Brain tumors are abnormal tissue masses found, either malignant or benign in nature. Medulloblastoma is a brain tumor subtype found to arise in the hind region of the brain, which is highly malignant and has poor long term prospects in general. On the basis of the driving force behind the tumor, medulloblastoma is further subgrouped into 4 categories: WNT; SHH; Group 3 and Group 4 tumors. Group 3 tumors show a high expression of N-Myc protein which is seen in certain types of cancerous cells. The cell cycle is regulated at several checkpoints by cyclin/cdk inhibitors. The primary cilium is an organelle found on the cellular surface, which has functions in cell growth, differentiation and neurogenesis. Aurora kinase is a protein kinase involved in the regulation and maintainence of the cilium. Often the cilium gets deleted from the cellular surface in tumors coupled with an increase in the kinase level inside the cells. Hence aurora kinase is found to be a viable target for therapy. Aurora kinase is also involved in stabilizing the MYCN gene by protecting it from degradation. In this project, the primary cilum was studied in neural stem cells and followed by study of its presence on tumor cells in culture. The gene involved in cilium development i.e. Kif3a was mutated and its aggressive nature was compared with that of the tumor cells. Aurora kinase was commonly found to be over-expressed in both the tumors and the mutants whereas N-Myc over-expression was seen only in tumors. Experiments suggest that cilia repression in Kif3a mutants takes place via an aurora kinase dependent pathway.

Aurora A and B are the major kinases that control key events in mitosis, such as centrosome function, spindle assembly, chromosome segregation and cytokinesis, through phosphorylation of multiple proteins. These kinases share identical consensus target motifs, so the substrate specificity is determined by distinctive sub-cellular localization of the Auroras. Many proteins have been identified as targets of either Aurora A, or Aurora B, or both kinases by mass spectrometry studies. However, only a few of the identified phosphorylation sites in these targets have a characterized function in vivo. Therefore, the molecular mechanisms underlying the regulation of certain mitotic events by Aurora kinases remain unclear. The objective of my work was to develop a tool for identifying new substrates of both Aurora kinases. More specifically, I aimed to identify the molecular targets of Aurora A at the kinetochores, and determine how Aurora A contributes to the error correction near spindle poles. I first demonstrated that the outer kinetochore protein HEC1/Ndc80, phosphorylated by Aurora B at kinetochores, can also be phosphorylated by Aurora A close to the centrosomes (Chapter 2). My finding showed that Aurora kinases can share substrates in the cells and revealed the mechanism by which Aurora A contributes to the error-correction near spindle poles. To identify and characterise novel substrates of Aurora kinases, I developed a bioinformatic approach in collaboration with the Centre Bioinformatician, Alastair Kerr. This bioinformatic method uses the Auroras’ shared consensus motifs combined with several parameters that control the substrate specificity of Aurora kinases. I tested the phosphorylation of the chosen candidates in vitro using radiolabelled kinase assays. In my study, five proteins were validated - SPICE1, TTLL4, AHCTF1, CLASP2 and an uncharacterized protein KIAA1468 - as in vitro substrates of Aurora A and Aurora B kinases (Chapter 3). I then focussed on the Aurora kinases-dependent regulation of spindle and centriole-associated protein, SPICE1, in cells (Chapter 4). Using either site-directed mutagenesis of SPICE1 or inhibition of Aurora kinases with small molecule inhibitors, I found that the predicted phosphorylation of the SPICE1 C terminus had the function in cells of directing the SPICE1 localization on the spindle MTs. My results demonstrate the high accuracy of this genome-wide bioinformatics approach. By complementing mass spectrometry studies, here lies a potential for the identification of other unknown substrates, which is important for the general understanding of how Aurora kinases regulate the mitotic apparatus.

Le complexe passager joue un rôle clé en mitose: contrôlant à la fois la ségrégation des chromosomes, la tension du fuseau, l'entrée en anaphase et la cytodirèse. Le complexe est composé de quatre protéines: INCENP, la kinase Aurora B, Survivine et Boréaline. Sachant que la protéine Survivine est phosphorylée par Aurora B et qu'elle a un role pivot au sein du complexe, nous avons étudié un mutant mimant sa phosphorylation: Survivine T117E. La phosphorylation de Survivine est nécessaire à la transition Métaphase/ Anaphase. Le mutant Survivine T117E est faiblement lié aux centromères en métaphase et agit comme un dominant négatif de la cytodirèse, empêchant la séparation des deux cellules filles. Lors de la recherche d'inhibiteurs des Aurora kinases, nous avons identifié une nouvelle classe de molécules qui inhibent la phosphorylation de l'histone H3 et le point de contrôle du fuseau. Ces molécules préviennent la prolifération des cellules tumorales. Ces composés sont des outils intéressants pour étudier la fonction du complexe passager et représentent un nouveau motif moléculaire pour le développement de drogues anticancéreuses. Survivine et Aurora B kinase dont l'expression est restreinte à la mitose sont deux cibles pour de nouvelles thérapies anti-mitotiques.

x, 60 p. : ill. (some col.) / Regulation of stem cell self-renewal versus differentiation is critical for embryonic development and adult tissue homeostasis. Drosophila larval neuroblasts divide asymmetrically to self-renew and are a model system for studying stem cell self-renewal. Here, we identify two proteins involved in distinct steps of the cell cycle that regulate neuroblast self-renewal. We first describe three mutations showing increased brain neuroblast numbers that map to the aurora-A gene, which encodes a conserved kinase implicated in human cancer. Clonal analysis and time-lapse imaging in aurora-A mutants show single neuroblasts generate multiple neuroblasts (ectopic self-renewal). This phenotype is due to two independent neuroblast defects: abnormal atypical protein kinase C (aPKC)/Numb cortical polarity and failure to align the mitotic spindle with the cortical polarity axis. numb mutant clones have ectopic neuroblasts, and Numb overexpression partially suppresses aurora-A neuroblast overgrowth (but not spindle misalignment). We conclude that Aurora-A and Numb are novel inhibitors of neuroblast self-renewal and that spindle orientation regulates neuroblast self-renewal. We next identified an sgt1 (suppressor-of-G2-allele-of-skp1 ) mutant that had fewer neuroblasts. We found that sgt1 neuroblasts have two polarity phenotypes: failure to establish apical cortical polarity at prophase and lack of cortical Scribble localization throughout the cell cycle. Apical cortical polarity was partially restored at metaphase by a microtubule-induced cortical polarity pathway. Double mutants lacking Sgt1 and Pins (a microtubule-induced polarity pathway component) resulted in neuroblasts without detectable cortical polarity and formation of "neuroblast tumors." Mutants in hsp83 (encoding the predicted Sgt1-binding protein Hsp90), LKB1, or AMPKα all show a similar apical cortical phenotype (but no Scribble phenotype), and activated AMPKα rescued the sgt1 mutant phenotype. We propose that an Sgt1/Hsp90-LKB1-AMPK pathway acts redundantly with a microtubule-induced polarity pathway to generate neuroblast cortical polarity, and the absence of neuroblast cortical polarity can produce neuroblast tumors. This dissertation includes published and unpublished co-authored material. / Committee in charge: Dr. Bruce Bowerman, Chair; Dr. Chris Doe, Advisor; Dr. Tory Herman, Member; Dr. Judith Eisen, Member; Dr. Kenneth Prehoda, Outside Member

A síndrome mielodisplásica (SMD) é uma doença hematológica heterogênea, caracterizada por hematopoese anormal, displasia e instabilidade genômica, portanto, a análise citogenética é determinante no diagnóstico, prognóstico e acompanhamento evolutivo da doença. Considerando que as células hematopoéticas (CHs) e as estromais mesenquimais multipotentes (CTMs) estão em estreita associação, estudos que visem à caracterização destas poderão contribuir para elucidar os mecanismos que governam a progressão tumoral e identificar novos alvos terapêuticos. Objetivo: Caracterizar e comparar as CHs e CTMs derivadas de pacientes através da citogenética convencional e molecular para os genes aurora cinase A e B. Avaliar as propriedades biológicas das CTMs derivadas de SMD e controles saudáveis. Métodos: o estudo iniciou-se com a avaliação clinica de 25 pacientes e 8 controles saudáveis doo HCFMRP-USP e HAC-Jaú. Em seguida, foi realizada a análise cariótipica das CHs e CTMs da medula óssea pelo bandamento G e por FISH para os genes aurora A e B e o perfil imunofenotípico, bem como potencial de diferenciação em adipócito e osteócito das CTMs de pacientes portadores de SMD e controles saudáveis. Resultados: A avaliação clínica mostrou plaquetopenia (76%), neutropenia (100%), hemoglobina baixa (16%). A análise citogenética das CHs revelou cariótipo alterado em 13 pacientes (52%), com cariótipo complexo resultando em alterações numéricas e estruturais. Ao contrário, nas CTMs, o cariótipo se mostrou alterado em sete pacientes (28%) e um padrão de menor complexidade, apenas quatro pacientes apresentaram alterações nas duas populações celulares, porém, diferentes. Foram encontradas apenas alterações numéricas (sendo 86% monossomia e 14% ganho de cromossomo). As CHs e CTMs dos controles apresentaram cariótipos 100% normais. Na análise de FISH não foi evidenciada amplificação dos genes AURKA e AURKB. As CTMs dos pacientes e controles apresentaram-se semelhantes quanto à morfologia e potencial de diferenciação. Entretanto, as CTMs de pacientes mostraram-se alteradas para dois antígenos de superfície, CD90 e CD146, os quais mostraram níveis de expressão mais elevados nas amostras dos pacientes (p= 0,04, p = 0,001 respectivamente). Conclusão: Observou-se que as CTMs se encontram alteradas embora em menor frequência e diferindo das alterações encontradas nas CHs. Esses dados sugerem que as CTMs devem exercer importante papel na progressão tumoral e devem ser consideradas como alvos na busca de novas terapias e melhor esclarecimento dos mecanismos que governam a progressão tumoral. Apesar de não ter evidenciado amplificação dos genes AURKA e AURKB em SMD, estudos futuros que visem avaliar o nível de expressão dessas enzimas em pacientes portadores ou não de alterações citogenéticas poderão contribuir para a compreensão do envolvimento ou não desse gene com a evolução da doença. Além disso, não foi evidenciada associação de anemia profunda e citogenética alterada. / The myelodysplastic syndrome (MDS) is a heterogeneous hematologic disease characterized by abnormal hematopoiesis, dysplasia and genomic instability, therefore, cytogenetic analysis is crucial in the diagnosis, prognosis and monitoring of disease evolution. Whereas hematopoietic cells (CHs) and stromal multipotent mesenchymal (MSCs) are in close association studies aimed at the characterization of these may help to elucidate the mechanisms that govern tumor progression and identify novel therapeutic targets. Objective: To characterize and compare the CHs and MSCs derived from patients by conventional cytogenetics and molecular genes aurora kinase A and B. To evaluate the biological properties of MSCs derived from MDS and healthy controls. Methods: The study began with the clinical evaluation of 25 patients and eight healthy controls HCFMRP dooUSP and CH-Jau. Next, we performed a karyotypic analysis of CHs and MSCs from bone marrow by G-banding and FISH for aurora A and B genes and immunophenotypic profile and potential to differentiate into adipocytes and osteocytes of MSCs in patients with MDS and controls healthy. Results: The clinical evaluation showed thrombocytopenia (76%), neutropenia (100%), low hemoglobin (16%). The cytogenetic analysis revealed karyotype of CHs changed in 13 patients (52%), resulting in complex karyotype with numerical and structural changes. In contrast, in MSC, the karyotype was abnormal in seven patients (28%) and a pattern of lower complexity, only four patients had changes in both cell populations, however, different. Were found only numerical changes (monosomy being 86% and 14% gain in chromosome). The CHs and MSCs controls showed 100% normal karyotypes. In FISH analysis there was no evidence of gene amplification and AURKA AURKB. The MSCs of patients and controls were similar regarding the morphology and differentiation potential. However, the CTMs of patients proved to be changed to two surface antigens, CD90 and CD146, which showed higher expression levels in samples of patients (p = 0.04, p = 0.001 respectively). Conclusion: Furthermore, it was observed that the MSCs are changed although less frequently and differing from changes found in CHs. These data suggest that MSCs should play an important role in tumor progression and should be considered as targets in the search for new therapies and better explain the mechanisms that govern tumor progression. Although not shown AURKA amplification of genes in MDS and AURKB, future studies aimed at assessing the level of expression of these enzymes in patients with or without cytogenetic alterations may contribute to the understanding of the involvement or not of this gene with the disease. This study can not associate with profound anemia cytogenetic changes.

Influenza viruses are respiratory pathogens that are responsible for annual influenza epidemics and sporadic influenza pandemics. Oseltamivir (Tamiflu((R))) is currently the only FDA-approved oral drug that is available for the prevention and treatment of influenza virus infection. However, its narrow therapeutic window, coupled with the increasing incidence of drug resistance, calls for the next generation of influenza antivirals. In this study, we discovered hesperadin, an aurora B kinase inhibitor, as a broad-spectrum influenza antiviral through forward chemical genomics screening. Hesperadin inhibits multiple human clinical isolates of influenza A and B viruses with single to submicromolar efficacy, including oseltamivir-resistant strains. Mechanistic studies revealed that hesperadin inhibits the early stage of viral replication by delaying the nuclear entry of viral ribonucleoprotein complex, thereby inhibiting viral RNA transcription and translation as well as viral protein synthesis. Moreover, a combination of hesperadin with oseltamivir shows synergistic antiviral activity, therefore hesperadin can be used either alone to treat infections by oseltamivir-resistant influenza viruses or used in combination with oseltamivir to delay resistance evolution among oseltamivir-sensitive strains. In summary, the discovery of hesperadin as a broad-spectrum influenza antiviral offers an alternative to combat future influenza epidemics and pandemics.

A síndrome mielodisplásica (SMD) é uma doença hematológica heterogênea, caracterizada por hematopoese anormal, displasia e instabilidade genômica, portanto, a análise citogenética é determinante no diagnóstico, prognóstico e acompanhamento evolutivo da doença. Considerando que as células hematopoéticas (CHs) e as estromais mesenquimais multipotentes (CTMs) estão em estreita associação, estudos que visem à caracterização destas poderão contribuir para elucidar os mecanismos que governam a progressão tumoral e identificar novos alvos terapêuticos. Objetivo: Caracterizar e comparar as CHs e CTMs derivadas de pacientes através da citogenética convencional e molecular para os genes aurora cinase A e B. Avaliar as propriedades biológicas das CTMs derivadas de SMD e controles saudáveis. Métodos: o estudo iniciou-se com a avaliação clinica de 25 pacientes e 8 controles saudáveis doo HCFMRP-USP e HAC-Jaú. Em seguida, foi realizada a análise cariótipica das CHs e CTMs da medula óssea pelo bandamento G e por FISH para os genes aurora A e B e o perfil imunofenotípico, bem como potencial de diferenciação em adipócito e osteócito das CTMs de pacientes portadores de SMD e controles saudáveis. Resultados: A avaliação clínica mostrou plaquetopenia (76%), neutropenia (100%), hemoglobina baixa (16%). A análise citogenética das CHs revelou cariótipo alterado em 13 pacientes (52%), com cariótipo complexo resultando em alterações numéricas e estruturais. Ao contrário, nas CTMs, o cariótipo se mostrou alterado em sete pacientes (28%) e um padrão de menor complexidade, apenas quatro pacientes apresentaram alterações nas duas populações celulares, porém, diferentes. Foram encontradas apenas alterações numéricas (sendo 86% monossomia e 14% ganho de cromossomo). As CHs e CTMs dos controles apresentaram cariótipos 100% normais. Na análise de FISH não foi evidenciada amplificação dos genes AURKA e AURKB. As CTMs dos pacientes e controles apresentaram-se semelhantes quanto à morfologia e potencial de diferenciação. Entretanto, as CTMs de pacientes mostraram-se alteradas para dois antígenos de superfície, CD90 e CD146, os quais mostraram níveis de expressão mais elevados nas amostras dos pacientes (p= 0,04, p = 0,001 respectivamente). Conclusão: Observou-se que as CTMs se encontram alteradas embora em menor frequência e diferindo das alterações encontradas nas CHs. Esses dados sugerem que as CTMs devem exercer importante papel na progressão tumoral e devem ser consideradas como alvos na busca de novas terapias e melhor esclarecimento dos mecanismos que governam a progressão tumoral. Apesar de não ter evidenciado amplificação dos genes AURKA e AURKB em SMD, estudos futuros que visem avaliar o nível de expressão dessas enzimas em pacientes portadores ou não de alterações citogenéticas poderão contribuir para a compreensão do envolvimento ou não desse gene com a evolução da doença. Além disso, não foi evidenciada associação de anemia profunda e citogenética alterada. / The myelodysplastic syndrome (MDS) is a heterogeneous hematologic disease characterized by abnormal hematopoiesis, dysplasia and genomic instability, therefore, cytogenetic analysis is crucial in the diagnosis, prognosis and monitoring of disease evolution. Whereas hematopoietic cells (CHs) and stromal multipotent mesenchymal (MSCs) are in close association studies aimed at the characterization of these may help to elucidate the mechanisms that govern tumor progression and identify novel therapeutic targets. Objective: To characterize and compare the CHs and MSCs derived from patients by conventional cytogenetics and molecular genes aurora kinase A and B. To evaluate the biological properties of MSCs derived from MDS and healthy controls. Methods: The study began with the clinical evaluation of 25 patients and eight healthy controls HCFMRP dooUSP and CH-Jau. Next, we performed a karyotypic analysis of CHs and MSCs from bone marrow by G-banding and FISH for aurora A and B genes and immunophenotypic profile and potential to differentiate into adipocytes and osteocytes of MSCs in patients with MDS and controls healthy. Results: The clinical evaluation showed thrombocytopenia (76%), neutropenia (100%), low hemoglobin (16%). The cytogenetic analysis revealed karyotype of CHs changed in 13 patients (52%), resulting in complex karyotype with numerical and structural changes. In contrast, in MSC, the karyotype was abnormal in seven patients (28%) and a pattern of lower complexity, only four patients had changes in both cell populations, however, different. Were found only numerical changes (monosomy being 86% and 14% gain in chromosome). The CHs and MSCs controls showed 100% normal karyotypes. In FISH analysis there was no evidence of gene amplification and AURKA AURKB. The MSCs of patients and controls were similar regarding the morphology and differentiation potential. However, the CTMs of patients proved to be changed to two surface antigens, CD90 and CD146, which showed higher expression levels in samples of patients (p = 0.04, p = 0.001 respectively). Conclusion: Furthermore, it was observed that the MSCs are changed although less frequently and differing from changes found in CHs. These data suggest that MSCs should play an important role in tumor progression and should be considered as targets in the search for new therapies and better explain the mechanisms that govern tumor progression. Although not shown AURKA amplification of genes in MDS and AURKB, future studies aimed at assessing the level of expression of these enzymes in patients with or without cytogenetic alterations may contribute to the understanding of the involvement or not of this gene with the disease. This study can not associate with profound anemia cytogenetic changes.

Mit einem medianen Überleben von 14 bis 16 Monaten und einer 5-Jahres-Überlebensrate von weniger als 5 % zählt das Glioblastoma multiforme (GBM) zu den aggressivsten Tumoren des zentralen Nervensystems (Cloughesy et al., 2014; Batash et al., 2017; Guberina et al., 2020). Das GBM, auch als WHO-Grad IV-Astrozytom bezeichnet, ist mit > 50 % aller glialen Tumoren der häufigste maligne hirneigene Tumor (Ohgaki und Kleihues, 2005). Aufgrund ihrer infausten Prognose ist eine Weiterentwicklung und Optimierung der aktuellen Leitlinientherapie sowie die Entwicklung neuartiger Therapiekonzepte für Primärtumore und Rezidive unentbehrlich. Im Rahmen dieser Arbeit wurden neuartige Therapieansätze, wie elektrische Wechselfelder (tumor treating fields, TTFields) und der Aurorakinaseinhibitor AZD1152 sowie die konventionelle, in der Leitlinie des Primärtumors verankerte Radiotherapie eingesetzt. Während eine Strahlentherapie in erster Linie durch die Induktion von DNA-Einzel- und Doppelstrangbrüchen wirkt, beruht der Wirkmechanismus der TTFields auf eine Störung der Dipol-gesteuerten Schritte während der Zellteilung. Dies führt folglich zu einer Arretierung des Zellzyklus in der G2/M- und G1/S-Phase. Sofern eine Reparatur an den checkpoints nicht möglich ist, erfolgt die Überleitung der Zelle in die Apoptose (Suzuki et al., 2003; Wilson et al., 2014; Fontana et al., 2015; Gerelchuluun et al., 2015). Die TTFields kamen mittels des InovitroTM-Systems zum Einsatz, die insbesondere inhibierend auf die M-Phase des Zellzyklus wirken (Gutin und Wong, 2012; Saria und Kesari, 2016). Für das Glioblastoma multiforme wurde dabei eine spezifische Frequenz von 200 kHz und eine Feldintensität von 1,7 V/cm bestimmt, welche das außerhalb des Zielgebiets liegende Gewebe schont (Kirson et al., 2009; Fabian et al., 2019). Für Primärtumore eines Glioblastoma multiforme konnte in der EF-14-Studie bereits ein signifikant verlängertes Überleben durch TTFields bestätigt werden, während für das Rezidiv in der EF-11-Studie lediglich eine Verbesserung der Lebensqualität erreicht wurde jedoch keine Verlängerung der Überlebenszeit (Stupp et al., 2012; Stupp et al., 2017). Ein vielversprechender Therapieansatz scheint außerdem der Einsatz des Aurora B-Kinase-Inhibitors AZD1152 zu sein. Als enzymatischer Teil des chromosomale passenger complex (CPC) liegt die Hauptaufgabe der Aurora B-Kinase in der Kontrolle der Mitose des Zellzyklus (Vader et al., 2006). Resultierend aus der Aufhebung des genannten Kontrollmechanismus mittels AZD1152 (Barasertib™) kommt es zum Anstieg polyploider Zellen, wodurch eine Überleitung in die Apoptose erfolgt (Zekri et al., 2016). Schlussfolgernd erscheint in Anbetracht der Einzeleffekte von Radiotherapie, TTFields und Aurora B-Kinase-Inhibierung deren kombinierter Einsatz wesentlich bedeutsam, wodurch der vorliegenden Arbeit die Hypothesen eines überwiegenden Effekts der Dreifachkombination im Vergleich zu der Einzeltherapie und den jeweiligen Zweifachkombinationsbehandlungen zugrunde liegen. Für die drei in dieser Arbeit eingesetzten Primärkulturen eines Glioblastoma multiforme Rezidivs konnte für die Dreifachkombinationstherapie gegenüber den Einzelbehandlungen ein hoch bis höchst signifikant additiv-zytotoxischer Effekt nachgewiesen werden. Im Mittel gelang eine Reduktion der Lebendzellzahl auf 20 – 34 % vitaler Zellen. Auch in Bezug auf die einzelnen Zweifachkombinationen wurden signifikante, hoch signifikante sowie ein höchst signifikantes Ergebnis für die Dreifachkombinationstherapie erzielt. Lediglich für die TTFields/AZD1152-Kombinationsbehandlung der Primärkultur HT18328-3 traf dies nicht zu. Mit Hilfe der konfokalen Laser-Scanning-Mikroskopie wurden ergänzend qualitative, zellmorphologische Änderungen visualisiert. Während sich in den Einzelbehandlungen sowie den Zweifachkombinationen Veränderungen der Zell- und Kerngröße sowie eine Kernfragmentierung andeuteten, waren diese Effekte in der Dreifachkombination deutlicher ausgeprägt. Die bereits quantitativ detektierten synergistisch zytotoxischen Effekte konnten durch lichtmikroskopische Bilder verifiziert werden. Langfristiges Ziel dieser Arbeit ist, die Kombinationstherapie im Rahmen von klinischen Studien zu testen. Jedoch sollte, aufgrund der insgesamt hohen inter- und intratumoralen Heterogenität des Glioblastoma multiforme im Vorfeld zur Etablierung des klinischen Einsatzes das Verhalten weiterer Primärkulturen untersucht werden. Ebenso erscheint die Berücksichtigung der vorausgehenden Behandlung der Patienten sowie des Ploidiegrades der Primärkultur als relevant, um ein unterschiedliches Therapieansprechen sowie mögliche Resistenzmechanismen nachzuvollziehen. Ferner sollte ein neoadjuvanter Einsatz des AZD1152 weiter verifiziert werden, denn eine Verbesserung der Radiosensibilität, resultierend in einem gesteigerten Therapieansprechen, konnte bereits aufgezeigt werden (Tao et al., 2009). Zur Minimierung der systemischen Nebenwirkungen des AZD1152 (Barasertib™) wäre die Etablierung einer gezielten, lokalen Anwendung im Sinne einer intraoperativen oder minimalinvasiven Applikation zielführend.:1 Einleitung 1.1 Glioblastoma multiforme: Definition, Ätiologie, Inzidenz 1.1.1 Symptome und Diagnostik 1.2 Molekulare Klassifizierung 1.2.1 Unterteilung in primäre und sekundäre Glioblastome mittels des IDH-Status 1.2.2 Molekulare Marker primärer Glioblastome 1.2.4 Die Methylguanin-Methyltransferase (MGMT) 1.3 Konventionelle Therapie 1.3.1 Leitlinie Primärtumor – Leitlinie Rezidiv 1.3.2 Radiotherapie 1.4 Neuartige Therapiekonzepte 1.4.1 Biologischer Hintergrund 1.4.2 Aurorakinase-Inhibitoren 1.4.3 Tumor Treating Fields (TTFields) 1.5 Zielstellung 2 Material und Methoden 2.1 Material 2.1.1 Antikörper 2.1.2 Chemikalien 2.1.3 Geräte 2.1.4 Lösungen 2.1.5 Medien 2.1.6 Kits 2.1.7 Primärkulturen 2.1.8 Software 2.1.9 Statistik 2.1.10 Verbrauchsmaterialien 2.2 Methoden 2.2.1 Zellkultivierung allgemein 2.2.2 Passagieren adhärenter Zellen . 2.2.3 Kultivierung von primärem Patientenmaterial 2.2.4 Kryokonservierung und Rekultivierung 2.2.5 Bestimmung der Lebendzellzahl – Neubauer-Zählkammer 2.2.6 Durchflusszytometrische Analyse 2.2.7 Bestimmung der Lebendzellzahl mittels PI 2.2.8 Bestimmung des DNA-Gehalt/Ploidiegrades mittels PI 2.2.9 Durchflusszytometrische Immunphänotypisierung von Glioblastomzellen 2.2.10 Beschichtung von Glascoverslips 2.2.11 Bestrahlung mittels Röntgensystem 2.2.12 Titration der Bestrahlungsdosis 2.2.13 Titration einer effektiven Aurora B-Kinase-Inhibitorkonzentration 2.2.14 In vitro-Applikation der TTFields 2.2.15 Konfokale Laser-Scanning-Mikroskopie 3 Ergebnisse 3.1 Wahl der Kontrollgruppe 3.2 Typisierung der verwendeten Primärkulturen 3.2.1 Befunde der Pathologie des UKD 3.2.2 Immunphänotypisierung 3.3 Titration der AZD1152-Konzentration 3.3.1 Titration der AZD1152-Konzentration an der Primärkultur HT16360-1 3.3.2 Titration der AZD1152-Konzentration an der Primärkultur HT18328-3 3.3.3 Titration der AZD1152-Konzentration an der Primärkultur HT18816 3.4 Dosistitration der Radiotherapie 3.4.1 Titration der Bestrahlungsdosis an HT16360-1 3.4.2 Titration der Bestrahlungsdosis an HT18328-3 3.4.3 Titration der Bestrahlungsdosis an HT18816 3.5 Kombinationstherapie mit Radiotherapie, TTFields und AZD1152 3.5.1 Quantitativer Effekt der Kombinationstherapie anhand der Lebendzellzahl 3.5.2 Zytoreduktiver Effekt der Kombinationstherapie 3.5.3 Quantitativer Effekt der Kombinationstherapie anhand des Ploidiegrades 3.5.4 Qualitativer Effekt der Kombinationstherapie 4 Diskussion 4.1 In vitro-Charakterisierung der Primärkulturen 4.2 Radiotherapie . 4.3 Neuartige Behandlungsoptionen 4.3.1 TTFields 4.3.2 Aurora B-Kinase-Inhibitor AZD1152 4.4 Kombinierte Behandlungsmethoden – Zwei- und Dreifachtherapie 5 Zusammenfassung Abstract Literaturverzeichnis Tabellenverzeichnis Abbildungsverzeichnis Abkürzungsverzeichnis Anhang / With a median survival of 14 to 16 months and a 5-year survival rate of less than 5 %, glioblastoma multiforme (GBM) is one of the most aggressive tumours of the central nervous system (Cloughesy et al., 2014; Batash et al., 2017; Guberina et al., 2020). GBM, also known as WHO grade IV astrocytoma, is the most common malignant brain tumor with > 50% of all glial tumors (Ohgaki und Kleihues, 2005). Due to its dismal prognosis, further development and optimisation of the current guideline therapy as well as the development of novel therapeutic concepts for primary tumours and recurrences is indispensable. Within the framework of this work, novel therapeutic approaches such as alternating electric fields (tumor treating fields, TTFields) and the aurorakinase inhibitor AZD1152 as well as conventional radiotherapy anchored in the guideline of the primary tumor were applied. While radiotherapy primarily works by the induction of DNA single and double strand breaks, the mechanism of action of TTFields is based on a disruption of the dipole-controlled steps during cell division. Consequently, this leads to a locking of the cell cycle in the G2/M and G1/S phase. If repair at the checkpoints is not possible, the cell is transferred to apoptosis (Suzuki et al., 2003; Wilson et al., 2014; Fontana et al., 2015; Gerelchuluun et al., 2015). The TTFields were used by means of the InovitroTM system, which has a particularly inhibitory effect on the M-phase of the cell cycle (Gutin und Wong, 2012; Saria und Kesari, 2016). For glioblastoma multiforme, a specific frequency of 200 kHz and a field intensity of 1.7 V/cm was determined, which spares the tissue outside the target area (Kirson et al., 2009; Fabian et al., 2019). For primary tumours of glioblastoma multiforme a significantly prolonged survival could already be confirmed by TTFields in the EF 14 study, whereas for recurrent tumours only an improvement in quality of life was achieved in the EF 11 study (Stupp et al., 2012; Stupp et al., 2017). The use of the Aurora B kinase inhibitor AZD1152 also appears to be a promising therapeutic approach. As an enzymatic part of the chromosomal passenger complex (CPC), the main task of the aurora B-kinase is to control cell cycle mitosis (Vader et al., 2006). As a result of the removal of the above-mentioned control mechanism by means of AZD1152 (BarasertibTM), there is an increase in polyploid cells, which leads to a transition to apoptosis (Zekri et al., 2016). In conclusion, considering the single effects of radiotherapy, TTFields and Aurora B-kinase inhibition, their combined use seems to be of considerable importance. Therefore, the present study is based on the hypotheses of a predominant effect of the triple combination compared to the single therapy and the respective dual combination treatments. For the three primary cultures of a glioblastoma multiforme recurrence used in this work, a high to highly significant additive cytotoxic effect could be demonstrated for the triple combination therapy compared to the single treatments. On average, a reduction in the number of living cells to 20 – 34 % vital cells was achieved. Significant, high significant and highly significant results were also achieved with regarding to the individual dual combination treatments. Only for the TTFields/AZD1152 combination treatment of the primary culture HT18328-3 this was not true. Confocal laser scanning microscopy was used to visualise qualitative, cell morphological changes. While changes in cell and core size as well as nucleus fragmentation were indicated in the single treatments as well as in the dual combination treatments, these effects were more pronounced in the triple combination. The already quantitatively detected synergistic cytotoxic effects could be verified by light microscopic images. The long-term goal of this work is to test the combination therapy in clinical trials. However, due to the overall high inter- and intratumoral heterogeneity of glioblastoma multiforme, the behaviour of further primary cultures should be investigated in advance of establishing clinical use. In addition, consideration of the previous treatment of the patients as well as the degree of ploidy of the primary culture seems to be relevant to understand a different response to therapy and possible resistance mechanisms. Furthermore, a neoadjuvant use of AZD1152 should be further verified, as an improvement in radiosensitivity resulting in an increased response to therapy has already been demonstrated (Tao et al., 2009). In order to minimize the systemic side effects of AZD1152 (BarasertibTM), the establishment of a targeted, local application in the sense of an intraoperative or minimally invasive application would be beneficial.:1 Einleitung 1.1 Glioblastoma multiforme: Definition, Ätiologie, Inzidenz 1.1.1 Symptome und Diagnostik 1.2 Molekulare Klassifizierung 1.2.1 Unterteilung in primäre und sekundäre Glioblastome mittels des IDH-Status 1.2.2 Molekulare Marker primärer Glioblastome 1.2.4 Die Methylguanin-Methyltransferase (MGMT) 1.3 Konventionelle Therapie 1.3.1 Leitlinie Primärtumor – Leitlinie Rezidiv 1.3.2 Radiotherapie 1.4 Neuartige Therapiekonzepte 1.4.1 Biologischer Hintergrund 1.4.2 Aurorakinase-Inhibitoren 1.4.3 Tumor Treating Fields (TTFields) 1.5 Zielstellung 2 Material und Methoden 2.1 Material 2.1.1 Antikörper 2.1.2 Chemikalien 2.1.3 Geräte 2.1.4 Lösungen 2.1.5 Medien 2.1.6 Kits 2.1.7 Primärkulturen 2.1.8 Software 2.1.9 Statistik 2.1.10 Verbrauchsmaterialien 2.2 Methoden 2.2.1 Zellkultivierung allgemein 2.2.2 Passagieren adhärenter Zellen . 2.2.3 Kultivierung von primärem Patientenmaterial 2.2.4 Kryokonservierung und Rekultivierung 2.2.5 Bestimmung der Lebendzellzahl – Neubauer-Zählkammer 2.2.6 Durchflusszytometrische Analyse 2.2.7 Bestimmung der Lebendzellzahl mittels PI 2.2.8 Bestimmung des DNA-Gehalt/Ploidiegrades mittels PI 2.2.9 Durchflusszytometrische Immunphänotypisierung von Glioblastomzellen 2.2.10 Beschichtung von Glascoverslips 2.2.11 Bestrahlung mittels Röntgensystem 2.2.12 Titration der Bestrahlungsdosis 2.2.13 Titration einer effektiven Aurora B-Kinase-Inhibitorkonzentration 2.2.14 In vitro-Applikation der TTFields 2.2.15 Konfokale Laser-Scanning-Mikroskopie 3 Ergebnisse 3.1 Wahl der Kontrollgruppe 3.2 Typisierung der verwendeten Primärkulturen 3.2.1 Befunde der Pathologie des UKD 3.2.2 Immunphänotypisierung 3.3 Titration der AZD1152-Konzentration 3.3.1 Titration der AZD1152-Konzentration an der Primärkultur HT16360-1 3.3.2 Titration der AZD1152-Konzentration an der Primärkultur HT18328-3 3.3.3 Titration der AZD1152-Konzentration an der Primärkultur HT18816 3.4 Dosistitration der Radiotherapie 3.4.1 Titration der Bestrahlungsdosis an HT16360-1 3.4.2 Titration der Bestrahlungsdosis an HT18328-3 3.4.3 Titration der Bestrahlungsdosis an HT18816 3.5 Kombinationstherapie mit Radiotherapie, TTFields und AZD1152 3.5.1 Quantitativer Effekt der Kombinationstherapie anhand der Lebendzellzahl 3.5.2 Zytoreduktiver Effekt der Kombinationstherapie 3.5.3 Quantitativer Effekt der Kombinationstherapie anhand des Ploidiegrades 3.5.4 Qualitativer Effekt der Kombinationstherapie 4 Diskussion 4.1 In vitro-Charakterisierung der Primärkulturen 4.2 Radiotherapie . 4.3 Neuartige Behandlungsoptionen 4.3.1 TTFields 4.3.2 Aurora B-Kinase-Inhibitor AZD1152 4.4 Kombinierte Behandlungsmethoden – Zwei- und Dreifachtherapie 5 Zusammenfassung Abstract Literaturverzeichnis Tabellenverzeichnis Abbildungsverzeichnis Abkürzungsverzeichnis Anhang

Durante a divisão celular as Aurora-quinases (AURKA e AURKB) participam da formação e controle das fibras do fuso mitótico enquanto as isoformas proteicas (DIDO1, DIDO2 e DIDO3), originadas do splicing alternativo do gene DIDO, auxiliam na junção dos microtúbulos aos cinetócoros. Portanto, ambas são relevantes na regulação do ciclo celular. Interessantemente, a superexpressão (ou o ganho de função) das AURKs ou a baixa expressão (ou perda de função) das isoformas de DIDO estão ambos associados com amplificação dos centrossomos e à instabilidade cromossômica (CIN), com consequente aneuploidia. Dentre as doenças hematológicas com registros de CIN, a leucemia linfoide crônica (LLC) pode apresentar amplificação dos centrossomos e alteração nos níveis de expressão das AURKs acarretando aneuplodias. Apesar disso, não existem estudos avaliando a potencial associação destes genes com CIN na LLC. Avaliando seus níveis de expressão gênica em amostras de LLC de pacientes com ou sem aberrações cromossômicas, mostramos que o aumento dos níveis de AURKA e AURKB e, inversamente, a redução dos níveis das variantes de DIDO, são significativamente associados com ganhos cromossômicos e com aumento da contagem de glóbulos brancos (WBC). Claramente, amostras de LLC sem qualquer anormalidade citogenética apresentam níveis de expressão semelhantes às amostras que contêm aberrações não-numéricas. O achado de que níveis de expressão de AURKs e variantes de DIDO são completamente opostos, mostrando um padrão discreto de inter-relação, levou-nos a investigar o potencial mecanismo regulatório por trás disso. Tendo em vista que outros, anteriormente, mostraram que o cluster oncogênico miR-17~92 é significativamente hiper-regulado em células de pacientes com LLC purificadas expressando genes IGHV não mutados (em comparação com células mutadas de pacientes) e, que o miR-17 é expresso em níveis significativamente mais elevados em células IGHV não mutadas ou ZAP-70 positivas (mau prognóstico geralmente associada à CIN), resolvemos investigar o potencial de regulação negativa dos microRNAs deste cluster sobre as variantes de DIDO. Além disso, com base no mecanismo regulatório já descrito pelo qual a superexpressão de AURKA induz a transcrição do cluster miR-17~92, mediada por E2F1 (com uma correlação entre as expressões de ambas as proteínas em diferentes tipos de câncer), decidimos investigar este eixo regulatório em LLC. Notavelmente, todas as variantes de DIDO apresentam-se preditas como fortes alvos de vários microRNAs deste cluster oncogênico. Mostramos, então, que amostras de LLC com baixa expressão de DIDO, além dos já mencionados níveis elevados de AURK, exibiram níveis significativamente mais elevados do fator de transcrição E2F1 e de seu alvo transcricional, o transcrito primário do miR-17~92 (MIR17HG). Além disso, por meio do uso da linhagem de celular NTERA-2, como modelo experimental, mostramos que o siRNA nocaute para AURKA (nos níveis transcricional e proteico, como confirmado por qPCR e western blot) é acompanhada por uma significativa redução de E2F1 e também de MIR17HG. Ainda, a transfecção de células NTERA-2 com sintéticos microRNAs miméticos do cluster miR-17~92 (ou seja, 19a-miR, miR-20a e miR-92a) resultou em uma clara e significativa redução dos níveis de transcrição de todas as variantes de DIDO. Por fim, a inibição do siRNA especifico para a variante DIDO3 (mas não às outras variantes) levou a uma redução significativa dos níveis de transcrição de todas as variantes de DIDO, indicando um mecanismo adicional contribuindo para a downregulação dos transcritos de DIDO. Ao todo, nossos resultados demonstram a existência de um potencial mecanismo regulatório interconectado entre AURK e DIDO, associado à CIN e maior contagem de WBC na LLC. Mais importante, os níveis de expressão elevada de AURKs e os baixos níveis associados das variantes de DIDO são especificamente relacionados com anormalidades citogenéticas apresentando ganhos cromossomais, com destaque para o mecanismo celular específico, subjacente à CIN, observado neste grupo distinto LLC. Dado o papel central da CIN na gênese e progressão do câncer, esses achados provavelmente terão um impacto importante no prognóstico ou tratamento da LLC. / During cell cycle division Aurora kinases (AURKA and AURKB) participate in the formation and control of mitotic spindle fibers, while, protein isoforms (DIDO1, DIDO2 and DIDO3), derived by alternative splicing of the DIDO gene, assist at the junction of microtubules to kinetochores. Thus, both are relevant to cell cycle maintenance. Interestingly, overexpression (or gain of function) of AURKs or low expression (or loss of function of DIDO) are both associated with centrosomal amplification and chromosomal instability (CIN), leading to aneuploidy. Among hematological diseases with CIN records, chronic lymphocytic leukemia (CLL) can display centrosome amplification and changes in AURKs expression levels leading to aneuploidy. Despite this, there are no studies evaluating the potential association of these genes with CIN in CLL. By evaluating their gene expression levels in CLL samples from patients with or without chromosomal aberrations, we show that increased levels of AURKA and AURKB and, conversely, reduced levels of DIDO variants, are both significantly associated with chromosomal gains and with increased white blood cell (WBC) counts. Clearly, CLL samples without any cytogenetic abnormality had expression levels similar to samples mostly harboring non-numerical aberrations. The finding that the expression levels of AURKs and DIDO variants are completely opposed, showing a discrete inter-related pattern, led us to investigate the potential regulatory mechanism behind this. Given that other have previously shown that the oncogenic miR-17~92 cluster is significantly upregulated in purified CLL patient cells expressing unmutated IGHV genes (as compared to mutated patient cells), and that miR-17 is expressed at significantly higher levels in unmutated or ZAP-70 high cases (bad prognostic cases generally associated with chromosomal instability), we investigated the potential negative regulation of DIDO variants by microRNAs from this cluster. In addition, based on the already described regulatory mechanism by which AURKA overexpression induces the E2F1-mediated transcription upregulation of the miR-17~92 cluster (with an observed expression correlation of both proteins in cancer specimens); we decided to investigate this regulatory axis in CLL. Notably, we found that all DIDO variants are predicted to be heavily targeted by several miRs of this oncogenic cluster. We show that CLL samples with low DIDO expression, in addition to the already mentioned AURK high levels, displayed significant higher levels of the transcription factor E2F1 and of its transcriptional target, the miR-17~92 primary transcript (MIR17HG). Moreover, by using the NTERA-2 cell line as a model, we show that siRNA knockdown of AURKA (at the transcript and protein level, as confirmed by qPCR and western blot) is accompanied by a striking significant reduction of E2F1 and also of MIR17HG. Furthermore, transfection of NTERA-2 cells with synthetic mimics of the miR-17~92 cluster (namely, miR-19a, miR-20a and miR-92a) results in a clear and significant reduction in the transcript levels of all DIDO variants. Finally, specific siRNA inhibition of the DIDO3 variant (but not the others) led to a significant reduction in the transcript levels of all DIDO variants, indicating an additional mechanism contributing to the downregulation of DIDO transcripts. Altogether, our results demonstrate the existence of a potential interconnected regulatory mechanism between AURK and DIDO, associated with CIN and higher WBC counts in CLL. More importantly, the high expression levels of AURKs and the associated low levels of DIDO variants are specifically associated with cytogenetic abnormalities presenting chromosomal gains, highlighting the specific cellular mechanism underlying the CIN observed in this distinct CLL group. Given the central role of CIN in cancer genesis and progression, these findings will likely have an important impact on prognosis or treatment of CLL.

Durante a divisão celular as Aurora-quinases (AURKA e AURKB) participam da formação e controle das fibras do fuso mitótico enquanto as isoformas proteicas (DIDO1, DIDO2 e DIDO3), originadas do splicing alternativo do gene DIDO, auxiliam na junção dos microtúbulos aos cinetócoros. Portanto, ambas são relevantes na regulação do ciclo celular. Interessantemente, a superexpressão (ou o ganho de função) das AURKs ou a baixa expressão (ou perda de função) das isoformas de DIDO estão ambos associados com amplificação dos centrossomos e à instabilidade cromossômica (CIN), com consequente aneuploidia. Dentre as doenças hematológicas com registros de CIN, a leucemia linfoide crônica (LLC) pode apresentar amplificação dos centrossomos e alteração nos níveis de expressão das AURKs acarretando aneuplodias. Apesar disso, não existem estudos avaliando a potencial associação destes genes com CIN na LLC. Avaliando seus níveis de expressão gênica em amostras de LLC de pacientes com ou sem aberrações cromossômicas, mostramos que o aumento dos níveis de AURKA e AURKB e, inversamente, a redução dos níveis das variantes de DIDO, são significativamente associados com ganhos cromossômicos e com aumento da contagem de glóbulos brancos (WBC). Claramente, amostras de LLC sem qualquer anormalidade citogenética apresentam níveis de expressão semelhantes às amostras que contêm aberrações não-numéricas. O achado de que níveis de expressão de AURKs e variantes de DIDO são completamente opostos, mostrando um padrão discreto de inter-relação, levou-nos a investigar o potencial mecanismo regulatório por trás disso. Tendo em vista que outros, anteriormente, mostraram que o cluster oncogênico miR-17~92 é significativamente hiper-regulado em células de pacientes com LLC purificadas expressando genes IGHV não mutados (em comparação com células mutadas de pacientes) e, que o miR-17 é expresso em níveis significativamente mais elevados em células IGHV não mutadas ou ZAP-70 positivas (mau prognóstico geralmente associada à CIN), resolvemos investigar o potencial de regulação negativa dos microRNAs deste cluster sobre as variantes de DIDO. Além disso, com base no mecanismo regulatório já descrito pelo qual a superexpressão de AURKA induz a transcrição do cluster miR-17~92, mediada por E2F1 (com uma correlação entre as expressões de ambas as proteínas em diferentes tipos de câncer), decidimos investigar este eixo regulatório em LLC. Notavelmente, todas as variantes de DIDO apresentam-se preditas como fortes alvos de vários microRNAs deste cluster oncogênico. Mostramos, então, que amostras de LLC com baixa expressão de DIDO, além dos já mencionados níveis elevados de AURK, exibiram níveis significativamente mais elevados do fator de transcrição E2F1 e de seu alvo transcricional, o transcrito primário do miR-17~92 (MIR17HG). Além disso, por meio do uso da linhagem de celular NTERA-2, como modelo experimental, mostramos que o siRNA nocaute para AURKA (nos níveis transcricional e proteico, como confirmado por qPCR e western blot) é acompanhada por uma significativa redução de E2F1 e também de MIR17HG. Ainda, a transfecção de células NTERA-2 com sintéticos microRNAs miméticos do cluster miR-17~92 (ou seja, 19a-miR, miR-20a e miR-92a) resultou em uma clara e significativa redução dos níveis de transcrição de todas as variantes de DIDO. Por fim, a inibição do siRNA especifico para a variante DIDO3 (mas não às outras variantes) levou a uma redução significativa dos níveis de transcrição de todas as variantes de DIDO, indicando um mecanismo adicional contribuindo para a downregulação dos transcritos de DIDO. Ao todo, nossos resultados demonstram a existência de um potencial mecanismo regulatório interconectado entre AURK e DIDO, associado à CIN e maior contagem de WBC na LLC. Mais importante, os níveis de expressão elevada de AURKs e os baixos níveis associados das variantes de DIDO são especificamente relacionados com anormalidades citogenéticas apresentando ganhos cromossomais, com destaque para o mecanismo celular específico, subjacente à CIN, observado neste grupo distinto LLC. Dado o papel central da CIN na gênese e progressão do câncer, esses achados provavelmente terão um impacto importante no prognóstico ou tratamento da LLC. / During cell cycle division Aurora kinases (AURKA and AURKB) participate in the formation and control of mitotic spindle fibers, while, protein isoforms (DIDO1, DIDO2 and DIDO3), derived by alternative splicing of the DIDO gene, assist at the junction of microtubules to kinetochores. Thus, both are relevant to cell cycle maintenance. Interestingly, overexpression (or gain of function) of AURKs or low expression (or loss of function of DIDO) are both associated with centrosomal amplification and chromosomal instability (CIN), leading to aneuploidy. Among hematological diseases with CIN records, chronic lymphocytic leukemia (CLL) can display centrosome amplification and changes in AURKs expression levels leading to aneuploidy. Despite this, there are no studies evaluating the potential association of these genes with CIN in CLL. By evaluating their gene expression levels in CLL samples from patients with or without chromosomal aberrations, we show that increased levels of AURKA and AURKB and, conversely, reduced levels of DIDO variants, are both significantly associated with chromosomal gains and with increased white blood cell (WBC) counts. Clearly, CLL samples without any cytogenetic abnormality had expression levels similar to samples mostly harboring non-numerical aberrations. The finding that the expression levels of AURKs and DIDO variants are completely opposed, showing a discrete inter-related pattern, led us to investigate the potential regulatory mechanism behind this. Given that other have previously shown that the oncogenic miR-17~92 cluster is significantly upregulated in purified CLL patient cells expressing unmutated IGHV genes (as compared to mutated patient cells), and that miR-17 is expressed at significantly higher levels in unmutated or ZAP-70 high cases (bad prognostic cases generally associated with chromosomal instability), we investigated the potential negative regulation of DIDO variants by microRNAs from this cluster. In addition, based on the already described regulatory mechanism by which AURKA overexpression induces the E2F1-mediated transcription upregulation of the miR-17~92 cluster (with an observed expression correlation of both proteins in cancer specimens); we decided to investigate this regulatory axis in CLL. Notably, we found that all DIDO variants are predicted to be heavily targeted by several miRs of this oncogenic cluster. We show that CLL samples with low DIDO expression, in addition to the already mentioned AURK high levels, displayed significant higher levels of the transcription factor E2F1 and of its transcriptional target, the miR-17~92 primary transcript (MIR17HG). Moreover, by using the NTERA-2 cell line as a model, we show that siRNA knockdown of AURKA (at the transcript and protein level, as confirmed by qPCR and western blot) is accompanied by a striking significant reduction of E2F1 and also of MIR17HG. Furthermore, transfection of NTERA-2 cells with synthetic mimics of the miR-17~92 cluster (namely, miR-19a, miR-20a and miR-92a) results in a clear and significant reduction in the transcript levels of all DIDO variants. Finally, specific siRNA inhibition of the DIDO3 variant (but not the others) led to a significant reduction in the transcript levels of all DIDO variants, indicating an additional mechanism contributing to the downregulation of DIDO transcripts. Altogether, our results demonstrate the existence of a potential interconnected regulatory mechanism between AURK and DIDO, associated with CIN and higher WBC counts in CLL. More importantly, the high expression levels of AURKs and the associated low levels of DIDO variants are specifically associated with cytogenetic abnormalities presenting chromosomal gains, highlighting the specific cellular mechanism underlying the CIN observed in this distinct CLL group. Given the central role of CIN in cancer genesis and progression, these findings will likely have an important impact on prognosis or treatment of CLL.