Brain tumors are among the most devastating types of solid tumors to treat. Standard of care for glioblastoma (GBMs), the most aggressive form of primary brain tumors, has failed to improve the current survival rates in the past decades. Despite many other solid tumors, recent advances in cancer immunotherapies have also shown disappointing outcomes in GBMs. The heterogenous nature of GBMs, the immunosuppressive tumor microenvironment and the restrictive role of blood brain barrier (BBB) are some of the main challenges faced for treating GBMs. Electroporation-based treatments have demonstrated promising results, treating preclinical models of GBMs. It has been shown that low and high frequency irreversible electroporation treatments shift the immunosuppressive tumor microenvironment and reversibly open large areas of blood brain barrier (BBB). In this dissertation, in vitro cell culture models are utilized to study electroporation-based treatments for achieving a more optimized treatment for glioblastoma. We are proposing to utilize the immunomodulatory effects of electroporation treatments to improve the outcomes of immunotherapies in the brain. / Doctor of Philosophy / Despite the current advancements in treating solid tumors, brain tumors remain among the most difficult cancers to treat. The special structure of the brain as an organ as well as tumor complexity can lead to treatment failure. It is also known that infiltration of the immune cells within the tumor mass is limited due to the tumor's immunosuppressive nature. Hence, the use of newly advancing immunotherapy techniques is limited in the brain. Local treatments have become one of the most promising tools against brain tumors. Such treatments include methods that use excessive heating of the tissue to kill the tumors. Relying on heat for tissue destruction could damage the critical structures near the tumor and will reduce the favorable immune response after the treatment. A new treatment modality known as electroporation has been introduced for non-thermal treatment of brain tumors. Due to its non-thermal nature, electroporation treatments will allow for sparing of critical structures and can lead to a more robust immune response comparing to thermal treatment modalities. In this dissertation, we utilize electroporation-based treatments to try to overcome some of the challenges associated with treating brain tumors such as tumor heterogeneity and immune suppression.

Plusieurs arguments de la littérature suggèrent l’importance de l’alimentation dans le développement tumoral et l’efficacité des traitements anti-cancereux. Dans différents modèles animaux, la restriction calorique (CR) supprime la prolifération des cellules tumorales et les sensibilise aux thérapies ciblées. Par conséquent, des approches non-pharmacologiques comme la restriction calorique ont un intérêt grandissant en clinique. Considérant l’addiction des cellules tumorales aux nutriments, nous nous sommes demandé quels macronutriments pouvaient avoir des propriétés anticancéreuses. A partir d’un modèle murin de lymphomes B (modèle transgénique Eµ-Myc) nous avons testé l’impact de deux régimes alimentaires : l’un pauvre en glucides (Low CHO, 25% de réduction en glucides) et l’autre pauvre en protéines (Low PROT, 25% de réduction en protéines). Des souris syngéniques C57BL/6 ont été injectées par voie intraveineuse avec des cellules primaires Eμ-Myc. Malgré un apport alimentaire équivalent entre les groupes, nous avons observé que le régime pauvre en protéines augmente la survie globale des souris C57BL/6 développant un lymphome B Eµ-Myc. De manière intéressante, nous avons démontré que cet effet pro-survie est dépendant du système immunitaire. En effet, la déplétion des cellules T CD8+ ou l’utilisation d’un modèle murin immunodéficient NSG (NOD-SCID il2rγ), empêche l’effet bénéfique du régime pauvre en protéines sur le développement tumoral. Nous avons reproduit et étendu nos observations en utilisant des lignées modèles de cancéreuses colorectaux (CT26) et de mélanome (B16) injectée dans des souris syngéniques, immunocompétente. Les cellules tumorales étant fortement dépendantes des nutriments, nous avons émis l’hypothèse qu’un régime pauvre en protéines pourrait induire un stress du réticulum endoplasmique (RE) dans ces dernières. En effet, nous avons observé une augmentation des protéines impliquées dans la signalisation du RE : CHOP et sXBP1. Par conséquent, nous avons traité les souris nourries en régime pauvre en protéines avec deux inhibiteurs du stress du RE : TUDCA, inhibiteur générique et MKC4485 qui cible l’activité ribonucléase d’IRE1. Dans les deux cas, ces inhibiteurs ont bloqué l’effet du régime faible en protéines sur le développement tumoral et l’infiltration des T CD8+ au sein de la tumeur. Pour s’affranchir, des potentiels effets secondaires des inhibiteurs chimiques, nous avons invalidé IRE1 dans la lignée CT26 et nous avons obtenus des résultats similaires, démontrant que la voie IRE1 dans les cellules tumorales est une voie centrale dans la réponse immunitaire anticancéreuse induite par un régime pauvre en protéines. En outre, nous avons découvert que l’activation de RIG-I est un événement en aval de l’activation d’IRE1 et que, par analyse bio-informatique nous avons pu corréler une signature IRE1 à une infiltration immunitaire élevée et à une immunogénicité accrue du cancer chez les patients atteints de mélanome, glioblastome et cancer colorectal. De ce fait, nous avons démontré que la réponse du système immunitaire induite par un régime pauvre en protéines est une conséquence de l’activation accrue de IRE1 dans les cellules cancéreuses. / Several arguments from the literature suggested the importance of diets in cancer development and in the efficacy of anti-cancer therapies. Calorie restriction (CR) suppresses cancer growth in various animal models and sensitizes tumor cells to targeted therapies (Meynet & Ricci, 2014). Thus, non-pharmacologic approaches such as CR have a growing interest in the clinic. Considering the nutrient addiction of cancer cells, we wondered which specific macronutrients contribute the most to anti-cancer effects. Therefore, we tested the reduction in specific macronutrient without decrease in general calorie intake on tumor development. We used two diets: reduced in carbohydrates (Low CHO, -25% carbohydrates) and diet reduced in protein (Low PROT, -25% proteins) on the Eµ-Myc transgenic mouse model of B-cell lymphoma. Syngeneic C57BL/6 mice were intravenously injected with primary Eμ-Myc cells. We observed that low PROT-diet, in spite of equal calorie intake among the groups, resulted in increase of the overall survival of Eµ-Myc-bearing C57BL/6 mice. Very importantly, we established that this pro-survival effect is immune system-dependent as both depletion of CD8+ T cells and use of immunodeficient NSG (NOD-SCID il2rγ) mouse model prevented the beneficial effect of the low PROT-diet on the tumor development. We reproduced and further extended our observations using subcutaneous injection of CT26 colorectal cancer cells in syngeneic immunocompetent BALB/c mice and B16 melanoma in C57BL/6 mice. As tumor cells are highly dependent on nutrients, we speculated that low PROT diet could induce ER stress in tumor cells. Indeed, we observed increase in proteins implicated in ER stress signaling – CHOP and sXBP1. Therefore, we treated low PROT-diet fed mice with two ER stress inhibitors, the general inhibitor TUDCA or MKC4485, which targets IRE1 RNAse activity. In both cases, inhibitors significantly prevented the effect of the Low PROT-diet on tumor development and on intratumoral number of CD8+ T cells. To eliminate any side effects of chemical inhibitors, we invalidated IRE1 in CT26 cells and obtained similar results, demonstrating that IRE1 signaling in tumor cells is a central event in the low PROT-diet induced anti-cancer immune response. In addition, we have uncovered RIG-I activation as a downstream event of IRE1 activation and by bioinformatic analysis correlated high-IRE1 signature with high immune infiltration and enhanced immunogenicity of cancer in patients bearing melanoma, glioblastoma and colorectal cancer. Hence, we have shown that the immune system response elicited under a Low PROT diet is a consequence of increased IRE1 activation in cancer cells.

<p>Pancreatic ductal adenocarcinoma (PDAC) is an incredibly lethal disease with a 5-year survival rate of less than 8 percent in the United States due to a lack of viable treatment options. The failures of chemo- and radiotherapies have been linked to the heterogeneous nature of the tumor microenvironment which forms a hypovascular, immunosuppressive and high coagulation activity tissue. Indeed, PDAC patients have one of the highest rates of thrombosis complications among all cancer types. The expression of two key coagulation factors, Tissue Factor (TF) and Protease Activated Receptor 1 (PAR-1), have been associated with poor patient prognosis and aggressive cancer progression. However, the molecular roles/mechanisms of TF and PAR-1 in PDAC progression are not known. To establish how clotting factors (PAR-1, TF) influence PDAC tumor progression, I utilized a genetically modified mouse model (KPC) where <i>KRas^G12D</i> and <i>TRP53^R172H</i> mutations were specifically introduced into mouse pancreas acinar cells to initiate PDAC progression. Multiple primary mouse PDAC cell lines were generated and characterized. TF and PAR-1 were highly expressed in primary KPC pancreatic lesions, in PDAC tumors, and in KPC-derived cell lines, an expression profile that is also observed in PDAC patient biopsies. In allograft studies, tumor growth and metastatic potential were significantly diminished by shRNA reduction of TF or PAR-1 in cancer cells or by genetic or pharmacological reduction of the coagulation zymogen prothrombin in mice. Notably, PAR-1 deleted KPC cells (KPC-Par-1^KO) failed to generate sizable tumors; a phenotype completely rescued by restoration of PAR-1 expression. To test the significance of targeting PAR-1 in a clinical setting, PAR-1 expression was withdrawn from established tumors to mimic a potential inhibitory effect of PAR-1 on solid PDAC tumors. Removal of PAR-1 from tumors (11 days post injection) yielded a diverse effect on tumor growth which can be categorized into (i) a decline in tumor growth; (ii) continued tumor growth; and (iii) stagnant tumor growth. Immunohistochemistry analysis of KPC2 shCon vs. shPar-1 subcutaneous allograft tumor samples revealed a massive immune cell infiltration in KPC2 shPAR-1 tumors when compared to KPC2 shCon control tumors. Accordingly, KPC-Par-1^KO cells failed to form tumors in immune-competent mice but displayed robust tumor growth in immune-compromised <i>NSG</i> mice, providing the first evidence of a PAR-1 mediated tumor immune evasion pathway operating in PDAC. </p> <p>Together, these results demonstrate that PDAC disease is driven by activation of the coagulation system through tumor cell-derived TF, circulating prothrombin, and tumor cell-derived PAR-1. These studies also highlight a novel mechanism by which thrombin/PAR-1-mediated tumor growth involves suppression of anti-tumor immunity in the tumor microenvironment. <b></b></p>