Gliomas s~ao tumores heterog^eneos, o que contribui para seu alto grau de mortalidade, apesar de avan¸cos na classifica¸c~ao e tratamento. Desde 2016, a incorpora¸c~ao do estado dos genes IDH e da integridade dos cromossomos 1p e 19q na classifica¸c~ao de gliomas fornece aplica¸c~oes cl´?nicas importantes para o diagn´ostico e tratamento deste tumor; entretanto, a procura por assinaturas moleculares que possam refinar ainda mais os subtipos de glioma em subgrupos mais homog^eneos ´e um esfor¸co cont´?nuo. Este estudo utilizou o maior n´umero de amostras de gliomas adultos (n=932) at´e a atualidade, variando dos graus II ao IV, a fim de definir subgrupos de glioma utilizando assinaturas de metila¸c~ao do DNA, indepentemente de grau e histologia. No total, 7 subtipos foram identificados: Classiclike, Mesenchymal-like, LGm6-GBM, PA-like, Codels, G-CIMP-low and G-CIMP-high. A maior parte dos subgrupos com IDH tipo selvagem, isto ´e, Classic-like, Mesenchymal-like, LGm6-GBM, possuem padr~ao de baixa metila¸c~ao do DNA e um pior risco progn´ostico; caracter´?sticas cl´?nicas t´?picas de glioblastomas, o tipo mais agressivo de gliomas. Uma descoberta interessante foi a identifica¸c~ao do subgrupo PA-like dentre gliomas com IDH tipo selvagem, o qual compartilha aspectos gen^omicos similares a astrocitoma piloc´?tico, um glioma pedi´atrico benigno com bom quadro cl´?nico entre gliomas com IDH tipo selvagem. Codels, os quais abragem pacientes com muta¸c~ao em IDH e codele¸c~ao dos cromossomos 1p e 19, possuem o melhor progn´ostico dentre os gliomas difusos em adultos. Uma descoberta importante em rela¸c~ao a gliomas com muta¸c~ao em IDH, por´em sem codele¸c~ao dos cromossomos 1p e 19q, foi a estratifica¸c~ao de gliomas com fen´otipo metilador de ilhas CpG (G-CIMP) em G-CIMP-low, com n´?veis mais baixos de metila¸c~ao do DNA e pior quadro cl´?nico, e G-CIMP-high, com n´?veis mais altos de metila¸c~ao do DNA e melhor risco progn´ostico. Curiosamente, o grau de metila¸c~ao do DNA (-low e -high) estava associado com altera¸c~oes distintas em elementos regulat´orios e modifica¸c~oes de histona aberrantes na regi~ao promotora de genes do ciclo celular. Estes achados consolidaram a import^ancia cl´?nica da epigen´etica, particularmente da metila¸c~ao do DNA, em gliomas, como tamb´em levantou a possibilidade de que a sobrevida m´edia ruim de G-CIMP-low pode ser associada a elementos regulat´orios. Al´em disso, a hip´otese de que enhancers ativos podem agir na regula¸c~ao g^enica de G-CIMP-low fornece mais evid^encias de que elementos regulat´orios podem levar `a maior agressividade e prolifera¸c~ao de G-CIMP-low. Este estudo visa 1) identificar e caracterizar subtipos de gliomas difusos em adultos baseados na metila¸c~ao do DNA, e 2) avaliar a associa¸c~ao entre modifica¸c~oes de histona com um subtipo mais agressivo de G-CIMP / Gliomas are heterogeneous tumors which contribute to their high mortality despite advancements in classification and treatment. As of 2016, the incorporation of IDH status and the integrity of chromosomes 1p and 19q to glioma classification have provided important clinical application for diagnostics and treatment; however, the search for molecular signatures that further refine glioma subtypes into more homogeneous subgroups is an ongoing effort. This study used the largest sample cohort (n=932) of adult gliomas to date, ranging from grades II to IV, in order to define gliomas subgroups using DNA methylation signatures, independent of histopathological grading. In total, 7 subtypes were identified: Classic-like, Mesenchymal-like, LGm6-GBM, PA-like, Codels, G-CIMP-low and G-CIMP-high. Most IDH -wildtype subgroups, e.g. Classic-like, Mesenchymal-like and LGm6-GBM, had low DNA methylation pattern and a poor outcome, typical of glioblastomas, the most aggressive phenotype of gliomas. An interesting finding was the identification of the PA-like subgroup within IDH -wildtype samples, which shared similar genomic features with pilocytic astrocytoma, a rare pediatric benign glioma, with a good overall survival (OS) among IDH -wildtype gliomas. Codels, which comprise IDH mutant gliomas with codeletion of chromosomes 1p/19q have the best OS across all adult gliomas. An important finding regarding IDH mutant gliomas with no codeletion of chromosomes 1p/19q, was the further segregation of the Glioma-CpG Island Methylator Phenotype (G-CIMP) into G-CIMP-low, with lower levels of DNA methylation and worse OS, and G-CIMP-high, characterized by higher DNA methylation profile and better OS. Interestingly, the degree of G-CIMP methylation (-low and -high) was associated with distinct alterations in regulatory elements and aberrant histone modifications at promoter regions of cell cycle genes. These findings consolidated the clinical importance of epigenetics, particularly DNA methylation, in gliomas, as well as the possibility that aggressive OS in G-CIMP-low may be driven by regulatory elements. Moreover, our results suggest that active enhancers that might be acting in gene regulation in G-CIMP-low provide more evidence of the regulatory elements that might be driving aggressiveness and proliferation in G-CIMP-low. This study aims 1) to identify and characterize adult diffuse glioma DNA methylation subtypes, and 2) evaluate the association of histone modifications with a more aggressive G-CIMP subtype

The main objective of this study is to divide a number of colorectal cancer cases into subgroups based on their molecular features using cluster analysis. The data used is supplied by a research group at Pathology, the Department of Medical Biosciences, Umeå University, and consists, after some preparation, of 455 observations which is a larger data set than many similar studies. The molecular variables that the clustering is based on are CIMP (CpG Island Methylator Phenotype), MSI (Micro Satellite Instability), BRAF- and KRAS-mutations. These are categorical variables and consequently the clustering method used is PAM (Partitioning Around Medoids) which is particularly useful with data on diverse variable level. The final analysis results in four subgroups that are represented by different combinations of attributes on the aforementioned variables. The disparity between the clusters are then evaluated by, for instance, comparing the survival time for their pertaining patients and it appears that two of the clusters are significantly different in this aspect. Other patient related and tumor specific characteristics are also linked with the separate cancer types and tested if they occur in varying extent. The locations of the tumors in the colon are for instance significantly different between the groups. Cluster analyses are exploratory tools so the choice of useful variables and subsequent interpretation of the results can be complicated and require relevant subject knowledge. / Huvudsyftet med denna studie är att med hjälp av klusteranalys dela in en mängd tjocktarmscancerfall i undergrupper baserat på deras molekylära egenskaper. Materialet som används tillhandahålls av en forskningsgrupp vid Patologi, Institutionen för medicinsk biovetenskap, Umeå universitet, och består efter viss bearbetning av 455 observationer vilket är en större datamängd än flera liknande studier. De molekylära variabler som ligger till grund för klusterindelningen är nivån på CIMP (CpG Island Methylator Phenotype), MSI (Mikrosatellitinstabillitet), BRAF- och KRAS-mutationer. Dessa är kategoriska variabler och därför används PAM (Partitioning Around Medoids) som är en särskild klusterteknik lämpad vid data på varierade variabelnivåer. I det slutliga resultatet fås fyra undergrupper som representeras av olika kombinationer av utfallen på ovannämnda variabler. Klustren utvärderas bland annat genom att jämföra överlevnadstiden för varje kluster, och det visar sig att två av klustren skiljer sig signifikant åt i detta avseende. Även andra patientrelaterade och tumörspecifika egenskaper kopplas samman till de olika cancertyperna och testas om de förekommer i varierande utsträckning. Var någonstans tumören är placerad är till exempel signifikant skilt mellan grupperna. Klusteranalyser är explorativa redskap så valet av variabler och sedermera tolkningar av resultat kan vara komplicerade och kräva stor sakkunskap.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24199号 / 医博第4893号 / 新制||医||1060(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 斎藤 通紀, 教授 浅野 雅秀 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Background Colorectal cancer (CRC) is the second most common malignancy in developed countries. The mortality is high, with nearly half of patients dying from the disease. The primary treatment of CRC is surgery, and decisions about additional treatment with chemotherapy are based mainly on tumor stage. Novel prognostic markers that identify patients at high risk of recurrence and cancer-related death are needed. The development of CRC has been described in terms of two different pathways; the microsatellite instability (MSI) and chromosomal instability (microsatellite stable, MSS) pathway. More recently, the CpG island methylator phenotype (CIMP), characterized by frequent DNA hypermethylation, has been described as an alternative pathway of tumorigenesis. The event of DNA methylation is dependent on one-carbon metabolism, in which folate and vitamin B12 have essential functions. The purpose of this thesis was to study CIMP in CRC. The specific aims were to investigate the potential role of components of one-carbon metabolism as risk factors for this subgroup of tumors, and the prognostic importance of CIMP status, taking into consideration important confounding factors, such as MSI and tumor-infiltrating T cells. Methods CRC cases and referents included in the Northern Sweden Health and Disease Study (NSHDS, 226 cases and 437 referents) and CRC cases in the Colorectal Cancer in Umeå Study (CRUMS, n=490) were studied. Prediagnostic plasma concentrations of folate and vitamin B12 were analyzed in NSHDS. In both study groups, CIMP status was determined in archival tumor tissue by real-time quantitative PCR using an eight-gene panel (CDKN2A, MLH1, CACNA1G, NEUROG1, RUNX3, SOCS1, IGF2 and CRABP1). MSI screening status and the density of tumor-infiltrating T cells were determined by immunohistochemistry.  Results An inverse association was found between plasma concentrations of vitamin B12 and rectal, but not colon, cancer risk. We also found a reduced risk of CIMP-high and CIMP-low CRC in study subjects with the lowest levels of plasma folate. We found that patients with CIMP-low tumors in both NSHDS and CRUMS had a poorer prognosis compared with CIMP-negative, regardless of MSI screening status. We also found that MSS CIMP-high patients had a poorer prognosis compared with MSS CIMP-negative. The density of tumor-infiltrating T cells and CIMP status were both found to be independent predictors of CRC patient prognosis. A particularly poor prognosis was found in patients with CIMP-low tumors poorly infiltrated by T cells. In addition, the density of T cells appeared to be more important than MSI screening status for predicting CRC patient prognosis. Conclusion Rather than being one disease, CRC is a heterogeneous set of diseases with respect to clinico-pathological and molecular characteristics. We found that the association between risk and plasma concentration of vitamin B12 and folate depends on tumor site and CIMP status, respectively. Patient prognosis was found to be different depending on CIMP and MSI screening status, and the density of tumor-infiltrating T cells.