used for treating TMJ disorders and promising clinical results have been reported. Experimental studies, from the perspective of cellular and molecular biology, are needed for better understanding of their respective biological effects allowing the development of secure clinical protocols. Thus, the aim of this study was to characterize the morphological and biochemical action of the therapy with LLL and HMWSH on a TMJ with induced arthritis. 48 male rats were divided into the following groups: GA, animals with arthritis induced by an intra-articular complete Freund's adjuvant (CFA) injection; GL, animals with arthritis treated with LLL; GH, animals with arthritis treated with HMWSH; and GHL, animals with arthritis treated with LLL and HMWSH. All experiments occurred in the left TMJ. The right TMJs in GA were used as controls (GC). Morphological analysis were performed using slices stained with hematoxylin-eosin (HE), toluidine blue and Picrosirius. Histomorphometric analysis and quantification of birefringence collagen fibers (polarization microscopy) were performed on the articular disc. The biochemical analysis of the TMJ tissues were performed by dosing sulfated glycosaminoglycans (GAGs) and zymography to assess the matrix metalloproteinases (MMP) 2 and 9. Data were statistically analyzed using the one-way ANOVA test with the Tukey's post hoc test and Kruskal-Wallis test followed by the Dunn's post hoc test. GA exhibited marked morphological changes in the components of the TMJ such as thickness of the joint disk; hyperplasia of the synovial membrane and pannus formation; bone resorption of mandibular fossa; flattening of the mandibular condyle and the presence of intense inflammatory infiltrate of mononuclear cells in the subsynovial tissue. The polarization microscopy showed lower birefringence of collagen fibers, indicating a high degree of collagen fibers disorganization. The GL, GH and GHL showed narrower articular disc and higher birefringence of collagen fibers compared to GA (p<0,05). In biochemical analysis, it was demonstrated that the concentration of GAGs and MMP-2 and MMP-9 activities were statistically higher in GA compared to GC (p<0,05). The GL, GH and GHL showed lower activity of the active isoform of MMP-2 and MMP-9 in comparison to GA (p<0,05). Based on the results, it is concluded that The LLL and HMWSH demonstrated anti-inflammatory and protective effects on joint structures. Therapy with concurrent use of LLL and HMWSH was not superior to the respective single treatments / Mestrado / Anatomia / Mestre em Biologia Celular e Estrutural

The main goal of this diploma thesis is to determine the role of hyaluron acid and phospholipids on friction and lubrication of articular cartilage in regard to optimization of viscosupplements. This is carried out by measuring the coefficient of friction of the articular cartilage with several lubricants. Cartilage is lubricated particularly by a conventional viscosuplement, optimized viscosuplementation with phospholipids and model synovial fluid. In order to observe the function of those viscosuplements in the human body, both are mixed with the model synovial fluid, ubiquitous in human joints, in given ratio. Experiments revealed high friction when it comes to convectional viscosupplementation as opposed to low friction of the optimized viscosuplement with phospholipids. The same situation occurs when cartilage is lubricated with those viscosuplements mixed with model synovial fluid which might lead to development of a new, better, viscosupplementation based on hyaluron acid and phospholipids.

Disertační práce se zabývá experimentálním studiem viskosuplementů na bázi kyseliny hyaluronové, které se aplikují do synoviálních kloubů postižených osteoartrózou. Hlavní pozornost byla věnována objasnění vlivu koncentrace a molekulové hmotnosti kyseliny hyaluronové na tření v kontaktu kloubí chrupavky resp. změnám tření v kontaktu po smíchání osteoartritické synoviální kapaliny s exogenní kyselinou hyaluronovou. Důležitou součástí experimentů bylo rovněž studium reologických vlastností synoviální kapaliny a kyseliny hyaluronové. Výsledky ukázaly, že molekulová hmotnost kyseliny hyaluronové významně ovlivňuje viskozitu a viskoelastické vlastnosti roztoku. Výrazná závislost mezi reologickými vlastnostmi kyseliny hyaluronové a třením v kontaktu však nebyla pozorována. Přimíchání kyseliny hyaluronové do synoviální kapaliny způsobí výrazný pokles součinitele tření v kontaktu. Rozdíly mezi viskosuplementy obsahující kyselinu hyaluronovou s různou molekulovou hmotností ale nijak výrazné nejsou. Nicméně, výsledky poukazují na možné ovlivnění režimu mazání v důsledku vysoké molekulové hmotnosti kyseliny hyaluronové. Tyto původní výsledky rozšiřují pochopení mechanizmů, ke kterým dochází v kloubu bezprostředně do vstříknutí kyseliny hyaluronové a mohou být použity při dalším vývoji viskosuplementů či v klinické praxi.

O presente estudo destinou-se a avaliar se os resultados clínicos iniciais da viscossuplementação poderiam ser melhorados com a adição de corticosteróide. As injeções intra-articulares são usadas há muitos anos no tratamento da osteoartrite dos joelhos, principalmente com suspensões cristalinas de corticosteróides. A viscossuplementação é uma intervenção relativamente nova, atualmente recomendada no tratamento da osteoartrite. Trata-se da injeção de ácido hialurônico exógeno em articulações diartrodiais, visando, além de restaurar as propriedades reológicas do líquido sinovial, efeitos modificadores da doença osteoartrite. Revisões sistemáticas mostram que a melhora clínica ocorre em duas a cinco semanas após a viscossuplementação. Comparando-se a viscossuplementação com a injeção intraarticular com corticosteróides, dados recentes sugerem maior eficiência no alívio da dor nas quatro primeiras semanas após a infiltração com corticosteróides, similaridade dos procedimentos ao redor da quarta semana e melhores resultados com a viscossuplementação após a oitava semana. Este inicio de ação mais tardio, associado a relatos de sinovite reacional após a viscossuplementação podem desencorajar médicos e pacientes ao uso desta modalidade de tratamento. No presente estudo foram avaliados 104 pacientes em tratamento para osteoartrite do joelho no grupo de doenças osteometabólicas do Instituto de Ortopedia do Hospital das Clínicas da FMUSP. Os pacientes foram randomizados em dois grupos. Um dos grupos foi denominado VS e recebeu uma única injeção intra-articular de 6ml de Hylan GF-20 (Synvisc One®-Genzyme) no joelho estudado. O segundo grupo foi denominado VS+T e recebeu uma injeção intra-articular de 6ml de Hylan GF-20 (Synvisc One®-Genzyme) mais 1ml (20mg) de Hexacetonido de Triancinolona (Triancil®-Apsen). Foram aplicados a escala visual analógica de dor (EVA) e os questionários de WOMAC e Lequesne uma semana antes da injeção e após uma, quatro, 12 e 24 semanas. Os dois grupos com 52 pacientes cada eram homogêneos. Na primeira semana, o WOMAC e a EVA apresentaram melhores resultados no Grupo VS+T (p < 0,01) em relação ao Grupo VS. Na quarta semana não houve diferença entre os grupos. Ambos apresentaram resultados similares nas semanas 12 e 24. Concluiu-se que a adição de hexacetonido de triancinolona melhorou os resultados clínicos da viscossuplementação no curto prazo, sem interferir nos resultados a longo prazo ou na incidência de efeitos adversos / The present study aims to assess if the initial results of viscosupplementation can be improved by the addition of corticosteroid. Intraarticular injections have been used for many years to treat arthritis and other painful articular disorders, mainly using long-lasting crystalline corticosteroid suspensions. Viscosupplementation is a relatively new intervention that is now widely used and recommended for the treatment of knee osteoarthritis. It is comprised of the injection of exogenous hyaluronic acid in diarthrodial joints, in order to restore the rheological properties of synovial fluid and also to promote osteoarthritis disease-modifying effects. Several placebo-controlled studies reported that clinical improvement began only within two to five weeks after viscosupplementation. When comparing viscosupplementation versus intraarticular injection of corticosteroid, recent data suggest that from baseline to week four, intraarticular steroid were more effective for pain relief. By the fourth week, however, both provided similar relief, but beyond the eighth week, hyaluronic acid provided greater pain reduction. The mechanism of action of hyaluronic acid, with delayed onset of pain/functional improvement, combined with reports of reactional sinovitis may discourage physicians and patients regarding this treatment modality. The present study evaluated 104 patients receiving usual care for knee osteoarthritis at the University of São Paulo Medical Center. Patients were randomized to receive either a single intra-articular injection of 6ml of Hylan GF-20 (Synvisc One®-Genzyme) (Group VS) or a single intra-articular injection of 6ml of Hylan GF-20 (Synvisc One®-Genzyme) plus 1ml (20mg) of Triamcinolone Hexacetonide (Triancil®-Apsen) (Group VS+T). VAS, WOMAC and Lequesne questionnaires were applied one week prior the injection, and after one, four, 12 and 24 weeks. The two groups with 52 patients each were homogeneous. At week one, WOMAC and VAS showed better results for Group VS+T compared to Group VS (p < 0,05). At week four the scores did not show statistically significant differences. The groups showed similar results at weeks 12 and 24. In conclusion, the addition of triamcinolone improved first-week symptom and functional scores of viscosupplementation, but not beyond. It did not seem to alter the likelihood of adverse effects

O presente estudo destinou-se a avaliar se os resultados clínicos iniciais da viscossuplementação poderiam ser melhorados com a adição de corticosteróide. As injeções intra-articulares são usadas há muitos anos no tratamento da osteoartrite dos joelhos, principalmente com suspensões cristalinas de corticosteróides. A viscossuplementação é uma intervenção relativamente nova, atualmente recomendada no tratamento da osteoartrite. Trata-se da injeção de ácido hialurônico exógeno em articulações diartrodiais, visando, além de restaurar as propriedades reológicas do líquido sinovial, efeitos modificadores da doença osteoartrite. Revisões sistemáticas mostram que a melhora clínica ocorre em duas a cinco semanas após a viscossuplementação. Comparando-se a viscossuplementação com a injeção intraarticular com corticosteróides, dados recentes sugerem maior eficiência no alívio da dor nas quatro primeiras semanas após a infiltração com corticosteróides, similaridade dos procedimentos ao redor da quarta semana e melhores resultados com a viscossuplementação após a oitava semana. Este inicio de ação mais tardio, associado a relatos de sinovite reacional após a viscossuplementação podem desencorajar médicos e pacientes ao uso desta modalidade de tratamento. No presente estudo foram avaliados 104 pacientes em tratamento para osteoartrite do joelho no grupo de doenças osteometabólicas do Instituto de Ortopedia do Hospital das Clínicas da FMUSP. Os pacientes foram randomizados em dois grupos. Um dos grupos foi denominado VS e recebeu uma única injeção intra-articular de 6ml de Hylan GF-20 (Synvisc One®-Genzyme) no joelho estudado. O segundo grupo foi denominado VS+T e recebeu uma injeção intra-articular de 6ml de Hylan GF-20 (Synvisc One®-Genzyme) mais 1ml (20mg) de Hexacetonido de Triancinolona (Triancil®-Apsen). Foram aplicados a escala visual analógica de dor (EVA) e os questionários de WOMAC e Lequesne uma semana antes da injeção e após uma, quatro, 12 e 24 semanas. Os dois grupos com 52 pacientes cada eram homogêneos. Na primeira semana, o WOMAC e a EVA apresentaram melhores resultados no Grupo VS+T (p < 0,01) em relação ao Grupo VS. Na quarta semana não houve diferença entre os grupos. Ambos apresentaram resultados similares nas semanas 12 e 24. Concluiu-se que a adição de hexacetonido de triancinolona melhorou os resultados clínicos da viscossuplementação no curto prazo, sem interferir nos resultados a longo prazo ou na incidência de efeitos adversos / The present study aims to assess if the initial results of viscosupplementation can be improved by the addition of corticosteroid. Intraarticular injections have been used for many years to treat arthritis and other painful articular disorders, mainly using long-lasting crystalline corticosteroid suspensions. Viscosupplementation is a relatively new intervention that is now widely used and recommended for the treatment of knee osteoarthritis. It is comprised of the injection of exogenous hyaluronic acid in diarthrodial joints, in order to restore the rheological properties of synovial fluid and also to promote osteoarthritis disease-modifying effects. Several placebo-controlled studies reported that clinical improvement began only within two to five weeks after viscosupplementation. When comparing viscosupplementation versus intraarticular injection of corticosteroid, recent data suggest that from baseline to week four, intraarticular steroid were more effective for pain relief. By the fourth week, however, both provided similar relief, but beyond the eighth week, hyaluronic acid provided greater pain reduction. The mechanism of action of hyaluronic acid, with delayed onset of pain/functional improvement, combined with reports of reactional sinovitis may discourage physicians and patients regarding this treatment modality. The present study evaluated 104 patients receiving usual care for knee osteoarthritis at the University of São Paulo Medical Center. Patients were randomized to receive either a single intra-articular injection of 6ml of Hylan GF-20 (Synvisc One®-Genzyme) (Group VS) or a single intra-articular injection of 6ml of Hylan GF-20 (Synvisc One®-Genzyme) plus 1ml (20mg) of Triamcinolone Hexacetonide (Triancil®-Apsen) (Group VS+T). VAS, WOMAC and Lequesne questionnaires were applied one week prior the injection, and after one, four, 12 and 24 weeks. The two groups with 52 patients each were homogeneous. At week one, WOMAC and VAS showed better results for Group VS+T compared to Group VS (p < 0,05). At week four the scores did not show statistically significant differences. The groups showed similar results at weeks 12 and 24. In conclusion, the addition of triamcinolone improved first-week symptom and functional scores of viscosupplementation, but not beyond. It did not seem to alter the likelihood of adverse effects