Angiogênese é o termo utilizado para descrever o crescimento de novos vasos sanguíneos a partir dos já existentes. Vários estudos demonstraram a densidade microvascular (DMV) como um fator prognóstico nas leucemias, em particular, leucemia promielocítica aguda (LPA). Este subtipo de leucemia corresponde a cerca de 20 a 25% das leucemias mielóides agudas nos países latino-americanos e apresenta características clínicas, morfológicas e biológicas peculiares. A halofuginona (HF), originalmente descrita como um agente antifúngico apresenta capacidade de inibir o crescimento tumoral e formação de vasos em modelos animais de tumores sólidos. Estudos realizados por nosso grupo demonstraram que a HF inibiu a secreção do VEGF e a proliferação de linhagens celulares de LPA. Desta forma, o presente trabalho teve por objetivo determinar o potencial antiproliferativo e antiangiogênico da HF em um modelo experimental in vivo da LPA e avaliar os mecanismos subjacentes a sua ação. Primeiramente, a análise do ciclo celular em células NB4 tratadas com HF apresentou significativa diminuição da proliferação celular (2,093 ± 0,304 vs. 41,21 ± 3,25), juntamente com um aumento significativo da apoptose (12,53 ± 1,53 vs. 21,95 ± 0,79; p=0,0007). Por meio da técnica de Real Time Array foi possível identificar dois grupos de genes associados a apoptose celular diferencialmente expressos em células tratadas com HF: TNF, TNFRSF9, TNFTSF10B, CD40, FAS, CASP10, CASP8 e CASP3, sugerindo que a HF induz a via extrínseca de apoptose. A análise in vivo da HF foi realizada em camundongos NOD/SCID previamente irradiados e transplantados com células leucêmicas PML-RAR murinas. Camundongos tratados com HF, por 21 dias após o transplante não apresentaram remissão molecular, determinada pela amplificação do gene PML-RARA por PCR, porém foi observada menor infiltração leucêmica em relação aos camundongos não tratados (Leucócitos: 4,2 ± 3,89 vs. 20,6 ± 21,9; p<0.0001); Hemoglobina: 12,0 ± 1,40 vs. 9,6 ± 1,67; p<0.0001; e Plaquetas: 932,0 ± 122,5 vs. 552,0 ± 83,2; p<0.001 respectivamente) e um menor peso relativo do baço (0,006 vs. 0,012, p=0,0415). Ademais, a contagem diferencial e imunofenotipagem da medula óssea evidenciaram menor porcentagem de células mielóides imaturas (16,88 ± 6,27 vs. 44,06 ± 27,06). A HF também foi capaz de inibir a fosforilação de SMAD2 e consequentemente bloquear a via do TGF- em células NB4. No entanto, animais leucêmicos apresentaram menor nível sérico de TGF- em relação aos saudáveis e tratados (475,58 vs. 1.378,45/1.146,82 pg/mL; p<0,0001), sugerindo que o blasto leucêmico produz esta citocina e a diminuição de células leucêmicas resultou em diminuição dos níveis séricos de TGF-. A HF não aumentou a sobrevida dos animais leucêmicos e a elevação das enzimas hepáticas sugeriu que o tratamento foi hepatotóxico. Por fim, com relação à angiogênese, a análise da expressão gênica mostrou que o tratamento com HF inibiu a expressão de VEGF e EGF e o estudo por imunohistoquímica de seções da medula óssea evidenciou menor expressão VEGF (30 vs. 80%, p=0,0227), porém não houve diminuição da DMV. O conjunto desses resultados mostrou que a angiogênese é um importante alvo terapêutico na LPA, e que apesar da toxicidade, a HF apresenta potencial antileucêmico, tanto por conta de seus efeitos antiproliferativos e próapoptóticos, quanto por sua capacidade de inibir a produção de fatores próangiogênicos. / Angiogenesis is the term used to describe the growth of new blood vessels from the existing ones. Several studies have demonstrated the microvascular density (MVD) as a prognostic factor in leukemia, particularly acute promyelocytic leukemia (APL). This subtype of leukemia corresponds to 20-25% of acute myeloid leukemia in Latin America and presents clinical, morphological and biological peculiar characteristics. The halofuginone (HF) originally described as an antifungal agent has ability to inhibit tumor growth and vessel formation in animal models of solid tumors. Our group demonstrated that HF inhibits the VEGF secretion and cell proliferation in APL cell lineages. Thus, this study aimed to determine the antiproliferative and antiangiogenic potential of HF in an experimental model of APL in vivo and evaluate the mechanisms underlying its action. First, the cell cycle analysis in NB4 cells treated with HF showed a significant decrease in cell proliferation (2.093 ± 0.304 vs. 41.21 ± 3.25), along with a significant increase in apoptosis (12.53 ± 1.53 vs . 21.95 ± 0.79, p = 0.0007). Through Real Time Array it was possible to identify two groups of apoptosis associated genes differentially expressed in HF treated cells: TNF, TNFRSF9, TNFTSF10B, CD40, FAS, CASP10, CASP8 and CASP3, suggesting that HF induces apoptosis by extrinsic pathway. In vivo analysis of HF was performed in irradiated NOD/SCID mice transplanted with murine PML-RAR leukemic cells. Mice treated with HF for 21 days after transplantation showed no molecular remission as determined by amplification of PML-RARA gene by PCR, however minor leukemic infiltration was observed compared to untreated mice (leukocytes: 4.2 ± 3.89 vs . 20.6 ± 21.9, p <0.0001), hemoglobin: 12.0 ± 1.40 vs. 9.6 ± 1.67, p <0.0001, and Platelets: 932.0 ± 122.5 vs. 552.0 ± 83.2, p <0.001 respectively) and a lower relative weight of spleen (0.006 vs. 0.012, p = 0.0415). Furthermore, the differential count and immunophenotyping of bone marrow showed a lower percentage of immature myeloid cells (16.88 ± 6.27 vs. 44.06 ± 27.06). The HF was also able to inhibit the SMAD2 phosphorylation and consequently block the TGF- pathway in NB4 cells. However, leukemic animals presented lower serum TGF- compared to the healthy and treated (475.58 vs. 1378.45/1146.82 pg / mL, p <0.0001), suggesting that the leukemic blasts produces this cytokines and the decrease in leukemic cells resulted in decreased serum levels of TGF-. The HF did not increase the survival of leukemic animals and elevated liver enzymes suggested that the treatment was hepatotoxic. Finally, regarding angiogenesis, gene expression analysis showed that the HF treatment inhibited the expression of VEGF and EGF and the study by immunohistochemistry of sections of bone marrow showed less VEGF expression (30 vs. 80%, p = 0 0227), but there was no decrease in the MVD. Taken together, these results showed that angiogenesis is an important therapeutic target in APL, and despite the toxicity, HF has antileukemic potential, for both the antiproliferative and proapoptotic effects, and also for its ability to inhibit the production of proangiogenic factors.

Angiogênese é o termo utilizado para descrever o crescimento de novos vasos sanguíneos a partir dos já existentes. Vários estudos demonstraram a densidade microvascular (DMV) como um fator prognóstico nas leucemias, em particular, leucemia promielocítica aguda (LPA). Este subtipo de leucemia corresponde a cerca de 20 a 25% das leucemias mielóides agudas nos países latino-americanos e apresenta características clínicas, morfológicas e biológicas peculiares. A halofuginona (HF), originalmente descrita como um agente antifúngico apresenta capacidade de inibir o crescimento tumoral e formação de vasos em modelos animais de tumores sólidos. Estudos realizados por nosso grupo demonstraram que a HF inibiu a secreção do VEGF e a proliferação de linhagens celulares de LPA. Desta forma, o presente trabalho teve por objetivo determinar o potencial antiproliferativo e antiangiogênico da HF em um modelo experimental in vivo da LPA e avaliar os mecanismos subjacentes a sua ação. Primeiramente, a análise do ciclo celular em células NB4 tratadas com HF apresentou significativa diminuição da proliferação celular (2,093 ± 0,304 vs. 41,21 ± 3,25), juntamente com um aumento significativo da apoptose (12,53 ± 1,53 vs. 21,95 ± 0,79; p=0,0007). Por meio da técnica de Real Time Array foi possível identificar dois grupos de genes associados a apoptose celular diferencialmente expressos em células tratadas com HF: TNF, TNFRSF9, TNFTSF10B, CD40, FAS, CASP10, CASP8 e CASP3, sugerindo que a HF induz a via extrínseca de apoptose. A análise in vivo da HF foi realizada em camundongos NOD/SCID previamente irradiados e transplantados com células leucêmicas PML-RAR murinas. Camundongos tratados com HF, por 21 dias após o transplante não apresentaram remissão molecular, determinada pela amplificação do gene PML-RARA por PCR, porém foi observada menor infiltração leucêmica em relação aos camundongos não tratados (Leucócitos: 4,2 ± 3,89 vs. 20,6 ± 21,9; p<0.0001); Hemoglobina: 12,0 ± 1,40 vs. 9,6 ± 1,67; p<0.0001; e Plaquetas: 932,0 ± 122,5 vs. 552,0 ± 83,2; p<0.001 respectivamente) e um menor peso relativo do baço (0,006 vs. 0,012, p=0,0415). Ademais, a contagem diferencial e imunofenotipagem da medula óssea evidenciaram menor porcentagem de células mielóides imaturas (16,88 ± 6,27 vs. 44,06 ± 27,06). A HF também foi capaz de inibir a fosforilação de SMAD2 e consequentemente bloquear a via do TGF- em células NB4. No entanto, animais leucêmicos apresentaram menor nível sérico de TGF- em relação aos saudáveis e tratados (475,58 vs. 1.378,45/1.146,82 pg/mL; p<0,0001), sugerindo que o blasto leucêmico produz esta citocina e a diminuição de células leucêmicas resultou em diminuição dos níveis séricos de TGF-. A HF não aumentou a sobrevida dos animais leucêmicos e a elevação das enzimas hepáticas sugeriu que o tratamento foi hepatotóxico. Por fim, com relação à angiogênese, a análise da expressão gênica mostrou que o tratamento com HF inibiu a expressão de VEGF e EGF e o estudo por imunohistoquímica de seções da medula óssea evidenciou menor expressão VEGF (30 vs. 80%, p=0,0227), porém não houve diminuição da DMV. O conjunto desses resultados mostrou que a angiogênese é um importante alvo terapêutico na LPA, e que apesar da toxicidade, a HF apresenta potencial antileucêmico, tanto por conta de seus efeitos antiproliferativos e próapoptóticos, quanto por sua capacidade de inibir a produção de fatores próangiogênicos. / Angiogenesis is the term used to describe the growth of new blood vessels from the existing ones. Several studies have demonstrated the microvascular density (MVD) as a prognostic factor in leukemia, particularly acute promyelocytic leukemia (APL). This subtype of leukemia corresponds to 20-25% of acute myeloid leukemia in Latin America and presents clinical, morphological and biological peculiar characteristics. The halofuginone (HF) originally described as an antifungal agent has ability to inhibit tumor growth and vessel formation in animal models of solid tumors. Our group demonstrated that HF inhibits the VEGF secretion and cell proliferation in APL cell lineages. Thus, this study aimed to determine the antiproliferative and antiangiogenic potential of HF in an experimental model of APL in vivo and evaluate the mechanisms underlying its action. First, the cell cycle analysis in NB4 cells treated with HF showed a significant decrease in cell proliferation (2.093 ± 0.304 vs. 41.21 ± 3.25), along with a significant increase in apoptosis (12.53 ± 1.53 vs . 21.95 ± 0.79, p = 0.0007). Through Real Time Array it was possible to identify two groups of apoptosis associated genes differentially expressed in HF treated cells: TNF, TNFRSF9, TNFTSF10B, CD40, FAS, CASP10, CASP8 and CASP3, suggesting that HF induces apoptosis by extrinsic pathway. In vivo analysis of HF was performed in irradiated NOD/SCID mice transplanted with murine PML-RAR leukemic cells. Mice treated with HF for 21 days after transplantation showed no molecular remission as determined by amplification of PML-RARA gene by PCR, however minor leukemic infiltration was observed compared to untreated mice (leukocytes: 4.2 ± 3.89 vs . 20.6 ± 21.9, p <0.0001), hemoglobin: 12.0 ± 1.40 vs. 9.6 ± 1.67, p <0.0001, and Platelets: 932.0 ± 122.5 vs. 552.0 ± 83.2, p <0.001 respectively) and a lower relative weight of spleen (0.006 vs. 0.012, p = 0.0415). Furthermore, the differential count and immunophenotyping of bone marrow showed a lower percentage of immature myeloid cells (16.88 ± 6.27 vs. 44.06 ± 27.06). The HF was also able to inhibit the SMAD2 phosphorylation and consequently block the TGF- pathway in NB4 cells. However, leukemic animals presented lower serum TGF- compared to the healthy and treated (475.58 vs. 1378.45/1146.82 pg / mL, p <0.0001), suggesting that the leukemic blasts produces this cytokines and the decrease in leukemic cells resulted in decreased serum levels of TGF-. The HF did not increase the survival of leukemic animals and elevated liver enzymes suggested that the treatment was hepatotoxic. Finally, regarding angiogenesis, gene expression analysis showed that the HF treatment inhibited the expression of VEGF and EGF and the study by immunohistochemistry of sections of bone marrow showed less VEGF expression (30 vs. 80%, p = 0 0227), but there was no decrease in the MVD. Taken together, these results showed that angiogenesis is an important therapeutic target in APL, and despite the toxicity, HF has antileukemic potential, for both the antiproliferative and proapoptotic effects, and also for its ability to inhibit the production of proangiogenic factors.

Acute promyelocytic leukemia (APL) is a clinically distinct and rare type of acute myeloid leukemia and represents an oncologic emergency. Even rarer is the incidence of APL in pregnancy with less than 60 cases described in the literature. A 33-year-old pregnant female at 34 week gestation presented to hospital with reports of abdominal pain. On admission she was found to have acute onset pancytopenia with a WBC count of 1.2, Hemoglobin of 9.7g/dl, and platelet count of 26000. Initial history, exam, and investigations including a peripheral smear, coagulation panel, liver function, vitamin b12 and folate levels did not reveal possible etiology of pancytopenia. Given worsening pancytopenia, bone marrow biopsy was done which showed 58% promyelocytes and 11% blasts with numerous Auer rods present. Cytogenetics showed abnormal female karyotype with t(15:17) and FISH analysis revealed PML/RARA fusion in 76.5% of analyzed cells. The above findings were diagnostic of APL. After multidisciplinary discussion with high risk obstetrics physician, it was decided to immediately induce labor for immediate initiation of treatment of APL. She had a prolonged labor requiring aggressive blood product support and initiation of All trans retinoic acid (ATRA) before delivery given concerns of coagulopathy. Induction treatment with Arsenic trioxide (ATO) was started the day after her delivery. Repeat bone marrow biopsy on day 24 showed complete morphologic remission. Shortly thereafter, she started cycle 1 of consolidation with ATRA and arsenic trioxide. APL is characterized by a translocation between chromosome 15 and 17. Coagulopathy is a pathognomonic feature of this leukemia and often the reason for high mortality in early course of disease. APL when treated with ATRA and ATO, has excellent remission rate and 99% overall survival at 2 years. APL in pregnancy is associated with increased risk of preterm delivery, perinatal mortality, and miscarriage. Following pregnancy, there is an increased risk of bleeding, infection, or placental abruption. ATRA, one of the pillars around which treatment of APL revolves, is highly teratogenic during the first trimester and has low risk later in pregnancy. Treatment is directed by the trimester of pregnancy. Termination of pregnancy or treatment with single agent conventional chemotherapy is preferred in the first trimester whereas treatment with ATRA prior to delivery and use of chemotherapy after delivery is the preferred approach in the 2nd and 3rd trimester. This case is an example of individualized approach with a multidisciplinary team need in the setting of scarce data.

La télomérase, enzyme qui permet le maintien de la longueur des télomères est activée dans la majorité des cellules cancéreuses. Du fait de son rôle dans l’immortalité cellulaire, elle a été proposée comme cible de nouvelles stratégies anticancéreuses; il est donc fondamental d’identifier les mécanismes de sa régulation. Des travaux récents du laboratoire ont démontré, en utilisant une lignée de leucémie aiguë promyélocytaire résistante à la différenciation par les rétinoïdes (NB4-LR1), que l’acide rétinoïque tout trans (ATRA) induit une répression transcriptionnelle de hTERT, sous-unité catalytique de la télomérase, indépendamment de la différenciation. Cette répression est également associée à la mort des clones résistants. Il a également été montré lors du traitement par l’ATRA de cellules résistantes à cette répression, NB4-LR1SFD, qu’il existait une hyperméthylation de la région distale du promoteur de hTERT associée à la persistance de sa transcription et à la prolifération cellulaire. Ceci nous a conduit à proposer un modèle de régulation de hTERT dans lequel l'induction de modifications épigénétiques de la région distale de son promoteur empêcherait la fixation d'éventuels répresseurs. Des résultats récents suggèrent que WT1, facteur connu pour contribuer à la répression de hTERT, pourrait être un de ces facteurs. WT1 code pour un facteur de transcription à doigt de zinc et a été décrit pour la première fois comme délété dans les tumeurs de Wilms (tumeurs rénales de l’enfant). Cependant le rôle de WT1 dans développement tumoral varie en fonction des modèles cellulaires ; il peut avoir un rôle d’oncogène ou au contraire agir comme un gène suppresseur de tumeur. Dans le but d’élucider les mécanismes de régulation de la télomérase, nous avons donc voulu étudier le rôle de WT1 dans la répression de hTERT. Pour ce travail, nous avons utilisé deux modèles cellulaires :• La Leucémie aigue promyélocytaire (LAP) : leucémie aigue myéloblastique caractérisée par un transcrit de fusion impliquant le récepteur aux rétinoïdes.• Le neuroblastome : tumeur solide extra crânienne la plus fréquente chez l’enfant. Cette maladie est très hétérogène aussi bien au niveau biologique que clinique ; en effet certaines formes peuvent régresser spontanément alors que d’autres, très agressives, sont résistantes à toutes les thérapeutiques actuelles. Cette hétérogénéité clinique est notamment liée à la différenciation de la tumeur et également à la présence ou non de l’amplification de l’oncogène N-Myc qui a un rôle pronostic majeur dans cette maladie. Les voies de signalisations impliquées dans le fort pouvoir tumorigène des neuroblastomes ne sont pas encore clairement identifiées.Nous avons pu montrer dans ces modèles que WT1 réprime hTERT et que cette répression semble fonction de l'état de méthylation de la région distale du promoteur de hTERTLa 2ème partie de mon travail a été d’étudier le rôle de WT1 dans les neuroblastomes. Les résultats de nos travaux montrent que WT1 est plus exprimé dans les tumeurs sans amplification de N-Myc et dont la différenciation est stromale. Cependant la surexpression de WT1 dans des tumeurs sans amplification de N-Myc semble associée à un moins bon pronostic. L’étude de l’expression de WT1 pourrait constituer un outil pronostic intéressant dans ces tumeurs. / Telomerase is expressed and active in most immortalized cells. Whereas telomerase becomes activated during neoplastic transformation, its activity decreases during differentiation of various immortal cells in response to pharmacological agents, including retinoids. We showed using both an Acute Promyelocytic Leukemia (APL) cellular model (NB4 cell model) and Neuroblastoma cells that all-trans-retinoic acid (ATRA) induced a transcriptional repression of the catalytic subunit of telomerase, hTERT, associated with differentiation. This repression also occurred independently of differentiation, as demonstrated during long term treatment of ATRA-induced maturation resistant NB4-LR1, leading to telomere shortening, growth arrest and cell death. Changes in chromatin environment of hTERT promoter and binding of transcriptional factors have been demonstrated in differentiating cells when hTERT is repressed. However, it is not clear whether these changes are directly involved in hTERT repression or only linked to differentiation. A variant cell line was isolated from NB4-LR1 cells, (NB4-LR1SFD), which bypassed the death step because of a re-activated telomerase and resisted to hTERT repression despite the continuous presence of ATRA. Using both NB4-LR1 and NB4-LR1SFD cells, it was shown that the mechanisms of ATRA-induced hTERT repression involved: 1) a switch from c-myc to mad1 binding at the proximal domain of hTERT promoter, 2) epigenetic modifications of the distal domain of hTERT promoter (-600 -250 nucleotides). Indeed, the persistence of hTERT transcription was associated with an hypermethylation of the distal domain in ATRA-treated NB4-LR1SFD. Interestingly, the binding of a known hTERT repressor, WT1, to this distal domain, was defective in NB4-LR1SFD. The first part of my thesis was to investigate the role in hTERT transcriptionnal regulation of both c-myc and WT1, two transcription factors, which bind to the proximal and the distal region of hTERT promoter, respectively. The second part was to determine the role of WT1 in neuroblastoma. Neuroblastoma is the most common extra cranial solid tumor in childhood and the most frequently diagnosed neoplasm during the infancy. A striking feature of this tumor is its clinical heterogeneity. Among tumor progression markers delineated so far, MYCN amplification occurs in about 25% of total neuroblastoma cases and this percentage increases at 30% in advanced stage NEUROBLASTOMA. Despite the fact that MYCN amplification is strongly correlated with neuroblastoma of poor outcome, MYCN status cannot predict all cases of poor survival in neuroblastoma. In addition, neuroblastoma without MYCN amplification (about 70-80% of neuroblastoma) are far to display favorable behavior. WT1 was initially identified as a tumor suppressor gene involved in the development of a pediatric renal tumor (Wilm’s tumor). Here, we describe an inverse correlation between WT1 expression and MYCN amplification and expression. However and most notably, our results show that WT1 gene expression is associated with a poor outcome for patients showing non-MYCN-amplified tumors. Thus WT1 expression may be a prognostic marker for a better risk-stratification and for an optimized therapeutic management of neuroblastoma.

Le couple télomère/télomérase apparaît comme une cible prometteuse pour de potentiels agents anticancéreux qui seraient actifs sur un large éventail de tumeurs. Le laboratoire d’accueil a montré dans un modèle de leucémie aiguë promyélocytaire (LAP), qu'un agent utilisé en clinique, l'acide rétinoïque (ATRA), exerce une activité anti-tumorale en réprimant la transcription de la sous-unité catalytique hTERT indépendamment de la différenciation. Ce modèle (NB4) avec ses variants cellulaires résistant (NB4-LR1SFD) ou non à la répression de hTERT (NB4-LR1) par l’ATRA constitue un outil de choix pour l’identification de facteurs régulateurs de hTERT et la recherche des bases moléculaires de sa réactivation.Une approche transcriptomique a été utilisée afin d’identifier de nouveaux gènes et/ou réseaux de signalisation induits par l’ATRA et régulateurs de hTERT. L’analyse bioinformatique nous a permis de construire des profils d’expression différentielle entre les 2 lignées et des réseaux d’interaction. Parmi les candidats, H19, un ARN long de 2.5Kb, polyadénylé et non codant. H19 est classé parmi les gènes supresseurs de tumeurs : en son absence il y a développement de cancer (cas de la tumeur de Wilms, rhabdomyosarcome embryonnaire, Syndrome Beekwith-Wiedman) ; sa réintroduction par transfection conduit à une perte de tumoriginicité. Cependant H19 est reconnu de plus en plus comme un oncogène vu que son expression est élevée dans plusieurs types de cancers solides. Par contre peu d’études s’intéressent au rôle de H19 dans les leucémies, d’où notre intérêt pour l’étudier dans le modèle LAP que nous avons développé.Nous avons mis au point la mesure d’expression de H19 par RT-PCR quantitative, validé les données obtenues dans l’analyse transcriptomique et montré que le traitement ATRA induit l’expression de H19 dans les cellules NB4-LR1 alors que cette expression est plutôt diminuée dans les cellules NB4-LR1SFD. L’induction observée dans les cellules NB4-LR1 existe indépendamment de la différenciation. Par contre, cette induction peut être observée associée à la différenciation ou à l’apoptose dans la lignée cellulaire NB4-LR1SFD parallèlement à une diminution importante de l’expression de hTERT. Ce résultat important montre que la lignée NB4-LR1SFD ne présente pas de défaut général d’induction de H19. Ces données suggèrent l’existence d’une corrélation inverse entre le niveau d’expression de hTERT et celui de H19 dans ce modèle cellulaire. De façon importante, l’analyse des banques de données issues de patients LAP publiquement accessibles retrouve cette corrélation inverse.Une diminution d’activité télomérasique est observée dans des extraits cellulaires incubés en présence de l’ARN H19 transcrit in vitro. Cette diminution d’activité est observée aussi après surexpression de H19 in cellulo. Les expériences de RIP (RNA immunoprecipitation) ont montré une diminution de la quantité de hTR lié à hTERT suite à une augmentation d’expression de H19 après traitement ATRA in vitro ou après surexpression de H19 in cellulo. Une hypothèse serait que H19 induirait un déplacement de hTR du complexe hTR-hTERT. Cependant, les expériences de « pull-down » n’ont pas réussi à confirmer l’hypothèse d’une interaction possible entre l’ARN H19 et la protéine TERT.Mon travail de thèse identifie pour la première fois H19, un ARN long non codant, comme facteur régulateur potentiel de hTERT pouvant modifier son activité. Ce travail proposerait non seulement un mécanisme nouveau de régulation de l’activité télomérase mais aussi une fonction nouvelle pour H19 dans ce type de cancer. / The telomere / telomerase pair appears to be a promising target for potential anticancer agents that would be active on a wide range of tumors. The host laboratory has shown in a model of acute promyelocytic leukemia (APL), that a clinically used agent, retinoic acid (ATRA), exerts anti-tumor activity by repressing the transcription of the catalytic subunit hTERT regardless of differentiation. This model (NB4) with its resistant cell variants (NB4-LR1SFD) or not to the repression of hTERT (NB4-LR1) by ATRA is a tool of choice for the identification of hTERT regulatory factors and the search for molecular bases of its reactivation.A "microarray" approach has been used to identify new ATRA-mediated genes and / or signaling networks and potential hTERT regulators. Bioinformatic analysis allowed us to build differential expression profiles between the 2 lineages and interaction networks. Among the candidates, H19, a 2.5Kb long, polyadenylated and non-coding RNA. H19 is classified as a tumor suppressor gene: in its absence there is cancer development (case of Wilms tumor, embryonic rhabdomyosarcoma, Beckwith-Wiedman syndrome); its reintroduction by transfection leads to a loss of tumorigenicity. However H19 is increasingly recognized as an oncogene as its expression is elevated in several types of solid cancers. However, few studies are interested in the role of H19 in leukemias, hence our interest in studying it in the APL model that we have developed.We developed the H19 expression measurement by quantitative RT-PCR, validated the data obtained in the "microarray" analysis and showed that the ATRA treatment induces the expression of H19 in NB4-LR1 cells whereas this expression is rather diminished in NB4-LR1SFD cells. The induction observed in NB4-LR1 cells exists independently of differentiation. On the other hand, this induction can be observed associated with the differentiation or apoptosis in the NB4-LR1SFD cell line in parallel with a significant decrease in the expression of hTERT. This important result shows that the NB4-LR1SFD line does not have a general H19 induction defect. These data suggest the existence of an inverse correlation between the expression level of hTERT and that of H19 in this cellular model. Importantly, the analysis of publicly accessible APL patients’ databases finds this inverse correlation as well.We observed a decrease in telomerase activity in cellular extracts incubated in the presence of in vitro transcribed H19 RNA. This decrease in activity was also observed after overexpression of H19 in cellulo. The RIP (RNA immunoprecipitation) experiments showed a decrease in hTR amount bound to hTERT following an increase in H19 expression after ATRA treatment in vitro or after overexpression of H19 in cellulo. We hypothesize that H19 induces a displacement of hTR from the hTR-hTERT complex. However, the "pull-down" experiments failed to confirm the hypothesis of a possible interaction between H19 RNA and TERT protein.My thesis work identifies, for the first time, the long non-coding RNA H19, as a potential regulator of hTERT that can modify its activity. This work would propose not only a new mechanism of regulation of telomerase activity but also a new function for H19 in this type of cancer.

Patients with acute promyelocytic leukemia (APL) often present with potentially lifethreatening hemorrhagic diathesis. The underlying pathomechanisms of APLassociated coagulopathy are complex. However, two pathways considered to be APLspecific had been identified: 1) annexin A2 (ANXA2)-associated hyperfibrinolysis and 2) podoplanin (PDPN)-mediated platelet activation and aggregation. In contrast, since disseminated intravascular coagulation (DIC) is far less frequent in patients with non- APL acute myeloid leukemia (AML), the pathophysiology of AML-associated hemorrhagic disorders is not well understood. Furthermore, the potential threat of coagulopathy in non- APL AML patients may be underestimated. Herein, we report a patient with non-APL AML presenting with severe coagulopathy with hyperfibrinolysis. Since his clinical course resembled a prototypical APL-associated hemorrhagic disorder, we hypothesized pathophysiological similarities. Performing multiparametric flow cytometry (MFC) and immunofluorescence imaging (IF) studies, we found the patient’s bone-marrow mononuclear cells (BM-MNC) to express ANXA2 - a biomarker previously thought to be APL-specific. In addition, whole-exome sequencing (WES) on sorted BM-MNC (leukemiaassociated immunophenotype (LAIP)1: ANXAlo, LAIP2: ANXAhi) demonstrated high intratumor heterogeneity. Since ANXA2 regulation is not well understood, further research to determine the coagulopathy-initiating events in AML and APL is indicated. Moreover, ANXA2 and PDPN MFC assessment as a tool to determine the risk of life-threatening DIC in AML and APL patients should be evaluated.

La leucémie aiguë promyélocytaire (APL) est un cancer des globules blancs qui se caractérise par l’accumulation de granulocytes immatures appelés promyélocytes. Dans la majorité des cas, la maladie est causée par la translocation réciproque des gènes RARα et PML, menant à l’expression de la protéine de fusion PML/RARα qui compromet à la fois les fonctions assurées normalement par RARα et par PML. Ainsi, la répression de la transcription des gènes cibles de RARα et la perturbation de la formation des corps nucléaires PML seraient la cause de la non-différenciation et de la survie par inhibition de l’apoptose des promyélocytes. Un des agents thérapeutiques utilisés dans le traitement de la maladie est le trioxyde d’arsenic (ATO) et malgré le fait que son efficacité soit prouvée, les mécanismes moléculaires par lesquels il exerce son action ne sont pas entièrement caractérisés. PML étant SUMOylée en réponse à l’ATO, nous avons émis l’hypothèse que d’autres protéines pourraient être régulées dans leurs modifications post-traductionnelles (PTMs) en réponse à l’agent thérapeutique et pourraient occuper un rôle dans le processus de guérison. Une analyse par protéomique quantitative de cellules HEK293 traitées à l’ATO a permis d’identifier 92 protéines significativement régulées en SUMOylation, incluant certains substrats connus de la caspase-3. Suite à cette observation, nous avons supposé que la SUMOylation pourrait protéger les substrats de la caspase-3 de leur clivage protéolytique. À l’aide d’essais in vitro et d’immunobuvardages, nous avons confirmé que la SUMOylation de PARP1 empêche son clivage par la caspase-3, ce qui pourrait jouer un rôle dans le destin cellulaire. / Acute promyelocytic leukemia (APL) is a cancer of white blood cells characterized by the accumulation of immature granulocytes called promyelocytes. In most cases, the disease is caused by the reciprocal translocation of the RARα and PML genes, leading to the expression of the PML/RARα fusion protein that compromises both the functions normally provided by RARα and by PML. Thus, repression of the transcription of RARα target genes and disruption of the formation of PML nuclear bodies may cause the non-differentiation of promyelocytes and the promotion of their survival by inhibition of apoptosis. One of the therapeutic agents used to treat the disease is arsenic trioxide (ATO) and despite the fact that its effectiveness is proven, the molecular mechanisms through which it exerts its action are not fully characterized. Since PML is SUMOylated in response to ATO, it is likely that other proteins may also exhibit changes in their post-translational modifications (PTMs) and play a role in the response. By using large-scale proteomic workflows on HEK293 cells following ATO treatment, we identified 92 proteins that shown significant changes in SUMOylation, including some known capase-3 substrates. Following this observation, we surmised that SUMOylation may protect these substrates from caspase-3 cleavage. Using in vitro assays and immunoblots, we confirmed that SUMOylation of PARP1 prevents its cleavage by caspase-3, an event that could mediate cell fate.

Background: Acute promyelocytic leukemia (APL) is considered a hematologic emergency due to high risk of bleeding and fatal hemorrhages being a major cause of death. Despite lower death rates reported from clinical trials, patient registry data suggest an early death rate of 20%, especially for elderly and frail patients. Therefore, reliable diagnosis is required as treatment with differentiation-inducing agents leads to cure in the majority of patients. However, diagnosis commonly relies on cytomorphology and genetic confirmation of the pathognomonic t(15;17). Yet, the latter is more time consuming and in some regions unavailable. - Methods: In recent years, deep learning (DL) has been evaluated for medical image recognition showing outstanding capabilities in analyzing large amounts of image data and provides reliable classification results. We developed a multi-stage DL platform that automatically reads images of bone marrow smears, accurately segments cells, and subsequently predicts APL using image data only. We retrospectively identified 51 APL patients from previous multicenter trials and compared them to 1048 non-APL acute myeloid leukemia (AML) patients and 236 healthy bone marrow donor samples, respectively. - Results: Our DL platform segments bone marrow cells with a mean average precision and a mean average recall of both 0.97. Further, it achieves high accuracy in detecting APL by distinguishing between APL and non-APL AML as well as APL and healthy donors with an area under the receiver operating characteristic of 0.8575 and 0.9585, respectively, using visual image data only. - Conclusions: Our study underlines not only the feasibility of DL to detect distinct morphologies that accompany a cytogenetic aberration like t(15;17) in APL, but also shows the capability of DL to abstract information from a small medical data set, i. e. 51 APL patients, and infer correct predictions. This demonstrates the suitability of DL to assist in the diagnosis of rare cancer entities. As our DL platform predicts APL from bone marrow smear images alone, this may be used to diagnose APL in regions were molecular or cytogenetic subtyping is not routinely available and raise attention to suspected cases of APL for expert evaluation.

Les leucémies myéloïdes aiguës (LMA) consistent en un groupe de cancers agressifs causés par une accumulation de mutations génétiques et épigénétiques survenant dans les cellules souches ou progénitrices de la moelle osseuse. Il s’agit d’un groupe de maladies très hétérogène, caractérisé par un grand nombre de combinaisons d’altérations qui perturbent à la fois les voies de signalisation qui y sont exprimées, leur sensibilité aux différents traitements et le pronostic des patients. Le déploiement des technologies de séquençage de nouvelle génération au courant de la dernière décennie a permis l’exploration à une échelle sans précédent du paysage mutationnel et transcriptomique de différents cancers, incluant les LMA. Dans le cadre de nos travaux, nous avons voulu tester l'hypothèse selon laquelle les LMA se déclinent en plusieurs sous-groupes génétiques caractérisés chacun par des mutations distinctes et une expression génique dérégulée, ainsi qu’une réponse différentielle à des molécules qui pourraient représenter de nouvelles stratégies thérapeutiques. Nous avons testé cette hypothèse au sein de la cohorte Leucegene, qui comprend un grand nombre de LMA primaires analysées par le séquençage du transcriptome, et nous avons analysé les différences entre les différents sous-groupes en les analysant un à la fois. Cette étude des différents sous-groupes nous a permis de disséquer le profil génomique, transcriptomique et les sensibilités aux petites molécules de sept sous-groupes génétiques, représentant environ la moitié des cas de LMA de l’adulte. Notre approche a permis de découvrir plusieurs nouvelles mutations spécifiques aux différents sous-groupes, dont certaines ont été validées dans des cohortes indépendantes. Nous avons également confirmé que les gènes différentiellement exprimés dans les sous-groupes sont plus informatifs que les signatures d'expression non supervisées pour identifier les biomarqueurs de la maladie. Nous avons ainsi identifié dans la majorité des sous-groupes des gènes représentant un biomarqueur d'intérêt, ayant une pertinence fonctionnelle ou pronostique. Ces données ont également mené à des criblages chimiques ciblés qui ont identifié de nouvelles vulnérabilités dépendant du contexte génétique. Au-delà de ces observations, nos travaux pourraient avoir une portée translationnelle tandis que le séquençage de nouvelle génération est de plus en plus utilisé en clinique. La combinaison avec d’autres modalités de séquençage et l’incorporation de technologies émergentes aideront à poursuivre la dissection génomique, transcriptomique et chimique de la LMA et l’approche utilisée pourra même éventuellement s’appliquer à d’autres types de cancers. / Acute myeloid leukemias (AML) are a group of cancers caused by an accumulation of genetic and epigenetic mutations occurring in the stem or progenitor cells of the bone marrow. They represent a very heterogeneous group of diseases, characterized by a large number of combinations of alterations which disrupt to varying degrees key networks in these cells, their sensitivity to treatments and the prognosis of the patients. The deployment of next-generation sequencing technologies over the past decade has enabled exploration on an unprecedented scale of the mutational and transcriptomic landscape of various cancers, including AML. As part of our work, we tested the hypothesis according to which AMLs comprise several genetic subgroups, each characterized by distinct mutations and deregulated gene expression profiles, as well as a differential response to molecules that could represent novel therapies. We tested this hypothesis in the Leucegene cohort, which includes a large number of primary AMLs analyzed by transcriptome sequencing, which we explored one subgroup after the other, dissecting the genomic, transcriptomic or small molecule sensitivities profile of seven AML subgroups representing approximately half of adult AML cases. Our approach has allowed us to discover several new mutations specific to different subgroups, some of which have been validated in independent cohorts. We also confirmed that genes differentially expressed in subgroups are more informative than unsupervised expression signatures, and we identified genes representing potential biomarkers, or having a functional or prognostic relevance in the majority of subgroups. Generated data also led to targeted chemical screens performed on primary AML cells, which identified new context-dependent vulnerabilities. Beyond these observations, our work could have a translational scope while next-generation sequencing is paving its way in the clinic. The combination with other Omics and the incorporation of emerging technologies will help to further the multi-dimensional dissection of these groups and additional ones, as the presented approach could be applied to additional disease subsets and cancer types.