L'implantation d'îlots de Langerhans microencapsulés est une thérapie prometteuse pour le diabète de type 1. Le concept est de rétablir la fonction de sécrétion d'insuline tout en évitant le rejet de greffe. Les premiers essais cliniques ont reporté des résultats encourageants mais encore peu reproductibles. En effet, les techniques actuelles de production de microcapsules sont manuelles et au sein d'un même lot les capsules ne sont pas homogènes. L'utilisation de la microfluidique offre la possibilité de remédier à ce problème. Ce projet présente les différentes étapes d'optimisation d'un système microfluidique complexe qui automatise le procédé d'encapsulation monocouche de cellules dans des capsules polymériques d'alginate. Ce système comporte trois fonctions principales en série : la formation de gouttes monodisperses d'alginate en flux d'huile par un module MFFD (Micro Flow Focusing Device), le transfert de ces gouttes de la phase huileuse vers une phase aqueuse gélifiante de calcium et enfin un second transfert vers un flux à concentration physiologique. Des capsules monodisperses et sphériques ont été obtenues en sortie de ce système et des premiers tests d'encapsulation de cellules ont été réalisés. Les capsules produites par le système automatisé ont conduit à une première implantation chez le rongeur. Ce système est une première étape clé vers un dispositif instrumenté qui permettrait aux cliniciens d'encapsuler des îlots rapidement et de façon reproductible directement après leur isolement, puis de les implanter chez les patients diabétiques. Mots clés : encapsulation, îlots de Langerhans, alginate, gélification, microfluidique, automatisation, MFFD, transfert de phase. / Epileptic seizures arise from pathological synchronization of neuronal ensemble.Seizures originating from primary motor cortex are often pharmacoresistant, and many times unsuitable for respective surgery because of location of epileptic focus in eloquent area. Basal ganglia play important role in seizure propagation. Micro electrode recordings performed during previous studies indicated that input structures of basal ganglia such as GPe, Putamen and Subthalamic nucleus (STN) are strongly modified during seizures. For example the mean firing rate of neurons of the STN and Putamen increased and the percentage of oscillatory neurons synchronized with the ictal EEG was higher during seizures as compared to interictal periods. Pilot studies in humans have shown the possible beneficial effect of chronic DBS applied to STN in treatment of pharmacoresistant motor seizures. Our study was aimed at studying the therapeutic effect of electrical stimulation of input structures of basal ganglia . We first developed a stable, predictable primate model of focal motor epilepsy by intracortical injection of penicillin and we documented it's pharmacoresistence. We then stereotactically implanted DBS electrodes in the STN and Putamen. The stimulator was embedded at the back of the animals. Subthreshold electrical stimulations at 130 Hz were applied to STN. Stimulator was turned ON when penicillin was injected. Sham stimulation at 0 volt was used as a control situation, each monkey being its own control. The time course, number and duration of seizures occurring in each epochs of 1 h were compared during ON and sham stimulation periods. Each experimental session lasted uptoo 6 hours,We also studied preventive high frequency stimulation of STN and subthershold low frequency stimulation of Putamen with 5 Hz and 20 Hz in the same model .Finally we studied combined effects of high frequency STN and low frequency Putamen stimulation in one monkey Results: Data was analysed from 1572 seizures in 30 experiments in three monkeys for chronic STN stimulation , 454 seizures in 10 experiments in one moneky during preventive STN stimulation ,289 seizures from 14 experiments in two monkeys during LFS putamen stimulation and 477 seizures from 10 sessions during combined STN and Putamen stimulation in one monkey The best results were observed during chronic STN stimulation The occurrence of first seizure was significantly delayed as compared to sham situation. Total time spent in focal seizures was significantly reduced by ≥69% on an average (p ≤0.05) after STN stimulation, due to a significant decrease in the number of seizures especially so during the first 3 hours after stimulation. The duration of individual seizures reduced moderately. Bipolar and monopolar stimulation modes were equally effective Preventive HFS STN (in one specimen) was not found to be superior to acute stimulation. LFS Putamen alone was effective but mainly in first two hours of stimulation .In a combined HFS STN and LFS Putamen stimulation the effect of stimulation in terms of seizure control was modest and poor compared to HFS STN alone or LFS Putamen alone. This study provides original data in primates showing the potential therapeutic effect of chronic HFS-STN DBS to treat focal motor seizures . A discussion explaining these
| Identifer | oai:union.ndltd.org:theses.fr/2012GRENS036 |
| Date | 17 December 2012 |
| Creators | Dalle, Prisca |
| Contributors | Grenoble, Benhamou, Pierre-Yves, Rivera, Florence |
| Source Sets | Dépôt national des thèses électroniques françaises |
| Language | French |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation, Text |
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