Les cellules Natural Killer (NK), actrices majeures de la vigilance anti-tumorale, sont modulées par des facteurs nutritionnels et métaboliques. L'inhibition de leur activité favorise le développement tumoral. Un régime alimentaire hypercalorique induisant l'obésité est un facteur de risque de développer un cancer du sein. Au niveau du micro-environnement tumoral mammaire, la biodisponibilité en certaines molécules contrôle non seulement les cellules néoplasiques mais, également les cellules immunes infiltrées. Ainsi, la leptine, sécrétée à forte concentration par les adipocytes mammaires, pourrait favoriser la croissance tumorale et altérer les cellules NK. L'arginine fortement consommée par les cellules tumorales et les cellules suppresseurs dérivées des myéloïdes pourrait faire défaut aux cellules NK. L'objectif de cette thèse est de caractériser les activités fonctionnelles et métaboliques des cellules NK en situation de stress nutritionnel. Dans un premier temps, nous avons exploré, in vivo, l'impact d'un régime hypercalorique sur l'activité des cellules NK et sur le développement tumoral mammaire. Ensuite, nous avons cherché à identifier les potentielles altérations fonctionnelles des cellules NK en mimant, in vitro, les conditions retrouvées au niveau du micro-environnement tumoral telles que la présence de concentration élevée en leptine et la déplétion en arginine. Des souris Balb-c "nude" femelles ont été soumises à un régime hypercalorique (HC) versus une diète normo-calorique (NC) pendant 6 mois. Au bout de 5 mois, des cellules tumorales mammaires (MCF-7 ; groupes NCT et HCT) ou le véhicule (groupes NC et HC) ont été implantés au niveau de la quatrième paire de glandes mammaires. Sous régime HC, le développement tumoral s'accompagne d'une perte de masse grasse, de masse maigre et de poids corporel avec un volume et un poids de tumeur augmentés. Cette diète induit au niveau tumoral une sur-expression des ARNm d'enzymes impliquées dans la glycolyse et une sous-expression des acteurs du cycle de Krebs. Sous régime HC, l'expression de la caspase 3 clivée et des récepteurs des oestrogènes β et de la progestérone est réduite alors que celle du Ki67 est accrue. Les cellules NK des souris HC ont une cytotoxicité diminuée. Bien que la présence de tumeur stimule l'activité lytique des cellules NK, la cytotoxicité de ces cellules reste inférieure dans le groupe HCT comparativement à celle du groupe NCT. La leptine stimule, in vitro, de façon dose-dépendante l'activité métabolique des cellules NK. A fortes concentrations, elle active leur cytotoxicité vis-à-vis des cellules cibles MDA-MB-231. Cet effet passe par une stimulation de l'expression de TRAIL et de l'IFN-γ par les cellules NK. En revanche, vis-à-vis des cellules cibles MCF7, les cellules NK présentent une activité lytique réduite en présence de fortes concentrations de leptine, probablement en lien avec une réduction de l'expression de la perforine. En réponse à une déplétion en arginine dans le milieu de culture, la prolifération et la cytotoxicité des cellules NK sont abaissées. L'altération de la reconnaissance des cellules cibles par les récepteurs NKp46 et NKp30, la moindre transmission du signal activateur par la chaine ζ et la faible production d'IFN-γ peuvent expliquer l'inhibition de la cytotoxicité des cellules NK. Ainsi, un apport énergétique élevé favorise le développement tumoral mammaire notamment eninhibant la cytotoxicité des cellules NK. De plus, la leptine à fortes concentrations stimule ou réduit, in vitro, la cytotoxicité des cellules NK selon la nature des cellules cancéreuses mammaires cibles. Une déplétion en arginine, in vitro, quant à elle, inhibe la prolifération et la cytotoxicité des cellules NK. Ces travaux contribuent à mieux comprendre l'impact du micro-environnement sur la réponse antitumorale des cellules NK. / Natural killer (NK) cells are critical mediators of anti-tumor immunity. A high-calorie diet inducing obesity is associated with breast cancer development. NK cells are modulated by dietary and metabolic factors and a decrease in their lytic activity promotes mammary tumor development. In the breast microenvironment, high concentration of leptin can be secreted by mammary adipocytes and thereby could stimulate tumor growth and control immune cells. Arginine, strongly consumed by tumor and myeloid-derived suppressor cells, could be lacking to NK cells. The aim of this work is to characterize the functional and metabolic activities of NK cells in response to nutritional stress. Initially, we explored in vivo the impact of a high-calorie diet on NK cells activity and mammary tumor development. Then, we identified potential functional alterations in NK cells by mimicking the conditions found in the tumor microenvironment such as the presence of high leptin concentration and arginine depletion. Female Balb-c nude mice were fed a high-caloric diet (HC) versus a standard caloric diet (SC) for 6 months. After five months, mammary tumor cells (MCF-7, SCT, HCT) or MatrigelTM (SC, HC) were implanted into the fourth mammary fat pads. The tumor development in HC diet-fed mice was associated with a decrease in body weight, body fat and lean mass and an increase in volume and weight of tumors. This diet induced tumor over-expression, at the transcriptional level, of enzymes involved in glycolysis and a down-expression of citrate cycle actors. Protein tumor levels of cleaved caspase 3, estrogen β and progesterone receptors were reduced while Ki67 was increased in the HC diet-fed mice. NK cell cytotoxicity of HC diet-fed mice was reduced. Although the presence of tumor stimulated NK cell lytic activity, this later was lower in the HCT group compared to the one of SCT mice. In vitro, leptin stimulated, in dose-dependent manner, the metabolic activity of NK cells. High leptin concentrations enhanced NK cell cytotoxicity against the MDA-MB-231 target cells. This phenomenon involved the increase of expression of TRAIL and IFN-γ in NK cells. However, against the MCF-7 target cells, NK cell lytic activity was reduced in the presence of high concentrations of leptin, probably in link to the decreased perforin expression. NK cell proliferation and cytotoxicity were impaired in response to arginine depletion. This inhibition of NK cell cytotoxicity could be linked to a low target cells recognition by NKp46 and NKp30, a reduced activating signal transmission by ζ chain and a low production of IFN-γ. Thus, high energy intake promotes mammary tumor development in particular by inhibiting NK cell cytotoxicity. In vitro, high leptin concentrations stimulate or reduce NK cell cytotoxicity according to the breast cancer cell targets. Furthermore, arginine depletion inhibits NK cell proliferation and cytotoxicity in vitro. These findings provide insight into the microenvironment impacts on NK cell antitumor response in tumor development.

Les métastases hépatiques de tumeurs endocrines digestives sont hypervasculaires et hétérogènes. Les mécanismes de développement de ces métastases hépatiques, en particulier le rôle de l’angiogenèse tumorale associée à ces tumeurs, sont complexes. Ceci explique la difficulté de prédire le profil évolutif de ces tumeurs et de trouver des facteurs prédictifs de réponses aux traitements médicaux utilisés. L’objectif de notre travail a été de mieux comprendre : le rôle de l’angiogenèse dans le développement des métastases hépatiques de tumeurs endocrines digestives ; les mécanismes d’actions et en particulier leur activité anti-angiogénique, de deux types de molécules (analogue de la somatostatine et inhibiteur de mTOR). Nos résultats nous ont permis à travers une double approche expérimentale, in vitro et in vivo de : (a) montrer la complexité de la régulation de la synthèse et de la sécrétion du VEGF par les cellules endocrines néoplasiques ; (b) confirmer expérimentalement la dissociation entre expression du VEGF et capacités angiogéniques d’une part, propriétés invasives et métastatiques d’autre part, dans les tumeurs endocrines digestives ; (c) montrer expérimentalement que l’inhibition de l’angiogenèse peut contribuer à l’effet anti-tumoral de substances d’intérêt thérapeutique dans les tumeurs endocrines digestives / Liver metastases of digestive endocrine tumors are hypervascular and heterogeneous. The mechanisms of development of these metastases, especially the role of angiogenesis, are complex. This explains the difficulty to predict the natural history of these tumors and to find predictive factors of response to medical treatments. Our aim was to evaluate: the role of angiogenesis in the development of liver metastasis from digestive endocrine tumors; mechanisms of action, especially antiangiogenic activity, of two drugs (somatostatin analogues and mTOR inhibitor). We were able to demonstrate through an in vitro and in vivo experimental approach that: (a) the regulation of VEGF synthesis and secretion is complex, with different roles according to the cell studied; (b) there is a dissociation between VEGF expression and angiogenic capacities, on one hand, and invasive and metastatic properties, on the other hand; (c) the inhibition of angiogenesis may contribute to the anti-tumoral effect of several drugs of therapeutic interest in digestive endocrine tumors

A regeneração óssea guiada é usada na reparação de defeitos ósseos com suficiente evidência de sucesso. Dentro desta técnica, os xenoenxertos são uma boa opção devido as suas características e segurança para o paciente. Todavia, estudos para melhorar as propriedades dos substitutos ósseos para a formação adequada de novo osso são constantes. Os bisfosfonatos (BPs) são análogos sintéticos dos pirofosfatos, constituem a primeira linha de tratamento para algumas desordens ósseas e tem sido utilizado com sucesso para reduzir o risco de fratura e melhorar a qualidade de vida dos pacientes. Os efeitos adversos e benefícios dos BPs são amplamente estudados. Está comprovado que os BPs inibem a reabsorção óssea reduzindo a atividade dos osteoclastos, mas também que as células osteoblásticas na presença de BPs que contêm nitrogênio aumentam sua proliferação e sua diferenciação na linhagem osteoblástica, promovendo mineralização além de inibir a apoptose de osteócitos e osteoblastos. Neste trabalho estudou-se o efeito do alendronato administrado local e sistemicamente na regeneração óssea com xenoenxerto porcino em ratos com defeitos críticos no osso parietal. Foram usados sessenta ratos Wistar albinos, distribuídos em três grupos (n=20), sendo que o grupo controle (GC) teve o defeito tratado apenas com xenoenxerto, o grupo experimental XE-ALNL que recebeu o xenoenxerto previamente hidratado com alendronato sódico, e o terceiro grupo, XE-ALNS, recebeu xenoenxerto com administração sistêmica diária de alendronato. As amostras foram fixadas, descalcificadas e processadas para análise histológica em microscopia de luz, histoquímica para fosfatase ácida tartarato-resistente (TRAP), e imuno-histoquímica para osteopontina (OPN). Determinou-se que o uso de alendronato potencializa a formação de novo osso. O que pode ser explicado pelo efeito conservador do alendronato no xenoenxerto prolongando seu efeito osteocondutor. Os resultados do grupo XE-ALNL mostraram que o efeito do alendronato sódico usado na hidratação do xenoenxerto colocado no defeito provocou uma maior formação de novo osso primário, tanto ao redor das bordas que limitavam o defeito como dos grânulos de xenoenxerto, quando comparado ao GC e ao grupo XE-ALNS, para os dois períodos avaliados (30 e 60 dias). Ainda que no grupo XE-ALNS nas amostras avaliadas para o período de 30 dias seu padrão foi similar ao GC, no período de 60 dias se observou maior quantidade de osso novo em relação ao GC no mesmo período. A presença de tecido conjuntivo com suas fibras colágenas entre os grânulos do xenoenxerto foi confirmada com a coloração de tricrômico de Mallory. A imunomarcação de OPN mostrou as áreas de osso primário formadas, bem como a presença de algumas linhas cimentantes. A escassa presença de osteoclastos evidenciou a baixa taxa de reabsorção dos grânulos do xenoenxerto nos períodos avaliados. / Guided bone regeneration is used in treatment for repairing bone defects with proven evidence of success. Within this technique, xenografts are a good alternative because of its characteristics and safety for the patient; however, studies aiming to enhance the properties of bone substitutes for proper formation of new bone is continuous. Bisphosphonates (BPs) are synthetic analogues of pyrophosphates, they represent the first line of treatment for some bone disorders. They have been successfully used to reduce the risk of fracture and improve the quality of life for patients, its adverse effects and benefits are widely studied. It has been established that BPs inhibit bone resorption by reducing osteoclast activity but also that osteoblastic cells in the presence of nitrogen-containing BPs increase their proliferation and differentiation in the osteoblastic lineage, inducing mineralization, and inhibiting apoptosis of osteocytes and osteoblasts. This study investigated the effect of alendronate administered locally and systemically on bone regeneration with porcine xenograft in rats with critical defects (5 mm in diameter) made in the parietal bone. Sixty Wistar albino rats were divided into three groups (n=20): control group (CG) with defect treated only with xenograft, XE-ALNL group received xenograft previously hydrated in 1 mg/ml of alendronate sodium, and the third group, XE-ALNS, received xenograft with daily systemic administration of alendronate (2.5 mg / kg). Each experimental group was randomly divided into two sub-groups (n=10): in the first sub-group of each experimental group the animals were sacrificed after 30 days and in the second after 60 days. The samples were fixed, decalcified and processed for light microscopic analysis, histochemistry for tartrate-resistance acid phosphatase (TRAP), and immunohistochemistry for osteopontin (OPN). The results of the XE-ALNL group showed that the effect of sodium alendronate used in the hydration of the xenograft placed in the defect caused a superior formation of new primary bone, both around the edges that limited the defect and the xenograft granules, when compared to CG and the XE-ALNS groups, for both periods of 30 and 60 days. For the XE-ALNS group even though smaller amount of primary bone was formed when compared to XE-ALNL at 30 and 60 days, its pattern was similar to the CG at 30 days; however, for the 60 days sub-group a greater amount of new bone was observed when compared to the CG in the same period. The presence of connective tissue with its collagen fibers between the granules of the xenograft was confirmed with Mallory\'s trichrome staining. The OPN immunolabeling showed the areas of primary bone formed, as well as the presence of cement lines. The low osteoclast presence indicated a low rate of xenografts reabsorption in the evaluated periods.

Em procedimentos de regeneração óssea guiada (ROG) as membranas de colágeno são os materiais mais utilizados como barreira; porém, sua tendência ao colapso faz indispensável a utilização de materiais de suporte. Para este propósito, os xenoenxertos são substitutos ósseos considerados padrão-ouro, embora apresentem um período longo de reabsorção que impede grande formação do osso. Em contrapartida o ?-fosfato tricálcico (?-TCP) permite boa formação do osso, mas é reabsorvido rapidamente e fracassa quando precisa dar suporte à membrana. O alendronato, um bisfosfonato nitrogenado, é uma droga antirreabsortiva para o tratamento da osteoporose e outras doenças ósseas porque inibe a função dos osteoclastos. O plasma rico em fibrina (PRF) é um concentrado de fibrina sem adição de químicos que consegue estimular processos de cicatrização pelos fatores que fazem parte de sua composição. Neste estudo qualitativo de ROG em defeitos de 5 mm no osso parietal de ratos foi avaliado: 1) o efeito na formação óssea da administração local de 1g/ml de alendronato sódico adicionado a xenoenxerto porcino e a ?-TCP; 2) a adição local de alendronato e PRF a ?-TCP na possibilidade de diminuir a rápida reabsorção do material e impedir o colapso da membrana. Foram usados 100 ratos adultos Wistar distribuídos em 5 grupos (n=20): Xenoenxerto controle (XE-C); xenoenxerto adicionado com alendronato (XE-AL); ?-TCP controle (TCP-C); ?-TCP adicionado com alendronato (TCP-AL); e, ?-TCP adicionado com PRF (TCP-F). Em todos os grupos o enxerto foi coberto com membrana. Dois tempos de estudo de quatro e oito semanas foram considerados para cada grupo (n=10). Ao final de cada tempo, os animais foram sacrificados e as amostras foram fixadas, descalcificadas e processadas para seu estudo em microscopia de luz por meio de análise histológica, histoquímica TRAP e imuno-histoquímica para osteopontina (OPN). Os resultados mostraram maior formação do osso tanto para xenoenxerto como para ?-TCP quando foram adicionados com alendronato local, em ambos tempos de estudo. Nos grupos do ?-TCP a adição de alendronato local permitiu diminuir a reabsorção dos grânulos, melhorando o suporte à membrana ao final dos tempos de estudo; no entanto, no grupo do PRF a reabsorção foi maior e teve pouca formação de osso, provocando colapso da membrana. Adicionalmente, regiões de osso primário subjacentes à membrana de colágeno foram observadas em todos os grupos. / Collagen membranes are the most used materials as a barrier in guided bone regeneration (GBR) procedures; however, its tendency to collapse makes indispensable the use of support materials. For this purpose, xenografts, which are bone substitutes, although they have a long period of resorption that prevents large bone formation, are still considered the gold standard support material. In contrast, tricalcium ?-phosphate (?-TCP) allows good bone formation, but is rapidly reabsorbed and fails when it needs to support the membrane. Alendronate, a nitrogenated bisphosphonate, is an anti-resorptive drug for treatment of osteoporosis and other bone diseases because it inhibits the function of osteoclasts. Fibrin-rich plasma (FRP) is a fibrin concentrate with no added chemicals that can stimulate healing processes by the factors that are part of its composition. In this qualitative study of ROG in 5 mm defects in the rat parietal bone, was evaluated: 1) the effect on bone formation of local administration of 1g / ml sodium alendronate added to porcine xenograft and ?-TCP; 2) the local addition of alendronate and PRF to ?-TCP in the possibility of diminishing the rapid reabsorption of the material and preventing the collapse of the membrane. A 100 adult Wistar rats distributed in 5 groups was used (n = 20): Xenograft control (XE-C); xenograft added with alendronate (XE-AL); ?-TCP control (TCP-C); ?-TCP added with alendronate (TCP-AL); and, ?-TCP added with PRF (TCP-F). In all groups the graft was covered with membrane. Two study times of four and eight weeks were considered for each group (n = 10). At the end of each time, the animals were sacrificed and the samples were fixed, decalcified and processed for light microscopy by histological analysis, TRAP histochemistry and immunohistochemistry for osteopontin (OPN). Results showed higher bone formation for both xenograft and ?-TCP when added with local alendronate at both study times. In the ?-TCP groups the addition of local alendronate allowed to decrease grain resorption, improving membrane support at the end of the study times; however, in the PRF group the resorption was greater and had little bone formation, causing membrane collapse. In addition, primary bone formed in the underlying collagen membrane were observed in all groups.

A reabsorção óssea alveolar associada as perdas dentais constitui uma condição inerente ao processo de cicatrização fisiológico natural. Técnicas como a instalação de implantes imediatos e técnicas de preservação alveolar têm sido sugeridas com o objetivo de limitar as alterações adversas sofridas pelo processo alveolar. Contudo, frequentemente as perdas dentárias estão associadas a infecções crônicas que tradicionalmente contraindicariam os procedimentos de enxerto ou implantes imediatos, a menos que meticulosos debridamento e irrigação alveolar associados a adequado protocolo antibiótico pré e pós-operatório sejam empregados. Alternativas precisam ser testadas para a substituição do uso indiscriminado de antibioticoterapia sistêmica. O objetivo do presente estudo foi avaliar o efeito da TFDa na descontaminação de alvéolos infectados previamente a instalação de implantes imediatos e na cicatrização de alvéolos pós-extração associados ou não ao uso de enxertos xenógeno através de análises microtomográficas e histomorfométricas. Para tanto, foram selecionados 8 cães, os quais foram submetidos a uma fase de indução de doença periodontal por ligadura, seguida por um período de estabelecimento da doença. Após a exodontia dos prémolares bilaterais, aleatoriamente os alvéolos de um lado da mandíbula foram descontaminados por debridamento mecânico associado a irrigação com solução salina (grupo controle) e do outro lado por debridamento mecânico e irrigação com solução salina associados a terapia fotodinâmica antimicrobiana (grupo teste), e subsequentemente submetidos a instalação de implantes imediatos, dando origem aos grupos GT-I (Grupo Teste - Implante) e GC-I (Grupo Controle - Implante). Os demais alvéolos, foram utilizados para o estudo da dinâmica de cicatrização alveolar. Os sítios foram aleatoriamente alocados em: GT-C (Grupo teste - Coágulo), GT-BO (Grupo Teste - Bio-Oss®), GT-BOC (Grupo Teste - Bio-Oss® Collagen), GC-C (Grupo Controle - Coágulo), GC-BO (Grupo Controle - Bio-Oss®) e GC-BOC (Grupo Controle - Bio-Oss® Collagen). Após 12 semanas, os cães foram sacrificados e as amostras processadas para as análises de microtomografia computadorizada, histologia e histomorfometria. Na avaliação da cicatrização dos alvéolos pós-extração, embora os alvéolos descontaminados com TFDa (GT-C, GT-BO, GT-BOC) tenham apresentado melhores resultados numéricos, em relação a altura da crista óssea vestibular (ACOV) e a dimensão buco-lingual (DBL), não foram evidenciadas diferenças relevantes na análise histomorfométrica. Apenas a ACOV, mensurada na avaliação microtomográfica bidimensional, demonstrou-se significativamente inferior nos alvéolos do grupo teste que não receberam material de enxerto (GT-C) quando comparados aos respectivos alvéolos do grupo controle (GC-C). Na avaliação dos implantes imediatos, a análise histomorfométrica dos parâmetros: reabsorção da crista óssea vestibular (RCOV) e contato osso implante (BIC) demonstrou resultados significantemente superiores no GT-I em relação ao GC-I, e do parâmetro densidade óssea (DO) demonstrou apenas resultado numericamente superior no GT-I em relação ao GC-I. Todas as análises microtomográficas bidimensionais (RCOV) e tridimensionais (volume ósseo BV, porcentagem óssea BV/TV, densidade de superfície óssea BS/TV, espessura trabecular Tb.TH, número de trabéculas Tb.N e separação trabecular Tb.SP) demonstraram resultados significantemente melhores nos implantes do grupo teste (GT-I) em relação aos implantes do grupo controle (GC-I). A TFDa demonstrou potencial como agente de descontaminação de alvéolos pósextração periodontalmente infectados, previamente a instalação de implantes imediatos e na cicatrização de alvéolos pós-extração associados ou não a materiais de enxerto xenógenos, sem o uso de antibioticoterapia sistêmica associada. / Alveolar bone resorption following tooth loss is an inherent condition of the natural healing process. Therefore, several techniques, such as immediate implants placement and post extraction socket preservation, have been suggested in order to limit the adverse changes suffered by the alveolar process. However, extraction sockets commonly results from the removal of teeth affected by chronic infection, which conventionally contraindicates immediate bone graft and implant placement unless meticulous wound debridement and alveolar irrigation associated to a suitable pre- and post-operatory antibiotic protocol are employed. Alternatives ought to be tested in order to substitute the indiscriminate use of systemic antibiotic therapy. The aim of the present study was to evaluate the effect of the antimicrobial photodynamic therapy (aPDT) in the decontamination of infected post extraction sockets, previously to immediate implant placement and in the healing of post extraction sockets associated or not to xenografts. In the first phase, periodontitis was induced with ligatures in the mandibular premolars of eight beagle dogs. After 2 months, in the second phase of the study the dogs had their mandibular bicuspids bilaterally extracted, and randomly one hemi-mandible was decontaminated by mechanic debridement associated to saline solution irrigation (Control Group - CG), and the other hemi-mandible was decontaminated with mechanic debridement and saline solution irrigation associated to antimicrobial photodynamic therapy (Test Group - TG). Thereafter, 3 immediate implants in each side of the mandible were placed and the following groups were devised: TG-I (Test Group - Implant) and CG-I (Control Group - Implant). The remaining sockets were used for the study of the healing dynamic. The sockets were randomly assigned to the following groups: Test Group - Blood clot (TG-BC), Test Group Bio- Oss® (TG-BO), TG - BOC (Test Group Bio-Oss® Collagen), Control Group - Blood Clot (CG-BC), Control Group - Bio-Oss® (CG-BO) and Control Group - Bio-Oss® Collagen (CG-BOC). After 12 weeks, the dogs were sacrificed and the specimens were processed for microtomographic, histological and histomorphometric analysis. When the post extraction healing process was evaluated, the aPDT decontaminated sockets (TG-BC, TG-BO and TG-BOC) presented better numerical results in comparison to both buccal bone crest height (BCL) and in the bucco-lingual dimension (BLD). However, there were no statistically differences among the groups for these parameters in the histomorphometric analysis. Only the BCL measured in the two-dimensional microtomographic analysis showed statistic better results in the TG-BC when compared to the CG-BC. In the evaluation of the immediate implant placement the histomorphometric analysis presented statistically better results for the TG-I in the bone-implant contact (BIC), as well as in the vertical buccal bone loss (VBBL). The bone density (BD) was numerically better in the TG-I than in the CG-I. Both two-dimensional (VBBL) and three-dimensional (bone volume BV, percentage of the total bone volume - BV/TV, bone surface density - BS/TV, trabecular thickness Tb.Th, trabecular separation Tb.Sp and trabecular number TB.N) microtomographic analysis showed statistically better results in the TG-I. The aPDT showed potential in the decontamination of infected post extraction sockets previously to immediate implant placement and in the healing of post extraction sockets associated or not to xenogeneic grafts, without the use of systemic antibiotics.

Neuartige Vakzinierungsstrategien zur Aktivierung einer Tumor-spezifischen zellulären Immunantwort sind vielversprechende Ansätze zur Therapie von Tumoren, insbesondere Human Papillomvirus (HPV)-assoziierte Tumore. Bisherige HPV-Impfstudien zeigen zwar die Aktivierung einer spezifischen zellulären Immunantwort, eine Tumorreduktion bleibt jedoch aus. Um diesen Effekt auf Immunzellebene zu definieren, wurde die Wirkung der HPV-Vakzine Ad p14 im Mausmodell und an Untersuchungsmaterial humaner Tumore analysiert. In Mäusen bildeten sich HPV+ TC1-Tumore einer frühen Entwicklungsphase nach Vakzinierung zurück. Tumore einer späten Entwicklungsphase wuchsen dagegen in zwei Intervallen aus. Immunologische Eigenschaften der Tumorzellen blieben dabei unverändert. Unterschiede zeigten sich in den Frequenzen Tumor-infiltrierender Lymphozyten; in progressiven Phasen wurden nur CD4+ T Zellen nachgewiesen, in Regressionsphasen zusätzlich zytotoxische CD8+ T Zellen. Immunmodulatoren, wie Interferon alpha oder DTA-1, einem Antikörper für den Glucocorticoid-induzierten Tumornekrosefaktor-Rezeptor, unterstützten die Wirkung der Vakzine; letzterer erhöhte die Anzahl zytotoxischer CD8+ T Zellen und führte zur Abstoßung der TC1-Tumore. HPV+ Tumorgewebe des Menschen, wie auch ihre Vorstufen, zeigten im Vergleich zu anderen Tumoren, wie Bronchial oder Kolonkarzinomen einen signifikant höheren Anteil an CD4+ und CD8+ T Zellen und an Forkhead Box P3+ regulatorischen T Zellen. Die Ergebnisse deuten darauf hin, dass die immunologischen Abläufe bei der Entwicklung HPV-assoziierter Tumore mit denen vorangeschrittener chronischer Erkrankungen vergleichbar sind, in denen sich CD4+ und CD8+ T Zellantworten erschöpfen während sich gleichzeitig immunsuppressive Mechanismen verstärken. Um die Entwicklung von Impfstoffen zur Therapie HPV-assoziierter Tumore zu verbessern sollten diese Mechanismen ausführlicher betrachtet werden. / Novel vaccination strategies, activating cellular tumour specific immune responses represent a promising approach for the treatment of cancer. Especially featured for these treatments are tumours evolving from chronic human papillomavirus (HPV) infections. But current strategies have not yet proved efficacious for complete tumour regression. Addressing cellular immunological aspects of tumour vaccination, this work focused on effects of HPV vaccine Ad p14 in mice and in samples of human tumours. In mice vaccination resulted in complete regression of early stage murine HPV+ TC1 tumours. Late stage TC1 tumours increased discontinuously. During that process, TC1 cells preserved their immunological characteristics. But frequencies of tumour-infiltrating lymphocytes varied; in progressing tumours only CD4+ T cells occurred, in temporary regressing tumours also CD8+ T cells were detected. Immune modulators, like interferon alpha or glucocorticoid-induced tumour necrosis factor receptor targeting antibody DTA-1 aggravated the effects of vaccination; latter raised cytotoxic CD8+ T cell numbers and resulted in complete tumour regression. Human HPV+ tumours as well as HPV+ precancerous stages revealed numbers of CD4+ and CD8+ T cells and especially of forkhead box P3+ regulatory T cells that were significantly increased compared to melanoma, bronchial or colon carcinoma. To assist further analysis of human HPV-associated cervical cancer and facilitate studies on therapeutic approaches, a humanized mouse model was established. The present work points to immunological exhaustion in the development of HPV-related tumours comparable to chronic diseases where CD4+ and CD8+ T cells exhaust and immunosuppression by regulatory T cells increases at the same time. For the development of appropriate strategies to enhance efficacy in HPV-associated tumour therapy, further knowledge of mechanisms involved in specific T cell activation, T cell exhaustion and immunosuppression is necessary.

A reabsorção óssea alveolar associada as perdas dentais constitui uma condição inerente ao processo de cicatrização fisiológico natural. Técnicas como a instalação de implantes imediatos e técnicas de preservação alveolar têm sido sugeridas com o objetivo de limitar as alterações adversas sofridas pelo processo alveolar. Contudo, frequentemente as perdas dentárias estão associadas a infecções crônicas que tradicionalmente contraindicariam os procedimentos de enxerto ou implantes imediatos, a menos que meticulosos debridamento e irrigação alveolar associados a adequado protocolo antibiótico pré e pós-operatório sejam empregados. Alternativas precisam ser testadas para a substituição do uso indiscriminado de antibioticoterapia sistêmica. O objetivo do presente estudo foi avaliar o efeito da TFDa na descontaminação de alvéolos infectados previamente a instalação de implantes imediatos e na cicatrização de alvéolos pós-extração associados ou não ao uso de enxertos xenógeno através de análises microtomográficas e histomorfométricas. Para tanto, foram selecionados 8 cães, os quais foram submetidos a uma fase de indução de doença periodontal por ligadura, seguida por um período de estabelecimento da doença. Após a exodontia dos prémolares bilaterais, aleatoriamente os alvéolos de um lado da mandíbula foram descontaminados por debridamento mecânico associado a irrigação com solução salina (grupo controle) e do outro lado por debridamento mecânico e irrigação com solução salina associados a terapia fotodinâmica antimicrobiana (grupo teste), e subsequentemente submetidos a instalação de implantes imediatos, dando origem aos grupos GT-I (Grupo Teste - Implante) e GC-I (Grupo Controle - Implante). Os demais alvéolos, foram utilizados para o estudo da dinâmica de cicatrização alveolar. Os sítios foram aleatoriamente alocados em: GT-C (Grupo teste - Coágulo), GT-BO (Grupo Teste - Bio-Oss®), GT-BOC (Grupo Teste - Bio-Oss® Collagen), GC-C (Grupo Controle - Coágulo), GC-BO (Grupo Controle - Bio-Oss®) e GC-BOC (Grupo Controle - Bio-Oss® Collagen). Após 12 semanas, os cães foram sacrificados e as amostras processadas para as análises de microtomografia computadorizada, histologia e histomorfometria. Na avaliação da cicatrização dos alvéolos pós-extração, embora os alvéolos descontaminados com TFDa (GT-C, GT-BO, GT-BOC) tenham apresentado melhores resultados numéricos, em relação a altura da crista óssea vestibular (ACOV) e a dimensão buco-lingual (DBL), não foram evidenciadas diferenças relevantes na análise histomorfométrica. Apenas a ACOV, mensurada na avaliação microtomográfica bidimensional, demonstrou-se significativamente inferior nos alvéolos do grupo teste que não receberam material de enxerto (GT-C) quando comparados aos respectivos alvéolos do grupo controle (GC-C). Na avaliação dos implantes imediatos, a análise histomorfométrica dos parâmetros: reabsorção da crista óssea vestibular (RCOV) e contato osso implante (BIC) demonstrou resultados significantemente superiores no GT-I em relação ao GC-I, e do parâmetro densidade óssea (DO) demonstrou apenas resultado numericamente superior no GT-I em relação ao GC-I. Todas as análises microtomográficas bidimensionais (RCOV) e tridimensionais (volume ósseo BV, porcentagem óssea BV/TV, densidade de superfície óssea BS/TV, espessura trabecular Tb.TH, número de trabéculas Tb.N e separação trabecular Tb.SP) demonstraram resultados significantemente melhores nos implantes do grupo teste (GT-I) em relação aos implantes do grupo controle (GC-I). A TFDa demonstrou potencial como agente de descontaminação de alvéolos pósextração periodontalmente infectados, previamente a instalação de implantes imediatos e na cicatrização de alvéolos pós-extração associados ou não a materiais de enxerto xenógenos, sem o uso de antibioticoterapia sistêmica associada. / Alveolar bone resorption following tooth loss is an inherent condition of the natural healing process. Therefore, several techniques, such as immediate implants placement and post extraction socket preservation, have been suggested in order to limit the adverse changes suffered by the alveolar process. However, extraction sockets commonly results from the removal of teeth affected by chronic infection, which conventionally contraindicates immediate bone graft and implant placement unless meticulous wound debridement and alveolar irrigation associated to a suitable pre- and post-operatory antibiotic protocol are employed. Alternatives ought to be tested in order to substitute the indiscriminate use of systemic antibiotic therapy. The aim of the present study was to evaluate the effect of the antimicrobial photodynamic therapy (aPDT) in the decontamination of infected post extraction sockets, previously to immediate implant placement and in the healing of post extraction sockets associated or not to xenografts. In the first phase, periodontitis was induced with ligatures in the mandibular premolars of eight beagle dogs. After 2 months, in the second phase of the study the dogs had their mandibular bicuspids bilaterally extracted, and randomly one hemi-mandible was decontaminated by mechanic debridement associated to saline solution irrigation (Control Group - CG), and the other hemi-mandible was decontaminated with mechanic debridement and saline solution irrigation associated to antimicrobial photodynamic therapy (Test Group - TG). Thereafter, 3 immediate implants in each side of the mandible were placed and the following groups were devised: TG-I (Test Group - Implant) and CG-I (Control Group - Implant). The remaining sockets were used for the study of the healing dynamic. The sockets were randomly assigned to the following groups: Test Group - Blood clot (TG-BC), Test Group Bio- Oss® (TG-BO), TG - BOC (Test Group Bio-Oss® Collagen), Control Group - Blood Clot (CG-BC), Control Group - Bio-Oss® (CG-BO) and Control Group - Bio-Oss® Collagen (CG-BOC). After 12 weeks, the dogs were sacrificed and the specimens were processed for microtomographic, histological and histomorphometric analysis. When the post extraction healing process was evaluated, the aPDT decontaminated sockets (TG-BC, TG-BO and TG-BOC) presented better numerical results in comparison to both buccal bone crest height (BCL) and in the bucco-lingual dimension (BLD). However, there were no statistically differences among the groups for these parameters in the histomorphometric analysis. Only the BCL measured in the two-dimensional microtomographic analysis showed statistic better results in the TG-BC when compared to the CG-BC. In the evaluation of the immediate implant placement the histomorphometric analysis presented statistically better results for the TG-I in the bone-implant contact (BIC), as well as in the vertical buccal bone loss (VBBL). The bone density (BD) was numerically better in the TG-I than in the CG-I. Both two-dimensional (VBBL) and three-dimensional (bone volume BV, percentage of the total bone volume - BV/TV, bone surface density - BS/TV, trabecular thickness Tb.Th, trabecular separation Tb.Sp and trabecular number TB.N) microtomographic analysis showed statistically better results in the TG-I. The aPDT showed potential in the decontamination of infected post extraction sockets previously to immediate implant placement and in the healing of post extraction sockets associated or not to xenogeneic grafts, without the use of systemic antibiotics.

La mise en place de la lignée germinale au cours du développement constitue une des étapes fondamentales conditionnant la fertilité de l’individu adulte. Au cours des dernières décennies, le nombre croissant de couples consultant pour une aide médicale à la procréation a fait émerger l’hypothèse d’une altération des fonctions de reproduction chez l’Homme qui pourrait trouver son origine dans la perturbation du développement précoce. Dans l’ovaire fœtal, les cellules germinales s’orienteront vers la voie de l’ovogénèse, caractérisée entre autres par l’entrée en méiose de ces cellules. La majorité des données actuelles relatives à ces évènements sont issues du modèle murin alors que le développement de l’ovaire humain est significativement diffèrent de celui de la souris. Il est donc nécessaire d’approfondir nos connaissances du développement ovarien humain et d’identifier ses éventuelles perturbations. L’objectif de mon travail a été de mettre au point un outil d’étude du développement ovarien et d’identifier de nouvelles voies impliquées dans la régulation de l’entrée en méiose des cellules germinales fœtales humaines et leurs perturbations éventuelles.Nous avons mis au point un nouveau modèle de xénogreffe d’ovaires fœtaux humains du premier trimestre de gestation (au moment de l’apparition des premières cellules méiotiques). Ce modèle nous a permis d’observer un développement de l’organe et une différenciation des cellules germinales similaires à ceux observés in vivo. Ce modèle permettra des travaux à des âges auxquels le matériel d’étude est peu accessible. En couplant ce modèle de xénogreffe à une stratégie d’ARN-interférence, il nous a été possible d’inhiber l’expression d’un gène spécifiquement exprimé dans les cellules germinales ovariennes, DMRTA2, et de mettre en évidence un potentiel rôle de ce gène dans leur différenciation pré-méiotique. Nous avons observé une diminution du nombre de cellules ayant initié la méiose après inhibition de l’expression de ce gène. Par ailleurs, nous avons également identifié la présence dans l’ovaire fœtal de nombreux marqueurs décrits comme testiculaires chez la souris (PLZF, DNMT3L, FGF9, NANOS2 ou CYP26B1). L’expression de ces marqueurs pourrait expliquer la présence de cellules mitotiques tardives dans l’ovaire fœtal humain que nous avons pu observer jusqu’à 30 semaines de gestation. En parallèle de ces travaux, nous avons testé la sensibilité des cellules germinales à la dexaméthasone, glucocorticoïde pouvant être administré au cours de la grossesse. Il a été observé une augmentation de l’expression de PLZF, gène cible de l’activation des récepteurs aux glucocorticoïdes, pouvant expliquer la diminution du nombre de cellules germinales.En conclusion, ce travail de thèse a permis d’identifier un nouveau gène potentiellement régulateur de la transition mitose/méiose dans l’ovaire humain, et d’affiner nos connaissances sur le développement de l’ovaire humain et l’entrée en méiose des cellules germinales. Toutefois, de nombreuses questions restent posées ainsi de futures études devront clarifier si les cellules germinales mitotiques observées à des stades tardifs sont capables de se différencier en ovocytes compétents. / Woman fertility is partially dictated by the set up of the human female germ line. During the last ten years, which saw an increased number of couples consulting for assisted reproductive cares, the hypothesis of an early alteration in reproduction functions has emerged.In the fetal ovary, germ cells enter the path of oogenesis differentiation characterized by meiotic initiation. On this subject, vast majority of the scientific data are obtained from the mouse model, even if differences with human ovarian physiology are widely acknowledged. Therefore it is necessary to extend our knowledge on human ovarian development and identify its perturbations. The objective of my work was to assess a new model to study ovarian growth, studying regulation of meiotic entry and perturbation of germ line differentiation.We sat up a new xenograft model of early human fetal ovaries, when very early meiotic germ cells appear. Organ growth and germ cells differentiation were comparable with in vivo observations. Using this model with an RNA-interference strategy, we inhibited the expression of an oogonia germ cell gene, DMRTA2. This inhibition conducted to a significantly reduced number of germ cells gene that initiated meiosis and DMRTA2 seemed to be required for mitotic-meiotic transition. In another hand, we identified, in the ovary, the expression of germ cells markers described as specifically male in rodent (PLZF, DNMT3L, FGF9, NANOS2 ou CYP26B1). The expression of these markers in the human ovary could explain the observation of mitotic germ cells in late fetal ovaries (30 wpf).In parallel, we tested germ cells sensibility to a synthetic glucocorticoid, dexamethasone, administrated during pregnancy in some justified pathologies. We observed an increased expression of PLZF that could explain the decreased number of germ cells observed in treated ovaries.In conclusion, we identified a new gene expressed in human fetal ovaries, potentially involved in the meiotic entry, and we extended our knowledge to characterized human germ line development. However, many points have to be clarified, as the possible competence of late mitotic germ cells to form oocytes.

Ovarian cancer is the fifth leading cause of cancer death in women between the ages of 35 and 74. With 22 thousand new cases and 15 thousand deaths annually ovarian cancer is among the most deadly cancers with a death to incidence ratio of 68%. With 70% of cases High Grade Serous Ovarian Carcinoma (HGSOC) is the most common type of ovarian cancer and causes 90% of ovarian cancer deaths. 80% of patients have reoccurrence within five years and only 15-30% of patients with recurrent metastatic ovarian cancer respond to current therapies, chemotherapy and surgery. One reason for the high reoccurrence rate is thought to be linked to the heterogeneity of tumors: there is evidence that, among tumor cells, a subpopulation is cancer stem cells (CSCs). Since CSCs are frequently drug resistant, when the patient undergoes chemotherapy many of the cells may die but the CSCs are left behind and the tumors can therefore regrow. CSCs are also more likely to undergo epithelial-mesenchymal transition which gives these cells the ability to more readily migrate and invade through the extracellular matrix, leaving the primary tumor to form metastases. One key inducer of EMT and therefore possibly of metastasis of particular interest in this project is SNAI1 (Snail). It is therefore the goal of this project to understand the growth, makeup and metastatic ability of HGSOC cell lines to test possible strategies to decrease growth of cancer and prevent metastasis. In this thesis project the phenotype, CSC population make up, and functionality of various HGSOC cell lines was examined. The cell lines assessed were A2780, Kuramochi, OVSAHO, COV318, SKOV3 and OVCAR8. A Snail knockdown OVCAR8 cell line was also assessed as described above and in a xenograft model. It was determined that the cell lines show varying phenotype from epithelial like to mesenchymal like morphology and the cell lines have varying concentrations of cancer stem cells. It was also determined that the CSC population of the HGSOC cell lines were positive for both epithelial and mesenchymal markers in the same cells. OVCAR8 stood out as a hybrid line with both epithelial and mesenchymal characteristics and was therefore chosen for the Snail knockdown model. In the Snail knockdown we observed that CSC markers were reduced, however no change between control and knockdown was seen in the in vitro functional experiments. There was a difference seen between Snail knockdown and control in the in vivo mouse xenograft model. Snail knockdown showed a trend for decreasing tumor burden in both primary and metastatic tumors and showed a significant decrease in growth of metastatic tumor at day 43. Based on these results Snail may be an important target for cancer therapy.

Diss. (sammanfattning) Umeå : Umeå universitet, 2008. / Härtill 4 uppsatser.