abstract: Following diagnosis of a glioblastoma (GBM) brain tumor, surgical resection, chemotherapy and radiation together yield a median patient survival of only 15 months. Importantly, standard treatments fail to address the dynamic regulation of the brain tumor microenvironment that actively supports tumor progression and treatment resistance. Moreover, specialized niches within the tumor microenvironment maintain a population of highly malignant glioblastoma stem-like cells (GSCs). GSCs are resistant to traditional chemotherapy and radiation therapy and are likely responsible for near universal rates of tumor recurrence and associated morbidity. Thus, disrupting microenvironmental support for GSCs could be critical to more effective GBM therapies. Three-dimensional (3D) culture models of the tumor microenvironment are powerful tools for identifying key biochemical and biophysical inputs that may support or inhibit malignant behaviors. Here, we developed synthetic poly(N-isopropylacrylamide-co-Jeffamine M-1000® acrylamide) or PNJ copolymers as a model 3D system for culturing GBM cell lines and low-passage patient-derived GSCs in vitro. These temperature responsive scaffolds reversibly transition from soluble to insoluble in aqueous solution by heating from room temperature to body temperature, thereby enabling easy encapsulation and release of cells in a 3D scaffold. We also designed this system with the capacity for presenting the cell-adhesion peptide sequence RGD for adherent culture conditions. Using this system, we identified conditions that promoted GBM proliferation, invasion, GSC phenotypes, and radiation resistance. In particular, using two separate patient-derived GSC models, we observed that PNJ scaffolds regulated self-renewal, provided protection from radiation induced cell death, and may promote stem cell plasticity in response to radiation. Furthermore, PNJ scaffolds produced de novo activation of the transcription factor HIF2α, which is critical to GSC tumorigenicity and stem plasticity. All together, these studies establish the robust utility of PNJ biomaterials as in vitro models for studying microenvironmental regulation of GSC behaviors and treatment resistance. / Dissertation/Thesis / Doctoral Dissertation Biomedical Engineering 2017

Class of 2012 Abstract / Specific Aims: This study was aimed to evaluate inpatient clinical treatment characteristics associated with the use of intracranial implantation of chemotherapeutic wafers for malignant brain neoplasms within United States, and assess inpatient mortality and total charges regarding treatment with wafer versus without. Methods: A retrospective cohort investigation was conducted utilizing inpatient discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample from 2005 to 2009. From this nationally-representative sample, 9,455 adults aged 18 years or older were identified with malignant neoplasms of the brain treated with implantable chemotherapeutic wafers. Outcomes of inpatient mortality and charges were assessed via multivariate regression analysis, controlling for patient characteristics, hospital structure, comorbidities, and clinical complications. Main Results: The average age of patients with brain neoplasms was 56.6 (±16.5) years, and of those patients, 42.9% were female. The odds ratio for inpatient mortality of patients treated with implantable chemotherapeutic wafers was OR=0.380 (P<0.001), and patients that received wafer treatment had increased charges exp(b)=2.147 (P<0.001). Conclusions: Multiple factors were associated with inpatient mortality and charges among the 247,829 patients that were diagnosed with malignant brain neoplasms from 2005-2009. With regards to these patients, implantable chemotherapeutic wafers were associated with increased inpatient survival and increased charges.

Os gliomas são tumores do sistema nervoso central (SNC) que evoluem a partir das células da glia. O tipo mais frequente e mais agressivo destes tumores é conhecido como glioblastoma multiforme (GBM) e entre as características biológicas de agressividade associadas a esse tumor estão o seu rápido crescimento e ausência de apoptose. O seu prognóstico desfavorável está associado à dificuldade de tratamento dessas células, pois possuem resistência à quimioterapia e a radioterapia. A expressão gênica das enzimas ciclooxigenase-1 (COX-1), ciclooxigenase-2 (COX-2), prostaglandina E sintase-1 microssomal (mPGES-1), prostaglandina E sintase-2 microssomal (mPGES-2), prostaglandina E sintase citosólica (cPGES) e os produtos da síntese destas enzimas, incluindo a prostaglandina E1 (PGE1) e a prostaglandina E2 (PGE2) estão diretamente relacionados com a malignidade dos gliomas. A PGE1 e a PGE2 podem atuar de modo autócrino e parácrino, interagindo com suas células alvos através de ligação aos receptores da superfície celular que estão ligados a proteína G. Estes receptores são conhecidos como receptores EPs e dividem-se em quatro subtipos: EP-1, EP-2, EP-3 e EP-4 sendo que cada um deles ativa vias distintas de sinalização intracelular. Desta forma, este estudo teve por objetivo analisar in vitro o papel da PGE1, PGE2 e seus receptores na proliferação e apoptose em glioma humano, e a expressão das enzimas COX-1, COX-2, mPGES-1, mPGES-2 e cPGES. / Gliomas are tumors of the central nervous system (CNS) that evolve from glial cells. The most common and most aggressive form of these tumors is known as glioblastoma multiforme (GBM). The biological aggressiveness of GBM is associated with its rapid growth and lack of apoptosis. Its poor prognosis is strongly associated with the difficulty of treating these cells as they are resistant to chemotherapy and radiotherapy. The gene expression of the enzymes cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2), microsomal prostaglandin E synthase-1 (mPGES-1), microsomal prostaglandin E synthase-2 (mPGES-2), cytosolic prostaglandin E synthase (cPGES) and the products of the activity of these enzymes, including prostaglandin E1 (PGE1) and prostaglandin E2 (PGE2), are directly related to the malignancy of gliomas. PGE1 and PGE2 can act in an autocrine and paracrine manner, by interacting with their target cells via binding to cell surface receptors that are linked to G-proteins. These receptors are known as EP receptors and are divided into four subtypes: EP1, EP2, EP3 and EP4; each of which activates distinct intracellular signaling pathways. Therefore, this study aimed to analyze, in vitro, the role of PGE1, PGE2 and their receptors in the proliferation and apoptosis of human glioma and the expression of COX-1, COX-2, mPGES-1, mPGES-2 and cPGES.

Brain tumors present the second highest cause of death among pediatric cancers. About 60% are located in the posterior fossa region of the brain; among the most frequent types the ones considered for this project were astrocytomas, medulloblastomas, and ependymomas. Diagnosis can be done either through invasive histopathology exams or by non-invasive magnetic resonance (MR) scans. The tumors listed can be difficult to diagnose, even for trained radiologists, so machine learning methods, in particular deep learning, can be useful in helping to assess a diagnosis. Deep learning has been investigated only in a few other studies.The dataset used included 115 different subjects, some with multiple scan sessions, for which there were 142 T2-w, 119 T1Gd-w, and 89 volumes that presented both MR modalities. 2D slices have been manually extracted from the registered and skull-stripped volumes in the transversal, sagittal, and frontal anatomical plane and have been preprocessed by normalizing them and selecting the slices containing the tumor. The scans employed are T2-w, T1Gd-w, and a combination of the two referred to as multimodal images. The images were divided session-wise into training, validation, and testing, using stratified cross-validation and have also been augmented. The convolutional neural networks (CNN) investigated were ResNet50, VGG16, and MobileNetV2. The model performances were evaluated for two-class and three-class classification tasks by computing the confusion matrix, accuracy, receiver operating characteristic curve (ROC), the area under the curve (AUROC), and F1-score. Moreover,  explanations for the behavior of networks were investigated using GradCAMs and occlusion maps. Preliminary investigations showed that the best plane and modality were the transversal one and T2-w images. Overall the best model was VGG16, for the two-class tasks the best classification was between astrocytomas and medulloblastomas which reached an F1-score of 0.86 for both classes on multimodal images, followed by astrocytomas and ependymomas with an F1-score of 0.76 for astrocytomas and 0.74 for ependymomas on T2-w, and last F1-score of 0.30 for ependymomas and 0.65 for medulloblastomas on multimodal images. The three-class classification reached F1-score values of 0.59 for astrocytomas, 0.46 for ependymomas, and 0.64 for medulloblastomas on T2-w images. GradCAMs and occlusion maps showed that VGG16 was able to focus mostly on the tumor region but that there also seemed to be other information in the background of the images that contributed to the final classification.To conclude, the classification of infratentorial pediatric brain tumors can be achieved with acceptable results by means of deep learning and using a single MR modality, though one might have to account for the dataset size, number of classes and class imbalance. GradCAMs and occlusion maps offer important insights into the decision process of the networks

The Wide Range Assessment of Memory and Learning (WRAML) is a relatively new instrument used in the assessment of memory in children. The purpose of this study was to examine the validity of the WRAML by comparing the performance of children on both the WRAML and the Woodcock-Johnson Tests of Cognitive Ability- Revised (WJTCA-R). Subjects for the study were children in treatment for a brain tumor at a regional children's medical center. Fifty children participated in the study ranging from ages 6 to 17. A multiple regression analysis was conducted to determine which of four selected clusters from the WJTCA-R would have the highest correlation with the Verbal Memory Index (VERI) from the WRAML. The Short-Term Memory (GSM) cluster had the highest correlation ( r = .82) as predicted. A Pearson's product-moment correlational analysis was conducted between the Visual Processing (GV) cluster from the WJTCA-R and the Visual Memory Index (VISI) from the WRAML. GV was found to have a high positive correlation ( r = .63) with VISI. A similar analysis was conducted between the Long-Term Retrieval (GLR) cluster from the WJTCA-R and the Learning Index (LRNI) from the WRAML. GLR was found to have a high positive correlation ( r = .81) with LRNI. Finally, a correlational analysis was conducted between the Broad Cognitive Ability (BCA) scale from the WJTCA-R and the General Memory Index (GENI) from the WRAML. A high positive correlation ( r = .87) was found between these most global measures from the two batteries. The observed correlation between BCA and GENI was much higher than anticipated. The author concluded that neurological impairment had affected subject memory and intellectual functioning in similar ways. The results do not generalize to children who have not had similar decrements in cognitive functioning. Future research should establish a baseline correlation between the two instruments with a non-impaired population.

Les tumeurs gliales et glioneuronales sont les tumeurs cérébrales les plus fréquentes chez l'enfant. Elles sont généralement d'excellent pronostic. En revanche, les astrocytomes pilocytiques (AP) hypothalamo-chiasmatiques, ont un potentiel évolutif plus agressif. Ce travail de thèse propose une nouvelle stratégie thérapeutique pour ce sous-type d'AP selon la méthode du « drug repositioning », en employant la combinaison du celecoxib et de la fluvastatine. Nos travaux ont montré in vitro que cette association de molécules était synergique, capable d'arrêter le cycle cellulaire, de diminuer la prolifération et d'induire l'apoptose des cellules tumorales. Cette combinaison a également été testée avec succès chez une patiente souffrant d'un AP multifocal et réfractaire aux traitements conventionnels dans le cadre d'une thérapie métronomique. Ce manuscrit décrit également l'étude histo-moléculaire de plusieurs séries de tumeurs gliales et glioneuronales pédiatriques menées afin d'améliorer leur caractérisation et leur diagnostic. Nos travaux ont confirmé la présence de la fusion KIAA1549:BRAF dans les AP analysés ainsi que le caractère péjoratif de la topographie hypothalamo-chiasmatique, du variant histologique pilomyxoïde et de l'âge au diagnostic inférieur à 36 mois. Ils ont également montré l'absence de différence moléculaire entre les gliomes corticaux de grade II et des DNT. Enfin, nos travaux ont montré que les DNT, les GG et les PXA partagent la mutation BRAFV600E et l'expression de CD34. Ces travaux confirment l'implication majeure de l'altération de la voie des MAPKinases dans la tumorigenèse de ces tumeurs, constituant ainsi une cible thérapeutique prometteuse. / Glial and glioneuronal tumors are the most frequent brain tumors in children. They are characterized by an excellent prognosis. However, hypothalamic-chiasmatic pilocytic astrocytomas (PA) have a more aggressive outcome. In the first part, we propose a new therapeutic strategy for hypothalamic-chiasmatic PA according to drug repositioning method, by using celecoxib, and fluvastatin. We showed that, in vitro, this combination was synergistic, stopped cell cycle, inhibited cell proliferation and increased apoptosis. In addition, this combination was tested with success, under a metronomic chemotherapy, for a girl suffering from a multifocal PA and refractory to conventional treatment. This new strategy of treatment appears promising for this type of tumor because it is less toxic than conventional chemotherapy and not too expensive. In the second part, this manuscript describes the histo-molecular study of several retrospective series of glial and glioneuronal pediatric tumors conducted to improve their characterization and their diagnosis. We confirmed the presence of the fusion gene KIAA1549: BRAF in PA as well as the pejorative nature of the hypothalamic-chiasmatic topography, pilomyxoïde histology and the age at diagnosis less than 36 months. We also showed no molecular difference between cortical grade II gliomas associated with chronic epilepsy and the DNT group. Finally, we showed that DNT, GG and PXA share BRAFV600E mutation and expression of CD34. These studies confirm the major implication of the MAPKinase altered pathway in tumorigenesis of glial and glioneuronal pediatric tumors, constituting a promising therapeutic target.

La classification OMS des tumeurs cérébrales de l'enfant distingue les tumeurs gliales des tumeurs glioneuronales, les gliomes circonscrits des infiltrants. Elle représente le meilleur indicateur pronostic mais se heurte pourtant à des limites de reproductibilité. Pour mieux préciser le diagnostic, mieux définir des sous-groupes de pronostic différent, et mieux orienter le thérapeutique, nous avons recherché les profils moléculaires de 108 tumeurs cérébrales circonscrites de l'enfant : astrocytome pilocytique (PA), tumeurs neuroépithéliales dysembryoplasiques (DNT), xanthoastrocytomes pléïomorphes (PXA) et gangliogliomes (GG). Aucune différence n'est retrouvée entre les gliomes corticaux de grade II (GC) et les DNT concernant IDH1 et 2, TP53 et la délétion1p19q. Les DNT non spécifiques et les GC partagent le même profil incluant CD34 et la mutation V600E de BRAF dans 50% des cas. Le PXA exprime la mutation V600E de BRAF dans plus de 50 % des cas et se rapproche du groupe des tumeurs glioneuronales. Concernant le PA, nous confirmons le caractère péjoratif de la topographie hypothalamo-chiasmatique, de l'histologie pilomyxoide, de l'âge inférieur à 36 mois et de l'exérèse partielle. A l'opposé des tumeurs infiltrantes qui appartiendraient au groupe " histones dépendantes", les tumeurs circonscrites pourraient être regroupées sous le terme "MAPKinases dépendantes". On y distinguerait alors les tumeurs avec fusion KIAA1543-BRAF de celles avec mutation V600E de BRAF. Ce travail a permis de mieux caractériser les tumeurs gliales et glioneuronales de l'enfant, reposant sur le transfert en routine de marqueurs moléculaires simples. / The OMS classification for pediatric brain tumors includes glial tumors and mixed glial and glioneuronal tumors, diffuse and no diffuse glioma. All strategic decision making are based on this current classification but it drives to some limits of diagnosis reproductibility.The goal of our study was to define molecular profils for low grade no diffuse pediatric brain tumors including pilocytic astrocytoma (PA), dysembryoplasic neuroepithelial tumor (DNT), pleiomorphic xanthoastrocytoma (PXA) and benign gangliogliome (GG), to improve the quality of diagnosis, define different subgroups with different prognosis and then to improve treatment strategy decision making.No molecular difference was found between cortical grade II glioma (GC) and DNT regarding IDH1 and 2 TP53 alterations and 1p19q deletion. Similarly 50 % of no specific form of DNT share the same molecular profil with GC with CD34 expression and V600E mutation of BRAF. PXA demonstrated BRAFV600E mutation in 60 % of cases. PXA could then be very close glioneuronal tumors. Finally in PA we confirmed the negative impact of hypothalochiasmatic location, pilomyxoid diagnosis and age lower than 36 months and partial resection. We could work on the elaboration of a new classification and define the group named “Histone dependant” for tumors with histone aberrations and the group named “MAPKinases dependant” for tumors with either KIAA 1543-BRAF fusion or V600E BRAF mutation.In conclusion, this work has led to improve the molecular profil characteristics of glioneuronal tumors of childhood with different easy diagnostic markers that can be used in routine practice, and could potentially replace DNA sequencing.

La thérapie photodynamique (PDT) appliquée aux tumeurs cérébrales est évaluée comme une stratégie complémentaire par rapport aux thérapies conventionnelles. De nombreux travaux mettent en exergue le rôle prépondérant joué par l'effet vasculaire de la PDT dans l'éradication tumorale. Ainsi, une accumulation sélective du photosensibilisateur au niveau des néo-vaisseaux tumoraux favorise cet effet et donc, l'efficacité du traitement photodynamique. La stratégie vasculaire consistant à coupler un photosensibilisateur à un peptide ligand pour cibler le récepteur neuropiline-1 (NRP-1) surexprimé par les cellules endothéliales angiogéniques a été validée, démontrant également l'induction de l'expression du facteur tissulaire immédiatement après PDT. Grâce à l'utilisation de nanoparticules multifonctionnelles, des améliorations ont été apportées à la stratégie initiale pour une PDT interstitielle (iPDT) guidée par l'imagerie. Fonctionnalisées par le peptide ligand, vecteur du photosensibilisateur et d'un agent de contraste puis rendues furtives, les nanoparticules sélectionnées présentent les propriétés originales requises pour une action combinée en IRM et PDT ciblée. Les nano-objets sont affins pour NRP-1 et conservent leur caractéristique photo-activable. Les essais sur rats nude xénogreffés en orthotopique par un modèle de gliome malin humain, valident la faisabilité du concept de iPDT guidée par l'IRM en temps réel. Après injection des nanoparticules par voie intraveineuse, un rehaussement positif du signal IRM est observé au niveau de la zone tumorale pour optimiser l'implantation de la fibre optique. Les résultats obtenus par IRM de perfusion et, l'expression protéique de NRP-1 au niveau du tissu et des berges tumorales, valident la sélectivité des nanoparticules fonctionnalisées. La combinaison des techniques d'imagerie non-invasives (IRM, SRM, TEP/CT) a permis le suivi thérapeutique / Photodynamic therapy (PDT) for brain tumors appears to be complementary to conventional treatments. Number studies show the major role of the vascular effect in the tumor eradication by PDT. To promote this vascular effect, a selective targeting of neuropilin-1 (NRP-1), mainly over-expressed by tumor angiogenic vessels, was investigated using a photosensitizer coupled to a ligand peptide. We validated the interest of using this active-targeting strategy to promote this vascular effect by the induction of tissue factor expression immediately post-PDT. For interstitial PDT (iPDT) of brain tumors guided by real-time imaging, multifunctional nanoparticles consisting of a surface-localized tumor vasculature targeting NRP-1 and encapsulated PDT and imaging agents, have been developed. The selected nanoparticles are favourable to a photosensitizer targeting strategy for iPDT combined with MRI.Characterization studies of the nanoparticles reveal a photodynamic efficiency and demonstrate a molecular affinity of the functionalized nanoparticle to NRP-1 target. After intravenous injection of the multifunctional nanoparticles into rats with intracranial glioma, we demonstrate a positive contrast enhancement of the tumor tissue by MRI, allowing the optimization of the optical fiber implantation. Perfusion MRI data and NRP-1 protein expression of the tumor and brain adjacent to tumor tissues check selectivity of the functionalized nanoparticle. The combination of non-invasive techniques of imaging (MRI, MRS, PET/CT) validates this concept of iPDT guided by MRI

Medulloblastoma (MB) and supratentorial primitive neuroectodermal tumor (stPNET) are pediatric embryonic brain tumors, which arise in a brain that is in the process of growth and development. They differ significantly from adult lesions and may involve unique genetic and epigenetic factors. However, the pathogenesis of these tumors is still elusive. My project consisted of four parts, investigating major genetic and epigenetic alterations of these tumors. / Multiple genetic studies have shown high frequency of loss (30--60%) on chromosome 8p in MBs. Microcell-mediated transfer of chromosome 8 suppressed tumorigenesis or the proliferation of colon and breast cancer cell, indicating that chromosome 8p is likely to include several TSGs in human cancers. In previous studies from our laboratory, results showed the frequency of loss on chromosome 8p is also rather high (66.7%). An overlapping HD region was identified in a 1.8cM interval on 8p22-23.1, between markers D8S520 and D8S1130, in two MBs (Yin et al., 2002), indicating that several candidate TSGs are located within or near this region. PinX1 on 8p23.1, a potential inhibitor of telomerase, is most likely the candidate TSG in MBs due to its location and function. To evaluate the genetic alterations of PinX1 and to investigate its role in MBs, the first part of my study is to perform mutation analysis in a series of 52 primary MBs, 3 MB cell lines and 4 primary stPNETs. Transcript expression of PinX1 was evaluated by reverse transcription-polymerase chain reaction (RT-PCR) in microdissected tumors and normal cerebellum. Using the telomeric repeat amplification protocol (TRAP) assay, 19 MBs, 2 stPNETs and all 3 MB cell lines were analyzed for telomerase activity. No somatic point mutations and loss of expression of PinX1 were detected in our series, suggesting that PinX1 is not the target gene on 8p23.1 in MBs. Although we did not find a significant association between PinX1 expression and telomerase activity, the presence of telomerase activity in 16 of 22 MBs and 1 of 2 stPNETs indicate that telomerase activation is associated with the development of this malignant disease. Our study represents the largest series of MB examined by telomerase repeat amplification protocol (TRAP) assay. (Abstract shortened by UMI.) / Chang Qing. / "April 2005." / Adviser: Ho-Keung Ng. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0191. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 201-228). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Nearly 80% of children treated for cancer are expected to survive, but not without cost. Survivors face unprecedented challenges associated with long-term consequences of treatment, also called late effects. Approximately half of children treated for cancer are at risk for experiencing cognitive late effects, which typically emerge several years post diagnosis. The nature and extent of cognitive late effects appear to be developmental and related to patient, disease, and treatment variables. However, the relationships between these variables is not well understood because there have been few prospective and longitudinal studies that report on the contributions of these variables over time. This dissertation examined the effects of patient, disease, and treatment variables, as well as their interactions over time on neurocognitive functioning in childhood cancer survivors. It comprises part of a large prospective, randomized clinical trial designed to examine changes in cognitive function over three years as a function of different levels of monitoring of school-based intervention based on individual educational plans (IEPs). This dissertation uniquely contributed a new measure (the Treatment Intensity Rating Scale) that was used to systematically classify treatment severity across different types of cancer and cancer treatments. Participants included 61 children ages 7 to 12 years at enrollment who were two to five years from completion of treatment for a brain tumor, leukemia, or lymphoma. Participants received yearly neuropsychological evaluations for a follow-up period of 3 years. Results of these evaluations were used to develop IEPs. Participants were randomized to have their IEPs monitored on a quarterly or annual basis for the duration of the study. Contrary to the progressive decline in neurocognitive functioning that is typically anticipated in pediatric cancer survivors, analyses revealed relative stability of performance on neurocognitive measures over time. Higher neurocognitive performance was noted in children whose IEPs were monitored more frequently versus less frequently. Results also supported gender-specific risk for late effects, with lower performance on select neurocognitive measures in females compared to males. Results of this study provide encouraging evidence of the positive effects of school-based interventions and their close monitoring. This has important implications for quality of life as these children survive well beyond childhood into adulthood.