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Bladder cancer is currently the 6th most common cancer in the United States, resulting in 17,000 deaths annually. Clinically, bladder cancers are mostly urothelial carcinoma, classified as either non-muscle invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC), with the latter having a 5-year survival rate of merely 50%. With recent advances in next-generation sequencing, several international consortia have elucidated molecular subtypes of MIBC. The two major subtypes of MIBCs are basal and luminal; the basal subtype frequently exhibits hallmarks of squamous differentiation and highly expressed basal markers (CD44, KRT14, KRT6A, KRT6B). Tumors of the luminal subtype have papillary morphology and highly express differentiation-associated luminal markers (e.g., KRT20, PPARG, UPKs, and FOXA1). Notably, the transcription factor Peroxisome Proliferator Activated Receptor Gamma (PPARG) gene is frequently amplified in luminal MIBC. And recurrent activating mutations have been reported for its obligatory functional partner Retinoic X Receptor (RXR). In addition, the basal subtype is immune-infiltrated and is postulated as more likely to respond to immunotherapies. In contrast, the luminal subtype is immune-cold. Despite these advances in recent years, the molecular driver of subtype determination, specifically in luminal MIBC, remains poorly understood. Furthermore, subtype-specific targeted therapy for MIBCs is still in its infancy. Our previous work determined that Pparg activation can drive luminal tumor formation. We generated a novel Krt5CreERT2; VP16;Pparg transgenic mouse model, where Pparg expression is constitutively active in basal urothelial cells upon tamoxifen induction. During homeostasis, constitutive Pparg promoted luminal differentiation and cell cycle exit in basal cells but did not produce tumors. However, increased Pparg signaling in activated basal cells following 1-month exposure to bladder-specific carcinogen BBN produced luminal tumors. These tumors are similar both in morphology and molecular markers to human luminal MIBCs. The resulting VP16;Pparg luminal tumors have reduced Nf-kb expression and are immune cold compared to basal tumors. These findings suggest that Pparg is a driver of luminal tumor formation and a suppressor of immune infiltration in bladder cancer. In Chapter 2 of the thesis, I focus on the therapeutic potential of activating Pparg in basal MIBC. We treated mice bearing BBN-induced, Pparg-negative basal tumors with synthetic Pparg ligand - Rosiglitazone (Rosi) and Mek1/2 inhibitor Trametinib (Tram), both of which have been shown to induce Pparg signaling in vitro and in vivo. The combined RosiTram treatment induced apoptosis and significantly reduced tumor burden. The post-treatment urothelium appeared similar in morphology to a healthy urothelium. RosiTram treatment also restored normal urothelial differentiation and generated resident cell types (e.g., superficial cells, intermediate cells, Keratin5+ (K5), basal cells, and Keratin14+ (K14) basal cells) that are normally seen in a healthy urothelium. In contrast, basal tumors are almost entirely composed of K14-Basal cells. Mechanistically, RosiTram treatment partially restores differentiation through retinoic acid signaling and Ezh2 inhibition. Together, our study established targeted transcriptionally and epigenetically reprogramming as a promising differentiation therapeutic approach for basal bladder tumors.

Made available in DSpace on 2015-08-20T17:10:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-04-17. Added 1 bitstream(s) on 2015-08-20T17:26:56Z : No. of bitstreams: 1 000840998_20151016.pdf: 568585 bytes, checksum: e8f035e4f942fd75fc6ad38083a8fd0d (MD5) Bitstreams deleted on 2015-10-16T13:54:07Z: 000840998_20151016.pdf,. Added 1 bitstream(s) on 2015-10-16T13:54:48Z : No. of bitstreams: 1 000840998.pdf: 3047380 bytes, checksum: 4f011bacf1f109d530d0cddd6178474e (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Agonistas dos receptores Toll-like (TLRs) podem representar candidatos promissores a serem desenvolvidos como medicamentos contra o câncer. Atualmente, a terapia mais eficaz para o câncer de bexiga urinária não-músculo invasivo (CBNMI) é a imunoterapia com BCG (Bacillus Calmette-Guerin), embora sua utilização esteja limitada a efeitos colaterais de intensidades variadas. Diante deste cenário destaca-se o P-MAPA, que por sua grande versatilidade e mínima citoxicidade, abre uma nova perspectiva para o combate de alguns tipos de cânceres, incluindo o CBNMI. Assim, os objetivos principais deste estudo foram caracterizar os efeitos histopatológicos e moleculares da imunoterapia intravesical com P-MAPA envolvendo as vias de sinalização dos TLRs 2 e 4 no tratamento do CBNMI induzido quimicamente em camundongos selvagens (wild type - WT) e knockouts (-/-) para TLR4 e MyD88. Os efeitos da imunoterapia com P-MAPA foram comparados com o tratamento com BCG. Foram utilizados 20 camundongos fêmeas de cada linhagem (WT, TLR4-/- e MyD88-/-), todos com 60 dias de idade e mantidos no Centro de Medicina Nuclear da Faculdade de Medicina/USP - São Paulo. Os animais foram divididos em 4 grupos de 5 animais, para cada linhagem: Grupo Controle (CTL): recebeu uma dose intravesical de solução fisiológica por 3 semanas consecutivas; Grupo MNU: recebeu uma dose intravesical de N-metil-N-nitrosouréia (MNU) a cada 15 dias, totalizando 3 doses; Grupo MNU+BCG: recebeu uma dose intravesical de BCG por 3 semanas consecutivas; Grupo MNU+P-MAPA: recebeu uma dose intravesical de P-MAPA por 3 semanas consecutivas. Após 09 semanas de experimento, as bexigas urinárias foram coletadas e submetidas às análises histopatológicas e Western Blotting. O presente trabalho demonstrou que a imunoterapia com P-MAPA promoveu distinta ativação do sistema imune inato mediada por TLRs 2 e 4 em relação ao BCG, resultando no aumento da via de sinalização para... / Compounds that are able to act as Toll-like receptors (TLRs) agonists may represent promising candidates to be developed as drugs against cancer. Currently, the most effective therapy for non-muscle invasive bladder cancer (NMIBC) is immunotherapy with BCG (Bacillus Calmette-Guerin) associated with transurethral resection. However, the use of BCG is associated with side effects of varying strengths and in this scenario highlights the P-MAPA, which in great versatility and minimal cytotoxicity, opens a new perspective for fighting certain types of cancers, including NMIBC. Thus, the main objectives of this study were to characterize the histopathological and molecular effects of intravesical immunotherapy with P-MAPA involving the signaling pathways of TLRs 2 and TLR4 in the NMIBC treatment chemically induced in Wild Type mice (Wild Type - WT) and knockouts (-/-) for TLR4 and MyD88. The effects of P-MAPA immunotherapy were compared with BCG treatment. It were utilized 20 female mice of each strain (WT, TLR4 -/- and MyD88 -/-), all with 60 days of age and kept in the Nuclear Medicine Center, School of Medicine / USP - São Paulo. The animals were divided into 4 groups of 5 animals for each strain: Control Group (CTL): received intravesical dose of saline for 3 consecutive weeks; MNU Group: received a intravesical dose of N-methyl-N-Nitrosourea (MNU) every 15 days, a total of 3 doses; MNU+BCG Group: received received intravesical dose of BCG for 3 consecutive weeks; MNU+P-MAPA Group: received intravesical dose of P-MAPA for 3 consecutive weeks. After 09 weeks of experiment, urinary bladders were collected and submitted to histopathological and Western blotting analysis. The present study showed that P-MAPA immunotherapy led to distinct activation of the innate immune system TLR2 and 4-mediated when compared to BCG, resulting in increased signaling pathway for interferon (TRIF, IRF3, IFN-α and IFN-γ ) and restoration of the p53 protein ...

Orientador: Wagner José Fávaro / Banca: Cintia Yuri Matsumura / Banca: Flávio de Oliveira Lima / Resumo: Agonistas dos receptores Toll-like (TLRs) podem representar candidatos promissores a serem desenvolvidos como medicamentos contra o câncer. Atualmente, a terapia mais eficaz para o câncer de bexiga urinária não-músculo invasivo (CBNMI) é a imunoterapia com BCG (Bacillus Calmette-Guerin), embora sua utilização esteja limitada a efeitos colaterais de intensidades variadas. Diante deste cenário destaca-se o P-MAPA, que por sua grande versatilidade e mínima citoxicidade, abre uma nova perspectiva para o combate de alguns tipos de cânceres, incluindo o CBNMI. Assim, os objetivos principais deste estudo foram caracterizar os efeitos histopatológicos e moleculares da imunoterapia intravesical com P-MAPA envolvendo as vias de sinalização dos TLRs 2 e 4 no tratamento do CBNMI induzido quimicamente em camundongos selvagens (wild type - WT) e knockouts (-/-) para TLR4 e MyD88. Os efeitos da imunoterapia com P-MAPA foram comparados com o tratamento com BCG. Foram utilizados 20 camundongos fêmeas de cada linhagem (WT, TLR4-/- e MyD88-/-), todos com 60 dias de idade e mantidos no Centro de Medicina Nuclear da Faculdade de Medicina/USP - São Paulo. Os animais foram divididos em 4 grupos de 5 animais, para cada linhagem: Grupo Controle (CTL): recebeu uma dose intravesical de solução fisiológica por 3 semanas consecutivas; Grupo MNU: recebeu uma dose intravesical de N-metil-N-nitrosouréia (MNU) a cada 15 dias, totalizando 3 doses; Grupo MNU+BCG: recebeu uma dose intravesical de BCG por 3 semanas consecutivas; Grupo MNU+P-MAPA: recebeu uma dose intravesical de P-MAPA por 3 semanas consecutivas. Após 09 semanas de experimento, as bexigas urinárias foram coletadas e submetidas às análises histopatológicas e Western Blotting. O presente trabalho demonstrou que a imunoterapia com P-MAPA promoveu distinta ativação do sistema imune inato mediada por TLRs 2 e 4 em relação ao BCG, resultando no aumento da via de sinalização para... / Abstract: Compounds that are able to act as Toll-like receptors (TLRs) agonists may represent promising candidates to be developed as drugs against cancer. Currently, the most effective therapy for non-muscle invasive bladder cancer (NMIBC) is immunotherapy with BCG (Bacillus Calmette-Guerin) associated with transurethral resection. However, the use of BCG is associated with side effects of varying strengths and in this scenario highlights the P-MAPA, which in great versatility and minimal cytotoxicity, opens a new perspective for fighting certain types of cancers, including NMIBC. Thus, the main objectives of this study were to characterize the histopathological and molecular effects of intravesical immunotherapy with P-MAPA involving the signaling pathways of TLRs 2 and TLR4 in the NMIBC treatment chemically induced in Wild Type mice (Wild Type - WT) and knockouts (-/-) for TLR4 and MyD88. The effects of P-MAPA immunotherapy were compared with BCG treatment. It were utilized 20 female mice of each strain (WT, TLR4 -/- and MyD88 -/-), all with 60 days of age and kept in the Nuclear Medicine Center, School of Medicine / USP - São Paulo. The animals were divided into 4 groups of 5 animals for each strain: Control Group (CTL): received intravesical dose of saline for 3 consecutive weeks; MNU Group: received a intravesical dose of N-methyl-N-Nitrosourea (MNU) every 15 days, a total of 3 doses; MNU+BCG Group: received received intravesical dose of BCG for 3 consecutive weeks; MNU+P-MAPA Group: received intravesical dose of P-MAPA for 3 consecutive weeks. After 09 weeks of experiment, urinary bladders were collected and submitted to histopathological and Western blotting analysis. The present study showed that P-MAPA immunotherapy led to distinct activation of the innate immune system TLR2 and 4-mediated when compared to BCG, resulting in increased signaling pathway for interferon (TRIF, IRF3, IFN-α and IFN-γ ) and restoration of the p53 protein ... / Mestre

Bladder Cancer is the tenth most common malignancy globally, and is the thirteenth most common cause of tumor associate morbidity. Bladder cancer is largely stratified into two categories: Non-Muscle Invasive Bladder Cancer (NMIBC) and Muscle Invasive Bladder Cancer (MIBC). NMIBC represents disease localized to the urinary bladder, and can be stratified into low and high-grade disease. MIBC represents an aggressive class of bladder cancer, with invasion into the underlying muscle layers of the bladder. MIBC can be classified as either non-metastatic MIBC, with disease localized to the bladder corpus, or metastatic MIBC, with disease spreading to sites beyond the bladder corpus. High grade NMIBC presents significant risk for progression to MIBC, and collectively both high grade NMIBC and MIBC bladder cancers demonstrate poor prognostic outcomes in clinical settings in terms of responses to therapy, recurrence risks, and overall survival. Hexaminolevulinate is a precursor of Protoporphyrin IX (PpIX) in the heme biosynthetic pathway. Hexaminolevulinate has been FDA approved under the trade name Cysview for diagnostic usage in blue light cystoscopies for fluorescence mediated visualization of disease along the bladder wall. I demonstrate that in addition to its diagnostic utility, Cysview and blue light irradiation can be utilized clinical as a potential therapeutic modality. I demonstrate the significant selective cytotoxicity of Cysview in combination with blue light against patient derived organoids (PDOs) from primary bladder cancers. My results determine that Cysview and blue light induce a rapid cell death program mediated by an influx in Reactive Oxygen Species (ROS) production, resulting in less than 5% viability within 24 hrs of treatment. This massive loss in viability is observed in low and high grade NMIBC, as well as MIBC derived PDOs with diverse mutational profiles. The results of this work demonstrate that PDOs are a significant platform for assessing therapy responses for correlation with the large patient population. Furthermore, the work identifies photodynamic therapy with Cysview and blue light irradiation as a putative therapeutic modality for localized bladder cancers, with the potential for significant improvement in patient outcomes. The identification and characterization of the therapeutic effects of Cysview come at a critical time during a global shortage of conventional therapeutics for localized bladder cancer, and presents a pathway for patients affected by these shortages. Progression in bladder cancer has been understood to be driven by processes governing subpopulation and cell state and lineage transformation. Previous studies identify phenotypic plasticity within a subset of bladder cancers and have correlated this phenomenon with an increased risk for disease progression from NMIBC to MIBC. In previous work, a subset of PDOs derived from luminal primary tumors demonstrated significant degrees of luminal to basal plasticity in vitro. In my analysis of these PDOs using transcriptomic and chromatin accessibility data, I identified a transcriptomic and epigenetic signature unique to plastic PDOs. Furthermore, I identified HNF1B, GRHL2, GATA6, and SNAI2 as putative regulators of luminal to basal plasticity in bladder cancer. Using these molecular profiles, I correlated the plasticity phenotype with reduction in overall survival using data from published bladder cancer patient cohorts. Finally, I developed a novel transcriptomic subtypes classification scheme and an accompanying R package to classify epithelial heterogeneity in bladder cancer, based on the transcriptomic subtypes I identified in bladder cancer PDOs.