Lung cancer is the leading cause of cancer deaths worldwide. A large part of this high mortality rate is due to the onset of metastatic disease prior to diagnosis. Advances in treatment for metastatic disease may be achieved by understanding more about the identity of metastatic tumor cells and the mechanisms those cells employ to spread throughout the body. This thesis examined the relationship between cells capable of tumor propagation upon serial transplantation (tumor-propagating cells, or TPCs) and those with metastatic potential.

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Sabemos hoje que os tumores sólidos apresentam uma composição celular heterogênia e que apenas uma pequena parcela dessas células apresenta capacidade de se proliferar e gerar novos tumores. Estudos prévios sobre a formação do câncer de mama têm sido realizados com base na combinação dos marcadores de superfície celular CD44 e CD24. Já foi demonstrado que uma subpopulação de células do câncer de mama com alta expressão de CD44 e baixa expressão de CD24 (CD44+/CD24-) tem maior capacidade de gerar tumores, quando comparadas com a subpopulação de células CD44-/CD24+. O objetivo do estudo foi identificar a taxa de células com fenótipo CD44+/CD24- presentes nos tumores mamários e relaciona-la com a taxa de comprometimento dos linfonodos axilares ipsilaterais por neoplasia, além de avaliar também sua relação com outros fatores sabidamente relacionados com mal prognóstico da paciente. Pacientes e métodos: avaliamos prospectivamente 53 amostras cirúrgicas provenientes de 42 pacientes com diagnóstico histopatológico de carcinoma de mama, quantificando as células CD44+/CD24- por citometria de fluxo. Relacionamos a porcentagem destas células encontrada em cada amostra com o comprometimento axilar, os receptores hormonais e Her-2, a idade da paciente, o grau histológico do tumor, o diâmetro patológico do tumor e o tipo histológico. Resultados: verificamos um significante aumento da população de células CD44+/CD24- no grupo de carcinomas ductais invasivos em pacientes que apresentavam metástase axilar [mediana 8,53% (3,6 71,2%)] em relação ao grupo de pacientes sem linfonodos comprometidos pela neoplasia [mediana 1,49% (0,3 17,1%)] (p=0,0002). Conclusão: concluímos então que quando estudamos vários tumores mamários invasivos de mesma classificação histológica, podemos notar que existe uma variação na quantidade de células CD44+/CD24- entre eles. Nosso estudo mostrou que essa variação está relacionada à agressividade tumoral e à sua capacidade de gerar metástases já que, tumores com maior quantidade de células CD44+/CD24- apresentam maior taxa de comprometimento dos linfonodos axilares. / It is known that solid tumors are composed by a heterogeneous combination of cells and only a small portion of these cells has the capacity to proliferate and generate new tumors. Previous studies about the breast cancer initiation have been based on a combination of CD44 and CD24cell surface markers. It has been shown that this subpopulation of breast cancer cells with high expression of CD44 and low expression of CD24 (CD44+/CD24-) has a greater capacity to generate tumors when compared with the subpopulation of cells CD44- /CD24+. The study objective was to identify whether the rate of cells with CD44+/CD24- phenotype present in breast tumors is related with the rate of ipsilateral lymph node metastasis, in addition to evaluate its relationship with other risk factors known to be related with worst prognosis. Patients and methods: we prospectively evaluated 53 surgical specimens from 42 patients with histological diagnosis of breast cancer, quantifying CD44+/CD24- cells through flow cytometry. We list the percentage of these cells found in each sample with axillary lymph node status, hormone receptors and Her-2, patient age, histological grade, pathological tumor diameter and histological tumorclassification. Results: we find a significant increase of CD44+/CD24- population in the invasive ductal carcinomas, in patients with axillary metastasis [median 8.53% (3.6 - 71.2%)] than in the group of patients without lymph nodes metastasis [median 1.49% (0.3 - 17.1%)] (p = 0.0002). Conclusion: when we studied several invasive breast tumors of same histological classification, we note that there is variation in the number of CD44+/CD24- cells. Our study showed that this variation is related to tumor aggressiveness and their ability to generate metastasis, because tumors with high rate of CD44+/CD24- cells have a higher rate of lymph node metastasis.

Sabemos hoje que os tumores sólidos apresentam uma composição celular heterogênia e que apenas uma pequena parcela dessas células apresenta capacidade de se proliferar e gerar novos tumores. Estudos prévios sobre a formação do câncer de mama têm sido realizados com base na combinação dos marcadores de superfície celular CD44 e CD24. Já foi demonstrado que uma subpopulação de células do câncer de mama com alta expressão de CD44 e baixa expressão de CD24 (CD44+/CD24-) tem maior capacidade de gerar tumores, quando comparadas com a subpopulação de células CD44-/CD24+. O objetivo do estudo foi identificar a taxa de células com fenótipo CD44+/CD24- presentes nos tumores mamários e relaciona-la com a taxa de comprometimento dos linfonodos axilares ipsilaterais por neoplasia, além de avaliar também sua relação com outros fatores sabidamente relacionados com mal prognóstico da paciente. Pacientes e métodos: avaliamos prospectivamente 53 amostras cirúrgicas provenientes de 42 pacientes com diagnóstico histopatológico de carcinoma de mama, quantificando as células CD44+/CD24- por citometria de fluxo. Relacionamos a porcentagem destas células encontrada em cada amostra com o comprometimento axilar, os receptores hormonais e Her-2, a idade da paciente, o grau histológico do tumor, o diâmetro patológico do tumor e o tipo histológico. Resultados: verificamos um significante aumento da população de células CD44+/CD24- no grupo de carcinomas ductais invasivos em pacientes que apresentavam metástase axilar [mediana 8,53% (3,6 71,2%)] em relação ao grupo de pacientes sem linfonodos comprometidos pela neoplasia [mediana 1,49% (0,3 17,1%)] (p=0,0002). Conclusão: concluímos então que quando estudamos vários tumores mamários invasivos de mesma classificação histológica, podemos notar que existe uma variação na quantidade de células CD44+/CD24- entre eles. Nosso estudo mostrou que essa variação está relacionada à agressividade tumoral e à sua capacidade de gerar metástases já que, tumores com maior quantidade de células CD44+/CD24- apresentam maior taxa de comprometimento dos linfonodos axilares. / It is known that solid tumors are composed by a heterogeneous combination of cells and only a small portion of these cells has the capacity to proliferate and generate new tumors. Previous studies about the breast cancer initiation have been based on a combination of CD44 and CD24cell surface markers. It has been shown that this subpopulation of breast cancer cells with high expression of CD44 and low expression of CD24 (CD44+/CD24-) has a greater capacity to generate tumors when compared with the subpopulation of cells CD44- /CD24+. The study objective was to identify whether the rate of cells with CD44+/CD24- phenotype present in breast tumors is related with the rate of ipsilateral lymph node metastasis, in addition to evaluate its relationship with other risk factors known to be related with worst prognosis. Patients and methods: we prospectively evaluated 53 surgical specimens from 42 patients with histological diagnosis of breast cancer, quantifying CD44+/CD24- cells through flow cytometry. We list the percentage of these cells found in each sample with axillary lymph node status, hormone receptors and Her-2, patient age, histological grade, pathological tumor diameter and histological tumorclassification. Results: we find a significant increase of CD44+/CD24- population in the invasive ductal carcinomas, in patients with axillary metastasis [median 8.53% (3.6 - 71.2%)] than in the group of patients without lymph nodes metastasis [median 1.49% (0.3 - 17.1%)] (p = 0.0002). Conclusion: when we studied several invasive breast tumors of same histological classification, we note that there is variation in the number of CD44+/CD24- cells. Our study showed that this variation is related to tumor aggressiveness and their ability to generate metastasis, because tumors with high rate of CD44+/CD24- cells have a higher rate of lymph node metastasis.

Durch Anwendung Array-basierter Transkriptanalyse auf mikrodissezierte Prostatagewebe konnten eine Vielzahl differenziell exprimierter Gene des Prostatakarzinoms identifiziert werden. Innerhalb dieser wurden CD166 und CD24 für die weiterführende Analyse ausgewählt. CD24 ist ein kleines Zelloberflächenmolekül, das ursprünglich in B-Zellen und malignen hämatologischen Erkrankungen beschrieben wurde. Eine CD24 Expression wurde auch in verschiedenen soliden Tumoren gefunden. Da CD24 ein Ligand von P-Selektin ist, könnte CD24 den Tumorzellen pro-metastatische Eigenschaften verleihen. Ziel der Studie war, die CD24 Expression in unseren Tumorkollektiven von Mamma- (n=201), Prostata- (n=102), Nicht-kleinzelligen Lungen- (n=89), Ovarial- (n=56) und Pankreaskarzinomen (n=95) immunhistologisch zu bestimmen. Diese Ergebnisse wurden mit klinisch-pathologischen Daten einschliesslich der Überlebensdaten korreliert. Die differenzielle Expression von CD166 wurde ebenfalls immunhistochemisch validiert. Eine CD24 Expression fand sich in 85% der Mammakarzinome, 48% der Prostatakarzinome, 45% der NSCLC, in 84% der Ovarialkarzinome und 72% der Pankreaskarzinome. CD24 Expression korrelierte univariat und multivariat signifikant (p / Applying array based transcript analysis to microdissected prostate tissues, a variety of differentially expressed genes of prostate cancer were identified. Among these, CD166 and CD24 were selected for further analysis. CD24 is a small cell surface molecule that has originally been described in B-cells and hematologic malignancies. Expression of CD24 was also found in various solid tumours. Being a ligand of P-selectin, CD24 might confer pro-metastatic properties to tumour cells. We aimed to clarify the expression of CD24 in our collectives of breast cancer (n=201), prostate cancer (n=102), non-small cell lung cancer (NSCLC, n=89), epithelial ovarian cancer (EOC, n=56) and pancreatic cancer (n=95) by immunohistochemistry. These results were correlated to clinicopathological parameters including survival data. The differential expression of CD166 was validated immunohistochemically as well. Expression of CD24 was found in 85% of breast cancer, 48% of prostate cancer, 45% of NSCLC, 84% of EOC and 72% of pancreatic cancer. CD24 expression correlated significantly (p

Il est généralement admis que le cancer du sein représente un ensemble de plusieurs maladies, définies comme des sous-types ayant des caractéristiques moléculaires et cliniques qui leurs sont propres. Une meilleure compréhension des mécanismes qui sous-tendent l'hétérogénéité du cancer du sein est essentielle au développement de thérapies mieux ajustées. Le concept de cellules souches cancéreuses (CSC) pourrait être un des clés de cette compréhension. A ce jour, un certain nombre de marqueurs ont été proposés pour isoler et caractériser les cellules souches dans le cancer du sein, mais aucun ne semble totalement satisfaisant.Le but de mon travail était de déterminer un marqueur ou une combinaison de marqueurs avec lesquels les fractions enrichies en CSC pourraient être isolées de manière reproductible dans le cancer du sein de sous-types basal (BLBC). En effet, les tumeurs basales représentent 15% de toutes les tumeurs mammaires, mais constituent le sous-type le plus agressif. À cet effet, j'ai analysé un certain nombre de marqueurs par analyse FACS et tri cellulaire et utilisé la capacité de formation de mammosphères (MS) comme critère de validation pour la présence de CSC. Les lignées cellulaires utilisées comme modèles étaient les SUM 159, MDA-MB-231, MDA-MB-436, HCC1143, MDA-MB-468, Hs578T et BT-549 correspondant aux modèles basal-A et B. J'ai également testé trois lignées luminales les MCF7, T47D et BT474.De tous les marqueurs testés, seules, la combinaison des protéines de surface cellulaire CD44/CD24/EpCAM et l’activité enzymatique ALDH élevée ont permis d’obtenir un enrichissement significatif en CSC. Toutefois, le niveau de l'activité ALDH est apparu inconstant d’une lignée cellulaire à une autre et selon le type de tumeurs. D'autres marqueurs membranaires ont donné des résultats mitigés dans le cancer du sein ER-. En effet, la plupart des lignées basales ont montré des profils FACS assez homogènes avec des proportions élevées de cellules CD44+. Cependant, l'association de la positivité de CD44 avec l'EMT et la souchitude, ainsi que la bonne corrélation observée dans les modèles luminaux de la population de cellules CD44+/CD24- avec l’enrichissement en CSC, nous a incité à déterminer si le niveau d'expression en CD44 faisait une différence dans les tumeurs basales. Sur cette base, j’ai montré que les cellules CD44 high présentent une forte capacité à former des MS dans toutes les lignées cellulaires testées. Cette constatation nous a incités à utiliser CD44high vs. CD44low comme critère de tri cellulaire et à utiliser ces fractions pour effectuer une analyse du transcriptome afin d'identifier d'autres marqueurs non encore déterminés, pouvant isoler des fractions cellulaires plus faibles avec un enrichissement plus élevé en CSC. / It is now accepted that breast cancer is a compendium of several diseases defined as subtypesthat are associated with different clinical outcomes and molecular characteristics. A betterunderstanding of the mechanisms underlying breast cancer heterogeneity is critical to the development of better adjusted therapies. One of the keys to breast cancer heterogeneity may be explained by cancer stem cells (CSC). A number of markers have been proposed to isolate and characterize breast cancer stem cells, but none appears totally satisfactory.The purpose of my work was determine a marker or combination of markers with which CSC enriched fractions could be reproducibly isolated in basal like breast cancer (BLBC). BLBC represent 15% of all breast tumors, but are the most aggressive subtype. To this aim, I have analyzed a number of markers by FACS analysis and cell sorting and used the capacity to form mammospheres (MS) as a validation criterion for the presence of CSCs. The cell lines used as models were SUM 159, MDA-MB-231, MDA-MB-436, HCC1143, MDA-MB-468, Hs578T and BT-549 comprising both Basal A and Basal B models. I also tested three luminal models MCF7, T47D and BT474.Of all the markers tested those that most consistently allowed enrichment of CSCs were the combination of cell surface proteins CD44/CD24/EpCAM and elevated ALDH enzyme activity. However, ALDH activity appeared irregular, ranging from good to inconsistent according to the cell line. Other cell surface markers gave mixed results in ER- breast cancer because the elevated fraction of CD44+ cells found in most of basal breast cancer cell lines and their propensity to show rather homogenous FACS labeling patterns. However, the association of CD44 positivity with EMT and stemness, as well as the good correlation, we observed in luminal models, of CD44+/CD24- cell population with CSC enrichment incited us to determine whether the level of expression of CD44 could make a difference in basal like models. I show that CD44high cells present higher capacity to form MS in all cell line models tested. This prompted us to use CD44high vs. CD44low as a cell sorting criterion and use these fractions to perform transcriptome analysis in order to identify other markers yet not determined, that may point to smaller cell fractions with a higher CSC enrichment.

Thesis (Ph. D.)--University of Virginia, 2008. / Title from title page. Includes bibliographical references. Also available online through Digital Dissertations.

INTRODUÇÃO: o câncer de mama é uma doença heterogênea. Há necessidade de critérios diagnósticos e prognósticos mais refinados. O emprego da imunohistoquímica, através do painel prognóstico, fez despontar a figura do carcinoma triplonegativo e, da mesma forma, a histogenética trouxe à evidência o carcinoma basal. Paralelamente, o conhecimento sobre a origem biológica das neoplasias e da sua heterogeneidade vem sendo acentuadamente debatido através do tema das células-tronco tumorais. OBJETIVOS: investigar a prevalência de carcinomas basais e pentanegativos, numa amostra de carcinomas triplonegativos, e estabelecer associações com a expressão de células-tronco tumorais nestes tumores. Verificar diferenças entre estes subtipos com as variáveis clinicopatológicas. MÉTODOS: 94 carcinomas mamários triplonegativos foram testados para CK5/6, HER1, CD44 e CD24. As expressões desses marcadores por imuno-histoquímica automatizada foram avaliadas através de escore simples de positividade (porcentagem de células) e correlacionadas com os dados clínico-patológicos e análise de sobrevivência. RESULTADOS: carcinomas basais apresentam maior grau tumoral que carcinomas pentanegativos (p=0,004). A negatividade para CD44 (p=0,007) e o perfil CD44- CD24+ (p=0,013) foram associados com maior invasão vascular entre carcinomas triplonegativos. A expressão de CD44 foi associada aos carcinomas basais (p=0,007). O perfil CD44-CD24-/low foi associado aos carcinomas pentanegativos (p=0,04). Nenhuma das variáveis em estudo foi associada com os desfechos clínicos. CONCLUSÃO: Carcinomas mamários basais e pentanegativos são subtipos tumorais bastante próximos. Nosso estudo é o primeiro desenhado especificamente para avaliar a presença células tronco-tumorais mamárias entre carcinomas basais e pentanegativos, onde o perfil CD44-CD24-/low foi associado ao subtipo pentanegativo, e o perfil CD44-CD24+ à invasão vascular, resultados que merecem confirmação por histogenética em estudos de maior porte. / INTRODUCTION: Breast cancer is a heterogeneous disease, and there is a need for more refined diagnostic and prognostic criteria. Immunohistochemistry, as a breast prognostic panel, has given rise to triple-negative carcinoma, as well as histogenetics highlighted basal carcinoma. Concomitantly, the understanding of the biological origins of neoplasia and its heterogeneity has been strongly debated through the theme of cancer stem cells. OBJECTIVES: To investigate the prevalence of basal and penta-negative carcinomas in a sample of triple-negative carcinomas and to establish associations with cancer stem cells (CD44/CD24 expression profiles) and the clinicopathological variables within these tumors. METHODS: Ninety-four triplenegative breast carcinomas were tested for CK5/6, HER1, CD44 and CD24. The expression of these markers was evaluated by automated immunohistochemistry using a simple positivity score (percentage of cells) and was correlated with the clinicopathological and survival analysis data. RESULTS: Basal carcinomas had higher tumor grades than penta-negative carcinomas (p=0.004). CD44 negativity (p=0.007) and the CD44-CD24+ phenotype (p=0.013) were associated with increased vascular invasion amongst the triple-negative carcinomas. CD44 expression was associated with basal carcinomas (p=0.007). The CD44-CD24-/low phenotype was associated with penta-negative carcinomas. None of the variables in the study were associated with clinical outcome. CONCLUSION: Basal and penta-negative breast carcinomas are closely related tumor subtypes. Our study is the first to be specifically designed to assess the presence of breast cancer stem cells in basal and pentanegative carcinomas. The CD44-CD24-/low phenotype was associated with the pentanegative subtype, and the CD44-CD24+ phenotype was associated with vascular invasion. These results require histogenetic confirmation in larger studies.

Platinum-based therapy is the most often used chemotherapeutic agent to treat advanced cases of head and neck cancers. However, only a small fraction of the patient population responds to cisplatin, with a median survival time of less than a year. Currently, there is a lack of clinically employable molecular characterization of the disease beyond HPV status to classify patients who would respond favorably to platinum-based therapy. In this regard, CD24 expression level appears to be a significant molecular phenotype of cisplatin resistance in laryngeal carcinoma. This study demonstrates that CD24 expression level in HNSCC has a linear relationship with cisplatin resistance, and it affects the transcription of critical apoptotic, stem, and drug resistance genes. The knockdown of the CD24 transcript reduces tumor growth rate and increases the overall cisplatin sensitivity in mice xenograft experiments. A retrospective analysis of a cohort of 25 HNSCC patient tumor samples suggests that CD24-high tumors go on to show an unfavorable response to cisplatin treatment. Overall, based on the strength of further clinical analysis, CD24 presents a strong rationale to be utilized as a predictive indicator to stratify head and neck cancer patients for platinum-based therapy. This study also provides a rationale for using CD24 as a therapeutic adjuvant target along with standard cisplatin therapy in head and neck cancers.

Understanding the mechanisms and nature of tumour heterogeneity is a key focus of current cancer research. Tumour heterogeneity can arise from clonal evolution and/or differentiation. This thesis investigated the role of methylation in dynamic regulation of CD24 based heterogeneity in colorectal cancer cell lines. First, E-Cadherin variation between the cell lines LS174T and LS180 was investigated to find out whether E-Cadherin had any causal role in the difference in lumen formation between these two cell lines derived from the same tumour. These studies found no evidence of a causal role of E-Cadherin. However, morphological heterogeneity in LS174T was observed during the E-Cadherin study, suggesting that this cell line might be a mixture of two different clones. Single cell sorting by FACS allowed to isolate and establish these clones which were stable in the culture for long enough (until passage ~30) to allow their characterisations. Between the two clones, the CD24⁺ clone (named the LS174T_Clone 1^CD24+) was found to have shorter doubling time (23 hours) than the CD24- clone (named the LS174T_Clone 2CD24-; 30 hours). When cultured in matrigel, the LS174T_Clone 1^CD24+ showed higher clonogenicity (Chapter 4). Microarray analysis further revealed differences in gene expression including LAPTM4B, CXCR4, TGFIB and IL8 between these clones. Interestingly, when maintained for a long time in culture (around passage 50, which is equivalent to ~7 months), CD24 expression went through a gradual change in these clones, which became more evident from subclones of LS174T_Clone 2^CD24- (Chapter 6) and clones from another CRC cell line SW480 (chapter 5 and 6). To understand the mechanism of this dynamic change in the expression of CD24, it was first shown that no mutation could be responsible for this phenomenon. This suggested that promoter methylation of CD24 might be the mechanism of the observed dynamic changes in CD24 expression. Bisulfite (BS) modification of DNA from the LS174T clones and CD24 differentially expressing CRC cell lines (such as CD24- cell lines: CC20, RKO vs CD24+ cell lines: DLD1, NCIH716) followed by Sanger sequencing showed that direct methylation of seven CpG positions in the CD24 promoter region Chr6:106975560-106975834 is strongly correlated with the expression of CD24. Further subcloning and sequencing revealed that changes in the methylation of only two out of the seven CpG positions might be the main contributor to the CD24 expression differences. This is the first evidence of direct methylation-mediated regulation of CD24, showing, more broadly, how methylation can contribute to and maintain dynamic heterogeneity in cancer cells. Finally, a mixed culture experiment with the CD24+ and CD24- clones was conducted to test a simple mathematical model, which aimed to explain the interaction between the clones that are stably present in the LS174T cell line (Chapter 7). Altogether, these experiments suggest that genes such as REG1A (an inducer of angiogenesis) might be expressed because of synergistic interactions between the clones, whereas CXCR4 and TFF2 might be involved in a receptor-ligand complementary relationship. These findings have set a ground for future studies to confirm such interactions between co-existing subpopulations within a heterogeneous milieu of cancer cells.