Thesis (PH. D.)--University of Chicago, 1918. / "Private edition, distributed by the University of Chicago Libraries, Chicago, Illinois." "Reprinted from the Journal of infectious diseases, vol. XXIV, no. 2, February 1919, pp. 81-113."

Made available in DSpace on 2014-06-11T19:27:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-03-16Bitstream added on 2014-06-13T20:36:37Z : No. of bitstreams: 1 bueno_rc_me_botfm_parcial.pdf: 184986 bytes, checksum: b4cc84cead8ca822c1ea62e1786a52da (MD5) Bitstreams deleted on 2015-03-20T11:45:13Z: bueno_rc_me_botfm_parcial.pdf,Bitstream added on 2015-03-20T11:45:48Z : No. of bitstreams: 1 000703048.pdf: 4139830 bytes, checksum: 4590a1be2f4cbb732b2d65f21b421cde (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Neste estudo foi proposto (1) validar a assinatura genética de metástase previamente identificada pelo grupo para cinco genes candidatos (POLR1B, IKBKB, TRIP10, PGM5 e ATM), identificados como centrais em redes biológicas e correlacionar os dados de expressão com os dados clínicos e histopatológicos das pacientes; (2) confirmar o valor prognóstico do gene ATM e o seu mecanismo de regulação pelo miR-203, miR-421, miR- 576-5p, miR-664, miR-26a, miR-26b e miR-18a. Foi utilizada a metodologia de RT-qPCR em 63 amostras de carcinomas mamários (CM) e 5 de tecido mamário normal. Foram observadas correlações positivas entre os níveis de expressão dos genes detectados pela técnica de microarray e RT-qPCR, embora sem significância estatística. Não foram observadas diferenças significativas na expressão destes genes nos CM quando comparados às amostras de mama normais. Nas comparações entre os níveis de expressão e as características clínicas e histopatológicas pode-se observar que os genes IKBKB, POLR1B e PGM5 apresentaram aumento significativo de expressão em tumores ER positivos. Foram observadas diminuições significativas dos transcritos de IKBKB, TRIP10, PGM5 e ATM em tumores HER2 positivos; para os genes PGM5 e ATM houve uma diminuição significativa de expressão nos tumores grau III. A análise da expressão proteica do ATM foi realizada por imunoistoquímica em 926 amostras de CM organizadas em quatro plataformas de microarranjos de tecidos. Foi verificada a diminuição da expressão da proteína ATM nos tumores quando comparados com a amostra de tecido mamário normal e sua diminuição estava associada a tumores de alto grau e metástase à distância. Pacientes com tumores ATM-negativos apresentaram diminuição do tempo de sobrevida livre de doença e de... / The present study aimed: 1) to validate the genetic signatures of metastasis previously detected by our group for five candidate genes (POLR1B, IKBKB, TRIP10, PGM5, and ATM), identified as central in biological networks, and to correlate the findings with clinical-histopathological data; 2) to confirm the prognostic value of the ATM gene and its mechanism of regulation by miR-203, miR-421, miR-576-5p, miR-664, miR-26a, miR- 26b and miR-18a. Sixty-three breast carcinomas (BC) samples and 5 normal breast tissue samples were evaluated by RT-qPCR. Positive correlations were observed between the gene expression levels detected by microarray and RT-qPCR, although not statistically significant. There was no significant difference between BC and normal samples. Overexpression of IKBKB, POLR1B, and PGM5 genes were significantly associated with ER positive tumours. Significant downexpression of IKBKB, TRIP10, PGM5 and ATM transcripts were observed in HER2-positive tumours. PGM5 and ATM downexpression were statistically associated with grade III tumours. ATM protein expression was evaluated by immunohistochemistry in 926 BC samples organized into four tissue microarray platforms. A decreased ATM protein expression was observed in tumours when compared to normal tissue as well as with high grade tumours and distant metastasis. Patients with ATM-negative tumours showed a decrease of diseasefree survival and overall survival. After multivariate analysis, ATM revealed to be an independent prognostic marker in BC and have been associated with lower risk of metastasis and death by disease (P<0.001, HR=0.535, and P<0.001, HR=0.534, respectively). A negative correlation between the transcript levels of ATM and the miR- 664 (P=0.035, r=-0.293), and miR-421 (P=0.075 e r=-0.249, respectively) was verified. The miR-26a... (Complete abstract click electronic access below)

Orientador: Silvia Regina Rogato / Coorientador: Sandra Drigo Linde / Banca: Patrícia Pintor dos Reis / Banca: Maria Isabel Alves de Souza Waddington Achatz / Resumo: Neste estudo foi proposto (1) validar a assinatura genética de metástase previamente identificada pelo grupo para cinco genes candidatos (POLR1B, IKBKB, TRIP10, PGM5 e ATM), identificados como centrais em redes biológicas e correlacionar os dados de expressão com os dados clínicos e histopatológicos das pacientes; (2) confirmar o valor prognóstico do gene ATM e o seu mecanismo de regulação pelo miR-203, miR-421, miR- 576-5p, miR-664, miR-26a, miR-26b e miR-18a. Foi utilizada a metodologia de RT-qPCR em 63 amostras de carcinomas mamários (CM) e 5 de tecido mamário normal. Foram observadas correlações positivas entre os níveis de expressão dos genes detectados pela técnica de microarray e RT-qPCR, embora sem significância estatística. Não foram observadas diferenças significativas na expressão destes genes nos CM quando comparados às amostras de mama normais. Nas comparações entre os níveis de expressão e as características clínicas e histopatológicas pode-se observar que os genes IKBKB, POLR1B e PGM5 apresentaram aumento significativo de expressão em tumores ER positivos. Foram observadas diminuições significativas dos transcritos de IKBKB, TRIP10, PGM5 e ATM em tumores HER2 positivos; para os genes PGM5 e ATM houve uma diminuição significativa de expressão nos tumores grau III. A análise da expressão proteica do ATM foi realizada por imunoistoquímica em 926 amostras de CM organizadas em quatro plataformas de microarranjos de tecidos. Foi verificada a diminuição da expressão da proteína ATM nos tumores quando comparados com a amostra de tecido mamário normal e sua diminuição estava associada a tumores de alto grau e metástase à distância. Pacientes com tumores ATM-negativos apresentaram diminuição do tempo de sobrevida livre de doença e de... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The present study aimed: 1) to validate the genetic signatures of metastasis previously detected by our group for five candidate genes (POLR1B, IKBKB, TRIP10, PGM5, and ATM), identified as central in biological networks, and to correlate the findings with clinical-histopathological data; 2) to confirm the prognostic value of the ATM gene and its mechanism of regulation by miR-203, miR-421, miR-576-5p, miR-664, miR-26a, miR- 26b and miR-18a. Sixty-three breast carcinomas (BC) samples and 5 normal breast tissue samples were evaluated by RT-qPCR. Positive correlations were observed between the gene expression levels detected by microarray and RT-qPCR, although not statistically significant. There was no significant difference between BC and normal samples. Overexpression of IKBKB, POLR1B, and PGM5 genes were significantly associated with ER positive tumours. Significant downexpression of IKBKB, TRIP10, PGM5 and ATM transcripts were observed in HER2-positive tumours. PGM5 and ATM downexpression were statistically associated with grade III tumours. ATM protein expression was evaluated by immunohistochemistry in 926 BC samples organized into four tissue microarray platforms. A decreased ATM protein expression was observed in tumours when compared to normal tissue as well as with high grade tumours and distant metastasis. Patients with ATM-negative tumours showed a decrease of diseasefree survival and overall survival. After multivariate analysis, ATM revealed to be an independent prognostic marker in BC and have been associated with lower risk of metastasis and death by disease (P<0.001, HR=0.535, and P<0.001, HR=0.534, respectively). A negative correlation between the transcript levels of ATM and the miR- 664 (P=0.035, r=-0.293), and miR-421 (P=0.075 e r=-0.249, respectively) was verified. The miR-26a... (Complete abstract click electronic access below) / Mestre

Les anatomopathologistes disposent d’outils permettant d’assister leurs décisions cliniques et d’évaluer les risques de récidive des patientes atteintes d’un cancer du sein. Parmi ceux-ci, le grade histologique du cancer du sein divise les patientes en trois sous-groupes pour lesquels le grade histologique 1 et 3 sont respectivement associés à de bons et mauvais pronostics. Cependant, cet outil est loin d’être parfait, dû au manque de reproductibilité de ce système et du risque de récurrence intermédiaire, peu informatif, des patients classés dans la catégorie « grade 2 ».<p>Afin de mieux caractériser ces tumeurs de risque intermédiaire, notre laboratoire a introduit un score appelé « Gene expression Grade Index (GGI) », basé sur l’expression de 97 gènes définis par microarrays. De façon intéressante, ce GGI permet de diviser les patientes de grade histologique 2, sur base de leur profil d’expression, en 2 groupes correspondant aux tumeurs de grade 1 ou aux tumeurs de grade 3. Cependant, bien que le GGI apporte une information importante, son applicabilité clinique est limitée par son prix et la nécessité d’utiliser du matériel congelé.<p>Durant ce travail de thèse, nous avons transposé la signature microarrays en un test RT-PCR, appelé PCR-GGI, basé sur l’expression de 8 gènes qui permet de reproduire les performances du GGI à partir de tissus congelés ou conservés dans de la paraffine. Cette amélioration permet de faciliter son utilisation en routine clinique. <p>De plus, nous avons approfondi notre connaissance du grade histologique, au niveau génomique et transcriptomique, et montré que les tumeurs mammaires (ER-positives) peuvent être divisées en deux groupes :un premier groupe de faible instabilité génomique, exprimant faiblement les gènes de prolifération et présentant un faible risque de récurrence ;et un deuxième groupe de haute instabilité génomique (impliquant principalement des amplifications localisées dans les régions 8q et 20q), une expression importante de gènes de prolifération et un mauvais pronostic.<p>D’autre part, les carcinomes canalaires in situ (DCIS) présentant des similarités avec les tumeurs invasives, nous avons voulu mieux comprendre le comportement du grade tumoral parmi ces tumeurs pré-invasives. Nous avons donc intégré le PCR-GGI au VNPI et défini le VNPI-GGI. Comparé au VNPI classique, le VNPI-GGI identifie mieux les patientes qui vont récidiver tôt dans les groupes de risque intermédiaire et haut, et permet donc d’éviter le sur-traitement.<p>Cependant, le calcul du VNPI est un travail fastidieux et le PCR-GGI seul ne permet pas de prédire les risques de récidives des DCIS. Nous avons donc cherché un nouveau marqueur pronostique. Alors, qu’il existe des preuves de plus en plus nombreuses supportant l’importance du rôle anti-tumoral des cellules myoépithéliales, nous avons montré qu’une diminution de l’expression de CD10 – un marqueur des cellules myoépithéliale – était hautement corrélée au risque de récidive. Ces résultats soulignent l’importance tant de l’agressivité de la tumeur que de son environnement directe, dans la progression tumorale.<p><p>En terme d’applications, les résultats obtenus durant ce travail de thèse nous ont permis de développer des outils utilisables par les cliniciens afin d’améliorer la prise en charge des patientes.<p><p><p><p>Traditional histopathological tools routinely used to evaluate breast cancer prognosis are designed to assist physicians in their evaluation of clinical outcome. The histological grade of invasive breast cancer, that assigns patients to one of 3 groups for which histological grade 1 and 3 tumors are respectively associated with lower and higher rate of recurrence, has long provided clinically important prognostic information. However, this tool is far from perfect due to concern over reproducibility and intermediate risk of recurrence of the histological grade 2 that is not informative for clinical decision. <p>To better characterize tumors classified as histological grade 2, our group has introduced a score called Gene expression Grade Index (GGI) based on a cassette of 97 genes defined by Microarrays. Interestingly, the GGI was able to reclassify patients with histological grade 2 tumors into 2 groups with distinct clinical outcomes similar to those of histological grade 1 and 3, respectively. However, its clinical applicability still remains expensive and often requires frozen tissue.<p>During this thesis work, we have transposed the GGI onto a qRT-PCR assay, called PCR-GGI, based on a set of 8 genes that could recapitulate in an accurate and reproducible manner the prognostic performance of GGI using both frozen and paraffin-embedded (FFPE) tumor samples, to facilitate its use in clinical practice. <p>Moreover, we have explored histological grade of invasive breast cancer at genomic and transcriptomic level and we have shown that two classes of ER-positive invasive breast cancer are observed: a first of low genomic instability, low proliferation gene expression and low risk of recurrence; and a second of high genomic instability (implying a major role for amplification of region located on chromosome arms 8q and 20q), high proliferation gene expression and worse prognosis.<p>In addition, since Ductal Carcinoma in situ (DCIS) and invasive breast cancer show concordant biologic behavior, we attempted to better understand the molecular basis of grade in pre-invasive breast cancer. We have then incorporated the PCR-GGI in the VNPI and defined the VNPI-GGI to improve its prognostic value. Compared to the classic VNPI, the VNPI-GGI had a better potential to identify early relapsing patients in the intermediate and high score group, and avoid under treatment in high-risk DCIS patients.<p>However, VNPI scoring is a tedious work and PCR-GGI alone can’t predict recurrence in pre-invasive breast cancer. We aimed then to find news prognosis marker in the field of DCIS. As there is now growing body of evidence supporting the role of myoepithelial cells (MECs) as natural tumor suppressors, we have showed that a decrease of CD10 expression- a surface biomarker of MECs – was significantly associated with an increased risk of relapse. <p>These results highlight the importance of assessing intrinsic DCIS properties as well as juxta-tumoral stroma, both seems to have a major role in DCIS progression.<p><p>In terms of applications, from these results obtained during this thesis work, we developed methods applicable into clinical practice to improve patients management.<p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished