Despite improvements in therapy, the prognosis for non-small cell lung cancer (NSCLC) patients remains poor, and cure is only possible in localized tumors after surgical resection. A new generation of targeted cancer drugs has led to the expectation that lung cancer therapy can be significantly improved, but these drugs are today only an option in a small subset of NSCLC patients, and their effect is temporary. Therefore, the aim of this thesis was to characterize NSCLC in order to find new treatment targets and to evaluate biomarkers that further optimize therapy selection. In Paper I, the expression of the potential treatment targets claudin 6 and claudin 18.2 were evaluated based on immunohistochemical- and gene expression analysis. High ectopic protein and gene expression were demonstrated for both claudins in small subgroups of NSCLC. Clinical trials using humanized monoclonal antibodies against both proteins are ongoing in other cancer forms and may be extended to NSCLC. In Paper II, the prognostic impact of the inflammatory mediator cyclooxygenase 2 (COX-2) was evaluated. No prognostic significance was found in a meta-analysis incorporating gene expression data of 1337 NSCLC patients. Likewise, COX-2 protein expression in tumor cells was not associated with survival in two independent NSCLC cohorts. However, in one of the analyzed cohorts, higher COX-2 expression in the tumor stroma was associated with longer survival and may therefore be a subject for further investigation. In Paper III, tumor and stromal COX-2 protein expression was examined in patients treated with the COX-2 inhibitor celecoxib in order to evaluate if COX-2 expression is a predictive biomarker for benefit of celecoxib therapy. Celecoxib did not prolong overall survival neither in the whole cohort nor in patients stratified according to COX-2 expression in tumor or stromal cells. Noteworthy, a tendency towards longer survival was again demonstrated in patients with high COX-2 stromal expression. In Paper IV, the diagnostic methods for identification of ALK rearrangements were assessed in a large representative Swedish NSCLC population. Fluorescence in situ hybridization (FISH), as the diagnostic standard, was compared to two immunohistochemical assays. ALK gene expression levels were incorporated to supplement the molecular data. The frequency of ALK rearrangements was lower than previously reported. The different methods to detect the ALK fusion demonstrated overlapping results. However, the overlap was poor, so the methods cannot be regarded as interchangeable and should thereby be interpreted with caution when used in clinical diagnostics. In summary, this thesis applied an integrative translational approach to characterize potential new treatment targets and to evaluate the detection of existing predictive biomarkers in NSCLC.

The diploma thesis was focused on evidence of selected somatic mutations in genes ALK (Anaplastic lymphoma receptor tyrosine kinase), BRAF (v-Raf murine sarcoma viral oncogene homolog B1) and β-catenin (CTNNB1) through molecular - genetic methods in the target group of neuroectodermal tumors (neuroblastoma, medulloblastoma, brain tumors, paraganglioma and pheochromocytoma). Some of them are already considered as prognostic indicators which help to identify the subtype of various tumors and on the basis of this molecular - biological classification choosing the appropriate treatment. The genetic material of 133 patients was used for the analysis divided by the type of cancer. The presence of the mutation was detected in seven cases, of which two of them beloged to the gene BRAF, one to the gene ALK and four to the gene β-catenin. The subject of research in the cases of this genes were hotspot mutation sites. The purpose was to confirm the presence of the mutation in the hotspots and contribute to the studies which are aimed at the introduction of more suitable treatment through the inhibitors of mutated genes. Keywords: ALK, BRAF, β-catenin (CTNNB1), neuroectodermal tumors, sequencing, MLPA

Antagonism of the activin receptor signaling pathway represents a promising potential therapy for the muscular dystrophies and other muscle wasting disorders (i.e., cachexia or sarcopenia). Previous research has shown that antagonism of activin signaling promotes muscle growth, attenuates muscle wasting, and restores function in both wild type and diseased animals. Our laboratory has recently developed a novel small molecule (SGI-1252) that inhibits activin downstream (i.e., Smad2/3 phosphorylation) signaling. Purpose: In this study we determined how eight weeks of orally administered SGI-1252 affected TGF-ß signaling, whole body mass, individual limb muscle mass, and muscle fiber cross sectional area (CSA). Methods: Wild-type (WT) mice were treated with SGI-1252 or a vehicle control (VC) via oral gavage (400 mg/kg 3 times per week) for 8 weeks. Body mass was measured twice per week during the 8-week treatment period. At the end of the treatment period, gastrocnemius and tibialis anterior (TA) muscles were excised, weighed, and prepared for histological and biochemical analyses. Results: Following 8 weeks of treatment, there was no difference in weight gain between SGI-1252 (24.8 ± 1.8g) and VC treated mice (23.2 ± 1.5g) (p = 0.06). Gastrocnemius whole muscle mass was significantly greater in the SGI-1252 treated group relative to the VC treated mice (139.6 ± 12.8 mg vs 128.8 ± 14.9 mg) (p = 0.04), although when normalized with body mass there was no difference in gastrocnemius mass. For the TA muscle, there were no significant differences in whole muscle mass between SGI-1252 and VC groups, yet TA muscles in the SGI-1252 treated group had a reduced muscle fiber CSA compared to controls (621 ± 44 µm2 vs 749 ± 36 µm2) (p = 0.0005). There was a statistical trend of decreasing Smad2 phosphorylation in the SGI-1252 treated TA muscles (mean SGI-1252 = 0.668 vs VC = 0.848) (p = 0.06), and no significant differences in Smad2 phosphorylation in the gastrocnemius. Conclusions: Contrary to our hypothesis, 8 weeks of orally administered SGI-1252 was not effective in promoting increases in whole body mass, limb whole muscle mass, or myofiber cross sectional area. This may be due to the inability of SGI-1252, at the administered dose, to effectively decrease signaling downstream of the activin receptor. Clearly, studies using a wider range of doses and delivery methods will be needed to ascertain the efficacy of SGI-1252 as a potential therapeutic.

The Drosophila gene Anaplastic lymphoma kinase (Alk) is homologous to mammalian ALK, a member of the Alk/Ltk family of receptor tyrosine kinases. In Drosophila Alk is crucial for development of the embryonic visceral mesoderm, where it is the receptor for Jelly Belly (Jeb) ligand. Jeb binding stimulates an Alk-driven, extracellular signal-regulated, kinase-mediated signaling pathway, which results in the expression of the downstream gene duf/kirre. The visceral mesoderm is made up from two different cell types, founder cells and fusion competent myoblasts. The Jeb-Alk signal transduction pathway drives specification of the founder cells of the Drosophila visceral muscle. In this work we aimed to identify genes specifically expressed in the founder cells and/or fusion competent myoblasts. Four genes from a number of candidiates were investigated further. These genes are Hand, expressed in founder cells, goliath, parcas and delilah, which are expressed in fusion competent myoblasts. Hand is a basic helix-loop-helix (bHLH) transcription factor. Alk-mediated signal transduction drives the expression of the bHLH transcription factor hand in vivo, and loss of Alk function results in a complete lack of hand expression in the visceral mesoderm, while Alk gain of function results in an expansion of hand expression. There are no obvious defects in the visceral muscle fusion process hand mutant animals, suggesting that Hand is not critical for visceral muscle fusion per se. I have studied another molecule Goliath, a putative RING finger E3 ligase. goliath is specifically expressed in the FCM of visceral and somatic muscles. goliath mutant animals do not display any obvious muscle phenotypes, perhaps reflecting a redundant role with CG10277, which encodes a second Goliath family protein in Drosophila. Deletion mutation of the CG10277 locus does not result in muscle defects either, and generation of double mutants of goliath and CG10277 will be required to determine their function in vivo. In addition, I have studied another bHLH transcription factor Delilah and its role in muscle development. We show that delilah is expressed in visceral muscle, somatic muscles and in tendon cells. Delilah mutant animals display a held out wing phenotype and are unable to fly. Inducible RNAi against delilah results in a similar phenotype. Delilah is transcriptionally regulated by mef2 and biniou, early regulators of muscle development. While delilah appears to function in tendon cells, we were unable to find any obvious phenotype in either visceral or somatic muscles. In order to further investigate the underlying mechanism of Delilah function we have used Tandem affinity purification (TAP) methodology followed by mass spectrometry to identify Delilah binding partners. This analysis suggests a number of candidate functional partners for the Delilah protein.

In Drosophila melanogaster the visceral mesoderm (VM) develops during embryogenesis in a process where myoblasts become specified to generate two distinct cell types, the founder cells (FCs) and the fusion competent myoblasts (FCMs) that consequently fuses. The cell specification is dependent on cell signaling mediated by the receptor tyrosine kinase (RTK) Anaplastic lymphoma kinase (Alk) and its ligand Jelly belly (Jeb), how this further sets up different identity programs that drive myoblasts to differentiate into FCs and FCMs is still not well understood. We have analysed whether the Midkine (MDK)/Pleiotrophin (PTN) homologues in Drosophila, Miple1 and Miple2 activate the Alk RTK in vivo. Earlier results from cell culture experiments suggested that vertebrate MDK/PTN is capable of activating ALK, findings that have become controversial with other studies showing contradictory results. We wanted to use Drosophila that have conserved homologues of both MDK/PTN and ALK, to address the question in vivo. We analysed the contribution of Miple in Alk dependent developmental processes such as visceral mesoderm (VM) specification during embryogenesis and in body size regulation of adult flies. Specification of VM as well as body size are not effected by loss of Miple proteins, and over expression of Miple proteins do not effect VM specification or body size. All together we conclude that there is no evidence that Miple1 or Miple2 can activate Alk in vivo. We found that loss of Miple protein effect the median lifespan of the fly which is reduced, interestingly the over expression of Miple proteins can promote an increased median life span in Drosophila. We have also analysed how Alk RTK signaling regulates the Gli-like transcription factor Lame duck (Lmd) in vivo on a post-translational level. It has already been reported that Lmd plays an essential role in specification of FCMs in the somatic mesoderm during embryogenesis. We detect Lmd protein exclusively in FCMs of VM in control embryos, but in Alk mutants Lmd protein is present in all cells of VM and opposite to this when Alk is activated in all cells in VM by over expression of Jeb this results in total loss of Lmd protein. This suggests that Alk signaling is regulating Lmd, and we additionally show that Lmd persist in FCMs in mutants where VM is specified but where myoblast fusion do not occur, supporting that Alk activity in FCs is regulating the downregulation of Lmd in FCMs upon fusion. Finally we have characterised the Rap1GEF C3G in vivo in Drosophila. In cell culture systems, the GTPase Rap1 has been identified to mediate Alk signaling and that this is regulated by the GEF C3G and interestingly the Drosophila C3G is expressed in the FCs of VM. We generated deletion mutants of C3G which exhibit semi-lethality and reduced life span, but no defects in visceral mesoderm development during embryogenesis. Instead we detected distinct phenotypes in somatic muscles of 3rd instar mutant larvae, with detachment and mistargeting of muscles, which effect localisation of integrins. We suggest that Drosophila C3G regulates Rap1 via inside out signaling of integrins which in turn effects cell adhesion in vivo in Drosophila larval muscles.

The fully developed and functional Drosophila midgut comprises two layers, the visceral mesoderm and the endoderm. The visceral muscle of the midgut is formed by the fusion of founder cells with fusion competent cells to form the muscle syncytia. The specification of these cells and thus the fusion and the formation of the midgut muscle is dependent on the  Receptor tyrosine kinase (RTK) Alk (Loren et al., 2003). The endoderm underlies the visceral muscle and is formed from cells that originate from the anterior and the posterior parts of the embryo. These cells use the visceral mesoderm as a substrate for their migration. Using Alk mutant animals, we have studied endoderm migration during embryonic development. While the initial migration of the endoderm is not affected in the absence of the visceral mesoderm, we observe that the later dorsal-ventral endodermal migration does not take place. The development of the visceral muscle and its dependence on the endoderm is poorly understood.  We have analysed gürtelchen (gurt) mutant animals, originally identified in a genetic screen for mutations affecting visceral muscle formation. Gurt mutants are so named due to their belt-like phenotype of the visceral muscle (gürtelchen is German for belt). Mapping of the genomic locus identified gurt as a mutation in a previously described gene - huckebein (hkb) which is known to have an important function in endoderm development. Gurt (hkb) mutants were used to further study the interaction between the endoderm and the visceral muscle during development. The initial specification of founder cells and fusion competent myoblasts as well as fusion events are unaffected in gurt (hkb) mutants, however, the elongation and stretching of the visceral muscle does not proceed as normal. Moreover, ablation of the visceral mesoderm disrupts endoderm migration, while ablation of the endoderm results in a delayed disruption of visceral muscle formation. Signaling between the two tissues was investigated in detail. Since Alk is a critical player in visceral muscle development, we employed Alk mutant embryos for this task. In addition to the role of Alk in specifying the founder cells and initiating the visceral muscle fusion, we have shown that Alk mediated signaling has a role in the induction of the midgut constriction process by regulating dpp expression in the developing embryonic gut.  Finally, we wished to identify genes in the founder cells/fusion competent myoblasts that might be regulated by Alk. C3G is a gunaine nucleotide exchange factor expressed in the visceral muscle founder cells. Deletion of the Drosophila C3G locus resulted in the generation of null mutants in C3G which are viable, but display decreased longevity, fitness and are semi-lethal. Further analysis of C3G mutants indicated that C3G is essential for normal larval musculature development, in part by regulating integrin localization at muscle attachment sites.

Les lymphomes anaplasiques à grandes cellules (ou ALCL) appartiennent au groupe des lymphomes T périphériques et peuvent être porteurs d'une translocation impliquant le gène ALK (ALK+). Ce sont des lymphomes rares, de haut grade de malignité qui touchent souvent les sujets jeunes. Les traitements actuels permettent d'obtenir une rémission complète pour plus de 80% des patients. Cependant près de 30% des patients dont le traitement est aujourd'hui stratifié selon des facteurs pronostiques cliniques, vont rechuter dans l'année qui suit l'arrêt du traitement. Il est donc essentiel de disposer de critères prédictifs de la rechute au moment du diagnostic afin d'adapter la prise en charge thérapeutique des patients. L'objectif de mon projet était d'une part, d'identifier des facteurs moléculaires dépendants de la tumeur ou de son microenvironnement, associés à la rechute ou à l'absence de rechute et d'autre part, d'établir une signature d'expression génique pronostique au moment du diagnostic utilisable en routine clinique. Nous avons effectué une analyse du profil d'expression génique d'échantillons obtenus au diagnostic d'une cohorte de 48 patients présentant un ALCL ALK+ avec un suivi suffisant (26 provenant de patients ayant rechuté précocement, 22 patients n'ayant pas rechuté). Nous avons mis en évidence une signature de 47 gènes différentiellement exprimés entre les deux groupes de patients. Cette signature montre notamment, dans le groupe des patients n'ayant pas rechuté, un enrichissement en gènes codant pour des protéines impliquées dans la régulation de la matrice extracellulaire. Cette signature a été ensuite validée par PCR quantitative (qPCR) à haut débit (Fluidigm). Les algorithmes de classification tels que les forêts aléatoires et la PLS-DA ont permis de sélectionner les huit gènes les plus discriminants en termes de pouvoir prédictif. Sur la base de leur niveau d'expression, trois gènes ayant le plus fort pouvoir prédictif ont été identifiés par régression logistique. Afin de rendre cette signature applicable en routine clinique, ces trois gènes ont été validés par une technique de qPCR classique. L'expression de ces trois gènes a permis d'établir un score et un seuil permettant de distinguer les patients qui ont un fort risque de rechute des patients qui n'ont qu'un faible risque de rechuter. Cette classification dichotomique donne un taux d'échec de prédiction de seulement 16% sur cette première cohorte de patients. Ce score de prédiction a été validé sur une cohorte indépendante de 18 patients, avec un taux d'échec de 22%. Ainsi cette étude démontre l'intérêt des signatures prédictives issues de données à haut débit afin de guider le clinicien dans le choix de la stratégie thérapeutique. / Anaplastic large cell lymphomas (ALCL) peripheral belong to T cell lymphomas and may be associated with translocations involving the ALK gene (ALK+). These lymphoma are rare, of high grade and often affect young subjects. Current treatments allow obtaining a complete remission for over 80% of patients. However nearly 30% of patients whose treatment is stratified according to current clinical prognostic factors, will relapse in the year following the end of treatment. It is therefore essential to decipher predictive factors of relapse at diagnosis in order to improve therapeutic management. The aim of my project was on one hand, to identify molecular factors of the tumor or its microenvironment, associated with relapse or lack of relapse and secondly, to establish a predictive gene expression signature at diagnosis that could be used in clinical routine. We performed transcriptome analysis of samples obtained at diagnosis in a cohort of 48 patients with ALK+ ALCL and sufficient follow up (26 from patients who early relapsed, 22 patients who did not relapse). We have identified 47 differentially expressed genes between the two groups. This signature shows in particular, from the group of patients who did not relapse, an enrichment of genes encoding proteins involved in the regulation of the extracellular matrix. This signature has been then validated by high-throughput quantitative PCR (Fluidigm). Classification algorithms such as Random Forests and PLS-DA helped select the eight most discriminating genes in terms of predictive power. Based on their expression level, three genes with the strongest predictive power were identified by logistic regression. For diagnostic testing in routine practice, these three genes were validated by standard qPCR. A score and a threshold for distinguishing patients who will relapse from patients who will not were established from the expression of these three genes. This dichotomous classification gives a prediction failure rate of only 16% on this first cohort. This prediction score was then validated in an independent cohort of 18 patients, with a failure rate of 22%. This study demonstrates the value of predictive signatures derived from high-throughput data to guide treatment strategy.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21956号 / 医博第4498号 / 新制||医||1037(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 小川 誠司, 教授 伊達 洋至 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Les lymphomes à grandes cellules anaplasiques ou ALCL (Anaplastic Large-Cell Lymphoma) sont des cancers appartenant à la famille des lymphomes de type non-Hodgkin. La majorité des ALCL est issue d'une translocation t(2;5)(p23;q35) donnant lieu à la formation d'une protéine de fusion appelée NPM-ALK. A ce jour, peu d'inhibiteurs présentent de bonnes activités contre cette protéine chimérique. L'obésité représente un problème socio-médical d'envergure, à la fois pour ses effets directs et indirects ; le surpoids étant un facteur primaire dans de nombreuses maladies, tout particulièrement les diabètes, les accidents cardiovasculaires, le cancer, etc. A contrario, une restriction calorique (RC) est associée à des bénéfices importants en terme de santé. A l'issue de plusieurs criblages, un inhibiteur au motif 2-acylaminothiazole a montré une activité anticancéreuse sur ALK mais également la faculté de mimer la restriction calorique chez C. Elegans. Par conséquent, les travaux de recherche réalisés lors de cette thèse ont concerné la synthèse d'inhibiteurs comportant le squelette 2-acylaminothiazole. Les chromatographies d'affinité effectuées sur deux de nos inhibiteurs ont permis l'identification de cibles principales potentielles dans le cadre de la restriction calorique et des cibles secondaires possibles pour NPM-ALK. Ensuite, la présence d'un atome de brome sur le cycle aromatique a mené à la formation de liaisons C(sp2)-C(sp2), C(sp2)-C(sp) et C(sp2)- N, en utilisant les couplages catalysés par le palladium. Les différentes méthodes de modulation chimique ont conduit à mettre en place une librairie de 134 molécules. Certains d'entres eux et plus précisément ceux possédant un atome de silicium ont démontré une très bonne activité contre ALK et son mutant L1196M. Enfin, des résultats préliminaires ont également été obtenus sur le sujet de la restriction calorique avec quatre composés montrant une réduction du taux de lipides chez C. Elegans / Anaplastic Large-Cell Lymphoma (ALCL) is a type of cancer belonging to the non-Hodgkin family. The majority of ALCL arises from a translocation t(2;5) (p23;35) which leads to the formation of a fusion protein called NPM-ALK. Nowadays, few molecules are known to inhibit the activity of this chimeric protein. Obesity is a major socio-medical problem, for both direct and indirect effects, overweight is a primary factor in many diseases, especially diabetes, cardiovascular events, cancer, etc... In contrast, caloric restriction (CR) is associated with significant benefits in terms of health. After several screenings, one inhibitor based on a 2-acylaminothiazol scaffold showed anticancer activity on the protein ALK but also the ability to mimic caloric restriction in C. Elegans. The aim of this PhD was to develop the synthesis of new inhibitors including the 2-acylaminothiazol scaffold. The affinity chromatography performed on two of our inhibitors was used to identify potential major cellular targets in the process of caloric restriction and secondary cellular targets for NPM-ALK. Then, the presence of a bromo group on the aromatic ring allowed the formation of C(sp2)-C(sp2), C(sp2)- C(sp) and C(sp2)-N bonds, using palladium-catalyzed couplings. The different chemical methodologies afforded the synthesis of a library of 134 molecules. Some of them especially with a silicon atom demonstrated very good inhibitory activity and high selectivity against NPM-ALK and L1196M-NPM-ALK. Finally, preliminary results were also obtained on the subject of calorie restriction with four compounds showing a reduction of lipids in C. Elegans

La progression du cancer colorectal procède selon une série de transitions, de la crypte épithéliale normale vers l'adénome conduisant au carcinome primaire in situ et aux métastases généralement localisées au niveau du foie. Ces événements séquentiels sont orchestrés par un ensemble d'altérations géniques et moléculaires (syndromes familiaux HNPCC, FAP et cancers sporadiques CIN-LOH et MSI) qui se traduisent de manière générale par l'activation constitutive de (proto)oncogènes ou par la perte de gènes suppresseurs de tumeurs ou de métastases. Si les récepteurs du TGF-β et leurs réseaux de signalisation associés ont été tout particulièrement incriminés quant à leur rôle péjoratif pendant les phases tardives de la progression des tumeurs solides et des cancers du côlon chez l'homme, les informations concernant le rôle des cytokines BMP apparentées au TGF-β dans ce domaine ne sont que très fragmentaires. Quand ce projet a été initié, une étude attribuait à BMP-7 un rôle anti-inflammatoire dans l'intestin chez le rat, suggérant ainsi que cette cytokine pouvait exercer un rôle direct et bénéfique sur la muqueuse digestive et les cellules épithéliales intestinales en particulier. Les BMP agissent par l'intermédiaire de leurs récepteurs de type II (BMPRII, ActRII, ActRIIB) , de type I (ALK-2, ALK-3, ALK-6), et des protéines SMADs (SMAD1, SMAD4, SMAD5, SMAD8). Cependant, 50% des cancers du côlon métastatiques présentent une forme mutée de SMAD4. Des mutations germinales dans le gène codant le récepteur ALK-3 sont observées chez 38% des patients atteints de polypose juvénile (JPS). Enfin, 83% des cancers colorectaux présentant une instabilité des séquences microsatellites (MSI) montrent une mutation dans le gène codant le récepteur de l'activine ActR-II. Dans ce contexte, mon projet de thèse a été centré sur l'expression et le rôle de BMP-7 sur la progression des cellules cancéreuses colorectales humaines et dans les tumeurs associées. Nous avons démontré par RT-PCR, immunohistochimie, et en ELISA que BMP-7 et ses récepteurs sont présents dans des cryptes coliques histologiquement normales, les foci de cryptes aberrantes dans la sigmoïdite, les tumeurs colorectales humaines et plusieurs lignées de cellules cancéreuses coliques. Nous avons aussi démontré que BMP-7 est un facteur de dissémination inducteur du " scattering " et de l'invasion cellulaire dans le collagène de type I. Le pouvoir invasif de BMP-7 est indépendant de SMAD4 et de l'oncogène src, mais associé à l'activation différentielle et cyclique des GTPases (Rac1 et RhoA), de la tyrosine kinase FAK (phosphorylation de la tyr925 impliquée dans la signalisation invasive et l'angiogenèse), et des MAPK /SAPK (JNK et ERK1/2). L'ensemble de ces travaux suggère que BMP-7 se comporte comme un facteur de dissémination proinvasif, agissant par un mécanisme autocrine et paracrine au niveau des cellules cancéreuses du côlon et du stroma tumoral. Cette cytokine exerce donc des actions divergentes sur la progression des tumeurs coliques humaines, en s'opposant aux processus inflammatoires transitoires (rôle bénéfique), mais en favorisant la néoplasie lors des étapes plus tardives associées à l'acquisition du pouvoir invasif à la transition adénome- carcinome pendant la cancérogenèse (rôle péjoratif). Parallèlement, dans cette thèse, nous avons démontré que l'intégrine α1 fait partie de l'échafaudage moléculaire impliqué dans l'invasion cellulaire dépendant de l'oncogène src. D'une autre part, nous démontrons que le VEGF est un inducteur autocrine de l'invasion cellulaire par les cellules cancéreuses du côlon. Selon ce modèle, le VEGF sécrété par les cellules tumorales au sein de la tumeur primaire agit à la fois sur les cellules cancéreuses et les cellules endothéliales en induisant des signaux de survie, de prolifération et d'invasion nécessaires à la croissance des tumeurs primaires et à la génération des métastases.