This study explored hydrostatic pressure as a mechanobiological parameter to control in vitro endothelial cell tubulogenesis in 3-D hydrogels as a model microvascular tissue engineering approach. For this purpose, the present investigation used an endothelial spheroid model, which we believe is an adaptable microvascularization strategy for many tissue engineering construct designs. We also aimed to identify the operating magnitudes and exposure times for hydrostatic pressure-sensitive sprout formation as well as verify the involvement of VEGFR-3 signaling. For this purpose, we used a custom-designed pressure system and a 3-D endothelial cell spheroid model of sprouting tubulogenesis. We report that an exposure time of 3 days is the minimum duration required to increase endothelial sprout formation in response to 20 mmHg. Notably, exposure to 5 mmHg for 3 days was inhibitory for endothelial spheroid lengths without affecting sprout numbers. Moreover, endothelial spheroids exposed to 40 mmHg also inhibited sprouting activity by reducing sprout numbers without affecting sprout lengths. Finally, blockade of VEGFR-3 signaling abolished the effects of the 20-mmHg stimuli on sprout formation. Based on these results, VEGFR-3 dependent endothelial sprouting appears to exhibit a complex pressure dependence that one may exploit to control microvessel formation.

La dent est un tissu vivant, confronté tout au long de la vie à de multiples agressions (caries, traumatismes...) qui peuvent entraîner la nécrose de la pulpe. La mise au point d’une «pulpe équivalente» pourrait constituer une approche thérapeutique innovante comme alternative aux traitements actuels d’endodontie. La pulpe des dents temporaires constitue un réservoir de cellules souches mésenchymateuses (SHED Stem cells from Human Exfoliated Deciduous teeth) aux potentiels de prolifération et de différenciation élevés. L’objectif global de ce travail est de reconstituer un tissu pulpaire fonctionnel en développant une pulpe équivalente (cellules pulpaires mésenchymateuses ensemencées dans une matrice 3D de collagène) pour être greffée à l’intérieur de la chambre pulpaire préalablement évidée afin de conserver la vitalité de la dent. Les objectifs spécifiques ont été : In vitro : 1) d'étudier le potentiel angiogénique des SHED comparés à des fibroblastes dermiques en conditions normoxiques et hypoxiques, 2) de déterminer la durée de pré-conditionnement hypoxique optimale pour stimuler le potentiel angiogénique des SHED, 3) de sélectionner une potentielle cytokine activant la formation de capillaires, 4) d’analyser l’effet de l’hypoxie sur l’expression des marqueurs de surfaces des SHED, et 5) de vérifier que l’hypoxie n’altérait pas le potentiel de minéralisation de ces cellules. In vivo : 1) d’évaluer, dans un modèle pré-clinique d’implantation de pulpes équivalentes en site ectopique chez la souris, l’effet du pré-conditionnement hypoxique sur le potentiel angiogénique des SHED. Ces expériences ont d’abord été conduites avec des cellules pulpaires de souris puis confirmées avec des SHED implantées dans des souris immunodéficientes, et 2) de développer des techniques d’imagerie dynamique pour suivre la néoangiogenèse dans les pulpes équivalentes implantées. Enfin, dans un objectif de transfert vers la clinique dentaire humaine, nous avons étudié l’effet d’un nouveau biomatériau à base de calcium tricalcique sur la réparation tissulaire dans un modèle de blessure pulpaire chez le rat, en comparaison aux matériaux de référence. / The tooth is a living organ, faced throughout life to multiple attacks (caries, trauma ...) which can cause necrosis of the pulp. The development of a" pulp equivalent " could be an innovative therapeutic approach as an alternative to current endodontic treatments. The pulp of deciduous teeth is a reservoir of mesenchymal stem cells (Stem cells SHED from Human Exfoliated Deciduous teeth) with a high potential of proliferation and differentiation. The overall objective of this work was to reconstitute a functional pulp tissue by developing a pulp equivalent (pulp mesenchymal cells seeded in a 3D collagen matrix) to be grafted within the previously hollowed pulp chamber to maintain tooth vitality. The specific objectives were: In vitro: 1) to study the angiogenic potential of SHED compared with dermal fibroblasts in normoxic and hypoxic conditions. 2) to determine the optimal hypoxic preconditioning period to stimulate the angiogenic potential of SHED, 3) to identify a potential cytokine activating the capillary formation, 4) to analyze the effect of hypoxia on the expression of markers surfaces SHED, and 5) to check that hypoxia did not alter the mineralization potential of these cells. In vivo: 1) to evaluate, in a pre-clinical model of pulp equivalent implantation in ectopic site in mice, the effect of either hypoxic or FGF preconditioning on the angiogenic potential of SHED. These experiments were first conducted with mouse pulp cells and further confirmed with SHED implanted in immunodeficient mice, and 2) to develop dynamic imaging techniques to monitor neoangiogenesis within pulp equivalent. Finally, in an objective of transfer to the human dental clinic, we studied the effect of a new biomaterial based on tricalcium on tissue repair in a pulp injury model in rats, compared to gold standard materials.

Early pregnancy is characterized by complex interactions between blood vessels, leukocytes, and conceptus-derived trophoblasts within the gestational uterus. Uterine Natural Killer (uNK) cells become the most abundant leukocyte during decidualization and produce a wide array of angiogenic factors, yet little is known regarding their early pregnancy functions. To characterize the role(s) of uNK cells, whole mount in situ immunohistochemistry of live early implant sites was performed. A timecourse examination of murine early pregnancy (virgin, and gd4.5-9.5) implantation sites was performed. Comparison of Gd6.5, 8.5 and 9.5 implant sites from BALB/c+/+ controls (BALB/c) and BALB/c-Rag2-/-Il2rg-/- (alymphoid) identified anomalies that result from the absence of lymphocytes. In alymphoid decidua basalis, mesometrial angiogenesis was widespread but pruning of nascent vessels within alymphoid decidua basalis was deficient. As early gestation progressed, vessels of alymphoid decidua basalis showed no evidence for remodeling. Alymphoid implantation sites showed ~24h delay in uterine lumen closure and embryonic development. To determine if uNK cells would normalize the anomalies observed in alymphoid implantation sites, adoptive cell transfer of NK+ B- T- marrow to alymphoid mice was performed. All of the above anomalies were reversed by adoptive transfer of NK+B-T- marrow. My results suggest that uNK cells support vascular growth and development which ensures the decidua can support the growing conceptus early in pregnancy prior to formation and function of the placenta. Human decidual NK cells may fill similar roles and be important targets for strategies designed to correct intra-uterine growth restriction. / Thesis (Master, Anatomy & Cell Biology) -- Queen's University, 2013-08-02 08:42:06.487

Résumé: La majorité des femmes ayant un cancer du sein en stade précoce sont traitées par radiothérapie impliquant souvent l’irradiation du sein entier. Malgré l’efficacité de cette modalité de traitement, la dose de radiation n’est pas optimale pour éliminer toutes les cellules cancéreuses résiduelles, mais plutôt pour obtenir les meilleurs résultats à long terme avec le moins de complications possibles. Les effets secondaires observés résultent tous de processus inflammatoires engendrés par la radiation. L’augmentation de l’expression et de l’activité de molécules inflammatoires, notamment la cyclooxygénase-2, dans les tissus normaux et malins stimulent l’invasion et l’angiogenèse tumorales, deux mécanismes importants menant à l’établissement de métastases. Le but global de ce projet de recherche est d’améliorer la radiothérapie en tentant de réduire la récurrence du cancer du sein. Les objectifs spécifiques étaient de déterminer grâce à l’imagerie par résonance magnétique que l’irradiation du stroma sain pouvait augmenter in vivo la capacité d’invasion des cellules cancéreuses du sein, stimuler la néovascularisation tumorale et qu’une co-administration à la radiothérapie d’un agent anti-inflammatoire inhibiteur sélectif de la cyclooxygénase-2 pouvait prévenir l’augmentation radio-induite de cette invasion. Dans notre étude, nous avons établi une méthode utilisant l’imagerie par résonance magnétique pour mesurer rapidement l’angiogenèse in vivo chez la souris dans des implants de Matrigel. Cette méthode servira ultérieurement à analyser l’effet de la radiation sur l’angiogenèse tumorale. Nous avons également suivi chez un modèle de souris l’invasion des cellules cancéreuses mammaires implantées après irradiation du tissu sain. Nous avons démontré que l’irradiation du tissu sain augmente l’invasion des cellules cancéreuses mammaires. L’invasion radio-induite est stimulée par une irradiation unique de 30 Gy tout comme avec un protocole d’irradiations fractionnées de 5x7,5 Gy se rapprochant plus des doses utilisées en clinique. Ensuite, un traitement avec un inhibiteur sélectif de cyclooxygénase-2, soit le NS-398, a été effectué. Le NS-398 limite l’augmentation radio-induite de l’invasion. Ces résultats supporteraient le développement de nouveaux traitements basés sur des inhibiteurs de COX-2 pour augmenter l’efficacité de la radiothérapie chez les femmes ayant un cancer du sein. / Abstract: Most women with early breast cancer are treated with radiotherapy to the whole breast. Despite the efficiency of this treatment, the dose of radiation is not calculated to eliminate all the residual cancer cells, but rather to obtain the best long-term results with minimal side-effects. The observed side-effects all result from inflammatory processes caused by radiation. Increase of inflammatory molecules expression and activity, such as cyclooxygenase-2, in normal and malignant tissues induce invasion and tumour angiogenesis. Both of these important mechanisms lead to metastasis formation. The general aim of this research project is to improve radiotherapy by decreasing breast cancer recurrence. Specific objectives were to determine with magnetic resonance imaging that irradiation of normal tissues could increase breast cancer cells invasiveness in vivo, stimulate tumour neovascularization and prevent radiation-enhanced invasion by the administration of an anti-inflammatory agent inhibiting selectively the cyclooxygenase-2 during radiotherapy. In this study, we have developed a new assay to monitor angiogenesis in Matrigel plugs in live mice using magnetic resonance imaging. This method would be a promising tool to test the effect of radiation on tumour angiogenesis. We also followed in a mouse model the invasion of mammary cancer cells implanted post-irradiation of healthy tissues. We demonstrated that irradiation of healthy tissues leads to an increase in mammary cancer cells invasion. Radiation-induced invasion was observed with a unique 30 Gy dose as well as with a more clinically-relevant fractionated protocol consisting in 5 irradiations of 7.5 Gy. Then, mice were treated with NS-398, a selective inhibitor of cyclooxygenase-2. NS-398 limits the increase of invasion stimulated by radiation. These results could support new treatments development based on COX-2 inhibition to increase radiotherapy efficiency for women with breast cancer.

En 1971, Le Dr. Américain Judah Folkman a publié une hypothèse selon laquelle la croissance tumorale dépendait de l'angiogenèse. Le défit des recherches actuelles est de trouver un moyen pour affamer la tumeur en inhibant son angiogenèse. L'angiogenèse est un processus physiologique complexe qui fait intervenir de nombreux récepteurs, parmi lesquels se trouve le récepteur du mannose-6-phosphate / Insulin-like growth factor II (RM6P/IGFII). Le but de ce travail a donc consisté en la synthèse de nano-objets mannosylés et de nouveaux analogues du Mannose-6-Phosphate (M6P) puis en l'évaluation de leur activité angiogénique par la méthode de la « CAM » sur des embryons de poulet et dans le modèle des explants d'aorte de rat. Dans un premier temps des nanoparticules d'or ont été préparées, fonctionnalisées avec les dérivés du M6P ayant montré des résultats intéressants au cours de travaux antérieurs réalisés au sein du laboratoire. Par la suite des analogues originaux tels que un borate, un acide boronique, un pyrophosphate, un pyrophosphonate ainsi que l'analogue rétroisotère du M6P ont été synthétisés. D'autre part, il a été montré que le RM6P/IGFII pouvait lier deux molécules de M6P ou une molécule d'oligosaccharide diphosphorylée par monomère. De ce fait, des molécules bidentées, des composés de type bolaforme et des trisaccharides difonctionnalisés ont été élaborés puis leur activité biologique a été valuée. / In 1971, the American Dr. Judah Folkman published the hypothesis : tumor growth depends on angiogenesis. The challenge of current research is to find a way to starve tumors by inhibiting angiogenesis. Angiogenesis is a complex physiological process that involves many receptors, among which is the receptor for mannose-6-phosphate / Insulin-like growth factor II (RM6P/IGF-II). The aim of this work was the synthesis of mannosyl nano-devices and new analogues of Mannose-6-Phosphate (M6P). Evaluation of their angiogenic activity was made by the 'CAM essay' on embryo of chicken and in the model of the explantations of rat's aorta. First, gold nanoparticles functionnalized with M6P analogues were prepared. Those analogues have been chosen among the most interesting candidates as described previously in our laboratory. Secondly, original analogues such as a borate, a boronic acid, a pyrophosphate, a pyrophosphonate as well as the retroisotere analogue of the M6P were synthetized. The RM6P/IGFII can bind two molecules of M6P or a diphosphoryled oligosaccharide molecule by monomer (receptor). Therefore, bidentate molecules, difunctionnalized bolaform compounds and difunctionnalized trisaccharides were synthesized and their biological activity evaluated.

La dent est un tissu vivant, confronté tout au long de la vie à de multiples agressions (caries, traumatismes...) qui peuvent entraîner la nécrose de la pulpe. La mise au point d’une «pulpe équivalente» pourrait constituer une approche thérapeutique innovante comme alternative aux traitements actuels d’endodontie. La pulpe des dents temporaires constitue un réservoir de cellules souches mésenchymateuses (SHED Stem cells from Human Exfoliated Deciduous teeth) aux potentiels de prolifération et de différenciation élevés. L’objectif global de ce travail est de reconstituer un tissu pulpaire fonctionnel en développant une pulpe équivalente (cellules pulpaires mésenchymateuses ensemencées dans une matrice 3D de collagène) pour être greffée à l’intérieur de la chambre pulpaire préalablement évidée afin de conserver la vitalité de la dent. Les objectifs spécifiques ont été : In vitro : 1) d'étudier le potentiel angiogénique des SHED comparés à des fibroblastes dermiques en conditions normoxiques et hypoxiques, 2) de déterminer la durée de pré-conditionnement hypoxique optimale pour stimuler le potentiel angiogénique des SHED, 3) de sélectionner une potentielle cytokine activant la formation de capillaires, 4) d’analyser l’effet de l’hypoxie sur l’expression des marqueurs de surfaces des SHED, et 5) de vérifier que l’hypoxie n’altérait pas le potentiel de minéralisation de ces cellules. In vivo : 1) d’évaluer, dans un modèle pré-clinique d’implantation de pulpes équivalentes en site ectopique chez la souris, l’effet du pré-conditionnement hypoxique sur le potentiel angiogénique des SHED. Ces expériences ont d’abord été conduites avec des cellules pulpaires de souris puis confirmées avec des SHED implantées dans des souris immunodéficientes, et 2) de développer des techniques d’imagerie dynamique pour suivre la néoangiogenèse dans les pulpes équivalentes implantées. Enfin, dans un objectif de transfert vers la clinique dentaire humaine, nous avons étudié l’effet d’un nouveau biomatériau à base de calcium tricalcique sur la réparation tissulaire dans un modèle de blessure pulpaire chez le rat, en comparaison aux matériaux de référence. / The tooth is a living organ, faced throughout life to multiple attacks (caries, trauma ...) which can cause necrosis of the pulp. The development of a" pulp equivalent " could be an innovative therapeutic approach as an alternative to current endodontic treatments. The pulp of deciduous teeth is a reservoir of mesenchymal stem cells (Stem cells SHED from Human Exfoliated Deciduous teeth) with a high potential of proliferation and differentiation. The overall objective of this work was to reconstitute a functional pulp tissue by developing a pulp equivalent (pulp mesenchymal cells seeded in a 3D collagen matrix) to be grafted within the previously hollowed pulp chamber to maintain tooth vitality. The specific objectives were: In vitro: 1) to study the angiogenic potential of SHED compared with dermal fibroblasts in normoxic and hypoxic conditions. 2) to determine the optimal hypoxic preconditioning period to stimulate the angiogenic potential of SHED, 3) to identify a potential cytokine activating the capillary formation, 4) to analyze the effect of hypoxia on the expression of markers surfaces SHED, and 5) to check that hypoxia did not alter the mineralization potential of these cells. In vivo: 1) to evaluate, in a pre-clinical model of pulp equivalent implantation in ectopic site in mice, the effect of either hypoxic or FGF preconditioning on the angiogenic potential of SHED. These experiments were first conducted with mouse pulp cells and further confirmed with SHED implanted in immunodeficient mice, and 2) to develop dynamic imaging techniques to monitor neoangiogenesis within pulp equivalent. Finally, in an objective of transfer to the human dental clinic, we studied the effect of a new biomaterial based on tricalcium on tissue repair in a pulp injury model in rats, compared to gold standard materials.

<p>To this day, cancer remains the leading cause of mortality worldwide1. A major contributor to cancer progression and metastasis is tumor angiogenesis. The formation of blood vessels around a tumor is facilitated by the complex interplay between cells in the tumor stroma and the surrounding microenvironment. Understanding this interplay and its dynamic interactions is crucial to identify promising targets for cancer therapy. Current methods in cancer research involve the use of two-dimensional (2D) monolayer cell culture. However, cell-cell and cell-ECM interactions that are important in vascularization and the three-dimensional (3D) tumor microenvironment cannot accurately be recapitulated in 2D. To obtain more biologically relevant information, it is essential to mimic the tumor microenvironment in a 3D culture system. To this end, we demonstrate the utility of poly(ethylene glycol) diacrylate (PEGDA) hydrogels modified for cell-mediated degradability and cell-adhesion to explore, in 3D, the effect of various tumor microenvironmental features such as cell-cell and cell-ECM interactions, and dimensionality on tumor vascularization and cancer cell phenotype. </p><p>In aim 1, PEG hydrogels were utilized to evaluate the effect of cells in the tumor stroma, specifically cancer associated fibroblasts (CAFs), on endothelial cells (ECs) and tumor vascularization. CAFs comprise a majority of the cells in the tumor stroma and secrete factors that may influence other cells in the vicinity such as ECs to promote the organization and formation of blood vessels. To investigate this theory, CAFs were isolated from tumors and co-cultured with HUVECs in PEG hydrogels. CAFs co-cultured with ECs organized into vessel-like structures as early as 7 days and were different in vessel morphology and density from co-cultures with normal lung fibroblasts. In contrast to normal lung fibroblasts (LF), CAFs and ECs organized into vessel-like networks that were structurally similar to vessels found in tumors. This work provides insight on the complex crosstalk between cells in the tumor stroma and their effect on tumor angiogenesis. Controlling this complex crosstalk can provide means for developing new therapies to treat cancer.</p><p>In aim 2, degradable PEG hydrogels were utilized to explore how extracellular matrix derived peptides modulate vessel formation and angiogenesis. Specifically, integrin-binding motifs derived from laminin such as IKVAV, a peptide derived from the α-chain of laminin and YIGSR, a peptide found in a cysteine-rich site of the laminin β chain, were examined along with RGDS. These peptides were conjugated to heterobifunctional PEG chains and covalently incorporated in hydrogels. The EC tubule formation in vitro and angiogenesis in vivo in response to the laminin-derived motifs were evaluated. </p><p>Based on these previous aims, in aim 3, PEG hydrogels were optimized to function as a 3D lung adenocarcinoma in vitro model with metastasis-prone lung tumor derived CAFs, HUVECs, and human lung adenocarcinoma derived A549 tumor cells. Similar to the complex tumor microenvironment consisting of interacting malignant and non-malignant cells, the PEG-based 3D lung adenocarcinoma model consists of both tumor and stromal cells that interact together to support vessel formation and tumor cell proliferation thereby more closely mimicking the functional properties of the tumor microenvironment. The utility of the PEG-based 3D lung adenocarcinoma model as a cancer drug screening platform is demonstrated with investigating the effects of doxorubicin, semaxanib, and cilengitide on cell apoptosis and proliferation. The results from drug screening studies using the PEG-based 3D in vitro lung adenocarcinoma model correlate with results reported from drug screening studies conducted in vivo. Thus, the PEG-based 3D in vitro lung adenocarcinoma model may serve as a better tool for identifying promising drug candidates than the conventional 2D monolayer culture method.</p> / Dissertation

Angiogenesis, the growth of new blood vessels, is vital to tumour growth. Prevailing dogma has been that tumours cannot grow without angiogenesis. Based on this premise, anti-angiogenic drugs are used clinically. However, the principle of angiogenesis as an absolute requirement for tumour growth has been challenged with reports that many tumours are entirely or partially non-angiogenic. This study describes and quantifies characteristics of non-angiogenic non-small cell lung tumours, demonstrates non-angiogenic growth in small-cell/neuroendocrine lung tumours and investigates the underlying pathogenetic processes by comparison with angiogenic lung tumours. Hypoxia is an important stimulus for angiogenesis. Differences in response to hypoxia may determine whether a tumour produces new vessels. In order to test this, levels of. necrosis, often considered a surrogate marker of hypoxic stress, were quantified but no difference in quantity of necrosis was found Moreover, immunohistochemical investigation of hypoxia and angiogenesis factors provided no unambiguous explanation for the differences in angiogenesis. Significant differences were seen, however, in fibrosis and inflammation, which were both greater in angiogenic tumours. Differences were greater for lymphocytes rather than cells of the ‘innate’ immune system. This provided an alternative hypothesis: angiogenesis occurs during wound healing and in the growth of granulation tissue, so it is possible that tumour angiogenesis is a response to factors produced by immune cells rather than the tumour itself. A tumour’s angiogenic status may, therefore, be determined by the response it provokes from the immune system. Further work to test this theory would compare levels of immunogenic factors such as Tumour Necrosis Factor and tumour cell surface antigens such as the HLA class I molecules. The study concludes with an investigation into the molecular basis of non-angiogenic growth using the technique of comparative genomic hybridisation (CGH) which allows amplifications and deletions of areas of DNA to be calculated. High-resolution array CGH was evaluated against conventional CGH, and the results compared with previous RNA studies from our laboratory. These revealed a set of genes with consistent changes in both RNA and DNA, several of which form part of known angiogenic and inflammatory pathways.

TRAP1 is a Heat Shock Protein (HSP) chaperone to retinoblastoma but also associated to the tumor necrosis factor receptor. HSPs are primarily up regulated in cancer. Work in our lab noted a down regulation of TRAP1 in some non-small cell lung cancers compared to normal lung. The first aim of this project was to evaluate the effect of the loss of TRAP1 on cell proliferation using a spheroid model. The presence of TRAP1 in spheroids promoted cell proliferation and a faster onset of hypoxia. This suggests an oncogenic role for TRAP1 since rapid hypoxia development equates to poor prognosis. Micro array analysis showed that TRAP1’s loss was associated with increased transcrpition of the Junctional Mediating and Regulatory protein (JMY). JMY possesses an oncogenic property due to its ability to facilitate cell motility. Additionally it has tumor suppressor activity in promoting p53 activation. The second aim of this project was to produce an anti-JMY antibody and use it to characterize JMY and additionally verify the association between TRAP1 and JMY. JMY was found to be widely expressed in normal tissues and in many types of tumors. In neoplastic tissues, comparing primary versus metastatic tumors, JMY was found to have significantly higher expression in the metastatic compared with the primary tumors. A pilot study showed that nuclear co-expression of JMY and P53 was associated with shorter overall survival suggesting that a possible tumorigenesis mechanism could be via a deregulation/mutation of JMY/p53 or both. Finally, using 3 dimensional constructions, I demonstrated the distinct morphological difference between an angiogenic tumor and a non-angiogenic tumor. Additionally, I showed a characteristic cytoplasmic p53 sequestration in the non-angiogenic phenotype that is absent in the angiogenic phenotype. This could be the mechanism that the non-angiogenic tumor uses to adapt to hypoxia. This would imply that there is a potential for cancers to escape therapy by switching between these 2 phenotypes.

Delta-like ligand 4 (DLL4) is a ligand for the Notch family of receptors. DLL4 is an important regulator of angiogenesis and DLL4 blockade promotes non-productive angiogenesis and delays tumour growth. The aim of this thesis was to investigate the effects of anti-DLL4 therapy in solid tumours in combination with a clinically relevant dose of ionising radiation (5 Gy; IR) and to analyse alterations in the Notch pathway induced by the treatments. Combining both treatments resulted in a greater than additive tumour growth delay in LS174T tumours, compared to either treatment alone. DLL4 blockade dysregulated vasculature and increased necrosis in LS174T and HCT-15 (DLL4-expressing and negative cell lines respectively) tumours within 3 days after treatment, but no changes were observed with IR alone. Additionally, combined IR and anti-DLL4 treatment of FaDu tumours (another DLL4-negative cell line) by our colleagues, also resulted in a supra-additive growth delay. These results show that combining IR with DLL4 blockade is an effective strategy for prolonging tumour growth delay and suggest that the stroma/vasculature provide the main therapeutic target for the anti-DLL4 therapy. Analysis of Notch pathway shows that IR upregulated Jag1 in tumour cells, and may inhibit Notch and downregulate DLL4 in the stroma. These changes may potentially affect tumour vessels and response to anti-DLL4 therapy. In vitro, anti-DLL4 therapy induced proliferation in quiescent contact-inhibited endothelial cells and also appeared to abrogate IR-induced inhibition of migration. These results suggest that DLL4 may be important in maintaining vessel quiescence and that IR may in part decrease migration through Notch signalling. Combining IR and DLL4 blockade to target tumour growth is an effective and well tolerated strategy and warrants further validation and refinement to be translated into clinical practice.